Breast Milk Feeding Research Articles

Breast Milk and Breastfeeding of Infants Born to SARS-CoV-2 Positive Mothers: A Prospective Observational Cohort Study

There are limited published data on the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus from mothers to newborns through breastfeeding or from breast milk. The World Health Organization released guidelines encouraging mothers with suspected or confirmed COVID-19 to breastfeed as the benefits of breastfeeding outweighs the possible risk of transmission. The objective of this study was to determine if SARS-CoV-2 was present in the breast milk of lactating mothers who had a positive SARS-CoV-2 nasopharyngeal swab test prior to delivery, and the clinical outcomes for their newborns. This was a single-center, observational, prospective cohort study. Maternal-newborn dyads that delivered at New York University Langone Hospital Brooklyn with confirmed maternal SARS-CoV-2 positive screen test at the time of admission were recruited for the study. Breast milk samples were collected during postpartum hospitalization and tested for the presence of SARS-CoV-2 genes N1 and N2 by two-step reverse transcription polymerase chain reaction. Additionally, the clinical characteristics of the maternal newborn dyad, results of nasopharyngeal SARS-CoV-2 testing, and neonatal follow-up data were collected. A total of 19 mothers were included in the study and their infants who were all fed breast milk. Breast milk samples from 18 mothers tested negative for SARS-CoV-2, and 1 was positive for SARS-CoV-2 RNA. The infant who ingested the breast milk that tested positive had a negative nasopharyngeal test for SARS-CoV-2, and had a benign clinical course. There was no evidence of significant clinical infection during the hospital stay or from outpatient neonatal follow-up data for all the infants included in this study. In a small cohort of SARS-CoV-2 positive lactating mothers giving birth at our institution, most of their breast milk samples (95%) contained no detectable virus, and there was no evidence of COVID-19 infection in their breast milk-fed neonates. · Breast milk may rarely contain detectable SARS-CoV-2 RNA and was not detected in asymptomatic mothers.. · Breast milk with detectable SARS-CoV-2 RNA from a symptomatic mother had no clinical significance for her infant.. · Breast feeding with appropriate infection control instructions appears to be safe in mother with COVID infection..

Factors Influencing Breast Milk Fat Loss during Administration in the Neonatal Intensive Care Unit.

The objective of this study was to investigate factors influencing fat loss during tube feeding of breast milk to preterm infants. An experimental study with 81 feeding simulations was performed, with nine continuous infusions in each of six modalities: Horizontal Higher, Horizontal Matched, Horizontal Lower, Tilted Higher, Tilted Matched, and Tilted Lower, and for comparison, 27 bolus feedings: nine flushed with air, nine with water, and nine that were not flushed, done at matched height. Each simulation utilized 16 mL of breast milk given over four hours. Continuous infusions were given with a flow rate of 4 mL/h. Bolus was given as 8 mL over the course of 15–20 min every other hour. Analysis for fat, true protein, carbohydrate, total solids, and energy was performed before and after each simulation. The percent of macronutrient loss was compared between all simulations. Continuous infusion resulted in an average fat loss of 40%. Bolus feedings resulted in an average fat loss of 11% (p ≤ 0.001). Considerable fat loss is seen during continuous tube feeding. Neither height in relation to the infant nor tilting of the pump reduce fat loss. To limit fat loss, the bolus feeding method should be utilized.

Consumption of Breast Milk Is Associated With Decreased Prevalence of Autism in Fragile X Syndrome

ObjectivesBreastfeeding is associated with numerous health benefits in infants, but early life nutrition has not been specifically studied in the neurodevelopmental disorder fragile X syndrome (FXS). Herein, we evaluate associations between the consumption of breast milk during infancy and the prevalence of autism, allergies, diabetes, gastrointestinal (GI) problems and seizures in participants with FXS. MethodsThe study design was a retrospective survey of families enrolled in the Fragile X Online Registry and Accessible Research Database (FORWARD). ResultsThere was a 73% rate of breastfeeding in the enrolled participants with an 81% rate for at least 3 months, 73% for 6 months and 41% for 12 months of age or longer. There was a 1.7-fold reduction in the prevalence of autism in participants with FXS who were fed breast milk for 12 months or longer and a 1.9-fold decrease in autism in participants reporting no use of any infant formula (P < 0.05). The most common reasons for cessation of breastfeeding were reduced milk production and age of the child. There were strong negative correlations between increased time the infant with FXS was fed breast milk and the prevalence of autism and seizures and moderate negative correlations with the prevalence of GI problems and allergies. However, participants reporting GI problems or allergies commenced these comorbidities significantly earlier than participants that were not fed breast milk. Parsing the data by sex indicated that males exclusively fed breast milk exhibited decreased prevalence of GI problems and allergies. ConclusionsThese data suggest that long-term or exclusive use of breast milk is associated with reduced prevalence of key comorbidities in FXS including autism, GI problems and allergies, although breast milk is associated with the earlier development of GI problems and allergies. Funding SourcesNICHD.

