Breastfeeding in modern and ancient times: facts, ideas, and beliefs.
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Breast Feeding↗
Biomedical subjects
O Tönz
Publications and source records attributed to O Tönz.
Provision of supplementary fluids to breast fed infants and later breast feeding success.
It has been shown that altering hospital policies in a way to avoid interference of routine prescriptions with initiation of breast feeding and to provide active encouragement to mothers and personnel can result in significant benefit for later breast feeding success. It is less clear, however, which of the elements of a promotional programme such as UNICEF/WHO's "ten steps to successful breast feeding" are absolutely essential and which can be adapted to local cultural habits. We performed an open randomized multicenter study in Switzerland to evaluate, whether restriction of supplementary fluids for breast fed infants in the first week of life and strict avoidance of artificial teats and pacifiers affects later breast feeding success. Follow up to 6 months was ensured by mailed questionnaires. 602 mother infant pairs were enrolled. Of 294 infants in the intervention group 39% were excluded from the final analysis because of protocol violations, mainly maternal request for the use of pacifiers or bottles. Though the number of dextrin maltose supplements during the first two days (1.7 vs. 2.2 on day 1, 2.2 vs. 2.6 on day 2) and the percentage of infants receiving any supplement (85% vs. 96.6%) was significantly smaller in the intervention group, the difference was disappointingly small. The prevalence of breast feeding was 100% vs. 99% at day 5, 88% vs. 88% at 2 months, 75% vs. 71% at 4 months and 57% vs. 55% at 6 months, none of the differences being significant. We conclude that rigorous adherence to all of the ten steps may encounter obstinate resistance from cultural habits even in a population highly favourable to breast feeding. An improvement in adherence does not necessarily lead to better breast feeding success. The results of the few comparable studies in the literature show also that cultural practices during the first months of life may influence profoundly the long term effects of interventions during the first days of life.
Breast Feeding↗
Effect of growth hormone and oxandrolone treatment on glucose metabolism in Turner syndrome. A longitudinal study.
In 18 girls with Turner syndrome, glucose tolerance was studied before treatment and after 6 and 24 months of growth-promoting treatment with recombinant human growth hormone (24 IU/m(2)/week; 8 mg/m(2)/week) and oxandrolone (0.06 mg/kg/day), as well as after termination of the treatment. One girl developed an overt non-ketotic diabetes mellitus 50 months after termination of treatment. The results of the remaining 17 girls in whom the effect of treatment on glucose metabolism was reversible are presented as a group. Their median age at the beginning of the treatment was 10.4 years (range 6.9-15.9), and 15.0 years (range 12.1-19.9) at the final assessment. There was a moderate, but not significant rise in fasting glucose throughout the course of the longitudinal study. At oral glucose tolerance testing (oGTT), the area under the curve for glucose rose significantly (p = 0.013) during the period of treatment and returned to the basic value thereafter. Fasting insulin and especially the integrated insulin values (AUCi; area under the curve for insulin) during oGTT increased continuously during treatment, declined after termination of treatment but were still significantly (p = 0.04) higher than before treatment. Considering the fact that in untreated girls with Turner syndrome the fasting insulin and the AUCi increase with age, one can conclude that the insulinaemia returned to age-specific norm after termination of treatment. Thus the effect of a combined growth hormone and oxandrolone growth-promoting treatment on glucose metabolism was fully reversible in these 17 girls with Turner syndrome.
Adolescent↗
UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding? Neonatal Study Group.
