Vitamin A and E status in very low birth weight infants.

OBJECTIVE: To determine vitamin A and vitamin E status in very low birth weight (VLBW) infants at the time of birth (TB), at the time of full feeding (TFF) and at term postmenstrual age (TT). STUDY DESIGN: An observational study was conducted in VLBW infants. Plasma retinol and α-tocopherol levels were measured at TB, TFF and TT. Multivitamin supplementation was given to all infants to meet the daily requirement. RESULT: A total of 35 infants were enrolled. The median (interquartile range) of gestational age and birth weight was 30 (28 to 32) weeks and 1157 g (982 to 1406 g). The median of vitamin A and vitamin E intakes from TFF to TT was 832 and 5.5 IU kg(-1) day(-1), respectively. Vitamin A deficiency occurred in 67.7% at birth, 51.6% at TFF and 82.1% at TT. Vitamin E deficiency occurred in 77.4% at birth, 16.1% at TFF and 35.7% at TT. Small-for-gestational age was the only risk factor for vitamin A deficiency. Lower amount of breast milk consumption was associated with higher incidence of vitamin E deficiency. No differences in vitamin A- or vitamin E-related morbidities between infants with and without vitamin deficiencies were found. CONCLUSION: High prevalence of vitamin A and vitamin E deficiency was found in VLBW infants starting from birth to term postmenstrual age. Therefore, a higher dose of vitamin supplementation is required.

Production and shelf stability of multiple-fortified quick-cooking rice as a complementary food.

Rice-based complementary foods normally contain inadequate amounts of several micronutrients, such as iron, calcium, and zinc. This study aimed at improving the quality of commercially produced rice-based complementary foods. The analysis centered on identifying a rice-based complementary food that is safe, stable, sensory acceptable, and economical in terms of fortificants (iron, calcium, zinc, thiamine, folate) and effectively packaged for industrial production and distribution. Product colors were mostly in green-yellow tone and slightly changed to more yellow during storage. Sensory acceptability was affected by changes in odor and rancidity but not in color. Rancidity scores were low in aluminum foil laminated plastic bags (ALU). Lipid oxidation significantly increased during storage, but at a slower rate when sodium citrate and ALU were used. Color differences of raw products were detected but not in the cooked ones. Mineral and vitamin losses during processing were 2% to 11% and 20% to 30%, respectively, but no losses were found during storage. FeSO(4)+ NaFeEDTA added with sodium citrate resulted in the most acceptable product for all packagings. The multiple-fortified quick-cooking rice (MFQCR) developed from this study could be a potentially useful tool for combating micronutrient deficiencies among infants and young children in the countries where rice is the staple food.

Combined raw cornstarch and nifedipine as an additional treatment in persistent hyperinsulinemic hypoglycemia of infancy.

This study reports the result of treatment with the combination of raw cornstarch and nifedipine in two infants affected with hyperinsulinemic hypoglycemia of variable severity. The first infant developed hypoglycemia during early neonatal period and required subtotal pancreatectomy. She still developed hypoglycemia after her second operation. The second infant developed hypoglycemia at the age of 7 months. Raw cornstarch and nifedipine efficiently normalized both infants' blood glucose levels. Although they still need frequent feedings, no hypoglycemic episode was reported except when they were sick. Their growth and development were markedly improved after initiation of treatment.

Reduction of rotavirus infection in children receiving bifidobacteria-supplemented formula.

This study was conducted at Pakkred Babies Home, Bangkok, Thailand; with the hypothesis that children receiving probiotic-supplemented milk-based formula may be protected from developing diarrheal diseases. Salivary rotavirus-specific IgA antibody was used as an indicator of rotavirus infection. One hundred and seventy-five children, aged 6-36 months, were enrolled in the study. They were divided into 3 groups according to the type of formula given. There were 81 episodes of diarrhea during an 8-month study period, most of which were caused by bacterial enteropathogens. Ninety-seven pairs of salivary samples were adequate for the analysis of rotavirus antibody. Among 23 children receiving milk-based follow-up formula and serving as control group, 30.4 per cent of them had > or = 4-fold increase in the antibody titre, indicating subclinical rotavirus infection. The majority of children in the other 2 study groups, receiving the same formula supplemented with either Bifidobacterium Bb12 alone or together with Streptococcus thermophilus, had no significant change in the antibody titres between the two time points. The results of this study support our hypothesis that children receiving bifidobacteria-supplemented milk-based formula may be protected against symptomatic rotavirus infection.

