Lactose-free Formula Research Articles

Should we be concerned about the use of lactose-free infant formulas?

Should we be concerned about the use of lactose-free infant formulas?

Awareness about Neonatal Lactose Intolerance among Chinese Neonatologists in Outpatient Settings: A Multi-Center Survey.

This study aimed to identify the specific areas of knowledge gaps regarding lactose intolerance among neonatologists in Chinese outpatient settings as well as to assess the availability of lactose intolerance testing in hospitals. A total of 278 neonatologists in outpatient settings from 144 hospitals were surveyed. To explore the awareness level, diagnosis, and treatment of neonatal lactose intolerance among neonatologists in outpatient settings, a multicenter cross-sectional survey was designed. Descriptive analysis based on frequency and percent distribution was performed for all variables. Most respondents were senior doctors (256, 92.09%) from general hospitals and maternity/maternal and child health hospitals, had over 10 years of experience, and were dominantly associate chief physicians and chief physicians (211, 75.90%). A significant proportion of the participants (236, 84.89%) believed that neonatal lactose intolerance tends to be overlooked during clinical practice. When the most common symptoms of neonatal lactose intolerance were surveyed, diarrhea was selected by 142 (51.08%) respondents, followed by bloating and milk regurgitation or emesis (71, 25.54%). Other symptoms included unexplained crying (36, 12.85%), stool with milk flap or foam (15, 5.40%), and increased venting (14, 5.04%). Furthermore, the survey results indicated that the most common method for diagnosing neonatal lactose intolerance in the respondents' hospitals was qualitative test for urinary galactose (78, 28.06%). Of the respondents, 137 (49.28%) stated that their hospital could not test for lactose intolerance. For treating lactose intolerance, the neonatologists primarily opted for exogenous lactase rather than lactose-free formula milk. This study sheds light on Chinese neonatologists' awareness of neonatal lactose intolerance, revealing some knowledge gaps. The expeditious popularization and conduct of lactose intolerance-related examinations in hospitals will have a positive stimulative effect on the management of lactose intolerance in newborns.

Efficacy of lactose-free formula in acute diarrheal management for children under 5 years: a systematic review and meta-analysis

Background Acute diarrhea is the most common gastrointestinal disease in children under five years of age with high morbidity and mortality risk. The use of lactose-free formula in the management of children with acute diarrhea was said to accelerate the diarrheal resolution time. Objective To determine the efficacy of lactose-free formula in managing acute diarrhea in pediatric patients by systematic review and meta-analysis. Methods A comprehensive literature search was conducted on PubMed, Proquest, Web of Science, and CINAHL Plus Database from November 1971 to July 11th, 2021. The study selection process was carried out under PRISMA 2020 guidelines based on several eligibility criteria. The quality of the included studies were further assessed using Modified Jadad Scores. Results Fifteen randomized controlled trials (RCTs) were included, involving a total of 1,390 children with acute diarrhea. Shorter recovery time (MD -0.21; 95%CI -0.50 to 0.08; P=0.16) was observed in patients receiving lactose-free formula than the control group. However, this finding was not statistically significant. The subgroup analysis showed that lactose-free formula significantly shortened the recovery time compared to oral rehydration solution (ORS) group (MD -0.70; 95%CI -0.98 to -0.41; P=0.00001). Furthermore, lactose-free formula also significantly reduced the amount of stool output (MD -0.61; 95%CI -0.86 to -0.36; P=0.00001) and the incidence of persistent diarrhea more than seven days (OR 0.22; 95%CI 0.10 to 0.51; P=0.0004) compared to the control group. Conclusion Lactose-free formula as dietary management for acute diarrhea in children can reduce stool output and the incidence of persistent diarrhea for more than seven days. It also may shorten the recovery time compared to the administration of ORS alone.

Efficacy of Lactose-Free Milk in Treating Acute Gastroenteritis in Vietnamese Children: A Randomized Controlled Trial.

Low lactase levels in Asian children appear to be genetically determined or rotavirus-induced gastroenteritis. Consuming lactose-free formula in children with acute gastroenteritis may shorten diarrhea's duration and increase weight gain. This study aims to determine whether lactose-free milk will change the duration of diarrhea and weight gain in Vietnamese children aged 2-24 months with acute gastroenteritis. A randomized control trial was performed on 66 children under 24 months of age with acute gastroenteritis at the Gastroenterology Department of Can Tho Children's Hospital. In adjunction to oral rehydration solution, they received either a lactose-free formula (n=33) or a lactose-containing formula (n=33). Diarrhea duration, weight gain, treatment failure, and days of hospitalization were all studied. A total of 66 children participated in this trial, with a mean age of 13.4 ± 5.1 months, and 38 participants (57.6%) were male. There were no significant differences between the lactose-free formula group and the lactose-containing formula group in the duration of diarrhea (2.2±0.8 days versus 2.4±0.9 days; P=0.321), percentage of weight gain (1.96 [IQR:1.35-2.36] percent vs. 2.29 [IQR:1.81-2.40] percent; P=0.131), treatment failure rate (33.3% vs. 36.4%; P= 0.796), and days of hospitalization (5.8±1.7 vs. 6.5±2.5 days; P=0.158). It may not be necessary to use lactose-free milk routinely in Vietnamese children under 24 months with acute gastroenteritis as the duration of diarrhea, weight change, treatment failure rates, and hospital stay are similar to those of children fed lactose-containing milk.

Detection of Aflatoxin M1 and Several Heavy Metals in Medical Infant Milk Formula Sold in Iraqi Markets

Milk is essential for infants, and infant feeding should be emphasized in any program to ensure good child health. To find harmful and trace elements in different milk powder brands bought in Iraq and fed to babies with metabolic syndrome, atomic absorption spectrometry (AAS) was used. Fluorescence high-performance liquid chromatography (HPLC) was also used to measure aflatoxin M1. The result reveals the concentrations of elements close to the product label's description, such as magnesium, calcium, zinc, selenium, iron, and manganese. Only the potassium element was higher than what was listed on the product label. Additionally, no quantities of hazardous elements like lead (Pb), cadmium (Cd), or arsenic (As) were found. As for aflatoxin M1, it was found that the PKU milk formula and lactose-free milk formula were found to be free of AFM1 contamination, indicating that they are safe to consume. AFM1 was found in concentrations above the permissible limit in the MSUD milk formula (0.08 µg/kg). The reason for this issue could be inadequate storage. The other two types, TYR and OAc milk formula, were lower than the allowable limit of 0.05 µg/kg. As a result, there needs to be more oversight of the milk that newborns with metabolic syndrome consumele S. aureus or Streptococcus pyogenes, and Streptococcus pneumoniae in community settings.

EFFICACY OF LACTOSE-FREE FORMULA AS A 24-HOUR MANAGEMENT APPROACH FOR ACUTE DIARRHEA AMONG CHILDREN

Background: Diarrhea continues to be a prominent contributor to morbidity and mortality among young children under five years, especially in developing nations. Secondary lactose intolerance is a significant complication that can arise from acute diarrhea. However, it can be effectively managed with lactose-free formula.
 Objective: This study aimed to compare the rate of diarrhea resolution within a 24-hour period among children receiving lactose-free formula and those receiving lactose-containing formula.
 Methods: This retrospective cohort study took place at Naresuan University Hospital and included 153 children aged between one month and five years admitted with acute diarrhea. Participants with bloody mucous diarrhea suspected to be bacterial in nature, positive stool culture, breastfeeding and chronic diarrhea (including cow’s milk protein allergy and inflammatory bowel disease) were excluded. We compared the effectiveness of lactose-free formula (n=48) and lactose-containing formula in improving clinical diarrhea within a 24-hour (n=105).
 Results: The study findings indicated the lactose-free formula group demonstrated a statistically significant increase in efficacy, with a 3.90 fold improvement in diarrhea within 24 hours compared with that of the group receiving lactose-containing formula. These results were obtained after the confounding factors were adjusted using multivariable regression analysis. The adjusted relative risk (RR) for a 24-hour improvement in diarrhea was 3.90 (95% CI: 1.91-7.95). However, this study encountered limitations regarding the sample size and accurate measurement of stool output.
 Conclusion: Lactose-free formula showed the potential for greater effectiveness in improving acute diarrhea within a 24-hour timeframe compared with lactose-containing formula.

