(Infants, Children, Adolescents, Pregnant & Breastfeeding Women & Elderly)

Selected abstracts:

1                    Abiona TC, Onayade AA, Ijadunola KT, Obiajunwa PO, Aina OI, Thairu LN. Acceptability, feasibility and affordability of infant feeding options for HIV-infected women: a qualitative study in south-west Nigeria. Matern Child Nutr. 2006 Jul;2(3):135-44.

Department of Community Health, Obafemi Awolowo University, Ile-Ife 220005, Nigeria.

The objective of this study was to explore the acceptability, feasibility, affordability, safety and sustainability of replacement feeding options for HIV-infected mothers in Ile-Ife, in south-west Nigeria. Six focus group discussions were conducted with a purposive sample of mothers, fathers and grandmothers. The HIV status of all participants was unknown to investigators. All text data were analysed using the Text-based Beta Software program. With regard to the acceptability of replacement feeds, respondents perceived the stigma associated with not breastfeeding to be an important consideration. In this community, breastfeeding is the norm--even though it is not necessarily exclusive. For infected mothers who choose to breastfeed exclusively and then to wean their infants before 6 months of age, respondents did not anticipate early cessation of breastfeeding to be problematic. Respondents noted that acceptable replacement foods included infant formula, soy milk and cow's milk. Barriers to replacement feeding that were mentioned included: the high costs of replacement foods and fuel for cooking; an unreliable supply of electrical power; poor access to safe water; and poor access to storage facilities. The research confirms the difficulty of replacement feeding for HIV-infected mothers in sub-Saharan Africa. The results also provide the basis for new issues and hypothesis for future research in other communities with similar socio-cultural and economic characteristics.

2                    Bode L. Recent advances on structure, metabolism, and function of human milk oligosaccharides. J Nutr. 2006 Aug;136(8):2127-30.

Burnham Institute for Medical Research, Glycobiology and Carbohydrate Chemistry Program, La Jolla, CA, USA.

Human milk is often the sole dietary source for the first few months in life. It contains all the nutrients necessary for the infant to thrive, but also ingredients that may provide health benefits beyond those of traditional nutrients. Human milk oligosaccharides (HMO) comprise part of these functional ingredients; 1 L of mature human milk contains approximately 5-10 g unbound oligosaccharides, and >130 different HMO have been identified. Both their high amount and structural diversity are unique to humans. Only trace amounts of these oligosaccharides are present in mature bovine milk and, as a consequence, in bovine milk-based infant formula. The potential health benefits of HMO that were uncovered over the years may affect breast-fed infants both locally and systemically. Recent advances in glycobiology and nutrition, including the use of stable isotopes, frontal-affinity chromatography, glycan microarrays, MS, and automated solid-phase carbohydrate synthesis, will help verify hypotheses and unravel the mysteries behind HMO.

3                    Cimiotti JP, Haas J, Saiman L, Larson EL. Impact of staffing on bloodstream infections in the neonatal intensive care unit. Arch Pediatr Adolesc Med. 2006 Aug;160(8):832-6.

Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, 19104-6096, USA.

OBJECTIVE: To examine the association between registered nurse staffing and healthcare-associated bloodstream infections in infants in the neonatal intensive care unit (NICU). DESIGN: Prospective cohort study. SETTING: Two level III-IV NICUs in New York, NY, from March 1, 2001, through January 31, 2003. PARTICIPANTS: A total of 2675 infants admitted to the NICUs for more than 48 hours and all registered nurses who worked in the same NICUs during the study period.Intervention Hours of care provided by registered nurses.Main Outcome Measure Time to first episode of healthcare-associated bloodstream infection. RESULTS: A total of 224 infants had an infection that met the study definition of healthcare-associated bloodstream infection. In a multivariate analysis, after controlling for infants' intrinsic and extrinsic risk factors, a greater number of hours of care provided by registered nurses in NICU 2 was associated with a decreased risk of bloodstream infection in these infants (hazard ratio, 0.21; 95% confidence interval, 0.06-0.79). CONCLUSION: Our findings suggest that registered nurse staffing is associated with the risk of bloodstream infection in infants in the NICU.

