Breastfeeding Medicine最新文献

Background: The Baby-Friendly Hospital Initiative is a WHO-UNICEF evidence-based initiative aiming to improve quality of care in maternity facilities through global implementation of the Ten Steps to Successful Breastfeeding as standards of perinatal care. Although each step is evidence-based, all Ten Steps are intended to work synergistically. Step 1b requires maternity facilities to adopt an infant feeding policy that supports breastfeeding. Key Information: This protocol updates the Academy of Breastfeeding Medicine's 2018 Model Maternity Policy Supportive of Breastfeeding and gives readers the most recent evidence basis. It includes a model policy that can be adapted to local needs. Its strength lies in the synergy of all its components. The importance of protecting families from the harmful influence of the commercial milk formula industry is stressed. The policy includes recommendations to verify health workers' competencies to adequately support breastfeeding, to offer prenatal education on breastfeeding to mothers and families, guidance for respectful and patient-centered care during childbirth, and immediate and postnatal support for mother and child. Safety issues are considered. Tools for implementation are included. Recommendations: Maternity facilities must have a policy that protects and supports breastfeeding. It should include all the Ten Steps, which must be implemented as a whole package. External assessments are recommended to ensure compliance with requirements. Continuous monitoring of practices should be routine. Ensuring that health workers who deal directly with mothers and infants have the competencies needed to protect and support breastfeeding through counseling and person-centered care is strongly recommended.

Background: The field of breastfeeding and lactation medicine (BFLM) is a developing area of clinical expertise among physicians and advanced practice providers, though it remains poorly described in the literature. We aimed to (1) characterize the workforce of U.S. prescribing clinicians who deliver BFLM and the clinical care they provide and (2) explore clinicians' perceived barriers, facilitators, and attitudes related to BFLM care. Methods: We performed a descriptive, cross-sectional study of U.S. clinicians who self-identify as BFLM clinicians. Inclusion was limited to medical clinicians who (1) hold a license to prescribe medication (physicians, advanced practice providers) and (2) independently diagnose and manage breastfeeding-related concerns or complications. Results: Our sample of 138 U.S. clinicians had a median of 8 years of BFLM clinical experience and included physicians (81%), nurse practitioners (13.0%), midwives (3.6%), and physician assistants (2.2%). Among clinicians within large healthcare organizations, 20% held BFLM-related positions/titles. Of clinicians who delivered dedicated outpatient BFLM care, 64.5% offered telehealth, 67.4% billed for mother and infant, and 43% offered outpatient frenotomy. A median wait time of 5 days for initial BFLM outpatient evaluation was reported. Few participants provided inpatient and electronic consultation services (i.e., "e-consult") dedicated to BFLM. Most agreed that BFLM care addresses critical gaps in U.S. healthcare (95%). Conclusions: We present the first description of a national sample of U.S. prescribing clinicians who practice BFLM. These findings may assist clinicians and organizations in implementing BFLM care and underscore a need for future research around the integration and impact of BFLM care within U.S. health systems.

Background: Perinatal opioid use disorder (OUD) remains prevalent in the United States and is associated with unfavorable breastfeeding outcomes, including low likelihood of initiation and decreased duration. Individuals with OUD face heightened risk for traumatic events across the life course, though we know little about how life stress impacts breastfeeding in those with OUD. Method: We investigated the differential and sequential impacts of adverse childhood experiences (ACEs) and past-year stressful life events (SLEs) on breastfeeding outcomes in a prospective cohort study of 50 pregnant individuals (100% identified as female, 42% non-Hispanic White, 42% Hispanic/Latina) in treatment for OUD, followed through 5 months postpartum. Results: Out of 50 participants, 37 (74.0%) initiated breastfeeding, 16 (32.0%) reported continued breastfeeding in any capacity at 2 months, and 5 (10%) reported exclusive breastfeeding at 2 months. Higher ACE scores were associated with increased odds of breastfeeding initiation (odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.11-16.34) and longer duration (B = 0.33, 95% CI: 0.04-0.60), suggesting resilience to early childhood adversity. Mediation analyses adjusted for demographic covariates revealed a significant indirect effect from higher ACEs to reduced likelihood of exclusive breastfeeding (β = -0.09, 95% CI: -0.09, -0.001, p = 0.04) via greater SLEs in the year prior to birth (β = 0.33, 95% CI: 0.06, 0.68, p = 0.01). Conclusions: Results highlight the importance of addressing both lifetime and recent trauma in clinical settings to improve breastfeeding outcomes in higher-risk populations. Interventions that incorporate social and behavioral support may be particularly beneficial to mitigate the negative impacts of stress on breastfeeding.

Introduction: There is little in the current literature regarding breastfeeding after a previous spinal cord injury (SCI). Potential concerns include challenges with let-down reflex and autonomic dysreflexia. This study aims to assess SCI- specific breastfeeding challenges as well as duration of breastfeeding in this population. Methods: This study is a subgroup analysis of a larger online international questionnaire distributed to women with SCI. Pregnancies following SCI resulting in live births >20 weeks were included. Demographic information, breastfeeding outcomes, and perceived support were assessed. Results: The recruitment rate was 85.4% (1,056/1,237) and completion rate was 73.8% (780/1,056). The pregnancies were from individuals with SCI levels C1-T9. 129/159 live births were followed by an attempt to breastfeed, and of these, 111 were successful in breastfeeding for a minimum of 2 weeks. Nine were affected by autonomic dysreflexia (AD). For 4/9 (44%) individuals, it was their first episode of AD. If a person had previous episodes of AD, there was a 2/52 (4%) chance of this being triggered by breastfeeding. In total, 28/210 (13%) had difficulty with let-down reflex (levels ranged from C4 to S1). Conclusions: Overall the majority of people who had a pregnancy following SCI attempted to and were successful in breastfeeding for at least 2 weeks. This outcome was regardless of the level of injury. Barriers in the form of AD or difficulty with let-down reflex were uncommon. This observational study should help encourage pregnant women post SCI and provide support for counseling by their health care providers.

