Accuracy and precision of test weighing to assess milk intake in newborn infants

BACKGROUND: Test weighing is commonly used to estimate milk intake in newborn infants. OBJECTIVE: To assess the accuracy and precision of test weighing in clinical practice. METHODS: Infants fed by bottle, cup, or nasogastric tube were weighed before and immediately after feeding by a blinded investigator. Actual milk intake was determined by reading the millilitre scale of the milk container before and after feeding. The accuracy and precision of test weighing was assessed by examining the frequency distribution of the difference between weight change and actual milk intake. RESULTS: Ninety four infants completed the study. The mean difference between weight change and actual milk intake was 1.3 ml, indicating good accuracy. The precision of test weighing, however, was poor: 95% of differences between weight change and actual milk intake ranged from -12.4 to 15 ml. The maximum difference was 30 ml. Imprecision was not influenced by the presence of monitor or oxygen saturation wires, intravenous lines, or vomiting of the infant. CONCLUSIONS: Test weighing is an imprecise method for assessing milk intake in young infants. This is probably because infant weighing scales are not sensitive enough to pick up small changes in an infant's weight after feeding. Because of its unreliability, test weighing should not be used in clinical practice.     

Quantifying breast milk intake by term and preterm infants for input into paediatric physiologically based pharmacokinetic models

Despite the many benefits of breast milk, mothers taking medication are often uncertain about the risks of drug exposure to their infants and decide not to breastfeed. Physiologically based pharmacokinetic models can contribute to drug‐in‐milk safety assessments by predicting the infant exposure and subsequently, risk for toxic effects that would result from continuous breastfeeding. This review aimed to quantify breast milk intake feeding parameters in term and preterm infants using literature data for input into paediatric physiologically based pharmacokinetic models designed for drug‐in‐milk risk assessment. Ovid MEDLINE and Embase were searched up to July 2, 2019. Key study reference lists and grey literature were reviewed. Title, abstract and full text were screened in nonduplicate. Daily weight‐normalized human milk intake (WHMI) and feeding frequency by age were extracted. The review process retrieved 52 studies. A nonlinear regression equation was constructed to describe the WHMI of exclusively breastfed term infants from birth to 1 year of age. In all cases, preterm infants fed with similar feeding parameters to term infants on a weight‐normalized basis. Maximum WHMI was 152.6 ml/kg/day at 19.7 days, and weighted mean feeding frequency was 7.7 feeds/day. Existing methods for approximating breast milk intake were refined by using a comprehensive set of literature data to describe WHMI and feeding frequency. Milk feeding parameters were quantified for preterm infants, a vulnerable population at risk for high drug exposure and toxic effects. A high‐risk period of exposure at 2–4 weeks of age was identified and can inform future drug‐in‐milk risk assessments.     

Milk intake and frequency of feeding in breast fed infants

To provide normative data for healthy full term infants in the United States when the mothers were encouraged to feed as often and as long as the infants wished, 46 mother-infant pairs were studied in the first month after delivery. Mothers recorded the length and time of each breast-feeding for the first 14 days postpartum, and weighed the infant before and after each feeding during a 24–48 h period at 1 month. The mean frequency of feeding during the first 2 weeks of life was 9.8 ±2.5 feeds/24h and the mean duration of feeding was 162 ±50 min/24 h. Infants heavier at birth demanded significantly more feedings and nursed longer during the first 14 days of life. At one month the infants were nursing an average of 7.2±1.3 times/24h and the mean duration of feeds was 158±63 min/24h. Although the frequency of feeding during the first 14 days postpartum was significantly higher than at 1 month, the total duration of feeding in 24h was similar. Daily milk intakes at 1 month ranged from 395 to 1011 ml (mean 681 ±136 ml) and were not significantly correlated with either the frequency or duration of feedings.     

