ObjectiveTo compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC and sepsis in preterm infants. MethodsStandard search strategy for the Cochrane Neonatal Review Group was performed by two review authors. Searches were made in PubMed, EMBASE, Ovid，Springer and CNKI databases with the terms "Preterm or newborn or infants or very low birth weight or extremely low birth weight and probiotics or lactobacillus or bifidobactrium or saccharomyces and necrosis enterocolitis. Only randomized or quasi-randomized controlled trials which involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome such as morbidity of severe NEC, sepsis or mortality were considered. Standard methods of the Cochrane Collaboration and its Neonatal Group were used to assess the methodological quality of the trials.RevMan 4.22 software was used to make meta analysis. Results107 literatures were reviewed.The studies including full-term infants RCTs(n=52),reviews(n=17),commentators(n=4),documents not meeting the major results of the meta analysis(n=15),case-control studies(n=3),self-control studies(n=2),not randomized studies(n=2),data undetailed and to contact the author unsuccessfully studies(n=10) were excluded.Ten eligible trials randomizing 2 117 infants(1 056 of treatment group and 1 061 of control group) were included. The results of quality assessment were that 8 studies were A, 1 was B and 1 was C.Included trials were highly variable with regard to enrollment criteria such as birth weight and gestational age, baseline risk of NEC in the control group, timing, dose, formulation of the probiotics, and feeding regimens. Data regarding extremely low birth weight(ELBW) infants were few. In a meta analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage Ⅱ or above)（OR=0.34，95%CI：0.22-0.55) and mortality（OR=0.36，95% CI：0.22-0.58）. There was no evidence on significant incidence reduction in nosocomial sepsis（OR=0.94，95%CI：0.62-1.42) or in NEC-related deaths（OR=0.48，95%CI：0.16-1.47).The hospilized days were longer in treatment group than that in control group(P<0.01).The included trials were reported no systemic infection with the probiotics supplemental organism. ConclusionsEnteral supplementation of probiotics reduced the risk of severe NEC and mortality in preterm infants. This analysis supports a change in practice in premature infants >1 000 g at birth. The safety and efficacy of administration of probiotic supplements couldn't be made in ELBW. A large randomized controlled trial is required to investigate the potential benefits and safety profile of probiotics supplementation in ELBW infants.
ObjectiveMechanical ventilation is associated with neonatal ventilator-associated pulmonary injury and bronchopulmonary dysplasia. Nasal continuous positive airway pressure (nCPAP) has been shown some effects on non-invasive respiratory support, but a lot of patients treated with nCPAP still need to be incubated and ventilated. The purpose of this study was to evaluate whether nasal intermittent positive pressure ventilation (nIPPV) would decrease the requirement for endotracheal ventilation compared with nCPAP in the treatment of respiratory failure in preterm and term infants. MethodsA prospective, randomized, controlled and single-center study was registered in Clinical Trial,USA（Protocol ID? NCR2008053, ClinicalTrials. gov ID? NCT0078062). Neonatal infants were randomly divided into nIPPV group and nCPAP group from January 2008 to December 2008 in a neonatal intensive care unit(NICU) of Daping Hospital, Third Military Medical University. The blood gas analysis, time of using nCPAP and nIPPV, ratio of requirement for endotracheal ventilation and the prognosis were investigated. ResultsTotally 1 369 neonatal infants were hospitalized in the NICU within the period of the study. 124 infants suffered from neonatal respiratory failure. Of them, 20 needed endotracheal ventilating immediately according to the exclusion criteria including severe respiratory acidosis (PaCO2>60 mmHg), cardiopulmonary arrest without effective resuscitation, severe congenital malformation and neonatal pulmonary hemorrhage. At the beginning, 104 neonatal infants who met the inclusion criteria were enrolled into the study and randomly divided into nIPPV group (n=50) and nCPAP group (n=54), but 2 patients in nIPPV group moved out the NICU within 24 hours, and 1 patient in nCPAP group was diagnosed as severe congenital malformation, who were excluded from the study according to the exclusion criteria. Hence, the enrolled patients were 48 in nIPPV group and 53 in nCPAP group finally. Neonates treated with nIPPV and nCPAP had comparable clinical conditions in study entry. Infants treated initially with nIPPV needed less endotracheal ventilation than those treated with nCPAP (22.9% vs 37.7%, P<0.05). The blood gas analysis also showed that pH and PaO2 in nIPPV group were better than those in nCPAP group 1 hour after non-invasive respiratory support (P<0.05, respectively). However, there was no significant difference in the ratio of good outcomes (93.8% vs 86.8%, P>0.05) between nIPPV group and nCPAP group. ConclusionsCompared with nCPAP,nIPPV could decrease the requirement for endotracheal ventilation in neonatal infants with respiratory failure. The effect of nIPPV as a mode of initial non-invasive respiratory support needs further investigation.
