Adult outcomes of three newborns with a combined weight of 1100 grams.

OBJECTIVE: To present the short- and long-term (20 years) growth and developmental outcomes of four micropremies (birth weight of less than 500 grams). METHOD: Retrospective review of medical records and prospective assessment/interview with patients and their families. RESULTS: One infant was lost at long-term follow-up. The other three showed a quite satisfactory health status and life style in early adulthood. CONCLUSIONS: Despite extreme low birth weight (less than 500 grams) normal outcomes are possible. In the case of micropremies, gestational age appears to be of greater importance than birth weight as well as female gender in the decision-making process regarding initiation of resuscitation.

Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in formula-fed term infants.

BACKGROUND: Human milk oligosaccharides have been shown to stimulate selectively the growth of Bifidobacteria and Lactobacilli in the intestine. In this study, the bifidogenic effect of an experimental prebiotic oligosaccharide mixture consisting of low-molecular-weight galactooligosaccharides and high-molecular-weight fructooligosaccharides was analyzed in 90 term infants. METHODS: Two test formulas were supplemented with either 0.4 g/dL or with 0.8 g/dL oligosaccharides. In the control formula, maltodextrin was used as placebo. At study day 1 and study day 28, the fecal species, colony forming units (cfu) and pH were measured and stool characteristics, growth, and side effects were recorded. RESULTS: At study day 1, the median number of Bifidobacteria did not differ among the groups (0.4 g/dL group, mean [interquartile range] 8.5 [1.9] cfu/g; 0.8 g/dL group, 7.7 [6.1] cfu/g; and the placebo group, 8.8 [6.1] cfu/g) (figures in square brackets are interquartile range). At the end of the 28-day feeding period, the number of Bifidobacteria was significantly increased for both groups receiving supplemented formulas (the 0.4 g/dL group, 9.3 [4.9] cfu/g; the 0.8 g/dL group, 9.7 [0.8] cfu/g) versus the placebo group (7.2 [4.9] cfu/g, P < 0.001). This effect was dose dependent (0.4 g/dL versus 0.8 g/dL, P < 0.01). The number of Lactobacilli also increased significantly in both groups fed the supplemented formulas (versus placebo, P < 0.001), but there was no statistically significant difference between the group fed formula with 0.4 g/dL oligosaccharides and the group fed formula with 0.8 g/dL oligosaccharides. The dosage of supplement significantly influenced the change in fecal pH (P < 0.05) (placebo, pH 5.5-6.1; 0.4 g/dL formula, pH 5.48-5.44; 0.8 g/dL formula, pH 5.54-5.19). Slight changes in the stool frequency resulted in a significant difference between the placebo group and the group fed the 0.8 g/dL formula at day 28 (P < 0.01). Supplementation had a significant dose-dependent influence on stool consistency (0.8 g/dL versus placebo, P < 0.0001; 0.8 g/dL versus 0.4 g/dL, P < 0.01). Supplementation had no influence on the incidence of side effects (crying, regurgitation, vomiting) or growth. CONCLUSIONS: These data indicate that supplementation of a term infant's formula with a mixture of galacto- and fructooligosaccharides has a dose-dependent stimulating effect on the growth of Bifidobacteria and Lactobacilli in the intestine and results in softer stool with increasing dosage of supplementation.

Protein intake and metabolism in formula-fed infants given Swedish or Italian weaning foods.

The aim of the study was to compare protein intake and metabolism between infants from two countries given similar infant formulae but different weaning foods. Healthy Swedish and Italian infants were studied between 3 and 12 mo. Infants in both populations were assigned to 1 of 3 infant formulae, containing 13, 15 or 18/20 g l(-1) of protein, given in addition to Swedish or Italian weaning foods. Protein intake from weaning foods was higher in Italian than in Swedish infants at 6 and 12 mo, whereas protein intake from formula at 6 mo and from formula/milk at 12 mo was similar in both populations. Plasma isoleucine, leucine, lysine, histidine and valine at 6 mo were lower in Italian than in Swedish infants fed formula with 13 g l(-1) of protein. All essential plasma amino acids were similar in Italian and Swedish groups at 12 mo. Serum urea was similar at 6 mo in corresponding formula groups, but was higher at 12 mo in the Italian than in the Swedish formula group. Serum albumin and growth were normal in both populations throughout infancy. In conclusion, formula with protein content of 13 g l(-1) seems to provide sufficient protein intake when combined with Swedish or Italian weaning foods during the second half of infancy, as indicated by normal serum albumin and normal growth. However, the bioavailability of protein and amino acids from weaning foods, in addition to their protein content, should be considered, as indicated by some indices of protein metabolism in the Italian infants.

Fat intake and metabolism in Swedish and Italian infants.

The purpose of the study was to compare fat intake and metabolism between two infant populations from Sweden and Italy given breast milk or similar infant formulas, but different weaning foods. Nutrient intake and fat metabolism were studied prospectively from 3-12 mo in 68 Swedish and 46 Italian healthy infants, breastfed or given similar infant formulas in combination with Swedish or Mediterranean weaning foods. Although nutrient intake and fat metabolism were similar at 6 mo, fat intake was lower at 12 mo in the Italian than in the Swedish formula group (p < 0.001). At 6 and 12 mo, higher dietary ratios of monounsaturated to saturated fatty acids (p < 0.01 and p < 0.001, respectively), and monounsaturated to polyunsaturated fatty acids (p < 0.05, p < 0.001) were found in the Italian than in the Swedish formula group. Total cholesterol and apolipoprotein B were lower at 6 mo (p < 0.01) in Italian breastfed infants than in Swedish ones. Lower concentrations at 6 and 12 mo of total cholesterol (p < 0.05, p < 0.05, respectively), apolipoprotein B (p < 0.05, p < 0.01) and triglycerides (p < 0.001, p < 0.01), and of apolipoprotein A1 (p < 0.01) at 12 mo, were found in the Italian formula group than in the Swedish one. In conclusion, plasma total cholesterol, apolipoprotein B and triglycerides were found to be lower in Italian infants than in Swedish infants during the second half of infancy. These findings may partly result from differences in fat compositions between Swedish and Mediterranean weaning diets and in total fat intake in late infancy. Differences in duration of breastfeeding and possibly in breast milk composition may also have influenced our results.

Postprandial plasma amino acids in preterm infants: influence of the protein source.

Preprandial plasma amino acid concentrations have been used extensively as a marker of the nutritional value of dietary proteins in preterm infants. This study investigated the postprandial plasma amino acid profiles of preterm infants fed with different dietary proteins at similar protein intakes during the first weeks of life. In 12 preterm infants, pre- and postprandial plasma amino acid concentrations were measured before the removal of an indwelling central venous catheter placed for parenteral nutrition. All infants received breast milk until the time of study. At the start day of the study, infants were randomized to receive a test meal of 10 ml/kg, either of breast milk fortified with breast milk protein to reach a protein content of 2.0 g/dl or of a bovine milk preterm formula with a protein content of 2.0 g/dl (whey/casein ratio 60/40). Five samples of 100 microl blood were obtained immediately before and 15, 30, 45 and 60 min after the test meal. The plasma amino acid analysis was performed by a reversed-phase high-performance liquid chromatography based on o-phthaldialdehyde/2-mercaptoethanol pre-column derivatization. In both groups, the plasma amino acid concentrations increased within the first 30 min and the levels did not return to the preprandial baseline during the observation period. Fifteen minutes after the test meal, the plasma levels of all essential amino acids with the exception of histidine were higher in the bovine milk formula fed infants than in the fortified breast milk fed infants. The sum of plasma essential amino acid levels found in the formula fed infants were significantly (p < 0.05) higher than the levels found in the fortified breast milk fed infants at 15, 30 and 45 min. The kinetics of individual amino acids were influenced by the different quality of the protein even when the intakes in the groups were similar, as demonstrated for histidine and phenylalanine. The data indicate that postprandial plasma amino acid concentrations depend significantly on the dietary amino acid source and cannot simply be calculated from the amino acid composition of dietary proteins. Therefore, postprandial plasma amino acid concentrations should be included in the nutritional evaluation of dietary proteins in preterm infants.

Individualized protein fortification of human milk for preterm infants: comparison of ultrafiltrated human milk protein and a bovine whey fortifier.

BACKGROUND: To improve the nutritional management of pre-term infants, a new individualized human milk fortification system based on presupplementation milk protein analyses was evaluated. METHODS: In an open, prospective, randomized multicenter study, 32 healthy preterm infants (birth weights, 920-1750 g) were enrolled at a mean of 21 days of age (range, 9-36 days) when tolerating exclusive enteral feedings of 150 ml/kg per day. All infants were fed human milk and were randomly allocated to fortification with a bovine whey protein fortifier (n = 16) or ultrafiltrated human milk protein (n = 16). All human milk was analyzed for protein content before fortification with the goal of a daily protein intake of 3.5 g/kg. During the study period (mean, 24 days) daily aliquots of the fortified milk were obtained for subsequent analyses of the protein content. RESULTS: Both fortifiers were well tolerated, and growth gain in weight, length, and head circumference, as well as final preprandial concentrations of serum urea, transthyretin, transferrin, and albumin were similar in both groups. The ultimate estimated protein intake was equivalent in both groups (mean 3.1+/-0.1 g/kg per day). Serum amino acid profiles were similar in both feeding groups, except for threonine (significantly higher in the bovine fortifier group) and proline and ornithine (significantly higher in the human milk protein group). CONCLUSIONS: Protein analyses of the milk before individual fortification provides a new tool for an individualized feeding system of the preterm infant. The bovine whey protein fortifier attained biochemical and growth results similar to those found in infants fed human milk protein exclusively with the corresponding protein intakes.

The influence of dietary nucleotides on erythrocyte membrane fatty acids and plasma lipids in preterm infants.

OBJECTIVE: The objective of this study was to evaluate whether a regular formula for premature infants supplemented with nucleotides has any influence on plasma lipids and erythrocyte membrane fatty acids. METHODS: Preterm infants fed either human milk supplemented with human milk protein (HM, n = 14), nucleotide-supplemented preterm formula (NF, n = 13), or a regular preterm formula (F, n = 13) were included in the study. The NF was supplemented with 18.2 mg cytidine monophosphate/l (CMP), 7.0 mg uridine monophosphate/l (UMP), 6.4 mg adenosine monophosphate/l (AMP), 3.0 mg inosine monophosphate/l (IMP) and 3.0 mg guanosine monophosphate/l (GMP). RESULTS: There were significantly higher concentrations of triglycerides (TG) in infants fed NF compared to those fed F (191.42 +/- 79.58 vs 108.21 +/- 43.73, p < 0.001, mean +/- SD lipid concentrations, mg/100 ml plasma). Infants fed F had significantly lower concentrations of total cholesterol (94.34 +/- 11.71 vs 115.69 +/- 39.29, p < 0.01) and TG in plasma (108.21 +/- 43.73 vs 172.27 +/- 68.19, p < 0.001, mean +/- SD lipid concentrations, mg/100 ml plasma) when compared to HM-fed infants. There were no significant differences in any of the erythrocyte membrane fatty acids and total long-chain polyunsaturated fatty acids (LC-PUFA) between NF and F during the study period (6 weeks). Furthermore, total LC-PUFA and docosahexaenoic acid (DHA) concentrations in red blood cell were not significantly different when infants fed NF were compared to those fed HM. In contrast, however, infants fed F had significantly lower concentrations of total n-3 LC-PUFA (p < 0.01) and DHA (p < 0.01) than those found in HM-fed infants. CONCLUSIONS: These results do not suggest an effect of nucleotides on the red blood cell LC-PUFA profile in preterm infants. However, the nucleotides may increase the concentrations of triglycerides in plasma.

