Journal of Human Lactation最新文献

Background: Disparities in breastfeeding rates and exclusivity exist across regions and countries despite multifaceted breastfeeding promotion efforts in recent decades. Markets for artificial milk formula continue to grow as its substitution for breastfeeding is common. A new approach is needed for breastfeeding promotion strategies.

Research aim: This state-of-the-art review aimed to describe the implications of not-breastfeeding on the environment within the context of food system sustainability.

Method: A total of 19 peer-reviewed articles within a 20-year timeframe were included in this review. Authors searched five databases for articles including Science Direct, GreenFILE, Springer Link, ProQuest, and PubMed.

Results: The demand for artificial milk formula production as a replacement for breastfeeding results in increased greenhouse gas emissions, water pollution, and waste, thereby aggravating problems with freshwater scarcity. A short duration of breastfeeding and limited exclusivity have been associated with close birth spacing and contributing to global population growth. Breastfeeding is a healthy, sustainable diet, and a culturally acceptable first food. It advances health equity and food security. Exclusive breastfeeding for the first 6 months of life can be promoted with emphasis on total carbon footprint reduction, prevention of waterway degradation, and natural birth spacing, thereby sustaining food systems at large.

Conclusion: It is important to reform food, nutrition, and environmental policies to protect exclusive breastfeeding while decarbonizing artificial milk formula production. More research is needed to provide directions for new breastfeeding promotion strategies connecting breastfeeding with environmental stewardship.

Introduction: Non-puerperal adoptive lactation sometimes requires long preparation and substantial expense for pharmacological intervention to be successful, which are not feasible in refugee camps. Here we report two case studies of non-puerperal adoptive breastfeeding of two infants in the Rohingya Refugee Camp of Cox's Bazar, Bangladesh.

Main issue: Two non-pregnant, non-breastfeeding caregivers with previous experience of breastfeeding brought two adopted infants-one a 12-day-old female with severe acute malnutrition, and the other a 2-day-old male with normal anthropometric measurements-to a nutritional stabilization center for feeding. After counseling, both families opted for adoptive lactation.

Management: Both infants were treated with a modified Action Against Hunger protocol of in-patient management of severe acute malnutrition using the supplementary suckling technique, a procedure to feed the baby with supplementary feed. Diluted F100 was used as the supplementary feed; the energy and protein gained from it were just enough to maintain body physiology and were not responsible for any weight gain. When the infants gained weight, indicating that the caregivers were producing milk, we reduced the supplementary feed as per protocol guidelines. The caregivers were prescribed domperidone and counseled on their ability to breastfeed the infants. The cases required 35 days and 20 days, respectively, for the full establishment of breastfeeding.

Conclusion: This is the first report of successful adoptive breastfeeding in a refugee camp. With proper counseling and motivation of the caregiver, induced lactation can be started without a preparatory period and with very low-cost intervention.

Background: Breastfeeding behaviors and experiences exist on a continuum. What differentiates normal from dysfunctional is defined by frequency and severity. No current validated tool addresses the subjective experience of dyads with a predictive score that can be followed over time.

Research aim: To create and validate a self-report tool to assess breastfeeding and evaluate its ability to predict risk of breastfeeding dysfunction.

Methods: This study used a cross-sectional design to determine the validity of a novel instrument to assess breastfeeding dysfunction. We gave the initial questionnaire to 2085 breastfeeding dyads. We assessed content validity by comparison with other tools. We used exploratory factor analysis with varimax rotation for concept identification and Cronbach's alpha for internal consistency. We employed logistic regression to assess the tool's ability to differentiate between normal breastfeeding and breastfeeding dysfunction.

Results: Factor analysis mapped 17 questions to four concepts to create a score (FLIP; flow, latch, injury [to the nipple], and post-feed behavior). Internal consistency and reliability of the scores in these concepts were acceptable (Cronbach's alpha ≥ 0.087 for all measures). A logistic regression model that controlled for infant age, with a breastfeeding dysfunction risk classification threshold of 60%, yielded a correct classification of 88.7%, with 93.1% sensitivity, 64.6% specificity, and a 6.5% false positive rate.

Conclusions: The FLIP score was determined to be a valid and reliable instrument for quantifying the severity of breastfeeding dysfunction in children under 1 year old. Further studies will assess its usefulness in the management of breastfeeding dysfunction.

Background: Breastfeeding is very important for maternal and infant health. With first pregnancies, many pregnant people face obstacles to achieving their breastfeeding goals.

Research aims: We aimed to investigate the outcomes of a breastfeeding education program and nurse-led online breastfeeding counseling system (BMUM) on breastfeeding self-efficacy, attitudes about breastfeeding, breastfeeding problems, breastfeeding frequencies and postpartum depression.

Methods: This study was a randomized controlled trial. Participants were randomly assigned to the intervention group (n = 36), or control group (n = 36). Assessments were conducted during pregnancy, between 32- and 37-weeks gestation, and on postpartum Day 1, Week 1, Week 3, and 6 months.

