Bo Lindblad

Folate, vitamin B12, and homocysteine levels in South Asian women with growth- retarded fetuses

Objective.u2002 To investigate whether intrauterine growth retardation (IUGR) and preterm delivery in a poor population of South Asia was associated with altered maternal and fetal levels of folate, vitamin B12, and homocysteine.

Cerebral blood flow and exchange of oxygen, glucose, ketone bodies, lactate, pyruvate and amino acids in infants.

Abstract. Cerebral blood flow (CBF) and cerebral av‐differences of oxygen and circulating substrates were measured in normocapnic infants during general anaesthesia before elective surgery in order to study possible age‐dependent variations. CBF was determined by a minor modification of the Kety‐Schmidt technique from desaturation curves of nitrous oxide (N2O) in arterial and cerebral venous blood (N2O analysed by gas chromatography on 15 μl blood samples) after reduction of inhaled N2O from 75 to 50%. The reproducibility was ±4.6%. Lactate, pyruvate and oxygen were determined in whole blood and amino acids in plasma by ion‐exchange chromatography. Reliable av‐differences of glucose, acetoacetate and d‐β‐hydroxybutyrate could be calculated from plasma values and hematocrits. Mean values from 12 infants (age II days‐12 months) were: CBF 69 ml/100 g · min‐1; cerebral uptake (in μmoles/100 g · min‐1): oxygen 104, glucose 27, acetoacetate 0.9, d‐β‐hydroxybutyrate 2.3; cerebral release: lactate 2.4 and pyruvate 0.8. Significant uptake of amino acids was found only for histidine 0.95 and arginine 0.7. Significant correlations between arterial concentration and cerebral exchange were found for: ornithine, arginine, phenylalanine, aspartic acid, serine, glutamine and acetoacetate. CBF and substrate exchange were unrelated to age within the group. Infants had higher mean CBF and greater uptake of ketone bodies than has been reported in adults.

The establishment of some microflora associated biochemical characteristics in feces from children during the first years of life.

ABSTRACT. This report presents a new approach to the study of the colonization of the digestive tract after birth. We have examined the development of four microflora associated characteristics, MACs, defined as the recording of any anatomical structure, biochemical or physiological function in the macroorganism, which has been influenced by the microflora. These MACs may create a basis for later investigations into the impact of diarrheal diseases and antibiotic therapy. The following biochemical characteristics were studied in feces from children of 0‐61 months of age: conversion of cholesterol to coprostanol and bilirubin to urobilins, inactivation of trypsin and degradation of mucin. These results indicate establishment of microbes capable of converting bilirubin to urobilins within the second year of life. The mucin degrading and cholesterol converting microbes are established in most of the children during the same period. Tryptic activity was found to be absent in meconium, present in feces from all children up to 21 months of age, and absent in 6 out of 15 children in the age group 46‐61 months. The study indicates that the establishment of the MACs in the digestive tract is a remarkably long drawn out process

Endothelial Function in Newborn Infants Is Related to Folate Levels and Birth Weight

OBJECTIVE. Low maternal folate levels during pregnancy correlate with low birth weight, a perinatal risk factor for later cardiovascular disease. We studied relationships between red blood cell folate levels, birth weight, and vascular endothelial function (a key factor in the early pathophysiologic processes of heart disease) in newborn infants. METHODS. We included 82 infants (30 low birth weight) and their mothers. A laser Doppler technique was used to measure skin perfusion during transdermal iontophoresis of acetylcholine (an endothelium-dependent vasodilator). Red blood cell folate, vitamin B12, and homocysteine levels were determined. RESULTS. The perfusion response to acetylcholine was lower in low birth weight infants than in normal birth weight control subjects (mean: 35 vs 76 perfusion units). The neonatal acetylcholine response correlated with red blood cell folate levels in both infants and their mothers. The folate levels of low birth weight and control infants did not differ significantly (mean: 1603 vs 1795 nmol/L), but mothers of low birth weight infants had lower folate levels than did mothers of control infants (mean: 805 vs 1109 nmol/L). In multivariate analysis, low birth weight and red blood cell folate levels contributed independently to endothelial function in newborn infants. The levels of vitamin B12 and homocysteine were similar in the 2 groups and did not correlate with endothelial function. CONCLUSION. The data presented here provide the first evidence for a relationship between folate levels and vascular endothelial function in newborn infants.

Breast feeding is a natural contraceptive and prevents disease and death in infants, linking infant mortality and birth rates

The trend of declining infant mortality has stopped or has increased in at least 21 developing countries. In the last 30 years in Pakistan infant mortality has been over 100/1000 live births. Population size has increased from 35 to 120 million between 1950 and 1993. Pakistan is experiencing a simultaneous rise in urbanization. Breast feeding and postpartum abstinence are often responsible for long birth intervals in certain populations. Breast feeding patterns have changed greatly from exclusive breast feeding to at most partial breast feeding. Partial breast feeding can have a contraceptive effect if sucking is frequent enough. For example mothers who breast fed for less than 4 months had many more new pregnancies than those who breast fed longer than 4 months (p < 0.05). Lymphoid cells that have migrated to mammary glands produce secretory IgA antibodies which are passed to the infant via the milk. These antibodies protect breast fed infants from infection and death. For example in Lahore Pakistan neonatal septicemia occurred 18 times more often among non-breastfed infants than partially breast fed infants. The risk of diarrhea-related death was 23.5 times greater among non-breastfed infants compared to exclusively breast fed infants. Frequent infections brings about undernutrition which only serves to increase the risk of poor growth and development or death. The practice of giving prelacteal feeds and supplementary feeds increases the risk of infection. In conclusion promotion of breast feeding improves the life and prevents the death of many children. Breast feeding campaigns should begin immediately especially in poor societies.

Age and sex are important factors in determining normal retinol levels

Cut-off levels for serum retinol levels of 20 micrograms/dl for marginal and 10 micrograms/dl for definite deficiency have been advocated and extensively used in population studies. However, the blood serum levels of retinol of the newborn are known to be very low and although the age dependency of the retinol binding protein has been described, the normal levels of serum retinol at different ages have not been reported from larger series. While studying poor populations of young infants in Lahore, Pakistan, we thought it necessary to try to achieve appropriate reference values by analysing the levels of serum retinol of expatriates from the Indian subcontinent who live in the affluent United Arab Emirates, where retinol deficiency is not seen either at the hospital or the community levels. We have studied material, cord blood, infantile and adult levels of retinol and found a highly significant age relationship of serum retinol levels. During very early infancy the normal mean is below what has been considered deficiency. This is new information and important in the evaluation of retinol status of individuals as well as populations. In addition, we found lower levels in women, pregnant or non-pregnant, than those in adult men. This sex difference in adults was not seen in infants. We recommend a cut off level for deficiency of 10 micrograms/dl, but only for those above 1 month of postnatal age.

Concomitant bacteraemia as a risk factor for diarrhoeal disease mortality in Karachi: a case‐control study of hospitalized children

The objective of this study was to evaluate risk factors for death due to diarrhoea among hospitalized children at the Aga Khan University Hospital (AKUH), Karachi. We conducted a retrospective case‐control study of all diarrhoea deaths at AKUH over the period 1988–93. For each death, the next two consecutive admissions matched for gender and type of diarrhoea were identified as controls. Data were analysed by univariate methods and logistic regression analysis. A total of 42 deaths and 84 matched controls were identified. Blood cultures at admission were obtained in all deaths and 94% of controls. The rates of isolation of organisms from blood cultures were significantly higher among deaths [38 versus 9%, odds ratio (OR) 6.5, 95% confidence interval (CI) 2.2–19.9], the majority of which were Gram‐negative Enterobacteriaceae (94 versus 57%, Fishers exact test p < 0.02). Conditional logistic regression revealed that several clinical and laboratory features of systemic infection were associated with a significantly increased risk of mortality, such as anorexia (OR 3.9,95% CI 1.4 10.9), drowsiness (OR 4.4,95% CI 1.3–15.3), respiratory distress (OR 7.0,95% CI 1.4 36.6), anaemia (OR 5.8, 95% CI 2.0–16.6) and a positive blood culture (OR 8.7, 95% CI 2.5–30.7). Our data suggest that bacteraemia with Enterobacteriaceae is common among hospitalized malnourished children with diarrhoea and systemic infection may be an important risk factor for mortality.

Regulation of serum sodium in dehydrated and orally rehydrated infants: influence of age and of purging rates

ABSTRACT. We have examined the control of serum sodium concentration (S‐Na) in 60 male infants with acute diarrheal disease, moderate dehydration, but without the presence of fever, vomiting or other conditions. The infants were studied on admission and during oral rehydration therapy (ORT). We examined the effect of rapid reduction of the purging rate on the control of S‐Na by adding pulverized rice and pulses (dal moong) to the rehydration solution. On admission S‐Na was significantly inversely related to age. This correlation could not only be attributed to difference in stool sodium losses. Changes in S‐Na and urinary K/Na ratio during oral rehydration therapy (ORT), were analyzed seperately in infants below and above 4 month of age. During the first six hours of ORT, there was an increase in S‐Na in all groups. During the following 18 hours, S‐Na tended to normalize around 138 mmol/1. Normalization occrred faster if purging rate was reduced. In all groups urinary K/Na ratio (index of aldosterone production and, inversely, of sodium balance), was high at admission and fell during ORT. In the youngest infants (below 4 month of age) the fall was significantly more pronounced if the purging was reduced. We conclude that it is important to consider age when prescribing ORT. The capacity to correct distrubances in S‐Na becomes more efficient during maintenance stage of ORT. Correction of S‐Na and sodium balance is enhanced by rapid reduction of abnormal intestinal losses.

What are the most effective means of promoting exclusive breastfeeding

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