Infant Weaning Research Articles

Physicochemical characteristics of weaning food formulated from different blends of cereal and soybean

The physicochemical characteristics of porridges of adult and infant weaning food prepared from fermented blends of cereals and soybean are reported in this study. The pH of the formulated flour blends was less than 5.0 within 12 h of fermentation with F15B and F410B, attaining a pH of 3.4. Titratable acidity, which was not detected in unfermented samples, increased as the fermentation progressed. An increase in the gross energy content was noted with F25B, yielding a value of 439.0 kcal/100 g. All the fermented flour blends reconstituted well in boiling water and the water-holding capacity also increased. There was a slight difference in the bulk densities of the loose and packed flour. The index of gelatinization of unfermented formulated flour ranged from 82 (B. U.) in F15A to 334 (B. U.) in F310A. However, there was an increase in the values of the index of gelatinization of the blends at the end of the fermentation. All the blends had relatively low viscosities except F310B. Based on the parameters considered in this study, F15B is recommended as a potential infant and adult food.

Biochemical composition of infant weaning food fabricated from fermented blends of cereal and soybean

Infant weaning foods were produced from fermented blends of germinated and ungerminated cereal–soybean flour paste, using Saccharomyces cerevisiae and L. plantarum ATCC 10776 as starter cultures. A shorter fermentation period of less than 24 h was obtained compared to the traditional 72–96 h. Protein content of the formulated blends increased with fermentation, ranging from 15.5% in F25B to 18.2% in F410B. This could be attributed to the breakdown of nutrients of the substrates especially soybean, by the starter organisms. The relative decrease in the calcium and phosphorus content of the fermented blends could have resulted from leaching during the steeping stage and subsequent loss from the discarded pomace of the grains which contained most of the minerals. Fermentation also provided optimal pH for the degradation of the phytate phosphorus constituents of the formulated blends. The observed increase in the riboflavin, thiamine, niacin, ascorbic acid and some of the amino acids of the fermented blends could be due to the metabolic activities of the fermenting microorganisms. Porridges made from all the formulated cereal-soybean blends were rated above average in terms of overall acceptability, but F15B had the highest preference rating. ©

Infant Weaning Practices among Hmong Women in Melbourne

This paper examines infant weaning practices and describes the role of cultural beliefs and practices on infant feeding patterns among Hmong immigrants in Melbourne. The paper is based on in-depth interviews and participant observation conducted with 27 Hmong mothers and some traditional healers during 1993 and 1998. Traditionally, Hmong women breastfeed their newborn infants. Exclusive breastfeeding continues until the infant is at least five months old when supplementary food is commenced. Hmong women practise prolonged breastfeeding, usually until a subsequent birth. However, solid foods are gradually given to the child and common household foods are offered when the child is ready for them. Weaning, therefore, does not usually present an abrupt interruption in the infant's habits and hence does not cause much upset. Cultural beliefs and practices relating to infant feeding and weaning among the Hmong constitute a favourable trend, as currently recommended by the World Health Organization. It is proposed that knowledge about cultural beliefs and practices among the Hmong will help to promote better understanding among health care professionals who work with immigrants, so that culturally appropriate care can be provided.

Effect of process improvement on the physico-chemical properties of infant weaning food from fermented composite blends of cereal and soybeans.

Saccharomyces cerevisiae and Lactobacillus plantarum ATCC 10776 were used as starters to ferment various composite blends of cereals and legumes produced through malting and toasting of two varieties of maize--Zea mays (DMR-LSR white & DMR-ESR yellow), sorghum--Sorghum bicolor (Dawa white & Dawa red) and one variety of soybeans (Glycine ax). Compared to the untoasted and unmalted fermented blends, a relatively lower pH (3.6), highly sour product was obtained with 12 h of fermentation. Results also showed that cereal and soybean toasting brought about a better reconstitution indices (B25, 84 ml; B45, 87 ml), water holding capacities (B25, 0.68 ml/g; B45, 0.62 ml/g), bulk densities (C15, 11.6; C35, 10.8) and gross energy (B15, 501.5 k cal/100g; B45, 508.5 kcal/100g) at the end of fermentation. Furthermore, reductions in total polyphenol and tannin contents were observed with fermentation of toasted and malted cereal blends supplemented with toasted and malted soybeans while porridges from the same blends displayed desirable starch stability and consistent gelling tendency, although B15 (a ferment of malted, toasted white maize supplemented with toasted and malted soybean) fell within acceptable limits. In all, the physical characteristics were affected by varieties of cereal and soybeans.

