Pediatric perioperative nutritional assessment and support.

Perioperative nutritional support reduces the healthcare burden of pediatric malnutrition and its risk. Strategic preventive, diagnostic and therapeutic nutritional management guidelines are now available for their optimization. The global needs for pediatric surgery are vast, amounting to millions of children and adolescents, with a corresponding workforce requirement, especially in less socioeconomically developed regions, and where malnutrition is endemic. Acute and elective surgery from neonate to adolescent, for congenital to infective, neoplastic and traumatic conditions, are involved. To identify, highlight and critique current perioperative pediatric nutrition guidelines with regard to availability, utility, affordability and accuracy. Advantages and limitations of nutritional methodologies are taken into account in an algorithmic approach to perioperative decision-making to optimise outcomes. Routine documentation, monitoring and surveillance of pediatric nutritional status as a contributor to surgical risk management should increase its benefits, and reduce costs.

Maternal Infant-Feeding Attitudes, Infant Eating Behaviors, and Maternal Feeding Choice at 3 and 6 Months Postpartum: A Comparative Multicenter International Study.

Objective: The aim of this study was to compare mothers' attitudes toward infant feeding and infant eating behavior in different countries, and their associations with infant feeding at 3 and 6 months. Methods: Data from 164 mothers with healthy term infants recruited for a randomized trial comparing breast pumps from the UK (n = 68), Russia (n = 51), and China (n = 45) were included in this analysis. Feeding practices were assessed using questionnaires at 3 and 6 months. Maternal attitudes toward infant feeding and infant eating behaviors were measured by Iowa Infant Feeding Attitudes Scale (IIFAS) and Baby Eating Behavior Questionnaire (BEBQ) at 5-6 weeks postpartum; scores were compared between countries and associations with infant feeding at 3 and 6 months were examined. Results: IIFAS score was significantly different between countries; mean scores in Chinese and Russian mothers (China 64.6 ± 4.88 and Russia 61.5 ± 6.15) lay in the range of "neutral breastfeeding attitudes," while British mothers had more positive attitudes (70.6 ± 6.47, post hoc p < 0.001). Russian infants had higher scores for "general appetite" (mean = 4.8 ± 0.41, p < 0.05) and "satiety responsiveness" (mean = 8.7 ± 1.08, p < 0.01) than Chinese or British infants. Longer duration of full-time education was associated with more positive attitudes toward breastfeeding in the whole sample (p < 0.001) and in the United Kingdom (p < 0.05). The majority of mothers were exclusively breastfeeding (EBF) at 3 months. Total IIFAS and BEBQ scores were not significant predictors of EBF at 3 and 6 months (p > 0.05), although greater agreement with the IIFAS statement "Formula feeding is more convenient than breastfeeding" was associated with lower EBF at 3 months (OR = 0.47, 95% CI: 0.29-0.78, p < 0.01). Conclusions: Maternal attitudes toward infant feeding and perceptions of infant eating behavior differed between countries, but were not associated with EBF at 6 months. Mothers with a greater baseline perception that formula feeding is more convenient than breastfeeding were less likely to EBF at 3 months; this could be a potential target for education.