International Breastfeeding Journal最新文献

Background: Global uptake of the Baby Friendly Hospital Initiative (BFHI) and Ten Steps to Successful Breastfeeding (Ten Steps) is low, and sustainability is a challenge. Although both programs are backed by strong evidence and international endorsement, their integration into national health systems has been inconsistent and often lacks institutional prioritization. This study aimed to analyze challenges to implementation of the BFHI and Ten Steps programs in Australia and Indonesia.

Methods: We used the Non-adoption, Scale-up, Spread and Sustainability (NASSS) framework and categorized the relative complexity of implementing the program into each setting.

Results: Most BFHI/Ten Steps implementation domains were categorized as complicated or complex, and the policy level, organizational and community settings for the intervention overlapped for most domains. Despite the cultural and health systems differences between Australia and Indonesia, both environments present challenges and also unique opportunities for the uptake and scale up of BFHI/Ten Steps with the right support and adaptation. Importantly, the complexity was not only technical but also institutional, with implementation often relying on individual champions rather than systemic support.

Conclusions: Systems that require and motivate compliance to the WHO Code (Step 1) and optimize healthcare professionals' (HCP) lactation support capacity (Step 2) are crucial, and need to be regulated and coordinated from the national level. To achieve optimal support for initiating and establishing breastfeeding, governments, facilities, and relevant HCPs must support birth models that ensure women receive continuity of care and adequate time with skilled midwives, who in turn are educated in ways that are free from commercial influence (Step 1). These policy and clinical level steps can reduce the misalignment of costs and benefits of BFHI and Ten Steps implementation. Strengthening institutional commitment and embedding BFHI into national quality frameworks may further enhance sustainability and scale-up. A coordinated, system-wide approach is essential to ensure these evidence-based practices become standard in maternal and newborn care.

Objective: This study aimed to elucidate healthcare professionals' (HCPs) evaluations of a breastfeeding training program that incorporated diverse professions along the care continuum.

Methods: The breastfeeding training program was conducted over a full day during 2018-2019. To enable as many HCPs as possible to participate, the program was offered om twelve different dates. Approximately 25 HCPs took part on each occasion. Both qualitative and quantitative data was gathered on each occasion. The cohort comprised 238 HCPs, including midwives, registered nurses, specialist registered nurses, assistant nurses, physicians, and psychologists, all actively engaged in clinical practice at delivery/maternity wards or child healthcare centers. HCPs completed questionnaires featuring both closed and open-ended queries at the commencement and conclusion of the training program. Additionally, participants collaborated in small groups to propose improvements within the care continuum.

Results: Following the training program, HCPs reported a perceived increase in their interest in breastfeeding and noted the acquisition of novel tools for breastfeeding support. Noteworthy aspects of the training program, as identified by participants, included group discussions, the structure of the training session, inspiration for breastfeeding support, newfound knowledge regarding breastfeeding, and the utility of provided parental materials.

Conclusion: The breastfeeding training program was beneficial across various HCP roles. The training program served to augment participants' interest in breastfeeding and equipped them with resources to bolster ongoing breastfeeding support efforts. Facilitating HCP attendance at such training sessions and fostering commitment to breastfeeding promotion emerge as crucial imperatives.

Trial registration: Detailed information about the program and its implementation is available in the trial registered in the ISRCTN Registry: https://doi.org/10.1186/ISRCTN91972905 .

Background: Early initiation of breastfeeding, defined as placing a newborn to the breast within the first hour of birth, is vital for improving neonatal survival, strengthening the mother-child bond, and ensuring the delivery of essential nutrients and antibodies. This study examines progress and socioeconomic inequalities in the early initiation of breastfeeding among women in Sierra Leone from 2008 to 2019.

Methods: We used data from the three rounds of the Sierra Leone Demographic and Health Survey conducted in 2008, 2013, and 2019. We used the Health Equity Assessment Toolkit developed by the World Health Organisation to calculate the inequality measures among women 15-49 years, which include simple difference (D), ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). The inequality assessment was conducted based on six stratifiers: age, economic status, level of education, place of residence, sex of the child, and sub-national region.

Results: In Sierra Leone, the early initiation of breastfeeding rate increased from 48.7% in 2008 to 75.2% in 2019. Higher rates of early initiation of breastfeeding were observed among mothers (15-19 years), women from the lowest wealth quintile, those without formal education, and those residing in rural areas. However, regional inequalities persisted, with the Eastern region showing the lowest rates. The inequality (D) in age increased from - 0.2 in 2008 to -1.6 in 2019. The economic status disparity increased from - 8.7% in 2008 to -18.4% in 2019. Inequality for education decreased from - 10.6 in 2008 to -4.7 in 2019. The increase in place of residence inequality was from -2.6% in 2008 to -13.4% in 2019. For the sex of the child, the disparity increased from - 1.5% to -3.6% in 2019. Regional disparity increased from 19.7 in 2008 to 28.6 in 2019. PAR also rose from 8.9 to 11.1 percentage points.

