The development of preterm infants' breastfeeding behavior

Extensive scientific data are available on the development of sucking in term infants, but corresponding knowledge about preterm infants has been lacking. The aim was to describe the development of preterm infants' behavior at the breast, according to postmenstrual and postnatal age. Mothers co-operated as data collectors using the Preterm Infant Breastfeeding Behavior Scale for observations. Seventy-one singletons (born after 26.7-35.9 gestational weeks) were studied prospectively. Mothers received regular advice about breastfeeding and guidance about interaction and appropriate stimulation. Breastfeeding was initiated at a postmenstrual age (PMA) of 27.9-35.9 weeks. Mothers provided 4321 records of infants' behavior, 70% of the total breastfeeding sessions during the infants' hospital stay. Irrespective of PMA, the infants responded by rooting and sucking on the first contact with the breast. Efficient rooting, areolar grasp and latching on were observed at 28 weeks, and repeated bursts of > or = 10 sucks and maximum bursts of > or = 30 sucks at 32 weeks. Nutritive sucking appeared from 30.6 weeks. Sixty-seven infants were breastfed at discharge. Fifty-seven of them established full breastfeeding at a mean PMA of 36.0 weeks (33.4-40.0 weeks). Their early sucking behavior is interpreted as the result of learning, enhanced by contingent stimuli. We therefore suggest that guidelines for initiation of breastfeeding in preterm infants should be based on cardiorespiratory stability, irrespective of current maturity, age or weight.

Neutrophils from term and preterm newborn infants express the high affinity Fcgamma-receptor I (CD64) during bacterial infections

The high affinity Fcgamma-receptor I (FcgammaRI, CD64) is normally expressed only to a very low extent by neutrophils. During bacterial infections, however, neutrophils from adult patients significantly increase their expression of FcgammaRI. Stimulation through FcgammaRI is a highly effective way to improve various aspects of neutrophil function, including phagocytosis. In our study the expression of FcgammaRI on neutrophils from preterm (n = 9) and term (n = 3) newborn infants, children (n = 14), and adults (n = 6) during the early phase of an acute bacterial infection was investigated. Our results showed that neutrophils from newborn infants with bacterial infection expressed FcgammaRI to a significantly higher extent than both noninfected preterm (p < 0.001) and term (p < 0.001) newborn infants and that neutrophils from preterm neonates expressed FcgammaRI to the same extent as neutrophils from term neonates and older infants, children, and adults. No difference in the neutrophil cell surface expression of FcgammaRI during bacterial infections was found among newborn infants, children, and adults. Expression of FcgammaRI probably represents an important mechanism to improve neutrophil phagocytosis as well as other aspects of neutrophil function during bacterial infections, especially in preterm infants. Our study indicates that measurement of cell surface expression of FcgammaRI on neutrophils could be a useful indicator of severe bacterial infections in preterm and term neonates, as well as in older children and adults.

Effect of theophylline on glucose production and lipolysis in preterm infants (< or = 32 weeks)

Apnea occurs commonly in preterm infants. Theophylline is used as prophylaxis and treatment. Apart from improving ventilatory function, theophylline may also have metabolic effects, including an effect on glucose metabolism and lipolysis. No data are available on the effect of theophylline on glucose production and lipolysis in preterm infants at start of medication. Ten preterm infants with gestational ages of < or = 32 wk, postnatal ages of 16-84 h, and birth weights > 900 g were recruited. Hepatic glucose production and lipolysis were measured by use of gas chromatography/mass spectrometry after constant rate infusion of [6,6-2H2]glucose and [2-13C]glycerol tracers. Plasma glucose levels increased after theophylline administration (mean +/- SD, 4.0 +/- 1.9 mmol/L before and 4.7 +/- 2.1 mmol/L after start of therapy), whereas the rate of glucose production decreased (6.0 +/- 2.5 mg.kg-1.min-1 and 4.3 +/- 1.9 mg.kg-1.min-1, respectively). The plasma glycerol concentration did not show any change after theophylline administration (154 +/- 257 mumol/L before and 217 +/- 258 mumol/L after), and the same was true for the rate of glycerol production (5.9 +/- 2.6 mumol.kg-1.min-1 before and 6.7 +/- 3.0 mumol.kg-1.min-1 after). The fraction of glycerol converted into glucose did not change significantly, although the percentage of glucose derived from glycerol increased after theophylline administration. The results are in line with the lack of adverse metabolic effects at start of theophylline treatment in the preterm infant.

