The starving newborn baby.

I n the newborn baby starvation implies the failure to consume and absorb enough calories and other materials to satisfy fully the requirements for growth as well as maintenance. If surgical treatment is necessary, involving the infliction of injury, these basic requirements are increased in order to provide for the resulting larger energy consumption and for the inflammatory response. Although the starving subject heals satisfactorily at any age, especially when the pre-operative nutritional state is good, this is achieved at the expense of the endogenous provision of the necessary materials. Such healing occurs normally and uneventfully in babies born as much as 8 weeks prematurely, who may weigh less than 2 kg, or who have been starved almost completely for up to 10 days or more, and may have lost a quarter of their stated birth weight. Pure starvation is seldom seen in surgical patients because they usually have some form of intestinal obstruction, which by vomiting causes the loss of upper gastro-intestinal secretions. It must also be emphasized that there is almost always some uncertainty about the stated birth weight, about the quantity and composition of the material which has been vomited, the amount of milk which has been consumed and how much of it has been retained. Some degree of starvation occurs even in normal newly born babies in the widely varying period of time between the ligation of the umbilical cord and the starting of milk feeds. This delay occurs even when an abundant supply of expressed human breast milk is regularly offered to the baby from a few hours after birth, and appears to be due to the failure of the baby to consume milk rather than to the deficient production of milk by the mother (Wilkinson, Stevens & Hughes, 1962). This delay is increased by foetal distress and after difficult or prolonged labour. During this sort of starvation immediately after birth the output of nitrogen, potassium and sodium in the urinc is small, partly because so little urine is formed, perhaps only 10 ml per kg per 24 h. When the volume of urine rises after the intake of milk begins there is usually an increase in the output of nitrogen for a few days although the output of potassium and sodium fall. Starvation of this kind immediately after birth is accompanicd by a loss of weight which varies a good deal and is related …