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PubMed2006

Adequacy and safety of an infant formula with a protein/energy ratio of 1.8 g/100 kcal and enhanced protein efficiency for term infants during the first 4 months of life.

OBJECTIVE: Excess protein in infant formula may lead to renal overload and play a role in later obesity. The objective of this controlled, prospective, randomized, double-blind study was to assess the suitability and safety of a modified protein content infant formula and its noninferiority as compared to a conventional formula. PATIENTS AND METHODS: Healthy term infants age < 7 days were either breast-fed or randomized to be fed exclusively with a conventional casein-predominant formula (protein/energy ratio: 2.6 g/100 kcal) or the isocaloric whey-predominant study formula (protein/energy ratio: 1.8 g/100 kcal) for 120 days. Primary outcome was daily weight gain between D0 and D120 (noninferiority criterion: difference in daily weight gain < or = 4 g). Secondary outcomes were daily gain in weight, length, head circumference and body mass index at monthly intervals. Tolerance and safety were assessed at each visit. RESULTS: 162 infants were enrolled, 84% of the formula-fed infants and 36% of the breast-fed infants completing the study. Mean daily weight gain from D0 to D120 in the formula-fed groups differed by 0.38 g/day [95% CI: -2.59; 1.83] signifying the noninferiority of the study formula. Secondary outcomes did not differ between the 2 groups at any time and were comparable to outcomes in the breast-fed group. Tolerance was good and adverse events were not different between study groups. CONCLUSIONS: The whey-predominant study infant formula with a protein/energy ratio of 1.8 g/100 kcal and enhanced protein efficiency is safe and not inferior to a conventional formula in ensuring normal growth during the first four months of life.

Anthropometry↗
PubMed1989

Pneumographic studies: predictors of future apnoeas but not sudden infant death in asymptomatic infants.

Pneumograms were performed on 401 asymptomatic infants: 322 siblings, 15 cousins and 24 twins of sudden infant death syndrome (SIDS) victims; 14 siblings of near-miss SIDS victims, and 26 infants of anxious parents. The infants of anxious parents had significantly fewer abnormalities than siblings of SIDS victims. In 222 infants subsequently monitored at home, the pneumogram as a predictor of future apnoea had a sensitivity rate of 97.5% and a specificity rate of 72% (P less than 0.001). Infants who were to experience future apnoeas had a significantly higher percentage of time in periodic breathing and a higher density of apnoeas in their original pneumograms. However, the abnormal pneumogram did not predict SIDS, because the eight infants who died all had normal pneumograms.

Apnea↗
PubMed1995

Influence of two infant formulas and human milk on the development of the faecal flora in newborn infants.

The establishment of the faecal flora of 39 full-term infants fed exclusively on breast milk (n = 20) or with two different modern adapted cow's milk formulas (n = 19) was studied during the first 3 months of life. One formula investigated was based on 100% bovine casein as the protein source whereas the other formula contained bovine milk proteins with a whey/casein ratio of 60:40. A faecal flora rich in bifidobacteria was found in all study groups; the growth of putrefactive bacteria (especially Bacteroides spp.), however, was limited. In formula-fed infants, significantly higher bacterial counts of enterococci and clostridia were detected compared to breast milk-fed infants. Similarities and differences due to the feeding regimen were particularly reflected in the pattern of the anaerobic bacterial species. Bifidobacterium bifidum, B. infantis and B. breve constituted the majority of the bifidobacterial flora independent of the type of milk feeding. Other bifidobacterial species such as B. longum, B. adolescentis, B. parabifidum and B. pseudo-catenulatum were detected in high numbers and at low frequencies in breastfed infants. The latter three were observed in infants fed the whey/casein formula as well. It seems that infants fed a casein formula develop a faecal flora more like that of breastfed infants concerning Lactobacillus spp. (especially L. fermentum and L. brevis).

Animals↗
PubMed2006

Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit.

BACKGROUND: Newborns of 30-34 weeks gestation comprise 3.9% of all live births in the United States and 32% of all premature infants. They have been studied much less than very low birthweight infants. OBJECTIVE: To measure in-hospital outcomes and readmission within three months of discharge of moderately premature infants. DESIGN: Prospective cohort study including retrospective chart review and telephone interviews after discharge. SETTING: Ten birth hospitals in California and Massachusetts. PATIENTS: Surviving moderately premature infants born between October 2001 and February 2003. MAIN OUTCOME MEASURES: (a) Occurrence of assisted ventilation during the hospital stay after birth; (b) adverse in-hospital outcomes-for example, necrotising enterocolitis; (c) readmission within three months of discharge. RESULTS: With the use of prospective cluster sampling, 850 eligible infants and their families were identified, randomly selected, and enrolled. A total of 677 families completed a telephone interview three months after hospital discharge. During the birth stay, these babies experienced substantial morbidity: 45.7% experienced assisted ventilation, and 3.2% still required supplemental oxygen at 36 weeks. Readmission within three months occurred in 11.2% of the cohort and was higher among male infants and those with chronic lung disease. CONCLUSIONS: Moderately premature infants experience significant morbidity, as evidenced by high rates of assisted ventilation, use of oxygen at 36 weeks, and readmission. Such morbidity deserves more research.

Birth Weight↗
PubMed1989

Respiratory control in infants at increased risk for sudden infant death syndrome.

There is much debate relating to possible abnormalities in respiratory control mechanisms in infants considered at increased risk for sudden infant death syndrome (SIDS). The P0.1 occlusion technique was used to assess the central respiratory response to hyperoxic hypercapnia during quiet sleep in 21 normal infants, 13 siblings of SIDS victims, and 17 infants with apparent life threatening events. The slope of P0.1 plotted against carbon dioxide concentration increased exponentially with age, independent of body weight in each group. Birth weight has a significant effect on slope with a lower weight predisposing to a lower slope. Siblings as a group had a significantly lower slope at any given age than normal infants, whereas the infants who had had apparent life threatening events were not significantly different from the controls. As intragroup variation in both siblings and control groups greatly exceeded the significant intergroup differences observed, the technique cannot identify individual infants as belonging to one or other group.

Age Factors↗
PubMed1991

Improvement of outcome for infants of birth weight under 1000 g. The Victorian Infant Collaborative Study Group.

The two year outcome of extremely low birth-weight (ELBW) infants (birth weight 500 to 999 g), born in the state of Victoria over two distinct eras, 1979-80 and 1985-7, were compared. In the 1979-80 era, 25.4% of the ELBW infants survived to 2 years of age; only 12.5% of liveborn ELBW infants survived to 2 years with no neurological disabilities. In the 1979-80 era, ELBW infants born outside the level III centres in the state were significantly disadvantaged in both mortality and neurological morbidity. By 1985-7, the two year survival rate of ELBW infants rose significantly from 25.4% to 37.9%. By 1985-7, the proportion of ELBW infants who survived to 2 years free of neurological disabilities increased from 12.5% to 26.2%. Despite the improved survival, the absolute number of 2 year old children survivors with severe neurological disabilities remained constant at 8/year in both eras. By 1985-7, fewer ELBW infants were born outside the level III centres, their survival rate remained lower, but the severe neurological disability rate in survivors was no longer significantly higher. There has been a concomitant improvement in both survival and reduction in neurological morbidity.

Blindness↗
PubMed1985

Respiratory and heart rate patterns in infants destined to be victims of sudden infant death syndrome: average rates and their variability measured over 24 hours.

