早产儿喂养不耐受临床诊疗指南（2020）

早产儿喂养不耐受是目前新生儿最常见的临床问题之一,常导致达全肠内营养时间延迟,住院时间延长。防治早产儿喂养不耐受对提高早产儿存活率有重要意义。该指南基于目前国内外研究,采用证据推荐分级的评估、制定与评价方法（GRADE）进行证据分级制定早产儿喂养不耐受的临床诊疗指南,旨在帮助新生儿科医生、护理人员、营养治疗师等对早产儿喂养不耐受进行早期识别与规范管理。     

早产儿喂养不耐受临床诊疗指南（2020）

早产儿喂养不耐受是目前新生儿最常见的临床问题之一,常导致达全肠内营养时间延迟,住院时间延长。防治早产儿喂养不耐受对提高早产儿存活率有重要意义。该指南基于目前国内外研究,采用证据推荐分级的评估、制定与评价方法（GRADE）进行证据分级制定早产儿喂养不耐受的临床诊疗指南,旨在帮助新生儿科医生、护理人员、营养治疗师等对早产儿喂养不耐受进行早期识别与规范管理。     

早产儿喂养不耐受治疗进展

生长受限和发育迟缓近来已成为早产儿尤其是极低体重儿的主要问题.达到完全肠内喂养时间的延长,也与矫正年龄2岁时的心理发育落后有明显关系.不增加坏死性小肠结肠炎(NEC)危险的肠内喂养已成为优先选择,阻止或减少早产儿喂养不耐受的喂养策略,反映了其定义的困难以及对NEC的担忧.文章讨论了目前早产儿喂养不耐受的喂养策略和治疗方法,但尚需进行大规模实用性的临床研究,以发展更为科学的干预方法.     

早产儿喂养不耐受及处理策略

喂养不耐受(feeding intolerance)指胃肠道不能消化胃肠内食物,表现为胃潴留增加、腹胀和呕吐,主要见于早产儿,尤其极低和超低出生体重(VLBW和ELBW)早产儿,主要与胃肠道发育未成熟有关,但也可为某些疾病的早期表现。临床上,喂养不耐受常常是不能顺利建立肠内营养的重要原因,可导致肠外营养时间延长、早产儿宫外生长迟缓等。一、喂养不耐受的定义[1]早产儿喂养不耐受的定义尚未达成共识。通常     

早产儿喂养不耐受的诊治进展

虽然早产儿喂养不耐受的定义及诊断在不断地修改与完善,但迄今为止,仍缺乏统一的定义及诊断标准.有关其干预措施(包括喂养策略、母乳喂养、药物治疗等)的疗效,尚需要大量的临床随机研究去验证和评估.该文将对喂养不耐受定义、喂养策略,药物治疗等进展进行综述.     

早产儿喂养不耐受

由于早产儿胃肠道动力不足,消化酶和激素的分泌减少,细菌定植异常和局部免疫力的不成熟,使得早产儿喂养不耐受成为新生儿医学中的常见问题。临床主要表现为过量的胃残余量,腹胀或呕吐,或两者皆有,导致肠内喂养计划中断。早产儿喂养策略在于优先肠内营养而不增加新生儿坏死性小肠结肠炎(NEC)的风险。早产儿喂养不耐受的预防或治疗方法的确切疗效尚需进行大规模的随机临床研究及系统综述进一步评价。     

喂养不耐受对早产儿近期结局的影响

目的 探讨喂养不耐受对早产儿近期结局的影响.方法 以2017年1月至12月住院且符合研究标准的早产儿为研究对象.根据是否发生喂养不耐受,分为喂养不耐受组和喂养耐受组.回顾分析早产儿住院及随访至校正月龄6个月的临床资料.结果 共纳入612例早产儿,其中喂养不耐受组182例和喂养耐受组430例.多因素分析结果显示,喂养不耐...     

