Breastfeeding,
how...
Domellof
M, Cohen RJ, Dewey KG, Hernell O, Rivera LL, Lonnerdal
B. Iron supplementation of breastfed Honduran and
Swedish infants from 4 to 9 months of age. J Pediatr
2001;138:679-87
In a randomized,
placebo-controlled trial, term Swedish (n = 101) and
Honduran (n = 131) infants were assigned to three groups
at 4 months of age: 1) iron supplements,
1 mg/kg/d, from 4 to 9 months; 2) placebo, 4 to 6 months
and iron, 6 to 9 months; and 3) placebo, 4 to 9 months.
All infants were breastfed exclusively to 6 months and
partially to 9 months. From 4 to 6 months, the effect
of iron (group 1 vs 2 + 3) was significant and similar
in both populations for haemoglobin, ferritin, and zinc
protoporphyrin. From 6 to 9 months, the effect (group
2 vs 3) was significant and similar at both sites for
all iron status variables except haemoglobin, for which
there was a significant effect only in Honduras, where
the prevalence of iron deficiency anaemia at 9 months
was 29% in the placebo group and 9% in the supplemented
groups. In Sweden, iron supplements caused no reduction
in the already low prevalence of iron deficiency anaemia
at 9 months (less than 3%). Iron supplementation from
4 to 9 months or 6 to 9 months significantly reduced
iron deficiency anaemia in Honduran breastfed infants.
The unexpected haemoglobin response at 4 to 6 months
in both populations suggests that regulation of haemoglobin
synthesis is immature at this age.
Male
C, Persson LA, Freeman V, Guerra A, van't Hof MA, Haschke
F; Euro-Growth Iron Study Group. Prevalence of iron
deficiency in 12-mo-old infants from 11 European areas
and influence of dietary factors on iron status (Euro-Growth
study). Acta Paediatr 2001;90:492-8
A prospective
longitudinal cohort study was performed to assess the
prevalence of iron deficiency in European infants at
12 months of age and to study the influence of socio-economic
status, dietary factors, growth and morbidity on iron
status. The cohort consisted of 488 normal term infants
from primary healthcare centres in 11 European areas.
The prevalence of anaemia at 12 months was 9.4%, of
iron deficiency 7.2%, and of iron deficiency anaemia
2.3%. More than 40% of anaemia was associated with normal
iron status and with an increased frequency of recent
infections. Iron deficiency anaemia was significantly
more frequent with low (5.1%) than high (0%) socio-economic
status. Dietary factors accounted for most of this variation
in multiple regression analysis. Early introduction
of cow’s milk was the strongest negative determinant
of iron status. Feeding of iron-fortified formula was
the main factor positively influencing iron status.
Other dietary factors, including breastfeeding, did
not play a significant role as determinants of iron
status at age 12 months.
Griffin
IJ, Abrams SA. Iron and breastfeeding. Pediatr
Clin North Am 2001;48:401-13
Given the
importance of iron nutrition during the first year of
life, there are surprisingly few true, randomized, controlled
studies addressing this issue. However, it seems that
iron deficiency is unlikely in full-term, breastfed
infants during the first 6 months of life because these
infants' body iron stores are sufficient to meet requirements.
After this time, many infants exhaust their iron stores
and become dependent on a secondary dietary iron supply.
Although iron deficiency is a significant nutritional
problem worldwide, most of the adverse effects of iron
deficiency in this age group are hypothetical and rely
on extrapolation from animal studies or studies at different
ages. This, however, is also true of most of the adverse
effects of iron excess in this age group. Given this
uncertainty, it seems prudent to use the lowest dose
of iron that prevents iron-deficiency anaemia. Currently,
the best evidence is that this is achieved by prolonged
breastfeeding, avoidance of unfortified formulas and
cow's milk, and the introduction of iron-fortified and
vitamin C-fortified weaning foods at approximately 6
months of age. There are many areas of uncertainty regarding
iron supplementation of infants, including that: 1)
The optimal age for introducing iron-fortified supplemental
foods is poorly defined. 2) The natural history of iron
deficiency and iron-deficiency anaemia during the first
year of life is unclear, as are its possible long-term
effects, especially on developmental outcome. 3) The
biologic variability among infants and their mothers
that allows many infants who do not receive iron-fortified
foods to prevent iron deficiency while receiving only
human milk throughout the first year of life is intriguing
and warrants additional study. 4) The iron requirements
of small-for-gestational-age, term infants are unknown;
their iron requirements are likely to be higher than
those of average term infants, but whether iron supplements
are required is unclear. 5) The optimum amount of dietary
iron in the weaning diet needs to be further defined;
similarly, the optimal source and amount of iron in
infant formulas given to infants who receive a mixture
of human milk and formula is unclear.