Docosahexaenoic and arachidonic acid absorption in preterm infants fed LCP-free or LCP-supplemented formula in comparison to infants fed fortified breast milk.

The absorption of long-chain polyunsaturated fatty acids (LCP) with particular respect to docosahexaenoic (DHA) and arachidonic acid (AA) has been studied in 39 very-low-birth-weight infants appropriate for gestational age after a 10-day feeding period. The infants were fed either a LCP-supplemented formula (n = 11), or a LCP-free formula (n = 11) or breast milk fortified with protein and carbohydrates to have similar protein and energy intakes as in the formula-fed infants (n = 17). Total fat content and fatty acid profile were measured in the human milk, the two formulas, and in the stool samples. After a 10-day feeding period, the fecal excretions of total fat, DHA and AA were measured during a 3-day balance period. The total fat apparent absorption rates were similar in all groups (84.1, 82.1 and 80.6% of intake, respectively). The DHA and AA intakes were significantly (p < 0.01) higher in the group fed the fortified breast milk than in the group fed the LCP-supplemented formula (DHA: 75.5 +/- 12.4 vs. 50.2 +/- 4.2 mg/72 h; AA: 45.5 +/- 5.8 vs. 30.2 +/- 2.7 mg/72 h). There was a tendency for lower apparent absorption rates for both LCPs studied in the group fed fortified breast milk when compared to the group fed LCP-supplemented formula (AA: 70.6 +/- 10.9 vs. 73.0 +/- 8.7% of intake, DHA: 69.0 +/- 10.6 vs. 74.2 +/- 9.5% of intakes, but the differences were not significant. As consequence of the different intakes, the net absorption of the two studied LCP fatty acids were significantly (p < 0.01) higher in the breast milk group than in the group fed the LCP-supplemented formula (DHA: 52.6 +/- 6.1 vs. 36.8 +/- 4.5 mg/72 h; AA: 31.4 +/- 3.1 vs. 22.4 +/- 2.3 mg/72 h). The data demonstrate that DHA and AA are absorbed from the studied LCP-supplemented formula at least as effectively as from human milk. The net absorption of these LCP depend on the amount of dietary intake, and seems to be influenced by the dietary LCP source.

Bile acid concentrations in serum and duodenal aspirates of healthy preterm infants: effects of gestational and postnatal age.

In 41 healthy human-milk-fed preterm infants the preprandial total bile acid (BA) concentrations in serum and duodenal juice were simultaneous measured during the first 60 days of life. The infants were subdivided into four groups according to their gestational age: 6 infants with a gestational age of 27 and 28 weeks, 7 infants with a gestational age of 29 and 30 weeks, 21 infants with a gestational age of 31 and 32 weeks and 7 infants with a gestational age of 33 and 34 weeks. The BA levels were enzymatically determined using 3-alpha-hydroxysteroid dehydrogenase. In the duodenal juice, cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid and lithocholic acid were separately quantified by thin-layer chromatography. During the first month of life, the serum BA concentrations increased significantly with postnatal age (p < 0.01) but remained nearly constant during the second month of life. In the duodenal aspirates, the BA concentrations increased continuously up to the end of the observations period (p < 0.001). In the duodenal aspirates, the CA/CDCA ratio was high immediately after birth and decreased significantly with increasing postnatal age (p < 0.001). During the first weeks of life, the BA levels were preferentially conjugated with taurine, but in spite of the taurine-rich diet during the whole observation period the taurine/glycine ratio decreased with postnatal age (p < 0.001). In all samples of duodenal juice, the sum of primary BA was > 98% of total 3-alpha-hydroxy-BA. These data indicate that the establishment of an intestinal microbial flora necessary for intestinal BA transformation and the development of the enterohepatic BA circulation lasts some months of postnatal life. The serum BA concentration reflects hepatic synthesis, intestinal absorption, renal excretion and hepatocellular transport into bile in a very complex way which may limit the diagnostic value of serum BA during this time. Additionally, a duodenal BA concentration below 4 mmol/l, as found in this study during the first 2 weeks of life, may be of clinical importance due to its possible effects on fat absorption.

