Granulocyte colony-stimulating factor in the cord blood of premature neonates born to mothers with pregnancy-induced hypertension.

OBJECTIVES: To estimate the cord blood levels of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in preterm infants and to study the relationship of these levels to pregnancy-induced hypertension (PIH) and absolute neutrophil counts. STUDY DESIGN: G-CSF and GM-CSF levels in the cord blood of preterm neonates (n = 74) either with or without maternal PIH were estimated by enzyme-linked immunosorbent assay. RESULTS: Infants in the PIH group had lower white blood cell, absolute neutrophil, absolute lymphocyte, and monocyte counts. The levels of G-CSF in cord blood were significantly lower in infants whose mothers had PIH (P =.04) and in infants with neutropenia (P =. 01). G-CSF levels were positively correlated with both absolute neutrophil count (P =.02) and total white blood cell count (P =.01). GM-CSF was undetectable in all subjects. According to logistic regression with neutropenia as the dependent variable, only maternal PIH (P <.001), gestational age (P <.001), and G-CSF (P =.01) were independently related. CONCLUSION: In this study maternal PIH and low gestational age were significantly associated with neutropenia in premature infants. Low G-CSF levels may contribute to the neutropenia that is commonly seen in infants born to mothers with PIH.     

Low Colostral IgA Associated with Cow's Milk Allergy

ABSTRACT. During a nutritional study of 198 infants, seven became allergic to cow's milk. The seven infants showed acute cutaneous manifestations during cow's milk challenge tests in hospital and six had increased levels of IgE cow's milk-specific antibodies. Neither in the development of the levels of immunoglobulins G, A and M, nor in that of the cow's milk-specific antibodies of these isotypes did these seven patients differ from the remaining infants. Beta-lactoglobulin content and levels of cow's milk-, and beta-lactoglobulin-specific antibodies and of immunoglobulins A, G and M were measured in samples of colostrum and milk from the mothers of the seven infants with cow's milk allergy and from a comparison group (non-atopic mothers of non-atopic infants). The milk of the mothers whose infants became allergic to cow's milk contained less IgA through the lactation: 95% confidence intervals of the groups did not overlap. The difference was most marked in the colostrum. All other measurements were similar in the two groups. This suggests that an infant is more likely to develop cow's milk allergy if the mother's colostrum had a low total IgA content.     

Protection of breast-fed infants against Campylobacter diarrhea by antibodies in human milk

To investigate the role of breast-feeding in preventing diarrhea caused by Campylobacter jejuni, we followed 98 Mexican children prospectively for 2 years beginning at their birth. Attack rates of diarrhea in children less than 6 months of age who were not fed human milk were 2.3 times greater than those in children of the same age who were fed human milk. Breast-fed children remained free of diarrhea for a longer time than non-breast-fed children (p less than 0.0005). The diarrhea attack rate caused by C. jejuni for non-breast-fed infants was significantly greater (p less than 0.005) than that in the breast-fed group. Secretory IgA milk antibody titers against glycine acid-extractable antigen of C. jejuni were high in colostrum, decreased during the first month of breast-feeding, and generally persisted throughout lactation. Human milk consumed by children in whom Campylobacter diarrhea developed did not contain secretory IgA antibodies to the glycine acid-extractable common antigen of Campylobacter. This study shows an association between Campylobacter antibodies in human milk and prevention of diarrhea caused by Campylobacter.     

Low colostral IgA associated with cow's milk allergy.

During a nutritional study of 198 infants, seven became allergic to cow's milk. The seven infants showed acute cutaneous manifestations during cow's milk challenge tests in hospital and six had increased levels of IgE cow's milk-specific antibodies. Neither in the development of the levels of immunoglobulins G, A and M, nor in that of the cow's milk-specific antibodies of these isotypes did these seven patients differ from the remaining infants. Beta-lactoglobulin content and levels of cow's milk-, and beta-lactoglobulin-specific antibodies and of immunoglobulins A, G and M were measured in samples of colostrum and milk from the mothers of the seven infants with cow's milk allergy and from a comparison group (non-atopic mothers of non-atopic infants). The milk of the mothers whose infants became allergic to cow's milk contained less IgA through the lactation: 95% confidence intervals of the groups did not overlap. The difference was most marked in the colostrum. All other measurements were similar in the two groups. This suggests that an infant is more likely to develop cow's milk allergy if the mother's colostrum had a low total IgA content.     

