锌及双歧杆菌制剂对早产儿胃肠激素的影响

目的探讨锌及双歧杆菌制剂对早产儿胃动素和胃泌素分泌的影响,为指导早产儿早期喂养提供理论依据。方法对我院NICU的60例早产儿随机分为A、B、C、D4组,A组为对照组,B组加入锌剂、C组加入双歧杆菌制剂、D组同时加入以上两种制剂,出生24h内、生后7d检测血浆胃动素、胃泌素水平。结果4组早产儿生后第1天时,两种激素水平差异无统计学意义(P>0.05),至第7天时,D组早产儿胃动素(365.89±32.60)ng/L胃泌素(138.20±22.11)ng/L与A组胃动素(316.12±38.47)ng/L胃泌素(110.75±27.68)ng/L差异均有统计学意义。治疗组B、C、D3组早产儿血胃动素和胃泌素的变化差值均与对照组A组差异有统计学意义(P<0.05);同时D组与B、C两组差异也有统计学意义(P<0.05)结论早期添加锌及双歧杆菌制剂可以促进早产儿胃动素、胃泌素的释放,加速早产儿胃肠道发育成熟。两种制剂同时添加对早产儿胃肠激素的释放优于单一制剂应用,有利于增进早产儿胃肠功能的发育和完善,加速早产儿的追赶性生长。     

出生早期新生儿肠道双歧杆菌动态检测

目的 了解出生1周新生儿肠道双歧杆菌的动态变化.方法 采用16srRNA/DNA荧光定量PCR技术,分别对40例足月儿和40例早产儿生后第1(>12 h)、4、7天粪便标本中的双歧杆菌进行定量分析.结果 生后第1、4、7天足月儿粪便标本中双歧杆菌数量(拷贝数/g湿便)的对数值分别为6.52±0.52、8.30±0.48、8.89±0.48,差异有统计学意义(F=210.87,P<0.01);早产儿分别为6.28±0.44、6.97±0.48、7.34±0.49,差异有统计学意义(F=29.31,P<0.01);相同日龄两组间比较,第4、7天差异有统计学意义(t=11.56、13.98,P均<0.01).结论 新生儿肠道双歧杆菌的建立呈动态变化,早产儿落后于足月儿.     

经鼻重组腺相关病毒T-bet基因转染对呼吸道合胞病毒感染小鼠呼吸道炎症的影响

目的 观察携带T-bet基因的重组腺相关病毒(rAAV-T-bet)转染对呼吸道合胞病毒(RSV)感染模型小鼠呼吸道炎症的影响.方法 健康6～8周龄Balb/c小鼠40只.按随机数字表法分为4组:正常对照组(A组)、RSV感染模型组(B组)、模型/对照病毒rAAV载体介导的增强型绿色荧光蛋白(rAAV-eGFP)干预组(C组)及模型/rAAV-T-bet干预组(D组),每组10只.将B组、C组和D组小鼠用滴度为1.26×1010 PFU·L-1的RSV液滴鼻,每只100 μL;A组用等量人喉癌上皮细胞(Hep-2细胞)培养上清液代替RSV液.于RSV接种第5天,再次麻醉小鼠,A组和B组经鼻滴入293细胞培养上清液;C组经鼻滴入293细胞包装的rAAV-eGFP对照病毒液,D组经鼻滴入293细胞包装的rAAV-T-bet.7 d后处死小鼠,检测各组小鼠支气管肺泡灌洗液(BALF)中细胞成分及IL-4和γ干扰素(IFN-γ)水平,并观察其肺组织病理学变化.结果 1.B组小鼠BALF中细胞总数和淋巴细胞计数百分比分别为(43.91±10.41)×109L-1、(65.15±1.88)%,A组分别为(14.52±3.57)×109L-1、(25.79±1.07)%,A组与B组比较差异均有统计学意义(Pa<0.05);D 组小鼠BALF中细胞总数和淋巴细胞计数百分比分别为(24.84±4.35)×109L-1、(29.48±11.97)%,与B组、C组比较差异均有统计学意义(Pa<0.05).2.B组小鼠BALF中IL-4和IFN-γ水平分别为(74.32±10.06) ng·L-1、(89.36±20.38) ng·L-1,A组分别为(6.01±1.02) ng·L-1、(177.32±18.16) ng·L-1,A组与B组比较差异均有统计学意义(Pa<0.05);D组分别为(49.14±7.59) ng·L-1、(145.28±43.52) ng·L-1,与B组、C组比较差异均有统计学意义(Pa<0.05).3.A组小鼠呼吸道无明显炎症改变;B组和C组小鼠小支气管、血管黏膜下和周围肺组织有明显炎性细胞浸润,血管壁明显水肿;D组小鼠呼吸道炎症明显减轻.结论 T-bet基因转染能改善RSV感染模型小鼠呼吸道内细胞因子IL-4和IFN-γ异常表达,同时对淋巴细胞在肺内聚集、肺组织炎症有一定抑制作用.     

锌对哮喘大鼠支气管肺泡灌洗液中嗜酸性粒细胞趋化蛋白、单核细胞趋化蛋白-1及白介素8的影响

目的探讨锌对哮喘大鼠支气管肺泡灌洗液(BALF)中嗜酸性粒细胞趋化蛋白(eotaxin)、单核细胞趋化蛋白-1(MCP-1)及白介素8(IL-8)的影响。方法建立哮喘大鼠模型,SD大鼠32只,按体质量随机分为4组,A组为缺锌饲料+卵清蛋白(OVA)激发组,B组为补锌饲料+OVA激发组,C组为正常锌饲料+OVA激发组,D组为正常锌饲料+生理盐水激发组。诱喘后24 h取BALF进行细胞分类,酶联免疫吸附法(ELISA)检测BALF中eotaxin、MCP-1及IL-8。结果与C组相比,A组大鼠BALF中嗜酸性粒细胞、中性粒细胞及单核细胞数均明显增加(P0.05),而B组则明显减少(P0.05);B组上述炎性细胞较D组仍有明显增加(P0.05)。A组大鼠BALF中eotaxin[(178.97±23.40)pg/ml]及MCP-1[(3.11±0.86)ng/ml]较C组[eotaxin(147.20±39.35)pg/ml,MCP-1(2.39±0.59)ng/ml]明显增加(P0.05),而B组eotaxin[(112.85±27.62)pg/ml]及MCP-1[(1.66±0.74)ng/ml]则明显减少(P0.05);A、B、C三组BALF中IL-8差异无统计学意义(P0.05)。结论锌对哮喘大鼠气道eotaxin及MCP-1具有抑制作用,但对IL-8无明显影响。     

危重症早产儿早期微量喂养与血清胃泌素动态变化及临床情况的研究

目的 探讨危重症早产儿早期微量喂养与其血清胃泌素动态变化之间的关系,评价早期微量喂养对早产儿胃肠发育及临床情况的影响.方法 本组共125例,其中出生时有合并症的早产儿(危重评分≤90)共95例,分为早喂组48例,非早喂组47例.30例出生时无合并症的早产儿(危重评分＞90)为正常对照组.并对其胃肠道喂养耐受情况,生长发育情况进行监测.对照组生后6 h开始试喂糖水,每次1～2 ml/kg,1～2次后喂配方乳,逐渐加量至足量.早喂组生后72 h内开始给予微量喂养刺激,0.5～1 ml/kg,3 h 1次,逐渐加量至足量.非早喂组病情平稳后(最早生后72 h),再给予胃肠内喂养.用放射免疫分析方法测定3组生后1、3、7 d的血清胃泌素的水平.结果 (1)胃泌素含量:对照组、早喂组的血清胃泌素在生后1、3、7 d均呈上升趋势.生后1 d,早喂组[(82.4±24.5)ng/L]和非早喂组[(87.0±40.2)ng/L]的血清胃泌素水平明显高于对照组[(66.4±19.7)ng/L](F=3.36,P＜0.05).3、7 d早喂组胃泌素[(96.3±14.6)ng/L,(113.0±16.5)ng/L]水平较非早喂组[(73.9±13.5)ng/L,(92.4 ±12.2)ng/L]高,差异有统计学意义(P＜0.05).(2)临床观察指标:对照组、早喂组、非早喂组喂养不耐受的人数(2/30,5/48,14/47)、达足量喂养的时间[(20.6±5.7)d,(27.8士6.1)d,(39.5 ±4.7)d]、住院天数[(29.0±4.6)d,(39.0±4.8)d,(48.0 ±5.6)d]等方面差异均有统计学意义(P＜0.05).(3)生长发育指标:早喂组与非早喂组患儿在出生1～2N体重增长差异无统计学意义[(5.9 ±2.9)g/d vs(5.0±2.1)g/d].恢复出生体重时间[(19.8±4.2)d vs(25.2±5.1)d],出生3～4周体重的增长差异有统计学意义[(19.1 ±2.4)g/d vs(11.9±3.3)g/d](P＜0.05).(4)出现合并症的情况:3组均无NEC及其他消化道合并症出现.早喂组与其他两组相比,感染、贫血、呼吸暂停、低血糖等合并症的发病人数差异无统计学意义.结论 危重症早产儿合适的早期微量喂养可以促进胃泌素的分泌,促进胃肠道发育,且不增加合并症的发生.     

