Antepartum and postpartum depression and infant feeding pattern: a prospective study

Mother's depression during pregnancy and postpartum is a risk factor that can adversely affect mother's relationship with her infant. As breast feeding is an important situation for early mother-child interaction the effect of mother's depression on her breast feeding attitude and practice was decided to be studied prospectively. In this study, 158 primigravidae attending antenatal clinics in two MCH centres were interviewed at third trimester. The interview data covered social background, attitudes to breast feeding as well as self rating of depression using the Edinburgh Postnatal Depression Scale (EPDS). At postnatal interview 72 mother-infant pairs could be reached between 6-16 weeks after birth. They were subjected again to EPDS along with inquiry about type of infant feeding and breast feeding practices. Findings revealed that the prevalence of antepartum depression was 25.32%. Antepartum depression was significantly linked to postpartum depression and negative attitudes to breast feeding. Persistent maternal depression (ante- and postpartum) was a risk factor for early resorting to mixed infant feeding, retarded infant growth as well as some adverse maternal and infant health outcomes. Logistic analysis indicated that negative mothers' attitudes to breast feeding and postpartum depressive scores taken together predicted mixed infant feeding. Hence, preventive programs should be directed specifically towards modifying the mother's psychological status and her attitude on behalf of her infant.     

Selection of infant feeding method: a population-based study in a rural area

The selection of infant feeding method was studied in a rural area. At discharge from the hospital, 70 percent of women were breast feeding, with 47 percent still breast feeding at three months. The decision regarding feeding method was made early, with the majority of women deciding before the pregnancy. Multiparous women almost always used the method that was favored by their experience feeding previous children. For primiparous women, the husband and mother were the most important sources of information. Educational efforts designed to increase the use of breast feeding should reach future parents prior to pregnancy, and every effort should be made to ensure that the first experience with breast feeding is successful and rewarding.     

Predictors of crying, feeding and sleeping problems: a prospective study

Background Infant regulatory problems, that is, excessive crying, feeding and/or sleeping difficulties, are precursors of adverse development. However, the aetiology of regulatory problems is still unclear. The aim of this study was to investigate pre‐, peri‐ and post‐natal neurophysiological and psychosocial predictors of single and multiple regulatory problems at 5 months of age. Methods This prospective longitudinal study included all children born at neonatal risk in a geographically defined area in southern Germany. The data of n= 5093 singleton infants (83.6%) were analysed using crude and multivariate logistic regression analyses. As outcome measures we used single and multiple regulatory problems, that is, crying, feeding and/or sleeping difficulties at 5 months of age, which were assessed via a standardized interview with the parents by study paediatricians as part of a neurodevelopmental examination. Results In total, 30.7% of the sample suffered from single or multiple regulatory problems at 5 months. Breastfeeding increased the odds of single sleeping problems 5.12‐fold, but decreased the odds of single feeding problems [odds ratio (OR) 0.51; 95% confidence interval (CI) 0.35–0.74]. Very preterm birth was predictive of single feeding (OR 1.79; 95% CI 1.25–2.55) and multiple regulatory problems (OR 2.03; 95% CI 1.19–3.46), and foetal abnormalities increased the odds of single feeding and multiple regulatory problems from 1.53‐ to 1.64‐fold. Family adversity and psychosocial stress factors were associated with single crying and multiple regulatory problems. Conclusions Pre‐, peri‐ and post‐natal neurophysiological and psychosocial factors are predictive of single and multiple regulatory problems. The results may be useful in terms of early recognition of at risk groups for regulatory problems.     

High frequency-low morbidity mechanical complications of tube feeding: a prospective study

Because of preferential use of the enteral route for nutritional support, a prospective study of mechanical complications was done in 109 consecutive patients. One hundred seventy-two nasogastric tubes were placed in 60 patients, 42 esophagostomies in 28 patients, 32 gastrostomies in 22 patients and 9 jejunostomies in 8 patients. Data show that the use of enteral feeding tubes is not without complications. The complications fell into two major categories. There were 15 low frequency mechanical complications, of which four (2 carotid artery blowouts, 1 gastrointestinal perforation, and 1 aspiration) were of high morbidity and 11 of low morbidity. There were 132 high frequency-low morbidity complications with the use of 255 tubes. These consisted mainly of unplanned and untimely removal of feeding tubes with interruption of feedings and necessitating tube replacement. Data indicate that the main problems related to the use of enteral nutrition are not the dramatic complications which create notoriety but those related to the ordinary mechanical complications occurring daily and which command little attention because of their low mortality. These can assume importance because of their high frequency and as such are characterized as high frequency-low morbidity complications.     

轮状病毒疫苗对婴儿轮状病毒肠炎的影响

目的 观察轮状病毒疫苗对预防婴儿轮状病毒性肠炎的有效性和安全性.方法 将300名年龄为2个月～1岁的健康婴儿分为两组,疫苗组(n=150)给予口服轮状病毒疫苗,非疫苗组不予口服轮状病毒疫苗,跟踪随访两组婴儿,比较两组婴儿轮状病毒肠炎的发生率、严重病例比率及住院治疗比例.结果 疫苗组轮状病毒性肠炎发生率为11.27%,严重病例比率为4.93%,住院治疗比例为7.04%;非疫苗组轮状病毒性肠炎发生率为27.74%,严重病例比率为13.87%,住院治疗比例为16.06%,两组比较有显著性差异(χ2值分别为11.11、6.59、5.58,均P<0.05).疫苗组未发现严重不良反应.结论 轮状病毒疫苗可减少小儿轮状病毒性肠炎的发病率,减轻病情的严重性,减少住院比例,且使用该疫苗较为安全.口服轮状病毒疫苗可减轻轮状病毒性肠炎对家庭和社会造成的经济负担.     

早期喂养方式对2岁以下婴幼儿肥胖影响的纵向研究

【目的】 探讨早期喂养方式对婴幼儿肥胖发生及转归的影响,为临床有效预防提供策略。 【方法】 回顾调查522名在南京市妇幼保健院儿保科体检的2岁儿童,按其0~4个月喂养方式不同分成母乳喂养组与人工喂养组,比较两组儿童在不同月龄(3、6、9、12、18及24个月)时超重及肥胖的发生率;并纵向观察3月龄组超重及肥胖儿童随月龄增长超重及肥胖的转归情况。 【结果】 人工喂养组儿童各月龄肥胖发生率、超重加肥胖发生率呈先递增后递减趋势,母乳喂养组则呈现随月龄增加递减趋势。其中18月龄母乳喂养组儿童肥胖发生率显著低于人工喂养组,12、24月龄母乳喂养组儿童超重加肥胖发生率显著低于人工喂养组(P＜0.05);两组中3月龄发生超重及肥胖的儿童在后期各月龄肥胖发生率逐渐下降,以母乳喂养组下降更明显(P＜0.05)。 【结论】 早期母乳喂养对2岁以内儿童超重及肥胖的发生有保护作用;母乳喂养对早期超重及肥胖儿童后期超重及肥胖的发生亦有保护作用。     

艾滋病病毒与婴儿喂养研究

母婴传播是艾滋病的重要传播途径之一,是儿童感染艾滋病病毒的最主要途径.婴儿喂养方式对艾滋病病毒的母婴传播产生着重要的影响,同时也影响着艾滋病病毒感染母亲所生婴儿的生存状况.该文从艾滋病病毒感染母亲对婴儿喂养方式的选择意愿、不同喂养方式、婴儿生存状况、母乳喂养与艾滋病病毒母婴传播率及对人工喂养安全性评价等方面,介绍了目前国际上对艾滋病病毒感染母亲所生婴儿喂养方面研究的进展,为基层向艾滋病病毒感染母亲传递婴儿喂养方面的信息提供参考.     

Modeling the effects of different infant feeding strategies on infant survival and mother-to-child transmission of HIV

OBJECTIVES: We investigated how, under various conditions, the risk of mother-to-child transmission of HIV through breastfeeding compares with the risk of death from artificial feeding. METHODS: We developed a spreadsheet simulation model to predict HIV-free survival during 7 age intervals from 0 to 24 months for 5 different infant feeding scenarios in resource-poor settings. RESULTS: Compared with artificial feeding, breastfeeding during the first 6 months by HIV-positive mothers increases HIV-free survival by 32 per 1000 live births. After 6 months, as the age-specific mortality rate and risk of death caused by replacement feeding both decline, replacement feeding appears to be safer. CONCLUSIONS: Under conditions common in countries with high HIV prevalence, replacement feeding by HIV-infected mothers should not be generally encouraged until after the infant is approximately 6 months old.     

