New Advances in Infant Feeding: New Products and Novel Technologies.

BACKGROUND: Breastfeeding is the best way to provide ideal food for infants. However, there are many situations in which breastfeeding is unviable (maternal illness, hygiene problems, intravenous feeding requirement, storage). Safe, efficient, and nutritious products should be offered by the industry to mothers and healthcare professionals as an alternative. OBJECTIVE: The present review aims to update the state of the art regarding the most innovative developments in infant feeding formulation and, the promising novel technologies that are being investigated to achieve a balance between the microbiological stability, organoleptic and nutritional value of baby food. METHODS: The research lines included in the present systematic review are focused on both, the most innovative ingredients and emergent technologies applied increasing the offer of tailor-made nutritional profiled products with improved quality and safety. RESULTS: According to the reviewed research and recently published patents the current emergence of a new generation of infant products is remarkable, with specific product lines aimed at infants at different stages of development and affected by several disorders (low-weight babies, premature neonates, allergenic patients), with special emphasis on the application of novel technologies (e.g. High Hydrostatic Pressure (HHP) and microencapsulation) as potential techniques to ensure the microbiological safety of developed products, and the improvement of their nutritional value, complementary to the addition of functional ingredients, such as omega 3 and 6 fatty acids, amino acids, prebiotics and probiotics, and medicinal herb supplementation (e.g. lemon balm, royal jelly). CONCLUSION: The present research work provides a general view of recent advances in infant products processing and formulation focusing on the technological effects and quality/safety developments.

Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies.

BACKGROUND: To evaluate disturbances in primary tooth eruption and their management with nonpharmacological remedies. METHODS: In this nonrandomized clinical trial, 270 children aged between 8 and 36 months were selected and divided into 5 groups with 54 children initially enrolled in each group. The children were seen during an 8-day period during tooth eruption. At each appointment data were recorded from oral examination, tympanic temperature measurement and a questionnaire. The five methods used as remedies to reduce teething symptoms were: 1) cuddle therapy, 2) ice, 3) rubbing the gums, 4) teething rings and 5) food for chewing. Teething symptoms, the type of erupted tooth, symptoms of recovery and the mother's satisfaction with treatment were evaluated. RESULTS: Two hundred and fifty four children (mean age 16 ± 7.2 months) completed the study. The most frequent teething symptoms were drooling (92%), sleep disturbances (82.3%) and irritability (75.6%). These symptoms were more pronounced in low birth weight children (p > 0.05). Canine eruption led to more loss of appetite than incisor (p = 0.033) or molars eruption (p = 0.014). Low grade increases in body temperature were observed only on the day of eruption (36.70 ± 0.39 °C), when body temperature was significantly different compared to the day before and the day after eruption (both p < 0.001). There was no significant correlation between fever as reported by mothers and temperature readings obtained by the investigators. The most favorable results for time to recovery and the mother's satisfaction were seen when teething rings were used, followed by cuddle therapy and rubbing the gums. CONCLUSIONS: There was no association between teething and symptoms such as fever or diarrhea. Low birth weight children may have more teething symptoms. Teething rings, cuddle therapy and rubbing the gums were the most effective methods to reduce symptoms. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: code IRCT201211127402N3.

Development of robotic mobility for infants: rationale and outcomes.

OBJECTIVES: To assess the feasibility of a robotic mobility device for infants using alternative control interfaces aimed at promoting early self-initiated mobility, and to assess the effects of a training protocol and robot experience. DESIGN: Observational and pre-post quantitative case studies. SETTING: Standardised, research laboratory and day-care centres with toys and individuals familiar to infants. PARTICIPANTS: Children with and without disabilities, aged 5 months to 3 years. INTERVENTIONS: In each study, infants were seated over a Pioneer™ 3-DX mobile robot. Some infants controlled the directional movement of the robot by weight shifting their body on a Nintendo® Wii™ Balance Board (the WeeBot), while others used a modified joystick. Infants participated in five sessions over 2 to 5 weeks. Sessions consisted of administering a 10-minute training protocol preceded and followed by 2 to 3 minutes of free play. One child with motor impairment used a button switch array and a different experimental design. MAIN OUTCOME MEASURES: From the videotaped free-play periods, goal-directed behaviours were coded and time in motion was measured. In the training period, a scoring system was developed to measure the infants' driving performance. RESULTS: Preliminary outcomes indicate that infants without disabilities, aged 5 to 10 months, demonstrated significant improvement in driving performance and goal-directed movement using the WeeBot. Infants who used the joystick were less successful on all measures. Results for infants with disabilities using the WeeBot were mixed. CONCLUSIONS: Mobile robots offer promise to enhance the development of early self-mobility. Novel types of interfaces, such as the WeeBot, warrant further investigation.

