Continuous Intragastric Milk Feeds in Infants of Low Birth Weight

In a feeding trial 66 infants of low birth weight received continuous intragastric milk feeds from the fourth hour of life, starting with 60 ml/kg/24 hr and reaching a maximum of 300 ml/kg/24 hr on the ninth day. Each infant received only full-strength milk, which was either expressed human breast milk or SMA-S26 (a proprietary low-protein adapted cows'' milk) or half-cream Regal milk (partly-skimmed evaporated cows'' milk). For various reasons 10 babies had to be withdrawn, and the final assessment was made on the 56 who completed the trial successfully.Persistent vomiting was a problem in only four infants. In two of them the trial was continued after gastric lavage and in the other two vomiting stopped when the volume was reduced. Despite a careful search no evidence was found of aspiration of feeds in any infant. Continuous intragastric milk infusion was shown to be a safe method of feeding infants of low birth weight and SMA-S26 was almost as well tolerated as human milk. Because of the high-protein content of half-cream cows'' milk preparations and the resultant high plasma amino-acid levels when they are given in these large volumes they should be avoided for this type of feeding although they produce better weight gains in the first week of life.     

Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants.

OBJECTIVE--To examine the effects of maternal diet during lactation and the use of formula feeds on the development of atopic eczema in infants at risk. DESIGN--Mothers who planned to breast feed exclusively were randomly allocated to either a restricted diet (avoiding milk and other dairy products, eggs, fish, peanuts, and soybeans) or a diet without restrictions. Mothers who did not plan to breast feed were randomly allocated to using one of three formula feeds. SETTING--Child health centre in Canada. SUBJECTS--97 Mothers who chose to breast feed and 124 mothers who did not. INTERVENTIONS--Restricted diet for 49 mothers who breast fed. Casein hydrolysate formula, soy milk formula, or cows'' milk formula for infants not breast fed. MAIN OUTCOME MEASURE--Development of eczema in babies. RESULTS--Infants were followed up over 18 months and examined for eczema. Eczema was less common and milder in babies who were breast fed and whose mothers were on a restricted diet (11/49 (22%) v 21/48 (48%)). In infants fed casein hydrolysate, soy milk, or cows'' milk 9/43 (21%), 26/41 (63%), and 28/40 (70%), respectively, developed atopic eczema. CONCLUSIONS--In families with a history of atopic disease [corrected] mothers who breast feed should avoid common allergenic foods during lactation. If they choose not to breast feed a hydrolysate formula should be used.     

Significance of Milk pH in Newborn Infants

Bottle-fed infants do not gain weight as rapidly as breast-fed babies during the first week of life. This weight lag can be corrected by the addition of a small amount of alkali (sodium bicarbonate or trometamol) to the feeds. The alkali corrects the acidity of cow''s milk which now assumes some of the properties of human breast milk. It has a bacteriostatic effect on specific Escherichia coli in vitro, and in infants it produces a stool with a preponderance of lactobacilli over E. coli organisms. When alkali is removed from the milk there is a decrease in the weight of an infant and the stools contain excessive numbers of E. coli bacteria.A pH-corrected milk appears to be more physiological than unaltered cow''s milk and may provide some protection against gastroenteritis in early life. Its bacteriostatic effect on specific E. coli may be of practical significance in feed preparations where terminal sterilization and refrigeration are not available. The study was conducted during the week after birth, and no conclusions are derived for older infants. The long-term effects of trometamol are unknown. No recommendation can be given for the addition of sodium bicarbonate to milks containing a higher content of sodium.     

Inaccuracies in Measurement of Dried Milk Powders

Infant feeds made up from dried milk are known to be hazardous if the mixture is too concentrated. Tests with five commercial brands of dried milk showed that nurses, midwives, and mothers often made up feeds incorrectly; in most cases the amount of powder used was excessive.Fewer mistakes would be made if scoops were standardized or, better, if the milk was made up in small, accurately weighed packets.     

Latent anaphylactic sensitisation of infants of low birth weight to cows' milk proteins.

