左乙拉西坦与苯妥英作为二线用药治疗儿童惊厥性癫痫持续状态的有效性及安全性的Meta分析

目的 系统评价左乙拉西坦(LEV)和苯妥英(PHT)作为二线用药治疗儿童惊厥性癫痫持续状态(CSE)的有效性及安全性.方法 检索中英文电子数据库,纳入对比LEV和PHT作为二线用药治疗儿童CSE的有效性及安全性的随机对照试验.使用RevMan 5.3软件进行数据分析.结果 纳入7个研究,共1434名患儿.Meta分析结...     

不同维持剂量枸橼酸咖啡因治疗早产儿呼吸暂停疗效和 安全性的 meta 分析

目的系统评价不同维持剂量枸橼酸咖啡因治疗早产儿呼吸暂停的疗效和安全性。方法计算机检索PubMed、The Cochrane Library、OVID、EMbase、Web of Science、CBM、VIP、WanFang和CNKI等数据库,检索从建库至2017年6月,有关高维持剂量[10~20 mg/(kg·d)]和低维持剂量[5~10 mg/(kg·d)]枸橼酸咖啡因治疗早产儿呼吸暂停的随机对照试验(RCT),采用RevMan 5.3和Stata 12.0对纳入研究进行meta分析。结果共纳入8个RCT,包括1 000例患儿。Meta分析结果显示,高维持剂量枸橼酸咖啡因组治疗有效率(RR=1.30,95%CI:1.09~1.56,P=0.003)、心动过速发生率(RR=2.23,95%CI:1.34~3.73,P=0.002)高于低维持剂量咖啡因组,拔管失败率(RR=0.50,95%CI:0.35~0.71,P=0.0001)、支气管肺发育不良发生率(RR=0.82,95%CI:0.70~0.95,P=0.01)低于低剂量咖啡因组,差异均有统计学意义。两组其他不良反应发生率的差异无统计学意义(P0.05)。结论高维持剂量枸橼酸咖啡因治疗早产儿呼吸暂停较低维持剂量组效果更好,而且安全。     

糖皮质激素与静脉注射人免疫球蛋白治疗儿童原发性免疫性血小板减少症meta分析

目的分析糖皮质激素与静脉注射用人免疫球蛋白(IVIG)治疗儿童急性原发性免疫性血小板减少症(ITP)的有效性及安全性。方法计算机检索Pub Med、the Cochrane Database of Systematic Reviews、the Cochrane Central Register of Controlled Trials、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库,手工查阅计算机检索到的文献的参考文献目录,按照纳入与排除标准筛选文献,提取数据和评价纳入文献的质量,采用Revman 5.3软件进行meta分析。结果共检索到相关文献1 500篇,有8篇文献符合纳入标准。meta分析显示,治疗48 h后,糖皮质激素组与IVIG组血小板计数(PLT)??20×109/L的差异有统计学意义(RR=0.77,95%CI:0.67~0.89);亚组分析,甲基泼尼松龙(MP)30 mg/kg与IVIG 1 g/(kg·d)×2 d比较,泼尼松(PDN)4 mg/kg与IVIG 1 g/(kg·d)×2 d比较,差异均有统计学意义(RR=0.66,95%CI:0.47~0.91;RR=0.79,95%CI:0.66~0.95)。治疗24、72 h后,糖皮质激素组与IVIG组血小板计数??20×109/L比较,差异有统计学意义(RR=0.69,95%CI:0.53~0.91;RR=0.82,95%CI:0.74~0.90)。治疗24、48、72 h后糖皮质激素组与IVIG组血小板计数??50×109/L比较,差异有统计学意义(RR=0.38,95%CI:0.21~0.69;RR=0.53,95%CI:0.41~0.69;RR=0.80,95%CI:0.70~0.93)。糖皮质激素组与IVIG组脾切除发生率的差异无统计学意义(RR=5.41,95%CI:0.95~30.74,P=0.06)。结论接受糖皮质激素治疗的急性ITP患儿在初始治疗48 h达到血小板计数??20×109/L的概率较接受IVIG患儿低23%;以在前3天内将血小板计数提升到??50×109/L为初始治疗目标,IVIG的效果更好。     

