Oligosaccharides might stimulate calcium absorption in formula-fed preterm infants

Among other components of human milk, oligosaccharides might contribute to the high efficiency of calcium absorption of breastfed infants. In adults, it can be shown that dietary oligosaccharides can improve calcium absorption. The present analysis was performed to evaluate a possible influence of dietary oligosaccharides on parameters of calcium metabolism in preterm infants. The concentrations of calcium and phosphorus in plasma and in spot urine samples as well as the plasma activity of the alkaline phosphatase were measured in preterm infants fed either a standard formula ( n = 15) or a formula supplemented with dietary oligosaccharides ( n = 15) at the end of a 4-wk feeding period.
Conclusions : There was no influence of the different diets on the plasma concentration of calcium and phosphorus or on the plasma activity of alkaline phosphatase. In urine, there was a tendency towards higher calcium concentrations in the group fed the supplemented formula compared concentrations in the group fed the standard formula. The concentrations of phosphate were not significantly different and, as a consequence, there was a tendency towards a higher Ca/P molar ratio in the group fed the supplemented formula. The data indicate that the calcium absorption might be influenced by the dietary oligosaccharides. Thus, the possible effect of dietary oligosaccharides on calcium homeostasis should be included in the discussion concerning the consequences of the use of dietary oligosaccharides in preterm infant nutrition.     

Energy expenditure in human milk- versus formula-fed preterm infants

OBJECTIVE: We compared energy expenditure (EE) of preterm infants fed their mother's milk versus preterm infant formula.Study design A prospective, randomized crossover study of 13 healthy, appropriate weight for gestational age, gavage-fed, preterm infants. Before the study and according to our feeding protocol, infants uniformly received alternate feeds of human milk and formula. Each infant was randomly assigned to 24 hours of formula feeding followed by 24 hours of breast milk or the reverse. Infants were studied asleep, at the end of each 24-hour period. EE was measured by indirect calorimetry 1 hour before feeding, 20 minutes during feeding, and 1 hour after feeding in a servo-controlled convective incubator. Energy content of human milk was analyzed by bomb calorimetry. RESULTS: EE was significantly lower in breast milk-fed infants during prefeeding (52+/-6 vs 57+/-10 kcal/kg per 24 hours) (P<.05), per feeding (55+/-6 vs 60+/-10 kcal/kg per 24 hours) (P<.05), and at the postfeeding measurement (60+/-7 vs 65+/-7 kcal/kg per 24 hours) (P=.059). After correction of the results for the actual measured energy intake, all statistical differences reached the <.05 level. CONCLUSIONS: Preterm infants have lower EE when they are fed breast milk than when they are fed preterm infant formula.     

Oligosaccharides might stimulate calcium absorption in formula-fed preterm infants

Among other components of human milk, oligosaccharides might contribute to the high efficiency of calcium absorption of breastfed infants. In adults, it can be shown that dietary oligosaccharides can improve calcium absorption. The present analysis was performed to evaluate a possible influence of dietary oligosaccharides on parameters of calcium metabolism in preterm infants. The concentrations of calcium and phosphorus in plasma and in spot urine samples as well as the plasma activity of the alkaline phosphatase were measured in preterm infants fed either a standard formula (n = 15) or a formula supplemented with dietary oligosaccharides (n = 15) at the end of a 4-wk feeding period. CONCLUSIONS: There was no influence of the different diets on the plasma concentration of calcium and phosphorus or on the plasma activity of alkaline phosphatase. In urine, there was a tendency towards higher calcium concentrations in the group fed the supplemented formula compared concentrations in the group fed the standard formula. The concentrations of phosphate were not significantly different and, as a consequence, there was a tendency towards a higher Ca/P molar ratio in the group fed the supplemented formula. The data indicate that the calcium absorption might be influenced by the dietary oligosaccharides. Thus, the possible effect of dietary oligosaccharides on calcium homeostasis should be included in the discussion concerning the consequences of the use of dietary oligosaccharides in preterm infant nutrition.     

Vitamin E status in preterm infants fed human milk or infant formula

Vitamin E status was assessed in 36 infants with birth weights less than 1500 gm who were assigned randomly to receive one of three sources of nutrition: milk obtained from mothers of preterm infants (preterm milk), mature human milk, or infant formula. Infants in each dietary group were further assigned randomly to receive iron supplementation (2 mg/kg/day) beginning at 2 weeks or to receive no iron supplementation. All infants received a standard multivitamin, providing 4.1 mg alpha-tocopherol daily. Serum vitamin E concentrations at 6 weeks were significantly related both to type of milk (P less than 0.0001) and to iron supplementation (P less than 0.05). Infants fed preterm milk had significantly higher serum vitamin E levels than did infants fed mature human milk, and both groups had significantly higher levels than did those fed formula. Ratios of serum vitamin E/total lipid were also significantly greater for infants fed human milks than for those fed formula. The addition of iron to all three diets resulted in significantly lower serum vitamin E levels at 6 weeks (P less than 0.05); however, only in the group fed formula was there evidence of vitamin E deficiency. Preterm milk with routine multivitamin supplementation uniformly resulted in vitamin E sufficiency in VLBW infants whether or not iron was administered.     

