Pancreatic endocrine response to the first feed in term newborn infants

Blood glucose, insulin, C-peptide and glucagon were evaluated in 36 newborn term infants at birth, and before and 60 min after the first feed during the first day of life. Under basal conditions glycaemia diminished during the first day of life and glucagon increased, while insulin and C-peptide did not show any variation. The C-peptide: insulin molar ratio was higher in the newborn than in adults because of the longer half-life of C-peptide, probably due to reduced renal function in the neonatal period.The subjects were divided into two groups: 18 newborn infants were given a feed of commercially available milk powder reconstituted in water at 10% (5 ml/kg); the other 18 were given a feed of 5 ml/kg 10% glucose solution. In each group 6 were given the first feed after a fast of 6 h, 6 after a fast of 12 h, and 6 after a fast of 24 h from birth. After the first feed with milk, the average increase of glycaemia was 19.83 mg%, of insulin 6.06 U/ml, and of C-peptide 1.88 ng/ml. After the first feed with glucose the average increase of glycaemia was 13.59 mg%, of insulin 2.46 U/ml, and of C-peptide 0.59 ng/ml. Glucagon did not show significant changes after the first feed.     

Vitamin E in human milk from mothers of preterm and term infants

The content of vitamin E (alpha- and beta + gamma-tocopherol) was analyzed in 63 human milk samples obtained from 13 mothers of preterm infants ("preterm" milk) and in 59 milk samples obtained from nine mothers of full-term infants ("term" milk). The changing pattern of the alpha- and beta + gamma-tocopherol content during the course of lactation was identical for both groups. Total vitamin E, alpha- as well as beta + gamma-tocopherol, decreased during the first 2 weeks of lactation and remained constant thereafter. The ratio of alpha- to beta + gamma-tocopherol decreased from about 10:1 to 4:1. At days 3 and 36 of lactation, vitamin E contents (median values and ranges) expressed as milligrams alpha-tocopherol equivalent per 100 ml were 1.45 (0.64-6.4) and 0.29 (0.17-0.48), respectively, for preterm and 1.14 (0.63-4.21) and 0.28 (0.19-0.86), respectively, for term human milk. The vitamin E, alpha-tocopherol and beta + gamma-tocopherol content of preterm human milk did not differ significantly (p less than or equal to 0.05) from that of term human milk at each sampling day. Based on these findings we conclude that the increased requirement of prematures for vitamin E is not reflected in the vitamin E content of milk from mothers delivering preterm infants.     

Comparison of the phospholipid classes in human milk in Japanese mothers of term and preterm infants

Background: Phospholipids (PLs) play an essential role in the growth and brain development of infants. Aim: To investigate PL composition in human milk (HM), including lysophosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, phosphatidylserine, phosphatidylcholine (PC) and sphingomyelin (SM), from healthy Japanese mothers. Analyses were performed on colostrum, transitional milk and mature milk from mothers of preterm and term infants. Methods: HM samples were collected from mothers of 15 term infants (term group) and of 19 preterm infants (preterm group). PL composition was determined by two-dimensional thin-layer chromatography in conjunction with phosphorus analysis. Results: In both groups, the PL content (% of total lipid) of mature milk was significantly lower than in colostrum. SM and PC were the main PLs in HM, but in the preterm group, the percentage of SM in mature milk was significantly higher and PC in mature milk was significantly lower than in the term group.

Conclusion: The transition from colostrum to mature milk leads to an increase in SM and a decrease in PC in the HM of preterm infants, along with a decrease in PL content. This is the first report to demonstrate the differences in PL composition in HM between mothers of preterm and term infants.     

Leptin determination in colostrum and early human milk from mothers of preterm and term infants

Background

Leptin is involved in the regulation of food intake and energy expenditure and is therefore important for growth and brain development. Analytical methods used for leptin measurement in human milk differ widely in the literature and yield varying results.

Aims

To compare different preparation methods for the analysis of leptin in human milk and to investigate the leptin levels in colostrum and mature human milk from mothers of preterm or term infants.

Methods

Mothers delivering a preterm (n = 37) or a term infant (n = 40) were recruited for a prospective study and were ask to collect breast milk on the 3rd and 28th day of lactation. Leptin, protein and fat concentrations were analysed. Clinical data of mother and child were recorded prospectively.

Results

Skim milk was most appropriate for leptin analysis. Human milk leptin concentrations did not differ between preterm and term human milk. In term milk, leptin concentration on day 28 was lower than on day 3 (p < 0.05). Milk leptin levels on the 3rd and 28th day were positively correlated with mothers' body mass index, but not with fat content in milk.

Conclusion

Skim milk was the most stabile preparation for leptin analysis. Preterm and term human milk contain leptin in equal concentrations. Human milk leptin depends on mothers' body mass index.     

