No abstract

The effects of concurrent administration of albumin with total parenteral nutrition were studied in 12 premature newborns (birth weight 1.26 +/- 0.1 kg [mean +/- SEM] and gestational age 30 +/- 0.8 weeks [mean +/- SEM]) compared with a control group of 12 premature newborns (birth weight 1.17 +/- 0.2 kg and gestational age 29 +/- 0.1 weeks) who received total parenteral nutrition. All newborns had a plasma albumin level below 3 g/dL and were in cardiorespiratory distress requiring assisted ventilation. Albumin supplementation of total parenteral nutrition resulted in a sustained increase in serum albumin concentration as well as increased mean arterial blood pressures in the study group. Slow albumin infusion had no observed effect on the severity of respiratory distress. Study group infants regained birth weight earlier than control group infants. These data suggest that the concurrent administration of albumin may be clinically beneficial in critically ill newborn infants.

The efficiency of a continuous infusion of insulin in improving glucose tolerance was compared in two groups of very low-birth weight infants (mean +/- SEM birth weights 757 +/- 40 vs 828 +/- 80 g and gestational ages 27.6 +/- 0.7 vs. 27.2 +/- 0.5 weeks) receiving total parenteral nutrition with and without the addition of lipid emulsion to the nutrition regimen. The mean +/- SEM cumulative doses of insulin (0.87 +/- 0.1 vs 1.15 +/- 0.3 U/kg) and hours required to decrease the blood glucose level to 120 mg/dL (9.1 +/- 0.8 vs 9.5 +/- 1.0 hours) were similar. Insulin was delivered with a syringe pump used for other routine purposes in the neonatal intensive care unit. Continuous intravenous insulin infusion is an effective, inexpensive, safe method for maintaining glucose homeostasis in low-birth weight infants who develop hyperglycemia as a consequence of total parenteral nutrition.

Blood concentrations of gastrin, motilin, insulin, and insulin-like growth factor-I were measured sequentially during the first 3 weeks of life in 22 very-low-birth-weight infants (birth weight 1.03 +/- 0.24 g; gestational age 28.3 +/- 1.9 weeks; mean +/- SD) who were in respiratory distress requiring mechanical ventilation and were receiving either total parenteral or enteral feedings. An increase in the blood concentration of motilin beyond the basal measurement was observed in enterally fed infants but not in infants receiving total parenteral nutrition. Motilin and gastrin concentrations were significantly increased in the enterally fed group compared with infants receiving total parenteral nutrition at 2 and 3 weeks and 1 and 3 weeks, respectively. There were no differences in serum insulin or plasma insulin-like growth factor-I concentrations between groups after the start of the study. The present data suggest that enteral nutrition in very-low-birth-weight infants is associated with a relative increase in peripheral motilin and gastrin concentrations compared with parenterally fed infants.