Latent systemic anaphylactic sensitisation to cows'' milk was assessed in 61 preterm infants who were randomly assigned to receive either a special formula for preterm infants based on cows'' milk or banked breast milk or one or other of these as a supplement to maternal milk. A single sample of venous blood was taken near to the time of discharge from the neonatal intensive care unit, and the histamine release by blood basophils in response to in vitro challenge with cows'' milk and anti-IgE was measured. Compared with the blood from infants fed on human milk, that from infants fed on preterm formula showed a significant increase in histamine release to challenge with cows'' milk, the response being greater in blood from infants of lower birth weight and gestational age. A smaller but significant increase in blood histamine release with anti-IgE challenge was observed in the group fed on preterm formula. Infants of low birth weight fed on preterm formula based on cows'' milk may develop latent systemic sensitisation more rapidly than infants born at term. The clinical importance of this requires further investigation.     

Common mistakes in infant feeding: survey from London borough.

A survey of infant-feeding practices among 265 mothers of 12-week-old infants in a London borough showed that only 18 gave breast milk alone, 236 giving bottle feeds, and 197 solids. Serious mistakes in feed preparation were common, and only 51 mothers followed manufacturers'' instructions exactly. Most mothers (239) had attended a well-baby clinic, but clinic staff gave conflicting advice on infant feeding. Health workers must pay greater attention to educating mothers on the details of infant feeding if the risks of hypernatraemia and obesity are to be reduced.     

Effect of antigen load on development of milk antibodies in infants allergic to milk.

The phenomenon that large amounts of antigen, such as are absorbed during the neonatal period, suppress the IgE response while low-dose exposure enhances it was investigated by analysing the antibody responses of infants allergic to milk according to their degree of exposure to cows''-milk protein. IgG, IgA, and IgM milk-specific antibodies in these infants and in age-matched controls were measured by enzyme-linked immunosorbent assay. Milk-specific IgE and total IgE were also measured. Children allergic to milk who were breast fed and had had minimal exposure to cows'' milk had decreased titres of IgG, IgA, and IgM milk antibodies compared with infants allergic to milk who, before diagnosis, had been fed substantial volumes of cows'' milk. Conversely, the infants with minimal exposure to cows'' milk showed vastly increased total and milk-specific IgE antibodies compared with the milk-fed infants. These results support recent experimental evidence that appreciable amounts of allergen suppress rather than stimulate IgE production. These data may have important implications for dietary regimens in at-risk infants. The results also lend support for the role of IgE in immediate-type allergic reactions and suggest that various non-IgE immune mechanisms play a part in the aetiology of intolerance to cows''-milk protein in some children.     

Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies.

Thirty seven breast fed infants with eczema were studied to see whether changes in their mothers'' diets affected their skin condition. Nineteen mothers and babies took part in a double blind crossover trial of exclusion of egg and cows'' milk, and 18 took part in open exclusion of 11 foods followed by double blind challenge to those mothers whose infants seemed to respond. Babies were examined at the beginning and end of each dietary period, and the extent and severity of the rash were given a numerical score. The eczema improved in six infants when their mothers avoided egg and cows'' milk and worsened again when these were reintroduced. Two infants suffered gastrointestinal reactions after maternal ingestion of egg and cows'' milk, one developing colitis. Maternal dietary exclusion seems to benefit some breast fed babies with eczema.     

Metabolic acidosis and infant feeding.

Most cows'' milk based formulae for infant feeding present a greater acid load to the infant than breast milk. To determine the effect of this difference the acid base state of 180 healthy term infants was measured on the sixth day of life and related to the type of feed. Those infants fed on cows'' milk formula (SMA) had a mean pH of 7-34 +/- 0-05 and a base deficit of 8-8 +/- 3-1, while those fed on breast milk had a mean pH of 7-38 +/- 0-05 and a base deficit of 5-6 +/- 3-1. The difference between the two groups of infants was significant for both these measurements. Metabolic acidosis was defined as a base deficit greater than 10 mmol/l. Seventy-four per cent of the 34 infants who were acidotic at six days were bottle-fed. There was a significant correlation between the pH of the feed and the degree of acidosis in the infant as measured by the base deficit. The findings suggest that when breast milk is not available a pH-adjusted milk formula would be desirable for preventing and treating neonatal metabolic acidosis.     

