Breastfeeding Difficulties Research Articles

Breastfeeding Practices (Initiation, Exclusivity, Duration) During the First Six Months of an Infant’s Life among Caesarean Mothers in Selangor

Introduction: During the first six months of an infant’s life, breastfeeding practices are essential for an infant’s growth as recommended by the World Health Organisation (WHO). Breastfeeding also helps to strengthen the bond between mother and child. In accordance with this, infants can obtain optimal nutrition through initiation, exclusivity, and optimal duration of breastfeeding practices. However, it is shown that a mother who undergoes caesarean delivery has higher chances to experience difficulties in breastfeeding than vaginal delivery mothers. Therefore, this study is aimed to determine the prevalence of breastfeeding practices among caesarean mothers during the first six months after delivery. Methods: This cross-sectional study was conducted in chosen government Health Clinics in Selangor from July to December 2021. A total of 424 mothers were recruited, and data on socio-demographic and breastfeeding practices were obtained. Results: In the first six months after birth, 50.9% of caesarean mothers exclusively breastfed their infants, and the prevalence of breastfeeding practices was 37%. Approximately 55.9% of mothers initiated breastfeeding between one and 24 hours, while 31.1% and 13.0% initiated breastfeeding within one hour and after 24 hours, respectively. Breastfeeding initiation is found to have a significant effect on the duration of breastfeeding (χ2(4)=9.751,p-value=.045) while, breastfeeding exclusivity is found significantly dependent on the time of breastfeeding initiation and duration, (χ2(4)=11.88, p-value<.05). Conclusion: From these findings, breastfeeding exclusivity is influenced by early initiation and predicts a longer duration of breastfeeding. Therefore, breastfeeding support during early postpartum from family members and healthcare providers are important in predicting positive breastfeeding outcomes.

Clinical characteristics in 26 children with congenital tuberculosis in Central Southern China: a retrospective study

ABSTRACT Background Congenital tuberculosis (CTB) is relatively rare and most patients are described in case reports. Aim To investigate the clinical characteristics of CTB in 26 children. Methods A retrospective analysis of 26 children with CTB from January 2013 to December 2021 in Changsha Central Hospital in Central Southern China was undertaken. Results The median age at onset was 25 days (17–33) and within 4 weeks of age in approximately 73% of cases. Of 24 mothers (including two mothers of twins), 18 (75.0%) were asymptomatic during pregnancy, and four were diagnosed with tuberculosis prenatally. The numbers of tuberculous meningitis, tuberculous encephalitis and liver TB were 17 (65.4%), five (19.2%) and four (15.4%), respectively. The main symptoms were fever (n = 18, 69.2%) and cough (n = 16, 61.5%). Positive rates of T-SPOT.TB, acid-fast bacilli smear, culture of Mycobacterium tuberculosis and GeneXpert MTB/RIF test were, respectively, 84.2% (16/19), 42.3% (11/26), 43.5% (10/23) and 83.3% (5/6). Radiograph or computed tomography demonstrated typical pulmonary tuberculous lesions in all cases and the head magnetic resonance imaging (MRI) showed marked meningeal enhancement or parenchymal lesions in seven cases (26.9%). One case had drug-resistant TB. During follow-up, nine cases had varying degrees of liver injury, and one had delayed growth and development. Eight died and 18 recovered satisfactorily. Conclusion Maternal TB status during pregnancy, the epidemiological history, T-SPOT.TB and other TB-related aetiological tests and imaging are important for the early diagnosis and treatment of CTB, and are associated with a favourable outcome. Abbreviations AFB: acid-fast bacilli; Amk: amikacin; Cs: cycloserine; CT: computed tomography; E: ethambutol; GeneXpert MTB/RIF: GeneXpert Mycobacterium tuberculosis and rifampicin resistance; H: isoniazid; IVF-ET: in-vitro fertilization-embryo transfer; Lzd: linezolid; Mfx: moxifloxacin; MTB: Mycobacterium tuberculosis; mNGS: next generation sequencing; MTB-DNA: Mycobacterium tuberculosis-deoxyribonucleic acid; Pto: protionamide; R: rifampicin; TB: tuberculosis; T-SPOT.TB: spot test of mycobacterium TB infection T-lymphocytes; Z: pyrazinamide.

