Mead Johnson Nutrition Research Articles

Determining the osmolality of over‐concentrated and supplemented infant formulas

Hyperosmolar infant feeds can cause osmotic diarrhoea and may be a risk factor for necrotising enterocolitis; the osmolality of infant formula is therefore usually <400 mOsm kg(-1) . However, in fluid-restricted infants and those needing nutritional support, formulas may be over-concentrated or supplemented. The present study aimed to determine the effect of these practices on osmolality. A clinical laboratory osmometer was used to measure the osmolality of infant formulas. The effect of over-concentration and supplementation on osmolality was then determined using three and seven different infant formulas, respectively. Osmolalities were measured in triplicate. The effect of over-concentration was shown to be linear using Pepti Junior (Cow & Gate, Trowbridge, UK) at concentrations of 12.8% (standard), 17% and 19%. This linear relationship was also demonstrated with Enfamil A.R. (Mead Johnson Nutritionals, Uxbridge, UK) (15%) and Neocate (SHS International Ltd, Liverpool, UK) (21%). The effect of individual additives on osmolality was found to be similar for the seven infant formulas. All preparations of SMA High Energy (SMA Nutrition, Maidenhead, UK) and five of the 12 preparations of Nutriprem 1 (Cow & Gate) exceeded an osmolality of 400 mOsm kg(-1) . The effect of over-concentrating infant formulas was shown to be linear, meaning that the osmolality at different concentrations can be predicted accurately. The over-concentrated infant formulas that were measured in the present study did not exceed 400 mOsm kg(-1) , with the exception of 21% Neocate, which would not be used in practice. When supplemented, some infant formulas exceeded an osmolality of 400 mOsm kg(-1) ; this may be relevant in cases of feed intolerance or in those at risk of necrotising enterocolitis.

Growth and tolerance of infants fed formula supplemented with polydextrose (PDX) and/or galactooligosaccharides (GOS): double-blind, randomized, controlled trial

BackgroundTo ensure the suitability of an infant formula as the sole source of nutrition or provide benefits similar to outcomes in breastfed infants, advancements in formula composition are warranted as more research detailing the nutrient composition of human milk becomes available. This study was designed to evaluate growth and tolerance in healthy infants who received one of two investigational cow’s milk-based formulas with adjustments in carbohydrate, fat, and calcium content and supplemented with a prebiotic blend of polydextrose (PDX) and galactooligosaccharides (GOS) or GOS alone.MethodsIn this multi-center, double-blind, parallel-designed, gender-stratified prospective study 419 infants were randomized and consumed either a marketed routine cow’s milk-based infant formula (Control; Enfamil® LIPIL®, Mead Johnson Nutrition, Evansville, IN) (n = 142) or one of two investigational formulas from 14 to 120 days of age. Investigational formulas were supplemented with 4 g/L (1:1 ratio) of a prebiotic blend of PDX and GOS (PDX/GOS; n = 139) or 4 g/L of GOS alone (GOS; n = 138). Anthropometric measurements were taken at 14, 30, 60, 90, and 120 days of age. Daily recall of formula intake, tolerance, and stool characteristics was collected during study weeks 1 and 2 and 24-h recall was collected at 60, 90, and 120 days of age. Medically-confirmed adverse events were recorded throughout the study.ResultsThere were no group differences in growth rate from 14 to 120 days of age. Discontinuation rates were not significantly different among study groups. No differences in formula intake or infant fussiness or gassiness were observed. During study weeks 1 and 2 and at 60 days of age stool consistency ratings were higher (i.e. softer stools) for infants in the PDX/GOS and GOS groups versus Control and remained higher at 120 days for the PDX/GOS group (all P < 0.05). The overall incidence of medically-confirmed adverse events was similar among groups.ConclusionsInvestigational routine infant formulas supplemented with 4 g/L of either a prebiotic blend of PDX and GOS or GOS alone were well-tolerated and supported normal growth. Compared to infants who received the unsupplemented control formula, infants who received prebiotic supplementation experienced a softer stooling pattern similar to that reported in breastfed infants.Trial registrationClinicalTrials.gov Identifier: NCT00712608

Relationship between maternal diet, plasma lipids and human milk cholesterol and fatty acids

