ABSTRACT
Background. Parenteral nutrition (PN) is an effective method of nourishing the neonate who is unable to receive full enteral feeds. Cholestasis can be a complication of PN and can lead to severe liver damage. Aim. We describe our patient population and determine risk factors for developing PN cholestasis. Methods. Retrospective chart review of newborns admitted from January 2006 to May 2011 to the Neonatal Intensive Care Unit at our institution and received PN >14 days. Cholestasis was defined as serum conjugated bilirubin >50 µ mol/L. Results. Eighty-seven newborns were included; 18 (20.7%) developed PN cholestasis. The most frequent surgical condition for both groups was gastroschisis (8/87; 9.2%). No significant differences were found between the cholestasis and control groups for the following parameters: birth weight, gestational age, intrauterine growth restriction, Apgar scores, and day of life at initiation of enteral feeds. Duration of PN in days and dosage of carbohydrates in g/kg/day were significantly higher in the cholestasis group than the control group. Conclusion. PN-related cholestasis presented in one-fifth of neonates receiving PN for more than two weeks. Longer duration of PN and higher dosage of carbohydrates were independent risk factors for the development of PN cholestasis in this population.
ABSTRACT
The effect of the dose of oral hydrocortisone on stature growth rate of patients with the salt losing form of congenital adrenal hyperplasia and adequate electrolyte balance was here assessed. Thirty patients (21 girls and 9 boys) were followed longitudinally for 0.52 to 8.64 years, between chronological ages 0.35 and 8.64 years. Nine consecutive periods (Ps) of follow up were defined in order to compare two auxological parameters, height (H) at the end of a follow up P and delta H standard deviation score (SDS). According to growth rate during a particular P, two types of Ps were defined: Ps with delta H SDS > -0.5 (Group 1, satisfactory growth rate) and Ps with delta H SDS = or < -0.5 (Group 2, poor growth rate). A cut off value of 18.5 mg/m2/day of oral hydrocortisone (95% CI upper limit of group 1) was defined to separate acceptable from excessive doses. In P2, mean (+/- SD) H SDS (-1.81 +/- 1.15) was significantly lower than in any of the other Ps (p < 0.001). In P1 and in P2, delta H SDS was negative, but it was positive in P3 and in P4. Hydrocortisone dose in P1 and in P2 was significantly higher than in the rest of the Ps. All patients in P1 and most patients in P2, but not in other Ps, received excessive doses. Predicted adult H, calculated in 9 patients was not statistically different from their respective target H. It is concluded that, during the first year of life, our patients received an excess of oral hydrocortisone (> 18 mg/m2/day) and grew poorly, but they were able to recover, at least temporarily, when the dose was adjusted during the following years.
Subject(s)
Adrenal Hyperplasia, Congenital/drug therapy , Anti-Inflammatory Agents/pharmacology , Body Height/drug effects , Hydrocortisone/pharmacology , Sodium Chloride/metabolism , Administration, Oral , Adrenal Hyperplasia, Congenital/metabolism , Anti-Inflammatory Agents/administration & dosage , Child , Child, Preschool , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Hydrocortisone/administration & dosage , Infant , Longitudinal Studies , Male , Retrospective Studies , Time FactorsABSTRACT
The effect of the dose of oral hydrocortisone on stature growth rate of patients with the salt losing form of congenital adrenal hyperplasia and adequate electrolyte balance was here assessed. Thirty patients (21 girls and 9 boys) were followed longitudinally for 0.52 to 8.64 years, between chronological ages 0.35 and 8.64 years. Nine consecutive periods (Ps) of follow up were defined in order to compare two auxological parameters, height (H) at the end of a follow up P and delta H standard deviation score (SDS). According to growth rate during a particular P, two types of Ps were defined: Ps with delta H SDS > -0.5 (Group 1, satisfactory growth rate) and Ps with delta H SDS = or < -0.5 (Group 2, poor growth rate). A cut off value of 18.5 mg/m2/day of oral hydrocortisone (95
CI upper limit of group 1) was defined to separate acceptable from excessive doses. In P2, mean (+/- SD) H SDS (-1.81 +/- 1.15) was significantly lower than in any of the other Ps (p < 0.001). In P1 and in P2, delta H SDS was negative, but it was positive in P3 and in P4. Hydrocortisone dose in P1 and in P2 was significantly higher than in the rest of the Ps. All patients in P1 and most patients in P2, but not in other Ps, received excessive doses. Predicted adult H, calculated in 9 patients was not statistically different from their respective target H. It is concluded that, during the first year of life, our patients received an excess of oral hydrocortisone (> 18 mg/m2/day) and grew poorly, but they were able to recover, at least temporarily, when the dose was adjusted during the following years.
ABSTRACT
Se estudió una técnica simple de análisis de la mortalidad infantil fundado en la encuesta directa de las familias, a fin de conocer algunos aspectos de la salud infantil en áreas empobrecidas, marginales y sin registros apropiados, como la misión "La Paz" en el Chaco Salteño. El método empleó el relato abierto de la madre para determinar el momento y la causa de la defunción infantil. Se observó una muy elevada tasa de mortalidad infantil (166,6 por ciento) con predominio de las causas fácilmente evitables (infecciones digestivas y respiratorias) luego del período neonatal y después del primer año de vida. La fecuencia de desnutrición (relación peso menor al 10 por ciento percentilo) fue menor a la observada en estudios realizados en el gran Buenos Aires. El método utilizado es un recurso sencillo, barato, realizable por cualquier personal entrenado del equipo de salud que permite un rápido diagnóstico de situación de la mortalidad infantil y posibilita la planificación de acciones tendientes a mejorar la salud infantil en áreas marginales y sin registros
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Adolescent , Infant Mortality/trends , Native Hawaiian or Other Pacific Islander , ArgentinaABSTRACT
Se estudió una técnica simple de análisis de la mortalidad infantil fundado en la encuesta directa de las familias, a fin de conocer algunos aspectos de la salud infantil en áreas empobrecidas, marginales y sin registros apropiados, como la misión "La Paz" en el Chaco Salteño. El método empleó el relato abierto de la madre para determinar el momento y la causa de la defunción infantil. Se observó una muy elevada tasa de mortalidad infantil (166,6 por ciento) con predominio de las causas fácilmente evitables (infecciones digestivas y respiratorias) luego del período neonatal y después del primer año de vida. La fecuencia de desnutrición (relación peso menor al 10 por ciento percentilo) fue menor a la observada en estudios realizados en el gran Buenos Aires. El método utilizado es un recurso sencillo, barato, realizable por cualquier personal entrenado del equipo de salud que permite un rápido diagnóstico de situación de la mortalidad infantil y posibilita la planificación de acciones tendientes a mejorar la salud infantil en áreas marginales y sin registros