Short-term effects of early suckling and touch of the nipple on maternal behaviour

The objective was to evaluate the effects of suckling within 30 min after birth when skin-to-skin body contact for mothers and infants was held constant in both cases (n = 32) and control groups (n = 25). Mother-infant interaction during breast-feeding, infants' time spent in nursery and different aspects of breast-feeding were evaluated. Prolactin and gastrin were measured in maternal serum before and after breast-feeding on day 4 post partum. The aim to evaluate effects of early post delivery suckling failed since only six of the 32 case infants did suck at this time. In spite of this, we found three significant differences among cases and controls. In the case group where all infants had touched or licked the areola and nipple, the mothers left the infants in the nursery for a significantly shorter time and significantly more mothers talked to their infants during the short breast-feeding observation. Median gastrin levels were significantly lower in cases than in controls both before (P less than 0.01) and after (P less than 0.03) breast-feeding. In conclusion, the infant's early touch of the mother's areola and nipple seemed to have positively influenced the mother/infant relationship during the first four days after birth. It was also associated with lower maternal gastrin levels which suggests that maternal neuroendocrine functions were also influenced. Ten months after birth, we found no differences between cases and controls.     

Growth in the first 5 years of life is unaffected in children with perinatally-acquired hepatitis C infection

OBJECTIVES: To identify the effect of vertical hepatitis C virus (HCV) infection or exposure on growth in childhood. STUDY DESIGN: Children (n=1203) born to HCV-infected mothers were followed up from birth prospectively in centers of the European Paediatric Hepatitis C virus Network. Z-scores compared height- and weight-for-age in HCV-infected and -uninfected children, adjusting for other factors using linear regression. We also quantified the effect of maternal chronic infection with HCV on childhood growth. RESULTS: There was no significant effect of vertical HCV infection on growth (height P=.223, weight P=.095) nor a significant effect of maternal chronic infection with HCV (height P=.733, weight P=.274). Prematurity and maternal injecting drug use were associated with a significant reduction in height (P < .001) and weight (P < .001) in all HCV-exposed children. CONCLUSIONS: This population of HCV exposed infants has higher rates of maternal injecting drug use and prematurity than standard populations and so there are implications for growth of these children, but this is not a direct result of HCV infection or exposure to chronic maternal HCV infection.     

Ferritin levels in human milk

Ferritin was detected and quantitated in breast milk from 24 mothers of healthy fullterm infants 3 days, 7 days, 6 weeks and 3 months after delivery. Highest concentrations were found at day 3 and demonstrated a marked decline at day 7, with negligible levels at 6 weeks and 3 months. The values in breast milk were compared with mother's serum ferritin concentration at delivery and a significant but weak correlation (r = 0.475, P less than 0.05) was found between the paired values of maternal serum ferritin at delivery and breast milk ferritin at day 3. The possible biological significance of ferritin in breast milk is discussed.     

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.     

