Risk factors for neonatal seizures: a population-based study, Harris County, Texas, 1992-1994.

Risk factors for neonatal seizures were evaluated in 116,048 infants born between 1992 and 1994 to residents of Harris County, Texas; 207 of these infants were diagnosed with clinical neonatal seizures. Information was obtained from the infant's birth certificate to assess the relation between seizures and birth weight, gender, ethnicity, place of birth, mother's age, method of delivery, parity, and multiple births. These factors were evaluated by univariate and multivariate analysis using logistic regression. For preterm infants, a birth weight of <1,500 g was the strongest risk factor (relative risk (RR) = 9.1, 95% confidence interval (CI): 4.7, 17.5), followed by birth in a private/university hospital (RR = 2.8, 95% CI: 1.5, 5.0) and male gender (RR = 1.8, 95% CI: 1.0, 3.4). For term infants, significant risk factors included birth by cesarean section (RR = 2.2, 95% CI: 1.5, 3.2), small birth weight for gestational age (RR = 1.9, 95% CI: 1.2, 2.9), birth in a private/university hospital (RR = 1.8, 95% CI: 1.1, 3.0), and maternal age of 18-24 compared with 25-29 years (RR = 1.6, 95% CI: 1.1, 2.3). Birth by assisted vaginal delivery and primiparity were marginally significant for term infants. Birth weight is a significant risk factor for neonatal seizures. The role of perinatal complications warrants further evaluation.     

Correlates of breast-feeding in a low-income population of whites, blacks, and southeast Asians

Infant feeding was examined in 492 children in a population-based survey conducted in a low-income, urban county of St Paul, Minn. Of 41 Southeast Asian infants who were foreign born, 93% (38) had been breast-fed compared with 10% (12) of Southeast Asian infants born in the United States (n = 116). Among non-Southeast Asian infants, 73% (173) of whites (n = 237), 63% (27) of blacks (n = 43) and 65% (36) of other ethnic groups (n = 55) had been breast-fed. Among the non-Southeast Asian infants, the initiation of breast-feeding was associated with higher parental education and with being married. Ethnic group, level of poverty, and participation in the Supplemental Food Program for Women, Infants, and Children during pregnancy did not appear to influence the initiation of breast-feeding. The findings indicate a higher incidence of breast-feeding than in previous surveys of low-income black and white women; however, this may reflect the higher educational level of the non-Southeast Asian study population. In contrast, the sharp decline in the incidence of breast-feeding among Southeast Asian infants who were born in the United States compared with those who were foreign born indicates the need for public health approaches to strengthen traditional breast-feeding practices.     

Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review

Background

Early breastfeeding is defined as the initiation of breastfeeding within twenty four hours of birth. While the benefits of breastfeeding have been known for decades, only recently has the role of time to initiation of breastfeeding in neonatal mortality and morbidity been assessed.

Objective

To review the evidence for early breastfeeding initiation practices and to estimate the association between timing and neonatal outcomes.

Methods

We systematically reviewed multiple databases from 1963 to 2011. Standardized abstraction tables were used and quality was assessed for each study utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Three meta-analyses were conducted for mortality among babies surviving to 48 hours.

Results

We identified 18 studies reporting a direct association between early breastfeeding initiation and neonatal mortality and morbidity outcomes. The results of random effects analyses of data from 3 studies (from 5 publications) demonstrated lower risks of all-cause neonatal mortality among all live births (RR = 0.56 [95% CI: 0.40 – 0.79]) and among low birth weight babies (RR=0.58 [95% CI: 0.43 – 0.78]), and infection-related neonatal mortality (RR = 0.55 [95% CI: 0.36 – 0.84]). Among exclusively breastfed infants, all-cause mortality risk did not differ between early and late initiators (RR = 0.69 [95% CI: 0.27 – 1.75]).

Conclusions

This review demonstrates that early breastfeeding initiation is a simple intervention that has the potential to significantly improve neonatal outcomes and should be universally recommended. Significant gaps in knowledge are highlighted, revealing a need to prioritize additional high quality studies that further clarify the specific cause of death, as well as providing improved understanding of the independent or combined effects of early initiation and breastfeeding patterns.

     

Full breast-feeding for at least four months has differential effects on growth before and after six months of age among children in a Mexican community

This study examines the relationship between breast-feeding and growth from 0 to 6 and 6 to 20 mo among 185 children in a Mexican community. Infants from a previous 6-mo longitudinal study were followed up for additional anthropometric measurements at a mean age of 19.9 mo. Size at 6 mo and at follow-up were modeled as outcomes of whether infants were fully breast-fed (exclusively or predominantly breast-fed) for at least 4 mo, controlling for size at birth and 6 mo, respectively, and potential confounders. From birth to 6 mo, fully breast-fed infants had ponderal index increments of 0.07 units larger (P = 0.04) than comparison infants. There were no differences in weight. For length, an interaction between full breast-feeding and socioeconomic status (SES) was found, with fully breast-fed infants of low SES growing more than comparison infants, whereas the opposite was seen at upper SES levels. From 6 to 20 mo, fully breast-fed infants had weight and length increments of 0.53 cm (P < 0.001) and 0.72 kg (P = 0.01) smaller than those of comparison infants. For ponderal index, an interaction between mother's education and breast-feeding revealed an inverted U-shaped response across levels of education. Additionally, logistic regressions of monthly breast-feeding on lagged measurements revealed that relatively heavier infants had higher odds of being fully breast-fed at 2 and 3 mo. Our findings indicate that the benefits of full breast-feeding on growth may be most pronounced early in life. Further research of unmeasured confounders may explain the association of full breast-feeding with slower growth beyond 6 mo.     

Infant feeding patterns during the first year of life in Denmark: Factors associated with the discontinuation of breast-feeding

We prospectively studied 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, over the first 12 months of life using a detailed monthly mailed questionnaire (overall response RATE = 73%) which focused on feeding practices and illnesses. Seventy-seven percent of respondents breast-fed their infants at 1 month of life compared to 19% at 12 months of life. Analysis of breast-feeding behavior using survival analysis showed that 50% of the mothers who breast-fed since the first month of their infant's life were still breast-feeding at 7 months of life. Also, there was a greater than two-fold increase in the rate of discontinuation of breast-feeding for infants in daycare compared to infants not attending daycare (RR = 2.08, 95% CI = 1.43, 3.01). Discontinuation of breast-feeding was not significantly associated with the number of children in the family or with social class.

These results give insight into infant feeding patterns in a developed country and suggest that: (1) breast-feeding is the dominant method of feeding during the infant's first year of life, and (2) the rate of discontinuation of breast-feeding is increased by the entry of these infants into daycare.     

早产儿早期神经心理发育的影响因素研究

目的 探讨早产儿神经心理发育情况及其影响因素,为早产儿保健提供指导。方法 对859例早产儿进行定期随访和早期家庭干预,矫正6月龄时应用贝利婴幼儿发育量表（bayley scales of infant development,BSID-I）进行评估,采用多元线性回归模型进行影响因素分析。结果 早产儿矫正6月龄智力和运动发育迟缓率分别为2.4%和3.4%。出生体重 ≥ 2 000 g、家庭月收入5 000元及以上、前六个月纯母乳喂养者,智力发育较好（均有P<0.05）;家庭月收入5 000元及以上、前六个月纯母乳喂养、完成早期家庭干预者,运动发育较好（均有P<0.05）。多元线性回归模型结果显示,智力发育与前六个月纯母乳喂养（β=2.827,95%CI:0.348~5.305）、较高出生体重（β=4.030,95%CI:1.351~6.710）和较高家庭月收入（β=2.909,95%CI:0.352~5.465）呈正相关;运动发育与完成早期家庭干预（β=2.331,95%CI:0.146~4.516）和较高家庭月收入（β=2.848,95%CI:0.156~5.541）呈正相关。结论 前六个月纯母乳喂养和早期家庭干预能够促进早产儿神经心理发育,建议更加关注低出生体重和家庭收入较低的早产儿的神经心理发育。     

#14-S breast-feeding and risk of childhood acute lymphoblastic leukemia: Results and commentary from a case-control study