Use of Expressed Breastmilk at Two Weeks Postpartum Is Associated With Early Cessation and Non-exclusive Breastmilk Feeding for Six Months in a Cohort of Vulnerable Women

ObjectivesPumping and feeding expressed breastmilk (EBM) in the early postpartum period are common but may not support longer-term breastfeeding outcomes. Our objectives were to examine in a cohort of vulnerable mothers of term-born infants: i) the prevalence of EBM feeding; and ii) associations between EBM use at two weeks and any and exclusive breastmilk feeding over the first six months postpartum. MethodsWe pooled data from two studies conducted with participants (n = 316) at three Toronto sites implementing the Canada Prenatal Nutrition Program, an initiative targeting vulnerable families. Socio-demographic data were collected prenatally or at two weeks postpartum. Household food insecurity was assessed at six months using the Canadian Community Health Survey module. A standardized questionnaire was administered prospectively at two weeks and two, four and six months postpartum to collect data on infant feeding practices in the previous two weeks. Descriptive statistics and logistic regression analyses were performed. ResultsThe mean age of participants was 32 years, 91% were born outside Canada and 38% had lived in Canada less than three years. Nearly half (44%) reported household food insecurity. All participants initiated breastfeeding and 34% reported EBM use at two weeks postpartum. This declined to 24% at two months, 14% at four months and 8% at six months postpartum. Over the six-month follow-up period, 20% discontinued any breastmilk feeding and only 16% practiced exclusive breastmilk feeding. In adjusted models, EBM use at two weeks was associated with breastmilk feeding cessation (OR 2.75; 95% CI: 1.4–5.2) and non-exclusive breastmilk feeding for six months postpartum (OR 4.32; 95% CI 1.8–10.5). ConclusionsEBM use in the first two weeks was a predictor of early cessation and non-exclusive breastmilk feeding for six months postpartum in our cohort of vulnerable women living in an urban Canadian context and accessing prenatal nutrition programs. Further research is needed to determine whether early EBM use is a marker for breastfeeding difficulties or undermines longer-term breastfeeding outcomes. Funding SourcesCanadian Institutes of Health Research; The Sprott Foundation: Joannah and Brian Lawson Centre for Child Nutrition.

Consumption of Breast Milk Is Associated with Decreased Prevalence of Autism in Fragile X Syndrome.

Breastfeeding is associated with numerous health benefits, but early life nutrition has not been specifically studied in the neurodevelopmental disorder fragile X syndrome (FXS). Herein, I evaluate associations between the consumption of breast milk during infancy and the prevalence of autism, allergies, diabetes, gastrointestinal (GI) problems and seizures in FXS. The study design was a retrospective survey of families enrolled in the Fragile X Online Registry and Accessible Research Database (FORWARD). There was a 1.7-fold reduction in the prevalence of autism in FXS participants who were fed breast milk for 12 months or longer. There were strong negative correlations between increased time the infant was fed breast milk and the prevalence of autism and seizures and moderate negative correlations with the prevalence of GI problems and allergies. However, participants reporting GI problems or allergies commenced these comorbidities significantly earlier than those not fed breast milk. Parsing the data by sex indicated that males exclusively fed breast milk exhibited decreased prevalence of GI problems and allergies. These data suggest that long-term or exclusive use of breast milk is associated with reduced prevalence of key comorbidities in FXS, although breast milk is associated with the earlier development of GI problems and allergies.

Reproductive Hormone Concentrations and Associated Anatomical Responses: Does Soy Formula Affect Minipuberty in Boys?

