Fructose in fetal cord blood and its relationship with maternal and 48-hour-newborn blood concentrations.

BACKGROUND: Studies have suggested that different non-glucose sugars and sugar alcohols play a role in placental and fetal metabolism. However, the role of fructose in the fetal and newborn metabolism is unclear and studies are scarce. AIM: Our objective was to investigate the presence of fructose in umbilical cord blood in full-term gestation and its relationship with maternal and 48-hour-old- newborn blood concentrations, to evaluate fructose production by the fetus and newborn infant. METHODS: Blood fructose and glucose concentrations were determined by HPLC in 26 paired samples of maternal blood, umbilical cord vein, and peripheral newborn blood at 48 h after birth. ANOVA, the Friedman Analysis of Variance on Ranks and the Pearson correlation with p<0.05 were used. RESULTS: Fructose concentration in umbilical cord blood was higher than maternal blood (p=0.024), suggesting endogenous fructose production by the fetal-placental unit via the sorbitol pathway. Fructose concentrations were higher in newborns at 48 h after birth than in the fetal umbilical cord blood (p=0.004), suggesting that fructose production is a continuous process from fetus to newborn. CONCLUSIONS: Fructose production by the sorbitol pathway, present in the fetus and newborn, is an alternative pathway in glucose metabolism probably used to maintain redox balance in the fetus. We suggest that endogenous fructose, similar to dietary ingested fructose, under physiological conditions produces the backbone for triacylglycerol and lipid synthesis in the fetus and newborn. Therefore the route for metabolizing fructose is already present in the early steps of human development.

Conductive hearing loss in children with bronchopulmonary dysplasia: a longitudinal follow-up study in children aged between 6 and 24 months.

AIMS: To determine the occurrence of isolated and recurrent episodes of conductive hearing loss (CHL) during the first two years of life in very low birth weight (VLBW) infants with and without bronchopulmonary dysplasia (BPD). STUDY DESIGN, SUBJECTS AND OUTCOME MEASURES: In a longitudinal clinical study, 187 children were evaluated at 6, 9, 12, 15 18 and 24 months of age by visual reinforcement audiometry, tympanometry and auditory brain response system. RESULTS: Of the children with BPD, 54.5% presented with episodes of CHL, as opposed to 34.7% of the children without BPD. This difference was found to be statistically significant. The recurrent or persistent episodes were more frequent among children with BPD (25.7%) than among those without BPD (8.3%). The independent variables that contributed to this finding were small for gestational age and a 5 min Apgar score. CONCLUSIONS: Recurrent CHL episodes are more frequent among VLBW infants with BPD than among VLBW infants without BPD.

Fatores de risco associados à mortalidade de recém-nascidos de muito baixo peso na cidade de Botucatu, São Paulo, no período 1995-2000 / Risk factors for mortality in very low birth-weight infants in the city of Botucaty, State of São Paulo, during the period 1995-2000

OBJETIVOS: avaliar as práticas assistenciais, a ocorrência de doenças, a mortalidade durante a hospitalização e os fatores associados em recém-nascidos prematuros de muito baixo peso (PT-MBP). MÉTODOS: estudo transversal comparando dois períodos: 1995-1997 e 1998-2000 e envolvendo todos os PT-MBP nascidos vivos (n= 451), em um centro perinatal, em Botucatu, São Paulo, Brasil. Os fatores de risco pré-natal e pós-natal foram submetidos a análise multivariada. RESULTADOS: a mortalidade diminuiu de 36,2 por cento para 29,5 por cento. A sobrevida melhorou e foi superior a 50 por cento a partir de 28 semanas e de 750 g de peso. O uso de corticosteróide antenatal aumentou de 25 por cento para 42 por cento, o surfactante exógeno de 14 por cento para 28 por cento, com redução na incidência e gravidade da síndrome do desconforto respiratório. A regressão logística mostrou que a síndrome do desconforto respiratório grave, Odds ratio=18, e a sepse precoce, Odds ratio=2,8, foram importantes fatores de risco para morte em 1995-1997. No período de 1998-2000, a sepse precoce e tardia, Odds ratio=10,5 e 12, respectivamente, aumentaram o risco de morte. CONCLUSÕES: a melhora na assistência perinatal diminuiu a mortalidade do PT-MBP. O aumento na exposição antenatal ao corticosteróide diminuiu a gravidade da síndrome do desconforto respiratório. Em 1998-2000, a sepse foi o único fator de risco para morte.

OBJECTIVES: to evaluate perinatal care, the incidence of diseases, and mortality during hospitalization and associated risk factors in very low birth-weight infants (VLBW). METHODS: a cross sectional survey comparing two periods: 1995-1997 and 1998-2000, including all live-born VLBW preterm infants (n= 451), delivered at a level III perinatal center in the city of Botucatu, State of São Paulo, Brazil. The antenatal and postnatal risk factors were analyzed using multivariable techniques. RESULTS: mortality decreased from 36.2 percent to 29.5 percent. The survival of infants 750 g, and 28 weeks' gestation improved and was higher than 50 percent. The use of antenatal corticosteroid increased from 25 percent to 42 percent, surfactant therapy from 14 percent to 28 percent, and the incidence and severity of respiratory distress syndrome decreased. Regression analysis showed that severe respiratory distress syndrome (Odds ratio= 18) and early-onset sepsis (Odds ratio=2.8) were important risk factors for death in 1995-1997. During 1998-2000 early- and late-onset sepsis (Odds ratio=10.5 and 12 respectively) increased the risk of death. CONCLUSIONS: the improvement in perinatal care has reduced the mortality of VLBW infants. The increase in antenatal corticosteroid exposure has reduced the severity of respiratory distress syndrome. In 1998-2000, sepsis was the only risk factor associated with death.

Blood galactose and glucose levels in mothers, cord blood, and 48-hour-old breast-fed full-term infants.

BACKGROUND: Although galactose is an important component in human lactose, there are few reports of its role in the newborn metabolism. OBJECTIVE: To determine the relationship of blood galactose and glucose levels in mothers, cord blood, and breast-fed full-term newborn infants. METHODS: Maternal and cord vein blood samples were obtained from 27 pregnant women at delivery, and from their breast-fed, full-term newborns 48 h later. Galactose and glucose were determined by HPLC. Statistical analysis used ANOVA and Pearson correlation with p < 0.05. RESULTS: Maternal galactose concentrations (0.08 +/- 0.03 mmol/l) were similar to cord blood galactose (0.07 +/- 0.03 mmol/l; p = 0.129). However, newborn blood galactose (0.05 +/- 0.02 mmol/l) was significantly lower than both cord (p = 0.042) and maternal blood (p = 0.002). Maternal blood glucose levels (4.72 +/- 0.86 mmol/l) were higher than cord blood (3.98 +/- 0.57 mmol/l; p < 0.001), and cord blood concentrations were higher than newborn blood levels (3.00 +/- 0.56 mmol/l; p < 0.001); all values expressed as mean +/- SD. Significant correlation was only seen between maternal and cord blood galactose levels (r = 0.67; p < 0.001) and glucose levels (r = 0.38; p = 0.047). CONCLUSION: The association and similarity between maternal and cord blood galactose levels suggest that the fetus is dependent on maternal galactose. In contrast, the lower galactose levels in newborn infants and a lack of association between both suggest self-regulation and a dependence on galactose ingestion.

Fração de excreção de sódio, osmolaridade e densidade urinária em recém-nascidos prematuros alimentados com leite humano de banco adicionado de suplemento / Fractional sodium excretion, urinary osmolality and specific gravity in preterm infants fed with fortified donor human milk

OBJETIVO: Esta pesquisa teve como objetivo investigar, em recém-nascidos prematuros, os efeitos renais da adição de suplemento ao leite humano de banco. MÉTODO: Ensaio clínico de intervenção, tipo antes e após, envolvendo 28 recém-nascidos prematuros distribuídos em dois grupos conforme a idade pós-concepção no início do estudo: GI < 34 semanas (n = 14) e GII > 34 semanas (n = 14), avaliados em três momentos: M1 = uso do leite humano de banco sem suplemento; M2 = após 3 dias e; M3 = 10-13 dias de uso do leite com suplemento. Foram comparadas oferta alimentar, evolução ponderal, fração de excreção de sódio, osmolaridade e densidade urinária pela análise estatística two-way ANOVA para medidas repetidas. RESULTADOS: A oferta hídrica, energética e de sódio foi similar nos dois grupos, e a evolução ponderal foi satisfatória. Nos prematuros < 34 semanas de idade pós-concepção, o sódio sérico diminuiu ao final do estudo e a fração de excreção de sódio foi elevada no início e final do estudo (M1 = 2,11±1,05; M2 = 1,25±0,64; M3 = 1,62±0,88), com diferença significante em relação ao GII (M1 = 1,34±0,94; M2 = 0,90±0,54; M3 = 0,91±0,82). Osmolaridade e densidade urinária foram normais, sem diferenças entre grupos e momentos. CONCLUSÃO: Não foi detectado efeito adverso na função renal dos prematuros com o uso de leite humano de banco suplementado.

