Ⅲ型先天性食管闭锁手术后吻合口漏的危险因素分析及风险模型建立

目的探讨Ⅲ型先天性食管闭锁手术后吻合口漏的危险因素并建立风险模型, 为拟定对应预防措施提供理论依据。方法回顾性分析2017年1月至2022年12月于山西省儿童医院(山西省妇幼保健院)确诊并经手术治疗的135例Ⅲ型先天性食管闭锁患儿临床资料, 依据手术后是否存在吻合口漏将患儿分为两组:吻合口漏组(n=28)、非吻合口漏组(n=107);采取单因素分析及二元Logistic回归分析筛选出独立危险因素, 建立风险模型并制作列线图, 使用受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)和bootstrap法对Logistic回归模型进行评价及验证评估。结果吻合口漏组与非吻合口漏组在性别、胎龄、手术日龄、手术类型、手术时间、术后吻合口狭窄以及术后合并肺部感染上比较, 差异无统计学意义(P>0.05);而体重、诊断分型、合并心血管畸形、使用呼吸机时间及低蛋白血症方面差异有统计学意义(P<0.05)。诊断分型为ⅢA型(OR=0.173, 95%CI:0.061～0.495)、存在低蛋白血症(OR=5.162, 95%CI:...     

量化脑电图对儿童重症监护病房非创伤性意识障碍患儿不良结局的预测价值

目的探讨量化脑电图(qEEG)对儿童重症监护病房非创伤性意识障碍患儿不良结局的预测价值。方法前瞻性研究。研究对象为2019年1至5月蚌埠医学院第一附属医院儿童重症监护病房收治的1月龄至11岁的62例非创伤性意识障碍患儿。入院24 h内NicoletOne脑功能仪床旁监测,记录qEEG参数,包括振幅整合脑电图(aEEG)、相对α变异(RAV)、相对频带能量(RBP)和光谱熵(SE),监测前完成改良儿童格拉斯哥昏迷评分(MPGCS)。以儿童脑功能分类量表为出院后1年结局判断依据,将患儿分为结局良好组和结局不良组。变量与不良结局的相关性采用单因素和多因素Logistic回归分析,变量对不良结局的预测效能采用受试者工作特征曲线分析。结果 62例患儿中男39例、女23例,年龄12.0(5.8,24.0)月龄,结局良好组50例(81%),结局不良组12例(19%)。单因素Logistic回归分析显示年龄(OR=1.037,95%CI 1.001～1.074,P=0.041)、重度异常aEEG(OR=128.000,95%CI 10.274～1 594.656,P<0.01)、RAV(OR=0...     

高血压儿童腰围发育曲线及其与高血压相关性的研究

目的 了解高血压儿童腰围发育曲线特点,探讨与儿童高血压相关的腰围正常值合理切点.方法 研究对象为安徽省北、中、南3个地市的8194名7～17岁汉族城乡中小学生,测量腰围与血压.以LMS( lambda-mu-sigma)法拟合腰围随年龄变化的百分位数曲线.建立Logistic回归模型,计算不同百分位数腰围学生发生高血压的OR值.结果 高血压男生的腰围发育曲线明显向上平行偏离总体男生标准曲线,而高血压女生腰围发育曲线在12岁前向上逐渐偏离总体女生标准曲线,之后逐渐回归.男生腰围上升至同年龄别第60百分位数、女生腰围上升至同年龄别第70百分位数时,高血压发生风险即开始显著增加,男生腰围p60～组、P70～组、P80～组和P90～组的OR值从1.88(95％CI:1.18 ～2.99)逐渐上升至4.87(95％CI:3.31 ～7.16),女生腰围P70～组、P80～组和P90～组的OR值从1.71 (95％CI:1.07～2.73)逐渐上升至3.32(95％ CI:2.16～5.09).结论 高血压男生和女生的腰围发育曲线轨迹明显不同.从第85百分位数向下适当降低儿童腰围正常值切点有利于儿童心血管疾病风险的预防.     

