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April 1977, Vol 131, No. 4 >
Article | April 1977

Human Milk and the Small Premature Infant FREE

Samuel J. Fomon, MD; Ekhard E. Ziegler, MD; Héctor D. Vázquez, MD
[+] Author Affiliations

Reprint requests to Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, IA 52242 (Dr Fomon).


Am J Dis Child. 1977;131(4):463-467. doi:10.1001/archpedi.1977.02120170089018.
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Advances in recent years in knowledge and techniques of treatment of premature infants have resulted in lower neonatal mortality. The advances relate to management of respiratory failure, maintenance of energy, fluid, and electrolyte balance, and control of body temperature. As a result of improvement in these areas, attention has become focused on other causes of death, including infections and necrotizing enterocolitis. Much of the current interest in feeding human milk to small premature infants centers around the possibility that human milk may offer some protection against infections and/or necrotizing enterocolitis.

Although the human infant, unlike the newborn of many species, absorbs little if any antibody from the maternal milk, it seems likely that human milk protects the human newborn against infection.1.2 The antimicrobial properties of milk include antibodies, complement components, lysozyme, lactoperoxidase, lactoferrin, fatty acids, and cellular components.3.4 The characteristic gut flora associated with feeding of human milk,

REFERENCES

1 +
Winberg J, Wessner G:  Does breast milk protect against septicaemia in the newborn? Lancet 1:1091-1094, 1971;.
2 +
Gerrard JW:  Breast-feeding: Second thoughts . Pediatrics 54:757-764, 1974;.
3 +
Hanson LO, Winberg J:  Breast milk and defense against infection in the newborn . Arch Dis Child 47:845-848, 1972;.
4 +
Goldman AS, Smith CW:  Host resistance factors in human milk . J Pediatr 82:1082-1090, 1973;.
5 +
Smith CW, Goldman AS:  The cells of human colostrum: I. In vitro studies of morphology and functions . Pediatr Res 2:103-109, 1968;.
6 +
Mohr JA, Leu R, Mabry W:  Colostral leukocytes J Surg Oncol 2:163-167, 1970;.
7 +
Diaz-Jouanen E, Williams RC Jr: T and B  lymphocytes in human colostrum . Clin Immunol Immunopathol 3:248-255, 1974;.
8 +
Mizrahi A, Barlow O, Berdon W, et al:  Necrotizing enterocolitis in premature infants . J Pediatr 66:697-706, 1965;.
9 +
Virnig NL, Reynolds JW:  Epidemiological aspects of neonatal necrotizing enterocolitis . Am J Dis Child 128:186-190, 1974;.
10 +
Santulli TV, Schullinger JN, Heird WC, et al:  Acute necrotizing enterocolitis in infancy: A review of 64 cases . Pediatrics 55:376-387, 1975;.
11 +
Barlow B, Santulli TV, Heird WC, et al:  An experimental study of acute neonatal enterocolitis: The importance of breast milk . J Pediatr Surg 9:587-595, 1974;.
12 +
Fomon SJ: Infant Nutrition , ed 2. Philadelphia, WB Saunders Co, 1974;.
13 +
Gaull G, Sturman JA, Räihä NCR:  Development of mammalian sulfur metabolism: Absence of cystathionase in human fetal tissues . Pediatr Res 6:538-547, 1972;.
14 +
Räihä NCR:  Biochemical basis for nutritional management of preterm infants . Pediatrics 53:147-156, 1974;.
15 +
Sturman JA, Rassin D, Gaull GE:  Taurine in development: Is it essential in the neonate?  abstracted. Pediatr Res 10:415, 1976;.
16 +
Ghadimi H, Pecora P:  Free amino acids of different kinds of milk . Am J Clin Nutr 13:75-81, 1963;.
17 +
Lönnerdal B, Forsum E, Hambraeus L:  The protein content of human milk: I. A transversal study of Swedish normal material . Nutr Rep Int 13:125-134, 1976;.
