Adel Bougatef

A Comparative Evaluation of Whey Hydrolysate and Whey-Predominant Formulas How Well Do Infants Accept and Tolerate Them?

Whey hydrolysate formulas are a recent and important innovation in infant feeding. This study compared clinical tolerance and acceptability of a whey hydrolysate formula (WH) with those of a whey-predominant formula (WF) in 45 infants. Four infants (16%) who refused to drink WH formula were eliminated from the study. Mean volume intake was significantly lower for WH (120 mL/kg/day) than for WF (147 mL/kg/day; P <.001). Consequently, mean caloric intake was also significantly different: 80 kcal/kg/day (WF) vs 97 kcal/kg/day (WF; P <.001). Nevertheless, weight gain from birth to 13 weeks of age was nearly identical in both groups (171% for WH vs 178% for WF). No significant differences were noted in duration of feeding, number of pauses during feeding, number of stools per day, or number of regurgitations per day. The lower rate of caloric intake and the dropout rate of 16% for WH raise questions about the use of WH formula in normal infants, as has become the case in some Western European regions.

The effect of cisapride on the corrected QT interval and QT dispersion in premature infants.

Background Cisapride is used frequently in premature neonates as a gastrointestinal prokinetic drug. Concerns exist, however, about its safety because of its effect on the QT interval. Premature infants could be at higher risk for side effects because of their immaturity. This prospective study investigated the pharmacokinetics of cisapride and its effects on corrected QT interval (QTc) and QT dispersion in premature infants. Methods Electrocardiogram examination was performed just before and after 72 hours of treatment with cisapride (0.2 mg/kg per dose, four times daily) in 10 premature infants. Trough and anticipated peak plasma level of cisapride and norcisapride were quantified after 72 hours of treatment. Results were compared with a cohort of 41 term infants aged 0 to 3 months receiving cisapride treatment. Results The QTc interval increased significantly from 423 ms to 461 ms after 72 hours of treatment (P = 0.0007). No effect was seen on QT dispersion (44.3 ms vs. 45.9 ms). The change in QTc interval was inversely related to postnatal age (R2 = 0.52;P = 0.02), whereas there was no correlation with gestational age or plasma levels of cisapride or norcisapride. Trough and anticipated peak plasma levels of cisapride and norcisapride were significantly higher in the premature infants compared with the term infants aged 0 to 3 months (P < 0.001). Conclusions Premature infants less than 1 month of age could be at higher risk for cardiac side effects of cisapride when used in the same dosage as in older infants. The daily dose should be reduced (0.1 mg/kg per dose, maximum four times daily), and the QTc interval should be monitored closely. The benefits and safety of cisapride in premature infants less than 1 month of age should be reconsidered.

The T wave as a marker of dispersion of ventricular repolarization in premature infants before and while on treatment with the I Kr channel blocker cisapride

AIMS Measurement of electrocardiographic intervals to assess dispersion in ventricular repolarization may be helpful in the assessment of the risk of ventricular arrhythmia. We measured QTc, QT dispersion, and T wave intervals in premature infants before and while on treatment with the I(Kr) blocker cisapride as markers for dispersion in ventricular repolarization. METHODS AND RESULTS We enrolled 15 non-ventilated premature infants with a mean gestational age of 30.5 weeks, ranging from 26.5 to 33.5 weeks, and mean postnatal age of 24 days, with a range from 5 to 51 days. A digital 12 lead electrocardiogram was recorded prior to and 3 days after administering cisapride at a dose of 0.8 mg/kg/day. Serum electrolytes were simultaneously measured. Electrocardiographic measurements before and after included: QT, QTc Bazett, QT dispersion, R-R, T wave interval peak to end, T wave interval peak to end/onset Q to T wave peak, T wave axis, T wave maximum voltage and QRS-T angle. A paired t test and analysis of variance was used to compare the variables before and during treatment. The QTc, T wave interval peak to end and the ratio T wave interval peak to end/onset Q to T peak increased significantly following treatment with cisapride. Results expressed as before and during treatment were for QTc: 429 (65) ms versus 454 (29) ms p < 0.02; for T wave interval peak to end: 65 (11) ms versus 103 (24) p <0.01, for the ratio T wave interval peak to end/onset Q to T peak: 0.32 (0.06) versus 0.55 (0.16) p < 0.001. Treatment with the I(Kr) blocker did not significantly alter the QT dispersion, T wave voltage, angle or QRS-T angle. CONCLUSION The interval from the peak to the end of the T wave and the ratio of this value to the onset Q to T peak interval, represents regional dispersion of repolarization across the ventricular wall. This is a potentially useful clinical index in the assessment of arrhythmic risk in premature infants being treated by blockade of the I(Kr) channels.

