肾小球疾病血清内源性洋地黄样物质测定

目的探讨儿童肾小球疾病血清内源性洋地黄样物质的变化规律及临床意义。方法用荧光偏振免疫法测定５２例肾小球疾病患儿（肾病综合征急性发作期１６例，肾病综合征恢复期１６例，肾小球肾炎２０例）及正常对照组儿童２０例血清内源性洋地黄样物质（ＥＤＬＳ）水平，并与临床表现、血及尿中β２微球蛋白（Ｓβ２－ＭＧ）、（Ｕβ２－ＭＧ）、血肌酐（Ｓｅｒ）、尿素氮（ＢＵＮ）进行相关分析。结果肾病综合征和肾小球肾炎患儿血清ＥＤＬＳ水平均显著增高（Ｐ＜０．００１，Ｐ＜０．０５），肾病综合征恢复期血清ＥＤＬＳ水平恢复正常。血清ＥＤＬＳ水平与患儿的血压、ＳＣｒ、ＢＵＮ．Ｓβ２－ＭＧ、Ｕβ２－ＭＧ浓度呈显著正相关。结论肾小球疾病血清ＥＤＬＳ水平升高，并与水肿、高血压和肾功能损害相关。ＥＤＬＳ在肾小球疾病的发展中起一定作用。     

Type of milk feeding in infants and young children up to 19 months of age in three Socio-economic groups in Madrid

The feeding practices of 344 children in Madrid between 3 and 19 months were investigated by controlled interview or their mothers of care-takers. Four different types of milk were given to the children: human milk, infant formula, follow-on formula and cow's milk. Three periods could be defined when infants were most likely to change from one milk type to another. The majority of babies changed from human milk to infant formula some time in the first three months of life. At between four and six months, about half the sample changed to a follow-on formula and, finally, around the baby's first year formula was substituted for cow's milk. Differences in feeding behaviour could be observed among Socio-economic groups, but were not statistically significant. Feeding patterns closely followed international recommendations for infant feeding.     

A cohort study of term infants from Vilnius, Lithuania: feeding patterns

AIM: To present infant feeding patterns and to relate these to selected biological and social factors. METHODS: One hundred and ninety-two infants born at four delivery departments were followed prospectively from birth to 12 mo of age. Their parents were asked to tick weekly if the infant received items on a list of the most common infant foods and drinks, including breast milk. RESULTS: All infants started breastfeeding. Median duration of exclusive breastfeeding was 0.5 mo, and 3.75 mo for "any breastfeeding". Mothers who were older (>25 y), better educated (>11 y) and non-smokers breastfed significantly longer (median 4 mo). Median introduction of cow's milk was 8 (range 2-12) mo. At the age of 12 mo, 78% of infants received cow's milk and 58% of infants received cow's milk as the sole source of milk. Mothers who were younger (<21 y) and less educated (<12 y) introduced cow's milk significantly earlier. Mean (SD) start of solids was 3.4 (1.0) mo. Longer duration of breastfeeding was the only factor significantly associated with the later start of solids. Ninety-two percent of infants were introduced to fresh cheese before 12 mo. Additional liquids were widely given both to breastfed and non-breastfed infants. CONCLUSIONS: Compliance with the current infant feeding recommendations is not sufficient. Breastfeeding rates are low. Use of high-protein products is widespread. More effort should be made to educate young, less educated and smoking mothers.     

Digoxin-like immunoreactive substance in serum of preterm and full-term neonates

A significant serum level of digoxin-like immunoreactive substance (DLIS) (≥0.5 ng/ml) has been found in healthy full-term neonates, in prematurely born neonates as well as in full-term but small for gestational age neonates. Neither the babies nor their mothers had received digoxin therapy. On the first day of life, the incidence of serum levels of DLIS≥0.5 ng/ml in the three groups of neonates were respectively 64% (32/50), 42% (8/19) and 77% (10/13). Longitudinal measurements in preterm and small for gestational age neonates indicate a progressive disappearance of DLIS from their serum, none of them having a significant serum level at 21 days of age. As long as the chemical structure, origin and physiological properties of DLIS remain unknown, clinicians must be cautious in interpreting the serum levels of digoxin used for therapeutical purpose in neonates.     

