Infants Receiving Breast Milk Research Articles

Risk Factors Associated With Bordetella pertussis Among Infants ≤4 Months of Age in the Pre-Tdap Era: United States, 2002-2005.

In the United States, infants have the highest reported pertussis incidence and death rates. Improved understanding of infant risk factors is needed to optimize prevention strategies. We prospectively enrolled infants ≤4 months of age with incident-confirmed pertussis from 4 sites during 2002-2005 (preceding pertussis antigen-containing vaccination recommendations for adolescents/adults); each case-patient was age and site matched with 2 control subjects. Caregivers completed structured interviews. Infants and their contacts ≥11 years of age were offered serologic testing for IgG; being seropositive was defined as ≥94 antipertussis toxin IgG enzyme-linked immunosorbent assay units per milliliter. Enrolled subjects (115 case-patients; 230 control subjects) had 4396 contacts during incubation periods; 83 (72%) case-patients had ≥1 contact with prolonged (≥5 days) new cough in primary or secondary households. In multivariable analysis, the odds for pertussis were higher for infants with primary/secondary household contacts who had a prolonged new cough, compared with infants who did not. These contacts included mother [adjusted matched odds ratio (aMOR), 43.8; 95% confidence interval (CI), 6.45-298.0] and ≥1 nonmother contact (aMOR, 20.1; 95% CI, 6.48-62.7). Infants receiving breast milk with 0-1 formula feedings daily had decreased pertussis odds (aMOR, 0.27; 95% CI, 0.08-0.89), compared with those receiving more formula. Of 41 tested case-patients, 37 (90%) were seropositive. Pertussis in infants was associated with prolonged new cough (≥5 days) in infants' household contacts. Findings suggest that breastfeeding protects against pertussis and warrants recommendation with pertussis prevention strategies, which currently include pertussis vaccination of pregnant mothers and infants' close contacts.

Cross‐Nursing in a Peruvian Peri‐urban Area

Despite recommendations that mothers should avoid the cross‐nursing of their infants (the occasional nursing by another woman) due to the risk of transmitting diseases such as HIV, this practice occurs.MethodsA cohort of 179 pregnant women and their toddlers living in a peri‐urban area of Lima, Peru was enrolled during the 3rd trimester of pregnancy. After birth, a total of 179 newborn infants were followed up until 6 months of age. Field workers visited the homes weekly to collect information about the infant for the previous seven days. Mothers were asked about the infant's health and feeding practices (breastfeeding, use of any liquids or foods, type of food).ResultsAbout 45% of the mothers (n=81) reported that their infants received breast milk from another woman during their first 6 months of life. Of those who were cross‐nursed, the frequency of days exposed ranged from one day (35%), between 2 to 7 days (40%), and 8 to 31 days (25%). The exposure occurred as early as the second day of life and as late as the six‐month birthday. Infants were most frequently cross‐nursed by their aunt (69%), followed by their neighbor (11%) and great aunts (11%). Grandmothers were also reported as breastfeeding the infant.ConclusionsAlthough this study provided data about one specific area of Peru, the population included migrants from other areas of the country; it is likely that this feeding behavior is common throughout Peru. More information is required to understand the practice of cross‐nursing and develop training to help health professionals effectively counsel mothers about the risks of this infant feeding practice.Support or Funding InformationCanadian Institutes of Health Research

Expression of Staphylokinase Gene S. aureus Strains Isolated from Breast Milk and Clinical Outcomes in Breastfed Infants

This study aimed to look for the presence of the immune evasion gene cluster in the strains of Staphylococcus aureus isolated from breast milk of women and to estimate their possible role in development of infant’s staphylococcal infections. Strains of S. aureus are isolated by bacteriological examination of breast milk in a hospital (24 strains) and an ambulatory (11 strains) basis. Breastfed infants had staphylococcal infections (42.9 %), intestinal infections (5.7 %), and respiratory infections (20 %), and 11 (31.4 %) infants were intestinal carriers of S. aureus. PCR analysis of 35 strains S. aureus was carried out to detect genes of staphylokinase (sak), inhibitor of the system of complement (scn), inhibitor of chemotaxis of leukocytes (chp), and β-hemolysin (hlb). Sak gene was found in 20 (57 %) S. aureus isolates. Scn, chp, and hlb genes in S. aureus isolates were not detected. Infants received breast milk infected with sak positive S. aureus strains more frequently had S. aureus intestinal colonization than infants who received breast milk infected with sak negative S. aureus (OR 4.5 (1.02; 20.30)). Presence of sak gene in S. aureus strains from breast milk was not associated with development of staphylococcal infection in infant (OR 1.2 (0.3–4.7)). In conclusion, sak is an important factor in avoiding immune defense by S. aureus strains in infected breast milk. Expression of sak gene by S. aureus in infected breast milk may be an important factor for S. aureus intestinal colonization of infants, but not the development of staphylococcal infections in breastfed infants.

