1,721,073 research outputs found
Information and psychosocial intervention in neonatology
No full textMaternity is a unique experience calling for shared responsibility in protecting the baby, the parents and their environment. Mood disorders (stress, depression) can occur and sometimes interfere with the complex network of relationships that lead to satisfactory family and infant relationships
Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science
Full text linkThe prevalence of childhood overweight and obesity has increased in most countries the last decades. Considering this in a simplistic way, we can say that obesity is the result of an imbalance between energy intake and energy expenditure. Moreover, the environment from conception to childhood could influence the child's future health. The first 1000 days of life start with woman's pregnancy, and offer a unique window of opportunity to contribute to obesity prevention. In light of the actual literature, the aim of our article is to discuss a proposal of 10 good practices to minimize obesity in the first 1000 days emerging from published science. (1) Both the mother's and the father's behaviors are important. A balanced diet with appropriate fat and protein intake, and favoring fruits and vegetables, is recommended for both parents during the conception period and pregnancy. Furthermore, overweight obese women who are planning to become pregnant should reduce their weight before conception. (2) During pregnancy, at birth, and during early life, body composition measurements are crucial to monitor the baby's growth. (3) Exclusive breastfeeding is recommended at the beginning of life until six months of age. (4) Four to six months of age is the optimal window to introduce complementary feeding. Until one year of age, breast milk or follow-on commercial formula is the main recommended feeding source, and cow's milk should be avoided until one year of age. (5) Fruit and vegetable introduction should begin early. Daily variety, diversity in a meal, and repeated exposure to the food, up to eight times, are efficient strategies to increase acceptance of food not well accepted at first. There is no need to add sugar, salt, or sugary fluids to the diet. (6) Respect the child's appetite and avoid coercive "clean your plate" feeding practices. Adapt the portion of food and don't use food as reward for good behavior. (7) Limit animal protein intake in early life to reduce the risk of an early adiposity rebound. Growing-up milk for children between one and three years of age should be preferred to cow's milk, in order to limit intake and meet essential fatty acid and iron needs. (8) The intake of adequate fat containing essential fatty acids should be promoted. (9) Parents should be role models when feeding, with TV and other screens turned-off during meals. (10) Preventive interventions consisting of promoting physical activity and sufficient time dedicated to sleep should be employed. In fact, short sleep duration may be associated with increased risk of developing obesity. Based on literature reviews, and given the suggestions described in this manuscript, concerted public health efforts are needed to achieve the healthy objectives for obesity and nutrition, and to fight the childhood obesity epidemic
Attitudes and practices of family paediatricians in Italy regarding infant feeding
No full textAim: The aim of this study was to examine attitudes and practices of family paediatricians in Italy towards infant feeding. Methods: A questionnaire was sent to 850 paediatricians across Italy, asking about attitudes and practices towards infant feeding with focus on the World Health Organization's criteria. Results: The response rate was 91.2%. Breastfeeding is recommended for 6-11 months (70.6%) or longer (29.4%). A 95% of paediatricians recommend introducing complementary foods throughout 4-5.9 months. Among paediatricians who give indications about the minimum acceptable diet (61.7%), recommendations agree with WHO in 71.3% and 83.3% of cases for infants aged 6-8 or 9-11 months, respectively. A 95.6% of paediatricians recommend consumption of meat for infants aged 6 months or more, and 98.4% use of formula milk for infants having breastfeeding stopped in the first year of life. Paediatricians reported own experience (73.4%) and reading (54.2%) as main sources of information. A 70% of paediatricians know the WHO/Infant and Young Child Feeding Practices criteria regarding breastfeeding but <5% the complementary feeding indicators. Conclusion: Family paediatricians in Italy have positive disposition towards infant feeding but their knowledge and practices are suboptimal with respect to the WHO criteria, especially regarding complementary feeding. © 2012 Foundation Acta Pædiatrica
Hyperthyrotropinemia of the Preterm Newborn: Treat or Not to Treat?
No full textBackground: It is often difficult to establish whether
hyperthyrotropinemia in preterm newborn is a simple physiologic
energy sparing phenomenon or a true hypothyroidism requiring
replacement treatment. Objective and hypotheses: This study
aimed to find in what extent thyroid function in the preterm
newborn can be influenced by clinical characteristics and
complications. Method: We studied 35 preterm newborn,
gestational age (GA) 32.0 (2.1) weeks, 21 males, 13 small for
gestational age (SGA), positive at TSH neonatal screening and
with persistent hyperthyrotropinemia during hospitalization.
