Association between early initiation of breastfeeding and reduced risk of respiratory infection: Implications for nonseparation of infant and mother in the COVID‐19 context

Early initiation of breastfeeding, within 1 h of birth, is vital for the health of newborns and reduces morbidity and mortality. Secondary analysis of the 2016 Nepal Demographic and Health Survey (DHS) showed that early initiation of breastfeeding significantly reduced the risk of acute respiratory infection (ARI) in children under 2 years. Early initiation of breastfeeding requires maternal proximity. Separation of infant and mother inhibits early initiation of breastfeeding and increases the risk that infants will suffer from ARIs. However, during the COVID‐19 pandemic, guidance varied, with some recommending that infants and mothers with SARS‐CoV‐2 be isolated from one another. Nepal''s Ministry of Health and Population recommended nonseparation, but the adherence to this guidance was inconsistent. Maternal proximity, nonseparation and early initiation of breastfeeding should be promoted in all birthing facilities.     

我国0～6岁儿童血清维生素A水平调查

【目的】　调查我国 0～ 6岁儿童的维生素A(VA)营养状况。　【方法】　以分层抽样法将全国划分为沿海、内地和边远三层 ,抽取 1 4个省、市、自治区的 8669名儿童进行问卷和血清VA含量测定。以FoxBase建立数据库 ,以Epinfo软件统计分析 ,计量资料用F、t检验和多元回归处理。　【结果】　儿童血清VA均值为(1 .0 6± 0 .33) μmol/L ,亚临床维生素A缺乏 (SVAD)患病率为 1 1 .7%。儿童血清VA水平随着年龄的增长 ,富含VA食物摄入频率的增加 ,所在地区呼吸道、发热、腹泻发病率的降低 ,家庭年人均收入和所在地区年人均国民生产总值 (GNP)的升高 ,母亲受教育程度的升高而逐渐升高(P均 <0 .0 0 0 )。儿童血清VA水平 ,取血前 2周内曾患呼吸道感染、发热、腹泻者明显低于未曾患病者。母亲是少数民族者明显低于母亲是汉族者 (P均 <0 .0 0 0 )。多元回归结果表明 :年龄小 ,未食用乳、蛋、鱼虾、肝炎、鱼肝油 ,曾患呼吸道感染、腹泻 ,所在地区及家庭经济状况差 ,母亲文化程度低 ,母亲为少数民族是其血清VA水平低下的危险因素。　【结论】　我国儿童血清VA含量尚处于较低水平     

青少年多囊卵巢综合征与其父母代谢综合征的相关性研究

目的探讨青少年多囊卵巢综合征（PCOS）与其父母代谢综合征（MBS）的相关性。方法选择2004年3月—2007年3月在浙江省慈溪市妇幼保健院与慈溪市人民医院的36例PCOS青少年患者（11～16岁）及其父母（35例母亲,19例父亲）、21例正常青少年（女,11～16岁）,进行其体质量指数（BMI）、腰围、血压测量,并检测其血清胆固醇（TC）、三酰甘油（TG）、雄性激素水平,同时进行糖耐量测定（OGTT）及超声检查多囊卵巢情况。结果①PCOS患者的父亲94%肥胖或超重,79%患有MBS。②PCOS患者的母亲停经前36%患MBS,明显高于患PCOS者（≤20%）。③PCOS患者的多囊卵巢特征极少数遗传于母亲,其主要遗传于父亲的MBS因素（P=0.008）。④PCOS患者中28%患有MBS。结论青少年PCOS在根本上是由其父亲患有MBS遗传因素所致。     

产程中镇痛分娩与无镇痛分娩试产成功率比较及失败原因分析

目的 探讨产程中镇痛分娩与无镇痛分娩试产的成功率,并分析比较两组试产失败的原因及改行剖宫产术后的相关指标.方法 回顾性分析在产程中行镇痛分娩300例（腰麻-硬膜外联合阻滞麻醉）及无镇痛分娩300例初产妇的临床资料.比较两组产妇试产分娩的成功率,分析比较失败的原因及改行剖宫产术后剖宫产术指征、催产素使用率、术中出血量、产后24 h出血量及新生儿阿氏（Apgar）评分情况.结果 镇痛分娩组300例中试产成功274例,成功率为91.3%,无镇痛分娩组300例中试产成功173例,成功率为57.7%.两组试产失败的主要原因均为胎方位异常、活跃期停滞、胎儿窘迫、产程延长和胎头下降停滞等,其中镇痛分娩组试产失败原因中以胎方位异常、活跃期停滞的发生率显著高于无镇痛分娩组（P〈0.05或〈0.01）,而胎儿窘迫、产程延长和胎头下降停滞的发生率低于无镇痛分娩组（P〈0.05）,催产素使用率高于无镇痛分娩组（P〈0.01）,改剖宫产术中及产后24 h出血量均多于无镇痛分娩组（P〈0.05或〈0.01）,新生儿Apgar评分显著高于无镇痛分娩组（P〈0.01）.结论 镇痛分娩配合体位指导可提高阴道分娩率,降低剖宫产率,降低新生儿窒息的风险,但对试产失败后行剖宫产术者其子宫收缩会有一定的影响,使催产素使用率增加,术中及术后出血量相对较多.     

