Bottle-fed Infants Research Articles

Turkish adaptation of the Neonatal Eating Assessment Tool-Bottle-Feeding in preterm infants discharged to home.

Preterm infants often continue to have feeding difficulties after hospital discharge. Parental use of assessment tools and collaboration with health professionals are important for the early diagnosis of postdischarge feeding difficulties. This methodological study examined the validity and reliability of the Turkish version of the Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding in postdischarge preterm infants in Türkiye. A Turkish version of the NeoEAT-Bottle-feeding was developed and applied to 321 mothers of preterm infants younger than 7 months of corrected age between August 2021 and December 2022. Cronbach's alpha, exploratory factor, confirmatory factor, item-total correlation, test-retest, and known-groups validity analyses were performed. The Turkish NeoEAT-Bottle-feeding has 60 items in five factors explaining 55.785% of the total variance. Exploratory factor analysis indicated that the item factor loading ranged from 0.320 to 0.792. The known-group validity analysis confirmed that preterm infants with diagnosed feeding problems had higher total and subscale scores than those without (p = 0.001). The Cronbach's alpha (α) of the entire scale was 0.96. The item-total correlation coefficients were between 0.31 and 0.77 (p = 0.001). There was excellent agreement between test values and retest values obtained after a 2-week interval (intraclass correlation coefficient: 0.930-1.000). The Turkish NeoEAT-Bottle-feeding was shown to be a reliable and valid parent-reported assessment tool for oral feeding skills and difficulties after neonatal intensive care unit discharge in bottle-fed preterm infants younger than 7 months of corrected age. Healthcare professionals can use this assessment tool during the initial evaluation of risk factors contributing to problematic feeding and to determine the effectiveness of planned interventions in preterm infants.

Overview of the Feeding Practices and Their Influence on the Nutritional Status of Infants Aged 6 to 23 Months in Guera Province, Tchad

Malnutrition affects many infants in Chad, impairing their general health. Infant feeding practices therefore require special monitoring. This study aimed to assess feeding practices and their influence on the nutritional status of infants aged 6 to 23 months in the Guera province in Tchad. Data were collected through a cross-sectional survey using a structured questionnaire. Participants were selected using random sampling, and statistical data were processed using SPSS and XLstat 2016 software. Results showed that 86.5% of the children received mixed breastfeeding and colostrum, respectively, at birth. Exclusive breastfeeding was low, at 12.5%. Meal frequency was low overall, with only 3% of children receiving three meals a day. Evaluation of the impact of Infant and Young Child Feeding (IYCF) practices showed that bottle-fed infants were generally in a poor nutritional state, with 50% severely malnourished and 50% moderately malnourished, while only 12% of exclusively breastfed children were in severely malnourished state. The high frequency of meal was also favorable to normal state, and no child receiving three meals was sick more than once in the last three months. What's more, only 44% of breastfed children and 52% of colostrum-fed children had fallen ill more than once in the previous three months. In general, malaria and diarrhea were the most frequently contracted by children. This study identified the factors that hurt the normal nutritional status of infants in this part of the Tchad.

Awareness and Support of Responsive Bottle Feeding Among WIC Counselors and Caregivers: A Formative Qualitative Study

To understand the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counselor experiences discussing responsive bottle feeding during counseling and WIC participants' knowledge, understanding, and use of responsive bottle feeding. Qualitative descriptive, semistructured interviews with 23 participants (8 WIC counselors and 15 WIC participants) were conducted online via Zoom. The WIC counselors and mothers of WIC-enrolled bottle-fed infants were recruited through a network of WIC clinics in North Carolina. Interviews were recorded, transcribed, and collaboratively analyzed using content analysis. The WIC participants received responsive infant feeding support from WIC counselors but often in the context of breastfeeding. WIC counselors provided valuable support for families but were challenged by limited training on responsive bottle feeding, balancing promoting breastfeeding with supporting mothers' feeding decisions, and time constraints. Findings provide preliminary support for the need to develop and pilot an intervention focused on promoting responsive feeding for parents of bottle-fed infants.

Infant Oral Candidiasis and Bottle Cleaning Methods: A Descriptive Study.

