published_or_final_version / Nursing Studies / Master / Master of Nursing

Human milk fortification is recommended to meet the nutritional requirements of preterm infants. Most human milk fortifiers (HMFs) contain non-protein energy (NPE) predominantly as carbohydrate which may lead to high fat deposition relative to lean mass accretion. We hypothesized that fortifying human milk with a HMF containing NPE predominantly as fat (fatHMF) would result in a higher (1) lean mass accretion (percent lean mass) and (2) growth (anthropometry), compared to fortifying with an isocaloric, isonitrogenous HMF containing NPE predominantly as carbohydrate (carbHMF). In a double-blind randomized trial, 29 infants (≤32 weeks and appropriate for gestational age) admitted to the Neonatal Intensive Care Unit received either mother's milk fortified with the fatHMF (n = 14) or the carbHMF (n = 15). Body composition and growth measurements were performed at Baseline (at ≤10% of goal intake 150 ml/kg), Phase 1, and Phase 2 (3 weeks and 6 weeks, respectively, from starting HMF). Although neither percent lean (fat) mass nor growth were statistically different, by Phase 2 infants receiving fatHMF showed a 63% increase in percent fat mass, gained 1194 g in weight and 8.8 cm in length, whereas the carbHMF showed a 96% increase in percent fat mass, gained 1005 g in weight and 6.9 cm in length (p = 0.3586, 0.3815, and 0.1851 respectively). By Phase 2, the fatHMF infants gained 128 g in absolute dry lean tissue, whereas the carbHMF infants gained 99 g (p = 0.0362, Post hoc analysis). Differences of this magnitude are clinically important, but a larger study is required to demonstrate statistical significance.

No description available.

D.Cur. / The feeding of low birth weight babies remains a challenge. Mother's milk is deficient in protein, calcium, magnesium and phosphate. These elements need to be supplemented in order for the low birth weight baby to grow under optimal conditions. The objective of the study was to compare the growth of the low birth weight baby, who was only fed mothers milk, to the low birth weight babay who was fed mother's milk with a commercial fortifier, using mass, lenght and head circumference as a guide. The literature study has shown that there are different methods which can be used to compliment the deficiencies in mothers's milk, for example: premature milk formula, alternating mother's milk with premature milk formula, additional additives to mother's milk and commercial fortifiers. Previous research of mother's milk fortifiers has shown that the biochemistry has positvely influenced their growth. Six patients were used in the experimental group and received 25% mother's milk and 75% fortifier. The control group consisted of eight babies who only received mother's milk. All the babies met the criteria and reached the 1600 gram weight by the time the study was completed. The Mann Whitney U test was used to calculate the results. No significant statistical growth was seen in any of the areas tested. It was concluded that mother's milk should be fortified, despite the results of the study, as mother's milk is definitely deficient in certain nutrients. It is possible to use mother's milk fortifiers in a stronger consentration.

No description available.

The purpose of the study was to identify factors associated with the delay in the initiation of breastfeeding to premature infants before discharge from hospital. The need for this research is evident in the current practice of feeding premature infants after a nasogastric tube is removed. The study sought to provide answers to delayed initiation of breastfeeding to premature infants before discharge from hospital. Fifty members of staff in the Sick Neonate Unit and 50 mothers of premature infants participated in the study. Self-administered data collection instruments were used to collect data from mothers of premature infants and staff of a Sick Neonate Unit in the hospital. The results showed that sociodemographic factors of staff 15 (f=30%) were 31-40 years old, and young nursing staff have decreased knowledge of breastfeeding as compared to senior and older staff members. Maternal demographic factors 36 (f=73.5%) were single and 13 (f=26.5) were married. Married mothers were more likely to breastfeed with the support of the partner than unmarried mothers. Health service factors staff views towards breastfeeding were 11(f=22.0% staff members were neutral about breastfeeding, and Eighteen (f=36.0%) staff members strongly disagreed to other methods of infant feeding. Maternal breastfeeding knowledge was one of the factors under maternal breastfeeding factors because it showed that 48 mothers (f=98.0%) did not have breastfeeding knowledge. Descriptive statistics were used to analyse data. / Health Studies / M.A. (Health Studies)

