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Background Although hyperfibrinogenemia and insulin resistance are common in obesity and diabetes mellitus, the impact of obesity per se on fibrinogen turnover and the insulin effects on fibrinogen and protein kinetics is unknown. Methods We measured fibrinogen and albumin fractional (FSR) and absolute (ASR) synthesis rates, as well as protein turnover, in non-diabetic, obese and in control male subjects both before and following an euglycemic, euaminoacidemic, hyperinsulinemic clamp, using L-[2H3]-Leucine isotope infusion. Results In the obese, basal fibrinogen concentrations was ≈ 25% greater (p < 0.035), and fibrinogen pool ≈ 45% greater (p < 0.005), than in controls. Both FSR and ASR of fibrinogen were similar to control values. With hyperinsulinemia, although fibrinogen FSR and ASR were not significantly modified with respect to baseline in either group, fibrinogen ASR resulted to be ≈ 50% greater in the obese than in controls (p < 0.015). Hyperinsulinemia equally stimulated albumin synthesis and suppressed leucine appearance from endogenous proteolysis in both groups. Amino acid clearance was also similar. In the obese, the insulin-mediated glucose disposal was ≈ 50% lower (p < 0.03) than in controls, and it was inversely correlated with fibrinogen ASR during the clamp in both groups (r = − 0.58). Conclusions In obese, non-diabetic males, post absorptive fibrinogen production is normal. Whole-body amino acid disposal, basal and insulin-responsive protein degradation, and albumin synthesis are also normal. However, the greater fibrinogen ASR in the obese with hyperinsulinemia, and the inverse relationship between insulin sensitivity and clamp fibrinogen production, suggest a role for hyperinsulinemia and/or insulin resistance on fibrinogen production in obesity. Copyright © 2009 John Wiley & Sons, Ltd.

Background Intravenous (IV) drug treatment of preterm neonates is affected by: clinical status (i.e. sepsis/infections, immature physiology, pharmacokinetic/pharmacodynamic variation), shortage of ready-to-use formulations, small doses of drug required and the dangers of the IV route. Purpose To identify the most prescribed IV antibiotics so that ready-to-use formulations can be prepared with standard concentrations (SCs) of drug avoiding handling (reconstitution/dilution) in the ward. Material and methods The Hospital Pharmacy, Neonatology and Hygiene Department of “Azienda Ospedali Riuniti-Ancona” conducted this multiphase study. Phase I: a review of IV antibiotics prescribed to preterm (24 +0 –31 +6 weeks) Neonatology inpatients from 2004–2013. Phase II: study of pharmaceutical quality and stability of SC (2 mg/ml) gentamicin sulphate (the gold standard in sepsis/infections). Aqueous solutions were prepared by pharmacists in two different ways: with and without filtration. Both batches were stored in polyethylene syringes for 90 days at 2–8°C and 25°C and were examined for: endotoxin absence with the LAL test (Limulus amoebocyte lysate, Endosafe Portable Test System) in accordance with the Italian Pharmacopoeia 12th edition (kinetic-chromogenic technique); sterility test (BacT/ALERT FA, six days of incubation at 36°C) for aerobic bacteria/fungi; quantification with HPLC-MS/MS technique of gentamicin components (C 1 , C 2 , C 1a ) at 0–3–7–14–21–28–60–90 days. Limits of detection (LOD) and quantitation (LOQ) were 0.25 ng. The SC was derived from the usual dose (2.5 mg/kg/12 h) for a 1,000 g patient. Results Phase I studies found: 1,011 preterm inpatients (521 males, 420 females), 222 cases of sepsis (52 early, 170 late) and 102 infections. Gentamicin was the most used antibiotic with 1,126 doses for 88 patients per year. Phase II studies certified: sterility (no microbiological growth), absence of endotoxins and stability of GS 2 mg/ml stored 90 days at 2–8°C and 25°C. No significant changes in concentration of gentamicin components: P not significant, t-test >0.05. Conclusion After this “pilot study” the next target could be to provide standard concentration unit dose treatments direct from the pharmacy to paediatric patients. References and/or Acknowledgements No conflict of interest.

