Length Of Exclusive Breastfeeding Research Articles

Association between perinatal and obstetric factors and early age at diagnosis of type 1 diabetes mellitus: a cohort study.

To evaluate the association between perinatal and obstetric factors as potential triggers for the early onset of T1DM. This was a retrospective cohort study enrolling 409 patients diagnosed with T1DM, in Bauru, São Paulo, Brazil, from 1981 to 2023. Data were retrieved from medical records, regarding sociodemographic parameters as age, sex, ethnicity, and socioeconomic status. Perinatal and obstetric factors as delivery type, gestational age, filiation order, length of exclusive breastfeeding, maternal age, maternal and fetal blood types, and occurrence of maternal gestational diabetes were also analyzed. An adapted survival analysis was employed to gauge the impact of each assessed variable at the age of T1DM diagnosis. The median age of T1DM diagnosis was 10.3 years with an interquartile range between 6.4 and 15.5 years. Delivery type and filiation order were the only factors statistically significantly associated with an early age at T1DM diagnosis. Patients who were born through cesarean section and who were firstborns showed a 28.6 and 18.0 % lower age at T1DM diagnosis, respectively, compared to those born through vaginal delivery and those that were nonfirstborns. Being born by cesarean section and being firstborn showed to be statistically significant factors to determine an early T1DM diagnosis.

Breastfeeding Practices in the United Arab Emirates: Prenatal Intentions and Postnatal Outcomes.

Breastfeeding provides the ideal nutrition in infancy, and its benefits extend to the health of mothers. Psychosocial factors such as the intention to breastfeed, self-efficacy, or maternal confidence to breastfeed have been shown to impact breastfeeding outcomes in other communities. The aim of this study was to assess the potential associations between mothers’ prenatal intention to breastfeed and post-delivery breastfeeding practices. A cross-sectional study was conducted from March to September 2017. Emirati and non-Emirati mothers with children below the age of 2 were recruited from maternal and child health centers in various geographical areas in Abu Dhabi Capital district, United Arab Emirates. The variables (mothers’ intention to breastfeed, breastfeeding knowledge, support from family and health care professionals, and initiation and duration of breastfeeding) were collected by research assistants during an in-person interview, using a structured questionnaire. A total of 1799 mothers participated in this study. Mothers’ prenatal intention to breastfeed was significantly associated with breastfeeding initiation (p < 0.001) and length of exclusive breastfeeding (p = 0.006). Furthermore, intention to breastfeed during early pregnancy showed a strong association (p < 0.001) with mothers who had exclusively breast fed for more than three months. In addition, knowledge on the benefits of breastfeeding and getting support from relatives and non-relatives demonstrated significant relationship with a longer period of exclusive breastfeeding (p < 0.01) In total, mothers in the study reported receiving almost four thousand advice about breastfeeding, of which 3869 (97%) were encouraging to our others in the study. Our findings on prenatal intentions, knowledge and network support on exclusive breastfeeding indicates the importance of including breastfeeding knowledge and support as critical topics during prenatal education, not only to the mothers but also to close network members who seek a healthy pregnancy outcome.

C-section Delivery Is a Barrier to and Demographic-maternal-child Factors Have Mixed Effects on the Length of Exclusive Breastfeeding Under Nutrition Transition in Lebanon (P11-058-19)

ObjectivesThe study aims to: estimate the prevalence of exclusive breastfeeding in Lebanon; and examine socio-demographic, maternal, and child-related determinants associated with exclusive breastfeeding for 40 days and 6 months. MethodsIn a cross-sectional study of a nationally representative sample of 1005 Lebanese mother-child dyads, mothers of children < 5 years completed face-to-face interviews about child feeding practices, socio-demographic, maternal, and child characteristics. Exclusive breastfeeding versus mixed feeding or exclusive bottle feeding at 40 days or versus mixed feeding or bottle and solid feeding at 6 months served as the dependent variables. Multivariable logistic regression models were fitted and adjusted for significant covariates with P < 0.10 in the unadjusted analysis. For all other analyses, P < 0.05 indicated statistical significance. Results41% and 12% of the children were exclusively breastfed for 40 days and 6 months, respectively. Compared to the mixed fed or exclusively bottle fed at 40 days, the older the child at the interview the higher the odds by 1.4% per month of exclusive breastfeeding, whereas children delivered via C-section had a 26% or 53% lower odds of exclusively breastfeeding respectively. Also, compared to the exclusively bottle fed at 40 days, children in families with 3 + siblings had a 73% higher odds of exclusively breastfeeding, while children in families owning 2 + cars had a 58% lower odds of exclusively breastfeeding. Compared to the mixed fed at 6 months, children of overweight or obese mothers at the interview had 45% or 53% lower odds of exclusively breastfeeding respectively, whereas heavier children at the interview had a 10% per kg higher odds of exclusively breastfeeding. Compared to the bottle and solid fed at 6 months, children delivered via C-section and those in families owning 2 + cars had a lower odds of exclusively breastfeeding by 62% and 58% respectively. ConclusionsSocio-demographic, maternal and child characteristics influenced infant feeding practices over time in Lebanon. C-section delivery was consistently associated with a lower odds of exclusive breastfeeding for 40 days and 6 months. Reducing elective C-section delivery would enhance exclusive breastfeeding in a population undergoing social and nutrition transition. Funding SourcesLebanese National Council for Scientific Research through its support to the Associated Research Unit (ARU) for “Nutrition and Non-communicable Diseases in Lebanon”.

The Impact of Previous Pregnancy Loss on Lactating Behaviors and Use of Herbal Medicines during Breastfeeding: A Post Hoc Analysis of the Herbal Supplements in Breastfeeding InvesTigation (HaBIT).

Introduction Complementary and alternative medicines (CAMs) are commonly used among lactating women, despite the poor knowledge of these products and of their safety. Perception of pregnancy- and breastfeeding-related difficulties and consequent use of CAMs may differ in bereaved women, by force of the distress related to previous loss, although no literature evidence is available. This Herbal supplements in Breastfeeding InvesTigation (HaBIT) post hoc analysis explored the impact of previous pregnancy loss on lactating behaviors and on use of CAMs during breastfeeding. Methods A web-based survey was conducted among lactating women with no previous alive child, resident in Tuscany (Italy). Data on lactating behavior and on CAMs use were collected and evaluated among women with previous pregnancy loss as compared to control women. Results Out of 476 women answering the questionnaire, 233 lactating women with one child were considered. Of them, 80 had history of pregnancy loss. Cesarean birth was significantly more frequent among women with history of pregnancy loss as compared to controls (41% versus 22%; p=0.004). Proportion, length of exclusive breastfeeding, and occurrence of breastfeeding-related complications were comparable among the two cohorts. More than half of women used CAMs during breastfeeding. Use of CAMs was more frequent among women with previous pregnancy loss (54% versus 68%; p=0.050), specifically considering herbal preparations (16% versus 30%; p=0.018). Major advisors for CAMs use were midwives. 18% and 23% of women without and with history of pregnancy loss declared no clear perception on CAMs efficacy and safety. Conclusion Overcoming the social taboo of pregnancy loss and training healthcare professionals for an adequate management of the perinatal period are essential for an effective and safe care. Despite the common use and advice on CAMs use during breastfeeding, it is important to acknowledge that limited evidence supports their safety and efficacy during such critical period.

Effect of infant feeding practices on iron status in a cohort study of Bolivian infants

BackgroundIron deficiency (ID) is the most common micronutrient deficiency worldwide, with potentially severe consequences on child neurodevelopment. Though exclusive breastfeeding (EBF) is recommended for 6 months, breast milk has low iron content. This study aimed to estimate the effect of the length of EBF on iron status at 6 – 8 months of age among a cohort of Bolivian infants.MethodsMother-infant pairs were recruited from 2 hospitals in El Alto, Bolivia, and followed from one through 6 – 8 months of age. Singleton infants > 34 weeks gestational age, iron-sufficient at baseline, and completing blood draws at 2 and 6 – 8 months of age were eligible for inclusion (N = 270). Ferritin was corrected for the effect of inflammation. ID was defined as inflammation-corrected ferritin < 12 μg/L, and anemia was defined as altitude-corrected hemoglobin < 11 g/dL; IDA was defined as ID plus anemia. The effect of length of EBF (infant received only breast milk with no other liquids or solids, categorized as < 4, 4 – 6, and > 6 months) was assessed for ID, IDA, and anemia (logistic regression) and ferritin (Fer) and hemoglobin (Hb, linear regression).ResultsLow iron status was common among infants at 6 – 8 months: 56% of infants were ID, 76% were anemic, and 46% had IDA. EBF of 4 months and above was significantly associated with ID as compared with EBF < 4 months (4 – 6 months: OR 2.0 [1.1 – 3.4]; > 6 months: 3.3 [1.0 – 12.3]), but not with IDA (4 – 6 months: OR 1.4 [0.8 – 2.4]; > 6 months: 2.2 [0.7 – 7.4]), or anemia (4 – 6 months: OR 1.4 [0.7 – 2.5]; > 6 months: 1.5 [0.7 – 7.2]). Fer and Hb concentrations were significantly lower with increasing months of EBF.ConclusionsResults suggest a relationship between prolonged EBF and ID, but are not sufficient to support changes to current breastfeeding recommendations. More research is needed in diverse populations, including exploration of early interventions to address infant IDA.

Investigating the Effects of Instructing Mothers Using BASNEF Model on Continuing Exclusive Breastfeeding of Late- Preterm Infants

Background: According to the American academy of pediatrics, there is a high correlation between the length of exclusive breastfeeding and increased benefits of mothers and preterm infants. Evidence shows that breastfeeding support programs are effective in prolonging the lactation period, but the effect of these programs on the length of exclusive breastfeeding is not clear. Objectives: The present study aimed at evaluating the effect of education on exclusive breastfeeding continuation in mothers with late- preterm infants. Methods: In this randomized experimental study, 124 mothers of hospitalized late- preterm infants at Fatemiyeh hospital (Hamedan, Iran) were randomly assigned into 2 groups (intervention or control). The data collection instruments included a demographic questionnaire, BASNEF, and checklist for lactation visits, which were required to be completed by mothers in both groups. Moreover, weight gain in infants was measured by researchers before the treatment, and then once a month for a period of 2 months. For mothers in the intervention group, 5 sessions of breastfeeding education on BASNEF model was held during 5 consecutive days. Analyses were conducted using the SPSS 21.0; and a P value less than 0.05 was considered significant. Results: Based on the results at the end of the first- and second- month follow-up, there were statistically significant differences between the intervention and control groups in lactation performance, knowledge, attitude, subjective norm, assessment of results, and enabling factors of the mothers (P < 0.001). At the end of the first- and second- month follow-up, the difference between intervention and control mothers was statistically significant in exclusive breastfeeding continuation, in frequency of breastfeeding without the use of liquids, and feeding apart from breast milk and formula in day and night (P < 0.001). Conclusions: The results of this study revealed that breastfeeding instructional sessions were effective in encouraging mothers to continue exclusive breastfeeding the infants by breast milk; thus, it is suggested to encourage mothers to breastfeed based on the BASNEF model.

An Area at War: Alarming Malnutrition Status and its Predictors among Children Aged 6-60 Months Old in Kokang, Myanmar

An Area at War: Alarming Malnutrition Status and its Predictors among Children Aged 6-60 Months Old in Kokang, Myanmar Aim: Myanmar is a populous and impoverished country with military conflicts for over 40 years and Kokang is one of the most turbulent regions. Malnutrition is a major health problem in this area, however researches are limited. This study aims to evaluate the malnutrition condition of children in Kokang, Myanmar and the factors associated with malnutrition. Methods: Data were obtained from 123 children aged from 6 to 60 months. Anthropometrical assessment was performed and validated questionnaires were used to collect socioeconomic and demographic data. Results: Among the children enrolled in this study, 42.5% were found to be stunting, 22.5% were underweight, 8.3% were wasting, 8.3% were thin, 5.9% had a small head circumference, and 3.3% were wasting with amid-upper arm circumference <12.5 cm. Drinking spring or river water (OR=7.11, 95% CI2.46–20.52) was a predictor of stunting and low family annual income contributed to underweight (OR=8.95, 95% CI 1.63–49.11) in the regression model. Predictors of wasting included age and length of exclusive breastfeeding. Conclusion: This study illustrates the alarming local prevalence of childhood malnutrition and the associated predictors, which require a multipronged approach to find a solution.

Breast-Milk Characteristics Protecting Against Allergy

Breast milk and colostrum are the first feeding sources for a child, providing nutrients, growth factors and immunological components, which are crucial for the newborn's correct development and health. Length of exclusive breastfeeding and time of solid foods introduction is a key factor that may influence allergy development. There is an emerging evidence of a relationship between breastfeeding, milk composition and lower risk of chronic diseases, such as diabetes, obesity, hypertension and allergies. This review examines current evidence regarding humoral and cellular characteristics of breast-milk, and potential role of environment, maternal diet and breastfeeding on the allergy development in children.

Association between Length of Exclusive Breastfeeding and Subsequent Breastfeeding Continuation

Although breastfeeding initiation rates have improved, later prevalence is very low in the United Kingdom, and Northeast England is the region with the lowest rates. This study aimed to investigate novel in addition to well-established risk factors for cessation of breastfeeding among women in this region. Participants were 870 women considering breastfeeding prior to birth who were enrolled in the postnatal ward North East Cot trial at a tertiary hospital in Northeast England from 2008 to 2010. They provided weekly data on feeding and sleeping practices for 26 weeks postpartum using an automated telephone system with reminder postcards and contact by telephone, letter, or email if necessary. Cox proportional hazards regression was used to investigate factors associated with terminating any and exclusive breastfeeding in this period. Ninety-four percent of women started any breastfeeding and 66% initiated exclusive breastfeeding. By 26 weeks postpartum, 47% were still breastfeeding, but < 1% were breastfeeding exclusively. Multivariate analysis showed that women who exclusively breastfed for at least 4 weeks breastfed for significantly longer after supplementation started (P < .001). Bed-sharing at home during the first 13 weeks was a significant predictor of both any and exclusive breastfeeding, as well as any breastfeeding after supplementation (P < .001). We also confirmed some recognized socio-demographic predictors of breastfeeding cessation in this location. We found that exclusive breastfeeding for at least 4 weeks was significantly associated with longer breastfeeding continuation after supplementation, and bed-sharing at home was associated with longer breastfeeding regardless of the definition used.

Iron supplementation is positively associated with increased serum ferritin levels in 9-month-old Danish infants

Fe deficiency is still common in infancy, even in affluent societies, and has prompted Fe fortification of food products and use of Fe supplements in many populations. In the present study, we tested the hypothesis that Fe status among 9-month-old infants following the Danish Fe supplementation recommendation (>400ml Fe-fortified formula or 8mg Fe/d) is associated with more favourable levels of Fe status indicators compared to those not following the recommendation. A random sample of 9-month-old infants living in Copenhagen was established and 312 healthy term infants were examined at 9·1 (sd 0·3) months of age. Blood samples were available from 278 infants. Overall, twenty infants (7·8%) had Fe deficiency (serum ferritin<12μg/l) and <1% had Fe deficiency anaemia (serum ferritin<12μg/l and Hb<100g/l). Serum ferritin was positively associated with birth weight (P<0·001), intake of fortified formula and follow-on formula (P=0·001), and female sex (P<0·001). Cow's milk intake and length of exclusive breast-feeding were negatively associated with Hb levels (P=0·013 and P<0·001). Serum ferritin levels were significantly higher (P<0·0001) and transferrin receptor (TfR) was significantly lower (P=0·003) among infants (n 188) meeting the Fe supplementation recommendation compared to those (n 67) not meeting the recommendation. No significant difference between these two groups was found for Hb. In conclusion, this study confirmed that Fe status of infants following the Danish Fe supplementation recommendation was significantly associated with increased serum ferritin and decreased levels of TfR indicating more favourable Fe status, compared to infants not following the recommendation.

Ovalbumin‐specific immunoglobulins A and G levels at age 2 years are associated with the occurrence of atopic disorders

Humoral responses to food antigens may reflect the propensity of a child's immune system to develop tolerance to innocuous antigens. Early nutrition as well as probiotics may influence these immunological responses. To study the association of humoral responses to early food antigens with the administration of prebiotics and probiotics, with the occurrence of allergy, and with the length of exclusive breastfeeding. In a randomized double-blind allergy prevention trial in high-risk children, 1018 mothers took probiotics or placebo from the 36th week of gestation, and their newborn infants received probiotics and prebiotics or placebo during 6 months. At 2 and 5 years, we evaluated the cumulative incidence of allergic diseases (food allergy, eczema, asthma, rhinitis) and sensitization (skin prick test ≥3 mm or serum antigen-specific IgE>0.7 kU/L). In 688 infants at age 2, we measured in sera-specific IgA, IgG, IgG1, and IgG4 antibody levels to cow's milk (CM), α-casein (CAS), β-lactoglobulin (BLG), and ovalbumin (OVA) with ELISA, and specific IgE levels to CM and hen's egg with UniCap. Probiotic treatment (n=342) compared with placebo (n=346) showed no effect on serum food-specific IgA, IgG, IgG1, or IgG4 concentrations at age 2. Atopic children had higher OVA-IgA (P<0.001), OVA-IgG (P=0.001), OVA-IgG1 (P<0.001), and egg-IgE but lower OVA-IgG4/egg-IgE ratio (P<0.001) than non-atopic children. Longer duration of exclusive breastfeeding (≥4 vs. <4 months) was associated with reduced CM- and CAS-specific serum IgA (P<0.001) and IgG levels (P<0.001; P=0.003). Allergy was associated with more intense IgA and IgG responses to OVA. Breastfeeding depressed humoral responses, whereas prebiotics and probiotics supplementation showed no immunomodulatory effect. The effect of probiotics on allergies is not mediated through food-specific antibody responses. Furthermore, OVA-specific IgA and IgG antibodies may help in assessing the risk for atopy.

Factors associated with disease outcome in children at Kenyatta National Hospital (KNH)

Globally, 10.5 million children die annually. Approximately 6 million of Kenya’s population are under five years with a child mortality rate of 74 per 1000 live births. Children attending Kenyatta National Hospital (KNH) have preventable and treatable illnesses. The aim of the study was to assess care taker factors associated with disease outcome among children at KNH. A cross sectional study was conducted; questionnaires were administered to the caretakers of the 156 children recruited in the study. Data entry was done in Microsoft Access and analyzed using statistical package for Social Science (SPSS). There was a significant association between diseases outcome and length of exclusive breast-feeding (P < 0.025), occupation of both fathers and mothers (P< 0.026 and P <0.001, respectively) in the priority disease outcomes. There was a statistically significant association between duration of illness and that of seeking treatment before visiting KNH, (P < 0.001). Children who stayed more than 2 months before seeking health care at KNH had a 3-fold risk of becoming priority cases. Using formal education as the reference category for mother occupation, the odds of priority outcome for unemployed compared to formal education was 10.4 and informal education compared to formal education was 7.6. Caretakers delayed in seeking health care, prior to admission. Results from this study suggest that occupation of parents was a major determinant in regard to disease outcome. Communities need to be empowered to obtain and access basic health care services. More studies need to be done to identify specific caretaker factors associated with childhood illnesses. This will enable to evaluate further the possible interventions in the health care delivery among children. A longitudinal study is crucial to follow up children post admission addressing specific illnesses. Occupation of parents, occupation of parents and length of exclusive breast-feeding was a major determinant in regard to disease category. Key words: Disease outcome, cross sectional, priority, emergency category.

