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1.
Mode of delivery and asthma -- is there a connection? 总被引:3,自引:0,他引:3
Kero J Gissler M Grönlund MM Kero P Koskinen P Hemminki E Isolauri E 《Pediatric research》2002,52(1):6-11
Genetic factors cannot explain the recent rapid increase in the incidence of atopic diseases. The phenomenon has been explained by environmental factors, and there are data for and against the hypothesis that a decline in the pressure of microbial stimulation early in life could be behind the allergy epidemic. Changes have also occurred in maternity care, among them a rise in the caesarean section rate, which could diminish initial microbial exposure and thereby alter T helper 1 cell/T helper-2 cell development and affect the risk of developing atopy. In this study, we sought to establish whether mode of delivery does influence the development of atopic asthma. Finnish 1987 Medical Birth Register (n = 59,927 live births) information was linked between several national health registers to obtain information on asthma and mode of delivery in children registered. The data were adjusted for maternal age, previous deliveries, child's sex, and birth size. Atopy was evaluated in the second study (Turku Birth Cohort), which involved 219 children born by vaginal delivery (n = 106) or caesarean section (n = 113); history of atopic symptoms was established by questionnaire and a clinical examination was conducted, including skin prick testing and determination of total and allergen-specific IgE in serum. The register study showed the cumulative incidence of asthma at the age of seven to be significantly higher in children born by caesarean section (4.2%) than in those vaginally delivered (3.3%), the adjusted odds ratio (OR) for confounding variables being 1.21 (1.08-1.36), p < 0.01. In the second study, significantly more positive allergy tests were reported in questionnaires in the caesarean (22%) than in the vaginal delivery group (11%), OR 2.22 (1.06-4.64), p < 0.01, and a trend toward more positive skin prick reactions was documented at clinical examination; 41% versus 29%, OR 1.31 (0.65-2.65), p = 0.11. In conclusion, these results suggest that caesarean section delivery may be associated with an increased prevalence of atopic asthma. 相似文献
2.
Nesterenko TH Acun C Mohamed MA Mohamed AN Karcher D Larsen J Aly H 《Early human development》2012,88(8):677-681
Background
Newborns exposed to oxygen suffer from an oxidative stress with significant alterations in the concentrations of superoxide dismutase (SOD) and glutathione (GSSG).Objective
To investigate the biological and clinical effects of oxygen administration to delivering mothers.Methods
We conducted a randomized, double-blinded, controlled trial on a cohort of delivering women (n = 56) with an uncomplicated term pregnancy. Women were randomly assigned to one of two groups: Oxygen group or Room Air group. The Oxygen group received 100% oxygen (2 l/min) via nasal cannula for at least 30 min before delivery. Subjects in the Room Air group were connected to a nasal cannula while on room air. Concentrations of SOD (μg/g of Hb) and GSSG (μM/ml) were measured in maternal and umbilical cord blood. Bivariate and multivariate analyses were used to compare the two groups using the SAS system.Results
Maternal SOD and GSSG did not differ between the two groups at baseline or after delivery. Concentrations of SOD and GSSG in umbilical cord blood did not differ between groups. More infants in Oxygen Group required delivery room resuscitation (20% vs. 0%, P = 0.03). This difference could not be explained by mode of delivery, infant sex, or other confounders.Conclusions
Maternal exposure to oxygen during delivery is not associated with changes in umbilical cord SOD or GSSG. Further studies are needed to explore mechanisms responsible for the need of resuscitation in the oxygen group. 相似文献3.
Ovarian tissue cryopreservation: a practical option? 总被引:1,自引:0,他引:1
Strategies to preserve fertility in young women undergoing potentially curative chemotherapy for malignant disease have been extremely limited. This limitation stems from the complex physiology of the human oocyte and the difficulties encountered in attempting to cryopreserve both developing and mature oocytes in sufficient quantities. Although in vitro fertilization and embryo cryopreservation can be used in those young women with a partner, this technique is unsuitable for the vast majority of patients and offers only a small chance of a pregnancy. Advances in cryobiology coupled with encouraging results in laboratory animals have prompted research into the storage of ovarian cortical tissue, which in young women is rich in primordial follicles. This tissue can be grafted back into the host, theoretically restoring the possibility of normal fertility. Primordial follicles contain oocytes at their least differentiated stage and appear to be relatively resistant to the combined insults of cryopreservation and the subsequent grafting procedure. Interest in this technique has been fuelled by its successful application in large domestic animals, such that ovarian tissue banking is being rapidly adopted into clinical practice before there is any hard evidence of its efficacy in humans. 相似文献
4.
