Lipid intolerance in newborns is associated with hepatic dysfunction but not infection.

OBJECTIVE: To examine the hypothesis that fat intolerance in newborns who receive intravenous lipid is related to both infection and liver dysfunction. DESIGN: Prospective survey. SETTING: Tertiary intensive care nursery. PATIENTS: All newborns who were admitted to the neonatal intensive care unit during a 20-month period and received parenteral lipid for 2 or more weeks were eligible for the study. Of 279 newborns who received parenteral nutrition, 162 met eligibility criteria and form the basis of this report. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Fat intolerance as defined by a serum triglyceride level of 1.69 mmol/L or greater (> or = 150 mg/dL). RESULTS: Triglyceride levels were similar in infected and noninfected patients. Newborns with hypertriglyceridemia were more likely to have liver dysfunction (P < .001) or growth retardation (P < .01), but not infections. Hypertriglyceridemia was approximately twice as likely (P < .05) in newborns with either growth retardation or liver dysfunction. CONCLUSIONS: Liver dysfunction and fetal growth retardation were associated with lipid intolerance in newborns who received intravenous fat. Infection does not appear to be independently associated with hypertriglyceridemia. In the absence of liver dysfunction or growth retardation, there is no a priori reason to limit intravenous lipid use in the presence of infection. Close monitoring of triglyceride levels with adjustments in lipid dose is warranted, especially in small, sick newborns who are at highest risk for hypertriglyceridemia.

Enteral feeding in very-low-birth-weight infants. A comparison of two nasogastric methods.

Nutritional benefits and feeding-related complications were prospectively compared in 53 preterm very-low-birth-weight infants receiving isoenergetic feeding by either the continuous nasogastric (n = 30) or intermittent nasogastric (n = 23) route. Stepwise regression techniques were used to develop models relating feeding-associated factors. Feeding method significantly affected weight gain in infants 1000 to 1249 g birth weight with continuous nasogastric feeding associated with an additional weight gain of 3.6 to 6.1 g/kg/d. No effects of feeding method on changes in occipitofrontal circumference, triceps skin-fold thickness, bilirubin values, or total protein values were demonstrable. There were few major differences between feeding groups on measures of feeding complications. Continuous nasogastric feeding was fairly well tolerated and resulted in improved weight gain when compared with intermittent nasogastric feeding in preterm infants 1000 to 1249 g birth weight.

Clinical and roentgenographic scoring systems for assessing bronchopulmonary dysplasia.

Because investigation of bronchopulmonary dysplasia (BPD) has been hampered by imprecise methods for diagnosis and grading of severity, we evaluated new clinical and roentgenographic scoring systems in neonates with severe respiratory distress. The study population included 110 premature neonates who were admitted consecutively over a two-year period and who required mechanical ventilation. The clinical scoring system used measures of gas exchange, respiratory distress, and growth rate; roentgenographic scoring involved numerical assessment of features characteristic of BPD. A significant correlation was noted at 21 days of age between clinical and roentgenographic scores. In a linear stepwise multiple regression, we found that the best predictors of clinical score were birth weight (ie, degree of prematurity) and roentgenographic score. With further development and validation, BPD scoring should be helpful by improving our understanding of the epidemiology of this disease, providing a means for evaluation of treatment, and facilitating multicenter investigations.

Symmetric bithalamic and striatal hemorrhage following perinatal hypoxia in a term infant.

A full-term infant who demonstrated a prolonged period of obtundation following asphyxia at birth was found on cranial computed tomography (CT) to have hemorrhage limited exclusively to symmetric bithalamic and striatal areas. This pattern of discrete, symmetric nuclear hemorrhage has not so far been reported as a complication of birth asphyxia. It differs from the germinal matrix hemorrhage on one hand in having a later time of onset (between the 4th and 10th day of life). It is also distinct from the more common supratentorial parenchymal hemorrhages in full-term infants owing to its topography, consequent interruption of the thalamocortical arousal mechanisms, and prolonged period of obtundation.