Breastfed Term Infants Research Articles

Iron deficiency in healthy, term infants aged five months, in a pediatric outpatient clinic: a prospective study

BackgroundIron deficiency (ID) is prevalent in Malaysian children. The incidence of ID in infants under 6 months of age is unknown. Our aim was to determine the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in healthy, term infants aged below 6 months in our hospital population.MethodsA prospective longitudinal pilot study of mother-infant pairs was conducted on infants receiving routine immunizations in a mother and child clinic at a university hospital, in Kuala Lumpur, Malaysia. Mothers completed standardized questionnaires at 3- and 5-month postnatal visits. Maternal and infant full blood count, ferritin, and C-reactive protein (CRP) levels were measured at 3 months and for the infants repeated at 5 months. Infant anthropometric measurements were obtained at both visits. We conducted a univariate analysis to identify factors associated with ID and IDA.ResultsAltogether, 91 mother-infant pairs were enrolled, with 88 completing the study. No infant had ID or IDA at 3 months; the lowest ferritin level was 16.6 µg/L. At 5 months, 5.9% (5/85) of infants had ID, and 2.4% (2/85) had IDA. Median (interquartile range) infant ferritin levels significantly declined from 113.4 (65.0–183.6) µg/L at 3 months to 50.9 (29.2–70.4) µg/L at 5 months, p < 0.001. Exclusive breastfeeding until 3 or 5 months was significantly associated with ID at 5 months (p = 0.020, and p = 0.008, respectively) on univariate analysis. The drop in ferritin between 3–5 months was significantly associated with weight and length gains between 0–3 months (p = 0.018, p = 0.009, respectively). Altogether, 14.3% of infants exclusively breastfed until 5 months developed ID. At 5 months, 3.4% of infants were underweight, 1.1% stunted, and 10.2% wasted.ConclusionsIn exclusively breastfed term infants, ID occurred by 5 months. Early introduction of iron-rich foods should be considered in exclusively breastfed babies. A high prevalence of wasting suggests a calorie deficit in this population and will lead to stunting if not addressed.

Effect and Concern of Breastfeeding in Infants.

Human breast milk is considered the optimal source of nutrition for infants and is recommended as the exclusive nutrient source for term infants during the first six months of life. Existing evidence strongly supports the direct benefits of breastfeeding, encompassing benefits for nutrition, gastrointestinal function, and protection against acute illness in both term and preterm infants. Previously, we demonstrated a notable reduction in a urinary marker of oxidative DNA damage in breastfed term and preterm infants compared to formula-fed infants. While long-term benefits of breastfeeding on neurodevelopmental outcomes and adult health have been reported, the effects may be relatively modest and limited.

Growth of late preterm infants fed nutrient-enriched formula to 120 days corrected age-A randomized controlled trial.

We aimed to compare the effects of nutrient-enriched formula with standard term formula on rate of body weight gain of late preterm infants appropriately grown for gestational age. A multi-center, randomized, controlled trial. Late preterm infants (34-37 weeks' gestation), with weight appropriate for gestational age (AGA), were randomized to nutrient enriched formula (NEF) with increased calories (22 kcal/30 ml) from protein, added bovine milk fat globule membrane, vitamin D and butyrate or standard term formula 20 kcal/30 ml (STF). Breastfed term infants were enrolled as an observational reference group (BFR). Primary outcome was rate of body weight gain from enrollment to 120 days corrected age (d/CA). Planned sample size was 100 infants per group. Secondary outcomes included body composition, weight, head circumference and length gain, and medically confirmed adverse events to 365 d/CA. The trial was terminated early due to recruitment challenges and sample size was substantially reduced. 40 infants were randomized to NEF (n = 22) and STF (n = 18). 39 infants were enrolled in the BFR group. At 120 d/CA there was no evidence of a difference in weight gain between randomized groups (mean difference 1.77 g/day, 95% CI, -1.63 to 5.18, P = 0.31). Secondary outcomes showed a significant reduction in risk of infectious illness in the NEF group at 120 d/CA [relative risk 0.37 (95% CI, 0.16-0.85), P = 0.02]. We saw no difference in rate of body weight gain between AGA late preterm infants fed NEF compared to STF. Results should be interpreted with caution due to small sample size. The Australia New Zealand Clinical Trials Registry (ACTRN 12618000092291). "mailto:maria.makrides@sahmri.com" maria.makrides@sahmri.com.

