Breastfeeding Medicine

Pasteurized donor human milk (PDHM) is the recommended feeding alternative for preterm infants when mother's own milk is not available. Use of PDHM in United States neonatal hospitals is increasing, although guidelines for the refrigerated and frozen storage are limited.

We aimed to review the current evidence for the storage of Holder PDHM (HPDHM) under refrigerated and frozen storage conditions.

A systematic review of the literature was conducted for studies published between 1985 and May 2018. Studies were included if they studied the storage of Holder-pasteurized human milk under refrigerated or frozen storage conditions.

Fourteen studies met the inclusion criteria. Five studies addressed refrigerated storage and nine studies addressed frozen storage. There was little overlap in the outcomes measured or the analytical methods employed. There was concordance in three studies reporting no microbial growth over 4–9 days of refrigerated storage, and in five studies reporting a reduction in fat during 1–8 months of frozen storage. Only one study assessed the storage of HPDHM that had been fortified.

Long-term refrigerated and frozen storage of HPDHM affects some components in milk more than others. While there is evidence of microbial purity during four or more days of refrigerated storage in clinical conditions, there is limited research on the impact of macro and micronutrients, or the impact of fortifiers. More research is needed in these areas.

To assess the efficacy of an oral sensorimotor intervention on breastfeeding establishment and maintenance in preterm infants.

Thirty-one preterm infants born ≤34 weeks gestation were randomized into an experimental or control group. The experimental group received a 15-minute program consisting of stroking the peri-oral structures for the first 5 minutes, tongue exercises for the next 5 minutes, followed by non-nutritive sucking for the final 5 minutes. The control group received a sham intervention for the same duration. The interventions were administered once daily for 10 days. The outcomes included: time to attainment of full oral feeding, breastfeeding acquisition (i.e., ≥50% of direct breastfeeding at hospital discharge), breastfeeding skill assessment using the Preterm Infant Breastfeeding Behavior Scale (PIBBS), length of hospitalization, and breastfeeding maintenance at 3 and 6 months posthospitalization.

Full oral feeding was attained earlier in the experimental group compared with the control (10.7 ± 2.1 vs. 19.3 ± 3.6 days, p < 0.01). This was associated with a greater number of infants in the intervention group acquiring breastfeeding at hospital discharge compared with the controls (n = 11 vs. 5, p = 0.049). There was no statistical difference in PIBBS score, length of hospitalization, and breastfeeding rates at 3 and 6 months posthospitalization between the two groups (all tests, p > 0.32).

An oral sensorimotor intervention accelerated the achievement of full oral feeding and enhanced direct breastfeeding rates at hospital discharge only. Provision of an oral sensorimotor intervention is a safe and low-cost intervention that may increase breastfeeding rates in a highly vulnerable population.

To objectively describe changes to nipple skin and classify signs of nipple trauma in breastfeeding women during postpartum week 1.

This study was conducted in two phases. Phase 1 was an observational prospective study of breastfeeding mothers in which data were obtained from photographs and digital images of nipple skin and analyzed to anatomically classify signs of nipple trauma. In Phase 2, the reliability of signs identified in Phase 1 was verified with the cooperation of eight clinical midwives.

A total of 776 images of 50 breastfeeding mothers were obtained daily. The signs of nipple trauma included erythema, swelling, blistering, fissure, and scabbing. Purpura and peeling were identified only with photographic image analysis. Scabbing and blistering were classified as damage to the dermis, and erythema and swelling as damage to the epidermis, based on anatomical evidence and the mothers' subjective experiences of pain intensity. Erythema and swelling were observed from day 0, with erythema most frequently observed. For inter-rater reliability of the five signs of nipple trauma, Kendall's coefficient of concordance ranged from 0.46 (moderate) to 0.85 (almost perfect). Reliability was high for fissure, substantial for blistering and scabbing, and moderate for erythema and swelling.

Image analysis revealed five signs of nipple trauma. Erythema and swelling were the most frequently observed signs during postpartum week 1. However, the agreement rate was lower than that for other signs, suggesting the possibility of conflicting interpretations in clinical evaluation.

Although the benefits of immediate, continuous, uninterrupted skin-to-skin contact (SSC) and early breastfeeding have been widely researched and confirmed, the challenge remains to improve the consistency of this practice. Fewer than half of newborns worldwide are breastfed in the first hour.

Cross-sectional descriptive study utilizing iterative review and analysis of video ethnography as well as data extracted from patient records.

Eighty-four medically uncomplicated mothers and full-term newborns were observed during the first hour after birth at a Baby-Friendly designated hospital in the United States.

Process mapping using an algorithm which included Robson criteria indicated that although included mothers were expected to give birth vaginally and had no medical concerns that would preclude eligibility for SSC in the first hour after birth, 31 of 84 newborns (37%) did not receive immediate SSC after vaginal birth as planned and only 23 (27.4%) self-attached and suckled.

Process mapping of optimal skin-to-skin practice in the first hour after birth using the algorithm, HCP-S2S-IA, produced an accurate and useful measurement, illuminating how work is conducted and providing patterns for analysis and opportunities for improvement with targeted interventions.

Iron deficiency anemia (IDA) is common in children aged 0–35 months in Lithuania. Nevertheless, there are no studies investigating IDA in this age group. We aimed to identify the major risk factors for disease development focusing on medical history and dietary habits.

