Plasma lipids and apolipoproteins in breastfed and formula-fed Swedish infants

This study was carried out to compare plasma lipid pattern in breastfed and formula-fed infants and the effects of exchanging breast milk for formula and of introducing weaning foods. Healthy infants, exclusively breastfed at least until 3 mo, were at this age randomly assigned to infant formulas with similar fat composition. Formula was gradually introduced when breastfeeding was discontinued. One group continued to breastfeed beyond 6 mo of age. All infants received the same weaning foods and were studied between 3 and 12 mo of age. Decreased plasma concentrations of total and low-density lipoprotein cholesterol (TC, LDL-C), apolipoprotein B (apo B) and A1 (p < 0.001), and of high-density lipoprotein cholesterol (p < 0.05) were found when breast milk was exchanged for formula before 6 mo. At this age plasma TC, LDL-C and apo B were lower in formula-fed than in breastfed infants (p < 0.001). These plasma lipids then increased (p < 0.01) when the intake of formula decreased and that of weaning foods increased. However, plasma TC and/or LDL-C remained lower at 12 mo in formula-fed than in breastfed infants (p < 0.05). Our results indicate that the plasma lipid profile of infants is highly responsive to the dietary nutrient intake, as indicated by the decrease in plasma lipids and apolipoproteins when breast milk was exchanged for formula and by the increase in these concentrations when the intake of weaning foods gradually increased.     

Responses to immunisation with Hib conjugate vaccine in Australian breastfed and formula-fed infants

OBJECTIVE: There are conflicting reports as to whether breastfed infants respond with higher antibody levels to conjugate Haemophilus influenzae type b (Hib) vaccine compared with formula-fed infants. These observations prompted us to investigate the effect of feeding method on the antibody concentration to Hib polyribosylribitol (PRP) both prior to and 3 months after the primary course of immunisation with Hib (PRP-OMP). METHODS: We measured plasma concentrations of IgG antibody to Hib PRP by enzyme-linked immunosorbent assay in blood samples from a total of 272 breastfed and formula-fed infants prior to immunisation (7 weeks of age, n = 82 and n = 148, respectively) and again 3 months after completion of the primary course of immunisation with Hib PRP-OMP (7 months of age, n = 88 and n = 132, respectively). RESULTS: Breastfeeding was associated with lower plasma antibody titres at both times (P < 0.01, T-test) with 49% of breastfed infants having anti-PRP concentrations below 1.0 microg/mL at age 7 months. There was no reported invasive Hib disease in this cohort of infants, and nationally the effectiveness of the Hib vaccination programme remains high. CONCLUSIONS: These data suggest that breastfeeding may be associated with immunomodulation of infant Hib immunisation responses with this immunisation regime. Further research is needed to determine whether differences in antibody concentration described here are primarily determined by factors directly attributed to breastfeeding or whether other environmental factors may play a significant role.     

Choice of formula and human milk supplement for preterm infants in Australia

Human milk (HM) is considered to be the optimal feed of choice for neonates, however, for preterm infants, HM fortifiers are often added to increase growth. If HM is unavailable, preterm formula is the next best option for preterm infants. Choosing which fortifier, if any, to use or which formula can be confusing. In this paper, the composition of milk feeds available in Australia and New Zealand is reviewed with the aim of assisting paediatricians to decide which feed is most appropriate for their patients.     

Chorioamnionitis with or without funisitis increases the risk of hypotension in very low birthweight infants on the first postnatal day but not later

