The ActionAid disability programmes: Experiences in early identification and early intervention

The World Health Organisation (WHO) estimates that about 10% of the world’s population has some form of disability, while statistics from different sources show that about 3.8% of India's population has locomotor, visual or communication disabilities or mental retardation. The Disability Division of ActionAid-India supports 38 non-governmental organisations involved in disability programmes in India. This paper touches upon the experiences of some of its project partners in the areas of early identification and early intervention.     

Behavioral assessment of language brain processing in the first year of life

An up-to-date review of the behavioral assessments of language development in the first year of life is reported. After recalling the anatomical bases of the early development of the auditory system, the different stages of language development during the first year of life are considered: discrimination, transition and perception. The different kinds of behavioral assessment during the course of the first year are then described by stressing their indications and limitations.     

Early childhood development: One developmental paediatrician's story

The present article is a discussion of the lessons that a paediatrician has learned from the evidence on early childhood development. The information that has been gathered is being used for advocacy for the creation of more efficient and higher quality programming that is accessible to all children. It is believed that by providing access to centralized and consolidated programming within neighbourhoods, more individuals will be reached earlier and more effectively.     

北京方庄社区婴幼儿早期教育效果初步观察

目的　探讨城市社区婴幼儿早期教育的效果。方法　１９９７ 年６ 月至１９９８ 年１ 月在北京方庄社区出生的７９ 名正常新生儿为早期教育组（ 早教组）,１９９７ 年１ 月至５ 月同社区出生的８６ 名健康常规育儿的儿童为对照组。早教组通过指导家长,从新生儿期开始接受包括运动、认知、语言和社会交往能力等方面的早期教育。１ 岁半时两组儿童接受婴幼儿智力测验（ＣＤＣＣ）。结果　在体格发育和文化社会因素方面,两组无显著差别。而智力测定结果显示,早教组的智能发育指数（ＭＤＩ） 和心理运动发育指数（ＰＤＩ）分别比对照组高１９ ．６ 分和１０ ．１ 分,两组差别非常显著,且早教组中ＭＤＩ≥１３０ 分（非常优秀） 者３１名（３９ ．２％ ）而对照组中只有５ 名（５ ．８ ％） 。结论　城市社区开展婴幼儿早期教育是有效和可行的。     

Children in poverty and the use of early development instrument mapping to improve their worlds

Population data can be used to help physicians better understand child poverty in relation to families, geography and access to community resources. The early development instrument (EDI) is a population m easure of kindergarten children’s early cognitive, social, emotional, language and physical development. Researchers and communities in British Columbia have used EDI and socioeconomic data to examine early child development trends across neighbourhoods, school districts and provincial geographies. It highlights that while vulnerabilities at school entry are more prevalent in poorer communities, they are present in all communities. Mapping EDI data and other information help to identify communities that are more vulnerable and ones that seem to be resilient. Physicians and community partners can identify local needs and interventions that can support parents and communities in promoting healthy development of children before their entry to the first grade.     

Early bougienage for relief of stricture formation following caustic esophageal burns

Accidental ingestion of corrosive substances remains a major health hazard in children. Most infants and children who ingest caustic substances present with very few symptoms or signs. Approximately 40% of caustic substance ingestions result in esophageal injury, but the optimal management of caustic esophageal burns remains controversial, with different treatment modalities in use. The aim of this study was to compare the results of prophylactic early bougienage with dilatation that was begun after stricture development. We retrospectively analyzed the management of 125 pediatric cases of corrosive substance ingestion. For children seen primarily at our institution, initial management consisted of prompt endoscopy. Of 125 children admitted with a history of caustic substance ingestion, 54 were found to have esophageal burns, and 32 underwent treatment for stricture formation. Patients with severe injury were divided into two groups: In group A, consisting of 20 patients, prophylactic early dilatation had been done. In the eight patients in group B, dilatation had begun after stricture development. The strictures had resolved after 6 months of dilatation in patients initially treated with prophylactic early bougienage, whereas in patients in whom dilatation began after stricture development, stricture resolution did not occur for more than a year. The goal of initial treatment is to avoid stricture formation. Although early dilatations do not eliminate stricture formation completely, the stricture can resolve more easily with early bougienage.     

小儿阑尾炎早期诊断的临床研究——30年10256例小儿阑尾炎经验总结

目的总结连续30年10256例小儿阑尾炎的诊断治疗经验,提出早期诊断的临床标准,为早期手术治疗提供依据,以降低病死率,减少并发症。方法统计1980年至2009年本院收治的小儿阑尾炎病例10256例,使用32项临床指标进行对比研究,提出核心诊断指标指导临床早期诊治。在新的理念指导下,分析前10年及后20年,阑尾炎病例在腹膜炎的发生率以及阑尾炎病理类型上的变化,探讨早期诊断标准在提高阑尾炎诊治水平方面的实际意义。结果10256例阑尾炎病例中,死亡1例,死亡率小于1／10000。8241例阑尾炎病例的有效统计中,持续性右下腹疼痛或伴哭吵不安症状的患儿8131例（98．67％）,右下腹固定压痛8103例（98．33％）。实施早期诊断标准后,阑尾炎穿孔形成腹膜炎的发生率从早期的43．82％降低为29．88％。10256例中,595例为婴幼儿阑尾炎,466例并发阑尾周围脓肿。结论持续性右下腹疼痛及右下腹固定压痛是临床诊断小儿阑尾炎的核心指标,既是必要的,也是充分的。小儿阑尾炎的临床早期诊断是提高治愈率,减少并发症的关键。     

感染的初步判定:临床表现

感染指由任何病原体引起的疑似或确诊的全身或局部感染,是儿童常见疾病之一,大部分儿童为轻度感染,预后良好,但少部分感染进展迅速,可引起多脏器功能障碍,甚至导致死亡,是儿童死亡的主要原因之一。发热是感染常见临床表现之一,发热严重程度预测疾病严重性的有效性目前仍存在争议,相比于发热严重程度,患儿感染部位临床表现能更好地预测疾病严重性。了解感染的临床表现是早期识别、积极干预的关键,文章拟对感染的常见临床表现做一介绍。     

脓毒症早期诊断的生物标志物研究进展

脓毒症是由感染引起的全身炎症反应综合征.脓毒症可加重发展为严重脓毒症、脓毒性休克、多器官功能障碍.由于抗菌药物的使用、液体复苏以及生命支持的发展,脓毒症的治疗水平已较过去有了明显的提高,但其病死率仍居高不下.对脓毒症早期、迅速、准确作出诊断是降低脓毒症高病死率的一项关键因素.近年来,医学界发现一些生物标志物与脓毒症早期诊断有密切关系,且有助于临床治疗.这些与脓毒症早期诊断相关的生物学标志物包括Presepsin(sCD14-亚型)、可溶性髓样细胞触发受体-1、中性粒细胞CD64、可溶性CD163、微小RNA和肽素等.这些生物标志物的单独或联合检测为早期确诊脓毒症带来新的机遇,且有望拓宽脓毒症的治疗思路.该文就上述新兴的脓毒症早期诊断的生物标志物作一综述.     

生命早期抗生素使用与儿童哮喘:因果关系还是混杂效应?

儿童哮喘的发病率逐年上升.基于卫生假说,抗生素使用可能减少了微生物暴露,从而增加了过敏性疾病发生的风险.近十年来,就早期抗生素暴露与儿童哮喘的关系进行的大量的流行病学调查的结果并不一致.大多数回顾性研究发现正相关联系,但前瞻性研究未发现联系或联系强度较弱.逆向因果和指示混淆可部分解释两者的关系,但也难以否定因果关系的存在.     

