Perineal lipoma in a newborn boy--a case report

We report the case of a newborn presenting with a pediculated mass arising from the anal margin. Antenatal sonogram and magnetic resonance imaging were unable to diagnose the precise nature of the lesion. Sacrococcygeal teratoma, an enterogenous cyst, a polyp, a prolapse or other perineal tumors were all proposed as possible entities. At birth, no other anatomic anomaly than this homogenous 2 cm para-anal lesion was seen. Excision of the mass was performed under general anesthesia. The postoperative histological exam showed mature fat cells. Reviewing the literature, there have been few previously reported cases of congenital perineal lipoma. It is a rare, benign and easy-to-treat condition that can be evocated by morphological sonography or magnetic resonance imaging (MRI).

[Neurodevelopment of extremely low birthweight infants born in Erasmus Hospital between 1992 and 2001]

Survival of extremely low birth weight infants has dramatically improved in the last decade of the twentieth century. The objective of our study was to evaluate the neurological evolution of the surviving infants because frequent motor, sensitive and psychological disturbances are related. Prospective, longitudinal study in a population of newborns, nursed in our neonatal intensive care unit and born between 1992 and 2001 with less than 1.000 g and/or less than 28 weeks of gestational age (GA). Neurological assessment of outcome was made using the neurodevelopmental score (O.M.S. 1988) at 6, 9, 12, 18, 24 and 36 months. Neurological follow-up every year and neuropsychological testing at 3, 5 and 8 years. Only children with at least 2 years of follow-up were included. The children were grouped in 3 categories: M (major neurological handicap), m (minor neurological handicap), N (normal neurological outcome). To evaluate the evolution with time, we compared the results from the first period (1992 to 1996) to the second part of this decade (1997 to 2001). Mortality fell from 38% (27/70) in the first period (1992-1996) to 18% (8/44) in the second one (1997-2001) (p = 0.02) including neonates of less than 25 weeks GA. Neurodevelopmental status improved and severe brain lesions decreased (25% with intraventricular haemorrhage III & IV and cystic periventricular leukomalacia versus 6% in the second period) (p = 0.017). Major handicap fell from 26% (9/34) to 16% (5/31) and normal neurological evolution raised from 15% (5/34) to 48% (15/31) (p = 0.013). With the survival of newborns less than 28 weeks, the severe ocular complications increased: 6% (5/79). In conclusion, mortality and quality of life have significantly improved in the past 10 years in our service. Severe brain lesions have decreased under a better multifactorial management. Nevertheless when the gestational age of the surviving babies diminishes, ocular sequelae increase. We still think that prematurity remains a burden for the child, his family and the society.

[The intensive and non-intensive neonatal care department]

To be born very prematurely in 2002 is very different of to be born very prematurely in 1978: the progress of the fetal and perinatal care have, amongst others, decrease the mortality of the neonates with a birthweight below < 1,000 g from 61% to 12%. The technological progresses in artificial ventilation have led to a significant decrease in chronic lung disease down to 5% or less, and of cerebral complications (intraventricular hemorrhages, grade 3 and 4 and/or periventricular leucomalacia) down to 11% or less. The progress in surgery and anesthesiology have allowed us to operate the extremely low birthweight infants in the neonatal unit when needed. This has been possible thanks to a multidisciplinary team approach: many specialists working together from conception to birth and from birth to home try to offer the best to these sometimes very small human beings.

Pulmonary sequestration-like anomaly presenting as a spontaneously resolving mass

A premature baby boy presented at birth with respiratory distress. A right lower lobe opacity was found on chest X-ray. Pulmonary sequestration was the diagnosis suggested by ultrasound. The size of the mass decreased on subsequent examinations. 4 months later X-rays and sonography failed to demonstrate any remaining mass. This case illustrates another example of involutive pathology and suggests that not all pulmonary sequestration-like anomalies should be operated on.

