Can Demir Karacan

Effect of Cup Feeding and Bottle Feeding on Breastfeeding in Late Preterm Infants: A Randomized Controlled Study

Background: Cup feeding has been used as an alternative feeding method for preterm infants. Objective: The purpose of this study was to determine the effect of bottle and cup feeding on exclusive breastfeeding rates at hospital discharge and 3 and 6 months post-discharge in late preterm infants. Methods: Included in the study were preterm infants of 32 to 35 weeks’ gestation fed only by intermittent gastric tube at the time of recruitment; 522 infants were randomly assigned to 2 groups: the cup-fed group (n = 254) and bottle-fed group (n = 268). Main outcomes were prevalence of exclusive breastfeeding at discharge and 3 and 6 months after discharge, and length of hospital stay. Results: Infants randomized to cup versus bottle feeding were more likely to be exclusively breastfed at discharge home (relative risk [RR], 1.58; 95% confidence interval [CI], 1.36-1.83), 3 months after discharge (RR, 1.64; 95% CI, 1.42-1.89), and 6 months after discharge (RR, 1.36; 95% CI, 1.14-1.63). There was no significant difference between groups for length of hospital stay. The mean hospital stay was 25.96 ± 2.20 days in the bottle-fed group and 25.68 ± 2.22 days in the cup-fed group. There was no significant difference between groups for time spent feeding, feeding problems, or weight gain in hospital. Conclusion: Cup feeding significantly increased the likelihood of late preterm infants being exclusively breastfed at discharge and 3 and 6 months after discharge, and cup feeding did not increase the length of hospital stay. Overall, we recommend cup feeding as a transitional method prior to breastfeeding for late preterm infants during hospitalization.

Brief Intervention to Preteens and Adolescents to Create Smoke-Free Homes and Cotinine Results A Randomized Trial

BACKGROUND Little research has focused on brief and practical strategies for addressing environmental tobacco smoke exposure through interventions focused explicitly on creating a smoke-free home. METHODS We used a two-group (intervention and control groups) repeated-measures randomized controlled trial design. Families were randomized to the intervention (n = 176) or control (n = 176) condition after the baseline interview, with outcome assessments for reported and urine cotinine measures at 2 (post-intervention), 6 (follow-up) and 12 (follow-up) months. RESULTS Baseline urinary cotinine levels of both groups were not statistically significantly different (P > 0.05); however, post-intervention urinary cotinine levels were significantly different at 2, 6 and 12 months after start of the study (P < 0.001). CONCLUSION As a physician-based brief intervention, our intervention was effective. Clinical providers might offer feedback and brief interventions to preteens and adolescents. Because of the ease of intervention on delivery, this intervention has the potential to have significant impact if widely disseminated.

Nebulized Epinephrine Treatment in Pediatric Emergency Department

Epinephrine, first isolated around 1900, is the main sympathomimetic agent released by the adrenal gland. It plays an integral role in the treatment of several diseases in the emergency department. It effects on alpha and beta adrenergic receptors. In lower doses, it usually causes systemic and pulmonary vasodilatation, with some increase in heart rate and stroke volume. A high dose causes intense systemic vasoconstriction. Its metabolism is rapid and half-life is less than 5 minutes.