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To describe infant feeding practices and predictors of exclusive breast-feeding among women attending a local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme.
Cross-sectional survey. Outcomes included reported infant feeding practices at 3 and 6 months, timing and reasons for introduction of formula. Descriptive statistics, χ2 tests and logistic regression were used describe the sample and explore relationships between variables.
Loudoun County, VA, USA.
A sample of 190 predominantly Hispanic women attending local WIC clinics.
Overall, 84 % of women reported ever breast-feeding and 61 % of infants received formula in the first few days of life. Mothers who reported on infant feeding practices were less likely to exclusively breast-feed (34 v. 45 %) and more likely to provide mixed feeding (50 v. 20 %) at 3 months compared with 6 months, respectively. Significant (P<0·05) predictors of exclusive breast-feeding at 3 months included setting an exclusive breast-feeding goal and completing some high school (compared with completing high school or more). Only education remained a significant predictor of exclusive breast-feeding at 6 months.
A high proportion of women reported giving formula in the first few days of life and many changed from mixed to exclusive breast-feeding or formula by 6 months, suggesting possibly modifiable factors. Further investigation can help drive direct service- as well as policy and systems-based interventions to improve exclusive breast-feeding.
Cerebrovascular reactivity monitoring has been used to identify the lower limit of pressure autoregulation in adult patients with brain injury. We hypothesise that impaired cerebrovascular reactivity and time spent below the lower limit of autoregulation during cardiopulmonary bypass will result in hypoperfusion injuries to the brain detectable by elevation in serum glial fibrillary acidic protein level.
We designed a multicentre observational pilot study combining concurrent cerebrovascular reactivity and biomarker monitoring during cardiopulmonary bypass. All children undergoing bypass for CHD were eligible. Autoregulation was monitored with the haemoglobin volume index, a moving correlation coefficient between the mean arterial blood pressure and the near-infrared spectroscopy-based trend of cerebral blood volume. Both haemoglobin volume index and glial fibrillary acidic protein data were analysed by phases of bypass. Each patient’s autoregulation curve was analysed to identify the lower limit of autoregulation and optimal arterial blood pressure.
A total of 57 children had autoregulation and biomarker data for all phases of bypass. The mean baseline haemoglobin volume index was 0.084. Haemoglobin volume index increased with lowering of pressure with 82% demonstrating a lower limit of autoregulation (41±9 mmHg), whereas 100% demonstrated optimal blood pressure (48±11 mmHg). There was a significant association between an individual’s peak autoregulation and biomarker values (p=0.01).
Individual, dynamic non-invasive cerebrovascular reactivity monitoring demonstrated transient periods of impairment related to possible silent brain injury. The association between an impaired autoregulation burden and elevation in the serum brain biomarker may identify brain perfusion risk that could result in injury.