From a prospective study in which 24 hour recordings of the electrocardiogram and respiratory activity (abdominal wall movement) were made on a population of full term infants, 22 recordings were obtained from 16 infants who later were victims of the sudden infant death syndrome. The average heart rate, average heart rate variability, average breath to breath interval, and average breath to breath interval variability over the whole of each recording for the 22 recordings were compared with those from a control group of 324 infants selected at random from the rest of the population. No significance was found in the number of recordings from those infants who suffered the sudden infant death syndrome which lay outside the 5th-95th percentile range of the control group for the four variables studied. In a group comparison no difference was found between the sudden infant death syndrome group and the controls either in terms of the respiratory variables studied or in terms of the average heart rate variability. The results did, however, suggest that there may be a group difference in terms of the average instantaneous heart rate.

Age Factors↗
PubMed2004

CoQ10 plasmatic levels in breast-fed infants compared to formula-fed infants.

BACKGROUND: Coenzyme Q10 has been recognized as an important antioxidant factor besides its main role in bioenergetic metabolism. CoQ10 tissue levels depend both on exogenous dietetic intake and on endogenous biosynthesis, as this compound can be partly synthesized in human cells. Q10 plasma levels reflect the tissue content of the coenzyme and can be used to evaluate the presence of this compound in the human organism. DESIGN/METHODS: Aim of the study was to measure CoQ10 plasmatic levels in a newborn breast-fed population and to compare them to CoQ10 levels in a newborn formula-fed population in order to verify whether changes in CoQ10 plasmatic contents could be related to a different dietetic intakes. We measured CoQ10 plasmatic levels in 25 healthy term neonates with different dietetic intakes: 15 breast-fed and 10 bottle-fed with a common infant formula. These infants were evaluated prospectively during the first month of life. The analyses were performed on the mothers' blood samples and cord blood samples at the time of delivery, then on infants at 4 and 28 days of age. RESULTS: Our results showed markedly reduced Q10 levels in cord blood samples compared to maternal Q10 plasmatic levels at the time of delivery, suggesting placental impermeability towards this molecule or increased fetal utilization during labor and delivery. At 4 days of age Q10 levels had increased in both groups of neonates, but significantly more in breast-fed infants compared to formula-fed babies (p <0.05). At 4 weeks of age no significant changes occurred in breast-fed infants, while values increased significantly in formula-fed infants (p <0.05). The content of Q10 in breast milk samples was lower than in infant formula. CONCLUSIONS: The results of this study show that CoQ10 plasmatic levels are at least partly influenced by the exogenous dietetic supply.

Aging↗
PubMed1990

Analysis of breathing patterns in a prospective population of term infants does not predict susceptibility to sudden infant death syndrome.

Oscillatory patterns in ventilation have been seen in term and premature infants and are indicative of the stability of the respiratory blood gas feedback control system. Apneas are related to these patterns and apnea duration is correlated with pattern characteristics. In our study breathing patterns were analyzed in recordings from 10 term infants who subsequently died of sudden infant death syndrome (SIDS) and 10 control infants matched for birth wt, gestational age, and postnatal age. Subjects were drawn from a prospectively studied population of 9856 infants. Breath-by-breath minute ventilation was estimated in each of these 24-h recordings and oscillatory patterns were detected using a comb of digital bandpass filters. Confidence limits on the filter output and a bad data flag for rejection of data during gross body movements or crying insured that only significant patterns in ventilation were evaluated. Pattern prevalence and amplitude were compared in three frequency regimes: 6- to 87-s cycle times, 6- to 28-s cycle times, and 28- to 87-s cycle times. There was no significant difference between the SIDS and the control infants in any of these pattern comparisons (paired t and Wilcoxon paired rank sum tests, p less than 0.05). In light of the normal breathing patterns found in the SIDS infants, it is unlikely that susceptibility to SIDS is distinguished, at the time of these recordings, by instability of the respiratory blood gas feedback control system.

Female↗
PubMed1992

Docosahexaenoic acid status of term infants fed breast milk or infant formula containing soy oil or corn oil.

