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Objectives:The present study aimed to assess the current state of breast-feeding promotion in hospitals and the prevalence of breast-feeding during the first year of life in Germany and to compare the results with a study 20 years earlier.Design:In the studies on ‘breast-feeding and infant nutrition in Germany’ named ‘SuSe’, a cross-sectional survey in hospitals was combined with a subsequent prospective survey of breast-feeding and infant nutrition during the first year of life (0·5, 2, 4, 6 and 12 months after birth) in mother–infant pairs who were recruited in the hospitals. Written questionnaires and phone calls were used in SuSe I and web-based questionnaires in SuSe II. Breast-feeding promotion and prevalence were evaluated using recommendations from the WHO and the UNICEF.Setting:Two nationwide surveys SuSe I (1997–1998) and SuSe II (2017–2019).Participants:In SuSe I, 177 hospitals and 1717 mother–infant pairs and in SuSe II 109 hospitals and 962 mother–infant pairs were included.Results:In SuSe II, hospitals implemented seven of the WHO ‘Ten Steps to Successful Breastfeeding’ to a greater extent than the hospitals in SuSe I. More mothers exclusively breastfed for 4 months (57 % v. 33 %) and continued breast-feeding until 6 (78 % v. 48 %) and 12 months (41 % v. 13 %). In both studies, exclusive breast-feeding decreased between 4 and 6 months of age due to the introduction of complementary feeding.Conclusions:In Germany, breast-feeding habits have come closer to the recommendations over the last 20 years.

Stillmonitoring bezeichnet die systematische Erhebung aktueller, umfassender und genauer Daten zu Stillquoten, Stillverhalten und stillrelevanten Rahmenbedingungen auf nationaler und regionaler Ebene mit dem Ziel einer optimalen Stillforderung. Hierfur hat die Nationale Stillkommission (NSK) in Deutschland im Jahr 2009 ein integratives Konzept eines Stillmonitorings vorgelegt, das unterschiedliche Erhebungsinstrumente in unterschiedlichen Erhebungsfeldern umfasst. Die bisherige fragmentierte Umsetzung ist jedoch noch unzureichend, insbesondere fehlt eine langerfristig angelegte Konzeption mit einer nachhaltigen Verankerung innerhalb der Strukturen des Gesundheitssystems. Fur eine systematische Erfassung von Stilldaten sind unterschiedliche Module zusammenzufuhren. Longitudinale Daten zu Kernindikatoren des Stillprozesses sollten uber Qualitatssicherungsverfahren aus der Perinatalmedizin und den Schuleingangsuntersuchungen kontinuierlich in die Gesundheitsberichterstattung eingehen. Vertiefend sollten in funfjahrigen Abstanden epidemiologische Untersuchungen zum Stillen und zur Sauglingsernahrung durchgefuhrt werden, die Einflussfaktoren von der Schwangerschaft bis zum Ende des 1. Lebensjahres abdecken. Das Monitoring in Hochrisikogruppen sollte im Rahmen systematischer Interventionen unter Nutzung der Strukturen Fruher Hilfen (lokale und regionale Unterstutzungssysteme mit Hilfsangeboten fur Eltern und Kinder) und der sozialkompensatorischen Tatigkeit der unteren Gesundheitsbehorden erfolgen, mit zeitnahem Transfer der Ergebnisse in die Praxis. Das integrative Konzept der NSK zum Stillmonitoring ist konform mit internationalen Kriterien, zugeschnitten auf vorhandene Strukturen und Erfahrungen in Deutschland und international vorzeigbar. Zur Koordinierung und Implementierung des Konzeptes bedarf es hinreichender zentraler Ressourcen.

Muttermilch bietet neben spezifischen nutritiven und funktionellen Vorteilen auch eine grosere sensorische Variabilitat als industriell hergestellte Sauglingsnahrung. Geruchs- und Geschmacksstimuli aus der Ernahrung der Mutter konnen schon pranatal in das Fruchtwasser und postnatal in die Muttermilch ubergehen und vom Fetus und Saugling wahrgenommen werden. Dem Stillen wird eine „Bruckenfunktion“ von der pranatalen sensorischen Exposition zur Geschmacksvielfalt der Beikost und anschliesenden Kinder- und Familienernahrung zugesprochen. Es fehlen aber uberzeugende Daten, um diese Annahme zu bestatigen. Die notwendigen randomisierten Interventionsstudien mit ausreichend langem Follow-up sind in der Umsetzung schwierig und kaum zu realisieren. Dass anhaltende Auswirkungen fruher sensorischer Erfahrungen uber die Muttermilch moglich sind, wurde bisher meist nur fur das 1. Lebensjahr und mit intensiver Intervention gezeigt, die bei ublicher mutterlicher Ernahrung kaum umsetzbar scheint. Die praktische Relevanz einer positiven sensorischen Pragung durch das Stillen bleibt somit offen. Davon unabhangig kann eine ausgewogene variationsreiche Kost in Schwangerschaft und Stillzeit nicht nur aus ernahrungsphysiologischen, sondern auch aus sensorisch-hedonischen Grunden empfohlen werden.

