Two parenteral amino acid solutions and plasma levels of amino acids in the neonate: A randomized trial.

OBJECTIVE: In neonates on total parenteral nutrition (TPN), amino acids may be a risk factor for developing total parenteral nutrition-associated cholestasis (TPNAC). We aimed, first, to compare methionine, cysteine, and taurine plasma levels between neonates on TPN who were receiving an intravenous amino acid solution based on a breast milk aminogram and those on an intravenous solution of pediatric amino acids based on an umbilical cord aminogram, and second, to determine the frequency of TPNAC. METHODS: A double-blind randomized controlled trial was conducted. Ninety-four neonates with a birthweight of 1000g or more and a gestational age of 30 wk or older were admitted and enrolled. Blood samples were obtained at 0, 7, and 14 d of TPN, and plasma amino acid concentrations were determined by ultra-high-resolution liquid chromatography. Continuous variables were compared using the Wilcoxon rank-sum test or Student's t test; categorical variables were compared using the Fisher exact test. RESULTS: Thirty-five neonates completed the study (Primene, n = 14; TrophAmine, n = 21). On day 14, methionine plasma concentrations were significantly lower in the Primene group than in the TrophAmine group (27 µmol/L versus 32.9 µmol/L, P = 0.044); the taurine concentration was significantly higher in the same group (72.4 µmol/L versus 45.3 µmol/L, P < 0.0001). There were no differences in TPNAC incidence. CONCLUSIONS: Administering an intravenous solution of pediatric amino acids based on the umbilical cord aminogram yielded a higher taurine and lower methionine plasma concentration than did administering a similar solution based on the breast milk aminogram.

[Parenteral nutrition in pediatric patients: indications and complications in third level]. / Nutrición parenteral en pacientes pediátricos: indicación y complicaciones en tercer nivel.

BACKGROUND: Parenteral nutrition (PN) is a mixture that covers the nutritional needs when enteral nutrition is not an option; however, PN is not free of complications. The aim of our study was to determine the indication and frequency of NP complications in pediatric patients treated at a tertiary center. METHODS: Children receiving PN at the Hospital de Pediatría del Centro Médico Nacional Siglo XXI were included. Demographic and anthropometric characteristics were recorded, as well as the reason of indicating PN, the time of administration, and the complications associated to this type of nutrition. RESULTS: Sixty-nine pediatric patients with PN were included: 33 neonates, 18 infants (between one and 11 months of age), nine preschoolers (from 1 to 5 years of age), and nine children over five years of age. Instructions for initiating the PN were given for the treatment of 71 % of the patients with diseases of the digestive tract who were treated surgically. Complications of PN occurred in 87 % of the children and 76.7 % had more than one complication. Metabolic complications occurred in 98 % of the children while mechanical and infectious complications only in 1 %, respectively. CONCLUSIONS: Parenteral nutrition was indicated more frequently in pediatric patients with digestive diseases treated surgically. Metabolic complications were the main concern in pediatric patients with PN.

Introducción: la nutrición parenteral (NP) es una mezcla que cubre las necesidades nutricionales cuando no es posible lograr esta tarea por la vía enteral en el paciente; sin embargo, no está exenta de complicaciones. El objetivo del estudio fue conocer la indicación y la frecuencia de complicaciones de la NP en pacientes pediátricos atendidos en un centro de tercer nivel. Métodos: se incluyeron niños que recibieron NP en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social. Se registraron las características demográficas, antropométricas, la causa de la indicación de la NP, su tiempo de administración y las complicaciones asociadas a este tipo de nutrición. Resultados: se incluyeron 69 pacientes pediátricos: 33 recién nacidos (RN) y 18 lactantes entre uno y 11 meses de edad; nueve preescolares entre uno y cinco años, y nueve niños mayores de cinco años. Las enfermedades del tracto digestivo tratadas quirúrgicamente constituyeron el 71 % de las indicaciones para el inicio de NP. Se presentaron complicaciones en el 87 % de los pacientes y 76.7% tuvieron más de una complicación. Las complicaciones metabólicas representaron 98 %, las mecánicas 1 % y las infecciosas 1 %. Conclusión: la NP en este centro de tercer nivel se indicó principalmente a pacientes sometidos a cirugía del tracto digestivo.

[Guía latinoamericana para el diagnóstico y tratamiento de alergia a las proteínas de la leche de vaca (GL-APLV)].

Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.

Niveles séricos de colesterol y lipoproteínas y frecuencia de hipercolesterolemia en un grupo de adolescentes de la Ciudad de México / Cholesterol and lipoprotein levels and hypercholesterolemia in adolescents of the México City

Introducción. El objetivo de este estudio fue determinar los niveles séricos de colesterol y lipoproteinas en un grupo de adolescentes de la Ciudad de México. Material y métodos. Se determinaron niveles séricos de lípidos en un grupo de adolescentes. Se aplicó un cuestionario sobre antecedentes familiares de infarto agudo al miocardio, hipercolesterolemia o diabetes mellitus. Para el análisis estadístico se usó SPSS Y EPI DAT.V3. Resultados. Se estudió a 413 adolescentes, hombres y mujeres, con una edad promedio de 13 años, 14% tenían antecedentes familiares de hipercolesterolemia, 5% de infarto al miocardio y 24.7% de obesidad. El grupo presentó los siguientes valores promedio: colesterol 161 ± 36 mg/dL, triglicéridos 103.9 ± 63 mg/dL, LDL 91.6 ± 58 mg/dL, VLDL 32.3 ± 64 mg/dL y HDL 25.34 mg/dL, sin diferencia significativa entre ambos sexos; 259 (62%) adolescentes presentaron colesterol normal, 102 (24.6%) tuvieron niveles limítrofes altos y 52 (12.6%) hipercolesterolemia. Conclusión. Los niveles de lípidos encontrados muestran un incremento de 10% en el promedio de colesterol, 30% más en la frecuencia de colesterol limítrofe alto y 40% más de hipercolesterolemia en relación a lo reportado en estudios de los últimos 10 años.

Introduction. To know the cholesterol and lipoprotein levels in an adolescents group in Mexico City. Material and methods. We applied a questionnaire about family history of: myocardial infarction, hypercholesterolemia and diabetes mellitus. Cholesterol and lipoproteins measurement were performed in a group of adolescents. SPSS and EPID AT. V3 were used for statistics. Results. Four hundred thirty adolescents were studied, the mean age were 13 years old. We found 14% hypercholesterolemic family history, 5% coronary disease and 24.7% obesity. The mean lipid levels were: cholesterol 161.3 ± 36 mg/dL, triglycerides 103 ± 63 mg/dL, low density lipoprotein 91.6 ± 58 mg/dL, very low density lipoprotein 32.4 ± 64 mg/dL and high density lipoprotein 25.34 mg/dL, there were not difference between male and female; 259 (62%) adolescents presented normal cholesterol levels, 102 (24.6%) high borderline levels and 52 (12.6%) had hypercholesterolemia. Conclusion. The main cholesterol level found was 10% higher, frequency of high borderline cholesterol levels was 30% more and hypercholesterolemia frequency increase 40% in relation to previous reports.