Absence Of Breastfeeding Research Articles

PRE- AND PERINATAL FACTORS ASSOCIATED WITH WEIGHT GAIN AMONG PRESCHOOL CHILDREN ENROLLED AT DAY CARE CENTERS.

ABSTRACTObjective:To identify the factors associated with excessive weight gain in preschool children enrolled at daycare centers in a capital of the Northeast region of Brazil.Methods:It was a cross-sectional study conducted at the five daycare centers located in the city’s district of most socioeconomic vulnerability. The study included 326 preschool children (17 to 63 months old) from both genders. The dependent variable was the conditional weight gain (CWG), that represents how much a child, according to their gender, deviated from their peers in relation to the expected weight gain, given sample’s birthweight, gender, and age at the survey. Univariate tests (t-test and analysis of variance) were used to compare CWG means according to environmental and biological factors, considering the independent variables with p<0.20 as electable for the multiple linear regression model. In the final model, variables with p<0.05 or that contributed to the model adjustment were kept.Results:Children’s mean age was 45.4±9.9 months, and 53.4% of the sample consisted of boys. The prevalence of overweight was 7%. In the multivariable linear regression model, it was possible to identify that the following factors were associated with excessive weight gain among preschool children: less than six prenatal care visits (0.36 SD [95%CI 0.13–0.60]), not rooming-in in the postpartum period (0.30 SD [95%CI 0.03–0.58]), and never breastfed (0.44 SD [95%CI 0.06–0.81]).Conclusions:Inadequate prenatal (appointments) and perinatal care (mother-infant rooming-in and absence of breastfeeding) were associated with excessive weight gain among low-income preschool children.

Recurrent respiratory diseases in practice of family physician and pediatrician: main issues (a literature review)

The aim of the study – to analyze the professional literature and evaluate modern scientific trends concerning definition, peculiarities of etiopathogenesis, differential diagnosis and prevention of recurrent respiratory diseases (RRD) in the practice of family doctors and pediatricians. Conclusions. Respiratory diseases in children can play an ambiguous role, because on the one hand, they are an inducement for the host defenses, while they can cause secondary immune dysfunction in a significant increase in their incidence and severity, on the other. However, there are no specific criteria for RRD diagnosis. Contributing factors include harmful ecological conditions, unfavorable family history, absence of breastfeeding, presence of comorbid pathology and many other factors. Some children with RRD have immune dysfunctions, including changes in nonspecific protection and cellular immunity. Even if there are no changes in the main immunological indices, RRD can occur. Children with RRD require special attention, because severe, sometimes incurable diseases can be under the mask of frequent RRD. For such children family doctor and pediatrician should conduct a differential diagnosis with atopy, primary immune deficiency, gastroesophageal reflux, bronchial foreign body, cystic fibrosis, psychogenic cough and other diseases. Children with chronic infection should also be separated. In order to adequately assess the situation and develop a well-grounded treatment tactics for such patients, it is necessary to work out domestic criteria for assigning children to the RRD group. A physician should provide an individual approach to such a patient with optimal diagnostic methods and the development of management tactics both in acute episodes of respiratory diseases and during non-acute periods with the maximum involvement of drug-free modalities and for prevention of the pathological process progression.

Efektivitas Pijat Oksitosin Dan Breast Care Pada Ibu Bersalin Terhadap Pengeluaran ASI Di Puskesmas Kamonji

Breastfeeding is one of the global health issues in the 21st century, given that breastfeeding has a significant effect on infant mortality. The absence of breastfeeding in the first days after giving birth is one of the reasons for not creating exclusive breastfeeding. The inhibition of breastmilk secretion can be caused by inhibition of oxytocin secretion which is very instrumental in smoothing out ASI expenditure. Stimulation of the hormone prolactin and oxytocin can be done through breast care and oxytocin massage. Kamonji Health Center is the health center with the lowest exclusive breastfeeding coverage in Palu City, which is 57.3%. The purpose of this study was to find out the comparative time of mother's milk delivery which was given oxytocin massage and breast care within 2 hours postpartum in the Kamonji Community Health Center work area. This study is a quasi-experimental study with the design of The posttest-only control group. The number of samples was 30 people, taken by consecutive sampling technique and divided by 15 respondents into the oxytocin and breast care massage groups. The intervention was carried out within 2 hours postpartum and then observed when the first ASI was discharged after the third stage ended. Data normality test using Shapiro-Wilk test, data analysis using Mann Whitney test obtained a significance value of 0.044, with the average time of mother's breastmilk given oxytocin massage was 14.19 hours and breast care 5.57 hours. The conclusion of the study is that there is a difference in the time of mother's milk to be given oxytocin massage and breast care in the fourth stage of labor. Based on the results of this study it is recommended to do breast care to help accelerate the release of breast milk.

