Cardiac changes in infants of diabetic mothers

Diabetes mellitus(DM)is a systemic chronic metabolic disorder characterized by increased insulin resistance and/orβ-cell defects.It affects all ages from the foetal life,neonates,childhood to late adulthood.Gestational diabetes is a critical risk factor for congenital heart diseases(CHDs).Moreover,the risk increases with low maternal education,high body mass index at conception,undiagnosed pregestational diabetes,inadequate antenatal care,improper diabetes control,and maternal smoking during pregnancy.Maternal DM significantly affects the foetal heart and foetal-placental circulation in both structure and function.Cardiac defects,myocardial hypertrophy are three times more prevalent in infants of diabetic mothers(IDMs).Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography.Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography,detection of early atherosclerotic changes by measuring aortic intima-media thickness,and retinal vascular changes by retinal photography.Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention.However,other measures to reduce the risk,such as using medications,nutritional supplements,or probiotics,still need more research.This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM,the various cardiac outcomes of gestational DM on the foetus and offspring,cardiac evaluation of foetuses and IDMs,and how to alleviate the consequences of gestational DM on the offspring.

Predictors of readiness for discharge in mothers of preterm infants: The role of stress, self-efficacy and perceived social support

Objective:To determine the predictive role of stress,self-efficacy,and perceived social support on readiness for discharge in mothers of preterm infants.Methods:The present cross-sectional,descriptive-analytical study was conducted on 120 mothers of preterm infants admitted to hospitals affiliated to Lorestan University of Medical Sciences,Iran in 2019.Participants were selected by a convenience sampling method and based on inclusion criteria.Data collection tools included the demographic questionnaire of mothers and infants,parent perceptions of their child's hospital discharge,parental stressor scale:neonatal intensive care unit,perceived maternal parenting,and multidimensional scale of perceived social support.Data were analyzed using Pearson correlation and stepwise regression at the significance level of 0.05.Results:Infant behavior and appearance,situational belief,and family support achieved the highest mean score from parents'stress,self-efficacy,and perceived social support dimensions,respectively.There was a significant relationship between stress,self-efficacy,and perceived social support with readiness for discharge in mothers of preterm infants(P<0.001).The score of mothers'readiness for discharge decreased by 0.07 per 1-point increase in stress score,and the score of readiness for discharge in mothers of preterm infants rose by 0.35 and 0.43,respectively,for a unit increase in the scores of self-efficacy and perceived social support.Conclusions:Stress,self-efficacy,and perceived social support can be considered as predictors of readiness for discharge in mothers of preterm infants.It is suggested that nurses in neonatal intensive care units provide a better platform for the readiness for discharge in mothers of preterm infants by reducing stressors and increasing maternal self-efficacy and social support.

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants.It may protect infants against many metabolic diseases,predominantly obesity and type 2 diabetes.Diabetes mellitus(DM)is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood.Breastfeeding protects against infant mortality and diseases,such as necrotizing enterocolitis,diarrhoea,respiratory infections,viral and bacterial infection,eczema,allergic rhinitis,asthma,food allergies,malocclusion,dental caries,Crohn's disease,and ulcerative colitis.It also protects against obesity and insulin resistance and increases intelligence and mental development.Gestational diabetes has short and long-term impacts on infants of diabetic mothers(IDM).Breast milk composition changes in mothers with gestational diabetes.AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15,2022,in this review.RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms.Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM.Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term,the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.CONCLUSION We need more comprehensive research to prove these effects.Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding,every effort should be made to encourage them to breastfeed.