Soy formula feeding is common in infancy and is a source of high exposure to phytoestrogens, documented to influence vaginal cytology in female infants. Its influence on minipuberty in males has not been established. To assess the association between infant feeding practice and longitudinally measured reproductive hormones and hormone-responsive tissues in infant boys. The Infant Feeding and Early Development study was a prospective cohort of maternal-infant dyads requiring exclusive soy formula, cow milk formula, or breast milk feeding during study follow-up. In the 147 infant boy participants, serum testosterone, luteinizing hormone, stretched penile length, anogenital distance, and testis volume were longitudinally assessed from birth to 28 weeks. We examined feeding-group differences in age trajectories for these outcomes using mixed-effects regression splines. Median serum testosterone was at pubertal levels at 2 weeks (176 ng/dL [quartiles: 124, 232]) and remained in this range until 12 weeks in all feeding groups. We did not observe differences in trajectories of hormone concentrations or anatomical measures between boys fed soy formula (n = 55) and boys fed cow milk formula (n = 54). Compared with breastfed boys (n = 38), soy formula-fed boys had a more rapid increase in penile length (P = .004) and slower initial lengthening of anogenital distance (P = .03), but no differences in hormone trajectories. Reproductive hormone concentrations and anatomical responses followed similar trajectories in soy and cow milk formula-fed infant boys. Our findings suggest that these measures of early male reproductive development do not respond to phytoestrogen exposure during infancy.

Rickets among a Group of Preterm Babies under the Age of Two Years at AL Ramadi Teaching Hospital for Maternity and Childhood

Background: Rickets of prematurity is a familiar status that leads to pathological fractures. Deficiency ofminerals leading to disturbed formation of bone is the most popular factor giving rise to disease and preterminfants are at increased risk of developing this condition.Objectives; To identify the incidence of rickets in preterm babies, and studying the risk factor associatedwith this disease like age, gender, residence, type of feeding, and changes in some biochemical tests.Patients and Methods: Across sectional study done in an outpatient clinic in maternity and childhoodteaching hospital, cases included in this study were children below two years old and were delivered before 37weeks of gestation. The diagnosis of rickets was done radiologically. All studied babies, data were collectedby history about (gender, age, type of feeding, and residence). Cases which diagnosed radiologically asrickets, a serological test was done for (serum calcium, phosphorus, alkaline phosphatase, and vitamin D).Results: (29.3%) of preterm babies were diagnosed as rickets of prematurity. The most common age reportedwith rickets was from 3months to less than13 months. Un-supplemented breast milk feeding was reported asa significant risk factor while residence and gender variation were not. High alkaline phosphatase level wasreported in more than (90%) of rickety children.Conclusion: A high incidence of rickets was found in preterm babies. Un-supplemented breastfeeding is animportant risk factor for the disease. Alkaline phosphatase activity and radiological features are importantfor screening.

The effect of feeding patterns on serum zonulin levels in infants at 3-4 months of age.

Zonulin so far is the only known endogenous modulator of intercellular tight junctions which regulate the intestinal permeability. Breastfeeding is considered to enhance the integrity of the gastrointestinal tract; however, limited data are available about the effect of feeding patterns on intestinal permeability. We aimed to investigate the potential association between the mode of feeding (breast versus formula milk) and the serum zonulin levels as a marker of intestinal permeability. One hundred fifty-seven full-term, healthy infants, born after an uncomplicated pregnancy, were enrolled within 72-96 h of life. Blood samples from 105 infants were obtained at 3 to 4 months of life. Serum zonulin levels were measured by ELISA. Out of 105 infants, 52.4% (55) were female, and 58.1% (61) were delivered by caesarian section at a mean gestational age of 38.9 (SD ± 1.0) weeks. At the time of blood sampling, median age was 3.4 (IQR 3.20-3.50) months, and mean weight was 6332 (SD ± 692) gr. Infants were divided in three groups according to the feeding patterns: exclusive breastfeeding (n = 42), mixed feeding (n = 41), and cow's milk formula (n = 22). The feeding pattern had no impact on infants' serum zonulin levels. Moreover, zonulin levels were not affected by infant's clinical and epidemiological characteristics such as body weight or family history of autoimmune disease.Conclusion: In our study, different feeding patterns were not associated with serum zonulin levels in healthy infants at 3-4 months of age. What is Known: • Serum zonulin is upregulated in conditions with increased intestinal permeability • Breast milk favors the physiological decline of the intestinal permeability after birth in the neonates What is New: • Serum zonulin levels were not affected by the feeding pattern (breast milk versus formula) in infants at 3-4 months of age • Clinical and epidemiological characteristics of infants had no impact on zonulin levels.

