目的 了解足月小样儿生后早期的潮气呼吸肺功能及1岁内发生喘息的情况。方法 选择我院2015年3月—2016年3月阴道分娩的足月小样儿及同期胎龄相近、阴道分娩的健康足月儿,比较2组生后5~7天的潮气呼吸肺功能各项指标及1岁内发生喘息的次数。结果 2组出生胎龄、性别、Apgar评分、母亲吸烟史、一级亲属中哮喘史比较均无差异;研究组中分钟通气量(MV)、潮气量(VT/kg)、达峰时间比(TPEF/TE)、达峰容积比(VPEF/VE)均低于对照组,差异有统计学意义(P＜0.05);呼吸频率(RR)、吸气时间(Ti)、呼气时间(Te)、吸呼比(Ti/Te)、潮气呼吸呼气峰流(PTEF)比较无差异(P＞0.05);研究组1岁内发生喘息的次数多于对照组,差异有统计学差异。结论 足月小样儿生后早期肺容量小于健康足月儿,小气道阻塞更明显,可能影响1岁内发生喘息的几率。

目的 探讨孕母甲状腺疾病的新生儿第一个月生长速率和甲状腺功能与2岁时神经发育结局之间的相关性。方法 2013年1月—2014年12月在我院出生的156例孕母甲状腺疾病的新生儿为实验组,观察其第1个月体质量、身长及头围生长的速率,生后当天、第7天、第28天的总甲状腺素(TT4)及促甲状腺素(TSH)的水平;妊娠期无高危因素的母亲分娩的正常新生儿中随机抽取150例为正常对照组,观察生后新生儿第1个月体质量、身长及头围生长的速率,2组均在2岁内分别每3个月均接受随访评估,2岁时行贝利婴幼儿发展量表进行Bailey智力发育指数(MDI)、精神运动发育指数(PDI)的评分。采用回归分析检验新生儿生后第一个月体质量、身长及头围生长的速率,新生儿生后当天、第7天、第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI之间的关联性。结果 ①实验组生后第1个月体质量(29.5±4.2 g/d)、身长(1.18±0.67 cm/周)及头围(0.79±0.39 cm/周)生长的速率慢于正常对照组的体质量(35.4±6.3 g/d)、身长(1.69±0.85 cm/周)及头围(1.10±0.42 cm/周)生长的速率,2组差异有统计学意义(t值分别为9.672、5.882、6.768,P均<0.05);②实验组2岁时MDI(108±15)、PDI评分(109±16)低于正常对照组MDI(115±14)、PDI评分(118±11),2组差异有统计学意义(t值分别为16.129、21.279,P均<0.05);③实验组孕母甲状腺疾病的新生儿生后第1个月体质量、身长及头围生长的速率与2岁时MDI、PDI呈正相关(相关系数分别为:0.874,0.842,0.890,0.857,0.871,0.845,t值分别为22.584,59.296,65.441,61.214,62.662,59.507,P均<0.05);④实验组孕母甲状腺疾病的新生儿生后当天、第7天及第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI呈负相关(相关系数分别为:-0.878,-0.894,-0.890,-0.690,-0.654,-0.702,t值分别为73.167,81.273,74.166,11.523,10.548,12.103,P均<0.05)。结论 母亲妊娠期患有甲状腺疾病会影响新生儿生后第1个月体质量、身长、头围生长的速率及2岁时的精神运动、智力发育,落后于母亲妊娠期无高危疾病的正常新生儿。另外孕母甲状腺疾病的新生儿第1个月体质量、身长及头围生长的速率和生后当天、生后第7天 及第28天的T4及TSH的水平与2岁时MDI、PDI密切相关。

