Supplementary feeding in the maternity ward shortens the duration of breast feeding

In a prospective study, feeding routines of a maternity unit and the subsequent feeding patterns of 521 newborns were analysed. During the stay in the maternity unit, 69% of newborns were exclusively breast fed and 1% received only donor's milk from the milk bank and/or formula. Nine percent received their mothers' milk by bottle at least once and 21% received one or more supplementary feedings with donor's milk from the milk bank. One-quarter of the children received supplementary feeds on the third day of life, the indications for this being birth weight less than 3.0 kg, maternal diabetes or gestational diabetes, “insufficient amounts” of milk or fussiness. At three months, 65% were being exclusively breast fed and 15% partially breast fed. In a multiple logistic regression analysis, the potential determinants (neonatal feeding, maternal characteristics, characteristics of the delivery and the child) for the duration of breast feeding were included. The adjusted relative risk (estimated as odds ratios, OR) of not being breast fed at three months was associated with maternal age (< 25 years, OR 4.2), maternal smoking (OR 4.0), neonatal feeding (supplements given, OR 3.9) and initial weight loss (10% or more, OR 2.8). Thus the administration of supplementary donor's milk or formula during the early neonatal period was associated with an increased risk of a short duration for breast feeding, even after adjustment for a number of potential confounders.     

SERUM IgA IN THE NEONATE

ABSTRACT. Yap, P. L., Pryde, A., Latham, P. J. and McClelland, D. B. L. (MRC Unit of Reproductive Biology, 2 Forrest Road, Edinburgh; Department of Therapeutics, Edinburgh University, Neonatal Unit, Simpson Memorial Maternity Pavilion and Blood Transfusion Service, Royal Infirmary, Edinburgh). Serum IgA in the neonate: Molecular size, concentration and effect of breast feeding. Acta Paediatr Scand, 68: 695, 1979.—IgA concentrations in the serum of 48 six-day-old neonates (23 exclusively artificially fed, 25 exclusively breast fed) were measured using a double antibody radioimmunoassay. In 24 of the neonates, umbilical cord blood was also studied. Gel filtration was used to estimate the molecular size of IgA present in cord and neonatal serum. The arithmetic mean concentration of IgA (±S.E.M.) found in the 48 neonates was 2.6± 1.45 mg/l. No significant difference was detected between the breast fed and artificially fed neonates. Only 7S IgA was detected in cord blood and in neonatal serum. Six days of exclusive breast feeding therefore has no influence on total serum IgA levels on the sixth day of neonatal life nor does it result in detectable circulating 11S IgA at that time.     

PROSPECTIVE STUDIES OF THE EFFECT OF BREAST FEEDING ON INCIDENCE OF INFECTION AND ALLERGY

ABSTRACT. Chandra, R. K. (Department of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland, Canada). Prospective studies of the effect of breast feeding on incidence of infection and allergy. Acta Paediatr Scand 68: 691, 1979.—The effect of exclusive breast feeding in the first few weeks after birth on infant morbidity due to infectious and allergic disorders was investigated in three separate prospective studies. In a rural community in India, breast-fed infants had a significantly lower incidence of respiratory infection, otitis, diarrhoea, dehydration and pneumonia. In an urban population in Canada, breast feeding was associated with a marked decrease in the occurrence of otitis and respiratory disease and to a lesser extent of diarrhoea and dehydration. In newborn siblings of children with atopic disease exclusively breast-fed for a minimum of six weeks, the incidence of eczema, recurrent wheezing, elevated serum IgE, IgE-antibodies to cow's milk, complement activation in vivo after milk challenge and hemagglutinating antibodies to β-lactoglobulin was significantly lower compared with formula-fed matched group. These observations provide clinical data attesting the immunologic advantages of human milk.     

INCREASING INCIDENCE OF NEONATAL SEPTICEMIA: CAUSATIVE ORGANISM AND PREDISPOSING RISK FACTORS

ABSTRACT. Bennet, R., Eriksson, M. and Zetterstrom, R. (Department of Paediatrics, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). Increasing incidence of neonatal septicemia: Causative organism and predisposing risk factors. Acta Paediatr Scand, 70:207, 1981. –The incidence of neonatal septicemia in the referral area of St. Göran's Children's Hospital in Stockholm has been studied during a ten-year period (1969–1978). An increase was noticed during the period 1974–1978 in comparison with the preceding five-year period. The incidence per 1000 live births was 1.4 and 3.1, respectively. The incidence of osteoarthritis increased from 0.21 to 0.41 per 1000. Mortality rate from neonatal septicemia remained unchanged. Gram-negative organisms as an etiologic factor seemed to be decreasing while staphylococcal infections have increased. Group B streptococcal infection occurred with the same frequency during the whole period. The low incidence of enteric organisms might be related to the common practice of feeding the babies with milk from their own mothers. Perinatal risk factors were equally common in both five-year periods. The observed increase of the prevalence of neonatal septicemia caused by Staphylococcus aureus may be explained by a higher rate of survival of highly susceptible low-birthweight infants and other sick neonates treated in the neonatal intensive care unit.     

BREAST FEEDING TRENDS AND RECENT INFORMATION ACTIVITIES IN SWEDEN

Abstract. Hofvander, Y. and Sjölin, S. (Department of Paediatrics, University Hospital, Uppsala, Sweden). Breast feeding trends and recent information activities in Sweden. The breast feeding rate has been declining steadily in Sweden since the 1930's up to the early 1970's. It is suggested that this was linked to the changing role of women, the development towards the nuclear family, the changing way of living, the influence of strict routines at the maternities and many other factors. A Committee was appointed in 1973 by the National Board of Health and Welfare, which initiated a number of breast feeding promoting activities: the editing of a Manual for health personnel, and booklets for mothers, the systematic arranging of workshops for key personnel in each county, stimulation to more flexible and breast feeding favouring maternity routines, backing of working groups of La Leche League-type, etc. Coinciding with these activities and probably a result of changed breast feeding attitudes among mothers, the breast feeding rate has increased considerably—at 2 months from an all time low of 31 % in 1972 to 62% in 1976/77, and at 6 months from 6% to 20%.     

Breastfeeding progression in late preterm infants from birth to one month

This study aimed to describe and compare breastfeeding progression, infants' feeding behaviours, maternal feeding difficulties, and mothers' usage of breastfeeding interventions for singleton late preterm (LPT) and term infants. A further aim was to identify associated factors for exclusive breastfeeding at breast at 1 month in LPT infants. This was a cohort study where mothers of LPT infants from a neonatal unit (n = 60), LPT infants from a maternity unit (n = 62), and term infants from a maternity unit (n = 269) answered a questionnaire approximately 1 month after delivery. Findings showed no significant differences in exclusive breastfeeding at breasts between LPT infants admitted to the neonatal unit compared with the maternity unit, during the first week at home (38% vs. 48%), or at 1 month of age (52% vs. 50%). Term infants were more likely to be exclusively breastfed at the breast (86% and 74%, p < 0.05) compared with LPT infants. Multiple regression analysis showed that usage of a nipple shield, not feeding breast milk exclusively during the first week at home, or feeding less than 10 times per day at 1 month were statistically significant for not exclusively breastfeed at the breast. A protective factor was the mothers' experience of having an abundance of milk during the first week at home. In conclusion, LPT infants are less likely to be exclusively breastfed at the breast than term infants, highlighting the need for further research to guide interventions aimed at optimising exclusive breastfeeding rates.     

