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Biomedical subjects

R F Drewett

Publications and source records attributed to R F Drewett.

At least 19 recordsLinked to original sources
PubMed2006

The influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive): data from a prospective birth cohort.

AIMS: To study the influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive) in the first year of life. METHODS: The Gateshead Millennium Baby Study is a population birth cohort in northeast England studied prospectively from birth, via parental questionnaires and a health check aged 13 months. Data were collected on maternal education, deprivation, eating attitudes, and depression, using the Edinburgh Post Natal Depression Scale (EPDS) at 3 months. Weight gain was assessed using change in weight SD score, conditional on birth weight (Thrive Index); weight faltering was defined as conditional weight gain below the 5th centile. RESULTS: Of 923 eligible infants born at term, 774 (84%) had both weight and questionnaire data. Replicating a previous finding, both the highest and the lowest levels of deprivation were associated with weight faltering; this was independent of the type of milk feeding. No relation was found with maternal educational status. Maternal eating restraint was unrelated to weight gain. Infants of mothers with high depression symptom scores (EPDS >12) had significantly slower weight gain and increased rates of weight faltering up to 4 months (relative risk 2.5), especially if they came from deprived families, but by 12 months they were no different from the remainder of the cohort. CONCLUSIONS: In this setting, social and maternal characteristics had little influence on infants' weight gain, apart from a strong, but transient effect of postnatal depression.

Child of Impaired Parents↗
PubMed2006

Physical and emotional development, appetite and body image in adolescents who failed to thrive as infants.

BACKGROUND: Previous studies suggest that failure to thrive in infancy may be associated with adverse sequelae in childhood. Although cognitive abilities have been extensively investigated, little systematic research is available on other aspects of development. METHODS: Eighty-nine children who failed to thrive as infants and 91 controls were followed up when twelve years old and examined using anthropometric measurement, self-ratings of appetite and body image, the Dutch Eating Behaviour Questionnaire, the Self-perception Profile for Children, The Revised Children's Manifest Anxiety Scale, the parent and child form of the Mood and Feelings Questionnaire and the parent and teacher's form of the Child Behavior Checklist. RESULTS: The children who failed to thrive were significantly shorter and lighter at twelve and had significantly lower BMIs, but they did not go into puberty any later. They were more likely to rate their appetite as lower than their best friend's, were generally more satisfied with their body shape, and had significantly lower restraint score on the Dutch Eating Behaviour Questionnaire. They were not significantly different from controls on any of the measures reflecting anxiety, depression or low self-esteem. CONCLUSIONS: Failure to thrive in infancy is not associated with adverse emotional development in childhood.

Anthropometry↗
PubMed2004

Family, socioeconomic and prenatal factors associated with failure to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC).

BACKGROUND: The epidemiological profile of infants failing to thrive is unclear. The aim of this study is to investigate the prenatal and socioeconomic factors associated with these infants using standardized weight gain conditional on previous weight. METHODS: In a large UK population cohort study, 11 718 infants born at term in 1991-1992 with no major congenital abnormalities were identified. Using a weight gain criterion conditional on initial weight from birth to 6-8 weeks, 6-8 weeks to 9 months, and birth to 9 months, the slowest gaining 5% were identified. RESULTS: None of the prenatal factors was associated with failure to thrive in the multivariable analysis nor were traditional markers of socioeconomic deprivation such as poor parental education or low occupational status. Parental height was significantly correlated with slow infant weight gain in both separate periods and from birth to 9 months (Pearson's r = +0.20, P < 0.001). Eight times as many infants born to shorter parents (8.7%, 95% CI: 6.6, 11.3) showed slow weight gain as infants born to taller parents (1.1%, 95% CI: 0.5, 2.5). Higher parity was also related to slow infant weight gain; infants born in the fourth or subsequent pregnancy were twice as likely to fail to thrive from birth to 9 months (8.3%, 95% CI: 6.4, 10.6) as first-born infants (3.4%, 95% CI: 2.9, 10.6). CONCLUSIONS: Future studies need to take account of parental height when calculating growth standards and look at why failure to thrive is more common, not in poorer families but in larger families.

