Early nutritional support for preterm infants is critical because such support influences long-term outcome. Minimal enteral feeding should be initiated as soon as possible if an infant is stable and if feeding advancement is recommended as relevant to the clinical course. Maternal milk is the gold standard for enteral feeding, but fortification may be needed to achieve optimal growth in a rapidly growing premature infant. Erythromycin may aid in promoting gastrointestinal motility in cases that exhibit feeding intolerance. Selected preterm infants need vitamins, mineral supplements, and calorie enhancers to meet their nutritional needs. Despite all that is known about this topic, additional research is needed to guide postdischarge nutrition of preterm infants in order to maintain optimal growth and neurodevelopment.
Enteral Nutrition ; Erythromycin ; Gastrointestinal Motility ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Milk ; Milk, Human ; Nutritional Support ; Vitamins

Debriefing is a conversational session that revolves around the sharing and examining of information after a specific event has taken place. Debriefing may follow a simulated or actual experience and provides a forum for the learners to reflect on the experience and learn from their mistakes. Originating from the military and aviation industry, it is used on a daily basis to reflect and improve the performance in other high-risk industries. Expert debriefers may facilitate the reflection by asking open-ended questions to probe into the framework of the learners and apply lessons learned to future situations. Debriefing has been proven to improve clinical outcomes such as the return of spontaneous circulation after cardiac arrest and the teaching of teamwork and communication in pediatrics. Incorporating debriefing into clinical practice would facilitate the cultural change necessary to talk more openly about team performance and learn from near misses, errors, and successes that will improve not only clinical outcome but also patient safety.
Aviation ; Education ; Heart Arrest ; Humans ; Military Personnel ; Patient Safety ; Pediatrics* ; Staff Development

Clinical trials in neonates of different gestational age, birth weight, postnatal age and general health status are needed to assure safe and optimal evidence-based-therapy to this special population. Pharmacodynamic maturation must be considered in grouping the neonates for clinical trials. Informed consent from the parents, protection of the neonates participating in the clinical trials, adherence to good clinical practice guidelines, and designation of short term and long term outcomes must be taken into consideration from the beginning of the trials. Collaboration between centers will be helpful in overcoming the problem with small patient size. Many of these challenges are surmountable and an well-designed clinical trial will improve the mortality and morbidity in these very small children.
Birth Weight ; Child ; Cooperative Behavior ; Gestational Age ; Humans ; Infant, Newborn ; Informed Consent ; Parents

Bronchopulmonary dysplasia (BPD) is characterized by arrest of vascular and alveolar development in premature infants. Recent advances in neonatology have increased the survival of immature babies. Consequently, the prevalence of BPD is increasing. Animal studies and autopsy findings of BPD have demonstrated interruption in vascular development and reversal of lung injury through promotion of vasculogenesis. Normal lung development is driven by temporal and spatial specific growth factors and cell- to- cell signaling in vascular development. Lung injury through various pathways causes disruption in this complex interactive process and results in aberrant vascular development and subsequent BPD. By understanding the regulation of vascular growth of the lung, it would be possible to find new targets in the treatment and prevention of BPD in premature infants.
Animals ; Autopsy ; Bronchopulmonary Dysplasia ; Humans ; Infant, Newborn ; Infant, Premature ; Intercellular Signaling Peptides and Proteins ; Lung ; Lung Injury ; Neonatology ; Prevalence

Breast milk is the gold standard for full term babies as well as premature babies. Breast milk provides nutritional, gastroenterological, immunological, neurodevelopmental and psychological benefits to the premature baby. These benefits decrease acute morbidities and provide long term benefits. Despite the knowledge that breast milk is best, many obstacles must be overcome for a premature infant to receive optimal nutrition from breast milk. Insufficient amount and difficulty in pumping are some issues that are easily solved with education and support. Inadequacy of minerals and electrolytes in breast milk after one month may be overcome with the use of commercial fortifiers for the optimal growth of the growing premature baby. The use of donor breast milk is increasing. It is the responsibility of the medical personnel to promote breast milk in premature babies by being concerned about the obstacles and preventing problems from arising beforehand.
Breast ; Electrolytes ; Enteral Nutrition ; Humans ; Infant, Newborn ; Infant, Premature ; Milk, Human ; Minerals ; Tissue Donors