Neonatal hypoglycaemia in Nepal 2. Availability of alternative fuels

AIMS: To study early neonatal metabolic adaptation in a hospital population of neonates in Nepal. METHODS: A cross sectional study was made of 578 neonates, 0 to 48 hours after birth, in the main maternity hospital in Kathmandu. The following clinical and nutritional variables were assessed: concentrations and age profiles of blood glucose, hydroxybutyrate, lactate, pyruvate, free fatty acids (FFA) and glycerol; associations between alternative fuel levels and hypoglycaemia; and regression of possible risk factors for ketone availability. RESULTS: Risk factors for impaired metabolic adaptation were common, especially low birthweight (32%), feeding delays, and cold stress. Blood glucose and ketones rose with age, but important age effects were also found for risk factors like hypothermia, thyroid hormone activities, and feeding practices. Alternative fuel concentrations, except FFA, were significantly reduced in infants with moderate hypoglycaemia during the first 48 hours after birth. Unlike earlier studies, small for gestational age (SGA) infants had significantly higher hydroxybutyrate:glucose ratios which suggested counter regulatory ketogenesis. Hypoglycaemic infants were not hyperinsulinaemic. Regression analysis showed risk factors for impaired counter regulation which included male and large infants, hypothermia, and poorer infant thyroid function. SGA infants and those whose mothers had received no antenatal care had increased counter regulation. CONCLUSIONS: Alternative fuels are important in the metabolic assessment of neonates, and they might provide effective cerebral metabolism even during moderate hypoglycaemia. Hypoglycaemic infants generally had lower concentrations of alternative fuels through either reduced availability or increased consumption. SGA and post term infants increased counter regulatory ketogenesis with early neonatal hypoglycaemia, but hypothermia, male gender, and low infant T4 were associated with impaired counter regulation after birth.     

METABOLIC AND ENDOCRINE RESPONSES TO A MILK FEED IN SIX-DAY-OLD TERM INFANTS: DIFFERENCES BETWEEN BREAST AND COW'S MILK FORMULA FEEDING

ABSTRACT. Lucas, A., Boyes, S., Aynsley-Green, A. (Department of Paediatrics, John Radcliffe Hospital, Oxford) and Bloom, S. R. (Hammersmith Hospital, London, England). Metabolic and endocrine responses to a milk feed in six-day-old term infants: JMfferences between breast and cow's milk formula feeding. Acta Paediatr Scand, 70:195, 1981. – There is little information on the metabolic and endocrine responses to milk feeding in the neonatal period particularly in relation to the mode of nutrition and composition of the milk. Plasma concentrations of insulin, glucagon and gastric inhibitory polypeptide (GIP) together with blood levels of glucose, ketone bodies, pyruvate, lactate and glycerol were measured pre- and post-prandially in 79 healthy six-day-old term infants who had been either breast fed or fed on a modified cow's milk formula (Cow and Gate Premium) from birth. Formula fed infants had a greater insulin and GIP response to feeding and their basal and postprandial blood ketones were considerably lower than in breast fed infants. In addition a significantly greater post feed rise in both lactate and pyruvate concentrations was observed with formula feeding. These results may have significant implications regarding infant feeding and postnatal metabolism.     

早期微量喂养对新生儿肺透明膜病临床康复的影响

目的 观察早期微量喂养在新生儿肺透明膜病(HMD)治疗中的效果.方法 收集2009年1月-2010年12月在本院NICU住院的HMD新生儿的临床喂养情况,分别统计实行早期微量喂养(早期微量喂养组)和常规喂养(常规喂养组)新生儿的一般资料,观察2组患儿达全量胃肠道营养时间、恢复出生体质量时间、胃肠功能紊乱发生率、血胆红素峰值、并发胆汁淤积比例等.采用t检验和x2检验进行统计学分析.结果 常规喂养组56例,早期微量喂养组48例,2组一般资料比较均无统计学差异.在达全量胃肠道营养时间、恢复出生体质量时间、血胆红素峰值、并发胆汁淤积等方面早期微量喂养组明显优于常规喂养组,差异均有统计学意义;2组患儿在住院天数及胃肠功能紊乱、吸人性肺炎、坏死性小肠结肠炎发生率方面差异均无统计学意义.结论 新生儿HMD实行早期微量喂养有利于患儿更早地过渡到全量胃肠道喂养,更好地恢复、增长体质量,减少胃肠外营养相关胆汁淤积的发生,无明显不良反应.     

THE INFLUENCE OF PERINATAL FACTORS ON BREAST FEEDING

ABSTRACT. The effect on breast feeding of various factors connected with delivery and the immediate post partum period were investigated in a group of 1701 parturients. Children born by caesarean section or assisted delivery, those of low birth weight or asphyxiated at birth started breast feeding significantly less often than healthy children delivered normally. The length of breast feeding was not affected by these factors once it was started, 49% breast feeding for six months or more. Exceptionally young and old mothers breast fed less well than mothers in general. Mothers whose husbands attended the delivery breast fed more often and longer than others. Failure to start breast feeding occurred in only 2.4% of the material. In this material with high breast feeding rates it can be concluded that obstetric and perinatal abnormalities have a small but nevertheless significant effect on the incidence of breast feeding.     