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: An association between maternal human immunodeficiency virus (HIV) infection and Necrotizing Enterocolitis (NEC) in preterm infants has been reported. The impact of probiotics in an HIV-exposed very low birth weight (VLBW) infant on the occurrence of NEC is uncertain at present; however it is known that probiotics have protective effects against inflammation and prevent NEC. Postnatal growth restriction is a major issue in preterm, especially extremely-low-birth-weight (ELBW) infants and probiotics have been found to improve feeding tolerance in preterm infants. Human milk oligosaccharides (HMO) also known as the prebiotics of human milk, are known to have bifidogenic and anti-adhesive effects. Infants that receive human milk show a reduced incidence of NEC compared to those who receive infant formula. Very little is known about the composition of breast milk in the HIV-infected mother. Objective: The primary objective of the study was to assess the effect of probiotics on the incidence and severity of NEC in high-risk infants born to HIV-positive and HIV-negative women. The secondary objectives were to assess the effect of probiotic administration on feeding tolerance and growth outcomes of HIV-exposed but uninfected preterm infants, to describe the HMO composition of HIV-infected mothers breast milk and lastly to determine if HMO composition affects the incidence of NEC in HIV-exposed preterm very low birth weight infants. Patients and Methods: A randomized, double blind, placebo controlled trial was conducted for the period July 2011 to August 2012. HIV-exposed and HIV-unexposed premature (<34 weeks gestation) infants with a birth weight of ≥500g and ≤1250g were randomized to receive either a probiotic or a placebo. The probiotic consisted of 1x109 CFU, L. rhamnosus GG and B. infantis per day and was administered for 28 days. NEC was graded according to Bell’s criteria. Anthropometrical parameters and daily intakes were monitored. Breats milk samples were analysed for oligosaccharide content. Results: 74 HIV-exposed and 110 HIV-unexposed infants were enrolled and randomized (mean birth-weight, 987g; mean gestational 28.7 weeks). The incidence of death and NEC did not differ significantly between the HIV-exposed and unexposed groups but a significantly higher NEC incidence was found in the control group. There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z-scores for length and head circumference at day 28 than the unexposed group (p<0.01 and p=0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. Our results show significantly higher absolute concentrations of 2’-fucosyllactose, laco-N-tetraose and lacto-N-fucopentaose 1 and higher relative abundance of 3’-sialyllactose, difucosyl-lacto-N-tetraose and fucosyl-disialyllacto-N-hexaose in HIV-infected compared to -uninfected Secretor women. DSLNT concentrations were significantly lower in the breast milk of mothers whose infants developed NEC compared to infants without NEC. Conclusion: Probiotic supplementation reduced the incidence of NEC in the premature infants; however results failed to show a lower incidence of NEC in HIV-exposed premature infants. Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV-exposure. The data confirms previous reports that HIV-infected mothers have higher 3’sialyllactose milk concentrations. Most intriguing though, the data also indicates that low levels of DSLNT in the mother’s milk increase the infant’s risk for NEC, which is in accordance with results from previously published animal studies and warrants further investigation. / AFRIKAANSE OPSOMMING: Inleiding: ʼn Verwantskap tussen moederlike menslike immuniteitsgebreksvirus (MIV) en nekrotiserende enterokolitis (NEK) in premature babas is aangemeld. Die impak van probiotika in ʼn MIV-blootgestelde baie lae geboortemassa (BLGM) baba op die voorkoms van NEK is tans nog onseker, maar dit is wel bekend dat probiotika ʼn beskermende effek het teen inflammasie en die voorkoms van NEK. Nageboortelike groei beperkings is ʼn groot probleem in premature, veral ekstreme lae geboortemassa (ELGM) babas. Daar is gevind dat probiotika voeding toleransie in premature babas kan verbeter. Menslike melk oligosakkariede (MMO), ook bekend as die prebiotika van menslike melk, is bekend om bifidogeniese en anti-kleef effekte te hê. Babas wat moedersmelk ontvang toon ʼn verlaagde voorkoms van NEK in vergelyking met diegene wat baba formule melk ontvang. Baie min inligting is bekend oor die samestelling van borsmelk in die MIV-positiewe moeder. Doel: Die primêre doel van die studie was om die effek van probiotika op die voorkoms en die graad van NEK in hoë risiko babas van MIV-positiewe en MIV-negatiewe vroue te bepaal. Die sekondêre doelwitte was om die effek van probiotika op voeding verdraagsaamheid en groei uitkomste van MIV-blootgestelde, maar nie- geinfekteerde premature babas te evalueer sowel as die MMO samestelling van MIV-positiewe moeders se borsmelk te beskryf en laastens om die invloed van die MMO samestelling op die voorkoms van NEK in baie lae geboortegewig MIV-blootgestelde premature babas te beskryf. Pasiënte en Metodes: ʼn Gerandomiseerde, dubbelblinde, plasebo-beheerde studie is vir die tydperk Julie 2011 tot Augustus 2012 onderneem. MIV-blootgestelde en nie-blootgestelde premature (<34 weke) babas met 'n geboorte gewig van ≥500g en ≤1250g was ewekansig verdeel om probiotika of plasebo te ontvang. Die probiotika het bestaan uit 1x109 kolonie vormende eenhede, L. rhamnosus GG en B. infantis per dag en is toegedien vir 28 dae. NEK is gegradeer volgens Bell se kriteria. Antropometriese parameters en daaglikse inname is gemonitor. Borsmelk monsters is geanaliseer vir oligosakkaried inhoud. Resultate: 74 MIV-blootgestelde en 110 MIV-nie-blootgestelde babas is ingesluit en ewekansig ingedeel (gemiddelde geboorte gewig, 987g, gemiddelde gestasie 28,7 weke). Die voorkoms van die sterftes en NEK het nie beduidend verskil tussen die MIV-blootgestelde en nie-blootgestelde groepe nie, maar 'n beduidende verskil is gevind vir NEK voorkoms tussen die studie en die kontrole groep. Daar was geen verskil in die gemiddelde daaglikse gewigstoename tussen die behandelings groepe of MIV-blootstelling nie. Die MIV-blootgestelde groep het beduidend hoër z-tellings vir lengte en kopomtrek op dag 28 getoon teenoor die nie-blootgestelde groep (p <0.01 en p = 0,03, onderskeidelik). Daar was geen verskille in die voorkoms van voeding onverdraagsaamheid en abdominale distensie tussen die twee groepe nie. Ons resultate dui op aansienlik hoër absolute konsentrasies van 2'-fucosyllactose, laco-N-tetraose en lakto-N-fucopentaose 1 en hoër relatiewe voorkoms van 3'-sialyllactose, difucosyl-lakto-N-tetraose en fucosyl-disialyllacto-N-hexaose in MIV-positiewe vroue in vergelyking met-negatiewe Sekretor vroue. DSLNT konsentrasies was aansienlik laer in die melk van moeders wie se babas NEK ontwikkel het in vergelyking met babas sonder NEK. Gevolgtrekking: Probiotika aanvullings verminder die voorkoms van NEK in premature babas, maar die resultate kon nie ʼn laer voorkoms van NEK in MIV-blootgestelde premature babas bewys nie. Probiotiese aanvulling het geen invloed op groei uitkomste of die voorkoms van voeding onverdraagsaamheid in MIV-blootstelling getoon nie. Die data bevestig vorige verslae wat aandui dat MIV-besmette moeders hoër 3'sialyllactose borsmelk konsentrasies het. ʼn Interessante aspek is dat lae vlakke van DSLNT in die moeder se melk beduidend is van ʼn verhoogde risiko vir NEK, wat in ooreenstemming is met die resultate uit voorheen gepubliseerde dier studies en regverdig verdere ondersoeke.

