PubMed · 14101421
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M F LISTON. 1964. PSYCHIATRIC NURSING.. https://doi.org/10.1176/ajp.120.7.682
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Intakes of macronutrients (energy, protein, fat, and carbohydrate) and vitamins (vitamin A, thiamin, riboflavin, niacin, and vitamin C) (per day and per 100 kcal) from complementary foods by a cohort of Filipino breast-fed infants and toddlers (n=1794) were studied at 10, 16, and 22 months of age using a single 24-h recall. With the exception of protein, intakes of energy and vitamins for all age groups were below the World Health Organization estimated needs and desired nutrient densities from complementary foods regardless of breast-feeding frequency. Nutrient deficits were greater for rural children compared with urban children, and were attributed to low intakes of energy, as well as cellular animal protein, fruits and vegetables.
The relation between breastfeeding and childhood cognitive development was examined in 1991-1993 among 439 school-age children weighing <1,500 g when born in the United States between 1991 and 1993. Measures of cognitive function included overall intellectual function, verbal ability, visual-spatial and visual-motor skill, and memory. Higher test scores for each domain of cognitive function except memory were observed among children who were breastfed directly. After covariate adjustment for home environment, maternal verbal ability, a composite measure of parental education and occupation, and length of hospitalization, the authors found that breastfed children evidenced an advantage only for measures specific to visual-motor integration (5.1 intelligence quotient (IQ) points, 95% confidence interval: 1.0, 9.2). Differences in test scores between breastfed children and those who did not receive any breast milk feedings were 3.6 IQ points (95% confidence interval: -0.3, 7.5) for overall intellectual functioning and 2.3 IQ points (95% confidence interval: -3.0, 7.6) for verbal ability. Indicators of social advantage confound the association between breastfeeding and cognitive function, but careful measurement can reduce residual confounding and may clarify causal relations.
Short-course antiretroviral regimens have been evaluated to reduce mother-to-child transmission of HIV in resource-limited settings. This report from Abidjan, Cote d'Ivoire, examines the risk factors for HIV transmission by 1 and 24 months among breast-feeding women. Eligible HIV-1-seropositive pregnant women enrolled in this randomized double-blind clinical trial were randomly assigned to receive either oral zidovudine (ZDV) (n = 126) prophylaxis or placebo (n = 124). Maternal prophylaxis began at 36 weeks of gestation (300 mg ZDV twice daily antepartum and 300 mg every 3 hours intrapartum); there was no neonatal prophylaxis component. The cumulative risk of transmission in the treatment group was 11.9% and 22.1% by 1 and 24 months, respectively. In adjusted analyses, viral load at enrollment was the strongest predictor of transmission (per log increment: odds ratio [OR] = 4.8, 95% confidence interval [CI]: 2.5-9.5 at 1 month; OR = 5.7; 95% CI: 3.1-10.8 at 24 months). Overall, ZDV prophylaxis was not significantly protective for infection at 1 or 24 months. Comparing ZDV with placebo following dichotomization of viral load (<50,000 vs. > or =50,000 copies/mL) at enrollment, however, there was a significant effect of ZDV seen only among those women with a low viral load at enrollment. The substantial risk of transmission despite ZDV prophylaxis, particularly among those with higher viral loads, underscores the need to find more effective regimens appropriate for use in resource-limited settings.