Formula Feed Research Articles

ESPEN guideline: Clinical nutrition in inflammatory bowel disease

Introduction: the ESPEN guideline offers a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). Methodology: the guideline is based on a extensive systematic review of the literature, but relies on expert opinion when objective data are lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process, in which uniformly positive responses (agree or strongly agree) were required. Results: IBD is increasingly common and potential dietary factors in its etiology are briefly reviewed. Malnutrition is highly prevalent in IBD - especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally, if necessary) is strongly recommended. Routine provision of a special diet in IBD is not, however, supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not in Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis but is moderately well supported in Crohn's disease, especially in children, where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. Conclusions: available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B), and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP).

To Assess Prevalance of Various Feeding Techniques Used for Children with Cleft Lip/Palate Prevalent in Southern India and to Assess Their Effectiveness in Improving Energy Intake and Growth of Children with Cleft Lip/Palate

Aim: To assess various feeding techniques used for children with cleft lip/cleft palate.
 Introduction: Cleft lip/palate is a condition wherein there is an opening or slit in the upper lip/palate. Maintaining optimum nutrition in children with cleft lip/palate is a challenge owing to the feeding and swallowing difficulties these children face. This article aims to discuss various feeding techniques used in southern India and to analyse their effectiveness in helping the infant with weight gain and overall development.
 Materials and Methods: Cross sectional study done in south India using structured questionnaire. It consisted of 100 children <2 years of age visiting the cleft clinic in Saveetha Medical College and Hospital. Data was analysed statistically and evaluated using chi square test.
 Results: This study concluded that paalada (65%) was the most commonly used technique to feed children with cleft lip/palate in southern India. The study also concludes that formula feed was the most widely used feed to effectively increasing weight of the child with cleft lip/palate. Education about feeding practices is vital in helping the mother understand the importance of healthy weight gain, growth and development.
 Conclusion: Though the majority of parents visiting a cleft clinic are educated on the do's and don'ts of feeding a child with cleft lip/cleft palate, the data is inconclusive of the exact situation in India, so more research on the subject is needed to improve the feeding experience of children with cleft lip/cleft palate.

Fermented Alfalfa Meal Instead of "Grain-Type" Feedstuffs in the Diet Improves Intestinal Health Related Indexes in Weaned Pigs.

Corn and soybean meal are the two main components in formula feed of farm animals, leading to a serious food competition between humans and livestock. An alternative may be to encourage the utilization of unconventional feedstuff in animal diet. In the current study, we evaluated the utilization of fermented alfalfa meal (FAM) in weaned pigs. Twenty weaned piglets (separately caged) were randomly divided into two groups. Pigs in the control group (CON) were fed corn-soybean meal diet, and part of corn and soya protein concentrate in the diet of another group was replaced by 8% FAM. After 40 days of feeding, the average feed intake of FAM pigs was increased (P > 0.05), and the villus height (VH) of jejunum and duodenum, crypt depth (CD), and VH/CD in FAM pigs was improved compared to the CON group (P < 0.05). The increase (P < 0.05) of goblet cells in the jejunum of FAM pigs was positively correlated with the expression of MUC-2 gene (R = 0.9150). The expression of genes related to immunity (IRAK4, NF-κB, and IL-10) and intestinal barrier (Occludin and MUC-2) in the jejunum, as well as the expression of ZO-1 and MUC-2 in the colon of these pigs, also showed increase (P < 0.05) compared to CON pigs, which was accompanied by the decrease (P < 0.05) of LPS concentration in the serum. The elevated proportion of CD3+ and CD8+ T-lymphocyte subsets in spleen (P < 0.05) confirmed the improvement of systemic immune function in FAM pigs. In addition, FAM pigs have a higher β-diversity of microbial community (P < 0.05) and promoted enrichment of probiotics such as Lactobacillus that positively was correlated with acetate concentration in the colon over CON pigs. In summary, partially replacement of expanded corn and soya protein concentrate with FAM (8%) may benefit the intestinal barrier and immune function of weaned pigs without affecting their growth. Our findings also provide evidence of the feasibility of FAM as a dietary component in pigs to reduce the consumption of grain.

'We make a mistake with shoes [that's no problem] but… not with baby milk': Facilitators of good and poor practice in distribution of infant formula in the 2014-2016 refugee crisis in Europe.

