Breastfeeding Medicine最新文献

Introduction: Infants born very prematurely usually are initially feeding by orogastric or nasogastric tube. These infants lack the maternal milk smell and taste, both of which initiate the cephalic phase of nutrition. Offering the olfactory and gustatory experience of breast milk could enhance weight growth and expedite discharge, which are the primary advantageous outcomes for extremely premature infants. Purpose: To evaluate the potential of exposing very preterm newborns to the smell and taste of breast milk to expedite weight growth and facilitate early discharge. Methods: This study is a double-blind, randomized, superiority clinical trial. A study was conducted on infants born very prematurely (less than 32 weeks gestation) who were receiving tube feeding. Prior to tube feeding, the interventional group was exposed to the smell and taste of breast milk. The primary outcomes were an increase in weight and a shorter length of hospital stay. Results: A total of 63 children born very prematurely were randomly assigned and completed the research. The intervention and control groups did not exhibit any significant difference in terms of weight increase and time to discharge. The weight gain was 715 g (95% CI: 544 to 876 g) in the intervention group and 657 g (95% CI: 510 to 804 g) in the control group, with a p value of 0.60. The time to discharge was 39 days (95% CI: 30 to 48) in the intervention group and 37 days (95% CI: 28 to 54) in the control group, with a p value of 0.735. Conclusion: The smell and taste of breast milk right before tube feeding did not speed up weight growth or lead to early discharge in extremely premature newborns.

Background: Mothers delivering preterm are very often exposed to antibiotics in the peripartum period. We hypothesize this may select bacteria bearing antibiotic resistance genes (ARGs) in the breast milk and be transmitted to the neonate's mouth while feeding. This study aimed to determine the prevalence of ARGs coding for extended-spectrum beta-lactamases (ESBLs) (including AmpC beta-lactamases [ACBLs]) and carbapenemases in breast milk and neonatal oral swab samples of preterm mother-infant pairs, the concordance of ARGs between paired samples, and risk factors of ARGs coding for ESBLs and carbapenemases. Methods: Breast milk and oral swab samples were obtained aseptically from 100 preterm mother-infant pairs (gestation 28-34 weeks) by postpartum day 10. Multiplex PCR was used to detect 15 common ARGs in these samples. Potential risk factors of the presence of any ARG coding for ESBLs or carbapenemases in breast milk and oral swab samples were studied. Results: The commonest ARGs for ESBLs, ACBLs, and carbapenemases in breast milk were bla_SHV (28%), bla_CIT (33%), and bla_IMP (49%), respectively; and oral swabs bla_CTX-M1 (30%), bla_CIT (58%), and bla_IMP (24%), respectively. ARGs common to breast milk and oral swabs included bla_CIT (13%), bla_IMP (10%), bla_CTX-M-1 (9%), and bla_SHV (6%). Formula milk intake was associated with less oral carbapenemase ARGs. Conclusion: ARGs for ESBLs and carbapenemases are highly prevalent in preterm breast milk and oral swabs.

Background: Due to their nonspecific symptoms, foreign bodies in the aerodigestive tract (FBA) are often misdiagnosed as respiratory conditions, especially when unwitnessed, posing significant risks for morbidity and mortality in the pediatric population. Case Presentation: We report a case of an otherwise healthy 4-month-old, predominantly breastfed infant with episodic "honking" breathing, choking with feeds, and a 2-month history of recurrent croup episodes requiring emergency services and an hospital admission. After referral to pediatric otolaryngology/respirology, a flexible laryngoscopy revealed a diagnosis of mild laryngomalacia, inconsistent with the severity of symptoms. A formal airway evaluation was performed, including supraglottoplasty. Results: Unexpectedly, extraluminal pulsatile tracheal compression was found, with correlating computed tomography findings of an innominate artery variation and a paraesophageal abnormality. This abnormality appeared as a fluid-filled density between the esophagus and trachea on magnetic resonance imaging, without patency to the esophagus on Upper GI series. Differential diagnoses included vascular malformation, esophageal diverticulum, and bronchogenic/foregut duplication cyst. Although evaluation with echoendoscopy was considered, collaboration with general/thoracic surgery for a flexible esophagoscopy revealed a 2-cm breast pump membrane embedded in a pseudo-diverticulum with a sealed esophageal perforation, which concluded with successful object removal via forceps. The patient's respiratory symptoms have resolved; however, persistence of the pseudo-diverticulum on follow-up imaging and endoscopy warrants ongoing surveillance. Conclusion: This case demonstrates the challenging diagnosis of a breast pump membrane as an unexpected esophageal FBA, compounded by nonspecific respiratory symptoms and the membrane's near-radiolucency on standard imaging. The exhibited multidisciplinary, collaborative approach was fundamental for the complication-free removal of the membrane.

