低出生体重儿不同喂养方法时血清视黄醇结合蛋白的变化

为评估低出生体重儿生后早期间断鼻胃管喂养和鼻十二指肠喂养的效果 ,将 40例低出生体重儿 (出生体重 1 0 50～ 1 92 0g)随机分为间断鼻胃管喂养组和鼻十二指肠喂养组 ,两组出生体重、性别、胎龄无显著差异 (P >0 0 5)。用同一种配方乳喂养 ,记录入液量、热能、蛋白质摄入量、大便性状及喂养相关并发症 ,喂养前和喂养后 1周用ELISA法测血清视黄醇结合蛋白。结果显示 ,喂养后 1周鼻十二指肠喂养组较鼻胃管喂养组奶量、热能、蛋白质摄入量均显著增加 (P <0 0 0 1 ) ;肠道营养热能达 1 0 0kcal (kg·d)的时间、恢复出生体重时间均明显缩短 (P <0 0 5)。前者较后者血清视黄醇结合蛋白明显增加 (P <0 0 5)。两组均无腹泻、十二指肠穿孔、坏死性小肠结肠炎发生 ,鼻十二指肠喂养组较鼻胃管喂养组吸入性肺炎、高胆红素血症的发生显著减少 (P <0 0 1 )。提示低出生体重儿生后早期鼻十二指肠喂养优于鼻胃管喂养。     

早产儿间断鼻十二指肠喂养和鼻胃管喂养时血清前白蛋白的变化

目的：早产儿存活率逐年提高,其生后早期经肠道喂养日益受到关注,目前国内普遍采用鼻胃管喂养。鼻十二指肠喂养有争议。该文比较早产儿生后早期间断鼻胃管喂养和鼻十二指肠喂养营养摄入量、生长情况、喂养相关并发症及血清前白蛋白的变化。方法：40例早产儿(出生体重1050g～1920g)随机分为间断鼻胃管喂养组和鼻十二指肠喂养组,用同一种配方乳喂养。记录喂养1周的入液量、热能、蛋白质摄入量;体格生长指标(体重、身长、头围)的变化;大便性状;喂养相关并发症。喂养前和喂养后1周用ELISA法测血清前白蛋白(PA)。结果：喂养后1周鼻十二指肠喂养组较鼻胃管喂养组平均进奶量、热能、蛋白质摄入量均显著增加(P＜0.01＝。肠道营养热能每日达 418.4 kJ/kg 的时间、恢复出生体重的时间明显缩短(P＜0.05＝;两组早产儿喂养前及1周后身长、头围的差异均无显著性(P＞0.05)。喂养前两组PA差异无显著性(P＞0.05);喂养1周后胃十二指肠喂养组的PA明显增加(P＜0.05＝。两组均无腹泻、坏死性小肠结肠炎发生;鼻十二指肠喂养组吸入性肺炎、呕吐、残留的发生率与鼻胃管喂养组比较差异无显著性(P>0.05),高胆红素血症发生率较后者显著减少(P＜0.01＝。结论：生后早期鼻十二指肠喂养儿营养摄入量显著增加,喂养相关并发症减少,营养状态优于鼻胃管喂养儿。     

早产儿间断鼻十二指肠喂养和鼻胃管喂养的对照研究

目的 比较早产儿生后早期间断鼻十二指肠喂养和间断鼻胃管喂养营养摄入量、生长情况、肠道及胃肠道转运时间、喂养相关并发症。方法 将40例早产儿（出生体重1050g－1920g），随机分为鼻十二指肠喂养组和鼻管喂养组，用同一种配方乳喂养。记录喂养1周的入液量（静脉入液量和奶量）、热能、蛋白质摄入量；体格生长指标（体重、身长、头围）的变化；大便性状；喂养相关开发症；测定肠道及胃肠道运转时间。结果 喂养后1周鼻十二指肠喂养组较鼻胃管养组平均进奶量、热量、蛋白质摄入量均显著增加（P＜0．001）。肠道营养热能达418．4kJ／（kg.d）的时间、恢复出生体重时间明显缩短（P＜0．05）；喂养前及1周后身长、头围的变化无差异（P＞0．05）。鼻十二指肠喂养组的肠道转运时间较鼻胃管喂养组的胃肠转运时间缩短，但两组均无腹泻发生，鼻十二指肠喂养组较鼻胃管喂养组呼吸暂停、吸入性肺炎、呕吐、残留的发生率减少；而高胆红素血症显著减少（P＜0．01）。结论 早产儿生后早期鼻十二指肠喂养优于鼻胃管喂养。     

