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Sandler, Stanley, William T. Bowers, William M. Hammond, and George MacGarrigle. "Black Soldier White Army: The 24th Infantry Regiment in Korea." Journal of Military History 61, no. 3 (July 1997): 647. http://dx.doi.org/10.2307/2954072.
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Christian, Garna L. "The Ordeal and the Prize: The 24th Infantry and Camp MacArthur." Military Affairs 50, no. 2 (April 1986): 65. http://dx.doi.org/10.2307/1987788.
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Miller, Laura L. "Book Review: Black Soldier, White Army: The 24th Infantry Regiment in Korea." Armed Forces & Society 24, no. 3 (April 1998): 469–72. http://dx.doi.org/10.1177/0095327x9802400312.
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Mikhaylov, Andrey. "The Military Route of 24th Infantry Division within the Troops of North-Western, Western and Northern Fronts. 1914-19172." Vestnik Volgogradskogo gosudarstvennogo universiteta. Serija 4. Istorija. Regionovedenie. Mezhdunarodnye otnoshenija, no. 5 (November 20, 2014): 22–31. http://dx.doi.org/10.15688/jvolsu4.2014.5.2.
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Park, Jisoo. "A historical evaluation of the Battle of Pyongyang in the Korean War through a tactical fault analysis." Journal of Advances in Military Studies 4, no. 1 (April 30, 2021): 61–82. http://dx.doi.org/10.37944/jams.v4i1.97.
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The purpose of this study is to consider the ‘Battle of Pyongyang’ of the I Corps during the Korean War from the historical point of view. This study argues that there are some limit to the U.N. military’s ‘Battle of Pyongyang’ that it failed to maximize the benefits of recapturing Pyongyang, the capital of North Korea. And this can be evidenced by some notable tactical faults that the 1 Corps has caused in ‘Battle of Pyongyang’. First, the I Corps (America’s First Corps) excessively delayed its time during the ‘Battle of Pyongyang’. Second, the 24th U.S. Infantry Division was excluded from the ‘Battle of Pyongyang’ and failed to concentrate its combat capabilities. Third, I Corps did not besiege the North Korean army, and North Korean could escape from Pyongyang. The I Corps was fiercely competitive to arrive in Pyongyang first, and failed to make efforts to contribute to higher-level operations. In conclusion, this study finds some lesson from the I Corps’s tactical faults behind the glory of ‘Battle of Pyongyang’.
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Vuralli, Dogus. "Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?" International Journal of Pediatrics 2019 (June 19, 2019): 1–7. http://dx.doi.org/10.1155/2019/4318075.
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Introduction. Hypocalcemia is a common metabolic problem in newborn period and infancy. There is consensus on the treatment of the symptomatic cases while the calcium level at which the treatment will be initiated and the treatment options are still controversial in asymptomatic hypocalcemia. Methods. This review article will cover hypocalcemia with specific reference to calcium homeostasis and definition, etiology, diagnosis, and treatment of hypocalcemia in newborn and infancy period. Results. Hypocalcemia is defined as total serum calcium <8 mg/dL (2 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L) for term infants or preterm infants weighing >1500 g at birth and total serum calcium <7 mg/dL (1.75 mmol/L) or ionized calcium <4 mg/dL (1 mmol/L) for very low birth weight infants weighing <1500 g. Early-onset hypocalcemia is generally asymptomatic; therefore, screening for hypocalcemia at the 24th and 48th hour after birth is warranted for infants with high risk of developing hypocalcemia. Late-onset hypocalcemia, which is generally symptomatic, develops after the first 72 h and toward the end of the first week of life. Excessive phosphate intake, hypomagnesemia, hypoparathyroidism, and vitamin D deficiency are commonest causes of late-onset hypocalcemia. Hypocalcemia should be treated according to etiology. Calcium replacement is the cornerstone of the treatment. Elementary calcium replacement of 40 to 80 mg/kg/d is recommended for asymptomatic newborns. Elementary calcium of 10 to 20 mg/kg (1–2 mL/kg/dose 10% calcium gluconate) is given as a slow intravenous infusion in the acute treatment of hypocalcemia in patients with symptoms of tetany or hypocalcemic convulsion. Conclusion. Since most infants with hypocalcemia are usually asymptomatic, serum total or ionized calcium levels must be monitored in preterm infants with a gestational age <32 weeks, small for gestational age infants, infants of diabetic mothers, and infants with severe prenatal asphyxia with a 1 min Apgar score of <4. The treatment of hypocalcemia should be initiated immediately in infants with reduced calcium levels while investigating the etiology.
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Ludington-Hoe, Susan, and Joan Swinth. "Kangaroo Mother Care During Phototherapy: Effect on Bilirubin Profile." Neonatal Network 20, no. 5 (August 2001): 41–48. http://dx.doi.org/10.1891/0730-0832.20.5.41.
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Purpose: To determine the safety and efficacy of allowing kangaroo mother care (KMC) one hour per day during the course of phototherapy using a fiberoptic phototherapy panel.Sample: Thirty premature infants, 30–35 weeks gestation, <2,500 gm, who required phototherapy. Infants were randomized into three groups: (1) infants who received traditional bank or spotlight phototherapy 24 hours per day, (2) infants who received traditional phototherapy 23 hours per day and for the 24th hour lay prone on a fiberoptic phototherapy panel, and (3) infants who received traditional phototherapy 23 hours per day and for the 24th hour were given KMC with a fiberoptic phototherapy panel held against their back.Outcome Variables: Nonparametric statistics were used for between-group comparisons on number of days of phototherapy, daily bilirubin decrement, and bilirubin profiles over the course of phototherapy.Results: Groups did not differ in the number of days of phototherapy or in daily mean bilirubin decrement. The bilirubin profile for the KMC group showed a more shallow descent than did the profiles for the other groups, but a significant difference in decline was present only on day 4 of treatment (p = .05).Conclusion: This pilot work suggests that KMC using a fiberoptic panel during phototherapy may be safe, but further study is needed.
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Içağasioğlu, Dilara, Hüseyn Çaksen, Idris Sütçu, and Ömer Cevit. "Serum C-Reactive Protein and Interleukin6 Levels in Neonatal Sepsis." Acta Medica (Hradec Kralove, Czech Republic) 45, no. 3 (2002): 111–13. http://dx.doi.org/10.14712/18059694.2019.65.
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In this article, we studied complete blood count, serum C-reactive protein (CRP) and interleukin (IL-6) levels in 30 newborn infants with sepsis at admission, in the 24th hour of admission and at the end of the treatment. Our purpose was to determine the relationship among these parameters in the early diagnosis of neonatal sepsis. In our study, there was not a significant difference in white blood cell (WBC) and thrombocyte count among the values of the first, 24th hour and end of therapy in the study group (P>0.05). However, there was not a significant difference in B/N ratio among the values at admission, 24th hour and end of therapy in the study group (P>0.05). Both serum CRP and IL-6 levels were found to be significantly higher than those of control subjects at the beginning (P<0.05). Similarly, the values obtained on the 24th hour were also elevated. However, at the end of therapy both decreased to normal level (P<0.05). Based on these data, we think that serum CRP levels only which is a simple method may be used in the diagnosis of neonatal sepsis. However, WBC and serum IL-6 levels may be useful to establish mortality, because there was a statistically significant difference for these parameters between the survivors and deaths (P<0.05).
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Mitoulas, Leon R., Jacqueline C. Kent, David B. Cox, Robyn A. Owens, Jillian L. Sherriff, and Peter E. Hartmann. "Variation in fat, lactose and protein in human milk over 24h and throughout the first year of lactation." British Journal of Nutrition 88, no. 1 (July 2002): 29–37. http://dx.doi.org/10.1079/bjn2002579.
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Fat in human milk is extremely variable and can represent up to 50 % of infant energy intake. To accurately determine milk composition and infant intake at 1 (n 17), 2 (n 17), 4 (n 17), 6 (n 15), 9 (n 6) and 12 (n 5) months of lactation, samples of fore- and hind-milk were collected from each breast at each feed over 24 h periods from an initial group of seventeen women. The content of fat in milk varied over 24 h, with a mean CV of 47·6 (SE 2·1) % (N 76) AND 46·7 (se 1·7) % (n 76) for left and right breasts respectively. The 24 h amounts of fat, lactose and protein in milk differed between women (P=0·0001), but were consistent between left and right breasts. Daily milk production differed between breasts (P=0·0001) and women (P=0·0001). Accordingly, amounts of fat (P=0·0008), lactose (P=0·0385) and protein (P=0·0173) delivered to the infant over 24 h also differed between breasts and women (P=0·0001). The energy content of milk and the amount of energy delivered to the infant over 24 h were the same between breasts, but differed between women (P=0·0001). The growth rate of a group of only six infants in the present study was not related to either the concentrations or amounts of fat, lactose, protein and energy in milk over the first 6 months of life. These results show the individuality of milk composition and suggest that only a rigorous sampling routine that takes into account all levels of variation will allow the accurate determination of infant intake of fat, lactose, protein and energy.
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Braun, MH, L. Bello-Espinosa, J. Appendino, J. Buchhalter, K. Mohammad, and M. Esser. "P.060 Utility analysis of continuous video EEG (cvEEG) monitoring during the treatment of hypoxic ischemic encephalopathy (HIE) in the NICU." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, s2 (June 2018): S31. http://dx.doi.org/10.1017/cjn.2018.162.
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Background: Therapeutic hypothermia (TH) improves the outcome in HIE but cvEEG is vital to detect any seizures that occur. Unfortunately, the costs associated with cvEEG can make it impractical. We studied outcomes in TH with the objective of optimizing the length of cvEEG required. Methods: Term infants with HIE were treated with 72 h of TH followed by 6 h of rewarming. cvEEG reports were quantified (background, sharp transients, seizures) and compared with pre and post-cooling variables to determine whether risk stratification was possible. Results: 25/78 infants had seizures during the TH, however, most seizures occurred early, with 7 infants seizing prior to cooling and 15 having their first seizure within 24h. Only 3 infants had their first seizure between 24-48h and none were recorded after. Novel seizures after 24h were brief and did not require treatment. EEG variables such as frequent sharp transients and first seizures within 24h were correlated with MRI abnormalities. Conclusions: For the majority of infants undergoing TH, 24h of cvEEG may be sufficient with few infants requiring longer than 48h. A combination of clinical variables (abnormal neurological exam) and EEG traits (frequency of discharges, seizures) can help to decide on the likelihood of seizures and length of EEG recording needed.
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Culley, Fiona J., Joanne Pollott, and Peter J. M. Openshaw. "Age at First Viral Infection Determines the Pattern of T Cell–mediated Disease during Reinfection in Adulthood." Journal of Experimental Medicine 196, no. 10 (November 18, 2002): 1381–86. http://dx.doi.org/10.1084/jem.20020943.
