Breastfeeding Medicine最新文献

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.

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: 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.

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: 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.

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.