高能量密度配方奶粉对紫绀型先天性心脏病患儿术后生长追赶的影响：前瞻性随机对照研究

目的 探讨高能量密度配方奶粉对紫绀型先天性心脏病（CHD）患儿术后生长追赶的影响。方法 前瞻性纳入2017年1~12月行外科手术的紫绀型CHD婴儿100例,随机分配至高能量组（术后给予高能量密度配方奶粉）和常规组（术后给予普通配方奶粉）,每组50例,随访观察6个月。观察指标包括术前、术后脱机拔管时、术后1个月、术后3个月、术后6个月的身高、体重、前白蛋白、N末端B型利钠肽原;计算年龄别身高Z评分（HAZ）、年龄别体重Z评分（WAZ）和身高别体重Z评分（WHZ）;同时记录两组不良反应。结果 术前高能量组和常规组分别有25例（50%）和21例（42%）营养不良,两组营养不良率差异无统计学意义（P > 0.05）。两组患儿术后6个月营养状况均有改善（P < 0.05）。术后6个月高能量组营养不良率低于常规组（18% vs 36%,P < 0.05）;高能量组WAZ < -2的比例低于常规组（P < 0.05）;高能量组营养不良患儿HAZ、WAZ、WHZ均高于常规组（P < 0.05）。两组患儿住院期间均未出现胃肠道不耐受。结论 高能量密度配方奶粉较普通配方奶粉更有助于紫绀型CHD患儿术后生长追赶。     

胆道闭锁Kasai术后自肝生存患儿体格发育Z评分

目的 本研究旨在对胆道闭锁Kasai术后自肝生存患儿的体格发育进行评价,了解胆道闭锁Kasai术后自肝生存患儿营养状况.方法 本研究采用横断面调查方式,于2014年10月至2015年1月对首都医科大学附属北京儿童医院普外科胆道闭锁Kasai术后自肝生存定期门诊复查的96例患儿进行体格测量(身高/身长、体重).采用WHO Anthro Plus 2007软件,计算年龄别身高/身长Z评分(Height for Age Z-score,HAZ)、年龄别体重Z评分(Weight for Age Z-score,WAZ)、身高别体重Z评分(Weight for Height Z-score,WHZ).统计我中心Ksasi术后自肝生存患儿生长迟缓、低体重、消瘦的患病率.采用方差分析或t检验,描述不同分组Z评分结果差异.结果 ①纳入研究的96例Kasai术后自肝生存患儿HAZ、WAZ、WHZ均值分别为-0.38±0.17、0.33±0.17、0.88±0.17;②生长迟缓(HAZ＜-2)患病率为14.58％(14/96),低体重(WAZ＜-2)患病率为5.21％(5/96),消瘦(WHZ＜-2)患病率为3.13％(3/96);③以年龄(月)分组,6～12个月组患儿HAZ、WAZ、WHZ均值均为负值,分别为-0.27±0.12、-0.55±0.37、-0.30±0.25;④以术时年龄(d)分组,＜60 d、60～90 d组患儿的WHZ均值均为正值,分别为1.08±0.27、0.85±0.25,＞90 d组患儿WHZ均值为负值,-0.26±0.24.结论①胆道闭锁Kasai术后自肝生存患儿存在营养不良问题,其中生长迟缓问题更为突出;②6～12个月组患儿HAZ、WAZ、WHZ均值均低于国际标准值(0),并且6～12个月组患儿WAZ、WHZ明显低于13～24个月组和≥25个月组,因此Kasai术后自肝生存患儿婴儿期营养状况尤其值得关注;③术时年龄＞90d组患儿WHZ明显低于＜60d组和60～90d组,所以尽早手术对于提升患儿术后营养状况有帮助.     

