Use of intravenously administered lipid in neonates

In this month's Pediatrics another method for feeding small infants is described. Although the method per se (i.e., intravenous supplementation of tolerated oral feedings) has been used frequently over the past few years, the present application is the first by which intrauterine growth rates with respect to weight, height, and head circumference have been achieved. The unique feature of the current application of the method is inclusion of an intravenously administered fat preparation as part of the nutrient infusate. The impressive growth rates were achieved without the use of central venous catheters with their attendant complications and without the use of indwelling intragastric or intraintestinal tubes. Several aspects of this interesting paper require comment. First, despite the fact that achievement of intrauterine growth rates postnatally has been the goal of neonatologists for a number of years, such a growth rate has never been shown to be beneficial. In fact, it can be argued that infants who are gaining weight, regardless of how slowly, are receiving adequate nutrients to meet on-going metabolic requirements and are not undergoing a net breakdown of endogenous nutrient stores. Furthermore, a number of changes in body composition (e.g., loss of body water) occur postnatally and these changes make a continued intrauterine growth rate almost impossible out major changes in metabolism and/or metabolic requirements. Moreover, most of the weight increase during the last trimester is fat which, perhaps beneficial before birth, may actually be detrimental when deposited postnatally. The appropriateness of a continued intrauterme growth rate is particularly pertinent when it is achieved with an agent that has not been evaluated thoroughly in very small infants (i.e., an intravenous soybean oil [Intralipid]).

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How I treat pediatric venous thromboembolism

Blood ◽

10.1182/blood-2017-04-742320 ◽

2017 ◽

Vol 130 (12) ◽

pp. 1402-1408 ◽

Cited By ~ 29

Author(s):

Guy Young

Keyword(s):

Clinical Trials ◽

Venous Thromboembolism ◽

Large Scale ◽

Central Venous Catheters ◽

Rare Disorder ◽

Central Venous ◽

Management Decisions ◽

Logical Approach ◽

The Past ◽

Medical Disorders

Abstract The incidence of pediatric venous thromboembolism (VTE) has been increasing significantly over the past decade in part as a result of increased recognition of this serious disorder but more so because of the increased use of central venous catheters and other technological advancements involved in the care of ill children. Management of pediatric VTE is a complex undertaking, considering that the vast majority of children who develop this complication have serious underlying medical disorders. Although the incidence is rising, in comparison with adults, this remains a relatively rare disorder, and as such, large-scale clinical trials have not been completed, rendering management decisions to be based on extrapolation from adult data and the experience of the treating physician. Clearly, both are fraught with problems. Thus, day-to-day management remains more art than science until such time that the results from clinical trials (many of which are under way) become available. This edition of “How I Treat” describes the author’s experience in managing 3 common scenarios that one may encounter in pediatric thrombosis and suggests a logical approach to such situations. Furthermore, the author provides 3 algorithms to help guide management decisions.

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The effect of level of environment on sex differences in pre-weaning growth rate in beef cattle

Animal Science ◽

10.1017/s0003356100039039 ◽

1977 ◽

Vol 25 (1) ◽

pp. 47-51 ◽

Cited By ~ 4

Author(s):

I. R. Hopkins

Keyword(s):

Growth Rate ◽

Sex Differences ◽

Beef Cattle ◽

Growth Rates ◽

Additive Models ◽

Regression Equations ◽

Male And Female ◽

Breed Differences ◽

Per Se ◽

Simple Regression

SUMMARYUsing pre-weaning records of 3822 calves from 11 Victorian herds, mean male and female growth rates and corresponding sex differences were calculated for each dam age and herd-year class. From these means simple regression equations relating sex differences and growth rates were calculated. There was a close similarity between equations based on dam age means and those based on herd-year means while correlations between sex differences and male growth rates were high.These results showed that sex differences and female growth rates could be predicted reliably from the level of environment as measured by male growth rate. Sex differences predicted by these regression relationships differed markedly from those predicted by the simple multiplicative and simple additive models generally used in adjusting for sex differences in selection.The results also suggested that other differences such as breed differences may be predictable in the same way and that such differences are determined primarily by the level of environment per se rather than differences in the nature of the components contributing to that level.

