Nutrition for Healthy Term Infants is the new national statement on nutrition for infants from birth to 24 months, developed collaboratively by the Canadian Paediatric Society, Dietitians of Canada and Health Canada.
The document summarizes the existing scientific literature on infant nutrition and presents principles and recommendations to help health care professionals promote optimal, evidence-based nutritional care for infants in Canada. Collaboration between the three key organizations involved in infant nutrition has produced unified messages for health professionals to deliver to the public.
For the first year of life four major topics are discussed: Breastfeeding, Alternate Milks, Other Fluids in Infant Feeding and Transition to Solid Foods. Safety Issues Around Feeding is presented next, followed by Nutrition in the Second Year of Life. The final section covers Other Issues in Infant Nutrition, and includes topics such as food allergies, colic, constipation, dietary fat, dental caries, gastroenteritis, diabetes, iron deficiency anemia and vegetarian diets. An extensive reference list of more than 200 citations is provided.
The Summary of Principles and Recommendations will be published in the official journals of the Canadian Paediatric Society (Paediatrics & Child Health, March/April 1998) and Dietitians of Canada (Canadian Journal of Dietetic Practice and Research, June 1998). The complete document can be downloaded from all three of the collaborating organizations’ web sites or a hard copy of the Statement, in either official language, can be obtained from the Canadian Paediatric Society, Dietitians of Canada or Health Canada.
Nutrition for Healthy Term Infants offers multidisciplinary health professionals the most current scientific tool for advising parents and positively influencing the nutritional environment provided to infants in Canada.
Guidelines; Infants; Nutrition
To determine whether NTrainer patterned orocutaneous therapy affects preterm infants' non-nutritive suck and/or oral feeding success.
Thirty-one preterm infants (mean gestational age 29.3 weeks) who demonstrated minimal non-nutritive suck output and delayed transition to oral feeds at 34 weeks post-menstrual age.
NTrainer treatment was provided to 21 infants. The NTrainer promotes non-nutritive suck output by providing patterned orocutaneous stimulation through a silicone pacifier that mimics the temporal organization of suck.
Infants' non-nutritive suck pressure signals were digitized in the NICU before and after NTrainer therapy and compared to matched controls. Non-nutritive suck motor pattern stability was calculated based on infants' time- and amplitude-normalized digital suck pressure signals, producing a single value termed the Non-Nutritive Suck Spatiotemporal Index. Percent oral feeding was the other outcome of interest, and revealed the NTrainer's ability to advance the infant from gavage to oral feeding.
Multilevel regression analyses revealed that treated infants manifest a disproportionate increase in suck pattern stability and percent oral feeding, beyond that attributed to maturational effects alone.
The NTrainer patterned orocutaneous therapy effectively accelerates non-nutritive suck development and oral feeding success in preterm infants who are at risk for oromotor dysfunction.
Feeding therapy; Non-nutritive suck; Oromotor control; Suck central pattern generator; Suck spatiotemporal variability
Recent reports from the Canadian Pediatric Society's Nutrition Committee1-5 have re-examined issues concerning the feeding of infants, and recommendations have been presented.
In an article reviewing a similar report by the Nutrition Committee of the American Academy of Pediatrics, Woodruff6 refers to the art of infant feeding and the science of infant nutrition—the former being the practical application of the latter.
The distinction is important. While the science of infant nutrition is obviously a complex area of expertise appropriate to pediatricians, factors affecting the art of infant feeding—the interplay between the needs of the infant and the community's current social and cultural beliefs and practices, between the recommendations of professional groups and food manufacturers' products and advertising—fall very definitely within the purview of the family physician.
These two papers examine some of the current Canadian recommendations, their rationale and the practical problems they pose from a family practice viewpoint.
A case-control study was conducted to determine the association between maternal height and infant length-for-age and to evaluate how this association is modified by either maternal or infant nutritional status. We hypothesized that maternal excess caloric intake (measured as BMI) would increase the association while infant nutrition (measured in main meals consumed in addition to breast feeding) will diminish the effect.
Mother and infant pairs in Chimaltenango, Guatemala were measured for anthropometric values and nutritional status, and mothers were interviewed to elicit nutritional and socio-economic information. Infant length was converted into z-scores based on the World Health Organization's (WHO) standards. Odds ratios (OR), associated 95% confidence intervals (CIs) and the relative excess risk due to interaction (RERI) were calculated. Cases were infants below 2 z-scores of the WHO's length-for-age while controls were infants within the -2 to 2 z-score range.
