Influence of two infant formulas and human milk on the development of the faecal flora in newborn infants

The establishment of the faecal flora of 39 full-term infants fed exclusively on breast milk (n = 20) or with two different modern adapted cow's milk formulas (n = 19) was studied during the first 3 months of life. One formula investigated was based on 100% bovine casein as the protein source whereas the other formula contained bovine milk proteins with a whey/casein ratio of 60:40. A faecal flora rich in bifidobacteria was found in all study groups; the growth of putrefactive bacteria (especially Bacteroides spp.), however, was limited. In formula-fed infants, significantly higher bacterial counts of enterococci and Clostridia were detected compared to breast milk-fed infants. Similarities and differences due to the feeding regimen were particularly reflected in the pattern of the anaerobic bacterial species. Bifidobacterium bifidum, B. infantis and B. breve constituted the majority of the bifidobacterial flora independent of the type of milk feeding. Other bifidobacterial species such as B. longum, B. adolescentis, B. parabifidum and B. pseudo-catenulatum were detected in high numbers and at low frequencies in breastfed infants. The latter three were observed in infants fed the whey/casein formula as well. It seems that infants fed a casein formula develop a faecal flora more like that of breastfed infants concerning Lactobacillus spp. (especially L. fermentum and L. brevis).     

Plasma amino acid and protein concentrations in infants fed human milk or a whey protein hydrolysate formula during the first month of life

The aim of the study was to compare growth parameters, biochemical indices of protein metabolism and plasma amino acid concentrations in infants fed either human milk ( n = 12) or a whey protein hydrolysate formula ( n = 13) during the first month of life. Growth and gain in skin fold thickness were similar in both groups whereas serum protein concentration was significantly decreased (57.4 ± 3.9 versus 61.2 ± 2.9 g/l) in the infants fed the whey hydrolysate formula. The discrepancies between the plasma amino acid pattern of the whey hydrolysate formula group and that of the human milk group lessened during the first month. Nevertheless, at a mean age of 33 days the plasma threonine concentration remained twice as high and the plasma tyrosine, phenylalanine and proline concentrations were Significantly lower in the whey hydrolysate formula group than in the human milk group. Thus, compared with breast-fed infants, growth and most of the biological indices of protein metabolism were satisfactory in infants fed during the first month of life on a whey protein hydrolysate formula. Nevertheless, the decrease in total plasma protein concentration needs to be confirmed in a larger cohort of infants. In addition, further research is necessary to investigate the possible ways of reducing the hyperthreoninemia and preventing other plasma amino acid disturbances since it would be desirable to obtain plasma amino acid levels similar to those of breast-fed infants.     

Fatty acids in formulae for term infants: compliance of present recommendations with the actual human milk fatty acid composition of geographically different populations

Aim: Recommendations for formula fatty acids (FA) are largely based on the mature human milk FA composition. This study aimed to investigate whether current recommendations for formula FA for term infants comply with the actual breast-milk FA composition of geographically distinct populations and to provide more realistic grounds for future recommendations. Methods: 455 mature breast-milk samples were collected in different countries over 25 y. Recommendations of different organizations were projected on their FA data. FA interrelationships were calculated with Spearman's rank tests. FA compositions of 30 formulae were compared with those of breast milk. Results: Many samples from non-Western communities did not meet the recommendations for formula 12:0, 14:0 and 18:2ω6, since these are mainly based on breast milk of mothers living in Western countries. Recommendations for 18:3ω3, 18:2ω6/18:3ω3, 20:4ω6 and 22:6ω3 were not met by many milk samples, which may point to the poorly developed recommendations for long-chain polyunsaturated FA. Most of the investigated breast-milk FA (12:0, 14:0, 16:0, 18:0, 18:3ω3, 22:6ω3, 18:2ω6, 20:4ω6, 18:1ω9) were either positively or negatively interrelated. Many formulae had FA compositions that were not consistent with the physiological interrelationships of FA in breast milk. Conclusion: Future recommendations, if based on human milk, should derive from its FA balance, as indicated by the FA interrelationships. A “humanized” formula FA composition would in this sense be any composition that cannot be distinguished from that of breast milk by techniques such as principal component analysis.     

