Non-breastfed Infants Research Articles

Spot the Red Herring: Breastfeeding, Fruitpurée, and Infant Autonomic Functioning—The Generation R Study

Several studies have suggested that breastfeeding is related to infant autonomic functioning. The authors investigated whether this is a causal relation. In all, 444 mothers reported breastfeeding practices 2 mo postpartum. Infant autonomic functioning was assessed by heart rate variability at age 14 mo, after discontinuation of breastfeeding. The dose-dependent association between breastfeeding and infant autonomic functioning was tested with linear regression models adjusted for multiple confounders. The authors investigated the relation of fruitpurée consumption with infant autonomic functioning. Fruitpurée consumption has similar socioeconomic epiphenomena but is not related via the same causal mechanism to autonomic regulation as breastfeeding. Nonbreastfed infants had high sympathetic modulation [7.87 log (ms)/SD, 95% CI: 7.71-8.02], partially breastfed infants had intermediate sympathetic modulation [7.75 log (ms)/SD, 95% CI: 7.51-7.82], sympathetic modulation of exclusively breastfed infants was low [7.63 log (ms)/SD, 95% CI: 7.50-7.77]. However, this association could be explained by socioeconomic confounders. Furthermore, fruitpurée consumption was similarly associated with reduced infant sympathetic modulation. The association between breastfeeding practices and infant sympathetic modulation was accounted for by socioeconomic and environmental factors. We found a similar association between fruitpurée consumption and autonomic functioning, further suggesting that the association between breastfeeding and infant autonomic functioning is noncausal.

Nonbreast-Fed HIV-1-Exposed Burkinabe Infants Have Low Energy Intake between 6 and 11 Months of Age Despite Free Access to Infant Food Aid1–3

In a WHO-coordinated, mother-to-child HIV transmission (MTCT) prevention trial in Burkina Faso, HIV-1–infected mothers were advised to either stop breast-feeding by 6 mo or totally avoid it. Participants were provided with cereal-based, infant fortified mix (IFM) from 6 to 12 mo postpartum along with infant feeding counseling. Our objective was to describe nonbreast-fed infants' food consumption and adequacy of nutrient intake. A 1-d weighed food record and one 24-h dietary recall were performed in 68 nonbreast-fed, non-HIV–infected 6- to 11-mo-old infants. Mean food energy density and feeding frequency were satisfactory in 6–8 mo olds [0.8 ± 0.2 kcal/g (3.3 ± 0.9 kJ/g) and 7.2 ± 1.6 times/d] and in 9–11 mo olds [0.9 ± 0.2 kcal/g (3.6 ± 0.8 kJ/g) and 7.7 ± 2.1 times/d]. Median energy intake was 523 kcal [range: 82–1053 (2187 kJ, range: 345–4401)] in 6–8- and 811 kcal [range: 34–1543 (3392 kJ, range: 144–6452)] in 9–11-mo-old infants, respectively. Approximately 75% of their energy intake was provided by subsidized foods (milk that mothers obtained from support networks and IFM). One-half of the infants had intakes < 80 kcal/kg (<334 kJ/kg) on the day of the survey, mainly because IFM and milk were consumed in amounts that were too low. Thus, coverage of energy needs required a diet with sufficient amounts of both IFM and milk in these vulnerable infants. These findings argue for the development of adequate, sustainable infant fortified foods and their rapid integration into MTCT prevention services. They also lend support to the recent revision of WHO infant feeding guidance for future MTCT prevention programming that recommends breast-feeding up to 12 mo postpartum (under cover of antiretroviral prophylaxis) as the safest feeding option for infants of HIV-infected mothers.

