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Objective:Oxygen toxicity is thought to contribute to the development of bronchopulmonary dysplasia (BPD). Oxidant injury leads to formation of F(2)-isoprostanes (F(2)-IsoP). We hypothesized that urinary excretion of the stable metabolite of F(2)-IsoP, 8-iso-PGF(2alpha), would be higher in infants who develop BPD than those who did not.Methods:Forty infants <30-weeks gestational age (GA) were enrolled, 24 infants with BPD and 16 without BPD. Urine specimens were collected weekly and stored at -80 degrees C until analyzed. Urinary 8-iso-PGF(2alpha) was measured by gas chromatography/mass spectrometry (GC-MS) and normalized to creatinine excretion.Results:GA and birth weight (BW) were lower in infants who developed BPD than those who did not. Urinary 8-iso-PGF(2alpha) levels in the first or third weeks of age were not significantly different between the two groups.Conclusion:Urinary excretion of 8-iso-PGF(2alpha) in early postnatal life in preterm infants is not correlated with the development of BPD.Journal of Perinatology (2007) 27, 303-306. doi:10.1038/sj.jp.7211684; published online 15 March 2007. [ABSTRACT FROM AUTHOR]

BACKGROUND: Feeding intolerance (ie, achieving and maintaining full enteral feedings) is a significant problem in preterm infants. A relation exists between feeding intolerance and incomplete lactose digestion. OBJECTIVES: We sought to identify the factors relating to lactose digestion and absorption, lactase activity, and small-intestinal mucosal growth. DESIGN: Lactose digestion and absorption, lactase-specific activity, and lumen-to-mucosa water flux as a measure of small-intestinal mucosal surface area were determined by using the triple-lumen perfusion technique on 2 occasions 3 wk apart in 10 preterm infants (x+/-SEM gestational age: 28.0+/-0.2 wk). RESULTS: Lactose digestion and absorption and lactase activity doubled between studies (P=0.035 and P=0.041, respectively). The change in digestion and absorption was related to lactase activity (P=0.034, R2=0.38). Lactase activity correlated with gestational age at birth (P=0.012, R2=0.51). The number of days of feeding explained 80% of the variability in small-intestinal mucosal surface area (P=0.001). CONCLUSIONS: To our knowledge, this is the first study to measure directly lactose digestion and absorption, lactase activity, and small-intestinal surface area in preterm infants. Changes in lactose absorption relate primarily to lactase activity rather than to mucosal growth. We showed directly a relation between enteral feeding and small-intestinal mucosal Copyright © 2005 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

BACKGROUND: Although skinfold-thickness equations are widely used to estimate body fat, their accuracy in a biracial population of female adolescents has not been established. OBJECTIVE: We undertook this study to determine the agreement between 8 widely used skinfold-thickness equations and a 4-compartment criterion model in predicting the percentage body fat of 72 white and 40 African American girls aged 13.0 +/- 1.9 y. DESIGN: The biceps, triceps, suprailiac, subscapular, thigh, calf, and abdominal skinfold thicknesses of the subjects were measured with skinfold calipers and the buttocks circumference with a metal tape. The percentage fat mass (%FM) predicted by using each skinfold-thickness equation was compared with the criterion value calculated by the 4-compartment model on the basis of measurements of body density, body water, and bone mineral content. RESULTS: When the racial groups were analyzed separately, the Bland-Altman analysis indicated that the quadratic equations agreed most closely with the 4-compartment model's measurement of %FM. Agreement of the other equations varied with body fatness. CONCLUSIONS: The quadratic equation of Slaughter et al is recommended for population studies in female adolescents because of its accuracy and simplicity. However, an individual %FM can be over- or underestimated by approximately 10% when this skinfold-thickness equation is used. Copyright © 2000 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

The use of prediction equations has been recommended for calculating energy expenditure. We evaluated two equations that predict energy expenditure, each of which were corrected for two different stress factors, and compared the values obtained with those calculated by indirect calorimetry. The subjects were 55 critically ill children on mechanical ventilation. Basal metabolic rates were calculated with the Harris-Benedict and Talbot methods. Measured resting energy expenditure was 4.72 +/- 2.53 MJ/d. The average difference between measured resting energy expenditure and the Harris-Benedict prediction with a stress factor of 1.5 was -0.98 MJ/d, with an SD delta of 1.56 MJ/d and limits of agreement from -4.12 to 2.15; for a stress factor of 1.3 the average difference was -0.22 MJ/d, with an SD delta of 1.57 MJ/d and limits of agreement from -3.37 to 2.93. The average difference between measured resting energy expenditure and the Talbot prediction with a stress factor of 1.5 was -0.23 MJ/d, with an SD delta of 1.36 MJ/d and limits of agreement from -2.95 to 2.48; for a stress factor of 1.3, it was 0.42 MJ/d, with an SD delta of 1.24 MJ/d and limits of agreement from -2.04 to 2.92. These limits of agreement indicate large differences in energy expenditure between the measured value and the prediction estimated for some patients. Therefore, neither the Harris-Benedict nor the Talbot method will predict resting energy expenditure with acceptable precision for clinical use. Indirect calorimetry appears to be the only useful way of determining resting energy expenditure in these patients. Copyright (c) 1998 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

Accurate methods for determining body fat mass during reproduction are necessary to evaluate energy balance. However, determination of fat mass is complicated during pregnancy by the accretion of water, which invalidates assumptions underlying standard two-compartment models. The extent to which the variability in body water during pregnancy invalidates use of pregnancy-corrected two-compartment models for determination of fat mass in individual women is unknown. Moreover, it is unclear whether body water returns to nonpregnant values by 2 wk postpartum, which is frequently used as the baseline in studies of postpartum women. The present study uses a four-component model as a criterion for evaluating two- and three-component models. Fifty-six healthy, normotensive women between the ages of 19 and 35 y were studied at 36 +/- 1 wk gestation and 15 +/- 2 d postpartum. Total body water (TBW), total body potassium (TBK), body density, and bone mineral content were measured by deuterium dilution, whole-body potassium counting, hydrodensitometry, and dual-energy X-ray absorptiometry (postpartum only), respectively. At 2 wk postpartum, hydration and density of fat-free mass (FFM) had not returned to nonpregnant values, and differed between lactating and nonlactating women (P < 0.05). Accordingly, standard TBW and body density estimates of fat mass differed from four-component estimates at both time points (P < 0.005). Moreover, our data indicate that even when pregnancy-specific values for hydration or density of FFM are used in TBW and body density models, individual fat mass estimates may differ by >3 kg from the four-component value. Fat mass by TBK may differ by >10 kg from fat mass by the four-component model during pregnancy, and by 6 kg postpartum. Use of standard two-compartment models to estimate fat mass results in significant error both during pregnancy and at 2 wk postpartum. Pregnancy-corrected two-compartment models produce reliable mean fat mass estimates during pregnancy, but individual fat mass estimates may vary widely from four-component values. (c) 1997 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

Background: In critically ill children with acute kidney injury (AKI), continuous kidney replacement therapy (CKRT) enables nutrition provision. The magnitude of amino acid loss during continuous venovenous hemodiafiltration (CVVHDF) is unknown and needs accurate quantification. We investigated the mass removal and clearance of amino acids in pediatric CVVHDF., Methods: This is a prospective observational cohort study of patients receiving CVVHDF from August 2014 to January 2016 in the pediatric intensive care unit (PICU) of a tertiary children's hospital., Results: Fifteen patients (40% male, median age 2.0 (IQR 0.7, 8.0) years) were enrolled. Median PICU and hospital lengths of stay were 20 (9, 59) and 36 (22, 132) days, respectively. Overall survival to discharge was 66.7%. Median daily protein prescription was 2.00 (1.25, 2.80) g/kg/day. Median daily amino acid mass removal was 299.0 (174.9, 452.0) mg/kg body weight, and median daily amino acid mass clearance was 18.2 (13.5, 27.9) ml/min/m 2 , resulting in a median 14.6 (8.3, 26.7) % protein loss. The rate of amino acid loss increased with increasing dialysis dose and blood flow rate., Conclusion: CVVHDF prescription and related amino acid loss impact nutrition provision, with 14.6% of the prescribed protein removed. Current recommendations for protein provision for children requiring CVVHDF should be adjusted to compensate for circuit-related loss. A higher resolution version of the Graphical abstract is available as Supplementary information., (© 2021. IPNA.)

Background: Maternal stress following the birth of an infant is well acknowledged. It is particularly so when infants are born prematurely as their mothers cannot fully take on their parenting role until their infant(s) is discharged from neonatal intensive care units (NICUs). In this exploratory study, we examined whether these mothers' parenting stress would lessen during their first-year reunification with their infant(s) as they settle into motherhood at home., Methods: Two groups of mothers with infants born between 24- and 33-week gestational age were recruited. A group of 25 mothers were monitored at their infants' 1-month corrected age (CA) and a second group of 24 mothers were monitored at their infants' 12-month CA. Subjects completed the long form Parental Stress Index (PSI) ranking how stressful they perceive the individual subscales in the Child and Parent Domains of the self-reported questionnaire (PSI-3; Abidin; PAR Inc). The PSI theorizes that the stress mothers perceive is a resultant of their respective characteristics, interactions with their infant(s), family, and environment. Statistical analyses include descriptive statistics, χ 2 square analysis, and independent t-test., Results: There was no significant difference in the levels of perceived stress in the PSI subscales between the two groups of mothers at 1- and 12-month CA. Scores for the majority of respondents fell within the 15th to 80th percentile (% ile) distribution of Abidin's normative population, with some mothers falling below the 15th % ile., Discussion/conclusion: The data collected suggest that: 1. the perceived stress experienced by mothers during their first-year reunited with their preterm infants is within the normal range observed in Abidin's normative population. 2. As the PSI is a self-reported survey, care providers need to be aware that some mothers may downplay their stress responses. 3. With the ability to monitor individual participants, the PSI can be readily offered to mothers at their infants' first year routine clinical visits to assist in the early identification of parenting issues that may threaten the development of a healthy mother-infant dyad. Early appropriate guidance and social support would help "at-risk" mothers develop more constructive parenting routines.

Importance: Immunization with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is recommended in the United States during weeks 27 through 36 of pregnancy to prevent life-threatening infant pertussis. The optimal gestation for immunization to maximize concentrations of neonatal pertussis toxin antibodies is unknown., Objective: To determine pertussis toxin antibody concentrations in cord blood from neonates born to women immunized and unimmunized with Tdap vaccine in pregnancy and optimal gestational age for immunization to maximize concentrations of neonatal antibodies., Design, Setting, and Participants: Prospective, observational, cohort study of term neonates in Houston, Texas (December 2013-March 2014)., Exposures: Tdap immunization during weeks 27 through 36 of pregnancy or no Tdap immunization., Main Outcomes and Measures: Primary outcome was geometric mean concentrations (GMCs) of pertussis toxin antibodies in cord blood of Tdap-exposed and Tdap-unexposed neonates and proportions of Tdap-exposed and Tdap-unexposed neonates with pertussis toxin antibody concentrations of 15 IU/mL or higher, 30 IU/mL or higher, and 40 IU/mL or higher, cutoffs representing quantifiable antibodies or levels that may be protective until the infant immunization series begins. Secondary outcome was the optimal gestation for immunization to achieve maximum pertussis toxin antibodies., Results: Six hundred twenty-six pregnancies (mean maternal age, 29.7 years; 41% white, 27% Hispanic, 26% black, 5% Asian, 1% other; mean gestation, 39.4 weeks) were included. Three hundred twelve women received Tdap vaccine at a mean gestation of 31.2 weeks (range, 27.3-36.4); 314 were unimmunized. GMC of neonatal cord pertussis toxin antibodies from the Tdap-exposed group was 47.3 IU/mL (95% CI, 42.1-53.2) compared with 12.9 IU/mL (95% CI, 11.7-14.3) in the Tdap-unexposed group, for a GMC ratio of 3.6 (95% CI, 3.1-4.2; P < .001). More Tdap-exposed than Tdap-unexposed neonates had pertussis toxin antibody concentrations of 15 IU/mL or higher (86% vs 37%; difference, 49% [95% CI, 42%-55%]), 30 IU/mL or higher (72% vs 17%; difference, 55% [95% CI, 49%-61%]), and 40 IU/mL or higher (59% vs 12%; difference, 47% [95% CI, 41%-54%]); P < .001 for each analysis. GMCs of pertussis toxin antibodies were highest when Tdap vaccine was administered during weeks 27 through 30 and declined thereafter, reaching a peak at week 30 (57.3 IU/mL [95% CI, 44.0-74.6])., Conclusions and Relevance: Immunization with Tdap vaccine during the third trimester of pregnancy, compared with no immunization, was associated with higher neonatal concentrations of pertussis toxin antibodies. Immunization early in the third trimester was associated with the highest concentrations.

