Percutaneous Balloon Angioplasty for Severe Native Aortic Coarctation in Young Infants Less Than 6 Months： Medium- to Long-term Follow-up

Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role ofpercutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods： The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient＇s weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results： The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient （PG） across the coarctation was 41.0 ± 16.0 mmHg （range 13-76 mmHg）. The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm （range 0.5-2.8 mm）. All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg （range 0-40 mmHg）, and the diameter ofcoarctation significantly improved to 3.8 ± 0.9 mm （range 2.5-5.3 mm）. No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year： （1） The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; （2） in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; （3） tricuspid regurgitation and pulmonary hypertension improved in all patients; （4） all patients were doing well and were asymptomatic. Conclusions： Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.

Effects of Nutrient Fortified Complementary Food Supplements on Anemia of Infants and Young Children in Poor Rural of Gansu

Objective To assess the effectiveness of complementary food supplements with protein and multi-micronutrients on hemoglobin and anemia in infants and young children. Methods In 5 poor counties of Gansu, 984 children aged 6-12 months were enrolled and divided into two groups. In addition to the usual home-made complementary food, all the children were fed one sachet of either Formula Ⅰ or Formula Ⅱ supplements each day. Protein and micronutrients were provided in Formula Ⅰ, while the same energy intake was secured in Formula Ⅱ as in Formula Ⅰ. A massive dose of vitamin A was supplemented to all the children every 6 months. Hemoglobin test was done at the same time. Results Prevalence of anemia was about 35% in both Formula Ⅰ and Formula Ⅱ group at baseline, and there were no differences in hemoglobin concentration between the two groups, During the 6-month and 12-month supplementation, hemoglobin of children in Formula Ⅰ group was higher than that in Formula Ⅱ group （P〈0.05）, and hemoglobin increase in Formula Ⅰ group was significantly higher than that in Formula Ⅱ group （P〈0.001）. After 6- and 12-mouth supplementation, the prevalence of anemia in Formula Ⅰ group dropped to 19.1% and 8.2% respectively, and it was 28.0% and 12.4% in Formula 2 group. The prevalence of anemia in Formula Ⅰ group was significantly lower than that in Formula Ⅱ group （P〈0.05）. After adjusting age and hemoglobin level at baseline, the hemoglobin increase at age of 24 months in formula 1 group was higher （10.7 g/L vs 7.9 g/L, P〈0.0001）. Conclusion Micronutrient fortified complementary food supplements, with large-dose vitamin A, is effective for children aged 6-12 months in terms of iron deficiency prevention.

Assessment of Infant and Young Child Feeding Practices of Caregiver’s in Jashore City, Bangladesh

Since infant and young child feeding practices play an important role in ameliorating childhood nutrition, an exploratory and descriptive study has thus been conducted employing a previously developed questionnaire at Ad-din shisu Hospital, Jashore, Bangladesh to obtain better insights about the breastfeeding and complementary feeding practices among infant and young child feeding caregivers. Out of 260 babies, 54% were female and 46% were male. Nearly all caregivers were found having the idea that breast milk is the best food for newborn babies. Around 81.9% of caregivers think that breast milk contains all the nutrients the baby needs to flourish, but in case of protection from disease, only 18.1% of caregivers think that it protects the baby from certain diseases. Around 46.9% mothers practiced early initiation of breastfeeding and they offered breast milk to their newborn right away (within one hour) after delivery, 53.5% lactating mothers had proper knowledge about breastfeeding methods, 39.6% mothers never practiced burping after breastfeeding, 66.4% mothers had normal delivery, 33.6% mothers had caesarian section, 99% mothers offered colostrums to their babies and only 1% of them didn’t give the colostrums. Besides, 88.8% continued breastfeeding up to 24 months or more along with 83.8% caregivers starting complementary feeding from six months, 55.4% caregivers said baby’s immune system is less developed, so they get attacked by infection easily and 44.6% caregivers said “their tummies are vulnerable to infection”, and 48.8% of the caregivers followed the type of hygiene required. Our findings revealed information on the knowledge, attitude, and practices of the caregiver’s towards breastfeeding and complementary feeding.

