RESUMO
Skipping breakfast is associated with higher BMI in children aged 5 years and older. However, not much is known about this association in younger children. In the Dutch GECKO Drenthe birth cohort we examined the association between breakfast skipping and objectively measured overweight at the age of 2 (n=1488) and 5 (n=1366) years. At 2 years, 124 (8.3%) children were overweight and 44 (3.0%) did not eat breakfast daily. At 5 years, 180 (13.2%) children were overweight and 73 (5.3%) did not eat breakfast daily. Children belonging to families of non-Dutch origin, those with lower educated parents and those with single parents skipped breakfast more often. Breakfast skipping in 2- and 5-year-olds is rare in the Netherlands. We found no association between skipping breakfast and overweight, neither at age 2 (odds ratio (OR): 1.85 (95% confidence interval (CI): 0.61-5.64)) nor at age 5 (OR: 0.46 (95% CI: 0.19-1.11)). Also the type of breakfast was not related to overweight at 5 years. An explanation for this finding might be that skipping breakfast is not (yet) an issue in these children.
Assuntos
Desjejum , Comportamento Infantil , Comportamento Alimentar , Sobrepeso/epidemiologia , Poder Familiar , Índice de Massa Corporal , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Promoção da Saúde , Humanos , Masculino , Países Baixos , Razão de Chances , Sobrepeso/etiologia , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
STUDY QUESTION: Do paternal and maternal lifestyle factors influence the risk of hypertensive pregnancy complications, gestational diabetes mellitus (GDM), spontaneous preterm birth and small-for-gestational-age (SGA)? SUMMARY ANSWER: Paternal lifestyle factors do not exert an independent effect on the investigated outcomes while maternal prepregnancy BMI and maternal smoking during pregnancy influence the risk of hypertensive pregnancy complications, GDM and SGA. WHAT IS KNOWN ALREADY: Maternal lifestyle factors are associated with perinatal complications, but the impact of paternal lifestyle factors is unclear. STUDY DESIGN, SIZE, DURATION: Data from the GECKO (Groningen Expert Center for Kids with Obesity) Drenthe cohort, a prospective population-based birth-cohort of children born between April 2006 and April 2007 in a northern province of The Netherlands, were analysed. The parents of 2958 children (62% of those approached) gave their consent to participate in the study and the data of 2264 (77%) couples were available for analysis. PARTICIPANTS/MATERIALS, SETTINGS, METHOD: All pregnant women in the Dutch province of Drenthe with an expected date of delivery between April 2006 and April 2007 were invited to participate and included during the third trimester of their pregnancy or within 6 months after delivery. All consenting couples received extensive questionnaires including lifestyle, biological and socio-demographic-related questions covering the period of 6 months prior to conception. Outcome data were obtained from midwives and hospital registries. Univariable and multivariable logistic regression analyses were used to determine the impact of the lifestyle factors on the primary outcome measures. MAIN RESULTS AND THE ROLE OF CHANCE: Of all 2264 women, 241 women (10.6%) developed a hypertensive pregnancy complication, 50 women (2.2%) developed GDM, 79 (3.5%) children were spontaneously delivered preterm and 155 children (6.8%) were SGA. All paternal and maternal lifestyle factors were positively correlated. Multivariable analysis showed that paternal lifestyle factors did not have an independent influence on the investigated outcomes. Of the maternal factors, prepregnancy BMI was independently associated with an increased risk of a hypertensive disorder during pregnancy (odds ratio (OR): 1.12, 95% CI 1.09-1.16), a higher risk of GDM (OR BMI >23 kg/m(2), per BMI unit: 1.13, 95% CI 1.08-1.18) and with a decreased risk of SGA (OR per BMI point 0.94, 95% CI 0.90-0.99). Maternal smoking during pregnancy was significantly associated with SGA (OR 3.00, 95% CI 1.80-4.99) in multivariable analysis. LIMITATIONS, REASONS FOR CAUTION: The retrospective nature of the questionnaire may have induced recall bias. Selection bias might have occurred, as ethnic minorities were less willing to co-operate in the GECKO Drenthe study. The possibility of misclassification bias regarding the primary outcome measures cannot be ruled out. Inclusion bias might have occurred as not all questionnaires of the parents of the children participating in the GECKO Drenthe cohort were completed. WIDER IMPLICATIONS OF THE FINDINGS: Paternal lifestyle factors do not have an independent effect on the investigated adverse pregnancy outcomes. However, as paternal and maternal lifestyles are positively correlated, both partners should be involved in preconception counselling regarding the investigated outcome measures.