PURPOSE: To test the hypothesis that breast-feeding mediates the occurrence of childhood ALL as a result of a rare, abnormal response to a common infection in the Northern California Childhood Leukemia Study.METHODS: Incident cases of leukemia (age 0–14) were rapidly ascertained from 1995-1999. Controls were randomly selected from the statewide birth registry and were 1:1 matched to cases on date of birth, sex, maternal race, maternal “Hispanicity,” and maternal county of residence at birth. Breast-feeding data were obtained by self-administered questionnaire and in-home interviews. Using conditional logistic regression adjusting for household income and birth weight, 140 case-control pairs were analyzed.RESULTS: Compared to no breast-feeding, breast-feeding showed a non-significant, higher risk of ALL: ever breast-fed (odds ratio (OR) = 1.16; 95% confidence interval (CI): 0.58–2.33), breast-fed ⩽6 months (OR = 1.04; 95% CI: 0.48–2.28), and breast-fed >6 months (OR = 1.31; 95% CI: 0.59-2.91). Compared to formula-fed only, breast-feeding exclusively produced no discernible pattern in ALL risk: ⩽3 months (OR = 0.85; 95% CI: 0.37–1.96), 4–6 months (OR = 1.80; 95% CI: 0.68–4.75), 7–12 months (OR = 1.23; 95% CI: 0.49–3.05), and ⩾3 months (OR = 0.81; 95% CI: 0.24–2.79).CONCLUSION: In the current literature on breast-feeding and its role in mediating childhood ALL, two recent large studies were conducted in the United States and the United Kingdom. Both studies drew differing conclusions on the effect of breast-feeding on childhood ALL. Although this study was comparatively smaller, the results do suggest further methods of elucidating the role of breast-feeding in the occurrence of childhood ALL via an infectious pathway.     

Maternal Intake of Cruciferous Vegetables and Other Foods and Colic Symptoms in Exclusively Breast-Fed Infants

Objective We sought to assess relationships among components of maternal diet and the presence of colic symptoms among exclusively breast-fed infants aged ≤4 months.Design Data were collected by means of a mailed questionnaire that solicited information on the presence of symptoms of colic in infants and maternal intake of 15 foods (including four cruciferous vegetables) during the week before completion of the questionnaire.Subjects Exclusively breast-feeding women (n=272) and their 273 infants aged ≤4 months.Statistical analyses performed Dietary variables were analyzed categorically by logistic regression. Two-by-two tables were used to calculate relative risks.Results Relative risks (RRs) and 95% confidence intervals (CIs) for colic symptoms by food items the mothers consumed ranged from 0.7 (CI=0.3 to 1.5) for beef to 2.0 (01=1.1 to 3.5) for cow's milk. Maternal intake of cabbage (RR=1.3, CI=1.1 to 1.5), cauliflower (RR=1.2, CI=1.0 to 1.4), broccoli (RR=1.3, CI=1.0 to 2.2), cow's milk (RR=2.0, CI=1.1 to 3.5), onion (RR=1.7, CI=1.1 to 2.5), and chocolate (RR=1.5, CI=1.0 to 2.2) were significantly related to colic symptoms. Maternal intake of more than one cruciferous vegetable was associated with an RR of 1.6 (CI=1.1 to 2.4) for infants experiencing one or more colic symptoms.Conclusion Results of this study provide initial evidence that maternal intake of cruciferous vegetables, cow's milk, onion, or chocolate during exclusive breast-feeding is associated with colic symptoms in young infants. J Am Diet Assoc. 1996; 96:47-48.     

