Gastric Emptying Time in Preterm Infents: Comparison between Breast Milk and Formula Milk

PURPOSE: Failure of adequate gastric emptying frequently interferes with successful enteral nutrition in infants. Study of gastric emptying in preterm infants has been hampered by the absence of a suitable and, valid technique, but ultrasonic assessment is well tolerated by infants. The aim of this study is to compare gastric emptying rates of breast milk and formula within preterm infants using an ultrasonic technique. METHODS: Ten infants(6 males, 4 females) were studied on 20 occasions. Median gestation of the group was 33 wks(29-38 wks), birthweight was 1506gms(850-1870gms). Each infant was receiving a minimum of 150 ml/kg/day of breast milk. We conducted the study with breast milk first and with formula milk 2 days later. With the infant in the right lateral position, ultrasonic images of the gastric antrum were obtained using the aorta bifurcational branch of superior mesenteric artery as constant landmarks. Measurements of antral cross sectional area(ACSA) were made before the feed and then sequentially, following its completion until ACSA returned to its pre-feeding state. Half-emptying time(t1/2) was calculated as the time taken for the ACSA to fall to half the maximal increment. The test was well tolerated by all subjects. RESULTS: There was a strong linear relationship between gastric volume and ACSA. The half-emptying time for breast milk was less than formula : t1/2 breast milk 32.0+/-9.8 min; t1/2 formula 45.0+/-11.6 min, P=0.0004. CONCLUSION: The data demonstrate that human milk increases gastric emptying compared to formula. This has important implications for the management of preterm infants who have feeding intolerances.

A Case of Hydranencephaly Caused by Internal Carotid Artery Stenosis: Diagnosis with Doppler Sonogram

Hydranencephaly is congenital absence of the cerebral hemispheres which are replaced by a large fluid-filled cavity. The brain stem and basal ganglia are well formed and rudiments of frontal k occipital cortex may be present. We experienced a case of hydranencephaly caused by both internal carotid artery stenosis. We diagnosed it through the brain CT sonogram and doppler sonogram. A brief review of the related literatures was made.

Effect of Indomethacin Therapy in Prematurity with Patent Ductus Arteriosus:study of Its Effectiveness in Treatment Modality

PURPOSE: Conventional indomethacin therapy(0.2mg/kg every 12 hours for three doses) has been used for closure of PDA. The effect of prolonged low dose of indomethacin therapy(0.1mg/kg daily for six days)had been reported in foreign country but, nothing had been reported in our country. So we attempted this study to examine effects of these two methods. METHODS: Forty one infants with PDA of prematurity from January 1992 to July 1995 who were admitted in NICU of Il Sin Christian Hospital were included. 27 of these infants received conventional dose of indomethacin therapy and 14 received prolonged low dose of indomethacin therapy, and we examined with closure rate and complication etc. RESULTS: 1) Closure of PDA was observed in 15(55.6%) and relapse was 3(11.1%) in conventional dose therapy group. In prolonged low dose therapy group, closure was 8(57.1%) and relapse was none. 2) Intraventricular hemorrhage was observed in 20(74.1%), 6(42.9%) and gastrointestinal tract bleeding was 6(22.2%), 13(92.2%) in each group. There was statistically significant between the two groups(p<0.05). 3) The rise of serum BUN, creatinine was observed in 9(33.3%), 6(46.2%), bleeding tendency was 9(33.3%), 8(57.1%), necrotizing enterocolitis was 2(7.4%), 0 and retinopathy of prematurity was 8(29.6%), 3(21.4%) in each group.But there was not statistically significant correlation between the two groups. 4) The development of sepsis and broncopulmonary dysplasia was slightly more in prolonged low dose therapy group. 5) The reduction of urine output was observed in 11(40.7%), 2(14.3%) in each group but, absolute oliguria was not observed in both groups. CONCLUSIONS: Though the closure rate of PDA was similar in both groups, prolonged low dose indomethacin therapy can be recommanded with its effectiveness on preventing the relapse of PDA and the accurrence of necrotizing enterocolitis.