Gradual Weaning Research Articles

Effect of Oral Vasopressors Used for Liberation from Intravenous Vasopressors in Intensive Care Unit Patients Recovering from Spinal Shock: A Randomized Controlled Trial.

Background Early vasopressor utilization has been associated with improved outcomes of patients with spinal shock; however, there are difficulties in weaning off vasopressors, in which patients after recovery from spinal shock develop a state of persistent vasodilation, which may take a few days to resolve and delays the discharge in the intensive care unit (ICU). Therefore, we tested the hypothesis using two oral vasopressors (midodrine and minirin) to facilitate weaning off intravenous vasopressors, reducing the ICU length of stay, and compare them for more efficacy. Methods A randomized controlled trial was conducted in the trauma ICU at the Assiut University Hospital in Egypt in patients with spinal shock who required intravenous vasopressor for ≥24 h. A convenience sample was classified into three groups, in which 30 patients were included for each group. The midodrine group received midodrine 10 mg per oral every 8 h with gradual weaning off intravenous (IV) vasopressor (noradrenaline) after receiving 4 doses, the minirin group received minirin 60 μg per oral every 8 h with gradual weaning off IV vasopressor after receiving 4 doses, whereas the control group received IV vasopressor (noradrenaline) with gradual weaning according to the routine hospital care without adding oral vasopressors. The primary outcome was shortening the duration of IV vasopressor requirements. The secondary outcome was reducing the ICU length of stay. Results Our results showed that the duration of IV vasopressor requirements in the midodrine (3.3 ± 1.32) and minirin groups (4.8 ± 1.83) was significantly lower than in the control group (6.93 ± 2.32). Additionally, the ICU length of stay (days) in the midodrine (5.13 ± 1.83) and minirin groups (5.5 ± 1.91) was significantly lower than in the control group (9.03 ± 3.74). Conclusion Midodrine and minirin accelerated liberation from intravenous noradrenaline and effective in reducing the ICU length of stay in patients with spinal shock.

Investigating the disjoint between education and health policy for infant feeding among teenage mothers in South Africa: a case for intersectoral work

BackgroundMany low-and-middle-income countries, including South Africa, have high rates of teenage pregnancy. Following the World Health Organisation recommendations, South African health policy on infant feeding promotes exclusive breastfeeding until six months of age, with gradual weaning. At the same time, South Africa’s education department, in the interest of learners, promotes adolescents’ early return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option.MethodsRecognising his this policy tension, we aimed to explore how policies are interpreted and implemented by the health and education sectors through interviews with key informants who produce, interpret and implement these policies. Using an interview guide developed for this study, we conducted in-depth interviews with 24 health policy makers, managers in both sectors, school principals and nursing staff who manage adolescent mothers (aged 16-19) and their babies. Data was analysed using thematic analysis.ResultsInformants from both sectors expressed discomfort at pregnant learners remaining in school late in pregnancy and were uncertain about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breastfeeding was not common. While health professionals highlighted the benefits of extended breastfeeding for infants and mothers, they recognised the potential conflict between the need for the mother to return to school and the recommendation for longer breastfeeding. Additionally, the need for ongoing support of young mothers and their families was highlighted.ConclusionsOur findings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breastfeeding for the initial 4-6 weeks postpartum, followed by guided support of formula-feeding. We encourage the active engagement of adolescents’ mothers and extended families who are often involved in infant feeding and care decisions. Education and health departments must engage to facilitate the interests of both the mother and infant: some exclusive infant feeding together with a supported return to school for the adolescent mother.

The influence of personality and weaning method on early feeding behavior and growth of Norwegian Red calves

Some research has described a relationship between personality and feeding behavior at weaning in Holstein dairy calves; our objective was to determine if personality traits, especially sociability, are associated with differences in feeding behavior and growth in Norwegian Red calves. Our secondary objective was to assess the interaction between personality traits and gradual weaning method (by age or by concentrate intake) on the behavior and growth of calves. Twenty-seven Norwegian Red calves were housed in 7 groups of 3 to 5 calves, with group composition based on birthdate to ensure that there were no more than 21 d between the youngest and oldest calves. Calves had access to an automated milk and concentrate feeder with ad libitum access to concentrates, water, hay, and silage. Calves were semi-randomly assigned to be either gradually weaned by age at d 56, or weaned by intake, where weaning was initiated based on reaching specific concentrate intake targets. We measured milk intake, concentrate intake, and the number of unrewarded visits to the automated feeder during each of 5 experimental periods: preweaning (12 L/d; 10-30 d of age), weaning (milk allowance gradually reduced by method until completely weaned), weaning week (3 d before weaning and the first 7 d of 0 L/d milk allowance), postweaning (20 d after complete milk removal), and the total experimental period (10-20 d postweaning). At 21 and 80 d of age, individual behavioral responses toward novelty and isolation (indicative of personality) were recorded in 3 personality tests: novel environment, novel object, and a social motivation test (time taken to return the group). At 83 d of age, a group novel object test was conducted. Principal component analysis revealed 3 factors interpreted as personality traits (playful/exploratory, vocal/active, interactive in group test) that together explained 56% of the variance. Calves that were more playful/exploratory consumed more milk per day preweaning and more concentrate per day over the experimental period. Calves that were more vocal/active (interpreted as a type of sociability trait where vocalizations and pacing serve to communicate with conspecifics when isolated from herd) had lower preweaning milk intakes and lower concentrate intakes over the experimental period. Calves that were more interactive in the group test (interpreted as a type of sociability trait when with other herd mates) had lower preweaning and weaning concentrate intakes. There was no interaction between personality traits and weaning method on feeding behavior or performance outcomes; however, calves that were weaned by intake (successfully reached all concentrate targets) had higher average daily gains postweaning, likely due to consuming more concentrate per day over the entire experiment, than calves who failed to reach all targets, or were weaned by age. We concluded that the sociability traits of Norwegian Red calves were related to individual differences in milk and concentrate intake. Although the relationship between personality and feeding behavior and growth did not depend on weaning method, gradual weaning based on individual concentrate intakes provides an opportunity for calves to wean at a pace that fits the needs of each individual calf.

741 A complex clinical mosaic of severe autoimmune calcific constrictive pericarditis with striking haemodynamic response to immunosuppressive therapy

Abstract Autoimmune constrictive pericarditis constitutes a conundrum to modern cardiology with much uncertainty surrounding both pathophysiology and optimal treatment strategies. We hereby describe the case of a 35-year-old woman of Nigerian origin with severe right heart failure secondary to calcific constrictive pericarditis. Her past medical history included coagulation factor XI deficiency, leukopenia, 2nd trimester miscarriage and premature labour due to placenta previa with fibrin deposition. Further investigations revealed atrial fibrillation, severe biatrial enlargement, moderate tricuspid and mitral regurgitation, pericardial thickening, post-capillary pulmonary hypertension and right ventricular dip-and-plateau pattern, compatible with severe constrictive pericarditis. Extensive screening for infectious and autoimmune causes only revealed borderline positive ANA (1:80). Thereafter, the patient underwent complete surgical pericardiectomy with pericardial biopsies revealing fibrous thickening, diffuse calcification and lymphocyte/macrophage infiltrates, in the absence of giant multinucleated cells or granulomas. The patient was later discharged but soon experienced relapse of exertional dyspnoea presenting with right-sided haemo-pneumothorax (requiring pleural drainage), diffuse alveolar haemorrhage, large right-sided basal and infrascissural pleural effusion, and ascites. She was treated with high dose iv furosemide, oral ibuprofen and colchicine, suspension of rate control medications, achieving initial reduction in pulmonary oedema and ascites, relapsing however after attempts to switch to oral diuretic therapy. Due to the finding of persistent lymphopenia, further immunological tests were conducted, revealing raised IgG1 levels as well as altered peripheral lymphocyte populations (raised CD4+/CD8+ ratio and CD8+ central memory, reduced CD8 effector memory). This finding in conjunction with the history of factor XI deficiency, 2nd trimester miscarriage and placental fibrin deposition as well as the observation of painful cutaneous nodules at sites of venepuncture, suggestive of Koebner’s phenomenon, veered the diagnostic focus to a potential autoimmune aetiology and in particular to systemic lupus erythematosus (>10 ACR-EULAR score points with case reports describing all the above as potential disease manifestations). Furthermore, revision of thoracic CT scans, demonstrated bilateral migratory peribronchovascular nodules with ground-glass halo. CT- guided biopsies thereof were performed revealing focal alveolar damage with capillaritis and alveolar haemorrhage, further corroborating the clinical suspicion of autoimmune disease and justifying the introduction of high-dose oral corticosteroid therapy. In liaison with our tertiary rheumatology centre, the patient was later switched to mycophenolate with gradual weaning from corticosteroid. Concurrent cardiological follow-up revealed persistence of good haemodynamic status (NYHA class II, absence of pulmonary oedema and ascites) with oral diuretic therapy, regression of cutaneous symptoms and echocardiography demonstrating consistent reduction in both mitral and tricuspid regurgitation. This constitutes to our knowledge the first report of autoimmune calcific constrictive pericarditis with significant haemodynamic response to immunosuppressive therapy. Despite the relative rarity of this disease entity, early recognition and instatement of immunosuppressive treatment may prove fundamental to halt and potentially reverse the haemodynamic progression of this highly morbid condition.

