Direct Breastfeeding Research Articles

The Effects of COVID-19 Hospital Practices on Breastfeeding Initiation and Duration Postdischarge.

Background: Early in the COVID-19 pandemic, many birth hospitals separated SARS-CoV-2-positive mothers from their newborn infants and advised against breastfeeding to decrease postnatal SARS-CoV-2 transmission. Information on how these practices impacted breastfeeding postdischarge is limited. Objectives: In a statewide sample of SARS-CoV-2-positive mothers, we aimed to determine the extent to which (1) mother-infant separation and (2) a lack of breastfeeding initiation in-hospital were associated with breast milk feeding postdischarge. Design/Methods: From 11 birthing hospitals in Massachusetts, we identified 187 women who tested positive for SARS-CoV-2 from 14 days before to 72 hours after delivery (March 1-July 31, 2020) and their newborn infants. We abstracted chart data from the delivery hospitalization on main exposure variables (mother-infant separation, in-hospital breast milk feeding [expressed milk feeding and/or direct breastfeeding]) and from outpatient visits until 30 days postdischarge. We evaluated associations of in-hospital practices with outcomes up to 30 days postdischarge, adjusting for confounders using multivariable logistic and linear regression. Results: Mother-infant separation in-hospital was associated with a shorter duration of any breast milk feeding (regression coefficient estimate -5.29 days, 95% confidence intervals [CI] [-8.89 to -1.69]). Direct breastfeeding in-hospital was associated with higher odds of any breast milk feeding (adjusted odds ratios [AOR] 5.68, 95% CI [1.65-23.63]) and direct breastfeeding (AOR 8.19, 95% CI [2.99-24.91]) postdischarge; results were similar for any breast milk feeding in-hospital. Conclusions: Perinatal hospital care practices implemented early in the COVID-19 pandemic, specifically mother-infant separation and prevention of breast milk feeding initiation, were associated with adverse effects on breast milk feeding outcomes assessed up to 1 month postdischarge.

Exclusive breastmilk pumping: A concept analysis.

AimTo analyze and examine the concept of exclusive breast pumping (EP).BackgroundBreastmilk is the ideal nutrition for infants, yet when breastfeeding is unsuccessful, parents resort to informal breastmilk sharing, artificial formula feeding, or EP. A growing proportion of families exclusively pump yet they often receive guidance from social media rather than healthcare providers because healthcare providers are uninformed about this feeding method.Data SourceCumulative Index of Nursing and Allied Health Literature, PubMed, and Google Scholar databases were searched using the following keywords: human milk express*, breast express*, breast milk express, breastmilk express*, exclusive pump, exclusive breast pumping, and exclusive expression.Review MethodsConcept analysis design using Walker and Avant's method.ResultsThree defining attributes of (1) absence of direct breastfeeding, (2) breastmilk expression, (3) and an enduring infant feeding pattern of feeding expressed breastmilk only via a bottle were identified. All three attributes are required to confirm the presence of the concept of exclusive pumping. Definitions, antecedents, consequences, and empirical referents are described. Model and contrary cases are discussed.ConclusionThis exclusive pumping concept analysis allows for consistency in terminology in practice and research. EP is a feeding method which can increase the proportion of infants who are fed breastmilk and may reduce the risks that arise from artificial formula feeding.

Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months

ObjectiveTo identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States. DesignA secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019. ParticipantsWe recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion. MeasurementsThe questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences. ResultsMothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]). ConclusionDemand feeding and an infant’s age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.

Outcome of Neonates Born to COVID-19 Positive Mothers at a Tertiary Centre: A Retrospective Cohort Study

