Timing of Introduction of Complementary Foods - United States, 2016-2018.

The American Academy of Pediatrics (AAP) recommends introducing complementary foods (i.e., any solid or liquid other than breast milk or infant formula) to infants at approximately age 6 months (1). Although a consensus on ideal timing is lacking, most experts agree that introduction of complementary foods before age 4 months is too early because of infant gastrointestinal and motor immaturity (1,2). In addition, early introduction prevents exclusively breastfed infants from reaching the recommended 6 months of exclusive breastfeeding (1) and might be associated with increased risk for overweight and obesity (3). Nationally representative data on complementary feeding are limited; state-level estimates have been previously unavailable. CDC analyzed 2016-2018 data from the National Survey of Children's Health (NSCH) (N = 23,743) to describe timing of complementary feeding introduction and prevalence of early introduction of complementary foods before age 4 months (early introduction) among children aged 1-5 years. Prevalence of early introduction was 15.6% nationally and varied geographically and across sociodemographic and infant feeding characteristics. These estimates suggest that approximately one in six infants are introduced to complementary foods before they are developmentally ready. Efforts by health care providers and others who might influence infant feeding practices could help decrease the number of infants who are introduced to complementary foods too early.

Human milk expression in the first year postpartum among persons with low incomes.

BACKGROUND: Expressing milk (i.e., human milk) is common in the USA, but practices are unknown among families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study of a WIC population explores the practice of and reasons for expressing milk in the first year postpartum. METHODS: We analysed data from a longitudinal study to examine milk expression at 1, 3, 5, 7, 9, 11, and 13 months postpartum among breastfeeding persons enrolled in WIC with term singletons. We cross-sectionally analysed the weighted prevalence of milk expression at each survey month and report reasons for milk expression in the first 7 months. RESULTS: Among the study participants who reported feeding human milk at Month 1, 70.4% expressed milk in the first 13 months postpartum. The prevalence of milk expression was 56.8% at Month 1 and decreased to 13.9% at Month 13 among those feeding any human milk that month. Reasons for expressing milk changed over time; in the first month, increasing milk supply, relieving engorgement, and having an emergency supply of milk were common. In later months, having a supply of milk available so that someone else could feed their infant was common. CONCLUSIONS: Clinicians, health educators, WIC staff, and others working with WIC families can promote optimal expressed milk feeding and storage practices. Extra attention and support may be especially important in the first months postpartum when milk expression is common. Support for persons who are expressing milk can be tailored for reasons of milk expression.

Public Belief in the Maternal Health Benefits of Breastfeeding - United States, 2018 and 2021.

The objective of this study was to better understand US public awareness of maternal health benefits of breastfeeding. Data from the 2018 and 2021 SummerStyles surveys were analyzed to explore public belief in select maternal benefits of breastfeeding. As in 2018, in 2021 a low percentage of respondents believed that breastfeeding protects the mother against breast cancer (23.9%), high blood pressure (15.5%), or type 2 diabetes (15.4%), with male, older, and unmarried respondents less likely to believe in these protective effects. More public awareness of maternal benefits of breastfeeding might help increase demand for breastfeeding-supportive programs and policies.

Disaggregation of Breastfeeding Initiation Rates by Race and Ethnicity - United States, 2020-2021.

Introduction: Although breastfeeding is the ideal source of nutrition for most infants, racial and ethnic disparities exist in its initiation. Surveillance rates based on aggregated data can challenge the understanding and monitoring of effective, culturally appropriate interventions among racial and ethnic subgroups. Aggregated data have historically estimated breastfeeding rates among a few large racial and ethnic groups. We examined differences in breastfeeding initiation rates by disaggregation of data to finer subgroups of race and ethnicity. Methods: We analyzed births from January 1, 2020, through December 31, 2021, in 48 states and the District of Columbia by using National Vital Statistics System birth certificate data. Data indicate whether an infant received any breast milk during birth hospitalization and include self-reported maternal race and ethnicity. Cross-tabulations of race and ethnicity by breastfeeding initiation were calculated and compared across aggregated and disaggregated categories. Results: The overall prevalence of breastfeeding initiation was 84.0%, ranging from 74.5% (mothers identifying as Black) to 94.0% (mothers identifying as Japanese). The aggregated prevalence of breastfeeding initiation among mothers identifying as Hispanic was 86.8%; disaggregated estimates by Hispanic origin ranged from 82.2% (Puerto Rican) to 90.9% (Cuban). Conclusion: Substantial variation in the prevalence of breastfeeding initiation across disaggregated racial or ethnic categories exists. Disaggregation of racial and ethnic data unmasked differences that could reflect variations in cultural practices or systemic barriers to breastfeeding. Understanding why these differences exist could guide public health practitioners' efforts to improve and tailor breastfeeding support.

Early introduction of complementary foods/drinks and milk feeding type in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

Infants younger than 4 months are not ready for complementary foods/drinks (any solid or liquid other than breast milk or infant formula). Almost half of US infants participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which provides nutrition education and support to low-income families. We describe the prevalence of early introduction (<4 months) of complementary foods/drinks and examine the association of milk feeding type (fully breastfed, partially breastfed or fully formula fed) with early introduction of complementary foods/drinks. We used data from 3310 families in the longitudinal WIC Infant and Toddler Feeding Practices Study-2. We described the prevalence of early introduction of complementary foods/drinks and modeled the association of milk feeding type at Month 1 with early introduction of complementary foods/drinks using multi-variable logistic regression. Thirty-eight percent of infants were introduced early to complementary foods/drinks (<4 months). In adjusted models, infants who were fully formula fed or partially breastfed at Month 1 were 75% and 57%, respectively, more likely to be introduced early to complementary foods/drinks compared with fully breastfed infants. Almost two in five infants were given complementary foods/drinks early. Formula feeding at Month 1 was associated with higher odds of early introduction of complementary foods/drinks. There are opportunities to support families participating in WIC to prevent early introduction of complementary foods/drinks and promote child health.

[Research and Development Trend of Medical Oxygen Production Equipment].

Oxygen therapy is an effective clinical method for the treatment of respiratory disorders, oxygen concentrator as a necessary medical auxiliary equipment in hospitals, its research and development has been a hot spot. The study reviewed the development history of the ventilator, introduced the two preparation technique of the oxygen generator pressure swing absorption (PSA) and vacuum pressure swing adsorption (VPSA), and analyzed the core technology development of the oxygen generator. In addition, the study compared some major brands of oxygen concentrators on the market and prospected the development trend of oxygen concentrators.

[Infrared Sensor ZTP-135SR and Its Application in Infrared Body Temperature Measurement].

Body temperature is an essential physiological parameter. Conducting non-contact, fast and accurate measurement of temperature is increasing important under the background of COVID-19. The study introduces an infrared temperature measurement system based on the thermopile infrared temperature sensor ZTP-135SR. Extracting original temperature date of sensor, post-amplification and filter processing have been performed to ensure accuracy of the system. In addition, the temperature data of environmental compensation which obtained by polynomial fitting is added to the system to further improve measurement accuracy.

[Development of a Wireless Wearable Body Temperature Measurement System Based on NTC].

Body temperature is an important physiological parameter of the human body and is used in medicine to reflect the physiological state and health status of the human body. At present, the commonly used clinical thermometers on the market are mainly divided into contact and non-contact types. Most of them are used for rapid body temperature measurement, and it is not easy to monitor body temperature changes in real time. This article introduces a new wearable wireless body temperature monitoring system based on NTC, which senses through NTC. The temperature changes are amplified and filtered, zeroed, and calibrated, and then the temperature data is uploaded to the mobile phone APP via Bluetooth in real time to achieve real-time accurate measurement of body temperature.

[An Adaptive Method for Detecting and Removing EEG Noise].

To solve the problem of real-time detection and removal of EEG signal noise in anesthesia depth monitoring, we proposed an adaptive EEG signal noise detection and removal method. This method uses discrete wavelet transform to extract the low-frequency energy and high-frequency energy of a segment of EEG signals, and sets two sets of thresholds for the low-frequency band and high-frequency band of the EEG signal. These two sets of thresholds can be updated adaptively according to the energy situation of the most recent EEG signal. Finally, we judge the level of signal interference according to the range of low-frequency energy and high-frequency energy, and perform corresponding denoising processing. The results show that the method can more accurately detect and remove the noise interference in the EEG signal, and improve the stability of the calculated characteristic parameters.

