Effects of a supervised,outpatient exercise and physiotherapy programme in children with cystic fibrosis

Previous work suggests benefit from outpatient exercise and physiotherapy in children with cystic fibrosis (CF), namely improved exercise capacity and lung function measures, as well reduced intravenous (IV) antibiotic needs. Our study aim was to investigate the effect of a year‐long supervised outpatient exercise and physiotherapy programme in children with CF. Subjects with CF aged ≥10 years who had received ≥4 courses of IV antibiotics in 2009 were enrolled and seen fortnightly for supervised exercise and physiotherapy throughout 2010. In addition, they were expected to exercise three times weekly, and if unwell complete additional physiotherapy sessions extra to usual chest physiotherapy. Assessments of exercise capacity using the Modified Shuttle Test (MST) and quality of life (QOL; CFQ‐UK) were recorded at baseline and after 1 year. Regular spirometry was performed before and throughout the study. Data were collected on IV antibiotic days. 12 subjects (6 female) were enrolled with mean (95% CI) age of 13.3 (11.8–14.6) years at study entry. A significant reduction in IV antibiotic days from 60 (56–64) days in 2009 to 50 (44–56) in 2010 (P = 0.02) was noted, along with improved MST distance (m) [735 (603–867) vs. 943 (725–1,161), P = 0.04] and level attained [9.4 (8.4–10.5) vs. 11.1 (9.6–12.6), P = 0.04]. Significant improvements in CFQ‐UK scores for physical [59 (47–72) vs. 83 (74–92), P = 0.001], emotional [63 (55–72) vs. 84 (74–93), P < 0.001], treatment [41 (30–51) vs. 61 (48–73), P = 0.002], and respiratory [54 (42–66) vs. 76 (70–82), P = 0.002] domains were noted. The mean (95% CI) rate of change of FEV₁ was ?4 (?18, +10)% in 2009, but was +6 (?2, +13)% in 2010, although this did not reach statistical significance. Supervised, outpatient exercise and physiotherapy are associated with improvements in QOL and exercise tolerance, a reduction in IV antibiotic days, and a trend towards reducing lung function decline in children with CF. The cost of IV antibiotics was reduced by £66,384 ($104,000) in 2010 when compared with 2009. Such cost‐benefit may have implications for workforce planning and service provision. Pediatr Pulmonol. 2012; 47:1235–1241. © 2012 Wiley Periodicals, Inc.     

Plasma Arginine Levels and Blood Glucose Control in Very Preterm Infants Receiving 2 Different Parenteral Nutrition Regimens

Background: Improving parenteral nutrition (PN) amino acid (AA) intake in very preterm infants is associated with less hyperglycemia. AAs stimulate newborn insulin secretion with arginine, demonstrating a specific effect. We hypothesized that low arginine levels would be associated with increased insulin‐treated hyperglycemia and higher mean daily blood glucose levels in very preterm infants. Methods: We performed a secondary analysis on previous study data comparing high‐protein/calorie PN (HPC‐PN) and control groups in infants <29 weeks’ gestation. Infants were substratified (within original groups) according to high (highARG) and low (lowARG) plasma arginine levels on days 8–10 using a reference population‐derived threshold for high/low arginine (57 µmol/L). Daily protein, arginine, carbohydrate intake, mean daily blood glucose, and insulin treatment data from the first 15 days of life were collected. Results: Control group infants (n = 60) were stratified into lowARG (n = 41) and highARG (n = 19) groups. There were no differences in basic demographic data or carbohydrate intake. LowARG infants had higher mean daily blood glucose levels (P < .05) and a trend to more insulin treatment on days 6–10. HPC‐PN group infants (n = 55) were stratified into lowARG (n = 33) and highARG (n = 22) groups. LowARG infants had lower gestation and birth weight and were sicker than highARG infants. There were no differences in carbohydrate intake. LowARG infants had higher mean daily blood glucose levels (P < .01) and more insulin treatment (P < .01) on days 1–5 and 6–10. Insulin‐treated hyperglycemia was also associated with low plasma glutamine levels. Conclusion: Low plasma arginine levels (≤57 µmol/L) in very preterm infants are associated with poorer blood glucose control.