Fortified product intake attenuates the relationship between complementary feeding diet diversity score and a measure of nutrient adequacy among peri‐urban Filipino infants

We examine the question “How well can diet diversity (DD) indicators predict dietary quality for Filipino infants 6 to 11 months old from an urban poor municipality?” Dietary data was collected monthly from 6 to 11 months of age, using a 24 hour recall method, from a sample of 1013 infants in peri‐urban Manila. Dietary diversity (DD) was calculated from the sum of 8 food groups with at least 1 g consumed over a 24 hour period. Mean DD score over the 6 month period was 2.1 for breastfed (BF) and 2.7 for non‐breastfed infants (BBF). Nutrient adequacy was measured as mean micronutrient density adequacy (MMDA). Mean MMDA for BF was 49.8 and 58.6 for NBF. In the combined sample the correlation between DD and MMDA is significant (p&lt;0.01, r=0.523) for the period 6–11 mos. However, fortified food product intake attenuates this relationship between DD and MMDA, and the interaction between fortified product intake &amp; DD significantly affects MMDA. Therefore in populations where fortified foods are common, DD is not a useful indicator of diet quality.Support was provided by WHO.

Visual development in infants: physiological and pathological mechanisms

This review summarizes current knowledge on ocular conditions related to abnormal visual development in infants, including prevalence, risk factors, causes, and mechanisms involved. We discuss the role of eyeball growth with pathologic mechanism of visual deprivation and development of amblyopia in infants, particular developmental issues in preterm neonates, methods of visual assessment and screening, diagnosis, treatment, and nutritional issues. Visual development is incomplete at birth, particularly in premature infants; maturation of the visual system--including neurological and ocular components--is influenced by many factors including prenatal and postnatal nutrition and postnatal visual stimulation. In early life, particularly during sensitive periods of development, abnormal visual input, for example caused by visual deprivation mechanism, amblyopia, or ocular misalignment, leads to abnormalities in visual development, including abnormal eyeball growth and neurological changes. Untreated anomalies or abnormal visual development can result in long-term or even permanent visual impairment. Nutrition plays a key role in visual development: infant formulas containing nutrients essential for normal visual development (specifically omega-3 fatty acid docosahexaenoic acid and omega-6 fatty acid arachidonic acid) may protect nonbreast-fed infants against visual development abnormalities. Problems related to visual anomalies are common among young children, particularly in preterm neonates. Screening to enable early diagnosis and correction of visual deficiency is important as abnormal visual input can lead to abnormalities in visual development, which can become permanent visual impairment if left untreated. Optimized nutrition can help to reduce the risk of abnormal visual development and prevent long-term or permanent visual deficits.

Feeding Practices and Blood Lead Levels in Infants in Nagpur, India

In a hospital-based cross-sectional study of 200 infants age 4-9 months in an Indian city (Nagpur), the authors determined the prevalence of elevated blood lead level (EBLL) and mean blood lead levels with respect to feeding patterns, i.e., breastfed or fed with formula or dairy milk. The blood lead levels in this study population ranged from 0.048 microg/dl to 42.944 microg/dl; the mean blood lead level was 10.148 microg/dl (+/- 9.128); EBLL prevalence was 38.2%. EBLL risk factors included removal of house paint in the past year, odds ratio (OR), 5.6 (95% confidence interval [CI], 1.6-19.65); use of surma (eye cosmetic), OR 4.27 (95% CI, 1.39-13.08); maternal use of sindur (vermillion), OR 2.118 (95% CI, 1.07-4.44). Feeding method (breastfed or not) did not appear to have an effect on blood lead level. In non-breastfed infants, boiling of water was significantly associated with EBLL, OR 1.97 (95% CI, 1.01-3.84).

The Paradox of Breastfeeding‐Associated Morbidity Among Late Preterm Infants

To synthesize the published research pertaining to breastfeeding establishment and outcomes among late preterm infants and to describe the state of the science on breastfeeding within this population. Online databases Ovid MEDLINE, CINAHL, PubMed, and reference lists of reviewed articles. Nine data-based research articles examining breastfeeding patterns and outcomes among infants born between 34 0/7 and 36 6/7 weeks gestation or overlapping with this time period by at least 2 weeks. Effect sizes and descriptive statistics pertaining to breastfeeding initiation, duration, exclusivity, and health outcomes among late preterm breastfed infants. Among late preterm mother/infant dyads, breastfeeding initiation appears to be approximately 59% to 70% (U.S.), whereas the odds of breastfeeding beyond 4 weeks or to the recommended 6 months (exclusive breastfeeding) appears to be significantly less than for term infants, and possibly less than infants ≤34 to 35 weeks gestation. Breastfeeding exclusivity is not routinely reported. Rehospitalization, often related to "jaundice" and "poor feeding," is nearly twice as common among late preterm breastfed infants as breastfed term or nonbreastfed late preterm infants. Barriers to optimal breastfeeding in this population are often inferred from research on younger preterm infants, and evidence-based breastfeeding guidelines are lacking. Late preterm infants are at greater risk for breastfeeding-associated rehospitalization and poor breastfeeding establishment compared to their term (and possibly early preterm) counterparts. Contributing factors have yet to be investigated systematically.

Letter to the Editor

Letter to the Editor

Infant feeding support strategy reduces growth faltering in late infancy among infants of HIV‐infected mothers in urban Haiti

There is growing consensus about strategies to reduce mother‐to‐child transmission of HIV through breastmilk during early infancy (0–5 mo) in low‐income countries, but less research on feeding in late infancy (6–12 mo) when risk of growth faltering is high. We evaluated a program strategy to support infant nutrition at GHESKIO, a clinic serving poor HIV‐infected mothers in Port‐au‐Prince, Haiti. In 2008–09, 82 six‐mo‐old non‐breastfed HIV‐exposed infants were enrolled in a 6‐month intervention that included a daily ration of micronutrient‐fortified ready‐to‐use supplementary food, monthly “mothers club” sessions for infant feeding education, and monthly individualized growth monitoring/counseling. Data was collected on growth, anemia, dietary intake, morbidity, compliance, caregiver knowledge, satisfaction and program feasibility. Outcomes in participants were compared to infants seen at GHESKIO in the previous year (n=174). At age 6 months, stunting (LAZ&lt;−2 WHO 2006) prevalence was slightly higher in intervention group than in controls (NS). Among 12‐mo‐olds, stunting was 9.6% in the intervention cohort vs. 20.8% in controls (p&lt;.05) and wasting (WLZ&lt;−2) 2.7% vs. 8.7% in controls (p=.074). The program was highly acceptable to mothers and feasible to implement in the clinical context. Research support was provided by Cornell's Einaudi Center, Weill Cornell Center for Global Health, and PEFPAR.Grant Funding Source: NIH

A sustainable food support for non-breastfed infants: implementation and acceptability within a WHO mother-to-child HIV transmission prevention trial in Burkina Faso

To provide HIV-positive mothers who opted for exclusive breastfeeding or formula feeding from birth to 6 months postpartum as a means of prevention of mother-to-child transmission (PMTCT) of HIV with a sustainable infant food support programme (FSP) from 6 to 12 months postpartum. We describe the implementation and assessment of this pilot initiative. The FSP included a 6-month provision of locally produced infant fortified mix (IFM; 418 kJ/100 g of gruel) for non-breastfed infants coupled with infant-feeding and psychosocial counselling and support. Acceptability and feasibility were assessed in a subsample of sixty-eight mother-infant pairs. The FSP was developed in collaboration with local partners to support participants in a PMTCT prevention study. Formula was provided for free from 0 to 6 months postpartum. Cessation by 6 months was recommended for breastfeeding mothers. The FSP was positively received and greatly encouraged breastfeeding mothers to cease by 6 months. As recommended, most infants were given milk as an additional replacement food, mainly formula subsidised by safety networks. Among daily IFM consumers, feeding practices were satisfactory overall; however, the IFM was shared within the family by more than one-third of the mothers. Cessation of IFM consumption was observed among twenty-two infants, seventeen of whom were fed milk and five neither of these. Without any food support most mothers would have been unable to provide appropriate replacement feeding. The food security of non-breastfed infants urgently needs to be addressed in HIV PMTCT programmes. Our findings on a simple cost-effective pioneer intervention provide an important foundation for this process.

Trick or treat? neurodevelopmental consequences of pharmacotherapy for affective disorders

Drugs used to treat affective disorders exert their effects largely through their actions on various neurotransmitter systems. Neurotransmitters are important regulators of neural development. Thus, even limited periods of drug use/exposure during fetal- or postnatal brain ontogeny, which continues to the end of the second decade, can, potentially, cause enduring, functionally significant changes in neuronal circuitry. The duration and timing of drug treatment are critical in determining long-term effects (Popa et al, 2008), owing to developmental changes in the neural substrates on which the drugs act. Stress, which is associated with affective disorders, adversely impacts neural development during fetal life and postnatally, and is ameliorated by therapies that improve affect. Thus, potential, adverse, long-term effects of exposing the developing brain to medication must be weighed against the deleterious impact of stress elevation as a result of interrupted pharmacotherapy of pregnant women, or not treating children or adolescents. Human studies have revealed few effects of fetal antidepressant drug (ADD) exposure that endure beyond infancy. By contrast, adult rodents exposed to ADDs only during stages corresponding to fetal life, childhood, or adolescence in humans exhibit a spectrum of abnormalities, many of which are, surprisingly, components of depression. Similar, long-term, ‘mirror image' effects (that is, drug-induced increases in disease components that are reduced by pharmacological treatment of adults) occur after early-life anxiolytic treatment (Depino et al, 2008). Early exposure to atypical antipsychotic drugs, used to treat bipolar disorder in children and adolescents, induces significant, long-lasting cognitive deficits (Zuo et al, 2008) and morphological abnormalities (Frost et al, 2009). Why do rodent and human data seem discrepant? In rodents, the behavioral syndromes induced by early ADD (Ansorge et al, 2008) or anxiolytic (Depino et al, 2008) treatment are progressive and emerge fully only in early adulthood. This is because early-life brain insults induce a cascade of effects over the course of development. Human studies of the effects on progeny of maternal ADD treatment during pregnancy so far reach only up to 7–10 years of age—too early to characterize long-term outcomes. Early-life experience and environmental factors are emerging as additional, important modulators of the effects of psychotropic medications. We recently showed that, in rats, some of the enduring behavioral consequences of fetal exposure to fluoxetine do not occur if exposed infants are subjected to behavioral testing, which, by its nature, provides supplemental sensory stimulation and exercise (R Gibb, DO Frost and B Kolb, unpublished data). A provocative, parallel finding has recently been reported in humans: In infants who are not breast fed, maternal SSRI use during pregnancy is associated with altered hypothalamo–pituitary–adrenal (HPA) stress responses, whereas breast feeding abolishes this effect of fetal SSRI exposure by 3 months of age (Oberlander et al, 2008). The mode of feeding seems to act epigenetically: breast-fed infants have lower methylation (and probably higher expression) of the glucocorticoid receptor gene NR3C1 than nonbreast-fed infants (Oberlander et al, 2008). Animal and human studies are consistent in demonstrating that environment and experience during fetal and postnatal brain maturation interact with early-life psychotropic drug exposure to shape the ontogeny of behavior and neural circuitry. Epigenetic modulation of gene expression appears to be one important mediator of these effects. These findings suggest possibilities for designing new therapeutic strategies that mitigate the effects of early-life ADD exposure.

Breast-Feeding Is Associated With a Reduced Frequency of Acute Otitis Media and High Serum Antibody Levels Against NTHi and Outer Membrane Protein Vaccine Antigen Candidate P6

Nontypeable Haemophilus influenzae (NTHi) causes acute otitis media (AOM) in infants. Breast-feeding protects against AOM and/or nasopharyngeal (NP) colonization; however, the mechanism of protection is incompletely understood. Children with AOM and healthy children were studied according to feeding status: breastfed,breast/formula fed, or formula fed. Cumulative episodes of AOM, ELISA titers of serum IgG antibodies to whole-cell NTHi and vaccine candidate outer membrane protein P6, bactericidal titers of serum and NP colonization by NTHi were assessed. A lower incidence of AOM was found in breast- versus formula-fed children. Levels of specific serum IgG antibody to NTHi and P6 were highest in breast-fed, intermediate in breast/formula fed, and lowest in formula-fed infants. Serum IgG antibody to P6 correlated with bactericidal activity against NTHi. Among children with AOM, the prevalence of NTHi in the NP was lower in breast- versus nonbreast-fed infants. We conclude that breast-feeding shows an association with higher levels of antibodies to NTHi and P6, suggesting that breast-feeding modulates the serum immune response to NTHi and P6. Higher serum IgG might facilitate protection against AOM and NP colonization in breast-fed children.

Evaluation of the daily iron intake by non-breastfed Egyptian infants and young children.

Iron deficiency is frequently associated with anaemia. The prevalence of anaemia among Egyptian infants and young children is 25%. Fortification of infant and followup milk-based formulae remains a valuable method for delivering iron to reduce the incidence of iron deficiency anaemia. Percentage of Egyptian non-breastfed children consuming milk or milk products (7-23 months) are 79.1%. No studies have focused on infant and follow-up milk-based formulae that are marketed in Egypt regardingiron fortification and consumption. The objective of the current study was to evaluate the intake of iron by non-breastfed Egyptian infants and young children. To achieve this goal the infant and follow-up milk based formulae brands and types, low – iron and iron – fortified, that are commercially available on the local market were collected. In addition, the iron concentration was determined in the collected formulae in relation to the label statements to ensure the correct intake. Finally, the actual dailyintake of iron from formulae consumption was estimated in relation to the nutritional requirements. The CRM 1846 and 3126a were used for the precision and accuracy of the method. It was shown that the iron levels in all milk-based formulae were lower than those reported on the labels and ranged between 6.17 -10.98 mg/L. No significant difference was found between the average concentration of iron in lowiron formula brands (8.1±2.3 mg/L) and iron-fortified formula brands (8.6± 2.0mg/L). The average levels of the iron in the infant formula brands were lower (p

Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study

We explored whether breastfeeding was protective against maternally perpetrated child maltreatment. A total of 7223 Australian mother-infant pairs were monitored prospectively over 15 years. In 6621 (91.7%) cases, the duration of breastfeeding was analyzed with respect to child maltreatment (including neglect, physical abuse, and emotional abuse), on the basis of substantiated child protection agency reports. Multinomial logistic regression was used to compare no maltreatment with nonmaternal and maternally perpetrated maltreatment and to adjust for confounding in 5890 cases with complete data (81.5%). Potential confounders included sociodemographic factors, pregnancy wantedness, substance abuse during pregnancy, postpartum employment, attitudes regarding infant caregiving, and symptoms of anxiety or depression. Of 512 children with substantiated maltreatment reports, >60% experienced > or =1 episode of maternally perpetrated abuse or neglect (4.3% of the cohort). The odds ratio for maternal maltreatment increased as breastfeeding duration decreased, with the odds of maternal maltreatment for nonbreastfed children being 4.8 times the odds for children breastfed for > or =4 months. After adjustment for confounding, the odds for nonbreastfed infants remained 2.6 times higher, with no association seen between breastfeeding and nonmaternal maltreatment. Maternal neglect was the only maltreatment subtype associated independently with breastfeeding duration. Among other factors, breastfeeding may help to protect against maternally perpetrated child maltreatment, particularly child neglect.

