Breastfeeding Medicine最新文献

Background: Donor breast milk (DBM) is often used to supplement maternal milk, especially for very low birth weight infants, a population vulnerable to suboptimal postnatal growth. The Holder pasteurization process used to ensure DBM safety reduces bioactive components, with unclear impact on preterm infant growth. Ghrelin and resistin are two hormones found in breast milk that may play roles in infant growth. This study aimed to evaluate changes in ghrelin and resistin concentrations in breast milk following pasteurization. Methods: Forty frozen, deidentified pooled expressed breast milk samples were heated to 63°C for 30 minutes and then rapidly cooled. Ghrelin and resistin were measured using enzyme-linked immunosorbent assays. Wilcoxon signed-rank tests assessed differences in hormone levels before and after pasteurization. Macronutrient composition was measured using a mid-infrared human milk analyzer, and associations with hormone levels were assessed using linear regression. Results: One paired sample was excluded due to unquantifiable assay results. Among the remaining 39 pairs, median prepasteurization concentrations were 11.05 pg/mL for ghrelin and 311 pg/mL for resistin. Pasteurization significantly reduced hormone levels, with median decreases of 36.7% for ghrelin and 24.3% for resistin (both p < 0.001). A moderate association was observed between resistin and protein content (R² 0.3399, p < 0.0001). Conclusions: Pasteurization significantly reduces ghrelin and resistin concentrations in breast milk. Further investigation is warranted to determine the clinical relevance of these hormonal changes, particularly in relation to growth outcomes in preterm infants.

Introduction: Human milk is the optimal source of nutrition and bioactives for infants, particularly preterm infants, who are at higher risk of morbidity and mortality. Many premature infants require pasteurized donor human milk (PDHM) to supplement their diet. Given the increased susceptibility of preterm infants to infections, PDHM is strictly regulated to ensure safety. Pasteurization of human milk eliminates most pathogens. However, spore-forming bacteria, notably Bacillus cereus and other Bacillus species, are capable of surviving pasteurization. These bacteria contribute significantly to PDHM discard rates, which average approximately 5-10% of the final donor milk products, making it a leading cause of contamination-related waste. Objective: The University of California Health Milk Bank adopted at their inception in 2020, a novel pre-pasteurization screening protocol with the aim to reduce discard rates. This study examines 3 years of data to assess the protocol's effectiveness and cost efficiency. Results: Ninety-eight percent of post-pasteurization positive cultures were Bacillus species. Following a pre-pasteurization screening protocol, the total discard rate due to Bacillus contamination was 3.1%-1.9% pre-pasteurization and 1.2% post-pasteurization. Without pre-pasteurization screening, 10.7% of PDHM could have potentially been discarded due to Bacillus contamination. The cost of pre-pasteurization screening of donor milk was $60,069 over 3 years, and the potential reduction in discard-related losses was 1,942,800 mL (64,760 ounces), with a value of approximately $323,800 for a return on investment of $4.39 per dollar spent. Conclusions: The findings highlight the role of pre-pasteurization screening cultures as a cost-effective method of reducing product loss.

Aim: In neonatal intensive care units (NICUs), the temperature of breast milk can significantly influence the comfort and physiological stability of preterm infants. The aim of this study was to compare the effects of breast milk warmed to different temperatures (traditional bain-marie method, 37°C using a milk warmer, and 32-34°C using a milk warmer) on the comfort and physiological parameters of preterm infants. Methods: This randomized crossover study included 24 preterm infants who were fed breast milk under three conditions as follows: warmed to 32-34°C, 37°C, and using the bain-marie method. Comfort was assessed using the Premature Infant Comfort Scale, and physiological parameters were evaluated before and after feeding. Nonparametric tests (Kruskal-Wallis and Friedman) were used for statistical analysis. Results: The infants had a mean gestational age of 30.48 weeks and a mean birth weight of 1353.25 grams. Postfeeding comfort scores were significantly higher in the 37°C and bain-marie groups compared with the 32-34°C group (p < 0.001). However, there were no significant differences in heart rate, oxygen saturation, or body temperature between the groups. Conclusion: Breast milk warmed to body temperature (37°C) improves infant comfort without adverse effects on physiological parameters. Standardization of warming protocols in NICUs may contribute to improved care practices for preterm infants.

Background: In the United States, 4% of incarcerated women are pregnant at the time of admission and women of childbearing age represent the fastest growing demographic in the carceral system. Biological mothers are typically separated from their infants between 24 and 48 hours after birth and infants are placed with alternative caregivers. Pumping breast milk is important for maternal and child health, however, there is little research examining programs aimed at supporting lactating people in state prisons. Objective: To explore the facilitators and barriers of implementing lactation support in seven state prisons. Methods: Repeat qualitative interviews were conducted with 46 subject matter experts associated with enhanced perinatal programs in seven, geographically diverse state prisons. Interviews were analyzed thematically using principles from the Exploration, Preparation, Implementation, Sustainment (EPIS) framework under the broad domains of facilitators and barriers to implementing lactation support in carceral settings. Results: Three main facilitators were identified: (1) protocols and processes that increased ease and access; (2) partnerships that supported programming; and (3) tailored support that recognized the specific needs of incarcerated individuals. Identified barriers include: (1) limited institutional support; (2) limited external support to protect and sustain programming; and (3) limited clarity on roles and responsibilities. Conclusion: Establishing formal protocols through collaborative partnerships with the Departments of Corrections (DOCs) and external community organizations is critical to ensure buy-in and commitment from stakeholders. Continued conversation with participants to adapt programming to meet maternal and infant health needs and goals is necessary for long-term success.

Objective: To evaluate immediate postnatal breastfeeding outcomes in mothers with retracted nipples managed with syringing and optimal lactation support, and to compare with outcomes in mothers without nipple deformity. Methods: In this prospective cohort study, all mothers admitted in the postnatal ward of a tertiary hospital were examined for nipple deformities, and mothers with retracted nipples were compared to those without nipple deformities for LATCH score, milk transfer, need for formula supplementation, direct breastfeeding (DBF), exclusive breastfeeding (EBF), breastfeeding problems and neonatal complications during hospital stay. Those with retracted nipples were routinely advised the syringing technique and provided additional lactation support. Results: Among screened mothers, the prevalence of retracted nipples was 12.5% (55/439), mostly grade 1 (24/55, 43.6%) and present bilaterally (45/55, 81.8%). Of these, 47 mothers with retracted nipples were compared with 47 matched controls. There were significant differences in LATCH score [mean (standard deviation) 6.6 (1.5) versus 8.5 (0.6); p < 0.001], milk transfer [mL; median (interquartile range) 10 (10-15) versus 17.5 (10-25); p < 0.001], and DBF rates [25/47 (53.2%) versus 42/47 (89.4%); p < 0.001] in mothers with and without retracted nipples, respectively. However, the need for formula supplementation, EBF rate, breastfeeding problems, and neonatal complications were similar in the two groups. Conclusion: A notable proportion of mothers have retracted nipples, which hinders DBF significantly in the immediate postnatal period. However, with optimal lactation support, most mothers with retracted nipples can achieve EBF without complications.

Importance: Atypical pneumonia in postpartum women may alter drug pharmacokinetics (PK) through cytokine-mediated changes in vascular permeability, yet the breast milk disposition of levofloxacin in this population remains uncharacterized. Objective: This observational study aimed to compare levofloxacin PK in lactating atypical pneumonia patients (n = 10) receiving 400 mg once daily for 3 days with historical healthy controls and to assess infant exposure risks. Methods: Breast milk samples from subjects 6-10 were collected at predetermined time points (0.5, 1, 2, 4, 6, 8, 10, 12, and 24 hours) following the last dose of 3 days. Subjects 1-5 had random daytime sampling. The concentration of levofloxacin in breast milk was measured using a validated high-performance liquid chromatography method with ultraviolet detection (correlation coefficient: 0.9997; limit of detection: 0.15 μg/mL; recovery: 91.36-102.28%; RSD <5%). PK parameters were derived using noncompartmental analysis in Phoenix WinNonlin (version 8.35). Results: Key milk PK parameters included C_max of subjects 1-5 was 15.74 ± 6.55 μg/mL, and in subjects 6-10 was 14.55 ± 2.56 μg/mL. The elimination half-life (t_1/2β) in subjects 1-5 was 7.46 ± 3.39 hours and in subjects 6-10 was 4.57 ± 1.14 hours. The AUC_0-24 in subjects 1-5 was 84.31 ± 22.60 mg·h/L and in subjects 6-10 was 63.99 ± 11.78 mg·h/L. Conclusions: Based on a 150 mL/kg/day milk intake, the estimated infant daily exposure in subjects 1-5 and 6-10 was 0.53 ± 0.14 and 0.40 ± 0.07 μg/kg/day, respectively, which was below 10% of the therapeutic dose (10 mg/kg once daily) for infants aged 0-12 months. This study first quantified levofloxacin in atypical pneumonia patients' breast milk using a validated method. Results suggest that breastfeeding can continue cautiously during maternal levofloxacin therapy. Avoid breastfeeding at peak drug concentration and monitor the infant for potential reactions.