Assuntos
Estilo de Vida , Comportamento Materno , Comportamento Paterno , Complicações na Gravidez/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido Pequeno para a Idade Gestacional , Modelos Logísticos , Análise Multivariada , Razão de Chances , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , FumarRESUMO
AIM: Up to 18.1% of Dutch children aged 3-5 are overweight and up to 3.3% are obese, with higher levels in girls. This study assessed the effect of a multidisciplinary intervention programme on health-related quality of life (HRQoL) in this patient group. METHODS: We randomised 75 children to a multidisciplinary intervention, comprising dietary advice, exercise sessions and psychological counselling for parents or the standard care programme, providing healthy lifestyle advice. The parents completed quality of life and child health questionnaires at baseline and after 16 weeks and 12 months. RESULTS: At 16 weeks, children in the intervention group experienced more bodily pain and less mental health than the standard care group, but at 12 months, this difference disappeared and they showed a more positive change in HRQoL than the standard care group, especially for the physical domain. When we combined both groups, a decreased BMIz-score over 12 months was associated with increased global health and reduced visceral fat correlated with increased general health. CONCLUSION: At 12 months, a multidisciplinary intervention programme for overweight and obese children aged 3-5 years had beneficial effects on HRQoL, especially for the physical domain. Reduced obesity parameters correlated with several increased HRQoL parameters.
Assuntos
Sobrepeso/terapia , Obesidade Infantil/terapia , Qualidade de Vida , Pré-Escolar , Feminino , Humanos , Masculino , Equipe de Assistência ao PacienteRESUMO
AIM: To comparing attitudes towards end-of-life (EOL) decisions in newborn infants between seven European countries. METHODS: One paediatrician and one lawyer from seven European countries were invited to attend a conference to discuss the practice of EOL decisions in newborn infants and the legal aspects involved. RESULTS: All paediatricians/neonatologists indicated that the best interest of the child should be the leading principle in all decisions. However, especially when discussing cases, important differences in attitude became apparent, although there are no significant differences between the involved countries with regard to national legal frameworks. CONCLUSION: Important differences in attitude towards neonatal EOL decisions between European countries exist, but they cannot be explained solely by medical or legal reasons.
Assuntos
Atitude do Pessoal de Saúde , Terapia Intensiva Neonatal , Assistência Terminal , Suspensão de Tratamento , Europa (Continente) , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/ética , Terapia Intensiva Neonatal/legislação & jurisprudência , Terapia Intensiva Neonatal/normas , Advogados , Responsabilidade Legal , Neonatologia/ética , Neonatologia/legislação & jurisprudência , Neonatologia/normas , Pediatria/ética , Pediatria/legislação & jurisprudência , Pediatria/normas , Médicos , Guias de Prática Clínica como Assunto , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência , Assistência Terminal/normas , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência , Suspensão de Tratamento/normasRESUMO
BACKGROUND: Prenatal exposure to endocrine disruptors, like organohalogen compounds (OHCs), might be responsible for the increased aberrations in human male sexual development (hypospadias, cryptorchidism, testicular cancer and fall in sperm count) observed over the past decades. This development is established during fetal life, and reflected in sex hormone levels, testes volume and penile length post-partum. The present study investigates the correlation between prenatal OHC levels and male sexual development outcomes. METHODS AND RESULTS: Levels of eight neutral [2,2'-bis-(4-chlorophenyl)-1,1'-dichloroethene (4,4'-DDE), 2,2',4,4',5,5'-hexachlorobiphenyl, 2,2',4,4'-tetrabromodiphenyl ether (BDE)-47, -99, -100, -153, -154 and 1,2,5,6,9,10-hexabromocyclododecane, HBCDD] and four phenolic [(pentachlorophenol (PCP), 4OH-CB-107 (4-hydroxy-2,3,3',4',5-pentachlorobiphenyl), -146 and -187)] OHCs were determined in 55 maternal serum samples taken at 35 weeks of pregnancy. Eight sex development-related hormones [testosterone, free testosterone, sex hormone-binding globulin (SHBG); LH, FSH, estradiol (E(2)), free E(2) (FE(2)) and inhibin B (InhB)] were determined in their sons at 3 months of age, and testes volume and penile length at 3 and 18 months of age. The following prenatal OHC levels correlated significantly with sex hormone levels: PCP with SHBG and InhB (ρ = 0.30 and -0.43, respectively), 4OH-CB-107 with testosterone (ρ = 0.31) and BDE-154 with FE(2), E(2) and InhB (ρ = 0.49, 0.54 and 0.34, respectively). BDE-154 levels correlated positively with testes volume at 18 months of age (ρ = 0.34). CONCLUSIONS: Prenatal OHC exposure is correlated with aspects of sexual development outcome in boys up to 18 months of age.
Assuntos
Disruptores Endócrinos/farmacologia , Hormônios Esteroides Gonadais/sangue , Hidrocarbonetos Halogenados/farmacologia , Pênis/efeitos dos fármacos , Efeitos Tardios da Exposição Pré-Natal , Desenvolvimento Sexual/efeitos dos fármacos , Testículo/efeitos dos fármacos , Estudos de Coortes , Disruptores Endócrinos/sangue , Feminino , Humanos , Hidrocarbonetos Halogenados/sangue , Masculino , Pênis/anatomia & histologia , Gravidez , Terceiro Trimestre da Gravidez , Testículo/anatomia & histologiaRESUMO
BACKGROUND: Both maternal and paternal factors have been suggested to influence a couple's fecundity. To investigate this, we examined the role of several maternal and paternal lifestyle and socio-demographic factors as determinants of time to pregnancy (TTP) in a Dutch birth-cohort. METHODS: Groningen Expert Center for Kids with Obesity (GECKO) Drenthe is a population-based birth-cohort study of children born between April 2006 and April 2007 in Drenthe, a province of The Netherlands. Both partners received extensive questionnaires during pregnancy. Univariable and multivariable Cox regression analyses were used to determine the impact of the investigated factors on TTP. RESULTS: A total of 4778 children were born, and the parents of 2997 children (63%) gave their consent to participate. After excluding unintended pregnancies and pregnancies as a result of fertility treatment, the data of 1924 couples were available for analysis. Hazards ratios and 95% confidence intervals of factors influencing TTP in multivariable Cox regression analysis were: maternal age 1.23 (0.98-1.54) for age <25 years, 1.17 (1.03-1.32) for age 25-30 years and 0.72 (0.61-0.85) for age >35 years (reference category: 30-35 years); paternal age: 1.31 (0.94-1.82) for age <25 years, 1.11 (0.97-1.28) for age 25-30 years and 0.91 (0.80-1.04 for age >35 years (reference category: 30-35 years); nulliparity: 0.76 (0.68-0.85) versus multiparity; menstrual cycle length: 1.12 (0.95-1.30) for 3 weeks, 0.72 (0.62-0.83) for 4-6 weeks, 0.68 (0.40-1.16) for >6 weeks and 0.66 (0.54-0.81) for irregular cycle (reference category: 4 weeks); prior contraceptive use: 0.78 (0.67-0.91) for no contraception, 1.68 (1.45-1.95) for condom use, 1.08 (0.89-1.33) for condom use combined with oral contraception, 1.40 (1.16-1.70) for intrauterine device and 0.50 (0.25-1.01) for contraceptive injection (reference category: oral contraception); and maternal educational level 0.75 (0.62-0.92) for low education level and 0.81 (0.73-0.90) for medium educational level (reference category: high educational level). CONCLUSIONS: This population-based birth-cohort study performed in fertile couples who had conceived revealed neither maternal nor paternal modifiable lifestyle factors were significantly associated with TTP after adjustment for confounding by socio-demographic factors. In contrast, several non-modifiable maternal socio-demographic factors are significant predictors of a couple's fecundity.
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Promoção da Saúde , Infertilidade Feminina/etiologia , Infertilidade Masculina/etiologia , Taxa de Gravidez , Saúde Reprodutiva , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Coortes , Características da Família , Feminino , Humanos , Infertilidade Feminina/prevenção & controle , Infertilidade Masculina/prevenção & controle , Estilo de Vida , Masculino , Países Baixos , Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fumar/efeitos adversos , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: The antiobesity effects of suppressed endocannabinoid signaling may rely, at least in part, on changes in lipid fluxes. As fatty acids exert specific effects depending on their level of saturation, we hypothesized that the dietary fatty acid composition would influence the outcome of treatment with a CB(1)-receptor antagonist (rimonabant). METHODS: Mice were treated with rimonabant (10 mg kg(-1) body weight per day) or vehicle while equicalorically fed either a low-fat diet (LF), a high-fat (HF) diet or an HF diet in which 10% of the saturated fatty acids (SFAs) were replaced by poly-unsaturated fatty acids (PUFA) from fish oil (FO). Food intake and body weight were registered daily. Indirect calorimetry was performed and feces were collected. After 3 weeks, mice were killed for blood and tissue collection. RESULTS: Relative to the LF diet, the HF diet caused anticipated metabolic derangements, which were partly reversed by the HF/FO diet. The HF/FO diet, however, was most obesity-promoting despite inhibiting lipogenesis as indicated by low gene expression levels of lipogenic enzymes. On all three diets, rimonabant treatment improved metabolic derangements and led to significantly lower body weight gain than their respective controls. This latter effect appeared largest in the HF/FO group, but occurred without major changes in nutrient absorption and energy expenditure. CONCLUSION: The effects of chronic rimonabant treatment on body weight gain occurred irrespective of diet-induced changes in lipogenic activity, food intake and daily energy expenditure, and were, in fact, most pronounced in HF/FO mice. The effects of dietary PUFA replacement in an HF diet on expansion of adipose tissue might allow the favorable effects of dietary PUFA on dyslipidemia and hepatic steatosis. In light of other disadvantageous effects of weight gain, this might be a risky trade-off.