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Infants experiencing severe respiratory syncytial virus (RSV) bronchiolitis have an increased frequency of wheeze and asthma in later childhood. Since most severe RSV infections occur between the 8th and 24th postnatal week, we examined whether age at first infection determines the balance of cytokine production and lung pathology during subsequent rechallenge. Primary RSV infection in newborn mice followed the same viral kinetics as in adults but was associated with reduced and delayed IFN-γ responses. To study rechallenge, mice were infected at 1 day or 1, 4, or 8 weeks of age and reinfected at 12 weeks. Neonatal priming produced more severe weight loss and increased inflammatory cell recruitment (including T helper 2 cells and eosinophils) during reinfection, whereas delayed priming led to enhanced interferon γ production and less severe disease during reinfection. These results show the crucial importance of age at first infection in determining the outcome of reinfection and suggest that the environment of the neonatal lung is a major determinant of cytokine production and disease patterns in later life. Thus, simply delaying RSV infection beyond infancy might reduce subsequent respiratory morbidity in later childhood.
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Czosnykowska-Łukacka, Matylda, Barbara Królak-Olejnik, and Magdalena Orczyk-Pawiłowicz. "Breast Milk Macronutrient Components in Prolonged Lactation." Nutrients 10, no. 12 (December 3, 2018): 1893. http://dx.doi.org/10.3390/nu10121893.
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Human milk (HM) is the first dietary exposure in infancy and the best nutritional option for growth and healthy development of the newborn and infant. The concentrations of macronutrients, namely proteins, carbohydrates and lipids, change during lactation stages. HM has been studied extensively in the first 6 months of lactation, but there are limited data regarding milk composition beyond 1 or 2 years postpartum. The aim of our study was to describe longitudinal changes in HM macronutrient concentrations during the prolonged lactation of healthy mothers from the 1st to the 48th month. For the macronutrient content of milk of mothers breastfeeding for longer than 18 months, fat and protein increased and carbohydrates decreased significantly, compared with milk expressed by women breastfeeding up to 12 months. Moreover, the concentration of fat, protein and carbohydrates in HM over 2 years of lactation from the 24th to the 48th month remained at a stable level. However, analyzed macronutrients were positively (carbohydrate, r = 0.51) or negatively (fat, r = −0.36 and protein, r = −0.58) correlated with the amount of feeding. Our results create a greater potential for understanding the nutritional contribution of HM over 2 years of lactation and showed that the source of calories in breast milk for older children is mainly fat, while carbohydrates play a greater role in infant nutrition in the early stage. The observed changes of macronutrient concentrations from the 1st to the 48th month of lactation are probably related to the adaptation of milk composition to the increased energy demand of the intensively growing child.
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Kenner, Carole, and Carol Hetteberg. "Nursing Challenges in the Care of Very Low Birth Weight Infants (<1,000 Grams)." AACN Advanced Critical Care 5, no. 3 (August 1, 1994): 231–41. http://dx.doi.org/10.4037/15597768-1994-3002.
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It is not unusual for neonates to be born before the 24th week of gestation and weigh less than 1,000 g. These neonates are surviving to be transferred to a tertiary care center, and many are discharged eventually to home. When one considers that these infants arc only “half developed” by the standard 40-week gestational period, it is understandable that the challenges for nurses caring for them are enormous. In this article, the authors review gestational development and the critical care needs of this special neonatal population
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Grgić, Gordana, Elvira Brkičević, Dženita Ljuca, Edin Ostrvica, and Azur Tulumović. "Frequency of neonatal complications after premature delivery." Journal of Health Sciences 3, no. 1 (April 15, 2013): 65–69. http://dx.doi.org/10.17532/jhsci.2013.32.
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Introduction: Preterm delivery is the delivery before 37 weeks of gestation are completed. The incidence of preterm birth ranges from 5 to 15%. Aims of the study were to determine the average body weight, Apgar score after one and five minutes, and the frequency of the most common complications in preterminfants.Methods: The study involved a total of 631 newborns, of whom 331 were born prematurely Aims of this study were to (24th-37th gestational weeks-experimental group), while 300 infants were born in time (37-42 weeks of gestation-control group).Results: Average body weight of prematurely born infants was 2382 grams, while the average Apgar score in this group after the fi rst minute was 7.32 and 7.79 after the fifth minute. The incidence of respiratory distress syndrome was 50%, intracranial hemorrhage, 28.1% and 4.8% of sepsis. Respiratory distresssyndrome was more common in infants born before 32 weeks of gestation. Mortality of premature infants is present in 9.1% and is higher than that of infants born at term.Conclusions: Birth body weight and Apgar scores was lower in preterm infants. Respiratory distress syndrome is the most common fetal complication of prematurity. Intracranial hemorrhage is the second most common complication of prematurity. Mortality of premature infants is higher than the mortality of infants born at term birth.
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Alves, Jordana Queiroz Nunes, Juliana Frossard Ribeiro Mendes, and Maria de Lourdes Jaborandy. "Perfil nutricional e consumo dietético de crianças alérgicas à proteína do leite de vaca acompanhadas em um hospital infantil de Brasília/DF, Brasil." Comunicação em Ciências da Saúde 28, no. 03/04 (August 23, 2018): 402–12. http://dx.doi.org/10.51723/ccs.v28i03/04.282.
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Objetivo: Investigar o perfil do estado nutricional e do consumo dietético de crianças com alergia à proteína do leite de vaca de até três anos de idade acompanhadas em um hospital infantil de Brasília/DF, Brasil.Métodos: Trata-se de um estudo transversal descritivo e prospectivo. Foram aferidos o peso e a estatura das crianças para classificação do estado nutricional por meio das curvas da OMS para escore z. A caracterização e consumo das fórmulas infantis específicas para APLV foram coletados através de questionário e recordatório 24h. Verificou-se a contribuição calórico-proteica, de cálcio, vitamina D e ácidos graxos essenciais em relação às DRIs.Resultados: 76,5% eram recém-nascidos a termo, de parto cesária (73,5%) e com peso adequado ao nascimento (85,3%). Foram encontradas adequações em relação aos indicadores E/I (91,2%), P/I (88,3%), P/E (88,2%) e IMC/I (85,3%). 17,6% da amostra tiveram AME até 6 meses e 94,1% das crianças não estavam em aleitamento materno. A idade média de introdução alimentação complementar foi de 5,16 ± 1,47 meses e 54,5% receberam alimentação complementar antes de 6 meses. A porcentagem de crianças que transgrediram a dieta foi de 11,8%. A fórmula extensamente hidrolisada foi a mais utilizada (64,7%) e 5,9% não recebiam fórmula infantil. As porcentagens médias de contribuição das fórmulas infantis em relação às DRIs foram: 45,72% (EER), 80,21% (proteína), 76,9% (cálcio), 176,64% (vitamina D), 34,77% (w3) e 24,87% (w6).Conclusão: Os resultados do presente estudo apontam que o desmame e a introdução da alimentação complementar foi precoce nessa amostra. As fórmulas infantis utilizadas eram específicas para APLV e contribuíam para atingir as recomendações nutricionais para a idade. Os resultados sugerem que as fórmulas prescritas contribuem para o adequado estado nutricional dessas crianças. A educação continuada da população, a orientação nutricional e a dieta isenta de leite e derivados são necessários para evitar o impacto negativo da APLV em crianças.
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Dag, Zeynep Ozcan, Yuksel Işik, Yavuz Simsek, Ozlem Banu Tulmac, and Demet Demiray. "HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy." Case Reports in Obstetrics and Gynecology 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/582890.
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Preeclampsia is a leading cause of maternal mortality and morbidity worldwide. The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality for women and their infants alike. Hormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism including cerebral venous sinus thrombosis (CVST). Factor 5 leiden (FVL) is a procoagulant mutation associated primarily with venous thrombosis and pregnancy complications. We report a patient with FVL mutation who presented with CVST at 24th week of pregnancy and was diagnosed as HELLP syndrome at 34th week of pregnancy.
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Deming, Denise M., Kathleen C. Reidy, Mary Kay Fox, Ronette R. Briefel, Emma Jacquier, and Alison L. Eldridge. "Cross-sectional analysis of eating patterns and snacking in the US Feeding Infants and Toddlers Study 2008." Public Health Nutrition 20, no. 9 (March 20, 2017): 1584–92. http://dx.doi.org/10.1017/s136898001700043x.
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AbstractObjectiveTo explore eating patterns and snacking among US infants, toddlers and pre-school children.DesignThe Feeding Infants and Toddlers Study (FITS) 2008 was a cross-sectional national survey of children aged 6–47 months, weighted to reflect US age and racial/ethnic distributions. Dietary data were collected using one multiple-pass 24h recall. Eating occasions were categorized as meals, snacks or other (comprised of all feedings of breast milk and/or infant formula). The percentage of children consuming meals and snacks and their contribution to total energy, the number of snacks consumed per day, energy and nutrients coming from snacks and the most commonly consumed snacks were evaluated by age.SettingA national sample of US infants, toddlers and pre-school children.SubjectsA total of 2891 children in five age groups: 6–8 months (n 249), 9–11 months (n 256), 12–23 months (n 925), 24–35 months (n 736) and 36–47 months (n 725).ResultsSnacks were already consumed by 37 % of infants beginning at 6 months; by 12 months of age, nearly 95 % were consuming at least one snack per day. Snacks provided 25 % of daily energy from the age of 12 months. Approximately 40 % of toddlers and pre-school children consumed fruit and cow’s milk during snacks; about 25 % consumed 100 % fruit juice. Cookies were introduced early; by 24 months, 57 % consumed cookies or candy in a given day.ConclusionsSnacking is common, contributing significantly to daily energy and nutrient needs of toddlers and pre-school children. There is room for improvement, however, with many popular snacking choices contributing to excess sugar.
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Cosic-Cerovac, Natasa, Slobodanka Todorovic, Nebojsa Jovic, and Milica Prostran. "Hypoxic-ischemic encefalopathy: Clinical course and prognosis." Vojnosanitetski pregled 60, no. 3 (2003): 291–97. http://dx.doi.org/10.2298/vsp0303291c.
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Background. Establishing the value of neurological examination, and additional diagnostic methods (ultrasonography and magnetic resonance imaging of the brain) in the diagnosis and prognosis of hypoxic-ischemic encephalopathy and its treatment, tracking the clinical course, and making the prognosis of neurological development in newborn infants with hypoxic-ischemic encefalopathy. Methods. The group of 40 term newborn infants with suspected intrauterine asphyxia was examined. All the infants were prospectivelly followed untill the 3rd year of age at the Clinic for Neurology and Psychiatry for Children and Youth in order to estimate their neurological development and to diagnose the occurence of persistent neurological disorders. All the infants were analyzed by their gestational age and Apgar score in the 1st and the 5th minute of life. They were all examined neurologically and by ultrasonography in the first week of life and, repeatedly, at the age of 1, 3, 6, 9, 12, 18, as well as in the 24th month of life. They were treated by the standard methods for this disease. Finally, all the infants were examined neurologically and by magnetic resonance imaging of the brain in their 3rd year of age. On the basis of neurological finding infants were devided into 3 groups: infants with normal neurological finding, infants with mild neurological symptomatology, and infants with severe neurological disorders. Results. It was shown that neurological finding, ultrasonography and magnetic resonance imaging of the brain positively correlated with the later neurological development of the infants with hypoxic-ischemic encephalopathy. Conclusion. Only the combined use of these techniques had full diagnostic and prognostic significance emphasizing that the integrative approach was very important in the diagnosis of brain lesions in infants.
