Hydrolysed protein accelerates the gastrointestinal transport of formula in preterm infants

Vomiting, large gastric residuals and abdominal distension are common in very immature infants on formula feeding. The present trial investigated whether a protein hydrolysate formula reduces the gastrointestinal transit time in preterm infants. Fifteen preterm infants (median gestational age 29 (24-32) wk, birthweight 1241 (660-1900) g, postnatal age 18 (5-54) d) on full enteral feeds (>150 ml/kg*d) were enrolled. It was hypothesized that the gastrointestinal transit time is at least 2 h shorter when protein hydrolysate formula is fed compared with standard preterm formula. In a randomized cross-over design study, each formula was fed for 5 d. On days 4 and 9 the gastrointestinal transit time was estimated using carmine red. The protein hydrolysate formula had a markedly shorter gastrointestinal (p = 0.0022, two-sided Mann-Whitney U test). Conclusion: The hydrolysate protein formula accelerated gastrointestinal transit of milk and stools, but whether hydrolysate formulas enable a more rapid establishment of full enteral feeding in preterm infants needs to be investigated. transit time (9.8 h) than the standard formula (19 h)     

婴儿早期接受新食物的影响因素分析

目的 观察食物转换期婴儿接受新食物的情况,分析婴儿接受能力的影响因素.方法 105名4～6月龄健康婴儿以市售胡萝卜泥作为测试食物尝试5 d.观察婴儿进食新食物胡萝卜泥的情况,按5级对婴儿每次接受程度进行评分.采用描述性统计方法分析测试对象的一般情况,x2检验分析出现接受能力发生明显变化的次数,方差分析检验不同喂养方式、性别、母亲的产次、受教育程度及对胡萝卜的喜好等对婴儿接受能力的影响..结果 婴儿接受新食物的程度随尝试次数的增加而增高,人乳喂养儿尝试10次得分3.98～4.54(r=0.29,P＜0.01),配方奶喂养儿得分3.29～4.38(r=0.44,P＜0.01),人乳喂养儿较配方奶喂养儿更易接受新食物.男婴得分(3.53～4.47),略低于女婴(3.73～4.51),但差异无统计学意义(P＞0.05).母亲教育程度不影响婴儿接受能力..结论 多种因素会影响到婴儿早期对新食物的接受.多次尝试新食物(给予的次数≥5次)有助于食物转换期婴儿对新食物的接受,喂养方式的不同也影响婴儿的接受能力.     

配方奶添加棕榈油对婴儿营养吸收和排便影响的Meta分析

目的 探讨配方奶中添加棕榈油对婴儿营养吸收和排便的影响.方法 检索Cochrane图书馆、PubMed、OVID、Springer数据库、中国期刊全文数据库、维普全文数据库、万方全文数据库和中国生物医学文献数据库(从1990年1月至2009年3月)中的中英文文献,并对纳入文献质量进行评估,分析婴儿肠道营养吸收营养物质,大便中电解质的含量,体内钙的沉积和婴儿排便的情况.结果 共纳入文献13篇,配方奶没有添加棕榈酸或添加棕榈酸(Sn-2位置)较配方奶添加棕榈酸(sn-1,3位置)喂养的婴儿,更有利于肠道吸收脂肪酸和钙离子,减少婴儿大便中钙离子的排泄(P<0.01);配方奶没有添加棕榈酸喂养婴儿3、6月龄时骨矿物质含量(bone mineral content,BMC)和骨密度(bone mineral density,BMD)明显高于配方奶添加棕榈酸(Sn-1,3位置)喂养婴儿(P<0.01),有利于婴儿体内钙的沉积;配方奶添加棕榈酸(Sn-2 位置)婴儿大便中皂化物的含量低于没有添加棕榈酸喂养婴儿(P<0.01),BMC高于没有添加棕榈酸喂养婴儿(P<0.01);配方奶没有添加棕榈酸或添加棕榈酸(Sn-2位置)喂养婴儿稀糊状大便的比例明显高于配方奶添加棕榈酸(sn-1,3位置)喂养的婴儿(P<0.01);配方奶没有添加棕榈酸或添加棕榈酸(Sn-2位置)喂养婴儿大便干硬的比例明显低于配方奶添加棕榈酸(Sn-1,3位置)喂养的婴儿(P<0.01).结论 添加棕榈酸(Sn-1,3位置)较不添加棕榈酸或添加棕榈酸(Sn-2 位置)配方奶喂养的婴儿,肠道吸收脂肪酸和钙离子减少,大便中钙离子的排泄增加,BMC含量明显降低,大便干硬的发生率增加.但研究纳入文献的质量有限,对此结论的运用和推广应谨慎.     

