PubMed · 8772868
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R N Srivastava. 1995. A balanced view.. https://pubmed.ncbi.nlm.nih.gov/8772868/
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BACKGROUND: Since 1989 the use of iodized salt has been allowed in Germany, additional supplementation with iodide tablets has been recommended during pregnancy and lactation. This study was undertaken to clarify whether the iodine intake of neonates and young infants improved since then. PATIENTS AND METHODS: In the first part of the study the urinary iodine excretion of 52 newborns and their mothers in 1998 was compared to data of similar studies 1983 in the area of Göttingen and 1982 in the areas of Heidelberg and Rothenburg, Germany. All these are geographically low-iodine areas. In the second part the iodine supply of infants in 1998-1999 under feeding with mother's milk or formulas in 1998 and 1999 was obtained by measuring iodide concentrations in urine and milk using a high pressure liquid chromatography (HPLC) method. RESULTS: 45% of pregnant women were without iodide supplementation in 1998. In 1998 the median urinary iodide concentration during the first week of life was 4.3 micrograms/dl, which was more than twice that found in 1983 (1.75 micrograms/dl). Infants feeding by mother's milk without maternal iodine supplementation or by semi-elementary diet had the lowest urinary iodine excretion, whereas significantly higher values were measured when feeding formulas for term or preterm infants. CONCLUSIONS: The iodine intake of newborns has markedly improved during 15 years. The WHO criterias for adequate iodine supply (TSH < 5 microU/ml and urinary iodine >/ = 10 micrograms/dl) were only partly fulfilled in Göttingen indicating that a mild iodine deficiency still exists with the risk of iodine deficiency disorders.
Two important aspects of the clinical feeding evaluation of infants are the assessment of their nonnutritive and nutritive sucking skills. Nonnutritive sucking is monitored routinely by using a gloved finger and nutritive sucking by observing infants' sucking while bottle feeding. This approach, however. provides only a subjective and descriptive evaluation. In this study, we developed a finger pressure device that allows for quantification of specific measures of nonnutritive sucking. We are proposing that its use, in combination with the nipple/bottle system developed for the monitoring of nutritive sucking. will allow therapists to conduct objective and quantitative evaluations of infants' nonnutritive and nutritive sucking. The suction and expression components of sucking are monitored via two catheters placed at the tip of the index finger of a disposable glove and at the tip of a bottle nipple. The observations made from the standard clinical feeding evaluation and from these two instruments were compared. In addition to providing quantitative measures of sucking, the latter techniques allowed the review/reassessment of data, the monitoring of the maturation of oral motor skills over time, and the comparison of these measures between infants. It is proposed that the concurrent use of these devices will allow therapists to conduct more objective and detailed evaluations of infants' feeding skills than can be obtained at present.
In summary, clinical interventions that are focused on increasing the rates with which mothers initiate and sustain lactation for infants with medical problems must reflect the scientific evidence for this vulnerable population. These interventions should include counseling to ensure that mothers may make an informed decision about providing milk; nonpharmacologic and pharmacologic strategies to maximize maternal milk volume; and basing protocols for at-breast feeding on studies conducted with breastfeeding for premature and other at-risk infants, rather than on ideology or research conducted with term, healthy infants.