[Non-invasive method of arterial oxygen saturation monitoring in the neonatal intensive care unit (with a review of blood oxygen monitoring methods)]. / Non-invasieve trendbewaking van de arteriële zuurstofsaturatie in de neonatale intensive care (met overzicht van bloedzuurstofbewakings-methoden).

Recently a new method (pulse oximetry) became available, which enables us to monitor non-invasively the arterial oxygen saturation in neonates. We tested this new method in several premature infants, from the time that oxygen therapy was instituted (IPPV; CPAP), in order to evaluate its potential clinical use. In stable patients we found a better correlation (r = 0.90) between the oxygen saturation measured transcutaneously and that measured in an arterial blood sample that the correlation (r = 0.22) between oxygen tensions measured either transcutaneously or in a blood sample. Although transcutaneous monitoring of the arterial oxygen saturation, especially because it is a continuous process, can be a valuable adjunct in monitoring premature infants who receive extra oxygen, it can not replace the necessity for intermittent blood sampling to determine 'arterial blood gases'. One should also remember that; due to the fact that the position of oxyhemoglobin dissociation curve depends on several factors; the SO2 can not simply be derived from the pO2 or vice versa. Continuous transcutaneous monitoring of oxygen saturation may decrease the frequency with which arterial blood samples for blood gas measurement have to be taken.

Total parenteral nutrition and sepsis.

In 1279 very premature or very low birthweight infants the use and duration of treatment with total parenteral nutrition were associated with short gestational age and low birth weight. Infants treated with total parenteral nutrition had a higher risk of sepsis usually caused by Staphylococcus epidermidis or Staphylococcus aureus.

Tolerance of intravenously administered lipid in newborns.

The tolerance for intravenously administered Intralipid in 262 premature and sick newborns was studied. The serum concentrations of triglycerides and of free fatty acids were determined during total parenteral nutrition including Intralipid in a maximum daily dose of 2 g/kg. A serum concentration of 1.5 mmol/l or higher was found in 270 out of 985 triglyceride determinations (27.4%). In the 262 infants serum triglyceride concentrations were found elevated once or more in 117 cases (44.7%). Serum free fatty acids concentrations were normal. A highly significant inverse correlation (p less than 0.001) between birth weight and triglyceride level was found. Elevated serum triglyceride concentrations were observed especially in preterm small-for-gestational-age infants.

Amino acids in parenteral nutrition of preterm infants. Comparison of oral and parenteral supply.

Parenteral feeding of preterm infants has been accepted as an alternative form of nutrition in those infants unable to accept oral feeding. The amount of amino acid nitrogen and the composition of the amino acid solution to be used, however, have not yet been defined. The amino acid intake and the plasma amino acid concentration of three groups of preterm infants were compared. Twenty-three infants were fed parenterally. Of these, 16 were studied during the first week of life (group I) and 7 during the second week (group II). A control group of 9 infants fed with oral formula was also studied in the second week (group III). In general, plasma amino acid concentrations in the parenterally fed groups were higher than in the orally fed group, in spite of a lower intake. Comparison of the amino acid intake of groups I and II relative to group III, with the plasma amino acid concentrations of groups I and II relative to group III, revealed a rather constant ratio with the exception of tyrosine and aspartic acid, where higher values were found. It is concluded that further increase in the amino acid nitrogen in parenteral feeding of preterm infants requires a more adapted preparation.

Intensive care for sick neonates, the earlier the better: improved survival rate of IRDS children, referred by means of a mobile neonatal intensive care unit.

A mobile intensive care unit has been used since september 1976 in the region referring sick neonates to the two University Hospital NICU's of Amsterdam. The present study compares two groups of neonates (suffering from the I.R.D.S.) i.e. a group that had been referred by non specialized transport teams (N S T-group) and a group admitted after institution of the neonatal-transport service (S. T.-group). Significant difference is found in the temperature on admission (S T group greater than N S T group). In the N S T-and the S T-group the need for ventilatory assistance was not significantly different but in the S T-group it was started significantly earlier. Survival after institution of ventilatory assistance and overall-survival are significantly better in the S T-group. These conclusions point to the fact that administering intensive care to sick neonates as early as possible and transportation of this group by means of special "neonatal"-transport services increases their survival rates.

A case of focal dermal hypoplasia (Goltz syndrome) with some new aspects.

A case of Focal Dermal Hypoplasia (Goltz syndrome), diagnosed at birth, is reported. Some findings not formerly described (hemimelia, schizis of the palatum molle and the absence of one umbilical artery) are reported. Normal findings in chromosome studies with banding techniques are discussed.