International Journal of Child Health and Nutrition

98-104

Authors: Onwaree Sukhosa, Kulnipa Kittisakmontri

Background: Hospitalized children are at risk of malnutrition and vulnerable for many adverse outcomes. Objectives: This study aimed to determine the prevalence of hospital malnutrition in pediatric patients admitted at Chiang Mai University (CMU) hospital and evaluate correlation between malnutrition and outcomes including length of hospital stay (LOS), total hospital cost and mortality.Methods and Study Design: A prospective cohort study was conducted at CMU hospital. Patients aged 1 month to 15 year-old who admitted to general pediatric wards were included. Demographic data, anthropometric assessments including weight, length/height and outcomes were collected. Malnutrition was classified by the WHO growth reference. Results: A total of 217 patients with mean age 68.8 ± 53.8 month-old were analyzed. Majority of them were male (65.4%) while leading diagnosis were oncologic, infectious and congenital heart diseases. The prevalence of all malnutrition was 59.9%. According to the WHO classification, percentages of the patients who were stunted, wasted, both of stunted and wasted, and overweight were 29.9%, 9.2%, 17.1%, and 3.7%, respectively. Moreover, compared to previous study of this center in 1985, more than half of hospitalized children have still assessed as under-malnourished patients. For the hospital outcomes, wasting regardless of stunting had significantly longer LOS (8 vs 5 days, p = 0.001) and higher hospital expenditure (37,283.0 vs 23,630.0 Baht, p = 0.004) while mortality was not different. Conclusions: The prevalence of malnutrition in hospitalized children is common and remains unchanged. Acute malnutrition significantly impact on total hospital cost and prolong LOS comparing with other groups

110-115

Authors: Mohammad El Azhari, Ahmad Abu Slaih, Yousef S. Khader, Abdulhalim Al-Musa, Ibrahim Iblan

Objectives:There is scarcity of data on malnutrition among children in Jordan. Therefore, this study was conducted to assess the nutritional status and estimate the prevalence rates of stunting, underweight, and wasting and their associated factors among children under five. Subjects and Methods:A cross-sectional study was conducted between January and April 2017 among children under five years in Amman, Jordan. All Jordanian children under five years who visited the selected health centers for vaccination or accompanied their mothers during the study period were included in this study. Mothers or caregivers of children were interviewed face-to face using the study questionnaire. Weight in kilograms and height in centimeters were measured for all children. Anthropometric indices were calculated using reference medians recommended by the World Health Organization.Results:This study included a total of 923 (463 boys and 460 girls) children. The prevalence rates of stunting, underweight, and wasting were 6.2%, 3.8%, and 2.8%, respectively. Multivariate analysis showed that low birth weight was significantly associated with stunting (OR = 2.9, 95% CI: 1.4,6.0; p-value=0.003) and underweight (OR =5.6, 95% CI: 2.5,12.3, p-value <0.001). Compared to exclusive breastfeeding, mixed feeding was associated with increased odds of stunting (OR =2, 95% CI: 1.1-3.9, p-value =0.029) and underweight (OR = 2.2, 95% CI: 1.002, 5.0; p = 0.049). None of the variables were significantly associated with wasting.Conclusions:The prevalence rates of stunting, wasting and undernutrition among children under five years in Jordan are low. Low birth weight and mixed feeding were associated with higher rates of malnutrition.

62-69

Authors: Camille Jung, Laurence Beck, Thierry Hanh, Marc Bellaiche

Background:Functional gastrointestinal disorders (FGID) are very common during infancy, leading to frequent medical consultations. The aim of this large, prospective study was to assess the quality of life (QoL) and clinical management of infants with FGID.Methods: Completely or partially bottle-fed infants under 5 months old, presenting one or more FGID (regurgitation, constipation, diarrhea, crying/fussing), were enrolled during initial consultation by 111 pediatricians in private practice throughout France and reassessed at one month. Parents were asked to complete the QUALIN QoL questionnaire at inclusion and at Day 15. Results:A total of 815 infants (mean age 2.1±1.2 months) were evaluable. Mean QoL score improved from +27.2±15.1 at inclusion to +38.0±12.9 at day 15 (p<0.0001) irrespective of FGID symptoms. Multivariate analysis indicated that younger age, dietary advice, and partial breastfeeding were associated with better QoL outcome. Gastrointestinal symptoms showed significant regression at Day 30. The number of bottle feeds followed by external reflux episodes decreased from 80.0±27.4% to 36.1±31.4% at Day 30 (p<0.0001), the weekly number of stools increasing from 3.9±4.0 to 8.0±3.7 (p<0.0001). Conclusion: Medical management based on information, reassurance, lifestyle advice and dietary intervention improved QoL in infants with FGID and led to a reduction in FGID symptoms

