THE PLASMA LEVELS OF 25-HYDROXYVITAMIN D IN PATIENTS WITH VARIOUS LIVER DISEASES AND THE RESPONSE OF 25-HYDROXYVITAMIN D TO VITAMIN D TREATMENT

ABSTRACT. The mean plasma levels of 25-hydroxyvitamin D (25-OH-D) were measured before and after the administration of 2000 units of daily oral vitamin D₂ for a period of 2 weeks in 9 normal infants and children, 7 infants with neonatal hepatitis and persistent neonatal hepatitis, and 4 infants with congenital biliary atresia. The mean plasma level of 25-OH-D increased significantly from 19.5±3.7 (S.E.) ng/ml to 34.0±6.8 (S.E.) ng/ml after administration of vitamin D₂ in controls ( p <0.05). The mean plasma level of 25-OH-D also increased from 8.0±2.1 (S.E.) ng/ml to 22.1±2.6 (S.E.) ng/ml after vitamin D treatment in hepatitis group ( p <0.05). In patients with congenital biliary atresia, vitamin D treatment did not affect the plasma levels of 25-OH-D.     

PLASMA CONCENTRATIONS OF VITAMIN D METABOLITES IN A CASE OF RICKETS OF PREMATURITY

ABSTRACT. Rickets was diagnosed in an extremely low-birthweight infant 16 weeks after birth. She had a normal plasma concentration of 25-hydroxyvitamin D, a relatively low level of 24,25-dthy-droxyvitamin D, and a markedly elevated 1,25-dihydroxyvitamin D level compared with adult standards. The plasma concentrations of the vitamin D metabolites were, however, indistin-guishable from those of healthy preterm infants who received a similar diet of human milk and vitamins. The results indicate that rickets was not caused by vitamin D deficiency or by abnormal vitamin D metabolism, but by calcium and/or phosphate deficiency, and that the calcium and phosphorous content of human milk may be inappropriately low for very low-birthweight infants.     

VITAMIN D METABOLISM IN PRETERM INFANTS

ABSTRACT. In order to evaluate after birth the changes in circulating vitamin D metabolite levels in preterm babies supplemented with vitamin D (2100 I. U./d), the serum concentration of 25-hydroxyvitamin D [25-OHD] and 1 α,25-dihydroxy vitamin D [1, 25(OH)₂D] were measured in 22 infants (31 to 35 weeks of gestation) from birth up to 96 hours of age. Compared to cord blood levels, serum calcium decreased significantly during the first 24 hours of life ( p <0.005) and remained low until day 4. Serum immunoreactive parathyroid hormone (iPTH) levels increased from birth to 24 hours and then plateaued. The 25-OHD levels at birth were 27.5±2.5 nmol/l and increased to 67.5±12.5 nmol/l ( p <0.005) during the four days of the study. During the same period, the 1, 25(OH)₂D serum levels increased steadily from 84<7 to 343<105 pmol/l ( p <0.005). At all times, there was a positive correlation between 25-OHD levels and those of 1, 25(OH)₂D. Our data demonstrate that in preterm infants after 31 weeks of gestation, absorption and activation of vitamin D is present as soon as 24 hours after birth and that early neonatal hypocalcemia is unlikely to be caused by an impairment of either PTH secretion or vitamin D activation.     

VITAMIN E REQUIREMENTS OF PRETERM INFANTS

ABSTRACT. Differences between feeding practices in earlier investigations prompted the present study of iron and vitamin E supplementation in breast milk fed preterm infants. A new and highly sensitive technique for quantitation of alpha-tocopherol in serum was used. Studies on 34 infants with a birth weight below 2000 g or gestational age ≤35 weeks showed that supplementation with 16.5 mg tocopheryl acetate/day from 10 days of age resulted in a significantly higher haemoglobin concentration and lower reticulocyte count at 8–10 weeks than supplementation with 1.5 mg/day (p<0.05). Studies on 23 infants with a birth weight of 2000–2499 g revealed subnormal alpha-tocopherol levels in 2 of the infants given 1.5 mg tocopheryl acetate/day but there was no effect on the haemoglobin concentration at 8–10 weeks. There were no untoward effects of an early iron supplementation with 2–3 mg Fe⁺⁺ (as ferrous succinate)/kg/day. It is concluded that extra supplementation with vitamin E is advisable also in breast milk fed preterm infants. A low dosage iron supplementation from 3 weeks of age is safe.     

