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Oreg A, Negev M. Peer-to-Peer Human Milk-Sharing Among Israeli Milk Donors: A Mixed-Methods Study in the Land of Milk and Honey. J Hum Lact 2023; 39:688-700. [PMID: 37688471 PMCID: PMC10580680 DOI: 10.1177/08903344231196113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/10/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Evidence is lacking on the phenomenon of peer-to-peer human milk-sharing in the Middle East, specifically, in Israel. RESEARCH AIMS This study aimed to uncover peer-to-peer human milk-sharing in Israel, learn about how and whether donors engage in safe milk handling and storage practices, and assess knowledge about human milk and breastfeeding among this milk-sharing population. We also aimed to investigate donors' selectiveness in their decisions about to whom they donate their milk and their perceptions about the sale and purchase of human milk. METHODS We conducted a semi-structured online survey, including both closed- and open-ended questions and used mixed methods to analyze responses descriptively. We used non-probability sampling to obtain a broad sample of human milk donors. RESULTS Out of 250 completed surveys, most participants (87.2%, n = 218) reported engaging in safe milk-sharing practices and were generally knowledgeable about the health risks associated with milk-sharing. Participant religiosity was associated with somewhat lower hygiene practices (r = -0.15, p ≤ .05). Most of the participants (81.7%, n = 190) were against the sale of human milk. Participants generally expressed no preference about the recipient of their milk, with some exceptions. CONCLUSION The milk-handling and storage practices of the participants in this study suggest a need to improve knowledge and awareness of safe milk storage temperature and the importance of washing hands before pumping milk, particularly within the religious sector. We propose that guidelines about safe milk-sharing practices be written and adopted by the Israeli Ministry of Health, and communicated through pediatricians, family doctors, nurses in Mother and Child Clinics (In Hebrew: Tipat Halav), and social media.
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Affiliation(s)
- Ayelet Oreg
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Maya Negev
- School of Public Health, University of Haifa, Haifa, Israel
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2
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Laforce-Lavoie A, Turgeon A, Gaussen A, Girard M. Comparison and Efficacy of Breast Pump Cleaning Techniques for Bioburden Reduction. Breastfeed Med 2023; 18:338-346. [PMID: 36862537 DOI: 10.1089/bfm.2022.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background: Donor milk is a good alternative for premature babies whose mothers cannot breastfeed. To reduce the risk of milk contamination, donors have to follow some hygiene instructions, including disinfecting their breast pump (BP). This study aims to investigate the efficacy of BP cleaning and disinfection methods. Methods: Contamination of BP parts was performed by passing milk inoculated with Bacillus cereus, Staphylococcus aureus, or Escherichia coli, through BPs. Devices were then rinsed with cold water or cleaned with hot soapy water. Disinfection was achieved using either a microwave or by immersing BP parts in boiling water. After treatment, residual bacteria were recovered by passing sterile phosphate buffer saline (PBS) through BPs before being inoculated on plates and performing bacterial counts. Method efficiency was assessed by comparing BP residual bioburden to results obtained from BPs that have not undergone cleaning or disinfection treatment (controls). Results: Rinsing BP parts with cold water leads to a diminution of residual bacteria in PBS recovered from device. This decrease is even more effective when hot soapy water is used. There is a slight persistence of all bacteria if disinfection of BPs is performed by using a microwave. This persistence reached up to 3.58 colony-forming unit/mL of sporulating B. cereus in PBS eluted from the pump parts. The use of boiling water, with or without cleaning step, removes bacteria to a level such that no residual contamination was observed. Conclusions: Cleaning BP parts in hot soapy water followed by a disinfection in boiling water ensures a completed decontamination of the BP. These results give evidences for instructions to milk bank donors for whom reducing risks of infections to minimal level is essential.
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Affiliation(s)
| | | | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Québec, Canada
| | - Mélissa Girard
- Medical Affairs and Innovation, Héma-Québec, Québec, Canada
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3
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Jarman M, Shen Y, Yuan Y, Madsen M, Robson PJ, Bell RC. Applying suggested new terminology and definitions for human milk feeding in the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal pregnancy cohort. Appl Physiol Nutr Metab 2023; 48:17-26. [PMID: 36137297 DOI: 10.1139/apnm-2021-0658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The complexity of human milk-feeding behaviours may not be captured using simpler definitions of "exclusive" and "non-exclusive" breastfeeding. New definitions have been suggested to describe variation in these behaviours more fully but have not been widely applied. We applied the new definitions to data derived from 3-day human milk-feeding diaries. Participants (n = 1091) recorded the number, beginning/end time, and modes of feeding of infants aged 3 months. Data were used to create six exclusive groups according to feeding mode(s): (1) human milk at-breast only; (2) human milk at-breast and human milk in a bottle; (3) human milk at-breast and infant formula in a bottle; (4) human milk at-breast and human milk and infant formula mixed in the same bottle; (5) human milk at-breast, human milk in a bottle, and infant formula in a bottle (not mixed); and (6) a bottle that sometimes contained human milk and sometimes infant formula (not mixed), never at-breast. Differences in maternal and infant characteristics were examined among groups. Fifty-seven percent fed at-breast only (Group 1). Those in Group 1 spent a similar amount of time feeding directly at-breast (median 132 (IQR 98-172) min/day) as those in Groups 2 (124 (95-158)), 3 (143 (100-190)), and 5 (114 (84-142)) (p > 0.05), indicating that adding bottle feeding did not always reduce the time infants were fed at-breast. Applying new suggested definitions to describe human milk-feeding behaviours from the mothers' perspective highlights the complexity of patterns used and warrants further application and research to explore impacts on health outcomes.
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Affiliation(s)
- Megan Jarman
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada.,School of Psychology, College of Health and Life Science, Aston University, Birmingham, UK
| | - Ye Shen
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton AB, Canada
| | - Mette Madsen
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Paula J Robson
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton AB, Canada.,Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3H1, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
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4
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Mikrobiyolog Gözüyle Yenidoğan Sepsisinin Tanısında Laboratuvarın Rolü. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2022. [DOI: 10.21673/anadoluklin.975177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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Gad S, Sheta MM, Al-Khalafawi AI, Abu El-Fadl HA, Anany M, Sahmoud S, Amin MK. Expressed Breast Milk Contamination in Neonatal Intensive Care Unit. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:307-313. [PMID: 34211314 PMCID: PMC8242104 DOI: 10.2147/phmt.s311632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
Background The health benefits of breastfeeding are well known. However, some ill babies including those admitted to the neonatal intensive care unit (NICU) cannot be directly breastfed. In this situation, expressed breast milk (EBM) can be used. However, breast milk is not always sterile and may be contaminated by many microorganisms. EBM contamination is probably attributed to improper technical and hygienic factors and may pose significant threats to the newborn baby. The present study aimed to document the prevalence of EBM contamination in NICU and to uncover the relevant risk factors. Subjects and Methods The study included 118 mothers who could express breast milk for their own neonates admitted to the NICU. A checklist was used to document the steps the mothers followed during expression of milk and all steps of handling until the EBM reached the NICU. A 1 mL sample of EBM was obtained and sent to the microbiology laboratory within 20 minutes. Data obtained from the present study are expressed as number and percentage or mean ± standard deviation (SD). Statistical calculations were computed using SPSS 25. Results In the present study, 106 (89.8%) out of the assessed 118 EBM samples were contaminated. Hygienic factors related to EBM contamination included hand only wash, possible recontamination of hands during turning taps off, lack of using cotton pads or cloth piece on nipple and breast cleaning by water only. Other factors related to EBM contamination included container cleaning by water only, fresh milk refrigeration after > 4 hours, adding freshly expressed warm breast milk to refrigerated milk expressed earlier in the same day, milk transport in plastic bags with ice packs and longer transportation time. In the contaminated samples, the most commonly isolated organisms included Staphylococcus aureus (55.7%),Staphylococcus epidermidis (21.7%) and Enterobacter (11.6%). Conclusion The present study identified bacterial contamination in about 90% of EBM samples delivered to NICU infants. Factors related to EBM contamination include hygienic, storage and transport factors.
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Affiliation(s)
- Suzan Gad
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Mohamed M Sheta
- Pediatrics and Neonatology Department, Mansoura General Hospital, Mansoura, Egypt
| | | | - Heba A Abu El-Fadl
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Maha Anany
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Shaimaa Sahmoud
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Mona Karem Amin
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
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6
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Rodrigo R, Badanasinghe N, Abayabandara-Herath T, Forster DA, Amir LH. Bacterial Growth in Expressed Mother's Milk Stored and Transported Under Different Simulated Conditions in a Tropical Country. Breastfeed Med 2021; 16:300-308. [PMID: 33404292 DOI: 10.1089/bfm.2020.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Research on how storage and transport of expressed human milk in a tropical country affect the milk bacterial count is limited. Materials and Methods: A cross-sectional descriptive study of 50 mothers of infants in a Sri Lankan tertiary neonatal unit was performed. Expressed mother's milk was divided into three bottles and kept under varied environmental conditions to simulate different storage and transport methods. Initial bacterial culture of milk was performed <30 minutes after expression, with further cultures at predetermined times. Bottles A and B were stored at room temperature and in a cool bag for the first 6 hours, respectively, and then refrigerated; and bottle C was refrigerated for 24 hours, transported in a cool bag for 6 hours, and rerefrigerated until 72 hours. Total colony counts >105 colony-forming units (CFU)/mL of viable microorganisms or >104 CFU/mL of either Enterobacteriaceae or Staphylococcus aureus were considered positive. Results: Initial culture was positive in 30% (15/50) of samples; majority, 87% (13/15), of these were S. aureus. For bottle A, 26% (13/50), 36% (18/50), 34% (17/50), and 26% (13/50) of samples were positive at 4, 6, 24, and 72 hours, respectively. For bottle B, positive cultures were found in 26% (13/50) and 17% (8/47) of samples at 24 and 72 hours, respectively. For bottle C, results were similar to bottle B. Conclusions: Transportation of expressed mother's milk for 4 hours in a tropical climate using a low-cost cool bag, with refrigeration at other times, maintained acceptable bacterial counts for up to 72 hours after expression. Hygienic practices at collection are extremely important as most samples with significant bacterial growth were positive on initial culture.
