新生儿及新生儿疾病

991118吸烟对脐血铅水平及新生儿神经行为发育的影响/任太芳…//实用儿科临床杂志.一1 998,13(4)一221一222 孕期被动吸烟和主动吸烟可使脐血铅水平明显升高,脐血铅含量平均值达0.52和o,61拼。01/I一,高于安全界限(0.48拼mol/L)的新生儿分别占69%和79%。当脐血铅含量高于0.48拜mol/L时,对神经行为发育有显著影响相似文献   

新生儿脐血铅水平对新生儿神经行为发育的影响

环境铅污染不仅影响儿童的生长发育，对于胎儿同样造成损害，其中最早出现的是神经行为功能的改变。研究证明，孕期低水平铅暴露即可引起新生儿神经行为发育的异常，特别是对视听功能产生不良影响。本文通过对产妇血铅及新生儿脐血铅与新生儿神经行为发育评分的分析，了解其间的关系，探讨胎儿期铅暴露对新生儿神经行为发育的影响。     

新生儿脐血铅水平对新生儿神经行为发育的影响

环境铅污染不仅影响儿童的生长发育,对于胎儿同样造成损害,其中最早出现的是神经行为功能的改变.研究证明,孕期低水平铅暴露即可引起新生儿神经行为发育的异常,特别是对视听功能产生不良影响[1].本文通过对产妇血铅及新生儿脐血铅与新生儿神经行为发育评分的分析,了解其间的关系,探讨胎儿期铅暴露对新生儿神经行为发育的影响.     

脐血胆红素预测新生儿黄疸的意义

目的研究脐带血胆红素水平预测足月健康新生儿后续黄疸程度的价值。方法523例足月健康新生儿,测定脐血胆红素、白蛋白水平,监测每日经皮胆红素值（TCB）。对时龄0—24hTCB≥18;-48hTCB≥21;-72hTCB≥25;〉72h≥25者,送检静脉血血清胆红素值（TSB）,考虑是否需要光疗。将新生儿按脐血胆红素水平分为〈30μmol／L;≥30μmoL／L;≥36μmol／L;≥42μmoL／L,共4组。比较4组新生儿TCB≥25、TSB〉205μmol／L、TSB〉257μmoL／L及需要光疗的发生率。对脐血胆红素水平预告新生儿黄疸进行分析。比较黄疸组新生儿和非黄疸组新生儿临床特征。结果脐血胆红素水平升高,各组新生儿TCB≥25、TSB〉205μmol／L、TSB〉257μmoL／L和需要光疗的发生率增加。脐血胆红素水平用于预测新生儿黄疸发生有统计学意义（P〈0．001）。黄疸组新生儿脐血胆红素值显著高于非黄疸组（t=10．96,P〈0．001）。而脐血清白蛋白值（t=2．38,P〉0．05）、妊娠周数（t=-0．90,P〉0．05）、出生体重（t=0．10,P〉0．05）比较,两组均无统计学差异。结论脐血胆红素水平用于预测足月健康新生儿后续黄疸的程度是一种有效的方法。     

母婴锌代谢的初步探讨

测定139名正常临产妇及相应的新生儿脐血清锌、红细胞锌，同时评定新生儿体格发育指标。结果表明，母亲孕晚期血清锌水平下降，达11．82±2．34μmol／L，脐血清锌为18．73±3．02μomol／L，母、脐血清锌显著正相关。而母红细胞锌增加，为212．44±26．7μol／L，脐红细胞锌则为34．92±8．67μmol／L，且与新生儿出生体重、身长、头围呈显著正相关。提示脐红细胞锌对评价新生儿锌营养状况及其与生长发育的关系有一定应用价值。     

