Nutritional practices in very low birth weight infants: a national survey.

BACKGROUND: Significant efforts have been made to improve the nutritional support of very preterm infants. Large surveys may help to know the nutritional practices for preterm infants in neonatal units and identify if they are in line with the current guidelines. METHODS: A multicentre nationwide web-based survey on clinical feeding practices in very low birth weight (VLBW) infants was conducted in tertiary neonatal hospitals that admit infants with a birth weight < 1,500 g and/or a gestational age of < 32 weeks. RESULTS: The questionnaire was completed by 53 units (response rate, 59%). Over 90% of the units surveyed start amino-acid administration immediately after birth and more than half use novel intravenous fish oil-based lipid emulsions. Enteral nutrition is started within 24 hours of birth in 65% of units and 86% of these are medium-sized or large. Feeding volumes are increased at a rate of 10-30 ml/kg/day in > 90% of units. Monitoring of serum phosphorus was measured more frequently than albumin (p = 0.009) or triglycerides (p = 0.037), but only 28% of centres regularly measure pre-albumin as a nutritional biomarker. Human milk fortification and iron supplementation, starting at four weeks of age, are almost universal. However, only 30% of units administer 800 IU/day of vitamin D. Nearly 50% of the units discharge infants on preterm formula. CONCLUSION: Most Spanish neonatology units use early amino-acid supplementation and over half use novel fish oil-based lipid emulsions. Post-discharge nutrition practices and vitamin administration vary greatly.

Nutritional practices in very low birth weight infants: a national survey / ¿Cuál es la nutrición que administramos a nuestros recién nacidos de muy bajo peso en las unidades neonatales?: una encuesta nacional

Background: Significant efforts have been made to improve the nutritional support of very preterm infants. Large surveys may help to know the nutritional practices for preterm infants in neonatal units and identify if they are in line with the current guidelines. Methods: A multicentre nationwide web-based survey on clinical feeding practices in very low birth weight (VLBW) infants was conducted in tertiary neonatal hospitals that admit infants with a birth weight < 1,500 g and/or a gestational age of < 32 weeks. Results: The questionnaire was completed by 53 units (response rate, 59%). Over 90% of the units surveyed start amino-acid administration immediately after birth and more than half use novel intravenous fish oil-based lipid emulsions. Enteral nutrition is started within 24 hours of birth in 65% of units and 86% of these are medium-sized or large. Feeding volumes are increased at a rate of 10-30 ml/kg/day in > 90% of units. Monitoring of serum phosphorus was measured more frequently than albumin (p = 0.009) or triglycerides (p = 0.037), but only 28% of centres regularly measure pre-albumin as a nutritional biomarker. Human milk fortification and iron supplementation, starting at four weeks of age, are almost universal. However, only 30% of units administer 800 IU/day of vitamin D. Nearly 50% of the units discharge infants on preterm formula. Conclusion: Most Spanish neonatology units use early amino-acid supplementation and over half use novel fish oil-based lipid emulsions. Post-discharge nutrition practices and vitamin administration vary greatly (AU)

Antecedentes: se han realizado esfuerzos significativos para mejorar la nutrición en los recién nacidos muy prematuros. Las grandes encuestas pueden ayudar a conocer cuál es la nutrición que reciben los recién nacidos prematuros en las unidades neonatales e identificar si están en línea con las directrices actuales. Métodos: se llevó a cabo una encuesta multicéntrica a nivel nacional sobre las prácticas clínicas empleadas en la alimentación en los recién nacidos de muy bajo peso en hospitales de nivel III que ingresan recién nacidos con un peso al nacer < 1.500 g y/o una edad gestacional < 32 semanas. Resultados: el cuestionario fue completado por 53 unidades neonatales (tasa de respuesta del 59%). Más del 90% de las unidades estudiadas inician la administración de aminoácidos inmediatamente después del nacimiento y más de la mitad utilizan nuevas emulsiones lipídicas intravenosas que contienen aceite de pescado. La nutrición enteral se inicia en las primeras 24 horas de nacimiento en el 65% de las unidades y el 86% de ellas son medianas o grandes. El volumen de alimentación aumenta a una velocidad de 10-30 ml/kg/día en > 90% de las unidades. El fósforo sérico se monitoriza con mayor frecuencia que la albúmina (p = 0,009) o los triglicéridos (p = 0,037), pero solo el 28% de los centros miden regularmente la prealbúmina como biomarcador nutricional. La fortificación de la leche humana y la suplementación con hierro, a partir de las cuatro semanas de edad, es casi universal. Sin embargo, solo el 30% de las unidades administran 800 UI/día de vitamina D. Casi el 50% de las unidades utilizan leche de fórmula del prematuro al alta de las unidades. Conclusión: la mayoría de las unidades neonatales españolas administran precozmente los suplementos de aminoácidos y más de la mitad emplean emulsiones de lípidos a base de aceite. Hay una importante variación en las prácticas nutricionales posteriores al alta y en la administración de vitaminas (AU)

Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial.

