Neonatology

Aim
This study evaluated the long-term effects of enteral glutamine supplementation on neurodevelopmental outcomes of a Dutch cohort of very preterm children at 13 years of age.

Methods
The cohort was enrolled in a randomised placebo-controlled trial between 2001 and 2003 in which infants received glutamine- or alanine-supplemented enteral nutrition during the first month of life. Participants were invited for follow-up at a mean age of 13.30 years. Motor, neurocognitive, academic and behavioural outcomes were assessed in 61 children.

Results
No differences were found between the groups regarding motor, intellectual, academic and behavioural functioning. Forward span visuospatial working memory performance was better in the controls (crude/adjusted model: d = 0.67/0.64, p = 0.02/0.02), but no difference was found for backward span. After the data were adjusted for confounders, the groups differed regarding parent-rated attention (crude/adjusted model: d = 0.47/0.73, p = 0.07/0.003), but both groups scored within the normal range.

Conclusion
This was the first study on the long-term effects of enteral glutamine supplementation on the neurodevelopmental outcomes of very preterm children. Our study provided no evidence that enteral glutamine supplementation had any beneficial or adverse effects on the children's motor, neurocognitive, academic and behavioural outcomes at 13 years of age.

Acquired Immuno Deficiency Syndrome has been remained one of the most health issue concerns till recently. HIV infection can be transmitted through unprotected sexual intercourse with an infected partner, unprotected oral sex, injection or transfusion of contaminated blood or blood products, sharing unsterilized injection equipment that was previously used by an infected person and maternal-fetal transmission during pregnancy, at birth or through breastfeeding. Transmission of HIV from an infected patient to a health-care worker has been documented after parenteral or mucous membrane exposure to blood. Oral manifestations are one of the earliest clinical indicators of HIV infection which is independent of CD4 status has a prognostic value. By the way, screening of the AIDS associated manifestations in the oral cavity is a noninvasive and feasible approach, these oral lesions should be used to help diagnose, prevent and intervene in the progression of HIV infection to AIDS. This review includes studies that investigate the impact of HIV infection on personal life and importance of oral lesion in early diagnosis of HIV infection in children. Articles were identified through searches of PubMed MEDLINE from 1970 to 2015, using the MESH based key words.

flora plays an important role in the enterohepatic circuit by breaking bilirubin down into metabolites that are easily excreted in feces and urine as well as by blocking beta-glucuronidase. Newborns lack intestinal flora until about day 3, when the first Lactobacillus and Bifidobacterium colonies begin to appear. [4] By the 2 nd week of life, the number of colonies has grown to resemble those of adults, although studies have shown delayed colonization in babies born by C-section. [4] Research into probiotic usage in some medical fields has made significant progress over the past two decades. While most studies have focused on preventing and treating acute infectious diarrhea and antibiotic-associated diarrhea, probiotics have a broader spectrum and have been successfully used to treat allergic diseases, Helicobacter pylori infections, and in Original Article for the most subjects (45%) in the low-to-intermediate-risk zone, compared to 30% in control Group 1 and 29% in Group 3 (P < 0.05). Eight subjects required light therapy, including two in Group 2 and three in each of control Group 1 and Group 3 (P > 0.05). Conclusions: The use of probiotics to prevent neonatal hyperbilirubinemia or bring down phototherapy admissions does not appear to be cost-effective.

Juan Paola, Becci Irene, 2018. "Le "soin spirituel" pratiqué à l'hôpital. Un regard en néonatologie. Entretien avec Isaline Chammartin, infirmière", dans Pahud de Mortanges René, Schmid Hansjörg, Becci Irene (eds.) Spitalseelsorge in einer vielfältigen Schweiz. Interreligiöse, rechtliche und praktische Herausforderungen, Schulthess,  pp. 135-146.

Introduction-Umbilical venous catheter (UVC) related extravasation is an under recognised yet potentially catastrophic complication which can result in death. Prompt recognition and catheter removal is associated with excellent outcomes but requires a high index of suspicion. A series of near fatal UVC extravasation prompted a retrospective analysis of umbilical catheters placed between April 2011 and July 2013.

Method-All extravasations diagnosed clinically or by ultrasound with an umbilical catheter in situ underwent root cause analysis. Factors looked at were placement, imaging, documentation, symptomatology, biochemistry and outcome after treatment. A simulated access workshop was implemented in September 2012 and posters addressing measurement, radiology and best practice were put in place in April 2013 at point of care.

Results-In 2012 a total of 161 UVC’s were placed, of which. 4.3% extravasated (n=7). In 2013, 3 cases of extravasation occurred up until the end of June with no further cases to date.

An analysis of 16 UVC extravasations reveals 100% were double lumen catheters. In all the babies, the UVC tip was found to be below the diaphragm at the time of extravasation. 87% of these babies had TPN running through the lines. The dextrose concentration in TPN varied between 12.1 to 18.6 %. 25% babies had multiple attempts at UVC insertion. 69% babies had inotropes and/or sodium bicarbonate administered through UVC. In 81% babies, extravasation injury was symptomatic. The most common symptom was abdominal distension (83%) which is subtle and has many other differentials. Other symptoms include nonspecific symptoms like abdominal discoloration (33.3%), hypotension (25%), and hepatomegaly (16.7%). 2 episodes were near fatal.

Conclusion-The majority of UVC extravasations were associated with hypertonic solutions running through catheters in a low position where blood flow is slower predisposing to this complication. The symptoms can be subtle necessitating a high index of suspicion. Early ultrasound is key in diagnosis. Prompt removal of the line with improvement in symptoms is the norm. Simulated access workshops and posters to highlight best practice and complications have helped reduce the incidence of extravasation since implementation.