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。     

Early-life gut microbiome and cow’s milk allergy- a prospective case - control 6-month follow-up study

Increasing evidence suggests that perturbations in the intestinal microbiota in early infancy are implicated in the pathogenesis of food allergy (FA); existing evidence on the structure and composition of the intestinal microbiota in human beings with FA is limited and conflicting. The main object of the study was to compare the faecal microbiota between healthy and cow’s milk allergy (CMA) infants at the baseline immediately after the diagnosis, and to evaluate the changes in the faecal microbiota after 6?months of treatment of CMA infants with hypoallergenic formula (HF), compared with healthy children fed on standard milk formulae. Sixty infants younger than 4?months of age with challenge-proven CMA and 60 healthy age-matched children were investigated in this prospective case - control follow-up study. Faecal samples were collected at baseline and at 6?months of follow-up, microbial diversity and composition were characterized by high-throughput 16S rRNA sequencing. The average age (±SD) of the infants at inclusion was 2.9?±?1.0?months. Children with CMA have lower gut microbiota diversity and an elevated Enterobacteriaceae to Bacteroidaceae (E/B ratio) in early infancy compared with healthy children (115.8 vs. 0.8, P?=?0.0002). After 6?months of treatment with HF, CMA infants had a higher Lactobacillaceae (6.3% vs. 0.5%, P?=?0.04) and lower Bifidobacteriaceae (0.3% vs. 8.2%, P?=?0.03) and Ruminococcaceae (1.5% vs. 10.5%, P?=?0.03) abundance compared with control children. Conclusion: Low gut microbiota diversity and an elevated E/B ratio in early infancy may contribute to the development of FA, including CMA. A strict elimination diet may weaken FA by reducing E/B ratio and promoting a gut microbiota that would benefit the acquisition of oral tolerance.     

Plasma carnitine status - a prognostic factor in children with dilated cardiomyopathy

Summary Objective - Dilated cardiomyopathy is a rare disorder in childhood that results in a high mortality. The aim of our study was to evaluate the prognostic relevance of the individual plasma carnitine status in children with dilated cardiomyopathy. Methods - In 26 patients plasma carnitine concentrations were determined before and after 6 and 12 months of L-carnitine treatment. According to the plasma short chain acyl-carnitine/free carnitine ratio (AC/FC) at the first presentation children were divided into two groups. Results - In group 1 (AC/FC < 0.4) the median time from diagnosis until death was 35.8 months, the cumulative survival rate was 84% after 2 years. In group 2 (AC/FC > 0.4) median time from diagnosis until death was 8 months, the cumulative survival rate was 50% at 2 years (p < 0.05).Dividing both groups into survivors and nonsurvivors in group 2 a significantly higher AC/FC ratio in the nonsurvivors could be found (survivors 0.78 v 1.3 in nonsurvivors). A significant improvement of left ventricular function 6 and 12 months after presentation and after starting L-carnitine treatment could only be documented in the surviving patients of group 2. Conclusion - The individual plasma carnitine status in children with dilated cardiomyopathy may serve as a risk factor for survival.     

2018-2020年乌鲁木齐市婴幼儿病毒性腹泻监测及病原学分析

分析乌鲁木齐市2018-2020年 < 5岁婴幼儿病毒性腹泻流行病学与病原学特征, 为本地区病毒性腹泻防控提供参考依据。

收集2018-2020年乌鲁木齐市哨点医院门诊 < 5岁婴幼儿病毒性腹泻流行病学信息和粪便标本, 用实时荧光定量PCR方法检测A组轮状病毒(RV)、札如病毒(SAV)、诺如病毒(NV)、肠道腺病毒(EADV)和星状病毒(ASV)核酸, 并用反转录聚合酶链反应(RT-PCR)检测A组RV基因分型。

