Microdialysis is a new method for continuous metabolic monitoring. We studied the possibility of using microdialysis in neonates treated in a paediatric intensive care unit after surgery. A microdialysis catheter was inserted in the abdominal subcutaneous adipose tissue in 14 neonates for a median of 93 h (range 24-106 h). In four neonates, two microdialysis catheters were used simultaneously. Samples were taken hourly for analysis of glucose, lactate and glycerol. Dialysate and blood concentrations were compared. Serum/whole blood glucose values (n = 68) were in the range 2.1-15.4 mM. The serum glucose levels showed good agreement with the dialysate concentrations of glucose, although these infants were subjected to various forms of stress, drugs and glucose infusions. The whole blood glucose levels were significantly lower than the dialysate levels. The microdialysis concentrations of glucose varied considerably. As almost identical dialysate glucose levels were found when two microdialysis catheters were used simultaneously, the variability probably reflects true changes in blood glucose levels. Our results indicate that microdialysis can be used in neonates.

Human adipose tissue exhibits marked age-dependent differences in morphology and regulation of lipolysis. The mechanism behind this phenomenon is poorly characterized. The aim of the present investigation was to evaluate the antilipolytic effect of insulin and the expression of insulin receptor mRNA in human adipose tissue during development. To study the antilipolytic effect of insulin, lipolysis was induced with submaximal effective concentrations of isoprenaline or forskolin in adipocytes from five infants below 2 mo of age, five infants above 2 mo of age, six children, and five adults. Isoprenaline was equally effective in stimulating lipolysis in all age groups, whereas forskolin was significantly more effective in adipocytes isolated from adults than from infants and children. Increasing the concentration of insulin during the incubation allowed construction of dose-response curves of insulin inhibition of lipolysis. Maximal inhibition was observed with 30 microU/mL of insulin in the presence of either isoprenaline or forskolin. No differences in the maximal antilipolytic effect of insulin or in the insulin sensitivity expressed as ED50 were observed. Furthermore, the expression of insulin receptor mRNA in adipocytes did not differ from six infants, five children, and six adults as determined with a solution hybridization RNase protection assay. Thus, age-dependent variations in the regulation of lipolysis do not appear to be accompanied by variations in insulin action and insulin receptor gene expression in isolated adipocytes.

In previous studies, we observed that lactate concentrations in interstitial white adipose tissue are higher in small infants than in adults. Moreover, no lipolysis following catecholamine challenge has been reported in neonates and small infants. Our aim was to determine with microdialysis whether the above mentioned age-dependent changes could be detected in situ after surgery. A microdialysis catheter was introduced into the abdominal subcutaneous tissue in 13 neonates and 12 children undergoing surgery. Interstitial concentrations of glucose, lactate and glycerol were measured hourly during the first 20 postoperative hours. The concentrations of lactate in interstitial white adipose tissue were consistently higher in neonates compared to older children, with a significant difference during the 9-18 h postoperative period (P < 0.05). A significant difference in the lactate:glucose ratio was observed at 1-2, 8-10, 15 and 18 h postoperatively (P < 0.05). No significant differences were observed between the two groups with respect to glycerol and glucose concentrations. Interstitial lactate concentrations in white adipose tissue were higher in neonates compared with children in the early postoperative period. No age-dependent difference in postoperative lipolysis, measured as interstitial glycerol concentrations, was observed. Thus, an age-dependent difference in interstitial lactate production, but not lipolysis, was detected in the early postoperative period.

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