Implementation of a Nurse-Empowered Renal Anemia Protocol in Children.

A high proportion of patients on hemodialysis persist with low hemoglobin levels despite receiving treatment with erythropoiesis-stimulating agents. A registered nurse-driven renal anemia protocol was designed and implemented by a team in a pediatric hemodialysis unit. We compared proportion of patients achieving the target hemoglobin (Hgb) and transferrin saturation (TSAT) before and after the implementation of the protocol. There was an increase in patients achieving the target Hgb and TSAT range, with an increase in the Hgb concentration. There were no differences in the proportion of patients with left ventricular hypertrophy, erythropoiesis-stimulating agents or intravenous iron dose, transfusion rates, or hospitalization rates. The implementation of a nurse-driven anemia protocol in a pediatric hemodialysis unit increased the proportion of patients achieving target Hgb and TSAT range without a rise in medication doses.

Inhalation of growth factors and apo-transferrin to protect and repair the hypoxic-ischemic brain.

Hypoxic-ischemic brain damage is a major contributor to chronic neurological dysfunction and acute mortality in infants as well as in adults. In this review, we summarize recent publications demonstrating that the intranasal administration (INA) of apo-transferrin (aTf) and different growth factors provides neuroprotection to the mouse and rat brain after a hypoxic-ischemic event. The intranasal delivery of growth factors such as insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF) has been found to improve neurological function and reduce infarct size in adult rats after a hypoxic-ischemic event. On the other hand, INA of aTf and epidermal growth factor (EGF) were effective in reducing white matter damage and inflammation and in promoting the proliferation and survival of oligodendroglial progenitor cells (OPCs) in a model of hypoxic-ischemic encephalopathy. Therefore, data summarized in this review suggest that INA of growth factors and aTf can be used in combination in clinical treatment in order to protect and repair the hypoxic-ischemic brain.