The immune response in iron-deficient young children: Effect of iron supplementation on cell-mediated immunity

The effects of iron deficiency on immunity remain controversial. This study was designed to assess the impact of iron supplementation on the immune status, in 81 children aged 6 months–3 years, at high risk for iron deficiency, using a longitudinal double blind randomised and placebo-controlled study. Lymphocytes of iron-deficient children produced less interleukin-2 in vitro. Iron supplementation for 2 months increased mean corpuscular volume, serum ferritin and serum transferrin, but had no effect on the parameters of T-cell mediated immunity. The lower interleukin-2 levels in iron-deficient suggest that cell-mediated immunity may be impaired in iron deficiency.This work was supported by a grant from the Ministry of Research and Technology (Aliment 2002, 90G0268), and by a grant from the Guigoz Corporation     

Effect of non-human neutral and acidic oligosaccharides on allergic and infectious diseases in preterm infants

Short-term supplementation of non-human neutral and acidic oligosaccharides during the first postnatal weeks may enhance the maturation of the immune response in preterm infants and may lead to less allergic and infectious diseases during the first year of life. In a randomized controlled trial, 113 preterm infants (gestational age <32 weeks and/or birth weight <1500 g) were allocated to receive enteral neutral and acidic oligosaccharide supplementation or placebo between days 3 and 30 of life. The median age at follow-up was not different in both groups: 12 months corrected age (interquartile range [IQR], 11–15) in the prebiotic mixture group and 12 months corrected age in the placebo group (IQR, 10–19), respectively. In addition, baseline patient, maternal, and environmental characteristics were not different between the prebiotic mixture (n?=?48) and placebo (n?=?46) group. Incidence of allergic and infectious diseases was assessed by validated questionnaires. In total, 94/98 (96 %) of the eligible, surviving infants participated in this follow-up study. The incidence of atopic dermatitis (odds ratio [OR], 0.80; 95 % confidence interval [CI], 0.24–2.67), bronchial hyper-reactivity (OR, 1.04; 95 % CI, 0.38–2.87) and infections of the upper respiratory (OR, 0.95; 95 % CI, 0.37–2.44), lower respiratory (OR, 1.03; 95 % CI, 0.37–2.88), and gastrointestinal (OR, 1.77; 95 % CI, 0.55–5.73) tract was not different between the groups. Adjustment for potential confounding factors did not change the results of the primary analysis. Conclusion: Short-term enteral supplementation of non-human neutral and acidic oligosaccharides during the neonatal period in preterm infants does not decrease the incidence of allergic and infectious diseases during the first year of life.     

单纯性肥胖儿童T细胞免疫功能及其影响因素分析

目的探讨单纯性肥胖症儿童的T细胞免疫功能及可能的影响因素。方法对符合诊断标准的45例单纯性肥胖症儿童测定其腹围、身高、体重,计算体块指数(BMI)。运用流式细胞仪测定其T细胞亚群,同时测定空腹血糖、血脂、胰岛素及微量元素,并与20例正常儿童相比较。结果肥胖组的CD3+、CD4+、CD4+/CD8+、NK细胞的比例(64.56%±7.04%,31.31%±5.33%,1.16%±0.29%,13.40%±4.01%)明显低于正常儿童(68.35%±5.25%,35.85%±3.41%,1.44%±0.21%,15.80%±1.64%,P均<0.05)。且CD3+、CD4+、CD4+/CD8+、血甘油三酯、血胆固醇、胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HBCI)与BMI密切相关(r=-0.556、-0.378、-0.674、0.622、0.512、-0.428、0.785,P均<0.01)。经多因素回归分析,细胞免疫功能(CD4+/CD8+)与腹围、肥胖BMI、血脂及胰岛素的抵抗密切相关。结论单纯性肥胖症儿童存在T细胞免疫功能受损和血微量元素的紊乱。免疫功能受损与肥胖BMI、血脂及胰岛素的抵抗有关。     

