儿童保健

900933 海南省(汉区)农村七岁以下儿童体格发育调查报告/海南省(汉区)儿童体格发育调查协作组∥海南医学。-1990,1(1)。-18～20,3 从初生到不满七岁的儿童分22个年龄组,随机抽出每个年龄组男女各200名。主要测查体重、身高、坐高、胸围、头围等五项形态指标。各项指标均随年龄而增长的趋势,年龄越小,增长越快,以出生首半年内增长最速。头胸围均值交叉时间在18～21月。身高体重指数     

经颅多普勒检测儿童偏头痛的临床研究

目的　观察儿童偏头痛发作时和间歇期颅底血管血流动力学的改变。方法　采用经颅多普勒 (TCD)测量 2 0例正常儿童及 37例儿童偏头痛发作时颅内各血管的血流速度 ,使用计算机自动测量平均血流速度 (Vm)。结果　以 2 0例健康儿童为对照组 ,37例偏头痛儿童的大脑中动脉 (MCA)、大脑前动脉(ACA)、大脑后动脉 (PCA)、基底动脉 (BA)、椎动脉 (VA)的Vm均明显高于对照组 ,组间比较有显著差异(P <0 .0 1)。结论　偏头痛儿童可能有大脑半球脑血管舒缩功能障碍 ,TCD通过对儿童偏头痛脑血流速度的检测 ,有助于偏头痛的诊断和药物选择。     

上臂围与头围比值对评估婴幼儿营养状况的价值探讨

对桂林市600名2岁以内婴幼儿进行了上臂围、头围、身高和体重的测量。结果提示头围与身高、上臂围与体重均呈正相关,各年龄组的上臂围/头围值相近,并与体重呈高度正相关(P<0.01)。用上臂围/头围值>0.37和<0.27对本组对象进行筛选,在所抽出的9名营养过剩及11名营养不良儿中,其上臂围值均大于或小于同年龄组均值的2S 以上。用上臂围/头围值评估2岁以内婴幼儿营养状态,比仅用上臂围值法更准确和客观.     

乌鲁木齐市7岁以下维、汉族儿童体格发育调查

目的 调查乌鲁木齐市0～6岁维、汉族儿童生长发育现状,为提高儿童健康水平提供理论依据.方法 用整群随机抽样方法,调查乌鲁木齐市7区1县0～6岁维、汉族儿童体格发育状况,包括体重、身高、坐高、头围、胸围5项指标;用Z评分法评价0～6岁儿童体格发育状况.结果 0～6岁维、汉族儿童各项生长指标随年龄增长而增长,以小年龄组增长最快;同年龄的男童体重、身高均值大于女童;同年龄、同性别维、汉族儿童体重和身高之间差异无统计学意义,其余生长发育指标差别有统计学意义.乌鲁术齐市维、汉儿童体重、身高均值达到世界卫生组织颁布的标准.结论 乌鲁木齐市维、汉族儿童生长发育存在性别和民族差异,生长发育水平与2005年九市城区儿童体格发育相当,达到2006年世界卫生组织颁布的儿童生长标准.     

正常儿童彩色经颅多普勒检测值研究

目的 应用彩色经颅多普勒(TCD)技术,检测正常儿童各年龄组TCD参数,旨在确立正常值范围.方法 对2004-2006年健康儿童颅内血管TCD检测的、资料数据完整的100例不同年龄段的结果进行统计学分析.结果 不同年龄段各组儿童颅内大脑前动脉(ACA)的平均血流速度(Vm)为(73.13±10.30)cm/s、收缩期流速(Vs)为(96.105±13.00)cm/s、舒张期流速(Vd)为(48.20±10.00)cm/s、血管搏动指数(PI)为0.88±10.10、血管阻力指数(RI)为0.56±0.15;大脑中动脉(MCA)的Vm为(96.10±11.06)cm/s、Vs为(138.00±14.00)cm/s、Vd为(68.00±8.00)cm/s、PI为(0.80±0.15)、RI为(0.53±0.20);大脑后动脉(PCA)的Vm为(53.00±12.20)cm/s、Vs为(85.20±12.10)cm/s、Vd为(42.06±6.00)cm/s、PI为(0.85±0.19)、RI为(0.52±0.12);颈内动脉颅内段(ICA)的Vm为(83.16±16.05)cm/s、Vs为(129.00±13.81)cm/s、Vd为(58.10±11.22)cm/s、PI为0.80±0.26、RI为0.60±0.14;椎动脉(VA)的Vm为(59.00±10.04)cm/s、Vs为(86.00±15.00)cm/s、Vd为(39.00±7.00)cm/s、PI为0.88±0.21、RI为0.57±0.26;基底动脉(BA)的Vm为(60.00±11.00)cm/s、Vs为(73.00±13.00)cm/s、Vd为(38.00±7.00)cm/s、PI为0.72±0.17、RI为0.52±0.22.结论 TCD各参数正常值范围的建立,使儿童TCD检查结果更为客观真实,对提高儿童TCD检查的阳性率、降低假阳性率尤为重要.     

