Devon General Hospital

ABSTRACTBackgroundThere is a paucity of data about water soluble vitamin status in low birthweight infants. Therefore, the authors' objective was to assess current feeding protocols.MethodsThe authors measured serum concentrations for riboflavin, pyridoxine, and vitamin C and functional assays for thiamine and riboflavin longitudinally in 16 premature infants (birthweight, 1,336 ± 351 g; gestational age, 30 ± 2.5 weeks) before receiving nutrition (time 1, 2 ± 1 days), during supplemental or parenteral nutrition (time 2, 16 ± 10 days) and while receiving full oral feedings (time 3, 32 ± 15 days). In plasma, vitamin C was measured colorimetrically, and riboflavin and pyridoxine were measured using high‐performance liquid chromatography. The erythrocyte transketolase test as a functional evaluation of thiamine and the erythrocyte glutathione reductase test for riboflavin were measured colorimetrically.ResultsAt time 1, nutrient intake of vitamins were negligible because infants were receiving intravenous glucose and electrolytes only. Intakes differed between time 2 and time 3 for thiamine (510 ± 280 and 254 ± 115 μg · kg −1 · d −1 , respectively), riboflavin (624 ± 305 and 371 ± 193 μg · kg −1 · d −1 , respectively), and pyridoxine (394 ± 243 and 173 ± 85 μg/100 kcal, respectively), but not for vitamin C (32 ± 17 and 28 ± 12 mg · kg −1 · d −1 , respectively). Blood levels at times 1, 2, and 3 were for thiamine (4.9 ± 2.7%, 3.3 ± 6.6%, and 4.1 ± 9% erythrocyte transketolase test, respectively), riboflavin (0.91 ± 0.31, 0.7 ± 0.3, 0.91 ± 0.18 erythrocyte glutathione reductase test, respectively), riboflavin (19.5 ± 17, 23.3 ± 8.6, 17.6 ± 10 ng/mL, respectively), pyridoxine (32 ± 25, 40 ± 16, 37 ± 26 ng/mL, respectively), and vitamin C (5.2 ± 3, 5 ± 2.2, 10 ± 5 μg/mL, respectively) and did not differ at those times.ConclusionsCurrent intakes of these vitamins, except for possibly vitamin C, during parenteral and enteral nutrition seem to result in adequate plasma concentrations and normal functional indices.

In Brief Objective To evaluate the effectiveness, safety, and gastrointestinal tolerance of misoprostol taken orally for induction of labor, against our established protocol, with the interval from induction to vaginal birth as the primary outcome measure. Methods Two hundred seventy-five women who presented with indication for induction of labor were assigned randomly to receive either 50 μg of misoprostol orally every 4 hours as needed or treatment according to our established protocol (physician-chosen combinations of intracervical or vaginal prostaglandins every 4–6 hours, artificial rupture of membranes, and oxytocin infusion). Sample size was calculated with a two-tailed alpha = .05 and power of 95%. Results The mean time (± standard deviation) to vaginal birth with oral misoprostol was 926 ± 521 minutes versus 909 ± 585 minutes with the established protocol, a nonsignificant difference. There were no clinically or statistically significant differences in maternal secondary outcome measures (cesarean rate, frequency of epidural use, perineal trauma, or manual removal of the placenta). There was no difference in frequency of maternal gastrointestinal side effects. Neonatal outcomes, including cord blood acid-base analysis, were not different. Conclusions Oral misoprostol may be a new option for labor induction. It appears to be no less effective or safe than our usual regimen for induction of labor at term and is well tolerated. Further studies are warranted to confirm the safety of this approach and to determine optimal dose and frequency of administration. Oral adminstration of misoprostol is effective as a method of labor induction and has no adverse maternal or fetal side effects.