Some selected abstracts:

1

Agren J, Sjors G, Sedin G. Ambient humidity influences the rate of skin barrier maturation in extremely preterm infants. J Pediatr. 2006 May;148(5):613-7.

Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. johan.agren@kbh.uu.se

OBJECTIVES: To test the hypothesis that the level of relative humidity (RH) in which preterm infants are nursed might influence their postnatal skin maturation. STUDY DESIGN: In 22 preterm infants (GA 23-27 weeks), transepidermal water loss (TEWL) was determined at postnatal ages (PNA) of 0, 3, 7, 14, and 28 days. At a PNA of 7 days, the infants were randomized to care at either 50% or 75% RH. RESULTS: TEWL decreased at a slower rate in infants nursed at the higher RH. At a PNA of 28 days, TEWL was about twice as high in infants nursed at 75% RH (22 +/- 2 g/m2 h) than in those nursed at 50% RH (13 +/- 1 g/m2 h; P < .001). CONCLUSIONS: The results indicate that the level of RH influences skin barrier development, with more rapid barrier formation in infants nursed at a lower RH. The findings have an impact on strategies for promoting skin barrier integrity in extremely preterm infants.
 

Becquet R, Leroy V, Ekouevi DK, Viho I, Castetbon K, Fassinou P, Dabis F, Timite-Konan M; ANRS 1201/1202 Ditrame Plus Study Group. Complementary feeding adequacy in relation to nutritional status among early weaned breastfed children who are born to HIV-infected mothers: ANRS 1201/1202 Ditrame Plus, Abidjan, Cote d'Ivoire. Pediatrics. 2006 Apr;117(4):e701-10.

Unite INSERM 593, Institut de Sante Publique Epidemiologie et Developpement, Universite Victor Segalen, Bordeaux, France. Renaud.Becquet@isped.u-bordeaux2.fr

OBJECTIVE: In high HIV prevalence resource-constrained settings, exclusive breastfeeding with early cessation is one of the conceivable interventions aimed at the prevention of HIV through breast milk. Nevertheless, this intervention has potential adverse effects, such as the inappropriateness of complementary feeding to take over breast milk. The purpose of our study first was to describe the nature and the ages of introduction of complementary feeding among early weaned breastfed infants up to their first birthday and second was to assess the nutritional adequacy of these complementary foods by creating a child feeding index and to investigate its association with child nutritional status. METHODS: A prospective cohort study in Abidjan, Cote d'Ivoire, was conducted in HIV-infected pregnant women who were willing to breastfeed and had received a perinatal antiretroviral prophylaxis. They were requested to practice exclusive breastfeeding and initiate early cessation of breastfeeding from the fourth month to reduce breast milk HIV transmission. Nature and ages of introductory complementary feeding were described in infants up to their first birthday by longitudinal compilation of 24-hour and 7-day recall histories. These recalls were done weekly until 6 weeks of age, monthly until 9 months of age, and then quarterly. We created an index to synthesize the nutritional adequacy of infant feeding practices (in terms of quality of the source of milk, dietary diversity, food, and meal frequencies) ranging from 0 to 12. The association of this feeding index with growth outcomes in children was investigated. RESULTS: Among the 262 breastfed children included, complete cessation of breastfeeding occurred in 77% by their first birthday, with a median duration of 4 months. Most of the complementary foods were introduced within the seventh month of life, except for infant food and infant formula that were introduced at age 4 months. The feeding index was relatively low (5 of 12) at age 6 months, mainly as a result of insufficient dietary diversity, but was improved in the next 6 months (8.5 of 12 at 12 months of age). Inadequate complementary feeding at age 6 months was associated with impaired growth during the next 12 months, with a 37% increased probability of stunting. CONCLUSION: Adequate feeding practices around the weaning period are crucial to achieving optimal child growth. HIV-infected women should turn to early cessation of breastfeeding only when they are counseled properly to provide adequate complementary feeding to take over breast milk. Our child feeding index could contribute to the assessment of the nutritional adequacy of complementary feeding around the weaning period and therefore help to detect children who are at risk for malnutrition.
 

Gibson A, Carney S, Wales JK. Growth and the premature baby. Horm Res. 2006;65 Suppl 3:75-81.

Jessop Wing, Sheffield, UK. Alan.Gibson@sth.nhs.uk

There is considerable evidence to show that babies born prematurely have poor postnatal growth, and the more premature the baby, the greater the impairment is likely to be and the longer it will persist. Nutrition has been shown to play an important part in this, but adequate nutrition is difficult, if not impossible, to achieve in these infants. In the most immature infants, growth retardation may continue for many months and catch-up may be delayed and incomplete. Evidence from long-term studies suggests that preterm infants will be shorter and lighter than term controls and that reduced stature and head size may be linked with lower intelligence. Although there is evidence linking better growth to better neurodevelopmental outcome, with reports suggesting that this can be achieved with dietary manipulation, there are also data that suggest that there could be a link between increased postnatal growth and increased morbidity and mortality in later childhood and adult life. Here, we provide an overview of current understanding of growth impairment in infants born prematurely and the effects in later life. Copyright 2006 S. Karger AG, Basel.
 

Hazel R. The psychosocial impact on parents of tube feeding their child. Paediatr Nurs. 2006 May;18(4):19-22. Review.
 

Luton and Dunstable Hospital.

A review of 13 papers investigating parents' experience of long-term tube feeding in disabled children and young people identified a significant impact on parents and families related to oral feeding, decision making and tube feeding itself. Mixed messages and pressure from health professionals and relatives made decision making about tube feeding more difficult for parents. Making the decision to tube feed or proceed to gastrostomy was described in terms of 'giving in'. Parents expressed a need for consistent, accurate information. Once tube feeding was established there is a positive impact on the lives of the child and family - although some parents reported reduced support and continued feelings of inadequacy. The significance parents attach to oral feeding and their information and respite care needs when tube feeding must be recognised and further explored.
 

James P. Marabou 2005: nutrition and human development. Nutr Rev. 2006 May;64(5 Pt 2):S1-11; discussion S72-91.

London School of Hygiene and Tropical Medicine, United Kingdom. jeanhjames@aol.com

Nutrition is now becoming once more of intense interest to biological and medical scientists working on the control of development and human health. It is also now of ever greater public health interest. Few scientists, however, recognize that the same interest for those involved in fundamental science and public health developed a century ago focusing on the way in which nutrition and specific micronutrients, as well as general energy and protein intakes, were crucial to infant growth and appropriate development. The discovery of vitamins was matched by the proposition that stunted children in poor communities in the Western world were suffering from poverty-related poor diets. The critical role of nutrition was established by feeding studies, which then led to major food and agricultural policy changes during the Second World War, when food supplies were scarce throughout Europe. The success of these wartime policies led to a revolution in governmental thinking and a cheap food policy, together with a major boost in national agricultural production as an issue of national security. Nutritionists transferred their scientific interest to the study of childhood malnutrition in the developing world. The promotion of intensive agriculture and the food industry led to a revolution in food supplies, with the intense promotion of meat, milk, butter, and sugar production and consumption. The resulting escalation in cardiovascular disease related to the dietary change slowly altered public health policies, but as cardiovascular deaths decreased in the developed world, obesity and diabetes progressively increased. Now the lower- and middle-income countries (i.e., the developing world) have far more cardiovascular disease as Western diets and cultural habits are imported. The remarkable escalation of diabetes and cardiovascular disease, particularly in populations currently and previously subjected to malnutrition, now reveals unusual susceptibility to these diseases. This susceptibility is increasingly related to the conjunction of fetal malnutrition and later inappropriate diets. The alarming escalation in the health burden suggests that two-thirds of the world's population is super-sensitive to weight gain, diabetes, cardiovascular disease, and perhaps many cancers. New evidence on epigenetics and the structural changes in the fetus in response to inappropriate maternal diets provides mechanisms to explain this. Unfortunately, a vicious intergenerational cycle of maternal and fetal epigenetic change seems to herald markedly increased future burdens of disease. The nutrition field is therefore challenged not only in terms of science, but also in new dimensions of public health of immense economic significance.
 

Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM, Islam S, Langer JC, Sato TT, Brandt ML, Lee H, Blakely ML, Lazar EL, Hirschl RB, Kenney BD, Hackam DJ, Zelterman D, Silverman BL. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med. 2006 May 25;354(21):2225-34.

Section of Pediatric Surgery, Yale University School of Medicine, New Haven, Conn 06520-8062, USA. larry.moss@yale.edu

BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P=0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P=0.53). The mean (+/-SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126+/-58 days and 116+/-56 days, respectively; P=0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants. (ClinicalTrials.gov number, NCT00252681.). Copyright 2006 Massachusetts Medical Society.
 

Ong KK. Size at birth, postnatal growth and risk of obesity. Horm Res. 2006;65 Suppl 3:65-9.

MRC Epidemiology Unit, Strangeways Research Laboratory, Cambridge, UK. ken.ong@mrc-epid.cam.ac.uk

Epidemiological studies over the last 15 years have shown that size at birth, early postnatal catch-up growth and excess childhood weight gain are associated with an increased risk of adult cardiovascular disease and type 2 diabetes. At the same time, rising rates of obesity and overweight in children, even at pre-school ages, have shifted efforts towards the identification of very early factors that predict risk of subsequent obesity, which may allow early targeted interventions. Overall, higher birth weight is positively associated with subsequent greater body mass index in childhood and later life; however, the relationship is complex. Higher birth weight is associated with greater subsequent lean mass, rather than fat mass. In contrast, lower birth weight is associated with a subsequent higher ratio of fat mass to lean mass, and greater central fat and insulin resistance. This paradoxical effect of lower birth weight is at least partly explained by the observation that infants who have been growth restrained in utero tend to gain weight more rapidly, or 'catch up', during the early postnatal period, which leads to increased central fat deposition. There is still debate as to whether there are critical early periods for obesity: does excess weight gain during infancy, childhood or even very early neonatal life have a greater impact on long-term fat deposition and insulin resistance? Early identification of childhood obesity risk will be aided by identification of maternal and fetal genes that regulate fetal nutrition and growth, and postnatal genes that regulate appetite, energy expenditure and the partitioning of energy intake into fat or lean tissue growth. Copyright 2006 S. Karger AG, Basel.
 

Valverde E, Pellicer A, Madero R, Elorza D, Quero J, Cabanas F. Dopamine versus epinephrine for cardiovascular support in low birth weight infants: analysis of systemic effects and neonatal clinical outcomes. Pediatrics. 2006 Jun;117(6):e1213-22.

Department of Neonatology, La Paz University Hospital, Madrid, Spain.

BACKGROUND: Early postnatal adaptation to transitional circulation in low birth weight infants frequently is associated with low blood pressure and decreased blood flow to organs. Catecholamines have been used widely as treatment, despite remarkably little empirical evidence on the effects of vasopressor/inotropic support on circulation and on clinically important outcomes in sick newborn infants. AIMS: To explore the effectiveness of low/moderate-dose dopamine and epinephrine in the treatment of early systemic hypotension in low birth weight infants, evaluate the frequency of adverse drug effects, and examine neonatal clinical outcomes of patients in relation to treatment. DESIGN/METHODS: Newborns of <1501-g birth weight or <32 weeks of gestational age, with a mean blood pressure lower than gestational age in the first 24 hours of life, were assigned randomly to receive dopamine (2.5, 5, 7.5, and 10 microg/kg per minute; n = 28) or epinephrine (0.125, 0.250, 0.375, and 0.5 microg/kg per minute; n = 32) at doses that were increased stepwise every 20 minutes until optimal mean blood pressure was attained and maintained (responders). If this treatment was unsuccessful (nonresponders), sequential rescue therapy was started, consisting first of the addition of the second study drug and then hydrocortisone. OUTCOME MEASURES: These included: (1) short-term changes (first 96 hours, only responders) in heart rate, mean blood pressure, acid-base status, lactate, glycemia, urine output, and fluid-carbohydrate debit; and (2) medium-term morbidity, enteral nutrition tolerance, gastrointestinal complications, severity of lung disease, patent ductus arteriosus, cerebral ultrasound diagnoses, retinopathy of prematurity, and mortality. RESULTS: Patients enrolled in this trial did not differ in birth weight or gestational age (1008 +/- 286 g and 28.3 +/- 2.3 weeks in the dopamine group; 944 +/- 281 g and 27.7 +/- 2.4 weeks in the epinephrine group). Other main antenatal variables were also comparable. However, responders and nonresponders differed significantly with respect to the need for cardiorespiratory resuscitation at birth (3% vs 23%), Critical Risk Index for Babies score (3.8 +/- 3 vs 7 +/- 5), and premature rupture of membranes >24 hours (39.5% vs 13.6%), respectively. No differences were found in the rate of treatment failure (dopamine: 36%; epinephrine: 37%) or need for rescue therapy according to treatment allocation. Groups did not differ in age at initiation of therapy (dopamine: 5.3 +/- 3.9 hours; epinephrine: 5.2 +/- 3.3 hours), but withdrawal was significantly later in the dopamine group. For short-term changes, mean blood pressure showed a significant increase from baseline throughout the first 96 hours with no differences between groups. However, epinephrine produced a greater increase in heart rate than dopamine. After treatment began, epinephrine patients showed higher plasma lactate (first 36 hours) and lower bicarbonate and base excess (first 6 hours) and received more bicarbonate. Patients in the epinephrine group also had higher glycemia (first 24 hours) and needed insulin therapy more often. Groups did not differ in urine output or fluid-carbohydrate supply during the first 96 hours. For medium-term morbidity, there were no differences in neonatal clinical outcomes in responders. However, significant differences were found in the incidence of patent ductus arteriosus, bronchopulmonary dysplasia, need for high-frequency ventilation, occurrence of necrotizing enterocolitis, and death between responders and nonresponders. CONCLUSIONS: Low/moderate-dose epinephrine is as effective as low/moderate-dose dopamine for the treatment of hypotension in low birth weight infants, although it is associated with more transitory adverse effects.
 

Zhang J, Wu TX, Liu GJ. Chinese herbal medicine for the treatment of pre-eclampsia. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005126. Review.

BACKGROUND: Pre-eclampsia is a common disorder of pregnancy with uncertain etiology. In Chinese herbal medicines, a number of herbs are used for treating pre-eclampsia. Traditional Chinese medicine considers that, when a woman is pregnant, most of the blood of the mother is directed to the placenta to provide the baby with the required nutrition; other maternal organs may in consequence be vulnerable to damage. These organs include the liver, the spleen, and the kidneys. The general effects of Chinese herbal medicines that can protect these organs may be valuable in pre-eclampsia by encouraging vasodilatation, increasing blood flow, and decreasing platelet aggregation. The use of Chinese herbal medicine is often based on the individual and presence of traditional Chinese medicine symptoms. OBJECTIVES: To assess the effect of Chinese herbal medicine for treating pre-eclampsia and compare it with that of placebo, no treatment or Western medicine. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Groups Trial Register (31 March 2024), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005), MEDLINE (1969 to December 2004), EMBASE (1984 to March 2004) and CBM (1978 to February 2005) and we handsearched several main journals published in China. SELECTION CRITERIA: Randomized controlled trials in which Chinese herbal medicine was used for treating pre-eclampsia. DATA COLLECTION AND ANALYSIS: One review author assessed trials for inclusion. The trials were also assessed by a second review author if there was any doubt about whether or not to include the trial. Analysis was not performed as there were no trials included in this review. MAIN RESULTS: No trials were suitable for inclusion in this review. AUTHORS' CONCLUSIONS: The effect of Chinese herbal medicine for treating pre-eclampsia remains unclear. There are currently no randomized controlled trials to address the efficacy and safety of Chinese herbal medicine for the treatment of pre-eclampsia. Well conducted randomized controlled trials are required.
 

14792.  Anderson PM, Butcher KE.  Childhood obesity: trends and potential causes. Future Child. 2006 Spring;16(1):19-45. Review.

14793.  Berger J, Ninh NX, Khan NC, Nhien NV, Lien DK, Trung NQ, Khoi HH. Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants. Eur J Clin Nutr. 2006 Apr;60(4):443-54.