Human milk cholesterol and fatty acids (FA) are important for infant development. Few studies have examined the relationship between maternal diet or plasma lipids on human milk composition. From 120 longitudinally‐studied breastfeeding mother‐infant pairs, mothers with the 15 highest (HC) and 15 lowest (LC) dietary cholesterol were analyzed. Maternal diet (4–13 weeks postpartum) was assessed, and plasma and milk were collected at 4 weeks postpartum. Demographics and anthropometrics were similar between LC and HC, but HC had higher intake of kcal and macronutrients, except carbohydrate. Plasma and milk total cholesterol did not differ by group. LC had lower milk palmitic acid (median 19.1 %wt/wt vs. 21.1, p=0.03), higher milk linoleic acid (20.5 vs 17.9, p=0.003) and marginally higher plasma linoleic acid (42.8 vs 40.4, p=0.06). In HC, milk oleic and stearic acids were correlated with kcal (Spearman rho=0.45 and 0.43, respectively). In LC, plasma and milk FAs were significantly correlated with each other. These data suggest that milk FA, but not total cholesterol, may be partially influenced by maternal diet and plasma FA. This work was funded by the CCHMC CTRC and Mead Johnson Nutrition, Inc.

Bovine lactoferrin and its effects on innate immune cells in a complex milk matrix

Human milk proteins provide a source of nutrition for the newborn infant but also are associated with biological functions. Lactoferrin is one of the major human milk proteins and has modulating effects on the immune system. This project determined the biological activity of bovine lactoferrin (bLF) on innate immune cells in the presence and absence of a liquid cow's milk based matrix (milk matrix) in vitro and in young mice. The expression of the costimulatory molecule CD80 on macrophages was significantly upregulated in vitro by human milk and the milk matrix. The greater expression by the milk matrix was reduced to the CD80 levels of human milk through the addition of bLF. The expression of CD80, CD86, and MHC class II on bone marrow‐derived dendritic cells (BMDCs) was upregulated by bLF and the milk matrix but not by human milk. Following oral administration of bLF to mice the respiratory burst capacity of neutrophils was determined. While the milk matrix had no effect, the levels were significantly decreased by human milk and bLF in the presence and absence of the milk matrix. Serum cytokine IL‐6 and IL‐12p40 levels were significantly reduced by the addition of bLF to the milk matrix. These studies demonstrate a biological role of bLF in a complex milk matrix in modulating the response of innate immune cells in in vitro and in vivo experiments.Research Support: provided by Mead Johnson Nutrition

The total amino acid profile of human milk is stable over the first three months of lactation

The amount and composition of human milk protein is thought to be critical in the development of breastfed infants. While the amino acid profile of human milk has been previously reported, there have been methodological advances which may result in more accurate amino acid determinations, and we are interested in the variability of the protein level and amino acid profile between mothers and over the course of lactation in rigorously collected samples. Here we report total nitrogen, as assessed by the Dumas method, as well as the protein associated amino acid profile over the course of the first three months of lactation (5 time points) in a cohort of 10 mothers in the US. Total nitrogen decreased by about half over the first three months of lactation (p&lt;0.001) and exhibited inter‐individual variation early on, while the amino acid profile, expressed as each amino acid in proportion to the total amino acids, remained remarkably consistent both between mothers as well as over time. Supported by Mead Johnson Nutrition and NIH HD 13021.

Active transcription factors in the development of the small intestine during early life

