Clinical trial of a milk formula for infants of low birth weight

An infant milk formula specially designed to meet the specific needs of the small premature infant was compared with a modified infant milk formula in common use. Healthy infants of very low birth weight were fed with either the specially designed infant milk formula or the standard modified infant milk formula. No statistically significant differences between the two groups of infants were found, although the weight gain, skinfold thickness, serum total protein, albumin and calcium values were marginally better at 28 days in the group fed with the specially designed formula.     

Avoiding the risk of aspiration in intubated infants

Aspiration is a potential problem in intubated infants who are fed enterally. In this prospective study, intubated preterm infants were fed orogastrically or oroduodenally. Aspiration was assessed by examining endotracheal aspirates for evidence of blue-colored dye. None of the babies had blue-colored endotracheal secretions when fed by either route. Heart and respiratory rates, blood pressure, and transcutaneous oxygen and carbon dioxide measurements were recorded at each interval of the study. There were no significant differences from baseline for these measurements. These findings indicate that there is no significant aspiration in intubated preterm infants who are fed by the orogastric or the oroduodenal route.     

Sodium deficit causing decreased weight gain and metabolic acidosis in infants with ileostomy

The records of 11 infants, 25 to 38 weeks' gestation, with metabolic abnormalities induced by ileostomy fluid losses were reviewed. At operation for necrotizing enterocolitis (NEC) (9) or meconium ileus (MI) (2), they weighed between 1,100 and 3,100 g and were from one to 41 days old. All developed total body sodium depletion and metabolic acidosis from ileostomy bicarbonate loss. In seven, sodium depletion was severe enough to require supplementation; six initially lost or failed to gain weight despite being fed adequate diet and calories. However, after receiving sodium supplementation (three with NaCl and three with NaHCO3), these six patients gained weight and improved their metabolic acidosis. The other five subjects did not initially receive sodium supplementation. Four gained weight; one of these later received supplemental NaHCO3 for a metabolic acidosis. The fifth patient failed to thrive until his ileostomy was closed. All infants initially had urine Na less than 10 mEq/L and normal serum Na. All infants whose urine Na rose above 10 mEq/L and had serum HCO3- greater than or equal to 20 mEq/L grew adequately. A direct relationship existed between ileostomy output and sodium intake required for growth. This expressed mathematically (Na intake = 1.2 + [0.13 x ileostomy output] shows a basal sodium need (with no ileostomy output) of 1.2 mEq/kg/d and an additional requirement of 0.13 mEq/kg/d of sodium for each mL/kg/d of ileostomy output. We conclude that infants with ileostomies are at extreme risk of total body sodium depletion with resultant metabolic acidosis and inadequate weight gain. These infants require sodium supplementation with a combination of NaCl and NaHCO3.(ABSTRACT TRUNCATED AT 250 WORDS)     

Changes in body composition in children following kidney transplantation

Rapid weight gain has been observed following kidney transplantation. To determine the accompanying changes in body composition, we studied 8 patients (7 females, 1 male) aged 3-17.5 years who underwent renal transplantation. Body composition measurements included weight, height, triceps skinfold thickness, total body potassium, total body water, and extracellular water. Excessive weight gain was observed in most of the patients. Weight as a percentage of ideal weight for height increased from 96.0 +/- 13.8 to 116.3 +/- 13.0% (p less than 0.01). This was accompanied by a gain in fat mass in the first 3 months and a subsequent increase in lean body mass in the next 3 months. Extracellular water was increased before transplantation (32.9 +/- 6.5% of body weight) and returned to normal (27.3 +/- 8.6%) 3 months after transplantation (p less than 0.01). The weight gain following kidney transplantation in children resulted mainly from increases in adipose tissue and lean body mass, and was not related to water retention.     

Increased kidney growth in formula-fed versus breast-fed healthy infants

A high protein intake results in increased kidney growth and glomerular filtration rate in human adults and young rats. It is unknown whether kidney size in young infants is influenced by increased protein intake in formula-fed compared with breast-fed infants. We investigated the effect of formula versus breast feeding on kidney growth in a cohort of 631 healthy children examined at birth, and at 3 and 18 months of age. Kidney size was determined by ultrasonography and related to gender, age, body size, and feeding category (fully breast fed, partially breast fed, or fully formula fed at 3 months). Serum urea nitrogen, serum creatinine, and estimated creatinine clearance were measured at 3 months of age. Kidney growth and serum urea nitrogen were significantly increased in partially or fully formula-fed 3-month-old infants. This effect was more pronounced in boys than in girls. The changes in relative kidney size were temporary, as they did not persist at 18 months of age, when all children received a normal mixed diet. The immediate renal effects of formula feeding should be taken into consideration for recommendations concerning infant feeding. Whether there are any long-term effects of early increased protein intake on later kidney function remains to be seen.     

Changes in total body water and extracellular fluid volume in infants receiving total parenteral nutrition

The nature of weight gain seen in infants receiving total parenteral nutrition continues to be controversial. The debate centers around whether or not the weight gain represents an increase in body mass or water retention. The following study was carried out to answer this question. Eighteen infants receiving peripheral or central intravenous nutrition following major surgery were studied for periods ranging from 1 to 17 weeks. The following studies were carried out after receiving informed consent from the parents and in accordance with the standards established by the Human Use Committee. Total body water was measured using the nonradioactive isotope, deuterium oxide; extracellular fluid volume was assayed using the nonradioactive isotope, sodium bromide. Both body fluid compartments were calculated using the Fick principle of dye dilution. Following double vacuum distillation, serum deuterium oxide was assayed using the falling drop technique. Serum bromide was measured by a technique developed in our laboratory that involves the complexing of bromide with gold chloride and the measurement of this chemical complex colorimetrically. Weight gain was observed in all patients. Total body water percent body weight was 82% +/- 15% prior to the initiation of intravenous nutrition; it decreased within the first week to 71% +/- 12% and then stabilized for the remainder of the study period at 75% +/- 7%. The extracellular fluid volume percent body weight was 56% +/- 15% prior to the start of intravenous nutrition; it fell to 47% +/- 10% during the first week of parenteral nutrition, and then stabilized at 40% +/- 9%.(ABSTRACT TRUNCATED AT 250 WORDS)     

传统维持性血液透析患者钠水平衡与高血压

目的 探讨传统维持性血液透析模式下透析患者钠水清除和高血压之间的关系.方法 血液透析组:3次/周,透析3个月及以上的维持性血液透析患者98例,收集人选病例最近1个月透析前的血压、血钠水平、脱水量占透析前体重的比例以及是否达到干体重等数据;未透析组:同期未进行过任何肾脏替代治疗的CKD4期、CKD5期所有住院患者118例,收集其入院当天的血压、血钠水平等.对组内和组间的数据以及与高血压之间的关系进行分析.结果 与未透析组相比维持性血液透析更好的控制了患者的血压(X2=10.767,P=0.001).两组组内高血压和血钠水平无相关关系,两组患者高血压和血钠之间存在等级相关关系(rs=0.151,p=0.027).透析组内达到干体重患者高血压的比例显著低于未达到干体重的患者(X2=16.450,P<0.01).结论 在低盐饮食的基础上,以超滤对流为主,配合以合适的透析液钠浓度弥散的方式为辅进一步完成对钠水的清除从而达到人体钠水平衡才是控制维持性血液患者高血压最重要的方案.     

Non-pharmacologic treatment of arterial hypertension in hemodialysis patients

High blood pressure in dialysis patients is related to extracellular volume excess and the related increase of systemic vascular resistances. Scribner has early described the treatment of hypertension with ultrafiltration and low salt diet, without any drugs. The dry weight method relies on the progressive reduction of the postdialysis body weight until blood pressure is normalized. Additional measures are needed such as low salt diet, neutral sodium balance during dialysis treatment, stop of antihypertensive drugs, adequate length of the dialysis session, and patient education. It may exist a lag time between the normalization of the extracellular volume and blood pressure. It is related to the correction of the hemodynamic consequences of the extracellular volume overload. Moreover, the dry weight may potentially vary in patients undergoing catabolic intercurrent events. The complications of these changes (severe hypertension, pulmonary oedema) must be anticipated by the nephrologist and the staff to avoid additional morbidity to the patient.     

A simulation study on transcellular fluid shifts induced by hemodialysis

A computer-based model has been developed to predict the changes in serum sodium, urea concentration, and osmolality as well as transcellular fluid distribution which occur during hemodialysis. Sodium and urea transfers across the dialyzer membrane and transcellular fluid shifts in response to the sodium transfer were modeled assuming that only sodium and its accompanying anions are important as effective osmotic substances in extracellular fluid. Model predictions were consistent with values measured in five patients who were studied on hemodialysis at three different dialysate sodium concentrations equal to 7% below and 7% above the predialysis serum concentration. The measurements and model predictions indicate that serum sodium concentration decreases and intracellular fluid volume increases in dialyses with dialysate Na+ concentration used in conventional hemodialysis, whereas serum sodium concentration increases and intracellular volume decreases in high sodium dialyses. An analysis of model predictions indicates that a reasonable estimation of total body water and the intracellular to extracellular volume ratio enables us to accurately predict the magnitude of transcellular fluid shifts induced by hemodialysis as well as the postdialysis serum sodium concentration and osmolality.     

Rate of change of blood pressure in premature and full term infants from birth to 4 months

Systolic and diastolic blood pressures were evaluated in a cohort of 61 non-hypertensive premature [very low birth weight (VLBW),n=16; low birth weight (LBW),n=22] and full-term [normal birth weight (NBW),n=23] newborn infants admitted to a neonatal intensive care unit (NICU) and followed to their 4-month age-adjusted outpatient examination. All were receiving routine postnatal care by 7 days of age. Blood pressure was measured at 7 days of age, at discharge from the NICU, and at the outpatient examination. Simple linear regression of blood pressure on weight was used to fit a straight line to the three measurements for each infant and the average regression line for each birth weight group was then obtained. There was a significant correlation between systolic blood pressure and both weight and length at each of the measurement points and also between the change in systolic, blood pressure and change in weight from the discharge to the 4-month examination. Diastolic blood pressure tended to follow this same pattern. Gestational age was correlated significantly with the 7-day blood pressure, but postnatal age at the outpatient examination was not correlated with either systolic or diastolic blood pressure. The average slopes of systolic and diastolic blood pressure on weight (mmHg/kg body weight) were virtually identical for the LBW and NBW groups; in constrast, the average slope of the VLBW group was greater than the other two groups, and the difference was statistically significant for diastolic blood pressure. These results show significant group differences in mean blood pressure prior to 4 months of age between VLBW, LBW, and NBW groups and, for the VLBW infants, a steeper slope of the estimated regression line of blood pressure on weight between birth and 4 months.     

Hyponatremia in the very young chronic peritoneal dialysis patient

Two anuric infants had recurrent hyponatremia during chronic peritoneal dialysis (PD). This occurred because at normal serum sodium concentrations ([Na]), Na losses from ultrafiltration (UF) were greater than the Na ingested from infant formula. Hyponatremia was corrected with increased oral Na intake or with increased dialysis solution [Na]. Anuric infants undergoing PD have hyponatremia because of their high UF requirements/body weight and the low Na content of proprietary infant formulas.     

Body composition and exercise performance in patients with chronic obstructive pulmonary disease.

To investigate whether a compromised nutritional state may limit exercise performance in patients with chronic obstructive pulmonary disease we studied 54 such patients (FEV1 less than 50% and arterial oxygen tension (PaO2) greater than 7.3 kPa) whose clinical condition was stable and who were admitted to a pulmonary rehabilitation centre. Fat free mass was assessed anthropometrically (from skinfold measurements at four sites) and by bioelectrical impedance; creatinine height index and arm muscle circumference were also assessed. The mean (SD) distance walked in 12 minutes was 845 (178) m. No association was established between the distance walked and spirometric measures. A good correlation was found between the distance walked and fat free mass in the whole group (r = 0.73 for impedance measurements and 0.65 for skinfold thickness) and in a subgroup of 23 lean patients (body weight less than 90% of ideal weight; r = 0.66 for impedance measurements and 0.46 for skinfold thickness). Body weight correlated with the distance walked only in the whole group (r = 0.61). On stepwise regression analysis fat free mass measured by bioelectrical impedance, maximal inspiratory mouth pressure, and PaO2 accounted for 60% of the variation in the distance walked in 12 minutes. We conclude that fat free mass, independently of airflow obstruction, is an important determinant of exercise performance in patients with severe chronic obstructive pulmonary disease.     

Feeding of very-low-birth-weight infants with special formula--continued use beyond 2000 g and effects on growth to 1 year

Ten very-low-birth-weight (VLBW) infants fed a premature formula up to a weight of 2 000 g were randomized either to continue on the premature formula for a further 8 weeks or to change to a standard infant formula. Four infants in each group completed the 8-week study period, while growth and biochemical data were available on the other 2 infants for half the study period. No significant differences were seen at the end of the study. Infants on the premature formula showed a trend towards more rapid growth during the 8-week period, but this was no longer evident at a corrected age of 3 months. All infants were followed up to a corrected age of 1 year, during which time growth curves were similar to those previously described for VLBW infants. No long-term tendency towards obesity was evident in these infants, who had gained weight up to 2 000 g at a rate equivalent to the intra-uterine rate.     

生物电阻抗矢量法评估血液透析合并高血压患者的容量负荷

目的应用生物电阻抗矢量法评估血液透析合并高血压患者的容量负荷,探讨高容量负荷状态对高血压患者预后的影响。方法研究对象来自南京医科大学附属明基医院透析前收缩压(6次透析治疗前平均收缩压值)>160 mmHg的血液透析患者。用生物电阻抗矢量法评估患者容量状态,并根据患者容量状态分为容量增加组和非容量增加组(包括容量正常和容量下降的患者)。比较两组患者临床资料、实验室指标、细胞内液比例(ICW)、细胞外液比例(ECW)、体细胞质量、瘦体重、干瘦体重及其占总体重的百分比、脂肪含量占总体重的百分比、阻抗/身高、容抗/身高、相位角、疾病指数的差异。采用Kaplan⁃Meier生存曲线比较两组患者生存率的差异。结果共51例血液透析合并高血压患者入选本研究,容量增加组19例,非容量增加组32例(容量正常27例,容量下降5例)。容量增加组患者的血白蛋白、前白蛋白、血红蛋白、血细胞比容、血磷较非容量增加组显著下降,淋巴细胞比例明显升高,组间比较差异均有统计学意义(均P<0.05)。容量增加组的细胞外液比例、疾病指数显著高于非容量增加组(均P<0.01);相位角、阻抗/身高、容抗/身高显著低于非容量增加组(均P<0.01)。临床追踪20个月,容量增加组患者血压达标率(透析前收缩压<160 mmHg)低于非容量增加组(26.3%比43.8%),但差异无统计学意义。容量增加组患者全因死亡率高于非容量增加组(26.3%比15.6%),Kaplan⁃Meier生存曲线分析提示两组生存率的差异尚无统计学意义。结论容量负荷增加的血液透析合并高血压患者细胞外液增加明显,营养状态评估指标较非容量增加的高血压患者明显下降,而淋巴细胞比例升高,可能与患者微炎症状态有关。容量负荷增加的高血压患者血压更加难以控制,临床预后可能不及非容量增加的患者。     

Evaluation of body fluid status after cardiac surgery using bioelectrical impedance analysis

BACKGROUND: In the assessment of fluid status after cardiac surgery, we applied bioelectrical impedance analysis (BIA) to measure the total body water (TBW), extracellular fluid (ECF), and intracellular fluid (ICF), and evaluated its validity. METHODS: Thirty patients who underwent cardiopulmonary bypass (CPB group) and 19 surgical patients not receiving CPB (non-CPB group). RESULTS: The change of BIA values (deltaTBW, deltaECF, deltaICF), body weight and cumulative fluid balance were determined for 120 postoperative hours, and the relationship between BIA values and body weight and fluid balance were evaluated. Postoperative changes in BIA values in the CPB group were compared with those in the non-CPB group. Finally the ECF/ICF ratio and hemodynamic parameters were compared. deltaTBW and deltaECF correlated with changes in body weight and fluid balance, respectively. Especially there was a high correlation in each case although large deviations in the slope of the regression lines were observed. TBW and ECF increased from immediately after operation up to 96 hours (the maximum value was at day 2). On the other hand, ICF decreased from 48 to 72 hours after operation. There were significant high ECF/ICF in the CPB group compared with the non-CPB group from 12 to 72 postoperative hours. We found that ECF/ICF correlated inversely with mean blood pressure, mixed venous oxygen saturation and colloid osmotic pressure, and positively with central venous pressure and pulmonary artery wedge pressure. CONCLUSIONS: It was considered that BIA was useful for evaluating the relative changes in TBW and fluid distribution, and ECF/ICF might be a new parameter for abnormal water metabolism after cardiac surgery.     

Weight reduction improves high blood pressure and microalbuminuria in hypertensive patients with obesity]

We investigated the effect of weight reduction on blood pressure, microalbuminuria and renal function in hypertensive patients with obesity for over 12 months. Twenty-five patients with a body mass index (BMI) of over 25 were prescribed low calorie diet (25 kcal/kg). All patients had mild hypertension and microalbuminuria. They were classified into 2 groups after 12 months. Group A consisted of 10 patients who had a weight loss of at least 5%. Group B consisted of 15 patients who did not have any weight loss. The following results were obtained. (1) The percentage of patients with hyperfiltration (GFR; more than 140 ml/min) was 20%. (2) Blood pressure, fasting plasma insulin level, urinary sodium and albumin excretion rate were significantly decreased in Group A. On the other hand, these changes were not observed in Group B. (3) Reduction in mean arterial blood pressure significantly correlated with the fall in body weight. (4) Renal function did not change during the study period in both groups. (5) Urinary albumin excretion rate significantly correlated with weight reduction, decrease in blood pressure and fasting insulin levels. Blood pressure and urinary albumin excretion rate in hypertensive patients with obesity significantly decreased with weight reduction. Probably, weight loss improves insulin resistance and decrease in the plasma insulin level causes a reduction in blood pressure and urinary albumin excretion rate.     

三聚氰胺污染奶粉致双肾结石婴幼儿2年后随访分析

目的：探讨三聚氰胺污染奶粉致双肾结石对婴幼儿生长发育的影响。方法：对2008年7～10月治疗的50例三聚氰胺双肾结石患儿（双肾结石组）进行2年后随访。随访包括泌尿系超声检查、肾功能检查、尿常规,同时记录身高、体重、临床症状及并发症情况。选取50例无三聚氰胺污染奶粉喂养史的正常儿童作为对照组,比较两组间的相关参数差异。结果：41例患儿得到成功随访。28例带石出院患儿中21例结石消失,5例变小,1例无明显变化,另1例变大。15例出院时仍有双侧或单侧肾积水患儿中9例消失,5例减轻及1例无明显变化。双肾结石组患儿补钙的比例明显低于对照组（P〈O．05）,身高偏低的比例明显高于对照组（P〈O．05）,体重差异无统计学意义（P〉O．05）。随访时未发现泌尿系占位性病变。结论：三聚氰胺污染奶粉致双肾结石患儿2年后随访显示,泌尿系统发育及生长发育未见明显影响。     

Prevention of body fluid retention by furosemide during estrogen therapy of prostatic cancer.

The usefulness of prophylactic diuretic therapy with furosemide was investigated in 6 patients with stages III and IV prostatic cancer who were undergoing diethylstilbestrol therapy. A significant increase was noted in sodium and water excretion, whereas outputs of chloride and potassium, and serum electrolyte concentrations, blood volume, blood pressure and body weight remained unchanged. The results demonstrate the value of diuretics in preventing fluid retention whenever large doses of estrogen are to be used in the treatment of prostatic cancer.     

Blood pressure reduction during hemodialysis correlates to intradialytic changes in plasma volume.

Blood pressure alterations during hemodialysis were related to changes in body fluid in 14 patients with chronic renal failure. Changes in plasma volume (PV) and extracellular volume (ECV) were calculated from determinations of fluid volumes before and after hemodialysis, using 125I-albumin and 51Cr EDTA respectively. Reduction in body water was estimated from body weight changes. Weight loss was 3.3 +/- 0.3 kg (range 1.8-6.0 kg). The relative reduction of fluid was greater in the ECV, 21.6 +/- 3.2%, compared to plasma volume, 6.9 +/- 1.8%. The reduction in systolic blood pressure was related to both absolute (r = 0.66, p less than 0.05) and relative PV reduction (r = 0.72, p less than 0.02). There was no correlation between blood pressure reduction and weight loss or ECV changes. Only minor alterations were found in diastolic blood pressure. Plasma volume maintenance relates to blood pressure changes. Plasma volume monitoring could be useful for improving intradialytic hemodynamic control.     

重度烧伤患者早期液体复苏与血钠变化观察

目的 了解重度烧伤患者早期电解质与胶体混合液体复苏量、电解质与胶体比值及血钠的改变. 方法 选择2004年3月-2009年3月笔者单位收治的烧伤总面积大于或等于70%,且Ⅲ度面积大于或等于50%TBSA的67例行液体复苏患者.回顾性总结患者伤后24、48、72 h电解质、胶体和水分的输入量及尿量,同时记录患者不同时间段血钠变化与补液情况.数据用SPSS 13.0软件行统计学分析. 结果 67例患者中,9例早期出现低钠血症、5例出现高钠血症、53例血钠正常.患者伤后72 h内尿量均在70 mL/h以上.患者实际补充的电解质和胶体总量(mL)=烧伤总面积(%TBSA)×体质量(kg)×K,上述公式中的K值在伤后第1个24 h约为1.7,电解质与胶体比值约为1.4;伤后第2个24 h的K值为1.3,电解质与胶体比值为1.6;伤后第3个24 h的K值为0.9,比值为2.0. 结论 重度烧伤患者早期实际液体复苏量略大于传统公式计算量(K值为1.5).早期液体复苏过程中电解质量以及电解质与胶体比值会影响患者血钠水平.