Objetivos: Objetivos: Avaliar o crescimento de crianças amamentadas cujas mães haviam inserido um implante de liberação de etonogestrel no pós-parto imediato. Métodos: Ensaio clínico aberto, randomizado, controlado e paralelo de mulheres pós-parto que foram randomizadas em blocos para inserção precoce (até 48 horas pós-parto antes da alta) ou convencional (6 semanas após o parto) de um implante etonogestrel. O desfecho primário foi o peso médio do bebê aos 12 meses (360 dias), e uma diferença de >=10% entre os grupos foi considerada clinicamente significativa. Os desfechos secundários foram a comprimento da criança, o perímetro cefálico e a circunferência braquial. Estas variáveis foram medidas no início e aos 14 e 40, 90, 180, 270 e 360 dias pós-parto. O modelo de regressão linear de efeitos mistos foi utilizado para avaliar os desfechos, com um poder de 80%, e um nível de significância de 1% para o desfecho primário e 0,3% para os desfechos secundários, devido à correção para múltiplas hipóteses. Resultados: De junho a agosto de 2015, um total de 100 mulheres foram randomizadas para inserção precoce ou convencional do implante de etonogestrel no pós-parto. As características sociodemográficas foram semelhantes entre os grupos, exceto no nível de escolaridade, que foi maior no grupo de inserção convencional (88% vs. 70% no grupo de inserção precoce, p = 0,02). Não houve diferença no peso do bebê em 360 dias entre os grupos [precoce: (média ± desvio padrão) 10060,3 ± 1156,0 g vs convencional: 9812,1 ± 1270,3g, estimativa da diferença de média 321,6g, intervalo de confiança 95% (IC): -183,5 A 495,7]. As curvas de crescimento do comprimento e as curvas dos perímetros cefálico e braquial também não diferiram entre os grupos. Conclusões: Não há diferença no crescimento das crianças amamentadas, em 12 meses, cujas mães receberam a inserção do implante liberador de etnogestrel precocemente comparado com a inserção pós-parto convencional. / Objective: To evaluate the growth of breastfed children whose mothers had inserted an etonogestrel-releasing implant in the immediate postpartum period. Methods: An open, randomized, controlled, and parallel trial of postpartum women who were block randomized to early (up to 48 hours postpartum before discharge) or conventional (at 6 weeks postpartum) insertion of a etonogestrel implant. The primary outcome was average infant weight at 12 months (360 days), and a difference of >=10% between groups was considered clinically significant. The secondary outcomes were infant\'s lenght, head and arm circumferences. These variables were measured at baseline and at 14 and 40, 90, 180, 270, and 360 days postpartum. The mixed-effects linear regression model was used to evaluate the outcomes, with a power of 80%, and a significance level of 1% for primary outcome and 0.3% for secondary outcomes, due to correction for multiple hypothesis testing. Results: From June to August of 2015, a total of 100 women were randomized to either early or conventional postpartum etonogestrel insertion. Sociodemographic characteristics were similar between the groups, except for educational attainment, which was higher in the conventional insertion group (88% vs. 70% in the early insertion group, p=.02). There was no difference in infant weight at 360 days between the groups [early: (mean ± standard deviation) 10060.3 ±1156.0 g vs conventional: 9812.1 ± 1270.3g, mean difference estimate 321.6g, 95% confidence interval (CI): - 183.5 to 495.7]. The growth curves of the lenght and the curves of the head and arm circumferences did not differ between the groups. Conclusion: There is no difference in growth at 12 months among breastfed infants whose mothers underwent early compared with conventional postpartum insertion of the etonogestrel implant.

