中国0~24月龄城市婴幼儿母乳喂养状况及相关因素分析#br#

目的：调查中国0~24月龄婴幼儿母乳喂养状况,分析其可能的相关因素。方法：采用方便抽样招募0~3月龄婴儿及其母亲459对为调查对象,在婴儿6~8、12~14、18~20、24~26月龄随访。通过问卷调查0~6月龄纯母乳喂养、7~24月龄继续母乳喂养状况及可能影响因素。结果：调查对象3月龄内、6月龄内纯母乳喂养率分别为34.4%和14.1%,基本纯母乳喂养率分别为61.6%和55.6%;12~14、18~20、24~26月龄继续母乳喂养率分别为59.1%、32.2%、19.5%。多因素分析显示,自报母乳充足（OR=3.155,95%CI：1.146~8.687）和自然分娩（OR=0.486,95%CI：0.239~0.986）是6月龄内纯母乳喂养促进因素,奶瓶喂养是不利因素（OR=0.486,95%CI：0.239~0.986）。自报母乳充足是12~14月龄（OR=2.144,95%CI：1.311~3.507）和18~20月龄（OR=0.596,95%CI：1.041~3.163）继续母乳喂养有利因素。奶瓶喂养（OR=0.405,95%CI：0.214~0.766）和健康食物禁忌（OR=0.447,95%CI：0.229~0.870）是24~26月龄母乳喂养的不利因素。结论：城市婴幼儿0~24月龄母乳喂养率随月龄增加不断降低,尤其12月龄后明显减少;母亲剖宫产、母乳分泌不足、健康食物禁忌和奶瓶喂养是母乳喂养的不利因素,应作为母乳喂养促进重点干预目标。     

中老年肩痛患者疼痛及肩关节功能恢复的影响因素分析

摘要 目的：探究分析中老年肩痛患者疼痛及肩关节功能恢复的影响因素分析。方法：采用便利抽样法,随机抽取2020年9月至2022年9月期间于我院门诊就诊的2010名中老年患者作为调查对象,对患者进行筛查、复查、确诊、随访等。并对所搜集信息进行疼痛及肩关节功能恢复单因素与多因素Logistic回归分析。结果：单因素分析显示,年龄（x²=15.274, P＜0.001）、性别（x²=10.401, P=0.001）、病程（x²=16.410, P＜0.001）和是否进行功能锻炼（x²=6.293, P=0.012）为影响中老年肩痛患者肩关节功能恢复的主要因素;年龄≥70岁（OR=1.292, 95%CI 0.953-1.750）、女性（OR=1.672, 95%CI 1.348-2.074）、病程＞1个月（OR=1.470, 95%CI 1.021-2.116）和未进行功能锻炼（OR=1.844, 95%CI 1.175-2.894）为影响中老年肩痛患者肩关节功能恢复的独立危险因素。结论：年龄≥70岁、女性、病程＞1个月和未进行功能锻炼为影响中老年肩痛患者肩关节功能恢复的独立危险因素,根据上述因素尽早快速甄别高风险患者,及早给予合理有效的康复治疗措施,可显著改善肩痛患者肩关节功能的预后。     

专家门诊亚专科化及专病门诊优化的效果分析

目的 探讨专家门诊亚专科化及专病门诊优化对学科发展及患者就诊的影响。方法 2011年及2014年分别对老年医学科及普通外科专家门诊实行亚专科化并在2013年至2014年对专病门诊进行优化,比较调整前后门诊相关指标的变化。结果 亚专科化后,两个专科的专家门诊量分别增长了63.0%和5.6%,均高于医院同期平均水平（经χ²检验,P=0.000）。普通外科4级手术率达34.9%,高于2013年同期（经χ²检验,P=0.000）,挂号错误率也明显下降（经χ²检验, P=0.000）。2014年底专病门诊增至38个,其中联合专病门诊7个,门诊量增长了36.5%,高于同期专病门诊数量及医院门诊量的增长率（经χ²检验,P=0.000）。结论 专家门诊的亚专科化及充分发挥专病门诊的作用是促进学科建设、提升医院影响力、方便患者就诊的有效措施之一。     

2015-2017年某综合医院医院感染现患率调查分析

摘要 目的：了解与掌握医院感染现状及抗菌药物的使用,为有效预防与控制医院感染提供科学依据。方法：采用横断面调查方法,对医院2015年9月12日、2016年9月7日、2017年8月23日住院患者医院感染横断面调查,并对调查的所有资料进行分析。结果：应调查4160例,实查4125例,实查率99.16%,实查率符合现患率调查要求。2015-2017年医院感染现患率分别为6.12%、4.58%、4.12%,三年调查现患率比较,差异有统计学意义（x²=6.537,P=0.038）。调查科室中综合ICU医院感染现患率最高,为30.30%,例次感染率为36.36%。2015-2017年医院感染部位均以下呼吸道最高,其次为泌尿道,血管相关最低。2015-2017年现患率调查统计病原菌共172株,以革兰阴性菌为主。2015-2017年调查抗菌药物使用率分别为27.54%、24.09%、23.32%,合计为24.99%,三年调查日的使用率比较,差异有统计学意义（x²=7.452,P=0.024）。病原学送检673例,送检率79.83%。结论：医院感染现患率调查有助于掌握医院感染现状,根据调查存在的问题,采取相应干预措施,可有效预防与控制医院感染。     

肠内营养不同递增输注速度对重症急性胰腺炎患者喂养耐受性、生存质量和胃肠功能恢复的影响

摘要 目的：观察肠内营养不同递增输注速度对重症急性胰腺炎（SAP）患者喂养耐受性、生存质量和胃肠功能恢复的影响。方法：选取2019年3月~2021年2月期间我院收治的SAP患者120例，按照随机数字表法分为低速组、中速组和高速组，各为40例，输注速度递增幅度由低到高给予肠内营养。对比三组患者的腹内压、喂养耐受性、生存质量和胃肠功能恢复情况。结果：干预8 h后、干预16 h后、干预20 h后低速组腹内压低于高速组、中速组，而中速组低于高速组（P<0.05）。低速组排气排便恢复时间、肠鸣音恢复时间、经口进食时间、腹胀缓解时间短于中速组、高速组，中速组则短于高速组（P<0.05）。低速组干预7 d后世界卫生组织生存质量简明量表（WHO-QOL-BREF）各维度评分高于中速组、高速组，中速组则高于高速组（P<0.05）。低速组喂养不耐受发生率低于中速组、高速组，中速组则低于高速组（P<0.05）。结论：肠内营养低速递增输注有利于防止腹内压升高，提高SAP患者喂养耐受性，促进胃肠功能恢复，进而提高患者生存质量。     

芪参益气滴丸联合利拉鲁肽对老年2型糖尿病合并冠心病患者血糖、心功能及T细胞亚群的影响

摘要 目的：探讨芪参益气滴丸联合利拉鲁肽对老年2型糖尿病合并冠心病患者血糖、心功能及T细胞亚群的影响。方法：选择2017年1月到2019年6月我院收治的老年2型糖尿病合并冠心病患者105例,依照随机数字表法分为对照组（52例）和观察组（53例）。两组均给予常规治疗,对照组在常规治疗的基础上给予利拉鲁肽治疗,观察组在对照组基础上给予芪参益气滴丸治疗,两组均连续给予治疗8周。观察两组临床疗效,比较两组治疗前后血糖指标[空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbAlc）],心功能[左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、舒张早期最大峰值速度/舒张晚期最大峰值速度（E/A）]及外周血T细胞亚群CD4⁺、CD8⁺、CD4⁺/CD8⁺水平。记录两组治疗过程中的不良反应情况。结果：观察组的临床总有效率为96.23%（51/53）,高于对照组的82.69%（43/52）（P<0.05）。治疗后,两组FPG、2hPG及HbAlc水平均较治疗前降低（P<0.05）,且观察组低于对照组（均P<0.05）;LVEF、E/A均升高,LVEDD降低（均P<0.05）,观察组LVEF、E/A、LVEDD的改善情况均优于对照组（P<0.05）;CD4⁺、CD4⁺/ CD8⁺水平均高于治疗前（P<0.05）,同时观察组CD4+、CD4+/CD8+水平均高于对照组（P<0.05）,两组治疗前后CD8⁺均无明显变化（P＞0.05）。治疗期间,观察组的不良反应发生率为9.43%（5/53）,对照组为9.62%（5/52）,两组比较差异无统计学意义（x²=0.001,P=0.975）。结论：芪参益气滴丸联合利拉鲁肽治疗老年2型糖尿病合并冠心病的临床疗效较好,有助于改善患者血糖水平和心功能,提高机体免疫功能,且安全性较好。     

靶向治疗联合介入治疗对晚期非小细胞肺癌疗效及远期复发率的影响

摘要 目的：探讨靶向治疗联合介入治疗对晚期非小细胞肺癌疗效及远期复发率的影响。方法：选取我院2017年1月到2019年12月收治的220例晚期非小细胞肺癌患者作为研究对象进行回顾性分析,依照患者选择的不同治疗方式进行分组,将选择单纯PP方案化疗的110例患者分为对照组,将选择在PP方案化疗基础上增加靶向治疗联合¹²⁵I放射性粒子植入介入治疗的110例患者分为观察组,对比两组患者生存情况,治疗前与治疗3个月后血管生成因子与肿瘤标志物水平,1年、2年、3年复发率情况以及不良反应情况。结果：观察组中位PFS为11.26（2.38~24.13）,对照组中位PFS为9.25（2.24~17.22）,观察组高于对照组,差异具有统计学意义（x²=4.536,P=0.041）。观察组中位OS为21.23（4.84~62.73）,对照组中位OS为16.52（5.27~50.27）,观察组高于对照组（x²=5.262,P=0.022）;两组患者治疗前碱性成纤维细胞生长因子（bFGF）、血管内皮生长因子（VEGF）血管生成因子,人细胞角蛋白21-1片段（Cyfra21-1）、糖类抗原125（CA125）肿瘤标志物水平对比无明显差异（P＞0.05）,治疗后两组患者bFGF、VEGF血管生成因子,CA125、Cyfra21-1肿瘤标志物水平均降低,且观察组低于对照组（P＜0.05）;观察组患者治疗后远期总复发率明显低于对照组（P＜0.05）;两组患者0~Ⅱ和Ⅲ~Ⅳ不良反应情况对比无明显差异（P＞0.05）。结论：对晚期非小细胞肺癌患者在常规化疗基础上增加靶向治疗联合125I放射性粒子植入介入治疗能够提升患者生存期和无进展生存期,同时能够改善患者机体炎症标志物水平,降低远期复发率,安全性较高,值得临床推广。     

影响sc镍钛器械分离的相关因素分析

摘要 目的：分析影响sc镍钛器械分离的相关因素。方法：收集2020年1月至2022年4月在本院接受根管治疗的病例的离体牙。据研究目的和内容设计一般调查表收集临床资料。采用Schneider法测定根管弯曲度。结果：本次研究共收集到10047例病例,涉及22306个根管。其中236例病例（247根镍钛器械）发生器械分离,分离率为2.35%。其中有205例镍钛器械分离发生在磨牙,分离率为4.29%。有106例镍钛器械分离发生在上颌,分离率为1.83%;有130例镍钛器械分离发生在下颌,分离率为3.06%,两者相比差异具有统计学意义（x²=77.128,P<0.001）。轻度弯曲组镍钛器械分离率为0.32%,中度弯曲组镍钛器械分离率为1.04%,重度弯曲组镍钛器械分离组为3.46%,极重度弯曲组镍钛器械分离率为5.82%;随着根管弯曲度的增加,镍钛器械分离率呈明显上升趋势（z=291.883,P<0.001）。结论：sc镍钛器械分离率为2.35%,下颌磨牙根管预备中,器械分离发生率最高,根管弯曲度对器械分离发生也具有一定影响。     

