The developmental paediatrician and neonatal follow-up

Recent advances in modern perinatal and neonatal intensive care have led to an increase in the survival of premature infants. This increased survival, unfortunately, has not been accompanied by an improvement in neurodevelopmental outcomes. Premature infants, especially those with an extremely low birth weight (less than 1000 g) or those born at less than 28 weeks’ gestation, are at increased risk of major disabilities and complex, ‘low severity’ dysfunctions that have significant, lasting effects on their school function, academic performance and behaviour, as well as on family function. Neonatal follow-up programs provide a number of functions to centres providing neonatal intensive care, including quality assurance and audits, research and follow-up clinical care to neonatal intensive care unit survivors and their families. The challenge for neonatal follow-up programs is to meet the often competing objectives of providing clinical services to children and their families while providing quality assurance and audits, and high-quality long-term outcome research components, given the available resources. There is also a need for ongoing research to develop and evaluate effective postdischarge intervention programs to improve the long-term outcome of prematurity and other neonatal complications. Developmental paediatricians – with their background and training in the provision of specialized health care to children and their care-givers with respect to developmental and psychosocial well-being, and in conducting developmental and behavioural disabilities research – play a valuable role in the follow-up assessment and care of neonatal intensive care unit graduates, and strengthen the multidisciplinary research groups necessary to assess long-term outcomes and the effects of perinatal and postdischarge interventions.     

Mortality among persons with a history of Kawasaki disease in Japan: Can paediatricians safely discontinue follow-up of children with a history of the disease but without cardiac sequelae?

Aim: To clarify the question of whether patients with Kawasaki disease suffer a higher mortality rate after the incidence of the disease in comparison with age-matched healthy individuals. Methods: Between July 1982 and December 1992, 52 collaborating hospitals collected data on all patients having a new, definite diagnosis of Kawasaki disease. Patients were followed up until 31 December 2001 or their death. The expected number of deaths was calculated from Japanese vital statistics data and compared with the observed number. Results: Of 6576 patients enrolled, 29 (20 males and 9 females) died. The standardized mortality ratio (SMR: the observed number of deaths divided by the expected number of deaths based on the vital statistics in Japan) was 1.15 (95% CI: 0.77-1.66). In spite of the high SMRs during the acute phase, the mortality rate was not high after the acute phase for the entire group of patients. Although the SMR after the acute phase was 0.75 for those without cardiac sequelae, six males (but none of the females) with cardiac sequelae died during this period; and the SMR for the male group with cardiac sequelae was 1.95 (95% CI: 0.71-4.25). The mortality from congenital anomalies of the circulatory system was elevated, but no increase in cancer deaths was observed.

Conclusion: Although it was not statistically significant, the mortality rate among males with cardiac sequelae due to Kawasaki disease appeared to be higher than in the general population. On the other hand, the mortality rates for females with the sequelae and both males and females without sequelae were not elevated.     

电话随访对家庭无创通气患者的影响

目的:探讨电话随访对家庭无创通气患者的影响。方法:将河北联合大学附属医院出院的仍需坚持家庭无创通气的106例患者,随机分为2组各53例。对照组给予常规出院指导,干预组在出院指导的基础上进行定期电话随访。1年后比较2组患者对无创通气治疗的依从性、不良反应发生率及血气指标改善情况。结果:干预组对无创通气治疗的依从性高于对照组、不良反应发生率低于对照组,干预组患者血气指标改善情况优于对照组,差异均有统计学意义(P0.01)。结论:电话随访可提高患者无创通气治疗的依从性,减少不良反应的发生,有效改善患者血气指标,提高患者的生活质量。     

鼻咽癌四野面颈联合野适形放疗可行性研究及近期疗效分析

目的本研究采用四野面颈联合野放疗治疗鼻咽癌患者,分析急性放射性反应和近期疗效。方法101例初治鼻咽癌患者进行四野面颈联合野适形放疗,其中90例接受FP方案同步化疗及辅助性化疗。结果患者在7周内完成治疗计划,四野面颈联合野适形放疗获得了满意的剂量分布。鼻咽癌病灶完全缓解(completeremission,CR)为95.0%(96/101),部分缓解(partial remission,PR)5.0%(5/101),总有效率达100.0%,淋巴结病灶CR 90.1%(91/101),PR 6.9%(7/101),总有效率为97.0%,1年总生存率、无瘤生存率分别为100.0%、97.0%,不良反应主要为Ⅰ～Ⅱ级放射性黏膜炎、白细胞下降。结论四野面颈联合野适形放疗剂量分布满意,近期疗效满意,急性放射反应可耐受,远期疗效及组织损伤尚有待长期随访观察。     

泛发性无菌性脓疱病长期随访1例

报告1例随访观察26年的疱疹样脓疱病。患者女,37岁。3岁开始发病,反复发作,1980—2005年共发病15次。1992年妊娠期间皮损加重,未予特殊处理,顺产一健康男婴。1993—2005年共发病8次。发作不重时仅予对症处理,一般2～3周皮损消退;发作严重时则采用雷公藤多苷、糖皮质激素治疗,疗效显著。诊断倾向于疱疹样脓疱病。     

电话回访出院患者服务满意度分析

目的通过电话回访出院患者,给予后续服务,提高群众满意度。方法患者出院后一个月内临床科室主管医师电话回访出院患者,进行生理健康、心理安抚的服务。患者出院后一个月内由医院行风办专职人员负责电话回访,进行服务满意度的调查。结果 2012年3月-2014年2月8个传染病区住院患者共18340例次,实际回访总数为7854例,回访成功率为42.82%;2012年3月-2014年2月全院病区住院患者共89534例次,实际回访总数为43138例,回访成功率为48.18%。2013年3月1日-2014年2月28日与2012年3月1日-2013年2月28日比较,其中8个临床科室有4个比较项有提高,其他科室各项满意率都在96%以上,患者满意度较高,全院总满意率为97.23%,亦有提高。结论电话回访体现了医院服务内涵的社会延续,是医院实现人本理念管理、优化患者服务的便捷平台,提高了患者对医院服务的满意度。     

Joseph病黄氏家系7例青少年患者2年追踪观察

本文对Joseph病黄氏家系中25岁以下的7例青少年患者追踪观察2年,其中1例属Ⅱ型,6例属未定型。6例中有1例由未定型转化为Ⅱ型,其他5例病情也有不同程度的加重。可见高危家系的监测,对指导优生优育具有重要的临床意义和社会意义。     

记忆合金肋骨环抱接骨板内固定术治疗创伤性连枷胸

目的探讨应用记忆合金肋骨环抱接骨板内固定术治疗创伤性连枷胸的方法和疗效。方法对本院收治的经临床及影像学检查诊断为连枷胸17例患者患者临床资料进行回顾性分析。通过本组病例的疗效、并发症、住院时间及疼痛情况等观察,综合评价记忆合金肋骨环抱接骨板内固定术的优、缺点。结果本组病例术后胸壁软化、纵隔移位或摆动消失,胸廓完整性好,呼吸状况明显改善,呼吸疼痛明显缓解,无肺部感染、肺不张等并发症发生,骨折处固定满意,无再次移位,术后住院10.31±3.14天痊愈出院。出院随访无明显异物感,接骨板无松动、脱落,骨性愈合恢复良好。结论记忆合金肋骨环抱接骨板内固定术治疗创伤性连枷胸安全可行,并有疗效好、疼痛轻、并发症少、住院时间短等优点。