Routine Formula Research Articles

Partially Hydrolyzed Whey Protein: A Review of Current Evidence, Implementation, and Further Directions

Background: Human milk is known to be the best nutrition for infants as it provides many health benefits. For non-breastfed infants, cow's milk based infant formula is the most optimal option to provide the needed nutrition. However, approximately 2-5% of all formula-fed infants experience cow’s milk allergy during their first year of life. Partially hydrolyzed whey formula (pHF-W) have been widely recommended to prevent the development of allergic disease in infants. However, according to epidemiological data, approximately half of the infants developing allergy are not part of the at-risk group.Objectives and Methods: This article aims to review the effects of pHF-W in preventing allergy, especially atopic disease, in all non-breastfed infants, as well as the safety aspect of pHF-W if used as routine formula. The role of pHF-W in the management of functional gastro-intestinal (GI) disorders is also reviewed.Results: Several clinical studies showed that pHF-W decrease the number of infants with eczema. The strongest evidence is provided by the 15-year follow up of the German Infant Nutritional Intervention study which showed reduction in the cumulative incidence of eczema and allergic rhinitis in pHF-W (OR 0.75, 95% CI 0.59-0.96 for eczema; OR 0.67, 95% CI 0.47-0.95 for allergic rhinitis) and casein extensively hydrolysed formula group (OR 0.60, 95% CI 0.46-0.77 for eczema; OR 0.59, 95% CI 0.41-0.84 for allergic rhinitis), compared to CMF as a control, after 15 years of follow-up. pHF-W was also found to be beneficial in the management of functional GI disorders such as regurgitation, constipation and colic.Conclusions: The use of pHF-W in allergic infants has been recommended in various guidelines across the countries, as a primary prevention of allergic disease. One pHF-W has been approved by the US FDA and the European Commission's European Food Safety Authority (EFSA) for its safety and suitability as a routine infant formula for all healthy infants. According to the data obtained in the management of functional GI disorders, pHF-W is better tolerated than formula with intact protein. Further studies assessing the effect of routine use of pHF-W in a larger population of non-breastfed infants should also be conducted, in order to observe any potential harm and to determine the benefit and cost-effectiveness ratio.

A NEW SIMPLE, PERSONALIZED, AND QUANTITATIVE EMPIRICAL METHOD FOR DETERMINING 131I ACTIVITY IN TREATING GRAVES' DISEASE.

The 131I activity for treating Graves' disease (GD) is usually determined based on physician's experience. This study aimed to design an empirical method that was not only personalized and quantitative, but also simple, convenient, and easy to grasp. The study population comprised patients with GD, selected between May 2013 and May 2016, who received 131I therapy in the Outpatient Department of Shanghai Ninth People's Hospital. The first-visit patients of physician 1 were placed in the traditional group: the activity of 131I (mCi) was calculated using the routine formula: [empirical activity (0.07-0.12 mCi/g) × thyroid mass]/[24-h thyroid 131I uptake]. The first-visit patients of physician 2 were placed in the personalized group. The activity of 131I (mCi) was calculated in two steps. First, the initial activity was calculated: 0.1 mCi/g × thyroid mass (g), and then a personalized and quantitative calibration table of 131I activity was used to obtain a final 131I activity. The cure rate with a single activity of 131I was recorded 1 year later. The traditional and personalized groups included 241 and 282 patients, respectively. Interestingly, the personalized group achieved a higher cure rate [86.5% (244/282) versus 73.4% (177/241), P = 0.000] with a relatively higher 131I activity for the first treatment [8.7 (7, 3.5-30) mCi versus 6.7(6, 2.5-30) mCi, P = 0.000] compared with the traditional group, while the incidence rate of permanent hypothyroidism was not significantly different between the two groups (P = 0.175). The empirical method designed in this study was reliable.

Effect of Whey Protein Supplementation on Inflammatory and Antioxidant Markers, and Clinical Prognosis in Acute Ischemic Stroke (TNS Trial): A Randomized, Double Blind, Controlled, Clinical Trial.