4                    Haiden N, Klebermass K, Cardona F, Schwindt J, Berger A, Kohlhauser-Vollmuth C, Jilma B, Pollak A. A randomized, controlled trial of the effects of adding vitamin B12 and folate to erythropoietin for the treatment of anemia of prematurity. Pediatrics. 2006 Jul;118(1):180-8.

Department of Pediatrics, Division of Neonatology, Inborn Errors, and Pediatric Intensive Care, Medical University of Vienna, Wahringer Gurtel 18-20, 1090 Vienna, Austria.

BACKGROUND: Premature infants, especially those with birth weights of <1500 g, often suffer from anemia of prematurity and associated problems. Erythropoietin therapy is a safe effective way to prevent and to treat anemia of prematurity. We hypothesized that combined administration of vitamin B12 and folate with erythropoietin and iron would enhance erythropoietin-induced erythropoiesis. METHODS: In a randomized, controlled trial, 64 premature infants (birth weight: 801-1300 g) receiving erythropoietin and iron supplementation were assigned randomly to receive either vitamin B12 (3 microg/kg per day) and folate (100 microg/kg per day) (treatment group) or a lower dose of folate (60 microg/kg per day) (control group). RESULTS: During the 4-week observation period, vitamin B12 and folate enhanced erythropoietin-induced erythropoiesis significantly, as indicated by a 10% increase in red blood cell counts, compared with folate alone. Hemoglobin and hematocrit levels remained stable in the treatment group, whereas they decreased in the control group. Vitamin B12 levels in the treatment group increased over baseline and control values, whereas red blood cell folate levels were comparable between the groups. Subsequent analysis showed slight nonsignificant differences in baseline red blood cell count, hemoglobin level, hematocrit level, and mean corpuscular volume values, which must be addressed as a limitation. CONCLUSIONS: With the limitation of a slight imbalance in baseline data between the study groups, combined therapy with vitamin B12, folate, erythropoietin, and orally and intravenously administered iron seemed more effective in stimulating erythropoiesis among premature infants, compared with erythropoietin, iron, and low-dose folate alone. Additional trials are necessary to confirm these data.

5                    Heyman MB; Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006 Sep;118(3):1279-86.

The American Academy of Pediatrics Committee on Nutrition presents an updated review of lactose intolerance in infants, children, and adolescents. Differences between primary, secondary, congenital, and developmental lactase deficiency that may result in lactose intolerance are discussed. Children with suspected lactose intolerance can be assessed clinically by dietary lactose elimination or by tests including noninvasive hydrogen breath testing or invasive intestinal biopsy determination of lactase (and other disaccharidase) concentrations. Treatment consists of use of lactase-treated dairy products or oral lactase supplementation, limitation of lactose-containing foods, or dairy elimination. The American Academy of Pediatrics supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents. If dairy products are eliminated, other dietary sources of calcium or calcium supplements need to be provided.

6                    Kelly MM. The basics of prematurity. : J Pediatr Health Care. 2006 Jul-Aug;20(4):238-44.

AI duPont Hospital for Children, Main Line Hospitals, Bryn Mawr, PA, USA.

Prematurity is the greatest single risk factor for death within the first year of life. The March of Dimes and Centers for Disease Control and Prevention define prematurity as birth before the completion of 37 weeks' gestation. In 2002, one in eight babies were delivered prematurely. This manuscript is Part I of a three-part series on premature infants. The overall goal of this series is to educate pediatric primary care providers regarding topics specific to delivering care to premature infants after discharge. Part I addresses the incidence of prematurity and the terminology used in neonatal literature and provides an overview of common comorbidities associated with prematurity. Part II will focus on the primary care management of uncomplicated premature infants. Part III will highlight issues of primary care for medically complex premature infants.

