缺铁性贫血对婴幼儿生长发育及睡眠质量的影响

目的探讨缺铁性贫血(IDA)对婴幼儿生长发育以及睡眠质量的影响,为临床防治婴幼儿IDA提供参考依据。方法选择2016年3月-2017年1月首都医科大学附属北京潞河医院保健科收治的85例IDA患儿为研究对象(轻度组49例、中重度组36例),并以同期50例健康婴幼儿为对照组,比较各组研究对象2岁时生长发育指标及睡眠质量指标。结果身高、身高增长率、体质量、体质量增长率、适应性、大运动、精细运动、语言、个人社交及平均DQ均按对照组、轻度IDA组、中重度IDA组依次降低,任意组间比较差异有统计学意义(均P0. 05);轻度IDA组、中重度IDA组夜间觉醒次数多于对照组,夜间睡眠时间少于对照组,轻度IDA组、中重度IDA组夜间觉醒次数、夜间睡眠时间两组间比较,差异无统计学意义(均P0. 05),对照组、轻度IDA组、中重度IDA组入睡潜伏时间依次升高,两两比较差异有统计学意义(均P0. 05)。结论 IDA对婴幼儿的生长发育及睡眠节律均有严重的不良影响,积极预防IDA的发生对婴幼儿的健康发育及我国人口素质的提高均有重要的临床意义。     

阿尔茨海默病与睡眠-觉醒节律紊乱

昼夜节律是生物对周期性出现的生存环境所作出的适应性反应,是生命体的基本特征之一,如睡眠-觉醒、静息-活动、体温、激素和认知功能等均在24 h内呈周期性变化。睡眠-觉醒节律循昼夜节律而变化,表现出睡眠和觉醒交替的规律,其调控中枢为视交叉上核(suprachiasmatic nucleus,SCN),睡眠的生物节律对调控精神心理、生理及认知功能等具有重要作用。在老年人群中,睡眠-觉醒节律紊乱是阿尔茨     

婴幼儿睡眠与认知发育相关性研究进展

婴幼儿期是儿童睡眠/觉醒模式昼夜节律发展形成的关键时期。婴儿早期快速动眼-非快速动眼睡眠周期结构异常可能是神经系统发育落后的早期表象,对其日后神经系统发育状况有预测作用;婴幼儿夜晚睡眠时间长,在矛盾解决能力、冲动控制能力、任务相关记忆力等任务执行的相关能力方面表现相对较好。此外,婴儿连续睡眠能力与认知发育水平之间也存在相关性,但在不同年龄点的研究结果不完全一致。目前国内外关于婴幼儿睡眠与认知发育之间的相关性研究资料积累十分有限,尤其是针对健康婴儿的纵向研究亟待开展。     

缺铁性贫血对婴幼儿生长发育及睡眠质量的影响

目的:研究缺铁性贫血对婴幼儿生长发育及睡眠质量的影响。方法:以103例缺铁性贫血患儿为研究对象,按贫血严重程度分为轻度组(41例)、中度组(39例)及重度组(23例),选取47例同年龄段健康婴幼儿为对照组,比较各组间婴幼儿生长发育及睡眠情况。结果:缺铁性贫血随病情严重程度的加深,婴幼儿体重、身长、头围、胸围与对照组比较均出现不同程度的降低或减少;夜间觉醒次数、夜间睡眠时间及入睡潜伏时间缺铁性贫血轻、中、重3组与对照组比较均有统计学差异(P<0.05),但缺铁性贫血轻、中、重3组间无统计学差异(P>0.05)。结论:缺铁性贫血对婴幼儿的生长发育及睡眠失衡危害严重,应积极应对采用相关措施预防婴幼儿缺铁性贫血的发生。     

6月龄婴儿夜晚睡眠-觉醒模式现状及影响因素分析

目的 评估海淀街道6月龄婴儿的夜晚睡眠-觉醒模式及其影响因素,为进一步评估指导婴儿早期睡眠提供参考依据。方法 通过Actiwatch腕表式活动记录仪评估6月龄婴儿的夜晚睡眠-觉醒模式,同时对影响夜晚睡眠的相关因素进行分析。结果 6月龄婴儿夜晚睡眠时间为(477.43±60.24)min,夜晚最长连续睡眠时间为 (312.60±106.00)min,夜晚入睡潜伏期为(19.06±14.53)min,夜晚平均觉醒次数为(2.24±1.21)次;单因素分析结果提示睡前1 h唱催眠曲(t=-2.158,P=0.039)是影响夜晚睡眠时间的因素;性别(t=-2.57,P=0.016)、喂养方式(t=-2.391,P=0.028)、睡前1 h抚触(t=-2.133,P=0.027)是影响夜晚最长连续睡眠时间的因素;是否同一时间放到床上(t=2.882,P=0.011)、睡前1 h洗澡或洗臀部(t=-2.314,P=0.026)、抚触(t=-2.888,P=0.011)是影响夜晚入睡潜伏期的影响因素;单独一人在小床上入睡(t=-2.091,P=0.045)是夜醒次数的影响因素;多因素结果提示夜晚睡眠时间与入睡前抚触呈线性相关(t=-2.158,P=0.039),夜晚最长连续睡眠时间与婴儿性别呈线性相关(t=-2.083,P=0.047),夜醒次数与单独一人在小床上睡眠呈线性相关(t=-2.091,P=0.045)。结论 家长的睡眠养育行为是影响婴儿的夜晚睡眠-觉醒模式的重要因素,加强对婴幼儿正确睡眠养育行为习惯的宣教力度,纠正不良的睡眠养育行为,促进婴儿夜晚睡眠能力的发展。     

睡眠养育照护行为与儿童健康

儿童早期是睡眠/觉醒模式发展变化迅速的一个阶段,不恰当的睡眠养育照护方式将会导致婴幼儿睡眠问题的高发.一旦出现睡眠问题,将会对儿童的体格生长、认知发育、情绪行为等方面造成不良影响.为了提高婴幼儿睡眠质量,预防睡眠问题的发生,儿童保健医生应积极为养育照护者提供婴幼儿睡眠健康知识宣传和预见性指导,引导养育照护者采取科学的睡...     

北京市海淀区婴儿期夜晚睡眠-觉醒模式的纵向研究

目的 应用Actiwatch评估婴儿出生后第一年夜晚睡眠-觉醒模式发展变化轨迹,为评估指导婴儿早期睡眠提供参考依据。方法 调查2009年10月-2011年10月期间,在北京市海淀区妇幼保健院分娩的32例婴儿在家庭自然环境状态下前瞻性追踪婴儿0~12个月的夜晚睡眠-觉醒模式的发展轨迹,监测年龄点包括出生后1~6、9、12月龄各1次,共8次。观察时间为每次60 h。通过Actiwatch腕表式活动记录仪采集各监测年龄点的睡眠-觉醒信息。结果 随着年龄的增长,婴儿夜晚总睡眠时间(366.07~497.04 min)和最长连续睡眠时间(213.21~381.10 min)逐渐延长,婴儿夜晚总睡眠时间5月龄与出生后1月龄相比增加了102.57 min、最长连续睡眠6月龄与1月龄相比增加了99.39 min,差异均有统计学意义(t=4.12、5.45,P均＜0.05)。婴儿的入睡潜伏期(56.85~15.13 min)和夜晚觉醒次数(2.83~1.60次)随月龄增长呈下降趋势,婴儿入睡潜伏期4月龄相比1月龄降低了29.65 min、夜晚觉醒次数5月龄相比1月龄减少了0.36次,差异均有统计学意义(t=9.47、3.51,P均＜0.05);相邻年龄点比较及不同性别比较差异均无统计学意义。结论 海淀区海淀街道婴儿夜晚睡眠-觉醒模式在生后4~6个月内变化发展最为迅速,随年龄增长婴儿夜晚入睡能力和连续睡眠能力增强。     

新生儿睡眠/觉醒状况与认知发育的相关性研究

目的探讨月龄为1个月新生儿的睡眠/觉醒状况及其6个月龄时的认知发育水平的关系,并进行相关性分析,进一步探讨婴儿早期睡眠/觉醒状况对认知发育的影响。方法选择2009年10月至2013年12月在青岛市妇女儿童医院定期进行体格检查的39例足月健康儿童为研究对象。采用腕表式睡眠活动记录仪,对39例受试者的睡眠/觉醒状况进行连续客观监测,并采用Bayley婴幼儿发育(BSID)量表测定其6个月龄时的认知发育水平[以智力发展指数(MDI)和精神运动发展指数(PDI)表示],并对二者进行相关性分析。本研究遵循的程序符合青岛市妇女儿童医院人体试验委员会制定的伦理学标准,得到该伦理委员会审批通过,且征得受试对象监护人的知情同意,并与其监护人签署临床研究知情同意书。结果 1男性与女性受试者的平均MDI分别为109.8±8.2与107.9±10.7;平均PDI分别为106.9±12.9与103.4±14.9,男性与女性受试者间的MDI、PDI比较,差异均无统计学意义(t=1.331,1.109;P>0.05)。同时,受试者人口社会学特征相比,差异亦无统计学意义(P>0.05)。2在控制受试者性别和相关人口信息学指标后,睡眠/觉醒参数中早上觉醒时间与PDI呈负相关关系(r=-0.329,P<0.05),其余睡眠/觉醒参数与PDI间均无相关性关系(P>0.05)。此外,各睡眠/觉醒参数与MDI间亦均无相关性(P>0.05)。结论新生儿期睡眠/觉醒状况与早期认知发育存在相关性关系,应重视婴儿早期的睡眠健康以促进其认知发育。     

我国婴幼儿睡床方式及其对睡眠结局影响的研究

目的 了解我国婴幼儿睡床方式现状、影响因素及其对睡眠结局的影响。方法 于2012-2013年按照“省-市-县-医院”的抽样技术路线,抽取全国8省市1 304名0~35月龄足月、健康婴幼儿作为研究对象。通过家长填写《简明婴幼儿睡眠问卷》( BISQ)和自编《儿童个人及家庭社会环境问卷》了解婴幼儿睡床方式、睡眠模式及人口统计学因素。结果 婴幼儿平均为(12±10)月龄,男婴占53.8%。婴幼儿与父母同床睡的比例高达84.8%,同房睡为13.2%,独立睡为2.0%。相比6月龄以下婴幼儿,≥6月龄同床睡比例显著较高,同房睡显著较低(P均<0.05),而独立睡无组间差异(P>0.05)。多因素Logistic回归分析显示,婴幼儿年龄≥6月龄、家庭人均月收入≤3 000元和居住郊区是同床睡的风险因素。一般线性回归分析显示,在矫正混杂因素后,同床睡对所有睡眠结局参数的预测作用均不显著(P均＞0.05)。结论 同床睡是我国0~35月龄婴幼儿最常见的睡床方式,发生率远高于欧美国家,与婴幼儿月龄和社会经济状况相关,但未发现其对睡眠结局有直接影响。     

婴幼儿睡眠障碍现状分析

目的:了解婴幼儿睡眠障碍的发生情况,分析其影响因素。方法:于2007年12月～2009年6月在该院儿保门诊进行常规体检的婴幼儿126例,由专人负责指导家长填写睡眠情况调查表。结果:婴幼儿睡眠障碍发生率31.75%,除昼夜节律紊乱婴儿发生率明显高于幼儿(χ2=3.85,P<0.05)外,其他方式的睡眠障碍婴儿与幼儿之间的差异无统计学意义。男女性别之间差异具有统计学意义(χ2=5.10,P<0.05),2～3岁男、女童之间差异有统计学意义(校正值χ2=4.06,P<0.05)。婴幼儿睡眠障碍主要与喂养方式、居住环境、父母睡眠习惯、睡前因素、睡眠依赖、睡眠规律等因素有关。结论:婴幼儿睡眠障碍发生率较高,社会及家庭应重视婴幼儿睡眠问题,促进其正常生长发育。     

Risk factors of sudden infant death syndrome and risk factors for sleep disturbances

Relationship between major risk factors of sudden infant death syndrome (SIDS) and sleep disorders in the infants is the subject of review and discussion. Improper micro‐environmental characteristics (especially poor environmental organisation and lack of developmental stimulation), pre‐term delivery and/or infant low birth weight, prone sleep position, maternal smoking during pregnancy, and infant–parent(s) bed‐sharing are among well‐established risk factors of SIDS. These factors may also be associated with sleep disorders in infants, principally with bedtime problems, abnormal night awakenings, and arrhythmic sleep. As an attempt to fix sleep problems, some inexperienced parents may try infant‐rearing practices that may only aggravate sleep troubles and lead to further increased risk of SIDS, thus giving start to a vicious circle. Health care providers need to be aware of such situations as an opportunity to provide parents with guidance with respect for individual infant and family characteristics.     

顺义区0~6月龄婴儿睡眠模式与夜醒关系的队列研究

目的 分析顺义区0~6月龄婴儿睡眠模式,为婴儿早期睡眠指导提供参考。方法 采用队列研究的方法,在顺义妇幼健康之约队列研究中招募220例健康新生儿,在42天、3月龄、6月龄进行随访,使用简明婴儿睡眠问卷(BISQ)评估婴儿睡眠模式和睡眠问题。结果 0~6月龄婴儿白天和夜晚睡眠时间变化显著,白天睡眠时间从42天(6.0±2.3)h逐渐下降至6月龄(3.8±1.5)h,夜晚睡眠时间从42天(6.9±2.2)h逐渐上升至6月龄(8.1±2.3)h。42天、6月龄婴儿夜醒次数与奶睡呈正相关(β=0.69、0.80,P<0.001)。结论 婴儿睡眠模式在生后6个月变化明显,奶睡的方式与夜醒次数明显相关,家长应采取正确的入睡方式以减少婴儿睡眠问题的发生。     

深圳市婴儿睡眠现状流行病学研究

【目的】 通过对深圳市婴儿睡眠现状的调查研究,了解婴儿睡眠存在的问题,分析可能影响婴儿睡眠问题的危险因素,为儿科和儿童保健工作者解决婴儿睡眠问题提供科学依据。 【方法】 采用分层随机整群抽样的方法抽取全市5家社区健康服务中心共904名婴儿父母进行问卷调查及气质测试。 【结果】 深圳市婴儿睡眠问题发生率为43.0%; 2) 婴儿睡眠姿势6月龄前以仰卧为主,6月龄后侧卧、不固定姿势均随着月龄增长逐渐增多, 婴儿自行入睡及需外界帮助入睡方式均与月龄无关;3)影响婴儿睡眠问题的主要因素有父母缺乏睡眠知识,婴儿难养型气质、夜间睡眠开灯等。 【结论】 婴儿睡眠问题已引起父母广泛关注,父母缺乏睡眠知识而又过多干预婴儿睡眠,是婴儿建立正常的睡眠模式主要相关危险因素。     

Type of Milk Feeding and Introduction to Complementary Foods in Relation to Infant Sleep: A Systematic Review

Inconsistent conclusions from infant sleep and feeding studies may influence parents feeding-related decisions. This study aimed to systematically review the existing literature on infant sleep and its relation to the timing of introduction to complementary foods and type of milk feeding to better understand their role(s) in infant sleep. Cohort, longitudinal, cross-sectional studies, and controlled trials were identified using online searches of five databases up to April 2020. Twenty-one articles with a total of 6225 infants under 12 months-of-age were eligible. Exclusively breastfed infants (≤6 months-of-age) had a greater number of night wakings, but most studies (67%) reported no difference in night-time and 24 h sleep duration compared to formula-fed infants. However, after 6 months-of-age, most studies (>65%) reported breastfed infants to sleep less in the night-time and over 24 h compared to formula-fed infants. Furthermore, studies reported no association between the timing of introduction to complementary foods and infant sleep duration (<12 months-of-age). Future studies using standardized methodologies and definitions, transdisciplinary expertise, and longitudinal design are required to better understand the complex role of feeding on sleep.     

MEDICAL RESEARCHES: A RESOURCE FOR ALERTING PARENTS AND CAREGIVERS

Iron deficiency anemia is a nutritional and medical risk factor that has been implicated in lowered developmental scores, as well as increased irritability and solemnity of infants. The present research examined possible further risk correlates of iron deficiency anemia (IDA) in the medical dossiers of 9 to 12 month old infants (M= 10 months) comprising three low-socioeconomic culture groups, French, African, and North African Muslim, in a Bilan de Sante health clinic in Paris, France. Using a strict dual criteria on measure of IDA: low hemoglobin (Hg ≤ 10.5) and low mean corpuscular volume levels, MCV ≤ 73), a trend was found for increased respiratory disease, such as otitis media and bronchitis, in infants with iron deficiency anemia. Medical monitoring and nutritional informational efforts with families can help prevent iron deficiency anemia and its risk sequelae for infants.     

Airway covering during bed-sharing

Background Parent–infant bed‐sharing is a common practice in Western post‐industrial nations with up to 50% of infants sleeping with their parents at some point during early infancy. However, researchers have claimed that infants may be at risk of suffocation or sudden infant death syndrome related to airway covering or compression in the bed‐sharing environment. To further understand the role of airway covering and compression in creating risks for bed‐sharing infants, we report here on a sleep‐lab trial of two infant sleep conditions. Methods In a sleep‐lab environment 20 infants aged 2–3 months old slept in their parents' bed, and in a cot by the bed, on adjacent nights. Infants' oxygen saturation and heart rate were monitored physiologically while infant and parental behaviours were recorded via ceiling‐mounted infra‐red cameras. Infants served as their own controls. Continuous 8‐h recordings were obtained for covering of infant external airways, levels of infant oxygen saturation, infant heart rate, evidence of parental compression/overlying of infant, circumstances leading up to potential infant airway obstruction, and parental awareness of and responses to infant airway covering. Results The majority of infants (14/20) spent some part of the bed night with their airways (both mouth and nose) covered, compared with 2/20 on the cot night; however, no consistent effect on either oxygen saturation levels or heart rate was revealed, even during prolonged bouts of airway covering. All cases of airway covering were initiated by parents; 70% were terminated by parents, the remainder by infants. Seven bouts of potential compression were observed with parental limbs resting across infant bodies for lengthy periods, however, in only two cases was the full weight of a parental limb resting on an infant, both events lasting less than 15 s, both being terminated by infant movement. Conclusion Although numerous authors have suggested that bed‐sharing infants face risks because of airway covering by bed‐clothes or parental bodies, the present trial does not lend support to this hypothesis.     

Complementary Feeding and Iron Status: “The Unbearable Lightness of Being” Infants

The complementary feeding (CF) period that takes place between 6 and 24 months of age is of key importance for nutritional and developmental reasons during the transition from exclusively feeding on milk to family meals. In 2021, a multidisciplinary panel of experts from four Italian scientific pediatric societies elaborated a consensus document on CF, focusing in particular on healthy term infants. The aim was to provide healthcare providers with useful guidelines for clinical practice. Complementary feeding is also the time window when iron deficiency (ID) and iron deficiency anemia (IDA) are most prevalent. Thus, it is appropriate to address the problem of iron deficiency through nutritional interventions. Adequate iron intake during the first two years is critical since rapid growth in that period increases iron requirements per kilogram more than at any other developmental stage. Complementary foods should be introduced at around six months of age, taking into account infant iron status.     

婴幼儿缺铁性贫血的现状及其影响因素分析

目的 了解婴幼儿缺铁性贫血的现状并探讨其主要影响因素。方法 随机抽取江苏丹阳6～24月的婴幼儿及其看护人作为调查对象, 对婴幼儿进行体格测量、血红蛋白和微量元素铁的测定, 通过对其监护人的现场问卷调查获得婴幼儿、母亲及父亲的基本情况、母亲孕期及哺乳期相关情况、家庭一般情况、婴幼儿喂养情况、家庭饮食习惯、接受健康教育情况等相关资料。应用多因素非条件二分类Logistic回归分析筛选婴幼儿缺铁性贫血的主要影响因素。结果 婴幼儿贫血患病率为23.32%。过早或过晚添加辅食、母亲孕晚期是否贫血、是否添加富含铁的食物、母亲哺乳期营养状况、家庭年人均收入、母亲文化程度、是否接受育儿指导等7个因素是婴幼儿缺铁性贫血的主要影响因素。结论 应重点针对当地经济条件较差、父母亲文化水平低的地区开展多种形式的健康教育, 提倡科学喂养, 合理地添加辅食, 多措并举才能降低婴幼儿缺铁性贫血患病率。     

重庆市城区0～5岁儿童睡眠状况的流行病学调查

【目的】了解重庆城区5岁以下儿童睡眠状况，为培养儿童良好的睡眠习惯提供理论依据。【方法】随机抽取本市2个主要城区1363名0～5岁儿童进行睡眠状况的问卷凋查。【结果】儿童每天总睡眠时间和白天睡眠时间随年龄增长逐渐缩短．夜间睡眠时间逐渐延长，8月龄夜间持续睡眠形成。睡眠昼夜节律于4月龄开始形成。和国内《儿童保健学》和尼氏儿科学比较，重庆城区儿童在3岁前的各年龄段的睡眠时间均减少1h左右。睡眠障碍总患病率为35．22％。女童入睡困难和睡眠节律紊乱的患病率较高。男童打鼾的患病率较高。2岁以下儿童以夜醒、睡眠节律紊乱、入睡过早、夜惊、打鼾、呼吸暂停多见．2岁以上儿童以入睡困难、梦话、磨牙多见。【结论】本市儿童总睡眠时间少于国内外教科书上的参考标准．睡眠障碍的发生率较高。