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Introduction: Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. Methods: A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. Results: Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. Conclusion: The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings. [ABSTRACT FROM AUTHOR]

Background: Controversy remains regarding optimal management of Pierre Robin sequence (PRS). The goal of this study was to compare airway and feeding outcomes in infants with PRS who underwent surgical intervention, specifically mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA), or who had conservative management (CM) without surgery. Methods: All consecutive patients treated for PRS at a pediatric academic medical center, with at least one year follow-up, were included. Patients who underwent tracheostomy as an index procedure were excluded. Patients were divided into those who underwent MDO, TLA or CM. Feeding status and data from initial and follow-up polysomnograms were collected. Comparisons between groups were made using the Kruskal-Wallis test, followed by Mann-Whitney pairwise comparison with a Bonferroni correction, when appropriate. Results: 67 neonates were included. 19 underwent TLA, 29 underwent MDO and 19 underwent CM. The proportions of syndromic patients were similar between groups. Patients undergoing CM had the lowest baseline AHI (9.1), but there were no significant differences between TLA (20.1) and MDO (25.4). At follow-up, the three groups had similar mean AHI (MDO 1.3, TLA 4.2, CM 4.5). A similar proportion of patients achieved AHI 5 or less (TLA 89.5%, MDO 96.6%, CM 84.2%). At one year, there were no significant differences in weight percentiles or in risk of failure-to-thrive between groups. One patient from the TLA group required a tracheostomy. Conclusion: The three treatment modalities achieved high airway and feeding success rates. All three modalities should have a place in the armamentarium of the craniofacial surgeon. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the prevalence and determinants of dietary supplement use in Saudi infants and toddlers. A cross-sectional sample of 156 Saudi infants and toddlers and their mothers who reside in Saudi Arabia was recruited via an online survey that was distributed on multiple social media platforms. Data collected include sociodemographic, maternal height and weight, feeding practices, types, initiation, and frequency of supplements use in infants and toddlers. Sixty-three percent of the infants and toddlers included in this study were using dietary supplements. Over three-quarters of the breastfed infants and toddlers were on dietary supplements. All infants and toddlers who were taking dietary supplements used vitamin D; yet, the use of multivitamins and minerals, iron, and vitamin C supplements was not frequently reported. The use of supplements was significantly higher among infants and toddlers who were the only children in the family and had younger and unemployed mothers. Interventions that target increasing maternal awareness concerning the importance of supplement use among young children in Saudi Arabia are needed. [ABSTRACT FROM AUTHOR]

Context: In 2018, Government of India initiated Home-Based Care for Young Child (HBYC) program having five quarterly structured home visits for children age 3 to 15 months to promote early childhood development. Assess knowledge and practices of Accredited Social Health Activist (ASHAs), other health functionaries, and mothers related to HBYC. Cross-sectional evaluation design with ASHAs, AWWs, ANMs, ASHA, and mothers of 3 to 15 month's children as participants. Material and Methods: Knowledge and practices of 801 ASHAs, 200 other health functionaries, and 787 mothers were assessed on exclusive breastfeeding, complementary feeding, hand washing, iron folic acid (IFA) and oral rehydration solution (ORS) supplementation, danger referral signs in eight aspirational districts of Madhya Pradesh. Results: 88% ASHAs had correct knowledge on ORS, 85% on complementary feeding, 85% on adequacy of IFA, and 47% on danger signs which required child referral. Similarly, 85% of mothers had knowledge on exclusive breastfeeding, 40% mothers knew about complementary feeding, and only 18% knew correct ORS preparation. Statistically significant association was observed between ASHAs home visits and availability of ORS with mothers and their knowledge on correct Initiation of IFA (p < 0.001). Conclusion: Findings of study confirmed majority of health functionaries were aware about roles, responsibilities, and key tasks under HBYC. However, there observed a gap in knowledge transfer by health functionaries and thus inadequate translation of knowledge into practices among mothers on HBYC. This necessitates the need of appropriate actions from health system strengthening to capacity building to accelerate uptake of HBYC program. [ABSTRACT FROM AUTHOR]

Nutritional support for acute respiratory distress syndrome (ARDS) patients shares metabolic notions common to other critically ill conditions. Nevertheless, it generates specific concern regarding the primary limitation of oxygen supply and the complications of carbon dioxide elimination, as well as the significant metabolic alterations due to the body's response to illness. In the present narrative review, after briefly summarizing the pathophysiology of critical illness stress response and patients' metabolic requirements, we focus on describing the characteristics of metabolic and artificial nutrition in patients with acute respiratory failure. In patients with ARDS, several aspects of metabolism assume special importance. The physiological effects of substrate metabolism are described for this setting, particularly regarding energy consumption, diet-induced thermogenesis, and the price of their clearance, transformation, and storage. Moreover, we review the possible direct effects of macronutrients on lung tissue viability during ARDS. Finally, we summarize the noteworthy characteristics of metabolic control in critically ill patients with ARDS and offer a suggestion as to the ideal methods of metabolic support for this problem. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS) protocols after colorectal surgery focused on reduced bowel preparation, standardized feeding schedule, earlier return of bowel function, and earlier resumption of normal activities. ERAS in pediatric surgical practice is not well established. The present study aims to present the results of two colonic anastomosis techniques of interrupted single-layered closure: Halsted (Horizontal Mattress) and Matheson (serosubmucosal or appositional extramucosal) along with two different methods of colostomy wound closure and their influence on the adoption of ERAS protocol of early feeding and early discharge. Materials and Methods: This single institute-based randomized control study was conducted in a tertiary care facility in Kolkata for 2.4 years. Patients were chosen randomly for serosubmucosal (Group I) and full-thickness (Group II) anastomosis. Results: Among total of 91 patients (Group I-43 and Group II-48), Return of bowel sounds and passage of bowel averaged 1.51 ± 0.51 and 1.91 ± 0.55 days in Group I and 1.91 ± 0.57 and 3.9 ± 0.66 days in Group II, respectively. Postoperative hospital stay averaged 5.88 ± 1.12 days in Group I and 8.9 ± 1.17 days in Group II. Overall 15 (16.48%) patients had complications among which SSI (Suprficial surgical site infection) and minor leaks (Group I--3 and 1 and Group II--5 and 3, respectively) which were treated conservatively (Clavien--Dindo Grade-I) and three major leaks under Group II requiring surgical intervention (Clavien--Dindo Grade-III). Conclusion: This study concludes that the technique of colostomy closure in the form serosubmucosal closure helps in the implementation of ERAS protocol by producing early bowel movement, early initiation of food, and less postoperative complications. [ABSTRACT FROM AUTHOR]

The in vitro feeding of ticks facilitates the conduction of studies involving the intrinsic vector-pathogen relationship, susceptibility tests, and resistance to acaricides, in addition to mimicking the use of experimental hosts. The objective of this study was to establish an in vitro feeding system using silicone membranes to supply various diets to the species Ornithodoros rostratus. Each experimental group included 130 first-instar O. rostratus nymphs. The groups were divided according to the diet provided: citrated rabbit blood, citrated bovine blood, bovine blood with antibiotics, and defibrinated bovine blood. The control group was fed directly on rabbits. Ticks were weighed before and after the feeding and monitored individually according to their biological parameters. The results of the experiment demonstrated that the proposed system was efficient in terms of fixation stimulus and satisfactory in terms of tick engorgement, which would allow the maintenance of O. rostratus colonies by using artificial feeding through silicone membranes. All diets provided were efficient for the maintenance of colonies, but the ticks that received citrated rabbit blood displayed similar biological parameters to those observed under in vivo feeding conditions. [ABSTRACT FROM AUTHOR]

Objective Cue-based feeding aims at matching introduction of per oral (PO) feeding with physiological readiness of preterm infants to facilitate PO intake and avoid oral aversion. It was claimed that cue-based feeding may lead to delay in the initiation or achieving full PO feeding in clinical setting primarily using bubble nasal continuous positive airway pressure (CPAP). The study aimed to examine the association of cue-based feeding with time of introduction and completing oral feeding in infants primarily managed with bubble CPAP. Study Design A retrospective analysis where outcomes of preterm infants ≤32 weeks' gestational age (GA) and ≤2,000 g birth weight (BW) were compared after a practice change from volume-based feeding advancement to cue-based feeding. Continuous variables were compared by using t -test and multilinear regression analysis to control for confounding variables. Results Of the 311 preterm infants who met inclusion and exclusion criteria, 194 were in the cue-based feeding group and 117 were in the volume-based advancement historical comparison group. There were no differences between groups regarding demographic or clinical variables. Postmenstrual age (PMA) of initial feeding assessment was less in the cue-based feeding group. Age of first PO feeding and when some PO was achieved every feed was mildly delayed in the cue-based feeding compared with comparison group, 34 (±1.3) versus 33.7 (±1.2) weeks, and 36.2 (±2.3) versus 36.0 (±2.4) weeks, (p < 0.01) respectively. However, the age of achieving full PO did not differ between groups, 36.8 (±2.2) versus 36.4 (±2.4) weeks (p = 0.13). There was no difference between groups regarding growth parameters at 36 weeks' PMA or at discharge. Similar results were obtained when examining subcategories of infants ≤1,000 g and 1,001 to 2,000 g. Conclusion Cue-based feeding may not be associated with a delay in achieving full oral feeding or prolongation of the length of stay in preterm infants managed with CPAP. Key Points Cue-based feeding matches introduction of PO feeding with physiological readiness. Cue-based feeding may not be associated with a delay in achieving full oral feeding in preterm infants. Cue-based feeding is not associated with prolongation of the length of stay in preterm infants. Cue based feeding in preterm infants managed with noninvasive bubble CPAP is examined. [ABSTRACT FROM AUTHOR]

Objective The study aimed to assess in a prospective randomized study the effect of Mozart's music on time to regain birth weight (BW) and development of oral feeding skills in babies born between 28 0/7 and 31 6/7 weeks of gestation. Study Design Healthy premature infants born between 28 0/7 and 31 6/7 completed weeks of gestation were randomized within 3 days of birth to either music or no music exposure. Infants in the music group were exposed to Mozart's double piano sonata twice per day for 14 days. The primary outcome was time to regain birth weight. The secondary outcome was development of oral feeding skills as evaluated by a speech/language pathologist blinded to the intervention. We hypothesized that exposure to Mozart's double piano sonata would decrease time to regain BW and improve feeding skills. A total of 32 newborns were needed to detect a 3-day difference in time to regain BW. Results Forty infants were enrolled and randomized. There were no significant differences between the two groups regarding the time to regain BW (p = 0.181) and the time to achievement of full oral feeds (p = 0.809). Conclusion Exposure to Mozart's double piano sonata for 14 days after birth did not significantly improve time to regain BW or time to achieve full oral feedings in very premature infants. It is possible that Mozart's music has no effect or that the duration of music exposure was not sufficient to have a physiologic effect on growth and oral feeding skills. Key Points Classical music improves the medical condition of adults. Music decreases neonatal resting energy expenditure. Music exposure did not significantly impact weight gain. This clinical relevance warrants further evaluation. [ABSTRACT FROM AUTHOR]

Background: The number of children infected with novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has increased during the outbreak of the Omicron strain. Hyperferritinemia has been reported in severe cases of COVID-19, and in children or neonates with multisystem inflammatory syndrome (MIS). Hyperferritinemia is considered to be one of the signs of MIS, but thus far, there have been few summarized reports on it. We retrospectively analyzed four infants less than 3 months of age with SARS-CoV-2 infections treated in our institution during the outbreak of the Omicron strain. Results: most patients were in good condition, but hyperferritinemia was observed in all of four cases. Conclusions: Hyperferritinemia can be observed in infantile COVID-19 patients even with mild symptoms. It is necessary to carefully monitor their clinical course and monitor the patients. [ABSTRACT FROM AUTHOR]

Madagascar is one of the poorest countries and has an alarming prevalence of food insecurity and child undernutrition. Most of the Malagasy population live from agricultural activities making livestock a livelihood asset and a source of animal-source foods, especially for smallholder farmers. This study aimed to examine the association between livestock ownership, household food security, and children's dietary diversity in a rural region of Madagascar. Data from a cross-sectional survey of 344 respondents were used to assess the association between household tropical livestock units (TLU) per capita, Household Food Insecurity Access Scale (HFIAS) scores, and dietary diversity scores (DDSs) among children aged 6–23 months. The estimation results from the ordered probit model showed that household TLU per capita is negatively associated with HFIAS scores and positively associated with DDSs among children. Additionally, households with mothers who received information on childcare and nutrition from health facilities and community nutrition agents were more likely to be food secure and have better dietary diversity. Therefore, promoting livestock ownership and strengthening nutrition-sensitive messages focusing on the benefits of raising livestock to mothers from rural Madagascar will likely be effective in improving household food security and nutrition for children. [ABSTRACT FROM AUTHOR]

The complementary feeding introduction period (introduction of solid foods alongside breastmilk or formula) is defining in children's health; however, it appears that many parents do not follow complementary feeding guidelines. Our aim was to describe current parental feeding practices during complementary feeding in relation to current recommendations and explore determinants of adherence to guidelines. We included any relevant studies published within the last decade in French or English and summarized findings by recommendation category. The timing of complementary food introduction varied widely across and within continents (earlier in North America and often delayed in Asia). The introduction of allergenic foods tended to be delayed globally. Although some parents now begin complementary feeding with solid foods (i.e., baby-led weaning), delayed introduction of lumpy textures was still prevalent in the United States and in Europe. The consumption of iron-rich foods was predominantly low in Africa. Added sugars were globally introduced early, especially in America. Evidence for the prevalence of responsive feeding practices among parents is unclear due to the small number of studies. Determinants of complementary feeding practices included parental characteristics, such as age, education, socio-economic status, and race/ethnicity. Interventions aiming to increase adherence to complementary feeding guidelines must account for parental characteristics. [ABSTRACT FROM AUTHOR]

The perception of human T-cell leukemia virus type 1 (HTlV-1) infection as a "silent disease" has recently given way to concern that its presence may be having a variety of effects. HTLV-1 is known to cause adult T-cell leukemia (ATL), an aggressive cancer of peripheral CD4 T cells; however, it is also responsible for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Most patients develop ATL as a result of HTLV-1 mother-to-child transmission. The primary route of mother-to-child transmission is through the mother's milk. In the absence of effective drug therapy, total artificial nutrition such as exclusive formula feeding is a reliable means of preventing mother-to-child transmission after birth, except for a small percentage of prenatal infections. A recent study found that the rate of mother-to-child transmission with short-term breastfeeding (within 90 days) did not exceed that of total artificial nutrition. Because these preventive measures are in exchange for the benefits of breastfeeding, clinical applications of antiretroviral drugs and immunotherapy with vaccines and neutralizing antibodies are urgently needed. [ABSTRACT FROM AUTHOR]

