刘筱玫医生MAMMA系列: 宝宝感冒发烧不要慌 小红点需要担心吗

刘筱玫医生MAMMA系列: 宝宝感冒发烧不要慌小红点需要担心吗

刘医生发表于：2013-11-03 赞一个(1) 收藏分享到朋友圈 1 31716

刘医生加关注发私信诊所中文预约电话3319502613 医生

发帖 135奋豆 399粉丝 15楼主

发表于：2013-11-03IP属地：意大利米兰

刘医生10月12日主题帖: 宝宝感冒发烧不要慌

进入冬季，气温逐渐降低，宝宝们咳嗽感冒发烧的情况多了起来，咳嗽TOSSE是一种症状,它本身不称作一种疾病，引起宝宝咳嗽的情况与疾病有很多，比如气管异物COROPO ESTRANEO，感冒L'INFLUENZA，气管炎BRONCHITE，支气管炎BRONCHIOLITE , 肺炎POLMONITE，哮喘L'ASMA等。

非疾病的情况气管异物需要马上用 MANOVRA DI HEIMLICH 拍出异物，同时叫医生可以用专业器械取出异物。气管炎，支气管炎，肺炎以及哮喘可以通过查体检查以及拍片气管舒张试验等与普通感冒相鉴别。

在这个帖子里主要在年轻妈妈们的建议下，详解一下宝宝们普通感冒发烧时的对策，对于普通感冒发烧意大利常用药的剂量与使用方法。

感冒是宝宝们冬季最常见的病，它可以由细菌引起，也可以由病毒引起，L'INFLUENZA 严格来讲是指由病毒引起的流感。

妈妈们应该怎么判断是细菌引起的还是病毒引起的呢？

细菌引起的感冒CATARRO卡他症状明显，即扁桃体明显红肿有脓点，咳痰多，且多为带颜色脓痰。如果不及时治疗，可引发中耳炎，气管炎或肺炎。

针对细菌感染，可以适当使用抗生素类药物，如主要针对革兰氏阳性菌感染的 GRAMPLUS SUPPOSTE，药粒分别有100mg, 200mg药粒不同包装，6个月以下的宝宝用100mg塞屁股，一天2至3次，一次一粒。大一点的宝宝用200mg的药粒，一天2至3次，一次一粒，连续用至少5天。

效果好些是PANACEF SCIROPPO，这是一种针对革兰氏阳性及某些阴性菌感染的第二代头孢类抗生素糖浆，也有针对小孩子的草莓味的冲剂 PANACEF 250mg/5ml GRANULATO PER SOSPENSIONE ORALE。

剂量为20 mg/kg/die，即一个20kg左右的宝宝，需要一天400mg分3次服，每次间隔8小时。感冒严重的宝宝可以适当加量，但不可超过40mg/kg/die, 一天不可超过1000mg.

以上针对细菌性感冒的所有抗生素都需要规律连续不间断服用，即使症状消失也需要至少满5天，否则易产生抗药性。

病毒引起的感冒扁桃体红肿不明显，呼吸道分泌物相对少，可能流清鼻涕，EMOCROMO血象检查白细胞数不变或降低，而不是如细菌感染引起的白细胞数升高。病毒性感冒有自限性，即几乎不用治疗也可以自愈，这种情况下不用给宝宝开任何药，多喝温开水即可。只有当发烧超过38.5'C 时有必要用些退烧药。

由于很多宝宝拒绝吃药，常用的退烧药为塞屁股的TACHIPIRINA SUPPOSTE , 图片如下，主要成分为PARACETAMOLO对乙酰氨基酚。

12kg 以下的宝宝用125mg的，一天2-3次，一次一粒。

12-20kg的宝宝用250mg的，一天2-3次，一次一粒。

20kg以上的小孩则可以用500mg的，一天2-3次，一次一粒。

咳嗽的宝宝可以喝 LEVOTUSS SCIROPPO 止咳糖浆。

10-20 KG的宝宝一天3次，一次3ml。

20-30 KG 的小孩一天3次，一次5ml。

服用到不咳嗽为止，如果持续服用2个周了还咳嗽，则需要去医院作进一步检查。

以上提到的非抗生素类的退烧药与止咳药都是属于对症药物，无论在细菌性感冒还是病毒性感冒都可以用。

中医的生姜红糖水

中医的说法: 如果宝宝发烧时手脚冷，舌苔白，面色苍白，小便颜色清淡，父母可用生姜红糖水为之祛寒，在水里再加两三段一寸长的葱白，更有利宝宝发汗。

如果宝宝发烧咽喉肿痛，舌苔黄，小便黄而气味重，说明孩子内热较重，这时不能喝姜糖水，而应喝大量温开水，也可在水中加少量的盐，平衡电解质代谢。

对拒绝吃药的宝宝在我的诊所通过穴位药贴或打针治疗伤风感冒。

注意: 严禁在宝宝生活的空间里吸烟。

十二岁下的宝宝不可以用含有邻-乙酰水杨酸阿斯匹林L'ASPIRINA ,乙酰水杨酸 L'ASA (商品名如 : VIVIN C) 消炎退烧成分的西药, 可以引起以急性肝病脑病为特点的SINDROME DI REYE。

