床旁激光治疗早产儿视网膜病变的疗效分析

目的：探讨床旁激光治疗早产儿视网膜病变（ROP）的临床效果。方法：回顾性分析2009年3月至2009年8月在我院新生儿重症监护室（NICU）内床旁激光治疗的30例ROP患儿的临床资料。结果：30例ROP患儿中59只眼接受了激光治疗,总体治愈率95%。根据ROP国际分类标准,30例ROP患儿中,Ⅰ区病变有13例（26眼）,Ⅱ区病变有17例（33眼）。Ⅰ区病变组平均出生胎龄、体重及治疗时纠正胎龄均明显低于Ⅱ区病变组,而激光斑点数量明显高于Ⅱ区病变组。Ⅱ区病变组治愈率（100%）明显高于Ⅰ 区病变组（88%）（P<0.05）。结论：NICU床边激光手术治疗Ⅰ区病变和Ⅱ区病变是有效的。与Ⅱ区病变相比,Ⅰ区病变患儿预后相对较差。［中国当代儿科杂志,2010,12（9）：696-699］     

早产儿视网膜病经间接检眼镜激光治疗后视网膜脱离分析

目的分析严重早产儿视网膜病(ROP)经间接检眼镜激光治疗后出现视网膜脱离的特点。方法回顾性收集2006年1月至2008年2月经间接检眼镜激光治疗后出现视网膜脱离的ROP患儿,统计其性别、孕周、出生体重、ROP诊断、激光治疗参数、眼底随访情况、RetCam图片等临床资料,分析激光治疗后视网膜脱离的发生时间、部位和范围等特点。结果7例患儿(共12只眼)经间接检眼镜激光治疗后出现视网膜脱离,其平均孕周为29.9周(28～35周),平均出生体重1366g(1140～1810g)。激光治疗前诊断为阈值病变8只眼(占66.7%),阈值前病变1型4只眼(33.3%)。所有患眼激光治疗后平均5.8周出现视网膜脱离,其中11只眼(91.7%)在治疗后2～7周出现视网膜脱离,仅1只眼(8.3%)于激光治疗后24周出现4B期。所有患眼中,9只眼(75.0%)表现为颞侧、局限性的牵引性视网膜脱离,脱离范围<4个钟点,1只眼(8.3%)表现为鼻侧、局限性视网膜脱离,脱离范围4个钟点,另2只眼(16.7%)为累及各象限的完全性视网膜脱离。所有患儿激光治疗后平均随访27.2周。结论严重早产儿视网膜病经间接检眼镜激光治疗后7周内出现视网膜脱离的可能性比较大,主要表现为颞侧玻璃体增殖、牵引而导致的局限性视网膜脱离。     

早产儿视网膜病的高危因素分析

目的了解我院早产儿视网膜病（refinopathy of prematurity,ROP）的发病状况,并对其高危因素进行分析。方法对2010年1月至2012年12月在我院新生儿科住院的早产儿（胎龄≤36周,体重≤2．5kg）,于生后2周进行ROP筛查,并定期随访。将患儿全身状况及吸氧、母孕期吸氧、先兆子痫、胎盘早剥等因素进行分析。结果255例患儿全部完成了眼底筛查,在周边视网膜血管化或病变退化后终止随访,发现ROP16例（26只眼）,ROP患病率为6．3％（5．1％）,其中Ⅰ期12例,Ⅱ期3例,Ⅲ期1例。高危因素分析示胎龄、出生体重、吸氧时间,吸氧浓度、机械通气与ROP相关（P〈0．05）;母孕期吸氧、先兆子痫、胎盘早剥等因素与ROP发病无关。结论早产、吸氧浓度高、机械通气是ROP的主要危险因素。对早产儿适时进行ROP筛查,并对发现的ROP早期进行有效视网膜激光光凝术,可控制病变,降低早产儿的致盲率。     

雷珠单抗治疗早产儿视网膜病变研究进展

<正>尽管激光治疗是目前早产儿视网膜病变(retinopathy of prematurity,ROP)最常用的治疗方法,但它并不适用于治疗所有类型的ROP,尤其对于1区病变ROP及急进性后部型ROP(AP-ROP),激光治疗往往难以实施或带来严重不良后果[1]。随着对ROP发病机制的不断深入认识,有越来越多的药物开发应用于ROP,ROP治疗已逐步迈进药物治疗时代。血管内皮生长因子(VEGF)在ROP发生     

