Anne B. Fletcher

The Potential Toxicity to Neonates of Multivitamin Preparations Used in Parenteral Nutrition

This study compares two groups of infants weighing less than 1500 g at birth. In the propylene glycol (PG) group, 30 infants received MVI-Concentrate containing 300 mg of PG daily with their intravenous nutrition (ivn), and vitamin E, 50 mg/week by intramuscular injection. In the mannitol group, 30 infants received MVI-Pediatric (containing 245 mg mannitol), 65% of a vial/day. Serum and urine osmolality, serum PG, blood-urea-nitrogen, creatinine, sodium, and glucose were measured on days 0, 2, 5, 12, 19, 26, 33 and 40 of ivn. Weight, urine output, and fluid intake were measured daily. Vitamin E levels were measured on days 5, 26, and 33 of ivn. There were no significant differences between the groups in birth weight, gestational age, sex, age, or weight at start of ivn. Our results indicated that neither MVI-Concentrate nor MVI-Pediatric was associated with a clinically significant diuresis. MVI-Pediatric, 65% of a vial/day, may produce higher than desirable blood levels of vitamin E, and use of drugs containing PG can produce significant blood levels of PG, in very low birth weight infants.

Nutrition for full-term and preterm infants: Meeting normal and exceptional needs

Providing adequate nutrition for the healthy full-term newborn is relatively easy; breast milk or formula is sufficient for the first six months of life. Although the full-term infants organ systems are relatively mature, the gastrointestinal tract is often stressed by the demands of rapid growth, and feeding difficulties, such as gastroesophageal reflux, colic, milk allergy, and constipation, may occur that necessitate special handling. The small preterm infant, however, has many urgent nutritional needs; management is usually complicated by the fact that the infants immature organs may be unable to cope with enteral feedings. Thus, total parenteral nutrition is necessary, with extensive laboratory monitoring of metabolic functions and precise attention to detail to avoid a prolonged period of partial starvation.

392 VITAMIN PREPARATIONS IN NEONATAL PARENTERAL NUTRITION (PN)

Toxicity to neonates from drug solvents is of concern. We reported serum hyperosmolarity due to Propylene Glycol (PG) in MVI-12. This study compared two groups of infants weighing < 1500 grams. Gr PG-received MVI-Conc. (with PG) 1 cc/d in their PN and Vit. E 50 u/wk IM. Gr Mann.-received MVI-Ped. (with Mannitol) 6.5 cc/d. Serum & urine osm. PG levels, BUN, creatinine, Na & glucose were measured days 0,2, 5, 12, 19, 26, 33 & 40 on PN. Weight, urine output, and fluid intake were measured daily. Vit E levels were measured on days 5, 26 & 33 on Pn. Mannitol levels were not measured. RESULTS: There were no differences between the groups in birth weight, gest. age, sex or age & wt. at start of PN. PG < 1000gm-serum mosm. correlated with serum PG during first 12 days of PN. (PG levels 2.4-108.4 mg/dl.) 14.2% of serum osmol. values were > 310mosmol/L. Mann, gr. < 1000gm-12.6% serum mosm. were > 310mosmol/L. No diuretic effect of Mannitol was detected. MVI-Ped. in recommended doses may produce higher than desirable vit. E levels.

Therapeutic intravenous galactose in glucose intolerant prematures

Small, sick prematures often require intravenous alimentation and are sometimes intolerant to concentrated glucose, with hyperglycemia and glycosuria. Animal studies have shown hetter glucose regulation in the presence of galactose, a normal product of lactose digestion. Possible benefit of IV galactose was studied.Blood galactose levels on 58 newborns taking milk by mouth showed prompt utilization with peak levels < 5 ng/dl. T1/2 was 45 min. with no significant effect of gestational age or time after birth, indicating necessary enzymes are present. Therapeutic infusions of equal conc. of glucose and galactose in 4 glucose-intolerant premies and 1 infant of a diabetic mother yielded promising results. All stabilized blood glucose in the normal range (70-120), 2 cleared significant urine glucose spills, 3 recovered from previous hyperglycemia, there was a tendency to tolerate higher CHO loads, and no clinical toxicity was noted. Blood galactose levels were monitored and remained below 20 mg/dl. These results suggest that IV galactose is feasible and may cause less hyperglycemia in sick prematures and less insulin stimulation in IDMs while allowing administration of additional calories as CHO.