广西扶绥白头叶猴对栖息地的选择与利用

为了解白头叶猴（Trachypithecus leucocephalus）的栖息地利用规律及其影响因素,2016年2月至2017年1月,采用瞬时扫描取样法对广西崇左白头叶猴国家级自然保护区一群白头叶猴的栖息地利用进行了研究。结果表明,白头叶猴对山体不同部位的利用存在显著性差异（χ² =39.467,df=3,P<0.001）,其中,对崖壁（56.75±9.55）%的利用比例最大,其次是对山坡（39.42±10.93）%和山顶（2.98±2.54）%的利用,而对山脚（0.84±1.47）%的利用频率最低。白头叶猴对不同微生境类型的利用存在差异（χ²=27.709,df=3,P<0.001）,其中对乔木（49.37±12.31）%的利用比例最大,其次是裸岩（24.05±13.61）%,随后依次为藤本（15.48±8.01）%和灌木（10.87±5.45）%。白头叶猴主要在山坡上觅食,利用崖壁移动、休息,进行社会活动;主要利用裸岩进行社会活动,觅食、移动、休息主要发生在乔木上。从整体来看,白头叶猴在雨季对乔木的利用频率显著大于旱季（Z=-2.680,n=12,P=0.007）;雨季在山坡觅食频率显著大于旱季（Z=-2.517,n=12,P=0.012）,而在崖壁觅食频率刚好相反（Z=-2.842,n=12,P=0.004）;白头叶猴雨季在乔木休息的频率显著大于旱季（Z=-2.355,n=12,P=0.019）。白头叶猴对栖息地的利用受到温度的影响。白头叶猴对乔木的总体利用频率随着平均温度的升高而增加（r=0.664,n=12,P=0.018）;觅食时,对崖壁、裸岩的利用频率均与平均温度成负相关关系（崖壁：r=-0.685,n=12,P=0.014;裸岩：r=-0.600,n=12,P=0.039）;休息时,对乔木的利用频率与平均温度呈正相关关系（r=0.650,n=12,P=0.022）。不同季节,白头叶猴对栖息地的利用方式不同。白头叶猴的栖息地利用模式可能是在觅食利益和捕食风险之间作出的权衡,并受到环境温度的影响。     

乳腺三维断层技术结合乳腺超声对致密型乳腺病变的诊断价值

摘要 目的：探讨乳腺三维断层技术（DBT）结合乳腺超声(BUS)对致密型乳腺病变的诊断价值。方法：回顾分析2018年6月至2019年4月在我院就诊且有完整病理结果的149例致密型乳腺病变患者的影像资料,对比DBT、BUS两种检查方法的检出率;以病理结果为金标准,分析DBT、BUS、DBT联合BUS三种检查模式的诊断效能。结果：BUS对良性病变的检出率（97.87%）高于DBT（89.36%）,差异有统计学意义（x²=5.697,P＜0.05）;DBT与BUS对恶性病变的检出率分别为98.44%、95.31%,差异无统计学意义（x²=1.032,P>0.05）。DBT诊断致密型乳腺病变的敏感度为90.61%、特异度为93.55％、准确率为91.77％,BUS诊断致密型乳腺病变的敏感度为78.13%、特异度为89.36%、准确率为84.81%,DBT联合BUS诊断致密型乳腺病变的敏感度为95.31%、特异度为95.74%、准确率为95.57%。DBT联合BUS诊断致密型乳腺恶性病变的受试者工作特征曲线（ROC）的曲线下面积（AUC）为0.977,稍高于DBT的AUC（0.951）,明显高于BUS的AUC（0.885）。结论：BUS对良性病变的检出率显著高于DBT,DBT对致密型乳腺病变的诊断效能高于BUS,二者结合能提高病变的检出率与诊断效能。     

