Optimal Infant Development Research Articles

Maternal characteristics and their relation to early mother-child interaction and cognitive development in toddlers.

Early mother-infant interaction is believed to have a significant impact on the social, cognitive, and emotional development of children. These interactions are not only influenced by child and contextual factors but also by the mother's personality traits and strain. In this study, we investigated the relation between maternal factors such as personality, depressive symptoms, or experiencing of emotions, and (i) children's early cognitive development and (ii) interaction patterns in a sample of 116 mother-child dyads (mean child age = 18.63 months ± 6.42). Maternal factors were assessed using standardized questionnaires and toddlers' cognitive development was measured using the Bayley Scales of Infant and Toddler Development. Interaction patterns were evaluated using the CARE-Index. The study found that children of mothers who scored higher in agreeableness, a personality trait reflecting compassion and cooperation, performed better in cognitive assessments. Additionally, mothers who placed significant importance on their bodily signals to assess their overall well-being had higher scores in the quality of interaction with their child. Statistical trends suggested that mothers with higher levels of conscientiousness, indicative of being organized and responsible, tended to be more responsive in the interaction with their infants, while those with higher levels of neuroticism, characterized by a tendency towards negative emotions, were more likely to have toddlers who inhibit their true negative affect. Finally, there was a trend indicating that maternal depression was associated with increased maternal controlling behavior towards toddlers. Overall, these findings show the intricate relation between maternal behavior and state with dyadic interaction quality. This should underline that optimal infant development is only possible if mothers are well supported especially if in need due to various burdens such as depressive symptoms.

Effect of pandemic-induced PTSD in pregnant women on infant physical growth: a prospective cohort study

BackgroundThe COVID-19 pandemic has had a profound impact on global mental health, particularly affecting vulnerable groups such as pregnant women. Post-traumatic stress disorder (PTSD) in this population may potentially hinder infant physical development, underscoring the necessity for specific interventions. This study seeks to explore the prevalence of PTSD among pregnant women during the pandemic and its implications for infant physical development, thereby providing evidence to mitigate the adverse effects of the pandemic on maternal and child health.MethodsA prospective cohort study was carried out involving 450 pregnant women from December 2022 to February 2023. Data included demographic details, PTSD evaluation using the PTSD Checklist-Civilian version (PCL-C) scale, coping mechanisms, and infant growth indicators at three months postpartum. Statistical methods included descriptive statistics, univariate analysis, and multivariate analysis of covariance (ANCOVA) to control for confounding factors.ResultsThe study enrolled a total of 450 pregnant women. Following exclusions and follow-up attrition, 422 pregnant women were analyzed. There were 72 pregnant women with PTSD and 350 without PTSD. There was no statistically significant difference in birth weight between the two groups of participants. Three months after birth, infants of PTSD-positive mothers exhibited significantly lower weight percentiles at three months (P < 0.001), adjusted for birth weight, feeding method, and coping strategies. Multivariate analysis affirmed a 9.44-point reduction in weight percentile among infants in the PTSD-positive group (95% CI: 4.01–14.87, P = 0.001). Conclusion: Pregnant women suffering from PTSD during the pandemic are at risk of giving birth to infants with impaired physical growth. These findings highlight the critical need for mental health support for pregnant women to foster optimal infant development and to guide public health policies and clinical practices.

Coupling Pre- and Postnatal Infant Exposures with Physiologically Based Pharmacokinetic Modeling to Predict Cumulative Maternal Levetiracetam Exposure During Breastfeeding.

