The normal newborn infant has inadequate homeostatic mechanisms for stabilizing the concentration of glucose in the blood (1, 2). Recent studies of carbohydrate metabolism in this age group have indicated a diminished responsiveness to small doses (30 jug per kg body weight) of exogenous glucagon (3, 4) and a slow rate of disappearance from the blood of either glucose or galactose administered intravenously (4, 5). Similar results have been observed in the premature infant (6). Glucose uptake by the tissues improves with a second dose and with age. The newborn infant is sensitive to exogenous insulin (5, 6), and insulin-like substances have been found in umbilical vein blood (7). We interpret the effects of the injection of either glucagon or galactose, which resulted in a prompt rise in the concentration of glucose in the blood, to indicate functional adequacy of the enzymes of the glycogen cycle in the liver of the newborn infant.Since the pathway for fructose metabolism in the liver differs from that of galactose or glucose, we wished to evaluate the effect of a rapid infusion of fructose on the concentration of glucose and lactate in the blood of newborn infants. The possible mechanisms involved are elucidated by combining the effects of epinephrine plus glucagon or galactose and fructose infusions.
MethodsSixty-one normal, newborn, full-term infants were studied after uncomplicated vaginal deliveries. Seventeen infants were born at the Cleveland Metropolitan General Hospital, the remaining forty-four at the University of Illinois, Research and Education Hospitals.All infants were fasted for 12 hours and given glucose water for 12 hours and then dilute formula, 15 cal per 30 ml, for 24 to 72 hours-routine newborn care. Infants less than 6 hours of age were fasted from the time of delivery. Infants between 6 and 24 hours of age were fasted variable times from a minimum of 3 hours after a glucose feeding to a maximum of 12 hours after delivery. Infants older than 24 hours were fasted 3 to 4 hours before study. All infants tolerated the procedures well, showing no marked alterations in temperature, nor any circulatory, respiratory, or neurological abnormalities. The responses to fructose in these infants were measured after a rapid injection of 25%o fructose (1 g per kg body weight) given within a 2-to 4-minute period into a peripheral vein. Blood samples were obtained from punctures of the skin of the unwarmed heel. After 0.2-ml control samples were obtained before any injection, further samples were taken at 5,10,20, 30, 45, 60, 75, 90, and 120 minutes after injection. To prevent glycolysis the capillary blood samples were either precipitated immediately with barium hydroxide and zinc sulfate or transferred to sodium fluoride solutions (0.6 mg per tube). Separate 0.1-ml samples were precipitated directly with trichloroacetic acid for the lactic acid determinations.The infants were grouped according to age and test, as indicated in Table I. Group I infants received fructose only. Group II infants were given 3...