Giselia Alves Pontes da Silva

Efficacy of Bifidobacterium breve and Lactobacillus casei oral supplementation on necrotizing enterocolitis in very-low-birth-weight preterm infants: a double-blind, randomized, controlled trial

BACKGROUND Probiotics are used for the prevention of necrotizing enterocolitis (NEC) because of their positive effects on intestinal motor function, modulation of inflammatory response, and mucosal barrier function. OBJECTIVE The objective was to assess whether the combined use of Lactobacillus casei and Bifidobacterium breve may prevent the occurrence of NEC stage ≥ 2 by the criteria of Bell in very-low-birth-weight preterm infants. DESIGN A double-blind, randomized, controlled clinical trial was conducted in 231 preterm infants weighing from 750 to 1499 g at birth. The intervention group was composed of 119 infants who received human milk with probiotic supplementation (B. breve and L. casei) and a control group of 112 infants who received human milk containing no probiotics. The primary outcome was the occurrence of NEC stage ≥ 2 as defined by Bells modified criteria. RESULTS Four confirmed cases of NEC stage ≥ 2 by Bells criteria occurred only in the control group. CONCLUSIONS Oral supplementation of B. breve and L. casei reduced the occurrence of NEC (Bells stage ≥ 2). It was considered that an improvement in intestinal motility might have contributed to this result. This trial was registered at www.isrctin.org as number 67165178 (International Standard Randomized Controlled Trial).

Prevalência de sobrepeso e obesidade em crianças e adolescentes de diferentes condições socioeconômicas

OBJECTIVES: to compare overweight and obesity in preschool children, school children and adolescents belonging to different socioeconomic conditions. METHODS: cross-sectional and based on a 1616 children and adolescents sample. Nutritional indicators were defined according to the National Center of Health Statistics 2000 recommendations, overweight being BMI equal to or above 85 percentile and below percentile 95; obesity indicator being defined with BMI equal to or above the 95 percentile. RESULTS: overweight was detected in 234 (14.5%) individuals and obesity in 134 (8.3%). Overweight prevalence was higher among preschool children (22.2%), though prevalence reduction was noted in younger school children (12.9%) and adolescents (10.8%). A similar pattern was found for obesity in 13.8% of preschool children, 8.2% of school children, and 4.9% of adolescents. Overweight and obesity were mostly observed among children and adolescents of high income families. CONCLUSIONS: as age increases overweight and obesity diminish. Similar overweight prevalence was detected among preschool children irrespective of socioeconomic conditions. Overweight prevalence was highest among school children with high socioeconomic conditions and adolescents with low socioeconomic conditions.

Does birth weight affect nutritional status at the end of first year of life

OBJECTIVE To evaluate the association between low birth weight and nutritional status at the end of the first year of life. METHODS This was a nested case-control study within a cohort. The study was carried out at maternity hospitals in four cities in the Zona da Mata Meridional in Pernambuco state, Brazil. Newborn infants were recruited during the first 24 hours of life. Their weights were measured at birth and at the end of the first year of life. Household visits were made twice weekly during the first year of life to collect data on breastfeeding and occurrence of diarrhea. In the case-control study, each case (child at nutritional risk) was a child with weight-for-age index < the 10th percentile (n = 117) and each control was a child with weight-for-age index > or = the 10th percentile (n = 411). Hierarchical logistic regression analysis was used to investigate risk factors for nutritional status at 12 months. RESULTS Low birth weight and living in a household with no latrine were significantly associated with nutritional risk at the end of the first year of life. Children born weighing 1,500 g to 2,499 g had 29 times (95% CI = 9.77-87.49) the chance of being at nutritional risk at 12 months of life than those whose birth weights had been > 3,500 g (p < 0.001). Children living in households without a flush toilet had three times (95% CI = 1.54-6.22) the chance of nutritional risk at 12 months of life in relation to those that had a latrine with a septic tank at home (p = 0.01). CONCLUSION Low birth weight is an important risk factor of nutritional risk at the end of the first year of life. It is important to adopt strategies for its reduction and prevention.