Although breastfeeding ensures optimal infant development and maternal health, mothers taking medications may abandon breastfeeding because of uncertainties regarding toxicity to infants. Current methods in predicting infant risk to maternal medication exposure do not account for breastfeeding-related variability or in utero exposure via the umbilical cord (UC). Previously, our workflow integrated variability in infant anatomy and physiology, breast milk intake volume, and drug concentrations in breast milk using physiologically based pharmacokinetic (PBPK) modeling. The upper area under the curve ratio (UAR) was then calculated to assess infant risk from maternal drug. Herein, we enhanced this workflow by coupling pre- and postnatal exposures to predict the overall levetiracetam exposure in breastfeeding infants. A published pediatric PBPK model of levetiracetam was used to simulate an infant population (n = 100). Daily infant doses were simulated using a weight-normalized milk intake model to calculate volumes ingested across age groups, alongside literature-derived or simulated milk concentrations across maternal doses to predict infant concentrations. Published UC concentrations were used to develop a cord-coupled neonatal model (CCM), which was integrated with the PBPK and milk intake models and evaluated by comparing observed and simulated infant blood concentrations using a 90% prediction interval (PI). UC concentration data from 14 mothers were used to develop the CCM. A total of 16 paired (known milk concentrations) and two unpaired (unknown milk concentrations) individual infant concentrations were identified for evaluating the model along with population values of 64 infants from two age groups (2-4 and 7-31days). The CCM improved the predictions overall compared with the original workflow, largely due to improvements for the youngest age group evaluated. Overall, 83% (10 of 12) of the individual infant plasma concentrations were successfully captured within the 90% PI for the paired, quantifiable (i.e. above the limit of quantification) evaluation datasets. After administration of a maternal dose of levetiracetam 2000mg, the calculated UAR ranged from 0.13 to 0.27 for the 95th percentile infants. To our knowledge, this is the first report to combine prenatal levetiracetam exposures from the UC and postnatal exposures from breastfeeding to predict overall infant drug exposure. The results indicate that infant exposure in infants aged 0-7 days may approach therapeutic levels of levetiracetam in the highest-risk infants (i.e. 95th percentile), with a low likelihood of adverse effects based on published clinical studies. This integrated modeling approach provides a more holistic analysis of neonatal exposures. It can be applied in future studies to derive the UAR of drugs administered during breastfeeding to identify infants at risk of potential toxicity.

FACTORS AFFECTING BREAST-FEEDING PRACTICES IN CHILDREN UNDER TWO YEARS OF AGE.

Background: Exclusive breastfeeding for the first six months is crucial for optimal infant health and development. However, various maternal, neonatal, and environmental factors can influence breastfeeding practices, leading to suboptimal outcomes. Objective: To identify and assess the impact of maternal, pregnancy, birth, and infant factors on exclusive breastfeeding among children under two years of age. Methods: A case-control study was conducted at the Department of Paediatrics, Combined Military Hospital, Kharian, from July 2022 to March 2023. The study included 150 mothers and their children aged over two years. Exclusion criteria encompassed mothers with a history of breast trauma, surgery, irradiation, contraindications to breastfeeding, and neonates with anatomical facial defects. Data were collected on maternal demographics, pregnancy and birth details, infant characteristics, and breastfeeding practices. Statistical analyses, including calculation of adjusted odds ratios (OR) with 95% confidence intervals (CI), were performed to determine associations between various factors and exclusive breastfeeding. Results: The study identified several factors associated with increased odds of not providing exclusive breastfeeding. Premature birth was significantly associated with higher odds (OR: 12.5; 95% CI: 3.3–45.1; p&lt;0.001). Maternal obesity also contributed to increased odds (OR: 3.6; 95% CI: 1.0–12.5; p=0.046). Additionally, maternal depression was linked to higher odds (OR: 18.5; 95% CI: 2.6–134.2; p=0.004). A maternal perception of inadequate milk supply was associated with increased odds (OR: 9.1; 95% CI: 2.4–35.2; p=0.001). Lastly, a non-supportive breastfeeding environment was significantly associated with higher odds (OR: 13.5; 95% CI: 4.2–43.0; p&lt;0.001). Conclusion: Premature birth, maternal obesity, depression, perceived insufficient milk supply, and lack of a supportive environment are significant barriers to exclusive breastfeeding. Addressing these factors through targeted interventions is essential to improve breastfeeding practices and, consequently, infant health outcomes.

Exclusive Breastfeeding Rates Among Roma and Non-Roma Mothers in Greece: A Single-Center Cross-Sectional Study from "Tzaneio" General Hospital of Piraeus.

