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OBJECTIVE: To determine the prevalence of micronutrient deficiencies in children with intestinal failure as they transitioned from parenteral nutrition (PN) to enteral nutrition (EN). STUDY DESIGN: We reviewed medical records of all patients with severe intestinal failure treated from 1999 to 2008 at a multidisciplinary intestinal rehabilitation program who had undergone micronutrient biochemical monitoring. RESULTS: The cohort of 30 children (mean age, 5 years; range, 2 to 9 years; 18 boys) had median PN duration of 23 weeks (IQR, 13 to 34 weeks). Median transition from PN to full EN lasted 12 weeks (IQR, 8 to 20 weeks); during this transition, 33% of patients had at least one vitamin deficiency and 77% at least one mineral deficiency. After transition to 100% EN, 70% had at least one vitamin deficiency and 77% had at least one mineral deficiency, with the most common deficiencies being vitamin D (68%), zinc (67%), and iron deficiency (37%). After transition to 100% EN, multivariate analysis identified regular use of a multivitamin supplement (P=.004) and intact ileocecal valve (P=.02) as protective against the development of vitamin deficiencies, independent of bowel length, gestational age, and days on PN. CONCLUSIONS: Children with intestinal failure exhibit a high prevalence of micronutrient deficiencies during intestinal rehabilitation. Regular monitoring and aggressive supplementation in children with intestinal failure is warranted.

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OBJECTIVE: To determine risk factors for intestinal failure (IF) in infants undergoing surgery for necrotizing enterocolitis (NEC). STUDY DESIGN: Infants were enrolled in a multicenter prospective cohort study. IF was defined as the requirement for parenteral nutrition for >or= 90 days. Logistic regression was used to identify predictors of IF. RESULTS: Among 473 patients enrolled, 129 had surgery and had adequate follow-up data, and of these patients, 54 (42%) developed IF. Of the 265 patients who did not require surgery, 6 (2%) developed IF (OR 31.1, 95% CI, 12.9 - 75.1, P < .001). Multivariate analysis identified the following risk factors for IF: use of parenteral antibiotics on the day of NEC diagnosis (OR = 16.61, P = .022); birth weight < 750 grams, (OR = 9.09, P < .001); requirement for mechanical ventilation on the day of NEC diagnosis (OR = 6.16, P = .009); exposure to enteral feeding before NEC diagnosis (OR=4.05, P = .048); and percentage of small bowel resected (OR = 1.85 per 10 percentage point greater resection, P = .031). CONCLUSION: The incidence of IF among infants undergoing surgical treatment for NEC is high. Variables characteristic of severe NEC (low birth weight, antibiotic use, ventilator use, and greater extent of bowel resection) were associated with the development of IF.

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Short bowel syndrome is at once a surgical, medical, and a disorder, with potential for life-threatening complications as well as eventual independence from artificial nutrition. Navigating through the diagnostic and therapeutic decisions is ideally accomplished by a multidisciplinary team comprised of nutrition, pharmacy, social work, medicine, and surgery. Early identification of patients at risk for long-term PN-dependency is the first step towards avoiding severe complications. Close monitoring of nutritional status, steady and early introduction of enteral nutrition, and aggressive prevention, diagnosis and treatment of infections such as line sepsis, and bacterial overgrowth can significantly improve prognosis. Intestinal transplantation is an emerging treatment that may be considered when intestinal failure is irreversible and children are suffering from serious complications related to TPN administration.

El síndrome de intestino corto es una entidad médico-quirúrgico, con potencial riesgo para poner en peligro la vida de los niños, y que en su manejo incluye nutrición artificial. El estudio diagnóstico y terapéutico se logra idealmente con un equipo multidisciplinario compuesto de nutricionista, químico, trabajadora social, médico y cirujano. Uno de los primeros pasos, es la identificación anticipada de pacientes a riesgo de presentar complicaciones severas por el uso prolongado de nutrición parenteral. Su pronóstico se mejora con la estrecha supervisión del estado nutricional, por la introducción temprana de la nutrición enteral y la prevención a tiempo en el diagnóstico y tratamiento de infecciones bien de la línea arterial, o por sobrecrecimiento bacteriano. El transplante intestinal emerge como parte del tratamiento que puede ser considerado cuando la falla intestinal es irreversible y en los niños que presentan complicaciones serias relacionadas con la administración de nutrición parenteral.

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BACKGROUND: Previous estimates of daily metabolic rate in infants were based on short-term unstandardized measurements of energy expenditure (EE). OBJECTIVE: Determine 24-hour metabolic profiles in infants. METHODS: Energy expenditure (kcal/min by indirect calorimetry) and physical activity (oscillations in weight/min/kg body weight) were measured in 10 healthy infants (5.0+/-0.8 months, 68+/-3 cm, 7.3+/-0.8 kg) for 24 hours in the Enhanced Metabolic Testing Activity Chamber while allowing parental interaction. Energy intake, 24-hour EE, resting metabolic rate (RMR), and sleeping metabolic rate (SMR) (kcal/kg/day) were determined. In addition, extrapolated 24-hour EE, RMR, and SMR from the first 4 and 6 hours of data were compared with 24-hour measurements. RESULTS: Twenty-four-hour energy intake, EE, RMR, and SMR (mean+/-SD) were 78.2+/-17.6, 74.7+/-3.8, 65.1+/-3.5, and 60.3+/-3.9, respectively. EE and physical activity showed a decrease at 11:30 pm and a return to daytime levels by 5:30 am, suggesting a metabolic circadian rhythm. Extrapolated 24-hour EE, RMR, and SMR from the first 4 hours (72.2+/-6.6, 65.9+/-8.7, and 64.9+/-6.4) and 6 hours (74.8+/-6.7, 65.8+/-6.6, and 64.8+/-5.6) were similar to 24-hour measurements. CONCLUSIONS: An apparent circadian rhythm in metabolic rate and physical activity was detected by 24-hour measurements. Furthermore, shorter-term measurements of the variables were comparable with 24-hour values.

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OBJECTIVES: To derive new equations for 24-hour energy expenditure (24-h EE; kcal/d) and resting (RMR; kcal/d) and sleeping metabolic rates (SMR; kcal/d) in young infants by using the Enhanced Metabolic Testing Activity Chamber (EMTAC). METHODS: Data from 50 (25 male/25 female) healthy normally growing infants (4.9 +/- 1.6 months, 7.1 +/- 1.4 kg, 65 +/- 5 cm) who had 24-h EE, RMR, and SMR extrapolated from 4- to 6-hour metabolic measurements in the EMTAC were used to derive new equations for 24-h EE, RMR, and SMR. Equations were derived by means of multiple regression analysis (SPSS 8.0), with weight alone or with length and weight entered as independent variables. Similar data from 10 additional test infants (4 male/6 female, 5.1 +/- 0.6 months, 7.5 +/- 1.0 kg, 65 +/- 5 cm) were used to cross-validate the new equations. RESULTS: Twenty-four-hour EE, RMR, and SMR were 79.6 +/- 19.2, 66.8 +/- 15.1, and 62.3 +/- 10.3 kcal/kg per day, respectively. No differences existed in RMR (kcal/kg per day) from the 10 test infants between the weight (68.6 +/- 1.9) and height-weight based equations (68.4 +/- 6.1) or that measured by the EMTAC (67.6 +/- 10.2). Weight was the major predictor of 24-h EE, RMR, and SMR. The WHO, Schofield-weight and weight-height equations underestimated (P <.05) by 19%, whereas the new equations were within 4% of RMR obtained from the EMTAC. CONCLUSIONS: The new equations for assessing energy requirements in healthy infants are more accurate than those previously published that underestimated 24-h EE by 15 kcal/kg per day.

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Os autores mostram estudo da atividade mioelétrica gástrica realizada por eletrogastrografia em dois grupos de recém-nascidos (RN) saudáveis (pré-termo e a termo) em que se comparou o traçado do EGG entre ambos. Nao foi encontrada diferença significativa na percentagem de ondas lentas entre os dois grupos, assim como nao ocorreu aumento significativo no período pós-prandial, nem na MnDF, DFIC, DPIC. No entanto a amplitude da onda de freqüência dominante no período pós-prandial, quando comparado ao pré-prandial, aumentou 4,2 vezes nos RN a termo e somente 1,2 nos RN pré-termo (p < O,05). Isso demonstra contraçao gástrica mais eficiente nos RN a termo.

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Neste estudo säo relatados casos de duas crianças do sexo masculino com diabete melito insulino-dependente associado muito provavelmente à doença celíaca. O primeiro caso foi encaminhado com suspeita de hepatite viral tipo A por apresentar provas funcionais hepáticas alteradas. O segundo caso era portador de hepatomegalia anictérica e de um diabete melito de difícil controle. Säo discutidas as relaçöes entre doença celíaca e diabete melito

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