Prevalence of subclinical Vitamin K deficiency in early infancy in exclusively breast-fed term infants

Prevalence of subclinical Vitamin K deficiency in early infancy in exclusively breast-fed term infants

Iron Deficiency Anaemia among Exclusively Breastfed Term Infants of 4-6 Months Age and its Contributing Factors: A Cross-sectional Study

Introduction: The risk of Iron Deficiency (ID) is a major concern associated with exclusively breastfed infants of age 4-6 months. According to World Health Organisation (WHO) iron should be universally supplemented from six months onwards instead of four months as recommended by American Academy of Paediatrics (AAP). Aim: To determine ID and Iron Deficiency Anaemia (IDA) among infants of age 4-6 months and relation of same to various socioeconomic and maternal parameters. Materials and Methods: This was a hospital-based, prospective, cross-sectional study conducted in the Department of Paediatrics of a tertiary care hospital in India. It included a sample population of 200 exclusively breastfed term infants, of age 4-6 months. Iron status was determined by studying the haemoglobin and serum ferritin levels and their associations to demographic, socio-economic and maternal parameters. Qualitative variables were analysed using the Chi-square test/Fisher's-exact test. Univariate and multivariate logistic regression was used to find out significant risk factors of ID and IDA. Results: Age wise distribution of infants was 91 (45.5%), 62 (31%), and 47 (23.5%) at 4, 5, and 6 months. Male-to-female ratio was 1.7:1. Mean±SD value of haemoglobin and serum ferritin was 10.82±0.60 g/dL and 44.60±25.02 μg/L, respectively. Prevalence of ID was 11 (12.09%), 16 (25.81%), and 16 (34.04%) at ages 4, 5, and 6 months, respectively. On multivariate regression analysis, age of mother &lt;20 years (p-value 0.043), and increasing parity (p-value 0.001) were associated with low iron status. Conclusion: Almost one-third healthy, term exclusively breastfed infants become iron deficient by the age of six months. The study supports the need for iron supplementation from the age of four months universally instead of six months in exclusively breastfed term infants.

Vitamin D status in full-term exclusively breastfed infants versus full-term breastfed infants receiving vitamin D supplementation in Thailand: a randomized controlled trial

BackgroundMany international medical organizations recommend vitamin D supplementation for infants, especially exclusively breastfed infants. In Thailand, however, data regarding the vitamin D status in Thai infants are lacking. Such data would help to support physician decisions and guide medical practice.MethodsFull-term, exclusively breastfed infants were randomized into two groups at 2 months of age to continue exclusive breastfeeding either without vitamin D supplementation (control group, n = 44) or with vitamin D3 supplementation at 400 IU/day (intervention group, n = 43) until 6 months of age. At 6 months, the serum vitamin D (25OHD) of the infants and their mothers, serum bone marker, and infants’ growth parameters were compared between the two groups.ResultsThe infants’ serum 25OHD concentration was lower in the control group than intervention group (20.57 ± 12.66 vs. 46.01 ± 16.42 ng/mL, p < 0.01). More infants had vitamin D sufficiency (25OHD of > 20 ng/mL) in the intervention group than control group (93.0% vs. 43.2%, p < 0.01). There were no significant differences in the maternal 25OHD concentrations between the control and intervention groups (25.08 ± 7.75 vs. 23.75 ± 7.64 ng/mL, p = 0.42). Serum calcium, phosphorus, intact parathyroid hormone, alkaline phosphatase, and infants’ growth parameters were comparable between the two groups. After adjustment for the confounding factors, 25OHD concentration in the intervention group was 25.66 ng/mL higher than the control group (95% confidence interval, 19.07–32.25; p < 0.001). Vitamin D supplement contributed to an 88.7% decrease in the prevalence of vitamin D insufficiency/deficiency (relative risk, 0.11; 95% confidence interval, 0.04–0.35; p < 0.01).ConclusionsMost full-term, exclusively breastfed Thai infants have serum vitamin D concentration below sufficiency level at 6 months of age. However, vitamin D supplementation (400 IU/day) improves their vitamin D status and prevents vitamin D deficiency.Trial registrationThe study was pre-registered in the Thai Clinical Trials Registry (TCTR20190622001) on 22/06/2019.