Exclusive breastfeeding is vital for the optimal development of infants, yet the practice of using infant formula has become increasingly prevalent. While many studies globally investigate factors affecting breastfeeding, there is a scarcity of research focusing on marginalized groups, particularly the Roma community. This study seeks to compare the breastfeeding rates of Roma and non-Roma mothers upon discharge from a maternity hospital in Greece. It also examines factors contributing to the decline in breastfeeding among Roma women, with particular emphasis on the role of midwifery support. The aim of this study is to promote the development of supportive policies and programs for breastfeeding among Roma mothers. A cross-sectional study was conducted from September 2019 to January 2022, involving 248 infants born at ≥37 weeks of gestation and their mothers, who were of Greek nationality. Both Roma and non-Roma participants received consistent, high-quality care from the same midwife researcher, who personally attended to them. All participants initiated breastfeeding immediately after their newborns' births and practiced rooming-in by keeping their babies in the room with them during their hospital stay. Data were collected through questionnaires to determine the rates of exclusive breastfeeding among the two groups. The study found that a smaller proportion of Roma mothers exclusively breastfed their infants compared to non-Roma mothers, despite receiving similar levels of support from healthcare professionals. The provision of midwifery support did not significantly enhance exclusive breastfeeding rates among Roma mothers. This suggests the need for more comprehensive and multi-faceted interventions. Further research is required to confirm these findings and to design effective programs aimed at increasing exclusive breastfeeding rates, thereby improving health outcomes for Roma children and mothers.

An investigation into the parental attitudes and challenges faced when introducing solid foods to infants in Ireland

The introduction of complementary foods, also known as 'weaning', refers to the process of introducing solid foods into an infant’s diet, alongside breast milk or infant formula milk(1). According to the Food Safety Authority of Ireland (FSAI) guidelines, weaning should commence around 6 months of age, with no earlier or later than 17 or 26 weeks, respectively(2). These guidelines provide evidence-based recommendations aimed at promoting optimal infant health, growth, and development(3). The aim of this study was to gain an insight into parental attitudes towards weaning and the common challenges faced when introducing solids.Data was collected using a 16-item questionnaire. Parents of infants aged 0–12 months were recruited through an online parenting club and descriptive statistics were performed using IBM SPSS (V29) to determine percentages.Of the 215 participants, 64% (n = 137) had initiated solid food introduction to their infants, with the age of these infants ranging from 4-12 months. Of those, the majority (80%, n = 109) followed FSAI guidelines(2), introducing new foods daily or every few days. The main factors guiding this decision were signs of readiness and developmental milestones, cited by 76% of respondents (n = 104). Among those who began weaning (n = 137), 70% reported a positive experience, though the majority (92%, n = 126) encountered challenges along the way. These included infant’s refusal to eat (34%, n = 47), allergy concerns (41%, n = 56), and difficulty determining appropriate portion sizes (48%, n = 66). Our findings showed that 12% (n = 16) of infants aged 6-9 months and 2% (n = 3) of infants aged 10-12 months had not yet been introduced to meat, poultry, or fish. Additionally, 4% of parents (n = 6) waited until their infants were at least 9 months old to introduce these foods, despite guidelines recommending early exposure to iron-rich foods(2).Most parents with infants aged 0-6 months (64%, n = 78) had not started weaning. Among them, 26% (n = 20) felt very confident about beginning the process, while 25% (n = 19) lacked confidence in introducing solid foods to their infants.Among all participants, information on weaning commonly came from family/friends (68%, n = 147), healthcare professionals (60%, n = 128), and social media (46%, n = 99). When asked about resources they would like access to, nearly two-thirds of parents (64%, n = 138) expressed interest in weaning recipe ideas. Additionally, 53% (n = 114) highlighted the need for guidelines on the appropriate amount of milk to give during weaning.In conclusion, our findings indicate that while most parents appear compliant with the recommended timing of weaning, challenges still persist. Moreover, there is a notable reliance on various sources for weaning information, with a demand for resources like weaning recipes and milk quantity guidelines. These insights highlight the importance of tailored support and education to facilitate a positive weaning experience for both parents and infants.

