Dojčenie a novorodenci s nízkou pôrodnou hmotnosťou
U nedonosených detí má výživa materským mliekom snáď ešte väčší význam ako u zrelých novorodencov. Bolo dokázané, že materské mlieko na rozdiel od umelých prípravkov nedonosencov účinne chráni pred sepsou (celkovou infekciou organizmu) a nekrotizujúcou enterokolitídou (životne nebezpečný zápal čreva typický pre nedonosencov, spolu so sepsou jedna z hlavných príčin úmrtnosti u nezrelcov). Dojčení nedonosenci sa lepšie vyvíjajú po intelektovej stránke ako deti kŕmené v úvodnom období života umelým mliekom. Zistilo sa, že počas sania z prsníka deti dýchajú pravidelnejšie a majú menej poklesov saturácii (nasýtenia krvi kyslíkom) ako pri pití z fľašky.
Nedonosené deti ostávajú rizikovými aj po prepustení z nemocnice, nezriedka musia byť z rôznych príčin znovu hospitalizované. Výsledky jednej štúdie naznačujú, že dojčení nedonosenci bývajú po prepustení zdravší a riziko opakovaných hospitalizácii je u nich nižšie.
Dojčenie, respektive odstriekavanie materského mlieka ma nezanedbateľný psychický význam pre mamičky kriticky chorých detí, ktoré tak získavajú pocit, že môžu pre svoje deti závislé na prístrojoch takisto niečo urobiť. Zlepšenie psychickej pohody a posilnenie sebadôvery je pre matku starajúcu sa dlhodobo o rizikové dieťa veľmi dôležité.
Nedonosenci sú schopní piť od 27.-30. týždňa postmenstruačného veku (z prsníka dokážu úspešne sať 800-900g vážiace deti). Neodporúča sa kŕmiť deti najprv z fľaše cumľom a potom prechádzať na dojčenie. Pitie cez cumeľ vyžaduje inú techniku pitia, ak si naň dieťa zvykne, ťažšie sa potom učí piť z prsníka. Preto ak dieťa ešte nevládze piť priamo od mamy, odporúča sa kŕmenie z malého pohárika (cup-feeding), ktoré neruší prirodzenú koordináciu sacích pohybov. Dojčiť sa dajú úspešne aj nedonosené dvojičky.
Pediatrics 1999 Jun;103(6 Pt 1):1150-7 |
Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula.
Schanler RJ, Shulman RJ, Lau C
Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. schanler@bcm.tmc.edu
BACKGROUND: In a large-scale study of feeding strategies in premature infants (early vs later initiation of enteral feeding, continuous vs bolus tube-feeding, and human milk vs formula), the feeding of human milk had more effect on the outcomes measured than any other strategy studied. Therefore, this report describes the growth, nutritional status, feeding tolerance, and health of participating premature infants who were fed fortified human milk (FHM) in comparison with those who were fed exclusively preterm formula (PF). METHODS: Premature infants were assigned randomly in a balanced two-way design to early (gastrointestinal priming for 10 days) versus late initiation of feeding (total parenteral nutrition only) and continuous infusion versus intermittent bolus tube-feeding groups. The type of milk was determined by parental choice and infants to receive their mother's milk were randomized separately from those to receive formula. The duration of the study spanned the entire hospitalization of the infant. To evaluate human milk versus formula feeding, we compared outcomes of infants fed >50 mL. kg-1. day-1 of any human milk (averaged throughout the hospitalization) with those of infants fed exclusively PF. Growth, feeding tolerance, and health status were measured daily. Serum indices of nutritional status were measured serially, and 72-hour nutrient balance studies were conducted at 6 and 9 weeks postnatally. RESULTS: A total of 108 infants were fed either >50 mL. kg-1. day-1 human milk (FHM, n = 62) or exclusively PF (n = 46). Gestational age (28 +/- 1 weeks each), birth weight (1.07 +/- 0.17 vs 1.04 +/- 0.19 kg), birth length and head circumference, and distribution among feeding strategies were similar between groups. Infants fed FHM were discharged earlier (73 +/- 19 vs 88 +/- 47 days) despite significantly slower rates of weight gain (22 +/- 7 vs 26 +/- 6 g. kg-1. day-1), length increment (0.8 +/- 0.3 vs 1.0 +/- 0.3 cm. week-1), and increment in the sum of five skinfold measurements (0.86 +/- 0.40 vs 1.23 +/- 0.42 mm. week-1) than infants fed PF. The incidence of necrotizing enterocolitis and late-onset sepsis was less in the FHM group. Overall, there were no differences in any measure of feeding tolerance between groups. Milk intakes of infants fed FHM were significantly greater than those fed PF (180 +/- 13 vs 157 +/- 10 mL. kg-1. day-1). The intakes of nitrogen and copper were higher and magnesium and zinc were lower in group FHM versus PF. Fat and energy absorption were lower and phosphorus, zinc, and copper absorption were higher in group FHM versus PF. The postnatal retention (balance) surpassed the intrauterine accretion rate of nitrogen, phosphorus, magnesium, zinc, and copper in the FHM group, and of nitrogen, magnesium, and copper in the PF group. CONCLUSIONS: Although the study does not allow a comparison of FHM with unfortified human milk, the data suggest that the unique properties of human milk promote an improved host defense and gastrointestinal function compared with the feeding of formula. The benefits of improved health (less sepsis and necrotizing enterocolitis) associated with the feeding of FHM outweighed the slower rate of growth observed, suggesting that the feeding of FHM should be promoted actively in premature infants.
