MOT SO Y^U TO ANH HU'DNG D^N TUOI MOC RANG

(1)

TCNCYH Phu trwang 80 (3A) - 2012

terrez G (2005), Simplified PRISM 111 score Med 10(1): 1 2 - 2 2 and outcome in the pediatnc intensive care

unit, Pediatrics International. (47). 80 - 83. 7. Wilkinson JD, Pollack MM et al (1987). Mortality associated with multiple or- 6. Proulx F, Joyal JS, Mariscaico MM, et gan system failure and sepsis in pediatric in- al (2009). The pediatric multiple organ dys- tensive care unit Journal Pediatric. ( I l l ) : function syndrome. Pediatnc Critical Care 324 - 328.

Summary

CLINICAL FEATURES AND SOME FACTORS RELATED TO MORTALITY OF PEDIATRIC MULTIPLE ORGAN DYSFUNCTION SYNDROME

The study was conducted to describe the clinical characteristics and some factors related to mortality of pediatric multiple organ dysfunction syndrome (MODS). Results showed that the incidence of MODS was 22.4%; 70% with MODS were less than 1 year old. 83.4%, with MODS associated with sepsis. The mortality rate of MODS was 70%. Mortality prognosis factors were:

number of organs dysfunction, age < 12 month, PRISM score > 20, presence of sepsis, history medical disease ,the first day of multiple organ dysfunction In conclusion, the rate and the mor- tality of MODS were very high in the ICU There were some factors related with high mortality.

Keywords: Clinical feature, multiple organ dysfunction syndrome, risk factors related mortality

MOT SO Y ^ U TO ANH HU'DNG D^N TUOI MOC RANG

Nguyin Phu Dat, Nguyen Thi Yen Trwdng Dai hoc Y Ha Noi

Qud trinh phdt thin rang cung Id mot vdn dd rdt quan trong trong qud trinh phdt thdn a trd em Cd nhiiu yiu td dnh hwdng tdi qud trinh phdt tnin rang cua tre em Di tdi dwac thwc hien nhdm nghien cdu mot sd yiu td dnh hwdng din tudi moc rang cua 1444 tre khod manh tudi td 6 thdng din 42 thdng tudi tai mdt sd nhd trd a Hd Ndi dwoc chon ngdu nhien trong thdi gian tw 01/10/2010 din 15/04/2011. Kit qud chi ra rdng trd em sdng trong khu vwc ndi thdnh Ha Ndl cd tudi kit thuc moc rang sua (trung binh Id 25 thdng tudi) sdm han tre sdng a ngoai thdnh (trung binh id 27 thang tudi). Nhu-ng tre nhe can khi sinh cd tudi moc rdng vd tudi kit thdc moc rang swa mudn han tre smh du cdn. Tu6i trung binh bdt ddu moc rang va tudi trung binh kit thdc moc rdng d nhdm tre dwac bd sung thdm vitamin D vd can xi hay chl vitamin D don thuin sdm han so vdi nhdm trd khdng dwac bd sung them (p < 0,05). Tuii trung binh kit thuc mgc rdng a nhdm tre dwac tdm ning hoac sdng a nai cd du dnh sang thi sdm han nhom trd khdng dwac tim ning (p < 0.01) Tdm lai. cdc yiu td anh hwdng din tudi bit diu moc rdng swa id cdn ndng cua tre khi sinh, sw bd sung them vitamin D. can xi cho trd Cdc yiu td anh hwdng din tudi kit thuc mgc rdng sCra Id dia dw. cdn ndng cua tre khi sinh. vide cho tre dn bd sung sdm. sw bd sung vitamin D va can xi cho trd, vide cho tri tim ning, diiu kidn dnh sdng nai d

TCr khoa: Tuoi moc rang, vitamin D, can nang khi sinh

(2)

