Serum ghrelin is associated with early feeding readiness but not growth in premature infants

BACKGROUND: Feeding tolerance among premature infants is unpredictable using clinical parameters. Ghrelin, a peptide hormone, acts on the hypothalamus to increase hunger and gut motility. It is present in fetal tissues, promotes intestinal maturation, and is secreted in milk. We hypothesized that higher serum ghrelin levels on days 0–7 are associated with improved feeding tolerance and growth in premature infants. METHODS: Infants (< 1500 g birth weight, n = 36) were recruited on day (D) 0–7. Serum ghrelin was measured by ELISA on D 0–7, D 10–14, and D 24–32, and milk ghrelin in a feeding concurrent with each serum sample. Feeding tolerance was assessed as days to first and full enteral feeds. Growth was quantified as both weight and adipose and muscle deposition by ultrasound. RESULTS: Mean serum ghrelin levels decreased from D 0–7 to D 24–32. Higher ghrelin levels on D 0–7 were correlated with shorter time to first enteral feeding, but not with time to full enteral feeds, rate of weight gain, or rate of accretion of muscle or adipose tissue. Milk ghrelin was not related to serum ghrelin or growth. Abdominal and suprascapular muscle and adipose increased during the first month, but weight gain correlated only with the rate of accretion of abdominal adipose. CONCLUSIONS: Elevated serum ghrelin in the first days of life may contribute to gut motility and readiness to feed. Weight gain in premature infants may primarily indicate abdominal fat accumulation, suggesting that ultrasound measurement of muscle accretion is a better marker for lean body growth.

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THE RELATIONSHIP OF THE SODIUM, POTASSIUM, AND CHLORIDE CONCENTRATION OF THE FEEDING TO THE WEIGHT GAIN OF PREMATURE INFANTS

PEDIATRICS ◽

10.1542/peds.30.6.909 ◽

1962 ◽

Vol 30 (6) ◽

pp. 909-916

Author(s):

Herbert I. Goldman ◽

Samuel Karelitz ◽

Hedda Acs ◽

Eli Seifter

Keyword(s):

Weight Gain ◽

Sodium Chloride ◽

Human Milk ◽

Premature Infants ◽

Chloride Concentration ◽

The Other ◽

Milk Formula ◽

Sodium Potassium ◽

Relationship Of ◽

The Relationship

One hundred four healthy premature infants, of birth weight 1,000 to 1,800 gm, were fed one of five feedings: (1) human milk; (2) human milk plus 13 meq/l of sodium chloride; (3) human milk plus 13 meq/l of sodium chloride and 18 meq/l of potassium chloride; (4) a half-skimmed cows milk formula; and (5) a partially-skimmed vegetable oil, cows milk formula. The infants fed any of the three human milk formulas gained weight at a slower rate than the infants fed either of the two cows milk formulas. Infants whose diets were changed from unmodified human milk to the half-skimmed cows milk gained large amounts of weight, and at times were visibly edematous. Infants whose diets were changed from the human milks with added sodium chloride, to the half-skimmed cows milk, gained lesser amounts of weight and did not become edematous. The infants fed the two cows milk diets gained similar amounts of weight, although one diet provided 6.5 gm/kg/day, the other 3.1 gm/kg/day of protein.

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EARLY FEEDING OF DEXTROSE AND SALINE SOLUTION TO PREMATURE INFANTS

PEDIATRICS ◽

10.1542/peds.26.5.756 ◽

1960 ◽

Vol 26 (5) ◽

pp. 756-761

Author(s):

William Allen Bauman

Keyword(s):

Premature Infants ◽

Saline Solution ◽

Treated Group ◽

Controlled Study ◽

Early Feeding ◽

Premature Babies ◽

Hyaline Membranes ◽

Average Intake ◽

Feeding Trials ◽

Physiologic Responses

Conflicting opinions concerning the optimum age at which to commence feeding premature infants have resulted in either early or late regimens. In order to test the hypothesis that the early administration of fluids to premature babies was beneficial, a controlled study of 50 newborn premature subjects was undertaken. Fluids consisting of 5% dextrose in 0.45% saline were started before the age of 6 hours by constant drip through a nasogastric plastic catheter in 24 subjects selected by a predesigned method using a table of random permutations. The average intake during the test period was 54.5 ml/kg/24 hours. The other 26 control subjects received no fluids until age 36 hours, when both groups were started on formula. There was no alteration of symptoms of respiratory distress in the group receiving early feedings. One-half of these subjects did not lose weight while being fed the dextrose and saline solution. They promptly lost weight, however, when regular milk feedings were commenced. The seven infants who died had similar pathologic findings. It was noted that three of the five in the fluid treated group also had pulmonary hyaline membranes. There were no hyaline membranes in the lungs of the two subjects deprived of water. From this study neither beneficial nor detrimental effects of early feeding could be demonstrated by use of the criteria of dyspnea or mortality. The question of when to start to feed premature babies is still unanswered. There is need for further feeding trials, in which associations among age of commencement, nature of substances fed and the consequent physiologic responses, can be observed.

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Digoxin and Low-Birth-Weight Infants

PEDIATRICS ◽

10.1542/peds.70.6.1011a ◽

1982 ◽

Vol 70 (6) ◽

pp. 1011-1012

Author(s):

DAVID S. OLANDER ◽

MICHAEL MAURER

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Premature Infants ◽

Elevated Serum ◽

Alternative Therapies ◽

Digoxin Toxicity ◽

Low Birth Weight Infants ◽

Serum Digoxin ◽

Clinically Significant

In their recent communication, Johnson et al suggested that conventional digoxin use may be sufficiently toxic forlow-birth-weight infants to prompt consideration of alternative therapies. This conclusion was supported by their detection of digitalis associated illness in 9/18 small premature infants receiving digoxin in doses of 0.003 to 0.005 mg/kg twice per day. The documentation of abnormally elevated serum digoxin concentrations in 7/9 patients further supports the possibility of clinically significant digoxin toxicity. Akin to the findings of Berman et al and Pinsky et al, this investigation only confirms the observation that overdosage of infants with digoxin may result in digitoxicity.

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