Long-term effects of caffeine therapy for apnea of prematurity on sleep at school age. Prospective associations of parental smoking, alcohol use, marital status, maternal satisfaction, and parental and childhood body mass index at 6.5 years with later problematic eating attitudes Pulque intake during pregnancy and lactation in rural Mexico: alcohol and child growth from 1 to 57 months Breastfeeding and Prolactin Levels in Lactating Women With a Family History of Alcoholism Parental smoking and alcohol consumption and risk of neuroblastoma. Breast-feeding Duration: Early Weaning—Do We Sufficiently Consider the Risk Factors? Risk factors for iron deficiency in a hospitalized urban New Zealand population. Delay in caffeine elimination in breast-fed infants. Effect of maternal caffeine consumption on heart rate and sleep time of breast-fed infants. MATERNAL DIET AND INFANTILE COLIC IN BREAST-FED INFANTS Breastfeeding and supplemental feeding for neonates in Al-Ain, United Arab Emirates. Infants' suckling responses to the flavor of alcohol in mothers' milk. Infant feeding and mental and motor development at 18 months of age in first born singletons. Infant colic: empirical evidence of the absence of an association with source of early infant nutrition. Factors associated with low consumption of fruits and vegetables by preschoolers of low socio-economic level.
RATIONALE Apnea of prematurity is a common condition that is usually treated with caffeine , an adenosine receptor blocker that has powerful influences on the central nervous system . However , little is known about the long-term effects of caffeine on sleep in the developing brain . OBJECTIVES We hypothesized that neonatal caffeine use result ed in long-term abnormalities in sleep architecture and breathing during sleep . METHODS A total of 201 ex-preterm children aged 5 - 12 years who participated as neonates in a double-blind , r and omized , controlled clinical trial of caffeine versus placebo underwent actigraphy , polysomnography , and  parental sleep question naires . Co primary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography . MEASUREMENTS AND MAIN RESULTS There were no significant differences in primary outcomes between the caffeine group and the placebo ( adjusted mean difference of -6.7 [ 95 % confidence interval ( CI ) = -15.3 to 2.0 min ] ; P = 0.13 for actigraphic total sleep time ; and adjusted rate ratio [ caffeine/placebo ] for apnea-hypopnea index of 0.89 [ 95 % CI = 0.55 - 1.43 ] ; P = 0.63 ) . Polysomnographic total recording time and total sleep time were longer in the caffeine group , but there was no difference in sleep efficiency between groups . The percentage of children with obstructive sleep apnea ( 8.2 % of caffeine group versus 11.0 % of placebo ; P = 0.22 ) or elevated periodic limb movements of sleep ( 17.5 % in caffeine group versus 11 % in placebo group ) was high , but did not differ significantly between groups . CONCLUSIONS Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood . Ex-preterm infants , regardless of caffeine status , are at risk for obstructive sleep apnea and periodic limb movements in later childhood Background : Few studies have prospect ively investigated whether early-life exposures are associated with pre-adolescent eating attitudes . Objective : The objective of this study is to prospect ively investigate associations of parental smoking , alcohol use , marital status , measures of maternal satisfaction , self-reported parental body mass index ( BMI ) and clinical ly measured childhood BMI , assessed between birth and 6.5 years , with problematic eating attitudes at 11.5 years . Methods : Observational cohort analysis nested within the Promotion of Breastfeeding Intervention Trial , a cluster-r and omised trial conducted in 31 maternity hospitals and affiliated polyclinics in Belarus . Our primary outcome was a Children ’s Eating Attitudes Test ( ChEAT ) score ⩾22.5 ( 85th percentile ) , an indicator of problematic eating attitudes . We employed multivariable mixed logistic regression models , which allow inference at the individual level . We also performed instrumental variable ( IV ) analysis using parents ’ BMI s as instruments for the child ’s BMI , to assess whether associations could be explained by residual confounding or reverse causation . Subjects : Of the 17 046 infants enrolled between 1996 and 1997 across Belarus , 13 751 ( 80.7 % ) completed the ChEAT test at 11.5 years . Results : In fully adjusted models , overweight children at age 6.5 years had a 2.14-fold ( 95 % confidence interval ( CI ) : 1.82 , 2.52 ) increased odds of having ChEAT scores ⩾85th percentile at age 11.5 years , and those who were obese had a 3.89-fold ( 95 % CI : 2.95 , 5.14 ) increased odds compared with normal-weight children . Children of mothers or fathers who were themselves overweight or obese were more likely to score ⩾85th percentile ( P for trend ⩽0.001 ) . IV analysis was consistent with a child ’s BMI causally affecting future eating attitudes . There was little evidence that parental smoking , alcohol use , or marital status or maternal satisfaction were associated with eating attitudes . Conclusion : In our large , prospect i ve cohort in Belarus , both parental and childhood overweight and obesity at 6.5 years were associated with pre-adolescent problematic eating attitudes 5 years later Objective : To examine maternal intake of a mildly alcoholic beverage ( pulque ) during pregnancy and lactation , and its potential effect on postpartum child growth and attained size . Design : A prospect i ve cohort study that followed mothers ( during pregnancy and lactation ) and their offspring ( from birth to approximately 57 months of age ) . Setting : Six villages in rural , central Mexico . Subjects : Subjects are 58 mother – child pairs .  Pulque intake  was measured as part of a dietary assessment that was conducted for 2days/month during pregnancy and early lactation . Results : Most mothers consumed pulque during pregnancy ( 69.0 % ) and lactation ( 72.4 % ) . Among pulque drinkers , the average ethanol intake was 125.1 g/week during pregnancy and 113.8 g/week during lactation . Greater pulque intake during lactation , independent of intake during pregnancy , was associated with slower weight and linear growth from 1 to 57 months , and smaller attained size at 57 months . Low-to-moderate pulque  intake during pregnancy , in comparison to either nonconsumption or heavy intake , was also associated with greater stature at 57 months . Conclusions : Pulque intake during lactation may have adversely influenced postnatal growth in this population . Public health interventions are urgently needed in Mexico to reduce heavy intake of pulque by pregnant and lactating women , and to replace intake with foods that provide the vitamins and minerals present in the traditional alcoholic beverage OBJECTIVE : Many motivated new mothers fail to reach public health goals for breastfeeding , highlighting the need to identify risk factors . Because having a family history of alcoholism is associated with blunted prolactin responses to an alcohol challenge in nonlactating individuals , this study aim ed to identify associations in family history of alcoholism , prolactin , and breastfeeding behaviors in lactating women . METHODS : This was a 2-day experimental study that used within-subject alcohol or control beverage consumption and between-subject family history of alcoholism factors . The participants were non – alcohol-dependent lactating women ; 7 were family history – positive ( FHP ) for alcohol dependence , and 21 were family history – negative ( FHN ) .  Consumption of 0.4 g/kg alcohol or nonalcoholic beverage occurred in separate r and omized sessions , followed by use of a breast pump . Basal and suckling-induced prolactin , blood alcohol concentrations , milk yield , self-reported drug effects , neophobia , and breastfeeding patterning were measured . RESULTS : Although no group differences in alcohol pharmacokinetics were detected , FHP women exhibited blunted prolactin to breast stimulation after drinking the control and alcohol beverage and felt more of the stimulant-like effects of alcohol than did FHN women . FHP women reported more frequent daily breastfeeding than did FHN women . CONCLUSIONS : This is the first evidence that family history of alcoholism is associated with a blunted magnitude , rapidity , and duration of the prolactin response to breast stimulation and an alcohol challenge in lactating women . More frequent breastfeeding by FHP women suggests behavioral compensation for perceived and /or actual poor lactation . Alcohol did not enhance lactational performance , further disputing the lore that alcohol is a galactagogue Previous studies and animal evidence have suggested a relationship between parental  tobacco or alcohol use and the  risk  of some  childhood cancers , including  neuroblastoma .  A case-control study was conducted to investigate the relationship between  parental tobacco smoking , alcohol consumption , and risk of neuroblastoma .  