摘要:

ABSTRACT.The effects of various social indicators on infant and child mortality were studied in Sweden with the use of a medical birth register to which census information was linked. Two years were studied: 1976 births linked to the 1975 census, and 1981 births linked to the 1980 census. Survival was followed to the age of 5 by linkage of the birth register with the death certificate register. The only statistically significant effect of a single socio‐economic variable was that of housing conditions on perinatal death rate and postperinatal death rate up to the age of one. The family situation (e. g., cohabitation or not) had some effect, although it was not statistically significant. On the basis of cohabitation status and other social indicators, including housing conditions, we selected two groups: one privileged and the other underprivileged. Using crude mortality rates, we found no definite difference. There was evidence that the mortality rate had decreased more between 1976 and 1981 in the privileged than in the underprivileged group, but the difference may have been coincidental. After standardization for maternal age and parity, however, a difference appeared with a ratio of 1.14 between the underprivileged and the privileged groups, which was valid for deaths up to the age of one. After that age, no difference was seen. Following standardization for birthweight, the opposite was found: a higher weight‐specific mortality rate in the privileged group than in the underprivileged group. The interpretation of these findings is discus

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11376.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.We studied the relationship between rooming‐in/not rooming‐in and breast‐feeding variables such as breast feeding frequency, breast milk intake, supplements of other human milk or 5% glucose solution, cumulative weight loss, weight recovery and hyperbilirubinemia. We found that the breast feeding frequency was significantly higher in infants rooming‐in than in those not rooming‐in. Intake of breast milk on days 3 and 5 was significantly lower and maximum weight loss was significantly higher in infants rooming‐in than in those not rooming‐in. Infants rooming‐in also had less supplement of other human milk compared with non‐rooming‐in infants (p<0.01). However, the weight increase per day from minimum to weight on day seven was higher in infants rooming‐in than in non‐rooming‐in infants (39.3 ± 21.4 g/day vs. 31.4 ± 15.3 g/day, p<0.01). The frequent suckling by rooming‐in infants may explain, in part, the better weight gain, since frequent suckling may decrease energy consumption by reducing movement and crying during the early days of life, thus contributing to better weight gain. Our study suggests that some of the neonatal feeding problems related to breast feeding could be eliminated by education of mothers and nurses and by changes in hospital policies an

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11377.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.In a retrospective study of neonatal septicaemia and meningitis in a defined region of western Sweden 1975‐1986, 231 cases were identified. The incidence was 2.8/1000 live births. The case‐fatality rate was 15%. Thirty‐three patients had meningitis. Only 55 patients (24 %) had no known risk factors. Preterm delivery was a most important risk factor for both morbidity and mortality. The most common causative organisms were group B streptococci, Staphylococcus aureus and aerobic Gramnegative rods, together isolated from 82 % of the patients. The cases were approximately equally divided between very early, early and late onset infections. Group B streptococci were over‐represented in very early onset infections in all birthweight groups and aerobic Gram‐negative rods were the most common isolates from low birthweight infants with late onset infections. However, group B streptococci, Staphylococcus aureus and Gram‐negative rods were found in all birthweight and gestational age groups. Thus, initial antimicrobial therapy must be equally broad in all neonates with suspected