Influence of feeding regimens on non-invasive inferior vena cava and hepatic vein velocity measurements in infants

The aim of this study was to investigate the effects of feeding type and osmotic load on intravascular volume status. Ninety term, healthy infants 2 mo of age were included in the study. The breastfed and formula-fed groups each consisted of 45 infants. Echocardiographic examination was performed before and after feeding. The collapse index of the inferior vena cava (IVCIC) and right atrial pressure (RAP) were calculated. No statistically significant differences were found between before- and after-feeding values of IVCIC, RAP and hepatic vein velocities in breastfed infants. In the formula-fed group, after-feeding values of IVCIC were significantly lower and RAP, hepatic vein systolic and diastolic velocities were significantly higher compared to the before-feeding values. Most of the mothers (78%) were unsuccessful at preparing the formula at appropriate concentrations. No statistically significant differences were found between the before- and after-feeding values of IVCIC, RAP and hepatic vein velocities in infants being fed appropriately prepared formula. The after-feeding values of hepatic vein velocities were higher than those of before-feeding values; after-feeding values of IVCIC were lower than before-feeding values in infants being fed highly concentrated formula. Conclusion: The values of inferior vena cava indices and hepatic vein velocities were not effected by feeding in infants receiving appropriately concentrated formula, like those of infants receiving breast milk. However, feeding with highly concentrated formula may cause intravascular volume expansion.     

Growth of infants with IgE-mediated cow''s milk allergy fed different formulas in the complementary feeding period

Observational studies have shown that allergic infants, irrespective of the type of diet, show various degrees of growth depression in the first year of life. We investigated whether the type of milk in the complementary feeding period (6-12 months of age) is associated with differences in the increase of standardized growth indices (weight-for-age, WA; length-for-age, LA; and weight-for-length, WL, z-scores) in infants with cow's milk allergy (CMA). Infants with immunoglobulin E-mediated CMA breastfed at least 4 months and progressively weaned in the 5- to 6-month period were randomly assigned to three special formulas, a soy formula (n = 32), a casein hydrolysate (n = 31), and a rice hydrolysate (n = 30). A fourth, non-randomized group was made up by allergic infants still breastfed up to 12 months (n = 32). Groups were compared for WA, LA, and WL z-scores at 6, 9 and 12 months of age. All groups showed low WA and LA z-scores at 6 months of age. Infants fed hydrolyzed products showed a trend toward higher WA z-score increments in the 6- to 12-month period. The use of casein- and rice-based hydrolyzed formulas resulted in higher changes in WA compared with soy formula. Further research should be aimed at optimizing the dietary needs and feeding regimens for infants with CMA.     

Allergy development and macromolecular absorption in infants with different feeding regimens during the first three days of life. A three-year prospective follow-up

A group of 129 infants were randomly assigned at birth to one of three feeding regimens: human milk (HM), cow's milk formula (CMF) or a casein hydrolysate formula (CHF) during the first 3 days of life. Blood samples were taken on at 4 days and at 2, 4, 8, 12 and 24 months of age. Macromolecular absorption was analysed by measuring the serum concentration of human α-lactalbumin (S-α-LA) with a competitive radioimmunoassay (RIA). Total serum IgE was measured by RIA. A family history of allergy correlated to the proportion of infants with allergic symptoms both at 24 and 36 months of age ( p = 0.03 and p = 0.04 respectively). In none of the three groups did correlation exist between the duration of breastfeeding and serum α-LA, serum IgE, family history of allergy, frequency of allergic symptoms and proportion of infants with infections.     

Early cessation of breast milk feeding in very low birthweight infants

This investigation was carried out to comparatively assess the duration of breast milk feeding and to analyze risk factors for early cessation of breast milk feeding in term and very preterm infants. A cohort study was performed in 89 consecutive very low birthweight (VLBW) infants (<1500 g) who survived for at least for one week, and 177 term infants with birthweights >2500 g born in the same hospital matched for gender and multiplicity. Median duration of breast milk feeding, as determined from charts and questionnaires mailed to the mothers at 6 and 12 months corrected age, was 36 days in VLBW infants, compared to 112 days in control infants (P<0.0001). In both VLBW and control infants, smoking during pregnancy, low maternal and low paternal school education were each significantly associated with short duration of breast milk feeding. In VLBW infants, multiple pregnancy and gestational age <29 weeks were each associated with prolonged breast milk feeding, as were maternal age >35 years and spontaneous pregnancy (as opposed to pregnancy following infertility treatment) in term infants. Multivariate analysis revealed that VLBW, smoking and low parental school education were independent negative predictors of breast milk feeding. While these results emphasize the need for special support of VLBW infant mothers promoting lactation, the relationships between smoking, school education and breast milk feeding in both strata show that efforts to increase breast milk feeding require a public health perspective.     

Chromatographic characterization of endogenous digoxin-like immunoreactive substances present in serum and urine of infants using gel filtration with Sephadex G 25

We assayed digoxin-like immunoreactivity in the serum of 19 healthy neonates (blood sample from umbilical cord), not receiving digoxin therapy, using a solid-phase radioimmunological method. In addition, urinary concentrations of a digoxin-like immunoreactive substance (DLIS) were assayed throughout the first 10 weeks of extrauterine life in 50 healthy infants. The mean (+/- SD) serum DLIS concentration obtained was 211 +/- 60 ng/l digoxin equivalents (d.e.) while, in the urinary samples of the first day of life, the mean concentration was 818 +/- 560 ng/l d.e. (n = 20). These DLIS values in infants were higher (about 5- to 10-fold) than those previously observed in adults. In addition, urinary DLIS values were very high in the first week of life and fell quite rapidly in the next weeks of life. We used serum and urine pools from neonates for gel filtration experiments using a Sephadex G 25 column. In the urine sample we found some immunoreactive peaks eluted at the end and after the region of salts, while the chromatographic profiles of the serum pool showed only a major peak eluted with the peak of proteins. After boiling, the same serum pool showed an elution pattern characterized by a smaller immunoreactive peak eluted with that of proteins and by other peaks similar to those observed for the urine sample. Our study demonstrated that a substance or more substances which cross-react with digoxin-specific antibodies are present in blood and urine of healthy infants. In addition, our chromatographic studies indicate that DLIS is probably a low molecular weight substance(s) which circulate(s) in blood bound to a higher molecular weight molecule.     

Plasma gastrin and somatostatin levels in newborn infants receiving supplementary formula feeding

Plasma gastrin and somatostatin concentrations were measured by radioimmunoassay in exclusively formula-fed infants and in breast-fed infants receiving supplementary formula during the first five postnatal days. Infants exclusively formula fed had a progressive increase in mean plasma gastrin concentration from 109±42 pmol/l (mean±SD) on the first day to 236±103 pmol/l on the fifth day after birth ( p = 0.0001). Breast-fed infants receiving supplementary formula had similar hormone concentrations as formula-fed infants of corresponding postnatal age and they also had a significant increase in hormone levels from the first to the fifth day ( p = 0.0001). A positive relationship was found between gastrin concentration and ingested milk volume: Rs = 0.51, n = 105, p = 0.0001. The high gastrin concentrations most probably reflect enhanced hormonal release from the gastrin-producing cells in response to increasing volumes of milk ingested by the infant. The mean plasma somatostatin concentration on the first day after birth was 18 ± 6 pmol/l. No significant change occurred during the first five postnatal days, independent of feeding type.     

Feeding practices of infants through the first year of life in Italy

AIM: To investigate infant feeding practices through the first year of life in Italy, and to identify factors associated with the duration of breastfeeding and early introduction of solid foods. METHODS: Structured phone interviews on feeding practices were conducted with 2450 Italian-speaking mothers randomly selected among women who delivered a healthy-term singleton infant in November 1999 in Italy. Interviews were performed 30 d after delivery and when the infants were aged 3, 6, 9 and 12 mo. Type of breastfeeding was classified according to the WHO criteria. RESULTS: Breastfeeding started in 91.1% of infants. At the age of 6 and 12 mo, respectively, 46.8% and 11.8% of the infants was still breastfed, 68.4% and 27.7% received formula, and 18.3% and 65.2% were given cow's milk. Solids were introduced at the mean age of 4.3 mo (range 1.6-6.5 mo). Introduction of solids occurred before age 3 and 4 mo in 5.6% and 34.2% of infants, respectively. The first solids introduced were fruit (73.1%) and cereals (63.9%). The main factors (negatively) associated with the duration of breastfeeding were pacifier use (p < 0.0001), early introduction of formula (p < 0.0001), lower mother's age (p < 0.01) and early introduction of solids (p = 0.05). Factors (negatively) associated with the introduction of solids foods before the age of 3 mo were mother not having breastfed (p < 0.01), early introduction of formula (p < 0.01), lower infant bodyweight at the age of 1 mo (p = 0.05) and mother smoking (p = 0.05). CONCLUSION: The duration of breastfeeding in Italy is still inadequate, as well as compliance with international recommendations for timing of introduction of complementary foods. National guidelines, public messages and educational campaigns should be promoted in Italy.     

