Perinatal Nutrition: Optimizing Infant Health and Development
http://www.100md.com
《新英格兰医药杂志》
Good nutrition is essential for increasing survival rates among infants born prematurely in resource-rich countries and among those born in poorer circumstances — babies who often have low birth weight despite having had a full-term delivery. Such infants are at long-term risk for growth failure and substantial morbidity and mortality due to malnutrition. This book, a compilation of scientific and dietary advice regarding perinatal nutrition and nutrition in pregnant and lactating mothers, is timely, and its mixture of practical, "how to" chapters and those on theoretical topics will appeal to a wide range of readers.
Currently, dietary recommendations in the United States are in a state of flux. The well-known recommended dietary allowances (RDAs), most recently revised in 1989, have been replaced during the past eight years by a series of dietary-guideline books that contain unfamiliar new terms such as "estimated average requirement" and "upper limit." Food labels continue to use the daily values, which are actually based on the 1968 RDA values and are frequently not easily adapted to the needs of small children or their mothers. There are additional dietary recommendations for infants in the Infant Formula Act and many authoritative panel statements by the World Health Organization (WHO). It is therefore necessary to be cautious about applying any set of guidelines, including those in this book, to such a rapidly changing target.
Unfortunately, this book mixes together old and new guidelines and their conflicting advice. This is particularly problematic for the maternal recommendations in chapter 3, which follow 1989 RDA values in recommending that daily calcium intake increase substantially during pregnancy. Chapter 2 accurately notes that an increase in calcium intake has not been recommended in the United States since 1997, when guidelines noted that such a change was not supported by scientific evidence.
Other controversies do not clearly reflect consensus views. For example, a long chapter on weaning contains multiple references to the view of a single scientist who believes that breast-fed babies require supplementation of iron from birth. Although an opposing view is indicated, it is not clear from the text that recent position statements by the WHO and the American Academy of Pediatrics recommend against the introduction of solid foods or iron supplements to the diet before six months of age for healthy, full-term, breast-fed infants.
The book closes with a remarkable chapter regarding the ethics of withholding nutrition from terminally ill neonatal patients. This clear discussion of a timely topic is well worth careful reading and consideration. The view that death by withdrawal of nutrition from appropriate palliative care in terminal cases is "comfortable" is consistent with my experience and is a most welcome contribution to the discussion of this topic. Neonatal caregivers at the forefront of such difficult decisions are in need of this kind of discussion before they themselves become headlines.
Steven Abrams, M.D.
Baylor College of Medicine
Houston, TX 77030
sabrams@bcm.edu((Nutrition and Disease Pr)
Currently, dietary recommendations in the United States are in a state of flux. The well-known recommended dietary allowances (RDAs), most recently revised in 1989, have been replaced during the past eight years by a series of dietary-guideline books that contain unfamiliar new terms such as "estimated average requirement" and "upper limit." Food labels continue to use the daily values, which are actually based on the 1968 RDA values and are frequently not easily adapted to the needs of small children or their mothers. There are additional dietary recommendations for infants in the Infant Formula Act and many authoritative panel statements by the World Health Organization (WHO). It is therefore necessary to be cautious about applying any set of guidelines, including those in this book, to such a rapidly changing target.
Unfortunately, this book mixes together old and new guidelines and their conflicting advice. This is particularly problematic for the maternal recommendations in chapter 3, which follow 1989 RDA values in recommending that daily calcium intake increase substantially during pregnancy. Chapter 2 accurately notes that an increase in calcium intake has not been recommended in the United States since 1997, when guidelines noted that such a change was not supported by scientific evidence.
Other controversies do not clearly reflect consensus views. For example, a long chapter on weaning contains multiple references to the view of a single scientist who believes that breast-fed babies require supplementation of iron from birth. Although an opposing view is indicated, it is not clear from the text that recent position statements by the WHO and the American Academy of Pediatrics recommend against the introduction of solid foods or iron supplements to the diet before six months of age for healthy, full-term, breast-fed infants.
The book closes with a remarkable chapter regarding the ethics of withholding nutrition from terminally ill neonatal patients. This clear discussion of a timely topic is well worth careful reading and consideration. The view that death by withdrawal of nutrition from appropriate palliative care in terminal cases is "comfortable" is consistent with my experience and is a most welcome contribution to the discussion of this topic. Neonatal caregivers at the forefront of such difficult decisions are in need of this kind of discussion before they themselves become headlines.
Steven Abrams, M.D.
Baylor College of Medicine
Houston, TX 77030
sabrams@bcm.edu((Nutrition and Disease Pr)