Eligibility criteria for ambulatory colectomy

PURPOSE OF THE STUDY

To determine the statistical indicators aimed at identifying patients for whom ambulatory colectomy could be proposed without additional risk.

PATIENTS AND METHODS

The medical charts of patients who benefited from scheduled colonic or rectal resection during conventional hospitalization stays between 2018 and 2019 were reviewed. Eligibility for ambulatory colectomy was defined by hospital stay≤4 days and absence of any postoperative complication. Patient characteristics were compared, and the results were modeled in the form of a decision-making tree. The effect of an enhanced recovery after surgery (ERAS) protocol for each sub-group was calculated.

RESULTS

One hundred and ten (110) patients were selected (41 "eligible" and 69 "non-eligible"). Median age was 73 years (27-95). Nearly 80% of the patients were operated for cancer. In multivariate analysis, age (≥65 years, OR=3.15, CI95%=1.22-8.12), diabetes (OR=3.91, CI95%=1.03-14.8) and indication (sigmoidectomy for diverticulosis, OR=0.21, CI=95%=0.05-0.9) were the only identified independent variables. Likelihood for ambulatory eligibility was 83.3% (<65 years, sigmoidectomy pour diverticulosis, +ERAS=92%-96.9%), 58.3% (<65 years, other indication, +ERAS=63.4%-89.9%), 35.7% (≥65 years without diabetes, +ERAS=40.0%-55.9%) and 8.3% (≥65 years with diabetes, +ERAS=10.0%-20.1%).

CONCLUSION

Sigmoidectomy for diverticulosis in a patient under 65 years age represents the best indication for ambulatory colectomy, a procedure that must not be proposed to diabetic patients over 65 years of age. In the other cases (<65 years operated in another indication and non-diabetic≥65 years), ambulatory surgery is possible, pending satisfactory application of the ERAS protocol.

Effect of a Cane with Microprism Reflecting Tape on the Nighttime Visibility of Blind Rural Travelers

The study reported here compared the visibility of a cane equipped with white Scotchlite Reflecting Tape with Reflexite AP 1000M Reflecting Tape. The subjects were 33 licensed drivers, randomly assigned to groups, who were told to look for and announce the sighting of a person with a cane while they rode as passengers in cars traveling at a constant speed at night on a flat, unlit rural road. Elapsed times were recorded and distances calculated. The findings indicated that microprism reflecting tape, such as Reflexite AP 1000M, provides far greater detection distances at night on rural roads than does the standard Scotchlite currently used on long canes, and thus may be safer for blind travelers in rural areas.

Systematic review of the impact of osteoarthritis on health outcomes for comorbid disease in older people

OBJECTIVE

A systematic review was undertaken examining the impact of comorbid osteoarthritis on health outcomes for people aged 50 years or older with cardiovascular disease, diabetes or obesity.

DESIGN

The protocol is registered in PROSPERO (CRD42015023417). Relevant electronic databases and grey literature were systematically searched for studies published in English between January 2005 and December 2016. Two reviewers independently screened studies for selection using predetermined inclusion and exclusion criteria, and independently completed methodological quality review. Data was extracted at study level by one reviewer and independently checked by a second reviewer, using a standardized form. The results across studies were qualitatively synthesized with outcomes described and summarized.

RESULTS

Of 1456 articles, we identified 15 relevant studies, with nine good to high quality studies describing significant negative impact of osteoarthritis on outcomes for cardiovascular diseases. There were too few studies focussing on diabetes and obesity to make conclusions in regard to these diseases.

CONCLUSIONS

This review provides evidence that osteoarthritis should not be overlooked when impacts of chronic disease on health outcomes and related health service use are considered. There is a clear need for more studies that consider the impacts of osteoarthritis on comorbid disease, especially those that consider the impact of osteoarthritis beyond the morbidity impacts. The management of comorbid osteoarthritis should be addressed for those with cardiovascular disease, and treatment choices considered given this association.

[Diagnostic difficulty for an acute hydrocephalus]

Tuberculosis disease, in its extra pulmonary form, remains a difficult diagnosis because of its atypical symptoms and evolution. We have observed a case of acute tuberculosis neuromeningitis, without being able to make a definite diagnosis prior to the patient's death because of the negativity of the initial bacteriological samples. We started the most probable appropriate treatment but in vain. This case allows us to challenge diagnostic methods and resulting treatments in emergency cases where tuberculosis is suspected. Moreover, it seems essential to do everything possible to find the bacterium when confronted with a patient with risk factors and clinical and radiological symptoms compatible with tubercular disease, before the disease becomes acute.

Long-term consequences of early infant injury and trauma upon somatosensory processing

Long-term consequences of early infant injury upon somatosensory processing were tested in school aged children. The aim was to test whether the long-term changes in sensitivity reported in animal models, in regions both local to and distant from the injury site, could be observed in humans. To do this we used quantitative sensory testing (QST) in children aged 9-12 years who had undergone cardiac surgery in infancy. Cutaneous mechanical and thermal thresholds were measured at the thoracic scar region and at control contralateral thoracic and reference thenar areas in this early surgery group (n=9), and compared with thresholds at the same regions in age and gender-matched controls (n=9). The results showed that the cardiac surgery group was significantly less sensitive to von Frey hair tactile stimulation in the non-injured thenar area than the control group; mean threshold 5.02, SD+/-1.59 compared to 2.76, SD+/-0.79 (von Frey hair number, p=0.04). In addition, their lateral thoracotomy scar areas were significantly less sensitive to von Frey hair stimulation (mean=9.82, SD+/-1.97, p<0.001) and to cooling and warming than any other site tested. Eight of the nine children in the early surgery group did not perceive warmth on their scars and were only able to detect uncomfortable heat as the temperature was raised. Three of these children felt a paradoxical cold prior to the hot sensation and all reported subtle abnormalities in everyday sensations. Questionnaires revealed perceived differences in pain perception, individual aberrant sensations and pain interfering with daily life that warrant further study. We conclude that tissue injured in early infancy remains measurably altered to mechanical and thermal stimulation in later life. These findings are consistent with the results of animal studies that early infant injury has not only local, but also global long-term consequences upon sensory processing.

Translating the tears: parents' use of behavioural cues to detect pain in normally developing young children with everyday minor illnesses or injuries

OBJECTIVES

The objectives of this paper were to (i) identify the behavioural cues used by parents to detect young children's transient pain from minor illnesses or injuries ('everyday pain'); and (ii) perform an initial psychometric evaluation of the Parents' Post-operative Pain Measure (PPPM) in the context of children's everyday pain.

METHOD

Cross-sectional Internet survey.

RESULTS

One thousand seven hundred sixteen parents of children (1-6 years) completed the survey. The parents reported more behaviours when children had pain from minor illnesses than from minor injuries (9.6 ± 3.9 vs. 2.5 ± 2.3, P < 0.001). Principal component analysis of the PPPM revealed a two-factor solution for illness-related pain and a three-factor solution for injury-related pain. Behavioural cues varied with characteristics of children (age, gender and prior hospital experience) and parents (gender, age and parenting experience).

CONCLUSIONS

The PPPM is a promising tool for parental assessment of children's pain in everyday situations. Further research is needed to determine its utility in facilitating communication between parents and healthcare professionals, and in improving the management of young children's pain.

From tears to words: the development of language to express pain in young children with everyday minor illnesses and injuries

BACKGROUND

Little is known about the development of language to express pain in the young or how children and parents verbally communicate when young children have everyday minor illnesses and injuries.

METHODS

UK parents of children between the ages of 1 and 6 were invited to complete an Internet survey on children's pain language during everyday situations of minor illness or injury.

RESULTS

Of the 1716 parents completing the survey, 45% reported their child had at least one word to express pain by 17 months of age, increasing to 81% by 23 months of age. Children used different words based on their age and in the contexts of minor illnesses and injuries, with words for expressing pain related to illness emerging slightly later. Children's language was purposeful in describing causes of pain and requesting specific forms of assistance from parents even in the very youngest age groups. Parents' communicated with their children primarily to gain further information about the source and nature of pain and to direct children's behaviour.

CONCLUSIONS

Children rapidly develop an extensive vocabulary to describe pain between 12 and 30 months of age, with words for pain from injury emerging first and reflecting the development of normal speech acquisition. The differences in verbal expressions in the context of minor illnesses and injuries suggest that children make a cognitive distinction between the origins and sensory aspects of pain. These findings can help parents, childcare and healthcare professionals to appreciate the early communication capabilities of young children and to engage in more effective pain assessment and management for young children.

Clinical trials: the viewpoint of children with a chronic illness compared with healthy children

The views of over 200 children (11-16 years old, who were either healthy or attending paediatric medical clinics with a chronic illness) on issues relating to paediatric clinical trials were determined by a questionnaire. Children with a chronic illness had a better understanding of the concept of dosing of medicines (40% vs 23%) and placebo (34% vs 20%). They were more likely to support children's involvement in clinical trials (51% vs 37%). The altruistic nature of children in both groups was similar. It was of concern, however, that 57-63% children would participate as healthy volunteers in a cancer drug trial. Both groups were able to differentiate between the different types of illnesses where it is appropriate to study medicines in children (86-89% for illness where there is no treatment; 34-40% for 'me-too' drugs). Young people should be given more opportunities to be involved in decision-making regarding clinical trials of medicines.

Clinical trials: the viewpoint of children

The views of 30 children (8-16 years old) attending paediatric medical clinics on paediatric clinical trials were determined by semi-structured interviews. Nineteen children recognised that there were risks involved with taking part in clinical trials. Risks concerned with being paid were recognised by all children.

Using the worldwide web to improve children's pain care

AIM

This paper describes a three-year project, the aims of which were to disseminate information regarding the assessment and management of children's pain, to reach consensus on the essential elements of pain assessment for children and to track nurses' perceived changes in pain assessment and management practices in hospital settings over time.

BACKGROUND

Despite the availability of research, guidelines and standards, paediatric nurses inconsistently practice evidence-based pain management. PROJECT METHODS: Nurses attending the 5th International Symposium on Paediatric Pain were invited to a workshop to discuss best practices and consider ways to share information regarding the assessment and management of children's pain. A website was designed and participants provided hospital guidelines, exchanged information via the Internet and completed periodic surveys.

CONCLUSION

Web-based resources were positively received. Consensus regarding the essential elements of pain management was achieved, but nurses identified organizational and resource restraints as barriers to achieving best practices. Surveys identified perceived increases in some hospital and ward level resources and activities to improve children's pain care. Sharing of information related to children's pain management and benchmarking of practice should be encouraged. Consensus building and networking may facilitate change, but organizational commitment is also required for successful implementation of new practices.

Behavioural, emotional and family functioning of hospitalized children in China and Hong Kong

PURPOSE

This study examined behavioural and emotional problems, social competence and family functioning of hospitalized Chinese children in Hong Kong and the Chinese Mainland.

METHOD

A sample of 210 hospitalized children (ages 2-11 years) and their families participated in the study. The families were from a cross-section of geographical areas in Hong Kong (two hospitals) and the Chinese Mainland (five hospitals). Parents completed an age-appropriate Chinese version of the Child Behaviour Checklist and the Family Assessment Device. Multiple regression models were used to examine predictors of children's behaviour problems.

RESULTS

Behavioural patterns appeared to be specific to the developmental stage. Children had greater problems when their families demonstrated poorer affective involvement. Hospitalized children on the Chinese Mainland experienced more internalizing and externalizing behaviour problems than those in Hong Kong. Sick children, according to their parents, however, demonstrate some resiliency based on social and academic competency factors.

CONCLUSIONS

Hospitalized Chinese children manifest behavioural, emotional and family problems that vary by region, the child's development and gender. Problems predominantly of an internalizing nature characterized this group. The findings support the need for culturally appropriate behavioural assessments and interventions with hospitalized children.

Successful toxoplasmosis prophylaxis after orthotopic cardiac transplantation with trimethoprim-sulfamethoxazole

BACKGROUND

The efficacy of trimethoprim-sulfamethoxazole (TMP/SMX) in the prevention of toxoplasmosis after orthotopic cardiac transplantation has been the subject of some controversy, with many transplant groups preferring to use the combination of pyrimethamine and sulfadiazine. Although effective, this latter regimen does not offer equal protection against other pathogens, such as or. To assess the value of TMP/SMX, we reviewed the experience in our heart transplant patients, all of whom received TMP/SMX (160/800 mg) three times weekly for approximately 8 months after transplantation.

METHODS

We report on 417 orthotopic cardiac transplants during a 17-year period. We have 100% one-year patient follow-up after transplantation. Data was collected on pretransplantation donor and recipient anti- serology, immunosuppression, allograft rejection, survival, yearly posttransplantation anti- serology, development of acute toxoplasmosis, and the occurrence of other infections.

RESULTS

In this cohort, acute toxoplasmosis developed after transplantation in one case (0.2%). Among the highest risk patients (D+R-) who were treated for at least one episode of rejection, the risk of acute toxoplasmosis was 5% (1 of 22 patients). No change in survival was found between the different anti- IgG serogroups (D-R-, D-R+, D+R-, or D+R+). Anti- IgG seroconversion occurred in eight -seronegative recipients after transplantation; all patients, except the case already noted, were asymptomatic and required no specific anti- therapy. No cases of, or infections were identified. Five proven and two suspected cases of pneumonia were found (only 2 of these 7 patients were receiving TMP/SMX at the time of pneumonia diagnosis).

CONCLUSIONS

These data demonstrate that TMP/SMX prophylaxis (160/800 mg) three times per week is effective prophylaxis after orthotopic cardiac transplantation and has prophylactic benefits against other posttransplantation opportunistic pathogens.

[The neonatal behavioral observation: a pertinent source of medical informations]

The neonatal behavioral observation is an important source of medical information in three domains: 1) assessment of development which can be done with the Assessment of Preterm Infant Behavior, 2) assessment of pain with the analysis of facial expression using validated pain scales such as the Neonatal Facial Coding System, 3) assessment of brain injuries with the Quality Assessment of General Movements. Such a behavioral observation of the newborn using validated tools is a useful complement of the neuro-imaging techniques.

Parent involvement in children's pain care: views of parents and nurses

AIM OF THE STUDY

This study investigated the views of parents and nurses about the involvement of parents in the management of their child's pain during the first 48 hours after surgery.

BACKGROUND

Children's pain management has been found to be problematic and in need of improvement. Nurses are the key health care professionals with responsibility for managing children's pain. Parents can make important contributions to assessment and management of their child's pain.

METHODS

Using a phenomenological approach, nurses and parents were interviewed about their perceptions of parent involvement in pain management.

FINDINGS

The findings indicated that parental involvement in their child's pain management is superficial and limited in nature. Parents described a passive role in relation to their child's pain care and conveyed feelings of frustration. Only a minority of parents expressed satisfaction with their child's pain care. Nurses perceived that there was adequate involvement of parents and adequate pain management for children.

CONCLUSIONS

These findings may be somewhat explained by differing views and a lack of effective communication between parents and nurses. There is a clear need for nurses to discuss parent involvement with parents and negotiate roles in relation to pain management.

Dominant role of the cytosolic C-terminal domain of the rat 5-HT1B receptor in axonal-apical targeting

