Nine chapters examine the role of breastfeeding in the growth and health of the full-term infant. Three chapters examine the role of the microbiome in the health of healthy and infants with severe gastrointestinal disease.
Overview: Global Perspectives
Premature Infant Feeding
Breast Feeding: Growth and Health
Micronutrients and Healthy Infant Nutritional Status 23 Consequences of Micronutrient Deficiency and Interventions
Lars Bode Departamento ti Pediatria, Unibersidad ti California, San Diego, CA, E.U.A. Antonio Oliver-Roig Departamento ti Nars, Unibersidad ti Alicante, San Vicente del Raspeig, Alacant, Espania.
Key Points
Early Nutrition and Lifelong Health
Rapid growth continues into the early postnatal period and the type of feeding during infancy is known to influence both the rate of weight gain and the type of tissue deposited [10], infancy may also be a critical period when nutritional programming occurs. This chapter reviews the evidence linking differences in early postnatal nutrition to functioning in later life – and the importance of adequate nutrition for lifelong health.
Infant Nutrition
Much of the existing literature is based on comparisons of types of milk feeding in infancy, and we currently know less about the importance of variations in weaning practices and whether there are long-term effects of qualitative differences in the weaning diet. It is therefore important to consider both milk feeding and variations in the weaning diet when examining the influences of infant diet and nutrition on later health.
Infant Growth
The definition of a 'normal' growth reference may therefore depend on the balance between the types of milk fed and the duration of milk feeding in the reference populations. However, lower energy intake is needed for babies who grow more slowly – and energy needs in infancy have historically been considered overestimated [28.
Infant Nutrition and Health Outcomes
Recent UK data show that there are also marked differences in the incidence of less serious infections in infancy according to the duration of breastfeeding [48. Further work is needed to determine the influence of qualitative differences in the weaning diet on cognitive development.
Conclusion
De Onis M, Garza C, Victora CG, et al., for the WHO Multicenter Growth Study Group. Kramer MS, Aboud F, Mironova E, et al., for the Promotion of Breastfeeding Intervention (PROBIT) Study Group.
Introduction
Maternal Nutrition and Breast Feeding
Milk, Formulas, and RDA
Another good source is cow's milk to fulfill vitamins and minerals according to RDA values, but it has a high protein content. There are several public nutrition assistance programs available at health centers or clinics, schools, child care centers, and licensed day care centers.
Recommended Supplements
The nutritional needs of premature or undersized infants require more supplementation due to their limited ability to absorb calcium, protein, fat, and vitamins A and D [14. Hypervitaminosis A due to high intake of fortified milk (about eight times above the RDA) causes loss of appetite, blurred vision, hair loss, cracked and dry skin, headaches, nausea and irritability.
Feeding Schedules
To meet this iron requirement, infants are fed six scoops of fortified cereal to provide 14 mg of iron during 4-6 months of age [13. The American Academy of Pediatrics Committee on Nutrition recommends that children between 2 weeks and 2 years of age need a supplement of 0.25 mg of fluoride per day.
Solid Foods
Nutritional Aspects in Infancy
An occasional dessert of fruit or custard can be fed, avoid some items such as cookies, cakes,. Instant baby food can be diluted with fluoridated water to reconstitute according to the baby's age.
Daily Feeding of Solids
Dinner with cottage cheese and meat with a lot of meat can be served as a main course at the end of the first meal. It can be stored tightly covered in a container for later use without risk of spoilage due to its low moisture content.
Socialization and Transition to Adult Food
Nutritional Risks in Infants
Maternal Vitamin A
Providing supplemental vitamin A, either daily at physiological doses through a vitamin A-rich diet [26] or fortified foods or as a high-dose supplement immediately after birth [29] , can increase breast milk vitamin A concentrations. Breast milk vitamin A concentrations in developed countries exceed an average of 2.1 m mol/L, while those of developing countries average below 1.75 m mol/L and are often close to 1.05 m mol/L [24 .
