Randomized trial of sterile water by gavage drip in the fluid management of extremely low birth weight infants

Abstract

Objective: To determine whether extremely low birth weight infants who receive enteral sterile water have a reduction in treated patent ductus arteriosus or death by 28 days compared to infants with routine management.Study Design: A total of 214 infants were enrolled and randomized by 36 h of age to receive up to 50 ml kg À1 per day of enteral sterile water (n ¼ 109) for 7 days or routine fluid management (n ¼ 104). Patent ductus arteriosus treatment was defined as either indomethacin treatment or surgical ligation.Result: The proportion of infants with a treated patent ductus arteriosus or death at <28 days of age was 63% in the sterile water group vs 64% in the control group (relative risk 0.99, 95% confidence interval 0.81 to 1.22). There were no differences in the proportion of infants in the sterile water group vs control group with a treated patent ductus arteriosus (55 vs 48%), death (21 vs 28%), necrotizing enterocolitis or death (24 vs 32%), or bronchopulmonary dysplasia or death at <28 days (80 vs 77%). Daily mean glucose levels were significantly higher (P ¼ 0.04) in control infants than sterile water infants. Conclusion:The use of sterile water did not decrease the incidence of patent ductus arteriosus or other adverse clinical outcomes. The role of enteral sterile water in the fluid management of extremely low birth weight infants remains uncertain.

Comparison of the China growth charts with the WHO growth standards in assessing malnutrition of children

“…On average, the WHO sample children were taller than the CDC sample children 10. Both Japanese breastfed children and Japanese growth charts children were shorter than the WHO growth standards children 18.…”

“…When the WHO weight-for-age curves were compared with the Centers for Disease Control and Prevention (CDC) ones, the median weight was greater for the CDC samples than for the WHO samples except during the first 6 months 10. Overall, the CDC sample children are heavier than the WHO sample children, which implies that the prevalence of underweight (<−2 SD) would be higher when using the CDC charts than when using the WHO charts.…”

“…However, a study in Hong Kong found that the centre of weight for age distribution of the breastfed Chinese children was similar to the one of the WHO growth standards reference population 14. The difference in underweight prevalence of these Chinese children between the China growth charts and the WHO growth standards could be due to the sample selection of children: (1) different type of feeding modes in the two standards (breastfeeding is not a criterion for the China growth reference) 10 15. According to the National Health Survey 2008 in China, the exclusive breastfeeding rate for 0–6-month-old infants was only 27.6%, which was even lower in urban areas (15.8%); only 37% of children aged 12–15 months continued breastfeeding nationwide and 15.5% of urban children continued breastfeeding.…”

Nutrition in pregnancy and early childhood and associations with obesity in developing countries

“…A randomised controlled trial in Nepal found that children 6-8 years old whose mothers received vitamin A, iron, zinc and folic acid supplements during pregnancy from~11 weeks of gestation had significantly greater height, smaller triceps skinfold thickness, subscapular skinfold thickness and arm fat area than those in the control group whose mothers were receiving vitamin A only. However, groups receiving folate alone, folate plus iron or a multiple micronutrient supplement (with the same amount of iron, zinc and folate) did not show similar results (Stewart et al 2009). A longitudinal cohort in India investigated the association between vitamin B 12 and folate status in pregnant women at 18 weeks and 28 weeks of gestation and adiposity and insulin resistance of their children at 6 years of age (Yajnik et al 2008).…”

“…However, groups receiving folate alone, folate plus iron or a multiple micronutrient supplement (with the same amount of iron, zinc and folate) did not show similar results (Stewart et al . ). A longitudinal cohort in India investigated the association between vitamin B 12 and folate status in pregnant women at 18 weeks and 28 weeks of gestation and adiposity and insulin resistance of their children at 6 years of age (Yajnik et al .…”