Use Of Infant Formula Research Articles

Cost-effectiveness model for a specific mixture of prebiotics in The Netherlands

The objective of this study was to assess the cost-effectiveness of the use of prebiotics for the primary prevention of atopic dermatitis in The Netherlands. A model was constructed using decision analytical techniques. The model was developed to estimate the health economic impact of prebiotic preventive disease management of atopic dermatitis. Data sources used include published literature, clinical trials and official price/tariff lists and national population statistics. The comparator was no supplementation with prebiotics. The primary perspective for conducting the economic evaluation was based on the situation in The Netherlands in 2009. The results show that the use of prebiotics infant formula (IMMUNOFORTIS(®)) leads to an additional cost of € 51 and an increase in Quality Adjusted Life Years (QALY) of 0.108, when compared with no prebiotics. Consequently, the use of infant formula with a specific mixture of prebiotics results in an incremental cost-effectiveness ratio (ICER) of € 472. The sensitivity analyses show that the ICER remains in all analyses far below the threshold of € 20,000/QALY. This study shows that the favourable health benefit of the use of a specific mixture of prebiotics results in positive short- and long-term health economic benefits. In addition, this study demonstrates that the use of infant formula with a specific mixture of prebiotics is a highly cost-effective way of preventing atopic dermatitis in The Netherlands.

Place des laits au cours de la diversification alimentaire des nourrissons et enfants en bas âge en France

Food diversification in infants and children is associated with major changes in both macronutrient and micronutrient intake. During this nutritional transition period, it is essential to continue to meet their nutritional needs for maintaining health and reducing morbidity. It has long been known that breast milk, when associated with an adequate intake of non-dairy food, is the ideal milk for meeting this objective. Clearly, all mothers do not want or cannot carry on breastfeeding throughout this period of diversification, and bottle-feeding has to be used. There is very little information on how a nutritionally adequate diet should be formulated in this situation. A recent French study provides new data however. It shows that a diet based on cow's milk is likely, in a high percentage of infants and young children, to give rise to an insufficient intake of essential fatty acids, iron, vitamin C and vitamin D. The use of supplemented formulas as a substitute for cow's milk avoids these nutritional risks, with the exception of vitamin D. It appears therefore appropriate during the period of food diversification to recommend the use of infant formula for infants less than 6-months-old, follow-on formula from 6 to 12 months, and fortified toddler milk from 12 to 36 months.

Determinants of breastfeeding initiation among mothers in Kuwait.

BackgroundExclusive breastfeeding is recommended as the optimal way to feed infants for the first six months of life. While overall breastfeeding rates are high, exclusive breastfeeding is relatively uncommon among Middle Eastern women. The objective of this study was to identify the incidence of breastfeeding amongst women in the six governorates of Kuwait and the factors associated with the initiation of breastfeeding.MethodsA sample of 373 women (aged 17-47 years), recruited shortly after delivery from four hospitals in Kuwait, completed a structured, interviewer-administered questionnaire. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.ResultsIn total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed since birth, the remainder of the breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. Of the mothers who attempted to breastfeed, the majority of women (55.4%) delayed their first attempt to breastfeed until 24 hours or more after delivery. Breastfeeding at discharge from hospital was positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery.ConclusionsThe reasons for the high use of prelacteal and supplementary formula feeding warrant investigation. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding by mothers in Kuwait.

