The effects of protein hydrolysate-monosaccharide infusion on low-birth-weight infants

A technique for evaluating sepsis in TPN patients

Sepsis continues to be one of the most feared complications of total parenteral nutrition. Many techniques have been advocated for dressing changes, solution preparation, and evaluation of patients with fever spikes. Our technique in evaluating such a patient with suspected sepsis is to remove the tubing and solution from the pumping mechanism and place the bottle below the patient, permitting approximately 10 cc of blood to flow into the tubing. The entire set-up of solution and tubing is then quickly replaced and the infusion resumed. The removed blood is transferred to a series of three standard blood culture bottles. The first bottle will be culturing blood; the second, a mixture of blood and infusate; the third, solution alone. When performed carefully, negative culture results appear to exclude TPN as a source of spesis. Positive results are obviously helpful, but must be interpreted with caution in that the blood, catheter, tubing, filter, or solution may be suspect.

Total parenteral alimentation via indwelling umbilical catheters in the newborn period

Total parenteral alimentation (TPA) was delivered to 80 infants via indwelling umbilical artery and to 9 via indwelling umbilical venous catheters. The primary indication for catheter placement and maintenance was monitoring of arterial blood gases (umbilical venous catheter tip in left atrium) in a group of sick neonates requiring increased inspired oxygen or assisted ventilation. Results were compared with those from 23 infants who had tunnelled jugular catheters for a variety of chronic medical and surgical problems preventing gastric or intestinal feeding. A mean weight gain was achieved in both groups. Mortality and morbidity rates were similar in both groups. The most common complications were infection and thrombotic phenomena. Metabolic complications were few. It is concluded that infusing TPA solutions via indwelling umbilical catheters presents no greater risk than infusion via tunnelled jugular catheters, and provides a method for supplying adequate caloric intake for growth during the acute stage of illness.

Nasojejunal feedings in low-birth-weight infants

Continuous nasojejunal and intermittent nasogastric feedings were compared in a controlled prospective study in 21 low-birth-weight infants. The groups were comparable in regard to period of gestation, birth weight, head circumference, and clinical findings. Cumulative weight gain, caloric and fluid intake, percent weight lost, blood chemistry values, and complications were used in evaluating the two groups. Upon completion of the 21-day study, N/J infants were found to have had statistically better weight gain, caloric intake, and fluid intake (p = 0.05-0.001) during the early part of the study. Weight loss was less in the N/J group (p less than 0.01). Neither group had abnormalities of blood chemistry or significant complications. It is concluded that N/J feeding in the low-birth-weight neonate is a safe, effective means of early nutritional intake, with advantages most pronounced during the first two weeks of life.

Carbohydrate intolerance in infants with acute diarrhoea and its complications

Two hundred and seventy-one infants with acute diarrhoea were studied for the presence of carbohydrate malabsorption and 110 infants (40.6%) were found to have carbohydrate intolerance. Malnutrition and severe diarrhoea were found to increase the predisposition to carbohydrate intolerance. The incidence of major complications, protracted diarrhoea and mortality were significantly higher in the carbohydrate intolerant infants as compared to those with carbohydrate tolerance.