We collected the following clinical data: GA, type of delivery,
birth weight (BW), length (BL) and head circumference, clinical
complications (RDS, jaundice, infections), time of detection and
level of the pathologic TSH value in the dried blood spot (DBS)
and in the serum sample, time of starting L-thyroxine and its
dosage at steady state. Data are reported as median (IQR). Mann-
Whitney test and simple regression were applied for statistical
analysis. Results: TSH levels and time of detection of pathologic
values were not correlated to GA, BW, length and head
circumference. SGA showed lower serum TSH levels (14.6 (5.1)
mU/ml vs 22.6 (69.9) mU/ml; P!0.05). The patients with RDS
showed lower TSH levels compared with patients without RDS
(14.6 (7.9) mU/ml vs 24.0 (66) mU/ml; P!0.05) and required lower
L-Thyroxine dosage at steady state (6.6 (4.0) vs 10.0 (2.0) mg/kg
per day; P!0.05). The starting time of replacement treatment was
inversely correlated to BW and BL (P!0.05) but was not different
in SGA compared to appropriate for gestational age newborns.
The patients who received replacement treatment had significantly
higher pretreatment TSH in serum (18.11 (65.07) mU/ml vs 11.55
(10.83) mU/ml; P!0.02) but not in DBS (10.0 (23.75) mU/ml vs
6.69 (3.05) mU/ml; PO0.05). Conclusion: Our results support the
hypothesis that subclinical hypothyroidism could play a protective
effect on growth and respiratory function in the preterm newborn.
Further studies are needed to determine whether or not to
undertake replacing therapy
Sleep Apnea throughout the First Two Years of Life: Assessment of the Effect of Pacifiers in Patients with ALTE
No full textBackground: Apparent Life-Threatening Event (ALTE), Obstructive Sleep Apnea syndrome (OSAs) and Sudden Infant Death Syndrome (SIDS) are strongly correlated and few studies analyze the role that pacifiers play in such conditions. Objective: The aim of the study is to evaluate how pacifiers affect sleep apnea among children with a history of ALTE. Methods: 10 subjects between 1 month and 2 years of age with a history of idiopathic ALTE were non-selectively recruited. Patients were subjected to cardio-respiratory monitoring at home for two consecutive nights; during the first night, the pacifier was not used, whereas the second night, the pacifier was used by the child for at least four hours sleep. Parents were given an assessment questionnaire to evaluate and report any irritation due to the pacifier use. All obtained traces were blindly analyzed by a pediatric specialist in sleep disorders, more specifically: Peripheral oxygen saturation (SpO2), heart rate (FC), Electrocardiogram (ECG) and the presence of apneas and/or hypopneas were assessed. In order to evaluate the differences between the average values collected from the two groups, a t-test was performed. Results: The use of the pacifier resulted in a statistically significant reduction in the number of pathological apneas/night (-1.7%; p = 0,0024), an improvement in the average SpO2 (+ 0.8%; p = 0.3328) and an increase in the value of the minimum SpO2 detected (+ 2%; p = 0.2571). Conclusion: The results show that the use of pacifiers improves the respiratory capacity of children that suffer from nocturnal apneas at night
Introducing complementary foods in the first year of life
Full text linkIntroduction of solid foods is a fundamental step in the development of an individual. There are many implications that weaning contains not only on a nutritional plan, but also on the contingent and long-term health of an individual. Over time this nutritional passage has evolved through the acquisition of new knowledge about maturation of anatomical and neurosensory structures involved in all the phases of such a complex process. The understanding of a maturing taste of infant and cultural changes is another key to understand the evolution of introduction of solid foods in infants. What is contained in this text encapsulates thus the evolutionary path of weaning in recent years, showing current trends in the light of cultural changes and new scientific acquisitions
Nutritional and metabolic programming during the first thousand days of life
Full text linkThe latest scientific acquisitions are demonstrating what has already been hypothesized for more than twenty years about the development of the state of health/illness of individuals. Indeed, certain stimuli, if applied to a sensible phase of development, are able to modify, through epigenetic mechanisms, gene expression of DNA, resulting in adaptive modifications of phenotype to the environment, which may reflect negatively on the health of every individual. This concept, applied to nutrition, has opened up important prospects for research in this area. The nutritional history of an individual, linked to the development of a healthy state, would begin very early. In fact, since the pregnancy and for the next two years (for a total of about 1000 days), the maternal eating habits, the type of breastfeeding and then the main stages of nutrition in the evolutionary phase represent those sensitive moments, essential for the development of important endocrine, metabolic, immunological alterations, better known as metabolic syndrome. This condition would represent the physiopathogenetic basis for explaining a series of disorders, known as non communicable diseases (NCDs) such as obesity, diabetes, hypertension, cardiovascolar disease and all those conditions that today affect the health of most industrialized countries and through the years are emerging especially in developing countries (South America, Asia), where new environmental conditions and increased food availability are changing food habits, with far-reaching public health impacts. This paper analyzes these new nutritional perspectives and the main implications of what has been termed the 1000-day theory
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