Transcription factors (TFs) regulate downstream gene expression individually or cooperatively in different cell types and specific tissues. Human milk contains several growth factors that maintain gastrointestinal mucosal homeostasis. We chose two major growth factors in human milk, TGF‐β and IGF‐1 to study global activation of TFs during early intestinal development in IEC‐6 (crypt cell) and FH74 cells (fetal intestine). TGF‐β treatment (10 ng/ml) for 5d significantly induced differentiation (expression of alkaline phosphatase) of IEC‐6 and lead to an abundance of cytoplasm and clear cell boundaries. Optimum proliferation of FHs 74 was found at 30 ng/ml IGF‐1 treatment for 24h (no significant change in morphology). Active transcription factors were detected by Protein‐DNA Array. For IEC‐6 cells, we found EGR1 and YY1 were upregulated; CREB, E2F1, Pax3 and OCT1 were downregulated. By bioinformatics analysis, we found 3 binding sites for EGR1 in the promoter of mir‐146b (−795/−786, −900/−812, −1013/−1005), which has been shown to be upregulated and play a role in TGF‐β signaling. In FHs 74 cells, c‐Myb was upregulated, whereas CREB, EGR1, P53 and Pax3 were downregulated. In conclusion, we showed several transcription factors are regulated by TGF‐β and IGF‐1 during small intestinal development. EGR1 was further found to participate in miRNA regulation of the TGF‐β treatment.Grant Funding Source : Mead Johnson Nutrition Global Discovery

Proteomic characterization of human milk whey proteins during a twelve‐month lactation period

Human milk is a rich source of bioactive proteins that support early growth and development of the newborn. Although the major components of the protein fraction have been studied, the minor components have received limited attention. We examined the expression of low-abundance proteins in the whey fraction of human milk and their dynamic changes over a twelve-month lactation period. The low-abundance proteins were enriched by ProteoMiner beads, and protein identification was performed by liquid chromatography tandem mass spectrometry using a Paradigm MG4 HPLC system coupled with a Thermo LTQ ion trap spectrometer. X! Tandem software was set up to search the Uniprot human complete proteome set data base and Scaffold (Proteome Software) was used to validate MS/MS based peptide and protein identifications. One hundred and fifteen proteins were identified, thirty-eight of which have not been previously reported in human colostrum or milk. Eight functional groups were found: 35% of all proteins are involved in immune function, 17% in cell communication/signal transduction, 16% in metabolism/energy production pathways, 8% in protein metabolism (including translation, folding, trafficking, etc), 5% in cell growth and/or maintenance, 3% in nucleic acid metabolism and 3 % are multifunctional proteins. We also for the first time describe differences in protein patterns among the low-abundance proteins during lactation. These results enhance our knowledge about the complexity of the human milk proteome and provide suggestions for their physiological significance in the mammary gland and in the breast-fed infant. (Supported by Mead Johnson Nutrition)

Preterm piglet model for investigation of preterm human neonatal co‐morbidities

Piglets have anatomy and physiology similar to humans, but published reports state that piglets less than 90% gestation are non‐viable even with intensive care. The objective was to provide proof of principle that a piglet in the Piglet Neonatal Intensive Care Unit (PNICU) less than 90% gestation can be viable and exhibit co‐morbidities frequently observed in preterm neonates in the Neonatal Intensive Care Unit (NICU). A piglet was delivered by caesarian section at 87% gestation, admitted to the PNICU, surgically implanted with an endotracheal cannula and a double lumen jugular vein catheter, and provided 24 hour NICU level of care including ventilation and parenteral nutrition. The piglet received periodic hyperoxia treatments during the course of PNICU care. On day 9 tissues and bodily fluids were collected. The piglet became ventilator dependent and had several episodes of oxygen desaturation and elevated heart rate accompanied by unusual rhythmical movements of the head, eyes and legs. Gross morphology of lungs was consistent with pulmonary damage associated with prematurity. Visual examination revealed some areas of the jejunum had luminal blood present. The retina was classified as immature by retinal exam performed by an ophthalmologist using NICU methods. A piglet less than 90% gestation can be used to investigate the co‐morbidities of preterm human neonates.Supported by Mead Johnson Nutrition Company