The Effect of Early Postnatal Nutrition on Human T Cell Leukemia Virus Type 1 Mother-to-Child Transmission: A Systematic Review and Meta-Analysis.

The main route of mother-to-child transmission (MTCT) of human T cell leukemia virus type 1 is vertical transmission via breastfeeding. Although the most reliable method for preventing MCTC is exclusive formula feeding (ExFF), short-term breastfeeding (STBF) or frozen–thawed breast milk feeding (FTBMF) has been offered as an alternative method if breastfeeding is strongly desired. The aim of this review was to clarify the pooled risk ratio of MCTC of STBF and FTBMF compared with ExFF. This study was registered with PROSPERO (number 42018087317). A literature search of PubMed, CINAHL, the Cochrane Database, EMBASE, and Japanese databases through September 2018 identified 1979 articles, 10 of which met the inclusion criteria. Finally, 11 articles, including these 10 studies and the report of a recent Japanese national cohort study, were included in the meta-analysis. The pooled relative risks of STBF ≤3 months, STBF ≤6 months, and FTBMF compared with ExFF were 0.72 (95% confidence interval (CI): 0.30–1.77; p = 0.48), 2.91 (95% CI: 1.69–5.03; p = 0.0001), and 1.14 (95% CI: 0.20–6.50; p = 0.88), respectively. This meta-analysis showed no statistical difference in the risk of MTCT between STBF ≤3 months and ExFF, but the risk of MTCT significantly increased in STBF ≤6 months.

Rates and Determinants of Mother’s Own Milk Feeding in Infants Born Very Preterm

To examine rates and determinants of mother's own milk (MOM) feeding at hospital discharge in a cohort of infants born very preterm within the Canadian Neonatal Network (CNN). This was a population-based cohort study of infants born at <33weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2015, and December 31, 2018. We examined the rates and determinants of MOM use at discharge home among the participating NICUs. We used multivariable logistic regression analysis to identify independent determinants of MOM feeding. Among the 6404 infants born very preterm and discharged home during the study period, 4457 (70%) received MOM or MOM supplemented with formula. Rates of MOM feeding at discharge varied from 49% to 87% across NICUs. Determinants associated with MOM feeding at discharge were gestational age 29-32weeks compared with <26weeks (aOR 1.56, 95% CI 1.25-1.93), primipara mothers (aOR 2.12, 95% CI 1.86-2.42), maternal diabetes (aOR 0.79, 95% CI 0.66-0.93), and maternal smoking (aOR 0.27, 95% CI 0.19-0.38). Receipt of MOM by day 3 of age was the major predictor of breast milk feeding at discharge (aOR 3.61, 95% CI 3.17-4.12). Approximately two-thirds of infants born very preterm received MOM at hospital discharge, and rates varied across NICUs. Supporting mothers to provide breast milk in the first 3days after birth may be associated with improved MOM feeding rates at discharge.

Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study.

BackgroundThe complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food “pouches” and “baby-led weaning” (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined.ObjectiveThe aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not.MethodsDietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide “dose-to-mother” technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect.ResultsThis observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022.ConclusionsThis large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436.International Registered Report Identifier (IRRID)DERR1-10.2196/29048

Feeding during neonatal therapeutic hypothermia, assessed using routinely collected National Neonatal Research Database data: a retrospective, UK population-based cohort study

