Premature Formula Research Articles

Human milk-derived versus bovine milk-derived fortifier use in very low birth weight infants: growth and vitamin D status.

Human milk-derived fortifier (HMDF) coupled with human milk feeding in extremely premature infants reduces the adverse outcome risks of early exposure to bovine milk ingredients but may not provide enough nutrients for adequate catch-up growth compared with bovine milk-derived fortifier (BMDF). This study aims to compare HMDF and BMDF effects on growth parameters and serum 25-hydroxy vitamin D (25OHD) levels in preterm very low birth weight (VLBW) infants during the first 8 weeks of life. We present a retrospective chart review of inpatient VLBW infants with birth weight <1,500 g and gestational age <32 completed weeks who received either their mother's milk or donor breast human milk fortified with HMDF or BMDF for the first 8 weeks. Weight, head circumference, length gain, and 25OHD level were calculated at 4 and 8 weeks of age. A total of 139 VLBW infants (91 HMDF + 48 BMDF) received fortified human milk without any supplemental premature formula from birth to 4 weeks of age, of whom 44 (37 HMDF + 7 BMDF) continued until 8 weeks of age. There was no statistically significant difference in the growth parameters between the two groups at 4 and 8 weeks of age. Serum 25OHD level in the HMDF group was significantly higher compared with that in the BMDF group at 4 weeks of age despite receiving lower vitamin D supplementation. Similar gain in growth parameters in HMDF and BMDF groups at 4 and 8 weeks of age was observed, suggesting that HMDF provides adequate nutrients for growth in VLBW infants. A higher 25OHD level in HMDF may suggest better absorption.

Risk Factors and Clinical Characteristics of Metabolic Bone Disease of Prematurity.

The study aimed to analyze the risk factors and clinical features of metabolic bone disease of prematurity (MBDP) in premature infants compared with infants of similar gestational age and birth weight without MBDP. This retrospective case-control study was performed by comparing 81 cases of MBDP with 63 controls to identify potential risk factors. Premature infants with a gestational age ≤33 weeks and birth weight <1,500 g were included. Medical records were examined in terms of maternal conditions, potential risk factors, and clinical characteristics. Bone fractures and invasive ventilator dependence were the most common clinical features of MBDP. Duration of invasive ventilation and total mechanical ventilation days, necrotizing enterocolitis, corticosteroid use, anticonvulsive drug use, duration of dexamethasone and caffeine use, total parenteral nutrition, and length of hospitalization were significantly higher in neonates with MBDP (p < 0.05). Breastfed neonates and those receiving human milk fortifier had a lower incidence of MBDP than those premature formula or mixed feeding (p < 0.05). Anticonvulsive drug use (odds ratio: 2.935; 95% confidence interval: 1.265-6.810) was identified as a risk factor for MBDP at multiple regression analysis. Our results show that anticonvulsive drug use is a significant risk factor for the development of MBDP. If long-term use is not required, anticonvulsive drugs should be stopped as soon as possible. Further studies involving patients with MBDP are required to determine the risk factors and clinical features. · MBDP is a multifactorial disorder.. · Anticonvulsive drug use is an important risk factor for the development of MBDP.. · Bone fractures and invasive ventilator dependence are the most common clinical features of MBDP..

Detection of Soybean Powder and Rice Flour Adulterations in Premature Formula by ATR-FTIR Spectroscopy and Chemometrics

Detection of Soybean Powder and Rice Flour Adulterations in Premature Formula by ATR-FTIR Spectroscopy and Chemometrics

SAT-356 Reversible Suppression of Serum 1,25-Dihydroxyvitamin D in Williams Syndrome