The Clinician-Educator's Handbook

OPEN ACCESSSeptember 17, 2010The Clinician-Educator's Handbook Teri Turner, MD, MPH, MEd, Debra Palazzi, MD, Mark Ward, MD, Martin Lorin, MD Teri Turner, MD, MPH, MEd Baylor College of Medicine Google Scholar More articles by this author , Debra Palazzi, MD Baylor College of Medicine Google Scholar More articles by this author , Mark Ward, MD Baylor College of Medicine Google Scholar More articles by this author , Martin Lorin, MD Baylor College of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.7749 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: The Clinician-Educator's Handbook addresses a wide variety of issues in clinical education and looks at many different settings in which clinical teaching takes place. The ultimate goal of clinical teaching is to improve patient care, and this handbook is designed to help the clinician-educator do the best possible job of teaching. Culling the literature on educational psychology and medical education, and drawing from their own observations and experiences, as well as those of many renowned clinician-teachers whom they observed and interviewed, the authors have created a physician-friendly work, written in the language of the clinician rather than of the educational theorist. Methods: This resource contains a 20 chapter book on how to conduct clinical teaching. Chapters are arranged by topics ranging from designing the educational experience to bedside teaching to leading a case discussion. An instruction guide explaining how to best use the resource is also provided. Results: Numerous personal communications have been received by the authors describing the usefulness to clinician-educators. The website has received over 1600 hits over a 9-month period. Discussion: The Clinician-Educator's Handbook addresses a wide variety of issues of clinical education and looks at many different settings in which clinical teaching takes place The authors acknowledge that they have neither the experience nor the expertise to address issues involved in teaching surgical skills or in teaching in certain environments such as the operating room or the intensive care unit, so these areas are not covered in this book. While the authors are pediatricians, they believe that this book will be of interest to all physicians who wish to improve their teaching skills and hope that all readers will find this book enlightening, challenging, and useful. Educational Objectives By reviewing this book, learners will be able to: Identify educational strategies to enhance teaching effectiveness in the clinical setting.Employ and adapt teaching methods to fit the needs of individual learners.Discuss lessons learned with teachers across the educational continuum. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.doc Clinician Educators Handbook.pdf weburl.txt To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2010 Turner et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsClinician-Educator Disclosures None to report. Funding/Support Preparation and distribution of this handbook have been funded, in part, by an unrestricted educational grant from Mead Johnson Nutritionals. Prior Presentations None to report. Loading ...

Polydextrose enrichment of infant formula acts as a prebiotic by increasing ileal lactobacilli and lactic acid concentration and decreasing pH

Oligosaccharides, the 3rd largest component in human milk, are virtually absent from cow's milk and most infant formula. Polydextrose (PDX) is a proposed substitute for human milk oligosaccharides. One‐day old pigs were fed a cow‐milk‐based formula supplemented with PDX (0, 1.7, 4.3, 8.5 or 17 g/L) for 18 days (n=13). Additional reference groups included 12 pigs sampled at day 0 and 12 sow‐reared pigs sampled at day 18. Ileal lactobacillus CFU, but not bifidobacteria, increased linearly with increasing PDX (P = 0.02). Short chain fatty acids did not differ among treatments, but lactic acid increased linearly with PDX (P = 0.001). Lactic acid increased ten‐fold over control pigs in those supplemented with 8.5 and 17 g/L PDX. Accordingly, digesta pH decreased linearly (P &lt; 0.05) as PDX increased, with a maximal reduction approaching 0.5 pH units in those fed 17 g/L. Ileal villus height, crypt depth, maltase, myeloperoxidase and the number of intraepithelial lymphocytes were not affected by dietary PDX (P &gt; 0.1). Polydextrose enrichment of infant formula acted as a prebiotic by increasing lactic acid production and decreasing pH. Research supported by Mead Johnson Nutrition.Grant Funding Source: Mead Johnson Nutrition

Maternal α‐linolenic acid supplementation during gestation and lactation alters postnatal brain development in the offspring

Perinatal nutrition influences postnatal brain development, with long‐lasting effects on learning, memory and brain aging. ω‐3 fatty acids are essential for normal brain development. This study established that maternal perinatal α‐linolenic acid (ALA) availability modulates postnatal hippocampal development.C57BL/6 female mice were fed either an ALA control (C, 2 groups) or an ALA deficit diet (D, 2 groups) for 30 days prior to, and during gestation. One day prior to delivery and during the lactation period (20 days), mice from one C group and one D group were switched on an ALA supplemented diet (CS and DS, respectively). The remaining two groups continued on their initial diet until postnatal day 20 (P20, CC and DD, respectively). At P20, mothers and pups were sacrificed. Within the dentate gyrus of male pups (DG), mitosis and early neuronal differentiation were increased in the CS group, while apoptosis was increased in the DD group. Fatty acid (FA) profiling in the maternal livers and serum, and in the pups’ brains revealed changes of several ω‐3, −6, −9, and saturated FAs.Perinatal ALA availability contributes to the postnatal development of the DG by altering the proliferation and early neuronal differentiation of neural precursors. Changes within FAs are induced by maternal ALA availability.Funded by a grant to MN from the UNC Center for Excellence in Children's Nutrition sponsored by Mead Johnson Nutrition.