OBJECTIVE: To evaluate the relation between chorioamnionitis and hypotension in very low birthweight infants. METHODS: Retrospective cohort study in infants with a birth weight of <1500 g born between January 2002 and September 2004. The placentas were examined for evidence of chorioamnionitis and funisitis. Hypotension was defined by the use of vasopressors. RESULTS: Of 105 infants, 37 (35%) were chorioamnionitis positive. The onset of hypotension had a skewed distribution: day 1 for 30 episodes and scattered from day 2 to day 19 for the remaining 22. Of the 30 infants who developed hypotension on day 1, 17 (57%) were chorioamnionitis positive. The mean maturity of the chorioamnionitis positive group was 27.91 weeks, marginally less than the mean maturity of 29.05 weeks of the chorioamnionitis negative group (p = 0.05). After adjustment of the effects for confounding variables (birth weight, gestation, surfactant therapy, mechanical ventilation on day 1, high frequency oscillatory ventilation, patent ductus arteriosus), chorioamnionitis was the significant factor in line with hypotension developing on day 1 (adjusted odds ratio 5.14, 95% confidence interval 1.51 to 17.50). There was no evidence that hypotension developing after day 1 was associated with chorioamnionitis. CONCLUSIONS: There is a strong association between chorioamnionitis and hypotension developing on day 1 in very low birthweight infants.     

Thymic size in uninfected infants born to HIV-positive mothers and fed with pasteurized human milk

AIM: To examine the size of the thymus in uninfected infants born to HIV-positive mothers and to study the effects of feeding by human donor milk on the size of the thymus in these infants. METHODS: The absolute and relative thymic size was assessed by sonography as thymic index (Ti), and the Ti/weight-ratio (Ti/w) at birth and at 4 mo of age in 12 healthy uninfected infants born to HlV-infected mothers. All infants were exclusively fed pasteurized donor milk. The results were compared with those obtained from a previous cohort of exclusively breastfed, partially breastfed and exclusively formula-fed infants. RESULTS: At birth the Ti was reduced in infants born to HIV-infected mothers in comparison with that in control infants but this difference disappeared when their birthweights were taken into consideration (Ti/w-ratio). At 4 mo of age the geometric mean Ti of infants fed donor milk was 23.8 and the mean Ti/w-ratio was 4.2. Compared with those of exclusively breastfed infants, the Ti and Ti/w-ratio of infants fed donor milk were significantly reduced (p < 0.01). The Ti/w-ratio increased in donor-milk-fed infants compared with that in the formula-fed infants (p = 0.02). CONCLUSION: At birth the size of the thymus was smaller in uninfected infants of HIV-positive mothers compared with infants of HIV-negative mothers but when birthweight was taken into account this difference disappeared. Feeding by human donor milk seemed to result in an increased size of the thymus at 4 mo of age compared with thymic size in infants that were exclusively formula fed.     

Growth and Plasma Amino Acid Concentrations in Very Low Birthweight Infants Fed Either Human Milk Protein Fortified Human Milk or a Whey-Predominant Formula

ABSTRACT. In a prospective, study involving 20 VLBW-infants (AGA), divided into two study groups of 10 infants, we have evaluated the effects on growth and metabolism of human milk fortified with ultrafiltrated human milk protein and a whey-predominant (whey/ casein = 60/40) formula containing 2 g/dl of protein. The study was initiated at a mean age of 30 days when an oral intake of 180 ml/kg/d was tolerated and continued until a weight of 2 kg was reached. The protein intake in both groups was about 3.7 g/kg/d. All infants in both groups reached intrauterine rates of growth for the age, weight gain 18.0 g/kg/d, and length 1.2 cm/week. BUN, acid-base status, total protein and albumin were normal and similar in the two groups. Plasma levels of threonine, glycine, citrulline and methionine were significantly greater in the formula-fed infants. Taurine and proline had higher concentrations in the protein fortified human milk group. There was good tolerance of protein from both sources but the differences in plasma amino acid profiles suggest that the dietary protein quality in formulas for preterm infants must be further modified, if the goal of formula feeding is to achieve metabolic indices of protein metabolism similar to those found when human milk protein is used.     

