重组人类促红细胞生成素治疗极低出生体重早产儿贫血的近期疗效观察

目的:应用重组人类促红细胞生成素(rhu-EPO)治疗极低出生体重早产儿贫血并随访至出生后4个月,观察其疗效。方法：将56例极低出生体重早产儿按随机抽样原则分为对照组(26例)、治疗组(30例)。治疗组于生后第8天即予rhu-EPO,每次300 IU/kg,皮下注射,每周2次,共4周;第3周开始口服铁剂(每日5～10 mg/kg)。两组均于生后7 d内口服维生素E(每日5 mg/kg)、叶酸片(5 mg/d)。随访至出生后4个月。结果：随年龄增大两组血红蛋白、红细胞数、红细胞压积均逐渐下降,在7 d, 14 d, 21 d,28 d,35 d时,治疗组上述指标均较对照组高,差异有显著性意义(P<0.01或0.05);治疗结束后,两组的血清铁蛋白［(103±25 μmol/L vs (123±24) μmol/L)差异有显著性(P<0.01);治疗组较对照组出现贫血率低(43% vs 89%),两组比较差异有显著性(P<0.01)。结论：早期大剂量rhu-EPO能减轻早产儿贫血的程度,可减少甚至替代输血。     

Est-il légitime d'administrer des vitamines liposolubles (A,E et D) chez le prématuré pendant 6 mois ?

Information on the vitamin A and E nutritional status in preterm infants is scarce. POPULATION AND METHODS: In the present prospective and longitudinal study, we measured the plasma concentrations of vitamins A, E, D and of retinol binding protein (RBP) in preterm infants (32-34 weeks of gestation) at birth, and verified whether oral supplementation with these 3 vitamins for 1, 3 and 6 months affected their plasma concentrations. The 17 consecutively recruited premature infants received daily 3000 IU of vitamin A, 5 mg of vitamin E and 1000 IU of vitamin D. RESULTS: At birth, premature infants exhibited a low plasma concentrations of vitamin A (0.66 [0.41-0.96]) micromol/l, vitamin E (8.1 [4.2-16.9] micromol/l), RBP (0.45 [0.22-0.71] micromol/l) and 25 hydroxyvitamine D (25 OHD) (20 [20-40] nmol/l). Plasma vitamin A, E , D and RBP concentrations increased with time, but vitamin A at 1, 3 and 6 months did not attain values considered normal in term infants or adolescents. At 6 months, the plasma 25 OHD was at 92 (71-116) nmol/l, a concentration considered normal and non-toxic. CONCLUSION: We recommend to increase oral administration of vitamin A to 5000 IU/day, at least for the first month of life and, thereafter to administer 3000 IU for 5 months. As for vitamin E and vitamin D, the doses used in this study are sufficient but should be administered for 6 months.     

Longitudinal zinc balances in breast-fed and formula-fed infants

Longitudinal zinc (Zn) balance studies were performed under domestic conditions in term breast-fed (n = 10), term formula-fed (n = 5; Zn concentration in the formula: 4 mg/l) and preterm formula-fed (n = 3) infants during the first 17 weeks of life. Samples of milk, urine and feces were analyzed by atomic absorption spectrometry. The median daily Zn intake in breast-fed infants decreased from 0.592 (0.457-0.829) mg Zn/kg body weight to 0.151 (0.095-0.304) mg Zn/kg body weight in the first 17 weeks of life; comparable values for bottle-fed term infants were 0.58 (0.511-0.701) and 0.674 (0.529-0.731) mg Zn/kg body weight. The median percent retention of Zn intake was 27 (-60 to 81.4)% in breast-fed infants and 21.5 (-42 to 64)% in formula-fed infants. In view of the urinary and fecal Zn losses measured, a daily intake of 0.3-0.5 mg Zn/kg body weight is considered to be sufficient to ensure a Zn retention equivalent to breast-fed infants. This requires a Zn concentration of 2-3 mg/l of Zn depending on milk volume intake.     

Vitamin A status in full-term and premature infants

Vitamin A status has been assessed by studying plasma vitamin A and retinol binding protein (RBP) levels in premature infants receiving 7,500 IU vitamin A/d (RDA 660-3,300 IU/d) and in control term babies during the 3 first months of life. Sampling was performed within the first week (D0-D7), between the 8th and the 30th day (D8-D30) and during the 2nd and the 3rd month of life (M2-M3). At D0-D7, vitamin A levels of the PTI group (28-32 weeks gestational age), PTII (33-36 weeks GA) and AT (control term newborn) were 242.1 +/- 20.5 (X +/- SEM), 176.1 +/- 12.3 and 213.1 +/- 17.1 micrograms/l respectively (P = 0.005). At D8-D30, these values were 264.2 +/- 26.0, 270.4 +/- 21.6 and 242.6 +/- 24.5 micrograms/l respectively (NS), and at M2-M3 234.2 +/- 21.6, 282.1 +/- 18.5 and 292.1 +/- 31.5 micrograms/l (NS). A significant difference was found between the values of the different dosage periods for PTII and AT groups; no difference in RBP levels was found either between groups or between dosage periods. At birth, our results show that the RBP synthesis is not closely linked to gestational age. The plasma vitamin A levels which rely on foetal stores and therefore on transplacental passage and on peripheral tissue requirements are low at 33-36 weeks gestational age. With a 7,500 IU daily supplement, excessively high vitamin A levels were not observed in premature infants; vitamin A and RBP levels in premature infants receiving supplement are not different from controls despite the 8-12-week term high vitamin A supply.     

Controversies in neonatal nutrition

The assessment of growth parameters remains one of the most practical and valuable tools to estimate nutritional status in neonates. Growth assessment in full-term infants is performed by using charts developed by the National Center for Health and Statistics. The assessment of post-natal growth in premature infants is controversial and can be performed by using either intrauterine or extrauterine standards. The selection of appropriate growth charts should be based on clinical, demographic, ethnic, and socioeconomic similarities of the population used for reference. Daily energy intakes ranging from 100 to 120 kcal/kg/day have been recommended for full-term infants, while higher intakes ranging from 114 to 181 kcal/kg/day have been recommended for premature neonates. Full-term infants should be nursed or nipple fed on demand; however, premature infants should ideally be tube fed by intermittent gastric feeding (gavage). Continuous gastric and transpyloric feedings are indicated in selected infants. Human milk is a preferred food for full-term infants during the first six months of life; however, this precept does not suggest that all infants who are exclusively breast-fed will grow adequately. Preterm human milk is also a preferred food for the low birthweight infant, provided nutritional supplements are used. It is unclear whether the supplementation of vitamin D, iron, and fluoride in full-term breast-fed infants should be started at birth, at the time of initiation of solid foods, or at the age of six months. The routine supplementation of multivitamins, folic acid, and vitamin E to all low birthweight infants is controversial. Most investigators suggest vitamin supplementation be given until the intake of formula or breast milk is sufficient to meet daily requirements. Vitamin E appears to exert a protective effect in premature infants against the development of severe retinopathy. The supplementation of vitamin E should be dependent upon the serum vitamin E concentration. It is controversial whether iron supplementation for premature infants should be initiated soon after birth or at two months of age, or whether higher doses of iron should be given to very low birthweight infants. If iron supplementation is started at birth, vitamin E status should be closely monitored. Although the optimal intakes of calcium and phosphorus in infant feedings have not been firmly established, the levels of calcium and phosphorus in human milk appear to be inadequate for the growing low birthweight infant.(ABSTRACT TRUNCATED AT 400 WORDS)     

Vitamin E concentrations in term and preterm newborns and their clinical course

Vitamin E deficiency in premature infants has been described as being associated with low hemoglobin levels in the 2nd month of life. Recently, low vitamine E concentrations were suspected as being associated with sudden death in infancy. As vitamin E is absorbed incompletely from the premature's intestine, vitamin E levels in the serum were determined in 80 prematures on the 10th day of life. The result was correlated to the clinical course of the infants and to the hemoglobin levels up to the 30th day.Low concentrations of vitamin E and lower hemoglobin levels were found more frequently in newborns, whose clinical course was characterized by additional complications and who received parenteral nutrition. A group of uncomplicated newborns showed no correlation of vitamin E to hemoglobin values. Thus early diagnosis of vitamin E-dependent anemia is not possible and the usefulness of vitamin E should be investigated only in newborns with an uneventful clinical course.Auszugsweise vorgetragen anläßlich der 24. Tagung der Nordwestdeutschen Gesellschaft für Kinderheilkunde, Kiel, 6.-8. 6. 1975.     

Pharmacokinetics of clindamycin phosphate in the first year of life

The pharmacokinetics of intravenously administered clindamycin phosphate was studied in 40 children less than 1 year of age. Mean peak serum concentrations were 10.92 micrograms/ml in premature infants less than 4 weeks of age, 10.45 micrograms/ml in term infants greater than 4 weeks, and 12.69 micrograms/ml in term infants less than 4 weeks of age. Mean trough concentrations were 5.52, 2.8, and 3.03 micrograms/ml, respectively, in the same groups. Serum half-life was significantly longer (8.68 vs 3.60 hours) in premature compared with term infants less than 4 weeks of age. Both premature and term infants less than 4 weeks had significantly decreased clearance when compared with infants greater than 4 weeks (0.294 and 0.678, respectively, vs 1.58 L/hr). Clearance was significantly greater (1.919 vs 0.310 L/hr) and serum half-life less (1.75 vs 7.57 hours) in infants with body weight greater than 3.5 kg. On the basis of these data it is recommended that in infants greater than 4 weeks or greater than 3.5 kg, intravenous clindamycin dosage be 20 mg/kg/day in four divided doses. In premature neonates less than 4 weeks, the dose should be reduced to 15 mg/kg/day in three divided doses. Term infants greater than 1 week of age may also receive 20 mg/kg/day in four doses.     

Vitamin E and haemolytic anaemia in premature infants

Studies in 50 premature babies aged 6 to 8 weeks showed that vitamin E plays a significant role in the pathogenesis of the `anaemia of prematurity''. Administration of 10 mg/day vitamin E orally elicited a clear-cut clinical and haematological response.There was a relation between the type of nutrition and the onset of anaemia, anaemia regularly developing within 2 weeks of changing from human milk to a powdered cow''s milk formula. Susceptibility to haemolysis was quantitated by measuring the free haemoglobin after exposure of the erythrocytes to hydrogen peroxide. This peroxide haemolysis was increased when the vitamin E level in the blood was below 0·6 mg/100 ml. It became normal a few days after vitamin E administration and the consequent rise in blood concentration.It is concluded that a supplement of vitamin E is advisable from the 10th day onwards in premature infants who are artificially fed.     

Low biotinidase activity in plasma of some preterm infants: possible source of false-positive screening results

Screening for biotinidase deficiency has been added recently to some national screening programmes. To clarify the problem of false-positive screening tests in premature infants, we have studied biotinidase activities in the plasma of this population in more detail. In 64 newborns (premature and term babies) biotinidase activities correlated positively with gestational age from the 2nd to the 30th day of life. During the 1st–3rd day the activities were below the normal adult range in all 64 infants. In 56 infants the activities subsequently increased gradually and reached the normal adult range during the 4th–40th day of life. In contrast, the biotinidase activities in eight preterm infants dropped during the 3rd–7th day of life. Impaired liver function as a possible cause for this finding could be ruled out in these infants. The lowest activities in these infants were measured during the 4th–6th day of life, i.e. unfortunately at a time when samples for the screening are normally taken. According to our data, 4–8 out of 48 preterm or small-for-date infants with biotinidase activities ranging from 4.7%–26% of the mean adult value would have given false-positive screening tests. A positive screening test was also obtained in a newborn and in an older unrelated child with a partial biotinidase deficiency. In these children the biotinidase activity did not rise but remained slightly below or at the lower range for heterozygotes (at 31% and 38% of the mean adult value). Currently we do not know whether such individuals are heterozygotes, or whether they have a variant of biotinidase deficiency. However, these children have developed normally without biotin therapy.Abbreviations DTT dithiothreitol     

