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.

Aim: To assess the degree of discomfort caused by length measurement in neonates, performed with one or both lower limbs extended, on the first and second day after birth, with either one or both lower limbs extended. Methods: Healthy full-term neonates were systematically sampled during the months of February and March 2004. Crown–heel length was measured, using a 1-mm precision neonatometer, at approximately 8 h and 32 h after birth, with one and both lower limbs extended. The Neonatal Facial Coding System was used to assess discomfort during measurements. Data were analysed by parametric and non-parametric tests as appropriate. Results: Whatever the measurement technique, discomfort scores are significantly higher during the length measurement than at baseline. Whenever length measurements are performed, discomfort scores are significantly higher when extending both lower limbs rather than one lower limb (p<0.006). The measured length is greater with one lower limb extended; however, the difference decreases over time, being 0.19 cm (95% CI 0.1–0.3; p<0.001) at approximately 32 h of age. No significant differences in length were found between measurements at approximately 8 or 32 h, regardless of the technique used. The best correlation between length measurements with one or both lower limbs extended was observed at approximately 32 h after birth (r=0.98).



Conclusion: Measuring crown–heel length is a distressful procedure for the neonate. Measurements with one lower limb extended result in less discomfort than when both lower limbs are extended, without decreasing the accuracy.

/pdf/reducing-discomfort-while-measuring-crown-heel-length-in-23q7e48jdz.pdf

Reducing discomfort while measuring crown–heel length in neonates

Summary Background Cholestasis is a common complication in infants receiving prolonged parenteral nutrition (PN). We studied the effects of two intravenous lipid emulsions composed with either 30% soybean oil, 30% medium-chain triglycerides (MCT), 25% olive oil, and 15% fish oil (SMOF) or with 50% MCT and 50% soybean oil n-6 (MCT/SOY) on the incidence of cholestasis in surgical term and near-term neonates. Methods A single-center, double-blinded, randomized controlled trial compared the incidence of cholestasis using either SMOF or MCT/SOY in neonates born at gestational age ≥34 weeks undergoing major surgery. The primary outcome was the incidence of conjugated serum bilirubin >1 mg/dL. Other liver enzymes were assessed as secondary outcomes. A post-hoc analysis assessed serum triglycerides levels. Odds ratios were estimated by mixed-effects regression models. Results Enrollment was prematurely interrupted because the MCT/SOY became unavailable, thus 49 infants (SMOF 22, MCT/SOY 27) completed the study. The exposure (time on PN, cumulative dose of lipids) was similar in both groups. Similar cumulative incidence rates were found for elevated conjugated bilirubinemia and other liver enzymes. Hypertriglyceridemia >250 mg/dL (12/49) was more frequent in MCT/SOY (37.0%, 95% CI 21.53–55.77) than in SMOF (9.1%, 95% CI 2.53–27.81, p = 0.024). Triglyceridemia at the first assessment (median 8 postnatal days) was significantly higher with MCT/SOY than with SMOF (181 vs. 134 mg/dL, p = 0.006). Over the whole study period, mean triglyceride concentration was 36.5 mg/dL higher with MCT/SOY compared with SMOF (p = 0.013). Conclusion Both emulsions had similar effects on the incidence of cholestasis and markers of liver integrity, but MCT/SOY induced higher serum triglyceride concentrations. Trial registration: ClinicalTrials.gov , NCT02633384

https://repositorio.chlc.min-saude.pt/bitstream/10400.17/2903/1/Clin%20Nutrition%20ESPEN%202017_7.pdf

Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions.

