NUTRITION IN LOW-BIRTH-WEIGHT INFANTS: II. Repeated Intravenous Injections of Fat Emulsion

Abstract. Gustafson, A., Kjellmer, I., Olegård, R. and Victorin, L. (Department of Paediatrics, Children's Hospital, and of Medicine I, Sahlgren's Hospital, Goteborg, Sweden). Nutrition in low-birth-weight infants. II. Repeated intravenous injections of fat emulsion. Acta Paediat Scand, 63: 177, 1974.–The elimination of an exogenous fat emulsion from the blood stream after repeated intravenous injections was investigated in two groups of low-birth-weight infants: 11 appropriate-for-date (AFD) pre-term babies and 8 light-for-date (LFD) pre- and full-term infants. During a period with six injections hourly of 0.15 g fat/kg 'b.w. the total lipids of plasma increased only moderately in the AFD group, from 264 to 351 mg/100 ml, while in the LFD group a progressive rise of total lipids occurred from 244 to 466 mg/100 ml. The plasma turbidity increased correspondingly more in the LFD than in the AFD group. In 5 LFD babies, where a progressive accumulation of total lipids occurred with each injection of fat emulsion, heparin was given intravenously after eight fat injections. The plasma was rapidly cleared of fat although fat injections were continued. It is concluded that AFD infants are able to hydrolyse fat emulsions given at an hourly rate of 0.15 g/kg b.w., while this amount of fat to LFD babies will cause an accumulation of plasma lipds unless heparin is supplied simultaneously.     

Intravenous pamidronate in juvenile osteoporosis.

AIMS: To investigate the use of the aminobisphosphonate, disodium pamidronate, in children with vertebral osteoporosis. METHODS: Five children (aged 10-15 years) with vertebral osteoporosis who developed compression fractures in the thoracic and/or lumbar spine as a consequence of five different conditions, received treatment with intravenous disodium pamidronate in doses ranging from 0.5 to 12 mg/kg/y. RESULTS: Each child had rapid pain relief following the first treatment, followed by large increments in lumbar spine bone density over one year; the change in bone density standard deviation score ranged from 0.5 to 2.5 with percentage increments of 26% to 54%. CONCLUSION: Intravenous pamidronate appears to be a useful therapeutic option in childhood osteoporosis, but its use in children must still be regarded as experimental and therefore closely monitored.     

Intravenous diazoxide in acute poststreptococcal glomerulonephritis.

Twenty-six patients with hypertension secondary to acute poststreptococcal glomerulonephritis were treated by the rapid intravenous infusion of diazoxide. The average pretreatment systolic pressure was 159 mm Hg. Five minutes after administration, the average systolic pressure was 122 mm Hg (a 23% reduction). The average initial diastolic pressure was 104 mm Hg, which fell 5 minutes after diazoxide injection to 71 mm Hg (a 32% reduction). No hypotensive episodes were noted. Occasional episodes of nausea occurred. Concentrations of blood glucose increased after administration of diazoxide; however, no values were above 155 mg/dl. Diazoxide appears to be a safe antihypertensive drug that is effective in the treatment of hypertension secondary to acute poststreptococcal glomerulonephritis.     

Intravenous indomethacin for patent ductus arteriosus.

Intravenous indomethacin was given to 36 neonates with a patent ductus arteriosus who where receiving ventilatory support for respiratory distress syndrome. Permanent closure of the ductus arteriosus occurred in 21 (58%) infants and in this group the mean 24 hour plasma indomethacin concentration was 0.37 micrograms/ml. Partial success was achieved in 6 (17%) infants (mean 24 hour indomethacin concentration 0.34 micrograms/ml) but in 9 patients (mean 24 hour indomethacin concentration 0.29 micrograms/ml) there was no clinical change. Although the mean 24 hour indomethacin concentration was lower in the group with no clinical change, this was not statistically significant. Five of the 21 patients in whom there was permanent closure of the ductus required more than one dose of indomethacin. The possible effects of birthweight and age at indomethacin treatment were difficult to separate because of the high negative correlation between these two variables. The chance of closure was enhanced significantly if the patient had either a birthweight of at least 1 kg or the age at indomethacin treatment did not exceed 10 days, or both. Six hour but not 24 hour indomethacin concentrations were higher in patients with a high birthweight treated at an early age.     

Intravenous nutrition for the pediatric patient.

Nutritional management of infants and children differs from that of adults because of the extra requirements for growth and the limitations of physiological immaturity. Although parenteral nutrition (PN) is an accepted practice and a potentially life-saving therapy for pediatric patients who cannot be fed through their gastrointestinal tract, it is associated with the risk of serious metabolic, mechanical, and infectious complications. Candidates for PN should be selected according to well-defined indications, with initial nutritional assessment and with careful attention given to fluid, electrolyte, vitamin, trace element, and caloric requirements. Total calories should be administered so that the nonprotein-calorie to gram-nitrogen ratio is in the range of 150 to 250:1. Although short-term supplemental nutritional support can be administered through a peripheral vein, long-term total PN is best delivered by central venous access. PN should be initiated and monitored in accordance with well-established protocols. The lowest complication rate and highest cost-effectiveness are achieved by an interdisciplinary team that includes one or more nurses, dietitians, pharmacists, and physicians. The development of safe, reliable, and miniaturized intravenous pumps with built-in monitors has made home parenteral nutrition possible and desirable in selected patients.     

Thoracic empyema: a study of 56 patients.

Fifty seven children with thoracic empyema (37 boys and 20 girls) aged less than 12 years were seen at the University of Port Harcourt Teaching Hospital between January 1989 and December 1991. Staphylococcus aureus was the most common organism isolated from the pus of these patients (36 (63%) patients). Pseudomonas aeruginosa, the next most common organism, was isolated in 10 (18%) patients. The most common symptoms at presentation were acute illness with fever and cough (51 (89%) patients). All the patients were treated with closed intercostal tube drainage and appropriate antibiotics. Decortication was resorted to in only one patient. There were two deaths and the overall survival rate was 97%.