Abstract Objective To carry out a narrative review on the use of marketing strategies in child nutrition, as well as potential implications for health professionals and children. Data source Searches were carried out on the PubMed, SciELO, and Google platforms, using the terms “child nutrition” or “industrialized baby food” or “infant formula” or “breast milk” or “breastfeeding” and “marketing”, with original articles, review articles, institutional reports, institutional position documents and websites considered relevant to the topic being analyzed. Data synthesis Children's food marketing started with the industrialization of food and the resulting actions aimed at increasing sales and meeting commercial interests. Since its inception to the present, infant formulas have been the most widely used products, which has impacted breastfeeding practices. International and national institutions, that care for children's health, are searching for strategies to limit the abusive marketing of industrialized children's foods. Marketing strategies interfere with medical knowledge and actions, potentially influencing the guidance provided by pediatricians to families, and finally, compromising healthy eating practices at a critical period in life, with possible long-term effects. Conclusions Health professionals, especially pediatricians, must provide the best care for children and families, and need to maintain the search for quality scientific information, not influenced by conflicts of interest. Updated and critical knowledge on the part of healthcare professionals can curb marketing strategies that aim to influence their actions. nutrition PubMed SciELO platforms formula breast milk “breastfeeding marketing, , “marketing” articles reports analyzed Childrens Children s interests present products institutions childrens foods families finally life longterm long term effects information interest “marketing

ABSTRACT Objective: To analyze the compliance with the commercialization of children's products included in the Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-Related Products (NBCAL) in drugstores in Uberlândia/MG. Methods: A cross-sectional study was carried out in 143 drugstores that sold infant products: infant formula (IF), follow-up IF, nipples, teats, pacifiers and nipple shields; FI for young children, transition foods and cereal-based foods, fluid or powdered milk, modified/similar milks of plant origin and dairy compounds. The location of drugstores in the five geographic sectors was performed by geoprocessing. The data collected were: types of promotion and types of drugstore administration (drugstore chains/drugstores with independent administration). Irregular commercial promotion was expressed as absolute and relative frequencies. Results: Irregular commercial promotion was found in 11.7% of nipples, pacifiers and bottles, in 10.0% of IF and follow-up formula, in 9.5% of IF for young children, in 11.1% fluid or powdered milk, in 25.0% of transition foods and cereal-based foods and in 59.1% of dairy compounds. In commercial drugstore chains, the presence of promotion for dairy (81.8 vs. 28.6%, respectively) was higher than in drugstores with independent administration. The opposite ocurred for fluid or powdered milk, modified and similar milks of plant origin. The downtown and eastern sectors had the highest percentages of promotions (26%). Conclusions: NBCAL violations still occur in drugstores, mainly in the sale of young children's foods and in the commercial network drugstores. Objective childrens children s ChildcareRelated Childcare Related (NBCAL UberlândiaMG Uberlândia MG Uberlândia/MG Methods crosssectional cross sectional 14 , (IF) followup follow up nipples teats shields cerealbased cereal based milk modifiedsimilar compounds geoprocessing were chainsdrugstores chains . administration) frequencies Results 117 11 7 11.7 bottles 100 10 0 10.0 95 9 5 9.5 111 1 11.1 250 25 25.0 591 59 59.1 81.8 818 81 8 (81. vs 286 28 6 28.6% respectively 26%. 26 26% (26%) Conclusions (IF 11. 10. 9. 2 25. 59. 81. (81 28.6 (26% (8 28. (26 ( (2

RESUMO Objetivo: Analisar a conformidade da comercialização dos produtos infantis incluídos na Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeira (NBCAL) e de compostos lácteos em drogarias de Uberlândia/MG. Métodos: Estudo transversal realizado em 143 drogarias que vendiam produtos infantis: fórmulas infantis (FI) para lactentes, FI de seguimento para lactentes, mamadeiras, bicos, chupetas e protetores de mamilo; FI para crianças de primeira infância, alimentos de transição e alimentos à base de cereais, leites fluidos/em pó, leites modificados/similares de origem vegetal e composto lácteo. A localização das drogarias nos cinco setores geográficos foi realizada por geoprocessamento. Os dados coletados foram: tipos de promoção comercial irregular e tipo de administração da drogaria (rede/independente). As promoções comerciais irregulares foram expressas em frequências absoluta e relativa. Resultados: Verificamos a presença de promoção comercial irregular em 11,7% dos bicos, chupetas e mamadeiras, em 10,0% das FI lactentes/seguimento de lactentes, em 9,5% das FI para crianças de primeira infância, em 11,1% dos leites, em 25,0% de alimentos de transição e em 59,1% dos compostos lácteos. Nas drogarias de rede, a presença de promoção comercial irregular foi maior para compostos lácteos (81,8 vs. 28,6%, respectivamente) e, para leites, foi maior nas drogarias independentes (30,8 vs. 6,0%). Os setores central e leste apresentaram os maiores percentuais de promoção comercial irregular (26%). Conclusões: As violações à NBCAL ainda ocorrem nas drogarias, principalmente para os produtos destinados às crianças de primeira infância, e nas drogarias de rede. Objetivo Infância Bicos (NBCAL UberlândiaMG Uberlândia MG Uberlândia/MG Métodos 14 (FI lactentes mamadeiras bicos mamilo infância cereais fluidosem fluidos pó modificadossimilares modificados similares lácteo geoprocessamento rede/independente. redeindependente rede/independente . rede independente (rede/independente) relativa Resultados 117 11 7 11,7 100 10 0 10,0 lactentesseguimento 95 9 5 9,5 111 1 11,1 250 25 25,0 591 59 59,1 81,8 818 81 8 (81, vs 286 28 6 28,6% respectivamente 30,8 308 30 (30, 6,0%. 60 6,0% 6,0%) 26%. 26 26% (26%) Conclusões (rede/independente 11, 10, 9, 2 25, 59, 81, (81 28,6 30, 3 (30 6,0 (26% (8 28, (3 6, (26 ( (2

