Aurelia Rakotondrainibe is an anesthetist and intensivist working in Antananarivo-Madagascar. After studying in Faculty of Medicine of Antananarivo, Bordeaux and Paris, her work is essentially focused on anesthesia and intensive care of digestive pathologies and postoperative recovery.
Statement of the problem: Surgical procedures of neonatal digestive malformations are often performed in poor nutritional status, which can alter the quality of the postoperative healing. An optimal nutritional support is necessary to ensure a favorable outcome after neonatal digestive surgery. In Madagascar, the perioperative nutritional support adapted to the infants is failing. The purpose of this study was to analyze the nutritional management of newborns operated for their digestive system abnormalities.rnMethodology: We carried out a 24-month retrospective study (January 2015 to December 2016) of Malagasy infants, operated for digestive atresia admitted in surgical intensive care unit. The demographic criteria, the type if the digestive atresia, the characteristics of the nutritional support, as well as the outcome of the patient were analyzed. Results are expressed as median [extremes]. The Spearman correlation test was used (XLSTAT®).rnFindings: Of the 40 newborns admitted in surgical intensive care unit, during the study period, 16 were retained for the study (4 [1-11] days old, 6 girls / 10 boys, 2210 [1400-3030] g). The most observed and operated digestive malformations were esophageal and duodenal atresia (10 cases). Intervention time was 1 [0-16] days. A parenteral admixture of amino-acids (Celemin® manufactured by CLARIS LIFESCIENCES Ltd) was given in eight patients. Administration time of postoperative enteral breast milk was 3 [1-5] days for 11 newborns. This was correlated with the site of atresia (p=0.006). Nine of them died; the length of stay was 7 [2-38] days.rnConclusion & Significance: The neonatal postoperative nutrition in Madagascar is still precarious. To introduce early enteral nutrition is the current recommendations. Inputs adapted to the newborn should be available. However, the latter being expensive, the alternative in a low-income country like Madagascar would be the enteral administration of breast milk, as soon as conditions permit it, with close clinical and biological monitoring.rnKeywords: Breast milk, Enteral nutrition, Esophageal atresia, Intestinal atresia, Newborn.
Makiko Nakade has previously worked in the Department of Nutritional Epidemiology of the National Institute of Health and Nutrition in Japan. Since 2015, he has have been working in the Faculty of Health and Welfare, Tokai Gakuin University, in Japan. His research field is public health nutrition, and he is especially interested in the theme of skipping breakfast and obesity. He has published an article about the characteristics of breakfast skippers with different intentions and self-efficacies toward eating breakfast using the National Health and Nutrition Survey data. He has also published articles about the effectiveness of a weight loss program, factors associated with successful weight loss/weight loss maintenance, and eating behaviors associated with obesity.
Skipping breakfast is considered a public health issue in Japan. We have previously reported that breakfast skippers aged 20 years or above showed different characteristics according to different intentions and self-efficacies toward eating breakfast. In Japan, the proportion of those skipping breakfast is the highest among young adults. However, no studies have specifically focused on university students and examined the characteristics of breakfast skippers with different intentions and self-efficacies toward eating breakfast.\r\nA questionnaire survey was conducted at a university in Japan in 2016. Among 2816 students who answered the questionnaire (response rate: 86.5%), the data of 2702 without missing values were analyzed. Multinomial logistic regression analyses were performed to examine the characteristics of each breakfast skipper (having intention and self-efficacy toward increasing the frequency of breakfast [IS], having intention but not self-efficacy [INS], not having intention but having self-efficacy [NIS], and having neither intention nor self-efficacy [NINS]) compared with breakfast eaters.\r\nCompared with breakfast eaters, breakfast skippers without self-efficacy (i.e., INS and NINS) were more likely to eat alone and to lack knowledge about a well-balanced diet. Breakfast skippers without intention (i.e., NIS and NINS) were more likely to report less frequency of breakfast to maintain own health. Additionally, the INS students were more likely to participate in circle activities, have financial limitations, and be less likely to exercise. The NINS students were less likely to report weight management behavior or participate in circle activities. Current smoking and having late-night snacks were commonly seen in breakfast skippers.\r\nThese results suggest the need for approaches considering different intentions and self-efficacies toward eating breakfast.