Objective To investigate the correlation between the growth rate, thyroid function in the first month and neurodevelopmental outcome at the age of 2 in the infants of the maternal thyroid disease. Methods We chose 156 infants of maternal thyroid disease from January 2013 to December 2014 born in our hospital as the experimental group and 150 normal infants of their mothers without high risk factors during pregnancy as the control group. We observed the rate of weight, length and head circumference growth in the first month and TT4 、TSH level at the 1^st day, 7^th day, and 28^th day after birth. We followed up two groups every 3 months up to the age of 2. We assessed Bailey mental development index (MDI) and psychomotor development index (PDI) at the age of 2. Regression analysis was used to test the correlation between the growth rate, TT4,TSH level in the 1^st month and MDI, PDI at the age of 2. Results ① The rate of growth rate in the 1^st month of the experimental group was slower than the control group. It was statistically significant difference between the two groups (P<0.05); ②MDI, PDI at the age of 2 in the experimental group were lower than those of the control group. It was statistically significant difference between the two groups (P<0.05); ③The rate of growth rate in the first month of the experimental group was positively related to MDI and PDI at the age of 2.④The difference between the level of TT4,TSH at the 1^st day, 7thday, and 28^th day and the median after birth was negatively related to MDI and PDI at the age of 2. Conclusion The maternal thyroid disease will affect the first month growth rate and neurodevelopmental outcome at the age of 2 of their infants. Their infants will grow behind than the normal newborns on pregnancy without high-risk disease.The growth rate of the first month and the level of T4 and TSH on the 1^st day, 7^th day, and 28^th day in maternal thyroid disease are closely related MDI and PDI at the age of 2.

目的 分析小婴儿化脓性脑膜炎的临床特点,探讨其预测因子。方法 回顾性分析我科2015—2017年53例小月龄化脓性脑膜炎患儿的临床资料。以同时期、同年龄层的细菌感染患儿81例为观察组。通过单因素和多因素分析进行两组比较。结果 单因素分析提示早产儿、激惹、嗜睡、前囟紧张、颈强直及循环不良方面有差异。脑脊液白细胞数量、蛋白浓度、糖浓度,糖与同期血糖比值以及乳酸脱氢酶浓度均有明显差异。多因素分析提示仅脑脊液蛋白及乳酸脱氢酶有统计学意义。受试者工作曲线显示脑脊液蛋白、乳酸脱氢酶及两项指标合并的诊断效能均较高。结论 小婴儿化脓性脑膜炎患儿缺乏典型表现,密切关注早产儿基础疾病,激惹、嗜睡、前囟紧、颈强直及循环不良的临床表现,脑脊液蛋白及乳酸脱氢酶等实验室指标,有利于早期识别,及时干预,减少不良事件的发生。

Objective We aimed to analyze the clinical characteristics of community acquired purulent meningitis(PM) in infants and explore the predictors of early diagnosis. Methods Retrospective study was done with patients in our NICU from Jan 2015 to Dec 2017 aged during 29 days to 90 days. We divided them into two groups, 53 of which diagnosed PM were included as a case group, while 81 of which admitted inpatients with fever at the same periods and in the same age ranges were included as a control group. Factors including adverse basic events, clinical manifestations, laboratory examinations and so on were compared between two groups. Results Univariate analysis showed that premature, manifestations such as irritability, lethargy, bulging fontanelle,a stiff neck and the poor circulation, and cerebrospinal fluid(CSF) data like the mount of white blood cell, concentration of CSF protein, concentration of CSF glucose, CSF/blood glucose ratio, concentration of CSF lactate dehydrogenase were different between two groups. In the multivariate analysis, concentration of CSF Protein(＞0.450 g/L, OR=5.819, P=0.002) and concentration of CSF lactate dehydrogenase(＞28.300 U/L,OR=7.892, P＜0.001) were proven to be independent risk factors for the diagnosis of PM. Receiver operating characteristic (ROC) analysis revealed that the CSF protein, the CSF lactate dehydrogenase and the combination of the two factors had an increased area under the curve (AUC), the mounts of each which were 0.839,0.867 and 0.890. Conclusion Patients with PM in early infantile period are often lack of atypical clinical characteristics. We need pay highly attention to the adverse basic events, irritability, lethargy, bulging fontanelle,a stiff neck, poor circulation and CSF results. The independent predictors for early diagnosis were concentration of CSF protein and lactate dehydrogenase. It indicates that if the predictors could be identified early, diagnosis could be made timely and interventions could be operated immediately. It will be beneficial for progression-free and overall survival.

