Breast Milk Feeding Research Articles

What supports mothers of very preterm babies to start and continue breast milk feeding neonatal units? A qualitative COM-B analysis of mothers’ experiences

BackgroundIt is challenging for mothers who give birth very preterm to produce sufficient breast milk by expressing for weeks before their baby is able to feed from the breast, and then to transition from tube feeding to breastfeeding. Lactation is most successful when stimulated shortly after birth, established within 72 h, and maintained by expressing 6–8 times a day. This study explored mothers’ experiences of how breast milk feeding and breastfeeding for very preterm babies can be supported by staff and the facilities of a neonatal unit.MethodsTwenty-three mothers of very preterm babies were interviewed, from four neonatal units in England with high or low rates of breast milk feeding at discharge. Interviews were analysed using the COM-B framework to consider how mothers’ behaviour (breast milk feeding and breastfeeding) is affected by capability, opportunity and motivation.ResultsMothers’ motivation in the traumatic situation of very preterm birth was strongly affected by information from staff about the benefits of breast milk for their baby, the importance of early and frequent expressing, and how to assess the effectiveness of direct breastfeeding. It was maintained through positive feedback about their efforts which built their confidence, and reassurance about what is ‘normal’ growth when a baby begins direct breastfeeding. Motivation needed to be supported by opportunity, including access to equipment for expressing and facilities to stay near the neonatal unit, and also by capability, which required proactive and skilled information and support from staff. Specialist support and facilities varied between units, and some mothers were not given necessary information or had their motivation undermined by staff comments.ConclusionsInterventions to increase breast milk feeding and breastfeeding for very preterm babies should address mothers’ motivation, capability and opportunity, aiming for systematic elimination of obstacles. Mothers value personalised and skilled specialist support, but also need other staff to be able to give consistent information and affirmation focused on their efforts rather than their success, with a trauma-informed approach. Investing in rooming-in facilities that minimise the separation of mothers and babies is likely to overcome a key obstacle.

Preterm infant attachment is independent of breast milk intake during neonatal care

Background Following preterm birth, breast milk feeding is recommended because it confers broad health benefits to preterm infants. Breast milk has been suggested to promote secure attachment in infancy, but this is uncertain. Elucidating the relationship between breast milk intake and infant attachment is crucial for supporting parents of preterm infants to make feeding choices and providing accurate counselling when breast milk is not available. We aimed to investigate if breast milk exposure during neonatal care associates with attachment outcomes derived from infants’ responses to the Still-Face Paradigm (SFP) at nine months of age. Methods We studied 77 preterm (< 33 weeks’ gestation) and 71 term infants. Preterm infant feeding data were collected from birth until hospital discharge. Infant responses to the SFP were videocoded at nine months corrected age. Infants’ distress, fretfulness, attentiveness to caregivers and attachment classification were compared between preterm infants who received exclusive breast milk for ≥ 75% of inpatient days, those who received exclusive breast milk for < 75% of inpatient days, and term infants. Milk intake thresholds were chosen based on our previous work demonstrating positive associations between breast milk intake and MRI markers of brain maturation. Results There were no significant differences in infant distress, fretfulness, attentiveness to caregivers (p-values > 0.19), or in the odds of secure versus insecure attachment classification (relative risk ratio = 0.57–0.89, p-values = 1.00) between preterm infants with high or low breast milk exposure, or term comparators. Conclusions Attachment outcomes at nine months were similar between term and preterm infants, and breast milk exposure did not associate with attachment in the preterm group. Although breast milk feeding has clear benefits, these findings may alleviate some of the pressures experienced by parents who are unable to provide breast milk for infants cared for in the neonatal unit.

Diverse weaning foods and diet patterns at multiple time points during infancy period and their association with neurodevelopmental outcomes in 6-year-old children.

