Incidence of infantile hypertrophic pyloric stenosis in Saskatchewan, 1970-85.

We reviewed the incidence rates of infantile hypertrophic pyloric stenosis (IHPS) and pylorospasm in Saskatchewan from 1970 to 1985 and found a marked decrease in the rates after 1976. As expected, there was a preponderance of males among those with IHPS and among those with pylorospasm discharged from hospital between 1 and 3 months of age. No seasonal pattern was observed. We believe that the decrease in incidence rates was related to environmental influences, such as changes in the methods of feeding observed since 1977.     

Epidemiological features of infantile hypertrophic pyloric stenosis in Taiwanese children: a Nation-Wide Analysis of Cases during 1997-2007

Objective

To describe the epidemiological characteristics of infantile hypertrophic pyloric stenosis (IHPS) in ethnic Chinese children.

Materials and Methods

We reviewed the National Health Insurance claims database and analyzed data from children less than one year of age who had been diagnosed with IHPS (ICD-9-CM 750.5) and had undergone pyloromyotomy (ICD-9-CM 43.3). We analyzed the incidence, gender, age at diagnosis, length of hospital stay, seasonal variation and cost of IHPS from data collected between January 1997 and December 2007.

Results

A total of 1,077 infants met inclusion criteria, including 889 boys and 188 girls. The annual incidence of IHPS ranged from 0.30 to 0.47 per 1,000 live births with a mean incidence of 0.39 per 1,000 live births. Between 2002 and 2007, the incidence showed a declining trend (P = 0.025) with coincidentally increasing trends for both exclusive breastfeeding (P = 0.014) and breastfeeding plus bottle feeding (P = 0.004). The male-to-female rate ratio was dynamic and increased from 3.03 during the first two weeks of life to 8.94 during the 8^th through 10^thweeks of life. The overall male-to-female rate ratio was 4.30. The mean age at diagnosis was 43.1±2.4 days. After analyzing the months of birth and hospital admission, no seasonal variation associated with IHPS was detected. The mean length of hospital stay was 8.28±7.10 days.

Conclusions

The incidence of IHPS in Taiwan, a country with a majority ethnic Chinese population, was lower than observed incidences in Caucasian populations living in Western countries. Breastfeeding campaigns and low maternal smoking rates may contribute to the lower incidence of IHPS in Taiwan. However, additional studies with longer follow-up periods are needed.     

酪酸梭菌活菌散在防治早产儿喂养不耐受方面的应用

目的观察和评价酪酸梭菌活菌散防治早产儿喂养不耐受的临床疗效。方法将56例早产儿随机分成观察组和对照组,观察组30例,对照组26例。对照组给予早产儿配方奶及部分肠外营养等常规治疗,观察组在常规治疗基础上同时添加酪酸梭菌活菌散。观察2组早产儿恢复出生体重、达到全胃肠喂养时间及发生喂养不耐受等情况。结果观察组早产儿恢复出生体重、达到全胃肠喂养时间明显短于对照组(P<0.01或P<0.05),喂养不耐受的发生率也显著少于对照组(P<0.05)。结论早产儿服用酪酸梭菌活菌散,对防治喂养不耐受具有积极的作用,能减少早产儿喂养过程中呕吐、胃潴留、腹胀的发生,促进患儿早期的生长发育,缩短达到全胃肠喂养的时间。     

非营养吸吮和金双歧预防早产儿喂养不耐受115例分析

目的评价比较非营养吸吮和金双歧对促进早产儿胃肠功能成熟度,预防早产儿喂养不耐受的效果。方法回顾分析我院2004年6月至2008年3月收治的符合标准的115例早产儿,根据喂养干预措施分成非营养吸吮（NNS）组（38例）、金双歧组（42例）和对照组（35例）,组间胎龄、出生体重及Apgar评分均衡。NNS组常规干预外,生后6～12h开始NNS,在每次喂养前给予吸吮无孔橡皮奶头10min,7—8次／24h。金双歧组常规干预外,生后6—12h开始口服金双歧,每次0．5g,每Et3次。对照组常规干预。临床观察喂养不耐受发生情况,生后10d评价结果。结果各组喂养不耐受的发生率比较,NNS组明显低于对照组,差异有显著性（χ^2=6．510,P〈0．05）;金双歧组也明显低于对照组,差异有显著性（χ^2=5．840,P〈0．05）;NNS组比金双歧组发生率略低,但差异元显著性（χ^2=0．066,P〉0．05）。结论早期NNS或早期使用金双歧都可以明显降低喂养不耐受的发生,均可作为预防喂养不耐受的有效措施,两者效果相当。对于吸吮极差的极低或超低体重儿,早期NNS并不具有可操作性或不能达到足够的操作时间,而使用金双歧灌喂更具有操作性。     

