Objective: This study aimed to investigate the association of maternal first-trimester vitamin D levels and vitamin D supplementation during pregnancy with infant atopic dermatitis (AD) and to determine the effect of variables such as mode of conception on the association. Methods: This study was based on the Shanghai sub-cohort of the International Birth Cohort of China. A total of 4051 woman–infant pairs with singleton pregnancies were recruited. Vitamin D deficiency and insufficiency were defined as serum 25-hydroxyvitamin D concentrations of 25 and 50 nmol/L, respectively. AD in infants was assessed during the first six months using a standardized questionnaire based on the British Working Party criteria. Modified Poisson regression estimated the association between maternal vitamin D status and infant AD. Results: The risk of AD in infants was higher in women with deficient 25-hydroxyvitamin D levels in the first trimester (RR: 1.77, 95% CI: 1.41–2.23). This increased risk was seen in naturally conceived pregnancies, but not in those conceived using assisted reproductive technology (ART). The incidence of AD decreased in infants of mothers who took multi-vitamin (RR: 0.79, 95% CI: 0.67–1.98) and vitamin D supplements (RR: 0.51, 95% CI: 0.37–0.71) compared to those whose mothers did not take any supplements. Maternal vitamin D deficiency had varying effects on AD risk based on passive smoking exposure and breastfeeding patterns. Conclusions: Our findings highlight the importance of monitoring and supplementing vitamin D during pregnancy, especially in specific maternal populations, to reduce the risk of AD in offspring.

目的 评价加强母乳喂养在降低新生儿重症监护病房(NICU)极低出生体重儿(VLBWI)坏死性小肠结肠炎(necrotizing enterocolitis,NEC)发生率的效果,分析VLBWI NEC发生的影响因素如危险因素或保护因素.方法 通过强化母乳喂养的方式,对前后两年在NICU住院的VLBWI进行持续质量改进管理.研究组为2016年1-12月医院NICU实施质量改进措施后收治的VLBWI,对照组为2015年1-12月NICU实施质量改进措施前收治的VLBWI,采用病例报告表的方式收集临床资料.对两组VLBWI的临床资料进行分析、总结,采用Logistic回归分析归纳NEC发生的影响因素.结果 NEC的发生率与母乳喂养、母亲妊娠期并发症[肝内胆汁淤积(intrahepatic cholestasis of pregnancy,ICP)、其他]、败血症、肺炎、肺炎合并休克、有血流动力学改变的动脉导管未闭(hemodynamic significant patent ductus arteriosus,hsPDA)、脐静脉置管(umbilical vein catheter,UVC)、出院时体重增长幅度等多种因素相关.对这些因素进行Logistic回归分析,结果显示:母乳喂养(OR=0.206,P=0.030)为极低出生体重儿NEC发生的保护因素,败血症(OR=6.222,P=0.013)是极低出生体重儿NEC发生的危险因素.结论 加强母乳喂养降低VLBWI NEC的发生具有良好效果.母乳喂养为VLBWI NEC发生的保护因素,败血症为VLBWI NEC发生的危险因素.积极提倡VLBWI母乳喂养,推动母乳库的建立,以降低其NEC发病率.

目的 探讨制定统一先天性梅毒(CS)诊断标准的必要性.方法 回顾分析2016年1月—2020年2月因母亲梅毒感染而入院的85例新生儿的临床资料,分别采用性传播疾病管理指南(2015)/2015美国儿科学会感染委员会报告(美国指南)、2014年欧洲梅毒管理指南(欧洲指南)和2015年版预防艾滋病、梅毒和乙肝母婴传播工作实施方案(中国方案)进行评估诊断,比较上述三种标准诊断CS的一致性.结果 将确诊/高度疑似或疑似病例归入CS,美国指南共诊断32例,欧洲指南诊断40例,中国方案诊断15例,三个标准共诊断40例,其中三个标准均符合者14例.美国指南和中国方案诊断病例均包含于欧洲指南诊断病例,美国指南和中国方案诊断病例重复例数为14例.10例梅毒螺旋体(Tp)试验阳性+长骨X线异常患儿中,7例因母亲孕前或孕期接受规范治疗未被美国指南诊断,其余仅3例因母孕期不规范治疗而被美国指南诊断,10例均未被中国方案诊断.Tp试验阳性+Tp-IgM阳性1例未被美国指南诊断,但均被其他两个标准所诊断.Tp试验阳性+其他指标阴性且母孕期不规范治疗15例未被中国方案诊断,但均被其他两个标准诊断.美国指南与欧洲指南、美国指南和中国方案一致性较强,加权κ值分别为0.611和0.705,而欧洲指南与中国方案一致性一般,加权κ值仅为0.304.结论 临床上制定统一的CS诊断标准非常必要.