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Mitoulas, Leon R., Lyle C. Gurrin, Dorota A. Doherty, Jillian L. Sherriff, and Peter E. Hartmann. "Infant intake of fatty acids from human milk over the first year of lactation." British Journal of Nutrition 90, no. 5 (November 2003): 979–86. http://dx.doi.org/10.1079/bjn2003979.
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Despite the importance of human milk fatty acids for infant growth and development, there are few reports describing infant intakes of individual fatty acids. We have measured volume, fat content and fatty acid composition of milk from each breast at each feed over a 24h period to determine the mean daily amounts of each fatty acid delivered to the infant from breast milk at 1, 2, 4, 6, 9 and 12 months of lactation in five women. Daily (24h) milk production was 336·60 (sem 26·21) and 414·49 (sem 28·39) ml and milk fat content was 36·06 (sem 1·37) and 34·97 (sem 1·50) g/l for left and right breasts respectively over the course of the first year of lactation. Fatty acid composition varied over the course of the day (mean CV 14·3 (sd 7·7) %), but did not follow a circadian rhythm. The proportions (g/100g total fatty acids) of fatty acids differed significantly between mothers (P<0·05) and over the first year of lactation (P<0·05). However, amounts (g) of most fatty acids delivered to the infant over 24h did not differ during the first year of lactation and only the amounts of 18:3n-3, 22:5n-3 and 22:6n-3 delivered differed between mothers (P<0·05). Mean amounts of 18:2n-6, 18:3n-3, 20:4n-6 and 22:6n-3 delivered to the infant per 24h over the first year of lactation were 2·380 (sd 0·980), 0·194 (sd 0·074), 0·093 (sd 0·031) and 0·049 (sd 0·021) g respectively. These results suggest that variation in proportions of fatty acids may not translate to variation in the amount delivered and that milk production and fat content need to be considered.
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Duyan Camurdan, Aysu, Ufuk Beyazova, Gulendam Bozdayı, Fusun Civil, Aylin Altay Kocak, and Zeliha Guzelkucuk. "Waning Time of Maternally Derived Anti-Hepatitis A and Anti-Varicella Zoster Virus Antibodies." Journal of Pediatric Infectious Diseases 14, no. 03 (January 9, 2019): 116–20. http://dx.doi.org/10.1055/s-0038-1677484.
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Objective The objective of this study was to investigate the persistence of maternally derived antibodies to hepatitis A (anti-HAV) and varicella zoster (anti-VZV) viruses to determine the optimal time of vaccination of infants. Materials and Methods This study was conducted between 2011 and 2012 at the Gazi University Hospital. Blood samples were collected from healthy infants' cord blood and at 12th, 18th, and 24th months of age. Anti-HAV and anti-VZV immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies were measured by enzyme-linked immunosorbent assay kit in blood samples. Results A total of 546 infants and children were included in the study; all had blood samples taken at four time points (at birth [cord blood], and at 12, 18, and 24 months). Anti-HAV IgG seropositivity rates in these samples were 77.3, 29.6, 14.8, and 17.7%, respectively (p < 0.05). Corresponding anti-VZV IgG seropositivity rates were 83.3, 21.5, 29.5, and 33.8%, respectively (p < 0.05). Conclusion Anti-HAV and anti-VZV seropositivity rates were lowest at 18 and 12 months, respectively. We suggest that if VZV and hepatitis A vaccines were included in the national vaccination program after the age of 1 year, there should be little interference from passively acquired maternal antibodies.
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Stojanovic, Vesna, Nenad Barisic, Aleksandra Doronjski, Dorottya Csuka, and Zoltán Prohászka. "Hemolytic uremic syndrome complicating whooping cough." Srpski arhiv za celokupno lekarstvo 147, no. 1-2 (2019): 89–93. http://dx.doi.org/10.2298/sarh171207058s.
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Introduction. We shall present a case of a two-month old infant who has developed a haemolytic uremic syndrome as an atypical complication of Bordetella pertussis infection. The observation that the development of haemolytic uremic syndrome is a late complication of Bordetella pertussis infection may be a clue for further studies. Case outline. A two-month-old female infant was admitted to the hospital because of fever, intensive cough, shortness of breath and poor feeding. Real-time polymerase chain reaction (PCR) for Bordetella pertussis was positive. A macrolide was introduced in therapy. On the eighth hospital day, the infant?s condition improved, she became afebrile and eupneic. On the 16th hospital day, she developed signs of progressive respiratory distress and oliguric acute kidney injury. Hemolytic uremic syndrome (HUS) was diagnosed, so the therapy with the fresh frozen plasma (FFP) transfusion, therapeutic plasma exchange and peritoneal dialysis was initiated. Levels of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) were decreased, while the levels of factor H, factor B, and factor I were normal. Despite the full supportive and targeted care, severe multiple organ failure had developed and on the 24th hospital day the infant died. Conclusion. Further studies are necessary to identify the mechanism of potential interaction between pertussis toxins, pathophysiology of the infection and the interaction of complement activation, coagulation and the regulation of these cascades.
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Scott, P. H. "Plasma Lactoferrin Levels in Newborn Preterm Infants: Effect of Infection." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 26, no. 5 (September 1989): 412–15. http://dx.doi.org/10.1177/000456328902600506.
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Plasma lactoferrin was measured within 24h of birth in 23 preterm infants of between 24 and 36 weeks gestation. Lactoferrin concentrations fell with decreasing gestational age whilst the incidence of subsequent infection rose. Sequential measurements on a subgroup of 10 preterm infants showed that even when initial lactoferrin concentrations were within the range for term infants, they fell during the first week. Lactoferrin concentrations in preterm babies may rise transiently, such increases often being associated with clinical signs of infection. A rise in plasma lactoferrin of 200μg/L or more over a period of less than 48 h is suggestive of infection. These findings are discussed in terms of both the possible role oflactoferrin, and the clinical usefulness of the measurement.
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Zulala, Nuli Nuryanti, Mei Neni Sitaresmi, and Sulistyaningsih Sulistyaningsih. "INISIASI MENYUSU DINI MENJAGA KESTABILAN SUHU PADA BAYI BARU LAHIR." Media Ilmu Kesehatan 7, no. 1 (April 30, 2018): 51–59. http://dx.doi.org/10.30989/mik.v7i1.267.
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Background: Hypothermia contributes 6.3% to neonatal mortality. Interventions to keep newborns warm can reduce neonatal mortality by 18-42%. Early Breastfeeding Initiation (EBI) is a simple intervention that reduces the risk of neonatal death.
Objective: The aim of this study to determine the difference of axillary temperature of newborn between improper EBI group and proper EBI group for 24 hours.
Methods: This prospective cohort study was conducted at Aisyiyah Muntilan Hospital. Sixty-two healthy newborns from healthy mothers born in November 2016 who meet the inclusion and exclusion criteria. Subjects were grouped in improper EBI groups (n=32) and proper EBI groups (n=32). Axila temperature measurements were performed at 1st minute, 30th minute, 60th minute, 6th hour, 12th hour, 24th hour.
Results: The result of the hypotermic occurrence is more happened on improper EBI than proper EBI. EBI is able to prevent hypothermia during the first 24 hours of newborn life
Conclussions: Infants with proper EBI have a lower risk of hypothermia.
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Aquino, Rita de Cássia de, and Sonia Tucunduva Philippi. "Consumo infantil de alimentos industrializados e renda familiar na cidade de São Paulo." Revista de Saúde Pública 36, no. 6 (December 2002): 655–60. http://dx.doi.org/10.1590/s0034-89102002000700001.
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OBJETIVO: Descrever o consumo infantil de alimentos industrializados e a relação com a renda familiar per capita, com base em inquérito domiciliar. MÉTODOS: O consumo alimentar de uma amostra probabilística da população infantil residente na cidade de São Paulo, entre zero e 59 meses de idade (n=718), foi estudado em 1995/1996 por meio de inquérito recordatório de 24h. Analisou-se a relação entre o consumo de 24 alimentos industrializados e a renda familiar per capita, distribuída em quartis. RESULTADOS: O consumo de açúcar foi maior entre as crianças de menor renda, enquanto achocolatados, chocolates, iogurte, leite em pó modificado e refrigerantes foram mais consumidos por crianças de maior renda familiar per capita (p<0,05). CONCLUSÕES: Concluiu-se que a renda familiar per capita influencia o consumo de alguns alimentos industrializados.
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Nuryanti Zulala, Nuli, Mei Neni Sitaresmi, and Sulistyaningsih. "INISIASI MENYUSU DINI MENJAGA KESTABILAN SUHU PADA BAYI BARU LAHIR." MEDIA ILMU KESEHATAN 7, no. 1 (November 17, 2019): 51–59. http://dx.doi.org/10.30989/mik.v7i1.222.
Full textAbstract:
Background: Hypothermia contributes 6.3% to neonatal mortality. Interventions to keep newborns warm can reduce neonatal mortality by 18-42%. Early Breastfeeding Initiation (EBI) is a simple intervention that reduces the risk of neonatal death.
Objective: The aim of this study to determine the difference of axillary temperature of newborn between improper EBI group and proper EBI group for 24 hours.
Methods: This prospective cohort study was conducted at Aisyiyah Muntilan Hospital. Sixty-two healthy newborns from healthy mothers born in November 2016 who meet the inclusion and exclusion criteria. Subjects were grouped in improper EBI groups (n=32) and proper EBI groups (n=32). Axila temperature measurements were performed at 1st minute, 30th minute, 60th minute, 6th hour, 12th hour, 24th hour.
Results: The result of the hypotermic occurrence is more happened on improper EBI than proper EBI. EBI is able to prevent hypothermia during the first 24 hours of newborn life
Conclussions: Infants with proper EBI have a lower risk of hypothermia.
Keyword: Early Breastfeeding Initiation, Hypothermia, Newborn
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Hartikainen-Sorri, Anna-Liisa. "Is Routine Hospitalization in Twin Pregnancy Necessary? A Follow-up Study." Acta geneticae medicae et gemellologiae: twin research 34, no. 3-4 (October 1985): 189–92. http://dx.doi.org/10.1017/s0001566000004724.