喂养不耐受早产儿大便大肠埃希菌、粪肠球菌和肺炎克雷伯菌的数量变化

目的观察早产儿喂养不耐受肠道中大肠埃希菌、粪肠球菌和肺炎克雷伯菌的变化。方法采用实时荧光定量PCR技术,分别对15例喂养不耐受早产儿和15例喂养耐受早产儿（对照组）生后第一天,出现喂养不耐受,喂养不耐受恢复后大便标本中的大肠埃希菌、肺炎克雷伯菌和粪肠球菌进行定量分析。结果喂养不耐受组中大肠埃希菌的拷贝数对数值（lg copies／g）分别为2．62±0．22、5．47±1．28、3．04±0．70,对照组分别为2．56±0．19、2．82±0．4、2．80±0．39;肺炎克雷伯菌的拷贝数对数值（1gcopies／g）分别为4．37±0．22、6．56±O．27、4．17±0．27,对照组分别为4,35±0．22、4．19±0．14、4．15±0．25;粪肠球菌的拷贝数（copies／g）分别为79．17±93．46、42。84±47．57、101。68±43．78,对照组分别为70．16±78．41、740．05±657．71、104．57±38．39。出现喂养不耐受时,两组的3种细菌拷贝数比较差异具有统计学意义（P〈0．05）,而出现之前和恢复后两组细菌拷贝数差异无统计学意义（P〉0．05）。结论喂养不耐受时大肠埃希菌、肺炎克雷伯菌数量显著增高,可能参与喂养不耐受的发生,而粪肠球菌降低,可能起保护作用。     

深度水解蛋白配方奶在不同体重早产儿喂养中的临床效果观察

目的:评估深度水解配方奶(eHPF)在不同体重早产儿早期喂养中临床应用效果。方法:选取2017年9月至2018年12月出生的早产儿,分为极低出生体重儿组(体重1000-1500g之间)62例和低出生体重儿(体重1500-2000g之间)100例,每组再随机分为两组,分别予以深度水解蛋白奶(eHPF)和早产儿配方奶(SPF)喂养。极低出生体重儿组于12小时后开始微量喂养,低出生体重儿12小时内适量喂养;极低出生体重儿组深度水解蛋白奶喂养2周后改早产儿奶喂养,低出生体重儿组深度水解蛋白奶1周后改早产儿奶喂养。比较深度水解蛋白奶在不同体重早产儿早期喂养中的临床应用效果,不同体重早产儿恢复出生体重时间、每日体重增长速度、胃管留置时间、完全肠内喂养天数、住院天数、喂养不耐受发生率、宫外发育迟缓发生率及尿素氮、碱性磷酸酶指标。结果:深度水解蛋白喂养组极低出生体重儿/低出生体重儿恢复出生体重天数、完全肠道喂养天数、胃管留置时间、住院天数较早产儿奶喂养组明显缩短(P0.05),每天体重增长优于早产儿组,喂养不耐受、宫外发育迟缓发生率明显低于早产儿组(P0.05),尿素氮、碱性磷酸酶无统计学差异(P0.05)。结论:深度水解蛋白奶用于不同体重早产儿早期喂养效果明显优于早产儿配方奶,其更有助于早产儿的生长发育。     

