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The World Health Organization recommends deworming to reduce soil‐transmitted helminth (STH)‐attributable morbidity in women of reproductive age, including pregnant and lactating women, to reduce blood loss, iron deficiency anaemia and nutrient malabsorption. This study assessed the impact of maternal postpartum deworming with albendazole approximately 1 day after delivery on infant milk intake among a subset of 216 randomly selected mother–infant pairs recruited into a large trial in Peru. Infant milk intake was measured using the deuterium‐oxide method at 1‐ and 6‐month postpartum. Maternal STH infection was measured at 6‐month postpartum. At 1‐month postpartum, mean intake was 756 ± 16 and 774 ± 18 mL day−1 in the albendazole and placebo groups, respectively (mean difference: −18 mL day−1; 95% CI: −65, 30). At 6‐month postpartum, mean intake was 903 ± 16 and 908 ± 18 mL day−1 in the albendazole and placebo groups, respectively (mean difference: −5 mL day−1; 95% CI: −52, 43). There was no statistically significant difference in milk intake between groups at either time point. At 6‐month postpartum, mothers infected with Trichuris trichiura had infants with higher milk intakes (adjusted mean difference: 70 mL day−1; 95% CI: 20, 120) compared with uninfected mothers. However, there was no statistically significant difference in infant milk intake between mothers who had moderate‐and‐heavy intensity infection compared with the comparison group (mothers with no and light intensity infection). A lower prevalence and intensity of infection, and inclusion of uninfected mothers in both arms of the trial, resulting in effect dilution, may explain the null findings. [ABSTRACT FROM AUTHOR]

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Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children’s Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: “iniciativa hospital amigo da criança”, “hospital amigo da criança”, “baby friendly initiative hospital”, “aleitamento materno” and “breastfeeding”. The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the frequency of cross-breastfeeding, human milk donation to human milk banks and reception of human milk from human milk banks, and to investigate the intersection between cross-breastfeeding and breast milk donation practices. This study used data from the national household-based survey Brazilian National Survey on Child Nutrition (ENANI-2019), which collected information from 14,558 children < 5 years old between February 2019 and March 2020. The present study included data from 5,831 biological mothers who reported having breastfed their child < 2 years old at least once and replied questions about cross-breastfeeding, donation and recaption of human milk to human milk banks. Prevalence and 95% confidence intervals (95%CI) were estimated for each stratifier, considering the study complex sample design. Among mothers of children < 2 years old who breastfed their child at least once, 21.1% practiced cross-breastfeeding; breastfeeding another child was more frequent (15.6%) than allowing a child to be breastfed by another woman (11.2%). Among this population, 4.8% of women donated human milk to a human milk bank, and 3.6% reported that their children had received donated human milk. The donation of human milk is a practice recommended by the Brazilian Ministry of Health and has the potential to save thousands of newborns throughout Brazil. In contrast, cross-breastfeeding is contraindicated due to the potential risk of transmitting HIV. There is a need for a broad debate on these practices in Brazil and worldwide.

Objective: To describe the trend of participation in group and individual support by human milk banks (HMBs) provided between 2010 and 2019 in Brazil., Methods: Ecological study with data from participation in group and individual support provided by the HMBs between 2010 and 2019, available in the production report of the Brazilian Network of Human Milk Banks. The number of participation in group and individual support was expressed for Brazil and for Brazilian macroregions in absolute numbers. Trend analysis was performed from the analysis of index numbers, considering the year 2010 as a reference. It was calculated the ratio of the number of participation in group and individual support by HMBs for each macroregion and year., Results: There was an increase of 42% in participation in group support (300,595 in 2010 vs 425,570 in 2019) and an increase of 69% in individual support (1,157,038 in 2010 vs 1,962,162 in 2019). The North and Northeast macroregions had the highest growth rates in the provision of these services (122 and 131%, respectively), above the national growth rate in the study period. In contrast, the Midwest region showed a downward trend throughout this period, for both types of support. However, in the Midwest, there was a higher ratio of participation in groups by HMBs between 2010 and 2016 and for individual support by HMBs between 2010 and 2012., Conclusion: Individual and group support provided by the HMB as a strategy to support breastfeeding increased considerably in Brazil during the study period, especially in the North and Northeast regions., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

