Randomized controlled trial of prophylactic rectal stimulation and enemas on stooling patterns in extremely low birth weight infants.

OBJECTIVE: We hypothesized that rectal stimulation and small volume enemas would accelerate normalization of stooling patterns in extremely low birth weight infants. STUDY DESIGN: In a randomized controlled trial, infants with a gestational age 28 weeks received one of the following: twice daily rectal stimulation and/or enemas until two stools were passed daily, without enemas or stimulation, for three consecutive days. Intervention only occurred when symptoms, abdominal distension and no defecation, occurred in the previous 24 h. Enema administration occurred if abdominal distension persisted without defecation occurring after rectal stimulation. Multivariable linear regression was used to determine the contribution of a patent ductus arteriosus (PDA) on normalization of stooling patterns and feeding tolerance. RESULT: Rectal stimulation and/or small volume enemas did not accelerate the median (quartile range) time normalization of stooling patterns, 13 (11-20) days in control group and 16 (12-25.5) days in intervention group. A higher frequency of PDA occurred in the intervention than the non-intervention group. Infants with a persistent PDA had a longer duration of parenteral nutrition, worse feeding tolerance and more days to achieve normal stooling patterns. In multivariable regression analysis, a PDA, not repeated rectal stimulation and/or enemas, was significantly related to stooling and feeding tolerance. CONCLUSION: Twice daily administration of rectal stimulation and/or enemas did not normalize stooling patterns (fecal frequency). A PDA is an important determinant of acquisition of normal stooling patterns and feeding tolerance of very immature newborns.

El crecimiento intrahospitalario del recién nacido de muy bajo peso en España / Postnatal growth during hospitalization of very low birth weight infants in Spain

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Efectos de la suplementación con cinc en el primer año de vida / Effects of supplementation with zinc in the first year of life

El cinc es un nutriente esencial por su papel fundamental en muchos aspectos del metabolismo celular. Se revisa en este artículo el papel del cinc en la incidencia de enfermedades infecciosas, la mortalidad, el crecimiento y el neurodesarrollo, haciendo especial hincapié en los ensayos publicados de suplementación con cinc (Zn) en lactantes. Se han revisado ensayos clínicos de suplementación randomizados y controlados, doble ciego, publicados e indexados en las bases de datos Medline, Embase y Cochrane. Se han seleccionado aquellos ensayos realizados en menores de 1 año en los que un grupo experimental recibe suplementos de Zn y un grupo control no, aceptándose la administración conjunta de otros micronutrientes (minerales y vitaminas) si existe un grupo control en el que la no administración de suplementos de Zn es la única diferencia con el experimental. Se consideraron los ensayos de una duración de al menos 2 semanas y con visitas domiciliarias por lo menos cada 4 semanas en el caso de estudiarse la morbilidad. El suplemento con cinc disminuye la incidencia de diarrea y neumonía y la duración de la diarrea si se administra durante su curso. En países en vías de desarrollo la suplementación con cinc mejora el crecimiento. En recién nacidos pretérmino existe una relación entre ingesta de cinc y crecimiento. La relación entre la ingesta de cinc y el neurodesarrollo precisa de más investigación (AU)

Zinc is a essential nutrient because of its major role in many aspects of cellular metabolism. In this article the role of zinc in the incidence of infectious diseases, mortality, growth and neurodevelopment is revised, emphasizing the clinical trials on supplementation with zinc in infants. We revised randomized controlled double-blind clinical trials of zinc supplementation, published and indexed in Medline, Embase and Cochrane databases. We selected those trials with children less of one year of life, in which an experimental group receives zinc supplementation and the control group does not; simultaneous administration of other micronutrients (vitamins and minerals) was accepted if there was a control group in which the only difference with respect to the experimental group was the no administration of supplemental zinc. We considered the trials with duration of almost 2 weeds and with home visits at least monthly in the case of morbidity studies. The zinc supplementation decreases the incidence of diarrhea and pneumonia and the duration of diarrhea if it is given during its cause. In developing countries, zinc supplementation improves growth. In preterm infants there is a relation between intake of zinc and growth. The relation between intake of zinc and neurodevelopment needs further investigation (AU)

Prevención de la ferropenia durante el primer año de vida / No disponible

La ferropenia continúa siendo un problema frecuente entre los lactantes españoles, con potenciales efectos negativos sobre su neurodesarrollo. La mayoría de organizaciones no recomiendan la suplementación universal con hierro en los lactantes nacidos a término sanos de países desarrollados, aunque puede considerarse justificada en aquellos casos en que no puede asegurarse la ingesta recomendada por medio de la dieta. Debe promoverse la ingesta de carne y pescado, evitar el consumo excesivo de zumos y, sobre todo la introducción de la leche de vaca en el primer año de vida. En los niños con lactancia artificial o mixta se recomienda utilizar fórmulas suplementadas. Los lactantes nacidos pretérmino o con bajo peso para su edad gestacional alimentados al pecho deben recibir suplementos que aporten un mínimo de 2 mg por kg de peso y día de hierro elemental. La fórmula para prematuros debe estar suplementada con un contenido en hierro igual o superior a 12 mg/L. Durante el tratamiento con eritropoyetina deben aportarse un mínimo de 6 mg/kg/día de hierro oral lo antes posible. La administración parenteral de hierro continúa planteando controversia (AU)

Iron deficiency is common in spanish infants, with potential negative effects on neurodevelopment. Most medical organizations do not recommend universal iron supplements in tem infants born in developed countries. Preventive measures include encouraging a diversified diet rich in sources of iron and avoiding excessive juice intake. In infants, the introduction of cow´s milk in the first year of life is the greatest dietary risk factor for the development of iron deficiency and iron deficiency anemia. Iron supplements can be used in those infants in which a diversified diet that is rich in sources of iron is not consumed. Formula-fed-infants should consume iron-containing infant formula. Premature and low-birth weight infants should receive iron supplements of at least 2 mg/kg/day during the first months of life. Premature infant formula should contain at least 12 mg/L of iron. Erythropoietin-treated premature infants should receive iron oral supplements of at least 6 mg/kg/day as soon as possible. Intravenous iron administration remains controversial (AU)

Effect of preeclampsia in the mother on the leucine metabolism in the newborn infant.

The leucine turnover in newborn infants is influenced by factors such as nutritional state and corticosteroid treatment. Little is known about maternal factors influencing the leucine turnover in the newborn. In order to approach the effect of preeclampsia in the mother on neonatal protein turnover, we studied the leucine turnover in preterm infants soon after birth and again after 7 days. Ten infants from preeclamptic mothers (birth weight 1,280 +/- 240 g, gestational age 31 +/- 2 weeks) and 15 control patients (birth weight 1,320 +/- 210 g, gestational age 30 +/- 2 weeks) were enrolled. The leucine turnover was measured using a primed constant 5-hour intravenous infusion of [1-(13)C]leucine within the first 24 h after delivery and again on day 7 of life. The turnover (leucine flux; micromol.kg(-1).h(-1)) was calculated from the enrichment in alpha-ketoisocaproic acid in plasma. The leucine turnover on day 1 was 300 +/- 65 in the preeclampsia group and 358 +/- 70 in the controls (ANOVA, p < 0.05). The values on day 7 were 474 +/- 73 in the preeclampsia group and 485 +/- 80 in the control group (n.s.). To conclude, the leucine turnover on day 1 is lower in infants of preeclamptic mothers as compared with controls. This difference has disappeared on day 7 of life after receiving the same protein and energy intake.

Nutrición del prematuro tras el alta hospitalaria / Nutrition of the premature after hospital discharge

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