RESUMO
In many centers presurgical term neonates with prostaglandin-dependent cardiac lesions experience nutritional deficiency because of postponed enteral feeds. We recently adopted early enteral feeding in these infants. This retrospective study demonstrates feeding tolerance in 33 of 34 neonates fed enterally while receiving prostaglandin, suggesting the safety of this practice.
Assuntos
Alprostadil/uso terapêutico , Nutrição Enteral/efeitos adversos , Enterocolite Necrosante/etiologia , Cardiopatias Congênitas/tratamento farmacológico , Cuidados Pré-Operatórios , Vasodilatadores/uso terapêutico , Alprostadil/administração & dosagem , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos , Vasodilatadores/administração & dosagemRESUMO
OBJECTIVES: To determine whether neonates undergoing major abdominal surgical procedures in the first day of life could achieve a positive protein balance without protein toxicity in the immediate perioperative period by using parenteral amino acids and fentanyl analgesia. STUDY DESIGN: Newborns undergoing major surgery for gastroschisis in the first 24 hours of life (n = 13) were alternately allocated to immediate postoperative parenteral administration of 1.5 g/kg(-1)/day(-1) versus 2.5 g/kg(-1)/day(-1) amino acids. Protein balance was determined at 1.6 to 2.6 days postoperatively with both nitrogen balance and leucine stable isotope methodology. Statistical analyses were conducted with the unpaired t test and linear regression. RESULTS: Protein balance was significantly different in the 2 groups with both nitrogen balance and leucine stable isotope methodology. There was no evidence of protein toxicity as determined with blood urea nitrogen, creatinine, and ammonia concentrations. CONCLUSIONS: Neonates undergoing the metabolic stress of abdominal surgery shortly after birth are able to achieve a net positive protein balance with parenteral amino acid administration without evidence of protein intolerance.
Assuntos
Abdome/cirurgia , Aminoácidos/administração & dosagem , Aminoácidos/metabolismo , Analgésicos Opioides/administração & dosagem , Proteínas Alimentares/administração & dosagem , Proteínas Alimentares/metabolismo , Fentanila/administração & dosagem , Nutrição Parenteral Total , Cuidados Pós-Operatórios/métodos , Amônia/sangue , Glicemia/metabolismo , Nitrogênio da Ureia Sanguínea , Calorimetria Indireta , Isótopos de Carbono , Creatinina/sangue , Feminino , Humanos , Recém-Nascido , Infusões Intravenosas , Masculino , Nutrição Parenteral Total/métodos , Período Pós-Operatório , Índice de Gravidade de DoençaRESUMO
Six of 22 mothers with gestational diabetes mellitus had infants with macrosomia, cord blood hyperinsulinemia, and increased amounts of a key mitogenic intermediate, farnesylated p21-Ras. The ability of fetal hyperinsulinemia to increase the availability of farnesylated p21-Ras may represent one mechanism of the growth-promoting action of insulin during fetal development.