[Twins: interpretation of height-weight curves at birth]

Weight, head circumference and body length curves were established with the data at birth of 770 twins born alive in our hospital. Those curves were compared with the Gairdner-Pearson curves realized on a population of singleton newborns. The twin weight curve shows the expected fall down from 32 weeks of gestation. More than 50% of twins would have been qualified as small for dates on the Gairdner standard for singletons. The head circumference and the body length curves show few differences, except a late fall down, significant from 39 weeks. So the normal twin shows usually an "asymmetrical" hypotrophy if compared with a general newborn population standard. The general weight standards do not allow to assess the normality of a twin and to suspect other reasons of fetal growth restriction that could also be present. These considerations plead for the use of specific twin charts. Yet the evaluation of twins on the general standards has still a place to estimate the immediate and at long-term adverse outcomes of fetal growth restriction. The evaluation of twin measurements would not be completed without the assessment of the weight discordancy inside the twin couple, as a risk factor of morbidity and mortality.

Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme

Risk factors for central venous catheter (CVC)-related bacteraemia among infants admitted to a neonatal intensive care unit (NICU) were analysed and the impact of surveillance and continuing education on the incidence of this complication investigated. Among patients admitted to a NICU, CVC-related bacteraemia increased from 1/15 (7%) in 1987 to 11/26 (42%) in 1988 (P = 0.01). Coagulase-negative staphylococci isolated from bacteraemia patients showed clonal diversity by plasmid and chromosomal fingerprinting. A review of CVC care procedures suggested breaches in aseptic techniques. Catheter-care technique was revised to ensure maximal aseptic precautions, including the use of sterile gloves, gown and drapes. The new policy was promoted by a continuing education programme and regular feed-back of CVC-related bacteraemia incidence to NICU staff. In the four-year follow-up period, the attack-rate of CVC-related bacteraemia decreased to 18/156 (12%) patients [relative risk (RR): 0.27, 95% confidence interval (CI); 0.15-0.51; P < 0.001 vs the previous period]. By using the Cox's model proportional hazards, very low birthweight and the period before use of strict aseptic CVC care were found to be predictors of increased risk of catheter-related bacteraemia after adjustment for duration of catheterization. These data provide further evidence that strict aseptic precautions during the maintenance and utilization of CVC can contribute to lower the risk of catheter infection in critically ill neonates. Regular feedback of surveillance data was associated with a progressive decrease in incidence of infection, suggesting that it improved staff compliance with aseptic precautions.

[The focus in neonatology]

During the last years, neonatology has greatly improved. In the last decade, mortality and morbidity have decreased: mortality from respiratory failure of prematurity has decreased from 22% to 12%, mortality of the very low birthweight infants under 1000 g fell from 56% to 35% and mortalities related to asphyxia have diminished from 21% to 12% and to malformations from 33% to 28%. Prematurity is now the first cause of neonatal mortality. During this period, the number of babies under 1000 g has increased 4-fold and the number of multiple births increased more than 2-fold from 3% to 7% of the live births of our hospital. Attitudes towards the premature infant have changed, especially towards the extremely small (called the micropremies). The number of disabled children has increased in parallel with the better survival of the very immature newborns who till recently were not resuscitated.

Auditory arousal thresholds are higher when infants sleep in the prone position

OBJECTIVE

To evaluate the possibility that infants sleeping in the prone position have higher arousal thresholds to auditory challenges than when sleeping in the supine position.

STUDY DESIGN

Polygraphic recordings were performed for 1 night in 25 healthy infants with a median age of 9 weeks. The infants were exposed to white noises of increasing intensities while sleeping successively in the prone and supine positions, or vice versa. Arousal thresholds were defined by the auditory stimuli needed to induce polygraphic arousals.