As manufacturers produce bottles with additional parts, such as an anticolic straw, cleaning time increases. Increased cleaning time potentially decreases cleaning effectiveness and, thus, increases the chance for thrush. This study explored the relationship between the number of bottle parts and cleaning methods for bottle-fed-only infants (<13 months) presenting with oral candidiasis. After obtaining demographic information on eligible infants (via parental consent) from the chart, caregivers of 60 infants verbally completed a questionnaire. The questionnaire elicited information about the preferred bottle for feeding, number of parts, washing frequency, washing method, drying method, sterilization frequency, and sterilization method. The χ2 test, and Fisher's exact test when necessary, was performed to examine the relationship between each reported cleaning method (washing, drying, and sterilization) compared with the number of bottle parts (≤3 or ≥4). The number of bottle parts showed no association with bottle cleaning methods (p > .05). Although there were no statistically significant relationships, trends did present that warrant investigation. Future studies to confirm recommended practices for cleaning methods and identify those at risk from demographic data could positively affect the health of bottle-fed infants by reducing the occurrence of thrush.

Isotopic analysis of formula milk reveals potential challenges in geolocating bottle-fed babies

In forensic investigations involving the identification of unknown deceased individuals, isotope analysis can provide valuable provenance information. This is especially pertinent when primary identifiers (i.e., DNA, dactyloscopy, etc.) fail to yield matches. The isotopic composition of human tissues is linked to that of the food consumed, potentially allowing the identification of regions of origin. However, the isotopic composition of deceased newborns and infants fed with milk formula may be influenced by that of the prepared milk. The findings contribute towards the possibility to isotopically identify bottle-fed infants. More importantly, the data convincingly show that the Sr isotope composition of the prepared milk is determined by that of the formula and not the (local) tap water, thereby limiting the potential of Sr isotope analysis for determining the geological or geographical origin in formula-fed babies in medico-legal cases.

Prevalence and Impact of Feeding-Related Events on Hospital Stay in Preterm and Term Newborns.

Nursing assessment of milk flow regulation and associated apnea, bradycardia, and desaturation (ABD events) contribute to considerations for the discharge of newborns from the acute care setting. Research regarding infant feeding-related (FR) events (sucking and swallowing difficulties) and ABD events in moderate to late-preterm and full-term infants is lacking. This study observes the impact of FR and ABD events during feeding on hospital length of stay (LOS) and healthcare utilization (cost) in moderate-to-late preterm newborns, as well as full-term infants. In a retrospective study, bottle-fed infants admitted to the level II specialty care nursery of an academic community hospital in Southern California were observed for FR and ABD events. Statistical analyses were used to determine the impact of FR events on adjusted LOS, to evaluate the interaction between FR event status and adjusted LOS on total hospital charges, and to assess the statistical independence between FR events and diagnostic-related group severity. The full sample of patient records included 308 infants born between 32- and 44-week gestational age between April 1, 2018, and October 31, 2022. LOS was twice as long in infants who had FR events. Total median charges were higher in the group with FR events at $160,165 versus $64,380 with non-FR events. Increased knowledge in the epidemiology and nursing care of infants experiencing milk flow regulation and associated ABD events is critical for informing practices and guidelines related to the prevention of related morbidities.

Effect of feeding pattern on the stage of primary dentition eruption in relation to growth parameters

Background: Feeding is a complicated process that involves the coordination of cardiovascular, respiratory, gastrointestinal (GI), and oropharyngeal mechanisms, with support from the musculoskeletal and craniofacial systems. The practice of feeding could be correlated with eruption stage and nutritional status in infants. Aim of the study: This study aimed to assess the relation of feeding patterns to a selected oral variable (stage of the eruption of primary teeth) and growth parameters among clinically healthy infants. Subjects and Methods: A cross-sectional comparative study on a sample of (300) infants aged between 6 and 18 months was performed in Karbala City, Iraq. The feeding pattern was investigated using an information sheet answered by parents. The stage of dental emergence was evaluated through intraoral examination. Growth parameters (height, weight, head circumference) were analyzed. Results: Bottle-fed infants had higher total tooth eruption incidence and nutritional status than the other feeding groups, but the difference was not statistically significant. Conclusion: Bottle-fed infants had the highest mean of erupted primary teeth and nutritional status.

