临床营养风险筛查在儿科中的应用

营养不良是社会中普遍存在的问题,尤其是在发展中国家。住院儿童的营养不良则更为普遍,且往往会伴随严重的后果,例如会使患儿的感染率和病死率增加,使其住院时间延长,从而导致额外的医疗费用。随着营养筛查工具的发展,其在成人的营养问题方面起了越来越大的作用。近几年某些营养筛查工具渐渐在儿科展开应用,但是依然缺乏公认的营养风险筛查工具。该文的目的为比较几种在儿科中常用的营养风险筛查工具在临床中的应用及存在的不足。     

Relation of childhood malnutrition to parental education and mothers’ nutrition related KAP

Severely malnourished children (26), weight for age 55.27±3.17, were identified in a colony of predominantly Muslim urban slum dwellers of low economic status. An equal number of normally nourished children matched for age, sex and per capita income were identified. A strong relation was found between nutritional status of the subjects and educational level of their mothers (P<0.025). Father's education was unrelated to childrens' nutritional status. A thirty seven point questionnaire was administered to the mothers to record their nutritional knowledge, attitudes and practices (KAP). Analysis revealed that better KAP in relation to 16 of these 37 questions was not associated with better nutritional status. Seven questions were found to have only a weak association. The remaining 14 questions were identified as important for a nutrition education programme. Comparison of nutritional KAP score based on these 14 questions in case of mothers of normal and severely malnourished children revealed a significantly higher score in the former. Questions related to growth monitoring and breast feeding were not found to be important. No significant association was found between mothers' KAP and educational level. It is concluded that (i) Maternal education and KAP are significantly and independently associated with childrens' nutritional status. (ii) The content areas of knowledge, attitudes and practices significantly associated with nutritional status pertain to nutritional requirements of children, nutritional value of foods, immunisation, hygiene, oral rehydration and diarrhea.     

营养不良儿童肠道菌群状况研究进展

儿童营养不良是威胁全球儿童健康的重要疾病。肠道菌群状况与食物的消化、吸收以及肠道功能有着密切的关系,目前研究认为肠道菌群的改变在很大程度上影响着营养不良的发生发展。该文从肠道菌群与机体营养状况的相互关系、肠道菌群在不同类型营养不良中的变化及其对营养不良治疗及预防的影响等方面,将最近研究进展综述如下,从微生态角度深入对儿童营养不良的认识。     

ICU患儿营养风险筛查

ICU患儿的病情较重,进展迅速,因此恰当的营养支持对于ICU患儿病情的恢复是有利的.ICU患儿需要根据其本身的营养状况以及潜在的营养风险来制定恰当的营养支持计划.营养风险筛查不仅可以评估患儿的营养状况,更能预测其潜在的营养风险,从而指导患儿的营养支持治疗计划的制定,最终改善预后.寻找出适用于ICU患儿的全面、简便、快捷、易行的营养风险筛查工具,实施恰当的营养风险筛查对ICU患儿的生长发育以及疾病的预后均具有重要意义.     

恶性肿瘤住院患儿和幸存者的体成分分析研究

目的 通过生物电阻抗法了解肿瘤住院患儿和幸存者的体成分变化.方法 选取2019年3月—2020年3月在首都医科大学附属北京儿童医院住院治疗和停止治疗定期复查的134例肿瘤患儿(包括治疗组74例,幸存组60例)及健康对照组.用问卷调查了解三组人群的活动及屏幕使用时间等情况;运用生物电阻抗法行人体成分检测和营养评估.结果 ...     

Campomelic Syndrome Associated with Potter's Syndrome and Car diosplenic Syndrome

ABSTRACT Campomelic syndrome is a heterogeneous group of disorders characterized by short-limbed dwarfism with congenital bowing or bending of the long bones particularly in the lower limbs and is frequently associated with a variety of non-skeletal manifestations. Two distinct types are (1) long-limbed campomelic dysplasia with bent bones of normal length and width: (2) short-limbed campomelic dysplasia in which the bent bones are short and wide. We reported an autopsy case of this syndrome.
This male baby with gestational age of 32 weeks was born to a mother with placenta previa, showing abdominal distention and short-limbed appearance. Postmortem examination revealed bilaterally enlarged Potter type 1 polycystic kidneys, a pancreatic cyst, and two spleens in the abdominal cavity. Both lungs were hypoplastic and the heart exhibited multiple congenital anomalies such as double outlet right ventricle, pulmonary artery hy-poplasia, mitral atresia, absence of ductus arteriosus, and inferior vena cava draining into the left atrium. Characteristically both femur bones were curved at proximal two-thirds with slightly shortened lengths. Both humeri also showed bending of distal one-third. Other chondro-osseous abnormalities such as small epiglottis, narrow thorax, dolichoce-phaly, and bilateral equinovarus deformity were noted. These findings were compatible with campomelic dysplasia of long-limbed type accompanying unusual sets of non-skeletal manifestations of Potter's syndrome and cardiosplenic syndrome. Key words: campomelic syndrome, Potter's syndrome, cardiosplenic syndrome     