Introducao: A prevalencia do estilo de vida sedentario esta a aumentar nas sociedades desenvolvidas, com efeito negativo na qualidade de vida, maiores taxas de mortalidade e morbilidade cardiovascular e risco acrescido de obesidade. A definicao de estrategias que promovam estilos de vida saudaveis em criancas constitui uma prioridade, sendo de salientar que os estudos realizados na populacao pediatrica nao tem sido suficientemente consistentes.Objectivo: Determinar a prevalencia de sedentarismo e a sua associacao com variaveis socio-demograficas e excesso de peso e obesidade em adolescentes.Metodos: Estudo epidemiologico transversal, de base comunitaria, com recolha de dados atraves de inquerito autopreenchido e de medicoes directas, em adolescentes escolarizados na area de influencia de um centro de saude de Lisboa, no ano de 2002. Adaptou-se o inquerito do Youth Risk Behavior Survey para a avaliacao da actividade fisica e o indice de massa corporal, segundo os valores de corte de Cole et al (2000), para definicao de excesso de peso e obesidade.Resultados: Foram incluidos 319 adolescentes, com idades entre os 11 e 17 anos. A prevalencia referida de individuos inactivos foi de 33,5% (IC95% 28,4-39,0); 24,5% dos adolescentes referiram ver televisao quatro ou mais horas por dia (IC95% 20,1–29,9) e 22% tinham excesso de peso ou obesidade (IC95% 17,8–27,2). A inactividade fisica foi mais elevada no sexo feminino, em niveis socio-economicos inferiores e nos obesos.Conclusao: Aprevalencia de inactividade e de habitos de vida sedentarios e elevada entre os adolescentes inquiridos, mas semelhante a de outros estudos. A actividade fisica esta inversamente relacionada com o sexo feminino, nivel socio-economico inferior e obesidade. Palavras-chave: Actividade fisica, adolescentes, obesidade, sedentarismo, televisao.

Actividade física e sedentarismo em adolescentes escolarizados do concelho de Lisboa

Background: Prematurity accounts for about 10.6% of neonates worldwide and tends to increase as does survival from lower gestational ages. Summary: The importance of preterm birth in public health stems from its link to infant and under-5 mortality, morbidity, and its economic impact. In both the short and long term, preterm birth consequences are inversely related with gestational age and carry a higher risk of mortality and morbidity with neurodevelopmental, sensorial, cognitive and physical health disturbances. Individuals needing lifelong support pose challenges to the responsiveness of health services and community systems. Public health can be decisive in prematurity prevention, providing data to policy-makers and reducing modifiable risk factors. This paper focuses on the long-term consequences of preterm birth and possible public health measures to tackle them. Key Messages: Addressing social determinants of health can have the highest impact on prematurity outcomes.

/pdf/born-preterm-a-public-health-issue-1hjgscis2s.pdf

Born Preterm: A Public Health Issue

Food allergy (FA) prevalence data in infants and preschool-age children are sparse, and proposed risk factors lack confirmation. In this study, 19 children's day care centers (DCC) from 2 main Portuguese cities were selected after stratification and cluster analysis. An ISAAC's (International Study of Asthma and Allergies in Childhood) derived health questionnaire was applied to a sample of children attending DCCs. Outcomes were FA parental report and anaphylaxis. Logistic regression was used to explore potential risk factors for reported FA. From the 2228 distributed questionnaires, 1217 were included in the analysis (54.6%). Children's median age was 3.5 years, and 10.8% were described as ever having had FA. Current FA was reported in 5.7%. Three (0.2%) reports compatible with anaphylaxis were identified. Reported parental history of FA, personal history of atopic dermatitis, and preterm birth increased the odds for reported current FA. A high prevalence of parental-perceived FA in preschool-age children was identified. Risk factor identification may enhance better prevention.

/pdf/food-allergy-and-anaphylaxis-in-infants-and-preschool-age-4u6q5etbki.pdf

Daniel Virella

Papers

Reducing discomfort while measuring crown–heel length in neonates

Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions.

Actividade física e sedentarismo em adolescentes escolarizados do concelho de Lisboa

Born Preterm: A Public Health Issue

Food Allergy and Anaphylaxis in Infants and Preschool-Age Children