Caregivers' nutrition-related knowledge, perceptions, practices and barriers regarding the therapeutic diet for classical galactosaemia.

BACKGROUND: Classical galactosaemia is a life-threatening disorder of carbohydrate metabolism, and the primary treatment is a lifelong galactose-restricted diet commenced in infancy. Adherence to restrictive diets can be burdensome for patients and their families; however, little is known about the impact on caregivers. AIM: This study aims to determine the nutrition-related knowledge, perceptions, practices, and barriers of caregivers related to the therapeutic diet for classical galactosaemia. METHODS: An online survey was conducted among 98 eligible members of the Galactosaemia Support Group using a novel questionnaire. Descriptive and inferential analyses were performed using Microsoft Excel 2021 and Stata/MP (version 17.0), respectively. Forty-three caregivers participated in the study. RESULTS AND CONCLUSION: Of those who participated, 98% had high levels of dietary knowledge. Caregivers' knowledge scores ( x ¯ $\bar{{\rm{x}}}$ = 17.9, standard deviation [SD] = 1.7) were positively correlated with educational level (r = 0.383, p = 0.013). High attitudinal scores ( x ¯ $\bar{{\rm{x}}}$ = 32.5, SD = 5.5) obtained by most caregivers (65%) revealed an overall positive attitude towards the galactosaemia diet. Negative perceptions of being unable to feed their child breast milk (49%) were apparent, and this perception was positively correlated with caregivers' intention to feed their child breast milk (r = 0.450, p = 0.003). Caregivers' concerns about the safety of their child in social settings (79%) and feeling that their child was excluded in social settings (49%) were clear barriers. A multidisciplinary approach to galactosaemia management is warranted, with healthcare interventions focusing on addressing caregivers' negative perceptions and barriers related to the diet to enable tailored support and facilitate lifelong compliance.

Impact of a multi-strain probiotic administration on peri-rectal colonization with drug-resistant Gram-negative bacteria in preterm neonates.

Background: Infections caused by drug resistant Gram-negative bacteria (DR-GNB) are a major health concern for hospitalized preterm neonates, globally. The aim of this study was to investigate the effect of a multi-strain probiotic on the incidence of rectal colonization with DR-GNB in preterm neonates. Methods: A double-blind, placebo-controlled, randomized clinical trial was conducted including 200 neonates, randomly allocated to a multi-strain probiotic (n = 100) or placebo (n = 100). Results: Fifteen percent of the neonates showed peri-rectal colonization with DR-GNB on the day of enrolment indicating probable maternal-to-neonate (vertical) bacterial transmission or environmental acquisition at time of delivery, with no difference between groups. Acquisition of further DR-GNB colonization was rapid, with an increase from 15% on the day enrolment to 77% by day 7 and 83% by day 14 of life. By day 7 (corresponding to early gut colonization), neonates in the probiotic group were 57% less likely to have peri-rectal DR-GNB colonization [OR: 0.43 (0.20-0.95); p = 0.04] and by day 14 (corresponding to late gut colonization), neonates in the probiotic group were 93% less likely to have peri-rectal DR-GNB colonization [OR: 0.07 (0.02-0.23); p < 0.001]. Conclusion: Hospitalized neonates showed substantial peri-rectal colonization with DR-GNB at enrolment and further rapid acquisition of DR-GNB in the first 2 weeks of life. The use of a multi-strain probiotic was effective in reducing early and late neonatal gut colonization with DR-GNB. Clinical Trial Registration: The trial was registered at the Pan African Clinical Trial Registry (PACTR202011513390736).

Effect of a Multi-Strain Probiotic on Growth and Time to Reach Full Feeds in Preterm Neonates.

