ICAN: Infant, Child, & Adolescent Nutrition current issue

Thoughts on the Nutrition Care Process

Wessel, J. — Wed, 07 Oct 2009 09:43:46 PDT

The Use of Probiotics for the Prevention of Necrotizing Enterocolitis in the Premature Infant

Anderson, T., Lord, A., Shotkoski, N., O'Keefe, C. — Wed, 07 Oct 2009 09:43:47 PDT

Studies have suggested the possible benefits of prophylactic administration of probiotics to the premature infant for the prevention of necrotizing enterocolitis (NEC). A survey was designed to determine the knowledge and practices of neonatal intensive care practitioners regarding the use of probiotics for the prevention of NEC in the premature infant. One hundred seventy-one surveys were completed. Most respondents were neonatal nurse practitioners (n = 100, 59%). Most (64%, n = 110) indicated that NEC was a significant problem; however, only 13 (8%) of these respondents used probiotics for the prevention of NEC. Eighty-six respondents (57%) identified the lack of published studies on the use of probiotics for the prevention of NEC as the reason for not administering probiotics. No statistically significant relationship was found between the use of probiotics for the prevention of NEC and duration of practice, location of practice, or willingness to try new treatments. A statistically significant relationship was revealed between the use of probiotics in general and the use of probiotics for the prevention of NEC. More research is needed in the area of probiotics and the prevention of NEC in the premature infant before a practice change can be considered.

Quantification of Energy Wastage From Canola Oil Supplementation in Preterm Infants

Cohen, S., Dollberg, S., Mimouni, F. B., Peled, Y., Mandel, D. — Wed, 07 Oct 2009 09:43:47 PDT

The objective of this study was to quantify energy wasted when canola oil (CO) is added to the diet of preterm infants. Eight preterm infants were studied; gestational age ranged from 27 to 33 weeks, and birth weight ranged from 800 to 1317 g. Each infant was studied at baseline for 3 days of stool collection, at the end of which energy expenditure (EE) was measured 1 hour after meals. Each infant was then supplemented with 3 g CO/kg/d for 3 days, after which the study was repeated. Stools were collected for fat analysis. EE increased from 58 ± 6.8 to 62.4 ± 4.6 kcal/kg/24 hours after introduction of CO (P < .03). Stool fat increased from 1.37 ± 1.2 to 2.18 ± 1.2 g/kg/d. Of the fat added, 27% was lost in stools, and 17% was wasted as spent energy. The increase in EE correlated significantly with the coefficient of fat absorption (R² = 0.56, P = .029). In conclusion, the addition of CO to the diet of preterm infants leads to net energy storage of more than half of the extra energy administered and may be an inexpensive alternative to medium-chain triglyceride oil.

Perspectives in Nasogastric Feeding the Eating Disorder Patient

Woods, B. K., Runyan, B., Lamb, R. P. — Wed, 07 Oct 2009 09:43:47 PDT

Sapropterin Dihydrochloride (6R-BH4) and Maternal Phenylketonuria Two Case Studies

Moseley, K., Skrabal, J., Yano, S., Koch, R. — Wed, 07 Oct 2009 09:43:47 PDT

The dietary treatment of phenylketonuria (PKU) is a success story. However, the Maternal PKU Collaborative Study reported microcephaly, congenital heart defects, facial dysmorphology, and intrauterine and postnatal growth retardation in the offspring of women with blood phenylalanine (phe) concentrations >600 µmol/L. Dietary control of phe during pregnancy is extremely difficult for many women because of hyper-emesis gravidarum, intolerance of the medical food products, and inability/ refusal to follow dietary recommendations. The authors report 2 case studies using 6R-BH4 along with the phere-stricted diet. Two individuals received 6R-BH4 shortly before conception and throughout the pregnancy. A pherestricted diet was followed with blood phe analysis obtained weekly. Interim plasma amino acids, complete metabolic panels, complete blood counts, and analyses for nutritional deficiencies were also obtained during the pregnancy. Both individuals maintained blood phe concentrations within the recommended range (120-360 µmol/L) nearly all through the pregnancy with a small percentage outside of recommendations. One participant showed deficiencies in vitamin D and zinc and received supplementation. Both were able to increase natural protein as the pregnancy progressed. Ingestion of the 6R-BH4 was well tolerated. Both gave birth to healthy normal infants. In these case studies, both babies’ birth measurements were in the normal range, and the 6R-BH4 had no adverse effects.

