Objective To measure the changes in whole blood fatty acid levels in premature infants and evaluate their association with neonatal morbidities. Study design Retrospective cohort study of 88 infants born at < 30 weeks of gestation. Serial fatty acid profiles during the first postnatal month and infant outcomes, including chronic lung disease (CLD), retinopathy of prematurity (ROP), and late-onset sepsis, were analyzed. Regression modeling was applied to determine the association between fatty acid levels and neonatal morbidities. Results DHA and AA levels declined rapidly in the first postnatal week with a concomitant increase in linoleic acid (LA) levels. Decreased DHA levels were associated with an increased risk of CLD (OR 2.5; 95% CI 1.3 – 5.0). Decreased AA levels were associated with an increased risk of late-onset sepsis (hazard ratio 1.4; 95% CI 1.1 – 1.7). The balance between fatty acids was also a predictor of CLD and late-onset sepsis. An increased LA:DHA ratio was associated with an increased risk of CLD (OR 8.6; 95% CI 1.4 – 53.1) and late-onset sepsis (hazard ratio 4.6; 95% CI 1.5 – 14.1). Conclusion Altered postnatal fatty acid levels in premature infants are associated with an increased risk of CLD and late-onset sepsis.

Background & Aims-Chronic visceral pain is frequent, extremely debilitating, and generally resistant to pharmacological treatment. It has been shown that chronic visceral inflammation, through altered afferent visceral sensory input, leads to plastic changes in the central nervous system that ultimately sustain pain. Therefore approaches aiming at modulation of brain activity are attractive candidates to control visceral pain.

OBJECTIVES The diagnosis of chronic pancreatitis in patients with characteristic symptoms but normal pancreatic imaging is challenging. Assessment of pancreatic function through secretin pancreatic function testing (SPFT) has been advocated in this setting, but its diagnostic accuracy is not fully known. METHODS This was a retrospective review of patients who received SPFT at our tertiary care institution between January 1995 and December 2008 for suspected chronic pancreatitis. For all patients, medical records were reviewed for evidence of subsequent development of chronic pancreatitis by imaging and/or pathology. Patients were then categorized as “true positive” or “true negative” for chronic pancreatitis based on follow-up imaging or histologic evidence. RESULTS In all, 116 patients underwent SPFT. Of the 27 patients who tested positive, 7 were lost to follow-up. Of the remaining 20 SPFT-positive patients, 9 (45 %) developed radiologic or histologic evidence of chronic pancreatitis after a median of 4 years (1–11 years). Of the 89 patients who had negative SPFT testing, 19 were lost to follow-up. Of the remaining 70 patients, 2 were eventually diagnosed with chronic pancreatitis based on subsequent imaging/histology after a median follow-up period of 7 years (3–11 years). The sensitivity of the SPFT in diagnosing chronic pancreatitis was 82 % with a specificity of 86 %. The positive predictive value (PPV) of chronic pancreatitis was 45 % with a negative predictive value (NPV) of 97 %. CONCLUSIONS In patients with suspected early chronic pancreatitis and normal pancreatic imaging, SPFT is highly accurate at ruling out early chronic pancreatitis with a NPV of 97 %.

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