Introduction: In the context of the COVID-19 pandemic, studies on perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection play an essential role in the understanding of the disease which in turn is necessary for optimal management of affected neonates. Aim and Objective: To determine the clinical outcomes in neonates born to mothers with SARS-CoV-2 infection and to identify possible risk factors in perinatal transmission. Materials and Methods: This was a retrospective cohort study performed at level-3 teaching Neonatal Intensive Care Unit (NICU) in South India. Medical records of all mothers who delivered in the COVID-19 facility and neonates born to COVID-19 confirmed mothers from April 15, 2020, to September 15, 2021, were collected and analyzed. Results: Of 15,720 deliveries, 556 mothers who tested positive for COVID-19 delivered 563 babies (7 twins), of which 6.3% were positive for SARS-CoV-2. Out of 563 babies, 14.5% were preterm and 95% were asymptomatic. Among COVID-19 positive mothers, cesarean was the most common mode of delivery (73.5% and 88% in COVID-19 positive and negative neonates respectively; P value = .01) and most of the babies were roomed-in (85.2% in COVID-19 positive and 94.6% in COVID-19 negative neonates; P value = .02). COVID-19 positive neonates had significantly high probability of pneumonia ( P value = .003), sepsis ( P value = .03), septic shock ( P value = .01), and abnormal CXR ( P value = .01). There was no significant difference in the mortality rate. Conclusion: COVID-19 positive status of the mother is not associated with increased risk of preterm birth, neonatal admission, morbidity, or mortality. The risk of transmission was not found to be associated with direct breastfeeding or rooming-in.

A review of the disruption of breastfeeding supports in response to the COVID-19 pandemic in five Western countries and applications for clinical practice

BackgroundThe COVID-19 pandemic has significantly altered how breastfeeding support is provided, resulting in mixed breastfeeding outcomes and experiences for mothers. The World Health Organization has consistently supported breastfeeding from the beginning of the pandemic. However, recommendations from obstetrical and gynaecological societies within individual countries have varied in their alignment with this guidance, resulting in inconsistent recommendations. It is unknown how breastfeeding guidelines, maternal breastfeeding experiences, and breastfeeding initiation and duration compared across five Western countries. The current study is comprised of two parts, each with a different objective. Part One objective: to review pandemic-related changes in professional society guidelines on breastfeeding support in Australia, New Zealand, Canada, the United Kingdom, and the United States; and Part Two objective: to conduct a narrative review to summarize the evidence of how the pandemic has changed breastfeeding initiation, duration, and mothers’ breastfeeding experiences during the pandemic in these five countries and provide recommendations for clinical lactation support.MethodsWe searched for indicators that are impactful on breastfeeding outcomes: skin-to-skin contact, rooming in, direct breastfeeding and breast washing, in the five countries mentioned above and compared these to the recommendations from the World Health Organization. Next, we conducted a narrative review of the literature from these five countries to explore how the pandemic altered breastfeeding outcomes and used this information to provide suggestions for clinical practice moving forward.ResultsRecommendations on the four practices above differed by country and were not always in alignment with the World Health Organization recommendations. Mother-infant separation after birth in the United States was associated with a lower prevalence of breastfeeding initiation and duration. While some mothers reported positive breastfeeding experiences during the pandemic, many mothers indicated negative experiences related to decreased social and professional support.ConclusionsThe pandemic can inform practice recommendations and can be viewed as an opportunity to permanently modify existing methods to support breastfeeding families. The use of virtual care increased during the pandemic and should continue with specific considerations for prioritizing in-person care. This will help to provide more timely and accessible support for breastfeeding mothers.

Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study

BackgroundThe effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed.ObjectiveTo evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission.Study DesignIn this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices.ResultsA total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2–9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2–4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity.Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity.ConclusionIn this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

Breastfeeding adequacy, behaviour and exclusivity in partially paladai fed and exclusive breast-fed stable neonates

IntroductionPaladai feeding has emerged as a reliable method of feeding for neonates with difficulty in direct breastfeeding. MethodsThis descriptive comparative study was undertaken to draw comparison of breastfeeding adequacy, behaviour and exclusivity of 288 partially paladai (PPFG) and exclusively breastfed neonates (EBFG) at discharge and at 6 weeks respectively. ResultsBreastfeeding adequacy was observed 1.4 times more in EBFG than in PPFG (59% vs. 41.7%, p = 0.01) (CI: 1.1–1.8). The effective breastfeeding behaviour was more in EBFG in comparison to PPFG (84% vs. 16%, p = 0.001) with the majority of neonates in PPFG requiring intervention as compared to EBFG (93.1% vs. 47.9%) (p = 0.01). Breastfeeding exclusivity at 6 weeks was 4.3 times more in EBFG as compared to PPFG (68.1% vs. 13.9%, p = 0.01) (CI: 2.8–6.4). ConclusionAdequacy of breastfeeding, breastfeeding behaviour and exclusivity were lower in PPFG in comparison to EBFG requiring more nursing interventions.

