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患儿男,5岁4个月。2012-03-02因"喘息2周,进行性水肿10d"收入上海交通大学医学院附属上海儿童医学中心病房。于入院前2周受凉后出现喘息,在家自行口服开瑞坦及顺尔宁治疗,喘息略有好转,10d前出现眼睑水肿,水肿呈进行性加重,逐渐波及全身,一直未予特殊处理。起病以来精神疲软,进食减少,排尿量减少,体重较3个月前增加5.5kg。发病以来无发热,无呕吐、腹泻,无视物模糊,患儿平时睡眠打鼾严重。患儿生后体质欠佳,每年患肺部感染5～6次,有生长发育落后,6个月抬头,1岁     

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??Abstract:Objective??Using the skill of head ultrasound to make an early diagnosis for preterm infants with periventricular leukomalacia??PVL????analyze some related risk factors which may result in PVL. Methods??Between Jan. 2006 and Jun. 2009??443 preterm infants were chosen?? who were born in Anhui Provincial Children’s Hospital. All subjects were divided into PVL group??125?? and non PVL group??318????non Cystic PVL group??116?? and Cystic PVL group??9?? by different grades of PVL. The factors of PVL were analyzed by Backward Stepwise Logistic regression. Results??Univariate factor analysis showed?? the difference was significant ??P < 0.05 or P < 0.01??among gestational age?? birth weight?? delivery pattern?? hypothermia?? apnea?? blood sugar?? myocardial enzyme?? postnatal infection?? cAMP receptor protein and albumin between PVL group and non PVL group. Multiple factors Logistic regression showed?? low birth weight and incidence of uterine-incision delivery?? postnatal infection?? higher level of myocardial enzyme and albumin were risk factors of PVL?? and postnatal infection was risk factor of cystic PVL. Conclusion??Low birth weight?? spontaneous delivery?? postnatal infection and high levels of albumin and myocardial enzyme are risk factors of PVL. Preterm infants with postnatal infection have higher incidence of cystic PVL.     

Adverse childhood experiences and resilience in childhood and adolescent and young adult cancer patients

Childhood and adolescent and young adult (AYA) cancer survivors experience poor health outcomes in adulthood. Adverse childhood experiences (ACEs) also portend poor health outcomes for the general population. Resilience can mitigate effects of ACEs. We examined the feasibility of assessing ACEs and resilience in childhood and AYA cancer patients. We also described occurrences of ACEs, resilience, and poor health outcomes. Of 52 participants, most rated their study experience favorably, with privacy in answering sensitive questions. Half reported ACEs, and those with ACEs had lower resilience; X²(3, N = 52) = 9.4, p = .02. Further investigations of ACEs and resilience in larger cohorts are warranted to delineate associations with long-term health outcomes.     

Providers' assessment of transition readiness among adolescent and young adult kidney transplant recipients

The Readiness for Transition Questionnaire‐ provider version (RTQ‐Provider) was developed to evaluate adolescent patients' transition readiness and healthcare behaviors from the perspective of the healthcare provider. The RTQ‐Provider is a parallel version of the RTQ‐Teen and RTQ‐Parent completed by patients and parents. This study seeks to evaluate the psychometric properties of the RTQ‐Provider and its utility as a clinical transition planning tool. Participants consisted of 49 kidney transplant recipients between the ages of 15 and 21. The RTQ‐Provider was completed by the pediatric nephrologist and psychologist from the multidisciplinary healthcare team and compared to RTQ data from teens and parents. The RTQ‐Provider demonstrated good‐to‐excellent internal consistency and interrater reliability. Construct validity was supported through significant predictive relationships between providers' perceptions of transition readiness and older patient age, increased patient healthcare responsibility, and decreased parent involvement in health care. By providing parallel teen, parent, and provider forms, the RTQ has the potential to foster open communication between patients, families, and healthcare team members regarding transition readiness. The study provides initial support for the RTQ‐Provider as a clinical tool to assess providers' perceptions of transition readiness; however, future longitudinal research is needed to evaluate predictive validity following patients' transfer to adult care.     

Hypertension and prehypertension in long-term survivors of childhood and adolescent cancer

BACKGROUND: Hypertension as a late effect following childhood and adolescent cancer has received little attention. Since obesity, a known risk factor for hypertension, is increased following some childhood cancers, it seems likely that significant numbers of survivors would have hypertension. PROCEDURES: The records of patients seen in the Long Term Follow Up Clinic of Children's National Medical Center were examined for a single institution, retrospective study of blood pressure in survivors of childhood and adolescent cancer. Of 103 consecutive survivors who attended the clinic from January 1 through June 30, 2004, 51 (49.5%) were female and 52 (50.5%) were male. Their mean age was 14.6 years. Systolic and diastolic blood pressures for children and adolescents under 18 years of age were evaluated for hypertension and prehypertensive according to standards for age, sex, and height. Blood pressures for adults 18 years of age and older were evaluated according to standard adult values. Children and adolescents were evaluated for obesity and overweight according to body mass index (BMI) standards for age and sex. Adults were evaluated according to standard adult values. RESULTS: Twenty-nine patients (28.2%) were hypertensive or prehypertensive, and 74 (71.8%) were normal. Thirty-eight patients (36.9%) were obese or overweight, and 65 (63.1%) were non-obese. Most Wilms tumor patients, 7 of 10 (70.0%), had hypertension or prehypertension, but only 4 of 10 (40.0%) were obese or overweight. CONCLUSION: Careful follow-up of their blood pressure status is warranted for long-term survivors of childhood and adolescent cancer, especially for those with an initial diagnosis of Wilms tumor.     

Issues of transition to adult care

Abstract A survey was carried out on adolescents with insulin dependent diabetes mellitus, aged 15 to 18 years, to elicit their views on the process of transfer from paediatric to adult care. The survey provided information on what they expected from a health service during this period of their life, their views on the role of specialist physicians and other health professionals and their preferred age for transfer from a paediatric to an adult service. Young people value continuity of care by a physician whom they trust. They expect confidentiality and privacy, some degree of informality and optimal waiting room conditions when they attend for consultation. Almost all suggested that transfer of care should be after the age of 17 years. An understanding of the views and expectations of young people with a chronic illness such as diabetes should assist those who are responsible for the development of health care. It is recommended that transition services for young people with a chronic illness be developed at those children's and adult hospitals that provide specialist care for them.