Human milk mineral intake and serum concentrations of calcium and phosphorus in newborn term infants: influence of intrauterine growth restriction

A prospective case-control study was performed to test the hypothesis that the milk Ca and P contents of term, small-for-gestational-age (SGA) newborns' mothers differs from that of term, adequate-for-gestational-age (AGA) newborns' mothers. We studied 71 pairs of mothers and newborns, divided into two groups: I (control): 41 pairs of mothers and term AGA newborns and II (study): 30 pairs of mothers and term SGA newborns. This latter group was subdivided according to type (symmetric: birthweight, length and head circumference <10th percentile; asymmetric: birthweight <10th percentile) and severity (P3 - P3 - 相似文献   

Protein quality of human milk fortifier in low birth weight infants: Effects on growth and plasma amino acid profiles

Serum preprandial essential amino acid, urea and prealbumin concentrations, and growth rates were studied in appropriate for gestational age low birth weight infants fed one of three regimens: (1) human milk enriched with human milk protein (n=17); (2) bovine whey protein hydrolysate (n=18; and (3) a mixture of bovine proteins, peptides and amino acids designed to have an amino acid composition close to that of human milk proteins (n=18). Energy and nitrogen intakes were similar in all groups. Growth rates and gross metabolic responses did not differ between the feeding groups. There were also no differences in the amino acid profiles between those infants fed human milk protein fortifier and mixed bovine protein fortifier. Infants fed the whey fortifier had significantly higher threonine concentrations in comparison to those fed exclusively human milk protein (287±63 mol/l vs 168±26 mol/l) whereas the levels of some other essential amino acids (i.e. valine, leucine, lysine, histidine, phenylalanine and tryptophan) were lower. The results indicate that growth rates and gross metabolic indices do not depend on the protein quality of human milk fortifiers. However, the addition of well balanced mixtures of bovine proteins to human milk results in amino acid profiles similar to those observed in LBW infants fed similar amounts of human milk proteins.     

Breast milk from mothers of very low birthweight infants: variability in fat and protein content

While breast milk appears to be superior to formula for the development of very low birthweight (VLBW) infants, it is supplemented to meet the metabolic demands of the rapidly growing premature infant. To estimate the nutritional variability of breast milk from mothers of VLBW infants, protein (bicinchoninic acid method) and fat content (creamatocrit) were measured in breast-milk spot samples from mothers of 20 VLBW infants, collected 4 times a day during the first 4 wk of lactation. Protein content (median 1.9 g dl(-1), range 1.1-3.5 g dl(-1)) and fat content (3.8/1.0-14.6 g dl(-1)) were highly variable and lacked a normal distribution over all samples and in individual women's milk. There was only a weak correlation between fat and protein (rs=0.416, p < 0.001). Fat but not protein was lower in morning samples than in samples collected later in the day (p < 0.001). Protein but not fat content decreased during the weeks of lactation (rs =-0.446, p < 0.001). No impact of the baby's gestational age was observed. CONCLUSION: The fat and protein content of breast milk from mothers of VLBW infants is highly variable, calling into question the clinical feasibility of individualized supplementation of breast milk for VLBW infants based on spot sample measurements.     

Safety and efficacy of a new extensively hydrolyzed formula for infants with cow's milk protein allergy

