ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A literature search of personal files, the Oxford Database of Perinatal Trials, Medline, and the Research Update databases, identified 19 perinatal trials published between October 1991 and September 1992. Included were only those trials in which the efficacy or effectiveness of an antenatal intervention was assessed by a neonatal outcome. A quality assessment of each study was performed. Quality scores ranged from 0.25 to 0.80 (maximum possible score, 1.00). Most trials did not show a statistically significant change in the primary outcome measure, because of an overestimate of the treatment effect on which the sample size had been based. Thus, clinically important treatment effects often may be overlooked. None of these trials on their own showed beyond doubt whether the intervention under study did more good than harm. There is a need to base sample size calculations on more realistic, but still clinically important, event rate differences to show the effectiveness of perinatal interventions aimed at improving neonatal outcomes. To do so usually requires a large sample size, necessitating multicenter trials with national and international cooperation.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Regionalization of perinatal care and the efficient provision of effective and safe interhospital transport of premature and critically ill newborn infants have evolved over two decades. Antenatal transfer of the high-risk fetus to a tertiary perinatal center is optimal but not always achievable. Neonatal transport is a complex, highly organized, dynamic process that is still evolving. Resuscitation and stabilization, supported by the tertiary perinatal care center, commence within the environment of the community hospital. Current developments improving communication with community physicians and the availability of outreach education programs assist these processes. Transport remains a sophisticated, highly technological procedure that requires extremely skilled personnel. The application of new ventilatory techniques and other strategies may enable the safer transport of critically ill newborn infants. Regionalization of perinatal care has been achieved in many areas, but its viability is threatened by the current competitive health care environment. The neonatal transport team is likely to be the most potent stimulus for the development of the “perinatal partnership” during the current decade.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Respiratory disorders remain a major cause of neonatal mortality and morbidity. This review focuses on clinical trials and diagnostic procedures in neonatal respiratory disorders reported from October 1991 to September 1992. It leaves out animal studies, artificial ventilation techniques, extracorporeal membrane oxygenation, and follow-up studies. Surfactant substitution comes of age and first side effects of this successful treatment are described. Infection with ureaplasma urealyticum seems to contribute to chronic lung disease. The latter can be effectively treated with dexamethasone. However, because of numerous and severe side effects, this treatment requires scrupulous risk-benefit evaluation in each case.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Important differences exist between adult and newborn responses to different cerebrovascular influences. This review discusses the important influence that the prostanoid system has in newborn cerebral hemodynamics. Activated oxygen species and their generation through different cerebral insults are discussed. The role of several radical scavengers as modes of therapy is reviewed. The endo-thelium-derived relaxing factor system and its major influence in the adult is compared with its lesser role in the newborn. Finally, the pathophysiology of the alterations in newborn cerebral hemodynamics seen with experimentally induced seizures is reviewed.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Proteinuria in children with idiopathic nephrotic syndrome is secondary to a loss of charge selectivity of the glomerular basement membrane. Loss of anionic charges may be secondary to a defect of heparan sulfate proteoglycans, which is also found in the congenital nephrotic syndrome, or to cationic proteins, which neutralize the anionic charges of the membrane. Reports on recurrence of nephrotic syndrome in patients with steroid-resistant idiopathic nephrotic syndrome following renal transplantation suggest that a humoral factor, possibly produced by T lymphocytes, may enhance glomerular permeability. Corticosteroids remain the basic treatment of idiopathic nephrotic syndrome. Most patients respond to steroid therapy and a high proportion of them relapse but continue to respond throughout the subsequent course of the disease. Levamisole may be effective in preventing relapses. Cyclosporine may be useful in steroid-dependent patients with signs of steroid toxicity and after a failure of a course of alkylating agent. Almost 85% of patients respond to cyclosporine, but they relapse after tapering or stopping the drug. In steroid-resistant patients, there is no study showing a clear-cut beneficial effect of alkylating agents, as the remission rate after treatment is close to the rate of spontaneous remission. Cyclosporine in association with prednisone may be effective, but the risk of nephrotoxicity seems to be higher than in steroid-dependent patients.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

When Schönlein-Henoch nephritis presents with more than just microhematuria, only 72% of cases go on to complete recovery. Evidence of renal disease may reappear after apparent complete recovery. Schonlein-Henoch nephritis may be the single commonest form of crescentic glomerulonephritis, accounting for 30% of cases. Prednisone for 2 weeks may prevent Schonlein-Henoch nephritis in children who do not already have it when first seen. IgA nephropathy was found in 8% of children with isolated proteinuria and has been reported with human immunodeficiency virus infection. Heavy proteinuria at onset, focal sclerotic and tubulointerstitial changes, and crescents and capsular adhesions are poor prognostic indicators. The prognostic significance of hypertension and of the absence of gross hematuria remains uncertain. After a follow-up of at least 8 years, 53% of patients are clinically in remission. In a short-term double-blind, crossover trial, prednisone had no effect on IgA nephropathy. Recent advances do not yet lead to a unifying concept of the pathogenesis of Schonlein-Henoch nephritis or IgA nephropathy.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Hypercalciuria has become a significant clinical focus both for pediatricians and for pediatric nephrologists after it was found that increased urinary calcium excretion is the most common abnormality in children with nonglomerular hematuria and with nephrolithiasis. The question of long-term implications of hypercalciuria in growing children, regardless of the underlying cause, remains unanswered. Whether dietary or pharmacologic therapy is warranted in children with hypercalciuria is controversial. One of the proposed consequences of hypercalciuria is nephrocalcinosis. With the availability of increasingly sensitive, noninvasive imaging techniques, nephrocalcinosis is being recognized more frequently. In some instances, concern about the risk and progression of nephrocalcinosis is provoking reevaluation of well-established metabolic therapies. New urinary inhibitors of crystal formation and aggregation have recently been identified. As the basic pathogenesis of nephrocalcinosis becomes clearer, clinical therapies will become more specific and effective.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Vesicoureteral reflux is seen in up to one half of all children with urinary tract infections and reflux nephropathy is potentially the leading reversible cause of end-stage renal disease in children and adults. Recent studies still leave some doubt to the pathogenesis of reflux nephropathy. In 1992, the International Reflux Study in Children published data on the 5-year follow-up of children with high-grade reflux showing no clear advantage toward either surgical or medical management (although new surgical techniques may prove beneficial). A need to identify children with dysfunctional voiding exists. Appropriate, preferably noninvasive, studies should be employed to identify children at risk including those with antenatally diagnosed hydronephrosis and siblings of children with documented reflux.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID