Breastfeeding Medicine最新文献

Background: Early introduction of complementary foods (CF) before 4 months of age is associated with potential negative health outcomes for infants and is not nutritionally necessary prior to 6 months. This study examined trends in the introduction of CF prior to 4 months and prior to 6 months among U.S. children. Methods: This study utilized National Survey of Children's Health data from 2016 to 2023, pooling data into 2-year increments. The analytic sample was restricted to children aged 9 months to 1 year old living with a biological or adopted mother. CF introduction before 4 months and before 6 months of age were constructed as binary indicators. Percent change in demographic characteristics was calculated alongside descriptive statistics to examine time trends in population characteristics between 2016/2017 and 2022/2023. Data were weighted to be nationally representative. Results: Between 2016/2017 and 2022/2023, the percentage of infants introduced to CF before 4 months decreased from 11.6% (95% CI: 0.09, 0.14) to 6.0% (95% CI: 0.05, 0.07), a 48.1% percentage reduction. Similarly, CF introduction before 6 months decreased from 43.1% (95% CI: 0.39, 0.46) to 30.7% (95% CI: 0.28, 0.32); a 28.9% percentage reduction. These decreases were accompanied by increases in mothers who were older, had higher education, and were in higher-income households. Conclusion: The United States has seen a decrease in the introduction of CF prior to 4 months and prior to 6 months. While this trend is promising, clinicians should consider providing additional education to parents on assessing infant readiness for CF and the importance of introducing CF at approximately 6 months of age.

Background: Breastfeeding offers significant health benefits to both infants and mothers, including long-term protection against chronic diseases. It is supported as a fundamental right by global health organizations. Despite the integration of breastfeeding education into medical curricula, supportive policies for medical students who are mothers are often lacking, potentially impacting their academic and personal well-being. The objective of this study was to investigate the existing barriers to motherhood and breastfeeding in undergraduate medical education in order to provide policy recommendations to better support this student demographic. Methods: This qualitative study employed constructivist grounded theory through semi-structured interviews with 17 Canadian medical students, residents, or fellows who were or became mothers during medical school. Participants were recruited via social media, and data was collected and analyzed using NVivo software, with iterative coding and theme development by the research team. Results: Three main themes emerged: inadequate lactation infrastructure, unfavorable power dynamics affecting accommodation requests, and internal and external pressures influencing breastfeeding and career decisions. Participants highlighted significant challenges, including the lack of accessible lactation spaces, inconsistent policies, and stress related to advocating for breastfeeding needs. Conclusion: This study reveals a disparity between the teachings on breastfeeding importance in medical education and the practical support provided to breastfeeding students. Formalized, transparent policies are needed to support lactating medical students, ensure equity, and align institutional practices with educational objectives. Recommendations include designated lactation spaces, flexible scheduling, and standardized policies to foster an inclusive learning environment for all students.

Background: More than 20% of newborn infants in the United States are fed formula to supplement breastfeeding in their first 2 days. Most hospitals that provide pasteurized donor human milk (PDHM) for supplemental feeding limit its use to infants <32 weeks' gestation or <1,500 g at birth. Cost is one perceived barrier to PDHM use among late preterm or full-term infants that do not meet premature age or low birth weight criteria. Objectives: The aim of the project was to identify and describe the current literature on the financial feasibility of providing donor breast milk instead of formula among a wider population. Methods: We performed an integrative review using The Johns Hopkins Evidence-Based Practice Model framework for article appraisal. The search used PubMed, CINAHL and JBI electronic databases for articles from 2011 to 2022. Results: From 536 articles retrieved, five met criteria for inclusion. Analyzed articles reported on trends, indications, costs, and accessibility of PDHM. Results revealed various methods of incorporating PDHM in their operational budget. Conclusions: Use of PDHM instead of the formula is increasing for supplementation. Facilities using PDHM beyond these limits have included its costs in their operational budget. This article reveals the multifactorial elements that contribute to the cost of PDHM, thus underscoring the lack of evidence demonstrating cost as a barrier to providing PDHM for infants >32 weeks or >1,500 g. More studies are needed to identify the cost-benefit ratio of the use of PDHM for this population.

