RESUMEN
OBJECTIVE: We sought to determine the incidence of necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in surviving extremely low-birth-weight (ELBW, <1000 g birth weight) infants and to establish the impact of NEC on outcomes by hospital discharge and at 18 to 22 months adjusted age in a large, contemporary, population-based practice. STUDY DESIGN: Hospital outcome data for all ELBW infants born in the greater Cincinnati region from 1998 to 2009 were extracted from the National Institute of Child Health Neonatal Research Network Database. Neurodevelopmental outcome at 18 to 22 months was assessed using Bayley Scales of Infant Development-II scores for Mental Developmental Index and Psychomotor Developmental Index. Multivariable logistic regression was used and adjusted odds ratios reported to control for confounders. RESULT: From 1998 to 2009, ELBW infants accounted for 0.5% of the 352 176 live-born infants in greater Cincinnati. The incidence of NEC was 12%, with a 50% case-fatality rate. Death before discharge, morbid complications of prematurity and neurodevelopmental impairment were all increased among infants diagnosed with NEC. Infants with surgical NEC and SIP had a higher incidence of death, but long-term neurodevelopmental outcomes were not different comparing surviving ELBW infants with medical NEC, surgical NEC and SIP. CONCLUSION: Although ELBW infants comprise a very small proportion of live-born infants, those who develop NEC and SIP are at an increased risk for death, morbid complications of prematurity and neurodevelopmental impairment. No significant differences in neurodevelopmental outcomes were observed between the medical and surgical NEC and SIP groups.
Asunto(s)
Desarrollo Infantil , Discapacidades del Desarrollo/etiología , Enterocolitis Necrotizante/complicaciones , Recien Nacido con Peso al Nacer Extremadamente Bajo , Enfermedades del Prematuro , Perforación Intestinal/complicaciones , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/cirugía , Humanos , Lactante , Recien Nacido con Peso al Nacer Extremadamente Bajo/crecimiento & desarrollo , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/cirugía , Perforación Intestinal/mortalidad , Perforación Intestinal/cirugíaRESUMEN
OBJECTIVE: The purpose of this investigation is to analyze childhood blood lead levels and growth status (ages 2-12) in Dallas, Texas lead smelter communities in the 1980s and 2002, where smelters operated from 1936 to 1990. METHODS AND MATERIALS: A sample of convenience study design was used in two cohorts (n=360): 1980-1989 (n=191) and 2002 (n=169). Multivariate analysis of variance and covariance and tandem multiple regressions were used to evaluate the association between stature and blood lead level in two time periods. RESULTS: In 2002 average child blood lead level (1.6 microg/dL+/-0.2 SE) was significantly (p<0.001) lower compared to the 1980 cohort mean level (23.6 microg/dL+/-1.3 SE). Average height and weight in 2002 were 4.5 cm and 4.0 kg greater, respectively, than in 1980. Lowered blood lead level was associated with 3.9 cm, 3.5 kg and 1.1 units greater height, weight and body mass index (BMI), respectively. Cohort effect was associated with greater height (0.6 cm), weight (0.5 kg) and BMI (0.1). CONCLUSION: This investigation reports on child growth in a community before and after the transition from high to low blood lead levels over several decades. Using child growth as a proxy, health status of Dallas's lead smelter communities increased markedly over the past two decades, primarily because of lower blood lead levels, while the poverty rate was only marginally lower.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Exposición a Riesgos Ambientales , Trastornos del Crecimiento/epidemiología , Hispánicos o Latinos/estadística & datos numéricos , Plomo/sangre , Metalurgia , Estatura , Índice de Masa Corporal , Peso Corporal , Niño , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Trastornos del Crecimiento/sangre , Trastornos del Crecimiento/etiología , Humanos , Lactante , Plomo/efectos adversos , Masculino , Pobreza , Texas/epidemiología , Población Urbana/estadística & datos numéricosRESUMEN
We previously suggested that "late" neonatal hypocalcemia is related to a low calcium-phosphorus ratio of current cow's milk-based formula compared with human milk. However, there are no longitudinal studies of ionized calcium and parathyroid hormone concentrations in neonates receiving formulas with varying Ca/P ratios. Sixty-nine term neonates were studied through 2 weeks of age, and formula-fed neonates were randomized at birth to receive formula with molar ratios of 0.9, 1.2, or 1.4. Serum phosphate concentrations on days 2 and 6 of age were higher, and ionized calcium levels lower on days 6 and 14, in formula-fed vs human milk-fed neonates. Serum intact parathyroid hormone level increased between days 2 and 6 in formula-fed neonates compared with a decrease in human milk-fed neonates. Serum parathyroid hormone level on day 6 correlated with phosphorus intake among formula-fed neonates. No differences were noted in serum mineral or hormone levels among formula-fed groups. We speculate that the lowering of serum ionized calcium concentrations in neonates fed a modern "humanized" cow's milk formula may be a factor in late neonatal hypocalcemia.