144例手足口病患儿细胞和体液免疫变化及意义

目的探讨轻症和重、危重症手足口病(HFMD)患儿细胞免疫及体液免疫改变与临床表现及预后的关系。方法将144例HFMD患儿分为轻症和重、危重症2组,于入院2 h内行血清体液免疫、细胞免疫检测,同期取10例择期手术儿童做正常对照,比较各组患儿体液免疫(血清免疫球蛋白IgA、IgG、IgM)及细胞免疫(T细胞亚群)水平的差异。结果轻症组和重、危重症组HFMD患儿体液免疫异常,两组HFMD患儿体液免疫与正常对照组比较,差异有统计学意义(P<0.05)。轻症组和重、危重症组HFMD患儿细胞免疫均存在异常,差异均有统计学意义(P<0.05)。结论 HFMD患儿有在细胞免疫和体液免疫变化,与临床轻症和重、危重症经过相关。     

A randomized, single-blind and crossover study of an amino acid-based milk formula in treating young children with atopic dermatitis

Cow's milk and soy protein allergies are commonly associated with atopic dermatitis (AD) in young children. Amino acid (AA)-based elemental milk formula may improve AD control in these patients. This study investigates the efficacy of AA-based formula in treating young AD patients irrespective of their food allergy status. AD patients younger than 3 yr old were eligible. Sensitization to food allergens was ascertained by skin prick tests and allergen-specific immunoglobulin E (IgE) assay. Patients were then randomly allocated to take either active treatment or pre-existing formulae (placebo) for 6 wk. They were allowed a 6-wk washout period before crossed over to the other intervention for another 6 wk. Fifteen AD patients, with median (interquartile range, IQR) age of 1.4 (0.6-2.6) yr, were recruited. Their median (IQR) SCORAD score was 23.9 (10.5-29.7). Seven of them were sensitized to cow's milk or soybean. Among 11 patients who completed the study, the median changes for all scores and urinary eosinophil protein X (EPX) concentration were not statistically significant. There was also no evidence of carry-over effects for SCORAD and its various components and global health score, except for urinary EPX concentration (p = 0.05). Our results do not support the use of AA-based elemental milk formula in treating young children with AD irrespective of their food allergy status.     

强化乳铁蛋白配方奶粉对人乳喂养婴儿生长发育和铁代谢影响的前瞻性多中心非随机对照研究

目的 了解添加强化乳铁蛋白(LF)配方奶粉对婴儿生长发育和铁代谢的影响。方法 本研究为前瞻性多中心非随机对照试验,生后以人乳喂养的4~6月龄健康足月儿自愿添加配方奶粉者纳入本研究,按门诊顺序分别纳入强化组(LF 38 mg·100 g-1 ,铁元素4 mg·100 g-1)和对照组(LF 0,铁元素4.2 mg·100 g-1,其余成分与强化组相同)。两组干预时间均为3个月。两组婴儿在干预前后分别测定身长、体重、头围、Hb、血清铁蛋白(SF)、血清转铁蛋白受体(sTfR);同时计算TFR-F指数、机体总铁含量(TBIC)、年龄别身高Z评分(HAZ)、年龄别体重Z评分(WAZ)、身高别体重Z评分(WHZ),比较上述指标的干预前后和组间差异。结果 213名婴儿完成了研究,强化组115名,对照组98名。强化组和对照组婴儿人均日摄入配方奶粉量(94.3±9.8) vs (88.2±8.7) g, P>0.05;人均日铁剂摄入量(3.8±0.4) vs (3.7±0.6) mg, P>0.05。强化组人均日LF摄入量为(35.8±3.7) mg。强化组与对照组干预后各指标改变值比较,体重：(2 213±82) vs (2 033±77) g, WAZ: (0.82±0.22) vs (-0.05±0.01), WHZ: (0.74±0.32) vs (0.20±0.06), Hb: (13.9±4.1) vs (7.2±1.8) g·L-1, SF: (1.37±0.08) vs (0.55±0.04) μg·L-1, TFR-F指数：(0.86±0.11) vs (0.39±0.05),TBIC: (19.4±8.8) vs (9.1±3.4) mg·kg-1, P均<0.05。同时干预后强化组贫血、铁缺乏和缺铁性贫血检出率均显著低于对照组,贫血： 4.1% vs 7.5%,铁缺乏：13.9% vs 24.4%,缺铁性贫血：1.7% vs 8.2%,P均<0.05。结论 添加强化LF配方奶粉干预可以显著改善人乳喂养婴儿生长发育以及铁营养状况     

