目的 通过对婴幼儿泌尿系感染并发脓毒症的临床特点、病原菌情况及相关因素的分析,探讨其早期诊断和及时治疗的措施。方法 选取83例我科收治的确诊泌尿系感染合并脓毒症的婴幼儿作为研究对象,回顾性分析其临床表现、实验室检查及治疗预后情况。结果 所选婴幼儿均确诊泌尿系感染合并脓毒症,以男性患儿多见,全身中毒症状重,6月以下多以严重脓毒症、脓毒性休克为首诊表现,尿路刺激症状不明显。有明显细菌感染生物标记物的改变。细菌学培养共检出细菌22株,大肠埃希菌占54.55% (12/22),对头孢吡肟较为敏感,对亚胺培南、美罗培南全部敏感;屎肠球菌占22.73%(5/22),对万古霉素、利奈唑胺、替考拉宁敏感。结论 在婴幼儿常见的感染部位中,泌尿系感染容易被忽略。而小于6月的患儿更易并发严重脓毒症、脓毒症休克等危重症。因此,以脓毒症为首诊表现的婴幼儿应特别警惕泌尿系感染,尽可能早期明确感染部位,防止漏诊。首诊1小时内给予广谱抗生素治疗,可降低婴幼儿脓毒症的病死率,改善患儿预后。

Objective By analyzing the clinical features, laboratory tests, pathogenic bacteria culture and the treatments of infants and toddlers with urinary tract infection UTI accompanied with sepsis, we aim to guide the further clinical treatments and prevention. Methods We selected 83 cases from January 1, 2014 to December 31, 2016 in our hospital as the research objects which were accepted the diagnosis and treatments of urinary tract infection complicated with sepsis. Its clinical manifestations, laboratory tests, bacteriology examination and treatment prognosis were retrospectively analyzed. Results Among the selected infants and toddlers diagnosed with urinary tract infection complicated with sepsis, male patients were more common. Symptoms of systemic poisoning were observed in the majority especially in the children aging under 6 months, with severe sepsis and septic shock as the first manifestation, while conventional symptoms were not obvious. Biological markers of bacterial infection were significantly changed. In bacterial culture, 22 strains of bacteria were detected, Escherichia coli accounted for 54.55% (12/22), were almost sensitive to cefepime, and all sensitive to imipenem and meropenem; Enterococcus following accounted for 22.73% (5/22), could be more sensitive to vancomycin, linezolid, teicoplanin. Conclusion Urinary tract infection is common in under 3 years old babies. Patients aging under 6 months are more likely to be complicated with severe sepsis and septic shock. Therefore, we should be especially vigilant of the UTI among the babies whose first manifestations appear to be sepsis only. It is important to find out the site of infection as early as possible, in order to prevent misdiagnosis. It is also critical to use broad-spectrum antimicrobial therapy within 1 hour when severe sepsis is diagnosed in order to reduce the mortality of sepsis in infants and improve the prognosis.

目的 探讨盐酸普萘洛尔凝胶外涂治疗婴幼儿浅表性血管瘤的疗效及安全性。方法 选取我院2015年5月—2017年5月收治的60例患有浅表性血管瘤的婴幼儿为研究对象,随机分为观察组和对照组,各30例。对照组口服盐酸普萘洛尔片治疗,观察组采用质量浓度为5 g/L的(20 g∶100 mg)盐酸普萘洛尔凝胶外涂方法治疗,疗程3个月。观察两组患者治疗效果及不良反应情况。结果 治疗后,采用Achauer评定疗效,观察组Ⅰ级患儿1例,Ⅱ级患儿6例,Ⅲ级患儿12例,Ⅳ级患儿8例,Ⅴ级患儿3例,总有效率为96.67%(29/30),对照组Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级分别为2例、8例、10例、6例、4例,总有效率为93.33%(28/30),两组患者差异无统计学意义(P>0.05);两组患者治疗后血管瘤血流峰值及阻力系数较治疗前均得到改善(P<0.05),而两组间差异均无统计学意义(P>0.05);不良反应情况,除观察组发生3例涂抹部位发红外,两组患者均未发生严重不良反应。结论 采用盐酸普萘洛尔凝胶外涂治疗婴幼儿浅表性血管瘤疗效显著,安全可靠,临床上值得进一步推广。