Assuntos
Peso Corporal/efeitos dos fármacos , Gorduras na Dieta/metabolismo , Ácidos Graxos/metabolismo , Óleos de Peixe/metabolismo , Obesidade/metabolismo , Piperidinas/administração & dosagem , Pirazóis/administração & dosagem , Animais , Canabinoides/antagonistas & inibidores , Gorduras na Dieta/farmacologia , Metabolismo Energético/efeitos dos fármacos , Óleos de Peixe/administração & dosagem , Regulação Enzimológica da Expressão Gênica , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/tratamento farmacológico , Obesidade/genética , Receptor CB1 de Canabinoide/antagonistas & inibidores , RimonabantoRESUMO
INTRODUCTION: A heavier weight in adults is becoming the norm rather than an abnormal weight. Whether the same trend is happening in children is unknown. OBJECTIVE: To assess the perception of the weight of 4- to 5-year-old children and the recognition of overweight by both parents. DESIGN: Population-based survey. PARTICIPANTS: A questionnaire was sent to parents of 1155 4- to 5-year-old children. RESULTS: In total, 439 questionnaires (35%) were returned. Of all, 90% of the children had a normal weight, 9.3% were overweight and 4.1% were obese. For all weight classes, the parents depicted the child as lighter on both the verbal and visual scale. Of all, 75% of mothers of overweight children stated that the child had a normal weight. In obese children, 50% of the mothers believed that the child had a normal weight. CONCLUSION: Children with a weight in the normal range were considered by their parents as a little too light or too light. Overweight was considered as normal weight, and obesity as normal or a little too heavy. The perception of a normal weight in children at 4-5 years is distorted.
Assuntos
Peso Corporal , Sobrepeso , Pais/psicologia , Pré-Escolar , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Países Baixos , Obesidade/psicologia , Sobrepeso/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Risk factors other than supplemental oxygen might play a role in the development of retinopathy of prematurity (ROP). In Indonesia ROP occurs in infants up to 34 weeks and 2000âg. Risk factors for the development of ROP in Indonesian NICUs have not been evaluated. Our aim was to identify other risk factors than the use of oxygen in the development and progression of ROP in preterm infants in Indonesia. METHODOLOGY: Data on 98 preterm infants with ROP and 77 controls were collected from four NICUs and two eye centers in Jakarta, Indonesia, between 2009 and 2014. We used multivariate logistic regression analysis to determine the relationship between infants and environmental variables and the development and progression of ROP. We obtained variables for ROP severity by using Cox regression analysis. RESULTS: Factors associated with the development of ROP were birthweight (BWt), intrauterine growth retardation (IUGR), exchange transfusion, duration of oxygen supplementation, minimum saturation monitor setting, and socioeconomic factors. Regarding the progression, gestational age (GA), out-born, duration of supplemental oxygen, minimum saturation monitor setting, and socioeconomic factors were identified as risk factors. CONCLUSION: The use and control of supplemental oxygen are the main risk factors for the development and progression of ROP in preterms in Indonesia. Additionally, we confirm that GA, BWt, and IUGR are risk factors. Moreover, we found exchange transfusion to be a risk factor, and we found a lower rate of ROP in infants from a lower socioeconomic background. These risk factors apply to infants with a GA up to 34 weeks and a BWt up to 2000âg.
