127 research outputs found
A nutritional program to improve outcome of very low birth weight infants
No full textBackground & aims: The growth of very low birth weight infants does not match intrauterine trajectories, likely due to inappropriate caloric intake. We therefore investigated whether modification of the standard nutritional schedule can impact postnatal growth. Methods: We introduced a set of evidence-based strategies in a study group of infants (n = 123): 1) higher maximum intake of intravenous amino acids and lipids; 2) prioritisation of earlier enteral feeding; 3) faster attainment of full enteral feeds; 4) daily adjustment of enteral feeds according to growth trajectory; and 5) utilisation of an electronic pre-structured prescription ordering system that tracks individual growth and energy intake. These infants were compared with a control group (n = 115) in a pre/post retrospective cohort study. Results: The study group achieved a higher caloric intake, attained full enteral feeds 5 days earlier, and returned to their birth weight more rapidly than the control group. At 36 weeks postmenstrual age, infants who had been born at <30 weeks were heavier (6,260 g) but had a similar percentage fat mass. Those born at <28 weeks had a larger head circumference (Delta 1.4 cm) and lower sepsis rate (7.8%). Conclusions: Optimization of early postnatal nutrition and daily adjustment of milk intake according to weight gain improved growth, without any unfavourable outcomes for body composition and neuro-developmental follow-up. (C) 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved
Stellungnahme der Ernährungskommission der Deutschen Gesellschaft für Kinder- und Jugendmedizin zur Vermarktung von Beikostprodukten zur Flaschenfütterung
No full textBöhles HJ, Fusch C, Genzel-Boroviczény O, Henker J, Koletzko B , Kersting M, Lentze MJ, Maaser RG, Mihatsch W, Przyrembel H, Wabitsch
Neonatologie/Pädiatrie – Leitlinie Parenterale Ernährung, Kapitel 13
No full textThere are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.Eine besondere Herausforderung bei der Durchführung parenteraler Ernährung (PE) bei pädiatrischen Patienten ergibt sich aus der großen Spannbreite zwischen den Patienten, die von extrem unreifen Frühgeborenen bis hin zu Jugendlichen mit einem Körpergewicht von mehr als 100 kg reicht, und ihrem unterschiedlichen Substratbedarf. Dabei sind alters- und reifeabhängige Veränderungen des Stoffwechsels sowie des Flüssigkeits- und Nährstoffbedarfs zu berücksichtigen sowie auch die klinische Situation, in der eine PE eingesetzt wird. Das Vorgehen unterscheidet sich deshalb ganz erheblich von der PE-Praxis bei erwachsenen Patienten, z.B. ist der Flüssigkeits-, Nährstoff- und Energiebedarf von Früh- und Neugeborenen pro kg Körpergewicht höher als bei älteren pädiatrischen und bei erwachsenen Patienten. In der Regel benötigen alle Frühgeborenen <35. SSW und alle kranken Reifgeborenen während der Phase des allmählichen Aufbaus der enteralen Nahrungszufuhr eine vollständige oder partielle PE. Die Zufuhrmengen der PE bei Neonaten müssen berechnet (nicht geschätzt) werden. Der Anteil der PE sollte zur Minimierung von Nebenwirkungen sobald wie möglich durch Einführung einer enteralen Ernährung vermindert (teilparenterale Ernährung) und schließlich komplett durch enterale Ernährung abgelöst werden. Eine unangemessene Substratzufuhr im frühen Säuglingsalter kann langfristig nachteilige Auswirkungen im Sinne einer metabolischen Programmierung des Krankheitsrisikos im späteren Lebensalter haben. Wenn bei älteren Kindern und Jugendlichen dagegen der Energie- und Nährstoffbedarf eines Patienten im Vorschul- oder Schulalter durch eine enterale Nährstoffzufuhr nicht gedeckt werden kann, ist abhängig von Ernährungszustand und klinischen Umständen spätestens innerhalb von 7 Tagen eine partielle oder totale PE zu erwägen
Increased Activity of the Immunoregulatory Enzyme Indoleamine-2,3-Dioxygenase (IDO) with Consecutive Tryptophan Depletion Predicts Death in Patients with Neuroendocrine Neoplasia.
No full textBACKGROUND/AIMS
Data from a considerable number of malignancies demonstrate that depletion of the essential amino acid tryptophan via induction of the immuno-regulatory enzyme Indoleamine-2,3-dioxygenase (IDO) serves as an important tumour escape strategy and is of prognostic importance. Here we investigate the predictive value of the activity of IDO as well as levels of tryptophan and respective downstream catabolites in a large cohort of patients with neuroendocrine neoplasia (NEN).
METHODS
142 consecutive Caucasian patients (62 male, aged 60.3 ± 11.9 years) with histologically confirmed NEN were systematically analysed in a retrospective blinded endpoint analysis. Patients were followed up for a mean period of about 3.9 ± 1.9 years. Clinical outcome, levels of established biomarkers, and tryptophan degradation markers (assessed using tandem mass spectrometry) including estimated IDO-activity were recorded. Cox-proportional hazards regression models were performed for the assessment of prognostic power.
