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A Prentice

Publications and source records attributed to A Prentice.

At least 37 records · Page 2Linked to original sources
PubMed1990

Breast-milk amylase activity in English and Gambian mothers: effects of prolonged lactation, maternal parity, and individual variations.

Breast milk contains an amylase that may contribute to carbohydrate digestion in infants. The aim of our study was to determine whether mothers differ in their breast-milk amylase activity and whether the activity is maintained during prolonged lactation. This was investigated by measuring breast-milk amylase activity by hydrolysis of maltotetraose in 63 English mothers of parity 1-5 and 107 Gambian mothers of parity 1-12 who were at various stages of lactation (0.5-27 mo). Amylase was present in all samples and showed a great range of activity from 0.08 to 3.53 IU/mL. Amylase activities did not vary during a feed nor over 24 h, and each mother had a characteristic level of activity in her milk. Amylase activity was higher in the 1st trimester of lactation, and decreased by 35% (p less than 0.001) to a plateau at 6-27 mo. Gambian mothers of very high parity (parity 11-12) had 54% of the activity of primiparous mothers (p less than 0.001), after adjustment for stage of lactation. Using community data on milk volume, the estimated breast-milk amylase intake by breast-fed children was on the order of 800-1000 IU/24 h in the 1st trimester and 400 IU/24 h in the 2nd year of lactation. Individual measurements emphasized the great differences in this intake among children of the same age. Our study showed that breast milk is an important source of amylase both in developed and developing countries, but there are large variations in intake among children.

Adult↗
PubMed1990

Successful pregnancy following bone marrow transplantation for leukaemia.

We report three pregnancies with successful outcomes in two women following allogeneic bone marrow transplantation (BMT) for acute leukaemia using high dose melphalan alone as conditioning therapy. The increasing application and success of BMT together with the instigation of conditioning regimens that do not include total body irradiation should increase such cases. These and previous cases document that a normal outcome of pregnancy is likely in these patients.

Adult↗
PubMed1989

Outcome of pregnancies referred to a general practitioner maternity unit in a district hospital.

OBJECTIVE: To audit the outcome of pregnancies booked for confinement in a general practitioner maternity unit in a district general hospital. DESIGN: Retrospective review of case records. SETTING: General practitioner maternity unit in a district general hospital. PATIENTS: 685 Women referred to a general practitioner unit in 1987. RESULTS: 315 Nulliparous women and 330 multiparous women were booked for confinement; 202 women transferred to consultant care before delivery and a further 104 during labour or after delivery. Recognised risk factors, other than nulliparity, rarely predicted the need for transfer. Confinement in the general practitioner unit was associated with low intervention and good fetal outcomes. CONCLUSIONS: The general practitioner maternity unit provides a safe alternative for confinement in low risk pregnancies. High rates of transfer deny this facility to many women who desire confinement in a low technology environment.

Apgar Score↗
PubMed1989

Breast-milk fatty acids of rural Gambian mothers: effects of diet and maternal parity.

The influence of diet and maternal parity on the fatty acid composition of mature breast milk have been studied in 23 rural Gambian mothers. The subjects' habitual diet was low in fat (16% total energy), groundnuts (peanuts) constituting the principal fat source. The high abundance of oleic and linoleic acids in groundnut fat were reflected in the proportions of these fatty acids in breast milk (47.0 +/- 1.5 and 13.0 +/- 0.3 g/100 g fat, respectively), which were elevated compared with mothers in other African communities. Estimates of daily breast-milk fatty acid secretion indicated that there was little risk of essential fatty acid deficiency in Gambian infants. The proportions of fatty acids synthesized de novo (10:0, 12:0, 14:0) were less than expected from published studies of mothers consuming low-fat diets, averaging 16.8 +/- 1.4 g/100 g fat. As the study was conducted at a time of food shortage and high energy expenditure, it is argued that mobilisation of body fat during negative energy balance increased the availability of long-chain fatty acids to the breast. The proportion of endogenous fatty acids was markedly reduced in the milk of mothers of very high parity (parity 1 = 19.3 +/- 1.6 g/100 g fat; parities 10 + = 11.4 +/- 1.5 g/100 g fat; p less than 0.01). It is hypothesised that this represents an impairment of the ability to synthesise breast-milk fatty acids de novo in these mothers.

