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Mineral retention rates in very low birth weight babies on TPN during steroid or diuretic therapy
0.15 Selenii --dbt.
0.13 Theeffectofdiffemntcaa W3b=id-WT-LcT) on plasma lipii and their relatiiip to plasma Mlirubin levels
intnkes in phawWMuric&Wenona cwrewbnwithbkmdrrk-
M. ftubin, A. hfoser, Z. Halpem, R. Bilik and E. Antebi Tel-Aviv University, Israel Univemitaire /nste//ing Antwerpn Diepenbeek
Wehave previously reported the beneficial effects of infusing a lipid emulsion of MCT/LCT 50%&O% w:w on the biliin levels in a small group of infants receiving TPN compared to a standard LCT containing TPN regimen. In the current study we included 18 premature neonates receiving TPN with a supplemental lipid emulsion, randomly assigned to either MCTILCT (A) or LCT (B). The study design called for a gradual increase from 1 @kg/day on the 3rd day of lie to 3g/kg/day on the 5th day of lie and thereafter. No significant differences were noted between groups in regard to weigM gain, acid-base balances, liver function tests, albumin and glucose levels. No adverse events were recorded in any infant. Despite the tripling in lipid load from the first TPN day to the third, the plasma triglyceride levels, remained at the levels attained after the first day (242 +_ 57 mg/dl in group A, 178 + 32 mg/dl in B, vs, 59 + 21 preinfusion). Similarly, FFA levels on the first day rose from preinfusion levels of 0.2mM to a constant level which was fourfold for grwp A and threefold for group B (p < 0.001). The unbound fraction of bilk&in decreased significantly during the study period by 35% in group A vs only 13% in group B. A positive correlation was found between free bilirubin and FFA (corrected for actual Albumin) only for the LCT group (R = 0.73, p < 0.002) and not for MCT/LCT. Thesefindings indicate that the effect of MCT on plasma FFA is probably more than compensated for by the lower affinity of MCFA for albumin. There was a significant increase of 40% in plasma cholesterol levels in the MCTILCT group versus a nonsignificant 11% increase in the LCT group. We c~lclude that both lipid emulsions are well tolerable in the premature neonate, and the risk of infusing lipids to icteric infants may be overestimated.
and 13 1. Witti-lnstihrut,
t&C.
In Belgium, the major sources of se!anium (SE) arepotein rioh produus such as meat, fish, mik, eggs and bread. The use of a naturul protein restdcted diet combined with the oral intake of purified amino-acids mixtures in children with phenylcetonuria (PKU) will most probably r&ice their SE intake. To objectify this, we measured the daily intake of 5 PKU children (aged 7 to 19 year) during 9 days of a PKU summer camp. Daily consumption was duplicated, homogenized and frozen. SE was measured with an atomic absorption spectrometry method after hybride generation. Reau& SE intakes from allowed natural foods and driiks ranged from 1.3 to 10.7 ug/d. The synthetic diet products (Phenyldon, PKU 2, FKU drink, protein restricted biscuit and soup) provided ~0.5 u@d (detecttin limit). The mean total SE intake was 2.8 f 2.2 ug/d (mean + SD) N:35. The mean SE plasma level was 38 +- 13.7 ng/ml (age matched controls: 77 + 13 @ml). Glutathion peroxkfase activity was CO.05 U/ml (n = 0.145 +O.O13).Therewasasignificant correlationbetwean PheintakeandSElevels. One patient had a slight increase of creatinine phosphokinase, all other children had normal values. All were symptom free. Conclusiom These 5 children with PKU on a phenylalanine restricted diet, had a SE daily intake far below the recommended allowances (40-60 ug/day); 115 had a elevation of CPK. We consider this group at high risk for SE depletion and deficiency and recommend suppletion.
0.16 Mineral retention rates in vety low bii on TPN during steroid or diuretic therapy
0.14 Influence of LCT emukions on surfectant (S), composition, ventbtoty needs and plasma lipids in premature infants treated with porcine (Pore) S for respiratory dietrees syndrome WSI D. Haumont, C. R&s/a, A. C/ercx, A. Biver, M. Richelte and Y.A. Carpentier
weight babii
M. Candusso,A. Trappan, U. de Lbndeweid, P.P. BmvedaniandL. Gig/i0 N.I.C.U., lstituto per l’lnfanzia, Trieste, Italy Very low birth weigM (VLBW) babies often develop osteopenia. The relative contributions of low postnatal mineral intakes and of other non nutritional factors to the development of this disease are not well known. Csteopenia often occurs in babies with bronchopulmonary dysplasia, as mce of the disease itself and/or of the side-effects of drugs used to treat it: steroids and diuretics. The aim of this study was to evaluate mineral retention rates in 3 groups of TPN fed VLBW babies: one treated with steroids(S), one with diuretics (D) and the third with no drugs (ND). A total of 105 balance studies were performed: 28 in group D, 13 in group S, 66 in group ND. Mean parenteral intakes of ND group were: Ca 56.5 (SD 10.8) -day; P 55.3 (SD 12.6) mg/kg/day. Intakes were not different in the other groups. Ca retention rate was 87.3% in group ND, 91% in group S, 83% in group D. Ca urinary losses were high in group D (9.7 mg/kg/day when comparedwith the other 2 groups (S: 7.5 mg@/day; ND: 7.7 mg/kg/day). P retention rate was low in both drug-treated groups: S 72.3%, D 70% when compared with non-treated group (86.7%) P urinary losses were higher during both S (15.1 mgJkg/day) and D (17.9 rn@k@day) treatments than in the third group (ND 7.4 mgIkg/day). Our data stress the negatii effect of drugs commonly used in neonatal intensive care on mineral metabolism during TPN. Many authors have reported hypercalciuria during diuretic therapy, but our data show that P metabolism is even more affected both by diuretics and steroids.
Free Universiiy ot Brussels, Belgium Port S has been shown to dramatically reduce ventilatory needs in neonatal RDS. Fourteen premature infants (BW 1630gm + 250, GA 30.5 +- 1.2) with RDS were treated with Port S during the first 24h of lie. They were prospectively randomized to receive RPN without or with lipids (up to Zgmlkgday). Measurements were performed at birth before Port S treatment, and again on day 6. Surfactant phospholipid pattern (SPLP) was analysed in tracheal effluent. Plasma lipids were determined after a 8 h lipkf free interval (when given). A similar increase of plasma triglycerides @G) and phospholipids(PL) was observed in both groups (TG from 23 to 48mg % and PLll8to207mg%inthelipidfrwgroupandTGfrom40to46mg%andPL from 129 to 226mg % in the lipid group). PL pattern remained unchanged in both groups. The lipid-free group showed higher increases of total (91 vs 49mg %) and esterified cholesterol (64 vs 23mg%y. Phosphatidylcholine content of SPLP tended to be higher on day 6 (77% vs 73%; NS) in the lipid group. The ventilatory index (mean airway pressure x Fi C&a Od was significantly lower in the lipid group (0.02 vs 0.047 indicating decreased ventilatory needs. This favourable effect of lipid containing TPN could be partly due to the higher calorie intake (78 kcaVkglday vs 63 kca!Ikg.dayT. Conoiuabm Our results suggest that lipid supplemented TPN enhances the beneficial effect of Port S treatment on the ventilatofy needs of premature infants with RDS, without altering plasma lipid parameters. r p < 0.05; * p < 0.01). l
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0.13 Theeffectofdiffemntcaa W3b=id-WT-LcT) on plasma lipii and their relatiiip to plasma Mlirubin levels
intnkes in phawWMuric&Wenona cwrewbnwithbkmdrrk-
M. ftubin, A. hfoser, Z. Halpem, R. Bilik and E. Antebi Tel-Aviv University, Israel Univemitaire /nste//ing Antwerpn Diepenbeek
Wehave previously reported the beneficial effects of infusing a lipid emulsion of MCT/LCT 50%&O% w:w on the biliin levels in a small group of infants receiving TPN compared to a standard LCT containing TPN regimen. In the current study we included 18 premature neonates receiving TPN with a supplemental lipid emulsion, randomly assigned to either MCTILCT (A) or LCT (B). The study design called for a gradual increase from 1 @kg/day on the 3rd day of lie to 3g/kg/day on the 5th day of lie and thereafter. No significant differences were noted between groups in regard to weigM gain, acid-base balances, liver function tests, albumin and glucose levels. No adverse events were recorded in any infant. Despite the tripling in lipid load from the first TPN day to the third, the plasma triglyceride levels, remained at the levels attained after the first day (242 +_ 57 mg/dl in group A, 178 + 32 mg/dl in B, vs, 59 + 21 preinfusion). Similarly, FFA levels on the first day rose from preinfusion levels of 0.2mM to a constant level which was fourfold for grwp A and threefold for group B (p < 0.001). The unbound fraction of bilk&in decreased significantly during the study period by 35% in group A vs only 13% in group B. A positive correlation was found between free bilirubin and FFA (corrected for actual Albumin) only for the LCT group (R = 0.73, p < 0.002) and not for MCT/LCT. Thesefindings indicate that the effect of MCT on plasma FFA is probably more than compensated for by the lower affinity of MCFA for albumin. There was a significant increase of 40% in plasma cholesterol levels in the MCTILCT group versus a nonsignificant 11% increase in the LCT group. We c~lclude that both lipid emulsions are well tolerable in the premature neonate, and the risk of infusing lipids to icteric infants may be overestimated.
and 13 1. Witti-lnstihrut,
t&C.
