Volume Of Milk Intake Research Articles

Comparing the effects of 5-minute premature infant oral motor intervention with 15-minute Fucile treatment in term infants with feeding difficulties: A multi-arm randomised clinical trial

Purpose The aim of the present study was to investigate whether term infants with feeding difficulties who received either a 5-minute premature infant oral motor intervention (PIOMI) or a 15-minute Fucile treatment had different outcomes, compared to term infants in a nontreatment group. Method Stable term infants (N = 51) born between 37–41 weeks of gestational age with feeding difficulties were randomly assigned into one of two intervention groups and a control group. One intervention group received PIOMI and the other group received Fucile treatment once a day for seven consecutive days; the control group received usual care only. The volume of milk intake, the amount of weight gain, and the length of hospital stay were compared across all groups. Result Findings indicated that the volume of milk intake and weight gain showed significant improvement in all three groups. However, pairwise comparison revealed that infants in the Fucile group had significantly higher volume of milk intake and weight gain compared to infants in both the control and PIOMI groups. Length of hospital stay was not significantly different amongst all groups. Conclusion The effects of Fucile treatment were more considerable than for usual care or PIOMI. This finding raises the possibility that prolonged exercise may facilitate improvement in feeding skills for term infants with feeding difficulties.

Maternal Ezetimibe Concentrations Measured in Breast Milk and Its Use in Breastfeeding Infant Exposure Predictions.

Lactating mothers taking ezetimibe, an antihyperlipidemic agent, may be hesitant to breastfeed despite the known benefit of breastfeeding to both mother and infant. Currently, no data exist on the presence or concentration of ezetimibe and its main active metabolite, ezetimibe-glucuronide (EZE-glucuronide), in human breast milk. Voluntary breast milk samples containing ezetimibe and EZE-glucuronide were attained from lactating mothers taking ezetimibe as part of their treatment. An assay was developed and validated to measure ezetimibe and EZE-glucuronide concentrations in breast milk. A workflow that utilized a developed and evaluated pediatric physiologically based pharmacokinetic (PBPK) model, the measured concentrations in milk, and weight-normalized breast milk intake volumes was applied to predict infant exposures and determine the upper area under the curve ratio (UAR). Fifteen breast milk samples from two maternal-infant pairs were collected. The developed liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay showed an analytical range of 0.039-5.0 ng/mL and 0.39-50.0 ng/mL for ezetimibe and EZE-glucuronide, respectively. The measured concentrations in the breast milk samples were 0.17-1.02 ng/mL and 0.42-2.65 ng/mL of ezetimibe and EZE-glucuronide, respectively. The evaluated pediatric PBPK model demonstrated minimal exposure overlap in adult therapeutic dose and breastfed infant simulated area under the concentration-time curve from time zero to 24h (AUC24). Calculated UAR across infant age groups ranged from 0.0015 to 0.0026. PBPK model-predicted ezetimibe and EZE-glucuronide exposures and UAR suggest that breastfeeding infants would receive non-therapeutic exposures. Future work should involve a 'mother-infant pair study' to ascertain breastfed infant plasma ezetimibe and EZE-glucuronide concentrations to confirm the findings of this work.

Effect of breast milk intake volume on early behavioral neurodevelopment of extremely preterm infants