Abstract The article aims to identify NBCAL violations and analyze the content of messages posted on the Instagram social network. This qualitative-quantitative study consisted of a convenience sample of profiles identified through specific terms preceded by the hashtag symbol (#). Data were collected for two months by trained researchers using a structured questionnaire. We calculated the product promotion frequency that characterized violation of the NBCAL per category and manufacturer. The messages were analyzed using the content analysis technique. We identified 64 personal accounts of mothers with violations in 89 products, mainly food (n = 72), dairy compounds (54.2%), and infant formulas (45.8%) were the most publicized. Two thematic categories emerged from the posted texts, one related to the quality of the products and the other about breastfeeding difficulty, especially low milk production. The study identified NBCAL violations on the Instagram social network, alerting the need to recognize digital marketing to include it in the rules imposed by the Norm in the virtual context, considering the capillarity of social networks in disseminating information to the public in question. network qualitativequantitative qualitative quantitative #. # . (#) questionnaire manufacturer technique 6 8 n 72, 72 , 72) 54.2%, 542 54.2% 54 2 (54.2%) 45.8% 458 45 (45.8% publicized texts difficulty production context question (# 7 54.2 5 (54.2% 45.8 4 (45.8 ( 54. (54.2 45. (45. (54. (45 (54 (4 (5

Resumo O artigo objetiva identificar infrações à NBCAL e analisar o conteúdo das mensagens postadas na rede social Instagram. Estudo de abordagem quali-quantitativa, com amostra de conveniência composta por perfis identificados por meio de termos específicos, precedidos do símbolo hashtag (#). A coleta de dados foi realizada durante dois meses por pesquisadores treinados, por meio de questionário estruturado. Calculou-se a frequência de promoção de produtos que caracterizava violação à NBCAL, segundo categoria e fabricante. As mensagens foram analisadas por meio da técnica de análise de conteúdo. Foram identificadas 64 contas pessoais de mulheres mães com infrações em 89 produtos, a maioria alimentos (n = 72), sendo os compostos lácteos (54,2%) e as fórmulas infantis para lactentes (45,8%) os mais divulgados. Duas categorias temáticas emergiram dos textos postados, uma relativa à qualidade dos produtos e a outra sobre a dificuldade com a amamentação, especialmente a baixa produção de leite. O estudo identificou violações à NBCAL na rede social Instagram, alertando para a necessidade do reconhecimento do marketing digital para incluí-lo nas regras impostas pela norma no contexto virtual, considerando a capilaridade das redes sociais na divulgação de informações para o público em questão. Instagram qualiquantitativa, qualiquantitativa quali quantitativa, quantitativa quali-quantitativa específicos #. # . (#) treinados estruturado Calculouse Calculou se fabricante 6 8 n 72, 72 , 72) 54,2% 542 54 2 (54,2% 45,8% 458 45 (45,8% divulgados postados amamentação leite incluílo incluí lo virtual questão (# 7 54,2 5 (54,2 45,8 4 (45,8 ( 54, (54, 45, (45, (54 (45 (5 (4

Resumo O artigo objetiva identificar infrações à NBCAL e analisar o conteúdo das mensagens postadas na rede social Instagram. Estudo de abordagem quali-quantitativa, com amostra de conveniência composta por perfis identificados por meio de termos específicos, precedidos do símbolo hashtag (#). A coleta de dados foi realizada durante dois meses por pesquisadores treinados, por meio de questionário estruturado. Calculou-se a frequência de promoção de produtos que caracterizava violação à NBCAL, segundo categoria e fabricante. As mensagens foram analisadas por meio da técnica de análise de conteúdo. Foram identificadas 64 contas pessoais de mulheres mães com infrações em 89 produtos, a maioria alimentos (n = 72), sendo os compostos lácteos (54,2%) e as fórmulas infantis para lactentes (45,8%) os mais divulgados. Duas categorias temáticas emergiram dos textos postados, uma relativa à qualidade dos produtos e a outra sobre a dificuldade com a amamentação, especialmente a baixa produção de leite. O estudo identificou violações à NBCAL na rede social Instagram, alertando para a necessidade do reconhecimento do marketing digital para incluí-lo nas regras impostas pela norma no contexto virtual, considerando a capilaridade das redes sociais na divulgação de informações para o público em questão.

