Intravenous glucose suppresses glucose production but not proteolysis in extremely premature newborns.

To ascertain whether the inability to suppress glucose production and increase glucose utilization in response to glucose infusion is an inherent characteristic of immature individuals, we determined glucose rate of appearance (R(a)) in minimally stressed, clinically stable, extremely premature infants (approximately 26-wk gestation) at two glucose infusion rates (6.2 +/- 0.4 and 9.5 +/- 0.5 mg/kg per min). We also assessed whether an increase in glucose delivery suppresses proteolysis by measuring the R(a) of phenylalanine and leucine. Glucose R(a) (and utilization) increased significantly at the higher glucose infusion rate (7.9 +/- 0.5 vs. 9.8 +/- 0.6 mg/kg per min). Glucose production persisted at the lower glucose infusion rate but was suppressed to nearly zero at the higher rate (1.7 +/- 0.5 vs. 0.3 +/- 0.1 mg/kg per min). Proteolysis was unaffected by the higher glucose infusion rate as reflected by no change in the rates of appearance of either phenylalanine (96 +/- 5 vs. 95 +/- 3 mumol/kg per h) or leucine (285 +/- 20 vs. 283 +/- 14 mumol/kg per h). Thus, clinically stable, extremely premature infants suppress glucose production and increase glucose utilization in response to increased glucose infusion, demonstrating no inherent immaturity of these processes. In contrast, increasing the rate of glucose delivery results in no change in whole body proteolysis in these infants. The regulation of proteolysis in this population remains to be defined.

Sepsis in asymptomatic term newborns delivered of antibiotic-treated mothers.

This study was undertaken to assess the incidence of culture-proved sepsis in term infants without symptoms born to mothers receiving intrapartum antibiotics and to determine the usefulness of the immature neutrophil: total neutrophil (I:T) ratio in the initial evaluation of these infants. A retrospective chart review was made of 103 infants born during a 3-year period. There was one positive blood culture and two positive cerebrospinal fluid cultures in three different patients; all three isolates were considered contaminants and all patients remained without symptoms. In spite of the lack of culture-proved sepsis and clinical illness, more than 50% of the initial I:T ratios were greater than the usually accepted upper limit of normal (that is, 0.16). We conclude that the incidence of sepsis in this population is very low and the initial I:T ratio is not useful as a predictive tool in term newborns without symptoms.