Follow-up into young adulthood after cardiopulmonary resuscitation in term and near-term newborn infants. I. Educational achievements and social adjustment

AIM: Long-term sequelae after perinatal asphyxia have generally been assessed at preschool or school age. The aim of the study was to confirm the hypothesis that there could be impairment of cognitive and memory functions that does not become apparent until education and adult life impose special demands. METHODS: Seventy-one term or near-term newborns in need of cardiopulmonary resuscitation because of presumed perinatal asphyxia were investigated with evoked EEG potentials during the first week of life and were investigated at a follow-up clinic until 18 mo of age. At that time 12 subjects showed signs of neuro-developmental impairment. The remaining 59 were considered healthy. They were contacted at young adult age and given a questionnaire containing questions about type of education, need for extra support at school, present activity/employment, living conditions, spare-time activities and self-estimation of health. RESULTS: Thirty-five control subjects were approached at the same time. From the group that was resuscitated at birth, 53 questionnaires were returned and 30 from the control group. Although the resuscitated subjects had signs of both encephalopathy and pathologic evoked responses during their neonatal period, the questionnaire revealed that they had coped with school equally as well as their peers, that the rate of entering university studies was the same and that living conditions were similar between the groups. CONCLUSION: These individuals who were resuscitated at birth and who demonstrated various degrees of neonatal encephalopathy suffered either brain injury that could be diagnosed at 18 mo of age or managed as well as their non-resuscitated peers in terms of educational achievement and social adjustment at young adult age.     

窒息后新生儿血中胃泌素和胃动素水平的研究

为了探讨出生窒息对新生儿消化系统的影响及其发生机理，用放射免疫法对窒息后新生儿生后喂奶前及第７天血中胃泌素、胃动素浓度进行了测定，并以正常新生儿作对照。结果：窒息后患儿生后喂奶前血清胃泌素浓度为１１６±７ｎｇ／Ｌ，明显低于正常对照组的１３５±４ｎｇ／Ｌ（Ｐ＜０．０５）。而血浆胃动素浓度为４３１±３８ｎｇ／Ｌ，明显高于对照组的３０４±２２ｎｇ／Ｌ（Ｐ＜０．０１）。窒息组生后第７日空腹血中胃泌素浓度（１３２±８ｎｇ／Ｌ）、胃动素浓度（７２６±６０ｎｇ／Ｌ）均较生后喂奶前明显升高（Ｐ＜０．０５，Ｐ＜０．０１）。提示：窒息后新生儿的某些胃肠道症状可能与消化道激素分泌异常有关。     

儿科急诊心肺复苏特点与预后分析

目的分析小儿院外呼吸或心跳停止(或呼吸、心跳停止)的病因、临床特征及影响心肺复苏预后的相关因素,为提高儿科急诊心肺复苏成功率及改善预后寻找可行方法。方法对急诊创伤中心(EDTC)2001年3月至2007年3月急诊心肺复苏(CPR)患儿的临床资料、心肺复苏原因及预后进行总结分析。结果共有199例患儿在EDTC进行CPR。就诊时呼吸停止84例(42.21%),出院时存活54例(64.29%);心跳停止115例(57.79%),急诊CPR后恢复自主循环(ROSC)38例(33.04%),出院时存活9例(7.83%);呼吸停止与心跳停止者病死率比较差异有统计学意义(χ2=71.52,P=0.000)。呼吸停止或心跳停止时157例(78.89%)有现场目击者,其中137例目击者为家长(87.26%),42例(21.11%)无目击者;有目击者予院前CPR20例(12.74%);有目击者与无目击者最终病死率比较差异无统计学意义(χ2=0.09,P=0.45)。意外伤害性疾病(58例,29.15%)是导致小儿急诊CPR的首要原因,其次为先天性心脏病(49例,24.62%)和严重感染性疾病(32例,16.08%)。院前救护车转运52例(26.13%)。结论小儿院外呼吸或心跳停止者病死率高,尤其是院外心跳停止者;意外伤害是儿童期急诊CPR的最常见原因,家长是儿童呼吸或心跳停止最常见的目击者;要提高儿科急诊CPR成功率,需要加强监护人对儿童的监护意识,预防意外伤害的发生;同时需要对监护人普及儿科急救的基本知识,提高他们第一时间救护患儿的能力,从而改善院外呼吸或心跳停止患儿的预后。     

儿童心肺复苏期间与复苏后通气策略

心肺复苏(cardiopulmonary resuscitation,CPR)期间,予以口对口送气或球囊面罩加压通气,通气频率12～20次/min.气管插管通气后通气频率8～10次/min.儿童胸外按压和通气比30∶2(1人施救)或15∶2(2人施救)较为合理.CPR后自主循环恢复,仍无自主呼吸或自主呼吸不规则、呼吸功能不全或部分患儿需要吸人高浓度氧,则需要机械通气.目前公认CPR后避免高氧和过度通气,并发急性肺损伤/急性呼吸窘迫综合征时采用肺保护通气策略.     