Background: Hypercalcemia has been reported in 5% to 50% of patients with Williams syndrome; however, observations about the role of 1,25-dihydroxyvitamin D in hypercalcemia related to Williams syndrome have been contradictory. Objective: The objective was to investigate the mineral metabolism in an 11-month-old patient with Williams-Beuren syndrome who had hypercalcemia, hypercalciuria and nephrocalcinosis. Methods: We reviewed test results in an 11-month-old infant with Williams syndrome who developed hypercalcemia following excessive dietary calcium intake that was two to three times higher than recommended for age because he continued receiving a premature formula with high calcium content from birth. Results: Our patient presented with feeding difficulties, daily vomiting, weight loss, and constipation. He had serum total calcium 14.8 mg/dL, phosphorus 4.0 mg/dL, PTH <4 pg/mL, 1,25-dihydroxyvitamin D <8 pg/mL, 25-hydroxyvitamin D 29 ng/mL, PTH-related peptide 3.7 pmoL/L (expected <4.2), alkaline phosphatase 118 U/L, beta-crosslaps 1257 pg/mL, and urinary calcium/creatinine ratio 1.19. XR Skeletal Survey revealed increased bone density in the metaphyseal regions, in particular, above the knee, distal radius and ulna that may result from hypercalcemia; no evidence of rickets, osteoporosis or congenital osteodystrophy was seen. Renal ultrasound revealed increased echogenicity of the renal medullary pyramids consistent with medullary nephrocalcinosis. Hypercalcemia and hypercalciuria were initially treated with IV fluids and Furosemide IV, and resolved only after Pamidronate 0.5 mg/kg/dose IV x 2 doses. After serum calcium normalized, the patient’s symptoms resolved, PTH recovered to 18 pg/mL (expected 10 - 65), and 1,25-dihydroxyvitamin D increased to 27 pg/mL (expected 24 - 86). Chromosomal micro-array analysis showed a 1.9 megabase deletion at 7q11.23 that overlapped the Williams syndrome critical region including the ELN gene, consistent with diagnosis of Williams syndrome. Serum calcium remained normal with dietary calcium restriction using a low-calcium formula and complementary foods. Conclusions: PTH-independent hypercalcemia in our patient with Williams syndrome was due to calcium overload resulting from dietary calcium excess in addition to possibly enhanced intestinal calcium absorption. Serum 1,25-dihydroxyvitamin D was undetectable and returned to normal only with resumption of PTH secretion required for its synthesis after hypercalcemia resolved. The balance between bone formation and resorption was shifted to resorption possibly to remove skeletal calcium excess, based on normal alkaline phosphatase (marker of osteoblast activity) and high collagen beta-crosslaps (marker of osteoclast activity). A premature formula with high calcium content should be switched to a full-term formula when risk for rickets of prematurity clears.

Necrotizing enterocolitis: a case report

Nectrotizing enterocilitis(NEC), a disease predominant in the premature formula fed infants, is a major cause of morbidity and mortality in NICU survivors. The symptoms may vary from apnea, fever, lethargy to abdominal distension, bloody stools, poor feeding and vomiting. The mainstay of treatment is the IV feeds, discontinuation of oral feeds, nasogastric (NG) decompression, possible breathing support and surgery. The objective of this case report is to discuss the presentation, treatment, prognosis and proposed preventative measures of NEC, which can help raise awareness and henceforth improve the management and subsequent prognosis of this disease. Authors present to you the case report of a VLBW (Very Low Birth Weight) premature infant with NEC.

Serum Transforming Growth Factor Beta2 and Feeding Intolerance in Premature Formula -Fed versus Breast Milk-fed Neonates

Abstract Serum Transforming Growth Factor Beta2 and Feeding Intolerance in Premature Formula -Fed versus Breast Milk-fed Neonates Objectives to assess occurance of feeding intolerance and NEC in relation to serum level of TGF-β2 in breast milk versus preterm formula fed neonates. Subjects and Methods a prospective observational study on 80 preterm neonates(≤36weeks gestational age). They were divided to two groups; breast milk fed group(n = 40) and preterm formula fed group(n = 40). They were assessed clinically for feeding intolerance and NEC and laboratory by measurement of TGF-β2 using ELISA technique. Results TGF-β2 serum level was significantly lower in preterm formula fed group than breast fed group;median(interquartile) 500(250-3000) pg/ml vs 7750(6500-11250) pg/ml (p &amp;lt; 0.0001). Both primary outcome(feeding intolerance and NEC) and secondary outcome(respiratory support and sepsis) were negatively correlated to TGF-β2 serum level. TGF-β2 serum level below 1250 pg/ml was found to be a good diagnostic test for feeding intolerance with sensitivity of 75.86% and specificity of 96.08%. Conclusion low serumTGF-β2 level is a specific marker for feeding intolerance in preterm neonate. Using premature formula in premature neonates is not recommended as it is associated with lower serum TGF-β2 and higher incidence of feeding intolerance compared to breast feeding.

