198
Paediatrica Indonesiana 15 : 198 — 206. July — August 1975.
From the Department o f Child Health, Medical School Vniveisity of Indonesia, Jakarta, Indonesia
Effect of Low Lactose Milk "Eiwit Melk”(E .M .) on Low Birth Weight Infants with Diarrhoea
by
TB. BAGDADIJI, SUHARJONO, ASWITHA BOEDIARSO and SUNOTO
Abstract
Thirty-nine low birth weight infants suffering from diarrhoea hospi talized in the Department o f Child Health, Dr. Tjipto Mangunkusumo Hos pital/Medical School University o f Indonesia from July 1972 to December 1973 were treated with ”Eiwit Melk” (low lactose milk). Results are not satisfactory although better than with the routine formula. 9 out of 39 cases (23% ) give excellent result. 3 out of 39 cases (7.6%) give good result. 27 out of 39 cases ( 6 9 . ) give poor result. In low birth weight infants, next to lactose intolerance, other factors in causing diarrhoea among others fa t malabsorption should be considered. Trials with formulas combining easily absorbable fats should be encouraged. Received 6th. Dec. 1974
EFFEC T
O F E IW X T M E L K
Introduction
In low birth weight newborns, temporary milk intolerance for a few days could occur until their lactase reaches adequate levels to be able to digest the lactose in the formula (Bayless and Christopher, 1969). The common carbohydrates in an infant’s diet are the disaccharides lactose and sucrose, which are hy drolyzed to monosaccharides by the enzymes lactase and suerase in the brush border of the small bowel mucosa (Holzel, 1957). Auricchik) et al. in 1965 found that the glycosidase activities are present by the third month of intra uterine life, when the intestinal mucosa is already differentiated. All alfa diisacoharidase activities (namely, those of the maltase and suerase) reach a maximum during the sixth or seventh month of intra uterine life, whilst the beta glucosidases (lac tase) develop rapidly during antena tal existence and reach their peak at the end of normal gestation. So there will be a low concentration of lactase in low birth weight infants. Small bowel biopsy from patients who fail to thrive after gastroente ritis often demonstrates histologi cally the presence of severe partial villous atrophy. This may persist for several months, but the mucosa usually returns to normal without specific therapy (Walker Smith, 1970).
199
The enzyme lactase is produced and acts in the brush border of the microvilli (Suharjono et al., 1974). Lactase deficiency in gastroenteritis due to changes in villous pattern might cause lactose intolerance. This paper presents the results of our study and discusses the effects of low lactose milk on low birth weight (LBW) infants with diarr hoea. Material and Method Thirty-nine LBW infants age ranging from 4 to 40 days and body weight ranging from 1000 to 2450 grams with diarrhoea, who were hospitalized in the Department of Child Health, Medical School, Uni versity of Indonesia in 1973, be longed to this study. They were treated with a low lactose milk Eiwit Melk” (E.M.), which contains 1.4% lactose. The main composition as a solu tion of 1 liter is as follows: protein 2.7 % lactose 1.4% fat 2.2% calories 600 As a control was put 8 LBW other infants of SGM (a locally produced formula) of Which the main compo sition as a solution of 1 liter is as follows : protein 2.4% lactose ' 3.1% fat 1.3% calories 514
M © O
TA BLE 1 :
No.
Name
Ef f e c t s of Low Lactose M&k C’Eiwit M elk” ) in Low Birth W eight infants with diarrhoea
Body weight Age on admission (days) (gram )
Increase of j D uration of Body weight HospitaliHb within 4 zation w eeks t (sm % ) (weeks) (gram ) j
D isappearance o f D iarrhoea (day)
W orking Diagnosis SI/I.G.