Cases (n=84) had an increased odds (OR 3.00, 95% CI 1.57-5.74) of being born to a stunted mother (below 145 cm) when compared to controls (n=85). When adjusted for potential confounders, the OR decreased to 2.55 (95% CI 1.30-5.02) . Negative RERI values were produced for the joint exposure of maternal BMI ≥25 and maternal stuntedness (RERI -0.96) as well as for the joint exposure of maternal stuntedness and infant nutrition (RERI -2.27).
Our results confirm that maternal stuntedness is a significant contributor to infant stuntedness; however, this association is modified negligibly by maternal nutritional status and significantly by infant nutritional status, each in a protective manner.
stunting; complementary feeding; infant growth; breast-feeding and maternal nutritional status; chronic malnutrition; Guatemala; Mayan populations
To determine to what extent intravenous nutrition can reduce proteolysis in very immature and normal newborns, and to assess the capacity of preterm and normal newborns to convert phenylalanine to tyrosine, phenylalanine and leucine kinetics were measured under basal conditions and during parenteral nutrition in clinically stable, extremely premature (approximately 26 wk of gestation) infants and in normal term newborns. In response to parenteral nutrition, there was significantly less suppression (P < 0.001) of endogenous leucine and phenylalanine rate of appearance in extremely premature infants compared with term infants. Phenylalanine utilization for protein synthesis during parenteral nutrition increased significantly (P < 0.01) and by the same magnitude (approximately 15%) in both extremely premature and term infants. Phenylalanine was converted to tyrosine at substantial rates in both extremely premature and term infants; however, this conversion rate was significantly higher (P < 0.05) in extremely premature infants during both the basal and parenteral nutrition periods. These data provide clear evidence that there is no immaturity in the phenylalanine hydroxylation pathway. Furthermore, although parenteral nutrition appears to produce similar increases in protein synthesis in extremely premature and term infants, proteolysis is suppressed much less in extremely premature newborns. The factors responsible for this apparent resistance to suppression of proteolysis in the very immature newborn remain to be elucidated.
Fifty nine infants of birthweight less than 1500 g were allocated alternately to initial total parenteral nutrition or to transpyloric feeding. Mortality was similar between the two groups. Ten of the 29 infants in the transpyloric group failed to establish full enteral nutrition during the first week of life. No beneficial effects on growth were shown in infants receiving parenteral nutrition. Acquired bacterial infection was higher in the parenteral group and associated with morbidity and mortality. Conjugated hyperbilirubinaemia occurred only in the parenterally fed infants. The incidence of necrotising enterocolitis was higher in the transpyloric group. Parenteral nutrition does not confer any appreciable benefit and because of greater complexity and higher risk of complications should be reserved for those infants in whom enteral feeding is impossible.
Breast milk is the gold standard for infant nutrition and the only necessary food for the first 6 months of an infant’s life. Infant formula is deficient and inferior to breast milk in meeting infants’ nutritional needs. The infant formula industry has contributed to low rates of breastfeeding through various methods of marketing and advertising infant formula. Today, in New York City, although the majority of mothers initiate breastfeeding (~85%), a minority of infants is breastfed exclusively at 8 weeks postpartum (~25%). The article reviews the practices of the formula industry and the impact of these practices. It then presents the strategic approach taken by the NYC Department of Health and Mental Hygiene and its partners to change hospital practices and educate health care providers and the public on the benefits of breast milk, and provides lessons learned from these efforts to make breastfeeding the normative and usual method of infant feeding in New York City.
