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功能性构音障碍(functional articulation disorder,FAD)是最常见的语言障碍[1],患儿常因语音不清造成人际交往困难和一系列情绪及行为问题。目前国内有关FAD的研究较少,对FAD儿童感觉统合能力的研究尚未见报道。为探讨FAD儿童的感觉统合能力发展水平及其在FAD发生中的作用,我们对FAD患儿和正常儿童进行了感觉统合能力的对照研究,现将结果报告如下。1对象和方法1.1对象病例组:以2005-01—2006-06来我院发育儿科就诊的以吐字不清为主诉的6~12岁儿童为研究对象,符合FAD诊断标准者共38例,其中男35例,女3例。FAD的诊断依据日本听力言…     

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??Abstract??Objective??To investigate alterations of circulating levels of the inflammatory markers— reflecting brain and adipose tissue inflammation—in the fetal growth restriction??FGR??fetuses and newborns??and explore its possible relation ship with adverse intrauterine development. Methods??Sixty parturients??hospitalized in Shengjing hospital of China Medical University??giving consecutively birth either to 30 appropriate for gestational-age??AGA?? singleton infants ??AGA group ?? or 30 FGR full-term singleton infants ??FGR group????were recruited.Plasm hs-CRP??PAI-1??S100B and leptin levels were determined by enzyme link immune assay??ELISA??in the umbilical cords blood ??UC ?? and venous blood from neonates on postnatal day 1 ??D1?? and day 4??D4??. Results??The birth weight??body length and the body mass index ??BMI?? of the FGR neonates were significantly lower compared with those of AGA group ??P < 0.05??.The leptin levels of UC in the FGR neonates were lower than that in the AGA groups??P < 0.05????and correlated positively with the birth weights and the BMI??P < 0.05??.Plasma hs-CRP levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05??.hs-CRP levels in Umbilical cords blood were significantly decreased when compared with D1 hs-CRP in both AGA and FGR groups ??P < 0.05????and D1 hs-CRP was significantly increasedwhen compared with respective D4 hs-CRP??P < 0.05??.Plasma PAI-1 and S100B levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05????and did not correlated with the birth weights and the BMI. Conclusion??Despite the lower birth weight??BMI and leptin levels in FGRs?? there was no difference for the levels of inflammatory markers hs-CRP and PAI-1 between IUGR and AGA fetuses/neonates.The CRP level in both studied groups fluctuated from fetus to neonate stage might attribute to parturition stress and adaptation recovery.     

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目的探讨弥散加权成像(DWI)、常规磁共振成像(MRI)在新生儿低血糖性脑损伤不同阶段的动态变化。方法回顾分析了2005年9月至2008年9月,中国医科大学附属盛京医院新生儿科收治的经MRI确诊的20例低血糖性脑损伤患儿(病例组)的临床资料,并随机选取同期住院MRI正常的20例单纯性低血糖患儿为对照组。结果病例组平均最低血糖值低于对照组(P<0.01),低血糖持续时间长于对照组(P<0.01)。病例组于低血糖发生后3.8(1～11)d完成首次MRI检查,受累部位主要为枕叶11例、枕顶叶8例,顶叶1例,受累部位在DWI均表现为高信号,常规MRI相应部位12例表现为T1加权成像(T1WI)、T2加权成像(T2WI)正常信号,仅6例表现为T1WI低信号、T2WI高信号;11例于首次检查后11.4(8～15)d完成第2次MRI检查,首次检查受累部位DWI7例转为正常信号,4例低信号,常规MRI均表现为T1WI低信号、T2WI高信号。3例于6个月随访,提示枕叶DWI正常信号,T1WI低信号、T2WI高信号。结论新生儿低血糖性脑损伤早期DWI表现为异常高信号的部位,与晚期常规MRI表现为T1WI低信号、T2WI高信号的部...     