Factors influencing exclusive breastfeeding duration in Pakistan: a population-based cross-sectional study

BackgroundBreastfeeding has the most profound impact on infant health and wellness, and also have significant implications for the mother. The duration of the breastfeeding determines the infant’s protection from malnutrition and other common infectious diseases; consequently, the World Health Organization (WHO) recommends exclusive breastfeeding (EBF) six months, followed by gradual weaning and breastfeeding until the baby is two years old. In Pakistan, the practice of breastfeeding is heavily dependent upon certain demographic, economic, social, and biological factors, which ultimately impact the quality of care provided to the infant and their health. The aim of this paper, therefore, is to measure the impact of these factors on the exclusive breastfeeding duration in Pakistan.MethodsThe data for the study has been collected from Pakistan Demographic and Health Survey (PDHS) for the year 2017–18. Binary logistic regression model and survival analysis are used to determine the relationship between the independent and dependent variables.ResultsWe use a binary logistic regression to estimate the effect of each factor on the duration of EBF. The binary logistic regression finds significant relationships between region, maternal education, wealth index, size of a child, watching television, delivery by cesarean, and maternal age and EBF. We then use log-likelihood, AIC, BIC criteria to determine if a parametric or non-parametric model would provide a better fit; based on these results we fit an Inverse Gaussian (Weibull) distribution for the survival analysis. These results show that there are more significant factors associated with EBF duration in parametric survival analysis than in the binary logistic regression results. Thus, the survival analysis is a better method for predicting the relationship between the duration of EBF and its factors. Furthermore, logically EBF is designated to be done for six months which would not be properly gauged with a binary response variable.ConclusionsThe results of this study provide proof that exclusive breastfeeding is a common practice among women in Pakistan, and to improve the quality of post-natal care, health policy in the country needs to focus on the existing demographic and social factors which are found significant in this study.

Abstract 1122‐000094: EVD Weaning Criteria Decreases VPS/ETV Placement and Hospital Stay in Subarachnoid Hemorrhage Patients

Introduction : The Neurocritical Care Society encourages an external ventricular drain (EVD) wean “as quickly as is clinically feasible” but guidelines on achieving it are limited (1). This study aims to improve quality of care by sharing a protocol to initiate EVD weaning. These criteria were developed over 7 years and showed a reduction in ventriculoperitoneal shunt/endoscopic third ventriculostomy (VPS/ETV) placement and length of stay (LOS) at our institute compared to national averages. Methods : 151 subarachnoid hemorrhage (SAH) patients from January 2016 to January 2019 were analyzed. 60 aneurysmal SAH (aSAH) and 18 non‐aneurysmal nontraumatic SAH (naSAH) patients required EVD placement. A gradual EVD weaning protocol was initiated if patients met the following criteria: the reason for EVD placement has resolved or is resolving, quantity of CSF output must be <250mL over 24 hours, quality of CSF must be nonbloody, ICP must be within normal limits, and the patient must be neurologically stable. It was acceptable to wean when the patient had mild cerebral vasospasm, but not moderate to severe cerebral vasospasm. EVD weaning was performed by increasing drain height by 5 millimeters of mercury every 24 hours if criteria were met. Charts were reviewed for LOS and rate of VPS/ETV. Gender, age, race, wean failure incidence, infection rates, and SIADH/CSW rates were obtained. Results : Average LOS for aSAH patients with EVD at our institute was 20.35 days. Incidence of VPS/ETV was 11%. Chi‐square analysis was performed, and aSAH patients were found to have higher rates of VPS/ETV placement (p<0.001) and EVD wean failures (p<0.001) than naSAH patients. Conclusions : Our criteria to initiate EVD weaning provided a reduction in VPS/ETV placement among aSAH patients compared to national averages and provides a standardized approach to EVD management. aSAH patients at our institute had a lower incidence of VPS/ETV placement of 11% compared to 21% nationally (2). aSAH patients at our institute also had a lower LOS at 20.35 days compared to 21.5 days nationally (3).

O30 Case report of Cogan syndrome in a child with audiovestibular dysfunction and ocular inflammation