Comparison of Outcome of Lactose-Free Formula Milk with Yogurt in Children with Acute Diarrhea

Background: Diarrhea is one of the most common problems in Pakistan where Khyber Pakhtunkhwa has the maximum prevalence i.e, 28% followed by Sindh (23%), Punjab (22%), and Baluchistan (12%). According to WHO every year 1.5 million children under 5 years, die just because of diarrhea. Therefore, this study aimed to look at the effect of lactose-free formula milk versus homemade plain yogurt in children with acute diarrhea. Methods: A randomized controlled trial was carried out on 60 children of age 4-24 months, 30 in each group in the Department of Pediatrics, Services Hospital Lahore. Group 1 was given yogurt while lactose-free milk was given to group 2. The duration of resolution of diarrhea was noted in hours and data was statistically analyzed using SPSS version 20. Practical Implication: The practical implication of comparing lactose-free formula milk with yogurt as a dietary intervention for children with acute diarrhea involves several considerations. Firstly, the severity and duration of diarrhea should be evaluated to determine the appropriate intervention. Secondly, the age and nutritional needs of the child should be taken into account. Thirdly, the availability and acceptance of lactose-free formula milk and yogurt in the local context should be considered. Additionally, the potential benefits and drawbacks of each option, such as the nutritional content, ease of digestion, and probiotic properties of yogurt, need to be assessed. It is important to consult with healthcare professionals and make an informed decision based on the specific circumstances to promote optimal outcomes in managing acute diarrhea in children. Results: Out of 60 children, 26 (43.33%) were male and 34 (56.67%) were female. In groups 1 and 2, the mean duration of resolution of diarrhea (outcome) was 43.9 ± 7.30 hours and 71.57 ± 12.92 hours respectively. Group 1 patients’ treatment showed a significant difference in the outcome than group 2 patients (P value= 0.00). However, the treatment effect on gender was found non-significant (P value= 0.48). The outcome in females was 43.6 ± 7.5 hours with yogurt and 70.6 ± 8.4 hours with lactose-free milk while in males the outcome was 44.3 ± 8.6 hours with yogurt and 73.1 ± 9.1 hours with lactose-free milk. Conclusion: The use of yogurt is better than lactose-free formula milk for the resolution of diarrhea. Keywords: Lactose-free formula milk, homemade plain yogurt, diarrhea.

Application of Lactose-Free Whey Protein to Greek Yogurts: Potential Health Benefits and Impact on Rheological Aspects and Sensory Attributes.

The application of β-galactosidase in the fermentation of milk enables the acquirement of lower levels of lactose that are tolerated by lactose maldigesters and can reduce the nutritional consequences of avoiding dairy products. The present study evaluated the viability of the fortification of lactose-free prebiotic Greek yogurt formulas with whey protein concentrate (WPC). Two rotational central composite designs (RCCDs) were applied: one to perform the hydrolysis of the whey protein concentrate and another for the yogurt formulations (α = 2 with 2 central points and 4 axial points). Two β-galactosidase enzymes obtained from Kluyveromyces lactis were used. The content of lactose, glucose, galactose, and lactic acid were determined in the WPC, milk (pasteurized and powdered), and yogurts. The three best formulations regarding the attributes’ viscosity, syneresis, firmness, and elasticity were sensorially evaluated by using a nine-point hedonic scale. A microbiological analysis was performed after 48 h of yogurt production. The characterization of the products and the comparison of the results obtained were evaluated using the Student’s T test and the analysis of variance with Tukey’s test (p-values < 0.05). The application of a lactose-free WPC promoted viscosity, firmness, and elasticity. The syneresis was reduced, and whey increased the protein and calcium content. Lactose-free WPC can be used as a partial substitute for skimmed powdered milk in yogurts. The obtained results are encouraging with respect to the production of lactose-free Greek yogurts by the dairy industry.

Pediatric diarrhea and lactose products.

Are lactose-containing formulas and diets associated with worsened acute pediatric diarrhea? Breastfed children should continue breastfeeding. In formula-fed children younger than 2 years, temporarily switching to lactose-free infant formula shortens diarrhea duration by about 18 hours and reduces

Lactose Concentration in Low-Lactose and Lactose-Free Milk, Milk Products, and Products Containing Dairy Ingredients by High Sensitivity Enzymatic Method (K-LOLAC), Collaborative Study: Final Action 2020.08.

