中期孕母与胎儿间铁营养状态的关系

为进一步确定中期孕母铁缺乏症对胎儿铁代谢的影响,我们中期孕母与胎儿铁代谢的关系。结果发现,二者的红细胞碱性铁蛋白（ＥＦ）值呈显著正相关关系,且孕母中度ＩＤＡ组胎儿ＥＦ值下降了１３．６％,而母、胎其它铁代谢指标间无相关关系;说明孕母铁缺乏影响其胎儿的铁储备,尤以严重铁缺乏时明显,证实孕母铁缺乏可致胎儿出生后易患铁缺乏症。     

中期孕母不同铁营养状态时胎盘微绒毛膜铁蛋白受体表达及其意义

为了了解中孕期胎盘铁蛋白受体（FnR）表达水平及其在母-胎铁代谢中的作用，本文采用FnR放射配体结合分析法，对30例中孕期（16－28周）胎盘微绒毛膜FnR表达进行了研究。结果发现：（1）孕母铁状态正常时，胎盘微绒毛膜FnR位点数为（9．63士4．72）X1012个／mg膜蛋白，与同期测定的足月孕胎盘FnR的表达水平相似（P＞0．1）；（2）隐性缺铁及轻度缺铁性贫血时，FnR位点数明显增高（PO．25）。表明胎盘微绒毛膜FnR在母-胎铁代谢中起重要的转运及调节作用，提示中期孕母严重铁缺乏时可能影响胎盘的铁转运，进而影响胎儿的铁供给。     

中期孕母铁缺乏症对胎儿铁代谢的影响

为了解孕母铁缺乏对胎儿铁代谢的影响，采用转铁蛋白受体（ＴｆＲ）放射配体结合分析法及红细胞内、外铁染色检查，对３３例１６～２８孕周胎儿骨髓幼红细胞ＴｆＲ及内、外铁进行了研究。结果发现，孕母铁状况正常者，其胎儿有一定数量的幼红细胞内铁存在，但较成人为少，未见红细胞外铁。随着孕母缺铁性贫血（ＩＤＡ）的出现，红细胞内铁粒减少，至中度ＩＤＡ时几乎全部消失。孕母隐性缺铁（ＩＤ），其胎儿幼红细胞ＴｆＲ与正常尚无明显差异。孕母轻度ＩＤＡ时，胎儿幼红细胞ＴｆＲ位点数明显升高，说明胎儿因铁代谢受到影响而出现了相应代偿性变化。上述结果提示，中期孕母患ＩＤＡ对胎儿铁代谢有直接的不良影响。     

铁缺乏症与某些微量元素的关系

近年来人们对微量元素尤其铁、铜,锌等在吸收和代谢方面的相互影响进行了一系列人体调查和动物实验,但结果各异。为此,我们对铁缺乏症患儿血清中的钼(Mo)、锌(Zn)、锰(Mn)、镉(Cd)铁(Fe)、铅(Pb)、铜(Cu)、镍(Ni)、钛(Ti)、钴(Co)、锂(Li)、铬(Cr)等十二种微量元素进行了测定,报告如下。     

铁缺乏症早期与微量元素关系

铁缺乏症早期又叫缺铁性RBC生成（IDE）,近年来有关铁缺乏症早期与血清微量元素关系的研究,国内报道很少,我们应用原子吸收分光光度法检测铁缺乏症早期儿童及正常健康儿童血清中铁、锌、铜3种微量元素的含量,探讨铁缺乏症早期与微量元素之间的关系,以便及早发现、及时预防缺铁性贫血的发生,现报告如下。     

母婴铁代谢与母婴铁缺乏症防治

铁是人体重要微量元素，体内贮存铁减少，不仅引起贫血，而且含铁酶和铁依赖酶活性降低引起非造血系统表现，对人体智力、体格发育、免疫功能、消化吸收功能、劳动能力等均有较大影响，已被世界卫生组织（WHO）列为全球四大营养性疾病之一。缺铁性贫血（IDA）已成为世界上最广泛的健康问题，它最大的危害是削弱发展中国家40％-60％6至24个月儿童的智力发育。就婴幼儿而言，即使是轻度的贫血也可能损害其智力发育，缺铁性贫血延缓运动神经发育并损害认知能力的发展，使智商下降约九个百分点。著名学者Ross和Horton（1998）推测，儿童期缺铁性贫血对其成年后劳动生产力的损失约2．5％。     

