New supplements to infant formulas.

Foods, which, in addition to their nutritional attributes, contain also elements that are considered to be health-promoting, have been termed "functional foods". In this regard, human milk has gained recognition as being the ultimate functional food for infants - by its biological compatibility, nutritional value and the undisputed added value of its health promoting qualities. Intensive research activity has recently evolved in a quest to identify and define the components of human milk that might confer disease-preventing and health-enhancing properties and to determine the instances and clinical conditions in which these factors become particularly important. The outcome of such research would also provide a rationale for advocating the supplementation of commercial infant formulas with such substances. In effect, the body of data accumulated from scientific and clinical studies on nucleotides, probiotics, prebiotics and long-chain polyunsaturated fatty acids in human milk and as additives to infant formula, has become regarded as convincing enough by the infant formula industry so as to launch into the market formulas supplemented with one or more of these factors - in an effort to emulate human milk and its beneficial effects. The following review is intended for the reader to obtain a general idea of the new supplements that have been introduced to infant formulas. We summarize the pertinent experimental and clinical observations concerning each of the supplements, pointing out their potential specific benefits, their possible disadvantages and the issues that still remain unresolved.

Influence of oral insulin supplementation on carbohydrate, lipid and protein metabolism in weaned Balb/c mice.

BACKGROUND: [corrected] Insulin is substantially present in human milk. Suckling animal models have demonstrated local trophic effects of insulin on the gut mucosa, but the effects of oral insulin in the post-weaning period are controversial. OBJECTIVE: To examine local and systemic effects of oral insulin supplementation in the post-weaning period. MATERIALS AND METHODS: Balb/c mice received oral insulin supplementation in their drinking water (1 U/ml) from beyond weaning during 40 days (S group). Plasma glucose, lipid levels, amylase and insulin were measured. The liver and intestine were weighed and thiobarbituric acid-reactive substance (TBARS) levels were examined in liver tissue. These data were compared to a control group (C group). RESULTS: Fasting glucose levels (mean +/- SD) were lower in the S than in the C group (116. 5 +/- 10.7 vs 143.9 +/- 25.4 mg/dl; p < 0.001), as were prandial glucose levels (123.1 +/- 12.2 vs 145.1 +/- 18.0 mg/dl; p = 0.03). Plasma insulin levels were higher in the S than in the C group (1,110.28 +/- 721.59 vs 308.17 +/- 100.50 pmol/; p = 0.03). Total triglyceride levels (130.4 +/- 32.4 vs 193.6 +/- 48.4 mg/dl; p < 0.02) and total cholesterol levels (83.6 +/- 5.7 vs 93.3 +/- 7.9 mg/dl; p < 0.05) were lower in the S group compared with the C group. Liver weight was significantly higher in the S group compared with C (0.75 +/- 0.1 vs 0. 7 +/- 0.1 g, p = 0.05). CONCLUSIONS: In the post-weaning period, oral insulin supplementation had a significant effect on plasma glucose levels and lipid profile, as well as on liver weight and protein content in Balb/c mice. The application of these findings in humans should be studied.

MPGN type I induced by granulocyte colony stimulating factor.

We report a girl with severe congenital neutropenia who has received long-term granulocyte-colony stimulating factor (G-CSF) therapy and has developed macroscopic hematuria, proteinuria, and decreased renal function associated with biopsy-proven membranoproliferative glomerulonephritis (MPGN) type I. Temporary discontinuation of G-CSF therapy as well as the use of glycosylated G-CSF has resulted in improvement in renal manifestations. We postulate that the MPGN was G-CSF-induced. Long-term G-CSF therapy should be used with great caution and close surveillance of kidney function.

Frequency of change of ventilator circuit in premature infants: Impact on ventilator-associated pneumonia.

OBJECTIVE: Ventilator-associated pneumonia (VAP) is associated with substantial mortality. The frequency of changing the ventilator circuit (VC) might influence the occurrence rate of VAP. In premature infants receiving ventilatory support, the question regarding the frequency of changing VC is as yet unsettled. DESIGN: A prospective, randomized, and controlled trial in 60 premature neonates receiving ventilatory support. INTERVENTIONS: We investigated the impact of two VC change regimens on VAP in premature infants, either every 24 hrs or every 72 hrs. In each patient, the humidifier, inspiratory tube, and expiratory tube were changed and cultured at the assigned intervals along with cultures of tracheal aspirates. Blood cultures were obtained whenever there was clinical evidence of pneumonia or sepsis. MEASUREMENTS AND MAIN RESULTS: The two study groups did not differ significantly in gestational age, birth weight, gender, duration of mechanical ventilatory support, surfactant therapy, duration of hospitalization, mortality rate, rate of bloodstream infection, or rate of colonization of tracheal aspirate, humidifier, and expiratory tube by microbes. The inspiratory tube was significantly less colonized in the 72-hr group as compared to the 24-hr group (p <.05). The rate of VAP per 1000 ventilator days was not higher in the 72-hr group, compared with the 24-hr group (23.3 vs. 37.7; not significant). Switching from a 24-hr to a 72-hr change policy would save our neonatal intensive care unit a yearly sum of $14,000 (US). CONCLUSIONS: Extending the VC-change interval in premature infants from 24 hrs to 72 hrs is safe and cost-effective.