Strategies to preserve fertility in young women undergoing potentially curative chemotherapy for malignant disease have been extremely limited. This limitation stems from the complex physiology of the human oocyte and the difficulties encountered in attempting to cryopreserve both developing and mature oocytes in sufficient quantities. Although in vitro fertilization and embryo cryopreservation can be used in those young women with a partner, this technique is unsuitable for the vast majority of patients and offers only a small chance of a pregnancy. Advances in cryobiology coupled with encouraging results in laboratory animals have prompted research into the storage of ovarian cortical tissue, which in young women is rich in primordial follicles. This tissue can be grafted back into the host, theoretically restoring the possibility of normal fertility. Primordial follicles contain oocytes at their least differentiated stage and appear to be relatively resistant to the combined insults of cryopreservation and the subsequent grafting procedure. Interest in this technique has been fuelled by its successful application in large domestic animals, such that ovarian tissue banking is being rapidly adopted into clinical practice before there is any hard evidence of its efficacy in humans. 相似文献
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Jawaheer J Khalil B Plummer T Bianchi A Morecroft J Rakoczy G Bruce J Bowen J Morabito A 《Pediatric surgery international》2007,23(11):1091-1093
Various options are available for the surgical treatment of meconium ileus (MI). This paper examines the use of resection
and primary anastomosis as the favoured option for the treatment of complicated meconium ileus. This was a retrospective study.
All patients (13 children) with MI treated with primary resection and anastomosis (RA) in the 10-year period (1996–2005) at
St Mary’s Hospital in Manchester were identified. The case notes were retrieved. The gestational age, type of surgery, length
of bowel resection and complications were recorded. Out of 13 (3 males, 10 females), 7 had severely dilated bowels, 5 had
perforation and 1 had volvulus. Mean length of bowel resection was 33.8 cm (range 20–50 cm). Overall survival in this group
was 85%. Seven patients (54%) developed complications. Four (31%) had surgical complications: two anastomotic strictures with
adhesions, one adhesive intestinal obstruction and one intra-abdominal drain retraction. Primary resection and anastomosis
is a safe option in the treatment of complicated meconium ileus. It has the advantage of less hospital stay and avoids a secondary
laparotomy for closure of the stoma. 相似文献
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T. E. Nevins 《European journal of pediatrics》1992,151(Z1):S13-S15
Renal transplantation is widely accepted as the treatment of choice for endstage renal failure in childhood. Since dialysis is regularly applied to infants with renal failure, the question logically arises, can infants also receive renal transplants and what are the outcomes? A review of the literature and the clinical experience at the University of Minnesota supports the performance of renal transplantation in infancy. Present patient and graft survival rates for infants are indistinguishable from those of older children. While living adult donors are preferred, adult cadaveric kidneys have also been successfully transplanted. Following successful transplantation, the infants have generally enjoyed catch-up growth and accelerated psychomotor development. While there may be problems related to fluid and electrolyte balance in these smallest patients, the majority of the problems encountered mirror those seen in any child undergoing transplantation. Renal transplantation is regularly successful in infancy and should be considered an integral component of the therapy for any child with chronic renal failure. 相似文献
9.
Fast and safe venous access can be a critical issue in the delivery room during neonatal cardiopulmonary resuscitation or before endotracheal intubation. Here, we describe a new method to inject drugs using the umbilical vein, directly punctured through Wharton's jelly, performed in ten newborns between November 2016 and May 2018. The umbilical vein was identified and punctured easily and a reflux was obtained in all patients. The treatments were efficient in all but two patients, which was imputable to the method in one patient. We describe a new route for administration of drugs that has been successfully used in neonates. 相似文献
10.