Perceived Factors Associated with Sustained Improvement Following Participation in a Multicenter Quality Improvement Collaborative

The California Perinatal Quality Care Collaborative led the Breastmilk Nutrition Quality Improvement Collaborative from October 2009 to September 2010 to increase the percentage of very low birth weight infants receiving breast milk at discharge in 11 collaborative neonatal ICUs (NICUs). Observed increases in breast milk feeding and decreases in necrotizing enterocolitis persisted for 6 months after the collaborative ended. Eighteen to 24 months after the end of the collaborative, some sites maintained or further increased their gains, while others trended back toward baseline. A study was conducted to assess the qualitative factors that affect sustained improvement following participation. Collaborative leaders at each of the 11 NICUs that participated in the Breastmilk Nutrition Quality Improvement Collaborative were invited to participate in a site-specific one-hour phone interview. Interviews were recorded and transcribed and then analyzed using qualitative research analysis software to identify themes associated with sustained improvement. Eight of 11 invited centers agreed to participate in the interviews. Thematic saturation was achieved by the sixth interview, so further interviews were not pursued. Factors contributing to sustainability included physician involvement within the multidisciplinary teams, continuous education, incorporation of interventions into the daily work flow, and integration of a data-driven feedback system. Early consideration by site leaders of how to integrate best-practice interventions into the daily work flow, and ensuring physician commitment and ongoing education based in continuous data review, should enhance the likelihood of sustaining improvements. To maximize sustained success, future collaborative design should consider proactively identifying and supporting these factors at participating sites.

Exclusive Breastfeeding and the Acceptability of Donor Breast Milk for Sick, Hospitalized Infants in Kupang, Nusa Tenggara Timur, Indonesia: A Mixed-Methods Study.

The eastern Indonesian province of Nusa Tenggara Timur (NTT) has an infant mortality rate of 45 per 1000, higher than the national average (28/1000). Exclusive breastfeeding, important for improving newborn and infant survival, is encouraged among hospitalized infants in Kupang, the provincial capital of NTT. However, barriers to hospitalized infants receiving breast milk may exist. This study explored the barriers and enablers to exclusive breastfeeding among sick and low birth weight hospitalized infants in Kupang, NTT. The attitudes and cultural beliefs of health workers and mothers regarding the use of donor breast milk (DBM) were also explored. A mixed-methods study using a convergent parallel design was conducted. A convenience sample of 74 mothers of hospitalized infants and 8 hospital staff participated in semi-structured interviews. Facility observational data were also collected. Analysis was conducted using Davis's barrier analysis method. Of the 73 questionnaires analyzed, we found that 39.7% of mothers retrospectively reported exclusively breastfeeding and 37% of mothers expressed breast milk. Expressing was associated with maternal reported exclusive breastfeeding χ(2) (1, N = 73) = 6.82, P = .009. Staff supported breastfeeding for sick infants, yet mothers could only access infants during set nursery visiting hours. No mothers used DBM, and most mothers and staff found the concept distasteful. Increasing mothers' opportunities for contact with infants is the first step to increasing exclusive breastfeeding rates among hospitalized infants in Kupang. This will facilitate mothers to express their breast milk, improve the acceptability of DBM, and enhance the feasibility of establishing a DBM bank.

Nutritional status of breast-fed and non-exclusively breast-fed infants from birth to age 5 months in 8 Chinese cities.