Understanding the impact of early-life nutritional choices on neurodevelopment in children is a growing area of research. To investigate the association between dietary patterns at multiple timelines and neurodevelopmental outcomes in 6-year-old children. This administrative observational study utilized a merged data from the national health insurance database and the health screening program for children. Information on the diet patterns from infancy to 3 years of age was obtained from parent-administered questionnaires. Dietary pattern clusters of the participants were identified using Polytomous Latent Class Analysis. The outcome was neurodevelopment using the Korean Developmental Screening Test (K-DST) at the age of 6 years. The study identified four distinct clusters among with the 133,243 eligible children (49.6% male, birth weight 3.22 kg, head circumference 42.7 cm at 4 months). The control cluster (53.4%) exhibited a diet including breast milk feeding and a variety of dietary patterns at the age of 1 year. In contrast, cluster 1 (36.0%) showed a skewed dietary pattern at the same age. Cluster 2 (6.6%) displayed diverse dietary patterns at one year but primarily consumed formula at four months, while cluster 3 (4.0%) had reduced dietary diversity and formula feeding. Compared with the control cluster, the adjusted odds ratio for unfavorable development was 1.209 (95% CI, 1.156-1.266) in cluster 1, 1.418 (95% CI, 1.312-1.532) in cluster 2, and 1.741 (95% CI, 1.593-1.903) in cluster 3. These findings remained consistent across individual domains of the K-DST. Dietary patterns during infancy and early childhood may be associated with neurodevelopment at the age of 6 years.

Fatty acids from nutrition sources for preterm infants and their effect on plasma fatty acid profiles

BackgroundIn preterm infants, IV administration of fat is less well tolerated compared to intake via the enteral route, often resulting in hypertriglyceridemia. It is therefore recommended that parenteral fat intake should not exceed 3.5 to 4.0 g/kg/d whereas human milk can provide up to 8 g/kg/d. It is unknown whether such hypertriglyceridemic conditions are caused by a uniform increase of all fatty acids or it is linked to an elevation of distinct fatty acids due to an unbalanced intake. Obviously, both scenarios could potentially influence the formulation of novel lipid solutions for preterm infants. Objective of this exploratory study was to compare fatty acid profiles between a) different nutritional sources and corresponding plasma samples, b) plasma of infants fed breast milk versus those receiving lipid emulsion, and c) plasma of infants with normal versus elevated triglyceride levels.MethodsForty-seven preterm infants < 36 weeks of gestation were included; fatty acid profiles were measured in serum samples and corresponding nutritional sources (breast milk and lipid emulsion) using gas chromatography/mass spectrometry.ResultsCompared to breast milk levels, plasma contained significantly lower C8:0, C10:0, C12:0, C14:0, C19:1n9, C18:3n3 (p < 0.0001). In contrast, relative abundance of C16:0, C18:0 and C20:4n6 was higher in plasma than in corresponding breast milk samples (p < 0.001) and lipid emulsion (p < 0.01). Compared to the corresponding lipid emulsion, the abundance of C18:2n6 and C18:3n3 was significantly lower in plasma (p < 0.001). Fatty acid profiles in plasma of infants fed breast milk compared to lipid emulsion were not markedly different. Hypertriglyceridemic samples showed elevated levels for C18:1n9 and C16:0 when compared with normotriglyceridemic samples.ConclusionsOur study reveals that lipid levels in plasma show both depletion and enrichment of distinct fatty acids which do not seem to be closely related to dietary intake. A more detailed understanding of fatty acid flux rates is needed, like the understanding of amino acid metabolism and is supported by the finding that hypertriglyceridemia might be a state of selective fatty acid accumulation. This would allow to develop more balanced diets for intensive care and potentially improve clinical outcomes.

