[Supplementary parenteral nutrition in premature infants. Adaptation to amino acid intake]

The authors report a controlled study of the use of 2 types of amino-acid solutions for premature infants nutrition in the first days of life, one of the solution (solution I) being adapted for prematures. The average amino-acid blood levels in prematures receiving solution I were close to those observed in cord blood; Plasma taurine, alanine and arginine concentrations were significantly lower with normalized levels of aromatic amino-acids, lysine, taurine and proline; serum ammonia level was also lower. This study shows that using an amino-acid solution adapted to prematures as a supplement to parenteral nutrition during the first days of life allows to progressively increase the nitrogen intakes without inducing dangerous plasma levels of some amino-acids.

Energy balance and composition of body weight

Weight gain composition of growing very low birthweight (VLBW) premature infants can be assessed by a combined technique of nutrient balance and indirect calorimetry measurement. Both protein and energy intakes play an important role in the rate of growth and in the amount of non-protein energy (i.e. fat) storage. High energy intake is not always correlated with a higher rate of growth and can lead to high fat storage.

Brainstem auditory evoked responses alteration in twin neonates

The authors obtained BAER recordings for 20 premature twins and 20 premature non-twins. The two groups were comparable as to conceptional age (36-37 weeks), gestational age, chronological age, birthweight, sex ratio and head size. The results showed a prolongation of the central conduction time (I-V interval) in the premature twins. This may be due to the intra-uterine growth retardation of twins.

Effects of calcium and phosphorus supplementation on calcium retention and fat absorption in preterm infants fed pooled human milk

Fat, phosphorus, and calcium balance studies were performed in normal very low birth weight infants (BW less than or equal to 1,500 g) fed either normal or calcium- and phosphorus-supplemented pooled pasteurized human milk. Calcium and phosphorus supplements were 27 mg/dl and 24.5 mg/dl, respectively, throughout the study. Measured calcium and phosphorus intake in the supplemented group averaged 90 +/- 6 mg/kg/day and 62 mg/kg/day, respectively, compared to 47 +/- 7 mg/kg/day and 24 +/- 6 mg/kg/day in the nonsupplemented group. The percent of fat, calcium, and phosphorus absorption was similar in the two groups: respectively, 71 +/- 23%, 73 +/- 13%, and 93 +/- 2% in the supplemented group compared to 75 +/- 11%, 71 +/- 14%, and 92 +/- 4% in the nonsupplemented group. Calcium and phosphorus retention reached 62 +/- 12 mg/kg/day and 53 +/- 4 mg/kg/day in the supplemented group against 21 +/- 10 mg/kg/day and 21 +/- 5 mg/kg/day in the nonsupplemented group. These data support the notion that calcium, in addition to phosphorus supplementation in pooled human breast milk, improves both calcium and phosphorus retention in preterm infants.

[Fate of infants weighting less than 1,500 grams]

Between 1981 and 1983, 251 premature infants with a birth weight of less than 1 500 grams were admitted to the Neonatal Pathology Unit of the E. Herriot hospital (malformations excluded). Forty two (17%) died during the neonatal period. These premature births resulted essentially from pathological pregnancies: multiple pregnancies (1/5 cases), renal pathology (1/3 cases), placental abnormalities (10%) and fetoplacental infections (10%). In half of all cases delivery was by cesarian section, indicated in 85% of cases because of acute or chronic fetal distress. These premature infants suffered from respiratory (including 40% hyaline membrane disease), neurological (abnormal cerebral echotomography with dilatation or intracranial haemorrhage in 35% of cases), infectious (6%) and digestive (6% necrosing enterocolitis) pathology. Of the 208 surviving children, 12 (i.e. 6% of the survivors) had major sequelae (with follow-up of one year or more).