不同喂养方式对婴儿骨密度及维生素A的影响

目的:探讨不同喂养方式对婴儿骨密度、维生素A的影响。方法:选择2015~2016年来我院体检的婴儿120例,根据不同喂养方式的不同分为母乳喂养组、混合喂养组及人工喂养组,比较三组婴儿1、3、6月的身长、头围、体质量、骨密度,6月时的维生素A及6月内的患病率。结果:三组婴儿1、3、6月内身长、体质量及头围对比差异无统计学意义(P0.05);1月、3月时,母乳喂养组与混合喂养组骨密度与明显高于人工喂养组(P0.05);母乳喂养组与人工喂养组对比差异无统计学意义(P0.05);6月时,混合喂养组婴儿的骨密度显著高于人工喂养组和母乳喂养组(P0.05),人工喂养组显著低于母乳喂养组(P0.05)。6月时,母乳喂养组的维生素A明显低于人工喂养组及混合喂养组(P0.05)。母乳喂养组6月内的患病率明显低于混合喂养组及人工喂养组(P0.05)。结论:6个月前不同喂养方式对婴儿的体格发育无明显影响,而6个月左右母乳喂养的婴儿骨密度及维生素A含量均低于混合喂养,母乳喂养可降低婴儿的患病率,6个月内应提倡母乳喂养。     

Effect of peppermint water on prevention of nipple cracks in lactating primiparous women: a randomized controlled trial

Background

Exclusive breastfeeding up to the completion of the sixth month of age is the national infant feeding recommendation for Sri Lanka. The objective of the present study was to collect data on exclusive breastfeeding up to six months and to describe the association between exclusive breastfeeding and selected socio-demographic factors.

Methods

A clinic based cross-sectional study was conducted in the Medical Officer of Health area, Beruwala, Sri Lanka in June 2006. Mothers with infants aged 4 to 12 months, attending the 19 child welfare clinics in the area were included in the study. Infants with specific feeding problems (cleft lip and palate and primary lactose intolerance) were excluded. Cluster sampling technique was used and consecutive infants fulfilling the inclusion criteria were enrolled. A total of 219 mothers participated in the study. The statistical tests used were survival analysis (Kaplan-Meier survival curves and Cox proportional Hazard model).

Results

All 219 mothers had initiated breastfeeding. The median duration of exclusive breastfeeding was four months (95% CI 3.75, 4.25). The rates of exclusive breastfeeding at 4 and 6 months were 61.6% (135/219) and 15.5% (24/155) respectively. Bivariate analysis showed that the Muslim ethnicity (p = 0.004), lower levels of parental education (p < 0.001) and being an unemployed mother (p = 0.021) were important associations of early cessation of exclusive breastfeeding. At the time of the study, 62% (135/219) of infants were receiving feeds via a bottle and 23% (51/219) were receiving infant formula. Muslim ethnicity was significantly associated with bottle and formula feeding (p < 0.001). Bottle feeding was also significantly higher among mothers with a low level of education and among employed mothers.

Conclusion

The rate of breastfeeding initiation and exclusive breastfeeding up to the fourth month is very high in Medical Officer of Health area, Beruwala, Sri Lanka. However exclusive breastfeeding up to six months is still low and the prevalence of inappropriate feeding practices is high.     

Impact of Withholding Breastfeeding at the Time of Vaccination on the Immunogenicity of Oral Rotavirus Vaccine—A Randomized Trial

