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目的利用潮气呼吸法进行小年龄儿童的支气管舒张试验,以确立适合0~6岁儿童支气管舒张试验的评定标准。方法2003-06—2004-03就诊于复旦大学附属儿科医院门诊及病房≤6岁的喘息性支气管炎患儿36例,以同期收治的支气管炎患儿25例作为急性支气管炎组,沙丁胺醇和异丙托溴铵两药联合应用作为支气管舒张药物。用潮气呼吸法分析评价支气管炎患儿与喘息性支气管炎患儿吸入两药前后肺功能的变化,以确立小年龄儿童气道高反应性疾病支气管舒张试验的评定标准。结果适合小年龄喘息性支气管炎患儿的支气管舒张试验的评定标准:(1)吸入支气管舒张剂前后,急性支气管炎组呼吸频率(RR)略有改善,喘息性支气管炎组达峰时间比(tPTEF/tE)、达峰容积比(VPEF/VE)明显改善。(2)两组比较达峰时间比(tPTEF/tE)改善率、达峰容积比(VPEF/VE)改善率差异有统计学意义。(3)以达峰时间比(tPTEF/tE)和达峰容积比(VPEF/VE)任意一个改善率≥15%为阳性标准,灵敏度为72·2%,特异度为80·0%。喘息性支气管炎组支气管舒张试验阳性率为72·2%。结论达峰时间比(tPTEF/tE)改善率或达峰容积比(VPEF/VE)改善率≥15%可以作为小年龄儿童支气管舒张试验的评定标准。     

潮气肺功能测定支气管舒张试验对婴幼儿哮喘的诊断价值

目的对婴幼儿哮喘和肺炎患儿行支气管舒张剂吸入前后潮气呼吸容积曲线检测,探讨各肺功能参数改变特点,为临床医师诊断婴幼儿哮喘提供客观依据。方法选择婴幼儿哮喘患儿105例,肺炎患儿26例。使用Jaeger公司Masterscreen Paed型肺功能仪,镇静后行支气管舒张剂吸入前后潮气呼吸容积曲线检测。根据婴幼儿患儿基础肺功能测定结果分轻度通气障碍组(达峰时间比≥15%,59例)和重度通气障碍组(达峰时间比<15%,46例)进行比较。结果1.肺炎患儿予支气管舒张剂后,除潮气量上升(P<0.01),呼吸频率亦增加(P<0.05),其他指标改善均无统计学意义。2.所有哮喘患儿予支气管舒张剂后,其潮气量、吸气时间、达峰容积比上升,改善有统计学意义(P<0.05,0.01)。3.吸呼比、达峰时间较吸入支气管舒张剂后略有升高,但差异均无显著意义(P>0.05),而呼气时间、呼吸频率几乎无变化。轻、重度组比较发现,轻度组支气管舒张试验前后各参数均无显著改善(P>0.05),而重度组患儿除呼吸频率、呼气时间吸入支气管舒张剂前后无明显改善外,其他参数均显著上升(P<0.05),尤以潮气量、达峰时间比、达峰容积比改善最显著。结论婴幼儿哮喘患儿吸入支气管舒张剂前后改变能在一定程度上反映其呼吸道可逆性阻塞特征,尤其在重症喘息患儿的意义更大。使用潮气呼吸模式进行潮气肺功能检测有其局限性,临床医师应结合患儿临床表现进行综合判断。     

潮气呼吸肺功能检测在1~4岁儿童喘息性疾病中的临床应用

目的 探讨潮气呼吸肺功能检测在1~4 岁儿童喘息性疾病中的临床意义。方法 选择1~4 岁喘息患儿141 例（哮喘41 例、喘息性支气管炎54 例、支气管肺炎46 例）作为观察组,另选取非呼吸道疾病患儿30 例作为对照组,进行潮气呼吸肺功能检测,并观察喘息患儿支气管舒张试验前后肺功能的变化。结果 观察组患儿TBFV 环形态以阻塞性改变为主（65%）,达峰时间比（TPTEF/TE）、达峰容积比（VPEF/VE）亦明显低于对照组（P<0.05）。哮喘组支气管舒张试验后TPTEF/TE、VPEF/VE 较试验前明显改善（P<0.05）。以TPTEF/TE、VPEF/VE 任意一个改善率≥ 15% 作为支气管舒张试验的阳性标准,潮气呼吸支气管舒张试验诊断哮喘的灵敏度为47%,特异度为84%。哮喘组患儿舒张试验前TPTEF/TE ≥ 23% 者的阳性率28%,TPTEF/TE<23% 者的阳性率为65%（P<0.05）。结论 1~4 岁喘息患儿肺功能损害以阻塞性通气障碍为主;潮气呼吸支气管舒张试验可在一定程度上反映哮喘气道可逆性特征;在1~4 岁儿童中以潮气呼吸支气管舒张试验诊断哮喘的敏感性不高,但在阻塞程度重的患儿中诊断意义相对较大。     

