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Summary Background Blood urea is considered a marker of amino acid utilization in preterm infants on routine parenteral nutrition. However, the association between blood urea and intravenous amino acid intake remains debated. Aims To evaluate the association between blood urea and both nutrition and clinical data, in a large cohort of preterm infants. Methods Consecutively admitted preterm infants with a gestational age of less than 32 weeks and a birth weight lower than 1250 g on routine parenteral nutrition from the first hour of life were studied. Clinical and nutrition data collected hourly during the hospitalization were used in multiple linear regression analysis. Results We studied 674 patients and 1863 blood urea determinations. Blood urea concentration was positively associated with blood creatinine concentration, intravenous amino acid intake, patent ductus arteriosus and respiratory distress syndrome, and negatively associated with intravenous non-protein energy intakes, daily weight change, gestational age, being small for gestational age, antenatal steroids therapy and reverse flow in the umbilical artery (p Conclusions From a nutrition perspective, in our large cohort of small preterm infants blood urea was positively correlated with intravenous amino acid intake and negatively correlated with intravenous non-protein energy intake. This is in line with current knowledge in human physiology and suggest that a reduction of intravenous amino acid intake based on blood urea concentrations was justified.

Summary Background & aims Long chain n-3 fatty acids (n-3 LCPUFA) play a pivotal role during central nervous system development and the provision of docosahexaenoic acid (DHA) is recommended for the preterm infant. However, there are concerns that oral fish oil, which is a good source of DHA, may adversely affect growth of preterm infants, as it decreases arachidonic acid (ARA). It has been about ten years since fish oil was added to the fat blend of intravenous (IV) lipid emulsions (LE) but information on growth and other clinical outcomes of preterm infants is still scarce. We studied the effect of fish oil containing IV LE vs standard IV LE on growth in a large cohort of preterm infants who received routine parenteral nutrition (PN). Methods We retrospectively reviewed growth data of 546 preterm infants with a birth weight (BW) Results Demographics, birth data and the incidence of the main complications of prematurity were similar between the two groups (IV-FO: n = 240, Gestational age (GA) 197 ± 16 d, BW 942 ± 181 g; CNTR: n = 237, GA 199 ± 17 d, BW 960 ± 197 g). No difference was found in PN and EN energy and macronutrient intakes from birth to 36+0W PMA, as well as in the proportion of human milk to infant milk formula. Weight gain from the regained BW to 36+0W PMA was slightly but significantly higher in IV-FO group: 17.3 ± 2.8 and 16.8 ± 2.7 g∙kg−1∙d−1, IV-FO and CNTR respectively (p = 0.03). There was no difference in length gain and head growth nor in body size at 36+0W PMA between the two groups. Conclusions The use of IV fish oil did not negatively affect weight gain in a cohort of preterm infants. Large randomized controlled trials are needed to assess the effect of IV fish oil on the complication of prematurity and on selected domains of infant development.

A large proportion of extremely low-birth-weight infants requires parenteral nutrition for variable lengths of time. Amino acids are the key ingredients of parenteral nutrition. The goal of appropriate amino acid administration is to promote anabolism and normal cellular development in order to limit the incidence of postnatal growth restriction, which is associated with neurodevelopmental delays. The benefits of early amino acid commencement soon after birth are compelling, especially on nitrogen balance, while long-term outcome studies are lacking. Amino acid administration at 2.5 g/kg per day has been shown to be superior to lower intakes; however, the benefits of intakes above 2.5 g/kg per day remain controversial.

A large proportion of extremely low-birth-weight infants requires parenteral nutrition for variable lengths of time. Amino acids are the key ingredients of parenteral nutrition. The goal of appropriate amino acid administration is to promote anabolism and normal cellular development in order to limit the incidence of postnatal growth restriction, which is associated with neurodevelopmental delays. The benefits of early amino acid commencement soon after birth are compelling, especially on nitrogen balance, while long-term outcome studies are lacking. Amino acid administration at 2.5 g/kg per day has been shown to be superior to lower intakes; however, the benefits of intakes above 2.5 g/kg per day remain controversial.