Breastfeeding; Corporate influence; Infant; Nutrition; Infant feeding; Infant formula
The requirements of growth and organ development create a challenge in nutritional management of newborn infants, especially premature newborn and intestinal-failure infants. Since their feeding may increase the risk of necrotizing enterocolitis, some high-risk infants receive a small volume of feeding or parenteral nutrition (PN) without enteral feeding. This review summarizes the current research progress in the nutritional management of newborn infants. Searches of MEDLINE (1998-2007), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2007), abstracts and conference proceedings, references from relevant publications in the English language were performed, showing that breast milk is the preferred source of nutrients for enteral feeding of newborn infants. The number of nutrients found in human milk was recommended as a guideline in establishing the minimum and maximum levels in infant formulas. The fear of necrotizing enterocolitis and feeding intolerance are the major factors limiting the use of the enteral route as the primary means of nourishing premature infants. PN may help to meet many of the nutritional needs of these infants, but has significant detrimental side effects. Trophic feedings (small volume of feeding given at the same rate for at least 5 d) during PN are a strategy to enhance the feeding tolerance and decrease the side effects of PN and the time to achieve full feeding. Human milk is a key component of any strategy for enteral nutrition of all infants. However, the amounts of calcium, phosphorus, zinc and other nutrients are inadequate to meet the needs of the very low birth weight (VLBW) infants during growth. Therefore, safe and effective means to fortify human milk are essential to the care of VLBW infants.
Breast milk; Infant formula; Trophic feeding; Parenteral nutrition
Preterm infants on parenteral nutrition are at a relatively high risk for hypertriglyceridemia because they have immature lipoprotein lipase activity. The purpose of this study was to analyze the clinical factors affecting lipid metabolism in preterm infants receiving parenteral nutrition and to evaluate the influence of intravenous heparin on serum triglycerides to determine the adequate heparin dose to prevent hypertriglyceridemia in preterm infants.
A single-center retrospective review was conducted among preterm infants receiving parenteral nutrition between January 2006 and February 2011. In 75 patients, 110 determinations were performed within 28 days postnatal age. Demographic and clinical data, including laboratory parameters, the dose and the duration of lipid administration, and the amount of intravenous heparin, were analyzed.
Serum triglycerides were higher in the small for gestational age (SGA) infants than in the appropriate for gestational age infants (185.5±134.9 mg/dL vs. 126.9±101.9 mg/dL, p=0.019). Birth weight, gestational age, and body weight were negatively correlated with serum triglyceride level (r=-0.289, p=0.002; r=-0.208, p=0.029; r=-0.287, p=0.002, respectively). The serum triglyceride level was statistically lower in preterm infants receiving 1 U/mL of heparin than in those receiving 0.5 U/mL heparin or no heparin.
Preterm infants receiving parenteral nutrition, particularly SGA and extremely low birth weight infants, tend to have hypertriglyceridemia. Thus, administration of 1 U/mL of heparin rather than 0.5 U/mL or none may be helpful to prevent hypertriglyceridemia in preterm infants.
Lipids; Hypertriglyceridemia; Parenteral nutrition; Heparin; Preterm infant
Prevention of postnatal growth restriction of very preterm infants still represents a challenge for neonatologists. As standard feeding regimens have proven to be inadequate. Improved feeding strategies are needed to promote growth. Aim of the present study was to evaluate whether a set of nutritional strategies could limit the postnatal growth restriction of a cohort of preterm infants.
We performed a prospective non randomized interventional cohort study. Growth and body composition were assessed in 102 very low birth weight infants after the introduction of a set of nutritional practice changes. 69 very low birth weight infants who had received nutrition according to the standard nutritional feeding strategy served as a historical control group. Weight was assessed daily, length and head circumference weekly. Body composition at term corrected age was assessed using an air displacement plethysmography system. The cumulative parenteral energy and protein intakes during the first 7 days of life were higher in the intervention group than in the historical group (530±81 vs 300±93 kcal/kg, p<0.001 and 21±2.9 vs 15±3.2 g/kg, p<0.01). During weaning from parenteral nutrition, the intervention group received higher parental/enteral energy and protein intakes than the historical control group (1380±58 vs 1090±70 kcal/kg; 52.6±7 vs 42.3±10 g/kg, p<0.01). Enteral energy (kcal/kg/d) and protein (g/kg/d) intakes in the intervention group were higher than in the historical group (130±11 vs 100±13; 3.5±0.5 vs 2.2±0.6, p<0.01). The negative changes in z score from birth to discharge for weight and head circumference were significantly lower in the intervention group as compared to the historical group. No difference in fat mass percentage between the intervention and the historical groups was found.
The optimization and the individualization of nutritional intervention promote postnatal growth of preterm infants without any effect on percentage of fat mass.
AIMS—To determine the
effect of trophic feeding on clinical outcome in ill preterm infants.
controlled, prospective study of 100 preterm infants, weighing less
than 1750 g at birth and requiring ventilatory support and parenteral
nutrition, was performed. Group TF (48infants) received trophic
feeding from day 3 (0.5-1 ml/h) along with parenteral nutrition until
ventilatory support finished. Group C (52 infants) received parenteral
nutrition alone. "Nutritive" milk feeding was then introduced to
both groups. Clinical outcomes measured included total energy intake
and growth over the first six postnatal weeks, sepsis incidence, liver
function, milk tolerance, duration of respiratory support, duration of
hospital stay and complication incidence.
well matched for birthweight, gestation and CRIB scores. Infants in
group TF had significantly greater energy intake, mean difference 41.4 (95% confidence interval 9, 73.7) kcal/kg p=0.02; weight gain, 130 (CI
1, 250) g p = 0.02; head circumference gain, mean difference 0.7 (CI
0.1, 1.3) cm, p =0.04; fewer episodes of culture confirmed sepsis,
mean difference −0.7 (−1.3, −0.2) episodes, p = 0.04; less
parenteral nutrition, mean difference −11.5 (CI −20, −3) days, p = 0.03; tolerated full milk feeds (165 ml/kg/day) earlier, mean
difference −11.2 (CI −19, −3) days, p = 0.03; reduced requirement
for supplemental oxygen, mean difference −22.4 (CI−41.5, −3.3)
days, p = 0.02; and were discharged home earlier, mean difference
−22.1 (CI −42.1, −2.2) days, p = 0.04. There was no significant
difference in the relative risk of any complication.
feeding improves clinical outcome in ill preterm infants requiring
OBJECTIVE: This study focuses attention on maternal nutrition and stress as possible reasons for excess black infant mortality after exploring lower infant mortality for the infants of foreign-born black mothers compared to native-born black mothers. METHODS: All births to non-Hispanic black women in New York City from 1988-1992 were examined and infant mortality for the infants of native-born women was compared to infant mortality for the infants of foreign-born women. RESULTS: Before controlling for potential confounders on the birth certificate, the infants of native-born black women had a greater risk of infant mortality than the infants of foreign-born black women: OR = 1.48 (95% confidence interval [CI] = 1.38, 1.58). After controlling for potential confounders, the infants of native-born black women still had a greater risk of infant mortality than the infants of foreign-born black women: OR(a) = 1.32 (95% Cl = 1.21, 1.43). CONCLUSIONS: Maternal nutrition and stress are possible causes of excess black infant mortality. They should be topics for research and program development.
A questionnaire was mailed to a random sample of 532 members of the Alberta Chapter of the College of Family Physicians in order to assess the role of physicians in providing nutrition education to their patients. Of the 255 respondents (53% response rate), over 97% agreed that “educating patients about nutrition is an important role for physicians.” Physicians most often gave nutrition information on obesity, constipation, heart disease and hypertension, alcohol, coffee, infant feeding, osteoporosis, and prenatal nutrition. Female physicians gave nutrition information significantly more often than male physicians on four maternal and child health topics. Perceived barriers to nutrition education included lack of reimbursement for physicians (86%), lack of time (48%), and limited access to patient information (42%). Most physicians often informed patients on the seven most common nutrition topics despite these concerns.
family medicine; nutrition; nutrition education
The objective of this study was to evaluate the relationship between maternal nutrition knowledge and maternal socio-demographics including participation in the Special Supplemental Women, Infants and Children’s (WIC) Program. A cross-sectional study of new mothers at two San Francisco hospitals was conducted using some of the American Academy of Pediatrics’ guidelines in a structured questionnaire to assess maternal nutritional knowledge. Maternal nutritional attitudes towards product nutrient labels were also assessed in a questionnaire format. Logistic regression models were used to evaluate the odds of having high maternal nutrition knowledge and of infrequently reading nutrition labels. In multivariate logistic regression models, higher maternal nutrition knowledge (defined as answering all four nutrition questions correctly) was associated with higher income levels defined as ≥$25 000/year, odds ratio (OR) 10.03 95% confidence interval (CI) (1.51–66.74), and in linear models, higher nutritional knowledge was associated with having more children (P < 0.01), a higher income (P = 0.01) and not being a WIC participant (P < 0.01). Mothers with higher incomes were also more likely to read product nutritional labels OR 4.24, 95% CI (1.24–14.51), compared with mothers with lower incomes as were mothers with higher education levels OR 3.32, 95% CI (1.28–8.63). In San Francisco, lower income mothers are at greatest risk for low maternal nutrition knowledge and not reading product nutritional labels. Higher household income was independently associated with increased maternal nutrition knowledge and likelihood of reading nutritional labels. More comprehensive interventions need to target low-income mothers including current WIC participants to help close the nutritional advantages gap conferred by income and education.