Cases were children diagnosed with neuroblastoma over the period 1992 - 1994 at Children 's Cancer Group and Pediatric Oncology Group institutions throughout the United States and Canada . One matched control was selected using r and om-digit dialing . Information on parental smoking and drinking history was obtained from 504 case and 504 control parents by telephone interview . Overall , there was no consistent pattern of association with parental smoking and alcohol consumption . For example , both maternal smoking and drinking during the period from 1 month before pregnancy through breastfeeding had adjusted odds ratios ( ORs ) of 1.1 [ 95 % confidence interval ( CI ) , 0.8 - 1.4 ] . There was no association with paternal smoking ( OR , 1.2 ; 95 % CI , 0.8 - 1.6 ) or paternal drinking 1 month before conception ( OR , 1.0 ; 95 % CI , 0.7 - 1.4 ) . There was no consistent increase in risk by the amount of smoking or drinking during any time period relative to pregnancy . There was no suggestion of an increased risk when only one parent smoked . Smoking or drinking among both parents did not jointly increase the risk of neuroblastoma in their offspring . The child 's age at diagnosis , stage , or MYCN oncogene amplification status did not material ly alter the OR estimates . It is concluded that the results from this study do not indicate any evidence for a relationship between neuroblastoma and parental tobacco or alcohol use Objectives : Breast-feeding is the recommended form of nutrition for the first 6 months . This target is unmet , however , in most industrialized regions . We evaluated aspects of breast-feeding in a cohort of mother – baby dyads . Methods : Breast-feeding practice s in 555 mother – baby dyads were prospect ively studied for 24 months ( personal interview at birth and 7 structured telephone interviews ) . Results : Of the babies , 71.3 % were fully breast-fed on discharge from maternity hospitals and 11.9 % were partially breast-feed . Median breast-feeding duration was 6.93 ( interquartile range 2.57–11.00 ) months ; for full ( exclusive ) breast-feeding 5.62 ( interquartile range 3.12–7.77 ) months ; 61.7 % received supplemental feedings during the first days of life . Breast-feeding duration in babies receiving supplemental feedings was significantly shorter ( median 5.06 months versus 8.21 months , P < 0.001 ) . At 6 months , 9.4 % of the mothers were exclusively and 39.5 % partially breast-feeding . Risk factors for early weaning were early supplemental feedings  ( odds ratio [ OR ] 2.87 , 95 % CI 1.65–4.98 ) , perceived milk insufficiency ( OR 7.35 , 95 % CI 3.59–15.07 ) , low breast-feeding self-efficacy ( a mother 's self-confidence in her ability to adequately feed her baby ) ( OR 3.42 , 95 % CI 1.48–7.94 ) , lower maternal age ( OR 3.89 , 95 % CI 1.45–10.46 ) , and lower education level of the mother ( OR 7.30 , 95 % CI 2.93–18.20 ) . Conclusions : The recommended full breast-feeding duration of the first 6 months of life was not reached . Sociodemographic variables and factors directly related to breast-feeding practice s play an important role on breast-feeding duration /weaning in our region . Underst and ing risk factors will provide insights to give better support to mothers and prevent short- and long-term morbidity following early weaning OBJECTIVE To determine which dietary practice s and sociodemographic factors are associated with iron deficiency anaemia ( IDA ) and iron deficiency ( ID ) in hospitalized New Zeal and children . METHODOLOGY A prospect i ve study of children 8 - 23 months of age hospitalized with an acute illness from 1997 to 1999 . Iron deficiency was defined as abnormal values for two out of three of serum ferritin ( < 10 micro g/L ) , serum iron saturation ( < 10 % ) and red cell distribution width ( > 14.5 % ) . Iron deficiency anaemia ( IDA ) was defined as ID + serum haemoglobin concentration < 110 g/L. Those with IDA or ID were compared separately with those who were not iron deficient . RESULTS Three hundred and ninety-one children were enrolled . Two hundred and twenty had IDA , 73 had ID and 98 were not iron deficient . In a multivariate analysis , those children who had a diagnosis of pneumonia ( odds ratio 4.43 , 95 % CI 1.49 , 13.13 ) were Pacific ( odds ratio 6.31 , 95 % CI 2.14 , 18.63 ) , were currently drinking breast milk ( odds ratio 10.22 , 95 % CI 2.95 , 35.42 ) , had a mother who restricted her meat intake during pregnancy ( odds ratio 4.40 , 95 % CI 1.53 , 12.64 ) or lived in a household with more than three children ( odds ratio 7.42 , 95 % CI 1.88 , 29.34 ) were at increased risk of IDA . Those children who were Pacific ( odds ratio 5.44 , 95 % CI 1.37 , 21.65 ) or who drank tea ( odds ratio 7.88 , 95 % CI 1.10 , 56.33 ) were at increased risk of ID . Those with a diagnosis of gastroenteritis ( odds ratio 0.16 , 95 % CI 0.03 , 0.75 ) were at decreased risk of ID . CONCLUSIONS Both dietary and non-dietary factors are associated with an increased risk of IDA and ID in New Zeal and children . In this hospitalized sample , more non-dietary than dietary factors were associated with poor iron status Because of a persistently elevated  caffeine half-life observed in a breast-fed infant during caffeine maintenance therapy , we conducted this prospect i ve longitudinal study in two groups of infants ( five exclusively breast-fed and 12 formula-fed ) . After 46 weeks ' postconceptional age , all five breast-fed infants had a marked delay in caffeine elimination , compared with one infant in the formula-fed group . Four breast-fed infants had measurements of significantly longer caffeine half-lives compared with 12 formula-fed infants ( 76 + /- 13 hours v 21 + /- 28 hours and 54 + /- 9 hours v 16 + /- 13 hours at 47 to 50 weeks and 51 to 54 weeks postconceptional age , respectively ) , as well as significantly higher trough blood levels ( three- to five-fold ) after 46 weeks ' postconceptional age . The fifth breast-fed infant accumulated caffeine secondary to a steep increase in caffeine half-life from 102 hours at 44 weeks to 372 hours at 51 weeks . The elevated blood caffeine levels in breast-fed infants was not related to higher daily dosage of caffeine citrate ( 4.4 mg/kg compared with 8.3 mg/kg in the formula-fed group at 56 weeks ' postconceptional age ) . Daily consumption of caffeine  was low or nonexistent in four nursing mothers , and transfer of caffeine to the infant was considered to be trivial . The findings from this study suggest , as does breast milk jaundice due to inhibition of glycuronyl transferase , that some components of human milk ( free fatty acid , lipase activity , or other factors ) inhibit or repress the postnatal normal maturation process of caffeine metabolism by hepatic cytochrome P-450 Eleven mother-infant pairs were studied to determine the effect of maternal caffeine ingestion ( 500 mg/day ) on heart rate and sleep time  of the infants . In a balanced cross-over design , mothers ingested 5 cups of decaffeinated coffee daily during one 5-day period and 5 cups of decaffeinated coffee with added caffeine ( 100 mg/cup ) during another 5-day period . Concentrations of caffeine in milk on the last day of the caffeine period ranged from 1.6 to 6.2 micrograms/ml and the intake of  caffeine  by the infants was estimated to be 0.3 - 1.0 mg/kg/day . Infant serum did not contain detectable amounts of caffeine on the last day of either experimental period . Performance during the caffeine and no-caffeine periods was not significantly different with respect to either 24-hour heart rate or sleep time This paper reports the results of placebo-controlled double-blind r and omized cross-over trial design ed to examine the effects of elimination of cow 's milk from maternal diet on rates of infantile colic . Subjects were 20 exclusively breast-fed infants , aged 3 - 18 weeks , with persistent colic . Each mother was given 600 ml drink to be drunk every day ; on 6 of the days the drink contained 300 ml of cow 's milk and 300 ml of soya milk ; on the remaining days it contained 600 ml of soya milk ; the 2 drinks were formulated to be undistinguishable ; the trial days were grouped into blocks of 2 days , r and omly assigned . Mothers were also instructed to record time and duration of any colic , and to record their own daily diet . Avoidance of cow 's milk produced no beneficial effects on the incidence of colic in the babies ; but when frequency of colic was related to days on which specific foods were eaten by the mothers the rates of colic were found to be significantly higher on days on which mothers reported eating chocolate or fruit . These results do not support the contention that elimination of cow 's milk from maternal diet may influence the likelihood of infantile colics ; the source of colic , however , can not be attributed to a single dietary component , but it may involve a combination of foodstuffs A prospect i ve cohort study was carried out to determine the factors affecting initiation of breastfeeding , and describe patterns of breastfeeding and supplemental feeding in the multiethnically and culturally diverse population of Al Ain , UAE . Two-hundred- and -twenty-one infants completed the 4 weeks of follow up . None of the mothers opted not to breastfeed , but only 4 per cent of them practice d exclusive breastfeeding during the first month of the infants ' life ; 51 per cent of them initiated breastfeeding on the first day of life . Factors associated with delayed initiation of breastfeeding beyond the first day of life included low birth weight , complicated delivery , ignorance of the advantages of colostrum , and young maternal age .  