群体反应性抗体干扰脐血CD34+细胞增殖、分化的实验研究

目的 探讨血清特异性群体反应件抗体(PRA)对脐血CD34+细胞增殖、分化能力的影响.方法 取含PRA(经实验证实)的β地中海贫血患儿血清,与脐血CD34+细胞、补体孵育,观察PRA对CD34+细胞增殖、分化的影响,分A组(不加血清组)、B组(PRA血清组)、C组(PRA血清加补体组)、D组(补体组)、E组(PRA阴性血清组)共5组.孵育后以3H-TaR掺入法测定细胞DNA合成及流式细胞仪检测Annexin V和CD95表达;并进行集落培养,于第10天计数集落.结果 A组为(20.71±2.81)U/L,低于B组(64.28±5.12)U/L、C组(84.29±4.99)U/L,B组低于C组;D、E组均为(22.86±2.91)U/L和(22.86±2.91)U/L,均低于B、C组;各组氚每分钟β射线释放量(cpm):A组为(22629±3288),高于B组(4598±2178)和C组(1626±1192),A组和D、E组之间的差异无统计学意义(P＞0.05);A组的总集落数、粒-巨噬细胞集落形成单位(CFU-GM)、混合系集落形成单位(CFU-GEMM)及爆式红系集落形成单位(BFU-E)数均高于B、C组,B组的总集落数、CFU-GM及CFU-GEMM数均高于C组;D组和E组的各种集落数与A组的差异无统计学意义(P＞0.05);各组CD34+细胞Annexin V及CD95表达百分率差异无统计学意义(P＞0.05).结论 特异件PRA血清对脐血CD34+细胞的增殖和分化有抑制作用,补体可增强上述作用;特异性PRA血清对脐血CD34+细胞的凋亡无明显影响.     

非营养性吸吮对早产儿血胃泌素与胃动素及胃排空的影响

目的 评价非营养性吸吮对早产儿血胃泌素、胃动素及胃排空的影响.方法 将38例需经鼻胃管喂养的健康早产适于胎龄儿,随机分为非营养性吸吮(NNS)组和对照组.放免法测定血胃泌素、胃动素水平,实时超声测定胃排空.结果 NNS组7 d龄体重恢复出生体重者达38.9%较对照组(10%)增多,胃残留发生率低于对照组(分别为16.7%、50%),差异有统计学意义(F=0.04,P＜0.05).NNS组达到418.4 kJ/(kg·d)时间较对照组缩短,差异有统计学意义(t=2.04,P＜0.05).NNS组7、14 d胃泌素均高于对照组,差异有统计学意义(t=2.09、2.04,P＜0.05);两组早产儿7、14 d胃动素水平无差异;NNS组胃半排空时间快于对照组,差异有统计学意义(t=2.33,P＜0.05).结论 NNS可促进胃泌素分泌,加快胃排空,有利于早产儿生后胃肠功能的发育,减少喂养不耐受的发生.     