营养性疾病

941550用上臂围/头围比值判断,J“)L营养状况/任杰…/’/山西医学院学报一1994,25(l)一33一35 1993年1一5月对太原市300名3岁以内小儿分别测量体重、身高、头围和上臂围,以判断小儿的健康水平。结果显示头围与身高、上臂围与体重均呈高度正相关(p<0.01),而各年龄组的上臂围‘头围比值均相近。用上臂围/头围比值>0.37和<0.27对本组小儿进行筛选,在所抽出的4名营养不良儿及8名肥胖儿中,其上臂围值均小于或大于同年龄组均值的两个标准差以上。提示用上臂围/头围比值结合上臂围值评估3岁以内小儿的发育营养状况是较准确且方便易行的客观指标。…     

基础医学

城乡视力正常的健康儿童少年比体重·比胸围指数李耀伦中华预防医学杂志18(4):233,1984 作者对3997例城乡视力正常的健康儿童少年的比体重·比胸围指数(Vervaeck指数)进行了研究。城市男、女生和农村女生从8岁起及农村男生从9岁起各年龄组Vervaeck指数均值有随年龄组增加而增大的趋势。城乡男女生各年龄组从12岁起Vervaeck指数均值都达到     

白银地区502例小儿血红蛋白、红细胞计数测定结果总结

我院1991年3～5月对白银市所属的某托儿所502名健康小儿进行了血红蛋白(Hb)及红细胞计数(RBC)测定,其中男275名,女227名,年龄为2～7岁。经统计学处理,被调查儿童Hb、RBC、MCH总的均值分别为:142.49±18.61g/L、4.75±0.72×10~(12)/L、29.82±2.54pg。各年龄组的Hb、RBC、MCH均值相近,且男女比较Hb、RBC总的均值、各年龄组均值亦相近,P>0.05,说明无论年     

青岛市0岁～14岁儿童生长发育指标的调查以及与现行评价标准的比较

为获得青岛市当前0岁－14岁儿童身高和体重的发育资料，包括年龄别身高，年龄别体重和身高别体重，并与目前所用标准比较，随机对8802名0岁－14岁健康儿童进行身高和体重测量，其中男4399岁，女4403名，各分为23个年龄组，获取各年龄组身高和体重的平均值及标准差，各身高段的体重平均值及标准差。用统计学方法与目前国内使用的全国9城市调查标准（1985年）及WHO推荐标准（1997年）进行比较。结果：取得了青岛市0岁－14岁男女童各年龄组的身高、体重正常平均值及标准差，各身高段的体重标准；大多数年龄组的身高与体重均值高于全国九城市调查标准及WHO推荐标准。提示青岛地区0岁－14岁儿童体格发育水平已达到或超过WHO标准，建议在评价儿童生长发育时应使用新的标准。     

成都地区脑性瘫痪患儿422例伴发小头畸形临床分析

目的分析伴小头畸形脑性瘫痪(脑瘫)患儿的临床特征,为合理康复管理提供依据。方法总结2013年2月至4月对成都市辖区残联登记为脑性瘫痪的0～18岁儿童进行了横断面调查结果,共计422例。根据头围对患儿进行分组,分析脑瘫患儿头围与粗大运动功能损伤程度(GMFCS)、智力、合并症等相关性。结果两组不同程度头围组与GMFCS分级的分布情况差异有统计学意义(P=0.001)、两组不同程度头围组与认知分级分布情况差异有统计学意义(P0.001),Spearman相关分析示伴小头畸形脑瘫患儿的伴发障碍数量、GMFCS和认知损伤程度与头围呈负相关(P0.001)。结论伴小头畸形的脑瘫患儿头围减小程度与GMFCS、伴发障碍的数量和认知损伤程度呈负相关。     

Transient stenoses and occlusions of main cerebral arteries in children —diagnosis and control of therapy by transcranial Doppler sonography

