International Journal of Child Health and Nutrition

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.

56-62

Authors: Justina S. Owusu, Esi K. Colecraft, Richmond N.O. Aryeetey, Joan A. Vaccaro, Fatma G. Huffman

Background:Malnutrition of children in Ghana continues during school years. There is limited information on how school meals meet nutrient recommendations in Ghana.Objectives:The aim of this study was to compare energy and nutrient content of meals served by Ghana School Feeding Programme (GSFP) and Non-Governmental School Feeding Programme (NGSFP) and adherence to nutrient recommendations.Methods:This was a cross sectional study design involving observation of school meals at two sites: GSFP and NGSFP. Average weights of a week’s meal were converted to energy and nutrient equivalence and compared with international recommendations. Differences assessed with t-tests.Results:NGSFP provided significantly higher portion size (416 ± 96 g vs. 243 ± 50 g; p=0.007), energy (776 ± 427 kcal vs. 315 ± 24 kcal; p=0.042) and fats (17± 8 vs. 6 ± 2; p=0.019) but similar micronutrient contributions to GSFP. NGSFP met energy and macronutrient recommendation set by World Food Programme; whereas, GSFP did not meet the recommendations.Conclusion and Recommendations:The NGSFP had more energy and macronutrients per serving size than the GSFP. Regulation of meals served by GSFP should be reviewed to ensure they contribute to the adequacy of children’s diets as well as meet recommendations set by World Food Programme

75-78

Authors: Adam W. Pickens, Mark E. Benden, Drew E. Schneider, Hongwei Zhao

Background:The purpose of this pilot study was to identify differences between sitting and standing time in high school students’ pre and post stand-biased desk intervention. Methods:ActivPal3™ activity monitors were affixed to 25 Bryan Collegiate High School students’ to monitor their standing time and activity levels. Data were collected at the beginning of the school year (fall) in traditional seated desks and in the spring in stand-biased desks. After attrition, 18 of the original 25 students were included in the final analysis. The physical activity data (steps) as well as standing and sitting time data provided by the monitors was used for within subject intervention analyses. Results:Descriptive statistics and a two-sided t-test were used to analyse differences between pre and post intervention sitting and standing times. Analysis indicated a significant reduction of sitting time post stand-biased desk intervention (p<0.0001) and a significant increase in standing time, post stand-biased desk intervention (p<0.0001). Analysis also revealed a non-statistically significant (p < 0.0619) average increase of 2,286 steps per school day when comparing mean steps pre-intervention (6,612) and post-intervention (8,898). Conclusions:Standing desks have the potential to reduce sedentary behavior and increase light to moderate physical activity for high school students during the school day.

10-16

Authors: Lawrence Kotlow

Physicians are often asked to diagnose and treat infants with clinical signs of gastroesophageal reflux (GER) symptoms and in extreme cases gastroesophageal reflux disease (GERD). Some infants are left to work out their pain, regurgitation and vomiting until they outgrow the symptoms while others may undergo expensive, invasive endoscopic procedures in the operating room under general anesthesia. Initial treatment is often for infants to be placed on prescription adult acid reflux medications, which have limited benefits [1]. Drugs prescribed include: H-2 blockers such as ranitidine (Zantac), a proton pump inhibitor such as omeprazole (Prilosec) or lansoprazole (Prevacid). TOTS may cause aerophagia, a condition where the infant’s latch onto the mother’s breast or bottle allows the infant to swallow excessive amounts of air into the stomach during feeding. This aerophagia may be responsible for symptoms mimicking GER or GERD [2]. When these infants are examined for symptoms of GER the differential diagnosis of tethered oral tissues (TOTS) may not be addressed [3]. Tethered oral tissues may involve ankyloglossia (tongue-tied), maxillary and /or mandibular frenum lip-ties and in some instances buccal frenum ties. These tethered oral tissues (TOTS) prevent the infant from achieving a good seal onto the breast and or bottle with the resulting ingestion of excessive amounts of air. Background: When assessing infants presenting with gastroesophageal reflux symptoms, aerophagia secondary to tethered oral tissues (tongue-ties ,Lip-ties) should be considered in the differential diagnosis since the release of these tissues may eliminate the need for invasive gastrointestinal investigations and pharmacologic treatment of gastroesophageal reflux. Patient Pool: 340 infants ranging from 1 week to 3 months were referred for the evaluation and release of lingual and maxillary lips which were interfering with infant’s ability to achieve a good seal and latch onto the mother’s breast of infant bottle .The survey the parents completed indicated that 208 or 61% of the infants had signs of gastroesophageal reflux (GER) such as; vomiting, regurgitation, inability to sleep lying supine, fussiness, crying after nursing and morning congestion. Of the 208 infants 40% (83 infants) were or had been treated for GER with pharmacologic medications such as proton pump inhibitors or H2 blockers without any resolution of the symptoms. Findings: All of the infants presenting with these signs and symptoms underwent laser revisions of the tethered attachments. Upon completion of the procedure and at a 48 hour post-surgical follow-up discussion with the parents 93% (194 infants) of the infants showed immediate improvements and were able to breastfeed successfully without signs or symptoms of GER. Survey returned at the end of two weeks post-surgery had similar results Conclusion: Infants presenting with signs of GER should also be evaluated for restrictive tethered oral tissues (TOTS) such as ankyloglossia, lip and buccal ties. If they are present, strong consideration should be given to the release of these tissues as an initial approach. This may eliminate the need for pharmacologic treatment of GER.

25-30

Authors: Divya Shakti, Veena Singh, Gertrude Nakigozi, Sarah Kiguli, Deepak Kamat

Delayed umbilical cord clamping and care practices have important implications for infant iron stores and neonatal survival. This is especially important in countries like Uganda, where there is a high prevalence of anemia in women and children coupled with a high newborn mortality rate. This study assesses cord clamping and care practices in home births in a coverage area of 12 health centers in 4 districts near Kampala, Uganda. We interviewed 147 women, most of who had at least primary school education and delivered their babies in the homes of traditional birth attendants. Only 65% of the persons conducting delivery washed hands, and most wore gloves. Most frequent cord ties were threads (86.7%), and glove rims (8.3%). Cords were cut with clean instruments in most (93.1%) deliveries. During cord clamping, newborn was positioned at a higher level than mother in 59%, delayed clamping (
3mins) was reported in 52%. Combination of delayed clamping and positioning of newborn at mother’s level or lower was reported in only 19%. Substances used for cord care included surgical spirit (42.4%), local herbs (24.5%), powder (22.6%), ash (21.6%), saline water (10.3%), and tea (2.8%). Cord care instructions given most commonly were: cleaning with warm saline water (27%), spirit or antiseptics (25%), and herb application (7%). Awareness regarding cord infections was poor (20%). Mother’s education level, and age were not associated with cord clamping or care practices. Our study indicates scope for interventions to help improve hemoglobin levels in infancy. Education regarding cord care practices may reduce infections