Breast Milk Feeding for Infants Who Required Major Surgery

ObjectiveTo identify barriers or facilitators that influenced mothers to provide mother’s own milk (MOM) for 6 months to their infants who were hospitalized in the NICU after major surgery. DesignDescriptive qualitative. SettingAn 80-bed, Level 4 NICU of a regional pediatric hospital in the western United States. ParticipantsFourteen mothers who provided MOM for their infants who required surgery within 1 week of age. MethodsWe conducted in-person interviews upon admission and discharge of the infant, phone interviews 1 and 2 weeks after discharge, and phone interviews monthly for 6 months or until discontinuance of the provision of MOM. We analyzed interviews using the Brooks thematic template analysis method. ResultsEleven infants received exclusive MOM at discharge, and nine infants remained on exclusive MOM at 6 months. We generated four principal themes from the participants’ comments: Value of Breast Milk, Challenges of Providing MOM, Emotional Fluctuation, and Coping With Reality of Circumstances. ConclusionInternalizing the value of MOM, family support, and coping with barriers were key factors that influenced participants to provide MOM for at least 4 months. Findings of this study suggest that prenatal education with anticipatory guidance and lactation support in the NICU can help mothers achieve the goal of extended provision of MOM to infants with serious conditions that require surgery. Education and support may be especially helpful for young, first-time mothers.

Effect of Work-related Stress on Breast Milk Feeding Beyond 6 Month of the Baby, among the Nursing Personnel: A Cross Sectional Study

Abstract Background: The largest drop in continuing breast milk feeding occurs with the return of the lactating mothers to work. Stress amongst the working mothers affects milk production. Nursing is a stressful job and work-related stress impacts nurses’ health-related quality of life. The effect of work-related stress on breast milk feeding beyond 6 months of the baby amongst nursing mothers is an unexplored area. Objectives: (a) To assess the work-related stress, (b) to estimate the proportion of discontinued breast milk feeding beyond 6 months of the baby and (c) to find out the association (if any) between work-related stress and discontinuation of breast milk feeding beyond 6 months, amongst the nursing personnel of Siliguri subdivision of Darjeeling district. Materials and Methods: A cross-sectional study was carried out amongst the eligible study population using a work-related stress questionnaire. Chi-square test was done as a test of association and binomial logistic regression was used to find out the adjusted odds ratio (AOR). Results: Work-related stress was present in 62.4% of the respondents, while 70.9% had discontinued breastfeeding beyond 6 months. 79.5% of respondents with work-related stress had discontinued breastfeeding. Nursing staffs having work-related stress had higher odds of discontinuing breastfeeding (AOR: 3.682; confidence interval: 1.4035–9.659). Conclusion: Work-related stress is present in a large proportion of nursing staffs and many of them have discontinued breast milk feeding beyond 6 months of age of their babies, which is influenced by work-related stress.

Effects of kangaroo mother care combined with nurse-assisted mindfulness training for reducing stress among mothers of preterm infants hospitalized in the NICU: a randomized controlled trial

BackgroundKangaroo mother care (KMC) can have a positive effect on the mental well-being of a mother. However, there are specific challenges associated with the process that may contribute to increased anxiety for the mother. By integrating nurse-assisted mindfulness training alongside KMC guidance, nurses may effectively alleviate maternal stress to a greater extent.MethodsA single-centre randomized controlled trial was conducted to investigate the effects of KMC combined with nurse-assisted mindfulness training. The study included preterm infants with a gestational age of less than 32 weeks or a birth weight of less than 1500 g and their mothers, who were randomly divided into two groups. The intervention group consisted of mothers who received KMC combined with nurse-assisted mindfulness training for 14 days. The control group comprised mothers who received only KMC for 14 days. Data from both groups were collected and compared for analysis.ResultsForty-seven infants and their mothers were included in the intervention group, whereas 44 pairs were included in the control group. After the intervention, the parental stressor scale scores for the neonatal intensive care unit (PSS: NICU) (3), PSS: NICU (4), and Hospital Anxiety and Depression Scale (HADS) scores for the intervention group were lower than those for the control group, whereas the Five Facet Mindfulness Questionnaire (FFMQ) (1), FFMQ (4), and FFMQ (5) scores for the intervention group were higher. The degree of change in the PSS: NICU and HADS scores was inversely correlated with the degree of change in the FFMQ score. The breast milk feed rate and weight gain rate were greater in the intervention group than in the control group. No adverse reactions were observed in either group.ConclusionsKangaroo mother care combined with nurse-assisted mindfulness training is an acceptable, feasible, and effective procedure for reducing anxiety in mothers of preterm infants in the NICU, with potential benefits for the short-term prognosis of these infants.Trial registrationChinese Clinical Trial Registry, ChiCTR1900023697, registered on June 8, 2019, retrospectively registered.

