Discontinuation Of Breastfeeding Research Articles

How to Wean: A Case Report of Abrupt Weaning and Acute Dystonia

World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months, followed by continued breastfeeding with complementary foods until 2 years of age or beyond. Despite these recommendations, there is limited research on the timing and methods of breastfeeding cessation, with abrupt weaning potentially causing unforeseen consequences. This report describes a case involving a 33-month-old girl who experienced acute dystonic reaction following the abrupt cessation of breastfeeding. It was learned that medication containing chlorpheniramine was given to the child to alleviate the uneasiness that developed due to abrupt cessation of breastfeeding. Patient’s symptoms were consistent with an acute dystonic reaction due to medication side effects, which improved with successful medical intervention. Breastfeeding initiation, continuation, and cessation influence the mental and physical health of the mother-baby pair. Abrupt weaning can pose challenges. While there are no strict guidelines for weaning, gradual weaning is generally considered a more comfortable approach for both mother and baby. To safeguard the well-being of the mother-baby pair, healthcare professionals should inform mothers about the discontinuation of breastfeeding and support a gradual weaning process. The presented case highlights the importance of careful consideration and professional guidance during the weaning process to prevent adverse outcomes.

The Prevalence of Exclusive Breastfeeding Practice and Its Predictors in the First Six Months of Life Among Working Mothers in Riyadh, Saudi Arabia.

Introduction The United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) recommendations are early initiation of breastfeeding and exclusive breastfeeding (EBF) for the first six months of infants' lives.Despite the WHO and UNICEF recommendationsand expanding evidence of the significance of exclusive breastfeeding, about two-thirds of infants worldwide have not received exclusive breastfeeding for the six recommended months. This study aims to estimate the prevalence of working mothers exclusively breastfeeding in the first six months of infants' lives and investigate their predictors in Riyadh, Saudi Arabia. Methods A cross-sectional community-based study was conducted for four months in 2022. The study included working mothers who have a child in the age range of 6-24 months living in Riyadh. Data was collected through an online questionnaire and analyzed using the Statistical Package for the Social Sciences (SPSS)version 29 (IBM SPSS Statistics, Armonk, NY) program. Results A sample of 118 participants were included in the study. Their prevalence for EBF practice for the recommended period is 28% (n=33). Around 58.5% (n=69) of the participants did not receive breastfeeding counseling during antenatal visits. Almost half the infants were given prelacteal feeding. Male infants are two times more likely to be exclusively breastfed for the recommended period than female infants. Work-related pressures were a key factor in the discontinuation of breastfeeding (53.4%, n=63). Conclusion This study highlights the lack of breastfeeding counseling and breastfeeding work regulation, alongside concerns about colostrum avoidance and prelacteal feeding. While EBF rates show progress, delayed initiation and work-related pressures remain challenges. Gender disparity in exclusive breastfeeding urges targeted interventions for more equitable outcomes.

Dysphoric Milk Ejection Reflex in Human Lactation: An Integrative Literature Review.

Dysphoric Milk Ejection Reflex is an understudied condition of lactation involving emotional dysregulation during letdown or milk ejection. Affected individuals may experience transient feelings of helplessness, melancholy, and general unhappiness. To evaluate the scope of published literature on Dysphoric Milk Ejection Reflex. Whittemore and Knafl's methodology guided this integrative review. Five databases were searched for primary research, summaries, and editorials on Dysphoric Milk Ejection Reflex in lactating individuals. Literature searched also included websites, pamphlets, and conference proceedings via Google and Google Scholar. A total of 11 articles, from five different countries, met inclusion criteria for review. Studies on Dysphoric Milk Ejection Reflex and negative emotional sensations during lactation were synthesized under five conceptual umbrellas: (1) Experiences, Sensations, and Symptom Management; (2) Biological Underpinnings; (3) Influence on Maternal Role and Breastfeeding Self-Efficacy; (4) Support, Understanding, and Awareness; and (5) Reduction and Cessation of Breastfeeding. Dysphoric Milk Ejection Reflex is a neurobiological condition characterized by low mood and negative feelings during milk ejection throughout lactation. Dysphoric Milk Ejection Reflex is linked to maternal psychological distress and breastfeeding discontinuation. Priority areas for future research include biological origins and interventions aimed at prevention, symptom control, and greater awareness of the condition on a more international scope.

Laid-back breastfeeding: knowledge, attitudes and practices of midwives and student midwives in Ireland.

