A longitudinal evaluation of growth outcomes at hospital discharge of very-low-birth-weight preterm infants.

BACKGROUND/OBJECTIVES: To quantify the rate of progressive failure of very-low-birth-weight (VLBW) infants over time in the neonatal intensive care unit to meet growth milestones. SUBJECTS/METHODS: In a prospective longitudinal study, 114 VLBW preterm infants (1500 g) of both sexes, with normal and/or low weight for gestational age were included. At the start, weight, length, mid-upper arm (MUAC), thigh and cephalic circumferences were measured. Weight/age (W/A), length/age and weight/length (±2 z-score) indices were calculated. All measurements were taken at inclusion, at 7, 15 and 30 days of hospitalization. Chi-square test, analysis of variance and repeated-measures tests were estimated. RESULTS: Thirteen cases (14%) died and were excluded soon after the first determinations. In all, 9 (8.9%) died during the study, 12 (11.9%) were discharged before 30 days of life and 80 (79.2%) completed the study. At 7 days, the percentage of preterm infants with an index of W/A <-2 z-scores increased from 44 to 67% (44-68 subjects; P<0.01), with no changes afterwards; the indicator MUAC <-2 z-scores increased at 7 days from 23 to 49% (23-49 subjects); at 15 from 23 to 65% (23-61 subjects) and at 30 days from 23 to 79% (23-63 subjects; P<0.001). CONCLUSIONS: Clinicians could use these indicators for earlier detection of growth failure in VLBW infants in order to target more aggressive nutrition early.

Body fat at pubertal genital stage 2: a comparison between Spanish and Mexican boys.

BACKGROUND/OBJECTIVES: To compare body fat mass at the same stage of pubertal maturation, genital stage 2 (G2), in a Spanish and in a Mexican sample of boys. SUBJECTS/METHODS: Data from Spain (n=177) were from a previous longitudinal clinical follow-up and data from Mexico (n=91) from a cross-sectional study. Subjects were grouped according to the presence of G2 at similar ages. Spanish sample was divided into boys with G2 at age 12 (n=60), 13 (n=74) and 14 (n=43). In Mexican sample, 23 boys were at G2 at 12 years, 38 at age 13 and 30 at 14 years. Height, weight, upper arm circumference and four skinfold thicknesses were recorded. Genital development was assessed (Tanner scale). Sum of four skinfolds (SUM), body mass index (BMI), percentage of body fat (%BF) and extremity/trunk skinfold ratio (ETR=(triceps+biceps)/(subscapular+suprailiac)) was calculated. RESULTS: When comparing subjects with different ages at G2 from the same country, or with the same age at G2 from different countries, no significant differences were found in adiposity variables (%BF, SUM), nor in BMI. Nevertheless, there were differences in body fat distribution: ETR was higher in Spanish boys (P<0.001), because of their greater triceps skinfold thickness (P=0.013), and due to the greater trunk fat stores in Mexican boys (P<0.01, subscapular and suprailiac skinfolds). CONCLUSIONS: There is a subcutaneous fat mass store characteristic of G2 in boys, which is not only independent of age, but is also observable in two different populations.

Iron absorption during recovery from malnutrition.

OBJECTIVE: In infants and children recovering from severe malnutrition, iron deficiency is common, and the ability to absorb iron during such recovery is uncertain. The objective of this study was to determine iron absorption during recovery from malnutrition. METHODS: During the later stages of recovery from malnutrition, erythrocyte incorporation of orally administered 58Fe was determined as a surrogate for iron absorption. Based on four indices, subjects were classified as iron-sufficient, iron-deficient or indeterminate. RESULTS: Of the 25 subjects, 9 were classified as iron sufficient, 5 as indeterminate and 11 as iron deficient; all but 5 had evidence of inflammation or infection. Geometric mean erythrocyte incorporation of 58Fe was 32.0% of the dose in the iron-deficient subjects, which was not significantly different (p = 0.073) than the 13.1% in the iron-sufficient subjects. Incorporation of 58Fe by the iron-sufficient subjects did not differ significantly from that by normal subjects in the same age range. Surprisingly, we found no correlation of erythrocyte incorporation of 58Fe and reticulocyte count. CONCLUSIONS: Even in the presence of infection or inflammation, iron absorption by children during a late stage of recovery from malnutrition is not impaired.

The impact of infant feeding patterns on infection and diarrheal disease due to enterotoxigenic Escherichia coli.