Acta Paediatr 1999 Oct;88(10):1101-6 |
Effect of breastfeeding and morbidity on the development of low birthweight term babies in Brazil.
Morris SS, Grantham-McGregor SM, Lira PI, Assuncao AM, Ashworth A
International Food Policy Research Institute, Washington, DC, USA.
Low birthweight (LBW) occurs in 17% of births in developing countries and many of them are full term. The subsequent development of LBW term infants is poorer than higher birthweight children and more likely to be affected by poor social circumstances. We investigated the effects of morbidity and breastfeeding on the development of these LBW term infants. Two parallel cohorts (n = 131 + 131) of LBW term (1500-2499 g) and higher birthweight (3000-3499 g) infants were recruited from six maternity centers in northeast Brazil. The longitudinal prevalence of morbidity and the frequency of breastfeeding over the first 6 mo of life were assessed. The infants' development was assessed on the Bayley Scales at 6 and 12 mo, and we previously reported that the low birthweight group had lower scores than the higher birthweight group. Hospitalizations in the first 6 mo were negatively associated with 6-mo and 12-mo Bayley scores in both groups. Among LBW infants, but not higher birthweight infants, there were significant associations between the prevalence of diarrhea and mental and motor development at 6 mo and mental development at 12 mo. Breastfeeding frequency in the first 4 wk of life was positively associated with mental development in both birthweight groups at 6 mo but not at 12 mo. Breastfeeding beyond 4 wk was not associated with the children's development. We conclude that low birthweight infants are especially vulnerable to the effects of diarrhea, and the greater frequency and differential effect of diarrhea partly explains their poorer development.
Morris SS, Grantham-McGregor SM, Lira PI, Assuncao AM, Ashworth A
International Food Policy Research Institute, Washington, DC, USA.
Low birthweight (LBW) occurs in 17% of births in developing countries and many of them are full term. The subsequent development of LBW term infants is poorer than higher birthweight children and more likely to be affected by poor social circumstances. We investigated the effects of morbidity and breastfeeding on the development of these LBW term infants. Two parallel cohorts (n = 131 + 131) of LBW term (1500-2499 g) and higher birthweight (3000-3499 g) infants were recruited from six maternity centers in northeast Brazil. The longitudinal prevalence of morbidity and the frequency of breastfeeding over the first 6 mo of life were assessed. The infants' development was assessed on the Bayley Scales at 6 and 12 mo, and we previously reported that the low birthweight group had lower scores than the higher birthweight group. Hospitalizations in the first 6 mo were negatively associated with 6-mo and 12-mo Bayley scores in both groups. Among LBW infants, but not higher birthweight infants, there were significant associations between the prevalence of diarrhea and mental and motor development at 6 mo and mental development at 12 mo. Breastfeeding frequency in the first 4 wk of life was positively associated with mental development in both birthweight groups at 6 mo but not at 12 mo. Breastfeeding beyond 4 wk was not associated with the children's development. We conclude that low birthweight infants are especially vulnerable to the effects of diarrhea, and the greater frequency and differential effect of diarrhea partly explains their poorer development.
BMJ 1990 Mar 31;300(6728):837-40 |
Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study.
Lucas A, Brooke OG, Morley R, Cole TJ, Bamford MF
MRC Dunn Nutrition Unit, Cambridge.
OBJECTIVE--To study the effect of early diet on the development of allergic reactions in infants born preterm. DESIGN--Two randomised prospective trails. In trail A infants were randomly allocated banked donor milk or preterm formula as their sole diet or (separately randomised) as a supplement to their mother's expressed breast milk. In trial B infants were allocated term or preterm formula. A blind follow up examination was done 18 months after the expected date of birth. SETTING--Neonatal units of hospitals in Cambridge, Ipswich, King's Lynn, Norwich, and Sheffield. Outpatient follow up. PARTICIPANTS--777 Infants with a birth weight less than 1850 g born during 1982 to 1984. MAIN OUTCOME MEASURES--Development of eczema, allergic reactions to food or drugs, and asthma or wheezing by nine and 18 months after term. Whenever possible the observations were confirmed by rechallenge or clinical examination. RESULTS--At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial. In the subgroup of infants with a family history of atopy, however, those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions (notably eczema) by 18 months (odds ratio 3.6; 95% confidence interval 1.4 to 9.1). CONCLUSIONS--Feeding neonates on formulas based on cows' milk, including those with a high protein content, did not increase the overall risk of allergy. Nevertheless, in the subgroup with a family history of atopy early exposure to cows' milk increased the risk of a wide range of allergic reactions, especially eczema.
Lucas A, Brooke OG, Morley R, Cole TJ, Bamford MF
MRC Dunn Nutrition Unit, Cambridge.