长期特异性免疫治疗对螨过敏儿童血清IgG4的影响

目的探讨长期特异性免疫治疗对螨过敏儿童血清IgG4的影响。方法对60例过敏性哮喘和(或)过敏性鼻炎的患儿,予屋尘螨特异性过敏原免疫治疗,在治疗前、治疗16周、治疗1年和治疗3年时分别进行血清IgG4检测。结果随着治疗的进行,螨特异性IgG4显著增高(F=83.91,P<0.001),各时间段差异均有统计学意义(P均<0.01),并且以治疗剂量递增过程患儿血中螨特异性IgG4含量增长最快,在三年治疗结束时血清IgG4值达到最高。结论螨特异性过敏原免疫治疗对患儿体内免疫状态有明显的调节作用,有利于改善螨过敏患儿的症状和体征。     

高能量密度配方奶粉对紫绀型先天性心脏病患儿术后生长追赶的影响：前瞻性随机对照研究

目的 探讨高能量密度配方奶粉对紫绀型先天性心脏病（CHD）患儿术后生长追赶的影响。方法 前瞻性纳入2017年1~12月行外科手术的紫绀型CHD婴儿100例,随机分配至高能量组（术后给予高能量密度配方奶粉）和常规组（术后给予普通配方奶粉）,每组50例,随访观察6个月。观察指标包括术前、术后脱机拔管时、术后1个月、术后3个月、术后6个月的身高、体重、前白蛋白、N末端B型利钠肽原;计算年龄别身高Z评分（HAZ）、年龄别体重Z评分（WAZ）和身高别体重Z评分（WHZ）;同时记录两组不良反应。结果 术前高能量组和常规组分别有25例（50%）和21例（42%）营养不良,两组营养不良率差异无统计学意义（P > 0.05）。两组患儿术后6个月营养状况均有改善（P < 0.05）。术后6个月高能量组营养不良率低于常规组（18% vs 36%,P < 0.05）;高能量组WAZ < -2的比例低于常规组（P < 0.05）;高能量组营养不良患儿HAZ、WAZ、WHZ均高于常规组（P < 0.05）。两组患儿住院期间均未出现胃肠道不耐受。结论 高能量密度配方奶粉较普通配方奶粉更有助于紫绀型CHD患儿术后生长追赶。     

Acute osteomyelitis and septic arthritis in children: a spectrum of disease

A spectrum of acute osteomyelitis and septic arthritis seen in children was studied, identifying four major groups, each with a different clinical presentation and different expected prognosis: (1) the usual group of osteomyelitis with a 10% incidence of poor results; (2) neonatal osteomyelitis (10% of osteomyelitis) with 25% poor results; (3) a group of severely ill patients with disseminated staphylococcal disease (10% of osteomyelitis) with 13% mortality and 38% poor results; and (4) the usual group of septic arthritis, with 5% poor results. Almost all cases of osteomyelitis were due to Staphylococcus aureus except in the neonatal group, where 28% were due to -haemolytic streptococci. Surgical drainage was performed in 91% of the usual osteomyelitis cases, in all with disseminated staphylococcal disease, and in 88% of babies with neonatal osteomyelitis, i.e. all the cases involving a joint. Cloxacillin was the drug of choice in osteomyelitis. In septic arthritis Staph. aureus was cultured in 29%, Haemophilus influenzae in 18%, streptococcus in 12%, pneumococcus in 6%, and no growth in 33%. Open arthrotomy was performed in all cases. Cloxacillin was used for cases infected with Staph. aureus, ampicillin for H. influenzae, and penicillin for streptococcal and pneumococcal infections. Offprint requests to: EB Hoffman     

Characteristics of the clinical course of the post-vaccination period and the development of anti-measles immunity in children with allergic diseases

During vaccination of children suffering from allergic diseases with live measles vaccine, some characteristics of the clinical course of the postvaccinal period and specific immunity formation were defined. It has been shown that an individual approach to the immunization of the given children's group is very advantageous, since such a policy favours the lowering of the incidence of odd postvaccinal reactions and allergic complications as well as the output of measles antibodies.     

The effect of social disadvantage on motor development in young children: a comparative study

BACKGROUND: Empirical research suggests that social disadvantage has a negative effect on the development of language, and related cognitive skills such as reading. There is, however, no corresponding body of research on the impact of social disadvantage on motor development. The primary purpose of this study was to investigate the impact of social disadvantage on motor development in young children. In addition, we explored a possible link between an early neuromotor indicator and attainments in language, and reading. METHODS: The Northern Ireland Multiple Deprivation Measure was used to identify two contrasting districts based on a composite measure of social disadvantage. We investigated the effect of social disadvantage on the motor attainments of a sample of 239 children aged 4-5 years, and 276 children aged 7-8 years attending mainstream schools in each district using a standardised motor assessment battery, and a motor neurodevelopmental measure. We used standardised receptive language and reading assessments to evaluate possible associations between motor and language/reading attainments. RESULTS: There was a significant negative effect of social disadvantage on motor skills, for both age groups, and for both males and females. A similar negative effect of social disadvantage on attainments in language, and reading was also found. Children from areas of social disadvantage had significant deficits in motor and receptive language attainments relative to their more advantaged peers. In addition, we revealed a significant predictive relationship between a neurodevelopmental measure of early motor development and reading attainment. CONCLUSIONS: Children growing up in socially disadvantaged areas may be at particular risk of motor, including neurodevelopmental, delay, as well as language and reading difficulties. The determinants of motor and neuromotor deficits in children from disadvantaged backgrounds should be explored, and the relationship between early neuromotor development and language/reading development requires further investigation.     

Joint attention and symbolic play in young children with autism: a randomized controlled intervention study

BACKGROUND: Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism. These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts (see Kasari, Freeman, & Paparella, 2001). In this study, we examine the efficacy of targeted interventions of joint attention and symbolic play. METHODS: Participants were 58 children with autism aged 3 and 4 years (46 boys). Children were randomized to a joint attention intervention, a symbolic play intervention, or control group. Interventions were conducted 30 minutes daily for 5-6 weeks. Both structured assessments of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors. RESULTS: Results indicate that both intervention groups improved significantly over the control group on certain behaviors. Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction. The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers. CONCLUSIONS: This randomized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism. Future studies need to examine the long-term effects of these early interventions on children's development.     

Efficacy and safety of a new apple-flavoured oral rehydration solution in children with acute gastroenteritis: a double-blind randomized controlled trial

Aim: To assess the efficacy and safety of a new oral rehydration solution (ORS) with improved flavour in the management of children with acute gastroenteritis (AGE). Methods: Children 4 to 48 months of age with AGE (≥3 loose or watery stools per day for >1 but <5 days) with mild‐to‐moderate dehydration (3% to 9% loss of body weight) according to the World Health Organization criteria randomly received regular hypotonic ORS (Na 60 mmol/L, glucose 78 mmol/L) or the same hypotonic ORS with an apple taste. Results: Of the 147 children randomized, 130 (88.4%) were available for intention‐to‐treat analysis. The proportion of children with the resolution of signs of dehydration in the experimental group compared with the control group was similar at 24 h (49/63 vs. 57/67, respectively, p = 0.28). There were also no significant differences in adequate weight gain (p = 0.48) and urine production at 24 h (p = 0.95) between groups. There were no differences between groups in any of the secondary outcome measures, including ORS intake. No adverse events were observed in the study groups. Conclusions: In an outpatient setting, there was no difference in efficacy between the study products. Both ORSs were equally effective and may be used interchangeably.