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1.
To assess whether lipid infusion could be a risk factor for parenteral nutrition-associated cholestasis (PNAC) in low birth
weight neonates, 22 newborns with cholestasis (29.8 ± 1.6 weeks, 1298 ± 217 g) were compared with 22 without cholestasis (29.5 ± 1.7 weeks,
1286 ± 363 g). The mean level of peak direct bilirubin for the cholestasis group was 4.6 mg/dl compared to 1.2 mg/dl for the
noncholestasis group. A univariate analysis revealed that PNAC was significantly related to duration of fasting (p = 0.008) and parenteral nutrition (p < 0.0001), days of antibiotics use (p = 0.025), positive C-reactive protein (p = 0.018) or gastric culture (p = 0.018), and feeding intolerance (p < 0.0001). Total amino acid amount (p < 0.0001), total lipid amount (p < 0.0001), and average daily lipid amount (p = 0.002) were significantly higher in the cholestasis group than in the noncholestasis group. Conversely, prenatal administration
of dexamethasone was a significant protective factor of PNAC (p = 0.008). Logistic regression analysis revealed that the cumulative amount of lipid infusion was an independent risk factor
for PNAC (p = 0.041; OR 1.174; CI 1.007–1.369). We suggest that decreasing the cumulative load of amino acids and intralipids with early
trophic feeding, control of infection, and prenatal administration of dexamethasone could possibly attenuate the severity
of PNAC. 相似文献
2.
Engin Günel Fatma Çağlayan Osman Çağlayan Aydan Canbilen Murat Tosun 《Pediatric surgery international》2002,18(1):24-27
To investigate the efficacy of antioxidant therapy on collagen synthesis in corrosive esophageal burns, 110 Sprague-Dawley
rats were divided into five groups of 22 animals each. A standard esophageal caustic burn was produced by 1 ml of 10% sodium
hydroxide solution for the rats in groups B to E; group A was instilled only with 0.9% saline after preparation of the distal
esophageal segment. Group A animals (controls) were uninjured and untreated. Group B had untreated esophageal burns. Esophageal
burns were treated in group C with vitamin E (10 mg/kg IM), in group D with vitamin C (10 mg/kg IP), and in group E with methylprednisolone
(30 mg/kg IM) on each of 5 days. Eight rats from each group were killed 4 days after initiation of the study and the abdominal
esophagus was studied for tissue malondialdehyde (MDA; μmol/g protein) levels. The other rats were killed 28 days after initiation
of the study and determination of hydroxyproline (HP) (μg/g tissue) levels in esophageal tissue was performed for 8 rats in
each group. Histopathologic evaluation was also performed in the other 6 rats from each group. MDA levels in esophageal tissue
were significantly lower in groups C (9.24 ± 2.62, P < 0.01) and group E (6.26 ± 2.22, P < 0.001) than in group B (12.35 ± 1.80). HP levels were significantly lower in groups A (0.75 ± 0.21, P < 0.001), C (1.11 ± 0.15, P < 0.01), and E (0.96 ± 0.15, P < 0.001) than in group B (1.40 ± 0.20). Histopathologically, collagen deposition in the submucosa and tunica muscularis was
lower in groups C and E than in group B (P < 0.05, and 0.01, respectively). Our results demonstrate that treatment with antioxidant drugs such as vitamin E and methylprednisolone
decreased tissue HP levels, and thus inhibited new collagen synthesis and stricture formation in rats with alkali-induced
caustic esophageal burns.
Accepted: 16 February 2001 相似文献
3.
Effect of central precocious puberty and gonadotropin-releasing hormone analogue treatment on peak bone mass and final height in females 总被引:5,自引:0,他引:5
S. Bertelloni G. I. Baroncelli M. C. Sorrentino G. Perri G. Saggese 《European journal of pediatrics》1998,157(5):363-367
To evaluate the effect of central precocious puberty (CPP) and its treatment with gonadotropin-releasing hormone (GnRH) analogues
on final height and peak bone mass (PBM), we measured lumbar bone mineral density (BMD) in 23 girls at final height. Patients
were distributed in two groups. Group 1: 14 patients with progressive CPP were treated with GnRH analogues; seven patients
received buserelin (1600 μg/daily), subsequently switched to depot triptorelin (60 μg/kg/26–28 days); seven patients were
treated with depot triptorelin (60 μg/kg/26–28 days); mean age of treatment was 6.2 years (range 2.7–7.8 years); the treatment
was discontinued at the mean age of 10.1 years (range 8.7–11.3 years); final height was reached at the mean age 13.4 years
(range 12.0–14.9 years). Group 2: 9 patients (mean age 6.5 years, range 4.8–7.7 years) with a slowly progressing variant of
CPP were followed without treatment; final height was reached at the mean␣age␣13.6 years (range 12.5–14.8 years). Lumbar BMD
(L2-L4 by dual energy X-ray␣absorptiometry) was measured in all patients at final height. In group 1, final height␣(158.9 ± 5.4 cm)
was significantly greater than the pre-treatment predicted height (153.5 ± 7.2 cm, P < 0.001), but significantly lower than mid-parental height (163.2 ± 6.2 cm, P < 0.005). Subdividing the girls of group 1 according to the bone age at discontinuation of therapy (i.e. ≤11.5 years, n = 5, or ≥12.0 years, n = 9), the former patients had a final height significantly higher than the latter (163.7 ± 3.9 cm vs 156.5 ± 4.6 cm, P < 0.02). In group 2, final height (161.8 ± 4.6 cm) was similar to the pre-treatment predicted height (163.1 ± 6.2 cm, P = NS) and was not significantly different from mid-parental height (161.0 ± 5.9 cm). BMD values (group 1: 1.11 ± 0.14 g/cm2, group 2: 1.22 ± 0.08 g/cm2) were not significantly different from those of a control group (1.18 ± 0.10 g/cm2; n = 20, age 16.3–20.5 years) and the patients' mothers (group 1: 1.16 ± 0.07 g/cm2, n = 11, age 32.9–45.1 years; group 2: 1.20 ± 0.08 g/cm2, n = 7, age 33.5–46.5 years). In group 1, the girls who stopped therapy at a bone age ≤11.5 years had significantly higher BMD
(1.22 ± 0.10 g/cm2) compared to those who discontinued therapy at a bone age ≥12.0 years (1.04 ± 0.12 g/cm2, P < 0.05).
Conclusion In girls with progressive CPP, long-term treatment with GnRH analogues improves final height. A subset of patients with CPP
does not require treatment because good statural outcome (slowly progressing variant). In CPP, the abnormal onset of puberty
and the long-term GnRH analogue treatment do not impair the achievement of PBM. In GnRH treated patients, the discontinuation
of therapy at an appropriate bone age for pubertal onset may improve both final height and PBM.
Received: 5 June 1997 / Accepted in revised form 21 November 1997 相似文献
4.
Ming-Guo Xu Li-Na Men Chun-Yu Zhao Xia Zhao Yuan-Xiang Wang Xiang-Chun Meng Ding-Rong Shen Bao-Ying Meng Qing Zhang Tao Wang 《European journal of pediatrics》2010,169(3):289-296
Kawasaki disease (KD) is associated with coronary artery injury. Studies have shown that the endothelial progenitor cell (EPC)
participates in the process of arterial repair. Data have been reported that the number of EPC increased significantly in
the subacute phase of KD. However, until now, there are no data about the functions of EPC in KD patients. The present study
was designed to further investigate the number and functions of EPC in KD. Ten KD patients in the acute phase and ten healthy
volunteers were recruited and attributed to the KD group and control group, respectively. The circulating CD34/kinase insert
domain-containing receptor double positive cells were evaluated in the two groups using flow cytometry. In vitro assays were
used to measure the functions of EPC, including proliferation, adhesion, and migration activities. The plasma levels of nitric
oxide (NO), tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (hs-CRP) were also assessed in both groups.
The number of EPC in the KD group was significantly higher than that of the control group (0.021 ± 0.007% vs. 0.014 ± 0.003%,
P < 0.05). The migratory response of EPC was significantly decreased in the KD group, compared with that of the control group
(5.50 ± 1.78 vs. 3.40 ± 1.35 cells/high power field, P < 0.01). Similarly, the proliferative and adhesive activities of EPC in the KD group were also decreased (0.47 ± 0.08 vs.
0.66 ± 0.07, P < 0.01; 6.5 ± 2.12 vs. 11.2 ± 2.04 cells/high power field, P < 0.01). The plasma NO, TNF-α, and hs-CRP levels in the KD group were higher than those of the control group (54.10 ± 11.78
vs. 38.80 ± 11.10 μmol/l, P < 0.01; 48.20 ± 7.42 vs. 37.00 ± 11.12 pg/ml, P < 0.05; 87.10 ± 30.18 vs. 5.30 ± 3.37 mg/l, P < 0.01). The number of circulating EPC positively correlated with the level of NO (r = 0.92, P < 0.001), and the functions of EPC negatively correlated with the levels of TNF-α and hs-CRP, respectively. In Kawasaki disease,
the number of EPC was enhanced and the functions of EPC were attenuated. The two-way regulation of circulating EPC in KD patients
may be associated with the disorders of cytokines or messengers in KD patients. 相似文献
5.
Weir KA McMahon SM Long G Bunch JA Pandeya N Coakley KS Chang AB 《Pediatric radiology》2007,37(3):283-290
Background There are minimal data on radiation doses to infants and children undergoing a modified barium swallow (MBS) study.
Objective To document screening times, dose area product (DAP) and effective doses to children undergoing MBS and to determine factors
associated with increased screening times and effective dose.
Materials and methods Fluoroscopic data (screening time, DAP, kVp) for 90 consecutive MBS studies using pulse fluoroscopy were prospectively recorded;
effective dose was calculated and data were analyzed for effects of behavior, number of swallow presentations, swallowing
dysfunction and medical problems.
