吴江地区新生儿宫内汞暴露的研究

目的 研究地区性宫内汞暴露状况以及脐血汞和胎发汞的相关性.方法 对入院产妇进行健康因素问卷调查,所分娩新生儿(除多胎外)作脐血汞和胎发汞配对测定.结果 1 214例配对测定脐血汞为(1.93 ± 1.86) μg/kg,胎发汞为(274.42 ± 2.08) μg/kg,两者呈正相关(r ＝ 0.526,P ＜ 0.05).不同性别间脐血汞及胎发汞差异无统计学意义(P均＞ 0.05).孕期有1种汞暴露高危因素者328例,脐血汞(2.55 ± 1.77)mg/kg,胎发汞(320.21 ± 2.20) μg/kg;有2种高危因素者67例,脐血汞(2.75 ± 1.81) μg/kg,胎发汞(370.90 ± 2.04) μg/kg;无高危因素者819例,脐血汞(1.68 ± 1.81) μg/kg,胎发汞(251.70 ± 1.98) μg/kg,组间差异有统计学意义(P 均＜ 0.01).1 214例中脐血汞高于安全范围上限5.8 μg/kg 30例,其中24例(32例次)有确切汞暴露高危因素.结论脐血汞、胎发汞呈正相关.加强孕期保健,避免孕期妇女汞接触甚为重要.除工业污染监控外,尚须重视避免生活中汞接触高危因素.     

父母环境因素暴露与胎儿先天性心脏病病因关系探讨

目的 探讨先天性心脏病与患儿父母孕前半年及孕期环境因素暴露的关系.方法 对先天性心脏病患儿的母亲行面对面结构式访谈,填写调查问卷,并在门诊中按1:2配对选取对照.共回收有效问卷168份,其中病例组56例,对照组112例.利用条件Logistic同归方法 ,分析父母双方孕前半年及孕期环境危险因素对胎儿先天性心脏病、房间隔缺损、室间隔缺损的影响.结果 母孕前半年工作生活环境嘈杂、既往自然流产史、孕早期服用激素、孕早期感冒、孕期检查到母亲或胎儿有异常与生育出先天性心脏病患儿关系显著(P<0.05),OR值(95%CI)分别为2.15(0.98～4.71)、13.16(1.31～132.72)、69.11(1.61～2970.17)、2.65(1.03～6.78)、4.07(1.42～11.68).母孕前半年工作生活环境嘈杂与生育出房间隔缺损患儿关系显著(P<0.05),OR值(95%CI)为5.13(1.64～16.08).父孕前半年重金属暴露、母孕期检查到母亲或胎儿有异常与生育出室间隔缺损患儿关系显著(P<0.05),OR值(95%CI)分别为4.14(1.081～15.867)、12.48(1.346～115.71).结论 改善父母双方健康状况,控制或减少父母双方工作生活环境中危险因素暴露,加强孕期检查,对于降低胎儿先天性心脏病发生风险尤为重要.     

孕期营养干预和代谢性危险因素对妊娠结局的影响

目的 探讨孕期营养干预和孕期代谢性危险因素对妊娠结局的影响。方法 研究对象为上海市国际和平妇幼保健院2010年5月至2012年4月接受常规产检并且分娩的孕妇。采用回顾性队列研究,在确诊为妊娠糖尿病(GDM)的孕妇中比较膳食干预组(接受膳食咨询) 和对照组(未接受膳食咨询)不良妊娠结局的差异,GDM诊断采用2010年国际糖尿病与妊娠研究组推荐标准。采用Logistics逐步回归分析母亲孕期危险因素对巨大儿发生的影响及作用大小。结果 ①10 421名孕妇的围生期信息进入数据分析。孕妇初诊时平均孕周20.8(19.4~22.4)周,初诊时空腹血糖(FBS)、三酰甘油(TG)和总胆固醇(CHOL)平均水平分别为(4.3±0.4)、(1.3±0.6)和(4.7±0.8) mmol·L-1,收缩压和舒张压的平均水平分别为(111.3±11.5)和(67.9±13.3)mmHg。高危孕妇的GDM的患病率为15.8%。新生儿平均出生体重(3 355.4±426.0) g,巨大儿发生率6.2%。②812名GDM孕妇中,干预组570例,对照组242例。两组孕妇年龄、文化程度、孕20周体重、初诊时血糖、血脂等基线水平均衡可比。干预组的新生儿出生体重、巨大儿发生率和妊娠期高血压发生率均低于对照组,分别为(3 347.4±19.6) vs (3 450.3±35.6) g(P=0.007)、6.7% vs 15.6%(P=0.001)和26.3% vs 47.9% (P<0.001)。随着营养干预次数的增加,孕中晚期体重增长量和新生儿出生体重均呈下降趋势(r=-0.126,P=0.003;r=-0.112,P=0.002),巨大儿的发生率也依次降低。③Logistic逐步回归分析显示,孕20周时体重(OR=1.08,95%CI:1.07～1.09)、孕中晚期体重增长量(OR=1.10,95%CI:1.07~1.12)和GDM(OR=1.63,95%CI:1.22~2.19)是巨大儿发生的危险因素。结论 对高危孕妇应考虑进行更早期的孕期危险因素管理以及膳食指导干预,控制孕期体重合理增长,有望减少不良妊娠结局的发生。     

