[Plasma aminogram in infants operated on complex congenital heart disease]. / Aminograma plasmático en lactantes intervenidos de una cardiopatía congénita compleja.

UNLABELLED: Post-surgical morbidity of congenital heart disease operated at early ages still is high. Both pre-surgical malnourishment and the repercussions of the systemic response to the aggression, including extracorporeal circulation contribute to it. The metabolism of proteins has been little studied in these infants and toddlers, as well as its repercussion on clinical outcomes. The aim of this study was to assess the effect of the surgery on the plasma aminogram of infants early operated for complex congenital heart disease. PATIENTS AND METHODS: We prospectively gathered the anthropometrical and analytical data of 55 children < 3 years of age submitted to elective heart surgery at the day of intervention and at days +1 (n = 53), +3 (n = 39), and +7 (n = 19). The data are presented as mean and standard deviation. The comparison between the variables through time was done by one-tailed analysis of variance for repeated samples. It was considered to be statistically significant with a p value < 0.05. RESULTS: Mean age at the time of surgery was 5.5+/-7.2 months (range 3 days-3 years). The z score for weight before the surgery was -1.24+/-1.14 and for height -0.73+/-1.53. 86.7% of the patients had hypo-prealbuminemia at day 0. The average plasma levels for all the amino acids were within the normal ranges. The evolution of the aminogram showed a general decrease as compared to the levels prior to surgery at day +1 (p < 0.005), which were kept low at +3 for isoleucine, alanine, arginine, glycine, threonine and glutamine (p < 0.005) and only for glutamine at day +7. CONCLUSIONS: 1. The plasma aminogram in infants with congenital heart disease was within the normal range before the surgery, irrespective of the nutritional status. 2. After the surgery, a significant decrease is observed for plasma levels of most of the amino acids, with a trend towards normalization, which is slower for certain branched amino acids, particularly for glutamine. 3. The clinical significance of these findings deserves further studies.

[Consensus on paediatric parenteral nutrition: a document approved by SENPE/SEGHNP/SEFH]. / Documento de consenso SENPE/SEGHNP/SEFH sobre nutrición parenteral pediátrica.

In current medical practice, standardization of procedures has become a desirable objective. The Spanish Society of Parenteral and Enteral Nutrition (SENPE) has undertaken a considerable effort to create clinical practice guidelines or documents of consensus and quality gold standards in artificial nutrition. As a result the SENPE group of standardization has put together a document called "Consensus of Paediatric Parenteral Nutrition" supported by the Spanish Society of Gastroenterology, Hepatology and Nutrition (SEGHNP) and by the Spanish Society of Hospital Pharmacies (SEFH). This is a reduced version of our work. The complete version is available at www.nutricionhospitalaria.com and www.senpe.com. This document covers many aspects such as paediatric patient indications, vascular access, macro and micro nutrients needs; also preparation in special situations, components, forms of prescription, possibilities for standardization of the elaboration and prescription, elaboration, administration, monitoring, complications and side effects. Much research has been done, incorporating current publications, books and clinical practice guidelines such as those published by the American Society for Parenteral and Enteral Nutrition (ASPEN) and by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in collaboration with the European Society for Clinical Nutrition and Metabolism (ESPEN).