DIGOXIN THERAPY AND LEFT VENTRICULAR PERFORMANCE IN PREMATURE INFANTS WITH PATENT DUCTUS ARTERIOSUS

ABSTRACT. Left ventricular systolic time intervals were assessed in 16 preterm infants with symptomatic left-to-right ductal shunts, before, during and after digoxin therapy. An intravenous loading dose of digoxin, 20 μg/kg, resulted in a serum digoxin concentration of 1.94±0.44 nmol/1 (mean ± 1 SD) but in no significant change in heart rate or systolic time intervals. Digoxin maintenance, 2.5 μg/kg/12 h, led 3–7 days later to serum concentrations of 2.57±1.06 nmol/1 with an associated shortening of left ventricular ejection time ( p <0.05) which probably reflected a reduced ductal shunt. Digoxin therapy was withdrawn after ductal closure. The terminal serum half-life was 87±17 h. Decreasing digoxin concentrations were associated with prolongation of left ventricular ejection time ( p <0.01). Digoxin therapy did not seem to influence left ventricular systolic time intervals while ductal patency persisted. This may be attributed to limitations of the method or the left ventricle already working at its maximum.     

Immunogenicity and reactogenicity of DTPa-HBV-IPV/Hib vaccine as primary and booster vaccination in low-birth-weight premature infants

AIM: To assess suitability of a combined DTPa-HBV-IPV/Hib vaccine (Infanrix hexa) for immunization of low-birth-weight (<2.0 kg) preterm infants, with particular focus on the hepatitis B response. METHODS: Open-label study in 170 preterm infants receiving primary vaccination at 2, 4 and 6 months of age and booster vaccination at 18-24 months. Enrollment and analysis were stratified in two groups: infants with birth weight between 1.5 kg and 2.0 kg (low birth weight: LBW), infants with BW <1.5 kg (very low birth weight: VLBW). RESULTS: One month after the three dose primary vaccination, 93.7% and 94.9% of infants in VLBW and LBW groups, respectively, had anti-HBs antibody concentrations > or = 10 mIU/mL. High seroprotection and response rates (92.4-100%) to all vaccine antigens were observed. Those were reinforced (>98%) by booster vaccination for all antigens except for HBs in VLBW children: only 88.7% of those had anti-HBs antibody concentrations > or = 10 mIU/mL, compared with 96.5% of LBW children (difference statistically not significant). The vaccine was well tolerated in both groups of infants. CONCLUSION: Preterm infants will benefit by the administration of a primary and booster vaccination with DTPa-HBV-IPV/Hib vaccine.     

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.     

Postnatal thyroid function in low birth weight infants: A cross-sectional assessment of free thyroxine and thyroid hormone binding globulin

To investigate the significance of low serum thyroxine in premature infants, serum FT4, T4, TSH and TBG were measured in 7 infants with BW<1000 g, 8 infants with BW 1001 to 1350 g, 9 infants with BW 1351 to 2499 g, and 11 full-term infants.FT4 concentrations were lower in the LBW infants than in the FT infants. Percent FT4 values in the infants with BW<1000 g were the highest in the groups studied, so that FT4 concentrations in those infants did not fall proportionally with the marked T4 decrease. TBG concentrations were lower in the VLBW infants (相似文献   