Bei der Behandlung von Patienten mit Migrationshintergrund sind Fragen zum soziokulturellen Hintergrund sehr wichtig. Die Einstellung der Familien zur Gesundheitsversorgung und Pravention sowie andere gesundheitsrelevante Faktoren der verschiedenen Herkunftslander konnen in der weiteren Betreuung von groser Bedeutung sein.

Despite the undeniable benefits, breastfeeding in public has led in the past to controversies that gained a lot of media coverage. For this reason, the attitudes of the general population towards breastfeeding in public and the experiences of mothers who breastfeed in public were examined.The objectives were to collect current data on the perception and acceptance of breastfeeding in public.We surveyed 1003 respondents from the general population aged 14 years and over and 306 mothers with children of breastfeeding age on the subject of breastfeeding in public by means of computer-assisted web interviewing.Of mothers, 6% reported that their experiences of breastfeeding in public tended to be rather or very negative. Of the general population sample, 66% held the fundamental opinion that breastfeeding should be possible everywhere at all times, compared to 80% of mothers (p 0.05). Special differences can be seen for breastfeeding in restaurants and cafes. Although only just under 50% of the population sample approves of breastfeeding in these locations, it is not avoided by the majority of mothers (54%). Overall, knowledge of the benefits of breastfeeding is associated with increased acceptance of breastfeeding in public. No special demographic characteristics were observed for the group of persons with a negative attitude towards breastfeeding in public (6%).No special target group for improving acceptance of breastfeeding in public can be identified in the population on the basis of the present findings. A conflict potential was identified for certain places and situations, however, which enables the development of strategies to increase acceptance.

Breastmilk provides well-known nutritional and functional advantages and in addition a greater sensory variety as compared to infant formula. Volatile and soluble sensory components from the mother's diet are transmitted prenatally into the amniotic fluid and postnatally into breastmilk and can be detected by the fetus and infant. Breastfeeding is suggested to serve as a bridge from prenatal flavor experiences to the varied sensory world of complementary feeding and family diet afterwards. Nevertheless definite data to prove this plausible assumption are still missing. Randomized intervention trials with a necessary long-term follow-up are difficult to implement and rarely achieved. Lasting effects of early sensory experiences have so far been demonstrated mostly in the first year of life and by applying intensive sensory interventions, which are hardly possible in a habitual maternal diet. The practical relevance of a potential sensory imprinting by breastfeeding still remains open. Nevertheless a varied diet in pregnancy and lactation can be recommended not only for nutritional reasons but also from a hedonic sensory perspective.

Breastfeeding monitoring is understood to be the systematic assessment of current, comprehensive and precise data on breastfeeding rates, breastfeeding behaviour and relevant framework conditions at a national and regional level, with the aim of optimal breastfeeding support. For this purpose, in 2009, the National Breastfeeding Committee in Germany presented an integrative monitoring concept that included different assessment instruments and assessment fields. The hitherto fragmented implementation is still insufficient; in particular, the implementation of longer-term and sustainable concepts within the structures of the healthcare system is still lacking.To systematically collect breastfeeding data, it is mandatory to integrate the different modules. Longitudinal data on selected core breastfeeding indicators should be collected within the quality assurance structures of perinatal medicine and within the regular school entrance examinations, and be integrated into the health surveillance system. Detailed epidemiological studies on breastfeeding and infant nutrition should be carried out every 5 years, covering influencing factors from pregnancy until the end of the first year of life. The monitoring of high-risk groups should take place with systematic interventions within the institutionalized frameworks of "Early Preventions" (local support systems offering assistance to parents and children) and health authorities with social compensatory activities, with the immediate transfer to of the results into practice.The integrative concept of breastfeeding monitoring in Germany is in accordance with international criteria, tailored to existing structures and experiences, and can be presented internationally. Sufficient centralized resources are needed to coordinate and implement this concept.

Introduction: Routine medical care in Germany, Austria and Switzerland is being increasingly impacted by the cultural and linguistic diversity of an ever more complex world. Both at home and as part of international student exchanges, medical students are confronted with different ways of thinking and acting in relation to health and disease. Despite an increasing number of courses on cultural competence and global health at German-speaking medical schools, systematic approaches are lacking on how to integrate this topic into medical curricula. Methodological approach: This paper is based on a structured consensus-building process by a multidisciplinary committee composed of faculty and students. In a first step, a qualitative online survey was carried out in order to establish an inventory of definitions and concepts. After the second step, in which a literature search was conducted and definitions of global health and transcultural and intercultural competence were clarified, recommendations were formulated regarding content, teaching and institutional infrastructure. Based on small-group work and large-group discussions, different perspectives and critical issues were compiled using multiple feedback loops that served to ensure quality. Results: An inventory on the national and international level showed that great heterogeneity exists in regard to definitions, teaching strategies, teaching formats and faculty qualification. Definitions and central aspects considered essential to medical education were thus established for the use of the terms “cultural competence” and “global health”. Recommendations are given for implementation, ranging from practical realization to qualification of teaching staff and education research. Outlook: High-quality healthcare as a goal calls for the systematic internationalization of undergraduate medical education. In addition to offering specific courses on cultural competence and global health, synergies would be created through the integration of cultural competence and global health content into the curricula of already existing subject areas. The NKLM (the national competence-based catalogue of learning objectives for undergraduate medical education) would serve as a basis for this., Einführung: Der medizinische Arbeitsalltag in Deutschland, Österreich und der Schweiz ist zunehmend durch kulturelle und sprachliche Diversität in einer komplexer werdenden Welt geprägt. Sowohl im Rahmen von Auslandsaufenthalten als auch im Inland kommen Medizinstudierende mit unterschiedlichen und ihnen teilweise fremd erscheinenden Denk- und Handlungsgewohnheiten bezogen auf Krankheit und Gesundheit in Berührung. Trotz einer steigenden Anzahl an Lehrangeboten zu den Themen Kulturelle Kompetenz und Global Health an den Fakultäten mangelt es bisher an systematischen Ansätzen zur Integration dieser Themenbereiche in die medizinischen Curricula. Methodisches Vorgehen: Das Papier basiert auf einem strukturierten Konsensfindungsprozess durch ein multidisziplinäres Gremium aus Lehrenden und Studierenden. Mittels einer qualitativen Online-Umfrage wurde in einem ersten Schritt eine Bestandsaufnahme zu Definitionen und Konzepten durchgeführt. Nach einer im zweiten Schritt erfolgten Literaturrecherche und Begriffsklärung zu den Bereichen Global Health und Trans- und Interkulturelle Kompetenz wurden in einem kontinuierlichen Arbeitsprozess inhaltliche, didaktische und strukturelle Empfehlungen erarbeitet. Über Kleingruppenarbeit und Plenumsdiskussionen wurden mit mehreren, der Qualitätssicherung dienenden Feedback-Schleifen unterschiedliche Perspektiven und kritische Standpunkte erarbeitet. Ergebnisse: Eine Bestandsaufnahme im nationalen und internationalen Raum ergab, dass eine große Heterogenität z.B. im Hinblick auf Definitionen, Lehrkonzepte und –formate oder die Qualifikation der Lehrenden besteht. Für die Nutzung der Begriffe Kulturelle Kompetenz und Global Health wurden daher für die medizinische Ausbildung als essentiell erachtete Definitionen und zentrale Aspekte benannt. Als Hilfe für die konkrete Umsetzung in der Lehre wurden Empfehlungen von der praktischen Umsetzung über die Qualifikation der Lehrenden bis hin zur Lehrforschung formuliert. Ausblick: Bei dem Ziel einer qualitativ hochwertigen Patientenversorgung besteht Bedarf an einer systematischen Internationalisierung des humanmedizinischen Studiums. Neben der Bereitstellung von spezifischen Lehrangeboten geht es im Sinne der Synergiebildung um eine Integration der Förderung Kultureller Kompetenz und der Vermittlung von Global Health-Inhalten in Angebote bestehender Fachdisziplinen. Der Nationale Kompetenzbasierte Lernzielkatalog Medizin (NKLM) bietet dafür eine Grundlage., GMS Journal for Medical Education; 35(3):Doc28

Aim: 20 years after establishment of the National Breastfeeding Committee, the present work, based on published data on breastfeeding, is aimed at providing insight into the development of breastfeeding behaviour in Germany. Methods: To identify relevant publications, a comprehensive literature search was conducted in PubMed and Web of Science using the search terms "breast feeding" or "breastfeeding" in combination with "Germany". The publication period was limited to the period 1995-2014. Results: A total of 35 studies with data on breastfeeding for the birth cohorts of 1990-2012 were identified. Most of the data had been collected in regional or local surveys, often retrospectively. About 60% of the studies had been conducted with the primary aim of collecting data on breastfeeding or infant nutrition. Over the past 2 decades, breastfeeding rates were always relatively high at the beginning (72-97%). However, they declined significantly within the first 2 months, and by the age of 6 months, only about 50% of infants were still breastfed. Conclusion: Breastfeeding support and early assistance should be offered to a greater extent in order to achieve sustainable improvement of breastfeeding frequency and duration in Germany. Regarding the quality of data collected on breastfeeding, it seems crucial to implement standardised approaches to monitor breastfeeding in Germany.

Zusammenfassung 17,6% der Neugeborenen in Deutschland hatten im Jahr 2013 eine Mutter nicht-deutscher Nationalität. Im früheren Bundesgebiet mit Berlin-Ost sind dies 19,7%; in den neuen Bundesländern 5,0%. Perinatale Mortalität und Säuglingssterblichkeit sind Indikatoren für die prä-, peri- und postnatale Qualität der Versorgung. Bei ausländischen Kindern in Deutschland sind sie erhöht. Prävention und Versorgung in der Schwangerschaft müssen der kulturellen und sprachlichen Diversität angepasst sein und insbesondere immigrierenden Frauen ein adäquates Angebot bieten.

