Bottle feeding linked to stomach obstruction in infants

New research says that bottle feeding appears to increase the risk of babies developing hypertrophic pyloric stenosis, a form of stomach obstruction characterized by severe and frequent projectile vomiting and most common among infants in their first 2 months of life.

Surgery, called pyloromyotomy, may be needed to clear the hypertrophic pyloric stenosis (HPS), which occurs when the smooth muscle layer of the pylorus (the "gateway" between the stomach and small intestines) thickens.

Doctors say in the study that although this is a fairly common condition - it occurs in approximately 2 in 1,000 births - the cause remains unknown.

This study,  sets out to establish if bottle feeding during early infancy increases the risk of developing HPS, and if so, how the risk is modified by other factors.

Largest study to date

The study reports that breastfeeding became a target of interest in the 1980s, as researchers noted that an upsurge in the breastfeeding rates coincided with a decrease in the number of cases of HPS.

The doctors claim that this study analyses the largest group of HPS patients with data on infant feeding practices yet studied.

Participants in the study had to be singleton babies under 6 months old who had been both diagnosed with HPS and undergone corrective surgery.

During the time period selected, researchers identified 714 such infants and matched them to "control" babies - ones without HPS.

The researchers do note that as the study is observational, all associations should be interpreted "with caution." They also point out the data of how a baby was fed is based on information provided when the mother and baby were discharged from the hospital.

Some babies who were breastfed initially could have switched to bottle feeding (or vice versa) prior to developing HPS, the researchers say.

There are many reasons why mothers stop breastfeeding their babies, including cracked and sore nipples or mastitis. A report, published by UNICEF, reports that 60% of women did not manage to breastfeed for as long as they would have wanted.

Another potential pitfall in this research is that babies bottle-fed expressed milk are coded as bottle-fed in the data, so interpretations regarding formula milk versus breast milk may also be skewed.

Bottle feeding 'may play a role in HPS'

The researchers found that the incidence of HPS decreased from 14 per 10,000 births in 2003 to 9 per 10,000 births in 2009. They note that the popularity of breastfeeding also increased during that time from 80% in 2003 to 94% in 2009.

The study revealed that bottle-fed infants were more likely to develop HPS, compared with controls (19.5% vs. 9.1%). The odds of an infant developing HPS also increased if they were male, and when mothers were 35 years and older and multiparous (having given birth more than once before.).

The study concludes:

"These data suggest that bottle feeding may play a role in HPS etiology, and further investigations may help to elucidate the mechanisms underlying the observed effect modification by age and parity."

In an accompanying editorial, Dr. writes:

"While the data seem convincing that bottle feeding increases the risk, the reason is not clear."  

"Further understanding of the pathogenesis of hypertrophic pyloric stenosis will come from both basic research and more detailed epidemiologic studies," Dr. concludes.

Dr. and his colleagues agree, adding:

"Further studies are warranted to validate these findings and to look more closely at the speculative mechanisms, including possible hormonal effects, underlying the bottle feeding-HPS association."

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Brain ultrasound to help treat depression, anxiety

Sending ultrasound waves to specific areas of the brain can alter patients' moods, a new study has found.

The discovery by researchers has led them conduct further investigations with the hope that this technique could one day be used to treat conditions such as depression and anxiety.

Hameroff became interested in applying ultrasound to the human brain when he read about a study by a colleague , who found physiological and behavioural effects in animals of ultrasound applied to the scalp, with the waves passing through the skull.

Hameroff knew that ultrasound vibrates in megahertz frequencies at about 10 million vibrations per second, and that microtubules, protein structures inside brain neurons linked to mood and consciousness, also resonate in megahertz frequencies. Hameroff proposed testing ultrasound treatment for mood on human brains.

"I said to my anaesthesiology colleagues, 'we should try this on chronic pain patient volunteers'," he said.

His colleagues respectfully suggested he try it on himself, first. Hameroff acquiesced.

After 15 seconds with an ultrasound transducer, a standard ultrasound imaging device, placed against his head, Hameroff felt no effect.

"I put it down and said, 'well, that's not going to work.' And then about a minute later I started to feel like I'd had a martini," he said.

His mood was elevated for the next hour or two, Hameroff said.

Aware that his experience could be a placebo effect, an imagined effect derived from his expectation to feel a change, Hameroff set out to properly test the treatment with a clinical trial.

With research committee and hospital approval, and patient informed consent, Hameroff and his colleagues applied transcranial ultrasound to 31 chronic pain patients, in a double blind study in which neither doctor nor subject knew if the ultrasound machine had been switched on or off.

Patients reported improvements in mood for up to 40 minutes following treatment with brain ultrasound, compared with no difference in mood when the machine was switched off.

The researchers confirmed the patients' subjective reports of increases in positive mood with a Visual Analog Mood Scale, or VAMS, a standardized objective mood scale often used in psychological studies.

The discovery may open the door to a possible range of new applications of ultrasound in medicine.

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