Nutritional management of newborn infants: practical guidelines.

The requirements of growth and organ development create a challenge in nutritional management of newborn infants, especially premature newborn and intestinal-failure infants. Since their feeding may increase the risk of necrotizing enterocolitis, some high-risk infants receive a small volume of feeding or parenteral nutrition (PN) without enteral feeding. This review summarizes the current research progress in the nutritional management of newborn infants. Searches of MEDLINE (1998-2007), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2007), abstracts and conference proceedings, references from relevant publications in the English language were performed, showing that breast milk is the preferred source of nutrients for enteral feeding of newborn infants. The number of nutrients found in human milk was recommended as a guideline in establishing the minimum and maximum levels in infant formulas. The fear of necrotizing enterocolitis and feeding intolerance are the major factors limiting the use of the enteral route as the primary means of nourishing premature infants. PN may help to meet many of the nutritional needs of these infants, but has significant detrimental side effects. Trophic feedings (small volume of feeding given at the same rate for at least 5 d) during PN are a strategy to enhance the feeding tolerance and decrease the side effects of PN and the time to achieve full feeding. Human milk is a key component of any strategy for enteral nutrition of all infants. However, the amounts of calcium, phosphorus, zinc and other nutrients are inadequate to meet the needs of the very low birth weight (VLBW) infants during growth. Therefore, safe and effective means to fortify human milk are essential to the care of VLBW infants.

Low level of galacto-oligosaccharide in infant formula stimulates growth of intestinal Bifidobacteria and Lactobacilli.

AIM: To investigate the effect of a new infant formula supplemented with a low level (0.24 g/100 mL) of galacto-oligosaccharide (GOS) on intestinal micro-flora (Bifidobacteria, Lactobacilli and E. coli) and fermentation characteristics in term infants, compared with human milk and a standard infant formula without GOS. METHODS: Term infants (n = 371) were approached in this study in three hospitals of China. All infants started breast-feeding. Those who changed to formula-feeding within 4 wk after birth were randomly assigned to one of the two formula groups. Growth and stool characteristics, and side effects that occurred in recruited infants were recorded in a 3-mo follow-up period. Fecal samples were collected from a subpopulation of recruited infants for analysis of intestinal bacteria (culture technique), acetic acid (gas chromatography) and pH (indicator strip). RESULTS: After 3 mo, the intestinal Bifidobacteria, Lactobacilli, acetic acid and stool frequency were significantly increased, and fecal pH was decreased in infants fed with the GOS-formula or human milk, compared with those fed with the formula without GOS. No significant differences were observed between the GOS formula and human milk groups. Supplementation with GOS did not influence the incidence of crying, regurgitation and vomiting. CONCLUSION: A low level of GOS (0.24 g/100 mL) in infant formula can improve stool frequency, decrease fecal pH, and stimulate intestinal Bifidobacteria and Lactobacilli as in those fed with human milk.

[Effects of infant formula containing galacto-oligosaccharides on the intestinal microflora in infants].

OBJECTIVE: To study the effect of a low level of galacto-oligosaccharides (GOS) on intestinal bifidobacteria and lactobacilli, and fermentation characteristics in term infants by comparing with human milk and a standard infant formula without GOS. METHODS: A total of 371 term infants from four hospitals of China were enrolled. The infants started with breast feeding. After 1-2 weeks, some of the infants were changed to feeding with formula milk and then were randomly assigned to two formula-feeding groups: with or without GOS supplementation (2.4 g/L). Growth, stool characteristics, and side effects were recorded in a 3-month-follow-up. Faecal samples were collected for analysis of intestinal bacteria (culture technique), acetic acid (gas chromatography) and pH (indicator strip) at postnatal 3 months. RESULTS: Compared with the formula-feeding group without GOS, the contents of bifidobacteria, lactobacilli and acetic acid and stool frequency increased, and faecal pH decreased significantly in the GOS-formula-feeding and the human milk group. There were no significant differences between the GOS-formula-feeding and the human milk groups. Supplementation with GOS did not lead to an increase in the incidence of crying, regurgitation and vomiting. CONCLUSIONS: A supplementation of low levels of GOS in infant formula seemed to improve stool frequency, decrease faecal pH, and stimulate intestinal bifidobacteria and lactobacilli up to levels as found in breast-fed infants.

Supplementation of milk formula with galacto-oligosaccharides improves intestinal micro-flora and fermentation in term infants.

BACKGROUND: Oligosaccharides in human milk may protect infants by improving the intestinal micro-flora and fermentation. This study was to investigate effects of infant formula milk consisting of galacto-oligosaccharide (GOS) on intestinal microbial populations and the fermentation characteristics in term infants in comparison with that of human milk. METHODS: The test formula (Frisolac H, Friesland, Netherland) was supplemented with GOS at a concentration of 0.24 g/dl. Human milk and another formula without oligosaccharides (Frisolac H, Friesland, Netherland) were used as positive and negative control respectively. Growth, stool characteristics, and side effects of the recruited infants were recorded after 3 and 6 months' follow-up, and the fecal species were collected for the analysis of intestinal micro-flora, short chain fatty acid (SCFA) and pH. RESULTS: At the end of 3- and 6-month feeding period, intestinal Bifidobacteria and Lactobacilli were significantly increased in infants fed with GOS supplemented formula and human milk when compared with infants fed with negative control formula; however, there was no statistically significant difference between GOS supplemented formula and human milk groups. Stool characteristics were influenced by the supplement and main fecal SCFA (acetic), and stool frequency were significantly increased in infants fed with GOS supplemented formula and human milk, while the fecal pH was significantly decreased as compared with that of negative control (P < 0.05). Supplementation had no influence on incidence of side effects (including crying, regurgitation and vomiting). CONCLUSIONS: Supplementing infant formula with GOS at a concentration of 0.24 g/dl stimulates the growth of Bifidobacteria and Lactobacilli in the intestine and stool characteristics are similar to in term infants fed with human milk.