Results Mean effective dose for the entire group was 0.0826 ± 0.0544 mSv, screening time 2.48 ± 0.81 min, and DAP 28.79 ± 41.72 cGy cm2. Significant differences were found across three age groups (≤1.0, >1.0–3.0 and >3.0 years) for effective dose (mean 0.1188,
0.0651 and 0.0529 mSv, respectively; P < 0.001), but not for screening time or DAP. Effective dose was correlated with screening time (P = 0.007), DAP (P < 0.001), number of swallow presentations (P = 0.007), lower age (P = 0.017), female gender (P = 0.004), and height (P < 0.001). Screening time was correlated with total number of swallow presentations (P < 0.001) and DAP (P < 0.001).
Conclusion Screening times, DAP, effective dose, and child and procedural factors associated with higher effective doses are presented
for children undergoing MBS studies.
This work was supported by the Royal Children’s Hospital Foundation, Brisbane. 相似文献
6.
K. de Meer K. R. Westerterp R. H. J. Houwen H. A. A. Brouwers R. Berger A. Okken 《European journal of pediatrics》1997,156(4):299-304
Growth failure is a well-known problem in infants with bronchopulmonary dysplasia (BPD). We studied BPD infants' total daily
energy expenditure (Ee), nutritional balance, and growth in relation to their past and current clinical status. Applying the
doubly labelled water technique, Ee was measured in nine preterm infants with BPD receiving supplemental oxygen (postnatal
age 61 ± 13 days) and nine matched controls (36 ± 21 days) during a 6-day period. Energy and protein balance, past and present
respiratory status, and growth were assessed as well. The results show that Ee was higher in the BPD infants compared to controls
(73 ± 9 vs 63 ± 8 kcal/kg/day, P < 0.05), but their faecal energy loss was lower (P < 0.01). Weight gain, energy intake, energy cost of growth, protein retention, and physical activity were not different.
The respiratory frequency (RR) in the BPD infants was elevated in comparison with controls (P < 0.01). Within the BPD group, RR was positively correlated with energy expenditure (regression equation: Ee [kcal/kg/day] = 26.3
+ 0.71*RR [min−1]; r
2 = 0.82, P < 0.001), and was the single most significant determinant of Ee.
Conclusion Total energy expenditure in BPD infants is elevated and is strongly associated with their respiratory status. These findings
could be of practical value for the nutritional management in infants with severe BPD.
Received: 17 January 1996 / Accepted: 23 July 1996 相似文献
7.
Meddah AT Leke L Romond MB Grenier E Cordonnier C Risbourg B Canarelli JP 《Pediatric surgery international》2001,17(7):515-520
The effects of mesenteric ischemia on ileal colonization, intestinal integrity, and bacterial translocation (BT) in newborn
piglets were investigated in 36-2-day-old Pietrain piglets. Group I, controls were not operated upon; group II underwent a
sham laparotomy; and group III underwent ligation of the mesenteric vessels in the distal ileum. After 3 days, the kidneys,
spleens, livers, and ileal segments were harvested for microbial and histologic analyses. Two piglets in the ischemic group
died; microscopic examination showed severe histologic lesions of the ischemic area. Escherichia coli counts were increased in the ischemic segment compared to the upper loop (P < 0.05). Ischemia favoured staphylococcal colonization, whereas in the sham group a drastic reduction of these organisms
was observed (P < 0.005). BT to the kidneys, spleen, and liver occurred normally in the control group. Ischemia significantly increased the
total microflora in the spleen and liver (P < 0.05) and furthered dissemination of Clostridium perfringens in the kidneys (P < 0.05); 50% of ischemic animals had proteolytic clostridia in this organ (P < 0.05). Moreover, the incidence of E. coli in the kidneys, spleen, and liver was significantly higher in the sham and ischemic groups than in the controls (P < 0.05). Ileal ischemia thus induced significant histologic lesions, and surgery rather than gut microflora controls translocation.
Accepted: 16 November 2000 相似文献
8.
Contribution of the blood glucose level in perinatal asphyxia 总被引:3,自引:0,他引:3
This is a comparative study between 60 asphyxiated newborns (cases) and 60 normal neonates (controls) in respect of their
plasma glucose and uric acid levels and also their clinical and neurological status. The mean plasma glucose level was significantly
lower (35.1 ± 11.4 mg/dl vs. 56.9 ± 5.5 mg/dl; P < 0.001) and the mean serum uric acid level was higher (8.0 ± 1.2 mg/dl vs. 4.5 ± 0.83 mg/dl; P < 0.001) in the asphyxiated group when compared to the controls. Within the perinatal asphyxia group, the plasma glucose
level and Apgar scores showed a significant positive linear correlation (r = 0.740, P < 0.001), whereas a significant negative linear correlation was observed between the glucose level and different stages of
hypoxic ischemic encephalopathy (HIE) (r = −0.875, P < 0.001). Although a strong positive linear correlation was found between uric acid and HIE stages (r = 0.734, P ≤ 0.001), the linear correlation between uric acid and Apgar scores (r = −0.885, P < 0.001) and uric acid and the plasma glucose level (r = −0.725, P < 0.001) were found to be significantly negative among the cases. Conclusion: The severity of encephalopathy and cellular
damage varies with the severity of hypoglycemia. 相似文献
9.
Tissue antioxidant capacity and bacterial translocation under total parenteral nutrition 总被引:4,自引:0,他引:4
I. Eizaguirre L. Aldámiz P. Aldazábal N. García Urkia A. B. Asensio P. Bachiller J. M. García Arenzana J. L. Ruiz P. Sanjurjo G. Perez Nanclares 《Pediatric surgery international》2001,17(4):280-283
Alterations in the antioxidative system have been observed during total parenteral nutrition (TPN). Light exposure or changes
in the composition of TPN formulas may affect this system. Bacterial translocation (BT) is frequent under TPN and may be related
to oxidative status. The aim of this study was to determine the adverse effects of standard and glutamine-enriched TPN, with
or without light exposure, on oxidative status (liver and kidney-reduced glutathione, GSH) and its relationship to BT. Thirty-three
adult Wistar rats underwent central-venous cannulation and were randomly assigned to one of four groups receiving different
TPN regimes for 10 days. The TPN group (n=10) had standard TPN, the TPN(-) group (n=8) standard TPN without light exposure,
the GTPN group (n=8) glutamine-enriched TPN, and the GTPN(-) group (n=7) glutamine-enriched TPN without light exposure. A
sham group (n=16) receiving chow and water ad libitum and saline i.v. served as controls. At the end of the experiment, GSH
was determined in liver and kidney tissue. Mesenteric lymph nodes and peripheral and portal blood samples were cultured for
BT. Compared to sham rats, TPN groups had statistically significant lower GSH levels, but there were no differences between
standard or glutamine-enriched groups or light-exposure groups. Sham animals had 12% BT. Significantly higher BT (P < 0.05) occurred in TPN rats: 70% in the TPN group, 88% in the TPN(-) group, 86% in GTPN (-) animals, and only 50% in the
GTPN group (P=0.06 vs TPN group). In conclusion, (1) TPN reduces antioxidant capacity; (2) glutamine supplementation or light protection
does not improve tissue antioxidant capacity under TPN; (3) the absence of light exposure does not improve TPN-related BT;
and (4) glutamine supplementation tends to reduce BT only in the presence of light. 相似文献
10.
H. Kobayashi T. Miyano K. Horikoshi K. Orihata S. Watanabe S. Futagawa 《Pediatric surgery international》1998,13(7):491-493
Biliary atresia (BA) is the end-result of a destructive inflammatory process that affects intra- and extrahepatic bile ducts,
leading to fibrosis and obliteration of the biliary tracts with the development of biliary cirrhosis and portal hypertension
(PH). Endothelins (ET) are 21-amino-acid peptides of endothelial origin with potent vasoconstrictor activity that bind to
various cells of the liver. Nothing is presently known about plasma ET levels in BA. The aim of this study was to determine
the clinical significance of plasma ET levels in patients with BA after hepatic portoenterostomy (Kasai's procedure) and to
correlate these with liver function tests (LFT) and PH. We measured plasma concentrations of ET in 19 patients with BA (5
boys and 14 girls; mean age 11.6 ± 5.5 years) after portoenterostomy and 10 age-matched controls. Patients were grouped according
to outcome based on LFT: group A consisted of 9 patients with an ‘‘unfavorable outcome” and Group B 10 patients with a “favorable
outcome”. The plasma ET levels were measured using a highly sensitive and specific enzyme immunometeric assay (EIA). No patient
had ascites or hepatorenal syndrome. Plasma ET levels were significantly higher in patients with BA than in controls (3.42 ± 0.42 vs
1.75 ± 0.39 pg/ml, respectively; P < 0.01) and in patients in group A than in group B. (3.75 ± 0.25 vs 3.06 ± 0.23 pg/ml, respectively; P < 0.01). In group A, plasma ET levels were higher in patients with PH (n = 4) than in those without PH (n = 5) (3.99 ± 0.06 vs 3.64 ± 0.22 pg/ml, respectively; P < 0.05). We conclude that plasma ET levels are high in patients with BA, especially those with severe biliary cirrhosis,
and that ET may partially contribute to development of PH in BA. The results of the present study also suggest that plasma
ET concentrations may be a useful marker in the follow-up of patients with BA.
Accepted: 12 September 1997 相似文献
11.