Effects of multivitamin supplementation for improvement of thiamin, riboflavin, and retinol nutrition in pediatric patients.

The effect of multivitamin supplementation on thiamin, riboflavin and retinol nutrition was studied in ten male chronic pediatric patients at Ramathibodi Hospital. MTV forte (Government Pharmaceutical Organization) was given 1 tablet daily for ten days and the effect was compared with the preceding ten-day control period. Anthropometric biochemical, clinical and dietary assessments were performed throughout the study. Biochemical assessments of vitamin nutrition at the beginning and the end of a 10-day non-supplementation period revealed multiple vitamin deficiencies in the subjects, though clinical manifestation was not seen. Hospital diets improved vitamin nutrition of some patients but most of them still showed subclinical vitamin deficiencies. Improvement of vitamin nutrition was clearly shown in most patients after MTV supplementation. Multiple vitamin supplements should be prescribed in high-risk patients since there was no definite pattern of vitamin deficiencies in various diseases and early detection of vitamin deficiency was difficult to perform. The dosage between 1-2 times of RDA was considered adequate in most of our patients.

Vitamin E status, glutathione peroxidase activity and the effect of vitamin E supplementation in children with thalassemia.

Vitamin E and selenium statuses were studied in thalassemic children in comparison with 16 normal controls. Twelve Hb H disease, 46 beta-thal/Hb E and 7 beta-thal major patients had lower plasma vitamin E level than controls but plasma vitamin E/total lipids ratio of Hb H disease subjects was not different from normal. Twelve Hb H disease and 33 beta-thal/Hb E patients had normal RBC Se but increased RBC GSH-Px activity. Ten vitamin E-deficient thalassemic subjects had been supplemented with 200 mg of oral vitamin E for 4-8 weeks. After supplementation, their plasma vitamin E increased and H2O2 hemolysis decreased to normal values. Their RBC GSH-Px activity also decreased but hematocrit did not change significantly. The results demonstrate that some types of thalassemic patients have vitamin E deficiency and support that vitamin E and selenium have related functions in the prevention of RBC oxidation. Vitamin E supplementation increased RBC resistance to oxidative damage.

Maple syrup urine disease: case report of 2 Thai infants.

Maple syrup urine disease (MSUD) is a rare inborn error of metabolism characterized by typical urine odor. The deficiency of branched-chain ketoacid decarboxylase enzyme is responsible for the clinical abnormalities. The classical disease usually manifests in the neonatal period with lethargy, refused feeding, seizures and death. Since 1984, at the Department of Pediatrics, Ramathibodi hospital, 2 patients with classical MSUD have been seen. The parents of one patient were relatives and already had 2 affected but undiagnosed daughters. Both patients had strong urine odor which was described as the odor of boiled Chinese herbal medicine. The first child died at 4 months old and the second was severely retarded at one year old. The importance of early diagnosis and genetic counselling are emphasized.

Wheat extract and milk mixture as a milk substitute for children with milk intolerance.

PIP: A mixture of milk with wheat extract and oil provides a low lactose formula which contains higher concentrations of energy than does diluted infant formula. To evaluate this mixture in malnourished children with diarrhea of more than 1 week's duration, 28 patients aged 3-18 months were studied at the pediatric isolation and metabolic wards of Ramathibodi Hospital. They were divided equally into study and control groups. The experimenta formula was a mixture of wheat extract, powdered whole milk and corn oil. The control diet was an infant formula. The lactose contents of the experimental and control formulas were, respectively, 1.1 and 7.2 g/100 ml. Amounts of fat, protein and carbohydrates were almost identical in both formulas. After rehydration with intravenous or oral electrolyte solutions, patients were fed full strength experimental formula or diluted infant formula. The latter's concentration was increased gradually according to clinical response, determined by daily weight, and stool frequency and consistency. All study group patients and 11 of 14 control group patients recovered from diarrhea. The mean +or- SD treatment durations in the study and control groups were 3.2 +or- 1.1 and 5.3 +or- 2.2 days respectively (p 0.01). The result suggested that a combined wheat extract/milk mixture is beneficial as a milk substitute for children with lactose intolerance.^ieng