Status of New HIV Infections among Infants Born of HIV Positive Mothers on Prevention of Mother to Child Transmission at Kisii Teaching and Referral Hospital, Kenya

Introduction: The goal of Prevention of Mother to child Transmission (PMTCT) is to minimize new HIV infection with PMTCT interventions which can reduce to as low as 2%. Gusii region is number 5 among counties that contribute to 65% of new HIV (Human Immunodeficiency Virus) in infections in Kenya. The study was to determine the prevalence of new HIV infections among infants (3 - 18 months) born of HIV positive mothers on PMTCT follow up at Kisii Teaching and Referral Hospital (KTRH). Method: This was a descriptive cross sectional study involving 96 infants born of HIV positive mothers on PMTCT programme at Kisii Teaching and Referral Hospital (KTRH) was conducted. The infants were between 3 to 18 months of age. The infants were investigated for their HIV status and factors associated with prevalence. The data collection was done during postnatal checkups, antiretroviral treatment follow up and immunization schedule. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: 13.5% (95% C.I = 10.1% to 16.9%) were found to be positive despite their mothers being on PMTCT program. There was no significant difference between gender and status of the infant (χ2 = 0.758, df = 1, p-value = 0.0384). Conclusion: The study confirms that there are still new HIV infections despite being followed up in the PMTCT program. The new HIV infections were associated with mixed feeding. Recommendation: Counseling on Infant feeding, use of ant-retroviral treatment and support from partners should be strengthen in the PMTCT program to ensure reduction of new HIV infections.

Predictors of caring behaviors of mothers of premature infants based on the health belief model

Objective:To investigate predictors of caring behaviors of mothers of premature infants based on the health belief model.Methods:This cross-sectional study was conducted by using the structural equation modeling on 168 mothers of premature infants,who were selected by convenience sampling method from October 2017 to February 2018 in Iran.Data were collected by using a standard scale.Validity and reliability of all data collection tools were approved.Data were analyzed by using SPSS V.16 and Mplus6 software.Results:The structural equation modeling of the initial health belief model did not have a good fit,but the fitness of model 2 obtaining from the modified initial model was confirmed by changes in locations of constructs.None of constructs of model 2 had a significant positive association with the caring behavior of mothers of premature infants and only 2.8%of variance of caring behaviors in mothers could be predicted by the sum of variables of demographic characteristics and the modified health belief model constructs.Conclusions:Given that the findings do not approve the use of the health belief model in predicting determinants of caring behavior of mothers of premature infants,it is suggested to apply this model to investigate the effect of educational intervention based on the health belief model on the caring behavior of mothers.

Assesment of polyunsaturated fatty acids in cord blood of infants of diabetic mothers

Objective:To assess whether infants of diabetic mothers [pre pregnancy diabetics(PPD)and gestational diabetics mellitus(GDM)] have compromised arachidonic and docosahexaenoic acids in their plasma and the relationship with deficiency of the same compounds in their mothers.Methods:This study was conducted on 30 diabetic mothers(both PPD and GDM)and their infants.Twenty healthy infants and their mothers with age and sex matched were included as controls.All infant(of diabetic and non diabetic mothers)were subjected to assessment of APGAR Scoring,thorough history taking and anthropometric measures.Lipid profile components as well as polyunsaturated fatty acids(PUFA)were assessed in diabetic GDM and PPD and non diabetic mothers as well as in their babies.Results:High-density lipoproteir(HDL)level was found to be significantly lower in diabetic mothers(specially those with PPD)compared to non diabetic ones,whereas no significant difference was found between babies of the two groups.Also,the current study revealed that diabetic mothers(GDM and PPD)and their babies had significantly higher levels of PUFA precursors linoleic acids(LA)and alpha linoleic acids(ALA).PUFA arachidonic acid(AA)and docosahexaenoic acids(DHA)were found to be significantly lower in diabetic mothers(GDM and PPD)compared to non diabetic mothers,and same results were found in the babies of the two groups.Conclusion:Neonates with diabetic mothers(both GDM and PPD)have highly compromised plasma levels of AA and DHA PUFA,which affects the child well being by far,and produces hazardous multi-system complications on the long run.

Influencing factors of the neurodevelopment of high-risk infants

Background High-risk infants refer to newborns exposed to high-risk factors in the prenatal, natal or postnatal period. High-risk infants are at high risk of developmental retardation, and early identification of developmental abnormalities plays a vital role in improving high-risk infants' quality of life.Aims To describe the neurodevelopment of high-risk infants aged less than 1 year old, and to analyse the incidences and influencing factors of neurodevelopmental abnormalities in order to provide a basis for neurodevelopment monitoring and management of highrisk infants.Methods High-risk infants born between January 2016 and December 2016 in the maternity and infant health hospitals of three districts in Shanghai were followed up.The Gesell Developmental Scale was used to assess the neurodevelopmental level at the time of recruitment(0-2 months) and at 9 months. Univariate and multivariate analyses of the influencing factors were conducted.Results 484 high-risk infants(male 51 %, female 49%)with an average gestation age of 36.5±2.2 weeks were recruited. At the time of recruitment, the average age was2.1(0.8) months, and the developmental quotient(DQ)scores of full-term high-risk infants in motor(t=3.542,p=0.001), cognitive(t=3.125, p=0.002), language(t=3.189, p=0.002) and social(t=3.316, p=0.001) areas were higher than those of preterm infants. The incidences of developmental abnormalities of full-term high-risk infants in motor(χ~2 =9.452, p=0.002), cognitive(χ~2=6.258, p=0.012), language(χ~2 =12.319, p =0.001) and social(χ~2 =6.811, p=0.009) areas were lower than the preterm infants. At 9 months, there was no difference in the DQ scores and incidences of developmental abnormalities in four areas between full-term and preterm high-risk infants, and the incidence of developmental abnormalities was around 10%.Conclusion The incidence of neurodevelopmental abnormalities in high-risk infants aged less than 1 year old is high. Preterm birth and parental bad habits are significant factors affecting the neurodevelopment.Monitoring and early interventions help to improve highrisk infants' neurodevelopment.

Lacticaseibacillus rhamnosus Probio-M9 may be vertically transmitted from mother to infant during lactation based on faeces metagenomics

Probiotics exert beneficial effects on the host.This study aimed to investigate whether maternally ingested Lacticaseibacillus rhamnosus Probio-M9 during pregnancy could access and colonize the infant gut.This study recruited one pregnant woman,who ingested Probio-M9 daily from 35 weeks of gestation to delivery.Feces of the mother-infant pair were regularly collected from one month before delivery to 6 months of infant's age for metagenomic sequencing.Probio-M9 genomes were mappable to all infant fecal samples,suggesting the ingested probiotics could be vertically transmitted from mother to infant.Infant-or mother-specific differential metabolic pathways were found between the maternal and infant's gut microbiome,implicating apparent differences in the intestinal metagenomic potential/function between the mother and the infant.In conclusion,maternal ingestion of Probio-M9 during the final weeks of gestation could deliver to the infant gut.The findings provided novel insights into shaping infant's gut microbiota.

Relationship between the different replication status of HBV and mutations in the core promoter in mothers and their children infected via mother-to-infant transmission

OBJECTIVE: To study the relationship between the different replication status of hepatitis B virus (HBV) and mutations in the core promoter (CP) in mother and her child infected by mother-to-infant transmission. METHODS: The core promoter was amplified by PCR and cloned into pGEM-T vector with the T-A choning technique. The recombinant plasmid pGEM-CP was confirmed by digestion with restriction enzyme Apa I and Sac I. Two clones were selected to be sequenced in each patient. RESULTS: Every pair of mother and child had same serotype and genotype and the homology of nucleotides encoding 'a' determinant was 98%-100%. The number of mutations in the core promoter of patients with a high replication status was less than that in those with a low replication status. Mutations were mainly distributed in basia core promoter (BCP) and the inbibitor region of Kunitz-type serine protease. This difference was not associated with mother or child. CONCLUSION: The different replication status of HBV is caused by mutations in the core promoter in mother and child infected hy mother-to-infant transmission and appears to be not associated with the status of development of the infection.

The Impact of COVID-19 Pandemic on Mother-Infant Bond: A Systematic Review

Background: The healthy bond that develops prenatally between the mother and her infant is important for the neuropsychological development and development of the child. In stressful situations and mental disorders, the development of this bond is inhibited. With this study, an attempt is made to investigate whether the COVID-19 pandemic affected the development of the mother-infant bond. Methods: We have searched in the databases, PubMed, Google Scholar, PsycINFO, from July to October 2023 and we have found 18 related articles. Results: Most studies supported a lower mother-infant attachment during the pandemic period. We also found increased rates of depressive symptoms, anxiety and post-traumatic stress during the pandemic. Conclusions: The period of the pandemic and the psychological factors were the right conditions for the reduced development of the mother-infant bond. In epidemiological outbreaks, the mental health of the mother and her relationship with the infant should be a priority for perinatal care professionals.

Deoxyribonucleic Acid-Polymerase Chain Reaction Status of HIV Exposed Infants in a Sub Regional Prevention of Mother-to-Child Transmission of HIV Programme during the Period 2009-2020

Introduction: Transitioning to more efficacious Antiretrovirals for HIV infected pregnant women and infant prophylaxis has reduced Mother to child transmission of HIV significantly. This study aimed to determine HIV infection status in HIVexposed infants who had their first DNA polymerase chain reaction test in our molecular Laboratory. Subjects, Materials and Methods: Dried Blood Spots for HIV DNA results from 5 states between 2009 and 2020 were analyzed in the PCR laboratory of the Federal Teaching Hospital, Gombe. Results: Nine thousand eight hundred and twenty-three Human Immunodeficiency Virus Deoxyribonucleic acid polymerase Chain Reaction results were analysed;4937 (50.2%) were males. During the study period, there was an overall declining trend in the mother-to-child transmission rate from 3.8% in 2009 to 1.0% in 2020. 6120 (62.3%) of HIV + mothers received Highly active antiretroviral therapy HAART before pregnancy. 7845 (76.2%) of the infants received Nevirapine prophylaxis. Dried blood spot samples were collected from 4077 (41.5%) at 6 - 8 weeks. 8438 (85.9%) received cotrimoxazole. 9469 (96.4%) were ever breastfed. Of the 9823 HIV DNA PCR results, 255 (2.6%) were positive while 69/4077 (1.7%) and 109/2662 (4.1%) were positive for HIV DNA at 6 - 8 weeks and > 12 weeks respectively. (p = 0.001). 86/747 (11.5%) of infants whose HIV-positive mothers received no ARVS were HIV DNA positive. (p = 0.001). 106/884 (12.0%) of infants who had no Antiretroviral prophylaxis had positive HIV DNA results;7/413 (1.7%) with Zidovudine/Nevirapine prophylaxis had positive results. (p = 0.001). 246/9469 (2.6%) of infants that were ever breastfed were positive for HIV DNA;11/354 (3.0%) that never breastfed had positive HIV DNA. Conclusion: Lack of maternal/infant ARVs and prolonged breastfeeding increased the risk of infant HIV infection.

Eeffect of super early comprehensive rehabilitationon neurodevelopmental prognosis of high-risk infants

Objective: To observe the effect of super-early comprehensive rehabilitation intervention on neurodevelopmental prognosis of premature high-risk infants;Methods: Premature high-risk infantsmet the inclusion criteria were divided into control group (n=30) and treatment group (n=30) according to parental willingness. The control group was given routine treatment, while the treatment group was treated with comprehensive rehabilitationon the basis of the control group. The course of treatment for both groups was 10 d. The changes of body weight, milk consumption, NBNA score, GMFM score and Gesell score were observed. Results:After treatment, the body weight and milk consumption of the treatment group increased significantly compared with those before treatment (P<0.01), which was significantly better than that of the control group (P<0.01);the NBNA score of the treatment group was higher than that of the control group at 40 weeks of gestational age (P<0.05), and the abnormal rate of NBNA was lower than that of the control group (P<0.01). The GMFM scores of A-energy and B-energy areas and the five dimensions of social adaptation, big exercise, fine exercise, language and personal social interaction in the treatment group increased significantly in 1 month, 2 months and 3 months after birth,which were significantly better than those in the control group (P<0.05 or P<0.01). Conclusion: Super-early comprehensive rehabilitation can improve the physical quality of high-risk infants and promote the development of the nervous system, with remarkable effect.

