Relationship of diet in the development of atopy in infancy

We examined the relationship of diet to the development of atopic manifestations in a group of infants with an immediate family history of atopy, followed prospectively from birth for up to 20 months of age. There was no relationship between the development of atopic dermatitis, rhinitis and wheeze and either 2 or 4 months exclusive breast feeding, or the introduction of cow's milk or solids in the first 4 months of life. In addition there was no relationship between the introduction of milk, egg or wheat into the diet and the development of skin-test positivity to these foods. In fact, five infants developed positive skin tests to the food prior to its introduction into the diet, suggesting exposure via maternal breast milk. Thus we have been unable to show a protective effect of either breast feeding or cow's milk or solid avoidance on the development of atopic disease in infancy.     

Soy versus cow's milk in infants with a biparental history of atopic disease: development of atopic disease and immunoglobulins from birth to 4 years of age

Forty-eight children with a biparental history of atopic disease were followed from birth to 4 years of age. One group was fed soy and the other cow's milk from weaning to 9 months of age. Two-thirds of the children developed symptoms of atopic disease with no significant difference between the groups. No difference was found in the serum immunoglobulins (IgE antibodies, IgA, IgG and IgM) during the observation period. The soy fed children showed transiently lower levels of IgG antibodies to cow's milk but higher levels of IgG antibodies to soy protein. Six children showed cow's milk intolerance and a further five had symptoms possibly related to the use of cow's milk. Withholding cow's milk during the first 9 months did not reduce the incidence of symptoms of cow's milk intolerance from birth to 4 years of age. Thus, no benefit was found from replacing cows' milk with soy. A prolonged breast feeding seems most rational for infants at risk of developing atopic disease, even if the present study did not show evidence of a prophylactic effect of breast milk against the development of atopic disease.     

Clinical symptoms and IgE responses to common food proteins in atopic and healthy children

The appearance of symptoms suggestive of allergy through the first 4 years of life was studied prospectively in eighty-six healthy newborn babies. Blood samples were obtained at birth, at 3, 8, 25 and 48 months of age and analyzed for levels of total serum IgE and for IgE antibodies to some common foods. The occurrence of IgE antibodies was related to atopic manifestations and to a detailed history of infant feeding and family history of allergy. All infants with elevated cord blood IgE (more than 1.3 kU/l) developed manifestations of atopy. Specific IgE antibodies against egg, cow's milk and soy were demonstrated at 3, 8, 25 and 48 months in nine, twenty-three, six and two children respectively. Egg was a more potent sensitizing agent than cow's milk, IgE antibodies to egg being present in thirty-one samples, to cow's milk in eleven and to soy in five samples. Nine infants developed IgE antibodies to eggs or cow's milk before the introduction of these nutrients into the food. The IgE antibody levels were generally low in healthy non-atopic children and did, with one exception, not reach RAST class 1. In contrast, the levels of IgE antibodies to egg or cow's milk were higher in eleven blood samples from atopic children. We conclude that transient low IgE antibody responses to food proteins appear relatively often even in healthy infants. High concentrations of IgE antibodies however are almost exclusively seen in infants with atopic disease. Sensitization may appear early in infancy sometimes even before the offending food has been introduced into the diet.     

长三角地区极/超低出生体重儿不同乳品种类搭配喂养现状的调查研究

目的 分析长三角地区各医疗机构的极/超低出生体重儿不同乳品种类搭配喂养的现状,为临床中该类群体喂养方式的选择提供依据。方法 2019年1月—12月,采用NICU极/超低出生体重儿喂养情况调查表,回顾性收集长三角地区5所三级甲等医院NICU胎龄≤35周且出生后24 h内入院的极/超低出生体重儿的临床资料,获得不同乳品种类搭配喂养的情况,同时比较纯母乳喂养组和亲母母乳不足时使用配方奶补足组患儿喂养的相关临床指标。结果 共收治极/超低出生体重儿830例,最终纳入667例。其中仅接受亲母母乳喂养82例（12.3%）,仅接受捐赠母乳喂养5例（0.8%）,接受亲母母乳+捐赠母乳喂养65例（9.8%）,以上3种方式统称为纯母乳喂养,共计152例（22.9%）。接受捐赠母乳+配方奶喂养34例（5.1%）,仅接受配方奶喂养75例（11.2%）,接受亲母母乳+配方奶喂养333例（49.9%）,接受亲母母乳+捐赠母乳+配方奶喂养73例（10.9%）。使用纯母乳喂养组肠外营养天数少于配方奶补足组,坏死性小肠结肠炎和迟发性败血症的发生率更低,差异均具有统计学意义（P<0.05）。结论 长三角地区各医疗机构...     

The Effects of Infant Feeding Decisions on Infant Growth

ISSUES AND PURPOSE. To determine the effects of feeding decisions on infant growth in the first 6 months of life.
DESIGN AND METHODS. Growth measurements were collected twice during the first 6 months of infancy as part of a larger investigation of infant feeding practices (N = 52).
RESULTS. Infants who received solid foods before the age of 4 to 6 months weighed less than those who received solid foods after 4 to 6 months. There were no differences in growth measurements between formula-fed and breastfed infants, although breast-fed infants weighed more at birth.
PRACTICE IMPLICATIONS. Emphasize the importance of feeding breast milk (preferably) or formula only for the first 6 months. Advise parents to withhold fruit juices until the infant is at least 6 months old.     

Factors affecting exclusive breastfeeding of healthy babies aged zero to four months: a community-based study of Turkish women

Aim. The purpose of this study was to determine the factors that affect exclusive breastfeeding of healthy babies aged 0–4 months. Background. Both the World Health Organization (WHO) and UNICEF recommend feeding babies of 0–6 months exclusively with breast milk and starting complementary foods after the sixth month. In Turkey, however, a vast majority of babies 1–5 months of age (89·4%) are given complementary foods. Methods. This cross‐sectional study was conducted in central Ankara province, with a sampling of 514 individuals who were selected using the convenience sampling method. Results. Of the 514 mothers who participated in my research, 260 (50·6%) were found to be feeding their babies exclusively with breast milk; 77 (15·0%), with breast milk + water; 87 (16·9%), with breast milk + baby formula; 70 (13·6%), with breast milk + baby formula + other foods; and 20 (3·9%), baby formula + other foods. Based on multivariate logistic regression analysis results, the mother's employment [odds ratio (OR) = 0·488; 95% confidence interval (CI) = 0·288–0·827) considerably reduced the incidence of complementary foods, while frequent crying of the baby (OR = 1·687; 95% CI = 1·125–2·530) significantly increased the use of supplementary foods in infant nutrition. Conclusion. This study concluded that frequent crying of the baby increases the likelihood of giving the baby complementary foods. Midwives and nurses can encourage exclusive breastfeeding behaviour by providing individual education and counselling to women whose babies cry frequently. Relevance to clinical practice. Exclusive breastfeeding of babies aged 0–6 months is crucial for the development and growth of the baby and instrumental in reducing infant morbidities and mortalities. One factor that increases the likelihood of provision of complementary foods is frequent crying of the baby. Midwives and nurses can encourage exclusive breastfeeding behaviour by providing individual education and counselling to women whose babies cry frequently.     

The prevention of iron dificency anemia in infants.

The prevention of iron deficiency requires attention to the toal feeding regimen as well as to its iron content. The use of fresh cow's milk in early infancy, a common practice, is associated with the development of measurable degrees of iron deficiency. In many instances excessive amounts of milk produce severe iron deficiency anemia during the second year of life in infants of greater than average birth weight. The psychological factors leading to such milk intakes have been reviewed. Present evidence supports the hypothesis that occult blood loss is a major etiologic factor in iron deficiency in infancy. Although the mechaisms of intestinal damage by fresh cow's milk protein is highly suspect and that the concentration of protein in the formula may play a significant role. What about iron fortification of infant formulas? Itis becoming clear that fullterm infants fed prepared formulas having protein concentrations approaching that of human milk and fed diets containing about 7 mg of iron daily after the age of 3 months infrequently develop biochemical iron deficiency. The addition of iron to the formula at levels of 10 to 12 mg/gt is assurance that their intake is adequate, whatever the iron intake from other foods. Low-birth-weight infants have increased iron needs because of their rapid growth. Iron-ofrtified formulas are necessary for these infants. Since iron from fortified formulas is well absorbed during the first three months of life, even if it is not immediately used for hemoglobin formation, an inccrease in the iron stores will occur...     

母乳库捐乳喂养对低体重早产儿喂养效果与并发症的影响

目的探讨母乳库捐乳喂养对低体重早产儿喂养效果与并发症的影响。方法选取我院新生儿监护室2017年4月至2019年4月收治的100例低体重早产儿为研究对象,随机将其等分为观察组和对照组,对照组给予早产儿配方乳喂养,观察组给予母乳库捐乳喂养,比较两组生长指标、达全肠道喂养时间、住院时间、出院体质量及并发症发生情况。结果两组早产儿生长指标、住院时间比较差异无统计学意义(P>0.05),观察组达全肠道喂养时间短于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。结论给予母乳不足的低体重早产儿以母乳库捐乳喂养可缩短全肠道喂养时间,降低并发症发生率,值得临床推广应用。     

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: influencing factors

Preventive measures for long-life illnesses such as asthma, obesity, and diabetes can start as early as in infant feeding practices. The American Academy of Pediatrics recommends introducing babies to solid foods, anything other than breast milk or formula, no earlier than 4-6 months of age (Kleinman, 2004). This study's purpose was to assess beliefs and attitudes of mothers enrolled in Medicaid about the introduction of solid foods and other infant feeding behaviors. Six focus groups (N = 23) were conducted with Black and Caucasian mothers with infants under 1 year old. The Theory of Planned Behavior was used as a framework for moderator questions and interpretation of themes. Maternal knowledge about infant feeding, maternal perceptions of applicability of infant feeding guidelines, and manner and type of information useful for infant feeding decisions emerged as themes. Implications of themes for informing an educational program for mothers to delay the introduction of solid foods are discussed.     

Serum antibodies against native, processed and digested cow's milk proteins in children with cow's milk protein intolerance

Children with or without cow's milk protein intolerance were investigated for serum antibodies to native cow's milk proteins, processed cow's milk proteins and native- and pepsin-digested beta-lactoglobulin. Antibodies of IgG and IgA isotypes were determined with ELISA and those of IgE isotype with RAST. Children who exhibited slowly appearing untoward reactions to cow's milk feeding had significantly higher titres of IgG antibodies against both native and digested beta-lactoglobulin than children with an immediate type of reaction or no intolerance. The IgG antibodies to pepsin-digested beta-lactoglobulin were efficiently inhibited by native beta-lactoglobulin even at low concentrations, which suggests that there were no antibodies specific for the degraded proteins. The children with slow reactions to cow's milk also tended to have higher antibody levels of the IgG and IgA isotypes to both native and processed cow's milk. Antibodies to this mix of antigens discriminated less well, however, than the antibodies to isolated beta-lactoglobulin between the groups of children with slowly appearing reactions, with immediate reactions and the controls. Seven out of nine children with an immediate type of reaction to cow's milk protein had IgE antibodies against cow's milk protein determined with the RAST, while this type of antibodies could not be demonstrated in any child in the two other groups. Using processed or digested protein as antigen did not increase the sensitivity of the antibody determinations.     

Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment.