Background: Parental feeding practices (PFPs) have been implicated in the development of children's eating behaviours. However, evidence suggests that feeding practices may also develop in response to their child's weight or emerging appetitive traits. We used the twin design to test the hypothesis that parents develop their feeding practices partly in response to their child's appetite. Methods: Data were from Gemini, a population-based cohort of 2402 British families with twins born in 2007. Psychometric measures of PFPs and appetite were completed by parents when their twins were 16-months and 5-years. Within-family analyses including all twins with available data in the sample (n = 1010–1858 pairs), examined if within-pair differences in PFPs were associated with differences in appetitive traits, controlling for differences in birth weight-SDS, early feeding method and child sex. In a subsample of twin pairs who were considerably discordant for appetitive traits by ≥ 1SD (n = 122–544 pairs), the direction and magnitude of within-pair differences in feeding practices was explored. Results: Within-family variation in parental feeding practices in toddlerhood and early childhood was low (discordance ranged from 0.1 to 6% of the sample), except for pressure to eat (toddlerhood: 19%; early childhood: 32%). Within-pair differences in all appetitive traits were associated with differential use of 'pressure to eat' at both 16-months and 5-years. In the subsample of twins most discordant for appetitive traits, parents used more pressure with the twin expressing lower food responsiveness, lower emotional overeating, lower food enjoyment, higher satiety responsiveness, slower speed of eating, higher emotional undereating and greater fussiness in toddlerhood and early childhood (p-values < 0.001). Effect sizes were small to large at 16-months (η2=0.02–0.09) and 5-years (η2=0.05–0.21). Conclusion: Parents rarely varied their feeding practices between twins in toddlerhood and early childhood, except for pressure. Parents exerted greater pressure on their twin who expressed a poorer appetite compared to their co-twin, suggesting that parents develop a pressuring feeding style when their child expresses a poorer appetite or lower interest in, and enthusiasm for, eating. These findings could be used to guide interventions seeking to support parents in feeding their children in a way that nurtures the development of healthy eating behaviours. [ABSTRACT FROM AUTHOR]

Pikeperch is a valuable object of fisheries around the world. Accordingly, the cultivation of this species under controlled conditions is a promising direction of aquaculture development. However, the technology of its cultivation needs improvement, as there are currently certain difficulties, especially at the early stages of ontogenesis, when a transition to artificial nutrition occurs and high mortality rates are observed. Therefore, we carried out a study the results of which suggest that natural spawning allows obtaining high-quality fish seeds. Weight of pikeperch during one growing season reaches 50 g that facilitates wintering and contributes to high rates of yield from it. The experiment was carried out on age-4--6 females and age-3-5 males, selected according to their outer appearance. The average individual body weight of the females was 2.4 kg and such of males was 2.0 kg. At the same time, females were characterized by a more slender body and a higher body weight than the males, but these differences were insignificant. According to the results of work with the brood fish, 810.7 kg of juvenile pikeperch were harvested from spawning ponds. They were characterized by the average body weight ranging 2.41 g to 2.50 g and the Fulton's condition factor measuring 3.5. The industrial fecundity of females based on the output of 3-week-old fry amounted to the average of 43.5 thousand ind. per female. According to the test catches, the highest body weight was observed in young-of-the-years, grown at the stocking density of 2.5 thousand ind./m2 (second experimental group). They also had the highest rate of daily weight gain, exceeding such in the other experimental groups, 18.2% in the first and 2.7% in the second, with the stocking densities of 1.5 thousand ind./m² and 2.0 thousand ind./m², respectively. In general, the dynamics of daily weigh gain in all experimental groups was progressing, measuring 0.05-0.10 g in the first 50 days of cultivation and 0.20-1.04 in the following days (from the middle to the end of the experiment). The absolute and relative weight gains confirm the obtained results. In particular, the minimum values of the absolute weight gain of pikeperch were recorded in the first half of the experiment. However, the relative increase did not have a clear trend in the experimental groups. In the first experimental group, a clear peak (32.5-39.0%) of the weigh gain was observed on days 67-85 of cultivation with a decline (29.1-15.3%) starting from day 99 until the end of the growing season. At the same time, similar growth peaks were not recorded in the second and third experimental groups. By contrast, there was a decline on day 67, increasing to 30% on day 71, and further having a tendency to decrease until the end of the season. The highest individual weight and absolute weigh gain were recorded in the second and third experimental groups, where the maximum fish productivity was achieved from 1 m2, being 61.2 and 78.8 kg, respectively. At the same time, the survival rate, which is important for aquaculture conditions, was lower in these two groups than such in the first experimental group, 1.6% and 1.4%, respectively. Thus, the results of our study can help in ensuring the availability of high-quality pikeperch seeds, which in turn would be positive for both the consumer market of fish products and the state of native fish populations. [ABSTRACT FROM AUTHOR]

Nutrition experts point to the importance of a multipronged approach to address high stunting rates in rural areas. This can include nutrition-specific and -sensitive interventions, such as the provision of micronutrient powder, eggs, and chlorine, and nutrition training to improve feeding practices. In 2018, an agricultural nongovernmental organisation initiated a multipronged approach as part of a randomised trial. However, adherence to a programme with so many components can be challenging for participants. The aim of this study is to understand which factors are associated with high adherence in complex multifaceted nutrition- sensitive agricultural programmes. We used a mixed method approach in which we used bivariate and multivariable analyses to estimate the relationship between child and caregiver demographic factors with product adherence. We analyzed data from six focus groups and 120 feedback sessions on barriers to product adherence. We found that the age and sex of the child did not influence product adherence, but caregivers were more likely to adhere to all products if they were not the child's biological mother (most often grandmothers) (0.28 higher adherence score; p < 0.001) and if caregivers were older (0.34 higher adherence score, p < 0.001). A higher monthly training attendance, combining product distribution and interactive training, predicted stronger product adherence. Participants noted that adherence was supported by the early demonstration of positive results, regular reminders, interactive trainings, and the encouragement of family members. These findings underscore the importance of combining product distribution with training and include potentially targeting grandmothers and other caregivers who may demonstrate higher product adherence. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine academic preparation in pediatric swallowing and feeding, specifically, how speech-language pathology graduate programs were addressing pediatric swallowing and feeding, both academically and clinically, prior to guideline changes and modifications in 2020 due to updates and the global health pandemic. Method: To gain a rounded image of speech-language pathology academic programs, two different methodological approaches were utilized. First, courses from 272 accredited programs were analyzed. Second, survey results from 100 participants were analyzed to investigate clinical clock hours and experiences received during participation in a graduate speech-language pathology academic program. Results: Less than 1% (0.4%) of academic courses analyzed were categorized as pediatric swallowing and feeding. Greater than 90% of participants reported receiving 20 hr or less in pediatric dysphagia, assessment, or treatment. Sixty percent of participants reported not feeling well prepared at all to provide pediatric swallowing and feeding services. Conclusions: There are a growing number of children requiring swallowing and feeding services, a trend that looks to continue its rise. Pediatric dysphagia is a complex area requiring unique knowledge and skills. Academic programs have a responsibility to their students, and the individuals requiring speech-language pathology services, to provide experiences that allow for knowledge and skill development across the entire scope of practice and life span. [ABSTRACT FROM AUTHOR]

To date, the feeding and oral-motor abilities of patients with CHARGE syndrome (CS) have not been longitudinally assessed. This study aims to investigate the level of these abilities at different ages and evaluate how they evolve during growth. We retrospectively analysed oral-motor features of 16 patients with molecularly confirmed CS (age range 4–21 years old; mean 11 years; SD 6 years; median 10 years). Nearly 100% of CS new-borns had weak sucking at birth, and half of them demonstrated poor coordination between breathing and swallowing. Over time, the percentages of children with tube feeding dependence (60% at birth) faced a slow but steady decrease (from 33% at 6 months, 25% at 12 months, to 13% at school age) in tandem with the decreasing risk of aspiration. The ability of eating foods requiring chewing was achieved at school age, after the acquisition of an adequate oral sensory processing. A mature chewing pattern with a variety of food textures was not achieved by more than half of patients, including those requiring artificial enteral nutrition. Most patients started prolonged oral-motor treatments with speech language therapists in early childhood. Conclusions: Although feeding and swallowing disorders are constant features in CS patients, a slow and gradual development of feeding abilities occurs in most cases. Rehabilitation plays a key role in overcoming structural and functional difficulties and attaining appropriate eating skills. What is Known: • Feeding problems and swallowing dysfunction have been noted in CHARGE syndrome. • The involvement of multiple factors, including structural problems in the mouth, throat, or esophagus, and neurological impairment, make feeding a complicated task in CHARGE individuals. What is New: • Dysphagia gradually improves in most CHARGE children over time, though with a wide interindividual variability. • The percentages of children with tube feeding dependence decrease over time from 60% at birth to 33% at 6 months and 13% at school age. [ABSTRACT FROM AUTHOR]