maternal nutrition knowledge; nutrient labels; WIC Program
The defining event in the area of infant feeding is the aggressive marketing of infant formula in the developing world by transnational companies in the 1970s. This practice shattered the trust of the global health community in the private sector, culminated in a global boycott of Nestle products and has extended to distrust of all commercial efforts to improve infant and young child nutrition. The lack of trust is a key barrier along the critical path to optimal infant and young child nutrition in the developing world.
To begin to bridge this gap in trust, we developed a set of shared principles based on the following ideals: Integrity; Solidarity; Justice; Equality; Partnership, cooperation, coordination, and communication; Responsible Activity; Sustainability; Transparency; Private enterprise and scale-up; and Fair trading and consumer choice. We hope these principles can serve as a platform on which various parties in the in the infant and young child nutrition arena, can begin a process of authentic trust-building that will ultimately result in coordinated efforts amongst parties.
A set of shared principles of ethics for infant and young child nutrition in the developing world could catalyze the scale-up of low cost, high quality, complementary foods for infants and young children, and eventually contribute to the eradication of infant and child malnutrition in the developing world.
Conventional practice is to reduce or eliminate copper supplementation in the parenteral nutrition of infants with cholestasis due to the increased risk of hepatotoxicity. However, there are reports of copper deficiency in cholestatic infants due to copper reduction in their parenteral nutrition.
1) To determine the proportion of cholestatic infants who develop elevated serum copper while receiving a non-reduced dose of parenteral copper, 2) To evaluate potential clinical factors that affect serum copper in cholestatic infants, and 3) To evaluate the impact of serum copper on liver disease.
This is a retrospective review of 28 cholestatic infants receiving 20 mcg/kg/d of copper via parenteral nutrition. Age-adjusted references were used to determine normality of serum copper levels. Multiple linear regression analyses were performed to determine predictors of serum copper and alanine aminotransferase.
Serum copper levels were elevated in 2 infants (7%). On average, infants received 80% of their energy intake from parenteral nutrition for 3 months. Intestinal failure was present in 50% of the patients. Birth weight, gestational age and alanine aminotransferase were identified as predictors of serum copper (R2=0.53; p= 0.0001). Serum copper, gestational age and total bilirubin were associated with serum alanine aminotransferase (R2 = 0.43; p = 0.001).
Supplementation of parenteral copper at 20 mcg/kg/day does not lead to a significant increase in copper toxicity or worsening of liver disease in cholestatic infants.
Copper supplementation; infant; copper toxicity; cholestasis; parenteral nutrition
To evaluate whether differences in early nutritional support provided to extremely premature infants mediate the effect of critical illness on later outcomes, we examined whether nutritional support provided to “more critically ill” infants differs from that provided to “less critically ill” infants during the initial weeks of life, and if, after controlling for critical illness, that difference is associated with growth and rates of adverse outcomes. 1366 participants in the NICHD Neonatal Research Network parenteral glutamine supplementation randomized controlled trial who were alive on day of life 7 were stratified by whether they received mechanical ventilation for the first 7 days of life. Compared to more critically ill infants, less critically ill infants received significantly more total nutritional support during each of the first 3 weeks of life, had significantly faster growth velocities, less moderate/severe bronchopulmonary dysplasia, less late-onset sepsis, less death, shorter hospital stays, and better neurodevelopmental outcomes at 18–22 months corrected age. Rates of necrotizing enterocolitis were similar. Adjusted analyses using general linear and logistic regression modeling and a formal mediation framework demonstrated that the influence of critical illness on the risk of adverse outcomes was mediated by total daily energy intake during the first week of life.
