Low plasma taurine and later neurodevelopment.

Dietary taurine intake may explain the benefits of both breast milk and preterm formula to neurodevelopment. Low plasma neonatal taurine was associated with lower scores on the Bayley mental development index at 18 months and the WISC-R arithmetic subtest at 7 years. Currently it is not mandatory to add taurine to infant formulas.

Distinctive aspects of metabolism and nutrition in infancy.

OBJECTIVES: The effects of genes, the stage of development, and the environment on various metabolic processes in infancy are described. Some themes discussed cross these three boundaries. CONCLUSIONS: Certain substances not normally regarded as essential may become conditionally essential if their precursors are limited in the diet or, alternatively, if the processes of conversion are reduced in activity because of abnormal gene function, or developmental immaturity. Diet is a clear environmental influence but, because the nature of the diet is closely related to age, it is a developmental influence as well. Certain nutrients are followed from the diet, via the gut and intermediary metabolism through to individual tissues and the whole body. The relationships of diet, metabolism and brain function have attracted considerable investigation in recent years. In the right environment, with the correct genes, the processes of development will be smooth and without undue metabolic disturbance. Considerable variation can be accommodated within the elasticity of the systems, but some changes may lead to temporary, or even permanent, malfunction.

Food and microbiological problems in the newborn: data and practice.

We have reviewed the relationships of food, nutrition and feeding practices to various infections in the newborn. Tentative conclusions are made: (a) the initial use of human milk (raw or pasteurized) continues to offer advantages in the care of babies in intensive care; (b) attempts to mimic the microbiological effects of breast milk by manipulation of the composition of infant formulas have so far achieved little success, but this is a rapidly developing field; (c) we are wary of the widespread use of breast milk "fortifiers" until there is evidence that they do not adversely affect the protective properties of breast milk; (d) the doubtful advantages of nasojejunal feeding need to be weighed against the increased bacterial contamination of the upper small bowel; (e) systems monitoring in milk kitchens and the handling of feeds in the neonatal unit are an integral part of comprehensive neonatal care; (f) to limit nosocomial infection, particular attention to the faecal-food-oral route is necessary since there is potential for multiplication of initial contamination of food.

Sorrento studies of diet and fecal flora in the newborn.

The fecal flora of a breast-fed baby is very different from that of a bottle-fed baby. This paper reviews five previous studies, performed at this hospital concerning the effect of various dietary components (whey proteins, casein, lactoferrin, iron, nucleotides) on the fecal flora. The babies received either breast milk or one of the test formulas from birth. Fecal samples were examined by quantitative microbiological methods at 4 and 14 days and at various intervals thereafter. By 14 days differences in the fecal flora were established. Among breast-fed babies bifidobacteria, lactobacilli and staphylococci were predominant organisms, whereas in the formula-fed babies the predominant organisms were enterococci, coliforms, and Bacteroides. A whey-based formula without bovine lactoferrin, iron or nucleotides gave a flora a little closer to but still remote from the breast-fed one. Despite extensive modification of cow's milk in the manufacture of a modern infant formula, the fecal flora of bottle-fed babies remains substantially different from that of breast-fed babies.

Protein nutrition, faecal flora and iron metabolism: the role of milk-based formulae.

This paper explores the role of milk-based formulae in achieving four aspects of nutritional health in infants and toddlers: in the suckling, to mimic the amino acid metabolism and the faecal flora of a breast-fed baby; in the weanling, to achieve adequate protein intakes in later infancy and beyond and to achieve satisfactory haemoglobin concentrations in the early toddler years. Milk-based formulae have two roles in infant nutrition: as so-called breast milk substitutes and as a safety net during the weaning period; the latter role may be the more important.

Does weight for height have prognostic significance in children with acute lymphoblastic leukemia?

PURPOSE: We tested the hypothesis that weight for height, a simple index of nutritional status, is related to prognosis in childhood acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: The study population was composed of 78 children with ALL tested at one U.K. center on the same protocol (UKALL-X). Outcome measures were relapse/no relapse and time to first relapse. Influence of weight for height, expressed as standard deviation scores, was tested using survival analysis in a retrospective design. RESULTS: The weight-for-height standard deviation score had a significant influence on time until first relapse (log ranks test, p = 0.012), with the highest risk of early relapse in children at the lower end of the weight-for-height distribution. CONCLUSIONS: The results suggest that weight for height does have an influence on outcome in ALL, but the mechanism is unclear and the finding requires confirmation by larger scale prospective studies.

Faecal short chain fatty acids in breast-fed and formula-fed babies.

The intestinal flora of breast-fed infants differs from that of formula-fed infants. It is thought that this difference in flora may be one important reason why breast-fed babies suffer less from gastrointestinal disease. Differences in intestinal flora are reflected in the profile of faecal short chain fatty acids (SCFA). Very little is known about faecal concentrations of SCFA in babies fed breast milk or infant formula. In this study, faecal SCFA were measured in babies at two and four weeks of age who had been either exclusively breast fed or bottle fed from birth. There was no significant difference in total faecal SCFA concentrations between breast-fed and formula-fed babies when lactate was included. The formula-fed group, however, had less lactic acid and higher concentrations of propionic and n-butyric acids than breast-fed babies. Very few babies had significant levels of n-butyric acid, although this SCFA is believed to be important for the health of the colonic mucosa of adults.

Diet and faecal flora in the newborn: nucleotides.

Breast milk contains nucleotide salts that are only present in minimal amounts in modern infant formulas prepared from cows' milk. Nucleotides have been suggested as cofactors for the growth of bifidobacteria in vitro. Bifidobacteria are found to be more numerous in the faeces of breast fed babies compared with those of formula fed babies. Faecal flora were examined at 2 weeks of age in 32 babies who from birth had been fed a whey based formula supplemented with nucleotide monophosphate salts, 33 babies fed an unsupplemented formula, and 21 breast fed babies. Faecal flora were also examined at 4 weeks, and 7 weeks but with fewer babies in each group. Most differences were found at 2 weeks of age when more babies fed the nucleotide supplemented formula were colonised with Escherichia coli and more had E coli as the dominant organism in their faecal flora. Fewer of these babies were colonised with bifidobacteria. The counts of bifidobacteria and enterococci were reduced in the nucleotide supplemented group but bacteroides accounted for a higher percentage of the total flora in this group of babies. Supplementation of a formula with nucleotide salts did not make the faecal flora closer to that of breast fed infants as the growth of bifidobacteria was discouraged. While there may be arguments to support the addition of nucleotides to infant formula the results of this study do not support their addition for the enhancement of bifidobacteria in the faecal flora.

Faecal flora in the newborn. Effect of lactoferrin and related nutrients.

Bifidobacteria, lactobacilli and staphylococci are the predominant organisms in the faeces of breast fed babies whereas in formula fed babies coliforms, enterococci and bacteroides predominate. In vitro studies suggest that the mechanisms responsible are probably related to the acid base properties of the formula and 'immunological' proteins such as lactoferrin and sIgA. In human babies however the addition of bovine lactoferrin to an infant formula has little effect on the faecal flora and does not move it in the direction of the breast fed baby. There are various possible explanations of this lack of effect, e.g., inactivation of the lactoferrin when it is added to a formula, and immunological responses in the intestine to a foreign protein. We consider the most likely explanation is that other factors necessary for the optimum activity of lactoferrin were not present or in inappropriate concentration, e.g. sIgA, lysozyme, citrate, bicarbonate. If human lactoferrin is added to an infant formula it may be these other factors will require attention if the lactoferrin is to have a significant effect. An iconoclastic interpretation which cannot be completely excluded is that the hypothesis of lactoferrin bacteriostatic activity is based on in vitro studies and is not a reflection of what happens in babies. The faecal flora of a breast fed baby is very different from that of a baby receiving either cow's milk or a modern infant formula (Figure 1). Among breast fed babies bifidobacteria lactobacilli and staphylococci are the predominant organisms, whereas in formula fed babies the predominant organisms are enterococci, coliforms, and bacteroides (1).

Diet and faecal flora in the newborn: iron.

The faecal flora of a baby receiving a modern infant formula is substantially different from that of a breast fed baby. This difference is a little less when whey based formulas are used. The addition of bovine lactoferrin has no effect and there is some evidence that the presence of added iron in a formula moved the faecal flora further away from that of a breast fed baby. the iron content of currently used infant formulas is much higher than that of breast milk. The effect of the addition of iron to both whey and casein based formulas on the faecal flora was examined in further detail. Faecal flora were examined at 14 days of age in 33 babies receiving a whey formula fortified with iron, 29 babies receiving a whey formula without iron, 29 babies receiving a casein formula fortified with iron, and 24 babies receiving casein formula without iron. Subsequently fewer babies in each group were examined at week 7, 11, and 15. The addition of iron to both casein and whey formulas discouraged colonisation and growth of staphylococci and bacteroids but encouraged the colonisation and growth of clostridia and enterococci. The type of protein and not the iron content had more effect upon the growth of bifidobacteria; both whey formulas, fortified or not, encouraged the colonisation by bifidobacteria. If an infant formula, for use in the first few months, is to mimic the physiological effects of breast milk, there may be microbiological arguments for not fortifying it with iron. However, large empirical trials would be necessary before advocating such a policy.

Diet-related reference values for plasma amino acids in newborns measured by reversed-phase HPLC.

We have measured by reversed-phase HPLC concentrations of amino acids in plasma in groups of 80 normal appropriate-weight term babies fed from birth either a casein formula (WhiteCap SMA, n = 26), a whey formula (Gold Cap SMA, n = 26), or breast milk (n = 28). They were studied from day 11 to week 15 postpartum. The trend was towards an increase in amino acid concentrations in plasma with age, more marked in formula-fed than in breast-fed infants. Reference values were derived for each group. Both formula-fed groups showed several differences from the breast-fed group. Detailed examination indicated that tyrosine, phenylalanine, and methionine concentrations were increased in the casein-fed group greater than 20% of the time, but only threonine was similarly increased in the whey-fed group. Other amino acids, different ones for each formula group, were increased less frequently. There were no consistent correlations with any aspect of infant growth. Appropriate reference values are important for interpreting amino acid concentrations in plasma from newborns and for evaluating the effects of any future dietary modifications to infant formulas. HPLC analysis provides a suitable highly sensitive method for undertaking such studies.

Ramadan and birth weight at full term in Asian Moslem pregnant women in Birmingham.

The birth weights of 13,351 babies born at full term from 1964-84 to Asian Moslem mothers in Birmingham were analysed to see if the effect of the Ramadan fast on maternal biochemical profiles was of any clinical relevance. These were compared with two age matched control groups comprising white and non-Moslem Asian babies. Ramadan had no effect on mean birth weight at whatever stage of pregnancy it occurred. There was an increase in the prevalence of low birth weights (4.5% to 8%) among babies who were born at full term when Ramadan had occurred during the second trimester, but this was not significant. We conclude that the Ramadan fast has no effect on the birth weights of babies born at full term.