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AbstractDuring the years 1979-1980, a prospective study was carried out to evaluate the value and efficacy of routine hospital bed rest in the prevention of premature birth and pregnancy complications in twin gestation. This was done by comparing hospital bed rest to special antenatal care at outpatient clinic. Since the results did not support the idea of using routine hospital bed rest, this was abandoned. Because the material was rather small, the results of the changed policy of management were controlled in the present follow-up study. The material consists of 102 twin pregnancies diagnosed during the years 1982-1983. The number of deliveries before the 34th gestational week and of < 1500 g weighing infants were still decreasing (9.0% and 3.0%). Perinatal mortality after the 24th gestational week was 2.0%. The follow-up study confirmed the unefficacy of routine hospital bed rest. Early diagnosis is the basis of the management of twin pregnancy. This allows counselling of the pregnant women, regular examinations to detect pregnancy complications, and also planning of the delivery.
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Shrestha, MK, M. Sherchan, BK Dhoubhadel, and RB Basnet. "Early Experience With Single-Stage Transanal Endorectal Pull Through For Rectosigmoid Hirschsprung’s Disease." Journal of Nepal Paediatric Society 34, no. 3 (April 7, 2015): 188–94. http://dx.doi.org/10.3126/jnps.v34i3.11617.
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On 24th August 2015, the spelling of the third author's name was changed from Dhaubhadel TO Dhoubhadel - Editor.Introduction: Recent trends in surgery for Hirschsprung’s disease (HD) have been towards earlier operation and fewer surgical stages. A single-stage transanal endorectal pull through (TEPT) is the latest development and minimally invasive technique for HD. This observational prospective study was designed to evaluate the safety and efficacy of single-stage TEPT technique in the management of rectosigmoid HD.Materials and Methods: Infants and children with biopsy-proved aganglionosis and barium enema (BE) documented rectosigmoid HD were included for single stage TEPT. Twenty children aged 22 days to 7 years (17 boys and 3 girls) underwent one stage TEPT over 5 year period. Median follow up was 18 months (range 6-36 months). These patients were evaluated with regard to age, sex, intraoperative details, postoperative functional outcome and complications and need for secondary surgical procedure.Results: The operating time was 105-180 minutes (mean 120 minutes). The length of resected bowel was 18-30 cm (mean 25 cm). Intraoperative blood loss was 5-40 ml, less in infants compared to older children. Blood transfusion was needed in none out of 12 infants and 2 out of 8 older children. Transient perianal excoriation occurred in 16 patients. Postoperative enterocolitis occurred in one patient. One patient developed constipation with encopresis following anastomotic stricture. None had adhesive obstruction and prolapse of pulled through colon, one required colostomy for anastomotic leakage and peritonitis while another had retained aganglionic segment and re-do pull through was required.Conclusion: Single-stage TEPT can be performed successfully in all age of children. The technique is safe, easily learned and has good clinical results.DOI: http://dx.doi.org/10.3126/jnps.v34i3.11617 J Nepal Paediatr Soc 2014;34(3):188-194
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Thymann, Thomas, Douglas G. Burrin, Kelly A. Tappenden, Charlotte R. Bjornvad, Søren K. Jensen, and Per T. Sangild. "Formula-feeding reduces lactose digestive capacity in neonatal pigs." British Journal of Nutrition 95, no. 6 (June 2006): 1075–81. http://dx.doi.org/10.1079/bjn20061743.
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The intestine of newborn pigs develops rapidly during the first days postpartum. We investigated if feeding milk replacer (infant formula) as an alternative to colostrum has compromising effects on nutrient digestive function in the neonatal period. Nineteen piglets born at termwere assigned to one of four treatments: (1) newborn controls; (2) natural suckling for 24h; (3) tube-fed formula for 24h; (4) tube-fed porcine colostrum for 24h. All three fed groups showed significant increases in small-intestinal and colonic weights, villous heights and widths, maltase and aminopeptidase A activities, and decreases in dipeptidylpeptidase IV activity, relative to newborn pigs. Following oral boluses of mannitol, lactose or galactose, formula-fed pigs showed significantly reduced plasma levels of mannitol and galactose compared with colostrum-fed pigs. Activity of intestinal inducible NO synthase and plasma levels of cortisol were significantly increased, whereas intestinal constitutive NO synthase and α-tocopherol were decreased in formula-fed pigs compared with colostrum-fed pigs. Although formula-fed pigs only showed minor clinical signs of intestinal dysfunction and showed similar intestinal trophic responses just after birth, as those fed colostrum, lactose digestivecapacity was markedly reduced. We conclude that formula-feeding may exert detrimental effects on intestinal function in neonates. Formula-induced subclinical malfunction of the gut in pigsborn at term was associated with altered NO synthase activity and antioxidative capacity.
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Seki, Keigo, Satoru Iwashima, Hiroki Uchiyama, Akira Ohishi, and Takamichi Ishikawa. "Successful Management of Pulmonary Arterial Hypertension by Monitoring N-Terminal Pro-B-Type Natriuretic Peptide Serum Levels in a Preterm Infant with Chronic Lung Disease: A Case Report." American Journal of Perinatology Reports 09, no. 02 (April 2019): e133-e137. http://dx.doi.org/10.1055/s-0039-1684026.
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AbstractWe measured the serial changes in N-terminal probrain natriuretic peptide (NT-proBNP) levels in a 6-month-old male infant with chronic lung disease (CLD) complicated by pulmonary arterial hypertension (PAH). The patient was born at the 24th week of gestation weighing 695 g. At 1 month after birth, an echocardiogram confirmed the diagnosis of CLD with PAH. He was treated with inhaled nitric oxide (iNO) and oral sildenafil and discharged from the hospital. At 190 days of age, the patient was readmitted to our department because of a viral upper respiratory infection. At 195 days of age, his respiratory condition worsened with pulmonary edema and his NT-proBNP level was determined to be 10,117 pg/mL. The patient was immediately administered iNO, and his respiratory condition improved, and NT-proBNP levels decreased. However, he experienced repeated severe cyanosis attacks. Before the attacks, his NT-proBNP level was > 1,000 pg/mL. Therefore, we continuously administered iNO until his NT-proBNP level decreased to < 1,000 pg/mL. We safely discontinued iNO administration at 473 days of age. In conclusion, serial change in NT-proBNP is a surrogate marker with prognostic value in patients with PAH associated with CLD.
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Ramos, Ianny Alves, Andreia Medeiros Rodrigues Cardoso, Rafaella Bastos Leite, Yuri Wanderley Cavalcanti, and Alessandro Leite Cavalcanti. "Efeito Inibitório de Dentifrícios Infantis Sobre o Crescimento de Bactérias Cariogênicas." Revista de Ciências Médicas e Biológicas 12, no. 3 (December 17, 2013): 274. http://dx.doi.org/10.9771/cmbio.v12i3.7892.
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<p class="MsoNormal" style="margin-bottom: .0001pt; text-align: justify; line-height: 150%;"><span style="font-family: 'Times New Roman', serif; font-size: small;"><span style="line-height: 24px;">Introdução: o uso de cremes dentais contendo flúor tem mostrado reduzir a incidência de cárie em diversos estudos clínicos. Objetivo: </span></span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">avaliar o efeito inibitório de dentifrícios infantis, comercialmente disponíveis, sobre Streptococcus mutans (ATCC25175), S. oralis </span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">(ATCC10557) e S. salivarius (ATCC25586). Metodologia: adotou-se uma abordagem indutiva com procedimento comparativo e técnica </span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">de observação direta em laboratório. A amostra compreendeu quatro dentifrícios infantis, a saber: Tandy®, Condor®, Even kids®, </span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">Bitufo Ben 10®. Adotou-se a Clorexidina a 2% como controle positivo. A atividade antibacteriana dos dentifrícios foi avaliada pela </span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">técnica de difusão em Agar em triplicata, na qual foram realizadas perfurações de 6mm no meio de cultura agar sangue e inseridos</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; text-align: justify; line-height: 150%;"><span style="font-family: 'Times New Roman', serif; font-size: small;"><span style="line-height: 24px;">os produtos testados. Após o período de incubação (24h, 37ºC), os halos de inibição do crescimento bacteriano, em milímetros, </span></span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">foram mensurados e analisados descritivamente. Resultados: sobre S. mutans, S. oralis e S. salivarius, o Diâmetro médio dos halos </span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">de inibição de crescimento, em mm, para cada dentrifício foi, respectivamente, 16, 16 e 15 (Condor®); 14, 14 e 13.66 (Even Kids®); </span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">13.34, 13.34 e 13 (Bitufo Ben); e, 13, 14.33 e 12.33 (Tandy®). A Clorexidina 2% apresentou atividade satisfatória frente às cepas </span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">testadas. Conclusão: todos os dentifrícios apresentaram atividade inibitória sobre as bactérias analisadas, porém o creme dental </span><span style="line-height: 24px; font-family: 'Times New Roman', serif; font-size: medium;">Condor Kids® apresentou os maiores halos de inibição microbiana.</span></p>
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Kriangkrai, Rungarun, Suconta Chareonvit, Sachiko Iseki, and Visaka Limwongse. "Pretreatment Effect of Folic Acid on 13-Cis-RA-Induced Cellular Damage of Developing Midfacial Processes in Cultured Rat Embryos." Open Dentistry Journal 11, no. 1 (March 31, 2017): 200–212. http://dx.doi.org/10.2174/1874210601711010200.
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Objective: Excess treatment of 13-cis-RA (Accutane®) on pregnant women induces craniofacial malformation found in infants. However, the effect of folic acid on 13-cis-RA-induced cellular damages of developing midfacial processes is still unknown. The purpose of this study was to investigate the pretreatment effect of folic acid (FA) on 13-cis-RA-induced cellular damage in developing midfacial processes in rat embryos. Materials and Methods: The rat embryos at developing midfacial processes were performed by whole embryo culture in vitro, in the presence of 13-cis-RA (20 µM) with or without pre-treatment of FA (100 µM). The midfacial morphogenesis score, PCNA and TUNEL assay staining were evaluated for morphogenesis, cell proliferation and apoptosis of the midfacial processes, respectively. Results: The 13-cis-RA-treated embryos at 24h showed atrophy of midfacial processes with significantly decreased morphogenesis score and cell proliferation, and increased apoptotic cell death. In contrast, the embryos pre-treated with FA for 18h, followed by 13-cis-RA treatment for 24h (FA-RA) showed significantly greater morphogenesis score, increased cell proliferation and lower apoptotic cell death compared to those of the 13-cis-RA-treated embryos. Conclusion: The results suggest that FA reduced the teratogenic effects of 13-cis-RA on midfacial process tissue. Future investigations regarding the anti-teratogenic mechanism of FA on the prevention of damages in midface processes induced by 13-cis-RA on pregnant woman are warranted.
