Shmuel Arnon

High Beta-Palmitate Formula and Bone Strength in Term Infants: A Randomized, Double-Blind, Controlled Trial

We aimed to compare the effect of 12-week feeding of commercially available infant formulas with different percentages of palmitic acid at sn-2 (beta-palmitate) on anthropometric measures and bone strength of term infants. It was hypothesized that feeding infants with high beta-palmitate (HBP) formula will enhance their bone speed of sound (SOS). Eighty-three infants appropriate for gestational age participated in the study; of these, 58 were formula-fed and 25 breast-fed infants, serving as a reference group. The formula-fed infants were randomly assigned to receive HBP formula (43xa0% of the palmitic acid is esterified to the middle position of the glycerol backbone, study group; nxa0=xa030) or regular formula with low-beta palmitate (LBP, 14xa0% of the palmitic acid is esterified to the middle position of the glycerol backbone, nxa0=xa028). Sixty-six infants completed the 12-week study. Anthropometric and quantitative ultrasound measurements of bone SOS for assessment of bone strength were performed at randomization and at 6 and 12xa0weeks postnatal age. At randomization, gestational age, birth weight, and bone SOS were comparable between the three groups. At 12xa0weeks postnatal age, the mean bone SOS of the HBP group was significantly higher than that of the LBP group (2,896xa0±xa0133 vs. 2,825xa0±xa079xa0m/s respectively, Pxa0=xa00.049) and comparable with that of the breast-fed group (2,875xa0±xa085xa0m/s). We concluded that infants consuming HBP formula had changes in bone SOS that were comparable to those of infants consuming breast milk and favorable compared to infants consuming LBP formula.

Music therapy intervention in the neonatal intensive care unit environment.

vianna et al.1, em seu ensaio clínico controlado, randomizado e aberto, utilizaram dois musicoterapeutas para trabalhar sistematicamente com mães de lactentes prétermo na unidade de terapia intensiva neonatal (UTIN) de sua instituição. As sessões eram realizadas três vezes por semana, tinham 1 hora de duração e compreendiam quatro movimentos: expressão verbal, expressão musical, canções de ninar e relaxamento e encerramento, resultando, na primeira consulta de seguimento após a alta hospitalar, em um índice mais elevado de aleitamento materno no grupo intervenção do que no grupo controle. Índices mais elevados de aleitamento materno também foram observados na consulta de seguimento de 60 dias. Parabenizo os autores por seu estudo interessante, que é, até onde sei, o primeiro com foco no impacto da musicoterapia nos índices de aleitamento materno entre mães de neonatos prematuros. Esses achados podem motivar profissionais de saúde a usar a música como redutor de estresse para mães que precisam de apoio e que têm dificuldade de continuar o aleitamento materno durante essa fase difícil de suas vidas. Não é possível saber se foi a intervenção musicoterápica que fez com que as mães se sentissem mais relaxadas e, portanto, mais dispostas a amamentar, ou se foi o encontro em uma atmosfera totalmente diferente para expressar a ansiedade que fez com que as mães se sentissem mais capazes de lidar com situações de estresse e, assim, responder às necessidades do lactente.

Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety

AbstractThe success rate of conservative treatment for children with uncomplicated appendicitis was prospectively evaluated among 197 children. All who received intravenous antibiotics for 3–5xa0days, and if symptoms resolved, were discharged home on oral antibiotics for 5xa0days. Failure rate, symptoms, laboratory signs, and sonographic findings were evaluated for prognostic markers of treatment failure. Children were followed for 18xa0months. The success rate of conservative treatment was 87%, with shorter hospital stays compared to children who eventually needed surgery (72 [60–84] vs. 84xa0h [72–126], Pxa0=xa00.001). Vomiting and/or nausea and intraluminal fluid on sonography were the only prognostic signs of failed treatment (Pxa0=xa00.028 and Pxa0=xa00.0001, respectively). After multi-regression analysis, intraluminal fluid was the only prognostic sign for failed treatment (odds ratioxa0=xa010.2; 95% CI 3.3–31.8, Pxa0=xa00.001). Patients who failed conservative treatment were successfully operated without significant morbidity. Pathology findings were compatible with acute or subacute inflammation in 94% of operated AA, with no perforated appendices.n Conclusion: When applying rigorous criteria for children with uncomplicated appendicitis, a high success rate can be achieved with conservative treatment. Those who fail conservative treatment have a benign medical course without serious complications. Intraluminal fluid may increase risk for conservative treatment failure.What is Known:• Conservative treatment in uncomplicated acute appendicitis is a reasonable alternative to appendectomy.What is New:• Using rigorous criteria for conservative treatment in uncomplicated acute appendicitis is safe and feasible.• Intraluminal fluid should be considered a contraindication to conservative treatment.

