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1.
An Pediatr (Barc) ; 2020 Feb 26.
Artigo em Espanhol | MEDLINE | ID: mdl-32111552

RESUMO

OBJECTIVES: To describe preventive, diagnostic and therapeutic strategies regarding necrotising enterocolitis in Spain and to identify the strengths, areas of further improvement, and future research lines. METHODS: Two questionnaires on the management of preterm infants less than 32 weeks, at risk of, or with diagnosed necrotising enterocolitis, were distributed among selected representatives of the surgeons and neonatologists of the Spanish Neonatal Network (SEN1500) participant hospitals with a Paediatric Surgery Department. RESULTS: Percentage of response was 77.1% of contacted surgeons and 88.6% of neonatologists. There is a written protocol on the diagnosis and medical management of necrotising enterocolitis in 52% of the hospitals, and as regards surgical treatment in 33%. There is wide access to donor bank milk and to staff dedicated to breastfeeding promotion (87%). On the contrary, only 52% of the centres perform delayed cord clamping, and probiotics are used in just 23%. The use of abdominal ultrasound is increasing. There are no large differences as regards duration of antibiotic use and bowel rest, whereas there was as regards antibiotic selection, surgical indication, and type of intervention. CONCLUSIONS: As regards prevention, delayed cord clamping and extended access to donor milk are two possible aspects of further improvement. The observed discrepancies noted in diagnostic and therapeutic aspects are common in precisely the areas where evidence in the literature is weakest.

2.
Nutrients ; 11(11)2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31717933

RESUMO

Postnatal steroids, often used to prevent and treat bronchopulmonary dysplasia, may influence the growth of preterm infants, although data are scarce in the literature. This is a multicenter cohort study including surviving preterm infants <32 weeks at birth (n = 17,621) from the Spanish Neonatal Network SEN1500 database, without major congenital malformations. Linear regression models were adjusted for postnatal steroids, respiratory severity course (invasive mechanical ventilation at 28 days), progression to moderate-severe bronchopulmonary dysplasia (O2 at 36 weeks), length of stay, sex, gestational age and z-scores at birth. A subgroup analysis depending on the timing of administration, ventilation status at 28 days and moderate-severe BPD diagnosis was also performed. Overall, systemic postnatal steroids were not independently associated with poorer weight gain (0.1; 95% CI: -0.05 to 0.2 g/kg/day), linear growth (0; 95% CI: -0.03 to 0.01 cm/week) or head circumference growth (-0.01; 95% CI: -0.02 to 0 cm/week). Patients who received steroids after 28 days or who were not O2 dependent at 36 weeks after having received steroids gained more weight (0.22; 95% CI: 0.04 to 0.4 and 0.2; 95% CI: 0.004 to 0.5 g/kg/day, respectively). Globally, systemic postnatal steroids had no significant adjusted effect on postnatal growth.

4.
Acta Paediatr ; 108(10): 1793-1800, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31002411

RESUMO

AIM: We describe the postnatal weight gain, linear and head growth trends of surviving preterm infants from 2005 to 2017. METHODS: Multicentre cohort study, including surviving preterm infants <32 weeks (n = 21 084), from the Spanish Neonatal Network database, without major congenital malformations who were less than 50 weeks postmenstrual age at discharge. Outcomes were weight gain (g/kg/day), linear and head growth (cm/week) and changes in weight, length and head circumference z-scores from birth to discharge. The study period was divided into 2005-8, 2009-11, 2012-14 and 2015-17. RESULTS: Weight gain, linear growth and head growth were slightly higher in 2015-2017 than in 2005-2008: 12.2 ± 2.6 to 13.1 ± 2.5 g/kg/day, 0.98 ± 0.6 to 1.03 ± 0.6 cm/week and 0.76 ± 0.2 to 0.77 ± 0.3 cm/week, respectively. It was associated with a decreased fall in weigh, length and head circumference z-scores from birth to discharge (-1.32 ± 0.9 to -1.01 ± 0.84, -1.38 ± 1.2 to -1.18 ± 1.2 and -0.41 ± 1.2 to -0.33 ± 1.3, respectively). CONCLUSION: Postnatal growth restriction remained a common complication of prematurity despite some increment over the last years. Growth disproportionality seemed to be worsening as weight gain was increased more than linear growth.