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TRUOG, William E., Eugenia PALLOTTO, Perry CLARK, Beverly BANKS, Harold A. KAFTAN, Ikechukwu I. EKEKEZIE, Mike NORBERG, and Roberta A. BALLARD. "Interaction of endogenous endothelin-1 and inhaled nitric oxide in term and preterm infants." Clinical Science 103, s2002 (September 1, 2002): 294S—297S. http://dx.doi.org/10.1042/cs103s294s.
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The peptide endothelin-1 (ET-1) plays an unknown role in the pathogenesis and progression of two important neonatal pulmonary disorders, chronic lung disease (CLD) of prematurity and persistent pulmonary hypertension of the newborn (PPHN). Inhaled nitric oxide (INO) is a proven vasodilator therapy in PPHN and is an experimental therapy in CLD. We sought to determine the effects, if any, of the interaction of inhaled INO with ET-1 in these two separate disorders. Infants (n = 21) with PPHN (mean gestation age, 39.4 weeks; mean birth weight, 3470g) were treated with INO. All infants were <72h of age at baseline. Plasma obtained at baseline and after 24h of INO therapy was assessed for ET-1. The change in ET-1 levels with INO was inversely correlated with change in arterial partial pressure of O2 (r =-0.71, P = 0.0003). A separate group of 33 patients with CLD (mean gestational age, 27 weeks; mean birth weight, 740g; mean age, 19 days) had tracheal aspirate levels of ET-1 obtained before, during, and after 7 days' administration of INO. Values were normalized by soluble secretory component of IgA. Tracheal aspirate ET-1 levels were detectable before INO therapy. There was no significant change during or after treatment with INO. There was not a significant correlation between baseline fractional inspired O2 and ET-1 levels. There was a non-significant trend in the correlation between the change in ET-1 and the change in interleukin-8 levels in tracheal aspirate. This report confirms the presence of ET-1 in tracheal aspirate of premature infants who are developing CLD and reaffirms the presence of ET-1 in plasma of infants with PPHN. Short-term INO therapy was associated with a decrease in plasma ET-1 levels in PPHN, but did not affect tracheal aspirate ET-1 in CLD. Given the vasconstrictive, profibrotic, and proinflammatory properties of ET-1, specific ET-1 receptor antagonists could be considered as candidates for trials as adjunct therapy in either or both of these disorders.
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Massara, Paraskevi, Robert Bandsma, Celine Bourdon, Jonathon Maguire, Elena Comelli, Catherine Birken, and Charles D. G. Keown-Stoneman. "Outlier Detection in Growth Data: Beyond Biologically Implausible Values." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1174. http://dx.doi.org/10.1093/cdn/nzaa056_021.
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Abstract Objectives Eliminating anthropometry measurement error and employing outlier and biological implausible values (BIV) detection methods adapted to longitudinal measurements is important for the study of growth. This work aimed to review and assess the accuracy of the available BIV and outlier detection methods and propose a growth trajectory outlier detection method. Methods We included 2354 infants from the Applied Research Group for Kids (TARGet Kids! ) cohort-based in Toronto (ON, Canada) that recruits healthy children from birth to 5 years of age. We considered infants with at least 8 length and weight measurements available between the 1st and the 24th month of age. Weight-for-length z-scores (wflz) were calculated using the WHO growth standards. Outlier measurements were randomly introduced in 5% of the wflz measurements using a normal distribution (μ = 0, σ = 1). We employed 4 outlier detection methods; an empirical detection method for BIV using the cut-offs derived from the WHO Child Growth Standards, a clustering method, a method based on cluster prototypes for individual outlier measurements and a method based on cluster prototypes for entire growth trajectories. Each method was applied individually and evaluated using the sensitivity and specificity indexes based on the manually introduced outliers. We also calculated the Kappa statistic to evaluate the agreement of each method against the manual outliers. Results After excluding premature (<37 weeks), low birth weight (<1500 g) neonates and children with missing length and weight measurements, we analyzed 393 children with a total of 3144 measurements. Sensitivity and specificity for the four methods ranged between 4.4%–55.0% and 83.7% −99.7%, respectively, with kappa being non-significant (P > 0.05) only for the empirical. The clustering detection method reported a higher finding rate, while the empirical method found most of the BIV, but few of the rest of the outliers. Conclusions BIV account for a small portion of the possible outliers in growth datasets. We show that additional statistical or model-based methods are required for a more comprehensive outlier detection process, which has implications for growth analysis and nutritional assessment. Funding Sources Joannah and Brian Lawson Center for Child Nutrition, Connaught Fund, Onassis Foundation.
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SOARES, Nadia Tavares, Augusto Reinaldo Pimentel GUIMARÃES, Helena Alves de Carvalho SAMPAIO, Paulo César de ALMEIDA, and Roberta Ribeiro COELHO. "Padrão alimentar de lactentes residentes em áreas periféricas de Fortaleza." Revista de Nutrição 13, no. 3 (December 2000): 167–76. http://dx.doi.org/10.1590/s1415-52732000000300003.
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Este estudo caracterizou o padrão alimentar de 96 crianças menores de um ano assistidas pelo Fundo Cristão para Crianças nos bairros Álvaro Weyne e Presidente Kennedy, na cidade de Fortaleza, Brasil. Os dados foram levantados por meio de entrevista domiciliar, utilizando o método recordatório 24h para conhecimento das quantidades dos alimentos consumidos, e um formulário contendo perguntas estruturadas sobre a prática do aleitamento materno e idade de introdução dos alimentos de desmame. Os resultados indicaram que o aleitamento materno misto predomina (68%) sobre o aleitamento artificial (32%) e exclusivo (10%) e que 7% das crianças nunca receberam leite materno. Porém, até o final do décimo mês de vida, 53% das crianças ainda são amamentadas. Mingau lácteo, preparado com leite de vaca não modificado, constitui a alimentação básica de desmame. Do ponto de vista nutricional, as dietas são desbalanceadas, sendo o ferro o nutriente mais deficiente. Devem ser intensificados os esforços na promoção da alimentação infantil apropriada.
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Michelet, Robin, Johanna Melin, Zinnia P. Parra-Guillen, Uta Neumann, J. Martin Whitaker, Viktoria Stachanow, Wilhelm Huisinga, et al. "Paediatric population pharmacokinetic modelling to assess hydrocortisone replacement dosing regimens in young children." European Journal of Endocrinology 183, no. 4 (October 2020): 357–68. http://dx.doi.org/10.1530/eje-20-0231.
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Context: Accurate hydrocortisone dosing in children with adrenal insufficiency is important to avoid the risks of over and under treatment including iatrogenic Cushing’s syndrome and adrenal crisis. Objective: To establish a population pharmacokinetic model of hydrocortisone in children and use this to refine hydrocortisone replacement regimens. Design and methods: Pharmacokinetic study of hydrocortisone granules, available in 0.5, 1, 2 and 5 mg dose strengths, in 24 children with adrenal insufficiency aged 2 weeks to 6 years. Cortisol concentrations quantified by LC-MS/MS were used to refine an adult pharmacokinetic model to a paediatric population model which was then used to simulate seven different hydrocortisone treatment regimens. Results: Pre-dose cortisol levels were undetectable in 54% of the 24 children. The developed pharmacokinetic model had good predictive performance. Simulations for the seven treatment regimens using either three- or four-times daily dosing showed treatment regimens delivered an AUC0-24h within the 90% reference range for healthy children except in neonates where two regimens had an AUC below the 5th percentile. Cortisol concentrations at individual time points in the 24 h were outside the 90% reference range for healthy individuals in 50%, 55–65% and 70–75% for children, infants and neonates, respectively, with low cortisol levels being most prevalent. Conclusions: Current paediatric hydrocortisone treatment regimens based on either three- or four-times daily administration replicate cortisol exposure based on AUC0-24h, but the majority of cortisol levels are above or below physiological cortisol levels with low levels very common before the next dose.
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Carneiro, Liliane Almeida, Márcia Dalastra Laurenti, Marliane Batista Campos, Claudia Maria de Castro Gomes, Carlos Eduardo Pereira Corbett, and Fernando Tobias Silveira. "Susceptibility of peritoneal macrophage from different species of neotropical primates to Ex vivo Leishmania (L.) infantum chagasi-infection." Revista do Instituto de Medicina Tropical de São Paulo 54, no. 2 (April 2012): 95–102. http://dx.doi.org/10.1590/s0036-46652012000200007.
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This study examined the susceptibility of peritoneal macrophage (PM) from the Neotropical primates: Callithrix jacchus, Callithrix penicillata, Saimiri sciureus, Aotus azarae infulatus and Callimico goeldii to ex vivo Leishmania (L.) infantum chagasi-infection, the etiological agent of American visceral leishmaniasis (AVL), as a screening assay for evaluating the potential of these non-human primates as experimental models for studying AVL. The PM-susceptibility to infection was accessed by the PM-infection index (PMI) at 24, 72 h and by the mean of these rates (FPMI), as well as by the TNF-α, IL-12 (Capture ELISA) and Nitric oxide (NO) responses (Griess method). At 24h, the PMI of A. azarae infulatus (128) was higher than those of C. penicillata (83), C. goeldii (78), S. sciureus (77) and C. jacchus (55). At 72h, there was a significant PMI decrease in four monkeys: A. azarae infulatus (128/37), C. penicillata (83/38), S. sciureus (77/38) and C. jacchus (55/12), with exception of C. goeldii (78/54). The FPMI of A. azarae infulatus (82.5) and C. goeldii (66) were higher than C. jacchus (33.5), but not higher than those of C. penicillata (60.5) and S. sciureus (57.5). The TNF-a response was more regular in those four primates which decreased their PMI at 24/72 h: C. jacchus (145/122 pg/mL), C. penicillata (154/130 pg/mL), S. sciureus (164/104 pg/mL) and A. azarae infulatus (154/104 pg/mL), with exception of C. goeldii (38/83 pg/mL). The IL-12 response was mainly prominent in A. infulatus and C. goeldii which presented the highest FPMI and, the NO response was higher in C. goeldii, mainly at 72 h. These findings strongly suggest that these New World primates have developed a resistant innate immune response mechanism capable of controlling the macrophage intracellular growth of L. (L.) i. chagasi-infection, which do not encourage their use as animal model for studying AVL.
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Akter, Nasima, Soofia Khatoon, and Wahida Khanom. "Feeding Practices of Sick Newborns Admitted in Neonatal Ward of ICMH: Breast Milk as the Only Food." Bangladesh Journal of Child Health 35, no. 1 (April 16, 2012): 1–5. http://dx.doi.org/10.3329/bjch.v35i1.10365.
