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Journal: Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine

34

Abstract Background and Objective: Until 2010, newborns at our institution were bathed in the nursery at approximately 2 hours of life. In May 2010, infant baths were delayed until at least 12 hours of life. Infants are now bathed in the hospital room with parents' participation and are placed skin-to-skin immediately after the bath. This study explored whether delaying the newborn’s first bath correlates with increased in-hospital breastfeeding rates at our Baby-Friendly, urban safety-net hospital. Subjects and Methods: We performed a retrospective chart review comparing in-hospital breastfeeding rates during the 6 months before and the 6 months after the bath was delayed. Results: Of the infants, 702 met inclusion criteria. Before the bath was delayed, infants were bathed at an average of 2.4 hours of life. Afterward, infants were bathed at an average of 13.5 hours of life. In-hospital exclusive breastfeeding rates increased from 32.7% to 40.2% (p<0.05) after the bath was delayed. Multivariate logistic regression analysis showed that infants born after implementation of delayed bathing had odds of exclusive breastfeeding 39% greater than infants born prior to the intervention (adjusted odds ratio [AOR]=1.39; 95% confidence interval [CI] 1.02, 1.91) and 59% greater odds of near-exclusive breastfeeding (AOR=1.59; 95% CI 1.18, 2.15). The odds of breastfeeding initiation were 166% greater for infants born after the intervention than for infants born before the intervention (AOR=2.66; 95% CI 1.29, 5.46). Conclusions: In our cohort, a delayed newborn bath was associated with increased likelihood of breastfeeding initiation and with increased in-hospital breastfeeding rates.

Concepts: Regression analysis, Logit, Logistic regression, Infant, Breastfeeding, Bathing, Statistical terminology, Bathtub

33

Abstract Background: Provision of human milk has important implications for the health and outcomes of extremely preterm (EP) infants. This study evaluated the effects of an exclusive human milk diet on the health of EP infants during their stay in the neonatal intensive care unit. Subjects and Methods: EP infants <1,250 g birth weight received a diet consisting of either human milk fortified with a human milk protein-based fortifier (HM) (n=167) or a diet containing variable amounts of milk containing cow milk-based protein (CM) (n=93). Principal outcomes were mortality, necrotizing enterocolitis (NEC), growth, and duration of parenteral nutrition (PN). Results: Mortality (2% versus 8%, p=0.004) and NEC (5% versus 17%, p=0.002) differed significantly between the HM and CM groups, respectively. For every 10% increase in the volume of milk containing CM, the risk of sepsis increased by 22% (p<0.001). Growth rates were similar between groups. The duration of PN was 8 days less in the subgroup of infants receiving a diet containing <10% CM versus ≥10% CM (p<0.02). Conclusions: An exclusive human milk diet, devoid of CM-containing products, was associated with lower mortality and morbidity in EP infants without compromising growth and should be considered as an approach to nutritional care of these infants.

Concepts: Childbirth, Infant, Nutrition, Intensive care medicine, Milk, Cattle, Pediatrics, Necrotizing enterocolitis

28

This study aimed to evaluate the effect of milk expression method (manual expression versus electric pump) on the composition of breastmilk.

Concepts: Breast pump

28

Abstract Background: Saudi Arabia has a declining rate of breastfeeding and increasing levels of childhood asthma and atopic disease. In highly economically developed countries, breastfeeding of children at high risk of atopic disease reduces the likelihood of atopic dermatitis, wheezing associated with respiratory infections, and possibly asthma. This study investigated the prevalence of breastfeeding and its association with wheezing/asthma and atopic disease in 1-3-year-old children in Riyadh, Saudi Arabia. Subjects and Methods: A cross-sectional study of children attending routine “well-baby” clinics in three Saudi State Hospitals in Riyadh. An interviewer administered a questionnaire to collect data on sociodemographics, breastfeeding, wheezing symptoms, asthma, and atopic disease. Results: In total, 622 children 1-3 years old were recruited. Of these, 75% of children were ever breastfed, and 36% of children were fully breastfed, with 20% of children being fully breastfed for ≥3 months. Increasing duration of full breastfeeding was associated with a reduced likelihood of maternal reporting of her child having “ever wheezed,” “wheezed' in the last 12 months,” and “ever having asthma,” with adjusted odds ratio for full breastfeeding ≥12 months versus never breastfed of 0.51 (95% confidence interval 0.29-0.90), 0.48 (0.26-0.88), and 0.46 (0.22-0.94), respectively. No associations were demonstrable between full or ever breastfeeding and atopic dermatitis/eczema, irrespective of family history of atopic disease. Conclusions: Although breastfeeding does not protect children from developing eczema in Riyadh, full breastfeeding is associated with reduced childhood wheezing and possibly asthma. Further efforts should be made to promote breastfeeding in Saudi Arabia.

Concepts: Asthma, Saudi Arabia, Arabian Peninsula, Riyadh, Mecca, Atopy, Jeddah, Ha'il

28

Abstract Ectopic breast tissue is defined as glands of breast tissue located outside of the normal anatomic breasts. Historically, ectopic breast tissue has been thought to arise from a remnant of the embryonic mammary ridge along the “milk line” or the midaxillary line from the axilla to the groin, including the vulvar region. Extramammary tissue displays the same pathologic and physiologic changes as normal breast tissue and is often discovered in multiparous women as the result of swelling from lactational activity. We present a case report of a gravid patient with lactating vulvar mass and a brief historical perspective of vulvar ectopic breast tissue.

Concepts: Prolactin, Milk, Lactation, Breast, Mammary gland, Male lactation, Nipple, Milk line

28

Abstract The objectives of this study were to provide an economic assessment as well as a calculated projection of the costs that typical U.S. tertiary-care hospitals would incur through policy reconfiguration and implementation to achieve the UNICEF/World Health Organization Baby-Friendly(®) Hospital designation and to examine the associated challenges and benefits of becoming a Baby-Friendly Hospital. We analyzed hospital resource utilization, focusing on formula use and staffing profiles at one U.S. urban tertiary-care teaching hospital, as well as conducted an online survey and telephone interviews with a selection of Baby-Friendly Hospitals to obtain their perspective on costs, challenges, and benefits. Findings indicate that added costs for a new Baby-Friendly Hospital will approximate $148 per birth, but these costs sharply decrease over time as breastfeeding rates increase in a Baby-Friendly environment.

Concepts: Health insurance, Hospital, Breastfeeding, Policy, World Health Organization, Teaching hospital, Hospitals

28

Abstract Purpose: There is little known about the association between breastfeeding and long-term child psychopathology. This study aimed to examine the impact of breastfeeding on child mental health and problem behavior at 14 years and whether this association is confounded by other variables. Subjects and Methods: Data were from a pre-birth prospective study that included mothers and their children followed up from pregnancy to 14 years of the child’s age in Brisbane, Australia. The child’s anxiety/depression, withdrawal problems, somatic complaints, social problems, thought problems, attention problems, aggression, and delinquency were measured using the Achenbach Youth Self Report at 14 years. Breastfeeding was prospectively assessed at the 6-month follow-up of the study. The analysis was based on 4,502 adolescents who responded to the YSR questionnaire and for whom prospective data were available on breastfeeding. Results: Breastfeeding as reported by mothers when the child was 6 months old predicted reduced symptoms of child mental health and problem behavior at 14 years. The impact of breastfeeding on the child’s social problems, attention problems, and aggressive behavior remained statistically significant after controlling for the effect of other variables, such as unplanned pregnancy, maternal mental health, and substance use during pregnancy. Conclusions: Our data suggest that breastfeeding for at least 4 months can have a significant protective effect on a child’s social, attention, and aggression problems in early adolescence. Given the limitations of the existing evidence, further research is needed to investigate the robustness of the findings of this study and the mechanisms of long-term association between breastfeeding and reduced social, attention, and aggression problems of the offspring in adolescence.

Concepts: Psychology, Pregnancy, Statistical significance, Aggression, Social rejection, Psychiatry, The Offspring, Problem behavior

28

Abstract Introduction: Simultaneous (SIM) breast expression saves mothers time compared with sequential (SEQ) expression, but it remains unclear whether the two methods differ in milk output efficiency and efficacy. Subjects and Methods: The Showmilk device (Medela AG, Baar, Switzerland) was used to measure milk output and milk ejection during breast expression (electric pump) in 31 Australian breastfeeding mothers of term infants (median age, 19 weeks [interquartile range, 10-33 weeks]). The order of expression type (SIM/SEQ) and breast (left/right) was randomized. Results: SIM expression yielded more milk ejections (p≤0.001) and greater amounts of milk at 2, 5, and 10 minutes (p≤0.01) and removed a greater total amount of milk (p≤0.01) and percentage of available milk (p<0.05) than SEQ expression. After SIM expression the cream content of both the overall (8.3% [p≤0.05]) and postexpression (12.6% [p≤0.001]) milk were greater. During SEQ expression, the breast expressed first had a shorter time to 50% and 80% of the total amount of milk than the breast expressed second (p≤0.05), but, overall, a similar percentage of available milk was removed from both breasts. Conclusions: SIM expression stimulated more milk ejections and was a more efficient and efficacious method of expression, yielding milk with a higher energy content.

Concepts: Infant, Randomized controlled trial, Milk, Lactation, Interquartile range, Breast, Breast milk, Male lactation

23

This study aims at systematically reviewing the observational and interventional studies on the association of maternal macro- and micronutrient intake with breast milk content.

Concepts: Nutrition, Milk, Breastfeeding, Lactation, Dietary mineral, Breast, Breast milk, Micronutrient

23

Purpose and Study Objective: Whether the preterm mothers' mature milk retains the same cellular components as those in colostrum including stem-like cell, cell adhesion molecules, and immune cells.

Concepts: DNA, Cell biology, Cell adhesion, Cell adhesion molecule, Cellular component, Design, Immunoglobulin superfamily