Context: Obese Hispanic adolescents (OHAs) with dysglycemia have increased cardiovascular disease risk burden., Objective: To investigate if nonalcoholic fatty liver disease (NAFLD) confers added risk for endothelial dysfunction in these youth., Design: Cross-sectional study., Setting: Academic institution., Participants: Thirty-six OHAs (15.3 ± 0.4 years), 20 with prediabetes and 16 with type 2 diabetes, with and without NAFLD., Intervention: Evaluation of reactive hyperemia index (RHI) and augmentation index (AIx) by peripheral arterial tonometry; muscle, hepatic, and adipose tissue insulin sensitivity (IS; hyperinsulinemic-euglycemic clamp 80 mu/m 2 /min, with [6,6 2 H 2 ]glucose and [ 2 H 5 ] glycerol); body composition; and abdominal and hepatic fat by magnetic resonance imaging/spectroscopy., Outcome Measures: RHI and AIx., Hypothesis: OHAs with dysglycemia and NAFLD have worse RHI and AIx vs those without NAFLD., Results: The NAFLD (n = 23) and non-NAFLD (n = 13) groups were of similar age, sex, glycemic status, body mass index, % body fat and abdominal fat. The NAFLD group had higher hepatic fat ( P < 0.001) lower skeletal muscle IS ( P = 0.01), hepatic IS ( P = 0.01), and adipose tissue IS ( P = 0.04). The NAFLD vs non-NAFLD group had lower RHI (1.4 ± 0.05 vs 1.7 ± 0.09, P = 0.002), greater AIx (-6.0 ± 1.6 vs -12.0 ± 2.1, P = 0.03). Hepatic fat was inversely related to RHI ( r = -0.49, P = 0.002) and positively related to AIx ( r = 0.45, P = 0.006). Hepatic IS ( r = -0.42, P = 0.01) and adipose IS ( r = -.54, P = 0.001) correlated with arterial stiffness (AIx)., Conclusion: In OHAs with dysglycemia, NAFLD is associated with worse endothelial function. RHI and AIx were related to hepatic fat content. Vascular stiffness was related to hepatic and adipose tissue insulin resistance.

Objective: To evaluate the impact of a tuberculosis (TB) educational intervention (EI) on change in adolescent student knowledge and participation in a TB prevention program., Methods: From 2/2013-5/2015, students from 2 high schools in Houston, TX participated. The 25-min EI discussed TB bacteriology, epidemiology, symptoms, and indications for TB testing/treatment. Students completed pre- and post-quizzes. Immediately after the EI, students were invited to participate in voluntary TB risk-factor screening, testing and treatment. At 6 months, focus groups were conducted., Results: 895 students attended the EI. 827 students (92%) completed the EI quizzes. Knowledge improved by 12% (pre: 70%; post: 82%, p<0.001); 78% shared their TB knowledge. Following the EI, 671/827 (81%) enrolled in a TB prevention program. Focus groups indicated that the EI stimulated student learning about TB and increased their willingness to participate., Conclusion: A brief, one-time, TB EI is an effective method to encourage adolescents to learn about TB and motivate their uptake of TB risk-factor screening, testing and treatment. Similar EIs should accompany TB prevention programs targeting adolescents., Practice Implications: The study's procedures could be considered for incorporation into school-based TB prevention programs to improve the identification, testing and treatment of adolescents at risk for TB., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS)., Methods: A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assembled from a single metropolitan health care system. Baseline socioeconomic status (SES) and clinical symptom measures were gathered. Various instruments measured participant and parental psychosocial traits. Study outcomes were stratified by GI referral versus primary pediatrics care. Two separate analyses of SES measures and GI clinical symptoms and psychosocial measures identified key factors by univariate and multiple logistic regression analyses. For each analysis, identified factors were placed in unadjusted and adjusted multivariate logistic regression models to assess their impact in predicting GI referral., Results: Of the 239 participants, 152 were referred to pediatric GI, and 87 were managed in primary pediatrics care. Of the SES and clinical symptom factors, child self-assessment of abdominal pain duration and lower percentage of people living in poverty were the strongest predictors of GI referral. Among the psychosocial measures, parental assessment of their child's functional disability was the sole predictor of GI referral. In multivariate logistic regression models, all selected factors continued to predict GI referral in each model., Conclusions: Socioeconomic environment, clinical symptoms, and functional disability are associated with GI referral. Future interventions designed to ameliorate the effect of these identified factors could reduce unnecessary specialty consultations and health care overutilization for IBS.

We developed a bedside algorithm for individually adjusting the high-dose methotrexate (HDMTX) dose (5 g/m) given to patients with acute lymphoblastic leukemia at high risk for methotrexate toxicity. Data were reviewed for 8 patients receiving 21 cycles of HDMTX as per our algorithm. Eleven cycles began with 5 g/m, 10 cycles began with a preinfusion 20% to 25% dose reduction. Neither mean MTX AUC (2320.5±179.1 vs. 2080.4±161.7 μmol×h/L), mean Cpss (64.3±7.9 vs. 60.8±6.1 μM), nor toxicities were statistically different between groups. Our algorithm allowed the safe administration of HDMTX to patients at risk of MTX toxicities and obviated the need for preinfusion dose reduction.

Objectives: Improving self-esteem, dietary habits, and physical activity is essential for long-term success in childhood obesity prevention. The aim is to evaluate the effects of a healthy living promotion program, Healthy Kids-Houston, on BMI, dietary habits, self-esteem, and physical activity among minority children., Methods: The after-school program was implemented at community centers in low-income neighborhoods with close proximity to public schools. The program consisted of 3 6-week sessions. Each week, children attended 2 2-hour sessions. Each 2-hour session in the intervention included 90 minutes of structured physical activities and 30 minutes of nutrition and healthy habit lessons. The control group received typical enrichment programs. Outcomes were measured before the intervention and at the end of each 6-week session., Results: We enrolled 877 children (age 10.2 ± 0.1 years (mean ± SE); body mass index z score: 1.49 ± 0.1; 52.0% boys; 72.6% Hispanic) in the program with 524 children received the intervention at 14 community centers and 353 children served as control at 10 community centers. The intervention led to no improvements in BMI z score (P = 0.78) and dietary habits (P = 0.46). Significant improvements (P ≤ 0.02) were detected in the amount of exercise that a child perceived to be required to offset a large meal and in several key self-esteem scores. No improvements were detected in physical activities (P ≥ 0.21)., Conclusions: The improvement in some key self-esteem scores and nutrition knowledge may act as a mediator to motivate these children to adopt a healthier lifestyle in the future.