Associations between dietary intake and breast milk dioxin levels in Tokyo, Japan

BACKGROUND: The presence of dioxins in breast milk has gained much attention recently. However, in Japan the relationship between the consumption of different foods and the human breast milk dioxin concentrations is still unclear. METHODS: Breast milk was taken from 240 mothers residing in Tokyo, Japan to measure and analyze the concentrations of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and coplanar poly-chlorinated biphenyls contained in the fat. Individual milk samples were obtained from the mothers 30 days after delivery in 1999 and 2000. The data of the mothers' diets before pregnancy were collected by means of food frequency and amount estimation. Spearman correlation analysis and stepwise multiple linear regression were used to analyze the data. RESULTS: The concentrations of dioxins in breast milk were influenced mainly by the mother's age and history of breast-feeding. All the Spearman correlation coefficients were less than 0.20. Pork, roast ham, sausage, salt codfish and tempura had negative correlations with breast milk dioxins. CONCLUSIONS: History of breast-feeding and the mother's age should be considered and emphasized in this kind of analysis. The cause effect relationship between dietary intake and breast milk dioxin levels were still uncertain.     

Breast milk zinc transfer and early post‐natal growth among urban South Indian term infants using measures of breast milk volume and breast milk zinc concentrations

Zinc (Zn) deficiency in infancy and early childhood is of public health concern in developing countries. This study aimed to longitudinally assess Zn intake of urban South Indian term infants in the first 6 months of life using measures of breast milk (BM) volume and BM Zn concentrations and, additionally, to study the effect of BM Zn intake on infant length and weight gain. BM intake by the deuterium dilution technique, BM Zn concentration at months 1, 3 and 6, as well as serum Zn level at months 3 and 6 were assessed in 50 mother–infant pairs. BM intake significantly declined from 627 mL day^?1 at month 1 to 608 mL day^?1 at month 6 (P < 0.01). BM Zn concentration and intake significantly declined from month 1 to month 6 (P < 0.001 for both). Mean infant serum Zn level at months 3 and 6 were 93.0 ± 27.1 and 99.6 ± 30.1 µg dL^?1, respectively. Infant BM Zn intake at months 1 and 3 was not associated with the weight and length gain between 1–3 and 3–6 months, respectively. Zn intake from BM, maternal BM Zn content and serum Zn levels were not significantly different between small‐for‐gestational age and appropriate‐for‐gestational age infants. Therefore, among urban south Indian term infants less than 6 months of age, BM Zn intakes were low, owing to low volumes of BM intake, despite BM Zn concentrations being in the normal range. Promotion of breastfeeding and thereby increasing the volumes of milk produced is a first important step towards improving Zn intake among infants.     

母乳成分与纯母乳喂养婴儿体重增长速率的关系

目的 探讨母乳成分对纯母乳喂养婴儿体重生长速率的影响。方法 选取定期进行儿童保健的138 例纯母乳喂养足月单胎婴儿及其乳母作为研究对象。在定期儿童保健时间点进行婴儿体重、身长及头围的测量,采用Z 积分计算生长速度,并根据ΔZ 积分将研究对象分为生长不良组（ΔZ 积分 ≤ -0.67）、生长速度低下组（-0.67 结果 生长不良组、生长速度低下组体重ΔZ 积分显著低于正常对照组（P P 结论 成熟乳母乳成分可短时间内在一定程度上影响纯母乳喂养婴儿的体重增长速率,乳母应均衡膳食,提高成熟乳质量以维持婴儿良好的体格生长速率。     

足月儿母乳淀粉酶活性动态变化

为了解我国足月儿母乳淀粉酶活性的动态变化规律,测定40例足月顺产儿乳母不同泌乳期及一次喂奶时前、中、后段乳及母血中淀粉酶的活性。结果显示初乳中淀粉酶活性为(9772.37±1.70)IU/L;随着泌乳期的延长,淀粉酶活性逐渐下降;一次喂奶前、中、后段乳中淀粉酶的活性差异无显著性意义;母乳淀粉酶98％为唾液型淀粉酶;母乳中淀粉酶活性高于母血100倍;产妇年龄与母乳淀粉酶活性无显著性相关。提示母乳中含有丰富的淀粉酶,对母乳喂养儿的淀粉消化和潜在的抗感染作用具有积极意义,应向广大群众大力提倡母乳喂养。     

