Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland.

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists' voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20-30 ng/mL (50-75 nmol/L)], and optimal concentration [30-50 ng/mL (75-125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland.

Effect of a Short-Time Probiotic Supplementation on the Abundance of the Main Constituents of the Gut Microbiota of Term Newborns Delivered by Cesarean Section-A Randomized, Prospective, Controlled Clinical Trial.

The gut microbiota plays a pivotal role in the maintenance of human health. Numerous factors, including the mode of delivery, impact early gut colonization in newborns. Recent research focuses on the use of probiotics in the prevention of gut dysbiosis in newborns delivered by cesarean section (CS). The objective of this study was to determine whether a probiotic supplement given to newborns delivered by CS during their stay in the maternity ward alters the pattern of early gut colonization by lactic acid bacteria versus potential pathogens. A prospective, randomized trial was conducted. In total, 150 newborns, born at 38-40 weeks gestational age and delivered by CS, were included in the study. They were randomized into the intervention group, supplemented orally with a probiotic containing Bifidobacterium breve PB04 and Lactobacillus rhamnosus KL53A, and the control group. Stool samples were obtained on days 5 and 6 of life and after one month of life and were analyzed for the presence and abundance of the main groups of bacteria. An application of two probiotic bacteria during the first days of life after CS resulted in quick and abundant colonization by days 5 and 6, with high populations of L. rhamnosus and B. breve. The applied bacterial strains were present in the majority of neonates one month after. The supplementation of term neonates delivered by cesarean section immediately after birth with a mixture of L. rhamnosus and B. breve enriched the gut microbiota composition with lactic acid bacteria.

[Lactoferrin - a glycoprotein of great therapeutic potentials]. / Laktoferyna-glikoproteina o duzym potencjale terapeutycznym.

Lactoferrin is an iron-binding glycoprotein, which is present in most biological fluids with particularly high levels in colostrum and in mammalian milk. Bovine lactoferrin is more than 70% homologous with human lactoferrin. Most of the clinical trials have used bovine lactoferrin for supplementation. This review summarizes the recent advances in explaining the mechanisms, which are responsible for the multifunctional roles of lactoferrin, and presents its potential prophylactic and therapeutic applications. On the ground of the results of preliminary clinical observations, authors suggest beneficial effect of lactoferrin supplementation on the prevalence of necrotizing enterocolitis in infants with birth weight below 1250 grams.

Nutritional therapy in paediatric intensive care units: a consensus statement of the Section of Paediatric Anaesthesia and Intensive Therapy the Polish Society of Anaesthesiology and Intensive Therapy, Polish Society of Neonatology and Polish Society for.

Providing nutritional therapy via the gastrointestinal tract in patients in paediatric intensive care units (PICUs) is an effective method for delivering energy and other nutrients. In the event of contraindications to using this method, it is necessary to commence parenteral nutrition. In the present study, methods for nutritional treatments in critically ill children are presented, depending on the clinical situation.

Fish-oil fat emulsion supplementation reduces the risk of retinopathy in very low birth weight infants: a prospective, randomized study.

BACKGROUND: Preliminary studies suggest that fish-oil lipid emulsion given parenterally to very preterm infants reduces the severity of retinopathy (ROP) and cholestasis. METHODS: Infants weighing <1250 g at birth were randomly allocated to 2 groups: an experimental group of 60 infants that received an intravenous (IV) soybean, olive oil, and fish oil emulsion, and a control group of 70 infants that was given a parenteral soybean and olive oil emulsion. Plasma and erythrocyte concentrations of docosahexaenoic acid (DHA) were determined using a high-performance liquid chromatography-mass spectrometry analysis. RESULTS: Nine infants in the fish oil group required laser therapy for ROP compared with 22 infants in the standard intralipid group (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.24-0.96). Three infants in the fish oil group developed cholestasis compared with 20 infants in the standard intralipid group (RR, 0.18; 95% CI, 0.055-0.56). The mean plasma DHA concentrations in treated infants were 2.9-fold higher in the fish oil group than in control infants on the 7th and 14th days of life. The mean DHA content in erythrocytes of treated infants was 4.5-fold and 2.7-fold higher compared with controls at 7 and 14 days of age. CONCLUSIONS: Premature infants receiving an IV fat emulsion containing fish oil had less ROP requiring laser treatment and less cholestasis than those receiving a standard lipid emulsion. These infants also had higher plasma and erythrocyte DHA levels at 7 and 14 days, suggesting potential long-term neurodevelopmental benefits.

May the supplementation of lipid emulsion containing DHA in VLBW infants influence their psychological development evaluated at three years of age? Preliminary study.