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Affiliation(s)
- Ranmali Rodrigo
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | | | | | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
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7
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Rigourd V, Mouadh B, Poupon J, Langrand J, Goutard A, Droguet C, Bille E, Frange P, Bahri Y, Pasquier D, Lapillonne A, Skurnik D. Chlorine Solutions for a Safe Method of Decontamination of Breast Pump Milk Collection Kits Before and After the Coronavirus Disease 2019 Pandemic. Front Nutr 2021; 8:574311. [PMID: 33748168 PMCID: PMC7969643 DOI: 10.3389/fnut.2021.574311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/14/2021] [Indexed: 12/20/2022] Open
Abstract
To promote breast feeding and breast pumping is essential for the most vulnerable infants even if the current coronavirus disease 2019 (COVID-19) pandemic sanitary crisis imposes more stringent hygienic measures. As recommended by the Centers for Disease Control and Prevention, World Health Organization, and Milk Bank Association, "after each pumping session, all pump part that come into contact with breast milk should be appropriately disinfected." The present study proposed different methods than can be used and focus on the safety analysis of chlorine solution (CS) in terms of residual hypochlorous acid (HCA) and total trihalomethanes (THM). We also performed an efficacy testing of the CS approach to decontaminate the devices used to collect the milk (breast pumps and bottles). The bacteriologic results of 1,982 breast pump milk samples collected in three different settings showed a major decrease of the microbial contamination using either sterile device or decontamination with CS compared to a simple soap washing. The main messages from our study are to propose a guideline for the safe use of CS and to define situations when breast pump decontamination might be necessary: vulnerable babies for which sterile device is recommended; special circumstances, for example the current COVID-19 pandemic; special situations, for example women living in precarious conditions; or women pumping their milk at work but that would have low or no access to boiled water. Overall, cold decontamination reduced losses of milk for bacteriological reasons in human milk banks and may also be interesting to prevent horizontal contamination by virus like COVID-19.
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Affiliation(s)
- Virginie Rigourd
- Human Milk Bank, Hôpital Necker-Enfants Malades, Assistance Publique Hopitaux De Paris, Paris, France
| | - Benali Mouadh
- Department of Neonatology, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Joel Poupon
- Biological Toxicology Laboratory, Hôpital Lariboisière, Paris, France
| | - Jerome Langrand
- Antipoison Center of Paris, Service de Pharmacie, Hôpital Fernand Widal, Paris, France
| | | | | | - Emmanuel Bille
- Department of Microbiology, Hôpital Necker-Enfants Malades, Assistance Publique Hopitaux De Paris, Paris, France
- INSERM U1151-Equipe 1, Institut Necker-Enfants Malades, Université de Paris, Paris, France
- Institut Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - Pierre Frange
- Institut Necker Enfants Malades, Université Paris Descartes, Paris, France
- Hôpital Necker-Enfants Malades, Assistance Publique Hopitaux De Paris, Paris, France
- EHU 7328 PACT, Imagine Institute, Institut Necker-Enfants Malades, Université de Paris, Paris, France
| | - Yasmina Bahri
- Human Milk Bank, Hôpital Necker-Enfants Malades, Assistance Publique Hopitaux De Paris, Paris, France
| | | | - Alexandre Lapillonne
- Department of Neonatalogy, Hôpital Necker-Enfants Malades, Assistance Publique Hopitaux De Paris, Paris, France
| | - David Skurnik
- Hôpital Necker-Enfants Malades, Assistance Publique Hopitaux De Paris, Paris, France
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- INSERM U1151-Equipe 1, Institut Necker Enfants Malades, Université Paris Descartes, Paris, France
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8
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Widjaja NA, Hardiyani K, Hanindita MH, Irawan R. Microbiological Assessment of Fresh Expressed Breast Milk on Room Temperature at Dr. Soetomo Hospital Neonatal Unit. FOLIA MEDICA INDONESIANA 2021. [DOI: 10.20473/fmi.v55i1.24346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Storing EBM at room temperature in several hours before consuming, frequently found in Indonesia. Based on Academy of Breastfeeding Medicine guidelines EBM can last for 6 to 8 hours in room temperature (25oC or 77oF). However, currently there hasn’t been study in tropical country especially Indonesia for the guidelines. This study aimed to assess microbiological quality of EBM on room temperature, including bacterial growth and major bacterial found on EBM for health care and society recommendations. An observational study of 30 expressed breast milk samples provided by 30 healthy women with term baby below 6 month old. The samples were kept sterile and laid at plates for 0 hours, 2 hours, 4 hours and 6 hours in room temperature (26°-32° C) and used drop plate technique on several culture media. Data was analyzed by Chi-square and paired sample T-test. Thirty of unheated fresh EBM from 30 lactating mothers were stored at room temperature, examined for the degree of bacterial contamination at 0 hour, 2 hours, 4 hours, and 6 hours. All the EBM samples were contaminated at 2 hour. Bacterial species identified was Coagulase-negative Staphylococcus (CNS), Escherichia coli, Klebsiella pneumoniae and Streptococcus faecalis, range of growth 109 cfu/ml-63 x 109 cfu/mm3 after 6 hour of storage. The EBM exposed at room temperature (30-36 0C) for more than two hour reduce the quality and do not recommended to be given to the infants.
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9
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Expressed breast milk feeding practices in Hong Kong Chinese women: A descriptive study. Midwifery 2020; 91:102835. [DOI: 10.1016/j.midw.2020.102835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022]
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10
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Fernández L, Pannaraj PS, Rautava S, Rodríguez JM. The Microbiota of the Human Mammary Ecosystem. Front Cell Infect Microbiol 2020; 10:586667. [PMID: 33330129 PMCID: PMC7718026 DOI: 10.3389/fcimb.2020.586667] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022] Open
Abstract
Human milk contains a dynamic and complex site-specific microbiome, which is not assembled in an aleatory way, formed by organized microbial consortia and networks. Presence of some genera, such as Staphylococcus, Streptococcus, Corynebacterium, Cutibacterium (formerly known as Propionibacterium), Lactobacillus, Lactococcus and Bifidobacterium, has been detected by both culture-dependent and culture-independent approaches. DNA from some gut-associated strict anaerobes has also been repeatedly found and some studies have revealed the presence of cells and/or nucleic acids from viruses, archaea, fungi and protozoa in human milk. Colostrum and milk microbes are transmitted to the infant and, therefore, they are among the first colonizers of the human gut. Still, the significance of human milk microbes in infant gut colonization remains an open question. Clinical studies trying to elucidate the question are confounded by the profound impact of non-microbial human milk components to intestinal microecology. Modifications in the microbiota of human milk may have biological consequences for infant colonization, metabolism, immune and neuroendocrine development, and for mammary health. However, the factors driving differences in the composition of the human milk microbiome remain poorly known. In addition to colostrum and milk, breast tissue in lactating and non-lactating women may also contain a microbiota, with implications in the pathogenesis of breast cancer and in some of the adverse outcomes associated with breast implants. This and other open issues, such as the origin of the human milk microbiome, and the current limitations and future prospects are addressed in this review.
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Affiliation(s)
- Leónides Fernández
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Pia S. Pannaraj
- Department of Pediatrics and Molecular Microbiology and Immunology, Keck School of Medicine and Children’s Hospital, Los Angeles, CA, United States
| | - Samuli Rautava
- University of Helsinki and Helsinki University Hospital, New Children’s Hospital, Pediatric Research Center, Helsinki, Finland
| | - Juan M. Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
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11
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Metabolomic and Metataxonomic Fingerprinting of Human Milk Suggests Compositional Stability over a Natural Term of Breastfeeding to 24 Months. Nutrients 2020; 12:nu12113450. [PMID: 33187120 PMCID: PMC7697254 DOI: 10.3390/nu12113450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 01/22/2023] Open
Abstract
Sparse data exist regarding the normal range of composition of maternal milk beyond the first postnatal weeks. This single timepoint, observational study in collaboration with the ‘Parenting Science Gang’ citizen science group evaluated the metabolite and bacterial composition of human milk from 62 participants (infants aged 3–48 months), nearly 3 years longer than previous studies. We utilised rapid evaporative ionisation mass spectrometry (REIMS) for metabolic fingerprinting and 16S rRNA gene metataxonomics for microbiome composition analysis. Milk expression volumes were significantly lower beyond 24 months of lactation, but there were no corresponding changes in bacterial load, composition, or whole-scale metabolomic fingerprint. Some individual metabolite features (~14%) showed altered abundances in nursling age groups above 24 months. Neither milk expression method nor nursling sex affected metabolite and metataxonomic fingerprints. Self-reported lifestyle factors, including diet and physical traits, had minimal impact on metabolite and metataxonomic fingerprints. Our findings suggest remarkable consistency in human milk composition over natural-term lactation. The results add to previous studies suggesting that milk donation can continue up to 24 months postnatally. Future longitudinal studies will confirm the inter-individual and temporal nature of compositional variations and the use of donor milk as a personalised therapeutic.