R esults E
G ’
SI :
U D S N D D M T E D S E I N A M S N .N A
22 10 10 30 14 30 23 4 9 9 24 5 10 13 12 13 28 30 37 15
S u g ar Intolerance;
2100 1730 1800 1900 2000 2300 1700 2300 1850 2325 2100 2380 2400 2300 2450 2320 2150 2300 2100 2200 IG :
2 1 1 1 2 1 1 1 1 3 1 3 1 1 1 2 3 1 3 1
400 160 40 760 400 900 900 500 100 173 800 300 1100 400 1200 310 270 900 0 400
Infection of the .Gut;
19.5 18.0 20.5 9.6 17.2 13.3 20.2 13.6 22.0 17.5 16.5 13.2 17.3 13.0 22.0 12.5 11.5 18.9 8.8 16.4 E
:
E xcellen t;
5 3 2 2 6
th rd nd nd th
1
St
2 2 3 8 3 12 4 3 1 9 12 1 5 2
nd nd rd th rd th th rd st th th st th nd
G :
Good;
SI + SI + SI + SI + SI SI + SI S I “f SI + SI S I ■+' SI + SI SI + SI + SI SI + SI + P :
IG IG IG IG IG IG
+
+ + + + +
+
IG IG IG IG IG
+ +
+
IG IG IG IG
Poor
+
+
+ 4-
T B . B A G D A D IJI E T AL
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
p •
TABLE 1 (continued).
No.
Body weight Name Age on admission (days) (gram )
Increase of D uration of Body weight Hospitali within 4 zation weeks (weeks) (gram )
Ht» (sm % )
Disappearance o f D iarrhoea (day)
W orking Diagnosis SI/I.G.
R esults E
G
P
-
N B W M S
32. 33. 34. 35. 36. 37. 38. 39.
M R
23 22 2 20 14 12 10 7 8 40 22
2420 2450 2480 2100 2400 2400 2400 2150 2050 2250 2400
1 2 1 3 2 1 2 1 4 0
0
360 0 0 400 0 1000 160 1200 700 0 0
R M L S U A J M
12 5 8 30 3 40 15 4
1950 2400 2350 2450 2200 2400 2400 2340
2 1 4 1 1 1 3 1
0 1000 480 0 200 740 1030 440
s s V u
S.I. =
'
8.8 21.3 22.7 16.5 22.0 17.8 17.8
4 7 1 8 12 4 9 5 16 11
th th st th th th th th th th
18.5 10.3 18.8 (run without permission) 8 th 13.5 15.8 2 nd 14 th 19.9 10.8 3 rd 18.8 1 st 13.2 4 th 13.6 9 th 20.0 2 nd
Su g ar Intolerance; I.G. = Infection of the Gut; E == E x cellen t.; G =
Good;
SI SI + SI SI + SI + IG SI + SI SI + SI + SI + SI SI SI SI SI SI SI SI
+ IG
-L
+ + +
IG IG IG
+ +
IG IG IG
+ + + "f +
+ IG + + + +
IG IG IG IG
+ IG
P =
Poor.
+
+ + + +
+ +
■
E F F E C T O F EIW XT M E LK
21. 22. 23. 24. 25. 26. 27. 28. 29. 30 31.
©
Ef f e c t of SGM in L B W infants with diarrhoea.
TA BLE 2 :
1. 2. S. 4. 5. 6. 7. 8.
Name
S
W A J N S J
w
31 24 11 15 13 6 15 4
2360 2400 2450 2400 2480 1000 1770 2000
S I = Sugar intolerance; IG = E = E xcellen t; G = Good; P = Poor.
Duration of Increase of Disappearance H ospitali Body weight Hb 1 within 4 zation (gm % ) | o f D iarrhoea weeks (day) (weeks) (gram ) 1 1 2 3 1 1 3 1
1160 920 400 0 880 600 310 400
Infection of the gut;
8.6 15.7 16.8 19.5 15.0 11.0 14.8
4 3 8 10 2 2 4 5
th th th th th th th th
i
W orking Diagnosis SI/I.G.
IG IG S I + IG IG IG IG S I + IG S I + IG
Results E
+ +
+ +
G
P
+
+ + + +
T B . B A G D A D IJI E T AL,
No.
Body weight Age on admission (days) (gram )
TA BLE 3 :
Sum m ary of the tria l on 39 L B W infants Number of Subjects
Age
IG
R esults S I + IG
E
G
P
23
7
1
15
6
1
16
15 days — 1 month
16
1
1
ii
3
2
11
39
11
2
26
9
3
27
Good; P =
Poor.