How learning to shake a rattle affects 8-month-old infants' perception of the rattle's sound: electrophysiological evidence for action-effect binding in infancy.

Bidirectional action-effect associations play a fundamental role in intentional action control and the development of the mirror neuron system. However, it has been questioned if infants are able to acquire bidirectional action-effect associations (i.e., are able to intentionally control their actions). To investigate this, we trained 8-month-old infants for one week to use a novel rattle that produced a specific sound when shaken. Infants were also presented with another sound, which was not related to an action. Thereafter, infants' EEG responses to these two sounds and to an additional, unfamiliar sound were recorded. Infants displayed a stronger mu-desynchronization above cortical motor sites (i.e., motor resonance) when listening to the action-related sound than when hearing other sounds. Our results provide therefore electrophysiological evidence that infants as young as 8 months are able to acquire bidirectional action-effect associations and parallel findings of audiovisual mirror neurons in the monkey brain.

Cup introduction, drink type and vitamin supplementation in preterm babies at 11-25 months.

BACKGROUND: To avoid adverse effects of prolonged bottle use, the recommendations are that full-term babies are introduced to cups from 6 months and discouraged bottles from 12 months old. There are no recommendations for preterm babies. In the UK, the Department of Heath recommends the introduction of vitamin supplements, alongside the transition from formula to cow's milk. The present study aimed to determine age of cup introduction in a group of preterm babies, identify drinks offered from bottles versus cups and the types of cups used, and establish the prevalence and appropriateness of vitamin supplementation. METHODS: A validated postal questionnaire was sent to the parents of 369 babies born <34 weeks of gestation at Queen Charlottes Neonatal Unit; 104 sent in 2003 and 265 sent in 2004-2005. The questionnaire was sent when the babies were calculated to be between 12 and 18 months (all ages stated are uncorrected). A separate questionnaire was sent for each baby from multiple pregnancies. RESULTS: The questionnaire return rate was 46% (n = 169). Length of gestation (P < 0.001), hospital stay (P = 0.009), birth weight (P = 0.002) and maternal age (P < 0.001) were significantly greater and more mothers were of European origin (P = 0.036) for those babies for whom questionnaires were returned compared to nonresponders. Infant gender did not differ. Fifty-seven percent had been introduced to a cup before 12 months, distribution was: 58% (n = 53) of singletons, 54% (n = 37) of twins and 67% (n = 6) of triplets. This rose to 80% before 13 months. Thirteen percent (n = 22) had not started drinking from a cup and 17% (n = 29) only used cups at the time of the questionnaire. Cow's milk had been introduced to 69% (n = 117) of all babies and 32% (n = 54) were still on formula (10 on both and eight were on neither; hence, the figures do not sum to 100%). Cow's milk was drunk from bottles by 56% (n = 95) and formula by 31% (n = 52). A significantly greater proportion of twins and triplets were drinking cow's milk compared to singletons [80% (n = 62) versus 60% (n = 55) P = 0.005] and significantly fewer were drinking formula [22% (n = 17) versus 40% (n = 37) P = 0.012]. Water was the drink most commonly given from a cup (80%) (n = 135) followed by juice, which was given to 64% (n = 108). Juice drinks were given by bottle in 16% (n = 27). Fifty-two percent (n = 88) used a 'spill-proof' cup some of the time. Vitamins were given as recommended in 18% (n = 31), given even though not recommended in 12% (n = 20), not given but recommended in 49% (n = 83) and appropriately not given in 21% (n = 35). A greater percentage of twins and triplets, compared to singletons, were not commenced on vitamins, even though they were no longer drinking formula. CONCLUSIONS: The present study reports baseline data on cup introduction in preterm babies both from singleton and multiple births. The data suggest that education about appropriate bottle drinks, timing of cup introduction, suitable cups and the correct use of vitamin drops is required. However, because the profile of responders differed from nonresponders, these results may not be applicable to all preterm babies.

Transferring preterm infants from incubators to open cots at 1600 g: a multicentre randomised controlled trial.

OBJECTIVES: To determine the effects on weight gain and temperature control of transferring preterm infants from incubators to open cots at a weight of 1600 g versus a weight of 1800 g. DESIGN: Randomised controlled trial. SETTING: One tertiary and two regional neonatal units in public hospitals in Queensland, Australia. PARTICIPANTS: 182 preterm infants born with a birth weight less than 1600 g, who were at least 48 h old; had not required ventilation or continuous positive airways pressure within the last 48 h; were medically stable with no oxygen requirement, or significant apnoea or bradycardia; did not require phototherapy; and were enterally fed with an intake (breast milk/formula) of at least 60 ml/kg/day. INTERVENTIONS: Transfer into an open cot at 1600 or 1800 g. MAIN OUTCOME MEASURES: The primary outcomes were temperature stability and average daily weight gain over the first 14 days following transfer to an open cot. RESULTS: 90 infants in the 1600 g group and 92 infants in the 1800 g group were included in the analysis. Over the first 72 h, more infants in the 1800 g group had temperatures <36.4°C than the 1600 g group (p=0.03). From post-transfer to discharge, the 1600 g group had more temperatures >37.1°C (p=0.02). Average daily weight gain in the 1600 g group was 17.07 (SD±4.5) g/kg/day and in the 1800 g group, 13.97 (SD±4.7) g/kg/day (p=<0.001). CONCLUSIONS: Medically stable, preterm infants can be transferred to open cots at a birth weight of 1600 g without any significant adverse effects on temperature stability or weight gain. TRIAL REGISTRATION: ACTRN12606000518561 (http://www.anzctr.org.au).