Objective To evaluate the efficacy and safety of Propranolol hydrochloride gel in the external application treatment of superficial hemangioma in infants. Methods We selected 60 infants with superficial hemangioma treated in our hospital from May 2015 to May 2017 and to randomly divide them into the observation group and the control group, each with 30 cases. The control group was treated with Propranolol hydrochloride tablets, and the observation group was treated with 0.5% (20 g∶100 mg) Propranolol hydrochloride gel external application method, the course of treatment was 3 months.We observed the therapeutic effects and adverse reactions of the two groups. Results After treatment, with the Achauer evaluation, patients with grade Ⅰ had 1 case, grade Ⅱ 6 cases, grade Ⅲ 12 cases, grade Ⅳ 8 cases, Ⅴ-grade 3 cases, and the total effective rate was 96.67% (29/30), while the grade Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ in the control group included 2 cases, 8 cases, 10 cases, 6 cases, 4 cases, and the total effective rate was 93.33% (28/30), there was no significant difference between the two groups (P>0.05); The hemangioma peak flow and resistance coefficient of patients in the two groups were significantly improved than that before the treatment (P<0.05), and all with no statistically significant difference between the two groups (P>0.05). As to the adverse reactions, except the applying parts of 3 cases having rubefaction occurred in the observation group, two groups of patients had no serious adverse reactions. Conclusion External application of Propranolol hydrochloride gel in the treatment of superficial hemangioma in infants is effective, safe and reliable. It is worthy of further promotion in clinic.

目的 总结本地区低龄婴儿侵袭性B族链球菌(GBS)感染的流行病学特点, 为临床预防和诊治提供指导。方法 对2012年1月—2015年12月广州地区两家三甲妇儿专科医院收治的0～89 d低龄婴儿侵袭性GBS感染病例进行回顾性分析。结果 研究期间两院共收治侵袭性GBS感染病例120例,2015年感染病例数为2012年的2.8倍,感染病例的发生无明显季节倾向。早发型感染以败血症合并肺炎(46.3%)为主,围产期多伴有一个或以上的高危因素,死亡率为7.4%;晚发型感染以败血症合并脑膜炎(占42.4%),多以发热为首发症状,其中42%伴有神经系统症状,14.6%遗留神经系统后遗症。结论 广州地区低龄婴儿侵袭性GBS感染病例呈逐年增加趋势,临床应重视新生儿GBS感染的预防,加强感染高风险新生儿的管理,及时诊治,改善预后。

Objective To describe the epidemiological characteristics of invasive group B streptococcal (GBS) infection among infants during the past 4 years in Guangzhou, in order to provide scientific basis for the prevention and control of the disease. Methods Medical records of infants with invasive GBS infection from two tertiary hospitals in Guangzhou from January 2012 to December 2015 were reviewed. Results There were 120 infants with invasive GBS infections during the past 4 years in two tertiary hospitals, the number of patients increased from 2012 to 2015, and the occurrence of infectionshad no obvious seasonal tendencies. Among infants with EOD, the most common syndrome was sepsis complicated pneumonia (46.3%), respiratory sign and at least one of perinatal risk factors were commonly recorded, and the mortality rate was 7.4%. By contrast, a higher proportion of late-onset cases manifested as sepsis associated with meningitis (42.4%), fever was the most common presentation and 42% LOD cases accompanied by neurological symptoms, 14.6% infants had neurological sequelae. Conclusion The number of GBS-infected infants increased during the past 4 years in Guangzhou. Relevant departments should pay attention to the prevention of neonatal GBS infection, strengthen the management of high risk newborns to improve the prognosis.

目的 探讨1~ 6个月婴儿母亲饮食结构以及婴儿喂养方式两者与湿疹发病的关系,并观察对进食敏感食物母亲进行饮食干预治疗婴儿湿疹的疗效。方法 采用问卷方式调查705例婴儿母亲饮食结构及其婴儿的喂养方式,根据婴儿喂养方式不同分为纯母乳喂养组和纯人工喂养组,对纯母乳喂养组根据母亲哺乳期饮食结构,分为进食大量敏感食物组和进食少量敏感食物组以及非敏感食物组,比较不同喂养方式以及母亲不同饮食结构婴儿湿疹的患病率以及不同组别湿疹发病的相关性分析;并对进食敏感食物组湿疹患儿的母亲进行饮食干预,观察治疗效果。结果 广州地区纯母乳喂养婴儿湿疹患病率高于纯人工喂养组(P＜0.05),母乳喂养组中母亲进食敏感食物发病率高于非敏感食物(P＜0.001),进食敏感食物与湿疹发病率呈正相关关系(r=0.36)。对进食敏感食物母亲进行饮食人工干预后,婴儿湿疹患病率下降(P＜0.001)。结论 母亲进食敏感食物可能是婴儿湿疹高发的原因,对母亲进行饮食干预可有效减少婴儿湿疹的发病。

