Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1990 Mar 31;300(6728):837–840. doi: 10.1136/bmj.300.6728.837

Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study.

A Lucas 1, O G Brooke 1, R Morley 1, T J Cole 1, M F Bamford 1
PMCID: PMC1662577  PMID: 2186825

Abstract

OBJECTIVE--To study the effect of early diet on the development of allergic reactions in infants born preterm. DESIGN--Two randomised prospective trails. In trail A infants were randomly allocated banked donor milk or preterm formula as their sole diet or (separately randomised) as a supplement to their mother's expressed breast milk. In trial B infants were allocated term or preterm formula. A blind follow up examination was done 18 months after the expected date of birth. SETTING--Neonatal units of hospitals in Cambridge, Ipswich, King's Lynn, Norwich, and Sheffield. Outpatient follow up. PARTICIPANTS--777 Infants with a birth weight less than 1850 g born during 1982 to 1984. MAIN OUTCOME MEASURES--Development of eczema, allergic reactions to food or drugs, and asthma or wheezing by nine and 18 months after term. Whenever possible the observations were confirmed by rechallenge or clinical examination. RESULTS--At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial. In the subgroup of infants with a family history of atopy, however, those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions (notably eczema) by 18 months (odds ratio 3.6; 95% confidence interval 1.4 to 9.1). CONCLUSIONS--Feeding neonates on formulas based on cows' milk, including those with a high protein content, did not increase the overall risk of allergy. Nevertheless, in the subgroup with a family history of atopy early exposure to cows' milk increased the risk of a wide range of allergic reactions, especially eczema.

