目的 探讨3～18个月婴幼儿头颅畸形的头颅形态特征及影响因素,为婴幼儿头颅畸形的预防和干预提供指导和依据.方法 于2022年1月选取2019年1-12月在南京市妇幼保健院健康体检时诊断为头颅畸形的228名婴幼儿为病例组,并选取同期健康体检的性别、年龄匹配的394名头颅形态正常婴幼儿为对照组.分析病例组婴幼儿头颅形态特征,并通过比较两组间基本信息、母亲孕产史、睡眠姿势、骨密度等差异分析头颅畸形的影响因素.结果 1)3～18个月头颅畸形患儿头颅形态特征:头颅畸形组中男性占比高于女性;6月±7 d的占比最高,之后随着年龄的增长,头颅畸形占比呈下降趋势;短头畸形的检出率最高,且不同类型头颅畸形在年龄(x2=34.409)和严重程度(x2=11.404)之间差异有统计学意义(P＜0.05).2)单因素分析结果显示:头颅畸形组和正常组在单/双胎(x2=4.724)、新生儿期头部损伤史(x2=8.430)、睡眠姿势(x2=23.881)和骨密度(t=2.771)之间差异有统计学意义(P＜0.05).3)多因素Logistic回归分析显示,年龄(以 3 月±7 d 组为参照,6 月±7 d 组 OR=3.720,95&CI:1.959～7.066,P＜0.05;8 月±7 d 组 OR=3.181,95％CI:1.449～6.984,P＜0.05;12 月±7 d 组 OR=3.195,95％CI:1.281～7.966,P＜0.05)、双胎(OR=3.950,95％CI:1.227～12.717,P＜0.05)是头颅畸形的危险因素、混合睡姿(OR=0.209,95％CI:0.129～0.338,P＜0.05)和骨密度(OR=0.763,95％CI:0.636～0.917,P＜0.05)是婴幼儿头颅畸形的保护因素.结论 年龄、双胎、睡眠姿势以及骨密度是婴幼儿头颅畸形的重要影响因素,随着婴幼儿年龄的增长,头颅畸形可能有所改善,仍需进一步的纵向研究去验证婴幼儿头颅畸形的影响因素.

Objective:To analyze the current situation of the mothers and infants at their first visit to the breastfeeding counseling clinic, and provide a reference for promoting breastfeeding in infancy.Methods:Clinical data of 581 mother-infant-dyads visiting the breastfeeding counseling clinic of Nanjing Maternal and Child Health Hospital from January 2019 to December 2019 were collected and analyzed retrospectively, including the general information of the dyads, and the subjective and actual reasons for visits. According to the age of infants coming to the clinics, they are divided into the younger group (60 d and below, n=316), middle-aged group (61-120 d, n=178), and older group (121 d and above, n=87). Differences in exclusive breastfeeding rate and reasons for visits between different groups were analyzed by analysis of variance, Kruskal-Wallis rank sum test, Chi-square test, or Fisher's exact test. Results:The age of the 581 infants at the first visit were mainly at 30-34, 41-45 and 90-94 d, which accounted for 9.3%( n=54), 25.3%( n=147), and 9.0%( n=52), respectively. The total exclusive breastfeeding rate was 71.8%( n=417) at visit, and there were significant differences among the younger, middle-aged and older group [67.7%(214/316), 79.8%(142/178), 70.1%(61/87), χ 2=14.294, P=0.006), and between the younger and middle-aged group in the pairwise comparison. The most common subjective reason for visiting was slow weight gain ( n=249, 42.9%), followed by worrying about insufficient milk ( n=142, 24.4%) and feeding difficulties ( n=132, 22.7%). Whereas the top three practical reasons for visiting included infant's inability to latch on or sucking ( n=165, 28.4%), lack of breastfeeding knowledge ( n=149, 25.6%) and inappropriate maternal feeding skills ( n=140, 24.1%). The younger group faced more problems regarding latching on or sucking [39.6%(125/316] and mother's feeding skills[25.9%(82/316)], while the lack of breastfeeding knowledge mainly occurred in the older group[48.3%(42/87)]. The coincidence rates between the subjective and actual reasons for slow weight gain, worrying of insufficient milk, and feeding difficulties were only 1.2%( n=3), 6.3%( n=11), and 21.2%( n=28). Conclusions:Breastfeeding- related problems exist in infants of different ages below one year old. There is a big knowledge gap between the subjective reasons for medical visits and the actual problems that interfere with breastfeeding. Therefore, individualized breastfeeding guidance for infants of different ages is recommended in children's health clinics.

目的 探讨母乳喂养门诊的延续性指导对婴幼儿生长发育及产妇出院后母乳喂养状况的影响.方法 选取2018年1-12月于南京市妇幼保健院儿童保健门诊就诊的1月龄内婴儿及其母亲240例,随机分为干预组与对照组.对照组婴儿只接受儿童保健门诊常规体检,干预组在对照组基础上继续转入母乳喂养门诊,并由国际认证泌乳顾问(IBCLC)对产妇母乳喂养给予延续性的指导干预.对比两组产妇产后1、3、6和12个月母乳喂养情况及两组婴儿的健康状况.结果 两组产妇产后1个月时纯母乳喂养率对比差异无统计学意义(P＞0.05);干预组产后3、6个月的纯母乳喂养率和12个月的母乳喂养率高于对照组,母乳喂养持续时间长于对照组,差异均有统计学意义(P＜0.05);干预组婴儿3、6月龄时的身高、体重和BMI均高于对照组,差异有统计学意义(P＜0.05);干预组产妇产后3个月时的自我效能在技巧维度和内在思考维度得分均高于对照组,产后6个月时技巧维度得分高于对照组,差异均有统计学意义(P＜0.05).结论 母乳喂养门诊开展延续性指导可明显提高产妇出院后纯母乳喂养率,增强产妇自我效能,并延长母乳喂养持续时间.

To know about the situation of family parenting for 0 ~ 2 years old infants,to provide the basis for formulating corresponding in-terventions and improving the parenting skills of majority of parents,and improve children’s health work targeted,promote the early and compre-hensive development of children.

Objective To explore the effect of early development training on infant neuropsychological development,demonstrating,and popularize the education mode of demonstration and individualized,Thereby promoting early child development. Methods A total of 71infants of early education group and 70infants of control group were regularly followed up within 12months.During follow-up,Gesell developmental scale was used at 6months,9months,12months of age,and the developmental quotient(DQ)were analyzed between early education group and control group. Results At 9months of age,both fine motor DQ and language DQ of early education group were significantly higher than control group(P0.05).At 12months of age,the fine motor DQ,language DQ,and social adaptation DQ of early education group were significantly higher than control group(P0.05). Conclusions The early development training can promote infant neuropsychological development,fine motor and language were more dependent on environmental stimulation,and the demonstration and individualized education mode of early child development was a long-term and positive significance.