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The review examines whether mode of feeding is associated with risk of hospitalisation for illness during infancy in developed countries. Databases were searched for published studies that included the terms 'infant feeding' and 'hospitalisation'. Six studies were included. Breastfeeding was associated with a reduced risk of hospitalisation and adjusted analyses showed mixed results. Conclusion There is no clear relationship between mode of feeding and reduction of infant hospitalisation for illness in developed countries.

Aim: To review the trends in low birth weight (LBW) in Japan and Okinawa and to discuss the public health implications of the trend. Methods: The statistical records of Japan and the Okinawa prefecture were reviewed to observe secular trends of LBW incidence rate and other health indicators. Literature researches were undertaken of English and Japanese language publications to complete the review. Results: The LBW rate in Japan declined until the 1970s, reaching a low point for the whole country in 1978–1979 when it was 5.2% (7.2% in Okinawa). In Okinawa the proportion of LBW declined from 8.1% in 1973 to 7.2 in 1978. Since 1980 the LBW rate has steadily increased to its current level of 9.3% in Japan and 10.9% in Okinawa. During this period, the prematurity rate has not increased and other indicators of child health have continued to improve. Conclusion: Japan is unique among developed countries in that the LBW rate has almost doubled in the past three decades and the rate in Okinawa is 20% greater than the mainland. The health costs of this trend include the neonatal care of LBW infants and the increased risk of chronic disease in later life.

UNLABELLED Neonatal intensive care is generally considered justified in the majority of very premature infants, but there is some concern about the effectiveness of the techniques used at the margins of viability (22-24 wk of gestation). The controversy that exists in this area is largely due to a lack of agreed endpoints for geographically based populations where all live births are considered. Evaluation of outcome must also take the quality of neurological function in surviving infants into consideration, and in reviewing these data the reader is struck by the few reports providing information on a high proportion of survivors. To inform this debate, the "best data" for analysis are reviewed based on a number of criteria of quality for survival and outcome studies. Based on these data sets, < 25% of babies born alive at 24 wk and below survive without major disability. CONCLUSION An objective review of "best data" will provide the basis of an informed debate on whether providing intensive care for all very immature babies is appropriate in developed countries.

Aim: To examine the recent evolution of abortion request rates among adolescents and young adults in the Canton of Vaud (Switzerland) and to describe the circumstances of the abortion requests and sociodemographic characteristics by age subgroups and nationality. Method: Data for women aged 14 to 24 y living in Vaud were selected from the 12358 abortion requests from residents aged 14–49 y between 1990 and 1998. Results: Overall, abortion request rates by age were stable over the study period. However, rates for non-Swiss women were two to three times higher than those for Swiss women, at 4.5 [95% confidence interval [CI]: 3.8–5.2] vs 2.4 [95% CI: 2.1–2.7] per 1000 adolescents below the age of 18, 18.1 [95% CI: 17.2–18.9] vs 8.0 [95% CI: 7.1–8.8] per 1000 women aged 18–19 and 30.5 [95% CI: 29.1–32.0] vs 10.2 [95% CI: 9.6–10.8] per 1000 women aged 20–24. The ratio of abortions to live births was greatest for women under 20 y of age, at 1.9, in comparison with the ratio observed among adult women aged 20–24 (at 0.4). The abortion rate per 1000 conceptions >6 wk remained stable; this rate was 590 per 1000 among 14–19-y-olds in 1997. Conclusion: The abortion request rate among youths in this Swiss region has not increased between 1990 and 1998. Efforts must be intensified to ensure universal access to family planning services and contraception, especially for young foreign women and adolescents.