Breastfeeding Duration and Exclusivity Decrease Infant Infections

Research Article| October 01 2010 Breastfeeding Duration and Exclusivity Decrease Infant Infections AAP Grand Rounds (2010) 24 (4): 44. https://doi.org/10.1542/gr.24-4-44 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Breastfeeding Duration and Exclusivity Decrease Infant Infections. AAP Grand Rounds October 2010; 24 (4): 44. https://doi.org/10.1542/gr.24-4-44 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: breast feeding Source: Duijts L, Jaddoe VWV, Hofman A, et al. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics. 2010; 126(1): e18– e25; doi: https://doi.org/10.1542/peds.2008-3256Google Scholar To assess the association between duration of breastfeeding and infant infections, investigators from the Netherlands collected data from a population-based prospective cohort study of infants born in Rotterdam. Mothers of study children completed questionnaires at age 6 and 12 months regarding duration and exclusivity of breastfeeding and whether any infectious diseases occurred. Breastfeeding at different ages was categorized as exclusive or partial based on whether the infant received any formula or food in addition to breast milk prior to that time. Results were adjusted for important confounders such as maternal age, education, ethnicity, smoking, number of siblings, day care attendance, and family history of asthma and allergies. Infections were categorized as upper respiratory tract infection (URTI) for a serious cold, ear, or throat infection; lower respiratory tract infection (LRTI) for pneumonia, bronchitis or bronchiolitis; and gastrointestinal tract infection (GI). Information on 4,164 infants was available. Compared to children who were never breastfed, in the first six months of life those who were breastfed exclusively until the age of 4 months and partially thereafter had a 35% lower risk of URTI, 50% lower risk of LRTI, and 59% lower risk of GI (all differences statistically significant). These children also had a 54% lower risk of LRTI between ages 7 and 12 months. Infants who were breastfed exclusively for six months also had significantly lower rates of URTI than those who were never breastfed. Overall, the length of exclusive breastfeeding was significantly associated with fewer URTI, LRTI, and GI in the first year of life. Partial breastfeeding, even for six months, did not significantly lower infection rates. Also, four months of exclusive breastfeeding without any later breastfeeding did not reduce rates of these infections. The authors conclude that exclusive breastfeeding in developed countries should be recommended for at least four months, but preferably six months. Previous studies have documented that breastfeeding results in improved infant and maternal health outcomes in both developed and developing countries.1–4 Although the World Health Organization has recommended that all children be exclusively breastfed for six months instead of four months, supporting studies have had methodological concerns such as varying duration and/or exclusivity of breastfeeding.5 Recent US breastfeeding initiation rates have approached the 2010 Healthy People Goals, but both duration of breastfeeding and exclusive breastfeeding fall short of the 2010 goals.6 The importance of duration and exclusivity are documented quite dramatically in the current study. Six months of partial breastfeeding or four months of exclusive breastfeeding without breastfeeding afterwards did not lower infection rates. However, significant reductions in rates of infection were obtained with exclusive breastfeeding for four months and partial thereafter. Exclusive breastfeeding for six months tended to be even more protective. Several limitations of this study must be noted.... You do not currently have access to this content.

Breast-Feeding and Lactational Amenorrhea in the United Arab Emirates

This study was designed to investigate the relation of breast-feeding and weaning practices with the duration of lactational amenorrhea among breast-feeding mothers in the United Arab Emirates. A total of 593 mothers were interviewed in the Maternal and Child Health Centers in three areas: Abu Dhabi, Dubai, and Al Ain. The total mean duration of lactational amenorrhea in this study was 6.1 months, and there was a direct relation with the length of exclusive breast-feeding. The duration of postpartum amenorrhea was the longest in Al Ain (7.2 months), as compared with Dubai (6.9 months) and Abu Dhabi (4.3 months). The age of the infant when formula milk and solid supplements were introduced was significantly related to the duration of lactational amenorrhea. This study confirms the results of other studies concerning the effectiveness of the lactational amenorrhea method as a natural method of contraception for the first 6 months postpartum, especially for mothers who breast-feed exclusively and more frequently and who delay the introduction of food supplements.