I. DAT VAN Dt.

Tre em la mot ca t h i dang Idn va phat triln, vi vay tang trudng la mdt dac dilm sinh hoe ca ban cua tre em Nghien ciru tang trudng dugc xem la khoa hpc ca ban cita Nhi khoa [1], Tang trudng dtre em khdng chf bao gdm tang trudng v l t h i chit (chilu cao, can nang) va su phat tnln tam van ddng ma con su phat tnln cua cae ca quan dae biet la phat trien rang Cd tac gia eho ring mpc rang la bdng chirng chirng td dira tre phat tnln binh thudng [5] Qua trinh phat triln rang chju anh hudng cua rdt nhieu y l u t l nhu:

che dd dinh dudng (bao gdm ca viec eung d p cae vitamin va muli khoang), dieu kien kinh t l , mdi trudng, khl hau, y l u t l di truyln, cac dilu kien dia ly, trinh dd hpe van ciia me

O Viet Nam da ed mdt s l cdng trinh nghien ciru v l qua trinh phat triln t h i ehlt d tre em, ve benh cdi xuang do thilu vitamin D trong do cung de cap d i n phat t n l n rang [2]

Ngoai ra, trong nhirng cdng trinh nghien eiru ve bp rang ngudi, benh ly cua rang, cae tae gta nhu Nguyen Duang Hing, Trln Ngoc Thanh eung cd nghien ciru v l tuli mpe rang cua tre Tuy vay, nhirng cong trinh nghien ciru v l rang sCra cua tre em la rdt it nen d l tai nay dugc thuc hien vdi muc tieu: Nghien cifu mot s6 yeu td anh hwdng din tuoi moc rang ciia tre em a Ha Noi.

II. D 6 | TU'gNG VA PHU'aNG PHAP 1. Ddi tu-cng nghien CIFU

Tre em tir 6 thang d i n 42 thang tuoi hpc tai mdt so nha tre d Ha Ndi dugc chpn nglu nhien trong thdi gian tu 01/10/2010 d i n 15/04/2011.

Ndl thanh Quan Hoan Kilm (Trudng m^u giao 1-6); Quan Ba Dinh (tdp m l u giao Tho nau, trudng mdm non s l 5 Ngoc Ha) Quan o i n g Da (trudng mdm non San Ca, tnj'dng m i m non Tay San). Quan Thanh

Xuan (nha tre Khuang Trung. nha tre Mai Phuang), Quan Long Bien (trudng mam non Hoa Sua, trudng mam non Xi nghiep X22).

Quan c l u Gily (trudng mdm non Sao Mai) Ngoai thanh Gia Lam (nha tre Giang Cao, nha tre Ddng Du). Ddng Anh (nha tre ciia nha may c h l tao thilt bt dten Ddng Anh),

2. Phu'ang phap nghien cii-u: Nghien CLTU md ta cat ngang vdi cd mdu duac tinh theo edng thirc

n - / ' P ( ' - P '

Trong dd: n: ting so tre cdn dilu tra 2^(1 a/2)- Do tin cay ddi hdi, do ngudi nghien ciru can eir tren phan b l xac suit binh thudng (nghta la dp tin cay 95% thi Z = 1,96)

p tre cd tuli bat ddu mpc rang tir 6 - 9 thang chilm 62,62% [6]. q = 1- p;

d sai s l eho phep thudng gap (lly la 0,05)

Thay s l vao eong thire tinh dwac n = 370 Cach tinh tuli. Theo each tinh tuli eiia T6 chuc Y t l T h i gidl quy dinh tinh tuli trdn. Vi du, tre smh ngay 11/1/2010, nlu ngay dilu tra la 10/2/2010 thi tinh la tre duac 1 thang tull, edn n l u ngay dilu tra la 12/2/2010 thi tinh la tre dupe 2 thang tuol.

Tieu chudn lua chpn: Tre khoe.

Tieu chudn loai trir

Loai nhirng tre mac benh man tinh, benh bdm sinh, di truyln cd anh hudng d i n su phat tnln cua tre nhu benh tim mach, tre bj sirt mdl, hd ham Ieh. Tre cd van d l ve phat tnln tam van ddng nhu nhirng tre mae beah Down, bai nao, tre cd benh r l i loan npi tilt nhu suy giap trang.

Cae chl s l nghien ciru Tuoi moc rang su'a:

(3)

TCNCYH Phu tmung 80 (3A) - 2012

Tuoi bat dau mpe rang sira tinh theo thang tuli

Tuli k i t thiie mpc rang sira (hay la tuli mpc du 20 rang): tinh theo thang tull.