Knowledge, Attitudes, and Practices Regarding Exclusive Breastfeeding among Lactating Mothers in Rural Bangladesh

Background: Exclusive breastfeeding stands at the forefront of maternal and child health, serving as a fundamental pillar for ensuring the optimal growth and development of infants. It not only acts as a crucial source of nutrition but also plays a pivotal role in fortifying the physical and cognitive well-being of newborns, while simultaneously fostering a profound bond between mothers and their infants.Objective: This research seeks to gauge the level of awareness among lactating mothers regarding the significance and benefits of exclusive breastfeeding. It aims to comprehend their attitudes towards exclusive breastfeeding (EBF) and scrutinize their actual practices in implementing this vital aspect of infant care.Materials and Methods: A cross-sectional study was conducted at the Department of Community Medicine, ASWMC, Jashore, in 2018. Data collection took place in the Outpatient Department (OPD) of 'Ad-din Sakina Medical College Hospital' and 'Mother &amp; Child Welfare Centre, Jashore.Results: The study demonstrates a high awareness and adherence to exclusive breastfeeding, with 94.4% aware, 90.9% knowledgeable about recommended duration, 49.9% recognizing advantages, 14.6% aware of disadvantages, and a substantial majority (92.5%) practicing exclusive breastfeeding, though 7.5% do not.Conclusion: Bridging knowledge gaps, cultivating positive attitudes, and promoting consistent breastfeeding practices emerge as crucial components of a comprehensive strategy to boost exclusive breastfeeding rates. The collaboration between healthcare providers, policymakers, and the community is indispensable for the success of such initiatives, ultimately contributing to the overall health and well-being of both infants and lactating mothers. KYAMC Journal Volume: 15, No: 01, April 2024: 46-49.

Parent Perspectives of Co-Occupations in Neonatal Intensive Care: A Thematic Review of Barriers and Supports.

Co-occupations within the neonatal intensive care unit (NICU), which include parenting activities, such as bathing, feeding, diapering, comfort care, and bonding for attachment, are consequential for optimal infant development. This thematic systematic review examines supports and barriers for facilitating co-occupations between parents and infants in the neonatal setting. A search of four databases (MEDLINE, CINAHL, PsycINFO, and PubMed) resulted in 20 studies that met inclusion criteria for data extraction. Family-centered NICU design, good communication between parents and NICU staff, increased physical contact, parent involvement in caregiving, psychological wellness, parent education, peer support, and established parental roles are identified as supports to co-occupational engagement. Identified barriers include physical separation, loss of parental role, restrictions of the NICU environment, medical technology, role strain, psychological burden, lack of knowledge, and poor communication. Findings suggest that neonatal occupational therapy practitioners can facilitate parent-infant co-occupations by addressing barriers and augmenting existing supports.

Reimagining Supportive Approaches at the Intersection of Mandatory Reporting Policies for the Mother-Infant Dyad Affected by Substance Use.

As rates of substance use during pregnancy persist, the health and optimal development of infants with prenatal substance exposure remain a key priority. Nurses are tasked with identifying and reporting suspected cases of child maltreatment, including abuse and neglect, which is often assumed to be synonymous with substance use during pregnancy. While policies aimed at protecting infants from child abuse and neglect are well intentioned, literature regarding the short- and long-term social and legal implications of mandatory reporting policies is emerging. In this article, we explore the intersections between the condition of substance use in pregnancy and policies related to mandatory reporting. We provide an overview of historical and current trends in mandatory reporting policies for nurses related to substance use in pregnancy and related ethical and social implications for mother-infant dyads. Nurses often function at the intersection of healthcare and social services, underscoring the important role they play in advocating for ethical and equitable care for both members of the mother-infant dyad affected by substance use. We offer recommendations for practice including the integration of respectful care and family-centered support for the mother-infant dyad affected by substance use. Cross-sectoral collaborations, inclusive of the family, are important to the advancement of evidence-based and equity-focused research, advocacy, and policy initiatives to support familial preservation and reduce mother-infant separation.