Case report - IntroductionCogan syndrome is a very rare disorder of probable autoimmune vasculitic origin, first described in 1934. The age of onset seems to range from 3 to 50 years with an average age of disease onset at 29 years. It is characterised by audiovestibular dysfunction and ocular inflammation. The cause remains unknown and the epidemiology of the disease is purely based on case reporting. As of 2015, there were fewer than 250 case reports. Interestingly, it seems extremely rare in Arabic and Middle Eastern countries in which a new case has been recently diagnosed and is being reported in this abstract.Case report - Case descriptionA 14-year-old girl of Arabic origin first presented to the ENT specialist with a 3-week history of balance problems, left tinnitus and sensorineural hearing loss in both ears worse on the left. She first received treatment for vestibular neuritis with no improvement. Two months later, she complained of bilateral red eyes and excessive lacrimation when diffuse interstitial keratitis was diagnosed by the ophthalmologist. An array of blood tests including a full autoimmune disease was arranged and a rheumatology opinion was sought.The patient had a normal inflammatory response and her screen for antinuclear antibodies, extractable nuclear antigen, rheumatoid factor and antineutrophil cytoplasmic antibodies were all negative. A full virology screen was also negative. Having failed to respond to all supportive treatment modalities, a trial of a tapering 2-week course of prednisolone starting at 25mg daily was instigated. The patient’s symptoms improved by more than 50% on glucocorticoids subsequent to which the diagnosis of Cogan syndrome was anticipated. As the patient’s symptoms relapsed when glucocorticoids were stopped, she was recommenced on prednisolone 25mg in line with azathioprine 100mg daily. The patient’s hearing, which was almost lost in the left ear, improved significantly by more than 70% initially, and then to normal hearing as stated by the patient supported by special ENT testing. Her balance problems and vertigo also improved remarkably. Her tinnitus, which was the last symptom to resolve, almost went away over the subsequent 2 months. The patient had already come off glucocorticoids 6 months down the line, and stayed on azathioprine 75-100mg daily for almost a year after which gradual weaning was trialled and then eventually succeeded. She has now been off azathioprine for 6 months without experiencing any disease relapse.Case report - DiscussionCogan syndrome can be difficult to diagnose particularly in children. The diagnosis is essentially clinical depending on the presence of audio-vestibular symptoms and interstitial keratitis along with a prompt response to immunosuppressive medication.In this patient, the consistent clinical picture supported by the positive response to glucocorticoids especially in the absence of an alternative diagnosis would have made the diagnosis of Cogan syndrome likely.Given the rarity of this disorder, there are no classification criteria as yet hence the ongoing need for case reporting. Moreover, there is no clear guidance on the duration of immunosuppressive treatment of this condition.Case report - Key learning pointsIt is pivotal in managing conditions with a suspected autoimmune origin to have a multidisciplinary approach involving other relevant specialties in a holistic approach.The prompt response to glucocorticoid therapy still remains the key in securing the diagnosis of a number of conditions in clinical practice especially in the absence of diagnostic criteria and/ or supportive investigations such as serological and tissue-based testing.Case reporting has a crucial role in enhancing awareness of rare medical conditions.

DISSEMINATED BLASTOMYCOSIS PRESENTING AS MONOARTICULAR SEPTIC ARTHRITIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Blastomycosis is a dimorphic fungus that causes acute or chronic pneumonia with extrapulmonary involvement in a minority of cases. Rarely it is implicated in disseminated disease causing joint involvement leading to septic arthritis. Recognizing blastomycosis as an important cause of septic arthritis and starting treatment is necessary to prevent joint destruction and overwhelming disseminated infection. CASE PRESENTATION: A 29-year-old male with no significant past medical history presented to the hospital with chief complaint of right knee pain of 3 weeks' duration associated with recent onset of productive cough, dyspnea on exertion and chest pain. Admitting vitals were remarkable for tachycardia and fever of 101 F. Physical examination revealed right knee swelling and pain on active and passive range of motion without overlying erythema. Joint aspiration revealed 68,000 WBC with 88% neutrophils with negative crystals. Cultures from synovial fluid grew blastomyces dermatitidis. During the hospital stay, patient's respiratory status worsened, and he was transferred to the ICU and intubated. CT Chest showed diffuse bilateral pulmonary nodules, suspicious for atypical pneumonia versus acute respiratory distress syndrome. Bronchoscopy was done and specimens were sent for culture. He was initially started and then maintained on broad spectrum antibiotics. Once respiratory and synovial cultures grew blastomyces, patient was started on IV amphoterecin. Patient's condition improved dramatically after starting amphoterecin. His remaining ICU course involved extubation, tracheostomy and gradual weaning of pressors. His knee pain and swelling subsided after starting amphoterecin and patient was discharged to rehab in stable condition on itraconazole. DISCUSSION: This case highlights the rare presentation of disseminated blastomycosis as monoarticular septic arthritis. About 3% of patients with blastomycosis have joint involvement. Extrapulmonary blastomycosis is usually seen in association with pneumonia which can often be severe enough to cause ARDS and shock, like our patient. It is important to have a high index of suspicion for blastomycosis in patients presenting with septic arthritis with an active pulmonary process and B symptoms. Diagnosis of blastomycosis is with culture, urinary and serum antigens. Treatment involves amphoterecin B followed by itraconazole for patients with severe disseminated disease. CONCLUSIONS: Disseminated blastomycosis can present with symptoms of extrapulmonary spread of disease. Diagnosis is with antigen identification in serum and urine and by culture. Treatment involves amphoterecin B and itraconazole. REFERENCE #1: Chapman, Stanley W., Andrew C. Lin, Katherine A. Hendricks, Rathel L. Nolan, Mary M. Currier, Ken R. Morris, and Helen R. Turner. "Endemic blastomycosis in Mississippi: epidemiological and clinical studies." In Seminars in respiratory infections, vol. 12, no. 3, pp. 219-228. 1997. REFERENCE #2: Wheat, L. J. "Antigen detection, serology, and molecular diagnosis of invasive mycoses in the immunocompromised host." Transplant infectious disease 8, no. 3 (2006): 128-139. DISCLOSURES: No relevant relationships by Fatima Ayub, source=Web Response No relevant relationships by Muhammad Hasib Khalil, source=Web Response

