Second Half Of Infancy Research Articles

Iron-Fortified Foods Are Needed To Meet the Estimated Average Requirement for Iron in Australian Infants Aged 6 to 12 Months

BackgroundMeeting iron intake recommendations is challenging for infants 6–12 mo, especially breastfed infants. Three-quarters of Australian infants 6–12 mo have iron intakes below the estimated average requirement (7 mg), placing them at risk of iron deficiency. After 6 mo, breastmilk is no longer sufficient to meet the increased demand for iron, and iron-rich complementary foods are recommended. Iron-fortified foods may be a means of improving iron intake in infants, particularly those that are breastfed. ObjectivesThe aims of the study were as follows: 1) to examine the effect of milk-type and fortified foods on iron intake and the prevalence of inadequacy in infants 6–12 mo; 2) to model the effect of fixed amounts of iron-fortified infant cereal (IFIC) at 6 levels of iron fortification on total iron intake and the prevalence of inadequacy; and 3) to assess the effect IFIC on the intake of other nutrients in the diet. DesignSecondary analysis of cross-sectional dietary intake data of infants 6–12 mo (n = 286) participating in the Australian Feeding Infants and Toddlers Study (OzFITS) 2021. ResultsMedian (interquartile range) iron intake was 8.9 (7.5, 10.3); 6.3 (4.5, 8.2); and 2.7 (1.5, 4.4) mg/d in formula-fed, combination-fed, and breastfed infants, respectively. The corresponding prevalence of inadequacy was 19%, 67%, and 96%. Infants who consumed fortified foods had higher median iron intakes than those who did not, 6.2 compared with 1.9 mg/d. Dietary modeling showed that consuming 18 g (300 kJ) of IFIC, fortified at 35 mg/100 g dry weight, reduces the prevalence of inadequacy for iron from 75% to 5% for all infants. ConclusionsIron intakes are low in Australian infants, especially for breastfed infants in the second half of infancy. Modeling shows that 300 kJ of IFIC, the current manufacturer-recommended serving, fortified at 35 mg/100 g dry weight, added to infant diets would be an effective means to reduce the prevalence of inadequacy for iron.

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

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

Associations of Less Healthy Snack Food Consumption with Infant Weight-for-Length Z-Score Trajectories: Findings from the Nurture Cohort Study.

Little is known about the impact of less healthy snack foods on weight trajectories during infancy. This secondary analysis of data from the Nurture cohort explored prospective associations of less healthy snack foods with infant weight trajectories. Pregnant women were recruited and, upon delivery of a single live infant, 666 mothers agreed to participate. Mothers completed sociodemographic and infant feeding questionnaires, and infant anthropometrics were collected during home visits at 3, 6, 9, and 12 months. Less healthy snack food consumption was assessed by asking how frequently baby snacks and sweets were consumed each day during the previous three months. Multilevel growth curve models explored associations of baby snacks and sweets with infant weight-for-length (WFL) z-scores. On average, mothers were 27 years old, 71.5% were non-Hispanic Black, and 55.4% had household incomes of ≤$20,000/year. Consumption of less healthy snack foods increased during infancy with a median intake of 3.0 baby snacks/day and 0.7 sweets/day between 10 and 12 months. Growth curve models showed that infants who consumed sweets >2 times/day had significantly higher WFL z-scores during the second half of infancy compared to infants who never consumed sweets. Less healthy snacks may contribute to the risk of obesity during infancy and promoting healthy snack food choices during this critical time is important.

Myxedema Ascites: A Rare Case Report

Congenital hypothyroidism is a very common condition in developing world, but myxedema ascites is very rare in pediatric population. We report a case of 13 years old girl with congenital hypothyroidism on irregular thyroxin started on second half of infancy, presented with recurrent ascites excluding all other causes and discuss different aspects of the condition on the basis of literature review.&#x0D; Bangladesh J Child Health 2019; VOL 43 (1) :66-68

Association between breast milk intake at 9-10months of age and growth and development among Malawian young children.