OBJECTIVE--To study the effect of early diet on the development of allergic reactions in infants born preterm. DESIGN--Two randomised prospective trails. In trail A infants were randomly allocated banked donor milk or preterm formula as their sole diet or (separately randomised) as a supplement to their mother's expressed breast milk. In trial B infants were allocated term or preterm formula. A blind follow up examination was done 18 months after the expected date of birth. SETTING--Neonatal units of hospitals in Cambridge, Ipswich, King's Lynn, Norwich, and Sheffield. Outpatient follow up. PARTICIPANTS--777 Infants with a birth weight less than 1850 g born during 1982 to 1984. MAIN OUTCOME MEASURES--Development of eczema, allergic reactions to food or drugs, and asthma or wheezing by nine and 18 months after term. Whenever possible the observations were confirmed by rechallenge or clinical examination. RESULTS--At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial. In the subgroup of infants with a family history of atopy, however, those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions (notably eczema) by 18 months (odds ratio 3.6; 95% confidence interval 1.4 to 9.1). CONCLUSIONS--Feeding neonates on formulas based on cows' milk, including those with a high protein content, did not increase the overall risk of allergy. Nevertheless, in the subgroup with a family history of atopy early exposure to cows' milk increased the risk of a wide range of allergic reactions, especially eczema.
Nurs Res 1999 Mar-Apr;48(2):78-85 |
Physiological responses of preterm infants to breast-feeding and bottle-feeding with the orthodontic nipple.
Dowling DA
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA. dad10@po.cwru.edu
BACKGROUND: Although the orthodontic nipple has been recommended for many years to supplement breast-feeding infants, it is not known if this nipple is suitable for hospitalized preterm infants whose mothers wish to breast-feed. OBJECTIVES: To describe and compare short-term physiologic responses of preterm infants serving as their own controls for two feeding methods, breast-feeding and bottle-feeding with the orthodontic nipple. METHOD: The sample consisted of eight preterm infants, mean birth weight of 1,370 grams and mean gestational age at birth of 30.2 weeks' gestation, who served as their own controls for breast- and bottle-feeding sessions. The dependent variables, sucking, breathing, and oxygen saturation, were measured noninvasively throughout breast- and bottle-feeding sessions and recorded on a polygraph. Data were analyzed quantitatively and qualitatively for 14 breast-feeding sessions and 15 bottle-feeding sessions. RESULTS: Statistically significant differences were found in that infants breathed more during sucking bursts for breast-feeding sessions when compared to bottle-feeding sessions and had fewer episodes of oxygen desaturation during breast-feeding. A characteristic sucking waveform associated with organized breathing was observed for some infants during bottle-feeding with the orthodontic nipple. CONCLUSIONS: These data suggest that the orthodontic nipple is appropriate for supplementing breast-feeding for some preterm infants. Further research is needed to examine long-term outcomes.
Dowling DA
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA. dad10@po.cwru.edu
BACKGROUND: Although the orthodontic nipple has been recommended for many years to supplement breast-feeding infants, it is not known if this nipple is suitable for hospitalized preterm infants whose mothers wish to breast-feed. OBJECTIVES: To describe and compare short-term physiologic responses of preterm infants serving as their own controls for two feeding methods, breast-feeding and bottle-feeding with the orthodontic nipple. METHOD: The sample consisted of eight preterm infants, mean birth weight of 1,370 grams and mean gestational age at birth of 30.2 weeks' gestation, who served as their own controls for breast- and bottle-feeding sessions. The dependent variables, sucking, breathing, and oxygen saturation, were measured noninvasively throughout breast- and bottle-feeding sessions and recorded on a polygraph. Data were analyzed quantitatively and qualitatively for 14 breast-feeding sessions and 15 bottle-feeding sessions. RESULTS: Statistically significant differences were found in that infants breathed more during sucking bursts for breast-feeding sessions when compared to bottle-feeding sessions and had fewer episodes of oxygen desaturation during breast-feeding. A characteristic sucking waveform associated with organized breathing was observed for some infants during bottle-feeding with the orthodontic nipple. CONCLUSIONS: These data suggest that the orthodontic nipple is appropriate for supplementing breast-feeding for some preterm infants. Further research is needed to examine long-term outcomes.
J Paediatr Child Health 1999 Apr;35(2):145-50 |
Hospital admissions in the first year of life in very preterm infants.
Elder DE, Hagan R, Evans SF, Benninger HR, French NP
Department of Neonatal Paediatrics, University of Western Australia.
OBJECTIVE: To analyse hospital readmissions to 1 year in infants < 33 weeks' gestation. STUDY DESIGN: Cohort of very preterm infants born in Western Australia. METHODS: Parental social class, history of asthma, race, gestational age, birthweight, sex, severity of respiratory disease and oxygen requirement at 28 days chronic lung disease (CLD), 36 weeks and term, maternal smoking, cohabitation with siblings, breast-feeding duration and hospital readmissions were recorded prospectively. RESULTS: Data were available for 538 of 560 (96%) infants discharged. Eight died in the first year. Two hundred and twenty-five infants (42%) had 443 readmissions, of which 370 were medical and 73 surgical. Risk factors for medical readmission were Aboriginal race, male sex and CLD. Breast-feeding was protective. Risk factors for surgical admission were male sex, lower gestation, severe hyaline membrane disease, severe CLD and birthweight < 10th centile. CONCLUSIONS: Readmission is common after very preterm birth. Risk factors for medical and surgical admission differ with CLD being the only perinatal factor associated with both medical and surgical admission.
