E. Sievers

Feeding Patterns in Breast-Fed and Formula-Fed Infants

Aim: The intention of this study performed in healthy breast- and formula-fed infants was to characterize physiological feeding patterns as a basis for counseling parents to feed their infants on demand. Methods:Ingested milk volumes of 10 breast-fed and 14 formula-fed infants were measured during five 72-hour investigation periods during the 3rd, 6th, 9th, 13th, and 17th weeks of life. Results: A comparable diurnal distribution of feeds was observed in both groups during the first 9 weeks of life, with a day-night asymmetry of feeding first observed at the age of 6 weeks. Thereafter, formula-fed infants showed a further decrease in their nightly milk intake. Within the investigation period, the milk volume per feed rose from 100 (range 40–200) g to 140 (range 30–300) g in the breast-fed group and from 100 (range 20–200) g to 200 (range 20–450) g in formula-fed infants. From the 6th week of life onwards, formula-fed infants had significantly higher feeding volumes. Conclusions: Parents should be informed about the variability of infant demands per feed and of feeding at night observed in breast-fed infants. The results suggest that feeding patterns similar to those of breast-fed infants are difficult to accomplish in formula-fed infants.

Iron Availability from an Infant Formula Supplemented with Bovine Lactoferrin

ABSTRACT. Iron balance studies were performed in 16 term infants from their 3rd until their 17th week of life. The balance studies were performed at home and comprised five periods with an interval of 3 to 4 weeks, each consisting of three 24‐hour collections of milk and stool samples. Seven infants were fed an adapted infant formula supplemented with bovine lactoferrin (100 mg/100 ml) and nine received the same formula without lactoferrin. The lactoferrin supplemented group received 169 μg iron/kg b.w. × day and retained 63 μg/kg b.w. × day. The mean iron intake of infants fed with the adapted formula without supplementation of lactoferrin was 118 μg/kg b.w. × day. The retention of iron was 43 μg/kg b.w. × day. Mean percentage retention of iron in the supplemented group was 36%, in the non‐supplemented group 28%.

Longitudinal zinc balances in breast‐fed and formula‐fed infants

Longitudinal zinc (Zn) balance studies were performed under domestic conditions in term breast‐fed (n= 10), term formula‐fed (n= 5; Zn concentration in the formula: 4 mg/l) and preterm formula‐fed (n= 3) infants during the first 17 weeks of life. Samples of milk, urine and feces were analyzed by atomic absorption spectrometry. The median daily Zn intake in breast‐fed infants decreased from 0.592 (0.457‐0.829) mg Zn/kg body weight to 0.151 (0.095‐0.304) mg Zn/kg body weight in the first 17 weeks of life; comparable values for bottle‐fed term infants were 0.58 (0.511‐0.701) and 0.674 (0.529‐0.731) mg Zn/kg body weight. The median percent retention of Zn intake was 27 (‐60 to 81.4)% in breast‐fed infants and 21.5 (‐42 to 64)% in formula‐fed infants. In view of the urinary and fecal Zn losses measured, a daily intake of 0.3‐0.5 mg Zn/kg body weight is considered to be sufficient to ensure a Zn retention equivalent to breast‐fed infants. This requires a Zn concentration of 2‐3 mg/1 of Zn depending on milk volume intake.

Plasma selenium in preterm and term infants during the first 12 months of life

Summary The goal of the present study was to prospectively assess the plasma selenium (Se) concentrations of term and preterm infants during the first year of life in relation to gestational age and nutrition. Blood specimens were collected from orally formula-fed preterm infants (gestational age Plasma selenium in preterm infants in hospital was 11.7 (6.5–20.8) g/l and 11.6 (8.8–16.7) g/l at 4 weeks corrected for gestational age. At the age of 4 months plasma selenium was still significantly lower than in the other groups: Preterm infants: 17.1 (10.4–30.5) g/l; formula-fed term infants: 31.3 (24.3–47.5) g/l; breast-fed term infants: 45.6 (27.1–65.1) g/l). The levels of breast-fed infants were significantly higher than those of both formula-fed groups up until the introduction of solids. Preterm infants had significantly low plasma selenium levels up until a postnatal age of at least 6 months. The levels were lower than those of term infants fed an identical unsupplemented infant formula during the first 4 months of life. These data support routine monitoring in hospital and selenium supplementation of preterm infants, preferably in hospital before discharge.

The Impact of Peripartum Factors on the Onset and Duration of Lactation

Knowledge of peripartum indicators of those mother-infant pairs that are at increased risk of early failure of lactation may improve specific support of breastfeeding. Mode of delivery, labor complications, hyperbilirubinemia, milk intake and weight development were evaluated in healthy term infants in a hospital (n = 338). Delayed onset of lactation was observed in primiparae and in study participants with peripartum complications. The quantitative intake of human milk, assessed by test weighing 0–24 h and 24–48 h after the onset of lactation, was not significantly different between these groups. In addition, volume intake, weight gain and lactation success were tracked in 77 infants. Partial feeding of infant formula or an intake of <150 g of human milk per day 24–48 h after the onset of lactation was linked to weaning within 4 weeks. Ninety-one percent of the infants were exclusively breastfed at discharge; this value had declined to 49, 35 and 20% at 4, 12 and 20 weeks, respectively. Peripartum factors may contribute to early lactation failure; the long-term success of breastfeeding was predominantly determined outside the hospital.