Use of supplementary equipment for resuscitation of newborn infants at tertiary perinatal centres in Australia and New Zealand

Aim: Neonatal resuscitation is a common and important intervention. International consensus statements advise how newborns should be resuscitated and suggest equipment to be used. Use of equipment not specifically recommended in these guidelines has been advocated. We wished to determine how widely this supplementary equipment is used in a geographically defined region. Methods: Each of the 25 tertiary perinatal centres with on-site deliveries in Australia and New Zealand was surveyed. The questionnaire asked about the use of the following items during delivery room resuscitation: pulse oximetry, exhaled carbon dioxide detection, polyethylene wrapping, oxygen blenders, laryngeal mask and oropharyngeal airways. Results: Data were obtained from all centres. Pulse oximetry is used at 12 (48%) centres. Exhaled CO ₂ detection is used to confirm endotracheal tube placement at three (12%) of the centres. Polyethylene wrapping is used to prevent heat loss in very-low-birthweight infants at delivery at 11 (44%) centres. Oxygen blenders are used to modify the amount of oxygen delivered at nine (36%) centres. Laryngeal mask airways are infrequently used at two (8%) centres. Oropharyngeal airways are infrequently used at five (20%) centres.

Conclusion: There is considerable variation in the equipment and techniques used to resuscitate newly born infants. Use of equipment not specifically recommended in international consensus statements is widespread. These are potentially effective tools to improve resuscitation. The evidence supporting their use is, however, limited. Urgent evaluation of their efficacy and safety is required before even more widespread use occurs.     

婴幼儿体外循环心内直视手术315例临床分析

目的总结婴幼儿体外循环(CPB)心内直视手术的治疗经验。方法总结2002年1月至2005年11月315例婴幼儿先心手术患儿资料。其中男187例,女128例;年龄4d～3岁,其中<6个月23例,～1岁41例,>1岁251例;体重2.5～18.5kg,平均(10.30±2.65)kg。非紫绀型心脏病254例,紫绀型心脏病61例。所有病例在体外循环下行根治性手术314例,姑息性手术1例。结果术后死亡11例,死亡率3.49%;术后出现并发症46例(14.60%)。结论婴幼儿先天性心脏病必须早诊断、早手术治疗;提高手术成功率的关键是把握好手术指征和时机,选择适当手术方式,加强术中心肌保护和术后治疗。     

Cerebral resuscitation after traumatic brain injury and cardiopulmonary arrest in infants and children in the new millennium.

As outlined in Figure 1, it is likely that a series of interventions beginning in the field and continuing through the emergency department, ICU, rehabilitation center, and possibly beyond, will be needed to optimize clinical outcome after severe TBI or asphyxial CA in infants and children. Despite the many differences between these two important pediatric insults, it is likely that many of the therapies targeting neuronal death, in either condition, will need to be administered early after the insult, possibly at the injury scene. Even cerebral swelling, a pathophysiologic derangement routinely treated in the PICU, almost certainly is better prevented rather than treated. Finally, this review includes, for one of the first times, a brief discussion of additional horizons in the management of patients with severe brain injury, namely, manipulation of the injured circuitry and stimulation of regeneration. Further research is needed to define better the pathobiology of these two important conditions at the bedside, to understand the optimal application of contemporary therapies, and to develop and apply novel therapies. The tools necessary to carry out these studies are materializing, although the obstacles are great. This difficult but important challenge awaits further investigation by clinician-scientists in pediatric neurointensive care.     

