Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk.

The present study was designed to determine the effects of milk composition and the influence of gastro-oesophageal reflux (GOR) on gastric emptying. Cineoesogastrocintigraphy (COGS) was performed in 201 infants between 0-1 year of age in order to detect GOR, and provided a means of estimation of the gastric emptying (GE). Ninety infants appeared free from GOR and constituted the control group; 111 had GOR. There infants were fed human milk or various standard formulae. In addition, 20 infants fed a whey-hydrolysate formula were tested. An appropriate volume of milk was marked with sulfur-colloid Tc (200 microcuries). Measurements of gastric radioactivity were made 30 min and 120 min after ingestion. For the whole population, the infants with GOR had slightly more rapid GE after 30 min (P less than 0.05), but, for the same type of milk, there was no significant difference between GOR and controls. GE did not differ with age or sex, but differed mainly according to the type of milk. In the control group, gastric residual content (GRC) at 120 min was 18 +/- 11 per cent with human milk (n = 7), 16 +/- 21 per cent with whey-hydrolysate formula (n = 8), 25 +/- 17 per cent with acidified formula (n = 13), 26 +/- 19 per cent with whey-predominant formula (n = 22), 39 +/- 17 per cent with casein-predominant formulae (n = 20), 47 +/- 19 per cent with follow-up formulae (n = 16) and 55 +/- 19 per cent with cow's milk (n = 12).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of preterm infant formula supplementation with alpha-linolenic acid with a linoleate/alpha-linolenate ratio of 6: a multicentric study.

OBJECTIVE: To investigate the effects of a milk formula supplemented with a alpha-linolenic acid (ALA) (18:2 n-6/18:3 n-3 ratio near 6/1) on plasma and red blood cell (RBC) fatty acids (FAs) in premature infants and compare with a non supplemented formula (18:2 n-6/18:3 n-3 = 22/1). DESIGN AND SUBJECTS: Infants of mothers who elected not to breast-feed were randomly assigned to either a high alpha linolenic formula (HLF: n = 31) group or a low alpha-linolenic formula (LLF: n = 32) control group. Infants fed human milk (HM: n = 25) were enrolled concurrently as a reference group. Anthropometric and biological measurements were made after two days (D2) and 15 d (D15) of enteral feeding and at the 37th week (W37) of postconceptual age. In HLF, the 18:3 n-3 content was 1.95% of total FAs (0.77% of total energy) and the 18:2 n-6/18:3 n-3 ratio was near 6/1. In LLF, the 18:3 n-3 content was 0.55% of total FAs (0.22% of total energy) and the 18:2 n-6/18:3 n-3 ratio was 22/1. RESULTS: ALA supplementation had minimal effect on the n-6 series, did not alter the anthropometric data and confirmed the conversion of ALA into docosahexaenoic acid (DHA). Throughout the study, it maintained, the RBC membrane DHA values within the confidence interval of those obtained in the HM group. Such was not the case with LLF CONCLUSION: alpha-linolenic acid supplementation (from Rapeseed oil and in a 18:2 n-6/18:3 n-3 ratio = 6) in premature infant formula can contribute efficiently to the maintenance of the n-3 status in the premature newborns.

Relative contribution of physical activity to neonatal oxygen consumption.

To explore the relevance of distinguishing between resting and global energy expenditure in newborn infants, oxygen consumption (VO2) was measured during extremes of physical activity in 17 parenterally fed newborn infants with a large range of body weights (1.0-3.4 kg) and gestational ages (28-41 weeks). Under constant nutrient intakes, each infant served as his/her own control when comparing VO2 during resting conditions and spontaneous intense physical activity, called exercise. VO2 was significantly correlated with body weight at rest (r = 0.96). But during intense activity, the better predictor of exercise-induced VO2 was body weight in the smaller infants (< 2.0 kg) and gestational age in the larger infants (> 35 weeks). The difference in VO2 between both levels of activity represented the oxygen cost of exercise, which decreased (P < 0.01) with body weight. For clinical purposes, the physical activity of low-birth-weight infants does not contribute substantially to their energy balance.

Trans fatty acids in adipose tissue of French women in relation to their dietary sources.

This study reports the fatty acid composition of subcutaneous adipose tissue in French women with special emphasis on the content of trans fatty acids originating from two main dietary sources, ruminant fats and partially hydrogenated vegetable oils (PHVO). Adipose tissue trans fatty acid levels from 71 women, recruited between 1997 and 1998, were determined using a combination of capillary gas chromatography and silver nitrate thin-layer chromatography. Results indicate that on average cis monounsaturates accounted for 47.9% of total fatty acids, saturates for 32.2%, and linoleic acid for 14.4%. Cis n-3 polyunsaturates represented only 0.7%. Total content of trans fatty acids was 2.32 +/- 0.50%, consisting of trans 18:1 (1.97 +/- 0.49%), trans 18:2 (0.28 +/- 0.08%), and trans 16:1 (0.06 +/- 0.03%). Trans 18:3 isomers were not detectable. The level of trans fatty acids found in adipose tissue of French women was lower than those reported for Canada, the United States, and Northern European countries but higher than that determined in Spain. Therefore, trans fatty acid consumption in France appears to be intermediate between that of the United States or North Europe and that of Spain. Based on the equation of Enig et al., we estimated the mean daily trans 18:1 acid intake of French women at 1.9 g per person. The major trans 18:1 isomer in adipose tissue was delta11 trans, as in ruminant fats. Estimates of relative contribution of trans fatty acid intake were 55% from ruminant fats and 45% from PHVO. This pattern contrasts sharply with those established for Canada and the United States where PHVO is reported to be the major dietary source of trans fatty acids.

Respiratory gas exchange in response to fat-free parenteral nutrition: a comparison after thoracic or abdominal surgery in newborn infants.

Thoracic surgery is known to cause a postoperative respiratory failure because of the mechanical problems following chest wall disruption and/or diaphragmatic dysfunction. This study was to verify whether the fat-free intravenous nutritional support of neonates who underwent thoracic surgery could lead to a CO2 production exceeding the patients' respiratory reserves. Respiratory gas exchange and alveolar ventilation were obtained by indirect calorimetry and continuous recordings of transcutaneous PO2 and PCO2. These noninvasive measurements were compared at the same age of 7 +/- 1 days between a group of 7 newborn infants (mean +/- SEM: 3.09 +/- 0.14 kg, 39 +/- 1 weeks) after thoracic surgery versus a group of 8 newborn infants (2.88 +/- 0.17 kg, 37 +/- 1 weeks) after abdominal surgery. The intravenous macronutrient support was the same between both groups: 14 g/kg/d of glucose, 2 g/kg/d of amino acids, 250 kJ/kg/d of energy. One week after surgery, the global metabolic rate (195 kJ/kg/d) was not increased, and comparable between both groups. We documented that early after thoracic surgery, the ventilatory compensation required to handle the CO2 production (6.7 +/- 0.2 mL/kg/min) associated with a positive energy balance (45 +/- 8 kJ/kg/d) was effective.

Townes-Brocks syndrome in an infant with translocation t (5;16).

We report the occurrence of Townes-Brocks syndrome (TBS) in an infant with a two break reciprocal translocation between chromosome 5 and chromosome 16. The occurrence of both abnormalities in the same subject could be due to chance. However, it is of interest to note that a familial case of TBS associated with an inv(16) with the same breakpoint at 16q12.1 has been reported. We suggest the possible disruption of the TBS gene at this breakpoint.

[Neonatal lupus erythematosus and neurologic involvement: an incidental association?]. / Lupus néonatal et atteinte neurologique: une association fortuite?

UNLABELLED: Neonatal lupus erythematosus is a rare disorder characterized by cutaneous lesions of the face and/or congenital heart block. The transplacental transfer of maternal anti-Ro/SSA, anti-La/SSB, or anti-U1RNP antibodies is responsible for the development of the disease. Few cases of neonatal lupus erythematosus with neurological involvement were reported in the medical literature. CASE REPORT: A 36-week GA female infant presented with neonatal lupus erythematosus comprising cutaneous, hematologic and hepatic disorders with a favorable outcome. However, cutaneous atrophy and hyperpigmentation persisted. Spastic paraparesis was diagnosed at the age of six months. CONCLUSION: The neurological lesions in neonatal lupus erythematosus could either be related to the presence of anti-Ro/SSA antibodies of maternal origin, or of anticardiolipin antibodies.