A prospective case–control study was conducted in a university hospital. The enrolled cohort was divided into three groups: IDA infants (IDA-In; n = 36, aged 3–11 months), IDA children (IDA-Ch; n = 23, aged 12–32 months), and healthy controls (HCs; n = 32, aged 6–34 months).

There was a higher number of premature, low birth weight (LBW), and faster gaining weight infants in the IDA-In group. Their diet diversity was lower than IDA-Ch and HC. In contrast, the IDA-Ch group had no signs of impaired iron stores at birth or higher iron need for fast growth; their diet diversity was similar to that of HC, but meat was introduced later as compared with those in the IDA-In and HC groups. Consumption of cow's milk was rather low among all study participants, but consumption of sugar-added products was found to be a new emerging problem. Exclusive breastfeeding did not differ in duration and prevalence; the age for introduction of complementary foods was similar in all groups.

Low compliance with World Health Organization (WHO) recommendations on breastfeeding and complementary feeding suggests an urgent need for nutritional counseling in early childhood, especially in premature, LBW, and fast gaining weight infants.

To determine bone mineral density (BMD) at the age of peak bone mass in women who previously experienced pregnancy and breastfeeding during adolescence.

In this retrospective study, female volunteers aged 24–30 years who were pregnant during the age of 15–19 years and have had one to two babies were recruited. All of them experienced breastfeeding without history of bone- or calcium-related problems, such as fracture or low calcium intake. BMD was determined at the femur and L1–L4 spine by dual-energy X-ray absorptiometry.

We found that both volunteers who previously experienced breastfeeding and age-matched control volunteers had similar BMD at the L1–L4 spines and femora. Further analysis for site-specific changes of lumbar and femoral BMDs showed that the values of the breastfeeding group were not different from those of the control group except at L1 and L2, where BMD values were greater in breastfeeding group compared with the control group. At both femoral and vertebral sites, T- and Z-scores were apparently similar between the two groups. In addition, the BMD at peak bone mass had no significant correlation with breastfeeding duration.

Teenage pregnancy and breastfeeding did not negatively affect BMD later at the age of peak bone mass. Therefore, breastfeeding can be encouraged in teenage mothers.

Women account for over 50% of the workforce in the United States with many working women being of childbearing age. The United States does not provide long paid parental leave, thus mothers who choose to breastfeed are confronted with the reality of combining breastfeeding and returning to work. Return to work is reported to negatively impact breastfeeding exclusivity and duration. While the existing federal law protects some women, not all women have legal support to breastfeed or express milk at work. Exemptions to the federal law include limitations related to the employee's status, classification of employer, total number of employees and the employer's annual revenue. This study aimed to examine existing city-level legislation protecting the rights of women to breastfeed or express milk at their place of employment during the postpartum period.

Prospective descriptive study with survey. The national sample includes the three largest cities of each state and the capital city of the United States (Washington, DC) for a total of 151 cities. The data were collected in a tiered approach with three phases: (1) assessment of city website, (2) e-mail to city mayor's office, and (3) telephone follow-up with the city's office.

Only 2/151 (1.3%) of cities had specific legislation outlining the protections for all breastfeeding women in the workplace.

This research demonstrates a clear need for political action to increase the number of women who have workplace regulations to protect breastfeeding.

Infant formulas are produced to resemble human milk (HM) and to provide adequate energy and appropriate nutritional components for suitability of infant growth and development, some of which are customized for specific medical conditions. However, it has remained unclear whether formulas contain any biofunctionality equivalent to HM, particularly fetal intestinal cell growth promotion.

To evaluate the biofunctionality in HM and various formulas by using an in vitro fetal intestinal cell growth assay.

Nine specimens of HM collected from 9 milk donors and 16 formulas consisting of 5 regular formulas (RFs), 2 preterm formulas (PFs), 2 partial hydrolysate formulas (PHFs), 3 extensive hydrolysate formulas (EHFs), 2 amino acid formulas (AAFs), and 2 soy protein formulas (SPFs) were included. Fetal intestinal cell growth assay was performed in six replicates per milk specimen. Biofunctionality of HM digest (HMD) derived from in vitro tryptic digestion of HM was also examined. Statistical analysis was performed by ANOVA with post-hoc Tukey's Honestly Significant Difference test.

The fetal intestinal cell growth-promoting activity of HM and formula groups were sorted from the highest as follows: HM, 192.8% ± 16.7%; AAF, 153.5% ± 17.8%; EHF, 149.4% ± 12.5%; RF, 123.5% ± 14.2%; PHF, 111.2% ± 17.9%; PF, 110.3% ± 8.2%; and SPF, 109.3% ± 17.3%. Statistical analysis showed that growth promotion of HM was significantly higher than that of all examined formulas (p < 0.0001). Among formulas, EHF and AAF showed greater growth-promoting activity than the others (p < 0.0001). HM and HMD had a comparable growth-promoting effect on fetal intestinal cells (198.5% ± 27.9% versus 191.2% ± 17.9%, p = 0.724), supporting the potential impact of HM biofunctionality under physiologic gastrointestinal digestion.

Our data suggested that formulas are not equivalent to HM in respect of fetal intestinal cell growth biofunctionality. Despite having less activity than HM, EHF and AAF exhibited considerable levels of growth-promoting effect that may have clinical implications, especially when HM is unavailable.