Effect of fractional exhaled nitric oxide (FENO)-based asthma management during pregnancy versus usual care on infant development, temperament, sensory function and autism signs

Asthma during pregnancy is associated with a range of adverse perinatal outcomes. It is also linked to increased rates of neurodevelopmental conditions in the offspring. We aimed to assess whether fractional exhaled nitric oxide (FENO)-based asthma management during pregnancy improves child developmental and behavioural outcomes compared to usual care. The Breathing for Life Trial was a randomised controlled trial that compared FENO-based asthma management during pregnancy to usual care. Participants were invited to the developmental follow-up, the Breathing for Life Trial – Infant Development study, which followed up infants at 6 weeks, 6 months and 12 months. The primary outcomes were measured in infants at 12 months using the Bayley-III: Cognitive, Language and Motor composite scores. Secondary outcomes included Bayley-III social-emotional and adaptive behaviour scores, autism likelihood and sensory and temperament outcomes. The exposure of interest was the randomised intervention group. Two hundred and twenty-two infants and their 217 participating mothers were recruited to the follow-up; 107 mothers were in the intervention group and 113 were in the control group. There was no evidence of an intervention effect for the primary outcomes: Bayley-III cognitive (mean = 108.9 control, 108.5 intervention, p = 0.93), language (mean = 95.9 control, 95.6 intervention, p = 0.87) and motor composite scores (mean = 97.2 control, 97.9 intervention, p = 0.25). Mean scores for secondary outcomes were also similar among infants born to control and FENO group mothers, with few results reaching p < 0.05.Conclusion: In this sample, FENO-guided asthma treatment during pregnancy did not improve infant developmental outcomes in the first year of life.Trial registration: ClinicalTrials.gov Identifier: ACTRN12613000202763.What is Known:• Maternal asthma during pregnancy has been associated with increased rates of neurodevelopmental conditions in offspring, including intellectual disability and autism.What is New:• This is the first study to examine how managing asthma during pregnancy via a FENO-guided algorithm or usual care affects infant developmental and behavioural outcomes. While the results of the study showed no impact of the intervention, and therefore do not support the integration of FENO-based management of asthma in antenatal settings for optimal infant development, they do send a positive message about the implications of active asthma management during pregnancy on infant developmental outcomes.

Supplemented Infant Formula and Human Breast Milk Show Similar Patterns in Modulating Infant Microbiota Composition and Function In Vitro.

The gut microbiota of healthy breastfed infants is often dominated by bifidobacteria. In an effort to mimic the microbiota of breastfed infants, modern formulas are fortified with bioactive and bifidogenic ingredients. These ingredients promote the optimal health and development of infants as well as the development of the infant microbiota. Here, we used INFOGEST and an in vitro batch fermentation model to investigate the gut health-promoting effects of a commercial infant formula supplemented with a blend containing docosahexaenoic acid (DHA) (20 mg/100 kcal), polydextrose and galactooligosaccharides (PDX/GOS) (4 g/L, 1:1 ratio), milk fat globule membrane (MFGM) (5 g/L), lactoferrin (0.6 g/L), and Bifidobacterium animalis subsp. lactis, BB-12 (BB-12) (106 CFU/g). Using fecal inoculates from three healthy infants, we assessed microbiota changes, the bifidogenic effect, and the short-chain fatty acid (SCFA) production of the supplemented test formula and compared those with data obtained from an unsupplemented base formula and from the breast milk control. Our results show that even after INFOGEST digestion of the formula, the supplemented formula can still maintain its bioactivity and modulate infants' microbiota composition, promote faster bifidobacterial growth, and stimulate production of SCFAs. Thus, it may be concluded that the test formula containing a bioactive blend promotes infant gut microbiota and SCFA profile to something similar, but not identical to those of breastfed infants.

Breastfeeding: science and knowledge in pediatric obesity prevention.