PURPOSE: There have been limited studies investigating the relationship between high-sensitivity C-reactive protein (hsCRP), metabolic diseases, and dietary factors in Korean adults. Here, we examined the association between nutrient intake and serum hsCRP among Korean adults. METHODS: Using data on 2,624 healthy Korean adults (1,537 women and 1,087 men) from the 2015 Korea National Health and Nutrition Examination Survey, demographic, anthropometric, biochemical, and dietary factors were analyzed once the subjects were grouped into either sex, age, or BMI. Nutrient intake was evaluated using the dietary data obtained by one-day 24-hour recall. Based on the guidelines of the US Centers for Disease Control and Prevention and the American Heart Association, hsCRP level was classified as HCRPG (High CRP Group, hsCRP > 1 mg/L) and LCRPG (Low CRP Group, hsCRP ≤ 1 mg/L). Proc surveyreg procedure was performed to examine the associations between nutrient intake and hsCRP after adjustment for potential confounding variables. RESULTS: The average hsCRP level of healthy Korean adults was 0.95 ±0.03 mg/L (0.97 ±0.04 mg/L in men, 0.92 ±0.05 mg/L in women). Obese subjects had significantly higher hsCRP than non-obese subjects in both sexes. The hsCRP level was positively associated with current smoking, physical inactivity, BMI, waist circumference, fasting blood glucose, triglycerides, total cholesterol, LDL-cholesterol, and blood pressure and inversely associated with HDL-cholesterol. LCRPG had significantly higher intake of dietary fiber compared to HCRPG in women. High hsCRP level was associated with more dietary cholesterol intake but less omega-3 fatty acid intake among subjects aged ≥ 50y. HCRPG of obese subjects had higher intakes of fat and saturated fatty acid than LCRPG. CONCLUSION: The hsCRP level is closely associated with several lifestyle variables and nutrient intake in healthy Korean adults. Individuals with high hsCRP level show low intakes of dietary fiber and omega-3 fatty acids but high intakes of dietary fat and cholesterol. Our findings suggest that a potential anti-inflammatory role for nutrients and lifestyle in the Korean adult population.
Adult* ; American Heart Association ; Blood Glucose ; Blood Pressure ; C-Reactive Protein* ; Centers for Disease Control and Prevention (U.S.) ; Cholesterol ; Cholesterol, Dietary ; Confounding Factors (Epidemiology) ; Dietary Fats ; Dietary Fiber ; Fasting ; Fatty Acids, Omega-3 ; Female ; Humans ; Korea* ; Life Style ; Male ; Metabolic Diseases ; Nutrition Surveys* ; Smoke ; Smoking ; Triglycerides ; Waist Circumference

PURPOSE: An increase in the breastfeeding rate has been followed by an increase in the number of mothers seeking help in relactation. We investigated the factors related to successful relactation by assessing the impact of medications, supplementer, consultations, and family support. METHODS: A retrospective review of the medical records and telephone survey of mothers who had visited the relactation clinic were conducted from January 2004 to April 2007. RESULTS: Data from 84 mothers were analyzed to identify the factors associated with success in relactation. Seventy-five percent of the mothers succeeded in obtaining exclusive breastfeeding. Success in relactation was associated with informed referral from medical personnel, the use of galactogogues, and family support. CONCLUSION: This study provides new and noteworthy insights concerning relactation. This highlights the need to inform the mothers about the data of relactation, to use galactogogues, and to have their families involved for psychological support and endurance during visits to the relactation clinic.
Breast Feeding ; Galactogogues ; Humans ; Medical Records ; Milk, Human ; Mothers ; Referral and Consultation ; Retrospective Studies ; Telephone

PURPOSE: An increase in the breastfeeding rate has been followed by an increase in the number of mothers seeking help in relactation. We investigated the factors related to successful relactation by assessing the impact of medications, supplementer, consultations, and family support. METHODS: A retrospective review of the medical records and telephone survey of mothers who had visited the relactation clinic were conducted from January 2004 to April 2007. RESULTS: Data from 84 mothers were analyzed to identify the factors associated with success in relactation. Seventy-five percent of the mothers succeeded in obtaining exclusive breastfeeding. Success in relactation was associated with informed referral from medical personnel, the use of galactogogues, and family support. CONCLUSION: This study provides new and noteworthy insights concerning relactation. This highlights the need to inform the mothers about the data of relactation, to use galactogogues, and to have their families involved for psychological support and endurance during visits to the relactation clinic.
Breast Feeding ; Galactogogues ; Humans ; Medical Records ; Milk, Human ; Mothers ; Referral and Consultation ; Retrospective Studies ; Telephone

Differentiated HL-60 is an effector cell widely used for the opsonophagocytic-killing assay (OPKA) to measure efficacy of pneumococcal vaccines. We investigated the correlation between phenotypic expression of immunoreceptors and phagocytic ability of HL-60 cells differentiated with N,N-dimethylformamide (DMF), all-trans retinoic acid (ATRA), or 1alpha, 25-dihydroxyvitamin D3 (VitD3) for 5 days. Phenotypic change was examined by flow cytometry with specific antibodies to CD11c, CD14, CD18, CD32, and CD64. Apoptosis was determined by flow cytometry using 7-aminoactinomycin D. Function was evaluated by a standard OPKA against serotype 19F and chemiluminescence-based respiratory burst assay. The expression of CD11c and CD14 gradually increased upon exposure to all three agents, while CD14 expression increased abruptly after VitD3. The expression of CD18, CD32, and CD64 increased during differentiation with all three agents. Apoptosis remained less than 10% until day 3 but increased after differentiation by DMF or ATRA. Differentiation with ATRA or VitD3 increased the respiratory burst after day 4. DMF differentiation showed a high OPKA titer at day 1 which sustained thereafter while ATRA or VitD3-differentiated cells gradually increased. Pearson analysis between the phenotypic changes and OPKA titers suggests that CD11c might be a useful differentiation marker for HL-60 cells for use in pneumococcal OPKA.
Antibodies, Bacterial/immunology ; Antigens, CD11c/metabolism ; Antigens, CD14/metabolism ; Antigens, CD18/metabolism ; Apoptosis/*immunology ; Biological Assay ; Cell Differentiation ; Cell Line, Tumor ; Cholecalciferol/pharmacology ; Dimethylformamide/pharmacology ; Flow Cytometry ; HL-60 Cells ; Humans ; Phagocytosis/*immunology ; Pneumococcal Vaccines/*immunology ; Receptors, IgG/metabolism ; Receptors, Immunologic/*biosynthesis ; Respiratory Burst/immunology ; Streptococcus pneumoniae/*immunology ; Tretinoin/pharmacology

Differentiated HL-60 is an effector cell widely used for the opsonophagocytic-killing assay (OPKA) to measure efficacy of pneumococcal vaccines. We investigated the correlation between phenotypic expression of immunoreceptors and phagocytic ability of HL-60 cells differentiated with N,N-dimethylformamide (DMF), all-trans retinoic acid (ATRA), or 1alpha, 25-dihydroxyvitamin D3 (VitD3) for 5 days. Phenotypic change was examined by flow cytometry with specific antibodies to CD11c, CD14, CD18, CD32, and CD64. Apoptosis was determined by flow cytometry using 7-aminoactinomycin D. Function was evaluated by a standard OPKA against serotype 19F and chemiluminescence-based respiratory burst assay. The expression of CD11c and CD14 gradually increased upon exposure to all three agents, while CD14 expression increased abruptly after VitD3. The expression of CD18, CD32, and CD64 increased during differentiation with all three agents. Apoptosis remained less than 10% until day 3 but increased after differentiation by DMF or ATRA. Differentiation with ATRA or VitD3 increased the respiratory burst after day 4. DMF differentiation showed a high OPKA titer at day 1 which sustained thereafter while ATRA or VitD3-differentiated cells gradually increased. Pearson analysis between the phenotypic changes and OPKA titers suggests that CD11c might be a useful differentiation marker for HL-60 cells for use in pneumococcal OPKA.
Antibodies, Bacterial/immunology ; Antigens, CD11c/metabolism ; Antigens, CD14/metabolism ; Antigens, CD18/metabolism ; Apoptosis/*immunology ; Biological Assay ; Cell Differentiation ; Cell Line, Tumor ; Cholecalciferol/pharmacology ; Dimethylformamide/pharmacology ; Flow Cytometry ; HL-60 Cells ; Humans ; Phagocytosis/*immunology ; Pneumococcal Vaccines/*immunology ; Receptors, IgG/metabolism ; Receptors, Immunologic/*biosynthesis ; Respiratory Burst/immunology ; Streptococcus pneumoniae/*immunology ; Tretinoin/pharmacology