J Hum Lact 1997 Mar;13(1):15-21 |
The rewards outweigh the efforts: breastfeeding outcomes for mothers of preterm infants.
Kavanaugh K, Meier P, Zimmermann B, Mead L
Department of Maternal-Child Nursing, University of Illinois at Chicago, USA.
This study describes the rewards and efforts of breastfeeding for mothers of preterm infants. Using a semi-structured interview guide, 20 mothers of preterm infants were interviewed in their homes approximately 1 month after infant discharge from a Level III NICU. Mothers described the following rewards of breastfeeding: knowing they were providing the healthiest nutrition for the infant, enhancing closeness between the mother and infant, perceiving infant contentment and tranquility during breastfeeding, providing convenience for the mother, and giving the mother a tangible claim on the infant. Most mothers identified some "efforts" associated with breastfeeding their preterm infants, but indicated that overall, breastfeeding was a rewarding experience. These data providescientific support for the promotion and facilitation of breastfeeding for mothers of preterm infants, in that mothers perceive specific emotional advantages that they relate to the breastfeeding experience.
Kavanaugh K, Meier P, Zimmermann B, Mead L
Department of Maternal-Child Nursing, University of Illinois at Chicago, USA.
This study describes the rewards and efforts of breastfeeding for mothers of preterm infants. Using a semi-structured interview guide, 20 mothers of preterm infants were interviewed in their homes approximately 1 month after infant discharge from a Level III NICU. Mothers described the following rewards of breastfeeding: knowing they were providing the healthiest nutrition for the infant, enhancing closeness between the mother and infant, perceiving infant contentment and tranquility during breastfeeding, providing convenience for the mother, and giving the mother a tangible claim on the infant. Most mothers identified some "efforts" associated with breastfeeding their preterm infants, but indicated that overall, breastfeeding was a rewarding experience. These data providescientific support for the promotion and facilitation of breastfeeding for mothers of preterm infants, in that mothers perceive specific emotional advantages that they relate to the breastfeeding experience.
Early Hum Dev 1999 Jul;55(3):247-64 |
The development of preterm infants' breastfeeding behavior.
Nyqvist KH, Sjoden PO, Ewald U
Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden.
Extensive scientific data are available on the development of sucking in term infants, but corresponding knowledge about preterm infants has been lacking. The aim was to describe the development of preterm infants' behavior at the breast, according to postmenstrual and postnatal age. Mothers co-operated as data collectors using the Preterm Infant Breastfeeding Behavior Scale for observations. Seventy-one singletons (born after 26.7-35.9 gestational weeks) were studied prospectively. Mothers received regular advice about breastfeeding and guidance about interaction and appropriate stimulation. Breastfeeding was initiated at a postmenstrual age (PMA) of 27.9-35.9 weeks. Mothers provided 4321 records of infants' behavior, 70% of the total breastfeeding sessions during the infants' hospital stay. Irrespective of postmenstrual age, the infants responded by rooting and sucking on the first contact with the breast. Efficient rooting, areolar grasp and latching on were observed at 28 weeks, and repeated bursts of > or = 10 sucks and maximum bursts of > or = 30 sucks at 32 weeks. Nutritive sucking appeared from 30.6 weeks. Sixty-seven infants were breastfed at discharge. Fifty-seven of them established full breastfeeding at a mean PMA of 36.0 weeks (33.4-40.0 weeks). Their early sucking behavior is interpreted as the result of learning, enhanced by contingent stimuli. We therefore suggest that guidelines for initiation of breastfeeding in preterm infants should be based on cardiorespiratory stability, irrespective of current maturity, age or weight.
Nyqvist KH, Sjoden PO, Ewald U
Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden.
Extensive scientific data are available on the development of sucking in term infants, but corresponding knowledge about preterm infants has been lacking. The aim was to describe the development of preterm infants' behavior at the breast, according to postmenstrual and postnatal age. Mothers co-operated as data collectors using the Preterm Infant Breastfeeding Behavior Scale for observations. Seventy-one singletons (born after 26.7-35.9 gestational weeks) were studied prospectively. Mothers received regular advice about breastfeeding and guidance about interaction and appropriate stimulation. Breastfeeding was initiated at a postmenstrual age (PMA) of 27.9-35.9 weeks. Mothers provided 4321 records of infants' behavior, 70% of the total breastfeeding sessions during the infants' hospital stay. Irrespective of postmenstrual age, the infants responded by rooting and sucking on the first contact with the breast. Efficient rooting, areolar grasp and latching on were observed at 28 weeks, and repeated bursts of > or = 10 sucks and maximum bursts of > or = 30 sucks at 32 weeks. Nutritive sucking appeared from 30.6 weeks. Sixty-seven infants were breastfed at discharge. Fifty-seven of them established full breastfeeding at a mean PMA of 36.0 weeks (33.4-40.0 weeks). Their early sucking behavior is interpreted as the result of learning, enhanced by contingent stimuli. We therefore suggest that guidelines for initiation of breastfeeding in preterm infants should be based on cardiorespiratory stability, irrespective of current maturity, age or weight.