Predicting Factors of Length of Stay at a Neonatal Intensive Care Unit in a Tertiary Hospital in Ghana

Objective: The aim of this research was to determine the factors that influence the length of stay in the NICU of the Korle Bu Teaching Hospital (KBTH), Accra. Methodology: This was a retrospective study involving 249 preterm infants who were admitted and discharged from the NICU, KBTH from November 2021 to October 2022. The multivariable negative binomial regression model was used to assess the factors associated with the number of hospital days among the newborns. Results: The median number of days stayed in the NICU was 12 days (IQR: 8-21). Predictor of shorter length of stay in the NICU was preterm infants with birthweight between 1500-2499g (aβ: -0.39, 95% CI: [-0.54, -0.24], p&lt;0.001). Predictors of prolonged length of stay in the NICU were late initiation of breastmilk feeding (aβ: 0.31, 95% CI: [0.01, 0.60], p=0.040), preterm infants with neonatal jaundice (aβ: 0.15, 95% CI: [0.02, 0.28], p=0.023), neonatal sepsis (aβ: 0.44, 95% CI: [0.30, 0.57], p&lt;0.001), and necrotising enterocolitis (aβ: 0.37, 95% CI: [0.16, 0.58], p&lt;0.001). Conclusion: Preterm infants who initiated breastmilk feeding late, developed neonatal sepsis, necrotising enterocolitis and neonatal jaundice were more likely to stay longer at the NICU. While those with birth weight between 1500-2499grams

Relationship Between Breast Milk Feeding and COVID-19 Incidence in Children Aged 0-2 Years at Siloam Hospital Kelapa Dua During The Pandemic

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The COVID-19 pandemic has claimed more than 6 million lives worldwide, and children are not spared from its danger. Breast milk is known to protect babies from various kinds of infections. Until now there are few data regarding the relationship between breastfeeding and the incidence of COVID-19 in children aged 0-2 years in Indonesia. This study aims to further examine the relationship between breastfeeding and the incidence of COVID-19 in children aged 0-2 years. Siloam Hospitals Kelapa Dua (SHKD) was chosen as a location because it was one of the referral hospitals for treating COVID-19 for pediatric patients in Tangerang that can be accessed by the researcher.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted using a cross-sectional study method on a sample of children aged 0-2 years from the medical record database of Siloam Hospitals Kelapa Dua for the period 2020 to 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; Upon calculation, it was found that the p-value is 0,154 (p&amp;gt;0,05). From 61 sample, 37,7% of the samples were breastfed and 44,3% was COVID-19 positive.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; No significant relationship was found between breastfeeding and COVID-19 infection among children aged 0-2 years old in SHKD.&lt;/p&gt;

