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Context: The incidence of urinary tract infection (UTI) varies with age, but there is limited evidence on the role of other risk factors. Objective: The aim of this meta-analysis was to investigate the risk factors for UTIs in children. Data sources: PubMed from 1966 to May 2019. Study selection: All studies assessing at least 1 possible risk factor for occurrence or recurrence of UTI with a clear definition of symptomatic UTI in children were eligible. We excluded studies with UTIs related to hospital treatment or severe congenital renal abnormalities. Data extraction: After the quality assessment we extracted data on the given risk factor in children with and without UTI. The data were extracted separately for the occurrence and recurrence of UTIs. Results: We included 24 studies in the meta-analysis. Circumcision decreased the occurrence of UTIs with an odds ratio (OR) of 0.1 [95% confidence interval (CI): 0.06–0.17) and breast-feeding with an OR of 0.4 (CI: 0.19–0.86), both with low heterogeneity. Being overweight or obese increased the risk of UTI (OR: 2.23; CI: 1.37–3.63). Both poor fluid intake (OR: 6.39; CI: 3.07–13.39) and infrequent voiding (OR: 3.54; CI: 1.68–7.46) were associated with recurrent UTIs. Limitations: The design, populations and definitions varied between the studies. Conclusions: Being overweight or obese and having poor fluid intake are modifiable risk factors that increase the risk for UTIs in children. Breast-feeding and circumcision are associated with a decreased occurrence of UTIs.

Introduction: The growth and development of babies are directly linked to breastfeeding, an action that is essential to be done. In 2020 there is concern about this act due to the pandemic by COVID-19. Objective: to describe the recommendations on prevention of transmission related to breastfeeding of mothers with suspected or confirmed COVID-19. Development: Currently, the pandemic caused by the new coronavirus SARS-CoV-2 has its transmission through close contact and without protection from infected individuals through their secretions or excretions, mostly through salivary droplets. When breastfeeding, it is necessary that the mother promotes health prevention, doing the correct hand hygiene, using a mask, disinfecting the bottle, if collecting milk. Conclusion: Breastfeeding at this time of pandemic is not contraindicated, but prevention is necessary. Introdução: O crescimento e desenvolvimento dos bebês estão ligados diretamente a amamentação, ação a qual é imprescindível ser feita. No ano de 2020 existe a preocupação em relação a este ato devido à pandemia pelo COVID-19. Objetivo: descrever as recomendações sobre a prevenção da transmissão relacionadas à amamentação de mães com suspeita ou confirmação de COVID-19. Desenvolvimento: Atualmente a pandemia provocada pelo novo coronavírus SARS-CoV-2 tem a sua transmissão através do contato próximo e sem proteção de indivíduos infectados por meio das suas secreções ou excreções, sendo na sua maioria através de gotículas salivares. Ao amamentar é necessário que a mãe promova a prevenção de saúde, fazendo a higienização correta das mãos, usando máscara, desinfectar o frasco, caso faça coleta do leite. Conclusão: A amamentação neste momento de pandemia não está contraindicada, mas é necessária a prevenção.

Breast-feeding initiation and continuation rates in the UK and Ireland are low relative to many European countries. As a core outcome of the prospective Cork Nutrition and Development Maternal-Infant Cohort (COMBINE) study (Cork, Ireland), we aimed to describe infant milk feeding practices in detail and examine the prevalence and impact of combination feeding of breast milk and infant formula on breast-feeding duration. COMBINE recruited 456 nulliparous mothers (2015–2017) for maternal–infant follow-up via interview at hospital discharge (median 3 (interquartile range (IQR) 2, 4) d (n 453)), 1 (n 418), 2 (n 392), 4 (n 366), 6 (n 362) and 9 (n 345) months of age. Median maternal age was 32 (IQR 29, 34) years, 97 % of mothers were of white ethnicity, 79 % were Irish-born and 75 % were college-educated. Overall, 75 % breastfed to any extent at discharge and 44 % breastfed solely. At 1, 2, 4, 6 and 9 months, respectively, 40, 36, 33, 24 and 19 % breastfed solely. Combination feeding of breast milk and infant formula was common at discharge (31 %) and 1 month (20 %). Reasons for combination feeding at 1 month included perceived/actual hunger (30 %), healthcare professional advice (31 %) and breast-feeding difficulties (13 %). Of mothers who breastfed to any extent at discharge, 45 % stopped within 4 months. Mothers who combination fed were more likely to cease breast-feeding than those who breastfed solely (relative risk 2·3 by 1 month and 12·0 by 2 months). These granular data provide valuable insight to early milk feeding practices and indicate that supporting early breast-feeding without formula use may be key to the successful continuation of breast-feeding.

Background The rates of exclusive breastfeeding at 6 months in Spain are far from recommended by the World Health Organization, which is 50% by 2025. Evidence of the effectiveness of group interventions in late postpartum is limited. The objective of this study was to evaluate the effectiveness of the PROLACT group educational intervention for increasing the proportion of mother-child dyads with exclusive breastfeeding at 6 months compared to the usual practice in primary care. Method Multicentre cluster randomized clinical trial. A total of 434 mother-child dyads who breastfed exclusively in the first 4 weeks of the children’s life and agreed to participate were included. The main outcome was exclusive breastfeeding at 6 months. Secondary variables were type of breastfeeding, reasons for abandonment, degree of adherence and satisfaction with the intervention. To study the effectiveness, the difference in the proportions of dyads with exclusive breastfeeding at 6 months was calculated, and the relative risk (RR) and number needed to treat (NNT) were calculated with their 95% CIs. To study the factors associated with the maintenance of exclusive breastfeeding at 6 months, a multilevel logistic regression model was fitted. All analyses were performed to intention to treat. Results The percentage of dyads with exclusive breastfeeding at 6 months was 22.4% in the intervention group and 8.8% in the control group. PROLACT intervention obtained an RR =2.53 (95% CI: 1.54–4.15) and an NNT = 7 (95%CI: 5–14). The factors associated with exclusive breastfeeding at 6 months were the PROLACT intervention, OR = 3.51 (95%CI: 1.55–7.93); age > 39 years, OR = 2.79 (95%CI: 1.02–7.6); previous breastfeeding experience, OR = 2.61 (95%CI: 1.29–5.29); income between 500 and 833.33 €, OR = 3.52 (95%CI 1.47–8.47).); planning to start work before the infant was 6 months old, OR = 0.35 (0.19–0.63) . Conclusions The PROLACT intervention in primary care is more effective than the usual practice for maintaining exclusive breastfeeding at 6 months, and can therefore be considered evidence-based practice for implementation in standard practice. Trial registration The trial was registered with ClinicalTrials.gov under code number NCT01869920 (03/06/2013).

International audience; Gut microbiota and the central nervous system have parallel developmental windows during pre and post-natal life. Increasing evidences suggest that intestinal dysbiosis in preterm infants predisposes the neonate to adverse neurological outcomes later in life. Understanding the link between gut microbiota colonization and brain development to tailor therapies aimed at optimizing initial colonization and microbiota development are promising strategies to warrant adequate brain development and enhance neurological outcomes in preterm infants. Breast-feeding has been associated with both adequate cognitive development and healthy microbiota in preterms. Infant formula are industrially produced substitutes for infant nutrition that do not completely recapitulate breastfeeding benefices and could be largely improved by the understanding of the role of breast milk components upon gut microbiota. In this review, we will first discuss the nutritional and bioactive component information on breast milk composition and its contribution to the assembly of the neonatal gut microbiota in preterms. We will then discuss the emerging pathways connecting the gut microbiota and brain development. Finally, we will discuss the promising microbiota modulation-based nutritional interventions (including probiotic and prebiotic supplementation of infant formula and maternal nutrition) for improving neurodevelopmental outcomes.

A paucity of evidence is available regarding the impact of diet's quality during pregnancy and lactation on the body composition of breast-feeding mothers. The purpose of the present study was to evaluate the association between maternal degree of adherence to the Mediterranean diet (MD) and body composition measures specifically those relating to body fat, in the lactation period. A cross-sectional study on healthy mothers of full-term babies has been conducted. At 30 ± 10 d after delivery, anthropometric measurements and body composition were assessed. A food frequency questionnaire was performed to compute the Italian Mediterranean Index (IMI) score as an index of adherence to the MD. Data related to pregnancy such as pre-pregnancy weight, gestational weight gain and morbidities were also collected. The 147 mothers included were categorised in IMI-1 (IMI score < 5; n 92) and IMI-2 (IMI score ≥ 5; n 55) groups. IMI-2 mothers showed higher daily energy, total carbohydrates, starch and fibre intakes than IMI-1. The dietary habits of IMI-2 mothers reflect the typical characteristics of MD: they consumed higher quantities of proteins and lipids of vegetal origin, higher amounts of monounsaturated and polyunsaturated fatty acids (PUFAs) and lower saturated to PUFAs ratio. The IMI-2 group showed lower absolute fat mass and fat mass index compared to IMI-1 [(20⋅2 ± 5⋅9) v. (22⋅9 ± 8⋅4) kg; P 0⋅036 and (7⋅5 ± 2⋅2) v. (8⋅5 ± 3⋅1) kg/m2; P 0⋅036, respectively], whereas body weight [(61⋅1 ± 8⋅0) v. (63⋅3 ± 9⋅2) kg] and body mass index [(22⋅4 ± 2⋅6) v. (23⋅3 ± 3⋅5) kg/m2] were similar. The degree of adherence to the MD during pregnancy and lactation is positively associated with lower maternal fat deposition in the breast-feeding period. The higher quality of dietary lipids, probably in synergy with the assumption of starchy carbohydrates and fibre, could influence maternal body fat.

