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Nutrition And The 0 6 Months Infants (Final)

Sep 03, 2014



  • Dr. K P Kushwaha Prof & Head, BRD Medical College, Gorakhpur Nutrition and the 0-6 Months Infants
  • Evidence classification
    • Evidence class
    • Class I
    • Class II
    • Class III
    • Criteria for evidence
    • Randomized control trial ;at least one
    • Well organized control trials without randomization, cohort or case control ,cross sectional, retrospective ;more than one
    • Case reports, reports of expert comittees, guidelines,
  • Infant feeding Recommendations (Global strategies for Infant & Young Child Feeding)
    • Exclusive breastfeeding form birth to 6 months
    • Appropriate complementary feeding after 6 months + Breastfeeding
    • Sustaining breastfeeding for 2 years and beyond
    • Related maternal, nutrition & care
    • Building community support and health system support protecting infant feeding practices from commercial influences
  • Infant feeding Recommendations (Global strategies for Infant & Young Child Feeding)
    • Preterm, ELBW, VLBW and above 1600gm. All need breastmilk.
    • Feeding method and approaches are varied.
  • HIV :2000 and 2006 WHO Recommendations
    • Exclusive breastfeeding is recommended for HIV-infected women for the first 6 months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time.
    • When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected women is recommended
    • When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended.
    • Otherwise, exclusive breastfeeding is recommended during the first months of life.
  • IYCF Practices-India
    • Initiation with in 1 Hr
    • Exclusive Breastfeeding
    • Timely (appropriate ?) complement
    • Sustained breastfeeding 2 years and beyond
    • 23.4
    • 46.3
    • 55.8
    • 38.4
    Source: NHFS-3 Slide ( Squeezing and discarding of colostrum and prelacteal feeds are quite common)
  • Trends in Nutritional Status Percent of children age under 3 years (Low-height-for-age) (Low-weight-for-height) (Low-weight-for- age) Slide Source: NHFS-2 & 3
  • Anaemia among Children Percent of children 6-35 months with anaemia Slide
  • How Many Children Receive Services from an AWC? ICDS (??? 0 6 yrs ) Percent of age-eligible children in areas with an AWC Slide How many 0-6 ms are being looked after? Source: NHFS-3
  • Benefits to Baby (evidence class I III)
    • Optimum growth
    • Brain growth
    • Reduce risk for:
      • Undernutrition
      • Upper and lower respiratory infections
      • Otitis media (ear infections)
      • Urinary tracts
      • Sytemic Infections
      • Gastroenteritis
      • Allergies
      • Overweight/obesity
      • SIDS
  • Why Breast milk for preterm
    • To Protect
        • Infections
        • NEC
    • To Provide
        • PUFA, growth factors, hormone, tropic factors
        • Better visual and cognitive development
    • To Involve mother in care, including KMC
    • To Provide nutrition's with high bio availability
    Slide Evidence class I
  • Lancet 2004;363:1571-8 Singhal A, Cole TJ, Lucas A Breastmilk and Lipoprotein profile in adolescents born preterm: Followup of a prospective randomised study (n=926) Slide Evidence class I
  • Breast milk composition differences (dynamic)
    • Gestational age at birth (preterm and full term)
    • Stage of lactation (colustrum and mature milk)
    • During a feed (foremilk and hindmilk)
    Slide Evidence class I
  • Slide
  • Slide
  • Colostrum ( evidence class I-III )
    • Property
    • Antibody-rich
    • Many white cells
    • Purgative
    • Growth factors
    • Vitamin-A rich
    • Importance
    • protects against infection and allergy
    • protects against infection
    • clears meconium; helps prevent jaundice
    • helps intestine mature; prevents allergy, intolerance
    • reduces severity of some infection (such as measles and diarrhoea); prevents vitamin A-related eye diseases
  • Slide
  • More Benefits to Baby (When they grow)
    • Reduced risk for:
    • - Dental disorders
      • Diabetes
      • Crohns disease
      • Childhood Leukemia
      • Cardiovascular disease
      • Celiac disease
      • Rheumatoid arthritis
    Slide Evidence class II -III
  • Benefices for Mom
    • Rapid recovery after having a baby
    • Decreases risk of anemia
    • Weight reduction
    • Reduces risk of breast cancer
    • Reduces risk of ovarian cancer
    • May reduce risk of endometrial cancer
    • Reduces risk for osteoporosis
    • Delays next pregnancy
    Slide Evidence class II -III
  • Community Benefits New parents miss Less work Fewer healthcare Visits & lower Treatment costs Breast milk is a Natural and Renewable resource Slide Evidence class III
  • Breastfeeding prevents under nutrition and obesity
    • Under nutrition 40-50%
    • Obesity 50%
    • Evidence class II-III
  • Breastfeeding decreases the prevalence of obesity in childhood at age five and six years, Germany Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity: cross sectional study. BMJ, 1999, 319:147-150. Slide
  • Higher Intelligence quotient ( Evidence class I-II) BF = breastfed FF = formula fed BM = breast milk Slide BF 2.1 points higher than FF Study in 6 months to 2 year- olds 1988 BF 8.3 points higher than FF Study in 7.5-8 year-olds 1992 BF 2 points higher than FF Study in 3-7 year-olds 1982 BM 7.5 points higher than no BM Study in 7.5-8 year-olds 1992 BF 12.9 points higher than FF Study in 9.5 year-olds 1996 References:
    • Fergusson DM et al. Soc
    SciMed 1982
    • Morrow-Tlucak M et al.
    SocSciMed 1988
    • Lucas A et al. Lancet 1992
    • Riva Eet al. Acta Paediatr 1996
  • Potential Child Mortality Reduction from Preventive Interventions Jones et al. How many deaths can we prevent this year? Lancet 2003 Slide Preventive Intervention Number (thousands) Deaths prevented as proportion of all child deaths Breastfeeding 1301 13% Insecticide - treated materials 691 7% Complementary feeding 587 6% Zinc 459 5% H influenzae vaccine 403 4% Antiseptic delivery 411 4% Water, sanitation, hygiene 326 3%
  • The value of breast milk to the national economy in India
    • National production of breast milk by all mothers in India for the children they were breastfeeding at the time of the estimate was about 3944 million liters over 2 yrs.
    • If the breast milk produced were replaced by tinned milk, it would cost 118 billion Rupees.
    • If imported, the breast-milk substitutes would cost 4.7 million USD.
    • If breastfeeding practices were optimal, breast milk production would be twice the current amount, doubling the savings by fully utilizing this national resource.
    Adapted from: Gupta and Khanna. Economic value of breastfeeding in India. The