Purpose: Malnutrition is extensively prevalent amongst critically ill patients afflicted by ischemic stroke (IS). This study purpose was to evaluate the protein whey effect on inflammatory and antioxidant markers and functional prognosis in acute IS patients. Methods: out of 42 patients with acute IS who were referred to Imam Reza Educational Hospital, Tabriz, Iran, 40 patients participated in the study. Twenty-one patients as control group received the hospital routine formula, and 19 patients as intervention group received 20 g/daily of whey protein through oral gavage. Inflammation and oxidative stress indicators (e.g., albumin, malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and high sensitivity C reactive protein (hs-CRP)and clinical variables included in were evaluated using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during admission and also 3 weeks after intervention. Results: Whey protein supplementation significantly decreased the NIHSS and mRS scores, TNF-α, IL-6, and hs-CRP by passing 3 weeks from intervention (P<0.05). However, whey formula had no significant effect on other markers including albumin, and MDA. The hs-CRP (P = 0.02) reduction was significantly higher in whey protein group in comparison with control group. Conclusion: Whey protein supplementation reduced inflammation markers in those patients with IS. However, these changes should be studied in larger-scale trials.

Testosterone improves the differentiation efficiency of insulin-producing cells from human induced pluripotent stem cells.

Human induced pluripotent stem cells (hiPSCs) may provide potential resource for regenerative medicine research, including generation of insulin-producing cells for diabetes research and insulin production. Testosterone (T) is an androgen hormone which promotes protein synthesis and improves the management of type 2 diabetes in clinical studies. Concurrently, co-existed hyperandrogenism and hyperinsulinism is frequently observed in polycystic ovary syndrome, congenital adrenal hyperplasia and some of Wermer's syndrome. However, the relationship among androgens, insulin and the differentiation of pancreatic β cells is still not fully clear. Here we find that T improves the differentiation efficiency of insulin-producing cells from hiPSCs. The addition of T into routine differentiation formula for pancreatic β cells increases the differentiation efficiency from 12% to 35%. The administration of T promotes the expression of key genes associated with β cells differentiation including NGN3, NEUROD1 and INS. This finding benefits the ongoing process to optimize the differentiation protocol of pancreatic β cells from hiPSCs, and provides some degree of understanding the clinical management of T for type 2 diabetes.

CFL learners’ recognition and production of pragmatic routine formulae

A pragmatic routine formula is any expression with a stable form that is commonly repeated in the routinized social interactions of a given culture. Previous research has reported that such pragmatic routine formulae are often underused by foreign language learners, even when they have been studying the language for a long time. To explore the reasons for this underuse, this study investigated the development of 59 Chinese as a foreign language (CFL) learners’ recognition and production of pragmatic routine formulae in situations they might encounter in China. Results showed that length of stay in the target language country had a significant effect on recognition but not on production. CFL learners with longer periods of residence abroad were able to recognize more pragmatic routine formulae, but which specific formulae were recognized depended on the interactional settings in which learners had engaged. Further analysis revealed that learning challenges may arise in three kinds of situations: (1) those requiring a pragmatic formula in the target language but a different formula in the learner’s native language, (2) those requiring a routine formula in the target language but no remarks in the native language, and (3) those in which the learner overgeneralizes a more familiar form.

Feeding intervention study on allergic proctocolitis in children induced by cow milk protein

