营养与早产儿神经发育结局

随着围产医学和新生儿医学发展,极低和超低出生体质量(VLBW/ELBW)早产儿存活率普遍提高,但这些早产儿可进一步发生神经系统发育不良。除与神经系统发育有关的疾病如脑损伤外,在大脑迅速生长和发育的时期,营养同样是影响神经系统发育及不良预后的重要因素。VLBW/ELBW早产儿发生生长发育迟缓的风险增高,主要与出生后营养摄入不足有关。目前的证据显示,VLBW/ELBW早产儿出生后生长发育迟缓与神经系统发育损害有关。此外某些特殊营养素,如长链多不饱和脂肪酸与早产儿神经发育有相关关系。     

Selenium status of New Zealand infants fed either a selenium supplemented or a standard formula

Objective: New Zealand soils are deficient in the essential micronutrient, selenium. New Zealand infants have low selenium levels at birth and experience a further decline if fed cows milk based formula. This study examined the selenium status of infants fed with a new commercially available selenium supplemented formula.
Methodology Forty-four newborn infants, whose mothers wished to formula feed, were randomized in an open controlled trial to be fed a commercially available selenium supplemented cows milk formula (containing 17 μg Se/L) or an unsupplemented formula (containing 4.6 μg Se/L). Cord, 1 and 3 month blood samples were obtained for selenium status (plasma and red cell selenium and glutathione peroxidase) and thyroid function.
Results Mean plasma selenium and glutathione peroxidase values were significantly higher in supplemented than unsupplemented infants at 1 month (unpaired t -tests; P <0.0001 and P = 0.001 respectively) and 3 months ( P <0.0001 and P = 0.0005). Analysis within treatment groups between time points (paired t -tests) showed that selenium supplementation prevented the fall in plasma selenium from birth to 1 month seen in unsupplemented infants and was associated with a rise in levels between 1 and 3 months ( P = 0.002).
Conclusions Supplementing cows milk formula with selenium to replicate the levels found in breast milk is nutritionally sound. Feeding from a few days of age with a formula containing 17 μg Se/L in infants with low selenium status at birth is sufficient to cause a rise to 80% of adult levels at 3 months of age.     

Selenium requirements in patients with inborn errors of amino acid metabolism and selenium deficiency

The diets of 5 patients with phenylketonuria or maple-syrup-urine disease were supplemented with yeast which was rich in selenium. For 120 days the patients received 45 g Se/day to increase the Se content of their diets to 10–12ng Se/Kjoule. Before supplementation the selenium content of serum (5–15 ng/ml) and whole blood (10–27 ng/ml), and the activity of the erythrocyte glutathione peroxidase (0.19–2.69 U₃₇/g Hb), amounted to only 10–20% of normal. The serum selenium content reached normal values within 4 weeks of supplementation, followed by normalisation of the selenium content of whole blood within 4–8 weeks. Restoration of the activity of erythrocyte glutathione peroxidase took 9 to 15 weeks —the red cell life span. There was a significant positive correlation between the selenium content of the erythrocytes and the activity of erythrocyte glutathione peroxidase.With support of Deutsche Forschungsgemeinschaft     

Selenium supply and glutathione peroxidase activity in breastfed Polish infants

Selenium (Se) concentration in human milk in Poland is below 10 ng ml^?1 and the Se intake by breastfed infants is about 6 μg day^?1. Supplementation of lactating mothers with selenium-enriched yeast increases rapidly and significantly the Se concentration and glutathione peroxidase activity in maternal blood components. Se concentration in milk is also significantly elevated. After 1 month the mean Se intakes by breastfed infants were greater than the recommended dietary allowance of 10 μg day^?1 for infants from birth to 6 months of age.     

Selenium in Plasma and Erythrocytes in Patients with Down's Syndrome and Healthy Controls

ABSTRACT. The mean plasma selenium concentration (P-Se) in 65 patients with Down's syndrome (DS) did not differ from that in 90 healthy controls. The concentration of selenium in the erythrocytes (E-Se) was higher in DS patients than in controls ( p <0.001). P-Se and E-Se increased progressively with age through childhood in both DS children and controls. The former children, however, started out with higher levels of E-Se and reached adult concentrations earlier (at 7-17 years) than controls (18 years). Adult DS patients and controls did not differ in their mean P-Se or E-Se concentration. There was a significant correlation between P-Se and E-Se both in DS patients and in controls. In DS patients each of these two variables was significantly correlated to glutathione peroxidase (GSH-Px) activity in erythrocytes. A sex difference in the DS children, but not in the controls, was observed with regard to P-Se and E-Se levels, these being higher in DS girls during childhood (0-17 years). This was in accordance with an earlier finding of higher GSH-Px activity in DS girls than in DS boys.     

Selenium Supplementation in X-linked Muscular Dystrophy

ABSTRACT. The selenium concentrations in serum and erythrocytes and the erythrocyte glutathione peroxidase activity were determined in 15 boys with the Duchenne type and in 5 boys with the Becker type of X-linked muscular dystrophy before and during long-term selenium and α-tocopherol supplementation and compared with values in unsupplemented controls. The purpose of the treatment was to improve the muscular strength. Twelve of the 20 patients had pretreatment levels of selenium in serum that were within the 95 % confidence limit of the unsupplemented control children. The values in 2 patients, both with the Duchenne type of muscular dystrophy, fell below this level. Selenium supplementation in a daily dose of 6 μg/kg/day for 6 months caused a substantial rise in both serum and erythrocyte selenium, suggesting suboptimal pretreatment body contents of selenium. The greatest increases in both serum and erythrocyte selenium were observed in subjects with initially low selenium levels. Only in 4 of the 20 patients did the selenium supplementation result in a significant rise in erythrocyte glutathione peroxidase activity. As no sure improvement was noted in muscular strength during this treatment period, the Se dose was increased to 20 μg/kg/day. This resulted in a further rise in both serum and erythrocyte selenium, but not in erythrocyte glutathione peroxidase activity.     

早产儿营养支持的研究进展

随着围生医学的发展,早产儿的存活率逐年提高,而合理的营养支持策略是提高早产儿存活率的关键环节之一,这不仅关系到早产儿近期的生长发育,还会影响到远期的预后,因此充足均衡的营养是保证早产儿健康成长的物质基础。近年来国内外一些新生儿机构对于早产儿的静脉营养进行了一些有意义的研究,对于临床进行早产儿营养支持有一定的指导意义,该文就目前早产儿静脉营养的发展现状、肠道外静脉营养和胃肠道喂养的最新进展进行综述。     

Increased Plasma and Erythrocyte Selenium Concentrations but Decreased Erythrocyte Glutathione Peroxidase Activity after Selenium Supplementation in Children with Down Syndrome

ABSTRACT. An investigation was made of the activity of glutathione peroxidase (GSH-Px) in erythrocytes and the levels of selenium in plasma and erythrocytes before, during and after selenium supplementation in children with Down syndrome (DS). This subject is of interest since it has been suggested that selenium supplementation could enhance the GSH-Px activity in erythrocytes, probably leading to unproved protection against oxygen radicals, which might cause damage by lipid peroxidation, especially in the brain. Forty-eight children with DS were treated with selenium-rich yeast tablets (10 μg/kg body weight/day) for 6 months. The supplementation was well tolerated and no side effects were observed. Selenium supplementation resulted in increased concentrations of selenium both in plasma and erythrocytes, but decreased GSH-Px-activity in erythrocytes. Plasma and erythrocyte selenium levels had almost regained the initial values 12 months after termination of the supplementation. Erythrocyte GSH-Px activity, on the other hand, remained reduced and did not return to the presupplementation levels. Until we gain more knowledge about the biological functions of selenium in man and the role of oxygen metabolism in the development of presenile dementia in DS, universal selenium supplementation in DS patients cannot be recommended.     

Assessment of Nutritional Status in Children With Cancer and Effectiveness of Oral Nutritional Supplements

Malnutrition is a common consequence of cancer in children, but the most effective methods of nutrition intervention are under debate. We aimed to evaluate the nutritional status of children diagnosed with cancer, and to investigate the effect of oral nutritional supplements on anthropometric measurements, biochemical parameters, and outcome. A randomized clinical study of 45 newly diagnosed cancer patients was performed. Anthropometric and biochemical data and related factors were assessed at 0, 3, and 6 months after diagnosis. On initial anthropometric assessment, prevalence of malnutrition by weight or height was found to be lower as compared with body mass index (BMI), or weight for height (WFH), or arm anthropometry. Twenty-six of the patients (55%) received oral nutritional supplement. During the second 3 months after diagnosis, there was a statistically significant decrease in number of the patients with WFH <90th percentile and BMI <5th percentile (P = .003 and P = .04, respectively). Infectious complications occurred more frequently in malnourished patients during first 3 months, and survival of children who were malnourished at the 6th month was significantly lower than that of well-nourished children (P = .003). On laboratory assessment, serum prealbumin levels of the all subjects were below normal ranges, but no relation was found for serum prealbumin or albumin levels in patients who were malnourished or not at diagnosis. Nutritional intervention is necessary to promote normal development and increase functional status as a child receives intensive treatment. Protein- and energy-dense oral nutritional supplements are effective for preventing weight loss in malnourished children.     

Immunocompetence Is a Sensitive and Functional Barometer of Nutritional Status

Nutrition is a critical determinant of immunocompetence and risk of illness. Young children with protein-energy malnutrition exhibit increased mortality and morbidity, due largely to infectious disease. Recent work has demonstrated that undernourished individuals have impaired immune responses. The most consistent abnormalities are seen in cell-mediated immunity, complement system, phagocytes, mucosal secretory antibody response, and antibody affinity. Many of these immunologic changes occur early in the course of nutritional depletion and therefore can serve as sensitive functional indices of nutritional status.     

Night Waking in Infants: Effects of Providing Advice and Support for Parents

A randomized controlled study was conducted with three groups of mothers with night waking infants less than 18 mths. Groups received a specially written advice booklet and support visits, the booklet only or no intervention. A fourth group of non-night waking infants acted as a comparison group. Mothers' estimates of waking frequency and infant sleep diaries and maternal well being measures were used to assess change. No significant differences in terms of outcome measures were found between three waking groups. Mothers of night wakers showed higher levels of distress than those in the sleeping group. Parents of wakers were positive about both the support they had received and the booklet.     

Effect of Jaw and Cheek Support on Nutritional Intake

The purpose of this study was to determine the effect of jaw and cheek support on nutritional intake. A 32-month-old child who had experienced a brainstem stroke was spoon fed, with and without jaw and cheek support, in an ABAB single case fashion. Jaw and cheek support elicited an increased amount of solid food consumption by the participant. There was no difference, between control and intervention sessions, in the amount of solid food expelled onto the bib. Jaw and cheek support enabled a 32-month-old child with a brainstem stroke to consume more solid foods than without support.     

Complement-Dependent Bactericidal Activity for E. coli K12 in Serum of Preterm Newborn Infants

ABSTRACT. Complement-dependent serum bactericidal activity for E. coli K12 was assessed in 12 term infants and in 16 preterm infants. In both groups of newborns, at birth, bactericidal reaction by the classical pathway of complement activation was impaired with respect to normal controls at <0.001 level of significance (as estimated by Student's t -test). The serum bactericidal reaction by the alternative pathway of complement activation was significantly impaired only in preterm newborns, being normal in term infants. At a time corresponding to 40 weeks' gestational age also in preterm newborns alternative pathway mediated bactericidal activity for E. coli K12 was found normal. Classical pathway mediated bactericidal activity became normal only at an age corresponding to 52 weeks' gestational age.     

Acute selenium poisoning of a 2-year-old child

After ingestion of an unknown amount of a gun blueing compound containing selenious acid (11 ml from the bottle fluid were missing, equivalent to 2.9 g Se) a 2-year-old girl suffered from continuous hyper-salivation, vomiting, diarrhoea, restlessness and muscle spasm. Blood pressure and pulse rate were increased. Symptomatic treatment was performed by parenteral fluid administration. The plasma Se concentration was increased to 20 times normal 5 h after ingestion. Erythrocyte Se exceeded plasma Se, 24 h after intoxication. Urinary Se excretion decreased parallel to the plasma Se concentration. Ten weeks later, the Se content of hair had risen to 10 times normal. The plasma glutathione peroxidase activity showed only a slight increase during the first 36 h, erythrocyte glutathione peroxidase, catalase and superoxide dismutase activities were not significantly altered. The child fully recovered.     

Infants of Depressed Mothers Exhibit Atypical Frontal Brain Activity A Replication and Extension of Previous Findings

The left frontal brain region is specialized for expression of positive emotions (e.g. joy) whereas the right frontal region is specialized for ncgative emotions (e.g, sadness). Depressed adults have been found to exhibit redeed left frontal electroencephalographic-activity. In this study, baseline frontal and parietal EEG activity was measured in l3–l5-month-old infants of depressed and nondepressed mothers who were of middle income with no other major psychiatric problems. Compared lo infants of nondepressed mothers, infants of depressed mothers exhibited reduced left frontal EEG activity. Infants of mothers with major depression exhibited lower levels of left frontal EEG activity than those of mothers with subthreshold depression.     

Early Intravenous Indomethacin Prolongs Respiratory Support in Very Low Birth Weight Infants

ABSTRACT. Infants weighing 1500 g at birth requiring either intermittent positive pressure ventilation or continuous positive airway pressure by 12 hours of age were entered in a randomized double blind controlled trial to test the efficacy of early intravenous indomethacin therapy in preventing chronic pulmonary disease of prematurity. Of the 30 newborns enrolled, 15 were treated with indomethacin and 15 were treated with placebo at 12, 24 and 36 hours of age. The groups were similar for birth weight, gestational age, sex, hyaline membrane disease and intracranial hemorrhage. Infants in the placebo group were successfully weaned from intermittent positive pressure ventilation at an earlier age than infants in the indomethacin group ( p <0.05). Furthermore, chronic pulmonary disease of prematurity was similar in the two groups despite a reduction in the incidence of patent ductus arteriosus in the indomethacin group.     

Performance of 6-Month-Old Asian American Infants on the Movement Assessment of Infants

The purpose of this study was to examine the performance of Asian American infants on the Movement Assessment of Infants (MAI). The sample consisted of 30 full-term 6-month-old Asian American infants. These infants tended to have slightly slower integration of some primitive reflexes and to acquire automatic reactions and volitional motor skills at a slightly different rate than the predominantly Caucasian group of infants in a previous study. When the Washington and Deitz 6-Month Profile was used with the Asian American infants, 40% of them were identified as having risk scores higher than any of the infants in the Washington and Deitz study. This occurred even though the Asian American infants were full term, with unremarkable birth histories and, according to parent report, had no developmental concerns identified by either a parent or a health care provider. This finding suggests that clinicians should be cautious when using the MAI 6-Month Profile to assess Asian American infants.     

Respiratory Water Loss in Relation to Activity in Fullterm Infants on Their First Day after Birth

ABSTRACT. Respiratory water loss (RWL), oxygen consumption and carbon dioxide production were measured in ten fullterm infants on their first day after birth, using an open flow-through system with a mass spectrometer, specially equipped with a water channel, for analysis of gas concentrations. Measurements were made both with the infant asleep and during different levels of motor activity. The ambient temperature was maintained at approximately 32.5°C and the ambient relative humidity at 50%. RWL increased from 4.2±0.7 (SD) mg/kg min when the infant was asleep to 6.3±1.0 mg/kg min when he or she was awake but calm; with increasing activity there was a further increase in RWL. The oxygen consumption increased from 5.4±0.9 (SD) ml/kg min during sleep to 6.9±0.8 (SD) ml/kg min when awake, and also increased further with increasing activity.