فهرست مطالب bahare imani

The aim of this study was to evaluate postoperative nutritional status in patients who underwent operations due to congenital gastrointestinal anomalies in surgical neonatal intensive care units (NICUs) and to investigate the role of nutrition support teams (NSTs) on the outcome.

A retrospective clinical study was carried out at two NICUs in Dr. Sheikh Pediatric Hospital, Mashhad, Iran. One of the NICUs was supported by NST and the other was not. A total of 120 patients were included through a non-random simple sampling. Different variables such as age, sex, prematurity, type of anomaly, birth weight, use of vasoactive drugs, weight gain in NICU, length of NICU stay, postoperative enteral nutrition initiation, duration of mechanical ventilation, mortality rate, maximum of blood sugar, the amount of calorie delivered to the calorie requirement ratio, and distribution of energy from enteral or parenteral roots were compared between the patients of two NICUs.

Median weight gain and the amount of calorie delivered during NICU stay in subjects of NST-supported NICU was significantly more than other NICU. There was no significant difference in the length of NICU stay, enteral nutrition initiation after the operation, ventilation days, and percent of mortality between the two groups. The percentage of enteral feeding was also increased by about 2.8%, which was not significant.

NST could increase post-operative weight gain and calorie delivery in patients as well as providing an increase in enteral feeding rather than parenteral.

Failure to thrive (FTT) is a common underlying condition in patients with Congenital diaphragmatic hernia (CDH). The aim of current study was to evaluate nutritional status and growth pattern in CDH patients. In current study, we investigated a total of 146 CDH patients who had undergone surgery in Dr. Sheikh Hospital, Mashhad, Iran between April 2006 to November 2013. Due to inaccessibility or lack of cooperation by some parents, 61 cases completed the study. Demographic and anthropometric data along with postoperative complications were taken into consideration. Among the 61 studied cases, 32.7% had died during the initial 6-months after surgery. The mean age of participants was 24.21 ± 30.26 months. According to Z-score classification of weight for height following surgery, 7.3% had severe malnutrition, 4.8% moderate malnutrition and 24.3% mild malnutrition while 51.2% were normal. While current evaluation indicates that the majority of subjects were in the normal range. Most children with congenital diaphragmatic hernia had a normal growth following surgery; however, few cases experienced a reduced growth rate in the early years of their life. Highlighting the need for additional calories to prevent FTT and other complications are recommended.

Several complications during childhood is associated with nutritional status of infants at birth. Therefore, nutritional status of newborns must be evaluated properly after birth. Assessment of the nutritional status of neonates based on anthropometric and physical indices is simple and inexpensive without the need for advanced medical equipment. However, no previous studies have focused on the assessment methods of the nutritional status of infants via anthropometric and physical indices. This study aimed to review some of the key methods used to determine the nutritional status of neonates using anthropometric and physical indices. To date, most studies have focused on the diagnosis of fetal malnutrition (FM) and growth monitoring. In order to diagnose FM, researchers have used growth charts and Ponderal index (PI) based on anthropometric indices, as well as Clinical Assessment of Nutritional (CAN) Score based on physical features. Moreover, in order to assess the growth status of infants, growth charts were used. According to the findings of this study, standard intrauterine growth curves and the PI are common measurement tools in the diagnosis of FM. Furthermore, CAN score is widely used in the evaluation of the nutritional status of neonates. Given the differences in the physical features of term and preterm infants, this index should be adjusted for preterm neonates. Longitudinal growth charts are one of the most prominent methods used for monitoring of the growth patterns of infants.