Sum m ary of the Trial on S L B W infants vMh diarrhoea refed with SG-M
Age
Number of Su b jects
0 — 15 days
W orking diagnosis SI
IG
4
1
1
15 days 1 month
4
2
Total
8
3
E xcellen t; G =
Good; P =
Results S I + IG
E
G
P
2
1
—
3
1
1
2
—
2
2
3
3
—
5
E F F E C T O F EXW IT MEL.IC
E xcellen t; G =
TA BLE 4 :
E =
W orking diagnosis SI
0 — 15 days
Total E =
with diarrhoea refed with EM
Poor.
8
CO
T B . B A G D A D IJI E T A L
204
There were no other serious con ditions except enteritis. One infant died 'because of worsening of the enteritis. The nutritional status was evalua ted weekly until approximately 4 weeks of hospitalization.
Results The criteria of growth used are as follows : Excellent, if the increase of body weight within 1 month (4 weeks) divided by the natural optimal in crease reflected by body weight and age is more than one. Example : A 31-day-old Infant with a body weight of 2.000 grams on admission was hospitalized during 4 weeks. On discharge, the body weight was 3.000 grams. So the increase of body weight within one month (4 weeks) was 1.000 grams. The natural optimal monthly in crease of an infant with a body weight of 2.000 grams as a healthy infant, of the first trimester of age is 750 grams. Increase of body weight (1 month) optimal increase (1 month)
1.000 750 The result in this patient is con sidered excellent.
Good, if the ratio obtained ac cording to the above mentioned cal culation is approximately 1. Exam ple: A 30-day-old infant, with a body weight of 1.900 grams on ad mission, was hospitalized during 4 weeks. On discharge, the body weight was 2.650 grams. So the increase of body weight within one month (4 weeks) is 650 grams. The natural optimal monthly in crease of an infant with a body weight of 1.900 grams as a healthy infant, of the first trimester of age is 750 grams. Increase of body weight (1 month) optimal increase (1 month) 750 750 The result in this patient is con sidered good. Poor, if the ratio is less than 1. Example : A 38-day-old infant, with a body weight of 2.340 grams on admission, was hospitalized during 4 weeks. On discharge, the body weight was 2.740 grams. So the increase ®f body weight within one month (4 weeks) was 400 grams. The natural optimal monthly in crease of an infant with a body
EFFEC T
O F E IW IT M EL K
weight of 2.340 grams as a healthy infant, of the first trimester of age is 750 grams. Increase of body weight (1 month) optimal increase (1 month) 400 = ------ = < 1. 750
lining of the luminal surface of the intestinal epithelium, and therefore are liable to be effected in any disor der in which the intestinal mucosa is damaged. Examples are gastroenteritis, pro tein calorie malnutrition and some parasitic infestations.
The result in this patient is consi dered poor. The result of this study can be seen in tables 1 and 2. Table 1 shows the effect ’’Eiwit Melk” as follows : excellent on 9 out if 39 patients 23.1% good on 3 out of 39 patients 7.6% excellent on 3 out of 8 patients 69.6%
205
of = = =
Table 2 shows the effect of SGM as follows : excellent on 3 out of 8 patients = 37.5% good on 0 out of 8 patients = 0% poor on 5 out of 8 patients = 62.5% Discussion As it has been described earlier, there will be a low concentration of lectase in low birth weight infants, It is justifiable that we choose a low or free lactose milk for those low birth weight babies. Miller and Crane (1964) stated that diisaocharidases are found within the brush border
Normally, lactase is present in lower concentration as compared with other brush border disaccharidases (Dahlqvist, 1964); ft 'is allso the last to recover completely follow ing mucosal damage (Plotkin and Isselbacher, 1964). Compared to older infants with diarrhoea, the incidence of fat malabsorption in low birth weight infants with diarrhoea is much higher due to possibly per sisting immature function of the organs e.g. liver, pancreas, intestine etc. next to the inadequate condition of the epithelial cells caused by the diarrhoea. From the study on 26 Indonesian infants with diarrhoea, 80.8% shows, fat malabsorption (Gracey et al., 1974), So, in treating diarrhoeal low birth weight infants, besides low or lactose free formula milk containing easily absorbable fats should also be seriously considered. From the present study, it got only 23.1% excellentand 7.6% good results in treating those low birth weight infants with milk containing only low lactose (see table 1).