SMOKING DURING PREGNANCY—EFFECTS ON THE FETUS AND ON THIOCYANATE LEVELS IN MOTHER AND BABY

Abstract. Twenty-eight mothers smoking 10–20 cigarettes daily during pregnancy had significantly higher serum thiocyanate concentrations at delivery compared to 25 non-smoking controls. The thiocyanate levels were positively correlated to cigarette consumption and inversely correlated to the birth weights of the infants. A highly significant correlation existed between serum thiocyanate levels of the mother and umbilical cord serum thiocyanate levels, reflecting a nearly complete equilibration. The thiocyanate concentrations in human milk on the 4th day after delivery were considerably lower than the serum concentrations, and no correlation existed between serum and milk concentrations. The infants of smoking mothers had significantly decreased weight and length at birth compared to infants of non-smokers. Birth weights were 3344±434 g and 3620±504 g respectively ( p <0.05), and lengths 49.8±1.7 cm and 51±1.6 cm respectively ( p <0.05). No differences were found between smokers and non-smokers in placental and umbilical cord histology, and umbilical cord artery medial area. It is concluded that serum thiocyanate concentration in smokers may be used as an objective measure for smoke exposure, and that maternal cigarette smoking acts as an exogenous factor which interferes with intrauterine development of the fetus in a dose related way.     

RELATIONSHIP BETWEEN GLOMERULAR FILTRATION RATE AND RADIOLOGICAL APPEARANCE OF THE RENAL PARENCHYMA IN CHILDREN

Selective renal function studies with determination of the glomerular filtration rate (inulin clearance) have been carried out in more than 30 children aged 3 to 15 years. Most of the patients had a history of one or more urinary tract infections as well as pathological IVP-findings of varying degree. The selective studies were accomplished by means of external ureteral compression. Themethod proved to have an extremely good validity even in cases of severe ureteral reflux with dilatation of ureter and pelvis. No correlation could be found between radiological size of the kidney and glomerular filtration rate. In almost half of the patients with significant unilateral reduction of the renal parenchyma the glomerular filtration rate of this side was found to be more than 40% of the total glomerular filtration rate. In contrast the glomerular filtration rate of several of the kidneys estimated to be of normal size was significantly reduced. It is obvious from these findings that nephrectomy must never be carried out until selective renal function studies have been made. An additional finding was an apparently good correlation between the clinical and functional finding, i.e. the glomerular filtration rate appeared to be inversely correlated to the relapse frequency of the urinary tract infections. The fact that the. functional finding correlated well with the clinical finding but not with the radiological size of the kidney suggests various etiologies for the parenchymal reduction.     

ASSOCIATION BETWEEN THE CHANGE IN NUTRITIONAL STATUS IN RESPONSE TO TUBE FEEDING AND THE OCCURRENCE OF INFECTIONS IN CHILDREN WITH A SOLID TUMOR

In 32 children with a solid tumor, the association between the change in weight for height, in response to 4 weeks of tube feeding during the intensive phase of treatment, and the occurrence of leukopenia, leukopenic infections, and nonleukopenic infections in a period thereafter (4-10 weeks) was studied. Factors possibly influencing the change in weight for height during the first 4 weeks of tube feeding were also assessed. A statistically significant negative correlation (rho = 0.59; p &lt; .001) was found between the change in z-score of weight for height in response to the first 4 weeks of tube feeding, and the occurrence of nonleukopenic infections between 4 and 10 weeks. A reduced occurrence of nonleukopenic infections resulted in a significant reduction of the number of days of infection related hospital admission (rho = .45; p = .009), which, besides providing advantages for the patient, also had economical benefits. The change in weight for height in response to tube feeding was mainly influenced by the incidence of therapy-induced vomiting (r = .45; p = .02) and by the amount of energy provided by tube feeding (r = .47; p = .007). Based on these findings, it is recommended that naso-gastric tube feeding be used in children with a solid tumor during the early intensive phase of treatment, and that one should aim for a considerable increase in weight for height during the first 4 weeks of administration, since this has been shown to reduce the number of nonleukopenic infections in a subsequent period. The increase in weight for height may be improved by providing an optimal antiemetic protocol, which will increase energy uptake, and an energy-enriched formula, which will increase energy intake.     