UNLABELLED: To promote breastfeeding, UNICEF/WHO have launched the "baby-friendly hospital initiative" focusing on hospital care routines during delivery and the first days of life. In industrialised countries, two aspects of the initiative have raised controversy: how do restriction of supplemental feedings and ban of bottles and pacifiers affect long-term breastfeeding performance? From ten centres 602 healthy newborns were randomly assigned either to a UNICEF group with restrictive fluid supplements and avoidance of bottles and pacifiers during the first 5 days of life, or to a standard group with conventional feeding practice. Breastfeeding was encouraged in both groups. The main study endpoints were the prevalences of breast-feeding on day 5, and after 2, 4 and 6 months. Of the newborns 46% violated the UNICEF protocol, mostly because of maternal requests to give a pacifier or supplements by bottle. In the standard group, the drop-out rate was 9.7%. No significant differences in breastfeeding frequency and duration could be found: (UNICEF vs standard) day 5: 100% vs 99%; 2 months: 88% vs 88%; 4 months: 75% vs 71%; 6 months: 57% vs 55%. Inclusion of drop-outs due to pacifier use did not alter the results. CONCLUSION: In our study population fluid supplements offered by bottle with or without the use of pacifiers during the first 5 days of life were not associated with a lower frequency or shorter duration of breastfeeding during the first 6 months of life.
Breast Feeding↗
[Folic acid in the prevention of neural tube defects].
Neural tube defects (spina bifida) imply a severe limitation of quality of life. 70 to 100% of these defects are preventable by additional intake of folic acid during the periconceptional period. In accordance with the recommendations of Anglo-Saxon and other authorities prevention of this grave malformation should be attempted not only after a first-affected child, but primarily in a general manner in Switzerland, too. All women of childbearing age not under contraceptives should be advised to consume a diet rich in folic acid and to take an additional daily dose of 0.4 mg folic acid as a monosubstance or with a multivitamin preparation. A supplement of folic acid to cereal grain products, mainly bread flours, is recommended. A generally elevated folic acid intake may have further beneficial effects, such as risk reduction for the occurrence of carcinoma and atherosclerosis.
Congenital Abnormalities↗
Human ferrochelatase: a novel mutation in patients with erythropoietic protoporphyria and an isoform caused by alternative splicing.
Erythropoietic protoporphyria (EPP), attributable to deficiency of ferrochelatase activity (FECH), is characterised mainly by cutaneous photosensitivity. To define the molecular defect in two EPP-affected siblings and their parents in a Swiss family, ferrochelatase cDNA was amplified by the polymerase chain reaction (PCR) and subjected to sequence analysis. A 5-bp deletion (T580-G584) was identified on one allele of the ferrochelatase gene in both patients and their mother. Screening of the mutation among family members of RsaI digestion of PCR-amplified genomic DNA revealed autosomal dominant inheritance associated with abnormal protoporphyrin concentration and enzyme activity. We also isolated ferrochelatase cDNAs containing a 18-bp insertion (part of the intron 2 sequence) between exons 2 and 3; this corresponded to six extra amino acids (YESNIR) inserted between Arg-65 and Lys-66 of the known ferrochelatase. This isoform was identified initially in mRNAs derived from both alleles of the ferrochelatase gene in one patient. Its existence was confirmed in six additional EPP patients, in five out of seven controls, and in four different cell lines (fibroblast, muscle, hepatoma and myelogenous leukaemia). This isoform, roughly 20% of the total ferrochelatase mRNA, was generated through splicing at a second donor site in intron 2 and its presence was not linked to EPP.
Adolescent↗
Imaging diagnosis and follow-up of infantile hepatic haemangioendothelioma: a case report.
A 4-week-old male infant was admitted to the hospital with acute gastrointestinal bleeding and marked coagulopathy secondary to vitamin K malabsorption in the presence of cholestasis. Physical examination revealed hepatomegaly and cutaneous haemangiomas. Ultrasonography, CT, and MRI demonstrated a multifocal vascular process and allowed the diagnosis of infantile hepatic haemangioendothelioma to be made without the use of more invasive diagnostic procedures. To avoid high-output congestive heart failure, the patient was treated with oral corticosteroids. After 5 months, rapid involution of the vascular malformations ensued. At age 2 years, a magnetic resonance scan confirmed complete resolution of the hepatic haemangioendothelioma.
Follow-Up Studies↗
Vitamin K1 concentration in breast-fed neonates after oral or intramuscular administration of a single dose of a new mixed-micellar preparation of phylloquinone.