Racial and Ethnic Disparities in Breastfeeding Initiation ─ United States, 2019.

Breastfeeding is the optimal source of nutrition for most infants (1). Although breastfeeding rates in the United States have increased during the past decade, racial/ethnic disparities persist (2). Breastfeeding surveillance typically focuses on disparities at the national level, because small sample sizes limit examination of disparities at the state or territorial level. However, birth certificate data allow for assessment of breastfeeding initiation among nearly all newborn infants in the United States both nationally and at the state and territorial levels. To describe breastfeeding initiation by maternal race/ethnicity,* CDC analyzed 2019 National Vital Statistics System (NVSS) birth certificate data for 3,129,646 births from 48 of the 50 states (all except California and Michigan†), the District of Columbia (DC), and three U.S. territories (Guam, Northern Mariana Islands, and Puerto Rico). The prevalence of breastfeeding initiation was 84.1% overall and varied by maternal race/ethnicity, ranging from 90.3% among infants of Asian mothers to 73.6% among infants of Black mothers, a difference of 16.7 percentage points. Across states, the magnitude of disparity between the highest and lowest breastfeeding rates by racial/ethnic groups varied, ranging from 6.6 percentage points in Vermont to 37.6 percentage points in North Dakota, as did the specific racial/ethnic groups with the highest and lowest rates. These state/territory-specific data highlight the variation that exists in breastfeeding disparities across the United States and can help public health practitioners and health departments identify groups on which to focus efforts. Targeting breastfeeding promotion programs on populations with lower breastfeeding rates might help reduce racial/ethnic disparities in breastfeeding initiation and improve infant nutrition and health.

Meeting breastfeeding intentions differ by race/ethnicity, Infant and Toddler Feeding Practices Study-2.

Prenatal breastfeeding intentions impact breastfeeding practices. Racial/ethnic disparities exist in breastfeeding rates; it is unknown if prenatal intentions and meeting intentions differ by race/ethnicity. A longitudinal cohort of USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) which enrolled participants beginning in 2013 were used to estimate prenatal intentions for breastfeeding initiation, exclusive breast milk feeds at 1 and 3 months by race/ethnicity (n = 2070). Meeting intentions were determined by reported breast milk consumption at birth, 1 month and 3 months. Multivariable logistic regression was used to determine the association of race/ethnicity with meeting intentions. There were no differences in prenatal breastfeeding intentions between non-Hispanic White and non-Hispanic Black women (initiation: 86.9% and 87.2%; Month 1: 52.3% and 48.3%; Month 3: 43.8% and 40.9%; respectively), but a higher percentage of Hispanic women intended to breastfeed at all time points (95.5%, 68.3% and 56.4%; respectively, P < 0.05). Among women who intended to breastfeed at Month 1, non-Hispanic Black and Hispanic women had significantly lower odds of meeting intentions compared with non-Hispanic White women after adjusting for covariates (aORs: 0.63 [95% CI: 0.41, 0.98]; 0.64 [95% CI: 0.44, 0.92], respectively). Similar findings were seen for Month 3. Despite no differences in breastfeeding intentions, non-Hispanic Black women were less likely to meet their breastfeeding intentions than non-Hispanic White women. Hispanic women were more likely to intend to breastfeed yet were less likely to meet their intentions. This suggests that non-Hispanic Black and Hispanic women face challenges to meeting their longer breastfeeding intentions. Understanding how racism, bias and discrimination contribute to women not meeting their breastfeeding intentions may help efforts to reduce breastfeeding disparities.

[An anesthesia depth computing method study based on wavelet transform and artificial neural network].

