Human Milk Supplements: Principles, Practices, and Current Controversies.

Human milk is the most optimal source of nutrition for preterm and term infants. However, in most preterm infants, breast milk fails to meet the energy needs of the newborn infant. Overwhelming evidence supports the fortification of breast milk in preterm infants to facilitate better short-term outcomes. Several single-nutrient and multinutrient breast milk supplements and fortifiers are used to improve the macronutrient and micronutrient content of breast milk. An individualized fortification strategy has the potential to offer better results compared with standard fortification strategies. Human milk-derived fortification is promising, but the benefits in exclusively human milk-fed preterm infants are unclear.

Zinc and copper requirements in preterm infants: an examination of the current literature.

BACKGROUND: Zinc and copper are essential for preterm infants, but recommended requirements from different groups vary widely. Recommended zinc intakes have steadily increased over the years. Although this would be expected to impair copper absorption, recommended copper intakes have not risen in parallel. OBJECTIVES: To systematically review the literature on zinc and copper retention in preterm infants; to examine the effect on zinc intake on copper retention; and to estimate the zinc and copper intakes required to meet the levels of zinc and copper retention required for normal growth. DESIGN: Studies reporting zinc and/or copper retention in preterm infants (<36 weeks of gestation) during the first 120 days of life were identified using PubMed. Only studies reporting net retention were included. RESULTS: Fourteen studies on zinc retention reporting data on 45 different groups were identified. Eleven studies (32 groups) were identified reporting copper retention. Zinc retention was significantly higher at higher zinc intakes, and higher in formula-based diets than in human milk based diets. Zinc intakes of between 1.8-2.4 mg/kg/d (from formula based diets) and 2.3-2.4 mg/kg/d (from human-milk based diets) were required to achieve adequate zinc retention. Copper retention was significantly positively correlated with copper intake and significantly negatively correlated with zinc intake. At the zinc intakes suggested previously (1.8-2.4, 2.3-2.4 mg/kg/d), copper intakes of between 200 and 250 mcg/kg/d are required to ensure adequate copper retention. CONCLUSIONS: Our results support the higher zinc intakes recommended in recent guidelines. However, they suggest that recommended copper intakes have not kept pace with increasing zinc intakes, and that preterm infants may need higher copper intakes than currently recommended.

A community-specific approach to cancer research in Indian country.

BACKGROUND: Health care leaders in a small, rural, American Indian community and university partners used the community-based participatory research (CBPR) method to survey cancer survivors. OBJECTIVES: We sought to provide support for the use of CBPR to generate ideas for how to improve the detection and treatment of cancer in American Indian communities. METHODS: Partners worked together to develop a mail-out survey and send it to the Indian health clinic's patients who had cancer in the past 5 years. The survey sought information on their experiences with cancer screenings, cancer diagnoses, and accessing and receiving cancer treatment. RESULTS: Community leaders identified three priority areas for intervention: (1) high incidence of breast cancer; (2) lack of culturally appropriate cancer education; and (3) need for a more in-depth assessment. CONCLUSIONS: CBPR's partnership principle allowed for results to be viewed within the community's context, availability of community resources, and relevant cultural beliefs and traditions.

Nutritional assessment and therapeutic interventions for the preterm infant.

All components of assessment contribute to the final decision regarding nutritional status of the infant and the nutritional therapy indicated. One parameter by itself such as nutrient intake, weight change, or a laboratory value cannot clearly determine the total nutritional state of the infant. Achieving appropriate intakes and weight gains are two excellent parameters. Laboratory values can determine if nutrition is tolerated and manipulations are indicated.

Feeding the ill or preterm infant.

Illness and immaturity often interfere with a neonate's ability to receive full enteral feedings during the first week of life. The goals of feeding in the NICU are to nourish the preterm infant for appropriate growth and development and to facilitate the earliest possible discharge from the NICU. Early, small-volume feedings, or trophic feedings, have been studied as a method for achieving these goals. The high-risk infant given such trophic feedings not only receives minimum enteral nutrition, but also attains earlier full nutritional feedings and, consequently, is discharged home earlier. Oro- or nasal-gastric gavage feedings are usually indicated for this group of infants because of their physiologic immaturity and the frequent presence of respiratory illness. Recent studies support the use of intermittent bolus feedings, which have long been used for the premature infant. Several authors have noted advantages to continuous infusions as well. Because the infant is unable to pace or refuse gavage feedings, the caretaker must determine the appropriate volume of each feeding. The optimal volume for initiation and advancement of trophic and nutritional feedings is still under investigation, but reports have demonstrated safe volumes for even the extremely premature infant.