Despite concerted efforts by policy developers, health professionals and lay groups, breastfeeding rates in Ireland remain one of the lowest in world, with 63.6% of mothers initiating breastfeeding at birth, dropping to 37.6% of mothers breastfeeding exclusively on hospital discharge. Nipple trauma and difficulties with baby latching are major contributors to the introduction of formula and discontinuation of breastfeeding. Research shows laid-back breastfeeding (LBBF) significantly reduces breast problems such as sore and cracked nipples, engorgement, and mastitis as well as facilitating a better latch. Although the benefits of LBBF are well documented, this position does not seem to be routinely suggested to mothers as an option when establishing breastfeeding. This study aims to determine midwives' and student midwives' knowledge, attitudes, and practices of using laid-back breastfeeding in Ireland. A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021. Two hundred and fifty-three valid responses were received from nine maternity units. Most participants (81.4%) were aware of laid-back breastfeeding. However, only 6.8% of respondents cited it as the position they most frequently use. Over one-third (38.34%) had never used this position with mothers. Those more likely to suggest LBBF had personal experience of it, were lactation consultants or working towards qualification, or had participated in specific education about LBBF. Barriers included lack of education, confidence, time, and experience. Further issues related to work culture, a tendency to continue using more familiar positions and concerns about mothers' anatomy and mothers' unfamiliarity with LBBF. Although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers' and babies' intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.

The effect of maternal caffeine consumption during the perinatal period on lactation

Background: Caffeine is a substance found in various seeds, foods, beverages and pharmaceuticals. We sought to assess perinatal caffeine consumption rates and the impact of maternal consumption on lactation. Material and Method: This is a prospective, descriptive cohort study conducted in Greece. Women were recruited from five tertiary maternity hospitals throughout 2020. A total of 847 mothers participated and data were collected during their hospitalization in the maternity hospital using a structured questionnaire. Follow-up included a telephone interview in the first, third and sixth month after delivery. Results: A significant decrease in caffeine consumption was reported during pregnancy (84.7%) compared to the period before pregnancy (96.3%, p<0.001). On the fourth day postpartum, caffeine intake (65.8%) was reduced significantly compared to the pre-pregnancy period (p<0.001), remaining relatively unchanged over a period of three months postpartum (1st month: 71%, 3rd month: 64.7%). Moreover, there was a significant decline in caffeine intake at six months postpartum (54.2%, p<0.001) and after discontinuation of breastfeeding (42.7%, p<0.001). Our findings showed that women who ceased breastfeeding at any stage over the six-month follow-up consumed less caffeine during the first three months after delivery (p<0.001) in comparison to those who maintained breastfeeding at six months. In addition, higher pre-pregnancy caffeine consumption (β = 0.04, SE: 0.02, p = 0.032) had a positive association with longer breastfeeding duration. Conclusions: Τhis study was the first to record caffeine intake in the perinatal period in the Greek setting. The results demonstrate that perinatal maternal caffeine consumption was reduced compared to the pre-pregnancy period and that there was a positive correlation between caffeine consumption and breastfeeding duration.

Risk factors for persistent versus episodic mother-to-infant bonding difficulties in postpartum women in a nationwide Japanese longitudinal study

BackgroundThe quality of mother-to-infant bonding (MIB) is a crucial determinant of nurturing behaviors and infant development, with bonding difficulties (MIBD) posing a substantial threat. While it is essential to identify MIBD risk factors, previous studies have generally examined MIBD at one time point, leaving the contributors to persistent MIBD uncertain. This study aims to discern longitudinal risk factors for persistent versus episodic MIBD. MethodsWe evaluated 1833 postpartum Japanese women who delivered in the past twelve months, utilizing the Mother-to-Infant Bonding Scale (MIBS) and other sociodemographic, health, pregnancy, childbirth, and child-rearing related data (T1). Follow-up data were obtained six months later (T2). MIBD was defined as a MIBS score of five or more, with “persistent” and “episodic” MIBD classified based on its occurrence at both or either one of the time points, respectively. Logistic generalized estimating equations and inverse probability weighting were used to identify risk factors and address selective attribution bias. ResultsOf the subjects, 15.8 % reported episodic and 11.3 % reported persistent MIBD. Shared risk factors for both conditions included postpartum depression and low levels of family support (OR = 1.501–6.343). However, pre-pregnancy underweight status (OR = 1.698) was a unique risk factor for episodic MIBD, while first-time motherhood, no or discontinuation of breastfeeding, and later postpartum months (OR = 1.540–3.179) were distinctive risk factors for persistent MIBD. ConclusionWe identified both shared and unique risk factors for episodic and persistent MIBD. Particular attention should be afforded to persistent MIBD and early and proactive interventions to mitigate identified risk factors are recommended.