妊娠期高血压时脐血脂联素与围产儿生长发育的关系

目的 探讨母妊娠期高血压疾病(HDCP)对新生儿脐血脂联素水平的影响及脂联素与围产儿生长发育的关系.方法 妊娠期高血压疾病母亲所生新生儿60例,按妊娠期高血压疾病诊断标准分为妊娠期高血压组(HDCP1)23例、子(癎)前期轻度组(HDCP2)22例、子(癎)前期重度组(HDCP3)15例;另设健康对照组40例.采用放射免疫分析法(RIA)测定脐血脂联素,并分析脂联素与胎龄、出生体质量、体质指数(BMI)、头围、身长之间的相关性.结果 妊娠期高血压疾病组新生儿脐血脂联素水平低于健康对照组,且随母亲妊娠期高血压疾病程度的加重呈进行性下降,组间比较有统计学意义(F=3.984,P＜0.05).妊娠期高血压疾病组新生儿胎龄、出生体质量、BMI低于健康对照组,且随母亲妊娠期高血压疾病程度的加重呈进行性下降,组间比较差异有统计学意义(F=2.772～6.262,P均＜0.05);头围、身长组间比较差异有统计学意义(F=5.597～6.466,P均＜0.01),呈子(癎)前期重度组与正常对照组、妊娠期高血压组、子(癎)前期轻度组比较差异有统计学意义(P＜0.05).妊娠期高血压疾病组新生儿脐血脂联素水平与胎龄、出生体质量、BMI呈显著正相关(r=0.320～0.338,P均＜0.05),而与头围、身长无相关性(r=0.197、0.322,P均＞0.05).结论 妊娠期高血压疾病时宫内不利环境影响胎儿内分泌代谢的调节,且随母亲妊娠期高血压疾病程度的加重而加重,脂联素与围产儿生长发育明显相关,可以作为衡量围产儿生长发育状态的一个重要指标.     

影响新生儿出生体质量的多因素分析

目的了解新生儿出生体质量的影响因素。方法采取随机整群抽样方法收集北京、哈尔滨、长沙及广州4个城市5 539例单胎活产新生儿出生体质量及相关数据,运用单因素分析及多元Logistic回归分析,筛选新生儿出生体质量的影响因素。结果单因素分析显示,新生儿性别和胎龄,母亲产次、年龄、妊娠前体质指数(BMI)、孕期增加体质量、文化程度和职业8个因素对新生儿出生体质量有影响。采用Logistic回归分析发现,胎儿为男性(OR=2.13)、母亲年龄≥25岁(OR=3.30)、母亲妊娠前BMI≥24.0 kg/m2(OR=3.77)、母亲孕期体质量增加≥12.5 kg(OR=1.64)为巨大儿发生的危险因素;而母亲妊娠前BMI18.5 kg/m2(OR=2.25)、早产(OR=16.43)是低出生体质量儿发生的危险因素。结论早产、孕期体质量增加过多、母亲孕前BMI偏高或偏低是导致异常出生体质量发生的主要因素。     