Prevalence of Vitamin B12 Deficiency among Exclusively Breast Fed term infants

Objective: To determine the rate of vitamin B 12 deficiency among exclusively breast fed term infants in central Punjab Method: This descriptive case series included all 120 exclusively breast fed, term, and healthy infants with age range 1-6 months at Children, Hospital, Lahore. The maternal socio-demographic details in addition to infants’ anthropometric measurements were recorded and CBS and serum Vit B12 levels were evaluated by sending the samples to the hospital lab. We used SPSS 16th vesion for data analysis. Results: Mean age of the infants was 3.25+1.47 months. 58.33%(n=70) were male and 41.67%(n=50) were female infants. The mean serum vitamin B12 levels were recorded as 196.81 (±121.432)pg/mL. Frequency of low vitamin B12 (&lt;200 pg/ml)in infants was recorded in Low serum vitamin B12 levels (&lt;200 pg/ml) was seen in 66 (55%) of infants. Conclusion: The rate of vit B12 deficiency is higher in EBF infants and due to its an important role in neurologic development during infancy, it is necessary to address this issue in infants

Osteopathic manipulative treatment to improve exclusive breast feeding at 1 month

ObjectivePrevious studies have assessed breastfeeding-support programmes. Among these, osteopathic manipulative treatment (OMT) is a frequently used approach, although without strong evidence of efficacy.MethodsA double-blind randomised controlled trial was conducted between...

Prevalence of Vitamin B12 Deficiency among Exclusively Breast Fed Term Infants in South India.

Vitamin B12 is not synthesized in the body and its only dietary sources are non-vegetarian. The breast milk of mothers in resource poor countries who are on predominantly vegetarian diets is deficient in vitamin B12. Hence exclusive breast feeding (EBF) may result in B12 deficiency in the infant, which can affect the neurodevelopmental outcome. Our aim was to study the serum vitamin B12 levels among EBF infants and identify the risk factors for B12 deficiency. This cross-sectional study was done among EBF, term, otherwise healthy infants, 1-6 month of age in the well-baby clinic .The sociodemographic data of mother and the infants' anthropometric measurements were noted and blood samples were sent for complete blood count and serum vitamin B12 levels. The data were analysed using SPSS software version 16. We enrolled 149 EBF infants, aged 1-6 months and the mean age was 3.1 (±1.03) months. The mean serum vitamin B12 level was 199.91 (±112.523) pg/ml. Low serum vitamin B12 levels (<200 pg/ml) was seen in 95 (63.7%) infants. On multivariate analysis, there were no other significant risk factors for B12 deficiency in the infants. The prevalence of vitamin B12 deficiency among EBF infants is 63.7%. Because of its importance in neurological development during infancy, there is an urgent need to address this issue while promoting exclusive breast feeding.

Birth weight related essential, non-essential and conditionally essential amino acid blood concentrations in 12,000 breastfed full-term infants perinatally

Essential, non-essential and conditionally essential amino acid blood concentrations play a critical role in newborns. We aimed to quantitate most of these amino acids in the blood of full-term breastfed infants, perinatally and correlate the obtained values with their birth weight. Breastfed full-term infants (n = 12,000; 6000 males, 6000 females) with birth weight 2000–4000 g were divided into 4 equal groups: Group A, 2000–2500 g; B, 2500–3000 g; C, 3000–3500 g and D, 3500–4000 g. Blood samples as Dried Blood Spots (DBS) were collected on the 3rd day of life and analyzed via liquid chromatography-tandem mass spectrometry (LC-MS/MS) protocol. Blood concentrations of the amino acids, Phenylalanine, Leucine, Glutamine, Ornithine, Alanine, Tyrosine and Glycine in full-term breastfed newborns, were found to be related to their birth weight, perinatally. On the contrary, no relationship between birth weight and blood concentrations of the amino acids Valine, Methionine, Citrulline and Arginine was found. Due to the number of the samples, data from this study could be applied as neonatal screening reference values for full-term breastfed newborns in relation to their birth weight.

