Pia Karlsland Åkeson

Protein and amino acid metabolism in three- to twelve-month-old infants fed human milk or formulas with varying protein concentrations.

BACKGROUND The metabolic response to different protein intakes from breast milk and/or formulas varying in protein concentrations, in combination with supplementary foods, has not been studied in infants who are in the second half of infancy. METHODS Healthy infants, exclusively breast-fed until 3 months old, were randomly assigned to one of three groups, F13, F15, or F18, and were given formulas with 13, 15, or 18 g/l of protein, respectively. Infants breast-fed (B) and mixed-fed (M) (breast milk and formula) at 6 months formed the fourth and fifth groups. All infants received the same supplementary foods and were studied from ages 3 to 12 months. RESULTS The concentrations of albumin, prealbumin, and transferrin were similar in all groups. At 6 months, serum and urine urea concentrations were lower in B and M, compared with urea levels in the formula-fed groups of infants. At 12 months, urine urea was lower in B + M than it was in F18. At 6 months, plasma concentrations of phenylalanine, tyrosine, and methionine were higher in all formula-fed groups; and those of valine. isoleucine, and threonine were higher in F18 and F15 than they were in B and M. Plasma concentrations of methionine, valine, and threonine were higher in F18 than in F13. At 12 months, plasma levels of tyrosine, methionine, valine, isoleucine, and leucine were higher in F18 than they were in B + M. CONCLUSION Many indexes of protein metabolism were similar in groups F13, B, and M, particularly at 6 months. In contrast, the provision of a formula with 18 g/l of protein resulted in a different metabolic pattern, which could indicate unnecessarily high protein intakes.

Growth and Nutrient Intake in Three- to Twelve-month-old Infants Fed Human Milk or Formulas with Varying Protein Concentrations

BACKGROUND Results on growth and nutrient intake in infants in the second half of infancy fed human milk or formulas with varying protein concentrations in combination with supplementary foods have not previously been reported. METHODS Seventy-one healthy infants were studied from 3 to 12 months of age. They were exclusively breast-fed until 3 months and were then randomly assigned to one of three feeding groups, F13, F15, or F18, indicating formulas with 13, 15 or 18 g/l of protein, respectively. Formula was gradually introduced when breast-feeding was terminated. Infants fed breast milk only were included in the breast-fed group, and those with breast milk and formula were included in the mixed-fed group. The same supplementary foods were provided to all infants. RESULTS There were no differences in growth between the feeding groups. Total protein intake exceeded minimum recommendations in all groups at all ages and was higher at 6 months in F18 than in F13 (2.3 vs. 1.9 g/kg per day; p < 0.01), whereas formula protein intake was higher at all ages in F18 compared with F13. Intake of protein from supplementary foods increased, but that from formula decreased between 6 and 12 months in all groups. CONCLUSIONS Intake of breast milk or infant formula with 13 g/l of protein along with high-protein supplementary foods provided enough protein with no adverse effect on growth. Infants fed formulas with higher protein concentrations had similar growth, despite higher intakes of formula protein.

Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children

Background:  Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire‐guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low‐dose midazolam in young children undergoing these procedures before and also after discharge from the hospital.

Increased vitamin D intake differentiated according to skin color is needed to meet requirements in young Swedish children during winter: a double-blind randomized clinical trial

Background: Dark skin and low exposure to sunlight increase the risk of vitamin D insufficiency in children.Objective: The aim of the study was to evaluate the amount of vitamin D needed to ascertain that most children >4 y of age attain sufficient serum 25-hydroxyvitamin D [S-25(OH)D; i.e., ≥50 nmol/L] during winter regardless of latitude and skin color.Design: In a longitudinal, double-blind, randomized, food-based intervention study, 5- to 7-y-old children from northern (63°N) and southern (55°N) Sweden with fair (n = 108) and dark (n = 98) skin were included. Children, stratified by skin color by using Fitzpatricks definition, were randomly assigned to receive milk-based vitamin D3 supplements that provided 2 (placebo), 10, or 25 μg/d during 3 winter months.Results: Mean daily vitamin D intake increased from 6 to 17 μg and 26 μg in the intervention groups supplemented with 10 and 25 μg, respectively. In the intention-to-treat analysis, 90.2% (95% CI: 81.1%, 99.3%) of fair-skinned children randomly assigned to supplementation of 10 μg/d attained sufficient concentrations, whereas 25 μg/d was needed in dark-skinned children to reach sufficiency in 95.1% (95% CI: 88.5%, 100%). In children adherent to the study product, 97% (95% CI: 91.3%, 100%) and 87.9% (95% CI: 76.8%, 99%) of fair- and dark-skinned children, respectively, achieved sufficient concentrations if supplemented with 10 μg/d. By using 95% prediction intervals for 30 and 50 nmol S-25(OH)D/L, intakes of 6 and 20 μg/d are required in fair-skinned children, whereas 14 and 28 μg/d are required in children with dark skin.Conclusion: Children with fair and dark skin require vitamin D intakes of 20 and 28 μg/d, respectively, to maintain S-25(OH)D ≥50 nmol/L, whereas intakes of 6 and 14 μg/d, respectively, are required to maintain concentrations ≥30 nmol/L during winter. This trial was registered at clinicaltrials.gov as NCT01741324.

Serum Vitamin D Depends Less on Latitude Than on Skin Color and Dietary Intake During Early Winter in Northern Europe.

