GASTRIC
ACIDITY
ON
THE
FIRST DAY
OF
LIFE
By Dale W. Ebers, M.D., Dorothy I. Smith, M.D., and Gordon E. Gibbs, M.D.
Department of Pediatrics, University of Nebraska College of Medicine
N
UMEROUS investigators havecontribu-ted to the present knowledge
con-cerning the gastric acidity in the newborn
period.6 There is agreement that the
acidity reaches relatively high levels
dur-ing the first 2 days of life. After this
early wave of acidity, a period of
de-creased acidity occurs for approximately
10 days. This is followed by a gradual
increase.6 The observations of Huhtikangas
would indicate that at birth the acidity of
the gastric contents is essentially neutral,
but that the pH is less than 3.0 by the age
of 5 hours. In his extensive study there
were 12 infants in whom serial
determina-tions were done. In six of these, the first
determination was at 15 to 30 minutes
after birth, and the second specimen was
at 1 hour. The initial acidities ranged
from p1-I 4.7 to pH 7.6 with median of 7.1.
At the age of 1 hour the pH ranged from
1.7 to 7.1 with median of 3.9. In the 12
infants the values at the age of 3 hours
ranged from 1.1 to 2.5 with a median of
1.5.
The present study was planned to
deter-mine more definitely the gastric acidity in
the first few hours of life, by performance of serial determinations in a larger number of infants.
PROCEDURE AND RESULTS
Removal of the first specimen served to
empty the stomach completely, as soon as
practical following birth. Because this
specimen contained material swallowed at
birth and material accumulated before
birth, it is of doubtful significance
regard-ing the composition of the new gastric
secretion at that time. Removal of all of the
gastric fluid at the first suctioning permits
Table I shows serial determinations of
pH in the gastric contents removed by
in-tubation from 53 newborn infants. The
results are in essential agreement with
those of Huhtikangas. The initial
speci-mens were taken at the following times
after birth: 0 to 15 minutes in 3; at 15
to 30 minutes in 6; at 30 to 45 minutes in
22; at 45 minutes to 1 hour in 18. The
median values of pH for these four groups
of initial specimens were 6.1, 5.2, 5.6, and
4.7, respectively. The total range was 8.4
to 2.3. The relative back of acidity in these
initial specimens is partially attributable
to the presence of prenatal contents, neu-tral fluids swallowed at delivery, and the
alkaline mucoid secretions of the gastric
mucous glands and sabiva. This lack of
acidity would seem to have a clinical sig-nificance in that the sterilizing action of
the gastric contents is frequently not
pres-ent to protect the infant from ingestion of infectious agents at the time of birth.
In the second specimens, the above
groups showed median values of pH of 3.2,
2.7, 2.8, and 3.6, respectively. The range of
values for all of these second specimens
was from 7.6 to 1.6. These values may be
considered to be the resultant acidity of
the gastric juices (and some saliva)
Se-creted during the hour preceding the ages
of 75 to 120 minutes. By the age of 5 to
6 hours, the acidity was only slightly
greater, the median pH being 2.1, 2.2, 2.2, and 2.2 and the total range 8.3 to 1.1.
SUMMARY
The initial gastric contents of the
new-born were found to have a median pH of
B-Bile stain.
M-Mucoul.
* Determined by Beckman pH meter, Model G, using glass and calomel electrodes.
