Effectiveness of a community‐based nutrition programme to improve child growth in rural Ethiopia: a cluster randomized trial

Few trials have shown that promoting complementary feeding among young children is effective in improving child linear growth in resource‐challenged settings. We designed a community‐based participatory nutrition promotion (CPNP) programme adapting a Positive Deviance/Hearth approach that engaged mothers in 2‐week nutrition sessions using the principles of ‘learning by doing’ around child feeding. We aimed to test the effectiveness of the CPNP for improving child growth in rural Ethiopia. A cluster randomized trial was implemented by adding the CPNP to the existing government nutrition programmes (six clusters) vs. government programmes only (six clusters). A total of 1790 children aged 6 to 12 months (876 in the intervention and 914 in the control areas) were enrolled and assessed on anthropometry every 3 months for a year. Multi‐level mixed‐effect regression analysis of longitudinal outcome data (n = 1475) examined the programme impact on growth, adjusting for clustering and enrollment characteristics. Compared with children 6 to 24 months of age in the control area, those in the intervention area had a greater increase in z scores for length‐for‐age [difference (diff): 0.021 z score/month, 95% CI: 0.008, 0.034] and weight‐for‐length (diff: 0.042 z score/month, 95% CI: 0.024, 0.059). At the end of the 12‐month follow‐up, children in the intervention area showed an 8.1% (P = 0.02) and 6.3% (P = 0.046) lower prevalence of stunting and underweight, respectively, after controlling for differences in the prevalence at enrollment, compared with the control group. A novel CPNP programme was effective in improving child growth and reducing undernutrition in this setting. © 2016 John Wiley & Sons Ltd     

Association between breast milk intake at 9–10 months of age and growth and development among Malawian young children

World Health Organization recommends exclusive breastfeeding for infants for the first 6 months of life, followed by introduction of nutritious complementary foods alongside breastfeeding. Breast milk remains a significant source of nourishment in the second half of infancy and beyond; however, it is not clear whether more breast milk is always better. The present study was designed to determine the association between amount of breast milk intake at 9–10 months of age and infant growth and development by 12–18 months of age. The study was nested in a randomized controlled trial conducted in Malawi. Regression analysis was used to determine associations between breast milk intake and growth and development. Mean (SD) breast milk intake at 9–10 months of age was 752 (244) g/day. Mean (SD) length‐for‐age z‐score at 12 months and change in length‐for‐age z‐score between 12 and 18 months were ?1.69 (1.0) and ?0.17 (0.6), respectively. At 18 months, mean (SD) expressive vocabulary score was 32 (24) words and median (interquartile range) skills successfully performed for fine, gross, and overall motor skills were 21 (19–22), 18 (16–19), and 38 (26–40), respectively. Breast milk intake (g/day) was not associated with either growth or development. Proportion of total energy intake from breast milk was negatively associated with fine motor (β = ?0.18, p = .015) but not other developmental scores in models adjusted for potential confounders. Among Malawian infants, neither breast milk intake nor percent of total energy intake from breast milk at 9–10 months was positively associated with subsequent growth between 12 and 18 months, or development at 18 months.     

Effects of maternal vitamin B12 supplementation on early infant neurocognitive outcomes: a randomized controlled clinical trial