Objetivos: Objetivos: Avaliar o crescimento de crianças amamentadas cujas mães haviam inserido um implante de liberação de etonogestrel no pós-parto imediato. Métodos: Ensaio clínico aberto, randomizado, controlado e paralelo de mulheres pós-parto que foram randomizadas em blocos para inserção precoce (até 48 horas pós-parto antes da alta) ou convencional (6 semanas após o parto) de um implante etonogestrel. O desfecho primário foi o peso médio do bebê aos 12 meses (360 dias), e uma diferença de >=10% entre os grupos foi considerada clinicamente significativa. Os desfechos secundários foram a comprimento da criança, o perímetro cefálico e a circunferência braquial. Estas variáveis foram medidas no início e aos 14 e 40, 90, 180, 270 e 360 dias pós-parto. O modelo de regressão linear de efeitos mistos foi utilizado para avaliar os desfechos, com um poder de 80%, e um nível de significância de 1% para o desfecho primário e 0,3% para os desfechos secundários, devido à correção para múltiplas hipóteses. Resultados: De junho a agosto de 2015, um total de 100 mulheres foram randomizadas para inserção precoce ou convencional do implante de etonogestrel no pós-parto. As características sociodemográficas foram semelhantes entre os grupos, exceto no nível de escolaridade, que foi maior no grupo de inserção convencional (88% vs. 70% no grupo de inserção precoce, p = 0,02). Não houve diferença no peso do bebê em 360 dias entre os grupos [precoce: (média ± desvio padrão) 10060,3 ± 1156,0 g vs convencional: 9812,1 ± 1270,3g, estimativa da diferença de média 321,6g, intervalo de confiança 95% (IC): -183,5 A 495,7]. As curvas de crescimento do comprimento e as curvas dos perímetros cefálico e braquial também não diferiram entre os grupos. Conclusões: Não há diferença no crescimento das crianças amamentadas, em 12 meses, cujas mães receberam a inserção do implante liberador de etnogestrel precocemente comparado com a inserção pós-parto convencional. / Objective: To evaluate the growth of breastfed children whose mothers had inserted an etonogestrel-releasing implant in the immediate postpartum period. Methods: An open, randomized, controlled, and parallel trial of postpartum women who were block randomized to early (up to 48 hours postpartum before discharge) or conventional (at 6 weeks postpartum) insertion of a etonogestrel implant. The primary outcome was average infant weight at 12 months (360 days), and a difference of >=10% between groups was considered clinically significant. The secondary outcomes were infant\'s lenght, head and arm circumferences. These variables were measured at baseline and at 14 and 40, 90, 180, 270, and 360 days postpartum. The mixed-effects linear regression model was used to evaluate the outcomes, with a power of 80%, and a significance level of 1% for primary outcome and 0.3% for secondary outcomes, due to correction for multiple hypothesis testing. Results: From June to August of 2015, a total of 100 women were randomized to either early or conventional postpartum etonogestrel insertion. Sociodemographic characteristics were similar between the groups, except for educational attainment, which was higher in the conventional insertion group (88% vs. 70% in the early insertion group, p=.02). There was no difference in infant weight at 360 days between the groups [early: (mean ± standard deviation) 10060.3 ±1156.0 g vs conventional: 9812.1 ± 1270.3g, mean difference estimate 321.6g, 95% confidence interval (CI): - 183.5 to 495.7]. The growth curves of the lenght and the curves of the head and arm circumferences did not differ between the groups. Conclusion: There is no difference in growth at 12 months among breastfed infants whose mothers underwent early compared with conventional postpartum insertion of the etonogestrel implant.

