Breastfeeding Medicine最新文献

Background: Cow's milk protein allergy (CMPA) is the most common food allergy in infants. The current standard of care (SOC) involves eliminating the allergen from both the infant's and mother's diet for 2-4 weeks. The purpose of this study is to assess the effectiveness of Lactobacillus rhamnosus (Ramnoflor) in reducing the duration of bleeding in these infants. Methods: This randomized clinical trial was conducted at Bahrami Children's Hospital on breastfed infants who were diagnosed with CMPA and had a positive occult blood (OB) test. Patients were randomly assigned to either the control or case groups. All patients received SOC therapy, with the case group receiving Ramnoflor and the control group receiving a placebo. Data were recorded on the checklist, and the children were followed and visited three times during the study, with an OB assessment at each visit. Results: The study enrolled 48 infants. Among the infants in the case group, the OB test was positive in four cases (8.3%) on the fifth day. However, there were no positive cases on the 14th and 30th days. The prevalence of this test was significantly lower in patients who received probiotics compared to the control group on the fifth day (p < 0.001). There were no positive OB tests on the 14th and 30th days in any of the groups, and no significant difference was observed between the groups. Conclusion: The addition of L. rhamnosus to SOC therapy led to a decrease in the duration of rectal bleeding in infants with CMPA compared to the control group.

Objective: To analyze the factors associated with weaning in infants with cow's milk allergy (CMA) treated at a food allergy reference center in a state in the northeast of Brazil. Method: A prospective cohort study, with a case group (children with CMA) and two control groups (symptomatic nonallergic children [SC] and asymptomatic [AC]). At the beginning of the study, 30 children comprised the CMA group, 84 the SC group, and 52 the AC group. Survival analysis was performed to compare breastfeeding time between the three groups and an adjusted linear regression model to verify the factors associated with breastfeeding time. Results: At the beginning of the study, 33.3% of children in the CMA group, 17.1% in the SC group, and 69.6% in the AC group were exclusively breastfeeding (p = 0.005). The most common factors for weaning in children with CMA were the cow's milk elimination diet (30%), allergic symptoms in the child (20%), and breast engorgement (20%). Children who used a cup as a means of offering infant formula spent 281 more days breastfeeding compared with those who used a baby bottle (B^std = 1.39; p = 0.031). Conclusion: Children with CMA and nonallergic gastrointestinal complaints weaned earlier compared with asymptomatic children. The main causes of weaning in CMA children were maternal difficulty adhering to the elimination diet, breast engorgement, and allergic symptoms in the child. Using a cup was the main factor associated with longer breastfeeding duration, regardless of gastrointestinal symptoms and socioeconomic factors.

Objectives: This study aimed to investigate the influence of newborns' sex on the concentrations of minor and trace elements in the human milk of lactating mothers during early lactation. The elemental analysis focused on calcium (Ca), potassium (K), sodium (Na), and chlorine (Cl) as minor elements and iodine (I), aluminum (Al), bromine (Br), and rubidium (Rb) as trace elements. Methods: Breast milk samples were collected from 75 lactating mothers in Tehran, Iran, during the early feeding stage. Neutron activation analysis was used to quantify elemental amounts in milk samples, and t tests were conducted to identify statistical differences in element levels between mothers of male and female newborns. Results: Statistically significant differences in the elemental composition of milk samples were found based on newborn infants' sex. Mothers of female newborns had notably higher mean levels of Br (14.8 mg/kg versus 11.3 mg/kg, p = 0.011), Cl (10.16 mg/g versus 7.10 mg/g, p = 0.009), and Na (6.18 mg/g versus 4.45 mg/g, p = 0.017) compared with mothers with male newborns. Although Ca, K, I, Al, and Rb did not show statistically substantial differences, there was a trend toward elevated levels of Al, I, and Ca in the milk of mothers with the females. Conclusion: The analysis reveals sex-based variations in human milk composition, with elevated levels of Br, Cl, and Na observed in mothers of female newborns. These findings suggest that infant sex may influence the elemental profile of maternal milk, highlighting the need for further research to uncover the mechanisms behind these differences and their potential implications for improving infant nutrition and health.