Objective To assess nutritional risks in children with allergic proctocolitis induced by cow milk protein, and to observe the effects of the feeding strategies for them with different interventions in feeding, and then to identify the best time and the best way to modify feeding strategies according to different individual. Methods The effectiveness of different feeding interventions was retrospectively analyzed after 2 weeks in 171 cases with allergic proctocolitis induced by cow milk protein in Hunan Children's Hospital during the period of Jan.2012 to Jul.2013.Thirty-two cases received breast feeding (18.7%) and 139 cases received non-breast feeding (81.3%). Intervention methods: 32 cases with breast feeding received the same feeding method; among 139 babies with non-breast feeding group, 36 were plus free amino acid (AAF) (21.1%), and 103 were plus the extensively hydrolyzed formula (eHF). The intervention formula changes were observed in 8, 12 and 24 weeks, respectively, and nutritional risks in 0, 3, 6 months were assessed, respectively. Results There were 171 patients totally, male to female ratio was 1.5 to 1.0, and the average age was (4.1±1.3) months.After 2 weeks, 147 cases were notably effective, accounting for 86%, and in the breast feeding group 79.2% of the patients were notably effective, and there was no significance compared with the AAF group and eHF group (P>0.05). The intervention formulation changes during the following 6 months were as follows: in 8 weeks, 30 cases in the breast feeding group breastfeeding continued, 2 cases turned to eHF feeding for the lack of breast milk, 21 cases were fed with AAF (12.3%), 85 cases with eHF (49.7%), and 35 cases with moderately hydrolyzed formula (20.5%); in 12 weeks: 23 cases had breast feeding (13.5%), 16 cases were fed with free amino acid formula powder (9.4%), 56 cases with extensively hydrolyzed formula (32.7%), and 76 cases with moderately hydrolyzed formula (44.4%); in 24 weeks: 21 cases (12.3%) had breast feeding, 7 cases were fed with AAF(4.1%), 13 cases with moderately hydrolyzed formula(7.6%), and 130 cases with normal formula(76.0%). The mean levels of the nutritional risks were assessed according to STAMP in 0, 3, 6 months respectively: breast feeding group[(1.69±0.78) scores, (1.50±0.88) scores, (1.53±0.67) scores, P>0.05]; AAF group[(1.72±0.78) scores, (1.53±0.88) scores, (1.53±0.65) scores, P>0.05]; eHF group[(1.80±0.69) scores, (1.68±0.68) scores, (1.66±0.65) scores, P>0.05]. Conclusions The nutrition risk levels in children with milk protein allergic proctocolitis are low, and different feeding interventions according to tolerance had no impact on the nutritional status; Breast feeding could effectively avoid cow milk allergy, and symptoms of the children with allergic proctocolitis would be relieved after 2-week intervention, and more than half of children could gain part of immune tolerance after intervention for 3 months or more, so for the children with allergic proctocolitis induced by cow milk protein, routine formula feeding should be stopped after 3 months, and individualized feeding intervention can be carried out according to immune tolerance to relieve the financial burden. Key words: Proctocolitis, cow milk protein allergy; Feeding intervention; Child

Barriers to Breastfeeding in the WIC Population

Breastfeeding (BF) initiation rates in the United States have increased over the past 11 years by 3.6%. However, women who participate in the Women, Infants, and Children (WIC) program are almost 12% less likely to initiate BF than the general population, and less likely to continue for a year. To identify barriers to BF in order to recommend guidelines for the WIC population. A systematic review using the search words WIC and BF was conducted using the CINAHL, PubMed, and Cochrane Library databases. Inclusion criteria were articles studying the WIC population alone and/or relative to other populations. Twenty-four articles from the last 5 years were reviewed and graded according to the Evans' hierarchy of evidence. Barriers to BF in the WIC population were sorted into five categories: lack of support inside/outside the hospital, returning to work, practical issues, WIC-related issues, and social/cultural barriers. Factors predisposing to lower BF rates include non-Hispanic ethnicity, obesity, depression, younger age, or an incomplete high school education. Interventions trialed with positive outcomes include peer counseling, improved communication between hospital lactation consultants and WIC staff, breast-pump programs, and discouraging routine formula provision in the hospital and by WIC. Reasons for low BF rates in the WIC population are complex. More research is needed into interventions tailored for WIC participants. Recommendations for clinicians include initiating peer-counseling programs, prenatal/ postpartum education, in-hospital BF support, and changing the focus of WIC from formula to BF promoting.

Re-examination of yoroshiku onegaishimasu—The routine formula as the linguistic implementation of one's tachiba-role

The present paper re-examines the routine formula, yoroshiku onegaishimasu. This formula was assumed to be initially as an example of Japanese politeness which challenges the principle of Brown and Levinson's Face Threatening Act (FTA), claiming that in many ways, Face Theory does not apply to Japanese politeness. Matsumoto (1988), for example, asserts that the formula is considered to be deferential imposition due to the speaker's dependence upon the hearer's benevolence.However, this paper argues that the formula is the implementation of one's tachiba-role which is mutually recognised between the interactants. Tachiba-roles are extracted through the interaction: what is the aim of the interaction, what social stance the interactants are taking, and what is actually going on in the interaction. They are interpreted as ‘job category, role, responsibility, task, stance’, depending on the nature of the interaction and are of primary importance in considering the occurrence of the formula. Although the formula itself presents a tentative approach, leaving the decision to the hearer, it cannot occur without the recognition of tachiba. This pragmatic condition entitles the speaker to utter the formula, and without it, the formula exercises a reverse effect; it constitutes an imposition by ignoring the interactive process with the hearer.This paper also examines various situations where the formula occurs. It is used not only as a ritualistic greeting, but also as a part of request or as confirmation of a request. Its interpretations vary, depending on how the given interaction proceeds, and its occurrence indicates the closing of a statement.

