Low birthweight infants: immediate feeding recalled
Article Abstract:
The feeding of infants with low birthweight has always been a controversial issue. The most effective type, amount, and method of feeding, and the long-term effects of feeding these small infants are not known. The issue of when to start feeding low-birthweight babies and factors related to changes in feeding practices are discussed. Feeding immediately after birth was initially recommended as a means of preventing death from starvation. However, immature infants have poor sucking and swallowing reflexes, and are at risk of aspirating milk or formula into the lungs. Hence, some physicians specializing in the care of premature infants advocated an initial period of fasting, during which the low-birthweight babies were deprived of fluid. However, recommendations for an initial starvation period persisted despite advances in the development of devices for delivering feeding solutions directly into the infant's stomach, thereby avoiding any possibility of aspiration. Others opposed starvation on the basis that it would cause acidosis (increased acidity of body fluids). After 1960, studies comparing early feeding and feeding after the first 24 hours of life reported that feeding premature infants within the first 4 to 6 hours of life was associated with a decrease in jaundice and levels of bilirubin (the yellowish pigment in the bile), earlier defecation, earlier restoration of birthweight, and less risk of hypoglycemia (abnormally low blood glucose). Although improvements in the care and feeding of premature infants has led to increased survival, early feeding may contribute to a rise in the incidence of necrotizing enterocolitis (inflammation and tissue destruction of the stomach and intestines). Premature infants are no longer starved in the period shortly after birth, and the importance of continued nutrition is now recognized. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1991
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Changes in bacterial meningitis
Article Abstract:
The three main causes of bacterial meningitis are meningococcus, Hemophilus influenzae, and pneumococcus. A review of bacterial meningitis among children in Scotland demonstrated that there are changing trends in the incidence, distribution, and mortality of this infection. Since bacterial meningitis is one of the most common life-threatening infections among children, it is pleasing to see a dramatic reduction in mortality. The overall mortality, which was 11.9 percent in the period from 1946 through 1961, declined to 1.8 percent for the period from 1971 to 1986. These figures are similar to improvements observed in other Western nations. Although the total number of new cases of meningitis each year per 100,000 population (in the north east region of Scotland) has remained essentially constant at around 17.8, more cases of meningitis are caused by Hemophilus influenzae. In fact, H. influenzae has become the most common cause of childhood meningitis in many parts of the world, including the United States, Canada, Australia and Scandinavia. Reasons for the increase in the number of cases of Hemophilus meningitis (or the decrease in meningococcal meningitis in Scotland) are not clear. Although there have doubtlessly been improvements in diagnosis, referral, and notification, these do not seem likely to account for the increased incidence of Hemophilus meningitis, especially among children under three years. Fortunately, newly developed vaccines are proving to be effective against H. influenzae, and clinical trials in Finland and the US suggest that the vaccines are effective even in early infancy. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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Iron supplements for preterm or low birthweight infants
Article Abstract:
Despite the recognition that iron supplements are necessary for low birthweight and preterm infants, a survey conducted in the United Kingdom showed a wide disparity among neonatal units in their methods of providing this supplement. The method of selecting patients to receive supplements was variable, with some units basing their decisions on birth weight, others relying on gestational period, and still others using a combination of these factors. Some units, rather than prescribing iron supplements, relied on blood transfusions to provide the additional iron needed. Since human milk cannot provide the quantities of iron required by these infants, it must be supplemented with iron-fortified formulas. However, many neonatal units did not distinguish between breast-fed and bottle-fed babies in providing supplements. Other units exceeded the recommended dosage of iron supplements. Variations also existed in the duration of administration of the iron supplements, both in terms of the point at which the supplements were started, and the age at which the unit weaned the infants from the supplements. It is suggested that these different policies be evaluated and that infants who were placed on these various regimens be followed-up in order to determine the clinical implications of these policy variations. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1989
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