Risk of Aspiration Increased by Post-swallow Residue in Infant Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

To assess the risk of aspiration associated with post-swallow residue subsites in Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in bottle-fed infants <1 year of age. This is a retrospective matched-pairs cohort study at an academic tertiary children's hospital. FEES and Videofluoroscopic Swallowing Study (VFSS) trials performed within the same infant <5 days apart were paired by matching bolus consistency and bottle flow rate. Positive aspiration was defined by the "or rule" in which aspiration is positive when either FEES or VFSS within a matched pair is positive. Eighty-seven FEES-VFSS matched pairs from 29 patients (16 males; mean [SD] age, 2.9 [2.8] months) were included. The rate of positive aspiration, as defined by the "or rule", was 59% (51/87). In FEES, post-swallow pyriform sinus residue was present in 16% (14/87) and anterior commissure residue 27% (31/87). Risk of positive aspiration was increased by pyriform sinus residue (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.9-19.3, p < 0.01) and anterior commissure residue in FEES (OR 2.5, 95% CI 1.1-6.1, p = 0.03). In the neonate subgroup, <1 month of age, multivariate-adjusted analysis showed that anterior commissure residue had better diagnostic accuracy for aspiration than in older infants (overall 70% vs. 42%, p < 0.01; sensitivity 60% vs. 10%, p < 0.01), whereas pyriform sinus residue had worse accuracy (overall 41% vs. 70%, p = 0.02; sensitivity 13% vs. 43%, p = 0.02). This study demonstrates that pyriform sinus and anterior commissure residue during infant FEES were associated with fivefold and twofold increased risk of aspiration, respectively. Using a retrospective matched-pairs cohort, this study assesses the diagnostic accuracy of post-swallow residue in FEES for predicting aspiration. Laryngoscope, 134:1431-1436, 2024.

Development of taste perception and complementary foods: A review

Breast milk meets the needs of a 6-month-old child in macronutrients (proteins, fats, carbohydrates) almost entirely, while in minerals and trace elements only partially. Complementary feeding is the stage of development of the child's eating behavior when its diet expands due to the introduction of additional products. The model of human eating behavior is formed in infancy and early childhood when stable taste preferences and attitudes to eating (regimen, serving size, table culture) are established. The European and North American Nutrition Committees, in their resolution (2008), noted that the timing of the introduction of complementary foods for breastfed and bottle-fed infants should be the same: no earlier than week 17 and no later than week 26. The age to introduce complementary foods in Russia is 4-6 months and 5.5 months in breastfed infants. Due to the intensive growth and increased physical activity of the child, it is advisable to use milk porridges as one of the main types of complementary foods necessary for children at 4–5 months to provide an additional (relative to human milk or its substitutes) amount of protein, energy, minerals, and vitamins. In recent years, ready-to-use liquid cereals have become popular. Due to the carbohydrate component of cereals, which promotes longer satiety, they can be given to young children before bedtime.

Preterm infant cues during breastfeeding and its measurement: A scoping review.

Preterm infants display certain behaviors to communicate their needs, known as preterm infant cues. However, the existing research on preterm infant cues primarily draws from studies conducted on bottle-fed infants rather than breastfed infants. This study aimed to investigate the concept of preterm infant cues during breastfeeding and its appropriate instruments. A scoping review. The articles published up to January 2022 were searched from multiple sources from EBSCOhost Web, namely CINAHL Plus with Full Text, MEDLINE, ERIC, and E-Journals. The articles retrieved for this review were screened using PICO (Population, Intervention, Comparison, and Outcomes) format. Preferred Reporting Items for Systematic Reviews (PRISMA) checklist was used in selecting the articles, and Joanna Briggs Institute Critical Appraisal was utilized by two independent authors to assess the articles' quality. A descriptive method was used to analyze the data. The initial review stage found 183 potential articles, but only four satisfied the criteria. The notion of preterm infant cues during breastfeeding is centered on the actions of preterm infants while positioned on their mother's chest. These feeding cues are identifiable before, during, and after breastfeeding and include cues for hunger, self-regulation, stress, satiation, approach, avoidance, and sucking quality. To effectively recognize these cues, tools such as the Preterm Infants Cues Coding System (PFCCS), Infant Driven Scale (IDS), Newborn Individualized Developmental Care and Assessment Program (NIDCAP), and Preterm Breastfeeding Behavior Scale (PIBBS) can be utilized. The study findings highlight the importance of recognizing preterm infant cues during breastfeeding to facilitate proper feeding and developmental care. Observational studies have proven to be an effective means of observing these cues during breastfeeding. By leveraging the cues identified in this review alongside tools such as PFCCS, IDS, NIDCAP, and PIBBS, nurses can accurately interpret preterm infants' breastfeeding cues in neonatal care settings of all levels. This, in turn, can aid in developing care plans that promote better feeding ability outcomes.

Bacteriological quality and safety of bottle food and associated factors among bottle-fed babies attending pediatric outpatient clinics of Government Health Institutions in Arba Minch, southern Ethiopia

BackgroundMicrobial contamination of baby bottle food has been identified as a significant public health concern, especially in developing countries, but it remains overlooked. Therefore, this study aimed to determine microbiological hazards, compliance with hygiene practices, and critical control points of contamination in baby bottle food in Arba Minch, southern Ethiopia.ObjectiveTo evaluate the bacteriological quality and prevalence of foodborne pathogens in baby bottle food and to identify associated factors among bottle-fed babies attending three government health institutions in Arba Minch, southern Ethiopia.MethodsA cross-sectional study was conducted between February 24 and March 30, 2022. A total of 220 food samples, comprising four types prepared with different sources of materials, were collected from systematically selected bottle-fed babies attending health facilities. The data on sociodemographic characteristics, food hygiene, and handling practices were solicited by face-to-face interview using a semi-structured questionnaire. Food samples (10 mL) were quantitatively analyzed for total viable counts (TVC) and total coliform count (TCC) and qualitatively for the presence of common foodborne bacterial pathogens. Data were analyzed using SPSS; ANOVA and multiple linear regression analyses were done to identify factors influencing microbial counts.ResultsResults revealed that the means and standard deviations of TVC and TCC were 5.3 ± 2.3 log10 colony forming units (CFU)/mL and 4.1 ± 2.6 log10 CFU/mL, respectively. Of the various food samples analyzed, 57.3 and 60.5% had a TVC and TCC above the maximum acceptable limits, respectively. The result of the ANOVA showed that there was a significant difference in the mean score of TCV and TCC among the four types of food samples (p < 0.001). Enterobacteriaceae were found in the majority of positive food samples (79.13%), followed by Gram-positive cocci (20.8%). Salmonella spp., diarrheagenic Escherichia coli, and Staphylococcus aureus were the common foodborne pathogens detected in 8.6% of tested foods. The regression result revealed that the type of baby food, hand washing practices of mothers or caregivers, and sterilizing and disinfecting procedures of feeding bottles are independent determinants of bacterial contamination (p < 0.001).ConclusionThe high microbial load and the presence of potential foodborne bacterial pathogens in the bottle food samples analyzed indicate unsanitary practices and the potential risk of exposure to foodborne pathogens in bottle-fed babies. Thus, interventions such as educating parents about proper hygiene practices, sterilizing feeding bottles and limiting bottle feeding practices are critical to reducing the risk of foodborne to bottle-fed infants.

Socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada.

Pacifier use can interfere with nurturing care practices such as breastfeeding, soothing, and sleeping. Due to contradicting beliefs, recommendations, and the high frequency of pacifier use, understanding its associations may support shaping equitable public health recommendations. This study explored the socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada. Cross-sectional survey was conducted in 2021 with a sample of mothers (n = 276) of infants under six months old in Clark County, Nevada. Participants were recruited through advertisements in birth, lactation, pediatric care centers, and social media. We used binomial and multinomial logistic models to assess the association between pacifier use and the age of pacifier introduction, respectively, with household, maternal, infant, healthcare characteristics, and feeding and sleeping practices. More than half of the participants offered pacifiers (60.5%). Pacifier use was higher among low-income households (OR (95% CI) 2.06 (0.99-4.27)), mothers who identified as non-Hispanic (OR (95% CI) 2.09 (1.22-3.59)), non-first-time mothers (OR (95% CI) 2.09 (1.11-3.05)), and bottle-feeding infants (OR (95% CI) 2.76 (1.35-5.65)). Compared to those who did not introduce a pacifier, non-Hispanic mothers (RRR (95% CI) 2.34 (1.30-4.21)) and bottle-fed infants (RRR (95% CI) 2.71 (1.29-5.69)) had a higher risk of introducing pacifier within two weeks. Likewise, infants living in food insecure households (RRR (95% CI) 2.53 (0.97-6.58)) and mothers who have more than one child (RRR (95% CI) 2.44 (1.11-5.34)) had a higher risk of introducing a pacifier after two weeks. Pacifier use is independently associated with maternal income, ethnicity, parity, and bottle feeding among six-month-old infants living in Clark County, Nevada. Household food insecurity increased the relative risk of introducing a pacifier after two weeks. Qualitative research on pacifier use among families with diverse ethnic/racial backgrounds is needed to improve equitable interventions.