This thematic issue consists of 14 articles derived from studies of the BRISA birth cohort (Ribeirão Preto, State of São Paulo and São Luís, State of Maranhão, northeastern Brazil, a socially and economically less developed region). In these more than 40 years of existence, these cohorts have been able to document the increase in women's education, the improvement of health conditions, the creation of a public Unified Health System (SUS) that provides universal and free access to health care, eradication of hunger, and transition of the nutritional status characterized by a decrease in malnutrition rates and an increase in obesity in Brazil. Particularly in reproductive health, the country experienced a significant drop in fertility, a decrease in maternal and child mortality, and an increase in breastfeeding rates. Universal access to prenatal care and hospital delivery was accompanied by an excessive number of cesareans without clinical indication and early-term births and premature births, largely due to scheduled cesareans. Articles with a longitudinal and transversal methodological approach are presented, using structural equation analysis and propensity score, together with multivariate regressions, which gave a robust analytical treatment to articles in this thematic issue.

Purpose: To analyze the influence of the breastfeeding profile on the occlusal characteristics of the primary dentition in children participating and not participating in an educational-preventive dental program as well as its influence in these aspects. Methods: This cross-sectional study was carried out using a questionnaire filled in by the guardians combined with the examination of the occlusal characteristics of 400 children aged between 27 and 48 months, divided into 2 groups, 200 participants of a preventive dental program, Baby Clinic (BC), and 200 from schools from the city, not participating in a preventive dental program. The questionnaire included retrospective information on duration, type and form of breastfeeding and non-nutritive sucking habits (NNSH). Clinical evaluation of dental occlusion was also performed, using the malocclusion index recommended by the World Health Organization. Data were analyzed using the chi-square test. Results: In both groups, a high percentage of mothers breastfed their children (90% BC; 84.5% schools); high percentage of children had NNSH (64.5% BC; 57.5% schools), as well as a high rate of dental malocclusion (63% BC; 58% schools), the main one being anterior open bite (20.5% BC; 15% schools). In both groups, a lower occurrence of malocclusion was observed in children who were exclusively breastfed for up to six months (29.5% BC; 16.5% schools). Conclusions: our results indicated that children who were breastfed up to 6 months had a lower occurrence of malocclusion compared to those who were weaned early. Objetivo: Analizar la influencia del perfil de lactancia en las características oclusales de la dentición primaria en niños participantes y no participantes de un programa odontológico educativo-preventivo, así como su influencia en estos aspectos. Métodos: Se realizó un estudio transversal usando un cuestionario que fue diligenciado por los tutores combinado con el examen de las características oclusales de 400 niños con edades entre 27 y 48 meses, divididos en 2 grupos, 200 participantes de un programa preventivo en salud bucal, Clínica del Bebe (CB), y 200 de las escuelas de la ciudad, que no participaban de ningún programa de prevención. El cuestionario incluyó información sobre duración, tipo y forma de lactancia materna y hábitos de succión no nutritivos (HSNN). También se realizó evaluación clínica de la oclusión dentaria, utilizando el índice de maloclusión recomendado por la Organización Mundial de la Salud. Los datos se analizaron mediante la prueba de chi-cuadrado. Resultados: En ambos grupos, un alto porcentaje de madres amamantó a sus hijos (90%CB; 84,5% escuelas); alto porcentaje de niños tenían HSNN (64,5%CB; 57,5% escuelas), así como una alta tasa de maloclusión dental (63%CB; 58% escuelas), siendo la principal mordida abierta anterior (20,5%CB; 15% escuelas). En ambos grupos, se observó una menor ocurrencia de maloclusión en los niños que recibieron lactancia materna exclusiva hasta los seis meses (29,5%CB; 16,5% escuelas). Conclusiones: los resultados indicaron que los niños que fueron amamantados hasta los 6 meses tuvieron una menor ocurrencia de maloclusión en comparación con aquellos que lo hicieron por menos tiempo. Objetivo: Analisar a influência do perfil de aleitamento sobre as características oclusais da dentição decídua em crianças participantes e não participantes de um programa odontológico educativo- preventivo, bem como sua influência nesses aspectos. Métodos: Este estudo transversal foi realizado por meio de um questionário preenchido pelos responsáveis ​​combinado com o exame das características oclusais de 400 crianças com idade entre 27 e 48 meses, divididas em 2 grupos, 200 participantes de um programa odontológico preventivo, Bebê Clínica (BC), e 200 de escolas da cidade, não participantes de programa odontológico preventivo. O questionário incluiu informações retrospectivas sobre duração, tipo e forma de aleitamento e hábitos de sucção não nutritiva (HSNN). A avaliação clínica da oclusão dentária também foi realizada, utilizando-se o índice de má oclusão recomendado pela Organização Mundial da Saúde. Os dados foram analisados pelo teste do qui-quadrado. Resultados: Em ambos os grupos, uma alta porcentagem de mães amamentaram seus filhos (90% BC; 84,5% escolas); alto percentual de crianças apresentou HSNN (64,5% BC; 57,5% escolas), assim como uma alta taxa de má oclusão dentária (63% BC; 58% escolas), sendo a principal a mordida aberta anterior (20,5% BC; 15% escolas). Em ambos os grupos, menor ocorrência de má oclusão foi observada em crianças que receberam aleitamento materno exclusivo até os seis meses (29,5% BC; 16,5% escolas). Conclusões: nossos resultados indicaram que crianças que foram amamentadas até 6 meses apresentaram menor ocorrência de má oclusão em comparação com aquelas que tiveram desmame precoce.

Andes virus (ANDV) is the only hantavirus transmitted between humans through close contact. We detected the genome and proteins of ANDV in breast milk cells from an infected mother in Chile who transmitted the virus to her child, suggesting gastrointestinal infection through breast milk as a route of ANDV person-to-person transmission.

Background Vitamin B12 (cobalamin, cbl) deficiency in children is rare and may occurs in exclusively breast fed infants of mothers on vegetarian or vegan diet with lack of appropriate supplementation. The clinical manifestation of vitamin B12 deficiency include neurological disorders, megaloblastic anemia and failure to thrive. Routine and commonly used laboratory tests such as cell blood count (CBC) or serum vitamin B12 level are sufficient for appropriate diagnosis. Typical therapy is based on intramuscular cobalamin injections. Early diagnosis and early onset of treatment are crucial factors for long-term prognosis of patients as the duration of deficiency may be correlated with the development of long lasting changes in the nervous system. The purpose of this article is to present influence of maternal vitamin B12 deficiency as a cause of infant psychomotor retardation. Case presentation We report the case of a 7 months old girl whose parents sought medical advice due to pathological somnolence and developmental regression of their daughter with onset approximately 2 months prior to the visit. Following several diagnostic tests it was determined that the infant’s symptoms were due to vitamin B12 deficiency which was secondary to the mother’s latent Addison-Biermer disease. Apart from neurological symptoms the infant also showed megaloblastic anemia which is typical to cobalamin deficiencies. Intramuscular vitamin B12 supplementation resulted in instant improvement of the patient’s general condition and blood morphology. Unfortunately, psychological examination indicated long-term psychomotor retardation due to delayed diagnosis of B12 deficiency. Conclusions Vitamin B12 levels should be considered during differential diagnosis of neurological symptoms in exclusively breast-fed infants especially if they co-exist with megaloblastic anemia and psychomotor retardation.

Malocclusions are changes in the development of craniofacial structures of high prevalence. Associated risk factors are diverse and nutritional and non-nutritional suction habits are the most reported. The aim of this study was to estimate the prevalence of malocclusions in the mixed dentition and to study possible association with practices of breastfeeding and suction habits among Brazilian schoolchildren. A cross-sectional study involving a sample of 664 6-year-old children and their families was carried out. Data collection was done through interviews with mothers in the homes and oral examinations of children in schools. Multivariate analyses were performed using the Poisson regression with a robust estimator. The prevalence of overjet over 4 mm was 21.1% and of posterior crossbite was 12.2%; 91.9% of the children were breastfed, 79.0% used a nursing bottle and 49.4% used a pacifier. Significant and independent associations were observed between father’s unemployment, private school, interruption of breastfeeding before the fourth month and pacifier use with certain malocclusions. High rates of malocclusion were found in the studied sample. Socioeconomic conditions, breastfeeding practices and suction habits were shown to be statistically associated with their occurrence.