先天性心脏病术后脓毒症患儿列线图预后模型的构建与验证

目的 探讨先天性心脏病术后脓毒症患儿死亡的预测因素,并建立列线图预测模型。方法 收集2012年1月至2021年12月广东省人民医院开胸手术的先天性心脏病术后脓毒症患儿临床数据。采用单因素、多因素Logistic回归分析,筛选出先天性心脏病术后脓毒症患儿死亡危险因素,根据筛选结果建立列线图预测模型,使用Bootstrap重抽样法进行内部验证。结果 共纳入157例,存活组135例患儿,死亡组22例。经单因素分析和多因素Logistics回归分析发现,术后发热总时间（OR=1.084,95%CI:1.022～1.151）、术后第3天血管活性-正性肌力评分（OR=1.162,95%CI:1.070～1.263）、二次开胸（OR=6.033,95%CI:1.906～19.098）是先天性心脏病术后脓毒症患儿死亡的独立危险因素（P<0.05）。以上述3项危险因素建立列线图预测模型,受试者工作特征曲线下面积为0.909(95%CI:0.852～0.966),重复抽样法验证的区分度C指数：0.9139(95%CI:0.9100～0.9178);HosmerLemeshow拟合优度检验显示,该模型...     

儿童反复肺炎危险因素的病例对照研究

目的：探讨无明确基础疾病儿童反复患肺炎的相关危险因素。方法：选择无明确基础疾病的106例反复肺炎患儿及106例单次肺炎患儿进行成组病例对照研究,采用单因素χ2检验及多因素logistic回归模型调查反复肺炎的危险因素。结果：单因素χ2检验分析结果显示,病例组患儿有喘息病史、食物或药物过敏史、湿疹病史及一过性粒细胞减少症的比例高于对照组,差异有统计学意义。多因素logistic回归分析结果显示,喘息病史（OR=13.387,95% CI: 5.541～32.343）、食物或药物过敏史（OR=4.267,95% CI: 2.081～8.751）及一过性粒细胞减少症（OR=3.606,95% CI: 1.806～7.202）是儿童反复肺炎的独立危险因素。结论：喘息病史、食物或药物过敏史及一过性粒细胞减少症病史增加了无明确基础疾病儿童反复患肺炎的风险。     

MYCN扩增型神经母细胞瘤潜在预后生物标志物的综合性分析

目的 分析比较MYCN扩增型神经母细胞瘤（NB）和MYCN非扩增型NB表达mRNA的差别，筛选具有预测MYCN扩增型NB预后功能的基因并分析其对预后的预测价值。方法 从TARGET数据库获得NB转录组数据和患儿临床资料，根据有无MYCN扩增分为MYCN扩增组（n=33）和MYCN非扩增组（n=121），对两组mRNA进行差异分析，得到差异表达基因（DEGs）。采用GO和KEGG数据库分析DEGs的主要功能。采用Cox比例风险回归模型分析影响MYCN扩增组NB预后的基因，根据风险评分的中位值分为高风险组（n=77）和低风险组（n=77），采用生存分析法比较两组生存率，ROC曲线分析风险评分对MYCN扩增型NB患儿预后的预测价值。结果 共筛选出582个DEGs，这些DEGs参与了核糖体组成、细胞黏附蛋白的表达以及膜蛋白受体活动等重要生物功能。多因素Cox回归模型分析结果显示FLVCR2、SCN7A、PRSS12、NTRK1、XAGE1A基因对MYCN扩增组NB患儿预后具有显著性影响（均P < 0.05）。生存分析发现，高风险组的总生存率低于低风险组（P < 0.05）。ROC分析显示，风险评分对MYCN扩增组NB患儿预后有预测价值（P < 0.05），曲线下面积为0.729，最佳截断值为1.316，灵敏度为53.2%，特异度为84.4%。结论 FLVCR2、SCN7A、PRSS12、NTRK1、XAGE1A基因的mRNA可作为预测MYCN扩增型NB预后的生物标志物，有助于细化临床危险分层。     

五岁以内儿童复杂性阑尾炎的临床预测模型探索

目的回顾性分析5岁以内儿童复杂性阑尾炎(CA)的独立危险因素并建立临床预测模型, 评价该模型在5岁以内儿童CA的临床应用价值。方法对2018年1月至2021年12月在上海交通大学医学院附属儿童医院行阑尾切除术的5岁以内患儿行回顾性分析, 根据术后阑尾组织是否存在坏疽及穿孔征象将患儿分成CA组和非CA组, 比较两组患儿间临床特征和术前实验室检查结果差异, 明确CA的独立危险因素并建立临床预测模型, 通过受试者工作特征曲线对临床预测模型进行验证。结果共纳入140例患儿, 其中CA组84例, 非CA组56例。经单因素和二元Logistic回归分析发现, 发病时间>23.5 h(OR=6.650, 95%CI 2.469～17.912, P<0.05), 腹部肌紧张(OR=3.082, 95%CI 1.190～7.979, P<0.05)和C-反应蛋白>41 mg/L(OR=3.287, 95%CI 1.274～8.480, P<0.05)为CA的独立危险因素, 通过上述3项独立危险因素构建CA临床预测模型, 经受试者工作特征曲线验证, 曲线下面积为0.881(9...     