非营养性吸吮对早产儿胃肠功能及体重增长的影响

目的 探讨早产儿早期非营养性吸吮(NNS)对其胃肠功能及体重增长的影响.方法 76例需经鼻胃管喂养的健康早产适于胎龄儿,出生体重＜2 500 g,胎龄＜35周,随机分为非营养性吸吮(NNS)组36例和对照组40例.NNS组在鼻胃管喂养前后吸空橡皮奶头5 min,每天7～8次,对照组单纯给予鼻胃管喂养(N-NNS),不足热量给予部分肠道外营养.观察体重、胃排空时间、肠道营养达418.4 kJ/(kg·d)时间,喂养耐受情况.结果 NNS组、对照组恢复出生体重时间分别为(8.6±3.9) d、(10.5±3.6) d,观察组明显缩短(P<0.05);NNS组胃半排空时间(58.3±22.9) min快于对照组(73.8±17.8) min,差异有统计学意义(P<0.05).NNS组热能达418.4 kJ/(kg·d)的时间(12.0±5.4) d较对照组(15.4±5.5) d明显缩短(P<0.05);胃残留发生率低于对照组,分别为16.7%、50.0%,差异有统计学意义(P<0.05).结论 NNS可促进胃排空,有利于早产儿生后胃肠功能发育,减少喂养不耐受的发生,促进体重增长.     

非营养性吸吮对早产儿营养及胃肠道转运时间的影响

目的　评估非营养性吸吮 (NNS)对早产儿营养、胃肠道转运时间 (WGTT)及喂养相关并发症的影响。方法　将 3 8例需经鼻胃管喂养 (INGF)的健康早产适于胎龄儿 (出生体重 10 5 0～1790g) ,根据是否辅以非营养性吸吮随机分成单纯鼻胃管喂养组和非营养性吸吮组 ,用同一种配方乳喂养。记录喂养 2周的生长发育指标 (体重、身长、头围 )的变化及恢复出生体重的时间 ;入液量、奶量、热能、肠道营养热能达 418 4kJ/(kg·d)的时间、鼻胃管留置时间 ;大便次数、性状 ;喂养相关并发症 ;测定胃肠道转运时间。结果　非营养性吸吮组恢复出生体重时间 [( 8 8± 3 7)d]较单纯鼻胃管喂养组 [( 11 1± 3 0 )d]显著缩短 (P <0 0 5 ) ;喂养前及 2周后体重、身长、头围的变化差异无显著性 (P>0 0 5 )。非营养性吸吮组肠道营养热能达 418 4kJ/(kg·d)的时间 [( 12 3± 5 1)d]较单纯鼻胃管喂养组 [( 15 7± 5 2 )d]明显缩短 (P <0 0 5 ) ;鼻胃管留置时间 [( 13± 10 )d]缩短 4d [( 17± 12 )d],但差异无显著性 (P >0 0 5 )。非营养性吸吮组胃残留的发生率 ( 16 7% )较单纯鼻胃管喂养组 ( 5 0 % )显著减少(P <0 0 5 ) ,两组其他并发症的发生率差异无显著性 (P >0 0 5 ) ;非营养性吸吮组第 2周的全胃肠道转运时间 [( 3 3     

早产儿喂养相关并发症的临床观察

目的 比较早产儿早期微量奶瓶喂养和间断鼻胃管喂养的相关并发症的发生情况。方法对早期微量奶瓶喂养和鼻胃管喂养的50例早产儿进行临床观察,在用同一种早产儿配方奶喂养下观察呼吸暂停、吸入性肺炎、误吸所致窒息、呕吐、胃和上消化道出血穿孔等喂养相关并发症,以及对肠道营养达[418.4 kJ/(kg·d),即100 kcal/(kg·d)]的时间和恢复出生体重的时间的影响。结果两组均无发生腹泻、坏死性小肠结肠炎、胃穿孔。奶瓶喂养组较鼻饲组上消化道出血、呼吸暂停、吸入性肺炎、呕吐和腹胀显著减少,x2检验,P<0.01。奶瓶喂养组未曾发生因误吸所致窒息,鼻饲组发生3例。同时肠道营养热能达到418.4 kJ/(kg·d)的时间和恢复出生体重的时间,奶瓶喂养组较鼻饲组明显缩短(P<0.01)。结论出生体重1 300 g以上的早产儿生后早期微量奶瓶喂养较鼻饲喂养的相关并发症少。     

早期滴服喂养在早产极低出生体质量儿的临床应用

目的 观察早期滴服喂养对早产极低出生体质量儿的喂养效果及其相关并发症的发生情况.方法 45例早产极低出生体质量儿随机分为观察组(早期滴服喂养组)23例,对照组(早期鼻胃管喂养组)22例.观察两组奶量增加速度、体质量增长速度、达全口喂养时间、恢复出生体质量时间、胎粪完全排出时间、累计光疗时间、住院时间及其相关并发症的发生情况.结果 观察组体质量增长速度较对照组增快(P<0.05),奶量增加速度较对照组明显增快(P<0.01),达全口喂养时间、恢复出生体质量时间、胎粪完全排出时间、累计光疗时间及住院时间均较对照组明显缩短(P<0.01).观察组无一例发生吸人性肺炎,对照组发生吸人性肺炎4例,2组差异显著(P<0.05).观察组胃出血、口腔炎、呼吸暂停、呕吐及腹胀的发生率均较对照组明显减少(P<0.05).结论 早期滴服喂养能较快提高胃肠道喂养的耐受性,缩短病程,减少并发症,值得临床推广应用.     