The increasing prevalence of childhood obesity worldwide is a significant concern due to its link to severe health issues in adulthood, such as non-communicable diseases (NCDs). To address this issue, this review evaluates the effectiveness of various preventive measures for childhood obesity, focusing on maternal nutrition and breastfeeding. The study underscores the criticality of the periconceptional period, where the diets of both parents can influence epigenetic modifications that impact the child's metabolic pathways and obesity risks. Breastfeeding is a potent protective mechanism against early-onset obesity, significantly enhancing the infant's metabolic and immune health by modifying DNA methylation and gene expression. Furthermore, the perspective underscores the significance of the Mediterranean diet during the periconceptional period and lactation. This diet can effectively prevent gestational complications and improve breast milk quality, fostering optimal infant development. Recognizing that obesity results from genetic, epigenetic, environmental, and social factors, the paper advocates for a comprehensive, multidisciplinary approach from the earliest stages of life. This approach champions a balanced maternal diet, exclusive breastfeeding, and timely introduction to complementary foods. In conclusion, addressing pediatric obesity requires a multifaceted strategy emphasizing improving prenatal and postnatal nutrition. Further research is necessary to understand the epigenetic mechanisms influenced by nutrition and their long-term effects on children's health. This will help refine interventions that curb the obesity epidemic among future generations.

Mother-infant interaction and infant development in women at risk of postpartum psychosis with and without a postpartum relapse.

This study aimed to investigate mother-infant interaction and infant development in women at-risk of postpartum psychosis (PP), with and without a postpartum relapse. 103 women (and their offspring) were included, 43 at-risk-of-PP because of a diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 60 with no current/previous mental illness or family history of PP. Of the at-risk women, 18 developed a psychiatric relapse within 4 weeks after delivery (AR-unwell), while 25 remained symptom-free (AR-well). Mother-infant interaction was assessed using the CARE-Index at 8 weeks' and 12 months' postpartum and infant development using the Bayley-III at 12 months' postpartum. Women at-risk-of-PP as a group, regardless of whether they developed a psychiatric relapse within 4 weeks after delivery, had less synchronous mother-infant interactions and had infants with less optimal cognitive, language, motor and socio-emotional development than healthy controls. In particular, boys of at-risk women had the lowest scores in cognitive, language and motor development and in mother-infant interaction, while girls of the at-risk women had the lowest scores in socio-emotional development. The synchrony in the dyad predicted infant cognitive and language development. There was no evidence for a difference in mother-infant interaction nor in infant development between the AR-unwell and AR-well groups. These results suggest that, while there is a lack of evidence that an early postpartum relapse in women at-risk-of-PP could represent a risk for the infant per se, maternal risk for PP may be associated with less optimal mother-infant interaction and infant development.

Dynamic Changes in the Human Milk Metabolome Over 25 Weeks of Lactation.

Human milk (HM) provides essential nutrition for ensuring optimal infant growth and development postpartum. Metabolomics offers insight into the dynamic composition of HM. Studies have reported the impact of lactation stage, maternal genotype, and gestational age on HM metabolome. However, the majority of the studies have considered changes within the first month of lactation or sampled with large intervals. This leaves a gap in the knowledge of progressing variation in HM composition beyond the first month of lactation. The objective of this study was to investigate whether the HM metabolome from mothers with term deliveries varies beyond 1 month of lactation, during the period in which HM is considered fully mature. Human milk samples (n = 101) from 59 mothers were collected at weeks 1–2, 3–5, 7–9, and 20–25 postpartum and analyzed using 1H nuclear magnetic resonance spectroscopy. Several metabolites varied over lactation and exhibited dynamic changes between multiple time points. Higher levels of HM oligosaccharides, cis-aconitate, O-phosphocholine, O-acetylcarnitine, gluconate, and citric acid were observed in early lactation, whereas later in lactation, levels of lactose, 3-fucosyllactose, glutamine, glutamate, and short- and medium-chain fatty acids were increased. Notably, we demonstrate that the HM metabolome is dynamic during the period of maturity.

The Shared Pleasure Paradigm: A study in an observational birth cohort in South Africa