The Infant and Young Child Feeding in Emergencies Operational Guidance (OG‐IFE) gives direction on providing aid to meet infants' and young children's feeding needs in emergencies. Because of the risks associated with formula feeding, the OG‐IFE provides limited circumstances when infant formula should be provided in aid. However, distributions against this guidance are common, reducing breastfeeding so risking increased infant morbidity and mortality. This study sought to identify factors that contributed to following (‘good practice’) or not following (‘poor practice’) the OG‐IFE regarding infant formula distribution in the 2014–16 refugee crisis in Europe. Thirty‐three individuals who supported, coordinated, or implemented infant feeding support in the Crisis were interviewed regarding their experiences and views. Reflexive thematic analysis of transcribed interviews was undertaken. It was identified that presence of breastfeeding support, presence of properly implemented formula feeding programmes, understanding that maternal choice to formula feed should be considered within the risk context of the emergency, and positive personal experiences of breastfeeding contributed to good practice. Presence of infant formula donations, absence of properly managed formula feeding programmes, belief that maternal choice to formula feed is paramount and should be facilitated, and personal experience of insurmountable breastfeeding challenges and/or formula feeding contributed to poor practice. Governments, humanitarian organisations, and donors should ensure that infant and young child feeding in emergencies preparedness and programmes are adequately resourced. Emergency responders should be appropriately trained with training including infant feeding experience debriefing. Health and emergency organisations should provide maternity protections enabling employees to breastfeed as recommended.

Lack of HIV RNA test result is a barrier to breastfeeding among women living with HIV in Botswana

BackgroundBotswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy.MethodsFrom September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice.ResultsAmong 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy.ConclusionsIn a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission.

Failure to Thrive and Vomiting in a 32-day-old Girl.

Failure to Thrive and Vomiting in a 32-day-old Girl.

국내 해양자원 유래 가축사료 연구 분석

This review provides an overview of research data form published journal and thesis using feed stuff derived from marine resources and current status of pet food. Marine feed stuff has been widely used as livestock feed for a traditionally in Korea. However, due to the production and price of marine feed stuff, the amount used as a formula feed is very low. Results of this study showed that marine feed stuff have sufficient nutritional value as a livestock feed, and thus could replace imported grain feed. Furthermore, expect to many uses of pet food. These feed stuff derived from marine resources are eventually cost-effective for livestock farmers. In addition, there is a high possibility of developing new products for pet food. However, which has a small amount of marine resources production and insufficient basic research to be used as formula feed industry. Therefore, suggest that best efforts to should be made to improve the quality of livestock products using marine feed stuff along with the development of mass production technology of marine resources.

Neonatal Feeding Trajectories in Mothers With Bipolar Disorder Taking Lithium: Pharmacokinetic Data.

Purpose: Women who take lithium during pregnancy and continue after delivery may choose to breastfeed, formula feed, or mix these options. The aim of the study was to evaluate the neonatal lithium serum concentrations based on these three feeding trajectories.Methods: We followed 24 women with bipolar disorder treated with lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ).Results: There was complete lithium placental passage at delivery, with a mean ratio of lithium concentration in the umbilical cord to maternal serum of 1.12 ± 0.17. The median times to LoQ were 6–8, 7–8, and 53–60 days for formula, mixed, and exclusive breastfeeding respectively. The generalized log-rank testing indicated that the median times to LoQ differ according to feeding trajectory (p = 0.037). According to the multivariate analysis-adjusted lithium serum concentrations at birth, times to LoQ are, on average, longer under exclusive breastfeeding (formula, p = 0.015; mixed, p = 0.012). No lithium accumulation was observed in infants under either exclusive or mixed breastfeeding. During the lactation follow-up, there was no acute growth or developmental delays in any neonate or infant. Indeed, lithium concentrations in the three trajectories declined in all cases. However, the time needed to reach the LoQ was much longer for those breastfeeding exclusively.Conclusions: In breastfeed infant no sustained accumulation of lithium and no adverse effects on development or growth were observed.

