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Is intravenous glucose the only treatment for neonatal hypoglycaemia?
228 and maternal blood samples were also obtained from 12 patients (controls) who were undergoing cordocentesis for rapid karyotyping at a median GA of 27 weeks (22-32). Biocyclo PGEM was estimated in all maternal and fetal samples using a radioimmunoassay. None of the 21 patients had clinical signs of chorioamnionitis or premature labour. Biocyclo PGEM levels were higher in both mothers and fetuses with PPROM than in the controls: mean maternal PPROM PGEM 347.8 pg ml-‘, mean maternal control 262.8 pg ml-‘, 95% Cl of the difference of the means 1.99-172 pg ml-‘, P < 0.05; mean fetal PPROM PGEM 348.9, mean fetal control 216.3, 95% Cl of the difference of the means 40.9-224.2 pg ml-‘, P < 0.01. Fetal breathing activity. in the PPROM patients, was lower than expected for gestational age. Our results suggest a prostaglandin synthetase inhibitor may improve FBM in pregnancies complicated by PPROM.
Is intravenous glucose the only treatment for neonatal hypoglycaemia? J.M. Hawdon Department
of Child Health,
University
of Newcastle
and M.P. Ward Platt,
upon Tyne, U.K.
The admission of hypoglycaemic babies to neonatal nurseries advantage of increasing nursery workload and parental
for intravenous glucose infusion anxiety. We are investigating
has the disalternative
treatments, which may obviate the need for glucose infusion. We studied 22 infants who were receiving intravenous glucose as treatment for hypoglycaemia. Of these, I I were randomised to receive intravenous glucagon (200 &kg) and I I to receive intragastric medium chain triglyceride mixture (MCT, 3 ml/kg). Blood was taken for concentrations of glucose (BG), gluconeogenic substrates (TGS), ketone bodies (KB) and non-esterified fatty acids (NEFA) before and after treatment. Using stable isotope infusion and GC/MS methods, endogenous glucose production rates (GPR) were calculated for I7 babies. There were no differences between the treatment groups in pretreatment blood glucose or other metabolite concentrations. After glucagon treatment, there were significant increases in BG, TGS and GPR (paired r-test, P < 0.001, P < 0.05, P < 0.05) and a decrease in NEFA (P < 0.05). After MCT there was an increase in BG only (P < 0.01). The mean increase in BG for the glucagon group was significantly greater than for the MCT group (1.6 vs. 0.4 mmol/l, P < 0.001). Glucagon injection may increase BG by releasing gluconeogenic precursors and stimulating gluconeogenesis. In our study, MCT did not appear to induce gluconeogenesis nor ketogenesis. but may have had a glucose sparing effect. Glucagon is a promising treatment for hypoglycaemia. Further study is needed into its efficacy in the absence of glucose infusion, its duration of action, and optimal dose and route of administration.
Neonatal cows milk protein intolerance -
A passing phase. S.J. Rose, East Birmingham
Hospital,
Birming-
ham, B9 5ST, U.K. Neonatal cows milk protein intolerance (CMPI) may present with rectal bleeding, which can also presage necrotising enterocolitis (NEC). CMPI may be more frequent in the preterm (< 33 weeks) secondary to increased whole protein absorption. Early diagnosis of CMPI would reduce unnecessary treatment for NEC and may identify. by gestational age, a group at high risk for later cows milk associated gastrointestinal pathology. An l8-month prospective study of rectal bleeding was undertaken using the following protocol: proctoscopy, cessation of oral feeds, abdominal X-ray, full blood count. clotting studies, stool culture. If clinically well, cows milk restarted later. If recurrence; the above plus rectal biopsy, IgE. RAST, soy milk substituted for cows milk: milk challenge with rectal biopsy at term plus 6 months. CMPI was considered the probable diagnosis if bleeding recurred with cows milk, ceased with soy milk and at least one other laboratory test was compatible with the diagnosis. 7894 live births occurred during the study period. 298 were less than 33 weeks gestation. rectal bleeding, 13 33 weeks, 2.4% of Although CMPI milk challenge and or it is a transient
44 infants had
(26”/u) satisfied CMPI criteria. 6 were > 33 weeks. 0.08% term population, 7 were > preterm population, only I infant (term) had a later positive milk challenge. was diagnosed more frequently in the preterm group, no preterm infants had a positive only I term infant reacted. Thus, either CMPI is not a common problem in neonates neonatal phenomenon that has not yet been clearly defined.