The objective of this study was to compare circulating lipid docosahexaenoic acid [22:6(n-3), DHA] levels in term infants fed a powdered (CORN oil) or liquid (SOY oil) infant formula or human milk (HM). Infants whose mothers chose not to breast feed were randomly assigned to the CORN or SOY formula group. The formula fat differed in linolenic acid [18:3(n-3)] content: it was 0.8% for the CORN and 4.8% for the SOY. Linoleic acid [18:2(n-6)] was 31.5 and 34.2% fatty acids in the CORN and SOY formula, respectively. The formulas or HM were fed from birth through 8 wk of age, and growth and the plasma and red blood cell (RBC) phospholipid fatty acid composition was determined at 3 d, 4 wk, and 8 wk of age. Growth did not differ among groups. The plasma phospholipid and RBC phosphatidylethanolamine DHA was similar in the CORN and SOY formula groups at all ages. Plasma and RBC phosphatidylethanolamine levels of DHA were significantly lower in infants fed the CORN or SOY formula than in infants fed HM during wk 4 and 8. Plasma and RBC 22:5(n-6) was not increased in the formula groups at any age. The formula content of linolenic acid had no effect on the RBC or plasma DHA levels of the infants. The biologic or functional significance of the lower plasma and RBC DHA in infants fed formula rather than HM is unknown. The need for a dietary source of DHA and specificity of plasma or RBC phospholipid DHA as a measure of desaturation and elongation of linolenic acid in developing organs remains uncertain.

Corn Oil↗
PubMed2002

Milk from mothers of both premature and full-term infants provides better antioxidant protection than does infant formula.

We hypothesized that premature (PT) infants' mother's milk may provide antioxidant advantages compared with milk from mothers of full-term (FT) infants, and human milk may provide antioxidant properties not seen in infant formulas. We designed three experiments to test these hypotheses. Experiment 1 assessed resistance to oxidative stress of human milk and formulas designed for FT and PT infants. Experiment 2 determined differences in resistance to oxidative stress between milk from mothers of FT and PT infants, including analysis of catalase activity. Experiment 3 examined factors in human milk that may account for increased resistance to oxidative stress. In experiment 1, we induced physiologic oxidative stress in human milk (n = 5) and formula (n = 2) and measured ascorbate radical using electron paramagnetic resonance. Results indicated the following: 1) during oxidative stress, ascorbate may be spared in human milk compared with formula; 2) ascorbate radical production is more intense in formula compared with human milk, with or without oxidative stress; and 3) oxygen consumption in human milk is less than that in formula, with or without oxidative stress. In experiment 2, milk samples were collected from mothers of PT (n = 28) and FT (n = 17) infants at wk 1, 2, and 12 of lactation. No differences in oxygen consumption after oxidative stress appeared between PT and FT milk. Catalase levels in human milk increased with time. In experiment 3, addition of catalase, superoxide dismutase, and glutathione peroxidase to formulas (n = 4) increased resistance to oxidative stress. Denaturing endogenous enzymes did not decrease the ability of human milk to resist oxidative stress. Ferrous sulfate plus vitamin C added to human milk and formulas fortified with iron increased oxidative stress. Addition of iron chelators to formula reduced oxidative stress. In conclusion, human milk has better antioxidant protection than do formulas, perhaps because of the higher iron content of formulas. Milk from mothers of PT and FT infants has equal resistance to oxidative stress.

Antioxidants↗
PubMed1989

The growth of healthy Australian infants in relation to infant feeding and social group.

A joint survey of infant-feeding practices and infant growth was carried out in Western Australia and Tasmania in 1984-1985. Birthweights and growth from birth to one year of age were similar in both States and to the international growth references. Infants who were never breast-fed or who were breast-fed for only a short time gained significantly more weight over the year (most of it after the age of three months) than did infants who were breast-fed for six months or longer. Infants from families of a lower socioeconomic group gained more weight after six months of age than did those infants from higher socioeconomic families. Analysis showed that the growth differences between the social groups was a result of differences in feeding practices. Linear growth was similar among infants of all social groups, irrespective of the feeding method.

Age Factors↗
PubMed2000

Alberta infant motor scale: reliability and validity when used on preterm infants in Taiwan.

