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近年来,我国新生儿领域在临床及基础方面均进行了大量的探索性研究,从2011年发表在国内核心期刊及国外SCI的相关学术论文,足以体现出国内新生儿专业不断进步、不断上升的研究水平,其中的某些实验结果及研究结论非常值得新生儿科医师借鉴、学习和应用。本文就2011年我国儿科新生儿疾病的研究进展综述如下。     

Comparative anatomy of neonates of the three major mammalian groups (monotremes,marsupials, placentals) and implications for the ancestral mammalian neonate morphotype

The existing different modes of reproduction in monotremes, marsupials and placentals are the main source for our current understanding of the origin and evolution of the mammalian reproduction. The reproductive strategies and, in particular, the maturity states of the neonates differ remarkably between the three groups. Monotremes, for example, are the only extant mammals that lay eggs and incubate them for the last third of their embryonic development. In contrast, marsupials and placentals are viviparous and rely on intra‐uterine development of the neonates via choriovitelline (mainly marsupials) and chorioallantoic (mainly placentals) placentae. The maturity of a newborn is closely linked to the parental care strategy once the neonate is born. The varying developmental degrees of neonates are the main focus of this study. Monotremes and marsupials produce highly altricial and nearly embryonic offspring. Placental mammals always give birth to more developed newborns with the widest range from altricial to precocial. The ability of a newborn to survive and grow in the environment it was born in depends highly on the degree of maturation of vital organs at the time of birth. Here, the anatomy of four neonates of the three major extant mammalian groups is compared. The basis for this study is histological and ultrastructural serial sections of a hatchling of Ornithorhynchus anatinus (Monotremata), and neonates of Monodelphis domestica (Marsupialia), Mesocricetus auratus (altricial Placentalia) and Macroscelides proboscideus (precocial Placentalia). Special attention was given to the developmental stages of the organs skin, lung, liver and kidney, which are considered crucial for the maintenance of vital functions. The state of the organs of newborn monotremes and marsupials are found to be able to support a minimum of vital functions outside the uterus. They are sufficient to survive, but without capacities for additional energetic challenges. The organs of the altricial placental neonate are further developed, able to support the maintenance of vital functions and short‐term metabolic increase. The precocial placental newborn shows the most advanced state of organ development, to allow the maintenance of vital functions, stable thermoregulation and high energetic performance. The ancestral condition of a mammalian neonate is interpreted to be similar to the state of organ development found in the newborns of marsupials and monotremes. In comparison, the newborns of altricial and precocial placentals are derived from the ancestral state to a more mature developmental degree associated with advanced organ systems.     

Maternally acquired genotoxic Escherichia coli alters offspring’s intestinal homeostasis

The neonatal gut is rapidly colonized by a newly dominant group of commensal Escherichia coli strains among which a large proportion produces a genotoxin called colibactin. In order to analyze the short- and long-term effects resulting from such evolution, we developed a rat model mimicking the natural transmission of E. coli from mothers to neonates. Genotoxic and non-genotoxic E. coli strains were equally transmitted to the offspring and stably colonized the gut across generations. DNA damage was only detected in neonates colonized with genotoxic E. coli strains. Signs of genotoxic stress such as anaphase bridges, higher occurrence of crypt fission and accelerated renewal of the mature epithelium were detected at adulthood. In addition, we observed alterations of secretory cell populations and gut epithelial barrier. Our findings illustrate how critical is the genotype of E. coli strains acquired at birth for gut homeostasis at adulthood.     

Social Control and Marijuana Use

Abstract

A case of self-poisoning with strychnine is reported. The patient had the recognized features of strychnine poisoning, but in addition had abnormal eye movements. These were nonresponsive to treatment with diazepam and ceased spontaneously.     

Survey on Neonatal End-of-Life Comfort Care Guidelines Across America

Context

Infants of age less than one year have the highest mortality rate in pediatrics. The American Academy of Pediatrics published guidelines for palliative care in 2013; however, significant variation persists among local protocols addressing neonatal comfort care at the end-of-life (EOL).

18例早产儿真菌败血症临床特点

目的对某院早产儿真菌败血症的临床特点进行分析,为临床诊治提供参考。方法对该院2011年1月—2013年12月18例早产儿真菌败血症的临床资料进行回顾性分析。结果 18例早产儿胎龄为27~36周,出生体重为1 050~3 100 g,其中极低出生体重儿(VLBWI)8例;均有广谱抗菌药物用药史,感染前均长时间静脉营养,10例机械通气,2例经外周静脉穿刺中心静脉置管(PICC)。临床表现以呼吸暂停、抽搐、喂养困难、反应差等为主;出现症状时间为出生后3 h~52 d。13例(72.22%)早产儿血白细胞(WBC)计数异常,12例(66.67%)血小板(PLT)100×109/L,18例(100.00%)C反应蛋白(CRP)均增高,平均CRP浓度为(41.90±26.77)mg/L。感染病原菌以假丝酵母菌属为主,共17例(94.44%),其中包括近平滑假丝酵母菌7例,白假丝酵母菌5例,白假丝酵母菌生物变种4例,无名假丝酵母菌1例。用氟康唑及两性霉素B治疗,15例治愈(83.33%),2例好转(11.11%),1例死亡(5.56%)。结论早产儿真菌败血症以假丝酵母菌感染为主,临床缺乏特异性表现,应严密观察具有高危因素的早产儿临床症状,定期检测血常规及CRP等指标,及时给予抗真菌药物治疗,有助于取得良好的治疗效果。