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Biomedical subjects

B L Salle

Publications and source records attributed to B L Salle.

At least 19 recordsLinked to original sources
PubMed1995

Nutritional evaluation of protein hydrolysate formulas.

Growth parameters, biochemical indice of protein metabolism and plasma Amino acid (AA) concentrations were investigated during the first month of life in term infants (n = 61) fed various protein hydrolysate formulas (whey (WHF, n = 3), soy collagen (SCHF, n = 1) and whey-casein hydrolysate formulas (WCHF, n = 1)). In addition, metabolic balance studies were performed in 10 infants fed WHF and in 5 fed WCHF. Comparatively to breast fed infants, growth reduction and decrease in plasma protein concentrations were observed with the use of one of the WHF and in a lesser extent with the SCHF and the WCHF. Plasma amino acid pattern reflected the AA content of the formulas. Whey hydrolysate formulas induced mainly an increase in threonine and a decrease in tyrosine concentrations. Soy-collagen hydrolysate formula led to an increase of non-essential amino acids, such as glycine and hydroxyproline and a decrease in plasma lysine and cystine. Whey-casein hydrolysate formula induced a plasma amino acid pattern close to the profile observed in breast fed infant. Metabolic balance studies showed a relative reduction in nitrogen absorption and utilisation in the infants fed the WHF and the WCHF. In addition a drastic reduction in fat, calcium and phosphorus absorption was also observed with the use of the WCHF. In preterm infants (n = 19) fed whey predominant hydrolysed preterm formulas (n = 3), metabolic balance studies an plasma AA concentration were evaluated at the end of the first month of life at 34 weeks of gestation age. Comparatively to similar preterm infants fed conventional preterm formulas, a relative reduction in nitrogen absorption (83% vs 90%) and retention (64 vs 70%) as well as in phosphorus absorption (78 vs 89%) was observed. Calcium retention was similar (48 vs 45 mg/kg/d) but calcium intake was significantly higher in infants fed hydrolysate formulas 120 vs 91 mg/kg/d. Plasma amino acid concentrations were related to amino acid composition of the formulas. Compared with the standard preterm formulas, all three protein hydrolysate formulas led to a significant increase in plasma threonine and a decrease in tyrosine and phenylalanine concentrations. In addition, there was a reduction in plasma histidine, valine, leucine, cystine, methionine and/or tryptophane with some of the hydrolysate formulas used. In conclusion, these studies provide evidence that protein hydrolysed formulas are not equivalent to whole protein formulas in terms of nutritional efficiency for preterm and term infants. Therefore further extensive nutritional studies on growth, biochemical indices of protein metabolism and metabolic balance, including minerals and trace elements, appear to be necessary before maintaining and promoting the use of such formulas for teh potential benefits on atopic disease in preterm and in full-term newborn infants.

Breast Feeding↗
PubMed1994

Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia.

OBJECTIVES: a) To assess the efficiency of preoperative stabilization with the use of high-frequency oscillatory ventilation in the treatment of congenital diaphragmatic hernia; b) to determine early prognosis factors. DESIGN: Prospective, consecutive patient study. SETTING: A tertiary neonatal intensive care unit in a university hospital. PATIENTS: All patients admitted to the neonatal intensive care unit with a diagnosis of congenital diaphragmatic hernia between April 1990 and June 1993 (n = 18). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eleven infants had an antenatal diagnosis. Ventilatory settings, blood gas values, arterial-alveolar oxygen ratio, and oxygenation index were recorded on admission and every 3 hrs thereafter until surgery. Surgery was performed if the FIO2 was < 0.3 and mean airway pressure was approximately 9 cm H2O, while the infants were ventilated with high-frequency oscillation. Mean duration of high-frequency oscillatory ventilation was 57 +/- 52 hrs before surgery and 60 +/- 104 hrs after surgery. Overall survival rate was 72%. Infants were divided into two groups, according to the time of surgery. Group 1 (n = 12) patients were operated on in the first 48 hrs of life; on admission, all group 1 patients had an arterial-alveolar oxygen ratio of > or = 0.3 and an oxygenation index of < or = 10, and all recovered. Group 2 (n = 6) consisted of patients for whom preoperative stabilization was difficult to achieve. One infant died before surgery. Four other infants had congenital malformations and subsequently died. Only one infant survived. In this group, the arterial-alveolar oxygen ratio and oxygenation index on admission were 0.08 +/- 0.05 and 33.2 +/- 14.6, respectively (p < .01 vs. group 1). CONCLUSIONS: a) This study demonstrated the efficiency of preoperative stabilization using high-frequency oscillation in the treatment of congenital diaphragmatic hernia. b) An arterial-alveolar oxygen ratio of > or = 0.3 and an oxygenation index of < or = 10 on admission are associated with a rapidly completed surgical procedure and a good outcome.

Female↗
PubMed1994

Plasma amino acid and protein concentrations in infants fed human milk or a whey protein hydrolysate formula during the first month of life.

The aim of the study was to compare growth parameters, biochemical indices of protein metabolism and plasma amino acid concentrations in infants fed either human milk (n = 12) or a whey protein hydrolysate formula (n = 13) during the first month of life. Growth and gain in skin fold thickness were similar in both groups whereas serum protein concentration was significantly decreased (57.4 +/- 3.9 versus 61.2 +/- 2.9 g/l) in the infants fed the whey hydrolysate formula. The discrepancies between the plasma amino acid pattern of the whey hydrolysate formula group and that of the human milk group lessened during the first month. Nevertheless, at a mean age of 33 days the plasma threonine concentration remained twice as high and the plasma tyrosine, phenylalanine and proline concentrations were significantly lower in the whey hydrolysate formula group than in the human milk group. Thus, compared with breast-fed infants, growth and most of the biological indices of protein metabolism were satisfactory in infants fed during the first month of life on a whey protein hydrolysate formula. Nevertheless, the decrease in total plasma protein concentration needs to be confirmed in a larger cohort of infants. In addition, further research is necessary to investigate the possible ways of reducing the hyperthreoninemia and preventing other plasma amino acid disturbances since it would be desirable to obtain plasma amino acid levels similar to those of breast-fed infants.

Amino Acids↗
PubMed1994

Nutritional evaluation of various protein hydrolysate formulae in term infants during the first month of life.

The aim of the study was to compare, during the first month of life, growth parameters, biochemical indices of protein metabolism and plasma amino acid concentrations in newborn infants fed either human milk (n = 23), three different whey hydrolysate formulae (WHF 1, n = 13; WHF 2, n = 10; WHF 3, n = 13), a soy-collagen hydrolysate formula (SCHF n = 18) or a whey-casein hydrolysate formula (WCHF, n = 20). Growth parameters and the various protein concentrations determined in the infants fed WHF 1 and WHF 2 were similar to the values observed with human milk. With WHF 3, growth in weight, length and head circumference and serum total protein concentrations were reduced significantly whereas blood urea nitrogen was increased. With SCHF, growth in weight and length as well as serum total protein and transferrin concentration were decreased significantly, whereas serum IgG concentration was increased. With WCHF growth in length and serum transferrin concentration were decreased compared to the human milk group. In the various groups, the plasma amino acid pattern reflected the amino acid content of the formula. Whey hydrolysate formula induced mainly an increase in threonine and a decrease in tyrosine concentrations. Soy-collagen hydrolysate formula led to an increase of non-essential amino acids, such as glycine and hydroxyproline, and a decrease in plasma lysine and cystine. Whey-casein hydrolysate formula induced a plasma amino acid pattern close to the profile observed with human milk. Nevertheless, the plasma concentrations of most of the various amino acids were higher.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1994

Metabolic and energy balance in small- and appropriate-for-gestational-age, very low-birth-weight infants.

This study compared nutrient utilization and postnatal weight gain composition in eight appropriate for gestational age (AGA: birth weight 1293 +/- 107 g; gestational age 28.8 +/- 1.4 weeks) and eight symmetrically growth-retarded (SGA: birth weight 1110 +/- 230 g; gestational age 32.7 +/- 1.9 weeks), very low-birth-weight (VLBW) infants. There was no significant difference in protein, mineral and energy intake between AGA and SGA infants. Nitrogen absorption (84 +/- 3 and 83 +/- 4%) and nitrogen retention (356 +/- 48 and 352 +/- 43 mg/kg/day) were similar in both groups. Fat absorption tended to be lower in AGA (78 +/- 15%) than in SGA (87 +/- 4%) infants. Calcium, phosphorus and magnesium absorptions were similar in AGA and SGA infants. Metabolizable energy utilization was similar in both groups; about 55% was expended and 45% stored in new tissues. Energy expenditure was 58 +/- 4 kcal/kg/day in SGA infants and 61 +/- 9 kcal/kg/day in AGA infants. Weight gain and its composition were similar in both groups. We conclude that nutrient and energy utilization are similar in AGA and symmetrically growth-retarded, VLBW infants.

Energy Metabolism↗
PubMed1994

Red blood cell fatty acid composition in low-birth-weight infants fed either human milk or formula during the first months of life.