SummaryBackgroundTherapeutic hypothermia is standard of care in high-income countries for babies born with signs of hypoxic ischaemic encephalopathy, but optimal feeding during treatment is uncertain and practice is variable. This study aimed to assess the association between feeding during therapeutic hypothermia and clinically important outcomes.MethodsWe did a population-level retrospective cohort study using the UK National Neonatal Research Database. We included all babies admitted to National Health Service neonatal units in England, Scotland, and Wales between Jan 1, 2010, and Dec 31, 2017, who received therapeutic hypothermia for 72 h or died during this period. For analysis, we created matched groups using propensity scores and compared outcomes in babies who were fed versus unfed enterally during therapeutic hypothermia. The primary outcome was severe necrotising enterocolitis, either confirmed at surgery or causing death. Secondary outcomes include pragmatically defined necrotising enterocolitis (a recorded diagnosis of necrotising enterocolitis in babies who received at least 5 consecutive days of antibiotics while also nil by mouth during their neonatal unit stay), late-onset infection (pragmatically defined as 5 consecutive days of antibiotic treatment commencing after day 3), survival to discharge, measures of breastmilk feeding, and length of stay in neonatal unit.Findings6030 babies received therapeutic hypothermia, of whom 1873 (31·1%) were fed during treatment. Seven (0·1%) babies were diagnosed with severe necrotising enterocolitis and the number was too small for further analyses. We selected 3236 (53·7%) babies for the matched feeding analysis (1618 pairs), achieving a good balance for all recorded background variables. Pragmatically defined necrotising enterocolitis was rare in both groups (incidence 0·5%, 95% CI 0·2–0·9] in the fed group vs 1·1% [0·7–1·4] in the unfed group). The enterally fed group had fewer pragmatically defined late-onset infections (difference −11·6% [95% CI −14·0 to −9·3]; p<0·0001), higher survival to discharge (5·2% [3·9–6·6]; p<0·0001), higher proportion of breastfeeding at discharge (8·0% [5·1–10·8]; p<0·0001), and shorter neonatal unit stays (−2·2 [–3·0 to −1·2] days; p<0·0001) compared with the unfed group.InterpretationNecrotising enterocolitis is rare in babies receiving therapeutic hypothermia. Enteral feeding during hypothermia is safe and associated with beneficial outcomes compared with not feeding, although residual confounding could not be completely ruled out. Our findings support starting milk feeds during therapeutic hypothermia.FundingUK National Institute for Health Research Health Technology Assessment programme 16/79/13.

Guidance for the clinical management of infants born to mothers with suspected/confirmed COVID-19 in Singapore.

In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.

HUBUNGAN MOTIVASI DAN PEKERJAAN IBU DENGAN PEMBERIAN MAKANAN PENDAMPING AIR SUSU IBU (MP-ASI) DINI PADA BAYI DI BAWAH USIA 6 BULAN

Complementary feeding of breastmilk to infants aged less than 6 months can cause health problems such as constipation, diarrhea and allergies. It will have an impact on the nutritional status of the infant. The purpose of this study was to determine the relationship between motivation and mother occupation with complementary feeding of breastmilk to infants under the age of 6 months in Naga Beralih village the work area of Community Health centre Kampar Utara in 2020. This type of research was analytic with cross sectional design. The population of this research was mothers who have infants aged 0-6 months in Naga Beralih village, the working area of Community Health centre Kampar Utara, totaling 41 people. Data collection tools in this study used a questionnaire. Data analysis in this study used univariate and bivariate analysis with chi square. The results showed that most of the respondents have high motivation in giving complementary breastfeeding, most of the respondents work, most of the respondents give complementary foods to infant under the age of 6 months. There was a relationship of motivation with complementary feeding with p value of 0.001. There was a work relationship with the provision of complementary feeding under the age of 6 months in Naga Beralih village the work area of Community Health centre Kampar Utara in 2020 with a p value of 0.002. For health workers, in order to increase education about the importance of complementary breastfeeding by forming classes for infants and toddlers to provide information and demonstrations, especially regarding the amount of complementary breastfeeding, types of food and timing of complementary feeding.

Thirdhand smoke associations with the gut microbiomes of infants admitted to a neonatal intensive care unit: An observational study

IntroductionMicrobiome differences have been found in adults who smoke cigarettes compared to non-smoking adults, but the impact of thirdhand smoke (THS; post-combustion tobacco residue) on hospitalized infants’ rapidly developing gut microbiomes is unexplored. Our aim was to explore gut microbiome differences in infants admitted to a neonatal ICU (NICU) with varying THS-related exposure. MethodsForty-three mother-infant dyads (household member[s] smoke cigarettes, n = 32; no household smoking, n = 11) consented to a carbon monoxide-breath sample, bedside furniture nicotine wipes, infant-urine samples (for cotinine [nicotine's primary metabolite] assays), and stool collection (for 16S rRNA V4 gene sequencing). Negative binomial regression modeled relative abundances of 8 bacterial genera with THS exposure-related variables (i.e., household cigarette use, surface nicotine, and infant urine cotinine), controlling for gestational age, postnatal age, antibiotic use, and breastmilk feeding. Microbiome-diversity outcomes were modeled similarly. Bayesian posterior probabilities (PP) ≥75.0% were considered meaningful. ResultsA majority of infants (78%) were born pre-term. Infants from non-smoking homes and/or with lower NICU-furniture surface nicotine had greater microbiome alpha-diversity compared to infants from smoking households (PP ≥ 75.0%). Associations (with PP ≥ 75.0%) of selected bacterial genera with urine cotinine, surface nicotine, and/or household cigarette use were evidenced for 7 (of 8) modeled genera. For example, lower Bifidobacterium relative abundance associated with greater furniture nicotine (IRR<0.01 [<0.01, 64.02]; PP = 87.1%), urine cotinine (IRR = 0.08 [<0.01,2.84]; PP = 86.9%), and household smoking (IRR<0.01 [<0.01, 7.38]; PP = 96.0%; FDR p < 0.05). ConclusionsTHS-related exposure was associated with microbiome differences in NICU-admitted infants. Additional research on effects of tobacco-related exposures on healthy infant gut-microbiome development is warranted.