This study aimed to assess the nutritional status of infants aged 0 to 5 months by different feeding approaches. A cross-sectional study on infant nutrition was performed in eight cities in China. A total of 622 infants from birth to 2 months of age and 456 infants from 3 months to 5 months of age were included in this study. Mix-fed infants received breast milk and complementary foods from birth to 2 months of age. Approximately 38.2% of mix-fed infants received excessive vitamin A, and 15.6% of infants exceeded the tolerable upper intake levels (ULs) of zinc. For artificially fed infants who received only complementary foods, approximately 20% and 12.5% infants received inadequate dietary vitamin A and zinc intakes, respectively. The vitamin A and zinc intakes of half of the infants exceeded the ULs. Results showed that the usual intake distribution of the infants from 3 months to 5 months of age were similar to that of the infants from birth to 2 months of age. The common vitamin A and zinc intakes were also severely imbalanced. In addition, higher disease prevalence and lower Z scores of length-forage, weight-for-age, and weight-for-length were found in artificially fed infants and mix-fed infants compared with those in breast-fed infants. In conclusion, the usual nutrient intakes were adequate for the majority of Chinese infants, except for an important number of infants at risk for imbalance of vitamin A and zinc intakes.

Randomized Trial Comparing the Effectiveness of 2 Electric Breast Pumps in the NICU

Mothers with preterm infants may need to express milk for considerable periods. Research to improve breast pump design has focused on compression stimuli, frequencies, and vacuums. This study aimed to compare the effectiveness of 2 electric pumps: Medela Symphony (pump S) and a novel pump (Philips AVENT Twin electronic pump; pump A). Both offer flexibility of rate and suction; pump A also incorporates petal compression cushions. Primary outcomes were (1) milk weight expressed during 10-day study period and (2) weight of milk expressed in a 15-minute test. Seventy-one mothers with preterm infants < 34 weeks were randomized. Mothers completed 10-day diaries including weight of milk expressed. Milk weight expressed during a single 15-minute test period and data on pumping mode, skin-to-skin contact, breastfeeding at infant discharge, and mothers' opinions of the pump were recorded. There was no significant difference in milk expressed during the first 10 days between groups. Pump S mothers expressed significantly more milk during a fixed 15-minute period. Mothers using pump A awarded higher scores for certain characteristics of the pump, notably location of control button and ease of use. Similar proportions of infants received breast milk at discharge, but pump A mothers were more likely to be directly breastfeeding (odds ratio, 4.27 [95% confidence interval, 1.29, 14.1]). The breast pumps showed similar effectiveness in terms of milk expression and maternal opinions. The finding that breast pump design may influence breastfeeding at infant discharge merits further investigation.

Gross blood in stools of premature neonates, a clinical and microbiological follow‐up study

To characterize the clinical course and the gut microecology of premature infants with macroscopic gross blood in stools. We studied 14 premature infants receiving breast milk supplemented with probiotics, according to our units practice, with macroscopic blood in stools without signs of ileus or systemic infection upon occurrence of the symptom and 14 days later. Controls were matched prospectively by gestational and postnatal age and type of feeding. Gut microbiota composition was analysed by quantitative real-time polymerase chain reaction (qPCR), and the presence of enteric viruses in the stools was assayed by PCR and by reverse transcription reaction followed by PCR (RT-PCR). The symptom was transient, benign and self-limiting and none of the background factors explained it. No enteric viruses were detected, and the bacterial analyses showed no statistically significant differences between the infants with or without gross blood in stools. The characterization of the gut microbiota revealed low bacterial diversity. Gross blood in the stools of premature infants without other clinical signs of infection can be an innocuous and self-limiting symptom. This cohort of preterm infants receiving breast milk supplemented with probiotics showed no alterations in gut microecology to be associated with the symptom.

Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe

The WHO recommends exclusive breastfeeding (EBF) for 6 mo after birth. However, the time at which breast milk ceases to provide adequate energy and nutrition, requiring the introduction of complementary foods, remains unclear. Most studies that investigated this issue were observational and potentially confounded by variability in social circumstances or infant growth. We hypothesized that EBF infants would consume more breast milk at age 6 mo than infants receiving breast milk and complementary foods. We measured anthropometric outcomes, body composition, and breast-milk intake at age 6 mo in infants who were randomly assigned at age 4 mo either to 6-mo EBF or to the introduction of complementary foods with continued breastfeeding. We recruited 119 infants from health centers in Reykjavik and neighboring municipalities in Iceland. In 100 infants who completed the protocol (50/group), breast-milk intake was measured by using stable isotopes, and complementary food intakes were weighed over 3 d in the complementary feeding (CF) group. Breast-milk intake was 83 g/d (95% CI: 19, 148 g/d) greater in EBF (mean ± SD: 901 ± 158 g/d) than in CF (818 ± 166 g/d) infants and was equivalent to 56 kcal/d; CF infants obtained 63 ± 52 kcal/d from complementary foods. Estimated total energy intakes were similar (EBF: 560 ± 98 kcal/d; CF: 571 ± 97 kcal/d). Secondary outcomes (anthropometric outcomes, body composition) did not differ significantly between groups. On a group basis, EBF to age 6 mo did not compromise infant growth or body composition, and energy intake at age 6 mo was comparable to that in CF infants whose energy intake was not constrained by maternal breast-milk output.

Breastfeeding Duration, Social and Occupational Characteristics of Mothers in the French ‘EDEN Mother–Child’ Cohort

Socio-demographic characteristics of mothers have been associated with exclusive breastfeeding duration, but little is known about the association with maternal full- and part-time employment and return to work in European countries. To study the associations between breastfeeding, any and almost exclusive (infants receiving breast milk as their only milk) breastfeeding, at 4 months of infant's age and the socio-demographic and occupational characteristics of mothers. We used the EDEN mother-child cohort, a prospective study of 2002 singleton pregnant women in two French university hospitals. We selected all mothers (n = 1,339) who were breastfeeding at discharge from the maternity unit. Data on feeding practices were collected at the maternity unit and by postal questionnaires at 4, 8 and 12 months after the birth. Among infants breastfed at discharge, 93% were still receiving any breastfeeding (83% almost exclusive breastfeeding) at the 3rd completed week of life, 78% (63%) at the 1st completed month, and 42% (20%) at the 4th completed month. Time of return to work was a major predictor for stopping breastfeeding: the sooner the mothers returned to work, the less they breastfed their babies at 4 months of infant's age, independently of full-time or part-time employment. The association was stronger for almost exclusive breastfeeding mothers than for any breastfeeding ones. In a society where breastfeeding is not the norm, women may have difficulties combining work and breastfeeding. Specific actions need to be developed and assessed among mothers who return to work and among employers.

Very high vitamin D supplementation rates among infants aged 2 months in Vancouver and Richmond, British Columbia, Canada.

BackgroundVitamin D deficiency during infancy may lead to rickets and possibly other poor health outcomes. The World Health Organization recommends exclusive breastfeeding for the first 6 months. Breast milk is the best food for infants but does not contain adequate vitamin D. Health Canada recommends all breastfed infants receive a daily vitamin D supplement of 400 IU; however, there appears to be limited current Canadian data as to whether parents or caregivers are following this advice. The aim of this study was to determine the rates of vitamin D supplementation among 2-month old infants in Vancouver and Richmond, British Columbia, Canada.MethodsMothers of all healthy infants born between April and May 2010 were approached to participate. Telephone surveys were conducted with 577 mothers (response rate 56%) when their infants turned 2 months.ResultsOver half of the infants received only breast milk in the week prior to the survey. One third received a mixture of breast milk and infant formula and 10% received only formula. About 80% of the infants were supplemented with vitamin D at 2 months. Infants who received only breast milk were most likely to be supplemented with vitamin D (91%). Over 60% of the infants had a total vitamin D intake of 300- < 500 IU/d from supplements and formula and only 5% did not receive any vitamin D. Most parents were advised to give vitamin D supplement by health professionals, such as public health nurses, midwives, and doctors.ConclusionsAbout 90% of the infants received breast milk at 2 months of age. The vitamin D supplementation rate was 80%. Future studies are needed to monitor breastfeeding duration and vitamin D supplementation rates as infants get older.

Providing Breast Milk for Neonates With Birth Weight Less Than 1,500 Grams

A retrospective review of very low birth weight (VLBW) infants' records revealed only 50.6% of VLBW infants had breast milk in their feeding plan at discharge. Our aim was to increase the number of VLBW infants receiving breast milk.

Food Consumption Patterns of Infants and Toddlers: Where Are We Now?

