Urinary excretion of 2,3-butanediol and acetoin by babies on a special care unit.

2,3-Butanediol was detected by capillary gas chromatography in 45 urine samples from 20 babies on a special care unit, 17 of whom were premature. The meso form of the diol predominated and in 21 samples was the only diastereoisomer present. Acetoin was found in 20 of the samples. It was never detected in the absence of 2,3-butanediol. 2,3-Butanediol was not detectable in more than trace amounts in urine from 66 other babies on the unit. The most likely origin of these compounds was from bacterial fermentation of pyruvate in the gut. Their presence may be explained by abnormal gut colonisation with acetoin-producing microorganisms, an abundant supply of nutrient lactose in the colon and increased intestinal permeability. It is further evidence of the magnitude of intestinal carbohydrate fermentation in preterm babies. 2,3-Butanediol could prove a useful biochemical marker for abnormal colonisation of neonates on special care units.