Objective:To study the efficacy of extracorporeal membrane oxygenation(ECMO)combined with continuous renal replacement therapy (CRRT) in the treatment of critically ill newborns.Method:The critical newborns treated by ECMO combined with CRRT in neonatal intensive care unit of the Shanghai Children's Hospital from November 2016 to December 2018 were studied retrospectively. The primary disease, the main cause of ECMO treatment, treatment age, birth weight, duration of combination therapy, complications, clinical outcomes of the 4 neonates were collected and studied. The changes of leukocytes, platelets, serum creatinine, blood urea nitrogen, output and blood gas analysis were compared before and after ECMO combined with CRRT. T-test was used to analyze the data.Result:A total of 4 critically ill newborns were included, including 1 case of neonatal meconium aspiration syndrome and 3 cases of pulmonary hypertension. ECMO mode was arterial-venous ECMO and CRRT mode was continuous venous-venous hemofiltration dialysis. The statistical results were as follows: gestational age(38.8±1.6)weeks, birth weight (3 643±346) g, age of admission (9.8±6.6)h, ECMO on board age (68.0±70.7)h, oxygen index before ECMO 51.8±17.5, ECMO treatment time (135.0±73.0)h, CRRT time (90.5±56.2)h. One day after treatment, the fluid output was significantly increased compared with that before treatment [(4.30±1.66) ml/ (kg·h) vs. (1.24 ±0.50) ml/ (kg·h)] ( P<0.05). There was no significant difference in leukocytes, platelets, creatinine, glutamic pyruvic transaminase and lactic acid before and after treatment( P>0.05). During the treatment, there were 1 case of intracranial hemorrhage, 1 case of hemolysis and 1 case of wound hemorrhage. 2 cases survived and 2 demised. Conclusion:ECMO combined with CRRT can achieve better results in the treatment of acute renal injury and fluid overload in critically ill newborns.

目的 比较孕周35周以上无急性胆红素脑病的同族免疫性溶血高胆红素血症新生儿强光治疗6h后血胆红素水平降至换血阈值以下但降低水平＜34 μmol/L时,选择换血与继续强光治疗的效果.方法 纳入2015年1月1日-2018年10月31日上海市儿童医院孕周35周以上同族免疫性溶血高胆红素血症新生儿60例,分为换血组(28例)和非换血组(32例),统计黄疸消退时间,头颅MRI、脑干听觉诱发电位(BAEP)、新生儿神经行为评分(NBNA评分)异常发生率,核黄疸确诊、可能、疑似的患儿比例,以及输血或血制品不良反应的发生率.结果 住院期间,换血组黄疸消退时间为(6.5±1.2)d,显著短于非换血组的(9.5±1.8)d(P＜0.01);首次BAEP异常的发生率为10.7％(3/28),有低于非换血组37.5％(12/32)的趋势,但差异无统计学意义(P＞0.05);头颅MRI异常、NBNA评分异常和输血或血制品不良反应发生率分别为17.9％(5/28)、0和10.7％(3/28),与非换血组34.4％(11/32)、9.4％(3/32)和3.1％(1/32)的差异均无统计学意义(P值均＞0.05).住院期间发生输血或血制品不良反应的4例患儿中,换血组3例,均为血小板减少;非换血组1例,为皮疹.出院后3～＜4个月复查,换血组和非换血组分别有2和5例失访,失访者均为住院期间首次MRI和BAEP正常者.换血组复查头颅MRI和BAEP异常的发生率均为3.8％(1/26),非换血组分别为18.5％(5/27)、14.8％(4/27),两组间的差异均无统计学意义(P值均＞0.05).两组均无核黄疸确诊和可能病例;换血组核黄疸疑似息儿比例为7.7％(2/26),有低于非换血组25.9％(7/27)的趋势,但差异无统计学意义(P＞0.05).9例核黄疸疑似患儿中,换血组BAEP异常和MRI异常各1例,均为住院期间首次BAEP或MRI异常患儿;非换血组MRI异常3例,BAEP异常2例,MRI和BAEP同时异常2例,均为住院期间首次BAEP或MRI异常患儿.两组均未发现住院期间首次BAEP或头颅MRI正常而出院后3～＜4个月复查异常的患儿,非换血组住院期间首次BAEP异常的12例患儿中8例在出院后3～＜4个月复查时恢复正常.结论 孕周35周以上无急性胆红素脑病的同族免疫性溶血高胆红素血症新生儿,换血准备过程中强光治疗6h后血胆红素水平降至换血阈值以下但降低水平＜34μmol/L时,尽管换血治疗可以缩短黄疸消退时间,但并不能明确其对减轻听力损害和神经异常有确切作用,故需谨慎选择.

目的 探讨孕早期梅毒阳性孕妇血清学监测的合理频次.方法 孕(12±1)周梅毒颗粒凝聚(treponema pallidum particle agglutination,TPPA)试验阳性和快速血浆反应素(rapid plasma reagin,RPR)试验阳性且既往梅毒感染史阴性,并在孕28～ 32周和临产前4周内完成梅毒血清学检查的孕妇53例,根据自孕(12±1)周起是否每月复查,分为每月监测(monitor per month,MPM)组(15例)和非每月监测(monitor non per month,MNPM)组(38例,超过8周未复查),比较MPM组和MNPM组发现孕妇治疗失败或再感染的比例以及发生新生儿先天性梅毒的比例.结果 MPM组新生儿先天性梅毒病例比例(0/15)明显少于MNPM组(9/29,P＜0.05),发现孕妇治疗失败或再次感染病例比例(4/11)统计学上高于MNPM组(2/36,P＜0.05).MPM组孕妇治疗失败或再次感染4例,增加了1个疗程青霉素静滴抗梅毒治疗,后期随访中RPR逐渐下降,分娩前4周内再次给予1个疗程抗梅毒治疗,整个孕期共3个疗程,无新生儿先天性梅毒发生.MNPM组孕妇治疗失败或再感染2例和另外RPR滴度较孕(12±1)周无升高7例,均在分娩前完成了2个疗程的抗梅毒治疗,仍发生了新生儿先天性梅毒.结论 孕早期梅毒阳性的孕妇每月监测梅毒滴度并及时治疗,可以减少新生儿先天性梅毒的发生.

目的 描述和分析NICU出院早产儿0～24月龄生长状况,为开展早产儿生长监测和营养管理提供依据.方法 回顾性分析2013年1月-2017年12月在上海市儿童医院NICU住院、出院后在本院早产儿随访门诊接受系统管理的早产儿体格随访数据,了解不同性别、出生胎龄早产儿0～24月龄身长和体重增长情况.结果 共纳入早产儿1143例,构成以极早和早期早产儿占比最多,两者合计占36.8％,中期早产儿占29.6％,晚期早产儿占33.6％.早产儿平均出生胎龄(32.2±2.4)周,男、女童出生胎龄构成差异无统计学意义(x2=2.048,P=0.562).校正0月龄时,各组早产儿平均身高、体重超过足月儿;校正足月后整体追赶生长良好,但身高、体重始终低于足月儿均值;各组早产儿的追赶生长趋势,以早期早产男童组最不理想.结论 NICU出院早产儿可实现良好追赶生长,需重点关注早期早产男童;对早产儿开展出院后系统管理有助于适宜追赶.

Objective To investigate the diagnostic value of cerebrospinal fluid protein in the assess-ment of neurological outcome in preterm infants with sepsis. Methods A total of 80 preterm infants with sepsis were enrolled in the department of neonatology of Shanghai Children's Hospital from June 2014 to June 2016. The lumbar puncture was completed within 24 hours after diagnosis of sepsis,and the results of ce-rebrospinal fluid protein were obtained. The prognosis of neurological development was assessed according to Gesell Developmental Quotient ( DQ) at 6 months of adjusted gestational age. DQ> 85 was used as an indi-cator of good prognosis group. DQ≤85 was assigned to the poor prognosis group. The differences in protein content of cerebrospinal fluid between these two groups were retrospectively analyzed. The receiver operating characteristic ( ROC) curve was used to evaluate the diagnostic value of cerebrospinal fluid in evaluating the prognosis of preterm infants with sepsis. Results Cerebrospinal fluid protein content of poor prognosis group was higher than those in good prognosis group[(2005. 56 ± 582. 85)mg/L vs. (1367. 92 ± 362. 29)mg/L, t= -6. 019,P<0. 01]. The area under the ROC curve was 0. 819(95％CI 0. 711 -0. 927,P<0. 05). The optimal threshold of cerebrospinal fluid protein was 1560 mg/L with specificity of 75. 5％ and sensitivity of 81. 5％. Conclusion Cerebrospinal fluid protein content has certain diagnostic value on the assessment of sepsis premature neurological prognosis.