Determination of nutritional requirements in preterm infants,with special reference to ‘catch-up’ growth

The usual recommendation for feeding preterm infants is to provide sufficient nutrients to support rates of growth and nutrient accretion equal to intrauterine rates. However, most preterm infants don't tolerate feedings immediately and, therefore, incur significant deficits prior to achieving sufficient intake to support growth. Furthermore, unless they receive nutrient intakes in excess of those usually recommended, they will be smaller than a fetus of the same postmenstrual age at discharge and remain smaller for some time thereafter. The consequences of these early deficits are not known with certainty but there is some evidence that they should be repleted as soon as possible. This requires a redefinition of requirements to include those for both normal growth and catch-up growth. Strategies for doing so include: more aggressive early parenteral nutrition to reduce the magnitude of early losses; greater enteral intakes of protein, and, perhaps, other nutrients once enteral feedings are tolerated; and more attention to nutrition post-discharge. Of these, the latter is somewhat problematic. This is because there seems to be a finite period – perhaps as brief as a few weeks – during which response to increased nutrient intake occurs. Firm data are limited, but those available suggest that current nutritional management of preterm infants can be improved. Whether this will have long-term benefits remains to be determined.     

Dismembered pyeloplasty using double ‘J’ stent in infants and children

Purpose  The purpose of the present study was to comprehensively assess the results of dismembered pyeloplasty in pelvi-ureteric junction obstruction (PUJO) using double ‘J’ ureteric stent. Materials and methods  Records of 61 dismembered pyeloplasties in 60 consecutive patients with PUJO who underwent pyeloplasty in a 5-year period were reviewed retrospectively. In 58 cases, a double ‘J’ stent was passed in an antegrade fashion during the operation. No other mode of drainage was used. Stent was not placed on three occasions. Records were reviewed for age at diagnosis, age at surgery, post-operative complication, post-operative drainage and length of hospital stay. Results  There were no episodes of urinary leak or re-obstruction in the stented group. Median post-operative stay in stented patients was 2 days. The use of this stent was associated with no serious complications. There were no episodes of post-operative urinary tract infection or stent displacement. Conclusions  We recommend double ‘J’ stent as the safest mode of drainage in pyeloplasty in infants and children. Keeping a double-J stent across the anastomosis reduces the complications and the hospital stay in these patients.     

Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late‐preterm infants: a multicenter study

Objectiveto prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late‐preterm infants.Methodsthis was a multicenter study that included 9,174 healthy term and late‐preterm infants in eight hospitals of China. TcB measurements were performed using a JM‐103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia.Resultsin the present study, 972 neonates (10.6%) developed significant hyperbilirubinemia. The 40^th percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonates above the 95^th percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75^th percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875.Conclusionsthis study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late‐preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination.