Mma Faridi

Mother's iron status, breastmilk iron and lactoferrin – are they related?

Objective:Exclusive breastfeeding is recommended till 6 months age. Factors regulating the breastmilk iron and lactoferrin levels are incompletely known. Considering high prevalence of nutritional anemia in lactating mothers, we studied the iron status of lactating mothers, their breastmilk iron and lactoferrin levels to determine any relationship between them.Design:Prospective study with 6 months follow-up.Setting:Tertiary care referral hospital.Subjects:Hundred nonanemic and 100 anemic mothers with their babies recruited at birth. Fifty-two nonanemic and 50 anemic mothers and their babies completed the 6-month follow-up.Interventions:Hemoglobin (Hb), total iron binding capacity (TIBC), percent transferrin saturation (%TS), serum iron (SI) and serum ferritin measured on day 1 and 6 months postpartum. Breastmilk iron and lactoferrin measured on day 1, 14 weeks and 6 months after delivery.Results:Breastmilk iron decreased progressively from day 1 to 14 weeks and at 6 months in both groups, but no significant difference was noted between nonanemic and anemic mothers (P>0.05). Significant decline in breastmilk lactoferrin concentration from day 1 to 14 weeks in nonanemic and anemic mothers (P<0.001) noted. Hemoglobin, TIBC, %TS, SI and serum ferritin of both groups had no correlation with breastmilk iron and lactoferrin concentration on day 1, 14 weeks and 6 months after delivery.Conclusions:Breastmilk iron and lactoferrin concentration had no relationship with the mothers Hb and iron status.Sponsorship:This work was carried out as part of thesis research under University of Delhi.

A prospective study of iron status in exclusively breastfed term infants up to 6 months of age

BackgroundCan exclusive breastfeeding until six months of age maintain optimum iron status in term babies? We evaluated iron status of exclusively breastfed term infants in relation to breast milk iron and lactoferrin.MethodsIn this prospective study in Delhi, India, during the period 2003–2004 normally delivered babies of non-anemic [(Hemoglobin (Hb) = 11 g/dl, n = 68] and anemic (Hb 7 – 10.9 g/dl, n = 61) mothers were followed until 6 months of age. Iron parameters were measured in the cord blood at 14 weeks and 6 months. Breast milk iron and lactoferrin were measured at the same intervals.ResultsIron parameters in babies of both groups were within normal limits at birth, 14 weeks and 6 months. Mean breast milk iron and lactoferrin in non-anemic (day 1: 0.89, 6 months: 0.26 mg/l; day 1: 12.02, 6 months: 5.85 mg/ml) and anemic mothers (day 1: 0.86, 6 months: 0.27 mg/l; day 1: 12.91, 6 months: 6.37 mg/ml) were not different on day one or at other times. No relationship was found between breast milk iron, lactoferrin and iron status of the babies.ConclusionExclusively breastfed infants of non-anemic and anemic mothers did not develop iron deficiency or iron deficiency anemia by six months of age.

Lipid profile of term infants on exclusive breastfeeding and mixed feeding: a comparative study

Objectives:To compare the lipid profiles of exclusively breastfed and mixed-fed term healthy infants in the first 6 months of life.Design:Prospective comparative study.Setting:Study was carried out in a tertiary care hospital.Subjects:Four hundred consecutive term healthy infants, 200 on exclusive breastfeeding (group 1) and 200 receiving mixed feeding (group 2) were recruited at 14 weeks of age. At 6 months, 149 and 150 mother–infant pairs were followed up in groups 1 and 2, respectively.Methods:Anthropometric measures of the mother and baby were recorded. Serum lipid levels of the mother and babies were determined at 14 weeks. Babies were followed up till 6 months and their lipid levels were determined again at 6 months. Statistical analysis was carried out using SPSS.Results:Two groups were comparable in birth weight and maternal characteristics (P>0.05). Weight and head circumference were significantly more in the breastfed group at 14 weeks as well as at 6 months (P<0.001). Mean total cholesterol (TC) was 205.27±47.31 and 176.55±32.01 mg/dl in groups 1 and 2, respectively at 14 weeks (CI=20.77–36.66, P<0.001). At 6 months TC was 192.79±40.52 and 161.05±22.53 mg/dl in the two groups (CI=24.26–39.22, P<0.001). Change in total cholesterol from 14 weeks to 6 months was also significant in both groups (P<0.001). Low-density lipoprotein cholesterol (LDL-C) and triglycerides were significantly higher in the breastfed groups at 14 weeks and 6 months. The high-density lipoprotein cholesterol (HDL-C)/LDL-C significantly improved at 6 months in exclusively breastfed group (P=0.045). A positive correlation was found only at 14 weeks between mothers TC and babys TC (r=0.332), mothers LDL-C with babys LDL-C (r=0.223) in mixed fed group.Conclusion:Breastfed babies have significantly higher TC and LDL-C compared to mixed fed babies in the first 6 months of life with improving HDL-C/LDL-C ratio at 6 months.Sponsorship:None.

