Umbilical cord clamping and preterm infants: a randomised trial.

OBJECTIVE: To investigate the clinical effects of regulating umbilical cord clamping in preterm infants. DESIGN: A prospective randomised study. SETTING: The Queen Mother's Hospital, Glasgow. SUBJECTS: 36 vaginally delivered infants over 27 and under 33 weeks' gestation. INTERVENTION: Holding the infant 20 cm below the introitus for 30 seconds before clamping the umbilical cord ("regulated" group, 17 patients), or conventional management ("random" group, 19 patients). MAIN OUTCOME MEASURES: Initial packed cell volume, peak serum bilirubin concentrations, red cell transfusion requirements, and respiratory impairment (assessed by ventilatory requirements, arterial-alveolar oxygen tension ratio over the first day in ventilated infants, and duration of dependence on supplemental oxygen). RESULTS: There were statistically significant differences between the two groups in mean initial packed cell volume (regulated group 0.564, random group 0.509) and median red cell transfusion requirements (regulated group zero, random group 23 ml/kg). 13 infants from each group underwent mechanical ventilation and showed significant differences in mean minimum arterial-alveolar oxygen tension ratio on the first day (regulated group 0.42, random group 0.22) and in median duration of dependence on supplemental oxygen (regulated group three days, random group 10 days). Differences in final outcome measures such as duration of supplemental oxygen dependence and red cell transfusion requirements were mediated primarily through arterial-alveolar oxygen tension ratio and also packed cell volume. CONCLUSIONS: This intervention at preterm deliveries produces clinical and economic benefits.

Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants.

Pregnant women receiving daily supplements of 400 IU (10 microgram) of vitamin D2 from the 12th week of pregnancy had plasma calcium concentrations higher at 24 weeks but similar at delivery to those in control pregnant women who did not receive the supplements. Infants of the women receiving the supplements had higher calcium, lower phosphorus, and similar magnesium concentrations on the sixth day of life and a lower incidence of hypocalcaemia than infants of the control women. Plasma concentrations of 25-hydroxycholecalciferol, which showed a seasonal variation, were higher in mothers and infants in the treated group. Cord-blood calcium, magnesium, phosphorus, and 25-hydroxycholecalciferol concentrations correlated with maternal values at delivery. Breast-fed infants had higher calcium and magnesium and lower phosphorus and 25-hydroxycholecalciferol concentrations than artificially fed infants. A defect of dental enamel was found in a high proportion of infants (many of whom had suffered from hypocalcaemia) born to the control women. These results suggest that vitamin D supplementation during pregnancy would be beneficial for mothers, whose intake from diet and skin synthesis is appreciably less than 500 IU of vitamin D daily.

Clinical and biochemical assessment of a modified evaporated milk for infant feeding.

A clinical and biochemical evaluation has been made of a new milk formula, Modified Carnation milk (MCM), based on cows' milk but with the mineral content and concentration of caloric nutrients altered to make it correspond more closely to human milk. MCM produced higher plasma calcium and magnesium concentrations in 6-day-old infants than those produced by unmodified evaporated and dried milks, achieving concentrations closer to those of breast milk. Plasma free amino acid concentrations in MCM-fed infants are nearer breast-fed values than those in unmodified milk-fed infants where higher individual plasma amino acid concentrations persist during the first 3 months. MCM-fed infants had low plasma urea concentrations and lower urine osmolalities at 6 days, 3 weeks, 6 weeks, 3 months, and 6 months than infants fed on the evaporated and dried milks, and similar plasma urea and urine osmolalities to those of breast-fed infants. MCM is likely to be superior to unmodified evaporated and dried milks in preventing convulsions of the hypocalcaemic/hypomagnesaemic/hyperphosphataemic type, and seems less likely to cause hypertonic dehydration. MCM is easily prepared, readily accepted by babies, and appears to be nutritionally adequate for the feeding of term infants.

Magnesium therapy in neonatal tetany.

104 infants with symptomatic hypocalcaemia were randomly allocated to treatment with calcium gluconate, phenobarbitone, or magnesium sulphate. Infants treated with magnesium sulphate had higher plasma-calcium concentrations after 48 hours' treatment and fewer convulsions during and after the treatment period. Magnesium sulphate is recommended as the treatment of choice in symptomatic neonatal tetany whether or not there is hypomagnesaemia.