Abstract The article aims to identify NBCAL violations and analyze the content of messages posted on the Instagram social network. This qualitative-quantitative study consisted of a convenience sample of profiles identified through specific terms preceded by the hashtag symbol (#). Data were collected for two months by trained researchers using a structured questionnaire. We calculated the product promotion frequency that characterized violation of the NBCAL per category and manufacturer. The messages were analyzed using the content analysis technique. We identified 64 personal accounts of mothers with violations in 89 products, mainly food (n = 72), dairy compounds (54.2%), and infant formulas (45.8%) were the most publicized. Two thematic categories emerged from the posted texts, one related to the quality of the products and the other about breastfeeding difficulty, especially low milk production. The study identified NBCAL violations on the Instagram social network, alerting the need to recognize digital marketing to include it in the rules imposed by the Norm in the virtual context, considering the capillarity of social networks in disseminating information to the public in question.

RESUMEN Si bien es extendida la evidencia de los beneficios de la lactancia materna, diversos son los desafíos para iniciarla y sostenerla. Las empresas productoras de fórmulas infantiles utilizan estrategias de marketing violatorias de las regulaciones existentes, contribuyendo a su temprano abandono. Exploramos la exposición al marketing digital de las fórmulas infantiles en Argentina mediante el análisis de las interacciones de la población con las marcas y las huellas de dichas interacciones en conversaciones entabladas en grupos de Facebook durante 2022, desde un enfoque cualitativo basado en la etnografía digital. Los resultados muestran que las empresas despliegan tácticas elusivas de las regulaciones y buscan el contacto con las madres. Las usuarias no interactúan con las cuentas, pero están expuestas a sus estrategias dado el correlato entre los atributos del producto presentes en la publicidad con sus motivaciones y aspiraciones. Los mediadores entre el marketing y las madres son los profesionales médicos, utilizados como recursos del marketing. Concluimos que las autoridades deben promover nuevos acuerdos sobre las prácticas de los profesionales médicos y desarrollar regulaciones teniendo en cuenta los entornos digitales.

ABSTRACT Although evidence of the benefits of breastfeeding is widespread, there are several challenges to initiate and sustain it. Infant formula companies use marketing strategies that violate existing regulations, contributing to its early abandonment. We explore the digital marketing exposure of infant formulas in Argentina by analyzing people’s interactions with brands and the traces of these interactions in conversations engaged in Facebook groups during 2022, from a qualitative approach based on digital ethnography. Results show that companies deploy regulatory avoidance tactics and seek contact with mothers. Users do not interact with the accounts but are exposed to their strategies given the correlation between product attributes present in advertising with their motivations and aspirations. The mediators between marketing and mothers are medical professionals, used as marketing resources. We conclude that authorities should promote new agreements on the practices of medical professionals and develop regulations taking into account digital environments.

ABSTRACT Objective: To analyze neonatal factors associated with early weaning. Method: This is a cross-sectional study conducted between March and September 2023 with 180 women six months to two years postpartum, from a municipality in Bahia, Brazil. For bivariate analysis, Pearson’s chi-square tests were used, considering p < 0.05. The adjusted analysis included variables with p < 0.20, keeping those with p < 0.05, using stepwise multiple logistic regression, with a 95% confidence interval. Results: The provision of pacifiers/bottles (OR: 18.96; 95% CI: 7.68–46.79; p < 0.001) and supplements in the maternity ward (OR: 4.44; 95% CI: 1.76–11.17; p: 0.002) were associated with greater likelihood of early weaning. Conclusion: Habits and beliefs, such as the use of bottles and pacifiers, and the introduction of infant formulas within the maternity ward with continued supplementation after hospital discharge were the neonatal factors associated with early weaning in this context. Objective Method crosssectional cross sectional 202 18 postpartum Bahia Brazil Pearsons Pearson s chisquare chi square used 005 0 05 0.05 020 20 0.20 regression 95 interval Results pacifiersbottles pacifiers OR (OR 18.96 1896 96 CI 7.68–46.79 7684679 7 68 46 79 0.001 0001 001 4.44 444 4 44 1.76–11.17 1761117 1 76 11 17 0.002 0002 002 Conclusion beliefs context 00 0.0 02 2 0.2 9 18.9 189 7.68–46.7 768467 6 0.00 000 4.4 1.76–11.1 176111 0. 18. 7.68–46. 76846 4. 1.76–11. 17611 7.68–46 7684 1.76–11 1761 7.68–4 768 1.76–1 176 7.68– 1.76– 7.68 1.76 7.6 1.7 7. 1.

RESUMO Objetivo: Analisar os fatores neonatais associados ao desmame precoce. Método: Trata-se de um estudo transversal, realizado entre os meses de março e setembro de 2023, com 180 mulheres entre seis meses e dois anos de pós-parto, de um município da Bahia. Para a análise bivariada, foram utilizados os testes do qui-quadrado de Pearson, considerando p < 0,05. A análise ajustada incluiu as variáveis com valor de p < 0,20, mantendo aquelas com p < 0,05, utilizando-se a técnica de Stepwise para regressão logística múltipla, com intervalo de confiança de 95%. Resultados: A oferta de bicos artificiais chupetas/mamadeiras (OR: 18,96; IC 95%: 7,68–46,79; p < 0,001) e oferta de complemento ainda na maternidade (OR: 4,44; IC95%: 1,76–11,17; p: 0,002) estiveram associados a maiores chances de desmame precoce. Conclusão: Hábitos e crenças, como o uso de mamadeira e chupetas, e a introdução de fórmulas infantis ainda dentro da maternidade com continuidade da suplementação após a alta hospitalar foram os fatores neonatais associados ao desmame precoce no contexto estudado. Objetivo Método Tratase Trata se transversal 2023 18 pósparto, pósparto pós parto, parto pós-parto Bahia bivariada quiquadrado qui quadrado Pearson 005 0 05 0,05 020 20 0,20 utilizandose utilizando múltipla 95 95% Resultados chupetasmamadeiras chupetas mamadeiras OR (OR 18,96 1896 96 7,68–46,79 7684679 7 68 46 79 0,001 0001 001 4,44 444 4 44 IC95% IC95 1,76–11,17 1761117 1 76 11 17 0,002 0002 002 Conclusão crenças estudado 202 00 0,0 02 2 0,2 9 18,9 189 7,68–46,7 768467 6 0,00 000 4,4 IC9 1,76–11,1 176111 0, 18, 7,68–46, 76846 4, 1,76–11, 17611 7,68–46 7684 1,76–11 1761 7,68–4 768 1,76–1 176 7,68– 1,76– 7,68 1,76 7,6 1,7 7, 1,

RESUMEN Objetivo: Analizar los factores neonatales relacionados con el destete precoz. Método: Estudio transversal realizado entre marzo y septiembre de 2023 que incluyó a 180 mujeres con entre seis meses y dos años de posparto, en un municipio de Bahía, Brasil. Para el análisis bivariado se emplearon pruebas de chi-cuadrado de Pearson, considerando un valor de p < 0,05. El análisis ajustado incluyó variables con p < 0,20, manteniendo las con p < 0,05, mediante regresión logística múltiple por pasos, con un intervalo de confianza del 95%. Resultados: El uso de chupetes y biberones (OR: 18,96; IC 95%: 7,68–46,79; p < 0,001) y la administración de suplementos en la maternidad (OR: 4,44; IC 95%: 1,76–11,17; p: 0,002) se asociaron con una mayor probabilidad de destete precoz. Conclusión: Los hábitos y creencias, como el uso de biberones y chupetes, así como la introducción de fórmulas infantiles en la maternidad y la continuidad de la suplementación tras el alta hospitalaria, son factores neonatales asociados al destete precoz en este contexto. Objetivo Método 202 18 posparto Bahía Brasil chicuadrado chi cuadrado Pearson 005 0 05 0,05 020 20 0,20 pasos 95 95% Resultados OR (OR 18,96 1896 96 7,68–46,79 7684679 7 68 46 79 0,001 0001 001 4,44 444 4 44 1,76–11,17 1761117 1 76 11 17 0,002 0002 002 Conclusión creencias hospitalaria contexto 00 0,0 02 2 0,2 9 18,9 189 7,68–46,7 768467 6 0,00 000 4,4 1,76–11,1 176111 0, 18, 7,68–46, 76846 4, 1,76–11, 17611 7,68–46 7684 1,76–11 1761 7,68–4 768 1,76–1 176 7,68– 1,76– 7,68 1,76 7,6 1,7 7, 1,

RESUMEN Si bien es extendida la evidencia de los beneficios de la lactancia materna, diversos son los desafíos para iniciarla y sostenerla. Las empresas productoras de fórmulas infantiles utilizan estrategias de marketing violatorias de las regulaciones existentes, contribuyendo a su temprano abandono. Exploramos la exposición al marketing digital de las fórmulas infantiles en Argentina mediante el análisis de las interacciones de la población con las marcas y las huellas de dichas interacciones en conversaciones entabladas en grupos de Facebook durante 2022, desde un enfoque cualitativo basado en la etnografía digital. Los resultados muestran que las empresas despliegan tácticas elusivas de las regulaciones y buscan el contacto con las madres. Las usuarias no interactúan con las cuentas, pero están expuestas a sus estrategias dado el correlato entre los atributos del producto presentes en la publicidad con sus motivaciones y aspiraciones. Los mediadores entre el marketing y las madres son los profesionales médicos, utilizados como recursos del marketing. Concluimos que las autoridades deben promover nuevos acuerdos sobre las prácticas de los profesionales médicos y desarrollar regulaciones teniendo en cuenta los entornos digitales.