The fatty acid composition of red blood cell (RBC) phospholipids in low-birth-weight infants was determined immediately after delivery and during the first 3 months of life. In the first study, infants were fed either human milk or two formulas with different fatty acid compositions but no long chain polyunsaturated fatty acids (LCPUFA). Both groups of formula-fed infants had significantly lower levels of docosahexaenoic acid (DHA) in RBC phospholipids compared with breast-fed infants. RBC phospholipid DHA was similar in the two formula groups at all ages. In the second study, infants received either a non-supplemented or a LCPUFA-supplemented formula. DHA remained stable in RBC phospholipids of infants supplemented with LCPUFA, whereas DHA decreased in RBC phospholipids of unsupplemented infants. These results confirm that adding DHA to formulas is more effective than increasing 18:3 n-3 content, in maintaining RBC phospholipid DHA levels.

Breast Feeding↗
PubMed1994

Mineral balance and whole body bone mineral content in very low-birth-weight infants.

Fat and mineral metabolic balance studies were performed in 25 normal very low-birth-weight infants (< or = 1500 g at birth) fed either pooled pasteurized human milk supplemented with calcium, phosphorus and magnesium, or a preterm formula. Calcium, phosphorus and magnesium intake were similar in both groups and averaged 100 mg/kg/day, 72 mg/kg/day and 8 mg/kg/day, respectively. Calcium and phosphorus retention was higher in the subjects fed fortified human milk than in those receiving a preterm formula (65 +/- 14 and 62 +/- 9 mg/kg/day versus 55 +/- 12 and 47 +/- 7 mg/kg/day respectively). The difference was only significant for phosphorus. Magnesium retention was similar in the two groups and averaged 3 mg/kg/day. Fat intake and absorption was significantly higher in the preterm formula fed group than in the one fed fortified human milk (5.5 +/- 0.4 g/kg/day and 88 +/- 4% versus 4.2 +/- 1 g/kg/day, 79 +/- 6% respectively). Assessment of the whole body bone mineral content by dual energy X-ray absorptiometry was performed at 3 and 6 months of age in another group of 25 low-birth-weight infants fed either fortified human milk or a preterm formula. Whole body bone mineral content (BMCt) was low (43.3 +/- 30.8 g of hydroxyapatite) at 3 months of age (theoretical term) compared to normal full-term newborns at birth. There was no significant influence of the diet. At 6 months of age, BMCt reached 168.6 +/- 36.6 g, a value similar to that of full-term newborns, with no significant difference between the two regimen groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Density↗
PubMed1994

[Persistence of fetal circulation and high frequency oscillation].

High frequency ventilation (HVF) was used in 17 newborns with severe respiratory distress due to persistent fetal circulation. All patients except one had been treated previously but not satisfactorily by conventional ventilation. Four children died from neurological causes despite respiratory improvement. HVF failed in one case. Twelve newborns recovered without any sequelae. Thus HVF appears to be a most valuable ventilation technique in this situation.

Blood Gas Monitoring, Transcutaneous↗
PubMed1994

[High frequency oscillation ventilation after surfactant use in hyaline membrane disease. Outcome of ventilation parameters].

Surfactant therapy in hyaline membrane disease (HMD) does not suppress all risks of subsequent broncho-pulmonary dysplasia. This study aimed to estimate the efficacy of Surfexo followed by high frequency ventilation (HFV) on respiratory parameters and long term outcome. 47 neonates (44 premature) with HMD received first Surfexo then HFV whenever hypercarbia (pH < 7.25, PaCO2 > 7 kPa) and/or hypoxaemia (PaO2 < 7kPa, FiO2 = 0.5) continued. Surfactant was given at 3 hours of life (mean), HFV was started at 5 h (mean) and continued for 36 h (mean). FiO2 was lowered after a HFV of 3 h (p < 0.01) and mean broncho-tracheal pressure decreased after 12 h (p < 0.001). Six children deceased (1 from massive pulmonary haemorrhage, 5 from neurological complications), 1 developed pneumothorax (this was the only barotraumatic complication in our series), 2 children had a mild broncho-pulmonary dysplasia. All the 38 remaining patients had a good uncomplicated outcome. Thus Surfexo -HFV association appears to be an excellent therapy of HMD in newborns.

Birth Weight↗
PubMed1994

[High frequency ventilation in neonatal surgery].

High frequency oscillatory ventilation (HFOV) is one of the artificial ventilation techniques used for the treatment of severe respiratory distress in the neonatal period. We studied (between 1987 and 1992) 57 newborn infants ventilated by HFOV during surgery. The aim was to facilitate the surgical procedure without having any deleterious effects on the gas exchange or the hemodynamic state of the infant. Three groups were studied. Group I (thoracic procedures: oesophageal atresia and pulmonary malformations, n = 25), group II (diaphragmatic hernia, n = 22), group III (abdominal procedures, n = 10). In the thoracic surgery group, no deleterious effect related to the HFOV was reported. The hyperventilation noticed after anaesthetic induction was rapidly corrected by placing the patient in a lateral position. In the three groups, no intraoperative complications related to the HFOV were observed. The diaphragmatic hernia group was divided into two subgroups according to the timing of surgery (emergency surgery, surgery after stabilization). In the latter subgroup, surgery was performed when the ventilation and gas exchange conditions had significantly improved. This subgroup showed the highest survival rate. This technique of peroperative ventilation is specifically used in the thoracic and diaphragmatic procedures of term and preterm newborn infants. It achieves a more stable operative field with less pulmonary expansions and diaphragmatic movements. In spite of the fact that HFOV is seldom used during anaesthesia, this study confirms its safety as well as the simplicity of its monitoring.

Birth Weight↗
PubMed1994

[Congenital diaphragmatic hernia: results of the association of preoperative stabilization and oscillation ventilation. (A prospective study of 17 patients)].

The authors studied the efficacy of ventilation by high frequency oscillation in preoperative stabilization of 17 newborns with diaphragmatic hernia. This prospective study covered the pre-, intra- and postoperative periods. The preparation to surgery lasted 57 +/- 52 hr. The newborns were operated at 61 +/- 46 hr of life and the duration of postoperative mechanical ventilation was 184 +/- 200 hours. Two groups were differentiated retrospectively. The first group (n = 11) comprises neonates in whom a good preoperative stabilization was obtained and who underwent surgery before 48 hours. In this group all children survived at one month of life (one infant died at six months from cardiac malformation during heart surgery). The second group (n = 6) consists of neonates having required a longer time for stabilization. The operation was performed on the fifth day only. After one month, 5 children survived (one newborn died from intractable hypoxaemia at 5 days of life, surgical cure being impossible; 3 infants died belatedly from associated severe malformations). Predictive factors can be individualized: arteriolar-alveolar ratio, associated abnormalities and particularly these concerning heart, oxygenation index at birth, time required to stabilize the newborn condition. Nevertheless, the association of preoperative stabilization and ventilation by high frequency oscillation appears to improve the prognosis of congenital diaphragmatic hernia.

Birth Weight↗
PubMed1993

Pharmacokinetics of cyclosporin A in 16 newborn infants of renal or cardiac transplant mothers.

Fourteen renal transplant and one heart transplant mothers receiving cyclosporin (mean dosage: 273 +/- 19 mg/day) underwent a Caesarean section at a mean gestational age of 34.1 +/- 1.9 weeks. Circulating cyclosporin was assayed by HPLC. The mean blood levels in the mothers before the Caesarean section were 210 +/- 16 ng/ml, in cord blood 62 +/- 16 ng/ml (14 infants) and in the peripheral blood within 6 h of birth 31 +/- 12 ng/ml (15 infants); there was no correlation between maternal and cord levels, nor between peripheral blood levels at 2 h and cord blood levels. Cyclosporin levels were undetectable at day 3 in 12 infants, but low levels were found in 1 infant up to day 12. There was no toxic effect on the fetus or neonate.

Adult↗
PubMed1993

[High frequency ventilation by oscillation].

The basic principles and indications of high frequency oscillatory ventilation are presented. The authors have used this technics in more than 400 neonates with respiratory failure. High frequency oscillatory ventilation appears as a simple, efficient and safe method of ventilation in the treatment of neonatal respiratory distress.

Hernia, Diaphragmatic↗
PubMed1992

An analysis of the microbial flora of premature neonates.

An analysis of the microbial flora of 10 premature neonates hospitalized in a neonatal intensive care unit (NICU) was made. The babies had received neither antibiotics nor antiseptics and nine out of 10 were born by caesarean section. Samples were collected on the fourth or fifth day of life from 18 skin or mucosal sites. Detailed bacterial counts were obtained by plating out suitable dilutions of the samples on to selective media. Representative samples of each colony type were then subcultured and identified, using standard laboratory methods. Two hundred and fifty-six isolates of staphylococci were obtained and their susceptibility to 23 antibiotics tested. Only 11% of the samples were sterile. Coagulase-negative staphylococci (CNS) were the commonest species isolated and were predominant in every site studied. They were found in 79% of the samples and represented almost 81% of the neonates' flora. Eight species and biotypes of CNS were identified. In decreasing order of frequency, they comprised S. epidermidis (biotypes 1 and 2), S. hominis (biotype 1), S. warneri, S. haemolyticus, S. capitis, S. cohnii and S. hominis (biotype 2). CNS distribution appeared to be highly heterogeneous with no significant specificity of any species for a particular body site. The main quantitative and qualitative variations seemed to relate to the method of delivery, and the intensity and nature of exposure of the neonate to its local environment. A high level of antibiotic resistance was found among the CNS isolates (especially S. epidermidis and S. haemolyticus): penicillin G (96%), oxacillin (31%), erythromycin (52%) and gentamicin (28%). Moreover, multiresistant strains were numerous, supporting the nosocomial origin of CNS.

Bacterial Typing Techniques↗