Objectives: To evaluate if dietary vitamin D intake is adequate for sufficient vitamin D status during early winter in children living in Sweden, irrespective of latitude or skin color. Methods: As part of a prospective, comparative, 2-center intervention study in northern (63°N) and southern (55°N) Sweden, dietary intake, serum 25-hydroxyvitamin D (S-25(OH) D), associated laboratory variables, and sociodemographic data were studied in 5 to 7-year-old children with fair and dark skin in November and December. Results: Two hundred six children with fair/dark skin were included, 44/41 and 64/57 children in northern and southern Sweden, respectively. Dietary vitamin D intake was higher in northern than southern Sweden (P = 0.001), irrespective of skin color, partly due to higher consumption of fortified foods, but only met 50–70% of national recommendations (10 &mgr;g/day). S-25(OH) D was higher in northern than southern Sweden, in children with fair (67 vs 59 nmol/L; P < 0.05) and dark skin (56 vs 42 nmol/L; P < 0.001). S-25(OH) D was lower in dark- than fair-skinned children at both sites (P < 0.01), and below 50 nmol/L in 40 and 75% of dark-skinned children in northern and southern Sweden, respectively. Conclusions: Insufficient vitamin D status was common during early winter in children living in Sweden, particularly in those with dark skin. Although, higher dietary vitamin D intake in northern than southern Sweden attenuated the effects of latitude, a northern country of living combined with darker skin and vitamin D intake below recommendations are important risk factors for vitamin D insufficiency.

Ultrasound measurements of subcutaneous adipose tissue in infants are reproducible

BACKGROUND The purpose of this study was to evaluate the ultrasound technique for measuring subcutaneous adipose tissue in infants. METHODS Twenty infants were investigated at 3, 6, and 12 months of age. All measurements were made by the same investigator in triplicate on the left side of the body at the triceps and subscapular anatomic landmarks and at the abdomen and thigh. An ultrasound system equipped with a linear 7.0-MHz transducer was used. RESULTS The intraclass correlation coefficients were 0.88 to 0.99. Random errors ranged from 0.01 to 0.19 mm. For log-transformed values, the random error ranged from 2.4% to 5.7%. CONCLUSIONS Measurements of subcutaneous fat in infants using ultrasound are reproducible when performed by the same observer.

Pediatric emergency department management benefits from appropriate early redirection of nonurgent visits.

Aims Overcrowding at pediatric emergency departments (EDs) may result in delayed clinical management and higher risks of medical error. This study was designed to prospectively evaluate what parents of sick children seek emergency care for and how these patients are being assessed and managed. Methods Patients aged 0 to 17 years seeking ED care at an urban Swedish university hospital, from 8 AM to 9 PM on 25 consecutive days, were included. Clinical urgency and further level of medical care were determined by experienced nurses based on individual clinical signs and vital parameters. Information on presenting problem, medical priority, gender, age, waiting time, day of week, time of day, and further management was recorded. Results Among 1057 included children, two thirds were assessed by physicians, whereas one third were referred directly by nurses for other ED (n = 54) or primary care (n = 114), or sent home with medical advice (n = 176), more often during evenings and weekends. Of primarily referred patients, 7.6% returned within 72 hours, and three of them were admitted. Young infants, patients with respiratory or neurological problems, and sicker patients with fever or infections were mainly assessed by physicians, within desired priority time. Discussion More than one fourth of pediatric ED patients might rapidly, appropriately, and safely be referred for primary care or sent home by experienced pediatric nurses soon after arrival, thereby facilitating management of urgent and more appropriate patients. Evaluations by physicians were primarily required in young infants and for urgent medical conditions demanding qualified pediatric skills.

HUMAN MILK AND STANDARD INFANT FORMULA TOGETHER WITH HIGH QUALITY SUPPLEMENTARY FOODS IS SUFFICIENT FOR NORMAL GROWTH DURING INFANCY † 1861

HUMAN MILK AND STANDARD INFANT FORMULA TOGETHER WITH HIGH QUALITY SUPPLEMENTARY FOODS IS SUFFICIENT FOR NORMAL GROWTH DURING INFANCY † 1861

A validation study of an interviewer-administered short food frequency questionnaire in assessing dietary vitamin D and calcium intake in swedish children

Vitamin D and calcium are essential nutrients with a range of biological effects of public health relevance. This study aimed to validate a short food frequency questionnaire (SFFQ) against a three-day food record (3D record), assessing the intake of vitamin D and calcium in Swedish children during wintertime. In a double-blinded, randomized food-based intervention study on the effect of feeding different daily doses of vitamin D supplement to 5–7-year-old children (n = 85), 79 (93%) participants completed SFFQ1 at baseline and SFFQ2 after the intervention, and 72 were informed to fill in a 3D record. The 28 (39%) children who completed the 3D record were included in this validation study. The baseline level of serum-25 hydroxy vitamin D [S-25(OH)D] was used as a biomarker. The correlation between all three instruments were moderate to strong. SFFQ2 and the 3D record correlated moderately to S-25(OH)D. Bland-Altman analysis showed that SFFQ2 overestimated vitamin D intake by on average 0.6 μg/day, (limits of agreement (LOA) 5.7 and −4.6 μg/day), whereas the intake of calcium was underestimated by on average 29 mg/day, (LOA 808 and −865 mg/day). Finally, the validity coefficient calculated for vitamin D using the method of triad was high (0.75). In conclusion, this SFFQ, assessed by a dietician, is a valid tool to assess dietary vitamin D and calcium intake in groups of young children.

Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care

Aims: Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments – with overall reference to socioeconomic status – of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. Methods: The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. Results: In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours (p=0.014) and were scored as less urgent (p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status (p=0.027). Conclusions: Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.