您想让您的宝宝健康成长吗?——向您推荐双工牌母乳化奶粉

双工牌母乳化奶粉(婴儿配方奶粉Ⅱ号)系以新鲜牛奶和进口乳清粉为主要原料,模拟人乳主要营养成份的组成,对牛奶中的蛋白质、脂肪,碳水化合物三大营养素的含量进行了调整,强化了多种维生素及铁、锌等微量元素而制成的一种新型婴儿主食品。双工牌母乳化奶粉较牛(羊)奶粉容易消化吸收,更符合婴儿生长发育的需要,且     

深度水解蛋白配方奶喂养对极低/超低出生体重儿生长发育的影响

目的探讨深度水解蛋白配方奶喂养对极低出生体重(VLBW)和超低出生体重(ELBW)婴儿生长发育的影响。方法选取VLBW和ELBW婴儿375例作为研究对象,根据随机数字表法将其分为观察组(n=187)和对照组(n=188)。观察组给予深度水解蛋白配方奶喂养,当喂养达10 mL/次后,改用标准早产儿配方奶喂养。对照组给予标准早产儿配方奶喂养。两组持续喂养4周,比较两组喂养不耐受发生率、达全肠道喂养时间、胎便排净时间、自主排便次数、生长发育情况、喂养后第4天和第10天胃动素水平以及感染发生情况。结果观察组喂养不耐受率低于对照组(P0.05);观察组达全肠道喂养时间和胎便排净时间均短于对照组(P0.05);观察组平均每日自主排便次数多于对照组(P0.05);观察组婴儿体重、头围和身长均大于对照组(分别是1 793±317 g vs 1 621±138 g、30.5±1.1 cm vs 30.0±1.6 cm和43.9±1.2 cm vs 42.1±2.0 cm;均P0.05);观察组婴儿喂养第4天和第10天胃动素水平均高于对照组(P0.05);观察组婴儿感染率低于对照组(P0.05)。结论深度水解蛋白配方奶可提高胃动素水平,增加胃肠道喂养耐受性,促进VLBW和ELBW婴儿早期生长发育,降低感染发生率。     

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目的初步分析3～6岁学龄前儿童血清视黄醇结合蛋白4(RBP4)与儿童身高(HT)、体重(WT)、年龄的身高的Z评分(HAZ)、年龄的体重的Z评分(WAZ)、身高的体重的Z评分(WHZ)、体重指数(BMI)及体重指数Z评分(BMIZ)的关系。方法 2010年10至12月采用整群抽样和分层抽样相结合的方法分别抽取成都市郫县花园镇8所幼儿园481名3～6岁学龄前儿童,测定WT、HT及血清RBP4水平。结果共370名完成检测,其中男188名,女182名;平均年龄(47.1±14.4)个月。偏相关分析显示,血清RBP4分别与WHZ、BMI和BMIZ存在明显正相关,偏相关系数r分别为0.18、0.21和0.20(P均<0.05);而与WT、HT、HAZ和WAZ则无明显相关性(P>0.05)。以各体格指标中位数为界,WHZ、BMI和BMIZ高组血清RBP4显著高于低组(P<0.05),而WT、HT、HAZ和WAZ高组与低组间RBP4差异无统计学意义(P>0.05)。以RBP4浓度的P25、P50及P75为界,仅BMIZ差异有统计学意义(P<0.05)。结论机体体脂成分影响学龄前儿童血清RBP4,而血清RBP4对体脂成分影响较小。     

