ABSTRACT. Background. Preterm infants are immunologically immature at birth. Previous studies have demonstrated that human milk protects against infection in full-term infants, but there are few studies of its effect for preterm infants.Objective. To examine the effect of human milk feedings on infection incidence among very low birth weight (VLBW) infants during their initial hospitalization.Study Design. The sample consisted of 212 consecutive VLBW infants admitted to the Georgetown University Medical Center neonatal intensive care unit (NICU) during 1992-1993 and surviving to receive enteral feeding. Type of feeding (human milk vs formula), presence of infection and sepsis/meningitis (clinical signs and positive cultures for pathogenic organisms), and potential confounding variables were abstracted from medical records. Multiple logistic regression was used to control for confounders. Conclusions. The incidence of any infection and sepsis/ meningitis are significantly reduced in human milk-fed VLBW infants compared with exclusively formula-fed VLBW infants. Pediatrics 1998;102(3). URL: http://www. pediatrics.org/cgi/content/full/102/3/e38; infection, sepsis, infant, low birth weight, human milk, breastfeeding. Results. The incidence of infection (human milk [29.3%] vs formula [47.2%]) and sepsis/meningitis (human milk [19.5%] vs formula [32.6%]) differed significantly by type of feeding. Major risk factors for infection were similar in both groups. Human milk feeding was independently correlated with a reduced odds of infection (odds ratio[ABBREVIATIONS. AAP, American Academy of Pediatrics; IgA, immunoglobulin A; VLBW, very low birth weight; NICU, neonatal intensive care unit; IV, intravenous; NPO, without enteral feedings; OR, odds ratio; CI confidence interval; EBM, expressed breast milk. I n a recent policy statement, the American Academy of Pediatrics (AAP) strongly advocated breastfeeding for full-term infants and for the first time extended this recommendation to premature infants.1 This statement from the AAP's Work Group on Breastfeeding cited the compelling advantages of human milk, which include immunologic benefits. Studies comparing human milk from preterm mothers with that from term mothers suggest that these immunologic benefits may be even greater for preterm infants because secretory immunoglobulin A (IgA), lysozyme, lactoferrin, and interferon are found in greater concentrations in preterm human milk compared with term milk.2-4 Very low birth weight (VLBW) infants do not benefit from the transplacental transfer of maternal immunoglobulins that occurs primarily after 34 weeks of gestation.5 These infants are exposed to abundant pathogenic organisms during neonatal intensive care unit (NICU) hospitalization and may benefit from the host defense factors present in preterm human milk. 6 -9 Although researchers have investigated the role of infant feeding type on the development of infection in full-term infants, 10 -15 the relation between type of infant feeding and infection among preterm inf...

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Isolated idiopathic growth hormone deficiency (GHD) and idiopathic short stature (ISS) can be difficult to distinguish, but the therapeutical consequences are different. In this report the data on final height of untreated and treated children with GHD and ISS are reviewed. Untreated GH-deficient individuals who underwent spontaneous puberty (22 male, 14 female patients) reached a mean final height of 4.7 SD (range 3.9 to 6.0) below the population's mean. If puberty was induced (19 male patients), mean final height SD score (SDS) was -3.1. Traditional regimens of GH administration (2-4 injections/wk) in 236 children (184 boys, 52 girls) with GHD and spontaneous puberty resulted in a final height SDS of -2.8 (range -1.5 to -4.7). In 190 children in whom puberty was induced (139 boys, 51 girls) mean final height was -1.6 (range - -1.1 to -2.4). The mean gain in final height SDS is therefore estimated at 1.5-2.0 in average cases, and 3.5 in extreme cases. Preliminary data suggest that on present regimens mean final height may approach target height. In untreated boys with ISS the mean final height was 2-5 cm lower than that predicted before puberty, whereas in girls it was almost equal to the prediction. After GH treatment the mean final height was 0.4-3.0 cm higher than the predicted adult height, which results in an average net gain in final height SDS of approximately 0.5-0.8 (3-5 cm).

The mother of a high risk infant is confronted with numerous parenting challenges, not the least of which is the decision about how to nourish her vulnerable newborn. Successful breastfeeding depends on overcoming obstacles posed by infant condition, maternal health, and the neonatal intensive care environment. These obstacles include maternal separation from the nursing infant during hospitalization, delayed initiation of the expression of breast milk due to maternal illness and/or surgery, the inability to suckle her infant or feed on demand, and the lack of sufficient maternal follow-up after discharge. This article reviews the benefits of providing breast milk to high risk infants, problems that may be encountered by mothers of high risk infants, and the interventions that may be used by the midwife to facilitate the breastfeeding process.

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