Concurs per a una Llar d'Infants

El projecte defineix un carrer interior tangent a l’edifici del pavelló per on es produeix l’entrada i per on s’atravessa visualment l’edifici, de manera que la façana del pavelló te continuïtat cap a l’interior de la llar d’infants. Perpendicularment es disposa l’espai del vestíbul que articula els espais de circulació i dona sortida i visuals al pati de jocs. Les zones de pas tenen una alçada inferior a la de les altres àrees per lògica d’us i per donar claredat volumètrica a l’edifici. L’entrada es produeix per una rampa, sota un voladís que a l’hora recull l’escletxa oberta a la façana del pavelló per il•luminar l’àrea administrativa. L’altre extrem del carrer és una sortida d’emergència. En una visió general s’observa que el pla de façana del pavelló fa de suport a dos volums que entren en relació: la rampa d’accés al pavelló i la coberta del carrer interior de la llar d’infants. Pel que fa a les alçades, el conjunt manté el criteri de donar major alçada als espais principals (pista i aules) respecte els d’accés. Pel que fa a la forma, el cos d’aules adopta la coberta plana per entrar en relació amb l’horitzontalitat de la visera de la façana principal del pavelló i no la forma corba perquè l’escala del cos d’aules no admet aquesta solució. S’enfatitzaria al màxim la percepció de conjunt si les cobertes de les aules i del pavelló fossin igualment inclinades. Les dependències s’organitzen en dues àrees: L’àrea administrativa es col•loca sota el forjat que defineix el projecte del pavelló. Atès que l’alçada lliure interior és de 3.00 m., i per tal de poder garantir il•luminació i ventil•lació natural a aquestes peces, es proposa baixar la cota de tota la llar d’infants 80 cm. respecte la cota del carrer. Consta d'una sala de reunions propera al vestíbul, un despatx per la direcció del centre uns vestidors amb bany per al personal i una sala d'usos múltiples. L’àrea d’activitats es col•loca separada del pavelló, definint un volum independent, tant en planta com en secció. Consta de 3 aules de 20 alumnes que donen resposta a les necessitats plantejades pel programa. Aquestes s’obren generosament al pati de jocs buscant la llum de nord i per la part superior amb una obertura molt més controlada tenen la llum del sud. Això permet il•luminar i ventil•lar de forma creuada. El tram de carrer interior davant de les aules es converteix en una zona de jocs comuna.

Whole body protein synthesis and energy expenditure in very low birth weight infants.

The aim of the present work was to study whole body protein synthesis and breakdown, as well as energy metabolism, in very low birth weight premature infants (less than 1500 g) during their rapid growth phase. Ten very low birth weight infants were studied during their first and second months of life. They received a mean energy intake of 114 kcal/kg X day and 3 g protein/kg X day as breast milk or milk formula. The average weight gain was 15 g/kg X day. The apparent energy digestibility was 88%, i.e. 99 kcal/kg X day. Their resting postprandial energy expenditure was 58 kcal/kg X day, indicating that 41 kcal/kg X day was retained. The apparent protein digestibility was 89%, i.e. 2.65 g/kg X day. Their rate of protein oxidation was 0.88 g/kg X day so that protein retention was 1.76 g/kg X day. There was a linear relationship between N retention and N intake (r = 0.78, p less than 0.001). The slope of the regression line indicates a net efficiency of N utilization of 67%. Estimates of body composition from the energy balance, coupled with N balance method, showed that 25% of the gain was fat and 75% was lean tissue. Whole body protein synthesis and breakdown were determined using repeated oral administration of 15N glycine for 60-72 h, and 15N enrichment in urinary urea was measured. Protein synthesis averaged 11.2 g/kg X day and protein breakdown 9.4 g/kg X day. Muscular protein breakdown, as estimated by 3-methylhistidine excretion, contributed to 12% of the total protein breakdown.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient-ventilator asynchrony during noninvasive pressure support ventilation and neurally adjusted ventilatory assist in infants and children.