OBJECTIVES: The aim of the study was to evaluate the possible influence of a lipid emulsion containing DHA (docosahexaenoic polyunsaturated fatty acid), parenterally administered from the first day of life, on the psychological development of 3-year-old children born with very low birth weight (VLBW). It was suspected that an increased amount of DHA in parenteral nutrition may be a variable that modifies the relation between other medical or social factors and their influence on the child's development. MATERIAL AND METHODS: Two groups of three-year-old children with calendar age ranging from 29 to 51 months (mean value--38 months) were tested. The children in the study group (n=23) were parenterally nourished during the first weeks of life with a lipid emulsion containing DHA. The patients in the control group (n=13) were fed with a lipid emulsion without DHA. RESULTS: Using the General Linear Model (GLM) with the analysis of interaction effects, it was found that the supplementation of the lipid emulsion containing DHA in parenteral nutrition from the first day of life beneficially influenced the relation between immaturity associated with the children's health status at birth and emotional development evaluated at three years of age. It also modified the relation between emotional and linguistic development. CONCLUSIONS: When administered after birth in prematurely born children, the lipid emulsion containing DHA may influence their development at the age of three years. It may either compensate the negative effects that immaturity associated with the health status at birth has on emotional development, or stimulate the language development in children whose emotional development is normal.

[The effects of enteral administration of glutamine enriched solution in very low birth weight infants on reducing the symptoms of feeding intolerance. A prospective, randomized pilot study]. / Wplyw enteralnej podazy roztworu wzbogaconego glutamina u noworodkow z bardzo mala urodzeniowa masa ciala, na ograniczenie objawow nietolerancji karmiena. Prospektywne, randomizowane badanie pilotazowe.

BACKGROUND: Feeding intolerance frequently occurs during the first several weeks of life in very low birth weight infants and may require the reduction of oral feeding. When significantly expressed, it may lead to the development of necrotizing enterocolitis. Apart from breast milk, also the maintenance of normal peristalsis, enterocyte nourishment and keeping a low pH value in the stomach seem to be important points in the NEC prophylaxis. AIM: The authors present the results of the randomized pilot study, performed in two, differently fed groups of VLBW newborns. The aim of the study was to compare the frequency of feeding intolerance, necrotizing enterocolitis, sepsis caused by Gram negative bacteria, intestinal perforation and the number of deaths between the study group and the control group of newborns. MATERIALS AND METHODS: 106 VLBW newborns were qualified for research. In the study group (50 newborns), apart from the mother's milk or preterm formula, infants were enteraly receiving a glutamine/ amino acid solution, the osmolality of which was comparable to amniotic fluid. The pH value of the solution was 5.5 so as to lower acidity of the stomach fluids. In the control group (56 newborns) infants were fed enteraly exclusively with the mother's milk or preterm formula. The patients in the two groups were comparable with regard to birth weight, gestational age, Apgar score and CRIB score, and the frequency of antenatal corticosteroid administration. RESULTS: There was a significantly lower risk of feeding intolerance in infants who were receiving the glutamine/amino acid solution (p=0.015). Also there was a lower risk of NEC (5 vs 10 cases), intestinal perforation (1 vs 4 cases), sepsis caused by Gram negative bacteria (1 vs 4 cases) and death (1 vs 3) in the study group. However, none of these differences reached statistical significance. CONCLUSIONS: Enteral supplementation of glutamine/amino acid solution given simultaneously with enteral feeding is safe and may significantly reduce feeding intolerance in very low birth weight infants in their first days or weeks of life. The results of our research can be useful when attempting to work out the principles of NEC prophylaxis by means of maintaining normal peristalsis, enterocyte nourishment and keeping a low pH value in the stomach.

The efficacy of fish-oil based fat emulsion administered from the first day of life in very low birth weight newborns.