Flow disturbances in main cerebral arteries may cause severe neurological symptoms. Using transcranial Doppler sonography (TCD) the blood flow velocities in the basal cerebral arteries (BCA) can be recorded at any age. Transient stenoses or occlusions of main cerebral arteries were detected in 11 children by this method and confirmed by other techniques. Vasospasm produced a marked increase in flow velocities in the affected arteries which was reduced by nimodipine, the calcium channel blocker. Vasospasm also occurred in severe bacterial meningitis. In acute hemiplegia due to cerebral arterial obstruction no flow velocities could be recorded at the corresponding site. If distal branches were obstructed reduced flow velocities were found proximally. Increased flow velocities or reversed flow in anastomoses indicated the collateralization. The transient nature of the occlusions was shown by repcated recordings. TCD is a reliable, noninvasive and rapidly available technique for diagnosing or excluding transient flow disturbances in the main cerebral arteries as the cause of neurological symptoms in children. It indicates the necessity and most advantageous stage for therapy.Abbreviations ACA anterior cerebral artery - BCA basal cerebral artery (-ies) - CT computed tomography - ICA internal carotid artery - MCA middle cerebral artery - MFV mean peak flow velocity - PCA posterior cerebral artery - TCD transcranial Doppler sonography     

Children of Alcoholic Mothers: Growth and Motor Performance Compared to Matched Controls

ABSTRACT. Twenty-one children born 1970-76, selected from 103 children of 30 alcoholic women, were paired to controls matched for sex, age, birth weight and gestational age. The sample (10 girls, 11 boys) was representative of the whole group with regard to weight, length and head circumference at birth. At follow-up (mean age 70 months) the study group was significantly leaner, shorter and had smaller mean head circumference than the control group. The controls had significant catch-up growth from birth to follow-up of weight, height and head circumference to the mean for Swedish children. The study group had no catch-up growth. Compared to controls the study group had significantly lower fine and gross motor age test scores and inferior coordination. One child had cerebral palsy (spastic hemiplegia) and in 6 other children slight tremor and ataxia were observed. Malformations and/or other signs of the fetal alcohol syndrome (FAS) were found in 10 cases. Study group children with FAS had significantly slower growth of head circumference than others without FAS. Children placed in foster home care ( n =11) were found to have significantly ( p <0.05) lower birth weight, birth length and head circumference than children raised at home ( n =10). There were no significant differences at follow up between study group children raised in foster homes or in homes of their biological mother.     

Children of alcoholic mothers. Growth and motor performance compared to matched controls

Twenty-one children born 1970-76, selected from 103 children of 30 alcoholic women, were paired to controls matched for sex, age, birth weight and gestational age. The sample (10 girls, 11 boys) was representative of the whole group with regard to weight, length and head circumference at birth. At follow-up (mean age 70 months) the study group was significantly leaner, shorter and had smaller mean head circumference than the control group. The controls had significant catch-up growth from birth to follow-up of weight, height and head circumference to the mean for Swedish children. The study group had no catch-up growth. Compared to controls the study group had significantly lower fine and gross motor age test scores and inferior coordination. One child had cerebral palsy (spastic hemiplegia) and in 6 other children slight tremor and ataxia were observed. Malformations and/or other signs of the fetal alcohol syndrome (FAS) were found in 10 cases. Study group children with FAS had significantly slower growth of head circumference than others without FAS. Children placed in foster home care (n = 11) were found to have significantly (p less than 0.05) lower birth weight, birth length and head circumference than children raised at home (n = 10). There were no significant differences at follow up between study group children raised in foster homes or in homes of their biological mother.     

Transcranial Doppler, MRA, and MRI as a screening examination for cerebrovascular disease in patients with sickle cell anemia: an 8-year study

Objective. The authors previously reported five transcranial Doppler ultrasonography (TCD) findings as significant in detecting clinical cerebrovascular disease in a 4-year study in patients with sickle cell disease. This is a follow-up to evaluate the validity of the original findings over another 4-year period during which the study population doubled. A clinical follow-up of the original asymptomatic sickle cell patients with positive TCD, MRA, and MRI was also made. Materials and methods. Over an 8-year period TCD, MRI, and MRA were prospectively performed in 90 sickle cell patients who were clinically asymptomatic for stroke and in 27 sickle cell patients with clinical stroke. Results. Of the 4 out of original 46 control patients in 1992 who had positive MRA and TCD, 3 have subsequently had clinical stroke. None of the 9 original patients with positive TCD and positive MRI but negative MRA have developed stroke. All five original TCD indicators of disease were still significant (P < 0.05) for detecting clinical disease: maximum velocity in ophthalmic artery (OA) > 35 cm/s, mean velocity in middle cerebral artery (MCA) > 170 cm/s, resistive index (RI) in OA < 50, velocity in OA greater than in MCA, and velocity in posterior cerebral (PCA), vertebral, or basilar arteries greater than in MCA. Four additional factors were also significant: turbulence, PCA or ACA without MCA, RI < 30, and maximum velocity in MCA > 200 cm/s. Conclusion. Positive MRA with a positive TCD in an asymptomatic patient in long-term follow-up suggests a trend for developing clinical stroke. A 4- to 8-year follow-up of nine patients with positive TCD, positive MRI, but not positive MRA did not show development of clinical stroke. Nine Doppler findings are significant in screening for clinically symptomatic vascular disease in sickle cell patients. It is recommended that children with sickle cell disease be screened for cerebrovascular disease with TCD. If one or two indicators of abnormality are present, MRA is recommended. If the MRA is positive, the patient may be considered for transfusion therapy or other treatment for prevention of stroke. Received: 17 April 1997 Accepted: 7 July 1997     

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??Objective??To characterize the clinical symptoms of all enrolled microcephalic children with cerebral palsy??CP????to provide evidence for rehabilitation management. Methods??To summarize the results of a cross-sectional survey of a total of 422 children??0-18 years old?? who were registered as cerebral palsy by Disabled Persons’ Federation of Chengdu from February to April in 2013. All children were grouped according to head circumference. We analyzed the correlation between head circumference with gross motor function classification system??GMFCS????intelligence and complications. Results??There were statistically significant between the two different degrees of head circumference group and the classification of GMFCS and cognition respectively??P??0.001??. Spearman correlation analysis showed that the number of comorbidities??GMFCS and degree of cognitive damage in children with cerebral palsy with microcephaly were negatively correlated with head circumference??P??0.001??. Conclusion??The degree of head circumference reduction in children with cerebral palsy complicated by microcephaly is negatively correlated with GMFCS??the number of comorbidities and the degree of cognitive impairment.     

Multicenter comparison of magnetic resonance imaging and transcranial Doppler ultrasonography in the evaluation of the central nervous system in children with sickle cell disease

PURPOSE: To compare the results of standardized magnetic resonance imaging (MRI) of the brain and transcranial Doppler (TCD) ultrasonography of cerebral arteries in school-aged children with sickle cell disease to determine the correlation between these two different neurodiagnostic tests. PATIENTS AND METHODS: Data were analyzed from 78 children with sickle cell disease (mean age 11 yrs) who participated in both the Cooperative Study of Sickle Cell Disease (CSSCD) and the Stroke Prevention Trial in Sickle Cell Anemia (STOP). Patients who had experienced an overt stroke were excluded. MRI findings were classified as normal or "silent infarct." Results of TCD were classified as normal, conditional, or abnormal, based on the time-averaged maximum mean flow velocity in the proximal middle cerebral and distal internal carotid arteries. RESULTS: Of 61 patients who had a normal MRI examination, 11 (18%) had either conditional (5 patients) or abnormal (6 patients) TCD results. Among 17 patients in whom silent infarction was seen on MRI, only 5 (29%) had a conditional (1 patient) or abnormal (4 patients) TCD velocity. Thus, discordant results were seen in 23 patients: 12 in which the TCD result was normal and the MRI abnormal; 11 in which the TCD velocity was elevated and the MRI normal. CONCLUSIONS: Abnormal TCD and MRI examinations reveal different aspects of the pathophysiology of central nervous system (CNS) injury in sickle cell disease and are often discordant. Although TCD abnormality is predictive of overt stroke, the lack of concordance between TCD and MRI findings suggests a need to develop more sensitive and specific indicators of early CNS pathology, such as neuropsychometric testing and positron-emission tomography (PET) scans, and to obtain more information about microvascular pathologic processes that may affect CNS function.     