Auestad
N, Halter R, Hall RT, Blatter M, Bogle ML, Burks W,
Erickson JR, Fitzgerald KM, Dobson V, Innis SM, Singer
LT, Montalto MB, Jacobs JR, Qiu W, Bornstein MH. Growth
and development in term infants fed long-chain polyunsaturated
fatty acids: a double-masked, randomized, parallel,
prospective, multivariate study. Pediatrics 2001;108:372-81
To evaluate
the effect of the intake of long-chain polyunsaturated
fatty acids on infant growth, psychological, mental
and cognitive development, intelligence, language, temperament
and visual acuity, a double-masked, randomized trial
was conducted with term infants fed formula (formula
group; n = 239) with or without arachidonic acid (AA)
and docosahexaenoic acid (DHA) for 1 year. Reference
groups of breastfed infants (n = 165) weaned to formulas
with or without AA+DHA were also studied. Infants in
the formula group were randomized at 9 or less days
of age to: 1) a control formula with no AA or DHA (n
= 77); 2) a formula containing AA+DHA from egg (n =
80) at levels similar to the average in breast milk;
or 3) a formula containing AA+DHA from fish or fungal
oil (n = 82) at levels similar to the average in breast
milk. All formulas contained 50% of energy from fat,
including 10% from linoleic acid and 1% from alpha-linolenic
acid (essential fatty acids). No developmental test
results distinguished among these groups in the follow-up.
These findings do not support adding AA+DHA to formulas
containing 10% energy as linoleic acid and 1% as alpha-linolenic
acid to enhance growth, visual acuity, general development,
language, or temperament in healthy, term infants during
the first 14 months after birth.
Pinelli
J, Atkinson SA, Saigal S. Randomized trial of breastfeeding
support in very low-birth-weight infants. Arch Pediatr
Adolesc Med 2001;155:548-53
Does breastfeeding
counselling improve the duration of breastfeeding in
very low-birth-weight infants ? A randomized trial with
longitudinal follow-up at term, and at ages 1, 3, 6,
and 12 months, was conducted in a tertiary-level neonatal
intensive care unit (NICU) in Ontario, Canada. The “counselling”
consisted of viewing a video on breastfeeding for preterm
infants; individual counselling by the research lactation
consultant; weekly personal contact in the hospital;
and frequent post-discharge contact through the infants'
first year or until breastfeeding was discontinued.
The “standard” group had standard breastfeeding
support from regular staff members confined to the period
of hospitalisation in the NICU. The mean duration of
breastfeeding was 26.1 weeks in the “counselling”
group and 24.0 weeks in the “standard” group
(not statistically significant). These results may be
explained by the high motivation to breastfeed in both
groups, a relatively advantaged population, and the
availability of community breastfeeding resources, which
may have diminished any significant differences that
could have resulted from a breastfeeding intervention.
Valdes
V, Labbok MH, Pugin E, Perez A. The efficacy of the
lactational amenorrhea method (LAM) among working women.
Contraception 2000;62:217-9
The authors
assessed the efficacy of the lactational amenorrhea
method (LAM) for family planning among mothers who are
separated from their infants by work. 170 urban middle
class women who planned to return to work before 120
days postpartum, were interviewed monthly for 6 months
postpartum and contacted at 12 months. They received
clinical support for expressing their milk and exclusively
breastmilk feeding the infants, and for the use of LAM.
The cumulative pregnancy rate by 6 months was 5.2%.
LAM for working women might be associated with a higher
pregnancy risk than LAM among non-working women. Women
using LAM should be informed that separation from the
infant might increase their risk of pregnancy.
Giuliani
M, Grossi GB, Pileri M, Lajolo C, Casparrini G. Could
local anesthesia while breast-feeding be harmful to
infants? J Pediatr Gastroenterol Nutr 2001;32:142-4
A nursing
mother may need dental treatment. The purpose of this
study was to determine the amount of lidocaine and its
metabolite monoethyl-glycinexylidide (MEGX) in breastmilk
after local anesthesia during dental procedures. Seven
nursing mothers (aged 23-39) received 3.6 to 7.2 mL
2% lidocaine without adrenaline. The concentration of
lidocaine and MEGX in maternal plasma and maternal milk
2 to 6 hours after injection corresponded to daily infant
dosages of 73.41 +/- 38.94 microg/L/day and 66.1 +/-
28.5 microg/L/day, respectively, considering an intake
of 90 mL breastmilk every 3 hours. This study suggests
that a nursing mother undergoing dental treatment with
local anesthesia using lidocaine without adrenaline
can safely continue to breastfeed.
Prepared
by the Geneva Infant Feeding Association (GIFA),
a member of the International Baby Food Action Network
(IBFAN)
Editors:
Marina Ferreira Rea, Adriano Cattaneo
Copies
of Breastfeeding Briefs sent upon request to GIFA, Avenue
de la Paix 11, 1202 Geneva, Switzerland,
Fax: +41-22-798 44 43, or to UNICEF country offices.
Available
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