When parents say “more” and health care professionals say “enough”

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers.In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß₂-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.     

When to say no to inhaled nitric oxide in neonates?

Inhaled nitric oxide (iNO) was approved for use in critically ill term and near-term neonates (>34 weeks gestational age) in 1999 for hypoxic respiratory failure (HRF) with evidence of pulmonary hypertension. In 2011 and 2014, the National Institutes of Health and American Academy of Pediatrics respectively recommended against the use of iNO in preterm infants <34 weeks. However, these guidelines were based on trials conducted with varying inclusion criteria and outcomes. Recent guidelines from the American Thoracic Society/American Heart Association, the Pediatric Pulmonary Hypertension Network (PPHNet) and European Pediatric Pulmonary Vascular Disease Network recommend the use of iNO in preterm neonates with HRF with confirmed pulmonary hypertension. This review discusses the available evidence for off-label use of iNO. Preterm infants with prolonged rupture of membranes and pulmonary hypoplasia appear to respond to iNO. Similarly, preterm infants with physiology of pulmonary hypertension with extrapulmonary right-to-left shunts may potentially have an oxygenation response to iNO. An overview of relative and absolute contraindications for iNO use in neonates is provided. Absolute contraindications to iNO use include a ductal dependent congenital heart disease where systemic circulation is supported by a right-to-left ductal shunt, severe left ventricular dysfunction and severe congenital methemoglobinemia. In preterm infants, we do not recommend the routine use of iNO in HRF due to parenchymal lung disease without pulmonary hypertension and prophylactic use to prevent bronchopulmonary dysplasia. Future randomized trials evaluating iNO in preterm infants with pulmonary hypertension and/or pulmonary hypoplasia are warranted. (233/250 words).     

Developmental outcomes following major surgery: What does the literature say?

Relative to the wealth of information in the medical literature regarding developmental outcome for infants who have had cardiac surgery available, few studies specifically detail how those who have undergone major surgery grow and develop. The few published studies tend to be disease specific, making their results difficult to translate to a more general setting. As mortality for most infants who require surgery in infancy continues to decrease, the focus for researchers and clinicians should be on how these children will grow and develop. As parents realise that their infant will survive, this becomes their next major concern. The most common conditions requiring early major surgery have been reviewed in relation to data on infant developmental outcomes.     

“黏”“粘”的用法

黏(nián):黏是指像糨糊或胶水等具有能使一个物体附着在另一个物体上的性质,常作名词性词素。如黏土、黏性(黏性土)、黏     

“黏”、“粘”的用法

黏(nin):黏是指像糨糊或胶水等具有能使一个物体附着在另一个物体上的性质,常作名词性词素。如黏土、黏性(黏性土)、黏米、黏膜、黏液、黏稠、黏度(动力或运动黏度)、黏滞     

“慢性肾小球肾炎”的“免疫抑制”疗法

10年来,激素和某些细胞毒性药物被广泛用于治疗某些被认为是起因于免疫机理的慢性肾疾患。通过早年记录,近年来认识到这些“慢性肾炎”可能的先兆表现为无症状性血尿和蛋白尿,或呈肾病综合征及高血压,也可呈一急性经过而类似急性肾炎。肾功能损害可有     

“电子游戏机”癫痫

1981年Rushton、1986年Ferry首先描述了一种玩电子游戏机诱发的癫痫,称之为“电子游戏机”癫痫(video-game epilepsy,VGE),其特点为:主要见于十几岁的男孩,绝大多数为全身性强直阵挛性发作,脑电图(EEG)显示多种异常,包括闪光惊厥性反应。     

“等张”和“等渗”不可混为一谈

“等张”和“等渗”在临床上常混为一谈,其实,这种看法并非确切,它们二者之间既有联系,又有差别。所谓等张液,是从生理观点来讲,指与红细胞的张力相等。在等张溶液中红细胞既不肿胀,亦不皱缩,而能维持其原来形状不变。所谓等渗液是指与血浆渗透压近似的溶液,是个理化概念。可以设想把某种溶液用一个半透膜与血浆隔开时,倘若半透膜两侧的溶液渗透压相等,这种溶液便是等渗液。     

Die “Grippelunge”

Zusammenfassung Die Grippeerkrankung im Säuglings-, Kleinkindes- und Schulalter führt zu so gleichförmigen und typischen radiologischen Veränderungen, daß hierfür der Name Grippelunge berechtigt erscheint. Die Veränderungen — Schwellung der oberen Hiluspole, verstärkte interstitielle Zeichnung in den Oberfeldern, Überblähung der Unterfelder und oft allgemeine Herzdilatation — variieren in jeder Altersklasse. Auf die erhebliche differentialdiagnostische Bedeutung der Grippelunge wird hingewiesen.