The prevalence of atopic diseases is increasing worldwide for reasons that are not clear. Food allergies are the earliest manifestations of atopy. This review defines the foods most commonly involved in allergic reactions and identifies an emerging group of syndromes in which food allergy is involved. A study of the frequency of food allergies in Australia and South-East Asia has recently shown that egg, cow's milk and peanut are the most common food allergens in Australia, but there were divergent results from different regions of South-East Asia. It is not clear whether the differences in reactivity to foods are due to genetic or cultural factors, but the findings raise the possibility that genetic susceptibility to food allergy may operate at the T-cell level modulated by the major histocompatibility complex. The Melbourne Milk Allergy Study defined a wide range of clinical symptoms and syndromes that could be reproduced by dietary challenge. A subsequent analysis of the infants with hypersensitivity to cow's milk and other multiple food proteins identified a new syndrome, multiple food protein intolerance of infancy. Food challenges demonstrated reactions developing slowly days after commencement of low-allergen soy formula or extensively hydrolysed formula. Follow-up at the age of 3 years showed that most children with this disorder tolerated most foods apart from cow's milk, egg and peanut. Atopic dermatitis affects about 18% of infants in the first 2 years of life. In a community-based study we have shown a very strong association (RR 3.5) between atopic dermatitis and infants with immunoglobulin E allergy to cow's milk, egg or peanut. Family studies on these infants have shown a link between atopic dermatitis and the genomic region 5q31 adjacent to the interleukin-4 gene cluster. Infantile colic (distress) affects 15-40% of infants in the first 4 months of life. Many theories of causation have been proposed, but a study from our centre showed that dietary modification, particularly that of breastfeeding mothers whose infants present with colic before the age of 6 weeks, alleviated symptoms. Colic associated with vomiting has been attributed to gastro-oesophageal reflux (GOR). This has been considered primarily a motility disorder, but a secondary form resulting from food protein intolerance has been described recently. We have also recently identified a group of infants with distressed behaviour attributed to GOR who have failed to respond to H2-receptor antagonists, prokinetic agents and multiple formula changes. Symptoms resolved on commencement of an elemental amino acid-based formula. In two-thirds of the patients, symptoms relapsed when challenged with low-allergen soy formula or extensively hydrolysed formula. We propose that a period of food protein intolerance is a part of the normal development of the immune system as it encounters common dietary proteins in infancy and early childhood. Future targets for research are development of appropriate dietary and management strategies for these entities and identification of genetic markers for these disorders.     

Milk Intolerance: Lactose Intolerance and Cow''s Milk Protein Allergy

Parents and health care providers often incorrectly use the term milk intolerance to describe a wide spectrum of symptoms seen in infants who have problems digesting cow's milk. The most common reasons for milk intolerance are the negative reactions to lactose or cow's milk protein. Identification and correct diagnosis of lactose intolerance or cow's milk protein allergy is imperative to correctly recommend alterations in feeding practices or suggest formula changes.     

采集母乳在NICU中的实施及对极低出生体重儿的影响

目的探讨采集母乳对无法获得直接母乳喂养的早产儿的喂养效果。方法将2013年1-12月入住NICU的极低出生体重儿60例分为早产儿配方乳组;2014年1-12月入住NICU的极低出生体重儿60例分为母乳喂养组,通过采集母乳的方式对早产儿进行喂养。同时对两种喂养方式的效果进行分析比较。结果通过采集母乳的实施,使早产儿的产妇在母婴分离时的母乳喂养率从原来的58%提高到94%;极低出生体重儿的喂养不耐受发生率由原来的35%降低到16%;极低出生体重儿的坏死性小肠结肠炎的发生率由原来的11%降低到1%;产妇的满意度由原来的86%提高到96%。结论采集母乳提高了母婴分离的母乳喂养率,降低了早产儿的喂养不耐受以及坏死性小肠结肠炎的发生率,提高了患者的满意度。     

Breast-feeding increases sleep duration of new parents

OBJECTIVES: This study describes sleep patterns for mothers and fathers after the birth of their first child and compares exclusive breast-feeding families with parents who used supplementation during the evening or night at 3 months postpartum. METHODS: As part of a randomized clinical trial, the study utilized infant feeding and sleep data at 3 months postpartum from 133 new mothers and fathers. Infant feeding type (breast milk or formula) was determined from parent diaries. Sleep was measured objectively using wrist actigraphy and subjectively using diaries. Lee's General Sleep Disturbance Scale was used to estimate perceived sleep disturbance. RESULTS: Parents of infants who were breastfed in the evening and/or at night slept an average of 40-45 minutes more than parents of infants given formula. Parents of infants given formula at night also self-reported more sleep disturbance than parents of infants who were exclusively breast-fed at night. CONCLUSIONS: Parents who supplement their infant feeding with formula under the impression that they will get more sleep should be encouraged to continue breast-feeding because sleep loss of more than 30 minutes each night can begin to affect daytime functioning, particularly in those parents who return to work.     

Supplementation with fully adapted milk substitute or calorie-free tea in the first days of life. Effect on drinking behavior and some measurements in mature healthy newborns

180 mature newborn infants (birth-weight 3390 +/- 397 g) were randomly divided into 2 groups of 90 each: all were breast-fed according to the guide-lines recommended by "La Leche League". When breast feeds did not suffice the infants in group A were supplemented with sugar-free tea (o kcal), those in group B with a fully adapted formula (518 kcal/dl). Group A infants generally were more hungry, scored a greater suckling activity, higher feeding frequency and less calorie intake. 19% of them received 1-2 additional milk-feeds because of severe hunger reactions. Group B had a somewhat lower intake of breast milk, a statistically significant higher intake of supplementary feeds and a higher calorie intake. 5.5% in either group were not supplemented at all. The groups did not differ in body temperature, greatest weight loss, serum bilirubin and blood glucose levels and red blood cell count. Supplementation of formula revealed no obvious advantage over supplementation of tea in the first 4 days of life. However, feeding frequency was lower in infants receiving milk supplements.     

Effect of antenatal and postnatal individualized counseling of mothers on exclusive human milk feeding in preterm infants during hospital stay and at discharge: A randomized controlled trial

IntroductionExclusive human milk feeding improves outcome in preterm infants however implementation is inadequate.MethodsThis randomized controlled trial was conducted in a tertiary care hospital (6 months) to assess the effect of antenatal and postnatal individualized counseling on exclusive human milk feeding in preterm infants. In intervention counseling regarding benefits of exclusive human-milk feeding and demonstration of expression of milk. Outcomes were proportion of infants on exclusive human-milk feeding,type of milk and method of feeding during hospital stay and at discharge.ResultsAt discharge, (97%) were on exclusive human-milk in intervention group as compared to (6%) in control group (p < 0.001). By day 21, in intervention group, (100%) were on exclusive human-milk as compared to (33.3%) in control group (p < 0.001). In intervention group (53%) and in control group (5%), (p < 0.001) were discharged on direct breastfeeding + spoon feeding.ConclusionIndividualized counseling improves exclusive human-milk feeding in preterm infants.     

Breast feeding in Cambridge, England: factors affecting the mother''s milk supply

Mothers breast feeding 2 weeks after delivery were studied. One group (106 mothers) were advised to 'eat for two' during lactation to sustain their milk supply. They were compared at 3 months with a control group of 152 mothers. At 3 months only half as many advised group mothers had weaned their babies due to insufficient milk as control mothers. The numbers weaning for other reasons were similar in both groups. More breast feeding mothers reported an increased appetite during lactation than did mothers who had changed to artificial feeding. Smokers were more likely to have given up breast feeding between 2 weeks and 3 months than non-smokers but smoking was not associated with any particular weaning reason. Women taking a contraceptive pill during lactation more often experienced a diminution of milk supply than non-pill-takers. Sustained lactation benefits the mother since those who were still breast feeding were less likely to suffer from depression or fatigue at 3 months, and were more likely to have lost weight. The early introduction of solids was less frequent among infants being breast fed at 3 months.     

Role of IgE in the pathogenesis of milk allergy in infancy: reassessment by a new ELISA technique

An ELISA technique using labelled antigen for the determination of cow's milk specific IgE in serum is described. The use of labelled antigen, rather than labelled antibody as in the RAST, permits avoidance of interference by antibodies other than IgE, such as IgG, at times responsible for a negative RAST. The results obtained with the 2 techniques in 43 infants with a positive cow's milk challenge showed a positive RAST in 28%, a positive ELISA in 35% and a positive RAST or ELISA in 42%. These findings suggest that the use of both ELISA and RAST permits in vitro diagnosis of cow's milk allergy in more patients than either test alone.     

运用品管圈方法提高纯母乳喂养率

目的 探讨运用品管圈的方法提高纯母乳喂养率的效果。 方法 2014年6月开展以“提高住院产妇纯母乳喂养率”为主题的品管圈活动,分别选取开展活动前的775例、开展后的813例产妇作为对照组与观察组。比较2组住院期间及出院后第6个月的纯母乳喂养情况。 结果 住院期间及出院后第6个月,观察组纯母乳喂养率均高于对照组。 结论 开展品管圈活动有助于提高纯母乳喂养率。