Journal of Human Lactation最新文献

Maintaining Baby-Friendly Hospital Initiative (BFHI) standards within a complex healthcare system presents unique challenges. This case study from a regional perinatal center in the northeast United States details the design and implementation of a program to address BFHI Step 2, which requires ongoing competency assessment and team member training to ensure breastfeeding support. The shift of BFHI competencies to continuous professional development introduced logistical challenges, compounded by staff turnover and budget constraints. To address these, the hospital team developed an in-house learning management system tailored to BFHI requirements. The learning management system offered modular, role-specific content, self-paced learning, and interactive assessments, ensuring adaptability, cost-effectiveness, and scalability. Administrative tools supported compliance tracking and reviews of test results, which assisted with timely resolution of knowledge gaps. A hybrid approach, including in-person training and team meetings, further reinforced staff competence. This sustainable, integrated system fostered continuous learning, and enhanced staff preparedness toward supporting breastfeeding families.

Background: The staff of maternity hospitals play an essential role in the start of breastfeeding. This study assessed specific aspects of breastfeeding promotion in German hospitals using the recommendations of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

Research aim: To identify specific hospital practices and structures that are in compliance with the recommendations and those that still need to be improved.

Method: A cross-sectional survey and descriptive analysis was conducted in 109 German hospitals. This web-based questionnaire examined the structural conditions and usual handling of breastfeeding support. Recommendations were reported using sub-criteria.

Results: The implementation of the sub-criteria ranged from less than 25% to more than 90%. Hospitals were more likely to have a breastfeeding policy (85.3%, n = 93) than a breastfeeding coordinator (73.4%, n = 80). Immediate skin-to-skin contact after birth and early breastfeeding initiation were implemented more frequently after a vaginal (89.9%, n = 98 and 71.6%, n = 78) than after Cesarean delivery (45.9%, n = 50 and 54.1%, n = 59). Additional feeding of fluids was usually restricted to a medical indication (70.6%, n = 77), however, the decision to feed formula was rarely made by hospital staff alone (27.5%, n = 30). Large hospitals (> 1000 births/year) had a written breastfeeding policy and a breastfeeding coordinator more frequently than smaller hospitals (p < 0.01, Fisher's exact test).

Conclusion: The use of sub-criteria of WHO recommendations helped identify critical parts of breastfeeding promotion in hospitals, providing concrete starting points for targeted interventions. This differentiated approach could be promising for future analyses of breastfeeding promotion.

Background: There is increasing interest in better understanding the immune cell composition of human milk and how these cells interact with neonatal immune development. However, consistent methods for immune cell isolation from human milk are lacking.

Research aim: Our aim was to systematically compare available cell isolation techniques to isolate T lymphocytes from human milk samples.

Methods: This repeated measures study design compared three cell isolation methods using human milk samples: (1) centrifugation, (2) immunomagnetic bead isolation, and (3) a combination of both methods. We assessed the proportion and viability of CD3+, CD4+, CD25+ and regulatory T cells using flow cytometry in isolated cells to compare the performance of these isolation methods.

Results: Immunomagnetic separation is a feasible method to isolate T lymphocytes in human milk, similar to blood. It improves target cell enrichment and cell viability compared to centrifugation, which may be an advantage when the goal is to characterize rare cell types or when cells are further used in functional assays. No excess cell activation (CD25 positivity) was observed with the use of magnetic beads.

Conclusion: Immunomagnetic separation of human milk T lymphocytes may have advantages over centrifugation depending on the intended downstream use of cells.

Background: Breastfeeding provides numerous benefits for mothers and infants, but there are disparities in breastfeeding rates by race and ethnicity in the United States.

Research aim: Our study aimed to identify the extent to which Baby Friendly Hospital Initiative (BFHI) key clinical practices during the birth hospitalization influenced breastfeeding success by race and ethnicity.

Method: This study was a secondary analysis of the 2016 to 2019 National Pregnancy Risk Assessment Measurement System (PRAMS), a cross-sectional survey. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We examined the odds of breastfeeding to ≥ 10 weeks by percent of key clinical practices received and racial and ethnic group. Absolute racial differences were calculated to reflect the difference in breastfeeding rates by race and ethnicity overall, and stratified by percent of BFHI key clinical practices received.

Results: BFHI key clinical practices were a significant predictor of breastfeeding at ≥ 10 weeks; receipt of progressively more key clinical practices resulted in higher odds of breastfeeding. Over 75% of mothers who received 100% of key clinical practices breastfed for at least 10 weeks across all racial and ethnic groups. Among mothers who received ideal breastfeeding care, disparities were eliminated; there were no statistically significant differences in rates of breastfeeding ≥ 10 weeks for Black non-Hispanic (adjusted absolute racial difference [aARD] -4.5, 95% CI [-9.5, 0.4]), Hispanic English-speaking (aARD -2.6, 95% CI [-6.6, 1.4]), or Hispanic Spanish-speaking (aARD 1.7, 95% CI [-5.2, 8.6]) mothers compared to White non-Hispanic mothers.

Conclusion: There is a need to renew the push for universal adoption of BFHI by U.S. hospitals to address racial and ethnic disparities in breastfeeding outcomes.

Background: Hydrotherapy is a complementary and alternative method in childbirth widely used to reduce labor pain and stress. The birth process significantly influences levels of β-endorphin in human milk. However, the relationship between hydrotherapy during labor and β-endorphin levels in the mother's milk is unclear.

Aims: We aimed to investigate the relationship between hydrotherapy during labor, and human milk β-endorphin levels. The study also aimed to investigate the relationship between milk β-endorphin levels and maternal labor pain and birth satisfaction.

Method: We conducted a cross-sectional observational study involving a total of 84 participants who gave birth vaginally. Among them, 42 received hydrotherapy during the initial stage of labor, while the remaining 42 did not. Considering the available data, an alpha of 0.05 (Type I error), and β-endorphin concentration, our sample of 84 participants provided a power calculation of 65%. Milk samples were collected, and the Perception of Birth Scale was administered 24 hours after birth. The concentration of β-endorphin in the participant's milk and the Perception of Birth Scale were compared using Mann-Whitney U tests.

Results: The amount of β-endorphin in milk was higher for participants who received hydrotherapy than for those who did not (Mean = 503.5 pg/ml, SD = 569.2; mean = 295.7 pg/ml, SD 274 respectively; p = 0.028). The total Perception of Birth Scale scores were higher in the hydrotherapy group compared to the control group (Mean = 78.9, SD = 6.2; mean = 74.1, SD = 6.4; p = 0.001).

Conclusions: Hydrotherapy is correlated with a positive perception of birth and higher levels of β-endorphin in milk. Further research on the causal relationship between hydrotherapy and β-endorphin levels in milk may support its use to facilitate positive changes in mother's milk.

Background: Breastfeeding self-efficacy among both mothers and fathers is critical in enhancing exclusive breastfeeding rates. However, the interrelationship between maternal and paternal breastfeeding self-efficacy and their determinants remains unknown.

Research aims: We aimed to (a) investigate the relationship between breastfeeding self-efficacy scores postpartum for mothers and fathers; (b) explore factors associated with breastfeeding self-efficacy in this group; and (c) examine determinants of combined self-efficacy scores among breastfeeding parents in Malawi.

Methods: We conducted a cross-sectional study on postpartum mother-father couples at a tertiary maternity facility in central Malawi. Breastfeeding self-efficacy was measured using the Breastfeeding Self-Efficacy Scale Short-Form. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. A structured questionnaire was used to collect demographic and health variables. Data were analyzed using multivariable logistic regression and multinomial logistic regression.

Results: Mothers demonstrated a higher score of self-efficacy (M = 55.7, SD = 6.5) in comparison to fathers (M = 50.2, SD = 11.9). A significant moderate positive correlation was identified between mothers' and fathers' breastfeeding self-efficacy (r = 0.32). Age, employment status, mode of birth, and practicing exclusive breastfeeding were significantly associated with maternal and paternal breastfeeding self-efficacy. Factors including advanced age, Cesarean delivery, and depressive symptoms emerged as significant determinants of combined breastfeeding self-efficacy scores among couples.

Conclusion: Breastfeeding self-efficacy is highly correlated between mothers and fathers, with a relatively higher score in mothers. Importantly, sociodemographic, obstetric, and psychological determinants play a substantial role in influencing parental breastfeeding efficacy. This highlights the necessity of incorporating both mothers and fathers into future breastfeeding promotion strategies.

BackgroundSupplementary feeding, colostrum or, in some countries, commercial milk formula, is given to newborns of women with Type 1 diabetes to prevent neonatal hypoglycemia. Few studies have explored the content of colostrum from women with Type 1 diabetes.Research AimsThis study aimed to investigate the macronutrients in colostrum collected during pregnancy and in the early postpartum period to compare colostrum contents in women with and without Type 1 diabetes.MethodsIn this cohort study, we collected colostrum among 20 women, 10 with and 10 without Type 1 diabetes, at 10 different time points in gestational weeks 36-40 and postpartum Days 1-5. We measured carbohydrates, protein, fat, and kilocalories in colostrum using a human milk analyzer; and we analyzed data using linear mixed models. In a follow-up analysis, we compared the content of colostrum from Day 1 with the nutritional values provided on the commercial milk formula, using a one-sample t test.ResultsThere were no mean differences in carbohydrates (6.6 g/100 ml; 95% CI [6.3, 6.9] vs. 6.7 g/100 ml; 95% CI [6.4, 7.0] p = 0.29); kilocalories (71.1 kcal/100 ml; 95% CI [62.9, 79.3] vs. 85.3 kcal/100 ml; 95% CI [77.2, 93.3] p = 0.21], and fat (2.7 g/100 ml; 95% CI [1.8, 3.6] vs. 2.3 g/100 ml; 95% CI [1.4, 3.2] p = 0.55) in colostrum when comparing women with and without Type 1 diabetes. However, antenatal protein differed at all timepoints tested (p = 0.01). Colostrum macronutrients on Day 1 differed from that of commercial milk formula and all other colostrum time points, except Gestational Week 38.ConclusionsOur study provides insights into antenatal and postnatal colostrum macronutrients among women with and without Type 1 diabetes. Further studies are needed to understand the effects of supplementary feeding using antenatal or postnatal colostrum or commercial milk formula on neonatal hypoglycemia.

Background: Indonesia is a middle-income country in Southeast Asia in which 2,394 disasters were recorded in 2022 alone, with a total loss of 178,367 lives. In 2018 governments at the World Health Assembly resolved to improve emergency planning using Operational Guidance on Infant and Young Child Feeding in Emergencies (OG IFE). Little is known about whether Indonesian policies protect the health and lives of women, infants, and young children in line with OG IFE through planning for breastfeeding support and protection during emergencies.

Research aim: To identify and audit Indonesian policy regulations regarding infant and young child feeding support and protection during emergencies.

Method: A search of the grey literature was conducted in 2023 through Google Basic and Advanced Search, official websites, and consultation with the Indonesian Breastfeeding Mothers Association (Asosiasi Ibu Menyusui Indonesia/AIMI) network. Keywords used included the Indonesian words for "regulation," "disaster," and the name of a province, city, or region, or the name of appropriate government organizations. Data was analyzed using a qualitative content analysis approach, and based on the Infant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and Program Managers (OG-IFE) framework.

Results: A total of 513 regulations were found online; however, only four were included for audit. The 509 excluded regulations did not specifically mention infant and young child feeding in emergencies. Those Indonesian policies that did mention infant and young child feeding in emergencies lacked attention to, and comprehensive planning for, breastfeeding protection and support during emergencies.

Conclusion: Mothers and infants may be exposed to unnecessary risk and avoidable morbidity and mortality during emergencies. Indonesia could enhance its disaster relief policies to align with international standards supporting breastfeeding in emergencies. This could involve more comprehensive and integrated regional planning and preparation before disasters, including regular assessment of local infant and young child feeding practices, communication measures to raise emergency workers' awareness of breastfeeding, and resourcing of training so as to translate policies into practice.