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Effect of early feeding on premature newborn infants
Volume 69
Number 5
Abstracts
~Oart 2
University, Montreal, Quebec, Canada Introduced by Paul Taylor When citrated blood is used for exchange transfusion there is a decrease in Ca ++ due to the formation of a calcium citrate complex. This is usually compensated for by the routine administration of calcium during the procedure. Like Ca +*, Mg ++ is a divalent cation similarly bound to citrate. Serum Mg ++ was studied in a total of 33 exchange transfusions. Mean pre-exchange serum Mg ++ was 1.81 mEq. per l i t e r (range, 1.6 to 2.0). Mean average concentration of Mg ++ in the donor blood used (380 ml. of blood + 120 ml. of A C D mixture) was 0.5 mEq. per liter. Mean postexchange serum Mg ++ after the initial exchange was 1.07 mEq. per liter (range, 0.8 to 1.3) with a fall to an average of 60 per cent of the preexchange value in each case. Measured at 100 ml. increments, Mg ++ showed a progressive decline with increasing amounts of blood exchanged, and a subsequent rise toward normal in the next 7 to 10 days. With repeat exchanges at short intervals both pre- and postexchange levels decreased further to levels as low as 0.6 mEq. per liter. At levels less than 0.8 mEq. per liter, flattening of the T waves on the ECG occurred. In 10 further exchanges using heparinized blood (470 ml. of blood + 28.2 ml. of heparin), no effect on Mg ++ was seen. Mean donor blood Mg +~ was 1.45 mEq. per liter; mean pre- and postexchange levels were identical at 1.59 mEq. per liter. The in vitro addition of citrate to a 4 raM. per liter Mg ++ standard shov]e~t;~'a progressive fall in recoverable Mg ++ with increasing amounts of citrate. No such effect was seen with heparin, dextrose, or saline. It is proposed that the fall in Mg ++ during citrated exchange transfusion is the combined result of a dilution effect of the ACD mixture and the magnesium citrate complexing. Consideration should be given to these changes as a possible cause for the clinical problems occurring when citrated blood is used.
41. E~ects of early feeding on premature newborn infants P a u l Y. K . W u ~ a n d P e t e r A. T e i l m a n n , ~ Michael
Reese Hospital,
Chicago,
Ill.
Introduced b y J a c k M e t c o f f Controversy exists with regard to the optimal time for the premature newborn infant's first feed and the effects of "early" feeding on the infant. The present studies were directed to observations on the effects of early feeding (2 hours after birth) of "well" infants with modified cow's milk (SMA-S26) in the 1,250 to 2,000 gram birth weight group (Group A) and comparing them with a controlled group of late fed (24 hours after birth ) infants of similar birth weight (Group B)..Weight loss was 4.7 per cent of birth weight in Group A, as opposed to 7.4 per cent in Group B, and was regained on days 7.3 and 12.6, respectively. Mean Serum bilirubin levels were 8.5,
967
7.3, 7.0, 7.9 mg. per cent on the third, fourth, fifth, and sixth day of life in Group A, and 8.9, 10.6, 10.7, 10.3 rag. per cent respectively in Group B, with statistically significant difference on the fourth (p = 0.05) and fifth, (p = 0.02) days. Mean blood sugars were 77.5, 75.3, 82.5, 86.0 rag. per cent at 24, 48, 72, and 144 hours of life in Group A, and 54.6, 67.3, 74.3, and 75.0 mg. per cent correspondingly in Group B, with significant difference at 24 hours (p = 0.02). Glucagon plus epinephrine tolerance tests at 24 hours of life produced a prolonged and marked rise in the level of blood sugar in Group A and a significantly lower rise in blood sugar in Group B, indicating a greater availability of glycogen stores in the liver of the early fed infants.
42. Physiologic observations of the normal fetus in utero Michael A. Heymann ~ and Abraham M. Rudolph, Albert Einstein College of Medicine, New York, N. Y. Few physiologic observations have been made on the fetus in its normal intrauterine environment. Pregnant animals (11 goats and 9 sheep) with gestational ages of 65 to 135 days, were studied under spinal analgesia. Vinyl catheters were inserted into an umbilical artery (UA) and vein ( U V ) and advanced into major vessels. A forelimb and hindlimb were exposed through small uterine incisions, catheters placed in veins and arteries, the limbs replaced and the abdomen closed. Repeated maternal and fetal pressures, blood 02 saturation and capacity, pH, pO~, and pCOz were measured from various sites. Placental blood flow was measured in 13 animals by the Fick method, with constant infusion of 4-aminoantipyrine into a limb vein, sampling repeatedly from U A and UV. Fetal O= consumption was calculated from these data. Fetal heart rate averaged 193 per minute (range 165 to 230) and maternal 125 per minute (range 100 to 160). Average values and ranges for pressures were: maternaI arterial (MA) 121/82 (100 to 145/70 to 105) ram. Hg, mean 96 (80 to 120) mm. Hg; U A 63/42 (50 to 80/ 25 to 47) mm. Hg, mean 49 (29 to 63) ram. Hg; mean U V 16 (10 to 23) mm. Hg; mean upper limb venous 16 (15 to 18) mm. Hg; mean lower limb venous 13 (10 to 15) mm. Hg; right ventricle 55 to 58/12 to 13 mm. Hg. Average pH values were: U A 7.40, U V 7.43, and MA 7.51. O~ saturation in UA averaged 58.6 per cent, in U V 78.2 per cent, and in M A 92.2 per cent. Mean pO.~ values were: U A 15, U V 25, and MA 66 mm. Hg; pCO= levels were: U A 35, U V 28, and M A 24 mm. Hg. O5 capacities averaged 12.5 vol. per cent in both fetus and mother. Placental blood flow averaged: 179 (100 to 295) ml. per kilogram per minute and fetal oxygen consumption 4.5 (2.5 to 5.9) ml. per kilogram p~r minute. Similar results were obtained in some animals a day or two after surgery with the mother standing.
Number 5
Abstracts
~Oart 2
University, Montreal, Quebec, Canada Introduced by Paul Taylor When citrated blood is used for exchange transfusion there is a decrease in Ca ++ due to the formation of a calcium citrate complex. This is usually compensated for by the routine administration of calcium during the procedure. Like Ca +*, Mg ++ is a divalent cation similarly bound to citrate. Serum Mg ++ was studied in a total of 33 exchange transfusions. Mean pre-exchange serum Mg ++ was 1.81 mEq. per l i t e r (range, 1.6 to 2.0). Mean average concentration of Mg ++ in the donor blood used (380 ml. of blood + 120 ml. of A C D mixture) was 0.5 mEq. per liter. Mean postexchange serum Mg ++ after the initial exchange was 1.07 mEq. per liter (range, 0.8 to 1.3) with a fall to an average of 60 per cent of the preexchange value in each case. Measured at 100 ml. increments, Mg ++ showed a progressive decline with increasing amounts of blood exchanged, and a subsequent rise toward normal in the next 7 to 10 days. With repeat exchanges at short intervals both pre- and postexchange levels decreased further to levels as low as 0.6 mEq. per liter. At levels less than 0.8 mEq. per liter, flattening of the T waves on the ECG occurred. In 10 further exchanges using heparinized blood (470 ml. of blood + 28.2 ml. of heparin), no effect on Mg ++ was seen. Mean donor blood Mg +~ was 1.45 mEq. per liter; mean pre- and postexchange levels were identical at 1.59 mEq. per liter. The in vitro addition of citrate to a 4 raM. per liter Mg ++ standard shov]e~t;~'a progressive fall in recoverable Mg ++ with increasing amounts of citrate. No such effect was seen with heparin, dextrose, or saline. It is proposed that the fall in Mg ++ during citrated exchange transfusion is the combined result of a dilution effect of the ACD mixture and the magnesium citrate complexing. Consideration should be given to these changes as a possible cause for the clinical problems occurring when citrated blood is used.
41. E~ects of early feeding on premature newborn infants P a u l Y. K . W u ~ a n d P e t e r A. T e i l m a n n , ~ Michael
Reese Hospital,
Chicago,
Ill.
Introduced b y J a c k M e t c o f f Controversy exists with regard to the optimal time for the premature newborn infant's first feed and the effects of "early" feeding on the infant. The present studies were directed to observations on the effects of early feeding (2 hours after birth) of "well" infants with modified cow's milk (SMA-S26) in the 1,250 to 2,000 gram birth weight group (Group A) and comparing them with a controlled group of late fed (24 hours after birth ) infants of similar birth weight (Group B)..Weight loss was 4.7 per cent of birth weight in Group A, as opposed to 7.4 per cent in Group B, and was regained on days 7.3 and 12.6, respectively. Mean Serum bilirubin levels were 8.5,
967
7.3, 7.0, 7.9 mg. per cent on the third, fourth, fifth, and sixth day of life in Group A, and 8.9, 10.6, 10.7, 10.3 rag. per cent respectively in Group B, with statistically significant difference on the fourth (p = 0.05) and fifth, (p = 0.02) days. Mean blood sugars were 77.5, 75.3, 82.5, 86.0 rag. per cent at 24, 48, 72, and 144 hours of life in Group A, and 54.6, 67.3, 74.3, and 75.0 mg. per cent correspondingly in Group B, with significant difference at 24 hours (p = 0.02). Glucagon plus epinephrine tolerance tests at 24 hours of life produced a prolonged and marked rise in the level of blood sugar in Group A and a significantly lower rise in blood sugar in Group B, indicating a greater availability of glycogen stores in the liver of the early fed infants.
42. Physiologic observations of the normal fetus in utero Michael A. Heymann ~ and Abraham M. Rudolph, Albert Einstein College of Medicine, New York, N. Y. Few physiologic observations have been made on the fetus in its normal intrauterine environment. Pregnant animals (11 goats and 9 sheep) with gestational ages of 65 to 135 days, were studied under spinal analgesia. Vinyl catheters were inserted into an umbilical artery (UA) and vein ( U V ) and advanced into major vessels. A forelimb and hindlimb were exposed through small uterine incisions, catheters placed in veins and arteries, the limbs replaced and the abdomen closed. Repeated maternal and fetal pressures, blood 02 saturation and capacity, pH, pO~, and pCOz were measured from various sites. Placental blood flow was measured in 13 animals by the Fick method, with constant infusion of 4-aminoantipyrine into a limb vein, sampling repeatedly from U A and UV. Fetal O= consumption was calculated from these data. Fetal heart rate averaged 193 per minute (range 165 to 230) and maternal 125 per minute (range 100 to 160). Average values and ranges for pressures were: maternaI arterial (MA) 121/82 (100 to 145/70 to 105) ram. Hg, mean 96 (80 to 120) mm. Hg; U A 63/42 (50 to 80/ 25 to 47) mm. Hg, mean 49 (29 to 63) ram. Hg; mean U V 16 (10 to 23) mm. Hg; mean upper limb venous 16 (15 to 18) mm. Hg; mean lower limb venous 13 (10 to 15) mm. Hg; right ventricle 55 to 58/12 to 13 mm. Hg. Average pH values were: U A 7.40, U V 7.43, and MA 7.51. O~ saturation in UA averaged 58.6 per cent, in U V 78.2 per cent, and in M A 92.2 per cent. Mean pO.~ values were: U A 15, U V 25, and MA 66 mm. Hg; pCO= levels were: U A 35, U V 28, and M A 24 mm. Hg. O5 capacities averaged 12.5 vol. per cent in both fetus and mother. Placental blood flow averaged: 179 (100 to 295) ml. per kilogram per minute and fetal oxygen consumption 4.5 (2.5 to 5.9) ml. per kilogram p~r minute. Similar results were obtained in some animals a day or two after surgery with the mother standing.