PURPOSE: To assess the performance of premature infant oral motor intervention for transition from gavage to full spoon feeding in preterm infants. METHODS: Preterm neonates born between 28 + 0–32 + 6 weeks gestation (n = 32) were randomised into an intervention group (premature infant oral motor intervention) for five minutes twice a day along with routine care (n = 16) and a control group (routine care, n = 16) once they reached a feed volume of at least 150 ml/kg/day administered by gavage method. The primary outcome measure was time (in days) to transition from gavage to full spoon feeds. RESULTS: The mean (SD) time to transition from gavage to full spoon feeds was attained significantly earlier in the intervention group than the control group (9.93 [5.83] vs 16.43 [10.46] days; mean difference, -6.5 days; 95% CI, -12.58 to -0.41). There was no significant difference between the two groups in terms of the duration of hospital stay, rates of physiological stability, and culture positive sepsis. CONCLUSION: Premature infant oral motor intervention, as used in this specific population, significantly reduces the time to transition to full spoon feeds without increasing culture positive sepsis and physiological instability. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the effect of breastfeeding on children's growth indices. Materials and Methods: Longitudinal data of children's growth (height, weight, and head circumference) were as a dependent variable and type of nutrition as an independent variable with using multivariate t linear mixed model. Results: The indicated that the height, weight, and head circumference of infants who were fed with breast milk showed a statistically significant difference (P < 0.05) with those of infants receiving formula. Conclusion: Exclusive feeding with breast milk, especially in the first 6 months of life, has a significant impact on the child's growth indicators compared to formula or, or a combination of both. [ABSTRACT FROM AUTHOR]

Artificial feeding is a widely used management tool, but it often attracts nontarget species, including birds, to permanent feeding sites. This study used camera traps to monitor the presence of birds at selected sites used for bear management in Dinaric forest. A large number of bird species (35) were recorded, representing roughly half of all species breeding in the surrounding area. These species were grouped based on monthly and hourly presence, and corresponded to food groups, with most belonging to granivores or scavengers. Some species, such as Pigeons (Columba sp.), Raven (Corvus corax) and Buzzard (Buteo buteo), adapted their presence to the availability of food at the feeding sites, while others were not affected by this. Both Chaffinches (Fringilla coelebs) and Jays (Garrulus glandarius) frequented the feeding sites, but their temporal presence was influenced by their biology rather than by food availability. The Sparrowhawk (Accipiter nisus) also adapted its presence to food availability, and its presence was closely associated with that of the Jay. This study confirms the temporal differences in the use of feeding sites by birds and mammals, which is likely due to their different biology and past management. This can be used to make wildlife management more efficient and reduce the undesirable effects of artificial feeding. [ABSTRACT FROM AUTHOR]

Honeybee drones are known to only have a reproductive function. In the current study, the drone'sactivities as affected by feeding with pollen substitutes were studied during two successive years 2020/2021 and 2021/2022. The effect of seven pollen substitutes patties on broad rearing and body weight (larvae and adult) as well as fertility (semen volume and sperm count) of Apis mellifera droneswas studied. Changes in these activities across months and seasonsof the two years of study observed. During the autumn and summer the bee drones showed highly broad rearingboth years. Whereas, during September the honeybee colonies were found to be more active in consumingall used patties than other months in both years. Finally, regarding the drone's fertility, the patty contained glycerol was the best one for all fertility parameters, semen volume was 1.28 mL, sperm count/ mL was 2.77 (x109)and sperm count/ one drone was 3.10 (x106)which confirm our hypothesis that the artificial feeding with pollen substitute may affect the drone's activities. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 57-year-old male with esophageal cancer who developed a self-knotted feeding jejunostomy tube. The patient presented with abdominal pain and a blockage in the feeding tube. An abdominal x-ray confirmed the knotting and kinking of the tube, which was safely removed without complications. The article also highlights the potential complications associated with feeding tubes and suggests preventive measures such as using broad bore tubes and proper lubricant, adjusting the placement process, and confirming the position with radiography. [Extracted from the article]

The article features the National Coalition for Infant Health (NCfIH), a collaborative of more than 200 professional, clinical, community health, and family support organizations focused on improving the lives of premature infants through age two and their families. Topics discussed include the mission of NCfIH, stand of the NCfIH on the nutritional needs of preterm infants, and importance of transparent and thorough communication between healthcare providers and families according to the NCfIH.

To evaluate the effectiveness of a nutrition education intervention (NEI) on caregivers' nutritional knowledge and child feeding practices. The Theory of Planned Behavior (TPB) constructs guided the development of the NEI modules. In each module we addressed both attitudes, subjective norms and self-efficacy of the caregivers in relation to proper complementary feeding practices. Additionally, various health literacy principles were employed to accommodate the low health literacy of the participants. Caregivers of children aged 6 to 59 months residing in Turkana County, Kenya. This was a two-month long quasi-experimental design with three time points. In total 246 child-caregivers' pairs were recruited for the study. The intervention group (IG) received 30-60 minutes daily NEI sessions, there were four modules in total covering breastfeeding practices, complementary feeding practices, and hygiene practices. The last module was a recap of all the previous modules. The control group (CG) did not receive any intervention. Knowledge was assessed using a validated questionnaire. Children's dietary intake was assessed using a 24-hour dietary recall. Linear mixed effects models were used to assess the effect of the intervention. Majority of the caregivers were illiterate (83.3%) and were young adults (29.4%). The mean age of children at baseline was 32.11 months. At the end of follow-up, the IG had a significant improvement in nutritional knowledge (CG: 7.5 vs IG: 9.7, P = 0.016), children's dietary diversity (CG: 1.8 vs IG: 3.7, P < 0.001), and children's meal frequency (CG: 2.1 vs IG: 3.4, P = 0.003). After adjusting for both child and caregivers 'characteristics, the significant improvement in both nutritional knowledge, children's dietary diversity scores and meal frequency among IG compared to CG persisted. Results of this study suggest that employing health literacy principles and providing sufficient dosage when conducting NEI among low literacy principles is effective in improving caregivers' child feeding practices. Breedlove Food Inc [ABSTRACT FROM AUTHOR]

Food access and nutrition education programs are delivered across settings, yet, the feasibility and overall implementation of these programs through clinical-community partnerships are understudied. To examine the feasibility and implementation of a pilot distance-based education program to promote food access and food parenting practices among low-income parents and caregivers of young children (3-8 years old). A non-controlled pilot study was conducted. Pediatricians and nutrition educators recruited food-insecure parents and caregivers visiting an urban pediatric primary care clinic. Parents participated in an 8-week distance-based intervention consisting of educational videos and telephonic motivational interviewing sessions in English or Spanish. Implementation outcomes including fidelity (dose), appropriateness, and acceptability were measured post-intervention. Appropriateness and acceptability were rated by participants using a five-point scale. Program outcomes including food assistance program participation and food parenting behaviors were measured at baseline and post-intervention (8 weeks). Descriptive statistics were used to characterize the study sample, implementation outcomes, and changes in food assistance program participation. Participants (n=27) were predominantly women (96%), who identified as Latino (74%), without a college degree (100%). Twenty-five participants (93%) were retained throughout the study, with two lost to follow-up. Two of the participants (8%) received the intervention in Spanish. Eighty-four percent of parents were already participating in a food access program at baseline, compared to 88% at completion of the intervention (post). Parents completed 68% of the educational videos, and received 24 minutes of motivational interview sessions, on average. On a scale of 1 to 5, parents rated intervention appropriateness as 4.5, and acceptability as 4.8, on average. Distance-based food access and nutrition education programs, by way of clinical-community partnerships, may be a feasible way to promote food access among parents and caregivers of young children. Supplemental Nutrition Assistance Program – Education, Rhode Island Foundation [ABSTRACT FROM AUTHOR]