LATE EVOLUTION OF SERUM IMMUNOREACTIVE PARATHYROID HORMONE, CALCITONIN AND PLASMA 25-HYDROXY CHOLECALCIFEROL CONCENTRATIONS IN VERY LOW BIRTHWEIGHT INFANTS

ABSTRACT. Sunn, L., Rigal, D., Krederich, A. and Lahet, C. (Department of Neonatology, Hopital Debrousse and Laboratory of polypeptide hormones, Hopital E. Herriot, Lyon, France). Late evolution of serum immunoreactive parathyroid hormone, calcitonin and plasma-hydroxycholecalciferol concentrations in very low birthweight infants. Acta Paediatr Scand, 70:479,.–The plasma concentrations of 25-hydroxycholecalciferol (25-OH-CC), immunoreactive parathyroid hormone (iPTH) and calcitonin (iCT) were measured at the age of 30 and 66 days in thirteen preterm neonates (birthweight: 970 to 1300 g). At the age of 30 days when all infants were fed only with breast milk (BM) serum iCT and iPTH levels were normal. During the second month 7 infants were fed with BM only (control group) and 6 infants were supplemented with formula (supplemented group). At the age of 66 days, mean ± S.D. serum iPTH concentration was higher in the supplemented group than in the control group: 169±79 vs. 60±33 μlEq/ml (p≤0.01). Serum iCT levels remained undetectable (<150 pg/ml) in both groups. Plasma 25-OH-CC concentrations were normal and similar in both groups. Serum iPTH concentrations were positively correlated with phosphorus intake and negatively correlated with calcium intake from BM only. The results suggest that secondary hyperparathyroidism can be detected in very low birthweight infants supplemented with a formula, probably because of a phosphorus load or decreased intestinal absorption of calcium.     

THE EFFECT OF VITAMIN E ON ERYTHROCYTE HEMOLYSIS AND LIPID PEROXIDATION IN NEWBORN PREMATURE INFANTS

ABSTRACT. The biochemical effect of vitamin E supplementation to mothers with threatened premature delivery and to premature infants after birth has been studied. Although a weak correlation was found between maternal and cord blood vitamin E levels at birth, cord blood levels were not significantly higher in the infants from supplemented mothers than those from unsupplemented mothers. Furthermore, maternal vitamin E treatment did not prevent either erythrocyte hemolysis or lipid peroxide formation in the premature infants after birth. On the other hand, intramuscular vitamin E to infants after birth produced a marked biochemical effect, with both zero erythrocyte hemolysis and low lipid peroxide formation when serum vitamin E increased above 2 mg/100 ml. We conclude that intramuscular vitamin E immediately after birth is necessary to achieve a biochemical effect of vitamin E in the early neonatal period. (No cases of retrolental fibroplasia occurred in the present study.)     

DEFICIENCY OF NEUTROPHIL PHAGOCYTOSIS IN PREMATURE INFANTS: EFFECT OF VITAMIN E SUPPLEMENTATION

ABSTRACT. In 20 healthy premature infants, 10 of whom were administered a total dose of 120 mg/kg vitamin E intramuscularly during the first 13 days after birth, polymorphonuclear leukocyte (PMN) bactericidal activity, frequency and index of phagocytosis, NBT reduction, random movement, chemotaxis and metabolic activity were evaluated within the first 48 hours and again at 5, 14 and 30 days of age. PMN function was also assessed in 30 adult controls. In the treated and untreated infants no differences were found in PMN function before treatment with vitamin E; however phagocytosis, bactericidal activity and chemotaxis were significantly lower than in the adult controls. At 5 days of age, in the untreated infants both index and frequency of phagocytosis remained low but in the treated groups increased significantly. At 14 and 30 days phagocytosis was normal in both treated and untreated infants. No differences were found in the bactericidal activity, NBT reduction, random movement, chemotaxis or metabolic activity of the treated and untreated infants at the ages studied. This preliminary report suggests that vitamin E may be used in premature newborns for accelerating normalization of phagocytic function in the neonatal period.     

PLASMA FERRITIN CONCENTRATIONS IN PRETERM INFANTS IN CORD BLOOD AND DURING THE EARLY ANAEMIA OF PREMATURITY

Abstract. Hågå, P. (Department of Paediatrics and Paediatric Research Institute, National Hospital of Norway, and Department of Paediatrics, Oslo City Hospital, Ullevål, Oslo, Norway). Plasma ferritin concentrations in preterm infants in cord blood and during the early anaemia of prematurity. Acta Paediatr Scand, 69: 637, 1980.—Ferritin concentrations in cord blood were determined in 22 normal term and 32 preterm infants (birth weights 600–2000 g). Eight of the preterms were SGA infants. AGA preterm infants had significantly lower concentrations than term infants, and the SGA preterm newborn had even lower levels. Plasma ferritin in cord blood of the term and AGA preterm infants correlated positively with plasma iron and transferrin saturations, but not with the transferrin level, while plasma iron and transferrin concentrations correlated positively. In a longitudinal study, 17 AGA preterm infants (birth wights 850–1500 g) were followed during the early anaemia of prematurity. Iron was supplemented from 4 weeks of age. Plasma ferritin rose rapidly during the first days after birth, peak levels being reached at 1–4 weeks. Thereafter linear falls (semilog) occurred with similar slopes in different infants. Transferrin concentrations showed a slow progressive increase from 0–8 weeks. Plasma ferritin, after reaching the peak value, correlated negatively with weight gain. No infant had low ferritin values indicating iron deficiency during the early anaemia.     

CONCENTRATIONS OF DIGOXIN IN PLASMA AND URINE IN NEONATES, INFANTS, AND CHILDREN WITH HEART DISEASE

ABSTRACT. Wettrell, G., Andersson, K.-E., Bertler, Å. and Lundström, N. R. (Departments of Paediatrics and Clinical Pharmacology, University Hospital, Lund, Sweden). Concentrations of digoxin in plasma and urine in neonates, infants, and children with heart disease. Acta Paediatr Scand, 63: 705, 1974.—By means of radioimmunoassay and ⁸⁶Rb-uptake inhibition assay, concentrations of digoxin in plasma and urine have been determined in different paediatric age groups. On equal daily maintenance doses (0.012–0.013 mg digoxin/kg b.w./day) a higher mean plasma digoxin level was found in full term neonates (3–30 days), 2.1 ng/ml, than in infants (1–12 months) and children (1–10 years), 1.2 and 1.4 ng/ml, respectively. On a maintenance dose of 0.019 mg/kg b.w./day, one group of infants had an average plasma digoxin level of 2.1 ng/ml (range 1.1–2.9 ng/ml). No signs of toxicity were found. A gradual increase in the renal clearance of digoxin during the first few months of life was demonstrated. There was a highly significant correlation between the clearances of digoxin and creatinine (r=0.87, p<0.001). It is concluded that the high mean plasma digoxin level in full-term neonates could be explained by low renal elimination of the glycoside.     

THE EFFECT OF DIETARY γ-TOCOPHEROL ON SERUM TOCOPHEROLS IN FORMULA-FED INFANTS

ABSTRACT. Jansson, L., Holmberg, L. and Jakobsson, I. (Department of Paediatrics, University of Lund, Malmö General Hospital, Malmö, Sweden). The effect of dietary γ-tocopherol on serum tocopherols in formula-fed infants. Acta Paediatr Scand, 70:297, 1981.–The levels of α-, β- and γ-tocopherol were determined in two formulas (Nutramigen± and Soja-semp±) and in 20 infants fed either of these formulas. The y-tocopherol concentration in Nutramigen was 22.8±1.9 µmol/l; and that in Soja-semp 3.7±0.5 µmol/l. This difference was reflected in the serum tocopherols of the infants, since in the 10 infants fed Nutramigen, γ-tocopherol accounted for 16.7 ± 7.9% of the total tocopherols compared to 4.2±1.8% in the 10 infants fed Soja-semp. The study shows that γ-tocopherol accumulates in the serum of infants fed large amounts of it. The serum γ-tocopherol level should therefore be taken into account, when estimating the vitamin E status in humans, especially when the intake of γ-tocopherol is high.     

EFFECT ON SERUM CALCIUM OF lα-HYDROXY-VITAMIN D3 SUPPLEMENTATION IN INFANTS OF LOW BIRTH WEIGHT, INFANTS WITH PERINATAL ASPHYXIA, AND INFANTS OF DIABETIC MOTHERS

Abstract. Petersen, S., Christensen, N. Chr. and Fogh-Andersen, N. (Department of Neonatology and Department of Clinical Chemistry, Rigshospitalet, Copenhagen, Denmark). Effect on serum calcium of lα-hydroxy-vitamin D₃ supplementation in infants of low birth weight, infants with perinatal asphyxia, and infants of diabetic mothers. Acta Paediatr Scand, 70: 897, 1981.-Thirty infants of low birth weight, 34 infants with perinatal asphyxia, and 16 infants of diabetic mothers were investigated for early neonatal hypocalcaemia. The infants were randomized into a group prophylactically given lα-hydroxy-vitamin D₃, 0.05 or 0.10 μ/kg i.v. on the first 3 days of life, and an untreated control group. In infants of low birth weight and infants of diabetic mothers there were no differences in serum ion-Ca concentrations on days 2, 3, 5, and 7 between the treated and untreated groups. In infants with perinatal asphyxia, however, serum ion-Ca concentrations on days 5 and 7 were significantly higher in the treated than in the untreated group, while on days 2 and 3 the differences were not statistically significant. The hypocalcaemia in asphyctic infants was not correlated to bicarbonate treatment, but infarits with severe signs of asphyxia had lower serum ion-Ca concentrations than infants with only mild or no signs. Hypocalcaemia in asphyctic infants might be explained by a decreased concentration of 1 α, 25-dihydroxy-vitamin D₃ following reduced lα-hydroxylation in the kidney as a consequence of anoxia during perinatal asphyxia.     

EFFECTS OF DIET ON FATTY ACID COMPOSITION OF PLASMA AND RED CELL PHOSPHOGLYCERIDES IN THREE-MONTH-OLD INFANTS

Concentrations of the main lipid classes in plasma and the blood phosphoglyceride fatty acid patterns were measured in 3-month-old infants, fed breast-milk or an industrial manufactured formula. The levels of cholesterol and phosphoglycerides were in the normal range for young adults, but the triglyceride concentration was twice as high as in adults. There were no significant differences in the levels of the plasma lipids between the two groups, but the mean of the triglycerides was 25 % higher in the formula-fed group. The plasma and red cell phosphoglycerides had already assumed a fatty acid pattern of adult type. The concentration of the total polyenoic acids was significantly lower in the breast-fed group, the difference being entirely confined to the fatty acids of the linoleic acid series. Linoleic acid was 27% and 40%, respectively, lower in plasma phosphoglycerides and red cell lecithin of breast-fed than of formula-fed infants, but arachidonic acid did not show any significant difference in the two groups. The concentration of the fatty acids of the linolenic acid series was higher in the breast-fed infants. The blood lecithin ratio between the fatty acids of the linolenic acid series and the linoleic acid series was thus much lower in the formula-fed than in the breast-fed infants, the ratio being closely correlated with the dietary linolenate/linoleate ratio. Although the concentration of essential fatty acids was low in both plasma and red cell phosphoglycerides of breast-fed infants, there was no increase of 20: 3 (n – 9).     

PLASMA FREE AMINO ACID CONCENTRATIONS OF BREAST-FED INFANTS

ABSTRACT. Photometric determination of alpha-amino nitrogen in peripheral venous plasma and urine from 20 healthy, full-term infants, 1–5 months of age, showing normal growth and development during an uncomplicated lactation, revealed lower plasma levels than what has been found in adults, or 3.7±1.1 mg/100 ml, and a urinary excretion of 41 + 14 mg/24 hours. Ion-exchange chromatography of deproteinized peripheral venous plasma showed low valine concentrations, an increased glycine/valine ratio and high cystine and very high taurine levels when compared to the levels of healthy American infants of comparable ages fed 3-3.5 g/kg of cow-milk protein. The findings indicate that a formula based on cow-milk protein should optimally contain only 1.0–1.2 g protein/100 ml provided that it is "humanized" not only with regard to the lactalbumin/casein ratio, but also to the cystine and taurine content. The pattern of the plasma concentrations of free amino acids reported in the present investigation may be used as a normal reference for breast-fed infants.     

佝偻病维生素D受体基因多态性与25-羟维生素D3相关性

目的：研究1~3岁佝偻病患儿中维生素D受体基因多态性FokⅠ位点与佝偻病相关性,初步探讨维生素D受体基因多态性FokⅠ位点在佝偻病发病中的作用。方法：病例组（佝偻病患儿）62例与对照组（正常健康儿童）60例,用ELISA方法检测血清25-羟维生素D3水平,比较两组之间血清25-羟维生素D3水平。用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）检测病例组和对照组维生素D受体基因多态性FokⅠ位点,比较两组之间基因型和等位基因分布频率。结果病例组血清25-羟维生素D3水平较对照组明显降低,差异有统计学意义（9.1±4.1 ng/mL vs 16.1±6.9 ng/mL;P＜0.05）。维生素D受体基因多态性FokⅠ位点病例组FF基因型明显高于对照组（53% vs 25%）,基因型分布频率差异有统计学意义（χ2=10.221,P＜0.05）,病例组F等位基因频率明显高于对照组（73% vs 57%）,等位基因分布频率差异有统计学意义（χ2=7.511,P＜0.05）。结论维生素D受体基因多态性FokⅠ位点与佝偻病有相关性,提示其在佝偻病遗传易感性方面起重要作用。［中国当代儿科杂志,2010,12（7）：544-546］     

石家庄市夏季汉族4月龄至14岁健康儿童血清25-羟维生素D和甲状旁腺素的关系

目的探讨汉族儿童青少年夏季血清25-羟维生素D(25OHD)和甲状旁腺素(PTH)水平的关系,以及儿童青少年是否存在PTH进入平台期的血清25OHD拐点值。方法河北医科大学第二医院儿科生长发育门诊于2011年6~8月及2012年6~8月向社会招募4月龄至14岁健康儿童青少年。分为1岁、~3岁、~6岁、~10岁和~14岁组。分别采用酶联免疫法和化学发光免疫分析法测定血清25OHD和全段PTH水平。对血清25OHD与PTH水平的关系分别行直线、二次多项式、指数和对数拟合等,计算血清PTH水平进入平台期的血清25OHD阈值。结果共招募632名健康儿童青少年,男童372名,女童260名。1血清25OHD和PTH水平的中位数(P25,P75)分别为56.7(42.2,76.4)nmol·L-1和2.5(2.0,3.3)pmol·L-1。2血清25OHD与PTH在除~10岁组外的其余年龄组中均呈负相关。3二次多项式回归方程能较好反映血清25OHD和PTH之间的曲线关系。回归方程为PTH(pmol·L-1)=4.2698-0.0352·25OHD+0.0002·25OHD2,R2=0.0684。PTH进入平台期时血清25OHD的拐点值为88 nmol·L-1,对应的PTH值为2.72 pmol·L-1。结论 4月龄至14岁汉族儿童青少年的血清25OHD和PTH水平呈负相关,且理想的血清25OHD水平可能为88 nmol·L-1。     

POST-MORTEM DISTRIBUTION AND TISSUE CONCENTRATIONS OF DIGOXIN IN INFANTS AND ADULTS

ABSTRACT: Andersson, K.-E., Bertler, å. and Wettrell, G. (Departments of Clinical Pharmacology and Paediatrics, University Hospital, Lund, and Department of Clinical Pharmacology, the Medical School, Linkoping, Sweden). Post-mortem distribution and tissue concentrations of digoxin in infants and adults. Acta Paediatr Scand, 64:497, 1975.–By means of ⁸⁶Rb uptake inhibition assay, the distribution and tissue concentrations of digoxin in various tissues during maintenance therapy were studied post mortem in 12 infants (aged 5 days to 8 months) and 17 adults (aged 49–91 years). The mean maintenance dose for infants was 0.014 mg/kg bw/24 h and for adults, 0·005 mg/kg bw/24 h. The same relative distribution of the glycoside found in infants and in adults was: choroid plexus>ventricular myocardium> kidney liver >skcletal muscle. Between infants and adults, the mean digoxin concentrations in choroid plexus, kidney, liver, and skeletal muscle did not differ significantly; however, significant differences were found in the glycoside concentrations in ventricular and in atrial myocardium. Both infants and adults showed a difference in the content of the glycoside within the heart, the concentration in ventricular muscle being significantly higher than in atrial. There seemed to be no direct relation between the tissue concentrations of the glycoside (myocardium, skeletal muscle) and the daily maintenance dose (mg/kg bw/24 h). The results suggest that the myocardial binding of digoxin is higher in infants than in adults.     

