Infant

To study the patients' characteristics, outcomes, contributory factors, factors minimizing the incidence and suggested corrective strategies for perioperative pulmonary aspiration in Thailand. This is a prospective descriptive research design. The relevant data was extracted from the incident reports on aspiration from 51 hospitals across Thailand during the study period between January 1 and June 30, 2007 from the Thai Anesthesia Incident Monitoring Study (Thai AIMS) database. Descriptive statistics was used. Each incident report was reviewed by three senior anesthesiologists. Any disagreement was discussed to achieve a consensus. From 1,996 incident reports, there were 28 reports (1.4%) that met the definition of pulmonary aspiration. Most of the incidents occurred in patients with ASA 1-2 (85.7%), during the official hour (64.3%) and the anesthesiologists were in charge (67.9%). Eleven incidents (39.3%) occurred during induction, seven (25%) during maintenance and seven (25%)...

A retrospective cohort study of children with sickle cell anemia (SCA) and strokes was used to test the hypothesis that exchange transfusion at the time of stroke presentation more effectively prevents second strokes than does simple transfusion. Children receiving simple transfusion had a 5-fold greater relative risk (95% confidence interval ‫؍‬ 1.3 to 18.6) of second stroke than those receiving exchange transfusion. (J Pediatr 2006;149:710-2)

By preserving part of the native liver, auxiliary partial orthotopic liver transplantation (APOLT) provides the advantage of potential immunosuppression (ISP) withdrawal if the native liver recovers but has had limited acceptance, especially in the United States, due to technical complications and low rates of native liver regeneration. No previous study has evaluated APOLT specifically for preadolescent children with fulminant hepatic failure (FHF). This population might benefit especially based on greater capacity for liver regeneration. Data from 13 preadolescent children who underwent APOLT were compared to 13 matched controls who underwent orthotopic liver transplantation (OLT) for FHF from 1996 to 2013. There were no significant differences in patient demographics or survival between the 2 groups. However, all surviving OLT recipients (10/13) remain on ISP, while all but 1 surviving APOLT recipient (12/13) showed native liver regeneration, and the first 10 recipients (76.9%) are currently off ISP with 2 additional patients currently weaning. In our experience, APOLT produced excellent survival and high rates of native liver regeneration in preadolescent children with FHF. This represents the largest series to date to report such outcomes. Liberating these children from lifelong ISP without the downside of increased surgical morbidity makes APOLT an attractive alternative. In conclusion, we therefore propose that, with the availability of technical expertise and with the technical modifications above, APOLT for FHF should be strongly considered for preteenage children with FHF.

To compare the patterns of motor type and gross motor functional severity in preschool-aged children with cerebral palsy (CP) in Bangladesh and Australia. We used comparison of 2 prospective studies. A total of 300 children with CP were aged 18 to 36 months, 219 Australian children (mean age, 26.6 months; 141 males) recruited through tertiary and community services, and 81 clinic-attendees born in Bangladesh (mean age, 27.5 months; 50 males). All children had diagnosis confirmed by an Australian physician, and birth and developmental history collected on the Physician Checklist. All children were classified by the same raters between countries using the Gross Motor Function Classification System (GMFCS), and motor type and distribution. There were more children from GMFCS I-II in the Australian sample (GMFCS I, P < .01; III, P < .01; V, P = .03). The patterns of motor type also differed significantly with more spasticity and less dyskinetic types in the Australian sample (spas...

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The aim of this study was to evaluate the clinical manifestations and prevalence of familial Mediterranean fever (FMF) in Japanese patients with unexplained fever and rheumatic manifestations. We enrolled 601 patients with unexplained fever or suspected FMF throughout Japan between 2009 and 2015. Patients were divided into three groups according to Tel Hashomer criteria: sure FMF, probable FMF, and non-FMF patients, including definitive rheumatic diseases. Mutation detection in exons 1, 2, 3, and 10 of the FMF gene MEFV was performed by direct sequencing. A total of 192 patients (31.9 %) were diagnosed with FMF according to FMF diagnostic criteria. These could be divided into sure FMF (56.3 %, n = 108) and probable FMF (43.7 %, n = 84) patients. Fever, abdominal symptoms, and thoracic symptoms were significantly more common in FMF than non-FMF patients. Among FMF patients, 26 (13.5 %) had concomitant rheumatic diseases. Most FMF patients (94.3 %, 181/192) carried at least one MEFV m...

