Feeding Outcomes Research Articles

A descriptive evaluation of early feeding development of infants in a local neonatal unit

PurposeA local neonatal unit undertook a descriptive evaluation of feeding development of infants receiving care so as to identify and maximise effective neonatal team care and support. MethodA retrospective data review examined infant feeding development from one local neonatal unit. Data were stratified according to gestational birth age and included infant health, post – menstrual age on introduction of oral feeding, oral feeding progression, method of feeding and re-admission to hospital in the first 12 months of life. ResultsA total of 150 infants met the criteria for inclusion in this retrospective review. Infants ranged in age from 23(+0) – 42(+2) gestational birth ages. Number of days on the neonatal unit ranged from 1 to 159 (mean = 25.87) days. Extremely preterm (EPT) infants experienced a significantly longer stay on the neonatal unit, had the highest number of respiratory problems, took significantly longer to achieve full oral feeding and tended to start oral feeding at a significantly later post - menstrual age compared with other infants. A high number of infants needed to access acute services post - discharge from the neonatal unit. ConclusionsAll infants regardless of gestational birth age were at risk of developing feeding problems and hospital re-admissions post neonatal discharge. EPT infants were significantly vulnerable to poor feeding outcomes. Parent and team working is necessary to identify and support complex infants.

The Incidence and Outcomes for Children with Cleft Palate and/or Lip and CHARGE Syndrome.

Published literature on children with cleft palate and/or lip (CP + /-L) and CHARGE syndrome (CS) is limited. This study investigated cleft characteristics including surgery, and feeding and communication outcomes in children identified with CP + /-L and CS. Retrospective cross-sectional review. Regional Referral Centre for Paediatric Cleft Surgery. All children diagnosed with CP + /-L and CS (based on clinical features and/or CHD7 mutation testing) between 1989-2019. Cleft type, timing of CP + /-L repair, reasons for 'delayed' repair, feeding methods and communication modality. Twenty-two children with CP + /-L and CS were identified. Cleft sub-types (%) were: Eleven (50%) had bilateral cleft lip and palate (BCLP), six (27%) had unilateral cleft lip and palate (UCLP) and five (23%) had cleft palate (CP). Cleft repair was delayed compared to protocol care for non-syndromic children with CP + /-L. Median age for lip repair + /- vomerine flap was 9 months (range 4-22 months), and palate repair was 21 months (range 11-40 months). Median age for isolated CP repair was 13 months (range 7-23). Surgery for cardiac anomalies (36%) before cleft repair, and (59%) were classed as having severe systemic disease at the time of cleft surgery. Only 27% of the children in this study had both full oral feeding and verbal communication. Children with CP + /-L and CS had severe cleft types and complex medical problems leading to delayed cleft surgery. Feeding and speech outcomes were better in the children aged over ten years.

The home environment and its relation to bottle feeding outcomes in the first year of life

BackgroundThe home environment and caregiver interactions have an impact on infant development. However, there is a paucity of research surrounding the home environment and its relation to early feeding outcomes within the first year of life. Therefore, the aim of this study was to examine the relationship between the home environment and infant bottle feeding outcomes at 3 and 12 months of age. MethodsSeventy-two full-term infants completed this study at 3 months of age and fifty-five infants completed the study at 12 months. Data in the current study were collected from a larger, ongoing study completed in the infant's home at 3 and 12 months of age. The Infant-Toddler Home Observation for Measurement of Environment Inventory (IT-HOME) was utilized to assess the infant's home environment. The Oral Feeding Skills (OFS) scale was completed while the infant was observed during a bottle feed. Caregivers completed a questionnaire about their infant's feeding abilities via the Neonatal Eating Assessment Tool (Neo-EAT) at 3 months and Pediatric Eating Assessment Tool (Pedi-EAT) at 12 months. ResultsAt 3 months of age, the IT-HOME Involvement subscale was associated with an increase in the amount of milk provided in the infant's bottle. There were no significant associations between the IT-HOME and caregiver report of feeding at 3 months of age. At 12 months of age, the IT-HOME Acceptance subscale was associated with an increase in oral transfer rate and the IT-HOME Variety subscale was associated with a decrease in oral transfer rate. Additionally, the IT-HOME Organization subscale was associated with caregiver report of feeding on the following Pedi-EAT scales: Mealtime Behaviors, Selective Restrictive Eating, and Oral Processing at 12 months. ConclusionsThese findings reveal that the home environment is significantly related to different infant bottle feeding outcomes over the first year of life. At 3 months, IT-HOME Involvement was associated with the amount of milk offered in the bottle, whereas at 12 months of age, subscales of the IT-HOME were associated with oral feeding transfer rate and caregiver report of feeding. Clinically, these findings point to the importance of considering the infant's bottle feeding skills in conjunction with certain aspect within the infant's environment. Additional research is needed to further explore these relationships in greater detail, with a larger sample size and across patient populations.

Male Partners' Roles in Infant Feeding Practices: Perspectives of Black Mothers Living with HIV in Three Countries.

Currently, mothers living with HIV (LWH) are challenged with different infant feeding guidelines depending on the country they are living in. This may contribute to confusion, stress, and mental health issues related to decision-making about infant feeding as a mother LWH. Yet, their male partners as their closest social capital have important roles to play in reducing or aggravating this psychosocial distress. Hence, we describe the role of male partners in supporting mothers who are living with HIV in the context of infant feeding. It is based on the results of a recent study of the socio-cultural context of infant feeding among Black mothers LWH in three countries; Canada, the USA, and Nigeria. The study was a tri-national, mixed-methods, community-based participatory research (CBPR) project, informed by postcolonialism and intersectionality theories. This paper is based on the qualitative component of the study. It was a focused ethnography (FE) involving 61 in-depth individual interviews (IDIs) with Black- mothers LWH. Thematic analysis guided the interpretation of these data, and trustworthiness was established through member-checking. Black mothers LWH acknowledged the various support roles that their male partners play in easing the practical and emotional burdens of infant feeding in the context of HIV. Male partners' roles were captured under three sub-themes: (1) Practical help, (2) Protection of the family, and (3) Emotional support and sounding board. These findings have explicated the evolving ways in which male partners support ACB mothers LWH to promote positive infant feeding outcomes, as well as enhance the emotional and physical well-being of both mother and infant. Our study has explicated the evolving ways in which male partners support Black mothers LWH to promote positive infant feeding outcomes, as well as enhance the emotional and physical well-being of both mother and infant.

Effects of Swaddling During Bottle Feeding in Preterm Infants.

Preterm infants have immature oral feeding skills, affecting length of hospital stay and long-term feeding outcomes. Swaddling has positive effects on pain and stress responses, state regulation, and physiological stability in preterm infants in the neonatal intensive care unit (NICU). Swaddling during bottle feeding may support preterm infant behavioral organization and oral feeding skills. Swaddling is used inconsistently during feeding in the NICU and has not been critically examined for effects on bottle feeding performance in preterm infants. To examine the effects of swaddling on bottle feeding quality and efficiency in preterm infants. A convenience sample of 30 infants born before 34 weeks of gestation was selected in an urban level IV NICU. Using an experimental, randomized crossover design, each infant was swaddled for one feeding and unswaddled for one feeding. Feeding efficiency was measured by rate and volume consumed. Feeding quality was examined by the Early Feeding Skills Assessment and frequency of physiological changes. Data were analyzed using dependent t tests and Wilcoxon signed rank test. When swaddled, participants demonstrated significantly better scores on all related subtests of the Early Feeding Skills Assessment ( P ≤ .001). Infants demonstrated no difference in frequency of bradycardia or oxygen desaturations greater than 4 seconds. No significant differences were found in feeding efficiency outcomes. Swaddling can be used in the NICU to improve bottle feeding quality in preterm infants. Future investigation is needed on long-term effects of swaddling during bottle feeding on feeding performance, weight gain, and length of stay.