Content and in vitro availability of Fe, Zn, Mg, Ca and P in homogenized fish-based weaning foods after bone addition

The aim of the present study was to compare the Fe, Zn, Mg, Ca and P contents and their in vitro availability in five fish-based infant weaning foods, as a function of the fish bone added with the muscle. The weaning foods studied were: sole without bone (S); hake without bone (H); sole with bone and hake without bone (SBH); sole with bone (SB); and hake with bone (HB). Low levels of Fe and Zn and low percentages of these dialysed minerals were found in all the weaning foods assayed. The incorporation of bone increased the Ca and P contents, particularly in HB weaning food (92.8 ± 0.44 mg 100 g −1 for Ca and 274 ± 1.93 mg 100 g −1 for P). The amounts of Ca and P dialysed were also higher in the weaning foods with bone.

Evaluation of iron bioavailability in infant weaning foods fortified with haem concentrate.

Nutritional iron deficiency in infants over 4 months of age is one of the most common deficiency disorders. Dietary iron is comprised of non-haem and haem iron, the latter being absorbed by a separate pathway and more efficiently than non-haem iron. Fortification of infant weaning foods is one of the strategies adopted for preventing iron deficiency and the aim of this project was to examine the potential use of haem iron concentrate as a fortificant. Sixteen non-anaemic 6-month old infants were recruited and allocated to two groups of 8. Each infant consumed 2 meals/day of a commercial weaning food (100 g) for 7 consecutive days containing 40 mg ascorbic acid and 2.5 mg haem iron/100 g (Group 1) or the same quantity of iron as ferrous sulphate plus 40 mg ascorbic acid (Group 2). Bioavailability was assessed by chemical balance using carmine to mark the beginning and end of the faecal collection. The effect of haem iron concentrate (as a candidate for the factor in meat that enhances iron absorption) was examined by measuring its effect on 57Fe-labelled non-haem iron absorption. There was no difference in iron balance between the two groups. Mean iron retention was 3.5 (SD 2.1) mg/day in Group 1 (haem iron) and 3.0 (SD 2.4) mg/day in Group 2 (ferrous sulphate). Haem concentrate did not enhance the absorption of 57Fe-labelled non-haem iron, Group 1: 1710 (SD 11.1)%, Group 2: 28.4 (SD 17.7)%. Haem iron concentrate appears to be a highly bioavailable form of iron when added to infant weaning foods. This protein is not, however, responsible for the enhancing effect of animal protein on non-haem iron absorption.

Body weight, body composition, and energy intake changes in breastfeeding mothers.

Body weight, body composition, and energy intake changes are described for 13 breastfeeding mothers followed for 18-24 months after delivery. Body weight was assessed at 1-6, 9, 12, 18, 24 months postpartum and 1 month after infant weaning, and energy intake was assessed at 2-6, 9, 12, 18, 24 months postpartum and 1 month after infant weaning. Compared to prepregnancy weight, participants were an average of 4.0 +/- 6.6 kg heavier 18 months postpartum (p < 0.05). The mean rate of weight loss from 1 month postpartum until termination of lactation was 0.32 +/- 0.27 kg/month. Eight of the 12 women gained weight after weaning their infant. Percent body fat assessed by underwater weighing declined from 34.6 +/- 2.8% at 1 month postpartum to 31.4 +/- 4.8% at 1 month after infant weaning (p < 0.05). Further research is needed to study the factors which affect weight loss postpartum, and how weight gain after weaning can be prevented.