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Peso ao Nascer , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Oxigenoterapia/estatística & dados numéricos , Retinopatia da Prematuridade/epidemiologia , Classe Social , Estudos de Casos e Controles , Progressão da Doença , Transfusão Total/estatística & dados numéricos , Feminino , Humanos , Indonésia/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Recém-Nascido de muito Baixo Peso , Masculino , Modelos de Riscos Proporcionais , Retinopatia da Prematuridade/fisiopatologia , Fatores de RiscoRESUMO
Non-alcoholic fatty liver disease (NAFLD) comprises a range of chronic liver diseases from simple steatosis to steatohepatitis and cirrhosis with liver failure. In children, NAFLD is mainly associated with obesity and metabolic syndrome, the results of an unhealthy lifestyle. Insulin resistance and free fatty acids play a key role in the pathogenesis of NAFLD. NAFLD can therefore be seen as a metabolic complication of obesity. Since the prevalence of obesity in Dutch children is increasing, the prevalence of NAFLD in children is expected to increase as well. Prevention of obesity and identification of children with an increased risk of NAFLD are important steps in preventing irreversible liver damage. Lifestyle changes aimed at improving insulin sensitivity through healthy food and sufficient physical activity are essential in the treatment of NAFLD. Pharmacological treatment may have additional value.
Assuntos
Exercício Físico/fisiologia , Fígado Gorduroso/epidemiologia , Obesidade/complicações , Redução de Peso/fisiologia , Adolescente , Criança , Fígado Gorduroso/etiologia , Feminino , Humanos , Estilo de Vida , Masculino , Obesidade/epidemiologia , Prevalência , Comportamento de Redução do RiscoRESUMO
Human milk provides optimal nutrition for the term new-born infant. This milk might give the infant certain advantages over formula milk, and the potential advantages are reviewed in this commentary. It is concluded that there are advantages to breastfeeding, but that these are limited for an infant in an industrialised country receiving adequate formula milk. Breastfeeding should be encouraged, but there is insufficient reason for a mother who either is not able or not willing to breastfeed to feel guilty about not doing so.
Assuntos
Alimentação com Mamadeira/psicologia , Aleitamento Materno , Culpa , Mães/psicologia , Animais , Feminino , Humanos , Lactente , Leite Humano , Países BaixosRESUMO
INTRODUCTION: In neonates with spina bifida aperta (SBA), leg movements by myotomes caudal to the meningomyelocele (MMC) are transiently observed. It is unclear whether these leg movements relate to functional neural conduction through the MMC. For optimal therapeutical intervention, pathophysiological insight in these transient leg movements seems relevant. If leg movements by myotomes caudal to the MMC concur with the execution of general movements (GMs), functional neural conduction through the MMC is implicated. OBJECTIVE: In neonates with SBA, we aimed to determine whether the transiently present leg movements caudal to the MMC indicate functional neural conduction through the MMC. METHODS: During the perinatal period, fetuses and neonates with SBA (n = 7 and n = 13, respectively) were longitudinally analysed for concurrency between leg movements caudal to the MMC and GMs. To address the integrity of the reflex arc in spinal segments (at, or) caudal to the MMC, tendon leg reflexes were assessed during the first postnatal week. RESULTS: At postnatal day 1, leg movements caudal to the MMC concurred with GMs in 12 of 13 infants. Isolated leg movements were observed in only 3 of these 12 infants (isolated vs. concurrent; p < 0.005). Leg movements concurring with GMs lasted longer than isolated leg movements (median duration = 11 s vs. 2 s; p < 0.05). Between days 1 and 7, tendon leg reflexes (at, or) caudal to the MMC had disappeared in all but 1 neonate. However, leg movements caudal to the MMC remained concurrently present with GMs in all five neonates available for follow-up after day 7. Comparing these leg movements between days 1 and 7 indicated a decreased duration (-44%, p < 0.05). CONCLUSIONS: In neonates with SBA, leg movements caudal to the MMC concur with GMs, indicative of functional neural conduction through the MMC. The disappearance of these leg movements is caused by lower motor neuron dysfunction at the reflex arc, whereas neural conduction through the MMC is still functional.