Factors associated with breast milk intake among 9–10‐month‐old Malawian infants

Exclusive breastfeeding is recommended during the first 6 months of life; thereafter, continued breastfeeding along with nutritious complementary foods is recommended. Continued breastfeeding contributes a substantial proportion of nutrient needs and promotes healthy growth and development, but the quantity of breast milk consumed may be highly variable and little is known about the factors associated with breast milk intake after 6 months of age. The present study was conducted to assess factors associated with breast milk intake of Malawian infants at 9–10 months of age. Breast milk intake was measured using the dose‐to‐mother deuterium oxide dilution method in a subsample of 358 Malawian infants who were participating in a randomized controlled trial of lipid‐based nutrient supplements. Regression analysis was used to assess associations between breast milk intake and several maternal and infant variables. Mean (standard deviation) breast milk intake was 752 (244) g day^–1. In multiple regression, breast milk intake was positively associated with infant weight (+62 g per kg body weight, P < 0.01) and maternal height (P < 0.01) and negatively associated with maternal education and age (P < 0.01). There was a non‐significant (P = 0.063) inverse association between energy from non‐breast milk sources and breast milk intake. In this rural Malawian population, infant weight is the main predictor of breast milk intake, even after the first 6 months of life.     

The breast vs the bottle controversy in India

In view of the observations that existing marketing practices of Baby Food Manufacturers act as a detriment to successful breast feeding, the World Health Assembly endorsed an International Code of Marketing of Breast Milk Substitutes in May this year. The Indian Government has also prepared a draft code based on the International Code. It appears that pediatricians are not fully aware of the contents and development of these codes. It is important to understand the related issues and to underline the role of pediatricians in not allowing the industry to change for worse the pattern of consumption of people in the third world.     

Type of milk feeding in infants and young children up to 19 months of age in three Socio-economic groups in Madrid

The feeding practices of 344 children in Madrid between 3 and 19 months were investigated by controlled interview or their mothers of care-takers. Four different types of milk were given to the children: human milk, infant formula, follow-on formula and cow's milk. Three periods could be defined when infants were most likely to change from one milk type to another. The majority of babies changed from human milk to infant formula some time in the first three months of life. At between four and six months, about half the sample changed to a follow-on formula and, finally, around the baby's first year formula was substituted for cow's milk. Differences in feeding behaviour could be observed among Socio-economic groups, but were not statistically significant. Feeding patterns closely followed international recommendations for infant feeding.     

喂养方式对婴幼儿轮状病毒腹泻的影响

目的探讨母乳与人工喂养对出生15d～18个月婴儿轮状病毒腹泻发生率、腹泻严重程度及病程的影响。方法2007年7月-2009年5月因腹泻来我院门诊及住院的患儿465例,喂养方式为母乳或人工喂养,年龄在出生15d～18个月,收集1h内新鲜粪便标本,进行大便常规+大便潜血检查,并同时检测轮状病毒。结果465例患儿中母乳喂养306例,82例粪便轮状病毒抗原阳性,阳性率26.8%;人工喂养患儿159例,69例粪便轮状病毒抗原阳性,阳性率43.4%。母乳喂养儿轮状病毒阳性率明显低于人工喂养儿,差异有统计学意义(P<0.01)。母乳喂养组发生脱水程度及并发症发生率较人工喂养组低,母乳喂养组腹泻病程亦较人工喂养组短,差异均有统计学意义(P均<0.05)。结论母乳喂养可保护婴幼儿减少轮状病毒感染率,或即便发生轮状病毒腹泻,其临床症状亦较人工喂养儿轻,病程短。提倡并推广母乳喂养,是减少婴幼儿轮状病毒感染和减轻腹泻症状、缩短病程的有效手段之一。     

Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya

Household food insecurity has been hypothesized to negatively impact breastfeeding practices and breast milk intake, but this relationship has not been rigorously assessed. To generate an evidence base for breastfeeding recommendations among food‐insecure mothers in settings where HIV is highly prevalent, we explored infant feeding practices among 119 mother–infant dyads in western Kenya at 6 and 24 weeks postpartum. We used the deuterium oxide dose‐to‐the‐mother technique to determine if breastfeeding was exclusive in the prior 2 weeks, and to quantify breast milk intake. Sociodemographic data were collected at baseline and household food insecurity was measured at each time point using the Household Food Insecurity Access Scale. Average breast milk intake significantly increased from 721.3 g/day at 6 weeks postpartum to 961.1 g/day at 24 weeks postpartum. Household food insecurity at 6 or 24 weeks postpartum was not associated with maternal recall of exclusive breastfeeding (EBF) in the prior 24 hr or deuterium oxide‐measured EBF in the prior 2 weeks at a significance level of 0.2 in bivariate models. In a fixed‐effects model of quantity of breast milk intake across time, deuterium oxide‐measured EBF in the prior 2 weeks was associated with greater breast milk intake (126.1 ± 40.5 g/day) and every one‐point increase in food insecurity score was associated with a 5.6 (±2.2)‐g/day decrease in breast milk intake. Given the nutritional and physical health risks of suboptimal feeding, public health practitioners should screen for and integrate programs that reduce food insecurity in order to increase breast milk intake.     

Gastric emptying in pre-term infants: the effect of breast milk fortifier

Failure of adequate gastric emptying frequently prevents successful, early enteral nutrition in the preterm infant. The effect on gastric emptying of adding breast milk fortifier is unknown, but clinical experience suggests that it is less well tolerated by some infants. We therefore compared gastric-emptying rates of breast milk and fortified breast milk within pre-term infants, using a previously described ultrasonic technique. Eleven infants were studied on 22 occasions. Median (range) gestation of the group was 28 weeks (25-31) with birth weight 1090 g (714-1360). The human milk fortifier FM-85 (Nestlé, Vevey, Switzerland) was used in all infants. Half-emptying time for unfortified breast milk was less than half that for fortified breast milk. Mean (±SEM) half emptying times were 21 min (±3.6) and 48 min (±4.0), respectively. Breast milk emptied faster than fortified breast milk in 10 out of 11 patients. These data demonstrate that the addition of human milk fortifier can significantly slow gastric emptying. This has important implications for the management of infants who have feed intolerance.     

采集母乳与母乳库母乳喂养对早产儿生长发育的影响

采集母乳与母乳库母乳可以作为早产儿在无法获得直接母乳喂养时可选择的一种喂养方式.目前文献提示,单纯以采集母乳与母乳库母乳喂养的早产儿生后短期内生长要慢于早产儿配方乳喂养,对早产儿远期生长的影响尚不明确;但采集母乳与母乳库母乳喂养可供给早产儿一定量的人乳特有成分,有利于早产儿神经发育,并减少坏死性小肠结肠炎、喂养不耐受等喂养相关并发症的发生.采集母乳与母乳库母乳的临床广泛应用还面临一些亟待解决的问题,将来的研究应更多关注于对早产儿远期生长发育的影响.     

Association between breast milk intake at 9–10 months of age and growth and development among Malawian young children

World Health Organization recommends exclusive breastfeeding for infants for the first 6 months of life, followed by introduction of nutritious complementary foods alongside breastfeeding. Breast milk remains a significant source of nourishment in the second half of infancy and beyond; however, it is not clear whether more breast milk is always better. The present study was designed to determine the association between amount of breast milk intake at 9–10 months of age and infant growth and development by 12–18 months of age. The study was nested in a randomized controlled trial conducted in Malawi. Regression analysis was used to determine associations between breast milk intake and growth and development. Mean (SD) breast milk intake at 9–10 months of age was 752 (244) g/day. Mean (SD) length‐for‐age z‐score at 12 months and change in length‐for‐age z‐score between 12 and 18 months were ?1.69 (1.0) and ?0.17 (0.6), respectively. At 18 months, mean (SD) expressive vocabulary score was 32 (24) words and median (interquartile range) skills successfully performed for fine, gross, and overall motor skills were 21 (19–22), 18 (16–19), and 38 (26–40), respectively. Breast milk intake (g/day) was not associated with either growth or development. Proportion of total energy intake from breast milk was negatively associated with fine motor (β = ?0.18, p = .015) but not other developmental scores in models adjusted for potential confounders. Among Malawian infants, neither breast milk intake nor percent of total energy intake from breast milk at 9–10 months was positively associated with subsequent growth between 12 and 18 months, or development at 18 months.     

