Clinical review of enteral feeding of extremely low birth weight infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To review the clinical data of enteral feeding of extremely low birth weight infants (ELBWI), and analyze the influencing factors.</p><p><b>METHOD</b>From Jan. 2000 to Jan. 2010, data of 31 ELBWI from Peking Union Medical College Hospital were retrospectively collected. ELBWI were assigned to different groups according to the time achieving full enteral feeding, comparison was done between two groups for enteral feeding.</p><p><b>RESULT</b>Twenty-four infants were analyzed, their mean gestational age was (29.0 ± 1.8) weeks (26.14 - 34.43 weeks), birth weight (882 ± 67) g (730 - 970 g), there were 11 infants in group A, whose time for achieving full enteral feeding was (27 ± 6)days, there were 13 infants in group B, whose time achieving full enteral feeding was (46 ± 10)days. The ratio of asphyxia (18.2% vs. 61.5%, P = 0.047), duration of umbilical vein catheterization longer than 10 days (18.2% vs. 61.5%, P = 0.047), and duration of mechanical ventilation longer than 14 days (27.3% vs. 76.9%, P = 0.038) in group A was higher than in group B. The milk volume on the 21st and 28th day in group A was much more than that in group B [(88.9 ± 35.4) ml vs. (37.4 ± 34.9) ml, P = 0.002; (121.1 ± 37.4) ml vs. (53.2 ± 33.1) ml, P = 0.000]. There were no significant differences between the two groups in gestational age, birth weight, patent ductus arterious, erythrocytosis, dysglycemia, sepsis, the time to begin enteral feeding, the beginning milk volume, the adding milk volume in the 1st, 2nd week, and the milk volume on the 3rd, 7th, 14th day.</p><p><b>CONCLUSION</b>Asphyxia, duration of umbilical vein catheterization, and duration of mechanical ventilation are likely to influence the enteral feeding of ELBWI, ELBWI with successful enteral feeding could show good tolerance in the 3rd week. But individual program should be made for enteral feeding of ELBWI, because enteral feeding could be influenced by multiple factors.</p>

Diagnosis of glycogen storage disease type IIIA by detecting glycogen debranching enzyme activity, glycogen content and structure in muscle / 中华儿科杂志

<p><b>OBJECTIVE</b>Glycogen storage disease type III (GSD III) is an autosomal recessive disease caused by glycogen debranching enzyme (GDE) gene (AGL gene) mutation resulting in hepatomegaly, hypoglycemia, short stature and hyperlipidemia. GSD IIIA, involves both liver and muscle, and accounts for up to 80% of GSD III. The definitive diagnosis depends on either mutation analysis or liver and muscle glycogen debranching enzyme activity tests. This study aimed to establish enzymologic diagnostic method for GSD IIIA firstly in China by detecting muscular GDE activity, glycogen content and structure and to determine the normal range of muscular GDE activity, glycogen content and structure in Chinese children.</p><p><b>METHOD</b>Muscle samples were collected from normal controls (male 15, female 20; 12-78 years old), molecularly confirmed GSD III A patients (male 8, female 4, 2-27 years old) and other myopathy patients (male 9, 2-19 years old). Glycogen in the muscle homogenate was degraded into glucose by amyloglucosidase and phosphorylase respectively. The glycogen content and structure were identified by glucose yield determination. The debranching enzyme activity was determined using limit dextrin as substrate. Independent samples Kruskal-Wallis H test, Nemenyi-Wilcoxson-Wilcox test, and Chi-square test were used for statistical analyses by SPSS 11.5.</p><p><b>RESULT</b>(1) GSD III A patients' glycogen content were higher, but G1P/G ratio and GDE activity were lower than those of the other two groups (P < 0.01). In all of the three parameters, there were no significant difference between normal controls and other myopathy patients. (2) The range of normal values: glycogen content 0.31%-0.43%, G1P/G ratio 22.37%- 26.43%, GDE activity 0.234-0.284 micromol/(g. min). (3) Enzymologic diagnostic method had a power similar to that of gene analysis in diagnosis of GSD-IIIA patients. The sensitivity and specificity of enzymologic diagnostic method and mutation detection were 91.7% and 100% respectively.</p><p><b>CONCLUSION</b>Enzymologic diagnostic method of GSD IIIA was firstly established in China. The range of normal values was determined. This method could be used in diagnosing suspected GSD IIIA patients in the clinic.</p>

Early diagnosis of the premature infant nosocomial infection by clinical assessment / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the possibility of bacterial infections in the hospital among the premature and low birth weight newborns by scoring their clinical assessments and laboratory examinations.</p><p><b>METHODS</b>From January 2002 to January 2003, 62 newborns with birth-weight less than 2,000 g were divided into two groups, infected group and control group, based on the current diagnostic standards for newborns. We scored the newborns according to the severity of their illnesses based on their clinical manifestations and laboratory examination, and compared the scores obtained before and after effective antibiotic treatment.</p><p><b>RESULTS</b>It was found that the scores were significantly different (P < 0.01) between the infected group and the control group before treatment; while after antibiotic treatment, the difference was no longer significant (P > 0.05). In the infected group, the scores obtained pre- and post-treatment were significantly different (P < 0.01). In the control group, in those with the scores >or= 11 before antibiotic treatment, the scores significantly decreased (P < 0.01) after-treatment; but in those with the scores < 11, the score did not decrease (P > 0.05). These results indicate that the current diagnostic criteria for newborns may not be sensitive enough for premature infants, low birth weight infants and very low birth weight infants.</p><p><b>CONCLUSION</b>Scoring the low birth weight premature infants with their clinical manifestations has the advantages in judging the possibility of infection and monitoring the effectiveness of the anti-infection treatment.</p>