Cac yeu td anh hwdng:

- Dia du: Ndi thanh, ngoai thanh Ha Ndi.

- Can nang ctja tre khi smh:

Tre nhe can: can nang khi sinh < 2,5kg Tre binh thudng. can nang kht stnh >

2,5kg.

- Mua sinh: Theo cac thang trong nam.

- An b l sung sdm: cho tre an b l sung III. K^T QUA

1. Tudi trung binh moc rang sira theo gici.

Bang 1. Tuoi trung binh moc rang su'a

trude 4 thang.

- Cat su'a sdm: tre duac cal sira trudc 12 thang tuli.

- Dilu kien anh sang.

+ Dit anh sang ehan hoa, anh mat trdi chieu vao du?ac trong nha,

+ Thilu: nai sing Sm thdp, thilu anh m^t trdt, anh sang khdng chilu vao duac trong nha.

3. Xlf ly s6 lieu:

s l lieu dugc nhap vao may tinh, phan tich va xu ly bang phan mim thong ke EPI - INFO 6.04.

dja dU' va can nang khi sinh theo gidi, dia du> va can nang khi sinh

Oia du'

Can khi sinh

Nam NH P Noi thanh Ngo^i thanh

P Nhe can Binh thuong

P

Tu6i b^t 6ku mpc rang (thang) 7,03 ± 1,89 (n = 437) 7,04 ± 1,72 (n = 385)

p>0,05 7,01 ± 1,89 (n = 452)

7,07 ±1,71 (n=370) p < 0,05 7,73 ± 1,99 (n = 33) 7,01 ± 1,80 (n = 789)

p < 0,05

Tu6i ket thuc moc rang (thang) 26,21 ± 4,73 (n = 323) 26,01 ± 4,90 (n = 299)

p > 0,05 25,09 ± 4,86 (n = 343) 27,36 ± 4,44 (n = 279)

p < 0,05 27,96 + 4,73 (n = 25) 26,03 ± 4,80 (n = 597)

p < 0,05

Tu6i trung binh b i t 6ku va ket thuc moc rang o nhOng tre s6ng 6 npi thanh va a ngoai thanh gan nhu' tu'ong du'ong, khoang 7 thang tuoi. Tre em sflng trong khu vyc noi thanh Ha Noi co tuoi ket thuc moc rang su-a (trung binh la 25 thang tufli) som hon tre sorg o ngoai thanh (trung binh la 27 thang tuoi) Nhu-ng tre nhe can khi sinh co tufli moc rang va tufli kflt thuc moc rang su'a mupn hon tre sinh 6u can

2. Tuoi trung binh mpc rang sipa theo s6 con trong gia dinh, che dp an

Tre an sam som co tufli trung binh mpc rang va kit thiic mpc rang som hon so voi tre khong r'I to an sam s6m, Tre cai su'a som co tufli trung binh kSt thiic moc rang muon hon, tuy nhien su khac biet khong cfl y nghTa thong ke (p > 0,05).

(4)

Bang 2. Tufli trung binh mpc rang su'a theo sfl con trong gia dinh, ch§ dp an, trinh dp hpc v i n cua me

Sfl con trong gia dinh

An sam

Sua me

Con d^u long Con thu P 3dm < 4 thang

Sau 6 thang P

Du sij'a Cai su'a so'm

P

Tuoi b i t dau mpc rang (thang) 7,14 ±1,90 (n = 450)

6,91 ±1,69 (n = 372) p > 0,05 7,01 ±,88 (n = 287) 7,09 ± 1,69 (n = 535)

p>0,05 7,02 ± 1,79 (n=786) 7,24 ± 2,08 (n = 54)

p > 0,05

Tufli ket thlic moc rang (thang) 25,80 ± 4,85 (n = 338) 26,48 ± 4,74 (n = 284)

p > 0,05 25,71 ± 4,76 (n = 288 ) 25,81 ± 4,83 (n = 394)

p>0,05 26,11 ±4,79 (n = 586)

26,17 ± 5,07 (n = 36) p>0,05 3. Tudi trung binh moc rang su>a va viec sir dung thudc canxi, vitamin D va anh sang

Bang 3: Tudi trung binh moc rang si>a va viec siJ dung thudc canxi, vitamin D va anh sang

Che phim thuoc

Tam nang

Anh sang

Co vitamin D Khflng vitamin D P

Co canxi Khong canxi Co vitamin D va canxi Khong vitamin D va canxi Co Khong Du Thieu

Tuoi bat d i u mpc rang (thang) 6,76 ± 1,55 (n = 123) 7,29 ± 2,03 (n = 226)

p < 0,05 7,08 ± 1,70 (n = 180) 7,29 ± 2,03 (n = 226)

p > 0,05 6,83 ± 1,77 (n = 293) 7,29 ± 1,84 (n = 226)

p<0,05 6,99 ± 1,78 (n = 510) 7,09 ± 1,87 (n = 312)

p > 0,05 7,01 ± 1,75 (n = 785) 7,13 ± 1,82 (n = 37)

p > 0,05

Tuoi ket thuc mpc rang (thang) 24,81 ± 4,29 (n = 96) 27,74 ± 4,65 (n = 155)

p<0,01 26,51 ± 4,31 (n = 149) 27,74 ± 4,65 (n= 155)

p < 0,05 25,27 + 5,12 (n = 222) 27,74 ± 4,65 (n = 155)

p<0,01 25,66 ± 4,85(n = 371) 26,77 ± 4,68 (n = 251)

p<0,01 25,99 ± 4,79 (n = 587) 30,05 ± 3,67 (n = 35)

p<0,01 Tuoi trung binh bat ddu moc rang va tuit trung binh k i t thitc mpc rang d nhdm tre dugc b l sung them vitamin D va can xt hay chi vitamin D dan thuln sdm han so vdt nhom tre khdng dugc bo sung them (p < 0,05)

219

(5)

Nhung tufli trung binh ket thuc moc rang o nhom tre duoc tam ning hoac song o noi co du anh sang thi so'm hon nhom tre khong duoc tam nang (p < 0,01)

4. Tudi trung binh mpc rang su'a theo mua sinh 30

25

WIS

= 10 5 0

-tuoi bSttfSll moc rang -tuoik^tthUi;

moc rang

1 X 3

n

^{10 11 12}^IhajJij

Bieu do 1. Lien quan giiVa miia sinh va tudi trung binh moc rang siea Khong cd su khac biet v l tuot moc rang trung binh giu'a nhdm tre duae sinh ra vao mua ndng va nhdm tre sinh vao miia lanh

IV. BAN LUAN

Trong nghien ciru ciia chiing tdi, tuli mpc rang su-a eua tre (ca tuli bit ddu lln kit thiic mpc rang), trung binh tre bat dau moc rang sua khi dugc 7 thang tuoi va d i n 26 thang thi mpc dil 20 rang. Chiing tdi nhan thly khdng cd su khac biet v l tudi moc rang giua tre trai va tre gai (p > 0,05). Kit qua eiia chiing tdi phii hgp vdi kit qua ciia tae gia khae [3], Tuy nhien, theo tae gia Choi NK [7] nghien eiru tren nhdm tre Han QuIe thi tre trai cd tuli mpc rang sira sdm han d tre gal, Co le do phong tue tap quan d nudc nay con trai duac coi trpng han, nen tre trai duge hudng c h l dp eham sdc t i t han, ddy dii han va vi t h i tuli mpc rang d tre trai sdm han tre gai

Tull bat ddu mpe rang trung binh cita nhdm tre sing trong ndi thanh la 7,01 thang tuol va d nhom tre ngoal thanh la 7,07 thang tull. Chung tdt thly khdng cd su khae biet ed y nghia giCra hai nhdm tre nay (p > 0,05) K i t