Prevalence of Nutritional De fi ciency in Industrialized vs. Less Developed Countries
Recent data have indicated that the amount of vitamin A in breast milk is directly related to the dietary intake of the mother, especially at low concentrations of intake [25.
Vitamin A De fi ciency in the Infants and Early Childhood
However, breast milk from a malnourished mother with a vitamin A deficiency may not be sufficient to maintain and build the body's reserves of the rapidly growing child. Indeed, it is notable that 10% of infants fed by supplemented mothers showed signs of inadequate body stores at six months and that this rate paralleled the prevalence of supplemented women with vitamin A concentrations in the breast milk <1.05 mmol/l.
Iron Requirement for Infants
Potential for Maternal Supplementation to Improve Infant Outcomes in Developing Countries
Vitamin A deficiency remains the leading cause of childhood blindness in developing countries, and can occur as early as two months of age in a non-breastfed and inappropriately fed infant in a deprived environment. Some people advocate direct infant supplementation in the first half of infancy as a more direct way to ensure adequate vitamin A status by six months of age.
World Health Organization Recommendations
A cost-effective delivery system exists through immunization systems, such as the WHO Expanded Program on Immunization (EPI). Currently, WHO policy supports supplementation in each contact from 6 to 12 months of age with 30,000 m g RE (100,000 IU) and specifically emphasizes the use of contact measles immunization for this purpose, where the case fatality rate of measles exceeds 1% [43.
Infancy Weight Gain and Obesity
It is thought that rapid weight gain in infancy leads to obesity risk later for obesity. Given its high prevalence, rapid weight gain in infancy may have heterogeneous effects on subsequent stature growth and body composition.
Present Developments and Future Prospective
In this nonrandomized analysis, faster weight gain in infancy was associated with greater fat mass in childhood [107. Breastfeeding, use of fortified docosahexaenoic acid formulas in infancy, and neuropsychological function in childhood.
Nutritional Concerns of Aboriginal Infants and Children in Remote and Northern Canadian Communities
There are large disparities in health outcomes between First Nations, Métis and Inuit (collectively .. referred to as Aboriginal people in this chapter) and the general Canadian population. A higher percentage of Aboriginal infants and children suffer from poor health (eg high prevalence of overweight and obesity and much higher rates of premature birth, stillbirth and infant death).
Health Concerns of Aboriginal Peoples in Canada
Health Concerns of Aboriginal Populations in Northern Canada
Many children in the 2007–2008 Nunavut Inuit Child Health Survey lived in homes that were overcrowded and/or in need of major repairs [17. Indeed, the infant mortality rate in Inuit-inhabited regions is live births, equivalent to the rate in the general Canadian population in.
Breastfeeding and Infant Health
Rising rates of obesity among Inuit children portends future increases in the prevalence of T2DM, heart disease, and high blood pressure in Inuit-inhabited regions. Recent data from Nunavut show that while only 67.6% of Inuit children receive breast milk, among non-adopted infants there is an 80.6% rate of initiation of breastfeeding.
Data from the First Nations Regional Health Survey (RHS) collected in 2008-2010 show that 57.5% of children living on reserve are breastfed. Hearing loss attributable to chronic otitis media is common among First Nations and Inuit children and adults in northern regions [35.
Speci fi c Issues with Breastfeeding in Northern Regions
Maternal risk factors for childhood rickets in Canada include limited sun exposure and lack of vitamin D from diet or supplements during pregnancy and lactation [59. The Canadian Pediatric Society recommends that the risk of vitamin D deficiency in infants is also minimized by supplementing mothers with vitamin D during pregnancy and breastfeeding so that breast milk contains enough vitamin D [67.
Conclusions and Future Directions
A review of aboriginal infant mortality in Canada: striking and persistent aboriginal/non-aboriginal disparity”. Improving the Nutritional Status of Indigenous Peoples in Canada. http://www.diabetes.ca/documents/for-professionals/DC--Spring_2011--N.Willows_.pdf. ed.), Nutrition in Infancy: Volume 1, Nutrition and Health,.