不同给药方法对潮气肺功能支气管舒张试验结果的影响观察

目的探讨影响潮气肺功能支气管舒张试验参数改善的因素,为婴幼儿哮喘的诊断提供参考依据。方法选择2017年3月至2018年6月就诊于首都儿科研究所哮喘门诊、经临床明确诊断为支气管哮喘且处于急性发作期(喘息发作≤7d)的71例婴幼儿,将患儿依就诊顺序分为气雾剂组20例及雾化组51例,前者采用定量气雾剂给予支气管舒张剂,后者采用雾化吸入给予支气管舒张剂。2组患儿均进行潮气肺功能支气管舒张试验,比较两种给药方式对支气管舒张试验结果的影响,主要观察参数包括呼吸频率、潮气量、吸气时间、呼气时间、吸呼比、达峰时间比、达峰容积比、呼气峰流量;随后进行组内分析,进一步探讨各参数改善率的影响因素。结果给药后,气雾剂组患儿呼吸频率显著下降(P=0.003),吸气时间显著延长(P=0.011);雾化组患儿潮气量、吸气时间、吸呼比、达峰时间比、达峰容积比显著上升(均P0.05)。雾化组患儿吸呼比、达峰容积比上升幅度显著高于气雾剂组(均P0.05)。气雾剂组内,与气道轻度阻塞患儿比较,气道重度阻塞患儿给药后,吸呼比、达峰时间比、达峰容积比改善显著(均P0.05);雾化组内,气道重度阻塞患儿给药后,以上参数亦明显改善。雾化组不同年龄组间比较,2岁以上患儿达峰时间比、达峰容积比上升幅度显著高于1岁以下患儿(均P0.05)。结论通过潮气肺功能技术进行支气管舒张试验,雾化吸入给药方式的舒张效果优于定量气雾剂;给药后肺功能参数的改善与气道阻塞程度有关,也与患儿年龄有关。     

潮气呼吸肺功能在婴幼儿喘息性疾病诊断中的作用

目的探讨潮气呼吸肺功能在婴幼儿喘息性疾病诊断中的作用。方法选择年龄在2个月～3岁同期住院婴幼儿哮喘患儿54例、毛细支气管炎患儿54例、支气管肺炎患儿45例作为研究组,非心胸疾患外科择期手术术前患儿51例作为正常对照组,进行潮气呼吸流速容量曲线测定,然后予复方异丙托溴胺溶液1.25ml,雾化吸入15min后再次测定潮气呼吸流速容量曲线,观察各研究组吸入支气管扩张剂前后肺功能指标变化及改善率的差异。结果①婴幼儿哮喘组、支气管肺炎组与正常对照组比较RR增快,Ti、Te、TPTEF/Te及VPTEF/Ve明显降低;支气管肺炎组Vt/kg减少,各指标差异均有统计学意义。毛细支气管炎组TPTEF/Te、VPTEF/Ve值与正常参考值比较均明显降低。②婴幼儿哮喘组吸入支气管扩张剂后Vt/kg增加,TPTEF/Te、VPTEF/Ve升高,差异均有统计学意义;毛细支气管炎组、支气管肺炎组吸入支气管扩张剂后RR减慢,余指标差异无统计学意义。③婴幼儿哮喘组与毛细支气管炎组、支气管肺炎组比较TPTEF/Te、VPTEF/Ve改善率差异均有统计学意义;而毛细支气管炎组与支气管肺炎组比较TPTEF/Te、VPTEF/Ve改善率差异无统计学意义。④以TPTEF/Te、VPTEF/Ve任意一个改善率≥15%作为支气管舒张试验的阳性标准,灵敏度为31.3%,特异度为82.6%。结论①潮气呼吸肺功能检测适宜于婴幼儿肺功能检测,间接反映婴幼儿哮喘、毛细支气管炎、支气管肺炎的病理生理特征;②TPTEF/Te、VPTEF/Ve可以显示气道阻塞;③吸入支气管扩张剂后TPTEF/Te、VPTEF/Ve的改善率可以为婴幼儿哮喘的临床诊断提供一定帮助。     