RESULTS

Three infants were excluded from the study because they awoke while their position was being changed. For the 22 infants included in the analysis, more intense auditory stimuli were needed to arouse the infants in the prone position than those in the supine body position (p = 0.011). Arousal thresholds were higher in the prone than in the supine position in 15 infants; unchanged in 4 infants; and lower in the prone position in 3 infants (p = 0.007).

CONCLUSIONS

Infants show higher arousal thresholds to auditory challenges when sleeping in the prone position than when sleeping in the supine position. The finding could be relevant to mechanisms concerned with the reported association between sudden deaths and the prone sleeping position in infants.

[Neonatal screening for hemoglobinopathies in the Brussels region]

We realised this study in order to determine the frequency of abnormal haemoglobins and to appreciate the need for a neonatal screening for haemoglobinopathies in Brussels. Over a two year-period, 9575 cord blood samples were systematically screened. The study disclosed following results : 40% of newborns were from regions at risk for haemoglobinopathies and abnormal haemoglobins were present in 2.5% of the neonates tested. This frequency is similar to those reported elsewhere in North Europe. The most frequent abnormal haemoglobins were the Hb S, Bart's, C, D and E. Three cases of severe forms of sickle cell anaemia were identified. The frequency of abnormal haemoglobins and Hb S traits combined to the high rate of mixed marriages (16%) justifies the need for a universal screening for haemoglobinopathies in Brussels.

Atypical and equivocal sonographic features of the spinal cord in neonates

Thanks to the wider use of sonography to examine the spinal content in the neonate, normal anatomy and anomalies may be detected easily. Yet, unusual sonographic patterns are also observed. These must be differentiated from true pathologies. During a prospective study of 103 neurologically asymptomatic neonates, atypical sonographic patterns were found in 16 patients, corresponding to normal variants in 13. Nine of these 13 patients presented with a widening of the distal part of the central echo complex (one had a dilated ventriculus terminalis). Nerve roots of the cauda equina were disposed asymmetrically in three patients; the spinal cord movements were still present. In two of these babies, this distribution was associated with thin arachnoid pseudocysts. One patient presented with transitorily hyperechoic and narrow subdural spaces, probably related to neonatal dehydration. None of the 13 patients showing normal variants required any treatment. The other 3 patients (of 16) presented with equivocal entities of unknown evolution: sonographic tethered cord, fibrolipoma of the filum terminale and epidural varices. Sonography is highly accurate in evaluating the spinal cord content and aids differentiation of normal and normal variants from equivocal or pathological entities.

Human milk banking: influence of storage processes and of bacterial contamination on some milk constituents

This paper reviews the effects of storage and bacterial content contaminating human milk on some milk constituents. Moreover, it reviews the inhibitory effect of refrigeration and freezing on bacterial growth. Our results suggest that the type and length of storage have an effect on some milk constituents, that this effect is modulated by the bacterial contamination of the milk and that refrigeration has a significant inhibitory effect on bacterial growth which is not observed after freezing. This stresses the importance of collecting noncontaminated milk and justifies the choice of refrigeration at 0-4 degrees C for storage up to 8 days.

Diagnosis of severe birth asphyxia and early prediction of neonatal neurological outcome in term asphyxiated newborns

Ten indicators available during the first two hours of life, such as clinical criteria of neonatal distress and postnatal arterial blood gases, were compared with the neonatal neurological course in sixty full term newborns with significant birth asphyxia in order to test their value for the diagnosis and the short-term prognosis of severe birth asphyxia. Birth asphyxia was defined as severe when it was followed by symptoms of moderate or severe post-asphyxial encephalopathy. We calculated a sensitivity lower than fifty percent for clinical criteria such as delay in establishing regular respiration and Apgar scores. It was clear that normal delay in establishing regular respiration and normal Apgar scores do not exclude severe birth asphyxia. Arterial pH and base deficit at thirty minutes of life were found to be the best criteria for the diagnosis of severe birth asphyxia, but lacked positive predictive value. The best predictive tool for the short-term neurological prognosis of birth asphyxia was a single score established at 30 minutes of life and based on the evaluation of consciousness, respiration and neonatal reflexes. Some aspects of the pathophysiology of birth asphyxia and the rationale for treatment of post-asphyxial metabolic acidosis are discussed.