布拉酵母菌散联合早期微量喂养对早产儿喂养不耐受及肠道菌群的影响

目的 探讨布拉酵母菌散联合早期微量喂养对早产儿喂养不耐受及肠道菌群的影响。方法 选取2014年1月至2018年6月在我院住院治疗的喂养不耐受早产儿80例,随机分为2组,各40例。对照组早产儿生后早期间歇持续微量喂养（12~24 h内）,观察组早产儿在对照组基础上加用布拉酵母菌散0.125 g/次,1次/d,通过奶瓶或鼻饲给药。两组患儿均连用3周。观察两组早产儿治疗后恢复情况、肠道菌群变化及治疗效果。结果 观察组早产儿呕吐腹胀消失时间、达全胃肠喂养时间及恢复出生体重时间均明显短于对照组（均P<0.05）。治疗3周后,两组早产儿肠道乳杆菌和双歧杆菌数量较治疗前明显上升（均P<0.05）,且观察组早产儿上升幅度较对照组更大（均P<0.05）。治疗后观察组早产儿临床总有效率明显高于对照组,差异有统计学意义（95.0% vs 80.0%,χ2=4.16,P<0.05）。结论 布拉酵母菌散联合早期微量喂养治疗早产儿喂养不耐受的疗效显著,能加快患儿的恢复,其作用机制可能与其能促进肠道正常菌群定植,加快肠道菌群的建立密切相关。     

Quantification of Bifidobacterium spp., Escherichia coli and Clostridium difficile in faecal samples of breast-fed and formula-fed infants by real-time PCR

To determine the influence of either exclusive breast-feeding or formula feeding on both composition and quantity of the gut microbiota in infants, we have developed real-time, quantitative PCR assays for the detection of Bifidobacterium spp. and Clostridium difficile. Furthermore, we have monitored the prevalence and counts of Escherichia coli by applying a previously described real-time PCR assay. We found all 100 infants tested to be colonized by Bifidobacterium spp. The bifidobacterial counts were comparable between the 50 breast-fed and 50 formula-fed infants with median values of 10.56 log10 and 10.24 log10 CFU g(-1) wet weight faeces, respectively. C. difficile was detected in 14% of the breast-fed and 30% of the formula-fed infants. In addition, the C. difficile counts were significantly lower in breast-fed infants than in the formula-fed group (median values of 3.28 log10 and 7.43 log10 CFU g(-1), respectively; p=0.03). The prevalence of E. coli in the breast-fed and formula-fed group was 80% and 94%, respectively. Also, the E. coli counts in colonized infants was significantly lower in the breast-fed infants than in the formula-fed group (median values of 9.11 log10 and 9.57 log10 CFU g(-1), respectively; p=0.004). We conclude that the prevalence and counts of C. difficile as well as E. coli are significantly lower in the gut microbiota of breast-fed infants than in that of formula-fed infants, whereas the prevalence and counts of Bifidobacterium spp. is similar among both groups.     

Breast-feeding protects against infection in Indian infants.

A retrospective study was undertaken at two isolated Manitoba Indian communities to determine whether the type of infant feeding was related to infection during the first year of life. Of 158 infants 28 were fully breast-fed, 58 initially breast-fed and then changed to bottle-feeding and 72 fully bottle-fed. Fully bottle-fed infants were hospitalized with infectious diseases 10 times more often and spent 10 times more days in hospital during the first year of life than fully breast-fed infants. Diagnoses were mainly lower respiratory tract infection and gastroenteritis. Gastroenteritis occurred in only one breast-fed infant. Breast-feeding was strongly protective against severe infection requiring hospital admission and also against minor infection. The protective effect, which lasted even after breast-feeding was discontinued, was independent of family size, overcrowding in the home, family income and education of the parents. Measures to achieve breast-feeding for virtually all infants, particularly in northern communities, should be given high priority.     

母乳联合妈咪爱对极低出生体重儿炎性细胞因子的影响

目的 探讨母乳联合妈咪爱对极低出生体重儿（ELBWI）炎性细胞因子的影响。方法 采用前瞻性研究法,选择2012年2月至2016年5月在我院诊治的ELBWI 76例,根据随机数字表法分为观察组与对照组各38例,对照组给予母乳喂养,观察组给予母乳联合妈咪爱喂养,两组均给予暖箱保暖、治疗原发病等对症治疗。治疗14 d后,观察两组患儿的预后与炎性细胞因子表达情况。结果 观察组与对照组的喂养不耐受率分别为7.9%和26.3%,观察组明显少于对照组（χ2=3.289,P0.05）。观察组治疗后的血清IL-6与TNF-α含量分别为（16.33±11.61）ng/L和（25.23±8.92）ng/L,均明显低于对照组的（26.35±11.56）ng/L与（33.72±10.36）ng/L（P<0.05）,且都明显低于治疗前（P<0.05）。结论 母乳联合妈咪爱喂养可改善ELBWI早期喂养的耐受性,提高患儿免疫功能,降低炎性细胞因子IL-6与TNF-α的表达,从而对生长发育有一定促进作用。     