Infant growth is a key indicator of health and a relevant component of paediatric surveillance. Certain growth characteristics are also associated with greater risk for diseases such as obesity and cardiovascular disease. South Asian populations are known to demonstrate poor infant growth and suffer from a high prevalence of non-communicable disease. Relatively little is known about the growth of Pakistani infants, especially following migration. In the United kingdom (UK), infant growth is routinely monitored to detect poor health, and this process produces a repository of largely unutilised data. In 2009, new growth charts, which include a component of the World Health Organisation (WHO) growth standards, were introduced to routine practice. The adoption of prescriptive standards, which are based on breastfed infants living in an unconstrained environment, will have implications for the assessment of growth. To develop and assess the quality of routine growth monitoring data collected in Bradford, UK, so that it can be used to describe the differences in growth between White British and Pakistani infants in the same city. To investigate the factors that influence this growth. To assess the implications of adopting growth standards for practice. The frequency of routine growth monitoring data that are collected at prescribed age periods was assessed. Test-retest growth data were collected from 192 practitioners, and technical error of measurements were calculated. Data on 2464 (boys 51%, White British 45%) infants were submitted to multilevel modelling analysis to produce sex and ethnic specific weight-for-age, abdominal circumference-for-age, head circumference-for-age, and length-for-age growth curves between birth and nine months. Multivariable linear regression models were used to investigate factors that influence size at birth and at nine months. Growth curves were plotted against the WHO standards and the UK 1990 references, Z-scores were calculated, and the relative risks (RR) of underweight, obesity, and poor infant weight gain using the standards compared to the references were assessed. During each prescribed age period for routine growth monitoring generally only 30% to 35% of measurements were recorded. None of the technical error of measurements were excessively large, and coefficients of reliability ranged from 0.96 to 1.00. Multilevel models explained that Pakistani infants were smaller than White British infants, in the first nine months of life, for weight (-210.3g to -321.7g), abdominal circumference (-1.15cm to -0.39cm), head circumference (-0.59cm), and length (-0.32cm). Compared to the WHO standards, infants demonstrated dissimilar weight growth, but similar head circumference and length growth. The common weight growth pattern was slow growth between birth and two months, followed by rapid growth. Using the standards, infants were significantly less likely to be classified as underweight (RR at birth 0.496; 95% Confidence Interval 0.363 to 0.678) and demonstrating poor weight gain from birth to nine months (0.783; 0.644 to 0.952). Growth monitoring data are not collected at prescribed age periods, but following initial training of practitioners are reliable. Integrating research with practice has developed routine data to research calibre and has established protocols to make data more accessible. Pakistani infants were consistently smaller than White British infants, and, despite efforts, the determinants of this phenomenon have not yet been fully elucidated. Growth in weight of infants in Bradford differs significantly from that represented by the WHO standards, and without adequate training of practitioners infant growth may be incorrectly interpreted.

Background: Substantial variation exists between ethnicities in both birth weight and the prevalence of obesity-related non-communicable diseases (OR-NCDs). South Asians, who display a reduced birth weight and increased risk of developing these OR-NCDS, have been the focus of much of the research into the developmental origins of health and disease (DOHaD) paradigm. However, little research utilising ultrasonically derived estimates of fetal growth has been conducted. The use of more direct measures of fetal growth may also enable the identification of relationships between patterns of fetal growth with patterns of postnatal growth, explicitly, whether periods of restricted or rapid growth lead to postnatal catch-up or down, respectively. The known differences in birth weight existing between South Asians and White British infants may also have implications for the assessment of neonatal health in these sub-groups when using a population derived birth weight chart, such as the UK-World Health Organisation (UK-WHO). Customised charts, which adjust for maternal variables including ethnicity, have been recommended for clinical practice, yet evidence