Factors derived from parenteral nutrition associated with cholestasis in 612 neonates / 中华儿科杂志

<p><b>OBJECTIVE</b>Some neonates especially premature infants, low birth weight infants and extremely low birth weight infants have limited endogenous energy stores. It is necessary to establish continuous administration of postnatal nutrition. The use of parenteral nutrition (PN) in neonates with immaturity of digestive system and intentionally delayed feedings has gained widespread acceptance. PN has been shown to provide sufficient nutrients to maintain growth in newborn infants. The major complication of PN in neonates is PN-associated cholestasis (PNAC). It remains a significant and frequent clinical problem for neonatal practitioners. In some cases, progressive liver damage, liver failure and death may become inevitable. In order to analyze the risk factors of the PNAC in neonates and to provide the evidence of safety and efficiency in clinical nutrition support, the clinical data of 612 neonates who had received PN for more than 5 days during the past 20 years were reviewed.</p><p><b>METHODS</b>Retrospective analysis on data collected from April 1985 to March 2005 was performed. The records of 612 neonates were divided into two groups according to the established Nutrition Support Team (NST) in our hospital. Each group included two sub-groups. Seventy neonates of the first group were divided into PNAC group (n = 6) and non-PNAC group (n = 64); these patients were seen between 1st April 1985 and 31st March 1995. The remaining 542 neonates of the second group who were also divided into 2 groups, i.e. PNAC group (n = 12) and non-PNAC group (n = 530) who were seen from 1st April 1995 through 31st March 2005. The incidence of PNAC between the first group and the second group was compared and the associated factors were analyzed. The PNAC was defined when serum level of direct-bilirubin exceeded 1.5 mg/dl or direct-bilirubin greater than 50% of the bilirubin and excluding cholestasis resulted from other diseases.</p><p><b>RESULTS</b>The total incidence of PNAC in neonates who had received TPN for more than 5 days was 2.94%. The incidence of PNAC of the first and the second decade was 8.57% and 2.21%, respectively (OR = 0.242, 95% CI = 0.088 approximately 0.666). The average gestational age (GA) and birth weight (BW) of PNAC group were less than those of the non-PNAC group (GA: (33 +/- 5) w vs. (36 +/- 4) w, P = 0.009; OR = 0.827, 95% CI = 0.698 approximately 0.980. BW: (2003 +/- 743) g vs. (2393 +/- 764) g, P = 0.045; OR = 1.001, 95% CI = 0.999 approximately 1.002). The PN duration and calorie intake of PNAC group was longer than that of the non-PNAC group (PN duration: 32 +/- 30 d vs. (13 +/- 10) d, P = 0.000; OR = 1.072, 95% CI = 1.032 approximately 1.112. Calorie intake: [(272 +/- 46) kJ/(kg.d)] [(65.0 +/- 10.9) kcal/(kg.d)] (1 kcal = 4.184 kJ) vs. [(232 +/- 55) kJ/(kg.d) (55.5 +/- 13.1) kcal/(kg.d)], (P = 0.002; OR = 1.066, 95% CI = 1.012 approximately 1.122), but the weight gain in the non-PNAC group had a tendency to increase as compared to that of the PNAC group [(20 +/- 27) g/d vs. (9 +/- 19) g/d, P = 0.175].</p><p><b>CONCLUSIONS</b>The incidence of PNAC was associated with the longer duration of PN, the smaller age at initiation of PN, the higher calorie intake, prematurity and lower birth weight. Establishment of the nutrition support team can normalize the practice of the PN administration and decrease the incidence of the complication with nutrition support. It is a favorable mode and it can provide a safer, more effective and reasonable means in clinical nutrition support. To avoid PNAC, it is suggested that the administration of enteric feeding should start as soon as possible, which may enhance effective contraction of gallbladder and secretion of gastrointestinal hormones, and it is best to avoid high calorie of PN and control the calorie intake under 251.04 approximately 334.72 kJ/(kg.d) [60 approximately 80 kcal/(kg.d)].</p>

Assessment of serum micronutrients in children with short bowel syndrome / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess micronutrients level in children with short bowel syndrome.</p><p><b>METHODS</b>Clinical data of 17 children with short bowel syndrome from April 2004 to July 2006 were collected. They received the measurement of serum vitamin A, E and - carotene by high performance liquid chromatography (HPLC).</p><p><b>RESULTS</b>There were 9 boys and 8 girls with age range of 3 months to 18 years. Eleven children did not need parenteral nutrition (PN), and 6 still depended on PN. Six cases were free of ileocolic valve and 11 cases had ileocolic valve. The length of remaining intestine was more than 75 cm in 5 patients and less than 75 cm in 12 patients. Among 11 cases without PN, 9 were tested for serum iron, zinc and copper levels. Their incidences of below the reference value of vitamin A, E and beta - carotene were 23.5%, 35.3% and 58.8%, respectively. The incidences of below the reference value of vitamin A and beta - carotene were higher in patients with weaned PN, less than 75 cm remaining intestine and without ileocolic valve. The patients with more than 75 cm remaining intestine and still with PN had a higher incidence of below the reference of vitamin E, but the incidence was similar in the patients with or without ileocolic valve. Serum zinc was lower than normal level in 3 cases and serum iron was low in 1 case.</p><p><b>CONCLUSION</b>Supplement of extra micronutrients is essential for short bowl syndrome patient whatever they receive the PN or have normal diets, and follow- up is recommended.</p>

Etiology and treatment of eating disorders in adolescents: a report of 6 cases / 中国当代儿科杂志

The occurrence of eating disorders in Chinese adolescents is increasing. However the cause, diagnosis, treatment and prognosis of this disorder are rarely reported by pediatricians. This paper investigated the cause and treatment of six cases of eating disorders in adolescent patients. The medical data of six cases of eating disorders in the Shanghai Children's Medical Center from January 2003 to September 2005 were retrospectively reviewed. The patients were 5 girls and 1 boy, whose onset ages ranged from 12.4 to 15.8 years. They were initially referred to the clinic between 12.9 to 16.7 years, with a course of disease varying from three to twelve months. The patients' body mass index (BMI) varied from 9.07 to 17.0. Four out of the six patients were hospitalized because of low temperature, low blood pressure, bradycardia, dehydration and multiple systems damages. The other two were treated in the out-patient clinic. Based on the medical history and physical examination as well as laboratory findings, five of them were diagnosed with anorexia nervosa and the other one were bulimia nervosa. All of the patients were under the care of a team consisting of pediatricians, dietitians, psychiatrists and nurses. When the patients whose vital signs were unstable, medical treatment focused on life sustention and they were kept on beds compulsively and given nutrition transfusion. Meanwhile cognition and behavior therapy was administered to help the patients find out the internal and environmental factors related to the development of this disorder, establish a new conception of healthy weight, and correct their abnormal eating behaviors. The patients who had a severe distortion of body image and a big resistance to the treatment were additionally administered with psychiatry drugs. After treatment, three patients set up a healthy eating behavior, their body weights gradually recovered and they had no relapse during a 1-year follow-up. The other three patients retained some abnormal eating behaviors and their body weights were always below normal. It was found that eating disorders in adolescents may be triggered by some environmental factors, such as comments on body shape from their peers, fashion influence, academic pressures, and problems in communication. Since the patients' abnormal eating behaviors were masked or neglected by parents at the early stage of the disease and the clinical presentations were related to multiple systems, it is difficult to make an early diagnosis and treatment. It is important to improve the pediatricians' knowledge of eating disorders of adolescents and perform cooperation between a multidisciplinary team for the early diagnosis and treatment of this disorder.

Optimal variables and corresponding cut-off points for identification of cardiovascular risk factors clustering among elderly males / 上海第二医科大学学报

Objective To explore the optimal cut-off points of body mass index(BMI),percentage of body fat(PBF) and body fat mass index(BFMI) for identification of cardiovascular risk factors clustering among elderly males. MethodsThe data of physical examinations from 1 052 Shanghai elderly males in 2007 were collected.The relationship between cardiovascular risk factors clustering and different strata of BMI,PBF and BFMI was analyzed.Receiver Operator Characteristic(ROC) curve analysis was employed to determine the optimal cut-points for identification of cardiovascular risk factors clustering,and area under curve(AUC) was worked out.The population attributable risk proportion(PARP) of risk factors clustering was calculated. Results Odds ratios of risk factors clustering tended to increase with BMI,PBF and BFMI.BMI≥24 kg/m2,PBF≥21% and BFMI≥5 kg/m2 were the cut-off points that had approximate sensitivity and specificity,and/or had the shortest distance in ROC curve.AUC of all the three indexes was larger than 0.5.Analysis of PARP indicated that BMI under 24 kg/m2,PBF under 21% and BFMI under 5 kg/m2 could prevent 27.1%,37.44% and 36.63% risk factors clustering,respectively. Conclusion BMI≥24 kg/m2,PBF≥21% and BFMI≥5 kg/m2 can well reflect the cardiovascular risk factors clustering among elderly males.

Resting energy expenditure in healthy newborn infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To establish the value of the resting energy expenditure (REE) in healthy newborns and evaluate relative factors of REE.</p><p><b>METHODS</b>One hundred and fifty-four healthy newborns (75 boys, 79 girls; birth-weight 2,500-3,999 g) were enrolled in this study. The Apgar score at the 5th minute was equal to or more than 8; the postnatal age was equal to or more than 5 days. The newborns had no apparent defect. The mothers had no history of metabolic and endocrine diseases. REE was measured by Deltatrac II in child canopy mode for 30-45 minutes during asleep or quiet awake status.</p><p><b>RESULTS</b>The average REE was (201.8 +/- 25.4) kJ/(kg.d), which was significantly lower than the predicted REE by Schofield formula[(226.1 +/- 4.8) kJ/(kg.d), P = 0.000], the predicted REE was 12.04% higher than the measured REE. There were no differences in sex and ways of delivery. The newborns whose birth-weight was between 2,500-2,999 g were measured in two modes: baby and child mode, and the REE values were significantly higher (122.6 +/- 25.0) kJ/(kg.d) and (208.8 +/- 26.4) kJ/(kg.d), respectively (P = 0.000).</p><p><b>CONCLUSIONS</b>The prediction formula might be improper for calculating the REE in newborn infants. The indirect calorimetry was the better way to know the actual REE of newborns. The authors recommended that in child mode the measurement of REE in newborns would be the indirect calorimetry, and the REE in healthy newborns was (201.8 +/- 25.4) kJ/(kg.d).</p>