Dietary exposure assessment of infants to bisphenol A from the use of polycarbonate baby milk bottles.

The residual bisphenol A (BPA) levels in 28 different brands of polycarbonate (PC) baby milk bottles available in the Singapore market were measured. With a detection limit of 3 mg/kg, BPA residues were detected in 19 out of the 28 PC baby milk bottles at levels between 4.01 and 141 mg/kg, with a mean of 28.1 +/- 31.4 mg/kg and a median of 17.2 mg/kg. The potential migration of BPA from each of the 28 PC milk bottles was also measured using food-simulating solvents and time conditions recommended by the US Food and Drug Administration (US FDA), but using temperatures more severe than actual use. The highest upper-bound mean BPA migration levels of 0.64 +/- 0.48 microg/in2 in 10% ethanol at 70 degrees C and 0.43 +/- 1.25 microg/in2 in corn oil at 100 degrees C were observed after incubating cut portions of the milk bottles for 240 h. With this migration data and using US FDA's procedure for estimation of dietary exposure, the worst-case dietary exposure assessment for the intake of BPA by infants between birth and three months of age was below the oral Reference Dose of 0.05 mg/kg bw/day established by the US Environmental Protection Agency. This study showed that the dietary exposure to BPA from actual uses of PC milk bottles is unlikely to pose a health risk in infants.

[The design of preoperative multipurpose coloclyster for the neonatal giant colons].

This paper proposes a designing concept of a multipurpose coloclyster for neonates, and introduces its structure and functions of its components in detail. The clinical application of this instrument will reduce the labour intensity of medical personnels, shorten the time of preoperative preparation and lessen complication of the patients.

The design of preoperative multipurpose coloclyster for the neonatal giant colons / 中国医疗器械杂志

This paper proposes a designing concept of a multipurpose coloclyster for neonates, and introduces its structure and functions of its components in detail. The clinical application of this instrument will reduce the labour intensity of medical personnels, shorten the time of preoperative preparation and lessen complication of the patients.

Injury prevention training: a cluster randomised controlled trial assessing its effect on the knowledge, attitudes, and practices of midwives and health visitors.

OBJECTIVE: To evaluate the effectiveness of injury prevention training. DESIGN: Cluster randomised controlled trial. SETTING: Primary care facilities in the East Midlands area of the United Kingdom. SUBJECTS: Midwives and health visitors. INTERVENTION: Evidence based training session on the risks associated with baby walkers. MAIN OUTCOME MEASURES: The primary outcome measures were knowledge of baby walker use and walker related injury, attitudes towards walkers and towards walker education, and practices relating to walker health education. RESULTS: Trained midwives and health visitors had greater knowledge of the risks associated with baby walkers than untrained midwives and health visitors (difference between the means 0.22; 95% confidence interval (CI) 0.12 to 0.33). Trained health visitors had more negative attitudes to baby walkers (difference between the means 0.35; 95% CI 0.10 to 0.59) and more positive attitudes towards baby walker health education (difference between the means 0.31; 95% CI 0.00 to 0.62) than untrained health visitors. Midwives who had been trained were more likely to discuss baby walkers in the antenatal period than those who were not trained (odds ratio 9.92; 95% CI 2.02 to 48.83). CONCLUSIONS: Injury prevention training was associated with increased knowledge, more negative attitudes towards walkers, and more positive attitudes towards walker education. Trained midwives were more likely to give advice antenatally. Training did not impact on other practices. Larger trials are required to assess the impact of training on parental safety behaviours, the adoption of safety practices, and injury reduction.

Increased cardiac autonomic responses to auditory challenges in swaddled infants.

