Cardiometabolic evaluation of small for gestational age children: protective effect of breast milk.

INTRODUCTION: Introduction: human growth is the result of an interaction between genetic, hormonal, nutritional, and environmental factors. It is not yet fully understood what is predominant and decisive in determining an individual's weight and height. Objective: the aim of this study was to evaluate the cardiometabolic profile of exclusively breastfed children born small for gestational age (SGA). Methods: this is a prospective cohort study of children born at term who were classified as SGA, and as appropiate for gestational age (AGA), who were followed up to pre-school age. Anthropometric measures and body composition parameters were obtained. Breastfeeding duration was calculated in days, and achievement of catch up of weight was considered an increase in Z-score ≥ 0.67. The cardiometabolic profile was evaluated in the first month of life and repeated at pre-school age. At pre-school age, fasting blood glucose, insulin, HOMA-IR, and blood pressure were measured. Results: twenty SGA and 12 AGA children were studied. The mean duration of exclusive breastfeeding (EBF) was 180 days in both groups. Of SGA children, 85 % had recovery anthropometric parameters for age within the first six months, with a speed of weight gain significantly higher than the that of AGAs (p < 0.001). SGAs continued to be thinner and smaller than AGAs at pre-school age. There was no diagnosis of overweight or obesity in the studied sample, and no differences were foun between groups in laboratory tests. Conclusion: these findings suggest that EBF may confer protection until pre-school age in children born SGA, who are considered at higher risk for chronic non-communicable diseases.

INTRODUCCIÓN: Introducción: el crecimiento humano es el resultado de la interacción de factores genéticos, hormonales, nutricionales y ambientales. Todavía no se comprende completamente lo que es predominante y decisivo para determinar el peso y la altura del individuo. Objetivo: el objetivo de este estudio fue evaluar el perfil cardiometabólico de niños alimentados con lactancia materna exclusivamente y que nacieron pequeños para la edad gestacional (PEG). Métodos: este es un estudio de cohortes prospectivo con niños nacidos a término, unos clasificados como PEG y otros como apropiados para la edad gestacional (AEG). Se hizo un seguimiento de estos niños hasta la edad preescolar. Se realizaron medidas antropométricas y de la composición corporal. La duración de la lactancia materna se calculó en días y el éxito en la recuperación del peso se consideró como un aumento de la puntuación Z ≥ 0,67. El perfil cardiometabólico se evaluó en el primer mes de vida y se repitió en la edad preescolar. En la edad preescolar se midieron la glucosa en sangre en ayunas, la insulina, el HOMA-IR y la presión arterial. Resultados: el grupo del estudio estaba formado por veinte niños PEG y doce niños AEG. La duración media de la lactancia materna exclusiva (LME) fue de 180 días en ambos grupos. De los niños PEG, el 85 % tenían parámetros antropométricos de recuperación para la edad en los primeros seis meses, siendo la velocidad del aumento de peso significativamente mayor que en los AEG (p < 0,001). Aun así, los niños PEG continuaron siendo más delgados y pequeños que los AEG en la edad preescolar. No hubo diagnóstico de sobrepeso u obesidad en la muestra estudiada, y no hay diferencia entre los grupos relativos a las pruebas de laboratorio. Conclusión: estos hallazgos sugieren que la LME puede conferir protección hasta la edad preescolar en los niños nacidos PEG, que se consideran en mayor riesgo de contraer enfermedades crónicas no transmisibles.

SARS-CoV-2 infection in pregnant women and newborns in two maternity hospitals in Salvador-Bahia, Brazil.

The outbreak of the new coronavirus (SARS-CoV-2) causing the coronavirus disease (COVID-19) has spread globally. As of June 18, 2020, a high maternal mortality rate due to SARS-CoV-2 infections was identified in Brazil, representing most of the world cases at that time. An observational, cross-sectional study was performed with pregnant women admitted in two maternity hospitals located in Salvador/Bahia and their newborns, from May 24th up to July 17th of 2020. Among 329 pregnant women enrolled at hospital admission, a high prevalence (n=28; 8.5%) of pregnant women with COVID-19 was observed, as well as a high proportion of asymptomatic cases (n=19; 67.9%). Two newborns had detectable SARS-CoV-2 but evolved without abnormalities. This data highlight the importance of identifying pregnant women with COVID-19 for proper isolation measures to prevent in-hospital transmission.

