Tag: nutrition

Exploring Total Parenteral Nutrition in Newborns

On March 25, 2021

In Child Health Care, Neonatal Care, Newborns, Research

Infants rely on their parents or caretakers to provide them with adequate nutrition needed for healthful physical and mental growth. Some babies aren’t able to receive nutrition via a bottle or a feeding tube due to developmental problems, disease or extreme prematurity. Parenteral nutrition may be necessary to help these infants get the calories and nutrients they need to thrive.

What is Total Parenteral Nutrition?

Parenteral nutrition was first given to babies more than 50 years ago. It has saved thousands of infants’ lives who are unable to take in enough calories and nutrients. The term parenteral refers to bypassing the digestive tract. Total parenteral nutrition means that all of the infants nutrition is delivered in this manner.

Nutrition in the form of carbohydrates, protein, fat, minerals, vitamins and electrolytes are given intravenously in total parenteral nutrition. This can be done by using an injection, but it typically requires that an IV be placed in the navel, hand, scalp or foot.

Emergency versus Ongoing Total Parenteral Nutrition

Preterm infants are often given parenteral nutrition immediately following their birth. This can give these babies the boost of nutrients they need to adjust to life outside of the womb. Total parenteral nutrition may continue to be given as the baby learns to use a bottle or breastfeed. When total parenteral nutrition is going to occur for a short time, medical professionals use smaller veins in a central location on the infant’s body to deliver the nutrients.

In some cases, an infant will need to receive total parenteral nutrition on an ongoing basis. This may be due to kidney or digestive tract problems. If ongoing parenteral nutrition is needed then a central line may be placed in the infant. This allows a larger amount of nutrients to quickly flow to the baby.

Success of Total Parenteral Nutrition in Newborns

Though there are some risks of continuing total parenteral nutrition in newborns, most do extremely well. Several studies have been done that compare the effect of milk feedings versus total parenteral nutrition in preterm infants with very low birthweights. Studies showed that these infants fared extremely well with total parenteral nutrition. The infants receiving total parenteral nurtiion were able to take in larger amounts of protein and carbohydrates versus the infants who were fed a milk diet.

Reflections on Cesarean Section Rates

By Dr. Allen Cherer

On May 9, 2016

In Child Health Care, Neonatal Care

Cesarean section delivery is among the most common surgical procedures. It is estimated that in 2012 alone, over 22 million cesarean deliveries were performed worldwide. Data from the National Vital Statistics show that the total cesarean section rate in the U.S. in 1996 was approximately 21%.

Since that time, there has been a rapid increase in the rate, such that in 2011, close to 1 in 3 mothers delivered by cesarean. Although the rate has leveled since then, there remains no evidence that such a significant increase has been accompanied by a concomitant decrease in maternal or neonatal mortality.

Although cesarean delivery can be life-saving for the fetus, the mother, or both in certain cases, the concern exists that cesarean delivery is overused. Hence, the matter is a global health issue. Since one of the main driving forces for the increased total cesarean rate has been a marked shift to repeat cesarean delivery following a previous primary cesarean section, a concerted effort over the past several years has been to examine closely the factors related to the safe management of the nulliparous pregnancy.

As early as 1985, the World Health Organization (WHO) stated there was no justification for any region to have a cesarean delivery rate greater than 10-15 /100 live births. Nevertheless, the rates continued to increase worldwide with no scientific evidence indicative of substantial maternal or perinatal benefit.

In fact, a number of studies have associated higher rates of cesarean deliveries with negative consequences, including increased maternal and neonatal morbidity and mortality as well as increased consumption of limited health resources by procedures without medical indications.

In March 2014, a consensus report was issued by the American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine on the safe prevention of the primary cesarean section. Among other points, it addressed management guidelines for the most frequent indications for primary cesarean deliveries, namely, labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected macrosomia.

The report encouraged obstetricians to allow more time to progress through a vaginal delivery without intervention, recommended improved and standardized fetal heart rate interpretation and management, and advocated access to non-medical interventionsduring labor, such as continuous labor and delivery support.

A study by researchers at Harvard Medical School and the Stanford University School of Medicine published December 2015 in The Journal of the American Medical Association suggested that based on analyses of cesarean section rates and maternal and neonatal outcomes among 194 WHO member countries the ideal rate of childbirth by cesarean section approximates 19% of all births as opposed tothe previously considered optimal rate of 10-15%. Although the finding is higher than the former target, it remains significantly lower than the current rate in U.S. hospitals.

In its April 2015 position statement on cesarean delivery, the WHO moved away from any target rate. Rather, it emphasized that every effort should be made to ensure cesarean sections are provided to the women in need and only be performed when medically necessary.

It is gratifying that the concept of “target rate” is no longer tied to the delivery of quality medical care. Primarily due to the lack of a consistent classification system to monitor and compare different obstetric profiles, meaningful data relative to cesarean section rates is missing.

It is only when such systems as the Robson Ten Group Classification System are widely adopted by institutions that valid “risk-adjusted”cesarean section rates can potentially be developed and comparisons be made between institutions, regions, and countries.

Proton Radiotherapy: A Gentler Form of Radiation Treatment

By Dr. Allen Cherer

On February 18, 2016

In Child Health Care

Recent studies in Pediatric patients with brain tumors point to the efficacy of a new way of delivering radiation treatment which may result in improved long term outcomes for children. Although not widely available, the new treatment, proton radiotherapy, focuses the radiation dose on the target area alone. Standard photon (X-ray) radiation has the troublesome effect of exposing surrounding healthy tissues and organs to the radiation as well. The new treatment has the distinct advantage of getting to “hard to get to” tumors.

A new study completed at the Massachusetts General Hospital describes the results in a Pediatric patient population with medulloblastoma treated with the usual combination of surgery, radiation, and chemotherapy. Medulloblastoma is a fast-growing, high grade tumor always located in the cerebellum of the brain. It is a relatively rare tumor with more than 70% being diagnosed in children under 10 years of age. Like many tumors, its exact cause is unknown. In the study, the newer form of targeted radiation therapy was used and compared with the more conventional (photon) radiation. The results, as pointed out by Dr. Torunn Yock, Associate Professor of Radiation Oncology at Harvard Medical School, showed comparable survival and tumor recurrence risks as well as long term hormone deficits between the two groups but far fewer side effects related to hearing, cognition, and other organ systems.

The results are exciting in that they demonstrate the efficacy and safety of proton radiotherapy with decreased long term side effects, thus improving the quality of life in these young survivors.

Eating Tips for Your Pregnancy

By Dr. Allen Cherer

On February 7, 2016

In Neonatal Care

The nutritional status of women when becoming pregnant and during pregnancy can have significant influence on infant and maternal health problems. Numerous studies of nutritional education and counseling before and during pregnancy have demonstrated beneficial effects in terms of improved gestational weight, increased head circumference, reduced risk of preterm birth, and reduced risk at birth of maternal anemia.

A pregnant woman needs to ensure that her diet provides enough nutrients and energy for her baby to grow and develop properly and also to make sure her body is capable of sustaining the multiple demands that come with pregnancy. Caloric intake grows with pregnancy and weight gain varies considerably. For the average healthy woman, ideal weight gain is 25-35 lbs during the nine month pregnancy.

Either excessive or insufficient weight gain can be deleterious to the health of both the baby and the mother. In general, mother’s diet needs to be balanced and nutritious, involving right proportions of protein, carbohydrate, and fat while consuming a wide variety of fruits and vegetables.

Specifically, fat should provide no more than 30% of daily calories with monosaturated fats being preferable. Examples are foods such as olive oil, peanut oil, sesame oil, canola oil, avocado, and many nuts and seeds. Excellent sources of carbohydrates are potatoes, rice, pasta, and bread.

Animal-sourced protein includes lean meat and fish, as well as eggs. Beans, lentils, and legumes are good sources of protein as well as being rich in iron. Quinoa is notable as a source of all the essential amino acids. As far as fruits and vegetables, fresh and frozen produce usually have higher vitamin and nutrient content as well as being excellent sources of fiber.

Micronutrient deficiencies can be addressed through diet as well as supplements. The value of prenatal vitamins cannot be overemphasized. Folic acid, iron, vitamin D, calcium, iodine, and zinc are especially important during pregnancy. Adequate folic acid before and during pregnancy is critical in preventing neural tube defects which affect the brain and spinal cord. Recommended daily intake is 400-600 mcg.

During pregnancy, maternal blood volume increases significantly and adequate iron supplementation is required to prevent anemia and promote adequate oxygen carrying capacity. Vitamin D deficiency is common even in the non-pregnant state. Adequate Vitamin D during pregnancy is critical for normal fetal skeletal development and may be beneficial in mother to prevent preeclampsia.

Recommended dose is controversial and ranges from 600-4000 IU/day. Iodine is important for normal fetal thyroid development and function.

Clearly, pregnancy places impressive metabolic demands on the mother’s body. Only through nutritional education and counseling can the best outcomes for both mother and baby be achieved.