CLINICAL SPECTRUM OF DISEASE IN NEONATES BORN TO MOTHERS WITH COVID-19 IN A TERTIARY CARE HOSPITAL

COVID-19 infection during pregnancy presents potential risks to neonates, yet the full clinical spectrum in newborns born to COVID-19-positive mothers remains under investigation. Understanding the clinical outcomes in these neonates is essential for guiding management and care. Objective: To study the spectrum of clinical presentations in neonates born to mothers who tested positive for COVID-19. Methods: This prospective cross-sectional study was conducted at the Department of Pediatrics, Shifa International Hospital, from April 1, 2020, to April 30, 2021. All neonates born to COVID-19-positive mothers were included in the study and followed daily during their hospital stay. After obtaining parental consent, nasopharyngeal swabs were taken from the neonates for SARS-CoV-2 PCR testing at 24-48 hours of age. After discharge, follow-up calls were made between days 7-14. Data were entered into a predesigned proforma and analyzed using SPSS version 23. Results: A total of 82 neonates were enrolled. Approximately half were born at term, with a mean weight of &gt;2500 grams. Forty-five neonates (53%) underwent SARS-CoV-2 PCR testing within 48 hours of age; all were negative. Sixty-one neonates (74%) were shifted to the mother’s care, while 25% required admission to the neonatal intensive care unit (NICU). The most common reasons for NICU admission included respiratory distress (15%), prematurity (6%), and lethargy (5%). Radiological findings included ground-glass appearance in five neonates (6%) and lung consolidation or infiltrates in two (3%). Hematological and biochemical abnormalities included leukocytosis (7%), leucopenia (3.6%), anemia (1.2%), metabolic acidosis (6%), and respiratory acidosis (3.6%). Most neonates (78.6%) received routine care and were fed breast milk. Fourteen neonates (16.7%) required respiratory support, with 13% needing mechanical ventilation. Complications included pneumonia (7%) and respiratory failure (9%). NICU stay varied, with 11 neonates (13%) staying less than 48 hours and 10 (12%) requiring a more extended stay. Four neonates (5%) died due to multiorgan complications. Conclusion: The majority of neonates born to COVID-19-positive mothers remained asymptomatic. However, symptomatic neonates were at risk of serious complications, requiring close monitoring and management, particularly in those with additional risk factors.

Microbiota regulates neonatal disease tolerance to virus-evoked necrotizing enterocolitis by shaping the STAT1-NLRC5 axis in the intestinal epithelium

Microbiota and feeding modes influence the susceptibility of premature newborns to necrotizing enterocolitis (NEC) through mechanisms that remain unknown. Here, we show that microbiota colonization facilitated by breastmilk feeding promotes NOD-like receptor family CARD domain containing 5 (Nlrc5) gene expression in mouse intestinal epithelial cells (IECs). Notably, inducible knockout of the Nlrc5 gene in IECs predisposes neonatal mice to NEC-like injury in the small intestine upon viral inflammation in an NK1.1+ cell-dependent manner. By contrast, formula feeding enhances neonatal gut colonization with environment-derived tilivalline-producing Klebsiella spp. Remarkably, tilivalline disrupts microbiota-activated STAT1 signaling that controls Nlrc5 gene expression in IECs through a PPAR-γ-mediated mechanism. Consequently, this dysregulation hinders the resistance of neonatal intestinal epithelium to self-NK1.1+ cell cytotoxicity upon virus infection/colonization, promoting NEC development. Together, we discover the underappreciated role of intestinal microbiota colonization in shaping a disease tolerance program to viral inflammation and elucidate the mechanisms impacting NEC development in neonates.

Comparison of human breast milk vs commercial formula-induced early trophic enteral nutrition during postoperative prolonged starvation in an animal model

The present study aimed to characterize the changes in macromolecular composition and structure in ileal tissue induced by postoperative prolonged starvation (PS), human breast milk feeding (HM) and commercial formula feeding (CF) for 48 and 72 h (h). Forty-two Wistar albino rats underwent an ileal transection and primary anastomosis and were then divided into six subgroups. Two groups of seven rats were food-deprived for 48 and 72 h with free access to water only in metabolic cages (48 h PS, 72 h PS). Then, two groups of seven rats received early enteral trophic nutrition (EEN) either using HM, and CF at 48 h post-operation (48 h HM, 48 h CF). The other two groups of seven rats received the same trophic enteral nutrition at 72 h post-operation (72 h HM, 72 h CF). An additional seven rats were fed normal rat chow (control), after which the ileal tissues were harvested and freeze-dried overnight. Then sample spectra were recorded by Fourier transform infrared (FTIR) spectroscopy. PS at 48 and 72 h resulted in an increase in the concentration of lipids and a decrease in the concentration of proteins. CF and HM trophic feeding induced a decrease in membrane fluidity and an increase in lipid order. Ileal tissues showed similar compositional and structural changes in lipids and proteins in the PS and CF groups after 48 and 72 h. A marked decrease in nucleic acid concentration was seen in CF at 48 h compared to HM. The human milk feeding groups did not induce any significant alterations and showed compositional and structural data similar to the controls. In conclusion, EEN application seems to be safer when introduced at 48 h rather than 72 h and time of this nutrition is crucial to maintain ileum structure and therefore immunity and well-being. HM-induced trophic nutrition is seen to protect the ileal tissue from significant alterations within lipid and protein compositions, whereas CF caused notable changes. HM is absolutely the best nutritional source for gut health in this animal model.