OBJECTIVES: To document the prevalence of asynchrony events during noninvasive ventilation in pressure support in infants and in children and to compare the results with neurally adjusted ventilatory assist. DESIGN: Prospective randomized cross-over study in children undergoing noninvasive ventilation. SETTING: The study was performed in a PICU. PATIENTS: From 4 weeks to 5 years. INTERVENTIONS: Two consecutive ventilation periods (pressure support and neurally adjusted ventilatory assist) were applied in random order. During pressure support (PS), three levels of expiratory trigger (ETS) setting were compared: initial ETS (PSinit), and ETS value decreased and increased by 15%. Of the three sessions, the period allowing for the lowest number of asynchrony events was defined as PSbest. Neurally adjusted ventilator assist level was adjusted to match the maximum airway pressure during PSinit. Positive end-expiratory pressure was the same during pressure support and neurally adjusted ventilator assist. Asynchrony events, trigger delay, and cycling-off delay were quantified for each period. RESULTS: Six infants and children were studied. Trigger delay was lower with neurally adjusted ventilator assist versus PSinit and PSbest (61 ms [56-79] vs 149 ms [134-180] and 146 ms [101-162]; p = 0.001 and 0.02, respectively). Inspiratory time in excess showed a trend to be shorter during pressure support versus neurally adjusted ventilator assist. Main asynchrony events during PSinit were autotriggering (4.8/min [1.7-12]), ineffective efforts (9.9/min [1.7-18]), and premature cycling (6.3/min [3.2-18.7]). Premature cycling (3.4/min [1.1-7.7]) was less frequent during PSbest versus PSinit (p = 0.059). The asynchrony index was significantly lower during PSbest versus PSinit (40% [28-65] vs 65.5% [42-76], p < 0.001). With neurally adjusted ventilator assist, all types of asynchronies except double triggering were reduced. The asynchrony index was lower with neurally adjusted ventilator assist (2.3% [0.7-5] vs PSinit and PSbest, p < 0.05 for both comparisons). CONCLUSION: Asynchrony events are frequent during noninvasive ventilation with pressure support in infants and in children despite adjusting the cycling-off criterion. Compared with pressure support, neurally adjusted ventilator assist allows improving patient-ventilator synchrony by reducing trigger delay and the number of asynchrony events. Further studies should determine the clinical impact of these findings.

L'espai dels Observatoris en el marc de les polítiques públiques d'infancia adolescencia

L'educació, la salut i la protecció són els drets més coneguts i respectats pels adults, pero hi ha un ciar deficit en re lació amb els drets relac ionats amb I 'exercici de la participació i l' expressió. El coneixement deis drets d'ex pressió i participació de la in fancia es dóna més entre els polítics i educadors socialsqueentreels pares i professors,el que seria un indicador d' una manca greu de polítiques insütucionals i culturals. Les polítiques de família reforcen a: la institució familiar i, per tant, poden incloure els in fants sense donar- los protagonisme. Per contra, les polítiques específicament adreçades a la infancia i adolescencia afavoreixen el procés d' autonomització i responsabilitzacióen el desenvolupament dels infants i joves.

Water, energy and early postnatal growth in preterm infants.

Non-invasive methods, including stable isotope techniques, indirect calorimetry, nutritional balance and skinfold thickness, have given a new insight into early postnatal growth in neonates. Neonates and premature infants in particular, create an unusual opportunity to study the fluid and metabolic adaptation to extrauterine life because their physical environment can be controlled, fluid and energy balance can be measured and the link between metabolism and the energetics of their postnatal growth can be assessed accurately. Thus the postnatal time course of total body water, heat production, energy cost of growth and composition of weight gain have been quantified in a series of "healthy" low-birth-weight premature infants. These results show that total body water is remarkably stable between postnatal days 3-21. Energy expenditure and heat production rates increase postnatally from mean values of 40 kcal/kg/day during the first week to 60 kcal/kg/day in the third week. An apparent energy balance deficit of 180 kcal/kg can be ascribed to premature delivery. The cost of protein metabolism is the highest energy demanding process related to growth. The fact that nitrogen balance becomes positive within 72 h after birth places the newborn in a transitional situation of dissociated balance between energy and protein metabolism during early postnatal growth: skinfold thickness, dry body mass and fat decrease, while there is a gain in protein and increase in supine length. This particular situation ends during the second postnatal week and soon thereafter the rate of weight gain matches statural growth. The goals of the following review are to summarize data on total body water and energy metabolism in premature infants and to discuss how they correlate with physiological aspects of early postnatal growth.