BACKGROUND: DHA has been shown to be important for foetal brain development, optimal development for motor skills and visual acuity in infants. Newborns born prematurely are at increased risk for DHA (docosahexaenoic acid) insufficiency because they may not have benefited from a full trimester of the mother's lipid stores and have very limited ability to synthesize DHA. Moreover, within the first 2-3 weeks of life, the main sources of lipids for most prematurely delivered infants are soyabean/safflower/olive oil emulsions which are rich in n-6 fatty acids and do not contain DHA. AIM: To perform a retrospective analysis, which compares the safety and efficacy outcomes of an intravenous fat emulsion based on fish-oil (containing docosahexaenoic acid- DHA), and is administered from the first day of life in very low birth weight newborns, with data obtained in preterm neonates with birthweight below 1500 g, receiving soyabean/olive oil emulsion, which do not contain DHA. MATERIALS AND METHODS: Infants from the two groups (the study group n=152; the control group n=185) were comparable with regard to demographic and clinical characteristics and were subjected to the same conventional therapy. Determination of plasma and erythrocytes DHA concentrations in newborns was made using a high-performance liquid chromatography-mass spectrometry (LC-ESI/MS) method. Detection of parent ions with negative ionization mode, m/z 327.5 amu. Method validation was according to the ICH and FDA requirements. RESULTS: There was a significantly lower risk of cholestasis in infants, who were receiving the soyabean/ olive oil/fish-oil emulsion (p=0.025). Also, there was a markedly lower risk of laser therapy in infants, who were receiving a fish-oil emulsion however, the difference did not reach statistical significance. CONCLUSIONS: Fish-oil-based fat emulsion administered as a component of total parenteral nutrition from the first day of life is safe in the prophylaxis of cholestasis and severe retinopathy of prematurity. Further clinical investigations are needed.

Docosahexaenoic acid (DHA) concentration in very low birth weight newborns receiving a fish-oil based fat emulsion from the first day of life. Preliminary clinical observation.

BACKGROUND: Preterm infants are at increased risk for DHA deficiency because from 26th weeks of pregnancy until term, 80% of the brain this acid accrues in the fetus. Moreover, the main sources of lipids for preterm newborns are fat emulsions which do not contain DHA. AIM: 1) to investigate the plasma DHA concentration in prematurely delivered newborns who are receiving a fish-oil emulsion in amount equal to one third of total daily intravenous lipid intake or soybean/olive oil fat emulsion from the first day of life. 2) to compare plasma DHA concentration, evaluated immediately after birth in prematurely born infants, with the respective data obtained in full term newborns. MATERIALS AND METHODS: Twenty one preterm infants in the two groups: the study group n=12 (newborns fed parenterally with a partially replaced a soybean/olive oil emulsion with a fish-oil emulsion); the control group n=9 (newborn fed parenterally with a soybean/olive oil emulsion) comparable with regard to demographic and clinical characteristics. Determination of plasma and erythrocytes DHA concentrations in newborns was made using a high-performance liquid chromatography-mass spectrometry (LC-ESI/MS) method. Detection of parent ions with negative ionization mode, m/z 327,5 amu. Method validation was according to the ICH and FDA requirements. RESULTS: The mean values of plasma DHA level measured on the 7th, 14th, 21st, 28th day of life, were statistically significantly lower in the control group when compared with respective data obtained in the study group (7th day: 7.98 vs 42.4 emol/L, p=0.0002; 14th day: 6.8 vs 21.14 emol/l, p=0.000001; 21st day: 11.56 vs 19.1 emol/L, p=0.035; 28th day: 11.4 vs 25.4 emol/L, p=0.0004). The mean value of plasma DHA level in full-term newborns measured in the first hours of life was 164.7 emol/L whereas in preterm neonates it reached 15.9 emol/L (p=0.000001). CONCLUSIONS: The administration of fish-oil-based fat emulsion as a component of total parenteral nutrition from the first day of life may alleviate a marked decrease in plasma DHA level observed in preterm infants within the first weeks after birth. Established method allows for routine determination of DNA concentrations in plasma erythrocytes of newborns.

Fish-oil fat emulsion supplementation may reduce the risk of severe retinopathy in VLBW infants.

OBJECTIVE: The retina contains rods and cones that have membranes highly enriched with docosahexaenoic acid (DHA). Infants born prematurely are at risk of DHA insufficiency, because they may not have benefited from a full third trimester of the mother's lipid stores. Moreover, within the first 2 to 3 weeks of life, the main sources of lipids for premature infants are fat emulsions, which do not contain DHA. PATIENTS AND METHODS: This observational study was designed to compare the safety and efficacy outcomes of an intravenous fat emulsion that consists of fish-oil emulsion (contains DHA) with soybean and olive oil, administered from the first day of life to 40 infants who weighed <1250 g; results were obtained from a historical cohort of 44 preterm neonates who were given an emulsion of soybean and olive oil. The primary study outcomes were the occurrence of retinopathy and need for laser therapy and cholestasis. Infants in the 2 groups were comparable with regard to demographic and clinical characteristics and were subjected to the same conventional therapy. RESULTS: There was a significantly lower risk of laser therapy for infants who received an emulsion of soybean, olive oil, and fish oil (P = .023). No significant differences were found in acuity and latency of visual evoked potentials between infants in the 2 groups. There was no infant with cholestasis among those who received fish-oil emulsion, and there were 5 subjects with cholestasis in the historical group (P = .056). CONCLUSION: Fish-oil-based fat emulsion administered from the first day of life may be effective in the prophylaxis of severe retinopathy.

Effects of oral L-arginine on the pulsatility indices of umbilical artery and middle cerebral artery in preterm labor.

OBJECTIVE: The objective of the study was the estimation of the influence of oral supplementation with low-dose l-arginine on feto-placental circulation in women with threatened preterm labor. STUDY DESIGN: Oral administration of 3g of L-arginine daily or placebo as a supplement to standard tocolytic therapy was tried in 70 women with threatened preterm delivery, randomly assigned to the L-arginine (n=37) or placebo (n=33) groups. Twenty-five and 20 completed the study, respectively. Doppler velocimetry of pulsatility indices (PI) of the umbilical (UA) and middle cerebral (MCA) arteries as well as pregnancy outcome and biochemical markers of nitric oxide synthesis (plasma amino acid and nitrite/nitrate levels, as well as 24 h nitrite/nitrate excretion with urine) were estimated. RESULTS: Starting from the second week of therapy, the UA PI values were significantly lower in the L-arginine group than in the placebo group. Moreover, treatment with L-arginine caused a significant increase in MCA PI and cerebro-placental ratio (CPR) values. The changes in feto-placental circulation in the L-arginine group were not associated with any signs of increased nitric oxide synthesis. CONCLUSION: Oral supplementation with low doses of L-arginine changed feto-placental blood flow distribution in patients with threatened preterm labor. The exact mechanism of L-arginine action on feto-placental circulation requires further investigation.

[Current neonatal resuscitation practices in Polish neonatal units - national survey]. / Stan przygotowania pod wzgledem merytorycznym i organizacyjnym oddzialów neonatologicznych o róznym stopniu referencji do prowadzenia resuscytacji noworodka po urodzeniu.

AIM: We surveyed current neonatal resuscitation practices in Polish neonatal units to determine the factors, relevant to improving practices in this area. MATERIAL AND METHODS: The study was performed within the framework of the National Standardization Programme on Neonatal Practices and Procedures in 2007. An 11 question survey included questions concerning the frequency of neonatal resuscitation, type of procedure performed during resuscitation ie.: medicaments and oxygen administration, umbilical vein catetherisation, equipment availability, resuscitation of extremely preterm babies. The survey included also questions concerning problems in resuscitation and their causes. 420 questionnaires were sent out and 274 were returned completed (65.2% response rate). 266 units providing delivery room resuscitation were included in the study. RESULTS: Neonatal resuscitation procedures were needed significantly more frequently in the centres of the highest degree reference (p<0.001). There were also marked differences between the centres according to the frequency of umbilical vessels catetherisation and availability of the necessary medical equipment. In 44.6% of neonatal units, resuscitated newborns are successfully ventilated with room air. However, in 23.5% of the surveyed units, 100% oxygen is used for ventilation. The finding of great importance is that 30.7% of neonatal units stated the need for a trained resuscitator to attend a high risk pregnancy delivery and to resuscitate asphyxiated newborns. CONCLUSIONS: There are substantial differences in neonatal resuscitation practices in different neonatal centres. These findings should stimulate appropriate authorities to start an educational programme to establish suitable polices in newborn resuscitation.

Effects of oral L-arginine on the foetal condition and neonatal outcome in preeclampsia: a preliminary report.

Estimation of the influence of oral supplementation with low dose of L-arginine on biophysical profile, foeto-placental circulation and neonatal outcome in preeclampsia. Randomized, placebo-controlled, double-blind, clinical trial. Oral therapy with 3 g of L-arginine daily or placebo as a supplement to standard therapy. Eighty-three preeclamptic women, randomly assigned to the L-arginine (n=42) or placebo (n=41) groups; [n=30 (L-arginine) and n=31 (placebo) ended the study, respectively]. Foetal gain chances due to ultrasound biometry, biophysical profile, Doppler velocimetry of pulsatility indices of umbilical and middle cerebral arteries, cerebro-placental ratio, as well as differences in duration of pregnancy and clinical data of newborn. L-arginine treatment transitory accelerated foetal gain and improved biophysical profile. Starting from 3rd week of therapy, the umbilical artery pulsatility indices values were significantly lower in L-arginine than in placebo group. Moreover, treatment with L-arginine caused significant increase of middle cerebral artery pulsatility indices and cerebro-placental ratio values. Latency was longer in L-arginine group. Neonates delivered in the L-arginine group revealed higher Apgar score. Supplementary treatment with oral L-arginine seems to be promising in improving foetal well-being and neonatal outcome as well as in prolonging pregnancy complicated with preeclampsia. However, these benefits require confirmation in more-powered, larger studies.