Quelle eau choisir pour la préparation des biberons destinés aux nourrissons ?

La source d'eau pour le nourrisson est quasi-exclusivement l'eau contenue dans le lait qu'on lui prépare. La proportion de nourrissons qui vont consommer du lait infantile dans leur première année de vie est très importante. Dans la plupart des pays, les laits infantiles sont présentés sous forme de poudre à reconstituer avec de l'eau. La composition de l'eau doit être prise en compte car l'apport final en électrolytes que va consommer le nourrisson en dépend. L'objectif de ce travail est d'établir un état des lieux des eaux disponibles en France afin d'aboutir à des recommandations pour le choix de l'eau à utiliser. Les informations concernant les critères de qualité des eaux embouteillées portant une mention nourrisson, des eaux minérales naturelles, des eaux de source et des eaux de distribution publique ont été regroupées dans un tableau pour permettre leur comparaison. Ensuite, ont été réalisés des tableaux de composition des eaux embouteillées plates commercialisées en France, et des eaux de distribution publique, pour permettre de dresser une liste des eaux convenant pour les nourrissons. Ont été analysées la composition et la qualité de 30 eaux minérales naturelles, 52 eaux de sources, 22 eaux de distribution publique des grandes villes de France avec un focus sur l'Isère. Pour conclure, concernant l'eau de distribution publique, ne peuvent être recommandées que les eaux pour lesquelles la composition et la qualité sont conformes aux recommandations pour nourrissons. A défaut de ces renseignements, il est plus licite de recommander une eau embouteillée faiblement minéralisée et portant une mention "nourrisson" attestant de sa conformité aux exigences de qualité.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Quelle eau choisir pour la préparation des biberons destinés aux nourrissons ?

La source d'eau pour le nourrisson est quasi-exclusivement l'eau contenue dans le lait qu'on lui prépare. La proportion de nourrissons qui vont consommer du lait infantile dans leur première année de vie est très importante. Dans la plupart des pays, les laits infantiles sont présentés sous forme de poudre à reconstituer avec de l'eau. La composition de l'eau doit être prise en compte car l'apport final en électrolytes que va consommer le nourrisson en dépend. L'objectif de ce travail est d'établir un état des lieux des eaux disponibles en France afin d'aboutir à des recommandations pour le choix de l'eau à utiliser. Les informations concernant les critères de qualité des eaux embouteillées portant une mention nourrisson, des eaux minérales naturelles, des eaux de source et des eaux de distribution publique ont été regroupées dans un tableau pour permettre leur comparaison. Ensuite, ont été réalisés des tableaux de composition des eaux embouteillées plates commercialisées en France, et des eaux de distribution publique, pour permettre de dresser une liste des eaux convenant pour les nourrissons. Ont été analysées la composition et la qualité de 30 eaux minérales naturelles, 52 eaux de sources, 22 eaux de distribution publique des grandes villes de France avec un focus sur l'Isère. Pour conclure, concernant l'eau de distribution publique, ne peuvent être recommandées que les eaux pour lesquelles la composition et la qualité sont conformes aux recommandations pour nourrissons. A défaut de ces renseignements, il est plus licite de recommander une eau embouteillée faiblement minéralisée et portant une mention "nourrisson" attestant de sa conformité aux exigences de qualité.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

External counterpulsation therapy improves endothelial function in patients with refractory angina pectoris

