Breastfeeding Medicine最新文献

Background: Infants with congenital heart disease (CHD) are at high risk for feeding difficulties and neurodevelopmental delays. Exclusive mother's own milk (MOM) reduces the risk of feeding intolerance and morbidity, yet feeding infants with CHD is complicated by decreased gastrointestinal perfusion, need for caloric fortification, and challenges in providing MOM by pump-dependent mothers. Lactation outcomes and support for pump-dependent mothers of infants with CHD are not well understood. Methods: We conducted a scoping review of original research identified in MEDLINE and Cumulative Index of Nursing and Allied Health Literature through November 2024 to identify key concepts, theories, and gaps in the literature on lactation support, outcomes, and experiences of mothers of infants with CHD. Studies were excluded if they were unavailable in English or were quality improvement projects, single case reports, or literature reviews. Results: Fourteen articles met the inclusion and exclusion criteria, of which 10 (71.4%) were quantitative. Results were grouped into five categories: (1) lactation outcomes, (2) lactation support, (3) lactation experiences, (4) barriers to breastfeeding and human milk (HM) feeding, and (5) predictors of breastfeeding and HM feeding. Conclusions: Mothers of infants with CHD can produce recommended MOM volumes by one month postpartum; however, breastfeeding and MOM feeding rates remain low in the first year. This review highlights barriers including inadequate support and mixed messaging from health care providers, emphasizing the need for further research, quality improvement measures, and health care provider education to address these challenges.

Introduction: Breast milk (BM) has numerous well-known, proven health benefits; however, the mechanisms underlying these effects are still not well-defined. Recent studies have shown that BM contains mesenchymal stem cells (MSCs), which might support both the growth and development of infants as well as provide protection from acute and chronic diseases. The effect of different conditions on the cellular components of BM is still unknown. This study focuses on investigating the influence of various storage methods on the properties of BM-derived MSCs. Methods: The study involved collecting 15 mL of BM samples from 17 participating mothers within the first week postpartum. MSC isolation was conducted on three sets of 5 mL samples from each participant: freshly obtained samples, refrigerated samples for 72 hours, and samples deep-frozen at -20°C for 1 month. Poststorage, MSCs were assessed for cell count, viability, and expression of specific markers using flow cytometry. Results: Analysis revealed a significant decrease in the average count of MSCs in BM poststorage. Freshly collected BM samples showed an average MSC count of 80.588,24 ± 50.0431,96, which significantly reduced to 28.333,33 ± 10.298,57 after 72 hours of refrigeration (p < 0.05). Despite this decrease, there was no notable change in the expression of MSC positive markers. Interestingly, MSCs were undetectable in samples stored in a deep freezer for one month upon microscopic examination. Conclusion: The study demonstrates a reduction in the viability of MSCs in BM when refrigerated, yet the surviving cells maintained their characteristic surface markers. However, freezing BM resulted in a complete loss of its MSC content.

Breastfeeding and Lactation Medicine is an emerging medical subspecialty that addresses the physiology, pathology, and sociodemographic components of breastfeeding and lactation. In the past 50 years, the field has grown into an international subspecialty supported by the Academy of Breastfeeding Medicine. Training programs are emerging in many countries, and it has become a reimbursable, board-certified medical specialty in the United States and Canada. Breastfeeding and Lactation Medicine providers manage routine and complex issues arising during lactation, across multiple care settings. Care requires a comprehensive skill set that includes a strong understanding of the distinct and interdependent physiologies of presenting patients as well as a consideration of the context in which families are immersed. Providers in this field are also advocates, researchers, policy consultants, and educators, leading global improvement in the clinical care and social support for families who are breastfeeding or lactating. Struggles for the field have included difficulties with institutionalizing programs, a research agenda not focused on diagnosis and management of common conditions, competition with commercial milk formula marketing practices, and limited training opportunities. This paper was developed by an international group of Breastfeeding and Lactation Medicine providers and the Academy of Breastfeeding Medicine to describe the scope of the field, who practices in the field, the problems addressed, challenges faced, and some cases that exemplify this work.

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.