Comparison of 2-h versus 3-h enteral feeding in extremely low birth weight infants, commencing after birth

AIM: Immaturity is associated with problems in enteral nutrition of extremely low birth weight (ELBW) infants. Different time intervals between single feedings are used; however, no data are available to show a benefit of either regime. METHODS: In January 2001 enteral feeding regime was changed from 2-h to 3-h intervals. In a retrospective study charts were analysed for all ELBW infants during a period of 2 years prior (01/99-12/00) and after (08/01-07/03) changing the feeding regime. RESULTS: Forty-two in the 2-h group (gestational age 27 +/- 2.1, birth weight 797 +/-150) and 32 infants in 3-h (GA 26.9 +/- 1.8 weeks, BW 809 +/- 148 g) were included. Median (range) time until complete enteral feeding (26 (7 to 69) vs. 20 (12 to 58) days) was not statistical different. There were no differences with respect to enteral morbidity (NEC, abdominal surgery, feeding intolerance), length of stay (84 +/- 23 vs. 86 +/- 26 days), growth parameters or weight at discharge. Total duration of phototherapy and average length of continuous positive airway pressure (CPAP) support were significantly (p < 0.01) longer in the 3-h feeding group. CONCLUSION: Weight gain and time until complete enteral nutrition are similar in 2-h and 3-h feeding regimes. Data suggest an advantage of 2-h feedings concerning the length of CPAP and phototherapy.     

Accuracy and reproducibility of 12-h esophageal pH monitoring

Seventy-five consecutive 24-h intraesophageal pH recordings performed according to the methods of Jolley et al. were evaluated. Total scores and the mean duration of sleep reflux (ZMD) were calculated for the first and the last 12 h, respectively, and compared to each other, as well as to the full 24-h recording. The accuracy of the first and last 12 h in predicting whether the 24-h study was abnormal was 85% and 87%, respectively. The accuracy in predicting whether the ZMD for the 24-h study was abnormal was 73% and 83%, respectively, with an overall 39% false-negative rate. The 12-h study reproducibility was 72% for the total score and 56% for the ZMD. Since the original standards were determined from 18- to 24-h recordings, the test was restandardized based on 12-h recordings from patients with normal 24-h studies. Restandardization did not improve the accuracy or reproducibility. The high false-negative rate for the ZMD and the poor reproducibility cast serious doubt on the utility of 12-h pH recordings, especially in patients with respiratory symptoms.     

Spontaneous awakenings in preterm and term infants assessed throughout 24-h video-recordings

The study aimed to evaluate the development of awakenings during preterm and term age in 12 low-risk infants observed between 33 and 40 weeks of post-conceptional age. Waking was been detected through the analysis of body motility. Gross generalized body movements with prolonged startles, marked stretching and writhing was considered as waking, whereas vigorous, forceful abrupt body movements with high frequency tremor sometimes superimposed upon movements were considered as corresponding to crying. Total number of awakenings in the 24 h does not show significant changes with age, whereas the mean duration increases significantly, which is accounted for mainly by those awakenings starting with crying, in particular, during the day. These data suggest a developmental gap between the ability to sustain the waking state, which already starts to increase before term age, and the ability to maintain prolonged sleep episodes, which has been shown to develop later. Furthermore, the developmental difference between awakenings starting with crying and awakenings starting with wakefulness suggests that two kinds of awakenings might be modulated by different factors.     

Sleep states development in the first year of life assessed through 24-h recordings

Sleep measures have been evaluated in 13 normal infants aged between 2 weeks and 11 months 3 weeks, with 24 h polygraphic records. Values over the whole 24 h period show that quiet sleep (QS) increases with age while paradoxical sleep (PS) and ambiguous sleep (AmbS) decrease; however, when the 24 h period is split into two periods (day-time, night-time) it can be seen that QS increases only during the night-time while PS and AmbS decrease only during the day-time. The QS in older subjects becomes mainly located at the beginning of the night-time period, when particularly long phases take place. The distribution during the night-time of PS (in terms of the amount and of the mean duration of the phases) does not change with age.     

Identifying Arrhythmias in Adults With Congenital Heart Disease by 24-h Ambulatory Electrocardiography

Adults with congenital heart disease (CHD) are at risk for the development of arrhythmias. This study aimed to assess the incidence of unsuspected arrhythmias among adults with CHD identified on electrocardiograms (ECGs) and 24-h ambulatory electrocardiographic monitoring (Holter monitoring). A review of the cardiology database at the authors’ institution from July 2004 through December 2007 identified all clinic patients 18 years old or older who had a recent ECG and Holter monitoring. Data collection included diagnosis, ECG and Holter monitoring results, arrhythmias, and the presence or absence of symptoms. The review identified 140 patients. Analysis of the ECGs showed that 15% of the patients had an arrhythmia. These arrhythmias consisted of ectopy (6%), supraventricular tachycardia (SVT) (3%), pacemaker issues (2%), and previously unrecognized atrioventricular block (AVB) (1%). The majority of the patients with arrhythmias were asymptomatic (76%). Analysis of the Holter monitoring results showed that 31% of the patients had arrhythmias consisting of ectopy (17%), SVT (12%), ventricular tachycardia (7%), high-grade AVB (5%), and pacemaker issues (3%). Of the patients with arrhythmias, 80% were asymptomatic. Among the patients without arrhythmias on ECG, 26% had arrhythmias noted on Holter monitoring. Of the patients with multiple Holter monitorings performed, 34% had a new arrhythmia noted on repeat monitoring. In conclusion, arrhythmias were present in a significant number of adults with CHD, but the majority were asymptomatic. Among adults with CHD, even those with normal ECGs, arrhythmias were frequently detected on Holter monitoring. In addition, repeat Holter monitoring may identify significant arrhythmias over time.     

Distribution of sleep and wakefulness EEG patterns in 24-h recordings of preterm and full-term newborns

The aim of this study was to evaluate the organisation of EEG patterns in 24-h recordings of preterm and near-term neonates. In particular, the distribution of the different EEG codes at different postmenstrual ages (PMA) and the variations of sleep-related EEG pattern organisation was studied, during day (8.00 a.m.-8.00 p.m.) and night (8.00 p.m.-8.00 a.m.) time. The age of appearance of different neonatal EEG patterns, previously described in literature for short lasting records, was confirmed in this 24-h study. The medium-voltage continuous EEG pattern (pattern "3") was less represented approaching term age, in coincidence with the appearance of the two low-voltage continuous patterns ("1" and "2"), which are also related to active sleep and wakefulness. Discontinuous pattern ("7") was also less represented with age, but in day-time only. The percentage of time occupied by this pattern, related to quiet sleep, was significantly higher during day-time hours, than at night.     

Energy concentration of human milk estimated from 24-h pools and various abbreviated sampling schemes

The concentration of gross energy in 24-h pooled samples of milk is compared with that of single samples obtained during the same period. Samples were collected from mothers exclusively breastfeeding their infants on demand. The objective of the comparison was to evaluate simplified sampling schemes for approximating the concentration of energy of milk produced over 24 h. The lowest concentration of energy of single samples occurred in milk collected between 12 midnight and 6 a.m. The concentration of energy of milk was related negatively to the volume expressed and the time interval preceding each expression. The interval preceding each expression was correlated positively to the volume expressed. These results indicate that the pattern of milk expression is important in the design of sampling schemes. Therefore, sampling schemes may not be transferable between populations with distinct feeding patterns. The highest correlation between single samples and the 24-h value was obtained from samples collected between 12 midnight and 6 a.m. (r = 0.84, p less than 0.001). The widths of the 95% confidence and prediction intervals for the equation relating values from single samples to the 24-h pools were +/- 2.7% and +/- 10.5%, respectively, of the mean 24-h pool sample value when three single samples (collected between 12 midnight and 6 a.m., 6 a.m. and 12 noon, and 6 p.m. and 12 midnight) were included in the predictive equation.     

Infektionen mit β-hämolysierenden Streptokokken der Gruppe A (GABS) und Streptokokkenfolgeerkrankungen

Group A β-hemolytic streptococci (GABS) are among the most frequent causes of bacterial infections during childhood. In addition to well-known local infections, scarlet fever, and sepsis, streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF) have been noted with increasing frequency.NF can also be induced in children by superinfected varicella, which is associated with a higher mortality rate.Triggering factors include pathogen-specific capsular proteins, virulent factors, and toxins as superantigens. Immunological quick tests display high reliability, and PCR enables analyses of types and toxins.Furthermore, type-specific streptococcal sequelae can be caused by group C streptococci.Rheumatic fever is rather rare in industrialized nations, but cardiac involvement accurs more frequent than previously assumed.Chorea apparently correlates with neuronal antibodies, as do pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS),and a series of cases of acute disseminated encephalomyelitis (ADEM) associated with streptococci have also been reported. No resistance to penicillin exists, but pathogenic persistence remains a problem.A 26-M valent vaccine is in clinical trials, but is still subject to controversy.     

Assessment of proteinuria using random urine samples

To determine the feasibility of accurately assessing proteinuria using random urine samples, 24-hour urine samples were obtained from five healthy adult volunteers and 15 children (ages 5 to 17 years) with renal disease. Protein concentration was measured using a Coomassie blue binding technique, and total protein excretion was compared with the urinary protein/creatinine ratio (Up/Ucr). Total protein excretion varied from 28.3 mg to 12.3 gm, or 15.4 to 8500 mg/m2/day, and Up/Ucr ranged from 27.9 to 7650 micrograms/mg in the 24-hour samples; the correlation was highly significant (r = 0.99; P less than 0.001). Reference values for urinary protein concentration and Up/Ucr were established by examining random urine samples in 219 healthy individuals (ages 1 month to 61 years). Age-related differences in protein concentration were noted, and 95th percentiles were calculated as the upper limit of normal. The results of our study indicate that Up/Ucr is an accurate assessment of quantitative protein excretion and could largely replace the collection of timed urine samples for the assessment of proteinuria.     

Behavioral state distribution throughout 24-h video recordings in preterm infants at term with good prognosis

Behavioral state distribution in 19 preterm infants at term with good developmental prognosis was studied by 24-h video recordings. The preterm infants of shortest gestation had longer time awake and this was concentrated in the daytime. On classifying behavioral states by Prechtl's criteria, the preterm infants had a smaller amount of state 1 than healthy term infants; but a similar amount of state 5 in awake time. Preterm infants were thought to have accelerated development in terms of diurnal sleep-awake rhythm, and decelerated development in terms of the content of sleep manifested by the amount of state 1.     

Characterization of proteinuria using random urine samples

The urinary albumin to creatinine ratio (Ualb/Ucr) was compared with quantitative albumin excretion in normal subjects and patients with renal disease. Urinary albumin excretion varied from 3.4 to 4,699 mg/m2/day and Ualb/cr from 5.3 to 6,600 micrograms/mg; the correlation was highly significant (r = .979, p less than .001, n = 20). To characterize normal proteinuria using random urine samples, specimens were obtained from 279 healthy subjects (2 months - 62 years). Total protein, albumin and lysozyme were measured in all samples. Glomerular permeability and tubular function were assessed using the random Ualb/Ucr, the urinary albumin to protein ratio (Ualb/Up) and the urinary lysozyme to albumin ratio (Uly/Ualb). Ualb/Ucr was higher in children less than four years although no age-related differences were noted for Ualb/Up or Uly/Ualb. Furthermore, no differences were seen between males and females and normal reference values are provided. The results of this study support the use of Ualb/Ucr as an estimate of urinary albumin excretion and characterizes normal proteinuria using markers of both glomerular and tubular function.     

QTc interval prolongation in children with Turner syndrome: the results of exercise testing and 24-h ECG

Background  Turner syndrome (TS) is the most common sex chromosome abnormality in females. Recently, a prolongation of the rate-corrected QT (QTc) interval in the electrocardiogram (ECG) of TS patients has been reported. A prolonged QTc interval has been correlated to an increased risk for sudden cardiac death, and medical treatment is warranted in patients with congenital long QT syndrome (LQTS). Additionally, several drugs of common use are contraindicated in LQTS because of their effects on myocardial repolarization. The importance of the QTc prolongation in TS patients is not known at present. Materials and methods  Eighteen TS patients with a prolonged QTc interval (group 1) and 11 TS patients with a normal QTc interval (group 2) (mean age 12.6±3.1 vs. 11.8±2.1 years, respectively) were tested. The QTc interval was calculated during exercise testing and during 24-h ECG recordings. Results  None of the patients experienced adverse cardiac events during the tests. The mean QTc interval decreased from 0.467 to 0.432 s in group 1 and from 0.432 to 0.412 s in group 2. During the 24-h ECG, the maximum QTc interval was significantly prolonged in group 1 (0.51 vs. 0.465 s, p<0.05, respectively). We conclude that exercise testing and 24-h ECG recording provide valuable information about the cardiac risk in the single TS patient with a prolonged QTc interval. This helps in counseling these girls, as clear therapeutic guidelines are currently lacking. All authors state that there is no conflict of interests.     

