[Nutrition in infants with esophagocolonoplasty for esophageal atresia and tracheoesophageal fistula]. / Nutritia copilului mic cu esofagocoloplastie pentru atrezie esofagiana asociata cu fistula esotraheala.

The aim of this clinical prospective study was the follow up of a nutritional management protocol for children with esophageal atresia and tracheoesophageal fistula for whom the esophageal substitution was performed with left vascularized colon. In this study entered infants aged 3 months to 18 months old with a major nutritional deficit, due to respiratory infections complications, parastomal leaks and accelerated gastrointestinal transit. All infants were underweight, with a single exception, who had no preoperative complications. The patient was enterally fed postoperatively, all the other patients receiving combined enteral and parenteral nutrition for 5-6 days. The enteral nutrition was delivered early through a trans-anastomotic feeding tube. In the 5th-7th day, complete enteral nutrition was obtained. The parenteral nutrition followed our own recipe: a 10% amino-acid mixture, 50% glucose and Ringer plus electrolytes and vitamins. There was a critical transitional stage between the gastric tube feeding and the oral nutrition. These infants have the suction and the deglutition reflexes modified, followed by oral sensory and motor deficits. After the release from the hospital the patients have been surveyed, the oldest reaching now the age of 7. The earlier the reconstruction was performed, the less problems in oral nutrition were encountered.

Atresia esofágica: a propósito de un caso / esophageal atresia: a case

Se trata de una recién nacida producto de la primera gesta, sin antecedentes personales ni familiares de importancia, parto por cesárea en una institución publica, APGAR 6-9, exámen físico inicial sin patología. A las 2 primeras horas de vida presenta cuadro de dificultad en la alimentación acompañado de vómito; intentan introducir una sonda orogástrica sin éxito' se realiza una radiografía torácica que eviden~ cia acodamiento de catéter. Se decide su traslado a un hospital de cuarto nivel, donde no es atendida, y posteriormente acude a esta casa de salud, hipoactiva, hipotérmica, sin medidas d~ transporte adecuado. Es intervenida quirúrglcamente a las 24 horas de edad, realizándose una fistulectomía y anastomosis termino terminal del esófago. Su manejo posquirúrgico fue en la unidad de cuidados intensivos, donde permaneció hospitalizada durante 12 días, con una evolución satisfactoria. La atresia esofágica (AE) tiene una incidencia de 1 en cada 3000 nacimientos. El diagnóstico prenatal se sospecha ante la presencia de polihidramnios materno, yel natal debe sospecharse ante un recién nacido,que presenta respiraciones ruidosas, salivación excesiva, episodios de tos, cianosis y la imposibilidad para introducir un catéter dentro del estómago; debe realizarse una radiografía de tórax que mostrará el acodamiento del catéter, y la presencia o no de aire en cámara gástrica. Los avances en las técnicas quirúrgicas para reparar la AE y el mejor manejo en la unidad de cuidados intensivos neonatales han incrementado el porcentaje de sobrevida hasta un 95 por ciento.

Metabolic response to postoperative parenteral nutrition in infants.

Thirty-five infants who had tracheoesophageal fistula, esophageal stenosis, anal atresia, or Hirschsprung's disease were managed with various types of parenteral solution after their radical operations. The infants were divided into 6 groups and given 1) the usual low calorie infusion consisting of 5% glucose, water, and electrolytes, 2) high calorie formula consisting of 21 g/kg/day glucose, and 4 g/kg/day synthesized crystalline L-amino acids, 3) solutions without phosphate, 4) solutions of Cal/N ratio 200 providing 4 g/kg/day amino acids, 5) solutions of Cal/N ratio 400 providing 2 g/kg/day amino acids, and 6) a regimen containing fat emulsion. Nitrogen (N) and phosphorus (P) balances, blood urea nitrogen (BUN), blood glucose, plasma phosphate, immunoreactive insulin (IRI), and non-esterified fatty acid (NEFA) values were investigated. Parenteral solutions, providing 100 Cal/kg/day of Cal/N ratio 200, yielded sufficient positive N balance (120 mg/kg/day average). High calorie solutions without phosphate caused marked hypophosphatemia (0.3 mEq/1) with undetectable P in 24-hr urine. P balance correlated with N balance. Solutions of Cal/N 400 induced a lower BUN level, although there was a cumulative negative N balance. Solutions of Cal/N 200 induced higher levels of IRI and lower glucose than those of Cal/N 400. Increased IRI response and remarkedly decreased NEFA levels were seen in the group administered solutions without fat. Solutions with fat emulsion suppressed IRI response and improved the level of plasma NEFA.

The effect of fat emulsion on essential fatty acid deficiency during intravenous hyperalimentation in pediatric patients.

A series of experiments on puppies and two newborn infants indicates that Intralipid which covered only 4% of the total caloreis, prevented or improved essential fatty acid deficiency in puppies and infants on hyperalimentation. This means that the intravenous fat emulsion, which covers about 2% of the total caloric intake with linoleic acid, still satisfies the essential fatty acid requirement, since half of the fatty acid composition of Intralipid is linoleate.