不同胎龄及出生体重早产儿血游离肉碱变化特点

目的检测不同胎龄及出生体重早产儿血游离肉碱（FC）浓度,为制定早产儿FC补充治疗方案提供依据。方法选取3 368例早产儿为研究对象。根据胎龄（GA）分为超早产（EPTB,GA<28周）组（n=39）、极早产（VPTB,28≤GA < 32周）组（n=405）、中期早产（MPTB,32≤GA<34周）组（n=507）、晚期早产（LPTB,34≤GA<37周）组（n=2 417）;根据出生体重（BW）分为超低出生体重（ELBW,BW < 1 000 g）组（n=36）、极低出生体重（VLBW,1 000 g≤BW < 1 500 g）组（n=387）、低出生体重组（LBW,1 500 g≤BW < 2 500 g）组（n=1 873）、正常出生体重（NBW,2 500 g≤BW≤4 000 g）组（n=1 072）。于生后72 h~7 d内采血进行FC浓度测定并进行比较。结果 EPTB、VPTB组FC浓度明显高于MPTB、LPTB组（P < 0.05）,MPTB组FC浓度明显高于LPTB组（P < 0.05）;胎龄越小,FC的95%医学参考范围下限越高。ELBW、VLBW组FC浓度明显高于LBW、NBW组（P < 0.05）,LBW组FC浓度明显高于NBW组（P < 0.05）;出生体重越低,FC的95%医学参考范围下限越高。结论极/超早产儿、极/超低出生体重儿血FC浓度明显升高,并且随着胎龄及出生体重的增加呈明显下降的趋势。     

A randomized controlled trial of enteral glutamine supplementation in very low birth weight infants: plasma amino acid concentrations

OBJECTIVE: Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression. Very low birth weight (VLBW) infants are susceptible to glutamine depletion, as enteral nutrition is limited in the first weeks of life. Enteral glutamine supplementation may have a positive effect on feeding tolerance, infectious morbidity and short-term outcome. The aim of the study was to determine the effect of enteral glutamine supplementation on plasma amino acid concentrations, reflecting one aspect of safety of enteral glutamine supplementation in VLBW infants. METHODS: In a double-blind placebo-controlled randomized controlled trial, VLBW infants (gestational age <32 weeks or birth weight <1500 g) received enteral glutamine supplementation (0.3 g/kg per day) or isonitrogenous placebo supplementation (alanine) between day 3 and day 30 of life. Supplementation was added to breast milk or to preterm formula. Plasma amino acid concentrations were measured at four time points: before the start of the study and at days 7, 14 and 30 of life. RESULTS: Baseline patient and nutritional characteristics were not different in glutamine (n = 52) and control (n = 50) groups. Plasma concentrations of most essential and non-essential amino acids increased throughout the study period. There was no effect of enteral glutamine supplementation. In particular, the increase of plasma glutamine and glutamate concentrations was not different between the treatment groups (P = 0.49 and P = 0.34 respectively, day 30). CONCLUSIONS: Enteral glutamine supplementation in VLBW infants does not alter plasma concentrations of glutamine, glutamate or other amino acids. Enteral supplementation in a dose of 0.3 g/kg per day seems safe in VLBW infants.     

Metabolism of potassium in preterm infants]

During the first days of life, hyperkalemia can affect 30 to 60% of very low birth weight infants free of acute renal insufficiency (i.e. nonoliguric hyperkalemia). The place of the kidney in the regulation of the potassium homeostasis of VLBW remains badly specified. OBJECTIVE: To evaluate the rate and the mechanisms of hyperkalemia in infants born at less than 32 weeks' gestation. METHODS: A prospective study was conducted in 33 preterm infants (BW=1289+/-382 g; GA=28.8+/-1.7 weeks). Fifteen consecutive 8-hour urine collections were performed for each infant from the 8th hour of life (495 periods). A plasma sample was obtained at the end of each urine collection. Sodium, potassium and creatinine were measured in urine and blood samples as often as possible. RESULTS: Plasma potassium concentrations varied significantly over the 15 successive periods with an initial value (P1) of 4.55+/-0.80 mmol/l, a peak on P3 (4.94+/-0.81 mmol/l) and the lowest value on P13 (3.88+/-0.42 mmol/l). Hyperkalemia (plasma potassium>6.0 mmol/l) was observed in 4 infants (12%) and in 1.2% of the periods. The cumulative potassium balance (output-input) was negative over the first 7 periods (-1.97 mmol/kg), and afterwards became positive (from P8 to P15:+1.57 mmol/kg). Over the first 3 days, plasma potassium concentrations were positively correlated (p<0.01) with urinary excretion of potassium, clearance of potassium, fractional excretion of potassium, and negatively with endogenous creatinine clearance. CONCLUSION: In the first days of life, very low birth weight infants present an increase in kalemia associated with a negative potassium balance indicating a intracellular to extracellular potassium shift rather than a lower renal potassium excretion.     