Objectives To describe current infant-feeding practices and current food group consumption patterns of infants and toddlers and to compare 2008 data with 2002 data to identify shifts in these practices and food consumption over time. Design The Feeding Infants and Toddlers Study (FITS) 2008 is a cross-sectional survey of a national random sample of US children from birth up to age 4 years. Data for three age subgroups (infants 4 to 5.9 months and 6 to 11.9 months and toddlers 12 to 23.9 months) were used from the 2002 (n=2,884) and 2008 surveys (n=1,596). Statistical methods All analyses use sample weights that reflect the US population aged 4 to 24 months. Descriptive statistics (means, proportions, and standard errors) and t tests were calculated using SUDAAN (release 9, 2005, Research Triangle Park Institute, Research Triangle Park, NC). Results These data show a higher percentage of infants receiving breast milk from 4 to 11.9 months of age with a concurrent decreasing percentage of infants receiving formula, which is significantly different from data for the 9- to 11.9-month-old age group. The use of complementary foods also appears to be delayed in FITS 2008: There is a significantly lower proportion of infants consuming infant cereal at 9 to 11.9 months in FITS 2008 compared to 2002 data. Fruit and vegetable consumption remains lower than desired. Significant reductions in the percentage of infants and toddlers consuming any desserts or candy, sweetened beverages, and salty snacks were seen in 2008. Conclusions The findings presented here provide important insights to the content of messages and types of interventions that are still needed to improve the diets of infants and toddlers.

Exploration of basal immune parameters in healthy infants receiving an infant milk formula supplemented with prebiotics

This double-blind, randomized, placebo-controlled study, aimed to explore the effect of an infant milk formula (IMF) with 6 g/l short-chain galacto- and long-chain fructo-oligosaccharides (scGOS/lcFOS, ratio 9:1) on basal immune parameters in 215 healthy, term infants during the first 26 wk of life. After birth, the infants received breast milk or were randomized to receive an IMF with or without scGOS/lcFOS. Blood samples were collected at the age of 8 wk and 26 wk for the analysis of serum immunoglobulins, lymphocyte subpopulations, and cytokines. The scGOS/lcFOS group and the control group were compared in the statistical analysis. A breast fed group was included as a reference. In total, 187 Infants completed the study. No significant differences were observed between both formula groups in the different studied immune parameters at weeks 8 and 26. This explorative study indicates that supplementation of infant formula with a mixture of prebiotic oligosaccharides did not change the basal level of the measured parameters of the developing immune system in healthy infants with a balanced immune system during the first 6 months of life in comparison to feeding a standard infant formula and in comparison to exclusive breastfeeding.

Low breast milk TGF‐β2 is induced by Lactobacillus reuteri supplementation and associates with reduced risk of sensitization during infancy

The immunological composition of breast milk differs between mothers. The reasons for these differences and the consequences for the breast-fed infants are poorly understood. The aim of this study was to evaluate the effect of probiotic Lactobacillus reuteri supplementation on the immunological composition of breast milk in relation to sensitization and eczema in the babies. Total IgA, secretory IgA (SIgA), TGF-beta1, TGF-beta2, IL-10, TNF, soluble CD14 (sCD14), and Na/K ratios were analyzed in colostrum and mature milk obtained from women treated with L. reuteri (n = 54) or placebo (n = 55) from gestational week 36 until delivery. Bacteriological analyses of L. reuteri were performed in faecal samples of the mothers. The infants were followed prospectively for 2 yr regarding development of eczema and sensitization as defined by a positive skin prick test and/or circulating allergen-specific IgE antibodies at 6, 12, and 24 months of age. Supplementation of L. reuteri during pregnancy was associated with low levels of TGF-beta2 and slightly increased levels of IL-10 in colostrum. For TGF-beta2, this association was most pronounced in mothers with detectable L. reuteri in faeces. Infants receiving breast milk with low levels of TGF-beta2 were less likely to become sensitized during their first 2 yr of life. A similar trend was observed for development of IgE-associated eczema. The levels of total IgA, SIgA, TGF-beta1, TNF, sCD14, and Na/K ratios in breast milk were not affected by the intake of L. reuteri. None of these parameters correlated with sensitization or development of eczema in the infant, except for high Na/K ratios that associated with increased risk of sensitization. Supplementation with L. reuteri during late pregnancy reduces breast milk levels of TGF-beta2, and low levels of this cytokine are associated with less sensitization and possibly less IgE-associated eczema in breast-fed infants.