The aim of this study was to verify the presence of glyphosate in breast milk and to characterize maternal environmental exposure. Sixty-seven milk samples were collected from lactating women in the city of Francisco Beltrão, Paraná, living in urban (n=26) and rural (n=41) areas, at the peak of glyphosate application in corn and soy crops in the region (April and May 2018). To characterize the study population, socio-epidemiological data of the women were collected. To determine glyphosate levels, a commercial enzyme immunosorbent assay kit was used. Glyphosate was detected in all breast milk samples analyzed with a mean value of 1.45 µg/L. Despite some descriptive differences, there were no statistically significant differences (P<0.05) between the categories of the variables tested. Also, glyphosate was detected in drinking water samples from the urban area and in artesian well water from the rural area of the region where the studied population lived. The estimation of the total amount of glyphosate ingested by breastfeeding babies in a period of 6 months was significant. These results suggest that the studied lactating population was contaminated with glyphosate, possibly through continued environmental exposure.

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Background: The mothers of very low birth weight infants face many challenges to achieve breastfeeding at hospital discharge, especially during long stays., Research Aim: The aim of this study was to describe the incidence and factors associated with breastfeeding rates (exclusive or with formula) at discharge, for very low birth weight infants, in a private Neonatal Intensive Care Unit in southern Brazil., Methods: We conducted a prospective longitudinal cohort study of infants ( N = 335) with very low birth weight and/or less than 30 weeks gestational age, who survived to discharge and had no contraindication to mother's own milk. Participants were initially divided into three groups (exclusive breastfeeding, some breastfeeding, and no breastfeeding) based on their feedings at discharge; however, later, two groups were analyzed (any breastfeeding, no breastfeeding)., Results: Most (93.4%; n = 313) were breastfeeding directly at least once daily at discharge, of which 16.1% ( n = 54) were receiving exclusive mother's milk and 77.3% ( n = 259) mixed feeding (mother's milk and formula). Breastfeeding at discharge was associated with gestational age ≥ 28 weeks, higher birth weight, not developing neonatal sepsis or bronchopulmonary dysplasia during the hospital stay, shorter lengths of stay, and lower weight at discharge. After Poisson regression, breastfeeding at discharge was associated only with a shorter length of stay (RR 0.98; CI 95% [0.95, 0.99], p < .05)., Conclusions: In our single unit experience in Brazil, most infants were breastfeeding at discharge. NICU staff might address mothers of infants who have prolonged hospitalization with specific strategies. Mothers and infants at risk can be identified early and personalized interventions can be developed for improving breastfeeding rates at discharge.

This article aims to investigate the relationship between intimate partner physical violence (IPPV) and breastfeeding (BF), use of breastmilk substitutes (BMS) and bottle-feeding among children aged 12 to 15 months. This is a cross-sectional study with mothers in primary care facilities of the city of Rio de Janeiro. IPPV was identified by the Brazilian version of the Conflict Tactics Scales 1-Form R and feeding practices were identified by a 24-hour Dietary Recall. Associations were verified by logistic regression with odds ratio (OR) estimates and 95% confidence intervals. BF was offered to 58.5% of the children and BMS to 88.5%. Also, 70.5% of the children used a baby bottle. Physical violence was observed in 26.7% of couples. Households where couples physically abuse each other are more likely to not breastfeed (OR=2.14, p-value=0.030), to use breastmilk substitutes (OR=5.15, p-value=0.03) and bottle-feed (OR=2.71; p-value=0.01), when compared to households without physical violence. The results highlight the need to investigate intrafamily relationships in cases where inadequate breastfeeding practices are identified, and to enable health professionals to support families in conflict situations.

