Effect of Phosphate Supplementation to Breast Fed Very Low Birthweight Infants on Urinary Calcium Excretion, Serum Immunoreactive Parathyroid Hormon and Plasma 1.25-Dihydroxy-vitamin D Concentration

ABSTRACT. The effect of two doses of Phosphorus (P) supplementation to pooled breast milk (BM): 0.48 and 0.800 mmol/kg/24 h given during the second month of life was evaluated in 22 very low birthweight infants. The concentration of calcium and phosphorus in serum and urine, the serum concentration of immunoreactive parathyroid hormon (iPTH) and the plasma 1,25-dihydroxy-vitamin D concentration (1,25-OH-D) were compared to the values in 19 control infants. The mean ± SD concentrations in control infants and adults are 63 ±18 ulEq/ml for serum iPTH and 85±pmol/l for plasma 1,25-OH-D. With 0.48 P supplementation, urinary Ca (UCa) excretion (median and range) 0.238 mmol/kg/24 h (0.105-0.520) was lower than in the control group 0.288 (0.205-0.679) (p<0.05); the reduction of UCa was larger with 0.8 P supplementation: 0.047 (0.023-0.163) (p<0.01). P supplementation induced no change in serum Ca concentration but a slight and significant increase in serum iPTH was observed only with the 0.8 P supplementation: 55 μl Eq/ml (<25-80) (p<0.05). With 0.8 P supplementation there was no significant change of plasma 1,25-OH-D concentration: 173 μmol/l (106-271) vs. 255 (132-293) in the control group. These data show that with 0.8 P supplementation, the hypercalciuria in BM-fed infant disappears without secondary hyperparathyroidism, but without any change in plasma 1,25-OH-D concentration.     

Selenium Status of Infants on Nutritional Support

ABSTRACT. We investigated the selenium status of 5 infants while on nutritional support. After 4 weeks of parenteral nutrition a significant fall in plasma selenium concentrations was observed (mean ± SD: 0.8±0.5 μg/dl; normal for this age: 3.6±0.9 μg/dl). In 1 infant the decline in selenium value occurred simultaneously with a transient rise in transaminases. A parallel but delayed decrease in red blood cell-glutathione peroxidase activity was seen in 3 patients. After reintroduction of enteral foods, the selenium levels increased progressively to and reached control values after 6 weeks, 4 and 5 months respectively in 3 patients, suggesting that the selenium requirement on TPN was not met. We consider it essential to provide longterm TPN patients with physiological amounts of selenium in order to prevent the progressive development of a deficiency state.     

Pharmacokinetics of recombinant human insulin-like growth factor I given subcutaneously to healthy volunteers and to patients with growth hormone receptor deficiency

The pharmacokinetics of recombinant human insulin-like growth factor I (rhIGF-I) were studied in healthy volunteers and in patients with growth hormone receptor deficiency (GHRD; Laron syndrome). Following single subcutaneous injections of rhIGF-I, 40 and 80 μgkg, to healthy volunteers, the peptide was absorbed slowly, with a maximum concentration reached after about 7 hours. Following daily multiple subcutaneous injections of rhIGF-I, 40 μg/kg, trough concentrations of IGF-I were increased by 277 ± 50 μg/l (mean ± SD) from baseline. IGF-I was thus characterized as a low-clearance peptide, with a clearance and half-life estimated at about 0.20 ml/minute/kg and 20 hours, respectively, in healthy volunteers. The volume of distribution was low, about 0.20–0.36 litres/kg, the bioavailability of subcutaneously administered rhIGF-I was 100%, and the rate of production of IGF-I was estimated to be about 50 μg/kg/day (3.5 mg/day). Patients with GHRD had low baseline IGF-I concentrations (30–50 μ g/ l) and a much more rapid turnover of IGF-I compared with that in healthy volunteers. The clearance and half-life of IGF-I were estimated to be about 0.60 ml/minute/kg and 6 hours, respectively. The volume of distribution was about the same as in healthy subjects. Due to the rapid turnover of IGF-I, trough IGF-I concentrations were increased to just above baseline during subcutaneous injections of 40 μg/kg once daily for 7 days. The maximum increase in IGF-I levels was 111 ± 12 μg/l and 150 ± 3 μg/l following daily subcutaneous injections of 40 × 1 and 40 × 2 μg/kg for 7 days, respectively.     