Maternal nutritional status during pregnancy impacts fetal brain development. Vitamin B12 plays a vital role in neuronal development. However, findings from studies on the association between maternal B12 status and child cognitive functions have been inconsistent. We performed a randomized, placebo‐controlled clinical trial of oral B12 supplementation (50 µg) beginning at <14 weeks of gestation through a 6‐week post‐partum. In the present study, we report the effects of maternal B12 supplementation on cognitive development in infants at 9 months of age on Bayley Scales of Infant Development‐III (BSID‐III). One hundred eighty‐three pregnant women received vitamin B12, and 183 received placebo. Nine‐month BSID‐III development score was available in 178 infants. There were no significant differences in maternal sociodemographic characteristics and baseline biochemical measures between infants who underwent BSID‐III evaluation and infants who were not evaluated. There were no significant differences in any of the subscales of BSID‐III between infants born to mothers who received B12 supplementation (n = 78) vs. placebo (n = 100). On multiple regression analysis, elevated maternal total homocysteine (tHcy) levels adjusted for treatment group, birthweight, parity, income and home environment at second trimester of pregnancy were significantly negatively associated with expressive language (β = 3.13 points, P < 0.001), and in third trimester of pregnancy with expressive language (β = ?2.29 points, P < 0.001) and fine motor (β = ?1.41 points, P = 0.005) domains of BSID‐III. While no significant effects of maternal B12 supplementation were seen on cognitive development in infants at 9 months of age, elevated maternal tHcy levels were associated with poorer cognitive performance in some of the subdomains of BSID‐III. In pregnant women with elevated tHcy levels and or B12 deficiencies, it may be worthwhile to study the impact of longer term maternal supplementation on infant cognitive outcomes.     

Breastfeeding and maternal weight changes during 24 months post‐partum: a cohort study

The relationship between breastfeeding and the loss of weight gained during pregnancy remains unclear. This study aimed to investigate the association between breastfeeding and maternal weight changes during 24 months post‐partum. We studied a dynamic cohort comprising 315 women living in two cities in the state of Bahia, Brazil. The outcome variable was change in the post‐partum weight; the exposure variable was the duration and intensity of breastfeeding. Demographic, socio‐economic, environmental, reproductive and lifestyle factors were integrated in the analysis as covariates. The data were analysed using multiple linear regression and linear mixed‐effects models. The average cumulative weight loss at 6 months post‐partum was 2.561 kg (SD 4.585), increasing at 12 months (3.066 kg; SD 5.098) and decreasing at 18 months (1.993 kg; SD 5.340), being 1.353 kg (SD, 5.574) at 24 months post‐partum. After adjustment, the data indicated that for every 1‐point increase in breastfeeding score, the estimated average post‐partum weight loss observed was 0.191 kg at 6 months (P = 0.03), 0.090 kg at 12 months (P = 0.043), 0.123 kg at 18 months (P < 0.001) and 0.077 kg at 24 months (P = 0.001). Based on these results, we concluded that despite the low expressiveness, the intensity and duration of breastfeeding was associated with post‐partum weight loss at all stages of the study during the 24‐month follow‐up.     

Cord serum adiponectin is positively related to postnatal body mass index gain

Background: The roles of adiponectin and leptin in the early stages of life are poorly understood. We previously studied longitudinal changes in these adipocytokines from birth to 12 months of age. The aim of this investigation was to evaluate the correlation between cord serum adipocytokine levels and postnatal growth by 3 years of age. Methods: A questionnaire was sent to obtain the general physical measurements of 3‐year‐olds from 56 healthy newborn infants born at a gestational age of 35 weeks or more; 45 valid responses were obtained. The correlations between variables, including cord serum adipocytokine levels at birth and general physical measurements at 3 years, were investigated. Results: Body mass index (BMI) Z‐score gain from birth to 3 years was negatively correlated with birthweight SD scores (β=?0.395, P= 0.019) and gestational age (β=?0.557, P= 0.016), and positively correlated with cord serum adiponectin levels (β= 0.253, P= 0.043). BMI Z‐score gain from birth to 6 months was negatively correlated with only birthweight SD score (β=?0.442, P= 0.017). Cord serum leptin levels were not a significant predictor of BMI Z‐scores gain in our subjects. BMI Z‐scores at 6 months, 12 months, and 3 years of age were not related to cord serum adiponectin or leptin levels. Conclusions: Birthweight SD score, gestational age, and cord serum adiponectin levels are significant predictors of BMI Z‐score gain from birth to 3 years of age in Japanese infants.     