BackgroundThis study aimed to explore the effects of breast milk feeding volume on the early behavioral neurodevelopment of extremely preterm infants (gestational age < 28 weeks).MethodsThe study was conducted from 1 January 2021 to 31 March 2023. A total of 187 preterm infants from a neonatal intensive care unit (NICU) in a Grade III Class A hospital in Zhejiang, China, were divided based on the proportion of breast milk in their total enteral nutrition: high proportion (≥ 80%, including exclusive breast milk feeding), medium proportion (20% ~ < 80%), and low proportion (< 20%). The study investigated motor performance and behavioral neurodevelopment at 37 weeks of corrected gestational age, as well as the total incidence of intracranial hemorrhage within the first four weeks postpartum.ResultsThe low breast milk feeding group had significantly lower scores in infant motor performance (31.34 ± 5.85) and elicited item scores (19.89 ± 5.55) compared to the medium and high groups (33.52 ± 4.33, 22.13 ± 4.22; and 35.86 ± 5.27, 23.91 ± 4.98), p < 0.05, respectively. Despite no significant difference in behavioral ability, the low proportion group exhibited lower passive muscle tension and primitive reflex scores than the medium and high proportion groups. The high proportion group showed higher active muscle tension scores. Ultrasound results revealed varying incidences of intracranial hemorrhage: 72.9% in low, 52.5% in medium, and 19.6% in the high proportion groups.ConclusionsMedium to high levels of breast milk feeding contribute positively to motor and behavioral neurological development in extremely preterm infants and decrease the likelihood of ventricular hemorrhage. However, it does not have a significant effect on the development of behavioral abilities. Due to the limited sample size, the next step will be to expand the sample size and further investigate the extent of the impact on various aspects of the nervous system.

Butyrate in Human Milk: Associations with Milk Microbiota, Milk Intake Volume, and Infant Growth.

Butyrate in human milk (HM) has been suggested to reduce excessive weight and adipo-sity gains during infancy. However, HM butyrate's origins, determinants, and its influencing mechanism on weight gain are not completely understood. These were studied in the prospective longitudinal Cambridge Baby Growth and Breastfeeding Study (CBGS-BF), in which infants (n = 59) were exclusively breastfed for at least 6 weeks. Infant growth (birth, 2 weeks, 6 weeks, 3 months, 6 months, and 12 months) and HM butyrate concentrations (2 weeks, 6 weeks, 3 months, and 6 months) were measured. At age 6 weeks, HM intake volume was measured by deuterium-labelled water technique and HM microbiota by 16S sequencing. Cross-sectionally at 6 weeks, HM butyrate was associated with HM microbiota composition (p = 0.036) although no association with the abundance of typical butyrate producers was detected. In longitudinal analyses across all time points, HM butyrate concentrations were overall negatively associated with infant weight and adiposity, and associations were stronger at younger infant ages. HM butyrate concentration was also inversely correlated with HM intake volume, supporting a possible mechanism whereby butyrate might reduce infant growth via appetite regulation and modulation of HM intake.

Associations between breast milk intake volume, macronutrient intake and infant growth in a longitudinal birth cohort: the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF).

Growth patterns of breastfed infants show substantial inter-individual differences, partly influenced by breast milk (BM) nutritional composition. However, BM nutritional composition does not accurately indicate BM nutrient intakes. This study aimed to examine the associations between both BM intake volumes and macronutrient intakes with infant growth. Mother-infant dyads (n 94) were recruited into the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF) from a single maternity hospital at birth; all infants received exclusive breast-feeding (EBF) for at least 6 weeks. Infant weight, length and skinfolds thicknesses (adiposity) were repeatedly measured from birth to 12 months. Post-feed BM samples were collected at 6 weeks to measure TAG (fat), lactose (carbohydrate) (both by 1H-NMR) and protein concentrations (Dumas method). BM intake volume was estimated from seventy infants between 4 and 6 weeks using dose-to-the-mother deuterium oxide (2H2O) turnover. In the full cohort and among sixty infants who received EBF for 3+ months, higher BM intake at 6 weeks was associated with initial faster growth between 0 and 6 weeks (β + se 3·58 + 0·47 for weight and 4·53 + 0·6 for adiposity gains, both P < 0·0001) but subsequent slower growth between 3 and 12 months (β + se - 2·27 + 0·7 for weight and -2·65 + 0·69 for adiposity gains, both P < 0·005). BM carbohydrate and protein intakes at 4-6 weeks were positively associated with early (0-6 weeks) but tended to be negatively related with later (3-12 months) adiposity gains, while BM fat intake showed no association, suggesting that carbohydrate and protein intakes may have more functional relevance to later infant growth and adiposity.

