Breastfeeding Medicine最新文献

Background: Prematurity presents numerous barriers to mother's own milk (MOM) feeding and direct breastfeeding (DBF). Aim: This study aimed to determine factors associated with MOM feeding and DBF at discharge from the neonatal intensive care unit (NICU) in preterm-born infants presenting with feeding difficulties. Methods: A retrospective study of data from 237 preterm-born infants referred for evaluation of feeding difficulties and discharged home on full oral feeds was examined. Maternal and infant characteristics and oral feeding milestones were examined for their association with MOM intake and DBF at discharge using bivariate and multivariate regression analyses. Results: MOM feeding at discharge occurred in 35.4% (n = 84) infants. The odds of any MOM feeding at discharge were higher with higher maternal age, absence of maternal substance use, and fewer days between full per oral (PO) and discharge (all, p < 0.05). Among the 84 MOM-fed infants, 4.76% (n = 4) were exclusively breastfed, whereas 39.3% (n = 33) were partially DBF at discharge. The DBF infants had higher birthweight, no incidence of being small for gestational age, lower incidence of respiratory support at birth and intraventricular hemorrhage, lower postmenstrual age (PMA) at full PO, shorter duration from first PO to full PO, and lower PMA at discharge (all, p < 0.05). Conclusion: We found reduced use of MOM and DBF among preterm-born infants with feeding difficulties at NICU discharge. Clinical management and research advocacy must focus on targeted interventions in this setting by recognizing significant modifiable factors applicable to prepregnancy, pregnancy, NICU, and postdischarge care.

Background: Statins are historically contraindicated during breastfeeding due to theoretical concerns of disruptions in infant development from drug exposure and nutritional changes in milk. Breastfeeding mothers requiring statins often discontinue statins or postpone treatment until breastfeeding cessation, contributing to delays in treatment up to 14 years. This study aims to determine the transfer of atorvastatin and its active metabolites into human milk and evaluate the infant's risk of drug exposure. Materials and Methods: Milk samples and health information were released from the InfantRisk Human Milk Biorepository for three women taking 20 mg, 40 mg, and 80 mg of atorvastatin daily at steady state conditions. The concentration of atorvastatin (AT) and its active metabolites, ortho-hydroxy AT (2OH AT) and para-hydroxy AT (4OH AT), was quantified in timed milk samples using liquid chromatography-mass spectrometry. Results: The highest absolute infant dose of AT was 0.00027 mg/kg/day, and the highest weight-adjusted relative infant dose of the combined analytes was 0.09%, far below established thresholds for infant safety. Milk cholesterol levels were within previously established norms in the range of 10 mg/dL. The mothers reported no adverse outcomes in the two exposed infants. Conclusions: The transfer of atorvastatin and its metabolites was exceedingly low. While the impact on milk composition in states of hyperlipidemia (whether treated or untreated) is not well understood, it is unlikely that the drug in the milk would be present in clinically significant levels to adversely affect a breastfed infant.

Background: Despite the known benefits of lactation, lactating graduate medical education (GME) trainees encounter difficulties when returning to work. Wearable lactation pumps are known to be beneficial in lactating physicians, but the benefit for GME trainees in clinical care and education has not been explored. Objectives: The objective of this study was to examine the benefits of wearable lactation pumps on education and clinical care for GME trainees. Methods: In 2022-2023, all lactating GME trainees at a large academic center were invited to participate in a wearable pump pilot. Participants completed six baseline surveys with questions on lactation practices and individuals' perceptions before receiving the pump, repeated the six surveys after receiving the pump, and completed a monthly survey for 6 months after receiving the pump. A linear mixed methods model was used to compare reported experiences before and after receiving the wearable pump. Results: Twelve trainees participated in the pilot, with 10 completing pre- and post-surveys. When compared with experiences before receiving the wearable pump, there was a significant decrease in the perceived impact of lactation on clinical care (p = 0.03), medical education (p = 0.004), and missed pumping sessions (p = 0.02) after using the wearable pump. All participants who used the wearable pumps reported that it helped them to meet lactation goals. Conclusions: Wearable pumps are beneficial to trainees and may decrease the barriers to education and clinical care. GME sponsored pump programs may better support lactating trainees on their return to work.

Objective: The aim of this study was to examine effects of the 2022 infant formula shortage as experienced by neonatal intensive care units (NICUs) in the United States, a previously unreported perspective. Methods: A mixed-method approach was utilized. Data were collected using an online survey of NICU medical directors. Quantitative data were analyzed with descriptive statistics and Student's t test. Thematic analysis was utilized to make sense of patterns within the qualitative data. Results: Responses from 139 medical directors were received. Both academic (41.7%) and community (58.3%) NICUs were represented among respondents. Thirty-nine percent of NICU medical directors reported an impact on their unit by the infant formula shortage. Within the qualitative data four themes were revealed as follows: alterations to discharge planning, policy modifications, suboptimal solutions, and extraordinary measures. These themes may inform strategies for mitigation of future infant formula shortages. Conclusions: NICUs were significantly impacted by the infant formula shortage with likely lasting effects. From the reported experiences, clear recommendations have been formed to minimize effects of future infant formula shortages.

Background: Human milk is considered the optimal source of nutrition for infants. Maternal diet is associated with the composition of human milk. The Mediterranean diet (MedDiet) has been studied in pregnancy and during lactation, and it has been associated with changes in milk composition, yet there is a lack of research on MedDiet during lactation and infant outcomes. Methods: Mother-infant dyads (n = 167) from ABC Baby, a prospective observational study, were included in this analysis. Maternal diet was obtained using an adapted version of the National Cancer Institute Diet History Questionnaire II, at 2 weeks or 2 months postpartum. Maternal MedDiet score was calculated using servings of vegetables, fruits, whole grains, nuts and seeds, legumes, fish, monounsaturated-to-saturated fatty acid ratio, red and processed meats, and added sugar. Infants' length, weight, and flank skinfold thickness were measured at 6 months. Using World Health Organization standards, weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) Z-scores were calculated. Multiple linear regression models were adjusted for potential confounders. Results: Higher maternal MedDiet score and intake of fruit and fish were associated with lower flank skinfold thickness (β = -0.33, -0.52, and -1.26, respectively). Intake of nuts and seeds was associated with higher WLZ (β = 0.29). Intake of red and processed meats was associated with lower WAZ (β = -0.18) and LAZ (β = -0.18). Energy-adjusted added sugar intake was associated with lower WLZ (β = -0.02). Conclusions: The maternal MedDiet score was associated with lower skinfold thickness, while its components were associated with differences in anthropometric Z-scores. Further research on the maternal MedDiet and corresponding human milk composition is needed to explore this relationship.

Background: Breast milk is essential for the development of a newborn's neurological, gastrointestinal, and immune systems and helps reduce the risk of infections and infant mortality. Banana flowers, often combined with additives such as ginger, are commonly included in the country's local diets because they are believed to enhance postpartum lactation. We aimed to investigate the impact of banana blossom extract pills on breast milk volume (BMV) in mothers of preterm newborns. Methods: A randomized, double-blind, placebo-controlled trial was conducted; it involved eligible preterm mothers, who were divided into two groups: a banana blossom group, which received banana blossom extract pills (36 mg/day), and a control group, which received placebo pills. All participants were given identical-looking tablets and were required to chew two tablets four times a day for 14 days. The primary outcome was the total BMV expressed (in milliliters) on the seventh day using an electric breast pump. Results: A total of 70 mothers of premature newborns were randomly allocated in equal numbers to either the banana blossom intervention group or the control group. There was no significant difference between the groups with respect to the median BMV on the seventh day postpartum (333 versus 350 mL, p = 0.73). A similar trend was observed on the 14th day postpartum (331 versus 510.0 mL, p = 0.6). Additionally, no significant differences were observed regarding maternal and neonatal adverse events. Conclusions: The administration of banana blossom extract pills (36 mg/day) to mothers with preterm infants did not increase the BMV on the seventh day postpartum.

Purpose: It is known that despite the benefits of breast milk and breastfeeding, children with Down syndrome (DS) are breastfed less than other children are. More information is needed to reveal the problems experienced regarding breastfeeding in this group of children and take precautions. The purpose of this study was to learn about the breastfeeding experiences of mothers of children with DS. Methods: The study was carried out by conducting in-depth interviews with 17 women who met the inclusion criteria in Turkey between September 1 and December 1, 2023. Content analysis was used to analyze the data. Results: As a result of the content analysis, five themes emerged. These themes were changing of body and emotions, why doesn't my baby suck?, I have to breastfeed my baby, I am not alone, and experiences should be shared. Conclusions: It was determined that mothers of children with DS experienced problems/difficulties due to individual, baby-related, and environmental factors. The positive effects of breastfeeding children with DS can be made prevalent in society by supporting these mothers.

Objective: This study examined the effect of breast milk on oral care practices in neonatal intensive care units. Methods: This study involved 64 preterm infants (intervention/breast milk: 32, control/distilled water: 32) and was carried out with a prospective, parallel, randomized controlled design. The "Newborn Oral Health Assessment Tool (NOHAT)" was used to assess oral care. The Mann-Whitney U test, continuity correction test, Fisher's exact test, independent-samples T test, and Wilcoxon signed ranks test were used to analyze the data. Results: Examining the oral care performed using breast milk and distilled water with NOHAT scores, it was determined that there was a significant difference in the intervention group (p < 0.05). Conclusions: It is recommended to use breast milk for oral care.