Diet↗
PubMed1989

A protocol for the routine measurement of lactate and pyruvate in cord blood.

The influence of the site of sampling and the delay in sample collection on cord blood concentrations of lactate and pyruvate were investigated. A delay in sample collection of greater than 1 min after cord clamping could invalidate the results obtained. Samples from umbilical artery had higher lactate values (mean 3.13 mmol/l) than paired vein samples (mean 2.32 mmol/l) but there were no significant differences in lactate values between different sites sampled within the umbilical vein. A calculation was devised to circumvent the need to take cord blood samples immediately after delivery.

Blood Specimen Collection↗
PubMed1989

Breast-milk IgA and lactoferrin survival in the gastrointestinal tract--a study in rural Gambian children.

The survival of breast-milk secretory-IgA and lactoferrin has been investigated in 23 Gambian children aged 1.5, 3 and 17 months. Endogenous excretion of these immune proteins was measured in 7 weaned 34-month-old children. Defaecation rate was the prime determinant of faecal secretory-IgA and lactoferrin outputs, indicating that partial degradation occurs in the large intestine. Calculations showed that at least 30% of IgA and 2% of lactoferrin ingested from breast-milk must survive in the small intestine. Variations in faecal immune protein outputs were related to differences in intake and defaecation rate and were not affected by age or solid food consumption. The raised faecal outputs of 5 children with diarrhoea were a consequence of their high stool frequencies. IgA disappearance in the large intestine proceeded twice as fast in Gambian breast-fed children as in comparable Cambridge infants, suggesting that differences in gut flora may influence IgA survival. Thus breast-feeding, irrespective of age or additional food, can deliver significant quantities of these antimicrobial proteins to the small intestine but differences in defaecation rate and gut flora may affect their protective potential in the large intestine.

Breast Feeding↗
PubMed1988

Increased energy expenditure in young children with cystic fibrosis.

To investigate the role of energy expenditure in the altered energy balance in cystic fibrosis (CF), total energy expenditure (TEE) was measured by the doubly-labelled water method in 9 clinically well CF infants (body weight 7.3-10.9 kg) without chronic lung disease. CF infants had 25% higher rates of energy expenditure when compared with data derived from measurements of TEE obtained by the same method in 16 healthy infants, matched for age and body weight. Mean TEE (SEM) for CF was 950 (38) kcal, vs 876 (72) kcal for controls matched for age and 758 (46) kcal for controls matched for weight. Although subclinical disease activity cannot be excluded as a determinant of the excess TEE, the possibility of an energy-requiring basic defect is suggested, because further analysis indicated that factors other than body weight, degree of underweight, presence of pancreatic insufficiency, or presence of lung disease were important. Increased TEE may contribute to undernutrition in CF, even in the absence of chronic lung disease.

Body Water↗
PubMed1988

Milk transfer of phenoxymethylpenicillin during puerperal mastitis.

1 The milk excretion of phenoxymethylpenicillin (PMP) was studied from both breasts in patients with mastitis (n = 12) and healthy volunteers (controls, n = 4) to investigate the hypothesis that milk transfer of PMP is higher in mastitic than in non-mastitic breasts. 2 Patients were included according to clinical symptoms of mastitis. Milk (and serum from controls) were sampled 0, 1, 2, 3, 4, 6 and 8 h after a single oral dose of 1320 mg PMP. Penicillin concentrations in milk and serum were measured by an agar diffusion technique. 3 Maximum milk concentrations (Cmax) of PMP in patients were higher (P less than 0.05) in mastitic than in non-mastitic breasts. The latter concentrations were higher (P less than 0.05) than those in breast milk from healthy controls. In milk from the mastitis patients (both breasts) the Cmax was reached after 2 h with a subsequent rapid decline in concentration. In milk from the healthy controls the PMP concentration reached a plateau after 4 h. The area under the milk concentration vs time curve (AUC0-8h) was not different for mastitic vs non-mastitic breast milk in patients nor for mastitic vs control breast milk. This can be explained by higher rates of appearance and disappearance of PMP in the breast milk of mastitis patients compared with healthy controls. In mastitic breast milk there was a moderate (P less than 0.01) increase in sodium and albumin compared with non-mastitic milk. However, milk potassium, glucose and lactose values were within normal limits.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Fetal heart rate monitoring during labour--too frequent intervention, too little benefit?

