There is no clear consensus on the correct definition of ideal body weight (IBW) in children or on the best method used to calculate IBW. There are at least 3 ways of obtaining IBW in children. They are (1) the McLaren method, (2) the Moore method, and (3) the body mass index method. In children under the age of 8 years, all of these methods provide relatively similar results across all percentiles. In older children, especially at the lowest and highest percentiles, the different methods provide widely disparate results for IBW. It is important to be consistent in the method used as the different methods will provide different results for IBW.

Because every child has individual needs, there are a variety of infant and pediatric formulas from which to choose. Not only are there several categories of formulas including milk protein-based, soy protein-based, hydrolyzed protein, and amino acid-based, but there are differences between products within each category. Research is being done in the area of formula design for the prevention or treatment of disease. In this article, the authors review types of formulas and their indications for use for infants and children, and review current literature on formula trends.

An estimated 60% of pediatric oncology patients experience malnutrition during cancer therapy. Initiation of enteral nutrition (EN) and parenteral nutrition (PN) are interventions aimed at maintaining and promoting growth. Limited literature addressing perceptions of nutrition support methods exists. To develop effective guidelines on nutrition education, it is important to understand perceptions regarding nutrition support. The purpose of this pilot study was to describe perceptions of pediatric oncology patients and parents regarding the use of EN and PN and identify influencing variables. A convenience sample of pediatric oncology patients and parents were surveyed at a large Midwestern children's hospital. The majority of those surveyed chose PN over EN if they or their child were unable to eat or maintain their nutritional status. Perceptions may be influenced by comfort, ease of nutrition or medication administration, experience, health care team's recommendation, choice, and image. This study provides health care professionals an initial opportunity to understand perceptions of EN and PN, which may provide a foundation for a multi-institutional study and enhance patient and family education.

Growth velocity assessment is a means for tracking growth in infants and children over time. With the revision of the Centers for Disease Control and Prevention (CDC) growth charts in 2000 and the introduction of the World Health Organization (WHO) growth charts in 2006, there is a need for an updated growth velocity reference to provide data that better align with these current charts. In this article, the authors provide data on weight velocity for males and females from birth through 20 years using the WHO data and the revised CDC data. Weight velocity charts can be especially useful when patients are seen within short time intervals and can be used to set weight goals for children requiring nutrition support and for children who are chronically ill.

BackgroundAnti-inflammatory drug development efforts for lung disease have been hampered in part by the lack of noninvasive inflammation biomarkers and the limited ability of animal models to predict efficacy in humans. We used 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in a human model of lung inflammation to assess whether pioglitazone, a peroxisome proliferator-activated receptor-γ (PPAR-γ) agonist, and zileuton, a 5-lipoxygenase inhibitor, reduce lung inflammation.MethodsFor this single center, single-blind, placebo-controlled cohort study, we enrolled healthy volunteers sequentially into the following treatment cohorts (N = 6 per cohort): pioglitazone plus placebo, zileuton plus placebo, or dual placebo prior to bronchoscopic endotoxin instillation. 18F-FDG uptake pre- and post-endotoxin was quantified as the Patlak graphical analysis-determined Ki (primary outcome measure). Secondary outcome measures included the mean standard uptake value (SUVmean), post-endotoxin bronchoalveolar lavage (BAL) cell counts and differentials and blood adiponectin and urinary leukotriene E4 (LTE4) levels, determined by enzyme-linked immunosorbent assay, to verify treatment compliance. One- or two-way analysis of variance assessed for differences among cohorts in the outcome measures (expressed as mean ± standard deviation).ResultsTen females and eight males (29±6 years of age) completed all study procedures except for one volunteer who did not complete the post-endotoxin BAL. Ki and SUVmean increased in all cohorts after endotoxin instillation (Ki increased by 0.0021±0.0019, 0.0023±0.0017, and 0.0024±0.0020 and SUVmean by 0.47±0.14, 0.55±0.15, and 0.54±0.38 in placebo, pioglitazone, and zileuton cohorts, respectively, p<0.001) with no differences among treatment cohorts (p = 0.933). Adiponectin levels increased as expected with pioglitazone treatment but not urinary LTE4 levels as expected with zileuton treatment. BAL cell counts (p = 0.442) and neutrophil percentage (p = 0.773) were similar among the treatment cohorts.ConclusionsEndotoxin-induced lung inflammation in humans is not responsive to pioglitazone or zileuton, highlighting the challenge in translating anti-inflammatory drug efficacy results from murine models to humans.Trial registrationClinicalTrials.gov NCT01174056.

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Fifty-three patients with hematological malignancies who underwent Allo-stem cell transplant (SCT) from HLA-identical siblings were randomly assigned to receive glutamine-enriched parenteral nutrition-PN (GlPN, n = 27) or standard PN (PN, n = 26), in isonitrogenous solutions. Deaths (D+100 and D+180), infections, acute graft versus host disease (GVHD), length of stay, time of neutropenia and intestinal permeability (IP) were studied. Ages, gender, diagnosis, disease status and treatment variables were equally distributed between groups. Survival on D+180 was increased in GlPN (74%) vs PN (46%), P = 0.03 (log-rank), as on D+100 (P = 0.05). Most deaths occurred before D+100, especially in PN (10/26, 39%) vs GlPN (4/27, 15%). GVHD was the most frequent cause of death (8/21, 38%), especially in PN (n = 6, five before D+100). Other outcomes were not affected. IP was affected on admission, was not affected by glutamine enrichment, but consistently worsened throughout the study. Results showed that GlPN was efficacious in increasing short-term survival after Allo-SCT. Benefits of glutamine seem to be independent of mucosal protection, as IP was not affected by its use. A trend to a lower incidence of GVHD deaths may suggest an immunomodulatory role of glutamine. (Bone Marrow Transplant. 2008;41:1021-1027 CommentStem cell transplantation (SCT) is a recognized therapy for an assortment of cancers. Factors affecting 1-year survival include age, health before transplant, the disease and disease stage, and whether donor stem cells are human leukocyte antigen (HLA)-matched or mismatched. Therapyrelated complications associated with SCT include oral and gastrointestinal mucositis, organ toxicities, and graft-vshost disease (GVHD) of the skin, liver, and gastrointestinal tract. These complications all have serious consequences affecting quality of life and overall treatment outcome.Hence, identifying an agent-either nutrient or medication-to counteract the side effects of therapy, protect the organs, and promote quick recovery is an ongoing endeavor.For nearly 2 decades, glutamine (GLN) has been one of these agents of interest to researchers. The amino acid is stored in the skeletal muscles and found circulating in the blood. It is the main fuel source for enterocytes during periods of stress and critical illness, at which time it becomes a "conditionally" essential nutrient. GLN also has a role in immune cell metabolism regulation. These properties suggest a mechanism through which GLN may ameliorate the regimen-related toxicities of SCT.To determine the impact GLN had on clinical outcomes in the SCT population, the authors randomly assigned 53 participants aged 18-64 years to a parenteral nutrition (PN) arm either with or without GLN. The selection criteria included individuals with a hematologic malignancy having no organ dysfunction and receiving a matched-sibling SCT. These participants were then classified as having low-or high-risk disease. Two myeloablative conditioning protocols were used along with 2 regimens for GVH...

Pediatric and adult parenteral nutrition have more similarities than differences. The differences between the two practices become apparent in the time frame for starting support, a few pediatric-specific products, and growth monitoring. The biggest challenge facing the practitioner is to familiarize him- or herself with the wide range of requirements for macro- and micronutrients.