From the Journals
Rønnestad A. et al. Late-onset septicemia in a Norwegian cohort of extremely premature infants receiving very early human milk feeding. Pediatrics 115: 269-276, 2005
http:// www.pediatrics.org/cgi/contentfull/115/3e269In order to determine the occurrence of and risk factors for late-onset septicemia in a cohort of extremely premature infants who received very early full human milk feeding, this prospective study investigated all infants born in Norway in 1999 and 2000 with gestational age of <28 weeks or birth weight of <1000 g. Extensive clinical information, including data on feeding practices and episodes of septicemia, was collected on the 464 eligible infants. Late-onset septicemia was diagnosed in 80 or 19.7% of infants. Case fatality rates associated with septicemia were 10% in general and 43% for Candida. Necrotizing enterocolitis or bowel perforation was diagnosed for 19 infants (4%).
Enteral feeding with human milk was started by the third day for 98% of the infants, and 92% were receiving full enteral feeding with human milk by the third week.
The greatest risk factor for late-onset septicemia was the number of days without establishment of full enteral feeding with human milk.
In conclusion the study determined that very early feeding with human milk can reduce the incidence and case fatality rate of septicemia in extremely preterm infants. Early feeding with human milk significantly reduces the risk of septicemia among extremely premature infants.
Viggiano D. et al. Breast feeding, bottle feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition. Arch Dis Child 89: 1121-1123, 2004
Breastfeed for straight teeth is the message from this research on feeding, sucking and dentition. This retrospective study of 1130 preschool children (3 to 5 years of age) looked at the impact of the type of feeding and non-nutritive sucking activity on occlusion in deciduous dentition. Detailed infant feeding and non-nutritive sucking activity history was collected by questionnaire in addition to an oral examination by a dentist.
Non-nutritive sucking activity has a substantial effect on altered occlusion, while the effect of bottle feeding is less marked. Posterior cross-bite was more frequent in bottle fed children and in those with non-nutritive sucking activity. The percentage of cross-bite was lower in breast fed children with non-nutritive sucking activity (5%) than in bottle fed children with non-nutritive sucking activity (13%). In conclusion, the data demonstrates that non-nutritive sucking activity in the first months of life is the main risk factor for development of altered occlusion and open bite in deciduous dentition. Children with non-nutritive sucking activity and who were bottle-fed had more than double the risk of posterior cross-bite, while breastfeeding seems to have a protective effect on development of posterior cross-bite in deciduous dentition.
Broadfoot M. et al. The Baby Friendly Hospital Initiative and breastfeeding rates in Scotland. Arch Dis Child fetal Neonatal Ed 90: 114-116, 2004
Does implementation of the Baby Friendly Hospital Initiative (BFHI) improve breastfeeding rates? Researchers from the Royal Hospital for Sick Children in Glasgow found clear evidence that it does. They examined the records of all 33 maternity hospitals between 1995 and 2002 and the BFHI status of each unit at the time of an infant’s birth and the breastfeeding status of the infant on day seven. The results were highly conclusive. Babies born in hospitals with the BFHI designation were 28 percent more likely to be exclusively breastfeeding at day seven than those born in hospitals without the designation. The authors conclude that all maternity units should be encouraged to achieve BFHI status since being born in a hospital with the designation increases the prospect of being breastfed.
Horton R. UNICEF leadership 2000-2025: A call for strategic change. Editorial. The Lancet 364: 2071, 2005
Richard Horton, editor of The Lancet launches an urgent appeal to those bodies that are especially mandated to protect the world’s children and addresses their failure in ending the deaths of millions of children every year.
During 2003, the journal published its influential Child Survival series to focus on the question of why do10.8 million children under five die every year? Most of these deaths are concentrated in impoverished countries and nearly two thirds, more than six million are preventable. Over the next several months Kof. Annan will appoint the successor to UNICEF’s Carol Bellamy’s, once the most respected of the UN’s agencies. Dr. Horton notes how the process is discredited and threatens not only the credibility of the UN system, but may prove to be disastrous for millions of the world’s children.
"UNICEF clearly has a pivotal role to lead the world’s efforts to make children a global priority. Under Bellamy’s leadership UNICEF is presently in a poor position to do so. Her distinctive focus has been to advocate for the rights of children. This rights-based approach to the future of children fits well with the zeitgeist of international development policy. But a preoccupation with rights ignores the fact that children will have no opportunity for development at all unless they survive. The language of rights means little to a child stillborn, an infant dying in pain from pneumonia, or a child desiccated by famine. The most fundamental right of all is the right to survive. Child survival must sit at the core of UNICEF’s advocacy and country work. Currently, and shamefully, it does not." "What are the skills and experiences that Ko. Annan should be looking for in the next executive director of UNICEF?... There are several general attributes that should inform the UN secretary-general’s decision. UNICEF needs to be led by an energetic and inspirational individual who is ambitious for the future of the world’s children. S/he must have political integrity, a willingness to speak with a strong voice against power, and a proven interest in the well-being and health of children - or at the very least, s/he should be able to show an understanding that child health is a critical factor in advancing human development. It is surprising that this important UN agency should have had 4 American executive directors. It is hard to believe that the person best equipped to address the global plight of children can only be an American. Ko. Annan must cast his net for nominations far and wide, looking especially hard at non-US candidates."
Children remain one of the most marginalized groups in our world today. The predicament of children is the predicament of our futures - and the future of our predicaments. UNICEF needs a visionary leader, a person of profound ability to make the next ten years the Decade of Child Survival and Development. Mr Annan, this is the most important decision of your career - its effects will touch the lives of millions of those who have no voice. Be their voice." .