Non-milk supplements fed to babies included water , tea , juice , yansun , and babunj ( local herbal drinks ) . The preferred method of feeding the supplements was the feeding bottle . There were significant associations between the use of these supplements and the mother 's nationality and education Contrary to medical folklore , previous research has demonstrated that alcohol consumption by lactating women diminished milk intake by their infants during breast feeding . To determine whether this decrease in milk consumption was due to the infants responding to the altered flavor of the milk that also result ed , we evaluated the infants ' intake and sucking responses to alcohol-flavored human milk outside of the context of breast feeding , thereby separating the changes due to the infants response to the flavor from any other changes that could also result from acute maternal alcohol consumption such as alterations in milk ejection or the composition of milk . The testing procedure consisted of a two-bottle preference test that was composed of four , 60-sec trials in which the mother 's milk flavored with alcohol was alternated with the mother 's milk alone in an ABBA or BAAB design . Attached to the nipple of each bottle was a transducer that responded to pressure changes produced by the infants ' suckling . There was no suppression of sucking or intake in response to the ethanol-flavored milk . Rather , the infants consumed significantly more and sucked more frequently when drinking the alcohol-flavored milk compared with the unaltered milk . That experience with the flavor of alcohol in mothers ' milk modified the infants ' responses to alcohol flavor is suggested by the relationship between the reported frequency of mothers ' drinking during lactation and the infants ' rhythm and frequency of sucking when feeding the alcohol-flavored milk . These findings indicate that infants can readily detect the flavor of alcohol in mother 's milk but that the decrease in consumption at the breast after maternal alcohol consumption is apparently not due to the infants rejecting the flavor of alcohol in their mothers ' milk OBJECTIVE To determine the relationship between type of  infant feeding and mental and psychomotor development  at age 18 months . METHOD A follow-up study of children born to primigravidae living in Dundee and booked into antenatal clinics in the City of Dundee ( Local Authority District ) from 1 May 1985 to 30 April 1986 . The study population was 846 first born singletons , of whom 592 attended for developmental assessment at age 18 months . The main outcome measures were the Bayley Scales of Infant Mental and Motor Development . RESULTS Higher mental development was significantly related to breast feeding on discharge from hospital and according to the health visitors ' notes at about 2 weeks after discharge after allowing for partner 's social class , mother 's education , height , alcohol and cigarette consumption ; placental weight and the child 's sex , birth weight and gestational age at birth . After adjustment for statistically significant variables , the difference in Bayley mental development index between breast and bottle fed infants was between 3.7 and 5.7 units depending on the source of feeding data . No differences were found for psychomotor development or behaviour . CONCLUSION The study provides further evidence of a robust statistical association between type of feeding and child intelligence . However , the literature is replete with suggestions for potential confounding variables which offer alternative causal explanations . To unravel what is an important clinical and public health question , further research should concentrate on r and omized trials of supplemented formula feeds for children of mothers opting for bottle feeding and on epidemiological studies design ed to disentangle the relation between method of feeding , parental intelligence and social environment BACKGROUND The etiology of infant colic  remains unknown , despite an abundance of research on the topic . OBJECTIVE To determine whether breastfeeding has a protective effect in colic 's development . DESIGN A prospect i ve cohort study of 856 mother-infant dyads . Eligible participants included English-speaking adult residents of a region in Ontario , who gave birth , at term , to a live singleton whose birth weight was appropriate for gestational age .  