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Earlier studies demonstrated that quality protein maize (QPM), with increased lysine and tryptophan and decreased leucine contents, was more digestible and supported 45% greater nitrogen retention than common maize. Ten recovering malnourished children (ages 13 to 29 months, height-ages 5 to 15 months, weight-ages 3 to 11 months) have now received 90% of their diet energy and 100% of protein and fat from QPM. Energy intake was adjusted to allow them to reach the 50th centile of weight-for-length (according to the National Center for Health Statistics) in 90 days (two completed 60 days only). Growth was compared with that of 10 children receiving modified cow's milk formula (CMF). Energy intakes (QPM 110 +/- 15, CMF 106 +/- 12, corrected for absorption to 94 and 97 kcal/kg.d), crude energy costs of gain (43 +/- 9 and 40 +/- 10, corrected to 37 and 37 kcal/g), linear growth (1.23 +/- 0.24 and 1.33 +/- 0.26 cm/mo), gains in height-age (3.1 +/- 0.7 and 3.3 +/- 1.2 mo), weight gain (2.6 +/- 0.6 and 2.6 +/- 0.8 g/kg.d), and final sums of fat folds (24.3 +/- 3.5 and 27.2 +/- 2.9 mm) were not different. Gains in weight-age were greater (7.5 +/- 2.3 vs 5.4 +/- 1.6 months, P less than .05) and serum albumin decreased (4.10 +/- 0.24 to 3.77 +/- 0.31 g/dL, P less than .01) during QPM feeding. Plasma-free total essential amino acids and ratio of these to total essential amino acids were less after QPM than after CMF diets. Equal growth rates with QPM and CMF diets offer great potential for developing- and developed-country children.

Between 1966 and 1976, heights and weights were determined yearly on all available children from 163 families who had had at least one child successfully treated for malnutrition between 1961 and 1971 and from eight families who had adopted such a child. Between 1959 and 1976, a total of 72 fathers departed from these families: 12 died, 47 deserted, six were jailed, and seven left to look for work elsewhere. Heights and weights as Z scores and the weight age/height age ratios were analyzed, when available, during four periods around the date of the event: 6 to 18 months before (period 1B), 0 to 6 months before (period 2B), 0 to 6 months after (period 3A), and 6 to 18 months after (period 4A). Mean Z scores for all children measured in the period were already low (-0.26 +/- 0.93 and -0.25 +/- 0.95) during period 1B, were higher during period 2B, (-0.15 and 0.04), lower during period 3A (-0.39 and -0.46), and similar to original levels during period 4A (-0.37 and -0.27). Mean weight age/height age was low (0.93 +/- 0.17) only during period 3A for children 2 to 18 years of age. In paired comparisons for children measured during any two periods there were significant increases in Z height and Z weight from periods 1B to 2B and from periods 1B to 4A in children less than 2 years of age and a significant decrease in the weight age/height age ratio from periods 1B to 3A in those 2 to 18 years of age. Loss of father had little or no further impact on the already poor growth of these children.

The opaque-2 gene was shown years ago to increase the nitrogen, lysine, and tryptophan contents of maize and to markedly increase its nutritional value for small children. Concerns about decreased yield, resistance, and acceptability discouraged further development of the gene. Quality protein maize, while retaining the opaque-2 characteristics, has overcome those constraints. Six recovering malnourished infants received diets in which all of the 6.4% protein energy was supplied by casein, quality protein maize, or common maize. The quality protein maize supplied 60% and common maize 75% of total energy. Vegetable oil was added to increase fat contents to 10% of total energy in all diets. Energy digestibility was less (87% and 84%) from quality protein maize and common maize than from casein diets (94%); most of the difference was due to carbohydrate digestibility. Apparent N absorptions from quality protein maize (70 +/- 5%) and common maize (69% +/- 7%) were much lower (P less than .01) than from casein (82% +/- 4%). Apparent retention of N from quality protein maize (34 +/- 4%) was less (P less than .01) than from casein (41% +/- 9%) but greater (P less than .01) than from common maize (22% +/- 10%). Breath hydrogen excretions were usually greater during quality protein maize consumption than during casein diets but not nearly as much as those during common maize diets. The nutritional advantages of quality protein maize v common maize are of a magnitude that must be exploited for the advantage of children in maize-consuming poor countries.

