Start Weaning Research Articles

Feeding protocol with live feed and inert diet to determine the ideal age/size for weaning mullet Mugil liza (Valenciennes, 1836).

The Lebranche mullet Mugil liza is a marine fish of great importance for artisanal and industrial fishing, as well as aquaculture. The use of live feeds during the larviculture phase of marine fish is a significant component of production costs. The present study evaluated the effects of the feeding transition on different larval stages of M. liza, from the combined supply of live feed (Brachionus rotundiformis + Artemia franciscana) and live + inert feed (Artemia franciscana + inert diet) until the weaning phase to only the inert diet. A total of 3240 M. liza larvae (weight 0.0133 ± 0.0062 g and length 0.793 ± 0.160 cm) were distributed among the 12 experimental units (n = 270), resulting in four groups with three replicates each. Treatment groups consisted of feed transition with A. franciscana (enriched metanauplii) to commercial inert feed starting weaning at four different larval ages: 28, 31, 34, and 37 days post hatching. Zootechnical performance indexes and intestinal histomorphometry were evaluated. Mortality, condition factor, and length variation coefficient did not show significant differences between treatments. Final weight, final length, weight gain, and length gain were significantly greater in larvae that started weaning at 31, 34, and 37 days post hatching. Weight coefficient of variation was significantly higher in larvae that started weaning at 28 days (67.51 ± 11.70) compared to 37 days (34.40 ± 7.30). In intestinal histology, villi height (180.3 ± 4.4) was significantly higher in larvae that started weaning at 37 days post hatching. Considering the evidence found in the present study, it is recommended to start weaning M. liza on the 31st day post-hatching, using a 2-day co-feeding protocol (31st and 32nd days). From the 33rd day after hatching, M. liza larvae can receive only commercial feed.

Diaphragm ultrasound: A predictor of extubation in head injury patients

Background: Timing is critical when determining if a patient can be successfully extubated. The criteria for obtaining the optimal time for extubation are bare minimum and subject to variability. There are not many studies that are done to use diaphragm function or diaphragm thickness (Tdi) to have any role in extubation outcome as success or failure. Aims and Objectives: The aims and objectives of the study are to apply diaphragmatic ultrasound as a predictor of extubation to reduce morbidity and mortality in these patients. Materials and Methods: This study was conducted as a prospective single-blind study among patients admitted in post-anesthesia care unit and surgical intensive care unit, Department of Anesthesiology at Trauma care Centre during the study period of June 2019–November 2021. The ultrasonographer was informed of the intensivist’s decision to start weaning. Tdi is measured at end expiration and end inspiration. The percent change in Tdi between end expiration and end inspiration (ΔTdi%) was calculated as (Tdi end inspiration–Tdi end expiration/Tdi end expiration) ×100. Results: Mean age was 46.2±15.2 years, ranging from 18 to 66 years. Tdi was above 30 in 64% cases, whereas Tdi% at end of expiration was above 0.17 cm in 62% cases. Weaning was successful in 78% cases whereas weaning failed in 22% cases. Weaning success rate was significantly associated with higher Tdi at end expiration (≥0.17 cm) (P<0.05). Conclusions: Timely weaning off is very important. Delayed weaning may lead to further infection and complications. Diaphragmatic ultrasound plays a vital role in extubating the patient. Ultrasound-guided Tdi and diaphragm motion can be used as a predictor for timely extubation. Diaphragmatic thickness reflects the strength of diaphragm and hence would help us to estimate a successful extubation.

Weaning strategies for children on home invasive mechanical ventilation.

Children who require home mechanical ventilation (HMV) with an artificial airway or invasive mechanical ventilation (HMV) have a possibility of successful weaning due to the potential of compensatory lung growth. Internationally accepted guidelines on how to wean from HMV in children is not available, we summarize the weaning strategies from the literature reviews combined with our 27-year experience in the Pediatric Home Respiratory Care program at the tertiary care center in Thailand. The readiness to wean is considered in patients with hemodynamic stability, having effective cough measured by maximal inspiratory pressure, requiring a fraction of inspired oxygen (FiO2) < 40%, positive end expiratory pressure <5 cmH2O, and acceptable arterial blood gases. The strategies of weaning is start weaning during the daytime while the child is awake and close monitoring is feasible. Disconnect time is gradually increased through naps and sleeping hours. Weaning from the conventional mechanical ventilator to Bilevel PAP or CPAP are optional. Factors affected the successful weaning are mainly the underlying diseases, complications, growth and development, caregivers, and resources. Weaning should be stopped during acute illness or increased work of breathing. The readiness for decannulation could be determined by using the speaking devices, tracheostomy capping, and measurement of end-expiratory pressure. Polysomnography and airway evaluation by bronchoscopy are recommended before decannulation.Weaning when the child is ready is crucial because living with HMV can be challenging and stressful. Failure to remove a tracheostomy when indicated can result in delayed speech, social problems as well as risk for infection.