High Fat Diet Feeding Impairs Lactogenesis and Butyrophilin Expression in the Mammary Gland of Mice

Overfeeding and obesity negatively impacts milk production in animals, but the underlying mechanisms are unknown. To address this, female C57BL/6J mice were assigned at weaning to a low‐fat control diet (LF, 7% by wt), or a high‐fat diet (HF, 35% by wt) for 8 wks then mated. Dams were killed on pregnancy day 14 (P14) or lactation day 1 (L1) and blood, gonadal fat pads and mammary glands were harvested. HF dams had 2–3 fold heavier mammary glands and fat pads as compared to LF dams. HF dams had 2–4 fold higher serum leptin and 25–35% lower serum adiponectin as compared to LF dams. Mammary whole mounts showed less ductal branching and alveolar buds in HF as compared to LF dams. Epithelial content digitally quantified from stained mammary sections confirmed significantly (~50%) less mammary development in HF. LF and HF litter sizes were similar, but the number of viable pups was lower in HF, and those that lived had little to no milk present in the stomach. Cross‐fostering HF litters onto LF dams rescued pups whereas the reverse was not true. Protein expression of adipophilin and butyrophilin increased in LF mammary gland between P14 and L1, while protein expression of perilipin did not. At L1, butyrophilin expression in HF mammary gland was reduced by at least 50% as compared to LF while adipophilin and perilipin expression remained stable. The results suggest that high fat diets hinder lactogenesis by inhibiting mammary gland development and expression of butyrophilin, a protein important for the onset of milk fat globule secretion. Funded by Mead Johnson Nutrition.

MiR‐103 modulates G1/S transition in IGF‐1 stimulated mouse intestinal crypt cell proliferation

microRNAs play extensive roles in cellular development. Analysis of the microRNA expression pattern during intestinal cell proliferation in early life is likely to unravel molecular mechanisms behind intestinal development and have implications for therapeutic intervention. In this study, we examined differences in microRNA expression and identified miR‐103 as a regulator in IGF‐1 stimulated proliferation of mouse intestinal crypt cells. Mouse intestinal crypt cells were cultured and treated with IGF‐1 for 24 h, microRNA microarrays showed that multiple microRNAs are regulated by IGF‐1, and miR‐103 was the most sharply down‐regulated among these microRNAs. Expression of miR‐103 in mouse intestinal crypt cells was confirmed by real‐time Q‐PCR. Sequence analyses showed that, among the 1040 predicted miR‐103 target genes, CCNE1, CREB1, IGFBP1, and CDKL2 contain complementary sequences to the miR‐103 seed region and are conserved between human and mouse. We further demonstrated that miR‐103 directly controls the expression level of the four genes by luciferase assay and immunoblotting assay, respectively. Taken together, our data suggest that in mouse crypt cells, miR‐103 is part of the G1/S transition regulation network, which targets CCNE1, CREB1, and CDKL2 during IGF‐1 stimulated proliferation. (Supported by Mead Johnson Nutrition)

A bifidogenic effect is observed in young infants fed infant formula supplemented with galactooligosaccharide (GOS) and polydextrose (PDX)