妊娠期血脂紊乱与胎儿先天性心脏病发病关系探讨

目的 探讨妊娠期血脂水平与胎儿先天性心脏病之间的关系。方法 收集2013年3月至2014年6月于中山大学附属第一医院产检的孕周为24～28周的孕母54例, 其中18例存在胎儿先天性心脏病, 为病例组, 余36例为正常对照组。病例组与对照组孕母的年龄分别为（29.06±3.11）岁、（29.03±3.90）岁,主要检测指标包括总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白以及同型半胱氨酸。结果 病例组孕母低密度脂蛋白胆固醇（4.15 mmol/L vs. 3.45 mmol/L,P＜0.05）及载脂蛋白B（2.23 g/L vs. 1.78 g/L,P＜0.05）水平较对照组明显升高。相关分析提示低密度脂蛋白胆固醇（r＝0.32,P＝0.017）、载脂蛋白B（r＝0.33,P＝0.016）及同型半胱氨酸（r＝0.34,P＝0.011）与胎儿患先天性心脏病相关。结论 病例组血清低密度脂蛋白胆固醇和载脂蛋白B水平较对照组明显升高。妊娠期血脂代谢异常可能会导致胎儿先天性心脏病的风险增加。     

妊娠期糖尿病母亲所生新生儿肾功能的变化

目的 探讨妊娠期糖尿病(GDM)母亲所生新生儿肾功能的变化,加强对GDM母亲所生新生儿并发症的认识,从而提高GDM母亲所生新生儿的生活质量.方法 选取2009年3月-2010年9月山东大学附属省立医院新生儿科收治的GDM母亲所生新生儿45例作为观察组.男23例,女22例;早产儿25例,足月儿20例;巨大儿20例,非巨大儿25例.选取同期出生的非GDM母亲所生新生儿45例作为对照组.男21例,女24例;早产儿18例,足月儿27例;巨大儿22例,非巨大儿23例.研究对象均于出生72 h内采集空腹外周静脉血,应用广州OLYMPUS-AU5400全自动生化分析仪检测血清胱抑素C(Cys-C)、β2微球蛋白(β2-MG)、BUN、肌酐(CREA)水平,观察各检测指标变化.结果 观察组BUN、CREA水平与对照组比较均无统计学差异(Pa＞0.05),血清Cys-C、β2-MG均较对照组升高(Pa＜0.05);观察组早产儿、足月儿Cys-C、β2-MG水平均较对照组显著升高(Pa＜0.05),而观察组早产儿和足月儿间Cys-C、β2-MG水平比较均无统计学差异(Pa＞0.05);观察组巨大儿和非巨大儿Cys-C、β2-MG水平均较对照组升高(Pa＜0.05),观察组巨大儿与非巨大儿间Cys-C、β2-MG水平均无统计学差异(Pa＞0.05).结论 GDM母亲所生新生儿较非GDM母亲所生新生儿血清Cys-C与β2-MG水平升高,GDM母亲所生新生儿可能存在早期肾功能损害,且不受胎龄、体质量影响.     

极低及超低出生体重儿肺出血的影响因素及预后分析

目的 探讨极低及超低出生体重(出生体重≤1200g)早产儿肺出血的影响因素及预后.方法 回顾性分析2010年1月至2015年12月于中国医科大学附属盛京医院第二新生儿科住院、出生体重≤1200g、住院期间发生肺出血的极低及超低出生体重儿临床资料,同期住院、相同体重范围非肺出血早产儿作为对照组.比较两组母孕期及新生儿期特点,多元回归分析探讨肺出血影响因素,了解肺出血新生儿的近期预后.结果 肺出血新生儿(肺出血组)71例,对照组364例.肺出血发生于 3d 以内者57例(占80.3%),肺出血组胎龄(28.2±1.7)周、出生体重(936±192)g,均明显低于对照组[(29.5±2.1)周,(1033±134)g,t分别为4.776、-5.145,P<0.01].肺出血组呼吸窘迫综合征(RDS)(76.1%)、肺表面活性物质治疗(76.1%,其中≥2次使用率9.9%)、动脉导管未闭(PDA)(66.2%)比例均明显高于对照组[41.2%、30.8%(4.1%)和38.7%,χ2值分别为33.457、28.970(4.074)和32.798,P<0.05].肺出血组产前类固醇激素治疗率(21.1%)亦明显低于对照组(41.2%,χ2=10.177,P<0.01).多因素Logistic逐步回归分析显示,RDS(OR=3.739,95%CI 1.383-10.113,P<0.05)、PDA(OR=2.206,95%CI 1.205-4.093,P<0.05)及5 min Apgar评分<7(OR=2.851,95%CI 1.191-6.828)是肺出血的独立危险因素;出生体重大(OR=0.998,95%CI 0.996-1.000,P<0.05)及母孕期应用激素 (OR=0.432,95%CI 0.224-0.834,P<0.05)是肺出血的保护因素.肺出血组颅内出血、早产儿视网膜病及重度支气管肺发育不良发生率(16.9%、12.7%及18.3%)明显高于对照组(5.8%、4.4%及2.2%,χ2值分别为36.824、7.520及33.568,P<0.01).肺出血组病死率(49.3%)亦明显高于对照组(14.0%,χ2=46.634,P<0.01).结论 多种围生期因素与肺出血有关;预防早产及产前类固醇激素治疗有助于预防肺出血;肺出血新生儿不良预后发生率高.     