BACKGROUND: Protein intake during infancy was associated with rapid early weight gain and later obesity in observational studies. OBJECTIVE: The objective was to test the hypothesis that higher protein intake in infancy leads to more rapid length and weight gain in the first 2 y of life. DESIGN: In a multicenter European study, 1138 healthy, formula-fed infants were randomly assigned to receive cow milk-based infant and follow-on formula with lower (1.77 and 2.2 g protein/100 kcal, respectively) or higher (2.9 and 4.4 g protein/100 kcal, respectively) protein contents for the first year. For comparison, 619 exclusively breastfed children were also followed. Weight, length, weight-for-length, and BMI were determined at inclusion and at 3, 6, 12, and 24 mo of age. The primary endpoints were length and weight at 24 mo of age, expressed as length and weight-for-length z scores based on the 2006 World Health Organization growth standards. RESULTS: Six hundred thirty-six children in the lower (n = 313) and higher (n = 323) protein formula groups and 298 children in the breastfed group were followed until 24 mo. Length was not different between randomized groups at any time. At 24 mo, the weight-for-length z score of infants in the lower protein formula group was 0.20 (0.06, 0.34) lower than that of the higher protein group and did not differ from that of the breastfed reference group. CONCLUSIONS: A higher protein content of infant formula is associated with higher weight in the first 2 y of life but has no effect on length. Lower protein intake in infancy might diminish the later risk of overweight and obesity. This trial was registered at clinicaltrials.gov as NCT00338689.

Can infant feeding choices modulate later obesity risk?

Since the concept of lasting programming effects on disease risk in human adults by the action of hormones, metabolites, and neurotransmitters during sensitive periods of early development was proposed >3 decades ago, ample supporting evidence has evolved from epidemiologic and experimental studies and clinical trials. For example, numerous studies have reported programming effects of infant feeding choices on later obesity. Three meta-analyses of observational studies found that obesity risk at school age was reduced by 15-25% with early breastfeeding compared with formula feeding. We proposed that breastfeeding protects against later obesity by reducing the occurrence of high weight gain in infancy and that one causative factor is the lower protein content of human milk compared with most infant formula (the early protein hypothesis). We are testing this hypothesis in the European Childhood Obesity Project, a double-blind, randomized clinical trial that includes >1000 infants in 5 countries (Belgium, Germany, Italy, Poland, and Spain). We randomly assigned healthy infants who were born at term to receive for the first year infant formula and follow-on formula with higher or lower protein contents, respectively. The follow-up data obtained at age 2 y indicate that feeding formula with reduced protein content normalizes early growth relative to a breastfed reference group and the new World Health Organization growth standard, which may furnish a significant long-term protection against later obesity. We conclude that infant feeding practice has a high potential for long-term health effects, and the results obtained should stimulate the review of recommendations and policies for infant formula composition.

Subcutaneous fat stores related to weight in full-term neonates.

BACKGROUND: Subcutaneous fat stores in newborns have been related to weight (W) and skinfolds (SK); both are influenced by gestational age (GA) and there are few studies analysing the association between them. AIM: The present study assessed fat storage in term newborns that are appropriately nourished. SUBJECTS: Subjects were 1259 singleton term newborns, with appropriate weight for GA. METHODS: A cross-sectional observational study was utilized where weight, length, tricipital skinfold (TSK), subscapular skinfold (SSK) and mid upper arm (MUA) circumference were measured at birth. MUA areas and the TSK/W and SSK/W ratios were calculated. Data were analysed according to gender and GA. RESULTS: Weight and length were higher in males, while TSK, SSK, MUA fat area, MUA fat percentage, TSK/W and SSK/W were higher in females. Weight and length increased with GA in both genders. SK did not increase with GA, except the TSK in males. The TSK/W and SSK/W ratios decreased significantly with GA age in both genders. Percentiles of TSK/W and SSK/W ratios are presented. CONCLUSION: The study provides a new perspective to the idea that fat storage increases continuously during the last period of gestation. The data presented showed that this phenomenon is not clearly demonstrated for full-term infants with appropriate weight for GA.

Pars plana vitrectomy from a temporal approach for a patient with a deep orbit.

PURPOSE: To present an alternate technique for safely performing pars plana vitrectomy (PPV) for patients with extremely deep-set eyes or prominent brow ridges. PATIENT AND METHODS: A single patient with a very deep orbit and severe glaucoma that limited the surgeon's ability to operate on the superior conjunctiva underwent 25-gauge PPV with the surgeon seated temporally. RESULTS: Twenty-five-gauge PPV with epiretinal membrane peeling and intraocular lens suturing was performed safely. CONCLUSION: PPV can be performed from a temporal approach if the access to the superior conjunctiva is limited.