7                    Rinne M, Kalliomaki M, Salminen S, Isolauri E. Probiotic intervention in the first months of life: short-term effects on gastrointestinal symptoms and long-term effects on gut microbiota. J Pediatr Gastroenterol Nutr. 2006 Aug;43(2):200-5.

Department of Pediatrics, Turku University Central Hospital, Finland.

OBJECTIVES: To determine whether probiotics administered for 6 months postnatally affect gastrointestinal symptoms, crying and the compositional development of the gut microbiota through infancy. METHODS: The study comprised of 132 newborns whose mothers were randomized to receive placebo or Lactobacillus rhamnosus GG (ATCC 53103) before delivery. The treatments of mothers/infants continued for 6 months postnatally. A specific symptom chart was used to monitor gastrointestinal symptoms and infant's crying during the 7th and the 12th weeks of life. Fluorescent in situ hybridization was used to establish the Bifidobacterium, Lactobacillus/Enterococcus, Bacteroides and Clostridium counts in fecal samples at 6, 12, 18 and 24 months of age. RESULTS: Numbers of different types of stools, vomits and crying time were comparable between the groups during the 7th and the 12th weeks of life. Dominant microbiota consisted of bifidobacteria throughout the study. At 6 months, there were less clostridia in faeces in the placebo compared with the probiotic group (P = 0.026), whereas after long-term follow-up at 2 years, there were less lactobacilli/enterococci and clostridia in faeces in the probiotic group than in the placebo group (P = 0.011 and P = 0.032, respectively), reflecting the impact of clostridia as a marker of microbiota succession in healthy infants. CONCLUSIONS: Probiotic administration in the first months of life was well tolerated and did not significantly interfere with long-term composition or quantity of gut microbiota.

8                    Rioux FM, Savoie N, Allard J. Is there a link between postpartum anemia and discontinuation of breastfeeding? Can J Diet Pract Res. 2006 Summer;67(2):72-6.

            Ecole des sciences des aliments, de nutrition et d'etudes familales, Universite de Moncton, NB.

Purpose: Factors associated with early cessation of breastfeeding were identified and patterns of infant feeding were examined. Feeding practices were compared with the 1998 guidelines in Nutrition for Healthy Term Infants and with recent Health Canada recommendations. Methods: To recruit participants, a letter was sent to every mother (n=424) who gave birth at Dr. Georges-L. Dumont Regional Hospital in Moncton from April 1998 to February 1999. Eighty-five mothers agreed to participate with their infants. Information on infant feeding patterns and socioeconomic background was gathered with semi-structured questionnaires. Only healthy infants from singleton pregnancies were included in this study. Results: At birth, almost 83% of infants were breastfed. The proportions of infants breastfed for at least four, six, and nine months were 43%, 22%, and 9%, respectively. As many as 34% of infants were introduced to baby cereals before age four months, and 21% were introduced to cow's milk before age nine months. Lower family income, lower level of parental education, and reduced postpartum hemoglobin level (below 95 g/L) were associated with discontinuation of breastfeeding before infants were four months old. Conclusions: Early postpartum nutrition interventions may be effective in ensuring follow-up care for mothers with compromised iron status, in supporting breastfeeding for at least six months, and in promoting better infant feeding practices.

9                    Williams HG. 'And not a drop to drink'--why water is harmful for newborns. Breastfeed Rev. 2006 Jul;14(2):5-9.

Breastmilk is a species-specific food, that is, milk made by human mothers for human infants, and thus is the only natural fluid appropriate for the newborn human. There is a plethora of information available discussing the dangers of water supplementation to babies. This article aims to collate the more recent research papers. Fully breastfed babies do not require water, even in the hottest weather. The dangers of newborn water intoxication, risk of reduction in breastmilk supply and early weaning as well as not following the Ten Steps to Successful Breastfeeding's step six, are discussed. The impact of the attitude of and information from influential persons in the mother's life is also noted.

10                Savenije OE, Brand PL. Accuracy and precision of test weighing to assess milk intake in newborn infants. Arch Dis Child Fetal Neonatal Ed. 2006 Sep;91(5):F330-2.

Princess Amalia Children's Clinic, Isala Klinieken, PO Box 10400, 8000 GK Zwolle, The Netherlands.

BACKGROUND: Test weighing is commonly used to estimate milk intake in newborn infants. OBJECTIVE: To assess the accuracy and precision of test weighing in clinical practice. METHODS: Infants fed by bottle, cup, or nasogastric tube were weighed before and immediately after feeding by a blinded investigator. Actual milk intake was determined by reading the millilitre scale of the milk container before and after feeding. The accuracy and precision of test weighing was assessed by examining the frequency distribution of the difference between weight change and actual milk intake. RESULTS: Ninety four infants completed the study. The mean difference between weight change and actual milk intake was 1.3 ml, indicating good accuracy. The precision of test weighing, however, was poor: 95% of differences between weight change and actual milk intake ranged from -12.4 to 15 ml. The maximum difference was 30 ml. Imprecision was not influenced by the presence of monitor or oxygen saturation wires, intravenous lines, or vomiting of the infant. CONCLUSIONS: Test weighing is an imprecise method for assessing milk intake in young infants. This is probably because infant weighing scales are not sensitive enough to pick up small changes in an infant's weight after feeding. Because of its unreliability, test weighing should not be used in clinical practice.

11                Tosh K, McGuire W. Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants. Cochrane Database Syst Rev. 2006 Jul 19;3:CD005255.

          BACKGROUND: Feeding preterm infants in response to their hunger and satiation cues (ad libitum or demand/semi demand) rather than at scheduled intervals might help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge. OBJECTIVES: To assess the effect of a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding prescribed volumes at scheduled intervals on growth rates and the time to hospital discharge. SEARCH STRATEGY: We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966 - March 2006), EMBASE (1980 - March 2006), CINAHL (1982 - March 2006), conference proceedings, and previous reviews. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (including cluster randomised trials) that compared a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding at scheduled intervals. DATA COLLECTION AND ANALYSIS: The standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors. The primary outcomes of interest were growth rates and age at hospital discharge. MAIN RESULTS: We found seven randomised controlled trials that compared ad libitum or demand/semi-demand regimes with scheduled interval regimes in preterm infants in the transition phase from intragastric tube to oral feeding. The trials were generally small and of variable methodological quality. The duration of the intervention and the duration of data collection and follow up in most of the trials is not likely to have allowed detection of measurable effects on growth. The single trial that assessed growth for longer than one week found that the rate of weight gain was lower in the ad libitum fed infants [mean difference -3.30 (95% confidence interval -6.2 to -0.4) grams per kilogram per day]. Two trials reported that feeding preterm infants using an ad libitum or demand/semi-demand feeding regime allowed earlier discharge from hospital, but the other trials did not confirm this finding. We were not able to undertake meta-analyses because of differences in study design and in the way the findings were reported. AUTHORS' CONCLUSIONS: There are insufficient data at present to guide clinical practice. A large randomised controlled trial is needed to determine if ad libitum of demand/semi-demand feeding of preterm infants affects clinically important outcomes. This trial should focus on infants in the transition phase from intragastric tube to oral feeding and should be of sufficient duration to assess effects on growth and time to oral feeding and hospital discharge.

15121.  Ashraf A, Mick G, Atchison J, Petrey B, Abdullatif H, McCormick K.  Prevalence of hypovitaminosis D in early infantile hypocalcemia. J Pediatr Endocrinol Metab. 2006 Aug;19(8):1025-31.

15122.  Bodnar LM, Tang G, Ness RB, Harger G, Roberts JM. Periconceptional multivitamin use reduces the risk of preeclampsia. Am J Epidemiol. 2006 Sep 1;164(5):470-7.