The aim of the study was to evaluate the effect on growth and neurodevelopment of increasing amino acid (AA) during parenteral nutrition and protein intake during enteral nutrition in extremely low birth-weight infants starting from birth to day of reaching 1800 g body weight.We randomized preterm infants with birth weight 500 to 1249 g either to a high AA/protein intake (HiP [high protein]: parenteral nutrition = 3.5 AA, enteral nutrition = 4.6 protein g · kg · day) or to a standard of care group (StP [standard protein]: parenteral nutrition = 2.5 AA, enteral nutrition = 3.6 protein g · kg · day). The primary outcome was weight gain from birth to 1800 g.TWO:: hundred twenty-six patients were screened, 164 completed the study and were analyzed (82 StP and 82 HiP). Cumulative AA/protein intake from birth to 1800 g was 178 ± 42 versus 223 ± 45 g/kg in the StP versus HiP group respectively, P 0.0001.Blood urea was higher in HiP than in StP group both during parenteral and enteral nutrition (P = 0.004).Weight gain from birth to 1800 g was 12.3 ± 1.6 in StP and 12.6 ± 1.7 g · kg · day in HiP group (P = 0.294). We found no difference in any growth parameters neither during hospital stay nor at 2 years corrected age. Bayley III score at 24 months corrected age was 93.8 ± 12.9 in StP group and 94.0 ± 13.9 in the HiP group, P = 0.92.Increasing AA/protein intake both during parenteral and enteral nutrition does not improve growth and neurodevelopment of small preterm infants 500 to 1249 g birth weight.

Summary Background & aims Lipid emulsions containing fish oil, as source of long chain omega 3 fatty acids, have recently became available for parenteral nutrition in infants, but scanty data exist in extremely low birth weight preterms. The objective of this study was to compare plasma fatty acids and lipid tolerance in preterm infants receiving different doses of a 15% fish oil vs. a soybean oil based lipid emulsion. Methods Preterm infants (birth weight 500–1249 g) were randomized to receive parenteral nutrition with MOSF (30% Medium-chain triglycerides, 25% Olive oil, 30% Soybean oil, 15% Fish oil) or S (S, 100% Soybean oil) both at two levels of fat intake: 2.5 or 3.5 g kg −1 d −1 , named 2.5Fat and 3.5Fat respectively. Plasma lipid classes and their fatty acid composition were determined on postnatal day 7 and 14 by gas chromatography together with routine biochemistry. Results We studied 80 infants. MOSF infants had significantly higher plasma phospholipid Docosahexaenoic acid and Eicosapentaenoic and lower Arachidonic acid. Plasma phospholipids, triglycerides and free cholesterol were all significantly higher in the MOSF-3.5Fat group, while cholesterol esters were lower with MOSF than with S. The area under the curve of total bilirubin was significantly lower with MOSF than with S. Conclusions The use of a lipid emulsion with 15% FO resulted in marked changes of plasma long-chain fatty acids. Whether the benefits of increasing Docosahexaenoic acid outweigh the potential negative effect of reduced Arachidonic acid should be further studied. MOSF patients exhibited reduced lipid tolerance at 3.5 g kg −1 d −1 fat intake. The trial was conducted between January 2008 and December 2012 so we had not registered it in a public trials registry as it is now required for trials that started after July 2008.

Objective To compare the effect of 2.5 vs 4 g/kg/d of amino acid (AA) in parenteral nutrition of extremely low birth weight infants on metabolic tolerance, short-term growth, and neurodevelopment. Study design One hundred thirty-one infants with birth weight between 500 and 1249 g were randomized to 2.5 (standard AA [SAA] group) or 4 (high AA [HAA] group) g/kg/d AA intake, with equal nonprotein energy. The primary outcome was body size at 36 weeks. Results One hundred thirty-one patients were randomized and 114 analyzed (58 SAA group and 56 HAA group). Study groups had similar demographics and clinical characteristics. Elevated blood urea (BU >70 mg/dL = BU nitrogen >32.6 mg/dL) occurred in 24% vs 59% ( P = .000) and hyperglycemia (>175 mg/dL) in 34% vs 11% ( P = .003) of the SAA and HAA patients, respectively. Body weight, length, and head circumference at 36 weeks and 2 years were similar between groups. Bayley Scales of Infant and Toddler Development, Third Edition score was 94 ± 13 in the SAA group and 97 ± 15 in the HAA group ( P = .35). Conclusions The HAA group had higher BU levels and better glucose control. An extra 8 g/kg of AA over the first 10 days of life did not improve growth and neurodevelopment.

To compare plasma lipids in preterm infants given a new lipid emulsion containing 10% fish oil, 50% medium-chain triacylglycerols, and 40% soybean oil, compared with a standard preparation containing 50:50 medium-chain triacylglycerols: soybean oil.Preterm infants weighing1250 g at birth (n=47) were randomly assigned to receive parenteral nutrition with a fish oil lipid (n=23) or soybean oil (n=24). Plasma lipid classes and plasma and red blood cell fatty acids were determined by gas chromatography in cord blood and on postnatal days 7 and 14.On day 7, the infants receiving fish oil lipid had significantly lower plasma phospholipids, cholesterol esters, and free cholesterol but similar triglyceride concentrations. They also had significantly higher phospholipid docosahexaenoic acid (2.77 ± 0.08 versus 2.46 ± 0.01 mol%, P.01) and eicosapentaenoic acid (1.58 ± 0.01 versus 0.25 ± 0.01 mol%, P.01) as well as lower arachidonic acid (10.64 ± 0.29 versus 11.93 ± 0.29 mol%, P.01) compared with those receiving soybean oil. Similar differences were found in red blood cells.The fish oil lipid emulsion was well tolerated, and infants receiving fish oil had lower plasma lipids and improved fatty acids status. The effect of these changes on inflammation, growth, and neurodevelopment should be explored.

Objectives: The aim of the study was an osteosonography assessment of the bone mineralization in young patients with celiac disease (CD) and its relationship with clinical, serological and istological features at diagnosis. Methods: Analysis included 38 children aged 1–11 years with untreated celiac disease at diagnosis. Anthropometric and diseaserelated data were collected. Each patients underwent a quantitative ultrasound bone measurements to measure amplitude dependent speed of sound (Ad-SoS) and bone transmission time (BTT) at hand phalanges. Results: Disturbances of mineral bone density were observed in 7 out of 38 children with diagnosed celiac disease (18.4%). At diagnosis, a pathologic osteosonography have a positive correlation with children with clinical sign of malabsorption: diarrhea (p = 0.03) and failure to thrive (p = 0.05). No correlation was found with atipic (p = 0.5) and silent (p = 0.2) form of CD. No statistical difference was found between children with normal and pathological osteosonography concerning serum anti htTG (p = 0.4) and histological grading (p = 0.3). Conclusions: Osteopenia is a common complication in patients with celiac disease. Our findings show that ultrasound signal parameters are influenced by clinical manifestation of celiac disease: patients with ‘classic’ CD symptoms showed more disturbances of bone mineralization respect patients with ‘atipical’ CD symptoms. No correlation was found between istological grading, serological values of ATtg and disturbances of bone mineralization. There is a need of diagnostic scheme for early diagnosis of mineral bone density disturbances in children with celiac disease.

The improved survival of patients with Thalassemia Major (TM) has allowed new complications to develop in the adult patients. These previously unknown clinical entities require a new approach to the management of thalassemia. Pulmonary dysfunction is one of the least understood, previously unrecognized, complications of TM. Patients and Methods The aim of our study was to define the spirometric pattern and lung damage in 35 TM patients (18 M and 17 F, age range from 18 to 44 years). All were regularly transfused (pre transfusion hemoglobin level 9+/−0,4 g/dl) and chelated (25 with deferoxamine,5 with deferiprone and 5 with both chelators). Their serum ferritin level was 1071+/−628 ng/ml All patients had normal cardiac ejection fraction. Nine patients were active smokers (10+2 pack/years) while 9 had been smokers in the past (6+2 pack/years). Four had a mild allergic asthma under good clinical control, 1 had a mild pulmonary hypertension and 1 had mediastinal hematopoietic tissue. Pulmonary function tests were performed before transfusion and included pulmonary volumes and flows recorded by spirometry; residual volume (RV) and total lung capacity (TLC)measured by helium closed-circuit rebreathing technique; carbon monoxide diffusion capacity (TLCO)measured by single breath method. Results: Only the patient with mediastinal masses showed an obstructive pattern with the FEV1/FVC ratio of 53% of predicted value. Thirteen patients (37%)had a restrictive pattern (TLC