Infantile Colic: A Survey of Physicians in Pakistan.

Infantile colic diagnostic criteria were established by Rome IV. A universally accepted management remains to be established. We aimed to evaluate diagnostic criteria, management strategies, and perceived regional prevalence of infantile colic in Pakistan, as well as its effect on physicians and parents. A questionnaire was distributed amongst 1,256 physicians. We received 800 replies. Wessel and Rome IV criteria were used by most physicians for diagnosis; however, the response "any infant who cries a lot" was selected by older physicians (48% of those over 60 years), physicians in rural areas (32%), physicians practicing in private clinics (27%), and general physicians (30%). Estimated prevalence of infantile colic ranges from 21-40%. Reassurance was the most widely recommended management strategy followed by herbal teas (51%), switching to a different formula (49%), probiotics (28%) and antibiotics (26%), discontinuation of breastfeeding (14%), elimination of dairy products from the breastfeeding mothers' diet (6%), and the administration of colic drops (1%). Most physicians considered the negative impact of colic on their personal lives and the parents as mild-to-moderate. Notably, 38% of percent of physicians routinely screened for maternal depression, and 45% of physicians were aware of the association between infantile colic and shaken baby syndrome. Most physicians in Pakistan diagnose and manage infantile colic according to the established guidelines. However, the guidelines pertaining to treatment planning are not followed. Educational efforts directed toward general physicians and doctors practicing in rural areas and clinics must be implemented to avoid unnecessary testing and treatment burden.

The Persistence of Specific Immunoglobulin A Against SARS-CoV-2 in Human Milk After Maternal COVID-19 Vaccination.

Objectives: To investigate SARS-CoV-2 specific immunoglobulin A (sIgA) in breast milk of Thai mothers post COVID-19 vaccination and/or SARS-CoV-2 infection, and to compare the sIgA among lactating mothers with varying COVID-19 vaccination regimes. Materials and Methods: A longitudinal study was conducted in lactating mothers receiving ≥2 doses of COVID-19 vaccine or confirming SARS-CoV-2-positive test as a part of an infant feeding survey. Vaccination and infection details were collected through questionnaires and interviews. Self-collected breast milk samples (30 mL) at 1, 3, and 6 months postvaccination or infection were analyzed for sIgA through enzyme-linked immunosorbent assay (ELISA). Results: Eighty-eight lactating mothers (152 milk samples), average age of 30.7 ± 6.2 years, were recruited. Fifty-five percent of milk samples were from lactating mothers with both SARS-CoV-2 infection and vaccination (hybrid immunity); 40% were from those with vaccination alone (COVID naïve). Sixty percent of lactating mothers received mixed types of vaccines. Median sIgA ratio in breast milk was 2.67 (0.82-7.85). Breast milk sIgA at 1, 3, and 6 months were higher in mothers with hybrid immunity than in COVID naïve (geometric mean [95% confidence interval]: 3.30 [2.06-5.29] versus 1.04 [0.52-2.04], 3.39 [2.24-5.13] versus 1.26 [0.77-2.06], 4.29 [3.04-6.06] versus 1.33 [0.74-2.42], respectively). No significant differences were observed among various vaccination regimes. Conclusion: sIgA against SARS-CoV-2 was detected in breast milk for up to 6 months after immunization together with infection at a greater level than after immunization or infection alone. This immunity could be transferred and protective against SARS-CoV-2 infection. Discontinuation of breastfeeding among mothers who received COVID vaccination or experienced infection should be discouraged. Clinical Trial Registration number: TCTR20220215012.

Factors associated with breastfeeding abandonment in the first month after the mother's return to work.

The return to work of lactating mothers has been identified as an important risk factor for breastfeeding interruption. We proposed to identify factors associated with breastfeeding abandonment in the first month after return. 252 women working at a hospital who had children aged 12 to 36 months and who were still breastfeeding when returned to work answered a questionnaire containing questions on sociodemographic characteristics, pregnancy, childbirth, breastfeeding and work-related factors. The associations were estimated using adjusted prevalence ratio (aPR), calculated with the hierarchical Poisson multivariable regression model. The following factors showed a significant association with breastfeeding abandonment: using a pacifier (aPR 4.58), cohabiting with someone other than partner (aPR 3.77), having no intention or having doubts about maintaining breastfeeding after returning (aPR 3.39), having a college degree (aPR 2.66), having no support from the infant's caregiver (aPR 2.26), and infant being older when the woman returned to work (PR 1.16 for each additional month of infant age). Longer duration of exclusive breastfeeding was a protective factor (aPR 0.990). Most of the factors associated with discontinuation of breastfeeding in the first month after the mother's return to work are not directly related to the woman's work.

