Breastfeeding

Exclusive breastfeeding greater than 50%, success of education in a university hospital in Bogotá: Case-control study

BACKGROUND

Maintenance rates of exclusive breastfeeding (EBF) worldwide are low, thus, one of the objectives of the summary of policies on breastfeeding (BF) in world nutrition goals for 2025 are that at least 50% of infants under six months of age receive EBF that year. The Objective of this study is to document the rates of EBF in children born in San Ignacio University Hospital (HUSI) and identify factors associated with maintenance.

AIM

To document the percentages of EBF in those that were born at HUSI and identify factors associated to their maintenance.

METHODS

This is a study of cases and controls in an analytic, retrospective cohort that took children born alive between January 2016 and January 2019 at HUSI located in the city of Bogotá, Colombia.

RESULTS

Receiving information about BF at HUSI was able to maintain EBF up until 4 mo (OR = 1.65; 95%CI: 1.02-2.66). The presence of gynecologic and obstetric comorbidities (OR = 0.32; 95%CI: 0.12-0.83), having mastitis (OR = 0.56; 95%CI: 0.33-0.94), and receiving information from mass media (OR = 0.52; 95%CI: 0.31-0.84) are factors associated with not maintaining EBF.

CONCLUSION

Receiving education at a Women- and Child-Friendly Institution was the only significant factor to achieve EBF until 4 mo, with a frequency greater than the one reported in the country, which matches multiple studies where counseling and individualized support on BF achieve this purpose. Knowledge about BF and early detection of obstetric/gynecologic complications must be strengthened among the healthcare staff in charge of mothers during post-partum. Additionally, strategies must be promoted to continue BF such as creating milk banks with the objective of increasing BF rates even when mothers return to work.

Antibiofilm Activity of Human Milk Oligosaccharides against Multidrug Resistant and Susceptible Isolates of Acinetobacter baumannii

Acinetobacter baumannii is a serious threat to human health, per the Centers for Disease Control and Prevention's latest threat assessment. A. baumannii is a Gram-negative opportunistic bacterial pathogen that causes severe community and nosocomial infections in immunocompromised patients. Treatment of these infections is confounded by the emergence of multi- and pan-drug resistant strains of A. baumannii. A. baumannii colonizes abiotic and biotic surfaces and evades antimicrobial challenges by forming biofilms, which are three-dimensional architectural structures of cells adhered to a substrate and encased in an extracellular matrix comprised of polymeric substances such as polysaccharides, proteins, and DNA. Biofilm-inhibiting compounds have recently gained attention as a chemotherapeutic strategy to prevent or disperse A. baumannii biofilms and restore the utility of traditional antimicrobial strategies. Recent work indicates that human milk oligosaccharides (HMOs) have potent antibacterial and biofilm-inhibiting properties. We sought to test the utility of HMOs against a bank of clinical isolates of A. baumannii to ascertain changes in bacterial growth or biofilm formation. Our results indicate that out of 18 strains tested, 14 were susceptible to the antibiofilm activities of HMOs, and that the potent antibiofilm activity was observed in strains isolated from diverse anatomical sites, disease manifestations, and across antibiotic-resistant and susceptible strains.

Causes of perception of insufficient milk supply in Western Australian mothers

A perception of insufficient milk supply (PIMS) is associated with early discontinuation of breastfeeding. Ideally, an objective measure of milk supply would either dispel or confirm this perception and provide reassurance or guide professional advice. Clinical signs of sufficient milk intake (steady growth, sufficient elimination, infant alertness and breasts feeling full before breastfeeds and soft after breastfeeds) should provide confidence in milk supply. We surveyed 423 mothers in early lactation who had breastfeeding problems to determine the proportion that had PIMS and to determine if the mothers with PIMS relied on these clinical signs or other perceptions of their infants' behaviour as indications of insufficient milk supply. By 3 weeks after birth, we found that the rate of PIMS among mothers with breastfeeding problems was 44%. Supplementary infant formula was being given to 66% of the infants, so the clinical indications were that milk intake was sufficient, but 74% of the mothers with PIMS cited concerns that their infants did not appear satisfied after breastfeeds. After targeted advice from lactation consultants, mothers with PIMS showed positive changes in their perceptions of their milk supply, underlining the value of professional guidance soon after birth. We conclude that an appearance of infant dissatisfaction is the major cause of PIMS in Western Australia.

Nutritive and non-nutritive sucking patterns associated with pacifier use and bottle-feeding in full-term infants

BACKGROUND

The current literature does not provide accurate information about the association between use of artificial nipples and sucking patterns in infants.

AIMS

We aimed to investigate whether pacifier use and/or bottle-feeding were associated with nutritive sucking (NS) and non-nutritive sucking (NNS) patterns.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

429 full-term infants/mothers.

OUTCOME MEASURES

Data were collected through a questionnaire and observations of NS during breastfeeding and NNS (finger sucking). Multivariate logistic regression was used to analyze the adjusted associations between artificial nipple use and between NS and NNS changes.

RESULTS

There were higher frequencies of changes in the NNS and NS patterns in the group that used artificial nipples. Regarding the type of artificial nipple, pacifier use had a greater influence on changes in the NNS pattern whereas the use of a baby bottle presented a greater number of associations with changes in the NS pattern.

CONCLUSION

The findings suggest that the use of artificial nipples may be associated with changes in the sucking patterns of infants, demonstrating the possible existence of nipple confusion and its effect on breastfeeding.

Trends and factors associated with early initiation of breastfeeding in Namibia: analysis of the Demographic and Health Surveys 2000-2013

BACKGROUND

Early initiation of breastfeeding (EIBF) lowers the risk for all-cause mortality in babies, including those with low birth weight. However, rates of neonatal mortality and delayed initiation of breastfeeding remain high in most low- and middle-income countries. This study aimed to assess the trends and factors associated with EIBF in Namibia from 2000 to 2013.

METHODS

An analysis of EIBF trends was conducted using data from three Namibia Demographic Health Surveys. The present sample included singleton children younger than 2-years from 2000 (n = 1655), 2006-2007 (n = 2152) and 2013 (n = 2062) surveys. Descriptive statistics were used to analyse respondents' demographic, socioeconomic and obstetric characteristics. Factors associated with EIBF were assessed using univariate analysis and further evaluated using multivariable logistic regression analysis.

RESULTS

EIBF significantly decreased from 82.5% (confidence interval [CI]: 79.5-85.0) in 2000 to 74.9% (72.5-77.2) in 2013. Factors associated with EIBF in 2000 were urban residence (adjusted odds ratio 0.58, 95% CI: 0.36-0.93), poorer household wealth index (1.82, 1.05-3.17), lack of antenatal care (0.14, 0.03-0.81), small birth size (0.38, 0.24-0.63) and large birth size (0.51, 0.37-0.79). In 2013, factors associated with EIBF were maternal age of 15-19 years (2.28, 1.22-4.24), vaginal delivery (2.74, 1.90-3.93), married mothers (1.57, 1.16-2.14), delivery assistance from health professionals (3.67, 1.23-10.9) and birth order of fourth or above (1.52, 1.03-2.26).

CONCLUSIONS

Namibia has experienced a declining trend in EIBF rates from 2000 to 2013. Factors associated with EIBF differed between 2000 and 2013. The present findings highlight the importance of continued commitment to addressing neonatal health challenges and strengthening implementation of interventions to increase EIBF in Namibia.

The Human Milk Glycome as a Defense Against Infectious Diseases: Rationale, Challenges, and Opportunities

Each year over 3 million people die from infectious diseases with most of these deaths being poor and young children who live in low- and middle-income countries. Infectious diseases emerge for a multitude of reasons. On the social front, reasons include a breakdown of public health standards, international travel, and immigration (for financial, civil, and social reasons). At the molecular level, the modern rise of infectious diseases is tied to the juxtaposition of drug-resistant pathogens and a lack of new antimicrobials. The consequence is the possibility that humankind will return to the preantibiotic era wherein millions of people will perish from what should be trivial illnesses. Given the stakes, it is imperative that the chemistry community take leadership in delivering new antibiotic leads for clinical development. We believe this can happen through innovation in two areas. First is the development of novel chemical scaffolds to treat infections caused by multidrug-resistant pathogens. The second area, which is not exclusive to the first, is the generation of antibiotics that do not cause collateral damage to the host or the host's microbiome. Both can be enabled through advances in chemical synthesis. It is with this general philosophy in mind that we hypothesized human milk oligosaccharides (HMOs) could serve as novel chemical scaffolds for antibacterial development. We provide herein a personal account of our laboratory's progress toward the goal of using HMOs as a defense against infectious diseases.

