影响左向右分流型先心病新生儿撤机成功的多因素分析

目的研究不同因素对左向右分流型先心病新生儿呼吸机撤离(简称撤机)成功率的影响。方法收集左向右分流型先心病机械通气新生儿95例,定义48 h内无需重新插管者属撤机成功。以撤机成功率为因变量,以新生儿胎龄、体重、肺动脉压力水平、肺血流量、缺损大小、缺损类型、合并心衰、肺炎为自变量进行多元线性逐步回归,筛选出可能的影响因素,进一步研究不同影响因素对撤机成功率的影响。结果肺动脉压力、肺血流量大小和缺损类型是影响撤机成功率的重要因素(P均<0．05)。中重度肺动脉高压组的撤机成功率低于轻度肺动脉高压组(P均<0．05),差异有统计学意义。高肺血流量组的撤机成功率低于无高肺血流量组(P均<0．05),差异有统计学意义。联合缺损组的撤机成功率低于单纯缺损组(P均<0．05),差异有统计学意义。结论肺动脉压、肺血流量、缺损类型是影响撤机成功率的重要因素。     

Correlates of breastfeeding duration in an urban cohort from Argentina

Aim: To analyse factors associated with the duration of breastfeeding in a representative cohort of mothers and children, including socio-demographic and cultural characteristics, breastfeeding antecedents, perinatal factors and perinatal healthcare practices. Methods: The study was conducted in the city of Cordoba, between 1993 and 1998. Mother-child binomials from all public and private hospitals were asked to participate. Follow-up consisted of home visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information was obtained on 650 healthy newborns. Cessation of breastfeeding during the first 24 mo of life was analysed using the Kaplan-Meier method, and factors associated with weaning were studied using Cox's proportional risk regression. Results. The median duration of breastfeeding was 4 mo. Factors associated with weaning were: the introduction of artificial formulas within 30 d postpartum [relative risk (RR) = 2.27; 95% confidence interval (CI) = 1.82-2.82]; breastfeeding of a previous child for less than 6 mo (RR = 1.64; 95% CI = 1.32-2.02); delay in the first mother-child contact for over 90 min (RR = 1.50; 95% CI = 1.17-1.93); mother's having completed primary or partially completed secondary education (RR = 1.40; 95% CI = 1.01-1.92) or completed secondary education or higher (RR = 1.59; 95% CI = 1.14-2.22); primiparous mother (RR = 1.39; 95% CI = 1.12-1.74) and; the mother recalling having been breastfed for less than 6 mo (RR = 1.27; 95% CI = 1.01-1.61).

Conclusions. The purpose of strategies to promote breastfeeding should be to eliminate inappropriate care practices, such as delay in the first mother-child contact, as well as reducing the impact of other factors leading to the introduction of artificial milk. Moreover, mothers need more and better support from professionals and peers.     

Breastfed and Formula-Fed Infants: Need of a Different Complementary Feeding Model?

Suboptimal nutrient quality/quantity during complementary feeding (CF) can impact negatively on infants’ healthy growth, even with adequate energy intake. CF must supplement at best human milk (HM) or formulas, which show nutritional differences. Considering this, a differentiated CF is probably advisable to correctly satisfy the different nutritional needs. To assess whether current needs at 6–24 months of age can still be met by one single CF scheme or different schemes are needed for breastfed vs. formula/cow’s milk (CM) fed infants, protein, iron and calcium intakes were assessed from daily menus using the same type and amount of solid food, leaving same amounts of HM and follow-up formula at 9 and again 18 months of age, when unmodified CM was added. Depending on the child’s age, calcium- and iron-fortified cereals or common retail foods were used. The single feeding scheme keeps protein intake low but higher than recommended, in HM-fed children while in formula/CM-fed ones, it achieves much higher protein intakes. Iron Population Recommended Intake (PRI) and calcium Adequate Intakes (AI) are met at the two ages only when a formula is used; otherwise, calcium-fortified cereals are needed. ESPGHAN statements on the futility of proposing different CF schemes according to the milk type fed do not allow to fully meet the nutritional recommendations issued by major Agencies/Organizations/Societies for all children of these age groups.     

Effect of spontaneous fermentation and amylase-rich flour on the nutritive value,functional and viscoelastic properties of cowpea-fortified nixtamalized maize

Abstract

Studies were conducted to evaluate the combined effects of spontaneous fermentation and amylase-rich flours (ARF) on some nutritive value, functional and viscoelastic properties of cowpea-fortified nixtamalized maize. A 2 × 3 × 3 factorial design, with fermentation medium, fermentation time and ARF level, was performed. The blends were fermented for the specific times and analysed for their titratable acidity, pH, water absorption capacity, viscoelastic properties, texture, protein and mineral content. Fermentation and ARF addition influenced titratable acidity, pH, water absorption, viscoelastic properties and texture of the cowpea-fortified nixtamalized maize. Addition of ARF decreased the viscoelastic properties, texture and pH of all the blends with a corresponding increase in acidity. Slight increases in protein and ash contents were noted with products fermented in coconut water, but ARF addition had only a marginal effect. Thus, fermentation and ARF addition could be applied to cowpea-fortified nixtamalized maize to enhance the functionalities with reduced viscosity and texture suitable for weaning food formulations.     

无创正压通气治疗慢性阻塞性肺疾病并发肺性脑病撤机时间分析

目的 分析无创正压通气治疗慢性阻塞性肺疾病（COPD）并发肺性脑病（PEP）的最佳撤机时机。方法 回顾性分析2014年1月至2016年12月铜陵市人民医院呼吸内科收治的88例进行无创正压通气治疗的COPD并发PEP患者的临床资料,所有患者均在COPD并发PEP的诱发因素去除后及患者临床症状缓解时进行撤机,根据撤机时的二氧化碳分压（PaCO₂）将患者分为对照组15例（PaCO₂<50 mmHg）与观察组73例（PaCO₂≥50 mmHg）;比较两组患者无创正压通气治疗时间及3个月内再次因PEP住院的复发率。结果 观察组无创正压通气治疗时间为（9.41±3.64）d,对照组无创正压通气治疗时间为（12.53±7.09）d,两组差异有统计学意义（P<0.05）。观察组3个月内复发率9.6%,对照组复发率6.7%,两组差异无统计学意义（P>0.05）。结论 无创正压通气治疗在COPD并发PEP的诱发因素去除后,患者临床症状缓解,无须等到PaCO₂低于50 mmHg即可考虑撤机。     

No difference in self‐reported frequency of choking between infants introduced to solid foods using a baby‐led weaning or traditional spoon‐feeding approach

Background

Baby‐led weaning (BLW) where infants self‐feed family foods during the period that they are introduced to solid foods is growing in popularity. The method may promote healthier eating patterns, although concerns have been raised regarding its safety. The present study therefore explored choking frequency amongst babies who were being introduced to solid foods using a baby‐led or traditional spoon‐fed approach.

Methods

In total, 1151 mothers with an infant aged 4–12 months reported how they introduced solid foods to their infant (following a strict BLW, loose BLW or traditional weaning style) and frequency of spoon‐feeding and puree use (percentage of mealtimes). Mothers recalled if their infant had ever choked and, if so, how many times and on what type of food (smooth puree, lumpy puree, finger food and specific food examples).

Results

In total, 13.6% of infants (n = 155) had ever choked. No significant association was found between weaning style and ever choking, or the frequency of spoon or puree use and ever choking. For infants who had ever choked, infants following a traditional weaning approach experience significantly more choking episodes for finger foods (F_2,147 = 4.417, P = 0.014) and lumpy purees (F_2,131 = 6.46, P = 0.002) than infants following a strict or loose baby‐led approach.

Conclusions

Baby‐led weaning was not associated with increased risk of choking and the highest frequency of choking on finger foods occurred in those who were given finger foods the least often. However, the limitations of noncausal results, a self‐selecting sample and reliability of recall must be emphasised.     