Unexpected diagnosis of Candida albicans meningitis in a premature neonate

Candida albicans meningitis was found in an otherwise healthy 44-day-old premature infant whose birth weight was 1,860 gm. Almost no abnormal clinical or neurologic findings were present. The electroencephalogram, however, was abnormal. All previous body fluid cultures were negative. The combined use of amphotericin B and 5-fluorocytosine resulted in negative cerebrospinal fluid cultures after 3 weeks of therapy. Physical and psychomotor development remained normal on subsequent examination.

Two mattresses for neonates compared for cost and quality of nursing care

Paul De Raeve, RN, MSc, MQA, NMDS co-ordinator, Nursing Department, Academisch Ziekenhuis van de Vrije Universiteit Brussel, Belgium (✉) Rita Vercruysse, RN, Head Nurse, NICU, Nursing Department, Academisch Ziekenhuis van de Vrije Universiteit Brussel, Belgium Tony Waterschoot, RN, Quality Assurance Nurse, NICU, Nursing Department, Academisch Ziekenhuis van de Vrije Universiteit Brussel, Belgium Geert Van Droogenbroeck, RN, Nurse, NICU, Nursing Department, Academisch Ziekenhuis van de Vrije Universiteit Brussel, Belgium Adel Bougatef, MD, Head of NICU, Nursing Department, Academisch Ziekenhuis van de Vrije Universiteit Brussel, Belgium Yvan Vandenplas, MD, PhD, Chair of Paediatrics, Academisch Ziekenhuis van de Vrije Universiteit Brussel, Belgium

90 PLASMA FATTY ACIDS IN PARENTERALLY FED PREMATURE AND TERM BORN INFRANTS: CHANGES INDUCED BY INTRALIPID AND SUNFLOWER-SEED OIL

Premature infants receiving PN free of fat soon develop essential fatty acid (EFA) deficiency, whereas they often have less than 1% of their body weight as fatdeposit. Experience has shown that Intralipid (IL) is a good source of calories and EFA. However, infants who are hypoxic, acidotic or septic present intolerance for IV administered fat-solutions, even at rates of infusion that have been tolerated before (Pediatr58:787, 1976). Because these conditions, are frequently encountered in premature babies and neonates, articles on cutaneous application of sunflower-oil (SO) appeared very attractive (Pediatr58:650,1976). 19 premature and term born babies on PN were studied during 14 days. IL 20% was administerd to 10; SO was rubbed 6times daily on the skin of 9. Plasma fatty acids were determined at birth, day 7 and 14. Levels of C16:0, C18:1, C18:2 and C20:4 did not change in the IL-group. In the SO-group a deficiency in C18:2 developed, that could be corrected by the administration of IL. We conclude that despites IL administration, is often controversal in prematures (displacement of albumin-bound bilirubin, altered synthesis of prostaglandins, cholestasis, impairment of pulmonary function and vasculitis, fat-overloading syndrome,...), the latter is necessary to prevent EFA deficiency. A deficiency in C18:2 can not be prevented by topical application of SO, even not in very-low-birth-weight infants.