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Analysis of Trends, Growth and Instability in Rice Production in Andhra Pradesh

Current Journal of Applied Science and Technology ◽

10.9734/cjast/2020/v39i4231129 ◽

2020 ◽

pp. 40-46

Author(s):

G. P. Sunandini ◽

K. Solmon Raju Paul ◽

Shakuntala Devi Irugu

Keyword(s):

Growth Rate ◽

Productivity Growth ◽

Growth Rates ◽

Sustainable Management ◽

Andhra Pradesh ◽

Management Practices ◽

Annual Growth ◽

Annual Growth Rate ◽

High Productivity ◽

The Past

The study has been taken up with the objective of investigating the trends, pattern of growth and the extent of instability in area, production and productivity of rice crop in Andhra Pradesh state over a period of five and half decades from 1959-60 to 2013-14. Compound Growth Rate and Coefficient of Variation were used to calculate the annual growth rate and instability. The area, production and productivity of rice in this period has increased by 25, 201 and 138 per cent respectively. In this period, the districts were categorised and grouped under different groups based on average productivity of rice. During the study period many of the districts moved from very low productivity to high productivity group. During 1960s, 17 districts are under very low productivity group (<1500 kg/ha) and in 2010s 13 districts are under high productivity group (>3000 kg/ha). During the period 2014-19 in the divided Andhra Pradesh contribution of different productivity groups to the states paddy production was calculated and concluded that 3 districts under high productivity group (>6000kg/ha) contributed 52 per cent of the production. During 2010s annual growth rates for area, production and productivity are 4.08, 4.02 and 1.21 respectively. In all the periods in the past five and half decades, production and productivity growth rates are higher than growth rate in area except in 2010s. Instability was higher in production and area than in productivity. The annual growth rate and the instability of production and area are higher in 2010s. Suitable crop planning is to be initiated, adoption of sustainable management practices are to be intensified to maintain the growth rate and reduce the instability in area and production.

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Treatment refractory Stenotrophomonas maltophilia bacteraemia and pneumonia in a COVID-19-positive patient

BMJ Case Reports ◽

10.1136/bcr-2021-242670 ◽

2021 ◽

Vol 14 (6) ◽

pp. e242670

Author(s):

Zachary Pek ◽

Maria Gabriela Cabanilla ◽

Shozab Ahmed

Keyword(s):

Stenotrophomonas Maltophilia ◽

Opportunistic Pathogen ◽

Central Venous Catheters ◽

First Line ◽

Central Venous ◽

Secondary Complications ◽

The Past ◽

Optimal Medical Management ◽

High Index Of Suspicion ◽

First Line Treatment

Stenotrophomonas maltophilia is an opportunistic pathogen that most often infects patients requiring mechanical ventilation, indwelling central venous catheters and broad-spectrum antibiotics. The reported incidence of S. maltophilia infection has increased over the past two decades, and many of its risk factors are commonly seen in patients with severe COVID-19 infection. Our case regards a patient with severe COVID-19 pneumonia, who subsequently developed disseminated S. maltophilia infection, refractory to first-line treatment and optimal medical management. This case highlights the high index of suspicion required for diagnosing secondary complications in patients with COVID-19 infection and highlights the difficulty in treating disseminated S. maltophilia infection in critically ill patients.

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A Technique for Placement of a Totally Implantable Central Venous Port

Clinical Pediatrics ◽

10.1177/000992289303200515 ◽

1993 ◽

Vol 32 (5) ◽

pp. 313-314 ◽

Cited By ~ 1

Author(s):

Brian F. Gilchrist ◽

Zina Novak

Keyword(s):

Pediatric Patient ◽

Technical Problem ◽

Technical Difficulty ◽

Central Venous Catheters ◽

Central Venous ◽

Operative Field ◽

Central Venous Port ◽

The Past ◽

Venous Port

The use of totally implantable central venous catheters with reservoirs has grown steadily over the past few years. These systems mitigate many of the inherent problems associated with catheter systems that protrude from the skin. Totally implantable systems are easily cared for and permit activities such as swimming. These features have led many surgeons and patients to favor their use. However, some surgeons have resisted their use because of the added technical difficulty in placing the reservoir. The technical problem in seating a subcutaneous reservoir can be solved by utilizing the technique described below. It is especially useful in the pediatric patient, where the operative field is confined.

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