Breastfeeding in children born small for gestational age and future nutritional and metabolic outcomes: a systematic review.

OBJECTIVE: To systematically review evidence related to nutritional and cardiometabolic outcomes in children born at term and small for gestational age and the association with breastfeeding. SOURCE OF DATA: Two independent reviewers searched the MEDLINE, LILACS, SciELO, and Embase databases without time or language restrictions. The PRISMA tool was used, and studies that evaluated infants born at term and small for gestational age, breastfed, and with an evaluation of cardiometabolic outcomes were included. Studies with preterm infants, those that did not have information on breastfeeding, and those with lack of evaluation of the outcome variables were excluded. Also excluded were review articles, editorials, and series of cases. SUMMARY OF DATA: Only seven articles were found that met the abovementioned criteria. There was a great variability in the type of evaluation, as well as in the age of these children. It was demonstrated that breastfeeding promoted growth without body composition alteration and without increased insulin resistance in children with exclusive breastfeeding, when compared to children receiving a higher calorie formula, except for one article that observed an increase in fat mass in exclusively breastfed children. CONCLUSION: Breastfeeding seems to be a safe feeding practice for infants born at term and small for gestational age, showing no association with deleterious short-term outcomes. Breastfeeding stimulation in these populations seems to be a way of preventing the health problems associated with the high risk of chronic noncommunicable diseases and obesity.

Cardiometabolic evaluation of small for gestational age children: protective effect of breast milk / Evaluación cardiometabólica de niños pequeños para su edad gestacional: efecto protector de la leche materna

INTRODUCTION: human growth is the result of an interaction between genetic, hormonal, nutritional, and environmental factors. It is not yet fully understood what is predominant and decisive in determining an individual's weight and height. OBJECTIVE: the aim of this study was to evaluate the cardiometabolic profile of exclusively breastfed children born small for gestational age (SGA). METHODS: this is a prospective cohort study of children born at term who were classified as SGA, and as appropiate for gestational age (AGA), who were followed up to pre-school age. Anthropometric measures and body composition parameters were obtained. Breastfeeding duration was calculated in days, and achievement of catch up of weight was considered an increase in Z-score ≥ 0.67. The cardiometabolic profile was evaluated in the first month of life and repeated at pre-school age. At pre-school age, fasting blood glucose, insulin, HOMA-IR, and blood pressure were measured. RESULTS: twenty SGA and 12 AGA children were studied. The mean duration of exclusive breastfeeding (EBF) was 180 days in both groups. Of SGA children, 85 % had recovery anthropometric parameters for age within the first six months, with a speed of weight gain significantly higher than the that of AGAs (p < 0.001). SGAs continued to be thinner and smaller than AGAs at pre-school age. There was no diagnosis of overweight or obesity in the studied sample, and no differences were foun between groups in laboratory tests. CONCLUSION: these findings suggest that EBF may confer protection until pre-school age in children born SGA, who are considered at higher risk for chronic non-communicable diseases

INTRODUCCIÓN: el crecimiento humano es el resultado de la interacción de factores genéticos, hormonales, nutricionales y ambientales. Todavía no se comprende completamente lo que es predominante y decisivo para determinar el peso y la altura del individuo. OBJETIVO: el objetivo de este estudio fue evaluar el perfil cardiometabólico de niños alimentados con lactancia materna exclusivamente y que nacieron pequeños para la edad gestacional (PEG). MÉTODOS: este es un estudio de cohortes prospectivo con niños nacidos a término, unos clasificados como PEG y otros como apropiados para la edad gestacional (AEG). Se hizo un seguimiento de estos niños hasta la edad preescolar. Se realizaron medidas antropométricas y de la composición corporal. La duración de la lactancia materna se calculó en días y el éxito en la recuperación del peso se consideró como un aumento de la puntuación Z ≥ 0,67. El perfil cardiometabólico se evaluó en el primer mes de vida y se repitió en la edad preescolar. En la edad preescolar se midieron la glucosa en sangre en ayunas, la insulina, el HOMA-IR y la presión arterial. RESULTADOS: el grupo del estudio estaba formado por veinte niños PEG y doce niños AEG. La duración media de la lactancia materna exclusiva (LME) fue de 180 días en ambos grupos. De los niños PEG, el 85 % tenían parámetros antropométricos de recuperación para la edad en los primeros seis meses, siendo la velocidad del aumento de peso significativamente mayor que en los AEG (p < 0,001). Aun así, los niños PEG continuaron siendo más delgados y pequeños que los AEG en la edad preescolar. No hubo diagnóstico de sobrepeso u obesidad en la muestra estudiada, y no hay diferencia entre los grupos relativos a las pruebas de laboratorio. CONCLUSIÓN: estos hallazgos sugieren que la LME puede conferir protección hasta la edad preescolar en los niños nacidos PEG, que se consideran en mayor riesgo de contraer enfermedades crónicas no transmisibles