Breastfeeding and breastmilk substitute use and feeding motivations among mothers in Bandung City, Indonesia.

Suboptimal breastfeeding is common in Indonesia, with only half of infants 0–5 months of age exclusively breastfed and feeding of breastmilk substitutes (BMS) highly prevalent among infants and toddlers. Various factors influence these feeding practices, including social norms, limited health system support and BMS manufacturer marketing practices. This cross‐sectional survey aimed to identify the prevalence of breastfeeding and BMS feeding among children aged 0–35 months, explore socio‐demographic characteristics and motivating factors associated with these feeding behaviours and identify the prevalence of mothers' exposure to BMS promotions. Indonesian mothers of children <3 years of age (n = 595) were interviewed in Bandung City health facilities using structured questionnaires. Although all children were ever breastfed, half of children across all age groups received BMS in the previous day. Maternal employment outside the home and insufficient breastmilk production were associated with BMS use. The most important motivational factors for feeding BMS were perceived benefits for growth, intelligence and immunity. Despite Indonesian legislation restricting some BMS marketing, 93% of mothers reported observing a BMS promotion outside the health system, with television, social media and newspapers as the most common sources. Half of mothers (43%) reported observing a BMS promotion within the health system, and half (46%) reported receiving recommendations from health workers to use BMS. Such high prevalence of BMS marketing may be influencing caregivers' feeding choices; stronger national legislation and implementation of laws are needed to ensure mothers' ability to make feeding choices free from manufacturer influence.

Cronobacter Sakazakii: A Foodborne Pathogenic Bacterium in Immunocompromised and Hospitalized Patients

Aims: Cronobacter sakazakii (CS) is a member of the Enterobacteriaceae family. It is a genomically heterogeneous, motile, Gram-negative bacillus. It is also an emergent foodborne pathogen associated with the ingestion of infant formula milk that can cause neonatal sepsis, necrotizing enterocolitis, and meningitis. This review is focused on the newest information about the bacterial characteristics of C. sakazakii and human infections causing by this pathogenic bacterium. Methods &amp; Materials: We searched medical databases such as ISI Web of Science, PubMed, Scopus, and other websites. Findings: Cronobacter sakazakii acts as a microbiological hazard in the infant food chain, with historic high mortality in neonates. The International Commission for Microbiological Specifications for Foods has categorized C. sakazakii as a severe hazard bacterium for some individuals, with long duration, substantial chronic sequelae, or life-threatening complications. Although the incidence of C. sakazakii infection is low, the prognosis of the disease is poor, and infection is associated with significant morbidity and mortality. Powdered Infant Formula (PIF) milk products contaminated with C. sakazakii have been epidemiologically linked to several clinical cases. Premature infants, low-birth-weight ones, and patients hospitalized in the Neonatal Intensive Care Units (NICUs) are more at infection risk than older infants. Conclusion: We recommend focusing on simple preventative strategies such as the promotion of breast milk feeding, the inclusion of warnings on the powder infant formula packages that may be contaminated with C. sakazakii, and abstinence from the practice of re-warming of reconstituted formula. Reconstituted dairy products should be avoided in adult immunosuppressed populations. Appropriate barrier precautions should be observed in NICU and intensive care unit settings, where the spread of infection may be more prevalent.