British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008

Top of page Abstract Introduction 1.0 Summary of recommendations 2.0 Scenarios: interventions to reduce mother-to child transmission of HIV 3.0 Background: UK prevalence of HIV in pregnancy and risk of transmission 4.0 Antenatal HIV testing 5.0 Preconception and fertility management in men and women infected with HIV 6.0 Sexual health of HIV-positive pregnant women 7.0 Psychosocial issues 8.0 Viral load and resistance 9.0 Management of HIV-related complications in pregnancy 10.0 Antiretroviral therapy in pregnancy: efficacy 11.0 Antiretroviral therapy in pregnancy: toxicity 12.0 Antiretroviral therapy and pregnancy: pharmacokinetics 13.0 Obstetric management of pregnancy and delivery 14.0 Pregnancy in women with HIV-2 infection 15.0 HIV and hepatitis B and C coinfections 16.0 Management of infants born to HIV-infected mothers 17.0 Infant feeding and HIV transmission during breastfeeding References Appendix

25-Hydroxyvitamin D: functional outcomes in infants and young children

Vitamin D deficiency occurs in the United States in exclusively breastfed infants who have high levels of skin pigmentation, inadequate vitamin D supplementation, and insufficient sunlight exposure. I review serum 25-hydroxyvitamin D [25(OH)D] concentrations and functional outcomes of vitamin deficiency in young children and breastfed and nonbreastfed infants. These outcomes include the presence or absence of vitamin D deficiency rickets, bone mineral content, and serum parathyroid hormone concentration. Daily vitamin D supplements of 400 IU/L keep serum 25(OH)D concentrations higher than 50 nmol/L and prevent rickets in infants and young children. The available evidence is not sufficient to support the use of bone mineral content or parathyroid hormone concentrations in infants and young children as functional outcomes to define deficient or sufficient levels of 25(OH)D. I therefore propose a research agenda to establish the functional definitions of vitamin D sufficiency or deficiency in infants and young children.

Hypothalamic–pituitary–adrenal (HPA) axis function in 3-month old infants with prenatal selective serotonin reuptake inhibitor (SSRI) antidepressant exposure

Background Prenatal exposure to stress and selective serotonin reuptake inhibitors (SSRIs) alter hypothalamic–pituitary–adrenal (HPA) stress reactivity in offspring, however, the effects of combined exposure to HPA activity in human infants is unknown. Objective To examine HPA basal levels and stress responsiveness in 3-month olds with prenatal exposure to SSRIs. Methods Salivary cortisol levels in infants of SSRI treated mothers ( n = 31, mean exposure 230.2 ± 72.2 days) were compared with non-SSRI exposed ( n = 45) infants in response to a challenge (infant-controlled habituation task) and under basal conditions in the late afternoon/early evening. Mode of feeding, to account for possible postnatal drug exposure via breast milk, as well as measures of pre and postnatal maternal mood, were included as covariates. Results Lower post-stress cortisol levels were observed in non-SSRI exposed/non-breastfed infants compared with non-SSRI exposed infants who were breastfed at 3 months of age. Stress reactivity patterns among SSRI exposed infants did not differ with mode of feeding. The cortisol reactivity slope (CRS) was significantly lower among non-SSRI exposed non-breastfed infants compared with non-SSRI exposed breastfed infants. Early evening basal cortisol levels were lower in SSRI exposed infants than in non-SSRI exposed infants, controlling for maternal mood and mode of feeding. Postnatal SSRI exposure (infant SSRI drug levels) via breast milk was not associated with stress or basal cortisol levels. Total cortisol, reflected by the AUC measure, did not differ significantly between exposure groups. Conclusions Prenatal SSRI exposure altered HPA stress response patterns and reduced early evening basal cortisol levels. Stress challenge HPA response differences only became apparent when the moderating effect of method of feeding was accounted for. These findings suggest an early “programming” effect of antenatal maternal mood, prenatal SSRI exposure and postnatal maternal care giving on the HPA system.

Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants

BackgroundFolate and cobalamin status changes markedly during infancy. ObjectiveWe aimed to examine the influence of breastfeeding on folate and cobalamin status in healthy infants. DesignIn a longitudinal study, we measured serum folate, cobalamin, holotranscobalamin, holohaptocorrin, methylmalonic acid, and homocysteine at birth and at ages 6, 12, and 24 mo (n = 361, 262, 244, and 224, respectively). Breastfeeding status and nutrient intake were assessed by using questionnaires and 7-d weighed-food records (at 12 mo). ResultsAll indexes changed significantly from birth to age 24 mo (P < 0.001). Folate was high until age 6 mo and then declined. At age 6 mo, folate was positively correlated with duration of exclusive breastfeeding (ρ = 0.29; P < 0.001). Cobalamin status declined after birth in breastfed but increased in nonbreastfed infants. Thus, holotranscobalamin (pmol/L) was lower in breastfed than in nonbreastfed children at age 6 mo [geometric x̄: 37 (95% CI: 33, 40) and 74 (64, 86), respectively], at 12 mo [51 (46, 56) and 76 (70, 82), respectively], and at 24 mo [65 (50, 83) and 90 (85, 97), respectively; P < 0.05 for all]. Complementary feeding did not increase (6 mo) or modestly increased (12 mo) cobalamin status in breastfed children. At 12 mo, cobalamin intake (μg/d), excluding breast milk cobalamin, was lower in breastfed than in nonbreastfed infants [geometric x̄: 1.4 (1.3, 1.6) and 2.4 (2.1, 2.6), respectively; P < 0.001]. However, after adjustment for total cobalamin intake, cobalamin status (ie, holotranscobalamin) remained significantly lower in breastfed than in nonbreastfed infants [54 (49, 59) and 70 (64, 78), respectively; P < 0.001]. ConclusionsLow cobalamin status is a characteristic finding in breastfed children. Reference limits according to age and breastfeeding status should be considered in early childhood.

Infant hospitalization and breastfeeding post-caesarean section

Breastfeeding has been shown to protect infants from illness, but there is minimal published research on the relationship between illness and breastfeeding following caesarean delivery. To examine the association between post-caesarean breastfeeding and infant hospitalization in the first year of life. A retrospective cohort study of 468 term infants examined the relationship between infant hospitalizations and breastfeeding, using hospital admissions records and surveys from a post-caesarean breastfeeding intervention study in an Israeli hospital. A significantly lower proportion of Jewish infants breastfed for at least 4 months (40%; 42) was hospitalized in the first year, compared with non-breastfed infants (60%; 62) (P = 0.003). Among the Muslim infants who were breastfed, a significantly lower proportion were hospitalized (33%; 35) than those who were not hospitalized (67%; 71) and a greater proportion of non-breastfed infants were hospitalized (80%; 8) than those who were not hospitalized (20%; 2) (P = 0.005, Fisher's exact test). In the logistic regression models, the significant variables decreasing the likelihood of hospitalization for Jewish infants were being born to a non-immigrant mother, higher maternal education, and being breastfed, and for Muslim infants the only significant variable was being breastfed. Breastfeeding in post-caesarean women has a protective effect on infant health, as demonstrated by a decrease in illness-related hospitalizations in the first year of life.