Comparison of Breastfeeding Outcomes Between Using the Laid-Back and Side-Lying Breastfeeding Positions in Mothers Delivering by Cesarean Section: A Randomized Controlled Trial

BACKGROUND

The breastfeeding position routinely used following a cesarean section is the side-lying position. However, there have been few studies about the effect of breastfeeding positions, including laid-back position on breastfeeding outcomes.

OBJECTIVE

To compare the breastfeeding outcomes between using laid-back and side-lying breastfeeding positions in mothers delivering by cesarean section.

MATERIALS AND METHODS

A randomized controlled trial was conducted. The postpartum mothers delivering by cesarean section who delivered term newborns were randomly assigned to learn the use of a laid-back or side-lying breastfeeding position. The breastfeeding outcomes were assessed by LATCH scores at the second day postpartum and exclusive breastfeeding rates during the 6-week postpartum period. The mother's satisfaction of each breastfeeding position was collected before discharge from the hospital.

RESULTS

The data from 152 postpartum mothers delivering by cesarean section were available for analysis, 76 from the laid-back position group and 76 from side-lying position group. The baseline characteristics of both groups were similar. There were no statistically significant differences of the breastfeeding outcomes, LATCH scores at the second day postpartum and the exclusive breastfeeding rates during the 6-week postpartum period. But the mothers had expressed more satisfaction from the side-lying than the laid-back position.

CONCLUSIONS

Among the mothers who delivered by cesarean section, the use of the laid-back breastfeeding position had not shown different breastfeeding outcomes from the side-lying breastfeeding position. It might be an alternative breastfeeding position, which can be taught for mothers delivering by cesarean section along with the side-lying position.

Breastfeeding, overweight status, and inflammation

Research documents a host of health benefits of breastfeeding for infants and children, including long-term health conditions arising from inflammation. Here, we provide new evidence about this association, focusing on the link between breastfeeding in infancy and inflammation in early adulthood. Our study is based on the National Longitudinal Study of Adolescent to Adult Health (Add Health) which allows us investigate a potentially important mediating pathway - overweight status from early adolescence into young adulthood. Results from pathway analyses in a structural equation modeling framework indicate that, in addition to a direct pathway linking breastfeeding and inflammation, an indirect pathway through overweight status across adolescence into young adulthood partially explains the association between breastfeeding and inflammation. Overweight status, moreover, links breastfeeding to inflammation not only through proximal timing of overweight status, but also through an indirect cascading process of overweight status over the life course that is evident in adolescence. Overall, this study highlights the importance of considering breastfeeding, overweight status and inflammation as dynamic life course processes that contribute to development of health inequalities.

Conocimiento sobre los beneficios de la Lactancia Materna en mujeres embarazadas y/o Post-Parto no primigestas en el Hospital General San Juan De Dios

Introducción: Se sabe que la leche materna es el alimento óptimo para el lactante durante los primeros seis meses de vida. Objetivo: Se realizó este estudio para identificar los conocimientos sobre lactancia materna en mujeres embarazadas y/o postparto no primigestas del departamento de maternidad en el Hospital General San Juan de Dios (HGSJDD). Diseño experimental: Se condujo el estudio en el HGSJDD en una población de 100 madres embarazadas y/ o post parto no primigestas. Métodos: Se utilizó un cuestionario de 23 preguntas, el cual se evaluó sobre 100 puntos, considerándose un conocimiento adecuado cuando se obtenía 60 ó más puntos. Se pasó el cuestionario a las 100 mujeres participantes. Resultados: Solamente 4 madres del grupo estudiado demostró tener conocimiento adecuado a través de la prueba, el resto obtuvieron una calificación menor a 60 puntos. Conclusiones: El nivel de conocimiento sobre LM en el grupo de madres estudiado en el HGSJDD es muy bajo.

