Jornal de pediatria最新文献_第9页

Abdominal complications of ascariasis in childhood 儿童蛔虫病的腹部并发症。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-21 DOI: 10.1016/j.jped.2024.02.001

Objective

Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients.

Data sources

A PubMed search was conducted using the key terms “ascariasis complications” and “hepatobiliary ascariasis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023.

Summary of findings

Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed.

Conclusion

The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.

目的：蛔虫病并发症是儿科急诊腹痛的一个重要原因，尤其是在蛔虫病流行的地方。为了改进对这些患者的诊断和治疗方法，我们进行了一次文献综述：使用关键词 "蛔虫病并发症 "和 "肝胆蛔虫病 "在 PubMed 上进行了搜索。检索策略包括截至 2023 年 12 月发表的荟萃分析、随机对照试验、临床试验、观察性研究、病例报告和综述：研究结果摘要：小肠阻塞是最常见的并发症。其他并发症，如胆道、肝脏和胰腺并发症、急性阑尾炎、梅克尔憩室炎或腹膜肉芽肿，则更为罕见，也更难正确识别和治疗。与成人相比，儿童的肝脏和胰腺并发症更为罕见和严重。在肠梗阻病例中，平片检查通常是唯一的选择，而在儿童肝胆、胰腺和阑尾蛔虫病并发症病例中，超声波检查则是首选检查方法。对大多数患者来说，治疗方法是临床保守治疗。如果保守治疗无效或出现并发症迹象，则应进行手术治疗。腹腔镜是治疗成人蛔虫病肝胆并发症的最佳技术选择，但仍需对其在儿童中的应用进行进一步研究：结论：为了更好地了解蛔虫病，并对因蛔虫大量感染而出现并发症的儿童进行早期诊断和适当治疗，应鼓励制定相关方案并就此展开更多讨论。

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引用次数: 0

Exclusive breastfeeding and length of hospital stay in premature infants at a Brazilian reference center for kangaroo mother care 巴西袋鼠妈妈护理参考中心早产儿的纯母乳喂养和住院时间。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-21 DOI: 10.1016/j.jped.2024.01.004

Patrícia de Padua Andrade Campanha , Maria Clara de Magalhães-Barbosa , Arnaldo Prata-Barbosa , Gustavo Rodrigues-Santos , Antônio José Ledo Alves da Cunha

Objective

To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in preterm infants undergoing or not the Kangaroo-Mother Care Method (KMC).

Methods

A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders.

Results

115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85–109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76–0.86) compared to the non-KMC group.

Conclusions

The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals.

目的评估采用或未采用袋鼠妈妈护理法（Kangaroo-Mother Care Method，KMC）的早产儿出院时的纯母乳喂养情况和住院时间：方法：我们进行了一项回顾性队列研究，研究对象包括 KMC 参考中心新生儿科收治的体重小于 1800 克的早产儿。这些婴儿被分为 KMC 组和非 KMC 组。在对潜在混杂因素进行调整后，对KMC与出院时纯母乳喂养和住院时间这两个结果之间的关系进行了多重逻辑和泊松回归评估：结果：共纳入了 115 个母婴二人组，其中 78 个为 KMC 组，37 个为非 KMC 组。在双变量分析中，KMC 组的产妇不良情况发生率较低（6% 对 32%，P 结论：KMC 与产妇的短期疗效更佳相关：KMC 与更好的新生儿短期预后有关，巴西所有产科医院都应鼓励采用。

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引用次数: 0

Advancing pediatric healthcare in Brazil: establishing reliable reference intervals for serum immunoglobulins 在巴西建立可靠的血清免疫球蛋白参考区间，推进儿科医疗保健。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-10 DOI: 10.1016/j.jped.2024.03.001

Khosrow Adeli

引用次数: 0

Alert for the high prevalence of vitamin D deficiency in adolescents in a large Brazilian sample 巴西大样本青少年维生素 D 缺乏症高发的警示。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-07 DOI: 10.1016/j.jped.2024.01.003

Vanessa Radonsky , Marise Lazaretti-Castro , Maria Izabel Chiamolera , Rosa Paula Mello Biscolla , José Viana Lima Junior , José Gilberto Henriques Vieira , Cynthia Maria Alvares Brandão , Rodrigo Fernandes Ramalho , Sergio Setsuo Maeda , Marcia Wehba Esteves Cavichio

Objective

To estimate the prevalence of vitamin D deficiency and severe deficiency in children and adolescents, in a large Brazilian sample.