Are stable postoperative biliary atresia patients really stable? 总被引:5,自引:0,他引:5
Kobayashi H Horikoshi K Yamataka A Lane GJ Furuhata A Sueyoshi N Miyano T 《Pediatric surgery international》2001,17(2-3):104-107
Transforming growth factor-beta 1 (TGF β-1) is an important mediator of liver-cell proliferation and replication that is
implicated in hepatic fibrosis (HF). Hepatic stellate cells (HSC) are activated by TGF β-1 and are the main precursor cells
involved in fibrogenesis. The correlation between serum TGF β-1, activated HSC in liver-biopsy specimens, and liver biochemistry
was investigated to determine the value of TGF β-1 as an indicator of clinical status in postoperative biliary atresia (BA)
patients. Thirty-two postoperative BA patients (mean age 11.2 ± 2.8 years) and 13 normal controls (mean age 10.3 ± 3.7 years)
were studied. Based on average liver function test (LFT) results over a 3-month period immediately prior to this study, the
BA patients were divided into group I (anicteric, normal LFT; n = 10); group II (anicteric, elevated liver transaminases; n = 12), and group III (jaundiced end-stage liver fibrosis awaiting liver transplantation; n = 10). Serum TGF β-1 was determined using ELISA. Liver-biopsy specimens were examined with antibody against TGF β-1 and α-smooth
muscle actin (SMA) antibody for detection of activated HSC. Serum TGF β-1 was significantly higher in groups I (11.4 ± 3.7 ng/ml;
P < 0.01) and II (23.3 ± 11.3 ng/ml; P < 0.001) than in group III (3.0 ± 1.5 ng/ml) and controls (4.5 ± 2.5 ng/ml) despite normal LFT in group I. The 3 subjects
with the highest serum TGF β-1 in group II had bile lakes. Biopsies from groups I and II were strongly positive for TGF β-1
in hepatocytes and Kupffer cells and for activated HSC detected by SMA compared with group III and controls. Because serum
TGF β-1 and activated HSC are only present during active fibrosis, we conclude that there is progressive fibrogenesis even
in seemingly normal postoperative BA patients. In particular, bile lakes should be regarded as a key sign of progressive HF,
the presence of which should be regarded with extreme caution. We suggest that serum TGF β-1 could be used as an accurate
indicator of progressive fibrogenesis in postoperative BA patients.
Accepted: 14 April 2000 相似文献
12.
Circulating soluble adhesion molecule levels in children with acute lymphoblastic leukaemia 总被引:3,自引:0,他引:3
M. Hatzistilianou F. Athanassiadou C. Agguridaki D. Catriu 《European journal of pediatrics》1997,156(7):537-540
The aim of this study was to evaluate levels of serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular
cell adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin) as parameters of disease activity and to monitor the
response to treatment in children with acute lymphoblastic leukaemia (ALL). The above soluble adhesion molecules were determined
in the serum of 35 children with ALL and 30 healthy children (control group) of the same age range. The samples were obtained
before treatment, 6 months after the beginning of the treatment (remission of the disease), 6 months after the end of the
treatment and during relapse of the disease. The mean levels of sICAM-1, sVCAM-1 and sE-selectin at the onset of the disease
were 646.6 ± 80.9 ng/ml, 1786 ± 151.8 ng/ml and 140.5 ± 17.3 ng/ml, respectively. These values were significantly higher (P < 0.001) than those of the control group, which were, 245.8 ± 25.7 ng/ml, 798.6 ± 78.9 ng/ml and 44.7 ± 18.2 ng/ml respectively.
During remission, the mean levels did not differ significantly from those of the control group. After the end of the treatment
the mean levels again did not show any significant differences compared to the control group. During relapse the soluble adhesion
molecule mean levels (923.9 ± 110.1 ng/ml, 2945.7 ± 349.9 ng/ml and 258.2 ± 5.1 ng/ml) were significantly higher (P < 0.001) than those of the control group and also than those obtained during remission and after the end of the treatment
(P < 0.001). Pearson's correlation coefficient r was computed in order to detect possible linear correlations between: (1) sICAM-1 and sVCAM-1 (r = 0.632); (2) sICAM-1 and sE-selectin (r = 0.788) and (3) sVCAM-1 and sE-selectin (r = 0.752). All three cases correspond to P < 0.001, thus indicating strong linear correlations.
Conclusion The levels of soluble circulating adhesion molecule levels can be utilized for monitoring disease activity of ALL and its
response to treatment, as well as for early detection of relapse. Strong linear correlations between the three soluble adhesion
molecules tested suggest that each of them may be sufficient as an indicator.
Received: 5 August 1996 / Accepted: 13 February 1997 相似文献
13.
L. Sirota R. Straussberg N. Gurary D. Aloni H. Bessler 《European journal of pediatrics》1999,158(11):910-913
The capacity of peripheral blood mononuclear cells (PBMC) to produce interleukin (IL) IL-1β, IL-2, IL-3, IL-6, IL-10 and
tumor necrosis factor-α (TNFα) was examined in term newborns with hyperbilirubinemia after 24 hours' exposure to phototherapy
(wave length 425–475 nm). The results were compared with those from untreated neonates. Fifty newborns spontaneously delivered
at term were included in the study. Blood samples were collected from 20 newborns before and 24 h after phototherapy. The
control group consisted of 30 neonates examined on two consecutive days. PBMC isolated from blood samples were incubated in
vitro for cytokine production. The concentration of cytokines in the supernatants was tested using ELISA kits (for IL-1β,
IL-6, IL-10 and TNFα), or by bioassays (for IL-2 and IL-3). Phototherapy caused a 70% increase in IL-2 secretion (123 ± 27
vs 208 ± 30 units/ml, P < 0.01) and 56% in IL-10 production (1.07 ± 0.19 vs 1.67 ± 0.33 ng/ml, P < 0.03), whereas the spontaneous secretion of IL-1β was reduced by 43% (13.7 ± 2.3 vs 7.3 ± 1.7 ng/ml, P < 0.02). In the control group the secretion of these cytokines was similar on the two consecutive days and did not differ
significantly from secretion in the other group before phototherapy. On the other hand, lipopolysaccharide induced TNFα production
was higher on the second day in the two groups of newborns irrespective of phototherapy (388 ± 58 vs 683 ± 88 pg/ml, P < 0.001, in the control group and 384 ± 75 vs 588 ± 91, P < 0.05, before and after phototherapy). The synthesis of IL-3 and IL-6 did not change significantly between the two days
of the study. The results demonstrate that in addition to the well-known positive effect of phototherapy on the neonate serum
bilirubin level, this treatment affects the function of the immune system in newborns via alterations in cytokine production.