N Z Med J 1997 Jun 13;110(1045):209-12 |
Can preterm twins breast feed successfully?
Liang R, Gunn AJ, Gunn TR
University of Auckland.
AIM: To compare the success of singleton and twin preterm infants in establishing and maintaining breast feeding, and to evaluate the effectiveness of current programmes to promote breast feeding. METHODS: All infants less than 37 weeks gestation discharged in one month from the special care baby unit at National Womens Hospital were studied. Data on the infants and their in hospital course was recorded from the neonatal records. The mothers were contacted by telephone 3 to 4 months after discharge, to elicit the subsequent breast feeding rates. RESULTS: Thirty of 33 preterm infants (29 to 36 weeks gestation) were breast fed at discharge from hospital: 93% of singletons, and 89% of twins. The twins were older and heavier at discharge (p < 0.004) due to their longer hospital stays (28.4 vs 16.3 days, p < 0.05). All but 2 infants progressed to exclusive breast feeding. There was a similar rate of decline in the rates of breast feeding in singletons and twins to 68% at 8-12 weeks and 49% at 12-16 weeks after birth. CONCLUSIONS: Preterm twins can breast feed as successfully as preterm singleton infants; as with sufficient assistance and encouragement, their rates of breast feeding were comparable to those of term infants. Although the resources of this hospital do not allow preterm infants to become fully breast fed before discharge, the current programme at National Womens Hospital is effective in establishing successful breast feeding in these high risk infants.
Liang R, Gunn AJ, Gunn TR
University of Auckland.
AIM: To compare the success of singleton and twin preterm infants in establishing and maintaining breast feeding, and to evaluate the effectiveness of current programmes to promote breast feeding. METHODS: All infants less than 37 weeks gestation discharged in one month from the special care baby unit at National Womens Hospital were studied. Data on the infants and their in hospital course was recorded from the neonatal records. The mothers were contacted by telephone 3 to 4 months after discharge, to elicit the subsequent breast feeding rates. RESULTS: Thirty of 33 preterm infants (29 to 36 weeks gestation) were breast fed at discharge from hospital: 93% of singletons, and 89% of twins. The twins were older and heavier at discharge (p < 0.004) due to their longer hospital stays (28.4 vs 16.3 days, p < 0.05). All but 2 infants progressed to exclusive breast feeding. There was a similar rate of decline in the rates of breast feeding in singletons and twins to 68% at 8-12 weeks and 49% at 12-16 weeks after birth. CONCLUSIONS: Preterm twins can breast feed as successfully as preterm singleton infants; as with sufficient assistance and encouragement, their rates of breast feeding were comparable to those of term infants. Although the resources of this hospital do not allow preterm infants to become fully breast fed before discharge, the current programme at National Womens Hospital is effective in establishing successful breast feeding in these high risk infants.
J Trop Pediatr 1999 Apr;45(2):108-10 |
Cup feeding: an alternative to bottle feeding in a neonatal intensive care unit.
Gupta A, Khanna K, Chattree S
Department of Pediatrics, Jaipur Golden Hospital, Rohini, New Delhi, India.
Cup feeding has been suggested as an alternative to bottle feeding to help promote breastfeeding by avoiding nipple confusion. To demonstrate the possibility and utility of cup feeding, records of 59 preterm and low birthweight babies (born before 37 weeks' gestation) admitted to a neonatal intensive care unit (NICU) from May 1995 to April 1996 were analyzed. Feeding was initiated on cup if swallowing was present and cup feeding was possible as early as 29 weeks' gestational age with a birthweight of 900 g. In the case of five infants (38 per cent) in the gestational age group 28-30 weeks, 19 infants (52 per cent) in the 31-34 weeks' gestation group, and six (56 per cent) in the 35-37 weeks' gestation group, feeding could be commenced directly with a cup. Out of 59 infants, 33 infants (56 per cent) could be discharged on exclusive breastfeeding. It was concluded that cup feeding is a useful alternative to bottle feeding and an effective method of feeding preterm and small infants in NICU. Cup feeding allows successful breastfeeding without causing 'nipple confusion'.
Gupta A, Khanna K, Chattree S
Department of Pediatrics, Jaipur Golden Hospital, Rohini, New Delhi, India.
Cup feeding has been suggested as an alternative to bottle feeding to help promote breastfeeding by avoiding nipple confusion. To demonstrate the possibility and utility of cup feeding, records of 59 preterm and low birthweight babies (born before 37 weeks' gestation) admitted to a neonatal intensive care unit (NICU) from May 1995 to April 1996 were analyzed. Feeding was initiated on cup if swallowing was present and cup feeding was possible as early as 29 weeks' gestational age with a birthweight of 900 g. In the case of five infants (38 per cent) in the gestational age group 28-30 weeks, 19 infants (52 per cent) in the 31-34 weeks' gestation group, and six (56 per cent) in the 35-37 weeks' gestation group, feeding could be commenced directly with a cup. Out of 59 infants, 33 infants (56 per cent) could be discharged on exclusive breastfeeding. It was concluded that cup feeding is a useful alternative to bottle feeding and an effective method of feeding preterm and small infants in NICU. Cup feeding allows successful breastfeeding without causing 'nipple confusion'.