18 +
Fomon SJ, Filer LJ Jr:  Milks and formulas , in Fomon SJ (ed): Infant Nutrition , ed 2. Philadelphia, WB Saunders Co, 1974;, pp 359-407.
19 +
Lönnerdal B, Forsum E, Hambraeus L: A  longitudinal study of the protein, nitrogen, and lactose contents of human milk from well-nourished Swedish mothers . Am J Clin Nutr 29:1127-1133, 1976;.
20 +
Lönnerdal B, Forsum E, Gebre-Medhin M, et al:  Breast milk composition in Ethiopian and Swedish mothers. II. Lactose, nitrogen, and protein contents . Am J Clin Nutr 29:1134-1141.
21 +
Fomon SJ, May CD:  Metabolic studies of normal full-term infants fed pasteurized human milk . Pediatrics 22:101-115, 1958;.
22 +
Fomon SJ, Owen GM, Jensen RL, et al:  Calcium and phosphorus balance studies with normal full-term infants fed pooled human milk or various formulas . Am J Clin Nutr 12:346-357, 1963;.
23 +
Picou D, Phillips M:  Urea metabolism in malnourished and recovered children receiving a high or low protein diet . Am J Clin Nutr 25:1261-1266, 1972;.
24 +
Fomon SJ, Thomas LN, May CD:  Equivalence of pasteurized and fresh human milk in promoting nitrogen retention by normal full-term infants . Pediatrics 22:935-944, 1958;.
25 +
Powers GF:  Some observations on the feeding of premature infants based on 20 years' experience at the New Haven Hospital . Pediatrics 1:145-158, 1948;.
26 +
Gordon HH, Levine SZ, McNamara H:  Feeding of premature infants: A comparison of human and cow's milk . Am J Dis Child 73:442-452, 1947;.
27 +
Kagan BM, Hess JH, Lundeen E, et al:  Feeding premature infants: A comparison of various milks . Pediatrics 15:373-382, 1955;.
28 +
Levin B, Mackay HMM, Neill CA, et al: Weight Gains, Serum Protein Levels, and Health of Breast Fed and Artificially Fed Infants . Medical Research Council Special Report Series, No. 296. London, Her Majesty's Stationery Office, 1959;.
29 +
Goldman HI, Karelitz S, Acs H, et al:  The relationship of the sodium, potassium, and chloride concentration of the feeding to the weight gain of premature infants . Pediatrics 30:909-916, 1962;.
30 +
Pincus JB, Gittleman IF, Schmerzler E, et al:  Protein levels in serum of premature infants fed diets varying in protein concentrations . Pediatrics 30:622-628, 1962;.
31 +
Kagan BM, Felix N, Molander CW, et al:  Body water changes in relation to nutrition of premature infants . Ann NY Acad Sci 110:830-839, 1963;.
32 +
Kagan BM, Stanincova V, Felix NS, et al:  Body composition of premature infants: Relation to nutrition . Am J Clin Nutr 25:1153-1164, 1972;.
33 +
Räihä NCR, Heinonen K, Rassin DK, et al:  Milk protein quantity and quality in low birth weight infants: I. Metabolic responses and effects on growth . Pediatrics 57:659-674, 1976;.
34 +
Ylppö A:  Zur Physiologie, Klinik und zum Schicksal der Frühgeborenen . Z Kinderheilkd 24:1-110, 1919;.
35 +
Von Sydow G:  A study of the development of rickets in premature infants . Acta Paediatr Scand (Suppl 2) to vol 33, 1946;.
36 +
Eek S, Gabrielsen LH, Halvorsen S:  Prematurity and rickets . Pediatrics 20:63-77, 1957;.
37 +
Day GM, Chance GW, Radde IC, et al:  Growth and mineral metabolism in very low birth weight infants: II. Effects of calcium supplementation on growth and divalent cations . Pediatr Res 9:568-575, 1975;.