Short-term outcome of perinatal care in a Swedish county. Mortality, neonatal intensive care and overall evaluation of neuromotor function at 0-10 months of corrected age in preterm and term infants

Improvements in obstetrical and neonatal care during the last decades have led to a marked increase in survival rate of preterm and term infants. In order to study the short- and long-term outcome in infants who survived neonatal intensive care (NIC) and were born in the county of Uppsala between January 1st 1986 and April 30th 1989, a prospective long-term follow-up study was conducted. Epidemiological data on all infants born in the county during the study period and the short-term outcome, measured as overall neuromotor function at term and at 2, 4, 6 and 10 months of corrected age in 245 infants surviving NIC and 72 healthy control infants are presented. The infants' neuromotor function was evaluated with different clinical neurological methods. In the study population of NIC infants 85.9% survived the neonatal period. The early infant mortality was high in this group 11.6% compared to that of all infants born in the county of Uppsala (0.30%). Only a minority of the infants showed abnormal neuromotor function. A comparison of the results of the overall evaluation of neuromotor function at 10 months of age with those of the examinations made at an earlier age showed poor correspondence in individual infants, especially in preterm and very preterm infants.

Fetal cardiocentesis in care of severe Kell immunisation

This case report demonstrates how severe a Kell immunisation can be. Fetal anemia and hydrops fetalis in the second trimester required six intrauterine transfusions, two by cardiocentesis. At 4 years of age the child has shown no abnormalities.

Attenuated hepatic glucose production but unimpaired lipolysis in newborn infants of mothers with diabetes

In infants of diabetic mothers, maternal-fetal hyperglycemia induces fetal hyperinsulinemia, which may be sustained for several hours after birth. The inhibitory effect of insulin on glycogenolysis, gluconeogenesis, and lipolysis increases the risk of hypoglycemia in these infants. Eight term infants of diabetic mothers were studied between 3.9 and 8.5 h postnatally. The maternal diabetes was considered well controlled as judged by self-monitoring of blood glucose and Hb Alc. Neonatal plasma concentrations of glucose, glycerol, and insulin were monitored and averaged 2.7 +/- 0.7 mM, 371 +/- 116 microM, and 15.9 +/- 2.8 microU.mL-1, respectively. Stable isotope-gas chromatography/ mass spectrometry techniques were used to determine glucose and glycerol turnover rates and gluconeogenesis from glycerol in the infants. The appearance rates of glucose and glycerol averaged 20.0 +/- 5.4 mumol.kg-1.min-1 (3.6 +/- 1.0 mg.kg-1.min-1), and 8.9 +/- 2.3 mumol.kg-1.min-1, respectively. The fraction of glycerol appearance rate converted to glucose was 68.2 +/- 17.3%, which accounted for 15.5 +/- 4.6% of glucose production. Thus, compared with healthy term infants studied previously under identical conditions, the infants of diabetic mothers had higher insulin concentrations and attenuated glucose production. Despite increased insulin concentrations, lipolysis was unimpaired, and the gluconeogenic contribution from glycerol was higher than in the healthy newborns.

Successful breast feeding in spite of early mother-baby separation for neonatal care

OBJECTIVE

To study the effects on breast feeding duration of mother-baby separation after birth, owing to full-term babies' care in a neonatal unit for a maximum of six days.

DESIGN

Retrospective review of medical records and telephone interviews with mothers.

SETTING

A level II and III NICU in a University Hospital.

PARTICIPANTS

148 mother-baby pairs in a separated group and 3516 in a comparison group.

MAIN OUTCOME MEASURES

Breast feeding success is defined as the duration of exclusive and partial breast feeding.

