Journal of Human Lactation最新文献

Background: Subclinical mastitis is an asymptomatic inflammatory condition of the lactating mammary glands possibly associated with premature interruption of breastfeeding and poor weight gain in infants. However, data on human milk composition in mothers with subclinical mastitis are limited and inconsistent. Although human milk from donors with subclinical mastitis may be used after pasteurization if it meets the criteria, whether the composition is suitable for donor human milk remains unknown.

Research aims: This study assessed the human milk composition of participants with subclinical mastitis and verified the safety of donor human milk, including that from mothers with subclinical mastitis.

Methods: This cross-sectional survey included 106 milk samples collected between March 2022 and January 2023. Subclinical mastitis status was assessed using the sodium-potassium ratio, which was measured using an ion-selective electrode. The concentrations of lactoferrin and secretory Immunoglobulin A were analyzed using an enzyme-linked immunosorbent assay. True protein, fat, carbohydrate, and energy levels were analyzed using a mid-infrared transmission spectroscopy.

Results: In human milk from the subclinical mastitis group, lactoferrin and true protein concentrations were significantly increased compared to those without subclinical mastitis. A positive correlation was observed between lactoferrin and secretory Immunoglobulin A levels.

Conclusions: Increased immunological substances and protein concentrations in human milk are similar to those observed in clinical mastitis, indicating an inflammatory response in the body, even in asymptomatic individuals. Immunological substances and proteins are beneficial for preterm infants. Therefore, human milk from mothers with subclinical mastitis is suitable for use by milk banks.

Background: Peer support programs may be effective for supporting breastfeeding among diverse groups, and in reducing disparities. This study provides insight regarding the implementation and outcomes of a peer breastfeeding support program.

Research aims: (1) to examine how participation affected the outcomes of breastfeeding motivation, confidence, and coping strategies; and (2) to evaluate satisfaction with the program.

Method: This was a cross-sectional, retrospective study. Seven pilot sites in the United States uniquely implemented a federally-funded peer support program for low-income women. Data were collected using a survey and focus groups/interviews. Over 12 months, 1,296 women participated, comprising 615 peer support pairs. A total of 401 women responded to the survey. Twenty-three focus groups and 63 interviews were conducted across the seven sites.

Results: Participants who enrolled in the program during pregnancy: t (189) = -6.55, p < 0.001, and after the baby was born: t (170) = -2.59, p = 0.001, gained confidence in breastfeeding. More satisfied participants were more likely to breastfeed longer: F (7,352) = 12.75, p < 0.001, and cope with breastfeeding challenges: F (7,352) = 7.83, p < 0.001.

Conclusion: Effective operation strategies of the peer breastfeeding support program have significantly influenced participant satisfaction. Introducing peer support for low-income women to share their breastfeeding experiences would be beneficial in enhancing breastfeeding rates. However, the generalizability of these findings may be limited to this U.S. federally-funded peer support program.

Background: Nipple trauma and pain pose a challenge, leading to premature discontinuation of breastfeeding. Moisturizing therapies, including lanolin and hydrogel dressings, have been proposed for nipple trauma and pain management. Despite the availability of multiple approaches, evidence for moisturizing therapy is lacking.

Research aim: This review aimed to determine the efficacy of moisturizing therapy in treating nipple trauma and nipple pain in lactating women.

Methods: A systematic review based on the PRISMA-P guidelines was conducted. Seven databases were systematically searched and screened, and 24 studies were analyzed. The interventions were categorized as high, moderate, or low, based on their moisturization levels. Sample characteristics, interventions, and outcomes were examined.

Results: A total of 21 interventions were identified: high moisturization (two types), moderate moisturization (12 types), and low moisturization (seven types). Hydrogel dressings, lanolin, and breast milk are commonly used interventions. Although intervention and effectiveness evaluation methods differed between studies and could not be compared, results in 10 (41%) of the studies demonstrated that one intervention with more moistening was more effective. Of the three studies categorized as including high moistening interventions, two (66%) supported their effectiveness compared to low moistening interventions; however, two of the three studies were judged to be at high risk of bias, and some reported adverse events.

Conclusions: Moisturization interventions show promise for treating nipple trauma and pain more than drying nipples or using breast milk, but high moisturization needs cautious use due to few rigorous trials and the presence of reported risks. Methodological challenges and the lack of robust trials hinder evidence synthesis and robust conclusions.

