Indian Infants Research Articles

Effect of an oral stimulation protocol on breastfeeding among preterm infants: a randomised controlled trial

ObjectivesThe objectives are to assess the effectiveness of a modified and adapted oral sensorimotor intervention (MA-OSMI) protocol for infants in India on the rate and performance of breastfeeding among preterm...

Haemophilus influenzae Type b Vaccine Immunogenicity in American Indian/Alaska Native Infants.

American Indian and Alaska Native (AI/AN) infants historically experienced a disproportionate burden of invasive Haemophilus influenzae type b (Hib) disease, especially early in life. PedvaxHIB vaccine is preferentially recommended for AI/AN infants because it elicits protective antibody levels postdose 1. Vaxelis, a hexavalent vaccine that contains the same Hib conjugate as PedvaxHIB but at lower concentration, is recommended for US children, but postdose 1 Hib immunogenicity data are needed to inform whether a preferential recommendation should be made for AI/AN infants. We conducted a phase IV randomized, open-label, noninferiority trial comparing postdose 1 immunogenicity of Vaxelis to PedvaxHIB in AI/AN infants. Participants were randomized to receive a primary series of PedvaxHIB or Vaxelis. Serum samples collected 30 days postdose 1 were tested for anti-Hib immunoglobulin G antibody by enzyme-linked immunosorbent assay. The anti-Hib immunoglobulin G geometric mean concentration (GMC) ratio (Vaxelis/PedvaxHIB) was estimated by constrained longitudinal data analysis. Noninferiority was defined a priori as the lower bound of the 95% confidence interval (CI) of the GMC ratio ≥0.67. A total of 327 of the 333 infants enrolled in the study were included in the per-protocol analysis. The postdose 1 anti-Hib GMC was 0.41 µg/mL (95% CI 0.33-0.52) in the Vaxelis group (n = 152) and 0.39 µg/mL (95% CI 0.31-0.50) in the PedvaxHIB group (n = 146). The constrained longitudinal data analysis GMC ratio was 1.03 (95% CI 0.76-1.39). Postdose 1 immunogenicity of Vaxelis was noninferior to PedvaxHIB. Our findings support the use of Vaxelis in AI/AN children, a population with elevated risk of Hib disease.

A Survey on Neonatal and Infant Skincare: Indian Dermatologists, Pediatricians and Cosmetologists' Perspective on Product Prescription Pattern and Parents’ Awareness

Objective: Newborn skin is incredibly delicate and vulnerable to issues like dermatitis and infections, which are prevalent in infants in India. To ensure optimal care and results, parents and caregivers must know about infant skincare products and implement a targeted and comprehensive skincare routine. This study aimed to gain insight into the best baby skincare practices as per dermatologists, pediatricians and cosmetologists (Healthcare Professionals [HCPs]), on product prescribing patterns in India and parent’s awareness of the neonatal skincare armamentarium. Methods: An online survey was conducted to assess the best baby skincare practices as per HCPs on product prescribing patterns in India and parent’s awareness of the neonatal skincare armamentarium. Here, a total of 59 HCPs participated in this survey on Cetaphil baby products range (Galderma) conducted to find out the prescribing pattern for baby skincare products and to record parents’ awareness of the available products. Results: The survey showed that dry skin (29%), atopic dermatitis (28%) and diaper rash (15%) were the most encountered skincare problems by HCPs in newborns. The HCPs reported that liquid cleansers (26%) and syndet bars (25%) are some of the most prescribed products and were deemed fit for the majority of the newborns (49%), owing to their gentle and non-irritating properties. A complete skincare regime (cleanser, lotion, diaper cream) was also prescribed to most infants (69%). Moreover, most parents were aware of liquid cleansers for newborns (63%) and the majority of them (62%) knew the difference between syndet bars and normal soaps. Conclusion: Proper product prescription and utilization by HCPs and parents is key to ensuring healthy skin development in newborns. Following an extensive skincare regime inclusive of gentle cleansers, moisturizing lotions and barrier creams from an early stage is essential to protect newborn skin and achieve the desired results.

Use of Haemophilus influenzae Type b-Containing Vaccines Among American Indian and Alaska Native Infants: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2024.

Invasive Haemophilus influenzae type b (Hib) disease is a serious bacterial infection that disproportionally affects American Indian and Alaska Native (AI/AN) populations. Hib vaccination with a monovalent Hib conjugate vaccine consisting of Hib capsular polysaccharide (polyribosylribitol phosphate [PRP]) conjugated to outer membrane protein complex of Neisseria meningitidis serogroup B, PRP-OMP (PedvaxHIB, Merck and Co., Inc.) has historically been preferred for AI/AN infants, who are at increased risk for invasive Hib disease, because it provides substantial protection after the first dose. On June 26, 2024, CDC's Advisory Committee on Immunization Practices (ACIP) recommended that a hexavalent, combined diphtheria and tetanus toxoids and acellular pertussis (DTaP), inactivated poliovirus (IPV), Hib conjugate, and hepatitis B (HepB) vaccine, DTaP-IPV-Hib-HepB (Vaxelis, MSP Vaccine Company) should be included with monovalent PRP-OMP in the preferential recommendation for AI/AN infants because of the PRP-OMP Hib component. A primary Hib vaccination series consisting of either 1) monovalent PRP-OMP (2-dose series at ages 2 and 4 months) or 2) DTaP-IPV-Hib-HepB (3-dose series at ages 2, 4, and 6 months) is preferred for AI/AN infants. DTaP-IPV-Hib-HepB is only indicated for use in infants at ages 2, 4, and 6 months and should not be used for the booster doses of Hib, DTaP, or IPV vaccines. For the booster dose of Hib vaccine, no vaccine formulation is preferred for AI/AN children; any Hib vaccine (except DTaP-IPV-Hib-HepB) should be used. This report summarizes evidence considered for these recommendations and provides clinical guidance for the use of Hib-containing vaccines among AI/AN infants and children.

June 2024 ACIP Meeting Update: Influenza, COVID-19, RSV, and Other Vaccines.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention, normally meets 3 times per year to develop US vaccine recommendations. The ACIP met June 26 through 28, 2024. This update summarizes the proceedings of this meeting, with an emphasis on topics that are most relevant to the pediatric population. Major updates for pediatric clinicians include COVID-19 and influenza vaccine recommendations for the 2024 to 2025 season, meningococcal vaccination considerations, information regarding preferred Haemophilus influenzae type B containing vaccines for American Indian and Alaskan Native infants, and updates regarding implementation and effectiveness of RSV immunization in pregnant people and infants.

Impact of Home Stimulation on the Motor Development of Malnourished Toddlers: A Cross-sectional Study

Objectives: The objectives of the study are to investigate the relationship between malnutrition (as measured by stunting), motor development, and early parental stimulation during the critical preschool years. Methodology: The sample comprised of 150 mother-child dyads. Children with a history of any chronic illness or disability were excluded. The StimQ (Toddler version) questionnaire was used to assess parental stimulation. Motor development was measured by the motor development scale of the Developmental Assessment Scales for Indian Infants. Stunting was measured by the height-for-age Z-score (2 standard deviation [SD] or more below the World Health Organization standard) and this was used as a proxy measure for malnutrition. Results: Among the 150 children studied, 38.7% were stunted and 36.7% were wasted. Overall, the motor development quotient was 91.11 (SD = 14.57) and one-fifth (19.3%) of the sample had a delay in the motor domain. Stunting was positively associated with delayed motor developmental status (t = 2.84, P = 0.005). The motor delayed group, relative to the normal developing preschool children, had significantly lower total StimQ scores as well as on all the subscales. Multiple stepwise linear regression analysis indicated that two variables, namely total StimQ score and extent of stunting, were significantly related to the motor quotient score and explained 23.3% variance (F = 23.68, P = 0.0001), even after controlling for socioeconomic factors. Conclusions: Primary care pediatricians are ideally suited to integrate the promotion of maternal-child responsive interactions, psychosocial stimulation, and child nutritional rehabilitation programs in their clinical practice to foster healthy child development, especially in the context of resource-poor settings.