Neonatal readmissions at Saint-Pierre hospital, epidemiology and risk factors

Background: Newborn attendance at pediatric emergency departments has sharply increased in France since the early 2000s. Early discharge from maternity is the main risk factor. The purpose of this study was to describe the demographic and perinatal factors involved in the readmission to hospital of newborn babies in Southern reunion Island.Methods: This was a 13-month, single-center, case-control retrospective study (December 2015 to December 2016) carried out in the neonatal and pediatric intensive care units of the Saint-Pierre university hospital. Cases were represented by any newborn released from the maternity hospital and having been re-hospitalized. Controls were represented by newborns born during the same study period and not readmitted during their first month of life. One case was matched with a control.Results: We included 109 newborns. The re-hospitalization rate was 2.08%. The most common presentation were: fever (35.7%), and neurological symptoms (34.8%). The main etiologies were infections (33.9%), respiratory pathologies (24.7%), and breastfeeding difficulties (11.9%). Breastfeeding OR=0.53; 95% CI [0.30-0.92] (p=0.03) and neonatal pathologies during the stay in the maternity hospital OR=0.49; 95% CI [0.28-0.45] (p=0.016) were protective factors.Conclusions: The lack of identification of a risk factor encourages us to expand our study population and to look for other factors such as the medical and paramedical supervision of the mother-child couple during the postpartum period and the follow-up of the new born after leaving the maternity ward.

Relationship of delayed lactogenesis II to maternal perception of insufficient milk: A longitudinal study

AimTo analyze the relationship of delayed lactogenesis II with maternal perception of insufficient milk. MethodsA prospective, multicenter, longitudinal observational study was conducted. Data were obtained at discharge and between 1 and 5 months postpartum on the perception of insufficient milk and related variables, by means of a self-administered questionnaire, and subsequent postal and online follow-up. Logistic regression analysis was used to develop the explanatory model. ResultsA total of 260 puerperal mothers participated. Of these, 31.9% had insufficient milk and 23.6% had delayed lactogenesis II. During postpartum admission, delayed lactogenesis II (OR = 2.26; 95%CI = 1.07–4.79), difficulty in breastfeeding (OR = 1.02; 95%CI = 1.00–1.03), and professional help in breastfeeding (OR = 0.70; 95%CI = 0.50–0.97) were associated with maternal perception of insufficient milk. ConclusionsThe occurrence of breastfeeding difficulties during postpartum admission and at discharge, especially when there is delayed lactogenesis II, should be considered risk indicators, suggesting the need for additional support to standardized care. The PIM is a suitable indicator to assess the quality of professional breastfeeding support in improvement interventions.

Breastfeeding challenges and support in a high initiation population

BackgroundThe breastfeeding initiation rate in Israel is approximately 90%, yet exclusive breastfeeding drops sharply in the early postnatal period. The study objective was to assess early postpartum professional breastfeeding support, its association with breastfeeding success and identification of risk factors for early breastfeeding discontinuation.MethodsAs part of a post-discharge newborn follow-up study, a convenience sample of 868 mothers attending Maternal and Child Health Centers (MCHCs) up to three months post-partum were interviewed using a 26-item questionnaire. Breastfeeding-related questions covered demographic variables, pregnancy and birth details; breastfeeding duration, lactation support in hospital and post-discharge; and problems experienced.ResultsMost mothers, 797 (91.8%), initiated breastfeeding in hospital. All women who initiated breastfeeding in the hospital reported exclusive breastfeeding; by two weeks postpartum, 70 women (13.2%) were supplementing with formula (partial breastfeeding). Kaplan–Meier Survival Analysis revealed an estimated mean duration of exclusive breastfeeding in the sample population of 66.8 ± 1.5 days. This duration was shorter for women with preterm births, low birthweight infants (LBW), cesarean births, and hospitalizations in neonatal intensive care units (NICU). A total of 472 (59.3%) breastfeeding mothers reported receiving in-hospital guidance. Of these, 290 (61.3%) were observed breastfeeding. Of all women who initiated breastfeeding, 280 (35.1%) attended MCHC follow-up within 72 h of hospital discharge. A higher proportion of women experiencing breastfeeding difficulties attended an MCHC within 72 h (131/297, 44.1%) compared to women not experiencing difficulties (148/499, 29.7%). The most frequently reported problems were mechanical (55.2%) or milk supply concerns (18.5%). First-time mothers were more likely to report problems, as were Jewish (vs Arab) mothers.ConclusionsEven in a population with high initiation rates of breastfeeding, breastfeeding duration, both exclusive and partial, is less than recommended. As much of this drop-off occurs during maternity leave, it is likely related to breastfeeding challenges other than employment. Breastfeeding support needs of women are currently not adequately met; staffing and time for both in-hospital and community-based counseling needs to be funded as well as mandated. Counseling hours should be tailored to assure adequate coverage of high-risk groups such as women after cesarean delivery and newborns requiring intensive care.

