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.

Neurogenic stunned myocardium - do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure?

Neurogenic stunned myocardium (NSM) is defined as myocardial injury and dysfunction of a sudden onset, occurring after various types of acute brain injury as a result of an imbalance in the autonomic nervous system. The typical spectrum of clinically observed abnormalities includes acute left ventricular failure, not uncommonly progressing to cardiogenic shock with hypotension that requires inotropic agents, pulmonary oedema and various arrhythmias. Commonly-seen electrocardiographic changes include: prolonged QT interval, ST segment changes, T-wave inversion, a new Q-wave or U-wave. Echocardiography shows both an impaired both systolic and diastolic function of the left ventricle. Biochemical markers of NSM comprise metabolic acidosis and increased cardiac enzymes and markers: creatine kinase (CK), and CK-MB, troponin I and B-type natriuretic peptide. The main cause of NSM is myocardial injury induced by local catecholamine release from nerve endings within the myocardium. Recently, a theory has been proposed to classify NSM as one of the stress-related cardiomyopathies, together with Takotsubo cardiomyopathy, acute left ventricular failure in the critically ill, cardiomyopathy associated with pheochromacytoma and exogenous catecholamine administration. The occurrence of NSM increases the risk of life-threatening complications, death, and worsens neurologic outcome. As far as we know, treatment should generally focus on the underlying neurologic process in order to maximize neurologic recovery. Improvement in neurologic pathology leads to rapid improvement in cardiac function and its full recovery, as NSM is a fully reversible condition if the patient survives. Awareness of the existence of NSM and a deeper knowledge of its etiopathology may reduce diagnostic errors, optimise its treatment.

Tolerance of, and metabolic effects of, preoperative oral carbohydrate administration in children - a preliminary report.

BACKGROUND: The need for long preoperative fasting has been questioned. Recent data shows that intake of an oral carbohydrate-containing clear fluid prior to anaesthesia is safe and may have a positive impact on recovery and metabolic status and could improve glucose tolerance. Such solutions are routinely used in adults but not children. The aim of this study was to evaluate the safety, tolerance and influence of oral carbohydrate on selected metabolic parameters in children. METHODS: With ethics committee approval and parental informed consent, 20 children, aged 4-17 years, ASA status I or II, scheduled for abdominal or thoracic surgery were randomised either to Group 1 - receiving a 12.6% carbohydrate-containing drink (10 mL kg(-1) the evening before surgery and two hours before anaesthesia), or the control Group 2 - fasting. Serum glucose and insulin concentration were measured four times: before and after anaesthesia, in the evening after surgery, and the following morning. IGF-1 concentration was measured once, before surgery. Insulin resistance was assessed by the HOMA-IR equation. RESULTS: Oral carbohydrate solution was well tolerated and no adverse events were noted. Glucose concentrations were within the normal range in both groups. Insulin concentration did not show significant differences between groups, however before surgery it tended to be lower in Group 1. Insulin resistance after surgery was significantly higher in Group 2 (2.0 vs. 0.62, P = 0.03), also the increase in insulin resistance after operation was significant only in the control group (P = 0.03). CONCLUSION: Oral carbohydrates are safe, well tolerated and do not cause any perioperative adverse events. They seem to improve postoperative metabolism by decreasing insulin resistance.

Immunologic properties differ in preterm infants fed olive oil vs soy-based lipid emulsions during parenteral nutrition.

BACKGROUND: In the first period of life, premature infants need parenteral nutrition. Lipid emulsions (LEs), which are a part of parenteral nutrition, are known as potent immunological modulators and may therefore influence the immune status of parenterally fed infants. The aim of the study was to compare tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-10 production in the peripheral blood mononuclear cells (PBMCs) of premature infants parenterally fed with 2 LEs: olive oil (OO) and soybean oil (SO). METHODS: Premature infants born at <32 weeks' gestation and with a birth weight <1500 g were randomized in a double-blind method within the first 48 hours of life to receive 1 of 2 LEs: OO based or SO based. At baseline and after 14 days, blood samples were collected, and PBMCs were isolated and then cultured for 48 hours in medium only and in the presence of anti-CD3 antibodies. RESULTS: Of 44 recruited infants, 38 completed the study, 18 in the OO group and 20 in the SO group. The cytokine synthesis profile before the LE introduction was the same in both groups (nonstimulated and anti-CD3-induced PBMC). In the succeeding 14 days of parenteral nutrition, TNF-alpha, IL-6, and IL-10 levels in nonstimulated PBMCs remained unchanged in both groups. In contrast, IL-6 production was significantly higher in the SO group. CONCLUSIONS: SO-based LE may promote an excess of IL-6 production, especially in the T cell-dependent way of PBMC activation (via anti-CD3). OO emulsion seems to be immunologically more neutral than SO emulsion.

[Tolerance of two lipid emulsions used in parenterally-fed premature infants - a comparative study]. / Porównanie tolerancji dwóch emulsji tluszczowych na bazie oleju sojowego i oliwy z oliwek stosowanych w zywieniu pozajelitowym noworodków urodzonych przedwczesnie.

INTRODUCTION: Parenteral nutrition is essential for premature infants during their first days of extrauterine life, when enteral feeding is not tolerated. Lipid emulsions are an integral part of parenteral nutrition. The aim of the study was to compare the effects of two lipid emulsions, based on olive-oil and soybean oil, used in parenteral nutrition of premature infants on: plasma lipid concentrations and hyperbilirubinemia based on plasma bilirubin levels and phototherapy times. MATERIAL AND METHODS: Forty-four premature infants aged less than 32 weeks of gestation and with birth weight below 1500 g were randomized within first 48 hours of life, to receive in double-blind manner olive oil based (ClinOleic) or soybean oil based (Ivelip) emulsions. Plasma lipid concentration and bilirubin level were determined at 7(th) day of life. RESULTS: Thirty-eight infants completed the study, 18 in the olive oil group (27+/-2 GW, 936+/-218 g) and 20 in the soybean oil group (27+/-2 GW, 924+/-221 g). Both lipid emulsions were well tolerated and plasma lipid concentration were within a normal range, however in olive-oil group plasma cholesterol concentration (159+/-19.89 mg% vs. 128+/-8.85 mg%, p<0.0126) and plasma LDL concentration (103.36+/-8.85 mg% vs. 78.87+/-7.59 mg%, p<0.0342) were significantly higher. Plasma bilirubin levels and phototherapy times did not differ among the groups. CONCLUSIONS: Both lipid emulsions were well tolerated, maintained normal plasma lipid concentration and did not increase plasma bilirubin level.

[Prevention of osteopenia in premature infants]. / Zapobieganie osteopenii u wczesniaków.

Proposition of recommendations for prevention of osteopenia in premature infants is presented in this article. In parenteral nutrition in premature infants calcium and phosphorus should be supplemented early in a dose of 80-100 mg/kg/24 h (2-2.5 mmol/kg/24 h) and 43-63 mg/kg/24 h (1.4-2 mmol/kg/24 h) respectively. In enteral nutrition calcium and phosphorus should be supplemented in a dose 90-150 mg/kg/24 h (2.25-3.7 mmol/kg/24 h), and: 45-80 mg/kg/24 h (1.5-2.6 mmol/kg) respectively. Breast milk fortifier is recommended up to the corrected age of 40 Hbd and in case of growth retarded infants - up to 52 Hbd. Vitamin D should be supplemented in a dose of 400-800 IU, particularly in breast fed infants. Vitamin content in formula or fortifier must be taken into account. Active metabolites of vitamin D are not recommended. Physical activities, together with appropriate mineral, protein and energy intake may decrease the risk of osteopenia. Laboratory assessment of calcium and phosphorus homeostasis is recommended every 2 weeks, from 6(th) week of life.

[Treatment of gastro-esophageal reflux in children and premature infants]. / Leczenie refluksu zoladkowo-przelykowego u dzieci i noworodków urodzonych przedwczesnie.

Gastroesophageal reflux is a common problem in the paediatric population, which affects especially infants, neonates and preterm infants. Usually the course is benign, but it can also be a cause of severe complications and acute life threatening events. In this paper diagnostic methods are presented and a systematic literature review of treatment options is given. Current recommendations are proposed according to the results of this review.