新生儿急性肾功能衰竭血和尿表皮生长因子的动态变化和意义

目的　探讨新生儿急性肾功能衰竭 (ARF)过程中血、尿表皮生长因子 (EGF)的变化及其意义。方法　采用放射免疫分析法 ,测定 17例对照组新生儿和 31例ARF新生儿少尿期、多尿期和恢复期血清和尿EGF水平。结果　肾衰组在少尿期和多尿期血清和尿EGF均显著下降 ,恢复期血清和尿EGF水平恢复至正常。肾衰组少尿期和恢复期尿EGF与同期尿素氮 (BUN)、血肌酐 (SCr)水平呈显著负相关。结论　在新生儿ARF过程中血、尿EGF呈先下降后上升变化趋势 ,反映了肾脏的损害及修复过程     

新生儿非少尿型急性肾功能衰竭临床研究

目的探讨新生儿非少尿型急性肾功能衰竭的临床特点、病因、发病机制及预后。方法前瞻性研究新生儿非少尿型急性肾功能衰竭(ARF)22例。冰点渗透压仪测定血浆、尿液渗透压,放射免疫法检测血清抗利尿激素(ADH)、血清及尿液β2-微球蛋白(β2-M);同时检测血钠、尿钠、血肌酐、尿肌酐、血尿素氮;计算钠排泄分数(FENa)、肌酐清除率(Ccr)、肾衰指数(REI)。对照组为同期肾功能正常的轻型病例。结果本组原发疾病为新生儿窒息12例,占54％。非少尿型急性肾功能衰竭组尿/血渗透压0.95±0.34,血β2-M4.51±1.97(mg/L),ADH14.71±5.04(ng/L)明显增高,Ccr10.5±7.3ml/(min·1.73m2),明显降低,尿β2-M改变不明显。结论新生儿窒息是导致非少尿型ARF的最主要病因。非少尿型ARF主要为肾前因素所致,肾小管损害较轻,对ADH有效应,且预后较好。     

窒息缺氧对新生儿血清瘦素及血脂水平的影响

目的探讨窒息缺氧对新生儿血清瘦素(Lp)与血脂水平的影响。方法2004-03—2005-08对暨南大学第五附属医院52例窒息新生儿出生后第1天、第5天、第10天血清Lp、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(apoA1)及载脂蛋白B(apoB)进行测定,以32例健康新生儿作对照。结果窒息患儿生后第1天血清Lp水平[(4.06±3.02)ng/mL]显著低于对照组[(12.87±5.71)ng/mL](P<0.05),且随窒息程度加重而显著减少;窒息患儿TG[(0.76±0.47)mmol/L]、apoA1[(1.08±0.24)g/L]显著高于对照组,HDL-C[(0.69±0.40)mmol/L]显著低于对照组,均P<0.05。27例窒息患儿第5d与第1d相比,TC、LDL-C与apoB明显升高(P<0.05),而与第10d比较则无差异(P>0.05),HDL-C、apoA1到第10d明显升高,TG保持稳定。Lp水平与TC、TG、LDL-C、apoB的水平呈负相关(P<0.05),与apoA1、HDL-C无相关性(P>0.05)。结论窒息缺氧可导致新生儿瘦素与血脂代谢紊乱;瘦素可能参与了窒息新生儿血脂代谢紊乱的发病过程。     

窒息新生儿血清肌钙蛋白I和磷酸肌酸激酶同工酶变化的意义

目的探讨血清肌钙蛋白I(cTnI)和磷酸肌酸激酶同工酶(CK-MB)对窒息新生儿心肌损伤的早期诊断价值。方法选择轻度窒息新生儿29例(轻度组)、重度窒息新生儿18例(重度组)。采用ELISA法和酶动力法检测新生儿血清cTnI水平和CK-MB活性。结果出生d1窒息新生儿血清cTnI和CK-MB水平在轻度组[(2.25±0.54)μg/L、(223.4±23.5)U/L]和重度组[(4.25±0.83)μg/L、(256.3±21.8)U/L]均显著高于对照组(Pa<0.01);重度组血清cTnI和CK-MB水平均显著高于轻度组(Pa<0.01)。治疗后d7窒息新生儿血清cTnI和CK-MB水平均明显下降,轻度组[(0.69±0.18)μg/L、(151.4±18.4)U/L]与对照组均无显著差异(Pa>0.05),重度组[(1.54±0.72)μg/L、(188.9±21.5)U/L]显著高于轻度组和对照组(Pa<0.01)。结论窒息新生儿伴心肌损伤时血清cTnI和CK-MB水平升高;动态观察可用于窒息新生儿微小心肌损伤的早期诊断。     

