新生儿母乳性黄疸的临床研究

目的　了解母乳性黄疸 (BMJ)患儿胆红素均值及峰值水平 ,探讨BMJ患儿胆红素增高对肝脏及心肌酶的影响 ,寻求最佳干预方案。方法　以 160例确诊为BMJ患儿为研究对象 ,观察黄疸出现及消退时间 ,并行经皮胆红素、血清胆红素测定及心肌酶谱、肝功能等检查 ,并将胆红素 >2 91μmol/L 80例患儿随机分成 4组治疗 ,并评价其疗效。结果　 1.BMJ胆红素高峰期在生后 2～ 4周 ,血清胆红素峰值和均值分别为 3 16μmol/L和 2 3 1μmol/L。黄疸消退时间为 6～ 12周 ;2 .经皮测胆红素与血清总胆红素呈正相关　r =0 .92 ;3 .BMJ患儿心肌酶、肝功能、总蛋白、清蛋白、球蛋白、碱性磷酸酶均在正常范围 ;4.继续母乳组、停止母乳组、光疗暂停母乳组、光疗继续母乳组患儿黄疸消退时间以光疗暂停母乳组与光疗继续母乳组患儿黄疸消退时间快 ,但两组间无显著性差异 (P >0 .0 5)。结论　 1.经皮测胆仪不仅可作为筛查、随访工具 ,且其结果可代替血清总胆红素作为指导治疗的依据 ;2 .BMJ患儿胆红素对肝功能、心肌酶无影响 ;3 .各组中以光疗不停母乳组黄疸消退时间最快 ,疗效最显著 ,故光疗时不必停母乳     

双歧杆菌活菌制剂治疗新生儿母乳性黄疽的疗效

目的观察双歧杆菌活菌制剂治疗新生儿母乳性黄疸的疗效.方法对63例新生儿母乳性黄疸患儿随机分为双歧杆菌治疗组和常规治疗组,常规治疗组采用输液、清蛋白静滴,重者采用蓝光治疗;双歧杆菌治疗组在常规治疗方法基础上加用双歧杆菌活菌制剂,并观察两组患儿黄疸消褪时间及血清总胆红素水平的变化.结果双歧杆菌治疗组和常规治疗组黄疸消褪时间分别为(4.0±2.1)、(5.5±2.5)d,两组比较有显著差异(P＜0.05),治疗d5血清总胆红素值分别为(45.6±17.3)、(82.5±32.6)μmol/L,两组比较有极显著差异(P＜0.01).结论双歧杆菌活菌制剂治疗新生儿母乳性黄疸有显著疗效.     

微生态调节剂干预母乳性黄疸临床观察和机制探讨

观察微生态调节剂(妈咪爱)干预母乳性黄疸疗效,并探讨其机制,检测"妈咪爱"治疗前后血清和十二指肠液胆红素值、胆汁和粪便β-葡萄糖醛酸苷酶(β-GD)活性.结果显示"妈咪爱"制剂干预组血清总胆红素值从130.60±20.06μmol/L下降到61.20±16.04μmol/L(P＜0.05),十二指肠液β-GD从1859.91±908.60U/100ml下降到858.26±260.90U/100ml,粪便中β-GD从4053±983.0U/100ml下降到2110.9±1541U/100ml(P＜0.05);而对照组十二指肠液胆红素值则无明显变化(P＞0.05).可以结论,"妈咪爱"调节剂能降低血清总胆红素值和肠道及胆汁中β-GD活性.     

口服金双歧辅助治疗重症母乳性黄疸43例疗效观察

近年来 ,新生儿黄疸 (高胆红素血症 )有逐年增多的趋势 ,除了临床上对黄疸重视程度提高之外 ,还与母乳喂养率的提高及母乳性黄疸逐渐被认识有关。我院儿科自 2 0 0 0年 2月— 2 0 0 2年10月用双歧杆菌制剂“金双歧”口服辅助治疗新生儿重症母乳性黄疸 ,取得满意的疗效 ,现将临床应用观察结果报告如下。1　资料与方法1 1　诊断条件　①母乳喂养 ;②黄疸在生理性黄疸期内 (3～ 14d)发生 ,但不随生理性黄疸的消退而消退 ;③黄疸程度轻重不等 ,以轻、中度为多 ,血清胆红素浓度 2 5 6 0～ 40 5 1μmol/L ,以未结合胆红素为主 ;④患儿一般状况好…     