World Health Organization recommends exclusive breastfeeding for infants for the first 6months of life, followed by introduction of nutritious complementary foods alongside breastfeeding. Breast milk remains a significant source of nourishment in the second half of infancy and beyond; however, it is not clear whether more breast milk is always better. The present study was designed to determine the association between amount of breast milk intake at 9-10months of age and infant growth and development by 12-18months of age. The study was nested in a randomized controlled trial conducted in Malawi. Regression analysis was used to determine associations between breast milk intake and growth and development. Mean (SD) breast milk intake at 9-10months of age was 752 (244)g/day. Mean (SD) length-for-age z-score at 12months and change in length-for-age z-score between 12 and 18months were -1.69 (1.0) and -0.17 (0.6), respectively. At 18months, mean (SD) expressive vocabulary score was 32 (24) words and median (interquartile range) skills successfully performed for fine, gross, and overall motor skills were 21 (19-22), 18 (16-19), and 38 (26-40), respectively. Breast milk intake (g/day) was not associated with either growth or development. Proportion of total energy intake from breast milk was negatively associated with fine motor (β=-0.18, p=.015) but not other developmental scores in models adjusted for potential confounders. Among Malawian infants, neither breast milk intake nor percent of total energy intake from breast milk at 9-10months was positively associated with subsequent growth between 12 and 18months, or development at 18months.

Otitis media in children

Otitis media is a spectrum of diseases associated with middle ear infection. Acute otitis media is one of the most common acute infections in childhood, with a peak incidence in the second half of infancy. A diagnosis of acute otitis media is often challenging and requires three criteria to be met - acute onset of symptoms, signs of middle ear inflammation, and effusion. Otitis media with effusion is the presence of middle ear effusion without signs or symptoms of ear inflammation such as pain and fever as a result of impaired middle ear ventilation. Features of middle ear effusion in the absence of features of inflammation helps to make the diagnosis of otitis media with effusion. Most cases are self-resolving with 75%–90% showing complete resolution within 3 months.

Knowledge, attitude and practice towards exclusive breast feeding among lactating mothers in a South Indian Hospital

Background: Exclusive breast feeding (EBF) isconsidered when the infant does not receive any additional food or nutriment other than breast milk. Aims and Objectives: The object of the study was to assess knowledge, attitude and practice towards EBF among lactating mothers in a south Indian hospital. Materials and Methods: This cross-sectional study was conducted among 300 mothers, attending outpatient department of a tertiary care hospital, Karpaga Vinayaga Institute of Medical Sciences over a period of one year. They were administereda structured questionnaire which sought such information as age, educational status, occupation, initiation of breast feeding, prelactealfeeding and knowledge and practice of exclusive breast feeding. Results: Exclusive breast feeding was given for six months by 77.3% of study population. Their knowledge to start early breast feeding wasgood (57.7%). Formula milk was the most commonly used top milk (25.7%). Not enough breast milk (38%) and baby didn’t drink well (15.3%) were the main reasons for stopping breastfeeding. Conclusion: Exclusive breastfeeding during approximately the first 6 months of life with continued breast feeding through at least the second half of infancy is associated with reduced risk of adverse outcomes in mother and infant.

Are postural adjustments during reaching related to walking development in typically developing infants and infants at risk of cerebral palsy?

BackgroundIn typical development, postural adjustments during reaching change in the second half of infancy, including increasing rates of direction-specific adjustments. These changes are absent or different in infants at risk of cerebral palsy (CP). To discover whether these changes are related to acquisition of independent walking, we studied postural adjustments during reaching in infants before and after they learned to walk. MethodsTen typically developing (TD) infants and 11 infants at very high risk (VHR) of CP were assessed before and after they learned to walk. Reaching movements were elicited during supported sitting, while surface electromyography was recorded of arm, neck, and trunk muscles. Percentages of direction-specific adjustments (first level of control), and recruitment patterns and anticipatory activation (second level of control) were calculated. ResultsIn both groups, postural adjustments during reaching were similar before and after acquisition of independent walking. Direction-specificity increased with age in typically developing infants but not in VHR-infants. ConclusionIncreasing age rather than the transition to independent walking is associated with increasing direction-specificity of TD-infants during reaching while sitting, while infants at very high risk of CP show no increase in direction-specificity, suggesting that they gradually grow into a postural deficit.