38 +
Fomon SJ:  Body composition of the male reference infant during the first year of life . Pediatrics 40:863-870, 1967;.
39 +
O'Donnell AM, Ziegler EE, Fomon SJ:  Ingestas recomendadas de nutrientes para prematuros en crecimiento . Arch Argent Pediatr 72:126-137, 1974;.
40 +
Ziegler EE, O'Donnell AM, Nelson SE, et al:  Body composition of the reference fetus . Growth 40:329-341, 1976;.
41 +
Fomon SJ, Thomas LN, Filer LJ Jr, et al:  Requirements for protein and essential amino acids in early infancy . Acta Paediatr Scand 62:33-45, 1973;.
42 +
Snyderman SE, Boyer A, Kogut MD, et al:  The protein requirement of the premature infant: I. The effect of protein intake on the retention of nitrogen . J Pediatr 74:872-880, 1969;.
43 +
Shaw JCL:  Evidence for defective skeletal mineralization in low birth weight infants: The absorption of calcium and fat . Pediatrics 57:16-25, 1976;.
44 +
Butterfield J, Lubchenco LO, Bergstedt J, et al:  Patterns in electrolyte and nitrogen balance in the newborn premature infant . Pediatrics 26:777-791, 1960;.
45 +
Day GM, Radde IC, Balfe JW, et al:  Electrolyte abnormalities in very low birth weight infants . Pediatr Res 10:522-526, 1976;.
46 +
Roy RN, Chance GW, Radde IC, et al:  Late hyponatremia in very low birth weight infants (< 1.3 kilograms) . Pediatr Res 10:526-531, 1976;.
47 +
Cooke RE, Pratt EL, Darrow DC:  The metabolic response of infants to heat stress . Yale J Biol Med 22:227-249, 1950;.
48 +
Davidson M, Levine SZ, Bauer CH, et al:  Feeding studies in low birth weight infants: I. Relationships of dietary protein, fat, and electrolyte to rates of weight gain, clinical courses, and serum chemical concentrations . J Pediatr 70:695-713, 1967;.
49 +
Babson SG, Bramhall JL: Diet and growth  in the premature infant: The effect of different dietary intakes of ash-electrolyte and protein on weight gain and linear growth . J Pediatr 74:890-900, 1969;.
50 +
Goldman HI, Goldman JS, Kaufman I, et al:  Late effects of early dietary protein intake on low birth weight infants . J Pediatr 85:764-769, 1974;.
51 +
Menkes JH, Welcher DW, Levi HS, et al:  Relationship of elevated blood tyrosine to the ultimate intellectual performance of premature infants . Pediatrics 49:218-224, 1972;.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Winberg J, Wessner G:  Does breast milk protect against septicaemia in the newborn? Lancet 1:1091-1094, 1971;.
2 +
Gerrard JW:  Breast-feeding: Second thoughts . Pediatrics 54:757-764, 1974;.
3 +
Hanson LO, Winberg J:  Breast milk and defense against infection in the newborn . Arch Dis Child 47:845-848, 1972;.
4 +
Goldman AS, Smith CW:  Host resistance factors in human milk . J Pediatr 82:1082-1090, 1973;.
5 +
Smith CW, Goldman AS:  The cells of human colostrum: I. In vitro studies of morphology and functions . Pediatr Res 2:103-109, 1968;.
6 +
Mohr JA, Leu R, Mabry W:  Colostral leukocytes J Surg Oncol 2:163-167, 1970;.
7 +
Diaz-Jouanen E, Williams RC Jr: T and B  lymphocytes in human colostrum . Clin Immunol Immunopathol 3:248-255, 1974;.
8 +
Mizrahi A, Barlow O, Berdon W, et al:  Necrotizing enterocolitis in premature infants . J Pediatr 66:697-706, 1965;.
9 +
Virnig NL, Reynolds JW:  Epidemiological aspects of neonatal necrotizing enterocolitis . Am J Dis Child 128:186-190, 1974;.