Etiology of diarrhea in pediatric outpatient settings

BACKGROUND: The frequency with which bacteria cause diarrhea evaluated in ambulatory settings is often unknown. We attempted to determine the microbiologic etiology of diarrhea in a private pediatric practice (site A) and a clinic serving largely immigrant children (site B) and to establish guidelines for bacterial culture. METHODS: Children with diarrhea were prospectively enrolled, and their stools were examined for diarrheagenic bacteria, viruses and parasites. RESULTS: A total of 123 and 103 children were enrolled at sites A and B, respectively. Stools from all (100%), 126 (55.8%), 104 (46.0%) and 75 (33.2%) were tested for bacterial enteric pathogens, parasites, Clostridium difficile toxin and viruses, respectively. Of the 75 patients whose stool underwent complete testing, 36 (48%) contained at least 1 definitive or plausible pathogen. Twelve stools (5.3%) tested positive for bacteria [Campylobacter jejuni (n = 7), Yersinia enterocolitica, Shigella flexneri, Shigella sonnei, Salmonella serogroup D and Salmonella Braenderup (n = 1 each)]. One contained Blastocystis hominis, 8 contained C. difficile toxin and 16 contained viruses (9 rotavirus, 5 adenovirus and 2 astrovirus). Visible fecal blood (P = 0.029), increased stool frequency (P = 0.035), abdominal tenderness (P = 0.011) and fecal white (P < 0.001) or red blood cells (P = 0.002) were associated with bacterial infection. All children with stool yielding diarrheagenic bacteria or C. difficile toxin had at least 1 of these factors, but so did 75% of children without these agents (positive predictive value, 11%; negative predictive value, 100%; sensitivity, 100%; specificity, 25%). CONCLUSIONS: The bacterial diarrhea prevalence is similar to that in other ambulatory studies, although the spectrum differs. Exclusion criteria for stool testing in diarrhea remain elusive. Studies to determine the etiology of unexplained diarrhea and cost-effective algorithms for diarrhea diagnosis, are needed.     

Necrotizing enterocolitis in neonates fed human milk.

The incidence of necrotizing enterocolitis encountered in neonates fed only refrigerated human milk was comparable to that in infants fed milk and isotonic formula or isotonic formula alone. The infants fed human milk were significantly (P less than 0.05) smaller, less mature, had lower Apgar scores, and were fed later than the formula-fed infants. The mean age of onset and time between first feeding and onset of NEC was similar among the three groups. These data indicate that refrigerated human milk was not effective in lowering the incidence of NEC. Possible explanations for the occurrence of NEC in neonates fed human milk include: (1) the introduction of a pathogen via contaminated milk; (2) inadequate maternal antigenic stimulation by the neonatal gastrointestinal flora; and (3) adverse affects of storage on cell number and function.     

Hiv-specific secretory IgA in breast milk of HIV-positive mothers is not associated with protection against HIV transmission among breast-fed infants

OBJECTIVES: To test whether secretory immunoglobulin A (sIgA) to human immunodeficiency virus (HIV) antigens in breast milk of HIV-positive women is associated with protection against HIV transmission among breast-fed infants. STUDY DESIGN: Nested, case-control design in which HIV-specific sIgA was measured in breast milk collected from 90 HIV-positive women enrolled in a study in Lusaka, Zambia. Milk samples were selected to include 26 HIV-positive mothers with infected infants (transmitters) and 64 mothers with uninfected infants (nontransmitters). RESULTS: HIV-specific sIgA was detected more often in breast milk of transmitting mothers (76.9%) than in breast milk of nontransmitting mothers (46.9%, P = .009). There were no significant associations between HIV-specific sIgA in breast milk and other maternal factors, including HIV RNA quantities in breast milk, CD4 count, and plasma RNA quantities. CONCLUSIONS: HIV-specific sIgA in breast milk does not appear to be a protective factor against HIV transmission among breast-fed infants.     

Impact of fluconazole prophylaxis on incidence and outcome of invasive candidiasis in a neonatal intensive care unit