A Case Study on the Impact of Mother-to-Mother Support Groups on Maternal, Infant and Young Child Nutrition and Care Practices in Habaswein and Wajir South Districts of North Eastern Kenya

Only about 25% of babies are exclusively breast fed until six months of age in developing countries though they are at a greater risk of infection and infant mortality. The Global Strategy for Maternal, Infant and Young Child Feeding (MI- YCF) Strategy developed by WHO/UNICEF in 2002 was to revitalize world attention to the impact of feeding practices on the nutritional status, growth, development, health and survival of infants and children. The data for this case study was collected through key informant interviews, observations and review of Save the Children nutrition programme reports and surveys. This information was then organized to produce a detailed description of the maternal, infant and young child nutrition programme in Habaswein and Wajir South districts or sub-counties. The maternal and infant young child nutrition (MIYCN) programme was launched in Habaswein and Wajir South districts in January 2012. The MIYCN programme followed recommendations of a Knowledge, Practice and Coverage (KPC) survey report in July 2012. To date, the programme has formed 48 Mother-to-mother Support Groups (MTMSGs), which are actively promoting the uptake of the recommended MIYCN practices in the community. MIYCN indicators have been markedly improved between July 2011 and February 2013 when surveys were conducted. The uptake of kitchen gardening has picked up significantly at Meri site and some mothers now have a changed attitude towards unskilled home deliveries and are conducting referrals for skilled births. The marked improvements in the performance of MIYCN indicators between July 2011 and February 2013 inWajir South and Habaswein districts can be partly attributed to the MIYCN programme established in January 2012. However, a randomized community trial is still required to provide conclusive results on the impact of care support groups on maternal, infant and young child feeding in this region.

婴幼儿轻度脑外伤后基底节梗死的临床特点及其远期随访研究

目的探讨婴幼儿轻度脑外伤后基底节梗死(basal ganglia infarction after minor head trauma,BGIMHT)的临床特点及预后。方法回顾性分析2011年1月—2022年1月在苏州大学附属儿童医院住院的28 d至3岁BGIMHT患儿的临床资料和随访结果。结果纳入的45例BGIMHT患儿中,最常见症状为肢体活动障碍(96%,43/45),其次为面瘫(56%,25/45),头颅影像学见梗死伴基底节钙化占72%(31/43)。经保守治疗后,42例(93%)患儿症状改善,3例(7%)出现卒中反复。中位随访时间82(范围:17~141)个月,截至末次随访,97%(29/30)残留基底节软化灶;29例参与问卷随访,复发和康复问卷评估示66%(19/29)患儿恢复正常,17%(5/29)症状明显改善,17%(5/29)改善欠佳;全球疾病负担重点控制项目分级量表评估示仅1例(3%)残存严重后遗症。无神经系统后遗症患儿及有神经系统后遗症患儿的起病年龄、性别及有无合并BGC比较差异无统计学意义(P>0.05)。结论BGIMHT最常见首发症状为肢体活动障碍,影像学结果见大部分患儿同时存在颅内钙化灶,多数梗死灶后期转化为软化灶,总体预后良好。

关中农村婴幼儿辅食添加状况及抚养人KAP问卷调查分析

目的调查分析陕西关中农村地区6~24月龄婴幼儿辅食添加现状以及抚养人关于辅食添加的KAP问卷调查,为制定合理的婴幼儿辅食添加方案以及婴幼儿辅食添加科普教育计划提供科学依据。方法采取随机抽样选取陕西省关中4个县的农村6~24月龄婴幼儿家庭,使用自行设计问卷进行调查,并对数据进行统计分析。结果陕西关中地区农村6~24月龄婴幼儿辅食添加不合理,调查中米面和谷类食物、配方奶粉、蛋类、深色蔬菜、强化铁的添加比例分别为91.46%、75.65%、78.41%、77.32%、54.39%。其中比例最少的是鱼虾类、动物内脏以及豆类。辅食添加时间较晚平均添加时间超过6月龄。该地区婴幼儿抚养人对辅食添加有着积极的态度,但缺乏合理的辅食添加知识,仅有29.2%的抚养人能正确回答婴幼儿的辅食添加时间。结论陕西关中农村地区婴幼儿辅食添加种类不够,添加时间较晚、频率低于推荐频率。主要抚养人缺乏合理的辅食添加方面知识,为陕西省关中地区普及婴幼儿辅食添加相关知识很有必要。

误诊为婴幼儿颈部淋巴管瘤的异位支气管源性囊肿二例

目的探讨婴幼儿颈部支气管源性囊肿的临床特点、误诊原因及防范措施。方法回顾分析2020年5月至2023年7月收治的2例误诊为婴幼儿颈部淋巴管瘤的颈部支气管源性囊肿的临床资料。结果2例婴幼儿首次均因发现颈部包块入院,均误诊为颈部淋巴管瘤,行淋巴管瘤硬化剂注射术。因颈部包块未完全消退,再次入院后行颈部肿物切除术,术后病理检查确诊为颈部支气管源性囊肿。随访至今患儿均恢复良好。结论虽然颈部支气管源性囊肿临床较少见,颈部淋巴管瘤相对常见,但对于新生儿以颈部包块就诊时应考虑颈部支气管源性囊肿可能,特别是对诊断性穿刺结果有疑问时,需进一步完善相关影像学检查,仔细查体、全面分析,避免误诊。