The Role of Infant Formulas in the Primary Prevention of Allergies in Non-Breastfed Infants at Risk of Developing Allergies-Recommendations from a Multidisciplinary Group of Experts.

The worldwide incidence of allergic diseases has been continuously increasing, and up to one in every five people are currently affected by these medical conditions. Although seldom fatal, allergies have a profound impact on children’s growth, development, and quality of life, besides being associated with heavy healthcare costs and resource utilisation. In this context, a group of experts in nutrition, paediatric gastroenterology, allergology, and neonatology joined forces to discuss the role of infant formulas in the primary prevention of allergies in infants for whom breastfeeding is not an option and who are at risk of developing allergies. The topics discussed included the assessment of risk, the impact of the microbiota on the modulation of immune tolerance, and the added value of certain formula characteristics, namely, protein integrity (hydrolysed protein vs. intact protein) and the addition of prebiotics, probiotics, or synbiotics. This article describes the latest evidence on each of the above-mentioned points, as well as a number of recommendations made by the experts to guide counselling of parents in the choice of a formula for infants at risk of allergy. Overall, the experts highlighted family history and dysbiosis-promoting factors (namely, caesarean delivery and antibiotic use) as two of the most important risk factors for allergy development. Moreover, in line with international guidelines, the panel advocated that intact protein formula should be offered to all bottle-fed healthy infants, irrespective of their allergic risk (with the exception of short-term bottle feeding of otherwise breastfed babies in their first week of life, for whom a hydrolysed formula may be advisable). Finally, the experts agreed that the use of prebiotic-, probiotic-, or synbiotic-enriched formulas should be considered in infants at risk of developing allergies.

Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research

BackgroundAlthough pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and procedures for children available to date.ObjectiveThis systematic PROSPERO-registered review aimed to identify implementation protocols for pediatric FEES described in research studies, and to analyze them in detail concerning procedural steps, equipment, and reported outcome.MethodsIncluded were all studies reporting a pediatric FEES protocol for children aged 0–18 years, if they described at least two criteria defined in advance. The databases MEDLINE and CINHAL were searched systematically from January 2000 to February 2021. Risk of bias for included studies was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis of the FEES protocols was conducted and the results compared in tabular form.ResultsIn total 22 studies were included, reporting on FEES in 1547 infants, children, and adolescents with a wide range of diagnoses. It was possible to identify protocols related to all age groups in general as well as to particular groups such as breastfed or bottle-fed infants. None of the included studies demonstrated a good methodological quality; all studies had missing data. Uniform implementation for sub-groups could not be determined. The reported outcome of FEES examinations could not be compared.DiscussionNone of the included studies showed good methodological quality and a significant amount of data were missing; the review still offers a systematic basis for future research to close the serious gap in the area of pediatric FEES. A proposal is made for a minimum requirement for pediatric FEES protocols in scientific studies.

Trends in Weight Gain Among Breastfed Infants Versus Bottle-Fed Infants at a Tertiary Care Hospital in Karachi, Pakistan