Breast-feeding Attitudes and Behavior Among WIC Mothers in Texas

Objective This study explored the influence of demographic characteristics on attitudes toward the benefits of breast-feeding, approval of public breast-feeding, and the use of infant formula. Additionally, the study examined whether attitudes were related to infant feeding practices among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas. Design This study used a cross-sectional design. Setting Participants completed questionnaires at WIC clinic sites across Texas. Participants Mothers of young children who were receiving WIC benefits. Main Outcome Measure(s) Attitudes toward the benefits of breast-feeding, attitudes toward public breast-feeding, attitudes toward infant formula, and the choice of infant feeding practice. Analysis Descriptive statistics, multivariate ordinary least squares regression, and multinomial logistic regression. Results A key finding was that many Hispanic mothers held favorable attitudes toward both breast milk and infant formula. Younger and less educated mothers were least likely to agree with the benefits of breast-feeding. Mothers with positive attitudes toward the benefits of breast-feeding were likely to exclusively breastfeed and use both formula and breast milk. Conclusions and Implications Attitudes toward breast-feeding, public breast-feeding, and infant formula and their influence on breast-feeding behavior should inform the curriculum of breast-feeding promotion programs.

What are the Risks Associated with Formula Feeding? A Re‐Analysis and Review

Most infant feeding studies present infant formula use as "standard" practice, supporting perceptions of formula feeding as normative and hindering translation of current research into counseling messages supportive of exclusive breastfeeding. To promote optimal counseling, and to challenge researchers to use exclusive breastfeeding as the standard, we have reviewed the scientific literature on exclusive breastfeeding and converted reported odds ratios to allow discussion of the "risks" of any formula use. Studies indexed in PubMed that investigated the association between exclusive breastfeeding and otitis media, asthma, types 1 and 2 diabetes, atopic dermatitis, and infant hospitalization secondary to lower respiratory tract diseases were reviewed. Findings were reconstructed with exclusive breastfeeding as the standard, and levels of significance calculated. When exclusive breastfeeding is set as the normative standard, the re-calculated odds ratios communicate the risks of any formula use. For example, any formula use in the first 6 months is significantly associated with increased incidence of otitis media (OR: 1.78, 95% CI: 1.19, 2.70 and OR: 4.55, 95% CI: 1.64, 12.50 in the available studies; pooled OR for any formula in the first 3 mo: 2.00, 95% CI: 1.40, 2.78). Only shorter durations of exclusive breastfeeding are available to use as standards for calculating the effect of "any formula use" for type 1 diabetes, asthma, atopic dermatitis, and hospitalization secondary to lower respiratory tract infections. Exclusive breastfeeding is an optimal practice, compared with which other infant feeding practices carry risks. Further studies on the influence of presenting exclusive breastfeeding as the standard in research studies and counseling messages are recommended.

Characterisation of soybean glycinin and β‐conglycinin fractionated by using MgCl2 instead of CaCl2

SummaryA simple two step precipitation method was used to investigate the effect of MgCl2 instead of CaCl2 on fractionation of soybean glycinin and β‐conglycinin. Compositional and physicochemical properties of the resulting protein fractions were characterised. The optimised procedure, in terms of protein yield, purity, phytate content and physicochemical properties, was obtained when the addition of 5 mm MgCl2 was used. After application of 5 mm MgCl2, the phytate content of the glycinin‐rich and β‐conglycinin‐rich fractions was about 0.4% and 1.3%, respectively, but the addition of 5 mm CaCl2 increased the phytate content of the glycinin‐rich fraction to 1.25% and decreased that of β‐conglycinin‐rich fraction to 0.67%. Low phytate protein product was suitable for use in infant formula and acidic food. The solubility of the glycinin‐rich fractions with MgCl2 was significantly higher than that with CaCl2 at pH < 4.5. Application of MgCl2 improved thermal stability of the β‐conglycinin‐rich fraction.

HIV, infant feeding and implementation failure: advancing policies for women with HIV infection and attaining the Millennium Development Goals

Coutsoudis et al.1 offer a viewpoint on the WHO guidelines on HIV and infant feeding that suggests that the use of infant formula among HIV-positive women in the developing world is, to a large extent, currently untenable. The article has many valid arguments: it is well known that promotion of formula feeding among HIV-positive women within the context of inadequate community support, unreliable formula supply and contaminated drinking water can result in excess infant mortality.2 However, empirical data exist that counter some of the authors’ views. It has been demonstrated that formula feeding among HIV-positive women in a context with counselling support and education, access to clean water and uninterrupted availability of breast-milk substitutes can offset the risk of infant mortality. In Cote d’Ivoire, there were no differences in risks of diarrhoea, respiratory infection, malnutrition, hospitalization or death in breastfed versus formula-fed infants of HIV-positive women. The authors of this study suggest that offering safer conditions (clean water, free formula) and a more supportive environment (replacement feeding counselling and education) were elements that reduced the potential threat of mortality among formula-fed infants. These findings were sustained after a two-year follow-up period.3 With safe formula feeding, the vertical HIV transmission rate can be reduced to less than 2%; this is an attainable goal in a resource-limited setting as indicated by results from a preliminary study in Rwanda.4 In addition to a low transmission rate, the mortality rate reported was modest (21 per 1000 person-years) among those infants enrolled at birth in the Inshuti Mu Buzima prevention of mother-to-child transmission programme in rural Rwanda that were offered free formula, materials, education and support through community health workers. Evidence from South Africa offers a more complex picture of infant feeding outcomes in the context of HIV. There, formula feeding demonstrated a protective effect on HIV transmission per death among those living in households with piped water (hazard ratio, HR: 0.51; 95% confidence interval, CI: 0.31–0.84). Among those who had piped water and fuel and who disclosed their HIV status, the protective effect of formula was greater (HR: 0.32; 95% CI: 0.16–0.62). However, among women who did not have piped water or fuel and did not disclose their HIV status, formula feeding conferred an increased risk of HIV transmission per death by 3.5 fold (HR: 3.45; 95% CI: 1.89–6.32).5 These findings suggest that contextual factors are critical when considering the appropriate feeding option for HIV-positive women in resource-poor settings, indicating that in some settings the provision of formula would result in increased child mortality as Coutsoudis et al.1 argue. However, these findings also suggest that aggressive measures to improve water quality and access to other resources may reduce the risk of child mortality associated with provision of infant formula. In fact, improving access to potable water may be the most critical element in offering safe feeding alternatives to HIV-positive women with infants in developing countries and should not be considered an unattainable goal. One of the eight Millennium Development Goals (MDGs) is to “ensure environmental sustainability” (Goal 7) and one of the targets is to “reduce by half the proportion of people without sustainable access to safe drinking water”. Although addressing the global water crisis may not be immediate, as indicated by the MDGs, targets for improving access to potable water must be set and attained for the near future. One should not lose sight of the fact that progress has been made in the past 20 years: since 1990 approximately 1.6 billion people have gained access to safe drinking water. During this period, the child mortality rate for developing countries declined from 103 to 80 per 1000 live births, suggesting improvement with respect to MDG Goal 4 of reducing child mortality.6 Therefore, despite the suggestion that “poverty is not easily or quickly reversed”1, a positive, goal-directed outlook can offer results more quickly. If programmes reducing mother-to-child transmission of HIV through formula feeding are deemed not feasible in a large majority of settings throughout the developing world, thousands of infants will continue to die due to the presumed inability to offer access to clean drinking water and a safe environment for formula feeding. However, in settings where women are offered a safe and supportive environment, the potential for child mortality can be offset and the risk of HIV transmission can be dramatically reduced. The fight against HIV/AIDS can serve as an entry point to demonstrate to families in remote areas that access to clean water and reduction in HIV transmission as well as child mortality are attainable goals as we work collectively towards reaching the MDGs. ■

Metabolic Bone Disease of Prematurity

The incidence of metabolic bone disease (MBD) in preterm infants has been declining due to advances in nutritional care. Although the terms osteopenia and rickets have been used in the literature, MBD of prematurity is the preferred terminology for this condition. Despite the use of human milk fortifiers and commercial infant formulas specified for this population, MBD remains an important cause of morbidity in preterm infants. This review focuses on the physiology of intrauterine bone growth, the development of MBD in preterm infants, the various risk factors for MBD, pitfalls in diagnosis, prevention, and treatment of MBD. The use of speed of sound (SOS) ultrasonography and dual-energy X-ray absorptiometry (DXA) in the diagnosis, management, and prognosis also is discussed.

