Male sex is an independent risk factor for poor neurodevelopmental outcome at 20 months' corrected age, in human milk-fed very preterm infants: a cohort study / O sexo masculino é fator de risco independente para pior desenvolvimento neurológico na idade corrigida de 20 meses, em lactentes muito prematuros e alimentados com leite humano: estudo de coorte

ABSTRACT Objective: To determine associations between sex and neurodevelopmental outcomes in human milk-fed very preterm infants, adjusted to early measured nutrient intakes and other neonatal cofactors. Methods: Consecutive inborn human milk-fed infants, with gestational age <33 weeks, were eligible. In-hospital energy and protein intakes have relied on measured human milk composition. The Bayley Scales of Infant Development II mental and psychomotor developmental indexes were used to assess neurodevelopment at 20 months' corrected age. After univariate analysis, some covariables were used for linear multiple regression. Results: Thirty-two infants were included, with a mean (standard deviation) gestational age of 29.8 (1.8) weeks, and a median birth weight of 1168g (interquartile range 990-1419g). Minimum recommended intakes were achieved in 63.6% and 15.2% of infants for protein and energy, respectively. The mental and psychomotor developmental indexes were within normal limits in 93.8% of infants. The mean mental and psychomotor developmental indexes were significantly lower in males. Only male sex negatively and significantly affected the mental and psychomotor developmental indexes (B=-9.44; 95%CI: -17.64- -1.23; adjusted r2=0.17; p=0.026), adjusted to gestational age and measured energy intake. Conclusion: In human milk-fed very preterm infants, males had a significantly lower mental and psychomotor developmental indexes score at 20 months' corrected age, adjusted for gestational age and measured energy intake.

RESUMO Objetivo: Determinar a associação entre sexo e desfechos relativos ao neurodesenvolvimento em lactentes muito prematuros e alimentados com leite humano, ajustada para a ingestão de nutrientes medida nos primeiros dias de vida e outros cofatores neonatais. Métodos: Consideramos, para este estudo, lactentes alimentados com leite humano, consecutivamente nascidos em um centro especializado, com idade gestacional <33 semanas. A ingestão intra-hospitalar de energia e proteínas baseou-se na composição medida do leite humano. Os índices de desenvolvimento mental e psicomotor das Bayley Scales of Infant Development II foram usados para avaliar o neurodesenvolvimento na idade corrigida de 20 meses. Após a análise univariada, algumas covariáveis foram usadas para a regressão múltipla linear. Resultados: Incluímos 32 lactentes, com idade gestacional média (desvio padrão) de 29,8 (1,8) semanas e mediana de peso ao nascimento de 1168g (intervalo interquartil: 990-1419g). A ingestão mínima recomendada foi atingida em 63,6% e 15,2% dos lactentes, para proteínas e energia, respectivamente. Os índices de desenvolvimento mental e psicomotor ficaram dentro dos limites normais em 93,8% dos lactentes. A pontuação média nos índices de desenvolvimento mental e psicomotor foi significativamente menor no bebês do sexo masculino. Somente o sexo masculino afetou negativa e significativamente os índices de desenvolvimento mental e psicomotor (B=-9,44; IC95%: -17,64- -1,23; r2 ajustado=0,17; p=0,026), ajustados para idade gestacional e ingestão de energia medida. Conclusão: Em lactentes muito prematuros e alimentados com leite humano, o sexo masculino teve pontuação significativamente mais baixa nos índices de desenvolvimento mental e psicomotor na idade corrigida de 20 meses, ajustada para idade gestacional e ingestão de energia medida.

Vínculos entre las creencias y prácticas de los cuidadores de una población vulnerable, con la malnutrición y las alteraciones del neurodesarrollo en la infancia temprana / Links between beliefs and practices of caregivers in a vulnerable population, with malnutrition and neurodevelopment disorders in early childhood

Objetivo: establecer vínculos entre prácticas y creencias de cuidadores, con el fenómeno de nutrición y alteraciones del neurodesarrollo en una población vulnerable de menores de 5 años que asisten a un Programa de Recuperación Nutricional.\r\nMetodología: entre 2007 y 2008 se realizó en una fundación para la recuperación nutricional infantil, en Bogotá, Colombia, una investigación mixta descriptiva y fenomenológica a 56 niños, clasificándolos nutricionalmente con los referentes de crecimiento de la Organización Mundial de la Salud (OMS), valoración de neurodesarrollo con la Escala de Nelson Ortiz, y a sus cuidadores, una encuesta validada por la Organización Panamericana de la Salud (OPS) de las 16 prácticas saludables acerca de nutrición; además se realizaron grupos focales sobre conocimientos, prácticas y actitudes de la nutrición y neurodesarrollo. El análisis cuantitativo se hizo con el programa SPSS y cualitativo a través de una codificación abierta manual por medio de categorización de la información; posteriormente se desarrolló una triangulación de toda la información para establecer los vínculos.\r\nResultados: la población participante se encontró bajo condiciones de vulnerabilidad: 5.8% con desnutrición aguda, 21% con desnutrición global, 40% con desnutrición crónica y 18% presentó alteraciones en el neurodesarrollo global. Existe desconocimiento y malas prácticas alimentarias como patrón cultural, generalmente transmitido por tradición oral y desconocimiento de las madres sobre el neurodesarrollo de sus hijos.\r\nprácConclusiones:\r\nes fundamental evaluar el contexto biopsicosocial de los niños que presentan el fenómeno de la malnutrición para realizar intervenciones que generen impacto. Se requiere de la intervención multisectorial bidireccional que incluya la comunidad como formadora de su propia estrategia de transformación para lograr un cambio en la perspectiva del aprendizaje de prácticas que mejoren el estado nutricional infantil en un contexto integral que involucre el neurodesarrollo

Objective: to establish links between practices and beliefs of caregivers with the phenomena of nutrition and neurodevelopmental disorders in a vulnerable population of children under 5 years who attend a nutrition recovery program.\r\nMethods: data was collected between 2007 and 2008 at a foundation for nutritional recovery of children in Bogota, Colombia. A descriptive and phenomenological mixed study was performed on fifty-six (56) children, classifying them nutritionally according to Growth Standards of the World Health Organization (WHO), performing an evaluation of neurodevelopment with Nelson Ortiz Scale, and applying a validated survey of the sixteen (16) healthy practices on nutrition of the Pan American Health Organization (PAHO) to their caregiver. Focus groups on knowledge, beliefs, and practices of nutrition and neurodevelopment were also performed. The quantitative analysis was done using SPSS and qualitative analysis with an open coding manual through categorization of the information. Later, a triangulation was performed on all the information to establish the links.\r\nResult: the studied population was found to be in a vulnerable condition: 5.8% with acute malnutrition, 21% global malnutrition, 40% with chronic malnutrition, and 18% showed neurodevelopment global disorders. There exists ignorance and poor feeding practices as a result of cultural patterns usually being transmitted by oral tradition as well as ignorance on the part of the mothers about their children's neurodevelopment.\r\nConclusions: it is essential to evaluate the biopsychosocial context of children with malnutrition in order to create strategy that will generate impact. This requires a two-way multi-sectorial intervention that involves the community as trainers of their own transformation strategy for change in the perspective of learning practices that improve the nutritional status of children in a comprehensive context involving neurodevelopment.