FINDINGS

There were no differences in breast feeding duration between babies in the separated group and the comparison group. More than 70% of the babies in both groups were breast fed exclusively after two months and more than 50% for more than four months. In the separated group delays in physical contact, first suckling and regular breast feeding, and duration of separation were not associated with shorter duration of breast feeding. Mixed feeding, both breast and bottle at the time of discharge from hospital, and baby diagnosis of hypoglycaemia had a negative impact. Maternal level of education was also associated with the breast feeding outcome.

CONCLUSIONS

Although every possible effort should be made to avoid mother-baby separation, women can be reassured that separation, because of their or the baby's medical condition during the first days after birth, need not be considered an obstacle to successful breast feeding.

Serum magnesium and protein concentrations during the first five years of insulin-dependent diabetes in children

Thirty-four children were followed up prospectively for 5 years from the onset of diabetes regarding serum magnesium, zinc and some proteins. Serum magnesium decreased to significantly lower values (0.76 +/- 0.05 mmol l-1) than those in matched controls after 2 and 5 years, with the lowest mean values in diabetic girls. Serum zinc concentration was higher in the diabetic group than in the control children, and again the diabetic girls differed most from the controls. Serum prealbumin was significantly lower in the diabetic patients after 2 and 5 years than in the controls. Serum albumin was also slightly reduced in the diabetic patients, while orosomucoid was normal. These data indicate chronic magnesium deficiency and insufficient liver synthesis of certain serum proteins in diabetic children.

Haemorheology in insulin-dependent diabetes is still normal five years after onset of the disease

In the development of insulin-dependent diabetes mellitus (IDDM), rheological changes have been shown to precede clinically detectable microangiopathy. We studied 34 IDDM children 13.1 (6-20) years old with a duration of the disease of 5 years and with a haemoglobin A1c of 8.3% (4.5-12.8%). Fifteen apparently healthy children 14.7 (10-18) years old served as a control group. Whole blood and plasma viscosity, erythrocyte aggregation tendency and erythrocyte fluidity were assessed by rotational couette viscometry. Apart from a significantly higher haematocrit (Hct) (42.6 vs 40.1; p < 0.05), the IDDM group did not differ from the controls in any of the measured in vitro rheological variables. The difference in Hct was due to an abnormally high Hct in the female diabetic group. The subgroup of female diabetics also displayed a higher plasma viscosity and fibrinogen concentration than the diabetic males. Despite the sex differences in the diabetic group, blood rheology was still normal in both sexes in this early stage of the IDDM disease. These findings suggest that altered haemorheology is a late phenomenon (i.e. later than 5 years after the onset of the disease) in the development of vascular disease in IDDM.

Vascular reactivity and platelet aggregability during the first five years of insulin-dependent diabetes in children

Skin microvascular reactivity and platelet aggregation in response to collagen and adenosine diphosphate (ADP) was studied prospectively in a population-based cohort of children with newly acquired type 1 diabetes mellitus (IDDM), who have now been followed up longitudinally for 5 years. The skin microvascular vasodilation in response to ischaemia was recorded by means of transcutaneous oximetry at 37 degrees C and compared with that in a control group of 58 healthy children. Platelet aggregation was compared with 42 healthy control children. Sixty months after diagnosis, the same degree of impairment of vasodilatory capacity was noted as previously recorded at 24 months and on admission, on all these occasions being significantly lower than the control value and the results from the 12-month follow-up. A sex difference was noted, diabetic girls both during and after puberty exhibiting a greater impairment of vasodilator capacity as compared with diabetic boys. The same degree of platelet aggregation in response to collagen was noted 60 months after diagnosis as had been recorded previously at 24 and 12 months, all significantly increased as compared with the results from admission, but not different from those in controls. By contrast, the aggregation in response to ADP was now lower than that observed on admission. No statistically significant gender difference was noted. The implication of the impaired skin microvascular vasodilation and of the changing pattern of platelet aggregation for later diabetic angiopathy needs to be evaluated in the coming decade.