for their efficacy is varied. Objectives: The aims of this thesis were to: 1) investigate whether fetal growth patterns differ between Pakistani and White British foetuses and determine whether maternal size and demographic variables mediate any such differences; 2) produce a birth weight chart adjusting for ethnicity and compare this to the UK-WHO and customised birth weight charts to determine which chart better identifies neonates at risk of the adverse delivery and neonatal outcomes associated with small-for-gestational-age (SGA) and large-for-gestational age (LGA); 3) identify whether there is evidence of weight growth tracking between fetal and infant periods and determine whether patterns of fetal growth predict patterns of postnatal growth. Methods: All data come from the Born in Bradford (BiB) birth cohort. Objective 1: Multilevel models and fractional polynomials were employed for the modelling of fetal weight, head circumference (HC) and abdominal circumference (AC) growth. Potential mediators of the effect of being of Pakistani origin were entered into the model and the effect on the ethnicity variable was assessed. Objective 2: Ethnic specific birth weight charts (BiB) were constructed using the LMS method. SGA and LGA were defined as a birth weight <10th and >90th relative to the BiB, the UK-WHO or the customised charts. Sensitivity, specificity, positive & negative predictive values and area-under-the curve were calculated for each of the three charts SGA and LGA cut-offs, to assess the predictive ability of each chart for a range of delivery and neonatal outcomes. Objective 3: Multilevel models were employed for the modelling of fetal and postnatal growth. Fitted values were produced at 20, 30, 40 prenatal weeks & 1, 3, 6, 9, 12, 24 postnatal months in both an internal reference and the sample population. Z scores were calculated and conditional Z scores were generated to account for regression to the mean. Growth tracking was defined as change in Z score ≤ 0.67 & ≥ -0.67. Restricted and rapid fetal growth were defined as a change in Z score in the fetal period of <-0.67 and >0.67, respectively. Catch-down and catch-up growth were defined in the same way, except in the postnatal period. ANOVAs were used to test for differences in size and growth by type of fetal growth. Furthermore, logistic regression and a sensitivity and specificity analysis were employed to examine the predictive ability of the type of fetal growth. Results: Objective 1: Pakistani fetuses were significantly smaller and lighter than White British fetuses, throughout gestation. In terms of weight, Pakistani fetuses were approximately 2.25% lighter at 20 weeks, 4.13% at 30 weeks and 5.94% at 40 weeks. The differences in size for AC and HC between the two groups were not as great, with the AC and HC of Pakistani fetuses being approximately 4.1% and 1.25% smaller, respectively, at 40 weeks. Despite these significant differences in size the pattern of growth for HC and weight was not significantly different between the two groups. There was a trend for Pakistani fetuses to display a greater deceleration of growth in the final trimester (figure 4-12). The biggest mediators of the effect of being of Pakistani origin were maternal height and weight. Objective 2: Classifying infants as SGA or LGA by the BiB, UK-WHO or customised charts had low predictive utility for the outcomes under investigation. Despite the fact that the BiB ethnic specific birth weight reference provided significantly better prediction for more outcomes than both the UK-WHO and customised charts in both White British and Pakistani infants, with the exception of shoulder dystocia, AUROC values for all three charts were all below 0.61. Objective 3: The prevalence of tracking within the same centile band from 20 weeks gestation to 2 years was 10.82%. Infants who experienced restricted fetal growth remained significantly lighter than those who had not, for the duration of infancy. In this group however, there was a pattern of greater growth than expected during infancy. This was opposite to the pattern observed in infants who had experienced rapid fetal growth, who exhibited less growth than expected during infancy. However, the ability of the type of fetal growth to predict the pattern of postnatal growth was minimal, with only rapid fetal growth being significantly associated with increased odds of catch-down growth in infancy. Conclusions: No ethnic difference in the pattern of growth was found in terms of the whole body (weight) or in HC. The trend for reduced growth of the AC in Pakistanis may be a result of a reduced growth of the visceral organs during the third trimester, which may lead to both an altered liver metabolism and impaired renal function in post-natal life. Although being small or large at birth may increase the risk of an adverse neonatal outcome, size alone is not sensitive or specific enough with current detection to be a useful clinical tool. The finding that neither restricted nor rapid fetal growth predicted postnatal catch-up growth may suggest that the timing of canalisation is outside of the fetal period. If infant catch-up and down growth are not associated with periods of restricted or rapid fetal growth, the definitions of these growth patterns may need revising.