Pobreza y su influencia en el riesgo y daño familiar en un distrito de Lima, Perú: resultados por sectorización y atención primaria en salud

ObjectivePoverty generates negative effects on health, education, and family environment. Sectoral analysis through its components enables to identify the risk groups and damage in the families. The objective of this work is to determine the state of poverty and its influence on the risk and family damage in the district of Villa Maria del Triunfo (VMT), Lima, Peru. Materials and methodsEcological study that used the database of the health facility of the VMT district, in which the family risk and the socioeconomic level of 450 families in 7 sectors are evaluated between the years 2015 to June 2017. ResultsMore than three-quarters of the families are poor (77.9%). The most prevalent damages were malnutrition and mental health. The most frequent family risk factors were family violence, with the absence of breastfeeding in infants, adolescent pregnancy, and old age. It was found that poverty was associated with family risk (P=.019, OR: 1.84, 95% CI: 1.07-3.23), and damage risk (P<.001, OR: 2.29; 95% CI: 1.32-3.92). ConclusionThe level of poverty is high. This condition was associated with increased risk and family damage, especially for malnutrition and mental health problems. Interventions should be carried out in families, especially among the poor, and decisive measures should be made on the social factors determining ill-health.

LARGE BOWEL MICROBIOCENTOSIS IN IMMATURE INFANTS WITH VERY LOW AND EXTREMELY LOW BODY WEIGHT IN THE FIRST YEAR OF LIFE

Aim. To assess qualitative and quantitative composition of culture large bowel bugs in immature infants with birth weight 1500 g and less during the first year of life. Materials and methods. Fecal matter culturing has been done in 58 immature infants with body weight 1500 g and less, who were under supervision during the year. Results. A significant deficit of large bowel micro-biocentosis in immature infants has been registered in the neonatal period. Up to 2 months of life a slow formation of bowel's microflora is observed mainly due to bifidus bacteria. Up to 1 year of life a formed colonic microbiota in immature infants was not observed firstly due to lactobacilli deficit and late formation of typical Escherichia. Conclusion. The process of large bowel microbiocentosis in immature infants with very low and extremely low birth weight is slowed down due to extended admission in the intensive care unit, absence of breast feeding and antybiotherapy.

The Effect of Human Immunodeficiency Virus and Cytomegalovirus Infection on Infant Responses to Vaccines: A Review.

The success of prevention of mother to child transmission programs over the last two decades has led to an increasing number of infants who are exposed to human immunodeficiency virus (HIV), but who are not themselves infected (HIV-exposed, uninfected infants). Although the morbidity and mortality among HIV-exposed, uninfected infants is considerably lower than that among HIV-infected infants, they may remain at increased risk of infections in the first 2 years of life compared with their HIV-unexposed peers, especially in the absence of breastfeeding. There is some evidence of immunological differences in HIV-exposed, uninfected infants, which could play a role in susceptibility to infection. Cytomegalovirus (CMV) may contribute to the increased immune activation observed in HIV-exposed, uninfected infants. Infants born to HIV-infected women are at increased risk of congenital CMV infection, as well as early acquisition of postnatal CMV infection. In infants with HIV infection, CMV co-infection in early life is associated with higher morbidity and mortality. This review considers how HIV infection, HIV exposure, and CMV infection affect infant responses to vaccination, and explores possible immunological and other explanations for these findings. HIV-infected infants have lower vaccine-induced antibody concentrations following tetanus, diphtheria, pertussis, hepatitis B, and pneumococcal vaccination, although the clinical relevance of this difference is not known. Despite lower concentrations of maternal-specific antibody at birth, HIV-exposed, uninfected infants respond to vaccination at least as well as their HIV-unexposed uninfected peers. CMV infection leads to an increase in activation and differentiation of the whole T-cell population, but there is limited data on the effects of CMV infection on infant vaccine responses. In light of growing evidence of poor clinical outcomes associated with CMV infection in HIV-exposed, uninfected infants, further studies are particularly important in this group. A clearer understanding of the mechanisms by which maternal viral infections influence the developing infant immune system is critical to the success of maternal and infant vaccination strategies.

