2017年 · 第55卷第08期

Breastfeeding is an ideal way to provide infants with the nutrients they need for healthy growth and development, and is one of the effective measures to ensure children's health and survival. State of Global Health data released by the World Health Organization shows that about 7 million children under the age of 5 die every year, with at least one third of the potential causes of death due to malnutrition, and one of the main causes of this problem is inadequate breastfeeding. In September 2015, the United Nations released the Sustainable Development Goals to eliminate preventable newborn and under-5 deaths by 2030, and breastfeeding is one of the proven interventions. In recent years, the recommendations on feeding premature and low birth weight infants after discharge from hospital, the guidelines for clinical application of nutritional support for neonates in China, and the recommendations on promoting breastfeeding for premature infants in neonatal intensive care units have been adopted.^[1,2,3]The release of guideline documents and the promotion of baby-friendly hospitals have improved the awareness and implementation of breastfeeding, and gradually increased the breastfeeding rate of hospitalized children, especially premature babies, in neonatal wards in various medical institutions in China.

Whooping cough is a serious acute respiratory infectious disease caused by B. pertussis, with a mortality rate of 10% in infants at the beginning of the 20th century^[1]。 Since the implementation of the expanded immunization program in 1974, pertussis has been effectively controlled worldwide. In recent years, the prevalence of whooping cough has increased worldwide, and even local outbreaks have occurred, that is, "whooping cough recurrence", and its epidemiological characteristics have changed new, which has a great impact on public health.

Whooping cough is a highly contagious acute respiratory diseases. Its characteristic clinical symptoms are paroxysmal spastic cough with inspiratory "rooster"-like echoes. The course of the disease can prolong for several months and often causes epidemics. In recent years, the incidence of whooping cough in children is increasing year by year, and some new features appear. Pertussis has become an infectious disease that pediatric clinicians pay widespread attention to. In China, the diagnostic methods and standards of children's pertussis, the use and treatment course of antimicrobial drugs, symptomatic management and many other problems need to be standardized urgently. In order to guide clinicians to correctly understand pertussis, the diagnosis and treatment of pertussis in children are recommended as follows.

Scientific research has confirmed that breast milk contains all the nutrients and important antibodies needed for early infant growth, making it the most ideal and natural food for newborns and babies. Both the World Health Organization (WHO) and governments encourage maternal breastfeeding, but donor human milk (DHM) is the best alternative to feeding when various reasons lead to insufficient maternal milk production or when the mother is unable to breastfeed directly due to disease. The short-term and long-term clinical efficacy of DHM in premature infants is unquestionable, such as reducing feeding intolerance in premature infants, reducing the prevalence and mortality of necrotizing enterocolitis (NEC), sepsis and other infections, shortening the length of hospitalization, reducing hospitalization costs, and improving the neurodevelopmental behavioral score^[1,2,3,4,5]。 In fact, DHM is not only a source of nutrition for newborns and infants, but even a therapeutic drug of choice for clinicians. Its application scope has gradually expanded from the initial premature infants and diseased newborns to children and adults, such as for the treatment of short bowel syndrome, formula feeding intolerance, chronic diarrhea, chronic renal failure, immunodeficiency or severe infection, etc^[4,5,6,7]。

Many countries and regions in the world have established human milk banks (human milk bank) based on local conditions, and formulated relevant guidelines for the operation and management of human milk banks^[1,2,3]。 In just three years, more than 10 human milk banks have been established in mainland China. The standards of establishing human milk bank are not uniform in all countries, and the operation quality and safety management are the key to the sustainable development of human milk bank.

The child, 2 days old, was admitted to Zhengzhou Children's Hospital for 1 day emergency department due to progressive dyspnea. The child was the first child and the mother was 36 years pregnant^＋6Zhou performed cesarean section due to "fetal intrauterine distress and low amniotic fluid". The child had a birth weight of 2 050 g, poor mental response after birth, less milk feeding, no bowel movement for 24 h, and mild-moderate jaundice for 36 h. Dyspnea occurred on the 2nd postnatal day. The parents are non-close relatives, and the mother is healthy during pregnancy. Physical examination at admission: weight 1 950 g, length 47 cm, heart rate 175 beats/min, breathing 72 beats/min, thin subcutaneous fat, mild-moderate yellowing of skin and mucosa, several scattered impetus on face and neck, irregular respiratory rhythm, three concave signs (+). The breathing sounds of both lungs were coarse, the heart sounds were strong, the rhythm was uniform, the heart rate was 175 beats/min, and a soft systolic grade II murmur could be heard in the precordial area. The liver and spleen were not touched, the muscle tone of the limbs was increased, and the muscle strength was normal. Laboratory test: white blood cell count 10.43×10⁹/L, neutrophils 0.724 (count 7.56×10⁹/L), hemoglobin 106 g/L, red blood cell count 2.94×10¹²/L, reticulocytes 0.118, suggesting hemolytic anemia. Peripheral blood smear analysis showed that rod-shaped nucleus granulocytes were 0.16, lobulated nuclei were 0.27, indicating that the nucleus shifted to the left, and poisoned granules were visible. Mature red blood cells were of different sizes, and the classification count was 100 white blood cells, but no nucleated red blood cells were found. Urinary ketone bodies negative. Blood gas analysis showed metabolic acidosis, pH 7.04, partial pressure of carbon dioxide (PCO₂) 17 mmHg (1 mmHg =0.133 kPa), oxygen partial pressure (PO₂) 125 mmHg, HCO₃^－4.6 mmol/L, residual base (BE) -24.2 mmol/L, lactic acid 2.2 mmol/L, blood glucose 5.6 mmol/L. Serum total bilirubin was 241.5 μ mol/L, indirect bilirubin was 165.2 μ mol/L, direct bilirubin was 76.3 μ mol/L, aspartate aminotransferase was 48 U/L, alanine aminotransferase was 55 U/L, and glutamine transpeptidase was 8 U/L. CRP 12.3 mg/L; Serum procalcitonin (PCT) 0.77 μ g/L. Blood cultures were free of bacterial growth. Cerebrospinal fluid was normal in routine and biochemistry, while smear staining and culture of cerebrospinal fluid were negative. The child was blood group O and Rh positive; Coombs test was negative. Neonatal hemolytic disease tests were all negative, folic acid, vitamin B₁₂The level is normal. After that, many reexaminations of blood routine, C-reactive protein (CRP), PCT and blood gas analysis showed anemia, infection and metabolic acidosis. Chest X-ray showed increased and blurred texture in both lungs. Cardiac ultrasound showed patent foramen ovale. Clinical diagnosis "neonatal respiratory distress syndrome, neonatal sepsis, metabolic acidosis, hemolytic anemia, neonatal impetus, patent foramen ovale".