Pharmacokinetic observations of phenytoin disposition in the newborn and young infant

The pharmacokinetic profile of phenytoin (DPH) was studied in 30 infants aged 2 days to 96 weeks. The plasma DPH half-life during the first week of life in term infants was prolonged and very variable (20-7 +/- 11-6 h, mean +/-SD). Thereafter the plasma half-life was much shorter (7-6 +/- 3-5 h). In preterm infants the half-life was much longer (75-4 +/- 64-5 h) and more variable. The mean apparent volume of distribution was similar in these groups of infants: preterm newborn 0-80 +/- 0-22 l/kg, term infants during the first week of life 0-80 +/- 0-26 l/kg, and term infants greater than 2 weeks of age 0-73 +/- 0-18 l/kg. Predictions of steady-state plasma DPH concentrations, based on these kinetic parameters, were confirmed. Very low "trough" plasma DPH concentrations were observed after the 14th postnatal day in 19 infants receiving 8 mg/kg per 24 h orally. On the other hand, infants of less than one week of age receiving the same dose, especially if preterm, frequently showed drug accumulation to toxic plasma DPH concentrations. The impaired binding of DPH to newborn plasma protein was confirmed but "normal adult values" were approached by the age of 3 months. An intravenous loading dose of 8 mg/kg (sodium phenytoin) can be expected to generate a mean plasma DPH concentration of 10 mg/l (40 micronmol/l) in the newborn. Loading doses of up to 12 mg/kg were given without untoward effects. During the first week or so of life plasma Dph half-life is so variable that no fixed dosage regimen can be derived from the available data. Beyond the second week of life, however, a dose of 8 mg/kg per 24 h is probably inadequate for most infants.     

Pharmacokinetic observations of phenytoin disposition in the newborn and young infant.

The pharmacokinetic profile of phenytoin (DPH) was studied in 30 infants aged 2 days to 96 weeks. The plasma DPH half-life during the first week of life in term infants was prolonged and very variable (20-7 +/- 11-6 h, mean +/-SD). Thereafter the plasma half-life was much shorter (7-6 +/- 3-5 h). In preterm infants the half-life was much longer (75-4 +/- 64-5 h) and more variable. The mean apparent volume of distribution was similar in these groups of infants: preterm newborn 0-80 +/- 0-22 l/kg, term infants during the first week of life 0-80 +/- 0-26 l/kg, and term infants greater than 2 weeks of age 0-73 +/- 0-18 l/kg. Predictions of steady-state plasma DPH concentrations, based on these kinetic parameters, were confirmed. Very low "trough" plasma DPH concentrations were observed after the 14th postnatal day in 19 infants receiving 8 mg/kg per 24 h orally. On the other hand, infants of less than one week of age receiving the same dose, especially if preterm, frequently showed drug accumulation to toxic plasma DPH concentrations. The impaired binding of DPH to newborn plasma protein was confirmed but "normal adult values" were approached by the age of 3 months. An intravenous loading dose of 8 mg/kg (sodium phenytoin) can be expected to generate a mean plasma DPH concentration of 10 mg/l (40 micronmol/l) in the newborn. Loading doses of up to 12 mg/kg were given without untoward effects. During the first week or so of life plasma Dph half-life is so variable that no fixed dosage regimen can be derived from the available data. Beyond the second week of life, however, a dose of 8 mg/kg per 24 h is probably inadequate for most infants.     

Serum creatinine and creatinine clearance in healthy neonates and prematures during the first 10 days of life

Normal serum creatinine (Scr) and creatinine clearance (Ccr) values during the first 10 days of life were obtained in 63 very premature (28–32 weeks of gestation), premature (33–37 weeks) and term infants (38–42 weeks). Scr fell, and Ccr rose less markedly in the very premature infants. Scr was 80 mol/l on the 1st day of life both in very premature and premature infants, and 77 mol/l in full-term neonates. After 10 days, Scr was 73, 53 and 35 mol/l respectively. There was an exponential correlation between Ccr and gestational age, indicating rapid maturation of glomerular function.Abbreviations Scr serum creatinine - Ccr creatinine clearance - GA gestational age - GFR glomerular filtration rate     

母乳喂养早产儿血清维生素E水平动态变化

目的：探讨母乳喂养健康早产儿血清维生素E水平的动态变化以及临床对于健康早产儿是否需要常规补给维生素E。方法：38例母乳喂养的健康早产儿随机分成干预组(n=20)和对照组(n=18),干预组早产儿于出生当天第1次采血后每天给予维生素E 50 mg肌肉注射,连续3 d;对照组不给予维生素E。用荧光分光光度计测定两组早产儿出生后0,10,30 d的血清维生素E水平,并作比较分析。结果：两组早产儿出生时血清维生素E水平,干预组1.64±0.68 mg/dL;对照组1.76±0.74 mg/dL差异无显著性(P>0.05);两组早产儿在生后10 d时血清维生素E均呈升高趋势,干预组2.54±1.23 mg/d l,对照组2.64±1.13 mg/dL,两组间差异无显著性,(P>0.05)。生后30 d时,干预组血清维生素E仍维持原增高水平,而对照组血清维生素E呈下降趋势,干预组2.77±1.56 mg/dL,对照组为2.37±1.07两组差异无显著性(P>0.05)。各时间点,两组早产儿血清维生素E均高于0.5 mg/dL(范围0.59~6.45 mg/dL)。结论：母乳喂养健康早产儿生后30 d内血清维生素E与用维生素E干预组比较无显著差别,且两组早产儿都无维生素E缺乏发生。故认为对于母乳喂养早产儿无需常规补给维生素E。[中国当代儿科杂志,2005,7(6):503-505]     

A modified vitamin regimen for vitamin B2, A, and E administration in very-low-birth-weight infants

INTRODUCTION: Very-low-birth-weight (VLBW; birth weight, <1,500 g) infants receive preterm infant formulas and parenteral multivitamin preparations that provide more riboflavin (vitamin B2) than does human milk and more than that recommended by the American Society of Clinical Nutrition. VLBW infants who are not breast-fed may have plasma riboflavin concentrations up to 50 times higher than those in cord blood. The authors examined a vitamin regimen designed to reduce daily riboflavin intake, with the hypothesis that this new regimen would result in lower plasma riboflavin concentrations while maintaining lipid-soluble vitamin levels. METHODS: Preterm infants with birth weight < or =1,000 g received either standard preterm infant nutrition providing 0.42 to 0.75 mg riboflavin/kg/day (standard group), or a modified regimen providing 0.19 to 0.35 mg/kg/day (modified group). The modified group parenteral vitamin infusion was premixed in Intralipid. Enteral feedings were selected to meet daily riboflavin administration guidelines. Plasma riboflavin, vitamin A, and vitamin E concentrations were measured weekly by high-performance liquid chromatography. Data were analyzed with the independent t test, chi, and analysis of variance. RESULTS: The 36 infants (17 standard group, 19 modified group) had birth weight and gestational age of 779 +/- 29 g and 25.5 +/- 0.3 weeks (mean +/- SEM) with no differences between groups. Modified group infants received 38% less riboflavin (0.281 +/- 0.009 mg/kg/day), 35% more vitamin A (318.3 +/- 11.4 microg/kg/day), and 14% more vitamin E (3.17 +/- 0.14 mg/kg/day) than standard group infants. Plasma riboflavin rose from baseline in both groups but was 37% lower in the modified group during the first postnatal month (133.3 +/- 9.9 ng/mL). Riboflavin intake and plasma riboflavin concentrations were directly correlated. Plasma vitamin A (0.222 +/- 0.022 microg/mL) and vitamin E (22.26 +/- 1.61 /mL) concentrations were greater in the modified group. CONCLUSIONS: The modified vitamin regimen resulted in reduced riboflavin intake and plasma riboflavin concentration, suggesting plasma riboflavin concentration is partially dose dependent during the first postnatal month in VLBW infants. Modified group plasma vitamin A and vitamin E concentrations were greater during the first month, possibly because the vitamins were premixed with parenteral lipid emulsion. Because of the complexity of this protocol, the authors suggest that a parenteral multivitamin product designed for VLBW infants which uses weight-based dosing should be developed.     

