Bacterial contamination of enteral nutrition in a paediatric hospital.

A prospective study was performed in a paediatric hospital to evaluate the incidence of bacterial contamination in enteral nutrition bags and to determine the critical points of process. During two separate one-month periods, all children receiving pump-assisted enteral nutrition were enrolled in the study. Samples for microbiological analysis were collected from enteral nutrition bags after administration in the first and second study period (sample T(2)). In the second study period, two additional samples were made at the end of the feed preparation process. One was refrigerated immediately (sample T(0)) and the other was sealed in a tube that followed the enteral nutrition solution until the end of its administration (sample T(1)). Bacterial contamination was detectable above 10(2)cfu/mL. Twenty-six out of 40 patients were included in the first study period and 14 out of 44 in the second study period. Contamination (>10(2)cfu/mL) occurred in nine of 26 samples (35%) and seven of 14 samples (50%) in the first and second study periods, respectively. Of these, five (20%) and three (21%) contained significant contamination (>/=10(4)cfu/mL). Bacteria of low pathogenicity were found in T(0) samples. Bacteria present in T(2) samples were pathogenic and multiple in 50% of cases. These results suggest that manipulation of the enteral nutrition bags at the bedside is critical for bacterial safety.

[Nutritional status and risk in hospitalized children]. / Etat et risque nutritionnel de l'enfant hospitalisé.

BACKGROUND: A few studies report malnutrition in hospitalized patients. MATERIAL AND METHODS: This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included. RESULTS: Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was < -2 SD, > +2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study. CONCLUSIONS: Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.

[Characteristics of the dietary intake of French children from 3 to 24 months of age. Diet of French infants]. / Caractéristiques de la ration alimentaire des enfants français de 3 à 24 mois.

The food consumption of 543 French infants, aged 3 to 24 months, was recorded during a 3 day period. The nutrient intake data were calculated by a computerized food table. The 1981 recommended dietary amounts proposed by the Committee of the Centre National de Coordination des Etudes et Recherches sur la Nutrition et l'Alimentation were used to assess adequacy of intake. Our results showed a great variability between individuals considering the caloric intake. The mean energy intakes were greater than the recommended amounts for the age range of 6 to 12 months: therefore a revision of the recommended amounts appears necessary. A marked decrease of the consumption of infant formulas was noted between 4-5 months (57% of the total energy intake) and 6-7 months (18% of the total energy intake). The consumption of the other baby foods was the highest at 6-7 months (23% of the total energy intake). The probability that a French infant has a protein intake less than the recommended amounts was less than 0.02. This probability was 0.04 for calcium intake and 0.50 to 0.78 for iron intake according to age. An increase of the iron intake from 4-5 months is a justified dietary goal. The mean intake of linoleic acid was the smallest at a mean age of 8 to 12 months and represented less than 2% of the caloric intake.

Circadian metabolic rhythms in obese children.

Obese children display constant hyperinsulinism and, frequently, hyperphagia. In animals, lesions of the hypothalamic system affect simultaneously the circadian rhythm of insulin secretion and of food intake. In this study, circadian metabolic rhythm was examined in obese and non-obese children, by two different protocols. (1) Oral glucose tolerance tests (OGTT) were carried out at 9 a.m. and 3 p.m. on 2 consecutive days. (2) Circadian variations of plasma glucose and insulin were determined. After OGTT, in the control children there was a significant drop in the insulin/glucose ratio in the afternoon, whereas in the obese group this ratio remained high, with no significant change during the day. Differences were also observed in free fatty acid, growth hormone, and cortisol responses. The control children showed a circadian rhythm for blood glucose levels which was not present in obesity. These preliminary data suggest impairment of metabolic rhythms in obese children; they should stimulate further studies on the hypothalamic system in obesity.

Effects of diet on insulin and gastric inhibitory polypeptide levels in obese children.

To improve understanding of the relationships between gastric inhibitory polypeptide (GIP) and insulin secretion and food intake in obesity, immunoreactive insulin and immunoreactive GIP were measured in 5 obese children during PO glucose tolerance test carried out before and after diet. Before diet, mean insulin levels were normal at fasting and rose after glucose ingestion. The mean fasting immunoreactive GIP level was very high (1235 +- 209 pg/ml) compared to that of 8 healthy adult controls (411 +/- 44 pg/ml) and remained at this level throughout the test. There was only a short postabsorptive rise to 1515 +/- 158 pg/ml at 30 min, which was not significantly different either from the patients' basal values or from the 30-min control values (1356 +/- 67 pg/ml). After dieting for 3 to 7 months, immunoreactive insulin responses returned to normal ranges. Concomitantly, both basal and total GIP release diminished significantly (basal GIP, 343 +/- 92 pg/ml; area under the GIP curve, 3820 and 1694 pg/ml/hr before and after diet, respectively). The postabsorptive GIP increment, however, rose significantly from 180 pg/ml/hr, before diet, to 665 pg/ml/hr afterwards. These results might be compatible with the hypothesis that in obesity, hyperinsulinemia, and overactivity of the GIP cells are associated phenomena caused by overeating and reversed by reduced food intake. However, several contradictory findings remain unexplained. The discrepancy between insignificant postabsorptive GIP increments and elevated insulin responses before diet casts doubts on the causal relationship between GIP and insulin secretion. The small GIP rise might be due to a limited secretory capacity of the GIP cells or to a diminished stimulatory capacity of glucose. The constantly high level of GIP might reflect chronic hypersecretion and/or some defect in basal regulation and feedback control of GIP release. The change caused by dietary measures in the GIP secretion pattern provides evidence that in obese children, basal GIP secretion in influenced by nutritional factors.

[Dietary behavior of the French child]. / Le comportement alimentaire de l'enfant français.

For 0 to 1 year old children, breast feeding represents a perfect reference. From the composition of maternal milk and the amount taken by a well developing child, some precise data can be drawn. These data were, in fact, utilized for preparing the maternized milks which must be, to-day the only substitute for human milk when, for any real reason, a mother is not able to feed her own baby. For older children and for adolescents, the data are incredibly rare. The few inquiries now available show some concordance on calories, glucides and lipides, but diverge strongly on proteins and calcium requirement. This lack of information does not seem to embarrass much physicians and dieticians in prescribing some measured diets to their patients; but, from a scientific point of view, this absence of data prevents strongly from understanding the studies made, for instance, on spontaneous diet in diabetic or obese children. A coordinated study, using revised nutritional tables, should be undertaken.