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August 2014 14. Lien EL. Toxicology and safety of DHA. Prostaglandins Leukot Essent Fatty Acids 2009;81:125-32. 15. Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother 2002;56:365-79. 16. Yang Q, Ayers K, Chen Y, Helderman J, Welch CD, O’Shea TM. Early enteral fat supplement and fish oil increases fat absorption in the premature infant with an enterostomy. J Pediatr 2013;163:429-34. 17. Diamond IR, de Silva NT, Tomlinson GA, Pencharz PB, Feldman BM, Moore AM, et al. The role of parenteral lipids in the development of advanced intestinal failure-associated liver disease in infants: a multiple-variable analysis. JPEN J Parental Enteral Nutr 2011;35: 596-602. 18. Chen WJ, Yeh SL, Huang PC. Effects of fat emulsions with different fatty acid composition on plasma and hepatic lipids in rats receiving total parenteral nutrition. Clin Nutr 1996;15:24-8. 19. Aksnes J, Eide TJ, Nordstrand K. Lipid entrapment and cellular changes in the rat myocard, lung and liver after long-term parenteral nutrition with lipid emulsion: a light microscopic and ultrastructural study. APMIS 1996;104:515-22. 20. Nehra D, Fallon EM, Carlson SJ, Potemkin AK, Hevelone ND, Mitchell PD, et al. Provision of soy-based intravenous lipid emulsion at 1 g/kg/d does not prevent cholestasis in neonates. JPEN J Parental Enteral Nutr 2013;37:498-505.

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50 Years Ago in THE JOURNAL OF PEDIATRICS Nitrogen Excretion by Newborn Infants During Oxygen Breathing Nelson NM, Prod’hom LS, Cherry RB. J Pediatr 1964;65:299-300

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he field of pulmonary physiology was stimulated by the combative needs of World War II, particularly for aeronautic and submarine requirements. This investigative activity continued apace during the post-war period, just as clinical interest in the newborn infant was proceeding from obstetric to physiologic questions. Many of the pulmonary investigative techniques were developed by Comroe et al at the University of Pennsylvania (and later at University of California, San Francisco) and then applied to investigations of the newborn infant, particularly by Karlberg and collaborators at the Karolinska University Hospital, Stockholm and Smith and collaborators at the Boston Lying-in Hospital. During the preventilator period of newborn care in the 1960s, the yet-to-be-named “neonatologists” were busily adapting adult pulmonary techniques to the realities of an “untrainable” newborn infant. This brief report deals with a real, but quite small, source of error in measuring lung volume by nitrogen washout. Its “take-away” message is “that the correction for N2 excretion is a negligible source of error.” Nitrogen washout can only measure the volume of lung that is communicating through open airways with the atmosphere. Plethysmography can fulfill the demands of Boyle’s Law (P1V1 = P2V2) to calculate lung volume by capturing airway pressure changes while breathing against a closed airway, which measures all thoracic gas whether or not it communicates through open airways. Our later examinations of newborns by both techniques documented that the normal newborn’s chest does, indeed, variably contain significant amounts of “trapped gas” as airways open and close during the commotion of first establishing regular breathing within the tenuous balance between a compliant thoracic cage and the retractive forces of the infant lung. Nicholas M. Nelson, MD Prof Pediatrics Emeritus Penn State Hershey Topsham, Maine http://dx.doi.org/10.1016/j.jpeds.2014.01.063

Randomized Controlled Trial of Early Enteral Fat Supplement and Fish Oil to Promote Intestinal Adaptation in Premature Infants with an Enterostomy

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50 years ago in the Journal of Pediatrics: nitrogen excretion by newborn infants during oxygen breathing.

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