Mother–infant dyads in low- and middle-income countries (LMICs) may be exposed to a range of factors associated with suboptimal development. Optimal infant development is likely supported by synchronicity in the early mother–infant relationship, but limited corroborative research is available in LMICs. The Drakenstein Child Health Study (DCHS) provided an opportunity to study this synchronicity and its associations in South Africa. A South African birth cohort study investigating early-life determinants of child health in a LMIC context provided participants. The Shared Pleasure (SP) paradigm helped assess early mother–infant synchronicity in videos of a sub-set of 291 mother–infant dyads at their 14-week well baby visit. General linear regression models investigated the relationship between selected maternal and infant characteristics and the presence of Shared Pleasure moments. Out of a possible 291 dyads, 82% (n = 239) yielded Shared Pleasure moments. The mean age of mothers was 27 years, while infant sex distribution comprised 54% females and 46% males. The shortest single Shared Pleasure moment lasted at least 0.5 s and the longest 28 s. Shared Pleasure moments were associated with higher gestation age at delivery (p = 0.008) and higher infant birth weight (p = 0.006), but were not related to mother's mental health and infant health outcomes at 14 weeks. The high frequency of positive Shared Pleasure moments in reciprocal dyadic interactions in this sample suggests that significant disruption in shared pleasure may be present only in extreme cases (e.g. mothers with severe mental disorders). Further work is needed to investigate the mechanisms underlying the associations between early mother–infant synchronicity and better outcomes noted here, and to assess whether SP may serve as a culturally appropriate screen for assessing connectedness.

Современные принципы организации питания недоношенных новорожденных с очень низкой и экстремально низкой массой тела

The growth rate of infants born preterm should match the growth rate of healthy fetuses of the same gestational age. However, despite many existing clinical guidelines and dietary protocols, preterm infants almost invariably experience postnatal growth restriction. To ensure optimal growth and development of preterm infants, it has become essential to revise nutritional strategies. For preterm infants with extremely low and very low birth weight, it is recommended to initiate parenteral nutrition within the first hours of life, as well as to initiate early enteral nutrition directly in the delivery room with mother’s colostrum using buccal and cotton swabs. If possible, to increase the volume of enteral nutrition, to enrich breast milk, preferably with liquid fortifiers and/or human milk-based fortifiers, and to optimize supplementation with additional minerals. This review presents the scientific rationale for nutrient requirements, practical recommendations and strategies for parenteral and enteral nutrition in preterm infants, current recommendations for initial and maximum macro- and micronutrient gestational requirements. Key words: parenteral nutrition, enteral nutrition, preterm infant, nutrients, micronutrients, breast milk fortifiers

Predictors of Stunting and Underweight Among Children Aged 6 to 59 months in Bussi Islands, Wakiso District, Uganda: A Cross-Sectional Study.

Background:Child undernutrition is a major public health concern in Uganda that can lead to increased risks of death with its prevalence higher in rural hard-to-reach areas than in urban areas. While it is assumed that the prevalence will be more concerning in islands with restricted accessibility to healthcare resources, limited research has been conducted on the prevalence and associated factors of stunting and underweight among children in Bussi Islands of Uganda. This study aimed to assess the prevalence and predictors of stunting and underweight among children aged 6 to 59 months in Bussi Islands of Wakiso District in Uganda.Methods:A cross-sectional study was conducted in Bussi Islands of Wakiso District. Sociodemographic and anthropometric measurements were obtained for randomly sampled 409 caretaker-child pairs from 409 households. Data was collected using pre-tested structured electronic questionnaires validated by the Uganda Ministry of Health. Anthropometric indices were calculated using ENA-SMART version 2011 and data analysis was conducted using STATA version 14. Modified Poisson regression was used to generate Unadjusted and Adjusted Prevalence Ratios (APRs) with 95% confidence intervals.Results:Prevalence of stunting and underweight among children in Bussi Islands were 29.8% and 16.1%, respectively. Independent predictors of stunting included: suffering from diarrhea (APR: 1.8; 95% CI: 1.3, 2.5); household food insecurity (APR: 1.7; 95% CI: 1.2, 2.4); and child age of 12 to 23 months and 24 to 35 months (APR: 2.3; 95% CI: 1.3, 4.0 and APR: 2.0; 95% CI: 1.1, 3.6 respectively). Protective factors against stunting were not suffering from measles (APR: 0.62; 95% CI: 0.42, 0.92); receiving deworming tablets every 6 months (APR: 0.58; 95% CI: 0.42, 0.81); and daily household utilization of more than 80 L of water (APR: 0.48; 95% CI: 0.24, 0.95). Predictors of underweight were suffering from diarrhea (APR: 2.2; 95% CI: 1.4, 3.4) and having more than 9 household members (APR: 2.8; 95% CI: 1.1, 7.5).Conclusions:Child stunting and underweight are prevalent public health problems in Bussi Islands of Wakiso District. Therefore, the study suggests that nutrition interventions in the Islands should focus on childhood vaccination, family planning, sufficient safe water coverage, household food security, and health education of child caretakers on optimal infant and young child feeding and development.

