早产儿PDA超声心动图血流形态改变类型对应用消炎痛治疗的指导作用

消炎痛是常规治疗早产儿动脉导管未闭（ＰＤＡ）的药物,该研究旨在比较依据多普勒超声心动图（ＥＣＨＯ）观察ＰＤＡ分流方式改变应用消炎痛与常规应用消炎痛治疗ＰＤＡ的疗效和安全性． 方法１９９５～１９９７年日本和台湾两所医院中,出生体重小于１５００ｇ,需机械通气,具有临床症状且经ＥＣＨＯ检查证实为ＰＤＡ的９３例患儿作为研究对象,随机分为两组：常规治疗组（对照组）４６例,消炎痛首次剂量０．２ｍｇ／ｋｇ然后每１２小时一次,再给两次（剂量依据患儿出生日龄：４８小时内０．１ｍｇ／ｋｇ超过４８小时０．２ｍｇ／ｋｇ…     

口服消炎痛和布洛芬治疗早产儿动脉导管未闭的比较

目的：静脉注射消炎痛是早产儿动脉导管未闭的常规治疗方法,但治疗过程中常出现一些副作用,如少尿、消化道出血、脑血流灌注减少。近年来,静脉注射布洛芬已用于治疗早产儿动脉导管未闭。布洛芬治疗不会减少脑血流灌注,也不会影响胃肠道和肾脏的血流动力学。伊朗目前尚无消炎痛和布洛芬的静脉制剂供应。该研究旨在比较这两种药的口服制剂治疗早产儿动脉导管未闭的疗效和安全性。方法：36例胎龄小于34周经超声心动图确诊患有动脉导管未闭的早产儿被随机分为两组,每组18人。一组给予消炎痛口服,每次0.2 mg/kg,24 h给药 1 次,共3次。另一组给予布洛芬口服,共 3 次,间隔时间为24 h,首剂为 10 mg/kg,随后两次各 5 mg/kg。用药后观察导管闭合率、副作用、并发症及临床过程。结果：用药后布洛芬组18例患儿动脉导管都闭合（100％）,而消炎痛组18例中有15例患儿动脉导管闭合（83.3%）（P＞0.05）。两组疗效差异统计学无显著性意义。治疗前后两组的血清尿素氮和肌酐含量差异也无显著性意义。消炎痛组发生了3例（16.6%）坏死性小肠结肠炎,布洛芬组则无,差异有显著性意义 (P＜0.05)。治疗1个月后两组成活率均为 94%（17／18）。消炎痛组1例死于坏死性小肠结肠炎,布洛芬组1例死于败血症。结论：口服布洛芬治疗早产儿动脉导管未闭和口服消炎痛治疗一样有效,而且坏死性小肠结肠炎的发生率较口服消炎痛治疗低。［中国当代儿科杂志,2007,9（5）：399-403］     

口服消炎痛治疗新生儿动脉导管末闭临床观察

为观察消炎痛关闭新生儿(足月儿及早产儿)动肪导管未闭(PDA)的效果，对经心脏彩超确诊的新生儿PDA90例，其中72例(足月儿33例，早产儿39例)口服消炎痛治疗，另18例未用消炎痛作为对照组。结果显示，消炎痛治疗组动脉导管关闭率明显高于对照组；其中早产儿关闭率(92．37％)高于足月儿(78．78％)，并明显高于对照组(92．37％比42．8％)；足月儿用药组与对照组相比无明显差异。消炎痛治疗组中有21例合并其他先心病，结果单纯PDA导管关闭率(94．12％)明显高于合井其他先心病的PDA组(61．9％)。早产儿动脉导管的自闭率低于足月儿。结论：口服消炎痛治疗早产儿PDA的效果优于足月儿，单纯PDA优于合并其他先心病者，足月儿在治疗原发病后PDA自闭的可能性大，早产儿自闭的可能性相对较小。     

新生儿期胃食道反流的检测与治疗

对５４例新生儿（早产儿２５例，足月儿２９例）进行了６６例次的二乙三胺五醋酸胃食道核素显像研究，检测出胃食道反流（ＧＥＲ）阳性者３５例（６４．８％），其中早产儿阳性率为８０．０／，足月儿为５１．７％（ｘ￣２＝４．７１０．Ｐ＜０．０５）。所有阳性患儿的反流指数均＞３．５％。在ＧＥＲ阳性的新生儿中，８５．０％的早产儿与４０．０％的足月儿临床无呕吐症状（Ｐ＜０．０１）。选择了６例反流阳性者给予吗丁啉抗反流治疗，取得了较满意的效果，且未发现不良反应。提示放射性核素胃食道显像是诊断婴幼儿ＧＥＲ的一种可靠技术，而吗丁啉是治疗该病的有效药物。     

农村新生儿冷伤发病率及影响因素研究

对铁岭县农村１８４０例新生儿体温监测发现：新生儿冷伤３８１例，发病率２０．７％，冷伤患儿死亡１５例，病死率３．７％，本病主要发生在出生２４小时内（９１．２％）发病率影响因素结果显示；春冬寒冷季节（２７．８％～３４．５％）显著高于夏秋温暖季节（５．８％～９．１％），Ｐ〈０．０５，产室温度愈低，发病率愈高（Ｆ＝４７．７９，Ｐ〈０．０１），室温〉２１℃，发病率低（７％），胎龄〈３７周的早产儿（３７．９％     