Received: 4 September 1997 / Accepted: 14 February 1998 相似文献
14.
M. Abele-Horn O. Genzel-Boroviczény T. Uhlig A. Zimmermann J. Peters M. Scholz 《European journal of pediatrics》1998,157(12):1004-1011
To determine the role of tracheal colonization at birth with Ureaplasma urealyticum and other pathogenic bacteria with regard to the development of bronchopulmonary dysplasia (BPD), 97 premature infants with
very low birth weight (<1500 g) were followed prospectively over 30 days in a multicentre study. Of those infants, 35 were
colonized with Ureaplasma urealyticum (group Ia), 22 with other pathogenic bacteria (group Ib) and 40 infants with sterile tracheal aspirates served as controls
(group II). Colonization with Ureaplasma urealyticum or with pathogenic bacteria independently increased the risk of developing BPD as compared to the controls (OR 2.55; 95%
CI [1.11, 5.87]). Among Ureaplasma urealyticum and bacterial colonized infants, duration of mechanical ventilation and oxygen requirement were significantly longer than
among controls (P < 0.05); during the interval of 11 to 35 days of life, every additional day of ventilation significantly increased the risk
of BPD (OR 1.22; CI [1.12, 1.32]). The rate of oxygen supplementation, which was similar in both groups during the first 2
weeks of life, was significantly higher among the colonized infants at day 21 (0.38 ± 0.18 and 0.39 ± 0.16 vs 0.31 ± 0.13,
P < 0.05) and at day 28 (0.38 ± 0.21 and 0.34 ± 0.15 vs 0.28 ± 0.12, P < 0.05). For infants still ventilated at age of 28 days, Ureaplasma urealyticum and bacterial colonization were associated with a significant higher risk for BPD than for uncolonized controls (OR 5.53;
[1.27, 24.02]. Association of Ureaplasma urealyticum and of bacterial colonization and BPD was not weakened after adjustments were made in a multivariate analysis for other significant
risk factors.
Conclusion
Ureaplasma urealyticum colonization is as an important risk factor in the development of bronchopulmonary dysplasia as bacterial colonization even
after treatment with surfactant.
Received: 23 January 1997 and in revised form: 30 December 1997 / Accepted: 5 January 1998 相似文献
15.
K. Schmitt G. Häusler P. Blümel E. Plöchl T. Waldhör H. Frisch 《European journal of pediatrics》1997,156(2):99-103
Administration of human growth hormone (GH) has yielded conflicting results concerning its role on thyroid function in patients
with Ullrich-Turner syndrome. Therefore, we investigated the course of thyroid hormone parameters and thyroxin binding globulin
in relation to GH therapy, IGF-I and additional oxandrolone-(Ox) or testosterone (T) treatment in 20 patients with Ullrich-Turner
syndrome. During the 1st year the patients received only GH. There was no change in T4, fT4, and TSH levels, T3 increased
significantly (P < 0.01) after 6 and 12 months, resulting in a higher T3/T4 ratio. TBG (P < 0.05) and IGF-I (P < 0.01) increased after 6 months and remained elevated at 12 months. A significant positive correlation was found between
the change of T4 and TBG after 6 months (r = 0.47, P < 0.05) and after 12 months (r = 0.69, P < 0.005). Thirteen patients were further investigated after addition of an anabolic compound; 7 received Ox (0.0625 mg/kg/day
po) and 6 low dose T (5 mg i.m. every 14 days). Chronological age was comparable in these groups (10.7 ± 2.7 vs 10.7 ± 3.6
years). After 6 months of combination therapy with Ox, T4, T3 and TSH decreased. As T4 and T3 showed a parallel decrease the
T3/T4 ratio remained elevated. TBG declined after 6 and 12 months (P < 0.05), while IGF-I showed a further increment (P < 0.05). There was no correlation between the changes in T4 and IGF-I, TSH and TBG, respectively. In the T-treated group
only IGF-I increased (P < 0.05) to the same extent as in the Ox-treated patients, whereas the thyroid parameters did not change.
Conclusion The observed changes in thyroid hormone and TBG levels in the Ox group were not mediated by GH or IGF-I. The Ox-induced TBG
decrease might be linked to altered pancreatic functions regulating carbo-hydrate metabolism.