Risk factors for neonatal death in Recife: a case-control study

OBJECTIVE: Neonatal mortality is the main cause of infant mortality in the city of Recife. The objective of the present study was to determine the major risk factors for neonatal death in Recife in 1995. METHODS: This is a case control study. Information was obtained from the mortality and live birth databases after validation of the data set, between January and December 1995. A sample of 456 cases and 2,280 controls was obtained after using the linkage technique between the two data sets. The difference in proportion was analyzed by the chi square test. The odds ratio was calculated as a risk measure, with a 95% confidence interval. The logistic regression technique was used to adjust potential confounding factors. RESULTS: 212 deaths (46.6%) occurred in the first 24 hours of life. We found that 358 (79.7%) of the cases presented low birth weight, with a 46-fold higher risk of death (CI =33.8-59.0 P 2,500g. The major risk factors observed in the logistic regression analyses of the measure, listed in descending order, were: birth weight < 1,500g (OR= 49.6 CI= 22.6-108.7 P < 0.001), 5-minute Apgar score < 7 (OR = 44.1 CI= 25.1-77.2 P < 0.001), birth weight between 1,500 and 2,500g (OR= 8.2 CI= 4.8-14.0 P < 0.001), gestational age < 37 weeks (OR= 4.3 CI= 2.6-7.1 P < 0.001). CONCLUSIONS: Among the studied variables, birth weight, gestational age, and Apgar score should be considered the main risk factors for the surveillance of neonatal death.

Risk factors for Helicobacter pylori infection in children

OBJECTIVE To establish the seroprevalence of Helicobacter pylori infection in children and to identify risk factors for seropositivity.\par METHODS A cross-sectional study established the seroprevalence of infection by Helicobacter pylori and afterwards a comparative study was performed amongst seropositive and seronegative children. A group of 228 children were cared for at the outpatient clinic of Instituto Materno Infantil de Pernambuco, from May to July 1999. Age, sex, indicators of environmental, social and economic conditions, health and nutritional status as well as children living in contact with dwellers with history of gastrointestinal pain or peptic disease were evaluated. All data was obtained through an interview with childrens parents or caretakers. Nutritional status was evaluated by anthropometric index. \par RESULTS Seroprevalence of infection caused by Helicobacter pylori was found in 32% (95% CI 26% - 38%); 25.8% (95% CI 17.8% - 33.8%) in preschool children and 39.4% (95% CI 30.4% - 48.4%) in school age children. Analysis of environmental variables demonstrated higher frequency of seropositivity in children living in houses without toilets or sanitary flush toilet facilities (p = 0.008), overcrowded (p = 0.05), lower family income (p = 0.03) and poor maternal education (p = 0.002). There were no statistically significant differences between the groups regarding health indicators, anthropometric indexes and children living with dwellers with history of gastritis or peptic ulcer.\par CONCLUSION Seroprevalence of Helicobacter pylori infection was high in the studied population, being even higher among the school age group. A positive association between seropositivity and less favorable environmental variables was detected.

A respiração oral em crianças e suas repercussões no estado nutricional

PURPOSE: identify nutritional state, masticatory function, respiratory mode, sense of smell and sense of taste among mouth breathing children. METHODS: nasal aeration, mastication, nutritional state of 77 mouth breathing children and 154 nasal breathers children between six and ten years were evaluated. RESULTS: mouth breathers exhibited alterations in the masticatory pattern when compared to the nasal-breathers, but did not have statistical significance in nutritional state. CONCLUSION: the oral-breathing children had more alteration in sleep, reduction in the ingestion of carbohydrate and increase in ingestion of lipids, however, no consistent data were found pointing out the association between mouth breathing and nutritional condition.

Determinants of impaired growth among hospitalized children: a case-control study

CONTEXT Protein energy malnutrition constitutes a public health problem, especially in less affluent countries. The identification of amenable predictive risk factors is of major importance for policy makers to plan interventions to reduce infant malnutrition. OBJECTIVE To identify risk factors for protein energy malnutrition among hospitalized low-income children aged 6 to 24 months. TYPE OF STUDY Case-control study. SETTING Two public hospitals in Recife, Brazil. PARTICIPANTS The cases were 124 infants with length-for-age below the 10th percentile of the National Center for Health Statistics curve and the controls were 241 infants with length-for-age equal to or above the 10th percentile who were recruited in the same infirmary. METHODS Cases and controls were compared in relation to a variety of sociodemographic, environmental and reproductive factors, and their healthcare, previous feeding practice and morbidity. Logistic regression analysis was used to investigate the net effect of risk factors on infant malnutrition, after adjusting for potential confounding variables. RESULTS The mothers age, possession of a TV set, type of water supply, family size and location of the home were significantly associated with child malnutrition in the bivariate analysis. However, these associations lost their significance after adjusting for other explanatory variables in the hierarchical logistic regression analysis. This analysis showed that low birth weight contributed the largest risk for impaired growth. Increased risks of infant malnutrition were also significantly associated with households that had no toilet facilities or refrigerator, high parity for the mother, no breastfeeding of the infant, inadequate vaccination coverage and previous hospitalization for diarrhea and pneumonia. DISCUSSION The literature shows that chronic malnutrition, as assessed by low length-for-age indexes, is often related to low income. However, this was not the case in this study, in which other variables had greater impact on child growth. CONCLUSIONS In view of the multiple causes of malnutrition, the interrelationship among its determinants should be taken into account when adopting strategies for its reduction and prevention.

Risk factors for hospitalization due to acute diarrhea in children under two years old: a case-control study

The aim of this study was to investigate the socioeconomic, demographic, and biological determinants of hospitalization due to acute diarrhea (AD) in children under two years old. The hospital-based, case-control study was conducted from May to October 1997 in a pediatric hospital in Recife, Pernambuco, Brazil. Cases (n = 185) were children hospitalized due to AD, and controls (n = 185) were children with various diseases (except AD) presenting in the previous 15 days in the same area and time period. Data analysis used the Epi Info and Stata software. Odds ratios and 95% confidence intervals were calculated by multiple logistic regression to control confounding factors, considering a hierarchical risk factor model. Investigation using the proposed model showed an association between hospitalization due to AD and packed earth or plank floors in the house, greater multiparity, age of child under six months, and severity of bouts of diarrhea, which depended on the interaction between unfavorable socioeconomic conditions, younger age of the child, and severity of the diarrhea.

Desnutricão e obesidade em crianças: delineamento do perfil de uma comunidade de baixa renda

OBJECTIVE: To establish the nutritional diagnosis of children living in a low-income community through anthropometric evaluation, detecting insufficient nutrition (low weight-for-age, wasting and stunting) and excessive nutrition (overweight and obesity). METHODS: A community-based survey identified children below 11 years living in a low-income community. Their weight and height (or lengths) were measured. The National Center for Health Statistics growth curve was used as reference. The cut-off points used were: low-weight-for-age z score of +2, according to weight-for-height. RESULTS: Prevalence rates were 3.8% for low weight for age, and 24% for low-weight-for-age risk factors; 1.2% for wasting, and 21.6% for wasting risk factors; 5% for stunting, and 14.3% for stunting risk factors; 10.1% for overweight, and 4.6% for obesity. CONCLUSIONS: Main nutritional issues were present in children from that community, with simultaneous occurrence of chronic malnutrition and obesity.

Allergy to cow’s milk proteins: what contribution does hypersensitivity in skin tests have to this diagnosis?

To cite this article: Costa AJF, Sarinho ESC, Motta MEFA, Gomes PN, de Oliveira de Melo SM, da Silva GAP. Allergy to cow’s milk proteins: what contribution does hypersensitivity in skin tests have to this diagnosis? Pediatr Allergy Immunol 2011; 22: e133–e138.