SUMMARY Serial 24 hour balance studies of nitrogen and energy were carried out over 10 days in two groups of ventilator dependent preterm infants of comparable weight and gestational age. In one group (n= 10) a parenteral amino acid source (Vamin 9) was started within 24 hours of birth, and in the other group (n=11) it was not started until 72 hours. The feeding protocol was otherwise identical. The nitrogen intake (286 compared with 21 mg/kg/day), energy intake (188 compared with 151 kJ), and nitrogen retention (120 compared with -133 mg/kg/day), were all significantly higher during the first three days of life in the group in which the amino acid solution was started early. There were no differences by 7-10 days. The early introduction of amino acids improves the early nutritional state of sick preterm infants. Preterm infants, particularly if they are unwell, are likely to require nutrients and energy in the immediate transitional period after birth at rates at least similar to those available in the uterus. We aimed to find out if there was any increase in overall nitrogen retention and energy intake in sick infants of low birthweight who were ventilator dependent and who were given amino acids intravenously from birth.
Patients and methodsVentilator dependent preterm infants of less than 30 weeks' gestation were entered sequentially on admission to the neonatal intensive care unit into one of two intravenous feeding regimen groups. Those in group E (early) were given intravenous glucose and nitrogen (as Vamin 9, KabiVitrum), within 24 hours of birth, while group L (late) initially received intravenous glucose alone, and nitrogen only after 72 hours of life. The nitrogen delivery rate in both groups was increased progressively over three days from 1 g/kg/day to a maximum of 3 g/kg/day. Intravenous fat (Intralipid, KabiVitrum) was introduced to both regimens at 7 days postnatal age. The infants continued to receive intravenous nutrition (based on standard clinical criteria) until oral feeding could safely be established.The feeding regimens of the two groups differed only in the time of introduction of amino acids. The vitamin intakes (for example, ascorbic acid) were similar in both groups. A computer based protocol was used for the prescription of parenteral solutions.The criteria for inclusion in the study were that the infants completed serial 24 hour balance studies of nitrogen and energy over the first 10 days of life, and that at least 75% of their nitrogen and energy was delivered intravenously. Thirty two infants were initially recruited: 17 in group E and 15 in group L.
SummaryThe laryngeal chemoreflex was tested in a standardized manner in eighteen 1-to 6-day-old lambs. The respiratory and swallowing commnents of the reflex resmnse to chemical solutions introduced to the larynx were quan;ified to characterize the function of the receptors and to elucidate what kind of receptors most likely are involved. A relationship between the strength of the stimulus and the respiratory response was found. The response was s u p pressed with the addition of small amounts of C a C b NaCI, and LiCI. NaCI, 0.3-0.6 M, 0.15 M NaCl titrated to a pH of 3-5 with hydrochloric or acetic acid, and 0.25-1.0 M glucose in 0.15 M NaCl elicited the reflex response.A quantitative separation was seen in the respiratory response to equimolar concentrations of the salt solutions as well as to the acid solutions in normal saline with equal pH. The response to glucose was significantly reduced after application of potassium gymnemate (P < 0.001). A direct relationship between the amount of swallowing and the respiratory response was found (r = 0.83). The laryngeal chemoreflex responses to the stimuli used have certain functional characteristics that are similar to taste receptor responses. This would suggest that the taste bud-like structures present in the laryngeal area are likely receptors for mediation of the reflex.
Trisomy 16 is thought to be incompatible with fetal survival. A boy with mosaic trisomy 16 who lived for 11 weeks is reported. Chromosome analysis was carried out on skin fibroblasts grown during life and confirmed on samples taken at necropsy. We believe that this is the first report of mosaic trisomy 16 that has been confirmed by cytogenetic banding. The baby required ventilatory support for the first three weeks because of respiratory distress, and was then maintained with oxygen given by headbox for a further three weeks. The respiratory insufficiency was thought to be caused by restriction from kyphoscoliosis. A ventilationperfusion lung scan carried out at 8 weeks showed equal ventilation bilaterally, but with reduced ventilation in the upper zones. There was a discrepancy between ventilation and perfusion in the right upper zone, which was underperfosed.A loud pulmonary second sound and forceful left parasternal impulse were noted at birth; a pansystolic murmur was audible at the lower left sternal edge from 4 weeks. An echocardiogram showed a small perimembranous ventricular septal defect, which seemed to be closing by apposition of the tricuspid valve tissue.
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