Journal of Human Lactation最新文献

Positionality and reflexivity are increasingly recognized as essential practices that enhance the rigor, transparency, and ethical integrity of research. Although these concepts are often associated with qualitative studies, they are equally relevant in quantitative and mixed methods approaches. In this article, we define positionality and reflexivity and describe the relationship between these concepts. We also provide three strategies for understanding one's positionality and practicing reflexivity-identity mapping, reflexive journaling, and bracketing-and consider how each method can be applied across different research designs and throughout the research process. We conclude with practical guidance and examples for how to communicate these practices through positionality statements. By explicitly acknowledging positionality and adopting reflexive practices, researchers can better manage assumptions and biases, strengthen credibility and trustworthiness, and promote equity and inclusivity in knowledge production.

Background: Freezing is commonly used to preserve human milk; however, microwave thawing is not recommended due to nutritional loss and creation of hotspots in the milk. Data on compositional changes after microwave thawing and uneven temperature distribution are scarce.

Research aim: To investigate the association between microwave heating and the composition and temperature distribution of human milk.

Methods: In this laboratory-based cross-sectional experimental study, 35 milk samples were divided into six groups based on preheating operations and milk bag material (35 samples each). After thawing at 600 watts for 30 seconds, temperature was immediately measured using thermography. Uneven temperature distribution was evaluated by the difference between maximum and minimum temperatures. Subsequently, it was mixed by inverting, and the temperature was measured again. The secretory Immunoglobulin A and lactoferrin concentrations were analyzed using enzyme-linked immunosorbent assays. Macronutrients were analyzed using mid-infrared transmission spectroscopy. Results were compared with thawing in running water to explore the feasibility of microwave thawing.

Results: The median temperature in the sonicated group (33.6 °C) was significantly decreased compared to that in the untreated group (54.9 °C). The median temperature in the polyethylene bag group (42.0 °C) was also significantly decreased compared to that in the polypropylene bag group (53.2 °C). The temperature after inversion mixing was close to the recommended temperature for feeding. The median concentration significantly decreased for secretory Immunoglobulin A (0.9-16.6%) and lactoferrin (21.3-29.1%) after microwaving.

Conclusion: Component losses caused by microwave thawing were not clinically problematic compared to the standard value and could be minimized. Microwave heating may be an option for thawing human milk.

Introduction: Fresh human milk for preterm infants is associated with a reduction of bronchopulmonary dysplasia, to improve survival without major complications, and with an increased breastfeeding duration. Nevertheless, its administration is frequently restricted due to the risk of post-natal cytomegalovirus infection. Looking at 12 years of medical records in a tertiary neonatal intensive care unit using fresh milk without restriction, we retrospectively collected cases of symptomatic postnatal cytomegalovirus infection in preterm infants born under 32 weeks receiving fresh milk. We present the prevalence and outcome of postnatal milk-acquired cytomegalovirus infection.

Main issue: Among 2554 preterm newborns < 32 weeks hospitalized during the study period (2009-2020), 1396 (54%) had received fresh milk, and eight newborns developed a symptomatic postnatal cytomegalovirus infection, representing an incidence of 5/1000 patients. Clinical presentation was severe in three out of the eight cases.

Management: Two patients received valganciclovir, and one patient died of the infection. After 2 years of follow-up, two patients had neurodevelopmental delay, including one who had abnormalities on brain magnetic resonance imaging before the cytomegalovirus infection. Liver function was normal. Breastfeeding was continued for all surviving patients with a mean duration of 4.5 months.

Conclusion: Fresh milk administration without restriction was associated with a limited number of symptomatic postnatal cytomegalovirus infections. Neonatologists must be aware of this risk to better diagnose and manage the infection. Multicenter studies are required to investigate which preterm infants are most at risk of severe postnatal cytomegalovirus, and to determine the optimal approach to prevention and treatment.

In an earlier paper, we summarized the meanings of the term "weaning" as it is used colloquially, clinically, and in scientific and grey literature. Due to the various potential definitions, we suggested that researchers avoid using the term and instead aim to use standard terms and definitions that more precisely describe the specific transition in infant and young child feeding they are referring to. One key concept from the first paper is "breastfeeding cessation." In this subsequent article, we go a step further to more precisely define breastfeeding cessation, guiding how to choose the level of its measurement. We discuss potential parameters, proxies for breastfeeding cessation, measurement tools, and instruments pertinent to the measurement and monitoring of breastfeeding cessation in qualitative and quantitative research. This paper draws on perspectives from different scientific disciplines, including clinical research, public health, psychology, and anthropology. By doing so, we aim to deepen appreciation for tools and instruments used across these disciplines, ultimately fostering a common understanding of parameters, tools, and approaches for measuring breastfeeding cessation.

Background: A disrupted gut microbiome during an infant's first 1000 days of life can lead to long-lasting negative effects on child health. Cesarean delivery and formula feeding are two factors that can detrimentally impact infant microbiome development as well as maternal mental health. Donor human milk may be a superior supplementation alternative to formula.

Research aim: To examine donor human milk supplementation compared to formula supplementation in full-term infants born via Cesarean section and the impact on the infant gut microbiome, infant health outcomes, breastfeeding outcomes, and maternal mental health.Methods and Planned Analyses:We are conducting a pilot clinical randomized controlled trial, comparing donor human milk to formula supplementation for 187 full-term infants born via Cesarean section who are breastfeeding and require supplementation in the first postnatal week of life. Infant stool samples, breastfeeding outcomes, maternal mental health, and child health outcomes will be measured at 1-week, 3-, 6-, and 12-months postpartum. Additionally, child health and maternal mental health are being assessed at 18- and 36-months postpartum.

Discussion: This study will generate essential data on the association between supplementation types and the full-term infant microbiome, breastfeeding exclusivity and duration, and infant health. It will also provide preliminary data to inform a multi-site, longitudinal mixed-methods randomized controlled trial that will assess longer term child health outcomes. This evidence may be used to inform guidelines and policies that will increase accessibility to and raise awareness of donor human milk as a supplementation option in this population.

This article narrates a lived experience of how to write a case study. The essential ingredient to get started is wonder-some sparkle of awe. As International Board Certified Lactation Consultants, we are in privileged position as we witness how families find the strength and courage to overcome puzzling situations to forge their own breastfeeding paths. In addition to a story, the author explains that she also needed a map and compass to write her first case study. She explored the medical literature and read many cases studies where she found guidance on developing the backbone of her first case study. This article explains how writing should be accessible to all-even to those who are not in academia. One does not have to have a PhD to get published.

Introduction: Existing evidence on the effects of combined hormonal contraception on mothers' milk production is inconclusive. This report describes two breastfeeding Swedish women who used combined hormonal contraceptives containing drospirenone (3 mg) and ethinylestradiol (0.03 mg).

Main issue: Both participants experienced decreased milk production after initiating the combined hormonal contraceptives. The growth charts of their children show decreased growth during the same period and recovery after combined hormonal contraception was discontinued.

Management: Combined hormonal contraception was discontinued, and measures were taken to increase milk production and follow infant growth.

Conclusion: These cases follow two experiences of low milk production after initiation of combined oral contraceptives. In these cases, there was a resolution of infant weight gain with discontinuation of the medication.