Iodine status remains critical in mother and infant in Central Anatolia (Kayseri) of Turkey

Summary. Background: Severe iodine deficiency disorders have been eradicated in many parts of the world, but milder forms still exist and may escape detection. Turkey has long been known to be a mild to moderate iodine deficiency area. Aim of the study: The aim of this study was to assess the iodine nutritional status and the thyroid function of pregnant women and their neonates in the region of Kayseri (central Anatolia of Turkey) that appeared to be iodine deficient in previous studies performed before the introduction of mandatory salt iodization. Methods: A cross-sectional voluntary screening study was performed in the Maternity Unit of a university hospital. A total of 70 mothers and their healthy full-term neonates were included in this study. Urinary iodine concentration was estimated in spot urine samples obtained from mothers and their neonates on day 5. All the neonates were breastfed. The iodine content was determined in the breast milk of all mothers on day 5. Serum concentrations of TSH, thyroglobulin (Tg), free triiodothyronine (FT3) and free thyroxine (FT4) were investigated in the cord serum of neonates and compared to those of mothers immediately after parturition Results: The median urinary iodine on day 5 in mothers and their babies were 30.20 and 23.80 µg/l, respectively. These figures are much lower than normal for these age groups (150–200 µg/l). The median iodine content of breast-milk was 73 µg/l. It is again much lower than in iodine sufficient areas, indicating that the status of iodine nutrition of pregnant and lactating women is clearly insufficient. The median concentrations (and ranges) of neonatal TSH, Tg, FT3 and FT4 were 7.44 mU/l, 71.62 ng/ml, 1.30 pg/ml and 1.34 ng/dl respectively. The corresponding levels for the mothers during labor were 2.19 mU/l, 25.65 ng/ml, 1.31 pg/ml and 1.23 ng/dl respectively. The median neonatal serum concentrations of TSH and Tg were significantly higher than the corresponding maternal levels (P < 0.0001, P < 0.0001, respectively) and 27.1% of the neonates had serum TSH concentrations above 10 mU/l and 57.1 % had cord blood serum Tg concentrations above 54 ng/ml. None of the mothers showed TSH concentrations above 5 mU/l and 41.4% had serum Tg concentrations above 30 ng/ml. Conclusion: Iodine deficiency with low urinary iodine excretion and high serum Tg and TSH concentrations were recognized among pregnant women and their babies in Kayseri in spite of the program of salt iodization. National measures are urgently required for improving the correction of iodine deficiency in Turkey. This includes regular supplementation with iodine, starting at preconception or in early pregnancy and continuing during the period of nursing in this region.     

Persistent effects of early infant diet and associated microbiota on the juvenile immune system

Early infant diet has significant impacts on the gut microbiota and developing immune system. We previously showed that breast-fed and formula-fed rhesus macaques develop significantly different gut microbial communities, which in turn are associated with different immune systems in infancy. Breast-fed animals manifested greater T cell activation and proliferation and harbored robust pools of T helper 17 (T_H17) cells. These differences were sustained throughout the first year of life. Here we examine groups of juvenile macaques (approximately 3 to 5 y old), which were breast-fed or formula-fed in infancy. We demonstrate that juveniles breast-fed in infancy maintain immunologic differences into the fifth year of life, principally in CD8⁺ memory T cell activation. Additionally, long-term correlation networks show that breast-fed animals maintain persistent relationships between immune subsets that are not seen in formula-fed animals. These findings demonstrate that infant feeding practices have continued influence on immunity for up to 3 to 5 y after birth and also reveal mechanisms for microbial modulation of the immune system.     

UGT1A1 G71R 基因多态性对母乳性黄疸程度的影响

目的探讨葡萄糖醛酸转移酶UGT1A1 G71R基因突变对晚发型母乳性黄疸患儿黄疸程度的影响。方法收集晚发型母乳性黄疸患儿56例,用套式PCR后限制性片段长度多态性分析(RFLP)确定UGT1A1 G71R基因型,通过全自动生化分析仪测定胆红素水平。结果UGT1A1 G71R突变纯合子5例,杂合子24例,野生型27例。UGT1A1 G71R等位基因频率为30.36%。UGT1A1 G71R纯合子或杂合子组(n=29)与UGT1A1G71R野生组(n=27)的胆红素水平分别为(237.85±31.92)μmol/L、(214.49±32.48)μmol/L,前者明显高于后者(t=2.7141,P=0.0089)。结论晚发型母乳性黄疸患儿如存在UGT1A1 G71R基因突变,临床上黄疸程度较重。     

Zinc Deficiency in Nursing Infants

Zinc deficiency during nursing can occur even in breast-fed infants. Zinc reserves accumulated during fetal development modulate the infant’s susceptibility to zinc deficiency. Improvement of maternal zinc nutrition during pregnancy is the key for infant’s zinc nutritional support and prevention of low-for-lactation-age zinc concentrations of breast-milk.     

枯草杆菌、肠球菌二联活菌多维颗粒剂联合鲁米那钠治疗母乳性黄疸临床观察

目的:观察枯草杆菌、肠球菌二联活菌多维颗粒剂联合鲁米那钠治疗母乳性黄疸的疗效。方法:将60例母乳性黄疸患儿随机分为Ⅰ、Ⅱ组,各30例患儿。两组均维持母乳喂养,Ⅰ组同时给予枯草杆菌、肠球菌二联活菌多维颗粒剂及鲁米那钠治疗;Ⅱ组仅用鲁米那钠治疗。两组患儿均治疗7至14天,观察其黄疸消退情况、治疗前及治疗7天后血清胆红素水平变化。结果:服药后3天两组患儿黄疸均开始减轻,7天时I组33%、Ⅱ组20%的患儿黄疸消失;第14天时Ⅰ组93%、Ⅱ组63%的患儿黄疸消失。用药前,两组患儿血清胆红素水平无明显差异(P>0.05),用药7天后Ⅰ组胆红素水平较Ⅱ组明显降低(P<0.05)。结论:对母乳性黄疸患儿,联合使用枯草杆菌、肠球菌二联活菌多维颗粒剂及鲁米那钠,对改善症状和降低血清胆红素水平优于单用鲁米那钠,疗效显著。     

Plasma and breast milk concentrations of dothiepin and northiaden in lactating women

Plasma and breast-milk concentrations of dothiepin and its metabolite northiaden were measured in 20 lactating women receiving the drug for post-partum depression. Samples were collected at steady-state and both compounds quantitated by HPLC. Doses of dothiepin varied from 75 mg/day to 225 mg/day. Accordingly a wide range of plasma and breast-milk concentrations of dothiepin and northiaden were determined. Most determinations were made for women receiving 150 mg/day. At this dose mean (± SD) plasma concentrations of dothiepin and northiaden were 56(±27)m?g/l and 72(±79)m?g/l respectively while breast-milk concentrations were 95(±71) m?g/l and 40(±29) m?g/l for dothiepin and northiaden respectively. The data reflect the well recognised inter-individual variability in plasma concentrations for subjects receiving the same oral dose. Similar variability was noted in breast-milk concentrations at all doses of dothiepin. Dothiepin passes into the breast-milk of lactating women receiving the drug for post-partum depression. In this respect the drug is similar to other tricyclic antidepressants. The inter-individual variability of results recorded here suggest the need to determine drug concentrations on an individual basis before reaching a decision about breastfeeding. Perceived side effects in the infant are clear criteria for cessation of breastfeeding; high levels of drug in breastmilk where the infant is unaffected, warrant monitoring in view of our inadequate knowledge regarding long term effects of these drugs.     

Effects of brief exposure to water, breast-milk substitutes, or other liquids on the success and duration of breastfeeding: a systematic review

AIM: To systematically evaluate the effect of supplemental fluids or feedings during the first days of life on the overall breastfeeding duration and rate of exclusive breastfeeding among healthy infants. METHODS: Medical subject headings and free-language terms were used to search the following electronic databases for studies relevant to breastfeeding: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library, and La Leche League. Only randomized, controlled trials (RCT) were considered for study inclusion. RESULTS: Of 56 potentially relevant clinical trials identified, only one RCT (170 infants) met the inclusion criteria for this systematic review. In this study, formula feeding was significantly more frequent at 4 wk in the experimental group in which breastfeeding had been supplemented with 5% glucose ad libitum during the first 3 d of life (n = 83) than in the exclusively breastfed control group (n = 87) (p < 0.05). At 16 wk (5 mo postpartum), the percentage of mothers who continued breastfeeding, either exclusively or partially, was significantly lower in the experimental group than in the control group (p < 0.01).Conclusion: There remains considerable uncertainty about the effect of brief exposure to water, breast-milk substitutes, or other liquids on the success and duration of breastfeeding.     