Motor performance of Indian preterm infants as compared to the US population on the Test of Infant Motor Performance (TIMP)

PurposeThe study aimed at scoring Indian preterm infants at three months corrected age on the TIMP and then comparing the scores to the United States age-based population scores. MethodsAfter obtaining Ethical clearance, participants meeting the inclusion criteria of 53 infants whose parents consented were screened and recruited (N = 47) at a tertiary care hospital. The TIMP was then administered at three months of corrected age. ResultsData obtained from 47 infants born preterm (Male = 33, Female = 14) at three months corrected age with mean gestational age (34.4 ± 2.36 weeks) and mean birth weight (1.93 ± 0.55 kgs) was analyzed. Indian infants born preterm scored a mean of (98.17 ± 20.90) compared to the US mean of (108 ± 19), suggesting an under-performance. The average scores were lower when comparing the mean of the study group with the US-based age-matched population. ConclusionMotor performance scores of Indian preterm infants were low when compared to their US counterparts. Since there exists a difference in the raw score obtained by Indian Preterm infants compared to the US-based population, it may not be appropriate to categorize the motor development of Indian infants based on the US population scores.

Body composition from birth to 6 months in term small-for-gestational-age Indian infants: effect of catch-up growth.

The objective of this prospective observational study was to assess the growth and body composition of term small-for-gestational-age (SGA) infants from birth to 6 months and evaluate the effect of catch-up growth (CUG) on body composition. Term SGA newborns were recruited at birth. Anthropometry and body composition were evaluated at 3 days, 6, 10 and 14 weeks, and 6 months. Fat and fat-free mass (FM and FFM) were compared between infants with and without CUG (increase in weight Z-score by > 0·67) by air displacement plethysmography. Factors that could affect body composition and CUG, including parents' BMI and stature, infants' birth weight, sex and feeding, were evaluated. A total of 143 SGA newborns (sixty-six boys) with birth weight of 2336 (sd 214) g were enrolled; 109 were followed up till 6 months. Median weight Z-score increased from -2·3 at birth to -1·3 at 6 months, with 51·9 % of infants showing CUG. Infants with CUG had higher FM (1796 (sd 491) g v. 1196 (sd 474) g, P < 0·001) but similar FFM (4969 (sd 508) g v. 4870 (sd 622) g, P = 0·380), and consequently higher FM percentage (FM%) (26·5 (sd 5·8) v. 19·7 (sd 6·9), P < 0·001), compared with those without CUG. Lower birth weight, exclusive breast-feeding and higher parental stature were positively associated with CUG. In conclusion, CUG in term SGA infants in the first 6 months of life was almost entirely attributable to greater gain in FM. Follow-up of this cohort will provide insight into the long-term effect of disproportionate gain in FM in early infancy in SGA babies.

Risk factors for the development of severe or very severe respiratory syncytial virus-related lower respiratory tract infection in Indian infants: A cohort study in Melghat, India.

Respiratory syncytial virus (RSV) is undoubtedly the single most important cause of severe lower respiratory tract infection (LRTI) globally. While new prevention measures in young infants have become available, their use in developing countries is likely many years away. While risk factors for severe or very severe RSV LRTI in impoverished rural areas likely differ to urban areas, there are very few studies, especially those conducted in India, the major country contributing to the global burden of disease. Active surveillance for acute LRTI in enrolled infants and children <2 years of age, was conducted through weekly home visits in 93 villages of Melghat, India, from August 2016 to December 2020. Local hospitals and primary health centres were surveyed for admissions of enrolled subjects. Nasopharyngeal swabs were collected from children with severe, or very severe LRTIs and all who died, with RSV testing using nucleic acid tests at ICMR, National Institute of Virology Pune. Risk factors for both RSV associated and non-RSV associated, severe and very severe LRTI were identified through univariate and multivariate logistic regression. There were 483 severe or very severe RSV LRTI cases and 2807 non-RSV severe or very severe LRTI infections in a cohort of 13,318 children. Weight for age z-score ≤-2, the use of kerosene or wood for cooking, obtaining drinking water from a public tap and low gestational age significantly increased the risk of RSV LRTI. A higher wealth score index and water purification were protective. Comparison with non-RSV LRTI showed male sex as an additional risk factor. The analysis highlighted the risk of kerosene use [OR = 17.8 (3.0-104.4) (p ≤ 0.001)] and [OR = 3.4 (0.8-14.4) (p ≤ 0.05)] for RSV and non-RSV LRTIs, respectively. Nutritional status and environmental air quality are predisposing factors for developing an RSV LRI in young children, factors which are amenable to environmental and behavioural interventions.

Comparison of growth patterns in the first year of life between term small for gestational age and appropriate for gestational age South Indian infants

BackgroundEarly life growth trajectories of Indian small for gestational age (SGA) infants are sparse. This study aimed to compare longitudinal growth in appropriate for gestational age (AGA) and SGA infants...

Impact of maternal education on the development of severe acute malnourished children

Background: Severe acute malnutrition (SAM) is a grave form of undernutrition that has been recognized as a medical and social disorder. Various factors contribute to the development of SAM, but the impact of maternal education on the nutritional status and development of the child is of paramount importance since focused interventions in this aspect can yield promising results. Aims and Objectives: The aims and objectives of the study are to assess the impact of maternal education on the development of children with SAM. Materials and Methods: A total of 125 SAM children in the age group 12–30 months were enrolled in this prospective observational study from among those admitted to the nutritional rehabilitation center of a tertiary care center in central India. The developmental status of SAM children was assessed using the Developmental Assessment Scale of Indian Infants. The association of maternal education with the development of SAM children was analyzed. Results: Overall developmental delay was observed in 44.8% of SAM children, whereas motor and mental development delay was noted in 45.6% and 44% of SAM children. The maternal education level was significantly associated with the overall development of the SAM child. (P=0.043 for motor development, P=0.017 for mental development, P=0.023 for motor developmental delay). Conclusion: Maternal education plays a key role in improving the developmental status of SAM children, who are more prone to developmental delays across various domains. Efforts toward enhancing maternal education, especially knowledge regarding child nutrition and development, can reduce the incidence and improve the management of SAM in children.

Immunogenicity and safety of a 14-valent pneumococcal polysaccharide conjugate vaccine (PNEUBEVAX 14™) administered to 6–8 weeks old healthy Indian Infants: A single blind, randomized, active-controlled, Phase-III study

BackgroundIntroduction of pneumococcal conjugate vaccines (PCVs) reduced the number of cases of pneumococcal disease (PD). However, there is an increase in clinical and economic burden of PD from serotypes that are not part of the existing pneumococcal vaccines, particularly impacting pediatric and elder population. In addition, the regions where the PCV is not available, the disease burden remains high. In this study, immunogenicity and safety of the BE’s 14-valent PCV (PNEUBEVAX 14™; BE-PCV-14) containing two additional epidemiologically important serotypes (22F and 33F) was evaluated in infants in comparison to licensed vaccine, Prevenar-13 (PCV-13). MethodsThis is a pivotal phase-3 single blind randomized active-controlled study conducted at 12 sites across India in 6–8 weeks old healthy infants at 6–10–14 weeks dosing schedule to assess immunogenic non-inferiority and safety of a candidate BE-PCV-14. In total, 1290 infants were equally randomized to receive either BE-PCV-14 or PCV-13. Solicited local reactions and systemic events, adverse events (AEs), serious AEs (SAEs), and medically attended AEs (MAAEs) were recorded. Immunogenicity was assessed by measuring anti-PnCPS (anti-pneumococcal capsular polysaccharide) IgG concentration and functional antibody titers through opsonophagocytic activity (OPA), one month after completing three dose schedule. Cross protection to serotype 6A offered by serotype 6B was also assessed in this study. FindingsThe safety profile of BE-PCV-14 was comparable to PCV-13 vaccine. Majority of reported AEs were mild in nature. No severe or serious AEs were reported in both the treatment groups. For the twelve common serotypes and for the additional serotypes (22F and 33F) in BE-PCV-14, NI criteria was demonstrated as defined by WHO TRS-977. Primary immunogenicity endpoint was met in terms of IgG immune responses for all 14 serotypesof BE-PCV-14. Moreover, a significant proportion of subjects (69%) seroconverted against serotype 6A, even though this antigen was not present in BE-PCV-14. This indicates that serotype 6B of BE-PCV-14 cross protects serotype 6A. BE-PCV-14 also elicited comparable serotype specific functional OPA immune responses to all the serotypes common to PCV-13. InterpretationsBE-PCV-14 was found to be safe and induced robust and functional serotype specific immune responses to all 14 serotypes. It also elicited cross protective immune response against serotype 6B.These findings suggest that BE-PCV-14 can be safely administered to infants and achieve protection against pneumococcal disease caused by serotypes covered in the vaccine.The study was prospectively registered with clinical trial registry of India – CTRI/2020/02/023129.