Correlation between lactoferrin and beneficial microbiota in breast milk and infant’s feces

Lactoferrin (LF) is a natural component of human milk with antimicrobial, immunostimulatory and immunomodulatory properties. Several in vitro studies suggest that LF could promote an environment in the gut of neonates that favors colonization with beneficial bacteria. However, clinical studies on the correlation between the concentration of LF in breast milk and feces of infants and the gut microbiota in infants are lacking. In our study we analyzed the content of LF and the microbiota of breast milk and feces of infants of 48 mother–infant pairs (34 full-term and 14 pre-term infants) at birth and 30 days after delivery. In the term group, a significant decrease of mean LF concentration between colostrum (7.0 ± 5.1 mg/ml) and mature milk (2.3 ± 0.4 mg/ml) was observed. In pre-term group, breast milk LF levels were similar to those observed in full-term group. Fecal LF concentration of healthy infants was extremely high both in term and pre-term infants, higher than the amount reported in healthy children and adults. In term infants mean fecal LF levels significantly increased from birth (994 ± 1,828 μg/ml) to 1 month of age (3,052 ± 4,323 μg/ml). The amount of LF in the feces of 30 day-old term infants was significantly associated with maternal mature milk LF concentration (p = 0.030) confirming that breast milk represents the main source of LF found in the gut of infants. A linear positive correlation between colostrum and mature milk LF concentration was observed (p = 0.008) indicating that milk LF levels reflect individual characteristics. In pre-term infants higher mean concentrations of fecal LF at birth (1,631 ± 2,206 μg/ml) and 30 days after delivery (7,633 ± 9,960 μg/ml) were observed in comparison to full-term infants. The amount of fecal bifidobacteria and lactobacilli resulted associated with the concentration of fecal LF 3 days after delivery (p = 0.017 and p = 0.026, respectively). These results suggest that high levels of fecal LF in neonates, particularly in the first days of life, could represent an important factor in the initiation, development and/or composition of the neonatal gut microbiota. Since early host–microbe interaction is a crucial component of healthy immune and metabolic programming, high levels of fecal LF in neonates may beneficially contribute to the immunologic maturation and well-being of the newborn, especially in pre-term infants.     

Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study.

OBJECTIVE--To study the effect of early diet on the development of allergic reactions in infants born preterm. DESIGN--Two randomised prospective trails. In trail A infants were randomly allocated banked donor milk or preterm formula as their sole diet or (separately randomised) as a supplement to their mother''s expressed breast milk. In trial B infants were allocated term or preterm formula. A blind follow up examination was done 18 months after the expected date of birth. SETTING--Neonatal units of hospitals in Cambridge, Ipswich, King''s Lynn, Norwich, and Sheffield. Outpatient follow up. PARTICIPANTS--777 Infants with a birth weight less than 1850 g born during 1982 to 1984. MAIN OUTCOME MEASURES--Development of eczema, allergic reactions to food or drugs, and asthma or wheezing by nine and 18 months after term. Whenever possible the observations were confirmed by rechallenge or clinical examination. RESULTS--At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial. In the subgroup of infants with a family history of atopy, however, those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions (notably eczema) by 18 months (odds ratio 3.6; 95% confidence interval 1.4 to 9.1). CONCLUSIONS--Feeding neonates on formulas based on cows'' milk, including those with a high protein content, did not increase the overall risk of allergy. Nevertheless, in the subgroup with a family history of atopy early exposure to cows'' milk increased the risk of a wide range of allergic reactions, especially eczema.     

Body fat of British and Dutch infants.