James R Palmieri,1 Susan L Meacham,2 Jenna Warehime,1 Sarah A Stokes,1 Janie Ogle,1 Dezarae Leto,1 Maggie Bax,1 Anca M Dauer,1 Janie Milliron Lozovski1 1Department of Microbiology and Immunology, 2Department of Preventative Medicine and Public Health, Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA Purpose: This study was to investigate weaning practices used by mothers when transitioning infants from breast milk to complementary foods and to determine the role these foods have in the transmission of gastrointestinal parasites. Participants and methods: On average, of the 175 mothers extensively interviewed, 93% said they had breast-fed their infants. Approximately 20.8% of mothers had added some other liquid to their infant’s diet at 3 months, while most mothers had added other liquids at 6 months (39.0%) and >6 months (32.1%). Some mothers expanded food offerings to infants before 3 months. The percentage of mothers who had added other liquids to their infants’ diet was reported by age of the infant: as early as 1 day (2.5%), 6 months (32.1%). These foods included fruit, vegetables, meat, and grains. The maximum age a child was found to be still breastfeeding was 13 years. Results: Forty percent of mothers involved in this survey reported that their children were diagnosed and/or treated for gastrointestinal parasitic infection. Routes of infection of protozoan and helminth parasites likely resulted from contaminated complementary foods and water given to infants while still breast-feeding or from contaminated foods after breast-feeding had been completed. Contaminated water is a likely source of protozoan parasites. Contaminated water was fed to infants, mixed with formula or complementary foods, or used to wash bottles for infant feeding. There was an absence of hand-washing by children and mothers before eating or while preparing foods. Conclusion: The major source of soil-transmitted helminth infections was likely the result of unwashed or uncooked pureed fruit or vegetables used as complementary foods, unpasteurized animal milk, insanitary food storage, poor living conditions with exposed dirt floors, and exposure to roaming domestic animals. Keywords: breast-feeding, complementary foods, gastrointestinal parasites, Honduras, transition foods, weaning period

Objectives: To study micronutrient status and nutritional intake from complementary feeding in children on a cows’ milk exclusion (CME) diet. Methods: Fifty-seven children with cows’ milk allergy, younger than 2 years, were included in a cross-sectional study. Blood was analyzed for micronutrient status. Complementary feeding was defined as all solids and liquids except of breast milk, and assessed by 3-day food diary. The results were analyzed according to 3 feeding patterns: mainly breast-fed (mBF), partially breast-fed, and no breast milk group (nBM). Results: The children had a median age of 9 months and micronutrient status was within normal range for total homocysteine (p-tHcy), s-B12, s-folate, b-Hb, s-ferritin, s-zinc, and s-25(OH)D. There were no significant differences between feedings groups, except for B12-biomarkers. The mBF had higher p-tHcy (P 6.5 μmol/L combined with s-B12

The aim of the research is to study the state of emotional-volitional function in infants, who were born and living in Lugansk and Donetsk during the military conflict. A dynamic clinical examination was made with the assessment of the rate of emotional-volitional development in 68 children in the area of military conflict. Among them 32 children were breast-fed, forming Ia (the main) group of children, and 36 children were bottle-fed, forming Ib (the comparison group). The second (control) group of our study consisted of 88 children, who were outside the area of military conflict. Among them there were 47 children, who were breast-fed (IIa group), and 41 children, who were bottle-fed (IIb group). The assessment of the level of emotional-volitional development in children was carried out using a standardized clinical-psychological technique called “Gnome”. Results: The level of development of emotional-volitional function in children depends on the type of feeding and the environment. Despite the stressful situation the mother’s milk and physical contact with the mother contributed to higher levels of emotional and volitional development compared to the comparison group of children. But the stress of the war still promoted inhibition of emotional and volitional development, compared with children, who had similar feeding, staying in a peaceful environment.

This is the protocol for a scoping review that aims to systematically explore and summarise the published evidence of violations of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent World Health Assembly Resolutions globally. The planned scoping review will seek to identify what research has been conducted on the topic, examine the geographic spread and nature of violations, and summarise knowledge gaps. The Code was adopted in 1981 by the World Health Assembly to protect infant health, in particular from aggressive and inappropriate marketing of breastmilk substitutes including formula and related products. Non-compliance with the Code or violations are described in reports, however, no existing systematic review of the global research appears to have been conducted that encompasses the varied disciplines including health, economics, and gender. The review will inform international and national decision-makers on the nature of violations and potentially highlight the need for new modalities to regulate this marketing. The proposed scoping review will use the six-step process of Arksey and O’Malley which includes defining the research question; identifying the relevant literature; selecting studies; charting the data; collating, summarising and reporting the findings; and will include a consultative group.

Objective: This study assessed the factors affecting the choice of type of delivery with breast feeding in Iranian mothers. Methods: This Cross section descriptive analytic study was performed using a random sampling technique, using data from 400 pregnant women who attended the maternity centers in Borazjan and Kazerun in Iran in 2014. A questionnaire covering demographic characteristics, mode of delivery and postpartum conditions was completed for each mother. Descriptive analysis and Chi square test were used along with SPSS 23 software to statistically analyze the data and p-value less than 0.05 was considered for statistical significance. Results: In this study, the rate of normal delivery and cesarean operation are considered equal. In the main factors influencing the choice of delivery, mothers’ education level (p=0.028) and pregnancy status (p=0.041) showed a significant relationship. Although no significant association between child nutrition with the type of delivery was found, duration of breastfeeding with the type of delivery showed significant association (p=0.046). Conclusion: Although cesarean delivery in many cases is life-saving for mother and fetus; in addition to medical indications, parents with higher education and pregnancy status are also important factors in increasing the rate of cesarean section compared to vaginal delivery. Babies of mothers with normal delivery had a longer time of breastfeeding. Further studies in Iran are necessary, regarding the reasons for high cesarean section and their outcomes.

Resumo: Este artigo aborda os discursos da atual Política Nacional de Aleitamento Materno brasileira, enfocando sentidos pouco explorados em seus materiais educativos. As perspectivas teórico-metodológicas adotadas foram a Semiologia dos Discursos Sociais, que entende o discurso como constitutivo e constituinte das relações sociais de poder, e os Estudos de Gênero, que questionam a naturalização da dualidade feminino/masculino como estruturante de uma essência fixa do ser. A análise identificou como, em geral, os materiais continuam a enfatizar a importância do aleitamento materno para a saúde da criança, omitindo ou tratando de forma estereotipada as perspectivas das mulheres sobre a prática. A complexidade da amamentação é pouco abordada, e o desmame como transição subjetiva na relação entre mãe, criança e mundo social, silenciado. Abstract: This article approaches the discourses of the national policy on breastfeeding in Brazil today, emphasizing underexplored meanings in its educational materials. The theoretical and methodological perspectives adopted were the Semiology of Social Discourses, which understands discourse as a constitutive/constituent of social power relations, and Gender Studies, and its questioning of the naturalization of the binary female/male division as structural to a fixed essence of beings. The analysis identified how materials continue to emphasize the importance of breastfeeding for children’s health, omitting or treating stereotypically women's perspectives on the practice. The complexity of breastfeeding is seldom addressed, and weaning as a subjective transition in the mother-child relationship and their social world is ignored.

The aim of the research is to study the state of behavioral function in infants who were born and living in the Lugansk and donetsk during the military conflict. A dynamic clinical examina- tion was made. Also it was made the assessment of the rate of behavioral development in 68 children in the area of military conflict. Among them 32 children were breast-fed, forming Ia (the main) group of children, and 36 children who were bottle-fed, forming the comparison group Ib. The control groups of our study consist of 88 children who were outside the zone of military conflict. Among them there were 47 children who were breast-fed (IIa group), and 41 children who were bottle-fed (IIb group). The assessment of the level of behavioral function development in children was carried out using a standard- ized clinical-psychological techniques "Gnome".Conclusions: The development of behavioral functions in infants and toddlers depends on the sur- rounding stressful conditions and the type of feeding. The level of formation of these functions in chil- dren who were bottle-fed and under stress of war was the lowest. The greatest delay in children of this group were the indicators of social development. From biological indicators much more suffered the functions associated with eating behavior. Children who were bottle-fed in the stress of military actions in infancy and early childhood are in need of rehabilitation activities.

The frequency of definitive childlessness in women with multiple sclerosis (MS) may be higher than in the general population. MS may also affect decisions on the delivery procedure and on breast-feeding issues. Aim of the study was to assess the frequency of childlessness and its possible causes, the proportion of cesarean deliveries (CD), and the frequency of breast-feeding in patients and controls who have reached the end of their reproductive period. Female MS patients (>43 years) and controls (>45 years) filled out a questionnaire. We enrolled 303 patients and 500 controls. MS was associated with a higher frequency of childlessness (22 vs 13%) and less patients were in a stable relationship (83 vs 89%). There was no difference in the reported rates of infertility and miscarriages, while elective abortions were more frequent in patients (20 vs 12%). MS did not significantly affect the frequency of CD or of breast-feeding. MS-related reasons for childlessness, reported by 16% of childless patients, included disability/fear of future disability, fear of genetically transmitting MS, fear of not starting/discontinuing treatments, and discouragement by physician. Definitive childlessness is more frequent in women with MS compared to controls. A portion of voluntary childlessness may be avoided through correct/tailored information to patients.

The article presents updated recommendations of the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists, which discuss period, content and methods of complementary food in healthy full-term European children. The main positions on the period of introduction of various complementary food, including the main allergen-containing foods (gluten, egg, fish, cow’s milk, etc.) are presented. We discuss the main conclusions of international studies on the introduction of complementary foods and its association with the development of allergic diseases. Updated recommendations, regarding period of introduction of gluten in infants and risk of developing celiac disease in childhood, are presented. Different methods of feeding are compared.

