No abstract

This randomised study aimed to compare the biochemical tolerance of three parenteral regimens administered during the first 48 hours of life. Twenty nine infants were randomised to either: (a) glucose 10%; (b) glucose 100/o/amino acids; (c) glucose 100/olamino acids/lipid.

SUMMARYThe results of this investigation demonstrate, using a position matching paradigm, that the ability of subjects to detect changes in the position of the proximal interphalangeal joint is impaired in patients with rheumatoid arthritis affecting this joint. In this group there is a systematic flexion bias in position judgements compared to an age-and sex-matched control group. This bias becomes progressively more pronounced at more extended positions. These results suggest that chronic inflammatory joint disease significantly alters proprioceptive sensations at finger joints and this may be due to the loss or distortion of afferent feedback from mechanoreceptors innervating the affected joint.

The aim of this study was to determine the energy expenditure and respiratory quotient (RQ) of ventilated and nonventilated low birthweight infants during the first five days oflife, in order to determine optimal feeding regimens. Eighty six infants, of birthweight less than 1750 g, were grouped according to whether they were artificially ventilated or breathing air spontaneously, and whether they were parenteraily or enterally fed at the time of study. Energy expenditure and respiratory quotient were measured during days 1-5 and the relation of energy expenditure to several explanatory variables was investigated using multiple regression analysis. The energy expenditure of ventilated infants was less than that of spontaneously breathing infants; the differences were significant on days 1-3. The respiratory quotient (mean (SE)) was greater in intravenously fed infants compared with milk-fed -0-99 (0.03) v 0-92 (0.01) (P<0.05), with 42% of studies of infants receiving total parenteral nutrition (TPN) producing an RQ of >1O0 compared with 16.6% of milk-fed infants (P<0.01). There was a significant correlation between glucose intake and RQ (r=0*39, P<0.001). The activity scores were measured during 75 studies and scores were significantly higher in spontaneously breathing milk-fed infants compared with ventilated parenterally fed infants. Factors independently related to energy expenditure were: postnatal age (P<0.01); milk feeds (P<0.01); and physical activity (P<0.05).A mix of carbohydrate and fat from day 1 may not only meet energy needs but may also reduce respiratory quotient. (Arch Dis Child 1995; 73: F4-F7)

This study aimed to investigate energy substrate utilisation and nitrogen balance in low birthweight infants receiving total parenteral nutrition during the first days of life, and in particular, to determine the effect of two different glucose intakes on carbon dioxide production. Twenty infants (mean (SE) birthweight 1314 (65) g, mean (SE) gestation 30 9 (0.4) weeks) were recruited to the study. Immediately after birth they were randomised to a carbohydrate intake of 8 glkglday (5.5 mg/kg/minute) or 12 g/kg/ day (8.3 mg/kg/minute). After 24 hours they were changed to the alternative regimen which was continued for a further 24 hours. Fat and protein intakes were kept constant throughout the study. Indirect calorimetry was performed during each of the regimens, urine was coliected for urinary nitrogen, and substrate utilisation calculated for 12 infants.The carbohydrate utilisation rate was increased during the higher carbohydrate intake. Lipid utilisation rates were significantly different, with net lipid synthesis occurring during high carbohydrate intake. Protein utilisation rates were not influenced by the different carbohydrate intakes. The mean plasma glucose concentration was higher during the high carbohydrate intake but the mean highest and lowest values were not significantly different during the two study periods. A plasma glucose below 2-6 mmol/l was recorded more frequently during the low glucose intake (9/20 v 5/20). Capillary Pco2 values measured during high and low glucose intakes were similar (5.9 (0.2) v 6-2 (0.3) kPa. Carbon dioxide production rates were increased during the higher carbohydrate intake but the differences were not significant. Similarly, there was no significant difference in the respiratory quotients (RQ), oxygen consumption, or energy expenditure during the two study periods. (Arch Dis Child 1995; 73: F13-F16)