早期抚触干预在早产低体质量儿神经系统发育中的临床研究

目的分析研究早期抚触干预对早产低体重儿神经系统发育的影响。方法 选取在我院2010年3月～2011年12月出生并住院的早产/低出生体重儿 70例,随机分成抚触干预组和对照组各35例,对照组患儿出生后采用常规治疗和护理,不进行任何神经系统干预;抚触干预组在常规治疗和护理的基础上,出生24小时后实施新生儿抚触干预。比较两组早产低出生体重儿在日龄28天时的行为神经评分（ NBNA）。结果 抚触干预组除对格格声反应、视听定向反应、腘窝角、围巾征这四项外,其余16项评分明显比对照组评分高（P〈0.05）;抚触干预组NBNA总平均分明显高于对照组（P〈0.05）。结论 早期抚触干预能促进早产低出生体重儿的神经系统发育,积极改善了其日后的生存质量。     

The health and developmental status of very low-birth-weight children at school age.

OBJECTIVE--To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights. DESIGN--Inception cohort. SETTING/PARTICIPANTS--Participants were selected from two previously studied multisite cohorts: very low-birth-weight (less than or equal to 1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible. MAIN OUTCOME MEASURES--The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores. RESULTS--Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight. CONCLUSIONS--Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.     

早期全静脉营养对低体重儿营养状态及生化指标的影响

目的:探讨早期全静脉营养对低体重儿营养状态及生化指标的影响。方法:选取2009年5月～2012年9月于本院进行早期全静脉营养干预的32例低体重儿为观察组,同期进行传统静脉营养干预的32例低体重儿为对照组,将两组小儿干预前及干预后不同时间段的生长发育、营养状态及生化指标进行比较。结果:观察组干预后不同时间段的生长发育指标均大于对照组,血清前白蛋白高于对照组,尿素氮、胆红素及肌酐均低于对照组,红细胞免疫指标及微量元素改善幅度均大于对照组,差异有统计学意义(P均<0.05)。结论:早期全静脉营养可有效改善低体重儿的营养状态及生化指标,可有效改善低体重新生儿的综合状态。     

Trends in twin birth outcomes and prenatal care utilization in the United States, 1981-1997

CONTEXT: Multiple births account for an increasing percentage of all low-birth-weight infants, preterm births, and infant mortality in the United States. Since 1981, the percentage of women with multiple births who received intensive prenatal care (defined as a high number of visits, exceeding the recommendation of the American College of Obstetricians and Gynecologists by approximately 1 SD beyond the mean number of visits for women initiating care within each trimester) has increased significantly. OBJECTIVES: To explore the hypothesis that more aggressive management of twin-birth pregnancies may be associated with changes in birth outcomes in this population. DESIGN, SETTING, AND SUBJECTS: Cross-sectional and trend analysis of data from the National Center for Health Statistics' birth and infant death records for all twin births occurring in the United States between 1981 and 1997, excluding those with missing or inconsistent data. MAIN OUTCOME MEASURES: Trends in preterm birth, low birth weight, preterm and term small-for-gestational-age (SGA) births, and infant mortality, by level of prenatal care utilization. RESULTS: The preterm birth rate for twins increased from 40.9% in 1981 to 55.0% in 1997. The percentage of low-birth-weight infants increased from 51.0% to 54.0%. The preterm SGA rate also increased from 11.9% to 14.1%, while the term SGA rate decreased from 30.7% to 20.5%. For women with intensive prenatal care utilization, the preterm birth rate increased from 35.1% to 55.8%, compared with an increase from 50.6% to 59.2% among women with only adequate use. Twin preterm deliveries involving either induction or first cesarean delivery also increased from 21.9% to 27.3% between 1989-1991 and 1995-1997. The twin infant mortality rate for women with intensive prenatal care use declined between 1983 and 1996 and remained lower than the overall twin infant mortality rate. CONCLUSIONS: An apparent increase in medical interventions in the management of twins may result in the seeming incongruity of more prenatal care and more preterm births; however, these data suggest that women with intensive prenatal care utilization also have a lower infant mortality rate. JAMA. 2000;283:335-341     

Selected measures of health status for Mexican-American, mainland Puerto Rican, and Cuban-American children

The 1987 National Vital Statistics System and the Hispanic Health and Nutrition Examination Survey (1982 through 1984) were used to assess the health status of Mexican-American, mainland Puerto Rican, and Cuban-American children by examining the prevalences of pregnancy outcomes and chronic medical conditions. The low-birth-weight rate among Hispanics (7.0%) compared favorably with that of non-Hispanic whites (7.1%) despite the greater poverty and lower levels of education among Hispanics. When examined by Hispanic subgroup, however, significant differences were present, with mainland Puerto Ricans having the highest prevalences of low-birth-weight infants. Premature births were more common among all three Hispanic subgroups than among non-Hispanic whites. Mexican-American and Cuban-American children had a similar prevalence of (3.9% and 2.5%, respectively) chronic medical conditions compared with non-Hispanic white children; Puerto Rican children had a higher prevalence of chronic medical conditions (6.2%). When assessed by these health status indicators, Hispanic children seem to have a health status similar to non-Hispanic white children. However, mainland Puerto Rican children seem at greater risk for poor health, reflecting the US Hispanic population's heterogeneity. Health programs targeted at US Hispanics should appropriately consider these group differences.     

Pattern of proven bacterial sepsis in a neonatal intensive care unit in Riyadh-Saudi Arabia: a 2-year analysis

Bacterial infections are an important cause of neonatal mortality and morbidity. The major pathogens for neonatal sepsis in the neonatal intensive care unit (NICU) vary with geographical area and time. It is therefore important to frequently audit neonatal sepsis in individual NICU, to aid in provision of adequate and appropriate preventive and therapeutic measures. We retrospectively reviewed the medical records of all infants who had positive blood cultures during a 2-year period in the NICU at a university hospital in Riyadh, Saudi Arabia. Overall the incidence of proven-bacterial-sepsis (PBS) was 10.2% of NICU admissions. The incidence of PBS in low-birth-weight (LBW), very low-birth-weight (VLBW), and extremely low-birth-weight (ELBW) infants were 19%, 41%, and 49% respectively. Multiple episodes of bacterial sepsis occurred in 21% of all infants infected. Coagulase negative Staphylococcus (CONS) (50%) was the most common infecting organism causing late onset sepsis (LOS) and Escherichia coli (29%) the most common causing early onset sepsis (EOS). Gram negative bacteria (GNB) were the infecting organisms in 50% of the EOS episodes and 29% of LOS episodes. Only 11% (14) of the PBS were EOS. Only 10 (10.4%) infants had bacterial meningitis. The overall PBS related mortality was 9%, representing 22% of all neonatal deaths.     

早期综合干预对脑功能障碍性综合征患儿智力发育的影响

目的探讨早期综合干预对改善脑功能障碍性综合征患儿预后的效果。方法82例脑功能障碍性综合征患儿随机分为干预组和对照组。干预组予以医学干预、早期干预、营养干预及康复治疗等早期综合干预;对照组常规育儿。患儿3、6、12月时均进行智力测定。结果3、6、12个月干预组平均发育商分别为80.2±14.2、95.1±13.4、112±10.4,对照组平均发育商为68.6±12.3、80.0±15.4、85.4±16.3,T值分别为3.89、4.75、8.89,干预组发育商明显高于对照组(t=3.89~8.89,P<0.01)。结论早期综合干预能有效的促进脑功能障碍性综合征患儿智能发育。     

Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant

CONTEXT: Few studies document how parents adapt to the experience of a very low-birth-weight (VLBW; <1500 g) birth despite societal concerns about the ethics and justification of intensive care for these infants. OBJECTIVE: To determine the degree and type of stress experienced over time by mothers whose infants vary in degree of prematurity and medical and developmental risk. DESIGN: Longitudinal prospective follow-up study of a cohort of mothers of high- and low-risk VLBW and term infants from birth to 3 years. SETTING: All level III neonatal intensive care units from a large midwestern metropolitan region. PARTICIPANTS: Mothers and infants prospectively and consecutively enrolled in a longitudinal study between 1989 and 1991. High-risk VLBW infants were diagnosed as having bronchopulmonary dysplasia, and comparison groups were low-risk VLBW infants without bronchopulmonary dysplasia and term infants (>36 weeks, >2500 g). MAIN OUTCOME MEASURES: Standardized, normative self-report measures of maternal psychological distress, parenting stress, family impact, and life stressors. RESULTS: Mothers of VLBW infants (high risk, n = 122; low risk, n = 84) had more psychological distress than mothers of term infants (n=123) at 1 month (13% vs 1%; P = .003). At 2 years, mothers of low-risk VLBW infants did not differ from term mothers, while mothers of high-risk infants continued to report psychological distress. By 3 years, mothers of high-risk VLBW children did not differ from mothers of term children in distress symptoms, while parenting stress remained greater. Severity of maternal depression was related to lower child developmental outcomes in both VLBW groups. CONCLUSIONS: The impact of VLBW birth varies with child medical risk status, age, and developmental outcome. Follow-up programs should incorporate psychological screening and support services for mothers of VLBW infants in the immediate postnatal period, with monitoring of mothers of high-risk VLBW infants.     