THE RELATIONSHIP BETWEEN CARNITINE AND KETONE BODY LEVELS IN DIABETIC CHILDREN

ABSTRACT. Free carnitine was significantly (p<0.001) reduced both in the ketotic (29.7±3.4 nmol/ml) and in the ketoacidotic (24.6±1.4 nmol/ml) groups when compared to controls (50.0±2.4 nmol/ml). At the same time, acylcarnitine values in the ketotic (21.2±2.4 nmol/ml) and ketoacidotic (25.4±2.3 nmol/ml) groups were significantly above the control value (4.71±0.6 nmol/ml). There was no significant difference between the two ketotic groups in carnitine derivatives. The abnormal distribution of plasma free and acylcarnitines could be reversed by insulin treatment. There was an inverse correlation between ketone body levels and free carnitine in the ketotic (r =-0.71, p<0.02) and ketoacidotic group (r =-0.71, p<0.05). However, there was no correlation between ketone bodies and acylcarnitine and between free carnitine and acylcarnitines. We concluded that the increased acylation was only partly responsible for the reduction of free carnitine in diabetic ketosis.     

RELATIONSHIP BETWEEN APNOEA AND BRADYCARDIA IN PRETERM INFANTS

Abstract. Vyas, H., Milner, A. D. and Hopkin. I. E. (Department of Child Health, Department of Neonatal Medicine and Surgery, City Hospital, Nottingham, England). Relationship between apnoea and bradycardia in preterm infants. Acta Paediatr Scand, 70: 785, 1981.-Nine studies were carried out on seven babies who were having repeated episodes of bradycardias without any clinically obvious apnoea. Their mean gestational age was 31.7 weeks (range 29 to 36 weeks) and the mean birth weight was 1.56 kg (range 1.08 kg to 2.16 kg). Investigations were carried out in a total body plethysmograph. Face mask with a pneumotachograph attached to it measured flow. Tidal volume was obtained by integrating these signals. An oesophageal balloon measured intrathoracic pressure changes and the heart rate was measured from ECG chest electrodes. A total of 172 episodes of apnoea were observed. In 50 % of these apnoeas, the airway was closed as determined by the absence of cardiac artefact on the flow signals. Apnoea was associated with bradycardia in just over 25 % of all apnoea. It tended to occur early (11 to 14 sec). Whether the apnoea was central or obstructive had no effect on the pattern provided the baby did not make any inspiratory efforts. Inspiration against a closed airway produced bradycardia in over 50 % of obstructive apnoea, the heart rate falling precipitously within 1 to 2 sec. These findings indicate that often bradycardias occur too early-in apnoea to be due to central hypoxia and must be due to a peripheral mechanism.     

PATHOGENESIS AND PATHOLOGY OF HEMATOGENOUS INFECTIONS OF THE FETUS AND NEWBORN

The earlier infections occur in intrauterine life the more severe are they. When the infection develops during embryogenesis, the lesions are much more serious, sometimes causing disruptions (malformations). At this time the organs are not completely formed and microorganisms may interfere with organogenesis to such an extent that the development of the functions necessary for viability become impaired. Infection acquired in utero may result in resorption of the embryo, abortion, stillbirth, neonatal death, intrauterine growth retardation (IUGR), or prematurity. The infected newborns commonly are apparently normal at birth but they may develop a late onset disease. Otherwise, neonates presenting symptomatology may develop untoward sequelae.     

THE RELATIONSHIP BETWEEN ATTENTION PROBLEMS IN CHILDHOOD AND ANTISOCIAL BEHAVIOR EIGHT YEARS LATER

Danish longitudinal population data indicated there was a significant, though weak, relationship between teacher ratings of attention problems in males at ages 10-13 and their cumulative arrest frequency eight years later. However, the child's IQ and maternal reports of his father's problems controlling alcohol intake moderated this relationship; once the variance in antisocial behavior due to these factors was removed, childhood attention problems did not account for any additional variance. These results raise the concern that previous findings of a relationship between clinically diagnosed attention deficit disorder-hyperactivity and later delinquency may be due in part to one or more third variables.