A Qualitative Exploration of the Reasons for Expressed Human Milk Feeding Informed by the Breastfeeding Self-Efficacy Theory.

There is an increasing prevalence of expressed human milk feeding. The reasons for expressed human milk feeding of healthy term infants may differ from those for preterm infants. The process of adopting expressed human milk feeding for healthy full-term infants has not been well-described in the existing literature. To describe the reasons for, and antecedents to, expressed human milk feeding among Chinese women who used a high proportion of expressed human milk for feeding. A descriptive, prospective cross-sectional qualitative design was used. Participants (N = 25) who used a high proportion of expressed human milk feeding were recruited from a larger perspective cohort study in two public hospitals in Hong Kong. Semi-structured, in-depth, one-to-one interviews were conducted 2017-2018. Data collection and thematic analysis were guided by the Breastfeeding Self-Efficacy Theory. The authors conducted thematic analysis and identified six core themes: (1) perceived maternal roles; (2) breastfeeding role models; (3) negative feedback from social networks; (4) negative direct breastfeeding experiences; (5) expressed human milk feeding as a solution to a problem; and (6) advice from health care professionals to express human milk. These themes were consistent with the four antecedents of the Breastfeeding Self-Efficacy Theory (e.g., physiological and affective state, vicarious experiences, performance accomplishments, and verbal persuasion). The main reason for participants to feed expressed human milk was experiencing difficulties with direct breastfeeding. Expressed human milk feeding was used as an immediate solution for breastfeeding problems. Strengthening breastfeeding support in the early postpartum period may decrease the perceived need for human milk expression.

Protecting Breastfeeding during the COVID-19 Pandemic: A Scoping Review of Perinatal Care Recommendations in the Context of Maternal and Child Well-Being.

The objective of this scoping review is to determine to what extent the recommendations on perinatal care protect breastfeeding during the COVID-19 pandemic. The review follows the PRISMA ScR Extension guidelines. The research was conducted in Scopus, Medline via Pubmed, and Web of Science databases from 1 March 2020 to 31 May 2021, using 392 combinations of keywords. We searched for reviews and original papers published in English providing recommendations on delivery mode, companion during labor, the possibility of skin-to-skin contact (SSC), breastfeeding, and visitors policy. After screening, 86 out of 8416 publications qualified for data extraction. The majority of them indicated that COVID-19 infection is not a sufficient reason for a cesarean section; however, on a national level, cesarean births in severely ill patients were overrepresented. A significant number of recommendations deprived mothers of the necessary support during their labor and stay in the maternity ward. A shared decision-making model was hardly visible. Only the earliest COVID-19 recommendations suspended direct breastfeeding; in later publications, decisions were related to the mother’s health, but other options of natural feeding were rarely discussed.

Exclusive breastfeeding among women with type 1 and type 2 diabetes mellitus

ObjectiveTo compare exclusive breastfeeding (BF) and BF initiation among 185 women with Type 1 and 212 women with Type 2 pregestational diabetes who intended exclusive or partial BF and delivered at ≥34 weeks of gestation.MethodsRetrospective cohort study. At discharge, exclusive BF is direct BF or BF complemented with expressed breast milk. BF initiation is defined by exclusive or partial BF.ResultsType 1 and Type 2 groups were similar in prior BF experience (69 vs 67%) but were different in intention to BF exclusively (92 vs 78%) and partially (8 vs 22%). Women in the Type 1 group were younger (median age 30 vs 33y), likely to be primiparous (47 vs 25%), have a lower median BMI (32 vs 36 kg/m2) and deliver by primary cesarean (37 vs 26%). Infants born to Type 1 women were more likely to be admitted to the NICU (44 vs 18%) and to have hypoglycemia (59 vs 41%). At discharge, exclusive BF among Type 1 was higher (34 vs 23%), partial BF was similar (47 vs 46%) while FF (formula feeding) was lower (19 vs 31%) than in the Type 2 group. BF initiation occurred in 81% of Type 1 and 69% of Type 2 women.ConclusionIntention to BF exclusively was higher in Type 1 women compared to Type 2. At discharge, exclusive BF and BF initiation were lower and FF higher in the Type 2 group highlighting the need for different strategies if lactation in this special population is to be improved.

Breastfeeding initiation among women with chronic hypertension superimposed on pregestational diabetes mellitus

To compare breastfeeding (BF) initiation among 317 women with chronic hypertension (CHTN) and 106 women with CHTN superimposed on pregestational diabetes (CHTN-DM) who intended exclusive or partial BF. Retrospective cohort study of women who delivered at≥34 weeks of gestation. At discharge, exclusive BF was defined by direct BF or BF complemented with expressed breast milk (EBM) while partial BF was defined by formula supplementation. CHTN and CHTN-DM groups were similar in prior BF experience (42 vs 52%), intention to BF exclusively (89 vs 79%) and intention to partially BF (11 vs 21%). Women in the CHTN group were younger (31 vs 33y), more likely primiparous (44 vs 27%), and delivered vaginally (59 vs 36%) at term (85 vs 75%). Women in the CHTN-DM group had higher repeat cesarean rates (32 vs 18%), preterm birth (25 vs 15%), neonatal hypoglycemia (42 vs 14%) and NICU admission (38 vs 16%). At discharge, exclusive BF rates among CHTN was higher (48 vs 19%), while rates of partial BF (34 vs 44%) and FF (18 vs 37%) were lower than in the CHTN-DM group. BF initiation (exclusive plus partial BF) occurred in 82%of CHTN and in 63% of CHTN-DM. Although intention to BF was similar, BF initiation rates were higher for the CHTN compared to the CHTN-DM group. Exclusive BF was low in the CHTN and even lower in the CHTN-DM group signaling the need for targeted interventions if BF initiation rates are to be improved.

Inappropriate feeding practices as a risk factor for severe acute malnutrition in children aged between one month to five years: a case control study

Background: In developing country like India, inappropriate feeding practices like lack of exclusive breastfeeding, early or late introduction of complimentary diet, lack of direct breastfeeding, prelacteal feed, bottle feeding are the major risk factors for development of severe acute malnutrition in children aged between one month to five years.Methods: It was a case control study, 109 children aged between one month to five years with severe acute malnutrition (SAM) who fulfilled the WHO criteria for SAM admitted to KIMS Hubli were taken as cases and 109 children aged between one month to five years without SAM admitted to KIMS Hubli were taken as control, the data gathering tool was questionnaire of children and mother. Data were entered and analysed using SPSS software version 11. Proportions were compared using Chi square (χ2) test of significance, categorical variables were assessed using χ2. Odds ratio (OR) and 95% confidence interval (CI) were calculated. To estimate the independent effect of the factors that were significantly associated with SAM and to control the confounding effect they may have on each other, logistic regression analysis was done. In all the above test the p value of less than 0.05 was accepted as indicating statistical significance.Results: In the study lack of EBF (exclusive breastfeeding), DBF (direct breastfeeding), h/o prelacteal feeds, h/o bottle feed and late initiation of complimentary diet &gt;6 months were significantly associated with SAM (p value less than 0.05).Conclusions: The findings of this study clearly establishes the association of SAM with inappropriate infant feeding practices prevailing in our country.