Pengaruh Metode SPEOS (Stimulasi Pijat Endorfin Oksitosin Suggestif) Terhadap Produksi ASI Pada Ibu Nifas

Health profile of Semarang in 2018, the exclusive feeding of the exclusive breast milk in the age of 0-6 months of 65.57%. It’s still far from Central Java target of 80%. This problem of breastfeeding influenced by reduced stimulation of oxytocin hormones, while physical and psychological changes can affect the lactation process. One of the efforts to increase the breast milk production with SPEOS (Suggestive Endorphin Oxytocin Massage Stimulation). The SPEOS method can help nifas mother to facilitate the expenditure of breast milk. To know the effect of the SPEOS method (Suggestive Endorfin Oxytocin Massage Stimulation) on Breast Milk Production in Nifas Mothers. The research design used quasy experiment with one group pre-post test. Sample in this study was nifas mother with spontaneous childbirth amounted to 27 people. The sampling technique used consecutive sampling. Breastfeeding production before mothers performed SPEOS method on average was 3.70 ml with standard deviation of 5,113. Breast milk production after mother performed SPEOS method on average was 129,63 ml with standard deviation 11,001. There was an influence of SPEOS method to breast milk production on nifas mother at Maternity Hospital of Mardi Rahayu Semarang (p-value = 0,000). Stimulation Massage Endorphin Oxytocin SuggestifBreastmilk Production,Nifas Mother

Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit: A Randomized Controlled Pilot Trial.

To measure the feasibility, reach, and potential impact of a virtual family-centered rounds (FCR) intervention in the neonatal intensive care unit. We conducted a randomized controlled pilot trial with a 2:1 intervention-to-control arm allocation ratio. Caregivers of intervention arm neonates were invited to participate in virtual FCR plus standard of care. We specified 5 feasibility objectives. We profiled intervention usage by neonatal and maternal characteristics. Exploratory outcomes included FCR caregiver attendance, length of stay, breast milk feeding at discharge, caregiver experience, and medical errors. We performed descriptive analyses to calculate proportions, means, and rates with 95% confidence intervals (CI). We included 74 intervention and 36 control subjects. Three of the five feasibility objectives were met based on the point estimates. The recruitment and intervention uptake objectives were not achieved. Among intervention arm subjects, recruitment of a caregiver occurred for 47 (63.5%, 95% CI 51.5%-74.4%) neonates. Caregiver use of the intervention occurred for 36 (48.6%, 95% CI 36.8%-60.6%) neonates in the intervention arm. Feasibility objectives assessing technical issues, burden, and data collection were achieved. Among the attempted virtual encounters, 95.0% (95% CI 91.5%-97.3%) had no technical issues. The survey response rate was 87.5% (95% CI 78.2%-93.8%). Intervention arm neonates had 3.36 (95% CI 2.66%-4.23) times the FCR caregiver attendance rate of subjects in the control arm. A randomized trial to compare virtual FCR to standard of care in neonatal subjects is feasible and has potential to improve patient and caregiver outcomes.

Infant Feeding Practices During the First Postnatal Year and Risk of Asthma and Allergic Disease During the First 6 Years of Life.

Background: Breastfeeding may protect against childhood asthma and allergic diseases. Studies have not focused on the mode of feeding human milk and followed children to school age although feeding human milk from a bottle rather than the breast may alter the risk of disease. Materials and Methods: At 12 months' postpartum, women in the Moms2Moms study (Columbus, OH) completed a survey assessing sociodemographic and infant feeding behaviors. At 6 years' postpartum, they completed a survey and pediatric medical records were abstracted to assess asthma and allergic disease diagnoses. Logistic regression models were used to estimate associations between infant feeding behaviors and asthma or allergic disease. Results: Of 285 children, 16% had asthma and 44% ever had ≥1 allergy diagnosis. Longer durations of each infant feeding behavior were not clearly associated with increased odds of asthma or allergic disease by age 6. Results suggested that longer durations of breast milk feeding (regardless of the mode of feeding) may be related to a lower risk of food allergy (e.g., odds ratio [OR]1-month, adjusted = 0.96, 95% confidence interval [CI] = 0.87-1.05; OR12-month, adjusted = 0.57, 95% CI = 0.19-1.74), but that the mode of feeding (regardless of the substance fed) may be more meaningful for environmental allergies (e.g., exclusive direct breast milk feeding OR12-month, adjusted = 0.32, 95% CI = 0.06-1.81). However, effect estimates were imprecise and CIs included the null. Conclusions: Although no clear associations between mode of breast milk feeding (breast versus expressed) and asthma and allergy outcomes were observed, future research with larger samples should further evaluate these associations.