Infants With Different Weight for Age Percentiles May Benefit From Stratified Daily Formula Milk Intake Recommendations

ObjectivesCurrently available guidelines on the daily formula milk requirements of infants, including those from the Institute of Medicine (IOM) and FAO/WHO/UNU, are based on the needs of infants with median body weight and the fact that their growth pattern follows the 50th percentile of the weight-for-age growth curve. Hence, current recommendations might not be sufficiently detailed to meet the needs of infants across the broad spectrum of body weight percentiles. This study aimed to provide stratified recommendations for daily formula milk intake of fully formula-fed infants across different weight-age categories from 0 to 4 months.MethodsAt first, theoretical age- and gender- specific weight ranges were constructed for infants across five predefined weight-for-length percentile categories of the WHO growth standard: small (10th percentile), medium-small (15th to 25th percentiles), medium (50th percentile), medium-large (75th to 85th percentiles), and large (90th percentile) infants. Thereafter, total daily energy requirements for each category were calculated using IOM equation and converted to daily formula milk needs. Subsequently, these stratified age- and weight- formula milk recommendations were compared to actual daily and relative formula milk of infants in these categories retrieved from pooled individual infant formula milk intake (6.174 data points, from 13 clinical intervention studies).ResultsQualitative comparison between theoretical calculation and actual formula milk intakes were both following the same trend with the median daily formula milk volume intake of infants increasing across increasing weight-for-age categories at each timepoint, with larger variations observed in “real life” data compared to theoretical recommendations. Interestingly, the relative daily formula milk volume intake (ml/kg/day) was relatively stable over time but was relatively higher in smaller infants compared to larger infants.ConclusionsQualitative evaluation of both theoretical calculations as well as real-life daily formula intake data showed that one fixed value as formula milk volume intake recommendation may not be optimal for the nutritional needs of infants growing at different percentiles of weight for age.Funding SourcesDanone Nutricia Research.

Detailed knowledge of maternal and infant factors and human milk composition could inform recommendations for optimal composition.

Breastfeeding is best for infants, but quantitative associations between specific milk components and infant biomarkers remain unclear. Methodological limitations include missing milk volume intake, variable milk composition and that standardised, fasted state blood sampling is impossible in infants. Milk protein and fat content appear marginally related to infant serum amino acid and phospholipid concentrations, with some association between milk fatty acid composition and lipid species levels. CONCLUSION: Detailed simultaneous examinations of maternal factors, milk composition and infant biomarkers or outcomes could identify the mechanistic basis of human milk effects and help develop dietary recommendations for optimal human milk composition.

The effect of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in premature infants: A single-blind randomized-clinical trial.

Feeding problems are common in premature infants (PIs) and may lead to negative consequences such as malnutrition, dehydration, excessive weight loss, as well as developmental and psychological deficits. Moreover, they are associated with increased length of hospital stay/cost. There is not enough evidence on how feeding problems should be treated in PIs. The goal of this study was to investigate the effects of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in PIs. A single-blind randomized clinical trial was performed on 44 PIs with feeding problems. Patients were randomly categorized into two groups: (1) combined intervention (CI) and (2) non-nutritive sucking (NNS). The CI group received NNS, oral motor stimulation and oral support simultaneously. Infants in both groups received 14 treatment sessions for 14 consecutive days. The Preterm Oral Feeding Readiness Assessment Scale (POFRAS) was used as the primary outcome measure. Weight, volume of milk intake, time to achieve full oral feeding, and length of hospital stay were secondary outcome measures. All measures were assessed before treatment, after the 7th session, after the 14th session, and after 7 days after the end of treatment. Both groups improved in all outcome measures across time (P < 0.001). The improvements in the POFRAS, volume of milk intake, and time to achieve full oral feeding were significantly greater in the CI group than the NNS group (P < 0.001). The improvements attained in weight and length of hospital stay were not significantly different between the CI and NNS groups (P > 0.05). Large effect sizes were found for POFRAS score in both CI (d = 3.98) and NNS (d = 2.19) groups. The current study showed that the combined intervention including NNS, oral motor stimulation, and oral support significantly improved the feeding performance in PIs.