Adult↗
PubMed2004

To what extent is failure to thrive in infancy associated with poorer cognitive development? A review and meta-analysis.

BACKGROUND: Previous empirical studies of the cognitive sequelae of failure to thrive in infancy have led to apparently inconsistent conclusions. METHODS: Studies of cognitive abilities in failure to thrive were located through published bibliographies, supplemented by a search through MEDLINE. They were classified (a) into those in which the cases were identified in hospital or other specialist clinics, and those in which they were identified in primary care or by whole population screening; (b) into those that were controlled and those that were not controlled; and (c) into those with a cross-sectional and those with a longitudinal design. Effect sizes in controlled studies were summarised using D statistics for the principal cognitive outcome measure, from the last occasion on which the child was tested if the study was longitudinal. RESULTS: In studies with cases identified in hospital or other specialist clinics (52 cases, 36 controls), the pooled effect size (weighted standardised mean difference) for cognitive outcomes was -.85 (95% CI -.41 to -1.30). In studies with cases identified in primary care (552 cases, 573 controls), it was -.30 (95% CI -.18 to -.42). In each longitudinal study testing the same children at different ages, the effect size was smaller when the children were older. To obtain an overall estimate of the long-term cognitive outcome of failure to thrive in infancy, data from controlled studies in which cases were identified in primary care, and restricted to IQ or McCarthy scale scores in older children (502 cases, 523 controls), were used. The weighted mean difference was -.28 (95% CI -.16 to -.41), equivalent to 4.2 IQ points (95% CI 2 to 6). CONCLUSIONS: Evidence from reasonably well-controlled studies indicates that failure to thrive in infancy is associated with adverse intellectual outcomes sufficiently large to be of importance at a population level.

Child↗
PubMed2004

Why are babies weaned early? Data from a prospective population based cohort study.

BACKGROUND: The recommended age of introduction of solids food to the diet of infants (weaning) has recently been increased in the UK to 6 months, but most babies are still weaned before the age of 4 months. AIMS: To examine what predicts the age of weaning and how this relates to weight gain and morbidity using data from a population based cohort. METHODS: Parents of 923 term infants born in a defined geographical area and recruited shortly after birth were studied prospectively using postal questionnaires, weaning diaries, and routinely collected weights, of whom 707 (77%) returned data on weaning. RESULTS: The median age of first weaning solids was 3.5 months, with 21% commencing before 3 months and only 6% after 4 months of age. Infants progressed quickly to regular solids with few reported difficulties, even when weaned early. Most parents did not perceive professional advice or written materials to be a major influence. The strongest independent predictors of earlier age at weaning were rapid weight gain to age 6 weeks, lower socioeconomic status, the parents' perception that their baby was hungry, and feeding mode. Weight gain after 6 weeks was unrelated to age of weaning. Babies weaned before 3 months, compared to after 4 months, had an increased risk of diarrhoea. CONCLUSIONS: Social factors had some influence on when weaning solids were introduced, but the great majority of all infants were established on solids before the previously recommended age of 4 months, without difficulty. Earlier weaning was associated with an increased rate of minor morbidity.

Age Factors↗
PubMed2004

Low cord ghrelin levels in term infants are associated with slow weight gain over the first 3 months of life.

Lower ghrelin levels have been related to slower growth in small for gestational age infants, and infants with higher cord leptin levels have been reported to gain weight more slowly from birth to 2 yr. This study investigated whether cord blood ghrelin and leptin levels are related to weight gain up to 12 wk of age. One hundred infants were weighed at birth and at 12 wk, and cord blood was assayed for ghrelin and leptin. The mean (+/-sd) birth weight was 3.458 (0.433) kg (median, 3.390; range, 2.510-4.615 kg). The mean (+/-sd) leptin level was 10.1 (6.7) ng/ml (median, 8.4; range, 1.6-36.7 ng/ml), and that of ghrelin was 760.9 (282.9) pg/ml (median, 770; range, 210-1670 pg/ml). Higher birth weight was associated with slower weight gain. Leptin was correlated with birth weight, but ghrelin was not, and leptin and ghrelin levels were not significantly correlated with one another. With birth weight as a control variable, ghrelin was significantly associated with slow weight gain (chi(2) = 7.20 with 1 df; P < 0.01), although leptin was not (chi(2) = 1.59 with 1 df; P > 0.1). In conclusion, lower cord ghrelin levels are associated with slower weight gain from birth to 3 months of age.

