Went to the emergency department less often (0.52 visits versus 1.78, P<0.05).

Went to the pediatrician less often (1.3 visits over the course of the study versus 2.3, P<0.05).

reuteri or a placebo for 90 days from 2010 to 2012 across nine neonatal units in Italy.Īfter 3 months, compared with infants in the control group, infants in the probiotic group: two critical areas are in need of investigation: the mechanisms of action and the effect on long-term health.'įor the study, 589 infants were randomized into a probiotic group to receive L. reuteri.'Ĭhumpatiza suggests possible mechanisms of probiotic function, but that a better understanding is still needed: 'Various mechanisms of action have been proposed for probiotics, including enhancing epithelial barrier function, increasing IgA production, modulating cytokine profiles, influencing T lymphocytes, influencing other gut microbes, and affecting the enteric nervous system, that may result in changes in motility, pain perception, and brain activity. My only reservation about the validity of this study is that it was funded by the company that manufactures L. than in Italy,' Powell said.Īri Brown, MD, FAAP, a pediatrician at 411 Pediatrics in Austin, Texas, told MedPage Today, 'This study lends further evidence to the growing body of studies showing that probiotics can be useful in infancy.

If anything, it is likely an underestimate of the savings, as the cost of medical care tends to be higher in the U.S. 'While the study provides evidence that oral supplementation with lactobacillus reuteri keeps babies healthier, the cost savings estimated in the study were determined in an Italian context and cannot be easily translated. In anesthetic practice, this formula has been further simplified, with the hourly requirement referred to as the “4-2-1 rule” (4 mL/kg/hr for the first 10 kg of weight, 2 mL/kg/hr for the next 10 kg, and 1 mL/kg/hr for each kilogram thereafter.Indrio and colleagues estimated the overall cost savings, on average, to be $118.71 for each family and $140.30 for the community from the use of probiotics to prevent colic, gastroesophageal reflux, and constipation, they wrote in JAMA Pediatrics.Īdam Powell, PhD, a healthcare economist at Payer + Provider in Boston, Mass., told MedPage Today, 'This study suggests that probiotic supplements can improve newborn health in the process, enabling parents to avoid missing work and reducing healthcare utilization.' Viewed in this manner, the authors concluded that 100 mL/kg/day for weights to 10 kg, an additional 50 mL/kg/day for each kilogram from 11 to 20 kg, and 20 mL/kg/day more for each kilogram beyond 20 kg. This curve could be seen comprising of three linear sections which coincided approximately with the following weight sections: 0 to 10 kg, 10 to 20 kg, and 20 to 70 kg.

Based on their data and assumptions, Holliday and Segar constructed a curve plotting Energy Caloric Requirements versus Weight. The relationship between Weight and Energy Expenditure was found to be NON-LINEAR.

In other words “the average needs for water, expressed in milliliters, equals energy expenditure in calories (under normal resting conditions, 1 ml of water is required to metabolize 1 kcal)'. In a study published in 1957, in the Journal Pediatrics, Malcolm Holliday and William Segar developed a simple scheme which could be easily remembered to calculate the maintenance water needs in hospitalized patients.Īssimilating the known physiology at the time, they observed that “there was a DIRECT LINEAR relationship between Physiologic Water Needs (insensible losses + urinary losses) and Energy Metabolism'. One of the primary objectives of maintenance parenteral fluid therapy is to provide water to meet physiologic losses (insensible loss + urine loss).

411 pediatrics