Vitamin D-Deficiency Rickets in Two Breast-Fed Infants Who Were Not Receiving Vitamin D Supplementation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66491/2/10.1177_000992287701600411.pd

The effect of a partially hydrolysed formula based on rice protein in the treatment of infants with cow’s milk protein allergy

Reche M, Pascual C, Fiandor A, Polanco I, Rivero-Urgell M, Chifre R, Johnston S, Martín-Esteban M. The effect of a partially hydrolysed formula based on rice protein in the treatment of infants with cow’s milk protein allergy. Pediatr Allergy Immunol 2010: 21: 577–585. © 2010 John Wiley & Sons A/

Bolstering Confidence in Obesity Prevention and Treatment Counseling for Resident and Community Pediatricians

Objective- To assess whether equipping resident pediatricians and community pediatricians with both training and practical tools improves their perceived confidence, ease, and frequency of obesity related counseling to patients. Methods- In 2005-2006, resident pediatricians (n = 49) and community pediatricians (n=18) received training regarding three evidence-based obesity prevention/treatment tools and responded to pre-and post-intervention questionnaires. We analyzed changes in reported mean confidence, ease, and frequency of dietary, physical activity, and weight status counseling. Results- Baseline scores of confidence, ease, and frequency of counseling were higher in community pediatricians than residents. Mean scores increased significantly in the combined group, among residents only, and trended towards improvement in the community pediatricians following the intervention. Means for "control" questions were unchanged. Conclusion- Training and tools for residents and community pediatricians improved their confidence, ease, and frequency of obesity-related counseling. Practice Implications- This study demonstrates that when feasible and appropriate tools and training were provided through a simple intervention, physicians gained confidence and ease and increased their counseling frequency. The results here suggest that widespread implementation of such educational interventions for community practitioners and practitioners in training could change the way physicians counsel patients to prevent the often frustrating problem of childhood obesity. Originally published Patient Education and Counseling, Vol. 73, No. 2, Nov 200

The American Experience With Desmopressin

Conclusive evidence of a polyuric etiology from a failure of vasopressin elevation led to a new pharmacologic approach to the treatment of childhood nocturnal enuresis. Desmopressin acetate, a vasopressin analogue, has been used successfully since 1978 to treat this condition. Desmopressin's efficacy at doses of 5 to 40 μg has been demonstrated in Europe and the United States. Similarly, its safety has been established, and it is a first-line choice for physicians worldwide.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67214/2/10.1177_000992289303200107.pd

Advanced Criteria for Clinicopathological Diagnosis of Food Protein-induced Proctocolitis

The clinicopathological findings in previous studies concerning food protein-induced proctocolitis (FPIPC) are quite diverse in terms of results and conclusions. The aim of this study was to suggest advanced clinicopathological diagnostic criteria that facilitate the early confirmation of FPIPC. Data of 38 FPIPC patients, who had received sigmoidoscopy and biopsy, was analyzed. Microscopic findings were compared with observations of previous studies. Feeding at onset of bleeding was exclusively breast-fed (94.7%) and formula-fed or mixed-fed (5.3%). Endoscopic abnormalities were observed in all patients; nodular hyperplasias with circumscribed and/or central pit-like erosions in 94.7% and erythema in 5.3%. Histopathological findings were; lymphoid aggregates in 94.7%, eosinophils in lamina propria of ≥60 cells/10 HPF in 97.4% and of >20 cells/HPF in 63.2%, epithelial or muscularis mucosa eosinophil infiltration in 97.4%, and crypt abscess in 2.6%. The majority of FPIPC patients are exclusively breast-fed and nodular hyperplasias with erosions may be a disease specific endoscopic finding. Histologic diagnosis of FPIPC is compatible with eosinophils in the lamina propria of ≥60 cells/10 high power fields; however, >20 cells/HPF is not an appropriate diagnostic criterion

Assessing exclusive breastfeeding practices, dietary intakes and body mass index (BMI) of nursing mothers in Ekiti State of Nigeria

Breastfeeding is an unequalled way of providing ideal food for the infants. The benefits of breastfeeding practices to infants and mothers are well documented. However, information on breastfeeding practices and its effect on body mass index (BMI) of mothers are scarce, particularly in Ekiti State of Nigeria. Therefore, the present study is designed to assess breastfeeding practices and its association with BMI of mothers. A descriptive and cross-sectional study was conducted among breastfeeding mothers that attended postnatal clinic of the state specialist hospitals and maternity centers in the study location. The specialist hospital and two-third of the nine maternity centers were purposively selected because of their health facilities and personnel. The mother-child pairs (200 respondents) were randomly selected from the study locations. Information on demographic characteristic, socio-economic parameters, nutritional knowledge of breastfeeding and dietary intakes of mothers were collected using questionnaires. BMI of mothers was determined as described by World Health Organization. Age distribution of mothers was between 25-34 years; and almost half of respondents had good educational background and were engaged in different occupations. The respondent monthly income ranged between = N = 3500 - 26000 ($26.92 -$200); and their dietary intakes varied between starchy and protein-based food. The result also showed that the respondent consumed enough nutrients to meet up the recommended daily allowance for protein, carbohydrate, fat, zinc, magnesium, sodium and phosphorous requirements. The BMI classifications showed that over three-fifth of respondents were normal, while the remaining were underweight (6%) and overweight/obese (26.5%). Also, large proportion of respondents engaged in exclusive breastfeeding and with good knowledge of breastfeeding practices. Statistically, exclusive breastfeeding practices had no correlation between the BMI and frequency of breastfeeding. The study, therefore, concluded that mothers had good knowledge of breastfeeding practice; and that there was no association between breastfeeding practices and BMI