Circadian cortisol dynamics across reproductive stages and in relation to breastfeeding in the Philippines

An increase in cortisol during human pregnancy helps coordinate the onset of parturition, and can have long-term effects on offspring biology. Maternal cortisol can also be transferred to offspring via breast milk during lactation. However, little is known about how diurnal cortisol profiles vary by trimester of pregnancy or during the postpartum period. Here, we describe diurnal cortisol profiles among a large cross-sectional sample of healthy Filipino young adult women varying in reproductive status and, during the postpartum period, in whether or not they are breastfeeding. Salivary cortisol, anthropometric, and questionnaire data were obtained from participants in a birth cohort in metropolitan Cebu, Philippines (N = 741; age 20.8-22.4 years). Cortisol was assessed at waking, thirty minutes after waking (cortisol awakening response, CAR), and before bed. Compared with nulliparous women, morning cortisol was roughly 50% higher among women in late gestation, while evening cortisol was roughly 4-fold higher and the CAR was lower. Postpartum waking and evening cortisol were lower among currently breastfeeding women compared to nulliparous women, but were comparable in the absence of breastfeeding. The CAR was significantly lower among postpartum women compared to nulliparous women irrespective of breastfeeding status. These findings are consistent with known alterations in hypothalamic-pituitary-adrenal axis function during reproduction, and in particular point to marked and progressive elevation in maternal cortisol during the course of gestation. Cortisol appears to return to nulliparous levels after parturition, with levels suppressed below nulliparous levels during lactation.

ОЦЕНКА РИСКА РАЗВИТИЯ ЗАБОЛЕВАНИЙ ОРГАНОВ ДЫХАНИЯ У ДЕТЕЙ, РОДИВШИХСЯ ПУТЕМ КЕСАРЕВА СЕЧЕНИЯ

Aim. To determine with use of a binary logistic regression the risk of respiratory diseases in children born by caesarean section . Methods. According to the aim of the study the statistical method of binary logistic regression was used. For the study, children born by caesarean section were taken under observation. Results. It was found that the high prognostic significance of the development of the disease in children born by caesarean section was the absence of breastfeeding, low financial position, smoking among parents.

Abstract 5276: Risk factors for ductal carcinoma in situ of the breast in African American women