BACKGROUND: Diverse early-life mortality outcomes have been documented in immigrant populations in northern Europe. A recent meta-analysis has suggested that national integration policy is a key factor in understanding this heterogeneous pattern. In this study, we investigated the variation of stillbirth and neonatal mortality between societies in northern Europe in one minority population, the Turkish. METHOD: Data on stillbirth and neonatal deaths in 239 387 births during 1990-2005, where the mother was of Turkish origin, was drawn from birth registries or surveys in nine northern European countries. Rates were compared with births from mothers who were born in the society of residence. Logistic regression was used to calculate odds ratios adjusted for year of birth of the offspring. RESULTS: The risks for stillbirth were, or tended to be, elevated for Turkish mothers in all countries compared with the native population, with the highest risk in Austria (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.4-2.1) and Switzerland (OR 1.6; 1.4-1.9). For neonatal mortality the results were heterogeneous, indicating no excess risk for Turkish-born children in the Netherlands, the UK and Norway, and elevated risks in Denmark (OR 1.3; 1.0-1.6), Switzerland (OR 1.3; 1.1-1.5), Austria (OR 1.4; 1.0-1.8) and Germany (OR 1.3; CI 1.2-1.5). CONCLUSION: This study suggests that preventable society-specific determinants are important for early-life mortality in Turkish migrants in Europe. An active integration policy is consistent with a favourable neonatal mortality outcome in continental Europe, but not with patterns in Scandinavia and the UK.

UNLABELLED This study investigated the supply of the essential trace element molybdenum (Mo) in infants with preternatural anus. It was divided into two separate investigations: (A) the complete fecal excretion of nine patients was collected in fractions over 24 h; and (B) 72 h balance studies and parallel plasma analysis were conducted in five infants and complemented by the longitudinal comparison of one of these patients with his (otherwise healthy) premature sister. Atomic absorption spectroscopy (balance studies) and high-resolution inductively coupled plasma mass spectrometry (HR-ICP-MS, plasma) were used for analysis. The following results were obtained. (A) The fecal Mo concentration ranged from 1.98 to 42.02 nmol Mo g(-1) dry fecal weight. (B) The daily intake in the balance studies was 43.2 (11.33-100.5) nmol Mo kg(-1) and the median retention was -2.91 (-32.45 to 48.6) nmol Mo kg(-1). In the premature twins the boy with an intestinal stoma had a negative balance and lost -3.32 micromol within 32 d, while his sister retained +0.45 micromol Mo in the same period. Plasma Mo ranged between 9.4 and 46.7 nmol l(-1). CONCLUSION The negative Mo balance results may indicate an increased risk of Mo deficiency in infants requiring a long-term preternatural anus.

Despite the fact that the trace element molybdenum (Mo) is essential, there is insufficient knowledge about the demands in infancy. Mo balances were therefore assessed under consideration of formula Mo concentrations ranging from 0.125 to 2.704 micromol/l. Sixteen premature male infants participated in the investigation. Their birth weights were between 1,500 and 1,990 g, the median (range) gestational age was 34 (32-36) weeks and the post-conceptual age at the time of study 37.4 (34.1-40.6) weeks. Twenty-four balance studies were performed and the materials analysed by atomic absorption spectroscopy. Infants with a "low" Mo intake received 0.024 (0.020-0.035) micromol/ kg per day, had a urinary excretion of 0.02 (0.008-0.045) and a retention of 0.0006 (-0.03 to 0.008) micromol/kg per day. Infants with a "high" intake received 0.284 (0.227-0.487) micromol/kg per day, had a urinary excretion of 0.243 (0.118-0.378) and a retention of 0.022 (-71.1 to 141.44) micromol/kg per day. Since the median urinary excretion exceeded 60% of the Mo intake at low and high intakes, sufficient resorption but minimal retention was assessed at low intakes of Mo.In view of the limited knowledge of long-term exposure to an elevated molybdenum intake and the substantial retention observed at higher intakes, upper limits should be set for molybdenum concentrations in preterm infant formulas.

The essential trace element molybdenum (Mo) is bound to and required for the function of molybdoenzymes, e.g. sulfite and xanthine oxidase. Dietary recommendations for early infancy are based on limited knowledge about its metabolism. 100Mo was used as an extrinsic tag to study the absorption and kinetics of excretion in infancy. 10 infants with a gestational age of 35 (30-39) weeks, a birth weight of 2.0 (0.9-2.3) kg and a post-natal age of 20 (10-54) days were studied. They received 25 microg 100Mo/kg with a feed of human milk or formula. Fractional urinary and fecal collections were conducted preceding the 100Mo intake and for 48-72 hours afterwards. The materials were analyzed by atomic absorption spectroscopy and inductively coupled plasma mass spectrometry. The median absorption of 100Mo intake was 97.5 (96.3 to 99.1) %. The retention of nutritive Mo intake and 100Mo in the study period was 11.2 (3.8-15.7) microg Mo/kg, equivalent to 35.7 (12.7-55.6) %. The Mo concentration increased to a peak value in urine within 8 (6-13) hours and in feces within 24 (7-48.5) hours. In addition, increases of copper in feces and urine were observed in 8 of 9 infants studied. Mo given orally is well resorbed in premature infants, and predominantly excreted in the urine. Dietary recommendations should prevent excessive intakes in infancy.

