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1 Schwartz Center for Metabolism and Nutrition, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109; and 2 Erasmus University and Sophia Children's Hospital, 3000 CB Rotterdam, The Netherlands
The rate of
glucose turnover (Ra) and gluconeogenesis (GNG) via
pyruvate were quantified in seven full-term healthy babies between 24 and 48 h after birth and in twelve low-birth-weight infants on
days 3 and 4 by use of
[13C6]glucose and
2H2O. The preterm babies were receiving
parenteral alimentation of either glucose or glucose plus amino acid
with or without lipids. The contribution of GNG to glucose production
was measured by the appearance of 2H on C-6 of glucose.
Glucose Ra in full-term babies was 30 ± 1.7 (SD)
µmol · kg
1 · min
1. GNG
via pyruvate contributed ~31% to glucose Ra. In preterm babies, the contribution of GNG to endogenous glucose Ra
was variable (range 6-60%). The highest contribution was in
infants receiving low rates of exogenous glucose infusion. In an
additional group of infants of normal and diabetic mothers, lactate
turnover and its incorporation into glucose were measured within
4-24 h of birth by use of [13C3]lactate
tracer. The rate of lactate turnover was 38 µmol · kg
1 · min
1, and
lactate C, not corrected for loss of tracer in the tricarboxylic acid
cycle, contributed ~18% to glucose C. Lactate and glucose kinetics
were similar in infants that were small for their gestational age and
in normal infants or infants of diabetic mothers. These data show that
gluconeogenesis is evident soon after birth in the newborn infant and
that, even after a brief fast (5 h), GNG via pyruvate makes a
significant contribution to glucose production in healthy full-term
infants. These data may have important implications for the nutritional
support of the healthy and sick newborn infant.
gluconeogenesis; lactate; stable isotopes; newborn infants; 2H2O
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