Conclusion: Early initiation of breastfeeding has shown substantial improvement in Sierra Leone, highlighting the effectiveness of recent public health interventions. However, inequalities accross economic status, level of education, sex of the child, and sub-national region still persist. To sustain these gains and ensure equitable progress, continued policy attention and targeted strategies are essential to address persistent socio-economic and regional inequalities disparities.

Background: Despite medical advancements, the rate of premature births remains at one in ten babies worldwide. Moderate and late preterm (MLPT, gestational age 32-36 weeks) infants constitute 80% of all preterm births and are at higher risk of short- and long-term complications compared to term infants. Breastfeeding helps to reduce these risks, but evidence on breastfeeding rates and success factors in MLPT infants is limited.

Methods: A prospective intervention trial included a pre-intervention phase from June to September 2022 (comparison) and a post-intervention phase from June to October 2023 (intervention) at one tertiary academic hospital. Clinical parameters from pregnancy, delivery, and postnatal care were collected from MPLT infants and their mothers, including mid-term breastfeeding at infant´s four-month health check-up. Intervention was a quality improvement (QI) initiative involving staff training and parent education using an information platform (Neo-MILK app) with breastfeeding content. Primary outcome was breastfeeding rate at the age of four months after birth. Various secondary outcomes were defined, including growth sufficient exclusive breast milk feeding at 14 days after birth. Relative risks (RR) and 95% confidence intervals approximated from odds ratios obtained through univariate logistic regression to identify predictors of breastfeeding success.

Results: Out of 170 eligible mothers of MLPT infants, 69 participated (36 intervention, 33 comparison group) with similar baseline characteristics. At four months of age (primary endpoint), 75% of the intervention group were breastfeeding compared to 48% of the comparison group (p = 0.023). Significant independent predictors of medium-term breastfeeding success were higher socioeconomic status (RR 1.16; 95% CI 1.01, 1.31), growth sufficient exclusive breast milk feeding and maternal self-efficacy, both measured at 14 days postpartum (RR 1.84; 95% CI 1.37, 2.01 and RR 1.04; 95% CI 1.02, 1.06, respectively). In contrast, delivery by cesarean section was associated with lower medium-term breastfeeding success (RR 0.21; 95% CI 0.07, 0.52).

Conclusions: The implementation of a QI initiative, including breastfeeding education, early postpartum milk pumping and lactation support based on a common information platform for staff and parents was associated with increased medium-term breastfeeding success in MLPT infants. Despite early interventions, caesarean section remains a barrier to breastfeeding.

Trial registration: The study is registered in the German Clinical Trials Register (DRKS00034762).

Background: This study aims to evaluate the current status of breastfeeding practices among healthcare workers in Southwest China, identify key factors influencing their exclusive breastfeeding (EBF), and provide targeted recommendations for increasing the EBF rate and prolonging EBF duration in this population.

Methods: A cross-sectional survey was conducted among 685 healthcare workers who were ≥ 6 months postpartum, with data collected from January 2019 to January 2024. The questionnaire included items on general demographics, breastfeeding knowledge, and breastfeeding practices. Exclusive breastfeeding (EBF) was defined as feeding infants only breast milk from birth, with no other foods or drinks (including water) provided. Logistic regression analysis was performed to identify factors influencing EBF, and based on the results, a nomogram prediction model was constructed and validated using R software.

Results: A total of 685 participants were enrolled in this study, among whom 363 (53.0%) had exclusive breastfeeding durations of less than 5 months (Group A) and 322 (47.0%) continued exclusive breastfeeding for 6 months (Group B). The primary sources of breastfeeding knowledge were the internet and professional consultations, while common barriers included nipple/breast problems and work-related factors. Logistic regression analysis identified four independent factors associated with the continuation of exclusive breastfeeding for 6 months (all p < 0.05): parity (OR 1.86; 95%CI 1.35, 2.58), breastfeeding consultations during pregnancy (OR 1.44; 95%CI 1.04, 2.00), three-shift work resumption (OR 1.67; 95%CI 1.32, 2.10), and family support for breastfeeding (OR 1.90; 95%CI 1.07, 3.37). A nomogram prediction model constructed based on these factors showed an area under the ROC curve of 0.75 (95% CI 0.70, 0.81), indicating good predictive performance with high consistency between predicted and observed outcomes.

Conclusion: Healthcare institutions should actively provide breastfeeding consultation services, encourage postpartum healthcare workers to delay participation in shift work, and strengthen breastfeeding education to enhance public awareness. These measures will help improve the exclusive breastfeeding rate among infants under 6 months of age.

Background: Breastfeeding is often compromised when clinical nutrition interventions are implemented for complex paediatric patients, in a healthcare environment where breastfeeding supports are currently under-resourced. This systematic review aimed to investigate how breastfeeding can be supported when it is disrupted for clinical nutrition interventions in the paediatric healthcare setting. The experience of mothers who breastfeed their child requiring nutrition support and/or therapeutic dietary measures is also explored.

Method: A search was conducted across five databases; Ovid-Medline, Ovid-Embase, CINAHL Complete, Scopus and Cochrane Library. Eligible papers included breastfeeding dyads where the infant/child required a nutrition intervention in the global paediatric healthcare setting, limited to those published in the English language and year 2000 onwards. Manuscripts that focused on preterm infants, maternity or neonatal care settings, healthcare professionals, or a maternal clinical condition impacting breastfeeding were excluded. Results were synthesised into key measures to support breastfeeding and overarching themes illustrating a mother's experience breastfeeding her child with complex nutritional needs.

Results: From 13,177 manuscripts screened, a total of 36 manuscripts were included. Clinical conditions in the manuscripts identified included congenital heart disease, congenital anomalies, inborn errors of metabolism, acute and chronic respiratory conditions, trisomy 21, faltering growth and hyperbilirubinaemia. Measures to support breastfeeding (n = 19 primary research studies and n = 5 case studies) encompassed environmental modifications and improvements to hospital procedures; access to lactation support professionals and education; and clinical practices that facilitated breastfeeding. Key themes across papers exploring maternal experience (n = 12 manuscripts) were difficulties breastfeeding a child with complex nutritional needs; a desire to breastfeed that informed maternal identity and emotions; and a supportive healthcare team that promoted breastfeeding.

Conclusion: This review highlights environmental and practical strategies that can optimise breastfeeding for paediatric patients receiving clinical nutrition interventions and support maternal feeding intentions. Many strategies to support breastfeeding are geared towards supporting lactation physiology to increase maternal milk supply. More research is needed to explore what psychological and emotional supports mothers need from the healthcare team when encountering breastfeeding difficulties and unmet expectations feeding a nutritionally complex child.

Background: Establishing the first Human Milk Bank (HMB) in Vietnam at the Da Nang Hospital for Women and Children marks a significant advancement in neonatal care. This specialized service addresses the critical need for donor human milk (DHM) when a mother's own milk is unavailable, providing essential nutrition to small vulnerable newborns. Introducing the new specialized service required developing a digital monitoring system to ensure the quality and safety of DHM.

Development of the tool: This digital and open access system was designed using an approach called DMADV (Define, Measure, Analyze, Design, and Verify), and includes features for human milk donor management, DHM processing, recipient management, and real-time data access. It has streamlined operations, enhanced efficiency, and ensured adherence to safety and quality standards.

The use of the tool: The application of the monitoring system has facilitated the tracking of DHM from collection to use, ensuring transparency and accountability. Data collected through this system has been instrumental in improving program performance, informing decisions, and supporting research. The successful scaling up of HMB services and the monitoring system to other regions in Vietnam demonstrates the project's effectiveness and potential for broader impact. The system's adaptability has allowed continuous improvements and integration of new functions, such as financial reporting and consumables tracking.

Lessons learned: Lessons learned from the Da Nang HMB have been shared to guide the development of HMB monitoring systems in other regions and countries. The digital monitoring system has proven to be a critical tool in maintaining the quality and safety of DHM, ultimately contributing to better health outcomes for children. The successful implementation of HMB services underscores the importance of robust monitoring systems in its operations and highlights the potential for digital solutions to enhance healthcare services.

Background: Most women who give birth will initiate lactation and breast/chestfeeding, with up to 40% of infants globally receiving human milk exclusively for the first 6 months of life. One of the studies indicates that 40% of breastfeeding women had used at least one prescription medication in the first 3 months postpartum. The lack of information on the safety of medications during lactation may lead to cessation of lactation in favor of treatments, therefore contribute to suboptimal breastfeeding rates. Inadequate terminology to define and grade adverse events for lactation and breast/chestfeeding limits the understanding of potential therapeutic harms. This results in lactating women commonly being excluded from participation in clinical trials, leading to inequitable access to effective treatments. We developed a comprehensive framework with new definitions and grades for breastfeeding Adverse Events (AEs) through consideration of the physiology and pathology of lactation.

Methods: We performed the Delphi consensus process between January 2021 and November 2023. An international multidisciplinary group of lactation and breast/chestfeeding experts identified a gap in AE terminology and developed definitions and grading of AEs based on the generic Common Regulatory Criteria for Adverse Events (CTCAE) structure. These underwent two rounds of a modified Delphi procedure involving an international multidisciplinary team of experts and patient representatives. The web platform REDCap^Ⓡ was used to collect the results of the Delphi surveys.

Results: Three new definitions, delayed secretory activation, primary lactation insufficiency, and secondary lactation insufficiency, were developed and mapped to the Medical Dictionary of Regulatory Activities (MedDRA, March 2023). Oversupply of milk and other changes in lactation/feeding patterns were mapped to existing MedDRA terms. Grading for all five definitions was developed and agreed upon through consensus.

Conclusions: These new definitions and grading of adverse events in lactation and breast/chestfeeding fill the gap in existing classifications and should encourage the inclusion of postpartum individuals into clinical trials.