445份标本中病毒阳性率分别为A组RV 45.02%、NV 10.33%、EADV 9.04%、SAV 5.35%、ASV 1.29%, 混合感染率为28.97%, 7~12月龄组阳性率最高为69.8%, 25~36月龄组最低为2.4%。不同季节A组RV、SAV、ASV阳性率差异有统计学意义(χ²=37.582、21.047、17.685, 均P < 0.001), A组RV 12月份和1月份检出高峰。A组RV的G血清型以G9为主占61.8%, P血清型以P[8]为主占87.7%;NV基因型以GⅡ型为主, 3年检出率分别为93.54%、88.64%、100.00%;病毒性腹泻冬春季高发分别为26.5%、28.5%。

乌鲁木齐市2018-2020年 < 5岁婴幼儿病毒性腹泻中, 2岁以下阳性率最高, A组RV和NV病毒为主要病原。

     

熊去氧胆酸对婴儿肝炎综合征患儿血清炎症因子和肝功能的影响*

目的:探讨熊去氧胆酸对婴儿肝炎综合征患儿血清炎症因子和肝功能的影响。方法:选取我院自2013年5月-2015年5月收治的婴儿肝炎综合征患儿91例,随机分为对照组(n=47)和观察组(n=44),对照组患儿给予常规护肝、利胆等治疗,观察组患儿在对照组的基础上给予熊去氧胆酸治疗,两组均治疗3周。比较两组患儿治疗前后的血清炎症因子及肝功能指标水平,观察两组患儿用药后的临床治疗效果及不良反应发生情况。结果:治疗后,所有患儿的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、总胆红素(TBil)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GGT)、总胆汁酸(TBA)水平均低于治疗前,且观察组低于对照组(P0.05)。观察组患儿治疗后总有效率高于对照组(P0.05)。两组患儿总不良反应发生率比较差异无统计学意义(P0.05)。结论:熊去氧胆酸可以减轻婴儿肝炎综合征患儿的炎症反应,改善其肝功能,疗效显著且安全性好。     

Rapid infant weight gain predicts childhood overweight

Objective : To determine among a contemporary cohort whether rapid weight gain between birth and 6 months is associated with risk of childhood overweight and if this risk differs by ethnicity and/or breast‐feeding history. Research Methods and Procedures : This was a cross‐sectional survey in 1999 to 2000 of parents/guardians of children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in New York State. Measurements were abstracted by chart review, including weight at birth and 6 months, and height and weight at time of survey and every 6 months subsequently. Overweight at 4 years of age was defined as a BMI ≥ 95th age‐ and sex‐specific percentiles. Results : The study sample was 32% Hispanic, 19% black, and 49% white; 17% of children were overweight. Rate of infant weight gain (expressed in terms of 100 g/mo) was significantly associated with being overweight at 4 years (odds ratio, 1.4; 95% confidence interval, 1.3 to 1.6 after adjusting for history of breast‐feeding, birth weight, and ethnicity). The odds of being overweight at 4 years of age for Hispanic children were twice those of non‐Hispanic children (odds ratio, 2.2; 95% confidence interval, 1.5 to 3.3). The population‐attributable risk of overweight at 4 years of age was 19% for children in the highest quintile of infant weight gain. Discussion : Among this contemporary, multi‐ethnic cohort, rapid infant weight gain was associated with increased risk of being overweight at 4 years of age, independently of potential confounders. Identification of the risk factors contributing to rapid weight gain during infancy might improve early recognition and guide strategies for optimal nutrition to prevent the development of childhood overweight.     

甲亢孕妇血清25-羟维生素D水平对42天婴儿骨密度影响的研究

目的：探讨甲状腺功能亢进（甲亢）孕妇经治疗后,其体内25-羟维生素D（25-（OH）D3）水平对42天婴儿胫骨声波的传导速度（speed of sound,SOS）值、骨代谢生化指标的影响。方法：选取我院门诊及住院确诊的甲亢孕妇40例为甲亢组（T组）,随机抽取健康孕妇40例作为对照组（C组）,甲亢组给予丙硫氧嘧啶治疗后,监测两组孕妇25-（OH）D3水平与生后42天婴儿的胫骨SOS值、骨代谢生化指标,并进行对比观察、统计分析。结果：甲亢组孕妇在产后42天体内25-（OH）D3的水平比其在产后第1天升高（P〈0.05）,甲亢组孕妇在产后42天体内25-（OH）D3水平接近对照组（P〉0.05）,在产后42天婴儿的胫骨SOS值接近对照组（P〉0.05）,甲亢组产后42天婴儿的血清钙（Ca）及血清碱性磷酸酶（AKP）接近对照组（P〉0.05）。结论：甲亢组孕妇给予丙硫氧嘧啶治疗后,甲状腺功能恢复正常,其体内25-（OH）D3水平升高,所产42天婴儿的骨密度也随着升高。     

时间分辨荧光分析技术在先天性甲状腺功能低下筛查中的应用

目的:探讨时间分辨荧光分析技术(DELFIA)筛查新生儿先天性甲状腺功能低下的的准确率。方法:回顾性分析我院2008年1月至2013年5月收治的20000例新生儿的临床资料。分别利用酶联免疫吸附法(ELISA)和时间分辨荧光分析技术检测新生儿足跟血中三碘甲腺原氨酸(T3)、四碘甲腺原氨酸(T4)及促甲状腺素(TSH)水平。比较两种检测方法的准确率。结果:DELFIA初次筛查CH的准确性明显高于ELISA。对召回的新生儿进行TSH复测,DELFIA对TSH≥20 m U/L的检测准确率最高,差异具有统计学意义(P0.05)。结论:DELFIA在筛查先天性甲状腺功能低下中具有较高的应用价值,可作为临床筛查的首选方法。     

Do social disadvantage and early family adversity affect the diurnal cortisol rhythm in infants? The Generation R Study

Dysregulation of diurnal cortisol secretion patterns may explain the link between adversities early in life and later mental health problems. However, few studies have investigated the influence of social disadvantage and family adversity on the hypothalamic-pituitary-adrenal (HPA) axis early in life. In 366 infants aged 12-20 months from the Generation R Study, a population-based cohort from fetal life onwards, parents collected saliva samples from their infant at 5 moments over the course of 1 day. The area under the curve (AUC), the cortisol awakening response (CAR) and the diurnal cortisol slope were calculated as different composite measures of the diurnal cortisol rhythm. Information about social disadvantage and early adversity was collected using prenatal and postnatal questionnaires.We found that older infants showed lower AUC levels; moreover, infants with a positive CAR were significantly older. Both the AUC and the CAR were related to indicators of social disadvantage and early adversity. Infants of low income families, in comparison to high income families, showed higher AUC levels and a positive CAR. Infants of mothers who smoked during pregnancy were also significantly more likely to show a positive CAR. Furthermore, infants of mothers experiencing parenting stress showed higher AUC levels. The results of our study show that effects of social disadvantage and early adversity on the diurnal cortisol rhythm are already observable in infants. This may reflect the influence of early negative life events on early maturation of the HPA axis.     

Longitudinal analysis and genotyping of infant dominant bifidobacterial populations

Bifidobacterial population dynamics were investigated by the longitudinal analysis of the dominant population isolated from the feces of young infants. After molecular identification and fingerprinting comparison, clone identity of the consecutive strains belonging to the same species for one individual was performed by pulsed-field gel electrophoresis. The results, obtained from 15 individuals sampled four times over a five-week period suggested a turnover of the dominant bifidobacteria in the population not only at the species but also at its species representative levels. This study provides new insights of the in vivo dynamics of commensal bifidobacteria. It highlights the need to take into consideration the fluctuation of bifidobacterial populations that may occur in one individual in order to investigate reliably the impact of dietary components, such as probiotics or prebiotics, on the intestinal ecosystem.