Bioavailability of iron glycine as a fortificant in infant foods

The bioavailability of iron glycine added to a vegetable infant weaning food was compared with ferrous sulfate. Stable, isotopically labeled compounds (57Fe or 58Fe) were mixed into the midday meal (1.4 mg added Fe/serving) and fed to 9-mo-old infants on alternate days for 8 d. Bioavailability, expressed as a percentage of the dose consumed, was measured from isotopic enrichment of hemoglobin 14 d after the last test meal. There was no difference between iron glycine and ferrous sulfate (x+/-SEM): 9.0+/-0.7% and 9.9+/-0.8%, respectively. The effect of chelation was examined by measuring iron bioavailability of iron glycine and ferrous sulfate added to a high-phytate (310 mg/100 g) whole-grain cereal weaning food and comparing it with a lower-phytate (147 mg/100 g) vegetable food, as used in the first study. Both iron compounds had lower bioavailability from the high-phytate food, 5.2+/-0.5% for iron glycine and 3.8+/-0.9% for ferrous sulfate, than the lower-phytate food, 9.8+/-1.5% for iron glycine and 9.1+/-1.3% for ferrous sulfate. The results showed no significant difference in bioavailability between the two forms of iron when added to infant weaning foods, suggesting that the glycine complex was fully or partially dissociated in the gastrointestinal tract. It is concluded that chelation does not improve the bioavailability of iron in the presence of dietary inhibitors.

Lactancia materna, destete y ablactación: una encuesta en comunidades rurales de México

To determine the prevalence of lactation, the use of industrialized milk and weaning, and the factors related to lack of breast-feeding and early weaning in young infants of rural communities.Transversal study performed by last year medical students doing Social Service in 222 rural communities in Mexico who applied structured interviews to 5,409 families with children younger than 1 year of age.The percentages of children who were never breast-fed were: in the north (N) 21.4%, in the center (C) 7.6% and in the south (S) 5.3%. Children who were still being breast-fed, either exclusively or with mixed feeding by the third trimester were 35.6% (N), 67.6% (C) and 77.5% (S); in the second trimester, 67.2% (N), 40.9% (C) and 51.6% (S) had been weaned. In the N region it was observed that lack of breast-feeding was associated to the health personnel who attended delivery, mothers with six or more years of education and less than four children, dwellings with permanent material floors, two or more household commodities and a head of the family different from the father. Early weaning was essentially associated to the same factors; additionally, to the child being taken care of by someone different from the mother, artificial lactation by parental decision or due to medical recommendation and the use of health services provided by social security or private physicians.Artificial lactation and early weaning are typical of small families, with high educational level of the mother, better living conditions and contact with medical personnel, especially in the N of the country. Children are weaned before the second semester of life and it is therefore deemed necessary to implement health programs which promote breast-feeding and gradual weaning after the sixth month of life among the infant population of Mexican rural communities.

Colonic fermentation capacity in vitro: development during weaning in breast-fed infants is slower for complex carbohydrates than for sugars

Fresh feces from 27 healthy infants-12 breastfed (complete, exclusive breast-feeding), 7 in early weaning (partial, high breast-feeding), and 8 in late weaning (partial, low breast-feeding)-were cultured with simple and complex carbohydrates in vitro to test the hypothesis that colonic fermentation capacity for carbohydrates increases during weaning. Infants in all three groups were able to ferment sugars, with no significant differences in median total short-chain fatty acid (SCFA) concentrations (mmol/L): preweaning, 56.4(range: 0-77.6); early weaning 68.5(range: 57.9-98.8); late weaning, 61.3(range: 28.6-120.4) for glucose. Preweaned infants were less able to ferment oligosaccharides and complex carbohydrates than were weaned infants (P < 0.05). Ability to ferment raftilose was higher in early weaning; median total SCFA concentrations (mmol/L) were as follows: preweaning 31.0 (range: 3.6-48.9), early weaning 57.1 (range: 2.5-70.6), late weaning 68.6 (range: 22.0-113.4) (P < 0.05). Ability to ferment complex carbohydrates did not develop until late weaning; median total SCFA concentrations for guar gum (mmol/L) were as follows: preweaning 6.4 (range: 0.1-57.3), early weaning 18.4 (range: 0.0-40.5), late weaning 45.4 (range: 15.6-62.1) (P < 0.05, preweaning and early weaning compared with late weaning). Development of the ability to ferment complex carbohydrate was slow. Cultures of feces from preweaned infants produced eight times more SCFAs with glucose than with complex carbohydrates, at early weaning there was a threefold difference and by late weaning the difference was only 25%, but this was still only 42% of the SCFAs produced by cultures of adult feces. These data suggest that for the complex carbohydrates tested, colonic fermentation is likely to contribute only a small proportion of daily energy needs of weaning infants.

