Breastfeeding and infant hospitalisation: analysis of the UK 2010 Infant Feeding Survey

To investigate the contributions of overall breastfeeding duration and exclusive breastfeeding in reducing the risk of hospitalisation for infectious causes, we analysed data from a three‐stage survey on infant feeding practices and health outcomes in over 10 000 UK women in 2010–2011. The main outcome measures were risk of overnight hospital admission in the first 8–10 months of infancy. A graded beneficial effect was found between longer duration of any breastfeeding and hospital admission for infectious causes and for respiratory tract infections, with a significantly lower risk in infants breastfed for at least 3 months compared with those never breastfed. The effects were stronger in the subgroup who was also exclusively breastfed. For example, among infants breastfed for 3–6 months, the reduction in risk for infectious causes for those who were also exclusively breastfed for at least 6 weeks was 0.42 (95% CI: 0.22–0.81) and for those not exclusively breastfed for 6 weeks 0.79 (95% CI: 0.49–1.26). Likewise, among infants breastfed for 6 months or more, the odds ratio for those who were also exclusively breastfed for at least 6 weeks was 0.48 (95% CI: 0.32–0.72) and for those not exclusively breastfed for 6 weeks 0.72 (95% CI: 0.48–1.08). The apparent protective effect of any breastfeeding for a long duration may in part be driven by a prolonged period of exclusive breastfeeding. Exclusive breastfeeding in the initial weeks after childbirth and continuing to breastfeed (either exclusively or partially) for at least 3 months, preferably 6 months, may reduce morbidity due to infectious illness in infants.     

Early deterioration of iron status among a cohort of Bolivian infants

Iron deficiency (ID) and iron deficiency anemia (IDA) are major contributors to infant and maternal morbidity worldwide. There is limited longitudinal data on iron status in young infants and on methods to adjust iron biomarkers for inflammation. We aimed to quantify the prevalence of inflammation‐adjusted ID, anemia, and IDA over the first year in a cohort of Bolivian infants and their mothers. Healthy mother‐infant dyads were recruited from two peri‐urban hospitals. Infants provided three blood draws (2, 6–8, and 12–18 months; N = 160); mothers provided two blood draws (1 and 6–8 months postpartum [plus third anemia measurement at 12–18 months]; N = 250). Blood was analyzed for hemoglobin, ferritin, soluble transferrin receptor, C‐reactive protein (CRP), and alpha(1)‐acid glycoprotein (AGP). Iron biomarkers were adjusted for inflammation using CRP and AGP; hemoglobin cutoffs were adjusted for altitude. Inflammation (elevated CRP or AGP) was 17% among toddlers 12–18 months of age. ID (inflammation‐adjusted ferritin) increased with age (<1%, 56%, and 79% at each blood draw), as did anemia and IDA (anemia: 70%, 76%, and 81%; IDA: <1%, 46%, and 68%). Maternal ID declined from the first to second assessment (39% vs. 27%). Inflammation‐adjusted ID prevalence was up to 15 percentage points higher than unadjusted estimates. The high prevalence of ID, anemia, and IDA in this cohort of Bolivian infants beginning at 6–8 months of age suggests that early interventions may be necessary in vulnerable populations.     

Association of 6 months of exclusive breastfeeding with higher fat‐free mass in infants in a low‐resource setting with high HIV prevalence in South Africa

Exclusive breastfeeding for 6 months is recommended by the World Health Organisation (WHO) for optimal health and growth of infants, but it is not a common practice in South Africa. A breastfeeding counselling programme was run to inform, encourage and support mothers to exclusively breastfeed their infants for 6 months, and mother–infant pairs were invited to participate in a research project to determine breast milk intake volumes using the dose‐to‐mother deuterium dilution stable isotope technique. This technique yields objective measurements of breast milk intake volumes and also enables determination of exclusivity of breastfeeding, which is most frequently determined by maternal recall and can be subject to bias. Exclusivity of breastfeeding at 6 weeks, 3 months and 6 months following birth of the infants was correlated with infant fat‐free mass at 12 months, which was determined by the dose‐to‐infant deuterium dilution stable isotope technique. Results showed that infants who were exclusively breastfed for 6 months had a higher per cent fat‐free mass at 12 months compared with infants who were not exclusively breastfed for 6 months (P < 0.05). This objective determination of both breastfeeding patterns and infant body composition gives weight to the WHO recommendation of exclusive breastfeeding for 6 months as it demonstrated adequate fat‐free mass in infants at 12 months, even in an area with high HIV prevalence. © 2016 John Wiley & Sons Ltd     

