Breast milk and breast feeding in very low birthweight infants 899 be on educating and encouraging mothers to breast feed their own babies. A high rate of breast feeding in neonatal units and postnatal wards will ensure a ready supply of fresh expressed breast milk. Table. All the babies were being fed routinely via indwelling polyvinyl nasogastric tubes every 4 hours. The method of serial test meals used for adults (Hunt, 1951) had been modified for studying gastric emptying in the newborn (Husband and Husband, 1969). Initially the stomach was washed out with

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SUMMARY The gastric emptying of 10% solutions of glucose and of Caloreen, a glucose polymer, was compared in 16 newborn infants. Caloreen left the stomach more rapidly than glucose on all but one occasion. This has potential advantages to infant feeding.In encouraging early feeding for low birthweight infants the paediatrician must take into account the problems that result from immature sucking and swallowing reflexes, an incomplete oesophageal cardiac sphincter, a poor gag reflex, and a small gastric capacity.1-2 Hypoglycaemia and jaundice may be prevented but only at the considerable risk of regurgitation and potentially fatal aspiration.3 Although there has long been agreement that early provision of an adequate caloric intake is desirable,4 the volume and composition of early feeds are still subjects for debate.For some years it has been the practice in our special care nursery to provide light-for-dates and other infants at risk from hypoglycaemia with a high-energy diet for the first few days of life. Originally this was achieved by the introduction of glucosefortified feeds,5 but when these were given earlier and in larger volumes it became apparent that they often produced vomiting, abdominal distension, and diarrhoea. Caloreen* was substituted for glucose and it has been our impression that the incidence of these symptoms has decreased. This favourable clinical experience and the dearth of data on the use of Caloreen for newborn infants have prompted us to evaluate the effect of Caloreen on gastric emptying in the newborn period.Caloreen is a white, slightly sweet powder prepared by the enzyme degradation of corn starch to give a mixture of malto-oligosaccharides containing 3 % glucose, 7% maltose, 5 % maltotriose, and 85 % polysaccharides containing 4 to 15 glucose units (mean 5 units).6 After ingestion in adults Caloreen is readily converted to glucose by enzymatic action.7 MethodsAn attempt was made to study gastric emptying in 18 infants in the first 6 weeks of life. All were patients *Roussel Laboratories Ltd, Wembley Park, Middlesex, England. in the special care nursery because they were preterm or light-for-dates. Two preterm infants were excluded because of vomiting after the glucose test meal.All infants were wholly or partially tube fed and each received a total of 4 test meals on 2 consecutive days, one of 10% Caloreen and one of 10% glucose on each day; the content of the first test meal was varied randomly and the meals were given in the reverse order on the second day. Tube-fed infants were given test meals over a period of 3 to 4 minutes. Those who could suck were given as much of the test meal as they could take by bottle; a study was considered unsatisfactory if the infant failed to consume the test meal within 5 minutes or regurgitated any portion of it. There is no agreement on the effect of posture on gastric emptying;8-10 throughout our study all infants were nursed prone.Gastric emptying was assessed using Husband and Husband's modification8 of the method described by Hunt and ...

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