吸入性糖皮质激素预防早产儿慢性肺疾病有效性和安全性的meta 分析

目的系统评价吸入性糖皮质激素预防早产儿慢性肺疾病(CLD)的有效性和安全性。方法计算机检索Pub Med、EMBASE、CENTRAL、the ISI Web of Knowledge Databases、CBM、CNKI和VIP、Wan Fang Data,检索时限均为建库至2016年10月,搜集所有研究吸入性糖皮质激素防治早产儿CLD的疗效和安全性的随机对照试验(RCT),并进行RCT的筛选、资料提取和质量评价,应用Rev Man 5.3软件进行meta分析。结果共纳入12篇RCT,2 051例早产儿。与对照组比较,28天组吸入糖皮质激素组,以及吸入布地奈德亚组、倍氯米松亚组和氟替卡松亚组,CLD发生率的差异无统计学意义(P均0.05)。与对照组比较,校正胎龄36周组吸入糖皮质激素组(RR=0.70,95%CI:0.61~0.80)、雾化吸入亚组(RR=0.74,95%CI:0.63~0.87)、气管内给药亚组(RR=0.57,95%CI:0.43~0.76)以及布地奈德亚组(RR=0.67;95%CI:0.57~0.78)和氟替卡松亚组(RR=0.58,95%CI:0.36~0.94),CLD发生率的差异有统计学意义(P均0.05);而倍氯米松组CLD发生率与对照组差异无统计学意义(P=0.90);总的病死率差异无统计学意义(P=0.55);雾化吸入亚组和气管内给药亚组以及布地奈德亚组、倍氯米松亚组和氟替卡松亚组病死率与对照组比较差异无统计学意义(P均0.05)。结论预防性使用吸入性糖皮质激素能有效降低早产儿CLD的发病率,但对病死率无影响,与给药方式和给药类型无显著相关性。同时推荐以校正胎龄36周为结局指标观察点,但相关研究数量有限,且缺乏长期随访结果,因此吸入性糖皮质激素的作用及远期并发症,仍需大量的临床研究来评估,建议临床谨慎使用。     

低渗口服补液盐治疗儿童腹泻所致脱水的Meta分析

目的系统评价低渗口服补液盐(ORS)和标准ORS治疗儿童腹泻所致脱水的疗效和安全性。方法计算机检索2014年11月前国内外数据库有关低渗ORS和标准ORS治疗儿童腹泻所致脱水的随机对照实验(RCT),对纳入的研究进行方法学评价后,采用Rev Man 5.3软件对纳入的文献进行Meta分析。结果共纳入24个RCT,合计3236例患者。Meta分析结果显示,使用低渗ORS和标准ORS治疗儿童腹泻所致脱水过程中静脉补液发生率(RR=0.76,95%CI:0.59~0.99,P0.05)和排便量(SMD=-0.53,95%CI:-0.84~-0.21,P0.05),差异有统计学意义。使用低渗ORS和标准ORS治疗儿童腹泻所致脱水过程中呕吐发生率(RR=0.89,95%CI:0.79~1.00,P≥0.05)和低钠血症发生率(RR=1.30,95%CI:0.90~1.87,P≥0.05),差异无统计学意义。结论低渗ORS治疗儿童腹泻所致脱水过程中能有效减少静脉补液发生率和患儿排便量,并不增加呕吐和低钠血症的发生率。     

他克莫司与环孢素A治疗难治性肾病综合征疗效的meta分析

目的评价他克莫司(TAC)与环孢素A(CsA)对难治性肾病综合征(RNS)治疗的有效性。方法查阅PubMed、CochraneLibrary、万方、维普、中国期刊全文数据库(CNKI)计算机检索系统,检索2000年1月至2017年6月间发表的随机对照临床试验,以完全缓解率、总缓解率、复发率作为指标,采用RevMan 5.3软件进行meta分析。结果共检索到相关文献426篇,根据纳入标准及排除标准,最终纳入6篇文献,共包括302例RNS患者。Meta分析结果示,TAC组较CsA组的完全缓解率(RR=2.01,95%CI:1.15～3.51,Z=2.44,P=0.01)、总缓解率(RR=2.53,95%CI:1.10～5.83,Z=2.19,P=0.03)的差异有统计学意义;复发率(RR=0.62,95%CI:0.30～1.27,Z=1.31,P=0.19)的差异无明显统计学意义。结论与CsA相比,TAC在提高RNS的完全缓解率、总缓解率方面占有一定优势。     