J Pediatr 1998 Aug;133(2):224-31 |
An epidemiologic longitudinal study of sleeping problems and feeding experience of preterm and term children in southern Finland: comparison with a southern German population sample.
Wolke D, Sohne B, Riegel K, Ohrt B, Osterlund K
University of Hertfordshire, Department of Psychology, Hatfield, Great Britain.
OBJECTIVE: To determine the influence of breast-feeding on the prevalence and persistence of sleeping problems in southern Finland (SF) and southern Germany (SG). DESIGN: Prospective binational population study of infants admitted to special care units (SCUs) in geographically defined areas in SF and SG. SUBJECTS: In SF, the number of SCU infants was 1057 (very preterm, 47; preterm, 258; term, 752); 485 term infants were control subjects. In SG, the number of SCU infants was 4427 (very preterm, 284; preterm, 1419; term, 2724). MAIN OUTCOME MEASURE: Parent reports of child sleeping problems at 5, 20, and 56 months of age. RESULTS: Night waking at 5 months of age was less frequent for SCU very preterm (25.5%), preterm (40.6%), and term infants (48%) than for term control subjects (56.7% to 59.9%) in SF. No differences in sleeping behavior according to gestation were found at 20 and 56 months. Sleeping problems were greater in SF infants (25.5% to 48%) than in SG infants (15.1% to 19.1%) at 5 months of age and were explained by a higher rate of breast-feeding in SF. Breast-feeding had no long-term effects on night waking or on co-sleeping in SF. In contrast, breast-fed infants continued to wake more often in SG. CONCLUSIONS:Breast-feeding rather than gestational age is strongly related to night waking. More support for dealing with night waking might prevent early termination of breast-feeding.
J Obstet Gynecol Neonatal Nurs 2000 Mar-Apr;29(2):145-52 |
Differential effects of breast- and formula-feeding on preterm infants' sleep-wake patterns.
Thomas KA
Department of Family and Child Nursing, University of Washington, Seattle 98195-7262, USA. kthomas@u.washington.edu
OBJECTIVE: To compare sleep-wake patterns of breastfed and formula-fed preterm infants. DESIGN: Data were taken from an exploratory study of infant biorhythm maturation. Parents completed a 24-hour diary of infant Sleep, Awake, and Cry states and feedings, recorded at 30-minute intervals. Infant health data were collected from medical records and parents' reports. SETTING: Infants were studied in the home after discharge from a neonatal intensive-care unit. PARTICIPANTS: The convenience sample included 12 breastfed and 25 formula-fed preterm infants (gestational age, 26-33 weeks; corrected postnatal age, 4-6 weeks). Groups were comparable in terms of gestational age, postnatal age, Apgar scores, maternal age, and home environment. MAIN OUTCOME MEASURE: The 24-hour recording period was divided into day (0600-1800) and night (1800-0600). Study variables were Day, Night, and 24-hour Sleep, Awake, and Cry. RESULTS: Breastfed preterm infants exhibited more Day Cry and 24-hour Cry than did formula-fed infants. Infants demonstrated a diurnal pattern in Cry, Awake, and Sleep. Breastfed preterm infants cried approximately 1 hour per day more than formula-fed infants. CONCLUSION: Preterm breastfed infants experienced more cry than did formula-fed infants. The relationship between feeding method and sleep-wake pattern has implications for supporting lactation as well as for research design.
Thomas KA
Department of Family and Child Nursing, University of Washington, Seattle 98195-7262, USA. kthomas@u.washington.edu
OBJECTIVE: To compare sleep-wake patterns of breastfed and formula-fed preterm infants. DESIGN: Data were taken from an exploratory study of infant biorhythm maturation. Parents completed a 24-hour diary of infant Sleep, Awake, and Cry states and feedings, recorded at 30-minute intervals. Infant health data were collected from medical records and parents' reports. SETTING: Infants were studied in the home after discharge from a neonatal intensive-care unit. PARTICIPANTS: The convenience sample included 12 breastfed and 25 formula-fed preterm infants (gestational age, 26-33 weeks; corrected postnatal age, 4-6 weeks). Groups were comparable in terms of gestational age, postnatal age, Apgar scores, maternal age, and home environment. MAIN OUTCOME MEASURE: The 24-hour recording period was divided into day (0600-1800) and night (1800-0600). Study variables were Day, Night, and 24-hour Sleep, Awake, and Cry. RESULTS: Breastfed preterm infants exhibited more Day Cry and 24-hour Cry than did formula-fed infants. Infants demonstrated a diurnal pattern in Cry, Awake, and Sleep. Breastfed preterm infants cried approximately 1 hour per day more than formula-fed infants. CONCLUSION: Preterm breastfed infants experienced more cry than did formula-fed infants. The relationship between feeding method and sleep-wake pattern has implications for supporting lactation as well as for research design.