Background: Aiming to protect breastfeeding, the World Health Organization released the International Code of Marketing of Breastmilk Substitutes in 1981, which was adopted by the vast majority of the 118 member countries, including Brazil. The Brazilian Code regulates the marketing of infant formulas, baby bottles, teats, pacifiers, milk, and processed complementary food., Research Aims: (1) To determine if retail stores had violated the Brazilian Code and (2) to analyze factors associated with these violations., Methods: This cross-sectional study included all drugstores, supermarkets, and department stores in the Southern Zone of Rio de Janeiro City, Brazil. Trained health professionals observed retail stores for marketed products and violations of the Brazilian Code and then interviewed their managers. Factors associated with the retail stores violating the Brazilian Code (outcome) were analyzed, employing a logistic regression model with 95% Confidence Interval., Results: Of the retail stores ( N = 349) evaluated, 62.8% violated the Brazilian Code, ranging from 1 to 37 violations per retail store. The most common promotion strategies were price discounts and special displays. Retail stores being part of a chain store (aOR = 4.59) and their manager receiving visits from industry business representatives (aOR = 2.14) were associated with the presence of violations., Conclusions: The prevalence of Brazilian Code violations was high, especially in chain stores. The association between regular visits by industry representatives and violations suggests an indirect influence of manufacturers on the promotion of human milk substitutes. We recommend strengthening compliance with the Brazilian Code through calling on governmental surveillance agencies and civil society mobilization.

Aimed at strengthening breastfeeding policies, human milk banks (HMBs) play an important role in promoting, protecting and supporting this practice. The objective of this study was to undertake a systematic review to identify activities developed by HMBs that demonstrate their role in promoting maternal and infant health. Searches for relevant articles were performed in the following databases: PubMed, Virtual Health Library (BVS), and BVS Breastfeeding linked to the portal of the Brazilian Human Milk Bank Network. Eleven articles were included in the final sample. The main topics covered by the articles were: the characteristics of breast milk donors; the importance of information provided by HMB professionals on maintaining breastfeeding for hospitalized premature infants; weight gain in premature babies fed on donated milk; HMB breastfeeding support actions; and factors influencing human milk donation. The actions developed by HMBs have a positive impact on the promotion of maternal and infant health, representing an important strategy for promoting breastfeeding and supporting the feeding of babies who are not able to feed directly at the breast.

Objective: To analyze the actions of the Human Milk Banks coordination to favor the continuity of breastfeeding in the COVID-19 pandemic., Methods: Descriptive study, of qualitative approach, with theoretical-methodological reference of Pierre Bourdieu. Data collection was done through interviews between March and April, with five coordinations and results organized by thematic analysis., Results: Two categories were produced: the actions of strategies for the maintenance of Human Milk Banks services by digital means as a way to ensure social distancing and breastfeeding in times of pandemic of the new coronavirus; and the actions of promotion, protection and support in strategies for maintenance of breastfeeding during the pandemic., Final Considerations: The benefits of breastfeeding outweigh any potential risks of transmission of the new coronavirus. The importance of systematic nursing practices in the quality and safety of the process of Protection, Promotion and Support of Breastfeeding is evident.

This study evaluated the nutritional status of lactating women with regard to vitamins A and E and the relationship between dietary intake and concentrations in serum and milk. A longitudinal study was conducted with 43 women at a hospital in northeastern Brazil. Blood and milk samples and food intake recalls were obtained at three moments during the breastfeeding period. Retinol and alpha-tocopherol were analysed by high-performance liquid chromatography. Dietary inadequacy was analysed according to the estimated average requirement, with intrapersonal variation adjusted by the multiple source method. Food intake was classified by quartiles of consumption. Serum retinol was 1.65 μmol/L, with 5% of low concentrations (<0.7 μmol/L) at the first collection. Serum alpha-tocopherol decreased from 30.18 to 25.49 μmol/L at the third collection (P = 0.008), with an increase in the percentage frequency of deficiency (<12 μmol/L). Both vitamins maintained stable concentrations in milk at the different collection times, and the overall dietary inadequacy of vitamins A and E was 58% and 100%, respectively. There was a correlation only between vitamin A intake and serum retinol (r = 0.403, P = 0.007), and higher retinol concentrations were found in women classified in the highest consumption quartile (P = 0.031). Over the course of lactation, there was a high degree of inadequacy in vitamin intake and a reduction in serum alpha-tocopherol, whereas its concentrations in milk remained unchanged. Dietary intake of vitamin A has been shown to influence serum retinol, which underscores the importance of adequate nutrition and monitoring of vitamin deficiency during lactation., (© 2018 John Wiley & Sons Ltd.)

In early twentieth-century Brazil the proponents of human milk banking considered this development to signal the end of wet nursing and the start of a whole new day, one altogether better for the paid donors of human milk, their children, and the children in need of human milk. But wet nursing persisted alongside the new human milk banks for most of the twentieth century. Moreover, as this paper argues, the organizers and directors of milk banks drew on and constructed ideas about wet nursing, and about the generations of poor Afro-Brazilian women who had performed this labor, in the design and operation of the first milk banks.

Brazil imported more enslaved Africans than any other slave-owning society in the Americas, and it was the last country in the western hemisphere to abolish the institution. Whereas many enslaved persons toiled on plantations and in mines, urban slavery was also prominent, with enslaved men carrying coffee through the streets and enslaved women washing clothes. One gendered aspect of urban slavery in 19th-century Brazil included slave owners renting out enslaved women as wet nurses to breastfeed the children of elite families. This article reviews medical dissertations, debates, and journal articles, as well as advertisements for wet nurses, showing that physicians believed that enslaved women's milk was both nutritionally and morally inferior to white women's milk. In the latter half of the 19th century, physicians viewed abolition as the only answer to what they deemed the increasingly "dangerous" practice of enslaved wet nursing, which they believed was the root cause of high infant mortality rates across races and classes. Readers should consider the ethical dilemmas of the practice of enslaved wet nursing, which often resulted in the violent separation of mother and child.

Anemia is a public health problem that affects about 30% of Brazilian women, which may cause deleterious effects on the health and quality of life of mother and child. This article seeks to evaluate the healthcare and gestational factors associated with anemia among mothers receiving care at a human milk bank (HMB) of reference. It is a cross-sectional study with secondary data about sociodemographic and pregnancy information on 12283 nursing mothers from 2009 to 2012. The Kolmogorov-Smirnov and chi-square or Fisher's exact tests were applied. The prevalence ratios (PR) and their 95% confidence intervals were estimated by Poisson regression with robust variance. Anemia was identified in 29.2% of the sample and the prevalence was higher among mothers who did not have prenatal appointments (PR = 3.84; 95% CI 3.26 to 4.54); those who made 3 or less antenatal visits (PR = 1.92; 95% CI 1.21 to 3.06) and those who have had multiple pregnancies (OR = 2.29, 95% CI 1.25 to 4.19). The results showed a higher prevalence of anemia among women who did not have the appropriate prenatal care and who have had multiple pregnancies, highlighting the importance of healthcare as a factor in the prevention of anemia and other complications during pregnancy.

Objective: The aim of the present study was to investigate the influence of enteral feeding management on occurrences of necrotizing enterocolitis (NEC) in very-low-birth-weight (VLBW) infants., Methods: This was a case-control study conducted in a sample of 1028 VLBW infants (750 to 1499 g) admitted to a neonatal intensive care unit between January 2003 and May 2008. "Cases" were infants born with VLBW and diagnosed with NEC within the first 30 days of life, and "controls" were VLBW infants who did not develop NEC during this period. Occurrences of NEC were defined using the modified Bell criteria (stage ≥2)., Results: Among the 1028 VLBW infants, 55 (5.4%) developed NEC within the first month of life. Logistic regression analysis showed that breast milk given exclusively for <7 days (odds ratio [OR] = 4.02), never achieving full enteral feeding during the first month (OR = 3.50), and parenteral nutrition (OR = 2.70) were factors that increased the chances of NEC occurrence. The use of vasoactive drugs was associated with a lower risk of NEC (OR = 0.15)., Conclusions: Breast milk should be recommended as a priority for the enteral nutrition of VLBW infants for no <7 days. Enteral nutrition should start early and progress quickly to achieve full enteral feeding; these procedures may help reduce the occurrence of NEC.

