David C Wilson

Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants

AIMS To improve energy intake in sick very low birthweight (VLBW) infants; to decrease growth problems, lessen pulmonary morbidity, shorten hospital stay, and avoid possible feeding related morbidity. Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia, necrotising enterocolitis, septicaemia, cholestasis and osteopenia of prematurity. METHODS A prospective randomised controlled trial (RCT) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit. Babies were randomly allocated to either an aggressive nutritional regimen (group A) or a control group (group B). Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition. Statistical analysis was done using Student’st test, the Mann-Whitney U test, the χ2 test and logistic regression. RESULTS There was an excess of sicker babies in group A, as measured by initial disease severity (P <0.01), but mean total energy intakes were significantly higher (P <0.001) in group A at days 3 to 42 while receiving total or partial parenteral nutrition. Survival and the incidences of bronchopulmonary dysplasia, septicaemia, cholestasis, osteopenia and necrotising enterocolitis were similar in both groups. Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay. CONCLUSION Nutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae. Improved nutritional intake resulted in better growth, both in the early neonatal period and at hospital discharge, but did not decrease pulmonary morbidity or shorten hospital stay.

Plasma manganese, selenium and glutathione peroxidase levels in the mother and newborn infant.

Manganese (Mn), selenium (Se) and glutathione peroxidase (GPX) levels were determined in 56 paired samples of maternal and cord blood plasma at birth in both term and preterm pregnancies. Correlations existed between maternal and newborn plasma levels for Se, but not for Mn or GPX. Values of Mn, Se and GPX were all greater in the term than the preterm infant. Levels of Mn were greater in the pregnant than the non-pregnant woman, but levels of Se and GPX were lower during pregnancy.

Comparison of clinical responses to natural and synthetic surfactants

The clinical responses to both natural and synthetic surfactants were observed in two District General Hospital Neonatal Units who were centrally randomised as part of two separate multicentre trials (OSIRIS and Curosurf 4). Forty five infants were enrolled consecutively in the OSIRIS trial using synthetic surfactant (Exosurf), while 21 infants were subsequently enrolled in the Curosurf 4 trial using natural surfactant (Curosurf). There were no significant differences between the groups for mean birth weight, gestational age, inspired oxygen (FiO2), or arterial: alveolar oxygen ratio (a/A) prior to surfactant administration. Oxygen requirements fell significantly more rapidly within the first 24 hours for patients treated with Curosurf compared to Exosurf (p < 0.001). Mean duration of > 40% oxygen requirement was significantly shorter in the Curosurf group (2.6 days) compared to 8.0 days in the Exosurf group (p < 0.01). Mean duration of oxygen therapy was also significantly shorter in the Curosurf group (10.2 days) compared to 17.1 days in the Exosurf group (p < 0.05). Ten infants (24%) in the Exosurf group developed intraventricular haemorrhage (IVH) compared to none in the Curosurf group (p < 0.05). As oxygen requirements appear to decrease more rapidly following administration of Curosurf compared to Exosurf a large prospective randomized multicentre trial needs to be performed to compare the effects of these surfactants on both short and long-term outcome.

Long term predictive value of Doppler studies in high risk fetuses

Objective To determine whether the predictive value of Doppler ultrasonography extends beyond the perinatal period.

Plasma Manganese Levels in the Very Low Birth Weight Infant Are High in Early Life

Plasma manganese levels were determined at birth and then serially to 3 months of age in 40 very low birth weight (VLBW) infants (mean birth weight 1,027 g). Mean plasma manganese concentration was 3.6 micrograms/l at birth and 3.0 micrograms/l at 3 months of age. These levels were approximately 3-fold greater than those of a group of 9 adults analysed using the same methods (mean 1.1 micrograms/l). Manganese was also measured in parenteral nutrition fluids, breast milk and 3 preterm formulas. There was no relationship between manganese intake and plasma manganese concentration.

Effect of Early Vs. Late Introduction of Intravenous Lipid To Preterm Infants on Death and Chronic Lung Disease (CLD) - Results of Meta-Analyses † 1250

Effect of Early Vs. Late Introduction of Intravenous Lipid To Preterm Infants on Death and Chronic Lung Disease (CLD) - Results of Meta-Analyses † 1250

Tolerance of mixed lipid emulsion in neonates: effect of concentration.

AIMS: To compare the effect of concentration of a mixed lipid emulsion (50:50 medium chain triglyceride/long chain triglyceride) (MCT/LCT) on lipid tolerance in neonates. METHODS: A prospective randomised controlled trial of 75 neonates requiring prolonged parenteral nutrition was conducted in the neonatal intensive care units of the Royal Maternity Hospital, Belfast, and the Waveney Hospital, Ballymena. Thirty eight infants received 10% and 37 20% lipid emulsion. Infants were randomly assigned to groups at the start of parenteral nutrition and studied if they required seven or more days of this. Lipid tolerance was assessed by twice weekly measurements of plasma triglyceride and cholesterol concentrations and weekly measurement of non-esterified fatty acids and beta hydroxy butyrate. Anthropometry was carried out weekly. RESULTS: The mean cholesterol in the 10% group was significantly higher within the first seven days of the study compared with the 20% group (3.5 vs 2.87 mmol/l), and continued to rise over the study period in contrast to the 20% group. A similar pattern was observed with the triglyceride concentrations. There was no significant difference in non-esterified fatty acids, beta hydroxy butyrate, or growth between the two groups. CONCLUSION: Sick neonates show better biochemical tolerance to 20% MCT/LCT emulsion than to 10% emulsion.

Breast Milk Beta-Glucuronidase and Exaggerated Jaundice in the Early Neonatal Period

Breast-feeding is associated with jaundice in the early neonatal period. Previous work has shown levels of the enzyme beta-glucuronidase in maternal breast milk to be related to infant serum bilirubin on postnatal day 21. Our aim was to establish if there was a correlation between the level of breast milk beta-glucuronidase and the degree of early (first week) neonatal hyperbilirubinaemia. A study of 55 mother and baby pairs showed that breast milk beta-glucuronidase levels had no relationship with the level of infant serum bilirubin between postnatal days 3 and 6. Breast milk beta-glucuronidase does not directly account for the early neonatal jaundice seen in breast-fed babies.

Noninvasive methods of body composition analysis in preterm infants:--comparison with dilution of 2H218O.

Very low birth weight (VLBW; < 1500 g) infants account for 1% of births in the developed world, but greater than half of the neonatal mortality rate. Advances in neonatal intensive care have resulted in a significant increase in survival of VLBW infants. As survival has increased, greater attention has focused on the nutrition and growth of these babies. The ability to estimate body composition is of central importance to these studies. Chemical analysis has shown that newborn babies differ greatly from adults in terms of body composition, and that this difference increases with degree of prematurity1,2.

Effect of blood transfusion on plasma selenium, glutathione peroxidase and manganese levels in very low birth weight infants

Very low birth weight infants often receive multiple blood transfusions. We measured the plasma levels of the trace elements selenium, manganese, and glutathione peroxidase in 20 very low birth weight infants prior to blood transfusion and then at 24, 48 and 72 h after transfusion. There was no detectable change in mean selenium or glutathione peroxidase concentrations after transfusion, but the mean (SD) plasma manganese increased from 3.8 (1.5) to 6.0 (2.3) micrograms/l at 72 h.