Breastfeeding Medicine最新文献

Background and Purpose: Preterm infants are born before the 37th gestational week and need prompt nutrition. The circadian rhythm is an internal 24-hour cycle regulated by endogenous molecules. Human milk contains different biological peptides at different times within this cycle. Chrononutrition is a feeding model that is adjusted to match the biological clock of the individual. This study tests chrononutrition as a superior feeding model in preterm infants. This study aimed to evaluate the effect of the chronobiological feeding model on growth parameters and discharge time among preterm infants. Methods: We conducted a prospective, randomized controlled trial in a tertiary neonatal intensive care unit between October 2021 and March 2022, randomized preterm infants to receive either chrononutrition (study group = 45) or standard feeding (control group = 46), and used the infant's follow-up form for data collection. Results: Among 91 neonates, the median gestational age was 33 weeks, and the mean birth weight was 2,100 g. Demographic findings and growth parameters showed no difference between the groups (p > 0.05). Weight gain and percentile measurements at discharge were statistically significantly higher in the study group (p = 0.002 and p = 0.003, respectively). Discharge time was statistically significantly lower after full enteral feeding and hospitalization time was shorter in the study group (p = 0.001). Conclusions: The chronobiological feeding model showcased significant positive effects on anthropometrics and percentile measurements at discharge and led to a 2-day reduction in the length of hospital stay.

Introduction: Although exclusive breastfeeding is recommended for the first six months of life, many lactating individuals discontinue due to low milk supply, a condition sometimes referred to as chronic lactation insufficiency (CLI). Affecting an estimated 5-15% of lactating individuals, CLI can stem from both extrinsic factors (e.g., infant feeding challenges) and intrinsic ones (e.g., endocrine or metabolic disorders). This qualitative study explored the lived experiences of individuals with CLI and their interactions with healthcare providers (HCPs). Methods: In-depth, semi-structured interviews were conducted with 30 individuals who self-reported experiencing low milk supply, were 18 or older, and were members of the "IGT and Low Milk Supply Support Group" on Facebook, which has approximately 10,700 members. Data were analyzed using phronetic iterative analysis which is a cyclical, reflexive coding approach that emphasizes practical reasoning. Results: Participants reported significant challenges, including: (1) not being believed or taken seriously; (2) facing discrepancies between providers that led to fragmented care; and (3) experiencing a lack of knowledge from HCPs, including lactation consultants. Many described actively seeking a diagnosis and meaningful support but instead receiving inconsistent advice and little to no diagnostic insight into their condition. Conclusions: These findings highlight the urgent need for improved education and training among HCPs to address the complex realities of CLI. They also point to the importance of advancing personalized approaches to breastfeeding support and expanding research to determine causes and diagnostics for low milk supply. By centering patient voices, this study identifies critical gaps in care and communication that prevent effective support for those navigating CLI.

Background: Preterm infants in the neonatal intensive care unit (NICU) frequently undergo painful procedures, which can lead to both short-term and long-term complications, including potential mortality. Effective pain management is crucial in this context. Although numerous studies have explored non-pharmacological pain relief methods for preterm infants, no research has simultaneously compared the effects of maternal breast milk odor, facilitated tucking, and nonnutritive sucking. Aim: This study aims to comparatively investigate the efficacy of nonnutritive sucking, facilitated tucking, and maternal breast milk odor in reducing pain in preterm neonates during heel sticks. Methods: A randomized controlled trial was conducted in a tertiary-level NICU with 144 preterm neonates (gestational age 31-36 weeks) requiring heel sticks. The infants were randomly assigned to four groups: control, nonnutritive sucking, facilitated tucking, and maternal breast milk odor. Pain and physiological parameters were assessed through video recordings of the procedures and scored at 1-minute intervals using the Premature Infant Pain Profile and Data Evaluation Form. Data were collected at baseline and at 1, 2, and 3 minutes before, during, and after the heel stick. Results: The study found significant effects of the interventions on physiological parameters and pain (heart rate: F = 7.5, p < 0.001; oxygen saturation: F = 16.39, p < 0.001; respiratory rate: F = 6.56, p < 0.001; pain: F = 61.45, p < 0.001). Facilitated tucking resulted in significantly lower pain scores (6.61 ± 1.44) compared with the control group (14.22 ± 3.61), maternal breast milk odor (12.22 ± 3.08), and nonnutritive sucking (10.41 ± 1.71) (p < 0.001). Conclusions: All interventions demonstrated effectiveness in maintaining physiological stability and alleviating pain. Nevertheless, the intervention identified as most effective in reducing pain was facilitated tucking group.