Neonatal Leuconostoc lactis meningitis

Leuconostoc lactis has a low potential for human infection, although serious infections have been documented in immunocompromised persons. The source of this organism is a dairy product. A 3-day old neonate was presented with multifocal clonic seizures who were given formula feed from birth. We isolated Leuconostoc lactis in his Cerebrospinal fluid (CSF), which is resistant to vancomycin. L. lactis meningitis was treated successfully with the injection of ampicillin-sulbactam.

First feeding of grass carp (Ctenopharyngodon idellus) with a high-carbohydrate diet:the effect on glucose metabolism in juveniles

The effective utilization of carbohydrate feed sources is important to save protein feed resources and reduce formula feed costs in fish aquaculture. The present study investigated whether high-carbohydrate diet stimulus in the early larval stage of the grass carp (Ctenopharyngodon idellus) could affect glucose metabolism in subsequent life stages (i.e., the juvenile). A 73-day feeding trial was divided to five groups (four treatments and a control). The trial was conducted from the first feeding of larval fish. During the first 66 days, the control was continuously fed a commercial grass carp diet (CD), the FF-3 group was initially fed with 60% malty dextrin diet (MD) for 3 days and then with the CD for 63 days, the YE-7 group was initially fed with 60% MD after yolk-sac exhaustion for 7 days and with the CD for 56 days, the FF-10 group was initially fed with 60% MD for 10 days and then with CD for 56 days, and the FF-66 group was continuously fed to 60% MD. During the next 7 days, all the treatment groups and the control were fed with 35% MD as challenge test. The results showed that short-term stimulation with high-carbohydrate resulted in significantly increased body weights. After 73 days of feeding, the final body weights of the FF-3 and YE-7 groups were significantly higher than that of the control. Early high-carbohydrate manipulation changed the normal structure of the gut tissues of juvenile fish. After a short challenge test (7 days) performed with a 35% carbohydrate diet in juvenile grass carp, the results showed that high-carbohydrate dietary histories affected plasma metabolites and liver (muscle) glycogen storage in the juvenile fish. The mRNA levels of glucokinase and fatty acid synthetase genes increased significantly at the juvenile stage in the first-feeding groups. The phosphoenolpyruvate carboxykinase gene expression in the FF-3 and FF-10 groups decreased by varying degrees. The glycogen synthase gene expression levels in all groups were not affected. Long-term intake of high-carbohydrate feed (FF-66 group) led to the nutritional deficiency and disorder of the glucose metabolism system. In conclusion, our results demonstrated that a high-carbohydrate diet stimulus at first-feeding stage can affect the growth performance, gut morphology, and the homeostasis of glucose metabolism in juvenile of grass carp.

Osteopontin Levels in Human Milk Are Related to Maternal Nutrition and Infant Health and Growth

Background: Osteopontin (OPN) is a glycosylated phosphoprotein found in human tissues and body fluids. OPN in breast milk is thought to play a major role in growth and immune system development in early infancy. Here, we investigated maternal factors that may affect concentrations of OPN in breast milk, and the possible associated consequences for the health of neonates. Methods: General characteristics, health status, dietary patterns, and anthropometric measurements of 85 mothers and their babies were recorded antenatally and during postnatal follow-up. Results: The mean concentration of OPN in breast milk was 137.1 ± 56.8 mg/L. Maternal factors including smoking, BMI, birth route, pregnancy weight gain, and energy intake during lactation were associated with OPN levels (p < 0.05). Significant correlations were determined between body weight, length, and head circumference, respectively, and OPN levels after one (r = 0.442, p = < 0.001; r = −0.284, p = < 0.001; r = −0.392, p = < 0.001) and three months (r = 0.501, p = < 0.001; r = −0.450, p = < 0.001; r = −0.498, p = < 0.001) of lactation. A negative relation between fever-related infant hospitalizations from 0–3 months and breast milk OPN levels (r = −0.599, p < 0.001) was identified. Conclusions: OPN concentrations in breast milk differ depending on maternal factors, and these differences can affect the growth and immune system functions of infants. OPN supplementation in infant formula feed may have benefits and should be further investigated.