奥曲肽在婴幼儿心胸手术后乳糜胸治疗中的临床应用

目的 探讨奥曲肽在婴幼儿心胸术后乳糜胸的临床疗效.方法 回顾性分析2003年7月至2011年11月间心胸手术后并发乳糜胸15例临床资料,15例分为对照组(9例)和奥曲肽组(6例),两组病例的年龄、体重、术后发生乳糜胸时间等一般资料间差异无统计学意义,乳糜胸的诊断标准一致.分析比较两组病例治疗前、治疗中乳糜胸引流量的变化、治愈时间等数据.两组的数据用均数及标准差(-x±s)表示,组间比较采用成组设计资料的t检验,组内比较采用配对t检验,P＜ 0.05(或P＜0.01)差异有统计学意义.结果 对照组胸引流量在治疗后72 h[(214.4±130.2) ml/d]、1周[(155.5±86.7) ml/d]较治疗前[(256.6±125.2) ml/d]明显减少(t=5.041,4.623;P=0.001,0.002).对照组胸引流量治疗后2周[(142.3±120.3)ml/d]、3周[(139.4±113.4) ml/d]较治疗前无明显减少(t=2.099,1.745;P=0.069,0.119).对照组有3例保守治疗无效,其中2例手术治疗,1例死亡.奥曲肽组6例保守治疗成功.胸引流量在治疗后72 h[(88.3±22.2) ml/d]、1周[(51.2±16.7) ml/d]、2周[(19.3±6.05)ml/d]较治疗前明显减少(t=5.227,5.549,6.638;P=0.003,0.003,0.002).两组胸引流量在治疗72 h、1周、2周间间差异有统计学意义(t=2.453,2.900,2.412;P=0.029,0.012,0.031).两组保守治愈病例术后痊愈时间[对照组(32.8±0.75)d;奥曲肽组(25.2±1.78) d]差异有统计学意义(t=2.512;P=0.028).结论 奥曲肽的使用能明显促进婴幼儿术后乳糜胸恢复,应积极使用.     

婴幼儿先天性心脏病体外循环术后急性肾损伤早期预警的临床研究

目的 探讨婴幼儿先天性心脏病体外循环术后急性肾损伤的发病情况以及尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、白介素18(IL-18)及N-乙酰-β-D氨基葡萄糖苷酶(NAG)、尿微量白蛋白(MA)、α1微球蛋白(α1-MG)在婴幼儿先天性心脏病体外循环术后急性肾损伤中的早期预测价值.方法 本组58例≤3岁的行体外循环手术的先天性心脏病患儿,分别在术前和体外循环开始后4、6、12、24 h留取尿样进行NGAL、IL-18、NAG、MA、α1-MG的检测.根据体外循环术后是否发生急性肾损伤分为急性肾损伤组和非急性肾损伤组,对2组以上指标进行比较.结果 急性肾损伤组和非急性肾损伤组各29例,两组性别、年龄、体重差异无统计学意义.急性肾损伤组术后4、6、12 h的尿NGAL/尿肌酐(UCr)水平(2820.0μg,/g,905.7 μg/g,76.1μg/g)均高于非急性肾损伤组(27.6 μg/g,19.5 μg/g,16.0 μg/g) (P ＜0.01).急性肾损伤组术后4、6、12和24 h的尿IL-18/UCr水平(3768.0 ng/g,1092 ng/g,421.0 ng/g,256.8 ng/g)均高于非急性肾损伤组(511.7 ng/g,304.1 ng/g,207.5 ng/g,100.8 ng/g) (P ＜0.05).急性肾损伤组术后4、6h的尿NAG/UCr水平(1205.5 U/g,294.7 U/g)均高于非急性肾损伤组(176.8 U/g,104.5 U/g) (P ＜0.01).急性肾损伤组术后4、6、12 h的尿MA/UCr水平(1628.0 mg/g,383.7 mg/g,121.2 mg/g)均高于非急性肾损伤组(119.0 mg/g,81.3 mg/g,86.5 mg/g) (P ＜0.05).急性肾损伤组术后4、6、12h的尿α1-MG/UCr水平(804.4 mg/g,384.5 mg/g,104.4 mg/g)高于非急性肾损伤组(154.0 mg/g,84.3 mg/g,37.2 mg/g)(P＜0.01).尿NGAL、IL-18、NAG、MA/UCr和α1-MG/UCr 5个指标均在术后4h预测价值最大.结论 尿生物学标志物NGAL、IL-18、NAG、MA、α1-MG对体外循环术后早期急性肾损伤有较强的预测价值.     

