S Maccario

Minor feeding problems during the first months of life: effect of a partially hydrolysed milk formula containing fructo- and galacto-oligosaccharides.

Background: Colic, regurgitation and constipation are common feeding problems in formula‐fed infants that might benefit from dietary treatment. A formula containing fructo‐ and galacto‐oligosaccharides, partially hydrolysed proteins, low levels of lactose and palmitic acid in the β position and higher density has been tested to reduce the occurrence of these symptoms. The aim of this prospective study was to describe the effects of such a formula in infants with minor gastrointestinal disorders. Methods: An observational prospective trial involving practising Italian paediatricians was performed. Formula fed‐infants up to 90 d of age with minor gastrointestinal problems such as infantile colics and/or regurgitation and/or constipation were enrolled in the study from January 2001 to May 2001. The study was completed within 14 d of treatment. On days 1, 7 and 14 the infants were visited by the paediatricians. Parents were given a structured diary to record daily episodes of colic, regurgitation and type and number of stools. Results: Of the 932 infants enrolled, 604 completed the study. Of the 214 infants with colic, 169 (79%) demonstrated a reduction in frequency of colic from 4.1 ± 2.0 per day at the beginning of the study to 2.0 ± 1.8 at the end of the study (I.C. 95%: 1.72–2.39; p < 0.005). A reduction in the number of episodes of colic of 1.8 per day at the beginning of the study (I.C. 95%: 1.49–2.11; p < 0.05) was recorded between day 1 and day 7, and of 0.26 (I.C. 95%: 0.15–0.37; p < 0.05) between day 7 and day 14. Of the 201 infants with regurgitation problems, 141 (70%) demonstrated a reduction of frequency of the symptoms from 4.2 ± 2.0 per day at the beginningof the study to 2.1 ± 2.2 at the end of the study (I.C. 95%: 1.75–2.35; p < 0.005). A reduction of 1.87 in the number of regurgitation episodes was reported between day 1 and day 7 (I.C. 95%: 1.57–2.16; p < 0.05) and of 0.18 (I.C. 95%: 0.06–0.31; p < 0.05) between day 7 and day 14. Of the 232 infants with constipation, 147 (63%) demonstrated an increase in the daily number of stools of 0.42 (I.C. 95%: 0.5–0.3; p < 0.005). An increase in stool frequency of 0.41 (I.C. 95%: 0.51–0.23; p < 0.05) was reported between day 1 and day 7, and of 0.04 (I.C. 95%: 0.22–0.14; p= ns) between day 7 and day 14. Parents’evaluation of the formula was 7.9 ± 1.8 (score 0–10); 550 parents (91%) gave a positive judgement (score >6). The evaluation by the paediatricians of the improvement in symptoms after the treatment was 8.2 ± 1.5; 574 (95%) a positive effect (score >6).

Methemoglobinemia caused by the ingestion of courgette soup given in order to resolve constipation in two formula-fed infants

Methemoglobinemia is not a rare condition arising from the exposure to hemoglobin-oxidizing agents such as nitrates-nitrites present in well water or vegetables. Infants <3 months of age are more susceptible than adults because of lower amounts of a key enzyme, NADH-cytochrome b5 reductase, which converts methemoglobin back to hemoglobin. We report 2 infants, aged respectively 2 and 1 months, suffering from methemoglobinemia, fed with a formula that was reconstituted with a high concentration of courgette soup to resolve constipation. They developed a severe cyanosis with methemoglobinemia (respectively 30.4 and 27%) and were hospitalized and treated with methylene blue at 1%. After 12 h the syndrome was completely resolved. Home-prepared infant foods containing vegetables are potential causes of methemoglobinemia. It is important not to feed infants with vegetables having a high nitrate content (e.g., courgette, spinach, beets and green beans) to resolve constipation since, particularly in the first months of life, they may cause severe methemoglobinemia.

Advances in the management of digestive problems during the first months of life

UNLABELLED A study was carried out on 168 full-term infants with digestive problems such as regurgitation and/or constipation to evaluate the efficacy of new infant formulas containing partially hydrolysed whey protein, modified vegetable oil with a high beta-palmitic acid content, prebiotic oligosaccharides and starch. Infants receiving the new formulas had an increase in stool frequency of 0.60 between day 1 and day 7 (95% CI 0.19-1.01; p=0.004) and 0.53 (95% CI 0.11-0.90; p=0.015) between day 7 and day 14. A reduction of 1.06 in the number of regurgitation episodes was reported between day 1 and day 7 (95% CI 0.24-1.88; p=0.012) and 1.31 (95% CI 0.42-2.21; p=0.005) between day 7 and day 14. CONCLUSION A prebiotic mixture of galacto-/fructo-oligosaccharides with a high beta-palmitic acid content may reduce digestive problems and improve intestinal tolerance in infants during the first months of life.

Relationships between IGF-I and Weight Z Score, BMI, Tricipital Skin-Fold Thickness, Type of Feeding in Healthy Infants in the First 5 Months of Life

Aim: To determine the concentration of insulin-like growth factor-I (IGF-I) in exclusively breast-fed (BF) and formula-fed (FF) infants in the first 5 months of life and to study the relationship between the IGF-I level and Z score for weight, body mass index (BMI) and tricipital skin-fold thickness. Methods: We performed a cross-sectional study in order to evaluate serum IGF-I in 97 age-matched healthy term infants: 50 FF and 47 BF. Results: FF infants showed higher values of IGF-I (38.9 ± 12 ng/ml) when compared to BF infants (26.7 ± 11.6 ng/ml; p < 0.05). A positive correlation was found between IGF-I values and Z score for weight (p < 0.001), BMI (p = 0.014), tricipital skin-fold thickness (p = 0.043) and age (p = 0.02). Conclusion: These results show that the IGF-I serum concentration is higher in FF infants. The observed association between IGF-I and Z score for weight, BMI, tricipital skin-fold thickness confirms the effect of different infant feeding on body size.

Bioimpedance Vector Analysis in Breastfed and Formula-Fed Infants in the First Six Months of Life

During the first months of life, modification of body composition occurs rapidly. Studies have reported that breastfed (BF) infants show a different growth pattern than formula-fed (FF) infants, particularly in the first years of life. Methods have been developed for estimating body composition. Even though the majority of these methods, such as isotope dilution techniques, total body nitrogen, and densitometry, provide precise analyses and estimations of the body mass, the use of invasive methods, which lead to an increasing risk of radiation exposure, cause difficulties, especially in pediatrics. Bioelectrical Impedance Analysis (BIA) estimates body composition in children and adults by measuring electrical impedance of body tissue. BIA has been accepted as a body composition measurement by the U.S. National Institutes of Health (NIH 1996). This test consists of applying an alternative current of 800 µA and 50 kHz, which is not perceivable and not dangerous. This technique is based on equations that translate the electrical signals in terms of body composition. The related theoretical assumptions and reference models are applicable and accurate only on selected groups of healthy adults and children.

Advances in the management of digestive problems during the first months of life: Prebiotics on digestive problems

A study was carried out on 168 full‐term infants with digestive problems such as regurgitation and/or constipation to evaluate the efficacy of new infant formulas containing partially hydrolysed whey protein, modified vegetable oil with a high β‐palmitic acid content, prebiotic oligosaccharides and starch. Infants receiving the new formulas had an increase in stool frequency of 0.60 between day 1 and day 7 (95% CI 0.19–1.01; p=0.004) and 0.53 (95% CI 0.11–0.90; p=0.015) between day 7 and day 14. A reduction of 1.06 in the number of regurgitation episodes was reported between day 1 and day 7 (95% CI 0.24–1.88; p=0.012) and 1.31 (95% CI 0.42–2.21; p=0.005) between day 7 and day 14.