80-89

Authors: Firas S. Azzeh

Background: The World Health Organization (WHO) recommends optimal feeding practices during infancy and early childhood for better health and growth of children. Objective: To determine the factors affecting exclusive breastfeeding (EBF) duration and the time of introducing complementary feeding (CF) in Mecca City, Saudi Arabia.Methods: This cross-sectional study recruited 814 Saudi mothers. All mothers filled out a closed questionnaire on family sociodemographics, health status of mothers and infants, and postpartum breastfeeding habits and patterns. The patterns of CF and bottle-feeding were examined, and binary logistic regression was performed.Results: The mean ± standard deviation EBF duration was 4.6 ± 2.5 months. The EBF rate showed a sharp decrease from 50.6% at birth to 14.4% at 6 months among children. Employment of mothers, weight at childbirth <2.5 kg, weight of 2.6–3 kg at child birth, postnatal disease in infants, and pacifier use for infants were associated with a low EBF rate. Intermediate education of the mother was found to increase EBF duration as compared to mothers with higher levels of education. Most mothers introduced plant-based CFs to infants at 4 months of age (median), but animal-based CFs were introduced only after 8 months (median). The median age of starting milk formula was 3 months. Conclusion and Recommendation: The reported rate of EBF is far below the current international recommendations. The patterns of CF practices and bottle-feeding differ widely from the WHO recommendations in Mecca City. National campaigns should be implemented to promote EBF in Saudi Arabia

16-33

Authors: Jocelyn E. Finlay, Melanie K. Norton, Iván Mejía- Guevara

Introduction:Contributing to the Sustainable Development Goals, Global Goals, Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030, we clarify the interaction between maternal age, parity and birth intervals to examine the effects on child health. Methods:We use Demographic and Health Survey data from 33 sub-Saharan African countries, and apply multivariate Poisson and logistic models to first examine the effect of maternal age (15-17, 18-19, 20-24, 25-29, 30-39) on infant mortality and stunting, then modify this relationship by parity and account for the confounding effects of short birth intervals. Results:We find that poor infant mortality outcomes of children born to teen mothers are driven by higher parity children, not first-born children. While first-born children of teen mothers are at a high risk of stunting, they are likely to survive. Short birth intervals have a negative effect on infant survival and stunting outcomes. But controlling for short birth intervals does not completely offset the effect of young age at birth on child survival outcomes. Discussion:High parity children of young mothers are at a high risk of infant mortality, driven in part – but not completely – by short birth intervals. Policies aimed at delaying first birth are warranted, but should not overshadow the need to support adolescent mothers at risk of multiple births that are tightly spaced.

43-53

Authors: Aysen Akay, Emre Yanikkerem

Background:The aim of the population-based study was to determine prenatal, obstetric, neonatal outcomes and contraceptive behaviors in women with four or more pregnancies. Methods:This study was conducted with women (n=294) using a questionnaire in two family centers of Manisa, Turkey where the fertility rate was high. Results:In the study, the mean number of pregnancies was 5.6±1.5. Loving children, willing to have a larger family and to have a male child were determined the main reasons of extreme fertility. Although 93.2% of women did not desire to have children in the future, only 43.3% of them used a birth control method. The rates of gestational diabetes, hypertension, depression, physical violence, lower weight of baby, risk of miscarriage, preterm birth and cesarean section were higher in the women with more pregnancies. Conclusions:It is very important to provide women with more pregnancies who had unmet need with client-centered counseling to encourage them to use more effective methods.

135-139

Authors: Steven Smith, Kyle Morrison, Elizabeth Bransdorfer, Samuel Barthel

This study examined the qualitative motor performance characteristics of 35 preadolescent obese children (18 female, 17 male) in the Midwest of the United States. An available sample of children ages six to 13 were classified as obese based on a BMI score of 30 or greater. The Test of Gross Motor Development-2 (TGMD-2)was used to assess all subjects. This test measures the qualitative motor ability of children using two subtest categories of fundamental motor skills including locomotors (running, hopping, skipping, jumping, leaping and galloping) as well as object control skills (throwing, catching, kicking, bouncing a ball, rolling a ball and striking). All participants received a raw score, standardized score, sum of standards and gross motor quotient score. All scores were compared to national norms established by the authors of the TGMD-2. The results indicated that the group norms of the obese children were significantly below the mean scores of the national average for all measures including locomotor standard scores (M=3.80, SD=2.44, p<0.001) and object-control standard scores(M=4.43, SD=2.89, p<0.001)and the gross motor development quotient (M=64.69, SD=15.05, p<0.001).The researchers concluded that the significantly lower motor performance scores of obese children may lead this population to participate less in health enhancing movement opportunities as they grow into adolescence and adulthood. The authors noted that the TGMD-2 is designed for children ages 3-10 and has a significant ceiling effect for older children. A younger population may reveal more robust conclusions in further study. Additionally, further study is recommended to determine whether programs aimed at lowering obesity levels in children can have an impact on qualitative fundamental motor skill performance.

147-151

Authors: Sunday O. Ochigbo, Udo J. Jacob, Anthony C. Nlemadim, Olaniyo O. Kudirat

Background:Microalbuminuria and serum creatinine are markers of acute kidney injury. Birth asphyxia is responsible for 50% of all newborn deaths and acute non-oliguric kidney injury is one of such complications. This study was undertaken to determine the efficacy of serum creatinine and microalbuminuria for the detection of early renal lesion in severely asphyxiated babies in Calabar, Nigeria.Materials and Method:This prospective cross-sectional investigational study was undertaken among severely asphyxiated babies admitted into the newborn units of the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Standard method for blood collection and determination of urea, electrolytes were used. Micral-test strips were used on samples negative only for albumin after using urine dipstick. Color comparison was done with the standardized color scale on test strip container after 5 minutes.Results:Fifty term newborn babies were enrolled, their serum electrolytes, creatinine and creatinine clearance were essentially normal. Six (12%) babies had positive microalbuminuria, while 44(88%) had negative microalbuminuria with specificity and negative predictive values of 100% and 88% respectively.Conclusion:Microalbuminuria was not useful for early detection of acute renal failure in babies with severe birth asphyxia, but further studies are recommended.

95-104

Authors: Delenya Allen, Harolyn M.E. Belcher, Allen Young, Lillian Williams Gibson, Elizabeth Colantuoni, Maria Trent

Importance: While urban African American adolescents face significant health disparities associated with overweight and obesity that follow them into adulthood; there is limited data on body image, emotional well-being, and weight control behaviors in this population to design effective public health interventions.Objective: This study was designed to understand the association of weight status to adolescent weight control, body image, and emotional well-being responses, in African American high school students. Design/Setting/Participants: The study cohort consisted of 776 students, mean age 15.8 years (±1.2). Data from Guidelines for Adolescent Preventive Services (GAPS) student surveys and anthropometric studies were collected at School-Based Health Centers.Main Outcome Measures: Associations between adolescent responses on the GAPS and body mass index (BMI) status (healthy weight: 5th to less than 85th percentile, overweight: 85th to less than 95th percentile, obese: 95th percentile or greater) were estimated using logistic regression and dose- response plots.Results: There were statistically significant associations between BMI category and weight control (ranging from a mean 5.18 to 7.68 odds of obesity) and body image (3.40 to 13.26 odds of obesity) responses. Responses to weight control and body image questions exhibited a dose- response for odds of overweight and obesity. Feelings of depressed mood were associated with obesity (1.47 times the odds of obesity compared to students who did not endorse depressed mood; 95% CI, 1.01 to 2.13) but not overweight status.Conclusion and Relevance: Overweight and obese urban African American adolescents are more likely to screen positively on weight control risk behaviors and negative body image questions than their normal weight peers. The weight control and body image measures on the GAPS may provide information to identify youth in need of services and those motivated for brief school-based weight control interventions.

112-120

Authors: Olufunke B. Bolaji, Olusegun J. Adebami, Olufunmilayo V. Adebara, Joshua A. Owa

Background:Early and accurate assessment of the nutritional status of newborns is important to many clinicians because of the potential immediate and late sequelae of malnutrition.Objective:To assess the relationship between different methods of assessing the nutritional status of neonates.Methods:Subjects were consecutive, live, singleton, full term neonates delivered in the hospital. The birth weights, Ponderal index, Mid arm circumference/head circumference ratio, birth weight for gestational age using intrauterine growth charts and Clinical Assessment of Fetal Nutritional Status Score (CANSCORE) were used to determine the nutritional status in the first 24 hours of life. Results:Of 386 subjects, 172 (44.6%) were males and 214 (55.4%) females. Nutritional status assessment using various indices showed the following prevalence of malnutrition: using birth weights, 54 (14.0%) were LBW; MAC/HC ratio showed 56 (14.5%), with PI, 64(16.6%), weight for gestational age,112(29.0%) were SGA and CANSCORE showed 90(23.3%) as malnourished among the babies.MAC/HC showed a better specificity and had a more positive correlation than PI when compared to CANSCORE whilst PI showed a better sensitivity than MAC/HC when evaluated against CANSCORE.Conclusions:Prevalence of FM is high in this study. Intrauterine growth charts and CANSCORE appeared to identify more babies with FM than other methods. CANSCORE in this study has revealed the rising trend in the prevalence of FM when compared with other studies with similar methodology. Early routine assessment of the nutritional status of newborns should be carried out so as to reduce the risk of increased morbidity and mortality associated with fetal malnutrition.