English

Child malnutrition is a public health problem in Côte d’Ivoire. The persistence of malnutrition, sometimes looking like an epidemic, seems contradictory in view of the many natural potentialities available in the Health Care District of Danané. The level of rainfall conducive to cereal production is satisfactory; this should normally guarantee minimum food availability. Through this work, we aim to understand the factors associated with malnutrition among children under five in the Health Care District of Danane in order to identify and implement the best prevention and control strategies. Using a case-control study (n =109 cases and n =218 controls), we performed a logistic regression model to identify factors associated with child malnutrition (z-score < -2) at the level of child, households, and of person in charge of the child, in the Health Care District of Danané from January 1st to March 31st, 2017. Odds ratio (OR) of child malnutrition were significantly high in the presence of over one child under 5 in a household (OR=3.05, 95%CI [1.34-6.91]; p ?0.01), of influenza episodes (OR=3.48, 95%CI [2.10-6.80], p ?0.01), of diarrhea (OR=2.56, 95%CI [1.30-5.05]; p ?0.01), and non-drinking water consumption OR=1.37, 95%CI [1.17-2.48]; p ?0.01). The care of the child by his/her biological mother, progressive weaning, exclusive breastfeeding, deworming, age of the person in charge of the child (≥25 years), were significantly protective factors. Promoting family planning, hygiene, and the strengthening of gradual weaning, exclusive breastfeeding and deworming could help reduce child malnutrition in Health Care District of Danané. Key words: Infant malnutrition, odds ratio, logistic regression, case control.

A comparison of methods of discontinuing nasal CPAP in premature infants

ObjectiveThe objective of this study was to determine whether abrupt discontinuation vs gradual wean of nasal CPAP (NCPAP) in infants <30 weeks gestation results in a decreased duration of NCPAP therapy.Study designWe performed a single-center, randomized control trial of premature infants born <30 weeks gestation (n = 66), comparing discontinuation of NCPAP from 6 cmH2O (CWP) (fast wean arm) to discontinuation at 4 CWP, weaning by 1 CWP per day (slow wean arm). The primary outcome was the total number of days on NCPAP or mechanical ventilation. Secondary outcomes included wean failure, growth, length of stay, and related comorbidities.ResultsDuration of NCPAP or mechanical ventilation was longer in the slow wean arm compared to the fast wean arm (17 vs 12 days, p = 0.03). There were no differences observed in secondary outcomes.ConclusionIn weaning NCPAP, abrupt discontinuation may be associated with a shorter duration of positive pressure respiratory support compared to a gradual weaning strategy.

External ventricular drain management in subarachnoid haemorrhage: a systematic review and meta-analysis.

External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures. Despite this, the optimal drainage and weaning strategies are still unknown. This PRISMA-compliant systematic review and meta-analysis analysed the outcomes of patients undergoing EVD procedures, comparing continuous versus intermittent drainage and rapid versus gradual weaning. Four databases were searched from inception to 01/10/2020. Articles reporting at least 10 patients treated for hydrocephalus secondary to subarachnoid haemorrhage were included. Other inclusion criteria were the description of the EVD drainage and weaning strategies used and a comparison of continuous versus intermittent drainage or rapid versus gradual weaning within the study. Random effect meta-analyses were used to compare functional outcomes, incidence of complications and hospital length of stay. Intermittent external CSF drainage was associated with lower incidence of EVD-related infections (RR = 0.20, 95% CI 0.05-0.72, I-squared = 0%) and EVD blockages compared to continuous CSF drainage (RR = 0.45, 95% CI 0.27-0.74, I-squared = 0%). There was no clear advantage in using gradual EVD weaning strategies compared to rapid EVD weaning; however, patients who underwent rapid EVD weaning had a shorter hospital length of stay (SMD = 0.34, 95% CI 0.22-0.47, I-squared = 0%). Intermittent external CSF drainage after SAH is associated with lower incidence of EVD-related infections and EVD blockages compared to continuous CSF drainage. Patients who underwent rapid EVD weaning had a shorter hospital length of stay and there was no clear clinical advantage in using gradual weaning.

Understanding Behavioural Development of Calves in Natural Settings to Inform Calf Management.

Simple SummaryAnimal welfare research is intended to address societal concerns regarding animal care, including natural living concerns. We reviewed the literature on calf behaviour when reared in more naturalistic outdoor systems with their mothers and herd. Understanding calf behaviour in more natural settings may help inform changes in calf management and housing that promote behaviours important to calf welfare.One important type of animal welfare concern is “natural living” (i.e., that animals are able to express natural behaviours that are important to them, and to engage with aspects of the natural world that they find important). The aims of this narrative review were to describe the behavioural development of calves (Bos taurus) in natural settings and use this to identify characteristics of natural systems that may be important to consider relative to this natural living conception of animal welfare. At birth, calves are licked by their mothers and soon stand to suckle for colostrum, and during the milk-feeding period, calves spend much of their time lying down. In natural systems, calves perform a variety of social behaviours with herd-mates, and slowly transition from their mother’s milk to eating solid food, by gradually increasing time spent grazing and ruminating. In contrast, on most commercial dairy systems, dairy calves are removed from their mothers at birth, housed individually, fed restricted amounts of milk and weaned abruptly at a young age. The results of this review suggest that accommodating key natural behaviours, for example through the use of teat feeding of milk, social housing, and gradual weaning, can help address welfare concerns.

Effects of delaying increase in milk allowance and type of gradual weaning program on performance and health of calves fed lower levels of milk

The objective of this study was to investigate the effects of delayed increase in milk allowance and type of gradual weaning program on the feed intake, health, and growth of male Holstein calves. Using a 2 × 2 factorial design, each male Holstein calf was randomly assigned to 1 of 2 milk level treatments and 1 of 2 weaning treatments upon arrival to a rearing facility. Calves were either assigned to a moderate (MM) or lower (LM) milk level treatment. All calves received the same milk program from arrival until d 12, increasing from 4 to 5 L/d (115 to 125 g/L) over the 12 d. On d 13, MM calves began receiving additional milk compared with LM calves until they were weaned, with MM offered milk increasing to a peak of 9 L/d (140 g/L). Calves on the MM treatment received a total of 35 kg of milk replacer over 45 d, compared with LM calves, who received a total of 25 kg of milk replacer over 45 d. Calves were also assigned to be weaned by either a 2-step gradual program or a 4-step gradual program. Calves assigned to the 2-step program had their milk reduced in 2 steps from d 30 to 45, and 4-step calves had their milk reduced in 4 steps from d 30 to 45. After d 46, calves received no milk but continued to be monitored until d 59. Calves had ad libitum access to water from arrival, and solid feed was offered from d 5 onward. No interactions of effects of milk level and weaning treatment were detected. By design, calves on the MM treatment consumed greater amounts of milk than LM calves in the preweaning phase from d 13 to 29 (6.1 vs. 4.8 L/d) and weaning phases from d 30 to 45 (4.7 vs. 3.2 L/d). The LM calves consumed greater amounts of solid feed than MM calves from d 22 to 29 of the preweaning phase, and from d 30 to 40 and d 43 to 45 of the weaning phase, whereas postweaning feed consumption was similar for both milk treatments. Calves in both milk treatments had similar blood β-hydroxybutyrate levels, indicating similar rumen development. Body weight and size measurements were similar between milk treatments across the study, although LM calves had a greater average daily gain than MM calves between d 38 and 46 (0.96 vs. 0.71 kg/d). Both gradual weaning treatments resulted in similar feed consumption, growth, and health parameters. Overall, the results indicate that delaying a moderate increase in milk until 12 d after arrival at a rearing facility provided no overall beneficial effect on growth or rumen development.

A guide to reducing adverse outcomes in rabbit models of sciatic nerve injury

BackgroundPeripheral nerve damage can have debilitating consequences. Rabbit sciatic nerve transection models allow the effective evaluation of surgical repair strategies for large nerve gaps. Despite advantages in size, ease of handling, and functional utility, rabbits can suffer from a number of side effects that affect animal welfare and the quality of scientific inquiry. Such side-effects, which include pressure ulcers and traumatic damage to the foot, are primarily a consequence of insensitivity of the distal hindlimb following sciatic nerve injury. In this study, we present a number of methodologies for identifying, treating, and preventing unintended adverse effects in rabbit sciatic nerve injury models.ResultsFirst, we categorize pressure ulcers according to their severity and describe the deployment of a padded bandaging technique to enable ulcer healing. We also introduce a proactive bandaging approach to reduce the likelihood of pressure ulcer formation. Second, we define phenotypes that distinguish between foot injuries resulting from self-mutilation (autotomy) from those caused by incidental traumatic injury secondary to sensori-motor damage. Finally, we detail an effective strategy to reduce the usage of Elizabethan collars; through a gradual weaning protocol, their usefulness in preventing autotomy is retained, while their propensity to impede rabbit grooming and cause abrasion-injury to the neck region is minimized.ConclusionsWe suggest that application of these methods offer a practical and systematic approach to avoid adverse side effects associated with rabbit sciatic nerve damage, enabling improved animal welfare and scientific outcomes in a powerful nerve injury model.

Effects of weaning on survival and growth of silver therapon ( Leiopotherapon plumbeus ) larvae fed live and artificial diet

This study examined the effects of early weaning strategies on growth and survival of the silver therapon Leiopotherapon plumbeus larvae. In Trial 1, four larval age groups (8, 14, 20 and 26 days post-hatch (dph)) were abruptly weaned to commercial powdered tilapia diet and compared with wild copepod-fed group as the control. In Trial 2, another batch of three weaning age groups were subjected to gradual weaning (8 dph larvae with 8 days co-feeding, 14 dph larvae with 6 days co-feeding and 20 dph larvae with 4 days co-feeding) with Artemia nauplii prior to weaning on commercial powdered prawn diet and compared with a control group consisted of larvae fed exclusively on Artemia nauplii. Both weaning trials were conducted for 21 days. A gradual weaning strategy promoted better survival (22.2%–40.0%) among weaning age groups than the abrupt weaning strategy (2.2%–36.7%). Except for those weaned at 26 dph, abrupt weaning resulted in significantly poor growth and survival among all weaning age groups compared with the wild copepod-fed control group. The highest survival and growth were observed in 20 dph larvae with 4 days live food co-feeding, although the values were significantly lower than the Artemia-fed control group. These results suggest that abrupt weaning at 26 dph, and gradual weaning for 4 days from 20 dph promote successful rearing of silver therapon larvae and that a microparticulate diet specifically formulated for this species needs to be developed.

Randomized trial of oxygen weaning strategies following chest compressions during neonatal resuscitation.

Background:The Neonatal Resuscitation Program (NRP) recommends using 100% O2 during chest compressions and adjusting FiO2 based on SpO2 after return of spontaneous circulation (ROSC). The optimal strategy for adjusting FiO2 is not known.Methods:Twenty-five near-term lambs asphyxiated by umbilical cord occlusion to cardiac arrest were resuscitated per NRP. Following ROSC, lambs were randomized to gradual decrease versus abrupt wean to 21% O2 followed by FiO2 titration to achieve NRP SpO2 targets. Carotid blood flow and blood gases were monitored.Results:Three minutes after ROSC, PaO2 was 229±32 mmHg in gradual wean group compared to 57±13 following abrupt wean to 21% O2 (p<0.001). PaO2 remained high in the gradual wean group at 10 min after ROSC (110±10 vs. 67±12, p <0.01) despite similar FiO2 (~0.3) in both groups. Cerebral O2 delivery (C-DO2) was higher above physiological range following ROSC with gradual wean (p<0.05). Lower blood oxidized/reduced glutathione ratio (suggesting less oxidative stress) was observed with abrupt wean.Conclusion:Weaning FiO2 abruptly to 0.21 with adjustment based on SpO2 prevents surge in PaO2 and C-DO2 and minimizes oxidative stress compared to gradual weaning from 100% O2 following ROSC. Clinical trials with neurodevelopmental outcomes comparing post-ROSC FiO2 weaning strategies are warranted.

Effects of canola meal inclusion rate in starter mixtures for Holstein heifer calves on dry matter intake, average daily gain, ruminal fermentation, plasma metabolites, and total-tract digestibility

The objective of this study was to determine the effects of the canola meal (CM) inclusion rate in pelleted starter mixtures for Holstein heifer calves on dry matter intake, average daily gain, ruminal fermentation, plasma metabolites, and total-tract digestibility. Fifty Holstein heifer calves were blocked by birth date and body weight and, within block, randomly assigned to 1 of 5 pelleted starter treatments with 0, 15, 30, 45, or 60% of the crude protein supplied by CM instead of soybean meal (SBM). Pellets were formulated to be similar in crude protein (24.3%), starch (26.6%), and neutral detergent fiber (17.8%) and were provided to calves starting on d 8 of age, with starter intake measured daily. From 8.0 ± 0.0 (mean ± standard deviation) d of age through d 35.3 ± 2.4, calves were fed milk replacer at 15% of body weight, offered in 3 equal feedings at 0600, 1500, and 2100 h. After that, a gradual 21-d step-down weaning process was imposed, where no further milk replacer was provided starting on d 57.0 ± 0.0. Data for milk replacer and starter intake were calculated to determine weekly averages. On d 62.2 ± 0.8 of age, blood was collected every 4 h and analyzed for glucose, β-hydroxybutyrate, insulin, and urea concentrations. From d 66.2 ± 0.8 of age and extending for 3 d, fecal samples were collected every 12 h with a 3-h daily offset, to estimate fecal nutrient output and to determine apparent total-tract digestibility. Additionally, ruminal fluid (d 70.2 ± 0.8 of age) was sampled at 1300 h through an esophageal tube connected to a vacuum pump. The pH of ruminal fluid was measured, and ruminal fluid was analyzed to determine short-chain fatty acid and ammonia concentrations. Data were analyzed with fixed effect of treatment and random effect of block. Polynomial contrasts were calculated to assess linear, quadratic, and cubic effects with repeated measures statement for variables analyzed over time. Starter intake, average daily gain, body weight, and feed efficiency did not differ among treatments. Crude protein and ether extract digestibility were affected in a cubic manner, where CP was greatest for CM0, CM30, and CM45, and ether extract digestibility was least for CM15 and CM60. The molar proportion of acetate responded cubically, but the proportions of propionate and butyrate did not differ among treatments. Ruminal ammonia and plasma urea concentrations were not affected by CM inclusion rate. In conclusion, CM can replace up to 60% of the CP provided from SBM without affecting starter intake and growth of calves.