Birth weight related blood concentrations of the neurotransmission amino acids glutamine plus glutamate, phenylalanine and tyrosine in full-term breastfed infants perinatally

Background The amino acids glutamine plus glutamate, phenylalanine and tyrosine are implicated in neurotransmission. We aimed to evaluate these amino acid blood concentrations in full-term breastfed infants with different birth weight (BW) perinatally. Methods Breastfed full-term infants (n = 6000, males 3000, females 3000) BW 2000-4000 g were divided into four equal groups. Both males and females Groups A, 2000-2500 g, B 2500-3000 g, C 3000-3500 g, D 3500-4000 g. Blood samples on Guthrie cards, were taken on the 3rd day of life and quantified via a liquid chromatography tandem mass spectrometry (LC-MS/MS) method. Results Glutamine plus glutamate mean values were found to be statistically significantly different between males vs. females in all the studied groups. The highest values were determined in both males and females in group D. Statistically significantly higher values of phenylalanine appeared in group D vs. other groups. Tyrosine mean values were calculated to be statistically significantly different in both sexes in group A compared to other groups. Conclusions Differences of glutamine plus glutamate, phenylalanine and tyrosine levels among full-term newborns with different BW are presented for the first time in the literature. Newborns with BW 3000-4000 g are benefited by having higher concentrations of the mentioned neurotransmission related amino acids. Neonatal screening reference values for these amino acids in relation to BW could be established, not only for preterm and low BW infants but also for full-term newborns with BW >3000 g.

Quantifying breast milk intake by term and preterm infants for input into paediatric physiologically based pharmacokinetic models.

Despite the many benefits of breast milk, mothers taking medication are often uncertain about the risks of drug exposure to their infants and decide not to breastfeed. Physiologically based pharmacokinetic models can contribute to drug‐in‐milk safety assessments by predicting the infant exposure and subsequently, risk for toxic effects that would result from continuous breastfeeding. This review aimed to quantify breast milk intake feeding parameters in term and preterm infants using literature data for input into paediatric physiologically based pharmacokinetic models designed for drug‐in‐milk risk assessment. Ovid MEDLINE and Embase were searched up to July 2, 2019. Key study reference lists and grey literature were reviewed. Title, abstract and full text were screened in nonduplicate. Daily weight‐normalized human milk intake (WHMI) and feeding frequency by age were extracted. The review process retrieved 52 studies. A nonlinear regression equation was constructed to describe the WHMI of exclusively breastfed term infants from birth to 1 year of age. In all cases, preterm infants fed with similar feeding parameters to term infants on a weight‐normalized basis. Maximum WHMI was 152.6 ml/kg/day at 19.7 days, and weighted mean feeding frequency was 7.7 feeds/day. Existing methods for approximating breast milk intake were refined by using a comprehensive set of literature data to describe WHMI and feeding frequency. Milk feeding parameters were quantified for preterm infants, a vulnerable population at risk for high drug exposure and toxic effects. A high‐risk period of exposure at 2–4 weeks of age was identified and can inform future drug‐in‐milk risk assessments.

Colonization by B. infantis EVC001 modulates enteric inflammation in exclusively breastfed infants

BackgroundInfant gut dysbiosis, often associated with low abundance of bifidobacteria, is linked to impaired immune development and inflammation—a risk factor for increased incidence of several childhood diseases. We investigated the impact of B. infantis EVC001 colonization on enteric inflammation in a subset of exclusively breastfed term infants from a larger clinical study.MethodsStool samples (n = 120) were collected from infants randomly selected to receive either 1.8 × 1010 CFU B. infantis EVC001 daily for 21 days (EVC001) or breast milk alone (controls), starting at day 7 postnatal. The fecal microbiome was analyzed using 16S ribosomal RNA, proinflammatory cytokines using multiplexed immunoassay, and fecal calprotectin using ELISA at three time points: days 6 (Baseline), 40, and 60 postnatal.ResultsFecal calprotectin concentration negatively correlated with Bifidobacterium abundance (P < 0.0001; ρ = −0.72), and proinflammatory cytokines correlated with Clostridiaceae and Enterobacteriaceae, yet negatively correlated with Bifidobacteriaceae abundance. Proinflammatory cytokines were significantly lower in EVC001-fed infants on days 40 and 60 postnatally compared to baseline and compared to control infants.ConclusionOur findings indicate that gut dysbiosis (absence of B. infantis) is associated with increased intestinal inflammation. Early addition of EVC001 to diet represents a novel strategy to prevent enteric inflammation during a critical developmental phase.