BACKGROUND AND PURPOSE: The goal of this study was to examine the reliability and validity of measurements obtained with the Alberta Infant Motor Scale (AIMS) for evaluation of preterm infants in Taiwan. SUBJECTS: Two independent groups of preterm infants were used to investigate the reliability (n=45) and validity (n=41) for the AIMS. METHODS: In the reliability study, the AIMS was administered to the infants by a physical therapist, and infant performance was videotaped. The performance was then rescored by the same therapist and by 2 other therapists to examine the intrarater and interrater reliability. In the validity study, the AIMS and the Bayley Motor Scale were administered to the infants at 6 and 12 months of age to examine criterion-related validity. RESULTS: Intraclass correlation coefficients (ICCs) for intrarater and interrater reliability of measurements obtained with the AIMS were high (ICC=.97-.99). The AIMS scores correlated with the Bayley Motor Scale scores at 6 and 12 months (r=.78 and.90), although the AIMS scores at 6 months were only moderately predictive of the motor function at 12 months (r=.56). CONCLUSION AND DISCUSSION: The results suggest that measurements obtained with the AIMS have acceptable reliability and concurrent validity but limited predictive value for evaluating preterm Taiwanese infants.

Child Development↗
PubMed2000

Maori infant care practices: implications for health messages, infant care services and SIDS prevention in Maori communities.

This paper uses findings from the Maori section of a multiethnic infant care practices (ICP) study undertaken in Auckland, New Zealand/Aotearoa, in 1998. It aims to increase understanding of present day Maori infant care practices in order, firstly, to inform infant health message and service delivery to Maori and, secondly, to understand the context of practices that comprise modifiable risk factors for SIDS. Publicity about modifiable SIDS risk factors since the early 1990s brought about a significant reduction in the national SIDS rate but the Māori rate reduced more slowly and in 1998 was still three times that of non-Māori. The ICP study was a qualitative study that, for the Māori section, involved seven focus groups and a one-on-one interview comprising 26 caregivers of under 12 month old infants. This paper focuses on five selected areas explored within the ICP study: sources of support, customary practices, infant feeding, infant sleeping arrangements and smoking. It discusses both valued infant care norms and factors that inhibit changes known to reduce SIDS risk. It argues that valued practices need recognition in order to make messages effective. It also challenges the emphasis on individual behaviour change as the primary means to reduce SIDS risk and argues that there is a need to extend prevention strategies beyond simple behaviour change messages to include structural change to reduce 'non modifiable' risk factors.

Female↗
PubMed1989

[Neuropsychiatric disorders in newborn infants with very low birth weight (VLBW infants)--before and following introduction of modern perinatal medicine. 1. Overview of the problem, criteria for quality of survival, major CNS disorders (major handicap)].

The survival quality of very low birthweight infants (VLBW infants) is highly actual just even in the time of modern perinatal medicine. Through the development and permanent improvement of the perinatal intensive therapy the survival chances of VLBW infants could be improved significantly in the last 25 years. In the 70's survival rates of 60-84 per cent were achieved in VLBW infants, in the leading centers even rates of 86 and 90.5 percent, respectively. In the 70's an enormous improvement in the survival rates from 20-45 per cent was achieved in tiny premature infants (birth weight 1,000 gm and less), too. However, the efforts of gynecologists and neonatologists to reduce the mortality of low birth-weight infants are again and again blamed for possibly obtaining successes with an increase in CNS morbidity. The parallel analysis of some brain damage groups in VLBW infants seems suitable to gain a clear statement if modern perinatal medicine contributes to reduce the frequency of early infantile cerebral damages and their consecutive handicaps altogether. In an extensive review of literature it is tried to prove this for the major CNS handicaps altogether and separately for the infantile cerebral palsies, epilepsies and mental retardations (oligophrenias). Simultaneously with an average increase from 29.7 to 69.5 per cent of the healthy surviving children, there was a reduction of major CNS handicaps on the average from 36 to 12 per cent.

