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This study examines the effect of two different fluids to maintain peripheral arterial line patency at 1 to 2 ml/hr in a randomized controlled trial. Sixty sick newborn infants requiring ventilatory support and frequent blood gas monitoring were randomly assigned to receive either heparinized normal saline (HNS) or heparinized 5% dextrose water (HD5W) to maintain peripheral arterial line patency. One unit of heparin was added to each mililiter of both solutions. The duration of functional arterial lines, sodium balance, and number of peripheral punctures for blood glucose monitoring were compared using Student's t test for independent samples. HNS peripheral arterial catheters functioned significantly longer than HD5W without increased risk of hypernatremia. We conclude that HNS in arterial catheters is safe, lasts longer, and saves the infant (1500 gm or more) from the unnecessary stress of multiple peripheral punctures for blood glucose measurements, which can be obtained from the arterial catheter if glucose is not part of the infusate.

Thirty-six preterm, sick, low-birth-weight neonates were given either total or partial parenteral nutrition. The patients were divided into three groups according to their birth weights: group A—less than 1,00 gm, 12 patients: group B—between 1,000 and 1,500 gm, 15 patients: group C—more than 1,500 gm, 9 patients. The solution for total parenteral nutrition contained 20% glucose and 2.6% crystalline amino acids plus appropriate amounts of vitamins and minerals. The volume of infusate given was usually 125 ml/kg/day, but varied depending on the clinical condition of the patient; occasionally it was as high as 150 to 175 ml/kg/day. Infusate of one-half strength was administered initially; its concentrations of glucose and amino acids were increased to three quarters and full strength gradually, if tolerated. The solution for total parenteral nutrition was infused into the superior vena cava via a central venous catheter; that for partial parenteral nutrition was given into a peripheral vein to supplement inadequate oral feedings. The period of parenteral nutrition lasted froni 5 to 49 days, with an average of 13.2 days. The intake of 500 mg of nitrogen as crystalline amino acids and 100 kcal as glucose was capable of achieving body weight gain. Positive nitrogen balance of various degrees was also observed. Hyperglycemia of a slight to moderate degree was observed in nine patients; only three required insulin therapy. Two patients had thrombotic occlusion of the central venous catheter. The conclusion was reached that total parenteral nutrition or partial parenteral nutrition, when properly managed, is a safe procedure in small, premature infants. The amino acid solution given as a nitrogen source along with adequate calories was effective in promoting weight gain and nitrogen balance; it was apparently well tolerated by low-birth-weight neonates.

We compared the effects of liquid and vaporized dry heparin on neonatal arterial blood gases. A total of 35 paired simultaneously drawn neonatal arterial blood samples were collected. In one of every paired sample, 0.05 cc of liquid heparin was used and in the other sample vaporized heparin syringes were used. Blood was drawn into every syringe to a total volume of 0.2 ml, pH, arterial oxygen tension (PaO2), and arterial carbon dioxide tension (PaCO2) of the paired samples were analyzed using the paired Student t method. There was no statistical difference in pH and PaO2 but the PaCO2 was statistically lower (p less than 0.0005) with liquid heparin. We conclude that the effects of heparin on neonatal arterial blood gases is dilutional in nature and that they are due to mixing heparin with its very low PaCO2 with the blood sample. If by mistake more heparin than necessary is used, the effects can be dramatic. We therefore suggest using syringes with vaporized heparin in obtaining neonatal arterial blood gases to obtain reliable and consistent results.