Vitamin K1 and K2 status and faecal flora in breast fed and formula fed 1-month-old infants

Faecal vitamin K₁ (VK₁, phylloquinone) and vitamin K₂ (menaquinone, MK) concentrations were measured in 12 breast fed and 9 formula fed 1-month-old infants. Faecal concentrations of VK₁ and MK-5 to-9 were significantly higher in the formula fed than in the breast fed infants. There was also a tendency for higher total faecal MK (4–10) concentrations in the formula fed [geometric mean (95% confidence intervals); 8995.0 (3872.6, 20893.0) pmol/g of dry faeces] than in the breast fed infants [2937.7 (1285.3, 6714.3),P=0.051]. The numbers of streptococci andEscherichia coli were 100 and 10 times higher, respectively, in the faeces of the formula fed than in those of the breast fed infants. Faecal concentrations of MK-6,-7 and-8, and MK-8 were correlated with the numbers of streptococci andE. coli in the faeces, respectively. Serum VK₁ and MK concentrations were measured in 9 out of 12 breast fed and eight out of nine formula fed infants. The serum VK₁ concentration was much higher in the formula fed infants [average (95% CI); 2.20 (1.48, 2.92) pmol/ml] than in the breast fed ones [0.30 (–0.10, 0.70),P=0.000], but MKs were not detected in the sera of most of the formula fed infants.     

新生儿味觉发育62例分析

目的观察新生儿味觉发育情况及性别差异。方法62个健康新生儿（男女各31名）在出生后90min进行四种味觉测试,味觉溶液浓度为：25％蔗糖（甜味）、5％氯化钠（咸味）、1．43％柠檬酸（酸味）、0．025％盐酸小檗碱。摄像记录新生儿味觉测试中的面部表情。采用卡方检验分析新生儿对味觉的不同面部表情,采用Wilcoxon秩和检验分析味觉性别差异。结果对甜味溶液新生儿的面部表情主要为没有13部动作或13部吸吮动作（P〈0．01）,对咸味溶液新生儿没有特殊表情（P〉0．01）,对酸味溶液的面部表情主要为撅嘴伴皱眉和皱鼻的面中上部表情（P〈0．01）,对苦味溶液的面部表情主要为嘴张开伴皱眉和皱鼻的面中上部表情（P〈0．01）。男性新生儿对甜味和苦味的面部表情较女孩敏感（P〈0．01）,对咸味和酸味男女间没有性别差异（P〉0．05）。结论新生儿能够区分甜、咸、酸、苦四种基本味觉,且男性新生儿对甜味和苦味较女性新生儿敏感。     

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.     

Dietary supplementation of long-chain polyunsaturated fatty acids in preterm infants: effects on cerebral maturation

Aim: To study the influence of dietary-supplied long-chain polyunsaturated fatty acids on structural brain maturation in preterm infants and to investigate parameters of functional brain development, relating them to structural maturation. Other studies have suggested that dietary supplementation of long-chain polyunsaturated fatty acids in preterm infants may enhance their visual development. The influence on structural brain development has never been evaluated. Methods: In a prospective, double-blind study, 42 formula-fed premature infants were randomized to be fed either a standard preterm formula without long-chain polyunsaturated fatty acids or an identical formula supplemented with docosahexaenoic acid (0.015 g/100 ml) and arachidonic acid (0.031 g/100 ml). Infants with significant cerebral damage, retinopathy, chronic disease or feeding problems were excluded. Follow-up was focused on assessment of cerebral myelination by MRI. Psychomotor, mental and visual development was analysed and flash-visual evoked potentials were recorded. Results: It was found that progress of myelination, mental and motor development and latencies of visual evoked potentials were not positively influenced by supplementation of long-chain polyunsaturated fatty acids. At each test age, visual acuity was slightly better in the supplemented infants than in the non-supplemented infants, but the difference never reached significance level Conclusion: Supplementation of long-chain polyunsaturated fatty acids did not have a demonstrable positive influence on structural brain maturation. Related to this finding, in this small cohort of preterm infants without significant neurological damage, sample size being restricted by strict inclusion criteria and MRI procedures, no significant positive effects were found on psychomotor, mental and visual development.     