The 5-HT(1A) and 5-HT(1B) receptors for serotonin exhibit a different membrane localization to either soma and dendrites (5-HT(1A)R) or axons and terminals (5-HT(1B)R) of neurons in the CNS. The mechanisms responsible for their differential targeting were investigated previously by transfecting various 5-HT(1A)R/5-HT(1B)R chimeras in the epithelial Lilly pork kidney (LLC-PK1) cell line. This first study suggested that a specific targeting signal is located in the C-terminal portion (comprising the last two transmembrane and the cytoplasmic C-terminal domains) of the 5-HT(1A)and/or 5-HT(1B) receptors. In the present study, the role of the cytosolic C-terminal tail of the receptors was further investigated by transfecting truncated receptors and 5-HT(1A)R/5-HT(1B)R chimeras in both the epithelial LLC-PK1 cells and rat hippocampal neurons in primary culture. Confocal microscopic analysis of immunofluorescence with specific anti-5-HTR antibodies and anti-microtubule-associated protein 2 or anti-neurofilament 200k antibodies showed that substitution of the cytosolic C-terminal tail of the 5-HT(1B)R in the 5-HT(1A)R addressed the resulting chimera to the axon of neurons and to the apical domain of LLC-PK1 cells. Therefore, the short tail of the 5-HT(1B)R presents an apical targeting signal that can also act as an axonal targeting signal. In addition, a domain within the third intracytoplasmic loop of the 5-HT(1B)R, responsible for its Golgi sequestration in LLC-PK1 cells, appeared to act as another axonal targeting signal in hippocampal neurons.

Review of research studies that evaluated the impact of treatment for childhood cancers on neurocognition and behavioral and social competence: nursing implications

ISSUES AND PURPOSE

Given the increasing incidence of childhood cancer, increasing survivor rates, and documented incidence of sequelae, nurses need evidence on which to base interventions for families at risk. The authors review and critique research studies that evaluated the impact of treatment for childhood cancers. Implications for nursing practice are discussed.

CONCLUSIONS

Research to evaluate the effects of treatment on neurocognition and behavioral and social competency of children with cancer has produced conflicting results. Most studies found deleterious effects on all three areas associated with childhood cancer treatment. Some studies, however, found no differences between childhood cancer survivors and children on therapy compared to normative data or healthy controls.

PRACTICE IMPLICATIONS

Knowledge of the short- and long-term impact of treatment for childhood cancer on neurocognition and behavioral and social competence allows nurses to design interventions that mitigate neurocognitive effects, decrease behavioral problems, and improve social competence.

Do cry features reflect pain intensity in preterm neonates? A preliminary study

The purpose of this study was to investigate if cries from preterm neonates would reflect changes in pain intensity following interventions. The cries from 25 preterm neonates from an original sample of 122 were audiorecorded while the infant was undergoing heelstick during a randomized crossover design testing the efficacy of: pacifier with sucrose or water, or prone position as compared to standard care. Both pacifier conditions reduced procedural pain according to a validated composite pain measure (the Premature Infant Pain Profile). There were proportionately fewer cries in the two pacifier groups compared to the prone positioning and standard care groups, and cry duration was positively correlated with PIPP scores. However, neither cry duration nor fundamental frequency reflected group differences. Further research is needed to determine if cry is a sensitive and valid indicator of pain in preterm infants.

The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates

BACKGROUND

Procedural pain management for very low birth weight (VLBW) neonates has been minimal or nonexistent in most neonatal intensive care units (NICUs).

OBJECTIVES

To compare the efficacy of developmentally sensitive behavioral interventions (nonnutritive sucking via a pacifier, positioning) and sucrose for relieving procedural pain in VLBW infants and to determine the influence of contextual factors (gestational age, postnatal age, birth weight, severity of illness, frequency of painful procedures) on pain response.

METHOD

In a prospective randomized crossover trial, pain was assessed in 122 VLBW neonates using the Premature Infant Pain Profile following four randomly ordered interventions during consecutive routine heel lance procedures.

RESULTS

Significant differences in pain existed among treatment interventions (F = 16.20, p < .0001). The pacifier with sucrose (F = 24.09, p < .0001) and pacifier with sterile water (F = 9.00, p = .003) significantly reduced pain. Prone positioning did not decrease pain (F = 2.24, p = .137). Frequency of painful procedures approached significance in influencing pain response (F = 3.59, p = .01).

CONCLUSIONS

The most efficacious interventions for reducing pain from single painful events were the pacifier with sucrose and the pacifier with sterile water. Research on the efficacy and safety of implementing these interventions, alone and in combination, for repeated painful procedures is needed. In addition, research is needed on the influence of implementing these interventions on pain response and clinical outcomes (e.g., health status and neurodevelopmental status) in VLBW neonates in the NICU.

Special needs of preterm infants in the management of pain and discomfort

Most infants born preterm are admitted to hospital neonatal intensive care units, where they undergo repeated multiple diagnostic and therapeutic procedures that result in pain and discomfort. Although there is convincing evidence to support the preterm infant's neurologic capacity for pain, management of pain often is not optimal. Accurate and reliable assessment of the preterm infant's pain is an important prerequisite for effective pain management. Pain assessment is a challenge for health professionals because the preterm infant's responses are less vigorous, more variable, and less consistent than are the responses of term neonates and older infants. Few reliable and valid assessment measures exist for this age group. There also is uncertainty in implementing pain-relieving intervention because of inadequate information on their safety and effectiveness and preconceived attitudes and beliefs of health professionals. The special needs of preterm infants related to the assessment and management of pain are discussed.

Assessment and management of opioid withdrawal in ill neonates

Neonatal physical dependence on opioids occurs in two ways: (1) through passive exposure in utero from maternal ingestion of drugs such as heroin or methadone or (2) through the administration of opioids such as morphine, fentanyl, or methadone for analgesia and sedation in the NICU. This article provides a comprehensive review of the mechanisms of opioid tolerance, physical dependence, and withdrawal specific to the neonate. Particular emphasis is given to the assessment of iatrogenic neonatal abstinence syndrome in the ill neonate and to its prevention and management in the NICU.

Predictive study of physical therapy admission variables

The purpose of this study was to determine the relationship of 12 preadmission academic scores with the professional cumulative grade point average (PT CUM GPA) achieved in a two-year physical therapy program. The objective of the study was to suggest to faculty ways to limit the admission-selection criteria to statistically significant predictors of academic achievement. Preadmission cumulative grade point average, science cumulative grade point average, average Allied Health Professions Aptitude Test (AHPAT) score, and nine other less often utilized academic scores were correlated with PT CUM GPA of 111 physical therapy students. The Pearson product-moment correlation and a stepwise regression procedure identified chemistry, physics, and science cumulative GPAs and AHPAT quantitative ability score as significant predictors of PT CUM GPA. These predictors accounted for 16% of the variance of the PT CUM GPA. Results suggest that these preadmission scores be used in the admission-selection process and be given equal weight in predicting academic achievement.

Skin-to-skin (kangaroo) holding of the intubated premature infant

Skin-to-skin holding has been reported to be a useful technique for helping mothers feel close to their nonintubated infants hospitalized in the NICU. This article describes our experience with skin-to-skin holding of 25 intubated infants in the NICU. We found this technique was safe for the intubated infant and promoted parental attachment, even in parents who were at high risk for attachment impairments. Our experience suggests that skin-to-skin holding with small intubated infants may offer some parents an effective method to overcome some of the barriers to attachment imposed by the infant's hospitalization. In addition, our observations raise several questions regarding parent-infant interaction.

Disaster preparedness for the ICN: evolution and testing of one unit's plan

A plan for the care of technology-dependent premature and critically ill children during a disaster or other emergency requires more guidance than a generic hospital disaster plan can offer. An intensive care nursery (ICN) devised disaster and emergency preparedness policies and procedures specific to its patient population. Staff responses to events such as loss of power, loss of medical gases, and partial evacuation are described.

Persistently low blood retinol levels during and after parenteral feeding of very low birth weight infants: examination of losses into intravenous administration sets and a method of prevention by addition to a lipid emulsion

Very low birth weight infants have little storage of hepatic retinol and are, therefore, highly dependent upon an exogenous supply. The recent association between low serum retinol level and bronchopulmonary dysplasia and the persistently low serum levels of retinol during total parenteral nutrition prompted a prospective study to evaluate serial changes in serum retinol levels during 1 month of total parenteral nutrition (retinol dose 455 micrograms/d) and again during 1 month of total enteral feeding (retinol dose 200 to 300 micrograms/d) in the same infants. Infants were divided into two groups. Group 1 consisted of infants weighing less than 1,000 g (n = 24) and group 2 consisted of infants weighing 1,000 to 1,500 g (n = 17). Although initial mean levels of retinol were similar in both groups (14.8 +/- 0.9 and 13.5 +/- 0.7 micrograms/dL), there was wide variation between infants. In group 1 infants, there was a significant (P less than .01) decline in retinol level by the second week of life (to 9.2 +/- 1 micrograms/dL), which persisted during total parenteral nutrition, but increased to 13.4 +/- 2 after 1 week of enteral feeding. This level was maintained throughout enteral feeding. In group 2 infants, there was no significant change in serum retinol level throughout the study. During total parenteral nutrition, several infants had retinol levels below 10 micrograms/dL, a level associated with signs of retinol deficiency in older children. Because losses of retinol are known to occur in smaller volume total parenteral nutrition solutions, it was speculated that losses of retinol in our patients were due to retinol losses in the total parenteral nutrition delivery system.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of a pediatric multiple vitamin preparation for total parenteral nutrition. II. Blood levels of vitamins A, D, and E

This study represents the first attempt to evaluate the American Medical Association Nutrition Advisory Group (NAG) recommendations for intravenous vitamin A, D, and E dosages for infants and children. Patients studied included 18 preterm infants (group 1) and 26 term infants and children (group 2A) receiving total parenteral nutrition for 2 to 4 weeks and eight infants and children receiving total parenteral nutrition for 3 to 6 months (group 2B). Term gestation infants and children up to 11 years of age all received the same dosages (those that were recommended by the NAG for children weighing more than 10 kg). Preterm infants received 65% of these doses. In group 1, cord blood alpha-tocopherol levels were less than 0.22 mg/dL in seven preterm infants (reference value = 0.29 +/- 0.04), but mean levels increased to 1.65 +/- 0.17 mg/dL after four days of treatment. Eight infants consistently received additional vitamin E orally (80 to 150 mg daily), and their levels increased to 2.18 +/- 0.26 mg/dL by four days of study and to 3.49 +/- 0.57 mg/dL after 3 weeks. Oral supplementation in the preterm infants appeared to be unnecessary because intravenous vitamins alone maintained levels above 1.1 mg/dL. In group 2, alpha-tocopherol levels were maintained within the reference range. Patients receiving lipid emulsions containing substantial quantities of alpha-tocopherol had significantly higher blood levels than patients receiving lipid emulsions containing little alpha-tocopherol (P less than .01). Mean 25-OH vitamin D levels were maintained above or within the reference range in groups 2A and 2B.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of a pediatric multiple vitamin preparation for total parenteral nutrition in infants and children. I. Blood levels of water-soluble vitamins

This study represents the first attempt to evaluate the response to the only intravenous vitamin preparation (MVI Pediatric) for infants and children receiving total parenteral nutrition. Eighteen preterm infants (group 1), 26 term infants and children receiving total parenteral nutrition for 2 to 4 weeks (group 2A), and eight infants and children receiving total parenteral nutrition for 3 to 6 months (group 2B) were studied. Term gestation infants and children up to 11 years of age received daily vitamin doses that approximated the 1974 Recommended Dietary Allowances and coincided with the 1975 American Medical Association Nutrition Advisory Group total parenteral nutrition dosage guidelines for children weighing more than 10 kg. Preterm infants received 65% of these dosages. RBC transketolase (vitamin B1), glutathione reductase (B2), and glutamic oxaloacetic transaminase (B6) activities were maintained at normal levels, and niacin levels were maintained within the reference range (7.1 +/- 0.32 micrograms/mL) in all study patients. Pantothenate, biotin, and ascorbate were maintained at reference levels in groups 2A and 2B. In group 1, ascorbic acid was increased significantly during treatment from 1.53 +/- 0.16 to 3.60 by seven days and to 2.54 +/- 0.62 by day 28 of treatment (reference normals = 0.99 +/- 0.1 mg/dL). RBC folate was maintained within the reference range of 411 +/- 76 pg/mL; however, pantothenate and biotin levels increased significantly to more than 2 SD above reference values during treatment, and vitamin B12 levels, which were above the reference range initially, were maintained at more than 2 SD above the reference range throughout treatment. The elevation in vitamin B12 was seen in both group 1 and 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)