RESULTS
We found that baseline tryptophan levels were significantly lower and IDO-activity was significantly increased in non-survivors. The risk for death inclined stepwise and was highest in patients in the upper tertile of IDO-activity. Cox-proportional regression models identified IDO-activity as an independent predictor for death.
CONCLUSIONS
In this retrospective analysis, we observed that baseline activity of the immunoregulatory enzyme IDO was significantly increased in non-survivors. IDO-activity was identified as an independent predictor for death in this cohort of NEN patients. Whether IDO-activity or tryptophan depletion serves to guide future therapeutic interventions in NEN remains to be established
Target Fortification of Breast Milk: Predicting the Final Osmolality of the Feeds.
No full textFor preterm infants, it is common practice to add human milk fortifiers to native breast milk to enhance protein and calorie supply because the growth rates and nutritional requirements of preterm infants are considerably higher than those of term infants. However, macronutrient intake may still be inadequate because the composition of native breast milk has individual inter- and intra-sample variation. Target fortification (TFO) of breast milk is a new nutritional regime aiming to reduce such variations by individually measuring and adding deficient macronutrients. Added TFO components contribute to the final osmolality of milk feeds. It is important to predict the final osmolality of TFO breast milk to ensure current osmolality recommendations are followed to minimize feeding intolerance and necrotizing enterocolitis. This study aims to develop and validate equations to predict the osmolality of TFO milk batches. To establish prediction models, the osmolalities of either native or supplemented breast milk with known amounts of fat, protein, and carbohydrates were analyzed. To validate prediction models, the osmolalities of each macronutrient and combinations of macronutrients were measured in an independent sample set. Additionally, osmolality was measured in TFO milk samples obtained from a previous clinical study and compared with predicted osmolality using the prediction equations. Following the addition of 1 g of carbohydrates (glucose polymer), 1 g of hydrolyzed protein, or 1 g of whey protein per 100 mL breast milk, the average increase in osmolality was 20, 38, and 4 mOsm/kg respectively. Adding fat decreased osmolality only marginally due to dilution effect. Measured and predicted osmolality of combinations of macronutrients as well as single macronutrient (R2 = 0.93) were highly correlated. Using clinical data (n = 696), the average difference between the measured and predicted osmolality was 3 ± 11 mOsm/kg and was not statistically significant. In conclusion, the prediction model can be utilized to estimate osmolality values after fortification
Hieracium jurassicum GRISEB.
No full textHieracium jurassicum GRISEB. Salzburg: Pinzgau, Hohe Tauern, Venedigergruppe, Hollersbachtal, Abstieg von der Marchleckalm gegen Talboden, Wald-Grünerlenkomplexe, ca. 1560m, 8740/3, 23.08.2006, leg. OS, det. G. Brandstätter, Herbarium OS/LI. Noch 1954 schreibt REITER für das Synonym H. juranum, dass diese Zwischenart (prenanthoides≥murorum) nicht in Salzburg vorkommt. In LEEDER & REITER (1958) scheint hingegen der bislang einzige uns bekannte Nachweis aus diesem Bundesland auf, der auf Kovats beruht und von der Embachalm bei Fusch stammt.Published as part of Stöhr, O., Pilsl, P., Essl, F., Hohla, M. & Schröck, C., 2007, Beiträge zur Flora von Österreich, II, pp. 155-292 in Linzer biologische Beiträge 39 (1) on page 209, DOI: 10.5281/zenodo.540754
Validation 2: correlation between measured (i.e. measurements using a freezing point device) and predicted (i.e. calculations from the prediction equations) osmolality of breast milk with added combinations of macronutrients (Fat: F, Whey Protein: P, Glucose Polymer Carbohydrates: C).
No full text<p>The average quantity to fortify in 100 mL breast milk was 1.3 mL (0.0, 3.2) (min, max), 1.2 g (0.6, 1.5), 1.8 g (1.1, 2.7) for F, P, C, respectively.</p
Hieracium jurassicum GRISEB.
No full textHieracium jurassicum GRISEB. Pinzgau: Hohe Tauern, Fuschertal, Fusch an der Glocknerstrasse, Weg in das Hirzbachtal, Fichtenwald vor dem Feistalpl, ca. 1200 m, 8742/4, 19.07.200 6, leg. PP, det. G. Brandstätter, Herbarium PP. Dieses seltene Habichtskraut konnte in Salzburg erst zweimal nachgewiesen werden: Embachalm im Fuschertal und Hollersbachtal (vgl. STÖHR et al. 2007). Nun gelang im Fuschertal der dritte Nachweis in den Hohen Tauern Salzburgs.Published as part of Stöhr, O., Pilsl, P., Essl, F., Wittmann, H. & Hohla, M., 2009, Beiträge zur Flora von Österreich, III, pp. 1677-1755 in Linzer biologische Beiträge 41 (2) on page 1715, DOI: 10.5281/zenodo.527972
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