母乳联合鼠李糖乳杆菌预防早产儿喂养不耐受的疗效观察

目的 观察母乳联合鼠李糖乳杆菌预防早产儿喂养不耐受的临床疗效。方法 选取2016年2月至2017年2月武汉大学人民医院收治的80例生后24 h内入住本院儿科新生儿病房的早产儿,随机分配成2组,其中研究组40例,对照组40例。研究组以新鲜母乳联合鼠李糖乳杆菌早期开奶喂养,对照组以早产儿配方奶早期开奶喂养,比较2组早产儿喂养不耐受症的发生率及其恢复出生体重时间、达全胃肠道喂养时间、体重增长速度和住院时间的差异。结果 研究组患儿喂养不耐受发生率低于对照组,研究组恢复出生体重时间、达全胃肠道喂养时间及住院时间均短于对照组（P<0.05）,研究组患儿体重增加速度快于对照组（P<0.05）。结论 早产儿早期喂养母乳联合鼠李糖乳杆菌能够较早建立全胃肠道营养,减少早产儿喂养不耐受症的发生率,促进患儿体重增长,缩短恢复出生体重时间及达全胃肠道喂养时间,降低住院天数。     

Chronic granulomatous otitis media in bottle-fed Inuit children.

Otitis media in Inuit children is a problem of relatively recent origin and unknown cause. The prevalence of otitis media in 238 Inuit and 47 Caucasian children in Nain, a small community in Labrador, was determined by examination, and the history of breast-feeding or bottle-feeding was obtained. The prevalence of otitis media was found to be inversely related to the age at which bottle-feeding was started. Clinical observations suggest that otitis media in Inuit children is part of a process leading to chronic foreign body granuloma of the middle ear, and that the granuloma is formed from milk introduced into the relatively short and straight eustachian tubes of Inuit infants by the high negative intraoral pressure necessary for bottle-feeding.     

益生菌制剂治疗极低出生体重儿喂养不耐受的临床研究

目的探讨益生菌制剂对极低出生体重儿（very low birth weight infant,VLBW）喂养不耐受的影响。方法将56例极低出生体重儿随机分成治疗组和对照组,每组28例。2组均予静脉营养及早产儿配方奶喂哺,治疗组在早产儿配方奶喂哺时添加益生菌制剂,每次0．5g,3次／d,2组同时记录恢复出生体重时间、达全胃肠喂养时间及黄疽消退时间。结果治疗组恢复出生体重时间、达全胃肠喂养时间均显著短于对照组（P〈0．01）,治疗组黄疸消退时间也明显缩短（P〈0．05）。微生态制剂治疗过程中无不良反应发生。结论益生菌制剂可改善极低出生体重儿喂养不耐受,促进患儿体重增长,缩短达到全胃肠喂养时间,值得推广应用。     

Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

Current knowledge suggests that, to be successful, oral feeding in preterm infants should be initiated as soon as possible, often at an age where immature respiration still requires ventilatory support in the form of nasal continuous positive airway pressure (nCPAP). While some neonatologist teams claim great success with initiation of oral feeding in immature infants with nCPAP, others strictly wait for this ventilatory support to be no longer necessary before any attempt at oral feeding, fearing laryngeal penetration and tracheal aspiration. Therefore, the aim of the present study was to provide a first assessment of the effect of various levels of nCPAP on bottle-feeding in a neonatal ovine model, including feeding safety, feeding efficiency, and nutritive swallowing-breathing coordination. Eight lambs born at term were surgically instrumented 48 h after birth to collect recordings of electrical activity of laryngeal constrictor muscle, electrocardiography, and arterial blood gases. Two days after surgery, lambs were bottle-fed under five randomized nCPAP conditions, including without any nCPAP or nasal mask and nCPAP of 0, 4, 7, and 10 cmH(2)O. Results revealed that application of nCPAP in the full-term lamb had no deleterious effect on feeding safety and efficiency or on nutritive swallowing-breathing coordination. The present study provides a first and unique insight on the effect of nCPAP on oral feeding, demonstrating its safety in newborn lambs born at term. These results open the way for further research in preterm lambs to better mimic the problems encountered in neonatology.     