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / INTRODUCTION: Since the start of the Prevention of Mother-to-Child Transmission (PMTCT) Programme at Dr George Mukhari Hospital in 2001, there has been no evaluation of the effect of formula feeding on the growth and dietary intakes of enrolled infants. AIM: The aim of this study was to determine the short-term growth, anthropometry and dietary intake of infants from two to ten weeks of age were entered into the PMTCT Programme at the Department of Human Nutrition at Dr George Mukhari Hospital from two to ten weeks of age. METHODS: This was a descriptive, longitudinal (eight weeks duration) study. Anthropometric assessment including length and head circumference was performed at two weeks of age and thereafter at ten weeks of age. Weight measurement was performed at age two weeks (visit 1), six weeks (visit 2) and ten weeks (visit 3). Anthropometric measurements were compared with CDC 20003 growth charts. Feeding practices and dietary intake (24 hour diet recall interview) were assessed at each of the four week interval visits and evaluated according to the DRIs59. At the third visit, a socio-demographic interview and a usual food intake interview were performed. RESULTS: A total of 151 [male (N = 75) and female (N = 76)] infants completed the study. A total of 110 (72%) mothers resided in the Soshanguve area and 138 (91%) of the mothers had attended high school. The majority (75%) of mothers was not generating an income from employment. Generally, mothers had access to safe drinking water and all (99%) but two mothers used pre-boiled water before preparing infant formula. The accuracy and correctness of reconstituting infant formula decreased with each visit as feeds were increasingly made too dilute. A total of 124 (82%) infants were exclusively formula fed. The remainder received water, water with sugar and/or complementary feeds. Mean energy and macronutrient intakes of both males (N = 65, 87%) and females (N = 61, 80%) were below recommendations at age two weeks. Of all the macronutrients, fats were consumed the least by both males (N = 67, 89%) and females (N = 66, 87%) at visit 1. Catch up growth was evident and nutrient intakes improved as the study progressed. The mean weight gain of all infants from visit 1 to 2 was 1.2 (SD 0.3) kg and 0.9 (SD 0.3) kg from visit 2 to 3 (exceeding the CDC 20003 recommendation for both male and female infants). The incidence of underweight, wasting and head circumference-for-age below the third percentile decreased from visit 1 to 3, but the number of stunted infants increased towards visit 3. The majority of infants in this study grew well in their first ten weeks of life. Growth accelerated as infants became older and growth faltering improved by ten weeks of age. CONCLUSION: Overall, the growth of the infants referred to the PMTCT Programme at the Department of Human Nutrition at Dr George Mukhari Hospital would appear to be adequate but mothers’ approach to formula feeding practices needs to be improved in some aspects of feeding their infants.

Made available in DSpace on 2016-08-19T18:15:59Z (GMT). No. of bitstreams: 1 MARIA DA GRACA MOUCHREK JALDIN.pdf: 589878 bytes, checksum: a4438de077d576ce70fce6d241683f81 (MD5) Previous issue date: 2009-11-18 / FUNDAÇÃO DE AMPARO À PESQUISA E AO DESENVOLVIMENTO CIENTIFICO E TECNOLÓGICO DO MARANHÃO / The aim of the present study was to evaluate the growth of exclusively breast-fed infants from birth to six months of age, as well as to compare weight, length and head circumference with the National Center for Health Statistics (NCHS/1978) reference, and the new international World Health Organization standard/2006 (WHO/2006). A prospective longitudinal study, undertaken in the Human Milk Bank of the Child Maternal University Hospital in São Luis, Maranhão-Brazil, in the period of October 2007 to November 2008. A convenience sampling of 328 full term singleton infants, with birth weight equal to or over 2.5 kg and lower or equal to 4.0kg, exclusively breastfed, upon demand, since their birth. The weight, length and head circumference recorded from birth to the sixth month of age. The growth was evaluated through mean standard deviation and percentiles, and the results were compared to those of the NCHS/1978 reference and WHO/2006 standard. A total of 181 infants (95 females and 86 males) concluded the study. The mean weight of infants at birth was 3.3kg and 8.2kg at six