Extensive Study of Breast Milk and Infant Growth: Protocol of the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF)

Growth and nutrition during early life have been strongly linked to future health and metabolic risks. The Cambridge Baby Growth Study (CBGS), a longitudinal birth cohort of 2229 mother–infant pairs, was set up in 2001 to investigate early life determinant factors of infant growth and body composition in the UK setting. To carry out extensive profiling of breastmilk intakes and composition in relation to infancy growth, the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF) was established upon the original CBGS. The strict inclusion criteria were applied, focusing on a normal birth weight vaginally delivered infant cohort born of healthy and non-obese mothers. Crucially, only infants who were exclusively breastfed for the first 6 weeks of life were retained in the analysed study sample. At each visit from birth, 2 weeks, 6 weeks, and then at 3, 6, 12, 24, and 36 months, longitudinal anthropometric measurements and blood spot collections were conducted. Infant body composition was assessed using air displacement plethysmography (ADP) at 6 weeks and 3 months of age. Breast milk was collected for macronutrients and human milk oligosaccharides (HMO) measurements. Breast milk intake volume was also estimated, as well as sterile breastmilk and infant stool collection for microbiome study.

Associations between the infant and young child feeding index and nutritional status.

The infant and child feeding index (ICFI) is a single summary World Health Organization influenced index to assess feeding quality in infants and young children aged 6-36months. This study aimed to demonstrate any associations between ICFI and nutritional status in a single Thai center. The demographic data and feeding practices of healthy infants and children aged 6-36months were collected from questionnaires given to 304 parents/caregivers; anthropometric measurements were taken. Associations between ICFI and weight-for-age Z scores (WAZ), length/height for age Z scores (LAZ/HAZ), weight-for-length/height Z scores (WLZ/WHZ), and body mass index-for-age Z scores (BAZ) were examined. The mean ICFI was 6.14 ± 1.63 and was lowest in the 6-8months age group. Breastfed infants had significantly higher ICFI scores than those not breastfed. Factors influencing ICFI were infant age and milk volume intake. The ICFI was negatively associated with WAZ, WLZ/WHZ, and BAZ (β = -0.13, P = 0.037; β = -0.17, p=0.01; β = -0.15, P = 0.026, respectively). Breastfeeding was also negatively associated with WAZ, LAZ/HAZ, WLZ/WHZ, and BAZ. This study demonstrated a negative association between the ICFI and nutritional status. Breastfeeding may have obscured some positive effects from appropriate feeding practices, while dairy consumption may have hidden negative outcome from inappropriate ones. Despite the ICFI appearing to reflect infant and young child feeding behaviors, using the ICFI alone may not accurately reveal nutritional status.

Incorporating Breastfeeding-Related Variability with Physiologically Based Pharmacokinetic Modeling to Predict Infant Exposure to Maternal Medication Through Breast Milk: a Workflow Applied to Lamotrigine.

Current methods to assess risk in infants exposed to maternal medication through breast milk do not specifically account for infants most vulnerable to high drug exposure. A workflow applied to lamotrigine incorporated variability in infant anatomy and physiology, milk intake volume, and milk concentration to predict infant exposure. An adult physiologically based pharmacokinetic model of lamotrigine was developed and evaluated. The model was scaled to account for growth and maturation of a virtual infant population (n=100). Daily infant doses were simulated using milk intake volume and concentration models described by a nonlinear equation of weight-normalized intake across infant age and a linear function on the relationship of observed milk concentrations and maternal doses, respectively. Average infant plasma concentration at steady state was obtained through simulation. Models were evaluated by comparing observed to simulated infant plasma concentrations from breastfeeding infants based on a 90% prediction interval (PI). Upper AUC ratio (UAR) was defined as a novel risk metric. Twenty-five paired (milk concentrations measured) and 18 unpaired (milk concentrations unknown) infant plasma samples were retrieved from the literature. Forty-four percent and 11% of the paired and unpaired infant plasma concentrations were outside of the 90% PI, respectively. Over all ages (0-7 months), unpaired predictions captured more observed infant plasma concentrations within 90% PI than paired. UAR was 0.18-0.44 when mothers received 200 mg lamotrigine, suggesting that infants can receive 18-44% of the exposure per dose as compared to adults. UARs determined for further medications could reveal trends to better classify at-risk mother-infant pairs.