The Nutritional Role of Breast-Milk IgA and Lactoferrin

ABSTRACT. The nutritional enigma concerning the extent to which breast-milk immune proteins are digested has been investigated by measuring the intakes and faecal outputs of IgA and lactoferrin over 7 days in 10 exclusively breast-fed (BF) and 9 formula-fed (FF) fullterm infants at 6 and 12 weeks post-partum. BF outputs (mg/day) greatly exceeded FF values ( p <0.001): at 6 weeks secretory-IgA BF=160±28, FF=14±2, lactoferrin BF=M±2, FF=0.9±0.1; at 12 weeks secretory-IgA BF=94±17, FF=25±5, lactoferrin BF=7±1, FF=1±0.3. Secretory-IgA represented 42% and 27% of BF faecal protein at 6 and 12 weeks compared with 6% for FF infants at both ages. BF secretory-IgA outputs were highly correlated with intakes ( r =0.83, p <0.001). IgA and lactoferrin outputs and the presence of faecal secretory-IgA fragments in BF and FF infants were influenced by defaecation rate, suggesting that partial degradation occurred in the large intestine. By 6 weeks post-partum only 1% lactoferrin and 17% secretory-IgA intakes appeared in the faeces and 95% breast-milk protein could be regarded as nutritionally available. The elevated BF outputs of IgA and lactoferrin relative to endogenous excretion suggest, however, that breast-milk may still make a considerable contribution to intestinal defence mechanisms after the neonatal period despite the small proportion of daily intake which escapes digestion. The protective action of IgA and lactoferrin may also depend on their site of degradation and the nature of fragments.     

Hepatitis C virus RNA present in saliva but absent in breast-milk of the hepatitis C carrier mother

In order to examine whether saliva and breast-milk are mediators of the vertical transmission of hepatitis C virus (HCV) from an HCV carrier mother, serum, saliva, and breast-milk samples from 11 HCV carrier mothers were collected at the time of delivery, and at approximately 1- to 3-month intervals for as long as 30 months postpartum. Serum was also sampled from their children. All samples were analysed for the presence of HCV RNA, using the nested polymerase chain reaction method. No HCV RNA was detected in any breast-milk samples. In saliva, HCV RNA was detected in four of the 11 mothers (36%). These four mothers also had liver function abnormalities. Hepatitis C virus RNA was not detected in any serum samples of the children, and all children had normal liver function. The children were monitored for periods from 2 to 44 months. During this period, there was no evidence of virus transmission. Breast-milk is not likely to be a source of mother-to-child transmission of HCV. Maternal saliva may harbour HCV, but it may not result in infant infection.     

Breastfeeding Practices and Associated Factors in Shanghai: A Cross-Sectional Study

The status of breastfeeding practices remains unsatisfactory across China, but regional differences persist. However, disaggregated data for specific provinces are limited. This representative survey determined the status of breastfeeding and factors associated with breastfeeding practices in Shanghai. The questionnaire was designed in compliance with indicators for assessing infant and young child-feeding practices defined by the World Health Organization and the United Nations Children’s Fund (UNICEF). A total of 2665 children aged two years and younger (0–730 days) were investigated, among whom 1677 were aged under six months. The early initiation of breastfeeding (EIBF) rate was 60.3%. Among children aged under six months, 43.4% were exclusively breastfed (EBF). The univariate regression analysis showed that the EBF rate was influenced by multiple factors, including individual, socioeconomic, workplace and employment, and health system. The subsequent multivariate analysis suggested that mothers with a higher rate of EBF shared the following characteristics: intention to breastfeed during pregnancy, breastfeeding knowledge, and higher satisfaction with support through the healthcare system after delivery. The rate of EBF in Shanghai is over 40%, and supporting breastfeeding requires measures at multiple levels, including individual attributes, women’s work and employment conditions, breastfeeding knowledge, and health services.