Physiological and bifidogenic effects of prebiotic supplements in infant formulae.

OBJECTIVES: This randomized controlled trial involving 110 healthy neonates studied physiological and bifidogenic effects of galactooligosaccharides (GOS), oligofructose, and long-chain inulin (fructooligosaccharides, FOS) in formula. METHODS: Subjects were randomized to Orafti Synergy1 (50 oligofructose:50 FOS) 0.4 g/dL or 0.8 g/dL, GOS:FOS (90:10) 0.8 g/dL, or a standard formula according to Good Clinical Practice guidelines. A breast-fed group was included for comparison. Outcome parameters were weight, length, intake, stool characteristics, crying, regurgitation, vomiting, adverse events, and fecal bacterial population counts. Statistical analyses used nonparametric tests. RESULTS: During the first month of life, weight, length, intake, and crying increased significantly in all of the groups. Regurgitation and vomiting scores were low and similar. Stool frequency decreased significantly and similarly in all of the formula groups but was lower than in the breast-fed group. All of the prebiotic groups maintained soft stools, only slightly harder than those of breast-fed infants. The standard group had significantly harder stools at weeks 2 and 4 compared with 1 (P < 0.001 and P = 0.0279). The total number of fecal bacteria increased in all of the prebiotic groups (9.82, 9.73, and 9.91 to 10.34, 10.38, and 10.37, respectively, log10 cells/g feces, P = 0.2298) and more closely resembled the breast-fed pattern. Numbers of lactic acid bacteria, bacteroides, and clostridia were comparable. In the SYN1 0.8 g/dL and GOS:FOS groups, Bifidobacterium counts were significantly higher at D14 and 28 compared with D3 and were comparable with the breast-fed group. Tolerance and growth were normal. CONCLUSIONS: Stool consistency and bacterial composition of infants taking SYN1 0.8 g/dL or GOS:FOS-supplemented formula were closer to the breast-fed pattern. There was no risk of dehydration.

Safety and adequacy of an optimized formula for pediatric patients with cow's milk-sensitive enteropathy.

AIM: Infants and children with cow's milk-sensitive enteropathy are treated with extensively hydrolyzed formulas. A formula (New Alfaré) was developed by a protein hydrolysis method that yields an amino acid profile that more closely resembles human milk compared to previous formulas, and contains nucleotides. METHODS: The current study was a prospective, open trial aimed at evaluating the safety and nutritional adequacy of this formula for pediatric patients with clinical indications for the enteral use of semi-elemental diet. Safety was measured as normal growth based on Euro-growth standards for body mass index (BMI)-for-age z-scores, and nutritional adequacy was evaluated based on measurements of blood parameters. Forty-seven patients <32 months old, having a gestational age of ≥ 26 weeks, and weighing ≥ 1,500 g were enrolled, and fed with New Alfaré for four weeks. Weight, length and blood parameters were measured at the beginning and end of the study. Signs of tolerance to the formula (amount of formula intake, gastrointestinal symptoms and stool characteristics) were recorded daily by the parents. Twenty-five patients completed the study with all measurements. RESULTS: There was a significant increase in the mean BMI-for-age z-score (P<0.05) and albumin concentration (P<0.01) after four weeks. Mean plasma threonine concentration decreased significantly (P=0.01) and the mean tryptophan concentration tended to increase by the end of the study (P=0.06). No adverse events related to the study formula were reported. CONCLUSION: These results show that New Alfaré is safe and nutritionally adequate for pediatric patients with cow's milk-sensitive enteropathy.

Salmonella enterica subspecies houtenae serotype 44:z4, z23:--as a rare cause of meningitis.

Reptiles can carry and shed the bacterium Salmonella without showing any signs of illness. Transmission occurs by ingesting Salmonella after handling a reptile or objects contaminated by a reptile. Young children are especially vulnerable to Salmonella infection and can experience serious complications. We describe a case of reptile-associated Salmonella meningitis in a 2.5-month-old infant.