出院后喂养方式对早产低出生体重儿生后3个月生长指标增长率的影响

目的：通过研究早产儿出院后配方奶（PDF）与母乳（BM）、足月儿配方奶（TF）等不同喂养方式对早产低出生体重儿（LBWI）出院至生后3个月时的体重、身长、头围等生长指标增长率的影响,为早产LBWI出院后喂养方式的选择提供参考。方法：广东省广州市、佛山市10家医院新生儿科出院的407例早产LBWI按照出院后喂养方式的不同,分为PDF组（n=258）、BM组（n=58）、TF组（n=91）,观察各组在生后3个月时的体重、身长、头围等生长指标值,并计算和比较各生长指标较出生时的增长率。结果：PDF组在生后3个月时的体重、身长和头围分别大于BM组和TF组（P＜0.05）;体重和身长增长率分别大于BM组和TF组（P＜0.05）。结论：出院后予PDF喂养能使早产LBWI在生后3个月时的体重、身长增长率较BM、TF喂养者更大,从而具有较大的体重、身长值,但远期效果有待进一步研究。     

极低出生体质量儿应用持续喂养或间断喂养的 meta 分析

目的评价持续喂养及间断弹丸式注射两种喂养方式在极低出生体质量儿的不同影响。方法应用continuous、intermittent bolus、nasogastric、premature、very low birth weight等关键词检索Pubmed、EMBASE、Ovid、the Cochrane Library和中国生物医学文献数据库发表的文章,并同时检索相关的参考文献,对资料进行meta分析。结果不同国家的7项研究被纳入。病例数共434例,其中使用持续鼻胃管喂养者217例,间断鼻胃管注射者217例,分析发现两种喂养方式对极低出生体质量儿的影响差异无统计学意义。结论在热卡足够的前提下,选择何种喂养方式均不会对极低出生体质量儿产生明显的影响。     

早期滴服喂养在早产极低出生体质量儿的临床应用

目的 观察早期滴服喂养对早产极低出生体质量儿的喂养效果及其相关并发症的发生情况.方法 45例早产极低出生体质量儿随机分为观察组(早期滴服喂养组)23例,对照组(早期鼻胃管喂养组)22例.观察两组奶量增加速度、体质量增长速度、达全口喂养时间、恢复出生体质量时间、胎粪完全排出时间、累计光疗时间、住院时间及其相关并发症的发生情况.结果 观察组体质量增长速度较对照组增快(P<0.05),奶量增加速度较对照组明显增快(P<0.01),达全口喂养时间、恢复出生体质量时间、胎粪完全排出时间、累计光疗时间及住院时间均较对照组明显缩短(P<0.01).观察组无一例发生吸人性肺炎,对照组发生吸人性肺炎4例,2组差异显著(P<0.05).观察组胃出血、口腔炎、呼吸暂停、呕吐及腹胀的发生率均较对照组明显减少(P<0.05).结论 早期滴服喂养能较快提高胃肠道喂养的耐受性,缩短病程,减少并发症,值得临床推广应用.     

CLINICAL AND BIOCHEMICAL-GENETIC ASPECTS OF INTERMITTENT BRANCHED-CHAIN KETOACIDURIA

Intermittent branched-chain ketoaciduria was detected in two Norwegian families. All three patients had normal intelligence. One died during an acute acidotic attack at the age of 8 years. The biochemical and clinical data in the two families suggest a separate variant of branched chain ketoaciduria. Possible mechanisms of genetic heterogeneity in this disorder are discussed.     

PROLONGED INTERMITTENT POSITIVE PRESSURE VENTILATION BY NASAL PRONGS IN INTRACTABLE APNEA OF PREMATURITY

ABSTRACT. Moretti, C, Marzetti, G., Agostino, R., Panero, A., Picece-Bucci, S., Mendicini, M., Colarizi, P. and Bucci, G. (Institute of Pediatrics, Neonatal Division, University of Rome Medical School, Rome, Italy). Prolonged intermittent positive pressure ventilation (IPPV) by nasal prongs in intractable apnea of prematurity. Acta Paediatr Scand, 70:211, 1981. –In order to avoid endotracheal intubation in very small newborn infants requiring prolonged intermittent positive pressure ventilation (IPPV), a method was developed allowing delivery of IPPV by means of nasal prongs (nasal IPPV). A series of 10 newborn infants weighing 1200 g or less, and requiring nasal IPPV for 5 to 14 days because of intractable apnea has been reported. Five infants survived. With the exeption of hearing defects in two survivors, no lesions possibly due to the ventilation procedure were observed. Follow-up examination showed severe mental and motor handicap in one infant, and apparently normal mental and motor development in 3 infants examined at the age of 12–27 months. It is suggested that nasal IPPV is an effective and safe method for prolonged ventilation of very small newborn infants with normal or not severely affected lungs, whereas it appears of very limited use in patients with stiff lungs, such as in severe HMD.     

