Infantile colic. Follow-up at four years of age: still more "emotional".

This paper presents a follow-up at 4 y of formerly colicky infants and controls, with respect to behaviour, temperament, eating and sleeping habits, psychosomatic complaints, number of hospital stays, growth and "family climate". There were no differences between the two groups in most parameters studied. However, ex-colicky children displayed more negative emotions according to the temperament scale. There were also more negative moods during meals, and more reported stomach-ache. Although relationships regarding crying and mother-infant interaction remain extremely complex, the findings point toward a possible temperamental contribution to the pathogenesis of the infantile colic syndrome.

Effectiveness of casein hydrolysate feedings in infants with colic.

This study found that two casein hydrolysate formulas varying in composition were equally effective in managing colicky symptoms associated with protein sensitivity. Both hydrolysate formulas were associated with a significant, comparable reduction in crying duration and intensity from baseline in 15 of 22 infants with complete data. Subsequent challenge data suggest that the population studied were infants experiencing colicky symptoms due to protein sensitivity. A greater proportion of infants showed a positive reaction (> or = 1.5 h of crying/d) to the protein challenges than the placebo challenge, and crying was rated as more intense during whey and milk protein challenges.

Development of immunoglobulin G and immunoglobulin E antibodies to cow's milk proteins and ovalbumin after a temporary neonatal exposure to hydrolyzed and whole cow's milk proteins.

The ingestion of food antigens usually results in the induction of oral tolerance, but the clinical and immunologic consequences of brief exposure to cow's milk proteins during the neonatal period are not well-documented. The aim of this work was to study immunoglobulin (Ig)E and IgG responses to cow's milk proteins and ovalbumin after exposure during the first three days of life in infants who were otherwise exclusively breast-fed. A group of 129 infants was randomly assigned at birth to one of three feeding regimens: human milk (HM), cow's milk formula (CMF), or a casein hydrolysate formula (CHF), during the first three days of life. They were then all exclusively breast-fed for a varying period of time and followed for two years. Serum IgG and IgE antibodies to cow's milk proteins and ovalbumin (OVA) were analyzed in blood samples obtained at birth, at 4 days and at 2, 4, 8, 12 and 24 months of age. The levels of IgG antibodies to beta-lactoglobulin (IgG-BLG) and bovine serum albumin (IgG-BSA) were higher in the CMF and the HM groups than in the CHF group for up to two years. This was particularly obvious for IgG-BLG in infants who started weaning before two months. The levels of IgG antibodies to casein (IgG-CAS) were higher in the CMF group, as compared with the CHF group at 8 and 12 months. The levels of IgG antibodies to OVA were similar in all three feeding groups. The levels of IgE antibodies to CAS or OVA were similar in the three feeding groups. Exposure to cow's milk during the first three days of life stimulated IgG antibody production to cow's milk proteins and this was still obvious at 2 years of age, while feeding with a casein hydrolysate during the first three days of life was associated with low levels of IgG antibodies to cow's milk proteins.

[The AD-drops can be replaced by D-drops]. / AD-dropparna kan ersättas med D-droppar.

Since 1932, when vitamin A and D supplementation, in the form of cod liver oil, was introduced in Sweden, rickets has been a rare diagnosis among Swedish infants. In 1978, the National Board of Health and Welfare issued recommendations of daily supplementation with 300 micrograms (1000 IU) of vitamin A and 10 micrograms (400 IU) of vitamin D. This has recently been under review by the Paediatric Committee on Nutrition and Health, of the Swedish Paediatric Association and the National Food Administration, who concluded that there is no reason to retain vitamin A supplementation, but that vitamin D supplementation should continue to be recommended at the same daily dose (400 IU).

The sevoflurane-sparing effect of nitrous oxide: a clinical study.