终末期肾病慢性腹膜透析患儿贫血影响因素病例对照研究

目的 了解终末期肾病慢性腹膜透析(腹透)患儿贫血的影响因素。方法 回顾性分析2006年1月至2012年4月在复旦大学附属儿科医院（我院）肾脏风湿科登记并行长期规律腹透治疗患儿,腹透后建立随访档案,要求每3个月来我院随访1次,至少随访12个月,并行随访指标的检查。腹透开始前的基线随访指标以例数表现,腹透后随访指标中的计量计数指标（体检项目、实验室检查项目和感染情况）以例次表现,选取每3个月随访时间±3 d时Hb值判断贫血,如符合贫血诊断标准则该阶段随访指标纳入贫血组统计,反之纳入非贫血组统计。 单因素分析采用独立样本t检验,计数资料采用χ2检验,多因素分析采用Logistic回归分析。结果（1）符合本文纳入排除标准的32例患儿进入分析,开始腹透年龄(8.4±3.7)岁,开始腹透前30例（93.8%）存在贫血;开始腹透后共随访120例次,8例次失访,贫血组57例次（47.5%）,非贫血组63例次,贫血组Hb、红细胞压积均明显低于非贫血组。（2）单因素分析显示：①基本情况：贫血组与非贫血组相比,腹透时年龄、性别差异无统计学意义（P＞0.05）;②体检项目： BMI、收缩压、舒张压两组差异无统计学意义（P＞0.05）;③实验室检查项目：随访12个月,贫血组血清全段甲状旁腺激素（iPTH）水平高于非贫血组［(605±582) vs （386±434） pg·mL-1, P＜0.05］,血清iPTH在500~1 000 pg·mL-1患儿贫血的发生率显著高于iPTH＜500 pg·mL-1者（P＜0.05）;贫血组残肾Kt/V值低于非贫血组［（0.35±0.42）vs (0.62±0.63),P＜0.05］,左心肥厚的发生率高于非贫血组（62.5% vs 35.1%,χ2=5.758, P=0.016）;贫血组血清白蛋白、总Kt/V、总CrCL、残肾CrCL均低于非贫血组（P＞0.05）,血尿素氮、肌酐均高于非贫血组(P＞0.05);④ACEI使用率贫血组与非贫血组间差异无统计学意义（P＞0.05）;⑤贫血组元素铁剂量、促红细胞生成素（EPO）剂量均低于非贫血组［元素铁剂量：(3.5±1.9) vs (4.2±1.2) mg·kg-1·d-1; EPO:每周（134±66） vs (170±62) U·kg-1, P＜0.05］;⑥感染发生率贫血组高于非贫血组（35.1% vs 19.0%,P＜0.05）;（3）多元回归分析显示,血清iPTH水平、残肾Kt/V、感染与慢性腹透患儿的贫血具有相关性（P＜0.05）。结论 ①慢性腹透患儿血清iPTH水平、有无感染和残肾Kt/V与贫血具有相关性;②强调EPO、铁剂的个体化治疗,在高血清iPTH水平、感染等情况下,可能需要更大剂量的EPO、铁剂改善贫血;③应加强对慢性肾脏病患儿管理,重视肾性贫血的早期治疗。     

重型β地中海贫血患儿生长发育异常及其与铁超负荷的关系

目的：探讨重型β-地中海贫血患儿生长发育状态及其与铁超负荷的关系。方法：于2007年7~8月对50例长期在该院儿科定期输血的重型β 地中海贫血患儿进行身高、体重和性发育评价，并与1995年中国0~18岁儿童体重、身高百分位数参考值比较，同时检测输血前血常规、肝功能和血清铁蛋白水平。结果：24例（48%）重型β-地中海贫血患儿表现身材矮小，其中15例同时伴体重低下。≥10岁者21例，仅7例出现自发性青春期发育，Tanner II~III期；≥14岁者8例，其中4例尚无性征发育。身高低于第10百分位者（n=31）与身高高于第10百分位者(n=19)分组比较，前者血清铁蛋白水平显著增高（8 239.2±5 865.5 vs 5 028.1±3 885.7 mg/L, P<0.05），输血前Hb水平显著降低(68.2±12.3 vs 79.7±14.5 g/L, P<0.05) ，肝脏显著增大(P<0.05)。而体重低于第10百分位者（n=20）与体重高于第10百分位者（n=30）分组比较，前者仅血清铁蛋白水平差异具有显著意义（9 165.5±6 042.5 vs 5 567.3±4 447.3 mg/L, P<0.05）。结论：接受中等量输血和不正规除铁治疗的重型β-地中海贫血患儿常伴有身材矮小、体重低下和性发育迟缓，其生长发育异常与体内铁严重超负荷有关。     