Early-life milk replacer feeding mediates lipid metabolism disorders induced by colonic microbiota and bile acid profiles to reduce body weight in goat model

BackgroundDysregulation of lipid metabolism and its consequences on growth performance in young ruminants have attracted attention, especially in the context of alternative feeding strategies. This study aims to elucidate the effects of milk replacer (MR) feeding on growth, lipid metabolism, colonic epithelial gene expression, colonic microbiota composition and systemic metabolism in goat kids compared to breast milk (BM) feeding, addressing a critical knowledge gap in early life nutrition.MethodsTen female goat kids were divided into 2 groups: those fed breast milk (BM group) and those fed a milk replacer (MR group). Over a period of 28 d, body weight was monitored and blood and tissue samples were collected for biochemical, transcriptomic and metabolomic analyses. Profiling of the colonial microbiota was performed using 16S rRNA gene sequencing. Intestinal microbiota transplantation (IMT) experiments in gnotobiotic mice were performed to validate causality.ResultsMR-fed pups exhibited reduced daily body-weight gain due to impaired lipid metabolism as evidenced by lower serum and liver total cholesterol (TC) and non-esterified fatty acid (NEFA) concentrations. Transcriptomic analysis of the colonic epithelium revealed upregulated genes involved in negative regulation of lipid metabolism, concomitant with microbiota shifts characterized by a decrease in Firmicutes and an increase in Actinobacteria. Specifically, genera such as Bifidobacterium and Prevotella were enriched in the MR group, while Clostridium and Faecalibacterium were depleted. Metabolomics analyses confirmed alterations in bile acid and fatty acid metabolic pathways. IMT experiments in mice recapitulated the metabolic phenotype observed in MR-fed goats, confirming the role of the microbiota in modulating host lipid metabolism.ConclusionsMilk replacer feeding in goat kids disrupts lipid metabolism and gut microbiota dynamics, resulting in reduced growth rates and metabolic alterations. These findings highlight the importance of early nutritional intervention on metabolic programming and suggest that modulation of the gut microbiota may be a target for improving growth and metabolic health in ruminants. This study contributes to the understanding of nutritional management strategies in livestock and their impact on animal health and productivity.

Influence of Feeding Practices on Intestinal Microbiota Composition in Healthy Chinese Infants: A Prospective Cohort Study

IntroductionThis study investigates the impact of different feeding methods (direct breastfeeding, expressed milk feeding, formula feeding) on the infant microbiota at 6 weeks of age. MethodsA total of 217 healthy infants stool samples were collected from Hong Kong between August 2018 and December 2019. ResultsVarious microbial taxa, including the genera Enterobacter and Raoultella were identified in the expressed breast milk feeding group. The richness and composition of the major bacterial phyla showed similar abundance between direct breastfeeding and expressed breast milk. DiscussionThese findings suggests that these bacteria may have colonized the milk during expression or could be introduced from other external sources. The mode of breastfeeding did not significantly alter microbiota parameters in the infant gut at 6 weeks.