Abstract Introduction: The clinical significance of a ductal carcinoma in situ (DCIS) diagnosis is uncertain. While overall breast cancer mortality risk from DCIS is very low, a recent analysis showed that African American women diagnosed with DCIS were more than twice as likely to die from breast cancer as U.S. white women. Elucidation of risk factors for DCIS in African American women may provide opportunities for risk reduction. Methods: To assess the relation of reproductive, anthropometric, and other factors to risk of DCIS in African American women, we pooled data from three epidemiologic studies participating in the African American Breast Cancer Epidemiology and Risk (AMBER) Consortium - the Black Women’s Health Study, the Carolina Breast Cancer Study, and the Women’s Circle of Health Study. These studies contributed 805 DCIS cases and 13,830 controls to the analysis. We used unconditional logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of DCIS in relation to each risk factor of interest. Multivariable models were used to mutually adjust for risk factors as well as matching factors (age, study, geographic region, and questionnaire time period). We also compared results to associations observed for invasive breast cancer (n=3,765). Results: First degree family history of breast cancer was associated with an increased risk of DCIS (OR 1.62, 95% CI 1.32, 1.98). Oral contraceptive use within the past 10 years (vs. never) was also associated with increased risk (OR 1.31, 95% CI 1.01, 1.70), as was late age at first birth (≥25 years vs. &amp;lt;20 years) (OR 1.29, 95% CI 1.04, 1.61). Older age at menarche (≥15 years vs. &amp;lt;11 years) was associated with a reduced risk (OR 0.67, 95% CI 0.49, 0.92). Women with higher body mass index (BMI) in early adulthood (≥25 kg/m2 at ages 18 or 21) had a reduced risk of DCIS compared to those who had a BMI &amp;lt;20 kg/m2 in early adulthood (OR 0.71, 95% CI 0.56, 0.91), but there was no association for current BMI. In general, associations of risk factors for DCIS were similar in magnitude and direction to those for invasive breast cancer. However, high waist-to-hip ratio and absence of breastfeeding, two factors associated with increased risk of invasive breast cancer, and particularly with estrogen receptor negative breast cancer among African American women, were not associated with DCIS, either overall or by estrogen receptor status. Conclusions: Our findings suggest that most risk factors for invasive breast cancer are also risk factors for DCIS among African American women. However, two important modifiable risk factors for invasive breast cancer in this population, higher waist-to-hip ratio and absence of breastfeeding, do not appear to influence DCIS risk. Citation Format: Kimberly A. Bertrand, Traci N. Bethea, Lynn Rosenberg, Elisa V. Bandera, Melissa Troester, Thaer Khoury, Christine B. Ambrosone, Julie R. Palmer. Risk factors for ductal carcinoma in situ of the breast in African American women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5276. doi:10.1158/1538-7445.AM2017-5276

Respiratory viruses detected in Mexican children younger than 5 years old with community-acquired pneumonia: a national multicenter study

BackgroundAcute respiratory infections are the leading cause of mortality in children worldwide, especially in developing countries. Pneumonia accounts for 16% of all deaths of children under 5 years of age and was the cause of death of 935000 children in 2015. Despite its frequency and severity, information regarding its etiology is limited. The aim of this study was to identify respiratory viruses associated with community-acquired pneumonia (CAP) in children younger than 5 years old. MethodsOne thousand four hundred and four children younger than 5 years of age with a clinical and/or radiological diagnosis of CAP in 11 hospitals in Mexico were included. Nasal washes were collected, placed in viral medium, and frozen at −70°C until processing. The first 832 samples were processed using the multiplex Bio‐Plex/Luminex system and the remaining 572 samples using the Anyplex multiplex RT-PCR. Clinical data regarding diagnosis, clinical signs and symptoms, radiographic pattern, and risk factors were obtained and recorded. ResultsOf the samples tested, 81.6% were positive for viruses. Respiratory syncytial virus (types A and B) was found in 23.7%, human enterovirus/rhinovirus in 16.6%, metapneumovirus in 5.7%, parainfluenza virus (types 1–4) in 5.5%, influenza virus (types A and B) in 3.6%, adenovirus in 2.2%, coronavirus (NL63, OC43, 229E, and HKU1) in 2.2%, and bocavirus in 0.4%. Co-infection with two or more viruses was present in 22.1%; 18.4% of the samples were negative. Using biomass for cooking, daycare attendance, absence of breastfeeding, and co-infections were found to be statistically significant risk factors for the presence of severe pneumonia. ConclusionsRespiratory syncytial virus (types A and B), human enterovirus/rhinovirus, and metapneumovirus were the respiratory viruses identified most frequently in children younger than 5 years old with CAP. Co-infection was present in an important proportion of the children.

The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study

BackgroundCongenital toxoplasmosis is associated with severe complications. German state health insurance covers rubella, but not toxoplasmosis, immunity screening. We analysed the effect of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy.MethodsToxoplasmosis and rubella screening data (n = 5402 mothers) were collected within the population-based Survey of Neonates in Pomerania (SNiP).ResultsAt the first-trimester screening, 34.4 % (88.1 %) of expecting mothers were immune to toxoplasmosis (rubella). Susceptibility for toxoplasmosis (rubella) was observed in 39.6 % (8.9 %) and 25.8 % (2.95 %) were not tested. Data on a 2nd screening were available in a subgroup of women with negative immunity showing less than 45 % participation rate. Active toxoplasmosis (no rubella) infection was observed in 0.3 % (n = 17) of pregnant women. A multiple logistic regression model (AIC = 719.67; AUC = 0.725) revealed that the likelihood of participating in a second toxoplasmosis screening increased among women with a good level of education and a steady partnership and decreased with paternal unemployment and the absence of breastfeeding. The highest probability of non-participation in toxoplasmosis screening was found among women with temporal burden and family responsibilities. A cost-benefit analysis showed that covering general screening for toxoplasmosis with health insurance saved costs.ConclusionToxoplasmosis carried a substantial risk of infection during pregnancy. Although increased socioeconomic status was positively associated with the participation in toxoplasmosis screening, this was not the case when pregnant women had strong temporal burden and family responsibilities. This data supports the need for toxoplasmosis screening among pregnant women as a general healthcare benefit covered by insurance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0966-0) contains supplementary material, which is available to authorized users.

Abstract 4298: Cytokines and adipokines in breastmilk of black and white women

Abstract Introduction: Giving birth may be associated with a transient increase in breast cancer risk post-delivery and with elevated risk of basal breast cancers, especially in the absence of breastfeeding, whereas parity is related to lower risk of postmenopausal ER-positive tumors. Black women develop more early-onset and basal breast cancers than White women, but factors contributing to this disparity are poorly understood. Accordingly, we compared levels of 15 proteins with hypothesized roles in breast cancer risk in breastmilk from healthy Black and White women. Methods: We tested breastmilk donated by 130 Black and 162 White women, annotated with breast cancer risk factor questionnaire data. Following pilot testing using the MesoScale Discovery system (Rockville, MD), the following analytes were measured in breastmilk, adjusted for total protein concentration: interferon-γ, IL1-β, IL-6, IL-8, TNF-α, FLT-1, TIE-2, PlGF, VEGFC, VEGFD, adiponectin, leptin, and FAS-L. M30-apoptosis and Bradford protein were measured with Molecular Devices VersaMax reader (Sunnyvale, CA). Univariate associations of race with women's characteristics were computed using chi square tests and t-tests. Multivariable logistic regression models with a random effect to account for plate effects were used to assess the associations (odds ratios (ORs) and 95% confidence intervals (CIs)) of analyte levels with: race, family history of breast cancer, smoking, baby's age in days, body mass index at time of sample donation, age, menarche, age at first birth, return of menses, parity, and over-the-counter pain medication. Results: Of the 15 analytes measured, all but VEGFC and TIE2 were detectable and reliably measured. Black women compared to White women had higher BMI (p = 0.05) and higher parity (p = 0.02), and were younger age at menarche (p = 0.005) and younger age at first birth (p = 0.01). White women had higher levels of smoking (p = 0.01) and more frequently had a first degree relative with breast cancer (p = 0.03). Compared with White women, Black women had significantly higher levels of IL1-β (OR 1.77, 95% CI 1.13 - 2.77, p = 0.01) adjusting for the baby's age in days. Black women had significantly higher levels of leptin (OR 2.01, 95% CI 1.28 - 3.15, p = 0.002) and leptin/adiponectin ratio (OR 2.36, 95% CI 1.49 - 3.72, p = 0.0004), even after adjusting for body mass index. Discussion: Preliminary data demonstrate differences in levels of putative markers of breast cancer risk between White and Black women, including IL1-β, leptin and the leptin/adiponectin ratio. These data suggest that further analyses of biomarkers in breastmilk may be useful for understanding breast cancer risk and to identify possible factors that may be associated with racial disparities in early onset and basal breast cancers. Citation Format: Jeanne Murphy, Mark E. Sherman, Ruth M. Pfeiffer, Hannah P. Yang, Ana I. Caballero, Eva P. Browne, Gretchen L. Gierach, Kathleen F. Arcaro. Cytokines and adipokines in breastmilk of black and white women. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4298.

Evaluation of a preventive educational program for malocclusions: 7-year study.

