Iron supplementation enhances response to high doses of recombinant human erythropoietin in preterm infants

AIMS: To determine whether iron supplementation would enhance erythropoiesis in preterm infants treated with high doses of human recombinant erythropoietin (r-HuEPO). METHODS: Sixty three preterm infants were randomly allocated at birth to one of three groups to receive: r-HuEPO alone, 1200 IU/kg/week (EPO); or r-HuEPO and iron, 1200 IU/kg/week of r-HuEPO plus 20 mg/kg/week of intravenous iron (EPO + iron); or to serve as controls. All three groups received blood transfusions according to uniform guidelines. RESULTS: Infants in the EPO + iron group needed fewer transfusions than controls--mean (95% CI) 1.0 (0.28-1.18) vs 2.9 (1.84-3.88) and received lower volumes of blood--mean (95% CI) 16.7 (4.9-28.6) vs 44.4 (29.0-59.7) ml/kg. The EPO group also needed lower volumes of blood than the controls--mean (95% CI) 20.1 (6.2-34.2) vs 44.4 (29.0-59.7) ml/kg, but the same number of transfusions, 1.3 (0.54-2.06) vs 2.9 (1.84-3.88). Reticulocyte and haematocrit values from postnatal weeks 5 to 8 were higher in the EPO + iron than in the EPO group, and both groups had higher values than the controls. Mean (SEM) plasma ferritin was lower in the EPO group-65 (55) micrograms/l than in the EPO + iron group 780 (182) micrograms/l, and 561 (228) micrograms/l in the control infants. CONCLUSIONS: Early administration of high doses of r-HuEPO with iron supplements significantly reduced the need for blood transfusion. Intravenous iron (20 mg/kg/week in conjunction with r-HuEPO yielded a higher reticulocyte count and haematocrit concentration after the forth week of life than r-HuEPO alone. Infants treated with r-HuEPO alone showed signs of reduced iron stores.     

Preservation of Interpolation Features by Fibring

Fibring is a metalogical constructor that permits to combinedifferent logics by operating on their deductive systems undercertain natural restrictions, as for example that the two givenlogics are presented by deductive systems of the same type.Under such circumstances, fibring will produce a new deductivesystem by means of the free use of inference rules from bothdeductive systems, provided the rules are schematic, in thesense of using variables that are open for application to formulaswith new linguistic symbols (from the point of view of eachlogic component). Fibring is a generalization of fusion, a lessgeneral but wider developed mechanism which permits resultsof the following kind: if each logic component is decidable(or sound, or complete with respect to a certain semantics)then the resulting logic heirs such a property. The interestfor such preservation results for combining logics is evident,and they have been achieved in the more general setting of fibringin several cases. The Craig interpolation property and the Maeharainterpolation have a special significance when combining logics,being related to certain problems of complexity theory, someproperties of model theory and to the usual (global) metatheoremof deduction. When the peculiarities of the distinction betweenlocal and global deduction interfere, justifying what we callcareful reasoning, the question of preservation of interpolationbecomes more subtle and other forms of interpolation can bedistinguished. These questions are investigated and several(global and local) preservation results for interpolation areobtained for fibring logics that fulfill mild requirements.     

Short-Term Stability of Whole Blood Polyunsaturated Fatty Acid Content on Filter Paper During Storage at −28 °C

Finger or heel‐pricked blood sampling for fatty acid analysis is suitable especially in newborn infants where blood sampling is difficult and phlebotomy for research can be unethical. The aim of this study was to evaluate dried blood long chain polyunsaturated fatty acids (LC‐PUFA) stability during storage at ?28 °C. We collected 12 blood cord samples that were analyzed immediately after blood drawing, with and without drying the blood on filter paper. Dried samples were then analyzed 7 days and 1, 3, and 6 months after collection. Butylated hydroxytoluene was added to all samples. Fatty acid composition and ¹³C enrichment were measured by gas chromatography and by gas chromatography‐isotope ratio mass spectrometry, respectively. The fatty acid composition, expressed in mol%, of the major LC‐PUFA at day 7 was not statistically different from time 0, however lower values were found by the first month of storage. The ¹³C enrichment of 20:4n‐6 and 22:6n‐3 did not differ during the whole study period. LC‐PUFA analysis from dried umbilical cord blood in neonates should be performed within a week, major losses of LC‐PUFA occur afterwards. However, fatty acids obtained from dried blood maintain their ¹³C enrichment value for up to 6 months and thus these samples are suitable for natural abundance isotopic studies.     