The impact of perinatal maternal alcohol intake on lactation: Results from a Greek survey during the COVID-19 pandemic

Aim: The aim of the present study is to assess the impact of perinatal maternal alcohol intake on lactation during the COVID-19 pandemic. Material and methods: This is a prospective, descriptive cohort study conducted during the COVID-19 pandemic in Greece. Women were recruited from five tertiary maternity hospitals during January-December 2020. A total of 847 mothers participated and data were collected during their hospitalization in the maternity hospital using a structured questionnaire. Follow-up included an interview via telephone, at 1, 3 and 6 months postpartum. Results: We report significantly lower alcohol intake during the antenatal period (3.4%), lactation period (3.1%) and after cessation of breastfeeding (5.1%) in comparison with the pre-pregnancy period (22.4%, p<0.001 for all correlations). Rates of alcohol intake during pregnancy, lactation and after breastfeeding discontinuation had no significant difference (p=0.848). Mothers who consumed more alcohol after discontinuation of breastfeeding (AOR = 11.51; 95% CI: 2.80 ─ 47.32, p<0.001) were significantly more likely to cease breastfeeding. Furthermore, lower weekly alcohol intake after breastfeeding cessation (β= -31.81, SE: 6.47, p<0.001) was associated with longer breastfeeding duration. Conclusions: Perinatal maternal alcohol intake was reduced in comparison to the pre-pregnancy period. This downward trend, compared to Greek studies carried out before the COVID-19 pandemic, indicates that this unprecedented pandemic might have contributed to the reduction of addictive substance use, possibly due to fear of illness during the vulnerable perinatal period. The involvement of spouses/partners and families in alcohol rehabilitation and abstinence programs would possibly increase the effectiveness of these programs and therefore improve overall public health.

Maternal drugs and breastfeeding: Risk assessment from pharmacokinetics to safety evidence - A contribution from the ConcePTION project

Human milk is the most appropriate form of nutrition for infants while taking medication during the postpartum period is common. Discontinuation of breastfeeding is sometimes wrongly recommended for fear of adverse effects in the breastfed infant whereas only a few drugs are strictly contraindicated while breastfeeding. Most drugs are transferred from the mother's blood to the milk, but the breastfed infant usually ingests a small drug amount through human milk. As population-based evidence is still scarce on safety of drugs during breastfeeding, risk assessment relies on the little clinical evidence available and on pharmacokinetic principles, as well as on specialized sources of information that are essential for clinical decision-making. Risk assessment should not only be based on the drug's potential risk for the breastfed infant but should always take into account the benefits associated to breastfeeding, the risks of untreated maternal disease and the maternal willingness to breastfeed. Identifying situations with potential for drug accumulation in the breastfed infant is decisive while assessing the risk. Health care providers should always assume that mothers will be concerned and use risk communication as a key to ensure medication adherence and prevent unnecessary interruption of breastfeeding. When a mother still expresses concerns, decision support algorithms may facilitate communication and some strategies can be offered to minimize the drug exposure in the breastfed infant even when clinically not justified.

Risk assessment of drugs during breastfeeding

Medication intake during the postpartum period is common with discontinuation of breastfeeding sometimes unnecessarily recommended for fear of adverse effects in the breastfed infant, while exposure through human milk is generally low. The assessment of risks associated with medication intake during breastfeeding is based, among other things, on the little clinical evidence available in specialized sources of information, and on pharmacokinetic principles. A decision-making support is presented to facilitate communication with mothers, foster medication adherence and prevent unnecessary interruption of breastfeeding.