The plasma disposition of a new mixed-micellar preparation (KONAKION MM, Roche) of phylloquinone (vitamin K1) has been studied in 25 healthy, fully breast-fed, newborn babies, randomized to receive a single dose of either 1.5 mg i.m. (11 babies) or 3 mg p.o. (14 babies). Venous blood samples were collected at 25 h, 4 days, and 24 days. After p.o. administration, the median plasma phylloquinone concentration increased to 89 ng/ml after 24 h, then decreased to 51 ng/ml after 4 days; the respective concentrations after i.m. injection were 146 ng/ml and 34 ng/ml. The higher plasma phylloquinone level in the i.m. group after 24 h was not statistically significant compared with that of the p.o. group, but the reversed higher concentration in the p.o. group after 4 days was significant (p < 0.01). After 24 days the median plasma phylloquinone had decreased to 0.44 ng/ml (range 0.19-1.44) and 1.05 ng/ml (range 0.37-1.87) in the p.o. and i.m. groups, respectively. There was a significant difference between these plasma concentrations (p < 0.01). They were within or above the reference adult fasting range (0.17-0.68 ng/ml). The narrow range of plasma concentrations at 24 h and 4 days suggests a greater consistency of absorption from this micellar preparation than from other emulsion-based preparations. Further studies are required to assess the long-term protection of a single oral dose against late hemorrhagic disease of the newborn. Until such time, breast-fed babies given this preparation orally should receive (an) additional dose(s).
Administration, Oral↗
N-acetylglutamate synthetase deficiency: diagnosis, management and follow-up of a rare disorder of ammonia detoxication.
We report the 9-year follow-up of a patient suffering from N-acetylglutamate synthetase deficiency, an urea cycle disorder leading to severe neonatal hyperammonaemia. Hitherto two patients from two families with this inborn error of metabolism had been observed. Our management consisted mainly of a protein-restricted diet and oral treatment with N-carbamylglutamate, an activator of carbamylphosphate synthetase, together with arginine or citrulline. The somatic development was normal whereas a moderate psychomotor retardation was diagnosed. The patient died after an episode of coma and prolonged generalized convulsions at the age of 9.5 years.
Acetyltransferases↗
Crohn disease with sclerosing cholangitis and liver cirrhosis in adolescence.
A 17-year-old patient suffering from Crohn disease (CD) and liver cirrhosis is presented. At an advanced stage of the disease, he died of a concomitant urosepsis. Autopsy showed that the liver cirrhosis was caused by sclerosing cholangitis. This very rare complication of CD in adolescence is discussed.
Adolescent↗
[Nutrition in the first days of life: how many infants need supplemental food?].
A prospective study of 280 consecutive newborns (birth weight greater than 2500 g) showed that on discharge from hospital 88.5% were fully and 8.6% partly breastfed. Only 8 children (2.9%) were weaned. In the group of the fully breastfed infants, 8.5% received no prelacteal food or fluid, 85.9% received a 10% dextromaltose (DM) solution and in only 5.6% of the children was there additional feeding with an adapted milk formula for some days. This restrictive attitude concerning supplemental feeding involved no observable drawbacks. The increasing incidence of atopic diseases--especially cow's milk allergy, the evolution of which is essentially promoted by the administration of foreign proteins in the first days of life--justifies a feeding policy on these lines. The elimination of bovine proteins in the newborn period is of considerable preventive significance. On the other hand, restriction of water supply (10% DM solution) is not advisable in our opinion.
Bottle Feeding↗
[Chronic, fatal, neonatally-acquired cytomegalovirus disease with hypereosinophilia and multiple organ involvement].
The case is reported of a boy who died at age four from perinatally acquired persistent cytomegalovirus (CMV) infection associated with hypereosinophilia. Although no primary immunodeficiency was found he developed chronic CMV infection of the lungs, liver, bones, kidneys and finally brain. The clinical picture was dominated for a long period by asthmatic attacks due to severe obstructive bronchopulmonary disease. The possible immunological background to CMV infection and the clinical significance of the associated hypereosinophilia are discussed.
Child, Preschool↗
[Helvetica Paediatrica Acta in changing times].
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History, 20th Century↗
[Growth and puberty in 7-to-16-year-old female gymnasts: a prospective study].