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Background: Breast milk is uniquely adopted most appropriate natural, preferred food for all infants including premature and sick newborns. It protects babies against many diseases and infections, better intelligence and greater academic achievement, lower risk for developing recurrent wheezing than children who were infant-formula fed. Objectives: The objective of the study is to see how early breast feeding could be started and when exclusive breast feeding could be established in admitted sick newborn. Materials and methods: This was a observational prospective study through a structured questionnaire conducted in Neonatal ward of Institute of Child and Mother Health. One hundred and sixty three sick newborns admitted in neonatal ward during November, 2005 to January, 2006 with weight more than 1200 gm, gestational age more than 32 weeks without major congenital anomaly were studied. Admitted babies were kept nill by mouth or nasogastric tube feeding and/or oral feeding as clinical condition permitted. Parenteral fluid was started as recommended daily fluid and gradually was advanced to oral or nasogastric tube feeding or spoon feeding of expressed breast milk as 1 to 3 hourly feeding which was individualized. During hospital stay, mothers were encouraged and motivated to breast feed and/or to expression of breast milk. Patients discharged when full breast feeding was established. Daily weight measurement and follow up were done after 7, 15, 30 days of discharge. Results: Among 330 admitted neonates, 163 were enrolled in this study. Mean age at presentation was 2.8 days. About one third of babies 55 (33.7%) had appropriate birth weight, seventy eight (47.8%) had perinatal asphyxia, and one third 55 (33.7%) had septicemia. Mean age of 1st feed was 2.9 days. Minimal and maximal days for initiation of breast feeding were 1st and 24th - day respectively. Mean days of full feeding was 3.6 days. About 67 (41%) of babies received and tolerated 1st feeding in between 24-72 hours and 48 babies (29.5%) in between 3rd-5th day. Out of 163 patients, weight gained in 22 (13%) babies during hospital stay. Average weight gain was 10 gram/day. Ninety two (55%) of study neonates needed assisted feeding with nasogastric tube. In spite of sickness breast feeding could be started in 22 (13.5%) neonates. Full feeding was established on 1st day in 44 (27%) of study neonates and in 80 (49%) neonates full feeding was established by 10 days. Expressed breast milk was from beginning in 66 (70%) of neonate. One hundred and thirty six neonates (83.4%) came for 1st follow up, 110 (67%) came for 2nd follow up, 144 (88%) babies came for 3rd follow up. Weight gain were found in 85%, 63.8%, 82% respectively. Conclusion: We can say from the present study that breast milk either by suckling or through nasogastric tube can safely be given to sick neonates under supervision and by that baby can maintained on normal weight gain. DOI: http://dx.doi.org/10.3329/bjch.v35i1.10365 BJCH 2011; 35(1): 1-5
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Silva, Sarah Nascimento, Marina Guimarães Lima, and Cristina Mariano Ruas. "Uso de medicamentos nos Centros de Atenção Psicossocial: análise das prescrições e perfil dos usuários em diferentes modalidades do serviço." Ciência & Saúde Coletiva 25, no. 7 (July 2020): 2871–82. http://dx.doi.org/10.1590/1413-81232020257.23102018.
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Resumo O objetivo deste artigo foi identificar o perfil dos usuários e a prescrição de medicamentos nos Centros de Atenção Psicossocial (CAPS) em uma região de Minas Gerais, Brasil. Foi realizado um estudo transversal em 11 CAPS de 5 diferentes modalidades. Dados sociodemográficos e informações sobre o uso de medicamentos foram obtidas por meio de entrevistas com os usuários, análise de prescrições e prontuários utilizando um formulário semiestruturado. O número médio de medicamentos prescritos por usuário dos CAPS foi de 3,38 (±1,76) e os valores foram 4,08 (±1,56), 3,54 (±1,64) e 2,00 (±1,66) para as modalidades de CAPS álcool e Drogas (CAPS ad), CAPS II e III e CAPS infantil, respectivamente. A classe terapêutica mais prescrita foi de antipsicóticos. Usuários que estavam na faixa etária economicamente ativa, frequentavam serviços de maior porte (24h) ou modalidade CAPS ad e relataram que já utilizaram os medicamentos de maneira inadequada, apresentaram maior prevalência de prescrições com 5 ou mais medicamentos. O uso de medicamentos nos CAPS diferiu segundo a modalidade do serviço, tendo sido observado um maior grau de utilização nos CAPS ad. As diferenças encontradas podem subsidiar a discussão de estratégias para a promoção do uso racional de medicamentos.
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Harrison, Natalie, Marion M. Bendixen, Josef Neu, Leslie A. Parker, and Graciela L. Lorca. "4052 A TL1 Team Approach to Personalization of Donor Human Milk for Preterm Infants." Journal of Clinical and Translational Science 4, s1 (June 2020): 91. http://dx.doi.org/10.1017/cts.2020.286.
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OBJECTIVES/GOALS: Feeding preterm infants with mother’s own milk (MOM) lowers rates of sepsis, decreases necrotizing enterocolitis, and shortens hospital stay. Our objective is to determine whether a similar microbial diversity to MOM can be obtained when fresh or frozen MOM is inoculated in donor human milk (DHM). METHODS/STUDY POPULATION: Subjects included 12 mothers of infants born 100ml of MOM per day and were excluded if they had taken antibiotics within 3 days of the 1-time pumped MOM sample collection. MOM sample was divided into fresh (processed immediately) and frozen (−20°C) for 24h fractions. MOM was inoculated in DHM [referred to as refaunated milk (RM)] at 10% (RM10) and 30% (RM30) dilutions, then incubated at timepoints: 0h, 2h, 4h at 37°C. At each timepoint, total viable microbial cell counts were performed in differential or selective media along with future 16S rRNA sequencing. RESULTS/ANTICIPATED RESULTS: Microbiota expansion was detected in MOM, RM10 and RM30 over time whether fresh or frozen milk was used as the inoculum. Incubated fresh and frozen MOM had similar bacterial loads when tested on nutrient agar (10^5-10^6 CFU/mL), mannitol salt (10^6 CFU/mL), MacConkey (10^2-10^5 CFU/mL), blood agar (10^6 CFU/mL) and MRS (10^4 CFU/mL) plates. Based on these CFU counts, RM30 incubated for 2h and RM10 at 4h showed similar counts to that of MOM at 0h. DISCUSSION/SIGNIFICANCE OF IMPACT: RM, inoculated with fresh or frozen MOM, obtained a similar microbial count compared to MOM at 0h indicates that fresh or frozen MOM can inoculate DHM. 16s rRNA sequencing is ongoing. Future studies are needed to support an inoculation protocol to be used in clinical practice and human milk banking.
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Supino, Carolina, Cristina Pacheco-Soares, and Newton Soares da Silva. "Effects of photobiomodulation on the growth of intestinal bacteria." Research, Society and Development 10, no. 8 (July 18, 2021): e56810817103. http://dx.doi.org/10.33448/rsd-v10i8.17103.
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Necrotizing enterocolitis is an inflammatory bowel disease that occurs in newborns, more commonly in preterm infants. It is the leading cause of death from gastrointestinal diseases in neonates, and is characterized by the development of diffuse intestinal necrosis in premature infants subjected to stress. The high incidence and lack of effective treatment strategies suggest that new approaches to treating the disease are needed. It is in this context that the possibility of using photobiomodulation as a therapeutic modality arises. However, studies on the use of photobiomodulation in intestinal bacteria are scarce. To study the effect of photobiomodulation used in clinical parameters on the growth of bacteria commonly present in the newborn microbiota. Four strains of bacteria were chosen to be studied, two belonging to healthy intestinal microbiota, Lactobacillus acidophilus and Lactobacillus reuteri, and two pathogenic bacteria, Escherichia coli and Staphylococcus aureus. These bacteria were cultivated in planktonic growth and irradiated with LED at a wavelength of 660 nm and a power density of 0.025 W/cm2, at fluences of 1, 5 and 10 J/cm2. The evaluation of cell growth was performed through absorbance readings in the periods of 4h, 24h and 48h after irradiation. The growth of L. acidophilus, L. reuteri and S. aureus did not undergo biomodulation in any of the fluences. The growth of E. coli was stimulated at 1 J/cm2 when compared to the Control group, with statistical significance (p<0.005). In the other fluencies there was no biostimulation for the E. coli bacteria. The use of a wavelength of 660 nm in the fluences of 5 J/cm2 and 10 J/cm2 in the studied bacteria did not lead to a significant change in the growth rate.
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Heazell, Alexander E. P., Christopher J. Weir, Sarah J. E. Stock, Catherine J. Calderwood, Sarah Cunningham Burley, J. Frederik Froen, Michael Geary, et al. "Can promoting awareness of fetal movements and focusing interventions reduce fetal mortality? A stepped-wedge cluster randomised trial (AFFIRM)." BMJ Open 7, no. 8 (August 2017): e014813. http://dx.doi.org/10.1136/bmjopen-2016-014813.
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BackgroundIn 2013, the stillbirth rate in the UK was 4.2 per 1000 live births, ranking 24th out of 49 high-income countries, with an annual rate of reduction of only 1.4% per year. The majority of stillbirths occur in normally formed infants, with (retrospective) evidence of placental insufficiency the most common clinical finding. Maternal perception of reduced fetal movements (RFM) is associated with placental insufficiency and increased risk of subsequent stillbirth.This study will test the hypothesis that the introduction of a package of care to increase women's awareness of the need for prompt reporting of RFM and standardised management to identify fetal compromise with timely delivery in confirmed cases, will reduce the rate of stillbirth. Following the introduction of a similar intervention in Norway the odds of stillbirth fell by 30%, but the efficacy of this intervention (and possible adverse effects and implications for service delivery) has not been tested in a randomised trial.MethodsWe describe a stepped-wedge cluster trial design, in which participating hospitals in the UK and Ireland will be randomised to the timing of introduction of the care package. Outcomes (including the primary outcome of stillbirth) will be derived from detailed routinely collected maternity data, allowing us to robustly test our hypothesis. The degree of implementation of the intervention will be assessed in each site. A nested qualitative study will examine the acceptability of the intervention to women and healthcare providers and identify process issues including barriers to implementation.Ethics and disseminationEthical approval was obtained from the Scotland A Research Ethics Committee (Ref 13/SS/0001) and from Research and Development offices in participating maternity units. The study started in February 2014 and delivery of the intervention completed in December 2016. Results of the study will be submitted for publication in peer-reviewed journals and disseminated to local investigating sites to inform education and care of women presenting with RFM.Trial registration numberwww.clinicaltrials.govNCT01777022.VersionProtocol Version 4.2, 3 February 2017.
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Falcão-Gomes, Renata Couto, Andréa Araciaba Soares Coelho, and Bethsáida de Abreu Soares Schmitz. "Caracterização dos estudos de avaliação do consumo alimentar de pré-escolares." Revista de Nutrição 19, no. 6 (December 2006): 713–27. http://dx.doi.org/10.1590/s1415-52732006000600008.