妊娠高血压母亲新生儿脐血S-100蛋白水平与脑血流变化的研究

目的 探讨妊娠高血压母亲新生儿脐血S-100蛋白水平与脑血流变化的关系.方法 我院2006年1月至2007年1月收治的妊娠高血压母亲所生新生儿为观察组,母亲重度子痫前期为重度组,只有高血压或轻度子痫前期为轻度组;无国产期缺氧史的足月儿为对照组.采用ELISA法对所有新生儿脐血S-100蛋白进行检测,同时应用彩色多谱勒超声观察生后24h内双侧大脑中动脉收缩期峰流速(Vs)、舒张末期流速(Vd)及阻力指数(RI).结果 重度组脐血S-100蛋白水平高于轻度组和对照组[(60.1±8.3)μg/L比(37.6±5.0)μg/L和(35.1±3.3)μg/L,P均＜0.01],轻度组和对照组之间差异无统计学意义(P＞0.05).重度组Vs、Vd均低于轻度组和对照组,RI高于对照组,差异有统计学意义(P＞0.05).妊娠高血压母亲新生儿脐血S-100蛋白水平与大脑中动脉血流速度呈负相关(r=-0.257,P＜0.05).结论 妊娠高血压母亲新生儿脐血S-100蛋白水平升高,脑血流速度降低,二者变化有明显相关性.     

儿童原发性肾病综合征脂联素与其他脂代谢相关因素的探讨

目的 初步探讨儿童原发性肾病综合征(PNS)脂联素(ADPN)的变化,了解ADPN与PNS其他脂代谢相关因素的联系.方法 对71例PNS急性期患儿、37例缓解期患儿和35例健康儿童的血浆、尿液ADPN浓度进行定量分析,并将急性期患儿分为激素敏感组59例和激素耐药组12例,测定急性期患儿的体质指数(BMI)、肾小球滤过率(GFR)、血清白蛋白(Alb)、肌酐(Cr)、补体C3、三酰甘油(TG)、胆固醇(Tch)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、脂蛋白aLP(a)、载脂蛋白A(apoA)、载脂蛋白B(apoB)以及24 h尿蛋白定量,并进行相关性分析.结果 急性组的血浆、尿ADPN(14.02 ± 3.44 μg/ml,4.71 ± 2.12 μg/ml)显著高于缓解期组(7.13 ± 5.07 μg/ml,2.50 ± 1.06 μg/ml)和正常对照组(7.17 ± 2.94 μg/ml,2.60 ± 1.06 μg/ml)(P ＜ 0.01).激素耐药组血浆、尿ADPN均显著高于激素敏感组(P ＜ 0.05).PNS急性期患儿血浆ADPN分别与尿ADPN、血清TG、Tch、LDL、LP(a)、apoB及24 h尿蛋白定量正相关(r ＝ 0.242 7 ～ 0.609 1,P均＜ 0.05),与血清Alb、HDL负相关(r ＝ -0.745 4、-0.489 7,P ＜ 0.01).结论 PNS患儿的血浆及尿液ADPN浓度明显升高.血浆和尿液ADPN浓度与其他脂代谢指标密切相关.     

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.