Objectives: To longitudinally assess bone mineral content (BMC), bone mineral density (BMD), and whole-body lean mass obtained through bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns (PTNs) and compare them with full-term newborns (FTNs) from birth to 6 months of corrected postnatal age., Methods: A total of 28 adequate for gestational age (AGA) newborns were studied: 14 preterm and 14 full-term newborns. DXA was used to determine BMC, BMD, and lean mass in three moments: 40 weeks corrected post-conceptual age, as well as 3 and 6 months of corrected postnatal age. PTNs had gestational age ≤ 32 weeks at birth and were fed their mother's own milk or milk from the human milk bank., Results: All infants had an increase in BMC, BMD, and lean body mass values during the study. PTNs had lower BMC, BMD, and lean mass at 40 weeks of corrected post-conceptual age in relation to FTNs (p<0.001, p<0.001, p=0.047, respectively). However, there was an acceleration in the mineralization process of PTNs, which was sufficient to achieve the normal values of FTNs at 6 months of corrected age., Conclusions: This study suggests that bone densitometry by dual-energy X-ray absorptiometry is a good method for the assessment of body composition parameters at baseline, and at the follow-up of these PTNs., (Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To review the conceptual relationship between telehealth and translational research., Methods: Bibliographical search on telehealth was conducted in the Scopus, Cochrane BVS, LILACS and MEDLINE databases to find experiences of telehealth in conjunction with discussion of translational research in health. The search retrieved eight studies based on analysis of models of the five stages of translational research and the multiple strands of public health policy in the context of telehealth in Brazil. The models were applied to telehealth activities concerning the Network of Human Milk Banks, in the Telemedicine University Network., Results: The translational research cycle of human milk collected, stored and distributed presents several integrated telehealth initiatives, such as video conferencing, and software and portals for synthesizing knowledge, composing elements of an information ecosystem, mediated by information and communication technologies in the health system., Conclusions: Telehealth should be composed of a set of activities in a computer mediated network promoting the translation of knowledge between research and health services.

Objective: to assess the intake, frequency, and type of milk consumed by Brazilian children younger than 60 months of age., Methods: this was a cross-sectional study, which used secondary data from the National Demographic and Health Survey of 2006-2007. Data from 4,817 children under the age of 60 months were used. All analyses were performed with expanded samples. The dietetic survey assessed the previous day's consumption, and estimates were made through univariate analysis, presented as a percentage., Results: on the day prior to the survey, breast milk was consumed by 91% of the children younger than six months of age, by 61.5% of the children aged 6 to 12 months, and by 34.8% of the children aged 13 to 24 months. Among the children who had received other types of milk, cow's milk was consumed by 62.4% of the children younger than six months, by 74.6% of the children aged 6 to 12 months, and by approximately 80% of the children older than 12 months. Infant formulas were consumed by 23% of the children younger than six months of age, by 9.8% of the children aged 6 to 12 months, and by less than 1% of the older children. Soy milk consumption varied from 14.6% to 20% among the investigated ages. Non-breast milk consumption before the age of six months was more frequent in children living in the Northeastern and Southern regions., Conclusion: the results of the present study demonstrated that most children received cow's milk prematurely as a substitute for breast milk, highlighting the importance of the development of public policies to promote, protect, and support breastfeeding in all regions of Brazil, aiming at reversing the observed scenario., (Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: (a) To compare breast milk and complementary food intake between breast-fed infants from high and low socio-economic status (SES) aged 8 months of age; (b) To compare these intakes with PAHO/WHO recommendations., Methods: Cross-sectional, community-based study in Pelotas, Brazil. Breast milk and complementary food intake were compared between 8-month-old infants from high (n=35) and low SES (n=30). Breast milk intake was measured using the 'dose-to-the mother' deuterium-oxide turnover method; complementary food intake was assessed using a questionnaire and by 24 hours food weighing., Results: Energy intake from breast milk (51.1 ± 26.4 kcal/kg/d) was not different between social groups, being in line with current recommendations. However, energy intake from complementary foods (34.5 ± 22.7 kcal/kg/d) and from milk, including breast milk, cow's milk and formula (60.1 ± 19.6 kcal/kg/d), were significantly higher than recommendations. Total energy intake was 20% higher than recommended (93.3 ± 24.4 versus 77.3 kcal/kg/day, p<0.001). This was mainly due to a high intake of complementary foods and addition of cow's milk to breast milk. Introduction of complementary foods before 6 months was common. In the high SES group, more infants consumed vegetables (p=0.005) and fruit (p=0.020), whereas fats and sugar tended to be consumed less frequently (p=0.05 and p=0.17, respectively)., Conclusions: Feeding habits deviate from PAHO/WHO recommendations, especially for infants of lower SES. Of main concern are the high-energy intake and early introduction of cow's milk and complementary foods. This may be important in view of metabolic programming and the development of obesity and associated diseases later in life.