A longitudinal study of breastmilk feeding duration, EEG power and early academic skills

BackgroundThe cognitive benefits of breastfeeding are widely recognized; however, its effects on brain development and later academic skills require further examination. This study aimed to examine the longitudinal relations between breastmilk feeding, neurophysiological changes, and early academic skills. MethodsIn the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort, breastmilk feeding practices were collected every 3 months from 3 weeks to 18 months postpartum. Resting electroencephalography (EEG) was recorded at 18 months and power spectral density was derived. The outcomes were a set of early academic assessments administered at age 4 (n = 810). Structural equation modelling was used to investigate EEG power as a mediator between breastmilk duration and early academic skills. ResultsBreastmilk feeding for ≥12 months was associated with better general knowledge, numeracy, and language at age 4 compared to shorter durations of breastmilk feeding (Cohen's d: 1.53–17.44). Linear regression showed that breastmilk duration was negatively and positively associated with low- (i.e., delta, theta) and high-frequency power (i.e., gamma), respectively (Cohen's f2: 0.03–0.09). After adjusting for demographic and child baseline covariates, a decrease in absolute and relative delta, as well as relative theta was associated with better general knowledge and numeracy (Cohen's f2: 0.16–0.25). Relative delta power provided an indirect path between breastmilk duration and early academic skills (x2: 18.390, p = 0.010; CFI: 0.978; TLI: 0.954; RMSEA: 0.040). ConclusionsExtended breastmilk feeding is associated with reduced low-frequency power and better early academic skills, suggesting benefits to brain development. Additional research to confirm this finding is warranted.

Breastfeeding When the Mother and the Baby Are Hospitalized Together or Separately

Objective:At the Regional High Specialty Hospital of Ixtapaluca, a lactation unit was implemented to promote breast milk feeding. This report aimed to describe the experience of breastfeeding in scenarios where the mother and the baby were hospitalized together or separately.Methods:This is a clinical practice article that describes situations where direct infant feeding was not an option. Lactation nursing staff provided educational support to mothers for breast milk expression with therapeutic self-care measures to promote exclusive breastfeeding.Results:Supplementation of breast milk was carried out in four scenarios: (1) mother and baby hospitalized together, (2) hospitalized separately, (3) the mother at home and the infant hospitalized, and (4) the mother hospitalized and the infant at home.Conclusions:The lactation unit of a non-obstetric hospital contributed to the promotion and training of exclusive breastfeeding techniques in situations where the mother or the baby was hospitalized.

What Happens in the Gut during the Formation of Neonatal Jaundice-Underhand Manipulation of Gut Microbiota?

Jaundice is a symptom of high blood bilirubin levels affecting about 80% of neonates. In neonates fed with breast milk, jaundice is particularly prevalent and severe, which is likely multifactorial. With the development of genomics and metagenomics, a deeper understanding of the neonatal gut microbiota has been achieved. We find there are accumulating evidence to indicate the importance of the gut microbiota in the mechanism of jaundice. In this paper, we present new comprehensive insight into the relationship between the microbiota and jaundice. In the new perspective, the gut is a crucial crossroad of bilirubin excretion, and bacteria colonizing the gut could play different roles in the excretion of bilirubin, including Escherichia coli as the main traffic jam causers, some Clostridium and Bacteroides strains as the traffic police, and most probiotic Bifidobacterium and Lactobacillus strains as bystanders with no effect or only a secondary indirect effect on the metabolism of bilirubin. This insight could explain why breast milk jaundice causes a longer duration of blood bilirubin and why most probiotics have limited effects on neonatal jaundice. With the encouragement of breastmilk feeding, our perspective could guide the development of new therapy methods to prevent this side effect of breastfeeding.

Lost in translation: Cesarean antibiotics and the infant microbiome

In this issue of Cell Host & Microbe, Sinha etal. describe their randomized trial assessing whether antibiotics given for maternal benefit prior to Cesarean disrupted the infants' microbiomes. Despite pre-incision antibiotics reaching the neonate, there was no meaningful alteration to the infant microbiome-especially when compared with breastmilk feeding.