Gastrointestinal and feeding issues for infants

Appropriate nutrition is essential for optimal development and growth of preterm infants. Infants less than 25 weeks corrected gestational age are frequently the most difficult group for which to provide adequate nutrition due to minimal energy stores and high fluid losses. Nutrient delivery becomes an integral, but also very challenging part in their management. Early administration of intravenous nutrients provides a critical bridge to full enteral nutrition. However, enteral feeding is challenging due to immaturities of the intestinal tract, feeding intolerance and the risk of catastrophic gastrointestinal disease such as necrotizing enterocolitis (NEC). Decreased gastric acid production, increased gut permeability, reduced immunoglobulins, immature intestinal epithelia and a decreased mucin barrier all contribute to weakness to gastrointestinal insult. This review aims to illustrate the importance of enteral feeding and the common challenges and approaches in the nutrition of infants born at this age.

The use of linear programming to determine whether breastfed infants can achieve a nutritionally adequate complementary feeding diet: a case study of 6–11-month-old infants from KwaMashu, KwaZulu-Natal, South Africa

Objectives: The objectives of this study were to ascertain whether the nutrient requirements of 6–11-month-old infants can be met with a food-based approach, and to identify the nutrients of which it is difficult to achieve adequate intakes. Design, setting and subjects: A cross-sectional survey and interviews with mothers and caregivers from the KwaMashu Community Health Centre were conducted. One hundred and thirty-four interviews were completed. This information provided the food consumption input for the model using Optifood software. Results: The results revealed that with the current food pattern of infants from the study group in KwaMashu, iron, zinc and calcium are nutrients whose requirements are likely not to be met in the diet. The percentage RNI (recommended nutrient intake) for iron was 25.2%, zinc 51.3% and calcium 77%. Nutrient intakes for these nutrients of concern improved in the ‘No pattern’ diet but iron and zinc intakes remained below the RNI. According to the best diets modelled by Optifood, it appears that infants in KwaMashu would be able to achieve the recommended intakes of energy, protein, and 8 of the 11 micronutrients, as long as breastfeeding on demand continues during the complementary feeding phase. Conclusions: This study calls into question the continued food-based focus to ensure nutrient adequacy in infants. In conjunction with efforts to improve household food security and continued support and promotion of breastfeeding for the first 2 years of life, targeted micronutrient supplementation may be needed to ensure the optimal growth and development of infants in South Africa.

Growth and Development in Preterm Infants: What is The Long-Term Risk?

ABSTRACT Background: Indonesia comes in the fifth for the greatest number of preterm births. Preterm infants may inflict various complication as the result of underdeveloped immunity, affecting their growth and development in the long run until they reach adult phase. Such complications could be prevented through adequate nutrition fulfillment. Purpose: This article aimed to elaborate the characteristics of growth and development of premature babies, long term effect on the development and the impact of immunity and gut health of preterm infants in supporting their growth and development. Methods: References cited in this article were obtained from the latest primary literature within the last 10 years. Discussion: The rate and ability of infants to perform catch-up growth depends on the birth weight and gestation age, at which the lower birth weight and lower gestational age had slower rate. Brain structures that of preterm infants differ compared to the term, and these changes give rise to various clinical outcomes, including long term emotional, behavioral changes, cognitive and executive functioning. Immature immune system in preterm infants reduces the protective ability by innate and adaptive immunity in overcoming pathogens compared to term infants, including gut microbiota prematurity which affects nutrition absorption and growth and development catch up ability. Appropriate and adequate nutrition supplementation has shown beneficial effects in promoting the growth of normal gut flora, which allow better absorption of nutrition and therefore enhancing growth rate and supporting the development of preterm infants. Conclusions: Optimal growth and development of preterm infants are supported by sufficient nutrition supplementation to support the growth of gut microbiota, facilitating the catch-up growth and development of premature infants and immune system maturity.