SARS-CoV-2 infection in pregnant women and newborns in two maternity hospitals in Salvador-Bahia, Brazil

ABSTRACT The outbreak of the new coronavirus (SARS-CoV-2) causing the coronavirus disease (COVID-19) has spread globally. As of June 18, 2020, a high maternal mortality rate due to SARS-CoV-2 infections was identified in Brazil, representing most of the world cases at that time. An observational, cross-sectional study was performed with pregnant women admitted in two maternity hospitals located in Salvador/Bahia and their newborns, from May 24th up to July 17th of 2020. Among 329 pregnant women enrolled at hospital admission, a high prevalence (n=28; 8.5%) of pregnant women with COVID-19 was observed, as well as a high proportion of asymptomatic cases (n=19; 67.9%). Two newborns had detectable SARS-CoV-2 but evolved without abnormalities. This data highlight the importance of identifying pregnant women with COVID-19 for proper isolation measures to prevent in-hospital transmission.

Erratum: Congenital Chikungunya Virus Infection after an Outbreak in Salvador, Bahia, Brazil.

[This corrects the article DOI: 10.1055/s-0036-1587323.].

Breastfeeding in children born small for gestational age and future nutritional and metabolic outcomes: a systematic review / Aleitamento materno em crianças nascidas pequenas para idade gestacional e os desfechos nutricionais e metabólicos futuros: revisão sistemática

Abstract Objective: To systematically review evidence related to nutritional and cardiometabolic outcomes in children born at term and small for gestational age and the association with breastfeeding. Source of data: Two independent reviewers searched the MEDLINE, LILACS, SciELO, and Embase databases without time or language restrictions. The PRISMA tool was used, and studies that evaluated infants born at term and small for gestational age, breastfed, and with an evaluation of cardiometabolic outcomes were included. Studies with preterm infants, those that did not have information on breastfeeding, and those with lack of evaluation of the outcome variables were excluded. Also excluded were review articles, editorials, and series of cases. Summary of data: Only seven articles were found that met the abovementioned criteria. There was a great variability in the type of evaluation, as well as in the age of these children. It was demonstrated that breastfeeding promoted growth without body composition alteration and without increased insulin resistance in children with exclusive breastfeeding, when compared to children receiving a higher calorie formula, except for one article that observed an increase in fat mass in exclusively breastfed children. Conclusion: Breastfeeding seems to be a safe feeding practice for infants born at term and small for gestational age, showing no association with deleterious short-term outcomes. Breastfeeding stimulation in these populations seems to be a way of preventing the health problems associated with the high risk of chronic noncommunicable diseases and obesity.