Background: The main nutritional goal for premature neonates is to achieve a postnatal growth rate that the neonate would have experienced in utero. Postnatal growth failure is, however, very common in very and extremely low birth weight neonates. The use of probiotics shows promising results in reducing the time for full feeds, as well as in increased weight gain. The optimal probiotic strain has, however, not been elucidated. The aim of the present study was to evaluate the difference in the growth and time to reach full feeds between the two treatment arms, using LabinicTM as a multi-strain probiotic and a placebo. Methods: We conducted a double-blind, placebo-controlled, randomized clinical trial investigating the effect of a multi strain probiotic (LabinicTM) on various outcomes in preterm neonates. The results on the time to reach full feeds and the growth will be discussed in this paper. A probiotic or placebo was given once daily to the neonates for 28 days. Weight and feeding volume were measured daily, and length and head circumference were measured weekly. Results: The probiotic group reached full feeds earlier 8.7 days; ± 2.0 than the placebo group 9.7 days; ±4.3 (p = 0.04) and regained their birthweight earlier than the placebo group 11.5 days ± 6.3 vs. 13.3 days ± 6.3 (p = 0.06). From day 21 onwards, the probiotic group showed a significantly greater crude gain in weight (p < 0.001) than the placebo group (estimated difference between the two groups day 21: 56.7 g and at day 28: 83.7 g. There was a significant improvement observed in the weight Z-score change in the probiotic group over the 28-day period. Conclusion: The use of a multi-strain probiotic (LabinicTM) shows great potential as a low-cost, low-risk intervention in reducing the time to reach full feeds as well as shortening the time to regain birthweight. The probiotic had an additional beneficial impact on Z-score change in weight potentially decreasing post-natal growth restriction.

Effect of a Multi-Strain Probiotic on the Incidence and Severity of Necrotizing Enterocolitis and Feeding Intolerances in Preterm Neonates.

Background: Necrotizing enterocolitis (NEC) is a multifactorial disease, causing inflammation of the bowel. The exact root of NEC is still unknown, but a low weight and gestational age at birth are known causes. Furthermore, antibiotic use and abnormal bacterial colonization of the premature gut are possible causes. Premature neonates often experience feeding intolerances that disrupts the nutritional intake, leading to poor growth and neurodevelopmental impairment. Methods: We conducted a double-blind, placebo-controlled, randomized clinical trial to investigate the effect of a multi-strain probiotic formulation (LabinicTM) on the incidence and severity of NEC and feeding intolerances in preterm neonates. Results: There were five neonates in the placebo group who developed NEC (Stage 1A−3B), compared to no neonates in the probiotic group. Further, the use of probiotics showed a statistically significant reduction in the development of feeding intolerances, p < 0.001. Conclusion: A multi-strain probiotic is a safe and cost-effective way of preventing NEC and feeding intolerances in premature neonates.

The Efficacy of Fish as an Early Complementary Food on the Linear Growth of Infants Aged 6-7 Months: A Randomised Controlled Trial.

Fish is a good animal-source protein for growth and development. The main objective of the study was to assess the efficacy of fish during the early complementary feeding period on infants' linear growth in the Samfya district of the Luapula Province of Zambia in 6 months randomised controlled trial. The study was conducted from April 2019 to January 2020. Infants aged 6-7 months (N = 238) were assigned to either the intervention (treatment) group or control (placebo) group to receive fish powder or sorghum powder, respectively. Participants were followed on a weekly basis to distribute the powder and record compliance/usage and any morbidities. Anthropometric measurements were taken monthly. A linear mixed-effects model showed that fish powder improved linear growth among infants over all the 6 months of the intervention period. The fish powder increased length-for-age z scores by 1.26 (95% CI: 0.94-1.57) and weight-for-age z score by 0.95 (95% CI 0.6-1.23). The addition of fish powder to the infant's usual food during the early complementary feeding improves the infant's linear growth outcome.

Effect of Nutritional Intake on the Body Composition of HIV-Exposed and HIV-Unexposed Preterm and Low Birth Weight Infants.