Die Didaktisierung von Phraseologismen im DaF-Unterricht anhand multimodaler Texte

Semantically complex units cover a high percentage of the lexicon of a language, ranging from collocations or routine formula to proverbs. The difficulty for learners of a foreign language lies in the fact that in many cases the meaning of those elements of the lexicon does not result just from addition of the meaning of individual constituents. Although (active and passive) knowledge about such lexical elements can be considered essential for successful communication in a foreign language, there still exists a lack (we focus on German as a foreign language, but we assume that the situation is comparable for other languages) of up-to-date and authentic didactic material that takes into account the characteristics of semantically complex units and the learners' cognitive strategies to analyze their meaning. In this paper we develop a didactic model that describes the use of magazine advertisements in teaching German as a foreign language. Due to their multimodality (e.g. the combination of verbal and visual elements) the texts allow the learners to better understand and actively use semantically complex units, even with a low competence level. In order to illustrate our didactic approach we present 5 advertisements that we have used with learners of German in their first and second year at a French university. It turns out that not only can phraseology be conveyed in an efficient way but that other educational objectives, such as a general increase of the learners' motivation, can be achieved.

Abuse of Casein Hydrolysate Formulas for Treating Infants With Severe Hyperbilirubinemia: In Reply

In Reply.—We thank Dr Bhutani for the opportunity to provide additional information regarding our controlled, randomized, double-blind trial of prophylaxis against jaundice among 64 breastfed newborns.1 Our study demonstrated that breastfed infants who received minimal aliquots of L-aspartic acid or enzymatically hydrolyzed casein for β-glucuronidase inhibition had increased fecal bilirubin excretion and less jaundice, without disruption of the breastfeeding experience. Although 2 previous studies of ours demonstrated that infants who were exclusively fed a casein hydrolysate formula had significantly less jaundice than infants who were exclusively fed either a routine formula or breast milk,2,3 we agree with Dr Bhutani that additional research would better define the ability of specific casein hydrolysate formula ingredients to reduce bilirubin and prevent excessive hyperbilirubinemia without interrupting breastfeeding.Space consideration prevented us from providing additional information regarding the subgroup analysis of 17 newborn infants with serum bilirubin levels in the first 48 hours of life that were above the low-risk zone (ie, >40th percentile on the nomogram developed by Bhutani et al4 that was included in the 2004 American Academy of Pediatrics hyperbilirubinemia guidelines5). The decline times (in hours) from a risk zone above the low-risk zone within the first 48 hours to a low-risk zone after 48 hours were compared among these 17 subjects and found to be significantly shorter in the combined groups that received a β-glucuronidase inhibitor compared with those that did not receive a β-glucuronidase inhibitor. Additional characteristics of these 17 infants are presented below in Table 1. The single infant in the enzymatically hydrolyzed casein group is particularly interesting because he was the only infant in the highest risk zone. As can be seen from these data, this infant had 2 significant risk factors for hyperbilirubinemia: male gender and a significantly lower gestational age (36 weeks) than the other groups. This infant's bilirubin level of 8.6 mg/dL at 22.7 hours of age (>95th percentile, highest risk zone) decreased to 8.5 mg/dL at 46.3 hours of age (40–75th percentile, low-intermediate–risk zone) and 7.7 mg/dL at 74.9 hours of age (<40th percentile, low-risk zone) and remained in the low-risk zone thereafter. Despite inclusion of this more significantly jaundiced, lower-gestational-age infant along with those in the L-aspartic acid group to form the group receiving β-glucuronidase inhibition, this group had a significantly faster decline from a risk zone above the low-risk zone within the first 48 hours to a low-risk zone after 48 hours than the group receiving no β-glucuronidase inhibition.Although our small study is very encouraging, at this point in time we concur with Dr Bhutani that the use of a casein hydrolysate formula, L-aspartic acid, or enzymatically hydrolyzed casein is premature and that administration of these supplements to infants at risk for severe hyperbilirubinemia requires additional research. Future research regarding use of such nutritional supplements for breastfed infants would be of particular interest in infants with either hour-specific bilirubin levels associated with increased risk for the subsequent development of severe hyperbilirubinemia or in infants with clinical risk factors increasing their risk of severe hyperbilirubinemia. This research should be conducted in a manner to minimize any possible negative effects on breastfeeding and must include careful analysis to assess any possible negative effects on breastfeeding.

