Protective factors for early initiation of breastfeeding among Brazilian nursing mothers.

Objectives: Evaluate the protective factors associated with early initiation of breastfeeding. Methods: Cross-sectional study conducted with Brazilian nursing mothers. Breastfeeding in the first hour of life and difficulty initiating breastfeeding in the birth room were adopted as outcome variables and associated with other maternal and child information. Poisson regression was conducted to synthesize the data. Results: Among 104 nursing mothers evaluated, 56.7% reported breastfeeding in the first hour of life and 43% had difficulty initiating breastfeeding in the birth room. There was a higher prevalence of breastfeeding in the first hour of life among mothers with previous breastfeeding experience (PR = 1.47, 95% CI 1.04-2.07). Difficulty initiating breastfeeding in the birth room was more prevalent among mothers who did not receive breastfeeding guidance during antenatal care (PR = 2.83, 95% CI 1.43-4.32) and those without previous breastfeeding experience (PR = 2.49, 95% CI 1.24-6.45). Conclusion: These findings highlight the importance of adequate professional guidance, especially for primiparous mothers.

Use of Artificial Nipples Among Brazilian Infants and Associated Factors.

Transversal study conducted in a Human Milk Bank to evaluate the factors associated with the use of artificial nipples (pacifier and/or nursing bottle) among Brazilian infants. Analyses were performed using the χ2 test and logistic regression analysis. A total of 6017 nursing mothers were evaluated and the use of artificial nipples was reported by 31.3%. The chance of using artificial nipples was higher among infants whose mothers attended antenatal care in private hospitals [odds ratio (OR): 1.61, 95% confidence interval (CI) 1.21-2.14], born in maternities without the Baby-Friendly Hospital Initiative (BFHI) (OR: 18.38, 95% CI 13.50-25.04) and those with adequate birth weight (OR: 2.83, 95% CI 1.99-4.03). A lower chance of using artificial nipples was observed among infants whose mothers had previous breastfeeding experience (OR: 0.76, 95% CI 0.61-0.95), received guidance on breastfeeding during antenatal care (OR: 0.80, 95% CI 0.65-0.98), practiced exclusive breastfeeding (OR: 0.36, 95% CI 0.28-0.45), breastfeeding on demand (OR: 0.66, 95% CI 0.52-0.85) and residents of inland cities/towns (OR: 0.38, 95% CI 0.20-0.72). The findings highlight the importance of breastfeeding guidance during antenatal care and the role of BFHI in clarifying risks associated with artificial nipple use.

Effectiveness of different interventions in public nurseries based on food and nutrition education: promoting breast-feeding and healthy complementary feeding.

OBJECTIVE: Food practices in the early years of life are important to form healthy eating habits; therefore, it is essential for the caregivers of infants to receive appropriate guidance. The present study aimed to investigate the effectiveness of different nutritional interventions on complementary feeding practices in municipal nurseries. DESIGN: Non-randomized controlled intervention study with education professionals and parents of infants (<2 years). Participants were divided into: control group (CG), standard food and nutrition education in writing; and intervention group (IG), the same information as the CG and face-to-face meetings (professionals, 8 h; parents, 5 h). Changes in professionals' knowledge on the subject and alterations in parents' beliefs, attitudes and intentions were assessed using questionnaires before and after the educational activities. SETTING: Ten public nurseries in Nova Lima, Belo Horizonte, Minas Gerais, Brazil, 2015. SUBJECTS: Ninety professionals (fifty in CG; forty in IG) and 169 parents (ninety-seven in CG; seventy-two in IG). RESULTS: After the intervention, there was a significant increase in the mean number of correct responses given by professionals in the IG (12·2 v. 10·7; P=0·001). In addition, there were improvements among the parents of the IG in relation to beliefs (soups and broths do not nourish my child: P=0·012), attitudes (offer meat from the sixth month: P=0·032) and intentions (do not offer soups and broths: P=0·003; offer vegetables: P=0·018; offer meat: P<0·001). CONCLUSIONS: Face-to-face nutritional intervention had a significantly greater effect on the parameters evaluated, indicating the importance of adequate guidance in childcare services to support the introduction of complementary feeding.

Energy expenditure in the immediate postpartum period: Indirect calorimetry versus predictive equations.

OBJECTIVE: The aim of this study was to evaluate the resting energy expenditure (REE) of postpartum women by indirect calorimetry and to provide the most appropriate predictive equations to estimate it. METHODS: This was a cross-sectional study with 79 women in the maternity unit of a Brazilian city hospital. Information regarding age, income, gestational age, and breastfeeding was collected. Height, weight, and body composition were measured. We measured REE by indirect calorimetry and predicted REE using eight equations. Analysis of comparison, correlation, agreement, and accuracy was performed. RESULTS: The median of measured REE was 1224 kcal (95% confidence interval [CI], 1157.4-1330), and the predicted REE ranged from 1213.8 (95% CI, 1207.3-1261.9) to 1553.1 kcal (95% CI, 1430.8-1488.5). No difference was found in REE between mothers who breastfed and those who did not (P = 0.994); however, there was a positive correlation with lean mass (r = 0.336; P = 0.003) and weight (r = 0.237; P = 0.036). The best predictor of REE was the Harris Benedict equation, with lower difference (P = 0.876), better median of adequacy (99.8%), and better interclass correlation coefficient (0.289). The Schofield equation was next, with greater percentage of accuracy (33.3%) and lower opposite agreement (7.6%). CONCLUSIONS: All predictive equations showed low agreement and accuracy, and, in most cases, the results were overestimated. These findings indicate the need for continued studies to propose more suitable methods to determine the energy requirements for this population.