Circadian rhythms are endogenously generated rhythms with a period length of approximately 24 hours. Evidence gathered during the past decade indicates that the circadian timing system develops prenatally and the suprachiasmatic nuclei, the site of a circadian clock, is present by midgestation in primates. Recent evidence also shows that the circadian system of primate infants is responsive to light at very premature stages and that low-intensity lighting can regulate the developing clock. After birth, there is progressive maturation of the circadian system outputs, with pronounced rhythms in sleep-wake and hormone secretion generally developing after 2 months of age. Showing the importance of photic regulation of circadian phase in infants, exposure of premature infants to low-intensity cycled lighting results in the early establishment of rest-activity patterns that are in phase with the 24-hour light-dark cycle. With the continued elucidation of circadian system development and influences on human physiology and illness, it is anticipated that consideration of circadian biology will become an increasingly important component of neonatal care. circadian rhythms, infant, human, baboon, suprachiasmatic nuclei., ABBREVIATIONS. SCN, suprachiasmatic nuclei; RHT, retinohypothalamic tract. THE CIRCADIAN TIMING SYSTEM Circadian rhythms are endogenously driven rhythms with a period length of approximately 24 hours. (1) Notable examples of circadian [...]

Objective. Newborn infants are vitamin K deficient. Vitamin K status in full-term infants after intramuscular vitamin K supplementation at birth has been described. Similar information in growing premature infants has not been reported. The objective of this study was to assess vitamin K status in premature infants by measuring plasma vitamin K and plasma protein-induced in vitamin K absence (PIVKA II) from birth until 40 weeks' postconceptional age. Methods. Premature infants ([less than or equal to] 36 weeks' gestation) were divided at birth into groups by gestational age (group 1, [less than or equal to] 28 weeks; group 2, 29-32 weeks; group 3, 33-36 weeks). Supplemental vitamin K (1 mg intramuscularly) was administered at birth followed by 60 [micro]g/day (weight Results. Of the 44 infants enrolled, 10 infants in each gestational age group completed the study. The patient characteristics for groups 1, 2, and 3 were as follows: gestational age, 26.3 [+ or -] 1.7, 30.3 [+ or -] 1.3, and 33.9 [+ or -] 1.1 weeks; birth weight, 876 [+ or -] 176, 1365 [+ or -] 186, and 1906 [+ or -] 163 g; and days of hyperalimentation, 28.9 [+ or -] 16,16.8 [+ or -] 12, and 4.3 [+ or -] 4 days, respectively. At 2 weeks of age, the vitamin K intake and plasma levels were highest in group 1 versus group 3 (intake: 71.2 [+ or -] 39.6 vs 13.4 [+ or -] 16.3 [micro]g/kg/day; plasma levels: 130.7 [+ or -] 125.6 vs 27.2 [+ or -] 24.4 ng/mL). By 40 weeks' postconception, the vitamin K intake and plasma levels were similar in all 3 groups (group 1, 2, and 3: intake, 11.4 [+ or -] 2.5, 15.4 [+ or -] 6.0, and 10.0 [+ or -] 7.0 [micro]g/kg/day; plasma level, 5.4 [+ or -] 3.8, 5.9 [+ or -] 3.9, and 9.3 [+ or -] 8.5 ng/mL). None of the postnatal plasma samples had any detectable PIVKA II. Conclusions. Premature infants at 2 weeks of age have high plasma vitamin K levels compared with those at 40 weeks' postconceptional age secondary to the parenteral administration of large amounts of vitamin K. By 40 weeks' postconception, these values are similar to those in term formula-fed infants. Confirming "adequate vitamin K status," PIVKA II was undetectable by 2 weeks of life in all of the premature infants. With the potential for unforeseen consequences of high vitamin K levels, consideration should be given to reducing the amount of parenteral vitamin K supplementation in the first few weeks of life in premature infants. Pediatrics 2001;108:1117-1122; vitamin K, PIVKA II, premature, total parenteral nutrition, enteral nutrition., ABBREVIATIONS. PIVKA II, protein-induced in vitamin K absence or antagonism; IM, intramuscularly; NICU, neonatal intensive care unit; TPN, total parenteral nutrition; MBM, maternal breast milk. All newborn infants are relatively [...]