BackgroundBreast milk contains anti-rotavirus IgA antibodies and other innate immune factors that inhibit rotavirus replication in vitro. These factors could diminish the immunogenicity of oral rotavirus vaccines, particularly if breastfeeding occurs close to the time of vaccine administration.MethodsBetween April 2011 and November 2012, we conducted an open label, randomized trial to compare the immunogenicity of Rotarix (RV1) in infants whose breastfeeding was withheld one hour before through one hour after vaccination with that in infants breastfed at the time of vaccination. The trial was conducted in the peri-urban area of Ibrahim Hyderi in Karachi, Pakistan. Both groups received three doses of RV1 at 6, 10 and 14 weeks of age. Seroconversion (anti-rotavirus IgA antibodies ≥20 U/mL in subjects seronegative at 6 weeks of age) following three vaccine doses (6, 10 and 14 weeks) was determined at 18 weeks of age (primary objective) and seroconversion following two doses (6 and 10 weeks) was determined at 14 weeks of age (secondary objective).ResultsFour hundred eligible infants were randomly assigned in a 1:1 ratio between the withholding breastfeeding and immediate breastfeeding arms. Overall, 353 (88.3%) infants completed the study according to protocol; 181 in the withholding breastfeeding group and 172 in the immediate breastfeeding group. After three RV1 doses, anti-rotavirus IgA antibody seroconversion was 28.2% (95% CI: 22.1; 35.1) in the withholding arm and 37.8% (95% CI: 30.9; 45.2) in the immediate breastfeeding arm (difference: -9.6% [95% CI: -19.2; 0.2] p=0.07). After two doses of RV1, seroconversion was 16.6% (95% CI: 11.9; 22.7) in the withholding arm and 29.1% (95% CI: 22.8, 36.3) in the immediate breastfeeding arm (difference: -12.5% [95% CI: -21.2,-3.8] p=0.005).ConclusionsWithholding breastfeeding around the time of RV1 vaccine administration did not lead to increased anti-rotavirus IgA seroconversion compared with that seen with a breastfeed at the time of vaccination. On the contrary, IgA seroconversion in infants immediately breastfed tended to be higher than in those withheld from a feeding. Our findings suggest that breastfeeding should be continued adlib around the time of rotavirus vaccination and withholding breastfeeding at that time is unlikely to improve the vaccine immunogenicity.

Trial Registration

ClinicalTrials.gov NCT01199874     

Brief Parenteral Nutrition Accelerates Weight Gain,Head Growth Even in Healthy VLBWs

IntroductionWhether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear. Our aim was to examine this issue using data from Japan, where enteral feeding typically advances at a rapid rate.MethodsWe studied 4005 hospitalized VLBW, very preterm (23–32 weeks'' gestation) infants who reached full enteral feeding (100 ml/kg/day) by day 14, from 75 institutions in the Neonatal Research Network Japan (2003–2007). Main outcomes were weight gain, head growth, and extra-uterine growth restriction (EUGR, measurement <10^th percentile for postmenstrual age) at discharge.Results40% of infants received parenteral nutrition. Adjusting for maternal, infant, and institutional characteristics, infants who received parenteral nutrition had greater weight gain [0.09 standard deviation (SD), 95% CI: 0.02, 0.16] and head growth (0.16 SD, 95% CI: 0.05, 0.28); lower odds of EUGR by head circumference (OR 0.66, 95% CI: 0.49, 0.88). No statistically significant difference was seen in the proportion of infants with EUGR at discharge. SGA infants and infants who took more than a week until full feeding had larger estimates.DiscussionEven in infants who are able to establish enteral nutrition within 2 weeks, deprivation of parenteral nutrition in the first weeks of life could lead to under nutrition, but infants who reached full feeding within one week benefit least. It is important to predict which infants are likely or not likely to advance on enteral feedings within a week and balance enteral and parenteral nutrition for these infants.     

Iodine Status of Preterm Infants Born in an Area of Iodine Sufficiency: Are They at Risk of Iodine Deficiency?

ObjectiveTo the assess the iodine status of preterm infants born in an area of iodine sufficiency using the urinary iodine concentration (UIC) and thyroid-stimulating hormone (TSH) levels and compare these values across different feeding practices during the first 7 days of life.MethodsIn this cross-sectional study, 88 preterm infants born at 30 to 34 weeks of gestation and admitted to the neonatal intensive care unit of a referral hospital in Tehran (Iran) were included. The infant UIC and TSH levels and breast milk iodine concentration in mothers who were exclusively breastfeeding were measured.ResultsMedian (interquartile range [IQR]) UIC and TSH levels in the study population were 81 (39-189) μg/L and 1.60 (0.80-2.85) mIU/L, respectively. When preterm infants were stratified by the type of feeding, the median (IQR) UICs were 64 (42-126) μg/L in parenteral nutrition, 125 (41-195) μg/L in exclusively breastfeeding, 57 (28-123) μg/L in formula feeding, and 45 (35-132) μg/L in mixed feeding, with no statistically significant difference between the groups (P = .31). The median (IQR) breast milk iodine concentration was 271 (177-521) μg/L in preterm infants exclusively fed their mothers’ own milk. There was no significant difference in the proportion of the TSH levels of >5 mIU/L between preterm infants who received enteral and parenteral nutrition (P = .27).ConclusionPreterm infants are at risk of iodine deficiency even in an area where the general population has adequate iodine. Only the preterm infants who received exclusively their mothers’ own milk had marginally adequate iodine status. Further studies are warranted to determine the necessity of iodine supplementation for this vulnerable group.     