Faster Gastric Emptying Is Unrelated to Feeding Success in Preterm Infants: Randomized Controlled Trial.

Objectives: To evaluate the relationship between gastric emptying (GE) time and days to achievement of full enteral feeding (≥140 mL/kg/day) in preterm infants randomly assigned to receive one of two marketed study formulas for the first 14 feeding days: intact protein premature formula (IPF) or extensively hydrolyzed protein (EHF) formula. Methods: In this triple-blind, controlled, prospective, clinical trial, we report GE time (time to half-emptying, t1/2) by real-time ultrasonography on Study Day 14, in preterm infants receiving IPF or EHF formula. The association between GE time and achievement of full enteral feeding was evaluated by Pearson correlation. Per-protocol populations for analysis included participants who (1) completed the study (overall) and (2) who received ≥ 75% study formula intake (mL/kg/day). Results: Median GE time at Day 14 was significantly faster for the EHF vs. IPF group overall and in participants who received ≥ 75% study formula intake (p ≤ 0.018). However, we demonstrated GE time had no correlation with the achievement of full enteral feeding (r = 0.08; p = 0.547). Conclusion: Feeding IP premature formula vs. EH formula was associated with shorter time to full enteral feeding. However, faster GE time did not predict feeding success and may not be a clinically relevant surrogate for assessing feeding tolerance.

Effect of fortifiers on the osmolality of preterm human milk

ABSTRACTBackground: The nutritional content of preterm human milk (HM) can be increased by adding human milk fortifier (HMF). Premature formula (PF) has been used as an alternative to HMF due to the high cost of HMF in some countries. However, the osmolality of HM after fortification remains a matter of concern.Aim: To evaluate the osmolality of fortified preterm HM.Methods: This was a cross-sectional study. HM was collected from 28 mothers of infants with a gestational age of <32 weeks or birthweight <1500 g. Expressed HM was divided into (i) pure HM; (ii) HM+PF to 24 kcal/oz; (iii) HM+PF to 28 kcal/oz; and (iv) HM+HMF to 24 kcal/oz + protein powder 0.5 g/100 ml.Results: Twenty-eight samples of preterm HM were analysed. The mean (SD) osmolality of baseline HM was 297.6 (9.7) mOsm/kg. Mean osmolality of preterm HM after fortification with PF to 24 and 28 kcal/oz was 357.2 (11.1) and 419.9 (18.8) mOsm/kg, respectively. The mean osmolality after fortification with HMF plus protein powder was 464.1 (18.8) mOsm/kg. Repeated-measures ANOVA was used to compare osmolality between pure HM and HM fortified with different fortifiers. All pairwise comparisons by the Bonferroni method were statistically significant (p < 0.001).Conclusions: The osmolality of preterm HM fortified with PF up to 28 kcal/oz does not exceed the American Academy of Paediatrics recommendation of 450 mOsm/kg. The addition of extra protein to preterm HM fortified with commercial HMF must be cautiously considered due to the risk of excessively high osmolality.

Preterm Infant with Abdominal Distention, Rapid Deterioration, and Cutaneous Abdominal Blood Vessel Findings

A preterm infant presents with loose stools, abdominal distention, progressive lethargy, rapid deterioration, and cutaneous abdominal blood vessel findings. ### Prenatal and Birth Histories The infant was admitted to the NICU with a birthweight of 1,020 g (50%) and transitioned from nasal prong CPAP to high-flow nasal cannula 1 day after birth. The infant initially received total parenteral nutrition and advanced to full enteral feedings (premature commercial formula) 12 days after birth. Twenty-one days after birth, the infant was noted to have loose, pasty yellow stools and mild abdominal distention. The next morning, the loose stools transitioned to normal but the abdominal distention became more significant. ### Vital Signs (Day 22, AM)

Post Discharge Formula Fortification of Maternal Human Milk of Very Low Birth Weight Preterm Infants: An Introduction of a Feeding Protocol in a University Hospital.

The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW). Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF) was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants’ weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb), electrolytes, blood urea nitrogen (BUN) and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430), length 0.76 and 0.58 cm/week (P=0.0027), and head circumference of 0.59 and 0.5 cm/week (P=0.0217) in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls), P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers’ milk for preterm VLBW infants in developing countries with low resources.

Research progress on nutritional intervention for premature infants

In recent years, premature birth rate has increased due to the development of medical technology and the change of socioeconomic environment. In order to reduce the possibilities of extrauterine growth retardation and neural development retardation among premature infants, nutrition support should be fully paid attention to in clinical settings. Currently, nutritional intervention for premature infants mainly adopts enteral or parenteral nutrition. Parenteral nutrition is prescribed according to the recommended value in China Neonatal Nutrition Support Application Guide, individualized for premature infants. Enteral nutrition commonly uses breast milk, milk supplements, premature infant formula milk, hydrolyzed protein milk and formula milk after discharge. In this review, we summarized the clinical application of nutritional intervention in premature infants. Key words: Premature infant; Enteral nutrition; Parenteral nutrition

Comparison of the outcome of premature babies fed by different ways

Objective To compare the body weight, height, head circumference of premature babies fed by different ways, and to analyze the advantages and disadvantages. Methods 260 premature infants were selected as the research subjects, according to random number table, they were divided into four groups.Group A: premature infant formula feeding, 80 cases; Group B: pure breast feeding group, 60 cases; Group C: normal full term formula feeding, 60 cases; Group D: premature infant formula mixed breast feeding, 60 cases.All children were fed at the first 12 to 24h after birth.The body weight, height, head circumference and catch up full term time were evaluation index. Results After correct gestational age 40 weeks, group B children' weight, height, head circumference were higher than other groups, group C was the lowest levels, the difference was statistically significant (F=3.563, P<0.05). Correct gestational age 1, 3, 6 months later, group A children' weight, height and head circumference index were higher than other feeding group, the level of group D was the second, the lowest level was group C, the differences were statistically significant (F=3.011, 2.853, 2.779, all P<0.05). In 6 months, group A, 38.8% (31/80), was the fastest one to reach the full term infant, the difference was statistically significant (χ2=29.149, P<0.05). At other time, the pursuing number of group A was bigger, but there was no statistically significant difference. Conclusion For premature babies, preterm infant formula milk powder or premature infant formula and milk feeding way is better than that of pure breast feeding and normal full term milk powder, which can guarantee the children's nutrition demand, shorten the time of pursuing full term infant, promote baby's health. Key words: Infant, premature; Feeding methods; Infant formula

Legal Briefs: Aggressive Gavage Feeding and Gastric Perforation

Twins at 341/7 weeks’ gestation were born to a 33-year-old healthy mother with a pregnancy remarkable for in vitro fertilization, diamniotic, dichorionic twins, and preterm labor. After a full course of antenatal corticosteroids, the twins were born by cesarean delivery. Twin A was a 2,410-g male infant with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. His examination findings were normal, and his complete blood count was unremarkable. On day 1 an order was written to begin feeding the infant with either breast milk or premature formula (20 calories per ounce). The feedings were to be initiated by gavage or nipple feeding at 5 mL every 3 hours for two times and subsequently to increase by 3 mL every 3 hours to a maximum feed of 20 mL/kg every 3 hours; a concomitant order to decrease the intravenous fluid rate was written as the oral feeds increased. On day 1 the infant fed well, taking each feed by nipple within 20 minutes. By the end of day 1, he was nippling 17 mL. The mean heart rate (HR) was 131 beats per minute. The abdominal girth, measured 4 times, was 28 cm. Instead of losing weight at this point, he gained 60 g. On day 2 the infant was initially nippling his feeds well, but when the amount reached 30 mL, he began feeding poorly; he needed stimulation to suck, was sleepy, needed chin support, and required an increasing time to nipple feed. At this point the nurse decided to gavage feed the infant to keep up with the feeding schedule of an increase of 3 mL every feed. The nurse inserted a nasogastric tube. She did not document the depth of insertion. The nurse maintained at her deposition that she inserted the …

