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An algorithm for pediatric enteral alimentation.

Many of the metabolic and gastrointestinal complications that occur when patients receive tube feedings result from improper selection or administration of the formula. An algorithm, available tables of formula composition, and adequate flowsheets for recording clinical information that can be adapted to individual institutions will provide simple and practical guidelines for the selection, administration, and management of enteral feeding programs in pediatric patients.

Adolescent↗

A rice starch added follow-on formula for infants with sleeping difficulty.

A total of 15 infants aged between 4-12 months with sleeping difficulty were enrolled in the study. All participants were given a test follow-on formula (cow's milk based), with added rice starch. The test formula was advised to be given at night-time for a 7-day period. Sleeping patterns were recorded 2 days prior to the study and during the 7-day study period. It was shown than 11 out of 15 cases (73.3%) had satisfactory results. Two cases (13.3%) were withdrawn from the study by their parents due to vomiting after taking the formula. We found that both cases developed concomitant respiratory tract infection one day after starting the study, and 2 cases (13.3%) were lost to follow-up. In conclusion, the majority of cases showed satisfactory results in terms of night sleeping pattern after switching to the rice starch added follow--on formula.

Bottle Feeding↗

Effectiveness of forced rehydration and early re-feeding in the treatment of acute diarrhoea in a tropical area.

BACKGROUND: The administration of oral re-hydration solution (ORS) via continuous infusion through a nasogastric (NG) tube and early refeeding facilitates delivery in hospitalised children and the return back home. METHODS DESIGN: the observation was made during a one-year stage in the Camillian Medical Centre (CMC) of Ouagadougou in Burkina Faso. 4,131 infants and children under 5 years old, affected by acute diarrhoea and severe dehydration (loss of weight > 10%) were studied. Those children having difficulties for oral re-hydration were hydrated by continuous infusion through naso-gastric (NG) tube; the NG tube was put in by the nurses and connected to a 500 ml bottle, in which a mixture of glucose and electrolytes was dissolved according to the formula (glucose 20 g + NaCl 3.5 g + NaHCO3 2.5 g KCl 1.5 g in 1 litre of water). The infusion rate was 20-30 drops/minute. No sedative or anti-emetic drug was given, unless in the presence of uncontrolled vomiting. At the end of infusion, flour of millet (60%), soy bean (20%), peanut butter (10%), sugar (10%) and salt (1%) was administered and continued at home or in the nearby areas available for the night. RESULTS: After 4-5 hrs of infusion 3,717 children (90%) showed a significant gain of weight, although the weight prior to the acute event preceding hospitalisation was never reached during their stay at the CMC. Only 413 children (10%) required a longer period of forced infusion: at the end of the day, however, they were fed with this flour. CONCLUSIONS: A simple strategy, based on a NG infusion plus an oral administration of flour has proven safe and effective in encompassing those difficulties encountered in the treatment and prevention of dehydration in developing countries where the therapy, in children affected by diarrhoea, still represents a major daily occupation.

Acute Disease↗

[Underlying cow's milk protein intolerance in excessively crying infants; desirable and undesirable effects of an elimination diet].

In three infants with excessive crying, two girls aged 3 and 13 months and a boy aged 5 weeks, feeding with a hypoallergenic formula was started because cow's milk protein intolerance was suspected. Yet in two of the cases, another explanation for the excessive crying, notably parental distress, was more likely based on the history. In these 2 cases, no provocation test with cow's milk had been performed, and the hypoallergenic formula had been continued for a prolonged period of time (without introduction of solid foods), even though the excessive crying had not ceased. Prolonged feeding with the hypoallergenic formula when cow's milk protein intolerance is not confirmed by appropriate provocation testing, may strengthen the parents' misconception that their baby has severe food intolerance, causing unnecessary delay in the introduction of solid foods. This may hamper the normal development of taste and oral motor development.

Crying↗

[Adverse effects of a liberal diagnosis of 'food intolerance'].

Signs and symptoms of food intolerance in young children are manifold and non-specific. When confronted with a patient with a sign or symptom that can be caused by food intolerance, the physician can take two approaches. One approach is aimed at not missing food intolerance (liberal approach), the other at not overdiagnosing food intolerance (restricted approach). Each approach has its own pros and cons. The main disadvantage of the restricted approach is that food intolerance may not be recognized straightaway. However, this is hardly ever harmful to the patient. The disadvantages of the liberal approach are more numerous and more serious. They include the excessive use of expensive hypoallergenic formulae, unjustified focus on food intolerance as the cause of numerous harmless and self-limiting symptoms in young children, increased risk of poor growth, and insufficient attention for any of the true cause of the patient's symptoms. Therefore, when confronted with a young child with signs and symptoms that could be caused by food intolerance, other causes should be considered prior to focusing on the food intolerance.

Child↗

[Long-chain polyunsaturated fatty acids in the early development of the human nervous system].

The role of long-chain polyunsaturated fatty acids (LCPUFA) in the early development of the human nervous system was put forward by the better cognitive development observed in breast-fed than in formula fed infants in parallel with the presence of LCPUFA in human milk but not in formula. The role of LCPUFA in early human neurodevelopment can be investigated by comparing data obtained in formula fed infants randomly assigned to receive formula with or without LCPUFA. Investigations in preterm infants indicate that the presence of LCPUFA in the formula offers benefits for the early postnatal development of visual and cognitive functions. The unequivocal results obtained in preterm infants led to the recommendation of LCPUFA supplementation to formulae for preterm infants. In several studies in full-term infants, enhanced dietary intake of LCPUFA was accompanied with better visual acuity and better results in various cognitive tests. However, other studies did not show visual or cognitive differences between full-term infants fed formula with or without LCPUFA. It is a question under current debate whether supplementation of LCPUFA to formulae for full-term infants is required to lessen the difference between the intellectual development of breast-fed and formula fed infants.

Breast Feeding↗

[Protein quality and quantity in infant formulas. A critical look].

The ideal quantity and quality of dietary proteins in milk formulas employed for infant nutrition is still a matter of controversy and debate. During the last years, there has been a tendency to lower the protein content in response to new estimations of protein requirements based on protein intakes and growth rates of breastfed infants. In most infant formulas the protein content is in the range of 1.4-1.8 g/100 ml. The lower limit of this range appears to be adequate for the growth and metabolic needs of the healthy infant. The safety of a further reduction of this limit to 1.2 g/100 ml (~1.8 g/100 kcal), which has been recently proposed, needs additional scrutiny and observation. In addition, the real benefits of this choice have still to be proven. Adjustments for protein digestibility and quality have recently been introduced. The removal from the whey protein fraction of the glycomacropeptide (GMP), with a consequent reduction of excessive threonine intakes, is a novel approach and a further step in the development of infant formulas closer to the model of hu-man milk.

Food, Formulated↗

Liquid chromatographic analysis of vitamin B6 in reconstituted infant formula: collaborative study.

A liquid chromatographic (LC) method was validated for the determination of total vitamin B6 in infant formula. Total vitamin B6 was quantified by converting the phosphorylated and free vitamers into pyridoxine. Pyridoxine was determined by ion pair reversed-phase LC with fluorescence detection. The method was subjected to an AOAC collaborative study involving a factory-manufactured, milk- and soy-based infant formula. Each was spiked at 3 concentrations in the range of 0-1 microg/g and sent as blind duplicate to participant laboratories. Nine laboratories returned valid data which were statistically analyzed for outliers and precision parameters. The repeatability relative standard deviation (RSD(r)) ranges were 2.0-4.0 and 3.5-5.9% for fortified milk- and soy-based formulas, respectively. The reproducibility relative standard deviation (RSD(R)) ranges were 8.2-8.4 and 6.7-11.2% for fortified milk- and soy-based formulas, respectively. HORRAT values ranged from 0.42 to 0.53, indicating that the precision of the method is acceptable. The mean RSD(r):RSD(R) values were 0.60 and 0.55 for milk- and soy-based formulas, respectively. As expected, RSDs for the unfortified samples were higher, but their HORRAT values (0.81 and 2.06) helped define a realistic limit of quantitation as 0.05 microg/g. Recovery data were quantitative and varied between 81.4 and 98.0% (mean = 89.8%) for each of 6 spiked materials.

Animals↗

Update on congressional hearings on the diet industry.

Three hearings on the diet industry took place during 1990 in the House of Representatives' Small Business Subcommittee on Regulation, Business Opportunities and Energy. Testimony from service organizations and consumers resulted in specific recommendations being made regarding consumer-protection standards. In addition, options for developing stricter regulatory standards were discussed.

Adult↗