BACKGROUND: Human breast milk (HBM) is considered inadequate in meeting protein requirements, especially for very low birth weight (VLBW) infants, which could affect body composition. OBJECTIVES: The primary objective was to determine the effect of HBM on body composition of HIV-exposed and unexposed preterm VLBW and extremely low birth weight infants. The secondary objectives were to ascertain the effect breast milk fortification and days nil per os (NPO) have on body composition. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted. Preterm infants with a birth weight of ≤1,200 g were included. Infant nutritional intakes and body composition measurements were recorded during the 28-day follow-up period. RESULTS: One hundred ten of 113 preterm infants received HBM and 91 infants received fortified HBM. HIV-exposed and unexposed infants receiving fortified HBM displayed differences in fat mass percentage (FM%) (0.88% versus 1.36%, p = 0.01; 0.97% versus 1.49%, p = 0.03) and fat-free mass percentage (FFM%) (98.98% versus 98.68%, p = 0.03; 99.02% versus 98.49%, p = 0.02) on days 21 and 28, respectively. Infants kept NPO displayed differences in FM% on days 7, 21, and 28 (0.9% versus 1.3%, p = 0.03; 0.99% versus 1.4%, p = 0.02; and 0.9% versus 1.6%, p = 0.0004) as well as differences in FFM% (99.1% versus 98.4%; p = 0.0005) on day 28 of life. CONCLUSION: There were no significant differences in the body composition of infants who received HBM versus fortified HBM. However, significant differences in body composition were reported between HIV exposure groups for infants who received fortified HBM. Infants who were kept NPO were generally smaller, shorter, and had lower FM% and more FFM%.

The effect of maternal HIV status and treatment duration on body composition of HIV-exposed and HIV-unexposed preterm, very and extremely low-birthweight infants.

BACKGROUND: There is an evidence gap regarding the relationship between HIV exposure, body composition (and the quality thereof) and preterm infants. AIM: This study determined the body composition of HIV-exposed, preterm very low-birthweight (VLBW) and extremely low-birthweight (ELBW) infants and to assess the effect of maternal HAART duration on the body composition of this vulnerable population. METHODS: A descriptive cross-sectional study was conducted. HIV-exposed and -unexposed preterm infants (<37 weeks) with a birthweight of ≤1200g were included. Maternal medical background was recorded. Infant body composition measurements were recorded weekly during the 28-day follow-up period. RESULTS: Thirty preterm infants (27%) were HIV-exposed. HIV-exposed infants had significantly (=0.01) lower gestational ages than HIV-unexposed infants (25-28 weeks). HIV-exposed infants had significantly lower measurements on day 21 and day 28 for triceps skinfold (TSF) (2.5 mm vs 2.7 mm, = 0.02 and 2.6 mm vs 2.9 mm, <0.01), subscapular skinfold (SSSF) (2.3 mm vs 2.6 mm, = 0.02 and 2.4 mm vs 2.7 mm, =<0.01) and fat mass percentage (FM%) (0.9% vs 1.4%, = 0.02 and 1.0% vs 1.5%, = 0.03). HIV-exposed infants whose mothers received HAART for ≥ 20 weeks were heavier and had a higher FM% and lower fat-free mass percentage (FFM%) at birth than HIV-exposed preterm infants whose mothers received highly active antiretroviral therapy for ≥ 4- < 20 weeks. CONCLUSION: Mothers receiving HAART could have increased risk of preterm delivery, and the duration of maternal HAART affects postnatal body composition of their infants. Body composition differs between HIV-exposed and HIV-unexposed preterm infants.

Anthropometric Parameters of HIV-Infected and HIV-Uninfected Mothers and their Premature Infants.

This study aimed to assess the maternal anthropometric parameters of human immunodeficiency virus (HIV)-infected and HIV-uninfected mothers as well as to assess the neonatal anthropometric parameters of premature infants in relation to maternal anthropometric parameters (weight, height and mid-upper-arm circumference), HIV status and anti-retroviral therapy (ART) regimen. Study participants included HIV-infected and HIV-uninfected mothers who gave birth to premature infants. All HIV-infected mothers received ART. The incidence of intra-uterine growth restriction (IUGR) among premature infants was high. Maternal anthropometric parameters, HIV status and ART exposure showed no association with IUGR in this study. Sufficient maternal ART exposure may positively influence head circumference at birth, which might determine the neurodevelopmental outcome of these infants.

Differences in Breast Milk Composition of HIV-Infected and HIV-Uninfected Mothers of Premature Infants: Effects of Antiretroviral Therapy.