毛细支气管炎患儿血清白细胞介素-4及尿白三烯E4水平的临床观察

目的 探讨毛细支气管炎患儿血清IL4及尿白三烯E4(LTFA)水平变化与病情分度的关系.方法 选择2006年12月至2008年12月我院小儿呼吸科住院毛细支气管炎患儿100例,按病情程度分为轻度、中重度两组,轻度组52例,中重度组48例.另选择健康体检儿50例为对照组.采用酶联免疫吸附法测定血清IL-4及尿LIFA水平.结果 毛细支气管炎患儿发病急性期血清IL-4水平为(11.34±7.56)ng/L,尿LTFA(20.3±4.75)pmol/μmol Cr;恢复期血清IL-4(6.84±5.64)ng/L及尿LTE4(3.6±1.12)pmol/μmol Cr;健康组IL-4(5.72±2.24)ng/L及尿LTFA(1.43±0.14)pmol/μmolCr.毛细支气管炎患儿发病急性期血清IL-4及尿LTE4明显增高(P<0.01).中重度组血清IL-4为(15.32±6.85)ng/L,及尿LTE4为(28.8±4.71)pmoL/μmol Cr,高于轻症组IL-4[(7.64±4.31)ng/L]及尿LTE4[(18.1±3.52)pmol/μmol Cr],两组问差异有显著性(P<0.05).恢复期IL-4为(6.84±5.64)ng/L 及尿LTFA为(3.6±1.21)pmol/μmol Cr;正常健康对照组IL-4(5.72±2.24)ng/L及尿LTE4(1.43±0.14)pmol/μmol Cr,两组间差异无显著性(P>0.01).血清IL-4与尿LTE4检测结果呈正相关,r值分别为0.628、0.564(P<0.01).结论 血清IL-4及尿LTE4水平可作为毛细支气管炎病情严重程度的指标之一,有利于指导临床诊治.     

毛细支气管炎患儿血清白细胞介素-4及尿白三烯E4水平的临床观察

目的 探讨毛细支气管炎患儿血清IL4及尿白三烯E4(LTFA)水平变化与病情分度的关系.方法 选择2006年12月至2008年12月我院小儿呼吸科住院毛细支气管炎患儿100例,按病情程度分为轻度、中重度两组,轻度组52例,中重度组48例.另选择健康体检儿50例为对照组.采用酶联免疫吸附法测定血清IL-4及尿LIFA水平.结果 毛细支气管炎患儿发病急性期血清IL-4水平为(11.34±7.56)ng/L,尿LTFA(20.3±4.75)pmol/μmol Cr;恢复期血清IL-4(6.84±5.64)ng/L及尿LTE4(3.6±1.12)pmol/μmol Cr;健康组IL-4(5.72±2.24)ng/L及尿LTFA(1.43±0.14)pmol/μmolCr.毛细支气管炎患儿发病急性期血清IL-4及尿LTE4明显增高(P<0.01).中重度组血清IL-4为(15.32±6.85)ng/L,及尿LTE4为(28.8±4.71)pmoL/μmol Cr,高于轻症组IL-4[(7.64±4.31)ng/L]及尿LTE4[(18.1±3.52)pmol/μmol Cr],两组问差异有显著性(P<0.05).恢复期IL-4为(6.84±5.64)ng/L 及尿LTFA为(3.6±1.21)pmol/μmol Cr;正常健康对照组IL-4(5.72±2.24)ng/L及尿LTE4(1.43±0.14)pmol/μmol Cr,两组间差异无显著性(P>0.01).血清IL-4与尿LTE4检测结果呈正相关,r值分别为0.628、0.564(P<0.01).结论 血清IL-4及尿LTE4水平可作为毛细支气管炎病情严重程度的指标之一,有利于指导临床诊治.     

新生儿血清瘦素水平变化及与胰岛素样生长因子－I和胰岛素关系研究

为探讨新生儿期血清瘦素、胰岛素样生长因子_I(IGF_I)和胰岛素水平变化及其对新生儿生长发育的影响,采用放射免疫法检测46例健康新生儿静脉血和脐静脉血瘦素、IGF_I和胰岛素水平 ,采用新生儿体重、身长和Rohrers指数[(RI)=出生体重(g)×100/身长(cm)3]估测新生儿生长营养状态。结果显示早期新生儿组血清瘦素水平(0.59±0.43μg/L)明显低于初生组(8.29±6.76μg/L)和晚期新生儿组(1.68±0.58μg/L) ;早期至晚期新生儿组血清瘦素水平的增长值与此期间血清IGF_I、胰岛素和新生儿体重的增长值呈显著正相关(r=0.383,r=0.284,r=0.365) ;初生至早期新生儿组血清瘦素水平的下降值与胰岛素水平、新生儿体重的变化无相关性。提示瘦素在调节新生儿期体重和能量平衡方面起重要作用 ;瘦素可能通过IGF_I、胰岛素共同调节新生儿生长发育     

窒息新生儿选择头部亚低温治疗前后血清神经元特异性烯醇化酶的变化

目的 探讨窒息脑损伤新生儿选择头部亚低温治疗前后血清神经元特异性烯醇化酶(NSE)的变化及早期亚低温治疗效果.方法 窒息新生儿82例.其中轻度窒息39例,重度窒息43例.无窒息足月新生儿29例作为健康对照组.重度窒息新生儿随机分成亚低温治疗组和常规治疗组,亚低温治疗组采用选择性头部亚低温治疗方法 ,维持鼻咽温度(34.0±0.5)℃,持续72 h;常规治疗组仅采用常规对症治疗.分别于治疗前、治疗72 h采集各组新生儿静脉血2 mL,采用放射免疫分析方法 检测血清NSE.采用SPSS 12.0软件进行统计学分析.结果 轻度窒息组血清NSE水平[(34.83±6.17)μg/L]及重度窒息组[(59.58±8.87)μg/L]均明显高于健康对照组[(30.57±4.88)μg/L](t=3.07 P<0.01;t=16.02 P<0.001);且重度窒息组明显高于轻度窒息组(t=14.52 P<0.001).亚低温治疗组和常规治疗组患儿治疗前血清NSE水平分别为(60.65±8.85)μg/L、(58.46±8.98)μg/L,二组比较无显著差异(t=0.81 P>0.05);治疗72 h亚低温治疗组[(40.97±6.55)μg/L]明显低于常规治疗组[(48.15±5.57)μg/L](t=3.86 P<0.001).结论 NSE可作为新生儿窒息脑损伤的早期监测指标之一,早期亚低温治疗重度窒息新生儿有脑神经保护作用.     

窒息新生儿血清肌钙蛋白I和磷酸肌酸激酶

目的探讨血清肌钙蛋白I（cTnI）和磷酸肌酸激酶同工酶（CK—MB）对窒息新生儿心肌损伤的早期诊断价值。方法选择轻度窒息新生儿29例（轻度组）、重度窒息新生儿18例（重度组）。采用ELISA法和酶动力法检测新生儿血清cTnI水平和CK—MB活性。结果出生d1窒息新生儿血清cTnI和CK-MB水平在轻度组[（2．25±0．54）μg／L、（223．4±23．5）U／L]和重度组[（4．25±0，83）μg／L、（256．3±21．8）U／L]均显著高于对照组（Pα〈0．01）；重度组血清cTnI和CK-MB水平均显著高于轻度组（Pα〈0．01）。治疗后d7窒息新生儿血清cTnI和CK—MB水平均明显下降，轻度组[（0．69±0．18）μg／L、（151．4±18．4）U／L]与对照组均无显著差异（Pα〉0．05），重度组[（1．54±0．72）μg／L、（188．9±21．5）U／L]显著高于轻度组和对照组（Pα〈0．01）。结论窒息新生儿伴心肌损伤时血清cTnI和CK—MB水平升高；动态观察可用于窒息新生儿微小心肌损伤的早期诊断。     

尿表皮生长因子和尿微量清蛋白及β2微球蛋白与过敏性紫癜患儿早期肾损伤的相关性

目的探讨尿表皮生长因子(EGF)、尿微量清蛋白(MA)及β2-微球蛋白(β2-MG)与过敏性紫癜(HSP)及过敏性紫癜性肾炎(HSPN)发病的关系与相关性;探寻HSP早期肾损伤敏感的实验室指标。方法HSP患儿73例,分为HSP组(皮肤型组、混合型组、HSPN型组);健康对照组;治疗前组、治疗后组。采用酶联免疫吸附双抗体夹心法(ABC-ELISA)测定各组尿EGF,采用放射免疫分析法测定尿MA及β2-MG水平。结果1.HSPN型组尿EGF水平为(173.90±112.53)μg/L,高于皮肤型组(89.22±40.21)μg/L和混合型组(132.96±56.41)μg/L;HSPN型组尿MA水平为(46.34±18.49)mg/L,高于皮肤型组(12.30±6.73)mg/L和混合型组(24.31±12.66)mg/L;HSPN型组尿β2-MG水平为(0.52±0.39)mg/L,高于皮肤型组(0.26±0.18)mg/L及混合型组(0.35±0.25)mg/L,其差异均有统计学意义(Pa<0.05)。2.尿EGF水平治疗前组[(122.16±63.71)μg/L]高于治疗后组[(59.13±11.60)μg/L]及健康对照组[(24.74±8.75)μg/L];MA水平治疗前组[(43.09±10.46)mg/L]高于治疗后组[(12.94±5.73)mg/L]及健康对照组[(6.12±3.91)mg/L];尿β2-MG水平治疗前组[(0.45±0.25)mg/L]高于治疗后组[(0.29±0.16)mg/L]及健康对照组[(0.19±0.12)mg/L](Pa<0.05),且治疗后组与健康对照组比较差异有统计学意义(P<0.05)。3.HSP患儿肾损害中BUN/Cr阳性13例(阳性率17.81%),尿检阳性22例(阳性率30.14%),BUN/Cr加尿检阳性35例(阳性率47.95%),β2-MG阳性49例(阳性率67.12%),MA阳性53例(阳性率72.60%),EGF阳性67例(阳性率91.78%)。EGF、MA和β2-MG分别与BUN/Cr、尿检、BUN/Cr加尿检阳性率比较,差异均有统计学意义(Pa<0.05)。4.尿EGF与尿MA和β2-MG水平均呈正相关(r=0.444,0.426Pa<0.05)。结论EGF参与了HSPN的发病过程,尿EGF、MA及β2-MG可作为反映早期HSP患儿肾损伤的指标之一。     

Gastroschisis with extracorporeal liver and stomach associated with sacrococcygeal teratoma and limb abnormalities

Gastroschisis is the herniation of abdominal viscera through a paramedian abdominal wall fusion defect without involvement of the umbilical cord. Evisceration usually contains intestinal loops and has no surrounding membrane. Rarely, herniation of other major viscera such as stomach and liver occurs, which makes the prognosis worse. Gastroschisis is usually not associated with sacrococcygeal teratoma. In the present report, a very rare case of gastroschisis associated with sacrococcygeal teratoma is described. The gastroschisis had complete evisceration of the stomach, bowel and extracorporeal liver. A large sacrococcygeal mass was located on the posteroinferior part of the trunk and gluteal region, and was completely external. The fetus also showed a malrotated lower limb and talipes equinovarus.     

PNP roles and interventions with children with special needs and their families.

Pediatric nurse practitioners (PNPs) can create excellent professional roles caring for children with special health care needs (CSHCN) and their families. Children with chronic conditions represent an estimated 31% of the US population younger than 18 years (approximately 20 million children in 1988). Five percent of all children who have multiple special needs account for approximately 40% of all pediatric health care expenditures. Skill building is needed for PNPs who have traditionally focused on wellness and common acute illnesses in primary care settings. Role theory and research can guide PNPs in creating roles and interventions to improve the health, safety, and developmental outcomes for CSHCN and their families. Two roles are described, with examples of specific nursing interventions. Assisting child care centers to serve children and families with special needs is an ideal role for PNPs who have knowledge of health and regulatory issues. Another important PNP role is working with adolescents with special health care needs as they transition from pediatric to adult care. Many resources (such as those from the Maternal and Child Health Bureau) are available to assist PNPs to create new roles and interventions for CSHCN and their families.     

Comparison of patients with Kawasaki disease with retropharyngeal edema and patients with retropharyngeal abscess

Kawasaki disease with retropharyngeal edema (KD with RPE) is a rare complication, and it is diagnosed by neck CT. Most reported cases had a delayed diagnosis because those patients' conditions were misdiagnosed as retropharyngeal abscess (RPA). The purpose of this study was to differentiate KD with RPE from RPA. We performed a retrospective case–control study comparing children with KD with RPE to those with RPA hospitalized at the tertiary pediatric hospital in Tokyo between 2005 and 2011. The 39 patients revealing RPE on neck CT were divided into two groups: group A was classified as KD (n?=?21) and group B was classified as non-KD (n?=?18). Patients in group B were finally evaluated as having RPA clinically and were treated with antibiotic therapy. A significantly higher proportion of patients in group B complained of dysphagia (11 patients vs. 5 patients; p?=?0.0170) and neck pain (17 patients vs. 12 patients; p?=?0.0106). Neck CT revealed a ring enhancement (16 patients vs. no patients; p?<?0.0001) and mass effect in a greater proportion of patients in group B (11 patients vs. 1 patient; p?<?0.0003). Conclusion: Careful attention to manifestations and close analyses of CT imaging may allow clinicians to differentiate KD with RPE from RPA.