Background: Before the COVID-19 pandemic, research studies indicated that breastfeeding was protective against postpartum depression (PPD). This study aimed to evaluate the impact of the COVID-19 pandemic on the protective association between breastfeeding and PPD. Methods: We performed a retrospective cohort study by comparing the Edinburgh Postnatal Depression Scale (EPDS) scores for patients in two cohorts, pre-COVID-19 (April 2019 to February 2020) and COVID-19 (April 2020 to February 2021). A cross-sectional design using descriptive statistics, Pearson correlations, analysis of variance (ANOVA), and stepwise multiple regression analysis (MRA) analyzed the EPDS scores of a prepandemic cohort (N = 448) and a pandemic cohort (N = 468) of women seen at a tertiary academic medical center for their first postpartum visit. Results: In the prepandemic cohort, 77.3% of breastfeeding women exhibited an unlikely risk for PPD compared with 78.5% in the pandemic cohort. Pearson correlations showed that the breastfeeding group in both cohorts had significantly lower EPDS scores, was less likely to exhibit PPD, and had a lower risk of severe PPD. ANOVA showed that nonbreastfeeding women had significantly higher EPDS scores in both cohorts. Stepwise MRA showed that the EPDS item Q8 ("I have felt sad or miserable") was the most significant predictor of PPD in breastfeeding women (both cohorts) and nonbreastfeeding women (prepandemic cohort) but had escalated to Q9 ("I have been so unhappy that I have been crying") for nonbreastfeeding women in the pandemic cohort. Conclusion: In both the prepandemic and pandemic cohorts, breastfeeding women had significantly lower EPDS scores.

Background: Probiotic bacteria isolated from human milk can have a preventive effect against necrotizing enterocolitis and other risks of prematurity. The aim of the study is to identify the possible factors that can influence the presence of lactic acid bacteria (LAB) in donated human milk (DHM). Methods: Next-generation sequencing and selective microbiological culturing of samples from pools of raw DHM were performed. Data on the donors, their children, and the milk are correlated with the microbiological findings. A regression model is performed, to predict the probability of the presence of the genera Lactobacillus and Bifidobacterium. Results: The abundance of the genus Bifidobacterium positively correlated with the donor's body mass index (p = 0.050). The abundance of the Lactobacillus positively correlated with the lactation age (p = 0.007) and negatively with the total bacterial count on blood agar (p = 0.001). The abundance of the Bifidobacterium positively correlated with the growth on selective transgalactosylated oligosaccharides-propionate agar media (p = 0.036). In the regression model for predicting the probability of the presence of LAB, the feeding mode and the length of storage in the milk bank proved to be statistically significant predictors. Conclusion: The results of this study indicate that mature DHM, that has a lower bacterial count, that was stored in the milk bank for a shorter time after pool formation and that is donated from a mother exclusively breastfeeding her infant is assumed to have both LAB.

Introduction: Mothers of very low birthweight (VLBW) infants rely on frequent, effective pumping for breast milk production. While hospital-grade breast pumps aid in mother's-own-milk (MOM) provision, accessing them after maternal discharge can be difficult. Methods: This quasi-experimental study assessed the impact of a bundled intervention on percentages of MOM and oral immune therapy (OIT) intake in the first 28 days of life (DOL) of VLBW infants admitted to a tertiary neonatal intensive care unit. The bundle included breastfeeding education, neonatal provider support, and a free 1-month hospital-grade breast pump rental for home use. Results: There were 102 infants enrolled, split into retrospective (n = 50) and prospective (n = 52) groups. While median %OIT intake was significantly higher in the prospective group (71.9% [interquartile range-IQR: 56, 78.2] versus 41.1% [IQR: 9.1, 60.7]; p ≤ 0.001), %MOM was not significantly increased after adjusting for race. More prospective infants received higher doses (≥90%) of MOM (71% versus 50%; p = 0.042), while more retrospective infants received lower doses (<5%) of MOM (18% versus 4%; p = 0.027). Black infants in the retrospective group received a lower median %MOM (69.1% [IQR: 3, 98.2] versus 93.9% [IQR: 68, 98.8] in non-Black infants; p = 0.388), but a significantly higher median %MOM in the prospective group (99.1% [IQR: 98, 100] versus 97.5% [IQR: 51, 99.5] in non-Black infants; p = 0.041). Conclusion: Bundled interventions including providing free hospital-grade breast pumps for home use may result in increased %OIT received and more VLBW infants receiving higher doses of MOM in the first 28 DOL. It may also help diminish existing racial disparities in %MOM intake.