Birth Weight,Growth and Feeding Pattern in Early Infancy Predict Overweight/Obesity Status at Two Years of Age: A Birth Cohort Study of Chinese Infants

Objectives

To investigate the early determinants of overweight and obesity status at age two years.

Methods

A total of 1098 healthy neonates (563 boys and 535 girls) were involved in this community-based prospective study in China. Data on body weight and length were collected at birth, the 3^rd and 24^th month. A self-administered questionnaire was used to collect data on social demography and feeding patterns of children, etc. Three multivariable logistic regression models were employed to make various comparisons of weight status, i.e., model 1 (obesity vs. non-obesity), model 2 (combined overweight and obesity vs. normal weight, and model 3 (obesity, overweight and normal weight).

Results

Prevalences of overweight/obesity (95^th >BMI ≥85^th p and BMI ≥95^th p, referring to WHO BMI standards) at 2 years of age are 15.8%/11.2% for boys and 12.9%/9.0% for girls, respectively. Being born with macrosomia (OR: 1.80–1.88), relatively greater BMI increment in the first 3 months (OR: 1.15–1.16) and bottle emptying by encouragement at age two (OR: 1.30–1.57) were found in all three models to be significant risk factors for higher BMI status at 2 years. Pre-pregnancy maternal BMI (OR: 1.09–1.12), paternal BMI (OR: 1.06), and mixed breastfeeding (OR: 1.54–1.57) or formula feeding (OR: 1.90–1.93) in the first month were identified as significant in models 2 and 3. Child-initiated bottle emptying at age two was observed to increase the risk of obesity by 1.31 times but only in model 1.

Conclusion

Fetal and early postnatal growth and feeding pattern appear to have significant impacts on early childhood overweight and obesity status independent of parental BMI. Policy-based and multidisciplinary approaches to promote breastfeeding and enhancement of feeding skills of care takers may be promising intervention strategies.     

Decreased Memory B Cells and Increased CD8 Memory T Cells in Blood of Breastfed Children: The Generation R Study

BackgroundBreastfeeding provides a protective effect against infectious diseases in infancy. Still, immunological evidence for enhanced adaptive immunity in breastfed children remains inconclusive.ObjectiveTo determine whether breastfeeding affects B- and T-cell memory in the first years of life.MethodsWe performed immunophenotypic analysis on blood samples within a population-based prospective cohort study. Participants included children at 6 months (n=258), 14 months (n=166), 25 months (n=112) and 6 years of age (n=332) with both data on breastfeeding and blood lymphocytes. Total B- and T-cell numbers and their memory subsets were determined with 6-color flow cytometry. Mothers completed questionnaires on breastfeeding when their children were aged 2, 6, and 12 months. Multiple linear regression models with adjustments for potential confounders were performed.ResultsPer month continuation of breastfeeding, a 3% (95% CI -6, -1) decrease in CD27+IgM+, a 2% (95 CI % -5, -1) decrease in CD27+IgA+ and a 2% (95% CI -4, -1) decrease in CD27-IgG+ memory B cell numbers were observed at 6 months of age. CD8 T-cell numbers at 6 months of age were 20% (95% CI 3, 37) higher in breastfed than in non-breastfed infants. This was mainly found for central memory CD8 T cells and associated with exposure to breast milk, rather than duration. The same trend was observed at 14 months, but associations disappeared at older ages.ConclusionsLonger breastfeeding is associated with increased CD8 T-cell memory, but not B-cell memory numbers in the first 6 months of life. This transient skewing towards T cell memory might contribute to the protective effect against infectious diseases in infancy.     

Growth of HIV-Exposed Uninfected Infants in the First 6 Months of Life in South Africa: The IeDEA-SA Collaboration

BackgroundHIV-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa especially with the increasing coverage of more effective prevention of mother-to-child transmission (PMTCT) antiretroviral therapy regimens. This study describes the characteristics of South African HEU infants, investigates factors impacting birth weight and assesses their growth within the first 28 weeks of life.MethodsThis is a retrospective cohort based on routine clinical data from two South African PMTCT programmes. Data were collected between 2007 and 2013. Linear regression assessed factors affecting birth weight-for-age z-scores (WAZ) while growth (longitudinal WAZ) was assessed using mixed effects models.ResultsWe assessed the growth of 2621 HEU infants (median birth WAZ was -0.65 (IQR -1.46; 0.0) and 51% were male). The feeding modalities practised were as follows: 0.5% exclusive breastfeeding, 7.9% breastfeeding with unknown exclusivity, 0.08% mixed breastfeeding and 89.2% formula feeding. Mothers with CD4 <200 cells/μl delivered infants with a lower birth WAZ (adjusted ß -0.253 [95% CI -0.043; -0.072], p = 0.006) compared to mothers with aCD4 ≥500 cells/μl. Similarly, mothers who did not receive antiretroviral drugs delivered infants with a lower birth WAZ (adjusted ß -0.39 [95% CI -0.67; -0.11], p = 0.007) compared to mothers who received antenatal antiretrovirals. Infants with a birth weight <2 500g (ß 0.070 [95% CI 0.061; 0.078], p <0.0001) experienced faster growth within the first 28 weeks of life compared to infants with a birth weight ≥2 500g. Infants with any breastfeeding exposure experienced slower longitudinal growth compared to formula fed infants (adjusted ß -0.012 [95% CI 0.021; -0.003], p = 0.011).ConclusionLess severe maternal disease and the use of antiretrovirals positively impacts birth weight in this cohort of South African HEU infants. Formula feeding was common with breastfed infants experiencing marginally slower longitudinal growth.     

Factors associated with exclusive breastfeeding practices among mothers in Goba district,south east Ethiopia: a cross-sectional study

Background

Exclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, with no addition of any liquid or solids apart from drops or syrups consisting of vitamins, mineral supplements or medicine, and nothing else. Several studies have shown that exclusive breastfeeding for the first six months plays a great role in preventing morbidity and mortality. However, in Ethiopia a large portion of infants are not exclusively breastfed according to the infant feeding recommendations. Understanding the factors that influence exclusive breastfeeding is crucial to promoting the practice. This study was carried out to identify factors predicting exclusive breastfeeding among mothers in Bale Goba district, south east Ethiopia.

Methods

A community-based cross-sectional study was conducted from March to February 2010 involving both quantitative and qualitative data. A total of 608 mothers were selected randomly. A convenience sampling technique was used to generate the qualitative data. The qualitative data were analyzed using thematic frameworks. A multivariable logistic regression analysis was used to identify independent predictors of exclusive breastfeeding after controlling for background variables.

Results

The prevalence of exclusive breastfeeding in the last 24?hours preceding the survey was 71.3%. The median duration of exclusive breastfeeding was three months and mean frequency of breastfeeding was six times per day. Being unemployed [AOR: 10.4 (95% CI: 1.51, 71.50)] and age of infants of less than two months [AOR: 5.6 (95% CI: 2.28, 13.60)] were independently associated with exclusive breastfeeding.

Conclusions

A large proportion of infants are not exclusively breastfed during the first 6?months, despite what is recommended in the national and global infant and young child feeding (IYCF) guidelines. Employed mothers were less likely to practice exclusive breastfeeding, implying the need for promoting workplace breastfeeding practices and creating an enabling environment for exclusive breastfeeding. Extensions of maternity leave up to the first six month of child’s age to achieve optimal level of exclusive breastfeeding practices should also be looked into as an alternative solution.