Non-invasive measurement of intracranial pressure in the newborn and the infant: the Rotterdam teletransducer

Knowledge of intracranial pressure may be important in many clinical situations in neonates and young infants. The best way to obtain this information would be a non-traumatic procedure. In order to test the reliability of a new fontanometer, the Rotterdam teletransducer, 25 simultaneous measurements of cerebrospinal fluid (CSF) pressure and anterior fontanelle pressure (AFP) were performed. Mean (SD) difference between CSF pressure and AFP was -0.2 (1.8) mm Hg (95% confidence interval from -0.48 to -0.88 mm Hg). The AFP was also measured in 60 healthy children (15 premature, 30 term newborn babies, and 15 infants). The different aspects of AFP were analysed and normal values computed. These results suggest that the Rotterdam teletransducer gives reliable continuous information about intracranial pressure and can be used in clinical practice. Interpretation of AFP plots must take the influence of postconceptional age and the physiological occurrence of pressure waves into account.

[Monitoring of fontanelle pressure in neonates and infants. Evaluation of a new measuring technique, determination of normal values and clinical usefulness]

The experience with 200 measurements of anterior fontanelle pressure with the Rotterdam Teletransducer in newborns and infants is reported. Statistical analysis of 25 comparative measurements between anterior fontanelle pressure and invasive cerebrospinal fluid pressure showed an excellent correlation (rs = 0.95). Measurements were reproducible and the plot quality allowed visualisation of pulse pressure and pressure waves. Normal values of the anterior fontanelle pressure, pulse pressure amplitude and pressure wave maximal amplitude were established in 15 prematures, 27 term newborns and 10 infants. Anterior fontanelle pressure monitoring was performed in 19 term newborns with post-asphyxial encephalopathy, 18 newborns and infants with hydrocephalus, 8 preterm and term newborns with respiratory distress and 19 patients with subdural haematomas, metabolic diseases, meningitis, subarachnoidal haemorrhage, head trauma, post cardiac arrest encephalopathy and abnormal head growth or bulging fontanelle. Abnormal patterns of anterior fontanelle pressure monitoring were found in moderate or severe neonatal post-asphyxial encephalopathy, evolutive hydrocephalus, subdural haematomas, metabolic diseases with hyperammoniemia and other clinical situations. In contrast, anterior fontanelle pressure monitoring yielded normal values in mild post-asphyxial encephalopathy, arrested hydrocephalus, well functioning ventriculo-peritoneal derivation, and in normal infants with rapid head growth or bulging fontanelle. The Rotterdam Teletransducer provides thus accurate and reproducible values of intracranial pressure. Anterior fontanelle pressure monitoring may be of value in many situations in clinical practice.

High-frequency ventilation and conventional mechanical ventilation in newborn babies with respiratory distress syndrome: a prospective, randomized trial

OBJECTIVE

Morbidity and mortality remain high amongst babies ventilated for a respiratory distress syndrome (RDS). Whether newly developed ventilators allowing high frequency ventilation such as high frequency flow interrupted ventilation (HFFIV) could decrease the morbidity and the mortality was investigated in a randomized study.

DESIGN

Preterm babies weighing < or = 1800 g suffering from RDS and ventilated by conventional mechanical ventilation (CMV) were randomized to be further ventilated either by CMV (group CMV) or by HFFIV (group HFFIV) when peak inspiratory pressure (PIP) on CMV was > or = 20 cmH2O.

SETTING

The study was undertaken in the neonatal intensive care unit of the Erasmus Hospital.

PATIENTS

24 patients entered into the investigation and were randomized but 2 patients were removed from the study because the switch over to HFFIV failed. Eight of the 12 CMV patients and 5 of the 10 HFFIV patients completed the study.

MEASUREMENTS AND RESULTS

Clinical variables, blood gas analysis and ventilatory variables were looked at. There were no differences in mortality, in incidence of air leaks and pulmonary complications or in blood gas analysis. Bronchopulmonary dysplasia was not decreased by the use of HFFIV.

CONCLUSION

It is concluded that HFFIV is safe although it offers no concrete advantages over CMV when applied as we did in a low pressure approach.

Biochemical diagnosis of a fatal case of Günther's disease in a newborn with hydrops foetalis

The birth of a male baby was induced at 32 weeks. In utero, the child presented, inter alia, signs of hydrops, hepatosplenomegaly and anaemia. Two in utero transfusions for correction of the anaemia were performed at 28 and 29 weeks, respectively. The baby rapidly presented respiratory distress with mixed acidosis. Three hours after birth, pink urine was excreted. Signs of icterus necessitated phototherapy, after which photosensitivity occurred. Erythrocytes were fluorescent under long-wavelength UV light. The baby died 24 hours after birth, displaying severe acidosis, a diffuse haemorrhagic syndrome, and repeated brady-cardia which did not respond to isoprenaline. The analysis of porphyrins in urine, blood and faeces of the baby gave the following results: 1) uroporphyrin (I and III isomeric series) was increased in urine and faeces, with traces in erythrocytes and plasma; 2) heptacarboxyporphyrin I was found mainly in urine and much less in erythrocytes, plasma and faeces; 3) coproporphyrin I was increased in urine, erythrocytes, plasma and faeces, and 4) 5-aminolaevulinic acid and porphobilinogen in urine and plasma were within the reference ranges. Determination of the enzymes of haem biosynthesis in erythrocytes and lymphocytes showed that both parents possessed only 50% of the normal activity of cosynthase. A previously described point mutation in codon 73 was observed in one parent. Fatal cases of neonatal Günther's disease are extremely rare and such an observation, according to our knowledge, is probably one of the first described.

[Prematurity: developments during the last decade at Erasmus Hospital. II. Long-term follow-up]

Morbidity and mortality of these preterm infants weighing < 1000 g at birth was reported in another paper. The mortality and neuro-developmental prognosis improved clearly in the last 3 years. A particular attention is given for protecting these babies against brain lesions. These ELBW have a high risk of neurodevelopmental disturbances. Therefore, a multidisciplinary team follows the neurological evolution to assess the quality of neonatal care and detect and treat developmental abnormalities as early as possible. We present the weight and height evolutions, the neurological, social and familial outcome of our 15 survivors. Economical and ethical discussions are open.

[Prematurity: development during the last decade at Erasme Hospital, neonatal evaluation]

Our institution admitted 39 ELBW (less than 1 kg) between November 1978 and December 1990. In our center, mortality has decreased from 61% to 33% within a decade. Improvements in neonatal intensive care have lowered the limit for these possible survival to 26 weeks of gestational age and 700g of birthweight. Morbidity is still very high. The mean hospital stay is 96 days. Perinatal asphyxia is frequent (3/4) as well as infections, nutritional problems and renal failure. Sixty-six % of this population suffer from respiratory distress syndrome which is the main cause of death. Morbidity and mortality are explained and compared to the recent literature.

Peri-cholecystic hyper-echogenicities in necrotizing enterocolitis: a specific sonographic sign?

The authors report a new sonographic pattern found in association with neonatal necrotizing enterocolitis in 5 newborns: hyperechogenicities around the gallbladder. The pattern probably corresponds to extension of the disease to the perivesicular space. The most probable hypothesis for that extension is diffusion by contiguity through the lesser sac and/or the right gutter. The hyperechogenicities could be related to the foamy infiltrate typical of NEC. Air within the pericholecystic vascular system similar to portal air could be another (less probable) explanation.