Objective Infantile eczema are possibly related to the feeding patterns and mother's dietary structure.The study in this paper is to investigate the relationship between them and evaluate the effect of diet intervention in breast feeding mother whose baby with eczema. Methods Infants were divided into 2 groups according to their feeding patterns:simple artificial feeding group and simple breast feeding group.In the simple breast feeding group,mothers were also divided into 3 levels according to their dietary structure.Mothers who ate a lot of allergenic food a day might get a dietary intervention.Prevalence rate of eczema was investigated and analyzed in each step. Results Simple breast feeding group had a higher eczema morbidity than simple artificial group(P＜0.05).The more allergenic food the mother ate,the higher occurrence of eczema of their babies(P＜0.001),which showed a positive correlation(r=0.36).The occurrence of eczema dropped significantly compared to the non intervention group(P＜0.001). Conclusion Mothers who are eating allergenic food is considered to a risk for infant's eczema. Food intervention is an effective method to reduce the prevalence rate.

目的 研究布拉氏酵母菌在合理治疗婴幼儿肠炎中的应用分析。方法 随机分组,观察组、对照组各60例病例,总例数120例,年龄均在2岁以下。观察组予以布拉氏酵母菌进行治疗;对照组采用常用的消化道黏膜保护剂(蒙脱石散)加微生态制剂(双歧杆菌四联活菌片)两联治疗。判定两组疗效。判定标准分为:大便次数及性状改变、发热、呕吐缓解、心酶下降、电解质紊乱、脱水纠正。结果 总有效率观察组为96.7％,对照组为86.7%,观察组临床疗效优于对照组(P<0.05),在各项症状及临床指标的改善上也优于对照组。结论 布拉氏酵母菌治疗婴幼儿肠炎临床疗效较常规方法能更好地缓解症状,使用更简单、合理,未监测到不良反应,值得在临床药物选择使用。

目的 了解CHPS患儿经胃镜下幽门肌切开术治疗后幽门部黏膜近期各种并发症的发生情况及对预后的影响。方法 选取2006—2012年我院新生儿科确诊的34例CHPS患儿。以超细胃镜进入十二指肠乳头处,使用电切刀按上行性方向,沿幽门管纵轴切割肥厚狭窄的幽门管黏膜及环形肌以解除幽门部梗阻。术后第1、3、6月复查胃镜。结果 34例CHPS患儿共行胃镜下幽门肌切开术48次,均未发生胃及幽门穿孔、撕裂等严重并发症。24例患儿术后通过胃镜进行了复查,胃镜见幽门部及黏膜改变主要有黏膜充血肿胀、切口未完全愈合、切口疤痕形成、幽门部息肉形成等。结论 经胃镜下幽门肌切开术是一种安全性较高的治疗CHPS的新技术。术后黏膜充血肿胀、切口未完全愈合等幽门部黏膜改变的发生率随时间下降。切口疤痕形成并未影响幽门功能。

        目的   探讨出生胎龄＜37周早产儿发生败血症时的临床特征及其不良结局的危险因素。方法   收集2020年1月—2023年12月安徽医科大学第一附属医院本部新生儿科收治出生胎龄＜37周且发生败血症早产儿的临床资料；根据败血症发生时间分为早发型败血症（EOS）49例，晚发型败血症（LOS）150例；根据是否出现不良结局，分为结局不良组90例，结局良好组109例。分析EOS和LOS败血症的临床特征，并采用多因素Logistic回归分析早产儿败血症出现不良结局的危险因素。结果  早产儿败血症中EOS患儿出生胎龄更小，生后1 min Apgar评分更低，孕母羊水污染、胎膜早破≥18 h发生率较LOS更高（P＜0.05）；早产儿败血症临床表现无特异性，但LOS患儿休克发生率更高（P＜0.05）；早产儿易发生革兰阴性菌感染，合并先天性心脏病（OR=2.490，P＜0.05）、出生胎龄＜30周（OR=4.851，P＜0.05）、出生体质量小于1 500 g（OR=4.169，P＜0.05）是早产儿败血症发生不良结局的危险因素。结论  早产儿败血症临床表现无特异性，更易发生革兰阴性菌感染，出生胎龄越小、体质量越低发生不良结局的风险更高。

       Objective  To analyze the clinical characteristics and  risk factors of adverse outcomes of  sepsis in premature infants with gestational age ＜ 37 weeks．Methods  Clinical data of preterm infants ＜ 37 weeksof gestational age admitted to the Department of Neonatology of the First Affiliated Hospital of Anhui Medical University from January 2020 to December 2023 were collected．According to the timing of sepsis，49 cases with early-onset sepsis（EOS）and 150 cases with late-onset sepsis（LOS）were diagnosed．According to the outcome，90 cases were divided into the adverse outcome group and 109 cases were good outcome group．The clinical characteristics of EOS and LOS were analyzed，and the risk factors of adverse outcomes were analyzed by multivariate logistic regression．Results The gestational age of EOS infants was smaller at birth，the 1 minute Apgar score was lower ，and the incidence of amniotic fluid contamination and premature rupture of membranes ≥18h were higher than those in LOS infants（P＜0.05）．The clinical manifestations of sepsis in premature infants were not specific，but the incidence of shock was higher in LOS children（P＜0.05）．Preterm infants were more likely to develop gram-negative bacterial infection，congenital heart disease（OR=2.490，P＜0.05），gestational age ＜30 weeks（OR=4.851，P＜0.05），and birth weight ＜ 1 500 g（OR=4.169，P＜0.05）were identified as significant risk factors for adverse sepsis outcomes in preterm infants．Conclusions The clinical manifestations of septicemia in preterm infants are non-specific，and they are more likely to suffer from gram-negative bacterial infection．The younger the gestational age and lower the birth weight of preterm infants，the higher the risk of adverse outcomes after sepsis．

       目的  探讨晚期早产儿中小于胎龄儿（SGA）与适于胎龄儿（AGA）出生时的铁代谢状态。方法  选取2020年1—12月合肥市妇幼保健院收治的150例晚期早产儿（胎龄34～36⁺⁶周）作为研究对象。按照出生体质量和胎龄将早产儿分为SGA组（36例）和AGA组（114例），分析比较两组早产儿出生时的铁代谢状态，并应用多因素线性回归分析血清铁的影响因素。结果  与AGA组相比，SGA婴儿的更低的血清铁［14.5 μmol /L （11.4，17.1） vs 16.4 μmol /L（14.1，18.4），P=0.004］、更低的血清铁蛋白［135.6 μg/L（101.8，176.2） vs 172.5 μg/L（123.0，218.3），P=0.009］和更低的总铁结合力［30.4 μmol/L（26.8，34.9）vs 35.4 μmol/L（29.5，44.6），P=0.001］。两组早产儿的血红蛋白、平均红细胞体积、平均红细胞血红蛋白含量和平均红细胞血红蛋白浓度比较差异均无统计学意义（P＞0.05）。在早产儿围生期特征中，胎盘异常（β= –1.949，P=0.009）和母亲糖尿病的发生（β= –2.324，P=0.001）与血清铁水平呈负相关。结论  与早产AGA相比，早产SGA铁储备水平较低，适量补充铁元素对小于胎龄新生儿身体发育有促进作用。

      Objective   To explore the iron metabolism status in late preterm infants who are small for gestational age（SGA）compared to those appropriate for gestational age（AGA）at birth．Methods   A total of 150 late preterm infants（gestational age 34 to 36⁺⁶ weeks）admitted to the Maternal and Child Health Hospital of Hefei from January to December 2020 were selected as the study subjects．The preterm infants were divided into the SGA group（36 cases）and the AGA group（114 cases）according to birth weight and gestational age．The iron metabolism status at birth was analyzed and compared between the two groups of preterm infants，and multiple linear regression analysis was applied to identify the influencing factors of serum iron．Results   Compared with the AGA group，SGA infants had lower serum iron（14.5［11.4，17.1］ vs 16.4 ［14.1，18.4］，P=0.004），lower serum iron protein（135.6［101.8，176.2］ vs 172.5［123.0，218.3］，P=0.009），and lower total iron binding capacity（30.4［26.8，34.9］ vs35.4［29.5，44.6］P=0.001）．There were no statistically significant differences in hemoglobin，mean corpuscular volume，mean corpuscular hemoglobin，and mean corpuscular hemoglobin concentration between the two groups of preterm infants（P＞0.05）．Among the perinatal characteristics of preterm infants，placental abnormalities（β= –1.949，P=0.009）and the occurrence of maternal diabetes（β= –2.324，P=0.001）were significantly negatively correlated with serum iron levels．Conclusions  Compared with preterm infants appropriate for gestational age，preterm infants who are small for gestational age have lower iron reserves at birth．Adequate supplementation of iron has a promoting effect on the physical development of small for gestational age newborns．

       目的    探究经鼻间歇正压通气（NIPPV）和经鼻持续正压通气（NCPAP）作为早产儿呼吸窘迫综合征气管插管机械通气拔管后无创呼吸支持过渡的临床效果的差异。方法   纳入2021年1月—2023年6月在广东省吴川市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征早产儿66例，用随机数字表法将患儿分为NIPPV组（33例）和NCPAP组（33例）。NIPPV组患儿予经鼻间歇正压通气作为过渡期无创呼吸支持，NCPAP组患儿则予以经鼻持续正压通气作为过渡期无创呼吸支持。对比两组患儿治疗前后血气分析结果、脱机失败率、无创呼吸支持时间、无创后吸氧时间、总给氧时间等指标。结果  接受无创呼吸支持12 h后，NIPPV组患儿的PaO₂升至（76.46±1.10）mmHg，高于NCPAP组患儿的（75.51±2.15）mmHg（t=2.249，P=0.028）。此外，NIPPV组患儿的SaO₂升至（96.36±0.52）%，也高于NCPAP组患儿的（96.07±0.59）%（t=2.138，P=0.034）。而NIPPV组患儿的PaCO₂则降至（41.39±0.74）mmHg，较NCPAP组患儿的（41.87±0.95 ）mmHg低（t=-2.230，P=0.025）。NIPPV组无创呼吸支持时间为（3.09±0.52）d，短于NCPAP组的（3.45±0.62）d，且该差异有统计学意义（t=2.584，P=0.012）。同样的，NIPPV组总给氧时间（9.52±0.76）天较NCPAP组的（10.00±0.79）天短，且该差异有统计学意义（t=-2.548，P=0.013）。而两组在脱机失败率、无创呼吸支持后吸氧时间、不良反应发生率等方面比较差异无统计学意义（均P＞0.05）。结论   与NCPAP模式相比，早产儿拔管后应用NIPPV模式进行无创呼吸支持取得的临床效果更优。

      Objective  To explore the difference of clinical effect of nasal intermittent positive pressure ventilation（NIPPV）and nasal continuous positive pressure ventilation（NCPAP）as non-invasive respiratory support mode after extubation in preterm infants with endotracheal intubation．Methods   Sixty-six cases of preterm infants with neonatal respiratory distress syndrome treated in our hospital from January 2021 to June 2023 were included．All the subjects were randomly divided into NIPPV group（n=33）and NCPAP group（n=33）．The blood gas analysis results，weaning failure rate，non-invasive respiratory support time，oxygen inhalation time after noninvasive ventilation，total oxygen administration time．were compared between the two groups．Results   After 12 hours of noninvasive respiratory support，PaO₂ in the NIPPV group increased to（76.46±1.10）mmHg，which was significantly higher than that（75.51±2.15）mmHg in the NCPAP group（t=2.249，P=0.028）．In addition，SaO₂ in the NIPPV group increased to （96.36±0.52）%，which was also significantly higher than that（96.07±0.59）% in the NCPAP group（t=2.138，P=0.034）．The PaCO₂ in the NIPPV group decreased to （41.39±0.74）mmHg，which was lower than that（41.87±0.95）mmHg in the NCPAP group（t=-2.230，P=0.025）．The  duration of  non-invasive  respiratory  support in the NIPPV group（3.09±0.52） days was shorter than that（3.45±0.62）days in the NCPAP group，and the difference was statistically significant（t=2.584，P=0.012）．Similarly，the total duration of oxygen administration in the NIPPV group（9.52±0.76）days was shorter than that（10.00±0.79）days in the NCPAP group，and the difference was statistically significant（t=-2.548，P=0.013）．There were no significant differences in weaning failure rate，oxygen inhalation time after noninvasive respiratory support，and incidence of adverse reactions between the two groups（P＞0.05）．Conclusions   Compared with NCPAP mode，NIPPV mode for non-invasive respiratory support in preterm infants after extubating has better clinical effect，and it is worthy of clinical application．