General anesthesia is an essential part of surgery to ensure the safety of patients. Electroencephalogram (EEG) has been widely used in anesthesia depth monitoring for abundant information and the ability of reflecting the brain activity. The paper proposes a method which combines wavelet transform and artificial neural network (ANN) to assess the depth of anesthesia. Discrete wavelet transform was used to decompose the EEG signal, and the approximation coefficients and detail coefficients were used to calculate the 9 characteristic parameters. Kruskal-Wallis statistical test was made to these characteristic parameters, and the test showed that the parameters were statistically significant for the differences of the four levels of anesthesia: awake, light anesthesia, moderate anesthesia and deep anesthesia ( P < 0.001). The 9 characteristic parameters were used as the input of ANN, the bispectral index (BIS) was used as the reference output, and the method was evaluated by the data of 8 patients during general anesthesia. The accuracy of the method in the classification of the four anesthesia levels of the test set in the 7:3 set-out method was 85.98%, and the correlation coefficient with the BIS was 0.977 0. The results show that this method can better distinguish four different anesthesia levels and has broad application prospects for monitoring the depth of anesthesia.

In vitro affinity maturation to improve the efficacy of a hypoxia-inducible factor 1α single-domain intrabody.

Affinity is an important property of therapeutic antibodies, so improving affinity is critical to the biological activity and clinical efficacy. An anti-HIF-1α nanobody, VHH212, was screened via a native ribosome display library with a 26.6 nM of KD value was used as the parent. In this paper, a Venn-intersection of multi-algorithms screening (VIMAS) strategy for computer-aided binding affinity prediction was designed. Homology modeling and protein docking methods were used to substitute the need for a crystal structure. Finally, a mutant with a 17.5-fold enhancement in binding affinity (1.52 nM) was obtained by using the VIMAS strategy. Furthermore, the biological activity of mutants was verified at the cellular level. Targeting HIF-1α can sensitize PDAC (pancreatic ductal adenocarcinoma) tumors to gemcitabine, which is a potential co-treatment method for pancreatic cancer patients. Our results showed that the cytotoxicity of gemcitabine on pancreatic cancer cell lines increased with the enhanced-affinity of an intrabody under combined treatment.

Timing of Introduction of Complementary Foods - United States, 2016-2018.

The American Academy of Pediatrics (AAP) recommends introducing complementary foods (i.e., any solid or liquid other than breast milk or infant formula) to infants at approximately age 6 months (1). Although a consensus on ideal timing is lacking, most experts agree that introduction of complementary foods before age 4 months is too early because of infant gastrointestinal and motor immaturity (1,2). In addition, early introduction prevents exclusively breastfed infants from reaching the recommended 6 months of exclusive breastfeeding (1) and might be associated with increased risk for overweight and obesity (3). Nationally representative data on complementary feeding are limited; state-level estimates have been previously unavailable. CDC analyzed 2016-2018 data from the National Survey of Children's Health (NSCH) (N = 23,927) to describe timing of complementary feeding introduction and prevalence of early introduction of complementary foods before age 4 months (early introduction) among children aged 1-5 years. Prevalence of early introduction was 31.9% nationally and varied geographically and across sociodemographic and infant feeding characteristics. These estimates suggest that many infants are introduced to complementary foods before they are developmentally ready. Efforts by health care providers and others who might influence infant feeding practices could help decrease the number of infants who are introduced to complementary foods too early.

Changes in mothers' intended duration of breastfeeding from the prenatal to neonatal periods.

BACKGROUND: Although previous studies suggest that the intentions of mothers to breastfeed during pregnancy strongly predict actual breastfeeding practice, no studies have examined the changes in the intentions of mothers to breastfeed from the prenatal to neonatal periods. The purpose of this study was to examine changes in intended breastfeeding duration from the prenatal to neonatal periods, their association with actual duration, and predictors for shortened duration. METHODS: The Infant Feeding Practices Study II was a longitudinal study of mothers in the United States. Changes to intended breastfeeding duration were calculated as the difference from prenatal to neonatal reports (months); we compared this change to actual breastfeeding duration. By using multivariable logistic regression, we identified maternal characteristics associated with a shortened breastfeeding intention. RESULTS: Of 1780 women, 43.7% had no change to intended breastfeeding duration, 35.0% had a shorter intended duration, and 21.3% had a longer intended duration. Mothers with shortened intended duration also had shorter actual duration (P < .001). Women of Hispanic ethnicity, with a prepregnancy body mass index of ≥30 kg/m2 , who were primiparous and who smoked prenatally had increased odds of shortening their breastfeeding intention from prenatal to neonatal reports. A maternal age of ≥35 years was associated with decreased odds of shortened breastfeeding intention. CONCLUSION: Approximately one in three women shorten their intended breastfeeding duration during the early postpartum period, which negatively affects the actual duration of their breastfeeding. Women may need additional support during the early postpartum period to meet their prenatal breastfeeding intentions.

Public Opinions About Infant Feeding in the United States.

BACKGROUND: Exclusive breastfeeding is recommended for the first 6 months of life. However, many barriers to breastfeeding exist. We examine public opinions about the benefits of breastfeeding and the infant health risks associated with formula feeding. METHODS: A national public opinion survey was conducted in 2013. Participants indicated their level of agreement with four breastfeeding-related statements. Except for the last one, all statements were positively worded with agreement representing positive opinions toward breastfeeding. To focus on the prevalence of positive opinions, we estimated percentage agreement with the first three statements, but disagreement with the fourth. Multiple logistic regression was used to examine how odds of these positive opinions varied by socio-demographic factors. RESULTS: Seventy-eight percent of participants agreed that breastmilk is nutritionally designed for infants, but few believed breastfeeding protects against overweight (12%). Approximately one-quarter agreed that formula feeding increases the chance of illness, whereas 45 percent disagreed that infant formula is equivalent to breastmilk. Older, less-educated, unmarried, and non-Hispanic black participants were less likely to agree that formula feeding increases the risk of infant illness. Races other than non-Hispanic white, participants aged 30-44 years and 45-59 years, unmarried, and less-educated participants were less likely to disagree with the equivalence of infant formula to breastmilk. DISCUSSION: The nutritional value of breastmilk is well known. Fewer adults believe that breastfeeding protects against childhood overweight or that formula feeding increases the chance of infant illness. Communication efforts may increase public awareness of the health benefits of breastfeeding.

Provision of Non-breast Milk Supplements to Healthy Breastfed Newborns in U.S. Hospitals, 2009 to 2013.

Introduction Breastfed newborns are often given non-breast milk supplements in the hospital, which can negatively impact breastfeeding outcomes. Efforts to improve maternity care practices include reducing supplementation of breastfed newborns. Methods The Maternity Practices in Infant Nutrition and Care (mPINC) survey is administered every 2 years to all hospitals in the United States and territories with registered maternity beds. We examined provision of non-breast milk supplements to healthy, full-term breastfed newborns from 2009 to 2013. Results Hospitals that provided non-breast milk supplements to at least 50 % of breastfed newborns decreased from 31.5 % in 2009 to 23.3 % in 2013. Among hospitals providing any supplements, there was no change in the percent that supplemented with infant formula; whereas, supplementing with water declined from 8.8 % in 2009 to 4.2 % in 2013 and with glucose water from 23.4 % to 12.5 %, respectively. In 2013, 64.9 % of breastfed infants were supplemented with formula for "mother's choice," 25.0 % for "doctor's orders," and 8.7 % for "nurse's recommendation." Discussion Despite improvements in maternity care practices, nearly one-fourth of hospitals are still providing at least 50 % of healthy, full-term breastfed newborns with non-breast milk supplements. While there has been no change in the proportion of hospitals providing infant formula supplements, the proportion supplementing with water and glucose water have declined. Additional education and support of mothers during the early post-partum period and training of physicians may address reasons breastfed infants are supplemented.

Mothers' child-feeding practices are associated with children's sugar-sweetened beverage intake.

BACKGROUND: Sugar-sweetened beverage (SSB) intake is a substantial source of energy in the diet of US children. OBJECTIVE: We examined the associations between mothers' child-feeding practices and SSB intake among 6-y-old children. METHODS: We analyzed data from the Year 6 Follow-up of the Infant Feeding Practices Study II in 1350 US children aged 6 y. The outcome variable was child's SSB intake. The exposure variables were 4 child-feeding practices of mothers: setting limits on sweets or junk foods, regulating their child's favorite food intake to prevent overconsumption, pressuring their child to eat enough, and pressuring their child to "clean the plate." We used multinomial logistic regression and controlled for child and maternal characteristics. Analyses were stratified on child weight status. RESULTS: The consumption of SSBs ≥1 time/d was observed among 17.1% of underweight/normal-weight children and in 23.2% of overweight/obese children. Adjusted ORs (aORs) of consuming SSBs ≥1 time/d (vs. no SSB consumption) were significantly lower in children whose mothers reported setting limits on sweets/junk foods (aOR: 0.29; 95% CI: 0.15, 0.58 for underweight/normal-weight children; aOR: 0.16; 95% CI: 0.03, 0.79 for overweight/obese children). SSB intake was higher among underweight/normal-weight children whose mothers reported trying to keep the child from eating too much of their favorite foods (aOR: 2.03; 95% CI: 1.25, 3.29). Mothers' tendency to pressure their children to consume more food or to "clean the plate" was not associated with child's SSB intake. CONCLUSIONS: SSBs were commonly consumed by young children. The odds of daily SSB intake were lower among children whose mothers set limits on sweets/junk foods regardless of child's weight but were higher among underweight/normal-weight children whose mothers restricted the child's favorite food intake. Future studies can investigate the impact of alternatives to restrictive feeding practices that could reduce children's SSB intake.

Infant and maternal characteristics in neonatal abstinence syndrome--selected hospitals in Florida, 2010-2011.

Neonatal abstinence syndrome (NAS) is a constellation of physiologic and neurobehavioral signs exhibited by newborns exposed to addictive prescription or illicit drugs taken by a mother during pregnancy. The number of hospital discharges of newborns diagnosed with NAS has increased more than 10-fold (from 0.4 to 4.4 discharges per 1,000 live births) in Florida since 1995, far exceeding the three-fold increase observed nationally. In February 2014, the Florida Department of Health requested the assistance of CDC to 1) assess the accuracy and validity of using Florida's hospital inpatient discharge data, linked to birth and infant death certificates, as a means of NAS surveillance and 2) describe the characteristics of infants with NAS and their mothers. This report focuses only on objective two, describing maternal and infant characteristics in the 242 confirmed NAS cases identified in three Florida hospitals during a 2-year period (2010-2011). Infants with NAS experienced serious medical complications, with 97.1% being admitted to an intensive care unit, and had prolonged hospital stays, with a mean duration of 26.1 days. The findings of this investigation underscore the important public health problem of NAS and add to current knowledge on the characteristics of these mothers and infants. Effective June 2014, NAS is now a mandatory reportable condition in Florida. Interventions are also needed to 1) increase the number and use of community resources available to drug-abusing and drug-dependent women of reproductive age, 2) improve drug addiction counseling and rehabilitation referral and documentation policies, and 3) link women to these resources before or earlier in pregnancy.

Racial disparities in access to maternity care practices that support breastfeeding - United States, 2011.

Despite the well documented health benefits of breastfeeding, initiation of breastfeeding and breastfeeding duration rates among black infants in the United States are approximately 16% lower than among whites. Although many factors play a role in a woman's ability to breastfeed, experiences during the childbirth hospitalization are critical for establishing breastfeeding. To analyze whether the implementation by maternity facilities of practices that support breastfeeding varied depending on the racial composition of the area surrounding the facility, CDC linked data from its 2011 Maternity Practices in Infant Nutrition and Care (mPINC) survey to U.S. Census data on the percentage of blacks living within the zip code area of each facility. The results of that analysis indicated that facilities in zip code areas where the percentage of black residents was >12.2% (the national average during 2007-2011) were less likely than facilities in zip code areas where the percentage was ≤12.2% to meet five of 10 mPINC indicators for recommended practices supportive of breastfeeding and more likely to implement one practice; differences for the other four practices were not statistically significant. Comparing facilities in areas with >12.2% black residents with facilities in areas with ≤12.2% black residents, the largest differences were in the percentage of facilities that implemented recommended practices related to early initiation of breastfeeding (46.0% compared with 59.9%), limited use of breastfeeding supplements (13.1% compared with 25.8%), and rooming-in (27.7% compared with 39.4%). These findings suggest there are racial disparities in access to maternity care practices known to support breastfeeding.