Fecal Secretory Immunoglobulin A Is Increased in Healthy Infants Who Receive a Formula with Short-Chain Galacto-Oligosaccharides and Long-Chain Fructo-Oligosaccharides

In this double-blind, randomized, placebo-controlled study, we investigated the effect of an infant milk formula with 6 g/L short-chain galacto- and long-chain fructo-oligosaccharides [(scGOS/lcFOS) ratio 9:1] on the development of the fecal secretory immunoglobulin A (sIgA) response and on the composition of the intestinal microbiota in 215 healthy infants during the first 26 wk of life. The infants received breast milk or were randomized to receive an infant milk formula with or without scGOS/lcFOS. Stool samples were collected after 8 and 26 wk of intervention. The concentration of fecal sIgA was determined by ELISA, and the composition of the intestinal microbiota was determined by quantitative fluorescent in situ hybridization. The scGOS/lcFOS group and the control group were compared in the statistical analysis. A breast fed group was included as a reference. In total, 187 infants completed the study. After 26 wk of intervention, in infants that were exclusively formula fed, the concentration of sIgA was higher (P < 0.001) in the scGOS/lcFOS group (719 μg/g) than in the control group (263 μg/g). In addition, the percentages of bifidobacteria were higher in the scGOS/lcFOS group (60.4%) than in the control group (52.6%, P = 0.04). The percentages of Clostridium spp. were 0.0 and 3.27%, respectively (P = 0.006). In conclusion, an infant milk formula with 6 g/L scGOS/lcFOS results in higher concentrations of fecal sIgA, suggesting a positive effect on mucosal immunity.

Prevalence of vitamin D deficiency among healthy infants in Sacramento, CA

Concern about vitamin D deficiency in infants and children has recently increased. We conducted a one year study to determine the prevalence of vitamin D deficiency in infants 6â18 mos of age in Sacramento, CA and to identify dietary and lifestyle risk factors for deficiency. 178 healthy infants seen at the pediatric clinic at UC Davis Medical Center were recruited 8/06-8/07. Demographic, lifestyle, and dietary data were collected and plasma 25(OH) vitamin D (25OHD) concentrations were measured by radioimmunoassay. The mean ± SD concentration for all infants was 94 ± 40 nmol/L. 9% (16/178) were found to be deficient (<50 nmol/L), 69% (11) of whom were currently breastfed. 28% (11/40) of all infants receiving breast milk were deficient. Exclusively breastfed infants (no other milk source) had significantly lower 25OHD levels (64 ± 41 nmol/L) than infants not currently breastfed and receiving milk, formula, or both (103 ± 37 nmol/L; p < 0.05). 12.5% (5/40) of breastfed infants reported taking vitamin D supplements. Significant differences were not seen based on sun exposure or race/ethnicity. These results suggest 25OHD values in infants 6â19 mos of age are most strongly determined by infant feeding practices and usual predictors for vitamin D status in adults such as seasonality, ethnicity, and sun exposure are less important. Vitamin D supplements are recommended for exclusively breastfed infants by two months of age. These data suggest that increased attention to this recommendation may decrease the prevalence of vitamin D deficiency in this population of infants.

Good short-term outcomes of kangaroo mother care in infants with a low birth weight in a rural South African hospital

Objective The aim of the study was to determine the outcome of kangaroo mother care (KMC) in low birth weight infants at a community hospital. Methods This descriptive study included 87 mothers and their low birth weight infants who were in a stable condition and eligible for KMC at Dr JS Moroka Hospital, Thaba Nchu. The infants were assessed four times: at birth, twice during hospitalisation, and a week after discharge. Infants received breast milk exclusively. Results Regarding the mothers’ obstetric history (n=87), gravidity ranged from 1 to 7 (median 3), with a 43% incidence of miscarriage. The median birth weight of the infants (n=87) was 1.5 kg (first assessment), the discharge weight (third assessment) was 1.8 kg, and a week after discharge (fourth assessment) it was 2.2 kg. Initially the infants lost weight significantly from birth to the second assessment (95% CI for median decrease [0.02; -0.01]), but significantly gained weight from the second to the third (95% CI for median increase [0.27; 0.33]) and from the third to the fourth assessment (95% CI for median increase [0.32; 0.45]). Approximately half (49%) of the infants had developed jaundice by the time of second assessment. These babies had a significantly lower birth weight [0.12;0.30]. Conclusion Our findings confirm that infants with a low birth weight treated with KMC can have a good growth pattern, and exclusive breast milk is sufficient to guarantee such growth. Kangaroo mother care is a safe method for stable infants with a low birth weight in a community hospital.