OBJECTIVE: This research was performed with the objective of investigating the renal effects on premature newborn infants of fortifying banked donor human milk. METHODS: Clinical intervention trial, of the before-and-after type, involving 28 premature newborn infants split into two groups by postconceptional age at the start of the study: GI < 34 weeks (n = 14) and GII > 34 weeks (n = 14), and assessed at three sample points: S1, on unfortified donor human milk, S2, after 3 days, and S3, after 10-13 days on fortified donor human milk. Nutrient intake, weight gain, fractional sodium excretion, urinary osmolality and specific density were compared with two-way ANOVA for repeated measures. RESULTS: Fluids, energy and sodium intakes were similar for both groups, and weight gain was satisfactory. Among the preterms with < 34 weeks postconceptional age, serum sodium was lower at the end of the study and the fractional sodium excretion was elevated at the start and at the end of the study (S1 = 2.11±1.05; S2 = 1.25±0.64; S3 = 1.62±0.88), with a significant difference in relation to GII (S1 = 1.34±0.94; S2 = 0.90±0.54; S3 = 0.91±0.82). Osmolality and urinary specific density were normal, with no differences between groups or collection dates. CONCLUSIONS: No adverse effects on the renal function of these preterms were detected as a result of being fed fortified donor human milk.

Fractional sodium excretion, urinary osmolality and specific gravity in preterm infants fed with fortified donor human milk.

OBJECTIVE: This research was performed with the objective of investigating the renal effects on premature newborn infants of fortifying banked donor human milk. METHODS: Clinical intervention trial, of the before-and-after type, involving 28 premature newborn infants split into two groups by postconceptional age at the start of the study: GI < 34 weeks (n = 14) and GII >or= 34 weeks (n = 14), and assessed at three sample points: S1, on unfortified donor human milk, S2, after 3 days, and S3, after 10-13 days on fortified donor human milk. Nutrient intake, weight gain, fractional sodium excretion, urinary osmolality and specific density were compared with two-way ANOVA for repeated measures. RESULTS: Fluids, energy and sodium intakes were similar for both groups, and weight gain was satisfactory. Among the preterms with < 34 weeks postconceptional age, serum sodium was lower at the end of the study and the fractional sodium excretion was elevated at the start and at the end of the study (S1 = 2.11+/-1.05; S2 = 1.25+/-0.64; S3 = 1.62+/-0.88), with a significant difference in relation to GII (S1 = 1.34+/-0.94; S2 = 0.90+/-0.54; S3 = 0.91+/-0.82). Osmolality and urinary specific density were normal, with no differences between groups or collection dates. CONCLUSIONS: No adverse effects on the renal function of these preterms were detected as a result of being fed fortified donor human milk.

[Minerals in the nutrition of extremely low birth weight infants]. / Importância dos minerais na alimentação do pré-termo extremo.