乙肝疫苗接种预防控制婴幼儿乙型肝炎感染的效果分析

目的探讨乙肝疫苗接种预防控制婴幼儿乙型肝炎感染的效果。方法选取分宜县2022年10月至2023年10月完成全程接种乙肝疫苗的60名婴幼儿作为研究对象,记录在接种疫苗1年和两年后的乙型肝炎抗体浓度,并分析在接种1年和两年后的乙型肝炎表面抗体(HBsAb)反应情况。结果接种疫苗1年后,乙型肝炎抗体的平均滴度为(118.33±3.30)mU/ml,高于接种两年后的(93.23±1.25)mU/ml(P<0.05)。接种1年后的HBsAb阳性率为96.67%,高于接种两年后的78.33%(P<0.05)。结论乙型肝炎疫苗接种可预防幼儿乙型肝炎感染。

血清YKL⁃40与气道炎性因子在婴幼儿喘息中的表达及临床意义

目的探讨血清YKL-40及气道炎性因子白细胞介素(IL)-5和IL-8在婴幼儿喘息中的表达情况及临床意义。方法选择2021年6月—2023年5月收治的喘息急性发作(急性期)患儿70例,其中初次喘息发作32例,反复喘息38例。经治疗恢复期34例。另选取同期体检健康婴幼儿22例为健康对照组。反复喘息患儿依据哮喘预测指数(API)分为阳性组23例和阴性组15例。检测上述各组血清YKL-40、IL-5和IL-8水平,分析YKL-40与IL-5、IL-8、外周血中性粒细胞及嗜酸粒细胞的相关性。结果喘息急性期患儿血清YKL-40、IL-5、IL-8水平均高于喘息恢复期和健康对照组(P<0.01)。反复喘息组血清YKL-40和IL-8水平均高于初次喘息组(P<0.01)。API阳性组与API阴性组血清YKL-40、IL-5和IL-8水平比较差异无统计学意义(P>0.05)。血清YKL-40与IL-8呈显著正相关(r=0.926,P<0.001),但与IL-5、外周血嗜酸粒细胞绝对值、中性粒细胞绝对值均无相关性(P>0.05)。结论血清YKL-40、IL-5和IL-8参与婴幼儿喘息急性气道炎症过程,YKL-40可能与中性粒细胞炎症有关。YKL-40水平增高可能是婴幼儿喘息发作和反复喘息的危险因素,但与API无关。

婴幼儿头皮医用粘胶相关性皮肤损伤防护方案的构建与应用

目的降低视频脑电图监测婴幼儿头皮医用粘胶相关性皮肤损伤。方法采用历史对照设计,将2018年1月至2019年12月入住癫痫监测单元行头皮视频脑电图监测的患儿856例纳入对照组,实施常规皮肤护理;将2021年1月至2022年12月入住癫痫监测单元行头皮视频脑电图监测的患儿851例纳入观察组,构建和实施医用粘胶相关性皮肤损伤防护方案。比较两组头皮医用粘胶相关性皮肤损伤发生率。结果观察组头皮医用粘胶相关性皮肤损伤发生率显著低于对照组(P<0.05)。结论婴幼儿头皮医用粘胶相关性皮肤损伤防护方案的应用,可有效降低婴幼儿头皮医用粘胶相关性皮肤损伤发生率。

婴幼儿川崎病急性期肠道菌群的特征分析

目的分析婴幼儿川崎病(Kawasaki disease,KD)急性期肠道菌群的构成、丰度及功能差异,探索肠道菌群在KD发病机制中的作用。方法前瞻性选择2021年7—10月在首都儿科研究所附属儿童医院心血管内科住院的6例0~3岁KD急性期婴幼儿为KD组,选取同期体检的年龄、性别匹配的6例健康婴幼儿为健康对照组。采用宏基因组测序检测并比较两组婴幼儿粪便样本的菌群结构及功能差异。结果两组样本肠道菌群在结构组成、多样性分析方面差异有统计学意义(P<0.05)。KD组婴幼儿肠道菌群中单核细胞增生李斯特菌(李斯特菌科、李斯特氏菌属)、鲁塞蒂双歧杆菌、海氏肠球菌、鸟肠球菌丰度高于健康对照组(|LDA|>2,P<0.05)。KD组中类固醇降解和细胞凋亡通路较健康对照组显著升高,而细菌分泌系统、硫代谢、丁酸甲酯代谢、苯甲酸降解、β丙氨酸代谢、α亚麻酸代谢等通路显著减低(|LDA|>2,P<0.05)。结论0~3岁KD急性期婴幼儿肠道菌群在结构及多样性方面与健康婴幼儿相比均有显著差异,提示KD急性期存在肠道菌群紊乱,尤其是单核细胞增生李斯特菌、海氏肠球菌、鸟肠球菌可能通过类固醇降解及细胞凋亡参与KD的发病机制。

