It has become a common practice to supplement human milk with a variety of additives to improve the nutritive content of the feeding for the premature infant. Twenty-two freshly frozen human milk samples were measured for lysozyme activity, total IgA, and specific IgA to Escherichia coli serotypes 01, 04, and 06. One mL aliquots were mixed with the following: 1 mL of Similac, Similac Special Care, Enfamil, Enfamil Premature Formula, and sterile water; 33 mL of Poly-Vi-Sol, 33 mg of Moducal, and 38 mg of breast-milk fortifier, and then reanalyzed. Significant decreases (41% to 74%) in lysozyme activity were seen with the addition of all formulas; breast-milk fortifier reduced activity by 19%, while no differences were seen with Moducal, sterile water, or Poly-Vi-Sol. No differences were seen in total IgA content, but some decreases were seen in specific IgA to E. coli serotypes 04 and 06. E. coli growth was determined after 3 1/2 hours of incubation at 37 degrees C after mixing. All cow-milk formulas enhanced E. coli growth; soy formulas and other additives preserved inhibition of bacterial growth. Nutritional additives can impair anti-infective properties of human milk, and such interplay should be considered in the decision on the feeding regimen of premature infants.

A review of three recent cases of death due to childhood asthma revealed consistent themes of depression, emotional precipitation of attacks, unsupportive families, and a tendency to deny asthma symptoms. Possible psychosomatic mechanisms are identified as potentially important for the interaction of emotions and asthma.

Constipation and its complications, particularly meconium ileus equivalent, may become management problems in patients with cystic fibrosis. The medical records of 168 patients with cystic fibrosis were reviewed for the prevalence of constipation and meconium ileus equivalent. Of 168 patients, 54 (32%) had experienced at least one episode of constipation which responded to oral or rectal laxative therapy. In 16 of the study group (9%) meconium ileus equivalent developed. Patients younger than 5 years of age had a lower prevalence and those older than 30 years of age had a much higher prevalence of both conditions. Those with prolonged histories of inadequately controlled steatorrhea appeared to be at higher risk for the eventual development of meconium ileus equivalent. Recurrences and complications of constipation may be avoided by instituting early and aggressive therapy.

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