This paper covers algorithms for the management of regurgitation, constipation and infantile colic in infants. Anti-regurgitation formula may be considered in infants with troublesome regurgitation, while diagnostic investigations or drug therapy are not indicated in the absence of warning signs. Although probiotics have shown some positive evidence for the management of functional gastrointestinal disorders (FGIDs), the evidence is not strong enough to make a recommendation. A partially hydrolyzed infant formula with prebiotics and ${\beta}$-palmitate may be considered as a dietary intervention for functional constipation in formula fed infants. Lactulose has been shown to be effective and safe in infants younger than 6 months that are constipated. Macrogol (polyethylene glycol, PEG) is not approved for use in infants less than 6 months of age. However, PEG is preferred over lactulose in infants >6 months of age. Limited data suggests that infant formula with a partial hydrolysate, galacto-oligosaccharides/fructo-oligosaccharides, added ${\beta}$-palmitate may be of benefit in reducing infantile colic in formula fed infants in cases where cow's milk protein allergy (CMPA) is not suspected. Evidence suggests that the use of extensively hydrolyzed infant formula for a formula-fed baby and a cow's milk free diet for a breastfeeding mother may be beneficial to decrease infantile colic if CMPA is suspected. None of the FGIDs is a reason to stop breastfeeding.
The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow's milk and processed to adjust for the nutritional needs of infants. However, cow's milk is one of the most common causes of food allergy, affecting 2%-5% of all formula-fed infants during their first year of life. One strategy to prevent cow's milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.
The objectives of this study were to examine the growth pattern of infants by anthropometric measurement according to the 5 feeding practices of infants with the subject of two hundred healthy newborn babies from their birth till sixty month of age at intervals of two months. Breast group(BF, n=38), formula group(FF, n=102) and mixed group(ME, n=14) were fed breast milk, formula milk, breast and formula milk, from birth till 6 mo. of age, respectively. Convert 1 group (C1F, n=14) and covert 2 group(CF, n=32) were fed breast milk and mixed milk at 2 mo. of age afterthat switched to formula milk, respectively. From these, the following results were made. All the infants of this study showed superiority to Korean standard growth rate in regards to each growth item for each month age. In the case of males, at their birth, the subscapular skinfold thickness and the total skin fold thickness in the BF group was significantly larger than in MF group and FF group(p<0.05). At 6th month age, the chese circumference of MF group was 45.9cm, and significantly larger than those of BF, FF and C2F groups(p<0.05). In the case of females, at theri birth and 2nd month age, there was no difference among all the feeding groups in regards to each growth rate. At 4th month age, the Kauf index of C1F group was 16.21 and significantly lower than those of four groups(p<0.05). And total skinfold thickness in BF group was larger than in C1F group. The increase rate per month age of all growth items were larger at 2nd month age than at the later months both in males and in females. And until 2nd month age males showed more increase than females in regards to each growth item but after 2nd month age, this sapect did not show up. Multiple linear regression was used to determine predictive factors for infant growth. It was expected that at 6th month age, in the measurement of head circumference and chest circumference and cross-sectional fat area, BF-males were bigger by 22-39% of the explanation index than the infants of other groups. As a result, in spite of the significant lower intakes of energy and nutrients in breast-fed infants than in formula-fed infants, breast-fed infants showed more growth than the average of Korean infant standard growth rate at every month age, and showed no significant growth difference among feeding groups.
Purpose: In Kyung Hee East-West Neo Medical Center, Seoul, Korea, efforts to raise rooming-in care success rate have been undertaken since when the hospital was established in 2006. We intended to analyze our experience over the past 3 years of period and to discuss the advantages of rooming-in. Methods: We analyzed the rooming-in practice rate, failure rate, and the breast feeding rate. Subjects were 860 normal healthy neonates from June 2006 to June 2009. Results: Among these 860 cases, 83 babies were required separation out of rooming-in in the middle of the course. Among these 83 cases, 70 cases had to stop the course due to poor condition of babies and 13 cases due to maternal condition. 70 cases of infant's causes consist of 68 cases of NICU admission and 2 cases of poor feeding support. The other 13 cases of separation include refusal by maternal condition. Therefore the success rate of rooming-in for the last 3 years was 90.3%, that is 777 cases among the total 860 cases. The percentage of exclusive breast feeding was 64%, that of mixed feeding with breast and formula feeding was 25%, and formula feeding only was 11%. Conclusion: We experienced successful rooming-in care for the last 3 years. Nursery facilities should educate and encourage the advantages of rooming-in, including the good formation of attachment between mother and infant, emotional stability, protection from infection, and increased breast feeding rate so that rooming-in care can be fully established.
This study was carried out to investigate the feeding practices, growth status and correlation with maternal perceptions of breast feeding and lactation with infuts' feeding methods in the Pocheon area. The subjects were 103 infants ranging from 3 to 21 postpartum months and their mothers. The results obtained were as follows : In this survey, 36.9% of the infants were breast-feeding, while 53.4% of them were bottle-feeding, and 9.7% of them were mixed-feeding. The reason for bottle-feeding was due mainly to the lack of breast-milk secretion. Z-scores of weight-f3r-age and height-for-age were similar to Korean standards, but malnutrition and overnutrition were also noticed by kaup index and WLI. The average maternal perceptions of breast-feeding and lactation was 3.7 out of 10 possible points, the breast-feeding group scored 4.7, and formula-feeding and mixed-feeding group scored 3.0. That of BF group was higher than FF+MF groups and was positively correlated with growth status. Therefore to ensure proper growth of infants and to promote breast-feeding, efforts should be given to community nutritional services including nutrition education for the importance of colostrum and breast-milk, practical breast-feeding methods, and nutritional management during pregnancy. Also nutrition education for mothers will be continued to 1-3 postpartum months to promote successful breast-feeding.
In order to provide the basic data on an education program for successful breast-feeding, the nutrition knowledge of and attitudes toward breast-feeding and the factors associated with infant feeding decision among male and female college students were investigated. The majority of students had correct knowledge of the maternal-infant bonding through breast-feeding and knew more about baby-centered benefits than about mother-centered benefits of breast-feeding. Students' attitudes toward breast-feeding were not so positive as expected, and male students had more positive attitudes toward breast-feeding than female students had. 54.8% of students answered to practice breast-feeding longer than 3 months. Nutrition knowledge scores and attitude scores were significantly higher in the breast-feeding decision group than in the formula-feeding decision group. The students residing in a rural community decided breast-feeding significantly more than the students residing in an urban community. It was concluded that nutrition knowledge about the breast-feeding played a significant role in deciding infant feeding method. In order to increase breast-feeding decision rates among college students, the education program may need to focus on understanding of correct nutrition knowledge about the benefits of breast-feeding. Also it would be important to have male students participated in education program.
Purpose: The purpose of this study was to investigate the difference in the incidence of diarrhea among the subjects given hypertonic and isotonic nutrients to the nasogastric tube feeding patients in the a critical care setting. Methods: This study is aquasi-experimental study with a pre & post-test design. The sample size of 40 was calculated based on Cohen's formula (1988). The total of 40 subjects who signed the informed consent were randomly selected and divided evenly into two groups, experimental and control group. Results: There are no significant differences between the two groups in homogeneity test (sex, age, albumin level, the use of antibiotics, antacid, and $H_2$ blocker). However, the frequencies of occurrence in diarrhea according to the density of nutrients formulation indicated a statistical difference at the level of .005 (p=.001): diarrhea occurred in four of 20 (20%) of the experiment group, but 14 (70%) of the control group. Also the onset date of diarrhea in the experiment group is later than that of the control group. Conclusion: The research findings suggest that we should begin with low density nutrients for nasogastric tube feeding, and increase its density gradually to decrease diarrhea incidence in the critical care setting.
This was a prospective cohort study of 976 infants from birth to 12 months of age. Infants were fed breast milk, goat infant formula, cow infant formula, or a combination of formula and breast milk during the first 4 months of age. Data on type of milk feeding and infant growth (weight and height) were collected at birth and at 4, 8, and 12 months during routine clinical assessment. The number and consistency of bowel motions per day were recorded based on observational data supplied by the mothers. Infants fed breast milk or goat or cow infant formula during the first 4 months displayed similar growth outcomes. More of the infants fed cow infant formula had fewer and more well-formed bowel motions compared with breast-fed infants. The stool characteristics of infants fed goat formula resembled those of infants fed breast milk.
Purpose: Breastfeeding is the best way to feed all infants, but not all infants can be (exclusively) breastfed. Cow's milk based infant formula is the second choice infant feeding. Methods: The safety of a new synbiotic infant formula, supplemented with Bifidobacterium lactis and fructo-oligosaccharides, with lactose and a whey/casein 60/40 protein ratio was tested in 280 infants during 3 months. Results: The median age of the infants at inclusion was 0.89 months. Weight evolution was in accordance with the World Health Organization growth charts for exclusive breastfed infants. The evolution of all anthropometric parameters (weight-for-length z score and body mass index-for-age z score) was within the normal range. The incidence of functional constipation (3.2%), daily regurgitation (10.9%), infantile crying and colic (10.5%) were all significantly lower than the reported median prevalence for a similar age according to literature (median value of 7.8% for functional constipation, 26.7% for regurgitation, 17.7% for infantile colic). Conclusion: The new synbiotic infant starter formula was safe, resulted in normal growth and was well tolerated. Functional gastro-intestinal manifestations (functional constipation, regurgitation and colic) were significantly lower than reported in literature. Synbiotics (Bifidobacterium lactis and fructo-oligosaccharides) in cow's milk based infant formula bring the second choice infant feeding, formula, closer to the golden standard, exclusive breastfeeding.
This study was to investigate the nutrient intakes from infant formula and supplemental foods of 129 infants(boys 69, girls 60) fed formula, aged from 5 to 12 months. Subjects were divided into $5{\sim}6\;months,\;7{\sim}8\;months,\;9{\sim}10\;months,\;and\;11{\sim}12\;months$ by ages. Dietary assessment was carried out by using 24-hour-recall method. The average intakes and feeding frequency of infant formula were $702m{\ell}$, 4.4 times in boys and $815m{\ell}$, 4.8 times in girls, respectively. Supplemental foods were introduced at the age of $4{\sim}6\;months$ in 86% of the infants. Foods introduced first as the supplemental food were rice gruel soup, commercial weaning foods, fruit juice. Energy intakes were similar to RDA. Daily intakes of calcium at all age groups were higher than the RDA, therefore, calciun overnutrition were elucidated. Average intakes of protein, phosphorus, iron, zinc, vitamin A, vitamin $B_1,\;vitamin\;B_2$, niacin, vitamin $B_6$, vitamin C were above RDA, folate did not meet RDA of infants at all ages. In conclusion, the average status of nutrient intakes of infants was fairly good, however, nutrient intakes from supplemental foods were lower in girls than in boys of $10{\sim}12$months, and folate status seemed to be poor. Therefore, mothers feeding infant formula to their infants should be educated for the importance of supplemental foods and its practice to support good nutrition.
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