Abstract in japanese: ： やはにをするである。そのとして、ラノリンやハイドロジェルドレッシングによるがされている。しかし、やにするのにするはしている。： システマティックレビューは、のとのにおけるのをすることをとした。： PRISMA-Pガイドラインにづくレビューをした。7つのデータベースをいて、にとスクリーニングをい、に24のをとした。をレベルにづいて、、にし、サンプルや、、およびについてした。： （2）、（12）、（7）の21のがされた。ハイドロジェルドレッシング、ラノリン、のがなとしてされていた。およびのはでなり、のはであったが、10（41％）でよりいのがであるとされていた。にされた3のうち2（66％）がのとしてであるとされたが、2（66％）はバイアスリスクがいとされたであり、のもあった。： はやのとしてやのとしてであるが、のにはなのとのがあり、ながである。なのとなが、のとエビデンスののげとなっている。Back translated by Katsumi Mizuno, PhD, MD, IBCLC.

Anwar Fazal has been a driving force in the founding of several civil society organizations in the areas of health, human rights, environment, and peace, that have been at the forefront of activism locally, nationally, and globally. In this interview, he shares his journey of 6 decades, involving a multiverse of public interest issues, which led him into the breastfeeding movement. It began with the setting up of the International Baby Food Action Network (IBFAN), a pioneering action that triggered the formation of Health Action International (HAI), Pesticide Action Network (PAN), and the World Alliance for Breastfeeding Action (WABA). Each of these resulted in several unique frameworks and codes relating to the marketing of infant foods, pharmaceuticals, and pesticides. They also led to the formation of World Breastfeeding Week, now being celebrated globally. Anwar studied Economics at the University of Malaya and did his postgraduate studies in Education. Anwar has served as a visiting professor at the University of Science Malaysia and the International Islamic University Malaysia (IIUM). He is the recipient of the Right Livelihood Award, popularly known as the "Alternative Nobel Prize," for his work on breastfeeding and infant nutrition and other health, environmental, and consumer issues. La Leche League International (LLLI) and the United Nations Development Programme (UNDP) have honored him with the International Health Award and the Millennium Development Goals Award. He has written extensively on breastfeeding. He is currently Chairperson Emeritus of the World Alliance for Breastfeeding Action (WABA) and continues to speak out actively on protecting, promoting, and supporting breastfeeding.

Introduction: Favipiravir is a known anti-influenza agent that has been used globally, especially during the coronavirus disease 2019 (COVID-19) pandemic. This drug has been important for treating influenza and other emerging infectious diseases, although it was ultimately proven to be ineffective for COVID-19. Currently, no studies have reported the human-milk transfer of favipiravir at doses of 1,600-3,600 mg/day in the treatment of diseases, including COVID-19.

Main issue: A 38-year-old mother gave birth at 38 gestational weeks because of severe respiratory distress caused by COVID-19. Considering her illness and the inadequate information available on the safety of favipiravir in breastfeeding, she chose formula feeding for her infant. However, she still provided human milk and blood samples for the analysis of drug concentrations.

Management: Five concentrations of favipiravir in the mother's milk and four in maternal blood were measured (3.0-80.9 and 3.5-78.4 μg/ml, respectively). Metabolites of favipiravir were not measured. The relative infant dose was 15.2%. The favipiravir concentration in human milk was as high as 80.9 μg/ml at 1.3 hours after the medication was given, when maternal blood levels are considered to be at their highest; however, favipiravir concentration was low in human milk immediately before medication administration (5.9-9.7 μg/ml).

Conclusion: Breastfeeding is not contraindicated in mothers undergoing favipiravir therapy and would be safer immediately before medication. Avoiding feeding at the peak time (1.3 hours after medication) minimizes infant exposure.

Background: Medical students should have adequate knowledge and positive attitudes toward breastfeeding to support breastfeeding dyads. No studies in Croatia have explored breastfeeding knowledge, attitudes or intentions among medical students.

Research aim: To investigate breastfeeding knowledge, attitudes and intentions among medical students at the University of Split School of Medicine.

Methods: A cross-sectional study was conducted from March to April 2023, using online and written questionnaires. All medical students without children were eligible to participate. The validated Breastfeeding Intentions, Attitudes, and Knowledge Questionnaire (BIAKQ) was used. Sociodemographic data were collected. Analysis was conducted using descriptive statistics, t tests, and Mann-Whitney U test.

Results: A total of 357 medical students participated (response rate 64.1%). There was no significant difference between preclinical and clinical students. Students who attended the elective "Breastfeeding Medicine" demonstrated significantly more positive attitudes toward breastfeeding (Mean Rank = 215.62) than those who did not attend (Mean Rank = 173.58; U= 5468.50, p = 0.010); however, no significant difference was found in knowledge or intentions. Female students had significantly more positive attitudes compared to male students (Mean Rank = 189.47 vs. Mean Rank = 150.55, U = 9796.50, p = 0.001), whereas male students expressed significantly more positive intentions (M = 36.97, SD = 5.26 vs. M = 34.44, SD = 5.86, t = -3.69, p = 0.002). The mean knowledge score was 11.92 (SD = 1.43) out of 13 points. Negative attitudes towards breastfeeding beyond 1 year and breastfeeding in public were found.

Conclusion: Despite adequate breastfeeding knowledge, some medical students demonstrated negative attitudes and intentions toward breastfeeding. Including breastfeeding education into core medical subjects focusing on the importance of breastfeeding for maternal and infant health and the risks of formula feeding could help improve attitudes, especially during the clinical years. It would also be important to address prevailing prejudices.

Background: Pumping is a common practice in the United States, but it can be uncomfortable and lead to concerns about milk supply. The fit of the flange, or breast shield, used while pumping can contribute to or alleviate these problems. Flanges are available in a wide variety of sizes, and there are inconsistencies in guidance provided by healthcare providers and pump manufacturers for parents choosing a size. There have been no studies comparing different methods of sizing in terms of comfort and milk output.

Research aims: The aim of this research was to examine differences in milk output and comfort using two methods of flange sizing.

Method: A within-subject cross-over design with a convenience sample of parents exclusively feeding their own human milk was used to compare comfort and milk yield between using smaller-fit and standard-fit flanges. Participants pumped for 1 week with each set of flanges and recorded milk output and comfort outcome measures. Data were collected on participant demographics, nipple measurements, and flange sizes used.

Results: When compared to the newer small-size fitting, participants using the standard fit flanges had significantly less milk output (mean difference = -15.0 g, 95% CI [-25.0, -5.0], d = -0.51, p = 0.004) and less comfort (mean difference = -1.2, 95% CI [-1.6, -0.91], d = -1.23, p < 0.001).

Conclusion: Flange fitting is a process that should be individualized to the patient and may require a trial of one or more sizes during a pumping session. Smaller sizes determined using this individualized process and starting with nipple tip measurement may be used without compromising milk output or comfort.

Background: No research has been conducted on the use of deep learning for breastfeeding support.

Research aim: This study aims to develop a nipple trauma evaluation system using deep learning.

Methods: We used an exploratory data analysis approach to develop a deep-learning model for medical imaging. Employing object detection and classification, this Japanese study retrieved 753 images from a previous study. The classification protocol, based on the "seven signs of nipple trauma associated with breastfeeding," categorized the images into eight classes. For practical purposes, the eight original classes were consolidated into four broader categories: "None," "Minor," "Moderate," and "Severe," using data augmentation procedures that were consistent with the original classification system. The Precision, Recall, Overall Accuracy, and Area Under the Curve (AUC) were calculated, and the model's efficiency was evaluated using Frames Per Second (FPS).

Results: The object detector's high mean average precision and frames per second rate for nipple and areola detection, confirmed exceptional accuracy. The eight-class image classifier returned notable AUC values, with fissures, peeling, purpura, and scabbing exceeding 0.8. The highest average recall and precision was for scabbing, and the lowest for blistering. The four-class classifier accurately predicted severe conditions, with an average AUC > 0.7, whereas categories without classifications and those deemed minor had lower recall and precision rates.

Conclusions: A sophisticated deep learning system detects and classifies nipple trauma automatically, potentially aiding breastfeeding caregivers through objective image assessment and operational improvements.

Abstract in japanese: ： におけるのにするはわれていない。： は、をいたシステムのをとした。： では、をいたモデルをするため、データアプローチをいた。およびのをい、でわれたでされた753のをした。「にうの７」にづき、を8クラスにした。をし、4つのカテゴリ「なし」、「」、「」、「」の4つのカテゴリにし、のシステムにするデータをった。、、Overall Accuracy、AUC（）をし、モデルのはFPS（Frames Per Second）でした。： におけるいmAP（）とFPSがされ、およびのがされた。8クラスのは、、、、で0.8をえるなAUCがられた。とがもかったのはであり、でもかった。4クラスのはのをにし、AUCは0.7をえたが、なしやとされるカテゴリはとがいとなった。： をしたこのなシステムは、のとをでうことができ、なをじて、のとをサポートするなツールとなりる。Back Translation Completed by Hiroko Hongo, MSW, PhD, IBCLC.