[Prenatal diagnosis of a hydrothorax secondary to an extralobar pulmonary sequestration]. / Diagnostic prénatal d'un hydrothorax secondaire à une séquestration pulmonaire extralobaire.

A case of antenatal hydrothorax was observed. The aetiology could not be determined before birth. At birth an extra-lobe lung sequestation was treated surgically after 3 weeks in the intensive care unit. The surgical cure was successful with no sequellae. This favourable outcome is unusual in this type of pathology and can be explained by the fact that the sequestration was isolated in a fetus with only minimal anasarca. Indications for prenatal pleural drainage are discussed.

[Maternal transport to the Bordeaux University Hospital: a retrospective study of 263 cases (1996-1998)]. / Le transfert des enfants in utero au Centre Hospitalier Universitaire de Bordeaux : analyse rétrospective de 263 cas (1996-1998).

OBJECTIVES: To describe a population of high risk pregnancies transported to a regional perinatal care centre (level III) and to analyze the advantages and limitations of the organization of this perinatal care network. METHODS: Retrospective study of 263 patients transported to the University Hospital of Bordeaux between September 1996 and September 1998. RESULTS: Maternal transport mainly came from the Gironde department (53%) and from level I care hospitals (66%). The rate of multiple pregnancies was 17%. Principal indications were preterm labor with or without rupture of fetal membranes (52%) and preeclampsia with or without intrauterine growth restriction (28%). The rate of returns to the referring care centre was 2%. The mean term at delivery was 32 WA. Forty-one percent of patients delivered within 24 hours of transport. The rate of caesarean sections was 55%. There were 303 live births. The mean duration of hospitalization of the neonates was 28 days. The rate of perinatal mortality was 6.2%. Among the 96 pregnancies beyond 32 WA, 17 (6.5%) could have been transported to some level IIb care hospitals, nearby the patient's residence, without changing maternal and neonatal prognosis. Neonatal mortality was not significantly different for maternel transport (18%) or neonatal transport (14%) in the group of premature infants born prior to 31 WA in our study. CONCLUSION: Our organization is currently trying to improve transport management (non-emergency situations, collaboration of level II care hospitals) and to increase the rate of returns to the referring care centres.

[Biological effects on premature neonates of a milk formula enriched with alpha-linolenic acid: a multicenter study]. / Effets biologiques, chez le prématuré, d'une supplémentation des formules lactées en acide alpha-linolénique: une étude multicentrique.

Nervous tissues and the retina are rich in docosahexaenoic acid [DHA, C22: 6(n-3)], an essential fatty acid which is the product of the elongation and desaturation of alpha-linolenic acid [alpha-LnA, C18:3(n-3)]. Lower plasma and membrane DHA levels as well as impaired nervous function (psychomotor development, visual disturbances) have been observed in premature babies receiving standard milk products compared to breast-fed babies and have been related to the lack of long-chain (> C20) fatty acids in these products. In the present study, we have investigated whether it is possible to increase the plasma and erythrocyte DHA level in premature infants by giving them a milk formula enriched in alpha-LnA (1.95% vs 0.55%). Results showed that, after 15 days of feeding, alpha-LnA supplementation significantly increased plasma DHA availability [2.20 vs 1.54% (p < 0.0001) in the plasma phospholipids] and increased DHA level in erythrocyte membranes [3.02 vs 2.54% (n.s.) in the red blood cell phosphatidylethanolamines]. At the LA/alpha-LnA ratio used (6/1), there was only a limited impact on the n-6 pathway which was reflected in a slight decrease in the arachidonic acid (AA) of the plasma phospholipids [6.88 vs 7.53% (p < 0.05) after 15 days]. Furthermore, the AA content of the red blood cell phosphatidylethanolamines was perfectly preserved even after a mean period of 4-5 weeks of feeding [(15.70 vs 14.86% (n.s)]. The observed enhancement in fatty acids of the n-3 series calls for a prospective study investigating whether these improvements are associated with changes in the kinetics of psychomotor development and in the visual function of enriched-formula-fed versus breast-fed babies.

Energy expenditure and severity of respiratory disease in very low birth weight infants receiving long-term ventilatory support.

We attempted to determine whether the hypermetabolism of infants with bronchopulmonary dysplasia was detectable during assisted ventilation. Respiratory gas exchange variables were measured with a metabolic gas monitor in 10 infants under similar nutritional conditions. Oxygen consumption increased linearly with the need for ventilatory support (R2 = 0.75), as documented by the ventilatory index.

