50 Years Ago in The Journal Of Pediatrics:
Lactic acid milk in the feeding of premature infants
Article Outline
Karelitz S, Schell NB, and Goldman HI. J Pediatr 1959;54:756-761.
This article describes what has remained a controversial topic: what is the appropriate nutrition for preterm infants? Increased survival of babies with lower gestational ages has complicated the challenges once faced. Although we have gained knowledge of the nutritional needs and growth patterns of neonates, as well as the physiology of their developing gastrointestinal tract, there remain many parallels between 50 years ago and today.
In terms of “acid formulas,” we currently know that premature babies cannot reach mature levels of gastric acid output in their first weeks,1 and the use of H2 blockers increases the likelihood of infections and necrotizing enterocolitis (NEC).2 Therefore acidification of formulas decreases the incidence of NEC.3 There are now preterm formulas with differing types and concentrations of proteins, carbohydrates, and lipids. Prebiotics and probiotics are receiving attention for their benefits in promoting a healthy gastrointestinal ecosystem. Whether fermentative processes of probiotic bacteria provide increased short-chain fatty acids (analogous to the acid formulas described in the article) such as lactate, propionate, and butyrate, which may have protective effects on the intestine, are again under investigation. On the horizon are studies of the premature intestinal microbiome with both culture and newly developed non-culture–based technology and delineation of normal and abnormal intestinal microbiota. This could lead to further expansion of the available formulas for preterm infants and early detection and potential treatment of gastrointestinal-related diseases.
Advances in technologies, such as intravenous nutrition solutions, are helping infants born smaller and earlier to survive. Despite these advances, there is still much to be learned about premature nutrition, metabolism, and developmental gastroenterology to optimize the outcomes of these premature infants.
References
- Gastric acid secretory function in preterm infants. J Pediatr. 1985;106:467–471
- Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2006;117:e137–e142
- . Prevention of neonatal necrotizing enterocolitis. J Pediatr Gastroenterol Nutr. 1990;11:317–323
PII: S0022-3476(08)01065-2
doi:10.1016/j.jpeds.2008.11.054
© 2009 Mosby, Inc. All rights reserved.