Mineral- and vitamin-enhanced micronutrient powder reduces stunting in full-term low-birth-weight infants receiving nutrition, health, and hygiene education: a 2 × 2 factorial, cluster-randomized trial in Bangladesh

The causes of stunting are complex but likely include prenatal effects, inadequate postnatal nutrient intake, and recurrent infections. Low-birth-weight (LBW) infants are at high risk of stunting. More than 25% of live births in low- and middle-income countries are at full term with low birth weight (FT-LBW). Evidence on the efficacy of specific interventions to enhance growth in this vulnerable group remains scant. We investigated the independent and combined effects of a directed use of a water-based hand sanitizer (HS) and a mineral- and vitamin-enhanced micronutrient powder (MNP) (22 minerals and vitamins) to prevent infections and improve nutrient intake to reduce stunting in FT-LBW infants. The study was a prospective 2 × 2 factorial, cluster-randomized trial in 467 FT-LBW infants during 2 periods: from 0 to 5 mo postpartum (0-180 d postpartum) and from 6 to 12 mo postpartum (181-360 d postpartum) with the use of 48 clusters. All groups received the same general nutrition, health, and hygiene education (NHHE) at enrollment and throughout the 12 mo. Group assignments initially included the following 2 groups: no HS (control) group or HS from 0 to 5 mo postpartum. These assignments were followed by further divisions into the following 4 groups from 6 to 12 mo postpartum: 1) no HS and no MNP (control), 2) HS only, 3) MNP only, and 4) HS and MNP. When delivered in combination with NHHE, the use of an HS showed no additional benefit in reducing indicators of infection in the first or second half of infancy or the likelihood of stunting at 12 mo postpartum. FT-LBW infants who received the MNP (with or without the HS) were significantly less likely to be stunted at 12 mo than were controls (OR: 0.35; 95% CI: 0.15, 0.84; P = 0.017). The use of a mineral- and vitamin-enhanced MNP significantly reduced stunting in FT-LBW infants in this high-risk setting. The use of a water-based HS did not have an additive effect. This trial was registered at clinicaltrials.gov as NCT01455636.

Current infant feeding practices and impact on growth in babies during the second half of infancy.

Sri Lanka has made remarkable improvements in health, social and educational indices. However, child malnutrition exists as a significant health problem. Infant feeding indicators have not reached expected levels and improvements are partly constrained by a lack of data. The present study aimed to determine current infant feeding practices and their impact on growth among 6-12-month-old infants. The study comprised a descriptive cross-sectional investigation conducted in randomly selected (n = 7) Public Health Midwife areas in Galle, Sri Lanka. An interviewer-administered questionnaire was used to obtain data on sociodemographics and infant feeding. Mothers (n = 515) attending well-baby clinics were recruited on voluntary and consecutive basis. Infants' body weights and lengths were measured using standard procedures. Exclusive breastfeeding rate for first 6 months was 49.0%. In total, 42.6% infants (219 out of 515) were given rice as first weaning food, followed by salt (58.6%) and sugar (42.3%). Oil had been introduced to 84.9% of infants by the end of 12 months. Most infants (over 71%) were given dairy products, whereas 62.3% were being fed various liquid foods using bottles. The introduction of commercial infant cereals, chocolates, plain tea, ice cream and deep fried snacks was noted. Age-specific body weight and length were not achieved by 30.5% and 29.5% of infants, respectively. Weight for length was not achieved by 25.5% of the infants. Delayed achievements of motor milestones were observed. Mothers' knowledge scores on basic nutrients were low. Complementary feeding indices of the study group were not satisfactory. Maternal and child healthcare personnel need to identify causative factors for inappropriate feeding with a view to improve the complementary feeding patterns.

Growth in children with congenital diaphragmatic hernia during the first year of life

PurposeInfants with congenital diaphragmatic hernia (CDH) have high rates of mortality and long-term morbidity, including poor growth and failure to thrive. The aim of this study was to describe growth patterns during the first year of life in infants with congenital diaphragmatic hernia in a non-ECMO cohort. MethodsMedical records of infants with CDH admitted to our center between January 2005 and December 2011 were reviewed. Infants with anthropometric measurements at 3, 6 and 12months were included. Anthropometric measurements were obtained for the first year of life. Logistic regression analyses were performed to find predictive associations with failure to thrive (FTT). ResultOf the 45 survivors, 38 were seen twice (84%) and 24 (53%) were seen on three occasions to age 12months. Poor growth was observed with weight being most affected. FTT was present in 63% during the first six months of life. Days of mechanical ventilation were the only predictor of FTT. Besides poor weight gain, height and head circumference were also reduced. However, catch-up growth occurred during the second half of infancy and at age 12months failure to thrive had reduced by two thirds to 21%. ConclusionsPoor growth is a common early finding in CDH patients, which improves during infancy. This emphasizes the importance of close follow-up and aggressive nutritional management in CDH patients.