Resumo Objetivo: Revisar sistematicamente as evidências relacionadas aos desfechos nutricionais e cardiometabólicos em crianças nascidas a termo e pequenas para idade gestacional e a relação com o aleitamento materno. Fonte de dados: Dois revisores independentes fizeram buscas nas bases de dados MEDLINE,LILACS, SciELO, EMBASE sem restrições de tempo ou idioma. Foi usada a ferramenta PRISMA sendo incluídos estudos que avaliaram crianças nascidas a termo e pequenas para idade gestacional, amamentadas e com avaliação dos desfechos cardiometabólicos. Foram excluídos estudos com prematuros, aqueles que não trouxessem informação do aleitamento materno, ausência de avaliação das variáveis de desfecho. Também não foram incluídos artigos de revisão, editorial e série de casos. Síntese dos dados: Foram encontrados apenas sete artigos que preencheram os critérios citados acima. Houve uma grande variabilidade na forma de avaliação, assim como na idade dessas crianças. Foi evidenciado que o aleitamento materno promoveu crescimento sem alteração de composição corporal e sem resistência insulínica aumentada nas crianças com aleitamento materno exclusivo, quando comparadas com crianças que receberam fórmula láctea de maior teor calórico, exceto por um artigo que observou aumento de massa gorda nos amamentados exclusivamente. Conclusão: Aleitamento materno parece ser uma forma segura de alimentação para crianças nascidas a termo e pequenas para idade gestacional sem associação com desfechos deletérios em curto prazo. O estímulo ao aleitamento materno nessas populações parece ser um caminho de prevenção aos agravos à saúde associados ao alto risco de doenças crônicas não transmissíveis e à obesidade.

Hepatitis B viral markers in banked human milk before and after Holder pasteurization.

BACKGROUND: Blood screening for hepatitis B virus (HBV) is not universally performed for donor selection in human milk banks. OBJECTIVES: To evaluate the frequency of detection of HBV surface antigen (HBsAg) and HBV-DNA in colostrum of HBV-infected nursing mothers before and after Holder pasteurization. STUDY DESIGN: Forty-two concentrated breast milk samples were obtained within two postnatal weeks from 24 HBsAg-positive women (4 HBeAg-positive and 20 HBeAg-negative, anti-HBe-positive) were tested for the presence of HBsAg and HBV-DNA before and after Holder pasteurization (30min at 62.5 degrees C). RESULTS: Before pasteurization, HBsAg and HBV-DNA were found in 14/24 (58%), and 20/24 (75%) first milk samples, respectively, obtained by 4 days after delivery. At least one marker was detected in 20/24 (83%) milk samples. Both markers were identified in milk of HBeAg-positive mothers, and most mothers with anti-HBe in blood had at least one HBV marker. Once detected, viral markers were frequently found in milk samples subsequently obtained from the same woman. Holder pasteurization did not affect the probability of detecting HBsAg (8/18, 44%), HBV-DNA (12/18, 67%), or at least one of them (15/18, 83%). CONCLUSIONS: Although the biological implications of these findings remain to be determined, considering that HBV is highly contagious and most recipients of banked human milk are preterm infants, these findings should be taken into account when donors are enlisted for human milk banks without serological screening.

Staphylococcus aureus sensíveis à meticilina provenientes de leite mastítico no Estado do Rio de Janeiro / Methicillin susceptible Staphylococcus aureus from mastitic milk in Rio de Janeiro State, Brazil

Em um total de 364 vacas portadoras de mastite subclínica e 1398 quartos mamários examinados, 555 amostras de leite foram coletadas durante os anos de 1996 e 1997 de 64 propriedades, em 15 municípios da regiäo Norte/Noroeste do Estado do Rio de Janeiro. As amostras de leite foram testadas a partir de CMT (California Mastitis Test) e 128 cepas de Staphylococcus aureus foram isoladas e identificadas após análise de rotina laboratorial. Antibiogramas foram realizados, testando-se 15 antibióticos diferentes para definir o padräo de sensibilidade. Nos testes para os b-lactâmicos 96,1 por cento das cepas foram resistentes (R), nenhuma cepa se enquadrou na faixa intermediária (I) e 3,9 por cento mostraram sensibilidade (S) à penicilina; seus derivados semi-sintéticos foram oxacilina 87,0 R, 5,3 por cento I e 7,6 por cento S; ampicilina 99,2 R e 0,8 por cento S e nenhuma intermediária, amoxicilina 88,2 por cento R, 9,8 por cento I e 2,0 S; para os b-lactâmicos cefalotina 96 por cento S, 0,9 por cento R, 3,1 por cento I e cefoxitina 71,6 por cento S, 5,5 por cento R e 22,8 por cento I. Todas as cepas foram 100 por cento sensíveis à gentamicina, sulfazotrim e vancomicina. Nenhuma das cepas isoladas foi resistente à meticilina quando utilizada a concentraçäo padräo de 25mg/mL da droga para testes de cepas de origem humana (clone brasileiro MRSA III::B:A).