'Supporting a first-time mother': Assessment of success of a breastfeeding promotion programme.

BACKGROUND: The aim of this study was to measure the effectiveness on breast feeding rates by the program 'Supporting a First-time Mother', a web-based platform of interactionbetween first-time mothers and breastfeeding-experienced women who act as peer-supporters. METHODS: A randomized study with a control and intervention group was conducted between April and October 2016. Participants were recruited from Hospital Universitario de Canarias (Spain). Inclusive criteria were singleton pregnancy, healthy term baby, vaginal or assisted delivery. Participants were randomly assigned to either an intervention or control group. Type of feeding (exclusive, partial or artificial) was noted at 3 and 6 months. The study also gathered information from the peer-supporters. RESULTS: Data showed higher rates of exclusive breastfeeding in the intervention group,at both 3 and 6 months post delivery (76% vs 56%, p = 0.020; 47% vs 35%, p = 0.049). Taking part in the study also increased the overall success of breastfeeding 2.65 times (IC95%, 1.21-5.78, p = 0.014) at 3 months and 3.30 times (IC95% 1.52-7.17, p = 0.003) at 6 months. CONCLUSIONS: A limitation of the study is mainly related to participation in the intervention. In spite of this limitation, this support programme increased breastfeeding rates 3 fold.

[Chemical pollution and breast milk: Taking positions]. / Contaminantes químicos y lactancia materna: tomando posiciones.

Chemical pollution affects all ecosystems of our planet. Human milk has been used as a biomarker of environmental pollution as, due to bioaccumulation processes in fat tissue, many chemical compounds reach measurable concentrations that can be readily tested in breast milk. Quite frequently information about the presence of contaminants in breast milk appears in the media, leading to misunderstanding among parents and health professionals, and in some cases breastfeeding the child is stopped. In this article, the Breastfeeding Committee of the Spanish Association of Paediatrics stresses the importance of promoting breastfeeding as the healthiest option, because its benefits clearly outweigh any health risks associated with chemical contaminants in breast milk. Breast milk contains protective factors that counteract the potential effects related to prenatal exposure to environmental pollutants. This article summarises the key recommendations to reduce the level of chemical contaminants in breast milk. It also highlights the importance of government involvement in the development of programs to eliminate or reduce chemical contamination of food and the environment. In this way, the negative effects on child health resulting from exposure to these toxic compounds through the placenta and breast milk may be prevented.

Fetal and neonatal habituation in infants of diabetic mothers.

OBJECTIVE: To evaluate whether maternal diabetes alters the habituation ability of fetuses and newborns. STUDY DESIGN: Two nonrandomized clinical trials were performed. First, we studied prenatal fetuses of women with pregestational diabetes, and control subjects matched for gestational age, and then we studied infants of diabetic mothers (IDM) and control subjects matched for gestational age and mode of delivery. Fetus and newborns were stimulated with vibroacoustic stimulus. RESULTS: In fetuses of diabetic mothers, the ability to habituate was lower, and the habituation rate was higher than in control subjects to all habituation tests. In the neonatal period, ability to habituate was lower (59% vs 100%; P< .001), and the habituation rate was higher (18 [14-21] vs 4 [1.2-6.8]; P< .001) in the IDM than in the control infants. We found a significant negative correlation between maternal glycosylated hemoglobin in each trimester of pregnancy and habituation ability in IDM. CONCLUSIONS: Fetuses and infants of diabetic mothers have impaired habituation ability, which is related to the degree of maternal metabolic control.

¿En qué situaciones está contraindicada la lactancia materna? / In what situations is breastfeeding contraindicated?

En la práctica, son muy pocas las situaciones que contraindican la lactancia. El padecimiento de algunas enfermedades por parte de la madre o el niño requiere una valoración individualizada, considerando los grandes beneficios de la alimentación con leche materna frente a los posibles riesgos. Si una madre lactante precisa medicación, se debe buscar un fármaco que sea adecuado para el tratamiento de la madre y compatible con la lactancia. Tanto el virus del sida como el virus de la leucemia humana de células T tipo I (HTLV-I) se transmiten a través de la leche materna y contraindican la alimentación a pecho, siempre y cuando se disponga de sustitutos adecuados de la leche materna. La lactancia materna no está contra indicada en los hijos de madres con hepatitis B ni A. Tampoco está contra indicada en los hijos de madres con hepatitis C ni en los lactantes sanos nacidos a término de madres portadoras de citomegalovirus (CMV). La pasteurización y la congelación de la leche inactiva el citomegalovirus y disminuye el riesgo potencial de contagio en los niños de bajo peso al nacer y los que sufren algún tipo de inmunodeficiencia. En el caso de tuberculosis activa, hay que tener en cuenta las circunstancias especificadas en el texto. La lactancia materna está contraindicada en los niños afectados por galactosemia. En la fenilcetonuria y otros errores congénitos del metabolismo de los aminoácidos, se puede mantener una lactancia materna parcial, monitorizando los niveles sanguíneos del aminoácido en cuestión