OBJECTIVE: Determine the impact of dietary risk factors on patterns of infection by heat labile toxin-producing Escherichia coli (LT-ETEC). MATERIALS AND METHODS: Ninety-eight infants were followed from birth for one year in Guadalajara, Mexico, beginning in august of 1986. Stool and breast milk samples were collected weekly from infants and their mothers, respectively. Mothers were also interviewed on a weekly basis regarding the health of the infants. Parametric hazard models were fit to durations of different LT-ETEC disease states determined through the analysis of stools. The child's consumption of supplemental foods and liquids as well as specific levels of LT-ETEC-specific breast milk antibodies were included in each model as time-varying covariates. RESULTS: The hazard of LT-ETEC asymptomatic infection increased 400 percent among children who received oats gruel (hazard rate = 4.01; 95% CI 2.77-5.24). The duration of infection was reduced if the child had had a previous LT-ETEC diarrheal episode (2.12; 95% CI 1.74-2.49) but was prolonged if the child consumed herbal teas (0.53; 95% CI 0.27-0.7). Herbal teas and high LT-ETEC-specific breast milk antibody levels each reduced the hazard of symptomatic infection by ninety percent. Symptomatic episodes became asymptomatic more rapidly if a child was given rice water. CONCLUSIONS: Specific weaning foods increase the risk of infection. Breastmilk antibodies and liquid infusions reduce diarrheal disease and infection duration.

[The nutritional status of the child entering the Nuevo Hospital Civil de Guadalajara]. / Estado de nutrición del niño que ingresa al Nuevo Hospital Civil de Guadalajara.

With the purpose to evaluate the nutritional status of children hospitalized in the Nuevo Hospital Civil de Guadalajara, they were included 278 subjects that entered in the infant, preschool, schoolchildren and infectious disease clinical ward of the Division of Pediatrics. There were chosen two subjects every day during one year. It was obtained information about family and sociodemographic background. In addition, there were undertaken anthropometric measurements; weight/age, weight/height and height/age indices were also calculated. It was obtained the parameters of median, percentiles and Z-score. Undernutrition was determined by the Gómez and Waterlow classifications. Is was also compared the reference pattern of Ramos-Galván and National Center for Health Statistics (NCHS). Blood was drawn for total protein and hemoglobin. Mean of height/age was 95.74% (NCHS), weight/age 84.04% and weight/height 89.7%. It was not difference on weight/age between Ramos-Galván and NCHS. Weight/height and height/age had little difference. The median system identified more cases with deficit than Z-score, which seems to be more specific and conservative. There is a high prevalence of acute and chronic malnutrition identified with the median system, and maybe reflects the poor quality of life and major morbidity in this population.

[Nutritional recommendations for the newborn infant]. / Recomendaciones nutrimentales en el recién nacido.

The nutritional recommendations for newborn babies and infants change when there is an improvement on the technics and knowledge for evaluating requirements of each nutrient. In general, breast milk is enough for covering the nutritional requirements on healthy infants during the first six months of life. Therefore, the nutritional recommendations are focused to newborn babies and infants who do not receive exclusively breast milk or preterm infants whether they receive their own mother's milk or formula. The calculations are based on the assumption that mothers who breast fed their babies are healthy, well nourished and supplying daily a mean of 750 mL of breast milk during the period of lactation.

[Mortality in children under 5 years of age in families of marginal settlements in Guadalajara]. / Mortalidad en niños menores de cinco años en familias de colonias marginadas de Guadalajara.

The purpose was, to determine the frequency of infant mortality in the marginal areas of Guadalajara and, find its association with sociodemographic and economical factors, which are known as determinant of the nutritional status of children. There were included 898 families in a cross sectional design among children who applied to the food supplementation program of ONI of Guadalajara. Through an interview and home visit, it was obtained information about sociodemographic and economical characteristics and food habits. The data was recorded and analyzed by the Dbase III Plus and Epi-Info program. It was also used Chi square test and Odds Ratio for the statistical analysis. Education of the mother and income per capita for feeding (as a percentage of the minimum salary) had a significantly and inverse association with infant mortality (P less than 0.0001 and P less than 0.001 respectively). There was also major mortality among children with no social security (P less than 0.05). The Odds Ratio for infant mortality was of 3.02 for education of the father, 8.42 for education of the mother and 6.8 for income per capita for feeding. Meanwhile the level of education and the economical situation of the studied population remain so low, it seems improbable to decrease the rate of infant mortality.

[Breast feeding habits in marginated neighborhoods in Guadalajara]. / Hábitos de lactancia materna en colonias marginadas de Guadalajara.

They were analyzed the reasons for avoiding or interrupting the breast feeding habits of infants. We included 701 pairs mother-child, who belonged to the marginal neighborhoods of Guadalajara City. Through an interview, it was gotten information about family, socioeconomic and demographic characteristics, and feeding patterns. In addition, it was carried out anthropometric measurements to all children for the evaluation of the nutritional status. Mothers with lower schooling (P less than 0.05), lower levels of life (P less than 0.01), higher parity (P less than 0.01), and with no social security had the higher prevalence of breast feeding practices. Insufficient production was the major cause of avoiding or interrupting breast feeding (65 and 35% respectively). Infant rejection of the breast milk was, the second cause in both cases, (7.6 and 21.6% respectively). Most of the cases, insufficient production and infant rejection of breast milk is due to defects on feeding techniques. Therefore, it is necessary to give more support and advise to the mother who is willing to breast feed her child. Breast feeding; interruption of; causes of; in marginal neighborhoods.

[Evaluation of the nutritional status of children seen at the ONI of Guadalajara]. / Evaluación del estado de nutrición de niños que acuden al ONI de Guadalajara.

The nutritional status of 701 subjects from 6 to 36 months of age was evaluated. They were living in the poorest neighborhoods of the metropolitan area of Guadalajara City. We looked for the association between diet, social, economic and family variables with anthropometric nutritional indicators. Some variables were associated with the nutritional indicators weight for age and arm circumference. Age (P less than 0.05), literacy of the mother (P = 0.01), episodes of diarrhea in the last 12 months (P less than 0.001), number of children in the family (P less than 0.001) and income for feeding per capita as a percentage of the minimum salary (P = 0.02), were those factors with a strong relationship to the nutritional indicator weight for age. A score of nutritional risk for children under 36 months of age is proposed, which could be useful for detecting those with the need for a food supplement program in marginal areas of Guadalajara.

[Nutritional recovery in marasmus using soy formula enriched with L-methionine]. / Recuperación nutricional en el marasmo con soya enriquecida con L-metionina.

It was evaluated the nutritional recovery of infants with marasmus using two different formulas: formula "X", soy based formula enriched con L-methionine; formula "Y" modified milk based formula; both, added with corn syrup at 10%. Seventeen infants were fed formula "X" and seventeen infants received formula "Y". The calorie and water intake were similar in both groups (p greater than 0.05). The protein intake was higher with formula "X" (p less than 0.05). After four weeks of study weight, height, triceps and sub-scapular skinfold, weight/age, height/age and weight/height did not showed significative differences (p greater than 0.05). Arm circumference was higher in the group fed formula "Y" (p less than 0.025). The final serum concentration of total proteins, albumin, calcium and magnesium was also higher in the group receiving formula "Y". It was required a major amount of calories and proteins per unit of gained body weight in the group of formula "X" (p less than 0.05 and p less than 0.005 respectively). Modified in fat and protein milk based formula represents a better choice for nutritional recovery of infants with severe malnutrition under one year of age. Soy based formulas enriched with l-methionine would be only used when intolerance to lactose or milk protein allergy are present.

Efficacy of trimethoprim-sulfamethoxazole in treatment of acute diarrhea in a Mexican pediatric population.

The efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) and placebo were compared in a randomized double-blind study of 141 Mexican children with acute diarrhea. Patients who met specific entry criteria received TMP-SMX or an identical appearing placebo for 5 days. Stools were examined for bacterial, viral, and parasitic pathogens. Enterotoxigenic Escherichia coli were the most commonly isolated pathogens (22% of total). Patients given TMP-SMX had a significantly shorter time to "last illness stool" than did those given placebo, but no difference in number of unformed stools in 5 days was found between treatment groups. However, TMP-SMX significantly shortened the illness in patients with fever or many fecal leukocytes. When stool cultures positive for any bacterial pathogen or for enterotoxigenic E. coli were analyzed as separate groups, a significantly faster recovery was observed in patients given TMP-SMX. TMP-SMX is efficacious in the treatment of Mexican children with diarrhea and culture-proved bacterial infection or when the clinical signs and symptoms suggest bacterial enteritis.