months for males, and 7.7kg for females. Males weighed more than females from the first to the sixth month (p<0.05). The greatest velocity in weight gain occurred in the first two months of life for both sexes. Both males and females doubled their mean birth weight around the third and fourth months, respectively. The mean weight of females was superior to the WHO/2006 standard, at birth and from the third to the sixth month (p<0.05); as to the males, it was superior from the fourth to the sixth month (p<0.05). The mean weight was above the NCHS/1978 reference, for both genders, from birth to the sixth month (p<0.05) except for males at birth. The mean length at birth was 49.1cm (males) and 48.9cm (females), and it was 67.0 cm (males) and 65.4cm (females) at the sixth month. The mean length of males was lower than the WHO/2006, from birth to the sixth month (p<0.05), except for the fifth month; it was also lower than the NCHS/1978 at birth, in the first, fourth and sixth months of life (p<0.05). As to the females, it was similar to the WHO/2006 and lower than the NCHS/1978, at birth and at the sixth month (p<0.05). The 50th percentile of weight of infants was comparable to WHO/2006 percentile, and the females and males surpassed the standard measure from the second and third months, respectively. The 50th percentile of the infants weight was superior to the NCHS/1978 from the first to the sixth month. The 50th percentiles of length and head circumference were comparable to the respective percentiles of the standard and the reference. The infants velocity of the monthly weight increment followed the 50th percentile curve of the WHO/2006, with a better performance, however. It was concluded that exclusively breast-fed infants up to six months presented satisfactory growth. The weight, length and head circumference were akin to the 50th percentile of the WHO standard and NCHS reference; however, the infants in the study were heavier than the reference. / O presente estudo teve como objetivo analisar o crescimento de crianças, em aleitamento materno exclusivo, do nascimento ao sexto mês e comparar o peso, o comprimento e o perímetro cefálico com a referência National Center for Health Statistics (NCHS/1978) e com o novo padrão internacional World Health Organization/2006 (WHO/2006). Estudo prospectivo, longitudinal realizado no Banco de Leite Humano do Hospital Universitário Materno Infantil, São Luís, Maranhão, Brasil, entre outubro de 2007 a novembro de 2008. Amostra de conveniência com 328 crianças nascidas a termo, não gemelares, peso ao nascer igual ou superior a 2,5kg e inferior ou igual a 4,0kg e em aleitamento exclusivo, do nascimento ao sexto mês, sob livre demanda. O peso, comprimento e perímetro cefálico foram verificados do nascimento ao sexto mês. Avaliouse o crescimento por meio de médias, desvio padrão e percentis, comparando-se os resultados aos da referência NCHS/1978 e do padrão WHO/2006. Finalizaram o estudo 181 crianças (95 meninas e 86 meninos). O peso médio das crianças ao nascer foi 3,3kg e, aos seis meses, 8,2kg, meninos e 7,7kg, meninas. Os meninos foram mais pesados que as meninas, do primeiro ao sexto mês (p<0,05). A maior velocidade no ganho ponderal ocorreu nos dois primeiros meses de vida, em ambos os sexos. Meninos e meninas dobraram o peso médio de nascimento por volta do terceiro e quarto meses, respectivamente. O peso médio das meninas foi superior ao padrão WHO/2006, ao nascer e do terceiro ao sexto mês (p<0,05); o dos meninos, superior do quarto ao sexto mês (p<0.05). Foi superior à referência NCHS/1978, em ambos os sexos, do nascimento ao sexto mês (p<0,05), exceto, ao nascer, nos meninos. O comprimento médio, ao nascer, foi 49,1cm (meninos) e 48,9cm (meninas), aos seis meses, 67,0cm (meninos) e 65,4cm (meninas). O comprimento médio dos meninos foi inferior ao WHO/2006, do nascimento ao sexto mês (p<0,05), exceto no quinto; foi inferior à NCHS/1978, ao nascer, no primeiro, quarto e sexto meses de vida (p<0,05); nas meninas foi semelhante ao WHO/2006 e menor que a NCHS/1978, ao nascer e no sexto mês (p<0,05). O percentil 50 do peso das crianças foi comparável ao WHO/2006, sendo que meninos e meninas superaram o padrão, a partir do segundo e terceiro meses, respectivamente. O percentil 50 do peso das crianças foi superior à NCHS/1978, do primeiro ao sexto mês. Os percentis 50 do comprimento e perímetro cefálico foram comparáveis aos respectivos percentis do padrão e da referência. A velocidade de ganho de peso mensal das crianças acompanhou o percentil 50 do padrão WHO/2006, porém com um desempenho melhor. Concluiu-se que crianças amamentadas exclusivamente, até o sexto mês de vida, apresentaram crescimento satisfatório. O peso, comprimento e perímetro cefálico foram comparáveis ao percentil 50 do padrão WHO e da referência NCHS, contudo as crianças do estudo foram mais pesadas que a referência.