早产儿动脉导管未闭的消炎痛治疗

目的 探讨消炎痛治疗早产儿动脉导管未闭(PDA)的疗效。方法 对确诊为早产儿PDA的20例患儿。以消炎痛每次0．1～0．3mg／kg鼻饲给药，每12小时一次。共用3次为一疗程。结果：第一个疗程PDA闭合为16例。第二个疗程PDA闭合1例．3例未闭合。结论 消炎痛关闭早产儿PDA成功率高，给药时间早,效果更佳。     

农村新生儿冷伤发病率及影响因素研究

对铁岭县农村1840例新生儿体温监测发现：新生儿冷伤381例，发病率20．7％。冷伤患儿死亡15例，病死率3．7％。本病主要发生在出生24小时内（91．2％）。发病率影响因素调查结果显示：春冬寒冷季节（27．8％～34．5％）显著高于夏秋温暖季节（5．8％～9．1％），P＜0．05；产室温度愈低，发病率愈高（F＝47．79，P＜0．01），室温＞21℃，发病率低（7％）；胎龄＜37周的早产儿（37．9％）高于足月儿（20．4％），差异显著（x2＝5．32，P＜0．05）；体重≤2500克者（29．4％）高于体重＞2500克者（20．3％），P＜0．05。且发现未按时喂哺或患病新生儿冷伤发病率增加。     

静脉注射丙种球蛋白治疗早产儿感染的研究

为了探讨静脉注射丙种球蛋白（ＩＶＩＧ）预防及治疗早产儿感染的价值，用单向免疫琼脂扩散法检测５１例出生１～３天（胎龄２８～３６周）的早产儿血清ＩｇＧ、ＩｇＡ、ＩｇＭ。结果显示ＩｇＧ均值随胎龄增加而升高（ｒ＝０．９９，Ｐ＜０．０１），２８～３６周者＜８．０ｇ／Ｌ（２８周仅４．５ｇ／Ｌ），＞３６周者＞８．０ｇ／Ｌ；而ＩｇＡ、ＩｇＭ差异无显著意义（２８～３６周者ＩｇＡ均值为６１５ｍｇ／Ｌ，＞３６周者为６２１ｍｇ／Ｌ；２８～３６周者ＩｇＭ均值为４２３ｍｇ／Ｌ，＞３６周者为４１８ｍｇ／Ｌ），，故胎龄越小越有应用静脉丙种球蛋白（ＩＶＩＧ）的指征。３０例重症感染的早产儿参考相似的孕周、体重及日龄，随机分为ＩＶＩＧ组及对照组各１５例，均选用同类抗生素，且不用其它免疫制剂及血浆治疗，ＩＶＩＧ组按每天０．５～１ｇ／ｋｇ稀释成５０ｍｌ在２～３小时内静脉滴注，连用２天，ＩＶＩＧ组治疗１周后均值从８．２ｇ／Ｌ升到１３．５ｇ／Ｌ（Ｐ＜０．０１）；而对照组治疗后ＩｇＧ均值仅６．７ｇ／Ｌ。提示早产儿感染用ＩＶＩＧ疗效十分满意。     

不同胎龄新生儿胃液卵磷脂／鞘磷脂比值变化及其临床意义

应用薄层层析法检测１１０例［足月儿５０例，其中正常新生儿３０例，窒息１２例，妊娠高血压综合征（简称好高征）母亲所生新生儿８例；早产儿６０例］新生儿胃液卵磷脂／鞘磷脂（Ｌ／Ｓ）比值。结果显示，足月儿Ｌ／Ｓ比值＞２．０，早产儿＜２．０，早产儿Ｌ／Ｓ比值与胎龄、体重有非常显著正相关（ｒ分别为０．８６、０．６５，Ｐ均＜０．０１）。足月窒息儿Ｌ／Ｓ比值明显低于正常对照组（ｔ＝２．６０，Ｐ＜０．０５）；患妊高征母亲所生新生儿Ｌ／Ｓ比值明显高于对照组（ｔ＝３．０３，Ｐ＜０．０１），提示母亲患妊高征有使胎儿肺成熟加速的倾向。６０例早产儿并发呼吸窘迫综合征７例，Ｌ／Ｓ比值均在１．０９以下，５例死亡，其中４例Ｌ／Ｓ比值在０．４以下。提示胃液Ｌ／Ｓ比值对评价肺成熟度及预估呼吸窘迫综合征发生及预后有重要参考价值。     

新生儿脐血单个核细胞产生肿瘤坏死因子α的能力及临床意义

对３０例早产儿、５０例足月儿脐血单个核细胞与３０例健康成年人外周血单个核细胞产生的肿瘤坏死因子α（ＴＮＦα）进行了测定。结果，早产儿、足月儿脐血单个核细胞产生的ＴＮＦα低于健康成年人，分别为０．４５±０．２４、０．８６±０．３９、１．８２±０．５６μｇ／Ｌ（ｘ±ｓ）；早产儿脐血中单个核细胞产生的ＴＮＦα比足月儿低，而且ＴＮＦα的含量与胎龄及１分钟Ａｐｇａｒ评分成正相关关系（ｒ＝０．３７．Ｐ＜０．０１）。本研究提示，新生儿，特别是早产儿，不成熟的单个核细胞产生较低的ＴＮＦα，可能是新生儿免疫功能低下而易受感染的原因之一。     

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   

�¶�֢��ϵ�ϰ���ע��ȱ�ݶද�ϰ������ڵ�ת��

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.

---

---

Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.