Political turmoil military conflicts and other international sociological upheavals are causing significant immigration of large numbers of people including infants and children in Europe. Many of these young migrants are refugees. These youngsters have significant health needs and medical conditions (such as infectious diseases) and mental health problems due to their previous stressful situations and the difficulties that they often experience while settling even temporarily into their new environments. Government authorities must screen for transmissible diseases and ensure that vaccine-preventable infections are adequately covered. Paediatricians must give the best possible care for these children and act as their advocates. This can be enhanced by collaborating with national and international paediatric societies and with international non-government agencies. This problem is not confined to Europe; world-wide it occurs on a massive scale and causes huge burdens for poorer countries that have serious difficulties in coping with the extra financial personnel and infrastructure needs imposed by massive uncontrolled migration of populations that are often unhealthy and inadequately nourished. However this should not be used as a pretext to deny safe refuge to children and their families who need it. Massive movements of infant and child immigrants and refugees across European borders over recent years have brought challenges to paediatricians because of the needs for the health and medical and mental health care of these young people. Paediatricians have an important role in their care and by acting wherever possible as their advocates. This is a massive problem world-wide in which paediatricians can have a potentially significant positive impact. (authors)

The Inter-Academy Panel (IAP) is critical about the scarce support to mother–child health (MCH) research in developing countries. At the request of the IAP, a group of members of the French and Swedish Academies of Science have arrived at the conclusion that an efficient network between scientists in resource-poor and industrialized countries will facilitate MCH research in developing countries. The priorities for such a network have been listed as follows: The present organization for the MCH website at the Pasteur Institute in Paris should be adapted to better promote collaboration between scientists from industrialized and developing countries. To provide short-term courses for young scientists from developing countries in the design of research protocols, and in the writing of scientific reports and manuscripts. To organize workshops on various topics of relevance for MCH in developing countries in order to create new research networks for scientific collaboration between industrialized and resource-poor countries. To establish collaboration between non-governmental organizations (NGOs) that support MCH research in developing countries. Topics for such collaborative studies and the way in which they may be performed are summarized.

The aim was to report the relationship between maternal prenatal intention to breastfeed and the actual initiation and duration of breastfeeding. Pregnant women resident within Avon UK expected to give birth between 1 April 1991 and 31 December 1992 were recruited in a longitudinal cohort study. Main outcome measures included maternal infant feeding intention (breastfeed breast and bottle feed bottle feed or uncertain) at 32 wk of pregnancy; intention in the first week intention for the rest of the first month and intention in months 2 to 4; initiation and duration of breastfeeding up to six months. Data were available on 10548 women. Prenatal intention to breastfeed had an influence on both initiation and duration of breastfeeding. Of the women intending to bottle feed from birth only 3.4% initiated breastfeeding compared with 96.6% of women planning to breastfeed for at least four months. At six months postpartum the mean duration of breastfeeding for women intending to breastfeed for at least five months was 4.4 mo (95% CI 4.3 4.4) compared with 2.5 mo (95% CI 2.4 2.6) for women with a prenatal intention to breastfeed for only one month. Logistic regression using intended duration as the only explanatory variable correctly predicted 91.4% of breastfeeding initiation and 72.2% of infant feeding at six months. This large population-based study confirms the strength of the relationship between maternal prenatal intention to breastfeed and both breastfeeding initiation and duration. Maternal intention was a stronger predictor than the standard demographic factors combined. This should be taken into account in future research and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration. (authors)

The aim of this study was to find the prevalence of mild mental retardation (MMR) in 6-10-y-old children in a prospectively followed cohort in Pakistan from four areas with different socioeconomic conditions. Retarded children were identified by a two-step method comprising a household screening with the Ten Questions Screening in 649 families followed by clinical investigation and psychometric testing (WISC-R and Griffiths) of the 132 children found by the screening. The overall prevalence of MMR among 6-10-yr-old children was 6.2%. The distribution of MMR was uneven with 1.2% among children from the upper-middle class 4.8% in the village 6.1% sin the urban slum and 10.5% in the poor periurban slum area. Additional impairments were found in 75% of the children with MMR of which speech impairment was the most common. Conclusion: The prevalence of MMR was found to be higher in a developing country than in developed countries. It also seemed to be related to poor socioeconomic conditions as the prevalence in the upper-middle class was comparable to figures from developed countries while the prevalence in children from poor population groups was much higher. (authors)