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11378.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.Using microanalytic assays various phagocytic functions of separated neutrophils from preterm neonates (mean birthweight 1 506 g, n = 13) were simultaneously studied. Adherence of neutrophils to nylon fibre was decreased in cells from preterm infants (77.1 ± 3.1 %) when compared with adult controls (86.9 ± 2.1 %, mean ± 1 SD, p<0.05). In addition neutrophil chemotaxis in response to zymosan activated serum was reduced in preterm neonates (131.9 ± 19.7, adults 166.6 ± 11.1, p<0.001); directed migration towards Formyl‐Methionyl‐Leucyl‐Phenylalanine was also decreased (preterm neonates 93.4 ± 15, adults 111.1 ± 16.8, p<0.05). Preterm infants had a higher percentage of slow moving neutrophils when compared with adults (p<0.001). Phagocytosis of Candida albicans was reduced in neutrophils from preterm neonates (phagocytic index: preterm neonates 41.4 ± 12.7, adults 83 ± 7.2). Adult neutrophils ingested more Candida per cell (p<0.001). Chemiluminescence, exocytosis of elastase and lactoferrin during uptake of opsonized zymosan was also reduced in neutrophils from preterm neonates. However, random migration, phagocytosis of Staphylococcus aureus and production of O‐2, in response to Phorbol myristate acetate or opsonized zymosan were identical in cells from either source. We conclude, that these abnormalities of neutrophils could predispose the preterm infant to serious and often overwhelming bacterial and f

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11379.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.Feeding of the infection prone preterm neonate with concentrated immunologically active ingredients in the form of colostrum may have even more significant clinical implications than in the full term infants. The scarcity of knowledge on anti‐infective factors in colostrum of mothers delivering prematurely prompted us to carry out this study. Colostrum was collected and analysed from 25 mothers delivering prematurely (Study group) and 10 delivering at term (Control group). Major anti‐infective factors namely IgA, IgG, IgM, lactoferrin and lysozyme were quantitated and total cell, macrophage, lymphocyte and neutrophil counts were performed. The mean concentrations of IgA, lysozyme and lactoferrin of preterm colostrum were significantly higher than in full term colostrum (p<0.001). IgG and IgM were found to be similar in both groups. The absolute counts of total cells, macrophages, lymphocytes and neutrophils were found to be significantly higher in the preterm colostrum as compared to the full term colostrum (p<0.001). Though in both the groups IgA was the predominant immunoglobulin, the mean percentage of IgA in the study group was significantly higher as compared to the control group. Degree of prematurity did not have any influence on the anti‐infective protein levels in colostrum. However total cells and macrophages were significantly higher in colostrum of mothers delivering severely preterm b

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11380.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.Ten patients, who developed postenteritis enteropathy with chronic diarrhoea, failure to thrive and small intestinal mucosal damage after an episode of acute gastroenteritis, were studied prospectively. All patients experienced severe growth retardation. Maximum deviation of height and weight from mean values of age‐correlated normal children were −1.7 and −3.1 SD (median values), respectively, as compared to −0.1 and 0 SD before onset of the illness. One child died after 14 months of illness. The long‐term outcome was satisfactory for the 9 surviving children. For these children, treatment with an elemental diet (in some cases supplemented initially with parenteral nutrition) and later a lactose‐free diet lead to resolution of diarrhoea within periods ranging from 0.5 to 10 months. The phase of catch‐up growth lasted from 4 to 36 months, resulting in final height and weight deviating −0.6 and −0.8 SD (median values), respectively, from normal mean values. Attempt to predict duration of diarrhoea or length of catch‐up growth phase by means of age, weight before illness, characteristics of small intestinal biopsy or maximum deviation of height or weight were unsuccessful. The incidence of postenteritis enteropathy for children of North European ethnic origin was estimated to be 7.6/1000000 children below 7 years of age/year, corresponding to 1.2/1000 children hospitalized for ac

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11381.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.In a randomised controlled trial 38 asthmatic children aged 2‐11 yr who had not received regular oral or inhaled steroids during the previous year, were treated with a standard regime of nebulised salbutamol and intravenous aminophylline plus either hydrocortisone and oral prednisolone for 5 days, or placebo. The children were observed throughout their hospital stay and for 3 months afterwards. There was a greater fall in heart rates in the steroid treated group on the second day of treatment (mean diff. 16 beats/min) and at discharge (mean diff. 13 beats/min); p<0.025. Peak Expiratory Flow Rates recorded in 26 children, 13 in each group, showed more improvement on day 2 in those given steroids (mean diff 16% predicted); p<0.05. This difference was not apparent at discharge but 9 children treated with steroids were clinically wheeze‐free when they left hospital compared with 3 in the placebo group, p<0.05. There were no differences in respiratory rate, pulsus paradoxus and arterial oxygen saturation. Trends in duration of hospital stay and relapse rate during the succeeding 3 months favoured active treatment. These findings support the use of systemic corticosteroids in addition to high dose bronchodilators to treat ‘non steroid dependent’ children hospitalised with acute severe

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11382.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.Integrated 12‐hour growth hormone secretion studies, peak growth hormone response to clonidine provocation. Somatomedin‐C levels, T‐4 and TSH levels were studied in six growth‐retarded children with the Prader‐Willi syndrome, of whom five had a 15 q‐karyotype. Only one of the subjects was obese. All showed abnormally low growth hormone secretion. None achieved a nocturnal peak above 10 μg/l, none had a mean nocturnal level over 1.8, and none showed a level above 8 μg/l after clonidine provocation. These findings contrasted with normal TSH in all and normal T‐4 in five. These findings suggest that the poor linear growth in the Prader‐Willi syndrome is caused by a true deficiency of growth hormone secretion, and that the low growth hormone levels observed in such cases are not an a

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11383.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.Three patients with hereditary tyrosinemia type 1, two brothers and one girl, studied at the age of 5, 12 and 15 years, respectively, had neither generalized hyperaminoaciduria, glucosuria nor clinical symptoms of rickets. Untreated the elder brother had only slightly elevated plasma tyrosine level (141 μmol/l, normal<80), and low excretion of p‐hydroxyphenyllactate. He presented with pronounced thrombocytopenia (3 × 109/1). At 13 years of age he contracted hepatocellular carcinoma. The younger brother presented with serum tyrosine of 318 μol/l and thrombocyte count 48 × 109/1. Succinylacetone in urine was elevated in both, 30 and 79 μmol/mmol creatinine, respectively. The female patient was investigated for hepatomegaly in infancy, atypical tyrosinemia being considered, but afterwards developed normally without diet or any other treatment until she contracted hepatoma at the age of 15 years. Her plasma tyrosine level was 600‐700 μmol/1, and she excreted large amounts of p‐hydroxyphenyllactate. Succinylacetone in urine was low but elevated (8 μmol/mmol creatinine). The fumarylacetoacetase activity in fibroblasts from the brothers and in lymphocytes from the girl was less than 5% and 10% of control levels, respectively. In conclusion, the chronic form of hereditary tyrosinemia may occur without evidence of renal tubular

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11384.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT.Fanconi anaemia (FA) is a recessively inherited disorder associated with a typical physical appearance and a spectrum of clinical and laboratory characteristics. Parental heterozygotes of FA patients are superficially normal in appearance and lack overt laboratory abnormalities. Furthermore, they are indistinguishable from normal subjects on chromosome analysis. In order to determine if any of the clinical or laboratory abnormalities seen in FA patients were detectable to a lesser degree in heterozygotes, we carried out detailed skeletal measurement and laboratory investigation on 16 obligate FA heterozygotes and compared the results with 40 normal control subjects. Skeletal proportions in FA heterozygotes showed significant differences from normal subjects in the ratio of the height to the inter‐acromial distance (p<0.001), and in having significantly shorter forearms (p<0.05). Apart from two patients with presumed iron deficiency, haemoglobin levels were normal, but three patients showed neutropenia (<1.5 × 109/1). Foetal haemoglobin measurements were significantly higher (p<0.01) and natural killer cell subsets lower (p<0.05) in heterozygotes. Significantly reduced mitogenetic responses to phytohaemagglutinin and interleukin‐2 of peripheral blood lymphocytes in heterozygotes was also demonstrated. These results suggest that heterozygotes show minor physical and haematological abnormalities consistent with partial expression of the Fanconi gene in the heterozy

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1990.tb11385.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY