Feeding the preterm infant.
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Biomedical subjects
Publications and source records attributed to F Cockburn.
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104 infants with symptomatic hypocalcaemia were randomly allocated to treatment with calcium gluconate, phenobarbitone, or magnesium sulphate. Infants treated with magnesium sulphate had higher plasma-calcium concentrations after 48 hours' treatment and fewer convulsions during and after the treatment period. Magnesium sulphate is recommended as the treatment of choice in symptomatic neonatal tetany whether or not there is hypomagnesaemia.
A clinical and biochemical evaluation has been made of a new milk formula, Modified Carnation milk (MCM), based on cows' milk but with the mineral content and concentration of caloric nutrients altered to make it correspond more closely to human milk. MCM produced higher plasma calcium and magnesium concentrations in 6-day-old infants than those produced by unmodified evaporated and dried milks, achieving concentrations closer to those of breast milk. Plasma free amino acid concentrations in MCM-fed infants are nearer breast-fed values than those in unmodified milk-fed infants where higher individual plasma amino acid concentrations persist during the first 3 months. MCM-fed infants had low plasma urea concentrations and lower urine osmolalities at 6 days, 3 weeks, 6 weeks, 3 months, and 6 months than infants fed on the evaporated and dried milks, and similar plasma urea and urine osmolalities to those of breast-fed infants. MCM is likely to be superior to unmodified evaporated and dried milks in preventing convulsions of the hypocalcaemic/hypomagnesaemic/hyperphosphataemic type, and seems less likely to cause hypertonic dehydration. MCM is easily prepared, readily accepted by babies, and appears to be nutritionally adequate for the feeding of term infants.
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In 55 preterm infants dying from hyaline-membrane disease (H.M.D.) in 1971-74, infants with associated cerebral intraventricular haemorrhage (H.M.D./I.V.H.) had been given more intravascular sodium-bicarbonate solution, but the same proportions of cases with H.M.D. and H.M.D./I.V.H. received bicarbonate at the time of birth. Much of the sodium-bicarbonate solution given to H.M.D./I.V.H. infants was injected in response to the clinical effects of I.V.H. Maximum serum-sodium concentrations correlated with sodium-bicarbonate dosage but not I.V.H. The incidence of I.V.H. in preterm infants in 1971-74 was unchanged from 1956-59 when alkaline buffer treatment was not used. These findings do not suggest that sodium-bicarbonate therapy plays a major part in the pathogenesis of I.V.H.
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Serum and urine concentrations of ampicillin, amoxycillin, and flucloxacillin achieved after oral administration have been measured in 27 newborn infants. Compared with adults and children, newborn infants show a delay in achieving adequate blood concentrations, presumably due to delayed absorption. However most infants achieve therapeutic concentrations in the serum. Infected newborn infants should be given these antibiotics by intramuscular injection for the first dose, but thereafter oral therapy (25 mg/lg every 6 hours begun concomitantly) should be satisfactory. The better absorption of amoxycillin compared with ampicillin reported in adults has not been confirmed in the newborn infant.
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