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Biomedical subjects

G Putet

Publications and source records attributed to G Putet.

At least 91 records · Page 5Linked to original sources

Supplementation of pooled human milk with casein hydrolysate: energy and nitrogen balance and weight gain composition in very low birth weight infants.

Growth and nitrogen and energy balances were studied with a combined technique of nutrient balance and indirect calorimetry measurement in two groups of eight very low birth weight infants fed pooled pasteurized human milk (HM) or cow's milk casein hydrolysate supplemented HM (HM-Pr). There was no difference in the amount of energy absorbed (91 +/- 17 kcal/kg/day with HM-Pr versus 95 +/- 8 with HM-P) or in the growth rate. The infants fed HM-Pr had a higher nitrogen intake (602 +/- 80 versus 395 +/- 64 mg/kg/day; p less than 0.001), urinary nitrogen excretion (160 +/- 64 versus 78 +/- 16 mg/kg/day; p less than 0.005) and nitrogen retention (326 +/- 32 versus 252 +/- 48 mg/kg/day; p less than 0.01). They also had increased plasma concentrations of essential amino acids, urea nitrogen, and total protein without metabolic imbalance. Energy expenditure was higher (58 versus 49 kcal/kg/day; p less than 0.005) and energy storage lower (33 versus 47 kcal/kg/day; p less than 0.05) with HM-Pr. In percent of weight gain, protein and fat accretion represented 12 and 14% in HM-Pr group versus 10 and 27% in HM group. Very low birth weight infants fed casein hydrolysate supplemented pooled HM achieved a growth rate and a weight gain composition similar to the fetus.

Body Weight↗

[Supplementary parenteral nutrition in premature infants. Adaptation to amino acid intake].

The authors report a controlled study of the use of 2 types of amino-acid solutions for premature infants nutrition in the first days of life, one of the solution (solution I) being adapted for prematures. The average amino-acid blood levels in prematures receiving solution I were close to those observed in cord blood; Plasma taurine, alanine and arginine concentrations were significantly lower with normalized levels of aromatic amino-acids, lysine, taurine and proline; serum ammonia level was also lower. This study shows that using an amino-acid solution adapted to prematures as a supplement to parenteral nutrition during the first days of life allows to progressively increase the nitrogen intakes without inducing dangerous plasma levels of some amino-acids.

Amino Acids↗

[High-frequency ventilation].

The authors describe the methodology of high frequency ventilation in the newborn infant. Ventilation by oscillator (HFO) actually represents the best method for ventilation in newborn infants; the rate of ventilation is between 15 and 25 Hz/min. They report their experience of HFO use for the treatment of hyaline membrane disease in newborns.

High-Frequency Jet Ventilation↗

[Pulse oximetry and peroperative monitoring of low birth weight infants].

In 2 very low birth weight infants, a Nelcor 100 pulse oximeter was used during surgery. These 2 babies were anesthetized during the first 3 weeks of life, one for patent ductus arteriosus ligation and the other for ventriculo-peritoneal derivation. SaO2 was maintained between 85-95% in the straight portion of hemoglobin dissociation curves, where PaO2 values are from 7 to 10 KPal. During anesthesia, FiO2 was kept between 21 and 30%. Oximeters which have a fast response time seem to be a useful tool for monitoring blood oxygenation when it is difficult to estimate normoxia but very important to avoid hypoxia or over-oxygenation.

Ductus Arteriosus, Patent↗

[Periventricular leukomalacia in the premature infant with gestational age less than or equal to 32 weeks. Circumstances of onset and echographic aspects].

In a retrospective study of 83 preterm newborns of 32 weeks of gestation or less, isolated periventricular leukomalacia was found in 7 cases (8.4%). Ultrasonographic diagnosis was made in all cases during the first 3 days of life and cystic lesions always occurred during the first 40 days. Five of the 7 newborns suffered from in utero asphyxia, 4 had an Apgar score below 5 at 5 min, and only 4 presented a respiratory distress syndrome. Thus the diagnosis of periventricular leukomalacia can be established early by ultrasonography. In utero asphyxia seems to be a critical determinant of ischaemic brain lesions.

Apgar Score↗

[Diaphragmatic hernia: the role of perioperative resuscitation].

Twenty-nine newborn infants with diaphragmatic hernia have been received in a neonatal intensive care unit over a seven year period. In three cases, clinical signs appeared after the first day: they all survived. Six infants died before surgery: five of them had major pulmonary hypoplasia. Surgery was performed in twenty cases: nine of these infants died. Death occurred during the first twelve post-surgical hours in six cases with major pulmonary hypoplasia. Fourteen infants were followed from 6 to 24 months; two developed post-anoxic hydrocephaly with poor neurological development in one case. A pH above 7.1 and an adequate hemodynamic status obtained before surgery are simple criteria of a good prognosis. When these criteria are not obtained, prognosis is poor as they are in favor of major pulmonary hypoplasia.

Hernia, Diaphragmatic↗

Carbohydrate derived energy and gross energy absorption in preterm infants fed human milk or formula.

Significant production of breath hydrogen has been shown in premature infants, suggesting limited intestinal capacity for digestion of carbohydrate. To evaluate net absorption of carbohydrate 24 three day balance studies were carried out in seven preterm infants fed pasteurised banked human milk and in 17 preterm infants fed a formula containing 75% lactose and 25% glucose polymers. Because carbohydrate reaching the colon may be converted to organic acids by bacterial flora, carbohydrate net absorption was determined by quantitating the faecal excretion of energy derived from carbohydrate. The carbohydrate derived energy content of milk and stools was calculated as the difference between the measured gross energy and the sum of energy related to nitrogen and fat. Faecal loss of carbohydrate derived energy was lower in the group fed formula (1.9 (SD 1.2) kcal/kg/day) than in the group fed human milk (4.0 (SD 1.8) kcal/kg/day). Net absorption of carbohydrate derived energy was 97.0 (SD 1.9)% as opposed to 92.6 (SD 3.9)%, respectively. Within each group there was no significant relation between carbohydrate energy absorption and fat, nitrogen, or gross energy absorption. Thus, although less complete with human milk than with formula, apparent absorption of energy derived from carbohydrate seemed quite satisfactory in these preterm infants.

Animals↗

[Respiratory ultradian variations of mean and low frequencies (from 2-80 cycles per day) in premature human infants].

Oxygen consumption (VO2) and carbon dioxide production (VCO2) were continuously measured in premature human (mean gestation age of 31 weeks at birth), nursed in incubators within a neutral thermal environment and submitted to a continuous lighting. At a mean postnatal age of 30 days, and for a mean body weight of 1.8 kg, spectral analysis shows VO2 and VCO2 ultradian variations of mean and low frequencies (2 less than f less than 80 c.day--1; i.e. periods 12 greater than t greater than 0.3 hr). It is hypothesized that these periodic variations can be compared to those previously evidenced in small laboratory vertebrates and in macaques.

Carbon Dioxide↗

[Cesarean section before the end of 32 weeks of amenorrhea].

The authors report the results of 59 caesarean operations in which 74 children were born before the end of the 32nd week of amenorrhoea. The gross mortality was 21.9% and the corrected mortality 18.5%. 7.9% of the infants had major neurological sequellae and 8.6% mild sequellae. 65.2% are alive and well with normal psychomotor development. The follow-up has been between 1 and 5 years. The factors that influence survival and the indications for caesarean section at this time are reviewed and discussed.

Birth Weight↗

[Fate of infants weighting less than 1,500 grams].

Between 1981 and 1983, 251 premature infants with a birth weight of less than 1 500 grams were admitted to the Neonatal Pathology Unit of the E. Herriot hospital (malformations excluded). Forty two (17%) died during the neonatal period. These premature births resulted essentially from pathological pregnancies: multiple pregnancies (1/5 cases), renal pathology (1/3 cases), placental abnormalities (10%) and fetoplacental infections (10%). In half of all cases delivery was by cesarian section, indicated in 85% of cases because of acute or chronic fetal distress. These premature infants suffered from respiratory (including 40% hyaline membrane disease), neurological (abnormal cerebral echotomography with dilatation or intracranial haemorrhage in 35% of cases), infectious (6%) and digestive (6% necrosing enterocolitis) pathology. Of the 208 surviving children, 12 (i.e. 6% of the survivors) had major sequelae (with follow-up of one year or more).

Humans↗

Nutrient balance, energy utilization, and composition of weight gain in very-low-birth-weight infants fed pooled human milk or a preterm formula.

Growth, protein, and energy balances were studied in two groups of very-low-birth-weight premature infants fed pooled pasteurized human milk (HM) or a preterm formula (PF). Each infant was studied at 33 and 36 weeks gestational age with a combined technique of nutrient balance and indirect calorimetry measurement. Weight and length gains were higher with PF than with HM, but head circumference growth was similar with both milks. Although the volume of milk given was lower, energy intake was higher with PF than with HM in both studies (126 to 130 vs 103 to 109 kcal/kg/day). Percentage of energy absorbed was better with PF than with HM (94% vs 84%) at 33 weeks, and similar (95%) with both milks at 36 weeks. Energy expenditure, which had increased from 33 weeks to 36 weeks, was higher with PF than with HM (57 to 63 vs 46 to 52 kcal/kg/day) during both studies. Energy retention accounted for about 50% of energy absorbed with both milks, but was higher with PF than with HM (60 vs 40 to 50 kcal/kg/day) in both studies, and resulted in fat accretion well above that seen during intrauterine growth for both milks in both studies. Protein intake was higher with PF than with HM (3.1 vs 2.4 gm/kg/day) in both studies, giving a protein accretion similar to the intrauterine accretion with PF (2.2 gm/kg/day), but lower with HM. Our results suggest that the nutritional value of pooled pasteurized human milk for VLBW infants should be reconsidered, especially because of its low protein content, and that energy density of preterm formulas must be questioned in view of elevated fat deposition.

Anthropometry↗

Metabolic consequences of intrauterine growth retardation in very low birthweight infants.

By the combination of energy and macronutrient balances, continuous open circuit computerized indirect calorimetry, and anthropometry, we have compared small for gestational age (SGA) and appropriate for gestational age (AGA) very low birthweight infants with respect to metabolizable energy intake (mean +/- SE: 125.9 +/- 2.5 versus 130.4 +/- 3.5 kcal/kg X day), energy expenditure (67.4 +/- 1.3 versus 62.6 +/- 0.9 kcal/kg X day), storage of energy and macronutrients and growth. Fourteen studies in six SGA infants (gestational age, 33.1 +/- 0.3 weeks; birthweight, 1120 +/- 30 g) and 22 studies in 13 AGA infants (gestational age, 29.3 +/- 0.4 weeks; birthweight, 1155 +/- 40 g) were performed. The SGA infants had a lower absorption of fat (68.7 +/- 3.2 versus 79.7 +/- 1.7%) and protein (69.1 +/- 3.2 versus 83.4 +/- 1.5%) and hence increased (P less than 0.001) energy loss in excreta (29.9 +/- 2.8 versus 18.2 +/- 1.5 kcal/kg X day). The significant hypermetabolism of SGA infants by 4.8 kcal/kg X day was associated with an increased fat oxidation. Despite lower energy storage, SGA infants were gaining weight (19.4 +/- 0.9 g/kg X day), length (1.25 +/- 0.14 cm/week), and head circumference (1.16 +/- 0.9 cm/week) at higher rates than the AGA group. The energy storage per g weight gain was lower (P less than 0.001) in the SGA group (3.0 +/- 0.14 versus 4.26 +/- 0.26 kcal) reflecting higher water, lower fat (22.2 +/- 1.8 versus 33.8 +/- 2.5%; P less than 0.001) and lower protein (7.7 +/- 0.5 versus 12.5 +/- 0.8%; P less than 0.001) contents of weight gain in the SGA group.

Body Weight↗

[Exclusive parenteral nutrition in children. Influence of continuous or cyclic intake on the utilization of food].

A continuous measurement of the energetic consumption and a nutritional evaluation were performed over 24 hours in two comparable groups of children under cyclic or continuous total parenteral nutrition (TPN). Over the 24 hours, energetic consumptions and nitrogenous retentions were equal in both groups. In cases submitted to continuous TPN, a similar utilization of nutriments was observed during the day and night periods, with global predominance of carbohydrate oxidation and of lipogenesis. In cases submitted to cyclic TPN, night and day utilization of nutriments was significantly different, with important utilization of glycogen and lipid stocks during the day. Thus, cyclic TPN allows a more important mobilization of the energetic stocks and physical activity during the day than continuous TPN and might change the quality of the weight gain and avoid an unnecessary storage of lipid deposits.

Calorimetry, Indirect↗

Quality of growth in premature infants fed their own mothers' milk.

With the renewed interest in the feeding of human milk to preterm infants, we have evaluated the partition of energy metabolism and of macronutrient utilization and accretion in growing very low birth weight infants fed their own mother's milk. Fifteen studies combining macronutrient balance, computerized continuous open-circuit indirect calorimetry, and anthropometric measurements were performed in 11 growing, very low birth weight (less than 1.300 gm) preterm infants. The mean milk intake of 172 ml/kg/day provided a gross energy intake of 111 kcal/kg/day. Energy losses in excreta were 11 kcal/kg/day, and the metabolic energy expenditure was 56 kcal/kg/day. The remainder (44 kcal/kg/day) represented the energy stored in the components of new tissue. The infants were gaining weight (15.3 g/kg/day), length (0.98 cm/wk), and head circumference (0.76 cm/wk) at rates approximating intrauterine growth rates. The metabolic energy expenditure was derived from the oxidation (mean +/- SE) of carbohydrate, 9.5 +/- 0.7 gm/kg/day; fat, 1.63 +/- 0.34 gm/kg/day; and protein, 0.68 +/- 0.07 gm/kg/day. The stored energy comprised 2.98 +/- 0.86 gm/kg/day as carbohydrate, 2.25 +/- 0.54 gm/kg/day as fat, and 1.97 +/- 0.1 gm/kg/day as protein. The accretion rates of fat and protein, as well as the composition of the weight gain (fat, 16.6 +/- 4.1%; protein, 13.4 +/- 0.5%), were similar to those reported for the fetus of comparable gestational age.

Anthropometry↗