AbstractObjectivesThe goal of this study was to investigate the influence of short-term external counterpulsation (ECP) therapy on flow-mediated dilation (FMD) in patients with coronary artery disease (CAD).BackgroundIn patients with CAD, the vascular endothelium is usually impaired and modification or reversal of endothelial dysfunction may significantly enhance treatment. Although ECP therapy reduces angina and improves exercise tolerance in patients with CAD, its short-term effects on FMD in patients with refractory angina pectoris have not yet been described.MethodsWe prospectively assessed endothelial function in 20 consecutive CAD patients (15 males), mean age 68 ± 11 years, with refractory angina pectoris (Canadian Cardiovascular Society [CCS] angina class III to IV), unsuitable for coronary revascularization, before and after ECP, and compared them with 20 age- and gender-matched controls. Endothelium-dependent brachial artery FMD and endothelium-independent nitroglycerin (NTG)-mediated vasodilation were assessed before and after ECP therapy, using high-resolution ultrasound.ResultsExternal counterpulsation therapy resulted in significant improvement in post-intervention FMD (8.2 ± 2.1%, p = 0.01), compared with controls (3.1 ± 2.2%, p = 0.78). There was no significant effect of treatment on NTG-induced vasodilation between ECP and controls (10.7 ± 2.8% vs. 10.2 ± 2.4%, p = 0.85). External counterpulsation significantly improved anginal symptoms assessed by reduction in mean sublingual daily nitrate consumption, compared with controls (4.2 ± 2.7 nitrate tablets vs. 0.4 ± 0.5 nitrate tablets, p <0.001 and 4.5 ± 2.3 nitrate tablets vs. 4.4 ± 2.6 nitrate tablets, p = 0.87, respectively) and in mean CCS angina class compared with controls (3.5 ± 0.5 vs. 1.9 ± 0.3, p <0.0001 and 3.3 ± 0.6 vs. 3.5 ± 0.5, p = 0.89, respectively).ConclusionsExternal counterpulsation significantly improved vascular endothelial function in CAD patients with refractory angina pectoris, thereby suggesting that improved anginal symptoms may be the result of such a mechanism

The distinction between coronary and myocardial reperfusion after thrombolytic therapy by clinical markers of reperfusion

AbstractObjectives. We sought to examine the hypothesis that rapid resolution of ST-segment elevation in acute myocardial infarction (AMI) patients with early peak creatine kinase (CK) after thrombolytic therapy differentiates among patients with early recanalization between those with and those without adequate tissue (myocardial) reperfusion.Background. Early recanalization of the epicardial infarct-related artery (IRA) during AMI does not ensure adequate reperfusion on the myocardial level. While early peak CK after thrombolysis results from early and abrupt restoration of the coronary flow to the infarcted area, rapid ST-segment resolution, which is another clinical marker of successful reperfusion, reflects changes of the myocardial tissue itself.Methods. We compared the clinical and the angiographic results of 162 AMI patients with early peak CK (≤12 h) after thrombolytic therapy with (group A) and without (group B) concomitant rapid resolution of ST-segment elevation.Results. Patients in groups A and B had similar patency rates of the IRA on angiography (anterior infarction: 93% vs. 93%; inferior infarction: 89% vs. 77%). Nevertheless, group A versus B patients had lower peak CK (anterior infarction: 1,083 ± 585 IU/ml vs. 1,950 ± 1,216, p < 0.01; and inferior infarction: 940 ± 750 IU/ml vs. 1,350 ± 820, p = 0.18) and better left ventricular ejection fraction (anterior infarction: 49 ± 8, vs. 44 ± 8, p < 0.01; inferior infarction: 56 ± 12 vs. 51 ± 10, p = 0.1). In a 2-year follow-up, group A as compared with group B patients had a lower rate of congestive heart failure (1% vs. 13%, p < 0.01) and mortality (2% vs. 13%, p < 0.01).Conclusions. Among patients in whom reperfusion appears to have taken place using an early peak CK as a marker, the coexistence of rapid resolution of ST-segment elevation further differentiates among patients with an opened culprit artery between the ones with and without adequate myocardial reperfusion

Effectiveness of a starch thickened infant formula with reduced lactose content, probiotics and prebiotics on quality of life and clinical outcome in infants with regurgitation and/or colic

BackgroundRegurgitation and colic are quite common in young infants, leading to a reduced quality of life (QoL) and to parental distress. Their management is challenging and aims to effectively reassure and relieve symptoms. This study aimed to assess the effectiveness over 30 days of a starch thickened formula with a reduced lactose content, Limosilactobacillus reuteri (Lactobacillus reuteri) DSM 17938 and FOS/GOS.MethodsA real-world prospective multicenter experimental study was conducted in a before-after design within subject. Full term infants 0−5 months with regurgitation or colic or both symptoms and without intercurrent illness were included after parental informed consent and received the studied formula. The primary endpoint was the improvement in QoL using the QUALIN infant’s questionnaire. Secondary endpoints were the symptoms outcome and the formula tolerance.ResultsOf the 101 infants included (age: 6.2 ± 4.3  weeks), 33 had regurgitation, 34 colic and 34 had both. At D30, the QoL score was improved in 75% of infants in per protocol analysis (n = 68; +8.2 ± 13.7; p &lt; 0.001), more in those with colic or both symptoms. Meanwhile, in intention to treat analysis (all p &lt; 0.001), the daily number of regurgitations decreased by 61% and the weekly number of days with colic by 63% while the daily cumulative duration of crying decreased by 82 ± 106 mn. These improvements were observed within the first week by 89 and 76% of parents, respectively.ConclusionThe study formula associated with reassurance is shown to be quickly effective in the management of infant’s regurgitation or/and colic in routine clinical practice.Clinical trial registrationhttps://clinicaltrials.gov/, identifier NCT04462640