Association of Malnutrition With Weaning Practices Among Infants in Pakistan.

Background An appropriate diet is critical for the growth and development of infants, especiallyin the first two years of life. Despite considerable efforts made by government and local authorities to raise awareness, mothers still lack basic knowledge of weaning practices;as a result, infants face a growing number of health problems in their later years of life. This research aims to investigate the association between malnutrition and knowledge of different weaning practices among mothers and to study the factors influencing it. Methodology The current study was a cross-sectional study conducted at Mayo Hospital, Services Hospital, and Jinnah Hospital, Lahore, Pakistan between November 2019and May 2020. A total of 200 infants of both gendersaged between one and 12 months were included in the study. Knowledge and practices of complementary feeding by the mothers were assessed using a close-ended, pre-tested questionnaire. Results Mothers of 200 infants were interviewed and it was found that 79.5% of the infants were being breastfed while 24% never received breast milk. Among those who never received breast milk were given liquids (25%)and semi-solid foods (64.5%). Of the mothers,8% started weaning at an early age (less than six months old) while the remaining started weaning at the age of sixmonths or later and reported that their infants were either underweight or had reduced heights for that age. Based on the medical reports obtained from the hospital after getting parental consent, it was also found that the infants had distinct signs of deficiency of vitamins A and D, iron, and folate. Conclusions The majority of infants were breastfed, and, in most cases, weaning started at an age of less than six months. Most of the infants were fed semi-solid food as their first complementary food. Two-thirds of the infants were underweight for that age, and one-fifth had reduced heights. Based on deficiency statistics, mothers should be encouraged to start weaning at six months to have minimized malnourishment instances in infants.

Alemtuzumab/Low Dose TBI Conditioning Facilitates Stable Long-Term Donor Hematopoietic Cell Engraftment from Sibling Donors in Children with Sickle Cell Disease