15123.  Devereux G, Turner SW, Craig LC, McNeill G, Martindale S, Harbour PJ, Helms PJ, Seaton A. Low maternal vitamin E intake during pregnancy is associated with asthma in 5-year-old children. Am J Respir Crit Care Med. 2006 Sep 1;174(5):499-507.

15124.  Gale CR, Jiang B, Robinson SM, Godfrey KM, Law CM, Martyn CN. Maternal diet during pregnancy and carotid intima-media thickness in children. Arterioscler Thromb Vasc Biol. 2006 Aug;26(8):1877-82.

15125.  Ganpule A, Yajnik CS, Fall CH, Rao S, Fisher DJ, Kanade A, Cooper C, Naik S, Joshi N, Lubree H, Deshpande V, Joglekar C. Bone mass in Indian children--relationships to maternal nutritional status and diet during pregnancy: the Pune Maternal Nutrition Study. J Clin Endocrinol Metab. 2006 Aug;91(8):2994-3001.

15126.  Garg A, Kashyap S. Effect of counseling on nutritional status during pregnancy. Indian J Pediatr. 2006 Aug; 73(8):687-92.

15127.  Harless W, Crowell E, Abraham J. Anemia and neutropenia associated with copper deficiency of unclear etiology. Am J Hematol. 2006 Jul;81(7):546-9.

15128.  Heinig MJ, Brown KH, Lonnerdal B, Dewey KG. Zinc supplementation does not affect growth, morbidity, or motor development of US term breastfed infants at 4-10 mo of age.Am J Clin Nutr. 2006 Sep;84(3):594-601.

15129.  Jackson AA, Ashworth A, Khanum S. Improving child survival: Malnutrition Task Force and the paediatrician's responsibility. Arch Dis Child. 2006 Aug;91(8):706-10. Review.

15130.  Lamberg-Allardt C. Vitamin D in foods and as supplements. Prog Biophys Mol Biol. 2006 Sep;92(1):33-8..

15131.  Lawlor DA, Clark H, Ronalds G, Leon DA. Season of birth and childhood intelligence: findings from the Aberdeen Children of the 1950s cohort study. Br J Educ Psychol. 2006 Sep;76(Pt 3):481-99.

15132.  Martin RJ, Hibbs AM. Diagnosing gastroesophageal reflux in preterm infants. Pediatrics. 2006 Aug;118(2):793-4.

15133.  Poddar U, Thapa BR, Singh K. Clinical features of celiac disease in Indian children: are they different from the West? J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):313-7.

15134.  Sacco LM, Caulfield LE, Gittelsohn J, Martinez H. The conceptualization of perceived insufficient milk among Mexican mothers. J Hum Lact. 2006 Aug;22(3):277-86.

15135.  Stoddard FJ, Usher CT, Abrams AN. Psychopharmacology in pediatric critical care. Child Adolesc Psychiatr Clin N Am. 2006 Jul;15(3):611-55. Review.

15136.  Stoner A, Walker J. Growth assessment: how do we measure up? Paediatr Nurs. 2006 Sep;18(7):26-8.

15137.  Tucker P, Irwin JD, He M, Bouck LM, Pollett G. Preschoolers' dietary behaviours: parents' perspectives. Can J Diet Pract Res. 2006 Summer;67(2):67-71.

15138.  Turck D, Grillon C, Lachambre E, Robiliard P, Beck L, Maurin JL, Kempf C, Bernet JP, Marx J, Lebrun F, Van Egroo LD. 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. J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):364-71.

15139.  Vohr BR, Poindexter BB, Dusick AM, McKinley LT, Wright LL, Langer JC, Poole WK; NICHD Neonatal Research Network. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics. 2006 Jul;118(1):e115-23.

15140. Walker AS, Mulenga V, Sinyinza F, Lishimpi K, Nunn A, Chintu C, Gibb DM; CHAP Trial Team. Determinants of survival without antiretroviral therapy after infancy in HIV-1-infected Zambian children in the CHAP Trial. J Acquir Immune Defic Syndr. 2006 Aug 15;42(5):637-45.