Breastfeeding history and adenomyosis risk using a novel case-control study design

To evaluate the association between breastfeeding history, including lifetime exclusive breastfeeding, and risk of adenomyosis. We used data from a case-control study designed with 2 control groups to address the challenge of selecting noncases for a valid epidemiologic study when cases are identified by hysterectomy. The case-control study was conducted among premenopausal and postmenopausal enrollees aged 18-59 years in a large, integrated health care system in western Washington state. Cases were enrollees with incident, pathology-confirmed adenomyosis diagnosed during 2001-2006 (n = 386). The 2 control groups were as follows: (1) randomly selected age-matched enrollees with intact uteri ("population controls," n = 323) and (2) hysterectomy controls (n = 233). Data on breastfeeding history were collected by in-person interviews. For each reported live birth, participants were asked whether they breastfed, along with infant age at supplemental feeding introduction and breastfeeding discontinuation. Among participants with at least 1 live birth (330 cases, 246 population controls, and 198 hysterectomy controls), we used unconditional logistic regression to estimate adjusted odds ratios and 95% confidence intervals (CIs) for the associations between the following: (1) ever breastfeeding, (2) ever breastfeeding for ≥8 weeks, (3) lifetime breastfeeding, and (4) lifetime exclusive breastfeeding and risk of adenomyosis. Analyses were adjusted for age, reference year, smoking, education, and parity. In analyses comparing cases with population controls, we observed a 40% decreased odds of adenomyosis with a history of ever breastfeeding (adjusted odds ratio, 0.6; 95% CI, 0.3-1.0) and breastfeeding for ≥8 weeks (adjusted odds ratio, 0.6; 95% CI, 0.4-0.8). The strongest associations, 60%-70% decreased odds of adenomyosis, were observed with ≥12 months of lifetime breastfeeding (vs. <3 months) (adjusted odds ratio, 0.4; 95% CI, 0.2-0.6) and 9 to <12 months of lifetime exclusive breastfeeding (vs. <3 months) (adjusted odds ratio, 0.3; 95% CI, 0.2-0.6), comparing cases to population controls. In analyses using hysterectomy controls, we observed similar patterns of associations slightly attenuated in magnitude. Breastfeeding history was associated with a 40% decreased odds of adenomyosis, a condition that can confer substantial morbidity and requires hysterectomy for definitive treatment. The consistency of our findings with that of a previous study lends support that breastfeeding may modify risk of adenomyosis.

The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study

BackgroundThe use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth.MethodsThis was a population-based cohort study of singleton livebirths at ≥37 weeks’ gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed.ResultsIn total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86–0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome.ConclusionCommon intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.

Assessment of Mothers' Knowledge, Practice and Attitude Regarding Prevention of Exclusive Breastfeeding Discontinuation

Assessment of Mothers' Knowledge, Practice and Attitude Regarding Prevention of Exclusive Breastfeeding Discontinuation

Prevalence of and factors associated with lactational mastitis in eastern and southern Africa: an exploratory analysis of community-based household surveys

BackgroundLactational mastitis is an extremely painful and distressing inflammation of the breast, which can seriously disrupt breastfeeding. Most of the evidence on the frequency of this condition and its risk factors is from high-income countries. Thus, there is a crucial need for more information on lactational mastitis and its associated factors in Sub-Saharan Africa (SSA).MethodsWe used data from representative, community-based cross-sectional household surveys conducted in 2020 with 3,315 women from four countries (Ethiopia, Kenya, Malawi, and Tanzania) who reported ever-breastfeeding their last child born in the two years before the survey. Our measure of lactational mastitis was self-reported and defined using a combination of breast symptoms (breast redness and swelling) and flu-like symptoms (fever and chills) experienced during the breastfeeding period. We first estimated country-specific and pooled prevalence of self-reported lactational mastitis and examined mastitis-related breastfeeding discontinuation. Additionally, we examined factors associated with reporting mastitis in the pooled sample using bivariate and multivariable logistic regression accounting for clustering at the country level and post-stratification weights.ResultsThe prevalence of self-reported lactational mastitis ranged from 3.1% in Ethiopia to 12.0% in Kenya. Close to 17.0% of women who experienced mastitis stopped breastfeeding because of mastitis. The adjusted odds of self-reported lactational mastitis were approximately two-fold higher among women who completed at least some primary school compared to women who had no formal education. Study participants who delivered by caesarean section had 1.46 times higher odds of reporting lactational mastitis than women with a vaginal birth. Despite wide confidence intervals, our models also indicate that young women (15 – 24 years) and women who practiced prelacteal feeding had higher odds of experiencing lactational mastitis than older women (25 + years) and women who did not give prelacteal feed to their newborns.ConclusionsThe prevalence of lactational mastitis in four countries of SSA might be somewhat lower than estimates reported from other settings. Further studies should explore the risk and protective factors for lactational mastitis in SSA contexts and address its negative consequences on breastfeeding.

Perinatal Depression

Key Points Perinatal mood and anxiety disorders affect 15% to 20% of mothers from conception to 1 year postpartum and 4% to 25% of fathers.Infants of affected mothers are at risk for impaired social interaction, delays in language and cognitive development, failure to thrive, reactive attachment disorder of infancy, early discontinuation of breastfeeding, and neglect and abuse; longer-term adverse effects can be seen in the child’s learning, memory, behavioral, and emotional adaptation.Formal screening for perinatal depression at infant preventive visits, consistent with the peaks of occurrence, is recommended by Bright Futures, 4th Edition; US Preventive Services Taskforce (2016); and Centers for Medicare &amp; Medicaid Services (2016).Caregivers with a positive screen result and/or symptoms of depression should be triaged for a psychiatric or social emergency and their infants should be screened and followed for potential social-emotional problems.Management is 2-generational.For the parents, demystification, brief interventions to promote the mother-infant relationship and encourage social connections, and referral for evidence-based therapy (individual or couple), emergency medical services, or hospitalizationFor the child, regular monitoring of social-emotional development and Early Intervention Part C servicesFor the mother-infant dyad, evidence-based therapy by a pediatric mental health specialist with expertise in treating infants and young children (0–5 years of age).

Risk factors for discontinuation of exclusive breast feeding within 1month: a retrospective cohort study in Japan

BackgroundWhile breastfeeding provides benefits for infants and the mother, many women either do not breastfeed or terminate breastfeeding earlier than recommended. The aim of this analysis was to identify factors associated with early discontinuation of breastfeeding in Japanese women.MethodsThis study used data from medical records of women delivering a singleton live birth between March 2017 and August 2019 in Iwase General Hospital, Fukushima Prefecture, Japan to assess cessation of breastfeeding by the 1-month postpartum appointment. Demographic (age at birth, and employment status), medical (parity, and physical and mental condition of the mother; and infant medical factors, such as sex, Apgar score, and jaundice, among other), and family factors (husband/partner, family members living at the same house, among others) in 734 women who had initiated breastfeeding during their delivery hospital stay were examined, and multiple logistic regression was used to determine significant predictors of early cessation of exclusive breastfeeding.ResultsBivariate analysis revealed that women who were primipara, unmarried, exposed to secondhand smoke, and employed; those who smoked before pregnancy; and those who had asthma were more likely to discontinue exclusive breastfeeding than other women. Infant factors associated with discontinuation were lower birthweight, earlier gestational age, neonatal intensive care unit admission, treatment for jaundice, or lower weight gain. Multivariable analysis revealed that primiparity, passive smoking before pregnancy, maternal employment, and neonatal jaundice therapy were associated with discontinuation of breastfeeding.ConclusionsIn particular, women whose partners smoked before pregnancy may need to be targeted for additional support for breastfeeding.

Relationship Between the Rates of Breast Milk Production of Preterm Mothers in the First Week Post-Delivery and Continuation of Breastfeeding Through Discharge

BackgroundMothers of preterm infants born between 26- and 35-weeks’ gestation often report challenges with maintaining a pumping schedule and experience perceptions of low milk supply, both of which may contribute to early termination of breastfeeding within the first few weeks.PurposeThe purpose of this study was to assess the relationship between the amount of expressed milk volumes in the first 2 weeks after delivery and infant’s continuing to receive mother’s milk at hospital discharge. These results were part of a larger study that examined multiple maternal variables that may impact the amount of milk volumes and continuation of breastfeeding in the preterm infant admitted to the NICU.MethodsMothers of infants (N = 37) in the NICU were recruited for this correlational, longitudinal study. Data was collected at 24–48 hours post-delivery, at 2 weeks, at 4 weeks from mothers participating in the study and from infant chart reviews.Results/OutcomesMothers who reported higher expressed milk volumes at 3 days post-delivery had consistently higher volumes of expressed breast milk and a higher percentage of continued breastfeeding at hospital discharge. There was no statistically significant relationship between breastfeeding self-efficacy scores, socio-demographic variables, or pumping frequency and the percentage of infants receiving breast milk at hospital discharge. Overall, 76.4% of the infants enrolled in the study were receiving 100% of their intake with fortified mother’s milk at hospital discharge.Discussion/Implications for PracticeThe use of a breast pump log in the first 2 weeks to monitor milk volumes may assist in predicting mothers who are at risk of lower milk supply and early discontinuation of breastfeeding.

A case of a premature infant with relapsed neonatal abstinence syndrome caused by discontinuation of breastfeeding

A case of a premature infant with relapsed neonatal abstinence syndrome caused by discontinuation of breastfeeding