Time in Parenting Activities in Dual‐Earner Families at the Transition to Parenthood

Time parenting was compared for new mothers and fathers in a sample of 182 dual‐earner families. Parenting domains included positive engagement, responsibility, routine child care, and accessibility. Time diaries captured parents' time use over a 24‐hour workday and nonworkday when infants were age 3 and 9 months. Parents were highly involved with their infants. Mothers were more involved than fathers in positive engagement and routine child care on days and at each assessment, and allocated more available time on workdays to these domains than fathers, with one exception. Fathers and mothers allocated similar shares of available workday time to positive engagement at 9 months. Greater equity in responsibility and accessibility was found; mothers spent more, and a greater share of, parenting time in responsibility than fathers on the 9‐month workday only, and were more accessible on the 3‐month workday only. Implications for parents in today's diverse families are discussed.     

Hepatitis B virus infection in children

For two decades, hepatitis B vaccine has been integrated into national routine childhood vaccination programs in almost all countries. The prevalence of HBsAg has decreased in children worldwide. However, there are children who miss the benefit of hepatitis B vaccine in some regions and countries. Long-term follow-up studies have revealed the clinical outcomes of chronic hepatitis B virus infection in children. A small percentage of chronically infected children develop liver cirrhosis and hepatocellular carcinoma. However, it is controversial who should be treated and when antiviral treatment should be initiated in children. Compared with adult studies, the data are insufficient to evaluate the pathogenesis of hepatitis B infection and the efficacy of antiviral treatment in childhood. New antiviral drugs have been approved for children and adults. Also, oral antiviral drugs are administered to pregnant women to reduce the hepatitis B virus mother-to-child transmission rate.     

Different outcomes of vertical transmission of hepatitis C virus in a twin pregnancy

The risk of vertical transmission of hepatitis C virus (HCV) from mother to infant has been well documented, but the exact mode of transmission is still unclear. In a set of monochorionic diamniotic monozygous twins, only the second baby was infected with HCV from the mother who was positive for serum HCV-RNA. The babies had an uncomplicated vaginal delivery 3 min apart and they were both bottle fed from the outset. The second baby developed clinical hepatitis that persisted to 30 months follow up. The intrauterine environment should have been identical for these twins, and therefore, the maternal HCV factors, including viral load are not the sole determining factors for mother-to-infant transmission of HCV.     

产妇血清表面抗原定量与乳汁中乙肝病毒载量的相关性分析

目的 探讨携带乙型肝炎病毒(HBV)的产妇血清表面抗原(HBsAg)含量与乳汁中HBV-DNA含量的相关性,并指导母乳喂养.方法 对140例产妇采用荧光定量PCR法测定乳汁中HBV-DNA和化学发光法测定表面抗原含量,并进行相关性分析.结果 A组乳汁HBV-DNA阳性组表面抗原含量为(58 183.2±39 147.8) IU/ml,B组HBV-DNA阴性组表面抗原含量为(1848.8±2458.3) IU/ml.A组血清中表面抗原含量比B组高,差异有统计学意义(P＜0.01),乳汁中HBV-DNA含量与血清中表面抗原含量呈正相关(r=0.799,P＜0.01).结论 慢性HBV感染孕产妇血清中乙肝表面抗原的定量的测定及检测其乳汁中HBV-DNA含量,对阻断母婴传播和预防家庭内水平传播及对HBV感染孕产妇的诊治和疗效评估有着重要意义,特别是为HBV感染产妇选择是否母乳喂养提供了指导依据.     

感染HIV的孕产妇预防艾滋病母婴传播服务需求与障碍分析

目的了解艾滋病病毒(HIV)感染孕产妇的预防艾滋病母婴传播服务需求与服务利用障碍。方法对某艾滋病高发地区,自2003年以来截至2004年10月发现并分娩的HIV感染孕产妇进行问卷调查。结果13.79%的孕产妇不愿意接受产前检查,5.17%的孕产妇不愿意住院分娩,怕歧视、担心检查和住院分娩费用高等是孕产妇不接受孕产期保健的主要原因;96.43%的孕产妇愿意本人和给孩子服用抗逆转录病毒药物预防艾滋病母婴传播,但只有87.50%的孕产妇服用了抗HIV药物,未服药的原因为临产急诊分娩,未得到检测结果,延误了孕产妇和婴儿的服药时机;89.29%的孕产妇希望其所生婴幼儿获得随访服务,但只有58.93%的婴幼儿得到过随访服务,其中51.52%的婴幼儿在出生后3个月内得到首次随访;怕别人知道自己的感染情况是不愿意接受随访的主要原因;近7%的孕产妇不愿意或不知道要给所生的婴幼儿进行HIV抗体检测。结论育龄妇女和孕产妇艾滋病检测不及时、非住院分娩、婴幼儿随访服务薄弱、经济负担、社会歧视等问题,是预防艾滋病母婴传播服务利用的主要障碍,预防艾滋病母婴传播综合能力亟待加强。