Background: Breastfeeding and Lactation Medicine (BFLM) programs at academic medical centers have the potential to transform the care of lactating people. Our hospital system initiated a BFLM program in 2016, culminating in a division in 2022. Objectives: To describe the impacts of a multidisciplinary academic BFLM program in its first 8 years. Methods: We created an outpatient BFLM clinic and support group, increased BFLM and lactation consultant (LC) coverage, dedicated a medical director and nurse manager for lactation, and expanded University-wide education. In 2017, our neonatal intensive care unit (NICU) instituted a donor milk program. We started an in-person fellowship in 2017 and a virtual fellowship program in 2022. In 2019, we founded a lactation research consortium. These services coalesced to form the first Division of Breastfeeding and Lactation Medicine in 2022. We tracked our impact using process outcomes (numbers of providers, visits, grants) and patient outcomes (breastfeeding rates). Simple frequencies and p-control charts were used to track access to care and breastfeeding outcomes. Results: From 2016 to 2024, we increased inpatient and outpatient care by BFLM providers and LCs. Breastfeeding rates on the postpartum floors increased by 7% between 2016 and 2024 (p < 0.01). In the NICU, there was a trend toward increased patients receiving any breastmilk and discharged receiving any maternal milk. Challenges included staff training, reimbursement, medical record infrastructure, and creating/accessing accurate data reports. Conclusion: A multidisciplinary BFLM program at a large academic medical center showed promise for improving patient access to care and breastfeeding outcomes.

Background: Donated human milk (DHM) is vital for nutrition of preterm and critically ill infants when the mother's own milk is unavailable. For safety reasons, DHM is routinely pasteurized and stored frozen. The impact of storage duration and temperature on the stability of its nutritional values has not been sufficiently investigated. This study aimed to evaluate the stability of macronutrients and energy content in pasteurized DHM stored at -30°C and -80°C over a 12-month period. Methods: Pasteurized DHM samples from ten single-donor pools were divided into aliquots and stored at -30°C and -80°C. Nutritional value analyses were performed at baseline (pre-pasteurization) and at predetermined monthly intervals for one year using a human milk analyzer MIRIS HMA^TM (Miris AB, Uppsala, Sweden). Stability was assessed by comparing changes in macronutrients and energy content over time and between storage temperatures. Data were analyzed using statistical software MedCalc (version 14.12.0, MedCalc, Ostend, Belgium) with p < 0.05 considered statistically significant. Results: Macronutrient values remained stable throughout the study period. No statistically significant differences were observed, regardless of the storage temperature, except for protein concentration in samples stored at -80°C (p = 0.039). Given the low protein values (median at all measurement points was 1.0 or 1.1 g/100 mL), this difference is not considered clinically relevant. No significant differences in macronutrients or energy content were found between samples stored at -30°C and -80°C over the same period. Conclusion: The nutritional values of pasteurized DHM are preserved for up to 12 months just as well at -30° C as at -80°C.

Background: Lower respiratory infections (LRIs) are a leading cause of death in young children. Exclusive breastfeeding provides essential protection in early infancy, yet suboptimal practices remain common. This study assessed the global burden of LRIs attributable to suboptimal breastfeeding in infants under 6 months between 1990 and 2021 across 204 countries and territories. Methods: Using Global Burden of Disease 2021 data, we assessed LRI-related deaths, disability-adjusted life years (DALYs), and age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) attributable to suboptimal breastfeeding in infants under 6 months, defined as any nonexclusive breastfeeding. Temporal trends were assessed by estimating annual percentage changes (EAPCs) with 95% confidence intervals (CIs), and associations with the sociodemographic index (SDI) were examined via Spearman correlation. Results: In 2021, suboptimal breastfeeding accounted for 37,890 (95% uncertainty interval [UI]: 21,011-55,423) LRI-related deaths and 3.41 million (95% UI: 1.89-4.98 million) DALYs. From 1990 to 2021, global ASMR declined from 268.25 (95% UI: 150.00-396.23) to 59.71 (95% UI: 33.11-87.34) per 100,000 (EAPC: -4.31%, 95% CI: -4.54 to -4.08) and ASDR from 24,104.89 (95% UI: 13479.26-35602.58) to 5,366.53 (95% UI: 2975.75-7849.25) (EAPC: -4.31%, 95% CI: -4.54 to -4.08). In 2021, the burden peaked in the low-SDI quintile; Western Sub-Saharan Africa had the greatest regional burden, and Chad ranked the highest nationally. Conclusions: Although the global LRI burden from suboptimal breastfeeding has decreased substantially, it remains concentrated in low-SDI settings. Promoting early initiation and exclusive breastfeeding, alongside strengthened maternal-child health services, is essential to reducing preventable infant mortality.