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We report a 27-week, 850 g infant with severe Streptococcus group B sepsis and life-threatening hyperkalemia due to progressive anuria. On the fourth day of life, after he failed treatment with diuretics, salbutamol, insulin, calcium gluconate and sodium bicarbonate, he was treated with sorbitol-free Kayexalate enemas. Potassium level slowly decreased from 9.2 mmol/l to normal level along with a recovery of normal urine output. On the 11th day of life, clinical and radiological signs of a perforated necrotizing enterocolitis (NEC) occurred and the patient required surgical intestinal resection. Histologic examination of the ileum specimen revealed areas of necrosis with fibrosis and giant cell reaction to a nonpolarizable material consistent with sodium polystyrene sulfonate. Usually, Kayexalate is suspended in hyperosmolar sorbitol solutions and the elevated osmolarity seems to be responsible for hemorrhagic colitis, transmural necrosis and definitely NEC. Our case report shows that Kayexalate per se, and not necessarily suspended in sorbitol, can lead to gastrointestinal tract complications and NEC in preterm infants.

It is important to suspect congenital hypopituitarism in the presence of persistent neonatal hypoglycemia associated with jaundice and of a precocious and severe reduction of the growth velocity in childhood. In all these cases, it is necessary to undertake a hypothalamic-pituitary magnetic resonance imaging scan as soon as possible, and to start appropriate treatment.

MAFFEIS, CLAUDIO, YVES SCHUTZ, LORENZA CHINI, ALESSANDRA GREZZANI, RITA PICCOLI, AND LUCIANO TATÒ . Effects of dinner composition on postprandial macronutrient oxidation in prepubertal girls. Obes Res. 2004;12:1128 -1135. Objective: To see whether a fat-rich (50%) evening meal promoted fat oxidation and a different spontaneous food intake on the following day at breakfast than a meal with a lower fat content (20%) in 10 prepubertal obese girls. Research Methods and Procedures:The postabsorptive and postprandial (10.5 hours) energy expenditure after a low-fat (LF) (20% fat, 68% carbohydrate, 12% protein) and an isocaloric (2.1 MJ) and isoproteic high-fat (HF; 50% fat, 38% carbohydrate, 12% protein) meal were measured by indirect calorimetry. Results: Fat oxidation was not significantly different after the two meals [LF, 31 Ϯ 9 vs. HF, 35 Ϯ 9 g/10.5 hours, p ϭ not significant (NS)]. The girls oxidized 1.8 Ϯ 0.9 times more fat than that ingested (11.1 grams) with the LF meal vs. 0.3 Ϯ 0.3 times more fat than that ingested (27.1 grams) with the HF meal (p Ͻ 0.001). Carbohydrate oxidation was significantly higher after an LF than an HF meal (39 Ϯ 12 vs. 29 Ϯ 9 g/10.5 hours, p Ͻ 0,05). At breakfast, the girls spontaneously ingested a similar amount of energy (1.5 Ϯ 0.7 vs. 1.5 Ϯ 0.6 MJ, p ϭ NS) and macronutrient proportions (fat, 23% vs. 26%, p ϭ NS; protein, 9% vs. 10%; carbohydrate, 68% vs. 64%,) independently of their having eaten an HF or an LF dinner. Discussion: An HF dinner did not stimulate fat oxidation, and no compensatory effect in spontaneous food intake was observed during breakfast the following morning. Cumulated total fat oxidation after dinner was higher than total fat ingested at dinner, but a much larger negative fat balance was observed after the LF meal. Spontaneous energy and nutrient intakes at breakfast were similar after LF and HF isocaloric, isoproteic dinners. This study points out the lack of sensitivity of short-term fat balance to subsequently readjust fat intake and emphasizes the importance of an LF meal to avoid transient positive fat imbalance.

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