Characterization of D-amino acids in colostral, transitional, and mature preterm human milk.

D-Amino acids are regulatory molecules that affect biological processes. Therefore, being able to accurately detect and quantify these compounds is important for understanding their impact on nutrition and health. There is a paucity of information regarding D-amino acids in human milk. We developed a fast method for simultaneous analysis of amino acid enantiomers in human milk using liquid chromatography with tandem mass spectrometry. The method enables the separation of 41 amino acids without chemical derivatization. Our results revealed that human milk from mothers of preterm infants contains concentrations of D-amino acids that range from 0.5 to 45% that of their L-counterparts and that levels of most D-amino acids decrease as the milk production matures. Moreover, we found that Holder pasteurization of milk does not cause racemization of L-amino acids. To our knowledge, this is the first study to describe percentages of D-amino acid levels in human milk; changes in D-amino acid concentration as the milk matures; and the effect of Holder pasteurization on D- and L-amino acid concentrations in human milk.

Congenital Adhesion Band Presenting as Intestinal Perforation in an Extremely Low Birth Weight Infant.

A 23 1/7 -week-old and 560-g-weighing premature male infant was evaluated on day of life 33 for increased frequency of bradycardias, bilious residual, and an increase in abdominal girth. Physical examination was notable for distended and mild tender abdomen. Investigations revealed pneumoperitoneum with dilated bowel loops and a normal acid-base balance. An urgent exploratory laparotomy demonstrated isolated jejunal perforation with an adhesive band extending from the omentum to the base of the mesentery. A segmental jejunal resection followed by an end-to-end anastomosis was performed. The diagnosis of intestinal perforation was inconsistent with focal spontaneous intestinal perforation and necrotizing enterocolitis. Decision to perform exploratory laparotomy led to diagnosis of congenital adhesion band, a rare clinical condition, and the patient had a favorable outcome. This premature infant made an excellent recovery and the upper gastrointestinal (GI) study demonstrated that the anastomotic site was intact. He is currently tolerating advancing enteral feeds.