先天性结核病一例报告

患儿男 ,40天。因纳差、面色苍白一月 ,发热、咳嗽十天入院。孕 35周早产。出生体重 2 2 0 0 g。出生时一般情况好。生后牛乳喂养 ,但患儿不愿进食 ,40天共耗奶粉不足1kg。体重不增 ,少哭少动、面色苍白日益加重。家长误认为早产儿表现未引起重视。近十天发热、咳嗽、呼吸增快拟诊“支气管肺炎”收住院。未接种卡介苗。其母于妊娠四个月始常发热、咳嗽乏力、盗汁、胸闷、气短。产后胸部摄片示右肺及左上肺斑点片状阴影 ,左下肺大片致密影、横膈不显影。诊断为血型播散性肺结核 (亚急性 ) 上中下上中下 集 (- )进展期 ;结核性胸膜炎 一中下 …     

先天性结核病1例

患儿男 ,1 6天。因少吃、少哭、少动伴气促 7天 ,发热 2天入院。系第 1胎第 1产 ,足月剖宫产 ,羊水Ⅲ°混浊、量少 ,1 .5分钟Ａｐｇａｒ评分均为 1 0分。其母孕期一直在外打工。于分娩前两天出现发热 ,体温持续不退 ,恶露多 ,宫腔内感染 ,随患儿转我院妇科治疗。体检和辅助检查 :体温 3 9 8℃ ,唇周紫绀 ,口吐泡沫 ,呼吸促 ,52次 /分 ,两肺呼吸音粗 ,心率 1 44次 /分 ,律齐 ,心音中等 ,腹部膨隆 ,肝肋下 6ｃｍ ,剑突下 5ｃｍ ,质地中等。血常规白细胞 1 5 2× 1 0 9/Ｌ ,中性 0 88,血红蛋白1 3 0ｇ/Ｌ ,血小板 84× 1 0 9/Ｌ ,血总蛋白 …     

新生儿先天性结核病误诊1例报告

患儿女，24d，因发热咳嗽10d入院。患儿系抱养儿，其产次、孕周、出生时情况不详，生后是否与咳嗽病人密切接触及其母是否患结核病情况不详。近10d来发热，咳嗽，拟诊为新生儿肺炎，败血症收住院。     

先天性麻疹一例

患儿　男 ,生后 30ｍｉｎ。孕 2产 2 ,孕 4 0周 +5天自然分娩 ,产程顺利 ,Ａｐｇａｒ评分 :1ｍｉｎ8分 ,5ｍｉｎ10分 ,羊水清。生后体检发现患儿面部 ,躯干及四肢布满粟粒大小红色皮疹。转入儿科治疗。患儿母亲 2 6岁 ,分娩时系麻疹病程第 12天 ,患儿已在感染科住院 8天 ,皮疹刚退。 10年前曾作麻疹疫苗接种。患儿体检 :体温 36 3℃ ,心率 14 0次 /ｍｉｎ ,呼吸36次 /ｍｉｎ ,体重 3 5 5 0ｋｇ ,面部 ,躯干及四肢布满粟粒大红色斑丘疹 ,压之退色 ,口腔粘膜可见Ｋｏｐｌｉｋ斑。双肺呼吸音粗糙 ,闻及中湿性音 ,心腹未见异常 ,神经系统检查…     

先天性结核病三例

先天性结核病是一种罕见、诊断困难且病死率高的严重结核病。本组3例确诊患儿发病年龄分别为7、20、7日龄,以发热为主要临床表现,结核病变均在肺部,胸部CT可见结节影、实变及淋巴结肿大等,胃液或肺泡灌洗液涂片检出抗酸杆菌,培养为结核分枝杆菌复合群且对利福平、异烟肼敏感,采用利福平、异烟肼二联抗结核治疗,疗程3~10个月,均临床痊愈,随访3年,3例患儿均生长发育良好。     

先天性结核3例

先天性结核３例重庆医科大学儿童医院（６３００１４）徐天鹤，沈犁，余世才，宋建华，吴仕孝为了提高生前诊断先天性结核的水平，特将近２年来收治的３例报道如下，并讨论其临床特点及诊断，以供同道参考。临床资料例１，男，足月顺产，生后一般情况好，１２天发病，Ｘ线...     

先天性结核病20例临床分析

目的探讨先天性结核病的临床特点。方法回顾分析20例先天性结核病患儿的临床资料。结果在20例患儿中19例(95.0%)母亲明确有孕期结核病史,产前诊断5例(25%);患儿发病日龄中位数26天(1～90天)。20例患儿中,咳嗽15例,发热14例,呼吸困难12例,肝脏伴脾脏肿大9例,腹胀7例。抗酸杆菌涂片或结核培养阳性10例,12例行T-SPOT检查9例阳性。20例患儿的胸部影像学检查均异常,表现为广泛结节和斑片影12例,弥漫粟粒结节影6例,右肺散在斑片影2例。16例行腹部超声和/或CT检查,发现肝脏和脾脏内多发结节影7例,腹腔淋巴结肿大6例,腹腔积液6例。结核感染部位主要为肺部20例均有,肝脏7例、脾脏7例、腹膜腔8例、颅内7例。3例患儿因病情危重家属要求放弃抗结核药物治疗,余17例使用抗结核药物,10例病情好转出院,7例病情恶化放弃治疗。结论先天性结核病常呈全身播散性感染,综合母孕期结核病史、反复查找病原学证据、影像学、T-SPOT等辅助检查,可提高早期诊断率,早期、正规抗结核治疗有望降低病死率。     

Transmission of tuberculosis from a seven-year-old child in a Sydney school

OBJECTIVES: To determine whether a 7-year-old child with extrapulmonary and pulmonary tuberculosis (TB) and direct smear positive sputum for acid-fast bacilli was infectious to home and school contacts, and to ascertain potential adult sources of infection for these contacts. METHODS: Contact tracing by Mantoux testing was conducted on 220 children at a primary school and after-school care facility, and 59 selected adults considered potential sources of infection. RESULTS: The participation rate for the children was 98% and 92% for the adults. Mantoux positivity (induration >/= 10 mm, or >/= 15 mm with previous BCG) among children was 13% at the school (anticipated rate 2-3%), 26% among school staff, and 7% among children at the after-school care centre where the index case attended. One exposed adult hospital staff member converted from Mantoux negative to positive. No other cases of TB disease were detected among children or adults tested. CONCLUSION: Although spread of TB from children to others is rare, the findings of this investigation indicate that transmission of TB from a young child to other children and an adult may have occurred, and that sputum testing and contact tracing for sputum smear positive children should be considered.     

北京地区新生儿先天巨细胞病毒感染状况研究

目的评估北京地区新生儿先天性巨细胞病毒(CMV)感染状态及其对新生儿的危害。方法选择2004年11月至2008年3月在北京居住、怀孕12周之内的孕妇,分别于孕早期和孕中期进行血清CMV IgG定量和CMV IgM定性检测;活动感染者接受CMV IgG亲和力、CMV pp65抗原血症和白细胞CMV巢式聚合酶链反应(nPCR)检测;白细胞CMV DNA阳性孕妇接受羊水CMV nPCR检测。所有入选孕妇分娩的新生儿出生后均检测脐血CMV nPCR,阳性者于生后2周内复查尿CMV nPCR。结果本研究共收入孕妇1752例,新生儿1756例;孕期血清学检查CMV活动感染51例,占2.91%(95%CI 2.12%～3.70%),其中原发活动感染2例,占全部孕妇的0.11%(95%CI 0.10%～0.41%);CMV nPCR阳性的孕期活动性感染占0.34%;活动感染孕妇羊水CMV nPCR检测全部阴性;新生儿先天性CMV感染发生率0.23%(95%CI 0.06%～0.58%)。所有先天性CMV感染新生儿出生时均为无症状性感染。结论北京地区CMV感染垂直传播率低,先天CMV感染发生率0.23%,未见到症状性先天性CMV感染患儿。     

Congenital tuberculosis

Abstract A 7 week old baby presented with generalized lymphadenopathy, obstructive jaundice and massive hepatosplenomegaly. The clinical picture closely resembled a case of disseminated malignancy. Soon after the diagnosis of tuberculosis was made by pathological examination of a lymph node, the patient died. An autopsy revealed primary tuberculous foci in the liver and massive lymphadenopathy at the porta hepatis consistent with transplacentally acquired tuberculosis. The importance of early diagnosis and treatment of this rare condition is emphasized.     

Changes in growth,anaemia, and iron deficiency among children aged 6–23 months in two districts in Nepal that were part of the post‐pilot scale‐up of an integrated infant and young child feeding and micronutrient powder intervention

There is limited research on integrated infant and young child feeding (IYCF) and micronutrient powders (MNPs) programmes operating at scale, despite widespread implementation. This study uses cross‐sectional baseline (n = 2,542) and endline (n = 2,578) surveys representative of children 6–23 months in two districts in Nepal that were part of a post‐pilot scale‐up of a IYCF–MNP programme. Multivariable log‐binomial regression models were used to estimate prevalence ratios (PRs) for stunting (length‐for‐age z‐score <?2), wasting (weight‐for‐length z‐score <?2), underweight (weight‐for‐age z‐score <?2), anaemia (altitude‐adjusted haemoglobin <110 μg/L), moderate or severe anaemia (altitude‐adjusted haemoglobin <100 g/L), iron deficiency (inflammation‐adjusted ferritin <12 μg/L), and iron deficiency anaemia (iron deficiency + anaemia [IDA]) at endline versus baseline and also to compare children in the endline survey based on frequency of mothers' interactions with female community health volunteers (FCHVs; >1× per month or monthly vs. <1× per month) and MNP coverage (1 or ≥2 distributions vs. none among children 12–23 months). Endline children were significantly less likely to be stunted than baseline children in both districts (multivariable‐adjusted PR [95% CI]: 0.77 [0.69, 0.85], P < 0.001 and 0.82 [0.75, 0.91], P < 0.001 in Kapilvastu and Achham, respectively); however, only Achham had significantly lower prevalences of underweight, moderate/severe anaemia, iron deficiency, and IDA at endline. At endline, 53.5% and 71.4% of children had tried MNP in Kapilvastu and Achham districts, respectively, consuming an average of 24 sachets from the last distribution. Frequent maternal–FCHV interactions were associated with a reduced risk of stunting and underweight at endline, whereas repeat MNP coverage was associated with reduced risk of anaemia and IDA. Future research using experimental designs should verify the potential of integrated IYCF–MNP programmes to improve children's nutritional status.     

婴幼儿体外循环心内直视手术315例临床分析

目的总结婴幼儿体外循环(CPB)心内直视手术的治疗经验。方法总结2002年1月至2005年11月315例婴幼儿先心手术患儿资料。其中男187例,女128例;年龄4d～3岁,其中<6个月23例,～1岁41例,>1岁251例;体重2.5～18.5kg,平均(10.30±2.65)kg。非紫绀型心脏病254例,紫绀型心脏病61例。所有病例在体外循环下行根治性手术314例,姑息性手术1例。结果术后死亡11例,死亡率3.49%;术后出现并发症46例(14.60%)。结论婴幼儿先天性心脏病必须早诊断、早手术治疗;提高手术成功率的关键是把握好手术指征和时机,选择适当手术方式,加强术中心肌保护和术后治疗。     

Perinatal tuberculosis a case series

Perinatal tuberculosis is insufficiently understood and has been rarely reported even in areas endemic for the disease, and unless a high index of suspicion is maintained the diagnosis can be missed. Differentiation of congenital from early postnatally acquired tuberculosis is only of epidemiological importance. We hereby report one case of congenital tuberculosis and three cases of perinatal tuberculosis, and problems faced during investigation and management and emphasize need for improved screening of women at risk and sensitization of the medical community about this entity.     

Age‐appropriate infant and young child feeding practices are associated with child nutrition in India: insights from nationally representative data

Age‐appropriate infant and young child feeding (IYCF) practices are critical to child nutrition. The objective of this paper was to examine the associations between age‐appropriate IYCF practices and child nutrition outcomes in India using data from ～18 463 children of 0–23.9 months old from India's National Family Health Survey, 2005–06‐3. The outcome measures were child height‐for‐age z‐score (HAZ), weight‐for‐age z‐score (WAZ), weight‐for‐height z‐score, stunting, underweight and wasting. Linear and logistic regression analyses were used, accounting for the clustered survey data. Regression models were adjusted for child, maternal, and household characteristics, and state and urban/rural residence. The analyses indicate that in India suboptimal IYCF practices are associated with poor nutrition outcomes in children. Early initiation of breastfeeding and exclusive breastfeeding were not associated with any of the nutrition outcomes considered. Not consuming any solid or semi‐solid foods at 6–8.9 months was associated with being underweight (P < 0.05). The diet diversity score and achieving minimum diet diversity (≥4 food groups) for children 6–23 months of age were most strongly and significantly associated with HAZ, WAZ, stunting and underweight (P < 0.05). Maternal characteristics were also strongly associated with child undernutrition. In summary, poor IYCF practices, particularly poor complementary foods and feeding practices, are associated with poor child nutrition outcomes in India, particularly linear growth.     

Measuring coverage of infant and young child feeding counselling interventions: A framework and empirical considerations for survey question design

Most countries implement nutrition counselling interventions as part of programmes to support breastfeeding and complementary feeding. However, data to track coverage of counselling interventions are rarely available. As a result, little is known about the coverage of counselling on infant and young child feeding (IYCF). Survey‐based data collection systems generally collect data on IYCF practices but do not collect data on coverage of interventions to support IYCF, and those surveys that do collect this information do not do so consistently. We present a framework to guide the design of survey questions to measure IYCF counselling coverage. We provide examples of how large‐scale surveys for programme evaluation and national monitoring have included survey questions to address these data gaps. Our review suggests that elements relevant to designing survey questions to capture coverage of counselling interventions include timing of contact, target behaviour and message content, place of contact, type of service provider, frequency of contact and mode of intervention. Application of this framework may help strengthen harmonized measurement of IYCF counselling coverage to enable better tracking of programme investments, document progress in scaling up nutrition services and allow for cross‐country comparisons. Thus, improving measurement of counselling coverage may lead to improved reach of programmes to support optimal IYCF practices.