<p>The concept of exclusive breastfeeding in relation to daily feeding practices and to health and growth of infants in an affluent society was examined. In a descriptive longitudinal prospective study 506 mother-infant pairs were followed from birth through the greater part of the first year. Feeding was recorded daily, and health and growth were recorded fortnightly. </p><p>Large individual variations were seen in breastfeeding patterns. A wide discrepancy between the exclusive breastfeeding rates obtained from "current status" data and data "since birth" was found.</p><p>Using a strict definition of exclusive breastfeeding from birth and taking into account the reasons for giving complementary feeding, the study showed that many exclusively breastfed infants had infections early in life, the incidence of which increased with age, despite continuation of exclusive breastfeeding. However, truly exclusively breastfed infants seem less likely to suffer infections than infants who receive formula in addition to breast milk. Increasing formula use was associated with an increasing likelihood of suffering respiratory illnesses. The growth of exclusively breastfed infants was similar to that of infants who were not exclusively breastfed. </p><p>The health of newborn infants during the first year of life was associated with factors other than feeding practices alone. Some of these factors may be prenatal, since increasing birth weight was associated with an increasing likelihood of having respiratory symptoms, even in exclusively breastfed infants. However, exclusive breastfeeding was shown to be beneficial for the health of the infant even in an affluent society. </p>

The concept of exclusive breastfeeding in relation to daily feeding practices and to health and growth of infants in an affluent society was examined. In a descriptive longitudinal prospective study 506 mother-infant pairs were followed from birth through the greater part of the first year. Feeding was recorded daily, and health and growth were recorded fortnightly. Large individual variations were seen in breastfeeding patterns. A wide discrepancy between the exclusive breastfeeding rates obtained from "current status" data and data "since birth" was found. Using a strict definition of exclusive breastfeeding from birth and taking into account the reasons for giving complementary feeding, the study showed that many exclusively breastfed infants had infections early in life, the incidence of which increased with age, despite continuation of exclusive breastfeeding. However, truly exclusively breastfed infants seem less likely to suffer infections than infants who receive formula in addition to breast milk. Increasing formula use was associated with an increasing likelihood of suffering respiratory illnesses. The growth of exclusively breastfed infants was similar to that of infants who were not exclusively breastfed. The health of newborn infants during the first year of life was associated with factors other than feeding practices alone. Some of these factors may be prenatal, since increasing birth weight was associated with an increasing likelihood of having respiratory symptoms, even in exclusively breastfed infants. However, exclusive breastfeeding was shown to be beneficial for the health of the infant even in an affluent society.

Orientador: Vanda Maria Gimenes Gonçalves / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T04:56:01Z (GMT). No. of bitstreams: 1 Mello_BernadeteBalaninAlmeida_D.pdf: 1984034 bytes, checksum: f83a4f24112d15ec9067e9d1be867d8d (MD5) Previous issue date: 2007 / Resumo: O objetivo deste estudo foi comparar o comportamento de lactentes nascidos a termo, pequenos para a idade gestacional (PIG) e lactentes nascidos com peso adequado para a idade gestacional (AIG), no primeiro ano de vida. Foram selecionados 125 neonatos na maternidade do Centro de Atenção Integral à Saúde da Mulher (CAISM/UNICAMP), obedecendo aos critérios de inclusão: pais ou responsáveis legais assinaram o Termo de Consentimento Livre e Esclarecido; neonatos que não necessitaram de cuidados especiais; com idade gestacional entre 37 e 41 semanas; com avaliação no 1º, 2º,3º,6º,9º,12º meses. A casuística foi composta por 95 lactentes que compareceram para pelo menos uma avaliação programada no 1º ano de vida, foi dividida em dois grupos de acordo com a adequação peso/idade gestacional; grupo PIG, constituído por 33 lactentes com peso ao nascer abaixo do percentil 10 e grupo AIG por 62 lactentes com peso entre o percentil 10 e 90 da curva de crescimento fetal de Battaglia e Lubchenco (1967). Para a avaliação do neurodesenvolvimento foram utilizadas as Escalas Bayley de