测定脑脊液胆红素含量在新生儿胆红素脑病中的诊断价值

目的探讨脑脊液(CSF)中未结合胆红素(UCB)水平在胆红素脑病中的诊断价值.方法对胆红素脑病组、母乳性黄疸组、对照组同时测定CSF中UCB、血中UCB和白蛋白水平,比较各组间CSF中UCB水平以及其与血中UCB、未结合胆红素/白蛋白比值(B/A)之间的相关性.结果胆红素脑病组CSF中UCB达(13.69±2.82)μmol/L明显高于其他两组;三组CSF中UCB与血中UCB无相关性;而CSF中UCB与B/A在胆红素脑病组与对照组呈正相关,在母乳性黄疸组二者无相关性.结论CSF中UCB可作为胆红素脑病诊断可靠指标;B/A作为胆红素毒性指标较血UCB更有意义.     

二例Rh抗—D引起新生儿晚期贫血

例1,男34天,G3P2。产后第5天因嗜睡、拒食、不哭、皮肤黄染呈进行性加深,当地医院体检,血红蛋白125g/L,网织红细胞16％,总胆红素307.8μmol/L,经抗感染,光疗、激素等治疗,黄疸消退出院,但一周后又因黄疸加深入我院,查血红蛋白50g/L,红细胞1.53×10~(12)/L,网织红细胞16.4％,总胆红素106.9μmol/L;患儿血型:B、CC-     

十二指肠液γ-谷氨酰转肽酶的测定对新生儿阻塞性黄疸的鉴别诊断

探讨十二指肠液γ-谷氨酰转肽酶(γ-GT)活性对新生儿阻塞性黄疸的鉴别诊断价值.应用婴儿十二指肠引流管收集38例新生儿期阻塞性黄疸的十二指肠液,检测十二指肠液中γ-GT活性.结果显示,随访黄疸消退的22例新生儿肝炎患儿,胆汁中胆红素值≥8.5μmol/L),胆汁酸阳性,γ-GT≥20Iu/L;16例肝外胆道闭锁者无胆汁,十二指肠液胆红素值0～5 μmol/L,胆汁酸阴性,十二指肠液γ-GT缺如.测定十二指肠液胆红素、胆汁酸和γ-GT活性有助于早期鉴别诊断新生儿肝炎与肝外胆道闭锁.     

思密达治疗新生儿高胆红素血症45例

新生儿高胆红素血症是新生儿常见疾病 ,在医院设备所限无法用光疗的情况下 ,给予茵栀黄退黄及保肝等综合治疗 ,但疗效不十分满意。思密达用于治疗新生儿母乳性黄疸文献中已有报道[1] 。我们用思密达口服辅助治疗新生儿高胆红素血症 ,疗效满意 ,现报告如下。资料与方法一、对象　 1999年 3月～ 2 0 0 2年 12月我院收治的 4 5例新生儿高胆红素血症 ,日龄均 <2 8d ,均符合病理性黄疸诊断标准[2 ] 。总胆红素 <342 .0 μmol/L(2 0mg/dl) ,未成熟儿总胆红素 <2 5 6 .5 μmol/L(15mg/dl)。感染性黄疸 14例 ,头颅血肿 8例 ,母乳性黄疸 13例 ,溶血…     

β-葡萄糖醛酸苷酶与母乳性黄疸关系的观察

目的动态观察母乳、新生儿粪便中β-葡萄糖醛酸苷酶（β-glucuronidase,β-GD）活性变化的规律及其与血清胆红素浓度的关系。方法以纯母乳喂养的18例母乳性黄疸患儿和12例生理性黄疸儿为观察对象。于生后第1、2、3和4周测定母乳及新生儿粪便中β-GD活性和血清胆红素浓度。结果母乳中β-GD活性在母乳性黄疸组第1、2、3、4周（中位数,M）分别为178、102、134和91kU/L,生理性黄疸组分别为320、128、182、164kU/L,两组各期差异无显著性(P＞0.05);新生儿粪便中β-GD活性在母乳性黄疸组分别为（512±291）、（660±153）、（629±282）和（639±237）U/g,生理性黄疸组分别为（672±118）、（582±270）、（573±211）和（714±153）U/g,两组差异亦无显著性(P＞0.05)。母乳性黄疸组血清胆红素浓度与母乳及粪便中酶活性的相关系数分别为0.224和0.027(P＞0.05);生理性黄疸组分别为0.109及0.140(P＞0.05),两组均无相关性。结论β-GD活性在母乳性黄疸的发病机理中不是唯一的或主要的原因。     

测定胆道闭锁术后皮肤胆红素动态变化与预后的关系

目的 初步探讨胆道闭锁患儿术后测定皮肤胆红素动态变化与黄疸消退及预后的关系.方法 2009年7月至12月,收治黄疸患儿52例,男19例,女33例,年龄36 d～304 d,平均年龄83 d,包括胆汁淤积5例,胆道闭锁47例,采血测血清胆红素同时测其皮肤胆红素.同期收治非黄疸患儿59例,男28例,女31例,年龄26 d～200 d,平均年龄119 d,采血测血清胆红素同时测其皮肤胆红素.其中行Kasai手术胆道闭锁患儿23例,男8例,女15例,年龄36d～127d,平均年龄63d,测其住院期间每日皮肤胆红素并以其术后3个月血清总胆红素20μmol/L为界,将其分为黄疸是否消退两组,对比观察两组患儿住院期间皮肤胆红素及其下降水平.结果 皮肤胆红素(x)与血清总胆红素(y)呈线性回归关系,其回归方程为:y=0.945x-46.273(P＜0.05).正常儿童的皮肤胆红素95%参考值范围为33.14～96.14μmol/L.黄疸消退患儿术后11 d、12 d皮肤胆红素水平(159 μmol/L和151μmol/L)显著低于黄疸未消退患儿(205 μmol/L和210 μmol/L),差异有统计学意义(P＜0.05).黄疸消退患儿术后平均每天皮肤胆红素下降较快(5.04 μmol/L vs 2.33 μmol/L,P＜0.05).结论 测定皮肤胆红素是一种安全可靠的方法,可以较早反映胆道闭锁患儿术后黄疸消退情况.

Abstract：

Objective To study the relationship between the post-op transcutaneous bilirubin changes after Surgery and the prognosis in children with biliary atresia. Methods Between July 2009to December 2009,52 children( 19 males and 33 female, age: 36 d～304 d, the mean age 83d, including 5cholestasis and 47 biliary atresia)with jaundice and 59 non-jaundiced children's (28 males and 31 females,aged 26 d～200 d and the mean age 119 d) were recruited for the study. The transcutaneous bilirubin and total serum bilirubin of children with jaundice and non-jaundice were measured at the same time. Twenty-three children with biliary atresia (8 males and 15 females, aged 36 d～ 127 d and the mean age 63 d) underwent Kasai operation. The children were divided into good or poor prognosis groups according to the serum bilirubin levels of 20 μmol/L three months after operation. Measurements were compared between the two groups during hospital stay. Results Linear regression oftranscutaneous bilirubin (x) correlated with that of serum bilirubin (y) (y = 0. 945x - 46. 273, P＜0. 05). The 95% confidence interval of transcutaneous bilirubin in normal children was 33. 14～96. 14μmol/L. The transcutaneous bilirubin of children with good prognosis was significantly lower than that of children with poor prognosis on postoperative day 11 ( 159 μmol/L vs 205 μmol/L,P＜0. 05) and 12(151 μmol/L vs 210μmol/L,P＜0. 05). Postoperative average daily decline of transcutaneous bilirubin in children with good prognosis was faster (5. 04 μmol/L vs 2. 33 μmol/L, P＜0. 05). Conclusions Transcutaneous bilirubin measurement is a safe and reliable method of monitoring the decline of jaundice of children with biliary atresia.     

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.     

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.