Limited fat digestion in infants with bronchopulmonary dysplasia.

In 10 hyaline membrane disease patients with development of bronchopulmonary dysplasia, 16 hyaline membrane disease patients without development of bronchopulmonary dysplasia, and 12 very-low-birthweight infants without major medical problems, we measured the lipase and trypsin activity as well as the bile acids concentrations in preprandially aspirated duodenal juice. In addition, fat and nitrogen balances were performed during the 5th and 6th weeks of postnatal life. The mean duodenal lipase activity in the patients with bronchopulmonary dysplasia was significantly lower than those of the patients without bronchopulmonary dysplasia (4.41 +/- 3.0 versus 9.95 +/- 3.0 U/ml, p < 0.05) and of the controls (19.94 +/- 6.8 U/ml). The mean total bile acid concentration was below the critical micellar concentration of 4 mmol/L only in the patients with bronchopulmonary dysplasia. The fecal fat excretion rate in the patients with bronchopulmonary dysplasia was significantly higher than in the patients without bronchopulmonary dysplasia (21.4 +/- 4.6% versus 11.3 +/- 3.4% of intake, p < 0.01) as well as that of the controls (7.9 +/- 2.8% of intake). The serum urea concentrations were similar in the patients without bronchopulmonary dysplasia and in the controls (1.97 +/- 0.6 and 1.89 +/- 0.4 mmol/L, respectively) but significantly higher in the patients with bronchopulmonary dysplasia (2.54 +/- 0.5 mmol/L). The lowest weight gain was found in the patients with bronchopulmonary dysplasia (8.2 +/- 4.7 g/kg/day). It was significantly lower than one of the patients without bronchopulmonary dysplasia or the controls (13.5 +/- 4.0 and 16.2 +/- 3.7 g/kg/day, respectively). The data indicate that patients who develop bronchopulmonary dysplasia have a limited fat absorption, which may help to explain the inadequate weight gain.

Activities of trypsin and lipase in duodenal aspirates of preterm infants: influence of dietary protein and fat composition.

The influence of three different feeding regimens on the activities of pancreatic lipase and trypsin in duodenal aspirates and on fecal nitrogen and fat excretion was studied in 35 healthy preterm infants after a 2-wk feeding period. Eleven infants received a standard preterm formula (without long-chain polyunsaturated fatty acids), 12 were fed with an experimental formula that only differed from the standard formula in fat blend composition (with long-chain polyunsaturated fatty acids), and 12 infants received human milk fortified with protein and energy to have similar nitrogen and energy contents as the two formulas. There were no significant differences in duodenal trypsin activities among the groups. In the group fed the standard formula, lipase activity was significantly lower than in the group fed the experimental formula (standard formula group: 8.4 +/- 3.5 kU/L; experimental formula group: 13.8 +/- 4.8 kU/L; P < 0.05) but there was no significant difference between the experimental formula group and the human milk group (15.1 +/- 4.2 kU/L). Fecal nitrogen as well as fat excretion were similar in the three feeding groups. The data suggest that dietary fat composition can influence the postnatal development of duodenal lipase activity in preterm infants.

Fecal cholesterol excretion in preterm infants fed breast milk or formula with different cholesterol contents.