Objective: To compare the effectiveness of different breast pumping interventions in breastfeeding for preterm mothers during the first 14 days postpartum. Study Design: In a single center, 69 preterm mothers were randomly allocated into three groups. Experimental Group 1 used a hospital-grade electric breast pump from postpartum days 1 to 14. Experimental Group 2 used a hospital-grade electric breast pump from postpartum days 1 to 5 and a personal standard bilateral electric breast pump from postpartum days 6 to 14. The control group used a personal standard bilateral electric breast pump from postpartum days 1 to 14. This study compared daily breast milk volume, time to lactogenesis II, and proportions of exclusive breast milk at 7 days, 3 months, and 6 months postdischarge. Results: The median daily milk volume was significantly higher in the experimental groups than in the control group from postpartum day 5 to day 14 (p < 0.05). Milk volume on postpartum days 5 and 14 showed a significant positive correlation (r = 0.74). The mean onset of lactogenesis II for all participants was 52.91 ± 17.30 hours, with significant differences among the groups (p = 0.018). Exclusive breast milk proportions were significantly higher in the experimental groups at 7 days and 3 months postdischarge (p < 0.05) but did not differ at 6 months (p = 0.143). Conclusions: Early use of a hospital-grade electric breast pump (within the first 5 days postpartum) promotes lactation in mothers of preterm infants, shortens the onset time of lactation, and improves exclusive breast milk proportions within 3 months postdischarge. These findings suggest that this approach is clinically beneficial and worth broader application.

Introduction: Breastfeeding disparities persist in Los Angeles County (LAC), particularly among communities of color, low-income families, and those with lower educational attainment. A key factor contributing to these disparities is the lack of racial and ethnic diversity among lactation professionals, particularly International Board-Certified Lactation Consultants (IBCLCs), limiting access to culturally congruent care. This study examines the demographic characteristics, certification status, and barriers to credentialing among lactation professionals in LAC. Methods: A cross-sectional survey was distributed by BreastfeedLA to lactation professionals serving LAC. The survey assessed sociodemographic information, lactation education, employment status, and barriers to certification. Descriptive analyses and chi-square tests were used to examine associations. Results: Among 483 respondents, the majority were White (60.5%) and female (83.7%). Lactation educators (47.2%) were the largest group, followed by peer counselors (24%) and IBCLCs (20%). Barriers to IBCLC certification included time constraints (24.8%), financial burden (13.4%), and family obligations (8.3%). Conclusion: Despite challenges, 78% of non-IBCLCs intended to pursue certification. Workforce diversity remains limited, reinforcing breastfeeding disparities. Expanding access to lactation training, financial support, and mentorship is critical for fostering a more inclusive workforce and improving breastfeeding outcomes in underserved communities.

Objectives: To define the safe weight loss percentile threshold for the development of hypernatremia by using the "early weight loss nomograms." Methods: This retrospective study included exclusively breastfed healthy neonates over 36 weeks' of gestation. (n = 450). Daily percentage points of weight loss were plotted on the "early weight loss nomograms for exclusively breastfed neonates." The presence of hypernatremia was checked if infants lost ≥5% of their birth weight. Hypernatremia was classified as mild, moderate, or severe. The relation of weight loss rates and percentiles to development of hypernatremia was assessed. Results: The mean gestational age was 38.6 ± 1.3 (36.0-42.3) weeks; the mean birth weight was 3,200 ± 482 g. The mean total weight loss percentage before discharge was 5.9% ± 1.6% (0.5%-17%). The weight loss percentages within first 24 hours were similar in infants born via cesarean section or vaginal delivery (6% ± 1.6% vs. 5.4% ± 1.7%). Mild or moderate hypernatremia developed in 145 infants (32.2%). ROC analyses showed that weight loss of ≥5.5% could predict the development of hypernatremia (AUC = 0.665) and weight loss of ≥7% could predict the development of moderate hypernatremia (AUC = 0.915). Weight loss percentile of ≥75 could also predict the development of hypernatremia with 73% sensitivity and 46% specificity (AUC = 0.622). Conclusion: To the best of our knowledge, this is the first study to evaluate the relationship between weight loss nomogram percentiles and the development of hypernatremia. Even if the weight loss is within the defined acceptable normal ranges and percentiles, hypernatremia may develop if the weight loss is greater than the 75^th percentile values.

