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Infant feeding
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Mothers' own milk is the best source of nutrition for nearly all infants. Beyond somatic growth, breast milk as a biologic fluid has a variety of other benefits, including modulation of postnatal intestinal function, immune ontogeny, and brain development. Although breastfeeding is highly recommended, breastfeeding may not always be possible, suitable or solely adequate. Infant formula is an industrially produced substitute for infant consumption. Infant formula attempts to mimic the nutritional composition of breast milk as closely as possible, and is based on cow's milk or soymilk. A number of alternatives to cow's milk-based formula also exist. In this article, we review the nutritional information of breast milk and infant formulas for better understanding of the importance of breastfeeding and the uses of infant formula from birth to 12 months of age when a substitute form of nutrition is required.
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The introduction of infant formulas created a new age in infant feeding practices. With the introduction of infant formulas, it became a great ambition to create a more adapted product, as the composition of breast milk is gold standard for infant feeding. In this paper, it was aimed to review the rationale and concerns of the use of newer infant formulas, supplemented with pro-, prebiotics, nucleotides, and long-chain polyunsaturated fatty acids, in order to help pediatricians for their choice. However, it should always be kept in mind that whatever can be achieved with these formulas, they will always be inferior to breast milk. Keywords: Infant formula, probiotics, prebiotics, nucleotides, and long chain fatty acids
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The American Academy of Pediatrics is committed to the use of maternal breast milk as the ideal source of nutrition for infant feeding. Even so, by 2 months of age, most infants in North America are formula-fed. Despite limited indications, the use of soy protein-based formula has nearly doubled during the past decade to achieve 25% of the market in the United States. Because an infant formula provides the largest, if not sole, source of nutrition for an extended interval, the nutritional adequacy of the formula must be confirmed and the indications for its use well understood. This statement updates the 1983 Committee on Nutrition review and contains some important recommendations on the appropriate use of soy protein-based formulas.
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Lactulose
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Human breast milk is generally and universally recognized as the optimal choice for nutrition during the first year of life. In certain cases in which it is not feasible to breast-feed the infant or the breast milk is not sufficient, especially in the case of preterm infants, infant formula is the next best alternative to provide nutrition to nurture the infant. Therefore, it is highly important that the nutrient composition of the infant formula is as close to breast milk as possible for proper growth and development of the infant. However, human milk is a complex dynamic matrix, and therefore significant research has been done and is still ongoing to fully understand and mimic human breast milk, particularly its fat composition. Lipids play a critical role in infant nutrition. A number of advances have been made in infant formula lipid content and composition so that formula can better simulate or mimic the nutritional functions of human maternal milk.
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The main functions of breast milk and infant formulae are to provide nourishment, protection and to aid normal development. It is well accepted that breastfeeding is the best way to meet an infant's nutritional requirements and is considered nutritionally adequate up until six months of age for healthy, term babies. Infant formulae are intended for infants who cannot be fed at the breast, or who should not receive breast milk, or for whom breast milk is not available. This article outlines the components of infant milk with an explanation of the benefits.
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Case ReportA 6-month-old girl was admitted to the intensive care unit of a tertiary pediatric hospital for shortness of breath and respiratory distress for three days following one month of cough.A er ve days antibiotics therapy (amoxicillin sulbactam for three days followed by meropenem for two days), chest CT scan showed severe pneumonia with local consolidation.A er beroptic bronchoscopy and alveolar lavage, she was intubated for ventilation and transported by ambulance to our hospital because of persistent cyanosis.e girl was gravida 2 para 2 and vaginal delivered spontaneously at full gestation age to a gravida 2 para 2 mother with Apgar score of 10 at rst minute and birth weight 4000 g.Her non-consanguineous parents and elder brother were healthy.ere was no family history of tuberculosis.She was vaccinated at birth for BCG and hepatitis B and no other vaccinations were given because of recurrent infections with oral herpes, bronchitis and pneumonia a er one month old.Physical examination revealed le sub-axillary lymphadenitis (Figure 1) and bilateral pulmonary rales, no rash and no hepatosplenomegaly were observed and failure to thrive (6000g at admission).Peripheral blood routine test showed: white blood cell counts 9.7 × 10 9 /L, lymphocytes di erential 8%, hemoglobin and platelet were normal.C-reactive protein, procalcitonin, serum electrolytes, biochemical enzymes of organs, liver and renal function and coagulation function were normal.Chest radiographs showed bilateral in ltration pneumonia.Abdominal sonography was normal.Super cial sonography showed le sub-axillary lymph node enlargement and liquefaction.High-throughput sequencing on Bronchoalveolar Lavage Fluid (BALF) identi ed 697 sequences of Mycobacteruim tuberculosis complex and 95146 sequences of Pneumocystis jiroveci, respectively.
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Infant feeding
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Introduction: human milk oligosaccharides (HMOs) are an important component of human milk supporting the development of a balanced intestinal microbiota and immune protection in breastfed infants. Randomized controlled trials (RCTs) have demonstrated that infant formulas supplemented with the HMOs 2'-fucosyllactose (2'FL) and lacto-N-neotetraose (LNnT) are safe, well-tolerated, and support normal growth. This Real-World Evidence (RWE) study aimed to evaluate growth and tolerance in infants consuming a formula supplemented with 1 g/L of 2'FL and 0.5 g/L of LNnT, and included a mixed-feeding group never studied before in RCTs. Participants and methods: this open-label, prospective study was conducted at six centers in Spain, and included healthy, exclusively breastfed infants (BF group), an exclusively formula-fed group (FF) who received a milk-based formula with 2' FL and LNnT, and a group mixed fed with both formula and human milk (MF), for 8 weeks. Co-primary outcomes were growth (anthropometry) and gastrointestinal tolerance (Infant Gastrointestinal Symptom Questionnaire, IGSQ). Secondary outcomes included formula satisfaction and adverse events (AEs). Results: 159 infants completed the study (66 FF, 48 MF, and 45 BF). Mean z-scores for growth were similar between all groups and within ± 0.5 of WHO medians at week 8. Composite IGSQ scores demonstrated low GI distress in all groups, with no significant group differences at baseline, week 4, or week 8. Incidence of AEs was low overall, and comparable across groups. Conclusions: in this RWE study examining a HMO-supplemented infant formula, growth and tolerance outcomes were similar to RCT findings, supporting the effectiveness of this early feeding option.Introducción: los oligosacáridos de la leche materna (HMO) contribuyen a desarrollar la inmunoprotección y la microbiota intestinal. Los ensayos aleatorizados (RCT) han demostrado que las fórmulas enriquecidas con 2’fucosilactosa (2’FL) y lacto-N-neotetraosa (LNnT) son seguras, bien toleradas y favorecen el crecimiento. El objetivo de este estudio ha sido valorar el crecimiento, la seguridad y la tolerancia digestiva en lactantes alimentados con una fórmula enriquecida con 1 g/L de 2’FL y 0,5 g/L de LNnT, con datos de la vida real (RWE), incluyendo un grupo de alimentación mixta no estudiado antes en los RCT. Participantes y métodos: estudio prospectivo abierto en seis hospitales españoles que incluyó lactantes sanos alimentados con leche materna (BF), con fórmula enriquecida en 2’FL y LNnT (FF) o con mezcla de ambas (MF), durante ocho semanas. Se valoraron el crecimiento (antropometría), la tolerancia gastrointestinal (cuestionario IGSQ) y los acontecimientos adversos. Resultados: 159 lactantes completaron el estudio (66, 48 y 45, en los grupos FF, MF y BF, respectivamente). Las puntuaciones Z antropométricas a la semana 8 fueron similares entre los grupos y se hallaron dentro del rango de ± 0,5 de la normalidad. Las puntuaciones IGSQ compuestas mostraron un bajo malestar digestivo, sin diferencias significativas entre los grupos, al inicio y en las semanas 4 y 8. La incidencia de eventos adversos fue baja y comparable entre los grupos. Conclusiones: en este estudio RWE que evaluó una fórmula para lactantes enriquecida en HMO, los resultados sobre el crecimiento, la tolerancia y la seguridad fueron similares a los obtenidos en los RCT, respaldando su eficacia como alimentación temprana opcional.
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Human breast milk (HBM) is the finest source of nutrition for almost all infants. Breast milk as a bodily fluid has many benefits beyond somatic cell growth, including regulation of postnatal intestinal function, immune ontogeny, and brain development. However, breastfeeding is strongly recommended, breastfeeding may not always be possible, suitable or solely adequate1. Hence, Infant formula is often an alternative source of infant nutrition when breastfeeding is unacceptable or impossible. The composition of infant formula should be as close as possible to the composition of human breast milk, both in terms of content and chemical specification2. Infant formulas try to mimic the nutritional composition of breast milk as closely as possible. A number of substitutes to milk-based formula also exist. In this article, we review nutritional information for breast milk and infant formulas to help you better understand the importance of breastfeeding and the use of infant formulas up to 24 months of age when alternative feeding is required. In general, breast milk is the ideal food to ensure that an infant's nutritional needs are met.
Keywords: breast milk; infant formula; type of infant formula; benefits
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