The article explores the theme of wet-nurses using photographs and theses of medical doctors during the second half of the 19th century. The doctors at that time condemned the indiscriminate use of wet-nurses and tried to encourage construction of the 'new mother' image, one who ought to breast feed her own children. They approached the complexity of the feeding subject (by mother, wet-nurse, animal or object) at that time and the problems arising from it for the parties involved: the white baby, the black baby, the wet-nurse, the mother of the white baby, the seignorial family involved and medical doctors. Photos are highlighted of wet-nurses with children in an attitude that was intended to be 'positive' to demonstrate harmony and affection and, apparently, contradicting the debates regarding them.

Objective: This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients' use of both homemade preparations and manufactured products before seeking specialized care., Materials and Methods: We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital., Results: The sample included 561 subjects, 51.3% males and 48.7% females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5% reported self-medicating; 29.4% used a homemade preparation (13.9% referred to an industrialized product like boric acid as a homemade preparation), and 11.1% used a manufactured product. The most frequently used products included a boric acid solution (53.3%), a normal saline solution (35.7%), herbal infusions (6.1%) and breast milk (4.8%). Viral conjunctivitis was the most frequent diagnosis (24.4%), followed by the presence of a corneal foreign body (7.4%). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition., Conclusion: Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

The objective of this article is to describe growth of very low birth weight infants born in southern Brazil. All infants weighing < or =1500 g were followed up until 12 months corrected age (CA). Growth was recorded at 40 weeks, 6 and 12 months CA. Catch up was considered if the measures were > or =-2 SD of World Health Organization growth charts for weight and length; and of National Center for Health Statistics for head circumference. One hundred and ninety three infants born were followed up for the study. At 40 weeks CA, 57.8% patients achieved catch-up in weight and 50.9% in length. At 6 months CA, 82.2% achieved catch-up for weight and length and at 1 year CA, 92% achieved catch-up in weight and 86.9% in length. Catch-up in head circumference was achieved for 93.4%, 85.9% and 85% patients at 40 weeks, 6 months and 12 months CA, respectively. At 12 months CA, no catch-up in weight, length and head circumference was related to higher SNAPPE-II (P = 0.046) and periventricular leukomalacia (PVL) (P = 0.003); longer time to achieve full enteral nutrition at the neonatal intensive care unit (NICU) (P = 0.037), lower maternal education (P = 0.018) and PVL (P = 0,003); higher SNAPPE-II (P = 0,004), PVL (P = 0.005) and longer time to achieve full enteral nutrition at the NICU (P = 0.044), respectively. In conclusion, PVL and higher SNAPPE-II were important factors to catch-up delay. Catch-up growth was high at 12 months CA.

This study aimed to identify factors associated with exclusive breastfeeding (AME) and the reasons mothers presented to introduce complementary feeding in the first four months of life. A total of 380 mothers (92.2%) of children under four months old vaccinated in a Multi-vaccination Campaign were interviewed. To identify factors associated to AME, univariate and multiple logistic regressions analyses were performed. Thirty-eight percent of the children were on AME; 33.4% consumed cow milk; 29.2% tea; and 22.4% water. The mothers justified introduction of cow milk by factors related to quantity/quality of maternal milk and "necessity" of the child. The use of a pacifier (odds ratio=2.63; CI95%=1.7-4.06) and difficulty to breastfeed (odds ratio=1.57; CI95%=1.02-2.41) were associated with the absence of AME. The populational attributable risk percentage for the use of a pacifier was estimated at 46.8 %. Thus, modifiable risk factors were associated with AME interruption.