Cow's milk protein allergy (CMPA) is best treated by complete elimination of cow's milk from the diet. For infants with CMPA who cannot be breast-fed, formulas based on extensively hydrolyzed proteins or on amino acids are the preferred substitutes for cow's milk-based formulas. In this study, we compared the tolerance and growth of infants with CMPA who were fed a new extensively hydrolyzed formula containing lactose (eHF) with those who were fed an amino acid formula (AAF). This was a prospective, multi-center, randomized, reference-controlled study. Seventy-seven infants <12 months old with suspected CMPA were enrolled. In 66 of these, CMPA was confirmed by oral challenge in a double-blind, placebo-controlled food challenge (DBPCFC) or by a medical history of severe allergic reaction to cow's milk and a positive skin prick test. These infants were then tested for their reaction to eHF and AAF in a DBPCFC. All infants tolerated both formulas and were randomized to receive either eHF (n = 34) or AAF (n = 32) for 180 days. Growth (weight, length, and head circumference) and tolerance [skin, gastro-intestinal, and respiratory tract symptoms of allergy] were evaluated after 30, 60, 90, and 180 days. There were no significant differences between the two groups in any of the growth measurements. Length and head circumference were similar to Euro-growth standards, but weight was slightly lower. Gastro-intestinal and respiratory tract symptoms of allergy were also similar in the two groups. However, whereas SCORAD scores for atopic dermatitis remained constant throughout the study in infants-fed eHF, there was a slight decrease in those fed AAF. Infants-fed eHF had significantly fewer incidents of vomiting than infants-fed AAF and a significantly higher frequency of soft stools. The new eHF is safe and well tolerated in infants diagnosed with CMPA.     

Supplementation of an adapted formula with bovine lactoferrin: 1. Effect on the infant faecal flora

The development of the infant faecal flora was studied over the first three months of life in infants receiving breast milk, a modern adapted formula and adaptations of this formula. Breast-fed infants developed a flora rich in Bifidobacterium sp. Facultative anaerobes were ubiquitous, but in relatively small numbers within the diet group. Other obligate anaerobes, such as Clostridium sp. and Bacteriodes sp. were rarely isolated. Standard formula produced a flora rich in bifidobacteria, but the growth of facultative organisms was not suppressed by this diet. Clostridium sp. and Bacteroides sp. were more common in this feeding group. After the addition of lactoferrin at 10 mg/100 ml to the formula diet, a flora similar to that of the standard formula-fed babies was achieved. Lactoferrin at 100 mg/100 ml was able to establish a "bifidus flora" in half of the babies given this formula, but only at age three months. Clostridium sp. and Bacteroides sp. were common faecal isolates from babies receiving both the lactoferrin diets.     

牛奶蛋白过敏诱发婴儿胃窦息肉形成2 例报告

目的探讨牛奶蛋白过敏与婴儿胃窦息肉的关系。方法回顾分析2例经电子胃镜和病理组织学检查确诊为胃窦增生性息肉导致胃输出道梗阻患儿的临床资料。结果男、女患儿各1例,分别为7月龄、11月龄,均表现为反复呕吐,营养不良。2例患儿的腹部超声检查均疑似先天性肥厚性幽门狭窄,其中女性患儿行幽门环肌切开术。2例患儿经无痛胃镜检查发现,胃窦附近息肉样增生导致胃输出道完全梗阻,术中置入空肠管。2例患儿的牛奶特异性IgE分别为0.43 IU/mL、1.35 IU/mL,均经激发试验确诊为牛奶蛋白过敏。2例患儿经持续空肠管喂养氨基酸配方粉,同时口服激素治疗,2个月后复查胃镜,胃窦息肉均明显缩小,并可自行进食。结论婴儿胃窦息肉少见,2例患儿的胃窦息肉可能与牛奶蛋白过敏相关。     