Breastfeeding and Infant Health in the Indian Subcontinent: Problems and Solutions
The neglected “m” in MCH – why maternal mental health matters for child nutrition. Breastfeeding can treat some health problems in the region according to.
Breastfeeding
In the MENA region, which consists mostly of developing countries with a relatively high prevalence of malnutrition and infectious diseases, BF may have considerable protective benefits [13. In general, there does not appear to be a high level of compliance with the WHO BF recommendations. in the MENA region with variability between countries and regions within the same country [ 22.
Undernutrition: Stunting, Wasting, and Micronutrient De fi ciencies
However, the effect of maternal education on breastfeeding continuation varied across countries. In Israel, breastfeeding duration increased with increasing maternal education [10], while in Lebanon [17], KSA [21] and the United Arab Emirates (UAE) [20], there was a negative correlation between these two factors. .
Overnutrition
Implications of using the new WHO growth charts for the interpretation of undernutrition and obesity in infants and young children in Oman. This development has not trickled down to the rural and urban poor in most developing countries.
The Infancy Period
Department of Food Science and Technology, University of Nigeria, Nsukka 410001, Nigeria e-mail: [email protected]. The emphasis on complementary feeding over the years is a reflection of the benefits that are sufficient.
Complementary Local Foods for Infants in Developing Countries
Growth in infancy is a complex process; it is influenced by factors such as diet, nutritional status and health of the mother and the occurrence of infections. For breastfed infants, the nutrition of the mother and that of her young are interrelated from conception to weaning.
Food Acceptance, Preference and Intake Patterns in Infants
However, human infants are born with a well-developed sensitivity and preference for sweet and fatty foods, but reject sour and bitter tastes. Recognition or preference for the taste of salt begins to emerge at around 4-6 months of age and may be due to the maturation of specific salt receptors on the tongue, early experiences with salty foods [5] and the taste of salt. in breast milk.
Infant Feeding Practices and Beliefs
Complementary food is introduced mostly when the child turns 4-6 months, but it can also be from 1 to 9 months. In Ghana, they use water and a glucose solution in the first few months of life to quench the thirst of a newborn after a laborious birth process or as a cultural gesture to welcome the child into the world [13.
Complementary Local Foods for Infants in Developing Countries
In addition to these, cereal-based complementary foods are used in Ethiopia and are summarized in Table 6.2. Complementary grain foods include Suji Upma (rava upma) and Suji kheer made from suji, Dalia (broken wheat) and rice preparations.
Improvement of Complementary Local Foods in Developing Countries
In Guatemala, mothers prefer thinner complementary foods (atolls) for children under one year of age and thicker foods (masa de maiz) for children over one year of age. Addition of animal foods (muscle tissue) and ascorbic acid sources (fruit, fruit juices) to complementary foods.
Strategic Thrusts in Improving Complementary Feeding Practices
The first approach to improving complementary feeding is to increase the nutritional adequacy of locally available complementary foods containing probiotics and prebiotics, dietary diversification (production, availability and consumption of foods rich in micronutrients) and modification elements that optimize bioavailability, increase trace and vitamin density. Optimal timing for the introduction of complementary foods will depend on the infant's physiological and developmental status [90.
Dissemination and Adoption of Improved Technologies and Practices
Manufactured complementary foods for infant and young child feeding in Asia: adequacy and improvement of micronutrients. The impact of maternal education on complementary nutrition and the provision of complementary foods on child growth in developing countries.
Introduction of Complementary Foods to Infants and Ultimate Risk of Allergies
These recommendations are based on the hypothesis that the immune system of the intestinal mucosa. This chapter begins with a presentation of current recommendations on the introduction of complementary foods as allergy prevention in children.
Recommendations on Complementary Foods for the Prevention of Allergies in Children
In describing the introduction of new foods, most studies in the literature have used the term "solid foods" to indicate the addition of complementary foods to the infant's diet. In a further step, it recommended that a careful individualized introduction of the complementary foods into the infant's diet should be pursued.
The Infant Mucosal Immune System, Allergies, and Introduction of Complementary Foods
Summary of evidence on the effect of age at introduction of complementary foods on the occurrence of allergies in children.
Summary of Evidence on the Effect of Age at Introduction of Complementary Foods on the Occurrence of Allergies in Children
Introduction of new foods after 3 months associated with reduced risk of allergic sensitization Zutavern et al. This may result in under- or overestimation of the effect of the introduction of complementary foods on the risk of allergy.
Conclusions
Prenatal determinants of neonatal immune responses to allergens. van Gool CJAW, Thijs C, Dagnelie PC, et al. Age at introduction of solid foods during the first year and allergic sensitization at age 5 years.
The Role of Nutrition in Health and Disease in Premature Infants: Current Knowledge Gaps and De fi ning
The influences on growth and nutrition in the neonate are multifactorial and require observation. Epigenetic modifications that regulate gene expression are influenced by human nutritional status.
Intoduction: Life Course Approach to Neonatal Nutrition and Growth
Thus, strategies to support faster weight gain in preterm infants may have competing short- and long-term effects. Next, studies should be designed to measure positive and negative short- and long-term outcomes.
Unique Aspects of Growth and Nutrition Among Infants
Finally, the growth and nutrition of preterm infants differs from that of fetuses and preterm infants. It is therefore important to evaluate the role of growth and nutrition among preterm infants separately, as this population represents a medically vulnerable population with unique immediate and long-term nutritional needs.
Challenges of Measurement Tools of Growth and Nutrition in the Neonatal Period
In research, the use of continuous z-scores as described in Oken growth charts is preferred. Second, most fetal growth charts are not prescriptive, but based on cross-sectional data [55–58.
The microbiota of the digestive tract and its metabolic activity are influenced by the host's dietary intake. For example, numerous studies have shown that there are differences in the gut microbiota between breastfed and formula-fed infants.
Summary
As can be seen from the discussion in the chapter, the impact of the microbiome on newborn health and development is great. There is a need to further characterize how the microbiome is established and maintained in fetuses, premature and term children.
Intestinal Development and Permeability
The effect of components in breast milk such as insulin-like growth factor, glutamine, prebiotics,. Determining the impact of feeding practices for premature infants, such as donor breast milk and cattle.
Intestinal Permeability Measurement
These functions are critical to survival because the gastrointestinal tract must control nutrient absorption for the growth and blocking of pathogens and toxins. To this end, the gastrointestinal tract constantly maintains a precarious balance that depends on intestinal permeability.
Preterm Infant Intestinal Development
The mucus layer is a complex gel that contains immune function factors and binding sites for the intestinal microflora. Premature infants have abnormal development of the intestinal mucosal layer and microflora compared to full-term infants and adults [23.
Preterm Infant Intestinal Permeability and Postnatal Age
The role of these breast milk components and the role of the developing intestinal mucosa and microflora in intestinal permeability is crucial to understanding the gastrointestinal maturation of preterm infants. 31 ] described how human milk feeding blunts the increase in intestinal permeability observed in formula-fed infants.
Preterm Infant Intestinal Permeability and Feeding
This increase and then decrease in the intestinal permeability of premature infants in the first postnatal weeks was once thought to be beneficial. The results of this study negate the health benefit theory of increased intestinal permeability and instead raise concerns that formula-fed infants develop intestinal disease in the first weeks after birth.
Preterm Infant Intestinal Permeability and Feeding Type
Potential Agents to Decrease Intestinal Permeability
Other studies of the effect of human milk factors on the intestinal permeability of preterm infants include evaluation of IGF-1. Perhaps the glutamine supplement promoted intestinal permeability in formula-fed infants, and with the high intake of breast milk in both groups, there was no significant difference in intestinal permeability.
Other Factors Related to Preterm Infant Intestinal Permeability
NO and its derivative, peroxynitrite, can affect intestinal permeability by inducing enterocyte apoptosis and necrosis or by disrupting the tight junctions [54. Further evaluation of the role of NO in intestinal permeability is expected as investigators continue to study the role of the gut. permeability breakdown in the development of NEC.