For many obstetricians and midwives continuous electronic fetal heart rate monitoring during labour has replaced the traditional method of intermittent auscultation. Of the eight prospective randomised controlled trials designed to assess its value in obstetric care, four were concerned with mothers defined as being at high-risk, three with normal or low-risk patients, and the eighth with the total population of a maternity hospital over several months. None suggested any major advantage of continuous fetal heart rate monitoring over intermittent surveillance in terms of neonatal mortality, morbidity, cord blood pH values, or the five minute Apgar score. The rates of caesarean section and forceps delivery were higher in the continuously monitored group. For low-risk mothers there is a good case for a return to the traditional method of intermittent auscultation with its lower false-positive rate, lesser incidence of intervention, and opportunity for greater contact between the maternity care staff and the mother.

Cesarean Section↗
PubMed1987

The nutritional role of breast-milk IgA and lactoferrin.

The nutritional enigma concerning the extent to which breast-milk immune proteins are digested has been investigated by measuring the intakes and faecal outputs of IgA and lactoferrin over 7 days in 10 exclusively breast-fed (BF) and 9 formula-fed (FF) fullterm infants at 6 and 12 weeks post-partum. BF outputs (mg/day) greatly exceeded FF values (p less than 0.001): at 6 weeks secretory-IgA BF = 160 +/- 28, FF = 14 +/- 2, lactoferrin BF = 14 +/- 2, FF = 0.9 +/- 0.1; at 12 weeks secretory-IgA BF = 94 +/- 17, FF = 25 +/- 5, lactoferrin BF = 7 +/- 1, FF = 1 +/- 0.3. Secretory-IgA represented 42% and 27% of BF faecal protein at 6 and 12 weeks compared with 6% for FF infants at both ages. BF secretory-IgA outputs were highly correlated with intakes (r = 0.83, p less than 0.001). IgA and lactoferrin outputs and the presence of faecal secretory-IgA fragments in BF and FF infants were influenced by defaecation rate, suggesting that partial degradation occurred in the large intestine. By 6 weeks post-partum only 1% lactoferrin and 17% secretory-IgA intakes appeared in the faeces and 95% breast-milk protein could be regarded as nutritionally available. The elevated BF outputs of IgA and lactoferrin relative to endogenous excretion suggest, however, that breast-milk may still make a considerable contribution to intestinal defence mechanisms after the neonatal period despite the small proportion of daily intake which escapes digestion. The protective action of IgA and lactoferrin may also depend on their site of degradation and the nature of fragments.

Feces↗
PubMed1987

Breast feeding increases concentrations of IgA in infants' urine.

To investigate the influence of breast feeding on mucosal immunity the concentrations and daily outputs of IgA and lactoferrin in urine were measured in 10 breast fed and 12 infants fed on formula milk at 6 and 12 weeks of age. The concentrations and outputs of secretory IgA in urine were significantly higher in the breast fed group by a factor of three. The secretion of IgA in urine by the breast fed infants was characteristic of the baby and was not related to the intake of IgA from breast milk. Lactoferrin concentrations were similar in the two groups at both ages. In addition to secretory IgA, two thirds of all samples contained proteins with alpha chain but no secretory component antigenic determinants. Breast feeding seems to increase the local production of secretory IgA into the urinary tract during early childhood, thus providing enhanced protection from infection.

Breast Feeding↗
PubMed1987

Impaired growth in infants born to mothers of very high parity.

