Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate

BACKGROUND: A retrospective survey of 339 infants who had undergone primary plastic surgery for cleft lip and palate was performed to evaluate the concomitant preoperative assessment based on severity grading of the common cold and the correlation of cleft type with the incidence of perioperative respiratory complications. METHODS: We assessed the severity of common cold symptoms in the preoperative period using the Common Cold Score, which comprises 10 symptoms and findings. We then determined the association of the incidence of perioperative respiratory complications with the increasing severity of common cold symptoms and also compared the complication incidence in the three cleft types in healthy infants without a common cold. RESULTS: The incidence of perioperative respiratory complications was greater in the group with a suspected presence of a common cold. Infants with severer cleft, who had bilateral cleft lip and palate, even without common cold symptoms, had a significantly higher incidence of perioperative respiratory complications (8.9%) than infants with simple cleft lip (1.7%, P < 0.05). CONCLUSIONS: Clinicians should consider postponing primary plastic surgery for cleft lip and palate in infants with a suspected presence of a common cold. Our results also suggest that the presence of a wide cleft is a risk factor for causing perioperative respiratory complications in infants with cleft lip and palate. We believe that a careful preoperative assessment of common cold symptoms in these infants can decrease the incidence of perioperative respiratory complications.     

Thoracic epidural catheters placed by the caudal route in infants: the importance of radiographic confirmation

BACKGROUND: Cephalad advancement of epidural catheters to the thoracic region via the caudal route has been shown to be feasible in neonates and small infants. This has allowed many young infants to receive thoracic level epidural analgesia with dilute local anaesthetic solutions using the simpler caudal approach. Since radiographic confirmation of the catheter tip is routine at this institution, we wished to determine how often radiographic studies led to adjustment or replacement of the epidural catheter. METHODS: After institutional review board approval, we retrospectively reviewed the medical records of neonates and infants less than 6 months of age who had thoracic or lumbar epidural analgesia via the caudal route between August 1995 and January 2000. Demographic data were recorded, including age, weight and type of surgery. The epidural catheter type, tip location by radiograph and any manipulation of the catheter after the radiograph were also noted. RESULTS: During the study period, a total of 115 infants were identified as having received caudal placement of a thoracic catheter. Radiographic studies were available for 86 of these infants. The position of 28 (32%) of the epidural catheters was considered to be inadequate after review of the confirmatory radiograph. Ten of these catheters were determined to be in the high thoracic or cervical region and were pulled back to the desired level. Seventeen of these catheters were coiled in the lumbosacral area and 15 of these were replaced at an adequate level. One catheter was found to be outside the epidural space in the presacral area. No correlation could be found between age, weight, type of catheter or type of surgery and the need for catheter manipulation. CONCLUSIONS: Even in young infants, radiographic determination of the catheter tip appears warranted when thoracic catheters are placed via the caudal route.     

围产儿死亡的临床分析

目的通过分析围产儿死亡的相关产科因素,以提高产科质量,降低围产儿的死亡率。方法对51例围产儿死亡的相关因素进行分析、归纳、总结。结果导致胎死宫内的主要原因是脐带和胎盘异常,导致新生儿死亡的主要原因是早产。结论孕早期(4个月左右)应行B超检查,可尽早发现畸形儿,及时终止妊娠,降低围产儿的死亡率。     

43例婴儿急性特发性血小板减少性紫癜的临床特点及治疗方案探讨

目的 探讨婴儿急性特发性血小板减少性紫癜（ITP）的临床特点，对比3种治疗方案的疗效，寻找最佳的治疗方案。方法 总结2001年1月-2005年8月婴儿ITP43例的临床特点，其中重度以上31例分别应用丙种球蛋白（丙球组11例）、丙种球蛋白＋激素（丙球＋激素组10例）、激素（激素组10例）治疗，比较治疗后血小板恢复情况。结果 婴儿ITP以重度、极重度多见，出血部位单纯，以皮肤出血点、淤点、淤斑为主；丙球组，丙球＋激素组治疗后血小板变化相似，差异无统计学意义，激素组治疗后血小板数较低，差异有统计学意义。结论 婴儿期ITP以皮肤粘膜出血为主，自然病程短，对严重病例特别并发内脏感染者可首选丙球治疗。     

婴幼儿病毒性肺炎免疫功能指标检测的临床意义

目的检测病毒性肺炎患儿的免疫指标（T细胞亚群、免疫球蛋白），探讨病毒性肺炎患儿免疫功能的变化。方法将血清病毒特异性IgM抗体阳性，CRP〈8mg／L且无其他病原感染的病毒性肺炎患几分为1个月～3个月、～1岁、q岁三个组和相应的对照组。T细胞亚群采用碱性磷酸酶标记链霉卵白素（SAP）法；免疫球蛋白用散射比浊法。统计分析检验结果。结果T细胞亚群CD3、CD4降低，CD8增高，CD4／CD8比值减小，与对照组比较（P〈0．05）差异有显著性；血清免疫球蛋白（IgG、IgA、IgM）与对照组比较（P〉O．05）差异无显著性。结论婴幼儿病毒性肺炎体液免疫无明显改变，细胞免疫功能受到明显抑制。     

雾化吸入沐舒坦预防早产儿呼吸窘迫综合征

目的：探讨雾化吸入沐舒坦预防早产儿呼吸窘迫综合征（RDS）的临床疗效。方法：将108例早产儿随机分为试验组54例，对照组54例。两组均予一般治疗，试验组在此基础上给予雾化吸入沐舒坦15mg，q12h，疗程3～5d。结果：试验组早产儿RDS的发生率为3．7％（2／54），对照组为16．7％（9／54）（P〈0．05）。结论：雾化吸入沐舒坦对预防早产儿RDS有一定疗效。     

Ultrasound in multiple pregnancy

The advances in reproductive technologies have changed the demographics of multifetal pregnancies. Ultrasound has become the most essential tool to diagnose multifetal pregnancies and to contribute to the surveillance the mother and the fetus during pregnancy, delivery and the puerperium. In the first trimester, it enables us to diagnose the number of vital or non-vital multiples, chorionicity and amnionicity, the presence or absence of nuchal translucency, early growth discordance, severe malformations, and the origin of spontaneous and induced activities. In the second and third trimester, we can exclude malformations and disturbed growth. In addition, the opportunity to examine the cervix by transvaginal ultrasound should not be missed to detect the risk of spontaneous preterm birth. Ultrasound is essential for grading and treatment of twin-to-twin transfusion syndrome (TTTS), the diagnosis of malformations and growth disturbances. Evidence-based medicine has shown that the outcome of twin pregnancies can be improved by early diagnosis and Doppler velocimetry. Before and during labor, ultrasound is necessary for diagnosing the position of multiples, and in order to decide for the optimal route of delivery and in all phases of delayed interval delivery. Postpartum, it can be helpful for the differential diagnosis of severe hemorrhage.     

Novel approaches to the nutritional management of the allergic infant

The increased prevalence of atopic diseases, i.e. atopic eczema, allergic rhinitis and asthma, has been described as the epidemic of the 21st century in Western societies. New approaches in the fight against allergic diseases are clearly called for, the target being the persistence of the allergic responder pattern beyond infancy. The advantage afforded by elimination diets lies in the silencing of specific allergic inflammation induced by an offending food. Novel nutritional approaches, beyond the treatment of food allergies, have recently attracted research interest subsequent to the identification of the immunomodulatory potential of specific dietary compounds. Dietary lipids as immunomodulators may prevent allergic sensitization by down-regulating inflammatory response whilst protecting the epithelial barrier. Probiotic bacteria have been shown to reinforce the different lines of gut defence: immune exclusion, immune elimination and immune regulation. On this basis, the strategy against allergic disease proposed here is based on the administration of tolerogenic gut-processed peptide fragments of a specific protein, in addition to the use of specific dietary compounds such as fatty acids and antioxidants, and introducing a microbial stimulus for the immature immune system by means of cultures of beneficial live micro-organisms characteristic of the healthy infant gut microbiota.     

Post-discharge nutrition for the preterm infant

Newly designed, 'enriched,' formulas are now available for the formula feeding premature infant after hospital discharge. These new formulations add to the array of milks from which to choose when the discharge of the premature infant is approaching. However, the data to support optimal or reference nutrient intakes to use for the premature infant in the post-discharge are lacking. Breastfeeding should be encouraged as its beneficial effects may be related to the duration in which it is fed. Infants at risk for growth failure in the post-discharge period, such as infants unable to consume ad libitum intakes of milk, and who already have growth faltering or abnormal nutritional indices, may benefit for the addition of enriched formula. This review summarizes the recent data and comments on recommendations on post-discharge nutrition for premature infants.     

经食管超声心动图引导经颈静脉封堵婴儿房间隔缺损（附13例报告）

目的　探讨经食管超声心动图引导下经颈静脉封堵婴儿房间隔缺损的应用价值。方法　回顾性分析2015年6月至2018年3月在青岛市妇女儿童医院经食管超声心动图引导经右侧颈静脉行房间隔缺损封堵的13例1岁以内房间隔缺损患儿，评价手术效果、手术时间及并发症等临床资料。结果　13例婴儿均封堵成功，食管超声心动图可准确引导输送轨道的建立，手术时间（27.2±15.1）min。全部患儿封堵器形态满意、位置固定，无新发心律失常、溶血、栓塞、感染、气胸、血胸及心血管损伤等并发症。结论　经食管超声心动图引导下经右侧颈静脉封堵婴儿房间隔缺损方法可行，可避免外科手术风险及低年龄、低体重患儿介入血管并发症，同时可避免潜在的辐射损伤。