Maximizing Nutrient Availability for the Breastfed Infant Through Colonization with B. Infantis EVC001 (FS04-04-19)

ObjectivesHuman breastmilk contains complete nutrient composition required for the developing infant, including human milk oligosaccharides (HMO). These complex carbohydrates are indigestible by the infant alone, and require digestion by gut microbes, namely Bifidobacterium longum subsp. infantis (B. infantis). However, decades of C-section delivery, formula feeding and increasing exposure to antibiotics have contributed the loss of this critical infant-associated gut bacterium in developed countries. Therefore, restoring B. infantis to the infant gut was hypothesized to improve the nutritional utilization of human breastmilk in healthy term infants. MethodsIn an open trial, healthy, exclusively breastfed term infants were fed 1.8 × 1010 CFU B. infantis EVC001 daily from day 7–27 postnatal (n = 34; EVC001-fed), or breastmilk alone (n = 32; control group). Fecal samples, milk samples, and weekly self-reported data were collected and analyzed for infant gut microbiome composition and function, human milk oligosaccharide composition, and fecal metabolites. 16S rRNA sequencing and shotgun metagenome sequencing provided characterization of microbial communities from birth through 60 days postnatal. ResultsInfants fed B. infantis EVC001 were uniformly colonized with this organism at 1011 CFU/g feces, while infants in the control group had a median total Bifidobacterium level below 10^5 CFU/g feces, despite exclusive breastfeeding. Mass spectrometry of fecal samples from B. infantis EVC001-fed infants showed that the resulting microbial community produced higher concentrations of lactate and acetate and lower excretion of HMO, while control infants showed significantly lower ability to capture and utilize these carbohydrates from human milk. Importantly, HMO content of breastmilk was not significantly different between groups and no difference was found in the gut microbiome of infants based on secretor status of mothers (presence or absence of 2’FL in breastmilk). Further, these changes were associated with reductions in taxa that have been associated with negative health outcomes including colic, asthma, eczema and allergy. ConclusionsOverall, colonization with B. infantis is observed to be an effective way to restore maximal function of the infant gut microbiome to improve nutrient availability in the breastfed infant. Funding SourcesThis study was funded by Evolve BioSystems, Inc.

Effectiveness of probiotics in infantile colic: A rapid review.

Infantile colic (IC) is a troubling condition with limited treatment options for young infants. This rapid review aims to synthesize the evidence for probiotics in the treatment and prevention of IC in healthy term infants. We searched in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews for systematic reviews (SRs), and randomized control trials (RCTs) published between January 1, 2000 and July 11, 2018. Trials were included if they recruited healthy full-term infants who received probiotics for treatment or prevention of colic. The quality of evidence was assessed using GRADE criteria. As supplementary information, the safety of probiotics in infants was searched within the reviewed studies and other recent publications. We identified four SRs and meta-analyses that included six RCTs, and found an additional three RCTs evaluating probiotics for the treatment of IC. One SR and six RCTs were identified for prevention of IC; four of the RCTs were included in the SR and two were published later. The probiotic Lactobacillus reuteri was used in the majority (five of eight) of treatment trials, and was found to significantly reduce crying in colicky breast-fed infants compared to placebo. Only two of the six prevention trials showed a significant decrease in crying time compared to placebo, although another two trials showed other benefits of probiotics, including reduced use of medications (simethicone and cimetropium bromide) and physician visits. No adverse events were identified in the included studies; other research suggests probiotics are generally safe in healthy children. This rapid review identified limited but favourable evidence of benefit of using probiotics for the treatment of IC in full-term breast-fed infants. While routine use of probiotics for treating or preventing IC cannot yet be recommended, it can be an option to manage IC.

Effect of human breast milk on biological metabolism in infants.

