C. Wall

Feeding Problems and Dysphagia in Six-Month-Old Extremely Low Birth Weight Infants

It is commonly assumed that feeding problems in extremely low birth weight (ELBW) infants, experienced during the neonatal period, dissipate with time and increasing maturity and experience of both the infant and the caregiver. This study compared objective feeding and oral-motor assessments at home of 20 ELBW infants aged 6 months corrected for gestation and 20 healthy infants matched for corrected chronological age, race, gender and socio-economic circumstances using a Maternal Interview, the videotaped Feeding Assessment Schedule (FAS), the Feeding Environment Checklist, Testers Ratings of Infant Behaviour (TRIB), the Infant Feeding Questionnaire, and a Dietary Analysis. Compared with controls, ELBW infants had sigruficant ongoing feeding difficulties, char-acterised by inconsistencies in oral-motor skill development, fewer readiness behaviours for solids, fewer self-feeding and biting skills, fewer smooth sequences in their mealtimes, and frequent environmental features such as poor positioning and inappropriate feeding equipment and mealtime settings. Behaviourally, they were more aversive, had poor attention, little vocalisation, and were less socially interactive. ELBW infants were receiving diets with lower energy and iron intake. Surprisingly, mothers of ELBW infants reported no signhcant feeding aversion or negative feelings about feeding. ELBW infants had significant feeding problems, behavioural disruption, and limited interpersonal skills. Links between early feeding dysfimction, nutritional status, and later communication and eating problems require further investigation. Working with parents to optimise early feeding and communication development in ELBW infants, both in neonatal intensive care wards and later at home, would appear important.

Nutrition in cystic fibrosis

BACKGROUND Cystic fibrosis (CF) is the most common autosomal recessive disorder leading to chronic disease in individuals with Caucasian ethnicity, although other ethnicities are susceptible to this disease as well. The underlying pathogenic mechanism is due to a mutation of the CF transmembrane conductance regulator (CFTR) which decreases chloride secretion and subsequent water transport across the apical surface of epithelial cells (1,2). Abnormal water transport leads to fluid hyperviscosity causing classic pulmonary, intestinal, hepatic, and pancreatic manifestations of the disease (Figure 1). Approximately 1000 known CFTR mutations are associated with CF (2). Currently, CF affects 30,000 individuals in the United States (3). Although progressive and life-threatening lung disease is a well-known complication in CF patients, 90% of CF patients have exocrine pancreatic insuffiency (PI) and subsequent fat malabsorption by one year of age. CF-related diabetes (CFRD), distal intestinal obstruction syndrome (DIOS), and various hepatobiliary diseases (cholelithiasis, fibrosis, and cirrhosis) also can occur as a result of impaired water A SPECIAL ARTICLE

The Nutritional Management of Acute Diarrhea in Young Infants - Effect of Carbohydrate Ingested

To compare the efficacy of a low-lactose hydrolyzed milk formula, a lactose-free corn syrup-based milk formula, and a standard lactose-containing formula during refeeding after rehydration in infants with gastroenteritis, 135 patients older than 2 years were studied by randomized trial. Clearly demonstrated disadvantages in terms of early weight loss and longer duration of diarrhea were observed with the lactose-based formula compared with early weight gains on both the low-lactose formulae, and thus the lactose-containing formula was discontinued after 91 patients. The early weight loss with the lactose-containing formula was statistically significantly related to the degree of relative (rehydrated) underweight. The two low-lactose formulae were further compared in the remaining 44 patients. Early weight gain (48 h) was significantly greater with the lactose-hydrolyzed formula compared with the corn syrup-based formula, but no statistically significant differences were observed in duration of diarrhea, energy intake, treatment failures, or late weight gain. We conclude that the routine use of a low-lactose formula during refeeding after rehydration in infants with gastroenteritis may have some advantages in underweight infants and toddlers in whom it is important to prevent further weight loss.

A controlled trial comparing the efficacy of rice-based and hypotonic glucose oral rehydration solutions in infants and young children with gastroenteritis

A prospective randomized trial was conducted to compare the efficacy of a rice‐based oral rehydration solution (ORS) with glucose ORS in infants and children under 5 years of age with acute diarrhoea and mild to moderate dehydration (< 10%). One hundred children presenting to a large metropolitan teaching hospital were eligible for entry to the study and were randomized to receive rice ORS or glucose ORS. Outcome measures were stool output (SO), duration of illness (DD) and recovery time to introduction of other fluids (RTF) and diet (RTD). Significant differences were found for all outcome measures in favour of the rice ORS group. Mean SO was lower (160 vs 213 mL; P < 0.02), mean DD was reduced (17.3 vs 24.3 h; P = 0.03) and median RTF was decreased (12.7 vs 18.1 h; P < 0.001) in the rice ORS group compared with the glucose ORS group. The median time to introduction of diet and mean length of hospital stay showed similar significant reductions. Our study has shown rice ORS to be an acceptable alternative to glucose ORS in young children and have shown that it is significantly more effective in reducing the course of diarrhoeal illness and the time taken to return to normal drinking and eating habits.

Studies of water and electrolyte movement from oral rehydration solutions (rice‐ and glucose‐based) across a normal and secreting gut using a dual isotope tracer technique in a rat perfusion model

To establish a model to measure bidirectional flow of water from a glucose oral rehydration solution (G‐ORS) and a newly developed rice‐based oral rehydration solution (R‐ORS) using a dual isotope tracer technique in a rat perfusion model. To measure net water, sodium and potassium absorption from the ORS.