Abuse of Casein Hydrolysate Formulas for Treating Infants With Severe Hyperbilirubinemia

In Reply .— We thank Dr Bhutani for the opportunity to provide additional information regarding our controlled, randomized, double-blind trial of prophylaxis against jaundice among 64 breastfed newborns.1 Our study demonstrated that breastfed infants who received minimal aliquots of L-aspartic acid or enzymatically hydrolyzed casein for β-glucuronidase inhibition had increased fecal bilirubin excretion and less jaundice, without disruption of the breastfeeding experience. Although 2 previous studies of ours demonstrated that infants who were exclusively fed a casein hydrolysate formula had significantly less jaundice than infants who were exclusively fed either a routine formula or breast milk,2,3 we agree with Dr Bhutani that additional research would better define the ability of …

Nutritional factors that affect the postnatal metabolic adaptation of full-term small- and large-for-gestational-age infants.

To document metabolic adaptation to ex utero life in small- (SGA) and large-for-gestational-age (LGA) infants in relation to fetal nutrition and postnatal feeding practices. In a prospective study, 65 SGA (< or = second centile) and 39 LGA (> or = 98th centile) full-term infants were recruited. Anthropometry was performed within the first 48 hours. There was full support of breastfeeding and close clinical observation. Blood glucose and ketone body (kb) concentrations were measured prefeed for the first 7 postnatal days. Infants were exclusively breastfed (BF), breastfed with formula milk supplementation (FS), or exclusively formula milk fed (FF). Within the SGA group, a measure of "thinness," the midarm circumference/head circumference ratio, was significantly correlated to the number of episodes of blood glucose < 2.00 mmol/L. Epoch (age at sampling) analysis in this group showed no difference in blood glucose levels across the different feeding groups but revealed a statistically significant greater kb concentration for infants who were exclusively breastfed. For SGA infants, the median peak kb concentration (peak kb) was significantly different for BF, FS, and FF groups. Multiple regression analysis for the SGA group demonstrated that peak kb concentration was negatively related to the volume of formula milk, independent of blood glucose levels and neonatal anthropometry. For LGA infants, low blood glucose levels were offset by kb concentrations equivalent to those observed in infants who were appropriate for gestational age. Neonatal ability to generate kb when blood glucose values are low depends more on successful breastfeeding than on size for gestational age or neonatal nutritional status. Routine blood glucose monitoring of LGA infants with no additional risk factors is not necessary. Routine formula milk supplementation for LGA and SGA infants should not be recommended.

Bacterial contamination during routine formula preparation

A major concern in infant nutrition is bacterial contamination during reconstitution of powdered formula. Although freshly expressed breast milk contains bacterial growth inhibitors that may prevent bacterial proliferation even for several hours of nonrefrigerated conditions, 1 Pittard WB Anderson DM Cerutti ER Boxerbaum B Bacteriostatic qualities of human milk. J Pediatr. 1985; 107: 240-243 Abstract Full Text PDF PubMed Scopus (18) Google Scholar reconstituted infant formula represents an ideal culture medium for bacterial growth. In third-world countries, formula-fed infants have higher infection rates and higher death rates from infection than do breast-fed infants, which may be explained, in part, by lack of appropriate hygiene during formula reconstitution and preparation.

Second-level discourse markers across languages

This article looks at a particular type of routine formula, called ‘second-level discourse marker’ (SLDM), which falls within the scope of what is sometimes termed ‘procedural vocabulary’. Having defined and exemplified the notion, I set up a structural typology of SLDMs. I then proceed to discuss the possibility of structural equivalence between English, German and French SLDMs. I conclude by exploring the treatment accorded to SLDMs in some of the major bilingual dictionaries. The language material used for purposes of illustration is drawn from a wide variety of corpora.

A novel inhibitor of beta-glucuronidase: L-aspartic acid.