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目的探讨氨溴特罗口服液改善毛细支气管炎患儿气道功能的疗效影响。方法将2009年11月至2010年9月广州市妇女儿童医疗中心93例毛细支气管炎患儿随机分为治疗组(氨溴特罗口服液组)和对照组。观察两组患儿治疗前后潮气呼吸流速-容量环(TBFV)的形态改变以及肺功能各项指标的变化。结果两组患儿治疗前TBFV环均变窄,呼气曲线升枝陡峭,高峰提前,降枝呈波谷样凹陷;治疗后明显好转。两组患儿治疗前各项主要参数比较,差异无统计学意义(P>0.05)。两组患儿治疗前后比较:呼吸频率(RR)、呼气峰流速(PEF)、呼吸系统阻力(Rrs)、每千克体重功能残气量(FRC/kg)均降低(P<0.05或P<0.01);每千克体重潮气量(VT/kg)、吸呼比(TI/TE)、呼气达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、呼气达峰容积(VPTEF)、达峰容积比(PFV)、呼出75%潮气量时的呼气流速/呼气峰流速(25/PF)、潮气呼气中期流速/潮气吸气中期流速(ME/MI)、每千克体重顺应性(Crs/kg)均增加(P<0.05或P<0.01)。其中治疗组与对照组比较,反映大小气道阻塞主要指标PFV、25/PF、ME/MI及肺顺...     

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目的探讨单纯性肥胖儿童是否存在反应控制能力缺陷和注意力缺陷及其与肥胖程度的相关关系。方法选择2005-05—2006-02在中国医科大学第二附属医院发育儿科门诊就诊的6~12岁中重度肥胖儿童48例和健康儿童36名,应用视听整合持续操作测试软件,进行反应控制能力指标和注意力指标的测试。结果肥胖儿童的各项反应控制能力商数和注意力商数均低于对照组,差异有显著性意义(P<0·05),反应控制力指标与体重指数(BMI)值呈负相关。结论肥胖儿童的反应控制能力和注意力均下降,反应控制能力随着肥胖程度的增加而降低。     

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??Objective??To explore the mechanisms of visfatin in fetal growth. Methods??From Dec.2008 to Dec.2009??the cord blood plasmaconcentrations of visfatin in 90 term neonates at birth in Wuxi Maternal and Child Health Hospital??Wuxi No.3 People’s Hospital and Wuxi Xishan Hospital was measured by Elisa and its mRNA expression by quantitative real-time PCR in placenta.The correlation between birth weight ??cord blood visfatin??and mRNA expression was analyzed. Results??Cord blood concentration of visfatin in IUGR were significantly higher than that of fetal macrosomia and healthy term infants??P < 0.05????while there was no difference between fetal macrosomia and healthy term infants??P > 0.05??.There was no difference in visfatin mRNA expression in placenta between the three subgroups. Regression analysis revealed that cord blood visfatin levels were inversely??r = -0.416??P < 0.05??correlated with birth weight??while visfatin mRNA expression was correlated with neither birth weight nor cord blood visfatin??P > 0.05??. Conclusion??Concentrations of cord blood visfatin are significantly higher in the IUGR than in the fetal macrosomia and healthy term infants??although no differences in its mRNA expression in placenta are observed.     

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目的探讨全自动换血术对高胆红素血症新生儿血液学指标的影响,评估其疗效与安全性以及间接胆红素和白蛋白比值的临床意义。方法 2008年1月至2010年5月南方医科大学南方医院对74例重症高胆红素血症患儿均采用周围动静脉同步换血术,监测换血前后胆红素、白蛋白、间接胆红素与白蛋白比值、电解质、血常规。结果血中胆红素、白蛋白、间接胆红素与白蛋白比值、电解质(Na+、K+、Cl-、Mg2+)、血常规换血后均较换血前明显下降,但Ca2+、P3+浓度换血后较换血前升高,差异均有统计学意义。换血术后无患儿发生不良反应。结论换血对胆红素、白蛋白、间接胆红素与白蛋白比值、Na+、K+、Cl-、Mg2+、Ca2+、P3+、白细胞、红细胞、血红蛋白、红细胞压积、血小板均有影响,应注意监测。特别要注意监测间接胆红素与白蛋白比值,该比值是评估胆红素毒性的危险指标。比值越高,其危险性越高,越需要输注白蛋白。     

高胆红素血症新生儿氧化应激状态的研究

目的 研究高胆红素血症新生儿的氧化应激状态.方法 选择非溶血性高间接胆红素血症新生儿60例作为研究对象,足月健康新生儿30例作为对照组,采用化学比色法检测血清丙二醛(MDA)浓度及超氧化物歧化酶(SOD)、过氧化酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)活性.结果 随着血清胆红素浓度升高,血清MDA浓度依次升高,且血清胆红素与血清MDA浓度呈正相关(r=0.774,P＜0.01);而血清SOD、CAT、GSHPx的活性却依次降低,血清胆红素浓度与血清SOD、CAT、GSH-Px的活性均呈负相关(r=-0.814～-0.672.P均＜0.01).高胆红素血症新生儿急性期MDA明显高于恢复期,两期均高于对照组,其中急性期与恢复期、急性期与对照组、恢复期与对照组比较差异均有统计学意义(P均＜0.01);而急性期血清SOD、CAT、GSH-Px的活性低于对照组,差异有统计学意义(P均＜0.01),恢复期血清SOD、CAT、GSH-Px的活性较急性期均升高,差异有统计学意义(P均＜0.05),SOD、CAT与对照组差异无统计学意义(P＞0.05),而GSH-Px仍低于对照组(P＜0.01).结论 高胆红素血症新生儿体内存在脂质过氧化损害,血清抗氧化酶活性减低,发生氧化应激反应,且黄疸越重氧化应激越强,并随黄疸消退氧化应激减弱.     

新生儿换血后贫血相关因素分析及干预策略

目的分析影响新生儿换血治疗后贫血的相关因素,探讨干预策略。方法回顾新生儿高胆红素血症换血治疗病例82例,比较换血后贫血组与非贫血组入院时、换血前、换血后红细胞和血红蛋白变化特点,分析影响因素。结果82例换血后血清胆红素明显下降(P<0.001),红细胞、血红蛋白上升(P<0.001)。但仍有39例(47.56%)存在贫血。两组在换血前红细胞、血红蛋白均较入院时下降,非贫血组下降较贫血组明显,经采取补输血,最终贫血均被纠正(P<0.001)。换血后贫血与换血前贫血、高胆红素血症的病因、输血达预定量后补输血等有关。结论换血治疗能有效降低血清胆红素;达到换血标准的高胆红素血症患儿入院时常存在血红蛋白“正常”假象;换血前贫血者易导致换血后贫血。ABO溶血病、G6PD缺乏并ABO溶血病患儿换血后贫血发生率较其他病因高。输血达预定量后补输血10～15ml/kg有利于纠正换血后贫血。     

控制成分输血输注速率提高新生儿换血疗效

目的探讨序贯调节悬浮红细胞和血浆输注速率进行新生儿换血的有效性及安全性。方法选择2006年10月至2013年9月我科收治的需要进行换血治疗的严重高胆红素血症患儿,随机分为对照组和观察组,对照组将所需红细胞与血浆按1∶1等速输注进行换血;观察组换血总量前1/3时,输注血浆速率为红细胞的两倍,中1/3时二者输注速率相等,后1/3时输注红细胞速率为血浆的两倍。换血前、中、后检测血常规、电解质、血糖及血胆红素等指标,并密切观察和记录患儿生命体征及经皮血氧饱和度(Sa O2)。结果对照组纳入40例,观察组纳入42例。两组患儿换血治疗后胆红素水平均明显降低[对照组:(222.1±30.3)μmol/L比(455.5±52.3)μmol/L,观察组:(207.3±27.8)μmol/L比(451.2±48.6)μmol/L,P<0.001],与对照组比较,观察组换血后胆红素水平更低,差异有统计学意义(P<0.05);观察组换血后血红蛋白含量明显高于对照组[(151±22)g/L比(135±26)g/L,P<0.01]。两组患儿换血相关并发症,如高血糖、血小板减少、低钙血症和低钠血症等均可在短时间内恢复正常。结论采用序贯调节悬浮红细胞和血浆的输注速率进行换血,在不增加用血量基础上,能明显降低胆红素水平和贫血的发生,且安全有效。     

Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria

Background  Since exchange blood transfusion (EBT) is associated with serious complications, phototherapy has been made more powerful to reduce the need for EBT in the developed world. This study was undertaken to determine the indications for EBT in neonatal jaundice (NNJ) at our unit and what proportion of EBTs was possibly avoidable. Methods  All the babies who had EBT for hyperbilirubinemia over a three-year period were included. Age, sex, weight, place of delivery, blood group of baby and mother, other investigations, management, and the outcome of the babies were recorded. Results  Of the 1686 babies admitted to the neonatal unit, 90 (5.3%) had EBT. Fourteen (15.6%) were inborn while 76 (84.4%) were out-born babies. Fifty-six (62.2%) babies were admitted primarily for NNJ while 34 (37.8%) developed NNJ during admission. Thirty-six (40.0%) of the babies had phototherapy for more than 24 hours prior to EBT either because they were of very low birthweight or NNJ was detected very early and therapy was so commenced. Sixty-eight (75.6%) babies had single EBT while the remaining 22 (24.4%) had two sessions of EBT. Factors associated with severe NNJ in babies requiring EBT included low birthweight (<2500 g, 44.4%), ABO incompatibility (30.0%), glucose-6-phosphate dehydrogenase deficiency (34.4%) and septicemia (26.1%). Twenty-seven (30.0%) of the neonates developed features of kernicterus: 26 before admission while 1 during admission; all except one were delivered outside the hospital. Conclusions  The EBT rate in our center was high. With more effective phototherapy, EBT could be avoided in most of the babies who initially had phototherapy for more than 24 hours before EBT and repeated EBT sessions. Health education of the population at risk, especially pregnant women, and early referral at the primary health care level will reduce the burden of severe NNJ.     

Adverse events associated with neonatal exchange transfusion for hyperbilirubinemia

To estimate the incidence of blood exchange and determine causes and complication of blood exchange and identify strategies for risk reduction of Kernicterus in newborn with jaundice. From march 2004 to march 2006 in neonatal Department in children hospital, medical center Tehran, Iran,346 neonates were admitted as neinatal jaundice without sign and symptoms of infections. We identified causes and complications of exchange. Of 346 infants with jaundice who received phototherapy. 50, 14.45 percent cases underwent exchange transfusion with mean age 9.38+5.75 days. The mean total Serum billirubin level was 29.39+6.13mg/dl. ABO incompatibility was the most common cause for hyperbillirubinemia.the incidence of apnea was 12% there was no direct death from exchange transfusion. To make payment women aware to cbserve jaundice regularly after birth of their child and short breast feeding to control dehydretion.     

新生儿高胆红素血症对其神经行为及预后的影响

目的　探讨新生儿高胆红素血症 (高胆 )对神经行为及预后的影响。方法　对 38例高胆新生儿及2 4例健康新生儿均行新生儿神经行为评分 (NBNA)和脑干听觉诱发电位 (BAEP)检测 ,幼儿期用婴幼儿智力发育量表 (CDCC)测定智力发育。结果　高胆组BAEP异常率明显高于对照组 (P <0 .0 1) ,两组Ⅰ、Ⅴ波潜伏期比较差异显著 (P <0 .0 1,P <0 .0 5 )。高胆组NBNA评分明显低于对照组 (P <0 .0 0 1) ,血清胆红素 (≥ 2 0 4 μmol/L)与NBNA评分呈显著负相关 (P <0 .0 1) ,围生因素、溶血、感染在黄疸高峰期NBNA评分明显低于对照组 (P <0 .0 1)。高胆组智力发育指数 (MDI)、心理运动发育指数 (PDI)与对照组比较差异显著 (P <0 .0 1,P <0 .0 5 ) ,智能分级比较 ,对照组明显优于高胆组 (P <0 .0 0 1)。结论　不同程度高胆均可影响新生儿神经行为能力和智能发育。新生儿高胆均应积极治疗 ,尽量减少后遗症的发生     

Prediction of significant hyperbilirubinemia in term neonates by early non-invasive bilirubin measurement

Background:Neonatal jaundice is a common problem.We evaluated the utility and best cut-off values of 24-and 48-hour transcutaneous bilirubin indices (TcBI) in predicting subsequent significant hyperbilirubinemia and evaluated various associated maternal and fetal risk factors.Methods:TcBI at 24 and 48 hours and serum bilirubin levels at 72 hours of age were obtained for healthy,term,appropriate for gestational age neonates.Neonates with prematurity,birth weight ＜2500 g,ABO or Rh incompatibility,onset of clinical jaundice ＜24 hours,clinical suspicion of septicemia,positive pressure ventilation at birth,admission in neonatal intensive care unit and contraindications for BiliChek were excluded.Twently-four and 48-hour TcB indices were assessed as predictors of subsequent hyperbilirubinemia,defined as serum bilirubin ＞17 mg/dL after 72 hours of life and various cut-offs,and were evaluated by calculating sensitivity,specificity and predictive values.Results:Of 500 newborns,4.6％ had significant hyperbilirubinemia,27％ had TcBI (mg/dL) ＜5 at 24 hours,and 27.4％ had TeBI ＜8 at 48 hours.None of them had subsequent hyperbilirubinemia (100％ negative predictive value).The percentage of newborns with subsequent hyperbilirubinemia increased from 3.4％ to 13.2％ as their 24-hour TcBI increased from 6 to above 9 mg/dL and from 4.2％ to 7.4％ as their 48-hour TcBI increased from 8 to above 11 mg/dL.The best cut-off value was TcBI (mg/dL) 7 (odd ratio=4.86,95％ confidence interval:1.66-15.22) at 24 hours and 10 (odd ratio=2.87,95％ confidence interval:1.04-8.29) at 48 hours.Area under the receiver operating characteristic curve for 24-and 48-hour measurements was 0.750 and 0.715,respectively.Maternal premature rupture of membranes,deep transverse arrest,post-date pregnancy,and fetal distress were significant risk factors for hyperbilirubinemia.Conclusions:Twenty-four and 48-hour TcB indices are good predictors of subsequent hyperbilirubinemia.Twenty-four-hour TcBI had better predictive ability than 48-hour TcBI.     

Detection and clinical evaluation of antineutrophil antibodies in neonates who had a blood transfusion or exchange transfusion

BACKGROUND: The aim of this study was to detect and investigate the clinical effects of antineutrophil antibodies in neonates who had received a blood transfusion or exchange transfusion. METHODS: Venous blood samples were drawn from 34 neonates at pretransfusion (sample 0), immediately after transfusion (sample 1), 2-3 weeks (sample 2) and 8-12 weeks (sample 3) after transfusion. Ten healthy neonates were in the control group. Antineutrophil antibodies were detected using flow cytometric assay. RESULTS: Antineutrophil antibody was detected in the sera of 20 (58.8%) neonates in the study group. Of these 20 neonates, nine had antineutrophil antibodies in serum samples 0, 1 and 2, which were probably due to the passive transfer of maternal antibodies. Nine neonates had antineutrophil antibodies in serum samples 1 and 2, which were probably due to neutrophil antibodies being present in the donor's blood. In two neonates, antineutrophil antibodies were not detected in samples 0 and 1, but appeared in sample 2, which were probably actively produced by the neonates. All of the antineutrophil antibodies disappeared in the serum samples, except in one neonate. Only one preterm newborn developed neutropenia, which resolved spontaneously in a week. The presence of antineutrophil antibody in transfused neonates was significantly higher than in non-transfused neonates. CONCLUSIONS: The presence of neutrophil specific antibodies in transfused neonates is not rare and antineutrophil antibodies may be found more often in transfused neonates compared to non-transfused neonates. The clinical significance of those antibodies needs to be assessed since they are transient and their clinical effects are not evident.