OBJECTIVE

This study aimed to investigate the determinants linked to stunting among infants and young children aged 0-23 months in the Fourth District of Camarines Sur.

An analytical cross-sectional study was conducted among 628 primary caregivers with infants and young children aged 0-23 months in four municipalities of the Fourth District of Camarines Sur, Philippines, using a two stage stratified random sampling design. Data on sociodemographic and economic factors were collected through face-to-face interviews. Infant and young child feeding (IYCF) indicators were assessed using a list-based approach, while weight and length were evaluated using the World Health Organization Anthro Plus software. Descriptive statistics and multiple logistic regression were done using R statistical software version 4.3.1.

The study revealed that the prevalence of stunting was of significant public health concern, reaching 42.8%. Holding other variables constant, age of the child (OR=0.77; 95% CI: 0.63-0.94), having college undergraduate mothers (OR=0.26; 95% CI: 0.05-1.28), and belonging to a poor income household (OR=0.40; 95% CI: 0.14-0.88) were associated with stunting among infants aged 0.01-6.00 months. Moreover, after controlling for the confounding effects of other variables, age (OR=1.09; 95% CI: 1.05-1.14) and sex of the child (OR=1.55; 95% CI: 1.05-2.28) were associated with stunting among older children aged 6.00-23.99 months.

This study emphasizes the challenge of stunting in the Fourth District of Camarines Sur. None of the IYCF indicators were associated with stunting; however, maternal education, the child’s age, sex, and socioeconomic status were identified as significant factors influencing stunting. Addressing these determinants through targeted interventions focusing on improving maternal education and enhancing socio-economic conditions were crucial to reducing stunting in the study areas.

Objective: This study aimed to investigate the determinants linked to stunting among infants and young children aged 0-23 months in the Fourth District of Camarines Sur. Methods: An analytical cross-sectional study was conducted among 628 primary caregivers with infants and young children aged 0-23 months in four municipalities of the Fourth District of Camarines Sur, Philippines, using a twostage stratified random sampling design. Data on sociodemographic and economic factors were collected through face-to-face interviews. Infant and young child feeding (IYCF) indicators were assessed using a list-based approach, while weight and length were evaluated using the World Health Organization Anthro Plus software. Descriptive statistics and multiple logistic regression were done using R statistical software version 4.3.1. Results: The study revealed that the prevalence of stunting was of significant public health concern, reaching 42.8%. Holding other variables constant, age of the child (OR=0.77; 95% CI: 0.63-0.94), having college undergraduate mothers (OR=0.26; 95% CI: 0.05-1.28), and belonging to a poor income household (OR=0.40; 95% CI: 0.14-0.88) were associated with stunting among infants aged 0.01-6.00 months. Moreover, after controlling for the confounding effects of other variables, age (OR=1.09; 95% CI: 1.05-1.14) and sex of the child (OR=1.55; 95% CI: 1.05-2.28) were associated with stunting among older children aged 6.00-23.99 months. Conclusion This study emphasizes the challenge of stunting in the Fourth District of Camarines Sur. None of the IYCF indicators were associated with stunting; however, maternal education, the child’s age, sex, and socioeconomic status were identified as significant factors influencing stunting. Addressing these determinants through targeted interventions focusing on improving maternal education and enhancing socio-economic conditions were crucial to reducing stunting in the study areas.
Human ; growth disorders ; risk factors ; nutritional status ; infant nutrition disorders

OBJECTIVES: To study the relationship between early parenteral nutrient intake and the development of bronchopulmonary dysplasia (BPD) in preterm infants with gestational age less than 32 weeks who could not receive enteral nutrition within one week after birth. METHODS: A retrospective study was conducted on preterm infants born between October 2017 and August 2022 with gestational age less than 32 weeks who were admitted to the Neonatal Intensive Care Unit in Children's Hospital of Soochow University within 24 hours after birth and relied solely on parenteral nutrition within the first week of life. The study population included 79 infants with BPD and 73 infants without BPD. Clinical data during hospitalization were compared between the two groups. RESULTS: The proportions of infants with weight loss of more than 10% after birth, extrauterine growth retardation, and parenteral nutrition-associated cholestasis in the BPD group were higher than in the non-BPD group (P<0.05). The time to regain birth weight, time to achieve full enteral feeding, and corrected gestational age at discharge were longer in the BPD group than in the non-BPD group. The Z-scores of physical growth at corrected gestational age of 36 weeks were lower in the BPD group than in the non-BPD group (P<0.05). The BPD group had a higher fluid intake and a lower calories intake in the first week than the non-BPD group (P<0.05). The starting dose and total amount of amino acids, glucose, and lipids in the first week were lower in the BPD group than in the non-BPD group (P<0.05). The BPD group had a higher glucose-to-lipid ratio on the third day and higher energy-to-nitrogen and glucose-to-lipid ratios on the seventh day after birth than the non-BPD group (P<0.05). CONCLUSIONS Preterm infants with BPD had lower intake of amino acids and lipids and a lower proportion of calories provided by amino acids and lipids in the first week of life, which suggests an association between early parenteral nutrition intake and the development of BPD.
Infant ; Child ; Infant, Newborn ; Humans ; Infant, Premature ; Bronchopulmonary Dysplasia/therapy* ; Retrospective Studies ; Gestational Age ; Amino Acids ; Parenteral Nutrition/adverse effects* ; Glucose ; Lipids

OBJECTIVES: To explore the value of the combined use of aspartate aminotransferase-to-platelet ratio index (APRI) and total bile acid (TBA) for predicting parenteral nutrition-associated cholestasis (PNAC) in preterm infants with gestational age <34 weeks. METHODS: A retrospective analysis was performed on medical data of 270 preterm infants born at <34 weeks of gestation who received parenteral nutrition (PN) during hospitalization in the First Affiliated Hospital of Wannan Medical College from January 2019 to September 2022, including 128 infants with PNAC and 142 infants without PNAC. The medical data between the two groups were compared, and predictive factors for the development of PNAC were explored through multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the value of APRI alone, TBA alone, and the combination of both for predicting PNAC. RESULTS: TBA levels in the PNAC group after 1, 2, and 3 weeks of PN were higher than those in the non-PNAC group (P<0.05). APRI in the PNAC group after 2 and 3 weeks of PN was higher than that in the non-PNAC group (P<0.05). Multivariate logistic regression analysis showed that elevated APRI and TBA after 2 weeks of PN were predictive factors for PNAC in preterm infants (P<0.05). ROC curve analysis showed that the sensitivity, specificity, and area under the curve (AUC) for predicting PNAC by combining APRI and TBA after 2 weeks of PN were 0.703, 0.803, and 0.806, respectively. The AUC for predicting PNAC by combining APRI and TBA was higher than that of APRI or TBA alone (P<0.05). CONCLUSIONS After 2 weeks of PN, the value of combining APRI and TBA for predicting PNAC is high in preterm infants with gestational age <34 weeks.
Infant, Newborn ; Infant ; Humans ; Gestational Age ; Infant, Premature ; Retrospective Studies ; Bile Acids and Salts ; Parenteral Nutrition ; Transaminases

OBJECTIVE: To investigate whether dynamic monitoring of citrulline (Cit) has guiding value for early enteral nutrition (EN) in patients with severe gastrointestinal injury. METHODS: A observational study was conducted. A total of 76 patients with severe gastrointestinal injury admitted to different intensive care units of Suzhou Hospital Affiliated to Nanjing Medical University from February 2021 to June 2022 were enrolled. Early EN was performed in 24-48 hours after admission as recommended by the guidelines. Those who did not terminate EN after 7 days were enrolled in the early EN success group, and those who terminated EN within 7 days due to persistent feeding intolerance or deterioration of general condition were enrolled in the early EN failure group. There was no intervention during the treatment. Serum Cit levels were measured by mass spectrometry at admission, before EN starting and EN 24 hours, respectively, and the changes in Cit within EN 24 hours (ΔCit) were calculated (ΔCit = EN 24-hour Cit-Cit before EN starting). Receiver operator characteristic curve (ROC curve) was plotted to investigate the predictive value of ΔCit for early EN failure, and the optimal predictive value was calculated. Multivariate unconditional Logistic regression was used to analyze the independent risk factors for early EN failure and death at 28 days. RESULTS: Seventy-six patients were enrolled in the final analysis, of which 40 succeeded in early EN and 36 failed. There were significant differences in age, main diagnosis, acute physiology and chronic health evaluation II (APACHE II) score at admission, blood lactic acid (Lac) before EN initiation and ΔCit between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 0.929, 95% confidence interval (95%CI) was 0.874-0.988, P = 0.018], ΔCit (OR = 2.026, 95%CI was 1.322-3.114, P = 0.001) and increased feeding rate within 48 hours (OR = 13.719, 95%CI was 1.795-104.851, P = 0.012) were independent risk factors for early EN failure in patients with severe gastrointestinal injury. ROC curve analysis showed that ΔCit had a good predictive value for early EN failure in patients with severe gastrointestinal injury [area under the ROC curve (AUC) = 0.787, 95%CI was 0.686-0.887, P < 0.001], and the optimal predictive value of ΔCit was 0.74 μmol/L (sensitivity was 65.0%, specificity was 75.0%). Combined with the optimal predictive value of ΔCit, "overfeeding" was defined as ΔCit < 0.74 μmol/L and increased feeding within 48 hours. Multivariate Logistic regression analysis showed that age (OR = 0.825, 95%CI was 0.732-0.930, P = 0.002), APACHE II score (OR = 0.696, 95%CI was 0.518-0.936, P = 0.017) and early EN failure (OR = 181.803, 95%CI was 3.916-8 439.606, P = 0.008) were independent risk factors for 28-day death in patients with severe gastrointestinal injury. The new variable "overfeeding" was also associated with an increased risk of death at 28 days (OR = 27.816, 95%CI was 1.023-755.996, P = 0.048). CONCLUSIONS Dynamic monitoring of Cit has guiding value for early EN in patients with severe gastrointestinal injury.
Humans ; Infant, Newborn ; Enteral Nutrition ; Citrulline ; APACHE ; Abdominal Injuries ; Cognition ; Thoracic Injuries