UK Views toward Breastfeeding in Public: An Analysis of the Public's Response to the Claridge's Incident

BACKGROUND

The embarrassment that UK mothers experience when breastfeeding in public has often been cited as a key factor in the decision of the mother to discontinue breastfeeding. There is convincing evidence that many UK residents are not comfortable with women breastfeeding in public; however, little is known about the underlying reasons for this discomfort.

OBJECTIVE

This study aimed to assess views on breastfeeding in public in the United Kingdom and to understand why some UK residents object to this practice.

METHODS

The comments sections of news media websites and parenting forums were systematically identified and reviewed for statements made in response to an incident widely reported in the British press: a woman was asked to cover up while breastfeeding in public at Claridge's, a London luxury hotel. Of these, 805 comments (73 108 words) met the inclusion criteria and were thematically analyzed.

RESULTS

The majority of commenters were supportive of "discreet" breastfeeding in public, but a significant portion felt that breastfeeding in public is always inappropriate. Sexualization of the breast was mainly evoked as something others may experience while viewing a breastfeeding mother, rather than to reflect the commenters' own views. Common justifications cited against breastfeeding in public were onlookers' embarrassment (not knowing where to look) and disgust (at bodily fluids and/or functions).

CONCLUSION

Campaigns portraying breastfeeding in public as normal and desirable with a focus on human milk as food rather than a bodily fluid may improve societal acceptance of breastfeeding in public.

Conocimiento sobre los Beneficios de la Lactancia Materna en pacientes Mujeres embarazadas y/o en Post-Parto no primigestas en San Juan Sacatepéquez

Introducción. La leche materna es el alimento óptimo para el lactante especialmente en los primeros seis meses de vida. Objetivo: Se realizó este estudio para identificar los conocimientos sobre lactancia materna en mujeres embarazadas y/o en posparto, no primigestas que acuden a la consulta externa del Centro de Salud Bárbara en San Juan Sacatepéquez. Diseño experimental: Se condujo el estudio en SJS, con una población de 100 madres embarazadas, y/ o post parto no primigestas. Métodos: Se utilizó un cuestionario de 23 preguntas, el cual se evaluó sobre 100 puntos, considerándose un conocimiento adecuado cuando se obtenía 60 o más puntos. Resultados: La mayoría de las madres en un rango de edad entre 27 y 31 años demostraron carecer de los conocimientos básicos sobre la lactancia materna. Conclusiones: Aunque la mayoría de mujeres participantes llevaron control prenatal, se concluyó que sus conocimientos básicos sobre la lactancia materna son pobres.

Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments

Background: Persistent nipple pain is one of the most common reasons given by mothers for ceasing exclusive breastfeeding. We aimed to determine the frequency of nipple pain as a reason for consultation, the most common attributed aetiologies, and the effectiveness of the advice and treatment given. Methods: All consultations at the Breast Feeding Centre of Western Australia (WA) were audited over two six-month periods in 2011 (n = 469) and 2014 (n = 708). Attributed cause(s) of nipple pain, microbiology results, treatment(s) advised, and resolution of pain were recorded. Results: Nipple pain was one of the reasons for consultation in 36% of cases. The most common attributed cause of nipple pain was incorrect positioning and attachment, followed by tongue tie, infection, palatal anomaly, flat or inverted nipples, mastitis, and vasospasm. Advice included correction of positioning and attachment, use of a nipple shield, resting the nipples and expressing breastmilk, frenotomy, oral antibiotics, topical treatments, and cold or warm compresses. Pain was resolving or resolved in 57% of cases after 18 days (range 2–110). Conclusion: The multiple attributed causes of nipple pain, possibly as a result of a cascade of events, suggests that effective early lactation management for prevention of nipple pain and early diagnosis and effective treatment are crucial to avoid early weaning.

Reliability of demographic and socioeconomic variables in predicting early initiation of breastfeeding: a replication analysis using the Kenya Demographic and Health Survey data

OBJECTIVES

Examine the reliability of sociodemographic variables in predicting initiation of breastfeeding within an hour of birth (EarlyBF), using data from 1998, 2003 and 2008-2009.

STUDY DESIGN

A replication analysis using the Kenya Demographic and Health Survey (KDHS) data collected in 1998, 2003 and 2008-2009. The candidate predictor variables were child's gender, home or health facility place of birth, vaginal or caesarean mode of birth, urban or rural setting, province of residence, Wealth Index and maternal education, occupation, literacy and media exposure.

SETTING

Kenya.

PARTICIPANTS

6375 dyads of mothers aged 15-49 and their children aged 0-23 months (2125 dyads in each of the survey years).

RESULTS

Mode of birth and province were statistically significant predictors of EarlyBF in 1998, 2003 and 2008-2009. Children delivered through caesarean section were non-EarlyBF in 1998 (OR 2.63, 95% CI 1.72 to 4.04), 2003 (OR 3.36, 95% CI 1.83 to 6.16) and 2008 (OR 3.51, 95% CI 2.17 to 5.69). The same was true of those living in the Western province in 1998 (OR 2.67, 95% CI 1.61 to 4.43), 2003 (OR 4.92, 95% CI 3.01 to 8.04) and 2008 (OR 6.07, 95% CI 3.54 to 10.39).

CONCLUSIONS

The 1998 KDHS data do not provide the basis for reliable prediction of EarlyBF, with reliability conceptualised as replicability of findings using highly similar data sets from 2003 and 2008-2009. Most of the demographic and socioeconomic variables were unreliable predictors of EarlyBF. We speculate that activities in parts or all of Kenya changed the analysis context in the period between 1998 and 2008-2009, and these changes were of a sufficient magnitude to affect the relationships under investigation. The degree to which this is a general problem in child health research is not known, calling for further research to investigate this methodological issue with other health end points and other data.

Nipple pain, damage, and vasospasm in the first 8 weeks postpartum

BACKGROUND

Nipple pain and damage are common in the early postpartum period and are associated with early cessation of breastfeeding and comorbidities such as depression, anxiety, and mastitis. The incidence of nipple vasospasm has not been reported previously. This article describes nipple pain and damage prospectively in first-time mothers and explores the relationship between method of birth and nipple pain and/or damage.

SUBJECTS AND METHODS

A prospective cohort of 360 primiparous women was recruited in Melbourne, Australia, in the interval 2009-2011, and after birth participants were followed up six times. The women completed a questionnaire about breastfeeding practices and problems at each time point. Pain scores were graphically represented using spaghetti plots to display each woman's experience of pain over the 8 weeks of the study.

RESULTS

After birth, before they were discharged home from hospital, 79% (250/317) of the women in this study reported nipple pain. Over the 8 weeks of the study 58% (198/336) of women reported nipple damage, and 23% (73/323) reported vasospasm. At 8 weeks postpartum 8% (27/340) of women continued to report nipple damage, and 20% (68/340) were still experiencing nipple pain. Ninety-four percent (320/340) of the women were breastfeeding at the end of the study, and there was no correlation between method of birth and nipple pain and/or damage.

CONCLUSIONS

Nipple pain is a common problem for new mothers in Australia and often persists for several weeks. Further studies are needed to establish the most effective means of preventing and treating breastfeeding problems in the postnatal period.

Alternative hospital gift bags and breastfeeding exclusivity

The type of gift bags given to new mothers at the time of discharge from the hospital can influence their confidence in breastfeeding. Most hospitals in the US continue to distribute commercial gift bags containing formula samples despite the reported negative influence of commercial bags on the duration of breastfeeding. This study compared breastfeeding outcomes in women receiving three different kinds of gift bags at discharge. A prospective intervention study was conducted during 2009-2010 in New Jersey. Three breastfeeding cohorts were recruited and assigned to three groups: COMMERCIAL received discharge bags containing formula samples, BF-INFO received breastfeeding information and supplies, and PUMP received breastfeeding information/supplies plus a manual breast pump. Follow-up contacts were at 2, 4, and 12 postpartum weeks to determine breastfeeding outcome. The mean durations of exclusive (EBF) and partial breastfeeding were compared between groups using ANOVA. A total of 386 participants completed the study. The mean EBF duration (weeks) in the PUMP (n = 138, 8.28 ± 4.86) and BF-INFO (n = 121, 7.87 ± 4.63) were significantly longer (P < 0.01) than COMMERCIAL (n = 127, 6.12 ± 4.49). The rate of EBF through 12 weeks in PUMP was most consistent. The mean duration of partial breastfeeding showed similar results: significantly longer in PUMP and BF-INFO than COMMERCIAL (P < 0.01).

A quality improvement project to increase breast milk use in very low birth weight infants

OBJECTIVE

To evaluate a multihospital collaborative designed to increase breast milk feeding in premature infants.

METHODS

Eleven NICUs in the California Perinatal Quality of Care Collaborative participated in an Institute for Healthcare Improvement-style collaborative to increase NICU breast milk feeding rates. Multiple interventions were recommended with participating sites implementing a self-selected combination of these interventions. Breast milk feeding rates were compared between baseline (October 2008-September 2009), implementation (October 2009-September 2010), and sustainability periods (October 2010-March 2011). Secondary outcome measures included necrotizing enterocolitis (NEC) rates and lengths of stay. California Perinatal Quality of Care Collaborative hospitals not participating in the project served as a control population.

RESULTS

The breast milk feeding rate in the intervention sites improved from baseline (54.6%) to intervention period (61.7%; P = .005) with sustained improvement over 6 months postintervention (64.0%; P = .003). NEC rates decreased from baseline (7.0%) to intervention period (4.3%; P = .022) to sustainability period (2.4%; P < .0001). Length of stay increased during the intervention but returned to baseline levels in the sustainability period. Control hospitals had higher rates of breast milk feeding at baseline (64.2% control vs 54.6% participants, P < .0001), but over the course of the implementation (65.7% vs 61.7%, P = .049) and sustainability periods (67.7% vs 64.0%, P = .199), participants improved to similar rates as the control group.

CONCLUSIONS

Implementation of a breast milk/nutrition change package by an 11-site collaborative resulted in an increase in breast milk feeding and decrease in NEC that was sustained over an 18-month period.

Predictors of poor weight gain in infants with a single ventricle

OBJECTIVE

To assess growth from the time of neonatal discharge to the time of performance of the bidirectional Glenn (BDG) procedure in infants with a single ventricle and determine predictors of poor growth.

STUDY DESIGN

We performed a retrospective case series of infants who underwent the BDG procedure at our institution between January 2001 and December 2007 (n=102). Anthropometric and clinical data were recorded during neonatal hospitalization and before BDG. Outcome variables included weight-for-age z-score (WAZ) at the time of BDG and average daily weight gain between neonatal discharge and BDG.

RESULTS

Median age at the time of BDG was 5.1 months (range, 2.4-10 months), and median WAZ was -0.4 (range, -2.6 to 3.2) at neonatal admission and -1.3 (range, -3.9 to 0.6) at the time of BDG. Non-Caucasian infants (P=.03) and those with lower WAZ at neonatal discharge (P<.0001) had a lower WAZ at BDG. Being formula-fed at neonatal discharge (P=.04), and having higher mean pulmonary arterial pressure (P=.04) and systemic oxygen saturation (P=.006) were associated with lower average daily weight gain between neonatal discharge and BDG.

CONCLUSIONS

Infants with a single ventricle have poor weight gain between neonatal discharge and BDG. Non-Caucasian infants and those with evidence of increased pulmonary blood flow are at particular risk for growth failure.

Ultrasound imaging of the lactating breast: methodology and application

Ultrasound imaging has been used extensively to detect abnormalities of the non-lactating breast. In contrast, the use of ultrasound for the investigation of pathology of the lactating breast is limited. Recent studies have re-examined the anatomy of the lactating breast highlighting features unique to this phase of breast development. These features should be taken into consideration along with knowledge of common lactation pathologies in order to make an accurate diagnosis when examining the lactating breast. Scanning techniques and ultrasound appearances of the normal lactating breast will be contrasted to those of the non-lactating breast. In addition ultrasound characteristics of common pathologies encountered during lactation will be described.