STUDY OBJECTIVES: When infants have been swaddled and sleep supine, their risk of dying from sudden infant death syndrome (SIDS) is reduced with an odds ratio of 0.64 to 0.69. Alternatively, the risk for SIDS in swaddled infants shows a 3-fold increase in the prone position. The protective role of swaddling during supine sleep has remained unexplained. This study was designed to evaluate the effects of swaddling on cardiac reactivity to auditory stimuli during sleep in both the prone and the supine position. DESIGN: Thirty healthy infants with a median age of 11 weeks (range 8 to 15 weeks) were studied polygraphically for 1 night while sleeping successively prone and supine, or vice versa. The infants were studied while swaddled and nonswaddled in both positions. Heart rates were studied during rapid eye movement sleep, before and after exposure to 90 dB(A) of white-noise. RESULTS: Ten infants were excluded from the study because they woke up during the position change or the auditory challenge. Before the administration of the noise stimulus, swaddling decreased values of basal heart rates in the supine position only (P = .049). Following swaddling, the values of basal heart rate were significantly lower in the supine than in the prone position (P = .003). Auditory challenges were followed by a greater increase in heart rate when the supine sleeping infants were swaddled than when not swaddled (P = .018). When swaddled, beat-to-beat heart-rate variability increased following auditory stimulation in the supine position only (P = .012). CONCLUSION: When sleeping supine, swaddled infants had greater cardiac autonomic changes in response to noise challenges than when they were not swaddled.

Midwives' knowledge of, attitudes to and practice with baby walkers.

OBJECTIVE: to determine community midwives' knowledge, attitudes and practice with regard to baby walkers. DESIGN: survey, using questionnaires. SETTING: primary care, East Midlands, UK. PARTICIPANTS: Sixty-five community midwives participating in a cluster randomised controlled trial to reduce baby walker use. FINDINGS: there was a 94% response. Seventy per cent of the midwives, felt that it was part of their role to discuss baby walkers, and 62% felt that giving advice about walkers before birth acceptable. The midwives had a limited knowledge of baby walker injury risk and only one midwife had any baby walker-related health education material. Three attitude scales were computed and indicated that the midwives held a negative view of baby walkers and were positive about baby walker health education, believing that parents hold a positive attitude to baby walkers. Those midwives who had used a walker with their own children were more positive about baby walkers and less positive about baby walker health education. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwives are willing to be involved in baby walker health education during pregnancy. However, they require evidence-based knowledge and materials rather than relying on personal experience.

Kinesthetic stimulation for preventing apnea in preterm infants.

BACKGROUND: Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation or other treatments. Physical stimulation is often used to restart breathing and it is possible that repeated stimulation, such as with an oscillating mattress (kinesthetic stimulation), might prevent apnea and its consequences. OBJECTIVES: In preterm infants at risk for apnea, does prophylactic use of kinesthetic stimulation lead to a clinically important reduction in apnea and bradycardia, and use of intermittent positive pressure ventilation (IPPV). SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal trials, Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2001), MEDLINE (1966-January 2002), EMBASE, CINAHL (1982-January 2002), previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal hand searching mainly in the English language. SELECTION CRITERIA: All trials in preterm infants at risk of developing clinical apnea which utilized random or quasi-random allocation to treatment with an oscillating mattress (or other forms of repetitive kinesthetic stimulation) or control, were eligible. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality and data extraction by each author and synthesis of the data using relative risk. MAIN RESULTS: Three trials enrolling a total of 154 babies were included in this review. There was no evidence of effect on short term outcomes (apnea /bradycardia, IVH, use of IPPV, sleep/wake cycles and neurological status at discharge) or long term outcomes (in one trial - growth and development to one year). REVIEWER'S CONCLUSIONS: Implications for practice. Prophylactic use of kinesthetic stimulation cannot be recommended to reduce apnea/bradycardia in preterm infants. Implications for research. There are currently no clear research questions regarding prophylactic use of kinesthetic stimulation to prevent apnea in preterm infants.

Kinesthetic stimulation for preventing apnea in preterm infants.

BACKGROUND: Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation or other treatments. Physical stimulation is often used to restart breathing and it is possible that repeated stimulation, such as with an oscillating mattress (kinesthetic stimulation), might prevent apnea and its consequences. OBJECTIVES: In preterm infants at risk for apnea, does prophylactic use of kinesthetic stimulation lead to a clinically important reduction in apnea and bradycardia, and use of intemittent positive preswsure ventilation (IPPV). SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language. SELECTION CRITERIA: All trials in preterm infants at risk of developing clinical apnea which utilised random or quasi-random allocation to treatment with an oscillating mattress or control, were eligible. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality and data extraction by each author and synthesis of the data using relative risk. MAIN RESULTS: There were no differences in short term effects (apnea /bradycardia, IVH, use of IPPV, sleep/wake cycles and neurological status at discharge) or longterm effects (in one trial - growth and development to one year). REVIEWER'S CONCLUSIONS: Implications for practice. Prophylactic use of kinesthetic stimulation cannot be recommended to reduce apnea/bradycardia in preterm infants. Implications for research. There are currently no clear research questions regarding prophylactic use of kinesthetic stimulation to prevent apnea in preterm infants.