《生长减缓婴幼儿的追赶生长:指导临床医师的专家建议》解读

生长减缓是帮助早期识别营养问题的重要临床表现,尽早识别和干预婴幼儿生长减缓对改善其近远期健康结局意义重大。之前发表的相关指南和专家共识对生长减缓缺乏统一的定义,影响临床识别、评估与规范管理。2023年3月,Journal of Pediatric Gastroenterology and Nutrition杂志发表了《生长减缓婴幼儿的追赶生长:指导临床医师的专家建议》,不仅阐述了追赶生长的重要性,还针对如何适当地定义、评估和管理生长减缓制定了切实可行的共识建议,对临床医生具有现实的指导价值。本文结合我国临床现状,对该“建议”进行解读,以期为我国临床医师管理生长减缓婴幼儿提供指导和参考。

“三孩”政策背景下婴幼儿家庭养育压力的影响因素探究

为了解“三孩”政策背景下0~6岁婴幼儿家庭养育压力的现状及其影响因素,采用基本信息问卷、简式养育压力量表(PSI-SF)对我国东、中、西部六省3982个婴幼儿家庭所面临的养育压力展开调查,并从个体家庭因素、经济因素和社会区域因素三个方面分析0~6岁婴幼儿家庭养育压力产生的原因。结果显示,在0~6岁婴幼儿家庭中,近五成家庭养育压力超出正常范围,且从养育压力的各个维度来看,育儿愁苦得分高于困难儿童得分高于亲子互动失调得分;家庭结构、社会经济地位以及城乡地区对0~6岁婴幼儿家庭的养育压力有显著影响。基于此,建议关注父亲的养育压力,政府社区家庭合作共育;明确家庭压力来源,缓解家庭养育压力;加大政府投入,降低家庭养育成本;完善社会服务支持,提高家庭养育知识与技能。

潍坊市婴幼儿和学龄前儿童贫血现状调查

目的:了解潍坊市5岁以下婴幼儿和学龄前儿童缺铁性贫血状况及变化趋势,为合理膳食行动提供指标数据,同时为健康影响因素的干预管理提供参考依据。方法:2023年5—7月采用随机抽样法从潍坊市市区8家妇幼保健机构中随机抽取1家,从其服务对象中随机抽取男女比例基本相当的0~5岁婴幼儿和学龄前儿童407人,采用方差分析和χ2检验对其贫血状况进行分析。结果:407名5岁以下婴幼儿和学龄前儿童中,贫血人数为57人,总贫血患病率为13.97%。其中,男童37人,贫血患病率为16.37%;女童20人,贫血患病率为11.05%;[28天,6月龄)4名,贫血患病率为4.44%;[6月龄,2周岁)44名,贫血患病率为24.18%;[2,5)周岁9名,贫血患病率为6.67%。结论:纳入调查的0~5岁婴幼儿和学龄前儿童的贫血患病率尚未达到《国民营养计划(2017—2030年)》推荐要求,建议儿童加强体格监测,家庭注重科学喂养,社会提升公共营养服务能力。

促进婴幼儿健康发展的公共卫生策略述评

婴幼儿期是生长发育的关键阶段,需要充足的营养和照护,以预防未来健康风险。鉴于中国的生育现状,国家在尽快推出完善的生育支持政策的同时,还需要制定更加全面有效的儿童早期发展干预策略。文章旨在结合生命早期发育的特点,对从资源整合、政策规范、营养刺激和护理保护等方面进行全生命周期的干预措施进行评述,以期为提升儿童全面发展质量和国家的人口可持续发展提供参考和依据。

新时代背景下构建“托幼一体化”服务体系的现状与展望

“托幼一体化”立足于整体性思维与儿童优先原则,将0~6岁婴幼儿托育幼教服务进行全人的系统性规划。其有利于推进普惠性托幼体系的构建,减轻家庭养育教育压力,提振育龄夫妇生育意愿。目前我国已出台一系列政策进行了“托幼一体化”的初步探索,但仍存在一定的问题和挑战。为应对这些需求,本文提出畅机制、育人才、优课程、控质量、促共育五大发展建议,助力于新时代背景下“托幼一体化”服务体系构建,以促进婴幼儿全面健康成长,并为决策者提供参考。

婴幼儿龋及口腔保健研究进展

对婴幼儿口腔保健研究进展进行综述,旨在为今后规范管理婴幼儿口腔健康状况、控制及降低儿童患龋率提供现实依据。

一种婴幼儿汁类罐装辅助食品对幼龄小鼠急性炎症的影响及抗氧化活性评价

[目的]考察一种婴幼儿汁类罐装辅助食品对幼龄小鼠急性炎症的影响,并评价其抗氧化活性。[方法]将70只小鼠分为空白组、模型组、低剂量组(8.6979 g/kg)、中剂量组(17.3958 g/kg)、高剂量组(34.7916 g/kg)、超高剂量组(69.5832 g/kg)和阳性药物对照组,采用巴豆油致小鼠急性耳廓肿胀模型评价汁类罐装辅助食品对幼龄小鼠急性炎症的影响;计算除空白组外其余各组小鼠的左耳耳廓肿胀率;通过ELISA法检测其血清中TNF-α、IL-2、IL-6、IL-1β细胞因子含量;HE染色检测小鼠肝脏组织病理形态;通过电子舌进行滋味分析;采用紫外分光光度法测定汁类罐装辅助食品的抗氧化能力(DPPH自由基清除能力和羟自由基清除能力)。[结果]与空白组相比,模型组小鼠左耳肿胀明显,血清中TNF-α、IL-6、IL-1β含量明显上升(P<0.05),IL-2含量显著下降(P<0.05),肝组织中炎性细胞浸润明显。与模型组相比,低、中、高、超高剂量组小鼠左耳肿胀程度随剂量的升高而逐渐降低(P<0.05),血清中TNF-α、IL-6、IL-1β含量下降(P<0.05),且随着剂量的升高,下降程度增大。高剂量和超高剂量组小鼠的IL-2含量上升(P<0.05),炎症症状得到缓解;中、高、超高剂量组小鼠肝脏组织细胞核肿胀程度得到明显改善,弥漫性的炎性细胞浸染情况减轻;DPPH自由基清除率和羟自由基清除率的IC50分别为0.023,0.022 mg/mL(以样品中总酚计)。[结论]该种婴幼儿汁类罐装辅助食品对由涂抹巴豆油引起的幼龄小鼠急性炎症具有良好的抗炎效果。

差异化视域下婴幼儿口腔保健认知及行为的质性研究

目的:探究差异化视域下医生、护士、婴幼儿照顾者对婴幼儿口腔保健的认知及行为,推动我国婴幼儿口腔保健的进一步普及,为制订针对性的干预策略提供依据。方法:采用目的抽样法于2022年10月-2023年2月在山东省青岛市某三级甲等儿童医院对8名医生、10名护士及9名婴幼儿照顾者开展半结构式深入访谈,婴幼儿照顾者来自儿童保健科门诊。运用主题分析法对资料进行整理分析并提炼主题。结果:共提炼出关于婴幼儿口腔保健认知及行为的3个主题,分别为知识水平呈现人群差异性、口腔保健认知及行为现状、推动口腔保健普及面临重重挑战。结论:通过对婴幼儿口腔保健相关利益人群进行半结构式访谈,了解到医护人员及照顾者对于婴幼儿口腔保健的认知有待加强,需制订针对性的干预策略促进婴幼儿口腔保健深入普及。

强化健康教育对婴幼儿期支气管肺炎患儿家属的应用效果

目的探究强化健康教育对婴幼儿期支气管肺炎(BP)患儿家属的应用效果。方法选取2020年1月至2023年4月本院接收的160例BP患儿及家属作为研究对象,以随机数表法为原则分为对照组(n=81)、实验组(n=79),对照组家属接受常规健康教育,实验组家属接受强化健康教育;比较两组患儿平均住院时间、家属对知识掌握度;于干预前、后,比较两组焦虑情绪[焦虑自评量表(SAS)];并比较患儿家属的满意度。结果实验组患儿平均住院日短于对照组,家属对知识掌握度评分及家属满意度均高于对照组,有统计学差异(P<0.05);干预后,两组SAS评分下降,且实验组低于对照组,有统计学差异(P<0.05)。结论强化健康教育应用于BP患儿家属中,能够提升家属对知识掌握度,缓解焦虑情绪,缩短患儿住院时间,提高家属满意度。