The Growth of Breast Fed and Artificially Fed Infants from Birth to Twelve Months

ABSTRACT. Growth data collected from 394 healthy infants were analysed in relation to feeding practices. Infants were grouped on the basis of sex, if breast fed or artificially fed, and duration of breast feeding. From birth to 3 months, weight gains were similar for boys (2.5 kg) and also for girls (2.3 kg) irrespective of feeding method. From 3 to 6 months weight gains were greater in infants who were artificially fed from birth (2.0 kg both sexes) or breast fed for only a short time (1.9 kg) than for those exclusively breast fed for 6 months (1.6 kg) or longer (1.7 kg). Weight gains continued to be greater in artificially fed infants after 6 months. Over 12 months, artificially fed boys gained 410 g and girls 750 g more than those who were breast fed from birth. These differences occurred even though the artificial feedings that prevailed to 6 months and longer were low-solute ('humanized') formulas.     

ASYMPTOMATIC BACTERIURIA IN SCHOOLGIRLS VI. The Correlation between Urinary and Faecal Escherichia coli. Relation to the Duration of the Bacteriuria and the Sampling Technique

Abstract. The occurrence of the urinary strain in the anus, rectum and faeces was investigated in 27 girls with asymptomatic bacteriuria (ABU). In patients with bacteriuria of relatively short duration 46% of the faecal isolates were of the urinary strain as compared to only 18% in patients with bacteriuria of relatively long duration. In general the correlation between the urinary and faecal flora is striking at the time of establishment of ABU but diminishes with time. The diminished correlation may be due to two factors: firstly, the composition of the faecal flora changes with time. Secondly, the correlation may be obscured by complex changes in the properties of bacterial strains established in the urinary tract. Contamination by the infected urine did not seem to be a serious problem when the rectal mucosa was swabbed proximal to the anal canal.     

Experimental milk formulae with reduced protein content and desialylated milk proteins: influence on the faecal flora and the growth of term newborn infants

We have assessed the growth, tolerance and the faecal flora composition in healthy infants on different feeding regimens. Four groups of infants were fed exclusively on mother's milk, a standard formula and two experimental formulae. The first experimental formula consisted of a milk with a reduced protein content (1.2 g/100 ml), the second in a formula with the same protein content and with milk proteins desialylated by mild acid hydrolysis. The aim of the study was to test whether lowering the protein content and/or modifying the proteins by desialylation would favour the development of a bifidus flora. A bifidus flora was detected in 60% of breastfed infants at 1 month of life. All formulae employed during the study failed to induce a prevalence of colonization with bifidobacteria at 1 month of age. The two experimental milk formulae were well tolerated, but the infant growth rate was slightly lower as compared to the breastfed infants and the infants fed the standard formula. The presence in milk formulae of pre-digested and desialylated proteins can offer some advantages in term of digestibility and mimic a physiological intestinal mechanism of the infant.     

Acute C-Peptide, Insulin and Branched Chain Amino Acid Response to Feeding in Formula and Breast Fed Infants

ABSTRACT. The response of C-peptide in serum and urine and of glucose and branched chain amino acids in blood to formula and breast feeding was assessed in six breast-fed and six formula-fed infants 3–6 months of age. We analysed serum C-peptide, branched chain amino acids (BCAA) in blood, and blood glucose in the fasting state at 90' and 180' after regular meal. The excretion of urinary C-peptide and creatinine was also determined. The formula-fed infants received formula in current use, containing 15–16 g protein/l and with casein/whey ratio of 40/60. In the fasting state, no significant inter-group difference was found in the level of serum C-peptide or the valine/glycine ratio. Postprandially, the formula-fed infants had significantly higher serum C-peptide values and valine/glycine ratio than the breast-fed infants, p ≤0.05. No significant inter-group difference was found for blood glucose. The urinary C-pep-tide/creatinine ratio was significantly lower in the breast-fed group, p =0.02, and significantly correlated both to the valine/glycine ratio at 90', r_s =0.75, p =0.02 and to the serum C-peptide value at 90', r_s =0.66, p =0.03. These results confirm that in formula-fed infants the insulin response to meal is enhanced compared to that in breast-fed infants. The finding of similar blood glucose values in the two groups may also indicate an insulin resistance in the formula-fed infants following meal.     