Isolated soy protein-based formulas may be safe and effective for use in term infants unable to consume human breast milk or cow milk-based formulas due to lactose intolerance. These formulas may also be recommended when a vegetarian-based diet is desired for a term infant. The use of soy formula is not associated with a reduction of colic or atopic disease. Infants with severe digestive reactions to cow-milk proteins are also likely to be sensitive to soy proteins and should be provided with an alternative formula. Soy protein formulas are not recommended for preterm infants., The American Academy of Pediatrics is committed to the use of maternal breast milk as the ideal source of nutrition for infant feeding. Even so, by 2 months of age, most infants in North America are formula-fed. Despite limited indications, the use of soy protein-based formula has nearly doubled during the past decade to achieve 25% of the market in the United States. Because an infant formula provides the largest, if not sole, source of nutrition for an extended interval, the nutritional adequacy of the formula must be confirmed and the indications for its use well understood. This statement updates the 1983 Committee on Nutrition review' and contains some important recommendations on the appropriate use of soy protein-based formulas., ABBREVIATION. IgE, immunoglobulin E. BACKGROUND Although soy protein-based nutrition has been used during infancy for centuries in the Orient, the first use of soy formula feeding in this country was [...]

Many of the "inactive" ingredients in medications have been shown to produce adverse reactions in some recipients. For this reason, the American Academy of Pediatrics recommends that the FDA mandate labeling of these ingredients because voluntary labeling has proved inadequate. Inactive ingredients include preservatives, stabilizers, dyes, sweeteners, and substances added to produce the desired bulk or consistency. Examples of adverse effects include bronchospasm from benzalkonium chloride in asthmatic inhalers, benzyl alcohol poisoning in newborns from infusions with preservative-containing medications, and sensitivity reactions to aspartame, saccharin, and dyes., Because of an increasing number of reports of adverse reactions associated with pharmaceutical excipients, in 1985 the Committee on Drugs issued a position statement[1] recommending that the Food and Drug Administration mandate labeling of over-the-counter and prescription formulations to include a qualitative list of inactive ingredients. However, labeling of inactive ingredients remains voluntary. Adverse reactions continue to be reported, although some are no longer considered clinically significant, and other new reactions have emerged. The original statement, therefore, has been updated and its information expanded., ABBREVIATIONS. FDA, Food and Drug Administration; MDIs, metered-dose inhalers Pharmaceutical products often contain agents that have a variety of purposes, including improvement of the appearance, bioavailability, stability, and palatability of [...]

Dietary fiber in the amounts currently recommended for children do not appear to pose any risk. The potential concerns of increasing dietary fiber intake are compromising caloric intake, reduced absorption of minerals or other nutrients, and gas production or abdominal discomfort. However, studies show that high-fiber diets do not appear to pose a risk of inadequate caloric or mineral absorption except in cases where there is malnutrition or a wide variety of foods is not consumed. The recommendation of fiber intake at the level of the child's age plus 5 to 10 grams per day would result in an insignificant reduction of caloric and mineral absorption. Gas and cramping can be avoided by increasing fiber intake gradually and by drinking sufficient water., Objectives: Although dietary fiber is associated with important health benefits in childhood, there have been concerns that very high fiber diets may result in adverse health effects. This report reviews the major safety concerns associated with consumption of very high fiber diets, estimates the amount of fiber that may cause adverse physiologic effects in children, and proposes safe levels of dietary fiber intake for children and adolescents. Methods. Published studies on dietary fiber intake in childhood were reviewed to determine major safety concerns, to document adverse effects, to characterize subjects involved and the dose and type of fiber consumed, and to estimate Potential relevance to US children and adolescents. Levels of dietary fiber reported to have adverse health effects were compared with recommended levels of fiber intake for children older than 2 years of age. Results and Conclusions. A review of the scientific literature suggests that a small loss of energy, protein, and fat may occur with a high intake of dietary fiber. However, this small loss of energy is unlikely to be significant to children consuming adequate levels of major nutrients, especially at conservative fiber intakes as recommended by the American Health Foundation's age plus 5 formula. In addition, it is estimated that even with a doubling of current dietary fiber, there is unlikely to be an adverse effect on serum vitamin and mineral concentrations in healthy US children consuming a balanced diet containing adequate levels of nutrients. Thus, evidence suggests that for US children, a moderate increase in dietary fiber is more likely to be healthful than harmful. Pediatrics 1995,96:1014-1019; dietary fiber, children, safety., ABBREVIATIONS. kcal, kilocalorie; AHF, American Health Foundation. Fibers in foods are complex carbohydrates, commonly defined as nonstarch polysaccharides and lignin, which are not digested by enzymes in the human intestinal [...]