ABSTRACT Although evidence of the benefits of breastfeeding is widespread, there are several challenges to initiate and sustain it. Infant formula companies use marketing strategies that violate existing regulations, contributing to its early abandonment. We explore the digital marketing exposure of infant formulas in Argentina by analyzing people’s interactions with brands and the traces of these interactions in conversations engaged in Facebook groups during 2022, from a qualitative approach based on digital ethnography. Results show that companies deploy regulatory avoidance tactics and seek contact with mothers. Users do not interact with the accounts but are exposed to their strategies given the correlation between product attributes present in advertising with their motivations and aspirations. The mediators between marketing and mothers are medical professionals, used as marketing resources. We conclude that authorities should promote new agreements on the practices of medical professionals and develop regulations taking into account digital environments.

Resumen Introducción: existe una amplia variedad de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles. La consulta de información relacionada debe hacerse en las herramientas propias de cada laboratorio, lo que dificulta la visión crítica y la comparativa entre las mismas. Objetivo: describir el desarrollo de NEmecum como la primera web que permite realizar una búsqueda dirigida e independiente de fórmulas de nutrición o preparados infantiles, analizar el abanico nutricional actual en España y evaluar los datos de uso de la herramienta. Métodos: se desarrolló la estructura de una base de datos que unifica los parámetros de todas las fórmulas y se analizó el abanico nutricional español. Posteriormente, se seleccionaron los principales algoritmos de búsqueda dirigida y se codificó la herramienta digital. Se llevó a cabo una intensa difusión y se evaluó el impacto obtenido. Se analizaron el perfil de usuarios y centros registrados y los datos de uso de la herramienta y se evaluó su usabilidad mediante el cuestionario System Usability Scale (SUS). Resultados: se obtuvo una web responsive de acceso gratuito (http://nemecum.com) que permite realizar búsquedas dirigidas en base a unos filtros de búsqueda preestablecidos. La herramienta permitió analizar detalladamente el abanico nutricional en España, observándose la gran variedad de fórmulas disponibles de similares características. La campaña de difusión consiguió incrementar su uso de forma exponencial y cuenta actualmente con 1.370 usuarios y 79 centros registrados. La usabilidad fue valorada como excelente. Conclusión: el desarrollo de NEmecum supone una herramienta valiosa en la búsqueda y consulta de datos de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles.

Abstract Introduction: there is a wide variety of enteral nutrition and infant formulas preparations. When there is a need to find infomation on a product, only the infomation from industy is available. Comparison amomg products becomes then ardous. Objective: to describe the development of NEmecum as the first website that allows a directed and independent search for enteral nutrition products and infant formulas, currently available in Spain, and to evaluate the initial use of NEmecum. Methods: the structure of a database that unifies the parameters of all formulas was developed, and the nutritional composition of all formulas was analyzed. Subsequently, the main search algorithms were selected and the digital tool was codified. Intensive dissemination was performed and the impact was evaluated. The profile of users and registered centers and the use of the tool were analyzed, and its usability was evaluated using the System Usability Scale (SUS) questionnaire. Results: a free-access responsive website (http://nemecum.com) that allows searches based on pre-established search filters was obtained. This tool allows for a detailed analysis available formulas in Spain by observing a wide variety of formulas with similar characteristics. The dissemination campaign managed to increase its use exponentially, currently reaching 1,370 users and 79 registered centers. Usability was rated as excellent. Conclusion: the development of the NEmecum represents a valuable tool in the search and consultation of the characteristics of enteral nutrition formulas and infant preparations.

Resumen Introducción: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. Métodos: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. Resultados: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. Conclusiones: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Abstract Background: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright’s or Shukla’s formula is used to introduce the catheters. However, Shukla’s formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright’s formula is better than Shukla’s formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. Methods: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. Results: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). Conclusions: We found 13% more correctly placed VUC using Wright’s formula. Moreover, Wright’s formula was 29% above Shukla’s VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Abstract Objective: the objective of this study was to identify the use of bioelectrical impedance in newborns (NB), as this is an easy-to-apply and non-invasive method of measurement that can be used for distinguishing fat-free mass (FFM), fat mass (FM), and total body water (TBW). Method: this was an integrative review of the literature using the PubMed/MEDLINE, EMBASE, Web of Science, and Virtual Health Library databases to search for original articles between 2010-2020. A total of 900 articles were retrieved; after checking for duplicity and applying the eligibility criteria, 9 were further analyzed. Results: about the results, five studies used single frequency bioimpedance, with a specific population of neonates, preterm and/or full term, and different clinical conditions. Resistance was the most studied bioelectric indicator, the phase angle is little explored, and four studies investigated body composition (FFM, FM and TBW). Studies found that preterm newborns had lower amounts of TBW, FFM, and FM than term newborns, and there were differences in body composition between sex. The phase angle was lower for preterm newborns. Babies fed with high protein formulas had increases in the FFM. Conclusion: there is a need for multicenter studies to define standardized methods to be used with this public.