Assuntos
Cinesiologia Aplicada , Joelho/fisiopatologia , Perna (Membro)/fisiologia , Movimento/fisiologia , Reflexo de Estiramento/fisiologia , Espinha Bífida Cística/fisiopatologia , Feto/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Estudos Longitudinais , Meningomielocele/fisiopatologiaRESUMO
A new stable isotope procedure has been developed and validated in rats, applying [1-(13)C]acetate infusion to quantify the production of bile salts from de novo synthesized cholesterol making use of the mass isotopomer distribution analysis (MIDA) principle. Ions (m/z) 458-461, 370-373 and 285-288 were monitored by GC/MS (EI-mode) for the methyl trimethylsilylether derivatives of cholate, chenodeoxycholate and beta-muricholate, respectively. Rats with intact exteriorized enterohepatic circulation and rats with chronic bile diversion were infused with [1-(13)C]acetate for up to 14 h. After 10 h of infusion the enterohepatic circulation of the intact group was interrupted to deplete the existing bile salt pool (acute bile diversion). The fractions of biliary cholesterol and individual bile salts derived from newly synthesized cholesterol were determined by MIDA at t=14 h. In rats with acute bile diversion, these fractions were 20, 25, 27 and 23% for biliary cholesterol, cholate, chenodeoxycholate and beta-muricholate, respectively. After bile diversion for 8 days to induce hepatic cholesterol and bile salt synthesis, these fractions increased significantly to 32, 47, 41 and 47%, respectively. Calculated enrichments of the acetyl-CoA precursor pools were similar for all bile salts and biliary cholesterol within the two rat groups. However, chronic enterohepatic interruption decreased the acetyl-CoA pool size almost two-fold. We conclude that MIDA is a validated new stable isotope technique for studying the synthetic pathway from acetyl-CoA to bile salts. This technique provides an important new tool for studying bile salt metabolism in humans using stable isotopes.
Assuntos
Ácidos e Sais Biliares/biossíntese , Colesterol/biossíntese , Animais , Ácidos e Sais Biliares/química , Colesterol/análise , Circulação Êntero-Hepática , Cromatografia Gasosa-Espectrometria de Massas/métodos , Masculino , Ratos , Ratos Wistar , Reprodutibilidade dos TestesRESUMO
Children, like all humans, are exposed to compounds in the environment and sometimes to drugs. The effect of this exposure cannot simply be deducted from studies in adults or animals. Effects might be different and even more dramatic than in adults due to the stage of growth and development of the infant. Around 80% of drugs used in young individuals are not licensed for use in this age group. Almost three new chemical compounds enter the environment each day. Toxicological studies in infants and children therefore are needed and ethically acceptable. However, appropriate safeguards must be taken into account. According to the Good Clinical Practice Directive of the European Parliament (2001/20) not only therapeutic, but also non-therapeutic research in infants and children is allowed, provided the study can only be conducted in children, and the results of the study in children will be of benefit to the group represented and no more than minimal harm and risk is inflicted to the children. Many more toxicological studies are needed in children and infants. Not conducting these studies is detrimental for this age group.
Assuntos
Ética em Pesquisa , Pediatria , Criança , Europa (Continente) , Humanos , LactenteRESUMO
OBJECTIVE: To gain insight into the reporting and assessment of active termination of life in newborns in The Netherlands. DESIGN; Retrospective. METHOD: Data on all cases of deliberate termination of life in newborns up to the age of 6 months, reported to the public prosecutor as from 1997 onward, were collected and compared. RESULTS: In January 1997-June 2004, 22 cases of deliberate termination of life in newborns were reported. All cases concerned newborns with spina bifida and hydrocephalus. Deliberate termination of life was acceptable to the physicians because of the presence of hopeless suffering, with no means of alleviating the suffering. In all cases, at least 2 doctors were consulted outside the medical team. In 17 of 22 cases, a multidisciplinary spina bifida team was consulted. All parents consented to the termination of life; in 4 cases they explicitly requested it. In 14 cases a combination of analgesics, sedatives and paralyzing drugs were used, in 8 cases only analgesics and sedatives were administered. For the public prosecutor the termination of life was acceptable if 4 requirements were properly fulfilled: the presence of hopeless and unbearable suffering, consent of the parents to termination of life, consultation having taken place and a careful execution ofthe termination. The mean time between reporting of the case and the decision concerning prosecution was 5.3 months. None of the cases led to prosecution. CONCLUSION: Three cases of deliberate termination of life in newborns were reported in The Netherlands annually. The public prosecutor used fixed criteria to assess the case and all cases of active termination of life reported were found to be in accordance with good practice.
Assuntos
Eutanásia Ativa , Hidrocefalia/complicações , Qualidade de Vida , Disrafismo Espinal/complicações , Tomada de Decisões , Ética Médica , Eutanásia Ativa/ética , Eutanásia Ativa/legislação & jurisprudência , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Países Baixos , Estudos RetrospectivosRESUMO
OBJECTIVE: The objectives of this study were (1) to determine the effects of gestational age on ceftazidime pharmacokinetics in the preterm infant, (2) to relate these effects to changes in glomerular filtration rate (GFR), and (3) to establish appropriate dosage recommendations for preterm infants on day 3 of life. METHODS: Multiple-dose pharmacokinetics of ceftazidime (administered twice daily in a 25 or 50 mg/kg body weight intravenous dose) were evaluated in 136 preterm infants on day 3 of life. Blood samples were collected from an arterial catheter 0, 1/2, 1, 2, 4, 8, and 12 hours after the intravenous dose. An HPLC method was used to determine ceftazidime concentrations in serum. The GFR was studied simultaneously by means of the 24-hour continuous inulin infusion technique. RESULTS: The total body clearance, volume of distribution, and elimination serum half-life of ceftazidime (mean +/- SD) were 55.7 +/- 34.4 ml/hr (37.3 +/- 11.9 ml/hr/kg), 496 +/- 228 ml (350 +/- 96 ml/kg), and 6.95 +/- 2.32 hours, respectively. The mean +/- SD peak and trough levels were 114.9 +/- 39.4 and 33.9 +/- 17.8 mg/L. All infants had a serum trough level above 5 mg/L. Clearance and volume of distribution of ceftazidime and GFR increased significantly with increasing gestational age, whereas serum trough levels and serum half-life of ceftazidime decreased significantly with increasing gestational age. Ceftazidime clearance increased significantly with increasing GFR. Prenatal exposure to indomethacin resulted in significantly lower GFR values and ceftazidime clearances. CONCLUSIONS: Dosage recommendations for ceftazidime administration in preterm infants during the first week of life should be based on gestational age and GFR. Additional adjustments in dosage are indicated in preterm infants who are exposed prenatally to indomethacin.
Assuntos
Ceftazidima/farmacocinética , Cefalosporinas/farmacocinética , Idade Gestacional , Taxa de Filtração Glomerular/fisiologia , Recém-Nascido Prematuro/sangue , Ceftazidima/administração & dosagem , Cefalosporinas/administração & dosagem , Cromatografia Líquida de Alta Pressão , Meia-Vida , Humanos , Recém-Nascido , Injeções Intravenosas , Modelos LinearesRESUMO
Parenterally fed preterm neonates are known to be at risk for carnitine deficiency. We studied substrate utilization in low-birth-weight infants receiving total parenteral nutrition (TPN) with (A) and without (B) supplementation of 48 mg carnitine.kg-1.d-1 on days 4-7 (birth weights 1334 +/- 282 vs 1318 +/- 248 g, gestational age 32 +/- 2 vs 32 +/- 2 wk, A vs B, respectively). TPN consisted of 11 g glucose.kg-1.d-1 and 2.4 g.kg-1.d-1 of both protein and fat. Plasma carnitine concentrations at day 7 were for free carnitine 11.8 +/- 5.0 vs 164 +/- 56 mumol/L and for acyl carnitine 3.8 +/- 2.0 vs 33.9 +/- 15.4 mumol/L, respectively. Indirect calorimetry at day 7 showed a higher fat oxidation (0.21, -0.31 to +0.60 vs 1.18, 0.70 to 1.95 g. kg-1.d-1, respectively, P less than 0.02, median and interquartile range) in group B and a higher protein oxidation (0.37, 0.30-0.43 vs 0.63, 0.53-0.88 g.kg-1.d-1, P less than 0.001). The time to regain birth weight was also higher in group B (7, 5.5-9 vs 9, 7-14 d, P less than 0.05). Carnitine supplementation and calorie intake were the best explanatory variables for metabolic rate (R2 = 0.45, P less than 0.002). We conclude that carnitine supplementation of TPN in this dosage does not seem advisable.