Outcome of Early Oral Feeding after Primary Repair of Traumatic Intestinal Injury: Prospective Observation in a Tertiary Hospital in Bangladesh

Introduction: A period of starvation is common practice after intestinal anastomosis. Starved patient became malnourished and underwent catabolic state, impairing the host immune response and thus increasing the risk of postoperative infections thereby long hospital stay. Objective: To observe the outcome of early oral feeding in patients having primary repair of traumatic intestinal injury and to assess its beneficial effect. Methods: This prospective observational study was conducted on 80 patients who underwent urgent intestinal resection with or without covering stoma in the Department of Casualty Surgery at Dhaka Medical College Hospital. Results: Early oral feeding is safe in the recently performed anastomosis even in emergency situations as there were no cases of clinical anastomotic dehiscence and no increase in morbidity. Among 80 patients 58(72.5%) patients had no complaints; rest 22(27.5%) patients had complication. Wound infection seen in 14(17.5%) patients among them 8(10%) patients had burst abdomen and 1(1.25%) patient had intraabdominal abscess. 14(17.5%) patients had chest infection. 10(12.5%) patients complained nausea and among them 8(10%) patients suffered from few episodes of vomiting. 1(1.25%) patient had diarrhoea. Abdominal distension was seen in 9(11.25%) patients. Hospital stay was significantly shorter in with a mean length of stay (9 ± 1) days. No hospital readmission rate was recorded. Conclusion: Early postoperative feeding is timely, safe and tolerable after emergency intestinal resection anastomosis without raised morbidity and mortality and has a considerable reduction in hospital stay with its physical, psychological and fiscal benefits. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 75-79

Relationship Between Start of Feeding and Functional Outcome in Aspiration Pneumonia: A Retrospective Cohort Study.

Aspiration pneumonia is the predominant form of pneumonia in the elderly. Low oral intake levels and malnutrition have been reported to be associated with increased mortality and loss of function in aspiration pneumonia. However, the relationship between start of feeding and readmission, which is associated with malnutrition and low oral intake levels, has not been reported. The purpose of this study was to clarify the relationship between start of feeding and functional prognosis in aspiration pneumonia. Patients' basic information, comorbidities, severity of pneumonia, swallowing function, time from admission to the start of feeding, geriatric nutritional risk index (GNRI), readmission, and Barthel index (BI) were evaluated in 160 patients. The patients were divided into two groups-a readmission group and a non-readmission group-and statistical verification was performed. The readmission group was 62 cases (38.8%). Univariate analysis showed that the time from admission to the start of feeding was significantly longer in the readmission group (p < 0.001). Age was significantly higher and nutrition parameters were lower in the readmission group (p = 0.001, 0.006). Furthermore, according to logistic regression analysis, readmission was associated with age (odds ratio, 1.063; p = 0.007; 95% confidence interval (CI) 1.017-1.111) and time from admission to the start of feeding (odds ratio 1.080; p < 0.001; 95% CI 1.025-1.137). The time from admission to the start of feeding was significantly longer in the readmitted patients. A comprehensive intervention with multidisciplinary collaboration should be performed from the early stage of hospitalization. This study is registered in the UMIN-Clinical Trials Registry (UMIN-CTR). UMIN-CTR meets the criteria of the International Committee of Medical Journal Editors (ICMJE). (Registration number: 000047141).

Feeding self-efficacy and feeding outcome expectancy mediate the association between maternal depressive symptoms and responsive feeding

Previous research has demonstrated a link between maternal depressive symptoms and infant feeding behavior; however, the underlying mechanisms linking the two remain unclear. This study examined the association between maternal depressive symptoms and responsive feeding, and the potential mediating role of feeding self-efficacy and outcome expectancy. A panel study with 487 women, from pregnancy through postpartum, was conducted. Maternal depressive symptoms at one month postpartum were assessed by the Edinburgh Postnatal Depression Scale. Responsive feeding included feeding on demand and unforced feeding domains. Responsive feeding, feeding self-efficacy, and feeding outcome expectancy were assessed at three months postpartum. Maternal depressive symptoms were associated with less responsive feeding, but the association was fully mediated by feeding self-efficacy and feeding outcome expectancy. Infant feeding problems are associated with depressive symptoms in mothers. Health professionals could work with depressed mothers to enhance infant feeding by targeting feeding self-efficacy and feeding outcome expectancy.