Development and Interrater Reliability of the Lactation Assessment Care Tool.

There have been no comprehensive predictive measurement instruments published that account for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Care Assessment Tool (LACT) was developed by the authors as a predictive measure of lactation acuity to identify families at risk for breastfeeding difficulty and facilitate access to the most effective level of care. To describe the development, content validation, and interrater reliability of the LACT. This study was a cross-sectional, online survey. Upon reading a standardized case scenario reflective of common experiences among families with goals to breastfeed, participants (N = 82) anonymously completed the LACT, which consisted of 16 measures based upon research relevant to maternal, infant, and functional factors affecting breastfeeding success. Descriptive statistics were used to summarize and describe the characteristics of the study sample. Interrater reliability was evaluated using Krippendorff's alpha. An acceptable degree of interrater reliability (α = 0.70) among participants was detected for the 16 measures included in the instrument. This instrument supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of care after discharge from the hospital by identifying families in need of referral to a level of care consistent with their lactation acuity. Future research is necessary to determine appropriate levels of care and support based on the instrument scores in diverse breastfeeding dyads during early lactation and through the duration of breastfeeding.

Associations Between Mothers' Adverse Childhood Experiences, Material Hardship, and Breastfeeding Challenges in the United States.

Breastfeeding is the biological norm and is associated with numerous superior health outcomes for children and mothers when compared to human milk substitutes. Yet, breastfeeding difficulties and the inability to meet one's breastfeeding goals are common in the United States and maybe more common among mothers who have experienced trauma. (1) Are mothers' adverse childhood experiences, and current experiences of discrimination, material hardship, and decreased social support associated with breastfeeding challenges; and (2) are these experiences associated with the number of breastfeeding challenges reported? A prospective, non-probability, cross-sectional study design with a diverse sample who had delivered a live baby within the previous year (N = 306) was conducted. Over 70% of participants reported breastfeeding challenges and 45.2% reported material hardship. Among those who attempted breastfeeding (n = 286), 74.1% had at least one adverse childhood experience; 30.3% had four or more. Logistic and negative binomial regression models determined that adverse childhood experiences, experiences of discrimination, material hardship, and decreased social support were not associated with experiencing any breastfeeding challenges. However, adverse childhood experiences were associated with the number of breastfeeding challenges reported. (The adjusted rate ratio was 1.05; 95% CI [1.00, 1.09], p = .034). We recommend further research on adverse childhood experiences and potential relationships with discrimination, material hardship, and social support to prevent and intervene in cases of breastfeeding challenges to maximize infant, maternal, and public health.

