Underdiagnosis of obesity in pediatric clinical care settings among children born preterm: a retrospective cohort study.

BACKGROUND: Neonatal care of preterm infants may include dietary approaches such as high calorie formulas to promote physical growth. However, continuing growth-promoting strategies beyond the point of necessity, coupled with poverty and food insecurity which are more common among families of children born preterm, may increase the risk of obesity. Because children born preterm tend to have more pressing health conditions that require ongoing care, obesity may go undiagnosed by providers. METHODS: This retrospective cohort study included 38,849 children (31,548 term, 7301 preterm) born from 2010 to 2015, who received clinical care at a large pediatric medical center (Ohio, USA). Electronic medical record data, linked to Ohio birth certificates, were used to identify children with measured obesity (≥2 weight-for-length values ≥95th percentile before 24 months of age or BMI values ≥95th percentile at or after 24 months of age). Children were considered to have diagnosed obesity if their medical record had an obesity-related phrase or billing code recorded. Modified Poisson regression was used to compare risk of obesity undiagnosis among obese children born preterm versus at term. RESULTS: In total, 13,697 children had measured obesity, 10,273 (75%) of which were undiagnosed. Children born preterm with measured obesity were 8% more likely to be undiagnosed compared to children born at term (adjusted relative risk = 1.08 95% CI 1.05, 1.11). The risk was slightly higher for preterm children born to white women or born to women with higher educational attainment. For both groups, Primary Care and subspecialist clinics were the most common settings for undiagnosed obesity (74.9% and 16.8% of undiagnosed cases, respectively). CONCLUSIONS AND RELEVANCE: Preterm birth was associated with increased risk of undiagnosed obesity in early childhood. This highlights the need to enhance obesity screening in the preterm population and to further explore reasons for this disparity.

Cow's Milk Contamination of Human Milk Purchased via the Internet.

BACKGROUND: The US Food and Drug Administration recommends against feeding infants human milk from unscreened donors, but sharing milk via the Internet is growing in popularity. Recipient infants risk the possibility of consuming contaminated or adulterated milk. Our objective was to test milk advertised for sale online as human milk to verify its human origin and to rule out contamination with cow's milk. METHODS: We anonymously purchased 102 samples advertised as human milk online. DNA was extracted from 200 µL of each sample. The presence of human or bovine mitochondrial DNA was assessed with a species-specific real-time polymerase chain reaction assay targeting the nicotinamide adenine dinucleotide (NADH) dehydrogenase subunit 5 gene. Four laboratory-created mixtures representing various dilutions of human milk with fluid cow's milk or reconstituted infant formula were compared with the Internet samples to semiquantitate the extent of contamination with cow's milk. RESULTS: All Internet samples amplified human DNA. After 2 rounds of testing, 11 samples also contained bovine DNA. Ten of these samples had a level of bovine DNA consistent with human milk mixed with at least 10% fluid cow's milk. CONCLUSIONS: Ten Internet samples had bovine DNA concentrations high enough to rule out minor contamination, suggesting a cow's milk product was added. Cow's milk can be problematic for infants with allergy or intolerance. Because buyers cannot verify the composition of milk they purchase, all should be aware that it might be adulterated with cow's milk. Pediatricians should be aware of the online market for human milk and the potential risks.

Breastmilk sharing: awareness and participation among women in the Moms2Moms Study.

BACKGROUND: Feeding infants unscreened, raw human milk from a source other than the mother may pose health risks. The objectives of the Moms2Moms Study were to estimate the proportions of mothers who were aware of breastmilk sharing, considered sharing, and shared milk and to identify associated maternal and child characteristics. SUBJECTS AND METHODS: All eligible women (n=813) who delivered at The Ohio State University Wexner Medical Center (Columbus, OH) and did not indicate an intention to exclusively "bottle feed" were asked to participate in this cohort by completing a postal questionnaire at 12 months postpartum (499 [61%] responded). Women who shared milk participated in a follow-up interview. RESULTS: Awareness of milk sharing was high (77%) and positively associated with socioeconomic status, age, non-Hispanic white race, having fed one's infant at the breast, and reporting no difficulty making enough milk. Twenty-five percent considered sharing. Primiparous women (odds ratio [OR]=2.12; 95% confidence interval [CI] 1.02, 4.62) and those who delivered preterm (OR=3.27; 95% CI 1.38, 7.30) were more likely to consider feeding milk from another mother. Women with public/no insurance (OR=0.52; 95% CI 0.27, 0.97) were less likely to consider providing milk for someone else; highly educated women were more likely (OR=1.90; 95% CI 1.12, 3.32). Almost 4% of women shared milk and did so among friends or relatives or had a preterm infant who received screened and pasteurized donor milk. CONCLUSIONS: Sharing milk among friends and relatives is occurring. Many women are aware of milk sharing and have considered it.