Novel mutation in the TMPRSS6 gene with iron‐refractory iron deficiency anemia

Iron‐refractory iron deficiency anemia (IRIDA) is a rare autosomal recessive disease characterized by congenital hypochromic microcytic anemia, low transferrin saturation, low serum iron, normal–high serum ferritin, and increased hepcidin. This disease is caused by loss‐of‐function mutations in TMPRSS6 that lead to high hepcidin and result in severe anemia. We report our experience with an 11‐year‐old Japanese girl with hypochromic microcytic anemia, low serum iron, and high serum ferritin, with anemia that was refractory to the oral iron that was prescribed frequently from early childhood. Presence of high hepcidin suggested a diagnosis of IRIDA, which was eventually confirmed by identification of a novel homozygous mutation, p.Pro354Leu, in the TMPRSS6 gene. This case suggests that serum hepcidin should be routinely measured for differential diagnosis when patients with IDA are unresponsive to oral iron or have unusual clinical features.     

Evaluation of erythropoiesis by serum transferrin receptor and ferritin in infants aged 0-6 months

The aim of this study was to evaluate erythropoiesis in 198 healthy babies aged 0-6 months by determination of their blood count, serum transferrin receptor (STfR), and ferritin levels. Anemia and microcytosis were present in 9% and 13% of the sample, respectively. Microcytosis rate was as high as 45% in 6-month-old babies. In infants with normal blood counts, the values of sTfR/ferritin and sTfR-F index were increasing with the increase of sTfR and decrease of ferritin beginning from 2 months of age. In the 5- to 6-month-old group, sTfR concentrations, sTfR/ferritin ratio, and sTfR-F index were higher in infants with anemia and microcytosis. This research showed a high frequency of iron deficiency detected in otherwise healthy babies. Only problems with early weaning practices were found to be significantly more common in babies with iron deficiency.     

Breastfeeding duration and exclusivity associated with infants' health and growth: data from a prospective cohort study in Bavaria, Germany

Aim: To investigate the relationship between breastfeeding and infant health and to describe growth in the first 9 months.
Methods: Mothers delivering a baby in April 2005 were recruited throughout Bavaria, Germany, for a prospective birth cohort study. These mothers reported breastfeeding data, health and growth data of 1901 infants assessed by a physician in questionnaires on day 2–6, and in months 2, 4, 6 and 9. Subjects were healthy term infants with a birth weight ≥2500 g. We compared 475 infants breastfed exclusively for ≥6 months (group A), 870 infants breastfed fully/exclusively ≥4 months, but not exclusively ≥6 months (group B) and 619 infants not breastfed/breastfed <4 months (group C).
Results: In multivariate analysis ≥6 months of exclusive breastfeeding reduced significantly the risk for ≥1 episode of gastrointestinal infection(s) during months 1–9 compared to no/<4 months breastfeeding (adjusted odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.44–0.82). The application of the World Health Organization (WHO) – child growth standards showed lower weight-for-length z-scores in first days of life in group C versus groups A and B, whereas in months 6/7 group C showed the highest scores.
Conclusion: Differences in child growth depending on breastfeeding duration should be investigated further. Concerning health outcomes our findings support the recommendation for ≥6 months of exclusive breastfeeding.     

Evaluation of Erythropoiesis by Serum Transferrin Receptor and Ferritin in Infants Aged 0–6 Months

The aim of this study was to evaluate erythropoiesis in 198 healthy babies aged 0–6 months by determination of their blood count, serum transferrin receptor (STfR), and ferritin levels. Anemia and microcytosis were present in 9% and 13% of the sample, respectively. Microcytosis rate was as high as 45% in 6-month-old babies. In infants with normal blood counts, the values of sTfR/ferritin and sTfR-F index were increasing with the increase of sTfR and decrease of ferritin beginning from 2 months of age. In the 5- to 6-month-old group, sTfR concentrations, sTfR/ferritin ratio, and sTfR-F index were higher in infants with anemia and microcytosis. This research showed a high frequency of iron deficiency detected in otherwise healthy babies. Only problems with early weaning practices were found to be significantly more common in babies with iron deficiency.     

Overweight in childhood of exclusively breastfed infants with a high weight at 5 months

High infant weight increases the risk of childhood overweight, while breastfeeding may reduce the risk. However, some infants have a very high weight gain even though they are exclusively breastfed. We examined the risk of a high body mass index (BMI) and overweight in childhood for infants ≥2.5 SD above the median weight‐for‐age (WAZ) at age 5 months according to duration of exclusive breastfeeding (≤2, >2 to <4 or ≥4 months). The study is based on 13,401 7‐year‐old and 9,819 11‐year‐old children enrolled into the Danish National Birth Cohort (born 1997–2003). Linear and logistic regression analyses were used to examine the associations while adjusting for presumed confounders including birth weight. The results showed that infants ≥2.5 SD at 5 months, breastfed exclusively ≤2, >2 to <4 or ≥4 months had adjusted odds ratios (ORs) for overweight at age 7 at 3.67 (95% confidence interval [CI] [2.10, 6.43]), 3.42 (95% CI [2.32, 5.04]) and 3.19 (95% CI [1.90, 5.36]) respectively, when compared with infants <2.5 SD WAZ exclusively breastfed ≥4 months. The corresponding results for BMI z‐scores were 0.82 (95% CI [0.60, 1.04]), 0.63 (95% CI [0.48, 0.78]) and 0.57 (95% CI [0.38, 0.77]). For the ≥2.5 SD infants, the differences in risk of overweight and BMI according to duration of exclusive breastfeeding were neither significantly different among the 7‐year nor among the 11‐year‐old children. A high infant weight increases the odds of overweight and is associated with a higher BMI in childhood. Whereas the odds and BMI z‐scores tended to be lower for those exclusively breastfed longer, the differences were not statistically significant.     

Twenty-four-hour motor activity in human infants with and without iron deficiency anemia

Iron deficiency anemia (IDA) is a very common nutritional problem that alters motor activity. The aim of this study was to compare 24-h motor activity in the home in healthy 6-month-old infants with and without IDA. Activity was assessed via actigraphs on the leg during 24 continuous hours in 17 Chilean infants with IDA and 18 with normal hemoglobin levels. All infants were given oral iron, and activity was reassessed at 12 and 18 months. The frequency of movement units per minute was determined for each waking/sleep state during the day and night, and the duration of each state was computed. At 6 months of age, there were no differences between anemic and nonanemic infants in time per state. However, infants with IDA showed an overall increase in motor activity compared to controls. These differences were no longer observed at 12 and 18 months of age. Increased activity during the period of IDA raises the issue of a shared underlying mechanism with restless legs syndrome, a sensorimotor dysfunction where iron deficiency increases the severity of the symptoms and iron supplementation ameliorates them. Due to previous findings of decreased motor activity in the laboratory at 12 months during the waking time surrounding an afternoon nap, we also compared those data to a nap in the home. Infants with IDA were less active in the laboratory than in the home. The home versus laboratory results suggest that contextual factors affect the motor activity of IDA infants to a larger extent than controls.     

Iron Deficiency in Infants and Toddlers in the United States

Iron deficiency anemia (IDA) continues to be overwhelmingly the leading cause of anemia in early childhood and a global public health challenge. Although there has been a significant decrease in the frequency of IDA and iron deficiency (ID) in infants and toddlers in recent years in the United States, ID and IDA persist and the adverse effects of ID are long-lasting if not permanent. Moreover, ID can result in lead toxicity, and this toxic exposure, even with low levels, can impair neurocognitive function as well. This review describes the major steps that have taken place to decrease the frequency of ID and IDA.     