BACKGROUND: We studied the sevoflurane-sparing effect of nitrous oxide in a prospective randomised study. METHODS: Forty-two ASA I-II patients scheduled for elective knee arthroscopy under general anaesthesia were randomly assigned to a fresh gas flow consisting of oxygen in air or oxygen in nitrous oxide 1:2. All patients received a standardised anaesthesia consisting of induction with fentanyl and propofol and maintenance with sevoflurane adjusted according to clinical signs. The sevoflurane consumption was studied by means of weighing the vaporiser before and after every anaesthesia. RESULTS: The mean sevoflurane consumption was reduced from 0.62 to 0.25 g/min, a 60% reduction, by the use of oxygen in nitrous oxide 1:2 in the fresh gas flow. The emergence was faster for the patients receiving nitrous oxide. No major differences were observed during recovery. CONCLUSION: Nitrous oxide was found to be cost-effective for use during short ambulatory knee arthroscopy.

Gastrostomy button causing perforation of the posterior gastric wall.

A gastrostomy button complication, not previously reported, is described. The button, with an inflatable balloon, was used for nutrition. The patient had had a gastrostomy for 4.5 y, with the same type of gastrostomy button for the previous 2 y and the same device for 1 y. The tip of the button caused a perforation of the posterior stomach wall, leading to death.

Digestion of proteins in human milk, human milk fortifier, and preterm formula in infant rhesus monkeys.

BACKGROUND: There is limited information in the literature on the capacity of the preterm infant to digest human and bovine milk proteins. We therefore studied in vivo the luminal phase of the hydrolysis of proteins in human milk, human milk fortifier, and preterm formula in preterm rhesus monkeys and in infant rhesus monkeys at 6 weeks and 7 months of age. METHODS: Protein hydrolysis was followed by polyacrylamide gradient gel electrophoresis and electroimmunoassay. The serum level of absorbed unhydrolyzed human alpha-lactalbumin was measured by a radioimmunoassay method. Trypsin and elastase activities in duodenal contents were measured before and after the meal. RESULTS: In 6-week-old monkeys, the enzyme activities decreased by 50% postprandially, whereas they increased in 7-month-old monkeys. In preterm and in 6-week-old monkeys, hydrolysis of human and bovine whey proteins was slow, and in 6-week-old monkeys, 30-50% of the proteins could still be detected immunochemically in duodenal contents after 60 min. At these ages, serum level of absorbed alpha-lactalbumin were high. At 7 months of age, no or small (lactoferrin and bovine serum albumin) amounts of the proteins could be detected in duodenal contents after 15 min. At this age alpha-lactalbumin was not measurable in serum. CONCLUSIONS: The low capacity to digest whey proteins in suckling monkeys may depend upon an immaturity of the exocrine pancreas to respond to secretogogues.

Allergy development and macromolecular absorption in infants with different feeding regimens during the first three days of life. A three-year prospective follow-up.

A group of 129 infants were randomly assigned at birth to one of three feeding regimens: human milk (HM), cow's milk formula (CMF) or a casein hydrolysate formula (CHF) during the first 3 days of life. Blood samples were taken on at 4 days and at 2, 4, 8, 12 and 24 months of age. Macromolecular absorption was analysed by measuring the serum concentration of human alpha-lactalbumin (S-alpha-LA) with a competitive radioimmunoassay (RIA). Total serum IgE was measured by RIA. A family history of allergy correlated to the proportion of infants with allergic symptoms both at 24 and 36 months of age (p = 0.03 and p = 0.04 respectively). In none of the three groups did correlation exist between the duration of breastfeeding and serum alpha-LA, serum IgE, family history of allergy, frequency of allergic symptoms and proportion of infants with infections.

Infantile colic--less common than previously estimated?

A two-part population-based study investigating the occurrence of infantile colic was undertaken, in which 92% of mothers with newborn healthy infants were reached. In the prospective part 152 mothers ("diary group") registered crying and fussing in their infants during 12 weeks. In the retrospective part 224 mothers ("interview group") were contacted by telephone at an infant age of 5-7 months. The colic occurrence was determined according to four different definitions; the rate varied from 3.3 to 17.1%. The classical "Wessel-type" colic was present in 9.3%. Colic defined as "crying seen as a problem by parent" was present in 12.1% of the "interview group", but in only 3.3% of the "diary group". Some earlier studies may have overestimated colic occurrence. Another possibility is an actual decline. The contributive part of preventive measures is discussed.

IgG antibodies to bovine serum albumin are not increased in children with IDDM.

IgG antibodies to bovine serum albumin (BSA) were measured in 91 serum samples from children 4-17 years of age with newly diagnosed insulin-dependent diabetes mellitus (IDDM). A total of 80 healthy 12-year-old children served as control subjects. BSA antibody values > 3 SDs were obtained in 6 IDDM patients and 3 control subjects (P = 0.50), and values > 2 SDs were obtained in 12 IDDM patients and 4 control subjects (P = 0.11). In conclusion, IgG antibodies to BSA were not significantly increased at onset of diabetes.

Does early diet have an effect on subsequent macromolecular absorption and serum IgE?

A group of 130 healthy term infants were randomly assigned at birth to one of three feeding regimens for the first 3 days of life: human milk (HM), cow-milk formula (CMF), or a casein hydrolysate formula (CHF). The formula-fed infants received no human milk during the study days. After day 3, all infants were exclusively breast-fed. Blood samples were taken at 4 days and at 2 and 4 months of age during outpatient visits. Macromolecular absorption was analyzed 60 min after a feed of human milk by measuring the serum alpha-lactalbumin (S-alpha LA) concentrations by a competitive radioimmunoassay. Total serum IgE (S-IgE) was assayed by radioimmunoassay. The median S-IgE value was significantly lower at 2 months of age in the CHF group than in the HM group. The values remained significantly lower, even at 4 months of age, in the CHF group than in either the HM or the CMF group. The median S-alpha LA concentration at 2 months of age was significantly higher in the CHF group than in either the HM group or the CMF group. No significant differences could be found between the CMF and HM groups at any time. One infant in the HM group and one infant in the CMF group developed infantile colic. Two infants in the CHF group developed symptoms of cow-milk allergy. All other infants were healthy at 4 months of age.

Munchausen syndrome by proxy: an unexpected cause of severe chronic diarrhoea in a child.

A six-year-old boy with severe intermittent diarrhoea was subjected to extensive diagnostic investigation and treatment before the administration of a laxative (sodium sulphate) by his mother was discovered. Early suspicion and analysis of faecal fluid for electrolytes and known laxative substances would have prevented the hazardous clinical course of this case.

Breastfeeding patterns: comparing the effects on infant behavior and maternal satisfaction of using one or two breasts.

In the Western world advice given by breastfeeding consultants about the use of one or two breasts at each feed has resulted in apparently arbitrary changes over time. This study compared 1-month-old breastfed infants' reactions to single- and two-breast feeds in terms of restlessness, crying, sleeping, and frequency of feeds, wet diapers, and loose stools. Eighty mothers were randomly assigned at the maternity ward, 44 to the single-breast group and 36 to the two-breast group. At one-month follow-up no differences between the groups were seen regarding any infant behavior variables, or in terms of maternal satisfaction, confidence, and mood throughout the full 24-hour observation period or during a 6-hour period in the evening. Compliance with the assigned feeding method was better in the two-breast than in the one-breast group. This may partly be due to tradition, since the two-breast practice has been recommended by child health nurses in Sweden for over 50 years. It seems reasonable that a baby should be allowed to finish the first breast and, if still hungary, be offered the second breast. The baby's appetite is the deciding factor.

Macromolecular absorption in small-for-gestational-age infants.

Using human alpha-lactalbumin as a marker protein, macromolecular absorption was studied in 40 preterm infants, appropriate for gestational age (AGA), in 12 AGA term infants and in 18 preterm infants, small for gestational age (SGA). The absorption of alpha-lactalbumin was measured as concentration in serum after a human milk feed and expressed as micrograms alpha-lactalbumin/l serum/l human milk/kg body weight on day 7, 14, 21 and 42 after delivery. The serum concentration of alpha-lactalbumin was correlated negatively with maturity and postnatal age. In the SGA infants, the concentration of alpha-lactalbumin was significantly higher than in the AGA infants of similar gestational age. The data show that intrauterine growth retardation causes a delayed postnatal decrease in macromolecular absorption. This may indicate delayed intestinal maturation.

Activities of lipase and trypsin in duodenal juice of infants small for gestational age.

In 18 low birth weight infants, small for gestational age, with different degrees of intrauterine growth retardation the activities of pancreatic lipase and trypsin and the concentrations of bile acids were measured in preprandially aspirated duodenal juice. The results were compared to those of 24 low birth weight infants, appropriate for gestational age, with comparable birth weights and postnatal ages. The activities of both measured pancreatic enzymes were negatively correlated with the degree of intrauterine growth retardation, expressed as the difference between the individual birth weight and the weight of the 10th percentile of the intrauterine growth curve (lipase: r = -0.697, p less than 0.001; trypsin: r = -0.739, p less than 0.001). The activity of trypsin in the small for gestational age infants was within the range of that found in the infants appropriate for gestational age. However, the lipase activity was decreased in infants who presented with growth retardation of greater than 400 g/kg birthweight. The concentrations of bile acids were similar in both groups (4.60 +/- 2.51 and 4.55 +/- 2.26 mmol/L, respectively) and sufficient for activating the bile salt stimulated lipase in human milk. The data suggest that in intrauterine growth retarded infants the lipase activity in the duodenal juice can be a limiting factor for optimal fat digestion. This should be considered in the nutritional management of such infants.

Macromolecular absorption and cows' milk allergy.

The absorption of macromolecules was analysed by measuring serum concentrations of human alpha-lactalbumin after feeding human milk, using a competitive radioimmunoassay. The control group consisted of 78 children fed by cows' milk formula; concentrations of alpha-lactalbumin in their serum were low. The median concentrations in the different age groups varied between 7-13 micrograms alpha-lactalbumin/1 serum/1 human milk/kg body weight. Twenty-eight children with cows' milk allergy were studied before introduction of a diet free of cows' milk. Nineteen had gastrointestinal and nine skin symptoms. High serum alpha-lactalbumin concentrations were found. Only two children had alpha-lactalbumin concentrations below 100 micrograms alpha-lactalbumin/1 serum/1 human milk/kg body weight. Altogether 76 children on a diet free of cows' milk were studied directly after a cows' milk challenge; 26 developed symptoms. They had significantly higher serum alpha-lactalbumin values than the 50 children with no symptoms upon challenge. Eighteen of the 26 children with symptoms had serum alpha-lactalbumin concentrations of more than 100 micrograms/1 serum/1 human milk/kg body weight in contrast with two of the 50 with no symptoms. Total serum IgE antibodies were analysed in 43 children. No correlation was found between concentrations of serum IgE and serum alpha-lactalbumin in the children with cows' milk allergy.

Macromolecular absorption in infants with infantile colic.

Intestinal absorption of macromolecules, using human alpha-lactalbumin (alpha-LA) as a marker, was studied in breast-fed and formula-fed infants with infantile colic. Serum samples taken at 30 and 60 min after an intake of human milk were analyzed for alpha-LA by a competitive radioimmunoassay technique. Breast-fed infants with infantile colic had significantly higher s-alpha-LA levels compared with age-matched breast-fed control infants 0-1 month of age: median value 926 micrograms alpha-LA/l serum/l human milk/kg bodyweight (n = 11) versus 150 (n = 34); 1-2 months of age: 173 (n = 22) versus 31 (n = 16); 2-3 months of age: 132 (n = 8) versus 11 (n = 16). Similarly, formula-fed colicky infants had significantly higher s-alpha-LA levels than age-matched formula-fed control infants 1-2 months of age: median value 126 (n = 12) versus less than 10 (n = 14); 2-3 months of age: 156 (n = 11) versus less than 10 (n = 10). The increased absorption of the macromolecule human alpha-lactalbumin in infantile colic suggests that the gut mucosa is affected in infants with infantile colic.