In 41 healthy human-milk-fed preterm infants the preprandial total bile acid (B A) concentrations in serum and duodenal juice were simultaneous measured during the first 60 days of life. The infants were subdivided into four groups according to their gestational age: 6 infants with a gestational age of 27 and 28 weeks, 7 infants with a gestational age of 29 and 30 weeks, 21 infants with a gestational age of 31 and 32 weeks and 7 infants with a gestational age of 33 and 34 weeks. The BA levels were enzymatically determined using 3-α-hydroxysteroid dehydrogenase. In the duodenal juice, cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid and lithocholic acid were separately quantified by thin-layer chromatography. During the first month of life, the serum BA concentrations increased significantly with postnatal age (p < 0.01) but remained nearly constant during the second month of life. In the duodenal aspirates, the BA concentrations increased continuously up to the end of the observation period (p < 0.001). In the duodenal aspirates, the CA/CDCA ratio was high immediately after birth and decreased significantly with increasing postnatal age (p < 0.001). During the first weeks of life, the BA levels were preferentially conjugated with taurine, but in spite of the taurine-rich diet during the whole observation period the taurine/glycine ratio decreased with postnatal age (p < 0.001). In all samples of duodenal juice, the sum of primary BA was > 98% of total 3-α-hydroxy-BA. These data indicate that the establishment of an intestinal microbial flora necessary for intestinal BA transformation and the development of the enterohepatic BA circulation lasts some months of postnatal life. The serum BA concentration reflects hepatic synthesis, intestinal absorption, renal excretion and hepatocellular transport into bile in a very complex way which may limit the diagnostic value of serum BA during this time. Additionally, a duodenal BA concentration below 4 mmol/l, as found in this study during the first 2 weeks of life, may be of clinical importance due to its possible effects on fat absorption.

Lipase and trypsin activities were estimated in preprandially aspirated duodenal juice of preterm infants with gestational ages between 29 and 32 weeks (group I, n = 33) or between 33 and 36 weeks (group II, n = 22) during the first 6 weeks of postnatal life. The results were compared with the enzyme activities measured in 2- to 6-year-old children. There were no significant differences of the mean lipase or trypsin activities between the two groups (lipase; group I 13.7 ± 7.9, group II 15.9 ± 9.8 U/ml; trypsin: group I.7.9 ± 4.7, group II 8.5 ± 5.1 U/ml). The activities of both enzymes increased significantly and similarly in both groups with postnatal age (lipase: group I r = 0.732, p < 0.01, group II r = 0.743, p < 0.01; trypsin: group I r = 0.705, p < 0.01, group II r = 0.669, p < 0.01). At the end of the study the lipase activities of both groups reached approximately 35% of the values found in the older children, whereas the trypsin activities reached the reference values within the 1st month of life. The results indicate an asynchronously age-related development of lipase and trypsin. The development of the lipase activity is delayed in comparison to the trypsin activity which should be considered in the nutritional management of preterm infants.

Pereira and Lemons (Controlled study of transpyloric and intermittent gavage feeding in the small preterm infant. Pediatrics 67:68, 1981) compared techniques of feeding low-birth-weight infants: transpyloric (nasoduodenal) feeding and intermittent gavage. They observed no significant differences for several parameters, and concluded that there was no difference between the two techniques in supplying nutrition to the low-birth-weight infants and that the transpyloric feeding could not be recommended because it was risky and difficult. According to our experience1 one of the advantages of the transpyloric feeding is that it permits a greater caloric and nutritional intake (140 to 150 kcal/kg/day) in the early days of life without the complications caused by the introduction of the same amount of nutrients into the stomach.

Clinical experience with yakriton in our Pediatric Department has shown a favorable effect upon the toxic form of typhoid cases, though the cases are yet only a few in number. The present work was started to examine if yakriton,') the detoxicating hormone of the liver, would have any effect upon the production of serum agglutinins.Method o f Experimentation.Of normal rabbits, only such ones as those whose sera had shown only a low normal agglutinin titre were used for the experiment. They were divided into three groups. Group A received a subcutaneous in jection of I R.A.U. (Rabbit-Ammonia-Units) of yakriton per kilogram of body weight and at the same time an intravenous injection of 0.25 c.c. of Asakawa's " typhoid diagnosticum. 72) Group B received a sub cutaneous injection of 20 R.A.U. of yakriton per kilo of body weight and at the same time an intravenous injection of 0.25 c.c. of the "diag nosticum" Group C (control animals) received the salve amount of the " diagnosticum " intravenously , but no yakriton at all.Blood was taken from an ear-lobe vein at different intervals after the above mentioned injection. Sera from different groups were made inactive and put to agglutination test with the use of the above men tioned typhoid emulsion. 1) . Throughout the experiment insoluble yakriton was used. 2) A saline suspension of killed bacillus typhosus (or paratyphosus A or B) for me dical practice. In the present work only that of typhoid bacilli was used. Three samples were mixed and shaken well before using.