The relation between the nutrition of the mother and that of her baby was assessed in a south Indian community where malnutrition is common and women do not smoke. Unselected mothers and their infants of over 37 weeks' gestation were studied in two groups: those who paid for their care (150) and a poorer group who did not (172). There were significnat differences between the paying and non-paying groups in maternal triceps skinfold thickness, infant weight, and infant length. Overall there was a significant positive correlation between maternal triceps thickness and infant weight, length, and triceps and subscapular skinfold thickness. The correlation with the infant head circumference was less significant. These findings are further evidence that the nutrition of the mother has an important effect on the nutrition of her baby and that malnutrition is an important reason why Indian babies are lighter than European ones.
Although household food security (HHFS) has been shown to affect diet, nutrition, and health of adults and also learning in children, no study has examined associations with infant feeding practices (IFP). We studied 1343 infants born between May 2002 and December 2003 in the Maternal and Infant Nutrition Intervention in Matlab study to investigate the effect of HHFS on IFP in rural Bangladesh. We measured HHFS using a previously developed 11-item scale. Cumulative and current infant feeding scales were created from monthly infant feeding data for the age groups of 1–3, 1–6, 1–9, and 1–12 mo based on comparison to infant feeding recommendations. We used lagged, dynamic, and difference longitudinal regression models adjusting for various infant and maternal variables to examine the association between HHFS and changes in IFP, and Cox proportional hazards models to examine the influence of HHFS on the duration of breast-feeding and the time of introduction of complementary foods. Better HHFS status was associated with poor IFP during 3–6 mo but was associated with better IFP during 6–9 and 9–12 mo of age. Although better HHFS was not associated with the time of introduction of complementary foods, it was associated with the type of complementary foods given to the infants. Intervention programs to support proper IFP should target mothers in food-secure households when their babies are 3–6 mo old and also mothers in food-insecure households during the 2nd half of infancy. Our results provide strong evidence that HHFS influences IFP in rural Bangladesh.
Nutrition support practitioners are currently dealing with shortages of parenteral nutrition micronutrients, including multivitamins (MVI), selenium and zinc. A recent survey from the American Society of Enteral and Parenteral Nutrition (ASPEN) indicates that this shortage is having a profound effect on clinical practice. A majority of respondents reported taking some aggressive measures to ration existing supplies. Most premature infants and many infants with congenital anomalies are dependent on parenteral nutrition for the first weeks of life to meet nutritional needs. Because of fragile health and poor reserves, they are uniquely susceptible to this problem. It should be understood that shortages and rationing have been associated with adverse outcomes, such as lactic acidosis and Wernicke encephalopathy from thiamine deficiency or pulmonary and skeletal development concerns related to inadequate stores of Vitamin A and D. In this review, we will discuss the current parenteral shortages and the possible impact on a population of very low birth weight infants. This review will also present a case study of a neonate who was impacted by these current shortages.
TPN; premature infant; nutrient deficiencies; neonate
Iron deficiency remains a very common nutritional problem despite the improvement in nutrition and increased understanding of methods for its prevention. Thus, we try to create a new method for screening iron nutrition through infant nutrition history.
Among the children who visited Inha University Hospital from March 2006 to July 2012, 181 children with iron deficiency anemia (IDA) and 52 children without IDA ranging from 6 to 36 months of age were reviewed in this study. We used the age when they began to wean food, the type of sort weaning foods, the time required for successful weaning, iron content in weaning foods, and the duration of breastfeeding for scoring infant nutrition history based on a questionnaire.
The mean score of the IDA group was 7.8±2.6 points, which was significantly higher than that of the control group (5.6±2.1) (p=0.000). If we set up the cutoff value at 6 points, this screening has 86.8% sensitivity and 36% specificity. In addition, as the IDA score increased, there was a falling trend of hemoglobin.
The IDA score does not have high specificity or high sensitivity. However, this study conveys that those patients who record a high score have low hemoglobin. Therefore, we suggest this score system for screening more IDA patients via nonpainful techniques.
Iron-deficiency anemia; Weaning; Breast feeding; Diet; Nutrition
It has been well established that breastfeeding is beneficial for child health, however there has been debate regarding the effect of lactation on maternal health in the presence of HIV infection and the need for nutritional supplementation in HIV positive lactating mothers.
