EARLY POSTOPERATIVE CHANGE OF PLASMA-LEVELS OF AMINO-ACIDS IN NEONATES WITH PERFORATIVE PERITONITIS AND ITS PROGNOSTIC-SIGNIFICANCE

As a possible prognostic index, plasma levels of amino acids were seri ally measured for 1 week in 22 neonates with perforative peritonitis i ncluding gastric rupture and necrotizing enterocolitis and 28 neonatal surgical patients without infection as a control, who were subjected to total parenteral nutrition with hypertonic glucose and amino acids formulated for neonates. Plasma levels of branched chain amino acids s ignificantly increased on the first day after operation in peritonitis group, whereas plasma levels of phenylalanine and histidine increased on the third postoperative day and tyrosine increased seventh postope rative day. In the peritonitis group, 5 neonates died within 2 weeks a fter operation (early death group) because of cardiopulmonary failure and 5 neonates died with hyperbilirubinemia from 1 month to 6 months a fter operation (late death group). The early death group showed increa sed levels of total amino acids compared with those in the late death group and survivors. The late death group also showed higher levels of total amino acids than survivors. Plasma levels of tyrosine increased in the early and late death groups compared with survivors. These res ults indicated that serial measurements of plasma amino acids early af ter operation showed the existence Of liver dysfunction in addition to the derangement of amino acid metabolism in the liver and muscle caus ed by septic insult, which predicted the prognosis of perforative peri tonitis in neonates. Copyright (C) 1995 by W.B. Saunders Company