Breastfeeding Medicine

Donor milk is a good alternative for premature babies whose mothers cannot breastfeed. To reduce the risk of milk contamination, donors have to follow some hygiene instructions, including disinfecting their breast pump (BP). This study aims to investigate the efficacy of BP cleaning and disinfection methods.

Contamination of BP parts was performed by passing milk inoculated with Bacillus cereus, Staphylococcus aureus, or Escherichia coli, through BPs. Devices were then rinsed with cold water or cleaned with hot soapy water. Disinfection was achieved using either a microwave or by immersing BP parts in boiling water. After treatment, residual bacteria were recovered by passing sterile phosphate buffer saline (PBS) through BPs before being inoculated on plates and performing bacterial counts. Method efficiency was assessed by comparing BP residual bioburden to results obtained from BPs that have not undergone cleaning or disinfection treatment (controls).

Rinsing BP parts with cold water leads to a diminution of residual bacteria in PBS recovered from device. This decrease is even more effective when hot soapy water is used. There is a slight persistence of all bacteria if disinfection of BPs is performed by using a microwave. This persistence reached up to 3.58 colony-forming unit/mL of sporulating B. cereus in PBS eluted from the pump parts. The use of boiling water, with or without cleaning step, removes bacteria to a level such that no residual contamination was observed.

Cleaning BP parts in hot soapy water followed by a disinfection in boiling water ensures a completed decontamination of the BP. These results give evidences for instructions to milk bank donors for whom reducing risks of infections to minimal level is essential.

Factors that contribute to low initiation and continuation of breastfeeding among mothers with opioid use disorder (OUD) are poorly understood.

To understand barriers and facilitators to breastfeeding initiation and continuation beyond the birth hospitalization for mothers with OUD.

We conducted 23 in-depth, semistructured interviews with mothers with OUD who cared for their infants at home 1–7 months after birth. Our interview guide was informed by the Theory of Planned Behavior (TPB) framework, which has been used to understand decision-making regarding breastfeeding. An iterative approach was used to develop codes and themes.

Among 23 participants, 16 initiated breastfeeding, 10 continued after hospital discharge, and 4 continued beyond 8 weeks. We identified factors influencing breastfeeding decisions in the four TPB domains. Regarding attitudes, feeding intentions were based on beliefs of the healthiness of breastfeeding particularly pertaining to infant withdrawal or exposure to mothers' medications. Regarding social norms, breastfeeding was widely recommended, but mothers had varying levels of trust in medical professional advice. Regarding perceived control, infant withdrawal and maternal pain caused breastfeeding to be difficult, with decisions to continue modulated by level of outside support. Regarding self-efficacy, mothers weighed their own recovery and well-being against the constant demands of breastfeeding, impacting decisions to continue.

Mothers with OUD face unique barriers to breastfeeding related to their infants' withdrawal as well as their own health, recovery, and social context. Overcoming these barriers may serve as future intervention targets for breastfeeding promotion among this high-risk population.

Guidelines in high-income countries recommend women living with human immunodeficiency virus (HIV) to formula feed their newborns, because the possibility of mother-to-child-transmission of HIV during breastfeeding cannot be ruled out. It is an ongoing debate if the possible transmission risk outweighs the medical, cultural, psychological, and social importance of breastfeeding in women stable on current first-line suppressive antiretroviral regimens. The study aim was to explore breastfeeding desires and decision-making of immigrant and nonimmigrant women living with HIV in the Netherlands.

A questionnaire was administered orally or online to 82 women living with HIV in the Netherlands. The breastfeeding desires of the participants were collected as categorical data, and breastfeeding decision-making and willingness to adhere to additional monitoring were collected on a 5-point Likert scale. Categorical data were presented as proportions, and Likert scale data were presented in Likert scale bar plots.

Seventy-one percent of the participants expressed a desire to breastfeed in the future. The most important factors influencing decision-making to breastfeed were the chance of transmission of HIV to the infant and the advice by the doctor or nurse practitioner. Of the participants, 42% expressed their interest in breastfeeding with a <1/100 transmission risk. More than half of the participants expressed their interest to breastfeed with additional monitoring.

A substantial proportion of the women living with HIV in the Netherlands has a desire to breastfeed, of which the majority are willing to adhere to additional monitoring to do so.

Patients from low-income, minoritized communities have limited access to outpatient breastfeeding support with International Board Certified Lactation Consultants (IBCLCs). Telelactation may increase access particularly when appointments can be self-scheduled.

To describe a medical center-based, outpatient breastfeeding support program that includes telelactation and serves a diverse patient population.

A retrospective electronic chart review was performed for patients with in-person or telelactation visit types between April 2020 and December 2021. Impact of demographics (language, race/ethnicity, insurance) on scheduling patterns (self-scheduled versus traditionally scheduled), visit reasons, and impact of initial visit type and reason on subsequent follow-ups were determined. Feeding practice-to-feeding goal ratios were compared between initial and last visit to determine if breastfeeding goals were met. Descriptive statistics, linear regression, chi-square, and paired t-tests were performed.