INTRODUCTION: A key strategy to prevent mother-to-child transmission of the human immunodeficiency virus (HIV) and to reduce infant morbidity and mortality includes providing the HIV-exposed premature infant with breast milk accompanied by dual anti-retroviral therapy (ART). The effects of HIV and ART on premature breast milk composition are largely unknown. The aim of the study was to assess and compare the breast milk composition of HIV-infected mothers receiving ART and HIV-uninfected mothers who gave birth to premature infants. MATERIALS AND METHODS: Lactating HIV-infected women receiving ART (n = 38) and HIV-uninfected women (n = 36) with premature infants provided two breast milk samples on days 7 and 9, respectively, of lactation. Breast milk samples were analyzed for total energy, protein, carbohydrates, fat, phosphate, iron, zinc, and copper content. RESULTS: Breast milk of HIV-infected women contained higher protein (1.95 versus 1.78 g/100 g; p = 0.04), fat (4.42 versus 3.49 g/100 g; p = 0.01), and copper (0.64 versus 0.56 mg/L; p = 0.02) levels; whereas carbohydrate (5.37 versus 6.67 g/100 g; p = 0.002) and zinc (5.26 versus 5.78 mg/L; p = 0.04) levels were lower compared with those of HIV-uninfected women. Zinc levels were significantly lower in HIV-infected women with early gestation periods, and the lowest levels were observed in women who received ART for ≤4 weeks (0.58 mg/L; p = 0.03). Total energy (78.22 versus 61.48 kCal/100 mL) and fat levels (5.39 versus 3.00 g/100 mL) were significantly higher in the late gestation period HIV-infected women. Copper levels (0.61 mg/L) were higher in the late gestation period women who received >4 weeks of ART exposure (p = 0.05). CONCLUSION: Differences existed in the breast milk composition of HIV-infected women on ART compared with HIV-uninfected women. ART exposure period may influence breast milk composition.

Probiotics Reduce Necrotizing Enterocolitis Severity in HIV-exposed Premature Infants.

OBJECTIVE: To assess the effect of probiotics on the incidence of necrotizing enterocolitis (NEC) in premature infants born to human immunodeficiency virus (HIV)-positive and HIV-negative women. PATIENTS AND METHODS: HIV-exposed and HIV-unexposed premature infants were randomized to either the probiotic or the placebo group. The probiotic consisted of 1 × 10(9) colony-forming units, Lactobacillus rhamnosus GG and Bifidobacterium infantis per day. RESULTS: In total, 74 HIV-exposed and 110 HIV-unexposed infants were enrolled and randomized. The incidence of death [4 (5.4%) vs. 7 (6%); p = 0.79] and NEC [4 (5%) vs. 5 (5%); p = 0.76] did not differ significantly between the HIV-exposed and HIV-unexposed groups. A significant difference was found for total NEC incidence between the study and control groups [3 (3%) vs. 6 (6%); p = 0.029]. The incidence of NEC in the HIV-exposed group differed significantly [Bells I 2 (5%) vs. Bells III 2 (5%); p = 0.045). CONCLUSION: Probiotic supplementation reduced the incidence of NEC in the premature very low birth weight infants; however, results failed to show a lower incidence of NEC in HIV-exposed premature infants. A reduction in the severity of disease was found in the HIV-exposed study group.

A randomized, controlled trial of omega-3 fatty acids plus an antioxidant for relapse prevention after antipsychotic discontinuation in first-episode schizophrenia.