婴幼儿急性肾后性尿闭的治疗体会

目的 探讨婴幼儿食用受三聚氰胺污染奶粉致急性肾后性尿闭的治疗.方法 对2008年1月1日至2008年9月30日诊治的17例存在上尿路结石梗阻婴幼儿病例进行回顾性分析.结果 13例保守治疗,4例行开放手术取石、解除梗阻.所有病例解除梗阻后肾功能明显改善,血钾恢复正常;随访1～9个月,尿流及肾功能均恢复正常.结论 婴幼儿食用含三聚氰胺奶粉所致结石,部分可通过水化、碱化等保守治疗,部分需急诊手术取石解除梗阻、挽救肾功能,且术中可观察是否合并上尿路畸形并予对症处理,预后良好.     

Sodium found in processed cow milk and estimated intake by infants

ObjectiveTo determine the sodium concentration in cow milk available for sale and to estimate its consumption by infants up to 6 months of age.MethodsSodium level was determined by flame emission spectrophotometry in eight different lots of five brands of liquid ultra-high temperature milk and three brands of powdered milk. To estimate sodium consumption via cow milk, orientations for exceptional situations when neither breastfeeding nor infant formula is possible were considered. Inferential statistics were performed and results were compared with critical parameters at a 5% significance level.ResultsThe mean sodium content per portion found in liquid milk (162.5 ± 16.2) mg/200 mL was higher than that in powdered milk (116.8 ± 3.0) mg/26 g. Estimated sodium consumption by infants through powdered milk varied from 149.8 to 224.7% of adequate intake, and via liquid milk can be more than 500% of the adequate intake, reaching 812.4% of it if dilution is not applied. Seven of the eight brands of milk studied had declared, on their labels, that the sodium content was 13–30% lower than that found in chemical analysis.ConclusionLiquid and powdered whole cow milk have high sodium content, and the content per portion is higher in liquid milk than in powdered milk. The estimated consumption of sodium through these products can far exceed the adequate intake for infants from 0 to 6 months old, even when the recommended dilution and maximum daily volumes are followed.     

极低出生体重儿母乳喂养与配方乳喂养的比较

目的探讨极低出生体重儿在进行母乳喂养、早产儿配方乳喂养条件下黄疸消退、体重增长、耐受全胃肠营养的时间及常见并发症的区别。方法对2002年10月至2005年4月我科收治的111例极低出生体重儿提供母乳喂养的39例,另72例采用早产儿配方乳喂养,观察两组在黄疸消退日龄、回升到出生体重日龄、过渡到全胃肠道营养日龄、住院天数等的差别,并比较两组在喂养不耐受、新生儿坏死性小肠结肠炎、酸中毒的发生率方面的不同。结果两组过渡到全胃肠道营养日龄的差异有统计学意义(t=15.06,P<0.01);两组在喂养不耐受和酸中毒发生率的差异也有统计学意义(χ2分别为4.203和4.811,P<0.05);黄疸消退日龄、回升到出生体重日龄差异两组无统计学意义(t值分别为0.70和0.27,P>0.05);新生儿坏死性小肠结肠炎发生率的两组差异也无统计学意义(χ2=0.01,P>0.05)。结论在极低出生体重儿应积极进行母乳喂养,这对于早日过渡到全胃肠道营养、减少喂养不耐受发生率、缩短住院天数、降低酸中毒发生率均有积极作用。     

