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Coregulated approach to feeding preterm infants with lung disease: effects during feeding.
Thoyre, SM, Holditch-Davis, D, Schwartz, TA, Melendez Roman, CR, Nix, W
Nursing research. 2012;(4):242-51
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Abstract
BACKGROUND Very preterm (VP) infants are at risk for poor oral feeding endurance, early cessation of eating, poor fluid management with aspiration risk, behavioral distress, and unstable heart rate (HR) and oxygenation during feeding. OBJECTIVE The study aims to determine the preliminary effectiveness of a coregulated approach (CoReg) to oral feeding for VP infants at risk for lung disease. METHODS A randomized, within-subject, cross-over design was used with 20 VP infants requiring oxygen at the start of oral feeding. Infants were bottle-fed by the Usual Care approach and by the CoReg approach on two consecutive days for an average of four feedings each. Intervention components included coregulation of suck, swallow, and breathe rhythms using enhanced auditory assessment, infant-guided feeding onsets, and infant positioning in a semielevated, side-lying position. Infant physiology metrics (HR and SaO2) were collected continuously before and during the feeding. Behavioral and auditory indicators of regulation were coded continuously from videotape during the feeding. RESULTS Up to 75 feedings were analyzed (40 Usual Care and 35 CoReg) using repeated measures modeling. CoReg feedings were characterized by more frequent preparation of the infant for the feeding, were more commonly initiated in response to infant readiness cues, had more rest periods and breath regulation events, and had fewer sucking stimulation events. CoReg feedings had less SaO2 variability, decline, and time spent in a desaturated state; less HR fluctuation and decline; less behavioral disorganization; better fluid management; and less observed effort to breathe. DISCUSSION Support is provided for an approach to feeding vulnerable infants. Enhanced auditory assessment of infant feeding rhythms increases the responsiveness of the feeder and improves infant behavioral and physiological responses.
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Blood glucose controller for neonatal intensive care: virtual trials development and first clinical trials.
Le Compte, A, Chase, JG, Lynn, A, Hann, C, Shaw, G, Wong, XW, Lin, J
Journal of diabetes science and technology. 2009;(5):1066-81
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BACKGROUND Premature neonates often experience hyperglycemia, which has been linked to worsened outcomes. Insulin therapy can assist in controlling blood glucose (BG) levels. However, a reliable, robust control protocol is required to avoid hypoglycemia and to ensure that clinically important nutrition goals are met. METHODS This study presents an adaptive, model-based predictive controller designed to incorporate the unique metabolic state of the neonate. Controller performance was tested and refined in virtual trials on a 25-patient retrospective cohort. The effects of measurement frequency and BG sensor error were evaluated. A stochastic model of insulin sensitivity was used in control to provide a guaranteed maximum 4% risk of BG < 72 mg/dl to protect against hypoglycemia as well as account for patient variability over 1-3 h intervals when determining the intervention. The resulting controller is demonstrated in two 24 h clinical neonatal pilot trials at Christchurch Women's Hospital. RESULTS Time in the 72-126 mg/dl BG band was increased by 103-161% compared to retrospective clinical control for virtual trials of the controller, with fewer hypoglycemic measurements. Controllers were robust to BG sensor errors. The model-based controller maintained glycemia to a tight target control range and accounted for interpatient variability in patient glycemic response despite using more insulin than the retrospective case, illustrating a further measure of controller robustness. Pilot clinical trials demonstrated initial safety and efficacy of the control method. CONCLUSIONS A controller was developed that made optimum use of the very limited available BG measurements in the neonatal intensive care unit and provided robustness against BG sensor error and longer BG measurement intervals. It used more insulin than typical sliding scale approaches or retrospective hospital control. The potential advantages of a model-based approach demonstrated in simulation were applied to initial clinical trials.
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Long-term monitoring of patients with infantile-onset Pompe disease on enzyme replacement therapy using a urinary glucose tetrasaccharide biomarker.
Young, SP, Zhang, H, Corzo, D, Thurberg, BL, Bali, D, Kishnani, PS, Millington, DS
Genetics in medicine : official journal of the American College of Medical Genetics. 2009;(7):536-41
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Abstract
PURPOSE To investigate the correlation of the urinary glucose tetrasaccharide, Glcalpha1-6Glcalpha1-4Glcalpha1-4Glc, (Glc4) with skeletal muscle glycogen content and the long-term clinical response to enzyme replacement therapy with recombinant human acid alpha glucosidase in infantile Pompe disease. METHODS Eighteen patients, < or =6 months old, were enrolled in a clinical trial of enzyme replacement therapy for up to 142 weeks. Urinary Glc4, skeletal muscle glycogen, and other clinical and laboratory assessments were made at baseline and at regular intervals. Urinary Glc4 was determined using an isotope-dilution tandem mass spectrometric assay. The clinical response to treatment was defined according to the motor function response. Trends in urinary Glc4 were correlated with the clinical response and compared with serum enzyme markers of skeletal muscle damage, creatine kinase, aspartate aminotransferase, and alanine aminotransferase. RESULTS Urinary Glc4, in contrast to the serum markers, correlated closely with skeletal muscle glycogen content and with the clinical response. Patients with the best response to treatment maintained the lowest levels of Glc4 throughout the trial. CONCLUSION The results from this study support the use of urinary Glc4 for monitoring patients with infantile-onset Pompe disease on therapy.
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Using pedometers to promote physical activity among working urban women.
Garbers, S, Nelson, JA, Rosenberg, T, Chiasson, MA
Preventing chronic disease. 2006;(2):A67
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Lack of agreement between tonometric and gastric juice partial carbon dioxide tension.
Dubin, A, Badie, J, Fernandez, S, Estenssoro, E, Canales, H, Bordoli, G, Pálizas, F
Critical care (London, England). 2000;(4):249-254
Abstract
STATEMENT OF FINDINGS Our goal was to compare measurement of tonometered saline and gastric juice partial carbon dioxide tension (PCO2). In this prospective observational study, 112 pairs of measurements were simultaneously obtained under various hemodynamic conditions, in 15 critical care patients. Linear regression analysis showed a significant correlation between the two methods of measuring PCO2 (r(2) = 0.43; P < 0.0001). However, gastric juice PCO2 was systematically higher (mean difference 51 mmHg). The 95% limits of agreement were 315 mmHg and the dispersion increased as the values of PCO2 increased. Tonometric and gastric juice PCO2 cannot be used interchangeably. Gastric juice PCO2 measurement should be interpreted with caution.