早产儿喂养不耐受临床特征分析

目的：探讨早产儿喂养不耐受的临床特征,为早产儿喂养不耐受的防治提供临床依据。方法：2007年1月至2009年12月入住新疆医科大学第一附属医院的早产儿716例为研究对象,对其临床特征进行回顾性分析。结果：①716例早产儿中197例(27.5%)发生喂养不耐受,其中极低出生体重儿喂养不耐受发生比率高达77.6%。临床表现中以单纯胃潴留所占比例最高(47.2%)。②喂养不耐受出现时间集中在开始喂养后3 d内。③喂养不耐受组早产儿胎龄和出生体重低于耐受组、开奶时间晚于耐受组、早产儿合并窒息及呼吸性疾病比例高于耐受组（P＜0.05）;而民族、性别、孕母年龄、分娩方式、有无宫内窘迫两组差别无统计学意义（P＞0.05）。随着胎龄增大、出生体重增加、尽早开始喂养,早产儿喂养不耐受发生风险降低。结论：早产儿喂养不耐受的发生与患儿胎龄、出生体重、开奶时间及合并症有关。     

小剂量红霉素治疗早产儿喂养不耐受的疗效

目的评价小剂量红霉素治疗早产儿喂养不耐受的疗效。方法将早产喂养不耐受患儿45例随机分为治疗组23例和对照组22例。治疗组予小剂量红霉素5 mg/(kg.d),静脉滴注,1次/d,疗程5~7 d。对照组减少喂奶次数或量,或停止喂养。结果两组在症状消退时间、达足量喂养日龄、体质量增长日龄、增至出生体质量日龄、静脉营养和住院天数等方面比较均有显著性差异(P均<0.05)。结论小剂量红霉素治疗早产儿喂养不耐受安全、有效,不良反应少。     

小剂量红霉素防治早产儿喂养不耐受疗效观察

目的 探讨小剂量红霉素早期干预防治早产儿喂养不耐受的疗效。方法 随机将早产低出生体质量儿和极低体质量儿86例分为治疗组44例,对照组42例,两组均于入院后48 h经胃肠喂养,不能吸吮者口饲。治疗组同时用小剂量红霉素防治喂养不耐受。了解两组早期经胃肠喂养耐受情况,并对两组体质量增长情况、自行吸吮时间、胆红素变化等因素进行比较。结果 治疗组喂养不耐受例数明显低于对照组(P<0.01),体质量增长、自行吸吮时间好于对照组,未见不良反应发生。结论 早期小剂量红霉素干预可促进早产儿胃肠动力,提高其喂养耐受性。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

�¶�֢��ϵ�ϰ���ע��ȱ�ݶද�ϰ������ڵ�ת��

孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

How well are we doing? – Metabolic control in patients with diabetes

OBJECTIVE: To compare the present level of metabolic control in children and adolescents with insulin-dependent diabetes mellitus (IDDM) attending Brisbane paediatric diabetes clinics with published overseas data. METHODOLOGY: Blood HbA1c concentrations, population characteristics, current treatment practices and short-term complications were recorded in all patients, aged 19 years and under, attending the diabetes clinics of the two Brisbane Children's Hospitals or the private practice of one of the authors (MJT) in the first quarter of 1998. RESULTS: Two hundred and sixty-eight patients were assessed (M/F 142/126). Ages ranged from 1 to 19 years (mean 11. 2 years); duration of IDDM was 0-16 years (mean 4.4 years); and 141 (53%) were pubertal. Of those aged less than 13 years, only 4% had more than two injections daily. Insulin doses (U/kg/day) rose with increasing age. Larger doses were required in regimens involving more than two injections per day than those involving one to two injections per day. Ketoacidosis or severe hypoglycaemia in the last 3 months were reported in eight (2.7%) and 17 (6.3%) of patients, respectively. Mean HbA1c (+/- SD) was 8.6 +/- 1.4% (range 5.2-14.0%), with 33% of children having a HbA1c concentration < 8%. HbA1c concentrations were significantly related (P < 0.05) to insulin dose and to duration of diabetes, but not to severe hypoglycaemia, ketoacidosis, age, frequency of injections, or number of clinic visits per year. Mean HbA1c concentration was significantly higher (P < 0.05) in those children in puberty (8.7 +/- 1.5%) than in those not in puberty (8.5 +/- 1.2%). CONCLUSION: Only 33% of patients had a HbA1C concentration less than 8% and 6.3% had a severe hypoglycaemic episode in the 3 months. These results are similar to published overseas data.