VITAMIN D NUTRITIONAL STATUS OF PREMATURE INFANTS SUPPLEMENTED WITH 500 IU VITAMIN D2 PER DAY

ABSTRACT. The vitamin D nutritional status of premature infants was assessed by determining plasma 25-hydroxyvitamin D concentrations before and during supplementation with 500 IU vitamin D₂ per day. Fifty-one samples were collected from 25 healthy infants fed breast milk and a vitamin D₃ fortified formula. Gestational age was 32.2±2.4 weeks (mean ± 1 SD). 25-hydroxyvitamin D levels before supplementation correlated well with maternal values ( r =0.81). The infants' mean plasma concentration increased from 30.6±13.7 nmol/l (mean±1 SD) after birth to 46.3±10.5 nmol/l after 9±1 days ( p <0.0025), and to 65.3±16.6 nmol/l after 37±10 days of vitamin D₂ treatment ( p <0.0005). 25-hydroxyvitamin D₂ and 25-hydroxyvitamin D₃ were determined separately, and it appeared that the rise was accounted for by the D₂ fraction while 25-hydroxyvitamin D₃ concentrations were unchanged. The results demonstrate that vitamin D₂ is well absorbed and hydroxylated in the 25 position by premature infants free of associated disease, and that a supplementation of 500 IU per day in addition to breast milk and a regular vitamin D fortified formula is adequate to rapidly establish 25-hydroxyvitamin D levels within the normal adult range.     

Vitamin D deficiency rickets at birth in Kuwait

In the present study vitamin D deficiency rickets has been diagnosed within 24 hrs. of birth. Seventy five full term, otherwise healthy newborns, weighing more than 2.5 kg were born with rachitic rosary. 25-Hydroxyvitamin D was lower than normal in 56 newborns and 15 mothers. Alkaline phosphatase was higher than normal in 26 and radiological changes suggestive of rickets were seen in the wrist X ray of only 14 newborns. Hyperphosphataemia was present in all the newborns. 1,25 dihydroxyvitamin D was markedly increased in six out of ten newborns.     

EFFECT OF INTRAVENOUS L-ALANINE ADMINISTRATION ON PLASMA GLUCOSE, INSULIN AND GLUCAGON, BLOOD PYRUVATE, LACTATE AND BETA-HYDROXYBUTYRATE CONCENTRATIONS IN NEWBORN INFANTS Study in Term and Preterm Newborn Infants

ABSTRACT. Ten term and eleven preterm newborn infants with appropriate weights for their gestational age were infused for one minute with L-alanine (150 mg/kg) at the age of 29 to 76 hours (mean 48 hours) and circulating levels of glucose, lactate, pyruvate, d -betahydroxybutyrate ( d -BOHB), insulin and glucagon were monitored. Plasma glucose concentrations increased from 2.7±0.16 (mean±S.E.M.) to 3.7±0.2 mmol/1 after 50 min (p±0.01) in term infants. In preterm infants, after an initial decrease of the glucose level from 3.1±0.16 to 2.6±0.16 mmol/1 (p±0.05), it returned to the baseline level at 50 min: 3.0±0.2 mmol/1. The blood concentration of d -BOHB decreased in term infants from 192±37 to 112±6 μM/1 (p±0.01) after 40 min. In preterms, its decrease was not significant (p±0.05). Plasma glucagon levels rose from 53±5 to 70±8 pmol/1 after ten minutes (p±0.01) in term infants and from 61±6 to 75±9 after 20 min (p±0.01) in preterm infants. There were no significant changes in plasma insulin concentrations in either group. Forty minutes after l -alanine infusion, I/G ratios were lower in preterm infants (1.26±0.14) than in term infants (1.71±0.25) (p±0.01). There was no relationship between the glycemic responses to l -alanine and the basal levels of d -BOHB.
The data suggest that the glycemic effect of l -alanine infusion and circulating glucagon depends upon a specific stage in maturation. The antiketogenic effect of l -alanine infusion is observed in term infants as in adults.