The Effects of Different Feeding Practices on the Nutritional Status of Infants below 12 Months Old in the Kumba 1 Sub-Division

Appropriate feeding practices are important during infancy for good health, growth and development of infants and children. WHO revised its earlier recommendation of Exclusive Breastfeeding (EBF) of infants from 4 to 6 months of age to EBF until about 6 months of age, with the addition of complementary foods thereafter. This recommendation confirms that breast milk alone is sufficient to meet infants’ nutritional requirements for the first 6 months of life. The main objective of this study was to investigate the effect of various feeding practices on the Nutritional status of infants 0 - 12-month-old in the Kumba 1 Sub-Division. A descriptive cross-sectional study was conducted from December 2019 to August 2020. A total of 341 nursing mothers and their infants 0 - 12 months of age were recruited. Socio-demographic factors and the different feeding habits of the children were assessed using a semi-structured questionnaire. Nutritional status was assessed using anthropometric measurements. The overall proportion of infants who exclusively breastfed for 6 months was 69.2% and those who were mix-fed were 30.8% in the study area. The overall prevalence of malnutrition in the population was 61.0%. Among the malnourished children, 53.1% were underweight, 19.6% were wasted and 10.0% were stunted. Though not significant, the prevalence of wasting (21.0%) and underweight (58.3%) was higher among Mix-Fed (MF) children when compared to their EBF counterparts. Feeding practices affected the nutritional status of the infants. Underweight and wasting were observed among infants on Complementary Feeding (CF), although some exclusively breast-fed infants were stunted. Hence, nursing mothers should try as much as possible to practice EBF as recommended by WHO and can practice CF when the child is above six months.

泡沫敷料联合下垫式充气暖风毯在低体重婴幼儿体外循环手术中预防压疮的研究

目的探讨使用泡沫敷料联合下垫式充气暖风毯在低体重婴幼儿体外循环手术中预防压疮的效果。方法将接受体外循环手术治疗的126例先天性心脏病患儿随机分为两组,单纯使用泡沫敷料组63例和联合使用下垫式充气暖风毯组63例,分别统计术后两组枕后、骶尾部、肩胛、颈后部、臀部、背部及双脚外踝等部位发生压疮前期症状的例数和体外循环时间及总手术时间。结果泡沫敷料联合使用下垫式充气暖风毯组的枕后和骶尾部压疮前期症状的发生率(枕后50.8%和骶尾部14.3%)明显低于泡沫敷料组(枕后74.6%和骶尾部39.7%)(枕后χ^2=7.635,P<0.01和骶尾部χ^2=9.063,P<0.01);此外,泡沫敷料联合使用下垫式充气暖风毯组的平均体外循环时间及手术时间分别为78.95±39.40分钟和142.47±54.78分钟,而泡沫敷料组的相应时间分别为83.54±33.01分钟和148.69±49.09分钟,泡沫敷料联合使用下垫式充气暖风毯组的平均体外循环时间及手术时间均较泡沫敷料组短(体外循环时间Z=-2.845,P<0.01和手术总时间Z=-3.078,P<0.01)。结论使用泡沫敷料联合下垫式充气暖风毯在低体重婴幼儿体外循环手术中预防压疮的效果良好,可进一步降低压疮前期症状的发生率。

10kg以下低体重婴幼儿先天性心脏病体外循环管理

目的总结2009年2月～8月36例10 kg以下低体重婴幼儿先天性心脏病体外循环管理方法。方法各种先天性心脏病心内直视手术36例,月龄为1～36个月,平均(10.6±5.3)个月;体重3～10 kg,平均(7.2±1.8)kg。均使用进口膜式氧合器,预充液总量为400～550 ml。浅低温高流量灌注26例,中低温中流量灌注7例,低温低流量灌注2例,DHCA 1例。全部采用4∶1含血心肌保护液。中术及术后采用改良超滤结合常规超滤。结果本组体外循环转流时间为26～192 min,平均73 min,升主动脉阻断时间为9～109 min,平均41 min。转中尿量满意,转流过程平稳,未出现与CPB相关故障和并发症,心脏全部自动复跳,全部顺利脱机。35例痊愈出院,1例死亡。结论低体重婴幼儿应根据病种及手术方式采取不同体外循环方法,尽量减少预充量,加强液体出入量平衡的管理,以及良好的心肌保护和脏器保护有助于提高手术成功率。