Risk Assessment of Micronutrients Deficiency in Vegetarian or Vegan Children: Not So Obvious

Vegetarian diets have gained in popularity worldwide and therefore an increasing number of children may be exposed to the resulting nutritional consequences. Among them, the risk of micronutrient shortfall is particularly of concern. This narrative review aims to assess and discuss the relevance of micronutrient deficiency risk based on the available data. It mainly draws attention to iron, zinc, iodine, and vitamins B12 and D intake. Diets that are more restrictive in animal source foods, such as vegan diets, have a greater likelihood of nutritional deficiencies. However, the actual risk of micronutrient deficiency in vegetarian children is relatively difficult to assert based on the limitations of evidence due to the lack of well-designed studies. The risk of vitamin B12 deficiency must be considered in newborns from vegan or macrobiotic mothers and children with the most restrictive diet, as well as the risk of iron, zinc, and iodine deficiency, possibly by performing the appropriate tests. A lacto-ovo-vegetarian diet exposes a low risk if it uses a very varied diet with a sufficient intake of dairy products. Vegan and macrobiotic diets should be avoided during pregnancy and childhood. There is a need for education and nutrition guidance and the need for supplementation should be assessed individually

Dietary Approaches to Iron Deficiency Prevention in Childhood&mdash;A Critical Public Health Issue

Iron is an essential nutrient, and individual iron status is determined by the regulation of iron absorption, which is driven by iron requirements. Iron deficiency (ID) disproportionately affects infants, children, and adolescents, particularly those who live in areas with unfavorable socioeconomic conditions. The main reason for this is that diet provides insufficient bioavailable iron to meet their needs. The consequences of ID include poor immune function and response to vaccination, and moderate ID anemia is associated with depressed neurodevelopment and impaired cognitive and academic performances. The persistently high prevalence of ID worldwide leads to the need for effective measures of ID prevention. The main strategies include the dietary diversification of foods with more bioavailable iron and/or the use of iron-fortified staple foods such as formula or cereals. However, this strategy may be limited due to its cost, especially in low-income countries where biofortification is a promising approach. Another option is iron supplementation. In terms of health policy, the choice between mass and targeted ID prevention depends on local conditions. In any case, this remains a critical public health issue in many countries that must be taken into consideration, especially in children under 5 years of age

Traitements de la constipation fonctionnelle aiguë et chronique du nourrisson et de l'enfant (de la théorie au conseil officinal)

La constipation, pathologie fréquente en pédiatrie à l origine de 3 à 10% des consultations d un pédiatre et de 10 à 25% de celles d un gastropédiatre. Elle est caractérisée par une réduction de la fréquence de défécation souvent associée à une encoprésie, une exonération de selles volumineuses et dures, une rétention et des douleurs lors de la défécation. Pour soulager l enfant, le pharmacien se trouve être souvent le premier interlocuteur des parents qui attendent de lui des conseils simples, efficaces et non délétères ou une orientation vers un médecin si cela s avère nécessaire. Parmi les étiologies organiques médicales, anatomiques, médicamenteuses et fonctionnelles, seules les deux dernières ont été abordées. Dans un premier temps, le traitement repose sur l application de règles hygiéno-diététiques. Si ces conseils s avèrent insuffisants, l administration conjointe d un traitement médicamenteux doit être envisagée. Il existe de nombreux traitements à disposition. Cependant, la littérature scientifique très abondante sur ce sujet constate, pour la plupart des molécules utilisées, un niveau de preuve souvent faible. Toutes les recommandations font état de l intérêt de l utilisation du polyéthylène glycol, seule molécule ayant réellement démontré son efficacité dans la prise en charge de la constipation de l enfant. Pour obtenir un bénéfice maximum, ce traitement doit être accompagné d une rééducation. Le but de ce travail de thèse a été d orienter le pharmacien d officine dans l optimisation de la prise en charge des enfants souffrant de constipation tant au niveau pharmacologique qu éducationnel.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF