ABSTRACT
Background. Bone mass is similar in pre-pubertal girls and boys and double in both genders between the onset of puberty and early adult life. Exogenous factors such as nutrition and exercise contribute to the acquisition of bone mass. The objective of this project was to correlate calcium intake and level of physical activity with bone mineral density (BMD) in a sample of Mexican school-age children. Methods. Avalidated questionnaire was applied. The questionnaire included the following dimensions: (a) sociodemographic information, (b) type of sports and games that involved physical activity and hours per week dedicated to them, (c) inactivity measured by hours expended watching TV or playing videogames per day and (d) dietary calcium. After completing the questionnaire, the children were invited to have a BMD and total body composition assessment using a dual-energy x-ray absorptiometry (DXA) (Prodigy LUNAR). Results. In this cross-sectional study, 212 children were included, 48.6% were girls. The average total BMD in boys and girls was 0.8805 ± 0.056 g/cm² and 0.8788 ± 0.056g/cm², respectively, with significant differences in the groups of 10- and 12-year-old girls. An average of 10.9 ± 6.48 h of weekly physical activity was reported in boys and 10.6 ± 7.31 h in girls. Number of glasses of milk consumed was reported (1.7 ± 0.95 and 1.33 ± 0.91) per day in boys and girls, respectively. Differences in BMD in 10- and 12-year-old girls adjusted according to menarche were found. In the linear regression analysis, lean body mass was significantly associated with total, L2-L4, pelvis, and forearm BMD. Physical activity was significantly associated with leg BMD and age was associated with pelvis and forearm BMD. Conclusions. High lean body mass, menarche and regular intense physical activity are predictors for a higher BMD in school-age children in Mexico City.
ABSTRACT
Background. Nosocomial infections are risk factors related to intrahospital mortality. Among other factors, these infections are strongly associated with invasive devices. In pediatric patients, the central venous catheter (CVC) is one of the most frequently related device-associated bloodstream infections. The aim of this study was to evaluate the efficacy and safety of a chlorhexidine-gluconate impregnated patch (CHGp) in reducing infections related to CVC in pediatric patients. Methods. We conducted a systematic review and meta-analysis. An electronic search of the literature (Medline, EMBASE, Lilacs and the Cochrane Library Plus) from 1966 to December 2010 was carried out for clinical trials comparing the CHGp vs. standard case management for prevention of catheter tip colonization (CTC); bloodstream infections (BSI) were retrieved. Results. Only two clinical trials were found with a total of 850 participants. Patients randomized to the CHGp group showed a lower incidence of CTC than the control group (14% vs. 25%), relative risk [RR]: 0.61, 95% confidence interval [CI 95% (0.45, 0.81)], p = 0.001), with a number needed to treat of 11. BSI showed a RR: 1.14, ([CI 95% (0.57, 2.28)], p = 0.71). Adverse events were found mainly in the CHGp group and were described as local skin reactions in 5.6% (RR 8.17 [95% CI: 1.19-56.14], p = 0.04). Local necrosis was present in only two infants of very low birth weight (0.48%). Conclusions. This meta-analysis demonstrated that the chlorhexidine-gluconate impregnated patch is effective in reducing CVC-related infections in the pediatric population. Serious adverse events are rare.
ABSTRACT
Background. Malnutrition is a common cause of morbidity in children with congenital heart disease (CHD). The aim of this study was to assess the impact of malnutrition and nutritional support on the length of hospitalization and mortality at the Pediatric Intensive Care Unit (PICU) in children with CHD after undergoing surgery. Methods. Clinical records (2000-2008) of patients £3 years old with CHD who were admitted for surgery were evaluated for nutritional status, nutritional support, and risk factors. Mortality was evaluated from the beginning of surgery and during the patient's stay at the PICU. Long-term hospitalization was considered according to the length of hospital stay on percentile >50. A multiple logistic regression model was used. Results. Two hundred eighty nine patients were included. Factors related to mortality were malnutrition before surgery (OR 3.447; 95% CI 1.006-11.812, p = 0.049), early or delayed enteral nutrition (OR 0.007; 95% CI 0.000-0.097, p = 0.000, and OR 0.011; 95% CI 0.001-0.126, p = 0.000, respectively), and early parenteral nutrition (OR 0.032; 95% CI 0.002-0.452, p = 0.000) vs. no nutritional support. Factors related to long-term stay were malnutrition at birth (OR 2.772; 95% CI 1.282-5.995, p = 0.010) and delayed parenteral nutrition (OR 12.049; 95% CI 1.626-94.724, p = 0.015). Conclusion. Malnutrition at birth and before surgery increases length of stay and mortality of children after open heart surgery. Early nutritional support reduces length of stay and mortality.