Amount of Zinc Transferred in Breast Milk to Breastfed Moroccan Babies with Normal or Low Birth Weight at 1, 3 and 6 Months After Birth
Pages 48-54
Ghizlane Choua, Nourddine El Haloui, Khalid El Kari, Hassan Aguenaou and Najat Mokhtar

DOI: http://dx.doi.org/10.6000/1929-4247.2014.03.01.6

Published: 10 March 2014

Abstract: The amount of zinc in breast milk is generally regarded as sufficient to cover the increasing zinc demands of most infants. However, this is not well investigated where stores zinc may be compromised in babies with low birth weight (LBW) who are born with low stores of zinc. In Morocco, this is the first time that the amount of zinc transferred in breast milkhas been estimated. This study included 32 mother-baby pairs. In our case study, we aimed to measure The quantity of zinc in mothers’ breast milk with normal birth weight (NBW) and LBW babies who were exclusively or not exclusively breast fed at 1,3 and 6 month after birth. The results showed that the majority of mothers have a BMI ≥25 kg/m² this means that all mothers are overweight during 6 months after birth.Zinc concentration (mg/l) in mothers’ breast milk decreased from first month to six month. p- value showed that for mothers with NBW babies, there is a significant difference between the 1 and 6 month (p=0.0003) and between 3 and 6 month after birth (p=0.0007). For mothers with LBW babies, p-value showed a significant difference between the zinc concentration in breast milk in the 1^st and 3^rd month (p=0.0007), 1 and 6 month (p< 0.0001) and between 3^rd and 6^th month after birth (p=0.0056). The rate of NBW babies who were exclusively breastfed was 36.67%, 30.25% and 10% successively in 1^st, 3^rd and 6^th month after birth. For LBW babies, the rate of exclusively breastfed was 15.38%, 7.69% and 2.69% successively in 1^st, 3^rd and 6^th month after birth. Based on the K. Brown study in 2009, we can develop a mathematical equation to our own population using our data: Ln [Zinc] = 0.960 – 0.161*Ln(âge) – 0.187*Ln(âge)². In conclusion the zinc concentration in milk is within normal range and decreases with the age of the babies. The predicted model of zinc concentration in breast milk was developed and tested.

Economic Recessions and Infant Mortality in the U.S., 1999-2008
Pages 60-66
David Bishai, Qingfeng Li and Sai Ma

DOI: http://dx.doi.org/10.6000/1929-4247.2014.03.01.8

Published: 10 March 2014

Abstract: Objectives: Prior studies of US data from the 1990s have shown that economic growth is associated with higher all cause mortality. This paper updates prior findings to more recent data on US infant mortality for blacks and whites.

Methods: We analyzed data from 50 US states from 1999 to 2008 using state fixed-effects regression models stratified to identify the racially disparate impact of each state’s economic performance on infant mortality, controlling for state policy-related variables, reflecting population,% black, % on TANF, % on Medicaid, and alcohol consumption.

Results: Economic recessions are significantly associated with lower post-neonatal mortality for white infants, but not black infants. Each 1% decrement a state’s gross state product, would be associated with an approximately 2.3 fewer infant deaths (95% CI: -0.294-4.894) in an average state with 64,000 total births. Results were robust to the inclusion of state trends, national trends, state fixed effects, lagged gross state product, and the inclusion of measures of unemployment and state policy variables.

Conclusions: This study in combination with studies from the 1990s reflects growing evidence that economic growth in the US can be harmful to child health. Policy makers need to be informed and mindful about the “side effects” of economic growth on health.

Refeeding Syndrome in a Critically Ill Child
Pages 48-54
Fabíola I. Suano de Souza, Heitor Pons Leite, Walter Jacob Chwals and Werther Brunow de Carvalho

DOI: http://dx.doi.org/10.6000/1929-4247.2014.03.01.7

Published: 10 March 2014

Abstract: Objective: To report a case of a child interned in an ICU of a University Hospital who developed refeeding syndrome, and to review the specific literature pertinent to this area.

Case Report: An eight year-old, previously healthy, male patient was admitted for necrotizing pneumonia. On admission the child had a z-score of weight for height of 0.38 and height for age of -0.74. Following 60 days’ hospital admission he had lost 27.5% of initial weight. Enteral tube feeding, with an energy intake equivalent to the basal metabolic rate plus 20% for stress, was initiated and gradually increased during the stabilization phase. After receiving 2000 kcal/day for 5 days, hypophosphatemia was detected in association with an increase in hepatic enzymes and hyperglycemia. No concomitant worsening of the white blood count or evidence of inflammatory activity was present. These alterations were accompanied by an increase in pulse rate and body temperature, thereby leading to a diagnosis of refeeding syndrome. Energy intake decreased to 1520 kcal/day, resulting in a marked improvement of the laboratorial parameters in less than a week.

Conclusions: Refeeding syndrome is a potentially dangerous complication of increased caloric administration in critically ill pediatric patients. Early recognition and appropriate adjustment of nutritional support is important to avoid the serious consequences which may ensue if this condition is left untreated.

Necrotizing Enterocolitis: An Update on the Benefits of Breast Milk
Pages 79-84
Adam Khader, Julie Gallagher, Megan Woods, Weng-Lang Yang, Ping Wang, Steven Stylianos and Jose M. Prince

DOI: http://dx.doi.org/10.6000/1929-4247.2013.02.02.1

Published: 20 May 2013

Abstract: Necrotizing enterocolitis (NEC) is the leading cause of death for preterm infants resulting from gastrointestinal disease. This review will focus on several components of human breast milk that may be beneficial in the prevention and treatment of NEC. The severe pathological features of NEC include inflammation, mucosal ulceration and disruption of the intestinal barrier. Despite maximal neonatal intensive care, the incidence and mortality rate of the disease remains high. Administration of breast milk, as well as donor breast milk, to preterm infants has been shown to reduce the incidence of NEC. Beyond this, there is no disease specific treatment for NEC. The immunomodulatory and protective properties of human breast milk have been evaluated in search of key components that may be utilized for the effective prevention and treatment of NEC.

Comparison of the Nutritional Values of Toddler Milks Available in Italy
Pages 85-98
Enrica Riva, Elvira Verduci, Giuseppe Banderali, Maria Elena Capra and Marcello Giovannini

DOI: http://dx.doi.org/10.6000/1929-4247.2013.02.02.2

Published: 20 May 2013

Abstract: If breast milk is not available infant formula ensures a balanced intake of nutrients and is undoubtedly more suitable for infants than cows’ milk. In particular, it should point out the absolute necessity to postpone to the end of the first year of life, or even after the 2 nd year, the use of cow's milk for the extreme imbalance of nutrients that lead to high-protein diets and low levels of polyunsaturated fats, iron and zinc. As a consequence, in the absence of breast milk, the use of an appropriately adapted formula in the first year of life and the use of “toddler milk” from 12 to 36 months may represent adequate nutritional alternatives, especially when compare to the use of cow milk, and in particular may appear to play a fundamental role in the prevention of iron deficiency anemia.

Different varieties of toddler milk are currently available in Italy. This review outlines the nutritional differences between breast, toddler and cows’ milks, and compares different brands of toddler milk.