Infant Formula and Enamel Fluorosis: A Systematic Review

Researchers have considered infant formula consumption a potential risk factor for enamel fluorosis in the U.S. population. The authors conducted a systematic review of controlled studies regarding the risk of developing enamel fluorosis associated with use of infant formula. One reviewer independently conducted systematic searches in eight databases. The authors then abstracted information, assessed study quality and combined odds ratios (ORs), when obtainable, by using a random-effects model. After evaluating 969 potentially eligible published studies, the reviewers found that the authors of 41 studies had evaluated the effect of infant formula on enamel fluorosis risk. Authors of 14 of the 41 studies did not report their findings in their results. The authors of the remaining 27 published studies reported the findings of 19 observational studies; authors of 17 of these 19 studies reported ORs and, among these, infant formula consumption was associated with a higher prevalence of enamel fluorosis in the permanent dentition (summary OR 1.8, 95 percent confidence interval [CI] 1.4-2.3). There was significant heterogeneity among studies (I(2) 66 percent) and evidence of publication bias (P = .002). A metaregression analysis indicated that the ORs associating infant formula with enamel fluorosis increased by 5 percent for each 0.1-part-per-million increase in the reported levels of fluoride in the water supply (OR 1.05, 95 percent CI 1.02-1.09). Infant formula consumption may be associated with an increased risk of developing at least some detectable level of enamel fluorosis, which depends on the level of fluoride in the water supply. The evidence that the fluoride in the infant formula caused enamel fluorosis was weak, as other mechanisms could explain the observed association.

Enrichment of Amaranth Oil with Ethyl Palmitate at the sn-2 Position by Chemical and Enzymatic Synthesis

Amaranth oil is rich in linoleic, oleic, and palmitic acids. Structured lipids (SLs) with specific functional and nutritional characteristics can be prepared through chemical or enzymatic interesterification. The aim of this study was to increase the palmitic acid content at the sn-2 position in amaranth oil triacylglycerols (TAG) for possible use in infant formula. Chemical and enzymatic interesterification techniques were assessed before selecting the latter for further optimization modeling. Enzymatic interesterification of ethyl palmitate and amaranth oil significantly increased the total content of palmitic acid, reduced linoleic acid content, and increased the amount of palmitic acid at the sn-2 position of the SL product. Even though amaranth oil content of palmitic acid (18.3%) was originally similar to that in breast milk (18.3-25.9%), the structural changes induced through enzymatic modification resulted in a SL closely resembling breast milk fat and hence its possible application as a fat substitute for infant nutrition. A second-order polynomial model was developed to predict the amount of total palmitic acid incorporated when reaction time and substrate level were manipulated, and to optimize the combination of parameters to achieve specific palmitic acid contents in amaranth oil. The resulting model is useful to develop an SL from amaranth oil enriched with palmitic acid specifically at the sn-2 position for possible application in infant formulas.

Body self‐esteem and formula use in the first 24 hours postpartum among low‐income, obese Latinas

The objective of this study is to identify risk factors for partial (vs exclusive) breastfeeding (BF) in a sample of low‐income, obese Latinas. We analyzed results from an ongoing randomized trial evaluating the efficacy of a specialized BF peer counseling intervention targeting obese women. Data were obtained prenatally and on day 1 postpartum (pp), including infant feeding practices, body esteem ratings, demographics and medical record review. Bivariate analyses were conducted to identify variables associated with the use of infant formula in the first 24 hours pp, with significant variables entered into a logistic regression model. Among those with exclusive breastfeeding (EBF) data on day 1 (n=69), 98.6% initiated BF and 58.0% had introduced non‐breastmilk fluids. Formula was used by 56.5% and formula, water and sugar water were used by 1.5%. In bivariate analyses, women with a high (vs low) body esteem score for weight‐sensitive body parts were less likely to EBF (p=0.025) and Puerto Rican women (vs all others) tended to be less likely to EBF (p = 0.058). In multivariate analyses, the only significant risk factor for partial BF by 24 h pp was a high body esteem score (OR = 2.98 (95% CI: 1.08, 8.26). These preliminary findings suggest that in this sample of obese women, those who are more satisfied with their body are less likely to EBF on day 1 pp. Funded by the Donaghue Foundation and NIH/NCMHD grant #P20MD001765.