Osmolality of the gastric and duodenal contents in low birth weight infants fed human milk or various formulae.

The osmolality of gastric and duodenal contents were determined simultaneously during 30 test-meals at 0, 45, 90, 135 and 180 min after feeding in 15 low birth weight infants, birthweight: 2075 +/- 330 g. gestational age: 35.4 +/- 1.8 weeks and postnatal age: 8 +/- 4 days. These infants were fed human milk or various formulae whose osmolalities ranged from 227 to 622 mosmol/kg. With human milk and isotonic formula, the osmolality in the stomach and duodenum remained close to 295 mosmol/kg throughout the test. With hypotonic formula (227), the osmolality in the stomach and duodenum rose during the first 45 min to a plateau of about 266 and 285 mosmol/kg, respectively. With the two most hypertonic diets (about 600) (10 g/dl glucose solution and an elemental formula), the osmolality in the stomach and duodenum remained high throughout the test, 470 +/- 73 mosmol/kg at 45 min and 345 +/- 55 mosmol/kg at 180 min. There was a significant positive linear correlation between the osmolality of the diet and the osmolality in the stomach and duodenum at each time of sampling but the slope of the regression lines decreased progressively during the 3 hours after feeding. On the pooled data, there was also a significant positive linear relationship between duodenal and gastric osmolalities. This study suggests that hyperosmolar feedings might be dangerous for the preterm infants and should be avoided if possible.

High-dose thiopental pharmacokinetics in brain-injured children and neonates.

High-dose thiopental was administered in 8 children with uncontrollable seizures or hypoxic encephalopathy (group A) and 7 full-term neonates with neonatal asphyxia (group B). All of them were submitted to artificial hyperventilation to maintain pCO2 near 3.5 kPa. Rectal temperature was kept at about 35 degrees C. Thiopental was infused with a rate of 2-4 mg X h-1 X kg-1, with treatment lasting 32-192 h for group A (mean 103 h), and 36-48 h for group B (mean 38.5 h). Plasma concentration-time data were analysed pharmacokinetically. Thiopental elimination half-life was 14.5 h (group A) and 20.9 h (group B). The clearance of thiopental was 0.27 liters X h-1 X kg-1 (group A) and 0.32 liters X h-1 X kg-1 (group B). The volume of distribution at steady-state was 5.41 liters X kg-1 (group A) and 8.26 liters X kg-1 (group B). These results show that high-dose thiopental pharmacokinetics is not very different for full-term newborns, children and adults. Elimination half-life and volume of distribution are changed when compared to single-dose studies, while clearance is only slightly modified. The time for disappearance of thiopental from blood is also very long (2 to 5 days). These pharmacokinetic characteristics would be worthy of consideration in cases where there may be prolonged use of thiopental, considering the risk of accumulation and toxicity.

De novo inv del(4) in an infant with the Wolf-Hirschhorn syndrome.

An infant was found to have a de novo complex rearrangement of one chromosome 4. Her karyotype was interpreted as 46,XX,inv del(4)(pter::p16.3::q31.2----p15.2::q31.2----qter). Clinically she showed the features of the Wolf-Hirschhorn syndrome.

[Maternal-fetal transmission of genital mycoplasma infection]. / Infection materno-foetale à mycoplasmes génitaux.

The authors report on a case of a preterm infant who suffered from pneumonia due to genital mycoplasma infection. Hepatic dysfunction was associated. Tetracyclines were successful.

[Ovarian cyst in newborn infants: what attitude should we adopt? (apropos of 8 cases)]. / Le kyste de l'ovaire du nouveau-né: quelle attitude adopter? (a propos de 8 observations).

With the advent of routine fetal ultrasonography, the frequency of prenatal diagnosis of ovarian cysts has considerably increased. Based upon a personal experience of 8 cases and a review of published series, the authors discuss the management of perinatal ovarian cysts. Before birth punction of the cyst under sonographic guidance or cesarean delivery may be considered in order to avoid the rupture during normal delivery. After birth, surgery should be performed in case or voluminous or complicated cyst or uncertain diagnosis. Homogenuos medium sized cysts or cysts with functional cytology should be followed by echography, before surgery being considered.