Implementing the Bedside Paediatric Early Warning System in a community hospital: A prospective observational study

BACKGROUND:

Late transfer of children with critical illness from community hospitals undermines the advantages of community-based care. It was hypothesized that implementation of the Bedside Paediatric Early Warning System (Bedside PEWS) would reduce late transfers.

METHODS:

A prospective before-and-after study was performed in a community hospital 22-bed inpatient paediatric ward. The primary outcome, significant clinical deterioration, was a composite measure of circulatory and respiratory support before transfer. Secondary outcomes were stat calls and resuscitation team calls, paediatrician workload and perceptions of frontline staff.

RESULTS:

Care was evaluated for 842 patient-days before and 2350 patient-days after implementation. The median inpatient census was 13. Implementation of the Bedside PEWS was associated with fewer stat calls to paediatricians (22.6 versus 5.1 per 1000 patient-days; P<0.0001), fewer significant clinical deterioration events (2.4 versus 0.43 per 1000 patient-days; P=0.013), reduced apprehension when calling the physician and no change in paediatrician workload.

DISCUSSION:

Implementation of the Bedside PEWS is feasible and safe, and may improve clinical outcomes.     

Evaluation of early stimulation programs for enhancing brain development

The term 'early intervention' designates educational and neuroprotection strategies aimed at enhancing brain development. Early educational strategies seek to take advantage of cerebral plasticity. Neuroprotection, a term initially used to characterize substances capable of preventing cell death, now encompasses all interventions that promote normal development and prevent disabilities, including organisational, therapeutic and environment-modifying measures, such as early stimulation programs. Early stimulation programs were first devised in the United States for vulnerable children in low-income families; positive effects were recorded regarding school failure rates and social problems. Programs have also been implemented in several countries for premature infants and low-birth-weight infants, who are at high risk for neurodevelopmental abnormalities. The programs target the child, the parents or both. The best evaluated programs are the NIDCAP (Newborn Individualized Developmental Care and Assessment Program) in Sweden for babies<1500 g in neonatal intensive care units and the longitudinal multisite program IHDP (Infant Health and Development Program) created in the United States for infants<37 weeks or <2500 g. CONCLUSION: Although the NIDCAP and the IHDP targeted different populations, they produced similar effects in several regards: efficacy was greatest with programs involving both the parents and the child; long-term stimulation improved cognitive outcomes and child-parent interactions; cognition showed greater improvements than motor skills and larger benefits were obtained in families that combined several risk factors including low education attainment by the mothers.     

两种肠道外营养方法在早产儿中的应用研究

目的 探讨早产儿应用两种肠道外营养(parenteral nutrition,PN)方法的疗效.方法 选择不能耐受完全胃肠道喂养的早产儿42例,随机分为观察组(22例)和对照组(20例).观察组患儿生后24 h内应用氨基酸,自1.0/g(kg·d)开始,每日递增1.0g/(kg·d),直至3.0/g(kg·d);48 h内应用脂肪乳,剂量及添加方法同氨基酸,生后第5天达全静脉营养.对照组患儿生后48 h应用氨基酸,自0.5g/(kg·d)开始,每日递增0.5g/(kg·d),直至3.0g/(kg·d);72 h后应用脂肪乳,剂量及添加方法同氨基酸,生后8～9 d达全静脉营养.两组患儿均监测营养效果,出生72 h内和第10天分别监测血生化指标,观察并发症发生情况.结果 观察组恢复至出生体质量时间、体质量下降幅度、PN时间、过渡到全胃肠道营养时间均较对照组短,差异有统计学意义(P＜0.01).并发症发生情况比较两组差异无统计学意义(x2=0.191,P＞0.05).两组患儿在血糖、总胆红素、尿素氮、二氧化碳结合力、总胆固醇等方面比较差异均无统计学意义(P＞0.05).结论 早产儿可以耐受生后24 h内早期足量的PN.     