Mapping of normal brain maturation in infants on phase-sensitive inversion--recovery MR images

It is illustrated that phase-sensitive inversion-recovery MR images are particularly well suited for the monitoring of brain maturation and myelination in the neonate and young infant. Provided appropriate timings are applied with the inversion-recovery MR pulse sequence, the myelinated areas show up as bright spots in the phase-sensitive images. The chronology of the appearance, and the location of these hyperintense zones correlate well with the chronology of brain maturation, as assessed by other means. In particular, the progressive functional capabilities of the infant correlate well with the progress of myelination, as exhibited by the MR images.

Hyaline membrane disease in the newborn: diagnosis by ultrasound

The authors report a new method of diagnosing hyaline membrane disease (HMD) in newborns: ultrasound. Babies with HMD display a specific pattern with retrohepatic hyperechogenicity on abdominal ultrasound. The specificity of the pattern was verified in 40 prematures with respiratory distress syndrome. The sign was present in 24, and in 22 of these the final diagnosis was moderate or marked HMD. In the last 2, mild HMD was suggested. The pattern was absent in the 16 others, none of whom had HMD. The pattern probably results from an ultrasound artifact: summation of multiple aerated airways surrounded by collapsed alveoli. Follow-up examinations were possible in 13 babies with HMD. Hyperechogenicity disappeared in 8 of these patients within 6-9 days and in 3 within 10-20 days; it persisted for 60 and 70 days in 2 with bronchopulmonary dysplasia. In conclusion, retrohepatic hyperechogenicity in newborns is pathognomonic for HMD and allows an instant diagnosis. The persistence of the pattern could be a useful criterion for evaluation of the prognosis.

Increased recall rate at screening for congenital hypothyroidism in breast fed infants born to iodine overloaded mothers

Skin disinfection with povidine-iodine (PVP-I) is widely used in obstetrics. We evaluated the influence of PVP-I in mothers at delivery on the serum thyroid stimulating hormone concentrations of their infants at the time of screening for congenital hypothyroidism. The study covered 4745 infants who were either breast fed (3659, 77%) or bottle fed (1086, 23%); 3086 (65%) of them were born to mothers with no iodine overload (controls) and 1659 (35%) to mothers with iodine overload. Compared with the control group, the breast and bottle fed infants born to mothers with iodide overload had a shift of neonatal thyroid stimulating hormone concentration towards high values. The shift was maximal in the breast fed infants with a 25 to 30 fold increase in the recall rate at screening for congenital hypothyroidism (serum thyroid stimulating hormone greater than 50 mU/l) while in the bottle fed infants, the recall rate was barely modified. In conclusion, the use of PVP-I in mothers at delivery induces a transient impairment of thyroid function in their infants, especially if breast fed. This situation is detrimental to screening for congenital hypothyroidism. Consequently PVP-I is not recommended in obstetrics.

Fatal ureaplasma infection in second twin born 60 days after delivery of the first in a patient with recurrent spontaneous abortion--a case report

A delay of more than one month between the birth of twins is an unusual occurrence presenting the obstetrician and the neonatalogist with many questions regarding the management of the case. There is the risk of prematurity for the second twin as labor has already occurred in the pregnancy. There is also a risk of infection to both mother and fetus during the interval between the two deliveries, since the stump of the first twin's cord may precipitate ascending colonization from vagina and cervix. Germs frequently recovered from the vagina e.g. Ureaplasma urealyticum, are associated with prematurity. The latter has also been responsible for lethal interstitial pneumonia in the neonate. We present a case of a patient who though she delivered twice normally, had suffered 4 first trimester abortions and one late abortion, all spontaneous. Her eighth pregnancy was a twin pregnancy. She underwent a cerclage at 14 weeks, but went into labor at 17 weeks, when she delivered the first macerated twin. She was then treated with fenoterol and ampicillin; nevertheless she delivered twin the second at 26 weeks. This 750 g baby-girl presented with severe respiratory distress. Repeated chest X rays showed perihilar infiltrates which became nodular. All cultures were negative. At the end of the first week, when her condition was considered satisfactory, she deteriorated dramatically and died in respiratory failure and DIC. Tracheal aspirates were positive for Ureaplasma urealyticum.

Partial bronchial stenosis following inadvertent right bronchial intubation in a neonate

This case reports difficulties encountered in weaning a premature infant with bronchopulmonary dysplasia from prolonged mechanical ventilation. On chest X-ray alternating atelectasis and hyperinflation of the right lung were observed. This resulted from a short episode of misplaced endotracheal tube that produced a traumatic bronchial stenosis. Treatment by prednisolone allowed the detubation.

Neonatal necrotizing enterocolitis: from reduction of mortality to reduction of morbidity

A prospective protocol was applied from October 1978 to December 1980 to 22 newborns presenting with necrotizing enterocolitis (Stages II and III). The total mortality was 32% (7/22) with a 100% mortality in the surgical group (4/4). The prospective protocol was changed and applied to 53 newborns from January 81 to December 84, showing a decrease in total mortality: 28% (81 and 82) and 4% (1983 and 1984), with a global mortality of zero in 1983. The main changes in the protocol are: Addition of metronidazole. More precocious and radical two stages surgical procedure. Earlier diagnostic, resuscitation and transfer to the surgical department. Improvement of anaesthesia and intensive care therapy. Duration of hospital stay fell by 50%. Despite significant intestinal resections, most infants were on a normal diet by the age of one year.

Partial trisomy 3p in two siblings: clinical and pathological findings

Two siblings affected with partial trisomy 3p resulting from a maternal balanced translocation 46,XXt(3;10) (p21;q26) are reported. The clinical features of this syndrome are reviewed. The necropsy findings of the two siblings are discussed.

Growth and metabolic response of healthy low birth-weight newborns fed a semi-elemental diet

Twelve normal low birth-weight newborns weighing between 110 and 1765 grams (means +/- SD, 1614 +/- 191) were fed by continuous intragastric drip a semi-elemental diet, providing per kilogram and per day 120 kilocalories, 2.9 grams of proteins, 17.5 grams of carbohydrates, 4.2 grams of fat and 2.4 milliequivalents of sodium. The diet contained a lactalbumin hydrolysate, dextrin maltose, and medium and long chain triglycerides. The newborns regained their birthweight between 6 and 16 days (mean +/- SD, 10.4 +/- 3.1) and gained 14 to 37 grams/day (mean +/- SD, 25.4 +/- 6.8) during the first month of life. The diet proved to be safe and clinically well-tolerated in low birth-weight infants and induced a weight gain similar to the intrauterine growth, once the birthweight had been regained.

Plasma amino acid patterns, one and two hours after continuous naso-gastric alimentation of low birth weight infants fed two types of milk during the first month of life

Plasma amino acid concentrations were determined in the morning, 1 and 2 h after discontinuing any naso-gastric feeding on the 3rd, 5th, 15th and 30th days of life, in order to establish their course according to the moment of sampling and to the type of diet given. Two types of conventional naso-gastric feeding were given in 12 infants with a birth weight of 1,500 g or less. The diets supplied either 1.2 g proteins/100 ml (pooled human milk) or 1.8 g proteins/100 ml ("humanized formula' with an albumin/casein ratio of 60/40) from the 3rd h to the 30th day of life. No statistically significant difference appeared between the amino acid concentrations 1 and 2h after discontinuation of naso-gastric alimentation on the 3rd, 5th and 15th days whichever milk was used, but a significant difference appeared for two amino acids on day 30 (phenylalanine and lysine) when fed the humanized formula. It is concluded that caution might be necessary when interpreting amino acid results: the moment of sampling induced a statistically significant difference on day 30 of life only for phenylalanine and lysine in children fed on a "humanized formula'.