Marital Age, Cigarette Exposure, Physical Activity, Sleep Duration, and Prenatal Depression

Background: Extensive studies indicate that prenatal depression disrupts a woman's life and has a detrimental effect on the mother-child and further breastfeeding. Numerous factors associated with nutrition, physical activity, sleep patterns, and exposure to cigarette smoke are strongly suspected of contributing to the dysregulation of hormones associated with depression. This study aims to examine the association between physical activity, nutritional status, prior exposure to cigarette smoke, and the risk of prenatal depression. Method: A cross-sectional study was conducted on 79 pregnant women at the Pampang Primary Healthcare Center between January and March 2021. Using chi-square and multiple logistic regression, identify the risk factors that most significantly contribute to the risk of prenatal depression. Result: Married under the age of 19th (p<0.039), inactive daily exercise (p<0.023), inadequate sleep duration (p<0.045), and mothers who have been exposed to cigarette smoke for more than a year (p<0.001) all increased the risk of prenatal depression. Cigarette exposure, contributes most, with a 5.4-fold increased risk of developing mental disorders while breastfeeding. Conclusion: It is critical for health services to include early screening for prenatal depression during antenatal care as a means of preventing future breastfeeding difficulties, particularly in mothers with vulnerability.

Studi Literatur: Pengalaman Menyusui pada Ibu Usia Remaja

Breastfeeding in one of the best ways to reduce infant mortality. However, UNICEF data in 2019 recorded that only 43% of newborns started breastfeeding in the first hour and 41% received exclusively breastfed. The causes of initiation and continuation of breastfeeding are closely related to the age of the mother. Adolescent mothers were found to not continue exclusive breastfeeding. This article aims to explore the experience of exclusive breastfeeding for adolescent mothers. The method used is a literature study. Research questions were identified using the PEOS (Population, Exposure, Outcome, Study Design) framework. The journals used in the literature review were obtained through the Pubmed, Science Direct and Google Scholar databases from 2010-2020. The keywords used according to MESH (Medical Subject Heading) are "experience", "exclusive breastfeeding", and "adolescent mothers", and selected full text. The results of the review of 6 articles include: mother’ decisions to breastfeed such as, breastfeeding is a natural, easy, and fun way, a supportive environment, breastfeeding can improve baby’s health, provide benefits for mothers, save costs. The obstacles faced by adolescent mother include, lack of knowledge and skills, uncontrollable and unplesant physical experiences, inadequate response to health services, lack of support for breastfeeding at work/school, and difficulty breastfeeding in public places. So, adolescent mothers need breastfeeding support such as information support, instrumental support, emotional support, and apraisal support.

CONGENITAL GRANULAR CELL EPULIS IN ANTERIOR REGION OF THE MANDIBLE: A RARE CASE

Congenital granular cell epulis (CGCE) is a rare benign tumor of unknown etiology, with a predilection for the maxilla. It is characterized by the proliferation of granular cells, exhibiting negative immunohistochemical expression for S-100 protein. An 8-day-old dark-skinned female newborn presented with a nodular lesion located in the anterior region of the mandible. It measured 1.3 × 1.0 × 0.7 cm and had a pedunculated base. It was covered by eroded mucosa and fibrous on palpation. After surgical excision, a diagnosis of congenital granular cell epulis was rendered, based on anatomopathologic and immunohistochemical findings (positive for vimentin and specific neuron enolase and negative for S-100, smooth muscle actin, and desmin). After 18 months of follow-up, there are no signs of recurrence. The recognition of this lesion is important because of functional limitations, such as difficulty in breastfeeding.

TEMPORARY REMOVAL: Adverse pregnancy outcomes after in vitro fertilization due to undiagnosed urogenital tuberculosis and proposed screening algorithm for patients from tuberculosis-endemic countries

ObjectiveTo report 2 cases of adverse pregnancy outcomes due to delayed diagnosis of urogenital tuberculosis and propose a screening algorithm for patients from tuberculosis-endemic countries.DesignCase report.SettingAcademic medical center.Patient(s)Two patients with delayed diagnosis of urogenital tuberculosis leading to a fetal loss and a preterm delivery of an infant with congenital tuberculosis.Intervention(s)Endometrial biopsy, acid-fast bacilli culture of urine, and endometrium.Main outcome measure(s)Pregnancy outcomes.Result(s)Fetal loss at 19 weeks and preterm delivery of an infant with congenital tuberculosis before urogenital tuberculosis treatment.Conclusion(s)Patients who are at risk of urogenital tuberculosis should be screened in advance of infertility treatment to potentially prevent adverse pregnancy outcomes.

