Judith A. Ernst

Growth outcome and feeding practices of the very low birth weight infant (less than 1500 grams) within the first year of life.

Growth outcome for 1 year of corrected age and feeding practices during that first year of life were described for a large population of very low birth weight (VLBW) infants. Growth patterns of weight, length, and occipitofrontal circumference through 12 months of corrected age, and weight/length ratios at 12 months, were determined for 122 VLBW infants less than or equal to 1500 gm and less than or equal to 35 weeks of gestational age at birth; feeding practices were surveyed within a subpopulation of 89 infants. Differences in growth were apparent when infants were grouped according to sex and appropriateness of intrauterine growth. When the mean values of each group were compared, the female infants of appropriate size for gestational age demonstrated growth at higher percentiles (National Center for Health Statistics term-infant norms) for all three measurements (weight, length, and occipitofrontal circumference). Male infants whose size was appropriate for gestational age, and male and female infants who were small for gestational age, all grew similarly, at lower percentiles for weight and length, when compared with the same norms. Growth in occipitofrontal circumference was closest to term infant norms in all subgroups of infants. The majority of the infants, regardless of subgroup, achieved weights and lengths greater than 5th percentile and proportionate growth with a normal weight/length ratio. At 12 months of corrected age, 30% remained at less than 5th percentile in weight, 21% in length, and 14% in occipitofrontal circumference. Eighteen infants (15%) had a marked discrepancy in weight for length, with a weight/length ratio less than 5th percentile. Three prevalent practices that could result in compromised nutrition were identified: (1) cereals were introduced at an early age, (2) 2% and skim cow milk were fed to approximately 50% of the infants within the first year of life, and (3) whole cow milk was introduced to some VLBW infants at an early age. Caretakers apparently viewed their infants in terms of chronologic age rather than age corrected for prematurity when it came to the initiation of solids and cow milk. Whether increased attention to appropriate feeding practices during the first year of life would result in a more favorable growth outcome for VLBW infants is not known.

Absorption of calcium and magnesium from fortified human milk by very low birth weight infants

ABSTRACT: Absorption of calcium and magnesium endogenous to human milk, as well as calcium and magnesium added as an exogenous supplement to human milk, was determined in 9 very low birth wt infants. Human milk, intrinsically labeled with stable isotopic tracers of calcium and magnesium, was prepared by administering isotopic tracers intravenously to a lactating woman. Different isotopic tracers, which were representative of calcium and magnesium in the supplement (Enfamil Human Milk Fortifier, Mead Johnson Nutritional Div.), were added to the intrinsically labeled milk. The fortified milk, which was labeled with two calcium tracers and two magnesium tracers, was given orally to the test subjects in a single feeding. True absorption of calcium and magnesium was determined from differences between the doses of tracer ingested and the quantities of tracer excreted in the feces. Stable isotopic tracers were quantified by fast atom bombardment mass spectrometry. These results demonstrate that the fractional absorptions of calcium in the human milk and the added mineral supplement are 80 and 82%, respectively. A total of 89% magnesium endogenous to human milk and 86% of magnesium derived from the mineral supplement was absorbed by the VLBW infants.

Food and nutrient intake of 6- to12-month-old infants fed formula or cow milk: A summary of four national surveys

Food and nutrient intakes of infants during the second 6 months of life were summarized with the use of four national surveys as the data base. Three of the surveys, the second National Health and Nutrition Examination Survey (1976-1980), the Ross Nutrition Survey (1984), and the U.S. Department of Agriculture Nationwide Food Consumption Survey (1977-1978), summarized and compared the nutrient composition of the diets of infants fed formula with that of the diets of infants fed cow milk during the second 6 months of life. The Gerber Nutrition Survey (GNS) summarized the nutrient composition of the diets of infants fed formula, cow milk, or human milk, or a combination of these, during 1986. Iron-fortified formula with beikost provided adequate but not excessive intakes of all nutrients for infants during the second 6 months of life with the possible exception of calcium for older infants. In contrast to cow milk, formula provided readily absorbed and adequate iron, generous linoleic acid, and adequate but not excessive intakes of protein, phosphorus, sodium, and potassium. The distribution of energy between protein, carbohydrate and fat, and potential renal solute load was reasonable in infants fed formula. Cow milk with beikost provided low intakes of readily bioavailable iron and linoleic acid and high intakes of protein, calcium, phosphorus, sodium, potassium, and potential renal solute load during the second 6 months of life. The diets of infants fed low-fat milks were even lower in linoleic acid and higher in volume of food consumed, protein, calcium, phosphorus, sodium, potassium, and potential renal solute load than the diets of infants fed whole cow milk. Apparently, infants fed cow milk were treated differently than those fed formula (i.e., they were given more solids and table foods and less baby food at all ages and less volume of milk at 9 and 12 months of age). These data provided the basis for the development of practical suggestions for feeding infants during the second 6 months of life.

Morbidity and nutrition status of rural drug-naïve Kenyan women living with HIV

This paper describes morbidity in a group of HIV-positive drug-naïve rural women in western Kenya. A total of 226 drug-naïve HIV-positive women were evaluated for baseline morbidity, immune function, and anthropometry before a food-based nutrition intervention. Kenyan nurses visited women in their homes and conducted semi-structured interviews regarding symptoms and physical signs experienced at the time of the visit and during the previous week and physical inspection. Blood and urine samples were examined for determination of immune function (CD4, CD8, and total lymphocyte counts), anaemia, malaria, and pregnancy status. Intradermal skin testing with tuberculin (PPD), candida, and tetanus toxoid antigens was also performed to evaluate cell-mediated immunity. Anthropometry was measured, and body mass index (BMI) was calculated. Seventy-six per cent of the women reported being sick on the day of the interview or within the previous week. Illnesses considered serious were reported by 13.7% of women. The most frequent morbidity episodes reported were upper respiratory tract infections (13.3%), suspected malaria (5.85%), skeletal pain (4.87%), and stomach pain (4.42%). The most common morbidity signs on physical inspection were respiratory symptoms, most commonly rhinorrhea and coughing. Confirmed malaria and severe diarrhea were significantly associated with a higher BMI.