Longitudinal zinc (Zn) balance studies were performed under domestic conditions in term breast-fed (n = 10), term formula-fed (n = 5; Zn concentration in the formula: 4 mg/l) and preterm formula-fed (n = 3) infants during the first 17 weeks of life. Samples of milk, urine and feces were analyzed by atomic absorption spectrometry. The median daily Zn intake in breast-fed infants decreased from 0.592 (0.457-0.829) mg Zn/kg body weight to 0.151 (0.095-0.304) mg Zn/kg body weight in the first 17 weeks of life; comparable values for bottle-fed term infants were 0.58 (0.511-0.701) and 0.674 (0.529-0.731) mg Zn/kg body weight. The median percent retention of Zn intake was 27 (-60 to 81.4)% in breast-fed infants and 21.5 (-42 to 64)% in formula-fed infants. In view of the urinary and fecal Zn losses measured, a daily intake of 0.3-0.5 mg Zn/kg body weight is considered to be sufficient to ensure a Zn retention equivalent to breast-fed infants. This requires a Zn concentration of 2-3 mg/l of Zn depending on milk volume intake.

Die bedarfsgerchte, ausgewogene Ernahrung ist nicht nur fur die Gesundheit der werdenden Mutter, sondern auch des ungeborenen Kindes von groser Bedeutung. Der Wunsch, die Entwicklung des Kindes zu fordern, eroffnet Chancen fur eine Ernahrungspravention von Anfang an. Eine intrauterine Fehlversorgung kann fruh erkennbare gesundheitliche Folgen haben, die bereits in der Schwangerschaft oder bei der Geburt deutlich sind. Daruber hinaus gibt es Hinweise auf langerfristige Effekte einer fetalen Pragung des Stoffwechsels, die teilweise erst spater im Erwachsenenalter erkennbar werden (Barker, 1999).

Iron balance studies were performed in 16 term infants from their 3rd until their 17th week of life. The balance studies were performed at home and comprised five periods with an interval of 3 to 4 weeks, each consisting of three 24-hour collections of milk and stool samples. Seven infants were fed an adapted infant formula supplemented with bovine lactoferrin (100 mg/100 ml) and nine received the same formula without lactoferrin. The lactoferrin supplemented group received 169 micrograms iron/kg b.w. x day and retained 63 micrograms/kg b.w. x day. The mean iron intake of infants fed with the adapted formula without supplementation of lactoferrin was 118 micrograms/kg b.w. x day. The retention of iron was 43 micrograms/kg b.w. x day. Mean percentage retention of iron in the supplemented group was 36%, in the non-supplemented group 28%.

Recommendations for “adequate intake” of the essential trace element molybdenum (Mo) in infancy have been based on its supply by human milk [NAS 2001] and are set at 0.3 µg/kg/day. These recommendations were derived mainly from analysis of Mo concentrations in human milk. Longitudinal data reporting the range of Mo intake in breastfed infants are scarce. Therefore, longitudinal investigations of Mo intake and retention were performed in healthy breastfed infants.

Human milk is regarded as the ideal nutrition for newborns and young infants, and exclusive breastfeeding is recommended (WHO 2003). Lactation consultation may benefit from a simple approach to evaluate the intake in exclusively breastfed infants.

Knowledge of peripartum indicators of those mother-infant pairs that are at increased risk of early failure of lactation may improve specific support of breastfeeding. Mode of delivery, labor complications, hyperbilirubinemia, milk intake and weight development were evaluated in healthy term infants in a hospital (n = 338). Delayed onset of lactation was observed in primiparae and in study participants with peripartum complications. The quantitative intake of human milk, assessed by test weighing 0–24 h and 24–48 h after the onset of lactation, was not significantly different between these groups. In addition, volume intake, weight gain and lactation success were tracked in 77 infants. Partial feeding of infant formula or an intake of

Aim: The intention of this study performed in healthy breast- and formula-fed infants was to characterize physiological feeding patterns as a basis for counseling parents to feed their infants on demand. Methods:Ingested milk volumes of 10 breast-fed and 14 formula-fed infants were measured during five 72-hour investigation periods during the 3rd, 6th, 9th, 13th, and 17th weeks of life. Results: A comparable diurnal distribution of feeds was observed in both groups during the first 9 weeks of life, with a day-night asymmetry of feeding first observed at the age of 6 weeks. Thereafter, formula-fed infants showed a further decrease in their nightly milk intake. Within the investigation period, the milk volume per feed rose from 100 (range 40–200) g to 140 (range 30–300) g in the breast-fed group and from 100 (range 20–200) g to 200 (range 20–450) g in formula-fed infants. From the 6th week of life onwards, formula-fed infants had significantly higher feeding volumes. Conclusions: Parents should be informed about the variability of infant demands per feed and of feeding at night observed in breast-fed infants. The results suggest that feeding patterns similar to those of breast-fed infants are difficult to accomplish in formula-fed infants.

Project: The clinical evaluation of trace element metabolism in infancy is based on optimal pre-analytical procedures. Urinary molybdenum excretion, the major determinant of its retention, was investigated to deduce criteria for representative specimen collection. Procedures: 1.) Molybdenum concentration was analyzed in 24-hour urinary specimens (n = 193) to evaluate the range in pediatric patients. 2.) In 20 children aged 0.4 to 9.3 (mean 2.3) years admitted for a micturition cystourethrogram, three urinary collection methods (catheter, spontaneous midstream samples, urinary collection bags) were compared. 3.) Diurnal variations of molybdenum concentration were assessed by fractional urinary collection in preterm infants fed infant formula or human milk (n = 10). Analysis was performed using atomic absorption spectroscopy. Results: 1.) The molybdenum concentration in 24hour specimens was 4.0 (0–123) μg Mo/l. 2.) Urine gained by catheter collection (n = 20) rendered 7.0 (0.5–60.1) μg Mo/l, midstream samples and the use of urinary collection bags showed a concentration of 21.25 (0–91) μg Mo/l (p > 0.05). 3.) Fractional collection over 72 hours rendered a significant increase in only one participant. Diurnal differences of the urinary molybdenum concentration were significant between 3–6 p.m. and 6–9 p.m.. The molybdenum/creatinine quotient differed between the time intervals 3–6 p.m. and 9–12 p.m., as well as 9–12 a.m. and 6–9 a.m. (p Conclusion: Pediatric routine procedures are suitable for the assessment of urinary molybdenum excretion. The diurnal variations assessed are of minor clinical relevance, but should be considered by respective definition of collecting times and reference values.

Data on normal defaecation patterns in relation to diet during the first months of infancy are very limited. We therefore investigated in a prospective study faecal weight and gastro-intestinal passage time of breast fed (n = 12) and formula fed (n = 14) male infants. These were studied in 72 h collecting periods at the age of 17, 35, 57, 87 and 113 (+/- 4) days. Breast fed infants had a significantly lower daily dry faecal weight than formula fed infants in all periods investigated (median at the age of 113 days: 0.28 (0.17-0.75) g/kg and 0.81 (0.22-1.2) g/kg, respectively). Breast fed infants showed a large variation of gastro-intestinal passage time (6.79 h [range: 1.79-13.38 h] at the age of 17 days, 21.84 h [range: 5.41-75 h] at the age of 113 days). Comparable values of formula red infants were 13.75 h (range: 7.13-35.25 h) and 17.42 h (range: 5.38-36.5 h). Despite the efforts of approximation of infant formula to breast milk, differences of defaecation patterns in relation to diet are still relevant at this age and have to be considered in clinical practice.

This explorative study was performed to assess basic data on the Mo metabolism of premature infants. Premature (n = 18, gestational age < or = 32 wk, birth weight < or = 1,500 g) and healthy formula-fed term infants (n = 14) were nourished and corrected for gestational age, identically. Plasma was collected at 3, 16, and 52 wk and 72 h balances were performed at 3 wk of age. In the premature infants, these investigations were preceded by two balance studies and an initial plasma collection. Increased Mo intake and low relative urinary excretion resulted in a retention of 4.4 (0.99-7.77) microg Mo/kg initially in premature infants (median, range). Parallel plasma concentrations were 5.5 (2.5-7.3) microg Mo/L, declining to 2.36 (0.73-3.87) microg Mo/L at 4 wk. Term infants rendered 1.49 (0.29-1.7) microg Mo/L (p < 0.05), with no significant differences later. It was concluded that the supplementation of formulas for premature infants with Mo should be recinded until there is evidence for its necessity. Index Entries: Mo; premature infants; trace elements; formula; nutrition.

The goal of the present study was to prospectively assess the plasma selenium (Se) concentrations of term and preterm infants during the first year of life in relation to gestational age and nutrition. Blood specimens were collected from orally formula-fed preterm infants (gestational age < 32 weeks, birth weight < 1500 g): 1.) in hospital and 2.) corrected for gestational age parallel to healthy term breast and formula-fed infants at the ages of 1, 4 and 12 months. All infants were fed according to a standardized nutritional concept, solids and follow-up formula were introduced at the age of 4 months. Plasma selenium in preterm infants in hospital was 11.7 (6.5-20.8) microg/l and 11.6 (8.8-16.7) microg/l at 4 weeks corrected for gestational age. At the age of 4 months plasma selenium was still significantly lower than in the other groups: Preterm infants: 17.1 (10.4-30.5) microg/l; formula-fed term infants: 31.3 (24.3-47.5) microg/l; breast-fed term infants: 45.6 (27.1-65.1) microg/l). The levels of breast-fed infants were significantly higher than those of both formula-fed groups up until the introduction of solids. Preterm infants had significantly low plasma selenium levels up until a postnatal age of at least 6 months. The levels were lower than those of term infants fed an identical unsupplemented infant formula during the first 4 months of life. These data support routine monitoring in hospital and selenium supplementation of preterm infants, preferably in hospital before discharge.

The knowledge of magnesium requirements of premature infants is still very limited, although it is essential for the optimal composition of suitable formulas.The study concept was 1) to assess physiological magnesium balance data of healthy term infants and longitudinal results from formula-fed premature infants and 2) to deduce conclusions on the magnesium content of the formulas.Premature infants (n = 14, birth weightor = 1500 g, gestational ageor = 32 weeks) were studied in conventional balance trials with 1) a semi-elemental diet (A), 2) preterm infant formula (B), and 3) infant formula (C). In addition, healthy term formula-fed (n = 11, D) and breast-fed (n = 14, E) infants were investigated. Analysis was performed by flame atomic absorption spectroscopy.The median magnesium intake ranged between 4.84 mg/kg x d-1 (breast-fed infants) and 16.33 mg/kg x d-1 (premature infants). The term breast-fed infants retained nearly as much magnesium as term formula-fed infants (3.37 vs. 3.97 mg/kg x d-1), due to a low percental fecal and urinary excretion. A higher magnesium retention was observed in the premature group: A: 7.97 mg/kg x d-1, B: 5.3 mg/kg x d-1, 3.) C: 5.54 mg/kg x d-1.In view of the high percental magnesium retention in formula-fed premature infants, excessive supply should be avoided. The long-term effects of lower intakes have to be monitored.

Rationale and Objectives Pancreatic and hepatic contrast enhancement after different modes of administration of Mn-bis pyridoxal ethylene diamine diacetic acid (Mn-DPDP) and the influence of the hormones secretin and cholecystokinin on the uptake of this new contrast agent were studied by using magnetic resonance (MR) imaging and atomic absorption spectroscopy (AAS) examinations carried out on 13 young domestic pigs. Methods Mn-DPDP was administered either as bolus injection or 30-min infusion. The course of contrast enhancement was noted. MR imaging was carried out with or without pancreatic stimulation. The Mn content in pancreatic and hepatic tissue was analyzed by using AAS. Results Mn-DPDP caused a significant increase (66±40.1%) in pancreatic signal intensity, an increase in hepatic signal intensity (78±23.0%), and a significantly higher Mn content on tissue samples of both organs. The results showed a wide individual range. With infusion of Mn-DPDP, pancreatic enhancement was slower, with a peak at 82±34 min compared with 54±51 min following bolus injection. The Mn content of both hepatic and pancreatic tissue determined by AAS seemed to be higher after infusion. An incomplete washout of Mn after 24 hr was demonstrated. Hormonal stimulation of the pancreas further increased pancreatic signal intensity but did not influence hepatic contrast enhancement. Conclusion Infusion is the method of choice for administering Mn-DPDP because it causes an increase in hepatic signal intensity but does not change pancreatic enhancement. Although pancreatic hormonal stimulation intensifies enhancement, the increase is not statistically significant, and this practice will not contribute to day-to-day clinical practice.

The long arm of the human Y-chromosome contains about 800 to 5000 copies of the tandemly repeated DNA sequence DYZ1. A major part of the repeating unit (pHY10)has been cloned and sequenced [1]. Primers were designed to match a part of this repeat sequence for the amplification of a 154 bp fragment spanning the Eco RI restriction site of the unit [2]. Typical dilution experiments showed that this polymerase chain reaction (PCR) method allows the detection of 5 to 10 male cells among 100000 female cells [3], or in 500 μL of cerebrospinal fluid containing only one cell per μL. In addition, the quality of the DNA used for the amplification reaction is less critical, thus allowing analysis of long-term stored samples such as bone marrow smears or dried blood stains spotted onto filter paper, which might contain partially degraded DNA [4]. We applied this technique to detect residual host cells in the clinical setting of human sex-mismatched bone marrow transplantation (BMT). Fourteen patients, receiving transplantations because of leukemias could be supervised so far. Throughout the whole period of monitoring (days + 14 until +911 post BMT; median: 160 days), residual host cells were detected in all but three patients. Persistence of host cells in the early phase post-BMT was mostly transient and probably due to long-term surviving host T-lym-phocytes. Reappearance of host cells several months after BMT is highly suspicious of relapse from the underlying malignancy. Due to its high sensitivity, PCR is a valuable tool in monitoring the switch from recipient to donor cell population. In addition, the documentation of persisting or reappearing recipient cells could be associated with clinical relapse [5].

Knowledge of trace element requirements of infants with phenylketonuria (PKU) fed a semisynthetic diet is limited. Three infants with PKU detected early were studied longitudinally in classical balance studies for 72 h, under domestic conditions, at the ages of 2, 5, 8, 12 and 16 weeks. Iron, copper and manganese concentrations in the diet and faeces were determined by atomic absorption spectroscopy. The median concentrations in the diet (4.8 mg Fe/L, 1.7 mg Cu/L, 0.43 mg Mn/L) exceed those in human milk. This is mainly due to supplementation of the amino acid preparation used. The increased intake led to a significantly higher daily retention of Cu and Mn from the PKU-diet fed, with a median of 0.17 mg Cu/kg and 6.4 micrograms Mn/kg body weight; the median retention of Fe was 0.24 mg Fe/kg. Our results confirmed the doubts about the suitability of the present trace element supplementation in formula for infants with PKU during the first four months of life.

Molybdenum (Mo) in preterm and term infants: Balance studies and plasma concentration † 1572

Interferences of copper (Cu) and molybdenum (Mo) metabolism have been described (1). We evaluated in preterm infants 1.Cu balances under consideration of formula Mo content and 2. the course of the Cu concentration in feces and urine in stable isotope studies with 100Mo. 1.) Intake, urinary and fecal excretion were collected over 72 hrs. in 14 male infants (gest. age: 32-37, 1.5-2.0 kg birth weight, 22 balances, formula: Prematil (Milupa AG, Germany)); Mo and Cu concentrations were determined by atomic absorption spectrometry : 2.) In 10 preterm infants fecal and urinary specimens were collected over 48-72 hrs. after the intake of 25 μg/kg 100Mo added to formula. Within 14 hours urinary Mo increased 13(4-84)fold. For fecal Mo a 3.2(1.1-5.5)fold increase was observed in all but 2 infants within 24(6-26.25)hrs. Compared to the initial values, in 6/9 infants Cu concentrations increased up to 220(183-326)% in urine and 142(120-156)% in feces after the 100Mo intake. In the others, specimens preceeding the 100Mo intake rendered the highest Cu concentrations. Despite their considerable range the results suggest a potential influence of Mo intake on Cu excretion. (1)AmJClinNutr(1972); 25:1022-1037.

1. Mn and Cu intake and retention in twenty full-term infants and six preterm infants were studied on the basis of 72 h balances. The age of the infants was 2–16 weeks and the gestational age of the preterm infants (triplets) 34 and 36 weeks. Three nutrition schemes were pursued: breast-fed, formula-fed with unsupplemented adapted formula and formula-fed with trace element supplementation.2. The mean Mn concentration of all breast-milk samples (n 2339) was 6·2 μg/1. The two formulas had similar Mn concentrations (77 and 99 μg/1) but had different Fe, Cu (121 and 619 μg/1), Zn and I contents. The mean Cu concentration in mother's milk was 833 μg/1.3. The following mean daily Mn intakes and retentions (μg/kg) respectively were measured: breast-fed fullterm 1·06 (sd 0·43) and 0·43 (sd 0·65), formula-fed full-term 14·2 (sd 3·1) and 2·8 (sd 4·8), formula-fed preterm 15·0 (sd 2·2) and 0·06 (sd 5·87). The results for Cu were 114·5 (sd 22·3) and 88·0 (sd 46·5) μg/kg in breast-fed, 19–8 (sd 4·2) and 4·6 (-11·5–9·6) in the unsupplemented formula-fed and 106·4 (sd 18·9) and 55·5 (sd 20·3) in the supplemented formula full-term infant group. No significant influence of the trace element contents of the formulas on the relative retention of Mn or Cu was found.4. Young preterm infants, and to some degree young full-term infants, often had negative Mn balances caused by a high faccal excretion. The formulas with a Mn concentration below 100 μg/l gave a sufficient supply of Mn. Preterm infants fed on the unsupplemented formula had a marginal Cu supply and their first balances were negative (-3·8 (sd 1·8) μg/kg).5. In accordance with the estimated safe and adequate daily dietary intakes (recommended dietary allowances), formula-fed infants receive much more Mn than breast-fed infants and their absolute retention is higher.6. Cu from breast-milk had a significantly better biological availability than that from cow's milk formula. If retentions similar to those in breast-fed infants are intended, we conclude, therefore, that cow's milk formula should be fortified with Cu up to a level of at least 600 μg/l.

Manganese balance data from newborns or infants are very scarce. There seem to be several reasons for this.

Top of pageAbstract The knowledge of the trace element requirements of infants fed a phenylalanine restricted diet due to PKU ( Phenylketonuria ) is very limited. We studied 3 infants with PKU under their diet ( Milupa PKU 1 ) longitudinally in balance studies ( ≥ 72 hours ) under home conditions at the age of 2, 5, 8, 12, 16 weeks. Mn, Cu, Fe concentrations in diet, feces and urine were determined by Atomic Absorption Spectroscopy. Median concentrations found in the final diet were 1.7 mg/l Cu, 6 mg/l Fe, 0.5 mg/l Mn. The comparison of the retention rates with the data of 10 healthy breast-fed ( BF ) infants studied before ( s. table (showed a higher range of Mn and Fe retention. The median absolute retention of copper from PKU-diet exceeded that from human milk. Iron supplementation leading to median retentions sixfold the retentions from human milk seems to be unnecessary. Manganese supplementation should be avoided as neither symptoms of deficiency in formula-fed infants have been described nor possible side effects have been excluded.

The ratios of ( trace- ) minerals may be of importance for their retention from human milk (HM) and formula. We determined the Ca, Cu, Fe, K, Mg, Mn, Na, P and Zn concentrations in more than 2300 samples of HM of 10 healthy mothers collected 2,5,8,12,16 weeks post partum. Zn/(trace-) mineral ratios (median and range) are compared with an unsupplemented formula (Pre-Aptamil (PA); Zn = 1.26 mg/l). The high Zn/Cu ratio in PA may partly be ascribed to the low copper concentration (0.12 mg/l), whereas high manganese levels leading to low Zn/Mn ratios are found in formulas without supplementation. Zn supplementation to values about twofold the present level (2-3 mg/l) would render an improved approach to ratios found in HM for Ca, Fe, Mg, Mn, Na. The results are of particular concern in view of isolated supplementation of e.g. iron, which might lead to inverse ratios as found in human milk.