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Peripheral intravenous alimentation of the small premature infant
347
ABSTRACTS GENERAL
CONSIDERATIONS
Effects of Hemorrhage in Fetal and Newborn Lambs. 13. M. Rodgers, R. N. Starascik, and R. L. Reis. Surgery 7151-55 (January), 1972. Twenty-seven fetal, newborn, and 4-i’day-old lambs were subjected to mild (25% to 30% blood volume), moderate (30% to 45% blood volume, and severe (45% to 55% blood volume) hemorrhage as central venous pressure, systemic arterial pressure, heart rate, hematocrit, and arterial blood gas tension, and pH were monitored. Fetuses with mild hemorrhage survived longer (130 min vs. 90 min) than newborn lambs. Blood gas tension and pH were maintained in the fetus but varied widely in newborn animals. Central venous pressure varied widely and was unpredictable in all groups. The authors conclude that, in the lamb, the fetus tolerates comparable degrees of hemorrhage better than the newborn animal, that central venous pressure and cardiac rate are not reliable in determining the degree of hemorrhage, and that decreases in hematocrit and arterial blood pressure are dependable in determining the degree of hemorrhage. -4VilZiam K. Sieber Peripheral Intravenous Alimentation of the Small Premature Infant. Gerda 1. M. Benda and S. Gorham Babson. J. Pediat. 79:494-498 (September), 1971. In recent years parenteral aliment&ion of infants using central venous catheters has been shown to sustain life and promote growth for prolonged periods of time when oral feedings are impossible or inadvisable. The feasibility of giving high-caloric feedings through a peripheral vein to the small and weak premature infant was tested in the neonatal center at the University of Oregon Medical School. Fourteen unselected infants whose birth weights were less than 1251 g were given a solution containing 65 calories/100 ml at rates up to 120 ml/km per day. The intravenous feedings were continued for a period of 5-22 days while oral feedings were being established. One may suspect osmotic overload when dehydration is observed and not
explained by other reasons. A weight loss of more than 2% of body weight after the first 3 days of life is suggestive of this state. This condition may require a temporary dilution of the infused solution. Average gain in weight of the ten survivors was satisfactory. No apparent complications from this method of feeding were observed. -George W. Holcomb, 7~. The Growth of Candida albicans in Nutritive Solutions Given Parenterally. M. F. Brennan, R. C. O’Connell, J. A. Rosol, and R. Kundsin. Arch. Surg. 103:705-708 (December), 1971. Cnndidn nlbicans grows rapidly in all mixtures of amino acid and dextrose used for parenteral nutrition at temperatures of 30 to 37°C. Growth was inhibited by cooling to 4°C. Growth was greater in solutions containing amino acids, dextrose; and electrolytes than it was in dextrose, or amino acids, or amino acid with electrolytes alone. In the recent_ experience of the authors, as well as in the experience of others, there is an increasing incidence of Candida cultured from the catheter tip and from the blood. This paper deals with an investigation designed to study some of the factors concerned in Cnndidn growth and in an effort to provide a model for a method of prevention of Candidn septicmeia. It is noted that potassium is apparently essential to Cmdidn growth. The serum inhibition that occurs may be due to chelation of iron by transferrin, thereby depriving the organism of this element and, consequently, inhibiting proliferation. This observation seems consistent with the increased incidence of Cnndidn sepsis in the newborn and in the leukemic, who have a low iron-binding capacity. Mycelial transformation of Cnndida cells in the presence of human serum has been employed as an identification test. The predisposition to Cnndida sepsis in patients receiving multiple antibiotics is recognized. The chemically related tetracyclines can be used as a source of nitrogen and in mice, increased growth can be seen if the mice are treated with either oxytetracycline or hydrocortisone, or when a metabolic aklalosis or acidosis exists. Although both of the amino acid mixtures employed in the study supported the growth of the pathogenic Candida, a
ABSTRACTS GENERAL
CONSIDERATIONS
Effects of Hemorrhage in Fetal and Newborn Lambs. 13. M. Rodgers, R. N. Starascik, and R. L. Reis. Surgery 7151-55 (January), 1972. Twenty-seven fetal, newborn, and 4-i’day-old lambs were subjected to mild (25% to 30% blood volume), moderate (30% to 45% blood volume, and severe (45% to 55% blood volume) hemorrhage as central venous pressure, systemic arterial pressure, heart rate, hematocrit, and arterial blood gas tension, and pH were monitored. Fetuses with mild hemorrhage survived longer (130 min vs. 90 min) than newborn lambs. Blood gas tension and pH were maintained in the fetus but varied widely in newborn animals. Central venous pressure varied widely and was unpredictable in all groups. The authors conclude that, in the lamb, the fetus tolerates comparable degrees of hemorrhage better than the newborn animal, that central venous pressure and cardiac rate are not reliable in determining the degree of hemorrhage, and that decreases in hematocrit and arterial blood pressure are dependable in determining the degree of hemorrhage. -4VilZiam K. Sieber Peripheral Intravenous Alimentation of the Small Premature Infant. Gerda 1. M. Benda and S. Gorham Babson. J. Pediat. 79:494-498 (September), 1971. In recent years parenteral aliment&ion of infants using central venous catheters has been shown to sustain life and promote growth for prolonged periods of time when oral feedings are impossible or inadvisable. The feasibility of giving high-caloric feedings through a peripheral vein to the small and weak premature infant was tested in the neonatal center at the University of Oregon Medical School. Fourteen unselected infants whose birth weights were less than 1251 g were given a solution containing 65 calories/100 ml at rates up to 120 ml/km per day. The intravenous feedings were continued for a period of 5-22 days while oral feedings were being established. One may suspect osmotic overload when dehydration is observed and not
explained by other reasons. A weight loss of more than 2% of body weight after the first 3 days of life is suggestive of this state. This condition may require a temporary dilution of the infused solution. Average gain in weight of the ten survivors was satisfactory. No apparent complications from this method of feeding were observed. -George W. Holcomb, 7~. The Growth of Candida albicans in Nutritive Solutions Given Parenterally. M. F. Brennan, R. C. O’Connell, J. A. Rosol, and R. Kundsin. Arch. Surg. 103:705-708 (December), 1971. Cnndidn nlbicans grows rapidly in all mixtures of amino acid and dextrose used for parenteral nutrition at temperatures of 30 to 37°C. Growth was inhibited by cooling to 4°C. Growth was greater in solutions containing amino acids, dextrose; and electrolytes than it was in dextrose, or amino acids, or amino acid with electrolytes alone. In the recent_ experience of the authors, as well as in the experience of others, there is an increasing incidence of Candida cultured from the catheter tip and from the blood. This paper deals with an investigation designed to study some of the factors concerned in Cnndidn growth and in an effort to provide a model for a method of prevention of Candidn septicmeia. It is noted that potassium is apparently essential to Cmdidn growth. The serum inhibition that occurs may be due to chelation of iron by transferrin, thereby depriving the organism of this element and, consequently, inhibiting proliferation. This observation seems consistent with the increased incidence of Cnndidn sepsis in the newborn and in the leukemic, who have a low iron-binding capacity. Mycelial transformation of Cnndida cells in the presence of human serum has been employed as an identification test. The predisposition to Cnndida sepsis in patients receiving multiple antibiotics is recognized. The chemically related tetracyclines can be used as a source of nitrogen and in mice, increased growth can be seen if the mice are treated with either oxytetracycline or hydrocortisone, or when a metabolic aklalosis or acidosis exists. Although both of the amino acid mixtures employed in the study supported the growth of the pathogenic Candida, a