BackgroundPrebiotics contribute to healthy gut and immune development in infants by promoting beneficial gut microbiota rich in Bifidobacterium, predominantly B. longum, B. infantis and B. breve.ObjectiveTo assess the impact of a GOS/PDX‐supplemented infant formula on fecal microbiota.MethodsIn this double‐blind study, 21 to 30‐day old healthy term, vaginally delivered infants were randomized to receive Control (Enfamil Lipil®, Mead Johnson Nutrition, CTRL) or Control + GOS/PDX (4 g/L, 1:1 ratio, GP) for 60 d; there was a breastfed (BF) reference group. Stool samples were obtained at baseline and after 30 and 60 d of feeding. Microbiota by fluorescent in situ hybridization (FISH) and quantitative polymerase chain reaction (qPCR) was analyzed by Wilcoxon rank‐sum test.Results230 of 289 infants completed the study (CTRL=81, GP=78, BF=71). Total bifidobacteria by FISH at 30 d was similar among groups and at 60 d lower in CTRL and GP vs. BF (P≤0.049), with it tending to be higher in GP vs. CTRL (P=0.084). By qPCR, bacterial counts at 30 d tended to be higher in GP vs. CTRL for total bifidobacteria (P=0.069) and B. longum (P=0.057); GP was higher vs. CTRL for B. infantis at 30 d and for total bifidobacteria and B. longum at 60 d (P=0.002); at 60 d CTRL, but not GP, was lower than BF for total bifidobacteria and B. longum (P≤0.009) [Table]. Mean ranks of qPCR absolute counts of total bifidobacteria, B. longum, and B infantis at 60 days of feeding.+ Total bifidobacteria B. longum B. infantis BF 119 113 106 CTRL 81ab 83ab 95 GP 109 111 104 Wilcoxon rank‐sum test CTRL &lt; BF, P≤0.009 GP &gt; CTRL, P=0.002 ConclusionGOS/PDX added to infant formula has a bifidogenic effect in young infants.

PHARMA BUSINESS BMS is splitting off nutrition company to focus on biopharmaceuticals

Bucking an industry trend toward diversification, Bristol-Myers Squibb is splitting off its Mead Johnson Nutrition business as an independent company so it can focus on its own biopharmaceutical operations. After holding an initial public offering (IPO) of Mead stock in February, Bristol-Myers is looking to liquidate its ownership stake entirely. “Now is the right time to move forward with a split-off, given the excellent performance of Mead Johnson since the IPO earlier this year and our confidence in the current and future performance of our biopharmaceuticals business,” Bristol-Myers CEO James M. Cornelius said when he announced the plan last week. “With a successful execution of this split-off, we fully consider ourselves a biopharma company.” Bristol-Myers owns 170 million shares, or 83%, of the infant-formula maker. It is giving its shareholders the opportunity to exchange some, none, or all of their Bristol-Myers shares for shares of Mead. Along with disposing of the Mead stock, the ...

The addition of polydextrose and galactooligossacharide to formula does not affect barrier function or bacterial translocation in neonatal piglets

The microbiota of breastfed and formula‐fed infants differ, largely due to the prebiotic activity of oligosaccharides in human milk. While there is interest in supplementing infant formulas with prebiotics, some studies suggest that prebiotics may increase bacterial translocation (BT). Thus, the objective of this study was to determine the impact of polydextrose (PDX) and galactooligossacharide (GOS), on intestinal BT in neonatal piglets. Colostrum‐deprived piglets (n=36) were randomized to receive total enteral nutrition as formula (TEN); TEN+GOS (4 g/L), TEN+PDX (4 g/L) or TEN+GOS+PDX (2 g/L each) for 7 days. An additional group of piglets (n=8) was placed on total parenteral nutrition (TPN) as a positive control. Blood, spleen, liver and mesenteric lymph nodes were cultured for aerobic (MacConkey and Trypic Soy + 5% sheep blood) and anaerobic (Wilkins‐Chalgren, Bacteroides Bile Esculin and Lactobacillus Agars) bacteria. Bacterial culturing demonstrated significant BT of Enterobacteriaceae, fastidious anaerobes and fastidious aerobes in TPN piglets. In contrast, BT was insignificant in TEN regardless of the presence of prebiotics. Ileal and colonic villus height and width were not affected by prebiotic supplementation (p&lt;0.05), but were affected by TPN. Our study shows that the addition of PDX and GOS to infant formula does not adversely impact BT. (Supported by Mead Johnson Nutritionals)

Infant Acceptance of a Bitter-Tasting Liquid Medication: A Randomized Controlled Trial Comparing the Rx Medibottle With an Oral Syringe