14794.  Blakely ML, Tyson JE, Lally KP, McDonald S, Stoll BJ, Stevenson DK, Poole WK, Jobe AH, Wright LL, Higgins RD; NICHD Neonatal Research Network. Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics. 2006 Apr;117(4):e680-7.

14795.  Chapman DJ. Does maternal diet contribute to colic among breastfed infants? J Hum Lact. 2006 May;22(2):236-7.

14796.  Garlick PJ.  Toxicity of methionine in humans. J Nutr. 2006 Jun;136(6 Suppl):1722S-1725S. Review.

14797.  Henriksen T. Nutrition and pregnancy outcome. Nutr Rev. 2006 May;64(5 Pt 2):S19-23; discussion S72-91. Review.

14798.     Islam MM, Peerson JM, Ahmed T, Dewey KG, Brown KH. Effects of varied energy density of complementary foods on breast-milk intakes and total energy consumption by healthy, breastfed Bangladeshi children. Am J Clin Nutr. 2006 Apr;83(4):851-8.

14799.     Jyothi DV, Umamaheshwari K. Health status and prevalence of anaemia among the adolescent girls of integrated child development services projectarea. J Res ANGRAU 2005, 33(1), 74111-7.

14800.     Lakshmi Devi N, Khader V, Vimala V. Nutritional Status of the Institutionalized Elderly in Andhra Pradesh. Indian J clin Pract 2005, 16(4), 14-19.

14801.  Lawrence RA. Lower breastfeeding rates among supplemental nutrition program for women, infants, and children participants: a call for action. Pediatrics. 2006 Apr;117(4):1432-3.

14802.  Lindsay AC, Sussner KM, Kim J, Gortmaker S.  The role of parents in preventing childhood obesity. Future Child. 2006 Spring;16(1):169-86.

14803.  Lovelady CA, Stephenson KG, Kuppler KM, Williams JP. The effects of dieting on food and nutrient intake of lactating women. J Am Diet Assoc. 2006 Jun;106(6):908-12.

14804.  Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Chang VW. Trends in the association of poverty with overweight among US adolescents, 1971-2004. JAMA. 2006 May 24;295(20):2385-93. 

14805.  Reilly JK, Lanou AJ, Barnard ND, Seidl K, Green AA. Acceptability of soymilk as a calcium-rich beverage in elementary school children. J Am Diet Assoc. 2006 Apr;106(4):590-3.

14806.  Reiter PD, Novak K, Valuck RJ, Rosenberg AA, Fish D. Effect of a closed drug-delivery system on the incidence of nosocomial and catheter-related bloodstream infections in infants. Epidemiol Infect. 2006 Apr;134(2):285-91.

14807.  Shaheen R, de Francisco A, El Arifeen S, Ekstrom EC, Persson LA. Effect of prenatal food supplementation on birth weight: an observational study from Bangladesh. Am J Clin Nutr. 2006 Jun;83(6):1355-61.

14808.  Taylor C. Lactose intolerance in infants. Nurs Times. 2006 Apr 25-May 1;102(17):43-4. Review.

14809.  Uauy R, Dangour AD. Nutrition in brain development and aging: role of essential fatty acids. Nutr Rev. 2006 May;64(5 Pt 2):S24-33; discussion S72-91. Review.

14810.  Wright K, Coverston C, Tiedeman M, Abegglen JA. Formula supplemented with docosahexaenoic acid (DHA) and arachidonic acid (ARA): a critical review of the research. J Spec Pediatr Nurs. 2006 Apr;11(2):100-12; discussion 112-3. Review. 

14811.  Zhou SJ, Gibson RA, Crowther CA, Baghurst P, Makrides M. Effect of iron supplementation during pregnancy on the intelligence quotient and behavior of children at 4 y of age: long-term follow-up of a randomized controlled trial. Am J Clin Nutr. 2006 May;83(5):1112-7.

14812.  Zlotkin SH, Schauer C, Owusu Agyei S, Wolfson J, Tondeur MC, Asante KP, Newton S, Serfass RE, Sharieff W.  Demonstrating zinc and iron bioavailability from intrinsically labeled microencapsulated ferrous fumarate and zinc gluconate Sprinkles in young children. J Nutr. 2006 Apr;136(4):920-5.