Supplemented vs. unsupplemented human milk on bone mineralization in very low birth weight preterm infants: a randomized clinical trial.

UNLABELLED: Very low birth weight preterm newborns weighing less than 1500 g were randomized to receive human milk supplemented with FM 85® or not. They have similar bone mineral content (BMC) at baseline, but, at the end of study, BMC was increasingly higher in the FM 85® group. INTRODUCTION: The purpose of this study is to evaluate the effectiveness of a human milk supplement (FM 85®; Nestlé, Vevey, Switzerland) developed for the purpose of improving nutrition, including bone mineralization, in very low birth weight preterm newborns. METHODS: Preterm infants weighing less than 1500 g at birth admitted to the neonatal intensive care unit of a university hospital were studied. During hospitalization, they were fed at least 50 % of human milk. Newborns with ≥20 days of age were randomly assigned to the intervention group (n = 19) to receive human milk supplemented with FM 85® or to a control group (n = 19) to receive human milk only. Anthropometric measurements, whole-body bone densitometry (DXA), and biochemical tests were performed at study entry and at the end of the study (shortly before discharge when the infant had reached 2000 g). RESULTS: There were no start- or end-of-study differences between the two groups, except for daily increase in length (p = 0.010). At baseline, both groups had similar BMC: 5.49 ± 3.65 vs. 4.34 ± 2.98 g (p = 0.39) for the intervention and control group, respectively. However, at the end of the study, BMC was higher in the intervention group: 10.3 ± 4.71 vs. 6.19 ± 3.23 g (p = 0.003). The mean increase in BMC during the observation period was 4.90 ± 4.46 g for the intervention group and 1.86 ± 3.17 g for the control group (p = 0.020). Serum alkaline phosphatase levels were higher in the control group (720 ± 465 vs. 391 ± 177 IU/L; p = 0.007). CONCLUSIONS: Our data suggest that supplementation of human milk with FM 85® leads to improved bone mineralization in very low birth weight preterm newborns.

Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: a randomized clinical trial.

AIM: To compare the therapeutic efficacy of intramuscular midazolam (MDZ-IM) with that of intravenous diazepam (DZP-IV) for seizures in children. DESIGN: Randomized clinical trial. SETTING: Pediatric emergency department. PATIENTS: Children aged 2 months to 14 years admitted to the study facility with seizures. INTERVENTION: Patients were randomized to receive DZP-IV or MDZ-IM. MAIN MEASUREMENTS: Groups were compared with respect to time to treatment start (min), time from drug administration to seizure cessation (min), time to seizure cessation (min), and rate of treatment failure. Treatment was considered successful when seizure cessation was achieved within 5min of drug administration. RESULTS: Overall, 32 children (16 per group) completed the study. Intravenous access could not be obtained within 5min in four patients (25%) in the DZP-IV group. Time from admission to active treatment and time to seizure cessation was shorter in the MDZ-IM group (2.8 versus 7.4min; p<0.001 and 7.3 versus 10.6min; p=0.006, respectively). In two children per group (12.5%), seizures continued after 10min of treatment, and additional medications were required. There were no between-group differences in physiological parameters or adverse events (p=0.171); one child (6.3%) developed hypotension in the MDZ-IM group and five (31%) developed hyperactivity or vomiting in the DZP-IV group. CONCLUSION: Given its efficacy and ease and speed of administration, intramuscular midazolam is an excellent option for treatment of childhood seizures, enabling earlier treatment and shortening overall seizure duration. There were no differences in complications when applying MDZ-IM or DZP-IV.

Accidental asphyxia due to closing of a motor vehicle power window.

Injuries and deaths among children left unattended in motor vehicles are frequent and the rates are increasing. Injuries associated with motor vehicle power windows usually affect children, in particular children under 6 years of age. This case report is about a child who was asphyxiated because of a motor vehicle power window closing. She was rapidly resuscitated and recovered fully. A brief review of the literature, epidemiology, and preventive measures to avoid this type of injury is also presented.

Hiperglicemia e uso da insulina na criança criticamente enferma / Hyperglycemia and use of the insulin in critically ill child

O objetivo deste trabalho é descrever sobre mecanismos da hiperglicemia e resistência à insulina na sepse grave e choque séptico, suas repercurssões em morbimortalidade nas Unidades de Tratamento Intensivo Pediátrico, assim como resultados e segurança do uso da insulina. Realizou-se revisão bibliográfica no banco de dados Medline no período de 1998 a 2005, utilizando os termos insulina, hiperglicemia, sepse e choque séptico. Estudos em adultos, relatam benefícios em mortalidade e morbidade com controle glicêmico estrito e uso de insulina. Os trabalhos envolvendo pacientes pediátricos, na maioria retros, apontam para resultados semelhantes. Os riscos de hipoglicemia não parecem significativos. Embora ainda não se disponha de evidências adequadas, parece prudente oferecer, aos pacientes pediátricos, controle glicêmico e uso de insulina quando necessário. Sugere-se protocolo clínico de controle glicêmico e uso da insulina nestes pacientes.