母亲情绪心理及家庭管理对早产儿校正12月龄低体质量的影响分析

目的分析母亲情绪心理因素及家庭管理对早产儿校正12月龄体质量的影响。方法采用便利抽样法,选取2016年7月—2017年11月上海市某三级甲等妇婴保健院新生儿科住院的早产儿及其母亲各264例作为研究对象。在早产儿校正1月时采用焦虑自评量表、围产期创伤后应激障碍问卷以及中文版家庭管理量表对母亲进行评估,采用一般资料调查表收集早产儿及其父母的相关资料。采用二分类Logistic回归分析早产儿校正12月龄体质量的影响因素。结果早产儿校正12月龄时低体质量的发生率为27.3%。二分类Logistic回归分析结果显示,校正1月时患儿认可(OR=0.855,P=0.045)、校正1月时照护能力(OR=0.904,P=0.019)是早产儿校正12月龄时低体质量的保护因素;男孩(OR=3.409,P=0.002)、校正1月时母亲焦虑(OR=1.085,P=0.032)、校正1月时照护负担(OR=1.183,P=0.043)是早产儿校正12月时低体质量的危险因素。结论影响早产儿校正12月龄低体质量的因素有校正1月时患儿认可低、校正1月时照护能力低、男孩、校正1月时母亲焦虑得分高、校正1月时照护负担得分高。建议在早产儿出院前,教会其母亲照护的知识及基本技能;与社区医院联动,建立并完善早产儿随访体系;随访时尤应注意男孩体质量情况,找出发生低体质量的原因,并给予相应处理;心理咨询师介入,帮助早产儿母亲建立照护信心,同时利用同伴间交流及互助,缓解母亲的焦虑情绪及照护负担,提高母亲对早产儿的认可度,从而保障早产儿顺利完成追赶生长,减少低体质量的发生。

Nutritional Status of Children during and post-Global Economic Crisis in China

Objective To describe the impact of the global economic crisis on the nutritional status of children in China during and after the crisis.Methods Data from 1990 to 2010 were sourced from the National Food and Nutrition Surveillance System.Approximately 16 000 children under 5 years old were selected using a stratified random cluster method from 40 surveillance sites.Anthropometric and hemoglobin measurements for children under 5 were conducted.Nutritional status was determined according to WHO child growth standards.Results Prevalence of underweight and stunting in children under 5 had a downward trend.Underweight prevalence was close to normal （less than 5%）,with prevalence of stunting 12.6% in 2009 and 12.1% in 2010 in rural areas.Prevalence of stunting in infants under 6 months and 6‐12 months old in poorer rural areas increased from 5.7%‐9.1% and 6.7%‐12.5%,respectively,in 2008‐2009.This trend also continued post‐crisis in 2010.Prevalence of stunting in children left behind by mothers was 20%‐30% higher than in children the same age in general and poorer rural areas.Prevalence of anemia in children did not change in rural areas,but prevalence of anemia in all age groups increased in poorer rural areas,especially in children under 24 months old.Level reached 30%‐40% in 2009,and fluctuated in 2010.Conclusion The nutritional status of children under 5 was comparatively stable during and after the global economic crisis,attributable to the Chinese government＇s policy response.The nutritional status in poorer rural areas fluctuated in response to the economic crisis and,thus,relevant action and intervention must be taken immediately to help the most vulnerable population in poorer rural areas.A proper national nutritional strategy for children under 2 years old,including nutrition supplementation for pregnant women and in‐home fortification for complementary feeding,should be initiated.