Enzymatic digestion and antioxidant activity of the native and molten globule states of camel α-lactalbumin: Possible significance for use in infant formula

Native- and molten globule states of α-lactalbumin (α-La) from camel and bovine milk were used for comparative assessment of digestibility and antioxidant activity. The proteolysis assessments were performed in the presence of gastrointestinal enzymes, using the o-phthaldialdehyde assay, and the antioxidant activity was carried out using a 2,20-azinobis(3-ethylenebenzothiazoline-6-sulfonic acid based method. Camel and bovine α-La revealed similar sensitivity to proteolysis by pepsin. The degree of hydrolysis (DH) of camel α-La by either trypsin or chymotrypsin was noticeably higher than that of the bovine protein counterpart. This can be explained by the different conformational and structural features of these proteins, as shown by studies of intrinsic- and 8-anilinonaphthalene-1-sulfonic acid fluorescence. The greater antioxidant activity of camel α-La could be explained by the higher content of antioxidant amino acid residues and different conformational features between bovine and camel α-La. The results may suggest that α-La produced from camel milk may be used for infant formulae as an alternative to that produced from bovine milk.

Growth of Infants With IgE-Mediated Cow's Milk Allergy Fed Different Formulas in the Complementary Feeding Period

Agostoni C, Fiocchi A, Riva E, et al. Pediatr Allergy Immunol. 2007;18(7):599–606 PURPOSE OF THE STUDY. Observational studies have shown that allergic infants, irrespective of their type of diet, show various degrees of growth depression in the first year of life. The authors investigated whether the type of milk in the complementary feeding period (6–12 months of age) is associated with differences in the increase of standardized growth indices (weight-for-age [WA], length-for-age [LA], and weight-for-length [WL] z scores) in infants with cow's milk allergy (CMA). STUDY POPULATION. One hundred sixty infants with immunoglobulin E–mediated CMA entered the study in a 5-year period; 108 were formula fed and 52 were still breastfed at 6 months. METHODS. Infants were randomly assigned to 3 special formulas: a soy formula (n = 32); a casein hydrolysate (n = 31); or a rice hydrolysate (n = 30). A fourth, nonrandomized group was made up of allergic infants who were still breastfed at up to 12 months (n = 32). Groups were compared for WA, LA, and WL z scores at 6, 9, and 12 months of age. RESULTS. All groups showed low WA and LA z scores at 6 months of age. Infants fed hydrolyzed products showed a trend toward higher WA z-score increments in the 6- to 12-month period. The use of casein- and rice-based hydrolyzed formulas resulted in higher changes in WA compared with soy formula. CONCLUSIONS. Further research should be aimed at optimizing the dietary needs and feeding regimens for infants with CMA. REVIEWER COMMENTS. Use of infant formulas for children with CMA, if not exclusively breastfeeding, is necessary to provide adequate nutrition at a critical time for a child's growth. Few studies have compared growth parameters in children with CMA using different formulas. This study demonstrates that different formulas can contribute to different growth rates in allergic children. This area requires additional investigation to optimize nutrition for these infants.