Resumen Objetivo: el objetivo de este estudio fue identificar el uso de la impedancia bioeléctrica en recién nacidos (NB), ya que ese método es de fácil medición y no invasivo para la distinción de masa libre de grasa (MLG), masa grasa (MG) y agua corporal total (ACT). Método: esta fue una revisión integradora de la literatura utilizando PubMed/MEDLINE, EMBASE, Web of Science y Virtual Health Library para la búsqueda de artículos originales (2010-2020). En total, se encontraron 900 artículos, aunque tras la verificación de duplicidad y aplicación de los criterios de elegibilidad, solo 9 fueron para análisis. Resultados: cinco estudios utilizaron el dispositivo de monofrecuencia. Cada investigación se aplicó en una población específica de neonatos, prematuros y/o a término y diferentes condiciones clínicas. La resistencia fue el indicador bioeléctrico más estudiado, el ángulo de fase fue poco explorado y cuatro estudios investigaron la composición corporal. Dos estudios encontraron que los recién nacidos prematuros tienen menos cantidades de ACT, MLG y MG que los RNT y se observó diferencia en la composición corporal entre los sexos. El ángulo de fase fue inferior en prematuros. Los lactantes que se alimentaron con una fórmula con mayor contenido proteico tenían una mayor cantidad de MLG. Conclusión: se observa la necesidad de estudios multicéntricos para definir métodos estandarizados para ser utilizados con este público.

Abstract Background: Correct endotracheal intubation results in better ventilation, prevents hypoxia and its possible damages, such as brain injury, and minimizes attempts for re-intubation. Up to now, several formulas have been published to estimate nasotracheal intubation tube length. This study aims to compare the accuracy of different suggested formulas to find the one that better estimates the tube insertion distance. Methods: This cross-sectional retrospective study was carried out in 102 (51 female, 51 male) children who underwent cardiac surgery under general anesthesia. Inclusion criteria were correct nasotracheal intubation according to the postintubation chest X-ray (CXR). The estimated tracheal tube length was calculated by four different formulas. Pearson’s correlation coefficient was used to find the correlations between the estimated length of each formula and the correct nasotracheal tube length. Also, linear regression was used to obtain a formula to estimate nasotracheal tube length by weight, height, and age. Results: The formula L=3*tube size+2 had the best correlation with tube length (r =0.81, Confidence Interval: 0.732–0.878, p-value < 0.001). Among demographic variables, height had the highest correlation coefficient with the tube length (r = 0.83, Confidence Interval: 0.788–0.802, p-value < 0.001). Therefore, considering the height as an independent variable and tube length as a dependent variable, using linear regression, the following formula was achieved for determining tube length: nasotracheal tube length =0.1*Height+7. Conclusions: The formula L=3*tube size+2 and the new suggested formula in this study can be used to estimate nasotracheal tube length in children under 4 years old. However, these formulas are only guides and require confirmation by auscultation and CXR. Background ventilation damages injury reintubation. reintubation re intubation. re-intubation now distance Methods crosssectional cross sectional 10 (5 female 5 male anesthesia Xray X ray CXR . (CXR) Pearsons Pearson s Also weight age Results L3tube Ltube L 3 size2 size 2 size+ r 081 0 81 =0.81 Interval 07320878 732 878 0.732–0.878 pvalue p value 0.001. 0001 0.001 001 0.001) variables 083 83 0.83 07880802 788 802 0.788–0.802 Therefore 01Height7 Height 1 7 =0.1*Height+7 Conclusions old However ( (CXR 08 8 =0.8 0732087 73 87 0.732–0.87 000 0.00 00 0.8 0788080 78 80 0.788–0.80 01Height =0.1*Height+ =0. 073208 0.732–0.8 0.0 0. 078808 0.788–0.8 =0.1*Height =0 07320 0.732–0. 07880 0.788–0. 0732 0.732–0 0788 0.788–0 073 0.732– 078 0.788– 07 0.732 0.788 0.73 0.78 0.7

ABSTRACT Introduction: feeding in early childhood is important because it is directly related to general health. Exclusive breast milk feeding up to six months of life is beneficial for strengthening the immune system of children, but there are situations in which children should be fed with formula milk depending on the needs or medical indications. Objective: to determine the variability of salivary pH in children from six to 18 months of age with breast milk - formula milk intake and its incidence in the presence of dental caries, in the "Senderos de luz" children's center, Pujilí canton, province of Cotopaxi. Methods: the sample was based on two groups; one group fed with breast milk and the other fed with formula milk. The salivary pH will be evaluated at fourspecific times: before the ingestion of breast milk or formula milk, five, 10, and 20 minutes after having consumed the milk. An oral hygiene care guide will be prepared for children between six and 18 months of age, establishing the direct benefits for infants to reduce the predisposition to develop dental caries, with the inclusion of oral hygiene measures even before the first dental organ has appeared in the mouth. Results: the number of children who consumed formula milk and maintained an acid salivary pH at 20 minutes was greater, while there were very few children who consumed breast milk and continued with an acid salivary pH. The number of children whose salivary pH returned to initial values was greater in those who consumed breast milk compared to those who consumed formula milk, which is good because it decreases the predisposition to develop dental caries. Conclusions: salivary pH can be modified by the type of food consumed, specifically in this research we speak of the variability of salivary pH, which when it is drastically modified favors bacterial growth, increasing the predisposition to develop dental caries at an early age.