母乳糖巨肽水平检测及其与多种初生婴儿配方奶粉的比较

目的 探讨人母乳糖巨肽(GMP)的水平,为优化初生婴儿配方奶粉的营养成分提供参考.方法 选取身体健康、无特殊饮食习惯、生活安定、奶量充足,年龄25 ～ 39岁,第1胎足月经阴道自然分娩的产妇30例.分为初乳组和成熟乳组,每组15例,每例采集5 mL母乳(前段乳汁).初乳组采集的时间为产后第2天,成熟乳组采集的时间为产后第42天.采用凝乳酶对母乳进行水解,再采用唾液酸测试盒检测上清液中唾液酸水平(比色法),并以此代表GMP的相对水平.另外,选取6种市售品牌配方奶粉作为奶粉组,各自配制成液态标准奶,用同样方法检测其唾液酸水平.采用方差分析法比较各组唾液酸水平.结果 GMP最佳酶解条件:酶液质量浓度0.25 g/L,酶解时间120 min.初乳组唾液酸质量浓度为(3486.98±406.70) mg/L,成熟乳组唾液酸质量浓度为(2687.95±375.85) mg/L,2组比较差异具有统计学意义(P＜0.01),前者高于后者,且各组内个体间差异小(CV初乳=0.12,CV成熟乳=0.14).配方奶粉组唾液酸质量浓度为(1196.93 ± 608.40) mg/L,低于初乳和成熟乳中的水平,差异均具有统计学意义(P均＜0.01);各种品牌配方奶粉的平均唾液酸水平差异较大(CV=0.63).结论 人初乳中GMP的水平较成熟乳高;不同品牌婴幼儿配方奶粉中的GMP水平多寡不均,测得值与人乳比较也存在较大差异.但由于人乳和牛乳GMP分子质量及所含氨基酸残基数量不同,因而达到同样的GMP生理功效所需人乳或牛乳GMP水平可能不同.为优化初生婴儿配方奶粉的营养成分,使之更接近人乳,有必要进一步探讨相对于人乳的最佳配方奶粉GMP水平.     

广西地区小婴儿牛奶蛋白过敏的临床特征与相关因素分析

目的：探讨广西地区≤3月龄婴儿牛奶蛋白过敏(cow＇s milk protein allergy,CMPA)的临床症状与相关因素,提高 CMPA 的诊断与防治水平。方法纳入2012年7月1日至2014年12月30日,广西壮族自治区妇幼保健院儿科门诊首诊及外周医院转诊疑似 CMPA 的就诊患儿,设计观察量表,由中、高级儿科医生分选并确诊病例,门诊及电话随访,完成资料收集。结果共纳入137例患儿,过敏组51例,对照组(排除病例)86例,过敏组与对照组共有的症状包括腹泻、便秘、血便、腹痛、胃食管反流(gastroesophageal reflux,GER)、消化不良、厌食拒食、喂养困难等。过敏组与对照组喂养方式(即母乳喂养、混合喂养、人工喂养)、不当添加辅食、新生儿期间长期使用抗生素、父母过敏体质等11项指标差异无统计学意义(P ﹥0.05)。两组间就诊时有胃食管反流[20例(39.2%)vs.7例(8.1%)]、新生儿期间接触牛奶成分配方奶[51例(100%)vs.71例(82.6%)]、喂养不耐受(含 GER)[17例(33.3%)vs.11例(12.8%)]、肠道感染[8例(15.7%)vs.4例(4.7%)]、输血及使用血制品[12例(23.5%)vs.11例(12.8%)]5项指标差异有统计学意义(χ2＝19.538、P ＝0.000,χ2＝9.989、P ＝0.002,χ2＝8.308、P ＝0.004,χ2＝4.691、P ＝0.030,χ2＝5.198、P ＝0.023)。结论≤3月龄婴儿 CMPA 以腹泻、血便、GER 等消化系统症状为主要表现,新生儿时期接触牛奶成分配方奶具有重要触发作用。     

水解蛋白配方与婴幼儿牛奶过敏的预防和治疗

食物过敏是婴幼儿最早出现的过敏问题,牛奶是婴幼儿最常见的过敏食物。牛奶过敏的临床表现多种多样,可涉及皮肤、呼吸道、消化道等多器官多系统。母乳喂养是过敏高风险婴儿的首选喂养方式,但对不能进行母乳喂养的婴儿应选择适当的低敏配方奶,水解蛋白是获得低敏配方的最好方法。根据水解的程度,水解蛋白配方分为适度水解蛋白配方和完全水解蛋白配方。完全水解配方被推荐用于牛乳蛋白过敏婴儿的治疗,适度水解配方通常推荐用于特应质高风险婴儿的初级干预。     