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Os estudos dietéticos fornecem elementos elucidativos que contribuem para a compreensão da dinâmica e determinação dos diversos agravos nutricionais que atingem a população infantil. As investigações do consumo alimentar de crianças pequenas utilizam os mesmos métodos de inquéritos empregados nas demais faixas etárias, diferenciando-se pela necessidade de um respondente, geralmente um dos pais ou o cuidador da criança. O objetivo do trabalho foi identificar os principais métodos de avaliação do consumo alimentar utilizados nos inquéritos com pré-escolares, assim como os itens e formas de análise mais comumente empregados. Verificou-se que os estudos apresentaram baixa comparabilidade, em função, entre outros fatores, do uso de diferentes formas de análise e metas de ingestão. O recordatório de 24h foi o método mais utilizado, geralmente associado a um outro método de inquérito. Ainda são poucos os estudos que empregam as novas cotas dietéticas de referência para avaliação da adequação das dietas. No Brasil, assim como nos demais países em desenvolvimento, os estudos ainda priorizam as carências nutricionais. Apesar do aumento no número de estudos brasileiros nos últimos anos, as pesquisas existentes são de limitada comparabilidade, sendo essencial que se invista em uma estrutura (tabelas, softwares, seleção de indicadores) que possibilite um diagnóstico nutricional mais fidedigno e com potencial de comparação.
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KUWAKI, Tomoyuki, Toru ISHII, Kihwan JU, Masashi YANAGISAWA, and Yasuichiro FUKUDA. "Blood pressure of endothelin-3 null (-/-) knockout mice and endothelin A receptor null (-/-) knockout mice under anaesthesia." Clinical Science 103, s2002 (September 1, 2002): 48S—52S. http://dx.doi.org/10.1042/cs103s048s.
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Blood pressure (BP) and heart rate (HR) in endothelin-3 (ET-3) null (-/-) knockout mice and ETA receptor (-/-) mice were measured using the servo null pressure measuring technique under halothane anaesthesia. In infant ET-3 (-/-) mice (2–3 weeks old), mean BP and HR were 55±2mmHg and 436±30beats/min respectively. These values were not different from those in age-matched wild-type mice (53±3mmHg and 430±18beats/min respectively). Baroreflex sensitivity, which was calculated as the slope of the relationship between systolic BP and RR interval on an ECG, was also similar in ET-3 (-/-) mice (0.84±0.20ms/mmHg) and wild-type mice (1.07±0.38ms/mmHg). ETA receptor (-/-) mice were obtained by caesarean section on the expected day of delivery and tracheotomized, so that they would live for more than 24h. Mean BP and HR in ETA receptor (-/-) mice were 15±1mmHg and 333±6beats/min respectively. These values were not different from those in age-matched, similarly treated wild-type mice (16±3mmHg and 308±10beats/min respectively). Baroreflex sensitivity in the newborn ETA receptor (-/-) mice (0.45±0.15ms/mmHg) and wild-type mice (0.31±0.06ms/mmHg) were very low compared with the values in infant wild-type mice, but not different between the mutant mice and their littermates. Moreover, HR in awake ETA receptor (-/-) mice (396±13beats/min) was not different from that in wild-type mice (409±13beats/min). These results show that the ETA receptor and ET-3 are not involved in cardiovascular regulation, at least during the very early life of the mice. A possible involvement of the ETA receptor in BP regulation, if any, seems to occur at later times and/or in some pathological settings.
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Donay, Adriana Pinheiro, Giliane Fraga Monk, Camila Irigonhé Ramos, Josiane Da Cunha Luçardo, Juliana Dos Santos Vaz, and Sandra Costa Valle. "Adesão a um protocolo de intervenção nutricional para crianças e adolescentes com transtorno do espectro autista." Saúde e Desenvolvimento Humano 8, no. 3 (September 2, 2020): 17. http://dx.doi.org/10.18316/sdh.v8i3.6636.
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Objetivo: avaliar a adesão às orientações nutricionais de um protocolo de intervenção nutricional individualizado a crianças e adolescentes com transtorno do espectro autista. Métodos: estudo longitudinal realizado em um ambulatório de nutrição infantil com pacientes do espectro autista, de 3 a 18 anos incompletos, de ambos os sexos. Foi realizado um questionário para obter dados sociodemográficos da família e do paciente, aferidos o peso e altura e realizadas orientações nutricionais baseadas em recordatório de 24h. Em consulta subsequente foi aplicado um checklist para avaliar a adesão as orientações referentes a redução do consumo de alimentos marcadores de má qualidade nutricional (bebidas açucaradas; frituras, salgadinhos de pacote, macarrão instantâneo, açúcares e guloseimas, carnes processadas e biscoitos doce). A comparação entre as frequências das orientações realizadas e as alcançadas foi analisada por meio do teste de Fisher. Adotou-se um erro alfa aceitável de 5%. Resultados: as orientações mais frequentes foram para redução de bebidas adoçadas, frituras e carnes processadas, representando 63%, 28% e 22% respectivamente. A frequência de adesão às orientações variou de 50% a 80%, correspondendo a 63%, 80% e 88% para bebidas adoçadas frituras e carnes processadas. Conclusão: a taxa de adesão às orientações propostas no protocolo foi satisfatória, mostrando que uma orientação nutricional direcionada ao ajuste do consumo de alimentos de baixa qualidade nutricional poderá ser efetiva e contribuir na prevenção de agravos à saúde em indivíduos do espectro autista.
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Hien, Alain, JW Some, IT Traore, C. Meda, B. Traore, and I. Savadogo. "Knowledge, attitudes and practices of mothers and caregivers on infant and young child feeding in peri-urban zones of Bobo-dioulasso in Burkina Faso." African Journal of Food, Agriculture, Nutrition and Development 20, no. 06 (October 31, 2020): 16703–16. http://dx.doi.org/10.18697/ajfand.94.19820.
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Knowledge, attitudes and practices(KAP) of mothers/caregivers on infant and young child feeding are key factors for optimal nutritional status, health and growth of the children. A community-based, cross-sectional descriptive study was conducted during January 2017 to assess the knowledge, attitudes and practices on infant and young child feeding (IYCF) of mothers/ caregivers who lived in peri-urban areas of Bobo-Dioulasso, Burkina-Faso.This study was carried out before a nutrition education-based intervention and included 245 mothers/ caregivers that were randomly selected in the peri-urban communities of Bobo-Dioulasso. A semi-structured interviewer-administered questionnaire developed based on Food and Agriculture Organization knowledge, attitudes and practices assessment method was used to collect KAP and socio-economic data. Analyses were performed using SPSS version 20. For this study, authorization was obtained from the regional directorate of health of the Hauts-Bassins region. Verbal consent was obtained after the participants had been informed about the study objectives. Among the 245 study participants, 55.1% were aged less than 30 years. More than 3 out of 4 mothers/caregivers (76.3%) were Muslim and 59.2% of them were illiterate. Almost all mothers/caregivers (98.8%) had adequate knowledge for breastfeeding and 87.9% of them knew about exclusive breast feeding up to 6 months. In addition, 91.8% of mothers/caregivers reported that they gave colostrum at birth. Furthermore, 67.5% of the mothers started breastfeeding within one hour after delivery. Based on mothers/caregivers’ report on complementary foods consumed by 6-59 months children in the previous 24h before the interview, cereals were the most reported consumed food group (89.8%) followed by meat and fish products (28.6%). This study found that mothers/caregivers had adequate knowledge about IYCF in general. However, mothers/caregivers’ practice of complementary feeding was inappropriate. Cereals were the food group consumed by most of children aged 6-59 months raising the needs for interventions, such as cooking demonstrations during postnatal visits in health facilities,to improve complementary feeding in this population.
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Ibañez, Jose F., Irimar P. Posso, and Verena Wallace. "Interference of age and repetition of the same noxious stimulus on hyperalgesia." Pesquisa Veterinária Brasileira 30, no. 9 (September 2010): 777–82. http://dx.doi.org/10.1590/s0100-736x2010000900011.
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Pain in animals has been recognized for less than one century. Several authors confirm that animals are capable to process, register and modulate nociceptive stimuli in a very similar way to human kind and there are several evidences registering the impact of pain sensation over vital systems interfering on disease outcome. Nevertheless, despite some evidences that animals, as human beings, can store information from past painful experiences less is known about how this so called pain memory works. The aims of this study were: to evaluate if the response to a painful stimuli differs during different stages of life and if repetition of a same acute stimuli in the same animal interferes with expression of hyperalgesia. Thus, 60 rats were selected and arranged in 3 equal groups: 3 months, 6 months, and 9 months of age. All animals were injected 5% formalin solution in the plantar face of hind paw under volatile general anesthesia. Von Frey filaments were applied at 1h, 24h and 48h after sensitization. Injection was repeated twice with a 30-day interval, each time in a different hind paw. Results showed that younger rats express lower hyperalgesia thresholds in the first stimulation compared to elder animals and that repetition of same stimulus diminishes hyperalgesia thresholds when it begins during infant period and augments hyperalgesia thresholds when it begins during elder ages.
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Veal, Gareth J., Julie Errington, Ghada Malik, Christopher R. Hill, and Alan V. Boddy. "Investigating the pharmacokinetics and dosing of anticancer drugs in infants and young children." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 10033. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.10033.
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10033 Background: Dosing regimens for anticancer drugs administered to infants and young children frequently differ between tumour types and protocols, with dosing based on body weight commonly implicated. We have recently highlighted a reduced exposure to 13-cis-retinoic acid in neuroblastoma patients <12kg dosed on body weight (Clin Cancer Res19:469-79,2013). Given the toxicity observed with many chemotherapeutics, it is appropriate to establish a pharmacological basis for dose adjustments implemented in younger patients. Methods: The pharmacokinetics of cyclophosphamide (CPA), actinomycin D (Act D), carboplatin and etoposide were investigated in children aged 0-6, 6-12 and 12-24 months. CPA was administered i.v. at a dose of 100-1,500 mg/m2, with infusion times up to 1.5h, Act D as a bolus i.v. infusion of 0.4-1.5mg/m2, carboplatin as an i.v. dose of 3.8-30mg/kg over 1-4h and etoposide as an i.v. dose of 3.5-14mg/kg over 1-6h. Eighty-six children were studied at 14 centres, with PK sampling carried out over 24h for CPA and Act D, 3h for carboplatin and up to 6h for etoposide. Plasma concentrations of CPA, Act D and etoposide were determined by LC-MS analysis, with carboplatin concentrations determined in plasma ultrafiltrate by AAS. PK parameters were calculated using WinNonlin or previously used PK models as appropriate. Results: Clearance values normalized to body weight ranged from 0.5-7.7 ml/min/kg for CPA, 1.7-17.4 for Act D, 1.6-10.5 for carboplatin and 0.2-1.7 for etoposide. No significant differences in normalized clearance were observed between the defined age cohorts of 0-6, 6-12 and 12-24 months and the data do not indicate clear differences in drug handling in infants and young children. However, when normalized clearance values were compared to data from older children, a greater degree of inter-patient variation was observed in patients <2 years than in children >2 years for all drugs. Conclusions: While normalized clearance values for the drugs studied do not support reduced dosing approaches, data suggest that individual drug clearance values may be more difficult to predict in younger patients. Further studies involving additional anticancer drugs may allow more rationale approaches to dosing. Clinical trial information: NCT00897871.
