Information summarized from early feeding practices of VLBW infants (1,500 gm. or less at birth) identified three prevalent practices which potentially could result in compromised nutrition for these babies: (1) Cereals were introduced at an early age. Feeding cereals before infants are developmentally ready may decrease formula intake or result in a forced feeding situation. (b) Two percent and skim milk were fed to approximately 50% of these infants within their first year of life. Feeding calorically dilute milk may reduce energy intake, as well as compromise the intake of essential fatty acids. (c) Whole cow's milk was introduced to some VLBW infants at an early age. The feeding of cow's milk to young infants without appropriate supplementation may predispose these infants to significant nutritional deficiencies and imbalances. Any one of these feeding practices could affect an infant's nutrient intake. If all three are encountered in the same baby, growth may be adversely affected. Whether increased attention to appropriate feeding practices during the first year of life would result in a more favorable growth outcome for VLBW infants is not known.

Growth patterns of weight, length, and OFC complete through 12 months corrected age were determined for 122 VLBW infants who weighed 1,500 gm. or less and were 35 weeks or less gestational age at birth. Significant differences in growth were apparent when infants were grouped according to sex and appropriateness of intrauterine growth. When the mean values of each group were compared, the female AGA infants demonstrated growth at higher percentiles (NCHS term infant norms) for all three growth parameters (weight, length, and OFC). AGA male, SGA male, and SGA female infants all grew similarly, at lower percentiles for weight and length, when compared with the same norms. Growth in OFC was closest to term infant norms in all subgroups of infants. (formula; see text) Appropriateness of weight for length was determined for each of the infants at one year corrected age. The majority of the babies, regardless of subgroup, achieved weights and lengths greater than the 5th percentile and with normal weights for lengths. At 12 months corrected age, 30% remained below the 5th percentile in weight, 21% below the 5th percentile in length, and 14% below the 5th percentile in OFC. Eighteen infants (15%) demonstrated a disproportionately low weight for length (less than the 5th percentile).

Summary: Aspiration of uncontaminated human amniotic fluid was investigated in adult and newborn rabbits and compared with three other experimental groups: 10% meconium solution, saline, and sham-injected controls. Fluids were injected into the trachea of adult animals (4 or 6 ml/kg body weight), newborn vaginally-delivered animals (a mean volume of 8 ml/kg), and cesarean-delivered animals before their first breath (a mean volume of 11 ml/kg). In adult animals aspirating amniotic fluid or saline, arterial Po2 measured over a 24-h period showed a mean difference between groups of <5% for both 4 and 6 ml/kg. Meconium aspiration produced a greater depression in Po2 than amniotic fluid aspiration (a mean difference of 16 and 31% for 4 and 6 ml/kg, respectively) and animals aspirating meconium showed a deteriorating trend over 24 h, whereas animals aspirating amniotic fluid improved. One of eight adult animals aspirating amniotic fluid died versus four of five aspirating meconium. AH five animals aspirating saline 6 ml/kg survived. Lung weight and resting volume of adult animals aspirating amniotic fluid were not significantly different from animals aspirating saline or nothing. Lung pressure volume curves from adult animals aspirating amniotic fluid were nearly identical to controls. Histology showed significantly greater atelectasis in adult animals that received 6 ml/kg amniotic fluid than controls, but this was not different from saline. There was no association between the number of cells in amniotic fluid and arterial Po2 after aspiration or any other aspect of pulmonary function measured. Newborn rabbits aspirating human amniotic fluid were not significantly different from those aspirating saline and non-aspirating controls with respect to mortality, respiratory rates, lung weights, static deflation curves, chest radiographs, or lung histology. This was in marked contrast to the effects of aspiration of an equal volume of 10% meconium solution, which produced a mortality of 100%. We conclude that aspiration of human amniotic fluid is unlikely to be associated with specific lung disease.

The purpose of this study was to determine the effects of varying infusion rates as well as different catheter sizes and types on the mean arterial pressure as measured by a system in which the pressure transducer is connected in series to the line of fluids being administered through the catheter. The results of this study show that, under most circumstances, errors in mean blood pressure measured by this system are minimal and clinically insignificant.

Growth and feeding outcomes during the first weeks of life were prospectively evaluated in 207 critically ill, very low-birth-weight (VLBW) infants (birth weight less than 1,500 gm). Maximal weight loss occurrd by day 9, averaging 13 percent of birth weight, while birth weight was regained by day 18. Energy intake during initial weight gain (19 gm. per day) averaged 100 kcal per kilogram. Feeding and growth outcome were highly correlated (p of less than 0.001) with severity of illness but were not significantly related to sex, birth weight, or appropriateness of weight for gestational age.

The purpose of this study was to investigate the metabolic adaptations of the fetus during maternal starvation and to determine the changes of plasma insulin and glucagon concentrations in the fed state and during severe maternal fasting in the chronic fetal sheep preparation. Maternal fasting resulted in a decrease in maternal and fetal plasma glucose as well as a decrease in fetal plasma fructose. Fetal-maternal arterial urea concentration differences increased with maternal fasting, suggesting increased fetal amino acid catabolism. Both maternal anf fetal plasma insulin decreased parallel to the decrease in plasma glucose concentration. Maternal glucagon did not change significantly during fasting and with a short-term fast there was no change in fetal glucagon concentration. However, by 6 days of fasting, the fetal glucagon concentration tended to increase.

The purpose of this study was to investigate the effect of nonsurgical stress on plasma glucose, insulin and glucagon in the ewe and fetus. Plasma glucose, insulin and glucagon were measured before and after a 2 min period of verbal and physical startling of much greater magnitude than that to which we ewe is exposed during routine blood drawing. Studies were completed on 5 fed ewes, 5 fasted ewes and on 4 fetuses of fasted ewes. There were no significant differences after a startling compared to the control values. Thus, there appears no need to allow the ewe a prolonged period (more than 1-2 weeks) to become accustomed to handling by humans before chronic metabolic studies involving serum glucose, insulin and glucagon are undertaken.

Aspiration of uncontaminated AF is considered by some to be one cause of neonatal respiratory distress due to alveolar plugging by its cellular content. We examined the degree of respiratory compromise that occurred in adult rabbits after being administered human AF of varying cell counts. Experimental groups received either 4 or 6 cc/kg of human AF (n=15), saline (n=9), a 10% meconium solution (n=10), or nothing (n=6). Saline was used to provide a control fluid without solid elements while meconium was included to ensure that the experimental model could produce a well-characterized aspiration syndrome. There was one death in the AF group, O in the saline group and 5/10 meconium animals died. The epithelial cell count of the AF samples (n=15, mean= 717 cells/ml3, range=15-2370) was slightly higher than previously reported values (Ob Gyn 49:280). There was no correlatio between the cell count of the AF aspirated and the PO2 at 10, 30, 60 and 90 min and 2, 6 and 24 hrs, nor with lung weight or residual volume. Pressure-volume curves of AF animals were nearly identical with those of controls. Histological finding were similar in the AF and control groups with regard to leukocytes, alveolar macrophages and atelectasis. These findings indicate no correlation between AF cell count and the degree of respiratory compromise and lung pathology in adult rabbits.

The Committee on Nutrition of the American Academy of Pediatrics has recently advocated breast-feeding for the normal, full-term newborn, unless contraindicated for specific reasons (including a desire by the mother not to breast-feed) or when breast-feeding is unsuccessful.1 This recommendation reflects the renewed interest throughout the world in providing human milk to the healthy infant. Further, expressed breast milk (either from the infant's mother or from donors) is being fed with increased frequency to the preterm or sick infant.2,3 The adequacy of human milk to meet the nutritional needs of all preterm babies has not been documented, however, as recently reviewed by Fleischman and Finberg.4

The records of 909 infants who required mechanical ventilation over a 42-month period were reviewed; 68.3% of the infants survived. The highest survival rate was in infants with persistent fetal circulation and hyaline membrane disease, and the lowest in infants with congenital anomalies and miscellaneous diseases. The survival rate for each year of the 3 1/2-year study increased from the previous year. There was also a dramatic increase in the survival rate in infants with a birth weight greater than 1,250 gm.

There were 47 seriously-ill neonates with medical causes of respiratory distress and 10 infants with severe respiratory distress secondary to a congenital diaphragmatic hernia treated with tolazoline according to a strict protocol designed to manage persistent fetal circulation (PFC). Of the 47 infants, 28 (60%) had a positive response defined as an increase in the pO2 greater than or equal to 24 mm Hg within 4 hr of beginning the drug. Of 7 infants, 4 with congenital diaphragmatic hernia had a positive response. The mean increase in the pO2 for the 47 infants was statistically significant (p less than .05). Of the 47 infants with medical disorders, 27 survived (survival 57%), whereas only 2 of the 10 infants with congenital diaphragmatic hernia and severe persistent fetal circulation survived (survival 28%). Erythema (60%), hematest positive gastric aspirates (55%), thrombocytopenia (45%), hyponatremia (40%) and increased gastric aspirates (36%) were the most common adverse effects occurring during tolazoline infusion. Hypotension occurred in nine cases, but was transient. Of the 27 survivors, 20 with medical causes of persistent fetal circulation were evaluated at age 1 yr. Eighty percent of these infants studied were considered normal as defined by an MDI and PI of the Bayley Scales of greater than or equal to 70. These data suggest that tolazoline is a useful adjunct in the management of neonates with PFC. In addition, tolazoline was more effective in mechanically ventilated neonates treated with respiratory paralytic agents. Although tolazoline resulted in a significant improvement in the paO2 in 4 infants with congenital diaphragmatic hernia, it did not appear to improve mortality in these infants.

The clinical course and chest radiographs of 47 infants with respiratory distress after elective cesarean section were reviewed. The mean difference between the gestational age determined prenatally and that postnatally was 2.6 ± 1.6 weeks. However, 14 of the infants were delivered at term. All 47 infants required more than 40% oxygen, and 18 infants required a respirator. Fifteen infants developed a pneumothorax; one, a pneumopericardium, one, bronchopulmonary dysplasia; and one infant died. Chest radiographs and the clinical course were consistent with hyaline membrane disease in 17 patients; respiratory distress syndrome type II in 24; and in three the radiographic findings were normal. These data suggest that some of the respiratory morbidity subsequent to elective repeat cesarean section is not secondary to latrogenic delivery of a premature infant, and that much of it is not due to hyaline membrane disease. These data emphasize that respiratory distress in an infant delivered by elective cesarean section does not necessarily suggest poor prenatal care in regard to the timing of delivery.

To determine the immediate effects of the "acute" experimental preparation, 11 near-term pregnant rabbits and 20 fetuses were studied. Blood samples were obtained from the maternal auricular artery, the fetal umbilical vein, and the fetal heart within 90 s of exposure of the uterus by laparotomy. Samples were assayed for pH, O2 and CO2 tension, O2 content, blood urea nitrogen, and plasma glucose. Results indicated that a pronounced fetal acidosis (primarily respiratory) had developed by the time samples were obtained. Further, fetal cardiac glucose levels were significantly elevated above umbilical vein concentrations in 7 of the 20 fetuses. In addition, maternal arterial O2 tension under light pentobarbital anesthesia was significantly less than that found in 35 unanesthetized does (52 vs. 79 Torr, P less than 0.01). All parameters measured varied over a wide range between animals. The results raise serious questions concerning the feasibility of performing and interpreting certain metabolic or cardiorespiratory studies in the acute small animal preparation.

Metrizamide (amipaque) has not been used previously as a diagnostic contrast agent in the gastrointestinal tract. Metrizamide is a water-soluble isotonic contrast material having many advantages over barium and existing hypertonic water-soluble agents. There are many clinical situations in children in which metrizamide should be the contrast agent of choice for investigating the gastrointestinal tract. Four neonates are presented in whom barium or gastrografin were absolutely contraindicated. In each case metrizamide gave excellent visualization of the gastrointestinal tract. It could be followed through be bowel giving excellent visualisation even up to 120 h after ingestion. No harmful effects were noted in the four cases studied.