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目的探讨新生儿常见肺部疾病支气管肺泡灌洗液肺表面活性蛋白A(BALSPA)水平及其与临床的关系。方法收集2000年1月至2003年2月在广州市儿童医院新生儿重症监护室住院的需行机械通气治疗的新生儿重症肺炎、胎粪吸入综合征(MAS)、急性呼吸窘迫综合征(ARDS)以及新生儿呼吸窘迫综合征(RDS)患儿共57例。测定其BALSPA水平,监测血气、PaO2/FiO2水平。结果重症肺炎组与MAS组患儿BALSPA水平无明显差异,但MAS组患儿PaO2、PaCO2及PaO2/FiO2水平较重症肺炎组明显降低(P值<0.01,<0.05,<0.05);ARDS及RDS组患儿BALSPA水平均较上述两组低(P值均<0.001),而RDS组患儿BALSPA水平较ARDS组低(P<0.001),但ARDS组患儿PaO2水平较RDS组患儿低(P<0.05)。PS治疗组患儿的病死率较非PS治疗组明显降低(P=0.049),其PaO2/FiO2与BALSPA水平密切相关(r=0.741,P=0.000)。结论与重症肺炎患儿比较胎粪吸入综合征患儿BALSPA水平无明显降低;ARDS及RDS患儿BALSPA水平明显降低;BALSPA水平能反映新生儿肺损伤的严重程度,对于新生儿肺部疾病预后的判断有一定意义。     

Family history of atopy in infants with cow's milk protein allergy: A French population-based study

ObjectivesThis French multicenter, cross-sectional, observational study aimed to describe the family history of atopy in infants with cow's milk protein allergy (CMPA), and the related diagnostic approaches used by specialists in a real-life ambulatory setting.Patients and methodsIn total, 1674 infants with suspected CMPA [median age 4.5 months (range: 0.1–18.0), males 54%] were enrolled in the study by 466 private physicians (pediatricians: 97%). Family history of atopy was defined as a known history of atopy in at least one first- (father, mother, and/or sibling) and/or second-degree relative (grandparents, uncles, and aunts), as reported by parents to physicians.ResultsAtopy in a first-degree relative was more common among infants with documented or high probability of CMPA (in 84% and 80% of cases, respectively, vs. the other subgroups, P = 0.005). Most infants experienced digestive (92%) and skin (61%) symptoms suggestive of CMPA. Delayed reactions were reported in 64% of infants. According to a post-classification based on the results of previous diagnostic tests and procedures, 1133 infants (68%) had highly probable (52%) or documented CMPA (16%). In these infants, a history of atopy was reported in first- and/or second-degree relative(s) in 86% of cases (81% in first-degree relatives). Whatever the family history of atopy, the characteristics of the infants were similar, except for fewer pets in the case of negative family atopy (14% vs. 25%, P < 0.001). Atopy in a parent was more frequent in infants who presented with the first signs suggestive of CMPA within the first 6 months of life vs. those with later first symptoms (75% vs. 65%, P = 0.063).ConclusionThis French study confirms the high rate of family history of atopy in first-degree relatives of infants with probable or documented CMPA.     

Z-score of weight for age of infants with atopic dermatitis and cow's milk allergy fed with a rice-hydrolysate formula during the first two years of life

Background: Recently, rice-based formulas have been widely used in hypoallergenic diets, but data on nutritional values are scarce. Aim: To evaluate the growth of infants fed with a rice-based hydrolysate formula, compared to those infants fed with a soy formula or an extensively hydrolysed casein formula, in the first 2 y of life. Methods: A total of 88 infants were enrolled between March 2002 and March 2004. Fifty-eight infants with atopic dermatitis (AD) and cow's milk allergy (CMA), confirmed by open challenge, were enrolled as study group: 15 were fed with a rice-based hydrolysate formula (RHF), 17 with a soy-based formula (SF) and 26 with an extensively hydrolysed casein formula (eHCF). Thirty infants with AD without cow's milk allergy were recruited as a control group (CG) and fed with a free diet. Weight was recorded on enrolment and at 3-monthly intervals in the first year of life, and at 6-monthly intervals in the second year. Infants were weighed naked, before feeding, by means of an electronic integrating scale. The z-scores of weight for age were calculated. Statistics: One-way analysis of variance and Student's t -test were used for statistical comparison. Significance was set at p <0.05. Results: No significant differences between the RHF, SF and eHCF groups were observed for the z-score of weight for age during the first 2 y of life, but a significantly lower difference was seen in the RHF group compared to the control group in the intervals 9 mo–1 y ( p =0.025) and 1–1.5 y ( p =0.020) of age. In contrast, the SF and eHCF groups were comparable to the control group, but the eHCF group was significantly lower ( p =0) in the first trimester of life.
Conclusion: Even if our findings show no significant difference between RHF and control, low weight observed in infants fed with RHF raises doubts about the nutritional adequacy of rice-hydrolysate formulas.     

