Feeding the feeble: steps towards nourishing preterm infants

This paper describes historic steps in feeding techniques and knowledge on the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920, including tube feeding by gavage, medicine droppers and pipettes, feeding bottles with an air inlet, and beaked spoons for nasal feeding. Indwelling nastrogastric tubes were in use from 1951. For alleged safety concerns in the 1950s, postnatal feeding was postponed until a week of starvation was reached, and studies showed an association with neurological handicaps. The premature infant's elevated need for energy, protein, and minerals has been established since 1919. However, these remained controversial, and nutritional practices continued to lag behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants who were fed formula than in those who were fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Nevertheless, compared with other aspects of neonatal medicine, there is still remarkably little evidence on how to feed preterm infants.

Milk demystified by chemistry

This article traces the decline of milk from a heavenly elixir to a tradeable food. Early cultures regarded milk not as a simple nutrient, but a living fluid. Heroes and gods were believed to have been nurtured by animals after being abandoned. Character traits were assumed to be transmitted by milk; infantile diseases were attributed to "bad milk", whereas "good milk" was used as a remedy. With chemical methods developed at the end of the 18th century, it became known that human milk was higher in sugar and lower in protein than cow's milk. During the 19th century, "scientific" feeding emerged that meant modifying cow's milk to imitate the proportion of nutrients in human milk. In Boston from 1893, Rotch initiated the "percentage" method, requiring a physician's prescription. In Paris from 1894, Budin sterilized bottled infant milk. In Berlin in 1898, Rubner measured oxygen and energy uptake by calorimetry, prompting feeding by calories, and Czerny introduced regulated feeding by the clock. These activities ignored the emotional dimension of infant nutrition and the anti-infective properties of human milk. They may have also enhanced the decline in breastfeeding, which reached an all-time low in 1971. Milk's demystification made artificial nutrition safer, but paved the way for commercially produced infant formula.

Trophic level and macronutrient shift effects associated with the weaning process in the Postclassic Maya

The weaning process was investigated at two Maya sites dominated by Postclassic remains: Marco Gonzalez (100 BC-AD 1350) and San Pedro (1400-AD 1650), Belize. Bone collagen and bioapatite were analyzed from 67 individuals (n < or = 6 years = 15, n > 6 years = 52). Five isotopic measures were used to reconstruct diet and weaning: stable nitrogen- and carbon-isotope ratios in collagen, stable carbon- and oxygen-isotope ratios in bioapatite, and the difference in stable carbon-isotope values of coexisting collagen and bioapatite. Nitrogen-isotope ratios in infant collagen from both sites are distinct from adult females, indicating a trophic level effect. Collagen-to-bioapatite differences in infant bone from both sites are distinct from adult females, indicating a shift in macronutrients. Oxygen-isotope ratios in infant bioapatite from both sites are also distinct from adult females, indicating the consumption of breast milk. Among infants, carbon- and nitrogen-isotope ratios vary, indicating death during different stages in the weaning process. The ethnohistoric and paleopathological literature on the Maya indicate cessation of breast-feeding between ages 3-4 years. Isotopic data from Marco Gonzalez and San Pedro also indicate an average weaning age of 3-4 years. Based on various isotopic indicators, weaning likely began around age 12 months. This data set is not only important for understanding the weaning process during the Postclassic, but also demonstrates the use of collagen-to-bioapatite spacing as an indicator of macronutrient shifts associated with weaning.

Sir George Newman, MD (1870-1948) and the prevention of perinatal disease

At the start of the 20th century, 15% of all infants in England and Wales died in the first year of life. Newman's classic work Infant mortality, published in 1906, identified the causes of these deaths, the significance of the period immediately after birth, the social problems underlying mortality, and possible methods of prevention. Later, as chief medical officer to the Board of Education (1907-1935) and to the Ministry of Health (1919-1935), he achieved many important and wide ranging improvements to the health of infants and children.

The role of changing childhood diets in the prehistoric evolution of food production: An isotopic assessment

Earlier weaning has often been suggested as a cause for population growth after the evolution of food production. However, evidence for weaning-time reduction is largely circumstantial. Collagen stable nitrogen- and carbon-isotope ratios from juvenile and adult burials from four sites in eastern North America were measured to estimate weaning onsets and durations before and after the appearance of intensive food production. Two preagricultural Late Archaic sites (Indian Knoll and Carlston Annis) are compared with two highly agricultural Middle Mississippian sites (Angel and Tinsley Hill). Isotopic data and paleodemographic measures of birth rates provide no evidence for changes in weaning behavior or fertility with the development of food production in the prehistoric Lower Ohio Valley. Birth rates and weaning behavior appear to have been roughly the same at all four sites. These results indicate that models attributing population growth after the appearance of food production to earlier weaning are not universally applicable.

A history of infant feeding. IV. Nineteenth century continued

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A history of infant feeding. III. Eighteenth and nineteenth century writers

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A history of infant feeding. II. Seventeenth and eighteenth centuries

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A history of infant feeding. I. Primitive peoples; ancient works; Renaissance writers

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