Received: 22 April 1996 / Accepted: 1 August 1996 相似文献
16.
Sepsis is a major complication of total parenteral nutrition (TPN) in children. Gut mucosal atrophy (GMA) and bacterial translocation
(BT) occur in patients receiving TPN, and the translocated enteric organisms may cause central venous catheter (CVC) infection.
Epidermal growth factor (EGF) has a trophic effect on the gut mucosa and may reduce BT, thereby reducing catheter infection.
Using a rat TPN model, the relationship between GMA, BT, and catheter sepsis was examined and the effect on these of intravenous
EGF was studied. There were four experimental groups. Group 1 had no CVC, Groups 2, 3, and 4 had a continuous central venous
infusion as follows: group 2, saline; group 3, TPN; group 4, TPN with EGF. Groups 1 and 2 had free access to chow, groups
3 and 4 had no enteral feeds. After killing at 1 week, blood, tissue, and catheter specimens were cultured and mucosal morphology
analysed. BT was defined as the presence of the same organism in cultures from the gut lumen and mesenteric lymph nodes (MLN).
TPN only (group 3) resulted in GMA and BT, and 5 of 12 animals with BT had the same gut bacteria in blood and/or catheter
cultures. The addition of EGF to the TPN significantly reduced GMA, BT to the MLN, and blood and/or catheter infections (P =< 0.05). In animals carrying enterococci, there was a significant reduction in translocation of enterococci (group 3: 8/14;
group 4: 0/11; P < 0.05) and catheter infection by enterococci was prevented (group 3: 3/14; group 4: 0/11). EGF thus reduced GMA, BT, and
blood and/or catheter infection when given IV to rats receiving TPN. Enterococcal translocation and subsequent blood and/or
catheter infection was completely prevented, suggesting a selective effect of EGF.
Accepted: 13 December 1999 相似文献
17.
Effect of elective antibiotic therapy on resting energy expenditure and inflammation in cystic fibrosis 总被引:1,自引:0,他引:1
L. Burdet O. Hugli J. D. Aubert Y. Schutz M. Roulet J. W. Fitting 《European journal of pediatrics》1999,158(9):711-716
Cystic fibrosis (CF) patients often present with malnutrition which may partly be due to increased resting energy expenditure
(REE) secondary to inflammation. Both REE and tumour necrosis factor-alpha (TNF-α), as other markers of inflammation, are
elevated during respiratory exacerbations and decrease after antibiotic treatment. However, the effect of antibiotic therapy
on REE and inflammation in patients without respiratory exacerbation is not known. The aim of our study was to determine the
effect of such an elective antibiotic therapy on REE, TNF-α, and other serum markers of inflammation. Twelve CF patients 5F/7M,
age 15.9 ± 6.1 years, weight for height ratio 89 ± 8% without clinically obvious exacerbation and treated by intravenous antibiotics
were studied. Both before (D0) and after (D14) treatment, pulmonary function tests were performed. REE was measured by indirect
calorimetry and blood taken to measure inflammation parameters. Body weight increased by 1.1 kg from D0 to D14 (P < 0.001), composed of 0.3 kg fat mass and 0.8 kg fat-free mass (FFM). The forced expiratory volume at 1 s increased from
43 ± 15% of predicted at D0 to 51 ± 15% of predicted at D14 (P < 0.01). Mean REE was 41.1 ± 7.6 kcal/kg FFM per day at D0 and did not change significantly at D14 (40.6 ± 8.5 kcal/kg FFM
per day). Serum markers of inflammation decreased from D0 to D14: C-reactive protein 17 ± 17 mg/l to 4 ± 7 mg/l (P < 0.05), elastase 62 ± 29 μg/l to 45 ± 18 μg/l (P < 0.02), orosomucoid acid 1.25 ± 0.11 g/l to 0.80 ± 0.15 g/l (P < 0.001), and TNF-α 37 ± 14 pg/ml to 29 ± 6 pg/ml (P = 0.05). Individual values showed a correlation between changes in REE and in TNF-α (P < 0.02).
Conclusion The contribution of inflammation to energy expenditure is possible but appears to be minimal in cystic fibrosis patients
treated by antibiotics on a regular basis in the absence of clinically obvious exacerbation.
Received: 6 August 1998 and in revised form: 23 November 1998 / Accepted: 23 November 1998 相似文献
18.
Left ventricle output and mean arterial blood pressure in preterm infants during the 1st day of life
P. Pladys E. Wodey A. Beuchée B. Branger P. Bétrémieux 《European journal of pediatrics》1999,158(10):817-824
The objective was to assess the contribution of left ventricular output (LVO) in determining low mean arterial blood pressure
(MABP) in preterm infants admitted to the neonatal intensive care unit. Doppler echocardiography was prospectively performed
on a cohort of 17 consecutive infants with low MABP (<30 mmHg) and on 17 consecutive control subjects (range: 600–1520 g;
27–30.7 weeks gestation). The median haematocrit was 42.5% in the low MABP group versus 49.4% in the control group (P < 0.01). The index of resistance to the LVO (RILV = MABP:LVO ratio) was lower in the low MABP group (98 vs 156 mmHg · l−1 · kg−1 · min−1; P < 0.05). An analysis of the low MABP group regarding LVO revealed that a subgroup of four infants had LVO <10th percentile
(185 ml · kg−1 · min−1) with a high RILV (>90th percentile: 226 mmHg · l−1 · kg−1 · min−1) for three of the infants. The remaining 13 infants had LVO >10th percentile and a shortening fraction >25th percentile.