新生儿高胆红素血症行为神经测定及婴幼儿期智能发育随访

目的探讨高胆红素血症对新生儿神经行为能力及婴幼儿期智能发育的影响。方法对43例新生儿高胆红素血症（NHB）患儿，根据血清胆红素水平，将所有观察病例分为3组：NHBⅠ组（205．5～256．5μmol／L）15例，NHBⅡ组（256．5～341．5μmol／L）21例，NHBⅢ组（342．5μmol／L）7例。健康新生儿39例作为健康对照组。采用新生儿神经行为评分（NBNA）方法分别在生后3～7d（黄疸高峰期）、15～25d（黄疸消退后）进行检测，并在生后18个月时分别对二组受试婴儿进行智力评定[Gesell量表（中国标准化）]。结果NHB组NBNA明显低于健康对照组（P〈0．001），主要表现在行为能力和肌张力方面。NHB组婴幼儿期智能发育与健康对照组差异显著（P〈0．01），且早期新生儿NHB（〈7d）比晚期NHB对智能发育影响更大（P〈0．05）。结论NHB对新生儿神经行为及婴幼儿期智能发育有一定影响。     

产母及脐血血铅与婴儿的神经行为发育

目的 探讨产母及脐血血铅水平作为胎儿期铅暴露示标在评价胎儿期铅暴露对婴儿期神经行为发育影响中的意义。方法 取配对的产母及脐血血铅水平进行相关分析；并分别与3、6月龄婴儿的Bayley发育评分进行相关分析及t检验。结果 产母血血铅与脐血铅水平高度相关；产母的血铅水平与3月龄婴儿的神经发育评分（MDI）、运动发育评分（PDI）及6月龄婴儿的MDI呈非常显著的负相关关系；脐血铅与3月龄婴儿的MDI呈显著负相关关系；以产母血铅水平第50百分位为界点区分的相对高、低铅组在3、6月龄婴儿的MDI及PDI之间已有非常显著的差异。结论 孕期的铅暴露即使在较低水平已影响到婴儿期的神经行为发育。产母血铅水平作为胎儿期铅暴露的指标较脐血血铅似更为理想。     

新生儿换血治疗的血源性铅暴露

目的探讨新生儿换血治疗中使用血库血的铅暴露危险性。方法2006年6～12月对本院新生儿科37例因高胆红素血症进行换血治疗的新生儿进行换血前后血铅水平监测，并对换血使用的53份血库血进行血铅检测。血铅测定采用石墨炉原子吸收光谱法。结果53份血库血平均血铅水平为101．02μg／L，已处于铅中毒水平；而高血铅（≥100μg／L）的血库血占28．5％（15／53份），其中3份血库血样本血铅量≥200μg／L，达Ⅲ级铅中毒水平。高胆红素血症患儿换血后血铅值≥100μg／L的百分率由2．9％升高到19．0％，换血后平均血铅水平明显高于换血前（P〈0．01），血铅水平平均增加26．62μg／L，最高1例增加81．0μg／L。结论血库血铅污染明显，新生儿换血的血源存在血源性铅暴露的危险，应在采血前进行铅筛检，避免新生儿血源性铅中毒。     

多种因素促使新生儿ABO溶血病发生高胆红素血症

本文观察30例经脐血血清学诊断为新生儿ABO溶血病后胆红素动态变化。22例出现高胆，8例黄疸呈生理性经过。高胆出现于生后24、48、72小时各为8例、11例、3例。作者认为，生后24小时发生高胆由多种因素所致，与脐血胆红素值、于血症、改良直接抗人球蛋白试验关系较大。生后24、48小时的胆红素值达到102．6μmol／L、153．9μmol／L可做为早期预防性光疗标准，能减少或避免重度黄疸的发生。     

妊娠期低水平铅暴露对新生儿血清钙、骨钙素及骨碱性磷酸酶的影响

目的研究妊娠期低水平铅暴露对新生儿血清钙(Ca)、骨钙素(OC)及骨碱性磷酸酶(BALP)的影响。方法于新生儿娩出断脐后采集脐静脉血5 ml分别检测血铅、血清钙、血清骨钙素及骨碱性磷酸酶,将新生儿以血铅值50μg/L、100μg/L为界分为低铅组(<50μg/L)、相对高铅组(50～99μg/L)和高铅组(≥100μg/L),研究脐血铅对新生儿骨代谢相关指标的影响。结果新生儿脐血铅水平与其血清骨钙素、血清钙水平呈负相关,与骨碱性磷酸酶水平呈正相关。高铅组与低铅组比较,血清骨钙素水平、血清钙几何均数水平显著降低;高铅组碱性磷酸酶水平显著高于相对高铅组及低铅组。结论妊娠期低水平铅暴露可能干扰了新生儿骨代谢。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.