INFLUENCE OF FORMULA CONCENTRATION ON CALORIC INTAKE AND GROWTH OF NORMAL INFANTS

ABSTRACT: Fomon, S. J., Filer, L. J., Jr, Thomas, L. N., Anderson, T. A. and Nelson, S. E. (Department of Pediatrics, University Hospital, University of Iowa, Iowa City, USA). Influence of formula concentration on caloric intake and growth of normal infants. Acta Paediatr Stand, 64:172, 1975.–Fifteen fullterm female infants were enrolled in each of two feeding groups and all but one completed the proposed period of observation to age 112 days. Formulas prepared from the same ingredients (fat-free milk solids, a mixture of corn and coconut oils, lactose, vitamins and minerals) were fed ad libitum to both groups. Formula concentration was 54 kcal/100 ml for one group and 100 kcal/100 ml for the other. A limited selection of commercially prepared strained foods was permitted after 28 days of age. Weighed intakes of food were recorded for each day of study. During the interval 8 through 41 days of age, the infants fed the 54 kcal/100 ml formula consumed a considerably greater quantity of food but fewer calories than did those fed the 100 kcal/100 ml formula. Those fed the 54 kcal/100 ml formula also gained less weight. These differences between feeding groups were statistically significant. After 41 days of age, mean caloric intakes (kcal/kg/day) and rates of gain in weight were similar for the two feeding groups. The data provide a basis for speculation on the possible difference in allocation of calories to growth and non-growth in the two groups.     

REQUIREMENTS FOR PROTEIN AND ESSENTIAL AMINO ACIDS IN EARLY INFANCY1Studies with a Soy-Isolate Formula

Thirteen normal female infants were observed from 8 through 111 days of age while receiving a diet providing 1.62 g of protein per 100 kcal, almost entirely from soy-isolate. Clinical observations, growth rates and serum concentrations of albumin were similar to those of female infants fed milk-based formulas providing greater intakes of protein. On the basis of these findings, it is assumed that the requirements for protein and essential amino acids of these infants were no greater than the amounts consumed. Reasons for preferring to express requirements for proteins and amino acids per unit of calorie intake rather than per unit of body weight are presented. The preliminary estimates of requirements presented here are believed applicable when the diet is adequate in total calories and non-nitrogenous essential nutrients, nitrogen is provided primarily in the form of whole proteins, and protein intakes do not greatly exceed the requirement. For reasons discussed, the approach is likely to yield estimates of requirements for some amino acids that are substantially greater than the true requirements. Nevertheless, our estimates of requirements for isoleucine and methionine are distinctly less than those reported by Holt & Snyderman. We conclude that the estimates of Holt & Snyderman from studies of infants fed mixtures of amino acids are less relevant than our estimates to circumstances in which whole proteins are fed in amounts that do not greatly exceed the requirement for protein.     

The Noncoronary Cusp as a Site for Successful Ablation of Accessory Pathways: Electrogram Characteristics in Three Cases

Noncoronary Cusp Accessory Pathway Ablation . Radiofrequency ablation is the treatment of choice to cure symptomatic patients with atrioventricular accessory pathways (APs). Septal APs are challenging because of the proximity of the normal conduction system. In some patients, despite aggressive lesion creation on the right anteroseptal region pathway, ablation is unsuccessful. We report 3 cases where the successful ablation site was in the noncoronary cusp of the aortic valve and discuss possible defining features of this variant of septal APs and an approach for successful ablation. (J Cardiovasc Electrophysiol, Vol. 22, pp. 203‐209, February 2011)     