Sachdeva RC 《Indian journal of pediatrics》2001,68(4):339-342
The estimation of cost-effectiveness of pediatric critical care services is an extremely relevant issue for both developing
and industrialized nations. Pediatric critical care is expensive and the long outcomes are still relatively unclear. From
the perspective of patients who receive the benefits of these services, there may be little controversy regarding cost-effectiveness.
However, the issue becomes very complex when attempts are made to identify which patients will benefit most. This also needs
to be considered while developing public policy when decisions for allocation of limited resources need to be made within
health care systems, and choices need to be made between the provision of health care and other public services. This article
addresses the complex issue of economic evaluations and describes various type of cost analyses. The difference between charges
and costs is defined, and a discussion of the measurement of costs and benefits, and their relationship to outcomes research
is provided. Although there is not a unique answer to the issue of cost-effectiveness for pediatric critical care services,
the available literature particularly from the United States is summarized, and the ethical implications explored.
An erratum to this article is available at . 相似文献
11.
The aim of this study was to determine whether barium enema reduction (BER) is safe and effective in patients with a long
duration of intussusception. Over the last 17 years, 104 patients were admitted to our hospital with a diagnosis of intussusception.
All except 1 with peritonitis underwent BER primarily. Of the 103 intussusceptions treated primarily by BER, 84 (82%) were
reduced by the enema alone, whereas 19 (18%) underwent surgical reduction. There were no differences in mean duration of disease
between the patients with successful and failed enema reduction (successful: 15 ± 14 h; failures: 14 ± 11 h, P = 0.6). The success rate of BER was 85% within 12 h of symptoms, 76% for 12–24 h, and 71% for more than 24 h. Of 8 cases
with a second trial, 4 (50%) were reduced by repeated barium enema. There were no deaths and no intestinal perforations. The
success rate of more than 70% even in patients with a long duration of intussusception suggests that BER is safe and effective
regardless of the duration of the disease.
Accepted: 4 September 1998 相似文献
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Bell EF 《Pediatrics》2005,115(1):173-174
14.
BACKGROUND: The efficacy and safety of epoetin alfa in ameliorating cancer- or chemotherapy-related anemia and reducing red blood cell (RBC) transfusion requirements have been demonstrated in numerous trials in adult patients. However, limited information is available about recombinant human erythropoietin (rHuEPO, epoetin alfa) as a treatment option in pediatric cancer patients. PROCEDURE: To gain more information about the efficacy and safety of epoetin alfa in the treatment of chemotherapy-induced anemia in children with solid tumors receiving either platinum- or nonplatinum-containing chemotherapy, an 8-week randomized trial was conducted. Epoetin alfa 150 IU/kg was given 3 times a week for 8 weeks to 17 patients; 17 control patients received standard of care. RESULTS: Transfusions, administered if the hemoglobin (Hb) level dropped to below 6 g/dL, were necessary for only one patient in the epoetin alfa group, as compared with eight patients in the control group (change in Hb from 8.5-10.21 g/dL in the epoetin alfa group vs. 8.48-8.41 g/dL in the control group). CONCLUSIONS: The data from this study suggest that this dosing regimen of epoetin alfa is effective and safe in pediatric cancer patients with chemotherapy-related anemia. Further studies with epoetin alfa in more children with different chemotherapy regimens are needed. 相似文献
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Are there predictors for proliferative retinopathy of prematurity and is supplemental oxygen a useful conservative treatment option? 总被引:2,自引:0,他引:2