不同给药方法对潮气肺功能支气管舒张试验结果的影响观察

目的　探讨影响潮气肺功能支气管舒张试验参数改善的因素,为婴幼儿哮喘的诊断提供参考依据。方法　选择2017年3月至2018年6月就诊于首都儿科研究所哮喘门诊、经临床明确诊断为支气管哮喘且处于急性发作期（喘息发作≤7 d）的71例婴幼儿,将患儿依就诊顺序分为气雾剂组20例及雾化组51例,前者采用定量气雾剂给予支气管舒张剂,后者采用雾化吸入给予支气管舒张剂。2组患儿均进行潮气肺功能支气管舒张试验,比较两种给药方式对支气管舒张试验结果的影响,主要观察参数包括呼吸频率、潮气量、吸气时间、呼气时间、吸呼比、达峰时间比、达峰容积比、呼气峰流量;随后进行组内分析,进一步探讨各参数改善率的影响因素。结果　给药后,气雾剂组患儿呼吸频率显著下降（P＝0.003）,吸气时间显著延长（P＝0.011）;雾化组患儿潮气量、吸气时间、吸呼比、达峰时间比、达峰容积比显著上升（均P＜0.05）。雾化组患儿吸呼比、达峰容积比上升幅度显著高于气雾剂组（均P＜0.05）。气雾剂组内,与气道轻度阻塞患儿比较,气道重度阻塞患儿给药后,吸呼比、达峰时间比、达峰容积比改善显著（均P＜0.05）;雾化组内,气道重度阻塞患儿给药后,以上参数亦明显改善。雾化组不同年龄组间比较,2岁以上患儿达峰时间比、达峰容积比上升幅度显著高于1岁以下患儿（均P＜0.05）。结论　通过潮气肺功能技术进行支气管舒张试验,雾化吸入给药方式的舒张效果优于定量气雾剂;给药后肺功能参数的改善与气道阻塞程度有关,也与患儿年龄有关。     

体外过敏原与潮气呼吸肺功能测定在毛细支气管炎中的作用

目的 研究体外过敏原与潮气呼吸肺功能测定在毛细支气管炎中的作用.方法 毛细支气管炎77例、婴幼儿哮喘81例、支气管肺炎72例纳入本次研究.应用Pharmacia UniCAP免疫检测分析仪,进行血吸入过敏原、食人过敏原筛查和尘螨特异性IgE检测,同时检测血总IgE和血嗜酸性粒细胞阳离子蛋白(ECP).患儿镇静后进行潮气呼吸肺功能检测,主要测定参数为每公斤体质量潮气量(VT)、达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE).结果 毛细支气管炎组(毛支组)与哮喘组吸人过敏原、食入过敏原阳性率、总IgE均高于肺炎组;毛支组VT值、TPTEF/TE值、VPTEF/VE值与哮喘组相比,差异无统计学意义;毛支组血ECP水平低于哮喘组,与肺炎组相比差异无统计学意义,毛支组血ECP与TPTEF/TE、VPTEF/VE无相关;毛支组吸入过敏原检测阳性14例,该14例患儿的血ECP水平与哮喘组相比差异无统计学意义,且血ECP与TPTEF/TE、与VPTEF/VE呈负相关.结论 通过检测血过敏原、ECP、肺功能,有助于了解毛细支气管炎气道炎症变化及肺部阻塞情况.     

喘息患儿潮气呼吸肺功能改变的特征

目的观察婴幼儿哮喘和毛细支气管炎患儿的潮气呼吸流速-容量曲线测定结果,探讨不同喘息患儿潮气呼吸肺功能改变的特征,为临床诊断提供依据。方法选择婴幼儿哮喘患儿63例,毛细支气管炎（毛支）患儿52例及正常对照组婴幼儿51例,于镇静后进行潮气呼吸流速容量曲线测定（TBFV）,主要参数有：每公斤体重潮气量（VT／kg）、呼吸频率（RR）、吸气时间（Ti）、呼气时间（Te）、吸呼比（Ti／Te）、达峰时间比（TPTEF／Te）、达峰容积比（VPEF／Ve）;并对哮喘患儿经正规治疗1～3个月后的缓解期、毛细支气管炎患儿住院治疗5～9d病情恢复后进行复查,观察其改善情况。结果哮喘组的潮气量与对照组比较差异无显著性,其他各指标差异均有显著性（P〈0．01）,而毛支组与对照组相比,除吸呼比差异无显著性外,其他各指标差异均有显著性（P〈0．01）,其VT／kg、Ti、Te、TPTEF／Te和VPEF／Ve明显降低、RR增加。哮喘组与毛支组比较发现,毛支组的RR较哮喘组明显增快;而哮喘组的潮气量高于毛支组,更接近于正常,其呼气时间较毛支组更长,吸呼比、达峰时间比和达峰容积比较毛支组降低更明显,两组间差异有显著性。毛支组经5～9d住院治疗后,VT／kg、RR明显改善,而哮喘组患儿1～3个月治疗缓解期后复查TPTEF／Te和VPEF／Ve显著上升。但两组的TPTEF／Te和VPEF／Ve与对照组比较仍存在很大差距,未能恢复至正常水平。结论潮气呼吸肺功能测定能够反映出婴幼儿哮喘、毛细支气管炎的病理生理特征,可成为呼吸道疾病临床诊断及病情评估的重要补充。     

气管支气管软化患儿潮气呼吸肺功能特征的研究

目的探讨气管支气管软化(TBM)患儿潮气呼吸肺功能的特征,为TBM患儿的诊断、疗效评估、预后判断提供新的思路。方法选取30例经电子支气管镜诊断为TBM的患儿作为研究组,30例健康儿童作为正常对照组。正常对照组和TBM组初诊时以及确诊后3个月、6个月、9个月、12个月进行潮气呼吸肺功能测定。结果 TBM确诊时与对照组在潮气量及吸气时间、呼气时间、吸呼比的差异无统计学意义(P0.05);与对照组比,TBM组确诊时的呼吸频率较快,达峰时间比和达峰容积比较低,差异具有统计学意义(P0.01);TBM患儿初诊时及确诊后3、6、9、12个月的潮气呼吸肺功能达峰时间比、达峰容积比逐渐增大。结论 TBM患儿潮气呼吸肺功能具有特征性改变,而且随着年龄增大,潮气呼吸肺功能逐渐接近正常。     

支气管舒张试验在婴幼儿支气管哮喘中的应用价值

目的探讨支气管舒张试验在婴幼儿支气管哮喘(哮喘)中的应用价值。方法对3岁以下哮喘患儿220例(哮喘组)进行潮气呼吸肺功能支气管舒张试验,以同期住院3岁以下支气管肺炎患儿123例为对照(肺炎组),比较2组患儿基础肺功能的差异、舒张前后肺功能改变及不同年龄组舒张阳性率的差异。结果 1.基础肺功能比较:哮喘组达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)及吸呼比(Ti/Te)均显著低于肺炎组,而每千克体质量潮气量(VT/kg)则显著高于肺炎组(Pa<0.05)。2.舒张前后肺功能比较:哮喘组吸药后呼吸频率减慢,吸气时间(Ti)及Ti/Te均增加;肺炎组吸药后TPTEF/TE降低更明显,VT/kg、Ti、Ti/Te均显著增加(Pa<0.05)。3.哮喘不同年龄组阳性率间差异有统计学意义(P<0.05),肺炎不同年龄组阳性率间差异无统计学意义(P>0.05)。结论 1.潮气呼吸肺功能可间接反映婴幼儿哮喘、支气管肺炎的病理生理特征,协助临床诊断。2.TPTEF/TE、VPEF/VE可反映呼吸道阻塞情况,VT/kg可为婴幼儿哮喘和肺炎的鉴别诊断提供参考。3.潮气呼吸支气管舒张试验对2岁以上哮喘患儿有一定参考价值,但对2岁以下者无应用价值。     

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.     

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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.     

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   

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.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.