Vitamin E and neonatal bilirubinemia.

A study was designed to determine the effect of vitamin E on bilirubinemia in the preterm infant. Twenty infants with birth weight between 1,000 and 1,500 gm and 20 infants with birth weights between 1,501 and 2,000 gm were studied. Half the infants in each birth weight group received vitamin E administered intramuscularly in a total dose of 50 mg/kg during days 1 to 3 of life; the remaining infants served as controls. The administration of vitamin E produced significantly increased plasma tocopherol concentrations and normal hydrogen peroxide hemolysis tests by the end of the first week of life. Infants with birthweights less than or equal to 1500 gm who received vitamin E demonstrated a significant decrease in serum bilirubin on day 3 of life (6.5 +/- 2.2 vs 8.8 +/- 2.2 mg/dl) as well as a significant decrease in peak serum bilirubin during the first week of life (8.3 +/- 2.2 vs 10.6 +/- 2.6 mg/dl). The duration of phototherapy also was significantly less in the vitamin E-supplemented group (48 +/- 18 vs 107 +/- 31 hours). These differences were less pronounced in infants with birth weights more than 1,500 gm.     

High total and free 1,25-dihydroxyvitamin D concentrations in serum of premature infants

We investigated the relationship between serum total and free 1,25-dihydroxyvitamin D (1,25-OH2D) and the biochemical regulation of 1,25-OH2D production in premature infants. We measured 1,25-OH2D, vitamin D binding protein and related biochemical parameters and calculated the free 1,25-OH2D index in serum of 17 premature infants (birthweight 810-1700 g; gestational age 31-36 weeks) on two different occasions defined by body weight (Study A: 1,750-1,850 g, Study B: 2,100-2,200 g). Dietary calcium (Ca) intake was 1,5 or 2,6 mmol/kg/d, phosphorus (P) intake 1,7 mmol/kg/d and vitamin D intake 1,000 IU/d. Biochemical results were similar in infants with different Ca intakes and all were within reference ranges. Concentrations of vitamin D binding protein (Study A 0.15 +/- 0.03 g/l, Study B 0.14 +/- 0.03 g/l; means +/- SD) were lower, concentrations of 1,25 (OH)2D (Study A 180 +/- 67 pmol/l, Study B 216 +/- 53 pmol/l) were higher, and consequently the free 1,25-OH2D index (Study A 6.6 +/- 2.7, Study B 8.8 +/- 2.6) was 4 to 6 times higher than in previously studied term infants. 1,25-OH2D and the free 1,25-OH2D index increased significantly with age and were not correlated with serum P or parathyroid hormone. The data indicate that in premature infants with normal biochemical parameters of Ca and P metabolism elevated concentrations of 1,25-OH2D signify an increased fraction of free 1,25-OH2D and that increased production of 1,25-OH2D is not due to hypophosphatemia or hyperparathyroidism.     

