Relation of forearm's bone and soft tissues to infant's body composition.

Small portable units using the dual X-ray absorptiometry method (pDEXA) are becoming available to evaluate a localized region of the body such as the forearm. The purpose of this study was to evaluate the relationship between infant's forearm measurements of bone mineral, lean, and fat mass and total body composition. Twenty-two infants participated in this study. Mean age of the infants was 21 d with a weight range of 1-3.6 kg. All infants were stable and had their forearm and total body scanned on the same day. The long-term precision error for the pDEXA was 0.4%. The infant's total body was scanned by the XR-26 (Norland Medical Systems, Fort Atkinson,WI). Forearm bone mineral content, bone mineral density (BMD), fat mass, and lean mass correlated to total body mineral content (BMC) (r = 0.84, p < 0.001), total body BMD (r = 0.73, p < 0.001), total fat mass (r = 0.53, p < 0.05), and total body lean mass (r = 0.80, p < 0.001). Forearm BMC, lean, and fat mass correlated significantly with body weight and length (r = 0.73-0.94). In conclusion, forearm measurements of bone mineral, fat, and lean mass reflect total body bone mineral, fat, and lean mass in small infants.

Daily physical activity program increases bone mineralization and growth in preterm very low birth weight infants.

OBJECTIVE: A study of daily physical activity was performed with 32 preterm infants to evaluate changes in body weight and bone mineralization. STUDY DESIGN: Subjects were matched by birth weight and gestational age and randomly assigned to the physical activity (PA; n = 16) or to the control (C; n = 16) program. PA consisted of range of motion against passive resistance to all extremities for 5 to 10 minutes daily. Peripheral dual-energy x-ray of the right forearm (ulna and radius); biomarkers of bone formation (serum type I collagen C-terminal propeptide [PICP]) and resorption (urine pyridinoline cross-links of collagen [Pyd]); serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH), and 1, 25-(OH)(2) vitamin D; and urine levels of calcium, phosphate, and creatinine were obtained. All measurements were made at study entry and at 2.0 kg of body weight. RESULTS: Despite a similar nutrient intake at advised levels for preterm infants, gains in body weight (g) and forearm bone length (cm), bone area (BA; cm(2)), bone mineral content (BMC; mg), and fat-free mass (g) were greater in PA infants. Forearm bone mineral density and fat mass gains did not differ between groups. Serum PICP levels remained constant in PA infants but decreased in C infants suggesting a slower rate of bone formation. Urine Pyd or bone resorption activity was similar between groups. A higher level of serum PTH was observed in PA infants at 2. 0 kg of body weight; however, the change from study entry to completion did not differ between groups. All other serum and urine values were similar and within normal limits. CONCLUSION: A daily PA program promotes greater gains in body weight, forearm length, BA, BMC, and fat-free mass in premature infants.

Elopement of adolescents: dynamics in the treatment process.

The authors believe that an adolescent's elopement from the hospital is often an attempt to communicate with staff. Therefore, by examining the various aspects of the elopement, staff may obtain information that will be valuable for treatment planning. The authors discuss seven of the most frequent causes of elopement, which include discomfort brought about by change, fear of being close to others, rejection of the treatment concept or of treatment staff, anxiety about a lack of external control, and an inability to show change while in the treatment milieu. They present a case illustration of an elopement by a teen-age boy and the messages that the act conveyed.