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Abstract : Refeeding Syndrome in a Critically Ill Child
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Abstract: Objective: To report a case of a child interned in an ICU of a University Hospital who developed refeeding syndrome, and to review the specific literature pertinent to this area. Case Report: An eight year-old, previously healthy, male patient was admitted for necrotizing pneumonia. On admission the child had a z-score of weight for height of 0.38 and height for age of -0.74. Following 60 days’ hospital admission he had lost 27.5% of initial weight. Enteral tube feeding, with an energy intake equivalent to the basal metabolic rate plus 20% for stress, was initiated and gradually increased during the stabilization phase. After receiving 2000 kcal/day for 5 days, hypophosphatemia was detected in association with an increase in hepatic enzymes and hyperglycemia. No concomitant worsening of the white blood count or evidence of inflammatory activity was present. These alterations were accompanied by an increase in pulse rate and body temperature, thereby leading to a diagnosis of refeeding syndrome. Energy intake decreased to 1520 kcal/day, resulting in a marked improvement of the laboratorial parameters in less than a week. Conclusions: Refeeding syndrome is a potentially dangerous complication of increased caloric administration in critically ill pediatric patients. Early recognition and appropriate adjustment of nutritional support is important to avoid the serious consequences which may ensue if this condition is left untreated. Keywords: Malnutrition, enteral nutrition, nutrition support, intensive care unit, critical illness.Download Full Article |
Abstract : Economic Recessions and Infant Mortality in the U.S., 1999-2008
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Abstract: Objectives: Prior studies of US data from the 1990s have shown that economic growth is associated with higher all cause mortality. This paper updates prior findings to more recent data on US infant mortality for blacks and whites. Methods: We analyzed data from 50 US states from 1999 to 2008 using state fixed-effects regression models stratified to identify the racially disparate impact of each state’s economic performance on infant mortality, controlling for state policy-related variables, reflecting population,% black, % on TANF, % on Medicaid, and alcohol consumption. Results: Economic recessions are significantly associated with lower post-neonatal mortality for white infants, but not black infants. Each 1% decrement a state’s gross state product, would be associated with an approximately 2.3 fewer infant deaths (95% CI: -0.294-4.894) in an average state with 64,000 total births. Results were robust to the inclusion of state trends, national trends, state fixed effects, lagged gross state product, and the inclusion of measures of unemployment and state policy variables. Conclusions: This study in combination with studies from the 1990s reflects growing evidence that economic growth in the US can be harmful to child health. Policy makers need to be informed and mindful about the “side effects” of economic growth on health. Keywords: Infant mortality, economics, recession, racial disparity, USA.Download Full Article |
Abstract : The Utilization of Process Evaluations in Childhood Obesity Intervention Research: A Review of Reviews
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Abstract: Process evaluations are an essential component to evaluating health promotion programs, however they are consistently under-utilized and oftentimes not reported upon in the literature. This study reports the use of process evaluations in childhood obesity prevention interventions implemented over the past three decades. Seven meta-analyses and systematic reviews were located for this review or reviews, and from these, 119 unique references were identified. Each article was retrieved and read for appropriateness, and 20 were excluded for a variety of reasons (ex. not published in English language), resulting in 99 articles included for this study. Overall, process evaluations were not well reported upon. Only 38 studies reported the fidelity of program implementation, 25 studies tracked participant attendance, 29 studied evaluated participant satisfaction, and 49 studies reported how staff members were trained. Additionally, one-third of the studies did not report using a single type of process evaluation, and only 5 studies reported using all four types. Results from this study suggest that the use of process evaluations has been low in this area of research, which may explain why many obesity prevention studies have reported mixed or modest results. Suggestions for implementing simple, yet effective process evaluations in future studies will be presented. Keywords: Process Evaluation, Childhood obesity.Download Full Article |
Abstract : Maternal and Neonatal Factors Influencing Preterm Birth and Low Birth Weight in Oman: A Hospital Based Study
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Abstract: Background: Preterm births (PTB) and low birth weight (LBW) - the two distinct adverse pregnancy outcomes - are the major determinants of perinatal survival and development. The purpose of this study was to determine the incidence of LBW and PTB and identify the maternal and neonatal risk factors influencing them. Methods: Data for the study come from a cross-sectional retrospective study conducted at the maternity ward of Sultan Qaboos University Hospital (SQUH) in Oman during the period between November 2011 and February 2012. Data on 534 singleton live births that occurred during the study period were extracted from hospital record. Descriptive statistics, bivariate analysis and multivariate logistic regression model were used for data analysis. Results: The incidence of PTB and LBW were observed to be 9.7% and 13.7% respectively. Half (51.8%) of the LBW babies were PTB and 48.2% of the LBW babies were of term births. Differences and similarities were noted for the risk profile for PTB and LBW. Risk factors specific to PTB were maternal age, previous pregnancy loss, and infant’s length, while birth interval, maternal weight and BMI during pregnancy, and gestational age were the risk factors unique to LBW. ANC visit, infant’s gender, Apgar score, and head circumference of infants were the common significant risk factors influencing both LBW and PTB. Conclusions: The incidence of PTB and LBW are moderately high in Oman. They are associated with different risk factors. A greater understanding and modification of identified risk factors would help reduce the incidence of PTB and LBW in Oman. Keywords: Birth weight, Low birth weight, Preterm birth, Incidence, Risk factor, Consanguinity, Oman.Download Full Article |