Predictors of the duration of exclusive breastfeeding among first‐time mothers

Few women currently meet revised WHO recommendations to breastfeed exclusively for 6 months postpartum. In this prospective study we aimed to determine the influence of socio-demographic, psychosocial, and perinatal factors on the length of exclusive breastfeeding among 189 Canadian primiparous mothers. A majority of the participants did not meet their exclusive breastfeeding goals, and only 5% breastfed exclusively for a full 6 months. Breastfeeding self-efficacy, in-hospital formula supplementation, prenatal class attendance, and type of delivery independently predicted exclusive breastfeeding duration. Findings underscore the complex interplay of factors influencing breastfeeding, highlight the early postpartum weeks as a critical period for the establishment of exclusive breastfeeding, and suggest the need for a continuum of pre- and postnatal strategies for prolonging the exclusive breastfeeding period.

Tratamento da desnutrição em crianças hospitalizadas em São Paulo

To study anthropometric development, nutritional support and mortality rate of malnourished children hospitalized in a referral center. In a retrospective study we surveyed 98 hospitalized malnourished children (ZW<--2) with no chronic disease. Data collected was: birth weight, gestational age, length of exclusive breast feeding, diagnosis at admission, formula used (type, delivery route and feeding tolerance) and length of stay. Weight and height were controlled at admission and discharge. To classify and evaluate nutritional rehabilitation we used the Z-score: weight-for-age (ZW), height-for-age (ZH), weight-for-height (ZW/H). The nutritional therapy used was based on the World Health Organization (WHO) guidelines, with minor modifications. All chosen formulas were industrialized: lactose-free polymeric formula (PLF) for children with diarrhea, low lactose polymeric formula (PLL) for children without diarrhea and cow's milk hydrolysate (CMH) for sepsis or chronic diarrhea. At the rehabilitation phase, all children were given the PLL formula. Student's t and chi-square tests. The median of age and length of stay were 9.8 months and 17 days, respectively and the mortality rate was of 2%. Diarrhea and/or pneumonia were diagnosed at admission in 81.6% of the children. An improvement of 17.3 % ZW, 82.7 % ZH and 92.2 % ZW/H was observed. PLF was more frequently given at admission (47.4%) while CMH was given to only 7.4% of the children. Twenty-four percent of the children were tube fed and 5.1 % received parenteral nutrition. Tolerance of the initial formula was considered good in 66.7% of cases. The WHO guidelines were effective in the nutritional therapy of severely malnourished hospitalized children, resulting in good nutritional rehabilitation with low mortality rates.

Breastfeeding patterns of primiparous mothers in Hong Kong.

An understanding of patterns of breastfeeding is necessary for the effective implementation of breastfeeding promotion and intervention programs. In Hong Kong, little current data have been gathered on women's breastfeeding rates. The objective of this study was to determine how patterns of breastfeeding, maternal demographics, and maternal employment affect continuation of breastfeeding in primiparous women in Hong Kong. A longitudinal self-report survey was used to collect data when first-time mothers (n=218) were in the hospital, at 1, 3, 6, 9, and 12 months postpartum, or until they weaned their infant. All data (self-report survey, demographic data, and follow-up telephone surveys) were collected in Cantonese and then translated into English. Data were analyzed by determining, first, the influence of individual variables on the length of breastfeeding using a simple Cox regression analysis, and second, by grouping variables according to time sequence and entering them into a Cox regression model in 4 sequential phases. Factors that were significantly associated with continuation of breastfeeding were maternal age (HR=0.97; p=0.048); attendance at a prenatal breastfeeding class (HR=0.69; p=0.020); intended weeks of breastfeeding (HR=0.97; p<0.001); breastfeeding score in hospital (HR=0.99; p=0.009); and length of exclusive breastfeeding (HR=0.93; p<0.001). Similar results were obtained in the multiphase Cox regression analysis; only the breastfeeding score in hospital became marginally insignificant (p=0.053) after adjusting for demographics, prenatal, and other immediate postpartum factors. Short periods of exclusive breastfeeding and early supplementation were common in this sample. Unlike previous research, maternal employment was not a statistically significant factor in length of continued breastfeeding. Study findings show that multiple factors influence continued breastfeeding in Hong Kong, suggesting further areas for investigation. Changes in practice may improve continued and exclusive breastfeeding rates.