Effect of age and serum creatinine on endogenous digoxin-like substances in infants and children

An apparent digoxin-like immunoreactive substance(s) (DLIS) was evaluated in 374 pediatric patients, 0 to 72 months of age, not receiving digoxin. The relationship between DLIS presence or concentration and age, weight, gender, race, and serum creatinine was investigated. Twenty-seven percent of patients had a positive apparent DLIS concentration (greater than or equal to 0.2 ng/ml). The mean +/- SD concentration of DLIS in the positive group was 0.39 +/- 0.18 ng/ml (range 0.2 to 1.37 ng/ml). Patients in the DLIS-positive group were younger than those in the negative group (P less than 0.01). Although a greater percentage of infants younger than 6 months of age had measurable DLIS, the mean DLIS concentrations, when present, were not significantly different for all age groups (P greater than 0.05). No significant relationship was found between race or gender and DLIS. A weakly positive correlation between serum creatinine concentration and DLIS was noted (r = 0.22, P less than 0.03), but elevated serum creatinine measurements (greater than 0.6 mg/dL) did not correlate with DLIS concentration. These results support the hypothesis that the presence of DLIS is age related, but DLIS appears to be present in a much larger and older population of pediatric patients than previously reported.     

Preliminary study on DNA damage in non breast-fed infants

BACKGROUND: There are many advantages of human milk for infants, including protection against cancer development and the advantages have been emphasized in several studies. In this study, infants fed by human milk has been compared with those fed by cow's milk concerning DNA damage. METHODS: The level of genetic damage in the peripheral blood lymphocytes of infants who were fed mainly by cow's milk and breast milk has been studied by sister chromatid exchange (SCE) analysis, which is a sensitive measurement of chromosomal damage. Each group consisted of 30 infants, whose ages ranged from 9 to 12 months. RESULTS: A significant increase (P < 0.0001) was found in the frequencies of SCE of infants not breast-fed (n = 30, mean SCE/cell +/- SD: 8.66 +/- 1.15) compared to those who were breast-fed (n = 30, mean SCE/cell +/- SD: 4.93 +/- 0.82). CONCLUSION: To our knowledge, there has been no published study investigating SCE ratio regarding DNA damage in infants not breast-fed. Molecular mechanism of DNA damage caused by the absence of human milk protection is a subject of future investigations.     

不同开奶配方应用于极低出生体重儿的临床研究

目的 研究不同奶方用于极低出生体重早产儿开奶对生长发育和喂养耐受性的影响。方法 根据开奶奶方,86例胎龄 < 34周、出生体重 < 1 500 g的早产儿分为标准早产儿配方奶喂养组（SPF组,n=31）、深度水解蛋白奶喂养组（eHF组,n=27）和母乳喂养组（对照组,n=28）,比较各组早产儿生长指标、喂养情况、血生化、住院时间及喂养不耐受、败血症、坏死性小肠结肠炎、宫外生长迟缓（EUGR）的发生率。结果 SPF组、eHF组和对照组三组间院内体重、头围及身长增长速率、住院时间和出院时EUGR发生率的比较差异无统计学意义（P > 0.05）;SPF组和eHF组胎便转黄时间明显短于对照组（P < 0.01）;SPF组的足量喂养时间明显短于eHF组和对照组（P < 0.01）,而后二者无显著差别;SPF组血清前白蛋白水平显著低于eHF组和对照组（P < 0.01）;SPF组和eHF组的出院Hb水平显著高于对照组（P < 0.01）;eHF组出院时血嗜酸性粒细胞百分比水平明显低于SPF组（P < 0.01）;各组喂养不耐受、败血症、坏死性小肠结肠炎的发生率差异无统计学意义（P > 0.05）。结论 eHF和SPF均可用于 < 34周的极低出生体重早产儿开奶,且不增加EUGR发生率。     