十二岁下的宝宝不可用中枢抑制成分的镇静药物退烧药物，如含可待因 CODEINA 的 COEFFERALGAN。

（复制转载请注明原创链接，问题请在“健康人生”版块的医生专栏留言，医生电子邮件[email protected] , 诊所中文预约电话 3319502613）

刘医生10月19日主题帖:孕7周查血可知宝宝性别

前几天，有准妈妈们问我关于在B超辨别出胎儿性别之前，通过采样母亲血来查胎儿性别的检查。在中国，很多人包括很多资深的妇科专家认为这是天方夜谭。实际上，这项技术确实存在，这种检查是从孕7周开始就可以查出胎儿性别。在意大利，MILANO，ROMA，FIRENZE，GENOVA等这几个城市都可以作，但造价高。

2011年就出现此项技术的相关新闻，原文如下，帮助大家探索此项技术的奥秘。

Non invasive Fetal Sex Determination Using Cell-Free Fetal DNA

Stephanie A. Devaney, PhD; Glenn E. Palomaki, PhD; Joan A. Scott, MS, CGC; Diana W. Bianchi, MD.这项技术的主要实现者为美国的 Stephanie A. Devaney

AMA. 2011;306(6):627-636. doi:10.1001/jama.2011.1114.

Context Non invasive prenatal determination of fetal sex using cell-free fetal DNA无创的产前检测母亲血中游离的胎儿DNA来确定胎儿性别，DNA provides an alternative to invasive techniques for some heritable disorders. In some countries this testing has transitioned to clinical care, despite the absence of a formal assessment of performance.

Objective To document overall test performance of noninvasive fetal sex determination using cell-free fetal DNA and to identify variables that affect performance.

Data Sources Systematic review and meta-analysis with search of PubMed (January 1, 1997-April 17, 2011) to identify English-language human studies reporting primary data. References from review articles were also searched.

Study Selection and Data Extraction Abstracts were read independently to identify studies reporting primary data suitable for analysis. Covariates included publication year, sample type, DNA amplification methodology, Y chromosome sequence, and gestational age. Data were independently extracted by 2 reviewers.

Conclusions Despite interstudy variability, performance was high using maternal blood. Sensitivity and specificity for detection of Y chromosome sequences was greatest using RTQ-PCR after 20 weeks' gestation. 通过母亲血液检查来寻找男性胎儿Y染色体，在孕20周后使用RTQ-PCR分析有最大的敏感度特异度，Tests using urine and tests performed before 7 weeks' gestation were unreliable. 孕7周之前母亲尿检或血液检查都无法查出。

Non invasive prenatal determination of fetal sex could provide an important alternative to invasive cytogenetic determination, which is currently the gold standard for ambiguous genitalia, X-linked conditions, and single-gene disorders such as congenital adrenal hyperplasia. Chorionic villus sampling and amniocentesis have small but measurable rates of procedure-related pregnancy loss. The availability of a reliable noninvasive alternative to determine fetal sex would reduce unintended fetal losses and would presumably be welcomed by pregnant women carrying fetuses at risk for disorders. A much broader potential application for fetal sex detection is family balancing, which poses ethical concerns.

Fetal sex determination can be performed by ecography at as early as 11 weeks' gestation , although not reliably 孕11周通过超声就可以查胎儿性别, 尽管不总是可靠. Test performance across published studies varies significantly. According to a review by Odeh et al, fetal sex cannot be determined by ultrasound examination in 7.5% to 50% of pregnancies at 11 weeks' gestation, and this decreases to 3% to 24% at 13 weeks. When reported, the sex determination is incorrect as often as 40% of the time at 11 weeks, although by 13 weeks, accuracy (when reported) is close to 100%. 根据Odeh等学者的说法，孕11周有7.5% 到 50%的胎儿性别不能被B超识别，孕13周这个数字会降低到3% 到 24%。据报道，孕11周验错率可以达到40%，而到了孕13周准确率会接近100%。

The presence of cell-free circulating Y chromosome DNA sequences in the plasma of pregnant women was first described in 1997. 1997年首次描述母亲血浆中可能出现男性胎儿游离的Y性染色体DNA序列。 Since that report, many groups worldwide have validated the initial finding that Y chromosome sequences can be amplified and used to identify male fetuses. 从那时起，世界范围内很多研究机构组织团体开始尝试通过生物技术放大这些微量的Y染色体序列来识别男性胎儿。

The research has been extended using a variety of methodologies, sex-specific markers, and sample types across all gestational ages. In countries such as the Netherlands, the United Kingdom, France, and Spain, this testing has already transitioned to routine clinical care despite the absence of a formal assessment of its performance. More recently, companies have begun offering this technology directly to the consumer over the Internet. 在荷兰，英国，法国，西班牙等国，这项通过母亲血液早期识别胎儿性别的检查已经成为很常见的临床检查，而并没有对它带来的影响男女平衡等一系列问题进行后果的评估。最近，互联网上有些机构对消费者直接提供此项检查的服务。

（复制转载请注明原创链接，问题请在“健康人生”版块的医生专栏留言，医生电子邮件[email protected] , 诊所中文预约电话 3319502613）

NOTA：准妈妈们如果想在米兰作这项7周就知道性别的抽血检查，可以直接联系我电子邮件或诊所中文预约电话。刘医生

医生宝宝

诊所中文预约电话3319502613 医生信箱[email protected]

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刘医生楼主加关注发私信诊所中文预约电话3319502613 医生

发帖 135奋豆 399 粉丝 150楼

发表于：2013-11-03

刘医生11月2日主题帖: 宝宝身上成片小红点需要担心吗?

Puntini rossi sulla pelle dei bambini

I puntini rossi sulla pelle sono principalmente comuni in età infantile, soprattutto quando si parla di neonati.宝宝皮肤上出现成片小红点很常见，尤其在新生儿期。
La causa scatenante di questo fenomeno è generalmente il sudore eccessivo dovuto al caldo. Solitamente questi puntini rossi sulla pelle generano solo prurito e compaiono nelle zone cutanee dove il sudore tende a formarsi maggiormente come collo, ascelle, inguine, area delle spalle e tra le giunture degli arti. 这些小红点一般只是痒，通常出现在皮肤汗区，如：脖子，腋下，腹股沟，肩膀，四肢关节之间，通常是由于热过度出汗引起。

那么，怎样区别这种不需要担心的出汗引起的红点与值得担心的病理的红点呢？

Quando i puntini rossi non sono sintomo di patologie
Questi puntini rossi sulla pelle non devono destare preoccupazione, infatti sono facilmente distinguibili dalle altre patologie, soprattuttto quelle esantematiche. In quest’ultimo caso i puntini rossi sulla pelle hanno innanzitutto un diametro di un centimetro, si mostrano più grandi e poi comportano anche la presenza di febbre. In genere poi mostrano anche una base fortemente acquosa, 首先需要与各种病毒细菌或过敏因素引起的各种疹子区别。它们一般不是小小的针尖样红点，直径会达到一厘米左右，不仅仅痒，而且可能会出现发烧症状，红斑基底部会含有液状物。
mentre quando si tratta di semplici puntini rossi sulla pelle causati da sudore ciò non avviene. Si possono poi distinguere anche da reazioni allergiche in quanto qui le macchie saranno sempre più grandi, ma si presenteranno praticamente in rilievo. In generale quindi non bisogna preoccuparsi quando c’è la comparsa di puntini rossi sulla pelle nelle zone citate in precedenza, è una reazione normale dovuta al caldo eccessivo.

怎样治疗这种过度出汗引起的红点呢？

Come curare i puntini rossi sulla pelle
E' consigliabile in questo caso, per donare sollievo e farsì che questi puntini svaniscono, rinfrescare il bambino spesso, aiutandosi con una spugna morbida e non strofinando con l’asciugamano sulla zona interessata. E' bene anche indossare capi leggeri ed evitare di uscire nelle ore più calde della giornata. La pelle deve avere modo di poter respirare ed essere quanto più possibile fresca, 经常用柔软的洗浴海绵而不是用粗糙的毛巾清洗宝宝皮肤的红点区。热的时候给宝宝穿少些，避免在一天中最热的时间带宝宝到户外。保持宝宝皮肤透气与清爽：穿透气性好的衣服让宝宝皮肤过度热量可以及时散发。 solo in questo modo i puntini rossi sulla pelle potranno svanire ed il piccolo ritroverà ristoro.

（复制转载请注明链接，问题请在“健康人生”版块的医生信箱留言，医生电子邮件[email protected] , 诊所中文预约电话 3319502613）

诊所中文预约电话3319502613 医生信箱[email protected]

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