Is intravenous glucose the only treatment for neonatal hypoglycaemia? J.M. Hawdon Department
of Child Health,
University
of Newcastle
and M.P. Ward Platt,
upon Tyne, U.K.
The admission of hypoglycaemic babies to neonatal nurseries advantage of increasing nursery workload and parental
for intravenous glucose infusion anxiety. We are investigating
has the disalternative
treatments, which may obviate the need for glucose infusion. We studied 22 infants who were receiving intravenous glucose as treatment for hypoglycaemia. Of these, I I were randomised to receive intravenous glucagon (200 &kg) and I I to receive intragastric medium chain triglyceride mixture (MCT, 3 ml/kg). Blood was taken for concentrations of glucose (BG), gluconeogenic substrates (TGS), ketone bodies (KB) and non-esterified fatty acids (NEFA) before and after treatment. Using stable isotope infusion and GC/MS methods, endogenous glucose production rates (GPR) were calculated for I7 babies. There were no differences between the treatment groups in pretreatment blood glucose or other metabolite concentrations. After glucagon treatment, there were significant increases in BG, TGS and GPR (paired r-test, P < 0.001, P < 0.05, P < 0.05) and a decrease in NEFA (P < 0.05). After MCT there was an increase in BG only (P < 0.01). The mean increase in BG for the glucagon group was significantly greater than for the MCT group (1.6 vs. 0.4 mmol/l, P < 0.001). Glucagon injection may increase BG by releasing gluconeogenic precursors and stimulating gluconeogenesis. In our study, MCT did not appear to induce gluconeogenesis nor ketogenesis. but may have had a glucose sparing effect. Glucagon is a promising treatment for hypoglycaemia. Further study is needed into its efficacy in the absence of glucose infusion, its duration of action, and optimal dose and route of administration.
Neonatal cows milk protein intolerance -
A passing phase. S.J. Rose, East Birmingham
Hospital,
Birming-
ham, B9 5ST, U.K. Neonatal cows milk protein intolerance (CMPI) may present with rectal bleeding, which can also presage necrotising enterocolitis (NEC). CMPI may be more frequent in the preterm (< 33 weeks) secondary to increased whole protein absorption. Early diagnosis of CMPI would reduce unnecessary treatment for NEC and may identify. by gestational age, a group at high risk for later cows milk associated gastrointestinal pathology. An l8-month prospective study of rectal bleeding was undertaken using the following protocol: proctoscopy, cessation of oral feeds, abdominal X-ray, full blood count. clotting studies, stool culture. If clinically well, cows milk restarted later. If recurrence; the above plus rectal biopsy, IgE. RAST, soy milk substituted for cows milk: milk challenge with rectal biopsy at term plus 6 months. CMPI was considered the probable diagnosis if bleeding recurred with cows milk, ceased with soy milk and at least one other laboratory test was compatible with the diagnosis. 7894 live births occurred during the study period. 298 were less than 33 weeks gestation. rectal bleeding, 13 33 weeks, 2.4% of Although CMPI milk challenge and or it is a transient
44 infants had
(26”/u) satisfied CMPI criteria. 6 were > 33 weeks. 0.08% term population, 7 were > preterm population, only I infant (term) had a later positive milk challenge. was diagnosed more frequently in the preterm group, no preterm infants had a positive only I term infant reacted. Thus, either CMPI is not a common problem in neonates neonatal phenomenon that has not yet been clearly defined.