Response to RIT 4237 Oral Rotavirus Vaccine in Human Milk, Adapted- and Soy-Formula Fed Infants

ABSTRACT. During the first month of life 28 full-term newborns were breast-fed (18 males and 11 females). Thereafter 8 infants continued breast-feeding while the remainder were randomly fed on either an adapted milk formula ( n =13) or a soy-formula ( n =7). At five months, after an oral dose of RIT 4237 rotavirus vaccine of bovine origin was given, growth and IgM/IgG type antibodies against rotavirus were measured. Weight gain was similar in all infants. There were 2 IgM and 1 IgG responders out of 7 soy fed infants, compared with 4 out of 8 human milk fed (both IgM and IgG) and 7 out of 13 IgM and 6/12 IgG formula fed infants responding to vaccination. This observation confirms previous results obtained with polio, diphtheria tetanus and pertussis vaccines indicating that soy-protein formulas may interfere with immunization processes.     

Faecal elastase-1 test is superior to faecal lipase test in the assessment of exocrine pancreatic function in cystic fibrosis

BACKGROUND AND AIMS: Direct tests are characterized by the highest sensitivity and specificity. However, their practical use, especially in children, is limited. Among the indirect tests, the highest sensitivity and specificity was documented for faecal elastase-1 test, yet the value of faecal lipase test in cystic fibrosis (CF) has not been defined. Therefore, the aim of the present study was to compare the sensitivity and the specificity of the faecal lipase test to the faecal elastase-1 test in the assessment of exocrine pancreatic function in children with CF. METHODS: The study comprised 90 CF patients and 95 healthy subjects (HS). In all subjects, faecal elastase-1 concentrations (ELISA) and lipase activities (ELISA) were measured. The presence of pancreatic insufficiency was documented by the determination of faecal fat excretion in 78 pancreatic insufficient and by the secretin-cholecystokinin test in 12 CF patients without steatorrhoea. Sensitivity and specificity of the faecal elastase-1 test and faecal lipase test were analysed and, in 50 HS, sample-to-sample and day-to-day variations were determined. RESULTS: With cut-off levels providing the same specificity for both tests (95.8%), the sensitivity of the faecal elastase-1 test (91.1%) was significantly higher (p < 0.0036) than that of the faecal lipase test (76.7%). Sample-to-sample (mean +/- SEM: 13.2 +/- 1.2% vs 23.4 +/- 2.2%) and day-to-day variations (mean +/- SEM: 16.3 +/- 1.2% vs 32.5 +/- 2.6%) were significantly lower (p < 0.0001) for elastase-1 than for lipase measurements. CONCLUSION: Among indirect tests, faecal elastase-1 test is superior to faecal lipase test in the assessment of exocrine pancreatic function in cystic fibrosis.     

Plasma Valine and Urinary C-Peptide in Breast-fed and Artificially Fed Infants up to 6 Months of Age

ABSTRACT. Plasma branched-chain amino acids and urinary C-peptide-creatinine excretion was determined at 3, 41/2 and 6 months of age in a group of 50 infants who were either breast-fed or artificially fed and selected at random. The average concentrations of valine in plasma and C-peptide in urine as well as the ratio between C-peptide and creatinine in urine were 2–3 times higher ( p < 0.01) in artificially fed as compared to breast-fed infants at all the ages studied. Plasma valine values correlated significantly with the urinary C-peptide/creatinine ratio ( r = 0.76, p < 0.01), which suggests that the enhanced insulin response induced by the artificial formula is related to its protein content.     