In 44 very low-birth-weight infants, fecal cholesterol excretion was measured and in 29 other infants serum total cholesterol concentrations in response to different cholesterol intakes were studied. The infants received fortified breast milk (mean cholesterol content 15.3 mg/dl) or were fed either a standard preterm formula (cholesterol content 5.5 mg/dl) or the same formula but with a modified lipid composition (long chain polyunsaturated fatty acid concentration closely related to breast milk fat) and 30 mg of cholesterol/dl. In the group fed the high cholesterol formula, fecal cholesterol excretion was significantly higher (35.5 mmol/kg/day) than in the groups fed breast milk or the standard formula (20.1 and 18.2 mmol/kg/day). Cholesterol balance in the group fed the high cholesterol formula (21.8 mg/kg/day) was significantly higher than in the group fed breast milk (+8.6 mg/kg/day). In the infants fed the low cholesterol formula the balance was negative (-7.7 mg/kg/day). Serum concentrations of total cholesterol were similar in the groups fed breast milk or the high cholesterol formula (3.47 and 3.51 mmol/l), but significantly higher than in the group fed the low cholesterol formula (3.15 mmol/l). The data suggest that preterm infants are able to regulate a higher cholesterol intake than during breast feeding by increasing fecal cholesterol excretion as well as decreasing endogenous synthesis.

Fortification of human milk: evaluation of a novel fortification scheme and of a new fortifier.

Human milk fed to very-low-birth-weight infants must be fortified with protein, minerals, and vitamins. We tested a new fortification regimen in which the amount of fortifier was adjusted on the basis of frequent determinations of serum urea nitrogen (SUN). A newly formulated fortifier based on bovine milk proteins was employed either in the new fashion (regimen ADJ) or in the conventional fixed proportion (regimen FIX). Using the fixed proportion, the study also compared the new fortifier with a fortifier based on human milk protein (regimen HMP). Twelve infants were studied with each of the three regimens; nearly all completed 3 weeks of study. Protein intake was generally higher in ADJ than FIX; the difference was significant (p < 0.01) during week 2. Weight gain was somewhat (but not significantly) greater in regimen ADJ (32.3 g/d or 18.8 g/kg/d) than in regimen FIX (30.0 g/d or 18.3 g/kg/d). SUN was higher in ADJ than in FIX, and several other serum chemical values (calcium, phosphorus, potassium) tended to be higher, probably reflecting higher intakes of these nutrients with ADJ than with FIX. Plasma concentrations of several amino acids were higher in ADJ than FIX, but none, including threonine, were outside the physiological range. In comparing regimen FIX to regimen HMP, infants on FIX received similar intakes of protein and showed slightly but not significantly more rapid weight gain. Concentrations of SUN were lower with FIX, but other serum chemical values, including amino acids, were generally similar to HMP. We conclude that use of the new adjustable fortification regimen is feasible and safe and that it should be studied further. It produced the expected increases in nutrient intakes and growth. The new bovine milk-based fortifier appears to be equivalent to the human milk-based fortifier.

Activities of trypsin and lipase in duodenal aspirates of healthy preterm infants: effects of gestational and postnatal age.

Lipase and trypsin activities were estimated in preprandially aspirated duodenal juice of preterm infants with gestational ages between 29 and 32 weeks (group I, n = 33) or between 33 and 36 weeks (group II, n = 22) during the first 6 weeks of postnatal life. The results were compared with the enzyme activities measured in 2- to 6-year-old children. There were no significant differences of the mean lipase or trypsin activities between the two groups lipase; group I 13.7 +/- 7.9, group II 15.9 +/- 9.8 U/ml; trypsin: group I 7.9 +/- 4.7, group II 8.5 +/- 5.1 U/ml). The activities of both enzymes increased significantly and similarly in both groups with postnatal age (lipase: group I r = 0.732, p < 0.01, group II r = 0.743, p < 0.01; trypsin: group I r = 0.705, p < 0.01, group II r = 0.669, p < 0.01). At the end of the study the lipase activities of both groups reached approximately 35% of the values found in the older children, whereas the trypsin activities reached the reference values within the 1st month of life. The results indicate an asynchronously age-related development of lipase and trypsin. The development of the lipase activity is delayed in comparison to the trypsin activity which should be considered in the nutritional management of preterm infants.

Protein quality of human milk fortifier in low birth weight infants: effects on growth and plasma amino acid profiles.

Serum preprandial essential amino acid, urea and prealbumin concentrations, and growth rates were studied in appropriate for gestational age low birth weight infants fed one of three regimens: (1) human milk enriched with human milk protein (n = 17); (2) bovine whey protein hydrolysate (n = 18; and (3) a mixture of bovine proteins, peptides and amino acids designed to have an amino acid composition close to that of human milk proteins (n = 18). Energy and nitrogen intakes were similar in all groups. Growth rates and gross metabolic responses did not differ between the feeding groups. There were also no differences in the amino acid profiles between those infants fed human milk protein fortifier and mixed bovine protein fortifier. Infants fed the whey fortifier had significantly higher threonine concentrations in comparison to those fed exclusively human milk protein (287 +/- 63 mumol/l vs 168 +/- 26 mumol/l) whereas the levels of some other essential amino acids (i.e. valine, leucine, lysine, histidine, phenylalanine and tryptophan) were lower. The results indicate that growth rates and gross metabolic indices do not depend on the protein quality of human milk fortifiers. However, the addition of well balanced mixtures of bovine proteins to human milk results in amino acid profiles similar to those observed in LBW infants fed similar amounts of human milk proteins.

[Effect of the amino acid content of breast milk supplements on the amino acid profile in the plasma of newborn infants: human albumin in comparison with Eoprotin]. / Einfluss der Aminosäurezusammensetzung von Frauenmilchsupplementen auf das Aminosäureprofil im Plasma Frühgeborener: Humanalbumin im Vergleich mit Eoprotin.

The influence of amino acid composition of two human milk fortifiers (Eoprotin, Milupa AG, Germany, and human albumin) on plasma amino acid profiles was studied in 28 preterm infants after a 14-day feeding period. The concentrations of total essential amino acids increased in both feeding groups significantly if compared to the period without supplementation; only the concentrations of methionine and phenylalanine in the eoprotin group and those of threonine, methionine and isoleucine in the human albumin group did not increase significantly. However, only the concentrations of isoleucine (Eoprotin: 79 +/- 19 mumol/l; human albumin: 45 +/- 20 mumol/l, p < 0.001) and methionine (Eoprotin: 26 +/- 10 mumol/l, human albumin: 16 +/- 10 mumol/l, p = 0.014) were significantly different between the two feeding groups. There was a significant correlation between the differences in the serum concentrations and the ones of each essential amino acid concentration in the fortifiers (r = 0.951). The results indicate that the amino acid composition of human milk fortifiers must be taken into consideration to achieve optimal nutritional management of preterm infants.

Fetal lung maturity evaluation with fluorescence polarization of the amniotic fluid.

Fluorescence polarization of the amniotic fluid from 39 high risk pregnancies requiring preterm delivery was measured in order to assess the maturity of the fetal lung. The study population included 15 cases of intrauterine growth retardation, ten maternal hypertension, five maternal Hodgkin's disease, three placenta previa, two fetal malformation, two polyamnios, one untreated diabetes, one maternal nephropathy. All patients underwent a single amniocentesis before deciding whether to deliver a preterm baby and FP of the amniotic fluid was done within two hours from amniocentesis. In five cases this was > 0.311, the cut-off limit taken as an indicator of fetal pulmonary status, and three of these developed respiratory distress syndrome. In 34 cases FP values were < or = 0.311; in spite of the apparent lung maturity two of these newborns developed respiratory distress syndrome. On the basis of these results the FP sensitivity was calculated as 60%, specificity 94% and the overall accuracy 90%.