Early Life Factors for Overweight Risk Among Infants of Hispanic Immigrant Mothers

Introduction

This study examined postpartum depression, food insecurity, and underestimation of infant size as potential early life factors for overweight risk at 12 months among infants of Hispanic immigrant mothers.

Grandparent Coresidence and Risk of Early Child Overweight and Obesity in Low-Income,Hispanic Families in New York City

ObjectiveChildren in low-income Hispanic families are at high risk of obesity and are more likely to live with grandparents than their non-Hispanic white counterparts. We aimed to determine if grandparent coresidence (prenatal through age 2 years) was associated with: 1) obesogenic feeding practices; and 2) child weight outcomes from birth to three years.MethodsWe analyzed data from 267 low-income, Hispanic mother-infant pairs in the control group of an obesity prevention trial in New York City. Linear and logistic regression tested differences in obesogenic feeding practices and weight outcomes at 2 and 3 years, dependent upon grandparent coresidence. Multilevel modeling tested associations between grandparent coresidence and WFAz over time.ResultsPersistent grandparent coresidence (vs none) was associated with putting cereal in the bottle (adjusted odds ratio [aOR] 3.46; 95% confidence interval [CI] 1.43, 8.40). Persistent grandparent coresidence (vs none) was associated with higher mean WFAz (2 years: B 0.83; 95% CI 0.41, 1.25; 3 years: B 0.79; 95% CI 0.32, 1.25) and higher odds of child overweight/obesity risk (2 years: aOR 4.38; 95% CI 1.64, 11.69; 3 years: aOR 3.15; 95% CI 1.19, 8.36). In multilevel models, more occasions of grandparent coresidence were associated with higher WFAz.ConclusionsGrandparent coresidence may be associated with higher risk of child overweight/obesity in low-income, Hispanic families. Further research is needed to elucidate mechanisms of these associations and to inform obesity prevention strategies in the context of multigenerational families.     

完全母乳喂养婴儿超重的危险因素分析

目的探讨3～4月龄完全母乳喂养婴儿发生超重的危险因素,为儿童肥胖的早期干预提供理论依据。方法选取2009年7-10月青岛大学医学院附属医院和青岛市市北区妇幼保健院符合条件的3～4月龄婴儿340名作为研究对象。男182例(53.5%),女158例(46.5%)。自行设计婴儿生长发育情况调查问卷,对抚养者进行一般状况和婴儿超重危险因素调查;测量婴儿的体格生长指标。按照喂养方式的不同分为完全母乳喂养婴儿组(162例)和非完全母乳喂养婴儿组(178例)。应用病例对照研究的方法探讨完全母乳喂养婴儿发生超重的危险因素。结果 3～4月龄婴儿超重的流行情况:3～4月龄婴儿超重检出率为17.6%,男婴和女婴的超重检出率分别为16.5%、19.0%,差异无统计学意义(χ2=0.365,P=0.546)。完全母乳喂养组婴儿的超重检出率高于非完全母乳喂养组婴儿(χ2=4.457,P=0.035)。完全母乳喂养组男婴的超重检出率(22.2%)高于非完全母乳喂养组男婴(13.5%)(χ2=6.108,P=0.013),而2种不同喂养方式组女婴的超重检出率差异无统计学意义。3～4月龄完全母乳喂养婴儿超重的危险因素:父亲文化水平高、经阴道分娩、每次喂养持续时间长、喂养间隔时间短以及夜间喂养次数较多是3～4月龄完全母乳喂养婴儿发生超重的危险因素。结论完全母乳喂养婴儿超重现象较严重,为预防超重发生,改善喂养行为是重要的。     

Associations between Introduction of Age-Inappropriate Foods and Early Eating Environments in Low-Socioeconomic Hispanic Infants

Purpose

To examine the associations between feeding practices and eating environments of low-socioeconomic Hispanic infants.

Association of Picky Eating With Weight Status and Dietary Quality Among Low-Income Preschoolers

Background

Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body mass index z-score (BMIz), dietary quality, and micronutrient intake.