Two thousand twenty-three patients (37.9% Spanish-speakers, 76.6% Latinx; 8.0% black/non-Latinx, 79.0% publicly insured) made 2,791 visits, of which 50.6% were for telelactation. Self-scheduling resulted in decreased no show rates (25.3% versus 42.8%, p < 0.001). Commercially insured patients had greater odds of self-scheduling versus publicly insured (adjusted odds ratio: 9.22; 95% confidence interval, CI [6.27–13.57]) with no impact of race/ethnicity or language. Reasons for visit differed slightly by initial visit type. Practice-to-feeding goal ratios increased regardless of initial visit type: telelactation visit (0.84 to 0.88 [difference 0.04; 95% CI: 0.006–0.066; p = 0.017]); and in-person visit (0.77 to 0.84 [difference 0.07; 95% CI: 0.044–0.11 p < 0.001]).

Telelactation as part of a medical center-based outpatient breastfeeding support program is a promising modality for both initial and follow-up visits. Self-scheduling decreased no show rates.

Donor human milk (DHM) is the recommended feeding for preterm infants when mother's own milk is unavailable or insufficient. DHM macronutrient's variability may have significant implications on preterm growth. Different pooling strategies could be used to improve the macronutrient content, facilitating the achievement of nutritional requirements of preterm.

The aim was to compare the impact of random pooling (RP) and target pooling (TP) strategies on the macronutrient content of DHM and to identify which RP practice allows the achievement of a macronutrient composition as similar as possible to that achievable with TP.

The macronutrient content of 1,169 single-donor pools was analyzed, and a TP strategy combining 2,3,4, or 5 single-donor pools was adopted. On the bases of single-donor pools' analyses, a simulation of 10,000 randomly selected pools for each configuration of donor considered and for different milk volume proportions was performed.

Regardless of the type of strategy and milk volume, as the number of donor per pool increases, the percentage of pools with a macronutrient content equal or higher than the reference values for human milk increases.

When a TP strategy is not feasible, a RP strategy combining at least five donors should be performed to obtain a better macronutrient content of DHM.

The qualitative study was conducted to determine the breastfeeding experiences of mothers working in radiation areas in hospitals.

The study was conducted in Turkey between December 2022 and February 2023 through in-depth interviews held with 13 mothers who met the inclusion criteria. The content analysis method was used in the analysis of the data.

As a result of the analyses of the data obtained in the interviews, four themes regarding the breastfeeding experiences of health professionals working in radiation environments in hospitals were identified. These themes were institutional/administrative obstacles, support systems, unhealthy childcare, and feeling of incompetence as a mother. The main theme of unhealthy childcare consisted of four categories, which were low-quality breast milk, toxic breast milk, frequent diseases, and future risk of cancer. The main theme of feeling of incompetence as a mother was composed of three categories, which were fear, feeling of guilt, and “Am I a mother?” The theme of institutional/administrative obstacles consisted of three categories, namely working environment, working duration, and awareness of managers. Finally, the theme of support systems included two categories, positive perceptions and negative perceptions.

In this study, it was determined that the mothers who worked in radiation areas in hospitals experienced problems due to individual, social, and institutional factors. The main concern of the mothers was found to be hurting their infants with their breast milk. Suitable working environments and the adequacy of practices related to daycare centers, social support, and motherhood rights are the main needs of working mothers aiming to keep breastfeeding their infants.

The symptoms of Dysphoric Milk Ejection Reflex (D-MER) occur just before milk release, last no more than a few minutes, and then subside spontaneously, which are characterized by a sudden and transient feeling of dysphoria, depression, sadness, or other negative emotions. These emotions may adversely affect the mother's lactation behavior and mental health, negatively influence the mother–child relationship, and even result in self-harm or suicidal tendencies in lactating women.

We reported two cases of breastfeeding mothers with D-MER who experienced unpleasant emotions during lactation. Severely affected by D-MER symptoms, the mother in the first case chose to wean prematurely after struggling for 6 months, and her symptoms disappeared after weaning. With the help of professional guidance, the mother with D-MER in the second case actively adjusted and persisted in breastfeeding until her daughter was 18 months old, after that her symptoms vanished.

Awareness and knowledge of D-MER are insufficient among the public and health care professionals. D-MER is not a psychological disorder but a physiological issue caused by hormones, which is different from postpartum depression. The severity of D-MER symptoms can be evaluated by the assessment tool of the D-MER spectrum. Lactating women can relieve their symptoms through self-regulation, lifestyle changes, and professional guidance and treatments.

The two cases studies about Chinese women with D-MER will enrich the knowledge of D-MER, and it might suggest some directions to health care workers for exploring scientific guidance and treatments for lactating women. Because the literature and published empirical studies about D-MER are scarce, further researches on the theory and interventions of D-MER are necessary.

Oxaliplatin is an alkylating chemotherapeutic agent commonly used for malignancies in women of reproductive age, including colorectal cancer. No research previously exists regarding the transfer of platinum into milk after administration of oxaliplatin.

We present a case of a lactating patient with stage 3a colorectal cancer requiring chemotherapy including oxaliplatin (130 mg/m²) infused every 4 weeks. Milk levels of platinum were tested at Lactation Lab, Inc., using a previously published mass spectrometry method.

Milk platinum concentrations 34 and 65 days after treatment were 7.8 and 10.3 ng/mL, respectively.

These levels are similar to cisplatin or carboplatin in the immediate weeks after their administration, suggesting that the equivalent platinum exposure risk persists for longer with oxaliplatin than with other platinum analogues. Findings from this report support current recommendations to cease breastfeeding after oxaliplatin administration.