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Intestinal blood loss during cow milk feeding in older infants: quantitative measurements
T Jiang1, J M Jeter, S E Nelson
1Department of Pediatrics, The University of Iowa, Iowa City, USA.
Insights
Cow milk consumption causes minimal fecal blood loss in 9 1/2-month-old infants, with a 29% response rate. While not clinically significant, infants with blood loss had poorer iron status.
Area of Science:
- Pediatric Nutrition
- Gastroenterology
- Hematology
Background:
- Cow milk is a common infant food, but its potential to cause gastrointestinal blood loss is a concern.
- Previous studies indicated blood loss in younger infants, but data for 9 1/2-month-olds is limited.
Purpose of the Study:
- To assess fecal hemoglobin excretion and clinical symptoms in 9 1/2-month-old infants fed cow milk.
- To compare the response to cow milk with baseline formula feeding.
Main Methods:
- A longitudinal before-after trial involving 31 healthy infants.
- Infants were fed formula for 1 month, followed by 3 months of cow milk.
- Measured fecal hemoglobin concentration, quantitative excretion, stool characteristics, and iron status.
Main Results:
- Nine of 31 infants (29%) showed increased fecal hemoglobin excretion in response to cow milk.
- The increase in fecal hemoglobin was modest and not associated with clinical symptoms or changes in stool characteristics.
- Responders had lower ferritin concentrations after 3 months of cow milk feeding compared to non-responders.
Conclusions:
- Cow milk-induced fecal blood loss occurs in 9 1/2-month-old infants but is generally of low intensity.
- The clinical significance of this low-level blood loss appears questionable.
- Infants without cow milk-induced blood loss maintained better iron nutritional status.
Objective:
To determine the response, in terms of fecal hemoglobin excretion and clinical symptoms, of normal 9 1/2-month-old infants to being fed cow milk.
Design:
Longitudinal (before-after) trial in which each infant was fed formula for 1 month (baseline) followed by 3 months during which cow milk was fed.
Setting:
Healthy infants living in Iowa City, Iowa, a town with a population of about 60,000.
Main Outcome Measures:
Hemoglobin concentration in spot stools, 96-hour quantitative fecal hemoglobin excretion, stool characteristics, feeding-related behaviors, and iron nutritional status.
Results:
Fecal hemoglobin concentration during formula feeding (baseline) was higher than previously observed in younger infants. Nine of 31 infants responded to cow milk feeding with increased fecal hemoglobin concentration. Fecal hemoglobin concentration (mean +/- SD) of the 9 responders rose from 1,395 +/- 856 microg/g of dry stool (baseline) to 2,711 +/- 1,732 microg/g of dry stool (P=.01). The response rate (29%) was similar to that in younger infants, but the intensity of the response was much less. Quantitative hemoglobin excretion was in general agreement with estimates based on spot stool hemoglobin concentrations. Cow milk feeding was not associated with recognizable changes in stool characteristics, nor were there clinical signs related to fecal blood loss. Iron status was similar, except that after 3 months of cow milk feeding responders showed lower (P= .047) ferritin concentrations than nonresponders.
Conclusions:
Cow milk-induced blood loss is present in 9 1/2-month-old infants but is of such low intensity that its clinical significance seems questionable. Nevertheless, infants without cow milk-induced blood loss were in better iron nutritional status than infants who showed blood loss.