The Influence of Infant Diet on Early Developmental Changes in Processing Human Voice Speech Stimuli: ERP Variations in Breast and Milk Formula-Fed Infants at 3 and 6 Months After Birth

The purpose of this investigation was to determine if processing of language stimuli during the first half year of life in breast-fed infants differs from that of formula-fed infants. This question was addressed by examining the brain event-related potentials of healthy infants receiving breast milk (n = 15) or milk-based formula (n = 18) recorded in response to consonant vowel syllables presented in an oddball paradigm. The same infants were studied when they were 3-months and 6-months-old. The two groups were comparable on several measures relating to biological and home environment variables previously reported to influence development, including gestation period, birth weight, mother's IQ, and family socioeconomic status, and did not differ in weight or mental or motor development at the times of the visits. In general, ERP response features previously documented in studies of syllable processing in 3–6-month-old infants were observed in this study, including positive components at ∼ 190 msec (P1), ∼ 370 msec (P2), and ∼ 600 msec (P600), and negative components at ∼ 250 msec (N250), ∼ 450 msec (N450), and a late, negative going slow wave between 655 and 995 msec (LSW). For both groups there were instances where specific components were either poorly defined, e.g., P1 and N250 to the infrequent syllable at 3 months, N450 and P600 to this syllable at both ages, or not present in many infants, e.g., the P600 to the frequent syllable at 6 months. These variations appeared to be related to individual differences in development or paradigm-related features, i.e., ISI and frequency of syllable occurrence. Developmental variations (changes from 3 to 6 months) common to both feeding groups included latency decreases for P1, decreased P2 amplitude, and increased amplitudes for N250 and LSW components. Within this framework, group differences were detected in areas involving the development of response components, the development of processing capabilities, and syllable discrimination. In all cases, these effects related to components following initial stimulus registration, i.e., to the processing of sound content rather than sound acoustic features. The pattern of these differences suggests advantages for BF infants in the development and processing of language stimuli during the first 6 months of life.

Alterations in Neurobehavior at Term Reflect Differing Perinatal Exposures in Very Preterm Infants

Preterm infants have higher rates of cognitive and behavioral difficulties at school age than their term-born peers. We hypothesized that neurobehavior at term would be different in very preterm infants compared with term infants and that perinatal exposures would be associated with these alterations in neurobehavior. Two standardized neurobehavioral evaluations were completed on 207 infants at term equivalent, including 168 very preterm infants (<1250 g or <30 weeks' gestation) and 39 term control infants. The assessments used were the Neonatal Intensive Care Unit Network Neurobehavioral Scale and the revised Hammersmith Neonatal Neurologic Examination. The relationship of perinatal variables to preterm infant neurobehavioral scores for both evaluations was examined. Compared with term-born infants, preterm infant neurobehavior was significantly altered for the Hammersmith Neonatal Neurologic Examination total score and all of the subtotals. Similarly, preterm infants displayed altered neurobehavior for the majority of the Neonatal Intensive Care Unit Network Neurobehavioral Scale summary scores. Complete perinatal data were available for 157 of 168 very preterm infants. The perinatal variables most strongly associated with altered preterm infant neurobehavior on multivariate regression analysis included the total number of days of assisted ventilation, intraventricular hemorrhage, and necrotizing enterocolitis. Positive perinatal influences on neurobehavioral performance at term on multivariate analysis included maternal antenatal steroids, female gender, and infants receiving breast milk at discharge home. Preterm infants at term equivalent showed alterations in motor behavior and higher cortically integrated functions. The pattern of abnormality in neurobehavior differed in relation to perinatal exposures. Neurobehavioral examination at term equivalent age is useful in evaluating the impact of neonatal intensive care.