5.
J Perinat Med ; 47(5): 568-573, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-30998502

RESUMO

Background Transcutaneous bilirubinometers are a non-invasive tool to estimate serum bilirubin. However, once on phototherapy (PHT) and after PHT, its usefulness is precluded. The objective of this study was to prove the hypothesis that transcutaneous bilirubin (TcB) assessment in a covered skin area during PHT could be used to guide the duration of PHT in term and moderate-late preterm infants with non-isoimmune hyperbilirubinemia. Methods A small area of parasternal skin was covered before starting on PHT. Total serum and TcB (both in exposed and non-exposed areas) were determined before starting treatment, every 12 h once on PHT and 12 h after its discontinuation. Pearson's correlation coefficient and paired mean differences between TcB and total serum bilirubin (TSB) were calculated. Bland-Altman plots were obtained. The percentage of correct treatment decisions made based on non-exposed TcB values was calculated. Results During PHT, there was a relatively good correlation between TSB and non-exposed TcB (0.74) estimates, in contrast to exposed TcB estimates (0.52). However, even when comparing non-exposed TcB with TSB, there was a wide range of agreement limits (-3.8 to 4.6 mg/dL). Decisions based on non-exposed TcB values would have been incorrect in 26.6% of the cases. Conclusion Although there is a relatively strong correlation between total serum and TcB in non-PHT-exposed regions, the difference is not narrow enough to be utilized in guiding clinical decisions on the duration of PHT.


Assuntos
Bilirrubina/sangue , Hiperbilirrubinemia/terapia , Fototerapia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Prospectivos
6.
Neonatology ; 115(4): 348-354, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893696

RESUMO

BACKGROUND: Extrauterine growth restriction is common in the preterm infant, and it is associated with poor neurodevelopment. Nutrition plays an important role in postnatal growth, but growth is also influenced by other factors like co-morbidity, and, also, there might be sex differences. METHODS: This is a cohort study including preterm infants < 32 weeks at birth (n = 21,825) from the Spanish Neonatal Network database. The effect of sex and morbidity (patent ductus arteriosus, bronchopulmonary dysplasia, necrotizing enterocolitis and late-onset sepsis) on weight gain as well as linear and head growth from birth to discharge/death was assessed with linear regression models adjusted by gestational age and Z-scores at birth. RESULTS: The 4 selected morbidities had an independent effect on all 6 growth parameters studied, which was greater in the case of necrotizing enterocolitis: changes in weight, length and head Z-scores were -0.60 (95% CI: -0.66 to -0.55), -0.62 (95% CI: -0.70 to -0.54) and -0.63 (95% CI: -0.71 to -0.56), respectively. Weight gain and linear growth were overall more affected than head growth. Girls lost slightly more weight Z-scores (-0.03; 95% CI: -0.06 to -0.002) than boys after adjustment by morbidity. There were no significant gender differences regarding linear and head growth velocity (cm/week), although girls lost more head Z-scores (-0.14; 95% CI: -0.18 to -0.10). CONCLUSIONS: Main co-morbidities associated with prematurity have an impact on postnatal growth. Head growth is less affected than length and weight. Girls are at slightly higher risk of postnatal weight and head restriction after adjustment by morbidity.


Assuntos
Estatura , Peso Corporal , Cabeça/fisiologia , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Doenças do Prematuro/epidemiologia , Caracteres Sexuais , Comorbidade , Bases de Dados Factuais , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Masculino , Morbidade , Análise Multivariada , Estudos Retrospectivos , Espanha/epidemiologia
7.
PLoS One ; 14(3): e0213210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30840669

RESUMO

INTRODUCTION: Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in childhood, related to prematurity, and the most common cause of pulmonary hypertension (PH) secondary to pulmonary disease in children. Moderate and severe BPD have a worse outcome and relate more frequently with PH. The prediction of moderate or severe BPD development in extremely premature newborns is vital to implement preventive strategies. Starting with the hypothesis that molecular biomarkers were better than clinical and echocardiographic factors, this study aims to explore the ability of clinical, echocardiographic and analytical variables to predict moderate or severe BPD in a cohort of extremely preterm infants. PATIENTS AND METHODS: We designed a prospective longitudinal study, in which we followed a cohort of preterm newborns (gestational age <28 weeks and weight ≤ 1250 grams). In these newborns we recorded weekly clinical and echocardiographic variables as well as blood and tracheal aspirate samples, to analyze molecular biomarkers (IL-6, IL-1, IP10, uric acid, HGF, endothelin-1, VEGF, CCL5). Variables and samples were collected since birth up to week 36 (postmenstrual age), time-point at which the diagnosis of BPD is established. RESULTS: We included 50 patients with a median gestational age of 26 weeks (IQR 25-27) and weight of 871 g (SD 161,0) (range 590-1200g). Three patients were excluded due to an early death. Thirty-five patients (74.5%) developed BPD (mild n = 14, moderate n = 15, severe n = 6). We performed a logistic regression in order to identify risk factors for moderate or severe BPD. We compared two predictive models, one with two variables (mechanical ventilation and inter-ventricular septum flattening), and another-one with an additional molecular biomarker (ET-1). CONCLUSIONS: The combination of clinical and echocardiographic variables is a valuable tool for determining the risk of BPD. We find the two variable model (mechanical ventilation and echocardiographic signs of PH) more practical for clinical and research purposes. Future research on BPD prediction should be oriented to explore the potential role of ET-1.


Assuntos
Biomarcadores/sangue , Displasia Broncopulmonar/diagnóstico , Ecocardiografia/métodos , Lactente Extremamente Prematuro/sangue , Recém-Nascido de Baixo Peso/sangue , Doenças do Prematuro/diagnóstico , Medição de Risco/métodos , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/metabolismo , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/metabolismo , Estudos Longitudinais , Masculino , Gravidez , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
8.
Nutrients ; 10(7)2018 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-29937492

RESUMO

Human milk fat is a concentrated source of energy and provides essential and long chain polyunsaturated fatty acids. According to previous experiments, human milk fat is partially lost during continuous enteral nutrition. However, these experiments were done over relatively short infusion times, and a complete profile of the lost fatty acids was never measured. Whether this loss happens considering longer infusion times or if some fatty acids are lost more than others remain unknown. Pooled breast milk was infused through a feeding tube by a peristaltic pump over a period of 30 min and 4, 12 and 24 h at 2 mL/h. Adsorbed fat was extracted from the tubes, and the fatty acid composition was analyzed by gas chromatography-mass spectrometry. Total fat loss (average fatty acid loss) after 24 h was 0.6 ± 0.1%. Total fat loss after 24 h infusion was 0.6 ± 0.1% of the total fat infused, although the highest losses occur in the first 30 min of infusion (13.0 ± 1.6%). Short-medium chain (0.7%, p = 0.15), long chain (0.6%, p = 0.56), saturated (0.7%, p = 0.4), monounsaturated (0.5%, p = 0.15), polyunsaturated fatty (0.7%, p = 0.15), linoleic (0.7%, p = 0.25), and docosahexaenoic acids (0.6%, p = 0.56) were not selectively adsorbed to the tube. However, very long chain fatty (0.9%, p = 0.04), alpha-linolenic (1.6%, p = 0.02) and arachidonic acids (1%, p = 0.02) were selectively adsorbed and, therefore, lost in a greater proportion than other fatty acids. In all cases, the magnitude of the loss was clinically low.


Assuntos
Gorduras na Dieta/análise , Nutrição Enteral , Recém-Nascido Prematuro/crescimento & desenvolvimento , Leite Humano/química , Ácidos Araquidônicos/análise , Ácidos Docosa-Hexaenoicos/análise , Ácidos Graxos/análise , Ácidos Graxos Monoinsaturados/análise , Ácidos Graxos Insaturados/análise , Feminino , Humanos , Lactente , Bombas de Infusão Implantáveis , Ácido Linoleico/análise , Ácido alfa-Linoleico/análise
9.
Neonatology ; 114(2): 177-180, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29920494

RESUMO

BACKGROUND: Postnatal growth restriction is very common among preterm infants. Growth restriction might be associated with neurodevelopment impairment. The definition of postnatal growth restriction varies among studies. It has often been based on statistical parameters, but we lack biological data to support this definition. OBJECTIVES: The aim here was to study the association between neurodevelopment and postnatal growth restriction defined applying 2 different strategies. METHODS: Bayley Scales of Infant Development-II was performed at 2 years corrected age in 168 preterm infants. Postnatal growth restriction was defined as a weight z-score at 36 weeks <-1.5 or treated as a continuous variable (fall in weight z-scores from birth to 36 weeks postmenstrual age). RESULTS: Weight z-scores fell in almost all patients (98.8%), and 44.1% had z-scores <-1.5 at 36 weeks. After adjusting for gestational age and small for gestational age at birth, every 1-point fall in weight z-score was associated with a 5.6 point (95% CI 1.7 to 9.4) decrease in the Mental Developmental Index. A weight z-score <-1.5 at 36 weeks was not associated with a worse mental or psychomotor result. CONCLUSION: A fall in the weight z-score from birth to 36 weeks is a more rational definition of postnatal growth restriction, and it could predict neurodevelopment.


Assuntos
Desenvolvimento Infantil , Recém-Nascido Prematuro/crescimento & desenvolvimento , Desempenho Psicomotor , Ganho de Peso , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/psicologia , Recém-Nascido Pequeno para a Idade Gestacional , Recém-Nascido de muito Baixo Peso , Modelos Lineares , Masculino , Análise Multivariada , Testes Neuropsicológicos , Estudos Retrospectivos
10.
Nutr Hosp ; 34(5): 1067-1072, 2017 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-29130703

RESUMO

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.


Assuntos
Inquéritos sobre Dietas , Recém-Nascido de muito Baixo Peso , Aminoácidos/administração & dosagem , Aminoácidos/uso terapêutico , Nutrição Enteral , Emulsões Gordurosas Intravenosas , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Leite Humano , Espanha , Vitaminas/administração & dosagem , Vitaminas/uso terapêutico
11.
Nutr. hosp ; 34(5): 1067-1072, sept.-oct. 2017. tab, graf
Artigo em Inglês | IBECS | ID: ibc-167565

RESUMO

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)


Assuntos
Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso/fisiologia , Unidades Hospitalares , Nutrição Enteral/métodos , Aminoácidos/administração & dosagem , Vitaminas/administração & dosagem , Unidades de Internação , Inquéritos e Questionários , Nutrição Parenteral , Declaração de Helsinki
12.
Eur J Pediatr ; 176(12): 1587-1593, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28889192

RESUMO

Bronchopulmonary dysplasia (BPD) is one of the most serious chronic lung diseases in infancy and one of the most important sequels of premature birth (prevalence of 15-50%). Our objective was to estimate the cost of BPD of one preterm baby, with no other major prematurity-related complications, during the first 2 years of life in Spain. Data from the Spanish Ministry of Health regarding costs of diagnosis-related group of preterm birth, hospital admissions and visits, palivizumab administration, and oxygen therapy in the year 2013 were analyzed. In 2013, 2628 preterm babies were born with a weight under 1500 g; 50.9% were males. The need for respiratory support was 2.5% needed only oxygen therapy, 39.5% required conventional mechanical ventilation, and 14.9% required high-frequency ventilation. The incidence of BPD was of 34.9%. The cost of the first 2 years of life of a preterm baby with BPD and no other major prematurity-related complications ranged between 45,049.81 € and 118,760.43 €, in Spain, depending on birth weight and gestational age. If the baby required home oxygen therapy or developed pulmonary hypertension, this cost could add up to 181,742.43 €. CONCLUSION: Prematurity and BPD have an elevated cost, even for public health care systems. This cost will probably increase in the coming years if the incidence and survival of preterm babies keeps rising. The development of new therapies and preventive strategies to decrease the incidence of BPD and other morbidities associated with prematurity should be a priority. What is known: • Bronchopulmonary dysplasia (BPD) is a serious chronic lung disease related with premature birth. • BPD is an increasing disease due to the up-rise in the number of premature births. What is new: • The economic cost of preterm birth and BPD has never before been estimated in Spain nor published with European data. • Preterm babies with BPD and a good clinical outcome carry also an important economic and social burden.


Assuntos
Displasia Broncopulmonar/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/terapia , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Espanha/epidemiologia
13.
Eur J Pediatr Surg ; 27(5): 431-436, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28081579

RESUMO

Introduction The objective of the study is to examine the factors associated with time to achieve full enteral feeding after repair of congenital diaphragmatic hernia. Materials and Methods Demographic, clinical, and therapeutic data were retrospectively assessed, and uni- and multivariate Cox regression were performed to examine factors predictive of achieving full enteral feeding that was defined as time to achieve120 mL/kg/d after surgical repair. Results Of 78 infants, 66 underwent intervention before hospital discharge. All infants who survived had reached full enteral feeding at the time of hospital discharge by a median of 22 days (range: 2-119 days) after surgery and 10 days (range: 1-91) after initiation of postoperative enteral feedings. Independent risk factors associated with a longer time to reach full enteral feeding achievement included gastroesophageal reflux and days of antibiotics in the postoperative period. Daily stool passage preoperatively predicted earlier enteral tolerance. Conclusion Infants who survive congenital diaphragmatic hernia generally are able to achieve full enteral feedings after surgical repair. A longer time to full feeding is needed in the most severe cases, but some specific characteristics can be used to help identify patients at higher risk. Although some of these characteristics are unavoidable, others including rational antibiotic usage and active gastroesophageal reflux prevention and treatment are feasible and may improve enteral tolerance.


