Evaluation of a peptide formula (milk) in the management of infants with multiple GIT intolerance

Metabolism and nutrition in the surgical neonate

Considerable improvements have been achieved in pediatric surgery during the last two decades: the mortality rate of neonates undergoing major operations has declined to less than 10%, and the morbidity of major operations has become negligible. This considerable improvement can be partly ascribed to a better understanding of the physiological changes that occur after an operation and to more appropriate management and nutrition of the critically ill and "stressed" neonates and children. The metabolic response to an operation is different in neonates from adults: there is a small increase in oxygen consumption and resting energy expenditure immediately after surgery with return to normal by 12-24 hours. The increase in resting energy expenditure is significantly greater in infants having a major operation than in those having a minor procedure. The limited increase in energy expenditure may be due to diversion of energy from growth to tissue repair. During parenteral nutrition, it is not advisable to administer more than 18 g/kg/day of carbohydrate because this intake will be associated with lipogenesis, increased CO(2) production, and increased free radical-mediated lipid peroxide formation. Glutamine intake is potentially beneficial during total parenteral nutrition, although a large, randomized, controlled trial in surgical neonates requiring parenteral nutrition is needed to provide evidence for its benefit.

[Nutritional physiology of whey and whey components]

Deriving from positive effects of whey drinking cures in antiquity, the Middle Ages and modern time, a review is given on nutritional significance of whey. The proteins are essential components of whey and belong to the proteins with highest biological value because of their amino acid composition. Besides, they show fundamental functional properties, which enable a varied application in foods, dietetic foods and beverages in form of different whey products (powder, protein concentrates and isolates). Whey proteins have found considerable usage in infant's nutrition as whey predominant formulas as well as whey protein hydrolysates in case of cow's milk protein intolerances. A recent field of research are biological active peptide sequences which become effective during digestion and are of importance for secretion of entero hormones as well as for immune enhancing effects. They may contribute to assess the biological value of whey proteins under enlarged points of view and to develop new application forms and areas. It is pointed to further fields of application (e.g. adipositas, gout, kidney insufficiency). Concerning the quantitatively most dominant lactose in whey, it is dealt with its importance for the healthy development of infants (adaptation to the increased lactose content of mother's milk) as well as with lactose intolerance and galactosaemia. In case of mineral salts of whey it is emphasized the high nutrient density of calcium (prophylaxis for osteoporosis), the beneficial Ca:P and Na:K proportions (antihypertensive in case of the last one), the promotion of absorption of mineral salts by lactose, and the high content of iodine. The whey is rich in B-vitamins, which contribute essentially for their satisfaction or requirement in case of a corresponding consumption. To be emphasized is the vitamin B12 in milk and whey, which is the sole source of this indispensable nutrient for blood-formation and cell division in lacto-ovo-vegetarian nutrition. In conclusion, a summarizing dietetics valuation of whey is performed.

Strategies for prevention

Allergy prevention is antigen specific. Elimination of native CMP from the diet in at-risk infants decreases the incidence of CMPA, but evidence for a decreased incidence of other atopic diseases is lacking. Clinical trials comparing the efficacy of different types of hydrolysates are needed.

Comparison of an elemental with a hydrolysed whey formula in intolerance to cows' milk

In a double blind study, 40 infants with cows' milk intolerance of various causes were randomised to receive a nutritionally complete formula in which nitrogen was supplied either as whey hydrolysate or amino acids. The median age of infants was 10 weeks (range 36 weeks' gestation to 108 weeks' postnatal age). After a median follow up period of 25 weeks there was no significant difference in dietary intake between the formulas. Twenty four weeks after entry, weight and weight for length improved equally on both formulas. Plasma albumin improved significantly on the hydrolysed whey formula but not in the amino acid group. Both milks were palatable and normal intakes of formula were maintained. Biochemical and haematological indices remained within normal limits. There was no difference in stool frequency and vomiting between the two formulas. Two infants developed a probable allergic colitis while receiving hydrolysed whey. Amino acid formula may have a role in the management of atopic infants with severe cows' milk intolerance who have already reacted to whey or casein hydrolysate formula.