[The nutritional status of the child with congenital cardiopathy]. / Estado nutricio del niño con cardiopatía congénita.

OBJECTIVE: To know the frequency and type of nutritional alterations of children with congenital heart disease. MATERIAL AND METHODS: Sixty six children with congenital heart disease were studied. MEASUREMENTS were: weight, size, mid arm circumference, tricipital and subscapular skinfold thickness. Blood samples for white blood cells count, and albumin were taken and urine was collected for determination of creatinine. Muscular and fat areas of the arm and creatinine/height index were calculated. In order to compare the children with both cyanotic and non-cyanotic types of heart diseases chi 2 test or Fisher's exact test, ware used. RESULTS: 41 girls and 25 boys, 42 with acyanotic and 24 cyanotic heart disease. 50 children were malnourished (26 compensated, 23 non-compensated and one acute); 16 were normal. 85% of the children presented diminished muscular area and 97% diminished fatty area. The creatinine/height index was diminished in 94% of the cases. No significant differences were demonstrated between both groups. CONCLUSION: chronic malnutrition in children with congenital heart disease is frequent. Most of the cases with malnutrition are compensated. This poor nutritional status is at the expense of fatty and muscular tissues.

[Improvement in diurnal oral ingestion in the malnourished newborn infant induced by the administration of nocturnal enteral nutrition]. / Mejoría de la ingestión oral diurna en el lactante desnutrido inducida por la administración de nutrición enteral nocturna.

The purpose of this study was evaluate the impact of nocturnal nasogastric tube feeding on diurnal caloric intake in children with severe energy protein-calorie malnutrition. Sixteen infants admitted to the Pediatric Nutrition Department with severe malnutrition were randomly assigned into groups: eight children in group A and eight in group B. Infants in both groups received 100% of their caloric requirements by oral feeding ad libitum. An additional 30% caloric charge was given to patients in group A by nocturnal nasogastric tube feeding. At admission and at their 7th day, weight, height, arm circumference, triceps and subscapular skinfold thickness were recorded. Weight for age, weight for height, height for age and upper arm muscle circumference were estimated. Every meal was weighted and measured before and after being eaten in order to calculate the child caloric intake using food composition tables. There were no statistically differences in all parameters between groups at admission. At discharge significant differences on caloric intake were found (179.7 +/- 75.34 kcal vs. 98.38 +/- 37.73 kcal; p 0.02). This findings suggest that nocturnal support with an extra caloric supply over the normal requirements for age improve the diurnal caloric intake of children with severe protein energy malnutrition.

[Morbidity-mortality due to exchange transfusion in a general hospital. A prospective study]. / Morbimortalidad por exanguinotransfusión en un hospital general. Estudio prospectivo.

In this prospective study, the complications and mortality appeared in 50 exchange transfusions (ET) were analyzed. The ET were performed in 84% of the cases through a catheter in the umbilical vessels, 22 through both vessels, 10 by vein and 10 by umbilical artery; in the rest of cases by central vein. We found complications in 33% of the cases. Cardiac arrhythmia (23 cases) was the most frequent complication; also metabolic complications in 20 cases, septic complications in 10 cases (8 cases of omphalitis and 4 of sepsis were included), 8 cases of necrotizing enterocolitis and 3 of bleeding were found. Some of the newborns has 2 or more complications at the same time. The total lethality rate was 4% which occurred in 2 preterm infants with critical state. Our finding suggest that morbidity due to ET is highest than previously reports and maybe the mortality is due to the critical state of patients more than the ET.

[Multisystemic impact in the full-term newborn with perinatal asphyxia]. / Repercusión multisistémica en el recién nacido a término con asfixia perinatal.

We studied 30 full-term newborn infants, admitted to the newborn intensive care unit of "Manuel Gea González" General Hospital between January 1, 1989 and December 31, 1990. All infants had 5-minute Apgar score of 5 or less. The disturbances related to: brain, heart, liver, bowel, coagulation system, calcium and glucose homeostasis were investigate in all cases. Of the 30 infants, 29 (97%) had developed 1 to 7 abnormalities in the systems studied. Most of them had from 2 to 5 abnormalities (77%). The commonest disturbance was brain involvement in 22 cases (73%); metabolic and coagulation changes had also been observed, while heart disturbances were less common. There was no significant difference between the intensity and number of systemic abnormalities observed in these infants and the alterations seen during pregnancy, labor, delivery, administration of anesthesia and Apgar score. These observations suggest a striking relationship between asphyxia in the newborn infant and the development of systemic disturbances.