Prenatal and Birth Care of Roma Women.

The reproductive health of Roma women has been poorly studied. It is important to determine the follow-up care received by Roma women from pregnancy to the first postpartum visit, together with neonatal outcomes, to improve prenatal care and maternal-child outcomes. The aim of this study was to examine differences in prenatal care and maternal-infant outcomes between Roma and non-Roma women. A retrospective longitudinal study was conducted in 122 pregnant women (28 Roma and 94 non-Roma women) recruited from seven primary care centers in three districts of Asturias (Spain). Sociodemographic variables, prenatal control, birth characteristics, feeding, and neonatal outcomes (gestational age, weight, and APGAR [appearance, pulse, grimace, activity, and respiration]) were collected from the electronic medical records. Prenatal care was assessed using three indices: the Kessner index, the Modified Adequacy of Prenatal Care Utilization Spanish Index, and an ad hoc index that considered adherence to the recommendations for pregnant women in Spain. Compared with non-Roma women, advanced maternal age (≥35 years) and primigravida were less common among Roma women. Roma women visited the dentist less often, smoked more, and underwent group B streptococcus screening less frequently. No differences were found in the number of prenatal visits between Roma and non-Roma women. Consequently, there were no differences between the Kessner index and the Modified Adequacy of Prenatal Care Utilization Spanish Index. Using the ad hoc index, the non-Roma women more frequently had adequate prenatal visits. There were no differences in birth characteristics, type of feeding, and neonatal outcomes. Overall, prenatal care was slightly worse in Roma women; however, this did not imply worse neonatal health outcomes. Both study groups had similar birth characteristics and immediate puerperium, including feeding.

Impact of an Infant-Driven Feeding Initiative on Feeding Outcomes in the Preterm Neonate.

Poor feeding techniques result in adverse outcomes for preterm infants. Infant-driven feeding (IDF) is a structured feeding method that standardizes neonatal cue-based feedings, and matches the neurodevelopmental stage of the preterm infant. The purpose of this quality improvement project is to assess whether initiation of an IDF initiative impacts time from first nipple feed (NF) to full NF and to discharge in infants born before 35 weeks' gestational age. Secondary aims include assessment of the impact of IDF on neonatal growth and feasibility of following an IDF protocol in a level III neonatal intensive care unit (NICU). This quality improvement project assesses differences in time to first NF, length of hospital stay, and neonatal growth before and after usage of an IDF protocol. Eighty infants were included, 40 prior to and 40 after IDF intervention. Nurses were trained on IDF philosophy and methods prior to initiation. IDF was associated with discharge at a younger corrected gestational age (CGA), attainment of ad lib feeds at a younger CGA, and shorter amount of days between first NF and discharge. Infants utilizing IDF had slower weight gain, demonstrated by a larger drop in z score in the IDF group. The medical team and bedside nurses were able to follow the IDF protocol with few exceptions. IDF allows for optimization of a preterm infant's NICU stay and prepares infants for a safe discharge sooner. This could lead to increased parental satisfaction and decreased hospital cost. Further studies are indicated to ensure these benefits remain and focus on impact direct breastfeeding plays in the IDF model.

Nutritional condition affects tergal gland secretion and courtship success of male cockroaches.