极低出生体重儿母乳喂养与配方乳喂养的比较

目的 探讨极低出生体重儿在进行母乳喂养、早产儿配方乳喂养条件下黄疸消退、体重增长、耐受全胃肠营养的时间及常见并发症的区别.方法 对2002年10月至2005年4月我科收治的111例极低出生体重儿提供母乳喂养的39例,另72例采用早产儿配方乳喂养,观察两组在黄疸消退日龄、回升到出生体重日龄、过渡到全胃肠道营养日龄、住院天数等的差别,并比较两组在喂养不耐受、新生儿坏死性小肠结肠炎、酸中毒的发生率方面的不同.结果 两组过渡到全胃肠道营养日龄的差异有统计学意义（t=15.06,P＜0.01）;两组在喂养不耐受和酸中毒发生率的差异也有统计学意义（χ2分别为4.203和4.811,P＜0.05）;黄疸消退日龄、回升到出生体重日龄差异两组无统计学意义（t值分别为0.70和0.27, P＞0.05）;新生儿坏死性小肠结肠炎发生率的两组差异也无统计学意义（χ^2=0.01,P＞0.05）.结论 在极低出生体重儿应积极进行母乳喂养,这对于早日过渡到全胃肠道营养、减少喂养不耐受发生率、缩短住院天数、降低酸中毒发生率均有积极作用.     

Introduction of solids and formula to breastfed infants: a longitudinal prospective study in Uppsala, Sweden

The introduction of solids and formula was studied among 506 breastfed infants in Uppsala, Sweden, based on daily recordings during the first year. The mothers had previously breastfed at least 1 infant for at least 4 mo. Thirty-four per cent of the infants were introduced to solids before the age of 4 mo (4-6 mo is recommended in Sweden). Accustoming the infants to solids was a lengthy process. Life-table analyses showed a median duration of 28 d from the first introduction of solids to consumption of >10 ml daily, and 46 d before the infants ate > or = 100 ml of solids in 1 d for the first time. These durations were longer the younger the infant was at the introduction of solids. Thirty-two per cent of infants given formula consumed > or = 100 ml the first time it was given, and 49% did so within I wk, regardless of infant age. CONCLUSION: Parents and healthcare personnel need to be aware that accustoming breastfed infants to solid food is a lengthy process, and that there is a strong age effect on this duration. It is also important to consider what consequences the (usually) more abrupt introduction of formula might have on breastfeeding.     

谷氨酰胺在早产儿肠外营养中的应用研究

目的研究谷氨酰胺（Gln）对早产儿的生长发育、胃肠功能成熟及感染发生率的影响。方法将35例早产儿分为两组，Gln组给予经静脉添加Gln的肠外营养（PN），对照组常规PN，PN时间均大于2周。监测两组生长发育、喂养耐受情况、胃肠功能及感染发生率。结果Gln组生后4周时尿素氮（BUN）水平较对照组高（P=0．044），但仍在正常范围内。平均PN及平均住院时间Gln组均明显短于对照组（P=0．031；P=0．020）。血清胃动素水平Gln组生后2周较生后3天明显升高（P=0．037）；Gln组生后2周较生后3d胃电节律中节律过快的百分数明显增加（P=0．017）。Gln组发生感染的次数较对照组明显减少（P=0．001）。结论初步观察提示Gln有助于早产儿胃肠功能的成熟，减少院内感染的发生。     

谷氨酰胺在早产儿肠外营养中的应用研究

目的研究谷氨酰胺(Gln)对早产儿的生长发育、胃肠功能成熟及感染发生率的影响。方法将35例早产儿分为两组,Gln组给予经静脉添加Gln的肠外营养(PN),对照组常规 PN,PN时间均大于2周。监测两组生长发育、喂养耐受情况、胃肠功能及感染发生率。结果 Gln 组生后4周时尿素氮(BUN)水平较对照组高(P=0．044),但仍在正常范围内。平均PN及平均住院时间Gln组均明显短于对照组(P=0．031;P=0．020)。血清胃动素水平Gln组生后2周较生后 3天明显升高(P=0．037);Gln组生后2周较生后3 d胃电节律中节律过快的百分数明显增加 (P=0．017)。Gln组发生感染的次数较对照组明显减少(P=0．001)。结论初步观察提示Gln 有助于早产儿胃肠功能的成熟,减少院内感染的发生。     

早产儿应用脂肪乳剂的安全性研究

目的评价２０％英脱利匹特（ｉｎｔｒａｌｉｐｉｄ）在早产儿应用中的安全性。方法４６例早产儿随机分为４组：治疗组分别于生后第１天（Ａ组,１１例）和第３天（Ｂ组,１２例）经外周静脉按０１５ｇ／（ｋｇ·ｈ）输入０５～３５ｇ／（ｋｇ·ｄ）脂肪乳剂１周;Ｃ（１１例）、Ｄ（１２例）组（不用脂肪乳剂）分别与Ａ、Ｂ组对照,并于实验前后监测血气、血生化、脂肪酸生化指标和血糖的变化。结果生后第１,３天治疗组和对照组动脉血氧分压、氧饱和度、胆红素、丙氨酸转氨酶、过氧化脂质、６－酮－前列腺素Ｆ１α、血栓素Ｂ２及血糖浓度差异均无显著性意义（Ｐ均＞００５）。结论自生后第１天或第３天即开始经外周静脉按０１５ｇ／（ｋｇ·ｈ）速率,逐渐增加剂量,从第１天０５ｇ／（ｋｇ·ｄ）,每天增加１ｇ／（ｋｇ·ｄ）,至最大量３５ｇ／（ｋｇ·ｄ）,供给早产儿２０％ｉｎｔｒａｌｉｐｉｄ１周是安全的     

Dietary nucleotides: effects on the immune and gastrointestinal systems

Nucleotides (NT) and their related metabolic products play key roles in many biological processes. NT can be synthesized endogenously and thus are not considered essential nutrients. Studies have demonstrated, however, that dietary NT can have beneficial effects; the term "conditionally essential" has been used to describe their role in human nutrition. These nutrients may become essential when the endogenous supply is insufficient for normal function, even though their absence from the diet does not lead to a classic clinical deficiency syndrome. Most dietary NT are rapidly metabolized and excreted. However, some are incorporated into tissues, particularly at younger ages and with fasting. Under conditions of limited NT intake, rapid growth or certain disease states, dietary NT may spare the cost of de novo NT synthesis and optimize the function of rapidly dividing tissues such as those of the gastrointestinal and immune systems. Animals fed NT-supplemented versus non-NT supplemented diets have enhanced gastrointestinal growth and maturation, and improved recovery following small and large bowel injury. Indices of humoral and cellular immunity are enhanced, and survival rates are higher following infection with pathogens. Infants receive NT in human milk, where they are present as nucleic acids, nucleosides, nucleotides and related metabolic products. The NT content of human milk is significantly higher than most cow's milk-based infant formulae. Dietary NT are reported to enhance the gastrointestinal and immune systems of formula-fed infants. Infants fed NT-supplemented versus non-supplemented formula have a lower incidence of diarrhea, higher antibody titers following Haemophilus influenzae type b vaccination and higher natural killer cell activity. These data suggest that human milk NT may contribute to the superior clinical performance of the breastfed infant.     

早产儿喂养不耐受的临床特征分析

目的探讨早产儿喂养不耐受的临床特征。方法对本院1994年1月至2002年12月在新生儿病房住院的早产儿进行回顾性的病例分析。结果早产儿喂养不耐受发生的比例为28．5％，出生体重和胎龄越小，其比例越高，极低出生体重儿则达到69．2％。呕吐、腹胀和胃潴留发生的开始时间多在肠道喂养后第1周内。胎龄、出生体重较小的早产儿发生喂养不耐受时以胃潴留和腹胀多见，而较大的早产儿则以呕吐多见。结论在早产儿尤其是极低出生体重儿开始肠道喂养后约1周内容易发生喂养不耐受，应严密监测喂养不耐受的症状。     

早产儿喂养不耐受的临床特征分析

目的探讨早产儿喂养不耐受的临床特征。方法对本院1994年1月至2002年12月在新生儿病房住院的早产儿进行回顾性的病例分析。结果早产儿喂养不耐受发生的比例为28·5%,出生体重和胎龄越小,其比例越高,极低出生体重儿则达到69·2%。呕吐、腹胀和胃潴留发生的开始时间多在肠道喂养后第1周内。胎龄、出生体重较小的早产儿发生喂养不耐受时以胃潴留和腹胀多见,而较大的早产儿则以呕吐多见。结论在早产儿尤其是极低出生体重儿开始肠道喂养后约1周内容易发生喂养不耐受,应严密监测喂养不耐受的症状。