Self-administered question naires , mailed to mothers at 1 and 6 weeks post partum , requested information on several infant and maternal factors , including source of infant nutrition ( exclusively breastfed , complementary fed , and exclusively formula fed ) . Cases of colic were identified by applying modified Wessel criteria to data recorded in the Barr Baby Day Diary or by interpreting responses to the Ames Cry Score . MAIN OUTCOME MEASURES Prevalence of colic among breastfed , formula-fed , and complementary-fed infants ; and adjusted odds ratios ( AORs ) reflecting the prevalence of colic among formula- and complementary-fed infants relative to those who were breastfed . RESULTS Of 856 mothers , 733 ( 86 % ) completed the first question naire and 617 ( 72 % ) completed the second question naire . Overall , the prevalence of colic at 6 weeks was 24 % . No association was seen between the source of infant nutrition and colic 's development . In multivariate analyses , higher levels of maternal trait anxiety ( AOR , 1.22 ; 95 % confidence interval [ CI ] , 0.96 - 1.54 ) , maternal alcohol consumption at 6 weeks ( AOR , 1.57 ; 95 % CI , 1.03 - 2.40 ) , and shift work during pregnancy ( AOR , 1.27 ; 95 % CI , 0.73 - 2.21 ) were associated with an increased likelihood of colic , after controlling for feeding method , maternal age , and parity . In these same analyses , being married or having a common-law partner ( AOR , 0.30 ; 95 % CI , 0.10 - 0.87 ) and being employed full-time during pregnancy ( AOR , 0.60 ; 95 % CI , 0.32 - 1.14 ) were associated with a reduced likelihood of colic . CONCLUSIONS Breastfeeding did not have a protective effect on the development of colic . Although colic was statistically associated with several variables , including preexisting maternal anxiety , much of colic 's etiology remains unexplained OBJECTIVE To evaluate factors associated with low consumption of fruits and vegetables  among preschoolers from families treated at basic health centers in Porto Alegre , RS , Brazil . METHODS This was a cohort study nested in a r and omized field trial . Data collection was performed through structured question naires to obtain demographic and dietary data , combined with two 24-hour recalls in the age groups 12 - 16 months and again at 2 - 3 years of age . Data on the consumption of one daily serving of fruits ( 80 g ) and vegetables ( 60 g ) were evaluated , as well as consumption of non-recommended foods such as c and y , chocolate , and soft drinks . Statistical analyses were performed using Poisson regression with robust estimation . RESULTS A total of 388 children aged 2 - 3 years were evaluated ; of these , 58 % and 87.4 % did not consume one daily serving of fruits and vegetables , respectively . The following factors were negatively associated with fruit consumption : family income higher than four minimum wages , ( p=0.024 ) , lower paternal educational level ( p=0.03 ) , and lower fruit consumption at 12 - 16 months ( p=0.002 ) . Factors negatively associated with the consumption of vegetables  were low paternal educational level ( p=0.033 ) and consumption of high-sugar content beverages at 12 - 16 months ( p=0.014 ) . CONCLUSION This study demonstrated a high prevalence of children who consumed less than one daily serving of fruit and vegetables ; early feeding practice s , parental education , and family income were associated with this process
BACKGROUND Nutrition in the first 1000 days between pregnancy and 24 months of life is critical for child health , and exclusive breastfeeding is promoted as the infant 's best source of nutrition in the first 6 months .
Caffeine is a central nervous system stimulant occurring naturally in some foods and used to treat primary apnoea in premature babies .
However high caffeine intake can be harmful , and caffeine is transmitted into breastmilk .
AIM To systematic ally review the evidence on the effects of maternal caffeine consumption during breastfeeding on the breastfed child .