Folate absorption in women with a history of neural tube defect-affected pregnancy.

BACKGROUND: The risk of neural tube defects (NTDs) is significantly reduced by supplemental folic acid. NTD risk may be associated with impaired absorption of polyglutamyl folate, the primary form of naturally occurring food folate, and of folic acid in supplements or fortified food. Stable-isotope methods provide the specificity needed to test this hypothesis. OBJECTIVE: We determined whether women who had an NTD-affected pregnancy had a reduced ability compared with control women to absorb polyglutamyl folate relative to folic acid. DESIGN: Healthy, nonpregnant women with a history of an NTD-affected pregnancy (cases; n = 11) and control women (n = 11) were administered an oral dose containing a mixture of [(2)H]pteroylpentaglutamate ([(2)H(2)]PteGlu(5); 233 nmol) and [(13)C]pteroylmonoglutamate ([(13)C(5)]PteGlu(1); 567 nmol) after a 30-d saturation protocol (2 mg unlabeled folic acid/d). Relative extents of absorption were evaluated by urinary excretion of (2)H(2)- and (13)C(5)-labeled folates 48 h postdose. RESULTS: During the first 24 h postdose, cases excreted less (f1.gif" BORDER="0"> +/- SD) [(2)H(2)]PteGlu(5) (21 +/- 12% compared with 37 +/- 19%; P = 0.01) and [(13)C(5)]PteGlu(1) (17 +/- 8% compared with 31 +/- 14%; P = 0.007) than did controls. No significant differences between cases and controls were detected in the percentage of [(2)H(2)]PteGlu(5) or [(13)C(5)]PteGlu(1) excreted during the second 24 h postdose or when the data were averaged over 48 h. However, excretion of the [(2)H(2)]folates tended to be lower in cases than in controls over the 48-h period (33 +/- 13% compared with 45 +/- 26%; P = 0.21). A similar trend (P = 0.29) for lower excretion of [(13)C(5)]folates in cases was also observed (31 +/- 16% compared with 39 +/- 17%). The ratio of urinary [(2)H(2)]folates to [(13)C(5)]folates did not differ significantly between cases and controls. CONCLUSION: These data suggest the need for a larger-scale study using stable-isotope methods to further investigate this hypothesis.

Discharging ventilator-dependent children: a continuing challenge.

Preparation of ventilator-dependent children, their families, the health care system, and communities for community-based care has presented many challenges over the past two decades. This article reviews some of the challenges that have been resolved by interdisciplinary discharge planning, discharge protocols, case management approaches, and collaborative care. Unresolved challenges continue to prevent children with special health care needs (CSHCN) from being served adequately by the health care system, the legal system and the community in this era of cost containment. Current literature, existing research and clinical observation were used to develop nursing implications and recommendations for continued research.

The team approach to pediatric asthma education.

An interdisciplinary pediatric pulmonary team of nurses, pharmacists, and social workers developed an asthma education program for presentation to children with asthma, ages 7-11, in a camp setting. Sound educational principles provide the foundation for this program, which includes a variety of teaching methods including puppet shows, games, crafts, and song. Informal evaluation methods of observation and feedback indicated that children's knowledge of asthma and asthma management increased.