Marília de Carvalho Lima

Comparison of the effect of two systems for the promotion of exclusive breastfeeding

BACKGROUND Promotion of breastfeeding is an important child-survival intervention, yet little is known about which promotional strategies are the most effective. We aimed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil--a hospital-based system and the same system combined with a programme of home visits. METHODS In February, 2001, maternity staff from two hospitals in Pernambuco, Brazil, were trained according to the Baby-Friendly Hospital Initiative (BFHI). In a randomised trial between March and August, 2001, 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding (n=175) or no home visits (n=175). Breastfeeding practices were studied on days 1, 10, 30, 60, 90, 120, 150, and 180 by researchers unaware of group allocation. The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months. Analyses were by intention to treat. FINDINGS The hospital-training intervention achieved a high rate (70%) of exclusive breastfeeding in the hospitals, but this rate was not sustained at home and at 10 days of age only 30% of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10-180 differed significantly (p<0.0001), with a mean aggregated prevalence of 45% among the group assigned home visits compared with 13% for the group assigned none. INTERPRETATION The BFHI achieves high rates of exclusive breastfeeding in hospital; however, in Brazil at least, the rates fall rapidly thereafter. Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed. A combination of promotional systems (hospital-based and in the community) is needed.

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).

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.

Desenvolvimento mental e motor aos 24 meses de crianças nascidas a termo com baixo peso

The objective of this study was to compare the development at 24 months of 152 full-term infants, born with low (<2500g) and appropriate birth weight (3000 to 3499g), paired in a proportion of 1:1 by sex and age. Mental and motor development were assessed through the Bayley scale. A variety of sociodemographic and environmental stimulation conditions were also assessed. The infants born with low weight had on average significantly lower mental and motor indexes than those born with appropriate weight (p<0.001), with a difference of 9.1 and 10.2 points, respectively. The multiple linear regression analysis showed that socioeconomic conditions and environmental stimulation explained 11% and 12% of the variation of mental index, and 12% and 9% of motor development, respectively. All together, they explained 23% and 21% of the variation of these indexes. Low birth weight influenced only 3% of the variation of mental index and 5% of motor index.

Determinants of mental and motor development at 12 months in a low income population: a cohort study in northeast Brazil.

Aim: To identify biological and environmental factors associated with poorer mental and motor development at age 12 mo in urban communities in northeast Brazil. Methods: A cohort of 245 infants born during January‐August 1998 in six hospitals in the interior of Pernambuco was followed twice weekly from birth until 12 mo of age. Socio‐economic, demographic and environmental data were collected, together with daily information on morbidity and feeding patterns. Gestational age, birth anthropometry and nutritional status at 12 mo were measured. Multiple linear regression analysis was used to identify variables that had independent effects on mental and motor development assessed at 12 mo of age with the Bayley Scales of Infant Development. Results: Environmental factors explained about 21% and 19% of the variance in mental and motor development, respectively. Of these, the most important were poverty‐related. Significant biological factors associated with mental development were birthweight and infant sex. For motor development, the biological factors were weight‐for‐age and haemoglobin concentration. Biological factors explained only 6% and 5% of the variance in mental and motor development, respectively.

Impacto de treinamento baseado na Iniciativa Hospital Amigo da Criança sobre práticas relacionadas à amamentação no interior do Nordeste

