Breastfeeding Behavior in Brazilian Children with Congenital Zika Syndrome

Abstract

Congenital Zika Syndrome (CZS) is a condition that has emerged only recently, bringing together multiple changes, including significant changes in the stomatognathic system, which may compromise sucking behavior and consequently the breastfeeding practice. e aim of this study was to investigate the breastfeeding behaviors in children with CZS. A longitudinal study was carried out in two reference centers in Northeastern Brazil. e nonprobabilistic sample consisted of 79 children diagnosed with physical, neurological, and behavioral alterations compatible with CZS. Information regarding the child, nutritive, and nonnutritive sucking behavior and changes related to the sucking reflex was collected. Data were presented through descriptive and inferential statistics. In the bivariate analyses, the chi-squared test was used and 5% significance level was adopted. e majority of children had severe microcephaly (59.7%). Breastfeeding was performed at birth in most of CZS children (89.9%) but only 36.6% of them presented exclusive breastfeeding in the six months of life. Bottle feeding and pacifier were used in 89.9% and 55.7%, respectively. Sucking and swallowing difficulties and occurrence of gastroesophageal reflux were observed in 27.8%, 48.0%, and 29.2% of children, respectively. Early weaning was associated with bottle feeding (p � 0.005) and pacifier sucking (p � 0.003). Although breastfeeding practice at birth constitutes a behavior adopted by most of mothers, adherence to this exclusive habit until the first six months of life was low since the children presenting a large number of comorbidities with direct interference in the suction reflex, sucking, and swallowing difficulty.

Métodos de alimentação e evolução do peso de recém-nascidos com microcefalia congênita por Zika Vírus

“…Above all, in view of the findings of the present study on the rapid speed of weight gain in the affected population, breastfeeding and good dietary practices could contribute with an important positive repercussion for growth and good postnatal nutrition in which increasing difficulties to feed these children are reported (17,30) . Thus, breast suction should be promoted regardless of the pathology of the NB provided that there are clinical conditions and that all multidisciplinary support is given to the mother-baby binomial especially speech therapy.…”

“…In the population with microcephaly studied here, there was a statistically similar acceptance although not significant regarding the feeding methods used in newborns without involvement despite the greater use of OGT in newborns of the GM. The literature also referred to the installation of OGT in specific situations, such as persistent choking (17) . Several factors are reported in the diet, depending on the degree of neurological impairment, including conditions related to the texture of food, the prolonged time of meals, with stress and fatigue, disturbances in the mechanisms of hunger and satiety, among others (3,4) .…”

“…Regarding oral diet offer to complement MB, it is worth mentioning that institutions that follow the BFHI guidelines (19) avoid the prescription of artificial nipples, which probably can explain the greater use of the glass than the bottle for newborns in both groups. Despite this practice, a longitudinal study showed a high incidence of bottle feeding (89.9%) at older ages in the population affected by ZKV (17) . It is recommended that there be speech therapy intervention to monitor the different feeding methods (15) .…”

“…Another limiting factor of the present study is that the participants were only followed up until hospital discharge and it is not possible to elucidate the subsequent food development. It is worth remembering that the literature has described that at older ages children with microcephaly present weaning before the age of 6 months (17) , eating problems such as dysphagia from the third month of life and deterioration of the nutritional status in the second year of life (9) . New studies should be proposed in this regard.…”

“…Studies have shown that children with ZKV-related microcephaly have difficulties in food intake, which may be related to both changes in the tone of the orofacial muscles, which interfere with adequate lip sealing, sucking and tongue movements (17) , as well as adverse conditions associated with the texture of food, prolonged meals and disturbances in the mechanisms of hunger and satiety (3,4) .…”