Reduced crying in term infants fed high beta-palmitate formula: a double-blind randomized clinical trial

BACKGROUND: Beta-palmitate (sn-2 palmitate) mimics human milk fat, enabling easier digestion. Therefore, we hypothesized that infants consuming high beta-palmitate formula would have more frequent, softer stools and reduced crying compared to infants consuming low beta-palmitate formula. METHODS: Formula-fed infants were randomly assigned to receive either (1) formula with high beta-palmitate (HBP, n = 21) or (2) regular formula with a standard vegetable oil mix (LBP, n = 21). A matched group of breastfed infants served as a reference (BF, n = 21). Crying and stool characteristics data were recorded by the parents for 3 days before the 6- and 12-week visits. RESULTS: We found no significant differences in the stool frequency or consistency between the two formula groups. The percentage of crying infants in the LBP group was significantly higher than that in the HBP and BF groups during the evening at 6 weeks (88.2% vs. 56.3% and 55.6%, p < 0.05) and during the afternoon at 12 weeks (91.7% vs. 50.0% and 40%, p < 0.05). The infants fed HBP had significantly shorter crying durations when compared with infants fed LBP formula (14.90 ± 3.85 vs.63.96 ± 21.76 min/day, respectively; p = 0.047). CONCLUSIONS: Our study indicates that consumption of a high beta-palmitate formula affects infant crying patterns during the first weeks of life. Comparable to breastfeeding, it reduced crying duration and frequency, primarily during the afternoon and evening hours, thereby improving the well-being of formula-fed infants and their parents. TRIAL REGISTRATION: NCT00874068. Registration date March 31, 200

Scientific Opinion on the substantiation of a health claim related to beta-palmitate and contribution to softening of stools pursuant to Article 14 of Regulation (EC) No 1924/2006

Following an application from Specialised Nutrition Europe (formerly IDACE), submitted for authorisation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of France, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to beta-palmitate and contribution to softening of stools. The food constituent, beta-palmitate, that is the subject of the health claim, is sufficiently characterised. Contribution to softening of stools is a beneficial physiological effect for infants. In weighing the evidence the Panel took into account that, out of two human intervention studies with important methodological limitations, one suggested a stool-softening effect of beta-palmitate whereas the second did not, that one animal study did not support a stool-softening effect of beta-palmitate, and that the evidence provided for a mechanism by which beta-palmitate could contribute to the softening of stools is weak. The Panel concludes that a cause and effect relationship has not been established between the consumption of beta-palmitate and softening of stools

High frequencies of elevated alkaline phosphatase activity and rickets exist in extremely low birth weight infants despite current nutritional support

<p>Abstract</p> <p>Background</p> <p>Osteopenia and rickets are common among extremely low birth weight infants (ELBW, <1000 g birth weight) despite current practices of vitamin and mineral supplementation. Few data are available evaluating the usual course of markers of mineral status in this population. Our objectives in this study were to determine the relationship between birth weight (BW) and peak serum alkaline phosphatase activity (P-APA) in ELBW infants and evaluate our experience with the diagnosis of rickets in these infants.</p> <p>Methods</p> <p>We evaluated all ELBW infants admitted to Texas Children's Hospital NICU in 2006 and 2007. Of 211 admissions, we excluded 98 patients who were admitted at >30 days of age or did not survive/stay for >6 weeks. Bone radiographs obtained in 32 infants were reviewed by a radiologist masked to laboratory values.</p> <p>Results</p> <p>In this cohort of 113 infants, P-APA was found to have a significant inverse relationship with BW, gestational age and serum phosphorus. In paired comparisons, P-APA of infants <600 g (957 ± 346 IU/L, n = 20) and infants 600–800 g (808 ± 323 IU/L, n = 43) were both significantly higher than P-APA of infants 800–1000 g (615 ± 252 IU/L, n = 50), p < 0.01. Thirty-two patients had radiographic evaluation for evidence of rickets, based on P-APA greater than 800 IU/L, parenteral nutrition greater than 3 to 4 weeks, or clinical suspicion. Of these, 18 showed radiologic rickets and 14 showed osteopenia without rickets. Infants with BW <600 g were more likely to have radiologic rickets (10/20 infants) compared to those with BW 600–800 g (6/43 infants) and BW 800–1000 g (2/50 infants), p < 0.01 for each. P-APA was not significantly higher in infants with radiologic rickets (1078 ± 356 IU/L) compared to those without radiologic evidence of rickets (943 ± 346, p = 0.18).</p> <p>Conclusion</p> <p>Elevation of P-APA >600 IU/L was very common in ELBW infants. BW was significantly inversely related to both P-APA and radiologic rickets. No single value of P-APA was related to radiological findings of rickets. Given the very high risk of osteopenia and rickets among ELBW infants, we recommend consideration of early screening and early mineral supplementation, especially among infants <600 g BW.</p