Virtual Reality (VR) Glasses for Oxytocin Relaxation Therapy to Increase Breast Milk Production of Postpartum Mothers

Background: Breast milk is the best food for newborns until the age of 2 years, but many breastfeeding mothers have difficulty breastfeeding and cause anxiety, stress, and depression. This condition causes the growth of the hormone oxytocin to be slow so that the milk production does not go smoothly. Objective: developing the application of virtual reality (VR) glasses as oxytocin relaxation therapy to increase breast milk production in postpartum mothers. Method: the method used was pre-experimental with a one-group pretest-posttest design approach. Results: This research involved respondents with the criteria; breastfeeding mothers with an age range of 20-35 years, the majority of whom have higher education, most of whom work. The results show that there is a difference in the average before and after treatment with VR glasses, namely the average before treatment was 57.11 with an SD of 13,546, the average after treatment was 73.55 with an SD of 9.921. Statistical test results obtained a p-value of 0.000 (p<) with a difference in the average value of 11.44. The conclusion is that postpartum mothers who are breastfeeding are comforted by the application of audio-visual, thereby stabilizing the increase in the hormone oxytocin which acts as an increase in breast milk production.

Association of Caesarean delivery and breastfeeding difficulties during the delivery hospitalization: a community-based cohort of women and full-term infants in Alberta, Canada.

Breastfeeding difficulties are the most common reason for breastfeeding cessation, particularly in the early postpartum. Caesarean delivery is associated with earlier breastfeeding cessation than is the case with vaginal delivery, but differences in breastfeeding difficulties by mode of delivery have not been thoroughly examined. Our objective was to explore the association between Caesarean delivery and types of breastfeeding difficulties. We conducted a secondary analysis of data from a prospective cohort study of mothers who delivered full-term, singleton infants in Calgary, Alberta, Canada (N = 418). Women completed self-report questionnaires during the delivery hospitalization. Mode of delivery was defined as vaginal or Caesarean, and further classified as planned or unplanned Caesarean. Breastfeeding difficulties were measured using the Breastfeeding Experiences Scale and operationalized with binary variables for presence of various types of maternal (i.e. physical, supply, social) and infant (i.e. latch, behaviour/health) difficulties that were reported as moderate to unbearable. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Overall, 37.1% of women had a Caesarean delivery and 80.9% experienced a breastfeeding difficulty during the delivery hospitalization. Of the difficulties studied, Caesarean delivery was significantly associated with low milk supply (AOR = 1.62, 95% CI = 1.16-2.28) and infant behaviour/health difficulties (AOR = 1.33, 95% CI = 1.01-1.75). The association with low milk supply persisted when examining both planned (AOR = 2.42, 95% CI = 1.19-4.92) and unplanned (AOR = 2.21, 95% CI = 1.16-4.22) Caesarean deliveries. Mothers who deliver by Caesarean have higher odds of reporting low milk supply and infant behaviour/health difficulties than women who deliver vaginally.

AMAMENTAÇÃO: ENTRE O DELEITE DO BEBÊ E A ESCOLHA MATERNA

The studies point to short- and long-term benefits, whether from the organic, psychological, and socioeconomic point of view. At the same time, breastfeeding is a favorable action for the mother-baby bond, since, even before sucking the milk, the baby feeds on the delight. From the baby's perspective, breastfeeding is associated with the maternal function, which involves implicated mothering and a responsive adult. On the other hand, breastfeeding seems to be related to maternal choice, grounded in psycho-affective, sociocultural, moral, and/or religious factors. Moreover, even if some mothers understand the importance of breastfeeding, ambivalent feelings and unconscious conflicts may arise, which generate difficulties in breastfeeding, even leading to failure. This is a narrative research that investigates the structuring effect of breastfeeding on the maternal function and the constitution of the subject and issues related to maternal choice to breastfeed. The results indicate that breastfeeding is a challenge for both mother and baby. For the baby, breastfeeding conceives an encounter between body development and subjective structuring, while for the mother, the choice to breastfeed seems to be associated with a plurality of feelings, besides issues ranging from her own constitutive history to the moment experienced, whose process is crossed by psycho-affective, sociocultural, moral and/or religious factors. Thus, the issues related to breastfeeding are beyond the organic and the professionals who assist families need to consider the subjectivity of this mother and this baby.