Clin Perinatol 1999 Jun;26(2):379-98, vii |
The use of human milk and breastfeeding in premature infants.
Schanler RJ, Hurst NM, Lau C
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. schanler@bcm.tmc.edu
Human milk is beneficial in the management of premature infants. The beneficial effects generally relate to improvements in host defenses, digestion, and absorption of nutrients, gastrointestinal function, neurodevelopment, and maternal psychological well-being. The use of fortified human milk generally provides the premature infant adequate growth, nutrient retention, and biochemical indices of nutritional status when fed at approximately 180 mL/kg/day compared with unfortified human milk. Human milk can only support the needs of the premature infant if adequate milk volumes are produced. Intensive efforts at lactation support are desirable. Therefore, neonatal centers should encourage the feeding of fortified human milk for premature infants along with skin-to-skin contact as a reasonable method to enhance milk production and promote success with early breastfeeding, while potentially facilitating the development of an enteromammary response.
Schanler RJ, Hurst NM, Lau C
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. schanler@bcm.tmc.edu
Human milk is beneficial in the management of premature infants. The beneficial effects generally relate to improvements in host defenses, digestion, and absorption of nutrients, gastrointestinal function, neurodevelopment, and maternal psychological well-being. The use of fortified human milk generally provides the premature infant adequate growth, nutrient retention, and biochemical indices of nutritional status when fed at approximately 180 mL/kg/day compared with unfortified human milk. Human milk can only support the needs of the premature infant if adequate milk volumes are produced. Intensive efforts at lactation support are desirable. Therefore, neonatal centers should encourage the feeding of fortified human milk for premature infants along with skin-to-skin contact as a reasonable method to enhance milk production and promote success with early breastfeeding, while potentially facilitating the development of an enteromammary response.
Pediatr Res 1998 Jul;44(1):54-9 |
Do healthy premature infants fed breast milk need vitamin E supplementation: alpha- and gamma-tocopherol levels in blood components and buccal mucosal cells.
Kaempf DE, Linderkamp O
Department of Pediatrics, University of Heidelberg, Germany.
Prematurely born, low birth weight infants are generally considered to be marginally vitamin E-deficient. Vitamin E deficiency has so far been defined as a low plasma alpha-tocopherol level (below 500 microg/dL) accompanied by a low tocopherol to lipid ratio or increased hydrogen peroxide hemolysis of erythrocytes. In the present study, we determined alpha- and gamma-tocopherol in plasma, red blood cells, platelets, buccal mucosal cells, monocytes, and polymorphonuclear leukocytes of premature infants to assess vitamin E status. Fourteen healthy, premature infants with birth weight (mean +/- SD) 1439 +/- 364 g and gestational age 30 +/- 1.7 wk were enrolled in the study. Alpha- and gamma-tocopherol were determined in cord blood and on d 0 to 1, 7, 14, 28, and 42 after birth in plasma and various cell types. Moreover, two randomly selected human milk samples were studied in each mother. Although subclinical or biochemical vitamin E deficiency was seen in healthy, premature infants in the first 6 wk of life in plasma and buccal mucosal cells, the other cells showed no such deficiency during the study. We conclude that these infants do not need routine vitamin E supplementation.
Kaempf DE, Linderkamp O
Department of Pediatrics, University of Heidelberg, Germany.
Prematurely born, low birth weight infants are generally considered to be marginally vitamin E-deficient. Vitamin E deficiency has so far been defined as a low plasma alpha-tocopherol level (below 500 microg/dL) accompanied by a low tocopherol to lipid ratio or increased hydrogen peroxide hemolysis of erythrocytes. In the present study, we determined alpha- and gamma-tocopherol in plasma, red blood cells, platelets, buccal mucosal cells, monocytes, and polymorphonuclear leukocytes of premature infants to assess vitamin E status. Fourteen healthy, premature infants with birth weight (mean +/- SD) 1439 +/- 364 g and gestational age 30 +/- 1.7 wk were enrolled in the study. Alpha- and gamma-tocopherol were determined in cord blood and on d 0 to 1, 7, 14, 28, and 42 after birth in plasma and various cell types. Moreover, two randomly selected human milk samples were studied in each mother. Although subclinical or biochemical vitamin E deficiency was seen in healthy, premature infants in the first 6 wk of life in plasma and buccal mucosal cells, the other cells showed no such deficiency during the study. We conclude that these infants do not need routine vitamin E supplementation.
J Paediatr Child Health 1998 Feb;34(1):97-100 |
Symptomatic zinc deficiency in breast-fed term and premature infants.
Stevens J, Lubitz L
Department of General Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia.
Two 3-month-old exclusively breast-fed infants, one born at full-term and the other born prematurely, developed symptomatic zinc deficiency manifested by an acrodermatitis enteropathica-like eruption. Inadequate breast milk zinc was demonstrated in both cases. A rapid clinical response followed oral zinc supplementation after which their serum zinc levels returned to normal. The infants remained asymptomatic following cessation of zinc therapy. Reports of similar cases suggest that in a group of infants breast milk does not meet their nutritional zinc requirements. Inadequate breast milk zinc is thought to result from a defect in transfer of zinc from maternal serum to breast milk.