Typical and atypical development of reaching and postural control in infancy

Successful reaching requires postural control, either by active regulation or by postural support. The present paper reviews literature on typical and atypical development of reaching and postural control during infancy. Typically, reaching movements end in grasping around 4 months of age. Initially, reaches are characterized by large variation, including many trajectory corrections. During the first year, the movements get increasingly straight and smooth. Reaching in low-risk preterm infants is initially characterized by advanced development, but minor impairments may emerge in the second half of infancy. In high-risk preterm infants, development of reaching is characterized by delay and non-optimal reaching performance. Typical development of postural adjustments is characterized by variation and an increasing ability to adapt the variable repertoire to the specifics of the situation. The latter is facilitated by an increasing role of anticipatory mechanisms in the second half of infancy. Atypically developing infants may have a reduced repertoire and usually have difficulties in adapting postural adjustments. In infancy, most reaching movements are performed during sitting. The postural challenge of sitting may interfere in particular with the development of reaching in atypically developing infants. The practical implications of this suggestion are discussed.

Biodiversity and clinico-demographic characteristics of human rhinoviruses from hospitalized children with acute lower respiratory tract infections in Malaysia

BackgroundThere is accumulating evidence that human rhinovirus (HRV) causes acute lower respiratory tract infections (ALRTI). Recently, HRV-C was identified as a new species of HRV, but its spectrum of clinical disease is not well understood. ObjectivesWe investigated the molecular epidemiology, demographic and clinical characteristics of HRVs among hospitalized children with ALRIs. Study designOne hundred and sixty-five nasopharangeal aspirates taken from children <5 years hospitalized with ALRTIs in Serdang Hospital, Malaysia, were subject to reverse transcriptase-PCR for HRV. Phylogenetic analysis on VP4/VP2 and 5′-NCR regions was used to further characterize HRV. Other respiratory viruses were also investigated using semi-nested multiplex RT-PCR assay. Clinical parameters were analyzed between HRV, RSV and IFV-A mono-infections and between HRV species. ResultsHRV was detected in 54 (33%) patients for both single (36 samples) and multiple (18 samples) infections, 61.1% (22/36) represents HRV-A strains while the remaining 14 HRV-C. Strain P51was the first reported representative of HRV98. The majority of the single HRV cases were in the second half of infancy; HRV-C occurred among older children compared with HRV-A. HRV children were admitted significantly earlier and less febrile than RSV and IFV-A infection. HRV-C infected children were more likely to have rhonchi and vomiting as compared to HRV-A. Pneumonia was the most common discharge diagnosis followed by bronchiolitis and post-viral wheeze in HRV patients. ConclusionOur study showed high prevalence of HRVs and detection of HRV-C among hospitalized children with ALRTIs in Malaysia. Analysis of clinical parameters suggested specific features associated with HRVs infections and specific HRV groups.

Clinical Practice Guidelines for Feeding Behaviors and Weight‐for‐Age at 12 months: A Secondary Analysis of the Infant Feeding Practices Study II

The World Health Organization has identified childhood obesity as a major threat to global health. Accumulating evidence indicates that excess weight early in life is predictive of later childhood and adolescent obesity. Clinical practice guidelines for infant feeding behaviors have been developed by national and international health organizations. The relationship between these guidelines and infant weight status has not been established. To examine the relationship between weight-for-age at 1 year and adherence to four clinical practice guidelines for feeding behaviors: no bottle-to-bed, minimal juice consumption, breastfeeding throughout the first year of life, and introduction to solid food no earlier than age 4-6 months. Data were obtained from the Infant Feeding Practices Study II, a longitudinal, national survey administered by the U.S. Food and Drug Administration and Centers for Disease Control and Prevention that followed mother-infant dyads from pregnancy through 1 year postpartum. The sample was comprised of 691 infants for whom 12-month survey data were available. Significant associations with weight-for-age were found for juice consumption (p= 0.003), breastfeeding during the second half of infancy (p < 0.001), and introduction to solid foods prior to age 4 months (p < 0.001). A regression model that controlled for infant and maternal characteristics demonstrated that these feeding behaviors remained significant predictors of weight-for-age at 12 months. Modifiable infant feeding behaviors contributed to weight-for-age at 1 year. Replication studies with economically and culturally diverse samples are needed. Further, testing longitudinal interventions that address infant feeding practices is likely to yield the evidence needed for shaping future clinical practice guidelines that reduce the risk for childhood obesity and related pediatric comorbidities.