Effect of Turmeric Flour (Curcuma domestica) and Fish Oil on Daily Egg Production and Organoleptics of Quail Eggs (Coturnix-coturnix japonica)

The purpose of this study was to determine the effect of adding the concentration of turmeric flour and fish oil to the quail formula feed. This research is an experimental study using the factorial method. This experiment used 96 quail (Cortunix cortunix japonica), which were randomized into 6 treatments with 4 replications. Quails were divided into 6 groups and treated with different concentrations of turmeric flour and fish oil in each feed formula. The effects of different formula feeds were observed on changes in egg production and organoleptic changes. Egg production data were taken every day from week 3 to week 4 during the treatment period. The data taken is called Quail Day Production (QDP%). The organoleptic data of eggs were taken at the 3rd week of treatment and the preference test was carried out by 40 panelists on the aroma, taste and level of preference of quail eggs after being boiled. The addition of 0.3% turmeric flour significantly affected egg production but its combination with fish oil did not affect egg production. The combination of the concentration of turmeric flour and fish oil does not change the aroma of the eggs, but changes the taste of the eggs.

Influencers of women's choice and experience of exclusive formula feeding in hospital

ObjectivesExplore what influenced women's decision to exclusively formula feed, and their experiences with formula feeding within a maternity hospital environment. DesignThis mixed methods study used a cross-sectional exploratory survey design. Short surveys were administered by telephone in the postpartum period. Content analysis revealed common themes for responses to open-ended questions on what influenced women's choice and experience with formula feeding. Descriptive statistics were used for demographic characteristics, and frequencies conducted on some themes. Participants and settingEnglish-speaking women who chose to exclusively formula feed, and attended a tertiary maternity hospital in Australia were invited to participate; 102 women were interviewed. FindingsThemes that influenced women to choose exclusive formula feeding were: ‘Previous breastfeeding challenges’, ‘social and societal issues’ including convenience, comfort, and trust in formula, and ‘maternal health’ including medical issues and medications, breast physiology and mental health. Themes from the formula feeding experience in hospital were: ‘Supportive’ elements such as midwifery care, convenience, and resources, and ‘hindering’ elements such as a perceived breastfeeding agenda and systemic barriers. Key conclusions and implications for practicePrevious breastfeeding difficulties were a common influence on exclusive formula feeding in subsequent pregnancies, highlighting the importance of adequate support during the primary lactation/infant feeding experience. Greater comfort and confidence levels with formula feeding and a sense of trust in formula were also influential. Some maternal medications, conditions, or physiological circumstances were perceived by women as impacting breastfeeding or breastmilk, signposting the importance of antenatal screening and assessment to support women's options and decisions regarding infant feeding. A perception of professional and organisational preferences for breastfeeding over formula feeding contributed to some women feeling judged for their choice. This reminds midwives to consider the complex intersection of factors that influence infant feeding decisions and ensure all mothers are respected and fully supported.

Postprandial rise of essential amino acids is impaired during critical illness and unrelated to small‐intestinal function

BackgroundPostprandial rise of plasma essential amino acids (EAAs) determines the anabolic effect of dietary protein. Disturbed gastrointestinal function could impair the anabolic response in critically ill patients. Aim was to investigate the postprandial EAA response in critically ill patients and its relation to small‐intestinal function.MethodsTwenty‐one mechanically ventilated patients and 9 healthy controls received a bolus containing 100 ml of a formula feed (Ensure) and 2 g of 3‐O‐Methyl‐d‐glucose (3‐OMG) via postpyloric feeding tube. Fasting and postprandial plasma concentrations of EAAs, 3‐OMG, total bile salts, and the gut‐released hormone fibroblast growth factor 19 (FGF19) were measured over a 4‐hour period. Changes over time and between groups were assessed with linear mixed‐effects analysis. Early (0–60 minutes) and total postprandial responses are summarized as the incremental area under the curve (iAUC).ResultsAt baseline, fasting EAA levels were similar in both groups: 1181 (1055–1276) vs 1150 (1065–1334) μmol·L−1, P = .87. The early postprandial rise in EAA was not apparent in critically ill patients compared with healthy controls (iAUC60, −4858 [−6859 to 2886] vs 5406 [3099–16,853] µmol·L−1·60 minutes; P = .039). Impaired EAA response did not correlate with impaired 3‐OMG response (Spearman ρ 0.32, P = .09). There was a limited increase in total bile salts but no relevant FGF19 response in either group.ConclusionPostprandial rise of EAA is blunted in critically ill patients and unrelated to glucose absorption measured with 3‐OMG. Future studies should aim to delineate governing mechanisms of macronutrient malabsorption.