The calibrated oral syringe is considered the standard system for administering liquid formulations of medications to infants. Medication acceptance using the syringe may not always be favorable, particularly with unpleasant-tasting liquids. The Rx Medibottle (The Medicine Bottle Co, Hinsdale, Illinois), an alternate drug-delivery device, is an infant-feeding bottle that contains a central sleeve within its body into which a syringe is inserted. Depressing the syringe's plunger in quick, short squirts synchronized with an infant's sucking allows drug ingestion, preventing dilution of the drug in the formula within the bottle's nipple. The Rx Medibottle costs $14.95 retail. Kraus et al demonstrated that it was more efficacious, with a higher level of infant acceptance compared with the syringe, when used to administer a 1-time dose of a pleasant-tasting liquid (acetaminophen, Tempra Syrup; Mead Johnson Nutritionals, Evansville, Indiana). Our study tests the efficacy of this bottle in administering a single dose of generic prednisolone liquid, a bitter-tasting drug, with an oral syringe serving as the control method of delivery.

Case 1: Progressive vomiting in a three-week-old infant

A 20-day-old female infant was transferred from a peripheral hospital with progressive vomiting and weight loss. The infant was born to a 31-year-old primiparous mother at 37 weeks’ gestation by spontaneous vaginal delivery. The pregnancy was uncomplicated, apart from a positive screen for group B streptococcus, which was adequately treated during labour. The infant’s birth weight was approximately 3 kg. Vomiting began at seven days of age, when nystatin was started for treatment of oral thrush. The vomiting progressively became more frequent and projectile in nature. By the time of admission, at three weeks of age, the infant had projectile nonbilious vomiting that occurred 1 h to 2 h after every attempted feeding. She appeared hungry immediately after vomiting. The infant had been offered two different formulas (Enfamil [Mead Johnson Nutritionals, Ottawa, Ontario] and Goodstart [Nestle Canada]), and minimal expressed breastmilk by bottle since birth. The formula changes did not result in symptomatic improvement. She was offered approximately 60 mL of feed every 2 h to 3 h. Her bowel movements were normal, apart from a few loose, nonbloody stools on the day of admission. Her parents reported that there had been four to five wet diapers per day before admission. The infant was otherwise healthy, with no fever, rash or systemic symptoms. Both parents were healthy and of Italian descent. Family history was not contributory. The infant’s admission weight was 2180 g (25% less than her birth weight), with the clinical appearance of significant dehydration and malnutrition (little subcutaneous fat and muscle wasting). She was afebrile, with stable vital signs for her age, including a pulse rate of 120 beats/min after initial fluid resuscitation of 20 mL/kg of 0.9% saline followed by isotonic fluid at a maintenance rate. Her abdomen was soft, scaphoid and nontender, with no organomegaly. There were no palpable masses, including no palpable ‘olive’ when the baby was quiet. The remainder of the examination was normal, apart from slight oral thrush. Initial laboratory investigations revealed severe metabolic alkalosis with venous pH 7.64, PCO2 50 mmHg, bicarbonate 54 mmol/L and base excess +26 mmol/L. Electrolytes were abnormal with serum sodium 119 mmol/L, potassium 4.7 mmol/L, chloride lower than 50 mmol/L and glucose 10.9 mmol/L. Both urea and creatinine concentrations were significantly elevated (blood urea nitrogen 22.7 mmol/L and creatinine 261 μmol/L). The infant’s complete blood count was normal, apart from thrombocytosis (767×109/L). Her urine pH was greater than 9.0 and specific gravity was 1.010 g/L; she had normal microscopy, except for 2+ protein. Her abdominal ultrasound revealed stomach contents passing through a nonhypertrophied pylorus that was seen to open and close normally. The infant’s abdominal radiograph showed a small amount of gas in a single, mildly prominent structure in the mid-abdomen and a paucity of bowel gas in the remainder of the abdomen. An additional investigation revealed the diagnosis.

European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases Evidence‐Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe: Executive Summary

European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases Evidence‐Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe: Executive Summary

European Society for Paediatric Infectious Diseases/European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Evidence‐Based Recommendations for Rotavirus Vaccination in Europe: Executive Summary

European Society for Paediatric Infectious Diseases/European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Evidence‐Based Recommendations for Rotavirus Vaccination in Europe: Executive Summary