先天性心脏病患儿术后谵妄危险因素的前瞻性巢式病例对照研究北大核心CSCD

目的探讨儿童先天性心脏病术后谵妄的危险因素。方法选取2020年12月至2021年6月于中国医学科学院阜外医院完成先天性心脏病外科手术的患儿进行前瞻性巢式病例对照研究。将术后谵妄组(n=114)和非谵妄组(n=102)的临床资料进行比较,应用多因素非条件logistic回归分析探索先天性心脏病患儿术后谵妄的危险因素。结果多因素logistic回归分析显示,年龄(OR=0.951,P<0.001)、性别(OR=2.127,P=0.049)、每日有创导管留置数量(OR=1.490,P=0.017)、术后疼痛程度(OR=5.856,P<0.001)、术前陪护家长焦虑程度(OR=1.025,P=0.010)是先天性心脏病患儿术后谵妄的独立影响因素。结论年龄越小、男性、每日有创导管留置数量越多、术后疼痛程度越高、术前陪护家长焦虑程度越高的先天性心脏病患儿,发生术后谵妄的风险越高。     

急诊科反复喘息婴幼儿需要住院并接受呼吸支持治疗的预测因素

目的 反复喘息患者多为2岁以下的婴幼儿。在热带国家,对该人群住院期间接受呼吸支持治疗的风险的临床预测模型研究较少。该研究旨在评估就诊于哥伦比亚急诊科的反复喘息婴幼儿需要住院并接受呼吸支持治疗的临床预测因素。方法 该研究是一项回顾性队列研究,纳入了2019年1~12月期间在哥伦比亚Rionegro的两个三级中心医院就诊的所有患有2次或2次以上喘息发作的婴幼儿（年龄均小于2岁）。主要结局指标是住院加呼吸支持治疗。采用多因素logistic回归模型确定需要住院并接受呼吸支持治疗的独立预测因素。结果 共85名婴幼儿住院并接受呼吸支持治疗,其中34名（40%）予以高流量鼻导管吸氧,2名（2%）予以无创通气,6名（7%）予以机械通气,43名（51%）予以常规氧疗。多因素logistic回归模型分析显示,早产（OR=1.79,95% CI：1.04~3.10）、喂养困难（OR=2.22,95% CI：1.25~3.94）、鼻煽和/或咕噜声（OR=4.27,95% CI：2.41~7.56）和既往有1次以上喘息发作需要住院治疗（OR=3.36,95% CI：1.86~7.08）是需要住院并接受呼吸支持治疗的预测因素。该模型特异度高（99.6%）,鉴别度中等,曲线下面积为0.70（95% CI：0.60~0.74）。结论 该研究表明,早产、喂养困难、鼻煽和/或呼噜声,以及有1次以上需要住院治疗的喘息发作史,是急诊科就诊的反复喘息婴幼儿需要住院并接受呼吸支持治疗的独立预测因素。然而,还需收集更多的其他热带国家的证据来验证这个结论。     

儿童重型毛细支气管炎相关危险因素分析

目的 探讨儿童重型毛细支气管炎的相关危险因素.方法 回顾性分析209例毛细支气管炎患儿的临床资料,根据临床病情分为重型毛细支气管炎(27例)和普通型毛细支气管炎(182例)两组,采用单因素分析和多因素非条件Logistic回归分析探讨重型毛细支气管炎的相关危险因素.结果 单因素分析提示年龄(f =3.455;P=0.001)、被动吸烟(x2=6.119;P=0.013)、早产(x2=17.124;P =0.000)、肥胖(x2=5.673;P=0.017)、特应体质(x2=5.736;P =0.017)、先天性心脏病(x2=20.694;P=0.000)6个变量因素影响毛细支气管炎的临床严重程度;经多因素非条件Logistic回归分析表明年龄(OR 0.742;95％ CI0.601～0.917)、被动吸烟(OR3.300;95％ CI1.060 ～ 10.276)、早产(OR5.265;95％ CI 1.565～ 17.705)、先天性心脏病(OR 13.634;95％ CI3.015～ 61.663)是重型毛细支气管炎的危险因素.结论 年龄小、被动吸烟、早产、特应体质及先天性心脏病是重型毛细支气管炎的危险因素.     

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.