1/49. Multiple spontaneous small bowel anastomosis in premature infants with multisegmental necrotizing enterocolitis.BACKGROUND/PURPOSE: Fulminant necrotizing enterocolitis (NEC) may result in extensive bowel necrosis. Resection of involved segments may result in short bowel syndrome. Multiple stomas result in complications and further loss of intestinal length with closure. methods: Two patients with extensive multisegmental NEC were treated with an intraluminal stent without anastomosis. All necrotic intestine was resected and the remaining viable intestine was lined up over a feeding tube without anastomosis of the intestinal segments. One patient had a diverting jejunostomy and mucous fistula with the tube used to orient the defunctionalized intervening intestinal segments. The second patient had the bowel left in continuity with the tube brought into the jejunem proximal to the first area of resection and distally brought out through the tip of the appendix. Both tubes were brought through the abdominal wall and secured in a loop. RESULTS: Contrast study findings showed that the intestinal segments had auto-anastomosed. In the first case the tube was left in place and intestinal continuity was restored. The patient is now 4 years old and takes full enteral feeds. The latter patient had the enterostomy tube removed at the time of the contrast study, but only tolerated partial feedings and died at 1 year of total parenteral nutrition-related liver failure. CONCLUSION: The technique eliminates nonviable bowel, maximizes length, avoids multiple stomas, and may help avoid reoperation.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
2/49. Management of cholestasis in infants with very low birth weight.Infants with very low birth weight (VLBW) are at increased risk of cholestasis when compared with older infants and children. Factors associated with this increased risk of cholestasis include immaturity of the biliary excretory system, a diminished immune response to sepsis, an increased incidence of necrotizing enterocolitis and short bowel syndrome, as well as an increased exposure to parenteral nutrition (PN). The current literature on cholestasis in VLBW infants and the factors that mediate the initiation and progression of cholestatic liver damage is reviewed. A protocol for managing infants with cholestatic jaundice is presented, and a case report is included that shows use of the protocol to normalize the bilirubin in a VLBW infant with severe cholestatic jaundice.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
3/49. A case of protein-losing enteropathy caused by intestinal lymphangiectasia in a preterm infant.Intestinal lymphangiectasia is characterized by obstruction of lymph drainage from the small intestine and lacteal dilation that distorts the villus architecture. Lymphatic vessel obstruction and elevated intestinal lymphatic pressure in turn cause lymphatic leakage into the intestinal lumen, thus resulting in malabsorption and protein-losing enteropathy. Intestinal lymphangiectasia can be congenital or secondary to a disease that blocks intestinal lymph drainage. We describe the first case of intestinal lymphangiectasia in a premature infant. The infant presented with peripheral edema and low serum albumin; high fecal concentration of alpha(1)-antitrypsin documented intestinal protein loss. endoscopy showed white opaque spots on the duodenal mucosa, which indicates dilated lacteal vessels. histology confirmed dilated lacteals and also showed villus blunting. A formula containing a high concentration of medium chain triglycerides resulted in a rapid clinical improvement and normalization of biochemical variables. These features should alert neonatologists to the possibility of intestinal lymphangiectasia in newborns with hypoalbuminemia and peripheral edema. The intestinal tract should be examined for enteric protein losses if other causes (ie, malnutrition and protein loss from other sites) are excluded. The diagnosis rests on jejunal biopsy demonstrating dilated lymphatic lacteal vessels.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
4/49. Case report: total parenteral nutrition extravasation associated with spinal cord compression and necrosis.A preterm infant, whose course was complicated by sepsis, necrotizing enterocolitis with jejunal perforation, intraventricular hemorrhage and cerebellar hemorrhage, suffered permanent and total paralysis below the neck from extravasation of parenteral nutrition fluids through a femoral venous catheter. MRI imaging revealed extravasation of fluid into the paraspinus musculature with extension into the spinal canal. This fluid was identified as hyperalimentation and intralipid. Postmortem examination found evidence of necrosis of the spinal cord as well as perforation of the right iliac vein.- - - - - - - - - - ranking = 5keywords = nutrition (Clic here for more details about this article) |