qua nghien ciru cua chiing tdi phii hgp vdi nghien ciru cita Hitchcock NE [10], Nguyin Thi Y i n [6]. Trong nhirng thang ddu cita cupc sing, phln ldn cac tre d i u duae nudi dudng chii yeu bdng sOa me. Thanh phan cae chit dtnh dudng trong sira me la phii hgp va dii eho su phat t h i n binh thudng eiia tre trong nhung thang ddu. Trong sCra me ed dii vitamin D, ham lugng can xi va phospho phii hgp nhlt eho su hap thu t l i da cua tre Day la nhilrng chat rat c i n thilt va quan trgng trong qua trinh phat he xuang ciia tre ndi ehung va su mpe rang ndi heng Do vay, du tre sing d dau, nong thdn hay thanh phd, ndi hay ngoai thanh nhung n l u duac nuoi dudng bdng su'a me trong nhi>ng thang dau thi van ed du cac chit cdn thilt, tre ed t i c do phat triln gdn tuang duang nhu nhau.

Tudt kit thuc moc rang d nhdm tre sing trong not thanh la 25,09 thang tuli sdm han han so vdi nhdm tre song d ngoai thanh la 27,36 thang tudi vdi p < 0,05.

220

(6)

M l i lien quan gil>a tudi kit thuc mpc rang va dja du cung da duac Hitchcock N E [10]

va Nguyin Thi Yen [6] d l cap d i n . Theo Hit- chcock N.E (nghien cuu tren nhdm tre Aus- tralia) thi tull k i t thitc moc rang d tre em la nhu nhau glO-a cac vimg, nhung theo Nguyen Thi Y i n thi tre em d ndng thdn cd tudt kit thitc mpe rang mudn han tre em d thanh phi. Kit qua nghien ciru ciia chiing toi cho k i t qua phii hgp vdi nghien ciru ciia Nguyin Thi Y i n . O eac nudc phat triln thi su chenh lech v l dtlu kien kinh t l , cac dieh vtJ y t l giQ'a cac viing miln la khdng dang k l , nen du sing d ndng thdn hay thanh p h i tre diu nhan dwac su eham soe day du nhu nhau, d i u dugc hudng mdt c h l dd dinh dudng nhu nhau. O nudc ta giQ'a ndng thdn va thanh phi, tham chi la giira npi va ngoai thanh Ha Ndi da cd mdt sa chenh leeh rd rang ve dtlu kien kinh t l cung nhu eac dich vu trong dd bao gom ca y t l Trong not thanh, ngudi dan cd muc sing eao han, dilu kien v l mpi mat la t i t han. Do dd, tre em dugc hudng su quan tam cham sde t i t han, duac cung d p ddy du eae chat dinh dudng can thilt cho su phat triln Day cd le la ly do khiln cho tre em trong not thanh cd tudt kit thuc mpc rang sCra sdm han han nhdm tre d ngoal thanh

Nhdm tre cd can nang kht sinh thap (< 2,5 kg) bit ddu mpc rang su'a khi dugc 7,73 thang tuli mupn han so vdi nhdm tre sinh dit can (trung binh la 7,01 thang tuot) va tuli kit thitc mpe rang (trung binh 27,96 thang tudt) cung cham han so vdl nhdm tre dit can (trung binh 26,03 thang tuoi) vdi p < 0,05 Kit qua nghien ciru ciia chiing tdi phu hgp vdi Haddad A.E [9], Mdm rang sQ-a bat dau hinh thanh t u tudn thir 6 d i n tudn thu 8 ciia phdi, va d i n thang thir 8 cua thai nhi thi tat ca cae rang sCra da hinh thanh mot phln md cirng [5]. Nhung tre khi sinh ed can nang

thap ed nghTa dd la mdt tre de ra thilu thang hoac la tre bi thilu ehlt dmh dudng khi con la bao thai. N l u la tre de thilu thang thi mdt phan mo cirng eua rang v i n chua duge hinh thanh khi tre duac sinh ra Cdn nlu tre duac de ra dii thang nhung lai bi suy dinh dudng khi edn la bao thai thi nhQ'ng tich luy, lang dong can xi vao rang va xuang khi tre cdn la bao thai da bi thilu Do do, khi ra ddi tre cdn ed mdt thdi gian d l hoan thien phln md cirng va vi t h i thdl diem bat ddu mpc rang sua bi eham lat va that dilm kit thiie moc rang swa thi keo dai ra. Vl t h i , tuoi moc rang sira chju anh hudng bdi can nang cua tre khi sinh