Assuntos
Nutrição Enteral/estatística & dados numéricos , Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia , Terapia Intensiva Neonatal/estatística & dados numéricos , Nutrição Parenteral/estatística & dados numéricos , Cuidados Pós-Operatórios/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Masculino , Período Pós-Operatório , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
14.
Nutr. hosp ; 31(1): 514-516, ene. 2015.
Artigo em Inglês | IBECS | ID: ibc-132637

RESUMO

Prolonged parenteral nutrition (PN) leads to liver damage. Recent interest has focused on the lipid component of PN. A lipid emulsion based on w-3 fatty acids decrease conjugated bilirubin. A mixed lipid emulsion derived from soybean, coconut, olive, and fish oils reverses jaundice. Here we report the reversal of cholestasis and the improvement of enteral feeding tolerance in 1 infant with intestinal failure-associated liver disease. Treatment involved the substitution of a mixed lipid emulsion with one containing primarily omega-3 fatty acids during 37 days. Growth and biochemical tests of liver function improved significantly. This suggests that fat emulsions made from fish oils may be more effective means of treating this condition compared with an intravenous lipid emulsion containing soybean oil, medium -chain triglycerides, olive oil, and fish oil (AU)


La nutrición parenteral prolongada produce daño hepático. Recientemente se ha comunicado el efecto de las emulsiones lipídicas intravenosas basadas exclusivamente en ácidos grasos omega-3 en la resolución de la colestasis. Lo mismo se ha observado con el uso de emulsiones lipídicas mixta derivadas del aceite de soja, coco, oliva y pescado. Comunicamos la desaparición de colestasis y mejoría de la tolerancia enteral en un niño con enfermedad hepática asociada a nutrición parenteral. El tratamiento consistió en sustituir una emulsión lipídica mixta por otra que contenía de forma exclusiva aceite de pescado durante 37 días. El crecimiento y los datos bioquímicos de función hepática mejoraron de forma significativa. Este caso sugiere que emulsiones lipídicas intravenosas a partir de aceite de pescado pueden ser mas eficaces para tratar la colestasis si se comparan con emulsiones mixtas (AU)


Assuntos
Humanos , Masculino , Recém-Nascido , Óleos de Peixe/uso terapêutico , Emulsões Gordurosas Intravenosas/uso terapêutico , Colestase/tratamento farmacológico , Emulsões Gordurosas Intravenosas/administração & dosagem , Ácidos Graxos Ômega-3/uso terapêutico , Óleos de Peixe/administração & dosagem , Gastrosquise/terapia , Nutrição Parenteral , Óleo de Soja/administração & dosagem , Triglicerídeos/sangue
15.
Nutr Hosp ; 31(1): 514-6, 2014 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-25561149

RESUMO

Prolonged parenteral nutrition (PN) leads to liver damage. Recent interest has focused on the lipid component of PN. A lipid emulsion based on w-3 fatty acids decrease conjugated bilirubin. A mixed lipid emulsion derived from soybean, coconut, olive, and fish oils reverses jaundice. Here we report the reversal of cholestasis and the improvement of enteral feeding tolerance in 1 infant with intestinal failure-associated liver disease. Treatment involved the substitution of a mixed lipid emulsion with one containing primarily omega-3 fatty acids during 37 days. Growth and biochemical tests of liver function improved significantly. This suggests that fat emulsions made from fish oils may be more effective means of treating this condition compared with an intravenous lipid emulsion containing soybean oil, medium -chain triglycerides, olive oil, and fish oil.


Assuntos
Colestase/tratamento farmacológico , Emulsões Gordurosas Intravenosas/uso terapêutico , Óleos de Peixe/uso terapêutico , Emulsões Gordurosas Intravenosas/administração & dosagem , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-3/uso terapêutico , Óleos de Peixe/administração & dosagem , Gastrosquise/terapia , Humanos , Recém-Nascido , Masculino , Nutrição Parenteral , Óleo de Soja/administração & dosagem , Óleo de Soja/uso terapêutico , Triglicerídeos/sangue
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