In this subgroup, a high proportion of infants (9/13 vs 2/17, P < 0.01) had low RILV (<10th percentile: 96 mmHg · l−1 · kg−1 · min−1) and the incidence of haemodynamically significant patent ductus arteriosus was higher than in the control group (10/13 vs
4/17, P < 0.01).
Conclusion Left ventricular output, index of resistance to left ventricular output and patent ductus arteriosus status are important
to consider in evaluating mean arterial blood pressure during early postnatal life in preterm infants. Low mean arterial blood
pressure is frequently associated with normal or high left ventricular output, low index of resistance to left ventricular
output and significant patent ductus arteriosus.
Received: 10 November 1998 and in revised form: 8 February 1999 / Accepted: 9 February 1999 相似文献
19.
Disease-related response to inhaled nitric oxide in newborns with severe hypoxaemic respiratory failure 总被引:2,自引:0,他引:2
J.-C. Mercier T. Lacaze L. Storme J.-C. Rozé A. Tuan Dinh-Xuan M. Dehan 《European journal of pediatrics》1998,157(9):747-752
Inhaled nitric oxide (iNO) has been shown to improve oxygenation in severe persistent pulmonary hypertension of the newborn
(PPHN). However, PPHN is often associated with various lung diseases. Thus, response to iNO may depend upon the aetiology
of neonatal acute respiratory failure. A total of 150 (29 preterm and 121 term) newborns with PPHN were prospectively enrolled
on the basis of oxygenation index (OI) higher than 30 and 40, respectively. NO dosage was stepwise increased (10–80 ppm) during
conventional mechanical or high-frequency oscillatory ventilation while monitoring the oxygenation. Effective dosages ranged
from 5 to 20 ppm in the responders, whereas iNO levels were unsuccessfully increased up to 80 ppm in the nonresponders. Within
30 min of iNO therapy, OI was significantly reduced in either preterm neonates (51 ± 21 vs 23 ± 17, P < .0001) or term infants with idiopathic or acute respiratory distress syndrome (45 ± 20 vs 20 ± 17, P < .0001), `idiopathic' PPHN (39 ± 14 vs 14 ± 9, P < .0001), and sepsis (55 ± 25 vs 26 ± 20, P < .0001) provided there was no associated refractory shock. Improvement in oxygenation was less significant and sustained
(OI = 41 ± 16 vs 28 ± 18, P < .001) in term neonates with meconium aspiration syndrome and much less (OI = 58 ± 25 vs 46 ± 32, P < .01) in those with congenital diaphragmatic hernia. Only 21 of the 129 term newborns (16%) required extracorporeal membrane
oxygenation (57% survival). Survival was significantly associated with the magnitude in the reduction in OI at 30 min of iNO
therapy, a gestational age ≥34 weeks, and associated diagnosis other than congenital diaphragmatic hernia. Conclusion, iNO
improves the oxygenation in most newborns with severe hypoxaemic respiratory failure including preterm neonates. However,
response to iNO is disease-specific. Furthermore, iNO when combined with adequate alveolar recruitment and limited barotrauma
using exogenous surfactant and HFOV may obviate the need for extracorporeal membrane oxygenation in many term infants.
Received: 24 April 1997 / Accepted in revised form 3 January 1998 相似文献
20.
Ichiba H Shintaku H Fujimaru M Hirai C Okano Y Funato M 《European journal of pediatrics》2000,159(3):215-218
To examine osteopenia in very low birth weight (VLBW) infants we used repeated dual-energy X-ray absorptiometry in a prospective
study of lumbar spinal bone mineral density (BMD) in Japanese VLBW infants (birthweight 426–1498 g; n = 61, group 1) aged 40 weeks postconception to 3 years of age. Control subjects were Japanese infants with birthweight 1500–1999 g
(group 2), 2000–2499 g (group 3), or more than 2500 g (group 4). BMD in group 1 during the early period after birth was very
low, increased rapidly for 1 year, and then gradually increased until 3 years of age (r = 0.931, P < 0.0001). BMD at the age of 40 weeks postconception was 0.085 ± 0.026, 0.132 ± 0.039, 0.178 ± 0.042, and 0.196 ± 0.046 g/cm2 in groups 1, 2, 3, and 4, respectively (P < 0.0001). However, at 1 and 2 years of age no differences were observed among the groups in BMD.
Conclusion This study shows that lumbar spinal BMD in VLBW infants can normalize by the age of 2 years.
Received: 12 May 1999 / Accepted: 11 October 1999 相似文献