BACKGROUND: While antipsychotics are effective in the maintenance treatment of schizophrenia they have safety and tolerability risks. We investigated whether a combination of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) and a metabolic antioxidant, alpha-lipoic acid (α-LA), is effective in preventing relapse after antipsychotic discontinuation in subjects who were successfully treated for 2-3 years after a first-episode of schizophrenia, schizo-affective or schizophreniform disorder. METHODS: In this randomized, double-blind, placebo controlled study antipsychotic treatment was tapered and discontinued and participants received either ω-3 PUFAs (eicosapentaenoic acid 2g/day and docosahexaenoic acid 1g/day)+α-LA 300 mg/day or placebo. Subjects were followed up for two years, or until relapse. RESULTS: Recruitment was terminated prematurely due to the high relapse rates in both treatment groups as well as the severity of some of the relapse episodes. Of the 33 participants, 19/21(90%) randomized to ω-3 PUFAs+α-LA relapsed and one (5%) completed two years without relapse (p=0.6); and 9/12 (75%) randomized to placebo relapsed and none completed two years without relapse. Mean times to relapse were 39.8 ± 25.4 and 38.3 ± 26.6 weeks for the ω-3 PUFAs+α-LA and placebo groups, respectively (p=0.9). There were no significant differences between the groups in relapse symptom severity. CONCLUSIONS: We found no evidence that ω-3 PUFAs+α-LA could be a suitable alternative to maintenance antipsychotic treatment in relapse prevention, in this small study. Antipsychotic discontinuation after a single episode of schizophrenia carries a very high risk of relapse, and treatment guidelines endorsing this practice should be revised.

Human milk oligosaccharides differ between HIV-infected and HIV-uninfected mothers and are related to necrotizing enterocolitis incidence in their preterm very-low-birth-weight infants.

The heavy burden of maternal HIV infection has resulted in a high prevalence of premature birth and associated necrotizing enterocolitis (NEC). Human milk oligosaccharides (HMOs) were recently associated with HIV infection and transmission through breastfeeding and were also shown to reduce NEC in an animal model, particularly the HMO disialyllacto-N-tetraose (DSLNT). The primary aim of this study was to verify differences in HMO composition between HIV-infected and HIV-uninfected women. The secondary aim was to assess whether the HMO composition in the milk of mothers whose infants were diagnosed with NEC differs from that of mothers whose infants did not develop NEC. This study forms part of a larger clinical trial conducted at the Tygerberg Children's Hospital, Cape Town, South Africa, which recruited HIV-infected and HIV-uninfected mothers and their preterm infants (<34 wk gestation; ≥500 and ≤1250 g). Eighty-two mother-infant pairs were selected for the substudy. Mother-infant pairs were stratified according to the mother's HIV (infected/uninfected) and secretor status (secretor/nonsecretor). HMOs in 4- and 28-d postpartum milk samples were analyzed by HPLC and compared between groups. Our results confirm previous reports that HIV-infected mothers have higher relative abundances of 3'-sialyllactose in their milk compared with HIV-uninfected mothers (10.7% vs. 6.8%; P < 0.01). Most intriguingly, the data also indicated that low concentrations of DSLNT in the 4-d milk samples in the mother's milk increased the infant's risk of NEC (200 ± 126 vs. 345 ± 186 µg/mL; P < 0.05), which is in accordance with results from previously published animal studies and warrants further investigation. This trial was registered at clinicaltrials.gov as NCT01868737.

Probiotics, feeding tolerance, and growth: a comparison between HIV-exposed and unexposed very low birth weight infants.

OBJECTIVE: The aim of this study was to compare the effect of administration of probiotics on feeding tolerance and growth outcomes of HIV-exposed (but uninfected) versus HIV non-exposed preterm infants. The null hypothesis of this study states that there will be no difference in the feeding tolerance and growth outcomes for both probiotic-exposed and unexposed premature very low birth weight infants. METHODS: A randomized, double-blind, placebo-controlled trial was conducted during the period from July 2011 to August 2012. HIV-exposed and non-exposed premature (<34 wk gestation) infants with a birth weight of ≥500 g and ≤1250 g were randomized to receive either a probiotic mixture or placebo. The multispecies probiotic mixture consisted of 1 × 10(9) CFU, Lactobacillus rhamnosus GG and Bifidobacterium infantis per day and was administered for 28 d. Anthropometrical parameters, daily intakes, and feeding tolerance were monitored. RESULTS: Seventy-four HIV-exposed and 110 unexposed infants were enrolled and randomized (mean birth weight 987 g ± 160 g, range, 560-1244 g; mean gestational age 28.7 wk). In all 4227 probiotic doses were administered (mean 22.9/infant). There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z scores for length and head circumference at day 28 than the unexposed group (P < 0.01 and P = 0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. CONCLUSION: Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV exposure.