The female members of two different gym squads who where subject to hard training (12 to 15 hours a week), were investigated in regard to their growth parameters shortly after the beginning of intensive training and at yearly intervals thereafter. 12 of the initial 25 girls gave up training before reaching their 14th year. Only data compiled during the training period were included in the study. At the beginning of training, the gymnasts were comparable to the standard population (Zurich Longitudinal Study of Growth and Development) in regard to height and bone age: their weight was slightly subaverage. Height, growth rate, bone age, weight development and skinfold thickness remained clearly below standard values during the years of training. Due to a prolonged growth spurt during puberty, the final height and body weight were again comparable to standard values. Thelarche, pubarche and menarche were also significantly delayed; thelarche and menarche did occur, though, when the same body measurements (height, weight) as compared to the standard population were reached. FH, FSH and estradiol showed the puberty rise only after the 14th year, i.e. with considerable delay. When separately analyzing the data of the girls who gave up training before completing their 14th year, preexisting greater body measurements (including bone age) as well as more rapid development during the first years of training were found. Thus, the observed physical growth retardation is partly due to predisposition in the form of a constitutional late puberty, and is partly caused by the intensive training. A permanent physical developmental loss was not observed.
Adolescent↗
Hepatic capillariasis in a 1-year-old child.
We described the 2nd European case of hepatic capillariasis. The diagnosis of this parasitosis caused by Capillaria hepatica was made by needle biopsy of the liver in a 1-year-old girl who presented with a triad of persistent fever, hepatomegaly and hypereosinophilia. The child recovered completely after treatment with thiabendazole (Mintezol, Merck, Sharp and Dohme, Hoddeston, UK).
Animals↗
Epidermolysis bullosa simplex with mottled pigmentation.
A patient with epidermolysis bullosa simplex with mottled pigmentation is described. Clinical features include blistering of the skin, especially of the extremities; healing without scars; slight atrophy of the skin; and striking mottled pigmentation of the trunk. Histologic examination of a biopsy specimen from freshly frictioned, clinically uninvolved skin indicated a split inside the basal keratinocytes, focal hyperpigmentation of the basal cells, and pigment incontinence without an inflammatory infiltrate. Indirect immunofluorescence demonstrated focal discontinuity of the basement membrane zone. Electron microscopic examination revealed basal keratinocytes with few intact intracellular organelles, aggregated tonofilaments, and subnuclear splitting with the basal parts of the cells adhering to the basement membrane. Both normal basement membrane and zones of irregular and interrupted structures were seen. Hemidesmosomes and anchoring fibrils appeared to be normal.
Adolescent↗
[Hepatitis B associated membraneous glomerulonephritis: healing following drug-induced reactivation of hepatitis].
We report on a 7-year-old boy with nephrotic syndrome due to a membranous glomerulonephritis. The disease was caused by a persistent hepatitis B antigenemia without formation of antibodies. It was possible to show diffuse deposits of HBs antigen in the glomerular basement membrane and the mesangium by immunohistology. Therapy with cyclophosphamide resulted in an acute exacerbation of the hepatitis and, consequently, in a seroconversion. Subsequently, the nephrotic syndrome and the HBs antigenemia disappeared, and the hepatitis healed.
Child↗
[Neonatal vitamin K prophylaxis and vitamin k deficiency hemorrhages in Switzerland 1986-1988].
On the basis of an inquiry held in Switzerland in May 1988, over 99% of all newborn receive vitamin K prophylaxis, 59% orally and 41% intramuscularly. In the previous 2 1/2 years, ten cases of bleeding due to vitamin K deficiency had been observed, of which two were inadequately documented. In two children there was early haemorrhage and late haemorrhage in eight. The latter were all exclusively breast-fed and had received oral vitamin K prophylaxis. Seven presented with vitamin K deficiency due to cholestasis or chronic diarrhea. The only "idiopathic" case is insufficiently documented. The advantages and disadvantages of oral and intramuscular prophylaxis are discussed. A definite stand in favour of the one route or the other is not possible at present. However, the continuation of general prophylaxis is undoubtedly necessary.
Female↗