Kangaroo mother care enhances exclusive breastmilk feeding and shortens time to achieve full enteral feeding in extremely preterm infants requiring non-invasive assisted ventilation

BackgroundExtremely preterm infants (EPIs) frequently encounter challenges in feeding due to their underdeveloped digestive systems. Attaining full enteral feeding at the earliest possible stage can facilitate the removal of vascular catheters and decrease catheter-related complications.MethodsWe performed a retrospective cohort study comprising 145 extremely preterm infants with a gestational age < 28 weeks who underwent non-invasive mechanical ventilation at Shenzhen Maternity & Child Healthcare Hospital between January 2019 and June 2020. The KMC group received standard nursing care along with KMC, while the control group received standard nursing care without KMC. KMC initiation took place three weeks after admission and continued for a period of two weeks or more while maintaining stable vital signs. We evaluated the rate of exclusive breastmilk feeding within 24 h prior to discharge and the time to full enteral feeding throughout hospitalization. Additionally, we conducted a multiple linear regression analysis to identify the independent factors associated with exclusive breastmilk feeding rates and the time to full enteral feeding.ResultsThe KMC group exhibited a significantly higher rate of exclusive breastmilk feeding in the 24 h before discharge in comparison to the Non-KMC group (52.8% vs. 31.5%, OR 2.43; 95% CI 1.24, 4.78). Moreover, the KMC group achieved full enteral feeding in a shorter duration than the Non-KMC group (43.1 ± 9.6 days vs. 48.7 ± 6.9 days, p < 0.001). Multiple linear regression analysis revealed that KMC was an independent protective factor associated with improved exclusive breastmilk feeding rates (OR 2.43; 95% CI 1.24, 4.78) and a reduction in the time to full enteral feeding (β -5.35, p < 0.001) in extremely preterm infants.ConclusionKangaroo Mother Care (KMC) can expedite the achievement of full enteral feeding and enhance exclusive breastmilk feeding rates in extremely preterm infants receiving non-invasive assisted ventilation. These findings highlight the beneficial effects of KMC on the feeding outcomes of this vulnerable population, underscoring the importance of implementing KMC as a part of comprehensive care for extremely preterm infants.

Predictors of Mortality in Late-Onset Sepsis in Very Low Birth Weight Newborns

Abstract Objective Late-onset sepsis (LOS) is a major public health burden globally. Newborns with very low birth weight (VLBW) are at high risk of mortality related to LOS. The protective effect of breast milk feeding against many infections has been studied but data on the effect of breast milk feeding on LOS mortality are limited. In this study, we aimed to evaluate the risk factors for LOS-related mortality. Methods This single-center, case–control study was conducted retrospectively from August 2013 to July 2018. VLBW newborns with ≤32 weeks of gestational age who had culture-proven LOS were included in the study. Demographics, clinical and laboratory data, and parenteral and enteral feeding details within 72 hours before LOS episodes were extracted from electronic and paper medical records. Results A total of 190 LOS episodes were identified in 168 VLBW newborns with a median birth weight of 888 (695–1,143) g. Lower birth weight (adjusted odds ratio [aOR] 0.81, 95% confidence interval [CI] [0.69–0.96], p = 0.01), C-section delivery (aOR 0.38, 95% CI [0.17–0.84], p = 0.02), gram-negative (aOR 4.97, 95% CI [2.01–12.28], p = 0.001) and polymicrobial sepsis (aOR 6.29, 95% CI [1.34–29.47], p = 0.03), and lower breast milk feeding 72 hours before LOS episodes (aOR 0.89, 95% CI [0.80–0.99], p = 0.03) were independently associated with higher odds of LOS related death. Conclusion Gram-negative sepsis was associated with higher odds of LOS mortality and C-section delivery was associated with lower odds of LOS mortality. Additionally, every 10 mL/kg/day increase in breast milk feeding was associated with 11% lower odds of LOS mortality although this finding should be interpreted cautiously as there may be unadjusted confounders due to the study design.