RESUMEN Introducción: la alimentación en la primera infancia es importante debido a que tiene relación directa con la salud en general, la alimentación con leche materna exclusiva hasta los seis meses de vida es beneficioso para el fortalecimiento del sistema inmune de los niños, pero existen situaciones en las que los niños deben ser alimentados con leche de fórmula dependiendo de las necesidades o indicaciones médicas. Objetivo: determinar la variabilidad del pH salival en niños de seis a 18 meses de edad con ingesta de leche materna - leche de fórmula y su incidencia en la presencia de caries dental, en el centro infantil “Senderos de luz”, cantón Pujilí, provincia de Cotopaxi. Métodos: la muestra se basó en dos grupos; un grupo alimentado con leche materna y el otro alimentado con leche de fórmula. La valoración del pH salival se realizará en cuatro tiempos específicos: antes de la ingesta de leche materna o de fórmula, a los cinco, 10, y 20 minutos de haber consumido la leche. Se elaborará una guía de cuidados de higiene oral para niños de seis a 18 meses de edad, estableciendo los beneficios directos de los infantes para disminuir la predisposición de desarrollar caries dental, con la inclusión de medidas de higiene oral aun sin que haya aparecido en la boca el primer órgano dental. Resultados: fue mayor el número de niños que consumieron leche de fórmula y mantuvieron pH salival ácido a los 20 minutos, mientras que fueron muy pocos los niños que consumieron leche materna y continuaron con pH salival ácido. El número de niños que su pH salival regresó a valores iniciales fue mayor en los que consumieron leche materna en comparación con los que consumieron leche de fórmula lo que es bueno porque disminuye la predisposición de desarrollar caries dental. Conclusiones: el pH salival puede modificarse por el tipo de alimentos consumidos, específicamente en esta investigación se habla de la variabilidad del pH salival, que cuando este es modificado drásticamente favorece el crecimiento bacteriano, aumentando la predisposición de desarrollar caries dental en edades tempranas.

The objective of this article is to characterize the assistance offered to children with milk allergies in public programs and the challenges faced in its implementation, in the context of the pre-incorporation in the Unified Health System of three infant formulas for milk allergy. Exploratory, cross-sectional study and quantitative approach. Twenty-one programs and/or services were evaluated (15 municipal and 6 states) from all Brazilian regions. The main driver of the creation of these programs was judicialization (80.9%) and the provision of these special formulas was carried out to children up to 2 years of age. Among the main difficulties in creating and executing these programs, the lack of human and financial resources was the most common reason, representing 71.4% and 61.9%, respectively. The most adopted strategy to reduce costs was the adequacy of norms and protocols (61.9%). There was no significant difference between state and municipal programs. This study presents an unprecedented and detailed evaluation of the programs, bringing discussions that support decision-making, rational use of public resources, better care for children and strengthening of the national health system. Key words: Unified Health System. Program Evaluation. Continuity of Patient Care. Milk Hypersensitivity. Health Manager.

Objetiva-se neste artigo caracterizar a assistência ofertada às crianças com alergia ao leite em programas públicos e os desafios enfrentados na sua implantação, no contexto da pré-incorporação no Sistema Único de Saúde de três fórmulas infantis para alergia ao leite. Estudo exploratório, transversal e abordagem quantitativa. Foram avaliados 21 programas e/ou serviços (15 municipais e 6 estaduais) de todas as regiões brasileiras. O principal indutor da criação destes programas foi a judicialização (80,9%) e o fornecimento destas fórmulas especiais era realizado às crianças com até 2 anos de idade. Dentre as principais dificuldades para criação e execução destes programas, a falta de recursos humanos e financeiros foram as razões mais presentes, representando 71,4% e 61,9%, respectivamente. A estratégia mais adotada para redução dos custos foi a adequação das normas e protocolos (61,9%). Não houve diferença significativa entre os programas estaduais e municipais. Este estudo apresenta uma avaliação inédita e detalhada sobre os programas trazendo discussões que corroboram na tomada de decisões, uso racional de recursos públicos, melhor assistência às crianças e fortalecimento do sistema de saúde nacional. Palavras-Chave: Sistema Único de Saúde. Avaliação de Programas e Projetos de Saúde. Continuidade da Assistência ao Paciente. Hipersensibilidade a Leite. Gestor de Saúde.