Nonbloody, Red Stools from Coadministration of Cefdinir and Iron‐Supplemented Infant Formulas

Cefdinir is an extended-spectrum, third-generation cephalosporin that may be used for treatment of acute otitis media in patients allergic to penicillin. When administered with iron-containing products, including infant formulas, cefdinir or one of its metabolites may bind to ferric ions, forming a nonabsorbable complex that imparts a reddish color to the stool. We describe a 9-month-old infant with failure to thrive and acute otitis media who developed an erythematous maculopapular rash during treatment with amoxicillin-clavulanate. His antibiotic therapy was changed to cefdinir. Five days into a 10-day course of therapy, the infant's mother brought him to the pediatric clinic and reported the appearance of red stools. He had no associated gastrointestinal symptoms (vomiting, abdominal pain, or diarrhea). His hematocrit and hemoglobin level were normal, and Clostridium difficile antigen studies and tests for species of Shigella, Salmonella, and Camphylobacter as well as ova and parasites were all negative. Cefdinir was discontinued, and his stools returned to normal within 48 hours. Three weeks later, he again received cefdinir for recurrent otitis media. Red stools reappeared 48 hours later, were determined to be guaiac negative, and resolved within hours of drug discontinuation. During both occurrences of red stools, the infant had been breastfed and was receiving supplemental feedings with an iron-containing infant formula. In the product labeling of cefdinir, this adverse event is described as a consequence of the drug-drug interaction; however, it is not listed in the adverse drug reaction section of the labeling. As such, one may miss the association between cefdinir and reddish stools when investigating this event as a potential adverse reaction to cefdinir. When using the Naranjo adverse drug reaction probability scale to assess causality in our patient's case, this adverse drug reaction was determined as highly probable. As this infant had been breastfed, the use of a supplemental iron-containing infant formula was not identified as a potential contributing factor until the second occurrence of red stools. Health care professionals should review the entire product labeling, including the drug-drug interaction section, when investigating a potential adverse drug reaction. With the recent approval of generic formulations of cefdinir, clinicians should be aware of this drug-drug interaction with iron-containing products to prevent unnecessary alarm by parents and caregivers, as well as costly medical evaluations for gastrointestinal bleeding.

Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensus panel opinion

Three types of infant formula (soy, extensively hydrolysed and amino acid) may be appropriate for treating cows milk protein allergy. Selection of a formula depends on the allergy syndrome to be treated. Extensively hydrolysed formula is recommended as first choice for infants under 6 months of age for treating immediate cows milk allergy (non-anaphylactic), food protein-induced enterocolitis syndrome, atopic eczema, gastrointestinal symptoms and food protein-induced proctocolitis. Soy formula is recommended as first choice for infants over 6 months of age with immediate food reactions, and for those with gastrointestinal symptoms or atopic dermatitis in the absence of failure to thrive. Amino acid formula is recommended as first choice in anaphylaxis and eosinophilic oesophagitis. If treatment with the initial formula is not successful, use of an alternative formula is recommended.

Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas

This clinical report reviews the nutritional options during pregnancy, lactation, and the first year of life that may affect the development of atopic disease (atopic dermatitis, asthma, food allergy) in early life. It replaces an earlier policy statement from the American Academy of Pediatrics that addressed the use of hypoallergenic infant formulas and included provisional recommendations for dietary management for the prevention of atopic disease. The documented benefits of nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy (ie, infants with at least 1 first-degree relative [parent or sibling] with allergic disease). Current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation. There is evidence that breastfeeding for at least 4 months, compared with feeding formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood. In studies of infants at high risk of atopy and who are not exclusively breastfed for 4 to 6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis. Comparative studies of the various hydrolyzed formulas also indicate that not all formulas have the same protective benefit. There is also little evidence that delaying the timing of the introduction of complementary foods beyond 4 to 6 months of age prevents the occurrence of atopic disease. At present, there are insufficient data to document a protective effect of any dietary intervention beyond 4 to 6 months of age for the development of atopic disease.