Stevens J, Lubitz L
Department of General Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia.
Two 3-month-old exclusively breast-fed infants, one born at full-term and the other born prematurely, developed symptomatic zinc deficiency manifested by an acrodermatitis enteropathica-like eruption. Inadequate breast milk zinc was demonstrated in both cases. A rapid clinical response followed oral zinc supplementation after which their serum zinc levels returned to normal. The infants remained asymptomatic following cessation of zinc therapy. Reports of similar cases suggest that in a group of infants breast milk does not meet their nutritional zinc requirements. Inadequate breast milk zinc is thought to result from a defect in transfer of zinc from maternal serum to breast milk.
J Trop Pediatr 1997 Feb;43(1):52-4 |
Zinc status of breastfed and formula-fed infants of different gestational ages.
Hemalatha P, Bhaskaram P, Kumar PA, Khan MM, Islam MA
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
Zinc status in 186 full term and preterm infants was determined at birth, and 3, 6, 9, and 12 months of age along with determination of zinc levels in breast or formula milk to find out if routine zinc supplements are needed during infancy. The leukocyte and plasma zinc levels in all breastfed infants were high at birth and gradually declined reaching lowest values by 4-6 months of age, and improved to normal levels by 9 months following weaning. The preterm infants however, had significantly (P < 0.05) higher leukocyte zinc (213.6 +/- 46.91 micrograms/10(10) cells) at birth compared to term infants. Colostrum of all the mothers had higher zinc concentrations which declined to significantly lower levels in breastmilk by 4-6 months of lactation, corresponding to the age when the breastfed infants had lower zinc levels. The improvement of the levels to normal after weaning suggests that the fall in zinc status during early infancy could be a transient phenomenon which could be reversed by proper weaning, thus strengthening the plea for timely food supplements rather than the need for single nutrient supplements. Formula-fed full term infants had significantly lower leukocyte zinc levels (49.3 +/- 2.59 micrograms/10(10) cells) at 3 months of age compared to breastfed infants of the same age (92.8 +/- 14.04 micrograms/10(10) cells). Even these infants improved their zinc status after weaning on par with breastfed infants. The functional significance of their transient, but low zinc values during early infancy needs to be investigated.
Hemalatha P, Bhaskaram P, Kumar PA, Khan MM, Islam MA
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
Zinc status in 186 full term and preterm infants was determined at birth, and 3, 6, 9, and 12 months of age along with determination of zinc levels in breast or formula milk to find out if routine zinc supplements are needed during infancy. The leukocyte and plasma zinc levels in all breastfed infants were high at birth and gradually declined reaching lowest values by 4-6 months of age, and improved to normal levels by 9 months following weaning. The preterm infants however, had significantly (P < 0.05) higher leukocyte zinc (213.6 +/- 46.91 micrograms/10(10) cells) at birth compared to term infants. Colostrum of all the mothers had higher zinc concentrations which declined to significantly lower levels in breastmilk by 4-6 months of lactation, corresponding to the age when the breastfed infants had lower zinc levels. The improvement of the levels to normal after weaning suggests that the fall in zinc status during early infancy could be a transient phenomenon which could be reversed by proper weaning, thus strengthening the plea for timely food supplements rather than the need for single nutrient supplements. Formula-fed full term infants had significantly lower leukocyte zinc levels (49.3 +/- 2.59 micrograms/10(10) cells) at 3 months of age compared to breastfed infants of the same age (92.8 +/- 14.04 micrograms/10(10) cells). Even these infants improved their zinc status after weaning on par with breastfed infants. The functional significance of their transient, but low zinc values during early infancy needs to be investigated.
Acta Paediatr 1998 Jan;87(1):6-10 |
Olfaction and human neonatal behaviour: clinical implications.
Winberg J, Porter RH
Department of Woman and Child Health, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
Winberg J, Porter RH
Department of Woman and Child Health, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
About 1-2% of the human genome is allocated to production of receptors for the olfactory epithelium--a hint as to the possible importance of this chemical sense, which includes two anatomically distinct systems: the main olfactory system with sensory cells located in the upper part of the nasal cavity, and the vomero-nasal organ with sensory cells on the nasal septum. In adults, individual odours may influence mate preferences and a growing body of evidence indicates that naturally occurring odours play an important role in the mediation of the infant's behaviour. Even foetal olfactory learning seems to occur and breast odours from the mother exert a pheromone-like effect at the newborn's first attempt to locate the nipple. Newborns are generally responsive to breast odours produced by lactating women. Olfactory recognition may be implicated in the early stages of the mother-infant attachment process, when the newborns learn to recognize the own mother's unique odour signature--a process possibly facilitated by the high norepinephrine release and the arousal of the locus coeruleus at birth. New knowledge about human odour physiology may have diagnostic and therapeutic implications--the initiation and stabilization of breastfeeding and termination of apnoeic spells are mentioned as examples.
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