International Breastfeeding Journal最新文献

Background: Despite efforts to promote mother‒newborn skin‒to‒skin contact (SSC) following delivery, this is seldom practiced. World Health Organization (WHO) recommends SSC at least one hour following birth. This trial determined the efficacy of nurse-led Breastfeeding Supportive Care (B-SUCA), an integrated intervention combining breast crawl with SSC for early initiation of breastfeeding outcomes, perinatal outcomes and exclusive breastfeeding (EBF).

Methods: A randomized controlled trial was conducted between 2022 and 2024 at a tertiary referral hospital in India. Approximately 160 mother-newborn dyad's were enrolled with an allocation ratio of 50:50, with 80 individuals randomly allocated each to intervention and control groups. The intervention group received the intervention in addition to routine standard care provided by the nurse-midwives, and control group received only standard care. Breastfeeding outcomes comprised time to initiation of breastfeeding, breastfeeding behaviors, perinatal outcomes assessed postintervention in the hospital and exclusive breastfeeding from birth to six months assessed by telephonic follow-up.

Results: The median time (in minutes) to initiation of breastfeeding was 32.5 (IQR:25.0-41.0) in the intervention and 48.5(IOR: 44.0 - 54.3) in the control group, respectively. The majority of participants reported positive attachment response (p<0.002), emotional bonding (p<0.001) and swallowing behavior (p<0.002) between the groups. All participants had spontaneous deliveries, and the uterus contracted well following birth. The median time for placental separation in the intervention group was 14.0 (IQR: 11.00 - 15.00) and the control group was 11.0 (IQR: 10.00- 12.30) respectively (p value <0.001). The Apgar scores at 0 min were 6 - 8 (both groups) and at 5 mins (7 - 10) in intervention; (7 - 9) in control group respectively. The mean newborns' body temperature (°F ) was 98.4 °F (SD = 0.475) intervention group and 98.1 °F (SD = 0.552) control group, with a statistically significant difference (p < 0.001). Sixty-seven (84%) and fifty-six (70%) participants exclusively breastfed up to 6 months in the intervention and control group respectively.

Conclusion: Findings provide critical evidence that nurse-led B-SUCA intervention was effective in improving breastfeeding outcomes. Its integration into routine care can empower nurse-midwives and enhance maternal-infant outcomes.

Trial registration: CTRI Reg. No. is CTRI/2022/03/040974, CTRI Reg. dated 10 March 2022.

Background: Although breastfeeding history is recognized as a potential protective factor against all-cause and cardiovascular disease (CVD) mortality in women, its impact on these outcomes remains underexplored, particularly in the context of diabetes. This study aims to address this gap by investigating the association between ever breastfeeding and mortality risks from all causes and CVD in adult women with and without diabetes.

Methods: This prospective cohort analysis utilized nationally representative U.S. data from the National Health and Nutrition Examination Survey (NHANES, 1999-2012). Mortality follow-up through December 31, 2019, was established via linkage to the NHANES Public-Use Linked Mortality File using probabilistic matching to National Death Index records. To estimate hazard ratios (HRs) and 95% confidence intervals (CIs), we utilized Cox proportional hazards regression models. We evaluated interactions between ever breastfeeding and diabetes status using both multiplicative and additive scales. The stability of the results was assessed using sensitivity analyses.

Results: Among the 10,965 parous women studied (mean age 53.2 years), 1,938 had diabetes and 6,310 reported ever breastfeeding at baseline. During median follow-up of 142 months (range: 7-20 years), 2,178 all-cause and 673 CVD deaths occurred. Following multivariable adjustment, ever breastfeeding was significantly linked to reduced all-cause mortality risk among individuals with diabetes (HR 0.76; 95% CI 0.63, 0.92), but not among those without diabetes (HR 1.05; 95% CI 0.93, 1.18). No significant associations were observed for CVD mortality in either group. Significant multiplicative interaction existed between ever breastfeeding and diabetes status for all-cause mortality (P_interaction=0.012). Additive interaction analyses revealed a relative excess risk due to interaction (RERI) of -0.41 (95% CI -0.69, -0.14), indicating subadditive joint effects. Sensitivity analyses excluding early deaths (≤ 2 years) or cancer histories yielded consistent results (HR range: 0.75-0.77).

Conclusions: Ever breastfeeding was significantly associated with reduced all-cause mortality risk among women with diabetes, suggesting potential long-term protective effects of breastfeeding on maternal survival in this population.

Background: When mother's own milk (MOM) is insufficient, feeding very preterm infants with donor human milk (DHM) reduces the incidence of multiple severe complications and provides greater benefits than infant formula. Donor human milk (DHM) is obtained from breast milk banks, but establishing a human milk bank is very expensive. We propose a same-city delivery model for donor human milk (SCDM-DHM), where DHM is delivered via a cold chain from milk banks to NICUs without milk bank facilities, providing DHM to very preterm infants (VPIs).

Methods: We retrospectively analyzed the medical records of VPIs who were admitted to Shenzhen People's Hospital between June 2023 and May 2025. We initiated the same-city delivery model for donor human milk (SCDM-DHM) in July 2024, providing DHM to VPIs born from June 2024 onward. We designated VPIs admitted from June 2023-June 2024 as the control group and those admitted from June 2024-May 2025 as the SCDM-DHM group. The economic benefits for both the human milk bank and recipient hospitals within the SCDM-DHM were evaluated, and clinical outcomes were assessed in VPIs receiving DHM in recipient hospital NICU.

Results: Our cost analysis revealed that the cost of the human milk bank is much greater than the cost of the recipient hospital ($526,576.40 vs. $279.58). The recipient hospital's cost per liter DHM ($25.34) is much lower than that of the human milk bank ($44.94). Our data revealed that after DHM was introduced, the breastfeeding rate of VPIs in recipient hospital NICU was higher (50.8% vs. 92.9%, p < 0.001, SMD=-1.09). The incidence of NEC (≥ Stage II) (6.7% vs. 3.5%) was not significantly different (p = 0.679, SMD = 0.14) from that in the control group, with a complete absence of adverse events.

Conclusions: The SCDM-DHM is an adaptation of existing international approaches to the unique infrastructure and policy environment in China. The SCDM-DHM improved breastfeeding rate in the NICU without a human milk bank and remained cost-efficient, demonstrating both feasibility and clinical effectiveness. However, more research is needed to confirm whether the SCDM-DHM can be promoted among NICUs in Shenzhen and other regions as well.

Background: Human milk feeding is crucial for the survival and development of preterm infants, yet their human milk feeding rates at Neonatal Intensive Care Units (NICUs) discharge remain lower than those of healthy newborns. Effective support is essential for improving breast milk feeding outcomes, but remains challenging for NICU nurses. Therefore, this study aimed to examine factors that influence NICU nurses in providing human milk feeding support, including the challenges they face and their needs.

Methods: This study employed a qualitative descriptive design. Using maximum variation and purposive sampling, 19 nurses in the NICU were recruited. Between August and September 2024, semi-structured interviews were conducted in the NICUs of two tertiary public hospitals in Jiaozuo, China. The interviews were transcribed verbatim and analyzed using a thematic analysis approach.

Results: This study highlighted the broader context of human milk feeding support in NICUs, influenced by institutional policies that limit parental involvement and the cultural practice of postpartum confinement, which keeps mothers at home after delivery. It underscored the key challenges NICU nurses faced in providing human milk feeding support in China. Against this backdrop, three main themes were identified, representing factors that influence human milk feeding support at the levels of preterm infants and their families, healthcare professionals, and institutions.

Conclusions: This qualitative study identified multiple modifiable factors influencing human milk feeding support for mothers of preterm infants in NICUs, especially offering new insights into the significant role of NICU management policy and postpartum culture. Future interventions should prioritize creating a family-friendly NICU environment and adopting culturally sensitive education and support strategies to address the unique challenges posed by institutional and cultural barriers.

Background: Antenatal colostrum expression refers to the practice of hand-expressing and storing breast milk during the final weeks of pregnancy, usually beginning around 36 weeks of gestation. Initially introduced to provide an immediate supply of colostrum for newborns at risk of hypoglycemia, particularly those born to mothers with diabetes, it was also intended to reduce reliance on commercial milk formula. Over time, the practice has gained significant international visibility through clinical recommendations, maternal testimonials, and social media promotion. As a result, antenatal colostrum expression is now being extended to low-risk pregnancies despite limited population-level evidence supporting its universal application. Implications of widespread adoption: Evidence from randomized controlled trials has shown that antenatal colostrum expression is safe for women with diabetes in pregnancy and does not increase rates of preterm birth. However, these studies did not find measurable improvements in breastfeeding initiation, exclusivity, or long-term breastfeeding outcomes when compared to standard care. Reports from mothers highlight additional concerns, including prenatal mastitis, anxiety about milk supply, and pressure to collect excessive amounts of colostrum without professional supervision. For infants, the use of stored colostrum immediately after birth may contribute to overfeeding, a poor latch, and early reliance on supplemental milk. Beyond clinical outcomes, the growing commercialization of this practice risks presenting it as a maternal obligation rather than a carefully targeted intervention for selected situations.

Conclusion: Antenatal colostrum expression may provide benefits for certain high-risk pregnancies, particularly when neonatal hypoglycemia is anticipated, but current evidence does not support its routine use for all women. Its adoption should remain guided by clinician judgment and individualized prenatal counseling rather than being promoted as a universal recommendation. Until larger, well-designed studies confirm both safety and measurable improvements in breastfeeding outcomes, this practice should be considered a supportive tool for specific populations rather than a standard component of prenatal care.