The objective of this paper is to present and discuss Brazilian policy concerning actions to protect breastfeeding, especially the history, international and national background, limitations, and perspectives of the Brazilian Guidelines for the Marketing of Baby Food, Pacifiers and Bottles. The Brazilian Guidelines, which play a crucial role in protecting breastfeeding against industry marketing strategies, were based on the International Code of Marketing of Breastmilk Substitutes, proposed by the World Health Organization in 1981. The first version of the Brazilian Guidelines was released in 1988, and there were subsequent revisions in 1992 and 2001/2002. In 2006, the Guidelines became national law. However, the strides made over this period in terms of regulation have been few because the law is not always observed. Thus, it is essential that all actors involved, including government officials, manufacturers and sellers of baby food and other baby products, teaching and health professionals and their associations, international bodies, and non-governmental organizations make a commitment to enforce the current law.

Objective: To investigate the practice of breastfeeding and related difficulties in children born in Porto Alegre, Brazil, with cleft lip, cleft palate, and cleft lip with cleft palate., Design: Cohort, observational, and population-based study., Population and Sample: Mothers of all children born in 2001 and 2002 with cleft lip and palate in the city of Porto Alegre, Brazil (n = 31), were interviewed in their homes. From the information collected, the frequencies of breastfeeding and exclusive breastfeeding in the first year of life were estimated and the median duration was computed according to the type of cleft. A descriptive analysis was used to study the difficulties. MAIN INDICATORS: Initiation rate, pattern, duration, and difficulties of breastfeeding and exclusive breastfeeding., Results: The initiation rate of breastfeeding was 100% and its median duration was 42.5 days. Exclusive breastfeeding was initiated by 67.7% of the sample and maintained for 15 days (median). The breastfeeding duration was significantly higher in the presence of cleft lip, being equal or even superior to (in the case of exclusive breastfeeding) the median of Porto Alegre's general population. The most frequently mentioned difficulties were weak suction, difficulty attaching to the breast, and breast milk escaping through the nostrils., Conclusions: In spite of the diverse difficulties reported and the lack of professional support after discharge from the maternity wards, the initiation rate and the duration of breastfeeding of children with cleft lip and palate found in this study reinforce the theory that this malformation, especially cleft lip, is compatible with successful breastfeeding.

Objective: To test the hypothesis that breast-feeding is a protective factor against IDDM and that early exposure to cow's milk is a risk factor for the disease., Research Design and Methods: A case-control study was conducted in São Paulo, Brazil. A total of 346 diabetic children, aged < 18 years, were identified in two institutions in the city of São Paulo. Duration of exclusive breast-feeding and age of introduction to cow's milk products in infant diet were compared with 346 sex-, age-, and neighborhood-matched control children. All comparisons between diabetic and control children were done using paired tests., Results: Statistically significant differences were found for the duration of exclusive breast-feeding (P = 0.007) and for the age of introduction to cow's milk products (P = 0.047). Control children had a longer time of exclusive breast-feeding and had received cow's milk later in their diet than the case children., Conclusions: The results suggest that a shorter duration of exclusive breast-feeding is a risk factor for IDDM (odds ratio [OR] 2.13; 95% CI 1.8-3.55) and that the introduction to cow's milk products before age 8 days is a risk factor for the disease.

We studied the types of food, time of introduction, frequency and nutrient intake among 133 infants during the 1st year of life. A 24-hour dietary recall indicated that 42 different types of food, including mothers' milk, were offered directly or in suitable preparations. Breast- and mixed-fed infants were likely to receive more milk feedings than non-breast-fed infants. Sugar and liquids such as tea, fruit juices and soft drinks were introduced at a very early age. The breast-fed babies were offered only teas before the 3rd month. Solid food was offered as early as at 4 months, regardless of breast or bottle feeding. Fe and vitamin A were estimated to be below the recommended dietary allowance in the group that was not receiving breast milk.