506 of the 802 guardians/children referred to the PPM joined. As for the children, the most frequently assessed habits were: bottle (56.1%), bottle and pacifier (18.4%), finger (11.9%), bottle and finger (7.1%), pacifier (5.7%), pacifier and finger (0.6%), and bottle/pacifier/finger (0.2%). After parent participation in the meetings, 335 (66.2%) children abandoned their habits. There was a statistical difference between type of oral habit and time to abandonment (p = 0.0001). However, those with only one habit abandoned it more easily (72.6%) than those with two or more associated habits (48.1%) (p = 0.042). Presence or absence of breastfeeding and parents' level of education had no significant effect on habit abandonment. PPM was an important tool for spreading knowledge to guardians, greatly contributing to the abandonment of deleterious oral habits. Bottle sucking warrants special attention - mentioned by 81.8% of parents - either alone or associated with other habits. Thus, educational actions to implement the children's approach to oral health are fundamental to making behavioral changes and promoting education of healthy habits, thereby keeping malocclusions from developing.

Infant gut immunity: a preliminary study of IgA associations with breastfeeding.

Secretory immunoglobulin A (IgA) plays a critical role in gut mucosal immune defense. Initially provided by breastmilk, IgA production by the infant gut is gradually stimulated by developing gut microbiota. This study reports associations between infant fecal IgA concentrations 4 months after birth, breastfeeding status and other pre/postnatal exposures in 47 infants in the Canadian Healthy Infant Longitudinal Development cohort. Breastfed infants and first-born infants had higher median fecal IgA concentrations (23.11 v. 9.34 µg/g protein, P<0.01 and 22.19 v. 8.23 µg/g protein, P=0.04). IgA levels increased successively with exclusivity of breastfeeding (β-coefficient, 0.37, P<0.05). This statistical association was independent of maternal parity and household pets. In the absence of breastfeeding, female sex and pet exposure elevated fecal IgA to levels found in breastfed infants. In addition to breastfeeding, infant fecal IgA associations with pre/postnatal exposures may affect gut immunity and risk of allergic disease.

Reproductive risk factors and breast cancer: a case control study from rural India

Background: Breast cancer is the most common type of cancer in women and is influenced by reproductive factors perceived by women worldwide.Aims: To identify the reproductive risk factors of breast cancer in newly diagnosed cases and to find out the strength of association of the risk factors with the breast cancer. Material and Methods: A hospital based case-control study was conducted in Satara district, India during year 2009 to 2011 among newly diagnosed cases of breast cancer and matched controls. A total of 434 participants including 217 cases and 217 controls were enrolled by purposive sampling technique from selected hospitals of study area. The information was collected by employing pre-tested questionnaire by utilizing interview method. Statistical Analysis used: Descriptive statistics, Odds ratio and Chi-square test was used to find out strength of association and statistical significant difference. Results: Highest proportion [31.80%] breast cancer cases was in age group 40-49 years with lowest age of 25 years at diagnosis of the disease. A very high proportion of both cases [88.02%] and controls [67.28%] were Hindu by religion and were from rural residence. Maximum proportion of breast cancer cases were housewives [63.59%], literate [71.42%] and from upper economic class [56.68%]. The proportions of cases were higher as compared to the controls with respect to risk factors like unmarried status, nulliparity, history of abortion, post menopausal status, absence of breast feeding and the history of exposure to hormonal contraceptives. The risk of getting breast cancer as indicated by Odds ratio was 8 times higher in unmarried women, 2.8 times in nulliparous women, 2.4 times with post menopausal status, 10.4 times with absence of breast feeding, 1.5 times with exposure to hormonal contraceptives and 4.5 times with history of ovarian disease respectively. Conclusion: The reproductive risk factors such as unmarried status of women, nulliparity, menopause, absence of breast feeding, history of ovarian disease and use of contraceptives were strongly associated with breast cancer.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.258-264

Association between the use of a baby's bottle and pacifier and the absence of breastfeeding in the second six months of life.