Brain Damage, Chronic↗
PubMed1986

Cardiorespiratory function in 16 full-term infants with sudden infant death syndrome.

Twenty-four-hour tape recordings of ECG and breathing movements from 16 term infants (greater than or equal to 37 weeks' gestation) who subsequently died of sudden infant death syndrome (SIDS) were compared with recordings from surviving infants from the same populations. Apneic pauses of varying durations, periodic and regular breathing patterns, heart and respiratory rates during regular breathing were measured. Only one of 16 full-term infants with SIDS had findings outside the range of age-matched control infants (an excess of periodic breathing patterns and an absence of regular breathing). When the first recordings of each of infants who died of SIDS, except one who had cyanotic episodes prior to death, were compared to recordings of survivors (six for each case) closely matched for age, gestation, and weight at birth, no differences in breathing patterns or heart or respiratory rates during regular breathing could be demonstrated. These particular measurements of cardiorespiratory function were, therefore, unable to identify the majority of full-term infants at risk for SIDS.

Apnea↗
PubMed1980

Outcome of very low birth weight (VLBW) infants. I. Neonatal behavior of 188 infants.

Behavioral characteristics of very low birth weight infants (less than 1,501 gm) were determined with the term Brazelton Neonatal Behavioral Assessment Scale and selected items from a preliminary form of the scale for premature and at-risk infants. The behavior of 188 infants was assessed at a time as optimal as possible for social interaction. Our very low birth weight infants were upset less easily, had several reflexes with below average scores, and were less responsive to visual stimuli than term infants of other studies. Improved description of interactive abilities and tolerance of the testing procedure was made possible with some items from the preliminary premature scale. Orienting responses in 6 infants tested after 44 weeks because of prolonged illness were less than optimal with a single exception. This suggests that behavioral capacity, not age, should define where the Brazelton scale is not applicable. Perinatal factors including birth weight, gestational age, and age that weight gain began, predicted some motoric and state control responses. Whether this predictive capacity will persist or change with time awaits results of follow-up of these infants.

Adult↗
PubMed2000

Servo-control for maintaining abdominal skin temperature at 36C in low birth weight infants.

BACKGROUND: Randomized trials have shown that the neonatal mortality rate of low birth-weight babies can be reduced by keeping them warm. For low birth-weight babies nursed in incubators, warm conditions may be achieved either by heating the air to a desired temperature, or by servo-controlling the baby's body temperature at a desired set-point. OBJECTIVES: In low birth weight infants, to determine the effect on death and other important clinical outcomes of targeting body temperature rather than air temperature as the end-point of control of incubator heating. SEARCH STRATEGY: Standard search strategy of the Cochrane Neonatal Collaborative Review Group. SELECTION CRITERIA: Randomized or quasi-randomized trials which test the effects of having the heat output of the incubator servo-controlled from body temperature compared with setting a constant incubator air temperature. DATA COLLECTION AND ANALYSIS: Trial methodologic quality was systematically assessed. Outcome measures included death, timing of death, cause of death, and other clinical outcomes. Categorical outcomes were analyzed using relative risk and risk difference. Meta-analysis assumed a fixed effect model. MAIN RESULTS: Compared to setting a constant incubator air temperature of 31.8C, servo-control of abdominal skin temperature at 36C reduces the neonatal death rate among low birth weight infants: relative risk 0.72 (95% CI 0.54, 0.97); risk difference -12.7% (95% CI -1.6, -23.9). This effect is even greater among VLBW infants. REVIEWER'S CONCLUSIONS: During at least the first week after birth, low birth weight babies should be provided with a carefully regulated thermal environment that is near the thermoneutral point. For LBW babies in incubators, this can be achieved by adjusting incubator temperature to maintain an anterior abdominal skin temperature of at least 36C, using either servo-control or frequent manual adjustment of incubator air temperature.

Body Temperature Regulation↗