Biochemical consequences of intravenous nutrition in the newborn

Cholelithiasis in infants: association with parenteral nutrition

Reported herein are two cholelithiasis-afflicted infants with a common inability to tolerate enteral feeding necessitating parenteral nutrition. One of the infants received parenteral nutrition for 5 months because of intestinal dysfunction and enterocolitis secondary to extensive aganglionosis, while the second child was premature and placed on parenteral nutrition because of bowel dysfunction after surgery to repair high jejunal atresia and a right diaphragmatic hernia. The relationship between parenteral nutrition and cholelithiasis is discussed.

Amniotic fluid endocrine changes during maternal hyperalimentation

Ten women with low estriol excretion received hyperalimentation prior to induction of labor. Six received an amino acid mixture (5% Aminofusin) and 25% dextrose, two received the amino acid mixture, and two received 25% dextrose. Amniotic fluid obtained before and after hyperalimentation was assayed for fetal surfactant production, thyroid, pituitary, and carbohydrate regulating hormones. In the combined amino acid/dextrose infusion group the amniotic fluid palmitic acid levels increased significantly post infusion; rT3 also increased significantly but T3 and T4 showed no significant change. The pituitary hormones growth hormone, prolactin, and ACTH showed no significant change, but beta-endorphin-like activity was significantly elevated. No thyroid-stimulating hormone was detected in any of the samples. All the carbohydrate regulating hormones, insulin, cortisol, and cAMP, showed significant increases but cGMP showed a significant decrease. The amino acid and dextrose only groups gave similar results. Seven of the infants showed some degree of intrauterine growth retardation but no neonatal complications attributable to the hyperalimentation.

Parenteral 20% safflower oil emulsion safety and effectiveness as a caloric source in newborn infants

Five surgical infants, ages 3 to 30 days, were studied while receiving peripheral total parenteral nutrition for a period of 2 weeks. By a randomized sequence, either 10 or 20% safflower oil emulsion was infused the first week, followed by the alternate solution during the second week. Caloric intake was 80 to 100 cal/kg/day, of which lipids comprised one-third to one-half. No adverse side effects were noted. Eosinophilia developed in three patients, but otherwise no changes in hematologic and biochemical parameters, including liver enzymes, were noted. Weight gain averaged 11.1 g/kg/day during the study period and was similar for the 10 and 20% solutions. Intravenous fluid intake averaged 21 ml/kg/day less during the week of the patients received 20% fluid emulsions. The 20% safflower oil emulsion proved comparable to the 10% solution in both safety and efficacy and enabled significant reduction of fluid intake while maintaining infused caloric levels.