Algorithm for Calculating the Protein Intake in Enteral and Parenteral Nutrition in Premature Infants.

INTRODUCTION: Calculating the exact nutritional balance especially for the premature infant has always been a challenge for the daily practice of the clinician. PURPOSE: we intend to establish a simplified formula and mathematical algorithms to calculate the necessary amino acids and proteins for the nutrition of the premature newborn, covering most of the international recommendations and also to give to the neonatal intensive care physician the opportunity of their rapid customization for each case. METHODS: following an extensive literature revision we have established the protein intake recommendations, indications and contraindications for enteral and parenteral nutrition in premature infants, by age of gestation, birth weight and postnatal age. Then, these recommendations were translated into simplified mathematical equations and we have proceeded to develop logical algorithms to enable the rapid choice of the best equation that fits each individual case with all its peculiarities, at a defined time. RESULTS: for all three premature categories, we have identified intervals for enteral and parenteral nutrition, which were translated into mathematical formulas and management regulations and then transposed into logic algorithms. CONCLUSIONS: although mathematically one can use a simplified calculation, for a rapid appreciation, the clinician is still required to go through these algorithms daily and sometimes several times a day. Moreover, to optimize protein intake, we have to calculate the protein / energy ratio and the non-protein calories / gram of protein ratio. This involves extending the calculation for the carbohydrates, fats and calories-practically the entire nutrition.

A Simple Method of Calculation in Excel for the Protein Requirements in Preterm New Borns.

INTRODUCTION: The nutritional balance between the nutritional requirements of the organism and the intake is a very delicate thing to adjust especially when it comes to the premature new-born in whom often the oral feeding is very challenging and the need for parenteral feeding is very pressing. PURPOSE: The goal of this article is to present a simple method of calculation for the amino acid parenteral intake in preterm infants using the Excel spreadsheet platform as a platform. MATERIAL AND METHOD: Using Excel commands, we translate the algorithms for the protein requirements calculation into an electronic format. This will allow the creation of a template that quickly identifies the need for proteins according to the clinical and evolutional features of the premature new-born, significantly reducing the duration of the calculation. RESULTS: This method is easy to perform, simple and efficient. The calculation template has significantly reduced the errors and the actual working time with the algorithms. These effects are very obvious in intensive care units that take care of a large number of premature babies. CONCLUSIONS: Computerized calculation allows a decrease in calculation errors and also reduces the time actually allocated for the calculation, especially for the very complicated algorithms. Following this template in Excel, we can create separate modules for the algorithms necessary to calculate the needs for the intake of liquids, calories, lipids, and minerals.

[Clinical and therapeutical considerations regarding the diagnosis and treatment in meconial disease]. / Consideratii clinico-terapeutice privind diagnosticul si tratamentul bolii meconiale.

The meconium disease represents a problem of great impact over the vital prognosis of the newborn, the mortality of this disease being rated in various studies between 30 and 50%. The meconial disease that reunites the meconial ileus and the meconial peritonitis is often associated with cystic fibrosis a disease of general impact over the entire organism increasing the gravity and influencing the vital prognosis of these patients. The authors' purpose is to evaluate the results obtained after the treatment of the meconial disease in the Pediatric Surgery Clinic of the Emergency Hospital of Craiova over a period of 10 years. The study has been made on a number of 16 cases of meconial ileus, plug and peritonitis analising the difficulty of the diagnostic process, the preoperative care as well as the possibilities of surgical treatment. The surgical treatment is composed of multiple procedures including simple suture of the bowel defect and segmentary bowel resections with primary anastomosis and/or secondary anastomosis after ileostoma. The mortality on the studied cases was of 37.5% despite recent progresses achieved in postoperative care of these type of patients.

[Clinical and therapeutical considerations regarding a rare case of pre-pyloric stenosis]. / Consideratii clinico-terapeutice privind un caz rar de stenoza prepilorica.

The neonatal obstacle caused by a pre-pyloric diaphragm represent a rare cause of high oclusion in new-born. We present the case of a 6 days old new-born admitted in our department for nonbilious vomiting and feeding intolerance in which the clinical exam and the imagistic explorations (plain and contrast abdominal X-Rays, and ultrasound) could not reveal an evident cause for the oclusion. The surgical intervention imposed by the simptoms revealed the existece of a complete diaphragm in the prepyloric region. The initial excision of the diaphragm was not sufficient, the patient undergoing a second surgical intervention of gastrojejunal anastromosis with favorable evolution this time. The authors are presenting diagnosis and theraputical management peculiarities of this rare condition.

[Evolutive particularities of appendicular plastron in children]. / Particularitati evolutive ale blocului apendicular la copil.

This paper analyses the experience of the Paediatric Surgery Department from the Emergency Hospital in Craiova regarding the clinical and therapeutical evaluation of 55 cases with appendicular plastron admitted in our department between 1997-2006. We analyse both the evolution and the complications in managing these cases, together with particular aspects of differential diagnosis related to this group of age. These 55 cases were children aged between 2 and 15 years with a 15 days average hospitalization period. Applying a standard treatment we had favorable results in 85% of cases with 15% cases underwent surgical treatment from the first admission. Comparative to a study realised in our dept. between 1975-1996, which registered 30 cases with a mortality of 6.70%, the present one revealed in the latest years an important increase of the number of appendicular plastron with a significant low mortality.

[The gastroschisis: clinical and therapeutic considerations]. / Laparoschizisul: consideratii clinico-terapeutice.

Gastroschisis is a severe congenital malformation of the abdominal wall, with relative low incidence. The authors are analysing different therapeutic methods, in a group of 17 cases, hospitalised and operated in Department of Pediatric Surgery, Emergency Hospital of Craiova. They are underlining the importance of the ultrasound prenatal diagnosis of the malformation, close related to different therapeutic methods applied in this period of time and also are advising secondary closure of the abdominal wall, using a synthetic material (Silo-bag) for temporary coverage of the intestine developed outside the peritoneal cavity. This method helped with the decreasing of mortality in gastroschisis but with high costs of treatment.

[Bowel intussusception on the child: clinical therapeutical study]. / Invaginatia intestinala la copil. Studiu clinico-terapeutic.

Intussusceptions is the most common cause of bowel obstruction in children between 5 months and 1 year of age. Intussusceptions occurs when a portion of the bowel folds like a telescope, with one segment slipping inside another segment. This study refers to a group of 72 children, with intussusceptions diagnosis between 1975-2000 in our clinic. The authors are also analyzing these cases from the point of view of frequency on years, seasons, age, sex, residence, clinical forms, time since the intussusceptions occurred until the treatment begun.

[Errors and difficulties in the diagnosis and management of acute and chronic abdomen in children]. / Intre dificultati si confuzii de diagnostic în abdomenul acut si cronic la copil.

The authors are reviewing on a lot of 2844 cases between 1996 and 2000 the difficult problems of differential diagnosis between acute surgical abdomen in children and intestinal tuberculosis, abdominal tumors and inflammatory diseases such as acute osteomielitis. They are presenting 13 particular cases in which the acute abdomen diagnosis was difficult or even omitted.