OBJETIVO: Avaliar o impacto de treinamento baseado na Iniciativa Hospital Amigo da Crianca sobre praticas relacionadas a amamentacao na maternidade e frequencias de aleitamento materno nos primeiros 6 meses de vida. METODOS: Foram treinadas 90% das auxiliares de enfermagem e parteiras de duas maternidades (A e B) de Palmares (PE). Foram entrevistadas 334 maes nas primeiras 48 horas e 10 dias apos o parto, para avaliar praticas que estimulam a amamentacao nas maternidades e o cumprimento do quarto ao 10o passo da Iniciativa Hospital Amigo da Crianca. Uma subamostra de 166 maes recebeu sete visitas domiciliares, para avaliar as frequencias do aleitamento materno nos 6 primeiros meses de vida. Os resultados foram comparados com os de estudo de coorte realizado na area em 1998. RESULTADOS: O desempenho da maternidade B foi melhor que o da maternidade A quanto as praticas que promovem o aleitamento materno relacionadas aos passos avaliados e quanto as frequencias de amamentacao exclusiva. Comparacao com coorte historica evidenciou melhora nas praticas relacionadas a amamentacao nas maternidades e aumento nas frequencias do aleitamento materno exclusivo (de 21,2 para 70%), nas primeiras 48 horas apos o parto e durante os 6 primeiros meses de vida. CONCLUSOES: O treinamento promoveu mudancas parciais em algumas praticas relacionadas a amamentacao, repercutindo de forma positiva sobre as frequencias de aleitamento materno e aleitamento materno exclusivo nas maternidades. Contudo, nao houve mudancas expressivas nessas frequencias ao longo dos 6 meses de vida, sugerindo a necessidade de intervencoes efetivas no apoio ao aleitamento exclusivo nos servicos de saude e na comunidade.

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.

Fatores determinantes dos níveis de hemoglobina em crianças aos 12 meses de vida na Zona da Mata Meridional de Pernambuco

OBJECTIVES: to evaluate factors determining hemoglobin levels in 12 months old infants living in four small towns located in the South of Pernambuco. METHODS: a cross-sectional study conducted in a sub-sample of 245 infants belonging to a cohort of 652 children. Data collection was performed from January to August 1999. RESULTS: the prevalence of anemia was 73.2% and mean hemoglobin level 9.8 g/dL (SD = 1.6 g/dL). Variance analysis indicated a significant association between hemoglobin levels and maternal education, absence of a television set at home, birth weight, duration of exclusive breast-feeding, occurrence of diarrhea and nutritional indicators (weight-for-age and length-for-age). Multiple linear regression analysis indicated that socio-economic conditions, birth weight, exclusive breast feeding duration and occurrence of diarrhea had a significant impact on hemoglobin levels. CONCLUSIONS: results confirm that anemia is a severe public health problem, especially during childhood, with multiple factors that contribute to the condition. There is a need to identify the prevailing ones so they can be addressed by programs targeting child health.

Desenvolvimento do sistema sensório motor oral e motor global em lactentes pré-termo

Background: development assessment of preterm infants. Aim: to evaluate the association between the gestational ages (GA) of premature infants with the global motor development as well as with early signs of sensory oral motor development delay, and to verify a possible association between them. Method: an exploratory study that assessed the development of 55 infants with corrected chronological ages between four to five months, born preterm at the Instituto Materno Infantil Professor Fernando Figueira (IMIP) and who were followed at the Kangaroo Mother Program Clinic between March and August of 2004. The assessment of the sensory oral motor development was performed through preselected indicators and of the global motor development through the Alberta Infant Motor Scale (AIMS). Results: infants with lower GA (29 to 34 weeks) presented a higher median of risk signs in the sensory oral motor development assessment when compared to those with higher GA (35 to 36 weeks). Regarding the global motor development, infants born with lower GA presented a higher number of scores in the AIMS below percentile 10 (26%) when compared to those with a higher GA (4%) (p=0.009). The median index of the risk signs for the sensory oral motor development were significantly higher among infants with total AIMS scores below percentile 25 when compared to those with scores equal to or above percentile 25. Conclusion: the gestational age of infants at birth influenced the sensory oral motor and global motor development - infants with lower gestational ages presented worse performances. These findings suggest a possible association between both aspects of infant

Development and behaviour of low-birthweight term infants at 8 years in northeast Brazil: a longitudinal study

Aim: To investigate the development and behaviour of low‐birthweight (LBW) term infants compared with matched term infants of appropriate birthweight (ABW).