Vegetable oil fortified feeds in the nutrition of very low birthweight babies.

Two kinds of oils (i) Polyunsaturated fatty acids (PUFA) rich Safflower oil, and (ii) Medium chain triglyceride (MCT) rich Coconut oil were added to the feeds of 46 very low birthweight (VLBW) babies to see if such a supplementation is capable of enhancing their weight gain. Twenty two well matched babies who received no fortification served as controls. The oil fortification raised the energy density of the feeds from approximately 67 kcal/dl to 79 kcal/dl. Feed volumes were restricted to a maximum of 200 ml/kg/day. The mean weight gain was highest and significantly higher than the controls in the Coconut oil group (19.47 +/- 8.67 g/day or 13.91 g/day). Increase in the triceps skinfold thickness and serum triglycerides were also correspondingly higher in this group. The lead in the weight gain in this group continued in the follow up period (corrected age 3 months). As against this, higher weight gain in Safflower oil group (13.26 +/- 6.58 g/day) as compared to the controls (11.59 +/- 5.33 g/day), failed to reach statistically significant proportions, probably because of increased statistically significant proportions, probably because of increased steatorrhea (stool fat 4+ in 50% of the samples tested). The differences in the two oil groups are presumably because of better absorption of MCT rich coconut oil. However, individual variations in weight gain amongst the babies were wide so that some control babies had higher growth rates than oil fortified ones. The technique of oil fortification is fraught with dangers of intolerance, contamination and aspiration. Long term effects of such supplementation are largely unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: During a period of 12 months, polyunsaturated fatty acids (PUFA) rich safflower oil and medium chain triglyceride (MCI) rich coconut oil were added to the feeds of 46 very low birth weight (VLBW) babies (birth weight of 1250-1500 g) to see if such a supplementation could augment their weight gain. In the safflower oil fortification group, 22 babies completed the study, and in the coconut oil fortification group, 24 did. 22 babies who received no fortification served as controls. The oil fortification raised the energy density of the feeds from approximately 67 kcal/dl to 79 kcal.dl. Feed volumes were restricted to a maximum of 200 ml/kg/day. 3 babies of the safflower oil group and 2 each of the 2 other groups developed loose motions, but they all survived and completed the study. The diarrhea in the safflower oil group was related to addition of oil exceeding 0.5 ml and responded to discontinuation of oil. An increase in serum triglyceride values was seen in all 3 study groups, but the increase in the coconut oil group was significantly greater than the increase in the controls (p 0.05). The mean weight gain per day, weight gain per kg per day (19.47 +or- 8.67 g/day or 13.91 g/day), and mean weekly increment in skinfold thickness were significantly greater in the coconut oil group as compared to controls (p 0.05). The lead in the weight gain in this group continued in the follow-up period (corrected age, 3 months). Higher weight gain in the safflower oil group (13.26 +or- 6.58 g/day) as compared to the controls (11.59 +or- 5.33 g/day) failed to reach statistical significance, probably because of increased steatorrhea (stool fat 4+ in 50% of the samples tested). The differences in the 2 oil groups presumably occurred because of better absorption of MCI rich coconut oil. The technique of oil fortification is fraught with dangers because of aspiration and contamination. Accordingly, such fortification should be used in selected situations only, rather than as a routine nursery policy.

Reduction in parenteral nutrition related complications in the newborn.

A comparison of total parenteral nutrition (TPN) related complication in newborns was made between two study periods, namely, 1986 (Study A) and 1989-90 (Study B). A significant reduction was seen in all complications in Study B. Local complications (thrombophlebitis, gangrene, abscess) reduced from 80.0 to 29.4%, septicemia from 52.0 to 11.7% and metabolic complications from a computed mean of 1.6 episode per baby to 0.88 episode per baby. The reduction in these complications has been attributed to the following additional inputs in the recent study (i) Additional staff (research officers, nurses, biochemist); (ii) Better training of resident staff; (iii) Use of a laminar flow system for mixing solutions; (iv) Specially designed locally manufactured intravenous sets and accessories; and (v) Use of well balanced nutrient solutions. Outstanding problems perceived are--high incidence of TPN-related cholestasis (14.7%), azotemia (26.4%), central catheter-related sepsis (75.0%) and the falling, but yet high cost of the technique (Rs. 650 per day).