‘We make a mistake with shoes [that's no problem] but… not with baby milk’: Facilitators of good and poor practice in distribution of infant formula in the 2014–2016 refugee crisis in Europe

The Infant and Young Child Feeding in Emergencies Operational Guidance (OG-IFE) gives direction on providing aid to meet infants' and young children's feeding needs in emergencies. Because of the risks associated with formula feeding, the OG-IFE provides limited circumstances when infant formula should be provided in aid. However, distributions against this guidance are common, reducing breastfeeding so risking increased infant morbidity and mortality. This study sought to identify factors that contributed to following (‘good practice’) or not following (‘poor practice’) the OG-IFE regarding infant formula distribution in the 2014–16 refugee crisis in Europe. Thirty-three individuals who supported, coordinated, or implemented infant feeding support in the Crisis were interviewed regarding their experiences and views. Reflexive thematic analysis of transcribed interviews was undertaken. It was identified that presence of breastfeeding support, presence of properly implemented formula feeding programmes, understanding that maternal choice to formula feed should be considered within the risk context of the emergency, and positive personal experiences of breastfeeding contributed to good practice. Presence of infant formula donations, absence of properly managed formula feeding programmes, belief that maternal choice to formula feed is paramount and should be facilitated, and personal experience of insurmountable breastfeeding challenges and/or formula feeding contributed to poor practice. Governments, humanitarian organisations, and donors should ensure that infant and young child feeding in emergencies preparedness and programmes are adequately resourced. Emergency responders should be appropriately trained with training including infant feeding experience debriefing. Health and emergency organisations should provide maternity protections enabling employees to breastfeed as recommended.     

Differences in the pattern of milk intake between breast and bottle fed infants

Two hundred and nine 6-day-old healthy term infants were test weighed either during bottle feeding (n = 77) or breast feeding (n = 132). Cross-sectional data collection avoided repeated interruptions of individual feeds. Bottle fed infants (fed ad libitum) and breast fed infants consumed a similar feed volume (respectively, 67 ± 2 ml versus 75 ±6 ml, mean ±S.E.M.) over a similar period of time (mean 25 min); yet the pattern of milk flow during feeding was significantly different in the two groups. In bottle fed infants, there was a linear pattern of milk intake over the first 10 min of feeding, by which time 81% of the feed has been consumed, contrasting with a biphasic intake pattern in breast fed infants in whom a total 84% of the feed was consumed either in the first 4 min or between 15 and 19 min after the start of the feed. It is speculated that these differences in the pattern of milk intake could influence the physiological responses to feeding and might account for differences between breast and bottle fed infants in gut hormonal responses to milk feeds.     

Development of the intestinal flora in very low birth weight infants compared to normal full-term newborns

Development of faecal flora was studied in seven very low birth weight (VLBW) infants, who were fed on human milk and whose birth weights ranged from 810–1350 g. The intestine of the VLBW infants was first colonised by enterobacteria and streptococci, as it was in full-term infants. VLBW infants differed, however, from full-term infants in that both types of organism continued to be predominant for a longer period, and establishment of bifidobacterial flora was retarded. Bifidobacteria first appeared in the stools of VLBW infants at a mean age of 10.6±2.7 days and became predominant at a mean of 19.8±8.9 days, in contrast to full-term, breast-fed infants in whom bifidobacterial flora appeared at as early as 4 days of age. The delay seemed to be related to the low milk intake of the VLBW infants.The number of viable staphylococci in the stools of VLBW infants was generally higher than that in full-term infants. Although emergence of Bacteroides, Clostridium and lactobacilli was delayed compared with full-term infants, differences in their occurrence and prevalence between VLBW and fullterm infants were not remarkable.Abbreviation VLBW very low birth weight     

Serum and Saliva Ig-levels in Infants of Non-Atopic Mothers Fed Breast Milk or Cow's Milk-based Formulas

ABSTRACT. Of twenty-five healthy, full term infants without a family history of atopic diseases, 13 were exclusively breast-fed from birth for a minimum of 3½ months (median 4½ months), whereas the remaining 12 infants were fed with cow's milk-based formulas from birth for a minimum of 4 months. In the latter group of children a significant increase in serum IgE as well as in salivary IgA was found. In infants exclusively breast-fed, no increase in serum IgE was seen until 6 months of age; at nine months of age, salivary IgA was still significantly lower than in the infants fed cow's milk-based formulas. No children developed obvious allergic diseases during the first three years of life. Thus, cow's milk proteins given to newborn children of non-atopic mothers did not seem to increase the risk of IgE-mediated diseases, maybe due to the development of "blocking" IgA-antibodies in the alimentary tract.     