EFFECT OF DEXAMETHASONE ON INTESTINAL SUGAR UPTAKE CAPACITY IN SUCKLING RATS.† 1367

Dexamethasone (DEX) is a glucocorticoid that is now widely used not only to prevent the development of bronchopulmonary dysplasia but also to facilitate weaning of infants already with BPD from respirator support. Concerns about its usage have mainly been related to sepsis, hypertension, hyperglycemia and delayed weight gain. The aim of this study is to address the latter complication and relate DEX's effect on small intestinal sugar uptake capacity. DEX, 0.4ug/g body weight (BW), was administered i.p. once daily to rat pups from d 8-9 (Group I). Control litter mates received phosphate buffer i.p. instead of DEX (Group II). Pups stayed with dams at all times. On d 10, pups were sacrificed and intestinal uptake studies using the everted sleeve technique were performed. DEX-treated pups failed to gain weight compared to control (P<0.0001). There was no statistically significant difference in small intestinal (SI) lengths (P=0.8) and weights (P=0.3) across treatment groups. One-way analysis of variance (ANOVA) showed that intestinal glucose uptake capacity increased 2X in DEX-treated pups (P<0.05) and intestinal fructose uptake capacity increased 3X in DEX-treated pups (P<0.03) over control. Two-way ANOVA showed that intestinal glucose uptake per mg and per cm SI doubled (P=0.003; P=0.003) while intestinal fructose uptake per mg and per cm SI tripled (P<0.0001; P=0.0006) in DEX-treated pups over control. These magnitudes of increases in sugar uptake was evident across intestinal regions. Uptakes were 2-3X greater in the proximal and middle than in the distal SI. DEX therefore non-specifically enhances intestinal transport of sugars and possibly other nutrients but these effects do not make up for its catabolic effects and prevent decrease in somatic growth. The proximate mechanism of DEX's effect on intestinal sugar uptake remains to be elucidated.

The influence of different cereal grains on iron absorption from infant cereal foods

Iron absorption from various cereal grains was evaluated in the present study to identify possible preferences for the preparation of infant weaning foods. In six separate studies, four radioiron absorption tests were performed in each of 57 volunteer subjects by using a sequential double-isotopic method. Serum ferritin concentration was used to adjust for the effect of differences in the iron status of subjects participating in separate studies. Identical commercial processing and test meal composition were used to evaluate iron absorption from 50 g cooked cereal prepared from rice, wheat, maize, oats, millet, and sweet or bitter quinoa. In an initial evaluation of cereals fortified with 2.5 mg Fe as FeSO4, geometric mean absorption values were uniformly < 1% for all cereals and were not significantly different. In subsequent studies, percentage iron absorption was enhanced by either eliminating the fortifying iron or adding 50 mg ascorbic acid to the test meal. The effect was similar for most of the cereals tested with a composite mean increase in absorption of 37% when fortifying iron was removed and 270% when ascorbic acid was added. There was a strong inverse correlation between iron absorption and the phytate content of different cereals. Except for a modestly lower absorption of iron from quinoa and a remarkably higher absorption from one lot of maize, we conclude that the type of cereal grain has little influence on iron bioavailability of infant cereals. On the other hand, modification in the milling and processing methods for cereal grains that reduce their content of phytic acid is likely to improve iron availability significantly.

Duration of breastfeeding of children visiting a pediatric outpatient unit

To observe the time of total and partial weaning as well as the alleged causes for precocious weaning of infants seen at the outpatient unit. 259 mothers of children aged 12-24 months were interviewed at the Pediatric Outpatient Unity of Fundação Santa Casa de Misericórdia do Pará. It was verified that only 3.9 % of the children received cow milk (artificial formula) during the neonatal period. Nevertheless, 62.9 % of the babies received tea and/or water at the first month of life. The most frequent reasons to give them tea or water were colics, flatulation and babieś thirst. Only 18.5 % of the infants were completely weaned in the first six months of life; 62.6 % of them were breastfed during 12 or more months. There was a significant improvement in the duration of breastfeeding as compared with a previous study conducted 10 years earlier in the same unity. The most frequent justifications mothers gave for total weaning in the first semester were "the child refused the breast" and "the breast dried out". Despite the favorable results concerning the duration of breastfeeding, efforts to encourage it must continue above all to avoid early use of tea and/or water.

A Survey on the Knowledge and Attitudes of Women in Taegu toward Weaning Diet for Infants

Successful weaning is very important to provide adequate nutrients for normal growth and to induce a good diet habit. We conducted a survey on the knowledge and attitudes of women who live in Taegu toward weaning in infants, to figure out how much they know about weaning diet for the infants, which source they prefer to get the information about weaning diet, whether their knowledge affect their practice about weaning in infants, and the most effective way to educate them. A survey was conducted with the prepared questionnaire on women who responded at the residential area and market place, and those who visited Department of Pediatrics, Yeungnam University Hospital from July 25 to September 15, 1997. Statistical analysis was done with student t-test and ANOVA using SPSS program. Among total 303 responders, those who aged between 30 and 39 years were 37.2%. Scores for the six questions about weaning policy showed highest in the age group between 30 and 39 years. Higher score was recorded in the more educated group, in those who get informations about weaning diet from books, magazines and pediatricians. The majority of the responders had wrong concepts, such as feeding weaning diet using bottle(69.1%), feeding mixed with formula in the same bottle(64.5%), addition of salt(68.4%). Those who had higher educational level preferred books, magazines rather than neighbors or mother to get informations about weaning diet. Those who preferred books or magazines started weaning, stopped bottle feeding, and used spoon earlier, and their children had unbalanced diet habits less frequently. Home-made food was used most frequently, and commercial products were used less frequently. Those who were employed preferred home-made food rather than commercial products, it may be caused by the difference of the educational backgrounds from those of the unemployed. In conclusion, most responders ask neighbors and mother to get informations about weaning, and the incorrect knowledge from them could cause inadequate weaning practice and induce bad diet habit in their children. We have to find the reasons why they did not refer books or magazines frequently, and the way to resolve the problem.

THE EFFECT OF TIDAL VOLUME (Vt) DRIVEN WEANING PROTOCOLS (WP) IN INTUBATED NEONATES WITH ACUTE RESPIRATORY DISTRESS SYNDROME (RDS) 1173

Historically, pressure limited, time cycled ventilation has been the cornerstone of neonatal ventilation. The advent of sensitive flow sensors now allows rapid, continuous measurement of Vt in small neonates. We hypothesized that an algorithm combining Vt measurements with maximal use of noninvasive monitoring would allow safe, uniform weaning of infants with RDS from mechanical ventilation with a minimum of blood draws. The primary premise of the algorithm: using Vt to modify peak inspiratory pressure (PIP) to keep Vt 5-7 ml/kg; modify rate to keep pH 7.27-7.33; modify FiO2 to maintain SaO2 89-94%. Tidal volumes were measured with the Bicore CP-100 Neonatal monitor. This uses a self calibrated transducer to measure air flow. Flow is then integrated to give the infant's tidal volume. CO2 was monitored with transcutaneous CO2 (Novametrix), SaO2 with the Nellcor pulse oximeter. Arterial blood gases were drawn from the umbilical arterial line when available, or peripheral capillary blood gases were followed. Data from 33 infants (mean BW=1326g, GA=29.5 wks, 54% male, 50% Caucasian, initial mean airway pressure (MAP)=8.5 cmH2O, initial FIO2= 0.62) intubated secondary to RDS and managed as per the WP were evaluated. This was compared with data from 33 matched retrospective controls (mean BW=1274 g, GA=29.2 wks, 57% male, 66% Caucasian, initial MAP=8.7 cm H2O, FIO2=0.63). Primary outcome variables included: initial PIP (IPIP) and maximum PIP (MPIP), total blood gases (BG) for initial 72 hours of management and for first 7 days of hospitalization, and duration of mechanical ventilation. No patient managed per the weaning protocol had a pH value of <7.25. There was a significant difference between the two groups in terms of IPIP (WP=21cm H2O vs NO WP= 24 cm H2O, p<0.03), MPIP (WP = 21.8 cm H2O vs NO WP= 25.0 cmH2O, p<0.01). The infants managed with the WP had an average of 13.6 BGs drawn during the first 72 hours vs. 22.5 BGs for the NO WP (p<0.001). For the first week, the WP infants had 19.0 BG vs. 33.5 BG (p < 0.01). In terms of hospital charges for BG in the first week, the WP charges were $1452 vs $2560 for the NO WP. Actual hospital COST (therapist time and supplies per blood gas) resulted in saving $65 per patient for the first week ($85 vs. $150; p<0.01). Although the infants on the WP had a trend for decreased time on ventilation, there was no significant difference. Institution of the Vt driven WP enhanced our ability to wean comparable infants with RDS in a uniform manner with significantly decreased IPIP and MPIP, and decreased BGs at both 72 hours and 7 days. We hypothesize that Vt driven WP may decrease barotrauma, and with their concurrent savings, can safely provide consistent and cost effective weaning of infants with acute RDS.