Asunto(s)
Calcio/sangre , Alimentos Infantiles/efectos adversos , Hormona Paratiroidea/sangre , Análisis de Varianza , Humanos , Hipocalcemia/etiología , Recién Nacido , Leche Humana , Fosfatos/sangre , FósforoRESUMEN
Nitrous oxide has been used as an anesthetic for 100 years by the health care profession. Until recently, it has been considered safe from the standpoint of the patient. There have been less physical impairments and anesthesia complications with this agent than others. However, evidence has been accumulating that long term exposure to trace amounts of nitrous oxide could have a detrimental effect on personnel administering the anesthetic or working in close proximity to it. Chronic exposure to nitrous oxide has been implicated in causing liver and kidney damage, spontaneous abortions and birth defects along with impairment of short-term memory, coordination and hearing among those exposed. The author briefly reviews some of the evidence that led to the NIOSH criteria document on the occupational exposure to waste anesthetic gases and vapors.
Asunto(s)
Óxido Nitroso/efectos adversos , Quirófanos/normas , Anestesiología , Odontología , Humanos , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Estados UnidosRESUMEN
By photon absorptiometry, extrauterine bone mineralization in low-birth-weight infants fed a standard commercial formula lags significantly behind intrauterine bone mineralization. In the present study, infants of 28- to 32-week and 33- to 35-week gestational age were studied. The calcium content in a standard formula was increased to provide a daily calcium intake of 220 to 250 mg/kg/day. Phosphate intake was 110 to 125 mg/kg/day. Extrauterine bone mineralization by photon absorptiometry appeared to approximate the intrauterine bone mineralization rate.
Asunto(s)
Enfermedades Óseas/dietoterapia , Calcio de la Dieta/administración & dosificación , Enfermedades del Prematuro/dietoterapia , Enfermedades Óseas/etiología , Enfermedades Óseas/metabolismo , Calcificación Fisiológica , Calcio/metabolismo , Humanos , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Enfermedades del Prematuro/etiología , Enfermedades del Prematuro/metabolismo , Fósforo/administración & dosificación , Fósforo/metabolismo , Vitamina D/administración & dosificación , Vitamina D/metabolismoRESUMEN
To investigate vitamin D homeostasis in term pregnancy, we measured 1,25-dihydroxyvitamin D (1,25(OH)2D) in serum samples from 19 term pregnant women and in samples from the placental veins of their infants. Samples were obtained from 14 neonates at 24 hours of age. At delivery, maternal concentrations of 1,25(OH)2D were elevated above normal adult values; placental-vein concentrations in the infants were significantly lower than adult normal or maternal values and bore no relation to maternal values. By the time the infants reached 24 hours of age, their serum concentrations had reached normal adult values, concomitant with a decrease in serum concentration of ionized calcium. We speculate that low 1,25(OH)2D concentrations in utero suggest that there is no need for intestinal calcium absorption in the fetus. Postnatal increase of 1,25(OH)2D may result from its production as a prerequisite to extrauterine requirements for intestinal absorption of calcium and phosphorus.