极低出生体重儿动脉导管未闭转归的影响因素分析

目的分析极低出生体重儿动脉导管未闭(PDA)转归的影响因素。方法以2012年1月至2014年12月收治的194例极低出生体重儿为研究对象,根据心脏超声检查及治疗转归情况分为无PDA组,PDA自然关闭组、药物关闭组、手术关闭组,分析其临床及超声心动图特征。结果 PDA自然关闭率58.7%。自然关闭组的出生胎龄、出生体重、小于胎龄儿比例均大于药物和手术关闭组,药物及手术关闭组的新生儿呼吸窘迫综合征发生率及肺表面活性物质(PS)应用比例高于自然关闭组(P0.05)。不同时间段自然关闭组的动脉导管直径均明显小于药物和手术关闭组(P0.05)。多因素logistic回归分析示出生胎龄、PS应用及48 h动脉导管直径与PDA转归显著相关。自然关闭组PDA分流类型均以关闭型为主,而药物及手术关闭组在48 h以肺高压型及进展型为主,在4 d、7 d时均以进展型为主。结论极低出生体重儿PDA自然关闭率较高,出生胎龄越小以及应用PS的患儿自然关闭率越低;动脉导管直径越大且分流类型为进展型或脉冲型的PDA不易自然关闭。     

布洛芬治疗极低出生体质量儿动脉导管未闭效果的相关因素北大核心CSCD

目的探讨布洛芬治疗早产儿动脉导管未闭（PDA）的相关影响因素。方法对2013年1月至2015年12月在河南省人民医院新生儿科住院且出生体质量〈1 500 g的1 236例早产儿进行分析。于出生7 d行床边超声心动图检查,对发生PDA的早产儿排除口服布洛芬的禁忌证者入组。实际进入调查376例。予口服/鼻饲布洛芬治疗后72 h再次床边超声心动图检查了解PDA的关闭率,分析引起布洛芬治疗PDA失败的高危因素。结果单因素分析显示,小胎龄、低出生体质量、宫内窘迫、出生窒息病史、呼吸窘迫综合征、感染、呼吸支持、导管直径、导管两端压差、导管水平峰值流速等是引起PDA药物治疗失败的高危因素（均P〈0.05）;Logistic回归分析显示,呼吸窘迫综合征、感染、呼吸支持、导管直径、导管两端压差、导管水平峰值流速等是PDA发生的独立高危因素,胎龄和出生体质量为保护性因素。结论关注引起早产儿PDA药物治疗失败的高危因素,早期防治PDA可提高早产儿的存活率和生存质量。     

早产儿动脉导管未闭高危因素分析

目的探讨早产儿动脉导管未闭(PDA)的危险因素。方法对2010年7月至2011年7月在我院新生儿监护病房住院的早产儿进行回顾性研究。其中出生48h后进行超声检查诊断PDA的患儿为病例组,按2.5∶1的比例从动脉导管关闭的早产儿中随机抽取对照组。将两组早产儿的产科合并症、宫内情况、早产儿相关疾病、生后干预及相关检验指标进行对照研究。单因素分析中有统计学意义的因素进行Logistic回归分析。结果共纳入病例组96例,对照组250例。单因素分析显示胎龄、出生体重、母亲产前用药情况、早产儿相关疾病及生后干预与PDA相关。趋势卡方检验等级效应分析显示,胎龄越小,出生体重越低,PDA发生率越高,Logistic回归分析提示感染和暂时性甲状腺功能低下是PDA的独立危险因素,胎龄为独立保护因素(OR值分别为2.183、2.935和0.806),P均<0.05。结论本研究中,早产儿PDA与小胎龄、低出生体重、合并感染及暂时性甲状腺功能低下密切相关。     

动脉导管未闭的药物治疗进展

正常足月儿生后24～48h动脉导管已呈功能性关闭，而早产儿的动脉导管常不能关闭，或功能性关闭后又重新开放。有呼吸窘迫综合征的极低出生体重儿，生后第3天动脉导管未闭(PDA)的发生率约为40％。PDA的临床结果取决于左向右分流的程度，可加重呼吸窘迫、促发充血性心力衰竭、支气管肺发育不良、肾脏低灌注及脑缺血、继发肠缺血。70％胎龄小于28周的早产儿需要药物或手术关闭动脉导管。     

动脉导管未闭的药物治疗进展

正常足月儿生后24～48 h动脉导管已呈功能性关闭,而早产儿的动脉导管常不能关闭,或功能性关闭后又重新开放.有呼吸窘迫综合征的极低出生体重儿,生后第3天动脉导管未闭(PDA)的发生率约为40%[1].PDA的临床结果取决于左向右分流的程度,可加重呼吸窘迫、促发充血性心力衰竭、支气管肺发育不良、肾脏低灌注及脑缺血、继发肠缺血.70%胎龄小于28周的早产儿需要药物或手术关闭动脉导管[2].手术结扎动脉导管有血压波动、感染、乳糜胸、喉神经麻痹,甚至死亡的危险.故在大多数新生儿重症监护病房中,药物治疗PDA是首选.     

氨基末端脑钠肽前体预测早产儿症状性动脉导管未闭的价值

目的 探讨氨基末端脑钠肽前体(NT-proBNP)预测早产儿症状性动脉导管未闭(sPDA)的价值。方法 选择2014年6月至2015年4月出生、胎龄≤32周、48 h内超声心动图确定存在动脉导管的早产儿为研究对象,监测其临床表现,于生后3 d及5 d检测血清NT-proBNP水平并行超声心动图检查,根据患儿临床表现、超声心动图结果分为sPDA组及非症状性动脉导管未闭(asPDA)组,分析血清NT-proBNP水平与超声指标的关系,比较两组间相同日龄血清NT-proBNP水平,ROC曲线确定血清NT-proBNP水平预测sPDA的敏感性、特异性。结果 共69例早产儿纳入研究,其中sPDA组13例,asPDA组56例。血清NT-proBNP水平与动脉导管管径、左房内径与主动脉根部内径比值(LA/AO)呈正相关关系(分别r=0.856、0.713,均 PPCI:0.892~1.000,PCI:0.848~1.000,P结论 NT-proBNP可能是动脉导管分流量的量化指标;生后3 d 及5 d血清NT-proBNP水平的检测均有助于早期预测sPDA。     

颅内出血早产儿生后24小时内脑血流变化及围产因素分析

目的　探讨颅内出血早产儿生后 2 4h内脑血流动力学的变化及颅内出血与围产因素的关系。方法　应用经颅多谱勒超声 (TCD)检测 2 0 0 3年 3～ 10月间河北省保定市妇幼保健院 2 6例颅内出血早产儿脑血流速度、阻力指数的变化及脑血流速度与平均动脉血压的关系 ,分析临床围产因素 ,并与同期无颅内出血的 36例早产儿进行比较。结果　颅内出血早产儿于生后 (6± 2 )h、2 4h脑血流速度增快 ,于出生 (6± 2 )h脑血流速度与平均动脉血压相关 ,且出生窒息、胎龄 <32周、出生体重 <15 0 0g的早产儿颅内出血发生率高。结论　颅内出血早产儿于生后 6h存在脑血流自主调节功能破坏 ,于生后 2 4h内脑血流存在过度灌注 ;且出生窒息、胎龄 <32周、出生体重<15 0 0g为颅内出血的高危因素。     

生后早期床旁心脏超声预测极低出生体重儿动脉导管持续开放的研究(英文翻译)

目的 探讨出生早期床旁心脏超声预测极低出生体重儿（very low birth weight infant,VLBWI）动脉导管持续开放的价值。 方法 回顾性选取2020年3月至2021年6月收治的51例VLBWI为研究对象,入院时日龄≤3 d并且住院时间≥14 d。根据出生14 d及28 d动脉导管未闭（patent ductus arteriosus,PDA）直径大小分为3组：大PDA组（PDA直径≥2 mm）、小PDA组（PDA直径<2 mm）和PDA关闭组（PDA直径=0 mm）,比较3组间生后72 h的心脏超声参数。采用受试者工作特征（receiver operating characteristic,ROC）曲线评估生后72 h心脏超声参数预测生后14 d和28 d动脉导管持续开放（PDA直径≥2 mm）的价值。 结果 生后14 d时,大PDA组有17例,小PDA组11例,PDA关闭组23例;生后28 d时,大PDA组有14例,小PDA组9例,PDA关闭组26例。3组患儿间胎龄、出生体重、肺泡表面活性物质应用及低血压发生率的比较差异有统计学意义（P<0.05）。生后72 h的PDA直径、左肺动脉舒张末期流速、左心室输出量、左心室输出量/上腔静脉血流与生后14 d及28 d时动脉导管持续开放有关（P<0.05）;左心房/主动脉根部直径与生后28 d时动脉导管持续开放有关（P<0.05）。ROC曲线结果显示,生后72 h PDA直径预测生后14 d及28 d动脉导管持续开放的曲线下面积最大,分别为0.841和0.927;其次是左肺动脉舒张末期流速,其曲线下面积分别为0.793和0.833。 结论 生后72 h的床旁心脏超声指标,尤其是PDA直径及左肺动脉舒张末期流速,可预测VLBWI生后14 d和28 d动脉导管持续开放,为后续PDA早期目标性治疗策略的实施提供依据。     

早产儿早期脑血流影响因素的多因素分析

目的 探讨影响早产儿早期脑血流的主要因素.方法 住院早产儿261例,分为生后1、3 d组各90例,7 d组81例.应用经颅多普勒超声监测3组早产儿大脑中动脉血流速度及血管弹性.应用彩色多普勒超声心动图监测早产儿心输出量(CO)及主动脉瓣口峰值流速,同时监测生后1 d组早产儿的体温、血气、血糖、血压及红细胞比积,并记录其胎龄及出生体重,应用多元逐步回归分析分析上述多因素对早产儿脑血流的影响.结果 影响早产儿早期脑血流改变的因素有平均动脉压(MBP)、体温(T)、每分心输出量(CO)、动脉血二氧化碳分压(PaCO2)及红细胞比积(HCT),MBP、T、CO、PaCO2、HCT与大脑中动脉平均血流速度(Vm)的回归系数分别为0.458、5.332、10.385、0.095、-0.159.胎龄、出生体重与Vm正相关(r=0.28,r=0.41,P均<0.01).脑血流速度均随日龄的增加而增加,其中收缩期峰值流速增加趋势最明显.3 d组的血管弹性最低,明显低于7 d组(P<0.05).结论 CO、T、MBP、PaCO2、HCT、胎龄、日龄及出生体重是影响早产儿早期脑血流变化的主要因素.     

早产儿脑室内出血的相关因素

目的探讨早产儿脑室内出血(IVH)发病相关因素及临床特点。方法调查172例早产儿胎龄、体质量、出生情况,通过床旁颅脑彩超确诊早产儿IVH,记录IVH临床表现、彩超结果,并与同期入院无IVH早产儿进行比较。结果1.胎龄与IVH发生有关(χ2=6.40P=0.011);2.出生体质量与IVH发生有关(χ2=26.49P=0);3.早产儿IVH多于生后72h内出现临床症状,生后5d内确诊,且多数早产儿IVH程度较轻,无明显临床症状;4.重度窒息早产儿较轻度窒息早产儿IVH发生率高、程度重。结论胎龄、出生体质量及窒息程度与早产儿IVH的发生呈线性关系;多数早产儿IVH无明显临床表现;床旁颅脑超声是诊断早产儿IVH可靠、敏感和简便的手段。     

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.     

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   

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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.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

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.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.