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Guo, JiaLin, Min Wu, Xi Gao, JingSi Chen, ShuGuang Li, Bo Chen, and RuiHua Dong. "Meconium Exposure to Phthalates, Sex and Thyroid Hormones, Birth Size and Pregnancy Outcomes in 251 Mother–Infant Pairs from Shanghai." International Journal of Environmental Research and Public Health 17, no. 21 (October 22, 2020): 7711. http://dx.doi.org/10.3390/ijerph17217711.
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Phthalates are hormonally active pollutants. In-utero exposure to phthalates has been reported to be associated with birth size parameters and pregnancy outcomes. However, previous reports were inconsistent. We examined the associations between meconium exposure to phthalates and the effects on birth size parameters, pregnancy outcomes and sex and thyroid hormones in 251 mother–infant pairs from a Shanghai hospital. We measured 10 metabolites of phthalates in meconium samples collected during the first 24h after delivery. Information on seven birth size parameters (birth weight, birth length, abdominal circumference, head circumference, femur length, biparietal diameter and anogenital distance) and three pregnancy outcomes (gestational diabetes, premature rupture of membrane, and premature birth) was available from the birth record. Concentrations of free testosterone, estradiol (E2), thyroid stimulating hormone, concentrations of total and free thyroxine and triiodothyronine were measured from cord blood. Multivariate linear regression and logistic regression were used to estimate associations between phthalate exposure and health outcomes. mono-iso-butylphthalate (MiBP), mono-n-butylphthalate (MnBP) and mono-2-ethyl-5-oxohexyl phthalate (MEOHP) were positively associated with birth length and femur length which seemed more obvious in female newborn; MiBP, MnBP and mono-2-ethylhexylphthalate (MEHP) were positively associated with gestational diabetes mellitus (GDM) only in mothers with male newborns; monomethyl phthalate (MMP), MiBP and MEOHP were positively associated with E2 in male newborns. This study indicates that meconium exposure to phthalates may adversely affect some fetal growth parameters and GDM with a potential gender effect.
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Morris, Stephen, Kimberly Mak, and Rebecca Lisseter. "P38 An audit of antibiotic use in the treatment of neonatal necrotising enterocolitis (NEC): what do we use and how long for?" Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e26.2-e27. http://dx.doi.org/10.1136/archdischild-2020-nppg.47.
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IntroductionNecrotising enterocolitis (NEC) is a serious condition in premature infants involving inflammation, and potentially necrosis, of the bowel. Several contributory factors have been identified; including prematurity, infection and reduced gut perfusion. 1 It has previously been reported that there is widespread variation in the treatment of NEC 2, including the use of antibiotics. 3 This is due to a lack of evidence evaluating which treatment option is most effective.Optimising the use of antibiotics for treating NEC is an opportunity to support the wider, global initiative of antimicrobial stewardship.4 Ensuring we use only the necessary course of antibiotics will reduce the spread of resistance and lower risks of potential adverse effects. Our local NEC treatment guideline states that the first line antibiotic regimen should be amoxicillin, gentamicin and metronidazole for up to 10 days treatment.AimThe aim of our audit was to identify the type of antibiotics and the duration of therapy used to treat NEC within a single UK tertiary children’s hospital providing neonatal intensive care and neonatal surgery.MethodsA retrospective audit was conducted over a five month period between August and December 2018. The neonatal database (Badger®) was used to identify patients with a confirmed diagnosed of NEC. Our electronic prescribing software (MedChart®) along with patient medical notes was then used to determine the antibiotics used and the prescribed length of treatment. A re-audit was also conducted over a 5 month period between January and May 2019.ResultsWe identified seven patients with confirmed diagnosis of NEC. The median gestational age was 30+6 weeks (range 29+4 to 36+1 weeks) and the median birth weight was 1530 grams (range 780 to 2100 grams). Four patients required surgery that involved laparotomies and bowel resections. No patients had allergies to penicillins.The most frequently prescribed antibiotic regimen was ceftazidime, vancomycin and metronidazole (n=4). Other regimens included meropenem and vancomycin (n=2), and amoxicillin, gentamicin and metronidazole (n=1). The median course length was 10 days (range 2 to 16 days). These results were presented to a neonatal surgery quality improvement meeting in January 2019.During the re-audit period, five infants were identified. The median gestation was 28+3 weeks (26+1 to 37+0 weeks) and median birth weight of 1310 grams (range 620–2090 grams). 3 patients had laparotomies and none had allergies to penicillins. In this cohort, the most popular regimen was amoxicillin, gentamicin and metronidazole (n=4), followed by ceftazidime, vancomycin, and metronidazole (n=1). The median course length was 11 days (range 5 to 12 days).ConclusionOur initial audit confirmed that considerable variation still exists in the antibiotic regimen used and the duration of treatment. We also found that patients were frequently not treated according to the local guideline. The initial audit results were used to highlight the issue to our surgical and neonatal teams. After the re-audit, it is clear that this approach improved the compliance with the guideline in terms of which antibiotics were used. However, we also found that the duration of treatment still varied considerably.ReferencesNeu, J. and Walker, W.A. Necrotizing Enterocolitis. New England Journal of Medicine. 2011;364:255–264.Zani A, Eaton S, Puri P, et al. International Survey on the Management of Necrotizing Enterocolitis. Eur J Pediatr Surg. 2015;25:27–33.Blackwood, B.P., Hunter, C.J. and Grabowski, J. Variability in Antibiotic Regimens for Surgical Necrotizing Enterocolitis Highlights the Need for New Guidelines.Surgical Infections 18:215–220World Health Organisation. Global action plan on antimicrobial resistance. [Online]. 2015. [Accessed 24th June 2019]. Available from: http://www.who.int/antimicrobial-resistance/global-action-plan
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Tamai, Minori, Yoshiyuki Furuichi, Shin Kasai, Norie Ando, Kumiko Goi, Takeshi Inukai, Masako Abe, Keiko Kagami, and Kanji Sugita. "TGFβ1 Induces MLL-Rearranged Acute Lymphoblastic Leukemia into Chemoresistant Quiescence in a Coordinated Manner with FLT3 Ligand." Blood 128, no. 22 (December 2, 2016): 3972. http://dx.doi.org/10.1182/blood.v128.22.3972.3972.
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Abstract Background Acute lymphoblastic leukemias with rearrangements of mixed-lineage leukemia gene (MLL+ALL) frequently develop in infants and have a dismal prognosis. The refractory nature of this leukemia is known to be associated with persistence of high levels of minimal residual disease (MRD). We previously reported that FLT3 ligand (FL) stimulation of MLL+ALL cells, which express FLT3 at high levels, induced quiescence resistant to anti-leukemic agents, to the process of which up-regulation of p27, one of cyclin-dependent kinase inhibitors (CDKIs), was closely attributable. Because a vast amount of FL is secreted from bone marrow stromal cells, it was postulated that this FLT3/FL interaction should contribute, at least in part, to the high levels of MRD in MLL+ALL (Furuichi et. al. Cancer Res 2007). Of interest, in B-cell precursor ALLs other than MLL+ALL, FL stimulated their proliferation. Therefore, we performed the microarray analysis using the MLL+ALL cell line and the ETV6-RUNX1-positive cell line for comparing changes in the gene expression profiles at 24h after FL stimulation, and picked up the transforming growth factor β1 (TGFβ1) as a gene whose mRNA level was conversely regulated between two cell lines. TGFβ1 is a growth inhibitory cytokine for some cancer cells and known to have a potential to induce hematopoietic stem cell quiescence. In the present study, we examined the effects of TGFβ1 and/or FL on MLL+ALL cells particularly in terms of induction of quiescence and chemosensitivity. Materials and Methods The MLL+ALL cell line KOCL58 (MLL-AF4+) was used throughout the study to examine TGFβ1 mRNA, cell cycle progression, induction of apoptosis, and changes in chemosensitivity in the presence of TGFβ1 and/or FL. Results 1. We first examined changes in TGFβ1 mRNA after FL (20ng/ml) stimulation by real time RT-PCR in KOCL58 cells, and confirmed that TGFβ1 mRNA expression level was significantly increased (1.5 fold at 24h). Of note, when the cells were stimulated with FL and TGFβ1 (10ng/ml), TGFβ1 mRNA expression level was further increased (3.5 fold) between 7 and 24h. 2. We next evaluated the effect of TGFβ1 on proliferation. When KOCL58 cells were incubated with a low concentration of TGFβ1 (0.33ng/ml) in the presence or absence of FL (20ng/m), flow cytometric analysis using the BrdU/PI double staining showed that the G0/G1 population (35.2%; before stimulation) was increased in the presence of TGFβ1 (48.4%) or FL (53.0%), and further in the presence of TGFβ1+FL (75.1%). We also examined expression levels of cell cycle regulating molecules, and found that p27 was significantly increased in the presence of FL and further in the presence of TGFβ1+FL. This p27 up-regulation was due to post-transcriptional mechanism, because p27 mRNA remained unchanged but the half-life of p27 protein was elongated in the presence of FL and/or TGFβ1. 3. To elucidate whether TGFβ1 affects the sensitivity of MLL+ALL cells to a cell cycle dependent anti-leukemic agent AraC, we pre-incubated KOCL58 cells in the presence of TGFβ1 and/or FL for 72h and then exposed to AraC (500nM) for 24h. Flow cytometric analysis using FITC-conjugated Annexin V demonstrated that the Annexin V-negative viable population (%) was decreased by AraC exposure (25.6±1.4%), but it was significantly restored by pre-incubation with FL (39.4±1.7%, P<0.0005) and further by pre-incubation with TGFβ1+FL (49.3±5.9%, P<0.003), although not significantly different by pre-incubation with TGFβ1 alone. Flow cytometric analysis using anti-active caspase 3 antibody also demonstrated that the positive population was increased to 50.8% by AraC exposure, but it was decreased by pre-incubation with either TGFβ1 (27.5%) or FL (24.8%), and further by pre-incubation with TGFβ1+FL (10.2%) (Figure). 4.We performed chmosensitivity experiments to AraC (800nM) using KOCL58 cells adhering to bone marrow stromal cells, which secrete FL and TGFβ1, in the presence of FLT3 inhibitor (CEP701, 5nM) and/or TGFβ-receptor 1 inhibitor (HTS, 5mM), and found that KOCL58 cells adhering to stromal cells showed a marked resistance to AraC (60% increase in Annexin V-negative population), but this restoring effect was partially (~20%) alleviated by each of inhibitors. [Discussion] TGFβ1 should be involved in the development of MRD in MLL+ALL in synergy with FL, and a combined use of inhibitors against FLT3 and TGFβ1 might be effective for eradicating MRD in MLL+ALL patients. Figure Figure. Disclosures No relevant conflicts of interest to declare.