Introduction: Breastfeeding is considered the ideal source of infant nutrition and has been shown to enhance maternal-infant health, but most women do not achieve their breastfeeding goals. Significant racial, ethnic, and socioeconomic disparities exist in breastfeeding outcomes. While current literature indicates a positive association between doula support and breastfeeding, the specific breastfeeding outcomes impacted by doulas remain unclear. Our objective was to synthesize existing literature on breastfeeding outcomes when doulas are utilized. Methods: Electronic searches were conducted in February 2022 and updated in April 2024 to include primary studies that examined doula support and breastfeeding outcomes (intention, initiation, duration, exclusivity, support, knowledge, education). Studies were excluded if they were secondary research or outside the perinatal period (pregnancy, childbirth, and/or up to 1 year postpartum). Data were extracted and synthesized narratively, and risk of bias was assessed. Results: A total of 1,917 deduplicated studies were screened, and 32 were included. Twenty-two studies were quantitative, and 10 studies were qualitative or mixed methods. Most studies (n = 24) consisted of birthing populations that experience marginalization, such as adolescents, low-income status, and racially/ethnically minoritized groups. Although doula support was associated with improved breastfeeding outcomes overall, there were mixed findings regarding breastfeeding duration and exclusivity. Lactating clients found doulas to be an important source of breastfeeding support, education, and knowledge. However, doulas reported a need for increased breastfeeding education during their training. Health care providers had limited knowledge of doulas' role in promoting breastfeeding. Conclusion: Doulas are associated with improved breastfeeding outcomes. Increased breastfeeding education in doula training and greater inclusion and awareness of doulas among the health care team could maximize this benefit.

Objective: Surgical correction of ankyloglossia through frenotomy has increased over 10-fold in the past decade, despite not seeing any significant improvement in breastfeeding rates. Due to heightened attention to this diagnosis and lack of consensus on treatment, we sought to evaluate our regional practice and standardize the screening for ankyloglossia. Materials and Methods: A retrospective cohort study of frenotomy practice within the birth hospital stay was conducted from June 1, 2019, to June 30, 2021. Patients were identified through billing data and grouped according to race, ethnicity, and health insurance status. The Tongue-tie and Breastfed Babies pictorial tool was then implemented regionally to test for differences. Post-intervention data was analyzed from June 1, 2023, to December 31, 2024. Chi-squared analysis was performed to test for differences. Results: Pre-intervention, there were significant disparities in frenotomy rates, with privately insured patients 2.75 times more likely than those with public insurance to receive a frenotomy during their birth hospitalization (OR 2.75, 95% CI: 2.43-3.12, p < 0.0001). Non-Hispanic White infants were 2.3 times more likely than non-Hispanic Black patients (OR 2.31, 95% CI: 1.94-2.74, p < 0.0001) and 3.9 times more likely than Hispanic infants to undergo the procedure (OR 3.87, 95% CI: 2.19-6.86, p < 0.0001). After the standardization, there were no longer any statistically significant disparities in frenotomy rates by insurance payor status as well as those between non-Hispanic White and non-Hispanic Black patients. Non-Hispanic White infants were still slightly more likely than Hispanic patients to undergo the procedure, but the odds ratio decreased significantly to just 1.37 (OR 1.37, 95% CI: 1.04-1.80, p = 0.0265). Conclusion: These findings suggest that standardizing the assessment of ankyloglossia can improve disparities among those who receive a frenotomy.

Introduction: Infants have an immature immune system, making them more susceptible to infectious diseases, including otitis media (OM). Breastfeeding is known to reduce OM risk. Although cytokines in breast milk regulate immune functions, their association with OM incidence is underexplored. This study investigated the breast milk cytokines associated with OM in infancy. Methods: A case-control study was conducted using mother-child pairs from the Chiba Study of Mother and Child Health (16 cases, 53 controls) with a history of OM. Breast milk samples were collected at three time points (colostrum, 1 month, and 4 months postpartum), and cytokine concentrations were measured. We compared cytokine levels between cases and controls and analyzed differences between primiparous and multiparous mothers, including subgroup analysis for multiparous mothers. Results: Children in the case group were more likely to have multiparous mothers. Cytokine concentrations were highest in colostrum and decreased over time, except for interleukin-7 (IL-7), which increased at 1 month postpartum. However, among multiparous mothers, IL-7 concentration was higher in the control group at 1 month postpartum (66.3 [45.7, 84.7] versus 14.1 [0.00, 42.5] pg/mL). Conclusions: IL-7 in mature breast milk significantly prevents OM, potentially in infants born to multiparous mothers. Trial Registration: This trial was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (trial registration number: UMIN000046221, registration date: 29/11/2021).