BackgroundThe nutritional care provided to moderately premature babies is poorly studied. For a large cohort of such babies, we aimed to describe: nutrition practice intentions, comparison of the intended with the actual practice, compliance of actual practice to current nutrition guidelines, and postnatal growth.MethodsA questionnaire was sent out to 29 neonatal intensive care units in France, in order to address practice intentions. In the same units, retrospective patient’s data were collected to assess actual practice, compliance to nutrition guidelines and infant postnatal growth. The cumulative nutritional deficit during the two first weeks of life was calculated and variables associated with ΔZ-score for weight at 36 weeks postconceptional age/discharge (ΔZ-scorew 36PCA/DC) were analysed by multivariate linear regression.Results276 infants born 30 to 33 weeks of gestation were studied. Among them, 76 % received parenteral nutrition on central venous line after birth. On day of life 1 (DOL1), 93 % of infants had parenteral amino acids (AA), at an intake ≥ 1.5 g/kg in 27 % of cases. Lipids were started at ≤ DOL2 in 47 % of infants. There was a divergence between the intended and the actual practice for both AA and lipids intake. The AA and energy cumulative deficit (DOL1 to DOL14) were respectively 10.9 ± 8.3 g/kg and 483 ± 181 kcal/kg. Weight Z-score (mean ± SD) significantly decreased from birth (−0.17 ± 0.88) to 36 weeks PCA/DC (−1.00 ± 0.82) (p < 0.0001), and the extra-uterine growth retardation (EUGR) rate at 36 weeks PCA/DC was 24.2 %. Independent variables associated with ΔZ-scorew 36PCA/DC were AA cumulative intake and DOL of full enteral feeding.ConclusionsNutrition intake was not in compliance with recommendations, and the rate of EUGR was considerable in this cohort. Efforts are needed to improve adherence to nutrition guidelines and growth outcome of moderately preterm infants.

Dear Editors,We read with great interest the review by Goldstein and Devarajan about the risk for progression to chronic kidney disease (CKD) after pediatric acute kidney injury (AKI) published in the April 2011 issue of Pediatric Nephrology [1].In this article, the authors conclude that the incidence of AKI among the pediatric population is increasing and that the etiology is changing. Progress in care has contributed to a substantial improvement in the survival of these children over the years. However, there is still a lack of data on the long-term renal sequelae of pediatric AKI, and little is known on whether a hospitalized episode of AKI in a child can lead to CKD later in life. Indeed, as shown in adult studies, pediatric AKI may progress to CKD, as renal recovery is not complete and there may be structural damage. To the best of our knowledge, extensive studies on the AKI-to-CKD transition in children and adolescents have not yet been carried out.In this letter, we describe the long-term renal outcome of pediatric patients on dialysis due to AKI at our institution. A total of 52 patients were included in this study, all of whom had severe AKI requiring acute renal replacement therapy (RRT) at the pediatric intensive care unit of Bordeaux University Hospital between 1989 and 1996. All children with previously known CKD were excluded from the study.The overall mortality rate was 30% (n=16) among these 52 children. Of the 36 survivors, 23 could not be contacted or refused to participate in the study. In 2008-2009, 12-18 (median 16) years after the pediatric AKI episode, 13 of the 36 survivors (36%) were seen at the daycare clinic to assess different markers of progression to CKD. These markers included blood pressure measurement, determination of glomerular filtration rate (GFR) by measuring 51 Cr-labeled EDTA clearance, and detection of proteinuria (defined as a protein-to-creatinine ratio >50 mg/mmol in a urine sample).In this group (8 boys, 5 girls), the median age at AKI onset was 5 (range 1-14) years. The RRT modality was peritoneal dialysis (7 patients, 54%) and intermittent hemodialysis (6 patients, 46%). Continuous RRT was not available at our hospital at that time. The median duration of RRT was 7 (range 4-14) days. The causes of AKI included hemolytic uremic syndrome (n=4), sepsis (n=3), acute tubular necrosis (n=3), hematologic oncologic complications (n=2), and rhabdomyolysis (n=1).A total of 69% (9/13) of the patients had at least one of the three signs of renal injury 12-18 years after the AKI episode, at a median age of 20 (range 16-28) years. The results of clinical investigations indicated that two patients (15%) had untreated hypertension, seven (54%) had significant proteinuria, and eight (61%) had a decreased GFR (5 with a GFR ranging from 60 to 90 ml/min/1.73 m 2 , 2 with a GFR <60, and 1 with a GFR <30). One patient had abnormalities in all three markers, while two signs of renal injury were found in six patients. Even in the most extreme case, assuming that the 23 patients lost to foll...