Cystic fibrosis infant care challenges in diagnosis and management in the era of newborn screening

With newborn screening for cystic fibrosis (CF) now accessible in every state in the US, more infants are being diagnosed. Currently, no large-scale randomized studies are available to assist clinicians in providing evidence-based medical care for the youngest CF patients. We review the standard of diagnostic evaluation, the sweat test, showing a slightly altered range for infants less than 6 months of age. Cystic fibrosis transmembrane conductance regulator (CFTR) metabolic syndrome is an entity that can be clinically challenging for parents and caregivers. Simply indentifying infants with CF can be challenging. This review tries to clarify the CFTR gene and its expressions and the additional benefits that may be drawn from newborn screening. We searched literature to review guidelines for care of infants with CF, and we reviewed newborn screening methods and diagnosis. We focused on early nutritional intervention and lung protective strategies to improve growth and lung function outcomes.     

Perinatal follow through: implications for primary physicians

Neonatal intensive care unit follow-through programs provide early evaluation information for the primary care physician. This article describes such data for 339 graduates of St Joseph's Special Care Nursery, 78% of whom were preterm and 70% were of low birth weight. At six months, 7% of the infants were diagnosed with cerebral palsy, based on a 15-month follow-up. Other neurological and respiratory problems were common. A normal neurodevelopmental outcome was found for the majority of the infants. Referrals to medical specialists (eg, ophthalmology) and early intervention programs were required for many infants. The case management role of the primary physician is highlighted along with specific recommendations for care of the medically at-risk or developmentally delayed infant.     

Health care for children in foster care

Every month 6,600 children in Oklahoma live under the custody of the state, most as result of being abused or neglected by their own families. The state provides medical care to these children via the Medicaid program. The American Academy of Pediatrics(AAP) has set forth a guideline for optimal care of these children. We discuss the current Oklahoma health care system for foster children and suggest changes that may move Oklahoma in the direction of the AAP recommendations. A more uniform, organized medical system may not only meet a foster child's medical needs but may also provide a degree of continuity to an otherwise discontinuous process.     

早期干预对脑损伤早产儿神经系统发育的影响

目的 探讨早期医院-家庭康复对脑损伤早产儿近期神经系统发育状况的影响.方法选择NICU生后6 h内进行aEEG检查显示脑损伤的早产儿289例,胎龄在28～36周,除外先天畸形和先天遗传代谢性疾病及新生儿期合并严重疾病.将家长不愿意参与早期干预指导者作为对照组;家长积极参与干预指导者为干预组.干预组200例,对照组89例.纠正胎龄满40周后干预组除常规体检,接受常规育儿指导外,建立系统档案监测,在医生的指导下在家中接受视、听、被动婴儿操和主动运动训练,出现异常运动者入院行系统康复训练,直到2周岁.对照组：只接受与干预组相同的常规体检和育儿指导,所有对象定期做体格、神经心理发育检查,1岁和2岁均行aEEG检查.测试者不知被测试者组别,以避免主观干扰.结果 ①两组早产儿头围、身长、体质量的体格发育在纠正胎龄6、12个月差异存在统计学意义（P〈0.05）;②两组早产儿的发育商在纠正胎龄6、9、12、18、24个月差异存在统计学意义（P〈0.05）,两组对象在不同月龄时干预组早产儿神经心理发育水平均高于对照组;③aEEG检查干预组较对照组异常率低,但脑瘫发生率虽然干预组低于对照组,但差异无统计学意义.结论 早期家庭医院-康复有助于早产儿神经系统、心理、运动系统的发育,降低脑瘫发生率,对早产儿脑损伤的恢复有积极作用.     

新生儿重症监护室实施家长参与早产儿护理的平行对照研究

目的探讨在新生儿重症监护室(NICU)早产儿护理中实施家长参与式护理模式的效果及可行性。方法以平行对照设计研究方案,对2018年7月—2019年12月南阳市中心医院NICU中符合纳入标准的261例早产儿,以胎龄、体重和出生时诊断相近为标准进行匹配分组,研究组纳入35例,对照组纳入70例。研究组在专科护士指导下患儿家长与专科护士共同完成患儿生活护理、病情观察、喂养护理、皮肤护理等工作,每天参与4 h至患儿出院;对照组所有患儿护理工作均由专科护士完成,家属每周隔窗探视3次,每次30 min。观察2组患儿体重增长情况,院内感染、二次住院及家属投诉发生率,医疗费用及科室支出费用等。结果入监护室时,研究组与对照组患儿体重差异无统计学意义[(1 890.75±317.57)g vs.(1 888.91±320.73)g,t=0.028,P=0.978];出监护室时,研究组体重高于对照组[(2 473.97±284.72)g vs.(2 267.59±316.54)g,t=3.254,P=0.002],差异有统计学意义。研究组体重增长速度较对照组高,平均治疗费用、住院时间、家属投诉率、出院后30 d...     

Disparities in children's oral health and access to dental care

Dental caries can be prevented by a combination of community, professional, and individual measures including water fluoridation, professionally applied topical fluorides and dental sealants, and use of fluoride toothpastes. Yet, tooth decay is the most common chronic disease of childhood. Dental care is the most prevalent unmet health need in US children with wide disparities existing in oral health and access to care. Only 1 in 5 children covered by Medicaid received preventive oral care for which they are eligible. Children from low income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants. Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children. Childhood oral disease has significant medical and financial consequences that may not be appreciated because of the separation of medicine and dentistry. The infectious nature of dental caries, its early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services. However, many pediatricians lack critical knowledge to promote oral health. We recommend financial incentives for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment dental services; managed care accountability; integration of medical and dental professional training, clinical care, and research; and national leadership. JAMA. 2000;284:2625-2631.     

儿童保健中开展早期综合发展指导对小儿发育的影响分析

目的探究儿童保健中开展早期综合发展指导对小儿发育的影响。方法选取2017年1月至2019年1月本院收治的100名健康体检儿童,采用简单随机化法分为两组,各50名。对照组采用常规儿童保健干预,实验组在儿童保健中实施早期综合发展指导干预,比较两组干预结果的差异性。结果实验组精细动作、语言能力、社交能力、适应能力、运动能力评分均高于对照组(P<0.05)。两组体质量、头围、身高比较差异无统计学意义。实验组常见疾病发生率为10.00%,低于对照组的26.00%,差异有统计学意义(P<0.05)。结论儿童保健中开展早期综合发展指导干预,能促进其智力发育,使儿童得到全面发展。     

Hip fracture management: tailoring care for the older patient

Hip fracture is a potentially devastating condition for older adults. Hip fracture leads to pain and immobilization with complications ranging from delirium to functional loss and death. Although a mainstay of treatment is orthopedic repair, a multidisciplinary comanagement approach, including medical specialists and rehabilitation, may maximize patient recovery. Using the case of Mr W, an older man who sustained a fall and hip fracture, we present evidence-based components of care both in the hospital and outpatient settings. Preoperatively, clinicians should correct medical abnormalities and consider the appropriateness, timing, and type of surgical repair in the context of the patient's life expectancy and goals of care. Perioperative care should include prophylaxis with antibiotics, chemoprophylaxis for venous thromboembolism, and correction of major clinical abnormalities prior to surgery. Pain control, delirium, and pressure ulcer prevention are important inpatient care elements. Multidisciplinary models incorporating these care elements can decrease complications during inpatient stay. Rehabilitation strategies should be tailored to patient needs; early mobilization followed by rehabilitation exercises in institutional, home, and group settings should be considered to maximize restoration of locomotive abilities. Attention to care transitions is necessary and treatment for osteoporosis should be considered. The road to recovery for hip fracture patients is long and most patients may not regain their prefracture functional status. Understanding and anticipating issues that may arise in the older patient with hip fracture, while delivering evidence-based care components, is necessary to maximize patient recovery.     

特发性血小板减少性紫癜的综合护理干预效果观察

目的观察综合护理干预对特发性血小板减少性紫癜（ITP）患儿治疗后疗效的影响。方法入选的56例ITP患儿随机分为干预组和对照组各28例,对照组仅根据病情及医嘱给予随机护理,干预组给予综合性的护理干预措施。比较两组的疗效及家属对护理人员工作护理满意度。结果干预组治疗的疗效明显高于对照组．且干预组血小板达标时间明显短于对照组,经过上述综合性护理干预后,与对照组比较,干预组的临床控制时间明显缩短,且干预组的护理满意度明显提高,两组比较,差异有统计学意义（P〈0．05）。结论对特发性血小板减少性紫癜患儿实施综合性的护理干预措施,能够有效地提高治疗效果,提高家属对护理人员工作护理满意度,降低死亡率,值得临床医护人员予以重视。     

Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools

CONTEXT: Most studies of the long-term effects of early childhood educational interventions are of demonstration programs rather than large-scale public programs. Previous studies of one of the oldest federally funded preschool programs have reported positive effects on school performance, but effects on educational attainment and crime are unknown. OBJECTIVE: To determine the long-term effectiveness of a federal center-based preschool and school-based intervention program for urban low-income children. DESIGN, SETTING, AND PARTICIPANTS: Fifteen-year follow-up of a nonrandomized, matched-group cohort of 1539 low-income, mostly black children born in 1980 and enrolled in alternative early childhood programs in 25 sites in Chicago, Ill. INTERVENTIONS: The Chicago Child-Parent Center (CPC) Program (n = 989 children) provides comprehensive education, family, and health services and includes half-day preschool at ages 3 to 4 years, half- or full-day kindergarten, and school-age services in linked elementary schools at ages 6 to 9 years. The comparison group (n = 550) consisted of children who participated in alternative early childhood programs (full-day kindergarten): 374 in the preschool comparison group from 5 randomly selected schools plus 2 others that provided full-day kindergarten and additional instructional resources and 176 who attended full-day kindergartens in 6 CPCs without preschool participation. MAIN OUTCOME MEASURES: Rates of high school completion and school dropout by age 20 years, juvenile arrests for violent and nonviolent offenses, and grade retention and special education placement by age 18 years. RESULTS: Relative to the preschool comparison group and adjusted for several covariates, children who participated in the preschool intervention for 1 or 2 years had a higher rate of high school completion (49.7 % vs 38.5%; P =.01); more years of completed education (10.6 vs 10.2; P =.03); and lower rates of juvenile arrest (16.9% vs 25.1%; P =.003), violent arrests (9.0% vs 15.3%; P =.002), and school dropout (46.7% vs 55.0%; P =.047). Both preschool and school-age participation were significantly associated with lower rates of grade retention and special education services. The effects of preschool participation on educational attainment were greater for boys than girls, especially in reducing school dropout rates (P =.03). Relative to less extensive participation, children with extended program participation from preschool through second or third grade also experienced lower rates of grade retention (21.9% vs 32.3%; P =.001) and special education (13.5% vs 20.7%; P =.004). CONCLUSIONS: Participation in an established early childhood intervention for low-income children was associated with better educational and social outcomes up to age 20 years. These findings are among the strongest evidence that established programs administered through public schools can promote children's long-term success.     

早期护理干预对新生儿缺血缺氧性脑病预后的影响

目的:探讨早期护理干预对新生儿缺血缺氧性脑病(HIE)患儿预后的影响,提出合理的护理干预措施.方法:实验法,将患儿随机分为干预组和对照组各25例,两组患儿均予HIE的常规治疗及基础护理,予合理喂养.干预组在以上基础上给予针对患儿的早期、系统化、个性化的护理干预,包括视觉刺激、听觉刺激、触觉刺激、前庭运动刺激.出院后继续给予干预.对两组患儿预后进行评估,并对评估结果进行分析.结果:干预组在1.5岁和2岁时身长、头围、体重略高于对照组.干预组1岁以后智能发育指数(MDI)、运动发育指数(PID)均高于对照组,两组比较差异具有统计学意义(P＜0.05).结论:早期护理干预能有效促进HIE患儿的智能发育,明显改善患儿预后.