Effectiveness and Safety of Fast Enteral Advancement in Preterm Infants Between 1000 and 2000 g of Birth Weight.

BACKGROUND: The advancement of enteral nutrition in premature infants is still controversial. Clinicians must provide adequate caloric intake but avoiding feeding intolerance and necrotizing enterocolitis (NEC). The aim of this study was to establish the safety and effectiveness of fast enteral advancement by comparing it with traditional advancement. METHODS: This is a controlled randomized clinical trial. Feeding was advanced at 30 mL/kg/d vs 20 mL/kg/d in premature infants under 34 weeks between 1000 and 1499g birth weight, and at 40 mL/kg/d vs 20 mL/kg/day in those weighing 1500-1999 g. Outcomes included time to reach total enteral nutrition, days of parenteral nutrition (PN) and/or intravenous fluid (IVF), days to recover birth weight, episodes of feeding intolerance, growth and weight gain at 40 weeks, sepsis, hypoglycemia, hyperbilirubinemia, NEC, and mortality. Student t-test or Mann-Whitney U test, Fisher test or χ2 test, and multiple linear regression were used. RESULTS: Differences were found in days to reach total enteral nutrition (slow: 7 [IQR(interquartile range), 6-9], fast: 4 [IQR, 4-6]; P < .001) and days of IVF or PN (slow: 6 [IQR, 4-8], fast: 3 [IQR, 3-5]; P < .001). Fast advancement decreases time to total enteral nutrition by 3 days and PN and/or IVF by up to 5 days. There were no differences in other outcomes. CONCLUSIONS: Fast enteral advancement decreases the days to reach total enteral nutrition and the days of PN and/or IVF without causing greater feeding intolerance. Additional studies are required for more evidence.

Síndrome de Coffin-Lowry / Coffin-Lowry syndrome

El síndrome de Coffin-Lowry es una enfermedad genética ligada al cromosoma X, caracterizada por múltiples deformidades esqueléticas, talla baja, retraso en el desarrollo neurológico, además de alteraciones renales, auditivas y otras. Si no se detecta y trata en forma temprana, lleva al paciente a pérdida de la audición neurosensorial y deformidad progresiva de la columna vertebral. Se presenta el caso de un niño de 10 años con los hallazgos clínicos característicos del síndrome de Coffin-Lowry: hipotonía, retardo del crecimiento y del desarrollo psicomotor, y deformidades esqueléticas progresivas. Se resalta la importancia de un diagnóstico precoz para mejorar la calidad de vida del paciente, controlando la pérdida de la audición neurosensorial y la deformidad progresiva de la columna vertebral (escoliosis o cifosis).

The Coffin-Lowry syndrome is an X-linked genetic disease, characterized by multiple skeletal deformities, short stature, and developmental delay, neurological disorder, cardiac disorders, renal and other disturbances. If not detected and treated early the syndrome may cause neural sensory hearing loss and progressive spine deformation. We report the case of a Coffin-Lowry syndrome in a 10 year old boy with hypotonic clinical characteristics, short stature, neurological development delay and progressive spine deformation. We stress the importance of early diagnosis to improve the quality of life of the patient by controlling neural sensory hearing deficit and progressive spine deformation (scoliosis and/or Kyphosis).