深度水解乳清蛋白配方奶粉改善婴儿湿疹的临床观察

目的了解深度水解乳清蛋白配方奶粉改善小婴儿头面部湿疹的作用。方法采用随机对照开放研究,将配方奶粉喂养或以配方奶粉喂养为主的头面部湿疹婴儿随机分为治疗组和对照组。所有入选婴儿均针对湿疹进行基础治疗,同时治疗组婴儿的配方奶粉改换为深度水解乳清蛋白配方奶粉,而对照组婴儿仍为普通配方奶粉。评价并记录就诊当日,治疗第7、14、28天时的婴儿皮损情况。结果治疗第14天,治疗组婴儿的湿疹EASI 4级评分、疗效指数、治疗显效率和痊愈率均高于对照组,差异有统计学意义(P均<0.05);第28天,治疗组婴儿湿疹痊愈后复发率明显低于对照组,差异有统计学意义(P<0.05)。结论深度水解乳清蛋白配方奶粉能有效改善部分婴儿湿疹。[临床儿科杂志,2012,30(5):438-441]     

早产儿贫血的相关因素分析

目的：贫血是早产儿生后常见的现象，严重影响了早产儿的生长发育，甚至危及生命。目前早产儿贫血的病因尚不明确。该文通过回顾性病例对照研究，分析早产儿贫血的发生与各种围产因素的相关性。方法：收集北京大学第三医院儿科2005年1月至2006年12月两年期间生后24 h内收入新生儿病房的165例早产儿的临床资料数据，按是否发生贫血，分贫血组和对照组两组，进行与贫血有关的围产因素的分析。结果：165例早产儿中发生贫血63例，占总例数的38.1％。贫血组胎龄、出生体重明显低于对照组，分别为32.5±2.0 vs 33.7±1.9周，1 682.7±393.9 vs 2 041.1±510.1 g；而采血量、住院天数则明显高于对照组，分别为12.4±6.5 vs 6.6±3.6 mL/kg，25.6±14.2 vs 14.1±8.7 d，差异均有统计学意义(均P<0.01)；贫血组的危重患儿比例较对照组高(33.3% vs 9.8%)，差异有非常显著意义(P<0.01)；贫血组母亲先兆子痫比例较对照组高(44.4% vs 28.4%)，差异有显著意义(P<0.05)。多因素logistic回归分析显示早产儿贫血发生的危险因素为采血量，与采血量＜5 mL/kg组相比，5～10 mL/kg组OR值为1.737(95% CI：0.699~ 4.316)，P>0.05；10～15 mL/kg组OR值为4.141 (95% CI:1.573~10.905)，P<0.01；≥15 mL/kg组OR值为32.267(95% CI:8.053~129.287)，P＜0.01。结论：早产儿贫血与胎龄小、出生体重低、采血量大、住院时间长、病情重、母亲患先兆子痫多种因素有关，而采血量是早产儿贫血发生的危险因素，2周内采血量累计10～15 mL/kg组发生贫血的危险性是＜5 mL/kg组的4倍，≥15 mL/kg 组发生贫血的危险性是＜5 mL/kg组的32倍。     

国外儿童生长发育、营养指南介绍

儿童适宜生长监测应包括定期测量体质量、身长,并评价其生长速度,有助于鉴别儿童矮小、消瘦、超重等,以便及时干预;体质量指数(BMI)/age不是诊断工具,但可筛查体脂肪不正常积聚的儿童。2003年泛美卫生组织(PAHO)/WHO提出纯母乳喂养婴儿的10项原则中建议纯母乳喂养6个月后引入其他食物,继续母乳喂养至2岁。美国儿科学会(AAP)建议婴儿6个月左右逐渐引入富含铁的食物,以补充母乳不足,但不增加总能量的摄入和改变生长速度;纯母乳喂养婴儿2月龄后开始补充维生素(Vit)D至少200IU/d;人工喂养婴儿、儿童、青少年摄入配方奶量或VitD强化奶达500mL/d可满足VitD需要,否则亦应补充VitD至少200IU/d;有过敏高危史的婴儿应纯母乳喂养或喂低敏配方奶粉,或部分水解配方奶粉补充喂养;这些婴儿6个月后引入固体食物,1岁后食用其他奶制品,2岁后食用鸡蛋,3岁后食用花生、坚果、鱼等食物;纯母乳喂养婴儿4个月始补充铁;9～12月龄婴儿进行贫血筛查,增加1～5岁高危儿童的贫血筛查。     

Iron supplementation of iron-replete Indonesian infants is associated with reduced weight-for-age

BACKGROUND: General iron supplementation to prevent iron deficiency in infants who are iron sufficient when starting supplementation may adversely affect their health. OBJECTIVE: A secondary analysis to explore the effect of iron supplementation on iron-replete (IR; Hb > or =113 g/L and S-ferritin > or =33 microg/L) or non-iron-replete 6-month-old Indonesian infants participating in a large, randomized trial on iron and zinc supplementation. RESULTS: Among the iron-supplemented IR (Fe-IR, n = 80) infants S-ferritin was, compared to non-iron-supplemented (NS) IR infants (NS-IR, n = 74), significantly higher (47.5 vs. 20.7 microg/L, p = 0.04), and S-zinc significantly lower (9.7 vs. 10.5 micromol/L, p = 0.04). Haemoglobin concentration (Hb) did not differ between the Fe-IR and NS-IR groups. Change in weight-for-age z-score (WAZ) from 6 to 12 months and mean WAZ at 12 months was lower in the Fe-IR group compared to the NS-IR group (-1.45 vs. -1.03, p < 0.001 and -1.97 vs. -1.60, p < 0.001, respectively). There was no difference in morbidity between groups. Iron supplementation of non-iron-replete infants increased Hb and S-ferritin, but did not affect S-zinc or anthropometrical indices. CONCLUSION: In our study, iron supplementation of IR infants affected WAZ adversely, whereas iron supplementation to non-iron-replete infants did not affect growth. These results support a cautious approach to iron supplementation of IR infants.     

维生素A联合其他微量营养素干预对铁代谢稳态的影响

目的 观察维生素A、维生素A+铁和7+1多种微量营养素联合补充对学龄前儿童铁代谢稳态的影响.方法 研究为随机、互相对照、盲法现场干预试验.采用分层与整群抽样相结合的方法从该地区随机选取3所幼儿园全部226名2～7岁学龄前儿童纳入计划干预对象,分别补充100％ RNI的维生素A、维生素A+铁和“7+1”维生素A、铁、维生素B1、核黄素、叶酸、尼克酸、锌和钙.干预前后分别采用氰化高铁法测定全血中血红蛋白含量,反相高效液相色谱法( HPLC)测定血清视黄醇浓度,酶联免疫定量检测法测定血清铁蛋白(serum ferritin,SF),微粒子增强透射免疫法检测可溶性转铁蛋白受体(soluble transferrin receptor,sTfR),并计算sTfR-SF指数(TFR-F指数)及机体总铁含量;同时利用问卷方式调查这些儿童的人口学资料、社会经济状况以及饮食习惯等.结果 完成干预试验儿童共有226名,平均年龄(均数±标准差)为(4.0±0.85)岁.贫血发生率为23.5％,储铁不足发生率为15.0％,维生素A缺乏以及边缘型维生素A缺乏发生率分别是6.3％和25.9％.干预后6个月各组SF水平均较干预前下降(x2=8.3298,x2=16.1471,x=15.1371,P均＜0.01),而维生素A+铁组和“7+1”多种微量营养素组下降最为明显(x2=16.1471,x2=15.1371,P均＜0.05).干预后各组sTfR水平均出现降低(x2=15.1171,x2=5.2617,x2=4.8844,P均＜0.01),尤以维生素A组最明显(x2 =15.1171,P＜0.05);维生素A组TFR-F指数以及机体总铁含量在干预前后无明显变化(t =0.1817,t=1.7736,P均＞0.05),而维生素A+铁组和“7+1”多种微量营养素组的TFR-F指数明显下降、机体总铁含量明显增加(t=5.3561,t=6.5979,t=11.1663,t =8.7306,P均＜0.05).结论 单独维生素A补充对铁动员和铁利用均有明显影响,但对铁在肠道的吸收作用不明显;维生素A联合铁剂或“7+1”多种微量营养素的补充比单独维生素A可更好地改善学前儿童铁缺乏.     

Interactions between Infections, Malnutrition and Ironnutritional Status in Pakistani Infants A Longitudinal Study

The interactions between infections, malnutrition and poor iron nutritional status in infants at weaning ages are poorly defined. Therefore, four groups of infants from an area with a high incidence of malnutrition (Lahore, Pakistan) were enrolled in a prospective, randomized nutritional intervention study. Between 122 and 365 days of age, the infants from one community received either a milk cereal without iron fortification ( n = 29), a milk cereal fortified with ferrous fumarate (7.5 mg/100 g; n = 30), or a milk cereal fortified with ferric-pyrophosphate (7.5 mg/100 g; n = 27). Forty-four infants from a neighbouring community did not receive a nutritional supplement and served as the control group. Calculated mean daily energy- and protein intake with the cereals was between 259–287 kcal, and 9.6–10.6 g at 12 months of age, respectively. Mean daily iron intake with the fortified cereals was between 4.1–5.1 mg at corresponding age. Nutritional supplementation resulted in significantly lower incidence of malnutrition and heigher weight gain. Incidence of acute diarrhoea was significantly ( p <0.05) lower in the supplemented groups. The infants fed the iron-fortified milk cereals had significantly higher hemoglobin (mean 10.4 vs. 9.8 gdl^-1) and serum ferritin (mean 13.3 vs. 8.5 ngml^-1) values than the infants fed the non-fortified milk cereals. However, no differences in the incidence of infections were found between the supplemented groups. It is concluded that poor nutritional intake between 122 and 365 days of age substantially contributed to the high incidence of diarrhoea and malnutrition in Pakistani infants.     

Lactoferrin in the preterm infants' diet attenuates iron-induced oxidation products

Free radical injury is thought to play a significant role in the pathogenesis of several disease processes in low birth weight premature infants including retinopathy of prematurity and necrotizing enterocolitis. Because iron is a known catalyst in free radical-mediated oxidation reactions, the objectives of the present in vitro studies were to determine whether after exposure to air 1) iron present in infant formula, or that added to human milk or formula as medicinal iron or as iron contained in human milk fortifier, increases free radical and lipid peroxidation products; and 2) recombinant human lactoferrin added to formula or human milk attenuates iron-mediated free radical formation and lipid peroxidation. Before adding medicinal iron to formula and human milk, significantly more ascorbate and alpha-hydroxyethyl radical production and more lipid peroxidation products (i.e. thiobarbituric acid reactive substances, malondialdehyde, and ethane) were observed in formula. After the addition of medicinal iron to either formula or human milk, further increases were observed in free radical and lipid peroxidation products. When iron-containing human milk fortifier was added to human milk, free radicals also increased. In contrast, the addition of apo-recombinant human lactoferrin to formula or human milk decreased the levels of oxidative products when medicinal iron or human milk fortifier was present. We speculate that the presence of greater concentration of iron and the absence of lactoferrin in formula compared with human milk results in greater in vitro generation of free radicals and lipid peroxidation products. Whether iron-containing formula with lactoferrin administered enterally to preterm infants will result in less free radical generation in vivo has yet to be established.     

Mineral balance and whole body bone mineral content in very low-birth-weight infants

Fat and mineral metabolic balance studies were performed in 25 normal very low-birth-weight infants ( 1500 g at birth) fed either pooled pasteurized human milk supplemented with calcium, phosphorus and magnesium, or a preterm formula. Calcium, phosphorus and magnesium intake were similar in both groups and averaged 100mg/kg/day, 72 mg/kg/day and 8 mg/kg/day, respectively. Calcium and phosphorus retention was higher in the subjects fed fortified human milk than in those receiving a preterm formula (65±14 and 62±9mg/kg/day versus 55±12 and 47±7mg/kg/day respectively). The difference was only significant for phosphorus. Magnesium retention was similar in the two groups and averaged 3 mg/kg/day. Fat intake and absorption was significantly higher in the preterm formula fed group than in the one fed fortified human milk (5.5±0.4 g/kg/day and 88±4% versus 4.2±1 g/kg/day, 79±6% respectively). Assessment of the whole body bone mineral content by dual energy X-ray absorptiometry was performed at 3 and 6 months of age in another group of 25 low-birth-weight infants fed either fortified human milk or a preterm formula. Whole body bone mineral content (BMCt) was low (43.3±30.8 g of hydroxyapatite) at 3 months of age (theoretical term) compared to normal full-term newborns at birth. There was no significant influence of the diet. At 6 months of age, BMCt reached 168.6±36.6g, a value similar to that of full-term newborns, with no significant difference between the two regimen groups. The deficit in the 12 subjects who had a BMCt under 30 g at 3 months of age had been corrected at age 6 months. Premature babies fed a pooled pasteurized human milk enriched with calcium, phosphorus and magnesium favored a better retention of calcium and phosphorus. However, no significant influence of the two diets studied was observed on the gain in BMCt over the first 6 months of life.     

Supplementation of an adapted formula with bovine lactoferrin. 2. Effects on serum iron, ferritin and zinc levels

Breast milk provides an excellent supply of most nutrients for newborn infants. Infant formulae should be nutritionally comparable to breast milk especially with regard to critical nutrients like iron and other trace elements. Infant formulae supplemented with various amounts of bovine lactoferrin were given to two groups of infants. These infants were compared with infants receiving unsupplemented formula and breast-fed infants. The effects of these diets on levels of haemoglobin, haematocrit, serum iron, ferritin and zinc were examined for a study period of 150 days. At birth, concentrations of iron, haemoglobin, haematocrit and zinc were comparable in all four feeding groups. The fact that the serum zinc level was not altered by lactoferrin supplementation appears to rule out an in-vivo effect of lactoferrin on zinc nutrition of infants. Ferritin levels of breast-fed infants were significantly higher than in non-supplemented formula-fed infants at day 30 and day 90. This difference was seen only at day 30, when comparing breast-fed infants to lactoferrin-supplemented formula-fed infants. Comparing the infants receiving formulae, the formula supplemented with the higher amount of bovine lactoferrin induced significantly higher serum ferritin levels compared to the unsupplemented formula at day 90 and day 150. These observations favour the idea that lactoferrin may be involved in iron absorption. Since this effect was pronounced only after 90 days, it has to be discussed as to whether this effect is a convincing argument for supplementing infant formulae with bovine lactoferrin.     

Growth, biochemical status, and mineral metabolism in very-low-birth-weight infants receiving fortified preterm human milk

We compared the growth, biochemical status, and mineral status of 30 very-low-birth-weight infants randomly assigned to receive preterm human milk (Group I, 10 infants) from their own mothers, fortified preterm human milk (Group II, 8 infants), or a high-caloric-density premature formula (Group III, 12 infants). Added to the infant's own mother's milk, a human milk fortifier at full strength provided additional protein (60:40 whey/casein, 0.7 g/dl), calories (4 kcal/oz), and minerals. Volume of intake, feeding tolerance, and complications were similar in the three groups. Infants receiving fortified preterm human milk showed growth, biochemical status, and mineral status similar to those receiving high-caloric-density formula, but infants receiving fortified preterm human milk grew faster (12.0 +/- 3.2 vs. 8.9 +/- 1.1 days/300 g, p less than 0.05), had higher serum protein (4.6 +/- 0.5 vs. 4.2 +/- 0.2 g/dl, p less than 0.05), and tended to have better mineral status (higher serum calcium, lower alkaline phosphatase, and higher serum phosphorus, none individually significant) than infants receiving preterm human milk alone. This study supports previous observations that fortified preterm human milk provides nutritional advantages for very-low-birth-weight infants.     

Bioavailability of iron in soy-based formula and its effect on iron nutriture in infancy

Soy products have been reported to inhibit absorption of nonheme food iron and fortification iron. Iron bioavailability from a soy formula (Prosobee-PP 710) (iron added as ferrous sulfate: 12 mg/L; ascorbic acid: 54 mg/L) was examined in 16 adult women using the extrinsic radioactive tag method. The geometric mean absorption from the soy formula was only 1.7%. The effect of this formula on iron nutrition in infants was studied in 47 healthy term infants weaned spontaneously before 2 months of age and who received the formula ad libitum until 9 months of age. For control, 45 infants received a cow's milk formula fortified with ferrous sulfate (iron: 15 mg/L; ascorbic acid: 100 mg/L), which has been shown to be effective in preventing iron deficiency, and 49 additional breast-fed infants were also followed. All babies received solid foods (vegetables and meat) starting at 4 months of age. Iron nutritional status was determined at 9 months. Infants fed soy formula and iron-fortified cow's milk had similar mean values of hemoglobin, mean corpuscular volume, transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin; both formula groups differed significantly (P less than .05) from the breast-fed group in all measurements except free erythrocyte protoporphyrin. Anemia (hemoglobin less than 11 g/dL) was present in only 4.3% and 2.2% of infants receiving the soy and the fortified formulas, respectively, v 27.3% in the breast-fed group. These results indicate that soy formula, in spite of the lower iron bioavailability when measured in adults, is essentially as effective as iron-fortified cow's milk in preventing iron deficiency in infants.     

Iron nutritional status in preterm infants fed formulas fortified with iron.

AIMS: To prospectively evaluate the iron nutritional status of preterm infants fed either a term (0.5 mg/dl iron) or preterm (0.9 mg/dl) formulas fortified with iron after hospital discharge. METHODS: Healthy low birthweight preterm infants were randomly assigned into three groups at the time of hospital discharge. Group A were fed an iron fortified preterm formula (0.9 mg/dl iron) until 6 months corrected age; group B, a fortified term formula (0.5 mg/l iron) until 6 months corrected age group C, the preterm formula between hospital discharge and term, then the term formula until 6 months corrected age. RESULTS: Seventy eight infants were followed up to 6 months corrected age. Iron intake from formula differed significantly between the groups (A, 1.17 mg/kg/day (SD 0.32) > C, 0. 86 mg/kg/day (SD 0.40) = B, 0.81 mg/kg/day (SD 0.23); p < 0.0001). Haemoglobin concentrations were similar to those of iron sufficient preterm infants of the same postnatal age, and term infants of the same postmenstrual age (after 3 months of age). There were no significant differences in haemoglobin concentration (p = 0.391), plasma ferritin (A vs B, p = 0.322), or in the incidence of iron deficiency (A vs B, p = 0.534). CONCLUSIONS: Iron fortified formulas containing between 0.5 and 0.9 mg/dl iron seem to meet the iron nutritional needs of preterm infants after hospital discharge.