[Pharmacokinetics of injectable phenobarbital in the premature infant. Study of a new lyophilized form]

A lyophilized preparation of phenobarbital was studied in newborns without cerebral palsy. Plasma levels were determined using gas chromatograph fitted with thermo ionic probe after either an intra-muscular (IM) injection in premature infants or an intravenous (IV) injection over single dose of phenobarbital 10 mg/kg within 6 hours after birth. Five term babies were included in the study as controls and received an IM injection. The results showed rapid increase in plasma concentration after IM injection in 10 of 13 subjects with a peak concentration reached 60 minutes after injection. The mean ratio (maximal concentration/dose) was 1.25 and 1.10 for term infants and preterm infants respectively. In all cases, the drug was well tolerated. In 15 preterm infants (n: 7 IM and n: 8 IV) the plasma concentrations were followed over a period of 15 days. The disappearance curve was biphasic; it varied the first 7 days, then remained constant for the following week (apparent half life 106 hours).

[Current aspects of laparoschisis. Apropos of 22 cases]

Study about 22 gastroschisis observed 17 years along allows to the authors to point out the elements of amelioration of prognostic and decrease of mortality. Antenatal diagnosis allows the hysterotomy at the end of gestation avoiding traumatic or infectious risks. Reanimation and transport are very important to bring the neonate in good conditions to the pediatric surgeon. The choice of surgical technics is only between primitive parietal closure or progressive reintegration (Schuster). Intestinal atresia must be cured in the same time, if possible. Finally, perisurgical nursing, antibiotherapy and recent parenteral nutrition method improved the prognosis. During the last 15 years, mortality has fallen from 80% to 10%.

Nutrient balance, energy utilization, and composition of weight gain in very-low-birth-weight infants fed pooled human milk or a preterm formula

Growth, protein, and energy balances were studied in two groups of very-low-birth-weight premature infants fed pooled pasteurized human milk (HM) or a preterm formula (PF). Each infant was studied at 33 and 36 weeks gestational age with a combined technique of nutrient balance and indirect calorimetry measurement. Weight and length gains were higher with PF than with HM, but head circumference growth was similar with both milks. Although the volume of milk given was lower, energy intake was higher with PF than with HM in both studies (126 to 130 vs 103 to 109 kcal/kg/day). Percentage of energy absorbed was better with PF than with HM (94% vs 84%) at 33 weeks, and similar (95%) with both milks at 36 weeks. Energy expenditure, which had increased from 33 weeks to 36 weeks, was higher with PF than with HM (57 to 63 vs 46 to 52 kcal/kg/day) during both studies. Energy retention accounted for about 50% of energy absorbed with both milks, but was higher with PF than with HM (60 vs 40 to 50 kcal/kg/day) in both studies, and resulted in fat accretion well above that seen during intrauterine growth for both milks in both studies. Protein intake was higher with PF than with HM (3.1 vs 2.4 gm/kg/day) in both studies, giving a protein accretion similar to the intrauterine accretion with PF (2.2 gm/kg/day), but lower with HM. Our results suggest that the nutritional value of pooled pasteurized human milk for VLBW infants should be reconsidered, especially because of its low protein content, and that energy density of preterm formulas must be questioned in view of elevated fat deposition.

[Fetomaternal blood incompatibility: the situation in 1983]

56 cases of allo-immunization were collected over a period of 4 1/2 years, i.e. 4.3 per 1 000 births. The authors analyse the aetiologies of these cases of allo-immunization and the therapeutic indications for the more severe cases. They discuss the indications for plasmapheresis, in utero transfusion and premature extraction of the fetus. Five deaths were recorded from this series of 56 births.

Control by the evoked potential of the brain stem of the administration of dibekacine in premature infants

The administration of dibekacine to 10 newborn carriers of a germ infection--or staphylococcus, was controlled for auditory tolerance. The auditory threshold was controlled by the evoked potential of the brain stem. Medication never caused the threshold to change. The evolution of latency in waves J1, J3 and J5 could not be seen except in wave 1 where latency decreased, as can be seen in other premature infants of babies born at term.

[Metabolism of minerals and vitamin D in the pregnant woman and the fetus]

The mineral metabolism in the fetus and pregnant woman is described with reference to data from the medical literature and personal studies. As soon as the twenty-eighth week of gestation, a concentration gradient is established between mother and fetus for calcium, phosphorus and magnesium, with higher levels in the fetus. The vitamin D content of the fetus is dependent on that of the mother; in France, where food is not supplemented, vitamin D deficiency is common in mothers and neonates, especially during the winter and spring and in areas where sunlight is scarce. Vitamin D supplementation is therefore required during the last trimester of gestation.