The effects of formula change on triglycerides and free fatty acids in preterm infants

We measured preprandial and 2-h postprandial plasma triglycerides (TG) and free fatty acids (FFA) in 13 preterm infants weekly for 3 consecutive weeks to examine the effects of a premature, medium-chain triglyceride (MCT)-containing formula advancing to a term, long-chain triglyceride (LCT)-containing formula. The infants were on premature formula for the first 2 weeks of the study and were switched to term formula 4-5 days before the last sampling. Significant increases were seen in preprandial and 2-h postprandial TG when the infants were advanced from the premature to the term formula. It was speculated that this increase was due to the predominance of LCT in term formula, which differed in its absorption and metabolism from MCT. Whether these increases persist and if their clinical significance requires further investigation. No consistent change was observed in the preprandial or postprandial FFA.     

Urinary excretion of lactose and oligosaccharides in preterm infants fed human milk or infant formula

At present, not much is known about the absorption and metabolism of human milk (HM) oligosaccharides in term and preterm infants. We investigated the renal excretion of lactose and complex oligosaccharides in preterm infants fed HM ( n = 9, mean actual body weight 2290 g) or a cow's milk-based infant formula ( n = 9, mean actual body weight 2470 g). We found that the renal excretion of lactose in HM-fed infants was slightly lower than in formula-fed infants (14.0 ± 7.4 versus 20.4 ± 8.7 mg kg^-1 day^-1, mean ± SD). The excretion of neutral sugars deriving from oligosaccharides was similar in HM-fed and formula-fed infants (3.8 ± 2.1 versus 2.9 ± 0.9mgkg^-1 day^1-); the difference between means was not statistically significant. The separation and characterization of oligosaccharides by high-pH anion exchange chromatography with pulsed amperometric detection (HPAE-PAD) and subsequent analysis by fast atom bombardment-mass spectrometry (FAB-MS) revealed a more complex pattern in HM-fed infants compared to the formula-fed group. Lactose-derived oligosaccharides characteristic for HM (e.g lacto- N -tetraose, and lacto- N -fucopentaoses I and II) were excreted in HM-fed but not in formula-fed infants. These results indicate that nutrition has a significant impact on the oligosaccharide composition in urine of preterm infants.     

Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis

OBJECTIVES: To compare the effect of donor breast milk with infant formula in preterm infants. Separate comparisons with formula were made for donor breast milk that was: (1) given as a sole diet; (2) given as a supplement to mother's own breast milk; and (3) fortified with macronutrients and micronutrients. The main outcomes were death, necrotising enterocolitis (NEC), infection, growth and development. DATA SOURCES: Electronic databases-Cochrane, CENTRAL, MEDLINE, EMBASE, CINAHL, and HMIC: DH. REVIEW METHODS: Systematic review and meta-analysis of trials and observational studies of preterm or low birthweight infants. RESULTS: Seven studies (including five randomised controlled trials), all from the 1970s and 1980s, fulfilled the inclusion criteria. All studies compared the effect of sole donor breast milk with formula (combined n = 471). One of these also compared the effect of donor breast milk with formula given as a supplement to mother's own milk (n = 343). No studies examined fortified donor breast milk. A meta-analysis based on three studies found a lower risk of NEC in infants receiving donor breast milk compared with formula (combined RR 0.21, 95% CI 0.06 to 0.76). Donor breast milk was associated with slower growth in the early postnatal period, but its long-term effect is unclear. CONCLUSION: Donor breast milk is associated with a lower risk of NEC and slower growth in the early postnatal period, but the quality of the evidence is limited. Further research is needed to confirm these findings and measure the effect of fortified or supplemented donor breast milk.     