Infant weaning practices of some Tiv women resident in Makurdi, Nigeria.

The weaning practices in infants aged 4 to 9 months of two hundred Tiv mothers in Makurdi, Nigeria were examined. The data was collected using a questionnaire from these randomly selected women from a known population and who regularly visited the public post-natal clinic in Makurdi. The study showed that all the mothers breast-fed their infants and most introduced supplementary feed at 3 to 4 months. Most also fed the traditional pap or "akamu' usually prepared by adding boiling water to fermented maize-sorghum paste. However, only a few of these (34%) enriched such paps. Price was a major determinant influencing the choice of feed fed to the infants. Only a few of the mothers (19%) used commercial milk formula, about a quarter fed legumes (24.5%) and fruits and vegetables (30%). The study showed that the mother's educational level and occupation influenced both time and duration of breast feeding and introduction of milk formula. Three-quarter of the mothers used bottle feeding while a quarter used spoon and cup and the feeds were improperly stored. The significance of these findings is discussed.

Maternal encouragement in nonhuman primates and the question of animal teaching

Most putative cases of teaching in nonhuman animals involve parent-offspring interactions. The interpretation of these cases, particularly with regard to the cognitive processes involved, is controversial. Qualitative and quantitative observations made in nonhuman primates suggest that, in some species, mothers encourage their infants' independent locomotion and that encouragement can be considered a form of instruction. In macaques, experience in raising previous offspring accounts in part for variability between mothers in propensity to encourage infant motor skills. Parsimony suggests that the cognitive mechanisms underlying maternal encouragement of infant locomotion in primates as well as some other putative cases of animal teaching may involve first-order intentionality (i.e., goal-directed behavior) and not higher cognitive processes such as attribution of knowledge/ignorance or perspective-taking. Encouragement of infant independent locomotion early in life may have benefits to mothers later on, in terms of reduction of costs of infant carrying, earlier infant weaning, and increased probability of reproduction in the mating season. The elementary forms of teaching observed in nonhuman primates may have played an important role in the origin and evolution of human culture.

Dietary Fiber in Weaning Foods of Young Children

An evaluation of the opportunity to introduce fiber in the diet of weaning infants. A descriptive review of the literature to assess the role of fiber in the following dietary interventions: (1) definition of the nutrient amounts that meet the weaning infant's physiologic needs; (2) modulation of digestive and absorption processes; and (3) improving the nutritional balance between the 6th and the 12th months of life and setting habitual dietary patterns for subsequent years. Whole cereals, nonstarchy vegetables, fruits, and legumes lower the caloric and proteic density of meals, modulate nutrient and antigen absorption, and provide bulk material. They supply proteins of low biological value, minimal amounts of lipids (mostly essential polyunsaturated), complex carbohydrates, and soluble fiber, which are fermented into short-chain fatty acids by the colonic flora, and insoluble fiber that modulates intestinal function. Minerals, trace elements, and vitamins add to the value of fiber-containing foods in the diet. Recent nutritional surveys indicate that the diets of 12-month-old infants tend to include too much animal proteins and to be too protein-dense, which could be corrected with an increase of fiber-containing foods. Fiber-containing foods share unique characteristics with nutritional and metabolic implications for the weaning infant. Whole cereals, green vegetables, and legumes should be routinely introduced during the weaning process to achieve a better nutritional balance and to accustom children to diets with fiber content. The daily intake of fiber should be gradually increased to 5 g/d during the second semester of life.

Measurement of lung volumes and pulmonary mechanics during weaning of newborn infants with intractable respiratory failure from extracorporeal membrane oxygenation.

Newborn infants with intractable respiratory failure who require extracorporeal membrane oxygenation (ECMO) experience diffuse pulmonary atelectasis shortly after initiation of ECMO. Atelectasis is likely due to the primary lung injury and the reduction of applied inspiratory ventilator pressure when the respirator settings are changed to the "rest settings." These pathophysiologic changes result in a decrease in lung compliance and lung volumes. We hypothesized that improving lung functions observed during ECMO and indicated by an increase in lung volumes will predict successful weaning from ECMO. Sixteen infants (mean +/- SEM: gestational age, 40.3 +/- 0.3 weeks; birth weight, 3.5 +/- 0.1 kg) with meconium aspiration syndrome (n = 13), sepsis (n = 2), and persistent pulmonary hypertension (n = 1) were studied. We measured passive respiratory system mechanics and lung volumes initially during full ECMO support (115 +/- 18 h on ECMO, Study I), and then within 24 h prior to weaning from ECMO (Study II). Respiratory system compliance (Crs), respiratory system resistance (Rrs), functional residual capacity (FRC), and tidal volume (VT) were measured. Prior to Study I lung volumes were too small to be detected. Crs increased between Study I and Study II (0.41 +/- 0.05 to 0.63 +/- 0.05 mL/cmH2O/kg, P < 0.05), and VT increased between Study I and Study II (5.6 +/- 0.6 to 10.4 +/- 0.8 mL/kg, P = 0.0005). FRC increased from 3.6 +/- 1.0 to 7.9 +/- 0.9 mL/kg (P = 0.0001). There was no change in Rrs (88 +/- 8 to 89 +/- 6 cm H2O/L/s, P = 0.9). The combination of Crs > 0.5 mL/cmH2O/kg and FRC > 5 mL/kg was a better predictor (P = 0.0002) of readiness to wean from ECMO than either Crs (> 0.5 mL/cmH2O/kg, P = 0.057) or FRC (> 5 mL/kg, P = 0.007) alone. The combination of FRC and Crs had a sensitivity of 73.3% and specificity of 100% for successful decannulation. We conclude that repeated measurements of FRC and Crs can assess lung recovery and may assist in establishing criteria for successful weaning from ECMO.

Determining Current Infant Feeding Practices and Teaching the Preparation of Appropriate Infant Weaning Foods Among Indian Urban Slum Dwellers.

The first year of life is so critical in the growth of an infant. After four to six months, breast milk alone is not sufficient to meet a baby's increasing requirements and supplementary foods should be introduced. However among intents of urban slum dwellers in India, protein calorie malnutrition is prevalent during this crucial timeframe. One explanation is that exclusive breastfeeding is practiced and foods are not introduced until much later, in some cases, not until the infant is 12–18 months of age. The objectives of this study were 1) to identify current infant feeding practices of a population in an urban slum in New Delhi, 2) develop a weaning food (cereal mix) appropriate to the needs of the infant and mother, 3) educate the mothers as to the benefits of this weaning food and other locally available foods, and 4) train a local community leader to prepare and market the weaning food to the mothers in the community. Two formal questionnaires were administered by trained interviewers to collect basic demographic data and ascertain the mother's current infant feeding practices. Based on the information collected, a weaning food (cereal mix) was developed that was nutritious, low in cost (since the average per capita income was $9.26 per month) and also convenient (since many of the mothers carry their infant to the worksite or leave the child at home with an older sibling). The weaning food developed was a mix of ground rice flakes, chickpeas, peanuts and sugar. 100 grams of the mix provided over 400 calories, 10g of protein and 8g of fat The cost was $.05 for a 50g, plastic, reclosable bag of the cereal. Cooking demonstrations on appropriate weaning foods, including the newly developed cereal mix, were then conducted. Posters with pictures were used since over 1/2 the women were illiterate. Instructions on the amounts of cereal and method of preparation were presented pictorially and small copies were included in each bag of the infant cereal. Success of the project was measured according to the number of bags of cereal mix sold, and the amount consumed. A woman in the community was then trained to grind the cereal, package and sell it among her peers. The project proved successful as both a nutrition education and income generation project and was not designed to give mothers infant food at no cost. Women in the slums were to produce, package and market the foods within their own community. This made the project unique from other weaning food projects.