Intervenção musicoterápica no ambiente da unidade de terapia intensiva neonatal

Estudos que usam a musica em diades pai/mae-filho tem a vantagem de melhorar os objetivos de desenvolvimento na UTIN e atuam no sentido de reduzir o estresse, estimular o desenvolvimento durante um periodo critico de crescimento, promover o vinculo com os pais e facilitar a comunicacao e o desenvolvimento neurologico e social. Sao necessarios mais estudos sobre o uso da musica em lactentes prematuros. Desenhos metodologicos meticulosos e relatos de estudos sobre o uso da musica na UTIN irao promover a pratica baseada em evidencia na area.

Association between neonatal morbidities and head growth from birth until discharge in very‐low‐birthweight infants born preterm: a population‐based study

To evaluate the possible association between major neonatal morbidities and poor head growth from birth to discharge home in very‐low‐birthweight (VLBW) infants born preterm.

Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible

PurposeAppendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center’s experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria.MethodsNon-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA. Data collected included clinical signs and symptoms; laboratory, ultrasound and pathology results. Follow-up was conducted through clinic visits, telephone conversations and national registry analysis.ResultsIncluded in CAT: 362 children, 19 underwent appendectomy within 1–2xa0days. Overall, 75 were readmitted for recurrent acute appendicitis during 22xa0months (6–43) follow-up. Thirty were treated successfully with antibiotics a second time. The remaining 45 had appendectomy. Overall, 86.8% underwent CAT with no surgery. Histology of all recurrent AUA revealed no perforations.ConclusionWe confirm the feasibility of conservative management of AUA in children. A rigorous diagnostic plan with strict inclusion and exclusion criteria will lead to high success rate of CAT with a strong safety profile. CAT does not compete with surgery or render appendectomy unnecessary. It is a safe alternative to surgery in selected cases.

Fatores de risco para raquianestesia em recém-nascidos pré-termo submetidos a herniorrafia inguinal

OBJECTIVESnTo investigate the risk factors and incidence of perioperative adverse effects from unsupplemented spinal anesthesia in preterm infants. Times to resumption of oral feeding and to home discharge were also evaluated.nnnMETHODSnPerioperative data were collected prospectively for all preterm and former preterm infants who underwent inguinal hernia repair with spinal anesthesia at a tertiary medical center.nnnRESULTSnThe study group consisted of 144 infants with a median gestational age of 30 weeks, postmenstrual age of 37 weeks, birth weight of 1,420 g, and weight at surgery of 2,140 g. Overall, six (4.2%) infants had intraoperative complications, which included apnea (2/1.4%), bradycardia (2/1.4%), and hypoxemia (4/2.8%). Postoperative complications occurred in 15 (10.4%) infants, mainly hypoxemia (3/2.1%), bradycardia (8/5.5%), and apnea (6/4.1%). Predictive factors of an unfavorable outcome (apnea, resumption of oral feeding > 6 h postoperatively, or discharge > 30 h postoperatively) were bronchopulmonary dysplasia (odds ratio [OR] = 3.2, 95% confidence interval [95%CI] 2.8-5.3; p = 0.01) and periventricular leukomalacia (OR = 2.8, 95%CI 2.1-4.9; p = 0.03).nnnCONCLUSIONSnSpinal anesthesia is safe and effective for inguinal hernia repair in preterm infants, with early resumption of oral feeding and short hospitalization. Bronchopulmonary dysplasia and periventricular leukomalacia may pose risks for an unfavorable outcome.OBJECTIVES: To investigate the risk factors and incidence of perioperative adverse effects from unsupplemented spinal anesthesia in preterm infants. Times to resumption of oral feeding and to home discharge were also evaluated. METHODS: Perioperative data were collected prospectively for all preterm and former preterm infants who underwent inguinal hernia repair with spinal anesthesia at a tertiary medical center. RESULTS: The study group consisted of 144 infants with a median gestational age of 30 weeks, postmenstrual age of 37 weeks, birth weight of 1,420 g, and weight at surgery of 2,140 g. Overall, six (4.2%) infants had intraoperative complications, which included apnea (2/1.4%), bradycardia (2/1.4%), and hypoxemia (4/2.8%). Postoperative complications occurred in 15 (10.4%) infants, mainly hypoxemia (3/2.1%), bradycardia (8/5.5%), and apnea (6/4.1%). Predictive factors of an unfavorable outcome (apnea, resumption of oral feeding > 6 h postoperatively, or discharge > 30 h postoperatively) were bronchopulmonary dysplasia (odds ratio [OR] = 3.2, 95% confidence interval [95%CI] 2.8-5.3; p = 0.01) and periventricular leukomalacia (OR = 2.8, 95%CI 2.1-4.9; p = 0.03). CONCLUSIONS: Spinal anesthesia is safe and effective for inguinal hernia repair in preterm infants, with early resumption of oral feeding and short hospitalization. Bronchopulmonary dysplasia and periventricular leukomalacia may pose risks for an unfavorable outcome.