婴幼儿短肠综合征的院内营养支持疗效观察

目的探讨肠内肠外营养支持对短肠综合征(SBS)患儿的治疗作用。方法回顾性分析2013年11月至2015年1月在本院进行营养治疗的7例短肠综合征患儿临床资料,观察营养支持对患儿体重增长和血清白蛋白、血红蛋白、尿素氮、胆红素等生化指标的影响。结果 7例患儿中,体重增长满意2例,体重变化不明显4例,体重下降明显1例。营养支持前后患儿生化指标无明显变化。结论及时有效的营养支持,可减少短肠综合征患儿的体重丢失,维持营养相关生化指标的合理水平,改善疾病预后。     

Acute Febrile Neutrophilic Dermatosis (Sweet's Syndrome) in Myelodysplastic Syndrome

This is the first report of the rare association of acute febrile neutrophilic dermatosis (Sweet's syndrome) and myelodysplastic syndrome (MDS) in a child. The skin lesions showed a dramatic response to colchicine.     

Nutritional differences in neurologically impaired children

OBJECTIVES:

To determine whether the recommended nutritional intake of moderately to severely neurologically impaired children is congruent with current growth parameter expectations.

METHODS:

Observational cross-sectional study at a children’s hospice and a tertiary care children’s hospital. Medically stable enterally fed children followed by the palliative care team underwent anthropometric assessment and chart review for diagnosis, intake and medications. Intakes, guidelines and recommendations were compared.

RESULTS:

Intakes were less than recommended. All children were <50th percentile weight-for-age, with many <3rd percentile. Fourteen of 15 were in higher percentiles for absolute and relative body fat.

CONCLUSIONS:

Recommended dietary intakes were not achieved by these children. Despite this, measures of body fat indicate adequate intake. Low weight values may reflect diagnosis-related growth stunting or decreased muscle mass and bone density from immobility. The Centers for Disease Control and Prevention (Georgia, USA) weight-for-age and body mass index are not suitable measures of adequate intake in this group of children.     

肝功能衰竭患儿如何进行营养支持

肝功能衰竭患儿营养障碍原因包括营养摄入、吸收不良和代谢改变等,常导致预后不良。临床上宜根据肝功能衰竭的原因与病情选择合适的营养支持途径,包括胃肠营养、胃肠外营养或混合营养。严重急性肝功能衰竭或合并肝昏迷的患儿尽可能在5~7d内开始胃肠营养,进行个体化的综合营养状况及能量代谢评估,按照代谢需求与代谢能力提供适当的能量和营养素,并及时地调整营养支持措施。     

A Case of Neonatal McCune-Albright Syndrome with Cushing Syndrome and Hyperthyroidism

ABSTRACT. We describe a female newborn infant with McCune-Albright syndrome. In addition to the cutaneous pigmentation, she had apparent manifestations of hyperthyroidism and Cushing syndrome since birth. X-ray examinations showed many scattered lucencies in multiple bones. Endocrinological findings were as follows: serum T4 276 nmol/l; free T4 125 pmol/l; TSH <1 mU/l; serum cortisol >2210 nmol/l; plasma ACTH < 10 pg/ml; urinary free cortisol 865 nmol/day; estradiol 0.36 nmol/l. Regardless of treatment with antithyroid drugs and an inhibitor of 3β-hydroxysteroid dehydrogenase, the patient died of cardiac failure at the age of 4 months. Autopsy findings included a follicle cyst in the right ovary and multinodular hyperplasia in the thyroid and both adrenals. To our knowledge such a severe neonatal form of McCune-Albright syndrome has not been described in the literature.     

Congenital Budd-Chiari Syndrome

Budd-Chiari syndrome, due to thrombotic occlusion of hepatic veins or ostia, is unusual in infants. Review of the literature reveals no documented case symptomatic at birth. We describe a male infant with ascites present at birth. A liver biopsy at 7 weeks of age showed sinusoidal dilatation, but the diagnosis of Budd-Chiari syndrome was made only at autopsy, 4 months later. The cause was not determined although maternal drug abuse was suspected.