Aging↗
PubMed2001

Feeding behaviour in the weaning period.

Feeding behaviour in the weaning period is important theoretically and practically. The aim of the study was to develop appropriate observational codes for its description, to assess their reliability, and to examine the relationships between feeding behaviour, meal duration, and food intake. One hundred children aged 12-14 months were visited in their own homes, and two of each child's usual meals video-recorded and analysed using direct observation. Codes were developed that distinguished between the mother feeding her child directly and assisting her child's self-feeding, and between the child's behaviour when responding to being fed by the mother and when feeding themselves. All-occurrence sampling was used to record counts of these feeding acts during the meals. Two observers replicated coding of 40 randomly chosen meals to determine the reliability of these counts. Except for three codes which were used very infrequently (median counts of zero over the 200 meals), reliability was high with p > .80. There was wide variation in the extent to which individual children fed themselves during meals, with only moderate consistency from meal to meal. Food intake was uncorrelated with meal duration, but correlated with the number of bites of food taken. Adjusted for the number of bites, longer meals were associated with a lower intake. When fed by the mother the child's food intake was greater than when they fed themselves, but the duration of the meals was little affected. The coding scheme is simple to use and generally reliable, and provides a means for relating more global measures of emotional or other characteristics of mealtime behaviour to feeding behaviour and nutritional intake.

Adult↗
PubMed1999

Energy intake, appetite and body mass in infancy.

Energy intake in infancy depends on the infant's appetite, which, in turn, depends to a considerable extent on the infant's size, as size is an important determinant of energy expenditure. Previous work on six-week old breast-fed infants has suggested that, at this age, milk intake in infants is proportional to the square root of body weight (wt.(0.5)). In this paper, the form of the relationship between body weight and energy intake is examined in infants of different ages, using data from two longitudinal studies, one of initially breast-fed and one of initially bottle-fed infants. In the first data set, energy intake is proportional to body weight raised to powers ranging from 0.63 to 1.23 at different ages and, in the second, to body weight raised to powers ranging from 0.50 to 1.07 at different ages. No single value is consistent with all the data at all ages. In general, the powers decrease up to six months of age, and then increase again, a pattern that may be due to the pattern of changes in the adiposity of the infants, as reflected in their body mass indexes (BMIs).

Appetite↗
PubMed1999

Effects of parity on breastfeeding: a study in the rural setting in northern Thailand.

UNLABELLED: This analysis was undertaken to see whether or not previous successful breastfeeding has any influence on subsequent breastfeeding behavior. Lactational outcomes were compared between those with and without breastfeeding experience. METHODS: Amount of breast milk transferred, frequency of breastfeeding, and time spent on the breast, as well as infant's weight, were recorded on days 15, 45, 90, 180, 270, and 360 postpartum in 30 primiparae and 30 multiparae. Outcomes of the primiparae were found to be similar to those of the more experienced breastfeeding multiparous mothers with respect to infant growth, amount of breast milk transferred, and the frequency of breastfeeding or number of attachments to the breast. Though primiparae took somewhat longer to transfer similar amounts of breast milk to their infants during the initial 45 to 90 days postpartum, feed duration after 90 days was similar to that of the multiparae. Lactation performance of the rural northern Thai mothers in our sample was highly successful with or without previous breastfeeding experience. It may be that a cultural pattern of breastfeeding on demand, strong family support, and traditional practices that encourage close contact between mother and her newborn compensate for the absence of lactational experience. Unlike reports from Western countries, previous breastfeeding does not appear to be an important predictor of successful and prolonged breastfeeding in our population.

Adult↗
PubMed1999

Cognitive and educational attainments at school age of children who failed to thrive in infancy: a population-based study.