Introduction: Breastfeeding provides substantial health benefits for both children and mothers; yet the U.S. rates remain suboptimal, with disparities shaped by structural, social, and policy factors. This study examines how the U.S. hospital maternity care practices influence breastfeeding initiation, with particular attention to their impact across different population groups. Methods: We analyzed cross-sectional county-level variations in hospital maternity care quality and breastfeeding initiation from 2017 to 2022 using data from the National Vital Statistics System and the Maternity Practices in Infant Nutrition and Care (mPINC) surveys. We employed a linear probability model to assess these relationships. Results: Higher county mPINC scores are significantly associated with increased breastfeeding initiation, with each additional point linked to a 0.10 percentage point (pp) increase (p < 0.001). This association varies by race/ethnicity. Each additional mPINC point corresponds to a 0.25 pp increase for non-Hispanic Black mothers (p < 0.001) and a 0.14 pp increase for non-Hispanic American Indian/Alaska Native mothers (p < 0.001), approximately three and two times higher, respectively, than the increase for non-Hispanic White mothers. The effect of better maternity practices also differs by county type, with a 0.08 pp increase in metro areas (p < 0.001) and a 0.17 pp increase in nonmetro areas (p < 0.001). Conclusions: Higher quality hospital maternity care practices are associated with increased breastfeeding initiation, particularly among population groups with historically lower breastfeeding rates. Enhancing maternity care policies and practices may help reduce long-standing breastfeeding disparities.

Background: Oral thrush is a common yeast infection caused by Candida albicans in infants during their first few weeks or months. Infant mothers' antibiotics consumption can contribute to this opportunistic fungal growth due to their weaker immune systems. Objectives: To investigate the relationship between maternal antibiotic consumption and oral thrush infection in breastfeeding infants, this study aims to provide insights for health care professionals regarding antibiotic prescriptions and preventive strategies for managing oral thrush. Methods: A quasi-experimental design with a control group was used. Eighty-two breastfeeding infants were divided into two groups: Group 1 (n = 40) infants of antibiotic-consuming mothers and Group 2 (n = 42) infants of nonantibiotic-consuming mothers. The oral samples were collected using sterile cotton swabs and cultured on Sabouraud's dextrose agar C. albicans, confirmed by simple staining and a germ tube test. Results: Infants aged 1-11 months with a mean ± standard deviation of 4.8 ± 3.51. Within all 82 oral swabs, 42.7% were positive for C. albicans growth and 57.3% were negative. The highest percentage was in 1-month-old infants (n = 9, 25.71%), and the lowest was in 11 months old (n = 2, 5.71%). Group 2 infants had significantly fewer positive C. albicans growth (n = 12, 28.57%) compared with group 1 (n = 23; 57.5%) (χ² = 7.0, p = 0.007; odds ratio = 3.332, 95% confidence interval = 1.35-8.46). Oral thrush clinical signs were identified in 66.6% and 33.4% of group 1 and 2 infants, respectively, while 31.4% of C. albicans-positive colonization showed no clinical manifestations. Conclusion: Maternal antibiotic consumption for more than 1 week is associated with the occurrence of oral thrush in breastfeeding infants. Differences in clinical signs in two groups of infants indicate the importance of laboratory tests for early oral thrush diagnosis. This can help health care professionals understand oral thrush causes, enable early detection, improve treatment, and enhance appropriate antibiotic use in breastfeeding mothers.

Background: When access to mother's own milk is limited, pasteurized donor human milk (PDHM) is the best alternative source of nutrition for high-risk preterm infants. Microbial screening of PDHM is essential to ensure its safety, as spore-forming bacteria may survive pasteurization. Standard screening will detect spore-forming bacteria that grow aerobically, such as Bacillus cereus, but may miss obligate anaerobes, such as Clostridium species. Although milk banking guidelines globally recommend microbial screening of milk batches, they do not specifically recommend anaerobic testing. This study aimed to determine the proportion of PDHM batches containing viable anaerobic bacteria after pasteurization. Materials and Methods: In this prospective cohort study, 150 batches of PDHM from unique donors were sampled (August-December 2024) at Australian Red Cross Lifeblood and tested at an accredited food safety laboratory. Prepasteurization samples were tested for aerobic bacteria, and postpasteurization samples were tested for both aerobic and anaerobic bacteria using a validated method (detection limit ≤1 CFU/mL). Results: No bacteria were recovered from any of the 150 postpasteurization samples tested using an anaerobic culture method. Using standard aerobic culture, 4.7% (7/150) of samples failed prepasteurization microbial screening according to local acceptance guidelines, due to a total colony count ≥ 10⁵ CFU/mL (n = 6) and/or the presence of Enterobacteriaceae ≥ 10⁴ CFU/mL (n = 3), and none failed postpasteurization testing. Conclusions: This study confirmed that obligate anaerobic bacteria are rarely cultured from PDHM. Additional process control through routine testing for anaerobes in PDHM is therefore not considered essential, particularly when PDHM is stored frozen (<18°C) after pasteurization. Clinicians should maintain vigilance for potential recipient adverse events and promptly report these to the source milk bank.

Background: Full oral feeding (FOF) is a critical milestone in preterm infants, often delayed because of immature feeding coordination. The Fucile oral motor stimulation protocol aims to address these challenges and enhance feeding progression. To evaluate the effectiveness of the Fucile oral motor stimulation protocol in reducing the transition time to FOF, shortening hospital stays, and improving feeding-related outcomes in preterm infants. Methods: A systematic review and meta-analysis was conducted following the PRISMA guidelines (PROSPERO: CRD42022369514). Databases, including PubMed, Scopus, Web of Science, CENTRAL, and CINAHL (1990-2024), were searched. Randomized controlled trials comparing the Fucile protocol with control interventions in preterm infants (<37 weeks of gestation) were included. Outcomes included transition time to FOF, hospital stay length, weight at discharge, and milk transfer rate. Risk of bias (RoB 2) and evidence certainty (Grading of Recommendations Assessment, Development, and Evaluation) were evaluated. Results: Nineteen trials (1,031 infants) showed that the Fucile protocol significantly reduced transition time to FOF (mean difference [MD]: -5.77 days; 95% confidence interval [CI]: -6.64 to -4.90) and hospital stay duration (MD: -6.47 days; 95% CI: -8.41 to -4.53) with moderate-certainty evidence. Conclusion: The Fucile protocol accelerates feeding milestones and reduces hospital stays for preterm infants, providing moderate-certainty evidence to support its clinical use. However, methodological limitations, including small sample sizes and risk of bias, underline the need for larger, high-quality trials to confirm these findings and refine clinical guidelines. These results suggest the potential of integrating oral motor stimulation into neonatal intensive care unit practices to enhance feeding outcomes and optimize care for preterm infants.

Introduction: Tetrahydrocannabinol (THC), the major psychoactive marijuana cannabinoid, can be transferred to neonates via maternal breast milk (MBM) feeds, but available literature on the safety of concomitant breastfeeding and THC use is inconsistent. This study aimed to assess neonatal intensive care unit (NICU) policies related to toxicology screening and provision of MBM from THC-positive mothers. We hypothesized variation in policies exists across the nation and may be associated with state legalization status. Methods: Cross-sectional survey of U.S. NICU policies related to: (1) toxicology screening of mother-baby dyads and (2) MBM feeding limitations based on THC screening status. We assessed the impact of THC legalization status on the various MBM limitations. Results: Of 187 NICUs surveyed, 79% performed selective toxicology screening based on risk factors, clinical concerns, or provider discretion. Of those that specifically addressed THC exposure and MBM feeding policies, 60% had at least one limitation to MBM feeds, ranging from preventing any MBM feeding during NICU admission to limiting MBM until mother tested negative for THC. We found no significant association between state legalization status and MBM limitations. NICU and nursery policies differed in 33% of institutions. Conclusions: Substantial variation exists in NICU policies regarding toxicology screening and MBM limitations related to THC. These inconsistent policies are based not on THC legalization status but rather on the location of delivery. More research is needed on the effect of THC exposure on neonates, but we could limit inconsistent care by following current national medical organization guidelines of education and shared decision-making with mothers.

Introduction: Although exclusive breastfeeding is recommended for the first six months of life, many lactating individuals discontinue due to low milk supply, a condition sometimes referred to as chronic lactation insufficiency (CLI). Affecting an estimated 5-15% of lactating individuals, CLI can stem from both extrinsic factors (e.g., infant feeding challenges) and intrinsic ones (e.g., endocrine or metabolic disorders). This qualitative study explored the lived experiences of individuals with CLI and their interactions with healthcare providers (HCPs). Methods: In-depth, semi-structured interviews were conducted with 30 individuals who self-reported experiencing low milk supply, were 18 or older, and were members of the "IGT and Low Milk Supply Support Group" on Facebook, which has approximately 10,700 members. Data were analyzed using phronetic iterative analysis which is a cyclical, reflexive coding approach that emphasizes practical reasoning. Results: Participants reported significant challenges, including: (1) not being believed or taken seriously; (2) facing discrepancies between providers that led to fragmented care; and (3) experiencing a lack of knowledge from HCPs, including lactation consultants. Many described actively seeking a diagnosis and meaningful support but instead receiving inconsistent advice and little to no diagnostic insight into their condition. Conclusions: These findings highlight the urgent need for improved education and training among HCPs to address the complex realities of CLI. They also point to the importance of advancing personalized approaches to breastfeeding support and expanding research to determine causes and diagnostics for low milk supply. By centering patient voices, this study identifies critical gaps in care and communication that prevent effective support for those navigating CLI.

Background: Racial/Ethnic disparities in breastfeeding practices exist despite strong evidence for significant health benefits of breastfeeding for the mother-newborn dyad. Breastfeeding intentions are known to predict breastfeeding practices at hospital discharge and breastfeeding retention in the long term. Interventions during postpartum hospitalization can help mothers achieve breastfeeding intentions and reduce racial/ethnic gaps in breastfeeding on discharge. This study aims to identify racial/ethnic disparities in meeting intentions to exclusively breast milk feed (EBMF) on hospital discharge. Methods: This was a retrospective cohort study of mothers who intended to EBMF and their newborns delivered at term at a single academic medical center during 2022. The primary outcome was EBMF at discharge. Results: Participants included non-Hispanic Black (NHB) (n = 96), Hispanic (n = 97), and non-Hispanic White (NHW) (n = 955) mothers who intended to EBMF. Mothers who identified as NHB (40.6%) or Hispanic (64.9%) were significantly less likely to EBMF compared with NHW (87.5%) mothers (odds ratio [OR] = 0.14, 95%CI [0.08, 0.23] and OR = 0.37, 95%CI [0.22, 0.61], respectively) at newborn hospital discharge. Rurality, insurance type, gravidity, parity, gestational diabetes, and birth weight were not associated with breast feeding choice/practices at discharge, but increasing age was associated with an increased likelihood of EBMF (OR = 1.07, 95%CI [1.03, 1.11]), as was neonatal intensive care unit admission (OR = 2.93, 95%CI [1.18, 7.31]). Cesarean birth was associated with decreased likelihood of EBMF (OR = 0.57, 95%CI [0.38, 0.85]). Conclusion: Significant racial/ethnic disparities in EBMF at hospital discharge exist among those who intended to EBMF, which are not explained by differences in other examined covariates.