Resumo Este trabalho visou elaborar e validar uma lista de verificação dos processos produtivos de dietas pediátricas para uso em lactários hospitalares. Para a elaboração do instrumento realizou-se pesquisa bibliográfica. A validação do conteúdo foi realizada com 5 especialistas, pela Técnica Delphi - utilizando a escala Likert de 5 pontos. A validação de aparência foi realizada por 3 nutricionistas, no mesmo ambiente, dia e horário. O instrumento incluiu cabeçalho, guia de instruções de preenchimento e 225 itens de avaliação que obtiveram o conteúdo validado. Os valores mínimos e máximos para o índice de validade de conteúdo (IVC) foi, respectivamente, 0,88 e 0,96. O coeficiente de correlação intraclasse (CCI) e Alfa de Cronbach (α) foi >0,80 em mais de 90% dos itens avaliados. Os valores mínimos e máximos para o índice de validade de aparência (IVA) foi, respectivamente, 0,73 e 0,93. O teste de Kruskal Wallis não apresentou diferença significativa durante as avaliações (p valor>0,05) para os blocos da versão rotina e versão gestão. As versões do instrumento apresentaram em mais de 80% dos blocos α e CCI>0,80. Portanto, o instrumento apresentou conteúdo e aparência validados tendo reprodutibilidade e confiabilidade, ou seja, viabilidade de utilização na prática do nutricionista.

Abstract This work aimed to draft and validate a checklist of the production processes of pediatric diets for use in hospital lactaries. A bibliographic search was carried out in order to draft the instrument. Content validation was performed with 5 experts, using the Delphi technique and the 5-point Likert scale. Appearance validation was performed by 3 nutritionists, in the same environment, day, and time. The instrument included a header, a guide to completion instructions, and 225 assessment items that obtained validated content. The minimum and maximum values for the content validity index (CVI) were 0.88 and 0.96, respectively. The intraclass correlation coefficient (ICC) and Cronbach’s alpha (α) was >0.80 in more than 90% of the items evaluated. The minimum and maximum values for the Appearance Validity Index (AVI) were, respectively, 0.73 and 0.93. The Kruskal Wallis test showed no significant difference during the evaluations (p-value>0.05) for the blocks of the routine version and the management version. The instrument versions presented in more than 80% of the α and ICC blocks > 0.80. Therefore, the instrument presented validated content and appearance, presenting reproducibility and reliability in terms of the feasibility of use in a nutritionist’s practice.

Resumo Este trabalho visou elaborar e validar uma lista de verificação dos processos produtivos de dietas pediátricas para uso em lactários hospitalares. Para a elaboração do instrumento realizou-se pesquisa bibliográfica. A validação do conteúdo foi realizada com 5 especialistas, pela Técnica Delphi - utilizando a escala Likert de 5 pontos. A validação de aparência foi realizada por 3 nutricionistas, no mesmo ambiente, dia e horário. O instrumento incluiu cabeçalho, guia de instruções de preenchimento e 225 itens de avaliação que obtiveram o conteúdo validado. Os valores mínimos e máximos para o índice de validade de conteúdo (IVC) foi, respectivamente, 0,88 e 0,96. O coeficiente de correlação intraclasse (CCI) e Alfa de Cronbach (α) foi >0,80 em mais de 90% dos itens avaliados. Os valores mínimos e máximos para o índice de validade de aparência (IVA) foi, respectivamente, 0,73 e 0,93. O teste de Kruskal Wallis não apresentou diferença significativa durante as avaliações (p valor>0,05) para os blocos da versão rotina e versão gestão. As versões do instrumento apresentaram em mais de 80% dos blocos α e CCI>0,80. Portanto, o instrumento apresentou conteúdo e aparência validados tendo reprodutibilidade e confiabilidade, ou seja, viabilidade de utilização na prática do nutricionista.

Abstract This work aimed to draft and validate a checklist of the production processes of pediatric diets for use in hospital lactaries. A bibliographic search was carried out in order to draft the instrument. Content validation was performed with 5 experts, using the Delphi technique and the 5-point Likert scale. Appearance validation was performed by 3 nutritionists, in the same environment, day, and time. The instrument included a header, a guide to completion instructions, and 225 assessment items that obtained validated content. The minimum and maximum values for the content validity index (CVI) were 0.88 and 0.96, respectively. The intraclass correlation coefficient (ICC) and Cronbach’s alpha (α) was >0.80 in more than 90% of the items evaluated. The minimum and maximum values for the Appearance Validity Index (AVI) were, respectively, 0.73 and 0.93. The Kruskal Wallis test showed no significant difference during the evaluations (p-value>0.05) for the blocks of the routine version and the management version. The instrument versions presented in more than 80% of the α and ICC blocks > 0.80. Therefore, the instrument presented validated content and appearance, presenting reproducibility and reliability in terms of the feasibility of use in a nutritionist’s practice.