[Immigration and factors associated with breastfeeding. CALINA study]. / Inmigración y factores asociados con la lactancia materna. Estudio CALINA.

OBJECTIVE: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin. MATERIAL AND METHODS: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452). RESULTS: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=.002), have higher academic level (P=.001), greater parity (P=.003), and a higher probability of vaginal delivery (P=.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=.001). CONCLUSIONS: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin.

Prevalencia de la lactancia materna durante el primer año de vida en Aragón. Estudio CALINA / Breastfeeding prevalence during the first year of life in Aragon. CALINA study

Objetivos: Estudiar la prevalencia actual de la lactancia materna (LM) hasta los 12 meses de edad en Aragón, analizando los aspectos demográficos, perinatales y sociales que la modifican. Material y métodos: Estudio observacional longitudinal en una cohorte representativa de la población de lactantes aragoneses, nacidos desde marzo del 2009 a marzo del 2010, y controlados hasta los 12 meses de edad (N=1.602). Se han evaluado sus variables obstétricas, perinatológicas y de alimentación. Resultados: La LM exclusiva o predominante fue superior al resto de modalidades de alimentación durante los 4 primeros meses de vida. El mantenimiento conjunto de la LM en cualquiera de sus modalidades fue del 82,5% al mes de edad, el 71,8% al tercero, el 54,3% al sexto y 27,8% al año. Las variables maternas que se asociaron significativamente al mantenimiento de la LM, tanto al mes como a los 6 meses de edad fueron: tipo de parto (mayor probabilidad si el parto es vaginal), el nivel de estudios (mayor probabilidad si tienen estudios superiores), la procedencia (mayor probabilidad en las madres de origen africano), la adiposidad (mayor probabilidad en las madres que tienen un peso adecuado o sobrepeso frente a las obesas) y no fumar durante la gestación. Conclusiones: La prevalencia de LM en Aragón durante los primeros 12 meses de vida es alta y ha aumentado respecto a los datos que previamente se disponían. La LM se mantiene en más de la mitad de los lactantes de 6 meses y en una cuarta parte al año de edad. Los condicionantes maternos que influyen significativamente en el inicio y mantenimiento de la LM en nuestro medio son el tipo de parto, el nivel de estudios, la procedencia (inmigración), la adiposidad y el hábito tabáquico (AU)

Objectives: To study the current prevalence of breastfeeding (BF) in Aragon (Spain) during the first 12 months of life, and analyse its demographic, perinatal and social influential factors. Material and methods: Obstetric, perinatal and feeding aspects were evaluated in a longitudinal and observational study, in a representative cohort of infant population from Aragon born between March 2009 to March 2010, controlled until 12 months of age (N=1.602). Results: Exclusive or predominant BF was more frequent than the rest of feeding modalities during the first 4 months of life. Maintenance prevalence of any BF modality was 82.5% at 1stmonth of age, 71.8% at 3rd, 54.3% at 6th, and 27.8% at 12 months of age. Maternal variables that were significantly associated with BF maintenance both at 1 and 6 months of age were: delivery modality (higher probability in case of vaginal delivery), academic level (higher probability if university studies), origin (higher probability in mothers from Africa), adiposity (higher probability of normal weight or overweight mothers compared with obese ones), and not to smoke during gestation. Conclusions: BF prevalence in Aragon (Spain) during the first 12 months of age is high and has increased compared with previous data. BF continues in more than half of infants at six months and in a quarter of infants at 12 months of age. Maternal factors that significantly influence BF initiation and maintenance are, delivery modality, academic level, origin (immigration), adiposity and smoking habit (AU)

[Breastfeeding prevalence during the first year of life in Aragon. CALINA study]. / Prevalencia de la lactancia materna durante el primer año de vida en Aragón. Estudio CALINA.