地西泮预防热性惊厥复发的疗效与安全性的系统评价和Meta分析

目的 采用Meta分析方法评价间歇使用地西泮预防热性惊厥（FS）复发的疗效及安全性。方法 计算机检索The Cochrane Library(2014年第7期)、PubMed、EMBASE、中国生物医学文献数据库、中国知网、维普中文期刊数据库和万方数据库,收集使用地西泮预防儿童FS复发的RCT文献,检索时限均为建库至2014年7月。由2位研究者按照纳入与排除标准筛选文献,提取数据和评价纳入文献的方法学质量。根据FS复发危险因素行亚组分析。采用RevMan 5.2软件进行Meta分析。结果 9篇RCT文献（n=1 578）进入Meta分析。纳入文献的随机序列产生、分配隐藏和盲法为高度偏倚,选择性报告研究结果、结果的完整性和其他偏倚来源为低度偏倚。①随访6个月地西泮组与对照组FS复发率差异无统计学意义,RR=0.62(95% CI：0.34~1.13), P=0.12;RD=-0.07(95%CI:-0.16~0.02);对FS复发危险因素行亚组分析：地西泮低危险亚组与对照组FS复发率差异无统计学意义,RR=0.69（95%CI：0.40~1.21),P=0.20,中危险亚组与高危险亚组FS复发率显著低于对照组,RR分别为0.31（95%CI：0.15~0.62)和0.24（95%CI：0.10~0.56）。②随访12和24个月地西泮组FS复发率显著低于对照组,RR分别为0.59（95%CI：0.38~0.91）和0.54(95%CI:0.37~0.78);RD分别为-0.12(95%CI：-0.22~-0.02)和-0.17(95%CI:-0.27~-0.07)。对FS复发危险因素行亚组分析：地西泮低危险亚组与对照组FS复发率差异无统计学意义,RR分别为0.81(95% CI:0.47~1.42)和0.71（95%CI：0.45~1.11),中危险亚组与高危险亚组FS复发率显著低于对照组,12个月： RR分别为0.39(95% CI:0.20~0.75)和0.27(95%CI:0.13~0.58);24个月：RR分别为0.43(95%CI：0.24~0.77)和0.35(95%CI：0.19~0.62)。③纳入文献均无地西泮严重不良事件的报告。结论 地西泮间歇给药可有效降低12和24个月FS复发率,对于FS中高危人群显示出较好疗效的趋势,但仍需进一步补充研究明确。     

初乳口腔涂抹/滴注预防早产儿坏死性小肠结肠炎meta分析

目的评价初乳口腔涂抹或滴注预防早产儿坏死性小肠结肠炎的有效性和安全性。方法计算机系统检索PubMed、Ovid-Embase、Web of Science、Cochrane Library、中国知网、万方数据库、维普数据库,收集早产儿初乳口腔涂抹/滴注的随机对照试验(RCT),检索时间从建库至2019年1月。2名研究员独立筛选文献,提取资料并对文献进行质量评价;采用RevMan5.3软件进行meta分析。结果共纳入7篇随机对照试验(研究对象368例)。Meta分析结果显示,与对照组相比,初乳口腔涂抹/滴注早产儿坏死性小肠结肠炎的发生率(OR=0.85,95%CI:0.40～1.79,P=0.67)、住院时间(WMD=-7.09,95%CI:-16. 84～2. 67,P=0. 15)、病死率(OR=0. 64,95%CI:0. 20～2. 06,P=0. 46)的差异均无统计学意义,而达到全肠道喂养时间(WMD=-1.90,95%CI:-2.15～-1.65,P0.01)、抗生素使用天数(WMD=-2.57,95%CI:-4.13～-1.01,P0. 01)的差异有统计学意义。结论初乳口腔涂抹/滴注不能降低早产儿坏死性小肠结肠炎的发生率和病死率,不能缩短早产儿住院天数,但能缩短住院早产儿达到全肠道喂养时间与抗生素使用天数。     

微生态制剂预防儿童抗生素相关性腹泻的Meta分析

目的抗生素在儿童的应用很普遍,最常见的副反应是胃肠道反应,而腹泻是胃肠道反应的直接表现。儿童是否可以常规应用微生态制剂预防抗生素相关性腹泻(AAD)仍存争议。用循证医学评估微生态制剂预防儿童AAD的临床疗效。方法检索Medline(Pub Med作为检索工具)、Ovid、Web of Science、Embase和Cochrane Library、中国生物医学文献数据库,国期刊全文数据库和维普中文科技期刊数据库等,并辅于手工检索,检索时间均从建库至2009-06-31,对同质资料进行Meta分析。结果最终有8篇完全随机对照试验(RCT)符合纳入标准,经Q检验被纳入RCT无统计学意义,应用固定效应模型进行统计分析,微生态制剂组与对照组相比,差异有统计学意义,相对危险度(RR)=0.36,95%CI:0.27～0.48,需要治疗数(NNT)=6.37,95%CI:5.06～8.03。结论微生态制剂在一定程度上能够减少儿童AAD的发生率,且尚无相关副反应的报道,这为儿童抗生素的使用中是否应用微生态制剂提供一定的参考。由于亚组分析单一微生态制剂的RCT尚少,要进一步系统评估具体某一种微生态制剂的预防作用则仍需将来有更多的RCT被纳入。     

