Letters to the Editor

Nutritional Dear

status

of infants

with

cystic

et al (1)

concerning

fibrosis

Sir:

The

recent

publication

nutritional Wisconsin

by

status of infants screening program

the

investigation For unspecified document either the individual description

Marcus

with cystic fibrosis (CF) raises many concerns

and management of infants reasons the authors chose the absorptive or pancreatic

patients. Instead, they or their own subjective

the

from the regarding

with CF. not to objectively function status

of many

of

relied on either the mother’s impression of the infants’

erage Note almost

1 SD below

evidence

absorption or that based and is inappropriate. In a large study of the

can

because,

CF (aged pancreatic and/or zyme

therapy.

pancreatic

8 wk)

48%

studies In fact,

of the

subsequently these results

function

(2) and

therefore

infants

had

pancreatic

function

appropriate measuring

oral enzyme-replacement the absorptive status,

absorption

the

who

expense

did

not

and

an extra

require

interpretation up to 12 mo

of infants’ of age, and

any meaningful requirements.

For

conclusions instance,

and biochemical indices infants with appropriate

(3). The Objective

intervention.

status

further

for

absorptive

Finally, to feed

Am

therefore

only

The

and even therapy

infants

J C/in Nuir

with

promote CF

1992:56:955-61.

despite

the the

health-

Printed

cost

and

complicates

the

in USA.

predigested the

natural

provide

infants

the benefits

good

formulas be questioned

far-less-expensive,

to

standard-

better.

Wisconsin for CF

program for deteris valid, it is vital that

is carried

out

in an objective

of the subsequent could invalidate

or disadvantages

data any

of screening.

Children’s

Institute

of Paediatric

Clinical

Dorney

Nutrition

Hospital Sydney

References 1. Marcus

formula desire

Downloaded from https://academic.oup.com/ajcn/article-abstract/56/5/955/4715574 by Washington University, Law School Library user on 09 April 2018

assessin av-

NSW 2050 Australia

in infants of their

© 1992 American

Fairfax

Camperdown,

and

in the majority of CF and supplements.”

use ofa

(4)

or the with

P0 Box 34

status.

the authors

by an results

Stuart

to administer

about dietary intakes be made after an assessment

the if not

of the screening

of these

regarding

study

Kevin Gaskin Donna Waters Jane Allen James

growth and biochemical data it virtually impossible to make

can be achieved dietary intervention

on

conclusions

necessity

is an unnecessary

for parents

infants do as well,

we

about energy and micronutrient they conclude that “normal growth

Recommendations

CF can

certainly, regimens

6of of

(2-4 wk, ofenzyme

observations

scientific fashion. If not, then any be questioned, and very importantly,

importance definition the

These

management

(age a figure

the median.

the practice of feeding predigested CF from a screening program should

and can

However, it may well be that a sizeable proportion ofthese infants had pancreatic sufficiency with normal absorption and therefore would have thrived with normal biochemical status without any with

with

(as determined function status),

the

en-

A recent

breast-feeding, formula,

near the zero Z score up until 2 y of age. et al study average weight at 6 mo was

Given the importance mining whether or not

therapy. The error of not as was the case in the Marcus

it, which

average makes

require

sufficiency,

determines

burden

patients to receive. Not knowing the absorptive

not diagnosis

et al study, led to delays in starting therapy longer in some cases) or to the administration care

with

that 37% had stimulation tests, did

ofscreening

confirmed in a later report cannot be overemphasized.

pancreatic

to some

infants

be misleading

of 78 infants

to demonstrate by pancreatic

at the time

and

that

feeding

0-4 y), we were able sufficiency as defined fat-balance

gazing”

breast-feeding.

if necessary or pancreatic

growth at or very that in the Marcus

of malabsorption. evaluation of mal-

“stool

to continue

enzyme supplements ment of absorptive

stools to determine the presence or absence We suggest that in the current era, historical on

mothers

of infants with CF has demonstrated that use of a standard cow milk-protein-containing

Society

MS, Sondel SA, Farrell PM, et a!. Nutritional status of infants with cystic fibrosis associated with early diagnosis and intervention. Am I Clin Nutr 199 l;54:578-85. 2. Waters DL, Dorney SFA, Gaskin KJ, Gruca MA, O’Halloran M, Wilcken B. Pancreatic function in infants identified as having cystic fibrosis in a neonatal screening program. N Engl I Med 1990;322: 303-8. 3. Gaskin K, Waters D, Dorney 5, Gruca M, O’Halloran M, Wilcken B. Assessment ofpancreatic function in screened infants with cystic fibrosis. Pediatr Pulmonol 199 1;7(suppl):69-7 1. 4. Holliday KE, Allen IR, Waters DL, Gruca MA, Thompson SM, Gaskin KJ. Growth ofhuman milk-fed and formula-fed infants with cystic fibrosis. I Pediatr 199 1 ; 1 18:77-9.

for Clinical

Nutrition

955