In practice there are very few situations in which breastfeeding is contraindicated. Some maternal or infants illnesses require an individual evaluation, considering the enormous benefits that breastfeeding compared to the possible risks. In the case that a breastfeeding mother needs medication a suitable drug for the maternal treatment should be searched for as long as it is compatible. BVIH and VTLV-I virus are transmitted through the mothers milks and breastfeeding is contraindicated, as long as appropriate alternatives are available. Breastfeeding is not contraindicated in the infants whose mothers have B hepatitis nor A hepatitis. Breastfeeding is also not contraindicated in the infants whose mothers has C hepatitis nor for healthy term infants born to mothers who are seropositive carriers of cytomegalovirus. Milk pasteurisation and freezing inactivate the cytomegalovirus and reduces the potential risk of transmission in low birth weight infants and in those that suffer some type of immunodeficiency. In the case of active tuberculosis it must keep in mind the circumstances specified in the text. Breastfeeding is contraindicated in those children with galactosemia. Partial breastfeeding can be maintained in phenylketonuria and others aminoacid congenital metabolic errors, monitoring blood levels of the mentioned aminoacid

Subclinical pain and thermal sensory dysfunction in children and adolescents with Type 1 diabetes mellitus.

AIMS: To assess cutaneous thermal and pain thresholds in upper and lower limbs in neurologically asymptomatic children and adolescents, and to study the relationships of clinical parameters and these sensory thresholds in subclinical diabetic neuropathy. METHODS: Thirty-five neurologically asymptomatic patients, aged 8-16 years, diagnosed with Type 1 diabetes mellitus (DM), and a control group of 35 healthy age-matched subjects participated in the study. Warmth, cold, and heat-induced pain thresholds were measured in the dorsum of the right arm and foot, using quantitative sensory testing (QST). Relevant clinical parameters, retrieved from medical records or measured at the QST session, were obtained for each patient. RESULTS: Compared with controls, diabetic patients had increased thresholds for warmth in the hand (P = 0.002), and cold and warmth in the foot (P = 0.015 and P = 0.004, respectively). Of the diabetic patients, 43% showed abnormality of at least one sensory threshold. A significant correlation was observed for duration of diabetes and heat-induced pain threshold in the hand (P = 0.045), but no correlation was found for age, height, weight, pre-test blood glucose, age of onset, current insulin dose, and mean of glycosylated haemoglobin determinations of the previous 18 months. No significant correlation was found for other sensory thresholds. CONCLUSIONS: Using QST, abnormal cutaneous thermal perception is a common finding, in both upper and lower limbs, in neurologically asymptomatic young diabetic patients. Heat-induced pain threshold in the hand was correlated with the duration of the diabetes.

Oral sucrose compares favourably with lidocaine-prilocaine cream for pain relief during venepuncture in neonates.

UNLABELLED: To compare the relative efficacy of oral sucrose versus EMLA cream for pain relief during venepuncture, 51 full-term newborns (38M, 13F; postnatal age <4 d) in a stable condition were randomly allocated to one of four treatment groups: placebo (2 ml spring water); 2 ml sucrose 24% w/v; 1 g lidocaine-prilocaine 5% cream (EMLA); or EMLA plus sucrose. Water or a single dose of sucrose solution was administered orally 2 min before venepuncture. EMLA cream was applied in the antecubital fossa 45-60 min before venepuncture and covered by a Tegaderm dressing. A pacifier was given before skin puncture, but it was not actively held or replaced during the procedure or observation periods. In total, 55 venepunctures were performed blindly, always for clinical reasons. As indicators of pain, the total crying time was recorded and heart rate, respiratory rate and arterial oxygen saturation were measured blindly at baseline, immediately post-venepuncture, and 2 and 4 min afterwards. The main effects observed were: (i) time spent crying decreased significantly in the sucrose alone (p = 0.001) and EMLA plus sucrose (p = 0.008) groups; (ii) the above treatments attenuated significantly (p < 0.05) the immediate heart rate response to pain; and (iii) the concomitant use of EMLA did not increase further the analgesic efficacy of sucrose. CONCLUSION: This study shows that a 24% oral sucrose solution compares favourably with EMLA cream as a safe and cheap analgesic procedure to decrease pain responses to venepuncture in newborns.

Zinc and perinatal growth.

AIM: To study the relationship between zinc, insulin-like growth factor (IGF-I), osteocalcin and perinatal growth. MATERIALS AND METHODS: Anthropometric variables, serum levels of IGF-I, osteocalcin and zinc were measured in preterm (PT) appropriate for gestational age (AGA), full term (FT) small for gestational age (SGA) and FT AGA newborns at birth (n=52), at first week (n=38) and at third week (n=38) of postnatal age. RESULTS: At birth, the FT SGA had lower levels of IGF-I. At the first week after birth, both FT SGA and PT AGA infants had less deposits of subcutaneous fat; FT SGA infants also showed significantly lower osteocalcin and zinc levels. At 3 weeks of postnatal life, FT SGA infants continued to show significantly lower zinc levels. They had increased their fat deposits so that differences between groups in skinfold measurements failed to be significant. The highest levels of osteocalcin were found in PT AGA infants at the third week after birth. CONCLUSIONS: Perinatal nutrition influences the IGF-I levels. The low concentration of osteocalcin found in SGA infants at first week of life probably reflects decreased bone turnover. During the first weeks of life, there is a progressive decrease in the serum levels of zinc, accentuated in the FT SGA group.

Breast-feeding and growth factors in preterm newborn infants.

BACKGROUND: We analyzed the role that nutrition and the insulin-like growth factors IGF-I and IGFBP-3 play on neonatal growth. METHODS: Full-term and preterm infants with 1 and 3 weeks of postnatal life (n = 54 and n = 33, respectively) were studied. Anthropmetric variables, daily intake of energy and nutrients, and serum levels of IGF-I and IGFBP-3 were measured. RESULTS: At the first week after birth, preterm infants had lower IGF-I levels than did those in the control group. At the third week of postnatal life, serum IGF-I and IGFBP-3 levels showed a significant increase. Preterm infants born before 33 gestational weeks showed lower IGF-I (p < 0.02) and IGFBP-3 (p < 0.02) levels than those born between 33 and 37 gestational weeks. Preterm infants fed with human milk supplemented with a formula showed higher serum IGF-I levels than those fed exclusively with a milk formula (mean +/- SEM 48.2 +/- 9.5 micrograms/L vs. 25.4 +/- 4.4 micrograms/L, p < 0.05). IGF-I and IGFBP-3 were correlated between themselves and with energy and protein intake. Multiple regression analysis confirmed that energy intake and serum IGFBP-3 levels were the most predictable variables with regard to IGF-I levels at neonatal period. CONCLUSIONS: These feedings suggest that IGF-I levels during the neonatal periods are influenced by the maturity stage of the newborn, energy intake, and the type of lactation.

[Influence of growth hormone (GH) and nutrition on neonatal growth]. / Influencia de la GH y de la nutrición sobre el crecimiento en el periodo neonatal.

OBJECTIVE: At present, growth regulating factors in the transition from fetal to postnatal life remain unknown. The purpose of this study was to analyze the influence of GH and nutrition on neonatal growth. PATIENTS AND METHODS: Serum and 24-hour urine GH levels, various anthopometric variables and daily energy and nutrient intake were measured in appropriate (AGA), large (LGA) and small for gestational age (SGA) newborn infants. These variables were measured at 1 (n = 98), 3 (n = 41) and 5 weeks of postnatal age (n = 8). RESULTS: The highest GH levels at the 1st week of postnatal life were obtained in preterm SGA infants (GHs: 61.4 +/- 20.0 microUI/m; GHu: 18.6 +/- 10.3 ng/kg/24 h). GH levels decreased in preterm infants, so that differences between groups failed to be significant at the third and fifth weeks of postnatal life. Urinary GH excretion did not show significant variations in the control group during the study (1st wk 3.0 +/- 3.5; 3rd wk 2.3 +/- 2.7; 5th wk 3.2 +/- 4.7 ng/kg/24 h). Daily protein intake had a direct relationship with both triceps skinfold and weight and head perimeter increase. SGA preterm infants showed a higher fat increase compared to AGA preterm infants. Serum and urinary GH levels were not related to the anthopometric variables studied. CONCLUSIONS: There are differences in GH secretion and body composition between SGA and AGA preterm infants. GH probably does not contribute to neonatal growth.

[Trace elements and growth factors in the perinatal period]. / Elementos traza y factores de crecimiento en el período perinatal.

The objective of this study was to measure serum IGF-I, IGFBP-3, copper and zinc levels and to analyze their relationship to perinatal growth. Serum IGF-I (RIA after acid-ethanol extraction), IGFBP-3 (RIA), copper and zinc (atomic absorption spectrophotometry) levels were measured in cord blood (n = 78) and in newborn children 1 (n = 110) and 3 (n = 42) weeks after birth. Anthropometric variables were measured and the weekly average intake of energy and nutrients were calculated. We found that IGF-I and zinc levels during the 1st week of postnatal life were lower in fullterm LGA and AGA and in preterm (PT) AGA infants than in cord blood. The highest IGF-I levels were obtained in LGE fullterm infants (37.9 +/- 29.5 ng/mL) and the lowest in SGA preterm infants (9.3 +/- 10.3 ng/mL). Serum zinc levels in preterm neonates continued decreasing at the 3rd week after birth. However, IGF-I and IGFBP-3 levels increased significantly (IGF-I: 13.2 +/- 15.5 vs 34.5 +/- 27.3 ng/mL, p < 0.01; IGFBP-3: 364.3 +/- 185.1 vs 634.1 +/- 306.9 ng/mL, p < 0.01). Serum copper levels in the control group increased in relationship to the levels found at the 1st week of life, while this increase neither happened in fullterm SGA infants nor in preterm infants. A positive relationship was found between IGF-I and IGFBP-3. Both were directly connected to energy and protein intake. We conclude that intrauterine over-nutrition is related to higher IGF-I levels, whereas prematurity and intrauterine growth retardation are associated with lower zinc, IGF-I and IGFBP-3 levels and with a lack of increase in copper serum levels.

[Metabolic control, C peptide and lipids in insulin-dependent diabetes mellitus]. / Control metabólico, péptido C y lípidos en la diabetes mellitus insulin-dependiente.

Total cholesterol, HDL cholesterol, triglyceride, glycohaemoglobine and plasma glycoprotein levels were measured in 67 diabetic children and 40 nondiabetic ones. A dynamic study on C peptide secretion was also made in 28 diabetic patients. It was checked the fact that diabetic children showed normal whole cholesterol (172.1 +/- 32.1 mg/dl), HDL cholesterol (48.1 +/- 18.8 mg/dl) and triglyceride (58.3 +/- 26.8 mg/dl) levels, demonstrating no relationship with sex, age, length of diabetes, nor with the degree of metabolic control of disease, classified taking into account several clinical and biochemical indicators. C peptide concentration was found to be within normal levels in the whole group of patients under clinical remission phase of diabetes and also in 75% of children during the first 6 months of disease development. C peptide levels were higher in male than female diabetic children, showing an inverse relationship with duration of disease (r = -0.577, p less than 0.001) and with daily insulin requirements (r = -0.532, p less than 0.005). Discriminant analysis and multiple regression analysis results showed that the patients with a higher risk of bad control of diabetes were the older, those with a larger duration of disease, specially female, those with no remission phase of diabetes during clinical course of disease, and those showing bad motivation in relation to treatment.

[Clinical evaluation of glycohemoglobin and serum glycoproteins using affinity chromatography in children with type I diabetes mellitus]. / Valoración clínica de la glicohemoglobina y glicoproteínas plasmáticas medidas por cromatografía de afinidad en niños con diabetes mellitus tipo I.

We measured in 67 diabetic and 40 non-diabetic children glycosylated haemoglobin levels by both affinity chromatography (Gly Hb) and cation exchange chromatography (Hb A1), glycosylated plasma proteins by affinity chromatography (Gly PP) and glycosylated serum proteins by the colorimetric method of thiobarbituric acid (PSG). There was in the diabetic children a significant linear correlation between these four determinations, as well as between them and the values in mean glycaemias and mean glycosurias. The average Hb A1 over a 20-month observation period was 11.7%; the mean Gly Hb, 12.7%; the mean Gly PP, 5.3%, and the average PSG, 0.77 nmol HMF/mg protein. Glycohaemoglobin levels were within the normal range in only 5% of the cases. About 25% of the diabetic children showed a bad therapeutic compliance, which progressively deteriorated when age and duration of disease increased. Daily insulin requirements and glycosylated haemoglobin levels were significantly higher in diabetic girls than boys, but these differences between sexes did not exist where concentration of glycosylated proteins was concerned. Values in glycohaemoglobin and glycoproteins increased together with age, duration of disease and insulin requirements, existing an inverse relationship with both duration of clinical remission period and socioeconomic level. Motivation, dietetic obedience and, above all, self-control compliance were the variables that exerted the greatest influence on glycohaemoglobin and glycoprotein levels.