An integral part of the courtship sequence of the German cockroach (Blattella germanica) involves the male raising his wings to expose tergal glands on his dorsum. When a female cockroach feeds on the secretion of these glands, she is optimally positioned for mating. Core chemical components have been identified, but the effect of male diet on the quality of the tergal gland secretion remains unexplored. After validating the pivotal role of tergal feeding in mating, we starved or fed reproductively mature males for one week. We then paired each male with a sexually receptive female and observed their interactions through an infrared-sensitive camera. While starvation had no effect on male courtship behavior, it did influence the duration of female tergal feeding and mating outcomes. Females fed longer on the gland secretion of fed males, and fed males experienced greater mating success than starved males (73.9% vs. 48.3%, respectively). These results suggest that the quality of the tergal gland secretions, and by association mating success, are dependent on the nutritional condition of the male.

The impact of a Donor Human Milk Program on the provision of mothers' own milk at discharge in very low birth weight infants.

Examine the effect of a donor human milk (DHM) program on mothers' own milk feedings at discharge for very low birth weight (VLBW) infants. A single center retrospective analysis of feeding outcomes in preterm infants. Data were assigned as: (1) pre DHM era (2) Bridge DHM era (3) Full DHM era. Each era was divided into infants <1500 g (n = 724) or ≥1500 g (n = 784). Both the percentage of mothers' own milk feeds and percent of infants exclusively receiving mothers' own milk at discharge were increased in the <1500 g (p = 0.003, p = 0.002) and the ≥1500 g group (p = 0.007, p = 0.004) respectively, following the introduction of DHM for VLBW infants. Practice changes that accompany a donor milk program likely play a prominent role in the provision of mothers' own milk and exclusivity of breast milk feedings at discharge for very low birth weight infants.

The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India

BackgroundDirect-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This...

A Literature Review of Feeding Disorders in Children with Tracheostomies and Ventilators.

Feeding disorders and gastrostomy use are highly prevalent in children with invasive mechanical ventilation (IMV) due to both common risk factors (eg, prematurity, neurological disorders) and resultant experiential deprivation (eg, long hospitalizations, delayed feeding experiences). Feeding in children with IMV is complicated by the presence of a tracheostomy, lung vulnerability, and medical complexity. The potential comorbidity of swallowing difficulties (dysphagia) and atypical early feeding experiences can result in complex feeding disorders. In this review of pediatric feeding disorders in children with invasive mechanical ventilation (IMV), we identify gaps in clinical translational research for this patient population and opportunities for improving evidence-based management. To improve long-term feeding outcomes and maximize oral feeding in this vulnerable population, children would benefit from earlier feeding opportunities during critical developmental windows, standardized protocols for advancing oral feeding, and involvement of intensive, comprehensive therapies throughout hospitalizations and early childhood. [Pediatr Ann. 2022;51(7):e291-e296.].

Infant feeding patterns before and after changes to food allergy prevention guidelines in Australia