Feeding of very low birth weight infants born to HCMV‐seropositive mothers in Germany,Austria and Switzerland

Aim: To evaluate the enteral feeding practice of preterm infants <32 weeks (W) gestational age (GA) or <1500 g birth weight (BW) from human cytomegalovirus (HCMV)‐seropositive mothers in Germany, Austria and Switzerland. Methods: This prospective cross‐sectional study included all neonatal units (NU) admitting preterm infants <32W or <1500 g BW in Germany, Austria and Switzerland. In June and July 2009, an anonymized questionnaire was sent via e‐mail, asking whether mothers of the above patients were screened for HCMV, and about the enteral feeding protocol for preterm infants <32W GA or <1500 g BW from HCMV‐seropositive mothers. Results: During the study period, 58.6% of the questionnaires (123/210) from Germany, 50% (13/26) from Austria and 50% (6/12) from Switzerland were returned, yielding a total of 6232 preterm infants for analysis. Formula was given to the mentioned preterm infants in 28.5% (35/123) of the German NUs but not in Austria or Switzerland. Untreated breast milk was given in 66.6% (4/6) of the Swiss, 14.6% (18/123) of the German and no Austrian NU. Long‐term pasteurized breast milk was given in 32.5% (40/123) of the German and 38.5% (5/13) of the Austrian NUs, but not in Switzerland. Short‐term pasteurized breast milk was given only in 5.7% (7/123) of German NUs. Freeze‐thawed breast milk was given in Germany (4.9%; 6/123), Austria (61.5%; 8/13) and Switzerland (16.7%; 1/6). Conclusion: Preterm infants <32W GA or <1500 g BW born to HCMV‐seropositive mothers are fed according to different regimes in German‐speaking countries. About 28.5% of the German VLBW‐infants receive formula, which is not recommended.     

Availability of donor milk improves enteral feeding but has limited effect on body growth of infants with very‐low birthweight: Data from a historic cohort study

Compare with preterm formula, donor human milk (DM) is associated with a lower risk of mortality and morbidity in preterm infants. It is thus deemed superior to preterm formula as the sole diet or supplement to own mother''s milk (OMM) for preterm infants, especially for those with very low birthweight (VLBW). This historic cohort study investigated the relationship between DM availability, and enteral feeding, body growth of VLBW infants by comparing two cohorts before and after the establishment of a human milk bank. A sub‐analysis was also conducted between small‐for‐gestational‐age (SGA) and non‐SGA infants in our cohorts. Our results showed that DM availability was associated with earlier initiation and faster advancement of enteral feeding, earlier attainment of full enteral feeding, and a higher proportion of OMM in enteral feeding. DM availability was also associated with earlier regain of birthweight, but not with better body growth. SGA and non‐SGA infants responded differently to DM availability with only the non‐SGA group showing improved enteral feeding associated with DM availability. The poor growth of VLBW infants with fortified DM warrants further investigations on better fortification strategies to further improve body growth. Studies are also needed on long‐term effects of DM feeding on the development of VLBW infants.     

Neutrophil but not eosinophil inflammation is related to the severity of a first acute epidemic bronchiolitis in young infants

Acute bronchiolitis is the main cause of emergency visits and hospitalizations in infants. Recent data suggest that neutrophil- and eosinophil-mediated inflammations were part of bronchiolitis pathophysiology. Apart from the defined risk factors, few was known on the underlying pathophysiology, which might point out the differences observed in the severity of the disease. The aim of this study was to assess whether the clinical severity of acute epidemic bronchiolitis in young infants might be related to a specific underlying inflammatory process. Total and differential cell counts, IL-8, eotaxin, eosinophil cationic protein (ECP) and albumin levels were assessed at the time of admission in bronchial secretions from 37 infants (median age 17 wk) with acute bronchiolitis. Outcome severity variables were: hypoxemia, Silverman score, tachypnea, feeding alteration, and duration of hospitalization. Neutrophils predominated, and eosinophils were present in 54% of the infants. IL-8 levels strongly correlated with ECP and albumin levels. Albumin levels were correlated with ECP and eotaxin levels. IL-8 levels were higher in infants with hypoxemia and inversely related with SaO₂ levels. IL-8 and albumin levels significantly rose with respiratory rate, and Silverman score. IL-8, albumin and ECP levels were significantly higher in infants hospitalized ≥7 days. Furthermore, IL-8 levels were correlated with the duration of hospitalization. Neither cell counts nor eotaxin levels were related to the severity criteria studied. This study suggests that IL-8-associated airway inflammation significantly contributed to the severity of acute epidemic bronchiolitis.     

Red blood cell fatty acid composition in low-birth-weight infants fed either human milk or formula during the first months of life

The fatty acid composition of red blood cell (RBC) phospholipids in low-birth-weight infants was determined immediately after delivery and during the first 3 months of life. In the first study, infants were fed either human milk or two formulas with different fatty acid compositions but no long chain polyunsaturated fatty acids (LCPUFA). Both groups of formula-fed infants had significantly lower levels of docosahexaenoic acid (DHA) in RBC phospholipids compared with breast-fed infants. RBC phospholipid DHA was similar in the two formula groups at all ages. In the second study, infants received either a non-supplemented or a LCPUFA-supplemented formula. DHA remained stable in RBC phospholipids of infants supplemented with LCPUFA, whereas DHA decreased in RBC phospholipids of unsupplemented infants. These results confirm that adding DHA to formulas is more effective than increasing 18:3 n-3 content, in maintaining RBC phospholipid DHA levels.     

Low frequency of CD4+, but not CD8+, T cells expressing interferon‐γ is related to cow's milk allergy in infancy

Low interferon‐γ (IFN‐γ) and tumor necrosis factor‐α (TNF‐α) production in peripheral blood mononuclear cells (PBMC) from patients with atopic dermatitis and food allergy have been reported previously. However, it remains unclear whether the weak cytokine production is caused by the imbalance of specific T‐cell subsets or by dysregulation of T‐cell function. In the present study we investigated the intracellular expression of these cytokines at a single‐cell level to clarify the background of the disruption. Twelve of 27 breast‐fed infants (0.1–8.8 months of age) had challenge‐proven cow's milk allergy (CMA), and 15 infants were studied as a healthy control group. PBMC were stimulated with phorbol 12‐myristate 13‐acetate (PMA) and ionomycin. The frequencies of the cells expressing intracellular IL‐4, IFN‐γ, and TNF‐α were assessed using flow cytometry. In addition, at this time‐point leucocyte subsets from the milk of mothers of these infants were evaluated using light microscopy. A lower number of CD8⁺ T cells and the defective capability of CD4⁺ T cells to express IFN‐γ in infant's peripheral blood co‐existed with a lower number of macrophages in their mother's milk.     

Administration of G‐CSF from day +6 post‐allogeneic hematopoietic stem cell transplantation in children and adolescents accelerates neutrophil engraftment but does not appear to have an impact on cost savings

G‐CSF post‐allogeneic HSCT accelerates neutrophil engraftment, but evidence that it impacts on cost‐related outcomes is lacking. We performed a retrospective child and adolescent single‐center cohort study examining G‐CSF administration from Day +6 of allogeneic HSCT vs. ad hoc G‐CSF use where clinically indicated. Forty consecutive children and adolescents undergoing allogeneic HSCT were included. End‐points were as follows: time to engraftment; incidence of acute and chronic GvHD; number of patients alive at Day +100; 180‐day TRM; post‐transplant days in hospital; and cost of antimicrobials, TPN, and G‐CSF usage. Neutrophil engraftment occurred earlier in the group that received G‐CSF from Day +6. There was no difference between groups in any of the other end‐points with the following exception: the cost of GCSF was significantly higher in the D + 6 G‐CSF group. However, median G‐CSF cost in this group amounted to only €280. There was a trend towards reduced cost of antimicrobials in the D + 6 G‐CSF group, although this did not reach significance (p = 0.13). The median cost per patient of antimicrobial agents between groups differed by €1116. This study demonstrated the administration of G‐CSF on Day +6 in pediatric HSCT to be safe. A further study using a larger cohort of patients is warranted to ascertain its true clinico‐economic value.