BackgroundInfants need to be exclusively breastfed up to six months of age, and breastfeeding should be continued up to two years of age along with complementary food. In Pakistan, the majority of newborns are not exclusively breastfed. This study was done to compare weight gain between breastfed infants and non-breastfed infants at a tertiary care hospital in Karachi, Pakistan.MethodologyThis observational cohort study was conducted at the well-baby clinic and vaccination center of the National Institute of Child Health, Karachi, Pakistan, from January 2021 to December 2021. A total of 360 normal term babies (180 in each group) with age below 11 months on either exclusively breastfeeding or other milk feed were included. Data were collected by the duty senior staff nurse of the well-baby clinic and monitored on daily basis by the researchers. The sociodemographic characteristics of mothers of breastfed and non-breastfed babies and birth weight, length, and BMI Z scores of babies in both groups were compared.ResultsIn a total of 360 babies, there were 192 (53.3%) boys and 168 (46.7%) girls. Overall, the mean maternal age was calculated to be 28.1±6.2 years, ranging between 18 and 37 years. The employment status of mothers (p=0.0117) and monthly income of parents (p=0.0388) were significantly different between groups. The mean weight gain in the exclusively breastfeeding group was 4.0±0.5 kg between the first and fifth visit (final visit) in comparison with 4.5±0.5 kg in the non-breastfeeding group (p<0.0001).ConclusionNon-breastfed babies gained significantly more weight in comparison with exclusively breastfed babies. More multicenter trials involving a large proportion of populations are needed to further verify the findings of the present study.

Variability in Swallowing Biomechanics in Infants with Feeding Difficulties: A Videofluoroscopic Analysis

Clinicians performing feeding evaluations in infants often report swallow variability or inconsistency as concerning. However, little is known about whether this represents pathological incoordination or normal physiologic variance in a developing child. Our retrospective study explored quantitative videofluoroscopic measures in 50 bottle-fed infants (0–9 months) referred with feeding concerns. Our research questions were as follows: Is it possible to assess swallow to swallow variability in an infant with feeding concerns, is there variability in pharyngeal timing and displacement in infants referred for videofluoroscopy, and is variability associated with aspiration risk? Measures were taken from a mid-feed, 20-s loop recorded at 30 frames per second. Each swallow within the 20-s loop (n = 349 swallows) was analysed using quantitative digital measures of timing, displacement and coordination (Swallowtail™). Two blinded raters measured all swallows with strong inter-rater reliability (ICC .78). Swallow frequency, suck-swallow ratio, residue and aspiration were also rated. Variability in timing and displacement was identified across all infants but did not correlate with aspiration (p > .05). Sixteen infants (32%) aspirated. Across the cohort, swallow frequency varied from 1 to 15 within the 20-s loops; suck-swallow ratios varied from 1:1 to 6:1. Within-infant variability in suck-swallow ratios was associated with higher penetration-aspiration scores (p < .001). In conclusion, pharyngeal timing and displacement variability is present in infants referred with feeding difficulties but does not correlate with aspiration. Suck-swallow ratio variability, however, is an important risk factor for aspiration that can be observed at bedside without radiation. These objective measures provide insight into infant swallowing biomechanics and deserve further exploration for their clinical applicability.

Promoting Responsive Bottle-Feeding Within WIC: Evaluation of a Policy, Systems, and Environmental Change Approach.

Bottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed. Our aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG. We conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age. Participants were mothers (n= 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August2019. Infant weight was assessed and standardized to sex- and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breast- and bottle-feeding patterns, and perceptions of WIC experiences. Logistic regression with estimation via generalized estimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively. Infants in PSE clinics had significantly lower likelihood of exhibiting RWG (P= .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P= .098) and had more stable intentions to stay in the WIC program (P= .002) compared with mothers in control clinics. PSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.

Instrumental Swallowing Assessments in the Neonatal and Pediatric Populations: A Systematic Review.

The scientific scope of swallowing disorders in the neonatal and pediatric populations is growing exponentially; however, the preponderance of evidence for evaluation protocols has been concentrated in non-instrumental evaluations creating a lack of research about protocols for instrumental swallowing assessment. Thus, the purpose of this study was to systematically review the literature to identify and to report protocols used in instrumental assessments through videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) in the neonatal and pediatric populations to support clinical decision making. The search strategy was applied in five online databases, no filters were applied to restrict languages or publication dates and the gray literature was reviewed. PRISMA statement was used to guide the construction of this review. The studies included validated and unvalidated protocols, the validated protocols had their risk of bias estimated using the QUADAS-2. In total, 13 studies were included in the final review, of these eleven assessed through QUADAS-2, and two classified with low risk of bias. One study is in the process of standardization and validation of an instrumental assessment protocol for swallowing in bottle-fed infants through VFSS. Information about validity and reliability of published protocols for instrumental evaluation in the neonatal and pediatric populations is limited. Therefore, further research is needs to development studies aiming to standardize and validate protocols for instrumental assessments in these populations.