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.     

Vitamin concentrations in very low birth weight infants given vitamins intravenously in a lipid emulsion: measurement of vitamins A, D, and E and riboflavin

Because total parenteral nutrition with vitamins added to the glucose-amino acid mixture is often associated with a reduction in blood levels of vitamin A (retinol) during the routine treatment of many very low birth weight (VLBW) infants (less than 1500 gm), and because retinol losses in the plastic delivery system can be prevented by adding the vitamins to an intravenous lipid emulsion, seven VLBW infants with a mean birth weight of 900 gm (range 450 to 1360 gm) were given 40% of a unit dose vial, per kilogram of body weight, of a multivitamin preparation (M.V.I. Pediatric) (280 micrograms retinol; 160 IU vitamin D; 2.8 mg tocopherol; 0.68 mg riboflavin) in a lipid emulsion, Intralipid. After treatment with the intralipid-vitamin mixture for 19 to 28 days, plasma vitamin A (retinol) concentrations increased significantly from 11.0 +/- 0.76 (mean +/- SEM) before intralipid to 19.2 +/- 0.97 micrograms/dl after the intralipid-vitamin mixture (p less than 0.01); 25-hydroxyvitamin D concentrations increased from an initial value of 12.6 +/- 2.6 to 20.2 +/- 1.9 mg/dl (p less than 0.01); alpha-tocopherol concentrations increased from an initial value of 0.31 +/- 0.06 to 2.44 +/- 0.13 mg/dl (p less than 0.01); and riboflavin levels increased from 64.1 +/- 7.8 ng/ml to concentrations between 20 and 100 times the initial level. Erythrocyte riboflavin levels increased from 71.8 +/- 14 initially to 166 +/- 41 ng/gm hemoglobin, and erythrocyte flavin-adenine dinucleotide levels increased similarly from 972 +/- 112 initially to 2005 +/- 294 ng/gm hemoglobin. These results show that the addition of M.V.I. Pediatric to Intralipid decreases the extensive in vivo loss of retinol and is associated with an increase in plasma retinol concentrations in VLBW infants. The daily doses of vitamins D (160 IU/kg) and E (2.8 mg/kg) appear sufficient, but the dose of vitamin A (280 micrograms/kg) is insufficient to raise blood levels of all infants into the normal range. The current dose of riboflavin is excessive and may be harmful.     

Stool water loss in very-low-birth-weight neonates

Fluid requirements in very-low-birth-weight (VLBW) infants include compensation for renal, insensible (skin and lung), and stool losses and provision for fluid retained for growth. Current estimates of stool water losses in VLBW infants are based on measurements established in term neonates. Therefore, the water content of 24-hour stool collections were determined in 11 healthy VLBW male infants on full enteral feeds and compared to the working norms. The neonates in this study were less than 2 weeks old with a mean +/- SD birth weight and gestational age of 1,311 +/- 112 g and 30.8 +/- 1.5 weeks, respectively. They were receiving only enteral formula feedings of 100 ml/kg/day or more with no parenteral fluid supplementation. The mean +/- SD number of stools and water content of the stools was 2.7 +/- 2.0/day and 7.2 +/- 4.0 ml/kg/day, respectively. There was a significant correlation (r = 0.696, p less than 0.02) between gestational age at birth and number of stools per day, but the correlation between stool water loss per day, gestational age, volume of feedings per day, and birthweight was not significant. Based on this study, 7 ml/kg/day is a reasonable estimate of daily stool water loss in VLBW babies.     

Nicotine and Cotinine Concentrations in the Nursing Mother and Her Infant

ABSTRACT. Twenty-two smoking mothers and their healthy newborn infants (mean postnatal age of 3.7 days) was studied in the maternity ward. A close correlation was found (r=0.94) between nicotine concentrations in the mothers' plasma and milk after smoking, the milk: plasma ratio being 2.9. The amount of nicotine transferred to the infant increased from 0.09 to 1.03 μg/kg infant body weight when mothers smoked before breast-feeding. The daily dose of nicotine via the mothers' milk was 6 μg per kg infant body weight. Cotinine but not nicotine concentrations in the plasma and milk of the mothers and the urine of the infants reflected the smoking habits of the mothers during pregnancy. There was no correlation between nicotine and cotinine concentrations in the infant's urine and the amount of nicotine given to the infant via the mother's milk.     

Dose of diogoxin and age of child

A single dose study was carried out to compare blood levels of digoxin using three preparations marketed as syrup and tablets. Digoxin was estimated by radio-immunoassay. Although blood levels at two and four hours did not reveal any difference in bioavailability of the three products, the levels varied to a great extent in children of different age groups. Children below six years of age, who were given digoxin in the dose of 0·025 mg/kg/day showed higher mean concentration (1·62±0·18 ng/ml) as compared with (0·98±0·45 ng/ml) children of 6 to 12 years age group, who were given digoxin in the dose of 0·25 mg/day. These doses calculated according to body weight had a mean value of 0·01 mg/kg/day. It is suggested that children above the age of six years be also given digoxin on a dose per weight basis to maintain adequate levels.     

Effect of recombinant human erythropoietin on transfusion needs in preterm infants

OBJECTIVE: To study the efficacy, safety and cost effectiveness of recombinant human erythropoietin (r-HuEPO) in reducing erythrocyte transfusion needs in very low birthweight (VLBW) infants. METHODS: We conducted a non-blind randomized controlled trial and assigned 100 VLBW infants, less than 33 weeks gestation, to receive either r-HuEPO 750 U/kg per week subcutaneously from day 5 to day 40 or no erythropoietin (EPO). Infants received oral iron 3-6 mg/kg per day from day 10. Transfusion needs were analysed for all enrolled infants and in five weight subgroups: birthweight of less than 600 g, 600-799 g, 800-999 g, 1000-1199 g and infants more than 1200 g. RESULTS: VLBW infants on r-HuEPO attained higher reticulocyte counts and haematocrit than control infants but the mean number of transfusions and volume of erythrocyte transfused per infant were not statistically different. Of infants 800-999 g at birth, the mean number of transfusions per infant was 2.1 compared with 3.5 transfusions per control infant (P = 0.04). Volume of erythrocytes transfused was 34.9 +/- 32.1 mL/kg in r-HuEPO-treated infants and 56.6 +/- 25.8 mL/kg in control infants (P = 0.03). The cost per patient for transfusion and EPO was S$388 for r-HuEPO recipient and S$438 for control infant. Blood pressure, neutrophil count, platelet count and complications of prematurity were not significantly different in both groups of VLBW infants. CONCLUSION: r-HuEPO at 750 U/kg per week stimulates erythropoiesis in VLBW infants but significantly reduces the need for erythrocyte transfusion only in infants weighing 800-999 g at birth.     

Influence of gestational age and intrauterine growth on leptin concentrations in venous cord blood of human newborns

BACKGROUND: The ob gene product leptin is involved in the regulation of body weight and energy expenditure, suggesting a potential role of leptin in embryonal and fetal development and progression of pregnancy. In term infants, leptin concentrations showed a positive correlation with birth weight. We aimed at comparing leptin cord blood levels in AGA (appropriate for gestational age) to SGA (small for gestational age) preterm and term newborns. PATIENTS AND METHODS: Ninety-seven human newborns, 47 females and 50 males, 33 born at term and 64 born before 36 weeks of gestation, were studied prospectively. Leptin concentrations in venous cord blood were determined using a specific RIA (radioimmunoassay). RESULTS: In term newborns, mean gestational age (GA) was 39 weeks (wk) (+/- 0.7 wk) and mean birth weight (BW) was 3316 g (+/- 473 g); in preterm newborns (n = 64), mean GA was 30 wk (+/- 5.0 wk) and mean BW was 1398 g (+/- 505 g). Mean standard deviation score of birth weight (BW SDS) was calculated as - 0.47. Mean leptin concentrations in term newborns differed significantly from those in preterm newborns (9.21 +/- 2.63 ng/ml vs. 1.58 +/- 0.88 ng/ml; p < 0.0001). In preterm and term infants, leptin concentrations showed a linear correlation with BW (r = 0.46; p < 0.0001) and GA (r = 0.48; p < 0.0001), respectively. Leptin levels were best predicted by an exponential regression model with GA (Leptin = exp(- 4.41 + 0.14 x GA); r = 0.61; p < 0.0001). Using multivariate regression analysis (r = 0.57; p < 0.0001), we found significant influences of GA (p < 0.00001) and BW SDS (p < 0.05) on leptin levels. No difference was observed between leptin values in AGA versus SGA preterm infants. CONCLUSION: These data suggest fetal leptin levels to be primarily determined by GA and additionally modulated by growth restriction in term newborns. We found a dramatic increase at weeks 33 to 35 of gestation and no modulation by BW SDS in very preterm infants.     