The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial.

BackgroundSeveral recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined.ObjectiveThis study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)—the single, leading modifiable cause of unintended breastfeeding reduction and cessation.MethodsWe recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message–based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging–based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum.ResultsParticipants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants’ pre-existing breastfeeding knowledge and unique breastfeeding trajectory.ConclusionsPrenatal and postpartum evidence–based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered.Trial RegistrationClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969

Is exclusive breastfeeding an option or a necessity in Africa? A pooled study using the deuterium oxide dose-to-mother technique.

Given the valuable health, development, and economic benefits of human milk Exclusive Breastfeeding (EBF) is recommended by the World Health Organisation for the first six months of an infant’s life. Many resource-limited regions in Africa do not line-up with these recommendations, therefore EBF promotion efforts on the continent need to be scaled up and monitored. This study explores the human milk intake volumes of 5 countries (Benin, Central African Republic, Morocco, South Africa and Tanzania) both at country level and in a pooled sample of children at 3 months (n= 355) and at 6 months (n=193). Mean human milk intake volumes in the pooled samples were 697.6 g/day at 3 months and 714.9 g/day at 6 months. EBF was determined both by maternal recall as well as using the deuterium oxide dose-to-mother technique, using two different cut-offs of non-milk oral intake. Comparison of these results showed substantial over-reporting of EBF by maternal recall, which suggests that actual rates of EBF are even lower than reported, thus highlighting the importance of scaling-up EBF promotion strategies.

Estimates of Preterm Infants' Breastfeeding Transfer Volumes Are Not Reliably Accurate

Adequate human milk nutrition is critical for infant growth and neurodevelopment; however, low milk transfer volumes are common when establishing preterm breastfeeding. Despite clinical assessments of milk transfer volumes at the breast being inaccurate, measurement of feed volume via test weighing is rarely carried out either routinely or in cases where infant weight gain is inadequate. To assess the accuracy of the Preterm Breastfeeding Assessment Tool (PBAT) in determining transfer volumes and examine factors associated with PBAT accuracy. Pre/postfeed weights were performed using electronic scales and PBAT scores recorded for 1186 breastfeeds in 60 preterm infants born less than 33/40 and 33 to 39/40 postmenstrual age. Measured milk intake volumes were converted to percent prescribed feed volume and compared with PBAT estimates of milk transfer. The PBAT is accurate in identifying when no milk is transferred at the breast but not in estimating transfer of half or the full prescribed volume (accuracy 26% and 47%, respectively). Wide ranges of transfer volumes (11-75 mL) were observed within and between infants, and for 20% of breastfeeds, no milk was transferred. Preterm Breastfeeding Assessment Tool accuracy decreased with each 1-week increase in birth gestation (odds ratio = 0.82; 95% confidence interval, 0.71-0.94; P = .004). When establishing breastfeeding, test weighing facilitates adequate nutrition by guiding appropriate complementary feeding. For mothers breastfeeding several times per day in preparation for discharge home, test weighing may offer a useful tool for developing maternal confidence in assessing milk transfer. Preterm Breastfeeding Assessment Tool is inaccurate in assessing preterm infants' milk transfer volumes when breastfeeding. While studies have typically focused on medically stable infants, test weighing offers a useful tool to examine breastfeeding efficacy and inform nutritional management of preterm infants with complications such as chronic lung and cardiac disease.