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12
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Hasan AMR, Smith G, Selim MA, Akter S, Khan NUZ, Sharmin T, Rasheed S. Work and breast milk feeding: a qualitative exploration of the experience of lactating mothers working in ready made garments factories in urban Bangladesh. Int Breastfeed J 2020; 15:93. [PMID: 33160366 PMCID: PMC7648991 DOI: 10.1186/s13006-020-00338-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive breastfeeding. As Ready Made Garment (RMG) factories have been the largest employer of low income women in Bangladesh, the objective of our study was to explore the barriers and facilitators of breastfeeding and perceptions about use of expressed breast milk among mothers who worked in the RMG sector. METHODS This formative research was conducted during July-September 2015 in two slums of Dhaka among RMG workers who were mothers and the caregivers of 0-12 month old infants. Qualitative data was obtained from purposively selected participants of 8 in-depth interviews and 4 focus group discussions (mothers and caregivers), and 2 key informant (RMG factory official) interviews. Mothers were from multiple RMG factories while factory officials were from a single factory. Thematic analysis was conducted. RESULTS The main themes of qualitative exploration were knowledge and experience of breastfeeding; structural barriers (home and workplace); consequences of inadequate breastfeeding; and perception and experience of using expressed breast milk. Despite knowledge both of the benefits of breast milk and of the importance of breastfeeding for 6 months, most mothers introduced formula as early as 2 months to prepare for their return to work. Barriers such as excessive workload, inadequate crèche facilities at work, and lack of adequate caregivers at home impeded exclusive breastfeeding. Mothers and caregivers had very little knowledge about the use of expressed breast milk and were concerned about contamination. CONCLUSION As RMG factories are the largest employer of low-income women in Bangladesh, facilitating RMG factory working mothers' ability to use breast milk could help to promote infant health and help women remain in the workforce.
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Affiliation(s)
- A M Rumayan Hasan
- Health Systems and Population Studies Division (HSPSD), icddr,b, Universal Health Coverage, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Mohammad Abdus Selim
- Health Systems and Population Studies Division (HSPSD), icddr,b, Universal Health Coverage, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shahinoor Akter
- Faculty of Health and Medicine, Schools of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Department of Anthropology, Jagannath University, Dhaka, Bangladesh
| | - Nazib Uz Zaman Khan
- Schools of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Tamanna Sharmin
- Monitoring Evaluation Research and Learning (MERL), Plan International, Dhaka, Bangladesh
| | - Sabrina Rasheed
- Health Systems and Population Studies Division (HSPSD), icddr,b, Universal Health Coverage, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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13
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Changes in the Bacterial Diversity of Human Milk during Late Lactation Period (Weeks 21 to 48). Foods 2020; 9:foods9091184. [PMID: 32867028 PMCID: PMC7554819 DOI: 10.3390/foods9091184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/28/2022] Open
Abstract
Breast milk from a single mother was collected during a 28-week lactation period. Bacterial diversity was studied by amplicon sequencing analysis of the V3-V4 variable region of the 16S rRNA gene. Firmicutes and Proteobacteria were the main phyla detected in the milk samples, followed by Actinobacteria and Bacteroidetes. The proportion of Firmicutes to Proteobacteria changed considerably depending on the sampling week. A total of 411 genera or higher taxons were detected in the set of samples. Genus Streptococcus was detected during the 28-week sampling period, at relative abundances between 2.0% and 68.8%, and it was the most abundant group in 14 of the samples. Carnobacterium and Lactobacillus had low relative abundances. At the genus level, bacterial diversity changed considerably at certain weeks within the studied period. The weeks or periods with lowest relative abundance of Streptococcus had more diverse bacterial compositions including genera belonging to Proteobacteria that were poorly represented in the rest of the samples.
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14
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The risk of infectious pathogens in breast-feeding, donated human milk and breast milk substitutes. Public Health Nutr 2020; 24:1725-1740. [PMID: 32539885 DOI: 10.1017/s1368980020000555] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This review collates the published reports that focus on microbial and viral illnesses that can be transmitted by breast milk, donor milk and powdered infant formula (PIF). In this context, we attempt to define a risk framework encompassing those hazards, exposure scenarios, vulnerability and protective factors. DESIGN A literature search was performed for reported cases of morbidity and mortality associated with different infant feeding modes. SETTING Exclusive breast-feeding is the recommended for infant feeding under 6 months, or failing that, provision of donated human milk. However, the use of PIF remains high despite its intrinsic and extrinsic risk of microbial contamination, as well as the potential for adverse physiological effects, including infant gut dysbiosis. RESULTS Viable pathogen transmission via breast-feeding or donor milk (pasteurised and unpasteurised) is rare. However, transmission of HIV and human T-cell lymphotropic virus-1 is a concern for breast-feeding mothers, particularly for mothers undertaking a mixed feeding mode (PIF and breast-feeding). In PIF, intrinsic and extrinsic microbial contamination, such as Cronobacter and Salmonella, remain significant identifiable causes of infant morbidity and mortality. CONCLUSIONS Disease transmission through breast-feeding or donor human milk is rare, most likely owing to its complex intrinsically protective composition of human milk and protection of the infant gut lining. Contamination of PIF and the morbidity associated with this is likely underappreciated in terms of community risk. A better system of safe donor milk sharing that also establishes security of supply for non-hospitalised healthy infants in need of breast milk would reduce the reliance on PIF.
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Treven P, Mahnič A, Rupnik M, Golob M, Pirš T, Matijašić BB, Lorbeg PM. Evaluation of Human Milk Microbiota by 16S rRNA Gene Next-Generation Sequencing (NGS) and Cultivation/MALDI-TOF Mass Spectrometry Identification. Front Microbiol 2019; 10:2612. [PMID: 31803156 PMCID: PMC6872673 DOI: 10.3389/fmicb.2019.02612] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/28/2019] [Indexed: 12/21/2022] Open
Abstract
The aim of the present study was to characterize human milk microbiota (HMM) with 16S rRNA gene amplicon next-generation sequencing and cultivation/matrix-assisted laser desorption/ionization (MALDI)-time of flight (TOF) mass spectrometry (MS) identification approaches. We analyzed 31 human milk samples from healthy Slovenian mothers. To check the accuracy of MALDI-TOF MS identification, several colonies representing most abundant genera and those, which could not be reliably identified by MALDI-TOF, were subjected to Sanger sequencing of their 16S rRNA gene. We showed that cultivation/MALDI-TOF MS was a suitable tool for culture-dependent determination of HMM. With both approaches, Staphylococcus and Streptococcus were found as predominant genera in HMM and the abundance of Staphylococcus was associated with decreased microbial diversity. In addition, we characterized factors that might influence HMM. The use of a breast pump was significantly associated with composition of HMM, lower microbial load, and higher abundance of cultivable staphylococci. Moreover, our study suggests that administration of probiotics to the suckling infant might influence HMM by increased abundance of lactobacilli and the presence of viable probiotic bacteria in human milk. However, since our study was observational with relatively small sample size, more targeted studies are needed to study possible transfer of probiotics to the mammary gland via an external route and the physiological relevance of these events.
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Affiliation(s)
- Primož Treven
- Department of Animal Science, Biotechnical Faculty, Institute of Dairy Science and Probiotics, University of Ljubljana, Ljubljana, Slovenia
| | - Aleksander Mahnič
- National Laboratory of Health, Environment and Food, Maribor, Slovenia
| | - Maja Rupnik
- National Laboratory of Health, Environment and Food, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Majda Golob
- Faculty of Veterinary Medicine, Institute of Microbiology and Parasitology, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Pirš
- Faculty of Veterinary Medicine, Institute of Microbiology and Parasitology, University of Ljubljana, Ljubljana, Slovenia
| | - Bojana Bogovič Matijašić
- Department of Animal Science, Biotechnical Faculty, Institute of Dairy Science and Probiotics, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Mohar Lorbeg
- Department of Animal Science, Biotechnical Faculty, Institute of Dairy Science and Probiotics, University of Ljubljana, Ljubljana, Slovenia
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A randomized crossover trial comparing the Nifty cup to a medicine cup in preterm infants who have difficulty breastfeeding at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. PLoS One 2019; 14:e0223951. [PMID: 31622421 PMCID: PMC6797128 DOI: 10.1371/journal.pone.0223951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/26/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Preterm infants make up the majority of the 9 million babies born in Africa and South Asia requiring supplemental feedings as they transition to exclusive breastfeeding. The World Health Organization recommends the use of a cup to feed newborns with breastfeeding difficulties in low-resource settings. We set out to evaluate the Nifty cup, a new feeding cup designed specifically for infants with breastfeeding difficulties. MATERIALS AND METHODS We conducted a randomized clinical trial in Ghana. We hypothesized infants would prefer the Nifty cup and that it would have less spillage as compared to a medicine cup. We enrolled mothers and preterm infants with breastfeeding difficulties indicated to cup feed at Komfo Anokye Teaching Hospital. Each mother-infant pair used the Nifty cup and a standard medicine cup; and two feeding assessments with each cup were conducted. We employed an intent-to-treat analysis comparing cup preference using a Wilcoxon signed rank test and spillage using generalized estimating equations. RESULTS We enrolled 200 mothers and 237 infants. Many infants were very low birth weight (62%), less than two weeks old (62%), and multiple birth (29%). In response to separate questions about each cup, more mothers reported liking the Nifty cup a lot as compared to the medicine cup (85% versus 57%, p<0.001). When asked to choose between the two cups, more than 75% preferred the Nifty cup (p < 0.001). There was slightly less spillage with the Nifty cup (8.9%) versus the medicine cup (9.3%), which was not statistically significant (p = 0.35). Mothers reported greater confidence and ease of using the Nifty cup and greater use one-month post-discharge compared to the medicine cup (p-values <0.001). Nearly all mothers were breastfeeding and cup feeding their infants at study initiation and at one-month post-discharge. DISCUSSION This is the first randomized clinical trial of cup feeding in sub-Saharan Africa. Mothers prefer the Nifty cup to a medicine cup for supplemental feeds to their preterm infant. The Nifty cup was used with greater ease and confidence. The Nifty cup can offer an improved feeding experience for the mother-infant pair.
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Fertitta L, Welfringer-Morin A, Rigourd V, Jamet A, Hadj-Rabia S, Lesage F, Bodemer C. Neonatal staphylococcal scalded skin syndrome in a breastfed neonate. J Eur Acad Dermatol Venereol 2019; 34:e36-e38. [PMID: 31420893 DOI: 10.1111/jdv.15889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Fertitta
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université de Paris AP-HP-5, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - A Welfringer-Morin
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université de Paris AP-HP-5, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - V Rigourd
- Breast Milk bank, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - A Jamet
- Department of Bacteriology, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - S Hadj-Rabia
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université de Paris AP-HP-5, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,INSERM U1163, Institut Imagine, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - F Lesage
- Department of Intensive Care, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - C Bodemer
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université de Paris AP-HP-5, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,INSERM U1163, Institut Imagine, Hôpital Universitaire Necker - Enfants Malades, Paris, France
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18
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Comparison of two methods for cleaning breast pump milk collection kits in human milk banks. J Hosp Infect 2019; 103:217-222. [PMID: 31301329 DOI: 10.1016/j.jhin.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Appropriate decontamination of breast pump milk collection kits (BPKs) is critical to obtain safe milk for infants and to avoid discarding donor human milk (DHM). AIM To evaluate two strategies for BPK decontamination by assessing microbial cultures and the proportion of discarded DHM, according to the criteria of the National Institute for Health and Care Excellence for pre-pasteurization cultures. METHODS Prospective comparative study, allocation ratio 1:1, microbiologist-blind. PARTICIPANTS 47 new donors in a human milk bank in Madrid. INTERVENTIONS Study group (N=21): BPKs washed with water and detergent after each use and further steam decontamination within a microwavable bag. Control group (N=26): washing, rinsing and drying only. Five samples: first sample by hand expression and four samples (one per week) collected using the same pump and method. OUTCOMES Primary: proportion of DHM discarded due to contamination. Secondary: comparison of the microbiota between samples obtained by hand expression and breast pump in both groups. FINDINGS In total, 217 milk samples were collected: 47 by hand expression and 170 by pump expression (78 from study group). Steam decontamination of BPKs using a microwavable bag after washing resulted in a lower proportion of discarded DHM samples (1.3% vs 18.5%, P<0.001) and samples contaminated with Enterobacteriaceae (1.3% vs 22.8%, P<0.001) and Candida spp. (1.3% vs 14.1%, P<0.05) compared with samples collected with BPKs that were washed but not steam decontaminated. There were no differences in bacterial contamination between samples obtained using steam decontaminated BPKs and those obtained by hand expression. CONCLUSIONS Steam decontamination of BPKs using a microwavable bag after washing decreases the amount of discarded DHM and the number of samples with potentially pathogenic bacteria.
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Fernández L, Ruiz L, Jara J, Orgaz B, Rodríguez JM. Strategies for the Preservation, Restoration and Modulation of the Human Milk Microbiota. Implications for Human Milk Banks and Neonatal Intensive Care Units. Front Microbiol 2018; 9:2676. [PMID: 30473683 PMCID: PMC6237971 DOI: 10.3389/fmicb.2018.02676] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Studies carried in the last years have revealed that human milk contains a site-specific microbiota and constitutes a source of potentially beneficial bacteria to the infant gut. Once in the infant gut, these bacteria contribute to the assembly of a physiological gut microbiota and may play several functions, contributing to infant metabolism, protection against infections, immunomodulation or neuromodulation. Many preterm neonates are fed with pasteurized donor’s human milk (DHM) or formula and, therefore, are devoid of contact with human milk microbes. As a consequence, new strategies are required to allow the exposition of a higher number of preterm infants to the human milk microbiota early in life. The first strategy would be to promote and to increase the use of own mother’s milk (OMM) in Neonatal Intensive Care Units (NICUs). Even small quantities of OMM can be very valuable since they would be added to DHM in order to microbiologically “customize” it. When OMM is not available, a better screening of donor women, including routine cytomegalovirus (CMV) screening of milk, may help to avoid the pasteurization of the milk provided by, at least, a relevant proportion of donors. Finally, when pasteurized DHM or formula are the only feeding option, their supplementation with probiotic bacteria isolated from human milk, such as lactic acid bacteria or bifidobacteria, may be an alternative to try to restore a human milk-like microbiota before feeding the babies. In the future, the design of human milk bacterial consortia (minimal human milk microbiotas), including well characterized strains representative of a healthy human milk microbiota, may be an attractive strategy to provide a complex mix of strains specifically tailored to this target population.
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Affiliation(s)
- Leónides Fernández
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Lorena Ruiz
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias - Consejo Superior de Investigaciones Científicas, Villaviciosa, Spain
| | - Josué Jara
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Belén Orgaz
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias - Consejo Superior de Investigaciones Científicas, Villaviciosa, Spain
| | - Juan M Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
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20
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Picaud JC, Buffin R, Gremmo‐Feger G, Rigo J, Putet G, Casper C. Review concludes that specific recommendations are needed to harmonise the provision of fresh mother's milk to their preterm infants. Acta Paediatr 2018; 107:1145-1155. [PMID: 29412475 PMCID: PMC6032854 DOI: 10.1111/apa.14259] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/02/2018] [Accepted: 01/30/2018] [Indexed: 01/27/2023]
Abstract
AIM There are no specific recommendations for using a mother's fresh milk for her preterm infant. We reviewed the available evidence on its collection, storage and administration. METHODS The working group of the French Neonatal Society on fresh human milk use in preterm infants searched the MEDLINE database and Cochrane Library up to June 2017 for papers published in English or French. They specifically analysed 282 papers providing information on prospective, retrospective and clinical studies and examined guidelines from various countries. RESULTS The review concluded that fresh mother's own milk should be favoured in accordance with the latest recommendations. However, it must be carried out under stringent conditions so that the expected benefits are not offset by risks related to different practices. The working group has summarised the best conditions for feeding preterm infants with human milk, balancing high nutritional and immunological quality with adequate virological and bacteriological safety. Professionals must provide parents with the necessary conditions to establish breastfeeding, together with specific and strong support. CONCLUSION Based on their review, the working group has made specific recommendations for using fresh mother's own milk under careful conditions, so that the expected benefits are not offset by risks related to practices.
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Affiliation(s)
- JC Picaud
- Neonatal UnitHôpital de la Croix RousseHospices Civils de LyonLyonFrance
- Faculté de médecine Lyon‐Sud Charles MérieuxUniversité Claude Bernard Lyon 1VilleurbanneFrance
| | - R Buffin
- Neonatal UnitHôpital de la Croix RousseHospices Civils de LyonLyonFrance
| | - G Gremmo‐Feger
- Neonatal UnitPôle de la Femme, de la Mère et de l'EnfantCHU BrestBrestFrance
| | - J Rigo
- Neonatal UnitChU Liège Hopital de la CitadelleUniversité de LiègeLiègeBelgium
| | - G Putet
- Neonatal UnitHôpital de la Croix RousseHospices Civils de LyonLyonFrance
| | - C Casper
- Neonatal UnitPaul Sabatier UniversityToulouseFrance
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21
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Escuder-Vieco D, Espinosa-Martos I, Rodríguez JM, Corzo N, Montilla A, Siegfried P, Pallás-Alonso CR, Fernández L. High-Temperature Short-Time Pasteurization System for Donor Milk in a Human Milk Bank Setting. Front Microbiol 2018; 9:926. [PMID: 29867837 PMCID: PMC5958646 DOI: 10.3389/fmicb.2018.00926] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/20/2018] [Indexed: 12/05/2022] Open
Abstract
Donor milk is the best alternative for the feeding of preterm newborns when mother's own milk is unavailable. For safety reasons, it is usually pasteurized by the Holder method (62.5°C for 30 min). Holder pasteurization results in a microbiological safe product but impairs the activity of many biologically active compounds such as immunoglobulins, enzymes, cytokines, growth factors, hormones or oxidative stress markers. High-temperature short-time (HTST) pasteurization has been proposed as an alternative for a better preservation of some of the biological components of human milk although, at present, there is no equipment available to perform this treatment under the current conditions of a human milk bank. In this work, the specific needs of a human milk bank setting were considered to design an HTST equipment for the continuous and adaptable (time-temperature combination) processing of donor milk. Microbiological quality, activity of indicator enzymes and indices for thermal damage of milk were evaluated before and after HTST treatment of 14 batches of donor milk using different temperature and time combinations and compared to the results obtained after Holder pasteurization. The HTST system has accurate and simple operation, allows the pasteurization of variable amounts of donor milk and reduces processing time and labor force. HTST processing at 72°C for, at least, 10 s efficiently destroyed all vegetative forms of microorganisms present initially in raw donor milk although sporulated Bacillus sp. survived this treatment. Alkaline phosphatase was completely destroyed after HTST processing at 72 and 75°C, but γ-glutamil transpeptidase showed higher thermoresistance. Furosine concentrations in HTST-treated donor milk were lower than after Holder pasteurization and lactulose content for HTST-treated donor milk was below the detection limit of analytical method (10 mg/L). In conclusion, processing of donor milk at 72°C for at least 10 s in this HTST system allows to achieve the microbiological safety objectives established in the milk bank while having a lower impact regarding the heat damage of the milk.
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Affiliation(s)
- Diana Escuder-Vieco
- Banco Regional de Leche Materna, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain
| | | | - Juan M Rodríguez
- Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Corzo
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), Madrid, Spain
| | - Antonia Montilla
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), Madrid, Spain
| | | | - Carmen R Pallás-Alonso
- Banco Regional de Leche Materna, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain.,Servicio de Neonatología, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Universidad Complutense de Madrid, Madrid, Spain
| | - Leónides Fernández
- Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
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Carré M, Dumoulin D, Jounwaz R, Mestdagh B, Pierrat V. Maternal adherence to guidance on breast milk collection process. Arch Pediatr 2018; 25:274-279. [DOI: 10.1016/j.arcped.2018.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/25/2018] [Accepted: 02/18/2018] [Indexed: 11/15/2022]
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23
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Froh EB, Vanderpool J, Spatz DL. Best Practices to Limit Contamination of Donor Milk in a Milk Bank. J Obstet Gynecol Neonatal Nurs 2018; 47:547-555. [PMID: 29304316 DOI: 10.1016/j.jogn.2017.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 11/30/2022] Open
Abstract
Human milk donated to a milk bank can become contaminated in a number of ways, but processes exist to eradicate pathogenic bacterial growth. Donor human milk may be cultured before or after pasteurization or both. The purpose of this article is to describe standard operations of the Mothers' Milk Bank of the Children's Hospital of Philadelphia, best practices to limit the bacterial contamination of donor human milk, and implications for future research.
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24
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Poor hygiene practices in infant formulae reconstitution and inappropriate storage of feeding bottles can cause spoilage issues by Serratia marcescens. Food Control 2017. [DOI: 10.1016/j.foodcont.2017.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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25
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Eglash A, Simon L. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants, Revised 2017. Breastfeed Med 2017; 12:390-395. [PMID: 29624432 DOI: 10.1089/bfm.2017.29047.aje] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anne Eglash
- 1 Department of Family and Community Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Liliana Simon
- 2 Department of Pediatrics, Pediatric Critical Care, University of Maryland School of Medicine , Baltimore, Maryland
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Felice JP, Geraghty SR, Quaglieri CW, Yamada R, Wong AJ, Rasmussen KM. "Breastfeeding" but not at the breast: Mothers' descriptions of providing pumped human milk to their infants via other containers and caregivers. MATERNAL & CHILD NUTRITION 2017; 13:e12425. [PMID: 28083933 PMCID: PMC5491362 DOI: 10.1111/mcn.12425] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/18/2016] [Accepted: 12/02/2016] [Indexed: 11/28/2022]
Abstract
As pumping has become more prevalent among American women, pumped human milk (HM) is on the rise in their infants' diets in place of some or all feeding at the breast. We aimed to fill a gap in knowledge about mothers' motivations, practices and perceptions related to pumping, and about mothers' and other caregivers' motivations, practices, and perceptions related to feeding pumped HM. Results related to providing pumped HM are reported here, and results related to pumping are reported elsewhere. We conducted in-depth, semi-structured interviews among a diverse sample of mothers whose infants were fed pumped HM (n = 20), following each up to 1 year postpartum. Data were analyzed using thematic analysis with Atlas.ti. Nearly all mothers felt bottles were necessary to meet infant HM-feeding goals. Nearly all pumped HM was fed by other caregivers because mothers typically preferred and prioritized feeding at the breast for convenience and maintaining their milk supply. Infants were bottle-fed HM for several reasons that changed over time, such as mother's absence, latch difficulty, or desire to share the burden and bonding of feeding. Feeding practices differed between feeds from bottles versus at the breast; some infants were bottle-fed on schedules but fed at the breast on demand. Mothers' methods for storing, transporting, and preparing HM varied substantially and included practices associated with loss of nutrients and microbial contamination. Mothers' reasons for bottle-feeding HM may affect how much their infants are bottle-fed. Consumption of pumped HM may not provide the same benefits to infants as feeding at the breast. These findings highlight important avenues for future research into the relationships between bottle-feeding HM and infant health, growth, and developmental outcomes.
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Affiliation(s)
- Julia P. Felice
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | | | | | - Rei Yamada
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Adriana J. Wong
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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Felice JP, Geraghty SR, Quaglieri CW, Yamada R, Wong AJ, Rasmussen KM. "Breastfeeding" without baby: A longitudinal, qualitative investigation of how mothers perceive, feel about, and practice human milk expression. MATERNAL & CHILD NUTRITION 2017; 13:e12426. [PMID: 28078789 PMCID: PMC5491350 DOI: 10.1111/mcn.12426] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/18/2016] [Accepted: 12/02/2016] [Indexed: 11/27/2022]
Abstract
Most American mothers who produce human milk (HM) now pump in place of some or all feeding at the breast, and most American infants are now fed pumped HM. We aimed to investigate mothers' perceptions of, attitudes toward, and practices for pumping and providing pumped HM. Results related to pumping are reported here. We conducted in-depth, semi-structured interviews among a diverse sample of 20 mothers who pumped, following each from pregnancy through infant HM-feeding cessation up to 1 year postpartum. Data were analyzed using thematic analysis with Atlas.ti. Mothers' reasons for pumping changed over time and reflected their needs and desires (e.g., latch difficulty, return to work, and increasing their milk supply). Mothers reported that pump type and quality were important to pumping success and that pumping was time-consuming, costly, and unpleasant compared to feeding at the breast. Regardless of how often mothers pumped, most felt pumping was necessary to meet their infant HM-feeding goals and was a welcome means of sharing with other caregivers the bonding opportunity and tasks they associated with feeding infants. Mothers interpreted output from pumping sessions to understand their ability to provide enough milk to meet their infants' needs. Mothers' reasons for pumping may signal constraints to infant HM feeding that may be addressed with policy changes. Mothers' attitudes and perceptions toward pumping indicate that, although pumping fills important and welcome roles for many mothers, the reality of its practice may make it an unacceptable or infeasible substitute for some.
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Affiliation(s)
- Julia P. Felice
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | | | | | - Rei Yamada
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Adriana J. Wong
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML, Kinn TJ, Klang MG, Lord L, Martin K, Pompeii-Wolfe C, Sullivan J, Wood A, Malone A, Guenter P. ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text]. JPEN J Parenter Enteral Nutr 2016; 41:15-103. [PMID: 27815525 DOI: 10.1177/0148607116673053] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.
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Affiliation(s)
- Joseph I Boullata
- 1 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania and Department of Nutrition, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Lillian Harvey
- 3 Northshore University Hospital, Manhasset, New York, and Hofstra University NorthWell School of Medicine, Garden City, New York, USA
| | - Arlene A Escuro
- 4 Digestive Disease Institute Cleveland Clinic Cleveland, Ohio, USA
| | - Lauren Hudson
- 5 Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Mays
- 6 Baptist Health Systems and University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Carol McGinnis
- 7 Sanford University of South Dakota Medical Center, Sioux Falls, South Dakota, USA
| | | | - Sarita Bajpai
- 9 Indiana University Health, Indianapolis, Indiana, USA
| | | | - Tamara J Kinn
- 11 Loyola University Medical Center, Maywood, Illinois, USA
| | - Mark G Klang
- 12 Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Linda Lord
- 13 University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Martin
- 14 University of Texas Center for Health Sciences at San Antonio, San Antonio, Texas, USA
| | - Cecelia Pompeii-Wolfe
- 15 University of Chicago, Medicine Comer Children's Hospital, Chicago, Illinois, USA
| | | | - Abby Wood
- 17 Baylor University Medical Center, Dallas, Texas, USA
| | - Ainsley Malone
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
| | - Peggi Guenter
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
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Yamada R, Rasmussen KM, Felice JP. Mothers' Use of Social Media to Inform Their Practices for Pumping and Providing Pumped Human Milk to Their Infants. CHILDREN-BASEL 2016; 3:children3040022. [PMID: 27809227 PMCID: PMC5184797 DOI: 10.3390/children3040022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/26/2016] [Accepted: 10/21/2016] [Indexed: 11/16/2022]
Abstract
Despite U.S. mothers’ wide adoption of pumps and bottles to provide human milk (HM) to their infants, mothers lack comprehensive, evidence-based guidelines for these practices. Thus, some women use online sources to seek information from each other. We aimed to characterize the information women sought online about pumping. We used data provided by ~25,000 women in an open cohort within a discussion forum about parenting. We examined 543 posts containing questions about providing pumped HM cross-sectionally and longitudinally in three time intervals: prenatal, 0 through 1.5 months postpartum, and 1.5 to 4.5 months postpartum. We used thematic analysis with Atlas.ti to analyze the content of posts. During pregnancy, women commonly asked questions about how and where to obtain pumps, both out-of-pocket and through insurance policies. Between 0–1.5 months postpartum, many mothers asked about how to handle pumped HM to ensure its safety as fed. Between 1.5–4.5 months postpartum, mothers sought strategies to overcome constraints to pumping both at home and at work and also asked about stopping pumping and providing their milk. Women’s questions related to ensuring the safety of pumped HM represent information women need from health professionals, while their questions related to obtaining pumps suggest that women may benefit from clearer guidelines from their insurance providers. The difficulties women face at home and at work identify avenues through which families and employers can support women to meet their goals for providing HM.
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Affiliation(s)
- Rei Yamada
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| | | | - Julia P Felice
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
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Practices, predictors and consequences of expressed breast-milk feeding in healthy full-term infants. Public Health Nutr 2016; 20:492-503. [DOI: 10.1017/s136898001600241x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo investigate the prevalence and predictors of expressed breast-milk feeding in healthy full-term infants and its association with total duration of breast-milk feeding.DesignProspective cohort study.SettingIn-patient postnatal units of four public hospitals in Hong Kong.SubjectsA total of 2450 mother–infant pairs were recruited in 2006–2007 and 2011–2012 and followed up prospectively for 12 months or until breast-milk feeding had stopped.ResultsAcross the first 6 months postpartum, the rate of exclusive expressed breast-milk feeding ranged from 5·1 to 8·0 % in 2006–2007 and from 18·0 to 19·8 % in 2011–2012. Factors associated with higher rate of exclusive expressed breast-milk feeding included supplementation with infant formula, lack of previous breast-milk feeding experience, having a planned caesarean section delivery and returning to work postpartum. Exclusive expressed breast-milk feeding was associated with an increased risk of early breast-milk feeding cessation when compared with direct feeding at the breast. The hazard ratio (95 % CI) ranged from 1·25 (1·04, 1·51) to 1·91 (1·34, 2·73) across the first 6 months.ConclusionsMothers of healthy term infants should be encouraged and supported to feed directly at the breast. Exclusive expressed breast-milk feeding should be recommended only when medically necessary and not as a substitute for feeding directly at the breast. Further research is required to explore mothers’ reasons for exclusive expressed breast-milk feeding and to identify the health outcomes associated with this practice.
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Abstract
BACKGROUND Breastfeeding is important, however not all infants can feed at the breast and methods of expressing milk need evaluation. OBJECTIVES To assess acceptability, effectiveness, safety, effect on milk composition, contamination and costs of methods of milk expression. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (21 March 2016), handsearched relevant journals and conference proceedings, and contacted experts in the field to seek additional published or unpublished studies. We also examined reference lists of all relevant retrieved papers. SELECTION CRITERIA Randomised and quasi-randomised trials comparing methods at any time after birth. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS This updated review includes 41 trials involving 2293 participants, with 22 trials involving 1339 participants contributing data for analysis. Twenty-six of the trials referred to mothers of infants in neonatal units (n = 1547) and 14 to mothers of healthy infants at home (n = 730), with one trial containing mothers of both neonatal and healthy older infants (n = 16). Eleven trials compared one or more types of pump versus hand expression and 14 studies compared one type of pump versus another type of pump, with three of these studies comparing both hand expression and pump types. Twenty studies compared a specific protocol or adjunct behaviour including sequential versus simultaneous pumping protocols, pumping frequency, provision of an education and support intervention, relaxation, breast massage, combining hand expression with pumping and a breast cleansing protocol.Due to heterogeneity in participants, interventions, and outcomes measured or reported, we were unable to pool findings for most of the specified outcomes. It was not possible therefore to produce a 'Summary of findings' table in this update. Most of the included results were derived from single studies. Trials took place in 14 countries under a variety of circumstances and were published from 1982 to 2015. Sixteen of the 30 trials that evaluated pumps or products had support from the manufacturers. The risk of bias of the included studies was variable. Primary outcomesOnly one of the 17 studies examining maternal satisfaction/acceptability with the method or adjunct behaviour provided data suitable for analysis. In this study, self-efficacy was assessed by asking mothers if they agreed or disagreed with the following statement: 'I don't want anyone to see me (hand expressing/pumping)'. The study found that mothers who were using the electric pump were more likely to agree with the statement compared to mothers hand expressing, (mean difference (MD) 0.70, 95% confidence interval (CI) 0.15 to 1.25; P = 0.01, participants = 68). Mothers who were hand expressing reported that the instructions for expression were clearer compared to the electric pump, (MD -0.40, 95% CI -0.75 to -0.05; P = 0.02, participants = 68). Descriptive reporting of satisfaction in the other studies varied in the measures used, did not indicate a clear preference for one pump type, although there was satisfaction with some relaxation and support interventions.We found no clinically significant differences between methods related to contamination of the milk that compared any type of pump to hand expression (risk ratio (RR) 1.13, 95% CI 0.79 to 1.61; P = 0.51, participants = 28), manual pump compared to hand expression, (MD 0.20, 95% CI -0.18 to 0.58; P = 0.30, participants = 142) a large electric pump compared to hand expression (MD 0.10, 95% CI -0.29 to 0.49; P = 0.61, participants = 123), or a large electric pump compared to a manual pump (MD -0.10, 95% CI -0.46 to 0.26; P = 0.59, participants = 141).The level of maternal breast or nipple pain or damage was similar in comparisons of a large electric pump to hand expression (MD 0.02, 95% CI -0.67 to 0.71; P = 0.96, participants = 68). A study comparing a manual and large electric pump, reported sore nipples in 7% for both groups and engorgement in 4% using a manual pump versus 6% using an electric pump; and in one study no nipple damage was reported in the hand-expression group, and one case of nipple damage in each of the manual pump and the large electric pump groups.One study examined adverse effects on infants, however as the infants did not all receive their mothers' expressed milk, we have not included the results. Secondary outcomesThe quantity of expressed milk obtained was increased, in some studies by a clinically significant amount, in interventions involving relaxation, music, warmth, massage, initiation of pumping, increased frequency of pumping and suitable breast shield size. Support programmes and simultaneous compared to sequential pumping did not show a difference in milk obtained. No pump consistently increased the milk volume obtained significantly.In relation to nutrient quality, hand expression or a large electric pump were found to provide higher protein than a manual pump, and hand expression provided higher sodium and lower potassium compared to a large electric pump or a manual pump. Fat content was higher with breast massage when pumping; no evidence of difference was found for energy content between methods.No consistent effect was found related to prolactin change or effect on oxytocin release with pump type or method. Economic aspects were not reported. AUTHORS' CONCLUSIONS The most suitable method for milk expression may depend on the time since birth, purpose of expression and the individual mother and infant. Low-cost interventions including initiation of milk expression sooner after birth when not feeding at the breast, relaxation, massage, warming the breasts, hand expression and lower cost pumps may be as effective, or more effective, than large electric pumps for some outcomes. Variation in nutrient content across methods may be relevant to some infants. Small sample sizes, large standard deviations, and the diversity of the interventions argue caution in applying these results beyond the specific method tested in the specific settings. Independently funded research is needed for more trials on hand expression, relaxation and other techniques that do not have a commercial potential.
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Affiliation(s)
| | - Hazel A Smith
- Our Lady's Children's HospitalPaediatric Intensive Care UnitCrumlinDublin 12Ireland
| | - Fionnuala Cooney
- HSE East, Dr Steevens' HospitalDepartment of Public HealthSteevens' LaneDublinDublinIrelandDublin 8
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Abstract
BACKGROUND This is an update of a 2008 Cochrane review. Breastfeeding is important. However, not all infants can feed at the breast and methods of expressing milk need evaluation. OBJECTIVES To assess acceptability, effectiveness, safety, effect on milk composition, contamination and cost implications of methods of milk expression. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2014), CINAHL (1982 to March 2014), conference proceedings, secondary references and contacted researchers. SELECTION CRITERIA Randomised and quasi-randomised trials comparing methods at any time after birth. DATA COLLECTION AND ANALYSIS Three authors independently assessed trials, extracted data and assessed risk of bias. MAIN RESULTS This updated review includes 34 studies involving 1998 participants, with 17 trials involving 961 participants providing data for analysis. Eight studies compared one or more types of pump versus hand expression and 14 studies compared one type of pump versus another type of pump, with three of these studies comparing both hand expression and multiple pump types. Fifteen studies compared a specific protocol or adjunct behaviour including sequential versus simultaneous pumping protocols (five studies), pumping > 4 times per day versus < 3 times per day (one study), provision of a milk expression education and support intervention to mothers of preterm infants versus no provision (one study), provision of audio/visual relaxation to mothers of preterm infants versus no specific relaxation (two studies), commencing pumping within one hour of delivery versus between one to six hours (one study), breast massage before or during pumping versus no massage (two studies, of which one also tested a second behaviour), therapeutic touch versus none (one study), warming breasts before pumping versus not warming breasts (one study), combining hand expression with pumping versus pumping alone (one study) and a breast cleansing protocol versus no protocol (one study).There were insufficient comparable data on outcomes to undertake meta-analysis and data reported relates to evidence from single studies.Only one of the 17 studies examining maternal satisfaction/acceptability provided data in a way that could be analysed, reporting that mothers assigned to the pumping group had more agreement with the statement 'I don't want anyone to see me pumping' than mothers in the hand expression group and the statement 'I don't want anyone to see me hand expressing' (n = 68, mean difference (MD) -0.70, 95% confidence interval (CI) -1.25 to -0.15, P = 0.01), and that mothers found instructions for hand expression were clearer than for pumping (n = 68, MD 0.40, 95% CI 0.05 to 0.75, P = 0.02). No evidence of a difference was found between methods related to adverse effects of milk contamination (one study, n = 28, risk ratio (RR) 0.89, 95% CI 0.62 to 1.27, P = 0.51), (one study, n = 142 milk samples, MD 0.20, 95% CI -0.18 to 0.58, P = 0.30), (one study, n = 123 milk samples, MD 0.10, 95% CI -0.29 to 0.49, P = 0.61), (one study, n = 141 milk samples, MD -0.10, 95% CI -0.46 to 0.26, P = 0.59 ); or level of maternal breast or nipple pain or damage (one study, n = 68, MD 0.02, 95% CI -0.67 to 0.71, P = 0.96).For the secondary outcomes, greater volume was obtained when mothers with infants in a neonatal unit were provided with a relaxation tape or music-listening interventions to use while pumping, when the breasts was warmed before pumping or massaged while pumping.Initiation of milk pumping within 60 minutes of birth of a very low birthweight infant obtained higher mean milk quantity in the first week than the group who initiated pumping later. No evidence of difference in volume was found with simultaneous or sequential pumping or between pumps studied. Differences between methods was found for sodium, potassium, protein and fat constituents; no evidence of difference was found for energy content.No consistent effect was found related to prolactin change or effect on oxytocin release with pump type or method. Economic aspects were not reported.Most studies were classified as unclear or low risk of bias. Most studies did not provide any information regarding blinding of outcome assessment. Fifteen of the 25 studies that evaluated pumps or products had support from the manufacturers. AUTHORS' CONCLUSIONS The most suitable method for milk expression may depend on the time since birth, purpose of expression and the individual mother and infant. Low-cost interventions including early initiation when not feeding at the breast, listening to relaxation music, massage and warming of the breasts, hand expression and lower cost pumps may be as effective, or more effective, than large electric pumps for some outcomes. Small sample sizes, large standard deviations, and the diversity of the interventions argue caution in applying these results beyond the specific method tested in the specific settings.
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Affiliation(s)
- Genevieve E Becker
- Unit for Health Services Research and International Health, WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, Italy, 34137
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Qi Y, Zhang Y, Fein S, Wang C, Loyo-Berríos N. Maternal and breast pump factors associated with breast pump problems and injuries. J Hum Lact 2014; 30:62-72; quiz 110-2. [PMID: 24166052 DOI: 10.1177/0890334413507499] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Benefits of using a breast pump are well documented, but pump-related problems and injuries and the associated risk factors have not been reported. OBJECTIVES This study aimed to describe breast pump-related problems and injuries and identify factors associated with these problems and injuries. METHODS Data were from the Infant Feeding Practices Study II; mothers were recruited from a nationally distributed consumer opinion panel. Mothers were asked about breast pump use, problems, and injuries at infant ages 2, 5, and 7 months. Survival analysis was used to identify factors associated with pump-related problems and injuries. RESULTS The sample included 1844 mothers. About 62% and 15% of mothers reported pump-related problems and injuries, respectively. The most commonly reported problem was that the pump did not extract enough milk and the most commonly reported injury was sore nipples. Using a battery-operated pump and intending to breastfeed less than 12 months were associated with higher risks of pump-related problems and injury. Learning from a friend to use the pump was associated with lower risk of pump-related problems, and using a manual pump and renting a pump were associated with a higher risk of problems. CONCLUSION Our results suggest that problems and injuries associated with breast pump use can happen to mothers of all socioeconomic characteristics. Breastfeeding mothers may reduce their risks of problems and injury by not using battery-operated pumps and may reduce breast pump problems by not using manual pumps and by learning breast pump skills from a person rather than following written or video instructions.
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Affiliation(s)
- Youlin Qi
- 1Food and Drug Administration, Silver Spring, MD, USA
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Clifford V, Dyson K, Jarvis M, Erac O, Jacobs SE, Daley AJ. My expressed breast milk turned pink! J Paediatr Child Health 2014; 50:81-2. [PMID: 24397452 DOI: 10.1111/jpc.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vanessa Clifford
- Department of Microbiology, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Microbiology, Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Johns HM, Forster DA, Amir LH, McLachlan HL. Prevalence and outcomes of breast milk expressing in women with healthy term infants: a systematic review. BMC Pregnancy Childbirth 2013; 13:212. [PMID: 24246046 PMCID: PMC4225568 DOI: 10.1186/1471-2393-13-212] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 11/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expressing breast milk has become increasingly prevalent, particularly in some developed countries. Concurrently, breast pumps have evolved to be more sophisticated and aesthetically appealing, adapted for domestic use, and have become more readily available. In the past, expressed breast milk feeding was predominantly for those infants who were premature, small or unwell; however it has become increasingly common for healthy term infants. The aim of this paper is to systematically explore the literature related to breast milk expressing by women who have healthy term infants, including the prevalence of breast milk expressing, reported reasons for, methods of, and outcomes related to, expressing. METHODS Databases (Medline, CINAHL, JSTOR, ProQuest Central, PsycINFO, PubMed and the Cochrane library) were searched using the keywords milk expression, breast milk expression, breast milk pumping, prevalence, outcomes, statistics and data, with no limit on year of publication. Reference lists of identified papers were also examined. A hand-search was conducted at the Australian Breastfeeding Association Lactation Resource Centre. Only English language papers were included. All papers about expressing breast milk for healthy term infants were considered for inclusion, with a focus on the prevalence, methods, reasons for and outcomes of breast milk expression. RESULTS A total of twenty two papers were relevant to breast milk expression, but only seven papers reported the prevalence and/or outcomes of expressing amongst mothers of well term infants; all of the identified papers were published between 1999 and 2012. Many were descriptive rather than analytical and some were commentaries which included calls for more research, more dialogue and clearer definitions of breastfeeding. While some studies found an association between expressing and the success and duration of breastfeeding, others found the opposite. In some cases these inconsistencies were compounded by imprecise definitions of breastfeeding and breast milk feeding. CONCLUSIONS There is limited evidence about the prevalence and outcomes of expressing breast milk amongst mothers of healthy term infants. The practice of expressing breast milk has increased along with the commercial availability of a range of infant feeding equipment. The reasons for expressing have become more complex while the outcomes, when they have been examined, are contradictory.
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Affiliation(s)
- Helene M Johns
- Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia.
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Janjindamai W, Thatrimontrichai A, Maneenil G, Puwanant M. Soft plastic bag instead of hard plastic container for long-term storage of breast milk. Indian J Pediatr 2013; 80:809-13. [PMID: 23355013 DOI: 10.1007/s12098-013-0963-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the fat content and contamination of expressed breast milk (EBM) before and after storage (30 d) in hard polypropylene containers (HC) and soft polyethylene bags (SB) containers. METHODS Ninety specimens of EBM were collected into HC and separated into two HC and two SB. The fat content of each specimen of EBM in HC and SB was measured and cultures were performed. The specimens in the second HC and SB containers were kept frozen for 30 d before thawing and then measuring the fat content and performing cultures. RESULTS The means ± SD of the fat content of fresh and thawed EBM in HC were 2.98 ± 0.97 and 2.66 ± 0.88 g/100 ml, respectively, with a loss of 0.32 g/100 ml (p < 0.001). The means ± SD of the fat content of fresh and thawed EBM in SB were 3.06 ± 1.00 and 2.77 ± 0.91 g/100 ml, respectively, with a mean loss of 0.29 g/100 ml during storage (p < 0.001). The loss of fat content during frozen storage did not differ significantly between the two types of containers (p = 0.53). All bacterial cultures of fresh and thawed EBM in HC and SB showed only nonpathogenic organisms. CONCLUSIONS SB can replace HC for the long-term storage of frozen EBM of up to 30 d without deleterious effects on fat loss or contamination.
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Affiliation(s)
- Waricha Janjindamai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanit Road, Tambon Korhong, Hat Yai District, Songkhla, 90110, Thailand,
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Burton P, Kennedy K, Ahluwalia JS, Nicholl R, Lucas A, Fewtrell MS. Randomized trial comparing the effectiveness of 2 electric breast pumps in the NICU. J Hum Lact 2013; 29:412-9. [PMID: 23776081 DOI: 10.1177/0890334413490995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mothers with preterm infants may need to express milk for considerable periods. Research to improve breast pump design has focused on compression stimuli, frequencies, and vacuums. OBJECTIVE This study aimed to compare the effectiveness of 2 electric pumps: Medela Symphony (pump S) and a novel pump (Philips AVENT Twin electronic pump; pump A). Both offer flexibility of rate and suction; pump A also incorporates petal compression cushions. Primary outcomes were (1) milk weight expressed during 10-day study period and (2) weight of milk expressed in a 15-minute test. METHODS Seventy-one mothers with preterm infants < 34 weeks were randomized. Mothers completed 10-day diaries including weight of milk expressed. Milk weight expressed during a single 15-minute test period and data on pumping mode, skin-to-skin contact, breastfeeding at infant discharge, and mothers' opinions of the pump were recorded. RESULTS There was no significant difference in milk expressed during the first 10 days between groups. Pump S mothers expressed significantly more milk during a fixed 15-minute period. Mothers using pump A awarded higher scores for certain characteristics of the pump, notably location of control button and ease of use. Similar proportions of infants received breast milk at discharge, but pump A mothers were more likely to be directly breastfeeding (odds ratio, 4.27 [95% confidence interval, 1.29, 14.1]). CONCLUSION The breast pumps showed similar effectiveness in terms of milk expression and maternal opinions. The finding that breast pump design may influence breastfeeding at infant discharge merits further investigation.
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Affiliation(s)
- Pat Burton
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
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Statler VA, Smith ML, Fouch BB, Woods CR. A Pink Milk Bottle Mystery. J Pediatric Infect Dis Soc 2012; 1:347-50. [PMID: 26619429 DOI: 10.1093/jpids/pis102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/05/2012] [Indexed: 11/12/2022]
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Miller EM, Aiello MO, Fujita M, Hinde K, Milligan L, Quinn EA. Field and laboratory methods in human milk research. Am J Hum Biol 2012; 25:1-11. [PMID: 23109280 DOI: 10.1002/ajhb.22334] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/26/2012] [Accepted: 09/25/2012] [Indexed: 12/13/2022] Open
Abstract
Human milk is a complex and variable fluid of increasing interest to human biologists who study nutrition and health. The collection and analysis of human milk poses many practical and ethical challenges to field workers, who must balance both appropriate methodology with the needs of participating mothers and infants and logistical challenges to collection and analysis. In this review, we address various collection methods, volume measurements, and ethical considerations and make recommendations for field researchers. We also review frequently used methods for the analysis of fat, protein, sugars/lactose, and specific biomarkers in human milk. Finally, we address new technologies in human milk research, the MIRIS Human Milk Analyzer and dried milk spots, which will improve the ability of human biologists and anthropologists to study human milk in field settings.
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Affiliation(s)
- Elizabeth M Miller
- Department of Anthropology, University of South Florida, Tampa, Florida 33620, USA.
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Heating-induced bacteriological and biochemical modifications in human donor milk after holder pasteurisation. J Pediatr Gastroenterol Nutr 2012; 54:197-203. [PMID: 21921811 DOI: 10.1097/mpg.0b013e318235d50d] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The objectives of the present study were to enumerate and characterize the pathogenic potential of the Bacillus population that may survive holder pasteurisation of human milk and to evaluate the nutritional damage of this treatment using the furosine and lactulose indexes. MATERIALS AND METHODS Milk samples from 21 donors were heated at 62.5°C for 30 minutes. Bacterial counts, lactose, glucose, myoinositol, lactulose, and furosine were determined before and after the heat treatment. Some B cereus isolates that survived after pasteurisation were evaluated for toxigenic potential. RESULTS Nonpasteurised milk samples showed bacterial growth in most of the agar media tested. Bacterial survival after pasteurisation was observed in only 3 samples and, in these cases, the microorganisms isolated belonged to the species B cereus. Furosine could not be detected in any of the samples, whereas changes in lactose, glucose, and myoinositol concentrations after holder pasteurisation were not relevant. Lactulose was below the detection limit of the analytical method in nonpasteurised samples, whereas it was found at low levels in 62% of the samples after holder pasteurisation. The lactation period influenced myoinositol content because its concentration was significantly higher in transition milk than in mature or late lactation milk samples. CONCLUSIONS Holder pasteurisation led to the destruction of bacteria present initially in donor milk samples, except for some B cereus that did not display a high virulence potential and did not modify significantly the concentration of the compounds analyzed in the present study.
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How can the microbiologist help in diagnosing neonatal sepsis? Int J Pediatr 2012; 2012:120139. [PMID: 22319539 PMCID: PMC3272815 DOI: 10.1155/2012/120139] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/15/2011] [Accepted: 11/29/2011] [Indexed: 01/23/2023] Open
Abstract
Neonatal sepsis can be classified into two subtypes depending upon whether the onset of symptoms is before 72 hours of life (early-onset neonatal sepsis—EONS) or later (late-onset neonatal sepsis—LONS). These definitions have contributed greatly to diagnosis and treatment by identifying which microorganisms are likely to be responsible for sepsis during these periods and the expected outcomes of infection. This paper focuses on the tools that microbiologist can offer to diagnose and eventually prevent neonatal sepsis. Here, we discuss the advantages and limitation of the blood culture, the actual gold standard for sepsis diagnosis. In addition, we examine the utility of molecular techniques in the diagnosis and management of neonatal sepsis.
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Abstract
BACKGROUND This is an update of a 2008 Cochrane review. Breastfeeding is important. However, not all infants can feed at the breast and methods of expressing milk need evaluation. OBJECTIVES To assess acceptability, effectiveness, safety, effect on composition, contamination and cost implications of methods of milk expression. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 January 2011), CINAHL (1982 to January 2011), conference proceedings, secondary references and contacted researchers. SELECTION CRITERIA Randomised and quasi-randomised trials comparing methods at any time after birth, and crossover trials commencing at least 28 days after birth. DATA COLLECTION AND ANALYSIS Three authors independently assessed trials, extracted data and assessed risk of bias. Data were checked for accuracy. MAIN RESULTS We included 23 studies with 10 studies (632 mothers) providing data for analysis.Mothers provided with a relaxation tape produced more milk than mothers who were not (mean difference (MD) 34.70 ml/single expression, 95% confidence interval (CI) 9.51 to 59.89, P = 0.007). A lower milk volume over six days was reported when comparing hand expression to the electric pump (standardised mean difference (SMD) -1.00 ml, 95% CI -1.64 to -0.36, P = 0.002); other studies of the same pump using different measures did not find a significant difference (12 to 36 hours postpartum SMD -0.38 cc, 95% CI -0.86 to 0.10, P = 0.12); day five postpartum SMD -0.62 ml/day, 95% CI -1.43 to 0.19, P = 0.13). No evidence of difference in volume was found with simultaneous or sequential pumping, or between manual and electric pumps studied. One study reported a higher sodium concentration in hand expressed milk compared to a manual pump (SMD 0.59 mmol/L, 95% CI 0.22 to 0.96, P = 0.002) and to an electric pump (SMD 0.70 mmol/L, 95% CI 0.32 to 1.09, P = 0.0003), and lower potassium concentration compared to a manual pump (MD -0.37 mmol/L, 95% CI 0.00 to 0.73, P = 0.05) or to an electric pump (SMD -0.32 mmol/L, 95% CI -0.69 to 0.06, P = 0.10). No evidence of difference was found for energy content, milk contamination or adverse effects. Reports of maternal views were not comparable. Economic aspects were not reported. AUTHORS' CONCLUSIONS The most suitable method for milk expression may depend on the time since birth, purpose of expression and the individual mother and infant. Low cost interventions including early initiation when not feeding at the breast, relaxation, hand expression and lower cost pumps may be as effective, or more effective, than large electric pumps for some outcomes. Small sample sizes, large standard deviations, small number of studies reviewed, and the diversity of the interventions argue caution in applying these results beyond the specific method tested in the specific settings.
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Contreras GA, Rodríguez JM. Mastitis: comparative etiology and epidemiology. J Mammary Gland Biol Neoplasia 2011; 16:339-56. [PMID: 21947764 DOI: 10.1007/s10911-011-9234-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/16/2011] [Indexed: 10/17/2022] Open
Abstract
Mastitis is broadly defined as the inflammation of the mammary gland; however, the concept of mastitis is customized to address its social and clinical impact in the case of humans and the health, welfare, and economic consequences for other mammals. There are many microbial, host, and environmental factors that influence the development of mastitis. Some are common to all mammals as well as inherent to each species. Together these factors influence the most prevalent etiological agents for each species and might determine the possibility of interspecies transmission with its consequences to public health. The present review will summarize and compare reports on mastitis etiology and its epidemiology in humans and food animal species.
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Affiliation(s)
- G Andres Contreras
- Department of Large Animal Clinical Sciences, Michigan State University, D202 VMC, East Lansing, MI 48824, USA.
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Gilks J, Price E, Hateley P, Gould D, Weaver G. Pros, cons and potential risks of on-site decontamination methods used on neonatal units for articles indirectly associated with infant feeding, including breast pump collection kits and neonatal dummies. J Infect Prev 2011. [DOI: 10.1177/1757177411415448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We discuss the pros, cons and potential risks of on-site decontamination methods used on neonatal units for articles indirectly associated with infant feeding, such as breast pump collection kits and neonatal dummies (pacifiers, comforters or soothers). Some practical recommendations are made and areas requiring further review are indicated. For neonatal units, decontamination methods involving use of chlorine-releasing disinfectants or domestic steam-producing equipment should be reassessed. They would not be considered acceptable on intensive care units for adult patients.
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Affiliation(s)
- Joanne Gilks
- Department of Nursing, Barts and the London NHS Trust, London, UK
| | - Elizabeth Price
- Department of Medical Microbiology, Barts and the London NHS Trust, London E1 2ES, UK
| | - Paul Hateley
- Department of Infection Prevention and Control, Birmingham Community Health Care Trust, Birmingham, UK
| | - Dinah Gould
- School of Health Science, City University, London, UK
| | - Gillian Weaver
- The Milk Bank, Queen Charlotte’s and Chelsea Hospital, London, UK
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Rasmussen KM, Geraghty SR. The quiet revolution: breastfeeding transformed with the use of breast pumps. Am J Public Health 2011; 101:1356-9. [PMID: 21680919 PMCID: PMC3134520 DOI: 10.2105/ajph.2011.300136] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2011] [Indexed: 11/04/2022]
Abstract
A quiet revolution has been taking place in the feeding of US infants in the form of women using electric breast pumps. This revolution in milk expression may be a boon for both mothers and infants if more infants are fed human milk or if they receive human milk for a longer period. Milk expression may also be problematic for mothers, and it may be particularly problematic for infants if they are fed too much, fed milk of an inappropriate composition, or fed milk that is contaminated. As a result, the time has come to determine the prevalence of exclusive and periodic breast milk expression and the consequences of these behaviors for the health of mothers and their infants.
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Schanler RJ, Fraley JK, Lau C, Hurst NM, Horvath L, Rossmann SN. Breastmilk cultures and infection in extremely premature infants. J Perinatol 2011; 31:335-8. [PMID: 21350430 DOI: 10.1038/jp.2011.13] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE As expressed mother's milk (MM) is known to be colonized by microbial species, it is occasionally considered as a source of infection in premature infants, prompting some clinicians to obtain milk bacterial culture results before infant feeding. To determine whether serial microbial cultures of MM predict infection in premature infants. STUDY DESIGN Milk microbial flora was determined by plate counts from aliquots of MM obtained from 161 mothers of infants born <30 weeks gestation (n = 209). Pathogens isolated from the same infant were tabulated. RESULT Milk samples (n = 813) yielded 1963 isolates. There were no relationships between microbial counts and maternal age, ethnicity, education, skin-to-skin contact and infant infection. In 64 infants, milk and pathological isolates had presumptively the same Gram-positive organism, yet the odds of infection before or after exposure to milk containing that Gram-positive organism were not significant (1.18; 95% confidence interval=0.51, 2.76). In eight infants, milk and pathological isolates had presumptively the same Gram-negative organism, which appeared sporadically in milk, either before or after isolation in the infant. CONCLUSION Results of initial milk cultures do not predict subsequent culture results. Random milk cultures, even if obtained at any time during hospitalization, are not predictive of infection in premature infants. The sporadic nature of the appearance of certain isolates, however, suggests common exposure of both mother and infant. Routine milk cultures do not provide sufficient data to be useful in clinical management.
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Affiliation(s)
- R J Schanler
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New York at North Shore, North Shore University Hospital, Manhasset, NY 11030, USA.
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Arslanoglu S, Bertino E, Tonetto P, De Nisi G, Ambruzzi AM, Biasini A, Profeti C, Spreghini MR, Moro GE. Guidelines for the establishment and operation of a donor human milk bank. J Matern Fetal Neonatal Med 2010; 23 Suppl 2:1-20. [DOI: 10.3109/14767058.2010.512414] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eglash A. ABM clinical protocol #8: human milk storage information for home use for full-term infants (original protocol March 2004; revision #1 March 2010). Breastfeed Med 2010; 5:127-30. [PMID: 21548822 DOI: 10.1089/bfm.2010.9988] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Abstract
OBJECTIVES In the last few years, it has been proved that human milk contains bacteria that constitute an important factor in the initiation and development of the neonatal gut microbiota. In this context, the objective of this study was to evaluate the effect of cold storage on the natural bacterial composition of breast milk. MATERIALS AND METHODS Breast milk samples provided by 34 healthy women and collected either by manual expression (n = 27) or breast pump (n = 7), were plated onto several culture media immediately after arrival at the laboratory (day 0) and after storage at -20 degrees C for 6 weeks. A high number of isolates from 8 of the women were identified at the species level. RESULTS No statistically significant differences were observed between the counts obtained at both sampling times in those media in which growth was detected. In all of the culture media, bacterial counts in pump-collected samples were higher than in those obtained by manual expression. Staphylococci and streptococci were the predominant bacteria in both fresh and frozen samples, Staphylococcus epidermidis being the most abundant species at both sampling times. Lactic acid bacteria and bifidobacteria were also present in fresh and frozen breast milk samples, but among them, only 1 species (Lactobacillus gasseri) could be isolated at both sampling times. CONCLUSIONS The results of this study suggest that cold storage of milk at -20 degrees C for 6 weeks does not significantly affect either the quantitative or the qualitative bacterial composition of breast milk.
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