MPH / Department of Public Health / See the attached abstract below

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objective: Primary: To investigate the effect of pasteurisation on the composition of expressed breast milk from HIV positive mothers and its adequacy in relation to the growth of their VLBW premature infants. Methods: A descriptive, prospective case-controlled pilot study was performed in 3 regional state hospitals in the Western Cape, South Africa. The control and study groups consisted of 12 HIV negative and 11 HIV positive mothers, with their VLBW premature infants, respectively. All mothers (19 - 35 years old) belonged to the Xhosa ethnic group. All infants were born <34 weeks gestation and birth weight <1500g. Eight breast milk samples were collected on days 6, 7, 13, 14, 20, 21, 27 and 28 from all mothers during the first 28 days after birth. Breast milk was expressed by hand or pump from either the right or left breast. Half of each breast milk sample was kept raw. The remaining sample was Pretoria pasteurised, after which both samples were subdivided into 3 or 4 aliquots to determine energy, protein, carbohydrate, fat, folate, calcium, phosphorus, magnesium, sodium, otassium, iron, copper, zinc content and HI viral load (study group only). The mothers’ dietary intake during pregnancy and lactation was obtained by means of a quantitative food frequency questionnaire and repeated 24-hour recall respectively. The infants’ dietary intake was recorded daily. Mothers’ anthropometric measurements taken at study entry and exit were weight, height and mid-upper arm circumference. All infants’ daily weight, as well as length and head circumference at birth and on day 28 postpartum was obtained. Biochemical analysis was performed on the blood samples obtained at study entry and exit from all mothers and infants. For statistical analysis, Statistica® (release no 7, 2006) was used for repeated measures analysis of variance (ANOVA) to determine the effect of HIV, pasteurisation, milk expression and time on the composition of the breast milk. Results: There was no significant difference in the studied macro- and micronutrient composition between raw or pasteurised expressed breast milk from HIV positive and HIV negative mothers with premature infants. A significant decline in breast milk protein (p<0.01), magnesium (p=0.045), potassium (p=0.002), zinc (p<0.01) and copper (p=0.03) content was observed for the whole study population over time, while folic acid content increased significantly (p=0.012) over time. The sodium/potassium ratio of both groups remained strongly indicative of the presence of sub-clinical mastitis. A significant (p=0.03) greater mean volume of milk was obtained with pump [42.5 Standard Deviation (SD) 18.1 ml], compared to hand expression [36.7 (16.7) ml]. Method of expression did not result in a significant difference in breast milk composition for any of the nutrients studied. Eight (35%) infants were born SGA while 21 (91%) infants were SGA on day 28. The infants gained a mean of 16.37 (4.5) g/kg/day (i.e. 91% of the recommended growth rate of >18g/kg/day) from the day on which birth weight was regained. The control and study group infants respectively consumed a mean of 3.27 (1.36) and 3.21 (1.36) g protein/kg/day and 138.1 (33.8) and 142.3 (33.8) kcal total energy/kg/day. This corresponds to a PER of 2.6 (control group) and 2.5 (study group) respectively, which cannot provide for the increased growth needs of the SGA infant in need of catch-up growth. Six infants experienced an incident of Grade 1 NEC which resolved and all completed the study. Two (18%) HIV-exposed infants were found to be HIV positive at 28 days post delivery. Four participating infants died. No adverse event or mortality was related to the study protocol as no intervention was undertaken. Conclusion: HIV positive Xhosa mothers provide as nutritious breast milk to their VLBW premature infants as HIV negative Xhosa mothers. Maternal nutrient intake during pregnancy and lactation did not have a significant effect on the nutritional composition of breast milk, except for folate content.

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: To determine (1) whether prescribed and delivered energy and protein intakes during the first two weeks of life met Ziegler’s estimated requirements for Very Low Birth Weight (VLBW) infants, (2) if actual energy during the first week of life correlated with time to regain birth weight and reach full enteral nutrition (EN) defined as 100 kcal/kg/day, (3) if growth velocity from time to reach full EN to 36 weeks’ postmenstrual age (PMA) met Ziegler’s estimated fetal growth velocity (16 g/kg/day), and (4) growth outcomes at 36 weeks’ PMA. Study design: Observational study of feeding, early nutrition and early growth of 40 VLBW infants ≤ 30 weeks GA at birth in three newborn intensive care units NICUs. Results: During the first week of life, the percentages of prescribed and delivered energy (69% [65 kcal/kg/day]) and protein (89% [3.1 g/kg/day]) were significantly less than theoretical estimated requirements. Delivered intakes were 15% less than prescribed because of numerous interruptions in delivery and medical complications. During the second week, the delivered intakes of energy (90% [86 kcal/kg/day]) and protein (102% [3.5 g/kg/day]) improved although the differences between prescribed and delivered were consistently 15%. Energy but not protein intake during the first week was significantly related to time to reach full EN. Neither energy nor protein intake significantly correlated with days to return to birth weight. The average growth velocity from the age that full EN was attained to 36 weeks’ PMA (15 g/kg/day) was significantly less than the theoretical estimated fetal growth velocity (16 g/kg/day) (p<0.03). A difference of 1 g/kg/day represents a total deficit of 42 - 54 grams over the course of a month. At 36 weeks’ PMA, 53% of the VLBW infants had extrauterine growth restriction, or EUGR (<10th percentile) on the Fenton growth grid and 34% had EUGR on the Lubchenco growth grid. Conclusions: The delivered nutrient intakes were consistently less than 15% of the prescribed intakes. Growth velocity between the age when full EN was achieved and 36 weeks’ PMA was 6.7% lower than Ziegler’s estimate. One-third to one-half of the infants have EUGR at 36 weeks’ PMA.