Factors Associated with Infant Feeding Choices Among Women with HIV in Botswana.

In resource-constrained settings, infant feeding decisions among women with HIV (WHIV) must balance the risk of infant HIV acquisition from breastfeeding with increased mortality associated with formula feeding. WHO guidelines recommend countries principally promote a single feeding method for WHIV, either breastfeeding or formula feeding. In 2016, Botswana revised its policy of formula feeding for infants born to WHIV, instead promoting exclusive breastfeeding during the first 6months of life. We sought to understand factors influencing infant feeding choices among WHIV by administering a questionnaire to pregnant and postpartum WHIV (2013-2015) participating in a clinical trial in Botswana (the Mpepu Study). Logistic regression analyses were used to identify factors associated with infant feeding choices. Of 810 surveyed participants, 24.0% chose breastfeeding and 76.0% chose formula feeding. Women were more likely to choose formula feeding if advised by a health worker to formula feed (aOR 1.90; 95% CI 1.02-3.57) or if they harboured doubts about the potency of antiretroviral treatment (ART) to prevent infant HIV acquisition (aOR 9.06; 95% CI 4.78-17.17). Women who reported lack of confidence in preparing infant formula safely (aOR 0.09; 95% CI 0.04-0.19) or low concerns about infant HIV acquisition (aOR 0.35; 95% CI 0.22-0.55) were significantly less likely to formula feed. Perceptions about ART effectiveness, social circumstances and health worker recommendations were key influencers of infant feeding choices among WHIV. Health system factors and maternal education interventions represent ideal targets for any programmatic actions aiming to shape informed decision-making towards HIV-free survival of infants.

Who Makes the Choice: Ethical Considerations Regarding Instituting Breastfeeding in a Mother Who Has Compromised Mental Capacity.

This case reports an ethical dilemma in which a mother who had recently delivered a baby through cesarean section after sustaining life-threatening injuries in a car accident did not have documented wishes whether she wanted to breastfeed. Her medical condition rendered her temporarily mentally incapacitated and critically ill, and the lactation medicine team was consulted about whether lactation choice should be preserved by pumping. Complicating considerations in this case were (1) lack of family or designated decision-makers available at the time of injury and emergent delivery, (2) lack of prenatal care, and (3) complex social situation, including prior history of illicit substance use, and state removal of other children into foster care. This case raises important ethical considerations regarding breastfeeding decision-making when a mother is incapable of making the decision, and if there is an intrinsic right for an infant to be breastfed in situations where maternal choice to lactate or to formula feed is unknown. Ultimately, the mother chose to discontinue breastfeeding once she was able to voice her own opinion. The issues discussed in this study may be relevant for future cases when providing guidance on the ethical argument to preserve maternal choice when a mother is critically ill and mentally incapacitated.

Infant exposure to lithium through breast milk

IntroductionWomen who take lithium during pregnancy and continue after delivery may opt to breastfeed, formula feed, or mix these options.ObjectivesTo evaluate the neonatal lithium plasma concentrations and nursing infant outcomes based on these three feeding trajectories.MethodsWe followed 24 women with bipolar disorder on lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ).ResultsThe mean ratio of lithium concentration in the umbilical cord to maternal serum being 1.12 (0.17). We used the Turnbull estimator for interval-censored data to estimate the probability that the LoQ was reached as a function of time. The median times to LoQ was 6–8, 7–8, and 53–60 days for formula, mixed, and breastfeeding, respectively. Generalised log-rank testing indicated that the median times to LoQ differed by feeding trajectory (p = 0.037). Multivariate analysis confirmed that the differences remained after adjusting for serum lithium concentrations at birth (formula, p = 0.015; mixed, p = 0.012). We did not found any acute observable growth or developmental delays in any of the neonates/infants.ConclusionsLithium did not accumulate in the infant under either exclusive or mixed-breastfeeding. Lithium concentrations declined in all trayectories. The time needed to reach the LoQ was much longer for those breastfeeding exclusively. Lithium transfer via breastmilk is much less than via the placenta. We did not found any acute observable growth or developmental delays in any infant during follow-up.DisclosureNo significant relationships.

