Concentrated Mixtures

CONCENTRATED MIXTURES, nutritional mixtures used in infant feeding and characterized by high caloric content. The increase in caloric content can be achieved by enriching milk with a single nutrient—carbohydrate, fat, or protein—or, much more frequently, simultaneously with two (Cherny-Kleinschmidt mixtures, Moro's, etc.). Concentrated mixtures were introduced into infant dietetics in the last 10 years by German pediatricians (Finkelstein, Czerny, Kleinschmidt, Moro, etc.) and found wide application first in German clinics. However, the success of feeding concentrated mixtures under certain indications was so obvious that these mixtures have now gained general recognition, and their introduction is a great achievement in the field of infant feeding. The main indication for the use of concentrated mixtures is the impossibility or persistent refusal of the child to eat all the prescribed amount of food, resulting in chronic starvation. The administration of concentrated mixtures makes it possible to introduce the necessary amount of nutrients in a small volume of fluid, which is often the only way to improve the child's nutrition and condition. Specifically, the question concerns the feeding of the following groups of children: 1) premature and feeble-minded; 2) dystrophics on the basis of constitutional dyspepsias; 3) with chronic infections (syphilis, tuberculosis, pyoderma, etc.); 4) during the reparative period after infectious diseases; 5) neurotics with persistent anorexia and pylorospasm; 6) generally poorly and weakly sucking infants, especially newborns. Contraindications are acute diarrhea and certain allergic diseases. When using concentrated mixtures, it is desirable to follow the following rules: 1) introduce concentrated mixtures gradually, starting with small amounts, and only gradually increase them, not exceeding 100.0 ml per dose if possible; 2) introduce water in sufficient quantity simultaneously; 3) feed children on concentrated food for a short time, considering it a therapeutic diet (Heilnahrung), which is not advisable for feeding healthy children (Dauernahrung). The following types of concentrated mixtures are distinguished. Carbohydrate mixtures. These include breast and cow's milk enriched with sugar: 8.5% and 17%. The mixture with 17% sugar is known as the Dubo mixture (see). Sugar-rich mixtures found application mainly in Pirquet's clinic and his students' work in feeding newborns. When applying them, the following question was raised: what is the tolerance of a newborn child to sugar and to water? Based on the successful feeding of 300 children, Schick (Schick) comes to the following conclusions: 1) the application of concentrated food, enriched with sugar, is possible even in the earliest (younger than 6 months) breast age; 2) the theoretical fear of sugar was not justified; 3) limiting fluid intake to half or more compared to the normal volume does not affect the success of feeding. The same good results were obtained in experiments feeding newborns with one Dubo and Dubo together with breast milk in a ratio of 1 part breast milk to 1.6 parts Dubo. Worse results are obtained when feeding premature infants (Lepsky, Ivenskaya). These children, after 2 weeks of application of this mixture, show weight loss and dyspepsia. The theoretical question of whether caloric replacement of fat by carbohydrates is possible without harm to the child's organism is resolved in the affirmative by Schick's experiments with feeding skimmed milk with the addition of 8.5% and 17% sugar. However, most authors (Schlossmann, Niemann, etc.) point to a decrease in immunity and the possibility of catastrophic weight loss during prolonged one-sided enrichment of food with carbohydrates at the expense of fat. Therefore, the introduction of the Dubo mixture, being a victory over the existing fear of sugar over the last 10 years, still has more theoretical than practical significance. The cloyingly sweet taste of this mixture often causes vomiting in children and even greater anorexia. The addition of 5% sugar to milk has found wide application in feeding healthy children, equalizing the unfavorable correlation of proteins and carbohydrates in cow's milk (1:1). Protein mixtures. Although the question of the significance for the organism of a large amount of protein in the food of an infant remains not entirely clarified, a number of authors point out that when feeding protein-rich food, weight stagnation, pallor, poor turgor, and eczematous irritation, protein fever (Rietschel), and even toxic dyspepsia (Kleinschmidt) with dehydration can be observed. The unfavorable effect of protein is especially sharply manifested with insufficient water intake. However, moderate enrichment of breast milk with protein gives excellent results in feeding premature infants, infants with initial diarrhea observed in the first weeks after admission to an institution, and constitutionally deficient children suffering from chronic dyspepsia. The beneficial effect of protein in such cases is reduced to the following: protein, binding fermentation acids as a buffer, reduces peristalsis and improves absorption; increasing intestinal secretion, it promotes better digestion. Increasing protein as a plastic material is important during the reparative period after severe illnesses. Enrichment of food with protein can be achieved by using concentrated protein milk or simply by adding lanason, plasmon, and cottage cheese to breast milk in amounts from 2% to 4%. Concentrated protein milk according to Finkelstein is prepared as follows: to 1 liter of boiling whole milk, 15 cm³ of a 20% solution of calcium chloride are added, and the milk is immediately removed from the fire and left to stand for about half an hour until the complete precipitation of casein. The separated serum is passed through a coarse sieve covered with a cloth, and the curd is left on it for 1/2 to 1 hour until the serum has completely drained. The resulting curd is passed through a fine sieve 6-7 times with 500 cm³ of cream. The whole mass is placed in a water bath and brought to a boil with constant vigorous stirring. Sugar is added to the already cooled concentrated protein milk in an amount of 10-20%. There is also a modification of the preparation by Jorno. 1 liter of concentrated protein milk prepared in this way without sugar contains 300 calories. The protein content in concentrated protein milk is twice that in ordinary milk. The addition of concentrated protein milk should be done carefully, and it should not exceed 1/3 of the total amount of food. With concentrated protein food, it is especially necessary to give the child water to drink. The addition of protein in the form of freshly prepared, sieved cottage cheese in an amount of 2-4% is practically convenient, easy, and can successfully replace lanason and plasmon. Fat mixtures. The starting point for preparing fat mixtures was the difficulty of digesting the casein of cow's milk by infants and the good digestibility of fat. Biederer, Gartner, Backhaus, and Müller sought to prepare a mixture by reducing protein and increasing fat, the composition of which would approach that of human milk. The most successful in this respect is the fatty-flour mixture of Cherny-Kleinschmidt (see Cherny-Kleinschmidt mixture), the first report on which was made in 1918. The correlation of fat and carbohydrates in this mixture is 1:1.6, while in human milk it is 1:1.7. There are two modifications of the fatty-flour mixture: the 1st modification (²/₅ milk and ³/s mixture) contains 937 calories per liter; the 2nd (³/₅ milk and ³/s mixture) contains 775 calories and is used for weaker children in the first months of life. Moro's mixture (see Moro food) is even higher in calories. It contains 1,500-1,600 calories per liter. Recently, the Kleinschmidt-Niemann mixture (see) has become widely used. Fatty-flour mixtures, due to the favorable ratio of fat and carbohydrates, the release of volatile fatty acids upon heating, and the chemical change of flour from overheating, are well tolerated even by the smallest children. Various modifications of these mixtures, allowing a great variety in the amount of added fat, sugar, and flour, give a wide choice and dosing possibility depending on the child's condition and age. All these advantages, along with a pleasant taste, have led to the fact that fatty-flour mixtures are the most valuable and widely distributed of all types of concentrated food. The indications for the use of these mixtures are even wider than indicated above in the general assessment of concentrated nutrition. They are used in artificial feeding where ordinary mixtures do not give good weight gain. Especially good results are obtained in feeding premature infants, constitutionally deficient children, and finally in various infections: purulent skin diseases, respiratory tract diseases, syphilis, tuberculosis. When feeding these mixtures, infections proceed more easily, the convalescent period is shorter, which is connected with the abundance of lipoids related to the production of immune bodies. The success of using these mixtures depends on the proportion in which they are given in relation to the rest of the food. The best results are obtained if they are used as an addition to the main food in a proportion not exceeding 1:3.

In addition to acute diarrheal diseases, atrophy is a contraindication to the use of concentrated mixtures, since atrophics have reduced tolerance to fat. The total caloric value of the food when using concentrated mixtures should not exceed 120–150 per 1 kg of body weight.