Supplemented vs. unsupplemented human milk on bone mineralization in very low birth weight preterm infants: a randomized clinical trial.

UNLABELLED: Very low birth weight preterm newborns weighing less than 1500 g were randomized to receive human milk supplemented with FM 85® or not. They have similar bone mineral content (BMC) at baseline, but, at the end of study, BMC was increasingly higher in the FM 85® group. INTRODUCTION: The purpose of this study is to evaluate the effectiveness of a human milk supplement (FM 85®; Nestlé, Vevey, Switzerland) developed for the purpose of improving nutrition, including bone mineralization, in very low birth weight preterm newborns. METHODS: Preterm infants weighing less than 1500 g at birth admitted to the neonatal intensive care unit of a university hospital were studied. During hospitalization, they were fed at least 50 % of human milk. Newborns with ≥20 days of age were randomly assigned to the intervention group (n = 19) to receive human milk supplemented with FM 85® or to a control group (n = 19) to receive human milk only. Anthropometric measurements, whole-body bone densitometry (DXA), and biochemical tests were performed at study entry and at the end of the study (shortly before discharge when the infant had reached 2000 g). RESULTS: There were no start- or end-of-study differences between the two groups, except for daily increase in length (p = 0.010). At baseline, both groups had similar BMC: 5.49 ± 3.65 vs. 4.34 ± 2.98 g (p = 0.39) for the intervention and control group, respectively. However, at the end of the study, BMC was higher in the intervention group: 10.3 ± 4.71 vs. 6.19 ± 3.23 g (p = 0.003). The mean increase in BMC during the observation period was 4.90 ± 4.46 g for the intervention group and 1.86 ± 3.17 g for the control group (p = 0.020). Serum alkaline phosphatase levels were higher in the control group (720 ± 465 vs. 391 ± 177 IU/L; p = 0.007). CONCLUSIONS: Our data suggest that supplementation of human milk with FM 85® leads to improved bone mineralization in very low birth weight preterm newborns.

[Short-term effects of prone positioning on the oxygenation of pediatric patients submitted to mechanical ventilation] / Efeito a curto prazo da posição prona na oxigenação de crianças em ventilação mecânica.

OBJECTIVE: To analyze the short-term effects of prone positioning on the oxygenation of mechanically-ventilated children suffering from severe hypoxemia. MATERIALS AND METHODS: A prospective, nonrandomized trial (each patient as his/her own control) was conducted between July 1998 and July 1999. Mechanically-ventilated children with peak inspiratory pressure greater than or equal to 30 cm H(2)O, FiO(2) greater than or equal to 0.5, and PaO(2)/FiO(2) ratio less than or equal to 200 were included in the study. Each patient was kept in the prone position for two hours, returning to the supine position after this period. Oxygenation was assessed by means of PaO(2)/FiO(2) in the supine position (one hour before prone positioning), one hour after prone positioning, and one hour after returning to the supine position. Patients who presented an increase of at least 20 in PaO(2)/FiO(2) were considered responsive. The results were compared by Student t-test, Friedman test, chi-square test, Fishers exact test, and confidence interval. RESULTS: Eighteen children (10 males), whose mean age was 11.5 -/+11.5 months, with initial PaO(2)/FiO(2) of 96.06 -/+ 41.78, participated in the study. After one hour in the prone position, 27.7% of the patients (5/18) improved their PaO(2)/FiO(2) ratio (P=0.045). Six of these patients presented reduced lung compliance (four of them had acute respiratory distress syndrome); and twelve patients showed increased airway resistance (six of them presented bronchiolitis). No significant difference was observed between these two groups (reduced lung compliance x increased airway resistance) in terms of age, sex, duration of ventilation prior to change in position, peak inspiratory pressure, FiO(2), severity of hypoxemia, and outcome. CONCLUSION: Prone positioning during mechanical ventilation of children with severe hypoxemia may improve the PaO(2)/FiO(2) ratio in the first hour.

[Autonomic dysfunction in Guillain-Barré Syndrome: a 13 year experience in pediatric intensive care unit]. / Distúrbios autonômicos na Síndrome de Guillain-Barré: experiência de 13 anos em UTI pediátrica.

The acute inflammatory demyelinating polyneuropathy (Guillain-Barré Syndrome) might have a severe presentation but a good prognosis in children. It is an immune-mediated and inflammatory disorder of the peripheral nervous system. This retrospective study observed that GBS is frequently complicated by hypertension and other autonomic disorders. Cardiovascular instability is due to the involvement of the autonomic nervous system and results in labile blood pressure, cardiac dysrhythmias and hypovolemia. During a 13-year period (1982-1995), 21 children were admitted to the Pediatric Intensive Care Unit of São Lucas Hospital, Porto Alegre, south of Brazil. Eight patients were mechanically ventilated. Symptoms of autonomic disturbance were frequently seen, especially in patients with severe clinical evolution. Previous investigations of the mechanism of hypertension associated with GBS did not evaluate the etiology of these phenomena. With modern pediatric intensive care support the deaths are rare. There is no death in this studied group.