Background The United States Head Start program serves low-income preschoolers and their caregivers and provides an opportunity for assessment and intervention on obesity. We sought to determine the prevalence of obesity among children and their caregivers and to identify variables that are associated with child BMI z-scores (BMIz) and caregiver BMI. Design/Setting Cross-sectional data on diet and BMI from 770 caregiver-child dyads recruited from 57 Head Start centers in Alabama and Texas. Methods Height and weight of each caregiver and child were measured using standardized protocols. Dietary intakes of caregiver-child dyads were collected using three 24-hour dietary recalls and Block Food Frequency Questionnaires. Data were collected between September, 2004 and November, 2005. The larger food pyramid categories were divided into 17 food consumption groups and tested for their association with child BMIz. ANOVA was used to test whether food groups were significantly associated with child BMIz. Results The prevalence of obesity among children was 18.4%, 24.3% and 37.3% among Black (B), Hispanic (H) and White (W), respectively (P<0.0001), while it was 58.3%, 41.4% and 41.6% among B, H and W caregivers, respectively (P<0.0001). Child BMIz and caregiver BMI were correlated (r=0.16, P<0.0001). In multivariable models, children were 1.90 (95% CI: 1.31-2.74) times more likely to have BMI ≥95th percentile if their caregiver was obese. Five variables (fruits, unsweetened beverages, low-fat dairy, race and caregiver’s BMI) were significantly associated with child BMIz. Fruits were inversely related, while unsweetened beverages, low-fat dairy, and caregiver’s BMI were positively associated with child BMIz (P<0.03). Compared to whites, B and H children had lower BMIz (P<0.05). Conclusions The high prevalence of obesity in this population together with the observed inverse association between fruit consumption and BMI, if replicated in other studies, suggests that interventions that promote fruit consumption could have beneficial effects on child BMI.

No abstract

Objective to describe neonatal intensive care unit (NICU) medical interventions and NICU mortality by birth weight and major anomaly types for infants with trisomy 13 (T13) or 18 (T18). Study Design retrospective cohort analysis of infants with T13 or T18 from 2005–12 in the Pediatrix Medical Group. We classified infants into 3 groups by associated anomaly type: neonatal surgical, non-neonatal surgical, and minor. Outcomes were NICU medical interventions and mortality. Results 841 infants were included from 186 NICUs. NICU mortality varied widely by anomaly type and birth weight, from 70% of infants <1500g with neonatal surgical anomalies to 31% of infants ≥2500g with minor anomalies. Infants ≥1500g without a neonatal surgical anomaly comprised 66% of infants admitted to the NICU; they had the lowest rates of NICU medical interventions and NICU mortality. Conclusions Risk stratification by anomaly type and birth weight may help provide more accurate family counseling for infants with T13 and T18.

Objective To compare healthcare use and parent health-related quality of life (HRQL) in 3 groups of infants whose neonatal intensive care unit (NICU) discharge was delayed by oral feedings.Study design This was a prospective, single-center cohort of infants in the NICU from September 2018 to March 2020. After enrollment, weekly chart review determined eligibility for home nasogastric (NG) feeds based on predetermined criteria. Actual discharge feeding decisions were at clinical discretion. At 3 months' postdischarge, we compared acute healthcare use and parental HRQL, measured by the PedsQL Family Impact Module, among infants who were NG eligible but discharged with all oral feeds, discharged with NG feeds, and discharged with gastrostomy (G) tubes. We calculated NICU days saved by home NG discharges.Results Among 180 infants, 80 were orally fed, 35 used NG, and 65 used G tubes. Compared with infants who had NG-tube feedings, infants who had G-tube feedings had more gastrointestinal or tube-related readmissions and emergency encounters (unadjusted OR 3.97, 95% CI 1.3-12.7, P = .02), and orally-fed infants showed no difference in use (unadjusted OR 0.41, 95% CI 0.1-1.7, P = .225). Multivariable adjustment did not change these comparisons. Parent HRQL at 3 months did not differ between groups. Infants discharged home with NG tubes saved 1574 NICU days.Conclusions NICU discharge with NG feeds is associated with reduced NICU stay without increased postdischarge healthcare use or decreased parent HRQL, whereas G-tube feeding was associated with increased postdischarge healthcare use.

(Abstracted from J Perinatol 2018;38:788–796) Trisomy 13 (T13) and 18 (T18) are chromosomal anomalies that have historically been considered lethal, but this notion has been questioned within the last decade by physicians, ethicists, and families. The literature has focused on the commonly described negative parental experience of prenatal and neonatal counseling and the extent of medical and surgical interventions that children with these conditions receive, their survival, and neurodevelopmental outcomes.