早期干预是预防和减少早产儿神经系统损伤的有效措施,可以促进早产儿的正常发育并减轻神经系统伤残的发生,对提高儿童综合素质和家庭幸福都至关重要。在早产儿早期干预过程中存在与医学伦理原则不相适应的方面,如医疗设施不足、医疗措施不当、专业人员不足,早产儿干预预后的不确定性,治疗时机与家长经济及遵医行为之间的冲突,家长知情选择和知情同意不足等,本文结合医学伦理学的观点对0~3岁早产儿在早期干预中存在的问题进行分析并提出相应的建议。

Early intervention is an effective measure to prevent and reduce the nervous system injury in preterm infants,It can promote the normal development of preterm infants and reduce the occurrence of the nervous system disability.It is vital to improve the comprehensive quality of children and family quality of life. In the stage of premature infant intervention,there are some aspects that are incompatible with the medical ethics principle,i.e. inadequate medical facilities,improper medical measures,lack of professionals,premature infants intervention prognosis uncertainty,the conflict between the timing of treatment and the parents' economic and compliance behaviors,parents' informed choice and informed consent. etc. This paper analyzes the problems in early intervention of 0~3 year old preterm infants and puts forward corresponding suggestions according to the viewpoint of medical ethics.

目的 探讨多维铁口服液联合维生素AD滴剂治疗婴幼儿缺铁性贫血的疗效。方法 将首次诊断缺铁性贫血的336例婴幼儿依家长意愿分为2个治疗组(A组和B组)与1个对照组,A组予多维铁口服液联合维生素AD滴剂治疗,B组予多维铁口服液联合维生素D滴剂治疗,对照组饮食调理并补充维生素AD,于治疗4周后(3天内)采末梢血行血细胞分析,比较三组患儿贫血治疗显效率、总有效率差异。结果 治疗4周后,A组显效率为71.70%,总有效率为97.17%;B组显效率为41.05%,总有效率为90.30%;对照组显效率为6.25%,总有效率为32.29%。A组贫血治疗显效率、总有效率高于B组和对照组,差异均有统计学意义(P<0.05)。结论 铁剂联合维生素A制剂可显著提高婴幼儿缺铁性贫血的治疗效果。

Objective To observe the curative effect of multivitamin iron oral solution combined with vitamin AD drops on the treatment of iron deficiency anemia in infants. Methods 336 cases of infants who was found with iron deficiency anemia for the first time were divided into two treatment groups (group A and group B) and one control group in accordance with their parents' will. Group A was treated with multivitamin iron oral solution combined with vitamin AD drops. Group B was treated with multivitamin iron oral solution combined with vitamin D drops. The control group was taken just dietary therapy combined with vitamin AD drops. All subjects were tested blood analysis after 4 weeks of treatment (within 3 days). The differences of the treatment excellence rates and the total effective rates were compared in the three groups. Results After 4 weeks of treatment, the excellence rate in group A was 71.70%. The total effective rate in group A was 97.17%. The excellence rate in group B was 41.05%. The total effective rate in group B was 90.30%. The excellence rate in control group was 6.25%. The total effective rate in control group was 32.29%. The differences of the treatment excellence rates and the total effective rates in group A were significantly higher than those in group B or in the control group. The differences were statistically significant (P<0.05). Conclusion Multivitamin iron combined with vitamin A can significantly improve the curative effect of the treatment of iron deficiency anemia in infants.

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。