ARTICLES 801
TABLE I
I)ATA CONCERNING ACIDITY OF GASTRIC CONTENTS DURING FIRST 24 buns OF LIFE
p!1 of Gastric Contents*
I108J). Sex Race Weight Minutes after Delivery Age
.. (g)
---
-15 30 45 60 75 90 105 WA) 375 330 3:5 ,l&) hoary
120133 F 0 3.3 S.() 3.2 1.5
-120275 M N 2.9 6.1 5.5 3.3 4.2
. 119926 F V 3.6 2.3 1.6 2.1 3.3
120329 M N 3.0 6.9 7.5M 2.2 1.9
120342 M W 3.3 7.3 4.3 2.1 4.5
120319 M W 34 5.7 2.3 1.9 3.6
120364 M W’ 3.5 3.9 2.7 1.6 5.6
120474 F N 3.3 4.6 2.5 2.9 4.4
120743 F N 3.0 3.6 ‘2.7 4.2 ‘2.1
120158 M N 3.7 3.7 2.9 2.2 2.3
120171 M \\. 3.1 6.2 2.4 2.3 1.3
1’20187 F N ‘2.6 6.1 4.4 1.4 2.9
120215 M N 3.2 5.3 2.2 1.3 4.0
120230 F W 2.2 5.8 3.2 2.1 4.5
120184 M N 3.0 6.1 - 1.7 4.1
120231 F N 2.5 5.9 - -
-120291 F W 2.2 2.7 3.2 1.6 2.2
120336 M N 3.2 4.1 7.2M I.3M 4.9
120354 M N 3.5 5.4 2.8 2.9 4.3
120356 M W 2.5 4.2 2.8 3.0 5.1
120369 M N 3.5 7.2 4.0 2.9 2.9
120487 F W 3.0 8.4 7.6 2.6 5.0
120486 Tl W 3.4 4.OB 2.3B 1.8 2.5
120509 F N 3.2 5.8 2.1 ‘2.0 4.5
120540 F N 3.0 3.6 1.9 1.3 2.3
120542 F W 3.2 2.5 1.9 L3 3.8
120307 F I 3.5 4.3 2.1 2.8 4.0
120653 F W 4.2 6.9 7.6 3.8 5.6
120663 M W 3.4 7.3 6.7 2.2 3.4
120664 M N 2.9 7.1 6.2 4.3 3.1
120704 F N 3.4 2.6 2.6 1.2 5.1
120143 M N 3.3 3.0 1.8 1.3 2.0
120159 F W 3.6 7.4 7.3 2.0 4.3
120173 F W 3.5 6.6 4.1 1.4 2.4
120175 M N 3.4 3.0 6.0 2.7 3.8
120179 M N 3.0 3.1 1.8 6.8M 3.8
120199 M \V 3.0 7.1 7.1M 6.BM 3.6
120246 F I 4.3 6.7 2.3 1.1 2.9
120260 N N 3.0 3.3 2.8 2.0 4.5
120288 ii: N 3.0 2.8 4.8 .3 3.5
120287 F \V 4.0 6.9 6.1 - 2.7
120376 ii: \v 3.3 5.5 2.3 1.8 4.9
120381 M W 4.3 4.8 4.1 5.2M 2.7
120424 F \V 2.8 7.7 5.0 3.0 6.0
120439 F \Y 2.9 6.1 4.7 1.7 3.4
120635 M N 2.6 4.1 3.2 2.6 5.2
120634 M W 3.5 - 6.5 4.0 4.1
120725 M N 3.2 4.7 6.0 6.0 4.9
120745 F W 2.9 4.7 2.2 1.5
-120228 F W 3.8 4.0 2.7 3.4
-120259 TL N 3.3 6.8 2.2 1.3 4.9
120373 F N 3.0 2.6 1.9 1.6 3.2
EBERS - GASTRIC ACIDITY
802
decreased only to 2.2 by 5 to 6 hours.
The clinical implication of the findings is
that the newborn does not have much of
the antiseptic effect of gastric acidity at birth but develops it within a few hours.
REFERENCES
1. Hess, A. F.: The gastric secretion of infants at birth. Am.
J.
Dis. Child., 6:264, 1913. 2. Griswold, C., and Shohl, A. T.: Gastricdigestion in new-born infants. Am.
J.
Dis. Child., 30:541, 1925.
3. Ritter,
J.
A.: Fractional gastric analysis inthe newborn; preliminary report. Penn-sylvania M.
J.,
44:1321, 1944.4. Huhtikangas, H. : Untersuchungen #{252}berdie
Reaktion des Mageninhabts bei Neuge-borenen. Acta Soc. med. fenn. duodecim.,
24:1, 1937.
5. Bradley,
J.
E., and Tibghman, M. : In situhydrogen ion measurements of the
mouth, espohagus and stomach in new-born infants. Am.
J.
Digest. Dis., 19:255,1952.
6. Miller, R. A.: Observations on the gastric
acidity during the first month of life. Arch. Dis. Childhood, 16:22, 1941.
7. Ivy, A. C., and Gibbs, G. E.: Physiology of the gastro-intestinal tract, in
Brenne-man’s Practice of Pediatrics, Vol. 1,