In Belgium, the major sources of se!anium (SE) arepotein rioh produus such as meat, fish, mik, eggs and bread. The use of a naturul protein restdcted diet combined with the oral intake of purified amino-acids mixtures in children with phenylcetonuria (PKU) will most probably r&ice their SE intake. To objectify this, we measured the daily intake of 5 PKU children (aged 7 to 19 year) during 9 days of a PKU summer camp. Daily consumption was duplicated, homogenized and frozen. SE was measured with an atomic absorption spectrometry method after hybride generation. Reau& SE intakes from allowed natural foods and driiks ranged from 1.3 to 10.7 ug/d. The synthetic diet products (Phenyldon, PKU 2, FKU drink, protein restricted biscuit and soup) provided ~0.5 u@d (detecttin limit). The mean total SE intake was 2.8 f 2.2 ug/d (mean + SD) N:35. The mean SE plasma level was 38 +- 13.7 ng/ml (age matched controls: 77 + 13 @ml). Glutathion peroxkfase activity was CO.05 U/ml (n = 0.145 +O.O13).Therewasasignificant correlationbetwean PheintakeandSElevels. One patient had a slight increase of creatinine phosphokinase, all other children had normal values. All were symptom free. Conclusiom These 5 children with PKU on a phenylalanine restricted diet, had a SE daily intake far below the recommended allowances (40-60 ug/day); 115 had a elevation of CPK. We consider this group at high risk for SE depletion and deficiency and recommend suppletion.
0.16 Mineral retention rates in vety low bii on TPN during steroid or diuretic therapy
0.14 Influence of LCT emukions on surfectant (S), composition, ventbtoty needs and plasma lipids in premature infants treated with porcine (Pore) S for respiratory dietrees syndrome WSI D. Haumont, C. R&s/a, A. C/ercx, A. Biver, M. Richelte and Y.A. Carpentier
weight babii
M. Candusso,A. Trappan, U. de Lbndeweid, P.P. BmvedaniandL. Gig/i0 N.I.C.U., lstituto per l’lnfanzia, Trieste, Italy Very low birth weigM (VLBW) babies often develop osteopenia. The relative contributions of low postnatal mineral intakes and of other non nutritional factors to the development of this disease are not well known. Csteopenia often occurs in babies with bronchopulmonary dysplasia, as mce of the disease itself and/or of the side-effects of drugs used to treat it: steroids and diuretics. The aim of this study was to evaluate mineral retention rates in 3 groups of TPN fed VLBW babies: one treated with steroids(S), one with diuretics (D) and the third with no drugs (ND). A total of 105 balance studies were performed: 28 in group D, 13 in group S, 66 in group ND. Mean parenteral intakes of ND group were: Ca 56.5 (SD 10.8) -day; P 55.3 (SD 12.6) mg/kg/day. Intakes were not different in the other groups. Ca retention rate was 87.3% in group ND, 91% in group S, 83% in group D. Ca urinary losses were high in group D (9.7 mg/kg/day when comparedwith the other 2 groups (S: 7.5 mg@/day; ND: 7.7 mg/kg/day). P retention rate was low in both drug-treated groups: S 72.3%, D 70% when compared with non-treated group (86.7%) P urinary losses were higher during both S (15.1 mgJkg/day) and D (17.9 rn@k@day) treatments than in the third group (ND 7.4 mgIkg/day). Our data stress the negatii effect of drugs commonly used in neonatal intensive care on mineral metabolism during TPN. Many authors have reported hypercalciuria during diuretic therapy, but our data show that P metabolism is even more affected both by diuretics and steroids.
Free Universiiy ot Brussels, Belgium Port S has been shown to dramatically reduce ventilatory needs in neonatal RDS. Fourteen premature infants (BW 1630gm + 250, GA 30.5 +- 1.2) with RDS were treated with Port S during the first 24h of lie. They were prospectively randomized to receive RPN without or with lipids (up to Zgmlkgday). Measurements were performed at birth before Port S treatment, and again on day 6. Surfactant phospholipid pattern (SPLP) was analysed in tracheal effluent. Plasma lipids were determined after a 8 h lipkf free interval (when given). A similar increase of plasma triglycerides @G) and phospholipids(PL) was observed in both groups (TG from 23 to 48mg % and PLll8to207mg%inthelipidfrwgroupandTGfrom40to46mg%andPL from 129 to 226mg % in the lipid group). PL pattern remained unchanged in both groups. The lipid-free group showed higher increases of total (91 vs 49mg %) and esterified cholesterol (64 vs 23mg%y. Phosphatidylcholine content of SPLP tended to be higher on day 6 (77% vs 73%; NS) in the lipid group. The ventilatory index (mean airway pressure x Fi C&a Od was significantly lower in the lipid group (0.02 vs 0.047 indicating decreased ventilatory needs. This favourable effect of lipid containing TPN could be partly due to the higher calorie intake (78 kcaVkglday vs 63 kca!Ikg.dayT. Conoiuabm Our results suggest that lipid supplemented TPN enhances the beneficial effect of Port S treatment on the ventilatofy needs of premature infants with RDS, without altering plasma lipid parameters. r p < 0.05; * p < 0.01). l
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