母乳性黄疸的诊断和治疗

目的探讨母乳性黄疸的诊断和治疗.方法 1.228例住院期间均停母乳改配方奶;2.每天监测血清总胆红素(TB);3.TB≥220.6μmol/L者蓝光治疗;4.对黄疸消退较慢或出院时黄疸未完全消退者进行随访.结果 TB>255μmo1/L者108例,其中>340 μmol/L者36例;停母乳后胆红素降至原来水平50%的天数为4.0±1.4 d;黄疸完全消退时间为7.0±2.0 d;随访110例中除4例外余病例出院后黄疸逐渐消退.结论诊断母乳性黄疸最可靠的依据是停母乳后未经病因治疗黄疸完全消退,但黄疸消退的时间有个体差异.     

LED蓝光对早产儿早期黄疸干预的疗效观察

目的 比较LED蓝光与普通蓝光灯照射治疗早产儿黄疸的疗效.方法 以新生儿科收治的胎龄在35～37周的早产儿180例为研究对象,入院后从出生后8h起每2小是时监测早产儿黄疸变化情况,当血清总胆红素≥P95后予以光疗.根据患儿人院顺序分成两组：观察组予以LED蓝光照射,当光疗间隙期血清总胆红素≤P40后停止光疗;对照组予以普通单面荧光蓝光灯管照射,当光疗间隙期血清胆红素≤P40时停止光疗.观察患儿黄疸消退的时间,以及腹泻、皮疹、发热等不良反应情况.结果 观察组黄疸消退时间明显短于对照组,差异有统计学意义（P＜0.01）;观察组皮疹、腹泻及母乳减少等发生率较对照组减少（P＜0.05）.结论 LED蓝光照射治疗早产儿黄疸疗效高于普通荧光蓝光灯,且发热、皮疹、腹泻等不良反应减少.     

新生儿ABO溶血病早期诊断和治疗的意义

目的 探讨新生儿ABO溶血病早期诊断和治疗的效果.方法 选择2001-2010年本院分娩新生儿中的ABO溶血病,密切监测患儿血清胆红素变化,在接近光疗标准时,及早给予光疗为主的综合治疗,监测和记录光疗过程中血清胆红素的动态变化、不良反应及预后.结果 共纳入新生儿ABO溶血病512例(含早产儿78例),开始光疗时血清胆红素(176.1±42.2)μmol/L,患儿光疗后胆红素一般先上升,平均峰值(261.1±37.4) μmol/L,随之逐渐下降,全组按总疗程平均每日胆红素下降(22.1±12.2) μmol/L,平均光疗疗程(3.5±1.1)天.所有患儿全部治愈,无需要换血或发生核黄疸或死亡的病例.结论 新生儿ABO溶血病通过早期诊断和早期光疗可以减少换血并防止核黄疸的发生.     

母乳性黄疸对肾功能的影响及其早期干预

目的探讨母乳性黄疸(BMJ)患儿肾功能变化及早期干预对肾功能的影响。方法测定50例BMJ患儿入院后12 h内血清胆红素和尿β2-徽球蛋白(β2-MG)、α1-MG、清蛋白(Alb)、IgG及出院前尿β2-MG、α1-MG、Alb、IgG,与20例足月新生儿生理性黄疽(对照组)对比。结果BMJ患儿随血清总胆红素升高,尿微量蛋白有升高趋势,血清胆红素205.2-256.5 μmol/ L时尿β2-MG较对照组明显升高(P<0.05);血清胆红素>256.6-342.O μmol/L,β2-MG、α1-MG显著升高(P均<0.01),Alb 较对照组明显升高(P<0.05)。出院前尿β2-MG、α1-MG、Alb恢复正常。结论BMJ可引起暂时肾功能损害,予早期干预治疗后肾功能很快恢复正常。     

洗肠对早产儿黄疸的疗效

目的探讨洗肠干预对早产儿黄疸的疗效。方法对48例黄疸早产儿随机分组,治疗组在常规治疗黄疸的同时应用0.9%温盐水30~40 mL反复洗肠,1次/d,连续3~4 d,监测经皮测胆红素值及光疗时间,观察胎便转为正常的时间及喂养耐受情况。结果1.洗肠组较未洗肠组早产儿的黄疸值明显下降(约34.2μmol/L),所需光疗时间缩短(P<0.05)。2.洗肠组较未洗肠组早产儿胎便排尽时间早,喂养相对顺利。结论洗肠可协助早产儿黄疸尽早消退,减少肠肝循环、减少肠壁对胆红素的重吸收,促进肠道蠕动。     

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.     

经皮测量总胆红素在新生儿高胆红素血症评估中的应用价值

目的探讨经皮测量胆红素浓度对新生儿黄疸检测的准确性和实用性。方法对400例高胆红素血症新生儿同时进行了经皮测量总胆红素和血清总胆红素的检测,分析两者的相关性,并评估体质量、胎龄、生后日龄、相关病因等对新生儿胆红素水平的影响。结果血清总胆红素<257μmol/L时,经皮测量总胆红素与血清总胆红素值的相关系数是0.932,血清总胆红素≥257μmol/L时,相关系数是0.282,两组均呈正相关性,血清总胆红素<257μmol/L组相关性高(P=0.0001),且不受胎龄、体质量、生后日龄及相关病因的影响。结论当胆红素浓度<257μmol/L,经皮测量总胆红素可以替代血清总胆红素;经皮测量总胆红素用于新生儿高胆的筛查,有可推广性及实用性。     

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-     

双歧杆菌活菌制剂治疗新生儿母乳性黄疸的疗效

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。     

脐血胆红素预测新生儿黄疸的意义

目的研究脐带血胆红素水平预测足月健康新生儿后续黄疸程度的价值。方法523例足月健康新生儿,测定脐血胆红素、白蛋白水平,监测每日经皮胆红素值（TCB）。对时龄0—24hTCB≥18;-48hTCB≥21;-72hTCB≥25;〉72h≥25者,送检静脉血血清胆红素值（TSB）,考虑是否需要光疗。将新生儿按脐血胆红素水平分为〈30μmol／L;≥30μmoL／L;≥36μmol／L;≥42μmoL／L,共4组。比较4组新生儿TCB≥25、TSB〉205μmol／L、TSB〉257μmoL／L及需要光疗的发生率。对脐血胆红素水平预告新生儿黄疸进行分析。比较黄疸组新生儿和非黄疸组新生儿临床特征。结果脐血胆红素水平升高,各组新生儿TCB≥25、TSB〉205μmol／L、TSB〉257μmoL／L和需要光疗的发生率增加。脐血胆红素水平用于预测新生儿黄疸发生有统计学意义（P〈0．001）。黄疸组新生儿脐血胆红素值显著高于非黄疸组（t=10．96,P〈0．001）。而脐血清白蛋白值（t=2．38,P〉0．05）、妊娠周数（t=-0．90,P〉0．05）、出生体重（t=0．10,P〉0．05）比较,两组均无统计学差异。结论脐血胆红素水平用于预测足月健康新生儿后续黄疸的程度是一种有效的方法。     

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.