OBJECTIVES: We assessed the impact of intravenous fluconazole prophylaxis (FP) in extremely low birth weight (ELBW [<1000 g]) infants on the incidence of and outcome from invasive candidiasis (IC) in all infants admitted to a neonatal intensive care unit (NICU). STUDY DESIGN: Beginning April 1, 2002, FP was given to ELBW infants aged < 5 days admitted to the NICU of Woman's Hospital of Texas. Infants in NICU in whom IC developed during the first 2 years of FP (FP period) were compared with those with IC during 2000-2001. RESULTS: During 2000-2001 and the FP period, the incidence of IC in ELBW infants decreased from 7% (15 of 206) to 2% (5 of 240) (P=.01), and the IC-related mortality rate decreased from 12% (4 of 33) to 0 (0 of 40) (P=.04); the incidence of IC increased from 0.1% (4 of 2806) to 0.2% (8 of 3372) in infants of birth weight > or = 1000 g (P=.06), and no IC-related deaths occurred. During the FP period, IC developed in older infants (24 vs 12 days; P=.12) who had similar risk factors for IC. CONCLUSION: Invasive candidiasis occurred in our NICU in spite of FP and shifted to bigger, more mature infants who had a better outcome.     

纯母乳喂养婴儿腹泻影响因素分析

目的通过分析纯母乳喂养婴儿腹泻影响因素,为重新定义“生理性腹泻”、预防腹泻、治疗腹泻、提高婴儿生活质量,降低远期过敏性及其他疾病的发生,提供理论依据。方法本组334例,均为2004年8月至2006年6月,在北京大学第三医院儿科门诊就诊的纯母乳喂养儿,其中男207名、女127名,平均年龄（3．0±0．4）个月。所有研究对象均通过问卷调查获悉父母的年龄、身高、文化程度、吸烟（支／d）、饮酒（g／月）情况、父亲的体重、母亲妊娠前体重、妊娠反应持续时间及程度、孕期有无感染及妊高征、母亲既往有无流产史、低体重儿生育史及慢性疾病史、新生儿的胎次、产次、分娩时孕周,家族过敏性疾病病史、消化道疾病家族史。母亲的饮食情况（哺乳期）。并观察患儿年龄、身高、体重、头围、胸围、有无皮疹、湿疹、纳食情况、呕吐、腹胀、哭闹、母乳的前列腺素E2、脂肪含量、乳糖含量、母、子血清的过敏原、点刺试验等。应用SPSS10．0软件进行Logistic回归分析。结果母乳喂养儿出现腹泻的相关影响因素有：母亲吸烟（OR=2．3）、母亲过敏史（OR=2．7）、家族过敏性疾病病史（OR=2．8）、母亲摄食海鲜（OR=1．8）、鸡蛋（OR=2．3）、花生（OR=2．0）,湿疹（OR=2．9）、哭闹（OR=2．7）、母乳前列腺素E：水平（OR=2．4）、脂肪含量（OR=3．0）、母子血清过敏原阳性（OR=4．0）、子点刺试验阳性（OR=2．7,P均〈0．05）等。结论通过研究发现,母亲或家族过敏史,母亲饮食结构、母乳前列腺素水平和脂肪水平增加等显示与母乳喂养儿腹泻有关。母乳喂养儿腹泻不单纯是一个生理过程,有环境因素和遗传学背景。其发病机制及预后值得进一步探讨。     

Macromineral balances in premature infants fed their own mothers' milk or formula

The premature infant's own mother's milk (preterm milk) and modified infant formula (SMA, 67 and 80 kcal/dl) were fed to paired groups of seven infants, all of whom were of very low birth weight (VLBW) (less than 1.3 kg) and were studied during the first month of life. Sodium, potassium, magnesium, calcium, and phosphorus status was compared. The apparent retention of sodium from their mother's milk paralleled intrauterine retention rates and was greater than retention from SMA formula (P less than 0.01) during the first two weeks of life. However, when the formula was supplemented with NaHCO3 to intakes of 2.7 mmol Na/kg/24 hr after week 2, the infants retained adequate amounts of sodium. Potassium retention was similar to intrauterine retention rates in both groups throughout the four postnatal weeks. Magnesium intake, but not retention, was consistently higher in the group fed SMA (P less than 0.01), and intrauterine retention rates were achieved only in the group given formula. Calcium and phosphorus intakes from SMA were also higher (P less than 0.01) than from human milk. However, retention of calcium and phosphorus in both groups did not meet intrauterine retention rates, and hypophosphatemia developed in infants who received their mothers' milk. Growth in length and head circumference in both groups approximated intrauterine growth rates. If it is assumed that body composition of the growing VLBW infants should be similar to the composition of the fetus at corresponding gestational ages, then their nutrient requirements should be based on knowledge of intrauterine nutrient accretion rates. Based on this premise, we conclude that, for the growing VLBW infant, early maternal milk provided for sufficient retention of sodium, chloride, and potassium during the first four postnatal weeks. Neither human preterm milk nor SMA supplied adequate calcium and phosphorus for the growing VLBW infant.     