Congenital tuberculosis in a premature newborn

Congenital tuberculosis in a premature newborn

Timing of Breastfeeding Initiation Mediates the Association between Delivery Mode, Source of Breastfeeding Education, and Postpartum Depression Symptoms.

Background: Emergency cesarean section (EMCS) and breastfeeding difficulties increase the risk of postpartum depressive (PPD) symptoms. Early initiation of breastfeeding (EIBF) may not only alleviate PPD symptoms but also facilitate subsequent breastfeeding success. EMCS is a risk factor for not practicing EIBF. Therefore, it is important to understand the relationship between EMCS, EIBF, and PPD symptoms. Methods: We conducted a prospective cohort study in three areas of China. At baseline, a total of 965 mothers completed electronic questionnaires within 72 h postpartum. Women were screened for PPD symptoms using the Edinburgh Postpartum Depression Scale (EPDS). Multivariate logistic regression was used to identify the determinants of PPD symptoms. Mediation analysis was used to determine if EIBF mediated the relationship between delivery mode or breastfeeding education source and PPD symptoms. Results: The prevalence of EIBF was 40.6%; 14% of 965 mothers experienced EMCS, and 20.4% had PPD symptoms. The risk factors for developing PPD symptoms were excessive gestational weight gain (adjusted odds ratio [aOR] = 1.55, confidence interval [95% CI]: 1.03–2.33, p = 0.037) and EMCS (aOR = 2.05, 95% CI: 1.30–3.25, p = 0.002). The protective factors for developing PPD symptoms were monthly household income over CNY 10000 (aOR = 0.68, 95% CI: 0.47–0.97, p = 0.034), EIBF (aOR = 0.49, 95% CI: 0.34–0.72, p < 0.001), and prenatal breastfeeding education from nurses (aOR = 0.46, 95% CI: 0.29–0.73, p = 0.001). EIBF indirectly affected PPD symptoms in patients who had undergone EMCS (percentage mediated [PM] = 16.69, 95% CI: 7.85–25.25, p < 0.001). The source of breastfeeding education through EIBF also affected PPD symptoms (PM = 17.29, 95% CI: 3.80–30.78, p = 0.012). Conclusion: The association between EMCS on PPD symptoms was mediated by EIBF. By providing breastfeeding education, nurses could also help alleviate PPD symptoms.

Limited English proficiency in the labor and delivery unit.

Limited English proficiency (LEP) impacts patient access to safe and comprehensive care during the antepartum, intrapartum, and postpartum periods. In this review, we explore disparities in care delivery and outcomes that LEP women experience, and discuss the importance of providing language concordant care and using interpretation services appropriately. The number of individuals with LEP is steadily increasing in the United States. Pregnant women with LEP suffer disparities in obstetric care and are at risk for postpartum depression, breastfeeding difficulties, and substandard newborn care after neonatal ICU discharge because of insufficient education. Addressing these issues requires the implementation of language concordant care and education, along with the utilization of medically trained interpreters. Although further evidence is needed, the authors support these interventions to improve patient satisfaction, decrease medical errors, and curtail misdiagnoses. The pregnant woman with limited English proficiency is at risk of receiving suboptimal care and experiencing negative outcomes during the antepartum, intrapartum, and postpartum periods. The use of medically trained interpreters and the provision of language concordant care, through workforce diversification and the creation of forms and educational materials in diverse languages, can improve patient safety, outcomes, and quality of care.

Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study

BackgroundAccess to donor human milk (DHM) has primarily been based on the health and development outcomes of premature infants but there has been little examination of the broader impact of an infant receiving it upon parental mental health. Breastfeeding and mental health are closely tied with women who experience breastfeeding difficulties or are unable to meet their own breastfeeding goals often experiencing feelings of guilt, sadness and anger, alongside an increased risk of postnatal depression. The aim of the current study was to explore how experience of receiving DHM for their baby affected the wellbeing of parents.MethodsUK parents of infants aged 0 – 12 months who had received screened DHM from a milk bank (typically on the neonatal unit or in some cases in the community) completed an online questionnaire exploring their experiences. The questionnaire included Likert scale items examining perceived impact upon infant health, own wellbeing and family functioning alongside open-ended questions exploring perceptions of how receiving DHM affected wellbeing.ResultsAlmost all of the 107 participants (women = 102) agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family’s wellbeing. Parents felt relieved that their infant was receiving DHM for health reasons but also due to the experience of being listened to, supported and having their infant feeding decisions facilitated. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby. Some parents did experience challenges, feeling guilty at receiving DHM, insecure that another woman was able to feed their baby when they could not, or negative reactions from family. Although the impact of receiving DHM upon breastfeeding was not measured, some women who were working to build their own milk supply noted that it helped motivate them to continue.ConclusionsDHM may play an important role not only in protecting infant health and development but in supporting the mental health and wellbeing of mothers for whom their infant receiving human milk is important.

Well-Informed and Willing, but Breastfeeding Does Not Work: A Qualitative Study on Perceived Support from Health Professionals among German Mothers with Breastfeeding Problems.

Although exclusive breastfeeding is recommended for the first six months of life, a large number of women worldwide do not practice it successfully. Our study aimed to investigate the perceived support from health professionals for women who experienced difficulties in breastfeeding. Furthermore, we examined women’s knowledge about breastfeeding and motivation to breastfeed. We conducted a qualitative exploratory study (June to October 2019) among 15 women who had experienced breastfeeding problems in Germany. Semi-structured interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis following Mayring’s approach. Prior to giving birth, the women’s motivation to breastfeed and theoretical knowledge were high, and breastfeeding problems were not anticipated. Difficulties in breastfeeding after giving birth created a highly demanding situation for the mothers. Health professionals were either perceived as very supportive, for example, by providing helpful technical advice or being emotional assistance, or they could be perceived as nonhelpful, thereby worsening the situation, for example, by pressuring the women to breastfeed or making improper remarks. Adequate support for young mothers in childbed consists of the provision of useful and realistic information concerning breastfeeding and a sensitive treatment when breastfeeding problems occur. Paying attention to this specific group of women who are experiencing difficulties in breastfeeding may improve maternal and child well-being and potentially enable breastfeeding.

Clinical analysis of the etiological spectrum of bilateral adrenal lesions: A large retrospective, single-center study.

To investigate the clinical characteristics, endocrinological function, and etiology of bilateral adrenal lesions in hospitalized patients. A retrospective study of 777 patients with bilateral adrenal lesions was conducted at the Chinese People's Liberation Army General Hospital between January 2013 and January 2018. Patients' demographic features, hormonal profiles, imaging findings, and histopathological findings were reviewed from database records. Of the 777 patients with bilateral adrenal lesions, 495 were men. The mean age at diagnosis was 52.0 ± 13.0 years. Overall, 511 (65.8%) cases were benign, followed by adrenal metastases (n = 224, 28.8%), pheochromocytoma (n = 26, 3.3%), adrenal lymphoma (n = 9, 1.2%), and adrenal corticocarcinoma (ACC; n = 7, 0.9%). Hormonal evaluation revealed that 34.3% of bilateral adrenal lesions were functional. The primary etiologies of functional lesions were primary aldosteronism (16.6%, 129/777), and primary bilateral macronodular adrenocortical hyperplasia (PBMAH; 8.8%, 68/777). Patients with lymphoma and metastases were significantly older than those with benign nonfunctional lesions (60.4 ± 11.0 years vs. 54.5 ± 10.4 years and 57.9 ± 10.8 years vs. 54.5 ± 10.4 years, respectively; both P < 0.001). Lesions in patients with adrenal lymphoma, ACC, pheochromocytoma, metastases, congenital adrenal hyperplasia, tuberculosis, and Cushing's syndrome were significantly larger than benign nonfunctional lesions (all P < 0.001). Benign adrenal lesions and metastases from the lungs are the most common causes of bilateral adrenal lesions. Primary aldosteronism and PBMAH are the most prevalent functional lesions. Moreover, patients with lymphoma or metastases are older and their masses are larger.