Glycerol carbon contributes to hepatic glucose production during the first eight hours in healthy term infants

The newborn infant must mobilize endogenous substrate stores to meet the requirements of glucose-dependent organs. High concentrations of free fatty acids and glycerol, and a rapid decrease in the respiratory quotient, indicate that lipids are an important fuel soon after birth. The purpose of the present study was to determine the onset of lipolysis and gluconeogenesis from glycerol in healthy, term, unfed infants. Eight infants were studied from a postnatal age of 3.5 +/- 0.5 h to 7.4 +/- 0.2 h using [6,6-2H2] glucose and [2-13C]glycerol analysed by gas chromatography/mass spectrometry. Plasma concentrations of glucose, glycerol and insulin averaged 2.9 +/- 0.4 mM, 369 +/- 89 microM and 9.4 +/- 9.4 +/- 3.7 microU.ml-1, respectively. The hepatic glucose production rate averaged 25.0 +/- 3.5 mumol.kg-1 min-1 (4.5 +/- 0.6 mg.kg-1.min-1) and the endogenous plasma appearance rate of glycerol 8.7 +/- 1.2 mumol.kg-1.min. On average, 57.9 +/- 8.4% of the glycerol was converted to glucose, representing 11.1 +/- 2.3% of hepatic glucose output. Thus, lipolysis and gluconeogenesis from glycerol are established within the first 8 h of life in term infants.

Extremely preterm infants (< 28 weeks) are capable of gluconeogenesis from glycerol on their first day of life

Extremely preterm infants have been shown capable of producing glucose at a rate comparable to that of term infants, but virtually no data are available on their capacity for lipolysis and gluconeogenesis. To address this issue, we studied the flux of glycerol and its gluconeogenic contribution to hepatic glucose output by determining the endogenous plasma appearance rate of glycerol (glycerol Ra) and its conversion to glucose in 10 newborn infants, 24-27 wk of gestational age. The study was performed during the 1st d of life by tracer dilution technique using [6,6-2H2]glucose and [2-13C]glycerol given as constant rate i.v. infusions. Plasma isotopic enrichments of the tracers were obtained by gas chromatography/mass spectrometry. Endogenous glycerol Ra ranged from 2.4 to 21.6 (median 5.0) mumol.kg-1.min-1, of which 31.5% (25.6-64.4%) was converted to glucose. The glucose production rate averaged 17.5 +/- 5.4 mumol.kg-1.min-1 (3.2 +/- 1.0 mg.kg-1.min-1), of which 5.0% (1.6-37.6%) was derived from glycerol. The results show that extremely preterm infants, despite limited fat stores, are capable of generating glycerol at a rate within the range reported for term and near term newborns. The infants were also capable of converting part of this glycerol to glucose, providing a contribution to hepatic glucose production comparable to that found in more mature newborns.

Supporting a preterm infant's behaviour during breastfeeding: a case report

Preterm infants present a special challenge to lactation consultants because of their high reactivity to stimuli from their physical and social environment, low muscle tone, and limited extent of awake, alert behavior. In a descriptive case report, a girl at an age corresponding to a gestational age of 29 weeks was observed during a breastfeeding session according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Recommendations, based on her behavioral responses, were given to her mother. In an observation two days later, she showed more wakefulness and more efficient sucking. General recommendations are offered for support of preterm infants' behavior during breastfeeding. The NIDCAP structure is advocated as a mental checklist for breastfeeding assessment and advice.

Development of the Preterm Infant Breastfeeding Behavior Scale (PIBBS): a study of nurse-mother agreement

Research on the development of preterm infant feeding behavior has focused mainly on bottlefeeding, using invasive methods or observations by professionals. In this study, a clinical method for observing breastfeeding was developed in collaboration between observers and mothers for the purpose of enabling neonatal personnel and mothers to describe developmental stages in preterm infant breastfeeding behavior. Tests of interobserver reliability resulted in acceptable agreement between observers, but a somewhat lower level of agreement between observers and mothers. The scale showed a good capacity to discriminate between infant gestational ages and can be used for helping mothers to identify their infants' emerging competence.

Foscarnet 5 versus 7 days a week treatment for severe gastrointestinal CMV disease in HIV-infected patients

In a randomized open trial foscarnet 90 mg/kg b.i.d. 5 days for 3 weeks was compared to 90 mg/kg b.i.d. daily in severe gastrointestinal cytomegalovirus disease in HIV-infected patients. Thirty-eight patients were randomized, 36 were evaluable (all male, age 24-54 years, median 40 years; CD4/microliter 0-150, median 10). Treatment efficacy was evaluated based on a score consisting of symptoms, endoscopic and histologic examination. In the 5-day treatment group 10/16 (62%) patients responded to treatment, in the 7-day treatment group 13/20 (65%), with symptoms resolving in most patients after 1 week. Side effects and adverse events were seen in 13 patients in the 5-day treatment group and in 15 patients in the 7-day treatment group. Laboratory abnormalities were common in both groups, in one patient reversible renal insufficiency developed. Efficacy and safety of treatment 5 days a week was comparable to the standard regimen.

Congenital chloride diarrhoea: a prenatal differential diagnosis of small bowel atresia

We compared ultrasound findings and pre- and postnatal clinical signs in 8 patients with congenital chloride diarrhoea and 14 with small bowel atresia diagnosed in 1977-1991 in order to evaluate the possibility of a prenatal distinguishing diagnostic sign. In the patients with congenital chloride diarrhoea the pregnancy was complicated by marked polyhydramnios, the symphysis-fundus distance exceeded + 2 SD before gestational week 31 and the fetus displayed normal peristalsis in extensively dilated intestines and the "frog position". In the patients with small bowel atresia the symphysis-fundus distance was normal before gestational week 31 and the fetus displayed increased peristalsis in a few dilated intestinal loops.

Differences in calcium kinetic pattern between CAPD and HD patients

To assess the effect of different dialysis modalities on calcium turnover, we studied 57 patients on maintenance hemodialysis treatment (HD) and 38 patients on continuous ambulatory peritoneal dialysis (CAPD) with tracer kinetic studies using two calcium isotopes (45Ca by mouth and 47Ca intravenously). The two groups were comparable in age, sex and prevalence of diabetes. The groups did not differ in their serum concentrations of intact parathyroid hormone (iPTH), calcium, inorganic phosphate and 1,25-dihydroxyvitamin D. 25-hydroxy-vitamin D and alkaline phosphatase were found to be significantly higher in HD patients. Despite these similarities, CAPD patients showed a significantly lower calcium kinetic response as measured by calcium retention and plasma calcium efflux than HD patients. Mean calcium retention was 39.5% in HD patients compared to 31.2% in the CAPD group (p < 0.05). Plasma calcium efflux was significantly lower in the CAPD group (2.7 vs 3.2 respectively; p < 0.01). iPTH correlated with calcium retention and plasma calcium efflux in HD patients (r = 0.69 and r = 0.67 respectively). In CAPD patients, the correlation coefficient between iPTH and calcium retention was markedly lower (r = 0.54), whereas no correlation was found between iPTH and plasma calcium efflux (r = 0.08). In addition, the slope of the correlation curve were higher in HD patients (p < 0.01 and p < 0.001, respectively), indicating a better response of this patient group to the action of parathyroid hormone. Our data are in accordance with recently published results showing that the dialysis modality has a major impact on bone turnover and on the progression of uremic bone disease. It has been shown that CAPD is an independent risk factor for the development of the adynamic form of renal bone disease. This finding may be explained by the lower response of calcium turnover to the action of PTH as shown here with tracer kinetic studies.

Mothers' advice about facilitating breastfeeding in a neonatal intensive care unit

Admission of newborn infants to neonatal intensive care units (NICU) has been considered an obstacle to breastfeeding because of mother-infant separation and hospital feeding routines. In order to obtain advice on facilitating breastfeeding, we interviewed by telephone 178 mothers of fullterm NICU patients three months after the infants' discharge from hospital. Mothers' advice, in order of prominence, concerned the disturbing impact of the NICU environment, lack of systematic breastfeeding advice, distance between infants' and mothers' units in the hospital, conflicts about parents' roles, perceived lack of organization of work, dissatisfaction with nurse behavior towards parents, and importance of skin-to-skin contact during the mother's first visit. Adaptation of the NICU environment, nurses' awareness of mothers' perspectives, and nurse attitudes and behavior change appear to be as important for facilitating breastfeeding as are routines for breastfeeding advice.

Very immature infants (< or = 30 Wk) respond to glucose infusion with incomplete suppression of glucose production

Small substrate stores and immature enzyme systems make preterm infants prone to develop hypoglycemia. Hyperglycemia may also occur, particularly when these infants are given i.v. glucose. To evaluate the capacity for regulation of glucose production in response to glucose infusion, 10 newborn infants, born after 25-30 wk of gestation, were studied. Their glucose production rates (GPR) were calculated and the concentrations of glucose, insulin, and glucagon in plasma were measured during infusion of glucose at a rate of first 1.7 +/- 0.2 and then 6.5 +/- 0.3 mg.kg-1.min-1 (9.4 +/- 1.1 and 36.1 +/- 1.7 mumol.kg-1.min-1) (mean +/- SD). GPR was determined by use of D-6,6-2H2-glucose. When the rate of infusion of glucose was increased, GPR decreased from 4.3 +/- 1.3 to 1.4 +/- 1.1 mg.kg-1.min-1 (23.9 +/- 7.2 to 7.8 +/- 6.1 mumol.kg-1.min-1) (mean +/- SD) (p = 0.00006). In addition, the plasma insulin concentration increased from 6 +/- 2 to 11 +/- 4 microU.mL-1 (p = 0.006) and the plasma glucose concentration from 3.6 +/- 1.1 to 6.1 +/- 1.3 mM (mean +/- SD) (p = 0.0002), whereas the glucagon concentration remained unchanged. Only the insulin concentration in plasma was significantly related to GPR. The results show that very immature newborn infants have an incomplete and varying capacity to respond to glucose infusion with suppression of glucose production. Insulin seems to be more important than plasma glucose in the regulation of glucose homeostasis in these infants.

Inter-relationship between serum concentrations of glucose, glucagon and insulin during the first two days of life in healthy newborns

The relationship between serum concentrations of glucose, insulin and glucagon during the first two days of life was studied in healthy newborns. The first capillary blood sample was obtained at 3-15 h of age (median 6 h; day 0) and a second sample approximately 24 h later (day 1). Serum glucose concentrations in the first sample averaged 2.1 +/- 0.07 mmol/l (mean +/- SEM; n = 60) and were positively correlated with postnatal age (p < 0.01). Serum glucagon concentrations in the first sample averaged 570 +/- 32 pg/ml and were inversely correlated with glucose concentrations (p < 0.0001). At the second sampling, serum glucose concentrations had increased to 2.9 +/- 0.07 mmol/l (p < 0.001; n = 57) and serum glucagon concentrations had decreased to 403 +/- 22 pg/ml (p < 0.001). Serum insulin concentrations were 11.7 +/- 0.3 microU/ml and 10.2 +/- 0.3 microU/ml at the two samplings and did not correlate with serum glucose concentrations. The relationship of serum glucose and hormone concentrations to maternal and infant characteristics was studied by stepwise regression analysis. Serum glucose concentration on day 0 was positively correlated with postnatal age (p < 0.01) and birth weight (p < 0.05) but inversely correlated with duration of labour (p < 0.05). Serum glucose concentration on day 1 was positively correlated with birth weight (p < 0.0001) and inversely correlated with maternal prep-pregnancy weight (p < 0.05). Similar analyses of serum hormone concentrations did not demonstrate any relationships with maternal or infant characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

The incidence of neonatal pneumococcal septicemia in Sweden 1991-92. The result of a national survey

In a survey of the incidence of pneumococcal neonatal septicemia in Sweden 1991-92, to our knowledge the first nationwide survey of this kind, an incidence of 3.6/100,000 was found. Based on this, the relative incidence of neonatal septicemia caused by pneumococci was calculated to be 0.9-1.3%. Despite recent reports of pneumococci resistant to antibiotics, no resistant strain was found, and among the affected neonates, all treated with conventional antibiotics, there was a lower mortality as compared to prior reports. This might reflect the facts that the infants were less often born preterm, were less often born after premature rupture of membranes, and had a higher proportion with a late onset of symptoms than in earlier surveys.