Early Life Nutrient Intake Is Associated with Weight-for-Length Z-Scores at 3 and 12 Months (P11-127-19)

ObjectivesRapid weight gain over the first 12 months of life is a risk factor for childhood obesity. While macronutrient concentrations in human milk (HM) or infant formula (IF) have been associated with rapid weight gain or weight-for-length Z-scores later in infancy, few studies evaluate milk intake. Therefore, the objective was to assess how nutrient intake at 6 weeks of age, across multiple feeding modes, influences growth over the first year of life. MethodsData were collected from 222 healthy mother-infant pairs enrolled in the STRONG Kids 2 Cohort. Twenty-four hour test weighing was conducted to measure milk intake volume and a human milk sample was collected at 6 weeks postpartum. Milk samples were analyzed for total protein (Bradford assay), fat (total lipid extraction), and carbohydrate (Orcinol assay). Mode of feeding at 6 weeks, servings per day of HM and/or IF, and formula type were reported by mothers. For exclusively breastfeeding infants, HM macronutrient concentrations and total intake were used to calculate nutrient intake. For those receiving IF, the numbers of feedings from HM and/or from IF and formula nutrition information were also used to calculate nutrient intake. Infant length and weight collected at study visits were used to calculate weight-for-length Z-scores (WFL-Z). Mixed linear models were used to measure associations between macronutrient intake, total calories, total milk intake and WFL-Z at 3 months and 12 months of age. Models were controlled for 6-week feeding mode, breastfeeding duration, and timing of solid food introduction. ResultsAt 3 months, WFL-Z was associated with total milk (P = 0.03) and caloric intake (P = 0.03) as well as intake of fat (P = 0.02), carbohydrate (P = 0.05), and protein (P = 0.03). WFL-Z at 12 months was associated with protein (P = 0.02) and fat (P = 0.04) intakes at 6 weeks but no longer associated with other measures of nutrient intake. ConclusionsOur results support previous findings suggesting that high protein intake in infancy contributes to obesity risk. While milk intake was only quantified once, data show that nutrient intake at 6 weeks-of-age influences future growth. More research is needed to understand other lifestyle and nutritional factors between 3 and 12 months that contribute to growth trajectories and weight during infancy. Funding SourcesNational Dairy Council, NIH RO1DK107561, The Gerber Foundation, The Doris Kelley Christopher Foundation.

The Effect of Human Milk on Modulating the Quality of Growth in Preterm Infants.

Introduction: Human milk is the optimal nutrition for preterm infants. When the mother's own milk is unavailable, donor human milk is recommended as an alternative for preterm infants. The association among early nutrition, body composition and the future risk of disease has recently attracted much interest. The aim of this study was to investigate the effect of human milk on the body composition of preterm infants.Materials and Methods: Very low birth weight infants (VLBW: birth weight <1,500 g) with a gestational age (GA) between 26 and 34 weeks were included. Clinical data, anthropometric measurements and nutritional intake in terms of the volume of human milk were extracted from computerized medical charts. The human milk intake was expressed as a percentage of target fortified donor human milk and/or target fortified fresh mother's milk, compared with the total volume of milk intake during the hospital stay. All included infants underwent anthropometric measurements and body composition analysis (expressed as fat-free mass percentage) at term corrected age (CA) by air-displacement plethysmography. A comparison between infants fed human milk at <50% (group 1) and infants fed human milk at ≥50% of the total volume of milk intake (group 2) was conducted. Multiple linear regression analyses were conducted to explore the modulating effect of fortified human milk on fat-free mass at term CA.Results: Seventy-three VLBW infants were included in the study. The mean weight and GA at birth were 1,248 ± 198 g and 30.2 ± 2.0 weeks, respectively. No differences were found regarding anthropometric measurements at birth, at discharge and at term CA between the two groups. The mean fortified human milk intake was 34.9 ± 12.5 and 80.9 ± 15.5% in groups 1 and 2, respectively (p < 0.001).A multiple regression analysis corrected for sex and birth weight demonstrated that intake of ≥50% fortified human milk was associated with a higher fat-free mass percentage at term CA than intake of <50% fortified human milk.Conclusion: The use of target fortified human milk modulated growth and improved growth quality in vulnerable preterm infants. Thus, the use of donor human milk should be encouraged when fresh mother's milk is insufficient or not available.

