Feeding small babies.
Authors: G Osborn
Journal: BMJ (1969)

Feeding Small BabiesThe first biochemical analysis of milk, by T. Young in 1761,1 had a start of a century over the discovery of bacteria by Pasteur.This priority of emphasis created a deep-rooted belief, evident to this day, that the chemical composition of infant's feeds is all-important in the genesis of feeding prob- lems and gastroenteritis.Thus at the first hint of a digestive disturbance in a baby it is still customary for mothers, nurses, and doctors to try the effect of changing the brand or weaken- ing the composition of the feed.In conformity with this principle it has always been held that small, weak babies can tolerate only small, weak feeds, whereas logic would seem to suggest that they particularly require a high calorie intake.In recent years the traditional concept has been challenged by several workers, most notably by H. G. Keitel and E. Chu' in Philadelphia.They studied the progress of a large series of small babies divided into groups fed on seven proprietary brands of milk offered in regular (20 calories per oz.-30 ml.) or concentrated (34 calories per oz.-30 ml.) formulae and compared the effect on those weighing under 2,001 g. with those between 2,001 and 2,501 g. at birth.They found that the smaller babies on average derived most benefit from concentrated feeds, gaining 20% more rapidly than those fed on the regular dilution, whereas the larger babies gained about 10% more rapidly.In Britain J. F. Frears3 has also shown that small premature babies gain weight faster on feeds made up to 30 calories per oz.(30 ml.) than on those of the standard 20 calories per oz. (30ml.).Very small babies-most weighed under 4 lb.(1-8 kg.)-tolerated concentrated feeds well, but failed to absorb all the fat at a level of 4-6%, though they suffered no detectable ill effects.However, raising the con- centration of protein may lead to offensive stools and possibly even to uraemia, accumulation of electrolytes, and anaemia (facilitated perhaps by superadded infection), but these hazards were not observed by Frears or by Keitel and Chu.If the sugar level exceeds 10% there is a risk of diarrhoea due to osmosis, but considerably higher levels can be tolerated with the larger molecules of dextrimaltose.Clearly the total daily intake, as well as the concentration, will affect these limits of tolerance.In practice the volume of each feed is adjusted to suit the individual baby.Keitel and Chu specifically state that no forced feeding was allowed, and it is interesting to note that their babies on concentrated feeds, which were 70% stronger than the standard feeds, took on average over the whole period of observation only 10% more calories than those on standard feeds.Evidently the babies restricted their intake considerably.But in Frears's much smaller series followed up for a shorter period the babies on concentrated feeds, which were 50% stronger than the standard, took on average 25% more calories daily, and, since utilization was as good as with the standard strength, they gained correspondingly faster.The best results were obtained in those babies who had weight to catch up, as in the stoking-up period after regaining the birth weight.H. G.