Newborns from Mothers Who Intensely Consumed Sucralose during Pregnancy Are Heavier and Exhibit Markers of Metabolic Alteration and Low-Grade Systemic Inflammation: A Cross-Sectional, Prospective Study.

Robust data in animals show that sucralose intake during gestation can predispose the offspring to weight gain, metabolic disturbances, and low-grade systemic inflammation; however, concluding information remains elusive in humans. In this cross-sectional, prospective study, we examined the birth weight, glucose and insulin cord blood levels, monocyte subsets, and inflammatory cytokine profile in 292 neonates at term from mothers with light sucralose ingestion (LSI) of less than 60 mg sucralose/week or heavy sucralose intake (HSI) of more than 36 mg sucralose/day during pregnancy. Mothers in the LSI (n = 205) or HSI (n = 87) groups showed no differences in age, pregestational body mass index, blood pressure, and glucose tolerance. Although there were no differences in glucose, infants from HSI mothers displayed significant increases in birth weight and insulin compared to newborns from LSI mothers. Newborns from HSI mothers showed a substantial increase in the percentage of inflammatory nonclassical monocytes compared to neonates from LSI mothers. Umbilical cord tissue of infants from HSI mothers exhibited higher IL-1 beta and TNF-alpha with lower IL-10 expression than that found in newborns from LSI mothers. Present results demonstrate that heavy sucralose ingestion during pregnancy affects neonates' anthropometric, metabolic, and inflammatory features.

Cord blood levels of interleukin-10 decrease in neonates with increased birth weight: novel implications of the cytokine network in early obesity.

Interleukin-10 (IL-10) and interferon-gamma (IFN-gamma) are associated with body weight alterations in children, adolescents, and adults. However, little is known regarding the role of IL-10 and IFN-gamma in birth weight of neonates. One hundred eighty-two infants were enrolled and divided in groups of normal birth weight (< 95th percentile) or increased birth weight (> 95th percentile) for gestational age. IL-10 and IFN-gamma levels were measured in umbilical cord tissue and blood of newborns by quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). The average value of birth weight in infants below and above the 95th percentile was 3.03±0.39 and 3.58±0.37 kg, respectively, and was independent of the mother's pre-gestational body mass index. The Student t test revealed that neonates with birth weights > 95th percentile show a significant 30% decrease in cord blood values of IL-10 as compared to infants with birth weights < 95th percentile (P<0.0001), with no significant changes in IFN-gamma levels (P=0.1661). Cord blood IL-10 was not of maternal origin but produced by umbilical cord tissue that showed less IL-10 expression in neonates with birth weights > 95th percentile than in infants with birth weights < 95th percentile (P=0.0252). Cord blood levels of IL-10 exhibited significant inverse correlations with birth weight (r = - 0.658, P=0.002) and INF-gamma (r = - 0.502, P=0.005).Conclusion: In conclusion, this work demonstrates for the first time that cord blood IL-10 decreases as birth weight increases in infants born at term and might help to improve early recognition of newborns at higher risk of developing obesity in childhood or adulthood. What is Known: • Reduction in interleukin-10 levels has been associated with obesity in adolescents and adults but not newborns. • The number of neonates with excess birth weight has alarmingly increased in the last 30 years. What is New: • We demonstrate that umbilical cord blood levels of interleukin-10 clearly decrease as birth weight increases. • Interleukin-10 and interferon-gamma integrate a cytokine network that might play a role in obesity in infants.

Risk Factors Associated with Nosocomial Peritonitis in Children on Peritoneal Dialysis.

BACKGROUND: Peritoneal dialysis is the most frequent dialysis method in children, and peritonitis is a frequent complication. The responsible organisms differ between nosocomial and community acquired peritonitis, they cause longer hospitalization time, and can lead to dialysis failure. OBJECTIVE: The aim of the study was to describe the risk factors associated with nosocomial peritonitis in children with end-stage renal disease undergoing dialysis treatment. METHODS: A nested case-control study was conducted in an academic medical center. SUBJECTS: The basic cohort included all pediatric patients with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis therapy and who were hospitalized for non-infectious causes during the study period, January 2008 to December 2009. Cases were subjects who developed nosocomial peritonitis during hospitalization, and controls were children free of nosocomial peritonitis. The final groups consisted of 10 cases and 35 controls. RESULTS: There were 11 episodes of nosocomial peritonitis in 10 subjects (incidence rate, 6.6 cases per year of hospitalization). By multiple logistic regression analysis, the presence of congenital abnormalities of the kidney and urinary tract was the only risk factor significantly associated with nosocomial peritonitis (OR: 11.54; 95% CI: 1.86-71.59). CONCLUSION: Congenital abnormality of the kidney and urinary tract was a significant risk factor for nosocomial peritonitis in pediatric patients with end-stage renal disease undergoing peritoneal dialysis.

Promoting networks between evidence-based medicine and values-based medicine in continuing medical education.

BACKGROUND: In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities. METHODS: A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice. RESULTS: The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P <0.001); notably, autonomy climbed from the 10th (order mean (OM) = 8.00) to the 3rd position (OM = 5.86). In ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P <0.000), self-transcendence (ST) (P <0.001), and self-enhancement (SE) (P <0.019). Predominant values in life history, ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. CONCLUSIONS: The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of educators and advisors with respect to healthcare personnel. The ethical values developed by healthcare professionals arise from their life history and their professional formation.

Evaluation of antihypoxemic maneuvers before tracheal aspiration in mechanically ventilated newborns.

Periodical tracheal aspiration in mechanically ventilated patients is necessary to remove mucus from the airways. In children and adults, this procedure causes transient hypoxemia, which may be prevented by hyperoxia and/or hyperventilation. These findings, however, have not been sufficiently assessed in newborn infants. Thus we investigated the usefulness of hyperoxia and/or hyperventilation as antihypoxemic maneuvers before tracheal aspiration in newborn infants. Our design was a prospective, randomized, multiple crossover study. The setting was the NICU of a third-level pediatric hospital in Mexico City. Patients included 15 newborn infants under mechanical ventilation. Within a 12-hr period, every patient received, in random order, three antihypoxemic maneuvers during 1 min just before tracheal aspiration: hyperoxia (10% increase of baseline FiO2), hyperventilation (50% increase of ventilator cycling rate), or both. Additionally, a control (sham) maneuver was also applied. Pulse oximeter saturation (SpO2) was recorded before and after each antihypoxemic maneuver, and at 0, 15, 30, 60, and 300 sec after tracheal aspiration. Basal values of SpO2 (81.5 +/- 1.5%) increased with all three antihypoxemic maneuvers (SpO2 over 90%, P <0.05 to P <0.01). Immediately after tracheal aspiration a drop in the SpO2 could be detected in all infants. However, patients receiving hyperoxia showed higher SpO2 values (87.1 +/- 1.8%) than those observed with the sham maneuver (76.9 +/- 2.3%, P <0.01). From this point on, all newborn infants in all conditions (even those with sham maneuver) had spontaneous increments of SpO2 that at 300 sec were again higher than their respective basal values (P <0.05 to P <0.0005). At this time, SpO2 values from following the hyperoxia maneuver were still higher than those following the sham maneuver (P <0.05). Our results show that, similar to what occurs at other ages, tracheal aspiration in mechanically ventilated newborn infants causes transient hypoxemia, which can be partially prevented by previous application of antihypoxemic maneuvers, especially hyperoxia.