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Very low birthweight (VLBW, &lt, 1500 g) infants may be predisposed to undernutrition during the nutritional transition phase from parenteral to enteral nutrition. We studied the associations among the length of the transition phase, postnatal macronutrient intake, and growth from birth to term equivalent age in VLBW infants. This retrospective cohort study included 248 VLBW infants born before 32 weeks of gestation and admitted to the Children’s Hospital, Helsinki, Finland during 2005–2013. Daily nutrient intakes were obtained from computerized medication administration records. The length of the transition phase correlated negatively with cumulative energy, protein, fat, and carbohydrate intake at 28 days of age. It also associated negatively with weight and head circumference growth from birth to term equivalent age. For infants with a long transition phase (over 12 d), the estimates (95% CI) for weight and head circumference z-score change from birth to term equivalent age were −0.3 (−0.56, −0.04) and −0.44 (−0.81, −0.07), respectively, in comparison to those with a short transition phase (ad 7 d). For VLBW infants, rapid transition to full enteral feeding might be beneficial. However, if enteral nutrition cannot be advanced, well-planned parenteral nutrition during the transition phase is necessary to promote adequate growth.

Very low birthweight (VLBW) infants are at risk of intraventricular haemorrhage (IVH) and delayed closure of ductus arteriosus. We investigated mean arterially recorded blood pressure (MAP) changes during the first day of life in VLBW infants as potential risk factors for a patent ductus arteriosus (PDA) and IVH. This retrospective cohort study exploring MAP changes during adaption and risk factors for a PDA and IVH comprised 844 VLBW infants admitted to the Helsinki University Children's Hospital during 2005-2013. For each infant, we investigated 600 time-points of MAP recorded 4-24 hours after birth. Based on blood pressure patterns revealed by a data-driven method, we divided the infants into two groups. Group 1 (n = 327, mean birthweight = 1019 g, mean gestational age = 28 + (1/7) weeks) consisted of infants whose mean MAP was lower at 18-24 hours than at 4-10 hours after birth. Group 2 (n = 517, mean birthweight = 1070 g, mean gestational age = 28 + (5/7) weeks) included infants with a higher mean MAP at 18-24 hours than at 4-10 hours after birth. We used the group assignments, MAP, gestational age at birth, relative size for gestational age, surfactant administration, inotrope usage, invasive ventilation, presence of respiratory distress syndrome or sepsis, fluid intake, and administration of antenatal steroids to predict the occurrence of IVH and use of pharmacological or surgical therapy for a PDA before 42 weeks of gestational age. Infants whose mean MAP is lower at 18-24 hours than at 4-10 hours after birth are more likely to undergo surgical ligation of a PDA (odds ratio = 2.1; CI 1.14-3.89; p = 0.018) and to suffer from IVH (odds ratio = 1.83; CI 1.23-2.72; p = 0.003).

Teema : turvallinen lääkehoito. Vertaisarvioitu. Lapsiin liittyy potilasryhmänä useita lääkityspoikkeamille altistavia erityispiirteitä. Sekä sairaalassa että perusterveydenhuollossa joudutaan usein käyttämään lääkkeitä, joilta puuttuu myyntilupa tai käyttöaihe lapsille, kyseiselle ikäryhmälle tai hoidettavaan tilaan. Tutkimustietoa erityisesti monilääkityksen haitta- ja interaktioriskeistä, tehosta sekä pitkäaikaisvaikutuksista lapsen kasvuun ja kehitykseen on saatavilla vähän. Lääkeannos määräytyy yksilöllisesti potilaan koon ja iän mukaan, mikä monimutkaistaa lääkehoitoprosessia ja lisää inhimillisten erehdysten riskiä. Lapsilla lääkityspoikkeamat liittyvät usein väärään annokseen, joka voi pilkkuvirheen seurauksena olla jopa kymmenkertainen. Lääkityspoikkeamien seuraukset voivat olla vakavia erityisesti silloin, kun kyseessä on suuren riskin lääke. Lasten lääkitysturvallisuutta voidaan parantaa yhtenäistämällä lääkkeiden käyttöä ja ottamalla käyttöön lääkityspoikkeamia ehkäiseviä suojauksia prosessin tunnistettuihin riskikohtiin.