Introduction The outcome of premature infants with only diffuse excessive high signal intensity (DEHSI) is not clear. We explored the relationship between DEHSI, white matter (WM) diffusion characteristics, perinatal characteristics, and neurobehavioral outcome at 1 year in a homogenous group of preterm infants without major brain abnormalities. Methods Fifty-eight preterm infants, gestational age 29± 2.6 weeks, underwent an MRI at term-equivalent age (TEA). Griffiths Mental Developmental Scales, neurological assessment, and Parental Stress Index (PSI) were performed at 1 year corrected age. These measures were compared between preterm infants according to DEHSI classification (none, mild, moderate). Diffusion tensor imaging was used in major WM volumes of interest to objectively measure the degree of WM maturation. Results No significant differences were detected in the perinatal risk characteristics, neurobehavioral outcome, and PSI at 1 year between infants with different DEHSI classifications. In infants with DEHSI, increased axial and radial diffusivities were detected in the optic radiations, centrum semiovale, and posterior limb of the internal capsule, indicating less advanced maturation of the WM. Significant correlations were detected between the time interval from birth to MRI and the WM microstructure in infants without DEHSI. Conclusion DEHSI in premature infants is neither a predictive measure for short-term adverse neurobehavioral outcome nor related to perinatal risk characteristics. Extrauterine exposure time had a differential effect on WM maturational trajectories in infants with DEHSI compared to those without. We suggest DEHSI may represent an alteration in WM maturational characteristics. Further follow-up studies may verify later consequences of DEHSI in premature infants.

RATIONALE: T lymphocytes accumulating in the skin of patients with atopic dermatitis have a prolonged survival and are key mediators of this inflammatory disease. The anti-apoptotic bfl-1 gene is unique in that it is the only member of the Bcl-2 family, which is transcriptionally regulated by inflammatory cytokines and might therefore be important in promoting the survival of effector T cells in patients with atopic dermatitis. The aim of the study was to determine whether polymorphisms in the bfl-1 gene are associated with a predisposition to atopic dermatitis. METHODS: bfl-1 gene single nucleotide polymorphisms (SNPs) were studied by ARMS-PCR in 83 Caucasian children with moderately severe atopic dermatitis and 110 non-atopic adult controls. RESULTS: Two known polymorphisms of exon were studied, but in addition we describe one novel polymorphism in the promoter region. No significant differences was found between individual bfl-1 SNPs and allele frequencies of children with atopic dermatitis and controls. CONCLUSIONS: Polymorphisms in the bfl-1 gene do not explain the genetic predisposition of certain individuals to atopic dermatitis. Funding: RATIONALE: Up to 30-60% of children who develop atopic dermatitis (AD) develop asthma. NKT cells have been shown to be essential for the development of allergen-induced airway hyperreactivity (AHR). Hence, we studied the role of NKT cells in a murine model of AD. METHODS: Wild type (WT) and NKT cell deficient CD1d-/-mice were epicutaneously sensitized (EC) with 100 microg. ovalbumin (OVA) or normal saline and then exposed to aerosolized OVA. IgG1, IgG2a and IgE OVA-specific antibody levels were determined. NKT cells were analyzed by FACS using Gal-Cer loaded CD1d dimers and a monoclonal antibody against the TCR-beta chain. IL-4 and IL-13 mRNA levels were measured by quantitative RT-PCR. AHR response to methacholine was measured after OVA inhalation. RESULTS: CD1d-/-mice exhibited a normal systemic immune response to EC sensitization measured by OVA-specific antibody responses. OVAsensitized skin from CD1d-/-mice contained normal amounts of CD4+ cells and eosinophils and increased IL-4 and IL-13 mRNA expression comparable to WT mice. NKT cells were not detectable in EC sensitized skin of either WT or CD1d-/-mice. In contrast, NKT cells were present in the BAL fluid from OVA challenged sensitized WT mice, but not in the BAL fluid of CD1d-/-mice. IL-4 and IL-13 mRNA was increased in lungs of WT, but not CD1d-/-mice. The latter failed to develop AHR. RATIONALE: There is evidence that antenatal factors play a role in the development of atopic dermatitis (AD). However, little is known about the effects of maternal lifestyle factors during pregnancy on the risk of atopic dermatitis in the offspring. The aim was to investigate the effect of alcohol consumption during pregnancy on the incidence of AD in the offspring.

Bilateral spastic cerebral palsy ICF-CY International Classification of Functioning, Disability and Health -Children and Youth version NSCP Non-spastic cerebral palsy USCP Unilateral spastic cerebral palsy VABS Vineland Adaptive Behavior Scales AIM The aim of this study was to determine the developmental trajectories of expressive (speech) and receptive (spoken and written language) communication by type of motor disorder and intellectual disability in individuals with cerebral palsy (CP).

The purpose of this collaborative research study was to evaluate the use of the Memory Book intervention for orphaned children's grief and loss recovery. A qualitative phenomenological approach was implemented to evaluate the Memory Book intervention with orphaned children at two children's homes in South Africa. Study findings support the ability of children to work through loss and grief when they are assisted in preserving and telling their story. The Memory Book intervention assists children to chronicle their lives and demonstrates the potential to guide future interventions by care providers and nurses in this context.

To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most common...

The etiology of obsessive-compulsive disorder (OCD) remains unknown, although it is thought to involve an interaction of genetic and environmental factors. This study aimed to identify prenatal, perinatal, and postnatal risk factors in OCD. Methods: We compared retrospectively 68 OCD patients to 70 control subjects based on responses given on a standardized questionnaire. The questionnaire was designed to evaluate environmental factors, with a special focus on gestation, labor, birth, and early infancy aspects. Results: The group of OCD patients had risk factors with greater frequency than the control group. Notable among the significant findings (p Յ 0.001) were edema of the hands, feet, or face and excessive weight gain during gestation; hyperemesis gravidarum; prolonged labor; preterm birth; and jaundice. When socioeconomic class was used as a covariable in the logistic regression analysis, prolonged labor and edema during pregnancy remained statistically significant. Conclusions: Some early risk factors may be associated with the expression of OCD later in life such as edema during pregnancy and prolonged labor. If our findings are confirmed in future studies, greater attention should be given to such factors in predisposed individuals, especially in prenatal care and delivery.

Objective: To determine cardioversion doses of biphasic DC shock for paediatric atrial dysrhythmias. Design: Prospective recording of energy, pre-shock and post-shock rhythms. Setting: Paediatric hospital. Patients: Shockable atrial dysrhythmias. Main results: Forty episodes of atrial dysrhythmias among 25 children (mean age 6.8 ± 7.1 years, mean weight 28.2 ± 28.5 kg) were treated with external shock. The first shock converted the dysrhythmia to sinus rhythm in 25 episodes. Cardioversion occurred in 2 of 8 (25%) episodes with a dose of <0.5 J/kg, 14 of 16 (88%) with a dose of 0.5-1.0 J/kg and 9 of 16 (56%) with a dose of >1.0 J/kg (p = 0.01, Fisher's exact test). Ten of 15 initially non-responsive episodes were cardioverted with additional shocks at 1.1 ± 0.6 J/kg (range 0.5-2.1 J/kg). Of the remaining 5 unresponsive episodes, 2 of ventricular fibrillation (induced by unsynchronized shock) were successfully defibrillated, and 3 were managed with cardiopulmonary bypass. Among 11 additional children (mean age 4.3 ± 6.8 years, mean weight 18.1 ± 22.0 kg), 18 episodes of atrial dysrhythmias were treated with internal shock which successfully cardioverted all episodes with one or more shocks at 0.4 ± 0.2 J/kg. Conclusions: In rounded doses, recommended initial external cardioversion doses are 0.5-1.0 J/kg and subsequently up to 2 J/kg, internal cardioversion doses are 0.5 J/kg.

Aims-Iron deficiency anaemia is associated, in observational studies, with developmental disadvantage. This study tested the hypothesis that feeding iron supplemented formula from 9 to 18 months of age would improve developmental performance. Subjects and methods-493 healthy children aged 9 months being fed pasteurised cows' milk were recruited from three UK centres. They were randomised to: cows' milk as before, formula containing 0.9 mg/ litre iron, or formula containing 1.2 mg/ litre iron, until 18 months of age. Bayley mental and psychomotor developmental indices were measured at 18 months, as were growth and haematological indices.

This paper outlines aspects of the HIV/AIDS epidemic scenario and the complexities associated with it. It reveals the socio-epidemiological patterns of the epidemic and in doing so identifies the populations with the greatest and fastest growing rates of infection. From the data presented it is evident that the pattern of HIV/AIDS in developing countries in sub-Saharan Africa in particular is unique. The pattern emerging in South Africa follows closely. The features of this pattern are as follows: the epidemic is mainly a heterosexual epidemic, the rates of infection in the general population are very high and the percentage of HIV-positive women is greater than men. An additional unique feature is the young age of onset of infection for women. These data demonstrate the need to focus our attention on young African women and the factors underpinning their predicament. In order to understand their position we examine the long standing relationship between social inequalities and health in general and further invoke the concepts of vulnerability and social capital to shed light on the position of women in the epidemic.

Offspringof patients treated for unilateral Wilms' tumour in childhood. Cancer 49, 2285-2288. Hawkins M. M. (1989) Long-term survival and cure after childhood canccr. Arrh Dis Child (in press). Hawkins M. M. & Smith R. A. (1988) Pregnancy outcomes in childhood cancer survivors: probable cffects of abdominal irradiation. Int J Cancer (in press). Hawkins M. M . , Smith R . A. & Curtice L. J. (19880) Childhood cancer survivors and their offspring studied through a postal survey of general practitioners: preliminary results. J R Coll Gen Pract 38, 102-10s. Defective haemochorial placentation as a cause of miscarriagc: a preliminary study. Br J Obstet Gynaecol94, 649-655. Kirk M. & Lyon M. F. (1982) Induction of congenital anomalies in offspring of female mice exposed to varying doses of X-rays. Mufat Res 106, 73-83. Kirk K. M. & Lyon M. F. (1984) Induction of congeni-

Cytotoxic chemotherapy suppresses the haematopoietic system, febrile neutropenia is the most serious haematological toxicity associated with the risk of life-threatening infections. We present a retrospective study of 200 episodes of febrile neutropenia in 128 patients treated in department of medical oncology. The aim of this study was to determinate the clinical, therapeutic and evolutive characteristics in patients treated essentially for solid tumors. Among these patients, 72% of them have at least two episodes, the median age was 34 years with extremes six and 75 years. It has been noticed that 26.3% of patients have diabetes, the dominate neoplasm was solid tumors in 79.7%, 65% of patients have received preventive colony-stimulating factors, 83% have received preventive buccal disinfection with antifungic. The median duration of hospitalisation was 12 days, the median delay of febrile neutropenia was 10 days with extremes two and 31 days, median duration of febrile neutropenia was 5.45 days with extremes one and 24 days. Among these cases, 9.45% of them have nadir zero, 68% of patients have clinical documented infections, ORL in 47% of cases. According to the study, 12% of cases have documented microbiological fever, the sites was urinary in 33% of cases, blood in 33% of cases, derm in 30% of cases. The microbe was staphylococcus negative coagulase in 37.5% essentially in blood and derm, the Escherichia coli in 20.8% essentially in urinary and blood. First line antibiotherapy was cefotaxim associated with amikacine in 93.5%, second line antibiotherapy was association of imipenam and amikacine in 82% of cases. Among these cases,7% of them have received anti-staphylococcus, and antifungic treatment in 50% of cases. The thermic defervescence was obtained in median delay of 2.8 days. We have noted nine deaths (22% of cases). Recent surveys indicate that neutropenia remains a prevalent problem associated with substantial morbidity, mortality and costs. The colony-stimulating have used effectively in a variety of clinical settings to prevent or treat febrile neutropenia and to assist patients receiving dose-intensive chemotherapy.

To determine the accuracy of noninvasive infrared temporal artery thermometry compared with rectal, axillary, and pulmonary artery catheter measurements in pediatric intensive care patients, and to determine whether temporal artery temperatures are affected by circulatory shock or by vasopressor use. We hypothesized that temporal artery temperatures do not differ from axillary and rectal temperatures in critically ill children, but temporal artery accuracy is decreased by shock or vasopressor use.

Purpose: To present the Interaction Model of Client Health Behavior (IMCHB) as a model to guide nurse practitioners (NPs) in their practice. Data sources: Selected research-based articles on Cox's IMCHB and selected text and writings on the NP movement and nursing practice models. Conclusions: Many NPs practice in a medical setting where the boundaries between medicine and nursing are blurred. The IMCHB offers a nursing model to guide NPs in their practice. Implications for practice: A nursing model that examines the elements of client uniqueness and assesses the interaction between NP and client can achieve positive health outcomes.

WHAT'S KNOWN ON THIS SUBJECT: Children with attentiondeficit/hyperactivity disorder (ADHD) have poorer academic and social functioning and more language problems than typically developing peers. However, it is unknown how language problems impact the academic and social functioning of these children.

When children in foster care are reunified with their families of origin they encounter changes that may influence their well-being in both positive and negative ways. We examined the effects of reunification among 218 children in foster care to test an integrative model of the effects of reunification using structural equation modeling. We hypothesized that reunification would exert indirect effects on subsequent child adjustment via changes in adverse life events, perceived social isolation, and mental health service utilization. Results indicated no direct effect of reunification on subsequent internalizing problems, but reunification was related to increased adverse life events that, in turn, were related to elevated symptoms. Second, reunification was negatively associated with mental health service use. Finally, reunification was associated with decreased child perceptions of social isolation. In summary, reunification with biological parents is associated with multiple environmental changes, with most but not all effects indicating negative consequences.

Poverty and associated health, nutrition, and social factors prevent at least 200 million children in developing countries from attaining their developmental potential. We review the evidence linking compromised development with modifi able biological and psychosocial risks encountered by children from birth to 5 years of age. We identify four key risk factors where the need for intervention is urgent: stunting, inadequate cognitive stimulation, iodine defi ciency, and iron defi ciency anaemia. The evidence is also suffi cient to warrant interventions for malaria, intrauterine growth restriction, maternal depression, exposure to violence, and exposure to heavy metals. We discuss the research needed to clarify the eff ect of other potential risk factors on child development. The prevalence of the risk factors and their eff ect on development and human potential are substantial. Furthermore, risks often occur together or cumulatively, with concomitant increased adverse eff ects on the development of the world's poorest children.

Exclusive breastfeeding is known to have nutritional and health benefits. This study investigated factors associated with exclusive breastfeeding among infants aged five months or less in Timor-Leste. The latest data from the national Demographic and Health Survey 2009–2010 were analyzed by binary logistic regression. Of the 975 infants included in the study, overall 49% (95% confidence interval 45.4% to 52.7%) were exclusively breastfed. The exclusive breastfeeding prevalence declined with increasing infant age, from 68.0% at less than one month to 24.9% at five months. Increasing infant age, mothers with a paid occupation, who perceived their newborn as non-average size, and residence in the capital city Dili, were associated with a lower likelihood of exclusive breastfeeding. On the other hand, women who could decide health-related matters tended to breastfeed exclusively, which was not the case for others whose decisions were made by someone else. The results suggested the need ...

We obtained data from all cities with full coverage by the NIMSS, 2001-2003. These cities, among the largest in the country, represent 12.9 million people, or 50% of the country's total urban population. 11 Children aged 0-14 years, who number 3.4 million, comprise 26% of their population. With the names of their historical urban centres and total population size in 2001, these cities are: City of Cape Town Metropolitan Municipality (Cape Town; 2.9 million); City of Johannesburg Metropolitan Municipality (Johannesburg; 3.2 million); City of Tshwane Metropolitan Municipality (Pretoria; 2.0 million); eThekwini Metropolitan Municipality (Durban; 3.1 million); Nelson Man-Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬ Objective To determine the leading causes of fatal injury for urban South African children aged 0-14 years, the distribution of those causes and the current potential for safety improvements. Methods We obtained injury surveillance data from the National Injury Mortality Surveillance System 2001-2003 for six major South African cities varying in size, development and sociodemographic composition. We calculated age-adjusted rates, by sex, population group and city, for death from the five leading causes of fatal injury as well as population attributable risks (PARs). Findings The leading causes of fatal injury in childhood included road traffic injuries-among vehicle passengers and especially among pedestrians-drowning, burns and, in some cities, firearm injuries. Large differences in PARs were observed, particularly for population groups and cities. Disparities between cities and between population groups were largest for deaths from pedestrian injuries, while differences between boys and girls were greatest for drowning deaths. Conclusion In the face of the high variability observed between cities and population groups in the rates of the most common types of fatal injuries, a safety agenda should combine safety-for-all countermeasures-i.e. lowering injury rates for all-and targeted countermeasures that help reduce the burden for those at greatest risk.

Objective: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in children upto 14 years of age. Methods: Equal number (115 each) of apparently healthy children of both sexes of different age groups i.e. <1, 1-4, 5-9 and 10-14 years, attending pediatric outpatient services and Well Baby Clinic of the hospital were tested for HBsAg using ELISA test. Positive results were confirmed by a second ELISA. Results: Overall 4.35% (95%CI, 2.44-6.25) of the 460 children tested were HBsAg positive. The prevalence rate was the highest (6.09%) in the 1-4 year age category. In the <1, 5-9 and 10-14 year age groups it was 4.35%, 4.35% and 2.61% respectively. The overall male to female ratio was 2.1:1, with no significant difference in seropositivity rates (P = 0.816).The difference in the prevalence rates between the rural (4.84%) and urban populations (3.77%) was also statistically insignificant (P = 0.577). Conclusion: Average HBsAg positivity in the pediatric population in this region is 4.35% (95%CI, 2.44-6.25). The prevalence progressively increases and peaks in the 1-4 years age group. It is least in 10-14 years age group.

* Data are given as number (percentage) unless otherwise indicated. † Final pathology report included recommendation to "defer to" or "correlate with" culture. ‡ Number of different surgical pathologists signing out each case in each group. Organism * Antifungals With Efficacy Antifungals With Inadequate or No Efficacy Aspergillus fumigatus Voriconazole, amphotericin B, itraconazole, Fluconazole an echinocandin † (for salvage or used by clinicians in combination with another agent), possibly posaconazole Aspergillus terreus Voriconazole Fluconazole, amphotericin B Fusarium solani Voriconazole plus amphotericin B Fluconazole, itraconazole, any single antifungal agent Mucorales genera Amphotericin B, posaconazole Fluconazole, voriconazole, itraconazole, an echinocandin as a sole agent Scedosporium apiospermum Voriconazole Fluconazole, amphotericin B, itraconazole, an echinocandin Coccidioides immitis Amphotericin B, fluconazole, itraconazole, Possibly echinocandin voriconazole, possibly posaconazole Candida spp (if pseudohyphae) Echinocandin, fluconazole, amphotericin B, Fluconazole, itraconazole, or voriconazole for voriconazole, itraconazole, possibly posaconazole certain Candida spp (eg, Candida krusei) Cryptococcus neoformans Amphotericin B + 5-flucytosine (5FC), fluconazole, An echinocandin or, less preferred, itraconazole Histoplasma capsulatum Amphotericin B, itraconazole, possibly posaconazole Fluconazole, an echinocandin * Final identification of fungal structures observed by microbiological methods. Organisms in the first 5 rows are commonly mistaken for each other on histologic examination, as are the organisms in the last 3 rows. Coccidioides can be confused with organisms in either of the other 2 groups. † Echinocandins include caspofungin, micafungin, and anidulafungin.

This research builds on literature that suggests a negative association between participation in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) and breastfeeding. Variation in results at the national, regional, and state level has important policy implications for breastfeeding promotion through WIC. Using the 2007 National Immunization Survey dataset, Chi-square, ANOVA, and adjusted regression modeling techniques assess the relationship between WIC participation and breastfeeding initiation and duration. Adjusted regression models suggest a negative association between WIC participation and breastfeeding initiation rates (OR = 0.67, 95% CI: 0.61, 0.72). Of those who initiated breastfeeding, WIC participation was associated with a mean breastfeeding duration decrease of 0.63 months (95% CI:-0.86,-0.39). At the regional level, 3 of 7 regions showed a negative association between WIC participation and breastfeeding initiation. All of the regions indicated a negative association between WIC participation and breastfeeding duration. Out of 50 states, 13 had a statistically significant reduction in odds of initiation of breastfeeding and 10 had reduced duration of breastfeeding among participants of WIC when compared to non-participants. No state showed a positive association between WIC participation and breastfeeding. Regional and state differences in breastfeeding rates suggest that further research is needed to understand the role of national, regional, and state level policies which may undermine WIC's breastfeeding promotion efforts. Although WIC revised the food packages to create a stronger incentive for breastfeeding, a disincentive for breastfeeding may exist given the higher market value of the formula packages.