Plasma thrombomodulin level in very low birthweight infants at birth

Objective: Plasma soluble thrombomodulin level reflects endothelial damage. The plasma thrombomodulin level at birth is increased in asphyxiated full-term infants. There is no report of plasma thrombomodulin level in premature infants. To determine the thrombomodulin level in premature infants and whether it might reflect endothelial damage, we examined the plasma thrombomodulin level in very low birthweight (VLBW) infants at birth. Methods: Forty-five VLBW infants, of whom 14 had perinatal asphyxia complications, were recruited. As a control, 50 full-term infants wimout complications were also studied. Plasma thrombomodulin concentration, pH, base deficit, serum creatinine and D-dimer concentration, platelet count and fibrinogen concentration were measured within 1 hour after birth. Results: There were significant differences in plasma pH, creatinine concentration, platelet count, antithrombin in activity and D-dimer concentration between VLBW infants and full-term infants. Plasma thrombomodulin concentration (39. 0 (16. 6–93. 7) vs 27. 0 (16. 6–39. 1) μg/L, p < 0. 0001) and plasma taombomodulin-to-serum creatinine ratio (0. 82 (0. 19–2. 65) vs 0. 47 (0. 24–0. 70) μg/μmol, p < 0. 0001) were significantly higher in VLBW infants than those in full-term infants. By univariate analyses for all neonates, there were significant relations between plasma thrombomodulin concentration and gestational age, birthweight, plasma pH, creatinine concentration, platelet count and antithrombin in activity. A stepwise multiple linear regression model using the above variables as dependent factors showed only birthweight contributed significantly to plasma thrombomodulin concentration (plasma thrombomodulin concentration (μg/1) = 45. 677–0. 006 (birthweight; g), r²= 0. 323, p < 0. 0001, n= 94). Plasma thrombomodulin concentration and plasma thrombomodulin-to -serum creatinine ratio in VLBW infants with asphyxia were higher than in those without asphyxia, but not significantly different (43. 2 ± 17. 7 vs 38. 3 ± 8. 5 μg/1 and 0. 92 ± 0. 60 vs 0. 83 ± 0. 37 μg/μmol). Conclusion: Plasma thrombomodulin level in VLBW infants shows a high value at birth, and we consider the main factor responsible for this elevation may be endothelial damage or low clearance rate of thrombomodulin, which may be related to early gestational age.     