早产儿振幅整合脑电图的影响因素

目的探讨早产儿振幅整合脑电图(aEEG)的影响因素。方法在出生12 h内采用NicoletOne脑功能监测仪对71例早产儿进行aEEG描记。根据aEEG背景活动的方式及有无惊厥样活动,将aEEG结果判断为正常和异常aEEG(包括轻度异常及重度异常)。床旁颅脑超声监测脑损伤的发生。分析胎龄、出生体质量、窒息、低氧血症、辅助通气及脑损伤对早产儿aEEG的影响。结果 1.早产儿71例中,正常aEEG 40例,异常aEEG 31例。2.胎龄<34周者54例,正常aEEG 25例,异常aEEG 29例(53.7%);≥34周者17例,正常aEEG 15例,异常aEEG 2例(11.8%);2组aEEG异常率比较差异有统计学意义(χ2=9.245 2,P<0.01)。3.出生体质量<1.5 kg者25例,正常aEEG 8例,异常aEEG 17例(68.0%);出生体质量≥1.5 kg者46例,正常aEEG 32例,异常aEEG14例(30.4%);2组aEEG异常率比较差异有统计学意义(χ2=9.291 9,P<0.001)。4.产时有窒息者36例,正常aEEG 15例,异常aEEG 21例(58.3%);无窒息者35例,正常aEEG 25例,异常aEEG 10例(28.6%);2组aEEG异常率比较差异有统计学意义(χ2=6.390 4,P<0.05)。5.低氧血症24例,正常aEEG 16例,异常aEEG 8例(33.3%);无低氧血症者47例,正常aEEG 24例,异常aEEG 23例(48.9%);2组aEEG异常率比较差异无统计学意义(χ2=1.572 4,P>0.05)。6.辅助通气者19例,正常aEEG 8例,异常aEEG 11例(57.9%);未辅助通气者52例,正常aEEG 32例,异常aEEG 20例(38.5%);2组aEEG异常率比较差异无统计学意义(χ2=2.136 4,P>0.05)。7.有脑损伤者51例,正常aEEG 24例,异常aEEG 27例(52.9%);无脑损伤者20例,正常aEEG 16例,异常aEEG 4例(20.0%);2组aEEG异常率比较差异有统计学意义(χ2=6.337 5,P<0.05)。结论胎龄和出生体质量对早产儿aEEG有显著影响。小胎龄、低出生体质量以及出生时窒息和脑损伤的早产儿异常aEEG的发生率高。在分析早产儿aEEG时应考虑胎龄、出生体质量、窒息及脑损伤等生理病理因素的影响。     

极低出生体质量儿并支气管肺发育不良的危险因素

目的探讨极低出生体质量儿（VLBWI）并支气管肺发育不良（BPD）的危险因素及预防对策。方法回顾性分析应用呼吸机治疗且住院28d以上的VLBWI共56例。分析20余种高危因素与BPD发生的关系。结果BPD发生率为41．07％（23／56例），占使用机械通气VLBWI的17．04％（23／135例），占所有VLBWI的6．20％（23／371例）。BPD组FiO2、吸气峰压（HP）、呼气末正压（PEEP）、平均呼吸道压（MAP）、上机日龄、产前应用地塞米松促肺成熟、生后应用肺表面活性物质（PS）等与对照组比较差异均无显著性意义（Pα〉0．05），而胎龄≤30周、出生体质量≤1250g、上机次数〉2次、并肺炎、肺出血、上机5d、痰培养阳性2次以上与对照组比较均有显著性差异（Pα〈0．05）；多因素Logistic回归分析显示，并肺炎、使用机械通气天数回归系数为0．952、0．144；OR值分别为2．591、1．154。结论缩短应用机械通气时间、防止及减少肺部感染，尤其是严重感染是预防VLBWI发生BPD的重要措施。     

早产儿脑损伤的高危因素

目的 探讨引起早产儿脑损伤的高危因素,以降低其发病率,改善神经发育预后.方法 对2005年8月-2007年8月本院NICU收治的130例早产儿于出生第1、3、4、7、15天及第1、3、6个月行颅脑超声检查,Ⅰ、Ⅱ级脑室内出血(IVH)为轻度脑损伤;Ⅲ、Ⅳ级IVH/脑室周围白质软化(PVL)为重度脑损伤.应用SPSS11.5统计软件对其胎龄、出生体质量、母亲有无妊娠高血L压综合征、胎膜早破、分娩方式(阴道分娩、剖宫产)、患儿产前有无宫内窘迫、产时有无窒息、窒息复苏(包括气管插管或面罩加压给氧)、是否给予肺泡表面活性物质、出生后有无呼吸暂停、惊厥、低氧血症、高碳酸血症、低碳酸血症、酸中毒、有无吸氧、是否采用鼻塞持续呼吸道正压(nCPAP)或呼吸机辅助通气17个项目行Logistic回归分析.结果130例早产儿中,颅脑超声检出脑损伤88例,发生率66.7%.其中,轻度脑损伤29例(占33%)(IVH Ⅰ级5例,Ⅱ级24例);重度脑损伤59例(占67%)[IVHⅢ级53例,Ⅳ级1例,PVL5例(伴IVH Ⅰ级1例,Ⅱ级、Ⅲ级各2例)].胎龄越小、出生体质量越低,脑损伤发生率越高;窒息复苏、出生后低氧血症及采用nCPAP或呼吸机辅助通气也是早产儿脑损伤较重要的高危因素,这些因素均可影响早产儿脑血流自主调节功能,触发或加重脑损伤.结论小胎龄、低出生体质量、窒息复苏、低氧血症及辅助通气等为早产儿脑损伤高危因素,通过影响早产儿脑血流自主调节功能,进而影响脑血流动力学参数,导致早产儿脑损伤的发生.     

Concurrent Validity and Reliability of the Alberta Infant Motor Scale in Infants at Dual Risk for Motor Delays

Concurrent validity of scores for the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Gross Motor Scale-2 (PDGMS-2) was examined with a sample of 35 infants at dual risk for motor delays or disabilities. Dual risk was defined as low birthweight (≤ 1,500 g at birth) and environmental risk (children from low-income families). Measures were administered to participants during one visit to a high-risk, follow-up program. Pearson product-moment correlation coefficients were high (r = .90 to .97), with the highest correlation between PDGMS-2 locomotion subscale and AIMS total score. Correlation coefficients were lower for infants > 9 months of age. Novice examiners' scores on both measures closely approximated those of experienced examiners (ICC range = .98 to .99). The results support concurrent validity of the AIMS and PDGMS-2 for infants at dual risk and have implications for using the AIMS in high-risk follow-up programs, particularly in relation to evaluating functional components of motor performance and ease of administration.     

Perinatal Morbidity of Infants of Diabetic Mothers

Along with the recent progress in controlling the diabetic state during pregnancy, the number of diabetic pregnancies in our country has been increasing. It is not appropriate to apply White's classification to Japanese pregnant women, because more than two-thirds are NIDDM and it is not easy to clarify their duration of illness. Neonatal complications were analyzed in 160 infants of diabetic mothers (IDMs) who were admitted to Tokyo Women's Medical College over the past five years. All were inborn except four. Neonatal outcomes of IDDM and NIDDM were not statistically different. The overall incidence of neonatal complications in IDMs was 66%, and there were no neonatal deaths. Offspring whose mothers had been suffering from retinopathy were likely to be premature and light-for-date infants. A planned pregnancy in diabetic women is likely to decrease neonatal complications. The cooperative total care of diabetic mothers and their offspring by respective specialists, namely endocrinologists, obstetricians and neonatologists is essential for the better prognosis of infants of diabetic mothers.     

Safety and Efficacy of Low-Profile Balloons in Native Coarctation and Recoarctation Balloon Angioplasty for Infants

Background Traditionally, high-profile/high-pressure balloons have been used for angioplasties, whereas low-profile/low-pressure balloons have been used for valvuloplasties. High-profile balloons require larger introducing sheaths, which can be a limiting factor for percutaneous catheter interventions in infants. This report aims to report the author’s experience with the efficacy of low-profile balloons using smaller introducing sheaths for coarctation balloon angioplasty in infants. Methods From April 2004 to April 2008, 15 infants, representing both native coarctation and recoarctation indications, underwent coarctation balloon angioplasty and were retrospectively reviewed. The arterial access was achieved using 4-Fr (Cook) introducing sheaths and Tyshak (NuMED, Hallenweg-Netherlands) balloons 5 to 8 mm in diameter for coarctation angioplasty in the study group. Results In this study, 15 infants (7 with native coarctation and 8 with postoperative recoarctation) underwent balloon angioplasty. These infants ranged in age from 2 to 9 months (median, 4 months) and in weight from 3.5 to 10.8 kg (median, 5.7 kg). The peak-to-peak coarctation gradient was reduced from 46.2 ± 28 mmHg before angioplasty to 10 ± 8 mmHg afterward (p = 0.001). The angiographic diameter of the coarctation segment was increased from 2.4 ± 1.0 mm before angioplasty to 5 ± 0.8 mm afterward (p = 0.001). There were no immediate major or minor complications. During a follow-up period up to 48 months, only one patient from the native coarctation group experienced recoarctation and underwent successful reballooning, and none of the patients experienced aneurysms. Conclusion This study shows that the use of low-profile/low-pressure balloons is an effective treatment for infants. Furthermore, low-profile balloons required smaller introducing sheaths, which provides a clear advantage of minimizing vascular complications with coarctation ballooning in younger infants.     

Seat belt use among Hispanic ethnic subgroups of national origin.

OBJECTIVE: Findings from over a dozen studies of Hispanic/white disparities in seat belt use have been inconsistent, variably revealing that seat belt use prevalence among Hispanics is higher, lower, or comparable to use among non-Hispanics. In contrast to previous studies, this study investigates disparities in seat belt use by Hispanic subgroups of national origin. METHODS: Data from the US Fatality Analysis Reporting System were used to compare seat belt use among 60 758 non-Hispanic whites and 6879 Hispanics (Mexican American (MA), n = 5175; Central American/South American (CASA), n = 876; Puerto Rican (PR), n = 412; Cuban (CU), n = 416) killed in crashes from 1999-2003. Logistic regression was used to adjust for age, gender, seat belt law, seat position, urban/rural region, and income. RESULTS: Overall adjusted odds ratios for seat belt use among Hispanic subgroups, relative to non-Hispanic whites, were 1.04 (95% confidence interval (CI) 0.85 to 1.28) for CUs, 1.17 (95% CI 0.95 to 1.44) for PRs, 1.33 (95% CI 1.25 to 1.42) for MAs, and 1.66 (95% CI 1.44 to 1.91) for CASAs. Relative to their non-Hispanic white counterparts, odds ratios among MA and CASA Hispanics were highest for men, younger age groups, drivers, primary law states, rural areas, and lower income quartiles. CONCLUSION: Among all Hispanic subgroups, seat belt use was at least as prevalent as among non-Hispanic whites. In the CASA and MA subgroups, which have the most rapidly growing subpopulations of immigrants, seat belt use was significantly more common than among whites.     

早产儿医院感染的危险因素

目的 探讨早产儿医院感染的发病情况及危险因素,为医院感染的监控和干预提供理论依据.方法回顾性调查本院2008年1月-2010年1月本院NICU 516例早产儿的临床资料,分析医院感染的危险因素.结果 1.早产儿516例中,74例发生医院感染,发生率为14.3%,共发生医院感染98例次,平均每例发生1.32次,医院感染的住院日相关发生率为8.9‰;感染部位以呼吸道为主(51.0%),其中呼吸机相关性肺炎最为多见(占36.0%),其次为皮肤软组织(26.5%)和消化道(14.3%).2.共培养出病原菌69株,革兰阴性杆菌占71.0%,以肺炎克雷伯菌最为多见(17.4%);革兰阳性球菌占18.8%,以草绿色链球菌最为多见;真菌占10.1%,主要为白色念珠菌.3.胎龄≤32周、出生体质量≤1.5 kg、羊水胎粪污染、胎膜早破≥48 h、糖尿病母亲儿、吸痰次数≥10次、气管插管次数≥3次、机械通气时间≥3 d、置胃管、静脉营养、应用抗生素时间≥2周及住院时间≥2周与医院感染率显著相关,多元Logistic回归方程显示胎龄≤32周、静脉营养、机械通气时间≥3 d及住院时间≥2周是医院感染发生的独立危险因素.结论 NICU早产儿医院感染的危险因素众多,尽量减少侵入性操作次数、缩短静脉营养及住院的时间、合理应用抗生素可有效降低医院感染发生率.     

极低出生体质量儿支气管肺发育不良的临床高危因素分析

目的 探讨极低出生体质量儿发生支气管肺发育不良(bronchopulmonary dysplasia,BPD)的临床高危因素.方法 回顾性分析2006年9月至2009年9月我院NICU收治的49例极低出生体质量儿的临床资料,分为BPD组(n=15)和非BPD组(n=34),分析BPD发生的可能危险因素.结果与非BPD组相比,BPD组患儿在胎龄[(29.30±1.48)周vs(30.54±1.60)周]、院内获得性感染(9例vs 10例)、宫内感染(9例vs 8例)、持续气道正压通气时间[(12.47±5.83)d vs(4.24±4.19)d]、高浓度氧疗时间[(1.47±1.41)dvs(0.18±0.63)d]、动脉导管未闭(5例vs 1例)等方面比较,差异有统计学意义(P均＜0.05).Logistic回归分析结果显示持续气道正压通气时间以及宫内感染是极低出生体质量儿发生BPD的高危因素(P＜0.05).结论 预防宫内感染可降低BPD的发生率和严重程度,长时间的持续气道正压通气可能预示早期BPD的发生.