RESUMEN
OBJECTIVE: Preterm infants are more likely to have episodes of abdominal distention, emesis, and gastric residuals 24 hours after their first screening examination for retinopathy of prematurity (ROP) than on the day preceding the examination. Because these feeding problems reflect abnormalities in motor function, the purpose of this study was to compare antral and duodenal motor activity and gastric emptying in preterm infants before and after the instillation of mydriatics. STUDY DESIGN: Using a low compliance continuous perfusion manometric system, we recorded antral and duodenal fasting motor activity in 11 preterm infants before and after the instillation of mydriatics for their first screening examination for ROP. Gastric emptying was compared before and after the eye examination. RESULTS: Although the number of antral motor contractions remained relatively constant throughout the study, duodenal motor contractions decreased nearly fourfold after the instillation of mydriatics versus that seen before (P <.01). Gastric emptying was significantly delayed after the completion of the eye examination compared with that seen before the examination (P <.05). CONCLUSION: Current doses of mydriatics inhibit duodenal motor activity and delay gastric emptying, and these gastrointestinal effects of mydriatics may underlie the feeding difficulties seen in preterm infants on the day of screening examinations for ROP.
Asunto(s)
Vaciamiento Gástrico/efectos de los fármacos , Motilidad Gastrointestinal/efectos de los fármacos , Recien Nacido Prematuro/fisiología , Midriáticos/efectos adversos , Duodeno/efectos de los fármacos , Duodeno/fisiología , Humanos , Recién Nacido , Midriáticos/administración & dosificación , Antro Pilórico/efectos de los fármacos , Antro Pilórico/fisiología , Retinopatía de la Prematuridad/diagnóstico , Estudios RetrospectivosRESUMEN
We evaluated the operation of the Yellow Springs Instrument Co. (YSI) glucose analyzer (model 23A) by clinical nurses for the measurement of blood glucose in the intensive care nursery. In vitro performance was determined with the use of aqueous standards; with a 2-point calibration of 0.0 and 200 mg/dl, a precision of better than 1.0% of each standard (25, 50, 100, 200 mg/dl) was achieved, and the linearity was excellent (Y = 0.99X - 0.49, r = 0.99). The YSI correlated well with a manual spectrophotometric glucose oxidase method (r = 0.99) and the Kodak Ektachem analyzer (r = 0.98) using human umbilical cord blood samples. Five trained clinical nurses performed all YSI and glucose reagent strip analyses, including all in vitro and patient samples. Four reagent strip methods were compared with the YSI from 104 neonatal heel-stick blood samples: Glucometer II with memory (r = 0.73), Glucostix (r = 0.74), Dextrostix (r = 0.70), and Chemstrip bG (r = 0.83). We conclude that clinical nurses can and do learn to use the YSI with excellent precision and that the YSI represents an improved method for measuring glucose concentrations in the newborn intensive care nursery.
Asunto(s)
Análisis Químico de la Sangre/instrumentación , Glucemia/análisis , Unidades de Cuidado Intensivo Neonatal , Análisis Químico de la Sangre/economía , Costos y Análisis de Costo , Estudios de Evaluación como Asunto , Humanos , Recién Nacido , Juego de Reactivos para DiagnósticoRESUMEN
Galactose is a major nutrient in normal newborn infants and serves as a substrate for energy production and fuel storage and a regulator of carbohydrate assimilation. Inborn errors of galactose metabolism have contributed to our understanding of the potential toxicity of this carbohydrate. In addition to the classic acute manifestations of neonatal galactosemia, long-term follow-up of surviving patients have revealed unusual neurodevelopmental and reproductive problems. Many investigators have suggested that the newborn infant can utilize galactose better than adults and that neonatal galactose assimilation exceeds that of glucose. Galactose may be an excellent substitute for glucose among hyperinsulinemic infants of diabetic mothers or premature infants with glucose intolerance. However, until further investigations are performed to define the role of galactose in newborn nutrition and to determine its potential toxicity, galactose should not be used as the primary carbohydrate in sick newborn infants.
Asunto(s)
Galactosa/metabolismo , Galactosemias/genética , Recién Nacido , Permeabilidad de la Membrana Celular , Metabolismo Energético , Femenino , Estudios de Seguimiento , Galactoquinasa/deficiencia , Galactosa/fisiología , Galactosemias/metabolismo , Galactosemias/terapia , Galactosafosfatos/metabolismo , Variación Genética , Humanos , Lactante , Absorción Intestinal , Hígado/metabolismo , Embarazo , Diagnóstico Prenatal , Transferasas/deficiencia , UDPglucosa 4-Epimerasa/deficiencia , UTP-Hexosa-1-Fosfato Uridililtransferasa/deficienciaRESUMEN
Blood galactose concentrations were measured in 55 neonates consuming at least 80 ml/kg/day of lactose-containing formula. The range of galactose concentration immediately after feeding was 0.8 to 4.2 mg/dl, with a mean of 1.5 +/- 0.2 mg/dl. Galactose concentration fell rapidly after feeding, and normal values for the population fell with a half-life of 45 minutes. Considering galactose as a potential intravenous nutrient, six glucose-intolerant premature infants were given galactose-containing solutions intravenously using a double-blind randomized crossover protocol. Infants were chosen who had sustained hyperglycemia (150 mg/dl) and glucosuria (2+ Clinitest) requiring glucose infusion at a rate below 7 mg/kg/minute for more than 24 hours. Compared to the control glucose period, intravenous alimentation with a solution containing carbohydrate as 50% glucose and 50% galactose resulted in a 65% increase in total carbohydrate infusion rate, normalization of the blood glucose concentration, and decreased glucosuria. Blood galactose concentration averaged 15 mg/dl, and no clinical or biochemical evidence of galactose toxicity was noted.