Variation in United States COVID-19 newborn care practices: results of an online physician survey

BackgroundNewborn care practices that best promote the health and well-being of mother-infant dyads after birth while minimizing transmission of COVID-19 were uncertain at the onset of the COVID-19 pandemic.ObjectiveExamine variation in COVID-19 newborn care practices among U.S. birth hospitals and by hospital characteristics (U.S. census region, highest level of neonatal level of care, and Baby-Friendly hospital status).Study DesignWe surveyed physicians via American Academy of Pediatrics email listservs and social media between 5/26/2020-6/8/2020. Physicians identified the birth hospital in which they provided newborn care and their hospital’s approach to obstetrical and newborn care related to COVID-19. Chi-square tests were used to examine variation in hospital practices by U.S. census region, highest level of neonatal care, and Baby-Friendly hospital status.ResultsFour hundred thirty three physicians responded from 318 hospitals across 46 states. Variation in care of SARS-CoV-2 positive mother-infant dyads was greatest for approaches to location of newborn care (31% separation, 17% rooming-in, and 51% based on shared-decision making), early skin-to-skin care (48% prohibited/discouraged, 11% encouraged, and 40% based on shared-decision making) and direct breastfeeding (37% prohibited/discouraged, 15% encouraged, and 48% based on shared-decision making). Among presumed uninfected dyads, 59% of hospitals discharged at least some mother-infant dyads early. We found variation in practices by U.S. census region.ConclusionApproaches to newborn care and breastfeeding support for mother-infant dyads with positive SARS-CoV-2 testing differed across U.S. birth hospitals during the COVID-19 pandemic. Early discharge of presumed uninfected mother-infant dyads was common.

Feeding practices among mothers of under five children at selected area, guntur (dt), andhra pradesh

Child-feeding practices in early life play an important role in the growth and development of life, in protecting against infectious diseases and preventing lifestyle disorders in later life. The present study aimed to explore the feeding practices of young children. A cross-sectional design was adopted for the study. Convenient sampling techniques were used to select 60 mothers of fewer than five children residing in Yerrabalem, Guntur district, Andhra Pradesh. Data was analyzed using descriptive and inferential statistics. The findings showed that 28% of them were 1 to 2 years old children. Half (51.6%) of them were female children, majority 63.3% of the families' income per month was Rs. 10000 to 20000. Nearly 26.6% of mothers were educated from middle school to intermediate education. Majority of them revealed that 25% were skilled agricultural and fishery workers and all of them sought information from family members. Regard to feeding practices, only 46.6% fed the baby with direct breast feeding, 30% of them had bottle fed, only 31.6% received vitamin drops or other medicines in 24 hrs recall. All the children were reported to be on breastfeeding, 48.3% breast fed immediately after birth. Adequate practices were reported a mean and standard deviation of 76.2% and 23.8% about infant and young child feeding practices. Overall, results showed good practices, but there are lacunae in a few practices that need to be improved on dietary diversity and iron fortification of food.

Breastfeeding media coverage and beliefs during the COVID-19 pandemic in Mexico: implications for breastfeeding equity

BackgroundBecause breastfeeding offers short- and long- term health benefits to mothers and children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination. WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19 pandemic, even among women with COVID-19; but conflicting practices have been adopted, which could widen existing inequities in breastfeeding. This study aims to describe how information about breastfeeding was communicated in Mexican media during the pandemic and assess Mexican adults’ beliefs regarding breastfeeding among mothers infected with COVID-19.MethodsWe conducted a retrospective content analysis of media coverage on breastfeeding in Mexico between March 1 and September 24, 2020, excluding advertisements. For the content analysis, we performed both a sentiment analysis and an analysis based on strengths, weaknesses, opportunities, and threats (SWOT) for breastfeeding promotion. Additionally, we conducted a descriptive analysis of nationally representative data on adults’ beliefs about breastfeeding from the July 2020 round of the ENCOVID-19 survey in Mexico and stratified the results by gender, age, and socioeconomic status.ResultsA total of 1014 publications on breastfeeding were identified on the internet and television and in newspapers and magazines. Most information was published during World Breastfeeding Week, celebrated in August. The sentiment analysis showed that 57.2% of all information was classified as positive. The SWOT analysis indicated that most information focused on current actions, messages, policies, or programs that enable breastfeeding (i.e., strengths) or those not currently in place but that may enable breastfeeding (i.e., opportunities) for breastfeeding promotion. However, ENCOVID-19 survey results showed that 67.3% of adults living in households with children under 3 years of age believe that mothers with COVID-19 should not breastfeed, and 19.8% do not know whether these mothers should breastfeed. These beliefs showed differences both by gender and by socioeconomic status.ConclusionsWhile the Mexican government endorsed the recommendation on breastfeeding during the COVID-19 pandemic, communication was sporadic, inconstant and unequal across types of media. There was a widespread notion that mothers with COVID-19 should not breastfeed and due to differences on beliefs by socioeconomic status, health inequities could be exacerbated by increasing the risk of poorer breastfeeding practices and preventing vulnerable groups from reaping the short and long-term benefits of breastfeeding.

Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant.

Provision of mother's own milk for hospitalized very low birth weight (VLBW) (≤1500 g) infants in the NICU provides short- and long-term health benefits. Mother's own milk, appropriately fortified, is the optimal nutrition source for VLBW infants. Every mother should receive information about the critical importance of mother's own milk to the health of a VLBW infant. Pasteurized human donor milk is recommended when mother's own milk is not available or sufficient. Neonatal health care providers can support lactation in the NICU and potentially reduce disparities in the provision of mother's own milk by providing institutional supports for early and frequent milk expression and by promoting skin-to-skin contact and direct breastfeeding, when appropriate. Promotion of human milk and breastfeeding for VLBW infants requires multidisciplinary and system-wide adoption of lactation support practices.

Oligosaccharides and Microbiota in Human Milk Are Interrelated at 3 Months Postpartum in a Cohort of Women with a High Prevalence of Gestational Impaired Glucose Tolerance

BackgroundHuman milk is a rich source of human milk oligosaccharides (HMOs) and bacteria. It is unclear how these components interact within the breast microenvironment. ObjectivesThe objectives were first, to investigate the association between maternal characteristics and HMOs, and second, to assess the association between HMOs and microbial community composition and predicted function in milk from women with high rates of gestational glucose intolerance. MethodsThis was an exploratory analysis of a previously completed prospective cohort study (NCT01405547) where milk samples (n = 107) were collected at 3 mo postpartum. Milk microbiota composition was analyzed by V4-16S ribosomal RNA gene sequencing and HMOs by rapid high-throughput HPLC. Data were stratified and analyzed by maternal secretor status phenotype and associations between HMOs and microbiota were determined using linear regression models (ɑ-diversity), Adonis (B-diversity), Poisson regression models (differential abundance), and general linear models (predicted microbial function). ResultsPrepregnancy BMI, race, and frequency of direct breastfeeding, but not gestational glucose intolerance, were found to be significantly associated with a number of HMOs among secretors and non-secretors. Fucosyllacto-N-hexaose was negatively associated with microbial richness (Chao1) among secretors [B-estimate (SE): −9.3 × 102 (3.4 × 102); P= 0.0082] and difucosyllacto-N-hexaose was negatively associated with microbiota diversity (Shannon index) [−1.7 (0.78); P= 0.029] among secretors. Lacto-N-neotetraose (LNnT) was associated with both microbial B-diversity (weighted UniFrac R2= 0.040, P= 0.036) and KEGG ortholog B-diversity (Bray-Curtis R2= 0.039, P= 0.043) in secretors. Additionally, difucosyllactose in secretors and disialyllacto-N-hexaose and LNnT in non-secretors were associated with enrichment of predicted microbial genes encoding for metabolism- and infection-related pathways (P-false discovery rate < 0.1). ConclusionsHMOs are associated with the microbial composition and predicted microbial functions in human milk at 3 mo postpartum. Further research is needed to investigate the role these relations play in maternal and infant health.

Breastfeeding supportive practices in European hospitals during the COVID-19 pandemic

