早期饮食干预对婴幼儿呼吸道变态反应疾病的影响

目的 观察早期饮食干预对婴幼儿呼吸道变态反应疾病发展的影响。方法 选取2003年1月-2004年6月复旦大学附属儿科医院0～6月变态反应疾病高危婴儿176例,在进行环境控制的前提下,随机分为干预组（饮食干预）和非干预组,随访两组患儿变态反应疾病发生、发展的情况。结果 （1）在干预6、12、18个月后,干预组发生两种以上变态反应疾病的人数均显著少于非干预组,过敏症状的严重程度较非干预组也显著减轻（P〈0．005）。（2）饮食干预18个月后,两组患儿在吸入性过敏原筛查阳性比例上的差异没有显著性（χ^2=0．002,P=0．969）,但干预组患儿的肺功能显著优于非干预组（P〈0．005）、干预组的食物过敏原筛查阳性比例显著低于非干预组（χ^2=8．91,P〈0．01）。结论 对变态反应性疾病高危婴儿进行饮食干预,能减轻或消除呼吸道变态反应疾病症状,改善肺功能。     

极低、超低体重早产儿医院感染变化及其危险因素分析

目的 探讨5年间极低、超低体重早产儿医院感染变化趋势及危险因素.方法 选取2014年1月—2018年12月江门市中心医院新生儿重症监护室的极低、超低体重早产儿303例患儿资料进行回顾性分析,比较5年间早产儿医院感染例数率、例次率及感染疾病发病率、感染组与非感染组临床特征、病原菌和耐药菌的变化并分析其危险因素.结果 5年...     

Facilitators and Barriers to Implementation of Safe Infant Sleep Recommendations in the Hospital Setting

ObjectiveTo identify facilitators and barriers to the implementation of safe sleep recommendations from the American Academy of Pediatrics from the perspective of hospital staff as part of a needs assessment that was used to design a successful quality improvement intervention to change clinical practice.DesignQualitative design.SettingMultiple sites of three hospitals in the northeastern and southern United States.ParticipantsWe used purposeful sampling to identify 46 participants who cared for infants on inpatient hospital units (nurses and other staff members).MethodsA qualitative researcher used grounded theory to moderate the focus groups. We constructed the initial interview guide and then changed it as needed to capture more information about new ideas as they arose. Researchers from diverse backgrounds participated in the analysis and used the constant comparative method to select important concepts and to develop codes and subsequent themes. We continued to collect data until saturation was reached.ResultsWe identified themes and subthemes, and the taxonomy fit into the Grol and Wensing framework for change in clinical practice. The six primary themes included The Innovation Itself, The Individual Health Care Professional, The Patient, The Social Context, The Organizational Context, and The Economic and Political Context.ConclusionParticipants described facilitators and barriers to the implementation of the American Academy of Pediatrics recommendations for safe infant sleep. Identification of these themes informed our quality improvement intervention to promote safe infant sleep. Findings can be used by others when faced with the need for similar change.     

Streptococcus pneumoniae carriage among febrile children at the time of PCV-10 immunization in pediatric emergencies at Mohammed VI University Hospital Centre in Marrakesh (Morocco)

ObjectivesIn Morocco, 13-valent pneumococcal conjugated vaccine (PCV) was introduced in the childhood immunization program in October 2010 and changed to PCV-10 in July 2012. The purpose of this study was firstly to determine the prevalence of pneumococcus carriage in a population of febrile infants in Marrakesh and secondly, to investigate the risk factors for carriage and the distribution of circulating serotypes.Material and methodsThis prospective study was conducted from February to June 2017, in the pediatric emergency department of the Mother and Child Hospital of Mohammed VI University Hospital Centre (UHC) in Marrakesh. At total of 183 febrile infants, aged 2–18 months, were enrolled in this study and were swabbed for nasopharyngeal carriage. Pneumococci were cultured, identified, serotyped, and tested for penicillin susceptibility. Demographic data and risk factors for carriage were collected. The statistical analyses performed were the following: the analysis of the risk factors using logistic regression, the estimation of serotype diversity with the Simpson index, and the Chi² test to compare serotype distribution in the prevaccination (a cohort of 660 healthy children, less than 2 years old, in the Marrakesh region, in 2008–2009) and postvaccination periods.ResultsThe prevalence of Streptococcus pneumoniae carriage was 68.3%. Of the 183 infants enrolled in this study, 111 had received at least one dose of PCV-10. Colonization by vaccine serotype among febrile children was related to incomplete vaccination status. In total, vaccine serotypes accounted for 6.4% (n = 8): 19F (n = 2), 1 (n = 2) and one strain for each of the following serotypes: 14, 23F, 6B, and 9 V. Non-vaccine and nontypeable strains presented 63.2% and 23.2%, respectively, with dominance of serotypes 6A (6.4%), 15A/15F (5.6%), 20, 22F/22A, 23B, and 11A/11D with a prevalence of 3.2%. The rate of pneumococcus strains with reduced susceptibility to penicillin was 33.6%, of which 90.2% were non-vaccine serotypes and nontypeable strains. Serotype diversity increased in the postvaccination period and the effectiveness of PCV-10 against vaccine serotypes was estimated at 89.6%.ConclusionAn important change in the distribution of vaccine and non-vaccine serotypes was observed after the introduction of the PCVs. In fact, the prevalence of vaccine serotypes decreased significantly while non-vaccine serotypes emerged. These results underscore the importance of maintaining close and prolonged surveillance of serotype distribution to monitor the dynamics of nasopharyngeal pneumococcal carriage.     

School-age human figure drawings by very preterm infants: Validity of the Draw-a-Man test to detect behavioral and cognitive disorders

Detecting an abnormal developmental trajectory in very preterm infants remains challenging. The objective of this study was to determine the correlation between the Draw-a-Man test (DAMT) and behavioral and cognitive disabilities in very preterm infants. From the school-age follow-up of the Premag study, which evaluated the neuroprotective effect of prenatal magnesium sulfate before 33 weeks of gestation, 281 human figure drawings were assessed (mean age, 11 years). Behavioral and cognitive disabilities were associated with delayed DAMTs but test performance indicators were insufficient to use DAMT as a screening or a diagnostic test.