不同喂养方式对婴儿骨密度及维生素A的影响

目的:探讨不同喂养方式对婴儿骨密度、维生素A的影响。方法:选择2015~2016年来我院体检的婴儿120例,根据不同喂养方式的不同分为母乳喂养组、混合喂养组及人工喂养组,比较三组婴儿1、3、6月的身长、头围、体质量、骨密度,6月时的维生素A及6月内的患病率。结果:三组婴儿1、3、6月内身长、体质量及头围对比差异无统计学意义(P0.05);1月、3月时,母乳喂养组与混合喂养组骨密度与明显高于人工喂养组(P0.05);母乳喂养组与人工喂养组对比差异无统计学意义(P0.05);6月时,混合喂养组婴儿的骨密度显著高于人工喂养组和母乳喂养组(P0.05),人工喂养组显著低于母乳喂养组(P0.05)。6月时,母乳喂养组的维生素A明显低于人工喂养组及混合喂养组(P0.05)。母乳喂养组6月内的患病率明显低于混合喂养组及人工喂养组(P0.05)。结论:6个月前不同喂养方式对婴儿的体格发育无明显影响,而6个月左右母乳喂养的婴儿骨密度及维生素A含量均低于混合喂养,母乳喂养可降低婴儿的患病率,6个月内应提倡母乳喂养。     

口腔支持干预提高早产儿喂养效果

为了观察口腔支持干预在早产儿喂养中的应用效果,本研究选取2016年6月至2017年12月在长沙市口腔医院接受治疗的早产儿为研究对象,并根据其喂养方式分为对照组和观察组。对照组给予常规喂养,观察组在此基础上给予口腔支持干预。观察两组早产儿喂养效果、体重增长、住院时间的差异,比较两组早产儿营养指标和预后的差异。结果表明,观察组早产儿的开始经口喂养效率、摄入奶量比和完全经口喂养效率均高于对照组(t=11.060, 3.324, 5.934, p<0.001);观察组早产儿的出院时体重、体重增长率均高于对照组(t=8.844, 3.577, p<0.001),住院时间较对照组短(t=9.515, p<0.001);两组早产儿干预前的红细胞(red blood cell,RBC)、血清白蛋白(blood albumin, ALB)和前白蛋白(prealbumin, PA)水平无差别,干预后,观察组早产儿的RBC、ALB和PA水平高于对照组(t=1.951, 7.999, 11.724, p<0.05);观察组早产儿吐奶、吸吮吞咽无力和便秘发生率低于对照组(χ~2=4.891, p=0.027)。口腔支持干预在早产儿喂养中的应用效果较好,可明显提高其喂养效率,改善营养状况,具有良好的临床应用价值。     

早期应用微生态制剂对极低出生体重儿影响的临床观察

目的观察早期应用微生态制剂对极低出生体重儿黄疸、喂养、生长以及免疫功能的影响。方法我院NICU收治的生后24h内极低出生体重儿84例,随机分为观察组46例,对照组38例。观察组生后4h内开始口服或鼻饲胃管服用妈咪爱0.5g,2次/d,连用14d。观察两组达到高胆红素血症标准的人数,以及生后24h、5d总胆红素值;喂养不耐受人数;生后5d生理性体重下降及1个月体重增长情况;生后1个月免疫学指标。并加以对比。结果24h内血清胆红素比较无统计学意义(P0.05),治疗5d后观察组血清总胆红素明显低于对照组(P0.05),观察组出现高胆红素血症人数明显低于对照组(P0.05);观察组喂养不耐受出现例数明显低于对照组(P0.01);观察组生后5d体重下降的克数低于对照组(P0.05),1个月时体重增长克数高于对照组(P0.01);观察组IgA水平较对照组明显增加(P0.05),但IgG及IgM含量与对照组比较差异无统计学意义(P0.05)。结论早期应用微生态制剂能降低血清胆红素水平,对预防极低出生体重儿高胆红素血症有一定作用;能提高喂养的耐受性,有利于患儿生长发育;对极低出生体重儿的肠道功能及免疫功能有明显影响,能增加免疫球蛋白IgA水平,从而促进体液免疫的发展。     

