Infants treated with Infasurf have a modest benefit in the acute phase of RDS. Infasurf seems to produce a longer duration of effect than Survanta.
SummaryThe role of osmolar load in the regulation of gastric emptying time was studied in 10 healthy premature infants. Two isocaloric infant feedings of similar composition with mean osmolalities of 279 and 448 mOsm/kg were compared. Emptying was studied over 120 min by the double sampling marker dilution technique and by a single aspiration of the feediig at 30 min. Similar gastric emptying times were noted for both formulas with approximately half of the initial gastric contents remaining at 30 min. The secretory response to the two meals during the first 30 min after feeding was compared by measuring the secretions present in the stomach during that time. The mean secretory response to the feedings did not differ significantly and was less than 2.5 ml in both cases. In general, a biphasic pattern of gastric emptying with a rapid early emptying phase was noted with both feedings. This study, therefore, provides evidence that when isocaloric feedines with-similar combsition are used. osmolar load does not davva . " significant role 6 the regulation of gastric emptying in premature infants. This study also demonstrates that differences in osmolality do not significantly affect the secretory response to a meal in the stomach of the premature infant. SpeculationBy developing a better understanding of the factors which regulate gastric emptying time in infancy, a physiologic basis for dealing with clinical problems such as gastroesophageal reflux or inadequate gastric emptying by premature infants may be developed. These patients could benefit from infant formulas which are n"tritionally sound but empty more rapidly than formulas currently available. The present data indicate that osmolar load is not an important ?onsideration in the feediig of these patients. The role of other factors such as the specific constituents of a feeding or its caloric density remain to be determined.The manner in which an infant empties food from his stomach can have a significant effect on his nutrition and health. Infants with gastroesophageal (GE) reflux, severe enough to cause failure to thrive or recurrent pulmonary disease, have delayed gastric emptying compared with infants with mild GE reflux (1 1). Problems in nutritional support can occur when residual volumes from previous feedings limit the amount offered to a premature infant. A better understanding of the factors which control gastric emptying might improve the methods of dealing with these problems.Studies in adults and infants have demonstrated that the type of food offered can significantly effect emptying. Hunt and Stubbs (17) analyzed a number of studies in adults and concluded that the caloric density of a meal was the major determinant in the regulation of gastric emptying. Despite this conclusion, Cave11 (6) demonstrated in premature infants that an adapted cow's milk formula emptied significantly more slowly than human milk even though the feedings were isocaloric. Therefore, in infancy factors other than caloric density appear to play a role in regulating gastri...
SummaryAmylase activity was found in saliva from 13 infants, 26-42 wk corrected gestational age. The levels of salivary amylase activity increased with advancing age. In 10 infants, 31-38 wk corrected gestational age (estimated gestational age in wk plus age in wk after birth), gastric aspirates collected before a feeding and sequentially at 30-min intervals after two consecutive feedi n g~ were analyzed for amylase activity and pH. Two different postprandial patterns were obtained. For six of the 10 infants, both the pH and amylase activities of their gastric aspirates showed a distinct maxima at about 60 min after a feeding and a minima at 180 min just before the second feeding. In the remaining four infants, the pHs of their gastric aspirates remained relatively high (5.0-6.0) for the entire postprandial period. In these infants, there was a persistently high level of the amylase activity. In all 10 infants, amylase activity was found in their gastric aspirate samples when the pH was above 3.0. Comparison of the amylase in the gastric aspirate with purified pancreatic and salivary amylases by polyacrylamide gel electrophoresis showed that the amylase in the gastric aspirate has an electrophoretic mobility similar to that of salivary amylase, which suggests a salivary origin. This study supports the possibility that salivary amylase could enter the stomach and retain a significant amount of its activity in premature infants.Starch and glucose polymers are given in some formulas to infants very early in life to accommodate the increased caloric demands. Clinical intolerance to glucose polymers has not been examined sufficiently. Pancreatic amylase is the key enzyme in hydrolysis of glucose polymers. Recognition of intolerance to glucose polymers has been rare in spite of the lack of pancreatic amylase in the duodenal fluids of young infants. In part, this can be due to the existence of alternate pathways with auxiliary enzymes for the hydrolysis of glucose polymers during the physiologic deficiency of pancreatic amylase. The auxiliary enzymes include: salivary amylase, small intestinal brush border glucoamylase and mammary amylase in the breast-fed infant. We have shown that glucoamylase reaches levels similar to those of older children at 1 month of age (13). Two studies have noted the presence of a-amylase in preterm and in term human milk. The ability of milk amylase to survive the gastric environment has been examined and its physiologic importance in the young infant discussed ( 1 1, 16). Recently, we also reported an investigation on the possible role of ingested mammary amylase in the hydrolysis of glucose polymers (1 0). Salivary amylase has been shown to be present in infancy and to reach adult levels much earlier than pancreatic amylase (I, 4, 5, 15, 2 1, 28). The level of salivary amylase in premature infants is however not known. In this study we determined whether the salivary amylase was present and active in gastric fluids during feeding. MATERIALS AND METHODSSubjects. The group of prematures inc...
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