Severe Subaortic Stenosis in Interrupted Aortic Arch in Infancy and Childhood

Thirteen out of a total 50 infants with interrupted aortic arch (IAA) seen between 1979-1988 had or developed severe subaortic stenosis (SAS). One had type A interruption and 12 type B. All had a large ventricular septal defect (VSD). The infundibular septum was displaced posteriorly in eight infants, severely narrowing the left ventricular outflow tract (LVOT). Three had fibromuscular narrowing of the LVOT, one each a subaortic muscle bar and membrane. The aortic root and subaortic area were small and measured between 3-8 mm. An anomalous right subclavian artery was noted in eight of the 12 type B IAA, the anomalous vessel arising from the descending aorta in seven. Thirteen infants with IAA and SAS were submitted to surgery, 12 having their subaortic area resected with three perioperative deaths early in the series and three late deaths where active treatment was ceased, including one infant with renal dysplasia who had had a successful establishment of arch continuity and pulmonary artery banding. Of the seven survivors, six have residual Doppler gradients of between 20-50 mmHg, two requiring a second resection and one a third resection. Alternate management programs are suggested based on anatomical evaluation and echocardiography. Any newborn presenting with IAA requires careful evaluation of the subaortic area, best seen on cross-sectional echocardiography. The improved surgical survival in infants following complete repair of IAA has led this important associated anomaly of subaortic stenosis to assume greater importance as a cause of mortality and long-term morbidity.     

Anaesthesia for extracorporeal shock wave lithotripsy

The anaesthetic considerations of patients presenting for extracorporeal shock wave lithotripsy are described. Regional anaesthesia with sedation may be preferable to general anaesthesia for patients undergoing this form of therapy. If regional anaesthesia is contra-indicated, general anaesthesia using controlled ventilation with muscle relaxation, supplemented with a narcotic and a low concentration of volatile anaesthetic has been found to be a suitable alternative. The additional epidural preparation time has to be balanced against the benefits of easier patient transfer, especially during multi-stage procedures, and better postoperative analgesia. The epidural catheter can be left in situ in patients who require multiple treatments or who may experience severe ureteric pain as the resulting 'sand mass' is passed. Epidural space localisation using a 'loss of resistance to saline' technique is recommended, in order to avoid the possible risk of damage to the spinal cord and emerging nerves (due to the presence of an air-water interface). Patients with cardiac insufficiency need special consideration, in view of the effects of immersion on right and left heart filling pressures.     

Conservation-withdrawal reaction in infancy? An underdescribed entity

Summary. Conservation-withdrawal is considered a biological non-pathological process subserving survival in circumstances which pose an extreme threat to an infant, child or adult. Although initially described in an infant, its reported frequency in that age group seems sparse. Four infants are described, three of whom presented with weight loss. Despite their mothers' assertions that their breast feeding was adequate, the three infants gained weight rapidly on complementary feeding and became more responsive. Previously they had passively accepted sub-optimal intakes, crying little and sleeping excessively. When their initial crying and objection went unheeded, they seemed to pass into a conservation-withdrawal state, conserving their energies, biologically adapting to their mothers' inability to provide adequate nutrition. These infants did not appear ill and investigations proved normal. With adequate feeding, rapid improvement was observed in their weight gain, activity and responsiveness with normal development. Their mothers' selective denial of their own inadequate breast supply resulted in their inability to perceive their infants appropriately, depriving them of their nutritional needs. Additional factors of emotional deprivation and neglect may have occurred in the fourth infant. The responses of these infants observed during their period of severe stress, may appropriately be characterised by Engel's conservation-withdrawal state.     

SYSTEMIC SALMONELLA INFECTIONS IN MAN CLINICAL AND BACTERIOLOGICAL STUDY

Several reports have been published from China on typhoid and paratyphoid A ana B fevers(I). Because of its relative prevalence and importance, typhoid fever naturally formed-either the main or the only thesis in those reports. Recently, however, considerable :interest has been given to human systemic infections with B. paratyphosus C, B. s"ipestifer and other members of the Salmonella group in addition to B. para:typhdsus A and B. It ;is infections with these organkrns as encountered in Peiping that we present in this communication, which we hope may be of some interest to the medical profession iri general.