Vitamin D Status of term exclusively breastfed infants and their mothers from India

Objectives:  (i) To measure 25‐OH vitamin D levels in term infants at 10 weeks and 6 months and to correlate with maternal vitamin D levels at 10‐week postpartum (ii) To evaluate infants at 6 months for rickets.

Breastfeeding and complementary feeding as a public health intervention for child survival in India

The relevance of breastfeeding and complementary feeding as proven child survival interventions, is well documented by the scientific research. These two preventive interventions can save as many as 19% of all child deaths. However, despite the volume of evidence favouring mainstreaming of these interventions, many countries, including India are yet to achieve universal appropriate infant and young child feeding practices. This article attempts to explore the evidenced based role of these interventions in the crusade to save children, and looks into the present scenario of infant and young child feeding in India, along with a possible road map to achieve high rates of early and exclusive breastfeeding and appropriate complementary feeding in the country.

Dizygotic twins with myelomeningocele

Among the neural tube defects incidence of spinabifida and myelomeningocele is less in twins compared to singletons. This article reports a case of dizygotic twins with myelomeningocele, a rare occurence. Possible association of twining and neural tube defects and its impact on genetic counseling in such cases has been discussed.

Effect of carbamazepine therapy on serum lipids in children with partial epilepsy.

Alteration in serum lipids leads to atherosclerosis. Antiepileptic drugs alter serum lipids. The effect of carbamazepine therapy on serum lipids of children with partial epilepsy and correlation of changes with carbamazepine level was prospectively studied. The study population of 29 children (16 male, 13 female; age range, 3-12 years) diagnosed with partial epilepsy were enrolled within 14 days of starting carbamazepine. Serum lipids were measured at enrollment and at 3 months. Carbamazepine levels were determined at 3 months of therapy. Mean total cholesterol was 130.2 +/- 27.3 mg/dL at enrollment, and increased significantly to 144.8 +/- 32.9 mg/dL at 3 months (P = 0.018). There was a significant change in mean low and very low density lipoproteins, and in triglycerides (P < 0.05). Both the ratio of total cholesterol to high density lipoprotein and the ratio of low density lipoprotein to high density lipoprotein increased significantly. There was no significant change in levels of high density lipoprotein. At 3 months, mean carbamazepine level was 6.5 +/- 1.8 microg/dL. Changes in serum lipids did not correlate with serum carbamazepine level (P > 0.05). Carbamazepine therapy increases levels of lipids that increase the risk of atherosclerosis.

Breastfeeding a baby with mother on Bromocripine.

Prolactinomas, the most common pituitary adenomas, are important causes of infertility. Bromocriptine remains the treatment of choice for managing hyperprolactinemia in most of these cases. Breastfeeding in mothers receiving bromocriptine is often doubtful and matter of concern for most people. Here we report a case, where by timely intervention and skilled counseling, exclusive breastfeeding could be established in a mother receiving bromocriptine for the treatment of hyperprolactinemia.

Long term follow-up study to evaluate immunogenicity and safety of a single dose of live attenuated hepatitis a vaccine in children

Worldwide, viral hepatitis continues to be a cause of considerable morbidity and mortality. Mass immunization with a single dose of live attenuated HAV has been shown to significantly reduce disease burden in the community. This was a phase IV, 5-year follow up study carried out at 4 centers (Kolkata, Delhi, Mumbai and Chennai) across India. The subjects with antibody titer <20 mIU/mL at baseline were evaluated for long term immunogenicity. Of the 503 subjects enrolled, 349 subjects were baseline seronegative with an anti-HAV antibody titer <20 mIU/mL. Overall, 343 subjects could be followed up at some point of time during this 5 y post vaccination period. In the last year (60 months) of follow-up, 108 subjects (97.3%) of 111 subjects (who came for follow-up at the end of 5 y) had a protective antibody titer (anti-HAV antibody titer >20 mIU/mL). The seroconversion rates considering seroprotection levels of anti-HAV antibody titer >20 mIU/mL, following vaccination starting from 6 weeks, 6 months, 12 months, 24 months, 36 months, 48 months and 60 months were 95.1%, 97.9%, 98.3%, 96.2%, 97.8%, 92.6% and 97.3%, respectively. The geometric mean concentration (GMC) over the years increased from 64.9 mIU/mL at 6 weeks to 38.1 mIU/mL and 135.2 mIU/mL at 6 months and 12 months, respectively and was maintained at 127.1 mIU/mL at 60 months. In conclusion, the result of this 5-year follow up study showed that the single dose of live attenuated vaccine is well tolerated and provides long-term immunogenicity in healthy Indian children.

Familial hypercholesterolemia with coarctation of aorta.

A six-year-old female presented with multiple nodular swellings over elbow and wrist which were noticed for last three years [Figures 1, 2]. She had history of frequent episodes of headache and vomiting. Family history was suggestive of sudden death in three siblings [Figure 3]. The exact cause of death was not available but all of them had xanthomas. Parents had an abnormal lipid profile. Father had myocardial infarction at the age of 35 years. On examination, the child had a pulse rate of 98/min. Blood pressure in the lower limbs was less than upper limbs. Examination of cardiovascular system revealed ejection systolic murmur Grade IV over left third intercostal space, which was radiating upwards. Left renal bruit was audible.