Plasma levels of fat-soluble vitamins A and E in neonates, after administration of two different vitamin solutions

The aim of this study was to compare the effects of 2 different vitamin solutions on plasma levels of vitamin A and E during and after short term total parenteral nutrition (TPN), after neonatal surgery. 2 compounds were compared, one with a higher vitamin A content (100 mu g/ml) and no vitamin E and one with vitamin E (0.64 mg/ml) and a lower vitamin A content (69 mu g/ml). 2 randomly chosen groups of 10 neonates were studied each with gastrointestinal malformations. The groups were comparable regarding gestational age (GA), weight and length. Diagnoses within the groups were similar. TPN was given after corrective surgery for a median time of 6.5 days to both groups. Vitamin A and retinol binding protein (RBP) levels increased significantly (p < 0.05) above the pre-treatment level in patients receiving supplementation with a higher dosage of vitamin A (100 mu g/ml). In patients receiving the lower dose of vitamin A (69 mu g/ml) plasma levels of this vitamin were unchanged but RBP levels fell significantly (p < 0.05). There was no significant difference in plasma vitamin E levels in the group of patients receiving vitamin E supplementation as compared with the unsupplemented group. In both groups vitamin E levels increased significantly (p < 0.005) after introduction of oral feeding. The results indicate that even during short term TPN endogenous stores of vitamin A might become depleted. In spite of the fact that no vitamin A deficiency was noted it seems obvious that a higher vitamin A intake is advisable which is in accordance with the recommendations from the Subcommittee on Paediatric Parenteral Nutrient Requirements from the Committee on Clinical Practice Issues of The American Society for Clinical Nutrition.

Glucose production rate in extremely immature neonates (< 28 weeks) studied by use of deuterated glucose

Neonatal hypoglycemia is a frequent complication in immature infants. This may be due to small substrate stores, a high brain:body weight ratio, and immature enzyme systems. The purpose of the present study was to investigate the rate of glucose production in newborn infants with gestational ages of less than 28 wk. The subjects were 10 newborn infants delivered after 25 to 26 gestational wk. Their mean birth weight was 772 g (range 588-1000 g), and their mean postnatal age at the time of the study was 15 h (range 4-24 h). An isotopic compound (D-6,6-2H2-glucose) was given as a constant-rate i.v. infusion. In addition to dideuteroglucose, eight of the infants also received an i.v. infusion of unlabeled glucose at a rate of 1.4-2.6 mg.kg-1.min-1. Blood samples for determination of the concentration and isotopic enrichment of plasma glucose were obtained every 15 min in a 2-h period. Isotopic enrichment, measured by gas chromatography/mass spectrometry, was used for calculating the glucose production rate. The mean glucose production rate related to body weight (+/- SD) was 6.1 +/- 1.5 mg.kg-1.min-1. The results show that infants born at < 28 gestational wk have a capacity to produce glucose on their 1st d of life at rates close to or even exceeding those reported in term infants.

Cutaneous blood flow during a hypoglycaemic clamp in insulin-dependent diabetic patients and healthy subjects

1. A marked cutaneous vasodilatation has been shown to occur in healthy subjects, but not in insulin-dependent diabetic patients, in response to hypoglycaemia induced by a rapid intravenous bolus injection of insulin. 2. In the present study cutaneous blood flow in response to a gradual decline in blood glucose concentration was investigated in eight young adult diabetic patients and in eight age- and sex-matched control subjects. After a hyperinsulinaemic euglycaemic clamp for 40 min, hypoglycaemia was induced (plasma glucose concentration 2 mmol/l) by a standardized stepwise reduction in the intravenous glucose infusion. 3. Blood flow was measured by using a laser Doppler sensor and a cutaneous O2 electrode placed on the medial aspect of the forearm, and a laser Doppler sensor placed on the forehead. 4. No significant change in cutaneous blood flow occurred during euglycaemic hyperinsulinaemia. 5. In control subjects a marked increase in blood flow during hypoglycaemia was observed in the forearm by both methods. No corresponding change was observed in the forehead. 6. In the diabetic patients the increase in cutaneous blood flow was absent in both the forearm and forehead. 7. It is concluded that hypoglycaemia, but not hyperinsulinaemia, is associated with a regional cutaneous vasodilatation in healthy control subjects. This cutaneous vasodilatation is absent in diabetic patients.