人工辅助投食滇金丝猴一雄多雌单元之间的等级序列

群居灵长类动物等级序列是长期进化的结果,也是动物行为生态学研究的热点。灵长类动物个体间通过等级序列,合理的利用自然资源、避免过多的伤亡、保护群体内的幼弱者,从而更好地适应复杂的生态环境。2013年6月至2014年1月,采用焦点动物取样法对白马雪山国家级自然保护区人工辅助投食滇金丝猴群的6个一雄多雌单位之间等级序列进行了研究。通过对一雄多雌单元之间攻击-屈服行为数据分析发现：一雄多雌单位之间存在明显的等级序列（大个子单元＞单疤单元＞红脸单元＞联合国单元＞偏冠单元＞花唇单元）;单元之间成年雄性的攻击行为多于成年雌性;单位之间的等级序列与取食次数、第一序位取食总次数呈显著正相关,与各单元取食总时间无明显相关性;同时,一雄多雌单元之间的等级序列与单元内成年雌性数量呈显著正相关。研究结果符合群居灵长类动物攻击-屈服假说和资源优先占据-雌性高序列偏好假说。     

Incidence and duration of lactation and lactational performance among mothers of low-birth-weight and term infants.

The lactation experience of 55 mothers of 62 infants of low birth weight (2500 g or less) was prospectively compared with that of 55 mothers of 55 control infants (38 weeks'' gestation or more, birth weight more than 2500 g) born at the same institution. The incidence rates of lactation at delivery were 73% for the control group and 58% for the low-birth-weight group; 11% of the infants of low birth weight fed breast milk were never put to the breast. The mean age at first suckling was 277.3 hours in the low-birth-weight group, compared with 3.3 hours in the control group (p less than 0.0005). At first suckling 81% of the low-birth-weight infants and 25% of the control infants sucked poorly or refused the breast (p less than 0.001). At discharge 65% of the breast-milk-fed control infants were exclusively breast-fed, compared with 3% of the low-birth-weight infants fed breast milk (p less than 0.001). The incidence rates of lactation over time were similar in the control and low-birth-weight groups (51% v. 44% at 1 month, 29% v. 13% at 3 months, 13% v. 4% at 6 months and 4% v. 2% at 12 months). The mean duration of lactation was 3.2 months for the control group and 2.5 months for the low-birth-weight group. In the long term 37% of the low-birth-weight infants fed breast milk failed to breast-feed, compared with 2% of the control infants, and only 31% were exclusively breast-fed, compared with 85% of the control infants (p less than 0.001). However, the degree of satisfaction with the lactation experience was similar in the two groups. We conclude that mothers of low-birth-weight infants have good potential for lactation.     

母亲声音刺激联合非营养性吸吮对早产儿经口喂养的影响

目的:探讨母亲声音刺激联合非营养性吸吮对早产儿经口喂养的影响。方法:选取2018年1月至2018年12月间在本院新生儿科病房住院早产儿(200例)作为研究对象,随机分为对照组(70例)、研究组A(65例)、研究组B(65例)。对照组按照新生儿科常规管理,研究组A在常规管理基础上给予单纯母亲声音刺激,研究组B在常规管理、单纯母亲声音刺激基础上,给予非营养性吸允管理。比较各组的喂养进程、喂养表现、体质量增长情况、喂养不耐受评分。结果:研究组A、研究组B的完全经口喂养时的纠正胎龄(PMA)、过渡时间均明显短于对照组,且研究组B均明显短于研究组A,差异均有统计学意义(P0.05);研究组A、研究组B的开始经口喂养时喂养效率、完全经口喂养时喂养效率均明显高于对照组,且研究组B均明显高于研究组A,差异均有统计学意义(P0.05);研究组A、研究组B的完全经口喂养时体质量、出院时体质量均明显低于对照组,且研究组B均明显低于研究组A,差异均有统计学意义(P0.05)。研究组B与对照组间的喂养不耐受评分情况差异有统计学意义(P0.05)。结论:母亲声音刺激联合非营养性吸吮可促进早产儿经口喂养进程,改善经口喂养表现,减少喂养不耐受发生率,加快恢复至出生体质量的时间。