OBJECTIVE: To review the literature on the role of calcium, phosphorus and trace elements in the nutrition of extremely low birth weight infants, considering their importance for metabolism, bone mineralization and as dietary components. SOURCES OF DATA: MEDLINE, the Cochrane Database of Systematic Reviews and books on nutrition were searched between 1994 and 2004. Original research studies and reviews were selected. SUMMARY OF THE FINDINGS: Extremely preterm infants are frequently growth-restricted at hospital discharge as a consequence of difficulties in the provision of adequate nutrition. The long-term effects of this growth restriction need to be determined. There is a paucity of studies about the role of minerals, especially micronutrients, in the nutrition of extremely preterm infants. The principal focus of this review was on calcium and phosphorus metabolism, bone mineralization and parenteral and enteral supplementation. A critical evaluation of post-discharge nutrition and its influence upon growth and bone mineralization was presented. Selenium and zinc requirements and the role of selenium as an antioxidant with possible effects on free radical diseases of the preterm infant were discussed. CONCLUSIONS: Extremely preterm infants have low mineral reserves and, as a consequence, may have deficiencies in the postnatal period if they do not receive parenteral or enteral supplementation. More studies are needed to elucidate the actual requirements and the appropriate supplementation of micronutrients. There are controversies about the outcome and the influence of post-discharge nutrition on bone disease of prematurity.

Importância dos minerais na alimentação do pré-termo extremo / Minerals in the nutrition of extremely low birth weight infants

OBJETIVO: Revisão crítica da literatura sobre os minerais cálcio, fósforo e microelementos na nutrição do pré-termo extremo, considerando a importância no crescimento, mineralização óssea e como componente de dietas. FONTES DOS DADOS: Utilizamos o banco de dados MEDLINE e o Cochrane Database of Systematic Reviews, de 1994 a 2004. Selecionamos artigos com enfoques originais, artigos de revisão e livros específicos. SíNTESE DOS DADOS: As dificuldades na nutrição de prematuros extremos aumentam a freqüência de prematuros com restrição de crescimento, cujas conseqüências futuras estão para serem determinadas. Todavia, há pouca literatura sobre minerais, especialmente sobre micronutrientes na nutrição do pré-termo extremo, considerando-se o deficiente armazenamento e a importância destes em nutrição. O principal enfoque desta revisão foi sobre o cálcio e o fósforo na mineralização óssea e na suplementação em nutrição parenteral e enteral, bem como a avaliação crítica da nutrição pós-alta sobre a mineralização óssea. São abordadas as necessidades de micronutrientes, principalmente selênio e zinco, e a função antioxidante do selênio na provável prevenção de doenças do prematuro com atuação de radicais livres. CONCLUSAO: Considerando os baixos estoques de minerais em prematuros extremos, há necessidade de mais pesquisas sobre minerais na nutrição destes prematuros para definir suas reais necessidades, os aspectos metabólicos, bem como aplicar os conhecimentos na formulação de dietas que permitam prevenir quadros de deficiência e conseqüências a longo prazo. Ainda há controvérsias sobre a influência de fórmulas pós-alta sobre a evolução da doença óssea da prematuridade.

Uso antenatal de corticosteróide e evolução clínica de recém-nascidos pré-termo / Antenatal corticosteroid use and clinical evolution of preterm newborn infants

OBJETIVO: Descrever a freqüência de utilização de corticosteróide antenatal e a evolução clínica dos recém-nascidos pré-termo. MÉTODOS: Estudo observacional prospectivo tipo coorte de todos os neonatos com idade gestacional entre 23 e 34 semanas nascidos na Rede Brasileira de Pesquisas Neonatais entre agosto e dezembro de 2001. Os prontuários médicos foram revistos, as mães entrevistadas e os pré-termos acompanhados. A análise dos dados foi realizada com o teste do qui-quadrado, t de Student, Mann-Whitney, ANOVA e regressão logística múltipla, com nível de significância de 5 por cento. RESULTADOS: Avaliaram-se 463 gestantes e seus 514 recém-nascidos. As gestantes tratadas tiveram mais gestações prévias, consultas de pré-natal, hipertensão arterial e maior uso de tocolíticos. Suas crianças apresentaram melhores escores de Apgar no 1º e 5º minutos, menor necessidade de intervenção na sala de parto e menor SNAPPE II. Nasceram com maior peso e idade gestacional, receberam menos surfatante exógeno, ventilação mecânica e oxigenoterapia. Após regressão logística, o uso pré-natal de corticosteróides manteve de forma independente o efeito protetor para as condições de nascimento e para a diminuição do tempo de ventilação mecânica e esteve associado com aumento na ocorrência de sepse neonatal. CONCLUSAO: O uso do corticosteróide antenatal foi associado a melhor atendimento pré-natal. As crianças nasceram em melhores condições e tiveram melhor evolução, porém com maior risco de infecção.