OBJECTIVES: To study the current prevalence of breastfeeding (BF) in Aragon (Spain) during the first 12 months of life, and analyse its demographic, perinatal and social influential factors. MATERIAL AND METHODS: Obstetric, perinatal and feeding aspects were evaluated in a longitudinal and observational study, in a representative cohort of infant population from Aragon born between March 2009 to March 2010, controlled until 12 months of age (N=1.602). RESULTS: Exclusive or predominant BF was more frequent than the rest of feeding modalities during the first 4 months of life. Maintenance prevalence of any BF modality was 82.5% at 1(st) month of age, 71.8% at 3(rd), 54.3% at 6(th), and 27.8% at 12 months of age. Maternal variables that were significantly associated with BF maintenance both at 1 and 6 months of age were: delivery modality (higher probability in case of vaginal delivery), academic level (higher probability if university studies), origin (higher probability in mothers from Africa), adiposity (higher probability of normal weight or overweight mothers compared with obese ones), and not to smoke during gestation. CONCLUSIONS: BF prevalence in Aragon (Spain) during the first 12 months of age is high and has increased compared with previous data. BF continues in more than half of infants at six months and in a quarter of infants at 12 months of age. Maternal factors that significantly influence BF initiation and maintenance are, delivery modality, academic level, origin (immigration), adiposity and smoking habit.

[Perinatal aspects, growth and feeding of infants born small for gestational age]. / Aspectos perinatales, crecimiento y tipo de lactancia de los nacidos pequeños para su edad gestacional.

INTRODUCTION: Being born small for gestational age (SGA) has short and long term risks. The aim of this study was to describe perinatal and socio-cultural characteristics, and the pattern of growth and diet of SGA infants during their first 6 months of life. MATERIALS AND METHODS: Anthropometry and diet were evaluated during six months in a representative sample of 1596 newborns the population of Aragon (Spain). RESULTS: Mothers of SGA (N=94) infants gained less weight during pregnancy (10.5±5.8 vs 12.0±5.07 kg, P=.012), gestational age at birth was lower (37.84±1.7 vs 39.06±1.6 weeks, P<.001), and the probability of cesarean delivery was higher (37.2% vs 20.5%, P=.001). The height of the mother was lower in the SGA group (1.61±0.58 vs 1.63±0.06 metres, P=.004), but their body mass index was similar. No differences were found between groups in social or cultural aspects. Mothers of SGA infants smoked more during pregnancy (32.3% vs 18.5%, P=.003) (RR = 1.92; 95% CI; 1.31 to 3.02). Infants born SGA remained smaller during the first 6 months of life, and the monthly weight gain was similar to the rest. In the SGA group, the prevalence of breastfeeding was lower at 4 months of age (54.9% vs 68.2%, RR = 0.58, 95% CI; 0.38 to 0.89). CONCLUSIONS: Infants born SGA are more likely to converge a number of characteristics that must be considered together because they may lead to health risks. SGA do not show a rapid recovery pattern of postnatal growth, and their smaller size persists at six months.

[Socio-cultural, obstetric and anthropometric characteristics of newborn children of mothers who smoke in Spain]. / Características socioculturales, obstétricas y antropométricas de los recién nacidos hijos de madre fumadora.

INTRODUCTION: One in every four women smoke at the beginning of the pregnancy in Spain; of these, 25-50% give up smoking during gestation and most of them smoke again after childbirth. Maternal smoking has harmful effects on babies, such as low birth-weight with its resulting morbidity. The objective of this study is to compare the anthropometric and socio-cultural characteristics between newborns from smoking mothers and those from non- smoking ones. MATERIALS AND METHODS: Smoking habits and the socio-cultural characteristics were assessed from a sample of 1499 pregnant women, as well as their newborn anthropometric variables of their newborn babies during 2009 in the Aragon region of Spain. RESULTS: In the sample of 1499 pregnant women the prevalence of smoking during pregnancy was 19.6%; among the Spanish women, 23% of them smoked during the gestation compared with only 11% in women from other countries. The smoker mothers were younger and they had a lower educational level than the non smoker ones; however, there were no statistical differences between their anthropometric characteristics. Newborns from smoker women in Aragon had a lower weigh at delivery (3155 vs. 3295 grams: p<.001) and a relative risk of low weight at birth for their gestational age of 2.1 (95% CI: 1.35 - 2.97). The length and the rest of newborn anthropometric variables were also affected. CONCLUSION: The prevalence of smoking during gestation is high in Aragon. The mothers who smoke are younger and have different socio-cultural characteristics compared with non-smoker mothers. Maternal smoking habits have a harmful effect on newborn nutritional status, representing an avoidable risk of low weight at birth.