The World Health Organization recommends breastfeeding for two years or more and advises against bottle feeding and pacifier use. Investigate the association between bottle feeding and pacifier use, and breastfeeding in the second half-year of life. Survey in a municipality of Rio de Janeiro state, in 2006, interviewing those responsible for 580 children aged 6-11 months. Bottle feeding and pacifier use, and variables which in the bivariate analysis were associated with the outcome 'absence of breastfeeding' (≥ 0.20), were selected for multiple analysis. Adjusted prevalence ratios were obtained by a Poisson regression model. 40% of the children 6-11 months were not being breastfed, 47% used a pacifier and 57% used a bottle. Pacifier use (PR = 3.245; CI95%: 2.490-4.228) and bottle feeding (PR = 1.605; CI95%: 1.273-2.023) were shown to be strongly associated with the outcome, and also with: mother's low schooling (PR = 0.826; CI95%: 0.689-0.990); low birth weight (PR = 1.488; CI95%: 1.159-1.910); mother not being the baby carer (PR = 1.324; CI95%: 1.080-1.622); and increasing age of the baby in days (PR = 1.004; CI95%: 1.002-1.006). The use of pacifiers and bottles can reduce continued breastfeeding. Stronger discouragement of these artifacts should be adopted in public health policies.

Evaluation of growth in very low birth weight preterm babies.

The aim of this study was to evaluate physical growth of very low birth weight (VLBW) preterm babies at a mean age of three years and to investigate the factors which affected growth. The factors including maternal problems, prenatal problems, early neonatal problems, nutrition, familial socioeconomical status and presence of chronic disease which affected catch-up growth in terms of height and weight in VLBW infants followed up in the neonatal intensive care unit (NICU) of our hospital were examined. The target height formula was used in assessment of growht in height and the contribution of genetic properties was investigated. The points of the subjects on the growth curve were plotted according to the Percentile Curve of the Turkish Children prepared by Neyzi et al. The states of the subjects with and without intrauterine growth retardation (were compared. The study was intitiated after obtaining approval from the ethics committeee of our hospital (100/25.10.2005). One hundred and seventeen preterm babies (57 females and 60 males) with a mean adjusted age of 35.8±2.39 80 of whom were appropriate for gestational age (AGA), 28 of whom were symmetrical (small gestational age) SGA and 9 of whom were asymmetrical SGA were included in the study. The mean gestational age (GA) was found to be 31±2.16 weeks and the mean birth weight (BW) was found to be 1271±226 g. The mean current height was found to be 92.06±4.90 cm. The mean weight was found to be 12.98±1.94 kg. The mean target height was calculated to be 163.66±8.1 cm (157.20 cm for the girls and 170.20 cm for the boys). It was found that 15 preterm babies (12.8%) could not achieve the target height (girls: 6%, boys: 6.8%). The risk factors related with failure to achieve target height were found to include ventilator treatment, presence of chronic disease, advanced stage intracranial bleeding (ICB), posthemorrhagic hydrocephalus, absence of breastfeeding, failure to sit at the table with the family and malnutrition. The maternal age, early rupture of membranes (PROM), preeclampsia, smoking, early neonatal problems, gender, being AGA and SGA, gestational age, birth weight and socioeconomical level were statistically insignificant in terms of achieving target height (p>0.05). If very low birth weight preterm babies have no chronic disease and condition leading to neurodevelopmental retardation and if they are breastfed early and continuously (0-24 months), they can achieve catch-up growth similar to term babies. In examination of growth in terms of height, using target height may be more appropriate to shown the genetic potential.

GRIN2B predicts attention problems among disadvantaged children.

It is well established that adversities and GRIN2B (coding an N-methyl-D-aspartate receptor subunit) are independently associated with behavioral and cognitive impairments in childhood. However, a high proportion of children exposed to adversities have good, long-term outcomes. We hypothesized that among children exposed to adversities, GRIN2B variants would predict the worst cognitive and behavioral outcomes. 6 single nucleotide polymorphisms of GRIN2B were genotyped in 625 children aged 6-11 years from an Italian community-based sample. The interacting effect of GRIN2B variants with 4 measures of adversities [low socioeconomic status (SES), preterm delivery, maternal smoking during pregnancy, and absence of breastfeeding] was investigated upon blindly assessed cognitive abilities (vocabulary, block design, digit spans of Wechsler's Intelligence Scale, and Rey complex figure) and parents-rated behavioral problems (Child Behavior Checklist/6-18). Rs2268119 × SES interaction (Hotelling's Trace = 0.07; F(12,1154) = 3.53; p = 0.00004) influenced behavior, with more attention problems among children in the 'either A/T or T/T genotype and low SES' group, compared to all other groups. This interaction effect was not significant in an independent, replication sample of 475 subjects from an Italian community-based sample. GRIN2B variants predict children with the worst outcome in attention functioning among children exposed to low SES. Our findings, if replicated, could help in the identification of children with the highest risk and may prompt cost-effective preventive/treatment strategies.