Rapid reacquisition of native phoneme contrasts after disuse: you do not always lose what you do not use

Infants attune to their birth language during the second half of infancy. However, internationally adopted children are often uniquely required to attune to their birth language, and then reattune to their adoptive language. Children who were adopted from India into America at ages 6-60 months (N = 8) and had minimal further exposure to their birth languages were compared to age-matched American non-adopted controls. Without training, neither group could discriminate a phonemic contrast that occurs in their birth language but not in English. However, after training on the contrast, the adopted group (N = 8) improved significantly and discriminated the contrast more accurately than their non-adopted peers. While English had explicitly replaced the birth language of the adopted sample, traces of early exposure conferred privileges on subsequent learning. These findings are consistent with behavioral and neurophysiological data from animals that have identified some of the mechanisms underlying such a 'retention without further use' phenomenon.

Morbidity Among Human Immunodeficiency Virus-exposed But Uninfected, Human Immunodeficiency Virus-infected, and Human Immunodeficiency Virus-unexposed Infants in Zimbabwe Before Availability of Highly Active Antiretroviral Therapy

Human immunodeficiency virus (HIV) remains a major cause of pediatric morbidity in Africa. In addition, HIV-exposed, but uninfected (HEU) infants can comprise a substantial proportion of all infants born in high prevalence countries and may also be a vulnerable group with special health problems. A total of 14,110 infants were recruited within 96 hours of birth between November 1996 and January 2000. Rates and causes of sick clinic visits and hospitalizations during infancy were investigated according to infant HIV infection group: infected-intrauterine, infected-intrapartum, postnatally-infected, HEU, and not-exposed (born to HIV-negative mother). A total of 382 infected-intrauterine, 499 infected-intrapartum, 188 postnatally-infected, 2849 HEU, and 9207 not-exposed infants were included in the analysis. Compared with not-exposed infants, HIV-infected infants made 2.8 times more all-cause sick clinic visits and required 13.3 times more hospitalizations; they had 7.2 times more clinic visits and 23.5 times more hospitalizations for lower respiratory tract infection after the neonatal period and were 159.9 times more likely to be hospitalized for malnutrition during the second half of infancy. Compared with not-exposed infants, sick clinic visits were 1.2 times more common among HEU infants, were inversely associated with maternal CD4 cell count, and were significantly higher for all HEU infants except those whose mothers had a CD4 count ≥ 800 cells/μL, which was the mean value of HIV-negative women enrolled in the trial. Morbidity is extremely high among HIV-infected infants. Compared with not-exposed infants, morbidity is higher among HEU infants and increases with severity of maternal disease, but is significantly higher for all mothers with CD4 cell count <800 cells/μL.

Breastfeeding and reported morbidity during infancy: findings from the Southampton Women's Survey

A number of studies in developed countries suggest that breastfeeding protects against infections in infancy. However, the choice to breastfeed is often related to maternal characteristics, and many of these studies are limited in the extent to which they can take account of confounding influences. In a prospective birth cohort study, we assessed the relationship between the duration of breastfeeding and the prevalence of lower respiratory tract infections, ear infections and gastrointestinal morbidity during the first year of life in 1764 infants. We considered the duration of all breastfeeding, including mixed feeding. Eighty-one per cent of the infants were breastfed initially, and 25% were breastfed up to 6 months. There were graded decreases in the prevalence of respiratory and gastrointestinal symptoms between birth and 6 months as breastfeeding duration increased; these were robust to adjustment for a number of confounding factors. The adjusted relative risks (95% confidence interval) for infants breastfed for six or more months compared with infants who were never breastfed were 0.72 (0.58-0.89), 0.43 (0.30-0.61) and 0.60 (0.39-0.92) for general respiratory morbidity, diarrhoea and vomiting, respectively. Duration of breastfeeding in the second half of infancy was less strongly related to diagnosed respiratory tract infections and gastrointestinal morbidity, although important benefits of breastfeeding were still seen. Our data provide strong support for a protective role of breastfeeding against respiratory and gastrointestinal infections in infancy. The graded inverse associations with breastfeeding duration suggest that current efforts to promote breastfeeding and increase duration will have important effects in reducing morbidity in infancy.