早产儿母乳喂养强化方法的探讨

目的通过回顾性队列研究评价早产儿母乳喂养强化时机对早产儿住院期间生长的影响,探讨早产儿母乳喂养强化的最佳时机和进程。方法选择2009年11月至2011年3月在4家三甲医院新生儿重症监护病房住院治疗、住院期间母乳喂养量大于总喂养量50％并应用母乳强化剂的早产儿为研究对象。根据开始添加母乳强化剂的时间分为早强化组[奶量〈90ml／（kg·d）即开始强化]和晚强化纽[奶量≥90ml／（kg·d）开始强化],再根据从开始添加母乳强化剂至足量强化的时间分为快强化组（1～3天完成足量强化）和慢强化组（≥4天完成足量强化）。对不同组间早产儿的合并症、肠内营养情况及生长情况进行比较。结果符合入选标准的早产儿共67例。早强化组32例,晚强化组35例,两组基本情况、坏死性小肠结肠炎（NEC）等合并症发生率、住院期间体重增长速率差异均无统计学意义（P〉0．05）。早强化组出院时小于胎龄儿（SGA）比例与出生时比较差异无统计学意义（P〉0．05）,晚强化组出院时SGA比例较出生时增多（72．7％比42．9％,P=0．013）。快强化组41例,慢强化组26例,两组基本情况、NEC等合并症发生率差异无统计学意义（P〉0．05）。快强化组住院时间更短[（34．0±15．6）天比（43．0-4-13．6）天,P=0．02],住院期间体重增长速率更快[（18．3±5．3）g／（kg·d）vs（15．7±3．7）g／（kg·d）,P=0．03]。快强化组出院时SGA比例与出生时比较差异无统计学意义（P〉0．05）,慢强化组出院时SGA比例较出生时更多（65．4％比30．8％,P=0．012）。结论早产儿母乳喂养晚强化或慢强化均加剧宫外生长迟缓,早强化或快强化对早产儿是安全的。建议在早产儿母乳喂养量达90ml／（kg·d）之前开始添加母乳强化剂;足量强化应尽量在3天内完成。     

Longitudinal changes in milk composition of mothers delivering preterm and term infants

The concentrations of protein nitrogen (PN), non-protein nitrogen (NPN), energy, fat, sodium (Na), calcium (Ca), phosphorus (P), magnesium (Mg), and zinc (Zn) were determined in human milk from mothers giving birth to full-term (n = 13) and preterm infants (n = 8). Milk samples were collected under controlled conditions at two-week intervals for 12 weeks postpartum. Statistically significant differences in PN, Ca, and P concentrations were detected between the milk from mothers of preterm and term infants. The mean PN concentration in the preterm milk was statistically higher than that of term milk (198 vs. 164 mg N/dl), in contrast to the lower mean Ca (220 vs. 261 mg/1) and P (125 vs. 153 mg/1) concentrations detected in the preterm milk. No other differences in mean nutrient concentration were observed between the two groups. Concentrations of PN, NPN, Na, P, and Zn decreased over time. The concentration of Mg increased slightly. The content of fat, energy, and Ca did not change.     

Food allergy in preterm infants fed human milk

In 80 preterms aged 9-24 months (mean age: 15.9) and in 80 sex- and age-matched full-terms the frequency of atopic diseases and of positive skin tests to 8 food and 6 inhalant allergens was determined. The two groups did not differ as to overall percentages of cutipositive subjects and patients with atopic diseases. In particular, frequencies of positive skin tests to foods and of atopic dermatitis (the peak prevalence of which occurs early in infancy) were similar in preterm (16.2 and 7.5%, respectively) and full-term (13.7 and 5.0%, respectively) infants. We suggest that preterm infants fed human milk are not at increased risk of developing food allergy and related diseases and that the absorption of antigens through the immature intestine does not seem to favor the development of an IgE sensitization to foods.     

Neurologic examination of preterm infants at term age: comparison with term infants

OBJECTIVES: The aim was to establish the range of neurologic findings in preterm infants reaching term age, their relation to gestational age at birth, and the possible differences with healthy term newborns tested during the first days of life. STUDY DESIGN: The Dubowitz neonatal neurologic examination was performed at term age in 157 low-risk preterm infants born between 25 and 34 weeks' gestation who had cranial ultrasonograms that were normal or showed minor abnormalities. Infants were subdivided in 3 groups according to their gestational age at birth. RESULTS: Within the preterm cohort, the range of scores for the 3 gestational age subgroups was different from each other for 21 of the 34 items, although the median scores were different only in 10 of the 34 items. The range of scores and their median in preterm infants however was wider than that found in term infants. Preterm infants examined at term were also more hyperexcitable and tended to have less flexor tone in the limbs and less extensor tone in the neck in the sitting posture. CONCLUSIONS: The distribution of scores provides useful guidelines when a preterm infant is examined at term.     

Cow's milk and anemia in preterm infants.

Introduction of pasteurised cows'' milk to the diet of preterm infants before 36 weeks'' postnatal age caused iron deficiency without anaemia. Cows'' milk before 24 weeks was associated with iron deficiency and anaemia. The cause was either inadequate absorption or increased loss rather than reduced intake of iron.     

母乳强化剂在母乳喂养早产儿中的应用

目的 通过前瞻性对照试验评价强化母乳对住院早产儿短期生长、营养状况的影响.方法 出生胎龄≤34周、出生体重≤1 800 g的24例早产儿分为强化母乳组(试验组,11例)和早产配方奶组(对照组,13例).试验组早产儿的母乳喂养量均超过总奶量的50%,当喂养量达到100 ml/(kg·d)时开始添加FM85母乳强化剂,不够的奶量用早产配方奶补足;对照组全部用早产配方奶喂养.对两组的生长速度、血生化指标、肠内外营养情况、合并症进行比较.结果 试验组出生胎龄(30.6±2.9)周,平均出生体重(1 80±286)g;对照组出生胎龄(31.6±1.9)周,平均出生体重(1 436±201)g.试验组在住院期间,平均母乳量占总喂养量81.6%,母乳强化剂在平均胎龄34.1周、生后24.6 d时开始添加.试验组与对照组的体重[18.9 vs 7.1 g/(kg·d),P=0.364]、身长(1.16 vs .00 cm/周,P=0.308)、头围(0.79 vs .61 cm/周,P=0.057)的增长速度近似,差异无统计学意义.出院时两组血尿素氮水平相似,试验组血清白蛋白、前白蛋白、血磷水平较对照组低,血清碱性磷酸酶和血钙值较对照组高,喂养不耐受、坏死性小肠结肠炎、院内感染的发生率无统计学意义.结论 强化母乳喂养与早产配方奶喂养的早产儿在住院期间的生长速度相似.     

人乳与早产儿配方乳喂养对早产儿生长的Meta分析

目的对单纯人乳、强化人乳和早产儿配方乳喂养早产儿的生长进行评价。方法检索PubMed、ScienceDirect、EBSCOHost 、EMBASE 、OVID 、Cochrane图书 馆、维普中文科技期刊数据库和中国期刊全文数据库,并手工检索会议记录和专 题论文集等,收集关于单纯人乳、强化人乳与早产儿配方乳喂养早产儿的RCT研究 ,进行文献筛选和质量评价,采用RevMan 5.0.18软件进行Meta分析,计量资料采 用加权均数差（WMD）及其95％CI表示。无法进行合并分析的资料进行描述性分析 。结果共纳入7篇文献,文献质量评价5篇为B级,2篇为C级。Meta分析结果显示：① 对近期生长的影响：单纯人乳喂养组新生儿期体重增加速度（WMD＝-6.03,95％ CI：-9.58～-2.47,P=0.000 9）、身长增长速度（WMD＝-1.96,95％CI：-2.77 ～-1.16,P<0.000 01）及头围增长速度（WMD＝-2.04,95%CI：-3.71～-0.37, P=0.02）均显著慢于早产儿配方乳喂养组;强化人乳喂养组新生儿期体重、身长和 头围的增长速度与早产儿配方乳喂养组差异均无统计学意义。②对远期生长的影 响：单纯人乳喂养组与早产儿配方乳喂养组随访至9和18个月,以及7.5~8岁时的 体重、身长（高）和头围的差异均无统计学意义。结论现有证据提示,强化人乳喂养可促进早产儿生后近期内生长,单纯人乳和强 化人乳对早产儿远期生长的影响仍需进一步研究。     

Neonatal hypercalcemia in preterm infants fed with human milk

Hypercalcemia (serum Ca greater than or equal to 2.83 mmol/l) was detected in 10 premature infants (gestational age: 31-37 weeks and birthweight: 1100-1950 g). All were fed with pooled human breast milk. Urinary Ca excretion was high (greater than 0.200 mmol/kg/24 h) in all but one infant while serum phosphorus (P) concentration and urinary P excretion were low. Serum immunoreactive parathyroid hormone and plasma 25-hydroxyvitamin-D concentrations were normal. A significant positive correlation was found between serum Ca concentration and urinary Ca excretion, and a negative correlation between serum Ca concentration and serum P concentration or urinary P excretion. Hypercalcemia disappeared spontaneously in two patients, was corrected by a humanized milk in three patients and by P supplementation in five patients. These data suggest that neonatal hypercalcemia is related to P depletion induced by human breast milk in premature infants.     

Fortified preterm human milk for very low birth weight infants.

We studied the nutritional effects of two types of human milk fortifiers for very low birth weight infants. These studies suggest that fortified human milk provides nutritional advantages for very low birth weight infants. However, providing calcium and phosphorus with supplementation is necessary for the improvement of bone density.