B. S. Lindblad

Breast feeding and protection against neonatal sepsis in a high risk population.

Protection against neonatal sepsis by breast feeding was investigated in a developing community. A case-control study was carried out with 42 cases from a hospital and 270 controls, matched for age and socioeconomic conditions from the community. Exclusive breast feeding was extremely rare, most babies being partially breast fed and a few being given formula feed or animal milk. A highly significant odds ratio of 18 was obtained, showing that even partial breast feeding protects against neonatal sepsis in such a population.

CEREBRAL BLOOD FLOW AND EXCHANGE OF OXYGEN, GLUCOSE KETONE BODIES, LACTATE, PYRUVATE AND AMINO ACIDS IN ANESTHETIZED CHILDREN

Abstract. Settergren, G., Lindblad, B. S. and Persson, B. (Department of Paediatrics, Karolinska Institutet and the Unit of Paediatric Anesthesiology, St. Görans Hospital, Stockholm, Sweden). Cerebral blood flow and exchange of oxygen, glucose, ketone bodies, lactate, pyruvate and amino acids in anesthetized children. Acta Paediatr Scand, 69: 457, 1980.—Cerebral blood flow (CBF) and cerebral av differences of oxygen, glucose, 3‐hydroxybutyrate, acetoacetate, lactate, pyruvate and amino acids were measured in anaesthetized children before elective surgery in order to study possible age‐dependent variations. CBF was measured in 70 children, aged 11 days to 15 years. Cerebral av differences were studied in approximately 50% of the subjects. Mean values were: CBF 0.65 ml X g‐1 X min‐1, cerebral exchange in nmoles Xg‐1 X min‐1: oxygen 1348, glucose 248, acetoacetate 12,3‐hydroxybutyrate 34 (uptake), lactate‐48, pyruvate‐8 (release). No net exchange of amino acids was found with the exception of histidine (uptake). Neither CBF nor the cerebral exchange of oxygen and circulating substrates showed any correlation to age within the group. Compared with adults anesthetized by the same technique (barbiturate induction, nitrous oxide‐oxygen relaxant) the children had a slightly higher mean CBF, while the cerebral up‐take of oxygen and glucose were equal to values in adults. The cerebral uptake of ketone bodies was higher in children than reported values in adults investigated in the awake state after comparable periods of fasting.

Excretion of δ-aminolevulinic acid in hereditary tyrosinemia

Abstract In two subjects with hereditary tyrosinemia attacks of severe pains in the abdomen and legs and pareses of peripheral type have been observed. The similarity of these attacks with the crises seen in acute intermittent porphyria prompted us to measure the excretion of δ-aminolevulinic acid, porphobilinogen and porphyrins in these patients and in 4 other patients with hereditary tyrosinemia. The urinary excretion of δ-aminolevulinic acid was from 10 to 250 mg per g of creatinine, i.e., up to a 100-fold increase above the normal range. The excretion of porphobilinogen and porphyrins fell within the normal ranges or was only slightly elevated.

NEW KNOWLEDGE IN HUMAN MILK IMMUNOGLOBULIN

ABSTRACT. One of the anti‐infection principles of maternal milk is the predominant milk immunoglobulin, secretory IgA. This immunoglobulin contains antibodies against many pathogens and potential pathogens, viruses as well as bacteria, including several members of Enterobacteriacae, The antigenic stimuli for these milk antibodies seem to take place in the Peyers patches of the intestine. Lymphoid cells leaving the patches after antigenic exposure seem to home to the mammary glands via the lymph and blood circulation. As a result, the milk contains secretory IgA antibodies against, among other things, the intestinal bacteria of the mother. These milk antibodies might reflect the spectrum of bacteria and viruses in the community and may be important for the protection of the breast‐fed baby. Via the same homing mechanism the maternal milk obtains antibodies against dietary antigens, including cows milk proteins. Studies of infants on mixed feeding suggest that the secretory IgA antibodies against the bovine proteins diminish the antigenic exposure, indicating the possibility of an anti‐allergic mechanism.

Early child health in Lahore, Pakistan: VII. Diarrhoea

Mahmud A, Jalil F, Karlberg J, Lindblad BS. Early child health in Lahore, Pakistan: VII. Diarrhoea. Acta Paediatr 1993;390(suppl):79–85. Stockholm. ISSN 0803–5326

METHYLMALONIC ACIDEMIA A Disorder Associated with Acidosis, Hyperglycinemia, and Hyperlactatemia

The clinical and biochemical features of a case of methylmalonic acidemia, a newly described inborn error of metabolism, are reported.

Growth Disturbance in an Urban Area of Lahore, Pakistan Related to Feeding Patterns, Infections and Age, Sex, Socio-Economic Factors and Seasons

ABSTRACT. Infantile growth in 910 longitudinally‐followed infants in a poor urban population of Lahore, Pakistan was followed from birth to two years of age and correlated to various socio‐economic variables, infections, and feeding‐practices. Attained body size was correlated with the number of episodes of diarrhoea and with family educational level and also, to some extent, with housing standards. The influence of environmental factors on growth was greatest during the hot and warm seasons, for children at an age of 6–9 months and in this culture especially for girls. Children living under the same conditions showed great individual variations in resistance to environmental factors as measured by growth parameters.

Longitudinal Analysis of Infantile Growth in an Urban Area of Lahore, Pakistan

ABSTRACT. Supine length has been registered longitudinally in 302 infants surviving to at least two years of age in an urban area of Lahore, Pakistan. According to the “ICP‐growth model”, normal linear growth can be represented during this age period by a combination of a sharply decelerating Infancy component with the addition of a slowly decelerating Childhood component, the latter acting from the second half of the first postnatal year. Between birth and 24 months of age the Pakistani children grew about 7.5 cm less than expected according to the Swedish standard. The difference in the gain was mainly related to the late onset of the Childhood component found in 56 % of the infants. The onset of the Childhood component in the Pakistani children occurred on an average some 5 months later than in the Swedish controls, which explains the age‐dependent reduction in the gain at about 1 year of age. Children with late onset showed no “catch‐up growth” during the observation period after the onset. This might very well indicate the functional implications of stunted height in populations of developing countries.

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.

Influence of Different Protein Intake on Renal Growth in Young Rats

ABSTRACT. We have examined the effect of high protein intake on kidney growth and function in growing rats. The rats were kept on an isocaloric diet containing 12%, 21% and 50% protein, from weaning (16 days) until the time of investigation (18, 20, 24,40 or 80 days). There was no significant difference between the 12% and 21% protein groups in any of the parameters studied. 50% protein increased body weight (BW) and kidney weight (KW). The increase in kidney weight was already evident after 2 days and exeeded the increase in body weight in all age groups. At 24 days renal cortical DNA and the protein/DNA ratio were significantly increased in the 50% protein group. At 40 days the cortical DNA content, but not the protein/DNA ratio, was significantly increased in the 50% group. The glomerular filtration rate (GFR) was studied at 40 days. Total GFR as well as GFR/BW was significantly higher in the 50% group than in the 21% group. In one protocol the diet was discontinued at age 40 days and the rats were studied at age 80 days. In these rats all parameters of renal size and function were the same as in the rats that had had a normal (21%) protein intake from weaning. We conclude that in young rats high protein intake reversibly increases GFR out of proportion to BW and selectively and reversibly stimulates kidney growth by stimulating cell proliferation.