The Lubchenco curves may not represent the current US population. The new intrauterine growth curves created and validated in this study, based on a contemporary, large, racially diverse US sample, provide clinicians with an updated tool for growth assessment in US NICUs. Research into the ability of the new definitions of small-for-gestational-age and large-for-gestational-age to identify high-risk infants in terms of short-term and long-term health outcomes is needed.

Treatment-resistant epilepsy affects 30% of children with epilepsy and results in significantly reduced quality of life. The ketogenic diets offer a chance for significant seizure reduction and seizure freedom. Compliance is strongly linked to the effectiveness of these treatments. The high-fat and low-carbohydrate content of the ketogenic diets makes creating and cooking palatable meals challenging. Keto centers typically support caretakers with recipes, but do not have a kitchen to provide hands-on education. Hence, our program built a ketogenic kitchen in 2013. The purpose of this study was to assess the effects of the kitchen on the quality of our education and confidence of caretakers during both initiation and ongoing outpatient support of the ketogenic diets. An anonymous survey of 37 questions was created using Survey Monkey, with a 5-point scale or yes-no responses. Families whose children have been a part of our dietary treatment program from 2014 to 2016, reachable by e-mail, were asked to take the survey. The data were analyzed using descriptive statistics. Seventy-seven families completed our survey. The overall quality of the classes taught by the dietitians improved with the use of the Ketogenic Teaching Kitchen. Hands-on cooking classes enhanced the learning experience, making our new ketogenic diet families noticeably more confident preparing meals at the time of discharge. The Keto Teaching Kitchen has greatly enhanced our dietary treatment program. We believe that all keto centers would benefit from access to a teaching kitchen.

Breastfeeding continues to be the recommended mode of infant feeding with numerous nutritive and nonnutritive benefits to both mothers and babies. The ketogenic diet (KD) is a high-fat, adequate protein, and very low carbohydrate diet prescribed for infants and children with treatment-resistant epilepsy. Due to the high carbohydrate content of breast milk (BM) and the extremely low carbohydrate allowance of the KD, these 2 modes of feeding are typically not used together. We report our experience to demonstrate that BM can be part of a successful KD treatment. A retrospective chart review was performed and 4 patients met criteria. They were younger than 2 years and were fed BM before KD initiation. All achieved ketosis at low (2-3:1) ratios and remained ketotic while using BM. The average amount of BM consumed was 139 ± 50 mL/day, equivalent to 11 ± 4.5 grams of carbohydrates per day. Three patients achieved >50% reduction in seizure frequency within 2 months of treatment. Patients continued using BM for an average of 105 ± 50 days. For all cases, BM was discontinued due to maternal preference. BM is a viable, preferred, carbohydrate source for infants prescribed the KD.

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Objective. The ketogenic diet (KD) can result in hyperlipidemias. We report improvements in the lipid profiles of 3 children who were switched from KetoCal 4:1 powder (formulation prior to fall 2013) to KetoCal 4:1 Liquid formula. Compared with the KetoCal 4:1 powder formulation prior to fall 2013, KetoCal 4:1 Liquid has no trans-fatty acids, reduced saturated fatty acids, added omega-3 fatty acids, and added fiber. Methods. A retrospective chart review revealed 3 patients in our KD program with elevated lipid profiles while receiving 100% of their nutritional needs from KetoCal 4:1 powder. The patients were switched to KetoCal 4:1 Liquid and treated for >3 months. Fasting lipid profiles were obtained before and 2 to 3 months after the formula switch. All patients were on ≥4:1 ratio KD formula. Results. After changing formulas, the lipid profiles of all 3 patients improved. Mean total cholesterol, triglycerides, and low-density lipoprotein were reduced by 29%, 33%, and 58%, respectively. High-density lipoprotein increased by 10% on average. Conclusion. A decrease in lipid levels was observed with the transition to KetoCal 4:1 Liquid after an average of 2.1 months. Changes in dietary fat profile (including addition of omega-3 fatty acids) and the addition of fiber in enteral formulas can positively affect lipid profiles of tube-fed KD patients.