CLINICAL ASPECTS OF NEONATAL HYPOGLYCAEMIA

ABSTRACT. Fluge, G. (Department of Paediatrics, University of Bergen, Bergen, Norway). Clinical aspects of neonatal hypoglycaemia. Acta Paediatr Scand, 63: 826, 194.—Fifty cases of neonatal hypoglycaemia were detected by routine blood glucose determination in 323 low birth weight infants during a three-year period (15.4%) and, in addition, hypoglycaemia was diagnosed in 17 full-term infants. The patients were divided in three groups according to clinical findings, with special reference to age at diagnosis, pretreatment blood glucose values and duration of hypoglycaemia. In asymptomatic hypoglycaemia the diagnosis was made during the first few hours after birth, and the mean pretreatment blood glucose value was 14 mg/100 ml. Except for one patient, the hypoglycaemia was of short duration. Symptomatic, transient hypoglycaemia was characterized by a delay in onset of symptoms until the second and third day after birth, low pretreatment blood glucose level and hypoglycaemia of long duration. Hypoglycaemia associated with other neonatal disorders classified as secondary hypoglycaemia usually was noted during the first few hours of life, and tended to he of short duration. Frequency of hypoglycaemia in small for gestational age infants was markedly higher when toxaemia of pregnancy was noted, compared with infants born to non-toxaemic mothers.     

II. FACTORS AFFECTING THE CONTINUANCE OF BREAST FEEDING

Bloom K., Goldbloom, R. B., Robinson, S. C. and Stevens, F. E. (Departments of Psychology, Pediatrics and Obstetrics, Grace Maternity Hospital, Halifax, Nova Scotia, Canada). Breast vs. formula feeding. II. Acta Paed Scand, Suppl. 300:9, 1982.—Study 1. A prospective, longitudinal study of 249 breast feeding mothers revealed that continuance of breast feeding was positively associated with breast feeding preparation (prenatal breast feeding class p =0.04, preparation of breast p =0.02) paternal preference ( p =0.02), early contact (immediate post-delivery contact, early initiation of breast feeding and daily rooming-in while in hospital, p =0.002), maternal education ( p =0.001). and paternal occupational status ( p =0.005). Duration of breast feeding was longer for multiparas ( p =0.009). Mothers who stopped breast feeding in the first 6 weeks breast fed for only 18.2 days. Early termination was related ( p =0.01) to reported infant behaviours (crying, waking) which were assumed to indicate hunger. Study 2. An experimental study was conducted to evaluate the effect of social support on increasing the duration of breast feeding. Three groups ( N =50 each, primiparas) were randomly selected: Formula, Breast Control, Breast Experimental. During weeks 1-4, Breast Experimental mothers were telephoned weekly by a nurse to provide informed support for breast feeding and related infant care. Social support for these primiparous mothers increased their duration of breast feeding ( p =0.05).     

THE METABOLIC CONSEQUENCES OF HUMAN MILK AND FORMULA FEEDING IN PREMATURE INFANTS

Abstract. Schultz, K., Soltész, G. and Mestyán, J. (Department of Paediatrics, University Medical School, Pécs, Hungary). The metabolic consequences of human milk and formula feeding in premature infants. Acta Paediatr Scand, 69: 647, 1980.—Twenty premature low-birthweight infants were divided into two groups and assigned randomly to either a pooled human milk or to a cow's milk based infant formula feeding regimen. The protein intake was 2.0 g/kg/day in the human milk fed group and 4.4 g/kg/day in the formula fed group of infants. The concentrations of different metabolites were estimated at weekly intervals, and plasma amino acid analysis was performed biweekly on blood samples in the two groups of infants during the four-week study period. Formula milk fed infants had significantly lower fasting blood glucose levels and developed azotaemia, hyperaminoacidemia and metabolic acidosis in the early weeks of postnatal life. Blood lactate and plasma free fatty acid concentrations did not change significantly in the two groups during the study. No significant differences were found in the rate of weight gain between the two groups of infants, although formula fed infants regained their birthweight more slowly than human milk fed infants. High protein formula feeding causes potentially unfavorable metabolic and amino acid imbalances in preterm infants in the early postnatal life.     