Introduction During the first year of the COVID-19 pandemic, international recommendations and guidelines regarding breastfeeding-supportive hospital practices changed frequently. For example, some recommended separation of mothers and infants; others, feeding pumped milk instead of milk fed directly from the breast. Many recommendations were inconsistent or in direct conflict with each other. Guidance from UENPS (the Union of European Neonatal and Perinatal Societies) published in April 2020 recommended rooming in and direct breastfeeding where feasible, under strict measures of infection control, for women who were COVID-19 positive or under investigation for COVID-19. Key findings Our study assessed data from respondents from 124 hospitals in 22 nations, with over 1000 births per year, who completed a survey on practices during the COVID-19 epidemic, as they related to the World Health Organization (WHO) Ten Steps to Successful Breastfeeding, considered to be the gold standard for breastfeeding support. The survey was conducted in the fall of 2020/winter of 2021. Overall 88% of responding hospitals had managed COVID positive mothers, and 7% had treated over 50 birthing women with confirmed COVID-19. The biggest change to hospital policy related to visitation policies, with 38% of hospitals disallowing all visitors for birthing women, and 19% shortening the postpartum stay. Eight hospitals (6%) recommended formula feeding instead of breastfeeding for women who tested positive for COVID-19 or were under investigation, whereas 73% continued to recommend direct, exclusive breastfeeding, but with some form of protection such as a mask or hand sanitizer for the mother or cleaning the breast before the feed. While 6% of hospitals discontinued rooming in, 31% strengthened their rooming in policy (keeping mothers and their babies together in the same room) to protect infants against possible exposure to the virus elsewhere in the hospital . Overall, 72% of hospitals used their country’s national guidelines when making policy, 31% used WHO guidelines and 22% UENPS/SIN guidelines. Many European hospitals relied on more than one accredited source. Discussion Our most concerning finding was that 6% of hospitals recommended formula feeding for COVID positive mothers, a measure that was later shown to be potentially harmful, as protection against the virus is transmitted through human milk. It is encouraging to note that a third of hospitals strengthened rooming in measures. Especially given the emergence of the highly transmissible Delta variant, the situation around postnatal care in maternity hospitals requires ongoing monitoring and may require proactive investment to regain pre-COVID era practices.

What Does It Mean to Be Breastfed? A Concept Analysis in the Context of Healthcare Research, Clinical Practice, and the Parent Perspective.

Over the past 3 decades, there have been attempts to define breastfeeding for scientific research. However, a lack of clarity remains, with concurrent ambiguity in clinical practice and insufficient inclusion of the parent perspective. Furthermore, previous concept analyses of "breastfeeding" may not fully represent what it means for an infant to be breastfed. Therefore, this concept analysis sought to define "breastfed" in the context of Western healthcare research, clinical practice, and the parent perspective. Informed by Rodgers' evolutionary method, a literature search resulted in 16 representative articles, with related terms, attributes, antecedents, and consequences identified. Analysis of the literature resulted in a theoretical definition of breastfed as a valuable process, experience, or characteristic that involves human milk consumption by an infant through a variety of delivery methods. To be breastfed relies on the existence of lactation, whether from a parent or another source, and depends upon the intentional decision of a birthing person, caregiver, or provider. It is recommended that healthcare providers and institutions adopt this inclusive definition, committing to a linguistic and conceptual distinction between a breastfed infant and direct breastfeeding. Increased clarity may improve comparability between studies, reporting to government agencies, provider communication, and supportive, family-centered care.

COVID-19: Relationship and Impact on Breastfeeding-A Systematic Review.

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus that was declared a Public Health Emergency of International Concern by the World Health Organization (WHO). One major problem faced is whether breastfeeding by mothers infected with the virus is safe. The objective of this work is to study the impact that the SARS-CoV-2 virus can have on breastfeeding, and whether the virus or antibodies can be transmitted from mother to child through milk. We carried out a systematic review of studies focusing on the impact of SARS-CoV-2 on breastfeeding by mothers infected with the virus. The bibliographic search was done through Medline (Pubmed), MedlinePlus and Google Scholar. From 292 records, the title and summary of each were examined according to the criteria, and whether they meet the selection criteria was also analysed. A total of 30 articles are included, of which 26 deal with the study of RNA virus in breastmilk and its involvement in breastfeeding and four on the study of SARS-CoV-2 antibodies in milk. Most studies have been conducted in China. Breastfeeding by mothers infected with SARS-CoV-2 is highly recommended for infants, if the health of the mother and the infant allow for it. Direct breastfeeding and maintaining appropriate protective measures should be encouraged. Should the mother’s health condition not permit direct breastfeeding, infants should be fed with pumped breastmilk or donor milk.