The calorie intake and weight gain of low birth weight infants fed on fresh breast milk or a special formula milk

The calorie intake and weight gain of 24 low birth weight (LBW) infants, <33 weeks gestation and <1500 g birth weight, was studied prospectively. Fourteen infants were fed on a commercially available LBW formula milk and ten were fed on their own mother's fresh unpasteurised expressed breast milk (EBM). The difference between the two feeding groups in the intake of milk and calories was not significant, but from the third week onwards those fed on the LBW formula gained weight faster. The mean (±SEM) weight increments for weeks 3–6 (inclusive) for LBW formula and EBM fed infants was 189.3 (±7.9) and 139.6 (±11.1) g/wk respectively (P<0.001).The LBW formula was well tolerated and is a suitable feed for LBW infants. However some babies thrived well on fresh EBM and so we are continuing to encourage mothers who wish, to breast feed their own preterm infants. When such infants fail to thrive it is appropriate to supplement with a LBW formula.     

Early cessation of breast milk feeding in very low birthweight infants

This investigation was carried out to comparatively assess the duration of breast milk feeding and to analyze risk factors for early cessation of breast milk feeding in term and very preterm infants. A cohort study was performed in 89 consecutive very low birthweight (VLBW) infants (<1500 g) who survived for at least for one week, and 177 term infants with birthweights >2500 g born in the same hospital matched for gender and multiplicity. Median duration of breast milk feeding, as determined from charts and questionnaires mailed to the mothers at 6 and 12 months corrected age, was 36 days in VLBW infants, compared to 112 days in control infants (P<0.0001). In both VLBW and control infants, smoking during pregnancy, low maternal and low paternal school education were each significantly associated with short duration of breast milk feeding. In VLBW infants, multiple pregnancy and gestational age <29 weeks were each associated with prolonged breast milk feeding, as were maternal age >35 years and spontaneous pregnancy (as opposed to pregnancy following infertility treatment) in term infants. Multivariate analysis revealed that VLBW, smoking and low parental school education were independent negative predictors of breast milk feeding. While these results emphasize the need for special support of VLBW infant mothers promoting lactation, the relationships between smoking, school education and breast milk feeding in both strata show that efforts to increase breast milk feeding require a public health perspective.     

Sucking behaviour and milk intake of neonates in relation to milk fat content

The hypothesis that a high concentration of fat in milk acts as a satiety signal for babies was tested by feeding neonates formula milks of different fat concentrations. Babies were tested on 2 consecutive days. On day 1 they were fed a high fat milk followed by a low fat milk, or vice versa, each for 2 min; and on day 2 the same procedure was followed but in the opposite order. Milk intake and 6 parameters of sucking behaviour were recorded. There was no indication that high fat milk acted as a cue to babies to slow or stop feeding. On the contrary babies appeared to feed more actively on the high fat milk, in that they sucked in longer bursts for it and spent a smaller proportion of the test period resting.     

Development of secretory immunity in breast fed and bottle fed infants.

Samples of saliva and nasal secretions were collected sequentially from 15 breast fed and 15 bottle fed infants on five occasions between 6 days and 9 months of age. Total immunoglobulin concentrations of G, M, and A classes, and class specific antibodies to tetanus toxoid and a pool of commensal strains of Escherichia coli were measured by solid phase radioimmunoassay and expressed per milligram of total protein. There were significant differences between feeding groups, which changed with age. Total IgM and IgA concentrations and IgA antibodies to E. coli were higher in the saliva and nasal secretions of breast fed infants at 6 days. There followed a rapid increase in IgM and IgA concentrations in secretions from all infants, and between 6 weeks and 9 months concentrations were higher in the saliva (but not in the nasal secretions) of the bottle fed group. There were no significant differences between the feeding groups for total IgG, specific G, M, and A antibodies to tetanus toxoid, and G and M antibodies to E. coli. These results suggest that breast feeding enhances secretory immunity in the early neonatal period only. By 6 weeks, local antigens are the main source of stimulation for production of immunoglobulin in the respiratory mucosa and thus may be obscuring any additional stimulation by growth factors in breast milk.