Breast feeding and cognitive development in childhood: a prospective birth cohort study

The aim of this study was to examine prospectively the relation between duration of breast feeding and cognitive outcomes. A cohort study of 2860 children enrolled before birth provided data from 2393 term infants of English-speaking mothers. Of these, complete infant feeding data in the first year of life and verbal cognitive IQ (Peabody Picture Vocabulary Test - PPVT-R) were available for 1450 children at 6 years, and a performance subtest (Perceptual organisation WISC - Block Design) for 1375 children at 8 years. Full breast feeding was categorised as none,> 0 to < 4 months, 4-6 months and> 6 months. Associations between breast-feeding duration and PPVT-R at 6 years and Block Design at 8 years were estimated before and after adjustment for gender, gestational age, maternal age, maternal education, parental smoking and the presence of older siblings. The early cessation of full breast feeding was associated with reduced verbal IQ and the performance subtest. In unadjusted analysis, mean standardised PPVT-R scores were 6.44 points greater (P < 0.0001) in children fully breast fed for> 6 months compared with those never breast fed. After adjustment, mean PPVT-R scores were 3.56 points higher in children fully breast fed for> 6 months compared with those children never breast fed (P = 0.003). Similarly, Block Design scores were higher in those fully breast fed for> 6 months compared with those never breast fed in unadjusted (P = 0.001) but not adjusted analyses (P = 0.223). Interactions between maternal education (four levels) and breast feeding demonstrated a positive association of maternal education on verbal IQ (F = 2.64; P = 0.005) in children breast fed for longer but not on performance (F = 0.74; P = 0.67). The early introduction of milk other than breast milk was associated with reduced verbal IQ after adjustment for social and perinatal confounders. Although these effects were interacting with maternal education, they may act through undefined mechanisms in human milk.     

The effects of non-response in a prospective study of cancer: 15-year follow-up

Out of 11,136 Japanese men identified on the island of Oahu, Hawaii in 1965 by the Honolulu Heart Program, 8006 responded to a mailed questionnaire and were examined. Some 1871 responded only to the mailed questionnaire, and 1259 did not respond at all. After 15 years of follow-up, the examined men had significantly lower risk of death from all causes and death from cancer. Minor differences were also noted between the two groups in the risk of cancer of the lung, stomach, colon, and rectum. However, the examined men had a significantly higher risk of prostate cancer. In general, the strength of these non-response effects was mainly due to risk differences in the first five years of the 15-year follow-up period. The relative risk (RR) of each of the seven endpoint events tended towards 1.0 as each of the three successive five-year follow-up intervals were considered. An exception to this was the prostate cancer incidence RR which favoured the unexamined men throughout the entire 15 years, but significantly so only in the last five-year follow-up interval. When the 8006 examined and 1871 unexamined men who responded to the mailed questionnaire were evaluated with respect to the association of cigarette smoking with lung cancer incidence, the RR for smokers was 9.77 for the examined men, and 6.73 for the unexamined men. Since these RRs are not significantly different, there should be little bias in RR estimates of cigarette smoking for lung cancer if the observation was limited to only the examined men. With regard to the association of body mass index (BMI) with colon cancer in older men, the RRs for men in the highest BMI quintile were quite comparable, at 1.37 for the examined group and 1.60 for the unexamined men. We conclude that although some non-response effects on cancer incidence exist in this cohort, they do not appear to be serious enough to have changed conclusions drawn about risk relationships.     

Maternal cognitions, psychopathologic symptoms, and infant temperament as predictors of early infant feeding problems: a longitudinal study

OBJECTIVE: The current study examined the contribution of prenatal and postnatal maternal core beliefs, self-esteem, psychopathologic symptoms, and postnatal infant temperament to the prediction of infant feeding difficulties. METHOD: Ninety-nine women completed questionnaires assessing their core beliefs, psychopathology, and self-esteem during pregnancy and at 6 months postpartum. At 6 months, mothers also rated their infant's temperament and feeding, and were ob-served feeding their infants. RESULTS: Maternal reports of child feeding difficulties were predicted by higher levels of emotional deprivation and entitlement core beliefs and lower levels of self-sacrifice and enmeshment core beliefs during pregnancy. Postnatal social isolation core beliefs, lower maternal self-esteem, and more difficult infant temperament added significantly to the variance explained by prenatal factors. Maternal core beliefs, self-esteem, psychopathology, and infant temperament failed to significantly predict independent observations of child food refusal. CONCLUSION: Maternal cognitions are implicated in the development of maternal reports of feeding difficulty.     

Association between maternal antenatal depression and infant development: a hospital-based prospective cohort study

Objective

To examine the association between antenatal depression and infant development after controlling for confounding factors.

Methods

A hospital-based prospective cohort study (Hokkaido Study on Environment and Children’s Health) was conducted between July 2002 and October 2005 in Sapporo, Japan. Of 309 mothers who delivered at Sapporo Toho Hospital during the study period and who agreed with the clinical assessment of depression, 154 mother–infant pairs were eligible for analysis. Antenatal depression was assessed between the second and third trimesters using the Edinburgh Postnatal Depression Scale (EPDS), and infant development was assessed at 6 months by the Bayley Scales of Infant Development II (BSID-II). Data on potential confounders, including socioeconomic status, birth complications, postnatal depression and child care environment, were obtained from medical records and self-administered questionnaires. Univariable and multivariable analyses were conducted in which the EPDS score was entered as an independent variable and the BSID-II scores as a dependent variable, adjusting for confounders.

Results

Although the antenatal EPDS score tended to be related to the BSID-II score in the univariable analysis, this correlation was lost in the multivariable analysis. However, based on a series of linear regression analyses, antenatal depression was found to be significantly related to shorter gestational age (β = −0.25, 95 % confidence interval (CI) [−1.20, −0.17]), and shorter gestational age was significantly related to a lower BSID-II (mental development) score (β = 0.23, 95 % CI [0.00, 0.00]).

Conclusions

Gestational age is an important confounder in the association between maternal antenatal depression and infant development. A delay in infant development may be related to a shorter gestational period caused by maternal depression during pregnancy.     

Certain aspects of infant mortality -- a prospective study in a rural community

A prospective study on infant mortality was conducted in the field practice area of Rural Health Training Center (RHTC), Jawan, Aligarh. A sample of 1792 registered families in 9 villages under RHTC with a population of 12,118 were selected. The household survey was done in March 1989 by a questionnaire on type and composition of family, socioeconomic status, family environment, age, parity, and interval between the births. All live births and infant deaths in these villages during the period of April 1989 to March 1990 were considered. There were 416 births in the study year, giving a birth rate of 34.02/1000 mid-year population. Male and female births were 52.8% and 47.12%, respectively. 33 infants died during the period, giving an infant mortality rate of 79.32/1000 live births. Infant deaths equalled 39.4% for males and 60.6% for females. Neonatal and postneonatal deaths made up 63.6% and 36.4%, respectively. 33.3% of the neonatal deaths occurred in the first 24 hours, 23.8% in the next 6 days, and 42.9% beyond this period. The mortality risk was high in 5th and higher parity births and lowest in 2nd to 4th parity births. Diarrhea (21.2%), pneumonia (18.18%), tetanus (15.15%), prematurity (9.1%), and unqualified fever (9.1%) constituted main causes of infant death. Pneumonia and prematurity were responsible for more than 70% of infant deaths. In the 2nd to 4th parity groups, diarrhea and tetanus were the main causes. Deaths during the first 24 hours were mainly caused by birth injury, while, during the next 6 days, pneumonia and tetanus were the leading causes. Beyond this period, in addition to the above causes, diarrhea played a major role. In the postnatal period, diarrhea, pneumonia, and malnutrition were the main causes. To reduce infant mortality further, training of health workers, strengthening of delivery systems, maximum utilization of existing health infrastructure, environmental hygiene and health education regarding oral rehydration, and control of respiratory infection are needed.     

The effects of occupational exposure to chlorpyrifos on the peripheral nervous system: a prospective cohort study

Aims: To determine whether chronic occupational exposure to chlorpyrifos at levels associated with various aspects of manufacturing produced a clinically evident or subclinical peripheral neuropathy.

Methods: Clinical and quantitative nerve conduction study (NCS) examinations were performed on two occasions on chlorpyrifos manufacturing workers who had measurable chlorpyrifos exposure and a referent group. Baseline evaluations were performed on 53 of 66 eligible chlorpyrifos subjects and on 60 of 74 eligible referent subjects; one-year evaluations were completed on 111 of the 113 subjects evaluated at baseline.

Results: Chlorpyrifos and referent groups differed significantly in measures of 3,5,6 trichloro-2-pyridinol excretion and plasma butyrylcholinesterase (BuChE) activity, indicating substantially higher exposures among chlorpyrifos subjects. Few subjects had clinically important neurological symptoms or signs. NCS results were comparable to control values, and there were no significant group differences in NCS results at baseline, one year, or change over one year. No chlorpyrifos subject fulfilled conventional criteria for confirmed peripheral neuropathy at baseline or one-year examinations. The odds ratios for developing any diagnosable level of peripheral neuropathy among the chlorpyrifos subjects was not increased at baseline or at one year compared to referents at baseline. Mixed regression models used to evaluate subclinical group-by-time interactions showed numerous significant NCS differences attributable to near-nerve temperature differences among all subjects between the baseline and one-year examinations, but only a few disparate effects related to group.

Conclusions: Chronic chlorpyrifos exposure during the manufacturing process sufficient to produce biological effects on BuChE activity was not associated with clinically evident or subclinical peripheral neuropathy at baseline or with measurable deterioration among chlorpyrifos subjects compared to referents after one year of additional exposure.