Age‐appropriate infant and young child feeding practices are associated with child nutrition in India: insights from nationally representative data

Age‐appropriate infant and young child feeding (IYCF) practices are critical to child nutrition. The objective of this paper was to examine the associations between age‐appropriate IYCF practices and child nutrition outcomes in India using data from ～18 463 children of 0–23.9 months old from India's National Family Health Survey, 2005–06‐3. The outcome measures were child height‐for‐age z‐score (HAZ), weight‐for‐age z‐score (WAZ), weight‐for‐height z‐score, stunting, underweight and wasting. Linear and logistic regression analyses were used, accounting for the clustered survey data. Regression models were adjusted for child, maternal, and household characteristics, and state and urban/rural residence. The analyses indicate that in India suboptimal IYCF practices are associated with poor nutrition outcomes in children. Early initiation of breastfeeding and exclusive breastfeeding were not associated with any of the nutrition outcomes considered. Not consuming any solid or semi‐solid foods at 6–8.9 months was associated with being underweight (P < 0.05). The diet diversity score and achieving minimum diet diversity (≥4 food groups) for children 6–23 months of age were most strongly and significantly associated with HAZ, WAZ, stunting and underweight (P < 0.05). Maternal characteristics were also strongly associated with child undernutrition. In summary, poor IYCF practices, particularly poor complementary foods and feeding practices, are associated with poor child nutrition outcomes in India, particularly linear growth.     

Effectiveness of a locally produced ready‐to‐use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial

This cluster randomised controlled trial tested the effectiveness of a locally produced, fish‐based, ready‐to‐use supplementary food (RUSF) to prevent growth faltering (decline in z‐scores). Cambodian infants (n= 485), aged 6 to 11 months, were randomised by site to receive the RUSF, Corn‐Soy Blend++ (CSB++), micronutrient powders (MNP), or no supplement (control). The intervention was for 6 months. In unadjusted analysis, the control group had statistically significantly decreased weight‐for‐age z‐scores (WAZ; ‐0.02, 95%CI = ‐0.03 ‐ ‐0.01, P= 0.001) and height‐for‐age z‐scores (HAZ; ‐0.07, 95%CI = ‐0.09 ‐ ‐0.05, P < 0.001), and increased mid‐upper arm‐circumference (MUAC; 0.02cm, 95%CI = 0.01 ‐ 0.04, P = 0.010), but no statistically significant change in weight‐for‐height z‐scores (WHZ). The RUSF group did not differ significantly from the control for WAZ, HAZ or WHZ (in other words, WAZ and HAZ decreased and WHZ did not change), but had increased MUAC in comparison to the control (0.04cm, 95%CI = 0.01 ‐ 0.06, P = 0.008). There were no statistically significant differences between the RUSF group and the CSB++ or MNP groups with respect to WAZ, HAZ, WHZ or MUAC. Interestingly, in adjusted analysis, low consumers of RUSF had increased WAZ, WHZ and MUAC (0.03, 95%CI = 0.01‐0.06, P = 0.006; 0.04, 95%CI = 0.01‐0.08, P = 0.026; and 0.05cm, 95%CI = 0.02‐0.09, P = 0.004, respectively) compared with the control. The novel RUSF, particularly in small quantities, protected against ponderal growth faltering, but the improvements were of limited clinical significance.     

Treatment of acute bronchitis with EPs 7630: Randomized,controlled trial in children and adolescents

Background: The aim of this trial was to investigate the efficacy and tolerability of EPs 7630, a herbal drug preparation from Pelargonium sidoides, in children and adolescents suffering from acute bronchitis, outside the strict indication for antibiotics. Methods: A total of 220 patients with acute bronchitis were randomized and given either verum containing EPs 7630 (1–6 years/>6–12 years/>12–18 years: 3 × 10/3 × 20/3 × 30 drops/day) or matching placebo for 7 days. The main outcome measure was the change in the total score of bronchitis‐specific symptoms (BSS) from day 0 to day 7. Results: The decrease in the BSS total score was significantly higher for EPs 7630 compared to placebo (change day 0–day 7: 4.4 ± 1.6 vs 2.9 ± 1.4 points; P < 0.0001). Improvements were most pronounced for ‘coughing’ and ‘rales at auscultation’. Tolerability was similarly good in both groups. Conclusions: EPs 7630 proved to be an efficacious and well‐tolerated option for the treatment of acute bronchitis in children and adolescents outside the strict indication for antibiotics.     

