No abstract

The fatty acid compositions of the major cerebral cortex phospholipids, phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine were measured in 16 term and one preterm 'cot death' infants fed exclusively either breast milk or one of two formulas. Docosahexaenoic acid (DHA; C22:6n-3) content in cerebral cortex phosphatidylethanolamine and phosphatidylserine of breast fed infants was greater than in both formula groups with significances varying between p<001 and p<0001. Compensation for this deficiency in DHA in the formula fed infants was largely achieved by increased incorporation of docosapentaenoic acid (C22:5n-6) in the cerebral cortex of term infants and Mead (C20:3n-9) and dihomo Mead acids (C22:3n-9) in the preterm infant.As the phospholipids most affected are known to perform an important role in membrane fimction and are possibly integral to neurotransmission it is recommended that breast milk substitute infant formulas should contain n-3 and n-6 series polyunsaturated fatty acids in proportions similar to those ofhuman milk. (Arch Dis Child 1995; 72: 198-203) Approximately 60% of the total energy intake of the infant during the first year is utilised by the brain and much of this energy is used to synthesise neuronal membrane and deposit myelin. Fatty acids from human milk or infant formulas provide not only a source of hydrocarbon for energy production but help synthesise the complex hydrocarbon structures necessary for the creation of neurotransmitter membranes.Breast fed infants have significantly greater concentrations of the long chain polyunsaturated fatty acid (PUFA), docosahexaenoic acid (DHA; C22:6n-3) in their cerebral cortex phospholipids than infants fed current infant formulas.2 3 Cerebral cortex neuronal membrane phospholipids are composed of phosphatidylcholine, phophatidylethanolamine, phosphatidylserine, and phosphatidylinositol. While the membrane receptor and secondary messenger characteristics of phosphatidylinositol and its meta-

Objective-To assess the nutritional status of children with congenital heart disease.Design-Six anthropometric, 24 biochemical, and five haematological markers of nutritional wellbeing were measured in children with congenital heart disease. Setting-The west of Scotland. Patients-48 children admitted consecutively for surgical correction of congenital heart disease. Main outcome measures-Height, weight, and triceps and subscapular skin fold thicknesses were considered abnormal if they were below the third centile compared with standard reference data for age matched British children. Midarm circumference and arm muscle circumference were considered abnormal if they fell below the fifth centile compared with standard data. Biochemical and haematological data were compared with age matched and locally validated laboratory normals. Results-A marked degree of undernutrition was evident in all children; 52% had weight less than the third centile, 37% were below the third centile for height, and 12-5% were below the third centile for triceps skin fold thickness and 18-8% for subscapular skin fold thickness. Midarm circumference and arm muscle circumference were below the fifth centile in 20*1% and 16*7% of children respectively. Five or more of the 29 biochemical and haematological measurements were abnormal in 83-3% of patients; 10 or more were abnormal in 12-5% of patients. Conclusions-Children with congenital heart disease are frequendy undernourished, irrespective of the nature of cardiac defect and the presence or absence of cyanosis. (Br HeartJ_ 1995;73:277-283)

This randomized study compared the metabolic responses to laparoscopic cholecystectomy (n = 10) and minilaparotomy cholecystectomy with a 5-7-cm incision (n = 10). Venous blood samples were taken before operation and at 3, 6, 9, 12, 18, 24, 48, 72 and 168 h after incision and analysed for levels of C-reactive protein, interleukin 6, cortisol, albumin, transferrin, iron, fibrinogen, fibrin degradation products and polymorphonuclear elastase, and for neutrophil and lymphocyte counts. Urine samples (24 h) were analysed for urea, creatinine, 3-methylhistidine and catecholamines. The magnitude of the metabolic changes from baseline levels was quantified by calculating areas under each individual curve. A significant metabolic response with a similar time course and magnitude of changes occurred after laparoscopic and minilaparotomy cholecystectomy but with wide variation in magnitude between individuals.

There is little evidence as to the fatty acid composition of the cerebellum in infancy and it remains uncertain whether milk diet can influence its composition. We therefore examined cerebellar gray and white matter of infants less than 6 month old who had died unexpectedly. The fatty acid content of 33 gray and 21 white matter specimens from infants born at term and 6 gray and 5 white matter specimens from preterm infants was assessed by gas chromatographic/mass spectrometric analysis. Infants were grouped according to whether they had received human or manufactured formula milk. Whereas cerebellar cortex docosahexaenoic acid (DHA, 22:6n-3) concentrations were significantly lower (P<0.01) in the formula-fed than breast-fed infants, no differences existed between the term (n = 10) and preterm (n = 5) Synthetic Milk Adapted [corrected] (SMA) formula-fed infants. Cerebellar white matter DHA concentrations were similarly lower (P<0.01) in the SMA formula-fed infants (n = 8) than in an age-matched breast-fed group. Low concentrations of cerebellar white matter lignoceric (24:0) and nervonic acid (24:1n-9) in two 7-wk-old preterm infants appeared to correlate with postgestational rather than chronological age. Dietary long-chain polyunsaturated fatty acids, particularly DHA, are probably essential for normal development of the infant cerebellum.