Provision Of Appropriate Nutrition Research Articles

Feeding Difficulties and Feeding Behaviors of Thai Children with Cow's Milk Protein Allergy.

Cow's milk protein allergy (CMPA) is a common food allergy in infants and young children and may be a risk factor for feeding difficulties. Studies exploring feeding difficulties and feeding behaviors in Thai children with CMPA are scarce. To determine the prevalence of feeding difficulties and feeding behaviors in Thai children with CMPA compared to healthy controls. A cross-sectional study was performed comparing children aged 1-6 years old diagnosed with CMPA and had eliminated cow's milk for at least 4 months with age-matched healthy children. Feeding difficulties were evaluated using the Montreal Children's Hospital Feeding Scale questionnaire, and feeding behaviors were measured using the Child Eating Behavior Questionnaire (CEBQ). One hundred and twenty-two participants were recruited (30 children with CMPA and 92 controls). The median age of the CMPA and control groups was 31.0 (14.0, 43.3) and 40.0 (28.0, 53.8) months, respectively (p value = 0.01). The CMPA group had lower calcium, phosphorus, and zinc intake than the healthy controls. The prevalence of feeding difficulties between the two groups did not show a significant difference (36.7 vs. 43.5%, p value = 0.70). The slowness in the eating subscale of feeding behaviors exhibited a lower score in the CMPA group than in the healthy group. Feeding difficulties was positively correlated with the desire to drink (β 3.079, p value = 0.011) but negatively correlated with the enjoyment of food subscale of CEBQ among the CMPA children (β -10.684, p value < 0.001). Despite a similar prevalence of feeding difficulties between CMPA and healthy children, the CMPA group demonstrated some differences in feeding behaviors. The lower score of enjoyment of food and a higher score of desire to drink correlated with a higher degree of feeding difficulties in the CMPA children. The provision of appropriate nutrition for this group of children should be prioritized.

The Application of Next-Generation Sequencing (NGS) in Neonatal-Onset Urea Cycle Disorders (UCDs): Clinical Course, Metabolomic Profiling, and Genetic Findings in Nine Chinese Hyperammonemia Patients.

During Jan. 2016–Dec. 2019, nine Chinese patients from eight unrelated families were diagnosed with neonatal-onset UCDs by targeted panel sequencing or whole-exome sequencing (WES). Their clinical manifestations, biochemical features, 180-day-age outcomes, and molecular genetic characteristics were reviewed retrospectively. NGS-based tests revealed 7 patients diagnosed with ornithine transcarbamylase deficiency (OTCD) and 2 with carbamoylphosphate synthetase I deficiency (CPS1D). The spectrum of the clinical presentation of nine affected individuals progressed from unspecific symptoms like poor feeding to somnolence, coma, and death. All patients presented with an acute hyperammonemia. The most robust metabolic pattern in OTCD was hyperglutaminemic hyperammonemia with high concentration of urine orotic acid, and it was reported in six patients. Of ten variants found on the OTC gene and CPS1 gene, 3 were novel: (c.176T>C (p.L59P)) in the OTC gene, c.2938G>A (p.G980S) and c.3734T>A (p.L1245H) in the CPS1 gene. There was a high mortality rate of 77.78% (7/9) for all the defects combined. An OTC-deficient male and a CPS1-deficient female survived from episodes of hyperammonemia. Although prompt recognition of UCD and the use of alternative pathway therapy in addition to provision of appropriate nutrition and dialysis improved survival, the overall outcomes for the neonatal-onset type are poor in China.

An observational study of pet feeding practices and how these have changed between 2008 and 2018

BackgroundPet owners have many feeding options, some may be considered unconventional by veterinary practitioners. Provision of appropriate nutrition is a basic requirement, with adverse health outcomes possible when a pet...

Intestinal failure: a review.

Intestinal failure (IF) is the inability of the gut to absorb necessary water, macronutrients (carbohydrate, protein, and fat), micronutrients, and electrolytes sufficient to sustain life and requiring intravenous supplementation or replacement. Acute IF (types 1 and 2) is the initial phase of the illness and may last for weeks to a few months, and chronic IF (type 3) from months to years. The challenge of caring for patients with IF is not merely the management of the underlying condition leading to IF or the correct provision of appropriate nutrition or both but also the prevention of complications, whether thromboembolic phenomenon (for example, venous occlusion), central venous catheter-related bloodstream infection, IF-associated liver disease, or metabolic bone disease. This review looks at recent questions regarding chronic IF (type 3), its diagnosis and management, the role of the multidisciplinary team, and novel therapies, including hormonal treatment for short bowel syndrome but also surgical options for intestinal lengthening and intestinal transplant.

Critical illness polyneuromyopathy

The clinical characteristics of and treatment approaches for critical illness polyneuromyopathy (CIPNM) are reviewed. CIPNM is an acute axonal sensory-motor polyneuropathy that tends to occur after the development of respiratory insufficiency in patients with systemic inflammatory response syndrome, sepsis, or multiple-organ dysfunction syndrome. Numerous mechanisms have been proposed to explain the pathophysiology of CIPNM, most of which are complex and not fully understood or proven. While the rate of intensive care unit-acquired weakness varies greatly among patients, an estimated 25-85% of critically ill adult patients will develop neuromuscular weakness, most commonly CIPNM, during hospitalization. While no specific pharmacologic treatments exist for CIPNM, the outcome for most patients is related to the severity of the illness and neuromyopathy, as well as early intervention to treat the underlying condition. Electrophysiologic studies, such as electromyography, electroneurography, and muscle and nerve biopsies, are considered the gold standard for aiding in the diagnosis of CIPNM. Preventive measures such as the early provision of appropriate nutrition, glucose control, physical rehabilitation, and the cautious use of medications such as corticosteroids and neuromuscular blocking agents (NMBAs) can help reduce the occurrence of CIPNM. CIPNM is an acute axonal sensory-motor polyneuropathy commonly seen in critically ill patients with sepsis and multiorgan failure. While no specific pharmacologic treatments exist, preventive measures such as the early provision of appropriate nutrition, glucose control, physical rehabilitation, and the cautious use of medications, including corticosteroids and NMBAs, can help reduce the incidence of CIPNM.

Current Infant Feeding Practices in Egor Local Government Area of EDO State

The provision of appropriate nutrition is of great importance during infancy and childhood in support of rapid growth and development inherent in these periods. Many initiatives have been started in the past decades and this study was carried out To assess what further progress may have been made in actualising optimal infant feeding practices in Benin City in the intervening decades, a community-based household survey was carried out. Infant feeding practices were evaluated using pre-tested questionnaires on 1068 mothers of infants aged less than 12 months. 546 (51.1%) infants were aged 0-5 months. The Ever Breastfed Rate of 99.5% was indicative of a high prevalence of breastfeeding in the community. The Time Suckling Rate of 35.4% was comparable to the national average of 32%. The Exclusive and Predominant Breastfeeding Rates of 40.7% and 30.4% respectively, have remained relatively stable over the past decade. The Bottle-feeding Rate was 28.9%. Significant determinants of optimal breastfeeding were high maternal education (X2 = 9.718; p = 0.045), high socio-economic status (X2 = 12.910; p = 0.012), increasing maternal age (X2 = 14.777; p = 0.022), higher parity (X2 = 15.212; p = 0.009), delivery in hospital (X2 = 15.079; p = 0.020) and infant age (X2 = 100.482; P = 0.0001). Breastfeeding practices in Benin City have not improved much from what obtained a decade ago. Greater emphasis on female education,socio-economic empowerment and improved funding of the Baby-friendly Hospital Initiative is advocated.

Stillen beim Frühgeborenen

Preterm infants have fewer nutrient reserves at birth than term infants. Additional physiological and metabolic stress factors, such as infection or respiratory distress, can affect their nutritional needs and metabolism. Hence, the provision of appropriate nutrition for growth and development is a cornerstone of care of preterm infants. Well infants of a gestational age > 34 weeks are usually able to suck effectively and coordinate swallowing and breathing. Therefore establishment of breast feeding seems reasonable for newborns of this gestational age. For less mature infants, national and international advisory boards also recommend enteral human milk feeding early postnatally. Challenges remain, particularly in establishing evidence-based standards of breastfeeding and the use of human milk for preterm infants in the intensive-care nursery. This article highlights the aspects of growth and nutritional needs, infection prophylaxis and neurological development with regard to the use of human milk versus formula for the preterm infant. Approaches to the initiation and maintenance of milk supply and the decision about when to replace gavage by breast feeding are illustrated.

International Perspectives

With continuing advances in preterm baby care, survival rates are increasing in very low-birthweight (VLBW) and very low gestational age newborns in both developed countries and large centers in developing countries. Preterm babies have metabolic characteristics and many diseases and complications due to immaturity that make provision of appropriate nutrition a challenge. Even greater difficulties are encountered with microelements, known also as trace elements or oligoelements, and vitamins because basic needs are not always perfectly defined. There are also no evident clinical signs of deficiency during the neonatal period, so the neonatologist is not always aware of a need to supplement them. Several situations contribute to deficiencies in these nutrients among VLBW preterm babies: human milk fortifiers do not contain all the necessary micronutrients or contain them in insufficient quantities; formula milks have different ingredients in different countries, with the most suitable ones often not available; and formulas for parenteral nutrition do not provide the necessary micronutrients, such as selenium. Recently, supplementation of minerals such as selenium and vitamins A and E, which have antioxidant properties, has been evaluated clinically for the possible prevention of preterm infant diseases in which free radicals have pathophysiologic importance. Also, many studies have been undertaken on mineral and vitamin supplements for pregnant mothers in poorer countries that are aimed at reducing low birthweight and perinatal and infant mortality. The important microelements in human nutrition are zinc, copper, selenium, chromium, molybdenum, manganese, iodine, and iron. Although they only represent a small fraction of the human body’s total mineral content, they play important roles in various metabolic routes. Preterm babies can present with deficiencies, even without clinical signs, due to low concentrations of the elements at birth because these minerals are only incorporated in the last trimester of pregnancy. The importance of selenium increases in all …

Growth failure in the preterm infant: can we catch up?

Postnatal growth failure is extremely common in the very low birth weight and extremely low birth weight infant. Recent data from the National Institute of Child and Human Development (NICHD) Neonatal Research Network indicates that 16% of extremely low birth weight infants are small for gestational age at birth, but by 36 weeks corrected age, 89% have growth failure. Follow-up at 18 to 22 months corrected age shows that 40% still have weights, lengths, and head circumferences less than the 10th percentile. Growth failure is associated with an increased risk of poor neurodevelopmental outcome. Inadequate postnatal nutrition is an important factor contributing to growth failure, as most extremely low birth weight infants experience major protein and energy deficits during the neonatal intensive care unit hospitalization, in spite of the fact that nutrition sufficient to support intrauterine growth rates can generally be provided safely. Aggressive nutritional support —parenteral and enteral— is well tolerated in the extremely low birth weight infant and is effective in improving growth. Continued provision of appropriate nutrition (premature formula or fortified human milk) is important throughout the neonatal intensive care unit stay. After discharge, nutrient-enriched postdischarge formula should be continued for approximately 9 months post-term. Exclusively breast-fed infants require additional supplementation/fortification postdischarge as well. Additional trials are needed to address a number of important questions concerning the role of nutrition and growth on ultimate development.

Nutrition for the pediatric surgical patient: approach in the peri-operative period

Nutrition is essential for maintenance of physiologic homeostasis and growth. Hypermetabolic states lead to a depletion of body stores, with decreased immunocompetence and increased morbidity and mortality. The purpose of this paper is to provide an update regarding the provision of appropriate nutrition for the pediatric surgical patient, emphasizing the preoperative and postoperative periods. Modern nutritional support for the surgical patient comprises numerous stages, including assessment of nutritional status, nutritional requirements, and nutritional therapy. Nutritional assessment is performed utilizing the clinical history, clinical examination, anthropometry, and biochemical evaluation. Anthropometric parameters include body weight, height, arm and head circumference, and skinfold thickness measurements. The biochemical evaluation is conducted using determinations of plasma levels of proteins, including album, pre-albumin, transferrin, and retinol-binding protein. These parameters are subject to error and are influenced by the rapid changes in body composition in the peri-operative period. Nutritional therapy includes enteral and/or parenteral nutrition. Enteral feeding is the first choice for nutritional therapy. If enteral feeding is not indicated, parenteral nutrition must be utilized. In all cases, an individualized, adequate diet (enteral formula or parenteral solution) is obligatory to decrease the occurrence of overfeeding and its undesirable consequences.

Feeding the preterm infant

The sick preterm infant has special nutritional needs, and the provision of appropriate nutrition is now recognised as an important part of the increasingly intensive management of this population. "Optimal" nutrition is difficult to define for an individual infant, but prospective randomised studies have shown that the early diet given to preterm infants can have a major impact on their neurological development and growth, with the best outcomes for those receiving either a preterm formula or maternal milk fortified with a range of nutrients. In contrast, diets suitable for term infants do not meet the needs of small preterm infants, either in the short or longer term, and should not be used. This article reviews the nutritional needs of the preterm infant and outlines the strategies commonly used in this area of neonatal intensive care.