β受体阻滞剂治疗婴幼儿血管瘤有效率和安全性的系统评价和Meta分析

目的 系统评价β受体阻滞剂(β-R)治疗婴幼儿血管瘤有效性和安全性。方法 计算机检索Cochrane图书馆、PubMed、EMBASE、Web of Science、中国生物医学文献数据库、中国知网、维普数据库，收集β-R治疗婴幼儿血管瘤的RCT文献，检索时限为建库至2014年11月。由2位研究者按照纳入与排除标准筛选文献，提取数据和评价纳入文献的方法学质量，采用RevMan 5.3软件进行Meta分析。结果 17篇RCT进入Meta分析，共纳入1 097例患儿(β-R组585例，对照组512例)。①普萘洛尔治疗有效率高于泼尼松(OR=6.15, 95%CI：1.69~22.40, P＝0.006)；低于激光(OR=0.13, 95%CI：0.02~0.67, P=0.02)；高于Sr-Y敷贴、维生素E、安慰剂等其他干预措施(OR=22.64, 95%CI：9.16~55.96, P<0.000 01)；与噻吗洛尔治疗有效率差异无统计学意义(OR=0.64, 95%CI：0.31~1.35, P=0.24)。②噻吗洛尔+激光治疗有效率与激光差异无统计学意义（OR=1.80,95%CI:0.14~23.37,P=0.65）；噻吗洛尔有效率高于空白对照(OR=21.80, 95%CI:7.10~66.90, P<0.05)。③普萘洛尔与其他干预措施（Sr-Y敷贴、维生素E、安慰剂）的总体不良事件发生率差异无统计学意义(OR=2.10, 95%CI；0.67~6.58, P=0.20)，普萘洛尔的不良事件发生率低于泼尼松(OR=0.20, 95%CI：0.06~0.65, P=0.007)；高于噻吗洛尔(OR=5.74, 95%CI：2.30~14.36, P=0.000 2)。β-R对患儿的心率、甲状腺功能及肝肾功能无明显影响。结论 β-R治疗婴幼儿血管瘤疗效优于传统的泼尼松，不良事件发生率低于泼尼松。在不同的β-R中，噻吗洛尔体现出与普萘洛尔相近的疗效和较低不良反应的趋向，有待补充研究证实。     

Age-dependency of alpha- and beta-adrenoceptors on thrombocytes and lymphocytes of asthmatic and nonasthmatic children

Among the possible mechanisms which may cause wheezing or asthmatic episodes a genetically determined -adrenoceptor blockade and a hyperresponsiveness of -andrenoceptors has been postulated. Evidence to support this hypothesis stems from an increased bronchial sensitivity to -blockers, a reduced formation of cyclic AMP in response to -adrenergic stimulation and enhanced -adrenergic responses in asthmatic subjects. The recent development of techniques for measuring the specific, high-affinity binding of radiolabeled -and -adrenergic antagonists made it possible to study - and -adrenoceptors in vitro. Based upon the assumption that a change in the number and/or affinity of adrenergic receptors might be a general phenomenon, we have performed - and -receptor binding studies on lymphocytes and platelets from wheezing infants and asthmatic children as well as of infants, children, and adults not suffering from these diseases.Using ¹²⁵[I]-cyanopindolol (ICYP) and ³[H]-yohimbine (HYOH) as highly specific ligands for - and -adrenoceptors, the following results were obtained: (1) Lymphocytes and platelets from control subjects and asthamatics bound similar amounts of ICYP and HYOH and thus showed no differences either in the number or the affinity of - and -adrenoceptors. Lymphocytes and platelets of wheezing and nonwheezing infants also bound the same amounts of the radioligands. (2) In asthmatic children receiving 4×2 puffs salbutamol -adrenoceptor were down-regulated and this may mimic -adrenoceptor blockade. (3) When subjects were divided into four categories according to age (0–5, 5–10, 10–20 years, adults) the number of -adrenoceptor binding sites showed an age-dependent increase. The number and affinity of -adreneceptor binding sites on platelets was neither influenced by age nor disease.It is concluded that the - and -adrenoceptors of wheezing infants and asthmatic children at least on blood cells are normal. However the -adrenoceptors show an age-dependent maturation process, which may account for an unresponsiveness to -adrenoceptor agonists in wheezing infants.Supported by a grant from the Ministerium für Wissenschaft und Forschung, NRWPresented at the 19th Workshop for Pediatric Research, University of Göttingen, March 10–11, 1983     