Index of Authors of Volume 12

Authors Index

Index of Authors of Volume 12     

Phytosterol Esterification is Markedly Decreased in Preterm Infants Receiving Routine Parenteral Nutrition

Several studies reported the association between total plasma phytosterol concentrations and the parenteral nutrition‐associated cholestasis (PNAC). To date, no data are available on phytosterol esterification in animals and in humans during parenteral nutrition (PN). We measured free and esterified sterols (cholesterol, campesterol, stigmasterol, and sitosterol) plasma concentrations during PN in 16 preterm infants (500–1249 g of birth weight; Preterm‐PN), in 11 term infants (Term‐PN) and in 12 adults (Adult‐PN). Gas chromatography–mass spectrometry was used for measurements. Plasma concentrations of free cholesterol (Free‐CHO), free phytosterols (Free‐PHY) and esterified phytosterols (Ester‐PHY) were not different among the three PN groups. Esterified cholesterol (Ester‐CHO) was statistically lower in Preterm‐PN than Adult‐PN. Preterm‐PN had significantly higher Free‐CHO/Ester‐CHO and Free‐PHY/Ester‐PHY ratios than Adult‐PN (Free‐CHO/Ester‐CHO: 1.1 ± 0.7 vs. 0.6 ± 0.2; Free‐PHY/Ester‐PHY: 4.1 ± 2.6 vs. 1.3 ± 0.8; *P < 0.05). Free‐CHO/Ester‐CHO and Free‐PHY/Ester‐PHY ratios of Term‐PN (Free‐CHO/Ester‐CHO: 1.1 ± 0.4; Free‐PHY/Ester‐PHY: 2.9 ± 1.7) were not different from either Preterm‐PN or from Adult‐PN. Plasma Free‐CHO/Ester‐CHO and Free‐PHY/Ester‐PHY were unchanged after 24 h on fat‐free PN both in Preterm‐PN and in Adult‐PN. Free‐PHY/Ester‐PHY did not correlate with phytosterol intake in Preterm‐PN. Free‐PHY/Ester‐PHY of Preterm‐PN was positively correlated with the Free‐CHO/Ester‐CHO and negatively correlated with gestational age and birth weight. In conclusion, PHY were esterified to a lesser extent than CHO in all study groups; the esterification was markedly decreased in Preterm‐PN compared to Adult‐PN. The clinical consequences of these findings warrant further investigations.     

Fibring Non-Truth-Functional Logics: Completeness Preservation

Fibring has been shown to be useful for combining logics endowed withtruth-functional semantics. However, the techniques used so far are unableto cope with fibring of logics endowed with non-truth-functional semanticsas, for example, paraconsistent logics. The first main contribution of thepaper is the development of a suitable abstract notion of logic, that mayalso encompass systems with non-truth-functional connectives, and wherefibring can still be dealt with. Furthermore, it is shown that thisextended notion of fibring preserves completeness under certain reasonableconditions. This completeness transfer result, the second main contributionof the paper, generalizes the one established in Zanardo et al. (2001) butis obtained using new techniques that explore the properties of a suitablemeta-logic (conditional equational logic) where the (possibly)non-truth-functional valuations are specified. The modal paraconsistentlogic of da Costa and Carnielli (1988) is studied in the context of this novel notionof fibring and its completeness is so established.     

Plasma Phytosterol Half‐Life and Levels Are Increased in Very Low Birth Weight Preterm Infants with Parenteral Nutrition‐Associated Cholestasis

Parenteral nutrition‐associated cholestasis (PNAC) has been linked to plasma accumulation of phytosterols in infants receiving vegetable‐oil‐based lipid emulsions (LE). To date, information on the ability of infants with PNAC to metabolize intravenous (IV) phytosterols has been very limited. We characterized plasma phytosterol half‐life in very low birth weight (VLBW) preterm infants with PNAC. As part of a prospective cohort study, VLBW infants with PNAC underwent serial blood sample measurements of sitosterol (Sito), campesterol (Camp), and stigmasterol (Stigma). Infants without PNAC served as controls (CTRL, control infants). Thirty‐seven PNAC infants and 14 CTRL were studied. On PN day 7 and PN day 14, PNAC infants had higher plasma phytosterol concentrations compared to those of CTRL (p < 0.05). A significant and positive correlation was found between plasma Camp, Stigma, Sito concentrations, and IV phytosterol intake from birth to PN day 7 (p = 0.001, p = 0.001, and p = 0.005, respectively). Stigma concentration was positively correlated with conjugated bilirubin on PN day 7 (p = 0.012). After stopping IV LE, half‐lives of Camp, Stigma, and Sito became significantly longer in PNAC infants than in CTRL (Camp: 18.8 ±6.2 vs 11.8 ±3.0 days, p = 0.001; Stigma: 13.8 ±5.8 vs 9.4 ±3.4 days, p = 0.023; Sito: 15.3 ±5.0 vs 9.8 ±3.0 days, p = 0.002). In conclusion, phytosterols increased earlier during PN and were eliminated slowly after stopping IV LE in PNAC infants than in CTRL. The Stigma concentration on PN day 7 could represent an early marker of cholestasis. Our results provide additional evidence on the relationship between IV phytosterols and PNAC.