PEDIATRICS Vol. 28 No. 6 December 1961, pp. 861-869
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FURTHER OBSERVATIONS ON THE CORRECTED BROMIDE SPACE OF THE NEONATE AND INVESTIGATION OF WATER AND ELECTROLYTE STATUS IN INFANTS BORN OF DIABETIC MOTHERS

Donald B. Cheek M.D., D.Sc.1, T. G. Maddison M.D., M.R.A.C.P.1, M. Malinek B.Sc.1, and J. H. Coldbeck M.B.B.S.1

1 The Research Foundation of the Royal Children's Hospital and the Royal Women's Hospital, Melbourne

The present study extends previous observation on the extracellular volume and total body chloride of infants in the neonatal period. It is shown that the decrease in the corrected bromide space is most rapid in postnatal life during the first 2 weeks when 40 ml/kg are lost. By the end of the second week, body weight approaches birth weight. Hence by that time there is a gain of 40 gm/kg, and mainly of protein and cell water. Growth processes are in full progress. The values obtained by other workers for the chloride space of muscle in premature, full-term and 6-month-old infants do not vary considerably from the corrected bromide space for the whole body at these age periods.

Nine infants born around the thirty-sixth week of gestation, and of diabetic mothers, were investigated concerning composition and distribution of water and electrolytes, mainly on the third day of postnatal life. It was found that total water was reduced on a weight basis by 37 ml/kg, and this reduction can be explained on the basis of increased body fat, as demonstrated by other workers. The corrected bromide space (on the basis of weight, not age) was reduced by 50 ml/kg of weight, and it was considered that part of this reduction was not due to body fat increase. As much as 40 ml of water/kg of lean body weight probably shifts from the extracellular to the intracellular phase. There is a reduction of extracellular sodium and chloride in infants born of diabetic mothers. This finding was supported by muscle analysis of one infant who died of the respiratory distress syndrome. No change was found in the plasma osmotic pressure or in the concentrations of sodium and chlorides in plasma. The urea content of plasma was elevated, due perhaps to the reduction in extracellular volume.