Reference gender-specific neonatal size at birth growth curves for singleton and twin neonates from North India.

To construct reference growth curves for the preterm population from North India and compare it with global charts. This prospective study enrolled preterm neonates (23 to 36 weeks) from July 2018 to August 2019 after excluding stillbirths and those with congenital malformations. Anthropometry was performed within 18 hours of birth. Gestation age was assessed by the best estimate of a combination of the last menstrual period, antenatal first-trimester ultrasound, and Expanded New Ballard Score (ENBS). Centile curves were constructed for both genders for twins and singleton neonates separately using the GAMLSS method using R software. During the study period, of the 14,908 births, 3253 (21.8%) were born preterm. After excluding malformations and stillbirths, 2976 preterm neonates were eligible, out of which anthropometry within 18 hours was done for 2719 neonates. Data was analyzed for 2290 singleton and 414 twin preterm neonates. Smoothed reference growth curves were constructed for all anthropometric parameters for both genders for singleton as well as twin neonates. Indian preterm infants were smaller compared to international standards. The proportion of small for gestational age (SGA) neonates was 23.1% (Fenton's charts) but only 10.9% when the data from the newly constructed chart was used. The concordance with international standards was better for very preterm neonates <32 weeks than moderate and late preterm neonates (32 to 36 weeks). The reference charts derived from the present study can be used for the North Indian preterm population. The use of western growth charts tends to overestimate the incidence of SGA.

Differences in Pertussis Incidence by Race and Ethnicity in the United States, 2010-2017.

An increased pertussis burden has been demonstrated among Hispanic or Latino and American Indian or Alaska Native (AI/AN) infants. However, data on potential disparities among other age and racial groups are limited. We analyzed pertussis cases reported through Enhanced Pertussis Surveillance from 2010 to 2017. Pertussis and severe pertussis incidence were calculated by race (White, Black or African American, AI/AN, and Asian or Pacific Islanders), ethnicity (Hispanic or Latino and non-Hispanic or non-Latino), and age. Compared with White persons, overall incidence was lower among Black or African American (incidence rate ratio [IRR], .57; 95% confidence interval [CI], .53-.61), AI/AN (IRR, 0.65; 95% CI, .58-.72), and Asian or Pacific Islander persons (IRR, 0.39; 95% CI, .35-.43). Overall incidence of pertussis was higher (1.5-fold; 95% CI, 1.37-1.60) among Hispanic or Latino compared with non-Hispanic or non-Latino adults, potentially related to household size or lower pertussis vaccine uptake among adult Hispanic or Latino cases. Severe pertussis incidence was similar among Black or African American and AI/AN persons compared with White persons. Among infants, severe pertussis incidence was 1.4-fold higher (95% CI, 1.03-1.82) among Black or African American infants than among White infants, and 2.1-fold higher (95% CI, 1.67-2.57) among Hispanic or Latino infants than non-Hispanic or non-Latino infants. The contrast between lower reported incidence but similar or higher severe pertussis incidence among Black or African American and AI/AN persons compared with White persons warrants further investigation and may reflect underdiagnosis or underreporting of mild disease.

Minipuberty in Full-term and Preterm Asian Indian Infants: The First Glance

Minipuberty in Full-term and Preterm Asian Indian Infants: The First Glance

Assessment of breast-feeding and weaning practices of under-fives and their associated co-morbidities in urban and rural areas of Ahmedabad City, Gujarat, India.

Shaping up the post-2015 development agenda is of crucial importance in the development process around the Globe as 20151 was the last year of milllenium development goals. It is the right time to asses our own progress vis-a-vis the Millennium development goals. Appropriate feeding and weaning practices are the key contributor for decreasing morbidities and mortalities in under-five children. As per national family health survey-5 (NFHS-5), only 55.8% of the Indian infants between 0 and 6 months were exclusively breastfed in Gujarat. Children age 6-8 months receiving solid or semi-solid food and breast milk were only 49.4% in Gujarat. Only 5.8% of breastfeeding infants aged 6-23 months receive an adequate diet in Gujarat. Hence the following study was done to know the practice of breastfeeding and weaning in mothers of urban and rural area of Ahmedabad city, Gujarat. The primary objective of this study was to describe the breastfeeding and newborn care practices and the factors affecting the initiation and duration of breastfeeding in urban and rural areas of Ahmedabad city, Gujarat and the secondary objective was to describe the comorbidities associated with them. Cross-sectional study was done in anganwadis of slums of urban and rural field practice area of B.J. Medical College, Ahmedabad. Half of the under-five children were provided jaggery as pre-lacteal feed both in urban (45%) and rural (53%) area. In urban area most common reason for providing pre lacteal feeds was due to family customs (55%) followed by their belief that it leads to help in removal of meconium from gut (22%) followed by as advised from their relatives (23%) as compared to in rural area where there was belief that it leads to help in removal of meconium from gut (52%) followed by family customs (31%) and advise from relatives (17%). There were 7.5% under-five children in urban area in whom breastfeeding was not initiated immediately compared to rural area in which there were 42% under-five children. Frequent occurrence of acute illness among under-fives may have lead to undernutrition.

A Study of General Movement Assessment and Its Association With Neurodevelopmental Outcome at Age 12 to 15 Months Among Term Neonates With Hyperbilirubinemia

BackgroundTo determine the association between optimality score at term age and age three to five months and neurodevelopmental outcome among neonates with hyperbilirubinemia. MethodsFifty infants with and without hyperbilirubinemia were enrolled. The motor repertoires of the infants were evaluated through general movement assessment (GMA) at term age and three to five months post-term. The association between the General Movement Optimality Score (GMOS), Motor Optimality Score (MOS), and Development Assessment Scale for Indian Infants (DASII) at age 12 to 15 months was also assessed. ResultsDuring term age, the median GMOS was significantly lower among infants in the study group when compared with the control group (40 [29 to 42] vs 42 [42 to 42], P < 0.001). However, at age three to five months, there was no significant difference between the groups. Significantly higher number of neonates had abnormal motor repertoire at term age and age three to five months in the study group when compared with the control group (18 [36%] vs 2 [4%], P = 0.001, at term age and 6 [12.2%] vs 1 [2%], P =0.04, at age three to five months). Among neonates with hyperbilirubinemia, the median GMOS and MOS were significantly lower at term age and age three to five months in infants with motor and mental developmental quotient scores <85 when compared with ≥85. ConclusionsGMA including GMOS and MOS performed in neonates with hyperbilirubinemia during the neonatal period and early infancy is associated with neurodevelopmental outcomes in the first year of life. GMA can help initiate early intervention in such neonates.