Good quality care of low birthweight infants could reduce neonatal mortality in low-income countries, but the technologies used in rich countries are inappropriate. Kangaroo Mother Care does not need expensive and sophisticated equipment, and for its simplicity it can be applied almost everywhere, including peripheral maternity units of very low-income countries. Kangaroo Mother Care (KMC) can also contribute to the humanization of neonatal care and to better bonding between mother and baby in both poor and rich countries. A group of health professionals with experience in KMC met in a workshop to discuss its effectiveness, safety, applicability and acceptability in different settings: from first and second level maternity units in settings with very limited resources, to second and third level units in settings with limited resources, to second and third level maternity and neonatal care units in settings with ample resources and infant mortality rates

Changes in the presentation and course of neonatal jaundice associated with breastfeeding have been recognized for some time now and have been the subject of scientific study for the past twenty years. Though the data still tend to be conflicting a reasonable summary of current knowledge suggests that breastfeeding is associated with an increased incidence of neonatal jaundice compared with formula feeding. Furthermore that jaundice in breast-fed infants tends to be more severe and thirdly that the duration of measurable hyperbilirubinaemia may extend for weeks or even months in some cases. Feeding the newborn infant at the breast has become the rule for the majority of mothers in many industrialized countries particularly in Scandinavia. Questions related to breastfeeding-associated jaundice have become a common occurrence in the well baby nursery as well as in the follow-up of healthy infants born in our hospital. (excerpt)

In research on control of the HIV/AIDS epidemic there are many ethical issues to be considered. The problem of personal autonomy versus the interest of society to prevent the spread of the disease in various settings makes it difficult to follow the regulations of the Declaration of Helsinki in all respects. This is particularly clear in the evaluation of trials aimed at preventing mother-to-child transmission of HIV. The interest of the child does not always conform to the policy of avoiding stigmatization of the mother. Programmes for the implementation of antiretroviral therapy and vaccine trials may differ in countries with different mean incomes of the inhabitants, and are also influenced by local patterns. For this reason, the Declaration of Helsinki should be changed in such a way that it conforms with the ways in which it may be possible to combat such a disastrous epidemic as that caused by HIV.

UNLABELLED Mastitis is a common maternal health problem which can lead to serious infant health problems such as poor growth and HIV infection. Anti-secretory factor (AF), which can be induced in milk by maternal consumption of a low-cost cereal product, has been associated with decreased mastitis. CONCLUSION Consumption of cereals which induce AF should be investigated as a potential intervention in less-developed countries where the consequences of mastitis for infants are most severe.

The aims were to assess the implementation of the "Selective Neonatal BCG Immunisation Policy" and to study the causes of non-compliance or failure of uptake of BCG immunization. The Birth Register data were used to generate a list of babies born in the catchment area of Basildon and Thurrock NHS Trust between 1 January 2001 and 31 December 2001 who were eligible for BCG immunization. The Community Child Health computer was used to generate information about their BCG immunization status. 201 children were included in the study. One hundred and seventy-one children had received BCG immunization in the neonatal period out of which 169 had received it before discharge from the hospital. Two children were immunized in the community in the neonatal period. Thus 85% of the newborns eligible for BCG immunization received their vaccination in the neonatal period. The current "Neonatal BCG Immunisation Policy" is effective and there is a high uptake of the vaccine in the neonatal period within the hospital itself. Newborn infants who do not receive BCG immunization in hospital rarely get immunized in the community. (authors)

Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6/1000 total births among singletons despite a low birthweight rate of 21.6/1000 total births among singletons despite a low birthweight rate of only 4.5%. Comparison of perinatal mortality rates with Danish mortality rates in 1983 revealed the Greek rates to be 3 times higher than those in Denmark. When divided by time of death the Greek stillbirth rates were 2 times higher and the early neonatal mortality rates were 4 times higher than the corresponding Danish rates. Subdivision of the Greek perinatal deaths using the Wigglesworth classification showed that the biggest group (40%) consisted of deaths associated with intrapartum asphyxia. The incidence of such deaths was 10 times higher than that found in Denmark. The authors conclude that in reducing the excessively high perinatal mortality rate in Greece special attention should be made to improve intrapartum and resuscitation techniques. (authors)

In this issue of Acta Paediatrica there is a paper on hospitalization of children under age 15 in the Barcelona area providing salient evidence that boys are hospitalized more often than girls. What are the reasons for this difference? The authors are wise enough to be rather vague about this. Reviews of current scientific literature may offer some explanations. Two main lines of reasoning are possible. There may be biological differences indicating that boys are more vulnerable to disease; or northern Spanish culture including that of the medical community may value boys more highly and give them preferential medical treatment. Perhaps people in most cultures value boys more highly and apply for medical care earlier or for slighter symptoms than in girls. A well-known example of such preferential treatment comes from China where more female foetuses are voluntarily aborted than male ones since families prefer to have sons when they are allowed only one child per family. Similar trends can also be noted in western societies today including Sweden according to daily newspapers. (excerpt)

The future revised WHO growth references for infancy and early childhood will have an international basis rather than just an American one as is the case with the current NCHS/WHO ones. The anthropometric data for analysis will be collected from babies breastfed in accordance with WHO guidelines. An important stipulation however is that their growth must have been unrestricted by environmental factors. A paper from Ghana describes a quantitative provisional study that has revealed how such a condition can be satisfied within a developing country. Family income and especially the higher education of the father up to university level can still be important variables in the achievement of optimal growth of babies even those brought up in situations of relative affluence. (authors)

Variability in stature among young children is often ascribed to health and nutrition differences in malnourished populations and to genetic differences in well-nourished populations. Hence, it was hypothesized that parent-child correlations in malnourished Guatemalan populations would be markedly lower than those reported for European samples. Instead, it was found that parent-child and sibling correlations were similar in both kinds of populations. The simplest interpretation of these results is that variability in stature among malnourished children is as much a reflection of genetic differences as in developed nations. However, explanations can also be advanced which would attribute the higher than expected correlations to the environment. For instance, it could be that socioeconomic and nutritional status is correlated across generations. In other words, parents who had relatively better conditions as children are more likely to provide a better environment for their children. Consequently, the relative contribution of genetics and environment to variability in height is still unsettled. Nonetheless, it appears that variability in body size in malnourished populations, regardless of the relative importance of its causes, is a useful indicator of health and nutrition.

Research on infant feeding practices indicate distinct social class- and country-specific patterns for breastfeeding. In industrialized countries educated upper class women breastfeed more often than women from lower classes and discriminated ethnic minorities. The reverse is true for developing countries, with high rates among traditional groups and low rates among the educated upper class women. The reasons for these discrepancies need to be studied to find more effective promotional messages for these groups of mothers in which the current rate of breastfeeding is low. Possible reasons leading to different attitudes toward breastfeeding in different socioeconomical and cultural environments are discussed.