Hypocalcemia in infants of diabetic mothers. Studies in circulating calciotropic hormone concentrations

Twenty-two infants of diabetic mothers (IDM) were studied and were divided into two groups: a first group of 14 IDM did not receive vitamin D3 and was studied at birth and at 2, 24, 48 and 120 hours; a second group was given daily dosage of 60 microgram of vitamin D3 from 3 hours to 120 hours and was studied at 2 hours and 120 hours. In the first group, serum calcium levels decreased markedly during the first 24 hours of life (mean +/- SD: 1.77 +/- 0.3 mmol/l, p less than 0.01) and remained low at 5 days. Serum phosphorus levels remained normal but serum magnesium levels decreased significantly at 24 hours (mean +/- SD: 0.64 +/- 0.108 mmol/l, p less than 0.01) and returned to normal at 5 days. Serum immunoreactive parathormone levels increased consistently to high levels at 24 hours and remained elevated at 120 hours (p less than 0.001). Serum immunoreactive calcitonin levels increased at 24 hours (p less than 0.001) and decreased at 120 hours to low or undetectable values in all infants. In group II, serum 25O-HD levels and 1.25 OH2 D levels increased significantly (p less than 0.001) respectively to 27.2 +/- 2.7 ng/ml and 114 +/- 20 pg/ml at 5 days. The results of this study show hypocalcemia to be a common event in IDM during the first days of life and furthermore hypophosphatemia, hypoparathyroidism, hypomagnesemia or defect of vitamin D metabolism would not seem to be the main etiological factors.

Influence of thermoregulation on energy metabolism of the low birthweight infant

By combining continuous measurements and recordings of (a) 02 consumption and CO2 production, (b) core, mean skin and temperature, (c) "radiative and convective" (R + C) heat loss, we have tried to assess the characteristics and effiency of different heating systems in the usual environment of an intensive care unit.

PRELIMINARY RESULTS

minimal heat loss is obtained in an incubator with manual temperature control versus serocontrolled incubator on radiant heater; the radiant heater can maintain adequate core temperature but with higher than normal heat loss from the sides of the body and increased warming only of the skin facing the heater; metabotic rate measurements do not show any statistical difference between these various environments; both with an incubator and a radiant heater, a thin plastic sheet (used as heatshield) lowers "R + C" heat loss.

Neutrophil chemotaxis in infants of diabetic mothers and in preterms at birth

The chemotaxis of polymorphonuclear leukocytes of infants of diabetic mothers and of preterms was found lower than that of full term newborns when cells were incubated in autologous serum. When leukocytes from full terms were incubated in preterm serum, chemotaxis was significantly reduced. When leukocytes from either infants of diabetic mothers or preterms were incubated with full term serum, chemotaxis was significantly increased. No difference was found between infants of diabetic mothers and preterms. These results suggest that both groups of patients have a deficiency in serum factors playing a part in chemotaxis.

Lymphocyte populations and responses to mitogens in infants of diabetic mothers

A group of 10 infants of diabetic mothers, born prematurely by Caesarian section was compared to an age-matched group of premature controls and to full-term newborns. There was no difference between the three groups in terms of lymphocyte populations at birth. The percentage of T-cells in the three groups was significantly lower than in adults but reached adult levels at 1 month of age. The mitogenic responses in infants of diabetic mothers was found significantly higher than in the two control groups at birth and remained so at one month of age. The suppressor T-cell activity was decreased in infants of diabetic mothers as compared with controls.

[Intracranial hemorrhage in infants born at term]

In 5 full-term neonates presenting with signs of acute neonatal brain damage, intracranial hemorrhage was proven by CT-scan performed within a few days after birth. Status epilepticus occurred soon after birth as shown on EEG. Prognosis was most often very poor. These data are compared with the series reported in the literature.