Effect of Left and Right Semi-Elevated Side-Lying Positions on Feeding Performance of Preterm Infants

ObjectiveTo determine the effect of right and left semi-elevated side-lying positions on the feeding performance and skills of bottle-fed preterm infants. DesignA single-group, crossover experimental study. SettingsLevel 3 NICU of a training and research hospital in Istanbul. ParticipantsA total of 60 preterm infants born at 24 to 36 6/7 weeks gestation. MethodsWe collected data using an infant information form, feeding observation form, and the Turkish version of the Early Feeding Skills Assessment (EFS-Turkish). For each infant, we collected data for two feeds: one in the right and one in the left semi-elevated side-lying position. ResultsWe found no difference between the right and left semi-elevated side-lying positions in the volume or percentage of food taken (p = .582 and p = .625, respectively), feeding duration (p = .901), or feeding efficiency (p = .423). We observed no significant differences between feedings in the left and right semi-elevated side-lying positions in mean EFS-Turkish total score (p = .251) or subscale scores (p > .05). ConclusionNeonatal nurses can feed preterm infants in both directions of the semi-elevated side-lying position when following evidence-based feeding guidelines.

A Comparative Study of Child’s Nourishment Methodology

This research undertaking attempted to determine the Comparative Study of Child’s, Nourishment Methodology in Calbayog City. Specifically, it tried to determine the demographic profile of lactating mothers in terms of their age, number of child, occupation, monthly income, marital status and educational attainment; to determine the status of child nourishment; to identify the attitudes of the lactating mothers towards three (3) feeding practices, namely: pure breastfeeding, bottle feeding and mixed feeding; to determine the breastfeeding practices of the lactating mothers; to identify common illness of children from 0 - 2 years old; to find out the significant difference in the child nourishment methodology when lactating mothers are group into pure, mixed and bottle fed; to determine significant relationship between the respondent’s demographic profile and their nourishment attitude and practices. A total of 96 lactating mothers with children 0 – 2 years old served as respondents of this study. This study utilized the descriptive – correlation method of research using a set of questionnaire checklist made and validated by the researcher. The statistical tool used was the chi – square test to determine the significant difference and relationship between independent variables and the dependent variables. The independent variables included the demographic profile on age, marital status, occupation, monthly income and educational attainment. Also considered as independent variables were the feeding attitudes and practices of lactating mothers. The dependent variable on the other hand was the child’s nourishment categorized as over nourished, normal, well– nourished and undernourished. Based on actual findings, a majority of the respondents belonged to the stage of young – adulthood, with ages ranging from 26 – 29 years old. Most of them were plain housewives and college graduates. Their income ranged from P500 –2,399. Since most of them are practicing the family planning method, they were found to have only 1 – 2 children and only one (1) respondent had ten (10) children. Most of the respondents were married and some were single and separated. Concerning the breastfeeding attitudes and practices of lactating mothers, a majority of them were uncertain when asked about some of the attitudes in breastfeeding. Their answer pointed out that it causes sagging of the breast, affects mother’s figure, and causes loss of weight for mothers and male infants when breastfed were more obedient and respectful. Most of them strongly agreed about an attitude that breastfeeding is economical and less expensive. A majority of the respondents disagreed that it increased the size of the other’s breast. Most agreed that breastfeeding helped in preventing pregnancy. They also agreed that breastfeeding is done whenever the baby demanded for it. It helped prevent diarrhea; and it is practical to enhance bonding between the mother and the baby. Most were uncertain that breastfeeding is done to relieve soreness of breast. Some said it is not done when the mother is angry and the mother should not drink cold water since it stops the flow of breast milk. The common health problems that were identified were the respiratory or gastrointestinal problems which were commonly observed among bottle-fed infants, as well as those who practiced mixed feeding. A significant difference was seen among children when grouped according to feeding method. As to relationship, out of 8 independent variables, six (6) were found to be significantly related, these were the number of children, marital status, monthly income, occupation, attitudes and practices. However, two (2) independent variables such as age and educational attainment were found to be not significant.