缺铁性贫血患儿血清胃泌素水平测定及间断补铁疗效观察

研究缺铁性贫血 (IDA)儿童胃泌素水平的变化 ;观察间断补铁治疗儿童IDA的疗效。方法 :49例 IDA患儿每周口服一次铁制剂 (元素铁 2 mg/kg) ,共 1 2周。在治疗前后测查 Hb、ZPP、SF及血清胃泌素。结果 :经补铁治疗 ,Hb、SF均极显著性升高 (P<0 .0 1 ) ,ZPP则明显下降 (P<0 .0 1 ) ;IDA患儿血清胃泌素水平明显升高 ,与对照组比较差异显著 ,治疗后恢复正常。结论 :1每周一次间断补铁治疗儿童 IDA效果显著。 2 IDA患儿胃泌素的异常分泌可能与缺铁所致的胃粘膜萎缩有关     

Breastfeeding modifies the impact of diarrhoeal disease on relative weight: a longitudinal analysis of 2–12 month‐old Filipino infants

Undernutrition and diarrhoeal disease are major causes of infant mortality. We investigated the combined roles of breastfeeding and diarrhoea on infant size in 2940 infants from the Cebu Longitudinal Health and Nutrition Survey. The study aimed to assess whether breastfeeding status modified the deficits associated with diarrhoeal disease. The primary exposures were combinations of current breastfeeding status (yes/no), the presence of diarrhoeal disease in previous week (yes/no) and a categorical survey variable (six surveys taken at bimonthly intervals when infants were 2–12 months of age). Relative weight (weight‐for‐length z‐scores), calculated using the WHO growth standards, was estimated using sex‐stratified, fixed‐effects longitudinal models that also adjusted for energy from complementary foods. Post‐estimation Wald tests were conducted to identify subgroup differences in relative weight. Diarrhoea was associated with reduced relative weight in both breastfed and non‐breastfed infants of 6–12 months. Diarrhoea‐related deficits in relative weight were significantly exacerbated in non‐breastfed girls of 6 and 8 months. Importantly, in infants <6 months, being breastfed and having diarrhoea was still associated with greater relative weight compared with being non‐breastfed and diarrhoea‐free. Breastfeeding emerged as a strong contributor to relative weight in younger infants (<6 months) while diarrhoeal disease strongly contributed to deficits in relative weight in older infants (6–12 months). These findings underscore the importance of breastfeeding for promoting infant nutritional status in infants with or without diarrhoea from birth to 12 months.     

Breastfeeding patterns in exclusively breastfed infants: a longitudinal prospective study in Uppsala, Sweden

Exclusive breastfeeding was studied among 506 infants in Uppsala, Sweden, based on daily recordings during the first 6 mo. The mothers had previously breastfed at least one infant for at least 4 mo. Most of the mothers considered that they breastfed on demand. Wide variations in breastfeeding frequency and suckling duration were found both between different infants and in the individual infant over time. At 2 wk, the mean frequency of daytime feeds (based on one 13-d record) between different infants ranged from 2.9 to 10.8 and night-time feeds from 1.0 to 5.1. The daytime suckling duration (based on one 24-h record) ranged from 20 min to 4h 35 min and night-time duration from 0 to 2h 8 min. At any given age, a maximum of only 2% of the infants were not breastfed during the night. At 4 mo, 95% of the infants were breastfeeding and 40% were exclusively breastfed at this age. Longer breastfeeding duration and longer duration of exclusive breastfeeding were both associated with higher frequency of breastfeeds, longer breastfeeding of the previous child and higher education. No gender differences were found. Maternal smoking was associated with shorter duration of exclusive breastfeeding, and pacifier use was associated with shorter duration of both exclusive breastfeeding and total breastfeeding. This study confirms that every mother-infant pair needs to be understood as a unique dyad throughout lactation. These data demonstrate a wide range of patterns among women who are exclusively breastfeeding and indicate that it would be inappropriate to put pressure on individual families to adopt preconceived patterns of infant feeding.     