Parent Preferences and Perceptions of Milliliters and Teaspoons: Role of Health Literacy and Experience

Background and Objectives

A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience.

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??The physiological characteristics of children determine their own particularity of their needs for the quality and quantity of proteins. Proteins not only play an important role in the development of children’s growth and development??cognitive function and immune function??but also have important effects on the long-term health of children.In this paper??the dietary protein reference intakes??amino acid patterns??dietary amino acid reference intakes??sources of high quality protein??and harm of deficiency and excess of protein in children were discussed in detail.     

婴幼儿膳食营养与生长发育指标调查

目的确定当前3岁以下儿童主要的营养问题，为制定营养改善对策提供科学依据。方法对在本院儿童保健中心定期进行体检的386例6—36个月儿童进行体格测量及智力发育检测，并同时进行膳食分析。结果膳食中能量、蛋白质、视黄醇、硫胺素、抗坏血酸及铁、钙的摄入均达到膳食营养素参考摄入量（DRIs）标准，膳食锌平均摄入量未达到DRIs的80％。Logistic回归分析提示碳水化合物摄入量过高是婴幼儿肥胖的一个危险因素。能量和碳水化合物摄入越多，智力发育指数越高。结论婴幼儿生长发育和膳食状况良好，父母要注意培养婴幼儿科学的膳食习惯。     

Prenatal and postnatal administration of prebiotics and probiotics

Colonization of the neonatal gut by beneficial bacteria is important for the establishment and maintenance of the mucosal barrier, thus protecting the neonate from enteric pathogens and local and systemic inflammation. The neonatal microbiome is influenced by infant diet, environment, and the maternal microbiome. Dysbiosis in pregnancy increases the risk of pre-eclampsia, diabetes, infection, preterm labor, and later childhood atopy. Dysbiosis of the neonatal gut plays an important role in colic in the term infant, in the disease processes which plague preterm infants, including necrotizing enterocolitis and sepsis, and in the long-term outcomes of neonates. Administration of enteral prebiotics, probiotics, and synbiotics during pregnancy, lactation, and postnatal life appears to be a safe and feasible method to alter the maternal and neonatal microbiome, thus improving pregnancy and neonatal outcomes.     

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??Bronchiolitis has been one of the hot spots in the researches on diseases of respiratory system nowadays. However?? the concepts and classifications of this disease remain unclear. In this paper?? the denotative and connotative concepts of bronchioles and bronchiolitis were analyzed from the views of anatomy and development biology?? and the classification changes of adult bronchiolitis were introduced. These content can be used as references for the systematic studies of pediatric bronchiolitis.     

Caring for the health and medical and emotional needs of children of migrants and asylum seekers

Political turmoil, military conflicts and other international sociological upheavals are causing significant immigration of large numbers of people, including infants and children, in Europe. Many of these young migrants are refugees. These youngsters have significant health needs, and medical conditions (such as infectious diseases) and mental health problems due to their previous stressful situations and the difficulties that they often experience while settling, even temporarily, into their new environments. Government authorities must screen for transmissible diseases and ensure that vaccine-preventable infections are adequately covered. Paediatricians must give the best possible care for these children and act as their advocates. This can be enhanced by collaborating with national and international paediatric societies and with international non-government agencies. This problem is not confined to Europe; world-wide, it occurs on a massive scale and causes huge burdens for poorer countries that have serious difficulties in coping with the extra financial, personnel and infrastructure needs imposed by massive, uncontrolled migration of populations that are often unhealthy and inadequately nourished. However, this should not be used as a pretext to deny safe refuge to children and their families who need it.

Conclusion: Massive movements of infant and child immigrants and refugees across European borders over recent years have brought challenges to paediatricians because of the needs for the health and medical and mental health care of these young people. Paediatricians have an important role in their care and by acting, wherever possible, as their advocates. This is a massive problem, world-wide, in which paediatricians can have a potentially significant positive impact.