The role of 1-h physical activity every day in preventing obesity in adolescents in Shandong, China

Several studies have reported that physical inactivity and sedentary lifestyle are associated with being overweight and obese in children and adults. A new policy of 1-h physical activity (PA) every day was released by the Chinese government. The present study examined the role of 1-h PA every day in preventing obesity in adolescents in Shandong, China. A total of 29,030 students (14,578 boys and 14,452 girls) aged 10–18 years participated in this study. Height, weight, waist circumference (WC), and skinfold thickness (SFT) of all subjects were measured; body mass index (BMI) of adolescents was calculated from their height and weight, and the prevalence of overweight and obesity was obtained according to the International Obesity Task Force cutoffs. All subjects were divided into two groups. Group 1 had a PA of more than 1 h/day while group 2 had less than 1 h/day. Comparisons of BMI, WC, SFT, and prevalences of overweight and obesity between the two groups were made. The overall percentages of students in group 1 were 34.29 % in boys and 30.15 % in girls. The prevalences of overweight and obesity for both boys and girls were all significantly lower in group 1 than in group 2 in all age categories. In conclusion, 1-h PA every day has a beneficial effect in preventing obesity in adolescents in Shandong, China. These observations highlight the importance of PA in the prevention of overweight and obesity in adolescents.     

毛细管法行末梢血脂肪廓清试验的观察报告

目的：观察能否以末梢血毛细管法取代静脉血试管法进行脂肪廓清试验。方法：对60例行胃肠外营养的新生儿同时采集静脉血和末梢血进行脂肪廓清试验,并行血清甘油三脂的测定。结果：末梢血毛细管法与静脉血试管法脂肪廓清试验及两者与血清甘油三脂水平均呈明显的正相关,相关系数分别为：r=0.907,0.784,0.734,均P<0.01。结论：末梢血毛细管法可以代替静脉血试管法进行脂肪廓清试验,且能反映血清甘油三脂水平,可以监测患儿对脂肪乳剂的耐受性。     

Immunocytochemical detection of neuroblastoma cells infiltrating clinical bone marrow samples

To evaluate the feasibility and clinical usefulness of immunocytochemical detection of bone marrow metastases in neuroblastoma, we studied bone marrow samples from patients undergoing intensive therapy, followed in the majority of cases by autologous bone marrow rescue. Two monoclonal antibodies were used in an indirect immunoenzymatic assay to test 384 samples collected from multiple bone marrow sites during 79 staging procedures in 48 patients. Of 578 immunocytochemical tests, 59 (10%) yielded non-evaluable results. Analysis by individual bone marrow sites showed an agreement between cytological and immunocytochemical examinations in 276 of 309 (89%) evaluable tests with 5 A7 and in 179 of 210 (85%) with UJ 13 A. Infiltration by neuroblastoma cells was reported in 9% of samples by cytology, in 6% by immunochemistry with 5 A7 and in 16% with 13 A. Analysis of results by staging demonstrated agreement between cytological examination and immunocytochemical detection with both monoclonal antibodies in 60 of 75 (80%) evaluable stagings. Bone marrow metastasis was detected by cytology in 22% of stagings, by immunochemistry with 5 A7 in 23%, with UJ 13 A in 25%. Detailed analysis of discordant results revealed that they were related partly to bone marrow sampling variability associated with focal and minimal metastasis of neuroblastoma cells. These data suggest the clinical usefulness of immunocytochemical detection as a complementary test to cytological examination for accurate evaluation of bone marrow infiltration in patients with disseminated neuroblastoma.Abbreviations IC immunocytochemical detection - BM bone marrow - Mabs monoclonal antibodies - CE cytological examination - NBL neuroblastoma - staging staging procedure Presented in part at the 19th meeting of the International Society of Paediatric Oncology, Jerusalem, 13–18 September 1987