PHARMACOKINETICS OF AMIKACIN IN INFANTS AND PRE-SCHOOL CHILDREN

Abstract. The pharmacokinetic properties of amikacin sulfate in infants and children aged from three weeks to 6 years were studied during treatment with doses of 7.5 mg/kg every 12 hours using standard assay methods and technique of two compartment open model kinetic analysis. Peak serum concentrations of amikacin were measured 30 or 60 min after the first intramuscular injection. These ranged from 11.8 μg/ml to 23 /μg/ml in infants and from 9.0 /μg/ml to 29 8 μg/ml in children. Five minutes after the first intravenous bolous injection they varied from 16 μg/ml to 29.8 μg/ml in infants and from 34 μg/ml to 42 μg/ml in children. Twelve hours after injection serum concentrations were less than 0.8 μg/ml in all patients. Mean serum half-lives of amikacin in infants and children were 2.1 hours and 2.0 hours after intramuscular, and 2.2 and 2.0 hours after intravenous administration respectively. No evidence of accumulation was observed after four days treatment. The amount of antibiotic recovered within 12 hours from the urine in all patients ranged from 34.5 to 65 % of an intramuscular dose, and from 45.8 to 63.3% of an intravenous dose. The dosage regime of 7.5 mg/kg body weight given every 12 hours should be safe and effective for the treatment of infections in the age groups studied.     

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     

Postnatal dexamethasone treatment and retinopathy of prematurity in very-low-birth-weight neonates

Whether postnatal dexamethasone treatment for bronchopulmonary dysplasia (BPD) increases the risk of retinopathy of prematurity (ROP) in very-low-birth-weight (VLBW) neonates is uncertain. We performed a retrospective cohort study to determine the association between dexamethasone administered postnatally and the development of ROP in VLBW (< or = 1,250 g birth weight, < or = 32 weeks' gestational age at birth) neonates. The incidence of severe ROP (stage 2 or higher) was 26% among 72 infants who received no dexamethasone postnatally, 61% among 23 infants who received a low cumulative dexamethasone dose (< or = 1.8 mg/kg body weight), and 85% among 20 infants who received a high cumulative dexamethasone dose (> 1.8 mg/kg body weight). However, after adjustment for confounding covariates of prematurity and severity of lung disease by logistic regression analysis, we found no independent association between postnatal dexamethasone treatment and the incidence of severe ROP.     

Long-term enteral glutamine supplementation in very low birth weight infants: effects on growth parameters

Enteral and parenteral glutamine supplementation in preterm infants has been shown to have some beneficial effects on neonatal morbidity and mortality, although the results are controversial. In this study, we aimed to determine if long-term glutamine-supplemented enteral nutrition affects growth parameters in very-low-birth-weight (VLBW) preterm infants. Preterm infants with a birth weight of < or = 1500 g were assigned to receive enteral glutamine supplementation (300 mg/kg/day) or placebo between 8-120 days (4 months) of life. At the end of each month, growth parameters [weight, length, head circumference, left upper mid-arm circumference (MAC) and left mid-thigh circumference (MTC)] were determined and enteral glutamine dose was adjusted according to the current weight. In VLBW infants (n = 69), the glutamine-supplemented group (n = 36) had significantly higher mean weight, length, head circumference, MAC and MTC than the control group (n=33) at the end of the fourth month. These findings suggest that long-term enteral glutamine supplementation may lead to significant improvements in growth in all body measures in VLBW infants, possibly in a time-dependent pattern.     

Concentration of Twelve Plasma Proteins at Birth in Very Low Birthweight and in Term Infants

ABSTRACT. Plasma samples obtained at birth from 70 very low birth weight (VLBW) infants (gestational age 24 to 34 weeks) and from 20 term infants were analysed for concentrations of 12 different proteins. The plasma concentrations of albumin, transthyretin (TTR), retinol-binding protein (RBP), vitamin D-binding protein, apolipoprotein A I, fibronectin, orosomucoid and α₁-antichymotrypsin were significantly lower in the VLBW infants than in the term infants, whereas the values of α-fetoprotein (AFP) were significantly higher in the VLBW infants. No differences were found between the two groups for apolipoprotein A II, apolipoprotein B and transferrin. Birth asphyxia and sex had no influence on the measured plasma protein concentrations. The plasma concentrations of apolipoprotein A I and A II were significantly lower in small-forgestational age (SGA), VLBW infants compared with appropriate-for-gestational age (AGA), VLBW infants. Possible acute inflammation (defined as raised concentrations of orosomucoid or α₁-antichymotrypsin) was associated with significantly higher values of vitamin D-binding protein in both VLBW and term infants, suggesting that this protein may act as an acute phase protein in newborn infants.