Objective: To explore the risk factors of malnutrition in infants with congenital heart disease within one year after surgery. Methods: This retrospective cohort study selected 502 infants with congenital heart disease who underwent surgical treatment in Guangzhou Women and Children's Medical Center from February 2018 to January 2019. Their basic information and clinical data were analyzed, and their nutrition status after the surgery was followed up by questionnaire survey. Weight-for-age Z score (WAZ)≤-2 one year after operation was defined as malnutrition group, and WAZ>-2 was non-malnutrition group. The perioperative indicators and complementary food advancement were compared between the two groups by chi-square test, t-test, and Kruskal-Wallis test. The risk factors of malnutrition were analyzed by Logistic regression. Results: A total of 502 infants were selected, including 301 males and 201 females, with the age of 4.1 (2.0, 6.8) months. There were 90 cases in malnutrition group and 412 cases in non-malnutrition group. The body length and weight at birth in the malnutrition group were lower than those in the non-malnutrition group ((47.8±3.8) vs. (49.3±2.5) cm, (2.7±0.6) vs.(3.0±0.5) kg, both P<0.001). The proportion of paternal high school education or above and the proportion of family per capita income of 5 000 yuan or above in the malnutrition group were lower than those in the non-malnutrition group ((18.9% (17/90) vs. 30.8% (127/412), 18.9% (17/90) vs. 33.7% (139/412), both P<0.05). Compared to the non-malnutrition group, the proportion of complex congenital heart disease in the malnutrition group was higher (62.2% (56/90) vs. 47.3% (195/412), P<0.05). The postoperative mechanical ventilation time, postoperative intensive care unit (ICU) stay time, postoperative hospital stay, total length of ICU stay and total hospital stay in the malnutrition group were significantly longer than those in non-malnutrition group (all P<0.05). The proportion of egg and fish supplementation over 2 times/week within one year after the surgery was also lower in the malnutrition group (both P<0.05). Logistic regression analysis showed that mother's weight at delivery (OR=0.95,95%CI 0.91-0.99), the pre-operative WAZ≤-2 (OR=6.04, 95%CI 3.13-11.65), the complexity of the cardiac disease (OR=2.23, 95%CI 1.22-4.06), the hospital stay after the surgery over 14 days (OR=2.61, 95%CI 1.30-5.26), the types of complementary food<4 (OR=2.57, 95%CI 1.39-4.76), and the frequency of meat and fish<2 times/week (OR=2.11, 95%CI 1.13-3.93) were the risk factors associated with malnutrition within one year after the surgery. Conclusion: Mother's weight at delivery pre-operative nutritional status, complexity of cardiac disease, postoperative hospital stay, types of daily supplements and frequency of fish are risk factors associated with malnutrition within one year after surgery in children with congenital heart disease.
Male ; Humans ; Female ; Cardiac Surgical Procedures ; Retrospective Studies ; Malnutrition/complications* ; Heart Defects, Congenital/surgery* ; Risk Factors ; Length of Stay ; Infant Nutrition Disorders/complications*

BACKGROUND: Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients. METHODS: We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis. RESULTS: The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064-3.493, P  = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115-10.707, P  = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233-3.456, P  = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108-18.228, P  = 0.001) in the ICU patients. CONCLUSIONS FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.
Critical Illness ; Enteral Nutrition/adverse effects* ; Humans ; Infant, Newborn ; Intensive Care Units ; Prevalence ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Vomiting/etiology*

Objectives: To compare the clinical outcomes of rapid versus slow enteral feeding advancement in preterm low birth weight neonates.

Methods: Searches for randomized controlled trials evaluating the effect of rapid versus slow rate of enteral feeding advancement on the clinical outcomes of preterm, low birth weight neonates were performed in different databases. Two authors screened the articles for inclusion and statistical analysis was done using Review Manager Version 5.3 (RevMan) software.

Results: Six trials with a total of 680 subjects comparing enteral feeding advancement protocols were identified. The number of days to reach full feeds in rapid enteral feeding was shorter by 2.79 days (95% CI 1.39, 4.19) and time to regain weight by 3.72 days (95% CI 2.86, 4.59) compared to slow enteral feeding. There was no significant difference in the incidence of feeding intolerance (OR 0.69, 95% CI 0.42, 1.11) and NEC (OR 0.88, 95% CI 0.45, 1.72) between the two groups.

Conclusions: Rapid enteral feeding protocols reduce the time to establish full enteral feeds and to regain birth weight in preterm low birth weight neonates. Rapid enteral feeding may facilitate early discharge and help reduce hospital costs for the care of these neonates.

OBJECTIVES: To investigate whether evidence-based standardized nutrition protocol can facilitate the establishment of full enteral nutrition and its effect on short-term clinical outcomes in very preterm/very low birth weight infants. METHODS: A retrospective analysis was performed on the medical data of 312 preterm infants with a gestational age of ≤32 weeks or a birth weight of <1 500 g. The standardized nutrition protocol for preterm infants was implemented in May 2020; 160 infants who were treated from May 1, 2019 to April 30, 2020 were enrolled as the control group, and 152 infants who were treated from June 1, 2020 to May 31, 2021 were enrolled as the test group. The two groups were compared in terms of the time to full enteral feeding, the time to the start of enteral feeding, duration of parenteral nutrition, the time to recovery to birth weight, the duration of central venous catheterization, and the incidence rates of common complications in preterm infants. RESULTS: Compared with the control group, the test group had significantly shorter time to full enteral feeding, time to the start of enteral feeding, duration of parenteral nutrition, and duration of central venous catheterization and a significantly lower incidence rate of catheter-related bloodstream infection (P<0.05). There were no significant differences between the two groups in the mortality rate and the incidence rate of common complications in preterm infants including grade II-III necrotizing enterocolitis (P>0.05). CONCLUSIONS Implementation of the standardized nutrition protocol can facilitate the establishment of full enteral feeding, shorten the duration of parenteral nutrition, and reduce catheter-related bloodstream infection in very preterm/very low birth weight infants, without increasing the risk of necrotizing enterocolitis.
Birth Weight ; Enteral Nutrition/methods* ; Enterocolitis, Necrotizing/prevention & control* ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Very Low Birth Weight ; Retrospective Studies ; Sepsis/epidemiology*

Bronchopulmonary dysplasia (BPD) is a chronic lung disease due to impaired pulmonary development and is one of the main causes of respiratory failure in preterm infants. Preterm infants with BPD have significantly higher complication and mortality rates than those without BPD. At present, comprehensive management is the main intervention method for BPD, including reasonable respiratory and circulatory support, appropriate enteral nutrition and parenteral nutrition, application of caffeine/glucocorticoids/surfactants, and out-of-hospital management after discharge. The continuous advances in stem cell medicine in recent years provide new ideas for the treatment of BPD. Various pre-clinical trials have confirmed that stem cell therapy can effectively prevent lung injury and promote lung growth and damage repair. This article performs a comprehensive analysis of the mechanism of mesenchymal stem cells in the treatment of BPD, so as to provide a basis for clinical applications.
Bronchopulmonary Dysplasia/prevention & control* ; Enteral Nutrition ; Humans ; Infant, Newborn ; Infant, Premature ; Lung ; Mesenchymal Stem Cells