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.

Post-stroke depression: can we predict its development from the acute stroke phase?

OBJECTIVES: To identify possible predictive factors for post-stroke depression (PSD) in the acute phase of stroke. METHODS: The study design was prospective, observational cohort study of patients with acute cerebral infarction (CI). Neurological and neuropsychological evaluations were conducted within the first 10 days from the onset of stroke and repeated at the 3-month follow-up. DSM-IV criteria were used to define PSD. RESULTS: From a total of 85 patients with CI, 59 patients completed the 3-month follow-up and 17 of them (28.8 %) fulfilled PSD criteria at the 3-month follow-up. Melancholy index of the Hamilton Depression Rankin Scale (HDRS) was associated with a risk three times greater than that of PSD at the 3-month follow-up in the univariate analysis (OR 3.07; 95% CI 1.53-6.16; P = 0.002) with no significant influence of stroke severity or the location of brain infarction (right or left side). The receiver operating characteristic curves pointed to a melancholy index > or =1.5 as the optimal cut-off level associated with the development of PSD at the 3-month follow-up. CONCLUSIONS: Melancholy index of the HDRS > or =1.5 could be a useful clinical tool to detect patients with acute stroke at high risk of developing PSD.