DEFICIENT CELL IMMUNITY AND MILD INTERMITTENT HYPERAMINOACIDEMIA IN A PATIENT WITH THE RUBINSTEIN-TAYBI SYNDROME

Abstract. Rivas, F., Fragoso, R., Ramos-Zepeda, R., Vaca, G., Hernandez, A., González-Quiroga, G., Olivares, Norma and Cantu, J. M. (Divisions of Genetics and Hematology, and Experimental Pathology, Subjefatura de Investigacion Cientifica, Unidad de Investigación Biomédica, Centro Médico de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México). Deficient cell immunity and mild intermittent hyperaminoacidemia in a patient with the Rubinstein-Taybi syndrome. Acta Paediatr Scand, 69: 123, 1980.—A boy aged 2 years 8 months presenting the Rubinstein-Taybi Syndrome (RTS) and a history of recurrent gastrointestinal and respiratory infections was studied. Partial deficient cell immunity and intermittent hyperaminoacidemia and aminoaciduria were ascertained. These findings were interpreted as evidence of phenotypic and probably genetic heterogeneity of RTS     

INTERMITTENT 20q- AND CONSISTENT i(7q) IN A PATIENT WITH SHWACHMAN-DIAMOND SYNDROME

Shwachman Diamond syndrome (SDS) is a genetic disorder characterized by pancreatic hypoplasia, recurrent infection and bone marrow dysfunction. Some cases have an abnormality of chromosome 7, such as isochromosome 7q (i(7q)), which may be associated with the development of leukemia. We present a boy who was diagnosed with SDS at 19 months of age. From age 5-14 years, bone marrow cytogenetics has shown a consistent abnormality - i(7q), with an intermittent separate abnormality - deletion 20q, from age 11 years. During this time, the boy has been clinically well without leukemic signs, managed conservatively. We suggest that deletion 20q may be a non random secondary change in SDS with i(7q).     

缺铁性贫血患儿血清胃泌素水平测定及间断补铁疗效观察

研究缺铁性贫血 (IDA)儿童胃泌素水平的变化 ;观察间断补铁治疗儿童IDA的疗效。方法 :49例 IDA患儿每周口服一次铁制剂 (元素铁 2 mg/kg) ,共 1 2周。在治疗前后测查 Hb、ZPP、SF及血清胃泌素。结果 :经补铁治疗 ,Hb、SF均极显著性升高 (P<0 .0 1 ) ,ZPP则明显下降 (P<0 .0 1 ) ;IDA患儿血清胃泌素水平明显升高 ,与对照组比较差异显著 ,治疗后恢复正常。结论 :1每周一次间断补铁治疗儿童 IDA效果显著。 2 IDA患儿胃泌素的异常分泌可能与缺铁所致的胃粘膜萎缩有关     

FEEDING AND THE DEVELOPMENT OF ENTEROINSULAR HORMONE SECRETION IN THE PRETERM INFANT: EFFECTS OF CONTINUOUS GASTRIC INFUSIONS OF HUMAN MILK COMPARED WITH INTERMITTENT BOLUSES

ABSTRACT. Preterm infants receive gastric milk feeds as continuous infusions or intermittent boluses. It is not known whether these feeding methods have different effects on the development of digestive metabolism. We have measured plasma levels of insulin, pancreatic polypeptide (PP), gastric inhibitory polypeptide (GIP), gastrin, motilin, enteroglucagon (EG) and neurotensin (NT) in 19 preterm infants (28-34 weeks gestation) tolerating full enteral feeding from birth. 7 infants received human milk by continuous infusion, 12 infants were bolus fed. Hormones were measured in cord blood and at 6 and 13 days of age; samples were drawn preprandially in bolus fed infants. Both groups showed similar significant increases in plasma motilin, PP, NT and EG levels. At 13 days infusion fed infants had higher insulin. GIP and gastrin levels. No difference in rate of weight gain was seen in the two groups of infants. We conclude that both methods of feeding induce progressive changes in circulating enteroinsular hormone levels. However, the endocrine milieu is different in the two groups, particularly since bolus-fed infants experience marked cyclical surges in hormones after boluses of milk by 13 days of age. These differences in hormone release may affect metabolic homeostasis.