ABSTRACT 780

Background and aims: Gastric lactobezoar (GL) is a rare neonatal pathology. Only 96 cases have been described since 1959. It’s a pathological conglomeration of milk and mucus in the stomach of milk-fed infants often causing gastric outlet obstruction. In the NICU of Fort de France (French West Indies), 7 GL appeared since 24.08.13 to 3.10.13 in premature babies whose 3 needs emergency surgery and one baby died. Aims: The aim of this work is to describe the cases and the changes induced by these cases. Methods: All the cases were check by epidemiologists and physicians to detect predisposing factors. In the same time, analyzed of the nutrition process have been made to detect anomalies. IRB approved the study. Results: The GL appeared 18 days after birth when enteral feeding is about 130 ml/kg/d. The firsts symptoms where seen 2.4 days before diagnosis. Abdominal distension, vomiting, regurgitation of curd milk were more frequent and associated in 5 cases. The X-ray image was pathognomonic. Treatment was only medical for 3 cases and surgical in 4 cases. Predisposing factors were prematurity, premature formula milk (PF), enhanced caloric density, association between PF and medium chain triglycerides (TG). Conclusions: LG can be a very serious condition and must be early detect. The diagnosis is difficult because symptoms are common in neonates. We decide to stop association between PF and TG and we are more cautious when there is an association between abdominal distension and vomiting or curd milk regurgitation. Since this analysis and changes, no LG appeared in the NICU.

Visual Diagnosis: Infant With Growth Failure, Body Asymmetry, and Dysmorphic Features

1. Deepa Prasad, MD* 2. Valerie Navarrete, MD† 3. Srividya Naganathan, MD, FAAP‡ 1. *Chief Resident, Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ. 2. †Pediatric resident, Jersey Shore University Medical Center, Neptune, NJ. 3. ‡Assistant professor of Pediatrics, UMDNJ, Pediatric clerkship site director, Jersey Shore University Medical Center, Neptune, NJ. A 5-month-old girl is admitted to the hospital by her pediatrician for evaluation of failure to thrive. The mother reports that her daughter has always been small and that she feels her daughter is not gaining weight as expected despite feeding her 24 ounces of a 22-calorie-per-ounce premature formula each day (135 kcal/kg per day). The mother also expresses concern that her daughter has a large head, developmental delays, and a right leg that is growing longer than the left. Evaluation by an orthopedic surgeon found no evidence of hip dysplasia. The infant’s past medical history reveals an uncomplicated premature birth at 35 weeks’ gestation via vaginal delivery. Her birthweight was 2 pounds and 14 ounces (<2 standard deviations [SD] from mean), which plotted as small for gestational age. She was hospitalized for 3 weeks for feeding and growth monitoring. Review of systems is negative for vomiting, diarrhea, swallowing difficulties, or weight loss. She is not on any medications, and her immunizations are up to date. She is an only child and there is no history of consanguinity. Family history is unremarkable. Physical examination reveals an alert, active, thin baby whose vital signs are normal for age. Her weight is 3.9 kg (<-3 SD from mean, according to World Health Organization Growth charts), length is 21 inches (<-3 SD from mean), head circumference is 16 inches (between 0 and -1 SD). Her head appears large in relation to the rest of her body, and she has a prominent forehead ( Fig 1 ) . Her right leg has larger girth and is 1 inch longer than the left leg ( Fig 2 ) . Further examination of her extremities reveals clinodactyly of her fifth fingers ( Fig 3 ) . She has poor head control and mild generalized hypotonia. The remainder of her …

1356 Continuous Glucose Monitoring in Very Low Birthweight Preterm Infants on Full Enteral Feeds

BackgroundWe previously observed hypoglycaemic episodes in preterm infants after achieving full enteral feeds and during a stable postnatal period. The purpose of this study was to prospectively determine subcutaneous glucose...