Food allergy is an important public health problem in Australia. Randomised controlled trials have provided evidence that introducing infants to peanut and egg early reduces the risk of developing allergies to these foods.1 The Australian Infant Feeding Summit was therefore held in 2015 to review infant feeding recommendations.2 Based on a consensus among expert stakeholders (state and federal health care agencies, consumers, and experts in allergy, infant feeding, and population health), and with the aim of providing clear guideline advice to the public while balancing the need for food allergy prevention and other nutritional priorities, including the known benefits of breastfeeding, three recommendations were made: to introduce solid foods at about six months (but not before four months) of age; to introduce peanut and egg during the first twelve months of life; and to no longer use hydrolysed infant formula for preventing allergy.2 These recommendations were incorporated into the infant feeding guidelines of the Australasian Society of Clinical Immunology and Allergy in 2016.3 We have previously reported that introducing peanut during the first year of life increased in Melbourne after the new guidelines were introduced, from 28% of infants during 2007–11 to more than 88% during 2017–19.4 In this article, we report our assessment of breastfeeding rates, the introduction of solid foods, and the use of partially hydrolysed formula before and after the new Australian guidelines were published. We analysed data from two population-based studies we had undertaken using the same recruitment methods and sampling frame.4 Twelve-month-old infants were recruited at local council vaccination sessions in Melbourne, for the HealthNuts study during 2007–11, and for EarlyNuts during 2017–19. Their parents completed questionnaires including items on infant feeding practices (Box 1), with similar response rates (HealthNuts, 74%; EarlyNuts, 76%). The Royal Children’s Hospital Human Research Ethics Committee approved each study (HealthNuts, #27047; EarlyNuts, #36160). The proportion of infants breastfed for at least twelve months was larger during 2017–2019 than 2007–2011 (52.7%; 95% confidence interval [CI], 50.3–55.0% v 35.9%; 95% CI, 34.5–37.2%), and the proportion of those who received formula slightly smaller (76.0%; 95% CI, 74.0–77.9% v 80.1%; 95% CI, 79.0–81.2%); changes in the proportions of infants ever breastfed or who received partially hydrolysed formula were not statistically significant. The proportion of infants introduced to solid foods at four months increased (31.9%; 95% CI, 29.7–34.1% v 19.2%; 95% CI, 18.2–20.4%), but not that of those introduced very early (before four months) (Box 2). Breastfeeding rates were higher in the Melbourne EarlyNuts study than in the 2017–18 National Health Survey5 — breastfeeding ever, 95% v 93%; at least twelve months, 53% v 41% — but a smaller proportion had been introduced to solid food at six months or later (39% v 48%). As EarlyNuts was a food allergy study, rates of breastfeeding and the adoption of guideline recommendations among its participants may have been higher than for the general population. Our findings suggest that introducing common food allergens early is not associated with a decline in breastfeeding. They do not establish a causal relationship between the new allergy guidelines and changes in infant feeding outcomes, but it is reassuring that the proportion of breastfed infants did not decline after their publication. Timely introduction of allergens can be recommended without concern that it might curtail breastfeeding or increase extremely early introduction to solid foods. We recommend ongoing monitoring of breastfeeding, timing of the introduction of solid and allergenic foods, and the incidence of food allergy in Australia. The EarlyNuts study was supported by the National Health and Medical Research Council (NHMRC; GNT1146769) and the Murdoch Children's Research Institute. Research at the Murdoch Children's Research Institute is supported by the Victorian Government Operational Infrastructure Program. Victoria Soriano is supported by a PhD scholarship from the NHMRC-funded Centre for Food and Allergy Research (GNT1134812). Jennifer Koplin (GNT1158699), Merryn Netting (GNT1156518), and Rachel Peters (GNT1160779) are supported by NHMRC fellowships. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians. No relevant disclosures.

The Effects of COVID-19 Hospital Practices on Breastfeeding Initiation and Duration Postdischarge.

Background: Early in the COVID-19 pandemic, many birth hospitals separated SARS-CoV-2-positive mothers from their newborn infants and advised against breastfeeding to decrease postnatal SARS-CoV-2 transmission. Information on how these practices impacted breastfeeding postdischarge is limited. Objectives: In a statewide sample of SARS-CoV-2-positive mothers, we aimed to determine the extent to which (1) mother-infant separation and (2) a lack of breastfeeding initiation in-hospital were associated with breast milk feeding postdischarge. Design/Methods: From 11 birthing hospitals in Massachusetts, we identified 187 women who tested positive for SARS-CoV-2 from 14 days before to 72 hours after delivery (March 1-July 31, 2020) and their newborn infants. We abstracted chart data from the delivery hospitalization on main exposure variables (mother-infant separation, in-hospital breast milk feeding [expressed milk feeding and/or direct breastfeeding]) and from outpatient visits until 30 days postdischarge. We evaluated associations of in-hospital practices with outcomes up to 30 days postdischarge, adjusting for confounders using multivariable logistic and linear regression. Results: Mother-infant separation in-hospital was associated with a shorter duration of any breast milk feeding (regression coefficient estimate -5.29 days, 95% confidence intervals [CI] [-8.89 to -1.69]). Direct breastfeeding in-hospital was associated with higher odds of any breast milk feeding (adjusted odds ratios [AOR] 5.68, 95% CI [1.65-23.63]) and direct breastfeeding (AOR 8.19, 95% CI [2.99-24.91]) postdischarge; results were similar for any breast milk feeding in-hospital. Conclusions: Perinatal hospital care practices implemented early in the COVID-19 pandemic, specifically mother-infant separation and prevention of breast milk feeding initiation, were associated with adverse effects on breast milk feeding outcomes assessed up to 1 month postdischarge.