Early Intervention in the Neurodevelopment of Premature Infants during the First Six Months of Life

Objective: Measure the effects of Early Intervention ad modum Katona (EI-K) in high-risk premature infants by means of clinical, neurobehavioral, and neurophysiologic tests. Method: We used the Amiel-Tison neurologic examination, the Bayley Scale of Infant Behavior, and electroencephalography (EEG) recordings at 42 weeks of conceptional age, and after 6 months of treatment EI-K (n = 14) and compared these results with those of a group of infants without early intervention (nEI) (n = 11). Results: We found better performance of infants in EI-K than nEI group after 6 months of treatment in neurologic and behavioral examination measurements, but found no differences in EEG comparisons. Conclusion: Our data suggest significant benefit of the use of EI-K program over n-EI in the neurologic and neurobe-havior examinations of premature infants after 6 months of age.

Birth outcome and correlates of low birth weight and preterm delivery among infants born to HIV-infected women in public hospitals of Northwest Ethiopia

Background: HIV-positive pregnant women are at an increased risk of adverse pregnancy outcomes. However, data on birth outcome among HIV-infected women are limited in Ethiopia. This study was conducted to identify the adverse birth outcomes and associated factors of low birth weight (LBW) and preterm delivery (PD) among HIV-infected women. Methods: A hospital based retrospective cohort study was conducted. All deliveries from HIV-infected women from September 1, 2009 to April 30, 2012 were included in the study. Multivariate logistic regression was performed to explore the potential risk factors for LBW and PD. Result: Out of 416 singleton infants born to HIV-infected mothers, the prevalence of LBW and PD was 89 (21.4%) and 69 (16.6%), respectively. The baseline maternal CD4 counts below 200 cells/mm3, maternal body mass index (BMI) below 18.5, maternal anemia and maternal exposure to Highly Active Antiretroviral Treatment (HAART) were factors significantly associated with LBW. On the other hand, a baseline maternal CD4 level below 200/ mm3, having no Prevention of Mother-to-Child Transmission (PMTCT) intervention during pregnancy, maternal BMI less than 18.5, maternal Eclamsia during pregnancy, and mothers being on HAART before pregnancy were factors associated with preterm delivery. Conclusion: There was a significant prevalence of low birth weight and preterm delivery among infants born to HIV-positive mothers. The programme for PMTCT services should maximize the need for an early identification of those mothers with predicted complications.

Hepatitis B Immunoprophylactic Failure and Characteristics of the Hepatitis B Virus Gene in Mother-Infant Pairs in Parts of China

Objective To determine the hepatitis B immunoprophylactic failure rate in infants born to hepatitis B virus （HBV） infected mothers and to characterize HBV genes. Methods HBV-serological testing was conducted for pregnant women and infants. The complete genomes of 30 HBV isolates were sequenced, and genetic characteristics were analyzed using MEGA 5 software. Results The immunoprophylactic failure rate for infants who had completed the scheduled hepatitis B vaccination program was 5.76% （32/556）. High sequence homology （99.8%-100%） was observed in 8 of the 10 mother-infant pairs. We identified 19 subgenotype C2 strains, 9 subgenotype B2 strains, and 2 subgenotype Cl strains. Three serotypes were detected： adr （19/30）, adw （9/30）, and ayw （2/30）. The frequency of amino acid mutation of the ＇a＇ determinant region was 16.67% （5/30）, including that of Q129H, F134Y,S136Y, and G145E. We detected 67 amino acid mutations in the basal core promoter, precore, and core regions of the genome. Conclusion The immunoprophylactic failure rate in infants born to HBV-infected mothers is low in the regions of China examined during this study. Moreover, HBV mutation in the ＇a＇ determinant region could not account for immunoprophylactic failure for all infants.

Effect of maternal alcohol consumption on gestational diabetes detection and mother-infant’s outcomes in Kinshasa, DR Congo

Objectives: Since it has been suggested that moderate alcohol drinking would increase insulin sensitivity, which could benefit Gestational Diabetes Mellitus (GDM), the study aimed at evaluating alcohol consumption during pregnancy, and seeing whether this consumption influences GDM detection and maternal/perinatal outcomes. Study design: Women with already known diabetes and those with multiple pregnancy were excluded. All other pregnant women attending antenatal care unit of the university clinics, Kinshasa, DR Congo during the period from 1 March throughout 31 October 2010, were invited at 24-week gestation to enroll in O’Sullivan blood glucose testing and if eligible in 100-gram oral glucose tolerance test. Alcohol consumption, risk factors for GDM, and general characteristics such as age, parity, gestity, BMI, fat mass were registered. Diagnosed GDM was first treated with diet and exercise, thereafter with Metformin, and if necessary with insulin. For other (normal) women data remained blinded until confinement. Maternal and infant’s adverse outcomes such as maternal urinary infection, preeclampsia, cesarean section, intrauterine growth retardation, birth weight percentile 90 in our milieu), Apgar score at the first minute < 7, shoulder dystocia or other birth injury, neonatal hypoglycemia and fetal alcohol syndrome (FAS) were compared and analyzed according to GDM diagnosis as well to alcohol status. Results: Up to 240 pregnant women accepted to enroll into the study. Alcohol consumption concerned 78 (32.5%) of the women, most of them (61 = 25.42%) being heavy consumers. Risk factors for GDM and Physical and blood glucose characteristics were alike (p not significant) in both consumers and non consumers, except for history of HTA in the family that was significantly more frequent (p = 0.02) among drinkers. GDM’s prevalence was 9%. No adverse outcome was more prominent in any subgroup, except Apgar score < 7 at the first minute that was more frequent (p = 0.038) among neonates of GDM mothers. No FAS, neither shoulder dystocia nor neonatal hypoglycemia were diagnosed. When alcohol status was considered, Birthweight ≥ 3800 g was found more frequent (p = 0.0284) in alcohol consumers than in abstainers. Risk of this outcome was three times higher when history of family hypertension was present (odds ratio 2.694;CI: 0.536 - 13.544). Conclusions: The prevalence of alcohol consumption by pregnant women of our series (32.5%) seems not to impact the detection of GDM (9%). FAS was not diagnosed. Lack of significant differences in adverse outcomes between GDM and non GDM could be attributed to huge follow-up of GDM women. Influence of alcohol consumption on birth weight mostly in setting of familial history of hypertension remains to be addressed.

Prelacteal Feeding Practice and Associated Factors among Mothers Attending Immunization Clinic in Harari Region Public Health Facilities, Eastern Ethiopia

Background: Breast feeding will have the intended outcome when it is initiated timely and exclusive for the first six months. Introducing prelacteal feeding and inadequate amount of breast milk contributes to over a million avoidable infant deaths each year in developing countries. The purpose of this study was to assess prelacteal feeding practice and associated factors among mothers attending immunization clinic in Harari region government health institutions. Methods: An institutional based cross-sectional study design was conducted among 634 mothers and infants dyads attending ten public health facilities. Systematic random sampling method was used to select the study participants. An exit interview using pretested structured questionnaire was conducted about their experience on prelacteal feeding and related experience. Logistic regressions with OR and 95% confidence interval were computed. Result: Two hundred seventy eight (45.4%) of mothers gave prelacteal liquids for their infants. The common pre-lacteal food includes sugar or glucose water 121 (43.5%) followed by milk other than breast milk 70 (25.1%). Home delivery, failure to attend ANC, late breastfeeding initiation and influence by friends were significantly associated with prelacteal feeding. Conclusion: The prevalence of prelacteal feeding was relatively high in the area. Failure to attend ANC, giving birth at home, late initiation of breast feeding and influence of friends and relatives to give prelacteal feeds for their new born infants were found to be positively associated with prelacteal feeding.

Investigation of regurgitation and other symptoms of gastroesophageal reflux in Indonesian infants

AIM:To evaluate the incidence of regurgitation and other symptoms of gastroesophageal reflux in Indonesian infants. METHODS:In a cross-sectional study at the University Outpatient Clinic for vaccination in Jakarta,138 mothers of healthy infants less than 12-mo old were prospectively asked to report the frequency of regurgitation. RESULTS:Whatever the age was,some infants did not regurgitate(from 10% during the first month of life to 67% in 1-year-old infants).Regurgitation of at least once a day was reported in 77% of infants younger than 3 too.Daily regurgitation decreased to 12% in the 9-12 mo old group. Reported peak prevalence was 81%(26/32)during the first month of life.Regurgitation decreased sharply between the 4-6 and 7-9 mo old groups(from 44% to 9%).The longer the regurgitation persisted,the more frequently the mother perceived regurgitation as a problem.Volume and frequency of regurgitation,back arching,irritability,crying and refusal of feeding were the symptoms causing maternal anxiety.The longer the regurgitation persisted,the more frequently the mothers viewed it as a health problem. CONCLUSION:Regurgitation occurs frequently in Indonesian infants,and is a frequent cause of concern to mothers.

Mothers overcoming remorse to care for self and baby:An emerging concept

Objectives:Mothers with substance use disorder(SUD)experience a range of emotions such as feeling ostracized,diminished,and distressed while watching their baby experience withdrawal from substances.Being fully present in the now moment is to trust self to do what is best by moving beyond perceived boundaries to care for self and baby.The process of concept building arose from nursing practice encounters in a special care nursery(SCN)for babies who experienced withdrawal from substances.Method:Liehr and Smith’s 10-phase concept building approach was used to guide the development of this concept.Concept building began with a practice story.The emerging concept was named,core qualities identified,and supported through a literature review.The middle range theory of uncertainty in illness was chosen to serve as theoretical support for the concept.A model was created to provide clarity on the relationships within the concept.Result:A mini-saga was gathered from a mother in the SCN whose newborn had experienced withdrawal from substances.The minisaga follows:Due to the baby’s discomfort and judging eyes of the staff,she was unable to mother her baby.As the baby recovered,she asked for help,comforted her baby,and gained confidence to move beyond perceived boundaries to become the mother she envisioned.Overcoming perceived boundaries to attend to self and baby is trusting oneself to do what is best in spite of feeling ostracized,diminished,and distressed while watching baby withdraw from substances.Conclusion:This concept provides the perspective of mothers with SUD through intermodernism from experiences in nursing practice.The Uncertainty in Illness theory further allows practitioners to gain an understanding of the role uncertainty plays in this unique situation.

Socioeconomic Characteristics of Child-Bearing Mothers and Feeding Practices of Under-Five Children in Kori Chiefdom, Sierra Leone

Introduction: The use of proper feeding practices is key for the overall development of children. Generally, breastfeeding and complementary feeding make up the diet and therefore the nutritional status of children. However, the degree to which mothers adhere to the recommendations of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) regarding breastfeeding and complementary feeding is key to the nutritional status of children. Again, the adherence to this dietary recommendation is contingent on the socio-economic conditions of the child-bearing parents, especially the mothers. Here in this study, the socio-economic characteristics were analyzed along with the feeding practices of children not more than five years old in rural Sierra Leone. Method: Data were collected in 2017 on representative mothers with children within 0 - 5 years old. A total of 10 communities and 200 respondents were randomly covered in the Kori Chiefdom of Moyamba District, Sierra Leone. The data collection instruments included structured questionnaire, inter-personal interaction, personal observation and experience. The collected data were analyzed in Microsoft Excel and SPSS and the results presented in simple graphs. Results: A large number of the respondents were married teenage mothers with 1 - 2 children and living under extreme hardship by the United Nations (UN) standard. Also, most of the mothers were illiterate and started breastfeeding their children within the very hour of birth. Because complementary feeding was started all too early, exclusive breastfeeding last for not more than two months for most of the respondent mothers. Also, because rice is by far the most widely eaten the staple food in Sierra Leone, complementary food was mostly powdered rice mixed with salt and oil. Hardly was protein food supplement used as complementary food, probably due to the economic conditions of the poor rural women. Conclusion: The study has thrown sufficient light on the socio-economic characteristics and adopted feeding practices of children in poor rural Sierra Leone. In this sense, the study has laid the basis for sufficient for in-depth correlativity studies on the factors driving feeding practices of children and how it in turn impacts nutritional status of children in poor rural Africa. From here, practically adoptable recommendations can be advanced for the attention of the governments, public institutions, the private sector and the individuals of the society.