河南贫困地区婴幼儿低体重与服用营养包关系

目的探究服用营养包与河南省贫困地区婴幼儿低体重间的相关性。方法于2015年6—9月,采用多阶段抽样方法纳入河南省贫困地区2901名6~24月龄婴幼儿进行体重测量,同时对随行看护人进行面访式问卷调查,采用二水平logistic回归模型探究服用营养包与婴幼儿低体重间的相关性。结果研究对象低体重检出率为11.68%;二水平logistic回归分析结果显示,每周服用营养包≥4包(OR=0.613,95%CI=0.472~0.798,P<0.001)及服用营养包≥7个月(OR=0.395,95%CI=0.237~0.657,P<0.001)均与研究对象低体重呈负向关联;与传统模型相比,二水平logistic回归模型数据拟合更优,效应估计更为稳健。结论与现阶段全国水平相比,河南省贫困地区婴幼儿低体重状况较为严峻;服用营养包可有效改善婴幼儿低体重状况。

湖南省贫困农村地区6～23月龄婴幼儿生长发育状况分析

目的了解湖南省贫困农村地区623月龄婴幼儿生长发育状况。方法2009—2015年在湖南省54个贫困县按乡级概率比例规模抽样（PPS）方法,调查15 248名623月龄婴幼儿,测量其身长、体重,依据《WHO儿童生长发育标准》计算WHZ、WAZ、HAZ和年龄别BMI Z评分,得出婴幼儿消瘦发生率、低体重发生率、生长迟缓发生率以及低体质指数发生率,并以《WHO儿童生长发育标准》为参数评价儿童体格发育水平。结果湖南省贫困农村地区623月龄婴幼儿女童和男童体重均值分别为9.17和9.79 kg,身长均值分别为75.53和77.19 cm,BMI均值分别为15.96和16.40,男童体重、身长及BMI均值均高于女童,差异有统计学意义（t体重=25.9,P〈0.01;t身长=15.3,P〈0.01;tBMI=17.9,P〈0.01）。623月龄婴幼儿中不同月龄组男性儿童身长、体重与WHO标准比较差异有统计学意义（t=17.1,P〈0.01;t=37.0,P〈0.01;t=40.1,P〈0.01;t=12.3,P〈0.01）;不同月龄组女性儿童身长、体重与WHO标准比较差异有统计学意义（t=17.2,P〈0.01;t=31.2,P〈0.01;t=30.5,P〈0.01;t=13.9,P〈0.01）。623月龄婴幼儿消瘦发生率为3.9%,低体重发生率为5.1%,生长迟缓发生率为7.2%,低体质指数发生率3.9%,男性的低体重发生率和生长迟缓发生率高于女性,随着月龄增加,低体重发生率和生长迟缓发生率具有一定的上升趋势（χ2=6.2,P=0.04）。结论湖南省贫困农村地区623月龄婴幼儿存在比较严重的营养和生长发育落后问题,与《WHO儿童生长发育标准》差距明显,应提高农村地区儿童保健服务能力和儿童喂养知识水平,有效改善农村儿童营养状况。

西藏婴幼儿生长迟缓和低体重与海拔的关联——基于倾向性评分匹配分析

目的西藏自治区(简称西藏)儿童生长发育状况整体不佳,其与中国和WHO的标准相比都有较大差距,本研究基于“西藏0~5岁儿童营养与健康调查”分析西藏婴幼儿生长迟缓和低体重发生率及其与海拔的关系。方法采用分层、多阶段与规模大小成比例的抽样和整群抽样相结合的抽样方法,抽取0~3岁婴幼儿进行现场体格检查并对其监护人进行问卷调查,采用倾向性评分匹配的方法以均衡两个比较组之间的混杂因素。单因素logistic回归分析模型分析海拔与生长迟缓和低体重的关系。结果西藏婴幼儿生长迟缓和低体重率分别为20.9%和8.7%。进行1∶1倾向性评分匹配后分别获得324对,共计648例匹配的样本,各混杂因素在比较组间达到均衡。匹配后,相对于居住较低海拔(<4000 m)的婴幼儿,居住高海拔(≥4000 m)的婴幼儿生长迟缓和低体重风险的OR(95%CI)值分别为2.31(1.74~3.10)和1.95(1.27~3.09)。无论男女、家庭收入水平、是否为低出生体重,高海拔都会增加生长迟缓风险,而对低体重的影响只在男性、家庭收入水平较高、出生体重正常和足月生产的婴幼儿中的差异有统计学意义(均有P<0.05)。结论西藏婴幼儿生长发育水平低,居住高海拔对生长迟缓有较大影响。