Many US preschoolers receive two-thirds of their dietary requirements while at Family Child Care Homes (FCCH) that are critical settings to offer fruits and vegetables, but less is known if these are served fresh or processed, which may include excess added sugar and sodium. This study explored the fruit and vegetable preparation styles, across one day in FCCHs catering to young children (aged 2 to 5 years). This descriptive study examined baseline measures of a virtual intervention study, delivered during the COVID-19 pandemic (2020). Sixty-three licensed FCCH providers across rural Oklahoma, participating in the Child and Adult Care Food Program were included. One day's meal photographs and detailed recipes for breakfast, lunch, and snack were collected. Fruit and vegetable preparation style by meal was calculated in SPSS. FCCH providers were 100% women, 43.1 ± 10.2 years old. For breakfast, canned fruits or vegetables was served 2.5 times greater than that of frozen fruits or vegetables (4.4% frozen and 11.1% canned) and canned fruits were served 6 times greater than that of fresh (73.3% fresh vs. 11.1% canned), and 6.8% served fruit juice. For lunch, approximately, half of the providers served fresh or frozen vegetables for lunch (35.6% fresh and 15.6% frozen), while more than one-third (44.4%) served canned vegetables, 0.0% dried vegetables, and 4.4% fruit juice. For snack, 11.1% served fresh and 0% frozen, canned, or dried vegetables; and 37.8% served fresh, 2.2% frozen, 13.3% canned, and 4.4% dried fruits and 13.3 % served fruit juice. Since canned foods are served more than that of the frozen foods and high in sodium, reducing the use of canned fruits and vegetables and promoting fresh and frozen equivalents is important to improve the nutrient quality of foods served in FCCHs. Future research can explore strategies to promote healthier preparation styles, such as fresh or frozen foods, over canned options. USDA [ABSTRACT FROM AUTHOR]

Background: Instilling healthy dietary habits and active play in early childhood is an important public health focus. Interventions supporting the establishment of nutrition and active play behaviours in the first years of life have shown positive outcomes and long-term cost-effectiveness, however, most are research trials, with limited evidence regarding real-world application. Implementation science theories, models and frameworks (TMFs) can guide the process of research translation from trial to real-world intervention. The application of TMFs within nutrition and active play intervention studies in early childhood (< 5 years) is currently unknown. This systematic review identified the use of TMFs and barriers/ enablers associated with intervention adoption, implementation, and sustainability in early childhood nutrition and active play interventions implemented under real-world conditions. Methods: Six databases were searched for peer-reviewed publications between 2000–2021. Studies were included if primary outcomes reported improvement in diet, physical activity or sedentary behaviours amongst children aged < 5 years and interventions were delivered under real-world conditions within a community and/or healthcare setting. Two reviewers extracted and evaluated studies, cross checked by a third and verified by all authors. Quality assessment of included studies was completed by two authors using the Mixed Methods Appraisal Tool (MMAT). Results: Eleven studies comprising eleven unique interventions were included. Studies represented low, middle and high-income countries, and were conducted across a range of settings. Five TMFs were identified representing four of Nilsen's implementation model categories, predominantly 'evaluation models'. Ninety-nine barriers/facilitators were extracted across the three intervention phases—Implementation (n = 33 barriers; 33 facilitators), Sustainability (n = 19 barriers; n = 9 facilitators), Adoption (n = 2 barriers; n = 3 facilitators). Identified barriers/facilitators were mapped to the five domains of the Durlak and DuPre framework, with 'funding', 'compatibility' and 'integration of new programming' common across the three intervention phases. Conclusions: Findings demonstrate that there is no systematic application of TMFs in the planning, implementation and/or evaluation of early childhood nutrition and active play interventions in real-world settings, and selective and sporadic application of TMFs occurs across the intervention lifespan. This apparent limited uptake of TMFs is a missed opportunity to enhance real-world implementation success. Trial registration: PROSPERO (CRD42021243841). [ABSTRACT FROM AUTHOR]

Despite an increasing appreciation of the importance of host–microbe interaction in healthy growth, information on gut microbiota changes of the Chinese giant salamander (Andrias davidianus) during growth is still lacking. Moreover, it is interesting to identify gut microbial structure for further monitoring A. davidianus health. This study explored the composition and functional characteristics of gut bacteria in different growth periods, including tadpole stage (ADT), gills internalization stage (ADG), 1 year age (ADY), 2 year age (ADE), and 3 year age (ADS), using high-throughput sequencing. The results showed that significant differences were observed in microbial community composition and abundance among different growth groups. The diversity and abundance of intestinal flora gradually reduced from larvae to adult stages. Overall, the gut microbial communities were mainly composed of Fusobacteriota, Firmicutes, Bacteroidota, and Proteobacteria. More specifically, the Cetobacterium genus was the most dominant, followed by Lactobacillus and Candidatus Amphibiichlamydia. Interestingly, Candidatus Amphibiichlamydia, a special species related to amphibian diseases, could be a promising indicator for healthy monitoring during A. davidianus growth. These results could be an important reference for future research on the relationship between the host and microbiota and also provide basic data for the artificial feeding of A. davidianus. [ABSTRACT FROM AUTHOR]

Purpose: To determine the stability of appetitive traits during infancy and their association with early life exposures. Methods: Participants were from the BiTwin birth cohort (longitudinal study of Portuguese infants). Appetitive traits at 3 months were measured using the Baby Eating Behaviour Questionnaire (n = 347) and at 12 months with the Children's Eating Behaviour Questionnaire for toddlers (n = 325). Stability was assessed with multi-level models. The association of early life exposures (weight for gestational age, mode of feeding, prematurity, smoking during pregnancy, maternal pre-pregnancy BMI, gestational weight gain, and diabetes mellitus diagnosis) with infant appetitive traits was estimated by multivariable linear regression models. Results: Appetite traits showed limited stability (ICCs: 0.25–0.34). Associations with early life exposures varied by age. At 3 months, infants of mothers with higher pre-pregnancy BMI and excessive gestational weight gain had low Satiety Responsiveness. In contrast, infants small for gestational age scored high in this trait (β̂ = 0.241; 95% CI 0.056–0.425). Exclusively formula-fed infants presented weak food approach traits at this age, namely low Enjoyment of Food (β̂ = − 0.145; 95% CI − 0.270 to − 0.019) and Food Responsiveness (β̂ = − 0.415; 95% CI − 0.618 to − 0.212). At 12 months, infants who were small for gestational age had low Food Responsiveness (β̂ = − 0.297; 95% CI − 0.523 to − 0.072), in contrast, infants of mothers who gained excessive gestational weight had high scores in this trait. Formula feeding was related to rapid eating (Slowness in Eating: β̂ = − 0.252; 95% CI 0.451 to − 0.054). Conclusion: Early life exposures may play a role in the development of infants' appetitive traits, which then change during the first year of life. Interventions focussed on maternal and infant health may have the potential to shape appetite in infancy. [ABSTRACT FROM AUTHOR]

This study aimed to investigate hypoalbuminemia-related factors in patients with stroke in the neurocritical care unit (NCU) and to establish a nomogram model for hypoalbuminemia prediction. Data from 902 patients hospitalized for stroke in the NCU who had normal albumin levels on admission from March 2018 to December 2020 were analyzed. Logistic regression was used to identify the risk factors associated with hypoalbuminemia. A novel nomogram prediction model for hypoalbuminemia was constructed, and it was validated in an independent set (n = 233). The nomogram incorporated seven risk factors, including age, high comorbidity, mechanical ventilation, feeding routes, total protein, high-sensitivity C-reactive protein, and fibrinogen levels, and its area under the curve for predicting hypoalbuminemia in the developmental set and validation set were 0.856 and 0.870, respectively. The novel nomogram facilitates risk prediction of hypoalbuminemia among patients with stroke in the NCU, which might be useful for selecting treatment strategies and management. [ABSTRACT FROM AUTHOR]

To precisely meet the nutritional requirements of sows during the stages of pregnancy and lactation, a precision feeding system was developed by using the intelligent sow feeder combined with a rule-based expert system and the Internet of Things (IoTs). The model of uncertain knowledge representation was established for inference by using the certainty factor. The daily feeding amount of each sow was calculated by the expert system. An improved pattern matching algorithm Reused Degree Model-RETE (RDM-RETE) was proposed for the decision of daily feeding amount, which sped up inference by optimizing the RETE network topology. A prediction model of daily feeding amount was established by a rule-based expert system and the precision feeding was achieved by an accurate control technology of variable volume. The experimental results demonstrated that the HASH-RDM-RETE algorithm could effectively reduce the network complexity and improve the inference efficiency. The feeding amount decided by the expert system was a logarithmic model, which was consistent with the feeding law of lactating sows. The inferential feeding amount was adopted as the predicted feed intake and the coefficient of correlation between predicted feed intake and actual feed intake was greater than or equal to 0.99. Each sow was fed at different feeding intervals and different feed amounts for each meal in a day. The feed intake was 26.84% higher than that of artificial feeding during lactation days (p<0.05). The piglets weaned per sow per year (PSY) can be increased by 1.51 compared with that of relatively high levels in domestic pig farms. This system is stable in feeding and lowers the breeding cost that can be applied in precision feeding in swine production. [ABSTRACT FROM AUTHOR]

The family environment, which involves parent eating behaviors and feeding practices, influences child intake and eating behaviors. Specifically, parental emotional eating or emotional feeding practices may lead to emotional eating in the child. Mindful eating practices may decrease emotional eating behaviors. The purpose of this narrative review was to investigate the influence of parental mindful eating on emotional eating behaviors of their children or adolescents. A secondary purpose of this review was to determine whether a family-based or child mindful eating intervention improves child emotional eating directly or through the improvements of the parent and parental role modeling. EBSCOhost was used to simultaneously search 5 databases. The search was limited to full-text, peer-reviewed articles in the English language. Seven studies, 4 cross-sectional studies and 3 intervention studies, were identified. Across studies, measures of mindful and emotional eating differed. Among the cross-sectional studies, parental mindful eating/feeding or mindful parenting were either directly or indirectly related to decreased emotional eating in the child or adolescent. The effect was unclear among the intervention studies; however, these were pilot feasibility studies. Overall, parental mindful eating is associated with emotional eating behaviors among children and adolescents. Additional studies with a randomized controlled design are needed to evaluate parent mindful eating interventions on child and adolescent eating behaviors. Additionally, future trials need to use similar validated measures to ensure consistent quality data collection and allow for comparison of findings across studies. [Display omitted] Seven studies, 4 cross-sectional and 3 intervention studies, were included in the narrative review. Among the cross-sectional studies, parental mindful eating/feeding/parenting skills were either directly or indirectly related to decreased emotional eating in the child or adolescent. The effect was unclear among the intervention studies; however, these were pilot feasibility studies. Overall, parental mindful eating is associated with decreased emotional eating behaviors among children and adolescents. [ABSTRACT FROM AUTHOR]

Abandoning undesired newborn infants was a Roman form of family limitation. They were exposed or given to foster mothers. Christianization alleviated their lot when in 374 CE, Emperor Valentinian's law provided some protection. The Milan Foundling Hospital was established in 787 CE. When the Carolingian Empire fell apart during the 10th century, monastic networks (the Holy Spirit Order and Daughters of Charity) took over social support for the poor, the sick, and the insane. Foundling hospitals proliferated in Italy between the 13th and 15th centuries, in France during the 16th and 17th, and in Germany and Austria in the 18th century. Metropolitan hospices admitted thousands of infants each year. Most were not "found" exposed but were admitted anonymously via a revolving box or registered in an open office. Soon after admission, they were transported for foster care to wet nurses in villages. Sick infants, especially those suspected of suffering from syphilis, were denied the breast, and artificial feeding was tried with little success. Official death statistics were falsified by relating infant deaths not to admissions but to the total number of children cared for. Over 60% died during their first year of life, mostly from pre-admission problems such as malformation, hypothermia, and disease; from poor hygiene in overcrowded wards; and from artificial feeding. Although not intended for that purpose, the hospices became medical research institutions when in late 18th century, physicians and surgeons were employed by maternity and foundling hospitals. [ABSTRACT FROM AUTHOR]

Objectives: COVID-19 caused stark increases in food insecurity. To maintain food provision, policy changes to the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program (SNAP) were instated. This longitudinal study examined (1) food security patterns across the timeline of COVID-19; (2) the relationship among food security patterns, NSLP/SNAP use, and parent feeding practices; and (3) parent perceptions of NSLP/SNAP policy changes. Methods: A total of 333 US parents completed online surveys during the COVID-19 pandemic: May 2020 (T1), September 2020 (T2), and May 2021 (T3). Food security and parent feeding practices were reported at each time point; pre–COVID-19 behaviors were retrospectively reported at T1. Use and perceptions of NSLP/SNAP policy changes were reported at T3. We examined associations between food security and parent feeding practices using repeated-measures mixed models. Results: The percentage of parents with very low food security increased from pre–COVID-19 (9.6%) to T1 (29.1%) and remained elevated at T3 (16.8%). One-third (31.2%) of families fluctuated between food security and food insecurity, with 27.0% remaining food insecure at T3. Thirty percent of consistently food-insecure families reported not receiving school-provided meals, and 45% did not receive SNAP benefits. Most parents reported that pickup school meal sites (71.4%), Pandemic Electronic Benefit Transfer cards (51.4%), and increased SNAP benefits (79.6%) were beneficial. Initial changes in parent feeding practices reported at T1 returned to pre–COVID-19 levels by T3, yet concern for child overweight remained significantly elevated. Conclusion: Continued policy efforts to support food-insecure families via expanded food access in NSLP/SNAP are critical. [ABSTRACT FROM AUTHOR]

Introduction: Due to the increased risk of obesity for boys with Duchenne muscular dystrophy (DMD), recent guidelines recommend that dietary intake is carefully managed. Parents play an important role in the development of their child's eating behaviours and patterns. However, despite what is known about the increased risk of obesity for children with DMD, little is known about parental feeding behaviours in this population. The objective of this study was to qualitatively explore the experiences of parents of children with DMD around their child's weight management and understand what influences their feeding behaviours. Methods: This paper reports a secondary data analysis. Semi‐structured, individual interviews were conducted and analysed using qualitative description. Results: Thirteen parents were interviewed for the study. Three themes were developed: (1) parent responses to healthcare provider interactions, (2) mixed emotions contributing to feeding approach and (3) variable parenting feeding styles. Within the third theme, two subthemes arose including (1) control and preoccupation and (2) striking a balance. Conclusion: Given the potential impact of higher weights on the progression of DMD, it is important that healthcare providers explore feeding behaviours with families. However, it is essential that healthcare providers consider the impact of these conversations on parents, as well as the broader issues that may place additional pressure on the lives of families. [ABSTRACT FROM AUTHOR]

Background: Better understanding of the factors associated with formula feeding during the hospital stay can help in identifying potential lactation problems and promote early intervention. Our aim was to ascertain factors associated with exclusive formula feeding in newborns of low‐risk pregnancies. Methods: A population‐based, retrospective study using the United States vital statistics datasets (2014‐2018) evaluating low‐risk pregnancies with a nonanomalous singleton delivery from 37 to 41 weeks. People with hypertensive disorders, or diabetes, were excluded. Primary outcome was newborn feeding (breast vs exclusive formula feeding) during hospital stay. Adjusted relative risks (aRRs) with 95% confidence intervals (CI) were calculated. Results: Of the 19 623 195 live births during the study period, 11 605 242 (59.1%) met inclusion criteria and among them, 1 929 526 (16.6%) were formula fed. Factors associated with formula feeding included: age < 20 years (aRR 1.31 [95% CI 1.31‐1.32]), non‐Hispanic Black (1.42, 1.41‐1.42), high school education (1.69, 1.69‐1.70) or less than high school education (1.94, 1.93, 1.95), Medicaid insurance (1.52, 1.51, 1.52), body mass index (BMI) < 18.5 (1.10, 1.09‐1.10), BMI 25‐29.9 (1.09, 1.09‐1.09), BMI 30‐34.9 (1.19, 1.19‐1.20), BMI 35‐39.9 (1.31, 1.30‐1.31), BMI ≥ 40 (1.43, 1.42‐1.44), multiparity (1.29, 1.29‐1.30), lack of prenatal care (1.49, 1.48‐1.50), smoking (1.75, 1.74‐1.75), and gestational age (ranged from 37 weeks [1.44, 1.43‐1.45] to 40 weeks [1.11, 1.11‐1.12]). Conclusions: Using a large cohort of low‐risk pregnancies, we identified several modifiable factors associated with newborn feeding (eg, prepregnancy BMI, access to prenatal care, and smoking cessation). Improving the breast feeding initiation rate should be a priority in our current practice to ensure equitable care for all neonates. [ABSTRACT FROM AUTHOR]

Neonatal therapists are a key team member, especially, when in concert with the medical teams, especially nurses. This column speaks of the challenges the author faced as a parent in the NICU then delves into an interview with Heather Batman, a feeding occupational and neonatal therapist who provides personal and professional insight into how those NICU days and the team members ultimately benefit that infant's long-term outcome. [ABSTRACT FROM AUTHOR]

Feeding disorders are increasingly common in children, especially as medical advancements improve the life expectancy of children born with prematurity and complex medical conditions. The most common symptoms include malnutrition, refusal to eat and drink, food pocketing, disruptive feeding behavior, slow feeding, food selectivity or rigid food preferences, limited appetite, and delayed feeding milestones. A unifying diagnostic definition of pediatric feeding disorder has been proposed by a panel of experts to improve the quality of health care and advance research. Referral to specialized care should be considered when feeding problems are complex or difficult to resolve. In this review, we provide an overview of the evaluation and management of pediatric feeding disorders and information that may be useful when considering whether referral to specialized care may be beneficial. [ABSTRACT FROM AUTHOR]

Although parental feeding plays an important role in child eating and weight status, high food motivation among children may also be a factor shaping how feeding impacts child weight. This study explored whether individual differences in preschool children's food motivation interacted with mothers' feeding styles in predicting subsequent child weight status. Participants included 129 Hispanic Head Start mother/child dyads. Data were collected at ages 4–5 years (Time 1) and 7–9 (Time 3). Staff measured heights/weights and observed children in an eating in the absence of hunger task. Mothers reported on feeding styles/practices and children's eating behaviors. A principal components analysis derived a measure of highly motivated eating in children. Multiple regressions predicted Time 3 child BMI z-scores. Time 3 BMI z-scores were positively predicted by authoritative and indulgent feeding styles and negatively predicted by monitoring. Since feeding style interacted with highly motivated eating, separate regressions were run for high and low food motivation in children. Unexpectedly, results showed that authoritative feeding positively predicted Time 3 child BMI z-scores only for children showing low levels of food motivation. Characterizing differential parental feeding and child eating phenotypes may assist in tailoring childhood obesity prevention programs for the target populations. [ABSTRACT FROM AUTHOR]

Learning to eat complementary foods is a crucial milestone for infants, having implications across development. The most used method for introducing complementary foods is Traditional Spoon-Feeding (TSF). However, the alternative method Baby-Led Weaning (BLW) is increasingly becoming used as it has been associated with positive outcomes. Research analyzing associations between complementary feeding methods and responsive parenting is practically non-existent. Therefore, the objective of this study was to analyze differences in emotional and feeding responsiveness between caregivers who previously implemented traditional vs. non-traditional feeding approaches. Caregivers (mostly mothers) of 179 children between 3 and 5 years were asked about the complementary feeding method that they had followed previously (70.4% reported using the TSF, 16.8% said they used the BLW and 12.8% used both methods simultaneously). In addition, they reported on their feeding practices using the Comprehensive Feeding Practices Questionnaire and on their responses to children's distress using the Coping with Children's Negative Emotions Scale. The results showed that parents who reported using a non-traditional (BLW or both) complementary feeding method reported less pressure to eat and minimization of reactions to children's negative emotions, compared to parents who used a traditional method (although these reported using more problem-focused reactions). The findings suggest that complementary feeding methods and responsive parenting may be linked, leaving the question of which one sets the stage for the other. [ABSTRACT FROM AUTHOR]

Background: This is the fourth paper in our supplement on improving the health and well-being of rural indigenous Maya mothers and children in the Western Highlands of Guatemala, where the prevalence of stunting is the highest in Latin America and among the highest in the world. Reducing childhood undernutrition was one of the objectives of the Maternal and Child Health Project, 2011–2015, implemented by Curamericas/Guatemala. The implementation research portion of the Project attempted to determine if there were greater improvements in childhood nutritional status in the Project Area than in comparison areas and whether or not a dose–response effect was present in terms of a greater improvement in the Project Area with a longer duration of interventions. Methods: The Project provided nutrition-related messages to mothers of young children, cooking sessions using locally available nutritious foods, a lipid-based nutrient supplement (Nutributter®) for a short period of time (4 months), anti-helminthic medication, and repeated growth monitoring and nutrition counseling. Measures of height and weight for calculating the prevalence of underweight, stunting, and wasting in under-2 children were analyzed and compared with the anthropometric data for children in the rural areas of the Northwestern Region and in the Western Highlands of Guatemala. Results: The prevalence of stunting declined in Area A from 74.5% in September 2012 to 39.5% in June 2015. Area A comprised approximately one-half of the Project Area and was the geographic area with the greatest intensity and duration of nutrition-related Project interventions. Minimal improvements in stunting were observed in the Northwestern Region, which served as a comparison area. Improvements in multiple output and outcome indicators associated with nutritional status were also observed in Areas A and B: infant and young child feeding practices, routine growth monitoring and counseling, and household practices for the prevention and treatment of diarrhea. Conclusion: The Project Area in which Curamericas/Guatemala implemented the CBIO+ Approach experienced a reduction in the prevalence of stunting and other measures of undernutrition in under-2 children. Given the burden of undernutrition in Guatemala and other parts of the world, this approach merits broader application and further evaluation. [ABSTRACT FROM AUTHOR]

To perform its propagative and circulative cycle into its insect vector, the flavescence dorée phytoplasma invades different cell types. Clathrin-mediated endocytosis is used by a wide range of bacteria to infect eukaryote cells. Among the insect proteins interacting with the phytoplasma adhesin VmpA, we identified the adaptor protein complex AP-1 and AP-2 suggesting that phytoplasmas could enter the insect cells via clathrin-mediated endocytosis. By infection assays of insect cells in culture, we showed that phytoplasmas entry into Drosophila S2 cells was more efficient than infection of the Euva cell line developed from the insect vector Euscelidius variegatus. Chlorpromazine, cytochalasin D and knockdown of clathrin heavy chain (chc) gene expression using RNA interference inhibited entry of phytoplasmas into S2 cells. During invasion of S2 cells, phytoplasmas were observed very closed to recombinant GFP-labelled clathrin light chain. To verify the role of clathrin in the insect colonization by phytoplasmas, RNAi was performed via artificial feeding of chc dsRNA by the vector E. variegatus. This decreased the expression of chc gene in the midgut and heads of E. variegatus. The chc lower expression correlated to a decreased of midgut and salivary gland cells colonization after the insects had ingested phytoplasmas from infected plants. In conclusion, results indicate that clathrin is important for the FD phytoplasma to enter insect cells and colonize its insect vector. [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review was to compare the benefits and harms of nasogastric and oral‐based refeeding on the quality of care, including effectiveness, safety, and patient experience, for patients hospitalised with an eating disorder. Methods: A systematic search for studies measuring comparative data between nasogastric and oral refeeding methods was conducted in August 2021. Title and abstracts and remaining full texts were screened by both authors. Risk of bias was evaluated using the PEDro scale, and overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation narrative synthesis. Results: Seven studies (one randomised controlled trial, five non‐randomised studies of interventions, and one qualitative study) with 917 participants were included. There was low certainty evidence that nasogastric refeeding resulted in no difference or a small increase in weekly weight gain, and moderate certainty of greater total weight gain, and very low certainty of increased length of stay compared to oral refeeding. There was no difference or a small increase in discharge weight and body mass index with nasogastric refeeding compared to oral refeeding. No serious adverse events were reported. Conclusion: Patients selected for nasogastric refeeding have a longer duration of illness and lower admission weight, making it difficult to determine which refeeding approach is superior. However, the lack of clear difference in weekly weight gain and the lack of reported harms suggests that other factors such as the normalisation of eating behaviour may be taken into account when choosing the most appropriate refeeding method. [ABSTRACT FROM AUTHOR]

Introduction: To extend research on positive aspects of health care, this article focusses on health care for children who tube‐feed—this is because knowledge about tube‐feeding for children is limited and fragmented. This is achieved by consulting with clinicians and carers who supported children who tube‐feed to clarify their understandings of and experiences with brilliant feeding care. Methods: Nine clinicians and nine carers who supported children who tube‐fed were interviewed. The interview transcripts were analysed thematically. Results: Findings highlighted several features of brilliant feeding care—namely: practices that go above and beyond; attentiveness; empowerment; being 'on the same page'; hopefulness and normalcy. Conclusions: These findings show that seemingly trivial or small acts of care can make a significant meaningful difference to carers of children who tube‐feed. Such accounts elucidate brilliant care as grounded in feasible, everyday actions, within clinicians' reach. The implications associated with these findings are threefold. First, the findings highlight the need for clinicians to listen, be attuned and committed to the well‐being of children who tube‐feed and their carers, share decision‐making, source resources, and instil hope. Second, the findings suggest that carers should seek out and acknowledge clinicians who listen, involve them in decision‐making processes, and continue to source the resources required to optimize child and carer well‐being. Third, the findings point to the need for research to clarify the models of care that foster brilliant feeding care, and the conditions required to introduce and sustain these models. Patient or Public Contribution: All of the carers and clinicians who contributed to this study were invited to participate in a workshop to discuss, critique, and sense‐check the findings. Three carers and one clinician accepted this invitation. Collectively, they indicated that the findings resonated with them, and they agreed with the themes, which they indicated were well‐substantiated by the data. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Nasogastric feeding is becoming commonly used to support patients with medically compromised eating disorders. Previous research has demonstrated the safety of this approach, however there is limited evidence as to how adult patients and staff perceive this feeding method. This study aimed to describe the acceptability of a nasogastric refeeding protocol with adult patients with medically unstable eating disorders and the staff involved in their treatment. Method: This was a qualitative exploratory study using semi‐structured interviews conducted in acute medical wards of a tertiary hospital where nasogastric nutrition is the sole source of nutrition for the first 7 days of the eating disorder admission. Data were analysed using the Framework method. Results: Eight patients (100% female, median: 22 years old, n = 6 diagnosed with anorexia nervosa) and 12 staff members (medical n = 5, nursing n = 5, dietitians n = 2; median: 8.5 years clinical experience) were interviewed. Patients reported that nasogastric feeding was tolerable, however concerns were raised regarding communication and the desire for concurrent oral feeding. Acceptability from staff was influenced by perceived competence, confidence, tensions around patient‐centred care, and working with stigma and ambivalence. Conclusions: Consideration needs to be given as to whether a 'nil by mouth' status during nasogastric feeding further impacts recommencing an oral diet to progress treatment. Improvements are required within the current service, including improved communication, additional educational resources for patients, and allowing patients to partake in decision‐making as able. [ABSTRACT FROM AUTHOR]

A postoperative pancreatic fistula (POPF) is the main complication after cephalic pancreaticoduodenectomy (CPD). Unlike its prevention, the curative management of POPFs has long been poorly codified. This review seeks best practices for managing POPFs after CPD. The diagnosis of a POPF is based on two signs: (i) an amylase level in drained fluid more than 3 times the upper limit of the blood amylase level; and (ii) an abnormal clinical course. In the standardised definition of the International Study Group of Pancreatic Surgery, a purely biochemical fistula is no longer counted as a POPF and is treated by gradual withdrawal of the drain over at most 3 weeks. POPF risk can be scored using pre- and intraoperative clinical criteria, many of which are related to the quality of the pancreatic parenchyma and are common to several scoring systems. The prognostic value of these scores can be improved as early as Day 1 by amylase assays in blood and drained fluid. Recent literature, including in particular the Dutch randomised trial PORSCH, argues for early systematic detection of a POPF (periodic assays, CT-scan with injection indicated on standardised clinical and biological criteria plus an opinion from a pancreatic surgeon), for rapid minimally invasive treatment of collections (percutaneous drainage, antibiotic therapy indicated on standardised criteria) to forestall severe septic and/or haemorrhagic forms, and for the swift withdrawal of abdominal drains when the risk of a POPF is theoretically low and evolution is favourable. A haemorrhage occurring after Day 1 always requires CT angiography with arterial time and monitoring in intensive care. Minimally invasive treatment of a POPF (radiologically-guided percutaneous drainage or, more rarely, endoscopic drainage, arterial embolisation) should be preferred as first-line treatment. The addition of artificial nutrition (enteral via a nasogastric or nasojejunal tube, or parenteral) is most often useful. If minimally invasive treatment fails, then reintervention is indicated, preserving the remaining pancreas if possible, but the expected mortality is higher. [ABSTRACT FROM AUTHOR]

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Several studies have found an association between eating behaviours and weight status and obesity risk in childhood. Children's eating behaviours arise from a combination of genetic and environmental factors. Parents appear to play a central role in their development as the main responsible for shaping children's feeding environment and eating experiences. The purpose of this paper is to review the literature on parental influences on eating behaviours across childhood, mainly focusing on parental feeding practices. The associations between parental feeding practices and children's eating behaviours have been extensively studied. However, most of the findings come from cross-sectional studies, so the possibility of reverse causality cannot be ruled out (i.e., children's behaviours influencing parents). Most recently, a few longitudinal studies with a cross-lagged design have shown that the relationship between children's eating behaviours and parental feeding practices seems to be bidirectional, where it is not straightforward whether parental feeding practices are a predictor or a consequence of children's eating behaviours. Children's eating behaviours influence parents to adopt certain feeding practices, but these practices also influence children's behaviours over time. Parental feeding practices may have the potential to shape children's eating behaviours and should be targeted to promote the development of non-obesogenic traits. However, parent–child interactions are complex and therefore both parent and child characteristics and the family dynamics should be considered. [ABSTRACT FROM AUTHOR]