Nipple Shield Effect on the Volume of Milk Intake in Premature Infants

Nipple Shield Effect on the Volume of Milk Intake in Premature Infants

Effects of oral stimulation and abdominal massage in premature infants

Objective To evaluate the effect of oral stimulation and abdominal massage on the progress and performance of oral feeding and length of hospital stay in premature infants. Methods A total of 80 premature infants were randomly assigned into experimental group, and control group. The infants in the experimental group (n=40) received oral stimulation and abdominal massage in addition to the routine care. The infants of control group (n=40) received routine care of NICU including intermittent feeding, oral support, and postural support, etc.. The corrected gestational ages were compared between two groups when infants of two groups achieved starting oral feeding and full oral feeding. The progress of oral feeding, performance of oral feeding and length of hospitalization were calculated. Results The progress of oral feeding and length of hospitalization were (3.38±1.84)d and (30.25±17.32)d that all were lower than those of control group; the efficacy of feeding, feeding effects and milk volume intake were (6.30±0.94)ml/min, (81.45±21.61)%, (78.97±18.99)%, which were higher than those of control group (t=-6.317, -2.862, 8.543, 2.698, 2.641; P<0.05). Conclusions The oral stimulation combined with abdominal massage is beneficial for the difficulty of oral feeding in premature infants. Key words: Infant, premature; Infant feeding; Oral simulation; Abdominal message

Association of 6 months of exclusive breastfeeding with higher fat-free mass in infants in a low-resource setting with high HIV prevalence in South Africa.

Exclusive breastfeeding for 6 months is recommended by the World Health Organisation (WHO) for optimal health and growth of infants, but it is not a common practice in South Africa. A breastfeeding counselling programme was run to inform, encourage and support mothers to exclusively breastfeed their infants for 6 months, and mother-infant pairs were invited to participate in a research project to determine breast milk intake volumes using the dose-to-mother deuterium dilution stable isotope technique. This technique yields objective measurements of breast milk intake volumes and also enables determination of exclusivity of breastfeeding, which is most frequently determined by maternal recall and can be subject to bias. Exclusivity of breastfeeding at 6 weeks, 3 months and 6 months following birth of the infants was correlated with infant fat-free mass at 12 months, which was determined by the dose-to-infant deuterium dilution stable isotope technique. Results showed that infants who were exclusively breastfed for 6 months had a higher per cent fat-free mass at 12 months compared with infants who were not exclusively breastfed for 6 months (P < 0.05). This objective determination of both breastfeeding patterns and infant body composition gives weight to the WHO recommendation of exclusive breastfeeding for 6 months as it demonstrated adequate fat-free mass in infants at 12 months, even in an area with high HIV prevalence. © 2016 John Wiley & Sons Ltd.

Bioimpedance spectroscopy in the infant: effect of milk intake and extracellular fluid reservoirs on resistance measurements in term breastfed infants.

Bioimpedance spectroscopy is an accurate non-invasive method for measuring body composition in adults, but in infants it requires further testing and validation. Of the few studies of bioimpedance conducted in infants, none have comprehensively investigated the effect of milk intake volume. This study assessed the effect of the milk intake, feed duration and the volume of the infant's stomach and bladder on the resistance values pre-/post-feed to establish the feasibility of using these values interchangeably during data collection. Forty-eight breastfeeding infants were measured at 2, 5, 9 and/or 12 months (n=62 sessions) within 1-2 min before the start and after the end of breastfeed. Median (IQR) time between measurements was 24 (20.0-30.0) min. Resistance measurements at 0 and 50 kHz, and infinite frequency (R0, R50 and Rinf) and resistance of intracellular water (Ricw) were analysed with customised infant settings. Milk intake was measured by test weights. Free-water volumes and free-water change were determined from stomach and bladder volumes calculated from ultrasound images. Small pre-to-post-feed changes (median (IQR): R0 -3.7 (-14.8, 14.3); R50 0.3 (-10.4, 15.0); Rinf 2.8 (-13.3, 35.5); Ricw 20.8 (-98.1, 290.9)) were not significantly different from zero (R0: P=0.92; R50: P=0.48; Rinf: P=0.32; Ricw: P=0.097). No significant effect of milk intake or free-water change was detected. The lack of consistent change in resistance across a breastfeed provides flexibility in the timing of measurements of infants in the research setting, such that typically pre- and post-feed measures of resistance can be used interchangeably.