ObjectiveTo set up an ICFI based on four components including breast feeding, meal frequency, food thickness,type and frequency of food consumed. To examine the relationship of ICFI and its components with growth and development of 6 to 8 months old infants living in poverty rural China to identify the efficacy of ICFI in quantity evaluation and compare infant feeding practice in rural China. MethodsA cross-sectional study was conducted in a poverty rural county, which located in Yunnan,south-west of China, in November 2007. Total 462 infants were recruited, 204 (442%) girls and 258 (558%) boys, aged 6 months(n=153), 7 months(n=166),8 months(n=143) respectively. Feeding practices were assessed by a qualitative feeding questionnaire. An adapted version of ICFI was examined and divided into terciles. The associations of ICFI and its components with infant anthropometric indices,length-for-age Z-score (LAZ),weight-for-age Z-score (WAZ) and weight-for-length Z-score (WLZ) were examined. The components and scores of ICFI were compared in different age groups. ResultsICFI increased with age from 6 to 8 months old but there was no significant difference. ICFI was positively associated with LAZ(P=0009). Compared with infants with ICFI≤5, infants with ICFI≥8 had significantly higher LAZ (P=0013) and WAZ (P=0037) Meanwhile, the complementary food thickness was also significantly associated with LAZ (P=0001) and WAZ (P=0002); the dietary diversity score had no significantly associated with LAZ,WAZ和WLZ. ConclusionsICFI was associated with nutritional status of infants in poverty rural area,south-west of China. ICFI could be used to identify vulnerable infants and to monitor nutrition interventions in this area.
ObjectiveTo investigate the the clinical features and long-term prognosis of neonatal lupus erythematosus (NLE) . MethodsThe clinical manifestations of patients and their mothers were summarized and analyzed.Their autoantibodies were detected, and long term follow-up was carried out. Results①12 NLE cases, 7 males and 5 females,all had lesions on skin.11 cases had hematologic changes,6 of them were with hepar impairments, and 4 cases had heart impairment. The antinuclear antibody and anti-SSA/Ro were positive in all cases.The anti-SSB/La was positive in 5 cases.The anti-dsDNA antibody was positive in 4 cases.Antibody against U1-RNP was positive in 4 cases, the level of ESR was higher in 6 cases.The alanine aminotransferase levels in 6 cases were higher than those in normal infants.②11 mothers had no symptom before pregnancy, one had solar dermatitis.7 mothers manifested solar dermatitis and light desquamation during the second trimester of pregnancy.2 had fever, hair loss and cytopenia.2 presented with rash and hair loss one month after delivery. The antinuclear antibody and anti-SSA/Ro antibody were positive in all mothers, the anti-SSB/La antibody was positive in 5 mothers, the anti-ds-DNA antibody was positive in 4 mothers, antibody against U1-RNP was positive in 4 mothers, the level of ESR was higher in 5 mothers. ③Among the 12 cases, 11 cases were followed-up for 18 months to 12 years,one case died from complete right bundle branch block. The hematologic changes and the hepatic impairment returned to normal, cutaneous lesions and autoantibodies disappeared about 6 to 12 months after birth in the 11 cases, at the time when maternal antibodies exhausted in the neonatal circulation. One case was diagnosed as JIA when he was 3 years old. Another case had recurrent rash when he was 12 years old, the ANA titer was 1∶320 and the anti ds-DNA antibody was negative. Ten mothers were diagnosed as SLE and two mothers were Sjogren′s syndrome. ConclusionsThe clinical manifestations of NLE include cardiac conduction disturbances, transient cutaneous lesions, cytopenia，hepatic impairment, etc. The long-term prognosis for children with NLE is still under investigation and some infants with NLE may progress to other autoimmune diseases later in the childhood.
ObjectiveTo determine the population pharmacokinetics of valproic acid(VPA) and identify the factors that explained PK variability in Chinese epileptic children. Methods390 steady-state serum concentration samples were collected totally. The plasma samples for VPA concentration were analyzed using automated fluorescence polarization method (FPIA) with monoclonal antibodies. In total, 321 patients aged 1.8(0.1-13.6) years and weighted 11.5(2.6-84) kg with 390 trough concentrations were extracted. Total body weight, VPA daily dose, gender and comedication with clonazepam, topiramate, carbamazepine, phenobarbital and oxcarbazepine were considered as covariates. A decrease of OFV (from basic model to covariate model) by more than 6.63 was considered to be statistically significant (P<0.01, df=1). An increase of OFV from the full model of at least 10.83 (P<0.001, df = 1) was used as the chosen criterion for retaining the covariate in the model. Pharmacokinetic modeling was performed using NONMEM program (version 6, level 1.1) complied with G77 Fortran. A one-compartment pharmacokinetic model with first-order absorption and elimination (subroutine ADVAN2 and TRANS2) was used to describe the concentration-time data. The first-order conditional estimation method with η-ε interaction (FOCE-I) was used throughout the model-building procedure. Various statistical models describing the random residual variability were considered. The reliability and stability of the population pharmacokinetic model developed was further assessed by a nonparametric bootstrap procedure. During this process, each patient was randomly sampled with replacement from the original data set to form new data set containing the same number of patients as the original data set. ResultsThe final model for VPA apparent clearance(CL/F),including age (years), CLO comedication and liver enzyme inducer(carbamazepine or phenobarbital) covariates with a significant influence on this parameter, was as follows: CL/F＝0.223·（Age/1.8）0.353·1.22CLO·1.36LEI,V＝13.0·（Total body weight/11.5） where CLO was 1 when co-medicated with clonazepam preparation, otherwise CLO was 0; LEI was 1 when co-medicated with carbamazepine or phenobarbital preparation.The typical values for CL/F and apparent volume of distribution (V/F) were 0.223 L·h-1 and 13.0 L, respectively. Interindividual variability (coefficient of variation) for CL/F was 34.3% for final model and 51.5% for basic model; The residual unexplained variability was 25.6 %.In a single attempt of 200 bootstrap analysis, 6(3.0%) runs terminated due to rounding errors and were excluded in the analysis. The parameter(except V/F) estimates from nonparametric bootstrap procedure were comparable and within 5% of the estimates from NONMEM. ConclusionsA population pharmacokinetic model was proposed to estimate the individual CL/F for paediatric patients receiving VPA in terms of patient′s age, and concomitant clonazepam, carbamazepine or phenobarbital, in order to establish a prior dosage regimens.
ObjectiveTo study the characteristics of amplitude integrated electroencephalogram(aEEG) of normal full-term neonates within 3 days after birth MethodsaEEG was recorded for 3 hours by the first native EEG instrument in 1,2 and 3 days old in normal full-term newborns; voltages of aEEG were calculated with semi-logarithmic formula manually. The background, voltage level and sleep-wake cycle were analyzed. Results①For normal full-term newborns,the background of aEEG was continuous voltage, and sleep-wake cycle was observed in 905% newborns 1 day after birth and 100% newborns 2 and 3 day after birth. ②The average duration of sleep-wake cycle was （699 ± 187）min. The average duration of sleep and awake phase was （220 ± 57）min and （479 ± 171）min,respectively. ③The minimum amplitude of the aEEG background was （128 ± 34）, （121 ± 20） and （125 ± 26）μV at the age of 1,2 and 3 days respectively; the maximum amplitude was （375 ± 110）,（384 ± 94） and （386 ± 96） μV at the age of 1,2 and 3 days respectively. ④The gestational age,age,gender,mode of delivery and maternal complications during pregnancy had no effect on aEEG voltage and sleep-wake cycle of aEEG among 38-42 weeks of gestational age in normal newborns.The voltages of the upper boundary of wide and narrow band were higher within the first three days at 37- weeks of gestational age newborns than those at 38-42 weeks newborns,especially the voltages of narrow-band(P=0014). ConclusionsIn normal full-term newborns，the aEEG background was continuous voltage and sleep-awake cycle existed;the minimum voltage was>5 μV and the maximum voltage>10 μV.The gestational age, age, gender, mode of delivery and maternal complications during pregnancy had no effect on aEEG in normal full-term newborns.
ObjectiveTo summarize the clinical features of brainstem encephalitis associated with hand, foot and mouth disease(HFMD) of Guangdong in 2008 and provide the basis for the diagnosis of the disease. MethodsThe clinical data of 19 children diagnosed as brainstem encephalitis associated with HFMD in May to July 2008 were collected. The clinical manifestation, laboratory examination, neuro-electrophysiology, imaging examination, treatment， prognosis and other characteristics were analyzed. The results were statistically analyzed by single factor and multiple factors analysis between above group and control group. ResultsThe data of 19 cases with brainstem encephalitis associated with HFMD were as follows, ① All of the 19 cases had fever and rash. The neurological symptoms such as limb tremor, abnormalities of eye movements(ocular drift or superduction), irritability, panic, walking instability and consciousness dysfunction were prevalent. The cranial nerves were damaged mainly on the single side, glossopharyngeal and vagus nerve paralysis were more common. Fifteen cases had respiratory failure, and three patients had pulmonary hemorrhage. ②Peripheral blood WBC number rised in 8 cases.Cerebrospinal fluid pressure ascended in 4 cases. ③EEG examination showed 8 cases were abnormal, and 14 cases were found abnormal in brainstem auditory evoked potential . ④X-ray of three cases showed lungs exudative lesions.Head CT examinations found nothing abnormal ,while 3 cases had abnormal MRI manifestations. ⑤ Two patients died of central respiratory and circulatory failure.Seventeen patients were cured and showed no neurological symptoms when followed up for 6 months. ⑥Single factor Logistic analysis showed brainstem encephalitis had great possibility to occur when following conditions appeared,such as limb tremor,change of respiratory rhythm,respiratory failure, abnormalities of eye movements(ocular drift or superduction) ,bucking in drinking,deviated mouth , tongue tremor,poor distal circulation,cross-paralysis and abnormal BAEP.Multiple factors Logistic analysis showed that limb tremor,abnormalities of eye movements(ocular drift or superduction) and abnormal BAEP were the risk factors for HFMD combined with brainstem encephalitis(OR=436.9,52.2,93.5,respectively). ConclusionsPeripheral blood WBC, blood glucose and cerebrospinal fluid examinations were not specitic for brainstem encephalitis associated with HFMD. In children cases of HFMD showing limb tremor, abnormalities of eye movements(ocular drift or superduction) and above mentioned symptoms, brainstem encephalitis was suggested. BAEP had good diagnostic value for brainstem injury. Most cases with brainstem encephalitis associated with HFMD had good prognosis after timely and standard treatment.
ObjectiveTo investigate the association of SNP276 polymorphism of adiponectin gene with obesity and relative trails in children and adolescents. MethodsObese/overweight children and adolescents and normal weight controls aged 6-18 years were recruited. Body height, weight were measured and body mass index（BMI） was calculated. Serum fasting plasm glucose ( FPG) , fasting insulin (FIns) , triglycerid(TG) and cholesterol(TC) were measured. HOMA-IR and QUICKI were calculated. Genomic DNA was extracted from peripheral blood and Taqman-MGB probe was used to detect the adiponection (APM1) gene SNP276 G/T polymorphism. Obesity was evaluated using IOTF BMI standard. ResultsObese group, overweight group and normal group included 227, 231 and 216 children, respectively. ①FPG,FIns,TG and HOMA-IR in obese + overweight group were significantly higher than those in normal control group.②The G allele frequency of SNP276 was 69.7% which didn′t exist significant statistically difference compared with obesity (allele frequency 71.4%) and overweight (allele frequency 72.5%) groups（P=0.678, 0.550).③There was significant statistically difference in FPG,FIns,TG,TC,HOMA-IR and QUICKI among three SNP276 genotypes (P=0.49-0.99).④Among all the IFG children, 15.3% (70/458) children were GG+GT and 0.9% (4/458) were TT genotype in obesity and overweight groups which didn′t exist significant statitically difference compared with normal control group(4.6% GG+GT genotype, 0 TT genotype) . ConclusionsAPM1 gene SNP276 was not associated with BMI and their metabolic parameters in Chinese obesity/overweight children, which suggested that APM1 gene SNP276 polymorphism may exist ethic difference in its relation with obesity and metabolic syndrome.
ObjectiveTo investigate the differences of anorectal dynamics among the various types of functional constipation and between children with functional constipation and healthy children .The study is to assist clinical classification in diagnosis and treatment of functional constipation. MethodsBased on functional gastrointestinal disease Rome Ⅲ criteria,children with functional constipation were enrolled in outpatient clinic and hospitalized patients from January 2008 to January 2009. In the same period,healthy children without gastrointestinal symptoms were enrolled as control group. The x-ray opaque markers（ROM）were used to measure colonic transit index (TI) in order to distinguish the types of functional constipation.Differences of anorectal dynamics were investigated among the various types of functional constipation and between children with functional constipation and healthy children by anorectal manometry. Results25 patients were enrolled in FC group,including 10 in STC subgroup and 15 in OOC subgroup. 10 children were enrolled in the control group.The resting pressure of anal sphincter showed no significant difference between the constipation groups and the normal control group, there was no difference between the two types of functional constipation（P＞0.05）. The maximal systolic pressure of anal sphincter had no significant difference between the slow transit constipation (STC) subgroup and the normal control group（P＞0.05）. The maximal systolic pressure of anal sphincter was significantly higher in the outlet obstruction constipation(OOC) subgroup than the normal control group and the STC subgroup（P＜0.05）. Minimal sensitive volume of rectum was significantly larger in the constipation groups than in the normal control group（P＜0.05）,and so was maximal tolerated volume of rectum（P＜0.05）. There was no significant difference in minimal sensitive and maximal tolerated volume of rectum between the OOC subgroup and the STC subgroup（P＞0.05）. ConclusionsThere were obvious anorectal dynamic disorder and abnormal feeling in children with functional constipation,and there existed some differences in anorectal dynamic features between different types of functional constipation. Therefore anorectal manometry could be used to diagnose functional constipation and assist clinical classification in diagnosis and treatment of functional constipation.
ObjectiveTo summarize and review the pathophysiology,diagnosis and management of tetralogy of Fallot (TOF) with absent pulmonary valve. MethodsThe clinical data of three cases with tetrology of Fallot with absent pulmonary valve who were diagnosed from Novermber 2007 to February 2009 were summarized,including clinical features,iconography characteristics,treatment and prognosis. ResultsThese 3 patients included 1 boy and 2 girls,aged 39 d,73 d and 4 months respectively.All the cases had symptoms of respiratory distress and variable cyanosis,and physical examinations revealed a to-and-fro murmur at the upper and mid-left sternal borders.Both echocardiography and angiocardiogram showed a large subaortic ventricular septal defect with overriding of the aorta,distally displaced pulmonary annulus with valve stenosis and severe regurgitation,massive aneurysm of the pulmonary trunk and its branches.One patient was with isolated and hypoplastic left pulmonary artery,and none of them was with ductus arteriosus patent.Two patients with severe respiratory distress symptoms received corrective surgery,with good result in one and perioperative death in the other one with isolated and hypoplastic left pulmonary artery.The parents of the other mild symptomatic baby preferred to follow up. ConclusionsThe anomaly of TOF with absent pulmonary valve should be kept in mind when meeting those patients who had repeated and refractory respiratory infection and distress in their early life.Early corrective surgery was the only effective management for those symptomatic patients,and even an asymptomatic child should receive elective surgery in the first 6 months of life.The surgical mortality of them was much higher than that of the isolated TOF patients,especially in those patients with one pulmonary artery hypoplasia or isolated.