Impact of rhinitis on asthma severity in school-age children.

BackgroundIn a population-based sample of school-age children, we investigated factors associated with rhinitis, and differences between allergic and nonallergic rhinitis. Amongst children with asthma, we explored the association between rhinitis and asthma severity.MethodsChildren participating in a birth cohort study (n = 906) were reviewed at age 8 years. Asthma was defined as at least two of the following three features: physician-diagnosed asthma, currently using asthma medication and current wheeze. We measured lung function (plethysmography and spirometry) and airway hyper-reactivity (AHR; methacholine challenge).ResultsIn the analysis adjusted for the presence of asthma, children with rhinitis had significantly higher AHR (P = 0.001). Maternal smoking and absence of breastfeeding were stronger predictors of nonallergic rhinitis, whereas current wheeze and eczema were stronger predictors of allergic rhinitis. Amongst asthmatics (n = 159), when compared to 76 children without rhinitis, those with rhinitis (n = 83) were 2.89-fold (95% CI 1.41–5.91) more likely to experience frequent attacks of wheezing, 3.44-fold (1.19–9.94) more likely to experience severe attacks of wheezing limiting speech, 10.14-fold (1.27–81.21) more likely to have frequent visits to their doctor because of asthma and nine-fold (1.11–72.83) more likely to miss school. Reported use of intranasal corticosteroids resulted in a numerically small, but consistent reduction in risk, rendering the associations between rhinitis and asthma severity nonsignificant.ConclusionWe observed differences in risk factors and severity between allergic and nonallergic rhinitis. In children with asthma, rhinitis had adverse impact on asthma severity. The use of intranasal corticosteroids resulted in a small, but consistent reduction in the risk.

A Clinical and Epidemiological Study of Enterovirus Associated Diarrhea in Hospitalized Children

Background: Diarrhea is a leading cause of morbidity and mortality in children less than five years of age. The etiology of diarrhea is unknown in nearly 40% of the cases. Enterovirus as a cause of diarrhea is well known, but there are few studies till date focusing on the epidemiological and clinical variables. Objectives: To determine the prevalence and seasonal variation and to study the clinical profile and course of enterovirus associated diarrhea in children up to five years of age. Methods: A hospital based prospective study was carried out at Vanivilas Childrens' Hospital and Bowring and Lady Curzon Hospital, Bangalore during the period November 2009 to May 2011. Enterovirus in fecal samples of 122 children with acute gastroenteritis was detected by its cytopathic effects in rhabdomyosarcoma and / or HeLa cells, followed by reverse transcription (RT)-PCR and sequence analysis of the VP1 gene. All the enterovirus positive samples were tested for wild and OPV poliovirus strains. As rotavirus is the most common cause of viral diarrhea in India, the stool samples were also analyzed for rotavirus using polyacrylamide gel electrophoresis. Results: Out of the 122 samples analyzed, 14 (11.5%) were confirmed enterovirus positive. The enterovirus detection was maximal in the months of June to August (monsoon), with a rate of 30.8%. Rotaviral detection rate was 22% and with maximal prevalence in winter months of December to February. Enterovirus detection rate was highest in the age group of less than six months, with a rate of 50%. The primary symptom was watery diarrhea with mean duration of four days and frequency of 7 per day. Fever and vomiting were present in 50% of the cases. Moderate dehydration was observed in 57.1% of the cases. A significant association was observed between enterovirus associated diarrhea and absence of breastfeeding ( p = 0.016), contact with individuals having diarrhea ( p = 0.009), and advanced protein energy malnutrition ( p = 0.045). Conclusions : Enterovirus associated diarrhea has a significant prevalence among children less than five years and is common in the monsoon season.