人类免疫缺陷病毒感染孕产妇所产婴儿死亡的影响因素分析

目的 了解我国获得性免疫缺陷综合征(AIDS)高流行地区人类免疫缺陷病毒(HIV)感染孕产妇所产婴儿死亡的影响因素.方法 结合2004年建立的HIV感染孕产妇及所产婴儿随访研究队列,于2008年8-11月对我国4省7县区2004年1月至2007年11月HIV感染孕产妇所产婴儿的死亡状况及其影响因素进行调查.实际收集了498对HIV感染孕产妇及所产婴儿的相关信息.采用单因素和多因素Cox比例风险模型对HIV感染孕产妇所产婴儿死亡的影响因素进行分析.结果 498名婴儿,总观察人年数为406.22人年,死亡45例,死亡密度为110.78/1000人年.单因素分析结果显示,母亲孕产期处于AIDS前期或发病期(RR=1.971,95%CI值:1.143～3.396)、孕产妇生存状况(RR=3.062,95%CI值:1.097～8.550)、经产妇(RR=0.517,95%CI值:0.278～0.961)、自然分娩(RR=0.561,95%CI值:0.345～0.910)、早产(RR=5.302,95%CI值:2.944～9.547)、低出生体重(RR=4.920,95%CI值:2.691～8.994)、母子预防性服用抗逆转录病毒药物(RR=0.227,95%CI值:0.121～0.428)及婴儿感染HIV(RR=5.870,95%CI值:3.232～10.660)等因素影响HIV感染孕产妇所产婴儿的死亡.进一步的多因素分析显示,处于AIDS前期或发病期的孕产妇较处于AIDS潜伏期者所产婴儿死亡危险增加(RR=6.99,95%CI值:1.92～25.64);孕产期CD4~+T淋巴细胞计数低于200个/μl的孕产妇,所产婴儿发生死亡的危险增加(RR=2.05,95%CI值:1.01～4.15);母子未预防性服用抗逆转录病毒药物增加婴儿死亡的危险(RR=6.17,95%CI值:1.62～23.26);早产婴儿死亡危险是足月产婴儿的2.87倍(95%CI值:1.12～7.35);HIV感染婴儿死亡危险是非HIV感染婴儿的9.87倍(95%CI值:3.81～25.62).结论 提高HIV感染孕产妇自身免疫力,降低HIV母婴传播率及HIV感染孕产妇所产婴儿早产、低出生体重的发生率有助于降低婴儿死亡率.     

No fathers' names: a risk factor for infant mortality in the State of Georgia, USA

Many studies have explored maternal and infant factors as risks for infant mortality, but little attention is given to paternal factors. In Georgia, listing a father's name on the birth certificate is optional for married couples and possible after paternal acknowledgment for unmarried couples. The authors evaluated father's name reporting as a paternity measure and risk for infant mortality. Using the linked 1989-1990 birth and death certificates of singleton Georgia infants to calculate relative risks (RRs), infant mortality rates for 38,943 infants with no father's names listed were compared to rates for 178,100 with father's names listed. Compared with the rate for married women listing names, the death rates were higher for unmarried mothers not listing fathers (relative risk, RR = 2.5; 95% CI 2.3-2.7), unmarried mothers listing fathers (RR = 1.4; 95% CI 1.3-1.6), and married women not listing fathers (RR = 2.3; 95% CI 1.6-3.1). Increased risks remained after stratifying by maternal race, age, adequacy of prenatal care and medical risks; and congenital malformations, birthweight, gestational age, and small-for-gestational age. Using logistic regression to examine for effect modification and to adjust for these factors together, the adjusted relative risks for death varied across different groups without fathers' names, regardless of marital status. For example, it remained statistically higher for infants with no father listed and without effect-modifying conditions such as low birthweight (estimated RR = 2.0; 95% CI 1.6-2.4). Although these findings suggest paternal involvement, as measured by listing fathers' names, is protective against low birthweight and infant mortality, further evaluation is needed.     

Breast-feeding and weight change in newborns in Jamaica

This study was conducted to examine weight change of exclusively breast-fed infants during the first week and through the first 24 days of life, and to evaluate the effect of breast-feeding factors and maternal characteristics on early weight change in the infants. The weights of 21 infants were recorded on day 1 (day of birth), and on days 3, 7, 10, 17, and 24, and the data analysed to evaluate weight change over the period. Multiple regression analysis was used to assess whether birth weight as well as maternal and breast-feeding factors were significant predictors of weight on day 24. Nineteen of the 21 infants gained weight between days 1 and 3, and 20 infants gained weight between days 3 and 7. All infants gained weight over the 24-day period and their weights at day 7 and day 24 were significantly different (P < 0.05 and P < 0.01, respectively) from their birth weights. Multiple linear regression analysis showed that significant (P < 0.01) predictors of weight gain by day 24 included birth weight, mother's educational level, whether the baby cried before feeding, and length of feeding time periods. This is the first study of weight change in the early days and weeks of life of exclusively breast-fed newborn infants in Jamaica. The infants showed significant weight gain during the study period and weight gain was affected by certain maternal and breast-feeding factors.     

Breast-feeding and cognitive development: a meta-analysis.

BACKGROUND: Although the results of many clinical studies suggest that breast-fed children score higher on tests of cognitive function than do formula-fed children, some investigators have suggested that these differences are related to confounding covariables such as socioeconomic status or maternal education. OBJECTIVE: Our objective was to conduct a meta-analysis of observed differences in cognitive development between breast-fed and formula-fed children. DESIGN: In this meta-analysis we defined the effect estimate as the mean difference in cognitive function between breast-fed and formula-fed groups and calculated average effects using fixed-effects and random-effects models. RESULTS: Of 20 studies meeting initial inclusion criteria, 11 studies controlled for >/=5 covariates and presented unadjusted and adjusted results. An unadjusted benefit of 5.32 (95% CI: 4.51, 6.14) points in cognitive function was observed for breast-fed compared with formula-fed children. After adjustment for covariates, the increment in cognitive function was 3.16 (95% CI: 2.35, 3.98) points. This adjusted difference was significant and homogeneous. Significantly higher levels of cognitive function were seen in breast-fed than in formula-fed children at 6-23 mo of age and these differences were stable across successive ages. Low-birth-weight infants showed larger differences (5.18 points; 95% CI: 3.59, 6.77) than did normal-birth-weight infants (2.66 points; 95% CI: 2.15, 3.17) suggesting that premature infants derive more benefits in cognitive development from breast milk than do full-term infants. Finally, the cognitive developmental benefits of breast-feeding increased with duration. CONCLUSION: This meta-analysis indicated that, after adjustment for appropriate key cofactors, breast-feeding was associated with significantly higher scores for cognitive development than was formula feeding.     

Do early infant feeding patterns relate to breast-feeding continuation and weight gain? Data from a longitudinal cohort study

OBJECTIVES: To describe the first-week feeding patterns for breast- vs bottle-fed babies, and their association with sustained breast-feeding and infant weight gain at 6 weeks. DESIGN: A longitudinal cohort study. SETTING: Feeding diaries were completed by mothers in an urban UK community shortly after birth; follow-up weight and feeding data were collected at routine health checks. SUBJECTS: Mothers of 923 full-term infants born during the recruiting period agreed to join the study. In all, 502 usable diaries were returned from 54% of the cohort. RESULTS: Breast-fed infants were fed more frequently (2.71 h between feeds) than bottle-fed infants (3.25 h between feeds) and mixed-fed infants (3.14 h between feeds) (P<0.001) in the first week of life, while duration of feeds was similar. Only exclusive breast-feeding in the first week (P<0.001) and maternal education (P=0.004) were related to continued breast-feeding at 6 weeks. Greater first-week feeding frequency (as measured by feed-to-feed interval, h) was associated with higher weight gain at 6 weeks for breast-feeders, but no analysed factors were associated with higher weight gain for bottle-feeders. CONCLUSIONS: This large-scale study of first-week feeding patterns sheds light on the important and complicated issues of breast-feeding continuation and infant weight gain, with implications for the feeding advice given to mothers. Supplementary bottle feeds were clearly associated with discontinued breast-feeding at 6 weeks. Over that period, higher weight gain was associated with more frequent feeding for breast-fed infants only. SPONSORSHIP: Henry Smith Charity, SPARKS, Child Growth Foundation.     

Maternal night blindness during pregnancy is associated with low birthweight, morbidity, and poor growth in South India

Maternal night blindness is common during pregnancy in many developing countries. Previous studies have demonstrated important consequences of maternal night blindness during pregnancy on the health of the mother and newborn infant. We compared birthweight, 6-mo infant mortality, morbidity, and growth among infants of women who did and did not report a history of night blindness from a community-based, randomized trial of newborn vitamin A supplementation in south India. Birthweight was measured within 72 h of delivery. Infants were followed until 6 mo of age for mortality and morbidity was assessed at household visits every 2 wk. Anthropometry was assessed at 6 mo of age. A total of 12,829 live-born infants were included, 680 of whom were infants of mothers with night blindness during the index pregnancy. Maternal night blindness was associated with an increased risk of low birthweight in a dose-dependent fashion based on birthweight cut-offs: <2500 g, adjusted relative risk (RR) = 1.13 (95% CI = 1.01, 1.26); <2000 g, adjusted RR = 1.70 (95% CI = 1.27, 2.26); <1500 g, adjusted RR = 3.38 (95% CI = 1.18, 6.33); with an increased risk of diarrhea (adjusted RR = 1.16, 95% CI = 1.03, 1.30), dysentery (adjusted RR = 1.25, 95% CI = 1.03, 1.53), acute respiratory illness (adjusted RR = 1.32, 95% CI = 1.21, 1.44), and poor growth at 6 mo; underweight (adjusted RR = 1.14, 95% CI = 1.02, 1.26), stunting (adjusted RR = 1.19, 95% CI = 1.05, 1.34). Maternal night blindness was not associated with 6-mo infant mortality or wasting at 6 mo. This study demonstrates that there are important consequences to the infant of maternal vitamin A deficiency during pregnancy.     

Newborn tongue-tie: prevalence and effect on breast-feeding

OBJECTIVE: The purposes of this study were: (1) to determine whether breast-fed infants with tongue-tie have decreased rates of breast-feeding at 1 week and 1 month of age, (2) to determine the prevalence of tongue-tie, and (3) to test the usefulness of the Assessment Tool for Lingual Frenulum Function (ATLFF) in assessing the severity of tongue-tie in breast-feeding newborns. METHODS: A case-control design was used. All infants in the Regions Hospital newborn nursery were examined for tongue-tie. Tongue-tied babies were examined using the ATLFF. Two breast-feeding babies with normal tongues were identified and matched for each case. Mothers were interviewed when the babies were 1 week and 1 month old. RESULTS: The prevalence of tongue-tie was 4.2%. Forty-nine tongue-tied and 98 control infants were enrolled. Tongue-tied babies were 3 times as likely as control babies to be bottle fed only at 1 week [risk ratio (RR), 3.11; 95% confidence interval (CI), 1.21, 8.03) By 1 month, tongue-tied babies were as likely as controls to be bottle fed only. (RR, 1.00; 95% CI, 0.55, 1.82) Twelve of the tongue-tied infants had ATLFF scores of "Perfect," none had scores of "Acceptable," and 6 had scores of "Function Impaired." The remaining 31 infants had scores that fell into none of these categories. CONCLUSIONS: Tongue-tie is a relatively common condition in newborns. Affected infants are significantly more likely to be exclusively bottle-fed by 1 week of age. The ATLFF was not a useful tool to identify which tongue-tied infants are at risk for breast-feeding problems.     

Maternal,paternal and environmental tobacco smoking and breast feeding

The effects of environmental tobacco smoke (ETS) on breast-feeding patterns are poorly understood, while those of parental smoking on breast-feeding initiation vs. duration have not been clearly delineated. We conducted a prospective, population-based birth cohort study to examine the independent effects of maternal, paternal and ETS on breast-feeding initiation and duration. A total of 6747 Hong Kong Chinese infants were recruited and followed up in 1997-8. We obtained detailed household smoking history and recorded breast-feeding patterns in three follow-up interviews over 9 months. We found that both maternal and paternal smoking were associated with not initiating breast feeding (odds ratio [OR] for ever maternal smoking = 2.51, 95% confidence interval [CI] = 1.63, 3.86; OR for ever paternal smoking = 1.22, 95% CI = 1.08, 1.39). Exposure to ETS in utero and post partum were also related to not starting breast feeding (OR(ETS in utero) = 1.10, 95% CI = 0.99,1.24; OR(ETS post partum) = 1.21, 95% CI = 1.08, 1.36). These effects, however, did not persist for breast-feeding duration of < or = 4 months. Cox proportional hazards modelling confirmed the lack of association between any form of smoking and breast-feeding duration. Our findings suggest that smoking of any kind, during or after pregnancy, is a strong risk indicator for not initiating breast feeding. Smoking as a risk indicator for underlying socio-economic, demographic and psychosocial factors is probably responsible for most of the observed adverse effects, although we cannot rule out direct contributions from pathophysiological mechanisms. Public health strategies directed at these underlying factors should be vigorously pursued to reduce the adverse effects of tobacco on breast feeding and infant health in general.     

Health consequences of breast-feeding: doctors' visits and hospitalizations during the first 18 months of life in Hong Kong Chinese infants

BACKGROUND: The evidence on whether breast-feeding reduces health services use in nonwhite infants is scant. We examined the effects of breast-feeding on health services utilization in Hong Kong Chinese infants. METHODS: We followed a population-based cohort of 8327 infants born in 1997 for 18 months. The main outcome measures were higher (above the sample mean) utilization of outpatient visits and hospitalizations for jaundice, gastrointestinal or respiratory/febrile illnesses, and all illnesses. RESULTS: Breast-fed infants had fewer illness-related doctor visits overall through the first 18 months of life. Results were strongest for infants breast fed exclusively for 2 to 3 months (odds ratio [OR] for higher utilization = 0.78; 95% confidence interval [CI] = 0.62-0.99) and for 4 or more months (0.65; 0.53-0.81). However, breast-fed infants were more likely to receive outpatient care for jaundice, particularly in the first 3 months of life (ORs ranging from 2.5 to 8.4). Any breast-feeding was also associated with more jaundice-related hospital admissions, the effects of which were most acute in the first 3 months of life. Compared with exclusively formula-fed infants, the OR (CI) for mixed breast- and formula-fed was 2.4 (1.7-3.5); for exclusive breast-feeding up to 1 month, 4.5 (2.7-7.6); for exclusive breast-feeding 2 to 3 months, 3.2 (1.8-5.7); and for exclusive breast-feeding 4 or more months, 3.4 (2.0-5.7). CONCLUSIONS: Breast-feeding in Hong Kong Chinese infants reduces doctor visits overall, but increases both outpatient visits and hospitalizations for jaundice.     

Incidence and duration of breast-feeding in Mexican-American infants, 1970-1982

The Mexican-American component of the Hispanic Health and Nutrition Examination Survey (HHANES-MA) was used to examine the breast-feeding behavior of 2402 infants born between 1970 and 1982. The proportion of infants ever breast-fed increased substantially in recent years. Weighted proportions were 30.7% for 1970-1974, 38.1% for 1975-1978, and 47.6% for 1979-1982. By use of logistic regression models, children born into households with a college-educated head were shown to be more likely to be breast-fed than were other children; breast-feeding was also positively associated with birth weight. Infants in households for which the preferred interview language was Spanish were more likely to be breast-fed than were infants living in households for which the interview was conducted in English. Analysis of the factors influencing the distribution of weaning times among infants was less definitive because reported weaning times are heaped on multiples of 3 mo. The gathering of current-status, or status quo, information on infant feeding is urged for data collection in future studies.     

Risk factors for early infant mortality in Sarlahi district, Nepal

OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. METHODS: Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy.     

新生儿出生体重变化趋势及与分娩结局的关系

目的:分析新生儿出生体重变化趋势,探讨其与分娩结局的关系。方法:以海南某医院2005～2009年全部产科分娩病历为样本,分析新生儿体重变化及新生儿结局。结果:近5年新生儿出生体重平均值为(3 144.36 g±516.47)g,足月单胎出生体重平均值为(3 222.1 3 g±411.74)g,5年间不同年份相比较,出生体重平均值无统计学差异(F=1.321,P=0.26),5年低出生体重儿总数195例(8.1%),正常体重儿2 125例(87.8%),巨大胎儿99例(4.1%)。5年来低出生体重儿、正常体重儿、巨大胎儿的发生率保持平衡,无统计学差异(2χ=13.34,P=0.10)。低出生体重儿的1 m in窒息率与5 m in窒息率、新生儿死亡率均高于正常体重儿与巨大胎儿(2χ=26.45,P<0.05),正常体重儿与巨大胎儿之间1 m in窒息发生率无统计学差异(2χ=2.79,P=0.10),5 m in新生儿窒息发生率无统计学差异(2χ=2.39,P=0.15),新生儿死亡发生率无统计学差异(2χ=0.42,P=0.50)。结论:新生儿出生体重变化趋势平衡,低出生体重是导致新生儿窒息和死亡的主要危险因素。应着力于提高孕周,防止早产,提高新生儿存活率。