206
T B . B A G D A D IJI E T A L
The results of SGM to 8 other low birth weight infants were also poor for the majority (see table 2 ). This latter is not surprising since SGM contains more lactose than "Eiwit Melk”. In general, the conclusion drawn
from this trial is that, formulas with low lactose alone in low birth weight infants with diarrhoea will not give good results; other factors such as poor fat absorption due to persist ing immaturity of the enzymes pro ducing organs might play a similar important role.
REFEREN CES 1. A U RICCH IO, S., RU BIN O , N. and M U R S E T , G. : In testin al glucosidase activ ities in human embryo, fetu s and newborn. Pediatr. 35 : 944 (1965). 2. B A Y L E S S , T.M. and C H R ISTO P H E R , N .L. : D isaccharidase deficiency. Am. J . clin. Nutr. 22 ; 181 (1969). 3. D A H LQ V IST, S .: Method fo r assay of intestinal disaccharidases. A nalyt. Biochem. 7 : 18 (1964).
sport. Arch. (1957).
Dis.
Childh.
212 : 341
6. M IL L E R , D. and C R A N E , R .K .: The digestive function of th e epithelium of the sm all intestine. Bioehem . Biophys. A cta 52 : 293 (1961). 7. P LO TK IN , C.R. and I S S E L B A C H ER , K .J. : Secondary d isaccharidase defi ciency in m alabsorption s ta te s . N, Engl. J.M ed. 27 : 1033 (1964).
4. G R A C E Y, M., THOMAS, J . , SU H A RJO N O and H EN TYA N TO H EN D ARD J I : A ssessm ent of steatorrhoea in malnourished children. Lipiodol absor ption test. Environ. Child Hlth. 20:223 (1972).
8. SUH ADRJO N O , I.G.N. W IL A W IR YA, SAM SUDIN , SUN OTO, Z EIN . SU LA IM A N and S U T E D JO : E ffe c t o f low lacjose m ilk on protein calorie m alnutrition. P resentel a t the F irst Asian P ediatric Congress, M anila, May 1974. Paediatr. Indones in iprinp
5: H O LZEL, A. : Su g ar m alabsorption due to deficiencies of disaccharidase activities and of monosaccharide tra n
9. W A L K E R SM ITH , J.A . : D iseases of the sm all bowel in childhood. Postgrad, med. J . 46 : 300 (1970).
Paediatrica Indonesiana 15 : 198 — 206. July — August 1975.
From the Department o f Child Health, Medical School Vniveisity of Indonesia, Jakarta, Indonesia
Effect of Low Lactose Milk "Eiwit Melk”(E .M .) on Low Birth Weight Infants with Diarrhoea
by
TB. BAGDADIJI, SUHARJONO, ASWITHA BOEDIARSO and SUNOTO
Abstract
Thirty-nine low birth weight infants suffering from diarrhoea hospi talized in the Department o f Child Health, Dr. Tjipto Mangunkusumo Hos pital/Medical School University o f Indonesia from July 1972 to December 1973 were treated with ”Eiwit Melk” (low lactose milk). Results are not satisfactory although better than with the routine formula. 9 out of 39 cases (23% ) give excellent result. 3 out of 39 cases (7.6%) give good result. 27 out of 39 cases ( 6 9 . ) give poor result. In low birth weight infants, next to lactose intolerance, other factors in causing diarrhoea among others fa t malabsorption should be considered. Trials with formulas combining easily absorbable fats should be encouraged. Received 6th. Dec. 1974
EFFEC T
O F E IW X T M E L K
Introduction
In low birth weight newborns, temporary milk intolerance for a few days could occur until their lactase reaches adequate levels to be able to digest the lactose in the formula (Bayless and Christopher, 1969). The common carbohydrates in an infant’s diet are the disaccharides lactose and sucrose, which are hy drolyzed to monosaccharides by the enzymes lactase and suerase in the brush border of the small bowel mucosa (Holzel, 1957). Auricchik) et al. in 1965 found that the glycosidase activities are present by the third month of intra uterine life, when the intestinal mucosa is already differentiated. All alfa diisacoharidase activities (namely, those of the maltase and suerase) reach a maximum during the sixth or seventh month of intra uterine life, whilst the beta glucosidases (lac tase) develop rapidly during antena tal existence and reach their peak at the end of normal gestation. So there will be a low concentration of lactase in low birth weight infants. Small bowel biopsy from patients who fail to thrive after gastroente ritis often demonstrates histologi cally the presence of severe partial villous atrophy. This may persist for several months, but the mucosa usually returns to normal without specific therapy (Walker Smith, 1970).
199
The enzyme lactase is produced and acts in the brush border of the microvilli (Suharjono et al., 1974). Lactase deficiency in gastroenteritis due to changes in villous pattern might cause lactose intolerance. This paper presents the results of our study and discusses the effects of low lactose milk on low birth weight (LBW) infants with diarr hoea. Material and Method Thirty-nine LBW infants age ranging from 4 to 40 days and body weight ranging from 1000 to 2450 grams with diarrhoea, who were hospitalized in the Department of Child Health, Medical School, Uni versity of Indonesia in 1973, be longed to this study. They were treated with a low lactose milk Eiwit Melk” (E.M.), which contains 1.4% lactose. The main composition as a solu tion of 1 liter is as follows: protein 2.7 % lactose 1.4% fat 2.2% calories 600 As a control was put 8 LBW other infants of SGM (a locally produced formula) of Which the main compo sition as a solution of 1 liter is as follows : protein 2.4% lactose ' 3.1% fat 1.3% calories 514
M © O
TA BLE 1 :
No.
Name
Ef f e c t s of Low Lactose M&k C’Eiwit M elk” ) in Low Birth W eight infants with diarrhoea
Body weight Age on admission (days) (gram )
Increase of j D uration of Body weight HospitaliHb within 4 zation w eeks t (sm % ) (weeks) (gram ) j
D isappearance o f D iarrhoea (day)
W orking Diagnosis SI/I.G.
R esults E
G ’
SI :
U D S N D D M T E D S E I N A M S N .N A
22 10 10 30 14 30 23 4 9 9 24 5 10 13 12 13 28 30 37 15
S u g ar Intolerance;
2100 1730 1800 1900 2000 2300 1700 2300 1850 2325 2100 2380 2400 2300 2450 2320 2150 2300 2100 2200 IG :
2 1 1 1 2 1 1 1 1 3 1 3 1 1 1 2 3 1 3 1
400 160 40 760 400 900 900 500 100 173 800 300 1100 400 1200 310 270 900 0 400
Infection of the .Gut;
19.5 18.0 20.5 9.6 17.2 13.3 20.2 13.6 22.0 17.5 16.5 13.2 17.3 13.0 22.0 12.5 11.5 18.9 8.8 16.4 E
:
E xcellen t;
5 3 2 2 6
th rd nd nd th
1
St
2 2 3 8 3 12 4 3 1 9 12 1 5 2
nd nd rd th rd th th rd st th th st th nd
G :
Good;
SI + SI + SI + SI + SI SI + SI S I “f SI + SI S I ■+' SI + SI SI + SI + SI SI + SI + P :
IG IG IG IG IG IG
+
+ + + + +
+
IG IG IG IG IG
+ +
+
IG IG IG IG
Poor
+
+
+ 4-
T B . B A G D A D IJI E T AL
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
p •
TABLE 1 (continued).
No.
Body weight Name Age on admission (days) (gram )
Increase of D uration of Body weight Hospitali within 4 zation weeks (weeks) (gram )
Ht» (sm % )
Disappearance o f D iarrhoea (day)
W orking Diagnosis SI/I.G.
R esults E
G
P
-
N B W M S
32. 33. 34. 35. 36. 37. 38. 39.
M R
23 22 2 20 14 12 10 7 8 40 22
2420 2450 2480 2100 2400 2400 2400 2150 2050 2250 2400
1 2 1 3 2 1 2 1 4 0
0
360 0 0 400 0 1000 160 1200 700 0 0
R M L S U A J M
12 5 8 30 3 40 15 4
1950 2400 2350 2450 2200 2400 2400 2340
2 1 4 1 1 1 3 1
0 1000 480 0 200 740 1030 440
s s V u
S.I. =
'
8.8 21.3 22.7 16.5 22.0 17.8 17.8
4 7 1 8 12 4 9 5 16 11
th th st th th th th th th th
18.5 10.3 18.8 (run without permission) 8 th 13.5 15.8 2 nd 14 th 19.9 10.8 3 rd 18.8 1 st 13.2 4 th 13.6 9 th 20.0 2 nd
Su g ar Intolerance; I.G. = Infection of the Gut; E == E x cellen t.; G =
Good;
SI SI + SI SI + SI + IG SI + SI SI + SI + SI + SI SI SI SI SI SI SI SI
+ IG
-L
+ + +
IG IG IG
+ +
IG IG IG
+ + + "f +
+ IG + + + +
IG IG IG IG
+ IG
P =
Poor.
+
+ + + +
+ +
■
E F F E C T O F EIW XT M E LK
21. 22. 23. 24. 25. 26. 27. 28. 29. 30 31.
©
Ef f e c t of SGM in L B W infants with diarrhoea.
TA BLE 2 :
1. 2. S. 4. 5. 6. 7. 8.
Name
S
W A J N S J
w
31 24 11 15 13 6 15 4
2360 2400 2450 2400 2480 1000 1770 2000
S I = Sugar intolerance; IG = E = E xcellen t; G = Good; P = Poor.
Duration of Increase of Disappearance H ospitali Body weight Hb 1 within 4 zation (gm % ) | o f D iarrhoea weeks (day) (weeks) (gram ) 1 1 2 3 1 1 3 1
1160 920 400 0 880 600 310 400
Infection of the gut;
8.6 15.7 16.8 19.5 15.0 11.0 14.8
4 3 8 10 2 2 4 5
th th th th th th th th
i
W orking Diagnosis SI/I.G.
IG IG S I + IG IG IG IG S I + IG S I + IG
Results E
+ +
+ +
G
P
+
+ + + +
T B . B A G D A D IJI E T AL,
No.
Body weight Age on admission (days) (gram )
TA BLE 3 :
Sum m ary of the tria l on 39 L B W infants Number of Subjects
Age
IG
R esults S I + IG
E
G
P
23
7
1
15
6
1
16
15 days — 1 month
16
1
1
ii
3
2
11
39
11
2
26
9
3
27
Good; P =
Poor.
Sum m ary of the Trial on S L B W infants vMh diarrhoea refed with SG-M
Age
Number of Su b jects
0 — 15 days
W orking diagnosis SI
IG
4
1
1
15 days 1 month
4
2
Total
8
3
E xcellen t; G =
Good; P =
Results S I + IG
E
G
P
2
1
—
3
1
1
2
—
2
2
3
3
—
5
E F F E C T O F EXW IT MEL.IC
E xcellen t; G =
TA BLE 4 :
E =
W orking diagnosis SI
0 — 15 days
Total E =
with diarrhoea refed with EM
Poor.
8
CO
T B . B A G D A D IJI E T A L
204
There were no other serious con ditions except enteritis. One infant died 'because of worsening of the enteritis. The nutritional status was evalua ted weekly until approximately 4 weeks of hospitalization.
Results The criteria of growth used are as follows : Excellent, if the increase of body weight within 1 month (4 weeks) divided by the natural optimal in crease reflected by body weight and age is more than one. Example : A 31-day-old Infant with a body weight of 2.000 grams on admission was hospitalized during 4 weeks. On discharge, the body weight was 3.000 grams. So the increase of body weight within one month (4 weeks) was 1.000 grams. The natural optimal monthly in crease of an infant with a body weight of 2.000 grams as a healthy infant, of the first trimester of age is 750 grams. Increase of body weight (1 month) optimal increase (1 month)
1.000 750 The result in this patient is con sidered excellent.
Good, if the ratio obtained ac cording to the above mentioned cal culation is approximately 1. Exam ple: A 30-day-old infant, with a body weight of 1.900 grams on ad mission, was hospitalized during 4 weeks. On discharge, the body weight was 2.650 grams. So the increase of body weight within one month (4 weeks) is 650 grams. The natural optimal monthly in crease of an infant with a body weight of 1.900 grams as a healthy infant, of the first trimester of age is 750 grams. Increase of body weight (1 month) optimal increase (1 month) 750 750 The result in this patient is con sidered good. Poor, if the ratio is less than 1. Example : A 38-day-old infant, with a body weight of 2.340 grams on admission, was hospitalized during 4 weeks. On discharge, the body weight was 2.740 grams. So the increase ®f body weight within one month (4 weeks) was 400 grams. The natural optimal monthly in crease of an infant with a body
EFFEC T
O F E IW IT M EL K
weight of 2.340 grams as a healthy infant, of the first trimester of age is 750 grams. Increase of body weight (1 month) optimal increase (1 month) 400 = ------ = < 1. 750
lining of the luminal surface of the intestinal epithelium, and therefore are liable to be effected in any disor der in which the intestinal mucosa is damaged. Examples are gastroenteritis, pro tein calorie malnutrition and some parasitic infestations.
The result in this patient is consi dered poor. The result of this study can be seen in tables 1 and 2. Table 1 shows the effect ’’Eiwit Melk” as follows : excellent on 9 out if 39 patients 23.1% good on 3 out of 39 patients 7.6% excellent on 3 out of 8 patients 69.6%
205
of = = =
Table 2 shows the effect of SGM as follows : excellent on 3 out of 8 patients = 37.5% good on 0 out of 8 patients = 0% poor on 5 out of 8 patients = 62.5% Discussion As it has been described earlier, there will be a low concentration of lectase in low birth weight infants, It is justifiable that we choose a low or free lactose milk for those low birth weight babies. Miller and Crane (1964) stated that diisaocharidases are found within the brush border
Normally, lactase is present in lower concentration as compared with other brush border disaccharidases (Dahlqvist, 1964); ft 'is allso the last to recover completely follow ing mucosal damage (Plotkin and Isselbacher, 1964). Compared to older infants with diarrhoea, the incidence of fat malabsorption in low birth weight infants with diarrhoea is much higher due to possibly per sisting immature function of the organs e.g. liver, pancreas, intestine etc. next to the inadequate condition of the epithelial cells caused by the diarrhoea. From the study on 26 Indonesian infants with diarrhoea, 80.8% shows, fat malabsorption (Gracey et al., 1974), So, in treating diarrhoeal low birth weight infants, besides low or lactose free formula milk containing easily absorbable fats should also be seriously considered. From the present study, it got only 23.1% excellentand 7.6% good results in treating those low birth weight infants with milk containing only low lactose (see table 1).
206
T B . B A G D A D IJI E T A L
The results of SGM to 8 other low birth weight infants were also poor for the majority (see table 2 ). This latter is not surprising since SGM contains more lactose than "Eiwit Melk”. In general, the conclusion drawn
from this trial is that, formulas with low lactose alone in low birth weight infants with diarrhoea will not give good results; other factors such as poor fat absorption due to persist ing immaturity of the enzymes pro ducing organs might play a similar important role.
REFEREN CES 1. A U RICCH IO, S., RU BIN O , N. and M U R S E T , G. : In testin al glucosidase activ ities in human embryo, fetu s and newborn. Pediatr. 35 : 944 (1965). 2. B A Y L E S S , T.M. and C H R ISTO P H E R , N .L. : D isaccharidase deficiency. Am. J . clin. Nutr. 22 ; 181 (1969). 3. D A H LQ V IST, S .: Method fo r assay of intestinal disaccharidases. A nalyt. Biochem. 7 : 18 (1964).
sport. Arch. (1957).
Dis.
Childh.
212 : 341
6. M IL L E R , D. and C R A N E , R .K .: The digestive function of th e epithelium of the sm all intestine. Bioehem . Biophys. A cta 52 : 293 (1961). 7. P LO TK IN , C.R. and I S S E L B A C H ER , K .J. : Secondary d isaccharidase defi ciency in m alabsorption s ta te s . N, Engl. J.M ed. 27 : 1033 (1964).
4. G R A C E Y, M., THOMAS, J . , SU H A RJO N O and H EN TYA N TO H EN D ARD J I : A ssessm ent of steatorrhoea in malnourished children. Lipiodol absor ption test. Environ. Child Hlth. 20:223 (1972).
8. SUH ADRJO N O , I.G.N. W IL A W IR YA, SAM SUDIN , SUN OTO, Z EIN . SU LA IM A N and S U T E D JO : E ffe c t o f low lacjose m ilk on protein calorie m alnutrition. P resentel a t the F irst Asian P ediatric Congress, M anila, May 1974. Paediatr. Indones in iprinp
5: H O LZEL, A. : Su g ar m alabsorption due to deficiencies of disaccharidase activities and of monosaccharide tra n
9. W A L K E R SM ITH , J.A . : D iseases of the sm all bowel in childhood. Postgrad, med. J . 46 : 300 (1970).