早产儿视网膜病变相关因素分析

目的 探讨早产儿视网膜病变(retinopathy of prematurity,ROP)发病情况及相关危险因素.方法 回顾性分析2008年12月至2011年2月我院出生的1 356例体重2500 g以下或胎龄小于37周早产儿的临床资料,分为ROP组(n=208)和非ROP组(n=1148),分析全部早产儿自生后4～6周或矫正胎龄32周筛查眼底改变情况.结果 1356例早产儿中,208例发生ROP,发病率为15.34％,其中,严重病变36例(2.65％).与非ROP组相比,ROP组患儿在出生体重[(1 528 ±243)g vs(1 960±187)g]、胎龄[(30.92±0.72)周vs (32.87±1.28)周]、吸氧＞8d(123例vs 865例)、应用肺表面活性物质(18例vs 216例)、败血症(42例vs 154例)、宫内窘迫(63例vs 511例)、贫血(64例vs 237例)等方面比较,差异有统计学意义(P均＜0.05).Logistic回归分析结果显示出生体重、胎龄、吸氧＞8d、败血症及应用肺表面活性物质是ROP发生的高危因素(P＜0.05).同时,不同出生体重、不同胎龄患儿ROP发病率比较,差异均有统计学意义(P＜0.05).结论 出生体重及胎龄越低,ROP发病率越高,病变程度越严重.婴儿出生的成熟度越低,ROP尤其是严重ROP发病可能性越高.     

早产儿视网膜病107例临床特点及预后分析

目的评价早产儿视网膜病(ROP)临床特点及远期治疗效果。方法回顾性分析2004-01-01—2009-07-31复旦大学附属儿科医院新生儿科收治的107例ROP患儿临床资料、ROP分期、治疗情况及远期预后。结果 1期和2期ROP共64例,6例2期病变达Ⅰ型阈值前病变而采用激光治疗,其他均未进行特殊治疗;除失访和死亡病例外,所有随访病例ROP病变均消退,远期视力不受影响。3期病变15例,其中14例达阈值病变者给予激光或冷凝治疗,1例未达阈值病变者不需要治疗。有完整随访资料的11例患儿中3例术后视力严重受损,仅存在光感,其余8例视力正常。4期和5期ROP共28例,随访的18例患儿中,仅1例手术后保存了正常视力(占5.6%),失明者达12例(占66.7%),其余5例虽保存视力,但视力极差,仅存光感(占27.7%)。结论 ROP防治关键在于预防ROP发生,当出现ROP早期病变时应严格筛查和及时干预,一旦疾病进入晚期,出现视网膜脱离时再治疗,则治疗效果不佳。     

地西泮、苯巴比妥联合表面麻醉对激光治疗早产儿视网膜病的镇痛效果

目的探讨地西泮、苯巴比妥联合表面麻醉对激光治疗早产儿视网膜病(ROP)的有效性和安全性。方法选择经双目间接检眼镜及Ret Cam Ⅱ眼底照相确诊的33例(66只眼)阈值期ROP患儿进行激光光凝术,术前30 min静脉注射苯巴比妥10mg·kg-1、术前5 min静脉注射地西泮0.4 mg.kg-1及结膜囊滴入5 g·L-1盐酸丙美卡因滴眼液。于术前、术中每隔15 min及术后15 min、30 min,分别对患儿进行CRIES疼痛评估,取最高分评估患儿在常规镇静联合表面麻醉下对激光手术的耐受程度。术前、术后检测其微量血糖评估患儿应激状态。结果激光手术持续时间为(34.4±10.1)min(17～53 min),激光点数为(1 228.7±542.7)点(290～2 350点);CRIES疼痛评分术中最高得分为(1.90±1.18)分,明显小于疼痛阈值(4分),其中29例全程得分<4分,占87.9%(29/33例),4例术中最高得分≥4分,经追加给药后手术均顺利完成;术后血糖[(6.3±1.2)mmol·L-1]显著高于术前[(5.4±1.7)mmol·L-1](t=3.987,P<0.05)。术中、术后并发症:术中均出现结膜下出血和角膜水肿,但不影响手术;仅6例在术中或术后出现短时呼吸暂停,经抚触、给氧或静脉滴注氨茶碱、或短期辅助通气等处理后较快缓解。结论地西泮、苯巴比妥联合表面麻醉进行激光治疗ROP,镇痛效果可靠、简便、安全,可在NICU内开展。     

早产儿视网膜病年度筛查报告

目的调查温州医学院附属育英儿童医院早产儿视网膜病变(ROP)的发生率及其发病高危因素,初步对2004年我国卫生部制定的ROP筛查标准进行评价。方法对2007年1月1日-12月31日入住该院新生儿科并符合筛查标准的254例早产儿进行ROP筛查,即出生体重<2000g的早产儿,在婴儿出生后4～6周或矫正胎龄32周开始进行检查,随诊至周边视网膜血管化。再分别按英国推荐的ROP筛查标准(体重≤1500g或孕周≤31周)和美国推荐的ROP筛查标准(体重≤1500g或孕周≤28周)对筛查结果进行比较。结果在接受筛查的254例早产儿中,发生ROP24例,发生率为9.4%。其中Ⅰ期病变18例,Ⅱ期病变4例,Ⅲ期病变2例,2例需激光治疗,无失明病例。若按美国推荐的ROP筛选标准统计,将遗漏21例,其中包括2例需要激光光凝治疗;若按英国推荐的标准筛选,将遗漏8例,其中1例同样需要激光光凝治疗。本研究将出生体重在1500～2000g的早产儿再细分为4组进行比较,发现发生ROP的患儿基本集中在出生体重1501～1600g组,与其余3组间两两比较差异均有统计学意义(P均<0.01),而在这组筛查患儿中出生体重在1601～2000g的患儿数远远多于1501～1600g患儿例数(165/30)。ROP相关因素的Logistic回归分析结果表明,孕周、出生体重、吸氧时间、机械通气、呼吸窘迫综合征、输血是发生ROP的高危因素。结论出生体重≤1600g的早产儿为ROP筛查标准更符合本地区的实际情况;对于出生体重>1600g的早产儿,根据患儿全身疾病情况有选择的进行筛查可减少漏诊率。孕周、出生体重、吸氧时间、机械通气、呼吸窘迫综合征、输血是发生ROP的高危因素。有必要根据更多的流行病学结果,制定出符合我国国情的ROP筛选标准。     

早产儿视网膜病1082例筛查报告及诊治分析

目的 探讨早产儿视网膜病(ROP)的早期诊治方法,分析其筛查结果.方法 由眼底病专科医生应用双目间接眼底镜对本院新生儿科2004年7月至2009年6月收治的胎龄＜34周或出生体质量＜2000 g的住院早产儿进行ROP筛查.首次筛查时间为纠正胎龄32～34周或生后4～6周,对检出的阈值期或阈值前期1型ROP(重症)患儿全部给予眼底激光光凝术,对视网膜血管未发育成熟、1～2期或阈值前期2型(轻度)ROP患儿进行密切随访,直至视网膜血管发育至锯齿缘或发展成为重症.对所有的临床资料进行回顾性分析.结果 5年共收治早产儿2 295例,符合筛查标准的早产儿1 082例,占47.14%;检出ROP总阳性病例154例,占筛查对象的14.23%(154/1082);其轻度ROP86例,占7.94%(86/1 082);重症ROP 68例,占6.28%(68/1 082).68例重症ROP患儿中,有6例出院后随访期间发现进展为重症ROP而再入院,有2例放弃治疗1年后证实全部失明.66例(132只眼)接受各种治疗,其中63例单用光凝术治疗;3例急进性后极ROP中2例采用玻璃体腔内注入血管内皮生长因子拮抗剂(Avastin)联合光凝术治疗,1例单用光凝术治疗者治疗后仍出现部分视网膜脱离,经玻璃体视网膜手术后仍失明;随访结果65例成功的保存了视力,成功率98.48%(65/66).在观察期间未达到光凝治疗条件,因原发病恶化死亡10例,经光凝治疗后的患儿未出现死亡.结论 ROP筛查是防止ROP病情发展的有效措施,对重症ROP及时给予光凝术治疗是安全有效的方法,对急进性后极ROP可用玻璃体腔内注入血管内皮生长因子拮抗剂联合光凝术治疗抢救视力.     

本院出生和外院转运早产儿视网膜病发病情况的对比研究

目的探讨广东省妇幼保健院出生和外院转运早产儿视网膜病(ROP)的发病及诊治情况。方法回顾性分析2013年1月至2015年12月收入广东省妇幼保健院新生儿重症监护室并诊断为ROP的755例早产儿的临床资料。本院出生组239例,外院转运组516例。收集2组患儿的胎龄、体质量、性别、ROP病变程度及手术治疗等资料。结果外院转运组ROP早产儿出生体质量[(1290.64±392.87)g]低于本院出生组[(1586.21±512.74)g],差异有统计学意义(P<0.001);外院转运组ROP早产儿诊断胎龄[(35.53±2.81)周]高于本院出生组[(34.51±2.17)周],差异有统计学意义(P<0.001);外院转运组严重ROP[如病变Ⅰ区、急进性后部型早产儿视网膜病(AP-ROP)、合并Plus病变]所占比例高于本院出生组,差异均有统计学意义(均P<0.001);外院转运组ROP早产儿行激光光凝术、玻璃体注药术、二者联合术、补激光术治疗所占比例均高于本院出生组[60.1%(310/516例)比20.9%(50/239例);10.9%(56/516例)比2.5%(6/239例);8.1%(42/516例)比1.7%(4/239例);4.5%(23/516例)比1.3%(3/239例)],差异均有统计学意义(均P<0.001)。结论外院转运ROP早产儿出生体质量较低,ROP病变较重,手术干预率高。提高基层医院早产儿ROP筛查水平,及时诊断和高效转运可有效防止ROP进一步恶化,提高早产儿生活质量。     

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.     

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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.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.