Infants who consume casein hydrolysate formula have been shown to have lower neonatal jaundice levels than infants who consume routine formula or breast milk. Because casein hydrolysate has been shown to contain a beta-glucuronidase inhibitor, one possible mechanism to explain this finding is blockage of the enterohepatic circulation of bilirubin by a component of the formula. The aim of this research was to identify the source of the beta-glucuronidase inhibition in hydrolyzed casein. A beta-glucuronidase inhibition assay and measurements of physical and kinetic parameters were used to analyze the components of hydrolyzed casein and infant formulas. Kinetic studies used purified beta-glucuronidase. The L-aspartic acid in hydrolyzed casein accounts for the majority of the beta-glucuronidase inhibition present. Kinetic studies indicate a competitive inhibition mechanism. L-aspartic acid is a newly identified competitive inhibitor of beta-glucuronidase.

Breastfeeding, Diet, and Neonatal Hyperbilirubinemia

After completing this article, readers should be able to: 1. Compare and contrast the incidence of hyperbilirubinemia between breastfed and formula-fed infants throughout the neonatal period and its relationship to early hospital discharge. 2. Describe possible reasons for the occurrence of hyperbilirubinemia in breastfed infants. 3. Compare and contrast the incidence of hyperbilirubinemia related to different infant formulas. Among the many factors related to neonatal hyperbilirubinemia is the composition of an affected infant’s diet. In 1879, Frerichs suggested that “bad nursing” could “exercise a powerful influence” on neonatal hyperbilirubinemia. Much has been learned since this suggestion was made. ### EPIDEMIOLOGY Many investigations have documented that the consumption of human milk is related to neonatal hyperbilirubinemia, including one review of 12 studies involving more than 8,000 infants in the first week of life and controlled for factors such as hemolysis to enable comparison of dietary effects alone. Moderate hyperbilirubinemia (total serum bilirubin [TSB], 205 mcmol/L [12 mg/dL]) was present in 12.9% of the breastfed infants and 4% of the formula-fed infants ( P <0.00001). Severe hyperbilirubinemia (TSB, 256 mcmol/L [15 mg/dL]) was present in 2% of the breastfed infants and 0.3% of the formula-fed infants ( P <0.00001). Breastfed infants have higher serum bilirubin levels on each of the first 5 days of life, and this hyperbilirubinemia can persist for weeks to months. The association between feedings of human milk and neonatal hyperbilirubinemia has been reported in preterm infants fed banked human milk or mixtures of human milk and formula and among various races. More recent studies of otherwise healthy newborns have used noninvasive transcutaneous devices to assess hyperbilirubinemia daily (Figs. 1⇓ and 2⇓ ). These studies agree with earlier conclusions that otherwise healthy infants exclusively fed human milk will have higher levels of hyperbilirubinemia than infants who consume formula. The difference begins to become significant …

Breastfeeding duration and current neonatal feeding practices in Emilia Romagna, Italy

A cohort of 1567 infants was studied at birth and at 3 mo of age to elucidate factors possibly affecting feeding policies in the maternity ward and the relationship with subsequent feeding patterns. During their stay in the maternity wards 89.6% of infants were breastfed, with 28.1% receiving formula in addition to mother's milk. Independent predictors of receiving a formula supplement in the maternity wards as a result of multivariate analyses were the separation of the newborn from the mother, a birthweight lower than 3000 g and a gestational age lower than 38 wk. At 3 mo of age, 66.1% infants were still at least partially breastfed and 48.9% were exclusively breastfed. An increased risk of not being breastfed at 3 mo of age was related to supplementary feeding at birth and birthweight. A weak relationship was found between the prevalence of breastfeeding at 3 mo of age and the magnitude of routine formula supplement use in the maternity ward. Given the present trends for early discharge from maternity wards and the National Health System facility for free paediatric assistance after discharge, in Italy paediatricians should be the main actors to support the continuation of breastfeeding.

Hubris or Humanism? A Reply to Susan White

I would like to thank Susan White (1997) for the interest she has taken in my paper, and indeed for her partial endorsement of my thesis. However, she raises a number of serious objections to my analysis which require response. As my allotted space is very limited, I must apologise in advance (not least to Sue White) for my brisk, blunt, skeletal and selective approach. Probably the most serious error that I am charged with is that I 'inadvertently equated power with repression', thus neglecting productive power, which 'ought to have been central' (1997:348) to my analysis. Accordingly, I failed to recognise that power can be enjoyed as well as suffered. There was nothing inadvertent in my treatment of productive power. I directly addressed the Foucauldian concept of the production of the subject and the possibility of 'happy prisoners within the panopticon', arguing that without the inclusion of some notion of coercion 'the concept of subjectification loses its critical purchase' (1996:70). Now it may well be that White does not accept my inclusion of conflicts of interest as an essential component of power, productive or otherwise (1996:74, cf. Lukes 1974), but, if so, it is incumbent upon her to argue the case. By not acknowledging that I explicitly articulated such a position, she absolves herself of that responsibility. My reason for attempting to pin down power was based on dissatisfaction with the broadness of Foucault's conceptualisation. If knowledge is produced by power, if pleasure and pain are produced by power, if discourse, 'truth' and indeed reality are produced by power, if our very human subjectivity is produced by power, then what isn't? There are two related problems here. First, the breadth of explanatory work that is being expected of power means that it loses the capacity to aid our understanding of specific instances. As the invariable answer to any question, it becomes a routine formula, an empty signifier. Conversely, such an approach does violence to the specificities of the social world, in that it attempts to dissolve the complexities of thoughts and actions into the universal of power. For these reasons, I cannot accept White's contention that my critique of Foucault's portrayal of power as ubiquitous was

Mineral balance studies in very low birth weight infants fed human milk

Mineral homeostasis often is disrupted in the very low birth weight (VLBW) infant fed either human milk or commercial formula that contains insufficient quantities of available calcium (Ca) and phosphorus (P). Alterations in mineral homeostasis include abnormal patterns of serum (Ca and P concentrations and alkaline phosphatase activity) and urine (Ca and P) biochemical markers, low net Ca and P retentions in comparison with intrauterine estimates of mineral accretion, and decreased bone mineral content. A two-phase study was conducted in our laboratory to test for these alterations in mineral homeostasis. In phase 1, VLBW infants fed a preparation of fortified human milk (either human milk-derived fortifier I or II or cow milk-derived fortifier) or cow milk-based formula specially designed for VLBW infants were evaluated during their hospitalization. In phase 2, after hospitalization, these infants were evaluated during the first 6 months of life when fed either their mother's milk or routine formula exclusively. The bioavailability of Ca and P from the tested preparations varied widely. Although the fortification of human milk resulted in both an improved biochemical pattern and net retention of Ca and P, optimal intrauterine mineral accretion was not achieved in any group tested. Longitudinal assessments of bone mineralization, by single photon absorptiometry, demonstrated that human milk-fed former VLBW infants had reduced bone mineral content. These investigations suggest that former VLBW infants fed human milk exclusively may be at risk for Ca and P deficiencies.

BONE MINERALIZATION IN PRETERM INFANTS FED HUMAN MILK

Bone mineral status was assessed in 20 healthy, appropriately grown infants <1600g birthweight assigned randomly to one of 2 diets: 1. Preterm human milk (PT milk) pooled by postpartum week and fed corresponding to infants postnatal age, providing calcium 22-26 mg/dl, phosphorus 13-17 mg/dl. 2. Supplemented PT milk, an equal mixture of premature infant formula and PT milk providing calcium 72-74 mg/dl, phosphorus 37-38 mg/dl. All infants were fed by gavage at 180 ml/kg/day and received 400 IU Vitamin D daily. Infants fed PT milk had significantly lower serum phosphorus levels at 4 and 5 wk (4.6±0.4 and 4.1±0.4 mg/dl) than infants fed supplemented PT milk (6.1±0.2 and 6.0±0.2 mg/dl), p<.005. They also had significantly higher serum alkaline phosphatase levels at 4 and 5 wk (569±81 and 824±127 IU/1) than the supplemented group (340±40 and 347±49 IU/1), p<.02. The serum differences were reflected in lower bone mineral content (BMC) of humerus by photon densitometry at 5 wk (PT milk, .084±.005 vs supplemented PT milk .107±.007 g/cm, p<.05). At 35-37 postconceptual wk, infants in both groups were discharged on standard infant formula (calcium 51 mg/dl, phosphorus 39 mg/dl). At 44 postconceptual weeks, infants initially fed either PT milk or supplemented PT milk, had similar serum phosphorus (6.7±0.2 and 7.2±0.2 mg/dl) and alkaline phosphatase (301±33 and 285±23 IU/1; BMC in both groups (.252±.021 and .246±.014 g/cm) was comparable to that of healthy term infants (.223±.006). Preterm infants fed unsupplemented PT milk show bone demineralization. BMC increases significantly after routine formula feeding irrespective of PT milk supplementation.