The AOAC Stakeholder Panel on Strategic Food Analytical Methods issued a call for methods in 2018 for the measurement of lactose in low-lactose and lactose-free products under Standard Method Performance Requirement (SMPR®) 2018.009. Megazyme's Lactose Assay Kit (K-LOLAC) was reviewed and accepted as a First Action Official MethodSM in 2020 (2020.08). A collaborative study was conducted to evaluate the to evaluate the reproducibility of AOAC Official MethodSM2020.08 for the measurement of lactose concentration in low-lactose and lactose-free milk, milk products, and products containing dairy ingredients. Samples are deproteinated and clarified by treatment with Carrez reagents, and then free glucose is removed using a glucose oxidase and catalase treatment system. Quantification of lactose is based on the hydrolytic activity of β-galactosidase, which hydrolyses lactose to glucose and galactose. Any remaining free D-glucose is first measured using a hexokinase (HK)/glucose 6-phosphate dehydrogenase (G-6PDH)/6-phosphogluconate dehydrogenase (6-PGDH) based assay procedure, and then β-galactosidase is added to hydrolyze the lactose in the same reaction vessel with concurrent measurement of the released D-glucose. The samples analyzed included a number of lactose-free and low-lactose milk samples, lactose-free infant formula, lactose-free milkshake, lactose-free adult nutritional drink, lactose-free cream, and lactose-free cheese. All materials had repeatability relative standard deviations (RSDr) <7%. The reproducibility relative standard deviation (RSDR) varied from 3.8 to 14.9% with seven of the 10 test samples having an RSDR of <10%. The Lactose Assay Kit (K-LOLAC) meets the requirements for reproducibility set out under SMPR 2018.009. The Lactose Assay (K-LOLAC) is a robust, simple, and reproducible method for analysis of lactose in foodstuffs and beverages.

Probiotics dairy drink for patients with Galactosemia

Objective: The objective of this study was to develop probiotic dairy products with lactose free and low-galactose contents were produced for patients with galactosemia from four different raw materials including conventional cow’s milk, lactose free cow’s milk and mixtures containing lactose free cow’s milk and three different lactose and galactose free infant formulas. Material and Methods: Probiotic fermented dairy drinks, specifically acidophilus milk and kefir, with lactose free and low galactose content for patients with galactose intolerance were produced by using a 1:1 mixture of lactose free milk and two different types of infant formula, fortified with strawberry flavor. Storage period was set for 30 days. Said types of products were also produced with lactose free milk and conventional milk as raw material in order to use as control groups. With priority, lactose and galactose contents, and some other chemical, physical, microbiological and sensory properties were examined. Results: Chemical, physical, microbiological and sensory properties of these products were found to match the common quality characteristics of a commercial fermented dairy product. Also, such properties of fermented dairy drinks produced from lactose free milk have the same quality characteristics of a fermented dairy product. Conclusion: The galactose contents of fermented dairy beverages produced from lactose free raw materials were reduced to a level suitable for the diets of galactosemic patients.

The Glycemic Response to Infant Formulas: A Randomized Clinical Trial.

Background: Commercial infant formulas attempt to imitate human milk’s unique composition. However, lactose-free and milk protein-free formulas are often chosen due to medical reasons or personal preferences. The aim of this study was to determine the glycemic and insulinemic indices of a variety of infant formulas. Methods: We conducted a three-arm, randomized, double-blind, crossover study. Participants were 25–40-year-old healthy adults. Three commercial infant formulas (cow’s milk protein-based [“standard”], soy protein-based, and lactose-free) were randomly given to each participant. Glycemic and insulinemic responses were determined and compared between the three formulas. Results: Twenty subjects were enrolled (11 females/9 males, mean age 32.8 ± 2.9 years). No significant difference was found in the glycemic index between the three formulas (21.5, 29.1, and 21.5 for the standard, soy protein-based, and lactose-free formulas, respectively, p = 0.21). However, maximal glucose levels were significantly higher for the soy protein-based formula compared to both the standard and lactose-free formulas (111.5 compared to 101.8 and 105.8 mg/dL, respectively, p = 0.001). Conclusion: Cow’s milk protein-based, soy protein-based, and lactose-free formulas have a similar glycemic index. However, soy protein-based formula produced a significantly higher increase in postprandial glucose levels. The implication and biological significance of these results have yet to be determined.