采集母乳与母乳库母乳喂养对早产儿生长发育的影响

采集母乳与母乳库母乳可以作为早产儿在无法获得直接母乳喂养时可选择的一种喂养方式.目前文献提示,单纯以采集母乳与母乳库母乳喂养的早产儿生后短期内生长要慢于早产儿配方乳喂养,对早产儿远期生长的影响尚不明确;但采集母乳与母乳库母乳喂养可供给早产儿一定量的人乳特有成分,有利于早产儿神经发育,并减少坏死性小肠结肠炎、喂养不耐受等喂养相关并发症的发生.采集母乳与母乳库母乳的临床广泛应用还面临一些亟待解决的问题,将来的研究应更多关注于对早产儿远期生长发育的影响.     

The effect of feeding human milk and adapted milk formulae on serum lipid and lipoprotein levels in young infants

The effect of feeding with human milk and commercially available milk substitutes was studied in a group of 154 healthy infants during the first 3 months of life by assessment of body weight, body length, head circumference, skinfold thickness, serum lipid and lipoprotein concentrations. Human milk and the different milk formulae have the same energy content (kcal/100 ml) and total fat, total protein and total carbohydrate contents are comparable but they differ in respect of their fatty acid compositions. The various diets were chosen freely by the parents and the newborns were exclusively fed either human milk (n=56), Multival 1 (n=31), Humana 1 (n=33), or Pre Aptamil (n=34). No significant differences in body, weight, body length or head circumference were observed between any of the different dietary groups. Fat storage, as assessed by measurements of skinfold thickness, was significantly less in breast-fed children compared to those on the formula diets. Breast-fed and Pre Aptamil-fed infants had the highest levels of total serum cholesterol, low density lipoprotein (LDL)-cholesterol and LDL. No differences were observed in the levels of total serum triglycerides, very low density lipoprotein (VLDL)- and high density lipoproteins (HDL)-cholesterol, VLDL and HDL. There were no strong correlations between the physical and the biochemical parameters. No indication of an increased risk of developing atherosclerosis was associated with any of the dietary treatments for the duration of this study. However, these investigations support the hypothesis that subtle early nutritional variation can influence mechanisms that regulate lipoprotein and cholesterol levels in later life.Abbreviations VLDL very low density lipoproteins - LDL low density lipoproteins - HDL high density lipoproteins - HMG-CoA reductase 3-hydroxy-3-methylglutaryl coenzyme A reductase     

The effect of prenatal consultation with a neonatologist on human milk feeding in preterm infants

OBJECTIVE: To study the effect of prenatal consultation (PC) with a neonatologist on the incidence and duration of human milk feeding (HMF) in preterm infants. DESIGN/METHODS: A retrospective matched case-control study was preformed at a perinatal centre. Study infants were preterm infants (23-35 wk) whose mothers had received PC emphasizing the importance of HMF. Control infants were matched by birthweight, gestational age and multiplicity. RESULTS: Each group included 29 mothers and 46 preterm infants. Mean gestational age was 30.1 +/- 3 wk in both groups. Mean birthweight was 1329 +/- 489 (PC) and 1334 +/- 441 g (control). PC infants received HMF for significantly longer, both in the hospital and after discharge (hospital: PC 37 +/- 34 d vs control 15 +/- 19 d, p = 0.001; discharge PC 60 +/- 57 d vs control 21 +/- 32 d; p = 0.0001). No significant difference in neonatal morbidity was detected between the groups. CONCLUSIONS: PC is associated with significantly longer HMF in preterm infants, both in hospital and after discharge.     

Dietary prevention of allergic diseases in infants and small children

The role of primary prevention of allergic diseases has been a matter of debate for the last 40 years. In order to shed some light on this issue, a group of experts of the Section of Pediatrics EAACI reviewed critically the existing literature on the subject. An analysis of published peer-reviewed observational and interventional studies was performed following the statements of evidence as defined by WHO. The results of the analysis indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is unequivocally effective in the prevention of allergic diseases in high-risk children. In these patients breastfeeding combined with avoidance of solid food and cow's milk for at least 4-6 months is the most effective preventive regimen. In the absence of breast milk, formulas with documented reduced allergenicity for at least 4-6 months should be used.