WHO, concerned with the declining breast feeding rate in developing countries, has organized investigations in nine different countries of different aspects of breast feeding and breast milk with the ultimate aim of formulating programmes of intervention. The basic epidemiological study on 24000 mother/child pairs is just completed and some preliminary data are reported on the pattern of breast feeding in the three studied socio-economic groups--urban elite, urban poor and traditional rural--which differ significantly in their breast feeding rate as well as in the pattern of return of menstruation in breast-feeding and non-breast-feeding mothers.Concerned with the declining breast-feeding rate in developing countries, WHO has organized investigations in 9 different countries of different aspects of breast-feeding and breast milk with the ultimate aim of formulating programs of intervention. The basic study was begun in 1975 and concentrated on the epidemiology of breast-feeding among 3 different socioeconomic groups, the urban elite, urban poor, and traditional rural. 9 countries, Chile, Guatemala, the Philippines, India, Ethiopia, Nigeria, Zaire, Sweden, and Hungary, participated in the study, and altogether almost 24,000 mother/child pairs were involved. Data from all 9 countries have now been compiled, and are being centrally analyzed. Results of a few of the important preliminary findings are reported here. As far as duration of breast-feeding is concerned, significant differences are appearing between the 3 different socioeconomic groups in each country. In most settings, it is apparent that breast-feeding declines most rapidly among the urban elite group and is most prolonged in the rural traditional populations. The preliminary data corroborate the long-held position that postpartum amenorrhea is more prolonged in breast-feeding than in non-breast-feeding mothers. The breast-feeding development in Sweden is contrasted with that in Guatemala, and marked differences are noted in breast-feeding patterns. It was felt that once the various factors influencing breast-feeding patterns are better understood, the specific action and intervention program suitable to each country and setting could be initiated to improve infant nutrition. The action program thus developed would be more effective and efficient since it would be addressed specifically to the factors influencing breast-feeding and infant feeding in a given area.

A large majority of low birthweight infants are born in developing countries where however, only few follow-up studies have been made. However, there are clear indications that in general the AGA infants catch-up better than the SGA of the same weight. A particularly poor catch-up growth is shown by full-term SGA indicating that if a fetal growth retardations is diagnosed, delivery should be induced prematurely. Social and environmental factors are important for the optimal growth postnatally and particularly so if the environmental conditions are adverse.At this time about 21 million children are born with low birthweight (LBW) below 2500 g corresponding to 17% of all births. 19 million of these LBW or 90% are born in developing countries. Applying 2250 gm instead of 2500 gm as a limit for LBW which many claim would be more nearly defining the high risk for LBW infant would bring the percentage of LBW in South East Asia down to 5 from 10 million infants. The lowest rates in Asia are to be found in East Asia where most countries, in particular China and Japan, have rates comparable to the lowest in Europe. The proportion of full term small for gestational age (SGA) of the LBW varies between 24-57% in developed countries. In Sweden and in the US it is 45%. In Africa it is about the same as in Europe while it is higher in Asia. For example, in India it is 75%. During the past few decades there has been a successively improved prognosis for the LBW. By 1950 the neonatal mortality of infants below 1000 gm was more than 90% and 50-60% of those below 1500 gm developed major handicaps. By now the neonatal mortality of infants below 1000 gm has decreased to 50-60% and for the 1000-1500 gm infants it is only about 15%. Of the survivors only some 10-30% will have major handicaps. An extensive literature reveiw yielding about 350 recent articles concerning the future growth and fate of LBW infants disclosed only a few articles from developing countries with very brief follow-up periods. Most were from the US, Canada, Australia, and a few European countries, mainly England. It is difficult to make a fair comparison between published studies. A few studies with follow-up periods ranging between 3 months and 8 years are reported. On a global basis maternal malnutrition and infections are the most important factors influencing fetal growth. The difference in birth weight between different socioeconomic groups depends to a great extent on these factors. The postnatal growth of any infant is influenced by its nutritional intake and infection rate. In developing countries both these factors are operating negatively on the child and in particular if the infant cannot be breastfed. Breastfeeding is a must for survival both in the short-term and in the longterm perspective. There are clear indications that in general the appropriate for gestational age (AGA) infants catch up better than the SGA of the same weight. A particularly poor catch up growth is shown by full-term SGA indicating that if a fetal growth retardation is diagnosed, delivery should be induced prematurely.

The children of mothers who smoked during pregnancy (n = 1819) and their controls, all born in northern Finland in 1966, were followed up to the age of 14. The children of the smokers were more prone to respiratory diseases than the others. They were also shorter and their mean ability at school poorer than among the controls. The differences remained significant after adjusting for the mother's height and age, social class as determined by the father's occupation, number of older and younger children in the family and the sex of the child. The smoking mothers were found to differ from their controls in each social class, in contrast to the situation at the time of pregnancy, now having on average poorer health, being more often unemployed and having more often left their families. Maternal smoking was still seen to have an effect on the children's physical and mental development, even when these factors were also taken into consideration in the regression analyses, although it was less important than many other socio-biological factors, and it was no more important than paternal smoking.