经幽门喂养和经胃管喂养对极低出生体质量儿的喂养耐受性比较

目的通过比较经幽门喂养(TP)和经胃管喂养(IG)对极低出生体质量儿(VLBWI)的喂养耐受性,探讨TP在VLBWI儿胃肠内营养中的应用价值。方法将43例胎龄为28～33周的VLBWI儿随机分为TP组(n=20)和IG组(n=23)。喂养开始于出生2～3d,且生命体征平稳。喂奶量由10～20mL/(kg.d)开始,间断喂养每3～6小时1次,VLBWI儿均同时进行部分外周静脉营养,逐渐过渡到完全肠道内营养。观察二组患儿喂养耐受性、呼吸暂停、体质量增长速度、达出生体质量时间、住院天数、并发症发生情况。结果喂养耐受性中呕吐发生率TP组显著低于IG组(χ2=4.74P<0.05),呼吸暂停发生次数TP组显著低于IG组(t=3.098P<0.05)。二组患儿腹胀、体质量增长速度、达出生体质量时间、平均住院天数经比较均无显著性差异(χ2=0.378;t=1.243,0.388,0.834Pa>0.05),坏死性小肠结肠炎发生率二组比较无显著性差异(χ2=0.027P>0.05),且二组患儿均无肠穿孔发生。结论TP能显著减少VLBWI儿呼吸暂停及呕吐的发生率,改善喂养的耐受性,TP可用于不能耐受IG而反复出现胃食管反流的VLBWI儿。     

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.     

The nine stages of skin‐to‐skin: practical guidelines and insights from four countries

Incorporating systematic evidence with clinical expertise is a key element in the quest to improve quality of care and patient outcomes. The evidence supporting skin‐to‐skin contact in the first hour after birth is robust and includes significantly improved outcomes for both mother and infant. This paper compares available iterative data about newborn behaviour in the first hour after birth to further describe the observable behaviour pattern and to provide clinical insight for further research. Although the evidence for positive outcomes through skin‐to‐skin contact are robust, there is a dearth of research specifically focused on clinical practice. The methodology considers the four available data sets that used Widström's 9 stages, which consists of studies from Japan, Sweden, Italy and the United States, examining the parameters of each stage across settings from around the world. This research provides an expanded understanding of the timing of the newborn's progression through Widström's 9 observable stages. We found that newborns in all four data sets began with a birth cry and continued through the remaining stages of relaxation, awakening, activity, rest, crawling, familiarization, suckling and sleeping during the first hours after birth and consolidated the data into a Sign of the Stages chart to assist in further research. The evidence supports making a safe space and time for this important newborn behaviour. Clinical practices should encourage and protect this sensitive period.     

Comparative study over a 12 year period of the weights of Tasmanian children from birth to 3 years of age

Abstract Comparisons of weight data obtained from surveys of Tasmanian children born in 1967–68, 1974 and 1979 suggest no change in birthweights but a significant decrease in weights at 1 year of age over this period. Evidence is presented to show that an observed increase in the incidence and duration of breastfeeding over the period may account for part of the decline in these weights but that other factors must also be involved. By 3 years of age there was very little difference between the weight distributions over the 12 year period.     

Evolution of infant feeding practices in children from 9 to 24 months,considering complementary feeding indicators and food processing: Results from the Brazilian cohort of the MAL‐ED study

Infant feeding practices impact children''s nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods.     