Objective: This study evaluates the impact of various processing steps in the human milk (HM) donation chain on nutritional composition and oxidative biomarkers, specifically focusing on triacylglycerols, glucose, polyphenols, and lipid peroxides. Materials and Methods: A total of 68 HM samples were collected from the Human Milk Bank of Córdoba (Argentina) between 2022 and 2023. The effects of storage and pasteurization using the Holder method were assessed. Biochemical analyses were conducted to measure nutrient levels and oxidative markers. Statistical analyses included time-related modeling and paired t tests to evaluate the effects of storage and pasteurization, respectively. Results: Triacylglycerol levels were markedly reduced during home storage (R² = 0.802, p = 0.0210), whereas glucose, lipid peroxides, and polyphenols remained stable (R² < 0.3, p > 0.05). Storage at the bank did not affect these biomarkers (R² < 0.25, p > 0.05). Pasteurization resulted in increased glucose levels (p = 0.0292) and decreased triacylglycerol levels (p = 0.0073), along with a significant reduction in lipid peroxides (p < 0.0001). Conclusions: The findings indicate that home storage conditions significantly diminish triacylglycerol levels in HM, highlighting the need for improved storage practices among donors. Pasteurization provides antioxidant benefits by reducing lipid peroxides while maintaining nutritional integrity.

Background: Breastfeeding is vital for infant nutrition, especially for multiple babies (twins) born prematurely, yet breastfeeding rates among mothers of twins are lower compared with mothers of singleton babies. This review presents a synthesis of research findings on breastfeeding challenges experienced by mothers following twins' births. Methods: The electronic databases of CINAHL, MEDLINE, PsycINFO, EMBASE, and Web of Science were systematically searched in August 2023. All eligible quantitative, qualitative, and mixed-methods studies reported on breastfeeding challenges experienced by mothers of twins were included. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and followed Lucas et al.'s framework for thematic synthesis. Two reviewers independently screened all studies by title, abstract, and full text. The methodological quality of studies was independently assessed by two reviewers using the Joanna Briggs Institute critical appraisal tool and mixed-methods appraisal tool based on study design. Results: The review included 16 studies: quantitative (n = 5), qualitative (n = 8), and mixed methods (n = 3), published between 1980 and 2022, involving 3,351 mothers from 16 countries. Three main themes were generated as follows: (1) transitioning to a new role, finding the balance between self and the newborns' needs; (2) the inevitability of emotional challenges; and (3) navigating support and information. Conclusion: The integrated findings of quantitative, qualitative, and mixed-methods studies on challenges experienced by mothers of twins will have scope for researchers to address the challenges through tailored intervention, education, and support and can help health care professionals revisit policy and practices to extend support services for mothers of twins beyond the initial postpartum and to the community for improving breastfeeding practices among mothers following multiple births.

Objective: Accuracy in the assessment of feed intake is important for preterm infants at risk of growth failure. Clinical observation tools are unvalidated in this population, and test weight measurement may be inaccurate in preterm infants taking small feed volumes. Methods: Test weights were performed to assess agreement between weights using a standardized protocol and a feed of known weight in preterm infants (born at <35 weeks gestational age [GA]) during their transition to oral feeding. Reproducibility was assessed using two repeated measurements in each participant. Agreement between test weights and known feed weights was assessed, and minimal detectable change was calculated. Results: Thirty-eight preterm infants (GA 30 + 5 (28-33 + 1), birth weight 1574 g (+/- 671 g)) were recruited and had test weights performed at CGA 35 + 3 (± 10 days). Each infant was weighed twice before and twice after each measured feed, and a high degree of reproducibility was found for both the paired pre-feed weights, ICC = 0.99 [0.99-0.99] and the paired post-feed weights, ICC = 0.99 [0.99-0.99]. The mean absolute difference between test weight and feed weight was 1.7 g (±2.2). We calculated the minimum detectable change as 0.96 g, representing the magnitude of change below which there is more than 95% chance that no real change occurred. Conclusions: During the establishment of oral feeds, a standardized protocol at the bedside for repeated pre- and post-feed weights demonstrated a high degree of reproducibility. Based on our data, test weight measurements are appropriate for use in this preterm population during the establishment of oral feeds.

Background: The aim was to examine the associations between breastfeeding intensity and changes in concentrations of mammary gland involution markers (protein and lactose) among mothers participating in federal food assistance programs. Methods: Pregnant women in their third trimester who planned to breastfeed were recruited from local prenatal clinics (n = 25). After delivery, six weekly home visits were conducted to collect human milk samples and 24-hour infant feeding recalls. Milk protein and lactose concentrations were measured utilizing Bicinchoninic Acid and Megazyme assays, respectively. Bivariate tests were carried out using a statistical significance of p < 0.05. Results: Majority (84%) of our participants were either African American or of Latino origin. About one-fourth of our participants were primiparous and the average monthly household income was $3,150 with an average household size of 4. In week 2 postpartum, 18 mothers had a 100% breastfeeding intensity, while in week 6 it decreased to 16 mothers. A significant difference in milk protein concentration was seen between exclusive and mixed-feeding mothers from weeks 2 to 6; meanwhile, for lactose concentrations, the significant differences were seen only in weeks 3 and 4 (p < 0.005). Protein changes were negatively associated with breastfeeding intensity (as breastfeeding intensity went up, protein decreased), while lactose changes were positively associated with breastfeeding intensity (protein r = -0.5578; lactose r = 0.6571). Conclusions: Significant associations between intensity of breast milk feeding and mammary gland involution markers highlight the sensitivity of the mammary gland to mixed feedings in the early postpartum period.

Surprisingly little is known about the effect of breastfeeding on the infant's immune system development. Systematic reviews have suggested the role of breastfeeding in the prevention against asthma, autoimmune diseases, inflammatory bowel disease, and childhood leukemia. However, studies on atopic disease suffer from reverse causation, small size, and those assessing food allergy (FA) have often relied on parent-reported outcomes. Randomized controlled trials (RCTs) are not possible for ethical reasons. In addition, epidemiological studies have not considered that there is a large interindividual variation in human milk (HM) composition and feeding at the breast versus pumped HM potentially impacting the effect of breastfeeding between mothers. While prevention strategies such as early introduction of highly allergenic food are impactful in preventing peanut and egg allergies, implementation of early introduction guidelines has been slow, and many infants are already sensitized by 4-6 months of age. To be more effective, primary prevention strategies must commence much earlier, during breastfeeding. There are studies that imply a definitive effect of breastfeeding on the gut microbiome and regulatory T cells (Tregs) as well as a higher rate of FA in populations with historically low rates of breastfeeding. These provide a strong rationale for assessing the effect of feeding HM in the context of HM composition and mode of feeding on immune development. The lack of well-conducted, large studies assessing the role of breastfeeding and HM composition in the development of immune system development is a significant gap when designing prevention strategies.

Background: Pasteurized donor human milk must be provided when mother's own milk (MOM) is not available for preterm infants. There are concerns that human milk banks (HMBs) and the use of donor milk may potentially reduce breastfeeding rates. Objective: To compare feeding during hospitalization and at discharge before and after the opening of a HMB and to evaluate the proportion of milk provided by mothers of premature babies, comparing the intake of MOM in infants born of donor and no donor mothers. Methods: Retrospective observational cohort study. Data on milk intake and feeding at discharge of newborns <1,500 grams and/or 32 weeks gestational age. Results: There were significant differences in the intake of preterm formula (PF) between the two groups in the first 28 days of life (87.8% versus 54.2%; p = 0.000) and at discharge (34% versus 18.2%; p = 0.000). The intake of MOM during hospitalization (90.5% versus 100%; p = 0.008) and exclusive breastfeeding at discharge (18.7% versus 61.8%; p = 0.000) increased and the intake of PF (71.4% versus 33.8%; p = 0.000) and exclusive PF (EPF) at discharge decreased (27.5% versus 7,3%; p = 0.000) for babies whose mothers were or were not donors. Mothers of preterm babies donated 57.6% of the total milk received by the milk bank. Conclusion: After the opening of a HMB, there was a decrease in PF intake during hospitalization and an increase in MOM intake at discharge in preterm babies, especially for those whose mothers were milk donors.