Respiratory Syncytial Virus-related Lower Respiratory Tract Infections in Neonatal and Post-neonatal Babies: A Series of Four Cases

Respiratory Syncytial Virus (RSV) is a highly contagious seasonal virus that is the leading cause of acute Lower Respiratory Tract Infections (LRTI) in the paediatric age group and is one of the leading causes of death in children under five in developing countries. There is evidence that severe RSV infection and hospitalisation in early life increase the risk of recurrent wheezing, childhood asthma, and allergic sensitisation. Even though RSV being a major global health concern, very few papers concentrate on the neonatal period in India. The present case series presents four cases (three females and one male baby) highlighting the impact of RSV in neonatal and post-neonatal infants in India. The cases highlight the diversity of presentation; one infant required prolonged High-flow Nasal Cannula (HFNC) support, while two needed just symptomatic care. The importance of Polymerase Chain Reaction (PCR) in resource-constrained situations is highlighted as diagnostic issues are examined. Treatment focuses on supportive care; oxygen and respiratory support are provided in more severe cases. The present study emphasises the need for early detection and preventative measures, such as using novel treatments like nirsevimab. The present case series advocates for focused therapies and additional research in the Indian paediatric environment, adding insightful perspectives to the expanding body of knowledge on RSV.

Food texture experiences across nine age groups in Indian infants from urban areas.

The introduction of complementary food plays a fundamental role in dietary behaviours later in life. Little is known about the influences of age on food texture acceptance in young Indian children. Thus, the objective of this cross-sectional study was to describe the relationship between age and food texture experiences in young children aged 4-36 months in India from urban areas using a parental-reported survey. This study relies on a face-to-face parent survey, which was conducted comprising 306 children categorised into 9 age groups. Questions focussed on food texture experience considering 16 textures were analysed. Textures such as dissolvable, sticky, and soupy/liquidy were already accepted by more than half of 4-5-month-old infants. In India, soupy/liquidy is a more common base texture than pureed. Indeed, pureed was found to be introduced to a majority of infants only from 8 to 9 months onwards. Food textures such as rubbery, slippery, and foods with skin were more likely rejected by the youngest children. With increasing age, the refusal probability of food textures decreased. Our survey showed food texture experiences in Indian children aged from 4 to 36 months. It provides useful insights for parents and healthcare professionals by contributing to the understanding of texture acceptance during the transition to complementary foods.

Exclusive breastfeeding practices and its determinants in Indian infants: findings from the National Family Health Surveys-4 and 5

BackgroundThe World Health Organization (WHO) recommends exclusive breastfeeding (EBF) in infants for the first 6 months of life. This analysis aims to estimate the proportion of Indian infants exclusively breastfed for the first 6 months using the National Family Health Surveys (NFHS)-4 and 5, and further, determine factors associated with EBF practices.MethodsEBF for this analysis was defined as when infants received only breast milk and no complementary feeds (solid food, water, animal milk, baby formula, juice, and fortified food) in the last 24 h prior to the survey. The proportion of infants exclusively breastfed was plotted from birth to 6 months as per the age of children at the time of the survey, and this was computed for individual states, union territories, and overall, for India. Univariate and multivariable logistic regression analyses were performed to examine factors influencing EBF in Indian infants.ResultsThe proportion of Indian infants exclusively breastfed for 6 months was 31.3% (1280/4095; 95% CI 29.9, 32.7) and 43% (1657/3853; 95% CI 41.4, 44.6) as per the NFHS-4 and 5 surveys, respectively. In NFHS-5, infants of scheduled tribes (aOR 1.5; 95% CI 1.2, 1.9) and mothers who delivered at public health facilities (aOR 1.3; 95% CI 1.1, 1.5) showed an increased odds of being exclusively breastfed at 6 months of life compared to their counterparts. Further, infants of mothers aged < 20 years (aOR 0.5; 95% CI 0.4, 0.7), low birth weight infants (aOR 0.6; 95% CI 0.4, 0.8), and infants in whom breastfeeding was initiated one hour after birth (aOR 0.8; 95% CI 0.7, 0.9) showed a reduced odds of being exclusively breastfed at 6 months compared to their counterparts.ConclusionsThe overall EBF practice showed an increasing trend in the NFHS-5 compared to the NFHS-4 survey. However, a vast gap remains unaddressed in the Indian setting with > 50% of the population still not exclusively breastfeeding their infants for the WHO recommended duration of first 6 months. Behavioral studies dissecting the complex interplay of factors influencing EBF within the heterogenous Indian population can help plan interventions to promote and scale-up EBF in Indian infants.