5/49. Continuous insulin infusion: promoting growth in low birth weight infants.Development of improved technologies in neonatal care has yielded increasing numbers of surviving low birth weight (LBW) infants who have challenged methods of supportive care. As researchers and practitioners have focused on respiratory, cardiac, and other body system requirements, nutritional support has been low on the priority list. Support for growth and maximized neurologic development, rather than simply for survival, has been the challenge in care of small and sick newborns. Use of insulin to enhance glucose tolerance in LBW infants, and thereby maximize growth, is a management modality that can be initiated early in the infant's course and is facilitated by implementation of clear and consistent policies and procedures. Continuous insulin infusions have been demonstrated to enhance glucose uptake and utilization--facilitating neonatal growth and in turn enhancing brain growth and developmental outcome.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
6/49. Pneumatosis coli, a benign form of necrotising enterocolitis.Necrotising enterocolitis (NEC) is the most common acquired gastrointestinal emergency in neonates. Presence of pneumatosis intestinalis is taken as evidence of definite NEC. A distinctive but rare form of NEC called "pneumatosis coli" has been described, presenting with gross blood in stools and minimal or absent local and systemic signs. radio-graph characteristically reveal isolated colonic pneumatosis without small bowel involvement. Pneumatosis coli has a more benign course compared with definite NEC. Total parenteral nutrition, antibiotics, an appropriate duration off feeds and close observation remain the corner stones of therapy assuring a benign course.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
7/49. Fracture and fortified breast milk in an extremely preterm infant.Metabolic bone disease (MBD) in the newborn predominantly affects preterm infants. The risk of MBD is inversely proportional to gestational age and birthweight, and directly related to postnatal complications. Poor bone mineralization has been shown in 55% of infants born at less than 1000 g. Optimal nutrition for very preterm infants is thought to be mother's own milk but supplementation is required to meet dietary requirements. However, there is insufficient evidence to determine that supplementation of human milk with commercial fortifiers has an effect on bone mineral content. We report a case of severe MBD with fractures in an extremely preterm infant who was fed with fortified mother's milk.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
8/49. cardiac tamponade from a fine silastic central venous catheter in a premature infant.A 790 g infant developed cardiac tamponade 17 h after starting parenteral nutrition through a fine silastic catheter, the tip of which was accidentally positioned against the wall of the right atrium. Cold light examination suggested the diagnosis and pericardial aspiration of clear fluid with a high glucose content restored the circulation.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
9/49. cardiac tamponade from percutaneous central venous catheterization: report of one case.central venous catheters (CVC) are occasionally associated with life-threatening extravasation complications. We report a case of cardiac tamponade in a premature infant complicating with percutaneous central venous catheter. The baby developed respiratory distress while receiving parenteral nutrition through a central venous line. Chest X-ray films revealed progressive increasing cardiomegaly and 2-dimensional (2-D) echocardiography showed a "swinging heart." A diagnosis of cardiac tamponade was made and the baby was rescued under emergency pericardiocentesis and removal of the central catheter. The aspirated fluid was the content of parenteral fluid administered.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
10/49. Management of infiltration injury in neonates using duoderm hydroactive gel.Neonates are at increased risk of injury from infiltration of intravenous fluids because of small vessel size and immature skin structure. Until recently, hyaluronidase injection was used to prevent tissue injury following the infiltration of intravenous solutions in neonates. The production of hyaluronidase injection was discontinued in 2001. The alternative, compounded hyaluronidase injection is not regulated by the U.S. food and Drug Administration and is subject to variation in quality assurance practices. Amorphous hydrogels have been used as wound dressings for sloughy or necrotic wounds in a variety of clinical settings. hydrogels facilitate autodebridement of the wound by rehydrating slough and enhancing the rate of autolysis. No adverse effects or increased infection rates have been associated with the use of hydrogel dressings. DuoDerm Hydroactive gel is a sterile, preservative-free, viscous, hydrating gel composed of natural hydrocolloids. We report our experience using DuoDerm Hydroactive gel for management of injury secondary to the infiltration of total parenteral nutrition solution and lipid emulsion in three neonates.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
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