BackgroundHematopoietic stem cell transplant (HCT) is the only established curative approach for sickle cell disease (SCD). Due to the high toxicity profile of myeloablative regimens, some adult patients with severe sickle cell anemia are not eligible for such therapy. However, a new adult nonmyeloablative protocol (National Institutes of Health, NIH protocol) described by Hsieh et al. (2014) was able to achieve a curative degree of mixed donor chimerisms with minimal transplant-related complications. The NIH protocol includes alemtuzumab, low dose total-body irradiation (TBI) of 300 cGy, and prolonged sirolimus for graft-versus-host disease (GVHD) prophylaxis for those recipients with a matched-sibling donor (MSD).The Alberta Children's Hospital has adopted this published regimen for MSD HCT in adolescents and younger children with SCD since the NIH data was presented in 2013.To our knowledge, there is no published literature describing the application of the NIH protocol in a pediatric population; the youngest subject in the referenced adult study was 16 years of age.MethodsThis retrospective cohort describes outcomes of nonmyeloablative allogeneic MSD HCT in children and adolescents with SCD who underwent HCT between 2013-2017. Fourteen patients with SCD under 18 years of age at the time of HCT received the NIH conditioning regimen. HLA-matched siblings had either normal hemoglobin or sickle cell trait and of the appropriate weight/height to donate peripheral blood stem cells (PBSCs) without blood priming of the apheresis circuit.The conditioning regimen consisted of alemtuzumab 1.0 mg/kg administered subcutaneously daily divided over five days (Days -7 to Day -3). Patients received a single TBI dose of 300 cGy on day -2, with testicular shielding for male recipients. GVHD prophylaxis consisted of a sirolimus loading dose of 3mg/m2/dose (PO) on day -1, followed by 1mg/m2/dose once daily starting on Day 0. PBSCs were typically collected on Day -3 to allow for cancellation of the HCT before TBI in the event of failed mobilization. Unmanipulated PBSCs were infused fresh on Day 0. Patients were eligible for early discharge post-transplant even prior to neutrophil engraftment. Weaning of sirolimus was initiated no earlier than 1-year post-HCT and if donor T-cell chimerisms were greater than 50%. Treatment failure was defined as clinical manifestation of SCD, failure to start weaning sirolimus by 2-years post-HSCT, or a failure to complete a sirolimus wean by 2.5 years post-HCT.ResultsFourteen patients (3 M,11 F) are included on this retrospective study. Median age at HCT was 11 years. Post-HCT follow-up ranges from 1 to 48 months (median 17). There were no failed donor stem cell mobilizations. Patients received a median of 11.4x106 CD34 cells per kilogram of body weight.All patients were discharged home prior to neutrophil engraftment with a median hospital stay of 7 days (range 5-19). All patients had donor neutrophil engraftment at a median of 21 days (mean= 22, SD= 4) and platelet engraftment at median of 14 days (mean= 12, SD= 14). Six patients never required platelet transfusion. Readmission after initial discharge was required in 9/14 patients with an average of 1 readmission/patient (range 1-4), typically for fever or CMV pre-emptive therapy. One patient developed septic shock with Acinetobacter ursingii related to poor central line care at home.All patients are currently alive. Post-HCT, there have been no cases of graft failure, sickling crises, veno-occlusive disease, idiopathic pneumonia syndrome, cerebral hemorrhage, PRES, or PTLD. Although 6/14 patients had CMV reactivation, only 3 patients required pre-emptive therapy. None had CMV/EBV disease.There were no treatment failures as defined by protocol. Currently, 8 patients are off sirolimus, 1 is currently weaning, with no secondary graft failure events. Only 2 patients over 1-year post-HCT have not initiated sirolimus weaning. There have been no cases of acute or chronic graft-versus-host disease.ConclusionsNonmyeloablative conditioning regimen is safe and effective as curative therapy for children with SCD. Outpatient management pre-engraftment was feasible in this population. In contrast to adult data, sirolimus weaning was possible in most patients by one-year post-HCT. Graft integrity was maintained after discontinuation of sirolimus in all eligible patients. [Display omitted] DisclosuresGuilcher:Patient Access Solutions: Consultancy; Canada Market Research: Consultancy; Jazz pharmaceuticals: Consultancy. Bruce:Bristol-Meyers-Squibb - consultant 2016-2017: Consultancy; ovartis consult and ad board 2015-2016: Consultancy; Apopharma 2015: Consultancy.

First-line support for assistance in breathing in children: statistical and health economic analysis plan for the FIRST-ABC trial

BackgroundThe FIRST-ABC trial comprises of two pragmatic, multicentre, parallel groups, non-inferiority randomised clinical trials designed to evaluate the clinical non-inferiority of first-line use of high flow nasal cannula (HFNC) to continuous positive airway pressure (CPAP) in critically ill children who require non-invasive respiratory support (NRS).ObjectivesTo describe the pre-specified statistical and health economic analysis for the FIRST-ABC trial before completion of patient recruitment and data collection.MethodsThe statistical analysis plan was designed by the chief investigators and statisticians. We define the primary and secondary outcomes, summarise methods for data collection and safety monitoring, and present a detailed description of the planned statistical and health economic analysis.ResultsThe primary clinical outcome is time to liberation from respiratory support. The primary effect estimate will be the adjusted hazard ratio, reported with a 95% confidence interval. As a sensitivity analysis, the primary analysis will be repeated using time to start weaning of NRS. Subgroup analyses will be performed to test for interactions between the effect of allocated treatment group and pre-specified baseline covariates. The health economic analysis will follow the intention-to-treat principle and report the mean (95% confidence interval) incremental costs, quality-adjusted life years (QALYs) and cost-effectiveness up to 6 months. All analyses will be performed separately for each of the two trials, and any results will not be combined.ConclusionThe FIRST-ABC trial will assess the non-inferiority of HFNC compared to CPAP in two parallel trials with shared infrastructure (step-up RCT and step-down RCT). We have developed a pre-specified statistical and health economics analysis plan for the FIRST-ABC study before trial completion to minimise analytical bias.Trial registrationISRCTN ISRCTN60048867. Registered on 19 June 2019.

Awareness Regarding Lactation Practices Among Lactating Women Attending Sir Ganga Ram Hospital, Lahore

Breast feeding is essential and plays an important role in the growth and development of a child. It is recommended to breast feed child till 6 months exclusively and to start weaning foods slowly to meet the nutritional requirements for the growth and development of child.

P 83 Parasomnia, parkinsonism, impulse control disorder and bulbar palsy with IgLON5 antibodies: A new case report

Background In 2014 a complex neurological syndrome with parasomnia, sleep breathing dysfunction and variable bulbar symptoms associated with antibodies to IgLON5, a neuronal cell-adhesion protein, was described (Sabater et al., 2016). Postmortal studies revealed tauopathy predominately involving the hypothalamus and tegmentum of the brainstem (Gelpi et al., 2016). To the best of our knowledge, there are 16 published cases so far. Methods (clinical presentation) We report a 72-year-old highly educated male Caucasian patient with a 6 year history of parasomnia with RBD in the beginning, following of multiple falls, parkinsonism, hypomania, frontal lobe disorder and impulse control disorder (ICD; leading to sentence of detention) with aggressive tendencies. By transcranial ultrasound hyperechogenicity of substantia nigra was demonstrated, FDG-PET imaging showed lower 18F-FDG activity in temporal lobes. Thus idiopathic Parkinson’s disease was assumed. Due to neuropsychiatric complications the antiparkinson medication was gradually reduced and eventually discontinued in 2014. Interestingly, there were no relevant changes in symptoms of parkinsonism thereafter. In 2016, after acute coronary syndrome the patient developed a sudden bilateral vocal cord paresis with stridor leading to intubation and following tracheotomy. Subsequently, he showed dysphagia, increasing rigidity, fluctuating level of consciousness with intermittent hypoventilation and hypercapnia, and autonomic dysregulation. Critical decompensation with need of short CPR occurred twice, continuous monitoring with mechanical ventilation was required. Results (workup and treatment, Table 1 ) Brain MRI showed iron accumulation in globus pallidus and dentate nucleus, and a small pineal cyst ( Fig. 1 a). The initial multiple EEGs were normal. Diverse EEGs from 2016 registered generalized slowing with intermittent hyperexcitability; nonconvulsive status epilepticus was captured once ( Fig. 1 b). Laboratory tests displayed neutrophil leukocytosis with MGUS IgG-kappa and -lambda. In serum (1:100) and in CSF (1:10) IgLON5 antibodies (IgG subclass) were detected. HLA-typing revealed HLA-DRB1∗10:01 and HLA-DQB1∗05:01 alleles. Tumor screening (thoracic and abdominal CT, bone marrow examination) did not detect malignancy. Because of suspected IgLON5-syndrome with autoimmune origin an immunosuppressive therapy with initial IV methylprednisolone pulse therapy following oral prednisolone (75 mg/d) and rituximab was initiated. Subsequently, after achieving better vigilance, it was possible to start weaning again. Conclusion Parasomnia, ICD, beginning frontal lobe syndrome with parkinsonism, multiple falls and bulbar symptoms is a new combination in IgLON5 antibody-linked syndrome. A connection to neurodegeneration with brain iron accumulation (NBIA) is possible and requires further investigation.

Ontogeny of the digestive tract of Centropomus parallelus larvae.

Development of the digestive tract and accessory glands of larvae of the fat snook Centropomus parallelus was examined under light microscopy, from hatching to 60 day post-hatching (dph). At hatching, the digestive tract is straight and composed by a cubic cell layer. The exogenous feeding starts at 3 dph, concomitantly with the mouth opening and subdivision of the rudimentary stomach and esophagus. At 4 dph, the intestine has three sectins, and vacuoles are observed in the posterior section, indicating the beginning of protein digestion and absorption. The pharyngeal teeth appear at 9 dph, and goblet cells appear at 13 dph in the esophagus. Gastric glands appear at 30 dph, marking the beginning of weaning. The disappearance of supranuclear vacuoles in the posterior intestine occurs at 35 dph, suggesting efficiency of extracellular digestion. This study shows that C. parallelus larvae is able to start weaning 15 days earlier than reported in earlier studies, increasing the success of larviculture.

When to Switch From Parenteral to Enteral Feeding With Intestinal Grafts? Can Serum Citrulline Provide the Answer?

Introduction: Serum citrulline was used as a biochemical marker to direct nutritional therapy in two phases of the post-operative course after intestinal transplantation. Methods: On a predetermined day of the week, serum citrulline levels were monitored on a weekly basis after small bowel transplantation. A level of 13 μmol/l with a normal GFR was used as a cut off to guide patient's feeding regimes. Citrulline levels above 13μmol/l were a trigger to start weaning TPN. Levels >18μmol/l were a trigger to stop TPN and achieve full enteral feeds. Patients were studied in two separate time periods: just after implantation and during acute graft dysfunction following a stable period of function. Results:From October 2007 to date, 24 patients underwent intestinal transplantation. Four patients had stomach included in the graft and 20 had isolated intestines. Mean citrulline levels in the first, second and third week after transplantation were 15.9±3.8μmol/L 13.4±5.6μmol/L and 21.9±9.1μmol/L respectively. Mean stoma output in the first, second and third week was 20mls/kg/24 hours, 25mls/kg/24 hours and 20mls/kg/24 hours respectively. Seven patients presented with acute onset intestinal dysfunction after a stable graft in the first year. Four were treated for acute rejection. Mean citrulline levels for the seven patients presenting with intestinal dysfunction were 15.2±1.9μmol/l and at 48 hours after presentation 10.7±11.9μmol/l. Mean time to achieve TPN independence after transplantation was 18 days (range 15- 30 days). Mean time to achieve TPN independence after acute graft dysfunction was 22 days (range 13- 35 days). Conclusion: Serum citrulline levels correlate well with stoma output and therefore the absorptive mass of the intestinal grafts. Serum citrulline levels initially show a drop in the second week after transplantation before a subsequent rise in the third week. Whatever the cause of acute graft dysfunction, initial TPN may be required and subsequent introduction of enteral nutritional therapy can be directed by serum citrulline.

Ontogenetic development of the digestive system and growth in coral trout (Plectropomus leopardus)

Histological studies were used to describe the ontogenetic development of the digestive tract and accessory glands in coral trout, Plectropomus leopardus, from the time of hatching to 54days after hatching (DAH). According to the structural changes in the digestive system, four significant stages were established: the endotrophic stage (Stage I), the endo-exotrophic stage (Stage II) and the exotrophic stage (subdivided into Stages III and IV). The first stage spanned from hatching to the onset of exotrophic feeding at 2DAH. During this stage, the digestive system started to differentiate into the buccopharynx, the oesophagus, the incipient stomach, the midgut, the hindgut and the rectum. During Stage II (2–3DAH), the coral trout larvae mouth opening reached a 0.24±0.05mm gape size, much smaller than most teleosts. Therefore, first-feeding coral trout must feed on small prey like protozoa or small size rotifers (Brachionus rotundiformis). Stage III (3–19DAH) started after the depletion of the yolk sac. During this stage, goblet cells, taste buds and pharyngeal teeth appeared. The pharyngeal teeth may be a sign that the larvae can feed on some live prey with a hard outer cover, such as copepods. Eosinophilic supranuclear vacuoles and lipid vacuoles were found in the hindgut and midgut, respectively, indicating the beginning of protein and lipid absorption. The last stage (after 19DAH) started when the gastric glands and pyloric caeca were formed. Gastric glands were only observed in the cardiac and fundic stomach and not in the pyloric region. The appearance of gastric glands and pyloric caeca could be regarded as the sign for coral trout to start weaning. The ultrastructure of the liver in the 54-DAH coral trout larvae proved that the liver was crucial for lipid storage and metabolism. This study suggested a relatively rapid development of the digestive system in coral trout and provided a theoretical basis for the nutritional requirements and digestive capacity of coral trout.

Nurses’ near-decision-making process of postoperative patients’ cardiosurgical weaning and extubation in an Italian environment

Despite the fact that Italian nurses have only recently gained autonomy when making health-care decisions, there is little evidence available regarding the decisions actually taken in clinical practice. Exploring the patterns that guide the nurses' decision-making process in weaning and extubating the patient after cardiac surgery. We have adopted a qualitative ethnographic approach. The study was conducted in the Cardiosurgical Intensive Care Unit (CICU) in a Teaching and Research Hospital (Milan) and was first created using participant non-directive observation in which decisions about weaning and extubation were observed. Through aimed sampling until saturation, 18 nurses at both expert and novice professional stages, the nurse manager and the anaesthesiologist director were interviewed. The pattern of a nurse's decision-making process in weaning and extubation is based on three themes: (a) collect data and suggest a decision, (b) standardise the competence and (c) maintain adherence to unwritten rules. The nurses would never take the initiative to start weaning and extubating the patient by themselves: they collect data, consult with other nurses and then propose decisions which are ultimately authorised by the physicians. The near-decision-making process of nurses expressed a pattern determined by personal factors, clinicians, organisations, structures and cultural reported unwritten rules. To ensure that the nurses become responsible and independent decision makers, it is necessary to pay particular attention to structural and cultural conditions in order to help them reach their full potential in the future.

SHA 78. Coarctation plus VSD one or two stage repair?

two stage procedures to correct Fontan Pathology. Left Glenn shunt as first stage then fenestrated Fontan with common atrioventricular valve repair as a second stage. The patient had uneventual post operative recovery and discharge home. However, she was re-admitted few days after discharge with high fever and manifestation of respiratory chest infection. On investigation she was proven to be H1N1positive. The patient respiratory condition deteriorated dramatically within 48 h. She developed acute respiratory failure which required mechanical respiratory support. She also developed a sever heart failure which required significant chemical ion tropic support. Despite all the above measures, the patient condition continue to deteriorate and the Decision was taken to insert the extracorporeal membrane oxygenation (ECMO), as a bridge for respiratory failure recovery. The ECMO cannulation were Veno-Venous. femoral vein as input flow and internal jugular as output flow connected to pediatric oxygenator D905 with 3/8–3/8 circuit We started with one liter flow per minute, 100% FiO2, 5 L gas flow to maintain her core temperature on 36 C. she got hemofiltration as additional device attached to the circuit to help taking out the excessive fluid. As she was on ECMO for long time her creatinine and urea and lactic acid started to be elevated, so we applied dialysis system beside the regular hemofiltration. She was on heparin infusion to maintain the ACT (180–200 s) therefore, we faced bleeding problem from the cannula sides and even from the mouth. Results: The patients were assessed daily for the respiratory and haemodynamic recovery. Chest X-ray were performed daily to check for any parenchymal infiltarate recovery and the patient became H1N1 negative after 10 days. We were able to start weaning from the respiratory support after 23 days and to be weaned from the mechanical ventilation after one month. Patient however, required aggressive dietary and physiotherapy to help her regain her strength. Conclusion: Diligence, persistence and luck were the essence of this case. Early diagnosis and respiratory support may have helped in saving this child. Tracks: Cardiac Perfusion.

SHA 79. Fontan operation to fenestrate or not fenestrate

two stage procedures to correct Fontan Pathology. Left Glenn shunt as first stage then fenestrated Fontan with common atrioventricular valve repair as a second stage. The patient had uneventual post operative recovery and discharge home. However, she was re-admitted few days after discharge with high fever and manifestation of respiratory chest infection. On investigation she was proven to be H1N1positive. The patient respiratory condition deteriorated dramatically within 48 h. She developed acute respiratory failure which required mechanical respiratory support. She also developed a sever heart failure which required significant chemical ion tropic support. Despite all the above measures, the patient condition continue to deteriorate and the Decision was taken to insert the extracorporeal membrane oxygenation (ECMO), as a bridge for respiratory failure recovery. The ECMO cannulation were Veno-Venous. femoral vein as input flow and internal jugular as output flow connected to pediatric oxygenator D905 with 3/8–3/8 circuit We started with one liter flow per minute, 100% FiO2, 5 L gas flow to maintain her core temperature on 36 C. she got hemofiltration as additional device attached to the circuit to help taking out the excessive fluid. As she was on ECMO for long time her creatinine and urea and lactic acid started to be elevated, so we applied dialysis system beside the regular hemofiltration. She was on heparin infusion to maintain the ACT (180–200 s) therefore, we faced bleeding problem from the cannula sides and even from the mouth. Results: The patients were assessed daily for the respiratory and haemodynamic recovery. Chest X-ray were performed daily to check for any parenchymal infiltarate recovery and the patient became H1N1 negative after 10 days. We were able to start weaning from the respiratory support after 23 days and to be weaned from the mechanical ventilation after one month. Patient however, required aggressive dietary and physiotherapy to help her regain her strength. Conclusion: Diligence, persistence and luck were the essence of this case. Early diagnosis and respiratory support may have helped in saving this child. Tracks: Cardiac Perfusion.

Practical Consultation on Weaning Diet

Weaning is the process of getting babies used to food other than breast milk or formula milk. Homemade baby food is preferable, including a varied selection of foods, starting from rice porridge followed by adding meat, vegetables, and fruits as appropriate. Baby food gradually becomes solid until the age of one when the babies can eat rice without further preparation. Avoid salt till the age of one, and even thereafter try not to make the baby food salty. Start adding meat from six months, and include meat on a daily basis when the baby is growing fast. Babies can self-feed by hand at 8 months of age and then can learn how to use a spoon. If the time to start weaning is too delayed or the way of weaning is not appropriate, feeding problems may ensue, which can potentially lead to developmental problems. It is important to remind that the weaning process is not just giving baby food as a source of nutrition for growth? It is a way of building a family bond and is a starting point of nourishing a healthy eating habit.

Infant feeding: which is the best practice?

Reviews the various ways of feeding infants from birth to one year since what an infant eats at this stage in life is crucial to his/her future health. Critically discusses the various practices of feeding infants, which are breast‐feeding, artificial feeding, mixed feeding, and weaning. Reports on the investigations done in various countries of Europe, North America, some countries in South America, Africa and Asia. Suggests the proper ways of infant feeding based on the investigations and recommendations from WHO and UNESCO; then concludes that breast‐feeding is the best method of infant feeding and the best time to start weaning infants is between five and six months old.

The culture and early weaning of larval haddock ( Melanogrammus aeglefinus) using a microparticulate diet

In order to effectuate haddock, Melanogrammus aeglefinus, as a practical aquaculture candidate, they must be able to successfully wean onto a formulated diet. This weaning should be accomplished soon after hatching in order to limit financial bottlenecks associated with the high cost of live feed production. Two experiments were designed to determine the earliest point at which haddock could be successfully weaned onto a formulated food. The first examined start weaning at 14, 21, 28, and 35 days post-hatch (dph) at 8.5°C. Control animals were given only live feeds throughout the experiment. Samples of larvae were taken weekly for length and dry weight analysis. Haddock did not wean as effectively as cod onto the commercial diet (Biokyowa™), and survival was compromised for all treatments examined. There were no differences in survival for any of the weaning periods investigated with averages ranging from 2.5% to 6.3%. However, the survival of the control group was significantly higher at 37.9%. The second experiment examined weaning at later stages and at an increased temperature. This experiment examined start weaning periods of 30, 35, and 42 days post-hatch. The 42-day start weaning period yielded results similar to those obtained with the live feed control, however survival and growth was compromised for both the 30- and 35-day weaning periods.

Weaning from mechanical ventilation in pediatric intensive care patients.

The development of weaning predictors in mechanically ventilated children has not been sufficiently investigated. The purpose of this study was to evaluate the accuracy of some weaning indices in predicting weaning failure. Prospective, interventional study. University-affiliated children's hospital with a 19-bed intensive care unit. 84 consecutive infants and children requiring mechanical ventilation for at least 48 h and judged ready to wean by their primary physicians. Patients who met the criteria to start weaning underwent a trial of spontaneous breathing lasting up to 2 h. Bedside measurements of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5 min of spontaneous breathing. The primary physicians were blinded to those measurements, and the decision to extubate a patient at the end of the spontaneous breathing trial or reinstitute mechanical ventilation was made by them. Failure to wean was defined as the requirement for mechanical ventilation at any time during the trial of spontaneous breathing (trial failure) or needing reintubation within 48 h of extubation (extubation failure). Seventy-five patients had neither signs of respiratory distress nor deterioration in gas exchange during the trial and were extubated. Twelve patients required reintubation within 48 h. In 9 patients, mechanical ventilation was reinstituted after a median duration of the spontaneous breathing trial of 35 min. The only independent predictor of trial failure was tidal volume indexed to body weight [odds ratio 2.60, 95 % confidence interval (CI) 1.40 to 24.9]. The only independent predictor of extubation failure was frequency-to-tidal volume ratio indexed to body weight (odds ratio 1.23, 95 % CI 1.11 to 1.36). The sensitivity, specificity, and positive and negative predictive values to predict weaning failure were calculated for each of the above variables. These values were 0.48, 0.86, 0.53, and 0.83, respectively, for a frequency-to-tidal volume ratio higher than 11 breaths/min per ml per kg and 0.43, 0.94, 0.69, and 0.83, respectively, for a tidal volume lower than 4 ml/kg. Three-quarters of ventilated children can be successfully weaned after a trial of spontaneous breathing lasting 2 h. Both tidal volume and frequency-to-tidal volume ratio indexed to body weight were poor predictors of weaning failure in the study population.