Cognitive behavioral treatment for childhood anxiety disorders: long‐term effects on anxiety and secondary disorders in young adulthood

Background: The present study’s aim was to examine the long‐term effects (8 to 13 years post‐treatment; M = 9.83 years; SD = 1.71) of the most widely used treatment approaches of exposure‐based cognitive behavioral treatment for phobic and anxiety disorders in children and adolescents (i.e., group treatment and two variants of individual treatment). An additional aim was to compare the relative long‐term efficacy of the treatment approaches. Method: At long‐term follow‐up, participants (N = 67) were between 16 and 26 years of age (M = 19.43 years, SD = 3.02). Primary outcome was the targeted anxiety disorder and targeted symptoms. Secondary outcomes were other disorders and symptoms not directly targeted in the treatments including (1) other anxiety disorders and symptoms, (2) depressive disorders and symptoms, and (3) substance use disorders and symptoms. Results: Long‐term remission for anxiety disorders and symptoms targeted in the treatments was evident 8 to 13 years post‐treatment. Long‐term remission also was found for the secondary outcomes. There were more similarities than differences in the long‐term gains when comparing the treatment approaches. Conclusions: Consistent with past research, the study’s findings provide further evidence that the short‐term benefits of exposure‐based CBT for childhood phobic and anxiety disorders using both group and individual treatment may extend into the critical transition years of young adulthood.     

Serum amyloid A (SAA) protein and high-sensitivity C-reactive protein (hsCRP) in healthy newborn infants and healthy young through elderly adults

AIM: To determine the levels of serum amyloid A (SAA) protein and high-sensitivity C-reactive protein (hsCRP) in different age groups. METHODS: Serum samples from 70 healthy newborn infants, 80 blood donors and 81 healthy elderly individuals were analysed using a nephelometric method. The 231 samples were grouped as follows: 35 umbilical cords, 35 newborns, 48 young adults, 28 middle-aged adults, and 85 elderly adults. RESULTS: Serum levels of both SAA and hsCRP were lower in umbilical cords than in the newborns and young, middle-aged and elderly adults (p<0.0001). The SAA and hsCRP levels were comparable in newborns, and young and middle-age adults, but higher in elderly adults (p<0.0001-0.03). SAA (r2=0.159, p<0.0001) and hsCRP (r2=0.059, p<0.0001) were positively correlated with age and to each other (r2=0.385, p<0.0001). CONCLUSION: Serum levels of SAA and hsCRP in umbilical cord blood are close to the detection limit and lower than in the other age groups investigated. The elderly have generally higher levels than the younger age groups, which require higher decision levels in inflammatory diseases, including infections. In newborns and young and middle-aged adults, the lower decision levels of 10 mg/l for SAA and 5 mg/l for CRP are suggested.     

尘螨阳性婴幼儿首次喘息后反复喘息发作的危险因素

目的 探讨尘螨阳性婴幼儿首次喘息后反复喘息发作的危险因素。方法 选取2014年8月至2015年2月间住院的首次喘息发作婴幼儿共1 236例,其中尘螨阳性387例,出院后随访1年,随访1年内再发喘息3次及3次以上的患儿设定为反复喘息组（n=67）,随访期间未再发生喘息的患儿设定为对照组（n=84）。采用单因素分析和多因素logistic逐步回归分析,探讨尘螨阳性的婴幼儿反复喘息发作的危险因素。结果 单因素分析显示,入院时年龄、入院前喘息时间、肺炎支原体感染率、流感病毒感染率与反复喘息发作相关联。多因素logistic逐步回归分析显示,入院时年龄较大（OR=2.21,P=0.04）、合并肺炎支原体感染（OR=3.54,P=0.001）为反复喘息发作的独立危险因素。结论 尘螨阳性的婴幼儿,特别是幼儿,若首次喘息时合并有肺炎支原体感染,则反复喘息发作的风险明显升高。     

Respiratory regulation after elastic loading and CO2 rebreathing in normal term infants.

Studies of airway pressure, tidal volume, respiratory duration, and total breath duration before and after elastic loading airway occlusions were carried out on ten full-term, normal infants on two occassions in the first week of life. Using these noninvasive techniques we infer that static compliance and the Hering-Breuer reflex are unchanged during the first week; that infants may increase sensitivity to chemical drive toward the end of the first week; and that there may be a volume related threshold for vagal inhibition of inspiration in some infants.     

Perinatal vitamin D metabolism. II. Serial 25-hydroxyvitamin D concentrations in sera of term and premature infants.