To assess the effect of nutritional supplementation to HIV infected lactating mothers on nutritional and health status of mothers and their infants.
A randomized controlled clinical trial to study the impact of nutritional supplementation on breastfeeding mothers. Measurements included anthropometry; body composition indicators; CD4 count, haemoglobin and albumin; as well as incidence rates of opportunistic infections; depression and quality of life scores. Infant measurements included anthropometry, development and rates of infections.
The supplement made no significant impact on any maternal or infant outcomes. However in the small group of mothers with low BMI, the intake of supplement was significantly associated with preventing loss of lean body mass (1.32 kg vs. 3.17 kg; p = 0.026). There was no significant impact of supplementation on the infants.
A 50 g daily nutritional supplement to breastfeeding mothers had no or limited effect on mother and child health outcomes.
Clinical trial registration
HIV positive mothers; HIV exposed infants; breastfeeding; nutrition supplement; body composition; anthropometry; SRQ 20; RCT
Failure to thrive is common in infants with hypoplastic left heart syndrome and its variants and those with poor growth may be at risk for worse surgical and neurodevelopmental outcomes. The etiology of growth failure in this population is multifactorial and complex, but may be impacted by nutritional intervention. There are no consensus guidelines outlining best practices for nutritional monitoring and intervention in this group of infants. The Feeding Work Group of the National Pediatric Cardiology Quality Improvement Collaborative performed a literature review and assessment of best nutrition practices from centers participating in the collaborative in order to provide nutritional recommendations and levels of evidence for those caring for infants with single ventricle physiology.
Nutrition; Hypoplastic Left Heart Syndrome; Feeding Guidelines; Enteral Nutrition; Parenteral Nutrition
AIMS—To improve energy intake in sick very low birthweight (VLBW) infants; to decrease growth problems, lessen pulmonary morbidity, shorten hospital stay, and avoid possible feeding related morbidity. Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia, necrotising enterocolitis, septicaemia, cholestasis and osteopenia of prematurity.
METHODS—A prospective randomised controlled trial (RCT) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit. Babies were randomly allocated to either an aggressive nutritional regimen (group A) or a control group (group B). Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition. Statistical analysis was done using Student's t test, the Mann-Whitney U test, the χ2 test and logistic regression.
RESULTS—There was an excess of sicker babies in group A, as measured by initial disease severity (P <0.01), but mean total energy intakes were significantly higher (P <0.001) in group A at days 3 to 42 while receiving total or partial parenteral nutrition. Survival and the incidences of bronchopulmonary dysplasia, septicaemia, cholestasis, osteopenia and necrotising enterocolitis were similar in both groups. Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay.
CONCLUSION—Nutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae. Improved nutritional intake resulted in better growth, both in the early neonatal period and at hospital discharge, but did not decrease pulmonary morbidity or shorten hospital stay.
Keywords: very low birthweight infant; nutrition; bronchopulmonary dysplasia; necrotising enterocolitis
Both the successful development of healthy, long-term animal models to study fetal nutrition and metabolism and the improved survival of low-birth-weight, preterm infants have focused interest and research on fetal and neonatal nutrition and metabolism. Such a focus is important, given the recent emphasis on promoting neonatal growth in preterm infants at “normal” in utero growth rates. Estimates of nutrient requirements for growth in a human fetus remain ill defined, however. Body composition data appear biased toward thin infants. Animal data suggest that fetal nutrition proceeds according to species-specific growth rates, with variations in fat content largely dependent on placental fat permeability and on maternal nutrient supply as regulated by the placenta.
After birth, neonatal nutrition is affected primarily by food intake and the functional integrity and capacity of the gastrointestinal tract. Additionally, muscle activity, thermoregulation and stresses of various kinds and degrees modify a neonate's nutritional requirements. Functional deficits of the gastrointestinal tract have been circumvented by a more aggressive use of intravenous nutrition. Both intravenous and enteral nutrient mixtures have been substantially improved in the quantity of all nutrients and have been modified qualitatively toward compositions that are closer to those of human milk. These nutrient mixtures now produce plasma nutrient concentrations that approximate those of a healthy, breast-fed infant.
Although such efforts to improve the nutritional balance and growth of preterm infants have been successful, much remains to be learned about the nutritional requirements of sick infants.