Injury during pregnancy and nervous system birth defects: Texas, 1999 to 2003

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/100279/1/bdra23143.pd

Early inhaled budesonide for the prevention of bronchopulmonary dysplasia

BACKGROUND Systemic glucocorticoids reduce the incidence of bronchopulmonary dysplasia among extremely preterm infants, but they may compromise brain development. The effects of inhaled glucocorticoids on outcomes in these infants are unclear. METHODS We randomly assigned 863 infants (gestational age, 23 weeks 0 days to 27 weeks 6 days) to early (within 24 hours after birth) inhaled budesonide or placebo until they no longer required oxygen and positive-pressure support or until they reached a postmenstrual age of 32 weeks 0 days. The primary outcome was death or bronchopulmonary dysplasia, confirmed by means of standardized oxygen-saturation monitoring, at a postmenstrual age of 36 weeks. RESULTS A total of 175 of 437 infants assigned to budesonide for whom adequate data were available (40.0%), as compared with 194 of 419 infants assigned to placebo for whom adequate data were available (46.3%), died or had bronchopulmonary dysplasia (relative risk, stratified according to gestational age, 0.86; 95% confidence interval [CI], 0.75 to 1.00; P = 0.05). The incidence of bronchopulmonary dysplasia was 27.8% in the budesonide group versus 38.0% in the placebo group (relative risk, stratified according to gestational age, 0.74; 95% CI, 0.60 to 0.91; P = 0.004); death occurred in 16.9% and 13.6% of the patients, respectively (relative risk, stratified according to gestational age, 1.24; 95% CI, 0.91 to 1.69; P = 0.17). The proportion of infants who required surgical closure of a patent ductus arteriosus was lower in the budesonide group than in the placebo group (relative risk, stratified according to gestational age, 0.55; 95% CI, 0.36 to 0.83; P = 0.004), as was the proportion of infants who required reintubation (relative risk, stratified according to gestational age, 0.58; 95% CI, 0.35 to 0.96; P = 0.03). Rates of other neonatal illnesses and adverse events were similar in the two groups. CONCLUSIONS Among extremely preterm infants, the incidence of bronchopulmonary dysplasia was lower among those who received early inhaled budesonide than among those who received placebo, but the advantage may have been gained at the expense of increased mortality

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

Objective To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. Study design In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 24(0/7) to 31(6/7) weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed. Results For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany. Conclusions In most countries, mortality decreased whereas BPD increased for neonates born very preterm

Moving towards an evidence-base of democratic police training: the development and evaluation of a complex social intervention in the Israeli border police

The centrality of the police in everyday life means police officers are in position of power to actively support or threaten democratic activities (Sklansky, 2008) for example during protests. In democracies, policing duties should be performed in ways that sustain democratic values, rather than undermine them (Loader, 2006), yet that is not always the reality. Police training is one of the tools for aligning officers' behaviour with societal norms; it is considered a protection against the possibility that police officers abuse the wide-ranging powers they hold (Manning, 2010). Training programs are therefore a basic feature of all police forces' organizational approach. Despite its centrality, training has not received extensive academic attention; there is a pressing need to understand the impact of training on police behaviour and the mechanisms thorough which it operates (Skogan &amp; Frydl, 2004). This thesis attempts to advance the evidence-base of democratic police training following the Medical Research Council's framework for the development and evaluation of complex social interventions (Craig et al., 2008). The Israeli Border Police was chosen as the context to examine the potential of training to advance democratic norms. The three stages of the research project included: theoretical modelling of the existing complex training intervention to assess its alignment with existing evidence; participatory development and piloting of a training curriculum on policing of protests in a democracy that used an Adult Education approach and introduced Procedural Justice-related components; and a pilot quasi-randomised study to evaluate this training. Analysis and reporting are carried out in a way that allows assessment of prospective scale-up and generalisability. Flowing from the empirical work, four strands of theoretical contributions are put forward. First, a theoretical model of police training is proposed, drawing on social psychology constructs. Second, contact theory, which originates in peace education, is proposed as a possible platform for designing both police training and their evaluation studies. Third, four factors limiting the efficacy of Procedural Justice &amp; Legitimacy based training interventions in deeply divided societies are outlined. Fourth, the Border Police case study is used to substantiate the value of participatory research methods for advancing knowledge translation and evidence-based policing.</p

Moving towards an evidence-base of democratic police training: the development and evaluation of a complex social intervention in the Israeli border police

The centrality of the police in everyday life means police officers are in position of power to actively support or threaten democratic activities (Sklansky, 2008) for example during protests. In democracies, policing duties should be performed in ways that sustain democratic values, rather than undermine them (Loader, 2006), yet that is not always the reality. Police training is one of the tools for aligning officers' behaviour with societal norms; it is considered a protection against the possibility that police officers abuse the wide-ranging powers they hold (Manning, 2010). Training programs are therefore a basic feature of all police forces' organizational approach. Despite its centrality, training has not received extensive academic attention; there is a pressing need to understand the impact of training on police behaviour and the mechanisms thorough which it operates (Skogan &amp; Frydl, 2004). This thesis attempts to advance the evidence-base of democratic police training following the Medical Research Council's framework for the development and evaluation of complex social interventions (Craig et al., 2008). The Israeli Border Police was chosen as the context to examine the potential of training to advance democratic norms. The three stages of the research project included: theoretical modelling of the existing complex training intervention to assess its alignment with existing evidence; participatory development and piloting of a training curriculum on policing of protests in a democracy that used an Adult Education approach and introduced Procedural Justice-related components; and a pilot quasi-randomised study to evaluate this training. Analysis and reporting are carried out in a way that allows assessment of prospective scale-up and generalisability. Flowing from the empirical work, four strands of theoretical contributions are put forward. First, a theoretical model of police training is proposed, drawing on social psychology constructs. Second, contact theory, which originates in peace education, is proposed as a possible platform for designing both police training and their evaluation studies. Third, four factors limiting the efficacy of Procedural Justice &amp; Legitimacy based training interventions in deeply divided societies are outlined. Fourth, the Border Police case study is used to substantiate the value of participatory research methods for advancing knowledge translation and evidence-based policing.</p