Apliquem correctament el protocol del nenimmigrant? / No disponible

Fonament. Augment de la immigració, amb l’atencióprimària com un dels primers punts de contacte amb lasanitat.Objectiu. Conèixer l’origen i les característiques desalut dels infants immigrants i el grau de compliment enl’aplicació del protocol del nen immigrant en les consultesd’atenció primària.Mètode. Estudi descriptiu transversal. Població d’estudi:infants immigrants demandants d’una àrea bàsica desalut (ABS). Mostra: 76 infants (atesos en tres equips de pediatriaentre els mesos de gener del 2005 i desembre del2006). Exploració informàtica de registres d’història clínica.Variables d’estudi: demogràfiques, salut, nivells d’immunització,compliment del protocol: ruta migratòria, exploracionscomplementàries (analítica, serologies, sediment,coprocultiu, paràsits en femta, prova de la tuberculina) iadequació del calendari vacunal.Resultats. 51% nens. Edat: 7,75 anys (desviació estàndard3,5). Procedència: Marroc (40,8%), Llatinoamèrica(34,2%), Europa de l’Est (21,1%). Desconeixem la ruta migratòriaen el 46,1% dels casos. Principals problemes de salut:anèmia (21,9%), càries (34,2%). Vacunació prèvia desconegudaen el 50% dels casos de l’Europa de l’Est i en el48,4% dels magribins. Aplicació del protocol: 47,4% alta,26,3% mitjana, 22,4% baixa, i molt baixa o no aplicat en el3,9%. Es va completar el calendari vacunal en el 54% i s’acceleràen el 36%; el 10,3% no es van vacunar. El 44,7% esva vacunar d’hepatitis A (VHA). Seguiment: el 14% no es facap prova. El seguiment més gran és per als llatinoamericans,amb el 92% (el 80% visitats el primer mes d’estada) iper als marroquins, amb el 87%.Conclusions. L’aplicació del protocol és insuficient i esdetecta un dèficit important en l’anamnesi. Excepte en elsllatinoamericans, els nivells de vacunació prèvia són moltdeficitaris. Bon compliment del calendari vacunal, exceptuantla vacunació d’hepatitis A (AU)

Fundamento. Aumento de la inmigración, siendo laatención primaria uno de los primeros puntos de contactocon la sanidad.Objetivo. Conocer el origen y las características de saludde los niños inmigrantes y el nivel de cumplimiento enla aplicación del protocolo del niño inmigrante en las consultasde atención primaria.Método. Estudio descriptivo transversal. Población deestudio: niños inmigrantes visitados en un área básica desalud. Muestra: 76 niños (atendidos en tres equipos de pediatríaentre enero de 2005 y diciembre de 2006). Exploracióninformática de registros de historia clínica. Variablesde estudio: demográficas, salud, niveles de inmunización,cumplimiento protocolo: ruta migratoria, exploracionescomplementarias (analítica, serologías, sedimento, coprocultivo,parásitos en heces, prueba de la tuberculina (PPD)y adecuación del calendario de vacunación.Resultados. 51% niños. Edad: 7,75 años (desviación estándar3,5). Procedencia: Marruecos (40,8%), Latinoamérica(34,2%), Europa del Este (21,1%). Desconocemos laruta migratoria en el 46,1% de casos. Principales problemasde salud: anemia (21,9%), caries (34,2%). Vacunaciónanterior desconocida en el 50% de casos de Europa delEste y en el 48,4% de los magrebíes. Aplicación del protocolo:47,4% alta, 26,3% media, 22,4% baja, y muy baja ono realizada en el 3,9%. Se completó el calendario de vacunaciónen el 54% y se aceleró en el 36%; el 10,3% no sevacunaron. El 44,7% se vacunan de hepatitis A. Seguimiento:el 14% no realizan ninguna prueba. Hay mayor seguimientopor parte de los latinoamericanos, en un 92%(el 80% visitados el primer mes de estancia), y de los magrebíes,en un 87%.Conclusiones. La aplicación del protocolo es insuficientey se detecta un déficit importante en la anamnesis.Excepto en los latinoamericanos, los niveles de vacunaciónprevia son muy deficitarios. Buen cumplimento del calendariovacunal, exceptuando la vacunación de hepatitis A (AU)

Yoghurt in the Spanish diet: nutritional implications and socio-cultural aspects of its consumption.

OBJECTIVES: This study aims to analyse the differences, with regard to socio-cultural characteristics and dietary habits, between low and high consumers of yoghurt and other fermented dairy product desserts, and the nutritional significance of these differences. METHODS: We analysed the diet of a healthy population (4-65 years), using the 24-hour recall method, on three non-consecutive days. The participants were grouped by age and sex and were also divided into tertiles on the basis of yoghurt consumption. We compared energy and nutrient intakes, educational level and socio-economic status in the low consumption (LC) group and the high consumption (HC) group. RESULTS: In general there were no significant differences in energy intake or nutritional profile between LC and HC groups. The only significant difference was in the percentage of energy provided by lipids, which was significantly lower in HC women, possibly due to the high number of women in this group who consumed low-fat yoghurt. There were significant differences in the distribution of HC and LC subjects according to the three educational levels but not according to socio-economic status. CONCLUSION: The fact of being a high consumer of fermented dairy products took place in the framework of other dietary changes that compensated for this high consumption, resulting in the absence of significant differences in energy intake and nutritional profile between HC and LC subjects. The only exception was found in women who consumed low-fat dairy products. There was a relationship between high consumption of fermented dairy products and educational level.

Reflexions en relació amb el banc de llet / No disponible

No disponible