Anthropometric data are presented on 412 rural Gambian infants measured longitudinally from birth to 18 months of age. Maternal parity was shown to exert a marked influence on growth. Firstborn babies had significantly depressed birthweights (parity 1: 2.79 +/- 0.06 kg, n = 62; parities 2-9: 3.05 +/- 0.09 kg, n = 309; P less than 0.001) but catch-up growth was complete by 3 months. In contrast, children born to mothers of very high parity (10 and above) had average birthweights (2.90 +/- 0.07 kg, n = 41) but early growth was poor. At 3 months their weights, mid-upper arm circumferences and triceps skinfolds were significantly below those of other infants (eg, weight-for-age (% NCHS): parities 10+: 90.3 +/- 2.3 per cent; parities 2-9: 97.4 +/- 2.7 per cent; P less than 0.01). Supine length and head circumference were not affected. After 3-6 months all children experienced severe growth retardation reflected in poor weight, length and head circumference gains. No catch-up growth occurred in the high parity group. Consequently, anthropometric differentials set up by 3 months were maintained throughout infancy (eg, weight-for-age at 12 months: parities 10+: 76.4 +/- 1.9 per cent; parities 2-9: 81.5 +/- 2.6 per cent; P less than 0.01). The relationship between these infant growth patterns and maternal lactational performance is discussed.

Anthropometry↗
PubMed1985

Mastitis in rural Gambian mothers and the protection of the breast by milk antimicrobial factors.

Mastitis was found to be a sizeable clinical problem in a group of lactating Gambian mothers. The mean monthly incidence was 2.6% and repeated episodes of mastitis were common. The role of milk antimicrobial factors in the local defence of the breast against mastitis was investigated by analysis of IgA, IgG, IgM, C3, C4, lactoferrin and lysozyme in the breast milk of 10 mastitis patients. Acute inflammation of the breast was accompanied by the rapid appearance of high concentrations of serum-derived immunoproteins in mastitic milk. Changes in the milk levels of lactose, sodium and transferrin indicated that this was due to a temporary opening of the paracellular pathway. Concentrations of secretory immunoproteins (IgA, lactoferrin and lysozyme) exhibited a delayed response, being elevated one week after the attack of mastitis. The normal milk of mastitis sufferers was significantly deficient in IgA, C3 and lactoferrin when compared with other lactating women suggesting that the former were predisposed to mastitis.

Complement C3↗
PubMed1984

Unilateral breast dysfunction in lactating Gambian women.

Approximately 3% of lactating women in a rural Gambian village displayed long-term unilateral breast dysfunction as evidenced by abnormal milk composition and virtual cessation of suckling by the infant. This paper presents case histories of four such women studied over two successive lactations. The average breast-milk output of these women did not differ significantly from the mean value for the remainder of the community, indicating that the non-affected breast was usually able to compensate for the dysfunction. This was confirmed by the fact that the child-rearing record of three of the four women was better than the community average. In two of the women the breast which was dysfunctioning in one lactation reverted completely to normal for the next lactation. It is suggested that in such cases the dysfunction is self-perpetuating and may be alleviated by counselling mothers to persevere with feeding from the affected breast.

Adult↗
PubMed1984

Breast-milk antimicrobial factors of rural Gambian mothers. I. Influence of stage of lactation and maternal plane of nutrition.

The concentrations of IgA, IgG, IgM, C3, C4, lactoferrin, lysozyme and secretory component in the mature breast milk of 152 rural Gambian mothers were measured up to 26 months lactation. The concentrations and daily secretion of all the immunoproteins, except lysozyme, decreased during the first year of lactation, but were well maintained thereafter. The production of lysozyme increased progressively throughout lactation. Compared with 10 mothers in Cambridge, U.K., the daily secretion of IgG, IgM, C3 and C4 was higher in The Gambia, that of IgA and lactoferrin was similar in the two communities, and that of lysozyme and secretory component was lower in The Gambia. A dietary supplement given to 90 Gambian mothers, raised the mean daily energy intake from a maximum of 1650 kcal/day and a hungry-season minimum of 1 200 kcal/day to 2 300 kcal/day throughout the study. The supplement did not enhance the production of breast milk immunoproteins.

Complement C3↗