BACKGROUND: Especially very immature preterm babies develop retinopathy of prematurity (ROP). This study aims at analysing risk factors for proliferative ROP and realizing the efficiency of supplemental oxygen therapy. PATIENTS: 180 preterm babies with birth weight < or = 1 500 grams were included retrospectively. METHODS: To determine potential predictors all preterm babies with ROP grade > or = 3 were matched to pairs with similar immature babies with ROP 1 or 2. Additionally we examined the influence of supplemental oxygen therapy on the coagulation rate of high grade retinopathy. RESULTS: 44 % of the preterm babies showed ROP. A longer duration of ventilation (21 vs. 33 days), a longer duration of oxygen supplementation (59 vs. 78 days), relapsing sepsis (10 vs. 19 babies with sepsis > 2 times), a large total volume of transfusions (median: 150 mL vs. 105 mL), chronic lung disease (CLD) (6 vs. 15 babies with oxygen requirements at 36 weeks post-menstrual age), a duration of intubation for more than 28 days (13 vs. 6 babies) and the lack of phototherapy (21 vs. 9 babies) were risk factors associated with ROP > or = 3 using univariate analysis [p < 0.05]. Only the both last criteria correlated with high grade ROP after logistic regression. The supplemental oxygen therapy showed no influence on the coagulation rate of high grade ROP. Possibly this therapy influences the frequency of surgical treatment of amotio- and of putting on a cerclage, but this remains still speculative because of the low case number. We saw no negative effect on the frequency of CLD and on the survival of the babies. CONCLUSIONS: Especially measures against long duration of intubation could help to prevent high grade ROP. The supplemental oxygen therapy may have a positive effect on course. 相似文献
17.
Michael J Rieder Canadian Paediatric Society Drug Therapy Hazardous Substances Committee 《Paediatrics & child health》2016,21(1):31-34
Cannabis is a psychoactive compound with a long history of recreational and therapeutic use. Current considerations regarding cannabis use for medical purposes in children have been stimulated by recent case reports describing its beneficial effect with refractory epilepsy. Overall, there are insufficient data to support either the efficacy or safety of cannabis use for any indications in children, and an increasing body of data suggests possible harm, most importantly in specific conditions. The potential for cannabis as a therapeutic agent must be evaluated carefully for both efficacy and safety in treating specific paediatric health conditions. Smoking is not an acceptable mode of drug delivery for children. The use of cannabis for medical purposes in specific cases should not be construed as a justification for recreational cannabis use by adolescents. Recommendations for therapeutic use in exceptional paediatric cases are offered, always providing that this treatment course is carefully evaluated in individuals and in ongoing, well-designed research studies to determine safety and efficacy. 相似文献
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Tracy M Downe L Holberton J 《Archives of disease in childhood. Fetal and neonatal edition》2004,89(1):F84-F87
Objectives: To examine whether clinically determined ventilator settings will produce acceptable arterial blood gas values on arrival, in preterm infants ventilated from delivery to the newborn intensive care unit (NICU). Further, to examine the usefulness of tidal volume and minute ventilation measurements at this time. Design: A prospective observational cohort study in a tertiary level 3 NICU. Patients: Twenty six preterm infants requiring intubation and mechanical ventilation at the point of delivery to the NICU. Setting: Infants who required mechanical ventilation were monitored with a blinded Ventrak 1550 dynamic lung function monitor from the point of delivery to the NICU. A Dräger Babylog 2000 transport ventilator was set up to achieve adequate chest wall movement, and FIO2 was adjusted to achieve preductal SaO2 of 90–98%. Dynamic lung function monitoring data were recorded and related to the arterial blood gas taken on arrival. Results: Mean gestation was 28 weeks (range 23–34) and mean birth weight was 1180 g (range 480–4200). A quarter (26% (95% confidence interval (CI) 12% to 48%)) were hypocarbic, with 20% (95% CI 7% to 39%) below 25 mm Hg, and 38% (95% CI 20% to 60%) had hyperoxia. Some (20% (95% CI 7% to 39%)) were both hypocarbic and hyperoxic. Total minute ventilation per kilogram correlated significantly with the inverse of PaCO2 (p < 0.001). Conclusions: Clinically determining appropriate mechanical ventilation settings from the point of delivery to the NICU is difficult, and inadvertent overventilation may be common. Severe hyperoxia can occur in spite of adjustment of the FIO2 concentration to achieve an SaO2 range of 90–98%. Limiting minute ventilation during resuscitation may prevent hypocarbia. 相似文献