早产儿早期体重增长速率对体格生长发育影响的研究

目的分析早产儿早期体重增长速率对其1周岁时体格生长指标的影响。方法以2005年8月至2008年5月南京市妇幼保健院产科出生的96名胎龄28～36周的早产儿为研究对象,按照出生后最初3个月体重增长速率的百分位数将其分为4组(以A、B、C、D组分别代表组别生长速率百分位数P25、P25～P50、P50～P75及P75),比较4组早产儿1周岁时的平均体重与平均身长。结果 4组早产儿出生平均体重差异无统计学意义(P0.05)。1周岁时A组平均体重显著低于C组及D组,而与B组差异无统计学意义(P0.05);B组平均体重亦低于C组及D组;C组与D组间差异无统计学意义(P0.05)。1周岁时除A组平均身长分别与C组和D组差异有统计学意义外(P0.05),其余各组间差异均无统计学意义(P0.05)。结论早产儿早期体重增长速率对其体格生长发育有一定影响。     

T-bet基因传递对支气管哮喘模型小鼠T淋巴细胞亚群的免疫调节作用

目的 应用携带T-bet基因的重组腺相关病毒载体(rAAV-T-bet)经鼻干预支气管哮喘(哮喘)小鼠模型,探讨T-bet基因传递对哮喘小鼠T淋巴细胞亚群的免疫调节及改善炎症的作用.方法 采用随机数字表法将40只健康的6～8周龄SPF级Balb/c小鼠随机分为正常对照组(A组)、哮喘模型组(B组)、rAAV介导的增强型绿色荧光蛋白(rAAV-eGFP)干预对照组(C组)及rAAV-T-bet干预组(D组),每组10只.B、C、D组以卵清蛋白(OVA)致敏和激发,建立哮喘小鼠模型,其中C、D组在第18、19天分别经鼻滴入等剂量rAAV-eGFP、rAAV-T-bet进行干预;B组处理方法同上,以等剂量的9 g/L盐水干预.于最后一次激发24 h后处死小鼠并取材.应用免疫组织化学方法观察小鼠肺组织中转录因子T-bet、GATA-3和Foxp3水平;计数BALF中细胞总数并分析其细胞类型;ELISA法测定BALF中细胞因子IFN-γ、IL-4、IL-5表达水平.结果1.B组、C组中T-bet表达细胞的阳性率均明显低于A组(P均＜0.05),GATA-3表达细胞的阳性率明显高于A组(P均＜0.05),D组中T-bet表达明显增强,GATA-3表达则显著下降(P均＜0.05),Foxp3的表达阳性率在各组间的差异与T-bet的表达类似.2.D组BALF中细胞总数为(0.35±0.11)×109/L,其中EOS比例为0.04±0.02,虽高于A组,但明显低于B、C组(P均＜0.05);IL-4和IL-5分别为(158±55) ng/L、(68±22) ng/L,显著低于B、C组(P均＜0.05),高于A组但差异无统计学意义(P均＞0.05),而IFL-γ水平[(113±35) ng/L]明显低于B、C组(P均＜0.05),与A组比较水平相近(P＞0.05).结论 在建立小鼠哮喘模型的基础上,经鼻应用rAAV-T-bet干预可使T-bet基因顺利定向插入到受转染细胞的基因组中,成功编码T-bet蛋白,并进一步对哮喘小鼠模型发挥相应的免疫调节作用.     

新生儿高胆红素血症与胃动素胃泌素水平的相关性研究(英文)

目的：新生儿高胆红素血症患儿常出现胃肠道症状。该研究目的是探讨高胆红素血症 (高胆 )对新生儿胃肠激素水平的影响及其可能的发生机制。方法：应用放射免疫分析法 (RIA)对 5 0例高胆患儿空腹状态下血中胃动素、胃泌素浓度进行测定 ,并以 30例正常新生儿作为对照。结果：高胆组患儿血浆胃动素浓度 (6 5 9±37ng/L)明显高于对照组 (4 86± 2 8ng/L) ,差异有显著性意义 (P <0 .0 1) ,且与血清胆红素水平呈正相关 ;血清胃泌素浓度 (12 8± 9ng/L)与对照组 (132± 11ng/L)比较差异无显著性 (P >0 .0 5 )。结论：高胆红素血症新生儿的某些胃肠道症状可能与胃动素分泌异常有关。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.