ABSTRACT. The vaccine response to poliovirus, diphtheria and tetanus toxoids in relation to protein intake was studied in infants, either breast‐fed or given low (1.1 g/100 ml) or conventional (1.5 g/100 ml) protein formula. Serum, salivá and faeces antibodies were measured by the enzyme‐linked immunosorbent assay. Neutralizing poliovirus antibodies were determined. The serum, saliva and faeces antibody responses in the two formula‐fed groups of infants did not differ significantly, but for the low protein formula group which had significantly higher serum neutralizing titres to poliovirus after the second vaccine dose than the conventional formula group. However, the breast‐fed group had significantly higher antibody levels than the two formula‐fed groups together: serum IgG to diphtheria toxoid (p<0.01) and serum neutralization of poliovirus (p<0.001) at 21‐40 months of age, saliva secretory IgA to tetanus (p<0.01), diphtheria toxoid (p<0.01) and poliovirus (p<0.05), as well as faecal IgM to tetanus toxoid (p<0.05) and poliovirus (p <0.01 and p <0.05) at 3 and 4 months of age. Breast‐fed infants thus showed better serum and secretory responses to peroral and parenteral vaccines than the formula‐fed, whether with a conventional or low protein content.
In a prospective, study involving 20 VLBW-infants (AGA), divided into two study groups of 10 infants, we have evaluated the effects on growth and metabolism of human milk fortified with ultrafiltrated human milk protein and a whey-predominant (whey/casein = 60/40) formula containing 2 g/dl of protein. The study was initiated at a mean age of 30 days when an oral intake of 180 ml/kg/d was tolerated and continued until a weight of 2 kg was reached. The protein intake in both groups was about 3.7 g/kg/d. All infants in both groups reached intrauterine rates of growth for the age, weight gain 18.0 g/kg/d, and length 1.2 cm/week. BUN, acid-base status, total protein and albumin were normal and similar in the two groups. Plasma levels of threonine, glycine, citrulline and methionine were significantly greater in the formula-fed infants. Taurine and proline had higher concentrations in the protein fortified human milk group. There was good tolerance of protein from both sources but the differences in plasma amino acid profiles suggest that the dietary protein quality in formulas for preterm infants must be further modified, if the goal of formula feeding is to achieve metabolic indices of protein metabolism similar to those found when human milk protein is used.
To compare in vivo and in vitro responses of fecal flora to L, breath was collected from 15 BR and 12 80 infants aged 0.1-6 mo and analyzed for H2 and CH4. Stools from 5 BR and 8 BO were analyzed for Hz, lactic acid (LA), glucose (GL), and galactose (GA) before and after anaerobic incubation with 1.25% L a t pH 6.8 and 5.5. Peak breath H2 values for BR and B0 were 3 6 3 8 ppm (range 2-120) and 16L10 ppm . Breath CHq values for BR and BO were 6 3 (0-12) and 8 3 (2-1 1 (26) 7(4) 0 0 6(6) l(2) 5(5) l(1) + L t 10(7) 19(5) 151(53) 102(39) l(1) 2(4) 6(6)21(17) 8(L4) 14(16) +LS 4(5) 6(2) 164(54) 86(46) l(2) 2(2) 5(6) 44(22) 11(20) 36(24) * Preincubated stool;tPostincubation pH 6.8 andS5.5. Preliminary results indicate that stool incubates a t pH 6.8 of 80 infants produced more Hz, GL, and GA than those of BR who accumulated more LA. At pH 5.5, H2 production decreased in both groups; GL and CA accumulation increased further in 80. This is the first report of CHq production in infants. Fecal flora of 80 appeared to have a limited capacity to utilize excessive amounts of GL and GA, particularly a t pH 5.5, while BR continued to transform GL and GA into LA. We postulate that these differences may explain the means by which BR and BO metabolized malabsorbed L in vivo. with HM-lyophilisate a t protein intakes ranging from 2.0 t o 3.5 g/kg/d a s calculated from protein content of the milk and the volumes ingested. a-amino-nitrogen and amino acids in serum a s well a s t o t a l nitrogen and a-amino-nitrogen excretion in the urine was measured. Serum a-amino-nitrogen and amino acid concentrations correlated with protein intake in both groups of infants, but concentrations were significantly higher in the SGA-infants above a protein intake of 2.5 g/kg/d. a-amino-nitrogen and t o t a l nitrogen excretions in the urine reflected a l s o protein intake and were significantly increased in the SGA-infants. On the eight day of l i f e a protein intake above 2.5 g/kg/d produces metabolic indices of protein overload in SGA-infants. These findings demonstrate t h a t differences in protein metabolism a r e present between AGA and SGA infants of VLBW. A decreased r a t e of protein u t i l i z a t i o n f o r some time a f t e r b i r t h may be present in the SGA-infants. When the nutritional management of VLBW-infants i s planned these differences must be considered and protein intakes should be increased with caution i n the SGA-infants.
PROTEIN METABOLISM IN VERY-LOW-BIRTH-WEIGHT (VLBW) INFANTS SMALL FOR GESTATIONAL AGE (SGA) FED PROTEIN
LO FORTIFIED HUMAN MILK (HMCunha Ferreira E . J . E l l i o t t , E.A. Brennan, 24 J . A . Walker-smith,^.;.^. Farthing.Departments of Child Health and Gastroenterology, St. Bartholomew's ~o s p i t a l , London, U.K. In previous studies, an o r a l rehydration solution containing glycine ( g l y ) and a glucose polymer performed b e t t e r than WHO-ORS i n reversing water secretion i n an animal model of secretory diarrhoea. W e have now assessed t h e r e l a t i v e contribution of gly and ...
A term-born 4 months old male infant presented with recurrent septicemia, no palpable lymph nodes, hepatosplenomegaly, and high leucocyte (1.5 -8 x lo4/vl)
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