Desenvolvimento Infantil II (BISID-II). Para a avaliação do comportamento do lactente, elegeu-se as Escalas de Classificação do Comportamento (ECC), das BSID-II. O estudo seccional avaliou no 1º mês: 63 lactentes (18PIG/45AIG). No 2º mês: 68 lactentes (25PIG/43AIG). No 3º mês: 68 lactentes (22PIG/46AIG). No 6º mês: 67 lactentes (25PIG/42AIG). No 9º mês: 61 lactentes (22PIG/39AIG) e no 12º mês: 68 lactentes (21PIG/47AIG). Os grupos foram semelhantes quanto às variáveis neonatais, exceto peso ao nascer. O peso foi significativamente menor no grupo PIG (p<0,001). Os grupos não apresentaram diferenças estatisticamente significativa na performance das Escalas Mental e Motora. Considerando o Index Score (IS) da Escala Mental, os resultados não demonstraram diferença estatisticamente significativa entre os grupos. Os resultados de IS da Escala Motora demonstraram diferença estatisticamente significativa entre os grupos, no 2º mês (p=0.008) e 12º mês (p=0.047). O grupo PIG apresentou valores medianos inferiores nestes meses. Considerando os resultados da performance comportamental na ECC, observou-se valores de significância estatística no 2º mês (pvalor=0.048), com maior freqüência relativa de lactentes PIG classificados como inadequados. Entre os fatores considerados na ECC nos primeiros meses de vida, apresentou valor de significância estatística o Fator Atenção/Vigília no 2º mês (p=0.005). Considerando a comparação dos resultados do percentil da ECC, os grupos demonstraram diferença estatisticamente significativa no 2º mês (p=0.001) e 3º mês (p=0.003). Os valores medianos foram inferiores no grupo PIG. No Fator Atenção/Vigília, os grupos de lactentes apresentaram diferença estatisticamente significativa no 2º mês (p=0.001) e 3º mês (p=0.003), sendo que os valores medianos foram inferiores no grupo PIG. No Fator Qualidade Motora os grupos apresentaram diferença estatisticamente significativa no 2º mês (p=0.045), sendo que os valores medianos foram inferiores no grupo PIG / Abstract: The objective of this study was to compare the behavior of full-term small-for-gestational age (SGA) with full-term appropriate-for gestational age (AGA) infants in the first year of life. A hundred twenty five full-term neonates were selected at Neonatology Service in the Center of Integral Attention to Woman¿s Health (CAISM) of the State University of Campinas (UNICAMP), São Paulo, Brazil observing the inclusion criteria as follow: parents or legal guardians who signed the Informed Consent; neonates who did not need special care; gestational age between 37 and 41 weeks. They were assessed in the 1st , 2nd ,3rd ,6th ,9th and 12th months of life. Ninety five infants who came at least to one assessment during the first year of life were the sample. This sample was divided into two groups, according to weight and gestational age. In the SGA group there were 33 infants with birth weight less than percentile 10th and, in the AGA group, there were 62 infants whose birth weight varies between the 10th and 90th percentile on fetal growing Battaglia and Lubchenco method (1967). The Bayley Scales of Infant Development-II (BSID-II) (BAYLEY, 1993) were used with emphasis on the Behavior Rating Scale (BRS). The cross-sectional study evaluated in the 1st month, 63 infants (18 SGA and 45 AGA); in the 2nd month, 68 infants (25 SGA and 43 AGA); in the 3rd month, 68 infants (22 SGA and 46 AGA); in the 6th month, 67 infants (25 SGA and 42 AGA); in the 9th month, 61 infants (22 SGA and 39 AGA); in the 12th month, 68 infants (21 SGA and 47 AGA). The groups showed similar distribution in biologic variables on birth, except birth weight. The SGA group showed lower birth weight than AGA, with significant difference between them (p<0.001). No differences were observed in Mental and Motor Scales performance. No differences were observed in the IS of the Mental Scale. The Motor Scale median comparison showed lower IS in the SGA with significant difference in the 2th month (p=0.008) and in the 12th month (p=0.047). Considering in the BRS, it was observed that the inadequate performance was associated in the 2nd month (p=0.048) to a bigger number of SGA infants, classified as inadequate. As the results of performance of BRS factors are concerned, the Attention/Arousal Factor displayed significantly lower average values (p=0.005) in SGA group. The percentile results in BRS showed significant difference in the 2nd (p=0.001) e 3rd (p=0.003) months, with lower medium values in the SGA group. The Motor Factor displayed significantly lower average values in the SGA group in the 2nd month (p=0.045) with medium values lower in the SGA grou / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas