The impact of oral glutamine supplementation on the intestinal permeability and incidence of necrotizing enterocolitis/septicemia in premature neonates

Objective. To examine the impact of oral glutamine (Gln) supplementation on gut integrity and on the incidence of necrotizing enterocolitis (NEC)/septicemia of premature neonates. Methods.Preterm neonates (n = 101, gestational age <34 weeks, birth weight <2000g) were randomly allocated to receive from day 3 to day 30 postpartum, either oral Gln (0.3 g/kg/day, n = 51-Gln group) or placebo (caloreen-isocaloric, n = 50-control group). Intestinal permeability was determined from the urinary lactulose/mannitol recovery (L/M ratio) following their oral administration and assessed at three time points: day 2 (before first administration), day 7 and day 30 of life. The incidence of NEC and septicemia over the study period was also recorded. Results.A decrease of lactulose recovery at days 7 (p = 0.001) and 30 (p < 0.001) and a decrease of L/M ratio at day 7 (p = 0.002) were observed only in the Gln group. Lactulose recovery and L/M ratio at day 7 (p = 0.022 and p = 0.004, respectively), as well as lactulose recovery (p = 0.001), mannitol recovery (p = 0.042), and L/M ratio (p = 0.001) at day 30, were decreased in the Gln group as compared to controls. NEC and septicemia were lower in the Gln group at the end of the first week (p = 0.009 and p = 0.041, respectively) and up to the end of the study (p < 0.001 and p = 0.048, respectively). Conclusion.Oral Gln administration may have beneficial effects on intestinal integrity and the overall incidence of NEC/septicemia in preterm infants. © 2011 Informa UK, Ltd

1H NMR-based metabonomics for the diagnosis of inborn errors of metabolism in urine

1H NMR-based metabonomics was used for the detection and diagnosis of inborn errors of metabolism from urine samples. 1D 1H NMR spectra from 47 normal, 9 phenylketonuric (PKU) newborns and 1 maple syrup urine disease (MSUD) child were obtained and investigated. Urine 1H NMR spectra of normal, PKU and MSUD samples exhibited differences concerning the phenylalanine (Phe) and branched-chain amino acids (leucine, valine, isoleucine) resonances, respectively. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were applied in order to establish adequate models for discrimination between pathological and normal samples. Normalization of the spectra was based to the total spectral intensity or to creatinine peak. Different data transformation procedures were used. Discrimination of PKU and MSUD samples from normal samples was achieved by the different models produced by PCA and PLS-DA. Comparing the two methods of statistical analysis, PLS-DA was found to lead to a most proper discrimination when all pathological samples were used, while PCA proved suitable to identify every single pathological sample among the physiological ones. Thus, 1H NMR in urine can be considered as an alternative to blood spots in order to develop a mass-screening method, which does not require sample pre-treatment and avoids any painful procedure for the newborns. © 2005 Elsevier B.V. All rights reserved

1H NMR-based metabonomics for the diagnosis of inborn errors of metabolism in urine

1H NMR-based metabonomics was used for the detection and diagnosis of inborn errors of metabolism from urine samples. 1D 1H NMR spectra from 47 normal, 9 phenylketonuric (PKU) newborns and 1 maple syrup urine disease (MSUD) child were obtained and investigated. Urine 1H NMR spectra of normal, PKU and MSUD samples exhibited differences concerning the phenylalanine (Phe) and branched-chain amino acids (leucine, valine, isoleucine) resonances, respectively. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were applied in order to establish adequate models for discrimination between pathological and normal samples. Normalization of the spectra was based to the total spectral intensity or to creatinine peak. Different data transformation procedures were used. Discrimination of PKU and MSUD samples from normal samples was achieved by the different models produced by PCA and PLS-DA. Comparing the two methods of statistical analysis, PLS-DA was found to lead to a most proper discrimination when all pathological samples were used, while PCA proved suitable to identify every single pathological sample among the physiological ones. Thus, 1H NMR in urine can be considered as an alternative to blood spots in order to develop a mass-screening method, which does not require sample pre-treatment and avoids any painful procedure for the newborns. © 2005 Elsevier B.V. All rights reserved

Outcome prediction in Greek neonatal intensive care units using a score for neonatal acute physiology (SNAP)

Objectives. This study was undertaken to evaluate the performance of the score for neonatal acute physiology (SNAP) in Greece, to examine the predictive power of SNAP calculated during the 12 hours after admission in comparison with customarily calculated SNAP during the first 24 hours, and to assess SNAP during the second 12 hours from admission as a measure of response to treatment. Methodology. A total of 579 newborns admitted to three neonatal intensive care units (NICUs) from two cities in Greece were enrolled in the study; SNAP was determined during the first 12 hours, the second 12 hours, and the first 24 hours from admission to the NICU and calculated using an algorithm based on deviations from normal values of 26 physiologic parameters. Results. All three variants of SNAP were powerful predictors of vital status at discharge, as well as of duration of stay among survivors. A five-point increase in SNAP in the first 12 hours corresponds to a more than twofold ratio in the odds for death, whereas a five-unit difference in SNAP from the second 12 hours corresponds to a more than threefold ratio. The combined 24-hour score was similar to that for the first 12 hours. A considerable advantage of SNAP was its independence from more traditional predictors of neonatal death, notably gestational age, birth weight, and Apgar score. The combination of all of these predictors improved further the overall predictive potential. Conclusions. SNAP is a useful tool in medical research and can be applied in different population groups. Its independence from birth weight underlines its added value to predict fatality ratios. Moreover, the results of the present study indicate that SNAP can be estimated without loss of predictive efficiency during the first 12 hours from admission to the NICU, whereas SNAP during the second 12 hours adequately reflects the effectiveness of early medical interventions