In Vitro Stability of Sapropterin Dihydrochloride From Crushed Tablets Mixed in Applesauce, Pudding, and Infant Formula

Striepeke, S., Jurecki, E. R., Hornfeldt, C. S., Turbeville, S., Prince, B. — Wed, 07 Oct 2009 09:43:47 PDT

Sapropterin is approved to reduce blood phenylalanine levels in patients with hyperphenylalaninemia due to tetrahydrobiopterin-responsive phenylketonuria. The current Food and Drug Administration—approved labeling states that sapropterin tablets should be dissolved in 4 to 8 oz of water or apple juice; however, numerous requests for information regarding the feasibility of administering crushed sapropterin tablets in infant formula or soft foods such as applesauce and pudding suggest that the current recommendations for administration may not be suitable for many infants and small children. To determine the safety of administering the medication in formula or soft foods, powdered tablets representing 200 mg of sapropterin were thoroughly mixed with applesauce, lemon pudding, and 3 brands of phenylalanine-free infant formula, incubated for up to 60 minutes at room temperature and then analyzed for sapropterin content. The results indicate there was no significant change in the amount of sapropterin present in any mixture after 60 minutes.

Do Dietary Modifications Made Prior to Pubertal Maturation Have the Potential to Decrease Obesity Later in Life? A Developmental Perspective

Casazza, K., Thomas, O. — Wed, 07 Oct 2009 09:43:47 PDT

Dietary intake is an important contributor to the obesity epidemic in children and adults, but the long-term effects of dietary interventions after obesity has occurred are modest at best. Childhood obesity significantly increases the risk of adult obesity. It has been suggested that prior to puberty, the interaction of physiological and dietary intake factors greatly affects overall trajectory of weight gain of the life course. This review article summarizes research on the role of diet on weight and metabolic outcomes, and it suggests how dietary interventions prior to puberty may decrease the prevalence of obesity life span. Specifically, presented literature examines dietary intake in early life and through the pubertal transition, as well as the role of macro- and micronutrients in mechanisms that influence fat accumulation and storage. The evidence suggests that multiple early life periods for dietary interventions could have a cumulative effect on optimizing tissue partitioning and limiting excessive fat accumulation into adulthood. Prior to the pubertal transition, it appears that improving diet quality in the context of energy balance may also be a key strategy for preventing current and future obesity.

Prader-Willi Syndrome A Review for Pediatric Nutrition Professionals

Pereira, R., Schalk, A., Geraghty, M. E. — Wed, 07 Oct 2009 09:43:47 PDT

Prader-Willi syndrome is a complex, multidimensional disease affecting approximately 1 in 8000 to 1 in 50 000 individuals. Although there is an abundance of data available regarding Prader-Willi syndrome, there are few sources of compiled, nutritionally pertinent information. Nutrition intervention is currently the only treatment for Prader-Willi syndrome, and therefore it is critical that nutrition professionals have an understanding of the disease. This review provides background information regarding Prader-Willi syndrome and the causes of obesity and hyperphagia, as well as outlines current nutritional recommendations and strategies for working with individuals with Prader-Willi syndrome. It is recommended that the diet of these children be strictly controlled and structure provided, yet it is important to allow for some flexibility to enhance quality of life. Behavioral issues also need to be considered as they render it a challenge for parents to impose restrictions on their children’s eating patterns.

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Wed, 07 Oct 2009 09:43:47 PDT

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Wed, 07 Oct 2009 09:43:47 PDT