The fatty acids in the body fat of 41 British and 37 Dutch infants between birth and 1 year were determined. At birth linoleic acid contributed 1-3% of the total fatty acids of the body fat in infants in both countries. By one month its proportion in the fat of the Dutch infants was about 25% and by four months 32-37%; in the fat of the British infants it was never more than 3%. In the Dutch infants this large increase in the linoleic acid percentage was accompanied by a fall in the percentage contribution of others, particularly the saturated acids myristic, palmitic, and stearic. Infants born preterm showed changes in their fat after birth similar to those in fullterm infants. The difference between the composition of the fat of the infants in the two countries is attributed to the nature of the fat in the milk they received. Until recently most British infants who are not breast-fed have been given milks based on cow''s milk with only minor modifications. For the past 10 years many Dutch infants have been given a milk in which all the cow''s milk fat has been replaced by maize oil. Dutch infants also had a lower concentration of cholesterol in their serum than British infants, which was not unexpected. The results show that the triglycerides in the adipose tissue are profoundly influenced by the nature of the fat in the diet.     

人乳寡糖2′-岩藻糖基乳糖的功能及其全细胞生物合成

母乳是新生儿最理想的营养剂。其中,人乳寡糖作为母乳的第三大固体组分,对新生儿的生长、发育及健康状况有重要影响,被应用于婴幼儿配方食品中。2′-岩藻糖基乳糖(2′-fucosyllactose,2′-FL),是分泌型母乳中含量最高的人乳寡糖,约占人乳寡糖总量的30%,具有重要的营养和医学价值。2′-FL能够促进婴幼儿生长发育、提高其认知能力、增强免疫力、抗过敏、抗病毒,以及调节肠道菌群,是极具潜力的新型营养强化剂。但是,2′-FL来源于母乳,依靠分离、提取获得大量2′-FL并不现实,因此亟需进行人工合成。人工合成2′-FL的方法有3种,包括：化学合成法、酶催化合成法和全细胞生物合成法。全细胞生物合成法因其成本相对低廉,且易于规模化扩大,而引起了国内外的广泛关注和研究。目前,国外很多跨国公司均开始布局2′-FL的工业化生产和应用,而我国在该领域尚处于研发阶段,因此,了解和掌握2′-FL的合成方法对我国开展2′-FL规模化生产具有重要的意义。本文旨在介绍2′-FL的功能特性,系统阐述其全细胞生物合成的关键技术和最新进展,讨论了针对限速步骤进一步提高产量的策略,旨在为2′-FL的合成和商业化生...     

Resistance of the Breast-fed Infant to Gastroenteritis

From in-vitro studies of breast and cow''s milk preparations, and of the faeces from breast-fed and bottle-fed infants, a number of factors seemed likely to influence the production and maintenance of a lactobacillary flora and low pH in the faeces of newborn infants. These were mainly attributable to the nature of the feed. It is suggested that responsible factors in breast milk include its high lactose, low protein, low phosphate content, together with its poor buffering capacity. Importance is also attached to the fact that breast milk seems to provide a fluid feed of small bulk and low residue, and that its use is unlikely to include periods of starvation. Cow''s milk, on the other hand, which has a low lactose, high protein, high phosphate content, and a high buffering capacity, is a relatively bulky, high-residue feed. Feeding regimens which employ it are likely to include periods of starvation.     

Egg and cows' milk hypersensitivity in exclusively breast fed infants with eczema,and detection of egg protein in breast milk.

Forty nine eczematous infants who were still solely and exclusively breast fed and who had never received anything but breast milk were studied for evidence of sensitisation to foods. Thirty four similar infants without eczema formed a control group. The eczematous infants were divided into three groups according to clinical criteria: (1) definite atopic eczema; (2) possible atopic eczema; (3) atopic eczema unlikely. Twenty three infants showed cutaneous hypersensitivity to foods, usually egg and cows'' milk. Seven of 14 infants in group 1 and nine of 20 in group 2 were sensitised compared with four of 15 in group 3 and three of 34 controls (p less than 0.01). Ovalbumin was detected in breast milk from 14 of 19 mothers tested after ingestion of egg, the concentrations being the same for mothers feeding eczematous and normal infants. Breast fed babies developing eczema may be sensitised by foods eaten by their mothers.     