Efficiency of iodine supplementation, as potassium iodide, during lactation: A study in neonates and their mothers

Abstract Iodine is an essential trace element, required for brain development of the foetus and in early postnatal life. This paper evaluates the effect of iodine supplementation during lactation in women living in Asturias (north of Spain). The iodine contents in breast milk (BMI) of premature and full term mothers, receiving during their pregnancy and lactation an iodine supplement (200 μg of KI/day), were compared with those of non-supplemented mothers. The iodine contents in premature and full term formula milks were also evaluated. Furthermore, the urine iodine (UI) in mothers and in both breast- and formula-fed children was also measured. Results showed that extra iodine supplementation with KI during lactation, as recommended by WHO/UNICEF and ICCIDD, is appropriate, and appears to be safe for mothers and neonates. Moreover, breast milk appears to be a better source of iodine for the babies than are formula milks, especially for premature infants.

Acute inhibition of iron bioavailability by zinc: studies in humans

Iron (Fe) and zinc (Zn) deficiencies constitute two of the most important nutritional and public health problems affecting developing countries. Combined supplementation or fortification with Zn and Fe are strategies that can be used to improve the Zn and Fe status of a population. However, there is concern about potential negative interactions between these two micronutrients due to a competitive binding to DMT1 and Zip14 transporter. Studies performed in humans have shown an inhibitory effect of Zn on Fe absorption when both minerals are given together as a solution in fasting conditions. We found that at low doses of iron (0.5 mg) the threshold for the inhibition of iron bioavailability was at a Zn:Fe wt/wt ratio ≥5.9:1, whereas at higher doses of Fe (10 mg) this inhibition occurred at 1:1 Zn:Fe wt/wt ratio. This differential response could be explained by the variation in the abundance of both cations as they compete for a limited number of shared transporters at the enterocyte. Conflicting results have been obtained when this interaction was studied in different food matrices. A negative interaction was not observed when Fe and Zn were provided in a composite hamburger meal, premature formula, human milk, or cow milk. A decrease on Fe absorption was observed in only 1 of 3 studies when Fe and Zn were supplied in wheat flour. The possibility of a negative interaction should be considered for supplementation or fortification programs with both microminerals.

Lead, cadmium and aluminum in Canadian infant formulae, oral electrolytes and glucose solutions

Lead (Pb), cadmium (Cd) and aluminum (Al) were determined in 437 individual samples of infant formulae, oral electrolytes and 5% glucose solutions available in Canada. In the electrolytes, Cd and Pb concentrations were all below 0.01 and 0.041 ng g−1, respectively. In the 5% glucose solutions, Pb and Cd levels averaged 0.01 and 0.09 ng g−1, respectively. Reported on an as-consumed basis, Pb levels in milk- and soya-based formulae averaged 0.90 and 1.45 ng g−1, respectively, while Cd levels averaged 0.23 and 1.18 ng g−1, respectively Average Al levels on an as-consumed basis were 440 ng g−1 (range 10–3400 ng g−1) in milk-based formulae and 730 ng g−1 (range 230–1100 ng g−1) in soy-based formulae. Al concentrations increased in the following order: plain formula < low-iron formula < iron-supplemented formula < casein hydrolysate formula ≈ premature formula ≤ soy formula. For example, in the powdered formulae, average Al concentrations were 18 ng g−1 for plain milk-based, 37 ng g−1 for low-iron, 128 ng g−1 for iron supplemented, 462 ng g−1 for lactose-free, 518 ng g−1 for hypoallergenic and 619 ng g−1 for soy-based formula. Al concentrations, as-consumed, increased with decreasing levels of concentration: powder < concentrated liquid < ready-to-use. Formulae stored in glass bottles contained between 100 and 300 ng g−1 more Al than the same formulae stored in cans. The source of the increased Al did not appear to be the glass itself, because most electrolytes and glucose solutions, also stored in glass, contained less than 8 ng g−1 Al. Corresponding differences in Pb and Cd levels were not observed. Al concentrations varied substantially among manufacturers; however, all manufacturers were able to produce plain milk-based formulae containing less than 50 ng g−1 Al, i.e. within the range of Al concentrations found in human milk. Next to soya-based and hypoallergenic formulae, premature formulae contained among the highest concentrations of Al, ranging 851–909 ng g−1 from one manufacturer and 365–461 ng g−1 from another.

Delayed Postnatal Presentation of Biliary Atresia in 2 Premature Neonates

Delayed Postnatal Presentation of Biliary Atresia in 2 Premature Neonates