The metabolic changes that occur during the postnatal weaning period appear to be particularly important for future health, and human breast milk is considered to provide the optimal source of nutrition for infants. Our previous studies examined the effect of feeding type on antioxidative properties, glucose and insulin metabolism, the lipid profile, metabolomics, and prostaglandin (PG) metabolism in term and preterm infants. A urinary marker of oxidative DNA damage (8-hydroxy-2'-deoxyguanosine) was significantly lower in breast-fed term and preterm infants than in formula-fed infants. Markers of insulin sensitivity were significantly lower and atherosclerotic indices were significantly higher in breast-fed preterm infants than in mixed-fed infants at discharge. On urinary metabolomics analysis, choline, choline metabolites, and lactic acid were significantly lower in breast-fed term infants than in formula-fed infants. Urinary PGD2 metabolite level in breast-fed term infants was also significantly lower than in formula-fed term infants. This indicates that human breast milk affects biological metabolism in early infancy.

Normative Data for Lean Mass and Fat Mass in Healthy Predominantly Breast-Fed Term Infants From 1 Month to 1 Year of Age

Background: A leaner body phenotype in infancy plays an important role in the early life prevention of obesity. However, there is a dearth of reference data for body composition in infancy. This study aimed to create a normative reference dataset for lean (LM) and fat (FM) mass and accretion rates in healthy infants. Methods: Healthy term-born infants (35 boys; 35 girls) were studied at ≤ 1, 3, 6, 9, and 12 mo of age for growth and compared to World Health Organization standards. LM (g) and FM (g) were measured using DXA (APEX version 13.3:3, Hologic 4500A) in infant whole-body mode. Sex specific reference curves were generated using the LMS method (LMSchartmaker, Medical Research Council, UK). Results: Infants were predominantly white (82.9%), breastfed (98.4% ≥ 3 mo), and grew in length and weight within World Health Organization Z-score ranges for normal growth across infancy. LM accretion was 327.4 ± 12.5 g/mo representing 95% increment in LM. Boys had more LM compared to girls at 12 mo (7807.4 ± 1114.0 vs 6817.4 ± 1016.1 g; p = 0.008). FM accretion was 114.3 ± 12.0 g/mo representing 114% increment in FM with no difference between the sexes. Conclusions: This data, which is based on a healthy sample of infants, characterizes LM and FM accretion during the first year of life and will aid in the interpretation of body composition.

The Imprint (infant Microbiota and Probiotic Intake) Study: Microbiome Remodeling in Breast-fed Term Infants Following Supplementation and Subsequent Colonization of a Keystone Bifidobacterium Species

The Imprint (infant Microbiota and Probiotic Intake) Study: Microbiome Remodeling in Breast-fed Term Infants Following Supplementation and Subsequent Colonization of a Keystone Bifidobacterium Species

Maternal Vitamin D Supplementation Among Lactating Mothers in the Prevention of Vitamin D Deficiency Among Breastfed Term Infants: A Meta Analysis

Maternal Vitamin D Supplementation Among Lactating Mothers in the Prevention of Vitamin D Deficiency Among Breastfed Term Infants: A Meta Analysis

Study of vitamin D levels in exclusively breastfed term infants in a tertiary care centre

Background: Exclusive breast-feeding is recommended up to 6 months of age with all its beneficial effects on child survival. Several studies have concluded that adequate intake of vitamin D cannot be met with human milk as the sole source of vitamin D. So this study was undertaken to study the serum vitamin D levels in exclusively breastfed babies and their mothers in a tertiary care hospital.Methods: It was a prospective observational study. A minimum of 100 healthy infants born at term (38-42 weeks) and weighed &gt;2.5kgs at birth and who were exclusively breast fed from age group 3-6 months attending the hospitals attached to J J M M C were selected for study. Approval from the ethical committee of the institution was obtained.Results: In this study there were totally 43% of males and 57% of females. Among them 14 (14%) of the infants were vitamin D deficient and 19 (19%) infants were vitamin D insufficient. And in 100 mothers studied 25 (25%) mothers were vitamin D deficient and 24 (24%) mothers were insufficient of vitamin D. The mean vitamin D level in infants was 25.72 ng/ml (±11.31ng/ml) and in mothers’ it was 22.09ng/ml (±9.17ng/ml).Conclusions: Breastfeeding might be one the contributing factors if the infant is not adequately exposed to sunlight for endogenous synthesis of vitamin D and if the mother is deplete in vitamin D levels transferring lower amount of vitamin D to infant through breast milk.