A reassessment of the breast milk requirements of young babies at different ages has been made from a statistical analysis of energy intake data collected prospectively in Cambridge, U.K. and from data derived from a literature survey of cross-sectional food energy intakes of infants from Canada, Sweden, the U.K. and USA. In contrast to the slow progressive linear decline in energy requirements per kg body-weight that has previously been assumed, measured intakes have been shown to fall more rapidly in the first six months of life. Thereafter they then rise again as the baby becomes more active. These findings are of fundamental importance to a realistic assessment of the adequacy of breast milk as the sole source of food in the first six months of life. The data show that typical breast milk intakes found in the industrialized countries can satisfy infant energy needs for healthy growth for much longer than would be indicated by current international dietary recommendations. A discussion of the physiological interpretation of the results is included as is an appraisal of their practical significance both to breast and bottle feeding practices.

The perinatal mortality in Sweden has been decreasing during the last four decades. From available vital statistics in 1976 Sweden's figures are the lowest internationally. The decline continues and in 1978 the figure was as low as 10.0 per thousand. The five-year period 1973--1977 has been specially analysed using medical birth records from all births. Data from an international perinatal study in 1973 coordinated by WHO have been treated in the same way. With birth weight (BW) specific mortality rates in groups of 250 g it is shown that late fetal deaths (LFD) are related to BW only for high BW and that early neonatal deaths (END) are inversly related to BW. There is no sex difference in LFD but a marked male dominance in END, with one third higher rate for the boys. BW specific mortality rates in BW groups of 250 g, separated in LFD and END can be used as a tool for evaluating the quality of perinatal care. The influence oof factors related to patterns and standards of living is emphasized. It is suggested that perinatal mortality should be given in its two components separately late fetal death rates (LFD) and early neonatal death rates (END).

An investigation was conducted to compare duration of lactation in mothers giving birth to preterm infants vis-a-vis mothers giving birth to healthy full-term infants. A written questionnaire was mailed to all Norwegian women whose preterm infants were admitted to the Neonatal Unit, Department of Pediatrics, Ulleval Hospital over the 1978-80 period. The same questionnaire was mailed to an equal number of Norwegian women who gave birth to healthy full-term infants at the Ulleval Hospital. The control group consisted of the 1st mothers with uncomplicated full-term vaginal deliveries on the same days as the preterm deliveries. There were 155 mothers in each group. There were 100 completed questionnaires from the preterm group and 108 from the full-term group. Significantly more women who gave birth at term were able to breastfeed their infants completely at discharge from the nursery, compared with women who gave birth to preterm infants, whereas more of the preterm mothers partly breastfed their infants. In the preterm group no correlation was found between duration of breastfeeding and the infants' birth weight or between duration of breastfeeding and gestational age. Although a higher potential for breastfeeding existed in the full-term group, a high percentage of the preterm mothers succeeded in breastfeeding. Of the preterm infants, 61% were breastfed (wholly or in part) for 3 months, 45% for 6 months, and 21% for 9 months. The corresponding figures for full-term infants were 83%, 59%, and 38%. The figures for duration of breastfeeding among mothers giving birth to healthy full-term infants in the present investigation were significantly higher than in similar investigations performed during 1976-1977. A high potential for breastfeeding existed in women giving birth to preterm infants referred to the Neonatal Unit. This may be taken as biological evidence for human milk as a physiological basis for nutrition of preterm infants. The separation trauma after admission of a preterm infant to a neonatal care unit does not necessarily impair the mother's ability to breastfeed, and it may be more important that attitudes and practical routines in nurseries and neonatal care units support these women in sustaining lactation.