Calcium homeostasis in premature infants and treatment of early hypocalcaemia by 1,25-dihydroxycholecalciferol

We studied calcium homeostasis and the serum calcium response to oral 1,25-dihydroxycholecalciferol [1,25 (OH)₂D₃] at a low pharmacological dosage of 0.1 g/kg daily in 14 early hypocalcaemic asymptomatic neonates. Seven hypocalcaemic neonates were not treated. In hypocalcaemic neonates serum PTH levels were normal, the urinary C-AMP response after PTH stimulation was poor and plasma 1,25 (OH)₂D₃ was low. Treatment with 1,25(OH)₂D₃ resulted in a rapid increase of serum calcium. The increase was more rapid in neonates treated with 1,25(OH)₂D₃ than in untreated subjects. A similar result was obtained in one of a pair of identical twins. These results suggest that a low dose of 1,25(OH)₂D₃ is effective in treating neonatal hypocalcaemia. However, the response was delayed for 48 h. The reason for this delay is not clear.Abbreviations 1,25(OH)₂D₃ 1,25-dihydroxycholecalciferol - RDS respiratory distress syndrome - PTH parathyroid hormone - E-H test Ellsworth-Howard test     

早发型发作性睡病患儿的非典型症状临床研究

早发型发作性睡病是一种病因不明的儿童慢性神经系统疾病,患儿可能以非典型临床症状为主要表现,是近年来国内重点关注的小儿神经科疾病之一.该文就早发型发作性睡病患儿的非典型临床症状、发病机制、诊断及治疗的研究进展作一综述.     

Parent ratings of executive functioning in children adopted from psychosocially depriving institutions

Background: Previous studies have found that post‐institutionalized (PI) children are particularly susceptible to attention problems and perform poorly on executive functioning (EF) lab tasks. Methods: Parent ratings of EF were examined in 288 school‐age and 130 preschool‐age children adopted from psychosocially depriving Russian institutions that provided adequate physical resources but not one‐on‐one interactions with a consistent set of responsive caregivers. Results: Results revealed a step‐like association between age at adoption and EF deficits; school‐age children adopted after 18 months of age had greater EF difficulties than younger‐adopted children and the never‐institutionalized normative sample. The onset of adolescence was associated with a greater increase in EF deficits for children adopted after 18 months than for younger‐adopted children. Preschool‐age children were not found to have greater EF difficulties than the normative sample. Conclusions: These findings suggest that prolonged early psychosocial deprivation may increase children’s risk of EF deficits and that the developmental stresses of adolescence may be particularly challenging for older‐adopted PI children.     

Early childhood growth and development in rural Guatemala

BACKGROUND: Small size at birth and in early childhood has been associated with impaired neurodevelopment in studies from developing countries, but few have examined associations with growth. AIMS: The objective of this study was to assess the relationship between growth and neurodevelopment during early childhood (birth-36 months). DESIGN: Multivariate regression models were used to analyze the data collected in the course of a study of pregnancy outcomes and early childhood growth and development carried out in rural Guatemala in 1991-1999. Motor and mental development scores were based on the Psychomotor and Mental Development Indices, respectively, derived from the administration of an adapted version of the Bayley Scales of Infant Development (Second Edition, 1993) at 6, 24 and 36 months. Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and head circumference-for-age (HCZ) were used as indicators of attained size; changes in these Z-scores over time represent growth. RESULTS: Birth size was significantly associated with child development at 6 and 24 months. Gains in length and weight during the first 24 months were positively associated with child development, whereas growth from 24 to 36 months age was not associated with child development at 36 months. Motor development was more strongly and consistently related to child growth than was mental development. Head circumference gain after 6 months was not a significant predictor of child development at 24 and 36 months. CONCLUSIONS: Small size at birth and poor physical growth during the first 24 months are related to neurodevelopmental delays. More evidence from developing countries will help explain the underlying mechanisms and identify appropriate interventions to prevent neurodevelopmental delay in early childhood.