Characteristics associated with the transition to partial breastfeeding prior to 6 months of age: Data from seven sites in a birth cohort study

The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants'' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors associated with the timing of an early transition to partial breastfeeding across seven sites of a birth cohort study in which twice weekly information on infant feeding practices was collected. Infant (size, sex, illness and temperament), maternal (age, education, parity and depressive symptoms), breastfeeding initiation practices (time of initiation, colostrum and pre‐lacteal feeding) and household factors (food security, crowding, assets, income and resources) were considered. Three consecutive caregiver reports of feeding animal milks and/or solids (over a 10‐day period) were characterized as a transition to partial breastfeeding, and Cox proportional hazard models with time (in days) to partial breastfeeding were used to evaluate associations with both fixed and time‐varying characteristics. Overall, 1470 infants were included in this analysis. Median age of transition to partial breastfeeding ranged from 59 days (South Africa and Tanzania) to 178 days (Bangladesh). Overall, higher weight‐for‐length z‐scores were associated with later transitions to partial breastfeeding, as were food insecurity, and infant cough in the past 30 days. Maternal depressive symptoms (evaluated amongst 1227 infants from six sites) were associated with an earlier transition to partial breastfeeding. Relative thinness or heaviness within each site was related to breastfeeding transitions, as opposed to absolute z‐scores. Further research is needed to understand relationships between local perceptions of infant body size and decisions about breastfeeding.     

Exploring the infant feeding practices of immigrant women in the North West of England: a case study of asylum seekers and refugees in Liverpool and Manchester

Little is known about the infant feeding experiences of refugees residing in the UK. To enable successful health promotion for this population, such experiences must be understood. The study aimed to gain an understanding of infant feeding practices among a group of UK‐based refugee mothers. Objectives were to explore mothers' perceptions and influences of infant feeding practices, to explore challenges faced by mothers in feeding their infants and to identify concerns and experiences of health care professionals with regard to caring for them. Fifteen semi‐structured interviews and two focus group discussions with refugee mothers and five semi‐structured interviews with health care providers were conducted in 2012. A framework approach was used to identify main themes. Overall mothers were dissatisfied with their infant feeding outcomes. A preference to exclusively breastfeed was often not achieved. Most resorted to using formula feed, perceiving that this was primarily due to a lack of support. Mothers who were positive to human immunodeficiency virus followed the UK guidelines of exclusively formula feeding for 6 months, but struggled with guilt of not being able to breastfeed. All mothers unable to exclusively breastfeed experienced a sense of loss. Lack of wider support services coupled with complex lifestyles appeared to create challenges in providing infant feeding support. The results highlight a need for an intensified response to facilitate these mothers to maintain their preferred infant feeding choices, or when required, to support them in the adoption of a new method. Using experienced refugee mothers to guide newer mothers, and integrating health and social care, would be positive starting points.     

Long-Term Follow-Up of Infants from Birth for Rotavirus Antigen and Antibody in the Feces

We followed up five infants from birth to five years of age for the shedding of rotavirus and the appearance of IgA antibody in the feces, in order to know the relation of rotavirus infections with diarrheal symptoms and the host's responses in fecal IgA antibody production. We collected fecal samples basically once a week from the infants, and evaluated the contents of rotayirus antigen and antibody and total IgA in all the samples by enzyme-linked immunosorbent assays. We also detected virus particles in some concentrated samples by electron microscopy. We found that all the infants shed a large amount of rotavirus in the winter seasons up to two years of age, but two infants showed no symptoms of diarrhea. After primary infection, the specific IgA index, defined as the specific IgA antibody titer divided by the total IgA concentration of each feces, rose and fluctuated from time to time. However, we observed occasional eight fold or greater rises in the index between two consecutive fecal samples, suggesting anamnestic responses in fecal IgA antibody production. Some of the rises were accompanied with mild diarrhea and the presence of a low amount of virus in the feces detected by electron microscopy. Probably, repeated mild reinfections with rotavirus are occurring in infants at all seasons.