Abstracts

Kangaroo Mother Versus Traditional Care for Newborn Infants < (less than) 2000 Grams: A Randomized, Controlled Trial

In 1979, the Kangaroo Mother Program (KMP) was proposed and developed by Rey, Martinez and Navarette in Bogota Colombia, in contrast to expensive, seldom available traditional care for low birth-weight babies. The programme has three components: kangaroo position, kangaroo feeding and kangaroo discharge policy. Author Charpak and her team report on a randomized, controlled trial to assess a number of variables related to the three components of the programme. When comparing kangaroos (382) to controls (364) they found:

• Survival as good or better than traditional methods of care,
• No reduction in early physical growth with the KMP (occasional supplementation was used),
• Early discharge did not increase readmissions attributable to metabolic and noninfectious respiratory complications of LBW babies. Kangaroo number of infectious episodes were the same as the control but kangaroo infections were of less severity,
• KMP reduced the number of total days in hospital,
• KMP improved early breastfeeding patterns.

Breastfeeding and catch-up growth in infants born small for gestational age

Infants born small for gestational age face a number of health risks, among them continued growth failure, learning and behavioural problems, long term health risks such as ischaemic heart disease, and type 2 diabetes mellitus. To determine the impact of post-natal nutrition on the growth outcomes of small for gestational age infants, the authors studied the outcomes of early nutrition on growth during the first year of life. Fifty-four infants born 37 to 42 weeks gestation and with birth weights below the 10th percentile for their gestational age were separated into breast or standard formula-fed group. The groups were similar in birth weight, gestation, gender, and anthropometry at enrolment. The breastfed group had the expected socioeconomic variables and the formula fed group had higher levels of parental smoking.

The outcomes showed that term, small for gestational age infants, who were breastfed had faster postnatal growth and were more likely to show significant catch-up growth than those who were fed standard infant formula. The faster earlier increase in head circumference of the breastfed group is of particular interest and likely reflects faster brain growth at this critical time. Adjustments for factors associated with the higher socioeconomic class impact on growth of the breastfeeding groups was made. Explanations of the improved results include, higher food intake, specific nutrients in breastmilk, better nutrient absorption, non-nutritive factors present in breastmilk such as hormones and growth factors, protein levels in breastmilk that fluctuate according to need. Breastfeeding may have a major beneficial impact on the long term health and development of small for gestational age infants.

Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians

Infant feeding data was collected from the mothers of 933 Pima Indians born between 1950 and 1978. As part of a longitudinal study 720 were examined between the ages of 10 and 39 years for diabetes. The type of feeding for the first two months was used to determine the association between breastfeeding and non-insulin-dependent diabetes (NIDDM). Results showed that exclusive breastfeeding for at least two months is associated with a lower rate of NIDDM for Pima Indians aged 40 years or less. The odds ratio for NIDDM in people who had been exclusively breastfed compared to those exclusively bottle fed was 0.41 after adjustment for confounding factors. The authors postulate an autoimmune response to explain the relationship between IDDM and cow’s milk formula feeding is not a hypothesis to explain the relationship to NIDDM, but that bottlefeeding can lead to overfeeding. In breastfed infants the high fat content of the hind milk may trigger a satiety response. Infant formulas with their uniform composition do not give such a satiety signal and the amount consumed is regulated by the amount in the bottle rather than need and may lead to overfeeding. “This excess weight may lead to increased insulin resistance and obesity in adolescents and young adults”.