Oral vitamin E supplementation for the prevention of anemia in premature infants: a controlled trial

Serum vitamin E levels are reduced in newborn infants. It has been reported that this deficiency is responsible, in part, for the development of anemia in premature infants during the first 6 weeks of life. The efficacy of vitamin E supplementation for the prevention of anemia in premature infants has been studied in a randomized, controlled, and blinded trial. Premature infants whose birth weights were less than 1,500 g were given, by gavage, 25 IU of dl-alpha-tocopherol or a similar volume of the drug vehicle. Treatment was continued for the first 6 weeks of life. A total of 178 infants were studied. Vitamin E levels were significantly higher in a supplemented group by day 3 and for the remainder of the 6-week period. At 6 weeks of age, there was no significant difference between the supplemented and unsupplemented groups in hemoglobin concentration, reticulocyte and platelet counts, or erythrocyte morphology. It is concluded that there is no evidence to support a policy of administering vitamin E to premature infants to prevent the anemia of prematurity.     

Iron Balances in Infant Nutrition

ABSTRACT. Iron balance studies were performed in 17 full term male infants from their 3rd until their 17th week of life. The balance studies were made in the infant's home and comprised 5 periods with an interval of 3–4 weeks, each consisting of three 24-hour collections. Ten infants were breast-fed, 3 received an adapted infant formula (P1, iron content 1.1 mg/l) and 4 were given the same formula enriched with iron, copper and zinc (P2, iron content 10.35 mg/l). From the 3rd to the 17th week of life the breast-fed infants got a mean iron intake of 0.2 mg/kg body weight ×3 days and they retained 0.09 mg/kg b.w. ×3 days. The P1 group received 0.48 and 0.47 mg/kg b.w. ×3 days and retained -0.01 and -0.5 mg iron/kg b.w. ×3 days, while the P2 group had an intake from 5.04 to 6.38 mg b.w. ×3 days and retained between 1.13 and 3.66 mg iron/kg b.w. ×3 days. Comparing the 3 groups it can be concluded that the P1 group retained definitely less iron than the breast-fed group, whereas the P2 group retained 12 to 40 times more iron than the breast-fed babies.     

Intestinal Absorption of Vitamin E in Low Birth Weight Infants

ABSTRACT. Intestinal absorption of dl-α-a-tocopheryl acetate was studied in low birth weight infants. Vitamin E was given from the first day of life, either as a water-soluble (Ephynal®) or as a lipid-soluble preparation (E-vitamin®). Serum-α-tocopherol concentrations were determined before treatment and on days three and seven. Treatment with both vitamin E preparations increased serum-a-tocopherol on day three and seven. The mean serum-a-tocopherol ± SD on day seven were 41.4±10.7 umol/l for the Ephynal® group and 26.7±12.5 umol/l for the E-vitamin® group, this difference being statistically significant ( p < 0.025). Oral feeding seems to influence the absorption of tocopherol from E-vitamin®, as the infants with the highest serum-a-tocopherol concentrations were those with the highest oral/total feeding ratios. In infants with birth weight <1000 g treatment with 25 mg Ephynal®/day was found to increase serum-a-tocopherol on day seven to 46.9± 12.3 umol/l (mean ± SD). This concentration is comparable to those reported by others using higher doses of oral vitamin E.     

Early growth of term SFD infants in relation to caloric intake

Growth and development of 100 term SFD infants divided into 3 groups with body weight of 1·5 kg or less (I), 1·51–1·75 kg (II), 1·76–2·25 kg (III) and 100 AFD term infants was determined longitudinally. Group I and II infants remained smaller and had delayed milestones of development throughout the 1st year of life, with limited catch up only in body weight in the first 3 months. Their milk intake was low (132 ml/kg). Group III infants, who had comparatively better growth parameters at birth, showed effective catch up growth in all the parameters to reach the level of those of AFD infants within 3–10 months by increased consumption of milk (186 ml/kg). Their milestones of development were at par with that of AFD infants who consumed 160 ml of milk/kg/day in the first 2–4 months. The low consumption of milk by group I and II infants with severe intrauterine malnutrition is possibly related to the reduced appetite geared to a small body size.