10 +
Santulli TV, Schullinger JN, Heird WC, et al:  Acute necrotizing enterocolitis in infancy: A review of 64 cases . Pediatrics 55:376-387, 1975;.
11 +
Barlow B, Santulli TV, Heird WC, et al:  An experimental study of acute neonatal enterocolitis: The importance of breast milk . J Pediatr Surg 9:587-595, 1974;.
12 +
Fomon SJ: Infant Nutrition , ed 2. Philadelphia, WB Saunders Co, 1974;.
13 +
Gaull G, Sturman JA, Räihä NCR:  Development of mammalian sulfur metabolism: Absence of cystathionase in human fetal tissues . Pediatr Res 6:538-547, 1972;.
14 +
Räihä NCR:  Biochemical basis for nutritional management of preterm infants . Pediatrics 53:147-156, 1974;.
15 +
Sturman JA, Rassin D, Gaull GE:  Taurine in development: Is it essential in the neonate?  abstracted. Pediatr Res 10:415, 1976;.
16 +
Ghadimi H, Pecora P:  Free amino acids of different kinds of milk . Am J Clin Nutr 13:75-81, 1963;.
17 +
Lönnerdal B, Forsum E, Hambraeus L:  The protein content of human milk: I. A transversal study of Swedish normal material . Nutr Rep Int 13:125-134, 1976;.
18 +
Fomon SJ, Filer LJ Jr:  Milks and formulas , in Fomon SJ (ed): Infant Nutrition , ed 2. Philadelphia, WB Saunders Co, 1974;, pp 359-407.
19 +
Lönnerdal B, Forsum E, Hambraeus L: A  longitudinal study of the protein, nitrogen, and lactose contents of human milk from well-nourished Swedish mothers . Am J Clin Nutr 29:1127-1133, 1976;.
20 +
Lönnerdal B, Forsum E, Gebre-Medhin M, et al:  Breast milk composition in Ethiopian and Swedish mothers. II. Lactose, nitrogen, and protein contents . Am J Clin Nutr 29:1134-1141.
21 +
Fomon SJ, May CD:  Metabolic studies of normal full-term infants fed pasteurized human milk . Pediatrics 22:101-115, 1958;.
22 +
Fomon SJ, Owen GM, Jensen RL, et al:  Calcium and phosphorus balance studies with normal full-term infants fed pooled human milk or various formulas . Am J Clin Nutr 12:346-357, 1963;.
23 +
Picou D, Phillips M:  Urea metabolism in malnourished and recovered children receiving a high or low protein diet . Am J Clin Nutr 25:1261-1266, 1972;.
24 +
Fomon SJ, Thomas LN, May CD:  Equivalence of pasteurized and fresh human milk in promoting nitrogen retention by normal full-term infants . Pediatrics 22:935-944, 1958;.
25 +
Powers GF:  Some observations on the feeding of premature infants based on 20 years' experience at the New Haven Hospital . Pediatrics 1:145-158, 1948;.
26 +
Gordon HH, Levine SZ, McNamara H:  Feeding of premature infants: A comparison of human and cow's milk . Am J Dis Child 73:442-452, 1947;.
27 +
Kagan BM, Hess JH, Lundeen E, et al:  Feeding premature infants: A comparison of various milks . Pediatrics 15:373-382, 1955;.
28 +
Levin B, Mackay HMM, Neill CA, et al: Weight Gains, Serum Protein Levels, and Health of Breast Fed and Artificially Fed Infants . Medical Research Council Special Report Series, No. 296. London, Her Majesty's Stationery Office, 1959;.
29 +
Goldman HI, Karelitz S, Acs H, et al:  The relationship of the sodium, potassium, and chloride concentration of the feeding to the weight gain of premature infants . Pediatrics 30:909-916, 1962;.
30 +
Pincus JB, Gittleman IF, Schmerzler E, et al:  Protein levels in serum of premature infants fed diets varying in protein concentrations . Pediatrics 30:622-628, 1962;.
31 +
Kagan BM, Felix N, Molander CW, et al:  Body water changes in relation to nutrition of premature infants . Ann NY Acad Sci 110:830-839, 1963;.
32 +
Kagan BM, Stanincova V, Felix NS, et al:  Body composition of premature infants: Relation to nutrition . Am J Clin Nutr 25:1153-1164, 1972;.
33 +
Räihä NCR, Heinonen K, Rassin DK, et al:  Milk protein quantity and quality in low birth weight infants: I. Metabolic responses and effects on growth . Pediatrics 57:659-674, 1976;.
34 +
Ylppö A:  Zur Physiologie, Klinik und zum Schicksal der Frühgeborenen . Z Kinderheilkd 24:1-110, 1919;.
35 +
Von Sydow G:  A study of the development of rickets in premature infants . Acta Paediatr Scand (Suppl 2) to vol 33, 1946;.
36 +
Eek S, Gabrielsen LH, Halvorsen S:  Prematurity and rickets . Pediatrics 20:63-77, 1957;.
37 +
Day GM, Chance GW, Radde IC, et al:  Growth and mineral metabolism in very low birth weight infants: II. Effects of calcium supplementation on growth and divalent cations . Pediatr Res 9:568-575, 1975;.
38 +
Fomon SJ:  Body composition of the male reference infant during the first year of life . Pediatrics 40:863-870, 1967;.
39 +
O'Donnell AM, Ziegler EE, Fomon SJ:  Ingestas recomendadas de nutrientes para prematuros en crecimiento . Arch Argent Pediatr 72:126-137, 1974;.
40 +
Ziegler EE, O'Donnell AM, Nelson SE, et al:  Body composition of the reference fetus . Growth 40:329-341, 1976;.
41 +
Fomon SJ, Thomas LN, Filer LJ Jr, et al:  Requirements for protein and essential amino acids in early infancy . Acta Paediatr Scand 62:33-45, 1973;.
42 +
Snyderman SE, Boyer A, Kogut MD, et al:  The protein requirement of the premature infant: I. The effect of protein intake on the retention of nitrogen . J Pediatr 74:872-880, 1969;.
43 +
Shaw JCL:  Evidence for defective skeletal mineralization in low birth weight infants: The absorption of calcium and fat . Pediatrics 57:16-25, 1976;.
44 +
Butterfield J, Lubchenco LO, Bergstedt J, et al:  Patterns in electrolyte and nitrogen balance in the newborn premature infant . Pediatrics 26:777-791, 1960;.
45 +
Day GM, Radde IC, Balfe JW, et al:  Electrolyte abnormalities in very low birth weight infants . Pediatr Res 10:522-526, 1976;.
46 +
Roy RN, Chance GW, Radde IC, et al:  Late hyponatremia in very low birth weight infants (< 1.3 kilograms) . Pediatr Res 10:526-531, 1976;.
47 +
Cooke RE, Pratt EL, Darrow DC:  The metabolic response of infants to heat stress . Yale J Biol Med 22:227-249, 1950;.
48 +
Davidson M, Levine SZ, Bauer CH, et al:  Feeding studies in low birth weight infants: I. Relationships of dietary protein, fat, and electrolyte to rates of weight gain, clinical courses, and serum chemical concentrations . J Pediatr 70:695-713, 1967;.
49 +
Babson SG, Bramhall JL: Diet and growth  in the premature infant: The effect of different dietary intakes of ash-electrolyte and protein on weight gain and linear growth . J Pediatr 74:890-900, 1969;.
50 +
Goldman HI, Goldman JS, Kaufman I, et al:  Late effects of early dietary protein intake on low birth weight infants . J Pediatr 85:764-769, 1974;.
51 +
Menkes JH, Welcher DW, Levi HS, et al:  Relationship of elevated blood tyrosine to the ultimate intellectual performance of premature infants . Pediatrics 49:218-224, 1972;.

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