Erythrocyte indicators of oxidative stress in gestational diabetes

Foetuses born to mothers with gestational diabetes are at increased risk of developing respiratory distress, foetal macrosomia, foetal anomalies and platelet hyperaggregability. High blood glucose level induces oxidative stress and decreases antioxidant defences. The present study discusses the possibility of lipid peroxidation and protein oxidation in both maternal and foetal erythrocytes as an indicator of oxygen radical activity. The level of lipid peroxidation and protein oxidation in erythrocytes was estimated in 20 mothers with gestational diabetes and their newborns. The maternal age varied between 19 and 42 y and foetal age ranged between 34 and 39 weeks. The proteolytic activities in the erythrocyte lysates obtained from mothers with gestational diabetes and their newborns were significantly greater [(mean ± SD) 24.41 ± 9.05 and 16.70 ± 3.36μM of amino groups/g haemoglobin, n = 20, respectively] than those from control group (10.18 ± 4.84 and 14.64 ± 6.21 μM amino groups/g haemoglobin, n = 15, respectively; p < 0:05 in both cases). Similarly erythrocyte malondialdehyde levels were significantly elevated in babies born to mothers with gestational diabetes (10.11 ±2.21 nM/g haemoglobin) when compared to controls (6.8 ± 3.75 nM/g haemoglobin) (p < 0:05). In the erythrocytes of mothers with gestational diabetes, malondialdehyde levels correlated significantly with glycated haemoglobin levels (p < 0:01). The results of this study indicate that the oxidative stress induced by gestational diabetes manifests as increased lipid peroxidation and protein oxidative damage in the erythrocytes of both mothers with gestational diabetes and their newborn infants.     

A Comparison of the Zinc, Copper and Manganese Status of Very Low Birth Weight Pre-Term and Full-Term Infants during the First Twelve Months

During a longitudinal study, hair samples and dietary intake data were collected from 50 preterm (mean birth weight = 1054 ± 234 g, mean gestational age = 29 ± 2.5 weeks) and 60 full-term infants (mean birth weight = 3 509 ± 269 g, mean gestational age = 40+1 weeks) at 3, 6 and 12 months of age. Mean daily zinc, copper and manganese intakes were calculated using three-day dietary records and test-weight data for the breast-fed infants. Hair samples were analyzed for these elements by instrumental neutron activation analyses. The medium hair zinc concentration in the pre-term group at six months (81 μg/g) was lower ( p < 0.05) than that of the full-term group (144 μg/g) and was associated with lower mean dietary zinc intakes at 3 and 6 months. At 12 months, the median hair copper (12.5 μg/g) and manganese (0.18 μg/g) concentrations for the pre-term were lower ( p < 0.05) than those of the full-term infants (Cu = 16.5 μg/g; Mn = 0.25 μg/g) and were also associated with low dietary copper and manganese intakes     

Altered erythrocyte sodium-lithium counter-transport and Na+/K+-ATPase activity in cystic fibrosis

Patients with cystic fibrosis (CF) exhibit normal concentrations of sodium and chloride in spite of the disturbance of Cl^- and Na+ transport in epithelial cells. To characterize compensatory mechanisms in the regulation of sodium homeostasis, erythrocytes of 13 CF patients were analysed for sodium-lithium counter-transport (SLC), Na+/K+ -ATPase activity and intracellular sodium content. Values were compared to those of healthy controls. Patients with CF had normal serum sodium and chloride concentrations and renal excretions of these ions were within the physiological range. Intracellular sodium concentration was similar in the CF and the control group (6.8 ± 2.2 vs 5.7 ± 1.0 mmol/l RBCs). Red blood cells' SLC and Na+/ K+ -ATPase activity were elevated in CF patients (381 ± 106 μmol/h/l RBCs vs 281 ± 64; p < 0.01) and (445 ± 129 μmol ATP mg prot/h vs 322 ± 84, p < 0.01). Our study demonstrates that transmembrane cation transport systems are highly activated in CF. The increased sodium transport may be part of a compensatory mechanism of sodium homeostasis in children with CF.     