Case Report: Managing Growth Failure While Maintaining Exclusive Breastfeeding

This case study presents a mother who was able to maintain exclusive breastfeeding after having an infant who experienced growth failure between the two- and four-month pediatric primary care visits. This mother was exclusively breastfeeding her child and the infant was noted to “fall off the growth curve” at the four-month infant pediatric visit. At this point the mother was advised to formula feed her infant. The mother did not want to give formula and sought out assistance from the first author who connected the mother with an advance practice nurse at the pediatric site.By working with a nurse practitioner to develop an individualized feeding plan, the mother's breastfeeding relationship was able to be maintained and the infant gained weight.Despite receiving initial recommendations to formula feed her child, we were able to work beyond those recommendations by providing evidence based breastfeeding interventions and support. A breastfeeding assessment is an important factor in each wellness visit.

INCIDENCE OF HYPOGLYCEMIA IN EXCLUSIVELY BREASTFED HIGH-RISK NEWBORNS

Background: Hypoglycemia is one of the commonest metabolic complications seen during neonatal period. In healthy newborns low blood glucose may not have much signicance and merely reect normal metabolic adaptation to extra-uterine life. However, in high-risk newborns, prolonged and/or recurrent episodes of hypoglycemia may negatively affect neurological and developmental prognosis. The incidence of hypoglycemia varies worldwide depending upon the blood sugar measurement protocols and feeding policies. There is paucity of data on incidence of hypoglycemia in institutions where exclusive breastfeeding is followed. Aims and Objectives: To determine the incidence and associated risk factors of hypoglycemia in rst 72 hours of life among exclusively breastfed healthy high-risk newborns.Study Design: Observational study Setting: Department of Pediatrics, Nalanda Medical College and Hospital Patna, Bihar, India. Period: From 1st July 2019 to 31st December 2019. Material &amp; Methods: The Observational study enrolled 560 exclusively breastfed high-risk newborns (infant of diabetic mother (IGDM/IDM), large-for-gestation (birth weight &gt;90th percentile), small-for-gestation (birth weight &lt;10th percentile), low birth weight (&gt;1800 to &lt;2500 grams) and late preterm), who did not require admission to neonatal intensive care unit and were kept in postnatal wards with mother. Babies on formula or pre-lacteal feed, major congenital malformations and admitted in NICU for other reasons were excluded from the study. Hypoglycemia screening was done at 2, 6, 12, 24, 48 and 72 hours of life, prior to feeding. Hypoglycemia was dened as blood glucose ≤40 mg/dL(2.2 mmol/L). Blood glucose was estimated from heel prick capillary samples using glucometer. Association of both maternal and neonatal risk factors was studied in relation to hypoglycemia. Result: Incidence of hypoglycemia in high-risk newborns was 27.1%. Incidence was signicantly higher in pre-term, low birth weight, Small-for-gestation age babies delivered to mothers with BMI &gt;30 kg/m2, born through caesarean section. Conclusion: in high-risk exclusively breast fed neonates blood glucose level should be regularly monitored for at least 1st 72 hours of life with special attention to 1st 24 hours.

Effects of wood kraft pulp feeding on feed digestibility and rumen fermentation of Japanese Black steer in the middle fattening stage.

We investigated the effects of wood kraft pulp (KP) feeding on feed digestibility and rumen fermentation of Japanese Black (JB) steer in the middle fattening stage. The feeding experiment was carried out a replicated 3 × 3 Latin square design using six JB steers (16.2 ± 0.8months of age). Steers were fed rice straw and three concentrated feeds: commercial formula feed (control), formula feed containing 7.5% KP on a dry matter (DM) basis (7.5% KP), and formula feed containing 15% KP on a DM basis (15% KP). Feed digestibility and rumen fermentation parameters were recorded for 3days during the measurement period, after an adaptation phase of 11 days. There was no significant difference in DM intake per day among diets. A slightly higher digestibility of neutral detergent fiber was observed in steers fed 15% KP, compared with those fed other diets (P = 0.059). The butyric acid ratio in rumen fluid was higher in steers fed KP diets than in steers fed control (P = 0.083). The average ruminal pH was unaffected by KP diets. This study suggests that replacing 15% of concentrated feed with KP has little effect on feed digestibility and rumen fermentation in JB fattening steer.