[Nutritional characteristics of newborns of overweight and obese mothers]. / Características nutricionales de los recién nacidos de madres con sobrepeso y obesidad.

INTRODUCTION: Maternal nutritional status is an important factor of adequate intrauterine growth and neonatal weight. The aim of this study is to evaluate the relationship between pre-gestational BMI (Body Mass Index) and breastfeeding duration, as well as infant anthropometric measurements during their first six months of life. MATERIALS AND METHODS: Anthropometric measurements and the type of feeding were evaluated in a representative sample of 1,547 newborns from our population during 2009, according to their maternal BMI, and also in a sub-cohort of 759 infants followed up to 6 months of life. RESULTS: A total of 72.9% of women had a normal weight, 18.7% were overweight and 8.4% obese. Women with a BMI ≥ 25 kg/m(2) had lower weight gain during pregnancy (P < .001), lower socioeconomic and cultural level (P < .001), and their infants had higher weight at delivery (P=.003) and at 6 months of life, with no differences in body length. Newborn weight increased in relation to maternal BMI, but over 35 kg/m(2) it decreased progressively (P < .001). Breastfeeding prevalence in obese women was 58.5% at hospital postpartum discharge, and 8.6% at six months of life; as opposed to 70.8% and 13.9%, respectively in women with normal BMI. CONCLUSIONS: In our sample, maternal obesity is associated with a low socioeconomic and cultural level, higher infant weight at delivery and at 6 months of life, and less prevalence of exclusive breastfeeding; all of them nutritional risk factors in the short and long term.

[To born small for gestational age may depend on the growth curve used]. / Nacer pequeño para la edad gestacional puede depender de la curva de crecimiento utilizada.

INTRODUCTION AND OBJECTIVE: Population standards of intrauterine growth are necessary to evaluate if the newborn has grown well, if their nutritional conditions are appropriate and to identify groups at risk as those small for gestational age (SGA). Differences in the number of SGA newborns identified, depending on the standard applied, have been analyzed in this study. MATERIAL AND METHODS: Cross-sectional study conducted in 4,486 Caucasian newborns (2,361 boys and 2,125 girls), born between 35 and 41 weeks. Weight and length valuation was performed following the standard methodology. Percentage of children under the 10(th) percentile for weight and length was calculated depending on the standard used (Olsen et al. 2010, Lubchenco et al. 1966, Delgado et al. 1996, Carrascosa et al. 2008), being diagnosed of SGA. RESULTS: Weight and length were significantly higher in boys than in girls at all ages. 10(th) percentile values defined for every gestational age are globally similar among the different standards and our population, with the clear exception of Lubchenco curves whose 10(th) percentile values are even 300 g. lower for the newborns at the highest gestational ages. Lubchenco charts do not fit the pattern of intrauterine growth of our population and identify a smaller number of SGA. The percentage of SGA of our sample ranged between 1.7% and 14% in depending on the standard, sex and gestational age considered. CONCLUSION: The number of children classified as SGA is different according to each standard used. Lubchenco charts identify a smaller number of SGA than the others. The rest of curves show similar values and seem to be well adapted for our population. The correct identification of SGA will allow a better assessment of short and long-term risks of these newborns.