Questions Remaining in Preterm Infant Intestinal Permeability
The effect of glutamine-enriched enteral feeding on intestinal permeability in very low birth weight infants: a randomized controlled trial. Alanyl-glutamine-supplemented parenteral nutrition increases luminal mucus gel and decreases permeability in the rat small intestine. van der Hulst RR, van Kreel BK, von Meyenfeldt MR, et al.
Extremely Premature Infants and Nosocomial Infections
Protection Against Nosocomial Infection with Human Milk
Preterm Colostrum: Implications for the Extremely Premature Infant
This rapid growth and development of the intestine is partly attributed to the abundance of growth factors in the amniotic fluid. The composition of amniotic fluid and human colostrum are very similar, suggesting that colostrum has an important biological function in facilitating the baby's transition to the extrauterine environment.
Preterm Colostrum as a Potential Immune Therapy
The absence of protective factors in the infant's oropharynx facilitates pathogen colonization that can lead to VAP. In addition, the inability to administer colostrum in the first days after birth may adversely affect intestinal maturation [96] and may increase the risk for subsequent feeding intolerance.
Oropharyngeal Administration of Colostrum
Sharing the science of human milk feeding with mothers of very low birth weight infants. The role of breast milk in the risk of necrotizing enterocolitis or death in extremely low birth weight infants.
Protein Requirements
The primary importance of protein and the adequacy of all the essential amino acids in the diet is for premature growth [3. The design of the chart included numerous infants and statistically smoothed the lines to provide a means for the clinician to assess the premature infants' growth [26.
Parenteral Nutrition
Amino acids are known to stimulate insulin and insulin-like growth factor [1], helping to alleviate hyperglycemic episodes previously demonstrated in glucose-only solutions in preterm infants. Most importantly, such early intervention with amino acids after delivery can reduce
Preterm infants fed human milk fortified with commercial fortifiers grow significantly better and tolerate it well [61-63. Careful attention is important to ensure that the baseline estimate for human milk is not underestimated.
Commercial Formulas
It is more prudent to estimate baseline breast milk at 1 g/dL with reinforcement - max 1.4 g/dL, as it is predominantly preterm infants who are fed week 2-12 week milk. Soy formulations should not be used because of the effects of soy on the calcium and phosphorus balance of the premature infant [91.
Nutrition Assessment
Early breast milk is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. Bioavailability of calcium and phosphorus in breast milk forti fi ers and infant formula for very low birth weight infants.
Parenteral Nutrition of Preterm Infants: Methods to Improve Safety and Prevent Disease
Parenteral nutrition (PN) is an essential part of preterm infant care, but PN delivery. is associated with serious complications. Reduction of complications associated with PN delivery via the umbilical venous catheter, a peripherally inserted central catheter.
Minimising the Complications Associated with the Delivery of PN Via an Umbilical Venous Catheter, a Peripherally Inserted Central Catheter
Improving the safety of the use of parenteral nutrition can be divided into methods that minimize the complications associated with giving parenteral nutrition and methods to improve the safety of the PN solution itself. Always check the position of the PICC after insertion by injecting radio-opaque contrast into the catheter before taking an X-ray [24.
Improving Safety by Minimising Central Line Associated Blood Stream Infections in the NICU
Insertion of the central line is a key moment in the development of CLABSI and thus there should be adequate preparation. The site of central line insertion may also have an impact on the safety of PN delivery.
Combining Evidence-Based Risk Reduction Strategies into “Bundles”
Once the central line is inserted, there must be constant vigilance and emphasis on sterility during the time the catheter is in situ. We have already discussed in this chapter how the risk of CLABSI is associated with the time the catheter is in situ [60-63.
Any catheter manipulation can result in colonization with evidence linking increased CLABSI rates directly to catheter manipulation, particularly catheter access for blood sampling and catheter disconnection for PN changes. Thus, a regular assessment of the need for the central line to remain in situ should be made, and there should be a concerted effort to advance enteral feeding so that once the catheter is no longer required, it is promptly removed.