Starting solid foods: does the feeding method matter?

The weaning period, in which complementary foods are introduced into the infant’s diet, can be challenging, with dislike of novel foods known to be common. However, even though at six months (the current recommended age for the introduction of complementary foods) most infants are able to feed themselves with graspable pieces of food, the majority of the research to date assumes the use of spoon feeding and pureed food. The potential impact of the format of the food and the feeding method on the development of food preferences has not been explored. This paper describes the development and piloting of a coding scheme to examine infants’ responses to their first solid food offered in two formats – whole and pureed – and by two methods – self-feeding and spoon feeding, and its first use. The findings for the 10 infants in the study point to some important differences between the two feeding methods.     

Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study

Background

In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)‐free protein substitute (PS) to help meet non‐Phe protein requirements. Semi‐solid weaning Phe‐free PS have been available for >15 years, although no long‐term studies have reported their efficacy.

Methods

Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe‐free infant L‐amino acid formula; natural protein intake; and issues with administration of PS or food.

Results

Median commencement age for weaning was 17 weeks (range 12–25 weeks) and, for weaning PS, 20 weeks (range 13–37 weeks). Median natural protein was 4 g day^?1 (range 3–11 g day^?1) and total protein intake was >2 g kg^?1 day^?1 from weaning to 2 years of age. Children started on 2–4 g day^?1 protein equivalent (5–10 g day^?1 of powder) from weaning PS, increasing by 0.2 g kg^?1 day^?1 (2 g day^?1) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02).

Conclusions

Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS.

     

42例COPD患者成功脱机的护理

目的：探讨机械通气的慢性阻塞性肺疾病（COPD）患者脱机的指征和护理方法。方法：ICU机械通气的COPD患者42例,呼吸机应用时间14～62天。采用过渡撤机方法,并指导患者进行呼吸肌锻炼,加强心理护理、呼吸道管理及营养支持。结果：38例撤机时间3—7天,平均4．71±1．32天,4例撤机时间〉7d。撤机后经气管插管内吸氧,呼吸、心率、血气分析各项指标稳定,咳嗽有力。结论：熟练应用呼吸机,做好患者心理护理,加强呼吸道管理及营养支持,是保证患者顺利撤机的关键措施。     

综合干预对北方农村离乳期营养性贫血儿童的效果研究

目的 观察铁剂补充结合喂养指导的综合干预对离乳期营养性贫血儿童的血红蛋白浓度升高和贫血纠正的效果。方法 对2012年5月河北省赵县两个乡镇体检发现的6~11月龄营养性贫血(Hb<110 g/L)的儿童分别入选干预组和对照组,两组分别有136名和87名儿童完成了全程随访,两组儿童都接受常规补充铁剂3个月。干预组每月由卫生室的医生提供一次家长离乳食指导。分别在1、3、12个月后复查儿童血红蛋白浓度和评估离乳食期喂养。结果 相对于入选时,随访时干预组和对照组的儿童自身血红蛋白浓度上升,3个月随访时分别为(14.85±14.85)g/L和(8.07±12.90)g/L,12个月随访时分别为(17.17±16.44)g/L和(5.77±13.87)g/L;各组每次随访时的上升值皆有统计学意义(P=0.000);两次随访时干预组的上升值高于对照组,皆有统计学意义(P=0.002和0.000)。干预组和对照组儿童的贫血纠正率在3个月随访时分别为52.2%和32.3%(P=0.004),12个月随访时为56.6%和31.0%(P=0.001)。相对于对照组的常规措施,干预组的离乳食干预对纠正儿童贫血的关联强度(RR)在3、12个月时分别为1.62和1.83,归因危险度(AR)分别为19.9%和25.6%。结论 在我国农村地区对离乳期营养性贫血的儿童进行喂养指导干预,短期内能够促进补铁治疗效果,而且通过长久影响儿童的营养状况,在补铁停止之后持续稳定纠正和预防儿童贫血,对婴幼儿营养改善具有长期意义。