It has been suggested that some of the limitations of the Van de Kamer method for fecal fat measurement could be overcome with the Jeejeebhoy method or the near-infrared reflectance assay.To test this hypothesis, a fecal fat test was carried out with the three methods, adding butter or MCT oil to the diet of four steatorrhoic patients. An in vitro recovery study of long- and medium-chain triglycerides was also performed.The Jeejeebhoy method measured long- and medium-chain fats more accurately than the Van de Kamer method. It found consistently higher steatorrhea values. Mean results of the near-infrared reflectance analysis resembled those of the Van de Kamer method, but with wide discordance of individual data.The Jeejeebhoy method is more accurate than the Van de Kamer method for fecal fat measurement. The difference may be clinically relevant when most fecal fatty acids derive from medium-chain triglycerides. Near-infrared reflectance may be a viable proposition only when a greater degree of approximation is acceptable.

The role of medium-chain triglycerides (MCTs) in the management of patients with pancreatic insufficiency is controversial. The aim of the study was to evaluate the absorption of MCTs in the presence of pancreatic insufficiency and the effect of pancreatic extracts on MCT absorption so as to clarify whether the replacement of usual dietary fats with MCTs is cost-effective.Six patients with severe pancreatic steatorrhea were for 5 days fed a low-fat diet to which butter (long-chain triglycerides (LCTs)) or MCT oil was added, with and without pancreatic extracts, in a crossover design.Fecal weight and nitrogen losses were the same during MCT and LCT intake. Steatorrhea was substantial during both periods but was significantly lower during MCT than LCT intake. Fecal weight and nitrogen and fat losses were reduced by pancreatic extracts in both diets. Steatorrhea was the same when MCTs and LCTs were consumed together with pancreatic extracts.MCTs are absorbed better than LCTs in the presence of pancreatic insufficiency but require pancreatic extracts for optimal absorption. No advantage is to be expected from replacing usual dietary fats with MCTs if pancreatic supplements are used.

The fatty acids of MCT are not deposited to any appreciable extent in fat stores and MCT diets diminish fat accretion in animals and probably in obese humans. No data are available in the newborn infant. Plasma levels of triglyceride (TG), cholesterol esters (ChE), free cholesterol (FGh), total cholesterol (TCh), phospholipids (PL), free fatty acids (FFA) and total lipids (TL), were measured weekly from the 2nd to the 5th week of postnatal age in two groups of premature AGA infants fed either own mother's milk (OMM) or mediun chain triglyceride formula (MCTF). Energy and macronutrient (protein, fat, and CHO) balances and anthropometry ware performed simultaneously. OMM (n=16) group and MCIF (n=20) group were comparable for birthweight: 1541 ± 55 vs. 1451 ± 41, grams and gestational age: 30.7 ± 0.4.VS. 30.9 ± 0.3, weeks (M ± SE). Results: MCTF fed group showed significantly greater weight gain and significantly diminished skinfold thickness. Fluid and energy intakes and metabolizable energy were comparable in the two groups. Metabolizable CHO was higher in MCTF in Week 4 and metabolizable fat was higher in OMM in week 3, but otherwise there were no significant differences. Metabolizable protein intake was lower in the OMM group after the 4th week. Plasma lipid content was lower in MCTF in Week 3 and 4. The reduction of plasma triglycerides contributed mast significantly to the lipid lowering effect of MCT diet (see table below). Conclusions: 1) the main effect of the MCT diet is the reduction of the plasma triglycerides either by decreasing the synthesis of chylomicrons and/or the very low density lipoproteins in the liver and/or the small intestine. 2) the long-term consequences of this dietary change on the development of the prenabre infant and its impact on the lipid metabolism later in life deserves serious consideration

Background Follow-up of very preterm infants is essential for reducing risks of health and developmental problems and relies on parental engagement. We investigated parents’ perceptions of post-discharge healthcare for their children born very preterm in a European multi-country cohort study. Methods Data come from a 5-year follow-up of an area-based cohort of births Results Questionnaires were returned for 3635 children (53.8% response rate). Care was rated as poor/fair for 14.2% [from 6.1% (France) to 31.6% (Denmark)]; rates were higher when children had health or developmental problems (e.g. cerebral palsy (34.4%) or epilepsy (36.9%)). From 971 responses, 4 themes and 25 subthemes concerning care improvement were identified. Conclusions Parents’ experiences provide guidance for improving very preterm children’s post-discharge care; this is a priority for children with health and developmental problems as parental dissatisfaction was high. Impact In a European population-based very preterm birth cohort, parents rated post-discharge healthcare as poor or fair for 14.2% of children, with a wide variation (6.1–31.6%) between countries. Dissatisfaction was reported in over one-third of cases when children had health or developmental difficulties, such as epilepsy or cerebral palsy. Parents’ free-text suggestions for improving preterm-related post-discharge healthcare were similar across countries; these focused primarily on better communication with parents and better coordination of care. Parents’ lived experiences are a valuable resource for understanding where care improvements are needed and should be included in future research.

Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe.We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace.Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries.Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care.Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services.UTILIZACIÓN DE SERVICIOS DE SALUD ESPECIALIZADOS EN UN ESTUDIO DE COHORTE EUROPEO DE NIÑOS NACIDOS MUY PREMATUROS: OBJETIVO: Niños nacidos muy prematuramente requieren cuidados especializados adicionales debido a su salud y a los riesgos asociados con la prematuros, sin embargo la información sobre el uso de servicios de salud es escasa. Buscamos describir la utilización de servicios especializados por niños nacidos muy prematuramente, en Europa. MÉTODO: Analizamos datos de una cohorte de nacimientos ocurridos antes de las 32 semanas de gestación tomados del Effective Perinatal Intensive Care in Europe (EPICE), basado en la población y multirregional, en 11 países europeos. Los datos perinatales fueron extraídos de las historias clínicas y los padres completaron un cuestionario a los 2 años de edad corregida (4.322 niños; 2026 sexo femenino, 2.296 masculino; edad gestacional mediana 29 semanas, rango intercuartílico (IQR) 27-31 semanas; mediana de peso de nacimiento 1.230 gr, IQR 970-1.511 gr). Comparamos el uso de servicios especializados (según informe de los padres) por país, riesgo perinatal (basado en edad gestacional, bajo peso para edad gestacional y morbilidades neonatales), educación materna y lugar de nacimiento. RESULTADOS: En total 65% de los niños habían consultado por lo menos a un especialista, con un rango entre países de 53,7% a 100%. Los especialistas más frecuentemente consultados fueron Oftalmólogos (53,4%) y Fisioterapeutas (48%) pero los especialistas consultados por cada individuo variaron mucho según el país. El riesgo perinatal se asoció al uso de especialista, pero el gradiente varió entre los países. Niños de madres con mayor nivel educativo tuvieron mayor proporción de uso de especialistas en tres países. INTERPRETACIÓN: Las grandes variaciones en el uso de servicios especializados en Europa no fueron explicadas por el riesgo perinatal y arrojan cuestionamientos sobre las fortalezas y limitaciones de los modelos de cuidados existentes.USO DE SERVIÇOS DE SAÚDE ESPECIALIZADOS EM UMA COORTE EUROPÉIA DE LACTENTES NASCIDOS MUITO PREMATUROS: OBJETIVO: Crianças nascidas muito prematuras requerem cuidado especializado adicional por causa dos riscos à saúde e ao desenvolvimento associados ao nascimento premature, mas informações sobreo uso de serviços de saúde são escassas. Procuramos descrever o uso de serviços especializados por crianças nascidas muito prematuras na Europa. MÉTODO: Analisamos dados de uma coorte populacional multi-regional, do Cuidado Intensivo Neonatal Efetivo na Europa (EPICE), com lactentes nascidos antes de 32 semanas de gestação em 11 países europeus. Dados perinatais foram extraídos dos registros médicos, e os pais completaram um questionário com 2 anos de idade corrigida (4.322 crianças; 2.026 do sexo feminino, 2.296 do sexo masculino; idade gestacional mediana 29semanas, intervalo interquartile [IIQ] 27-31sem; peso ao nascimento mediano 1,230g, IIQ 970-1511g). Comparamos o uso de serviços especializados reportados pelos pais por país, risco perinatal (com base na idade gestacional, pequeno para a idade gestacional e morbidades neonatais), educação materna e local de nascimento. RESULTADOS: Setenta e seis por cento das crianças consultou pelo menos um especialista, variando entre países de 53,7 a 100%. Oftalmologistas (53,4%) e fisioterapeutas (48,0%) foram os mais frequentemente consultados, mas os especialistas individuais variaram bastante por país. O risco perinatal se associou com uso de serviços especializados, mas o gradient diferiu entre países. Crianças com mães mais educadas tinham maior proporção de uso de especialistas em três países. INTERPRETAÇÃO: Grandes variações no uso de serviços especializados na Europa não foram explicadas pelo risco perinatal, e levantam questões sobre as forças e limitações dos modelos de cuidado existentes.