中国九市不同喂养方式婴儿体格生长水平的横断面调查

目的 调查不同喂养方式婴儿体格生长水平的现状和差异。方法 1~<12月龄婴儿的母乳喂养、辅食添加及体格生长数据来自2015年“第五次中国九市7岁以下儿童体格发育调查”。1~<6月龄婴儿的喂养方式分为纯母乳喂养、部分母乳喂养和人工喂养,~<12月龄的喂养方式分为持续母乳喂养和人工喂养。不同喂养方式婴儿体重、身长及头围生长水平比较采用方差分析或t检验。结果 共纳入1~<12月龄婴儿59 170人。1~<6月龄纯母乳喂养率、部分母乳喂养率和人工喂养率分别为48.6%、37.4%和14.0%,~<12月龄持续母乳喂养率和人工喂养率分别为59.9%和40.1%。1~<6月龄纯母乳喂养婴儿平均体重略高于部分母乳喂养婴儿,差值范围为0.06~0.20 kg;也略高于人工喂养婴儿,差值范围为0.09~0.22 kg。6~<12月龄持续母乳喂养婴儿平均身长低于人工喂养婴儿,差值范围为-0.3~-0.1 cm。不同喂养方式在6~<12月龄体重、1~<6月龄身长及1~<12月龄头围上差异均无统计学意义。不同喂养方式婴儿体重、身长及头围生长模式与WHO儿童生长标准相似,但总体上体重和身长平均生长水平略高于WHO儿童生长标准。结论 不同喂养方式生长模式相似,在生后的前半年纯母乳喂养婴儿的生长水平略高于部分母乳喂养和人工喂养婴儿,在后半年持续母乳喂养婴儿的生长水平略低于人工喂养婴儿。     

Thimerosal exposure (from tetanus‐diphtheria vaccine) during pregnancy and neurodevelopment of breastfed infants at 6 months

Aim: We studied the effect on neurodevelopment of infants who are exposed to thimerosal in tetanus‐diphtheria (Td) vaccines during pregnancy. Methods: We compared Gesell Developmental Schedules (GDS) of exclusive breastfed infants at 6 months born to mothers who received Td (1 to 3 doses) against those who were born to mothers who did not take such vaccines. Results: Compared with the group of infants not exposed to ethylmercury in utero, the infants of exposed mothers showed no significant difference in neurodevelopment delays. Although there was a significant correlation between hair‐Hg of mothers and hair‐Hg of neonates (Spearman r = 0.353; p = 0.0011), there was no significant correlation between the level of in utero exposure to ethylmercury in Td vaccines and neonate’s hair‐Hg concentrations (Spearman r = 0.060; p = 0.5922). However, regression analysis showed that GDS at 6 months was significantly associated with total mercury concentration of neonate’s hair but was not sensitive to the number of vaccines taken by the mother. Conclusion: Early neurodevelopment of exclusively breastfed infants is sensitive to in utero exposure to mercury, but maternal thimerosal exposure in tetanus‐diphtheria vaccines per se cannot portend clinical neurodevelopment delays measured by GDS at 6 months.     

Intergenerational breastfeeding practices among parents and children: 1993 Pelotas (Brazil) birth cohort

The objective of this study was to investigate intergenerational breastfeeding practices according to parental sex and age at delivery in the 1993 Pelotas (Brazil) birth cohort study. This is a prospective birth cohort study, and at the 22‐year follow‐up, a substudy with all children of the cohort members who had become parents was conducted (93Cohort‐II). First generation breastfeeding data were collected at 3 months and 4‐year‐old follow‐ups. In the 93Cohort‐II, parents answered a questionnaire about their children's breastfeeding practices. Adjusted Tobit and Poisson regression models with robust variance were applied to estimate the association between predominant parental breastfeeding duration and exclusive breastfeeding duration of the children at 3 and 6 months. Out of 3,810 cohort participants, 955 (25%) had delivered at least one live‐born infant, and 1,222 children were assessed. Fifty‐four percent of parents were ≤19 years old. Direct effects of predominant parental breastfeeding duration on exclusive breastfeeding duration of their children were only observed when data were stratified by parental age: children born to parents aged ≥20 years old and who were predominantly breastfed for at least 3 months presented higher exclusive breastfeeding duration and higher prevalence of being exclusively breastfed for at least 3 months. When analyses were stratified by mothers and fathers, the result remained significant only among mothers. Longer predominant breastfeeding duration in the first generation was associated with longer exclusive breastfeeding duration in the second generation, but only among older mothers. Education and social support surrounding breastfeeding should be intensified among fathers and younger parents to create a positive environment supportive of breastfeeding.     

汉中市儿童、孕妇铁缺乏症流行病学调查研究分析

目的调查了解儿童、妇女铁减少(ID)、缺铁性贫血(IDA)及铁缺乏症(IDD)患病率。方法随机抽取汉中市城区7月～7岁儿童532名,30岁以下妊娠38周以内孕妇203名,30岁以下未孕育龄妇女200名为调查对象。检测了血红蛋白(Hb)、锌原卟啉(ZPP)、血清铁蛋白(SF)等指标。结果7个月～7岁儿童ID平均43.80%,IDA平均9.96%。其中7个月～12个月婴儿ID71.67%,IDA22.50%;3个月～36个月幼儿ID33.13%,IDA8.13%;37个月～7岁儿童ID37.30%,IDA5.16%。孕妇ID平均82.17%,IDA平均37.93%。其中早孕组ID75.91%,IDA14.46%,中孕组ID77.14%,IDA51.43%;晚孕组ID100.00%,IDA58.00%。未孕育龄妇女ID49.50%,IDA25.00%。儿童ID、IDA不同年龄组有显著差异(P<0.01),即年龄越小、患病率越高。孕妇孕龄组之间有显著性差异(P<0.01)。即孕龄越大,患病率越高。孕妇ID、IDA患病率与育龄妇女有显著性差异(P<0.01)。孕妇患病率明显高于育龄妇女。不同年龄组儿童、不同孕期孕妇及育龄妇女ID患病率均大于IDA患病率。结论本市儿童、孕妇、育龄妇女铁缺乏症比较普遍,ID、IDA患病率均高于国外和全国平均水平。隐性缺铁十分严重,已成为营养性铁缺乏症的主要问题。婴幼儿和晚期孕妇是铁缺乏症高发人群。     

Deficiencies in the Management of Iron Deficiency Anemia During Childhood

Limited high‐quality evidence supports the management of iron deficiency anemia (IDA). To assess our institutional performance in this area, we retrospectively reviewed IDA treatment practices in 195 consecutive children referred to our center from 2006 to mid‐2010. The majority of children were ≤4 years old (64%) and had nutritional IDA (74%). In 11‐ to 18‐year‐old patients (31%), the primary etiology was menorrhagia (42%). Many were referred directly to the emergency department and/or prescribed iron doses outside the recommended range. Poor medication adherence and being lost‐to‐follow‐up were common. Substantial improvements are required in the management of IDA.     

Growth under privileged conditions of healthy Swedish infants exclusively breastfed from birth to 4-6 months: a longitudinal prospective study based on daily records of feeding

Aim: In most studies the methodology used to study growth in relation to breastfeeding patterns cannot ensure that exclusive breastfeeding has in fact occurred since birth. The aim of this study was to investigate the growth of healthy infants in Sweden in whom exclusive breastfeeding for the first 4-6 mo was ascertained through daily feeding records and to compare the results with the World Health Organization (WHO) "12-month breastfed pooled data set" and the Euro-Growth references for exclusively breastfed infants, as well as with the National Center for Health Statistics (NCHS)/WHO reference. Methods: 147 exclusively breastfed infants and 325 non-exclusively breastfed Swedish infants, with a birthweight of 33 kg, were included. The mothers had previous breastfed at least one infant for at least 4 mo. Weight was recorded fortnightly and length monthly. Results: Infants exclusively breastfed since birth showed similar growth in weight and height to that of the non-exclusively breastfed infants. During the first 6 mo of life the growth of exclusively breastfed infants was also similar to that of the infants regularly receiving formula at 12-16 wk of age, mostly in addition to breast milk. The monthly growth increments were fairly similar to those of the "WHO pooled breastfed data set" and the Euro-Growth references for exclusively breastfed infants. Conclusion: In an affluent society truly exclusively breastfed infants seem to have the same growth during the first half year of life as non-exclusively breastfed infants with a high breastfeeding rate.