儿科
词汇介绍
拓展阅读
解析
neonatal 英 /,niːə(ʊ)'neɪt(ə)l/ 美 /,nio'netl/
释 义 adj. 新生的；初生的
例 句 Jaundice in adults and older children is not related to neonatal jaundice; it is usually the sign of a health problem. 黄疸在成人和年龄较大的儿童是不相关的新生儿黄疸，这是通常的迹象是一个健康问题。
hypoglycemia 美 /,haɪpoglaɪ'simɪə/
释 义 n. 低血糖症；血糖过低
例 句 In the intensive insulin group, 17 percent had severe hypoglycemia compared to just 4 percent of those on standard insulin therapy. 在强化胰岛素治疗组，17％的患者出现了严重低血糖症而标准胰岛素治疗组仅4％出现。
概述
概述
低血糖症是新生儿常见的代谢性疾病，其发病率为3%-11%。目前以静脉血糖＜2.2 mmol/L为诊断标准，血糖＜2.6 mmol/ L是临床干预的界值。低血糖症是新生儿惊厥的重要病因之一，严重的低血糖症可以影响新生儿中枢神经系统，造成永久性的脑损伤。新生儿低血糖分为暂时性低血糖以及持续性低血糖，新生儿低血糖的发生是在多种因素的影响下导致的。剖宫产患儿出现低血糖可能由于突然中断母亲血糖的供应，患儿尚未完全准备好有关。窒息患儿低血糖和高血糖都比较常见，主要是由于窒息应激有关。
病因及临床意义
早产儿、低出生体质量儿、巨大儿、剖宫产、男孩、窒息都是发生新生儿低血糖的高危因素。早产儿、低出生体质量儿发生低血糖的原因与体内糖原贮存不足有关。巨大儿、母亲妊娠糖尿病的患儿发生低血糖与母亲长期给予较高的糖速、患 儿长期处于高糖状态下、胰岛素分泌过多、处于一过性的高胰岛素血症状态、脱离母体后中断母体高糖的供应有关。
症状表现
反应能力降低、多汗、面色苍白、发绀、嗜睡、肌肉 颤抖等症状。
诊断方法
临床症状：新生儿低血糖分为有症状以及无症状两类，对于有症状的新生儿，临床可出现反应能力减弱、嗜睡、呼吸增快、发绀、肌肉抽搐等症状。实验室检查：患儿血糖＜2. 2 mmol/ L，白蛋白正常水平，谷丙转氨酶＞67 U/L，谷草转氨酶＞25 U/ L。
治疗
为降低新生儿低血糖发生率，孕妇应定期进行产前检查，对体重低于正常水平的孕妇，应进行围产期血糖检测，对降低新生儿低血糖症的发生具有重要的意义。 对于产前检查血糖偏低的孕妇，应指导孕妇在胎儿娩出前开奶，争取做到新生儿出生后0. 5-1小时内可以人工哺乳，哺乳后对新生儿血糖进行24小时监测，根据检测情况给予葡萄糖输液治疗、泼尼松药物治疗，纠正新生低血糖状态，对于低血糖持续时间过长，出现黄疸，不同程度贫血的患儿，应给予抗感染以及输血 治疗，待胎儿血糖恢复正常后，安排出院，并建立微信平台，电话随访等机制，对患儿进行常规血糖检测。
Glibenclamide oral suspension: Suitable and effective in patients with neonatal diabetes
复制标题
格列本脲口服混悬液对新生儿糖尿病患者的治疗效果
发表时间：2019-05-01
影响指数：3.3
作者： Beltrand Jacques
期刊：Pediatr Diabetes
Neonatal diabetes (NDM) was treated in the same way as type 1 diabetes until elucidation of the genetic basis of with the disease was shown to involve activating mutations in KCNJ11 or ABCC81. This discovery led to the first example of precision medicine in diabetes and to the radically different, specific and successful therapeutic approach consisting in giving oral sulfonylureas (glibenclamide, also known as glyburide) instead of insulin injections. Patients carrying these mutations can produce insulin but have an insufficient insulin response to glucose. In addition to providing therapeutic benefits, oral glibenclamide treatment is more convenient than insulin injections, eliminates the pain due to injections, and provides greater flexibility, thereby allowing optimization of the dosage regimen and much better glycemic control. The better glycemic control is associated with improvements indyspraxia, supporting the early initiation of sulfonylureas (SU) therapy.Precision medicine in pediatrics requires suitable drug preparation allowing the administration of the lowest possible dosage that provides optimal glycemic control and neuropsychological improvements. Until recently, glibenclamide was available only as tablets, which had to be crushed and mixed with water for administration to neonates and infants. Even when prepared by hospital pharmacies, crushed tablets in water lack reliability as they have no microbiological stability and vary in concentration over time due to gradual sedimentation of the glibenclamide, which has limited solubility in water. AMMTeK has developed a paediatric glibenclamide (named glyburide in the US) oral suspension (AMGLIDIA®), which has been designated as an orphan drug for the treatment of NDM in europe and the US. Compared to crush tablets the suspension assures more consistent pharmacokinetics and could be more acceptable for children.
译文