Faecal excretion in infants

Data on normal defaecation patterns in relation to diet during the first months of infancy are very limited. We therefore investigated in a prospective study faecal weight and gastro-intestinal passage time of breast fed (n=12) and formula fed (n=14) male infants. These were studied in 72 h collecting periods at the age of 17, 35, 57, 87 and 113 (±4) days. Breast fed infants had a significantly lower daily dry faecal weight than formula fed infants in all periods investigated (median at the age of 113 days: 0.28 (0.17–0.75) g/kg and 0.81 (0.22–1.2) g/kg, respectively). Breast fed infants showed a large variation of gastro-intestinal passage time (6.79 h [range: 1.79–13.38 h] at the age of 17 days, 21.84 h [range: 5.41–75 h] at the age of 113 days). Comparable values of formula red infants were 13.75 h (range: 7.13–35.25 h) and 17.42 h (range: 5.38–36.5 h). Despite the efforts of approximation of infant formula to breast milk, differences of defaecation patterns in relation to diet are still relevant at this age and have to be considered in clinical practice.

Molybdenum balance studies in premature male infants

Abstract Despite the fact that the trace element molybdenum (Mo) is essential, there is insufficient knowledge about the demands in infancy. Mo balances were therefore assessed under consideration of formula Mo concentrations ranging from 0.125 to 2.704u2009μmol/l. Sixteen premature male infants participated in the investigation. Their birth weights were between 1500 and 1990 g, the median (range) gestational age was 34 (32–36) weeks and the post-conceptual age at the time of study 37.4 (34.1–40.6) weeks. Twenty-four balance studies were performed and the materials analysed by atomic absorption spectroscopy. Infants with a “low” Mo intake received 0.024 (0.020–0.035)u2009μmol/kgu2009peru2009day, had a urinary excretion of 0.02 (0.008–0.045) and a retention of 0.0006 (−0.03 to 0.008)u2009μmol/kgu2009peru2009day. Infants with a “high” intake received 0.284 (0.227–0.487)u2009μmol/kgu2009peru2009day, had a urinary excretion of 0.243 (0.118–0.378) and a retention of 0.022 (−71.1 to 141.44)u2009μmol/kgu2009peru2009day. Since the median urinary excretion exceeded 60% of the Mo intake at low and high intakes, sufficient resorption but minimal retention was assessed at low intakes of Mo.nConclusion In view of the limited knowledge of long-term exposure to an elevated molybdenum intake and the substantial retention observed at higher intakes, upper limits should be set for molybdenum concentrations in preterm infant formulas.

Cerebrospinal fluid concentrations of leukotriene B4 in bacterial meningitis

We investigated whether leukotriene B4 (LTB4), a granulocyte inflammatory mediator, is detectable in cerebrospinal fluid using a high performance liquid chromatographic method. In non‐pleocytotic cerebrospinal fluid (n = 5) and in cerebrospinal fluid from children with aseptic meningitis (n = 8). LTB4 concentrations were below the detection limit (<0.2ngml 1). In the range 0 20ngml 1. the recovery rate of LTB4 that had been added to non‐pleocytotic cerebrospinal fluid was >90%. In cerebrospinal fluid with a polymorphonuclear leucocyte (PMN) count higher than 1,000/ml, LTB4 was detectable in six out of seven specimens with a concentration of 0.35‐3.3 ngml−1. LTB4 concentration was significantly correlated with PMN number. These results, together with observations in animal models, are discussed with regard to a pathophysiological role of LTB4 in bacterial meningitis.

Molybdenum supply of very low-birth-weight premature infants during the first months of life

This explorative study was performed to assess basic data on the Mo metabolism of premature infants. Premature (n=18, gestational age ≤32 wk, birth weight ≤1500 g) and healthy formula-fed term infants (n=14) were nourished and corrected for gestational age, identically. Plasma was collected at 3, 16, and 52 wk and 72 h balances were performed at 3 wk of age. In the premature infants, these investigations were preceded by two balance studies and an initial plasma collection. Increased Mo intake and low relative urinary excretion resulted in a retention of 4.4 (0.99–7.77) µg Mo/kg initially in premature infants (median, range). Parallel plasma concentrations were 5.5 (2.5–7.3) µg Mo/L, declining to 2.36 (0.73–3.87) µg Mo/L at 4 wk. Term infants rendered 1.49 (0.29–1.7) µg Mo/L (p<0.05), with no significant differences later. It was concluded that the supplementation of formulas for premature infants with Mo should be recinded until there is evidence for its necessity.

Trace element excess in PKU diets

SummaryKnowledge of trace element requirements of infants with phenylketonuria (PKU) fed a semisynthetic diet is limited. Three infants with PKU detected early were studied longitudinally in classical balance studies for 72 h, under domestic conditions, at the ages of 2, 5, 8, 12 and 16 weeks. Iron, copper and manganese concentrations in the diet and faeces were determined by atomic absorption spectroscopy. The median concentrations in the diet (4.8 mg Fe/L, 1.7 mg Cu/L, 0.43 mg Mn/L) exceed those in human milk. This is mainly due to supplementation of the amino acid preparation used. The increased intake led to a significantly higher daily retention of Cu and Mn from the PKU-diet fed, with a median of 0.17 mg Cu/kg and 6.4 µg Mn/kg body weight; the median retention of Fe was 0.24 mg Fe/kg. Our results confirmed the doubts about the suitability of the present trace element supplementation in formula for infants with PKU during the first four months of life.