Physical activity promotion and obesity prevention in Girl Scouts: Scouting Nutrition and Activity Program+

Background: A previous version of Scouting Nutrition and Activity Program (SNAP) resulted in greater physical activity (PA) during troop meetings, but no impact on girls' body mass index (BMI) or overall PA. The purpose of this study was to evaluate the effects of a 6‐month intervention that coupled the evidence‐based program SNAP with a channel of communication to parents using health report cards. Methods: Thirty‐two Girl Scouts (mean age = 9.5, SD = 1.4 years) received the SNAP+ intervention. Girls were measured before and after the intervention on body composition, BMI, and 7‐day step counts. Troop leaders were trained to implement an interactive obesity‐prevention curriculum. Parents received health report cards designed to provide personalized information about their daughters' PA and weight status. Results: The full sample of participants took more steps per day after the intervention (mean difference = 1741, P= 0.007). Results showed that lower values for body fat percentage (P= 0.620), BMI percentile (P= 0.100) and BMI z‐scores (P= 0.055) at intervention end were not statistically significant. In the subsample of girls at risk for overweight and obesity, there were lower values for BMI z‐score (P= 0.010), BMI percentile (P= 0.027), and body fat percentage (P= 0.053). Conclusions: From this preliminary study, the SNAP+ intervention appears to be effective for Scout‐based promotion of PA, and for the prevention of overweight and obesity in at‐risk Girl Scouts, but further evaluation through a fully powered randomized controlled trial is warranted.     

Variance in the transaminase levels over the body mass index spectrum in 10‐ and 13‐year‐olds

Background: Transaminase levels increase with body mass index (BMI) and also with an extreme drop in the BMI, as in the case of patients with anorexia nervosa. We examined these levels over the BMI spectrum in Japanese 10‐ and 13‐year‐olds. Methods: Fifth‐ and eighth‐grade students (n= 3747) from all schools in Shunan City, Japan, between 2006 and 2008 were included in the study. BMI z‐score and serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma‐glutamyltransferase (GGT) were measured. Results: The ALT and GGT levels increased with z‐BMI values in the boys and 10‐year‐old girls (P≤ 0.001). In the 13‐year‐old girls, only the ALT levels increased with the z‐BMI values (P= 0.018). Similarly, the proportion of subjects with elevated ALT and GGT levels increased with the z‐BMI values (p_trend < 0.05). The AST levels were negatively associated with BMI in the girls (P < 0.001). Among the boys, these levels were elevated at the highest z‐BMI values and slightly elevated at lower values, but not significantly. These associations did not change after adjustments for confounders. Generalized additive model analyses revealed that transaminase had non‐linear relationships with z‐BMI, except for the AST levels in the girls. Conclusion: The elevated ALT and GGT levels were associated with high BMI in both sexes. In the same study population, however, AST increased in the girls with low BMI and in the boys with high BMI.     

Feeding on one side or both sides in a breast‐feeding session

Background: The aim of the present study was to examine the effects of breast‐feeding method (on only one or on two sides in a single feeding session) on growth, sleep duration and sucking period, and stool frequency. Methods: Exclusively breast‐fed healthy infants, aged 1–6 months, were included in the study during child health follow‐up visits. Mothers were given a questionnaire on sleep duration, sucking periods, and stool frequencies of their infants. Results: The height‐for‐age and weight‐for‐age z scores were significantly higher in infants breast‐fed from one side during a single session than from both sides (P= 0.002, P < 0.001; respectively). Infants sucking on only one breast in a breast‐feeding session defecated significantly less at night (P= 0.005), their maximum sucking periods at night were shorter (P= 0.049). Conclusion: Breast‐feeding at one side only during a single breast‐feeding session increases growth, decreases stool frequency and the maximum sucking period at night and does not influence the overall sleep pattern.     

Impact of massage therapy on motor outcomes in very low‐birthweight infants: Randomized controlled pilot study

Background: The purpose of the present study was to determine the effects of massage therapy on motor development, weight gain, and hospital discharge in preterm very low‐birthweight (VLBW) newborns. Methods: Twenty‐four preterm VLBW newborns (<34 weeks and <1500 g) were enrolled in this randomized controlled pilot study. The intervention group (n = 12) received massage therapy starting at 34 weeks post‐conceptional age (15 min daily, 5 days/week for 4 weeks). The infants in the sham treatment group (n = 12) received similar duration of light still touch. Test of Infant Motor Performance (TIMP) score gain, weight gain, and post‐conceptional age at discharge were compared between the two groups after intervention using Mann–Whitney U‐test. Results: No significant between‐group difference in TIMP score gain and weight gain was identified when all subjects were analyzed. In subgroup analysis, among those with below‐average pre‐treatment TIMP score (<35), the intervention group (n = 6) achieved significantly higher TIMP score gain (P = 0.043) and earlier hospital discharge (P = 0.045) than the sham treatment group (n = 5). These same infants, however, also had significantly shorter duration of total parenteral nutrition than their counterparts in the sham treatment group (P = 0.044). Conclusions: Massage therapy might be a viable intervention to promote motor outcomes in a subgroup of VLBW newborns with poor motor performance. A larger randomized controlled trial is required to further explore the effects of massage therapy in this high‐risk group.     

Preterm infants fed nutrient‐enriched formula until 6 months show improved growth and development

Background: The purpose of the present study was to determine the effect of feeding nutrient‐enriched preterm formula to preterm infants until 6 months' corrected age (CA) on growth and development in the first 18 months of life. Methods: Very low‐birthweight preterm infants were fed preterm formula until term (40 weeks CA). Infants were then assigned to one of three groups and were fed term formula until 6 months' CA (group 1, n= 29); preterm formula to 3 months' CA and then term formula to 6 months' CA (group 2, n= 30); or preterm formula until 6 months' CA (group 3, n= 31). Anthropometry was performed at term, 3, 6, 9, 12, 15, and at s18 months' CA. Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 months' CA. Results: Although body weight, length, head circumference and z score for CA at term in group 3 were significantly lower than those of groups 1 and 2, growth rates of these parameters were significantly higher in group 3 up to 18 months CA', as compared to groups 1 and 2. The mental developmental index and psychomotor developmental index of the Bayley test were not significantly different between the three groups. Conclusions: Very low‐birthweight preterm infants fed nutrient‐enriched preterm formula until 6 months' CA demonstrated significantly improved growth rates for bodyweight, length and head circumference, and comparable mental and psychomotor development throughout the first 18 months of life.     

Influence of early life factors on body mass index trajectory during childhood: a population‐based longitudinal analysis in the Western Brazilian Amazon

Low‐ to middle‐income countries may experience the occurrence of a dual burden of under and overnutrition. To better understand the overall progression of body mass index (BMI) during childhood, we estimated average BMI‐for‐age z‐score (BAZ) growth curves in a population‐based longitudinal study of 255 children living in the Brazilian Amazon. Children were aged 0.1–5.5 years at recruitment (2003). We collected data on socio‐economic and maternal characteristics, children's birthweight and infant feeding practices. Child anthropometric measurements were taken in 2003, 2007 and 2009. BAZ differences among categories of exposure variables were calculated at 6 and 12 months, and 2, 7 and 10 years. At baseline, the mean (standard deviation) age was 2.6 (1.4) years; 12.9% were overweight and 3.9% thin. After adjustment, mean BAZ estimates were mostly negative. Boys were close to the median value for BAZ until 12 months, whereas girls were below the median (P = 0.05). Children from households above the wealth median were 0.36 z‐ and 0.49 z‐less underweight than poorer children at 7 and 10 years, respectively (P < 0.01). Maternal BMI was positively associated with children's BAZ since 12 months old; BAZ in children from overweight mothers was higher by 0.69 compared with their counterparts at 10 years (P < 0.01). Birthweight was positively related to BAZ up until 2 years (P = 0.01). Socio‐economic background and maternal nutritional status are important predictors of BAZ throughout childhood. Although excessive weight gain is a public health concern, it is critical to restrict inequities, while promoting healthier growth in developing countries.     

New insights into the pathogenesis of perinatal hypoxic‐ischemic brain injury

Background: Pathogenesis of perinatal hypoxic‐ischemic brain injury (HIE) is complex. In this study, we examined the role of neuroinflammation, oxidative stress and growth factors in perinatal hypoxic‐ischemic brain damage. Methods: Ninety neonates (>32 weeks' gestation) with perinatal HIE were enrolled prospectively. Perinatal HIE was categorized into three stages according to the Sarnat and Sarnat clinical scoring system and changes seen on amplitude integrated electroencephalography. Cerebrospinal fluid (CSF) for interleukin‐6 (IL‐6) and glutathione peroxidase analysis was taken in the first 48 h of life and subsequent CSF for neuron‐specific enolase (NSE) and vascular endothelial growth factor (VEGF) analysis 72 h after birth. Neurodevelopmental outcome was assessed at 12 months of corrected gestational age using the Denver Developmental Screening Test. Results: Concentrations of NSE in CSF correlated with severity of HIE (P < 0.0001) and corresponded well with subsequent neurodevelopmental outcome. Concentrations of IL‐6 in CSF were markedly increased in neonates with severe HIE (P < 0.0001) and those with subsequent neurological sequels, but were normal in the majority of neonates with mild and moderate HIE. Glutathione peroxidase activity in CSF was significant with the stage of HIE (P < 0.0001) and gestational age (P < 0.0001) and corresponded well with subsequent neurodevelopmental outcome. Advanced stage of HIE was associated with increased concentrations of VEGF in CSF (P < 0.0001). Neurological outcomes at 12 months of age correlated best with CSF level of NSE (P < 0.001) and IL‐6 (P < 0.001). Conclusion: Our results suggest that neuroinflammation plays a principal role in perinatal hypoxic‐ischemic brain damage and we postulate that oxidative stress and upregulation of VEGF might be important contributing factors in the pathogenesis of hypoxic‐ischemic brain injury, particularly in preterm neonates.     

Association between maternal depressive symptoms in the early post‐natal period and responsiveness in feeding at child age 2 years

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self‐reported maternal post‐natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first‐time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04–0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001–0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005–0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01–0.29, P = 0.03) feeding practices (ΔR² values: 0.02–0.03, P < 0.05). This study provides evidence for the proposed link between maternal post‐natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post‐natal period may improve responsiveness in the child feeding relationship.     

Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis

Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0–60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants <6mo and children aged 6–60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P < 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight‐for‐length z‐score values, 95% CI: 14.3; 16.9, P < 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P < 0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P < 0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care.     

Randomized controlled trial of probiotics to reduce common cold in schoolchildren

Background: The common cold is responsible for the largest proportion of school and work absenteeism and causes a huge economic burden. None of the current interventions is greatly effective for prevention. Our aim was to assess the efficacy of a two‐strain combination probiotic for prevention of common cold symptoms in healthy schoolchildren. Methods: A double‐blind randomized controlled trial was performed during the winter season in a public school of central Thailand. Children, aged 8–13 years, were randomized to receive either a two‐strain combination probiotic (Lactobacillus acidophilus and Bifidobacterium bifidum) or placebo given twice a day for 3 months. The primary outcome was any symptom of cold during the 3‐month study period while vomiting, diarrhea, use of antibiotics, school absence due to any cause, school absence due to cold and duration of all symptoms were secondary outcomes. Results: Of the 40 children in each group, 31 (77%) in the probiotic group, compared to 38 (95%) in the placebo group (P= 0.048), developed at least one symptom of cold. Children in the probiotics group had significantly lower risk of fever, cough, rhinorrhea, school absence and school absence related to common cold compared to children in the placebo group. There was no impact on diarrhea and vomiting. Conclusion: A two‐strain probiotic combination given twice a day for 3 months was able to reduce the symptoms of the common cold and school absenteeism in schoolchildren.     

Does more protein in the first week of life change outcomes for very low birthweight babies?

Background: Following publication of revised recommended nutrient intakes (RNI) for infants <1500 g, our intravenous nutrition (IVN) solutions were reformulated to deliver RNI in a restricted volume to ensure additional non‐nutritional fluids did not detract from nutritional intake. An audit was performed to determine whether these changes achieved RNI and influenced growth, clinical or neurodevelopmental outcomes. Methods: Two cohorts of 40 infants <1500 g were identified from a prospectively maintained database: babies born before and after reformulation of the IVN solutions. Data on nutritional intakes for the first 30 days of life, growth and clinical outcomes were collected. Neurodevelopmental outcomes at 18 months corrected age (CA) were obtained from a Bayley III assessment. Results are presented as mean ± SD. Results: The ‘after’ group received significantly less fluid (105 ± 12 vs. 132 ± 15 mL/kg/day, P < 0.001) but more protein (3.2 ± 0.6 vs. 2.4 ± 0.5 g/kg/day, P < 0.001) in the first week of life. There were no differences in clinical outcome, growth z‐scores at 4 weeks of age or neurodevelopmental outcome at 18 months CA between the ‘before’ and ‘after’ infants. Enteral protein intake in the first 2 weeks of life was positively associated with neurodevelopmental outcome (cognitive score r²= 0.13 P= 0.03, motor score r²= 0.27 P= 0.001). Conclusion: Although the new IVN regimen achieved intakes closer to RNI, there were no major effects on growth, clinical outcome or neurodevelopmental outcome at 18 months CA. Enteral protein intake in the first two weeks was positively associated with neurodevelopmental outcome, suggesting early enteral protein intake is important for optimal brain function.     

The effect of montelukast on early‐life wheezing: A randomized,double‐blinded placebo‐controlled study

Background

Cysteinyl‐leukotrienes are increased in the airways of infants with virus‐associated wheezing. We aimed to determine the effects of a cysteinyl‐leukotriene‐1 receptor antagonist on symptoms during an early‐life wheezing illness and to investigate the factors that affect the response to this drug.

Method

This placebo‐controlled double‐blinded randomized controlled trial recruited children aged 3‐36 months with wheezing illness and randomized to active drug or placebo for 56 days. A symptom score diary (SSD) was kept by the children's caregivers.

Results

One‐hundred patients completed the study, and 62 (30 montelukast and 32 placebo) were analyzed. There were no significant differences in the percent of symptom‐free days, symptom scores, and the need for rescue salbutamol between the two groups. However, the percent of symptom‐free days within the first week was significantly higher for the montelukast than for the placebo group (13.8 ± 4.1% vs. 5.4 ± 3.4%; P = 0.028); wheezing score at 7th day was significantly lower for the montelukast than for the placebo group (0.5 ± 0.1 vs. 1.4 ± 0.2; P = 0.002). In addition, the number of inhaled ß₂‐agonist rescue episodes per day during the first week was significantly lower for the montelukast compared with the placebo group (12.7 ± 1.8 vs. 19.2 ± 1.6; P = 0.013).

Conclusions

Our results indicate that montelukast may be effective for reducing caregiver‐observed wheezing and the need for salbutamol during the first week of treatment for early‐life wheezing. The impact for caregivers and the optimal duration of treatment will need to be explored in studies of larger size.