Serial concentration values of 25-hydroxyvitamin D (25-OHD) were determined in the sera of term, premature, and twin infants. In infants born at term with normal concentrations of 25-OHD in cord blood, serial concentrations of 25-OHD remained normal; in infants born at term with low concentrations of 25-OHD in cord blood, serial concentrations of 25-OHD increased. In premature infants with normal concentrations of 25-OHD in cord blood, serial concentrations of 25-OHD decreased; in premature infants with low values of 25-OHD in cord blood, serial concentrations of 25-OHD did not increase until a postconceptual age of 36 to 38 weeks. The concentrations of 25-OHD in the sera of twin infant pairs followed parallel courses. Oral and intravenous supplementation of vitamin D did not significantly increase the concentrations of 25-OHD in serum of premature infants. These findings suggest that a decreased rate of 25-hydroxylation of vitamin D may be a factor impairing homeostasis of 25-OHD in premature infants.     

Lidocaine for treatment of severe seizures in newborn infants. II. Blood concentrations of lidocaine and metabolites during intravenous infusion

The blood concentrations of lidocaine and its main active metabolites, methylethylglycinexylidide (MEGX) and glycinexylidide (GX), were measured in 24 newborn infants during anticonvulsive treatment with an iv infusion of lidocaine. After a bolus dose of 1.5-2.2 mg/kg and continuous infusion of lidocaine (4.7-6.3 mg/kg/h) there was accumulation of the drug and MEGX within 24 h. After termination of the iv infusion, both lidocaine and the metabolites were eliminated within 24-48 h. The anticonvulsive effectiveness--estimated by clinical observation and continuous amplitude integrated EEG monitoring (cerebral function monitor)--was immediate in 15 infants (nine term and six preterm). There was no correlation between blood concentrations of lidocaine and metabolites, and anticonvulsive effect (i.e. good, intermediate or no response). No differences in blood concentrations were found between full-term and preterm babies, or between infants with or without birth asphyxia. In combination with a fast withdrawal of the drug, few adverse reactions were seen with the dosages used, even though blood concentrations were high. Routine measurements of lidocaine concentrations during anticonvulsive treatment in neonates seem to be of little clinical value. For evaluation of the anticonvulsive effect and for early detection of seizure activity during lidocaine withdrawal, continuous EEG monitoring is preferable.     

Reactions and serologic responses in young children and infants after administration of inactivated monovalent influenza A vaccine.

Infants, two years of age and under, received zonally purified whole-virus A/Aichi/2/68 (H3N2) influenza vaccine. Febrile responses, including one febrile convulsion, were observed in nine of 13 (69%). There was a fourfold rise in serum-neutralizing antibody in nine of 11 (82%) of those lacking initial antibody titers. Purity of the vaccine was documented by electron microscopy, absence of egg protein, and very low levels of endotoxin (0.048mug/dose). It is concluded that the toxicity of vaccine is related to the virus itself and that, despite the good antibody response, influenza vaccine should be administered only to children two years and under at high-risk of complications from influenza, if at all.     

The maturation of respiratory patterns in normal full term infants during the first six postnatal months. II: Sleep states and apnoea

ABSTRACT. Four term healthy infants had their respiratory pattern monitored during a 2-hour afternoon nap period at monthly intervals up to six months of age. Apnoeas 4 seconds or more at 1 week expressed as a percentage of breaths were significantly more frequent in active sleep than quiet sleep (2.1% vs 0.6%) and increased at 2 months in both sleep states (8.0% and 8.5% respectively) due to the onset of periodic breathing. Apnoeas then decreased in frequency up to 6 months in both sleep states (3.8% and 0.8% respectively). In the first month a startle and/or sigh occurred in 78% of apnoeas in quiet sleep, and gross body movement in 72% of apnoeas in active sleep. Between 4 to 6 months all apnoeas in quiet sleep were preceded by a startle and/or sigh, in contrast to active sleep, where the incidence of gross body movement and apnoea decreased (49%) and apnoea alone increased (48%). These findings confirm a maturational change in the incidence and pattern of apnoea in normal infants from 1 to 6 months.     

Local and serum antibody response in full–term and premature infants after artificial colonization of the intestine with E. coli strain Nissle 1917 (Mutaflor®)

After oral colonization with the non–enteropathogenic E. coli strain Nissle 1917 ( E. coli SK22, Mutaflor®) in 22 full–term and 9 premature infants, the strain was detected in the stools from day 3 after administration and persisted throughout the study. The presence of E. coli SK22 in the intestine evoked a pronounced local, as well as a serum antibody response. The anti–SK22 antibodies of IgA and IgM isotypes in stool filtrates and in serum were significantly higher in colonized infants than in controls. Full–term infants had higher titers of IgA and IgM isotypes in stool filtrates than premature infants. The specific response against E. coli SK22 was higher than the antibody response against a control E. coli strain.