Lactose-free dulce de leche with different concentrations of green banana biomass

Abstract The production and consumption of dulce de leche is one of the most important sweets in the Mercosul Region. However, recent studies have shown consumers’ interest for healthier food and no lactose products, hence creating a demand for this study aims to develop a more nutritional lactose-free dulce de leche with less calories and higher yielding by adding green banana biomass. Five lactose-free dulce de leche formulas have been elaborated in which four were added 5%, 10%, 15% and 20% of green banana biomass and one of them received a standard 0.5% of commercial starch addition. The samples were evaluated regarding its microbiological, physicochemical and sensorial quality. The different lactose-free dulce de leche formulas attended the microbiological standards and demonstrated an increased yield of the green banana biomass concentration. The results indicated that the rise of the green banana biomass concentration has increased moisture and decreased protein, lipids and calories levels. In regards of acceptance, all samples evaluated received grades between 7.23 to 8.72, that is, above 6 which is the minimum value accepted to all the evaluated attributes hence demonstrating the acceptance on behalf of evaluators. All samples presented high ratios of intent to purchase therefore confirming the acceptance results found. It has been observed that the use of green banana biomass aggregated positive characteristics to the product and did not influence the sensorial quality of the sweets, seeing that all of them could improve their yield and thus demonstrating to be a good option to the development of healthier products.

Лактазная недостаточность при аллергии к белкам коровьего молока – дифференцированный подход к выбору лечебной смеси

The similarity of clinical symptoms of lactase deficiency and cow’s milk protein allergy (CMPA), as well as a frequent combination of these pathologies in the form of secondary hypolactasia against the background of CMPA often lead to under-diagnosis of CMPA and erroneous prescription of lactose-free and low-lactose formulas to children with food allergies. Children with the combination of CMPA and secondary lactase deficiency require complete elimination of milk protein from their diet and selection of extensively hydrolyzed or amino acid-based formulas in the absence or lack of breastfeeding. At the same time, exclusion of lactose from the child’s diet is not required in the absence of gastrointestinal manifestations of CMPA, and in the presence of secondary lactase deficiency against the background of CMPA, it is required only until gastrointestinal symptoms are relieved. Therefore, when remission of gastrointestinal manifestations of food allergies is achieved, it is recommended to transfer children to extensively hydrolyzed formulas containing lactose, since therapeutic formulas with lactose provide beneficial effects, including on the gut microbiota and fecal metabolome. This article presents a detailed analysis of literature and proposes an algorithm for individual selection of therapeutic formulas for children with CMPA, depending on clinical manifestations. Key words: cow’s milk protein allergy, amino acid-based formulas, extensively hydrolyzed formulas, children, lactase deficiency, infants, nutrition, food allergy

Lactose versus Lactose Free Regimen in Children with Acute Diarrhea

BACKGROUND: Acute diarrhea (AD) is the most frequent gastroenterological disorder, and the main cause of dehydration in childhood, and it is one of the most important causes of morbidity and mortality in children. AIM: Assessment of lactose-free formula effect in nutritional treatment in formula-fed children with acute diarrhea. PATIENTS AND METHODS: A cross-section interventional study carried out on 60 formula-fed children, under two years, referring with acute diarrhea, 30 children obtain lactose-free formulation and 30 children with no lactose-containing formula. According to the period of diarrheal stop and weight, changes compering two groups. RESULTS: Thirty-two males and 28 females children (7.25 ± 5.1 months) included. Children with lactose-free formula had a significantly slighter dated to diarrhea relief compared with control group children (p &lt; 0.01). No variance between two groups in weight change (6.9 ± 3.03 vs. 7.05 ± 3.07 kg, p = 0.2). (46.6%) of patients on Lactose free formula were discharged on the third post admission day, lactose-free formula has more effective recovery to those on cow milk formula (4.1 ± 1.2 vs. 6 ± 1.3 days, p &lt; 0.01 significant). CONCLUSION: Quick giving of lactose-free formulation to children on formula feeding show rapid relief of acute diarrhea.