Transcranial Doppler (TCD) screening for stroke prevention in sickle cell anemia: pitfalls in technique variation

Background. The Stroke Prevention Trial in Sickle Cell Anemia (STOP) identified children as being at high stroke risk if the time-averaged maximum mean velocity (TAMMV) of the middle cerebral or intracranial internal carotid arteries measured ≥ 200 cm/s. These values were obtained utilizing a 2-mHz dedicated nonimaging pulsed Doppler technique (TCD) and manual measurements. Questions have been raised as to the comparability of results obtained with different ultrasound machines and measurement techniques.¶Objective. The purpose of this study was to compare nonimaging (TCD) and transcranial duplex imaging (TCDI) findings in children potentially at risk for stroke with sickle cell disease.¶Materials and methods. Twenty-two children with sickle cell disease and no history of stroke were evaluated by both TCD and TCDI. Examinations were performed on the same day without knowledge of the other modality results and read independently using manually obtained measurements. Mean velocities, peak systolic velocities, and end diastolic velocities obtained by the two techniques were compared. In a subgroup, manual measurements were compared to electronically obtained measurements. ¶Results. TCDI values were lower than TCD measurements for all vessels. TCDI TAMMV values were most similar to the TCD values in the middle cerebral artery (–9.0 %) and distal internal cerebral artery (–10.8 %), with greater variability in the anterior cerebral artery (–19.3 %), bifurcation (–16.3 %), and basilar arteries (–23.1 %). Risk group placement based on middle cerebral artery TAMMV values did not change when comparing the two techniques. Measurements obtained electronically were lower than those obtained manually. ¶Conclusion. Velocities obtained by TCDI may be lower than TCD measurements, and these differences should be taken into consideration when performing screening for stroke risk and selection for prophylactic transfusion based on the STOP protocol.     

A Comparison of the Mid-Arm Circumference/Head Circumference Ratio and Ponderal Index for the Evaluation of Newborn Infants after Abnormal Intrauterine Growth

ABSTRACT. We studied the accuracy of the ponderal index and the mid-arm circumference/head circumference ratio for detecting newborn infants who were likely to be symptomatic because of aberrant intrauterine growth. Sixty infants were evaluated because of suspected intrauterine growth retardation; both the mean ponderal index and mid-arm circumference/head circumference ratio were significantly lower in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants ( p <0.05). However, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (80% vs. 47%; p =0.007). An additional 60 infants were evaluated because of suspected abnormal intrauterine growth acceleration. The mean mid-arm circumference/head circumference ratio, but not the ponderal index, was significantly higher in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants ( p <0.005). Again, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (79% vs. 33%; p <0.001). The mid-arm circumference/head circumference ratio is more accurate than the ponderal index for the evaluation of potentially symptomatic newborn infants who suffered abnormal fetal growth. The ponderal index is not useful for the detection of symptomatic large-for-dates infants.     

A comparison of the mid-arm circumference/head circumference ratio and ponderal index for the evaluation of newborn infants after abnormal intrauterine growth

We studied the accuracy of the ponderal index and the mid-arm circumference/head circumference ratio for detecting newborn infants who were likely to be symptomatic because of aberrant intrauterine growth. Sixty infants were evaluated because of suspected intrauterine growth retardation; both the mean ponderal index and mid-arm circumference/head circumference ratio were significantly lower in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants (p less than 0.05). However, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (80% vs. 47%; p = 0.007). An additional 60 infants were evaluated because of suspected abnormal intrauterine growth acceleration. The mean mid-arm circumference/head circumference ratio, but not the ponderal index, was significantly higher in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants (p less than 0.005). Again, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (79% vs. 33%; p less than 0.001). The mid-arm circumference/head circumference ratio is more accurate than the ponderal index for the evaluation of potentially symptomatic newborn infants who suffered abnormal fetal growth. The ponderal index is not useful for the detection of symptomatic large-for-dates infants.     

Cerebral atrophy following shaken impact syndrome and other non-accidental head injury (NAHI)

PURPOSE OF THE STUDY: To determine the frequency of cerebral atrophy and microcephaly in a group of children with sequential MRI brain scans after surviving a non-accidental head injury (n = 16). METHODS: Serial head circumference measurements (OFC) were extracted and plotted on standard growth charts for each child retrospectively to determine the frequency of secondary microcephaly. Cerebral atrophy was diagnosed and quantified by measurement of the ventricular/cortical ratio on coronal images of the sequential scans. RESULTS: Acquired microcephaly was found in 15 children (93.8%) over a median follow-up period of 67.93 weeks. There was a significant reduction in the median Z-score for the OFC at the most recent follow-up when compared with that at presentation (p < 0.001, Wilcoxon Signed Rank Test). Cerebral atrophy was found to be the cause of the microcephaly in eight of the 15 children and was evident as early as 9 days after presentation. CONCLUSION: A large proportion of the cohort (93.8%) develops acquired microcephaly after an inflicted head injury and cerebral atrophy is responsible in half of these cases.