Evaluation and treatment of the human immunodeficiency virus-1--exposed infant

In developed countries, care and treatment are available for pregnant women and infants that can decrease the rate of perinatal human immunodeficiency virus type 1 (HIV-1) infection to 2% or less. The pediatrician has a key role in prevention of mother-to-child transmission of HIV-1 by identifying HIV-exposed infants whose mothers' HIV infection was not diagnosed before delivery, prescribing antiretroviral prophylaxis for these infants to decrease the risk of acquiring HIV-1 infection, and promoting avoidance of HIV-1 transmission through human milk. In addition, the pediatrician can provide care for HIV-exposed infants by monitoring them for early determination of HIV-1 infection status and for possible short- and long-term toxicities of antiretroviral exposure, providing chemoprophylaxis for Pneumocystis pneumonia, and supporting families living with HIV-1 infection by providing counseling to parents or caregivers.     

小儿急进性肾炎和新月体肾炎的再认识:附43例临床与病理分析

目的 探讨小儿急进性肾炎和新月体肾炎的病因、临床以及病理特点及两者之间的关系。方法 回顾总结1987年至2002年临床诊断急进性肾炎或病理诊断新月体肾炎的43例住院患儿的临床资料。结果 患儿以学龄儿童多见，60．5％为原发性肾脏疾病，绝大多数表现为浮肿、少尿、高血压、肉眼血尿及肾病水平蛋白尿。部分(24．0％)急进性肾炎的肾脏病理为非新月体肾炎，包括毛细血管内增生性肾小球肾炎、Ⅳ型膜增殖性狼疮性肾炎、增生硬化性肾小球肾炎及局灶节段性肾小球硬化：而部分(32．1％)新月体肾炎的临床表现为非急进性肾炎，包括肾病综合征(肾炎型)、急性肾炎综合征及慢性肾脏疾病。予正规治疗的25例患儿中，44．0％的患儿肾功能恢复，44．0％的患儿肾功能好转。结论 急进性肾炎是临床诊断，新月体肾炎是病理诊断，两者并非完全一致；积极行肾穿刺活检，有助于明确肾脏病理类型，指导治疗；早期诊断、及时治疗有助于改善急进性肾炎或新月体肾炎患儿的预后。     

北京地区婴幼儿人类杯状病毒感染状况及型别分析

目的 研究人类杯状病毒与北京地区婴幼儿急性腹泻的病原关系。方法 用RT－PCR检测了婴幼儿非细菌性腹泻患儿粪便标本中的杯状病毒核酸，并用地高辛标记的不同型人类杯状病毒的cDNA(NLV基因型Ⅱ型探针CR840和SLV探针A141）作为探针，用斑点杂交对阳性标本进行分型。结果 从233份标本中检测出阳性标本58份（阳性率24.9%）：6个月以下的幼儿阳性19份，占阳性标本总数的32.8%，7－12个月的婴儿阳性15份，占总阳性标本总数的25.9%,1-2岁的幼儿阳性9份，占总阳性标本总数的15.5%，2－3岁的阳性5份，占总阳性标本总数的8.6%,3－4岁的阳性4份，占总阳性标本总数的6.9%，5岁以上的儿童的阳性6份，占总阳性标本总数的10.2%，杂交阳性标本共29份，占50.0%：A141探针杂交阳性的标本14份，占24.1%，CR840探针杂交阳性的标本8份，占13.8%，A141和CR840探针杂交均为阳性的标本7份，占12.1%。结论 我国婴幼儿腹泻与人类杯状病毒感染有关，北京地区儿童中存在多种型别杯状病毒的感染，同时显示不同基因型的杯状病毒基因序列之间的差异可以用杂交分型的方法加以区别。     

Diagnosis of HIV-1 infection in children younger than 18 months in the United States

The objectives of this technical report are to describe methods of diagnosis of HIV-1 infection in children younger than 18 months in the United States and to review important issues that must be considered by clinicians who care for infants and young children born to HIV-1-infected women. Appropriate HIV-1 diagnostic testing for infants and children younger than 18 months differs from that for older children, adolescents, and adults because of passively transferred maternal HIV-1 antibodies, which may be detectable in the child's bloodstream until 18 months of age. Therefore, routine serologic testing of these infants and young children is generally only informative before the age of 18 months if the test result is negative. Virologic assays, including HIV-1 DNA or RNA assays, represent the gold standard for diagnostic testing of infants and children younger than 18 months. With such testing, the diagnosis of HIV-1 infection (as well as the presumptive exclusion of HIV-1 infection) can be established within the first several weeks of life among nonbreastfed infants. Important factors that must be considered when selecting HIV-1 diagnostic assays for pediatric patients and when choosing the timing of such assays include the age of the child, potential timing of infection of the child, whether the infection status of the child's mother is known or unknown, the antiretroviral exposure history of the mother and of the child, and characteristics of the virus. If the mother's HIV-1 serostatus is unknown, rapid HIV-1 antibody testing of the newborn infant to identify HIV-1 exposure is essential so that antiretroviral prophylaxis can be initiated within the first 12 hours of life if test results are positive. For HIV-1-exposed infants (identified by positive maternal test results or positive antibody results for the infant shortly after birth), it has been recommended that diagnostic testing with HIV-1 DNA or RNA assays be performed within the first 14 days of life, at 1 to 2 months of age, and at 3 to 6 months of age. If any of these test results are positive, repeat testing is recommended to confirm the diagnosis of HIV-1 infection. A diagnosis of HIV-1 infection can be made on the basis of 2 positive HIV-1 DNA or RNA assay results. In nonbreastfeeding children younger than 18 months with no positive HIV-1 virologic test results, presumptive exclusion of HIV-1 infection can be based on 2 negative virologic test results (1 obtained at > or = 2 weeks and 1 obtained at > or = 4 weeks of age); 1 negative virologic test result obtained at > or = 8 weeks of age; or 1 negative HIV-1 antibody test result obtained at > or = 6 months of age. Alternatively, presumptive exclusion of HIV-1 infection can be based on 1 positive HIV-1 virologic test with at least 2 subsequent negative virologic test results (at least 1 of which is performed at > or = 8 weeks of age) or negative HIV-1 antibody test results (at least 1 of which is performed at > or = 6 months of age). Definitive exclusion of HIV-1 infection is based on 2 negative virologic test results, 1 obtained at > or = 1 month of age and 1 obtained at > or = 4 months of age, or 2 negative HIV-1 antibody test results from separate specimens obtained at > or = 6 months of age. For both presumptive and definitive exclusion of infection, the child should have no other laboratory (eg, no positive virologic test results) or clinical (eg, no AIDS-defining conditions) evidence of HIV-1 infection. Many clinicians confirm the absence of HIV-1 infection with a negative HIV-1 antibody assay result at 12 to 18 months of age. For breastfeeding infants, a similar testing algorithm can be followed, with timing of testing starting from the date of complete cessation of breastfeeding instead of the date of birth.     

Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule

National varicella immunization coverage using the current 1-dose immunization strategy has increased among vaccine-eligible children 19 through 35 months of age from 27% in 1997 to 88% by 2005. These high immunization rates have resulted in a 71% to 84% decrease in the reported number of varicella cases, an 88% decrease in varicella-related hospitalizations, a 59% decrease in varicella-related ambulatory care visits, and a 92% decrease in varicella-related deaths in 1- to 4-year-old children when compared with data from the prevaccine era. Despite this significant decrease, the number of reported cases of varicella has remained relatively constant during the past 5 to 6 years. Since vaccine effectiveness for prevention of disease of any severity has been 80% to 85%, a large number of cases of varicella continue to occur among people who already have received the vaccine (breakthrough varicella), and outbreaks of varicella have been reported among highly immunized populations of schoolchildren. The peak age-specific incidence has shifted from 3- to 6-year-old children in the prevaccine era to 9- to 11-year-old children in the postvaccine era for cases in both immunized and unimmunized children during these outbreaks. Outbreaks of varicella are likely to continue with the current 1-dose immunization strategy. After administration of 2 doses of varicella vaccine in children, the immune response is markedly enhanced, with > 99% of children achieving an antibody concentration (determined by glycoprotein enzyme-linked immunosorbent assay) of > or = 5 U/mL (an approximate correlate of protection) and a marked increase in geometric mean antibody titers after the second vaccine dose. The estimated vaccine efficacy over a 10-year observation period of 2 doses for prevention of any varicella disease is 98% (compared with 94% for 1 dose), with 100% efficacy for prevention of severe disease. Recipients of 2 doses of varicella vaccine are 3.3-fold less likely to have breakthrough varicella, compared with those who are given 1 dose, during the first 10 years after immunization. To achieve greater levels of immunity with fewer serosusceptible people, greater protection against breakthrough varicella disease, and reduction in the number of outbreaks that occur nationwide among school-aged populations, a 2-dose varicella immunization strategy is now recommended for children > or = 12 months of age.     

Prevention of influenza: recommendations for influenza immunization of children, 2006-2007

The purpose of this statement is to update recommendations for routine use of influenza vaccine in children for the 2006-2007 influenza season. The American Academy of Pediatrics recommends annual influenza immunization for (1) children with high-risk conditions who are 6 months and older; (2) healthy children 6 through 59 months of age; (3) household contacts and out-of-home caregivers of children with high-risk conditions and all healthy children younger than 5 years; and (4) health care professionals. Other children, adolescents, and adults can be immunized to decrease the impact of influenza as indicated in the Red Book: 2006 Report of the Committee on Infectious Diseases.     

中华医学会系列杂志网上在线订阅通知婴幼儿喂养建议

婴幼儿(O～36个月)营养的基本要求是满足生长、避免营养素缺乏.儿童良好的营养状态有助于预防急、慢性疾病,有益于儿童体格生长、神经心理发育.因遗传、代谢水平不同,儿童的营养需要个体差异很大.恰当的营养和喂养方式不仅可以改善生命早期生长发育,并且对生命后期的健康(如预防肥胖、心血管疾病等)有重要意义.     

第九届全国儿科危重症研讨会纪要

中华医学会儿科学分会急诊学组和中华医学会急诊医学分会儿科学组,于2006年9月7至10日在贵州省贵阳市召开了第九届全国儿科危重症研讨会。200余名来自全国22个省、市、自治区（含台湾）的代表参加会议。会议共收到论文186篇,12位专家作了专题讲座,37篇大会发言。论文涉题范围广,质量较往年有所提高,某些研究直指国际医学发展前沿。分组讨论半天（脓毒症、新生儿）,重点对近两年儿科危重症诊治的新进展、合理应用抗生素、儿科感染性休克（脓毒性休克）诊断治疗、以及当前普遍关心的医疗体制改革、医患关系等问题进行了深入讨论。[第一段]     

血管内皮生长因子对肺表面活性物质磷脂合成的影响

目的研究血管内皮生长因子(VEGF)对肺表面活性物质合成、分泌的影响,探讨防治早产儿呼吸窘迫综合征(RDS)的新途径。方法孕19dWistar大鼠剖腹取胎鼠,原代培养肺泡Ⅱ型细胞,分成VEGF-165组、地塞米松组、VEGF加地塞米松组和对照组进行试验,测定肺表面活性物质总磷脂、磷脂酰胆碱(PC)、磷脂酰甘油(PG)、鞘磷脂(SM)含量。结果VEGF-165组、地塞米松组与VEGF加地塞米松组总磷脂及各成分含量增加,VEGF组和地塞米松组PC、SM、PG含量差异有统计学意义。结论VEGF-165能促进肺表面活性物质的合成和分泌,VEGF、地塞米松对肺泡磷脂各成分的影响各不相同,两者可能通过不同的机制,增加了肺泡表面活性物质的合成和分泌,改善了肺泡上皮细胞的功能。     

基于多元统计和社会网络分析的中国儿童保健学科知识发展可视化研究

目的 通过多元统计和社会网络分析法中主题词共现的方式,研究中国儿童保健学科知识发展和分布,研究学科知识聚类,预测未来发展趋势。方法 检索《中华儿科杂志》、《临床儿科杂志》、《中国实用儿科杂志》和《中国儿童保健杂志》,双人手工筛选儿童保健相关文献,按照文献数量和中国人均GDP水平分为1978至1994年、~2003年和~2011年3个阶段,使用Endnote X4软件提取主题词,建立共词矩阵;使用SPSS 17.0软件对共现矩阵进行转换、降维和聚类分析,并根据聚类分析结果绘制战略坐标图;使用Ucinet 6.0软件绘制可视化网络图形。结果 共提取文献5 771篇,成功建立并直观展示了中国儿童保健学科知识可视化图谱及发展趋势。1978至1994年17年儿童保健发文总量162篇（年均9.5篇）,1995年后17年发文总量5 618篇（年均330篇）,后者是前者发文总量的34 .8倍;1978年至累积发文近百篇历经了14年（1991年）,累积发文超千篇又经过了7年（1998年）,以后每3年约增加1 000篇。1978至1994年阶段中国儿童保健学科发展缓慢,方向零散,聚类归纳欠佳,佝偻病研究突出。~2003年阶段以儿童营养性疾病为研究核心,聚类归纳较好,构建了中国儿童保健学科基本框架,新兴研究领域发展稍显不足。~2011年阶段儿童社会心理行为研究成为核心,研究方法更加科学,各个聚类发展较之前平衡,知识更新迅速。结论 中国儿童保健学科研究起步于20世纪90年代初,新千年后有了长足的进步,知识网络是一个逐渐完善的过程,并与国家的重视和经济发展相吻合。儿童保健研究方法学和儿童心理和社会行为发育规律等8个聚类形成了目前中国儿童保健学科架构,其中儿童发育和流行病学为最核心主题词。