Breastfeeding, Fertility, and Family Planning

Breastfeeding is associated with many maternal and child health benefits, 1, 2, 3 including a delay in fertility return postpartum. This has been recognized for centuries; medical literature from Aristotle to the Renaissance, and, occasionally, thereafter, noted that women who suckle are less likely to become pregnant. This physiological response was forgotten or disbelieved in scientific circles of the mid 20th century as the use of commercial infant formula displaced breastfeeding in industrialized settings, and family planning methods became more widely available. However, recent scientific evidence, compiled both by social and biomedical sciences, demonstrating the population level impact of breastfeeding on fertility and the biologic basis of lactational infertility, has reinitiated interest in breastfeeding and the mechanisms related to lactational infertility. If we allow breastfeeding to deteriorate further, the increase in fertility in settings with limited family planning use would be significant, and very difficult to remedy. 4, 5

Determinants of persistent underweight among children, aged 6-35 months, after huge economic development and improvements in health services in Oman.

Over the last decades, health indicators have witnessed major improvements in the Sultanate of Oman. This study was aimed at factors associated with underweight among children in four regions of Oman, as, in 1998, underweight was prevalent among 17.9% of children aged less than five years. A case-control study was conducted in 2002: 190 cases were 6-35-month old children with weight-for-age < -2 z-scores. Controls were individually matched by village of residence, sex, and age. The questionnaire included anthropometry of children, child-feeding practices, morbidity, anthropometry of mothers, parity, birth-spacing, and socioeconomic characteristics. Conditional logistic regression was used for analyses. Birth-weight of < 2,500 g was strongly associated with underweight and also were height of mother, low level of education of mother, bad quality of water in households, diarrhoea of children in the last two weeks, and regular use of infant formula. Factors, such as birth-weight, height of mother, supply of safe water in household, and care for mothers and children were the determinants of persistent underweight after huge economic development and improvements in health services. Further research is also needed to investigate further specific determinants of low birth-weight in the Omani context and try to disentangle emaciation and determinants of linear growth retardation.

Prévention et traitement de la diarrhée aiguë du nourrisson

The prognosis of acute diarrhoea in infants is most often satisfactory in industrialized countries. However, it has been estimated that 10 to 15 children die every year in France from acute dehydration due to acute diarrhoea. In spite of an increasing use over the least few years, oral rehydration solutions (ORS) are used in only 70% of infants presenting with acute diarrhoea. The use of homemade ORS, plain water or fizzy drink should be strictly avoided. In case of acute diarrhoea there is no indication to stop breastfeeding or the use of infant formula for more than 4 hours. Lactose intolerance is observed in only 5–10% of infants. Lactose free formulae should only be used in infants with severe, persistent or recurrent diarrhoea. Under 3–4 months of age, infants with severe diarrhoea should receive for a period of 2–4 weeks lactose free protein hydrolysate formulae. Racecadotril is the only drug with anti-diarrheal properties, with a reduction of the stool output of 50%. Oral antibiotics should only be used in case of Shigella infection or in case of bacterial infection with severe sepsis or underlying debilitating disease. Oral Rotavirus vaccine, that is not reimbursed yet in France, has been shown to dramatically reduce the number of severe cases of diarrhoea with dehydration, and has been associated with a striking reduction of both morbidity and mortality, as well as of the number of hospitalisations during periods of epidemics.

Familiarity of Pediatricians With Different Commercially Available Neonatal and Infant Formulas

To assess the familiarity of pediatricians with commercially available formulas and their use for cow's milk protein allergy and colic, a list of formulas was generated by visiting several grocery stores. Pediatricians were ask to indicate their familiarity with these and other "specialized" formulas with regard to protein and carbohydrate sources, energy content, hypoallergenicity, and indication for infant colic. The participants answered an average of 46% of the questions correctly. Respondents were very familiar with 27% of the formulas, and unfamiliar with 35%. The highest score was 70%, and 10% of the responders correctly answered 65% or more of the questions. Fifty-one percent correctly identified the protein source of the formulas; 32% correctly identified the carbohydrate source. The energy content of the formulas was correctly identified by 54%. These data suggest that pediatricians have a poor understanding of the content and appropriate use of neonatal and infant formulas.