A 1-year cohort of children born at term in Newcastle-upon-Tyne in 1987/8 was screened for failure to thrive in infancy using a conditional longitudinal standard which identified those whose weight gain was in the lowest 5%. A group of 136 cases and 136 controls (from the same GP practice and living in a neighbourhood with the same deprivation index) was followed up at 7-9 years of age, when 79% of cases and 87% of controls were successfully studied. Cases at 7-9 were significantly shorter (mean 126.0 cm, SD 5.6) than controls (mean 130.7 cm, SD 5.9); adjusted for parental heights a difference of 4.4 cm (95% CI 2.92 to 5.90 cm) remained. They had smaller head circumferences (mean 51.9 cm, SD 1.8) than controls (mean 52.8 cm, SD 1.7), were significantly lighter (medians 23.8 kg, IR 21.5 to 26.9 in cases, and 27.9 kg, IR 25.2 to 31.6 in controls) and had a lower body mass index (median 14.9, IR 14.1 to 16.0 in cases, and 16.3, IR 15.3 to 17.8 in controls). Despite these large growth differences, no statistically significant differences in cognitive outcomes were found. Mean IQ was 87.6 (SD 17.4) in cases and 90.6 (SD 17.1) in controls; after adjustment for organic cause and mother's IQ the mean difference was 1.7 IQ points (95% CI -5.2 to 1.9). There were no statistically significant differences in the reading, spelling, or reading comprehension scores; the mean standardised reading score was 93.5 (SD 16.2) for cases and 94.5 (SD 15.6) for controls. These results show that when carefully defined by velocity-based anthropometric criteria, nonorganic failure to thrive in infancy is followed by persisting stunting and wasting, and a reduced head circumference, but is not associated with cognitive or educational disadvantages at school age.

Achievement↗
PubMed1998

A mixture model for sucking patterns of breast-fed infants.

Previous studies of sucking patterns have mainly been on bottle-fed babies and have assumed that the babies' sucks occur within bursts separated by gaps of predetermined minimum length which is fixed over the feed. This study considers babies that are breast-fed, a more complex and natural process than bottle-feeding, and develops a more sophisticated model for the pattern of bursts and gaps which allows the parameters of the process to vary over the feed. We consider data from four breast feeds of each of 32 babies. We develop a two-component mixture model based on an underlying Markov chain model for the switching between bursts and gaps. We use the model to provide summary statistics for each feed and give estimates of the normal range of each of the model's parameters.

Breast Feeding↗
PubMed1996

Sex differences in weight in infancy and the British 1990 national growth standards.

OBJECTIVES: To determine if there is a sex difference in infancy in the new British national standards for weight (based on data from 1990). DESIGN: Weight data in a birth cohort were compared with the 1990 standards and Tanner and Whitehouse (1966) standards up to age 12 months. SETTING: Newcastle upon Tyne. SUBJECTS: 3418 term infants. RESULTS: Our cohort showed a mean difference in standard deviation scores of 0.42 between boys and girls (P < 0.0001) when compared with the 1990 standards. Two and a half times as many girls as boys had weights below the 3rd centile during the first year, with an equivalent excess of boys above the 97th centile (P < 0.0001). Similar results were found with Tanner and Whitehouse standards. CONCLUSIONS: These differences could result in substantial sex bias in the identification of poor growth in early childhood. The standards need modification.

Body Weight↗
PubMed1996

Does a fall down a centile chart matter? The growth and developmental sequelae of mild failure to thrive.

Fifty-two children aged 18 months who had fallen across two weight centile lines were compared to 52 controls. Five years after the initial study, 89% of these children were traced. At follow-up, four of the cases but none of the controls had been placed in care and cases were significantly shorter and lighter than controls. Reanalysis of the early weight data revealed that the screening criterion had been over-inclusive, identifying a majority with only borderline failure to thrive (FTT). Although the mean IQ was lower in the cases than in controls, the difference was not statistically significant. However, a significant association was found within the cases between severity of FTT and IQ. There was no difference in the number of behaviour problems reported. The use of a simple centile shift-based definition of FTT, while proving to be over-sensitive, has identified a subgroup of children who suffered adverse long-term cognitive outcomes.

Child↗
PubMed1995

Maternal behaviour and socio-economic influences on the bacterial content of infant weaning foods in rural northern Thailand.

The bacterial contamination of infant weaning foods was examined in the context of a longitudinal study of lactation and infant growth, the Chiang Mai Lactation Study. Sixty-two mother-infant pairs were selected by random sampling from a rural area outside the city of Chiang Mai and studied for 48 hours in their homes on six occasions over the first year of life. Data on food hygiene practices and maternal factors were related to the total bacterial count per gram and coliform content of weaning foods. Bottle feeding, premastication, and mashing were significantly related to an increased bacterial content of weaning foods, while boiling foods to make soups, preparing in and feeding from a banana leaf, and using boiled water to prepare foods all reduced their bacterial content. Storage also increased the bacterial contamination in foods and foods were more highly contaminated in the rainy season. Maternal age and education were also related to some feeding practices. By promoting the feeding of traditional, but less contaminated weaning foods, an intervention is put forward which would aim to reduce weaning food contamination and thereby reduce incidence of diarrhoea in this area of Northern Thailand.

Adult↗
PubMed1995

Thirst induced by a suckling episode during breast feeding and relation with plasma vasopressin, oxytocin and osmoregulation.

OBJECTIVE: There have been anecdotal reports of increased maternal thirst during breast feeding, but the physiological mechanisms remain obscure. We have assessed and quantified the stimulation of maternal thirst during breast feeding (suckling), and correlated the changes with plasma oxytocin and vasopressin levels. DESIGN: A within subject design was used with each subject acting as her own control. Each subject participated in a suckling period and a control non-suckling period the order of which was counterbalanced. SUBJECTS: Ten healthy breastfeeding women ranging from 28 to 52 days post partum. MEASUREMENTS: Thirst (assessed by a visual analogue scale), plasma vasopressin, plasma oxytocin (pOT), plasma osmolality and haematocrit, blood pressure, volume of milk transferred to baby, volume of water drunk immediately following each experimental period. RESULTS: Thirst increased significantly more over a suckling period than over a comparable control period (P = 0.013). The peak level of thirst correlated with the volume of water consumed to satiety following the suckling period (r = 0.7, P = 0.024). As expected, pOT levels rose significantly in response to suckling (P < 0.001). Six women demonstrated a close relation between thirst and oxytocin response during the suckling period. Despite significant changes in thirst during suckling there was no increase in plasma vasopressin or in osmoregulatory parameters. CONCLUSIONS: This study confirms that suckling is a potent stimulus to thirst in the mother, and is not associated with vasopressin release or dependent on any measurable alterations in osmoregulation. What actually stimulates thirst during breast feeding remains unknown, but there are two potential explanations for these observations: (1) suckling sends nerve impulses to the paraventricular and supraoptic nuclei in the hypothalamus which may have afferents within the central nervous system which stimulates a thirst response simultaneous with oxytocin release; (ii) a learned anticipation of thirst may be occurring in a situation associated with expectant fluid loss to preserve homeostasis.

Blood Pressure↗
PubMed1994

A move from hospital to community-based homes for people with learning disabilities: activities outside the home.

Eighteen people with learning disabilities who moved from hospital to community-based homes were compared with a matched group of 18 who did not. A week-long time budget diary was used to record each occasion that the person left their home, the people accompanying them on each trip, their mode of transport and their destination. The diary was completed before they left the hospital and was repeated at least 1 year later. There was a strong correlation between the number of trips made from hospital wards at baseline and the number made at follow-up in both groups. Moving from the hospital had no significant effect on the number of trips made, but it did change their nature. Movers made more trips to unsegregated facilities; they made fewer trips alone and more in groups which included both staff and residents.

Activities of Daily Living↗
PubMed1993

Modelling lactation using an inverse polynomial in a multilevel statistical model.

A method is outlined for modelling the relationship between breast-milk production and time from delivery, suitable for data collected longitudinally. The relationship is described using inverse polynomials. In a two-level model the coefficients are specified as random variables across subjects, allowing within- and between-subject variation to be separately estimated. In a three-level model, day-to-day variation can also be separately estimated. The model is illustrated using data from the Chiang Mai Lactation Project. It allows the use of covariates that vary over time, and provides a method of analysis that is compatible with the practical constraints on the timing of data collection that are inherent in longitudinal studies.

Age Factors↗