Results: The means of the Breastfeeding Self-Efficacy-Short Form scores, and the Infant Feeding Attitude Scale (IIFAS) scores were similar between the groups at the first assessment (p = 0.733). IIFAS scores in the intervention group were significantly higher in the follow-up measurements on postpartum Day 1, Week 1, Week 3, and 6 months compared to scores in the control group (p = 0.006; p = 0.000; p = 0.002; p = 0.001) Edinburgh Postpartum Depression Scale (EPDS) scores were similar between the two groups at 1 week (p = 0.678). EPDS scores were significantly higher in the control group on Day 1 and at 3 and 6 months postpartum (p = 0.000; p = 0.038; p = 0.042). There was no statistically significant difference in breastfeeding problems between the two groups (p > 0.05 across breastfeeding problems examined). The mean values of breastfeeding frequency were similar between groups on Day 1, and significantly higher in the intervention group on follow-up measurements.

Conclusion: The results of this intervention appear to promote positive attitudes toward breastfeeding and decrease feelings of postpartum depression. However, further randomized controlled trials are needed to support our outcomes.

Introduction: Human lactation should be taken into account as an important issue for the international agenda. Despite advances in lactation information and knowledge, insufficient milk production is still a concern for mothers and health practitioners, including International Board Certified Lactation Consultants and others. Primary hypogalactia, or insufficient milk production is uncommon, but should be considered when there is poor weight gain and decreased urine output in infants despite good latch-on and suckling, or anatomic differences in the physical exam of the lactating breast.

Main issue: This case series presents three cases illustrating insufficient milk production resulting in infants who experienced significant dehydration and poor weight gain.

Management: Primary hypoplasia was diagnosed by means of a thorough interview and physical examination that entailed a consultation with a physician who was also an International Board Certified Lactation Consultant.

Conclusion: Awareness of an infant's feeding needs and proper evaluation of a child's health status is paramount if health care providers are to identify the important factors contributing to breastfeeding problems. In some instances, breastfeeding goals cannot be achieved, and then the provider's role becomes support in coming to terms with persistent insufficient milk production, and coordinating appropriate supplementation to meet each baby's nutritional needs.

Late preterm infants have lower breastfeeding rates than term infants, yet few published interventions or guidelines exist to guide hospitals in managing them in the non-intensive nursery setting. Here we describe the development and implementation of an interdisciplinary, hospital-based, breastfeeding support program among late preterm infants not requiring intensive care. The Early Bloomer Program includes an order set applied at birth, immediate lactation consultation, availability of donor milk, parent education on late preterm infants, hand expression teaching and kit including spoon and video link, and daily interdisciplinary team huddles. The program was developed with staff input using Diffusion of Innovation Theory, and implemented first among early adopters before expanding to all postpartum nurses. Nursing staff received education on late preterm infant physiology and feeding, and trainings on the Early Bloomers program through various learning modalities during the year leading up to implementation. To further understand the strengths and weakness of the program, we surveyed nurses (n = 43). Nurses reported that they were more attentive to the needs of late preterm infants, more confident in their care, and more aware of possible complications and feeding needs. Areas noted in need of improvement included lack of overnight lactation consults and little involvement of labor and delivery staff in the program. The Early Bloomers program increased confidence in care and was well received by nurses. Well-designed clinical studies are needed to identify effective breastfeeding support practices for late preterm infants.

Background: Although many mothers initiate breastfeeding, supplementation with human-milk substitutes (formula) during the birth hospitalization is common and has been associated with early breastfeeding cessation. Colostrum hand expressed in the last few weeks before birth, known as antenatal colostrum expression (ACE), can be used instead of human-milk substitutes. However, evidence is lacking on the efficacy of ACE on breastfeeding outcomes and in non-diabetic mothers.

Methods and planned analysis: This multicenter stepped-wedge cluster (nested) randomized controlled trial aims to recruit 945 nulliparous pregnant individuals. The trial is conducted in two phases. During Phase 1, control group participants are under standard care. During Phase 2, participants are randomized to ACE instruction via a pre-recorded online video or a one-on-one session with a midwife. Adjusted logistic regression analysis will be used to examine the relationship between ACE instruction and breastfeeding outcomes.

Research aims and questions: Primary aim: (1) Does advising pregnant individuals to practice ACE and providing instruction improve exclusive breastfeeding rates at 4 months postpartum? Secondary research questions: (2) Do individuals who practice ACE have higher rates of exclusive breastfeeding during the initial hospital stay after birth? (3) Is teaching ACE via an online video non-inferior to one-on-one instruction from a midwife? (4) Does expressing colostrum in pregnancy influence time to secretory activation, or (5) result in any differences in the composition of postnatal colostrum?

Discussion: Trial findings have important implications for maternity practice, with the online video providing an easily accessible opportunity for ACE education as part of standard antenatal care.