Lactose and protein absorption from breast milk and cow's milk preparations and its influence on the intestinal flora. Investigations on two infants with an artificial anus

Lactose and protein absorption from breast milk and a cow's milk preparation enriched up to 7% of lactose were studied in two infants with an artificial anus applied in the ascending colon region. The concentrations of protein, lactose, glucose and galactose were measured in the fistula stools. In addition, the stools were analysed microbiologically. There were relatively high concentrations of lactose and its decomposition products and low concentrations of protein and aminonitrogen in the fistula stools when breast milk was fed. When the cow's milk formula was applied, only traces of lactose but high amounts of protein were measured. The microbiological findings are in agreement with the hypothesis that the bacterial flora of the large intestine is influenced by the lactose and protein concentrations in the intestinal content which reach the large intestine.     

The effect of milk type and fortification on the growth of low‐birthweight infants: An umbrella review of systematic reviews and meta‐analyses

Approximately 15% of infants worldwide are born with low birthweight (<2500 g). These children are at risk for growth failure. The aim of this umbrella review is to assess the relationship between infant milk type, fortification and growth in low‐birthweight infants, with particular focus on low‐ and lower middle–income countries. We conducted a systematic review in PubMed, CINAHL, Embase and Web of Science comparing infant milk options and growth, grading the strength of evidence based on standard umbrella review criteria. Twenty‐six systematic reviews qualified for inclusion. They predominantly focused on infants with very low birthweight (<1500 g) in high‐income countries. We found the strongest evidence for (1) the addition of energy and protein fortification to human milk (donor or mother''s milk) leading to increased weight gain (mean difference [MD] 1.81 g/kg/day; 95% confidence interval [CI] 1.23, 2.40), linear growth (MD 0.18 cm/week; 95% CI 0.10, 0.26) and head growth (MD 0.08 cm/week; 95% CI 0.04, 0.12) and (2) formula compared with donor human milk leading to increased weight gain (MD 2.51 g/kg/day; 95% CI 1.93, 3.08), linear growth (MD 1.21 mm/week; 95% CI 0.77, 1.65) and head growth (MD 0.85 mm/week; 95% CI 0.47, 1.23). We also found evidence of improved growth when protein is added to both human milk and formula. Fat supplementation did not seem to affect growth. More research is needed for infants with birthweight 1500–2500 g in low‐ and lower middle–income countries.     

Efficacy and safety of hydrolyzed rice-protein formulas for the treatment of cow's milk protein allergy

Foods for special medical purposes (FSMPs) with a protein fraction made of hydrolyzed rice protein (HRPs) have been on the market in Europe since the 2000s for the treatment of cow's milk protein allergy (CMPA). HRP formulas (HRPFs) are proposed as a plant-based alternative to cow's milk protein-based extensively hydrolyzed formulas (CMP-eHF) beside the soy protein formulas whose use in CMPA is controversial. HRPFs do not contain phytoestrogens and are derived from non-genetically modified rice. HRPFs are strictly plant-based apart from the addition of vitamin D₃ (cholecalciferol). As the amino acid content of rice proteins differs from that of human milk proteins, the protein quality of these formulas is improved by supplementation with free lysine, threonine, and tryptophan. The consumption of HRPFs has risen: for example, in France HRPFs account for 4.9% in volume of all formulas for children aged 0–3 years. Several studies have shown the adequacy of HRPFs in treating CMPA. They ensure satisfactory growth from the 1st weeks of life for infants and toddlers, both in healthy children and in those with CMPA. HRPFs can be used to treat children with CMPA either straightaway or in second intention in cases of poor tolerance to CMP-eHF for organoleptic reasons or for lack of efficacy. In France, the cost of HRPFs is close to that of regular infant or follow-on formulas.