Pentavalent human-bovine (WC3) reassortant rotavirus vaccine in special populations: a review of data from the Rotavirus Efficacy and Safety Trial

Rotavirus gastroenteritis is a disease that causes significant morbidity and mortality worldwide in infants and children. The recent availability of efficacious rotavirus vaccines with favorable safety profiles has prompted medical agencies around the world to register the vaccines and countries and regions to recommend universal vaccination of healthy infants to prevent the serious health and economic consequences of rotavirus illness in children. Premature infants can be especially vulnerable to severe rotavirus infections, which may lead to serious outcomes. The clinical efficacy and safety of the pentavalent human-bovine rotavirus vaccine (PRV, RotaTeq, Merck, Whitehouse Station, NJ, USA) in healthy infants has been evaluated in the large phase III Rotavirus Efficacy and Safety Trial (REST). Preterm (N = 2,070) and exclusively breastfed infants (N = 1,566) were included in this study. The efficacy and safety of PRV in premature infants and in breastfed infants from the REST database are reviewed along with guidelines from national medical organizations for the use of PRV in these populations. Based on these data from the REST study, premature infants receive the same protection from PRV compared with nonpremature infants, without additional safety risk. Similarly, breastfed and nonbreastfed infants are equally protected from severe consequences of rotavirus gastroenteritis.

Breastfeeding In Pmtct Services; Tilting The Balance In Favour Of Cost-Effective Programme

By 2005, the world's estimated population of people living with HIV/AIDS (PLWHA) was 40.3 million. Sub-Saharan Africa (SSA) contributed 25.8 million (over 64%) and almost one million more than in 2003. Of the estimated 4.9 million people newly infected with the virus in 2005, SSA contributed 3.2million (over 65%).1 With an estimated population of 3.7million people infected with the virus,3 Nigeria has the third largest population of PLWHA, being next to India and South Africa in that order.1The implication of this is that the devastation of the disease was yet to take a downward trend. It is estimated that over 14% of all new HIV infections are in paediatric patients compared with 10% in 2003. Over 90% of these infections are from vertical transmission. World-wide, over 95% of the under-5 infected with HIV are Africans without preventive measures, about 35% of all children born to HIV-positive mothers will be infected. HIV infection is now a chronic treatable but yet incurable disease in developed countries but this is not so in SSA where the preponderance of the infection is on the increase and mortality of the infection is most severe. Preventing vertical transmission (VT) is the noble goal of Prevention of Mother-to-Child Transmission (PMTCT) Programmes. In the absence of a cure, it is a cost-effective way of reducing the HIV burden and ensuring a future HIV- free generation. The interventions are targeted at the antenatal, intrapartum and the post natal periods.4-9 Post natal interventions target optimal child feeding options and paediatric antiretroviral therapy for post exposure prophylaxis in addition to counseling on other harmful socio-cultural practices. Of all the interventions aimed at reducing VT, breastfeeding is the only one that is most influenced by culture and social belief and dichotomized by racial and socio-economic factors. Fortunately, it is also the only one that the would- be-mother can positively or negatively influence its effect on the outcome on the infant. Though, the Nigerian PMTCT programme started since 2002, no scientific figures are available for VT for breastfed and non-breastfed infants. In spite of this, mothers are often left to make the choice between breastfeeding and formula feeding of their infants in the so called informed choice. But records available from Africa and elsewhere have often revealed the deleterious effects of breast feeding in good PMTCT programmes. From our practical experience, the issue of breastfeeding is still contentious can easily cause a divide among counselors themselves and clinicians too. This review focuses on the issue of breastfeeding, the past, the present and a look into the future as it is likely to affect the PMTCT programme and its implications for the Nigeria populace. It also examined factors that may be militating against success of interventions aimed at reduction of VT in the programme. We are of the view that those women who are electing for breastfeeding may not be getting enough information on the implication of their decisions. Also, socioeconomic pressures may be the most compelling factor for their choice of infant feeding. We suggest that interventions should urgently be targeted at the militating factors for timely realization of the goal 4 in the Millennium Development Goals of Nigeria. Encouraging breastfeeding under any guise will amount to tilting the balance in favour of a less cost- effective PMTCT Programme. Keywords : Breastfeeding, PMTCT, Vertical Transmission, Cost Effective Programme. Annals of Biomedical Science Vol. 4 (1) 2005: pp. 1-9