Infant-feeding Practices

A survey of mothers attending infant welfare clinics showed that 26% changed their infant''s milk in the first two weeks after birth and that multiple changes were common. Twenty-two per cent. were preparing a milk formula more concentrated than the recommended strength by using either heaped or packed scoops instead of level scoops of powder or by giving extra scoops. The commonest age for starting solid feeding was between 3 and 4 weeks and the practice of adding rusk or cereal to the bottle was common. There are obvious dangers of hypernatraemia from taking concentrated milk feeds and problems of obesity which may follow the early introduction of cereals.     

Are breast-fed babies still getting a raw deal in hospital?

After preliminary validation of test weighing under ward conditions the fluid intake and weight gain of 39 breast-fed and 25 artificially fed infants were compared. All were fed every four hours for six feeds a day, and the breast-fed infants received dextrose supplements only. The average intake and weight gain of the breast-fed group was significantly less than that of the group fed artificially.When cows''-milk supplements are withheld from breast-fed infants a four-hourly regimen provides insufficient stimulus to lactation for their needs in the first week of life. If more than lip service is to be paid to the mother who desires to breast-feed in hospital, early and more frequent feeding should be practised.     

Cadmium, Lead, Copper and Zinc in Breast Milk in Poland

Mother's milk is the fundamental food for infants. It contains proteins, fat, carbohydrates and essential metals which are necessary to ensure correct functioning of the organism. Unfortunately, breast milk is a potential source of toxic metals, which are dangerous for a baby. In Poland, previous research concerning the content of metals in breast milk was very scarce or its results were unavailable. The present study aimed at assessing the content of Cd, Pb, Cu and Zn in human breast milk, as well as estimating the mean weekly intake of these metals by breast-fed infants from Poland. The average concentrations of Cd, Pb, Cu and Zn were 2.114 μg/l, 6.331 μg/l, 0.137 mg/l and 1.623 mg/l, respectively. The admissible levels of supply of these toxic metals has not been exceeded, but their contents were high, particularly in 6-month-old infants (nearly 85 % TWI for Cd and nearly 70 % BMDL₀₁ for Pb). The daily intake of Cu and Zn did not fully satisfy the infant's requirements determined by Polish standards and WHO recommendations. Since the lifestyle of lactating women has a direct influence on the content of these elements in breast milk, women should be educated in this respect with particular focus on eliminating tobacco smoking, both by breastfeeding mothers and by their direct environment.     

Breast Milk Substitute: A Bacteriological Study

The increased susceptibility of infants fed on cows'' milk preparations has been attributed, at least in part, to differences in the nature of the large-bowel content—owing to the acidity of the faeces and their high content of Lactobacillus bifidus. In an attempt to mimic these features of the breastfed infant in one who is fed artificially, a breast milk substitute was devised which resembles breast milk in several important ways. When this material was fed to newborn infants the faeces developed the characteristics of those of the breast-fed child.     

Strontium-89 and Strontium-90 Levels in Breast Milk and in Mineral-Supplement Preparations

Strontium-90, strontium-89 and S.U. values were determined in human milk before and after the resumption of atmospheric nuclear testings in 1961, and the levels were compared to cows'' milk values reported during the same time. S.U.⁹⁰ levels in human milk were approximately one-fifth of those found in cows'' milk. Assuming an average dietary intake of 11-13 S.U.⁹⁰ during the period tested, the mean strontium/calcium ratio of 1.78 found in human milk represents an Observed Ratio milk-diet of approximately 0.14-0.16. Although strontium-89 was present in cows'' milk already in September 1961, it did not appear in human milk until November 1961. It seems, therefore, that there was a two-month lag period between the appearance of fresh fallout in cows'' milk and human milk. Calcium-supplement mineral preparations used by pregnant and lactating women were tested to find their strontium-89, strontium-90 and S.U. levels, because strontium isotopes, if present in these products, will be transferred to the fetus and to breast-fed infants. The compounds tested had S.U.⁹⁰ levels of 0.13-2.62; in none of the preparations was Sr⁸⁹ present.