The infant’s gut microbiome is generally rich in the Bifidobacterium genus. The mother’s milk contains natural prebiotics, called human milk oligosaccharides (HMOs), as the third most abundant solid component after lactose and lipids, and of the different gut microbes, infant gut-associated bifidobacteria are the most efficient in assimilating HMOs. Indeed, the fecal concentration of HMOs was found to be negatively correlated with the fecal abundance of Bifidobacterium in infants. Given these results, two HMO molecules, 2′-fucosyllactose and lacto-N-neotetraose, have recently been industrialized to fortify formula milk. As of now, however, our knowledge about the HMO consumption pathways in infant gut-associated bifidobacteria is still incomplete. The recent studies indicate that HMO assimilation abilities significantly vary among different Bifidobacterium species and strains. Therefore, to truly maximize the effects of prebiotic and probiotic supplementation in commercialized formula, we need to understand HMO consumption behaviors of bifidobacteria in more detail. In this review, we summarized how different Bifidobacterium species/strains are equipped with varied gene sets required for HMO assimilation. We then examined the correlation between the abundance of the HMO-related genes and bifidobacteria-rich microbiota formation in the infant gut through data mining analysis of a deposited fecal microbiome shotgun sequencing dataset. Finally, we shortly described future perspectives on HMO-related studies.

The aim of this study was to assess the economic benefits of improved cognitive development related to being breast-fed. Breast-feeding rates were assessed in the Avon Longitudinal Study of Parents and Children. Educational attainment was assessed at age 16 years with higher attainment defined as gaining five General Certificate of Secondary Education (GCSE) passes at a high grade. The economic benefit of being breast-fed was calculated in a decision model using a child’s educational attainment and the corresponding expected value of average income in later life. There was a positive association between being breast-fed and achieving higher educational attainment, which remained significant, after adjustment for possible confounders: being breast-fed £33·6 million over the working life of the cohort. Therefore, breast-feeding promotion is likely to be highly cost-effective and policymakers should take this into consideration.

Fabian-Danielewska Anna, Korabiusz Katarzyna, Wawryków Agata, Stecko Monika, Janik-Fuks Inga, Maciejewska Martyna, Grudzińska Ewa, Gibka Magdalena. Nutrition of healthy infants. Journal of Education, Health and Sport. 2019;9(7):299-302. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3337389 http://ojs.ukw.edu.pl/index.php/johs/article/view/7142 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 20.06.2019. Revised: 25.06.2019. Accepted: 16.07.2019. Nutrition of healthy infants Anna Fabian-Danielewska1, Katarzyna Korabiusz2, Agata Wawryków2, MonikaStecko2, Inga Janik-Fuks2, Martyna Maciejewska2, Ewa Grudzińska1, Magdalena Gibka1 1. Pomeranian Medical University in Szczecin, PhD study at the Faculty of Medicine 2. Pomeranian Medical University in Szczecin, PhD Studies at the Faculty of Health Sciences Abstract The daily energy requirement of infants depends on age, sex and body weight. Breastfeeding is the most appropriate way to feed babies in the first 6 months of their lives. According to WHO recommendations, one should aim for exclusive breast-feeding for the first 6 months of your child's life. After 6 months, the baby's diet should be extended, continuing breastfeeding. It is recommended to continue feeding with the mother's milk, according to the WHO, until the second year of life, and according to AAP up to 12 months, with the simultaneous introduction of supplementary foods. When, for various reasons, it is not possible to feed the infant with mother's milk, the products substituting for female milk are used. Infant formula is intended for children under 6 months of age and fully satisfies the nutritional needs of an infant. Complementary Feeding should be started between 17 and 26 weeks of age. Key words: nutrition, breast-feeding, infant formula, complementary feeding

The purpose of this study is to evaluate the association between blood pressure (BP) at 7-13 years of age and body mass index (BMI), early feeding, lifestyle indicators, and parental characteristics.Retrospective plus cross-sectional cohort study was started in 1294 children born in 2000-2004, right from their birth in primary care settings. Early feeding was estimated by measuring breast-feeding (BF) duration, complementary feeding (CF) introduction time, and lifestyle indicators such as daily screen time and weekly extracurricular sports activity time. Parental education, smoking, and obesity-related diseases were also considered. Multivariable linear regression and mediation analysis were used. CF introduction at 5-6 months of age was a negative predictor of systolic and diastolic BP (mean systolic BP-standard deviation score (SDS) -0.38 [95% CI: -0.47, -0.29] (p 0.001); mean diastolic BP-SDS -0.32 [95% CI: -0.40, -0.24]) (p 0.001); BMI was a positive predictor of systolic and diastolic BP (p 0.001); and parental hypertension was a positive predictor of diastolic BP (p 0.05). Predictors of mean BMI-SDS at 7-13 years of age were birth weight, screen time, and parental obesity and smoking (p 0.001). BF had no effect on BP or BMI. Mediation analysis showed virtually no indication of the effect of CF on BP mediated by BMI.CF introduction between 5 and 6 months of age could be associated with low BP at 7-13 years. The effect of CF on BP seems to be independent of BMI. Low screen time is associated with low BMI. CF time may play a role in the occurrence of surrogates of noncommunicable disorders in future.

Background : Provision of breast milk (ASI) is important because it lowers the risk of morbidity and mortality in infants. Breast milk is the ideal food for a baby's growth and development from birth to age 6 months. Thus, the appropriate interventions to improve the behavior of exclusive breastfeeding is really needed. Aim : To determine the effect of education lactation on behavior breastfeeding for infants 0-6 months. Methods : This was Quasy Experiment study with pre-test and post-test design with control group. Samples mother (gestational age ≥28-32 weeks) were divided into 3 groups: 1) those who received education lactation and a modification module (n = 21), 2) a group that only received a modification module (n = 21) and 3) a group that only received the MCH book (n = 20). Data were collected using a questionnaire, the implementation of the pre-test before starting lactation education, the first post-test after the intervention with a lag time of 2 months and the second post-test after the intervention with a lag time of 3 months. Results : There had been an increase of knowledge and attitude scores in each group and the highest in the group 1. At the age of 0-3 months, there was a difference in breastfeeding in all groups. In the sixth month, there was a change in group 2, while group 3 had no change, but some mothers given partially breastfed and formula. The tendency of increasing age of the baby causes mothers to give formula milk, but in group 1, majority of women still gave exclusive breastfeeding until the baby 6 months old. It was shown that there was an influence of lactation education on behavior of breastfeeding infants 0-6 months. Conclusion : Education lactation can improve knowledge, attitudes and behavior of mother to give breastfeeding up to 6 months.

The authors raise the question of the role of goat milk in the nutrition of infants. The properties of goat milk and its difference from cow milk are discussed. Indications for goat milk infant formula are defined. The authors demonstrate examples of administration of goat milk formula from their own practice.

Background Early reports of COVID‐19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding, is this practise justified? Objective To estimate the risk of the neonate becoming infected with SARS‐COV‐2 by mode of delivery, type of infant feeding and mother‐infant interaction Search Strategy Two biomedical databases were searched between September 2019 ‐ June 2020. Selection Criteria Case reports or case series of pregnant women with confirmed COVID‐19, where neonatal outcomes were reported. Data Collection and Analysis Data was extracted on mode of delivery, infant infection status, infant feeding and mother‐infant interaction. For reported infant infection a critical analysis was performed to evaluate the likelihood of vertical transmission. Main Results We included 49 studies which included 666 neonates and 655 women where information was provided on the mode of delivery and the infant’s infection status. 28/666 (4%) neonates had confirmed COVID‐19 infection postnatally. Of the 291 women who delivered vaginally, 8/292 (2.7%) neonates were positive. Of the 364 women who had a Caesarean birth, 20/374 (5.3%) neonates were positive. Of the 28 neonates with confirmed COVID‐19 infection, 7 were breast fed, 3 formula fed, 1 was given expressed breast milk and in 17 neonates the method of infant feeding was not reported. Conclusions Neonatal COVID‐19 infection is uncommon, uncommonly symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or allowed contact with the mother.

International audience; Background: Successful prevention of food allergy requires the identification of the factors adversely affecting the capacity to develop oral tolerance to food antigen in early life. Objectives: This study sought to determine whether oral exposure to Dermatophagoides pteronyssinus through breast milk affects gut mucosal immunity with long-term effects on IgE-mediated food allergy susceptibility. Methods: Gut immunity was explored in 2-week-old mice breast-fed by mothers exposed to D pteronyssinus, protease-inactivated D pteronyssinus, or to PBS during lactation. We further analyzed oral tolerance to a bystander food allergen, ovalbumin (OVA). In a proof-of-concept study, Der p 1 and OVA levels were determined in 100 human breast milk samples and the association with prevalence of IgE-mediated egg allergy at 1 year was assessed. Results: Increased permeability, IL-33 levels, type 2 innate lymphoid cell activation, and TH2 cell differentiation were found in gut mucosa of mice nursed by mothers exposed to D pteronyssinus compared with PBS. This pro-TH2 gut mucosal environment inhibited the induction of antigen-specific FoxP3 regulatory T cells and the prevention of food allergy by OVA exposure through breast milk. In contrast, protease-inactivated D pteronyssinus had no effect on offspring gut mucosal immunity. Based on the presence of Der p 1 and/or OVA in human breast milk, we identified groups of lactating mothers, which mirror the ones found in mice to be responsible for different egg allergy risk. Conclusions: This study highlights an unpredicted potential risk factor for the development of food allergy, that is, D pteronyssinus allergens in breast milk, which disrupt gut immune homeostasis and prevents oral tolerance induction to bystander food antigen through their protease activity. © 2020 American Academy of Allergy, Asthma & Immunology

Breast milk long-chain PUFA (LCPUFA) have been associated with changes in early life immune responses and may modulate T-cell function in infancy. We studied the effect of maternal fatty acid desaturase (FADS) genotype and breast milk LCPUFA levels on infants’ blood T-cell profiles and ex vivo-produced cytokines after anti-CD3/CD28 stimulation of peripheral blood mononuclear cells in 6-month-old infants from the Copenhagen Prospective Study of Asthma in Childhood birth cohort. LCPUFA concentrations of breast milk were assessed at 4 weeks of age, and FADS SNP were determined in both mothers and infants (n 109). In general, breast milk arachidonic acid (AA) levels were inversely correlated with the production of IL-10 (r −0·25; P=0·004), IL-17 (r −0·24; P=0·005), IL-5 (r −0·21; P=0·014) and IL-13 (r −0·17; P=0·047), whereas EPA was positively correlated with the counts of blood regulatory T-cells and cytotoxic T-cells and decreased T-helper cell counts. The minor FADS alleles were associated with lower breast milk AA and EPA, and infants of mothers carrying the minor allele of FADS SNP rs174556 had higher production of IL-10 (r −0·23; P=0·018), IL-17 (r −0·25; P=0·009) and IL-5 (r −0·21; P=0·038) from ex vivo-activated immune cells. We observed no association between T-cell distribution and maternal or infant FADS gene variants. We conclude that increased maternal LCPUFA synthesis and breast milk AA are associated with decreased levels of IL-5, IL-13 (type-2 related), IL-17 (type-17 related) and IL-10 (regulatory immune responses), but not with interferon-γ and TNF-α, which could be due to an effect of the maternal FADS variants on the offspring immune response transferred via breast milk LCPUFA.

In this case-control study the association between the approaches used to feed infants, together with known family and environmental factors, and the occurrence of atopic illness in toddlers between the ages of 4 months to 3 years in Hong Kong was examined. A total of 206 subjects were recruited from April to June of 2014. The results obtained by binary logistic regression indicated that atopy is associated with boys (OR 2.072, CI 1.089–3.941), the maternal use of antibiotics in utero or while breast feeding (OR 2.276, CI 1.151–4.504), the later commencement of mixed feeding (OR 2.497, CI 1.025–6.082), breast feeding exclusively for 3 months (OR 1.972, CI 1.009–3.857), and having a mother who was diagnosed with eczema (OR 4.510, CI 1.764–11.530). Although an exclusive reliance on breast feeding has been shown to be predictive of atopy among toddlers, the positive qualities of breast milk cannot be ignored. A further study of the contents and nutritional values of breast milk is warranted.

ObjectiveTo determine current status, areas for improvement and effect of conflict on infant and young child feeding (IYCF) practices among internally displaced persons (IDP) in eastern Ukraine.DesignCross-sectional household survey, June 2015.SettingKharkiv, Dnipropetrovsk and Zaporizhia oblasts (Ukrainian administrative divisions) bordering conflict area in Ukraine.SubjectsRandomly selected IDP households with children aged ResultsExclusive breast-feeding prevalence for infants aged PConclusionsTo mitigate the effects of conflict and improve child health, humanitarian action is needed focused on helping mothers cope with stress related to conflict and displacement while supporting women to adhere to recommended IYCF practices if possible and providing appropriate support to women when adherence is not feasible.

ObjectiveTo assess the prevalence and sociodemographic determinants of breast-feeding (BF) and exclusive breast-feeding (EBF) in Cyprus up to the sixth month.DesignCross-sectional and longitudinal descriptive study. BF and EBF were estimated based on mothers’ self-reported BF status in line with Step 7 of the WHO/UNICEF Baby-Friendly Hospital Initiative questionnaire and based on 24 h recall.SettingMaternity wards in all public hospitals and twenty-nine (of thirty-five) private maternity clinics nationwide.SubjectsConsecutive sample of 586 mothers recruited within 48 h from birth, followed up by telephone interview at the first, fourth and sixth month.ResultsAlthough 84·3 % of mothers initiated BF before discharge, prevalence of BF at the sixth month was 32·4 %, with the highest reduction observed between the first and fourth months. Prevalence of EBF at 48 h was 18·8 % and fell gradually to 5·0 % at the sixth month. Mothers with higher educational attainment or higher family income were more likely to breast-feed until the sixth month. In terms of EBF, an association was observed only with education, which persisted until the sixth month. Other than social gradient, mode of delivery was the strongest determinant of BF initiation, exclusivity and continuation. Mothers who gave birth vaginally were three to four times more likely to initiate BF (OR=3·1; 95 % CI 1·7, 5·4) and EBF (OR=4·3; 95 % CI 2·7, 6·8).ConclusionsThe low prevalence of BF and EBF in Cyprus, together with the fact that caesarean section rates are currently among the highest in Europe, suggest the need for further research to understand this multidimensional phenomenon and for interdisciplinary policy action to protect, promote and support BF.

Nutrition of the child is an important factor and plays a fundamental role in its normal physical and psychomotor development. In order to study the feeding habits of infants who are breastfed, a random sample was conducted by questioning 285 mothers who had children between the ages of one and a year and a half and 115 district paediatricians in St. Petersburg. The study showed that most mothers receive individual recommendations from their district paediatrician on the nutrition of the child. Most mothers start luring at the recommended time, listening to the advice of doctors. However, some mothers are not sufficiently aware of the timing of the introduction of individual foods in their child's diet and introduce them to previously recommended terms. When choosing products that are used to feed children, most mothers are primarily guided by the advice of the doctor and the quality of the products., {"references":["Yuryev, V. K., & Yuryeva, V. V. (2010). The existing breastfeeding support system and its appraisal by women and physicians. Rossiyskiy pediatricheskiy zhurnal, (4), 48-53. (in Russian)","Yuriyeva, V. V. (2009). Status and ways of optimization of modern system of support of breastfeeding (on an example of St.-Petersburg): autoref. M.D. Dis. St. Petersburg, 2009, 22. (in Russian)","Sokolova, V. V. (2017). Particular results of investigation for parents satisfaction of treatment in hospital department. Vrach-aspirant, 81, 2.2, 286-294. (in Russian)","Kirilenko, V. V. (2015). Problems of the development of health care facilities in Russia. Nauchno-obrazovatelnyi tsentr Tekhnologii tovarovedcheskoy, ta-mozhennoy i kriminalisticheskoy ekspertizy: sb. nauch. rab. Ed. by G. D. Drozdov. St. Petersburg, SpbGE, 301-303. (in Russian)","Kirilenko, V. V. (2012). Formation of development of public-private partnership in public health services in Russia. Innovatsionnyye tekhnologii v servise: materialy III Mezhdunarodnoi nauchno-prakticheskoi konferentsii. St. Petersburg, Sankt-Peterburgskii gosudarstvennyi universitet servisa i ekonomiki, 187-189. (in Russian)","Alekseyeva, A. V., Khromtsova, Yu. A., & Shakmayeva, M. A. (2017). Self-medication in children, as a medical and social problem. Territoriya innovatsiy, (6), 121-128. (in Russian)","Kharicheva, A. A., Bazhenova, O. V., & Alekseyeva, A. V. (2017). Medico-social characteristics of patients with neurological diseases. Fundamentalnyye i akademicheskiye prikladnyye issledovaniya: materialy I Mezhdunar. nauch.-prakt. interdistsiplinarnoy konf. 302-311. (in Russian)","Baskakov, V. S., Kuchumova, N. G., Vitenko, N. V., & al. (2010). The results of a subjective assessment of the activities of hospital medical personnel. Problemy gorodskogo zdravokhraneniya: sb. nauch. tr. St. Petersburg, VVM, (15), 169-170. (in Russian)","Zaslavskii, D. V., Kharbediya, Sh. D., Khvedelidze, M. G., & al. Results of patients' assessment of medical personnel. Novyye gorizonty: innovatsii i sotrudnichestvo v meditsine i zdravookhranenii: materialy IX rossiysko-nemetskoi nauch.-prakt. konf. foruma im. R. Kokha i I. I. Mechnikova. Eds. O.V. Kravchenko, G. Khan. Novosibirsk, Sibirskii Tsentr Delovykh Tekhnologiy, 28-29. (in Russian)","Yuriyev, V. K., Artamonov, K. V., Kharbediya, Sh. D., & al. (2010). Some results of quality assessment of inpatient treatment of syphilis patients. Obshchestvennoye zdoroviye: pravovyye, ekonomicheskiye i organizatsionnyye aspekty modernizatsii zdravookhraneniya RF: materialy II mezhdunar. nauch.-prakt. konf. Novosibirsk, Sibmedizdat, NGMU, 705-707. (in Russian)","Yuriev, V. K., Zaslavskii, D. V., Vitenko, N. V., Artamonov, K. V., Isenov, S. K., Kharbediya, Sh. D., & Kuchumova, N. G. (2010). Some results of patients' assessment of the quality of care. Uchenyye zapiski SPbGMU im. akad. I. P. Pavlova, 17, (2), 5-7. (in Russian)","Medik, V. A., Yuriyev, V. K. (2008). Public health and health care. Moscow, Akademkniga, 223. (in Russian)","Blinov, Ye. F., & Kirilenko, V. V. (2012). Social responsibility and motivation of personnel in social organizations. St. Petersburg, Sankt-Peterburgskii gosudarstvennyi universitet servisa i ekonomiki, 19. (in Russian)","Kharbediya, Sh. D., & Sergiyenko, A. A., Kerimova, F. R. (2017). Assessment of patients' satisfaction with inpatient health care in rural healthcare facilities. Territoriya innovatsiy, (4). 112-117. (in Russian)"]}

ObjectiveTo determine the prevalence and factors associated with stunting in 6-month-old South African infants.DesignThis cross-sectional study was part of the baseline of a randomized controlled trial. Weight-for-length, length-for-age and weight-for-ageZ-scores were based on the WHO classification. Blood samples were analysed for Hb, plasma ferritin and soluble transferrin receptor (sTfR). Socio-economic, breast-feeding and complementary feeding practices were assessed by questionnaire.Setting/SubjectsInfants aged 6 months (n750) from a peri-urban area of Matlosana Municipality, North West Province of South Africa.ResultsStunting, underweight, wasting and overweight affected 28·5, 11·1, 1·7 and 10·1 % of infants, respectively. Exclusive breast-feeding to 6 months of age was reported in 5·9 % of the infants. Multivariable binary logistic regression showed that birth weight (OR=0·12; 95 % CI 0·07, 0·21,PP=0·001) were inversely associated with stunting; while male sex (OR=1·73; 95 % CI 1·10, 2·70,P=0·014) was associated with higher odds for stunting. Stunting was also associated with higher plasma sTfR (>8·3 mg/l) concentrations.ConclusionsThe association between stunting and lower birth weight, shorter maternal height and male sex reflects possibly the intergenerational origins of stunting. Therefore, interventions that focus on improving preconceptual and maternal nutritional status, combined with strategies to promote appropriate infant feeding practices, may be an important strategy to prevent stunting in vulnerable settings.

Нейротоксичность нередкое явление при применении лекарственных средств многих терапевтических классов. Проявления нейротоксичности варьируют от ототоксичности, висцеральной нейропатии и нейромышечной блокады (поражение периферической нервной системы) до нарушения сознания, неспецифической энцефалопатии, судорог и неконвульсивного эпилептического статуса (поражение центральной нервной системы). В статье приведены предрасполагающие факторы нейротоксичности, а также механизмы её развития. На примере нейроактивных лекарств (антиконвульсанты, анестетики и психотропные средства) рассмотрено их воздействие в антенатальном периоде и во время кормления грудью. В постнеонатальном периоде заметную роль в оказании нейротоксического эффекта играют антибиотики, в частности ß-лактамы и фторхинолоны.Neurotoxicity is not uncommon in use of the drugs in many therapeutic classes. Manifestations of neurotoxicity vary from ototoxicity, visceral neuropathy and neuromuscular blockade (defeat of the peripheral nervous system) to impaired consciousness, nonspecific encephalopathy, seizures and non-convulsive epileptic status (central nervous system damage). The article presents predisposing factors of neurotoxicity, as well as the mechanisms of its development. On the example of neuroactive drugs (anticonvulsants, anesthetics and psychotropic drugs) their effect in the antenatal period and during lactation is examined. In the post-neonatal period antibiotics play an important role in the neurotoxic effect, in particular, ß-lactams and fluoroquinolones.

Objetivo verificar e caracterizar os requisitos para efetiva participação dos Agentes Comunitários de Saúde (ACS) em ambientes virtuais de aprendizagem, utilizando o tema “amamentação”;. Métodos participaram do estudo 49 ACS do município de Monte Negro-RO; após 45 dias, durante os quais o processo foi monitorado, ocorreu uma videoconferência para coletar depoimentos sobre o acesso e conteúdo. Foi utilizada a Análise do Discurso do Sujeito Coletivo para identificar dificuldades/facilidades/sugestões/proposições dos participantes, considerando três categorias: (a) Desejo de adquirir conhecimentos; (b) Consecução do estudo e (c) Avaliação da formação do profissional e do conteúdo. Resultados oito ACS (15,69%) acessaram o cybertutor em tempo hábil; destes 100% cursou o módulo introdutório completo; 62,5% os módulos 2 e 3; 37,5% os módulos de 4 à 8. Para a Categoria (a) oito ACS relataram que estiveram motivados no uso do cybertutor, visto ser um meio para reforçar e adquirir novos conhecimentos. Quanto à Categoria (b), as maiores dificuldades descritas foram a falta de conhecimento da informática, de recursos materiais e financeiros, além de tempo disponível. Na Categoria (c) referiram ter obtido novos conhecimentos que puderam levar para a população imediatamente e o desejo de ter outras experiências semelhantes. Conclusão os requisitos necessários para ministrar cursos a distância aos ACS implicam a viabilização de recursos pelos gestores locais, conhecimentos prévios de informática básica, acesso à Internet, computadores disponíveis em locais apropriados, assim como outros aspectos como disponibilizar tempo em horário de trabalho e/ou extra, e temas desafiadores para efetivar a educação continuada à distância. Purpose to verify and to feature the conditions of the effective participation of community health workers (CHW) in virtual learning environment with topic “breast-feeding”;. Methods participated in the study 49 CHW from Rondônia, and after 45 days, in wich all the process was monitored, occurred a videoconference to take testimonials about the access and content. It was used the Collective Subject Discurse to identify difficulties/easiness/suggestions/ proposals of wich were extracted three categories: (a) Willing to obtain knowledge; (b) Conditions to the achieving of the study; and (c) Assesment of professional education and the content. Results 8 CHW (15.69%) accessed the cybertutor in correct time; 100% folowed the introductory module complete; 62.50% the modulus 2 and 3; 37.50% the modulus 4 at 8. For the Category (a) 8 CHW reported were motivated in using cybertutor, since it is a way to reinforce and acquire new knowledge. As to Category (b) the main difficulties were described as lack of knowledge on technology, material and financial resources and time availabilities. In Category (c) it was reported having obtained new knowledge that could be passed immediately to population and the desire to have similar experiences. Conclusion the requeriments for the distance courses for CHW imply the viability of resources by local administrators, prior knowledge of basic computer, Internet access, computers availables in appropriate sites, well as others aspects such, to time available during working hours and/or extra time and challenging themes to make effect continuing distance education.

The infant’s gut microbiome is generally rich in the Bifidobacterium genus. The mother’s milk contains natural prebiotics, called human milk oligosaccharides (HMOs), as the third most abundant solid component after lactose and lipids, and of the different gut microbes, infant gut-associated bifidobacteria are the most efficient in assimilating HMOs. Indeed, the fecal concentration of HMOs was found to be negatively correlated with the fecal abundance of Bifidobacterium in infants. Given these results, two HMO molecules, 2′-fucosyllactose and lacto-N-neotetraose, have recently been industrialized to fortify formula milk. As of now, however, our knowledge about the HMO consumption pathways in infant gut-associated bifidobacteria is still incomplete. The recent studies indicate that HMO assimilation abilities significantly vary among different Bifidobacterium species and strains. Therefore, to truly maximize the effects of prebiotic and probiotic supplementation in commercialized formula, we need to understand HMO consumption behaviors of bifidobacteria in more detail. In this review, we summarized how different Bifidobacterium species/strains are equipped with varied gene sets required for HMO assimilation. We then examined the correlation between the abundance of the HMO-related genes and bifidobacteria-rich microbiota formation in the infant gut through data mining analysis of a deposited fecal microbiome shotgun sequencing dataset. Finally, we shortly described future perspectives on HMO-related studies.

In a cross-sectional study on 433 schoolchildren (aged 6&ndash, 9 years) from 9 schools in Austria, we observed associations between housing factors like passive smoking and lung function as well as improved lung function in children who had been breast-fed. The latter findings urged the question of whether the protective effects of breast-feeding act on environmental stressors or if they act independently. Therefore, the effect of passive smoking on lung function was stratified by breast-feeding. The detrimental effects of passive smoking were significant but restricted to the group of 53 children without breast-feeding. Breast-feeding counteracts the effect of environmental stressors on the growing respiratory organs.

Purpose There have been conflicting reports concerning the relationship between breast-feeding and the development of atopic dermatitis (AD) in early childhood. The objective of this study was to investigate the associations between breast-feeding and the risk of AD in early childhood in Korea. Methods We combined the fourth and fifth Korea National Health and Nutrition Examination Survey data collected from 2007 to 2012 and analyzed 2,015 children at 1 to 3 years old. Regression analysis was used to determine the association of the following variables: AD, feeding types, duration of breast-feeding, and others. Results The annual prevalence of exclusive breast-feeding and AD decreased. Parents with allergic diseases preferred breast-feeding and extended duration of feeding compared with those without. In multiple logistic regression analyses, exclusive breast-feeding in feeding type I (P=0.070; adjusted odds ratio [OR]=1.990), exclusive breast-feeding in feeding type II (P=0.095; adjusted OR=1.495) and breast-feeding duration (P=0.430; adjusted OR=1.013) were not significantly related to AD. Conclusions Breast-feeding was not found to be associated with an occurrence of AD in young children. Rather, parents with histories of allergic diseases tended to prefer breast-feeding and extend its duration. To clarify the role of breast-feeding in the development of AD, a nation-wide prospective study is needed.

A 20-d-old boy was referred to our department because of hyperthyrotropinemia at neonatal mass screening and diagnosed with neonatal transient hyperthyrotropinemia. A follow-up examination when the patient was 5 mo old revealed severe hypercholesterolemia. Familial hypercholesterolemia was first suspected because of the patient’s significantly high levels of total and low-density lipoprotein cholesterol. The parent’s serum lipid profiles were examined and found to be normal. He was completely breast-fed until 6 mo of age. Breast milk was still the main source of food for a period following weaning. At 14 mo old, the patient was weaned completely from breast milk, and his serum cholesterol levels decreased dramatically. According to the normal lipid profiles of the patient’s parents and the spontaneous normalization of serum cholesterol levels after complete weaning from breast milk, breast-feeding was suggested to be responsible for his transient severe hypercholesterolemia. It is well documented that breast-fed infants have higher serum cholesterol levels than formula-fed infants. However, there is no reported case with severe hypercholesterolemia equivalent to or higher than the levels observed in the case of familial hypercholesterolemia. Although the exact mechanism is unknown, it is necessary to consider that a small number of cases develop severe hypercholesterolemia related to breast-feeding.

Only few studies have focused on organochlorine pesticides (OCPs) in breast milk and the related health risks for women in Taiwan. Our goal is to examine breast milk OCPs and their associations with female reproductive function (infertility, gynecological diseases, and menstruation characteristics) as well as their correlation with sociodemographic parameters (age, pre-pregnant body mass index (BMI), annual incomes, population, birth year, and parity) and dietary habit. The breast milk samples were collected in southern Taiwan (n = 68) from 2013 to 2016 and the OCP residues were analyzed using high resolution gas chromatography with low resolution mass spectrometry (HRGC/LRMS). The results show that the most abundant OCP residues in the breast milk was ΣDDT with the geometric mean ± standard deviation of 9.81 ± 7.52 ng−1 lipid−1 followed by ΣHCH (0.539 ± 0.557 ng−1·lipid−1). In the principal component analysis, cis-chlordane (cis-CHL) and γ-HCH were found to be related to participants who received medical treatment for infertility, and 4,4′-DDT was associated with those who received gynecological surgery. The logistic regression showed that the odds ratio (OR) of log γ-hexachlorocyclohexane (γ-HCH) was higher for mothers who had received medical treatment for infertility than for the normal group (OR = 25.6, p = 0.035) after adjustments for age, pre-pregnant BMI, annual income, population (i.e., native-born Taiwanese), birth year, and parity. Cow milk and beef consumption as well as menstruation characteristics such as average menstrual period (>5 days), shortest menstrual period (

Resumen: Objetivo: Comparar la eficacia analgésica de la lactancia materna en la toma sanguínea del talón en el recién nacido sano frente a otros procedimientos. Pacientes y métodos: Se estudió a 228 recién nacidos en nuestra maternidad en 2 fases consecutivas. En una primera fase participaron 150 recién nacidos distribuidos en 3 grupos: el primer grupo no recibió intervención analgésica específica y el segundo y el tercer grupo recibieron succión no nutritiva-placebo o succión no nutritiva-sacarosa al 24%, respectivamente. En la segunda fase participaron 78 recién nacidos, en los que la extracción se realizó durante la toma de lactancia materna. Los resultados en la escala de malestar se compararon con los obtenidos en el resto de los procedimientos analgésicos explorados. Resultados: El grupo que recibió analgesia con lactancia materna mostró una puntuación en la escala de malestar de 0,62 y un tiempo de llanto medio de 0,19s. El análisis comparativo de los resultados obtenidos durante el amamantamiento frente al resto de procedimientos mostró que la lactancia materna es la mejor opción analgésica, con un descenso en el malestar del 51% y de un 98% en el tiempo de llanto (p

This medical position article by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition summarises the current status of breast-feeding practice, the present knowledge on the composition of human milk, advisable duration of exclusive and partial breast-feeding, growth of the breast-fed infant, health benefits associated with breast-feeding, nutritional supplementation for breast-fed infants, and contraindications to breast-feeding. This article emphasises the important role of paediatricians in the implementation of health policies devised to promote breast-feeding.The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition recognises breast-feeding as the natural and advisable way of supporting the healthy growth and development of young children. This article delineates the health benefits of breast-feeding, reduced risk of infectious diarrhoea and acute otitis media being the best documented. Exclusive breast-feeding for around 6 months is a desirable goal, but partial breast-feeding as well as breast-feeding for shorter periods of time are also valuable. Continuation of breast-feeding after the introduction of complementary feeding is encouraged as long as mutually desired by mother and child.The role of health care workers, including paediatricians, is to protect, promote, and support breast-feeding. Health care workers should be trained in breast-feeding issues and counselling, and they should encourage practices that do not undermine breast-feeding. Societal standards and legal regulations that facilitate breast-feeding should be promoted, such as providing maternity leave for at least 6 months and protecting working mothers.

Background: Reduction of HIV-1 breast-feeding transmission remains a challenge for prevention of pediatric infections in Sub-Saharan Africa. Provision of formula decreases transmission but often increases child mortality in this setting. Methods: A prospective observational cohort study of HIV-1 exposed infants of mothers receiving pre and postnatal medical care at Drug Resource Enhancement Against AIDS and Malnutrition centers in Mozambique was conducted. Live-born infants of HIV-1-infected women receiving medical care were enrolled, HIV-1 testing was performed at 1, 6, and 12 months of age using branched DNA. Mothers were counseled to breast-feed exclusively for 6 months and were provided HAART antenatally mid postnatally for the first 6 months. Women with CD4 cell counts less than 350/cmm at baseline continued HAART indefinitely. Results: Of 341 infants followed from birth, 313 mother-infant pairs (92%) completed 6 months and 283 (83%) completed 12 months of follow-up. HIV-1 diagnosis was ascertained in 287 infants (84%) including 4 who died. There were 9 cases of HIV-1 transmission: 4 of 341 (1.2%) at 1 month, 2 of 313 (0.6%) at 6 months, and 2 of 276 (0.7%) at 12 months (cumulative rate: 2.8%). Two mothers (0.6%) and 11 infants (3.2%) died. Maternal and infant mortality rates were 587 of 100,000 and 33 of 1000, while country rates are 1000 of 100,000 and 101 of 1000. HIV risk reduction was 93% and HIV-free survival at 12 months was 94%. Conclusions: Late postnatal transmission of HIV-1 is significantly decreased by maternal use of HAART with high infant survival rates up to 12 months of age.

The advertising about maternal milk substitutes has been pointed as one of the factors responsible for the breastfeeding low rates. In this way, legal support was created to assure that the use of such products would not interfere on the healthy breastfeeding habit of the population. This study, developed between June 2006 and May 2008 in the city of Natal, state of Rio Grande do Norte, analyzed the food advertisements divulged under the validity of Law # 11.265/2006, which controls in Brazil the food commercialization and the publicity addressed to parents or keepers of nursling and children in the first childhood. 220 advertisements, being 141 of technical-scientific nature, and 79 for strictly commercial promotion, were collected and evaluated according to legal requirements. The results from this analysis showed that 100% of the advertisements of technical-scientific nature overstepped the clause V; 18.4% the clause IV and 14.2% the clauses I, II and III of article 19th of Law # 11265/2006. In 42% of the advertisements strictly for commercial promotion, the mandatory information mentioned at clauses I and II of the article 5th were not shown. In 8.7% of the advertisements containing such information, it was placed in an area that embarrassed its identification and reading, due to used fonts size and/or color; similarly as occurred with the information required by article 19th, in the advertisements of technical-scientific nature.A propaganda de substitutos do leite materno tem sido apontada como um dos fatores responsáveis pelos baixos índices da amamentação. Neste sentido, dispositivos legais foram criados para assegurar o uso desses produtos, sem que haja interferência no aleitamento materno. Este estudo objetivou analisar propagandas de alimentos abrangidos pela Lei nº 11.265/2006, que regulamenta a comercialização e publicidade de alimentos para lactentes e crianças de primeira infância no Brasil, no período de junho 2006 a maio de 2008, na cidade de Natal/RN. Foram coletadas 220 propagandas, sendo 141 de material técnico-científico e 79 de promoção comercial que foram avaliadas quanto às exigências legais. O resultado desta análise demonstrou que 100% das propagandas veiculadas em material técnico-científico infringiram o inciso V; 18,4% o inciso IV e 14,2% os incisos I, II e III do artigo 19 da Lei nº 11.265/2006. Em 42% das promoções comerciais não foram veiculadas as informações obrigatórias constantes dos incisos I e II do artigo 5º. Em 8,7% das que continham essas informações, estas estavam postas em local que dificultava sua identificação e leitura devido ao tamanho e cor das letras, semelhantemente ao ocorrido com as informações exigidas pelo artigo 19 nas propagandas veiculadas em material técnico-científico.

BACKGROUND: Environmental factors are likely to have profound effects on the development of host immune responses, with serious implications for infectious diseases and inflammatory disorders such as asthma. OBJECTIVE: This study was designed to investigate the effects of environmental exposures on the cytokine profile of children. METHODS: The study involved measurement of T helper (Th) 1 (interferon-gamma), 2 [interleukin (IL)-5 and IL-13], and the regulatory cytokine IL-10 in unstimulated peripheral blood leukocytes from 1,376 children 4-11 years of age living in a poor urban area of the tropics. We also assessed the impact of environmental exposures in addition to biological characteristics recorded at the time of blood collection and earlier in childhood (0-3 years before blood collection). RESULTS: The proportion of children producing IL-10 was greater among those without access to drinking water [p < 0.05, chi-square test, odds ratio (OR) = 1.67]. The proportion of children producing IL-5 and IL-10 (OR = 10.76) was significantly greater in households that had never had a sewage system (p < 0.05, trend test). CONCLUSIONS: These data provide evidence for the profound effects of environmental exposures in early life as well as immune homeostasis in later childhood. Decreased hygiene (lack of access to clean drinking water and sanitation) in the first 3 years of life is associated with higher spontaneous IL-10 production up to 8 years later in life.

The aims of the study were to identify the reasons why high socio-economic class women in the Cape Metropole decide not to breast-feed;to evaluate whether the type and volume of infant formula selected by the mother was appropriate for her infant’s current age and to identify the factors that influence the decision-making process when deciding which infant formula to feed her infant. An observational descriptive study with consecutive sampling was utilised. Data of 55 mothers with infants aged 0 to 6 months that were not currently breast-fed was captured in day care centres and private clinics situated in the Cape Metropole. Data was collected by means of a self-administered questionnaire available in Afrikaans and English. The majority of mothers (80%) decided only after the birth of their infant to rather opt for formula feeding. Evident factors that were identified as barriers to breast-feeding include a lack of knowledge and experience (38%) as well as a lack of facilities at public places (75%) and at work (71%) to breast-feed. Perceived benefits of infant formula included that the father could help with the workload (67%) and does not feel left out (38%), the mother knows what volume of milk is received (84%) and the convenience if the mother is working (64%). The mothers were overall not concerned about possible side-effects of breast-feeding and did not feel that their breasts were physically not of optimal physiology to breast-feed. One of the greatest challenges to support, protect and promote breast-feeding is to ensure that information sources give scientifically correct information to the uninformed or information-seeking mother in a standardised and positive manner.

Objetivo: Comparar las variaciones de los ácidos grasos poliinsaturados de cadena larga (LCPUFA) al nacer y al año de edad en niños alimentados con lactancia materna prolongada, lactancia materna de duración media y fórmula artificial. Pacientes: Un total de 77 niños sanos a término con alimentación conocida fueron divididos en grupos: el grupo A (n = 25) había recibido lactancia prolongada (más de 6 meses); el B (n = 26), lactancia media (más de 3 meses y menos de 5), y el C (n = 26), cuyos sujetos fueron alimentados únicamente con fórmula artificial. Se midió la proporción de ácidos grasos plasmáticos al nacer y al primer año de vida. Resultados: No existen diferencias en el momento del nacimiento. Sin embargo, hay una disminución significativa de la proporción de los principales LCPUFA, ácido docosahexaenoico (DHA) y ácido araquidónico (AA), entre el nacimiento y el primer año de vida. Al año, el porcentaje de DHA varía significativamente entre el grupo A y los otros dos: 2,46 ± 0,84 frente a 1,80 ± 0,48 y 1,89 ± 0,75 (p

WOS: 000253121600006 PubMed: 18279201 Background: The aim of the present paper was to define the incidence, complications, morbidity and mortality of hypernatremic dehydration due to inadequate breast-feeding in a neonatal intensive care unit. Methods: A retrospective study was carried out between 2002 and 2005, to identify the term breast-fed neonates with serum sodium level >= 150 mEq/L at the Ministry of Health Ankara Diskapi Children's and Research Hospital. Results: The incidence of hypernatremic dehydration secondary to inadequate breast-feeding was 4.1%, occurring in 169 term infants among 4136 hospitalized term neonates with the following characteristics: mean gestational age, 39.1 weeks (37-42 weeks); birthweight, 3352 g (2200-4500 g); mother's age, 26.1 years (17-38 years); weight loss, 15.9% (5.4-32.7%); proportion of spontaneous vaginal deliveries, 75.7%; and proportion of first-time mothers, 74.6%. Major presenting symptoms were neonatal jaundice (47.3%) and poor infant suck (29.6%). The median sodium; blood urea nitrogen (BUN); and creatinine levels on admission were 155 mmol/L (150-194 mmol/L), 35 mg/dL (7-253 mg/dL), and 0.9 mg/dL (0.2-10 mg/dL), respectively. Major complications were as follows: acute renal failure, 82.8%; elevated liver enzymes, 20.7%; disseminated intravascular coagulation, 6.5%; brain edema, 5.2%; intracranial hemorrhage, 3.6%; cavernous sinus thrombosis, 1.2%; and bilateral iliac artery thrombosis, 0.6%. Ten patients (5.9%) developed seizure within the first 24 h of rehydration therapy with a mean sodium decrease of 11.9 mmol/L per day (4-19 mmol/L per day). Two patients (1.2%) died. There were positive correlation between weight loss and serum sodium, BUN, bilirubin levels (P < 0.01); there was no correlation between weight loss and mothers' age, education level, delivery route, or first-born status (P > 0.05). Conclusions: Hypernatremic dehydration in neonates due to inadequate breast-feeding is a serious, potentially devastating and life-threatening disorder, and can damage the central nervous system. Follow up of infants for adequate breast-feeding is important. Pediatricians must maintain a high level of suspicion, especially in cases of pathologic infant weight loss after delivery.

Objetivo: Determinar la prevalencia de la deficiencia subclínica de vitamina D en lactantes del área de Valencia, España (latitud 39,5° N) y su relación con la lactancia materna. Material y métodos: Se midieron los niveles séricos de calcio, fosfato, fosfatasas alcalinas, 25-hidroxivitamina D (25[OH]D) y hormona paratiroidea (PTH) intacta en 60 lactantes entre 1 y 6 meses de edad, nacidos a término (media de edad 3,9 meses), sin enfermedad ósea, gastrointestinal o renal (33 alimentados con lactancia materna exclusiva y 27 con lactancia artificial). Se recogieron datos de suplementación con vitamina D y de tiempo semanal de exposición solar. Resultados: Todos los lactantes tenían niveles normales de calcio, fosfato y PTH. En cinco de ellos (el 8,3 %), los niveles de 25(OH)D eran menores de 10 ng/ml (límite inferior de la normalidad). Todos ellos estaban alimentados con lactancia materna (el 15,1 % del grupo) y ninguno estaba suplementado con vitamina D. Los lactantes con hipovitaminosis D tenían ligeramente elevadas las fosfatasas alcalinas. Sólo el 48 % de los lactantes alimentados al pecho recibían habitualmente suplementos de vitamina D. La media de niveles de 25(OH)D en invierno del grupo con lactancia materna (16,8 ng/ml) fue significativamente más baja que la del grupo con alimentación artificial en verano (23,6 ng/ml; p < 0,05). Conclusiones: La asociación de escasa exposición al sol y ausencia de suplementación con vitamina D confiere a los niños con lactancia materna un alto riesgo para la deficiencia subclínica de vitamina D, incluso en regiones de clima templado. : Objective: To determine the prevalence of subclinical vitamin D deficiency among infants in Valencia, Spain (latitude 39.5 degrees N) and its relation with breast- feeding. Material and methods: Serum levels of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25-OHD) and intact parathyroid hormone (PTH) were measured in 60 term infants aged between 1 and 6 months (mean age: 3.9 months), with no known bone, gastrointestinal or renal disease (33 exclusively breast-fed, 27 bottle-fed). Data on vitamin D supplementation and weekly direct sunlight exposure were also gathered. Results: All infants had normal serum calcium, phosphate and PTH levels. Five infants (8.3 %) had 25-OHD levels < 10 ng/ml (lower limit of normality) and all of these infants were breast-fed (15.1 % of the group). None of these five infants received vitamin D supplementation. Infants with vitamin D deficiency had slightly elevated serum alkaline phosphatase. Only 48 % of breast-fed infants received regular vitamin D supplementation. The mean serum 25-OHD concentration of breast-fed infants in winter (16.8 ng/ml) was significantly lower than that in bottle-fed infants in summer (23.6 ng/ml, p < 0.05). Conclusions: In breast-fed infants, the association of limited sunshine exposure and poor dietary vitamin D supplementation confers a high risk of subclinical vitamin D deficiency, even in regions with a temperate climate.