Feeding Skill and Behavior Changes in Children With Complex Feeding Disorders Following Therapy in an Intensive Multidisciplinary Feeding Program

Purpose: This study aims to measure and describe changes in oral feeding skills and mealtime behaviors observed in children with complex feeding disorders and/or feeding tube dependence after participation in an intensive multidisciplinary feeding program. This is the first study to use a standardized tool to report feeding outcomes after patients received intensive feeding therapy using a combination of therapeutic strategies. Method: This was a prospective observational study examining the treatment outcomes of 34 patients (range: 13 months to 6.5 years) admitted into the Intensive Multidisciplinary Feeding Program using the Pediatric Eating Assessment Tool (PediEAT). Eighteen patients were tube dependent; 16 patients were oral feeders. All patients received 19 days of intensive feeding intervention. The PediEAT was completed by patient's caregiver at admission and discharge from the feeding program. Caregiver and patient demographics were also collected. Results: Statistical analysis of scores at admission (prescore) and at discharge (postscore) revealed significant improvements in PediEAT total scores and across all subscales for all patients. The largest degree of change was noted in the Problematic Mealtime Behaviors subscale. Patients who were oral feeders also demonstrated significant improvements in the Oral Processing subscale in addition to Problematic Mealtime Behaviors subscale. Tube-dependent patients presented with a large degree of change in the Selective Restrictive Eating subscale and in the Problematic Mealtime Behaviors subscale. Conclusions: This study demonstrates that the use of an individualized approach using a combination of therapeutic strategies results in statistically significant improvements in multiple feeding domains as measured by a validated tool after participating in an intensive multidisciplinary feeding program. Improvement in a child's ability to manage advanced textures and consistencies can have a significant impact on their willingness to engage in mealtimes. It is important to measure and report on their skills, in addition to behavioral responses and intake.

Investigating the impact of multiple feeding attempts on mosquito dynamics via mathematical models

A deterministic differential equation model for the dynamics of terrestrial forms of mosquito populations is studied. The model assesses the impact of multiple probing attempts by mosquitoes that quest for blood within human populations by including a waiting class for mosquitoes that failed a blood feeding attempt. The equations are derived based on the idea that the reproductive cycle of the mosquito can be viewed as a set of alternating egg laying and blood feeding outcomes realised on a directed path called the gonotrophic cycle pathway. There exists a threshold parameter, the basic offspring number for mosquitoes, whose nature is affected by the way we interpret the transitions involving the different classes on the gonotrophic cycle path. The trivial steady state for the system, which always exists, can be globally asymptomatically stable whenever the threshold parameter is less than unity. The non-trivial steady state, when it exists, is stable for a range of values of the threshold parameter but can also be driven to instability via a Hopf bifurcation. The model’s output reveals that the waiting class mosquitoes do contribute positively to sustain mosquito populations as well as increase their interactions with humans via increased frequency and initial amplitude of oscillations. We conclude that to understand human–mosquito interactions, it is informative to consider multiple probing attempts; known to occur when mosquitoes quest for blood meals within human populations.

Complementary Feeding and Growth Among Low Birthweight Infants in the The Second Half of Infancy: Results From a Multi-Site Observational Cohort

ObjectivesThis study was designed to address the high prevalence of infant undernutrition among low birthweight (LBW, < 2.5kg) infants in the second half of infancy, and the dearth of evidence on the optimal transition and provision of complementary feeding and growth of LBW infants. The objectives were to understand the complementary feeding profile and growth outcomes in the second half of infancy; and to assess the relationship between poor nutritional status at the time of transition to complementary feeding and poor growth outcomes at one year.MethodsThe results presented in this abstract are part of the larger Low Birthweight Infant Feeding Exploration (LIFE) study conducted in India, Malawi and Tanzania. This was a formative, multi-site, observational cohort study that collected data on over 1100 moderately LBW infants throughout infancy. After the six month visit, mother-infant pairs were visited at nine and 12 months.ResultsA total of 1114 infants and their mothers were enrolled in the observational study. More than 95% of infants were fed breast milk at six, nine and 12 months of age. At nine and 12 months respectively, 48% and 31% of infants were not achieving a minimum acceptable diet, highlighting gaps in dietary diversity. A lack of dietary diversity was exacerbated among infants born to younger, less educated and/or multiparous mothers. Proteins were more limited than any other food group; only 66% and 70% of infants were fed animal source foods at nine and 12 months, respectively. Prevalence of stunting (>30%) increased from six to 12 months while underweight (26%) and wasting (10%) remained consistent; regional differences were observed. Importantly, poor growth outcomes at six months were predictive of those at 12 months even when adjusted for key covariates (stunting RR = 2.84, p < 0.001; underweight RR = 6.41, p < 0.001; wasting RR = 4.89, p < 0.001).ConclusionsGiven the gaps in the optimal quality of complementary feeding and predictive relationship between six and 12 month growth outcomes, efforts should be made to enhance the promotion of feeding counseling before and during the transition to complementary feeding and to address key barriers to the provision of a diverse diet. In addition, growth monitoring and proactive intervention at six months or earlier could serve to prevent poor outcomes at one year of life.Funding SourcesBill & Melinda Gates Foundation.

Dietary Aronia melanocarpa Pomace Supplementation Enhances the Expression of ZO-1 and Occludin and Promotes Intestinal Development in Pigs.

A fruit juice production byproduct, Aronia melanocarpa pomace (AMP) is rich in natural polyphenol antioxidant components. The objectives of this study were to study the effects of dietary AMP supplementation on the feeding outcome and intestinal barrier function of pigs. In total, 27 growing pigs (Duroc × Landrace × Yorkshire, ~60 days, average weight of 27.77 ± 2.87 kg, males and females included at random) were randomly allotted to 3 treatment groups, with 3 repetitions per group and 3 pigs per repetition. At the experiment completion, 2 pigs (close to the average body weight of all experimental pigs) per replicate were slaughtered. The control group (CON group) was fed a basic diet, and the experimental groups were fed 4% (4% AMP group) and 8% (8% AMP group) AMP in the basic diet. These pigs were prefed for 3 days, and the formal experiments were performed for 7 weeks. The results showed that compared with the CON diet, the 4% AMP supplementation significantly increased the average daily gain of pigs (P < 0.05). Regarding intestinal development, 4% AMP significantly increased the jejunal villus height/crypt depth ratio (P < 0.05), and different AMP levels had no significant effect on the pig cecum morphology. Different AMP levels significantly decreased the relative abundance of Proteobacteria (P < 0.05). Regarding other microbial genera, 4% AMP supplementation significantly increased the levels of Lachnospira, Solobacterium, Romboutsia and other beneficial microorganisms (P < 0.05). Different AMP levels significantly decreased the relative abundances of the opportunistic pathogens Escherichia-Shigella and Pseudoscardovia (P < 0.05) and increased the contents of acetic acid and butyric acid in the pig cecal contents (P < 0.05). Compared with the CON treatment, 4% AMP supplementation significantly downregulated the jejunal gene expression of porcine proinflammatory factors (IL-1β, IL-6, IL-8 and TNF-α) and significantly upregulated the jejunal gene expression of ZO-1, Occludin and Claudin-1 (P < 0.05). In conclusion, 4% AMP supplementation in feed is beneficial to overall pig health and growth.