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??Abstract?? Attention deficit hyperactivity disorder??ADHD??is the most popular mental disorder. It influenced 5%??10% of children and about 4% of adults. There are a huge number of researches about ADHD every year. ADHD is a long-term??chronic condition if it is not treated correctly. ADHD may lead to bed prognosis??even some troubles with the law. So it is very important to make early diagnosis and intervention for ADHD. The new Diagnostic and Statistical Manual of Mental Disorders??5th Edition ??DSM-???? has a number of changes to ADHD. To master the changes in DSM-??is the best way to get quickly and thoroughly updated on diagnostic criteria and classifications of ADHD.     

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目的评价小剂量芬太尼持续滴注对机械通气早产儿的镇痛作用、神经行为以及短期预后的影响。方法2000年10月至2003年10月,将广东省妇幼保健院新生儿科行机械通气治疗的36例早产儿随机分为实验组与对照组,实验组18例早产儿滴注芬太尼,平均剂量为(1.10±0.06)μg/(kg·h),平均滴注时间为(65±5)h,对照组18例患儿,以相同滴注速度滴注注射用水。应用镇静行为评分评价患儿的镇静效果,并记录各患儿的通气指标以及预后数据。结果实验组的镇静行为评分显著低于对照组,2组的机械通气参数及短期预后无显著差异。结论短时间小剂量滴注芬太尼可降低机械通气的早产儿行为评分,并能取得良好的镇痛效果。     

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目的探讨血浆谷氨酰胺(Gln)浓度与新生儿坏死性小肠结肠炎(NEC)的关系。方法选取2002年10月至2003年10月福建省妇幼保健院住院治疗的NEC患儿16例,以同期住院的性别相同,年龄、胎龄、出生体重相当的非NEC患儿16例为对照组,采用反向高效液相色谱法测定血浆Gln值,观察两组间差异;以多因素分析的方法判定血浆Gln浓度与NEC的关系。结果NEC患儿血浆Gln浓度为(0·21±0·08)mmol/L,对照组为(0·35±0·14)mmol/L,差异有显著性意义(P<0·05)。控制了缺氧和感染因素的影响后,NEC组和对照组的血浆Gln浓度的边缘估计均值及95%可信区间分别为:0·216mmol/L(0·150~0·282mmol/L)和0·344mmol/L(0·278~0·410mmol/L)。两组校正均值比较,差异有显著性意义(P=0·032)。在单因素分析筛选出关联因素的基础上,建立多因素条件Logistic回归模型,结果显示血浆Gln浓度是NEC的危险因素,OR值为13·342(2·006~88·735)。结论NEC患儿血浆Gln浓度降低,低浓度的血浆Gln是NEC发生的危险因素。     

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座谈内容1.近年来国外关于心肌病的定义和分类有哪些变化和进展?最新的心肌病的定义是什么?当前国外对心肌病有几种分类方法?对各类方法如何评价?2.根据国外研究进展,结合中国国情,对我国小儿心肌病应如何进行分类?采用该种分类方法的理由是什么?3.对我国儿科临床上几种常见的心肌病,如DCM、HCM等,在治疗方面近年有哪些新进展?心肌病的预后如何?4.何谓炎症性心肌病?诊断依据有哪些?怎样治疗     

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??Enteroscopy has high diagnostic and therapeutic value in adult intestinal diseases and is a safe and effective method. However??enteroscopy is rarely used in children. Enteroscopy is used for the diagnosis and treatment of obscure gastrointestinal bleeding??intestinal polyps??Crohn’s disease??intestinal stenosis and biliary stricture in children. The paper summarizes the clinical application of enteroscopy in small bowel disorders in pediatric patients.     

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<中国实用儿科杂志>1999年第1期曾发表过<小儿癫疒间诊断治疗中的几个问题>一文,但根据我们临床接触的各地患儿和资料发现,目前仍普遍存在若干问题,现整理如下.     

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??Neonatal behavioral neurological assessment??NBNA?? can early predict the neurodevelopmental outcome of all high-risk infants??including preterm infants with corrected gestational age??. At the same time??in the process of evaluation??NBNA stresses that the medical staff should share observation and interpretation of these behaviors with parents and give the necessary guidance??so that parents can understand their infant behavior and unique personality??this process is called neonatal behavioral neurological observation??NBNO??. NBNO can be used of early intervention for preterm infants and high-risk children from birth to 3 months.     

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??Brain development in preterm and little infants is immature. They are particularly vulnerable to various environmental stress factors??resulting in neurobehavioral abnormalities. However??due to the brain plasticity of preterm and little infants??early detection and intervention can reduce or eliminate neurobehavioral abnormalities. Neonatal behavior observation??NBO?? is an observation - intervention tool??which has a unique advantage in the early assessment and intervention of neurobehavioral abnormalities in preterm and little infants. NBO is cost-effective??practical??efficient??easily implemented??flexible and satisfactory. NBO has been widely used in many affiliated hospitals and preventive care organizations??and has achieved satisfactory results in clinical work.     

Treatment of children with congenital heart disease and growth retardation with recombinant human growth hormone

Seven prepubertal short children with congenital heart disease were treated with recombinant human growth hormone (GH). Although complete surgical correction was performed for their heart disease at least 2 years before the start of GH therapy, improvement in growth was less than expected in these children. They received 0.5 IU kg⁻¹ week⁻¹ of GH daily for 2 years or more. The growth rate increased from a mean of 4.3 cm year⁻¹ before treatment to a mean of 7.8 cm year⁻¹ in the first year and to a mean of 6.3 cm year⁻¹ in the second year of treatment. Their mean standardized height improved from −3.41 ± 0.78 to −2.54 ± 0.62 after 2 years. The mean height age difference minus the bone age difference became positive in these children. We conclude that recombinant GH increases the growth rate in children with congenital heart disease and prepubertal growth retardation.     

瘦素和血管内皮生长因子在先天性心脏病患儿中的变化

目的：探讨血清瘦素（LEP）和血管内皮生长因子(VEGF)在先天性心脏病（CHD）患儿中的变化与作用。方法：左向右分流型先心病组（非发绀组）48例（心衰组20例,无心衰组28例）,右向左分流型先心病组（发绀组）20例,正常对照组20例。分别测定以上各组儿童血清LEP,VEGF和总蛋白、白蛋白浓度及体重指数（BMI）。结果：先心病患儿各组与对照组之间血清总蛋白、白蛋白浓度差异无显著性(P>0.05),BMI差异有显著性(P<0.01)。发绀组、心衰组、无心衰组及对照组间血清LEP,LEP/BMI及VEGF浓度有明显差异(P<0.01)。与无心衰组比较,发绀组、心衰组LEP,LEP/BMI及VEGF浓度明显升高（P<0.01）。在非发绀组患儿中,心衰组和无心衰组血清LEP与BMI均呈正相关（P<0.01）。在发绀组患儿中,血清LEP与VEGF水平呈正相关（P<0.01）; 血红蛋白含量与VEGF水平呈明显的正相关（P<0.01）;动脉血氧饱和度与血清VEGF及LEP水平呈明显的负相关（P<0.01)。结论：LEP和VEGF参与CHD的病理生理过程。LEP和VEGF与非发绀型CHD的心衰发生有关。［中国当代儿科杂志,2009,11（10）：802-805］     

Risk of pulmonary tuberculosis in children with congenital heart disease

Children with low-flow congenital heart lesions are reported to have an increased incidence of pulmonary tuberculosis. The aim of this study was to investigate if children with congenital heart disease have an increased incidence of pulmonary tuberculosis and to determine if patients with certain heart conditions are more susceptible to pulmonary tuberculosis than others. This retrospective study over a 6-year period showed that pulmonary tuberculosis was 2.5-fold more common in children with congenital heart disease than in normal children from the same community. Children with congenital pulmonary stenosis had a prevalence equal to those with acyanotic (ventricular and atrial septal defects) and cyanotic (transposition of the great arteries) high-flow heart lesions, whereas there were no cases of tuberculosis in children with low-flow cyanotic heart lesions such as tetralogy of Fallot. Cardiac surgery had to be postponed as a result of pulmonary tuberculosis in 7.2% of all patients in whom it was required. Over the 6-year period of the study, cardiac surgery had to be delayed in 60% of cases with pulmonary tuberculosis and congenital heart lesions so antituberculosis therapy could be completed. Physicians treating children with congenital heart lesions should maintain a high index of suspicion for the development of pulmonary tuberculosis, especially in those with acyanotic and cyanotic high-flow lesions and pulmonary stenosis.     

小儿先天性心脏病介入治疗进展

从1966年Rashkind等进行球囊房间隔造口术至今,先天性心脏病介入治疗已经经过了50余年的发展,从最初的导管检查、姑息手术到现在的根治性封堵、支架的植入及瓣膜的替换等,介入性心导管技术已经成为治疗先天性心脏病的主要手段之一。我国先天性心脏病介入治疗已取得长足进步,但与发达国家相比仍有一定差距,现就间隔缺损性疾病、主肺分流性疾病、瓣膜性疾病及内外科镶嵌治疗等介入治疗进展进行梳理总结,以期对我国先天性心脏病的介入治疗提供借鉴。     

Keeping children with congenital heart disease healthy

Keeping children with congenital heart disease healthy is vital to their long-term survival and quality of life. Nurse practitioners are in an excellent position to keep these sometimes fragile children healthy before, between, and after their cardiac surgeries. Primary care visits should address developmental morbidity. Referral for in-depth evaluations and intervention should be initiated for children with hemodynamically significant heart disease. Infants may also experience poor feeding. Nutritional guidance may include fortifying formulas or enteral tube feedings. Attention to immunization status and prevention of winter illnesses and endocarditis may reduce complications in this high-risk group of children.     

Noncardiac comorbidities of congenital heart disease in children

BACKGROUND: Noncardiac conditions may complicate heart disease care, contribute to the progression of the disease and alter the response to treatment. The aim of this prospective study was to evaluate the proportion of cardiac children with such significant conditions. METHODS: Of the 1058 children with congenital heart disease primarily diagnosed during a 10-year-period in one hospital, we identified those patients who had significant congenital and acquired comorbidities. RESULTS: Associated problems were diagnosed in 224 children (21.2%). Among them, 118 children (11.2%) had genetic or syndromic conditions, of which 38 had Trisomy 21. Six subspecialty areas accounted for the vast majority of the cases: neurology (n = 140), pulmonology (n = 36), orthopaedics (n = 26), nephro-urology (n = 19), gastroenterology (n = 14) and endocrinology (n = 13). The most frequent associated conditions were mental retardation, asthma, epilepsy and scoliosis. During the study period, death occurred in 46 of the children (4.3%) and was not related to the cardiac disease in 20 cases (1.9%). CONCLUSION: A substantial proportion of children with congenital heart disease have significant noncardiac comorbidities. Close collaboration between paediatric cardiologists and paediatricians of other subspecialties is imperative to optimize care for these children.     

Growth and nutritional intake of infants with congenital heart disease

Summary Poor weight and length gain of infants with congenital heart disease is generally considered to be related to inadequate nutritional intake, but no longitudinal data on growth and nutritional intake of such infants are available. We compared weight, length, subscapular and triceps skinfold thickness, energy and protein intake (24-h dietary intake records) as well as serum prealbumin and albumin of infants with cyanotic heart disease (n=8) or isolated left-to-right shunt (n=8) with those of healthy infants aged (n=8) 45–365 days. Weight, length, and combined (subscapular and triceps) skinfold thickness of the two groups with congenital heart disease (CHD) were significantly less from 183 through 365 days of age. However, energy and protein intake was similar to that of the control group from 45 through 365 days of age. Normal serum prealbumin and albumin in the infants with CHD ruled out protein-calorie malnutrition. It is concluded that a low level of food intake was not the main cause of inadequate growth and of small subcutaneous fat stores in these two small, but homogeneous, groups of infants with CHD.     

肾上腺髓质素在先天性心脏病中的测定及临床意义

目的：肾上腺髓质素(ADM)对心血管疾病有多方面的影响,但其与先天性心脏病关系的研究较少。该实验通过检测不同类型先天性心脏病患儿体内ADM的变化,分析ADM在先天性心脏病病理生理中的作用。方法：筛选住院的48例先天性心脏病患儿,经超声心动图及心导管检查术证实,在心导管检查术中测定血流动力学指数及采血备测,依据血流动力学特征分为高肺血流非肺动脉高压组、高肺血流并肺动脉高压组、紫绀组,平均肺动脉压(mPAP)>20 mmHg为肺动脉高压的标准。选6例川崎病痊愈患儿作为对照组。采用特异性放射免疫法检测血浆ADM的水平。结果：先天性心脏病患儿股静脉中的血浆ADM水平较股动脉明显增高(P<0.05);与对照组相比,高肺血流并肺高压组及紫绀组中的ADM明显增高,均P<0.01;ADM与主动脉平均压(mSAP)、混合静脉血氧饱和度(MVsat)、主动脉血氧饱和度(AOsat)及肺血管阻力(Rp)之间有密切的关系。结论：高肺血流并肺动脉高压和紫绀型先天性心脏病患儿的ADM水平增高,ADM的变化同肺动脉阻力和缺氧有密切关系,推测ADM水平的升高可能有助于减轻肺动脉阻力和改善缺氧。     

Birth weight of children with congenital heart disease

Birth weights of 843 children with congenital heart disease (CHD) were compared to the respective data of a normal West German population. On average, the CHD group had significantly lower birth weights, but the weight deficit was far less pronounced than in previous studies. The decrease in birth weight was distinct only in children with tetralogy of Fallot and atrial septal defect. Compared to normal newborns, patients with CHD were more often small for gestational age (15.0%) or had a low (<2500 g) birth weight (8.6%). The prevalence of prematurity was not increased. Extracardiac malformations were not significantly more common in CHD patients, who were small for gestational age, than in CHD patients with normal birth weight.     

Clinical and haemodynamic correlates of heart rate variability in children with congenital heart disease

Heart rate variability (HRV) represents a noninvasive parameter for studying the autonomic control of the heart. Cardiac patients have a complex autonomic disturbance. The relation of HRV to this abnormality in children with congenital heart disease (CHD) has not yet been examined. The present study examined HRV indices from 24 h Holter recordings in 258 children with an operated or non-operated CHD, to determine their differences as an indicator of the severity of heart disease. The latter was defined clinically as New York Heart Association (NYHA) functional class I to IV and haemodynamically by invasive parameters. Five time-domain measures (SDNN, SDNNi, SDANNi, rMSSD and pNN50) and three frequency-domain measures (LF, HF and balance LF/HF) were compared with normal ranges. HRV was reduced in children with CHD, except in patients of NYHA class I. The level of reduction depended on the NYHA functional class. None of the measures was significantly related to haemodynamic data. Conclusion Heart rate variability is reduced in children with Congenital heart disease depending on the functional limitation but not on haemodynamic disturbances. Heart rate variability indices are sensitive markers of the clinical state. Received: 3 December 1997 / Accepted in revised form: 22 June 1998