https://www.cdc.gov/coronavirus/mers/downloads/Isolation2007.pdf

2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings.

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Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007.

Retinopathy of prematurity

Background Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calcium-phosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na- or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE?

/pdf/a-s-p-e-n-clinical-guidelines-parenteral-nutrition-ordering-4o1aoxjwfc.pdf

A.S.P.E.N. Clinical Guidelines Parenteral Nutrition Ordering, Order Review, Compounding, Labeling, and Dispensing

Некротизирующий энтероколит (НЭК) новорожденных — наиболее частая причина постнатальной критической ситуации воспалительного генеза. Долгое время в качестве синонимов НЭК фигурировали такие патологические состояния, как функциональная кишечная непроходимость, внутрибрюшной абсцесс, спонтанная перфорация подвздошной кишки, аппендицит, некротический колит новорожденных с перфорацией, ишемический энтероколит, инфаркт кишечника новорожденных. Таким образом, почти до второй половины прошлого века данное патологическое состояние не было очерчено как нозологическая форма. В настоящее время НЭК нашел свое место в МКБ-10 под рубрикой Р.77. С клинической точки зрения НЭК представляет собой широкий спектр вариантов течения заболевания: от случаев, заканчивающихся благополучно, без каких-либо последствий, до тяжелых форм, осложняющихся некрозом кишечника, перфорацией, перитонитом и сепсисом, приводящим, как правило, к летальному исходу. С.В. МальцеВ, Э.М. ШакироВа Казанская государственная медицинская академия

Neonatal necrotizing enterocolitis.

Introduction The gut microbiota plays a main role in the maintenance of host’s health. Exposure to different conditions in early life contributes to distinct ‘pioneer’ bacterial communities in the intestine, which shape the newborn infant development. Newborn infants with congenital malformations of the gastrointestinal tract (CMGIT), necrotising enterocolitis (NEC) and spontaneous intestinal perforation (SIP) commonly require abdominal surgery and enterostomy. The knowledge about the colonisation of these newborns’ intestine by microorganisms is scarce. This protocol is designed to explore the microbial colonisation over time of the proximal intestinal remnant in newborn infants who underwent surgery for CMGIT, NEC or SIP and require enterostomy. Methods and analysis The literature about microbiota colonisation in newborn infants with enterostomy was reviewed and an observational, longitudinal, prospective study was designed. The infants will be recruited at the Neonatal Intensive Care Unit of the Hospital Dona Estefânia, Centro Hospitalar Universitario de Lisboa Central. Samples of the enterostomy effluent will be collected every 3 days, through 21 days after the first collection. The microorganisms colonising the proximal intestinal remnant will be identified using the 16S rRNA sequence analysis and a subset of microorganisms will be quantified using real-time PCR. This protocol may serve as basis for future observational and interventional studies on the modulation of the intestinal microbiota (eg, probiotics) on short and long-term outcomes in this population. Ethics and dissemination This study protocol was approved by the Ethics Committee of Centro Hospitalar Universitario de Lisboa Central (441/2017) and by the Ethics Committee of NOVA Medical School, Universidade Nova de Lisboa (n°50/2018/CEFCM). The results will be spread through peer-reviewed publications and presentations at international scientific meetings. Trial registration number NCT03340259.

https://bmjopen.bmj.com/content/bmjopen/9/11/e028916.full.pdf

Colonisation of the proximal intestinal remnant in newborn infants with enterostomy: a longitudinal study protocol.

Background: Addition of energy supplements to preterm formulas is a possible strategy to increase the enteral energy intake, without exceeding the protein intake or the potential renal solute load, in infants submitted to fluid restriction, such as in bronchopulmonary dysplasia. This manipulation of standard formulas may lead to undesirable increase in osmolality of feedings, 400 mOsm/kg is the maximum recommended limit.

/pdf/212-osmolality-of-preterm-formulas-supplemented-with-glucose-4vjlq7tcnb.pdf

212 Osmolality of Preterm Formulas Supplemented with Glucose Polymers and Medium Chain Triglycerides

/pdf/recomendacao-de-curvas-e-valores-de-referencia-para-avaliar-4ec7tyr6m5.pdf

Recomendação de curvas e valores de referência para avaliar o crescimento de crianças nascidas pré-termo

Reference values for bone strength in term and preterm neonates assessed by the quantitative ultrasound method

As mechanisms of gaze stability, both visual stabilization and the vestibulo-ocular reflex are needed to coordinate the movements of the head, trunk and pelvis during walking1,2. Balance impairment after stroke is strongly associated with more severely impaired motor function, a decrease in recovery potential and an increase of the number of falls3-5. To verify the efficacy of a domiciliary training program to improve balance impairment due to stroke in senior patients.

/pdf/domiciliary-gaze-stability-and-oculomotor-exercises-improves-1gfkcy67um.pdf

Daniel Virella

Papers

Colonisation of the proximal intestinal remnant in newborn infants with enterostomy: a longitudinal study protocol.

212 Osmolality of Preterm Formulas Supplemented with Glucose Polymers and Medium Chain Triglycerides

Recomendação de curvas e valores de referência para avaliar o crescimento de crianças nascidas pré-termo

Reference values for bone strength in term and preterm neonates assessed by the quantitative ultrasound method

Domiciliary Gaze Stability and Oculomotor Exercises Improves Balance After Stroke. Better Balance, a Randomized Controlled Trial