Immune status of infants fed soy-based formulas with or without added nucleotides for 1 year: part 1: vaccine responses, and morbidity

BACKGROUND: Immunologic development of soy-fed infants has not been extensively studied. Early studies of soy flour-based formulas showed decreased immunoglobulin production when soy protein intake was limited. However, there were no significant differences in rotavirus vaccine responses between breast-fed and soy protein isolate-based formula-fed infants. Nucleotides added to milk-based formula benefit infant immune status, but reports of the immunologic effects of adding nucleotides to soy-based formula are not available. This study evaluated immune status and morbidity of infants fed soy protein isolate formulas with and without added nucleotides for 1 year. METHODS: Newborn, term infants enrolled in a masked 12-month feeding trial were assigned randomly to groups fed soy formula with or without added nucleotides (n = 94, n = 92). A nonrandomized human milk/formula cohort (n = 81) was concurrently enrolled. Recommended immunizations were administered at 2, 4, and 6 months. Immune status was determined from antibody responses to Haemophilus influenzae type b, tetanus, diphtheria, and poliovirus vaccines at 6, 7, and 12 months. Parents and physicians reported morbidity data. RESULTS: All vaccine responses were within normal ranges. No response differences were observed between infants fed soy formula and those fed nucleotide-supplemented soy. However, antibody to H. influenzae type b at 7 and 12 months was higher in infants fed nucleotide-supplemented soy than in infants fed human milk/formula ( P = 0.007, P = 0.008, respectively). Human milk/formula-fed infants had higher poliovirus neutralizing antibody at 12 months than did soy-fed infants ( P = 0.016). Morbidity analyses showed that only physician-reported diarrhea was different among groups (groups fed human milk/formula had less diarrhea than did soy groups, P = 0.011). CONCLUSIONS: Term infants fed soy protein isolate-based formulas have normal immune development as measured by antibody responses to childhood immunizations.     

Breast milk feeding rates of mothers of multiples compared to mothers of singletons.

OBJECTIVE: Over 3% of infants born annually in the United States are from a multiple gestation pregnancy, yet there is little data published about the feeding practices of their mothers. The objectives of this study were to determine and compare the rates of breast milk feeding of mothers of multiples and mothers of singletons. METHODS: Stratified random sampling (n = 686) on the basis of plurality of pregnancy and gestational age at delivery was performed on a 1999 birth certificate database in the greater Cincinnati area. We collected information about infant feeding during the first 6 months of life using a retrospective, self-administered questionnaire and phone interview from mothers of term singletons (TS), preterm singletons (PS), term multiples (TM), and preterm multiples (PM). Data were analyzed using chi-square and logistic or multiple regression. RESULTS: We obtained feeding information from 346 mothers (n = 81 TS, 80 PS, 90 TM, and 95 PM). By 3 days postpartum, PM provided breast milk less often than all other groups: TS = 69%, PS = 66%, TM = 73%, PM = 57% (P =.035). Among mothers who initiated breast milk feeding, the geometric mean duration of at least some breast milk feeding was significantly shorter for PM than for all other groups: TS = 23 weeks, PS = 19 weeks, TM = 24 weeks, and PM = 12 weeks (P =.002). CONCLUSIONS: Further evaluation of the potential causes for the lower breast milk feeding rates among PM is needed to develop effective intervention strategies and increase the number of preterm multiple gestation infants receiving breast milk.     

The impact of gestational length on human milk selenium concentration and glutathione peroxidase activity

Longitudinal changes in selenium (Se) and protein concentrations and glutathione peroxidase (GSH-Px) activity of milk collected from healthy mothers of term (n = 12), preterm (n = 10), and very preterm (n = 12) infants were assessed. All infants were size appropriate for gestational age. Milk samples representative of colostrum (d 3), transitional (d 7), and mature milk (d 21 and 42) were assayed. The content of Se in the colostrum secreted by mothers of preterm infants was significantly greater than the Se content of milk secreted by the same mothers at d 21 and 42 of lactation. Mothers of term and very preterm infants, however, produced colostrum with significantly higher levels of Se than milk produced at d 7 (p less than 0.05), d 21 (p less than 0.01), or d 42 (p less than 0.001). Significant differences between the protein concentrations measured in early lactation and in late lactation were evident in all maternal groups. Protein content did not differ significantly among groups at anytime during lactation. An age-related difference was detected in milk GSH-Px activities of mature milk (d 21). Mature milk produced by mothers of very preterm infants on d 21 of lactation contained significantly greater enzyme activity (p less than 0.05) than milk produced by mothers of term infants at the same stage of lactation. Activity of GSH-Px in milk from mothers of very preterm and preterm infants paralleled previously noted changes in long-chain polyunsaturated fatty acid content in human milk with the progression of lactation.(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

The effect of Ramadan on maternal nutrition and composition of breast milk

BACKGROUND: There are many advantages of breast milk for infants. Many factors can affect the volume and composition of breast milk. One of them is the maternal diet. The objective of this study is to determine the effect of Ramadan fasting on maternal nutrition and breast milk composition. METHODS: A total of 21 breast-feeding mothers aged between 17 and 38 years who fasted during Ramadan month and volunteered to give milk samples were surveyed. The ages of the infants were between 2 and 5 months. The study was performed during Ramadan and 2 weeks after the end of Ramadan. RESULTS: The results showed that during Ramadan, zinc, magnesium and potassium levels in breast milk decreased significantly (P<0.05). The mother's weight increased approximately 1 kg after Ramadan. Changes in body mass index of the mother were not statistically significant. A significant decrease in vitamin A intake was observed after Ramadan (P < 0.05). During Ramadan, energy and most nutrient intakes except protein and vitamins A and C were found below daily recommended dietary allowances necessary for lactating women. CONCLUSIONS: Ramadan fasting had no significant effect on the macronutrient composition of the breast milk and consequently the growth of the infants. There were significant differences in some of the micronutrients such as zinc, magnesium and potassium. The nutritional status of lactating women was affected by Ramadan fasting. All of the nutrient intakes (except vitamins A, E and C) decreased during Ramadan. For these reasons, it would seem prudent to excuse lactating women from fasting during Ramadan.     

Improved Bone Mineral Status in Very Low Birthweight Infants Fed Human Milk Mixed with Preterm Formula

The bone mineral status of very low birthweight (VLBW) infants fed exclusively their own mother's milk (group I) was compared with that of VLBW infants fed mother's milk in the initial 4 weeks followed by a 1:1 mixture of mother's milk and preterm formula containing high phosphorus (P) and calcium (Ca) (group II). In both groups, most infants showed a biochemical picture characteristic of phosphorus deficiency syndrome by the fourth week. Thereafter, serum alkaline phosphatase activity (ALP) decreased and serum P increased in all group II infants. Conversely, serum ALP rose and hypophosphatemia persisted in most group I infants. Group II had a significantly higher serum P at weeks 8 and 12 and a significantly lower ALP at week 12 than group I. Furthermore, group II had a lower incidence of severe radiographic abnormalities than group I at week 12. We confumed previous observations that VLBW infants fed exclusively human milk require P and Ca supplementation to prevent metabolic bone disease of prematurity.