Immunogenicity of Two Investigational Serogroup B Meningococcal Vaccines in the First Year of Life

An investigational vaccine against serogroup B meningococcal (MenB) disease containing 3 main recombinant proteins (factor H-binding protein, Neisserial adhesion A, and Neisserial heparin-binding antigen) has been developed. We evaluated the immunogenicity and reactogenicity of a 3-dose course of this vaccine administered alone (recombinant MenB [rMenB]) or combined with the outer membrane vesicle (OMV) component of the vaccine used in New Zealand (rMenB+OMV). A randomized, single-blind, comparative study of 60 healthy infants enrolled at 6 to 8 months of age and immunized with rMenB or rMenB+OMV at day 0, day 60, and at age 12 months. Blood samples obtained at baseline and 1 month following the second and third doses of vaccine were analyzed for serum bactericidal antibody (SBA) using human complement (hSBA) against 7 MenB strains. The putative correlate of protection was an hSBA titer of ≥4. The per-protocol analysis included 24 of 30 participants randomized to each group. After 3 doses of rMenB+OMV, 90% or more of participants had an hSBA titer ≥4 for 5 MenB strains, with 70% of participants having an hSBA titer ≥4 for a sixth strain. rMenB alone was immunogenic for only 3 strains. Both vaccines were well tolerated. Three doses of rMenB+OMV in the second half of infancy induce bactericidal antibodies against strains expressing vaccine antigens, demonstrating the potential for broader vaccine prevention of MenB disease. This vaccine is now in phase III clinical trials.

Iron intake and iron status in breastfed infants during the first year of life

Breastfed infants may be at particular risk for iron deficiency because breast milk is low in iron. In a secondary analysis of data from a complementary feeding trial, indicators of iron status were examined, with particular focus on the development of iron status in those infants who were fully breastfed during the first 4 months of life. In this retrospective analysis of data from a randomized controlled trial infants were stratified according to their predominant milk diet during the first 4 months of life, a subgroup of breastfed infants (group BM, n=53) were compared with a subgroup of infants fed (iron-fortified) formula (group F, n=23). Dietary iron intake and indicators of iron status were analysed at 4 months of age (during the full milk feeding period), and during the complementary feeding period at 7 and 10 months of age. Iron intake was low in the BM group, ranging below the Dietary Reference Intakes throughout the complementary feeding period, with the (estimated) bioavailable iron intake only just achieving the reference requirements. At 4 months, iron deficiency (ID, Ferritin <12.0 ng/mL) was observed in 3 infants in the BM group and in 1 infant in the F group; no infant developed iron deficiency anaemia (IDA, ID and Hb <10.5 g/dl). At 7 and at 10 months of age, iron status was adequate in all infants of the F group. In the BM group, at 7 (10) months of age, ID was diagnosed in 10 (11) infants and IDA was found in 2 (1) infants. Healthy infants, fully breastfed at 4 months of age, demonstrated ID in about 21% and IDA in up to 6% during the second half of infancy while fed according to the paediatric dietary guidelines. This finding supports the recommendation that supplementation with bioavailable iron via complementary foods should be started early (4-6 months of age) in order to prevent iron deficiency during infancy.

Morbidity among infants in South India: A longitudinal study

To study the incidence and types of morbidity in the first year of life in a birth cohort, a longitudinal study. This study was undertaken in northern part of Karnataka state in India. Birth cohort consisted of all the children born during first six months of the study period. They were assessed at the time of enrollment and monthly follow up was done till they attained one yr of age. Out of the 194 newborns, 46.4% were boys and 53.6% were girls. 24.8% of newborns were of low birth weight and 5.1% were preterm. Four (2.1%) had congenital anomalies and 2.5% developed birth asphyxia. Diarrhea (10.8%) and skin diseases (8.2%) were the commonest morbidities in the neonatal period. The incidence of morbidity was 3.28 per infant per yr. It was more among boys and in the second half of infancy. Commonest morbidities during infancy were respiratory tract infection (62.4%), diarrhea 42.8% and skin diseases (21.6%). Incidence of disease in infancy highlights the need to improve and plan health programmes.