Decreased Incidence of Necrotizing Enterocolitis after Introduction of Exclusive Breast Milk Feeding in a Single Neonatal Intensive Care Center

PURPOSE: To evaluate the effects of exclusive breast milk feeding (BMF) on the incidence of necrotizing enterocolitis (NEC) in preterm infants. METHODS: All newborn infants, born at <32 weeks of gestation and weighing <1,500 g, admitted to the neonatal intensive care center at Seoul National University Bundang Hospital during the study period, were included. The study was divided into period I: pre-exclusive BMF (January 2010–March 2014) and period II: exclusive BMF (April 2014–December 2016). RESULTS: A total of 374 infants were enrolled in this study, with 174 in period I and 174 in period II. The incidence of NEC was 11.5% in period I and 3.4% in period II. As the mean gestational age and birth weight were significantly greater in infants in period II, the difference in the incidence of NEC between the two periods was adjusted by gestational age. After adjustment, the incidence of NEC in period II was significantly lower than in period I (P=0.024). CONCLUSION: Exclusive BMF significantly reduced the incidence of NEC in a single neonatal intensive care center.

Monitoring of Clostridium difficile Colonization in Preterm Infants in Neonatal Intensive Care Units / 대한소아소화기영양학회지

PURPOSE: To examine the prevalence of Clostridium difficile (C. difficile) colonization (CDC) and potential neonatal determinants of CDC in hospitalized preterm infants. METHODS: Fecal samples were serially collected within 72 h after birth and at 1, 2, and 4-6 weeks of age from preterm infants in the neonatal intensive care units (NICUs) of two different university hospitals. Total bacterial DNA was extracted from each fecal sample from 49 infants, and polymerase chain reaction (PCR) was performed with primers for the 16S gene of C. difficile and the toxin A and toxin B genes. The correlation between the results of C. difficile PCR assays and the clinical characteristics of the infants was analyzed. RESULTS: The prevalence rates of CDC were 34.7, 37.2, 41.3, and 53.1% within 72 h after birth and at 1, 2, and 4-6 weeks of age, respectively. The toxin positivity rate was significantly higher in the infants with persistent CDC than in those with transient CDC (8/12 [66.7%] vs. 6/25 [24.5%] (p=0.001). Among the various neonatal factors, only the feeding method during the first week after birth was significantly associated with persistent CDC. Exclusive breast-milk feeding (EBMF) significantly decreased the risk of persistent CDC compared to formula or mixed feeding (adjusted odds ratio: 0.133, 95% confidence interval: 0.02-0.898, p=0.038). CONCLUSION: The prevalence of CDC increased with the duration of hospitalization in preterm infants in the NICU. EBMF during the first week after birth in hospitalized preterm infants may protect against persistent CDC.

Comparison of the Effects of Breast Milk Feeding with Maternal Restriction and Hypoallergenic Milk Feeding on the Acquisition of Tolerance to Cow Milk / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to compare the effects of breast milk (BM) feeding with those of maternal cow milk (CM) restriction and extensively hydrolyzed CM formula feeding on the duration of CM allergy as well as changes in specific immunoglobulin E (IgE) levels in infants with CM allergy. METHODS: Children diagnosed with CM allergy before 12 months age and BM fed were included retrospectively. CM allergy was diagnosed by CM specific IgE over 0.35 kU/L and 1) obvious clinical symptoms, 2) a suspicious history with positive provocation test, or 3) CM specific IgE over the 95% positive predictive value and subsequent documented report of clinical symptoms. The patients were classified into three groups by feeding regimen: BM group, extensively hydrolyzed formula (eHF) group, or mixed feeding (MF) group. Analysis of the groups regarding the duration of food allergy and changes in CM specific IgE was then performed. RESULTS: Forty-six children were included. Twenty-four children were in the BM group, 13 children were in the eHF group, and 9 children comprised the MF group. Thirteen patients reached tolerance. The means of the tolerance age were 69.7+/-5.4 months in the BM group, 36.6+/-4.6 months in the eHF group, and 38.2+/-7.9 months in the MF group. The survival curves of tolerance showed significant difference among the three groups (P=0.04). CM specific IgE levels measured at a second time period were 9.6 kU/L (interquartile range, 3.6-44.2) in the BM group, 2.0 kU/L (1.0-18.0) in the eHF group, and 4.8 kU/L (0.2-10.4) in the MF group (P=0.04). CONCLUSION: Feeding regimen influences the duration of CM allergy. Exclusively BM-fed children achieved tolerance later than eHF-fed children. Prospective and randomized controlled studies are required.

The active components of milk in human milk bank / 国际儿科学杂志

Human milk is the optimal feeding choice for neonats, especialy for premature infants. Besides lactose, protein and fat, human milk also contains many kinds of active components, such as immunoglobins,lacferrins, lysozymes, vitamins and so on. Human milk bank has been well developed worldwide, but after cold storage and Pasteurization, many different microcomponents in milk have been affected. There is still controversy on how to preserve and sterilize human milk

Incidence of Febrile Urinary Tract Infection According to Clinical Characteristics in Patients with Congenital Hydronephrosis and Hydronephrotic Patients Diagnosed at First Febrile Urinary Tract Infection

PURPOSE: The aim of this study was to evaluate the incidence of febrile urinary tract infection (UTI) according to clinical characteristics in patients with congenital hydronephrosis (CH) and hydronephrotic patients first diagnosed with hydronephrosis during treatment of febrile UTII. METHODS: In this study, 200 patients with congenital hydronephrosis were enrolled in group 1 and 252 patients first diagnosed with hydronephrosis during treatment of febrile UTI were enrolled in group 2. We counted the episodes of UTI in the two groups according to clinical characteristics, the presence of VUR, type of feeding, and clinical outcomes since 2000. And we compared those results between the two groups. and compared two groups as well. RESULTS: The incidence of recurrent UTI was 10%, 0.028 per person-year in group 1 and 16.7%, 0.051 per person-year in group 2, respectively (P <0.05). Group 2 had more VUR (3% vs. 27%, P <0.05) and higher incidence of UTI than group 1. The incidence of UTI in patients with CH of Society of Fetal Urology (SFU) grade 4 or grade 4-5 VUR was 80% and 44.4%, respectively. No significant differences were found in incidence of UTI between BMF (breast milk feeding) and artificial milk feeding group in both groups (P 1= 0.274, P 2=0.4). The time of resolution of CH had no correlation with either number of UTI episodes or the presence of VUR. CONCLUSION: The overall incidence of UTI is low in patients with CH as well as patients patients first diagnosed with hydronephrosis during treatment of febrile UTI except patients with SFU grade 4 or grade 4-5 VUR. BMF has no protective effect against UTI.

A Study on Knowledges and Attitudes about Breast Milk Feeding and Needs for Breast Milk Feeding Education among High School Students / 대한지역사회영양학회지

This study was carried out to investigate the experiences of breast milk feeding information and education, breast milk feeding knowledge and attitude and needs for breast milk feeding nutrition education of high school students to encourage breast milk feeding. The subjects were 565 (male: 250, female: 315) high school students from first to third grade. The results obtained were as follows: In this survey, only 30.0% of subjects experienced breast milk feeding information and only 6.1% of subjects had breast milk feeding education. And the subjects showed the average scores of knowledge of breast milk feeding were 0.29 points of 1 point. Subjects knew well about ingredients of breast milk but they didn't know well about the physiology and method of breast milk feeding and benefits of breast milk feeding for mothers. The average scores of attitude of breast milk feeding were 3.03 points of 4 points, showed slight positive attitudes of breast milk feeding, but they had negative attitudes of emotional and practical aspects. The future plan of feeding practices was breast milk feeding 35.9% and 60.0% of formula milk feeding. A concern was that the students showed high ratio of formula milk feeding plan and they decided by incorrect knowledge of breast milk feeding. The 33.5% of students answered high school students will need breast milk feeding nutrition education, and they thought hospital faculties were the proper educators of breast milk feeding education, but dietitians were recomended as educators because of easy access at school and good knowledge of life-cycle nutrition. Therefore, to encourage breast milk feeding by mothers and supporters of breast milk feeding, breast milk feeding nutrition education is needed urgently among high school male and female students. And nutrition education programs will have to contain benefits of breast milk for babies and mothers and physiology and practical methods of breast milk feeding to improve emotional and practical attitudes for breast milk feeding. Nationwide campaign to promote breast milk feeding at public areas will be needed.

Anaphylactic Shock in a Breast Milk-Fed Infant due to Skin Contact with Egg White / 대한소아소화기영양학회지

Food allergy is not uncommon among small children. Cow milk and eggs are most frequently incriminated as the major cause of food allergy. A 4-month-old female infant who did not have a previous history of contact with the egg developed anaphylactic shock when an emulsion of raw egg white was rubbed on the buttock by her mother to relieve erosive diaper dermatitis. She had been fed on breast milk. She had no past medical history of any other allergy and no family history of atopy, asthma or allergic rhinitis. Her IgE PRIST was 29.46 IU/ml and multiple antigen simultaneous testing chemiluminescent assay for food specific IgE antibody showed a level 4 positive value only to egg white.

The Impact of Prolonged Breast Milk Feeding and Large Amount of Whole Cow' s Milk Intake on Iron Status in Early Childhood

PURPOSE: The Large amounts of whole cow' s milk intake, just followed by prolonged breast milk feeding may induce a severe deficit of iron. We performed this study to investigate the severity of iron deficiency in these subjects. METHODS: Seventy-one subjects (12 to 48 months of age) were classified according to history of prolonged breast milk feeding and intake of large amounts of whole cow' s milk. Prolonged breast milk feeding and large amounts cow' s milk intake subjects were assigned as group A (n=15), the large amounts of cow's milk intake subjects as group B (n=15), the prolonged breast milk feeding subjects as group C (n=24) and the normal control subjects as Group D (n=17). The hematologic and iron status were evaluated and compared between each group. RESULTS: Although the mean of group A was lower than the mean of group B and C, the level of hemoglobin of group A was significantly lower than group D (P<0.01). The level of the ferritin of group A was significantly lower than group B, C (P<0.05, respectively) and group D (P<0.01). Of the 15 study subjects of group A, 14 (93.3%) had microcytic hypochromic anemia and 7 (46.7%) revealed that serum ferritin levels were at 1.0ng/dL, indicating severe deficit of storage iron. CONCLUSION: The intake of large amounts of whole cow' s milk, just followed by prolonged breast milk feeding induced iron deficiency anemia and a severe deficit of storage iron. It is necessary to inform parents to avoid irreversible recognition impairment and behavioral change.

Assessment of Infantile Mental and Motor Development Influenced by Breast Milk and Formula Feeding

PURPOSE: This study was undertaken to compare the mental and motor development, unsing Bayley Developmental Scale, during infancy(6-8 months of age) according to the choice of feeding, either breast milk of formula, as well as to evaluate its influence on physical growth. METHODS: The study population was 43 normal infants between 6 and 8 months of age, of birth at gestational ages between 37 and 42 weeks, and with birth weights greater or equal to 2500g and below 4000g, excluding high risk infants who were liable for poor neurological prognosis. The breast-fed group was defined as those whoe were breast-fed for at least 3 months after birth. Bayley Developmental Test was performed using Bayley Scales of Infant Development(BSID) test kt. To obtain the data for the analysis of factors influencing the choice of feeding, we used questionnaires. We also measured height, weight, and head circumference for the evaluation of physical growth. RESULTS: We analysed statistically the influence of the educational status of mother or father, the occupational status of mother, birth rank, sex and the mode of delivery on the choice of fedding, but there were no factors causing and significant difference between the breast-fed group(n=22) and the formula-fed group(n=21). The MDI's of the breast-fed and the formula-fed were 101.0 and 103.0, respectively, while the PDI's were 104.2 and 107.0, respectively, There was no statistical difference. The mean height, weight, and head circumference were greater in the breast-fed group but wighout statistical significance. CONCLUSIONS: We may cautiously conclude from the given results that the choice of feeding would not have a great impact on the growth and development of infants.