Few cases of persistent hyperinsulinemic hypoglycemia of infancy (PHHI) have been reported, so far. The main concern in the management of PHHI is to prevent severe hypoglycemia, which can lead to coma, brain damage and mental retardation. Total or subtotal pancreatectomy is normally required for the infants, despite the availability of medical therapies. Case report: In this report, we present the case of a three-day-old male infant with hypoglycemia and seizure, admitted to a hospital in Mashhad with the diagnosis of PHHI. Further evaluations revealed multiple congenital disorders including dextrocardia, posterior communicating aneurysm, atrial septal defect, ventricular septal defect, situs inversus and asplenia. Maximal doses of diazoxide, octreotide and intravenous glucose were prescribed for the infant. The patient was referred to our hospital and subtotal pancreatectomy was performed. In addition, due to frequent hypoglycemic episodes, a near-total pancreatectomy was conducted six days after the first surgery. The patient died eight months after total pancreatectomy at the age of nine months with no follow-ups. Infants with PHHI are at a high risk of severe neurological damage due to severe hypoglycemia, unless immediate and adequate medical interventions are carried out. Considering the co-occurrence of different congenital anomalies and PHHI in the present case, further assessment of concomitant congenital disorders is highly recommended in PHHI patients.

Prognosis of small intestine Artesia، the most common agents causing intestinal obstruction in neonates، has improved in last decades. Some variable such as weight change، type of feeding، post operation oral feeding starting time، and adequacy of energy and protein intake can change patients clinical outcomes. We performed a retrospective study to evaluate all neonates with small intestinal Artesia who were admitted to pediatric intensive care unit (PICU)، during 2002-2010 and followed-up their clinical outcomes over an 8-year period. We reviewed medical records of all patients with small intestinal atresia treated at Dr. Sheikh hospital in the between 2002 and 2010. Information of all patients were recorded، including demographic data، type and location of atresia، other problem or anomalies، being term or preterm، term of stay and length of hospitalization، weight change، type of feeding، post operation oral feeding starting time، and adequacy of energy and protein intake. 65 neonates presented with small intestinal atresia treated at Dr. Sheikh hospital during 2002-2010 entered our study. The age of neonates at admission time was median 3 days (1 day – 2 month). The median weight at reception was 2. 32 0. 6 kg (ranged 0. 75-3. 85 kg). The median of hospitalization period was 15 days. The mean amount of delivered calorie- protein and energy intake was significantly lower than the guidelines of the American Society for Parenteral and Enteral Nutrition (P<0. 001). We recommend full investigation of congenital anomalies and possible prevention of infections and its resultant sepsis in all infants with intestinal atresia، in order to reduce the risk of mortality in these infants.

methylmalonic acidemia (MMA) is a metabolic disorder and especial nutritional support has an important role in improvement of growth and development in these patients. A 3-month old female infant with known MMA was admitted to emergency department of Dr Sheikh Children Hospital with primary diagnosis of pneumonia and sepsis. This patient was a full term baby; MMA was diagnosed at 3th day of her life after several episodes of tachypnea, lethargia, poor feeding and irritability. After patient was stabilized, she was referred to nutritional support team for specialized MMA medical nutritional therapy. The patient’s growth and development improved significantly after 2 months of follow up.

NPO or absence of oral feeding in long term for hospitalized patients and insufficient attention to correct diet of them in hospitals can be seen. Regard to the impact of this issue on nutritional status and growth of children، this study with the aim of identifying the limitations about the nutritional supports of NPO children was done in Mashhad Dr Sheikh children hospital. This cross-sectional study was carried out in all wards of the Dr Sheikh children hospital with a questionnaire which included the items of nutritional cares for NPO children. Results of the present study showed that the total NPO patients during the study were 31. 7 percent of the all patients of the hospital. Reasons of NPO in these patients included esophageal atresia، diaphragmatic hernia، abdominal distention، intestinal obstruction، intestinal mal-rotation، imperforated anus، ileus، other surgery procedures، respiratory distress and loss of consciousness level، unclear reasons and carelessness of staff and biopsy. Nearly 88 percent of patients had total parenteral nutrition (TPN) during the NPO time. A total of 88. 23 percent of patients received intravenous dextrose water serums during the NPO time and 52 percent of them received less than 10 percent of their energy needs during the NPO time. The present study showed that the most important reason of the NPO was surgery in Dr Sheikh children hospital and majority of the NPO patients did not receive sufficient energy during the NPO time. More future researches are needed on the nutrition of NPO children.