Background: Transfeminine individuals are capable of developing breast tissue that is indistinguishable from cis-females, allowing them to breastfeed effectively. Breastfeeding affords known health benefits for both members of a lactating individual-infant dyad and supporting this experience for transfeminine individuals fosters reproductive equity. Objective: This study assessed experiences, attitudes, and knowledge regarding breastfeeding and lactation among a group of transfeminine individuals receiving hormone therapy within a specialized gender care clinic. Methods: Transfeminine individuals on estrogen therapy who were part of the Duke Research for Equitable Access to Medicine (DREAM) Registry were invited to complete a 15-question online survey about experiences, goals, attitudes, and knowledge regarding lactation and breastfeeding. Results: A total of 71 out of 130 eligible DREAM individuals completed the survey (54.6%). No survey participants had breastfed and three (4.2%) had experienced lactation. One in four participants designated lactation a health care goal. Four out of five participants reported it was important, most commonly to affirm their gender identity (n = 41, 57.7%) and/or to bring their breasts to full maturity (n = 36, 50.7%). One in eight participants designated breastfeeding as a health care goal. Four out of five participants reported it was important, most commonly for parent-child bonding (n = 34, 47.9%) and/or health/nutritional benefits to the newborn (n = 34, 47.9%). Conclusion: Transfeminine individuals may be interested in experiencing lactation for multifaceted reasons, including goals for parent-infant feeding (breastfeeding-dyad bonding and breast milk health benefits) and for their gender transition (affirming gender and breast maturity). Future community-engaged research is warranted to inform both clinical practice and lactation protocols for transfeminine individuals hoping to breastfeed.

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.

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: 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 and Objective: Tryptophan is an essential amino acid that is not produced in the body and can only be consumed through diet. Tryptophan is a precursor for serotonin, which, in turn, helps produce melatonin. Melatonin exhibits a circadian rhythm, peaking at night and dissipating during the day, with basal levels significantly differing between mothers. Both tryptophan and melatonin are found in breast milk. The aim of this project is to determine if the variations in tryptophan levels found in breast milk are related to the amount of melatonin detected in breast milk and the amount of tryptophan consumed in a mother's diet. Method: Three hundred and eighty breast milk samples were collected by participants at four timepoints across 5 consecutive days, along with a food diary. Melatonin and tryptophan in these samples were measured. Results: No significant relationship was found between tryptophan and melatonin in breast milk or diet. There were also no significant changes in tryptophan across the day or night, suggesting no circadian rhythm timing like melatonin. Discussion: The findings from this study differ from earlier research, suggesting that more work needs to be completed in this area to understand the variation of melatonin in breast milk across mothers.

Background: This study investigated the association between feeding practices and the development of childhood intussusception. Materials and Methods: We conducted secondary data analyses using the Longitudinal Survey of Newborns in the 21st Century in Japan. We performed multivariable logistic regression analyses to examine the association between feeding practice and intussusception development in children aged between 6 and 18 months. We used the following variables as potential confounders: gender, gestational age, birth weight, singleton or multiple births, parity, maternal age at delivery, maternal smoking status, and paternal smoking status. Furthermore, we performed multivariable logistic regression analyses to examine the association between breastfeeding duration and intussusception development. Results: In total, 31,802 children were analyzed in this study. The annual incidence of intussusception was 1.6 cases per 1,000 children aged between 6 and 18 months. No significant association was found between exclusive breastfeeding and the development of intussusception, compared with exclusive formula feeding (odds ratio, 1.64; 95% confidence interval, 0.32-30.0). Furthermore, no significant association was observed between breastfeeding duration and intussusception development. Conclusions: Our findings demonstrated no association between breastfeeding and the development of childhood intussusception.

Objective: Donor human milk (DHM) can provide many benefits to neonates. This study examines access to DHM and how structural barriers may exacerbate inequities. Study Design: The median test and analysis of variance test were used to compare the distribution of maternal race/ethnicity and insurance status variables with DHM access for California neonatal intensive care units (NICUs) in 2021. Results: Across 124 NICUs, those serving a higher percentage of white families were more likely to have access to DHM (p = 0.04). NICUs with a higher percentage of Hispanic families were less likely to have access to DHM (p = 0.03). Hospitals that had higher proportions of uninsured patients were also less likely to have access to DHM (p = 0.015). Conclusion: Inequities in DHM access and use among NICU infants begin at the structural level. Policies that reduce barriers to DHM access may reduce health inequities for Hispanic and uninsured families.