Household Contamination of Baby Bottles and Opportunities to Improve Bottle Hygiene in Peri-Urban Lima, Peru.

Feeding of infant formula using contaminated bottles may be an important transmission pathway of enteric pathogens during early life. Determinants of suboptimal bottle hygiene and the feasibility and acceptability of intervention strategies have not been well assessed. We evaluated the extent of bottle contamination, its contributing factors, and options for promoting improved bottle hygiene in a Peruvian shantytown. During Phase 1, we sampled from bottles and caregiver hands (n = 48) and processed for enumeration of total coliform and Escherichia coli colony-forming units. A semi-structured questionnaire captured bottle use and hygiene practices. Phase 2 involved the identification of candidate practices to recommend to caregivers. Phase 3 consisted of a behavioral trial in which 14 caregivers were educated about improved practices for bottle disinfection and later reported on their experiences implementing them. Fecal bacteria were detected in 43.8% of bottles sampled during Phase 1 and in 21.7% of hands. Caregivers overall did not use effective methods for disinfecting bottles, displayed misunderstandings surrounding hygienic practices, and few had ever discussed bottle hygiene with a health provider. Findings from the behavioral trial indicated that the improved practice of brushing the bottle with dish detergent for 30 seconds after every use is preferable to boiling the bottle for several minutes daily as caregivers reported that the brush was simple to use, efficient, and practical. The promotion of a bottle brush and detergent is a feasible and acceptable intervention strategy in peri-urban settings, and future research should evaluate its long-term effectiveness for reducing bottle contamination.

Interference of conventional and orthodontic nipples in system stomatognatic: systematic review. / Interferência dos bicos ortodônticos e convencionais no sistema estomatognático: revisão sistemática.

PURPOSE: Check if the type of nozzle, orthodontic or conventional, of pacifier and bottle have any influence on the changes found in the stomatognathic system caused by the maintenance of the sucking habit. Research Strategies: Through a systematic literature review with meta-analysis, performed from the databases Lilacs, Medline and Embase and Scholar Google, with the following key words in Portuguese and English: "malocclusion" + "Pacifiers "; "Malocclusion" + "Bottle Feeding"; "Malocclusion" + "Bottle feeding" beyond words "Orthodontic Beak" + "Conventional Beak". SELECTION CRITERIA: We included studies that presented in their methods to compare groups who used pacifiers and/or bottle with conventional nozzle with groups using orthodontic nipple without temporal delimitation. DATA ANALYSIS: The analysis of the article in its entirety was performed systematically, ordering the relevant results in the following categories: objective, method-case studies and evaluation, results, and conclusion. RESULTS: Found 1,041 jobs, from the period 1969 to 2013, 848 jobs were excluded based on the exclusion criteria and another 174 that were repetitions. A total of 19 articles were read in full of which 4 articles met the proposed inclusion criteria, and three studies were included in the meta-analysis. These results show that there are no significant differences between the orthodontic and conventional nozzles on the implications of the stomatognathic system. CONCLUSION: There is no way to conclude that there are differences as to the consequences to the stomatognathic system caused by conventional nozzles and orthodontic pacifier/bottle.

Interferência dos bicos ortodônticos e convencionais no sistema estomatognático: revisão sistemática / Interference of conventional and orthodontic nipples in system stomatognatic: systematic review

RESUMO Objetivo: Verificar se o tipo de bico, ortodôntico ou convencional, de chupeta e mamadeira, tem alguma influência sobre as alterações encontradas no sistema estomatognático causadas pela manutenção do hábito de sucção. Estratégia de pesquisa: Por meio de uma revisão de literatura sistemática com metanálise, realizada a partir das bases de dados Lilacs, Medline e Embase e com a ferramenta de busca Google Acadêmico™, com os seguintes descritores em português e inglês: “Má oclusão” + “Chupetas”; “Má oclusão” + “Alimentação Artificial”; “Má oclusão” + “Mamadeira”, além das palavras “Bico Ortodôntico” + “Bico Convencional”. Critérios de seleção: Foram incluídos estudos que apresentassem em seus métodos a comparação de grupos que utilizaram chupeta e/ou mamadeira com bico convencional com grupos que utilizaram o bico ortodôntico, sem delimitação temporal. Análise dos dados: A análise do artigo na íntegra foi realizada de modo sistemático, com as seguintes categorias tabelando os resultados pertinentes: objetivo, método - casuística e avaliação, resultados e conclusão. Resultados: Foram encontrados 1.041 trabalhos, período de 1969 a 2013, desses foram excluídos 848 trabalhos, devido aos critérios de exclusão, e outros 174 que eram repetições. Foram lidos na íntegra 19 trabalhos, dos quais quatro artigos atenderam aos critérios de inclusão propostos, e três trabalhos foram incluídos na metanálise. Tais resultados expressaram que não há diferenças significantes entre os bicos ortodôntico e convencional quanto às implicações no sistema estomatognático. Conclusão: Não há possibilidade de concluir a existência de diferenças quanto às consequências no sistema estomatognático ocasionadas por bicos convencionais e ortodônticos de chupetas/mamadeiras.

ABSTRACT Purpose: Check if the type of nozzle, orthodontic or conventional, of pacifier and bottle have any influence on the changes found in the stomatognathic system caused by the maintenance of the sucking habit. Research Strategies: Through a systematic literature review with meta-analysis, performed from the databases Lilacs, Medline and Embase and Scholar Google, with the following key words in Portuguese and English: “malocclusion” + “Pacifiers “; “Malocclusion” + “Bottle Feeding”; “Malocclusion” + “Bottle feeding” beyond words “Orthodontic Beak” + “Conventional Beak”. Selection Criteria: We included studies that presented in their methods to compare groups who used pacifiers and/or bottle with conventional nozzle with groups using orthodontic nipple without temporal delimitation. Data Analysis: The analysis of the article in its entirety was performed systematically, ordering the relevant results in the following categories: objective, method—case studies and evaluation, results, and conclusion. Results: Found 1,041 jobs, from the period 1969 to 2013, 848 jobs were excluded based on the exclusion criteria and another 174 that were repetitions. A total of 19 articles were read in full of which 4 articles met the proposed inclusion criteria, and three studies were included in the meta-analysis. These results show that there are no significant differences between the orthodontic and conventional nozzles on the implications of the stomatognathic system. Conclusion: There is no way to conclude that there are differences as to the consequences to the stomatognathic system caused by conventional nozzles and orthodontic pacifier/bottle.

Phthalates and bisphenols migration in Mexican food cans and plastic food containers.

The presence of endocrine disruptors bisphenol-A, bisphenol-A-dimethacrylate, bisphenol-A-diglycidyl-ether, phthalic-acid, dibutyl-phthalate, diethyl-phthalate and dioctyl-phthalate was determined in vegetable cans, baby bottles and microwaveable containers from the Mexican market. Gas-Chromatography-Mass-Spectrometry was used for the identification and High-Performance-Liquid-Chromatography with UV/Visible light and fluorescence detectors was used for the quantification. Endocrine disruptors were found in all samples. PA and DOP were the substances most commonly found, and maximum concentrations were 9.549 and 0.664 µg/kg, respectively from a jalapeno peppers can. Bisphenol A, phthalic-acid, bisphenol-A-dimethacrylate, bisphenol-A-diglycidyl-ether, dioctyl-phtalate and dibutyl-phthalate were found in baby bottles and microwaveable containers.

Do sucking habits in preschool children influence the position of the primary incisors?

The aim of this study was to verify whether sucking habits influence the position of the primary incisors. The sample comprised 34 preschool children (mean age 44 months ± 9 months). They were divided into three groups: group B (n=9) with a baby bottle habit; group BP (n=13) with baby bottle and pacifier habits; and a control group C (n=12) with no sucking habit. Data were derived from face-to-face interviews with the parents/guardians, oral examinations, study casts, facial photographs (frontal/lateral views), and cephalograms. The cephalograms were scanned and subsequently analyzed by one trained and calibrated operator. The cephalometric parameters recorded were: interincisal angle (U1/L1), U1/NA (angle/distance), and L1/NB (angle/distance). The data were analyzed using Stata 7.0. The Kruskall-Wallis test was used to compare the cephalometric measurements in the children with and without sucking habits. The level of significance was set at P≤.05. This study found a significant relationship between existing sucking habits and a protrusion of the maxillary and mandibular primary incisors.

Feeding-facilitating techniques for the nursing infant with Robin sequence.

OBJECTIVE: To determine the effectiveness of feeding-facilitating techniques in children with Robin sequence. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, São Paulo, Brazil. PATIENTS: Twenty-six children less than 2 months of age with Robin sequence, whose only cause of respiratory obstruction was glossoptosis. Thirteen infants were treated by being placed in the prone position (Group 1), and 13 were treated by nasopharyngeal intubation (Group 2). INTERVENTIONS: During hospitalization, the following feeding-facilitating techniques were applied daily to all children: pacifier, massage to relax and anteriorize the tongue, long and soft bottle nipple with original or enlarged hole, global symmetric position, rhythmic movement of the nipple during suction, and insertion of the nipple on the tongue. RESULTS: During the first evaluation, Group 1 patients accepted 36.15 +/- 33.05 mL milk orally within a period of 44.62 +/- 42.94 minutes, whereas Group 2 ingested 20.00 +/- 20.51 mL milk within 30.38 +/- 25.77 minutes. A significant increase (p < .01) in the volume of ingested milk was observed for the two groups at hospital discharge after a mean treatment period of 10.7 days (Group 1: 63.46 +/- 22.58 mL and Group 2: 55.00 +/- 13.07 mL). The mean duration of feeding decreased in the two groups, with a value of 21.54 +/- 7.18 minutes for Group 1 and of 20.28 +/- 8.53 minutes for Group 2. CONCLUSION: The results showed that feeding-facilitating techniques can foster oral feeding in infants with Robin sequence.

Determination of bisphenol A in food-simulating liquids using LCED with a chemically modified electrode.

Liquid chromatography with electrochemical detector (LC-ED), using a chemically modified electrode coated with a metalloporphyrin film, is reported for determination of bisphenol A (BPA) migration from polycarbonate baby bottles. The extraction process of the samples was performed according to regulations of the Southern Common Market (MERCOSUR), where certain food-simulating liquids [(A) distilled water, (B) acetic acid 3% V/V in distilled water, and (C) ethanol 15% V/V in distilled water] are defined along with controlled time and temperature conditions. The baseline obtained using the naked electrode showed a considerable drift which increased the detection limit. This effect was suppressed with the chemically modified electrode. A linear range up to 450 ppb along with a detection limit of 20 ppb for the amperometric detection technique was observed. The procedure described herein allowed lowering the detection limit of the method to 0.2 ppb. The value found for BPA in the food-simulating liquid is 1.2 ppb, which is below the tolerance limit for specific migration (4.8 ppm).

Bacterial contamination of the lacteal contents of feeding bottles in metropolitan São Paulo, Brazil.

Reported are the results of a study in São Paulo, Brazil, to evaluate the bacterial contamination of the lacteal contents of feeding bottles prepared in urban households of low (LSE) and high (HSE) socioeconomic groups, involving 100 and 32 mothers of infants, respectively. Samples of the lacteal contents of the feeding bottles were cultured and the medians (25th and 75th percentiles) of the counts (bacteria per ml) were significantly higher in the LSE group: mesophilic bacteria, 555,000 (17,250-4,350,000) in the LSE group and 1615 (20-500,000) in the HSE group; coliforms, 2400 (19-150,000) in the LSE group and 7 (0-7800) in the HSE group. Escherichia coli was isolated from 26% (26/100) of the samples from the LSE group and from 6% (2/32) of those from the HSE group (P = 0.03). In the HSE group, higher coliform counts were associated with foodhandlers other than the mother, lower levels of maternal education, the use of pasteurized milk, and the addition of ingredients other than milk. In the LSE group, feeding bottles prepared using tap water and those prepared for infants aged over 6 months had higher coliform counts. In general, the feeding bottles prepared in the households studied were heavily contaminated, especially in the LSE group.

Calibrated-orifice nipples for measurement of infant nutritive sucking.

To measure infant nutritive sucking reproducibly, nipple flow resistance must be controlled. Previous investigators have accomplished this with flow-limiting venturis, which has two limitations: flow resistance is highly dependent on fluid viscosity and older infants often reject the venturi nipple. This report describes the validation of calibrated-orifice nipples for the measurement of infant nutritive sucking. The flow characteristics of two infant formulas and water through these nipples were not different; those through venturi nipples were (analysis of variance; p < 0.0001). Flow characteristics did not differ among calibrated-orifice nipples constructed from three commercial nipple styles, indicating that the calibrated-orifice design is applicable to different types of baby bottle nipples. Among 3-month-old infants using calibrated-orifice nipples, acceptability was high, and sucking accounted for 85% of the variance in fluid intake during a feeding. We conclude that calibrated-orifice nipples are a valid and acceptable tool for the measurement of infant nutritive sucking.

Mechanics and energetics of nutritive sucking: a functional comparison of commercially available nipples.

The purpose of this study was to compare the mechanics of sucking for 48 term infants with four different nipple units: Gerber Newborn (Gerber Products Company, Fremont, Mich.), Playtex (Playtex Products, Westport, Conn.), Evenflo (Evenflo Products Co., Canton, Ga.), and Gerber NUK. At 24 hours after birth, infants were assigned randomly to one of the nipple units and were studied twice with that nipple unit. A customized data acquisition system was used to measure and record the following variables: intraoral suction, sucking frequency, work, power, milk flow, milk volume per suck, and oxygen saturation. Although no statistically significant differences among the nipple units were noted for intraoral suction, sucking frequency, power, and oxygen saturation, the data revealed that the Playtex nipple unit was accompanied by higher peak milk flow and greater volume of milk per suck (p < 0.05). Infants fed differently with the Playtex nipple than they did with the other nipples. Our findings indicate that the Playtex nipple permits a greater milk flow in response to similar amounts of suction, work, and power when compared with others. The mean total work per such was significantly lower in the Gerber NUK group compared with the Playtex group. In addition, the total number of sucks per volume ingested was higher, and the total time to ingest a specific quantity of milk was longer for the Gerber NUK nipple.

Breathing patterns of preterm infants during bottle feeding: role of milk flow.

Milk flow achieved during feeding may contribute to the ventilatory depression observed during nipple feeding. One of the important determinants of milk flow is the size of the feeding hole. In the first phase of the study, investigators compared the breathing patterns of 10 preterm infants during bottle feeding with two types of commercially available (Enfamil) single-hole nipples: one type designed for term infants and the other for preterm infants. Reductions in ventilation, tidal volume, and breathing frequency, compared with prefeeding control values, were observed with both nipple types during continuous and intermittent sucking phases; no significant differences were observed for any of the variables. Unlike the commercially available, mechanically drilled nipples, laser-cut nipple units showed a markedly lower coefficient of variation in milk flow. In the second phase of the study, two sizes of laser-cut nipple units, low and high flow, were used to feed nine preterm infants. Significantly lower sucking pressures were observed with high-flow nipples as compared with low-flow nipples. Decreases in minute ventilation and breathing frequency were also significantly greater with high-flow nipples. These results suggest that milk flow contributes to the observed reduction in ventilation during nipple feeding and that preterm infants have limited ability to self-regulate milk flow.