Tuberculosis in infants less than 3 months of age

The clinical and radiological features in 38 infants less than 3 months of age with tuberculosis proved by culture are described and may aid early diagnosis of this often fatal condition. Respiratory symptoms, cough in 33 (87%) and tachypnoea in 31 (82%), were the commonest presenting symptoms. Twenty five infants (66%) had hepatomegaly and 20 (53%) splenomegaly. Mantoux testing gave an induration of > 15 mm in three of 17 (18%) infants. In a further five a Tine test gave confluent response. Chest radiography in 27 infants showed miliary tuberculosis in seven (26%) and hilar or paratracheal adenopathy in 14 (52%) and 10 (37%) respectively. Compression of either the bronchi or trachea or both was noted in 15 (56%). Detection of this complication was aided by high kilovolt radiographs. A culture of Mycobacterium tuberculosis was obtained from gastric aspirate in 35 (92%) infants, but positive cultures were also obtained from cerebrospinal fluid, tracheal or bronchial aspirate and liver and lymph node biopsy. Of 30 mothers evaluated seven (23) had previously unsuspected pulmonary tuberculosis.     

Safety of percutaneous liver biopsy in infants less than three months old

OBJECTIVES: To evaluate the safety, outcomes, and complications of percutaneous liver biopsies (PLB) in infants aged 0 to 3 months. METHODS: We retrospectively reviewed the hospital records of all infants less than 3 months old who underwent PLB at Children's Memorial Hospital between July 1, 1997 and June 30, 2004 for complications surrounding the procedure and risk factors that might lead to complications. RESULTS: Sixty-six PLBs were performed in 63 infants. Most patients tolerated the procedure without complications. Twelve complications were recorded, for an overall complication rate of 18%. Of these, five were directly related to the procedure, and seven were sedation related. Three patients experienced a drop in hemoglobin greater than 2 gm/dL, one patient developed a bile leak, and one developed a skin hematoma. Seven patients had respiratory difficulty related to sedation, which manifested as increased work of breathing or decreased respiratory rate with depression in pulse oximetry. CONCLUSION: We conclude that PLB in young infants is associated with a somewhat higher risk of complications than in older children, particularly complications related to sedation.     

Tuberculosis in infants less than 3 months of age.

The clinical and radiological features in 38 infants less than 3 months of age with tuberculosis proved by culture are described and may aid early diagnosis of this often fatal condition. Respiratory symptoms, cough in 33 (87%) and tachypnoea in 31 (82%), were the commonest presenting symptoms. Twenty five infants (66%) had hepatomegaly and 20 (53%) splenomegaly. Mantoux testing gave an induration of > 15 mm in three of 17 (18%) infants. In a further five a Tine test gave confluent response. Chest radiography in 27 infants showed miliary tuberculosis in seven (26%) and hilar or paratracheal adenopathy in 14 (52%) and 10 (37%) respectively. Compression of either the bronchi or trachea or both was noted in 15 (56%). Detection of this complication was aided by high kilovolt radiographs. A culture of Mycobacterium tuberculosis was obtained from gastric aspirate in 35 (92%) infants, but positive cultures were also obtained from cerebrospinal fluid, tracheal or bronchial aspirate and liver and lymph node biopsy. Of 30 mothers evaluated seven (23) had previously unsuspected pulmonary tuberculosis.     

Acute fever without source in infants and children less than 36 months of age

OBJECTIVES: The objective of this article is to review current information about fever without source in children less than 36 months of age and to discuss the practical aspects of diagnosis and management.METHODS: Articles from the specific area were reviewed and presented in a practical form with recommendations from the authors.RESULTS: Febrile children comprise a substantial proportion of ambulatory pediatric visits. The majority of children are less than 3 years old. At first examination, there may be considerable overlap in the clinical appearance of children with fever due to viral illness, occult bacteremia and serious bacterial infection. The authors present the recommendations and protocols cited in the literature to assist physicians in managing infants and children with fever without source.CONCLUSION: Although many approaches to the evaluation and management of the febrile infant exist, no diagnostic protocol or therapeutic scheme is optimal for all patients. Pediatricians may individualize their management of these patients, depending on their experience, or interpretation of the recommendations presented in the literature.     

基于16S rDNA可变区测序技术对抗生素治疗后的6月龄内肺炎婴儿的呼吸道菌群现况调查

目的观察6月龄肺炎婴儿的上、下呼吸道菌群状况。方法纳入2017年1至8月在复旦大学附属儿科医院呼吸科住院的6月龄的肺炎婴儿,同时收集口咽拭子及支气管肺泡灌洗液(BALF)标本,利用16S r DNA可变区测序技术分析呼吸道菌群结构,比较上、下呼吸道菌群。结果 24例婴儿的口咽拭子和BALF标本进入本文分析。上呼吸道菌群丰度前5位依次是:链球菌属、假单胞菌属、普氏菌属7、韦荣球菌属和埃希氏-志贺菌属,下呼吸道菌群丰度前5位依次是假单胞菌属、链球菌属、普氏菌属7、克雷伯菌属、罗氏菌属。下呼吸道菌群相较于上呼吸道有更多的独有菌,下呼吸道菌群的物种丰富度显著高于上呼吸道,多样性低于上呼吸道(P0.05)。上呼吸道与下呼吸道菌群丰度在前42位的菌属均为共有菌,占上、下呼吸道总细菌的98%以上。链球菌属和假单胞菌属是上、下呼吸道中相对丰度有显著差异的主要菌属。结论小婴儿肺炎的上、下呼吸道菌群均存在显著改变;上、下呼吸道菌群物种组成相似,物种比例有差异。     

三个月以内婴儿室间隔缺损的外科治疗

目的　总结手术矫治 3个月以内婴儿室间隔缺损的效果。方法　 1999年 6月～ 2 0 0 1年 11月手术治疗 2 0例先天性心脏病室间隔缺损伴肺动脉高压婴儿 ,其中男 12例 ,女 8例。年龄 34～ 10 4d ,平均 (74.6 5± 9.70 )d。体重 3.35～ 7.0 0kg ,平均 (4 .93± 0 .94)kg。室间隔缺损均为单发 ,其中膜周型 16例 ,肺动脉瓣下 4例。 2例合并动脉导管未闭 (PDA) ,1例合并房间隔缺损 (ASD)、PDA及主动脉缩窄 (CoA) ,1例合并ASD和右冠状动脉 右室瘘。所有患儿均在全麻低温体外循环下行Ⅰ期矫治术。结果　术后早期 (30d内 )死亡 1例 (病死率 5 .0 % )。发生并发症者 10例 ,发生率5 0 .0 %。肺不张 4例 ,低心排 2例 ,心律失常 2例 ,肺炎 2例 ,胸腔积液 1例 ,渗漏综合征 1例 ,经治疗后痊愈出院。结论　反复肺炎和肺动脉高压的室间隔缺损婴儿应尽早手术根治。术后应注重呼吸道的管理和出入量的调整     

Does breast-feeding protect against infections in infants less than 3 months of age?

To determine whether breast-feeding protects infants from infections, a case-control study was conducted. The cases were previously healthy children who were admitted to Yale-New Haven Hospital for an infectious illness at or before 90 days of age. The controls were chosen from the log of births and matched to the cases for five important demographic variables. In addition, logistic regression models were used to adjust the results for other potential confounders. To minimize the potential surveillance bias that might occur if formula-fed and breast-fed infants with the same degree of illness have a different probability of being hospitalized, the case-control pairs were stratified by the severity of the medical condition of the case at the time of hospitalization. For the 281 case-control pairs, the matched odds ratio was .50 (95% confidence interval .32, .77; P less than .005), which indicates that breast-feeding is protective against infections. However, this apparent protective effect was diminished substantially when the data were stratified according to the severity of illness: the matched odds ratio for the 164 infants with serious illnesses was .79 (.47, 1.32; P less than .50), and for the 117 infants with mild illnesses it was .17 (.03, .44; P less than .001). These stratified results suggest that breast-feeding protects infants from hospitalization rather than from infections. Failure to consider the problem of surveillance bias may lead to erroneous conclusions about the protective effect of breast-feeding.     

Group B streptococcal osteomyelitis and septic arthritis. Its occurrence in infants less than 2 months old.

Nine infants less than 2 months of age with group B streptococcal (GBS) osteomyelitis or septic arthritis, or both, were seen from January 1975 through January 1978. The infants had local joint signs, usually in the absence of systemic signs. The bones and joints involved were equally distributed between proximal humerus and proximal and distal femur. An infant had involvement of the talus. Treatment consisted of two to three weeks of parenteral antibiotics, arthrotomy in infants with arthritis, and bone decompression in infants with osteomyelitis. Clinical follow-up showed normal growth and function of the affected joint. Of the organisms, five were typed: four were type III and one was type Ib. Group B streptococcal osteomyelitis and/or septic arthritis was the second most common late-onset GSB infection, being surpassed only by meningitis.     

3月龄内婴儿原发性免疫缺陷病的诊断方案建议

<正>原发性免疫缺陷病(primary immunodifficiency disease,PID)是指由遗传因素所致的免疫细胞和免疫分子缺陷引起的免疫反应缺如或降低,导致机体抗感染免疫功能低下的一组临床综合征。虽然PID的临床表现多样且缺乏特异性,但是又具有共同特征:反复发生慢性、难治性感染,易患自身免疫性疾病和恶性肿瘤,致死及致残率高等。目前,关于PID的发病率尚无确切的资料,国外报     

Paracetamol poisoning in infants aged less than six months: dosage errors

In infants under 6 months of age, paracetamol overdose is usually due to dose confusion by caretakers. Recently, liquid formulations of this drug have been commercialized in larger,60-ml bottles. The syringe to measure the syrup in these new formulations is also bigger (5 cc versus 1.2-2 cc). We present six cases of 2-4-month-old infants mistakenly given an overdose of paracetamol, each from this new 60-ml formulation. These patients are especially susceptible to poisoning because of liver immaturity and require more aggressive management. To prevent this kind of poisoning, correct and clear information must be given to caregivers about drug dosage.     

8月龄内婴儿麻疹临床分析

近几年 ,8月龄内婴儿麻疹逐渐增多 ,现将我院1998年 1月至 2 0 0 0年 10月间 2 3例婴儿麻疹报告如下。1　临床资料1.1　一般资料男性 13例 ,女性 10例 ,其中～ 3月龄 5例 ,～ 6月龄 5例 ,～ 8月龄 13例。 2 3例均有发热 ,体温 38～ 38.9℃ 8例 ,39℃以上 15例 ,咳嗽 17例 ,结膜     

广西地区小婴儿牛奶蛋白过敏的临床特征与相关因素分析

目的：探讨广西地区≤3月龄婴儿牛奶蛋白过敏(cow＇s milk protein allergy,CMPA)的临床症状与相关因素,提高 CMPA 的诊断与防治水平。方法纳入2012年7月1日至2014年12月30日,广西壮族自治区妇幼保健院儿科门诊首诊及外周医院转诊疑似 CMPA 的就诊患儿,设计观察量表,由中、高级儿科医生分选并确诊病例,门诊及电话随访,完成资料收集。结果共纳入137例患儿,过敏组51例,对照组(排除病例)86例,过敏组与对照组共有的症状包括腹泻、便秘、血便、腹痛、胃食管反流(gastroesophageal reflux,GER)、消化不良、厌食拒食、喂养困难等。过敏组与对照组喂养方式(即母乳喂养、混合喂养、人工喂养)、不当添加辅食、新生儿期间长期使用抗生素、父母过敏体质等11项指标差异无统计学意义(P ﹥0.05)。两组间就诊时有胃食管反流[20例(39.2%)vs.7例(8.1%)]、新生儿期间接触牛奶成分配方奶[51例(100%)vs.71例(82.6%)]、喂养不耐受(含 GER)[17例(33.3%)vs.11例(12.8%)]、肠道感染[8例(15.7%)vs.4例(4.7%)]、输血及使用血制品[12例(23.5%)vs.11例(12.8%)]5项指标差异有统计学意义(χ2＝19.538、P ＝0.000,χ2＝9.989、P ＝0.002,χ2＝8.308、P ＝0.004,χ2＝4.691、P ＝0.030,χ2＝5.198、P ＝0.023)。结论≤3月龄婴儿 CMPA 以腹泻、血便、GER 等消化系统症状为主要表现,新生儿时期接触牛奶成分配方奶具有重要触发作用。