A 6-year-old male was admitted for 1 week due to edema of both eyelids. The child developed double eyelid edema without inducement 1 week ago, and was not diagnosed and treated outside the hospital. Now he is in our hospital for treatment. During the course of the disease, the child's spirit, diet and sleep are good, the urine output is unknown, and the stool is normal. Past history: The child went to an external hospital 1 year ago for "swollen lymph nodes in the neck (about 3 cm in diameter, no tenderness)". At that time, there was no fever, night sweats, weight loss, etc. CT examination in the external hospital showed that there were swollen lymph nodes in the abdominal cavity with a diameter of about 2 cm, and the swollen lymph nodes in the neck were surgically removed. Postoperative pathology showed "B-cell non-Hodgkin's lymphoma", immunohistochemistry: CD₂₀(+), CD₁₀(+), Bcl-2 (+), MUM-1 (partial +), CD₃(−), CD₂₁(FDC +), Ki67 (70%-80% +), Bcl-6 (+), in situ hybridization EBER (-). Combined with morphology and immunohistochemistry, the diagnosis: childhood follicular lymphoma grade 3a, diffuse mixed follicular type, clinical stage is stage III. Oral "Chinese medicine soup" treatment for about 3 months, family members refused chemotherapy, intermittent abdominal pain during this period, no special treatment.

Breast milk is the most ideal food for newborns. The American Academy of Pediatrics encourages all mothers to breastfeed exclusively, and donating human milk can be used as an alternative feeding when breast milk is not the first choice for newborn feeding^[1]。 The establishment of human milk banks is an important way to collect donor human milk, so that newborns with lack of breast milk or lack of breast milk can also be fed with human milk. The applicable population of donated human milk includes: premature infants, infants with malabsorption, children with feeding intolerance, children with immunodeficiency, children with congenital abnormalities, children with postoperative enhanced nutrition, children with parenteral nutrition or intestinal stimulation. Indications can also be expanded if the human milk bank is adequately loaded, including but not limited to: absence or insufficiency of breast milk, adoption or surrogacy, breastfeeding suspension due to maternal disease, potential health hazards to the baby due to maternal breast milk, and death of the mother^[2]。 Improving the human milk feeding rate of premature and critically ill newborns in neonatal intensive care unit (NICU) has been gradually paid attention by clinical workers. In some developed countries, the human milk feeding rate of premature infants in the NICU even reaches 100%^[3]。 In China, the premature infants in the NICU have low human breast feeding rate. A domestic multicenter survey on the current status of in-hospital nutrition of very low birth weight premature infants (VLBW) in 15 hospitals showed that only 2 hospitals carried out intensive human breast feeding for premature infants and all of them were less than 10%^[4]。 Therefore, how to improve the human breastfeeding rate of premature infants in the domestic NICU is particularly urgent.

There are controversies and confusions in the treatment of childhood primary nephrotic syndrome (NS), and there are individual differences in the treatment effect. Which scheme should be adopted by different individuals needs to be weighed and considered in many aspects. Advances in different clinical types of treatment options and indications for different immunosuppressants are reviewed in combination with recent clinical evidence.

Medical decision-making is a very important part of the entire medical process. Traditional medical decision-making models are mostly paternalistic, informed consent or patient-led. The emergence of the study of Shared Decision Making (SDM) in the 1990s makes the study of medical decision-making model enter a brand-new stage. It emphasizes the importance of medical decision-making jointly between doctors and patients through full communication and discussion, so as to enhance the mutual trust between doctors and patients, alleviate the dispute between doctors and patients, improve patients' compliance with diagnosis and treatment methods, and improve patients' satisfaction with the medical process.

Professor He Xiaohu, former deputy chairman of the Academic Steering Committee of the 12th and 13th editorial boards of Chinese Journal of Pediatrics, died in Beijing on June 28, 2017 at the age of 80.