The association between infant feeding habits and infant mortality from diarrhea was investigated in a population-based case-control study in two urban areas in southern Brazil during 1985. Each of 170 infants who died due to diarrhea was compared with two neighborhood controls. After allowance was made for confounding variables, infants who received powdered milk or cow's milk, in addition to breast milk, were at 4.2 times (95% confidence interval (CI) 1.7-10.1) the risk of death from diarrhea compared with infants who did not receive artificial milk, while the risk for infants who did not receive any breast milk was 14.2 times higher (95% CI 5.9-34.1). Similar results were obtained when infants who died from diarrhea were compared with infants who died from diseases that were presumed to be due to noninfectious causes. Each additional daily breast feed reduced the risk of diarrhea death by 20% (95% CI 2-34%), but the increase in risk associated with each bottle feed was not significant after allowance was made for the number of breast feeds. The only other consumption variable associated with diarrhea mortality was the frequency with which tea, water, or juice were drunk with each feed (increase in risk, 42% (95% CI 4-93%]. The odds ratios associated with nonbreast milk were highest in the first two months of life. Possible biases were investigated, including the interruption of breast-feeding as an early consequence of the terminal illness, but the strong protective effect of breast-feeding persisted after these adjustments.

Feeding practices related to osmotic strength of bottle-milk and breast-milk were studied in 133 families with infants less than 1 year of age in a poor urban settlement in Brasilia, Brazil. Osmolality [mean (SEM)] of breast-milk [318.8 (4.46) mOsm/kg water] was significantly less than that of bottle-milk [568.7 (29.9) mOsm/kg water]. The wide range of osmotic strength (253.7-1,380.0 mOsm/kg water) found in bottle-milk was partly due to the predominant use (82%) of powdered cow's milk among non-breastfeeders and its improper reconstitution. Diarrhoea and feeding management are also discussed.

A study was carried out to evaluate the effects of a human milk and cows' milk regime on plasma tocopherols and hematological status of 176 Brazilian infants from birth to 12 months of age. Plasma total tocopherols and the ratio of tocopherols/total lipids were significantly higher (p less than 0.01) for breast-fed infants than for cows' milk-fed infants at all ages. Hydrogen peroxide-stimulated erythrocyte hemolysis was greater for cows' milk-fed infants than breast-fed infants; the difference was statistically significant (p less than 0.01) at 3, 6, and 9 months of age. Among the hematological indices examined, Hb levels were significantly higher (p less than 0.01) for the breast-fed infants at 3 and 12 months, while the reticulocyte counts were significantly higher for the cows' milk-fed infants at all ages; hematocrit values more or less remained similar for both groups. It is concluded from these results that although a human milk regime is ideal as compared to a cow's milk regime for maintaining adequate vitamin E status during the 1st year of early life, there may be other influencing factors besides vitamin E to explain such differences in the hematological indices of the breast-fed and cows' milk fed-Brazilian infants.

The Yanomama Indians of northern Brazil and southern Venezuela have been identified as a "no-salt" culture. In this study, data were obtained to determine in this population the adjustments of sodium-related hormones to the stresses imposed upon sodium balance by pregnancy and prolonged lactation. Controls against the possibility that findings in the Yanomama were ethnic rather than dietary were provided by similar observations in the Guaymi Indians of Panama, who have free access to salt. Urinary concentrations of sodium were approximately 1 mEq/l in male and female Yanomama, with 24-hour excretion rates in the males averaging 1 mEq, similar to our prior observation. The pregnant Yanomama had exceeding high urinary concentrations of aldosterone. These were associated with higher plasma renin activities and serum aldosterone concentrations than in all other subjects. Although pregnant Guaymi had elevations of serum and urinary aldosterone, these were significantly lower (p < 0.001) than those of the Yanomama. Prolonged lactation in the Yanomama was associated with elevation of plasma renin activity and serum and urinary aldosterone concentration compared with the Guaymi, but were not higher than those in nonlactating Yanomama females. The findings suggest that pregnancy in a salt-poor environment is associated with an exaggerated augmentation of hormonal responses that enhance positive sodium balance.

One hundred and thirty-three children from birth to 1 year of age were studied to investigate the value of breast milk as a solution to the infant nutrition problem. Fifteen per cent of the children were being fed exclusively breast milk, 44 (44.4%) were fed breast milk plus cow's milk and 40.6% were fed only cow's milk. Thirty-three per cent of the breast fed children, 44.4% of those on mixed feeding and 47% of those on cow's milk alone, were malnourished.