High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

BACKGROUND: Breast milk alone, given at standard recommended volumes (150 to 180 mL/kg/d), is not adequate to meet the protein, energy, and other nutrient requirements of growing preterm or low birth weight infants. One strategy that may be used to address these potential nutrient deficits is to give infants enteral feeds in excess of 200 mL/kg/d ('high-volume' feeds). This approach may increase nutrient uptake and growth rates, but concerns include that high-volume enteral feeds may cause feed intolerance, gastro-oesophageal reflux, aspiration pneumonia, necrotising enterocolitis, or complications related to fluid overload, including patent ductus arteriosus and bronchopulmonary dysplasia. OBJECTIVES: To assess the effect on growth and safety of feeding preterm or low birth weight infants with high (> 200 mL/kg/d) versus standard (≤ 200 mL/kg/d) volume of enteral feeds. Infants in intervention and control groups should have received the same type of milk (breast milk, formula, or both), the same fortification or micronutrient supplements, and the same enteral feeding regimen (bolus, continuous) and rate of feed volume advancement.To conduct subgroup analyses based on type of milk (breast milk vs formula), gestational age or birth weight category of included infants (very preterm or VLBW vs preterm or LBW), presence of intrauterine growth restriction (using birth weight relative to the reference population as a surrogate), and income level of the country in which the trial was conducted (low or middle income vs high income) (see 'Subgroup analysis and investigation of heterogeneity'). SEARCH METHODS: We used the Cochrane Neonatal standard search strategy, which included searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 2) in the Cochrane Library; MEDLINE (1946 to November 2016); Embase (1974 to November 2016); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to November 2016), as well as conference proceedings, previous reviews, and trial registries. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials that compared high-volume versus standard-volume enteral feeds for preterm or low birth weight infants. DATA COLLECTION AND ANALYSIS: Two review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials and reported the risk ratio and risk difference for dichotomous data, and the mean difference for continuous data, with respective 95% confidence intervals. . We assessed the quality of evidence at the outcome level via the GRADE approach. MAIN RESULTS: We found one eligible trial that included 64 infants. This trial was not blinded. Analysis showed a higher rate of weight gain in the high-volume feeds group: mean difference 6.20 g/kg/d (95% confidence interval 2.71 to 9.69). There was no increase in the risk of feed intolerance or necrotising enterocolitis with high-volume feeds, but 95% confidence intervals around these estimates were wide. We assessed the quality of evidence for these outcomes as 'low' or 'very low' because of imprecision of the estimates of effect and concern about risk of bias due to lack of blinding in the included trial. Trial authors provided no data on other outcomes, including gastro-oesophageal reflux, aspiration pneumonia, necrotising enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, or long-term growth and neurodevelopment. AUTHORS' CONCLUSIONS: We found only very limited data from one small unblinded trial on the effects of high-volume feeds on important outcomes for preterm or low birth weight infants. The quality of evidence is low to very low. Hence, available evidence is insufficient to support or refute high-volume enteral feeds in preterm or low birth weight infants. A large, pragmatic randomised controlled trial is needed to provide data of sufficient quality and precision to inform policy and practice

Relation of Sources of Systemic Fluoride to Prevalence of Dental Fluorosis

The prevalence of dental fluorosis in a nonfluoridated area was determined and related to the reported fluoride ingestion histories of the children examined. A convenience sample of 543 schoolchildren in rural areas of Michigan was examined for fluorosis using the Tooth Surface Index of Fluorosis. Questionnaires that asked about previous use of fluorides were sent to parents of all children examined. The response rate was 76 percent (412 usable questionnaires). A criterion for inclusion in the data analysis stipulated that only fluorosed surfaces that occurred bilaterally would be included. Fluorosis was found on 7 percent of all tooth surfaces and only in the mild form. Twenty-two percent of the subjects were classified as having fluorosis. Dietary supplement was the only fluoride that was found to be significantly related to the occurrence of fluorosis. A greater proportion of the subjects with fluorosis fisted physicians, rather than dentists, as the source of fluoride prescriptions. The results demonstrate similarities to the fluorosis reported in other studies in non-fluoridated areas, but also suggest the need to minimize the occurrence of fluorosis through proper assessment of a child's fluoride exposure and the judicious use of additional fluoride.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65695/1/j.1752-7325.1989.tb02030.x.pd