THE CONCENTRATIONS OF TOTAL CORTISOL AND CORTICOSTERONE IN MIXED CORD PLASMA

ABSTRACT: Homoki, J., Teller, W. M., Tschürtz, D., and Fazekas, A. T. A. (Department of Paediatrics, Division of Endocrinology and Metabolism, University of Ulm/Donau, BRD). The concentrations of total Cortisol and corticosterone in mixed cord plasma. Acta Paediatr Scand, 64:587, 1975.–Cortisol and corticosterone were determined in mixed umbilical cord plasma of 43 healthy full-term newborns. The method consisted of a combined thin-layer chromatographic-ftuorimetric procedure which proved to be specific and reliable. The mean concentration in cord plasma of Cortisol was 10.6±4.9 μ.g/100 ml, of corticosterone 1.8±0.8 μg/100 ml. The mean ratio cortisol/corticosterone F/B was 6.3±2.5. Neither the duration nor the time of day of delivery appeared to influence the concentration of Cortisol or corticosterone in umbilical cord plasma. Also, there was no significant difference between male and female infants. In 18 instances of a pathological course of gestation and/or delivery the mean Cortisol level was 9.1±4.7 μg/ml, the mean corticosterone level 2.2±9 μg/100 ml. The mean F/B ratio was slightly but not significantly decreased (4.2±1.4 μg/100 ml; p >0.05). It is speculated that the high corticosterone concentration in umbilical cord plasma reflects a defect in Cortisol biosynthesis (17α-hydroxylase deficiency) in the newborn, compared with later life.     

Perhaps vigintiphobia should only apply to infants with Rhesus erythroblastosis

Forty-two children who sustained a serum bilirubin (SBR) level above 339 μmol/L as newborn infants were assessed at our Growth and Development Clinic to determine presence of sequelae. Only one child (2.3%) had mild sensorineural deafness and one child (2.3%) performed below age-matched standards on psychological testing. As the SBR level rose the psychological scores were lower. Three infants had sepsis associated with the hyperbilirubinaemia. Two (maximum SBR levels of 371 and 366 μmol/L) children were normal (General Cognitive Index (GCI) 117 and 119, respectively) and one child (maximum SBR level 556 μmol/L) was borderline abnormal (GCI 74) on psychological testing; he also suffered from Rhesus erythroblastosis. Premature infants recorded a mean GCI of 109.9 (±33.4) and for term infants mean GCI was 110.3 (±17.3; NS); however, the youngest premature infant was 32 weeks' gestation. When maximum SBR level was correlated with GCI and Motor Index (MI) the only significant correlation ( r = -0.7445; P = 0.03) occurred in infants with Rhesus erythroblastosis and GCI. Since exchange transfusion has a mortality of between 0.3 and 5.3% and an associated morbidity incidence of 5.2% we suggest that the standard indication for its use (SBR level of 342 μmol/L) should only apply to infants with Rhesus erythroblastosis. The actual SBR level which places a newborn infant at significant risk of bilirubin encephalopathy, where the cause of jaundice is other than Rhesus erythroblastosis, cannot be determined by this study. However, it is above 342 μmol/L and our results suggest that a re-evaluation should occur of a SBR level of 342 μmol/L in a term infant, being the indicator for exchange transfusion where the cause of jaundice is other than Rhesus erythroblastosis.     

The effects of iron deficiency on infants' developmental test performance

Aim : To assess the effects of iron deficiency on developmental test scores in infants. Methods : This prospective, single-blind, controlled clinical intervention study was made on 108 children aged 6–30 mo who applied to our paediatric outpatient clinic. The cases were classified as control ( n = 31, haemoglobin ± 11 g/dl, serum ferritin >12 μg/l, MCV ± 70 fl), non-anaemic iron deficiency (NAID, n = 40, haemoglobin ± 11 g/dl, serum ferritin ± 12 μg/l, MCV ± 70 fl) and iron deficiency anaemia (IDA, n = 37, haemoglobin < 11 g/dl, ferritin ± 12 μg/l, MCV >70 fl) due to their anaemia status. In each group, MCV, haemoglobin and ferritin levels were measured, and Denver Developmental Screening Test (DDST) and Bayley Scales of Infant Development (BSID-I) were administered before and after a 3-mo follow-up. IDA and about half of the NAID subjects were treated with oral iron for 3 mo. Results : Subjects with iron deficiency showed significantly lower developmental test scores both with BSID-I and DDST-II compared to their iron-sufficient peers ( p < 0.05). After 3 mo of iron treatment, lower mental developmental test scores were no longer observed among the IDA and NAID groups whose anaemia and iron deficiency were also corrected. No significant differences were found between control NAID and control IDA groups on DGTT-II results after treatment. The difference in motor and mental developmental scores did not appear to depend on environmental and family factors considered in the analyses.
Conclusion : These findings support the conclusions that iron deficiency may cause lower mental and motor test scores in infants and these adverse effects can be improved by iron therapy.     

EFFECT OF SEASON AND VITAMIN D SUPPLEMENTATION ON PLASMA CONCENTRATIONS OF 25-HYDROXYVITAMIN D IN NORWEGIAN INFANTS

ABSTRACT. Plasma concentrations of 25-hydroxyvitamin D (250HD) were determined in 81 vitamin D supplemented or unsupplemented infants at the end of winter. The values were compared with maternal levels and with concentrations found in 22 unsupplemented infants at the end of summer. The 250HD levels of the neonates were lower, but closely related to maternal values ( r =0.95, p <0.0005). Unsupplemented breast-fed infants had lower 250HD levels at 6 weeks than at 4 days (16±7 vs. 32±15 nmol/l, mean ±1 SD, p <0.0005). The mean 250HD level of vitamin D supplemented 6-12 months old infants was intermediate between those of the unsupplemented nursed groups and the unsupplemented children studied during summer (53±28 vs. 85±28 nmol/l, p <0.0005). Six weeks old infants who had received a milk formula containing 400 IU vitamin D₃ per liter had levels similar to the latter group (92±21 nmol/l). The data suggest that the vitamin D stores acquired during fetal life, or from ultraviolet light exposure during the summer, may be inadequate to maintain safe levels of 250HD throughout the winter, but that a daily supplement of 400 IU is adequate to establish concentrations in the summer range.     

Effects of Short-Term Growth Hormone Therapy in Short Children without Growth Hormone Deficiency

ABSTRACT. Evaluation of 24-hour endogenous growth hormone (GH) secretion was carried out in 62 children, aged 7-16 years, who did not have classic GH deficiency (GHD). The mean 24-hour GH concentration, determined at 20-minute intervals over 24 hours, was variable, ranging from 1.28 to 11.39 μg/l with a mean of 4.95 ± 2.55 μl (± SD). There was a positive correlation between mean 24-hour GH concentration and plasma insulin-like growth factor I (IGF-I) values ( r = 0.54; p < 0.01). Recombinant human GH, 0.1 IU/kg/day was administered to 30 of the 62 children for 6 months followed by 6 months'observation without treatment. Thereafter, GH was administered at the same dose for a further 6 months to 16 children. The mean height velocities before, during, and after the first treatment period were 4.3 ± 0.9, 7.3 ± 1.9 and 4.9 ± 2.0 cm/year (mean ± SD), respectively. The height velocity during treatment was greater than pre- and post-treatment values ( p < 0.001). The height velocity Increased again during the second treatment period to a mean of 8.5 ± 2.0 cm/year ( p < 0.001). Nine other children were treated continuously in a similar manner for 1 year and their height velocity increased significantly from 4.1 ± 1.4 to 6.0 ± 1.9 cm/year ( p < 0.001). According to our criteria, 29 of the 39 children (74.4%) who were treated for 6-12 months showed a GH-dependent height increase during therapy. There were no differences between the children who responded to GH treatment and those who did not in terms of Chronological age, bone age, plasma IGF-I level, maximal GH level to insulin-induced hypoglycaemia, or mean 24-hour plasma GH concentration. These data indicate that some short children without GHD respond to GH treatment with an increased height velocity. Further investigations are required to determine the effect of GH on final height.     

Increased lipid peroxidation in children with autoimmune diseases

To examine the role of oxidative damage in children and adolescents with autoimmune diseases, we compared blood serum levels of the lipid peroxidation (LPO) products 4-hydroxynonenal (HNE) and malondialdehyde (MDA) in 22 children with systemic lupus erythematosus (SLE), 13 children with focal type of scleroderma, and 21 healthy controls. In order to study the influence of disease activity in SLE on serum LPO product levels, the SLE group was divided into one group with active disease ( n = 11) and one group with non-active disease ( n = 11) according to SLEDAI-score, 15.1 and 1.8, respectively. SLE patients with active SLE (146 ± 14nmol/l, median 145nmol/l) have significantly higher HNE levels compared to controls (61 ± 10nmol/l, median 52nmol/l), whereas the MDA serum levels are similar to those of the control group, 1.94 ± 0.18μmol/l (median: 2.02μmol/l) and 1.58 ± 0.11 μmol/1 (median: 1.52 μmol/l), respectively. Children with SCL had HNE and MDA levels similar to the control group.     

Efficacy of phototherapy for hyperbilirubinaemia in infants with the respiratory distress syndrome

Objectives: To evaluate the efficacy of phototherapy for hyperbilirubinaemia in preterm infants with and without the respiratory distress syndrome (RDS).
Methodology: Prospective cohort study of preterm infants cared for at Kandang Kerbau Hospital, Singapore: 170 with RDS and 477 without RDS, sepsis or other complications (control group) presenting with non-haemolytic hyperbilirubinaemia at about the same time were exposed to daylight phototherapy when bilirubin concentrations exceeded 255 μmol/L or 222 μmol/L if <48h of age. Bilirubin values were monitored 6-hourly during exposure, and daily for at least 2 days postphototherapy.
Results The infants were comparable in birthweight, gestational age, postnatal age, haemoglobin, haematocrit and bilirubin values, at start. The response to phototherapy of the infants with RDS was comparable to that of the well preterm infants; the duration of exposure was 50.1 ± 1.6 (mean ± s.e.m.) versus 50.1 ± 1.4 h, 24-hour decline rate 25.71 ± 1.29% versus 26.32 ± 0.65, and overall decline rate 0.96± 0.03%/h versus 0.95±0.02%/h.
Conclusion The presence of RDS did not affect the efficacy of phototherapy for neonatal hyperbilirubinaemia in preterm infants.     

Lactate and pyruvate concentrations in capillary blood from newborns

Using high pressure liquid chromatography on strong cation exchange column, we analyzed capillary blood from 141 healthy full-term newborns for lactate and pyruvate concentrations. Total range of lactate was 367–3245 μmol/l and reference interval (mean ± 2 SD) was 260–2212 μmol/l. Total range of pyruvate was 10–141 μmol/l and reference interval (10th/90th percentile) was 12–71μmol/l.     

Psychological Development at 7 Years of Age in Children with Congenital Hypothyroidism: Timing and Dosage of Initial Treatment

ABSTRACT. Sixty of 68 consecutive patients detected during the first two years of the Swedish screening programme for congenital hypothyroidism were Griffiths tested at the age 6.5–7.5 years. The test quotients of the patients could not be distinguished from those of reference population. Replacement therapy with 8.7 ± 2.8 μg of l -thyroxine (mean±SD)/kg/d had been started at 15.0 ± 7.1 days of life. Furthermore, normal results on Griffiths tests were also found in 13 patients with delayed normalization of serum TSH, i.e. ≥ 19 mU/l at the age of six weeks, as well as in patients with retarded skeletal maturity and/or very low neonatal serum levels of thyroxine, i.e. < 18 nmol/l and tri-iodothyronine, i.e. <0.92 nmol/l. Our findings indicate that replacement dose of 6–11 μg l -thyroxine/kg/d is adequate and allows normal psychological development if treatment is started early.     

EFFECT OF INTRAVENOUS HYDROCORTISONE ADMINISTRATION ON GLUCOSE HOMEOSTASIS IN SMALL FOR GESTATIONAL AGE INFANTS

Abstract. The effects of I.V. hydrocortisone (H) (10 mg/kg) on glucose homeostasis were evaluated at 25 to 85 hours of age in 14 infants who were small for gestational age (SGA) in comparison to 17 control SGA infants. Three hours after H administration, higher levels of plasma glucose than in controls were detected (mean ±S.E.M.): 4.78±0.2 vs. 2.88±0.2 mmol/1 ( p <0.01), while lower levels were found for blood pyruvate (38±7 vs. 89±12 μmol/l— p <0.01), plasma insulin (6.4±0.5 vs. 12±0.8 μIU/ml— p <0.05) and plasma glucagon (62.25±6.6 vs. 81.6±6.6 pmol/l— p <0.05). Three hours after H administration, I.V. injection of l -alanine (150 mg/kg) produced a significant rise over baseline of plasma glucose concentration from 4.78±0.2 to 5.94±0.2 mmol/l at 50 min ( p <0.05), whereas no significant change was observed in controls. There was no significant change in plasma glucagon and insulin concentrations after l -alanine injection in either group. These results show that in SGA infants primed with H, the rise of plasma glucose concentration after l -alanine administration is observed with low plasma insulin levels and without stimulation of glucagon secretion. They suggest that H induced a reduced peripheral utilization of glucose by lowering the plasma levels of insulin and a production of glucose from alanine through gluconeogenesis.     

Plasminogen activators and plasminogen activator inhibitors in plasma of premature and term newborns

Objective : To compare the plasminogen activators (tPA, uPA) and their inhibitors (PAI-1, PAI-2) at different gestational ages, related to levels in women at term and non-pregnant women. Methods : Blood samples were obtained by puncture of the umbilical cord vein, in gestational weeks 39–40 ( n = 21), 30–32 ( n = 15), and 27–29 ( n = 9). Analyses of PA and PAI antigen concentrations and of PAI-1 activity were performed. Results : The mean tPA antigen level in term newborn infants was 14.5 μg/l compared to the premature newborns (7.0 μg/l) women at term (7.5 μg/l) and non-pregnant women (2.3 μg/l). PAI-1 activity and PAI-2 antigen concentrations were also higher in term newborn than in premature infants. Conclusions : The plasma levels of the plasminogen activators and inhibitors are higher in term newborn compared with premature newborn infants, reflecting maturation of protein synthesis.     

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.     

Lipid and apolipoprotein levels and enteral nutrition in very low-birth-weight preterm infants

Lipid, lipoprotein cholesterol and apolipoprotein A-I, A-II and B levels were determined in 10 very low-birth-weight (birth weight 1279 ±144 g; gestational age 29.2±1.2 weeks, mean ± SD) preterm infants on postnatal days 3, 10 and 21. Feeding with pooled human milk began on day 3 ± 1 and by day 10 all infants were exclusively enterally fed. Both triglyceride and total cholesterol levels increased significantly from day 3 to day 10 (0.84 ± 0.28 versus 1.53 ± 0.72 and 2.42 ± 0.47 versus 3.24 ± 0.80, mmol/l, respectively) ( p <0.01); thereafter no further increase was observed. The increase in total cholesterol level was primarily due to a significant enhancement of very low-density lipoprotein and low-density lipoprotein cholesterol (1.52±.34 versus 2.29 ± 0.73 mmol/l, p <0.01). Apo A-I, A-II and B levels did not change between day 3 and day 10. From day 10 to day 21, however, a significant increase in apo A-I concentration was noted (0.57±.20 versus 0.87 ± 0.17 g/l, p <0.01), whereas apo A-II levels increased significantly from day 3 to 21 (0.15 ± 0.03 versus 0.27 ± 0.08 g/l, p<0.01). No change in apo B level was seen.     

Lipid and apolipoprotein levels and enteral nutrition in very low-birth-weight preterm infants

Lipid, lipoprotein cholesterol and apolipoprotein A-I, A-II and B levels were determined in 10 very low-birth-weight (birth weight 1279 ± 144 g; gestational age 29.2 ± 1.2 weeks, mean ± SD) preterm infants on postnatal days 3, 10 and 21. Feeding with pooled human milk began on day 3 ± 1 and by day 10 all infants were exclusively enterally fed. Both triglyceride and total cholesterol levels increased significantly from day 3 to day 10 (0.84 ± 0.28 versus 1.53 ± 0.72 and 2.42 ± 0.47 versus 3.24 ± 0.80, mmol/l, respectively) ( p <0.01); thereafter no further increase was observed. The increase in total cholesterol level was primarily due to a significant enhancement of very low-density lipoprotein and low-density lipoprotein cholesterol (1.52 ± 0.34 versus 2.29 ± 0.73 mmol/l, p< 0.01). Apo A-I, A-II and B levels did not change between day 3 and day 10. From day 10 to day 21, however, a significant increase in apo A-I concentration was noted (0.57 ± 0.20 versus 0.87 ± 0.17 g/l, p< 0.01), whereas apo A-II levels increased significantly from day 3 to 21 (0.15 ± 0.03 versus 0.27 ± 0.08 g/l, p<0.01). No change in apo B level was seen.