ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence?

Since 2002, the World Health Organization and many governments and professional associations have recommended exclusive breastfeeding for 6 months followed by complementary feeding (giving solid foods alongside breast milk) as optimal infant feeding practice. Several articles have been published challenging this recommendation. Arguably, the most influential has been the 2008 commentary of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition, which recommended that complementary foods should be introduced to all infants between 17 and 26 weeks. We challenge the validity of ESPGHAN's position, questioning the adequacy of the literature search, the interpretation and evidence used to reach their conclusions and the balance of an approach that focuses on disease prevention, with scant consideration of growth and neuromotor development. We contend that ESPGHAN's position should be understood as an expert opinion that may be influenced by conflicts of interest. In our view, the ESPGHAN position paper is not evidence based and does not justify a change of the current public health recommendation for 6 months of exclusive breastfeeding. At an individual level, health professionals should understand that developmental readiness for starting solid foods has an age range like other developmental milestones; that fewer infants will probably be ready to start complementary feeding before, rather than after, 6 months; and that their role is to equip parents with the confidence and skills to recognise the signs of developmental readiness. This empowerment process for infants and parents should be preferred over the prescriptive ESPGHAN approach.

Is it compatible with breastfeeding? www.e-lactancia.org: Analysis of visits, user profile and most visited products.

INTRODUCTION: One of the factors to influence abandoning breastfeeding is mothers' use of medications. The www.e-lactancia.org website is a reliable source in Spanish and English for online free-access information about the compatibility of medications with breastfeeding. The aim of this study was to analyse the search profiles, and groups and products, searched the most on this website. MATERIALS AND METHODS: A retrospective and descriptive study of the e-lactancia.org website during 2014-2018. Google Analytics was used for data collection. The following variables were analysed: number of users and queries; professional profile; country; language; users' and groups' access modes/devices; most searched products. RESULTS: We found 16,821.559 users and 63,783.866 pages. Of users, 62.7 % were "mother/father", and 31.9 % were health professionals. Visits came mostly from: Spain (25.86 %); Mexico (16.87 %); Argentina (7.99 %); Chile (7.31 %). The preferred access mode and device were organic searches (62.1 %) and mobile phones (73.4 %), respectively. Phytotherapy (14.4 %), antibacterial agents (12.3 %) and NSAIDs (12.3 %) were the most searched groups, and ibuprofen (6.25 %) was the most popular product. CONCLUSION: Users and consultations in e-lactation increased significantly during the study period. Mothers/fathers were the main website users, followed by health professionals. The main consulted groups were antibacterial agents, NSAIDs and systemic phytotherapy. Ibuprofen, paracetamol and amoxicillin stood out as the most consulted products. These results revealed increase Internet resources use to solve parents and health professionals' breastfeeding doubts. Future research should study how users (parents, health professionals) interact with this information.

[Epidemiological surveillance of vertically-transmitted Chagas disease at three maternity hospitals in the Valencian Community]. / Vigilancia epidemiológica de la transmisión vertical de la enfermedad de Chagas en tres maternidades de la Comunidad Valenciana.

INTRODUCTION AND AIM: Immigration to Spain of Latin Americans with Chagas disease in its indeterminate phase could result in vertical transmission of the disease or transmission by transfusion or organ transplantation. To ascertain the magnitude of this problem, we investigated the prevalence of bearers among women who gave birth in 3 state maternity hospitals in the Valencian Community and the incidence of vertical transmission. PATIENTS AND METHODS: An immunoprecipitation test to detect anti-Trypanosoma cruzi antibodies was carried out on 624 pregnant Latin American women. In positive cases, indirect immunofluorescence and PCR analysis were performed on mothers. In addition, a microhematocrit and PCR analysis were performed on the newborns of these mothers, and immune precipitation was carried out from age 7 months. Chagas-positive mothers were referred for outpatient care at the hospital internal medicine departments. Percentage of positive serology was calculated for the total number of patients and by country of origin. RESULTS: A total of 29 women (4.8%; 95% CI, 3.1-6.3) were Chagas-positive; all were asymptomatic and PCR-negative. None of their children were positive to the tests performed. Bolivian women were the most frequently affected: 24 out of 137 (17.5%; 95% CI, 11.2-23.9) DISCUSSION: The high prevalence of Chagas disease in the Latin American immigrant population has raised awareness of this disease among professionals involved in the study and treatment of this illness. Further epidemiological studies are needed to establish the feasibility of universal detection programs in this population.

Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras.

Iron supplements are often prescribed during infancy but their benefits and risks have not been well documented. We examined whether iron supplements affect growth or morbidity of breast-fed infants. Full-term infants in Sweden (n = 101) and Honduras (n = 131) were randomly assigned to three groups at 4 mo of age: 1) placebo from 4 to 9 mo; 2) placebo from 4 to 6 mo and iron supplements [1 mg/(kg. d)] from 6 to 9 mo; or 3) iron supplements from 4 to 9 mo. All infants were exclusively or nearly exclusively breast-fed to 6 mo and continued to be breast-fed to at least 9 mo. Growth was measured monthly and morbidity data were collected every 2 wk. Among the Swedish infants, gains in length and head circumference were significantly lower in those who received iron than in those given placebo from 4 to 9 mo. The same effect on length was seen in Honduras, but only at 4-6 mo among those with initial hemoglobin (Hb) > or =110 g/L. There was no significant main effect of iron supplementation on morbidity, nor any significant interaction between iron supplementation and site, but for diarrhea (with both sites combined), there was an interaction between iron supplementation and initial Hb. Among infants with Hb < 110 g/L at 4 mo, diarrhea was less common among those given iron than in those given placebo from 4-9 mo, whereas the opposite was true among those with Hb > or = 110 g/L (P < 0.05). We conclude that routine iron supplementation of breast-fed infants may benefit those with low Hb but may present risks for those with normal Hb.

Parasitismo intestinal en la infancia

Se estudiaron las caracteristicas de la infestación parasitaria en un grupo de pacientes pediatricos que acudio a la consulta externa del HSS de San Pedro Sula, encontrandose una prevalencia de 43%, con leve predominio de protozoos sobre helmintos. Se vió mayor afectación del estado nutricional asociada a la infestación por helmintos que por protozoos

Crecimiento bacteriano en leche humana

Se cultivaron 40 muestras de leche humana extraídas con bomba eléctrica y manualmente para estudiar el crecimiento bacteriano tanto en condiciones de refrigeración como a temperatura ambiente. Se obtuvo 40% de positividad en los cultivos con 23% de microorganismos patógenos. La menor presencia de cultivos positivos se observó entre las muestras extraídas manualmente y mantenidas en refrigeración. Hasta las 6 horas no hubo diferencia significativa entre grupo refrigerado y el mantenido a temperatura ambiente