Selenium status of preterm infants fed human milk, preterm formula, or selenium-supplemented preterm formula

The selenium status of 46 orally fed vitamin E-sufficient preterm infants (birth weight less than 1700 gm) was studied longitudinally for 3 weeks to determine the efficacy of selenium supplementation. Infants were fed either human milk (n = 21; 24 ng selenium/ml), preterm formula (n = 13; 7.8 ng selenium/ml), or preterm formula supplemented with sodium selenite (n = 12; 34.8 ng selenium/ml). Plasma and erythrocyte selenium and glutathione peroxidase activity and urinary and dietary selenium content were evaluated on study day 1 (day enteral feeds reached 100 kcal/kg/day) and weekly for 3 weeks. Throughout the study, selenium intakes of infants fed preterm formula plus sodium selenite were greater than those of infants fed human milk, which were greater than those of infants fed preterm formula (p less than 0.001). After 3 weeks no differences were observed among groups for plasma or erythrocyte selenium or glutathione peroxidase. Plasma selenium and glutathione peroxidase values within all groups were low compared with those reported for term infants fed human milk. Whereas urinary selenium levels of infants fed preterm formula plus sodium selenite were greater than those of infants fed preterm formula at weeks 1 and 2 (p less than 0.01), infants fed human milk and preterm formula had lower levels at week 3 than on study day 1 (p less than 0.05). We conclude that blood selenium measurements typically used to monitor selenium status do not reflect dietary selenium intakes of orally fed preterm infants.     

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.     

Postdischarge formula consumption in infants born preterm.

In 31 infants born preterm and formula fed ad libitum, all milk intake was weighed from hospital discharge to nine months post-term. Mean daily milk intake was high, reaching 230 g/kg before four weeks post-term and was still over 150 g/kg beyond six months. Five of the 31 infants (16%) consumed 300-350 g/kg; 50% 'voluntarily' consumed more than upper recommended limits for energy intake and 35% did so for protein intake.     

Feeding preterm infants with L-carnitine supplemented formula

A total of 29 preterm infants maintained on mixed enteral nutrition (50% pooled human milk, 50% formula daily) were studied over a 15 days period. 16 of them received L-carnitine supplemented formula during the first seven consecutive days (600 nmol/ml, as added supplement), 13 infants served as controls. In response to enhanced dietary intake, the plasma levels and urinary excretion rates of carnitines were increased by the 7th day of study. The plasma carnitines then returned to the initial values, whilst the urinary excretion remained elevated at the 14th day of study. The elevated daily urinary excretion of carnitines was accompanied by increased clearance and decreased relative reabsorption rates in the supplemented group. In the control group the plasma carnitine levels remained unchanged throughout the observations, while the daily excretion of free carnitine decreased by the end of the study. In the supplemented group statistically significant decrease was found in the daily excreted ammonia and urea with a decrease of plasma alanine and glutamine levels by the 7th day of study. The plasma levels of beta-hydroxybutyrate, glucose and creatinine remained unchanged in both groups.     

人乳与早产儿配方乳喂养对早产儿生长的Meta分析

目的对单纯人乳、强化人乳和早产儿配方乳喂养早产儿的生长进行评价。方法检索PubMed、ScienceDirect、EBSCOHost 、EMBASE 、OVID 、Cochrane图书 馆、维普中文科技期刊数据库和中国期刊全文数据库，并手工检索会议记录和专 题论文集等，收集关于单纯人乳、强化人乳与早产儿配方乳喂养早产儿的RCT研究 ，进行文献筛选和质量评价，采用RevMan 5.0.18软件进行Meta分析，计量资料采 用加权均数差（WMD）及其95％CI表示。无法进行合并分析的资料进行描述性分析 。结果共纳入7篇文献，文献质量评价5篇为B级，2篇为C级。Meta分析结果显示：① 对近期生长的影响：单纯人乳喂养组新生儿期体重增加速度（WMD＝-6.03，95％ CI：-9.58～-2.47，P=0.000 9）、身长增长速度（WMD＝-1.96，95％CI：-2.77 ～-1.16，P<0.000 01）及头围增长速度（WMD＝-2.04，95%CI：-3.71～-0.37， P=0.02）均显著慢于早产儿配方乳喂养组;强化人乳喂养组新生儿期体重、身长和 头围的增长速度与早产儿配方乳喂养组差异均无统计学意义。②对远期生长的影 响：单纯人乳喂养组与早产儿配方乳喂养组随访至9和18个月，以及7.5~8岁时的 体重、身长（高）和头围的差异均无统计学意义。结论现有证据提示，强化人乳喂养可促进早产儿生后近期内生长，单纯人乳和强 化人乳对早产儿远期生长的影响仍需进一步研究。     

A comparative study of a premature infant formula and preterm breast milk for low birthweight infants