What we should know about the carbohydrate component of infant formula

The article is devoted to the discussion of the carbohydrate component of infant formula for feeding healthy and sick children. The role of glycemic and non-glycemic carbohydrates is shown. In addition to lactose, the following glycemic carbohydrates can be used in infant formulas: maltose, sucrose, glucose, glucose syrup, maltodextrins, pretreated starch and gelatinized starch. Resistant oligosaccharides, nonstarch polysaccharides, and resistant modified starches are also used in child nutrition. The composition and amount of lactose, the main carbohydrate of women’s milk, is discussed. The article presents data on the role of galactose, which is conditionally essential for children in the first months of life due to the rapid growth rate of the infant. Information is presented on the lactose breakdown, the importance of enzymes in the digestion and assimilation processes, the prebiotic effects of lactose, and its effect on the absorption of calcium and other minerals. Advantages of lactose include its low glycemic index, as well as its reduced sweetness, which affects the proper development of taste and low risk of dental caries compared to other fermentable sugars. Specific requirements for the carbohydrate composition of low-lactose and lactose-free formulas are discussed because of the often unwarranted increase in the frequency of their use. Evidence is presented using the Cochrane Systematic Review (2018) that reducing or eliminating lactose from infant formulas in infants with infantile colic is not always appropriate. Special low-lactose and lactose-free formulas replace lactose with glucose polymers such as maltodextrin, glucose syrup, and solid glucose syrup, which are produced by hydrolyzing starches (corn, rice, or potato). The article discusses the data on the effect of maltodextrin on the state of the intestinal mucosa, the microbiota of the large intestine and the possible role of this ingredient in the pathogenesis of chronic inflammatory bowel diseases. The results of various studies regarding the effect of maltodextrin on the intestinal microbiota are contradictory. However, special low-lactose or lactose-free products are prescribed in the presence of symptoms of lactase deficiency in an artificially fed baby. It is a major mistake to prescribe lactose-free mixtures on the basis of intact protein or partially hydrolysed ones for secondary lactase deficiency caused by an allergy to cow’s milk proteins. The carbohydrate component of Friso therapeutic hydrolysates contains no maltodextrin, and lactose is partially or completely replaced with glucose syrup.

Lactose and Digestible Maltodextrin in Milk Replacers Differently Affect Energy Metabolism and Substrate Oxidation: A Calorimetric Study in Piglets

Background:In recent years, lactose-free infant formulas have been increasingly used. Digestible maltodextrins are commonly used as a substitute for lactose in these formulas, but the effects on energy metabolism are unknown. Objective:We aimed to evaluate the differences in energy metabolism and substrate oxidation in piglets fed milk replacers containing lactose compared with maltodextrin as the only source of carbohydrates. Methods:Piglets (Tempo × Topigs 20) from 8 litters were fed milk replacers containing lactose or maltodextrin (28% w/w, milk powder basis) from 1 to 9 wk of age (n = 4 litters/milk replacer). At 5 wk of age, 4 females and 4 entire males (mean ± SEM bodyweight, 10 ± 0.3 kg) were selected per litter, and housed in 16 groups of 4 littermates, with 2 females and 2 males per pen (n = 8 groups/milk replacer). Between 7 and 9 wk of age, groups were housed for 72 h in climate respiration chambers, and fed their experimental milk replacer in 2 meals per day, at 08:30 and 16:30. Heat production data were calculated from the continuous measurement of gaseous exchanges and analyzed using general linear models in SAS. Results:Resting metabolic rate was 6% less in maltodextrin- than in lactose-fed piglets, notably before the morning meal. The postprandial respiratory quotient was 13% greater in maltodextrin- than in lactose-fed piglets after both meals. Net rates of carbohydrate oxidation were on average 5% greater in maltodextrin- than in lactose-fed piglets, particularly after the afternoon meal, whereas net rates of fat oxidation were 9% less in maltodextrin- than in lactose-fed piglets, particularly after the morning meal. Conclusions:Compared with lactose, maltodextrin in milk replacers reduced resting metabolic rate in the fasting state, and induced a shift in postprandial substrate oxidation profiles in pigs. Further research is warranted to evaluate the consequences of these metabolic changes for body composition.

Lactose-free infant formula does not change outcomes of neonatal abstinence syndrome (NAS): a randomized clinical trial.

To determine if lactose-free formula, compared to lactose-containing formula, decreases the cumulative morphine dose required to treat neonatal abstinence syndrome (NAS). In a double-blind clinical trial, we randomized 74 infants (36-42 weeks gestation) at risk for developing NAS due to in-utero exposure to opioids to receive either lactose-free (Similac Sensitive®) or lactose-containing (Similac Advance®) infant formula. The primary outcome measure was the cumulative dose of morphine used for the treatment of NAS during the first 14 days of life. Data on 69 (4 withdrew consent and 1 ineligible)/74 randomized infants were analyzed. Patient characteristics between the infant groups fed lactose-free (n = 34) vs. lactose-containing (n = 35) infant formula were similar except more common maternal heroin abuse in the latter group (p = 0.013). Cumulative morphine dose (20.7 ± 19.8 vs. 23 ± 23.5 mg, p = 0.61) between the two groups were similar. Lactose-free vs. lactose-containing infant formula did not change the outcomes of infants with NAS.

Comparative study of lactose and lactose free milk for acute diarrheal management in children upto 1 year of age.

Objectives: The objective of this particular research was to contrast mean duration of acute diarrhea in infants taking lactose free formula versus lactose-containing formula milk along with standard treatment. Study Design: Randomized Controlled Trial. Setting: Department of Paediatric Medicine DHQ Teaching Hospital Sargodha. Period: 6 months from 29 October 2016 to 28 April 2017. Material &amp; Methods: This study included 60 infants of both genders who were between 1month to 1 year of age and presented with acute diarrhea. These infants were separated into two groups. Infants in Group-A were given lactose-free formula milk while those in Group-B received lactose-containing formula milk. Outcome variable was mean duration of diarrhea which was compared between the two groups. Consent was taken in black and white from parents of each infant. Results: The average age of the infants was 7.2±3.1 months. Majority (n=41, 68.3%) of the infants were aged 6 months and above followed by 19 (31.7%) infants aged between 1-5 months. There were 29 (48.3%) male and 31 (51.7%) female infants with a female to male ratio of 1.1:1 the weight of infants ranged from 2.6 Kg to 11.9 Kg with a mean of 8.1±2.2 Kg. Both study groups were compared in terms of mean age (p-value=0.741), mean weight (p-value=0.932) and age (p-value=0.781), gender (p-value=0.438) and weight (p-value=0.573) groups distribution. The mean period of diarrhea was notably shorter in infants taking lactose-free milk (1.7±0.8 vs. 2.7±0.8 days; p&lt;0.001) as compared to those receiving lactose-containing milk. Similar significant differences were observed across various subgroups based on patient’s age, gender and weight. Conclusion: Lactose-free formula milk reduces mean duration of diarrhoea significantly when compared to lactose-containing formula milk regardless of patient’s age, gender and weight which advocate its preferred use in future practice in infants presenting with acute diarrhea.

A case of classical Galactosaemia presenting with Fanconi syndrome

Introduction Galactosemia is a rare autosomal recessive metabolic disorder with the prevalence of 1;60000. Classical Galactosemia (CG) is the most common variant of Galactosemia and which is due to deficiency of Galactose-1-phosphate uridyltransferace enzyme. Fanconi Syndrome (FS) is a rare presentation of CG. Here we present a baby girl with CG presenting with FS. Case Report A 5-month old baby girl presents with recurrent non bilious vomiting since early neonatal period. She was the first baby born to second degree consanguineous parents. The baby was exclusively breast fed since birth and there was a history of feeding intolerance. Her weight gain was suboptimal. On admission, she looks ill, tachypneic and dehydrated and her anthropometric parameters were <-3SD. There was 4cm hepatomegaly without splenomegaly. Her development age was 3 months. Her basic haematological parameters and inflammatory markers were normal. There was elevated liver enzymes with normal renal functions. She had normal anion gap metabolic acidosis with positive clinitest and clinistix tests. Further investigations reveled proximal tubular dysfunction, hypophosphatemia, hypocalcaemia and low vitamin D3 levels. Dry blood spot for serum galactose level was well above the normal range. (67.55mg/dL). Based on the clinical and biochemical findings, the diagnosis of CG complicated with FS was made and she was commenced on lactose free formula, bicarbonate and oral potassium. Her symptoms were markedly improved with good weight gain following the treatment. Conclusion When CG presenting with FS, both clinitest and clinistix tests become positive resulting diagnostic difficulty.