晚发型母乳性黄疸患儿停母乳前后表皮生长因子的变化研究

目的 观察晚发型母乳性黄疸患儿停母乳前后患儿血清及母乳中表皮生长因子（epidermal growth factor,EGF）的变化。方法 选取30例足月晚发型母乳性黄疸患儿为研究对象,收集停母乳72 h前后两次的患儿血清及母乳,分别检测患儿血清中的总胆红素值、EGF浓度及母乳中的EGF浓度。结果 停母乳72 h后患儿血清总胆红素值及EGF浓度较停母乳前显著下降（均P<0.05）;而母乳中EGF浓度在停母乳前后差异无统计学意义（P >0.05）。结论 晚发型母乳性黄疸患儿停母乳前后母乳中EGF浓度无明显变化,而患儿血清中EGF浓度显著下降,其在晚发型母乳性黄疸中的作用及机制有待进一步研究。     

Factors associated with the choice of breast or bottle-feeding for hospitalized newborns]

This study was carried out in Rennes's maternity hospitals (France), to determine the breastfeeding rate for newborns hospitalized after birth, as well as the factors associated with the choice to breastfeed or not in these conditions. METHODS: Three hundred and twenty mothers delivered in Rennes Teaching Hospital, whose neonates were transferred in neonatal care unit, were questioned about their choice for neonate feeding. RESULTS: Three hundred and eight of the 320 mothers concerned by the study answered our interview. Fifty one percent of them chose to breast feed, which is near the breastfeeding rate of the general population of Rennes' maternity hospitals (52%). A high sociocultural level, a mother previously breastfed herself, and a previous breast feeding (RR = 5.2; P < 10(-8)) were associated with the choice of breastfeeding. Factors concerning the information of the mothers were also associated with the choice of breastfeeding information during the preparation to birth sessions (RR = 1.7; P < 10(-5)), individual information on the breastfeeding of an ill newborn (RR = 1.5; P < 0.01), and the simple advice to breastfeed given by a health care professional (RR = 2; P < 10(-8)). Of the four qualities named, the more breast-milk qualities a mother knew, the higher breastfeeding rate was (10% for none, 27% for one, 54% for two, and 76% for three or four). Concerning the postnatal factors, gestational age below 31 weeks multiplied breast feeding by 1.5 (P < 0.05), and an early contact mother-child (first day) by 1.3 (P < 0.05). CONCLUSION: This study pointed out the populations at risk of no breastfeeding. Informations on the properties of breastfeeding given to mothers by health care professionals may influence them in their choice of breast feeding or not their ill newborn.     

Hypoglycaemia and the neonatal brain

There has been much controversy and confusion regarding potential damage caused to the neonatal brain by low blood glucose levels. Previous studies of outcome after neonatal hypoglycaemia are flawed by many factors including retrospective data collection and inability to control for co-existing clinical complications. There is no doubt that hypoglycaemic brain damage does occur but the severity and duration of low blood glucose levels required to cause lasting harm varies between subjects and is related to the ability of each baby to mount a protective response such as the production of ketone bodies which are alternative cerebral fuels. Evidence from studies of humans and other animals suggests that cortical damage and long-term sequelae occur after prolonged hypoglycaemia sufficiently severe to cause neurological signs. Conclusion Prolonged hypoglycaemia should be avoided by close clinical observation of vulnerable infants whilst avoiding excessively invasive management in populations of neonates which may jeopardise the successful establishment of breast feeding.     

Establishing breast feeding in hospital.

The experience and practice of the author is described in her appointment as a breast feeding advisor to the paediatric and obstetric units at University College Hospital with special responsibility for supervising infant feeding, especially breast feeding in the maternity unit. During 1980-5 there were 13,185 mothers whose babies fed. The feeding method of 12,842 mothers was recorded on discharge from the postnatal wards and 77% were breast feeding; only 3% of these mothers gave complement feeds of infant formula. The practices in the maternity wards to enable mothers to establish successful breast feeding and the methods of dealing with common problems of breast feeding are described.     

Our experience in "ad libitum" feeding after pyloromyotomy (review of 97 cases).]

A recent alternative feeding regimen at the progressive feeding (PF) after a pyloromyotomy for hypertrophic pyloric stenosis (HPS) is the so-called ad libitum feeding (AL). The aim of this study was to determine if this new feeding regimen has modified the follow-up of postoperative course in HPS. POPULATION AND METHODS: From January 1998 to December 2003, 97 consecutive neonates have been operated on for HPS in our hospital. This retrospective study was based on the comparison between two groups of patients with different postoperative feeding regimens: group one of 30 neonates with PF regimen and group two of 60 neonates with AL regimen. Seven remaining neonates had had a mucosal perforation and were not included in this comparative study but in a separate group (MP). The clinical, ultrasonographic, operative and postoperative data were compared. RESULTS: There was no difference between the PF and AL groups for sex ratio M/F=4/1, preoperative weight loss ratio, ultrasonographic data and intra-operative difficulties rate. A small difference was found - which was not significative - between the PF and the AL groups for median age at diagnosis (44,6 v 36,7 days, respectively). A statistically significative difference between the PF and the AL groups was observed for time to establish feeding (69 vs 35.6 hours, respectively) (P<0,001), postoperative stay (4.16 vs 2.98 days, respectively) (P<0,001) and total hospital charges. We didn't found any difference in the incidence and severity of postoperative emesis whether slow (PF) or rapid (AL) feeding regimens were used. Furthermore, intra-operative mucosal tear didn't influence postoperative course and the duration of hospital stay. CONCLUSION: We recommend AL regimen for routine feeding in simple cases after pyloromyotomy for HPS. It has a positive impact on length of hospital stay, and decreases hospital charges. Most neonates with MP can be managed with a rapid feeding regimen.     

GROWTH HORMONE RESPONSE TO FEEDING IN TERM AND PRETERM NEONATES

ABSTRACT. Plasma growth hormone concentrations were measured in 248 healthy term and preterm infants. At birth growth hormone concentrations in cord blood from both term and preterm babies were approximately 100-fold higher than those in blood drawn from healthy adults. By the sixth postnatal day basal pre-feed levels had fallen in term neonates by 65% and a marked postprandial rise was apparent; preterm infants did not show this initial fall in preprandial hormone levels nor was any response to feeding seen. However a fall in preprandial concentrations accompanied by the development of postprandial surges in growth hormone occurred during the next 2 weeks so that by 24 days the postprandial rise was similar to that of term neonates on the sixth day. We conclude that although the initial postnatal changes in plasma growth hormone concentrations are different in preterm and term infants, feeding is a major stimulus to growth hormone secretion in both groups of neonates. Further work is needed to define the precise role of this hormone in neonatal metabolic adaptation.     

Bilirubin levels predict renal cortical changes in jaundiced neonates with urinary tract infection

Background  This study was undertaken to determine the incidence of urinary tract infection (UTI) and the frequency of anatomical abnormalities in newborns with unexplained jaundice and to find out if there is any correlation between bilirubin level and renal damage. Methods  We studied 462 full-term neonates for UTI. They were aged 3–25 days, with either high (>10 mg/dL) or prolonged (>10 days) hyperbilirubinemia, with or without manifestations such as fever, vomiting, diarrhea, poor feeding, lethargy, and irritability. Neonates positive for UTI were further investigated with ultrasound, cystourethrography, and acute phase renal scintigraphy with technetium-99m dimercaptosuccinate acid (DMSA). Results  Thirty neonates (6.5%) were found to have UTI. Twenty-eight of them had indirect hyperbilirubinemia and two had direct hyperbilirubinemia, with total bilirubin levels of 11.8–20.1 mg/dL. None of the neonates was found to have jaundice because of other reasons such as infection. Vesicoureteral reflux was found in 5 neonates and one of them was combined with hydronephrosis. Renal scintigraphy with technetium-99m DMSA showed renal cortex changes in 14 (46.7%) of the 30 neonates with UTI. These 14 neonates also had increased levels of bilirubin in comparison to those with normal findings of DMSA. Conclusions  The incidence of UTI in uncomplicated neonatal jaundice is relatively high. Anatomical abnormalities of the urinary tract are not rare in infected children. Increased bilirubin levels are related to pathological findings in renal scintigraphy.