Pacifier Non-nutritive Sucking in Infancy and Early Childhood

Objectives To comprehensively review all relevant literature related to pacifier non-nutritive sucking for full term healthy infants and young children. Questions What is the evidence of adverse and/or positive outcomes of pacifier non-nutritive sucking in infancy and early childhood in relation to each of the following subtopics? • Infant calming and stress relief • Breast feeding • Sudden infant death syndrome • Dentition and oral health • General oro-pharyngeal and gastrointestinal infections Criteria for considering studies for this review Types of participants Healthy term infants and healthy young children up to the age of five years. Types of interventions Interventions of interest are those related to pacifier non-nutritive sucking in all settings, home or health care. This review will take into account type of pacifiers, additives, timing and duration, and age of child. Types of outcome measures Outcome measures will include, but not be confined to, research related to: • Effectiveness to promote infant calming and stress reduction. • Duration of breastfeeding, length of exclusive breast feeding, breast feeding problems such as cracked nipples and poor sucking technique. • Possible protective strategy to reduce SIDS in infancy, thus reducing infant mortality. • Increased incidence of dental caries, and abnormal dentition and oro-facial development. • Increased incidence of oro-pharyngeal and gastrointestinal infections.

Length of Exclusive Breastfeeding: Linking Biology and Scientific Evidence to a Public Health Recommendation

The objective of this commentary is to briefly review key issues related to i) the uses of energy balance vs. growth to determine the recommended length of extended breast feeding; ii) the merits as well as criticisms of the most recent scientific evidence on its recommended length; and iii) the conceptual and practical issues in using this information to make a public health recommendation. (excerpt)

In Colombia, Fertility Decreases as Contraceptive Prevalence Among Women in Union Reaches 72%

This paper presents some findings from the 1995 Demographic and Health Survey in Colombia. Total population was about 36 million. Population growth was about 1.8% annually. 71% lived in urban areas. The proportion of children aged under 15 years began to decline. 33% of working women had at least 1 child under the age of 6 years. 32% of the sample were single 55% were in a union 12% were separated and 20% were widowed or divorced. The median age at marriage was 21.4 years. The median age at birth was 22.1 years. The total fertility rate was 3.0 births/woman. 14% of adolescents already had a first child and 4% were pregnant for the first time. Fertility was lowest in urban areas (2.5 births) and among women with some college education (1.8 births). The ideal family size was 2.7 children among women in a union. 46% of births in the 5 years preceding the survey were unwanted (21%) or mistimed (24%). Unplanned fertility increased with age and parity. If unwanted fertility were avoided the total fertility rate would be 0.8 fewer children. 41% did not desire another child and 26% were sterilized. The proportion of women who desired no more children or were sterilized was very high among the least educated and rural women. Contraceptive use among women in a union increased from 66% in 1990 to 72% in 1995. Increases in use were concentrated among women who desired to stop childbearing. Sterilization was the most widely used method (26%). Current use of contraception was 75% among women who were sexually active and not in a union. Most contraception was obtained from the private sector. Infant mortality was higher among uneducated and rural women. Over 75% of births occurred in a health facility. The median length of exclusive breast feeding was 0.6 months. Knowledge of AIDS was almost universal but 82% of women did not change their sex behavior to avoid AIDS.