Tuoi bit dau moc rang su'a trung binh eua nhdm tre duac sinh vao cac thang trong nam d i u x l p Xl' 7 thang tuli, khdng ed su khac biet giira cac nhdm tre. Cdn ve tuli kit thiic moc rang su'a tht tuy nhdm tre sinh vao cac thang 6, 7, 8 ed tuoi trung binh moc dii rang sdm han nhung su khac biet nay cung khdng cd y nghTa vdi p > 0,05

Tudi trung binh bat dau mpc rang su'a d nhdm tre dugc cho an sam sau 6 thang tuli va nhdm tre duae cho an sam sdm (trudc 4 thang tuoi) la g i n nhu nhau, khdng cd su khac biet giira hai nhdm (p > 0.05).

Ngay nay, t i c dd tang trudng eiia tre em nhanh han, tre em cd xu hudng phat tnln tit han do vay can nhilu chat dinh dudng han.

Theo Holman D,J [11] thi nhung tre bi nudi dudng kem cd tuli mpe rang muon han han so vdt nhirng tre dugc cham sde dii chdt.

Can phat cung cap dii ehlt dtnh dudng cho su phat tnln cita tre, d l i vdi su phat trten v l xuang va rang thi do la vitamin D va can xi.

Nhdm tre duac b l sung them vitamin D dan thuan cd that dilm bit ddu moc rang sdm han (trung binh 6,76 thang tuli) nhdm tre khdng dugc diing vitamin D (trung binh 7,29 thang tuli). Tuang t u nhu vay, nhdm tre 221

(7)

cd duac b l sung ca vitamin D va can xt cung cd tuoi bat ddu mpc rang trung binh sdm han nhdm tre khdng duae b l sung, su khac biet nay cd y nghTa thing ke-(p < 0,05)

Vitamin D la rdt mdt yeu to cin thilt va dong vat trd quan trpng trong qua trinh phat tnln he xuang va rang cua tre Viec bo sung eho tre vitamin D d l phdng va chOa benh edt xuang da duge nhilu tac gta nghien ciru [4]

va d i u cho thly kit qua kha quan Mpt trong nhii'ng bilu hien xem tre cd bi cdi xuang hay khdng la tre mpc rang stra dung tuoi hay cham moc rang Nghien ciru ciia chiing toi eho thly la tuli moc rang d tre (ea tuli bat ddu mpe eiling nhu tuli k i t thue moc rang) cd lien quan chat che vdi viec cho tre sir dung vitamin D (p < 0,01). nhdm tre duac b l sung vitamin D (dan thuln hay kem theo ca ean xi) cd tull moc rang sdm han c6 y nghTa Trong khi do, can xi cung la mdt ylu to quan trong cho SIJ' phat tnln xuang va rang d tre, la thanh phln ehinh trong elu triie cua rang nhung viec dimg them ean xi chi anh hudng d i n tull k i t thiic mpe rang su'a d tre va khdng ed Hen quan d i n tuoi bat dau moc rang, Cd le la do trong sua me eo d i y dii ean xl va phospho vdi ham luang phii hap, d l hap thu nen trong nhQ'ng thang ddu chi cdn bu su'a me la tre cd du luang ean xi cdn thilt ma khdng cdn phai b l sung them cac chl phim khac

Nhdm tre dugc t i m nang moc dii 20 rang sij'a sdm han han (trung binh 25,66 thang tuli) nhdm tre khdng dugc tam ndng (trung binh 26,77 thang tuli) vdi p < 0,01.

Tir lau ngudi ta 'da bilt la tam nang rat can cho sti* phat tnln eua tre dae biet la dli vdi xuang va rang vl anh nang mat trdi giiip chuyen tlln vitamin D sdn co d da thanh vitamin D d l ca t h i dung dugc [8]. Tre khong dwac tdm nang dong nghTa vdi viee tre se bi

thilu vitamin D, Do vay, tuli kit thiic mpc rang cua tre ed hen quan chat che vdl viec tre dugc tam nang (p < 0,01)

Nhdm tre song trong dieu kien dii anh sang thi tuli kit thiic moc rang sua sdm han nhilu (trung binh 25,99 thang tuli) so vdl nhdm tre sing trong dieu kien thilu anh sang (trung binh 30,05 thang tull) vdi p < 0,05.Tre song trong dilu kien nha d thilu anh sang mat trdi co nghTa ia da tre khdng dugc tilp xuc vdl anh nang mat trdi, chinh vi vay tre bl thilu vitamin D, giam qua trinh hip thu can xi d ruot va kha nang bi cdi xuang d nhdm tre nay la rat cao. Mot trong nhirng bilu hien ciia viec nay la tre cham moc rang.

V. KET LUAN

Cac yeu td anh huvyng den tuoi mgc rang su'a la: can nang eiia tre khi sinh, eho tre tam nang va b l sung them vitamin D, can XI eho tre

TAI LIEU THAIVI KHAO 1. Bp Mdn Nhi (2009). Su tang trudng t h i chit tre em Bai giang Nhi khoa tap 1, Nha xuat ban Yhoc- 1 1 - 2 8

2. Le Thj Hai (1985). Dac dilm lam sang va xet nghiem benh cdi xuang d tre suy dinh dudng Luan van tot nghiep bac sy npi trii, Trudng Oai hoc Y Ha Ndi,

3. Mai Oinh Hu'ng (1965). Vdn d l moc rang d tre em Viet Nam Ndi san Rang Ham Mat 15-25.

4. Nguyin Van Sen (2004). Nghien ciru cac ylu t l nguy ea cdi xuang dinh dudng d tre em dual 3 tuli tai mot s l viing nui phia Bac va hieu qua dieu tri bang vitamin D lilu thdp, Luan van tiln sy y hoc, Trudng Oai hoc Y Ha Npi

5. Trln Ngoc Thanh (1989). Mdt s l nhan xet v l phat triln ham rang su'a d tre em khu

222

(8)

vuc Ha Npi. Luan van thac sy y hoc, Trudng 9. Haddad AE, Correa MS (2005). The Oai hpc Y Ha Ndl relationship between the number of erupted

6. Nguyen Thj Yin (2004). Nghien ciru su tang trudng eua tre em tir khl sinh d i n 5 tudi va mpt s l y l u t l anh hudng Luan van

tiln sy y hpe, Trudng Oai hpc Y Ha Ndi ' ' ° - Hitchcock NE (1984). Australian Ion- pnmary teeth and the child's height and weight a eross-seetional study. J Clin Pediatr Dent, 29 (4) 357 - 362

gitudinal studies of time and order of eruption of pnmary teeth Community Dent Oral Epi- 7. Choi NK, Yang KH (2009). A study on

the eruption timing of primary teeth in korean demiol 32 (2) 123-126 children ASDC J Dent Child, 68 (4) 244-

249 11. Holman DJ, Jones RE (2005). Longi-

tudinal analysis of deeious tooth emergence' 8. Francis H, Glorieux (1991). Rickets. IV Covahate effects in Japanese children Nestle Nutrition Workshop Series, 21 1 - 9. Am J Rhys Anthropol, 126 (3) 352 - 358.

Summary

FACTORS RELATED TO TEETHING AGE

Development process a important issue of development In children There are many factors that influenced the development of children's teeth This study was conducted to find somes af- fect factors on teething age of 1444 healthy children with age from 6 months to 42 months in nursery school in Hanoi that were randomly selected during the period from 01/10/2010 to 15/04/2011. Results showed that 'children living In Hanoi city had an eruption of primary teeth (average 25 months) eadier than children living in the suburbs (average age 27). The low birth weight infants and age of eruption of primary teeth was later than normal birth weight babies.

Average age of primary teeth and the average age of the end teething infants who received ad- ditional vitamin D and can xium or vitamin D atone only were eadier than infants not added (p <

0.05). The average age of the end teething babies who had sunbathing or live in places with full light was earlier than other group (p < 0.01). In conclusion, the affect factors of average age of primary teeth were birth weight, additional vitamin D, canxium. The affect factors of average age of the end teething were geography, birth weight, the baby early complementary feeding, the supplements of vitamin D and canxium for children, sunbathing, sunlight in accommodation

Keywords: teeth age, vitamin D, birth weight

223