Methodology

Results of 413,988 25(OH)D measurements in children and adolescents aged 0 to 18 years collected between 01/2014 and 10/2018 were obtained from the database of a Clinical Laboratory. In this population, 25 hydroxyvitamin D concentrations below 20 ng/mL are considered deficient, and below 12 ng/mL as severe deficiency. All measurements were performed by immunoassay and the results were distributed by gender, age group, seasonality, and latitude.

Results

The mean of 25(OH)D levels was 29.2 ng/mL with a standard deviation of 9.2 ng/mL. Of the total samples, 0.8% had a concentration < 12 ng/mL, and 12.5% of the samples had a concentration < 20 ng/mL, with a higher prevalence in females. Children under 2 years of age had the lowest prevalence. The effects of latitude and seasonality were quite evident. In samples of female adolescents from the southern region in winter, 36% of vitamin D deficiency and 5% of severe deficiency were found.

Conclusion

In this large number of measurements of 25(OH)D in children and adolescents, 12.5% had a deficiency and 0.8% had severe deficiency. A greater deficiency was observed among adolescents, especially females, which raises questions about the need for supplementation during this period of life.

目的估计巴西大样本儿童和青少年维生素 D 缺乏症和严重缺乏症的患病率：从临床实验室的数据库中获取了2014年1月至2018年10月期间对413976名0至18岁儿童和青少年进行的25（OH）D测量结果。在这一人群中，25羟基维生素D浓度低于20纳克/毫升即为缺乏，低于12纳克/毫升为严重缺乏。所有测量均通过免疫测定法进行，结果按性别、年龄组、季节和纬度分布：结果：25（OH）D 水平的平均值为 29.2 纳克/毫升，标准偏差为 9.2 纳克/毫升。在所有样本中，0.8%的样本浓度小于12纳克/毫升，12.5%的样本浓度小于20纳克/毫升，女性的发病率更高。2 岁以下儿童的发病率最低。纬度和季节性的影响非常明显。在冬季南方地区的女性青少年样本中，发现 36% 缺乏维生素 D，5% 严重缺乏：在对儿童和青少年进行的大量 25（OH）D 测量中，12.5% 的人缺乏维生素 D，0.8% 的人严重缺乏。青少年，尤其是女性的维生素 D 缺乏率更高，这就提出了在这一时期是否需要补充维生素 D 的问题。

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引用次数: 0

Child undernutrition in Brazil: the wound that never healed 巴西儿童营养不良：从未愈合的创伤。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-01 DOI: 10.1016/j.jped.2023.09.014

Maria Paula de Albuquerque, Paola Micheloni Elvira Ibelli, Ana Lydia Sawaya

Objective

To describe the scenario of child undernutrition in Brazil and its determinants.

Data source

Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN.

Data synthesis

Household surveys carried out from 1974 to 2019 indicate that undernutrition (<5 years) decreased until 2006. Underweight (W/A ≤-2 Z) and stunting (H/A ≤-2 Z) showed a decrease of 17% to 3% and 37% to 7%, respectively. After 2006, there was an increase in underweight of 53% and 76% for wasting (BMI/A ≤-2 Z), with the prevalence of stunting being stagnant at around 7%. Active search data in favelas and underserved communities show that the prevalence of stunting is 11% in those <5 years. In 2021, 30% of the population lived in poverty, 73% of which were black or brown. Stunting in black and brown children <5 years old is, respectively, 9% and 12% higher when compared to white children. Poverty decreased between 2012 and 2015 (27 to 25%), but increased again (2016=26% to 2021=30%), in parallel with food insecurity, which decreased between 2004 and 2013 (12% to 6%), but reached its worst level in the historical series (2022:15%).

Conclusion

Despite advances, Brazil's social protection system was not able to reduce inequalities and the reversal of the trend towards decreasing child undernutrition could be observed from 2006 onwards.

目的：描述巴西儿童营养不良的情况及其决定因素。数据来源：文献叙述性综述，包括来自人口调查、监测和监测系统的数据，以及CREN在亚正常集群中进行的积极搜索。数据综合：1974年至2019年进行的家庭调查表明，营养不良（结论：尽管取得了进展，但巴西的社会保护制度未能减少不平等现象，从2006年起，儿童营养不良现象减少的趋势可能出现逆转。

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引用次数: 0

Comparison of the effectiveness of different high-flow devices in neonatal care 不同高流量设备在新生儿护理中的效果比较。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-01 DOI: 10.1016/j.jped.2023.10.006

Diogo Machado Kaminski , Graziela Ferreira Biazus , Rita C. Silveira , Renato Soibelmann Procianoy

Objective

To evaluate the success rate of high-flow nasal cannula (HFNC) therapy using an adapted obsolete mechanical ventilator (MV), Optiflow™ and Vapotherm™ in newborns (NBs).

Method

This was a retrospective observational study conducted in the neonatal intensive care unit (NICU). The sample comprised NBs who underwent HFNC therapy due to ventilatory dysfunction, for weaning from non-invasive ventilation (NIV), or post-extubation. The three groups, stratified according to gestational age (GA) and birth weight, and corrected GA and weight at the beginning of HFNC use, were as follows: Optiflow ™, Vapotherm ™, and obsolete Mechanical Ventilator (MV) adapted for high flow therapy. Subsequently, the NBs were divided into a success group (SG) and a failure group (FG). HFNC success was defined as a therapy duration exceeding 72 h.

Results

A total of 209 NBs were evaluated, with 31.1 % using HFNC due to ventilatory dysfunction, 2.4 % after extubation, and 66.5 % after NIV weaning. HFNC success rate was observed in 90.9 % of the NBs, with no difference between equipment types (Vapotherm ™, Optiflow ™, and adapted VM).

Conclusion

Different types of HFNC equipment are equally effective when used in neonatology for respiratory dysfunction, as a method of weaning from NIV and post-extubation. Adapted obsolete MV can be an alternative for HFCN therapy in resource-constrained settings.

目的:评价采用旧机械呼吸机(MV)、Optiflow™和Vapotherm™进行高流量鼻插管(HFNC)治疗新生儿(nb)的成功率。方法:在新生儿重症监护病房(NICU)进行回顾性观察性研究。样本包括因呼吸功能障碍、无创通气(NIV)脱机或拔管后接受HFNC治疗的新生儿。根据胎龄(GA)和出生体重，以及HFNC开始使用时校正的胎龄和体重，三组分别为:Optiflow™、Vapotherm™和过时的适用于高流量治疗的机械呼吸机(MV)。随后，将NBs分为成功组(SG)和失败组(FG)。结果:共对209例新生儿进行了评估，其中31.1% %因呼吸功能障碍而使用HFNC, 2.4% %在拔管后使用，66.5% %在NIV脱机后使用。HFNC的成功率为90.9% %，设备类型(Vapotherm™，Optiflow™和改编VM)之间没有差异。结论:不同类型的HFNC设备用于新生儿呼吸功能障碍，作为一种脱离NIV和拔管后的方法，效果相同。在资源有限的情况下，经改造的过时MV可作为HFCN治疗的替代方案。

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引用次数: 0

Use of dietary supplements by children and adolescents 儿童和青少年使用膳食补充剂的情况

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-01 DOI: 10.1016/j.jped.2023.09.008

Junaura Rocha Barretto , Mara Alves da Cruz Gouveia , Crésio Alves

Objectives

Narrative review evaluating the use of dietary supplements by children and adolescents.

Data source

The terms “dietary supplements”, “children” and “adolescents” were used in combination in the PubMed, MEDLINE, and SciELO databases, between 2000 and 2023, evaluating studies in humans, published in Portuguese, English, French and Spanish.

Data synthesis

The use of dietary supplements by children and adolescents has increased in recent decades. The most commonly used supplements are vitamins, minerals, trace elements, proteins, amino acids, melatonin, fatty acids, probiotics and energy drinks.

Conclusion

Despite having specific indications, most of the time they are not prescribed by a healthcare professional. The reasons for use are varied. In children, the main reasons are protection against infections, stimulating growth, and poor food intake, with multivitamins and minerals being the most commonly used supplements. In adolescents, they are used to improve athletic performance and attain the “ideal body”, with proteins and amino acids being the most often used nutrients. As they are not regulated by health agencies and are sold without a prescription, their unsupervised use can lead to inadequate doses, with inefficiency or overdose risk. As for compounding formulations, or when available in preparations with multiple nutrients, the chance of errors increases. It is essential that pediatricians advise parents and patients about the indications, risks and benefits, prescribing them when necessary.

目的对儿童和青少年使用膳食补充剂的情况进行评估的叙述性综述。数据来源在 2000 年至 2023 年期间，在 PubMed、MEDLINE 和 SciELO 数据库中结合使用了 "膳食补充剂"、"儿童 "和 "青少年 "等术语，评估了以葡萄牙语、英语、法语和西班牙语发表的人类研究。最常用的营养补充剂包括维生素、矿物质、微量元素、蛋白质、氨基酸、褪黑素、脂肪酸、益生菌和能量饮料。使用的原因多种多样。在儿童中，主要原因是防止感染、刺激生长和食物摄入不足，而多种维生素和矿物质是最常用的补充剂。在青少年中，它们被用来提高运动成绩和达到 "理想体型"，蛋白质和氨基酸是最常用的营养素。由于这些保健品不受卫生机构监管，也不凭处方销售，因此在无人监督的情况下使用可能导致剂量不足、效率低下或用药过量的风险。至于复方制剂，或含有多种营养素的制剂，出错的几率也会增加。儿科医生必须向家长和患者说明这些药物的适应症、风险和益处，并在必要时开具处方。

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引用次数: 0

Parameters of pubertal growth spurt in children and adolescents living at high altitude in Peru 秘鲁高海拔地区儿童和青少年青春期生长突增的参数。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-01 DOI: 10.1016/j.jped.2023.08.010

Lucila Sanchez-Macedo , Rubén Vidal-Espinoza , Juan Minango-Negrete , Enio Vaz Ronque , Luis Felipe Castelli Correia de Campos , José Fuentes-López , Eliseny Vargas-Ramos , Margot Rivera-Portugal , Marco Cossio-Bolaños , Rossana Gomez-Campos

Objectives

The aim was to estimate the pubertal growth height of children and adolescents living in a high-altitude region of Peru using the Preece-Baines model 1 (1 PB).

Methods

A cross-sectional study was conducted in schoolchildren from the department of Puno (Peru) between 3841 and 3874 masl. The age range was between 4 and 17 years. Standing height was evaluated. 1 PB was used to infer the mathematical and biological parameters of stature.

Results

Mathematical parameters estimated by the 1 PB model reflected small residual standard error (RSE) values in both sexes (0.25 in boys and 0.27 in girls). In boys, the age at which peak velocity was reached (APHV) was estimated at 13.21 ± 0.33years. While in girls it was 9.96 ± 0.26years (p < 0.05). In general, girls reached APHV (y) 3.25 years earlier than boys. On the other hand, the growth velocity of maximum height [APHV (cm/y)] of boys was higher (6.33 ± 6.06 cm/y) relative to girls (6.06 ± 0.32 cm/y). Estimated final adult height (EFAH) in boys was reached at 166.020 ± 0.99 cm and height at maximum growth velocity (HPHV) was 153.07 ± 0.67 cm, while in girls they were significantly lower (EFAH; 153.74 ± 0.44 cm and HPHV: 139.73 ± 0.84 cm).

Conclusions

This study showed that girls living in Puno at a high altitude in Peru reached APHV 3 years earlier than boys and at the same time reflected slower PHV. These results suggest that pubertal growth at high altitudes is slower in both sexes and especially in girls. Thus, modeling physical growth may be an important step in understanding the onset of puberty at different latitudes.

目的：使用Preece-Banes模型1（1 PB）。方法：对秘鲁普诺省3841至3874名小学生进行横断面研究。年龄范围在4-17岁之间。对站立高度进行了评估。1. PB用于推断身高的数学和生物学参数。结果：由1估计的数学参数 PB模型反映了男女的小残差标准误差（RSE）值（男孩0.25，女孩0.27）。男孩达到峰值速度（APHV）的年龄估计为13.21岁 ± 0.33岁。而女孩是9.96岁 ± 0.26年（p＜0.05）。总体而言，女孩比男孩早3.25年达到APHV（y）。另一方面，男孩最大身高[APVV（cm/y）]的生长速度较高（6.33 ± 6.06 厘米/年）相对于女孩（6.06 ± 0.32 cm/y）。男孩的最终身高估计为166.020 ± 0.99 cm，最大生长速度下的高度（HPHV）为153.07 ± 0.67 cm，而女孩的这一比例明显较低（EFAH；153.74 ± 0.44 cm和HPHV:139.73 ± 0.84 cm）。结论：这项研究表明，生活在秘鲁高海拔普诺的女孩比男孩早3年达到APHV，同时PHV反应较慢。这些结果表明，在高海拔地区，男女的青春期生长都较慢，尤其是女孩。因此，模拟身体生长可能是理解不同纬度青春期开始的重要一步。

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引用次数: 0

Early-life nutrition and adult-life outcomes 早期生活营养和成年生活结果。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-01 DOI: 10.1016/j.jped.2023.08.007

João Guilherme Bezerra Alves , Lucas Victor Alves

Objectives

To verify the association between early-life nutrition and chronic adult diseases.

Data Sources

Medline, Embase, Cochrane Database, and Lilacs.

Summary of finds

The Developmental Origins of Health and Disease (DOHaD) hypothesis postulates that a mismatch between early-life circumstances and later-life situations may have an impact on chronic diseases. In this review, the authors emphasize the research supporting the impact of early nutrition on the origins of adult height, obesity and metabolic syndrome, type 2 diabetes mellitus, cardiovascular diseases, and reproductive outcomes.

Conclusion

Even though this is a new topic and there are still many research questions to be answered, there is strong evidence that both deficiency and excess nutrition in early life can cause epigenetic changes that have effects that last a lifetime and contribute to the development of chronic diseases. Public health efforts to protect adults from getting chronic diseases should focus on nutrition in the first 1000 days of life, from conception to the end of the second year of life.

目的：验证早期营养与成人慢性疾病之间的关系。数据来源：Medline、Embase、Cochrane数据库和Lilacs。研究结果摘要：健康与疾病的发展起源（DOHaD）假说假设，早期生活环境和后期生活环境之间的不匹配可能会对慢性病产生影响。在这篇综述中，作者强调了支持早期营养对成人身高、肥胖和代谢综合征、2型糖尿病、心血管疾病和生殖结果的影响的研究。结论：尽管这是一个新课题，仍有许多研究问题需要回答，但有强有力的证据表明，早期营养不足和过量都会导致表观遗传学变化，这种变化会持续一生，并导致慢性疾病的发展。保护成年人免受慢性病侵害的公共卫生工作应侧重于生命前1000天的营养，从受孕到生命第二年结束。

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引用次数: 0

Risk of dysphagia in a population of infants born pre-term: characteristic risk factors in a tertiary NICU 早产婴儿吞咽困难的风险：三级新生儿重症监护室的特征性风险因素。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-01 DOI: 10.1016/j.jped.2023.09.004

Dwi Juliana Dewi , Elvie Zulka Kautzia Rachmawati , Luh Karunia Wahyuni , Wei-Chung Hsu , Susyana Tamin , Rahmanofa Yunizaf , Joedo Prihartono , R. Adhi Teguh Permana Iskandar

Objective

To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties.

Method

A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic.

Results

The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %).

Conclusion

Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

目的：探讨吞咽困难和吞咽呼吸不协调作为口腔喂养困难表型的患病率和特点。方法：一项横断面研究，使用2020年10月至2022年10月连续2年收集的二次数据，在三级综合吞咽困难诊所使用灵活的吞咽检查内镜评估来测量早产儿吞咽和口腔喂养困难的患病率。结果：吞咽障碍的患病率为25 % 吞咽不协调的患病率为62.5 %. 可能与口服喂养困难相关的显著危险因素是月经后成熟年龄（p = 0.006）和更长的停留时间（p = 0.004）。上呼吸道异常和紊乱的主要百分比是腭后塌陷（40 %), 喉软化症（42.5 %), 反常的声带运动（12.5 %), 和胃食管反流病（60 %). 口腔运动检查和吞咽检查的灵活内镜评估的主要特征是非营养性吮吸不足（45 %), 姿势音调不足（35 %), 以及营养吸收不足（65 %).结论：早产儿吞咽困难主要发生在月经后年龄成熟、停留时间较长、存在非营养性吮吸和营养性吮吸能力不足的胃食管反流病的婴儿身上。吮吸-吞咽呼吸不协调主要发生在月经后年龄不成熟、心肺共病患病率较高、营养性吮吸能力不足的上呼吸道病变（喉软化、声带运动异常）患病率较高的人群中。

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