Although the unique composition of preterm milk (PTM) has led to its increasing use in feeding of low birthweight (LBW) infants, controversy exists as to whether such milk adequately meets their requirements. This study compares the clinical tolerance and anthropometric, biochemical and haematological parameters of LBW infants fed exclusively with their own mother's PTM, a premature infant formula (Alprem; Nestlé Australia) and a mixture of PTM and Alprem. Of 90 enrolled LBW infants (1000-1750 g birthweight), 78 completed the feeding trial for a mean duration of 42 days. Twenty-eight babies were fed Alprem (Group A), 31 received a mixture of Alprem and PTM (Group B) and 18 received PTM (Group C). Babies in Groups A and B were smaller, less mature and more asphyxiated at birth than those in Group C. Weight gain from full enteral feeding was greater in Group A (18.1 g/kg per day) and Group B (17.6 g/kg per day) than in Group C (13.0 g/kg per day). Throughout the trial, weight gain in Groups A and B exceeded predicted intra-uterine growth rates, whereas that for Group C approximated the predicted intra-uterine growth rates. Growth rates of length and head circumference were also greatest in the Alprem-fed babies. Infants receiving PTM were supplemented with calcium, sodium, vitamins and energy, whereas the only three infants requiring mineral supplementation in the Alprem group were those receiving Frusemide therapy for chronic lung disease. lower serum concentrations of phosphorus, iron, albumin and urea, and higher zinc and alkaline phosphatase concentrations were found in infants receiving PTM (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparative study of a premature infant formula and preterm breast milk for low birthweight infants

Although the unique composition of preterm milk (PTM) has led to its increasing use in feeding of low birthweight (LBW) infants, controversy exists as to whether such milk adequately meets their requirements. This study compares the clinical tolerance and anthropometric, biochemical and haematological parameters of LBW infants fed exclusively with their own mother's PTM, a premature infant formula (Alprem; Nestlé Australia) and a mixture of PTM and Alprem. Of 90 enrolled LBW infants (1000-1750 g birthweight), 78 completed the feeding trial for a mean duration of 42 days. Twenty-eight babies were fed Alprem (Group A), 31 received a mixture of Alprem and PTM (Group B) and 18 received PTM (Group C). Babies in Groups A and B were smaller, less mature and more asphyxiated at birth than those in Group C. Weight gain from full enteral feeding was greater in Group A (18.1 g/kg per day) and Group B (17.6 g/kg per day) than in Group C (13.0 g/kg per day). Throughout the trial, weight gain in Groups A and B exceeded predicted intra-uterine growth rates, whereas that for Group C approximated the predicted intra-uterine growth rates. Growth rates of length and head circumference were also greatest in the Alprem-fed babies. Infants receiving PTM were supplemented with calcium, sodium, vitamins and energy, whereas the only three infants requiring mineral supplementation in the Alprem group were those receiving Frusemide therapy for chronic lung disease. Lower serum concentrations of phosphorus, iron, albumin and urea, and higher zinc and alkaline phosphatase concentrations were found in infants receiving PTM (P<0.05). Overall both PTM and Alprem were well tolerated with the four cases of necrotizing enterocolitis and five cases of transient gastrointestinal intolerance distributed equally among the groups. Alprem is a satisfactory alternative to PTM for the feeding of LBW infants as it provides adequate nutrition and supports a growth rate in excess of that in utero without stressing the infant's metabolic or excretory systems.     

A longitudinal study of salivary sialic acid in preterm infants: Comparison of human milk-fed versus formula-fed infants

We found that the saliva of preterm infants fed human milk contains twice the level of sialic acid as that in infants fed commercial formulas. The higher sialic acid level suggests greater viscosity and enhanced protection of the mucosal surfaces in breast-fed infants. Human milk itself is a rich source of sialylated oligosaccharides.     

Fat absorption in preterm infants fed a taurine-enriched formula

An adapted cow's milk infant formula without or with extra taurine (350 μmol/l) was fed to four and five infants, respectively. The infants, born after 28–32 weeks gestation, and initially fed with a starting formula for preterms, were switched to one of the two above-mentioned formulae at approximately the 16th day of life. Each infant was studied during 4 consecutive weeks. The faecal excretion of fat, energy and total bile acids was determined from 3-day stool collections each week. The addition of taurine to the infant formula neither improved the uptake of fat and energy nor changed the faecal bile acid excretion. Growth velocity was similar in both groups of infants. Based on these results there is no rationale for adding taurine to adapted cow's milk infant formula to obtain a better fat absorption.     

Influence of protein and energy intakes on body composition of formula-fed preterm infants after term

The aim of the present study was to evaluate changes in body composition in 48 preterm infants in relation to protein and energy intakes from term up to 3 months of corrected age, using air displacement plethysmography. Protein intake (grams per kilogram per day) was negatively associated with percentage of fat mass at 1 month of corrected age. The high-protein-intake group showed greater gain in lean body mass gain than did the low-protein-intake group. This finding suggests that during the first month of corrected age, high protein intake results in a significantly different weight gain composition.