Assuntos
Carnitina/administração & dosagem , Recém-Nascido de Baixo Peso/metabolismo , Nutrição Parenteral Total , Calorimetria Indireta , Carnitina/metabolismo , Carnitina/farmacologia , Gorduras na Dieta/metabolismo , Humanos , Recém-Nascido , Aumento de PesoRESUMO
BACKGROUND: Currently available preterm formulas with energy contents of 3350 kJ (800 kcal)/L promote weight and length gain at rates at or above intrauterine growth rates but disproportionately increase total body fat. OBJECTIVE: The objective of this study was to determine whether fat accretion in formula-fed, very-low-birth-weight (VLBW) infants could be decreased and net protein gain maintained by reducing energy intakes from 502 kJ (80 kcal)*kg(-)(1)*d(-)(1) [normal-energy (NE) formula] to 419 kJ (100 kcal)*kg(-)(1)*d(-)(1) [low-energy (LE) formula] while providing similar protein intakes (3.3 g*kg(-)(1)*d(-)(1)). DESIGN: The study was a randomized, controlled trial enrolling 20 appropriate-for-gestational-age (AGA) and 16 small-for-gestational-age (SGA) VLBW infants (mean birth weight: 1.1 kg; mean gestational age: 31 wk); energy expenditure and nutrient balance were measured at 4 wk of age and anthropometric measurements were made when infants weighed 2 kg. RESULTS: The percentage of fat in newly formed tissue was significantly lower in AGA infants fed the LE formula (n = 9) than in those fed the NE formula (n = 10) (9% compared with 23%; analysis of variance, P = 0.001). Energy expenditure was higher in AGA infants fed the NE formula than in those fed the LE formula. Skinfold thickness was markedly lower in AGA infants fed the LE formula than in those fed the NE formula, resulting in a lower estimated percentage body fat (8.0 +/- 1.9% and 10.8 +/- 3.5%, respectively; P < 0.05). Three of 6 SGA infants fed the LE formula were excluded during the study because of poor weight gain. CONCLUSIONS: Body composition can easily be altered by changing the energy intakes of formula-fed VLBW infants. Energy intakes in these infants should be >419 kJ (100 kcal)*kg(-)(1)*d(-)(1).
Assuntos
Ingestão de Energia , Alimentos Infantis , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Tecido Adiposo , Calorimetria Indireta , Proteínas Alimentares/administração & dosagem , Metabolismo Energético , Idade Gestacional , Humanos , Recém-Nascido , Dobras Cutâneas , Aumento de PesoRESUMO
The importance of long-chain polyunsaturated fatty acids (LCPs) in the development of preterm infants is now well accepted but the source of dietary LCPs to be added to infant formulas remains controversial. We measured dietary intakes, fecal output, and percentages of intestinal absorption of n-6 and n-3 LCPs in healthy preterm infants fed exclusively preterm breast milk (PBM; n = 20), formula without LCPs added (NLCPs; n = 19), formula with LCPs derived from phospholipids (PL-LCPs; n = 19), or formula with LCPs from triacylglycerols (TG-LCPs; n = 19). Intestinal absorption of arachidonic acid was not different in the four groups but docosahexaenoic acid was better absorbed from PL-LCPs than from PBM (88.3 +/- 1.8% compared with 78.4 +/- 4.0%, P < 0.05) Total absorption of n-6 LCPs was not different between groups but total n-3 LCPs were better absorbed from PL-LCPs than from PBM or TG-LCPs (88.7 +/- 1.9%, 79.2 +/- 4.4%, and 80.4 +/- 2.2%, respectively). In conclusion, docosahexaenoic acid and arachidonic acid were absorbed as efficiently from TG-LCPs formula as from breast milk fat. Absorption of docosahexaenoic acid and n-3 LCPs was greater from PL-LCPs formula than from PBM or TG-LCPs formula.
Assuntos
Ácidos Graxos Insaturados/farmacocinética , Alimentos Infantis/normas , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido Prematuro/metabolismo , Absorção Intestinal/fisiologia , Leite Humano/metabolismo , Estudos de Coortes , Ácidos Graxos Insaturados/administração & dosagem , Ácidos Graxos Insaturados/análise , Fezes/química , Feminino , Humanos , Lactente , Alimentos Infantis/análise , Recém-Nascido , Masculino , Leite Humano/químicaRESUMO
The effect on energy metabolism and fuel utilization of increasing energy intake by adding intravenous lipid to a glucose and amino acid regimen was examined. Twenty fullterm, appropriate-for-gestational-age, intravenously fed neonates were entered into one of two groups: total energy intake was 261 kJ.kg-1 x d-1 (62 kcal.kg-1 x d-1) in group 1 and 355 kJ.kg-1 x d-1 (85 kcal.kg-1 x d-1) in group 2. Both groups received 2.8 g protein.kg-1 x d-1 and 14 g glucose.kg-1 x d-1. Group 2 received an additional 2 g lipid.kg-1 x d-1. Metabolic rate, respiratory gas exchange, and nonprotein substrate oxidation were similar in both groups. The addition of energy as lipid enhanced nitrogen retention (230 vs 306 mg.kg-1 x d-1; P < 0.02) and utilization (52.8% vs 66.5%; P < 0.03). Our data suggest that nitrogen utilization is improved in parenterally fed neonates by adding fat and increasing energy intake without change in metabolic rate, carbon dioxide production, oxygen consumption, and nonprotein substrate utilization. Energy expenditure does not necessarily increase with increasing energy intake independently of diet composition.