Energy Balance and the Nature of Growth in Low Birthweight Infants

  • R. K. Whyte
  • J. C. Sinclair
  • H. S. Bayley


Human milk, either from milk banks or as milk expressed by the baby’s own mother, is often considered the feed of first preference for low birthweight infants. Infant formulas (“preterm formulas”) are now available which have been designed to address the theoretical nutritional needs of growing low birthweight infants, and unlike previous formulas there is a deliberate departure in their design from the composition of human milk. A number of studies have shown that infants fed with banked human milk gain weight more slowly than do the infants fed with a “regular” 2.8 mJ/L (20 kcal/oz) commercial formula (1,2,3,4) and that the advantage in weight gain is even more striking when infants fed with 3.5 mJ/L (24 kcal/oz) formulas are compared to those fed with banked human milk (4,5,6). It has been demonstrated that in many of these studies the methods used for collecting human milk for banking resulted in a banked milk of exceptionally low nutrient content (5,6), and feedings with mother’s own expressed breast milk gave rates of weight gain comparable to those of infants fed with regular formula (3). Nevertheless, low birthweight infants fed with high-energy, protein and mineral containing “preterm” formulas appear to experience much greater weight gains than do infants fed with their own mother’s expressed breast milk.


Weight Gain Premature Infant Human Milk Body Cell Mass Express Breast Milk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    H.H. Gordon, S.Z. Levine, and H. McNamara, Feeding of premature infants: a comparison of human and cow’s milk, Am. J. Dis. Child 73: 442–452 (1947).Google Scholar
  2. 2.
    D.P. Davies, Adequacy of expressed breast milk for early growth of preterm infants, Arch. Dis. Child 52:296–301 (1977).CrossRefGoogle Scholar
  3. 3.
    S.A. Atkinson, H. Bryan, and G.H. Anderson, Human milk feeding in premature infants: protein, fat, and carbohydrate balances in the first two weeks of life, J. Pediatr. 99:617–624 (1981).CrossRefGoogle Scholar
  4. 4.
    W.B. Omans, L.A. Barness, C.S. Rose, and P. Gyorgy, Prolonged feeding studies in premature infants, J. Pediatr. 59:951–957 (1961).CrossRefGoogle Scholar
  5. 5.
    O.G. Brooke, C. Wood, and J. Barley, Energy balance, nitrogen balance, and growth in preterm infants fed expressed breast milk, a premature infant formula, and two low-solute adapted formulae, Arch. Pis. Child 57:898–904 (1982).CrossRefGoogle Scholar
  6. 6.
    J.E. Tyson, R.E. Lasky, C.E. Mize, C.J. Richards, N. Blair-Smith, R. Whyte, and A. Beer, Growth, metabolic response, and development in very-low-birth-weight infants fed banked human milk or enriched formula 1. Neonatal findings, J. Pediatr. 103:95–104 (1983).CrossRefGoogle Scholar
  7. 7.
    A. Lucas, S.M. Gore, T.J. Cole, M.F. Bamford, J.F.B. Possetor, I. Barr, L. Picarlo, S. Cork, and P.J. Lucas, Multicentre trial on feeding low birthweight infants: effects of diet on early growth, Arch. Pis. Child. 59:722–730 (1984).CrossRefGoogle Scholar
  8. 8.
    B.M. Kagan, J.H. Hess, E. Lundeen, K. Shafer, J.B. Parker, C. Stigall, Feeding premature infants:a comparison of various milks, Pediatrics 15:373–382 (1955).Google Scholar
  9. 9.
    N. Raiha, K. Heinonen, P. Rassin, and G.E. Gaull, Milk protein quantity and quality in low-birthweight infants: 1. Metabolic responses and effects on growth, Pediatrics 57:659–674 (1976).Google Scholar
  10. 10.
    L. Novak, Total body potassium in the first year of life determined by whole-body counting of 40K, J. Nucl. Med. 14:550–557 (1973).Google Scholar
  11. 11.
    R.K. Whyte, H.S. Bayley, and H.P. Schwarz, The measurement of whole body water by H2O18 dilution in newborn pigs, Am J. Clin. Nutr. 41:801–809 (1985).Google Scholar
  12. 12.
    F.L. Trowbridge, G.G. Graham, W. Wong, E.P. Mellits, J.P. Rabold, L.S. Lee, M.P. Cabrera, and P. Klein, Body water measurements in premature and older infants using H2O18 isotopic determinations, Pediatr. Res. 18:524–527 (1984).CrossRefGoogle Scholar
  13. 13.
    F.D. Moore, K.H. Otesen, J.D. McMuney, V.H. Parker, H.R. Ball, and B.M. Boyden, The body cell mass and its supporting environment, in: “Body Composition in Health and Disease,” W.B. Saunders, Philadephia (1963).Google Scholar
  14. 14.
    S.J. Fomon, Comment on metabolic balance studies as a method of measuring body composition, Pediatrics 29:495–498 (1962).Google Scholar
  15. 15.
    A.L. Merrill, and B.K. Watt, Energy value of foods: basis and derivation, “Agricultural Handbook No. 74,” United States Department of Agriculture (1973).Google Scholar
  16. 16.
    E.M. Widdowson and J.W.T. Dickerson, Chemical composition of the body, in: “Mineral Metabolism: An Advanced Treatise,” C.L. Comar, F. Bronner, eds., Vol. IIA, Academic Press, New York (1964).Google Scholar
  17. 17.
    M.T. Clandinin, J.E. Chappell, T. Heim, P.R. Swyer, and G.V. Chance, Fatty acid utilization in perinatal de novo synthesis, Early Hum. Dev. 5:355–366 (1983).CrossRefGoogle Scholar
  18. 18.
    E.E. Ziegler, A.M. O’Donnell, J.E. Nelson, and S.J. Fomon, Body composition of the reference fetus, Growth 40:329 (1976).Google Scholar
  19. 19.
    S.J. Fomon, Body composition of the male reference infant during the first year of life, Pediatrics 40:863–870 (1967).Google Scholar
  20. 20.
    R.K. Whyte, R. Haslam, H.S. Bayley, C. Vlainic, S. Shannon, K. Samulski, D. Campbell, H.S. Bayley, and J.C. Sinclair, Energy balance and nitrogen balance in growing low birthweight fed human milk or formula, Pediatr. Res. 17:891–898 (1983).CrossRefGoogle Scholar
  21. 21.
    Ross Laboratories, Similac/Similac with iron, Product monograph, Ross laboratories, Columbus, Ohio (1978).Google Scholar
  22. 22.
    J.E. Chappell, M.T. Clandinin, C. Kearney-Volpe, B. Reichmann, and P.R. Swyer, Fatty acid balance studies in premature infants fed human milk or formula: effect of calcium supplementation, J. Pediatr. 108:439–447 (1986).CrossRefGoogle Scholar
  23. 23.
    N. Baba, E.F. Bracco, and S.A. Hashim, Enhanced thermogenesis and diminished deposition of fat in response to overfeeding with diet containing medium chain triglyceride, Am. J Clin. Nutr. 35:678–682 (1982).Google Scholar
  24. 24.
    R.K. Whyte, R. Stanhope, D. Campbell, H.S. Bayley, and J.C. Sinclair, Energy balance of growing low birthweight infants fed with medium or long chain triglycerides, J. Pediatr. 108:964–971 (1986).CrossRefGoogle Scholar
  25. 25.
    R.K. Whyte, H.S. Bayley, and J.C. Sinclair, Energy intake and the nature of growth in low birthweight infants, Can. J. Physiol. Pharm. 632:565–570 (1985).CrossRefGoogle Scholar
  26. 26.
    B.L. Reichman, P. Chessex, G. Putet, G.J.E. Verrellen, G. Putet, J.M. Smith, T. Heim, and P.R. Swyer, Diet, fat accretion and growth in preterm infants, N. Eng. J. Med. 305:1495–1500 (1982).CrossRefGoogle Scholar
  27. 27.
    P. Chessex, G. Reichman, G. Verellen, G. Putet, J.M. Smith, T. Heim, and P.R. Swyer, Quality of growth in premature infants fed their own mothers milk, J. Pediatr. 102:107–112 (1983).CrossRefGoogle Scholar
  28. 28.
    G. Putet, J. Senterre, J. Rigo, and B. Salle, Nutrient balance, energy utilization, and composition of weight gain in very-low-birth-weight infants fed pooled human milk or a preterm formula, J. Pediatr. 105:79–85 (1984).CrossRefGoogle Scholar
  29. 29.
    R.K. Whyte, D. Whelen, R. Hill, and S. McClorry, Excretion of dicarboxylic and-1 hydroxy fatty acids by low birthweight infants fed with medium-chain triglycerides, Pediatr. Res. 20:122–125 (1986).CrossRefGoogle Scholar
  30. 30.
    M.T. Clandinin, C.J. Field, K. Hargreaves, L. Morson, and E. Zsigmond, Role of diet fat in subcellular structure and function, Can. J. Physiol. Pharmacol. 63:546–555 (1985).CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1987

Authors and Affiliations

  • R. K. Whyte
    • 1
    • 2
  • J. C. Sinclair
    • 1
    • 2
  • H. S. Bayley
    • 1
    • 2
  1. 1.Department of PediatricsMcMaster UniversityHamiltonCanada
  2. 2.The Department of NutritionUniversity of GuelphGuelphCanada

Personalised recommendations