Full text

PDF
837

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Antonowicz I., Lebenthal E. Developmental pattern of small intestinal enterokinase and disaccharidase activities in the human fetus. Gastroenterology. 1977 Jun;72(6):1299–1303. [PubMed] [Google Scholar]
  2. Bisgaard H., Dalgaard P., Nyboe J. Risk factors for wheezing during infancy. A study of 5,953 infants. Acta Paediatr Scand. 1987 Sep;76(5):719–726. doi: 10.1111/j.1651-2227.1987.tb10555.x. [DOI] [PubMed] [Google Scholar]
  3. Brooke O. G., Wood C., Barley J. Energy balance, nitrogen balance, and growth in preterm infants fed expressed breast milk, a premature infant formula, and two low-solute adapted formulae. Arch Dis Child. 1982 Dec;57(12):898–904. doi: 10.1136/adc.57.12.898. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chandra R. K. Prospective studies of the effect of breast feeding on incidence of infection and allergy. Acta Paediatr Scand. 1979 Sep;68(5):691–694. doi: 10.1111/j.1651-2227.1979.tb18439.x. [DOI] [PubMed] [Google Scholar]
  5. Croner S., Kjellman N. I., Eriksson B., Roth A. IgE screening in 1701 newborn infants and the development of atopic disease during infancy. Arch Dis Child. 1982 May;57(5):364–368. doi: 10.1136/adc.57.5.364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fälth-Magnusson K., Oman H., Kjellman N. I. Maternal abstention from cow milk and egg in allergy risk pregnancies. Effect on antibody production in the mother and the newborn. Allergy. 1987 Jan;42(1):64–73. doi: 10.1111/j.1398-9995.1987.tb02189.x. [DOI] [PubMed] [Google Scholar]
  7. Gross S. J. Growth and biochemical response of preterm infants fed human milk or modified infant formula. N Engl J Med. 1983 Feb 3;308(5):237–241. doi: 10.1056/NEJM198302033080501. [DOI] [PubMed] [Google Scholar]
  8. Kjellman N. I. Atopic disease in seven-year-old children. Incidence in relation to family history. Acta Paediatr Scand. 1977 Jul;66(4):465–471. doi: 10.1111/j.1651-2227.1977.tb07928.x. [DOI] [PubMed] [Google Scholar]
  9. Lindfors A., Enocksson E. Development of atopic disease after early administration of cow milk formula. Allergy. 1988 Jan;43(1):11–16. doi: 10.1111/j.1398-9995.1988.tb02038.x. [DOI] [PubMed] [Google Scholar]
  10. Lucas A., Brooke O. G., Baker B. A., Bishop N., Morley R. High alkaline phosphatase activity and growth in preterm neonates. Arch Dis Child. 1989 Jul;64(7 Spec No):902–909. doi: 10.1136/adc.64.7_spec_no.902. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lucas A., Gore S. M., Cole T. J., Bamford M. F., Dossetor J. F., Barr I., Dicarlo L., Cork S., Lucas P. J. Multicentre trial on feeding low birthweight infants: effects of diet on early growth. Arch Dis Child. 1984 Aug;59(8):722–730. doi: 10.1136/adc.59.8.722. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lucas A., McLaughlan P., Coombs R. R. Latent anaphylactic sensitisation of infants of low birth weight to cows' milk proteins. Br Med J (Clin Res Ed) 1984 Nov 10;289(6454):1254–1256. doi: 10.1136/bmj.289.6454.1254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lucas A., Morley R., Cole T. J., Gore S. M., Davis J. A., Bamford M. F., Dossetor J. F. Early diet in preterm babies and developmental status in infancy. Arch Dis Child. 1989 Nov;64(11):1570–1578. doi: 10.1136/adc.64.11.1570. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mellander L., Carlsson B., Hanson L. A. Secretory IgA and IgM antibodies to E. coli O and poliovirus type I antigens occur in amniotic fluid, meconium and saliva from newborns. A neonatal immune response without antigenic exposure: a result of anti-idiotypic induction? Clin Exp Immunol. 1986 Mar;63(3):555–561. [PMC free article] [PubMed] [Google Scholar]
  15. Michel F. B., Bousquet J., Greillier P., Robinet-Levy M., Coulomb Y. Comparison of cord blood immunoglobulin E concentrations and maternal allergy for the prediction of atopic diseases in infancy. J Allergy Clin Immunol. 1980 Jun;65(6):422–430. doi: 10.1016/0091-6749(80)90234-1. [DOI] [PubMed] [Google Scholar]
  16. Midwinter R. E., Morris A. F., Colley J. R. Infant feeding and atopy. Arch Dis Child. 1987 Sep;62(9):965–967. doi: 10.1136/adc.62.9.965. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Müller W., Rieger C. H., von der Hardt H. Increased concentrations of milk antibodies in recurrent pulmonary aspiration in infants and young children. Acta Paediatr Scand. 1985 Sep;74(5):660–663. doi: 10.1111/j.1651-2227.1985.tb10008.x. [DOI] [PubMed] [Google Scholar]
  18. Price J. ABC of asthma. Asthma in children: diagnosis. Br Med J (Clin Res Ed) 1984 Jun 2;288(6431):1666–1668. doi: 10.1136/bmj.288.6431.1666. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Roberton D. M., Paganelli R., Dinwiddie R., Levinsky R. J. Milk antigen absorption in the preterm and term neonate. Arch Dis Child. 1982 May;57(5):369–372. doi: 10.1136/adc.57.5.369. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Savilahti E., Tainio V. M., Salmenperä L., Siimes M. A., Perheentupa J. Prolonged exclusive breast feeding and heredity as determinants in infantile atopy. Arch Dis Child. 1987 Mar;62(3):269–273. doi: 10.1136/adc.62.3.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Taylor B., Wadsworth J., Wadsworth M., Peckham C. Changes in the reported prevalence of childhood eczema since the 1939-45 war. Lancet. 1984 Dec 1;2(8414):1255–1257. doi: 10.1016/s0140-6736(84)92805-8. [DOI] [PubMed] [Google Scholar]
  22. Van Asperen P. P., Kemp A. S., Mellis C. M. Relationship of diet in the development of atopy in infancy. Clin Allergy. 1984 Nov;14(6):525–532. doi: 10.1111/j.1365-2222.1984.tb02239.x. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES