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Plasma glucose, blood urea nitrogen, and ammonia were measured simultaneously in 44 newborns a few hours after birth. When the concentration of plasma glucose was below 30 mg/dl, plasma ammonia concentration was significantly higher (129 +/- 67 mumol/l) than in normoglycemic infants (74 +/- 33 mumol/l; p less than 0.01). Blood urea nitrogen was slightly lower in hypoglycemic infants (3.65 +/- 0.7 mmol/l) than in the control group (4.5 +/- 1 mmol/l) but the difference was not significant. These data show that hyperammonemia can be associated to hypoglycemia in low birth weight infants. Therefore, further investigations are required to determine the link between urea and glucose production rates in hypoglycemic newborns and whether hyperammonemia participates in the deleterious effects of hypoglycemia on the neonatal brain.

This effect was studied in 23 preterm neonates at the age of 2--8 hours. Betamethasone was administered at a dose of 12 mg intramuscular once or several times before delivery. This glycemia was compared with the glycemia of 52 control preterm infants studied at the same period. In the control preterm neonates, the mean (+/- 1 S.D.) blood glucose level was 0.51 +/- 0.26 g/l versus 0.53 +/- 0.24 g/l in the preterm infants pretreated with betamethasone. The incidence of glycemia less than 0.30 or 0.20 g/l was not significantly different in the two groups. These data show that prenatal betamethasone therapy has no harmful or diserable effect on the neonatal glycemia of preterm infants.

A quantitative study of the fecal flora was carried out in 21 neonates with necrotizing enterocolitis (NEC), (4 infants being born at term) and 57 control infants (30 born at term and 27 born before term). In the population as a whole Klebsiella was detected more frequently in NEC than in the controls. This was especially true in premature infants where Klebsiella was found in 65% of the affected infants versus 33% of the controls (p less than 0,05), while no Klebsiella was detected in the 4 term infants with NEC and in 87% of the term controls. These data suggest that Klebsiella could play a role in the pathogenesis of NEC, especially in the premature infant. Therefore, it seems required to avoid the artificial selection of Klebsiella in the neonate.

The aim of this study was to evaluate the influence of an hyperosmolar solution of theophylline and of blood transfusion in the occurrence of necrotizing enterocolitis (NEC). By the end of 1982, theophylline previously given in alcoholic solution (osmolality greater than 4000 mosm/kg) was given in a preparation of sodium benzoate isoosmotic to the plasma; in addition, blood was irradiated for 20 minutes by X-Rays (5000 rads) before every transfusion. In the same unit of premature infants, the incidence of NEC was 6.7% in 1981-82; it decreased to 2.7% in 1983-84 (p less than 0.02). In the same periods of time, the incidence of NEC in very low birth weight infants (less than 1500 g) decreased from 18% to 4.7% (p less than 0.001) while the number of these very low birth weight infants had increased significantly. The incidence of blood transfusion prior to NEC was found in 67% of the patients. These data suggest a beneficial role of reducing the osmolality of theophylline and of X-Rays irradiation of blood before transfusion as a prophylaxis of NEC in premature infants.

A retrospective study of the occurrence of hyponatremia (i.e. less than 135 mmol/l) was carried out in 17 control preterm neonates and 25 infants treated with theophylline. These infants had a birthweight lower than 1,301 g and a gestational age less than 36 weeks. Despite a similar sodium and water intake in both groups, hyponatremia was detected at the age of 7-8 days in 37% infants treated with theophylline and none of the control infants. Their mean weight loss was 11% with theophylline and 5% in the controls. These data suggest that theophylline may play a role in the occurrence of hyponatremia of very low birthweight infants.

Hypercalcemia (serum Ca greater than or equal to 2.83 mmol/l) was detected in 10 premature infants (gestational age: 31-37 weeks and birthweight: 1100-1950 g). All were fed with pooled human breast milk. Urinary Ca excretion was high (greater than 0.200 mmol/kg/24 h) in all but one infant while serum phosphorus (P) concentration and urinary P excretion were low. Serum immunoreactive parathyroid hormone and plasma 25-hydroxyvitamin-D concentrations were normal. A significant positive correlation was found between serum Ca concentration and urinary Ca excretion, and a negative correlation between serum Ca concentration and serum P concentration or urinary P excretion. Hypercalcemia disappeared spontaneously in two patients, was corrected by a humanized milk in three patients and by P supplementation in five patients. These data suggest that neonatal hypercalcemia is related to P depletion induced by human breast milk in premature infants.