Parálisis branquial obstétrica en nuestro Servicio: Revisión de 10 años / Obstetric brachial paralysis in our Department: A 10 years review

Introducción. La parálisis branquial obstétrica es una entidad relativamente frecuente, originada en el período neonatal. Objetivo. Determinar la incidencia y pronóstico de la parálisis obstétrica del plexo branquial y analizar factores de riesgo asociados. Material y métodos. Estudio retrospectivo descriptivo, de todos aquellos niños nacidos en nuestro centro y diagnosticados de parálisis braquial en los últimos 10 años, valorando variables perinatales y evolución de los mismos. Resultados. Se diagnosticaron 23 parálisis braquiales (1/1.000 recién nacidos), 13 varones (56,5%) y 10 mujeres 843,5%). Todos los partos fueron a término con una incidencia de distocia de hombros del 69,5% y un peso medio al nacimiento de 3.937 g (3.390-5.110 g). La parálisis fue más frecuente en el lado derecho (65,2%), con afectación de raíces superiores en todos los casos. El 74% de los niños se recuperó en los primeros 6 meses de vida, precisando fisioterapia un 57,1%; solo en dos casos se llevaron a cabo otras pautas terapéuticas. A pesar del tratamiento, un 17% de los niños presentaron secuelas permanentes. Conclusiones. La parálisis branquial obstétrica sigue siendo un problema frecuente en nuestro medio; habitualmente, se afectan las raíces superiores, suele ser unilateral con predominio del lado derecho y puede originar secuelas permanentes (AU)

Introduction. The obstetrical brachial palsy is a relatively frequent entity with origin in the neonatal period. Objective. To determine the incidence and prognosis of obstetric brachial plexus injuries and analyze associated risk factors. Material and methods. Retrospective descriptive study, of all those children born in our center and diagnosed of brachial palsy, in the last 10 years, valuing perinatal variables and evolution of the same ones. Results. Obstetrical brachial palsy was diagnosed in 23 children’s 81/1000 newborn), 12 males 856.5&) and 10 females (43.5%). All the patients were born full term with an incident of distocia of shoulders of 69.5% and an average weight to the birth of 3937 g (3390-5110 g). The palsy was more frequent in the right side (65.2%), mainly of upper roots in all the cases. 74% of the children recovered in the first 6 months of life, needing physical therapy 57,1%, only in two cases other treatments were carried out. In spite of the treatment, 17% of the children presented permanent sequels. Conclusions. The obstetrical brachial palsy continues being a frequent problem in our environment, usually affecting upper roots, unilaterally, with predominance of the right side and can originate permanent sequels (AU)

Programas de intervención para promocionar la lactancia materna. Proyecto PALMA / Intervention programs to promote breastfeeding: the PALMA project

La lactancia materna (LM) es la mejor forma de alimentar al recién nacido y al lactante, ya que confiere una serie de beneficios tanto a corto como a largo plazo. Según recomienda la Organización Mundial de la Salud, la LM debe mantenerse durante los primeros 6 meses como alimento exclusivo, y a partir de este momento junto con la alimentación complementaria, mientras la madre y el niño deseen. Según los datos disponibles, el tiempo medio de mantenimiento de la LM en nuestro entorno no supera los 3-5 meses, el abandono precoz durante el primer mes de vida ocurre en un 30% de los casos y sólo en un 10-20% se mantiene a los 6 meses. Se revisan los factores de riesgo para la instauración y el mantenimiento de la LM, los momentos clave para la promoción de la LM desde las instituciones sanitarias y el tipo de medidas que son más efectivas. Asimismo, se presenta el Proyecto PALMA, que pretende evaluarla efectividad de un programa de intervención de apoyo multidisciplinario a la LM desde atención primaria en un grupo de lactantes frente a un grupo control (AU)

Breastfeeding is the best way to feed infants as the properties of breast milk confer many short and longer-term benefits. As recommended by the World Health Organization, exclusive breastfeeding should continue throughout the first 6 months of life and, after this time, be accompanied by complementary feeding for as long as the mother and infant want. Data from our general population show that the mean duration of breastfeeding does not exceed 3-5 months, early cessation during the first month occurs in 30% of cases and only 10%-20% of the mother infantdyads maintain it up to 6 months. We review the risk factors for the initiation and continuation of breastfeeding, the best moments to promote breastfeeding on the part of health institutions and the most effective actions. At the same time, we present the PALMA project, the purpose of which is to evaluate the effectiveness of a multidisciplinary intervention program to promote breastfeeding at the primary care level, comparing a group of infants with a control group (AU)

[Anthropometric and nutritional study of full-term newborns. Evaluation of the submandibular adipose skinfold]. / Estudio antropométrico nutricional en recién nacidos a término. Valoración del pliegue adiposo submandibular.

OBJECTIVE: We performed an anthropometric study in a series of normal full-term newborns to evaluate the discriminatory capabilities of the submandibular skinfold compared to other anthropometric parameters. MATERIAL AND METHODS: We studied 794 consecutive Caucasian newborns, 377 males and 471 females, with a mean gestational age of 39.5 +/- 0.9 weeks and adequate weights for age. Anthropometric variables analyzed included weight, length, left arm circumference and bicipital, tricipital, subscapular, suprailiac and submandibular skinfolds. Statistical analysis was performed by using the Student's t-test to evaluate differences between the different parameters and by Pearson's test to look for correlations among them. RESULTS: The weight and lengths of male newborns were significantly higher than those of female newborns (p < 0.005) These parameters showed differences with other series of newborns studied. Measurements of the tricipital, subscapular and suprailiac skinfolds were significantly different between males and females (p < 0.005); however, bicipital and submandibular skinfolds were not. The submandibular skinfold measurement highly correlated with the other skinfold measurements, especially with the bicipital measurement, in both males (0.536; p < 0.0001) and females (0.578; p < 0.001). Submandibular skinfold measurements also correlated with weight and arm circumference in both sexes. CONCLUSIONS: Some somatometric measurements in normal term newborns differ significantly between the sexes, especially weight, length and tricipital, subscapular and suprailiac skinfolds. The submandibular skinfold correlates well with weight, arm circumference and the four routinely measured skinfolds. This finding suggests that measurement of the submandibular skinfold should be included in the evaluation of the newborn's nutritional status.

[Brachial measurements as nutritional indicators in health term newborns]. / Medidas braquiales en recién nacidos término sanos como índices nutricionales.

OBJECTIVE: Our objective was to study the correlations between weight and length and weight index and brachial areas in healthy term newborns as indicators of nutritional status. PATIENTS AND METHODS: We studied 794 consecutive Caucasian newborns, 377 male and 417 females, with gestational ages of 39 +/- 09 weeks and adequate weights. We measured weight, length, weight/length index, body mass index and weight index. Measurements of the arm perimeter and tricipital skinfold were used to calculate the fatty, lean and total areas by two different methods. Mean, standard deviation and percentiles were utilized in the measurements. The Student's t-test was used to calculate differences and Pearson's test for correlations. RESULTS: We found that weight, length and weight/length indexes were higher in males than in females, except for the weight index. Brachial areas and parameter were higher in females, except for the lean area. We did not find significant differences between gender in brachial measurements calculated by the different methods. Among the males, we found a high degree of correlation between weight and the weight/length index (r = 0.963; p < 0.0001), and weight and total body area (r = 0.649; p < 0.0001). Similar data were obtained among females, where in addition a high correlation was found between the fat percentage and the body mass index (BMI, r = 0.223; p < 0.0001), as well as between brachial areas and BMI in both genders (p < 0.0001). CONCLUSIONS: In normal newborns, the brachial areas, taken as indicators of body composition, are statistically significantly correlated with the anthropometric parameters widely used to measure the nutritional status of newborns.

[Quantification of heart rate variability in newborn infants and during the first 6 months of age]. / Cuantificación de la variabilidad de la frecuencia cardiaca en el período de recién nacido y su evolución durante los seis primeros meses de edad.

We have registered, on 36 normal newborns at term, ECG recordings of sixty seconds at a speed of 100 mm/second, from birth tooth sixth month of postnatal life. The heart rate variability was measured on its double slope, short and long term by the numerical method that Yeh proposed, consistent with the "differential index" (DI) and the "interval index" (II). For the short term variability, we have obtained minimum values at birth and maximum values at 72 hours of postnatal life, with a tendency to drop up to the end of the first month and later to become stable until the end of six months of age. The changes found among different ages, could be related to modifications in basal heart rate under autonomic nervous system control. The variability values of the long term, do not show a clear age relation.