Prone Position Improve Physiological Parameters of Preterm Infants Weaning from CPAP: A Randomized Control Trial

The need for continuous positive airway pressure (CPAP) was vital for preterm infant with respiratory distress, but the impact of long-term use was very harmful. The effort to do weaning must be done and facilitate the infant to adapt wean off CPAP. The effect of positioning on stabilized physiological parameters may help preterm infant to adapt under gradual weaning from CPAP. Aim in this study to determine the effect of prone positioning on physiological parameters in preterm infants under gradual weaning CPAP. From Mei to September 2020 total sample 60 preterm infants on non-invasive ventilation or CPAP were randomized into prone position (intervention group, n = 30) and supine position (control group, n = 30). Oxygen saturation, respiratory and heart rate between groups were compared. In the prone position was significant higher than supine position at 30 th minute. The mean oxygen saturation in the prone position (99.87±0.35) was higher than in the supine position (97.63±1.45; p=0.001), the mean respiratory rate in the prone position (42.10±8.59 breaths/min) was lower than in the supine position (53.20±6.24 breaths/min; p=0.001), and the mean heart rate in the prone position (144.63±13.07/beats/min) was lower than in the supine position (153.53±10.02/beats/min; p=0.001), so that the prone position can be applied to increase oxygen saturation and to maintain the stability of respiratory rate in preterm infants during gradual weaning. The failure to wean off CPAP (re-CPAP) in the prone group was less frequent which is 3 respondents (5% versus 10%). However, there is no relation between positioning and re-CPAP (p=0.472).

Prone Position Improve Physiological Parameters of Preterm Infants Weaning from CPAP: A Randomized Control Trial

The need for continuous positive airway pressure (CPAP) was vital for preterm infant with respiratory distress, but the impact of long-term use was very harmful. The effort to do weaning must be done and facilitate the infant to adapt wean off CPAP. The effect of positioning on stabilized physiological parameters may help preterm infant to adapt under gradual weaning from CPAP. Aim in this study to determine the effect of prone positioning on physiological parameters in preterm infants under gradual weaning CPAP. From Mei to September 2020 total sample 60 preterm infants on non-invasive ventilation or CPAP were randomized into prone position (intervention group, n = 30) and supine position (control group, n = 30). Oxygen saturation, respiratory and heart rate between groups were compared. In the prone position was significant higher than supine position at 30th minute. The mean oxygen saturation in the prone position (99.87±0.35) was higher than in the supine position (97.63±1.45; p=0.001), the mean respiratory rate in the prone position (42.10±8.59 breaths/min) was lower than in the supine position (53.20±6.24 breaths/min; p=0.001), and the mean heart rate in the prone position (144.63±13.07/beats/min) was lower than in the supine position (153.53±10.02/beats/min; p=0.001), so that the prone position can be applied to increase oxygen saturation and to maintain the stability of respiratory rate in preterm infants during gradual weaning. The failure to wean off CPAP (re-CPAP) in the prone group was less frequent which is 3 respondents (5% versus 10%). However, there is no relation between positioning and re-CPAP (p=0.472).

Canola meal or soybean meal as protein source and the effect of microencapsulated sodium butyrate supplementation in calf starter mixture. II. Development of the gastrointestinal tract

The aim of this study was to assess the effect of protein source, either soybean meal (SM) or canola meal (CM), and microencapsulated sodium butyrate (MSB) supplementation in a pelleted starter mixture on the development of the gastrointestinal tract (GIT) in dairy calves. Twenty-eight bull calves (8.7 ± 0.8 d of age and 43.0 ± 4.4 kg; mean ± SD) were assigned to 1 of 4 treatments in a 2 × 2 factorial arrangement: CM as a main source of protein without or with MSB or SM without or with MSB. Calves were fed starters ad libitum and exposed to a gradual weaning program, with weaning taking place on 51.7 ± 0.8 d of age. Calves were observed for an additional 3 wk after weaning and slaughtered on d 72.1 ± 0.9 of age, after which the GIT was dissected. Morphometric measurements were recorded, and samples for determination of ruminal fermentation, histology, gene expression, and brush border enzyme activities were collected. Canola meal use in the starter mixture increased abomasal tissue weight, jejunal tissue weight and length, and mRNA expression of SLC16A4 (formerly known as MCT4) and FFAR2 (GPR43) in the ruminal epithelium, and decreased ruminal ammonia and mRNA expression of SLC15A2 (PEPT2) and SLC6A14 (ATB0+) in the proximal small intestine and ileum, respectively. However, MSB inclusion in the starter mixture decreased ruminal papillae length, ruminal epithelial surface, and ruminal epithelium dry weight, while increasing mRNA expression of SLC16A1 (MCT1) in ruminal epithelia. Reduced ruminal surface area associated with MSB supplementation was the most apparent when MSB was combined with CM in the starter mixture. Additionally, MSB supplementation decreased the thickness of omasal epithelium, omasal epithelium living strata, and stratum corneum, and increased duodenal and ileal aminopeptidase A enzymatic activity and ileal aminopeptidase N enzymatic activity. Overall, CM might increase growth of the GIT of calves, particularly of the small intestine, but may negatively affect intestinal epithelium function and peptide and AA absorption. Supplementation of MSB has a negative effect on the ruminal and omasal epithelium development, particularly when combined in a starter mixture with CM.