Breast Milk Feeding Research Articles

Greater Breastfeeding in Early Infancy Is Associated with Slower Weight Gain among High Birth Weight Infants

To examine whether feeding patterns from birth to age 6 months modify the association between birth weight and weight at 7-12 months of age. Longitudinal mixed models were used to examine feeding trajectories across categories of birth weight and weight at 7-12 months of age in 1799 mother-infant dyads enrolled in the Infant Feeding Practices Study II. The percentage of breast milk received and the average daily formula consumption were calculated from birth to 6 months of age. Birth weights were classified as high (≥4000 g) and normal (≥2500 g and <4000 g). Weights at 7-12 months of age were categorized as high (z score >1) or normal (z score ≤1). A secondary analysis was performed using categories defined by birth weight adjusted for gestational age percentiles (>90% and 10th-90th percentile). High birth weight (HBW) infants with high weights at 7-12 months of age demonstrated a rapid decline in the percentage of breast milk feedings compared with HBW infants with normal weights at 7-12 months of age. Normal birth weight infants with high weights at 7-12 months of age received a lower percentage of breast milk and had greater absolute intakes of formula than those with normal weights at 7-12 months of age; these associations did not vary over time. Results were similar when infants were categorized by birth weight percentiles. A lower proportion of breast milk feedings was associated with excess weight at 7-12 months of age in HBW infants. These findings suggest an initial target for obesity prevention programs focusing on the first 6 months after birth.

Breastfeeding self-efficacy and breastmilk feeding for moderate and late preterm infants in the Family Integrated Care trial: a mixed methods protocol

BackgroundBreastmilk is the ideal nutrition for preterm infants. Yet, breastmilk feeding rates among preterm infants are substantially lower than those of full-term infants. Barriers incurred through hospital care practices as well as the physical environment of the neonatal intensive care unit (NICU) can result in physical and emotional separation of infants from their parents, posing a substantial risk to establishing and maintaining breastfeeding. Additionally, current practitioner-focused care provision in the NICU can result in decreased breastfeeding self-efficacy (BSE), which is predictive of breastfeeding rates in mothers of preterm infants at 6 weeks postpartum.MethodsFamily Integrated Care (FICare) integrates and supports parents to actively participate in the care of their infant while in the NICU. Nested within the broader FICare trial, we will conduct an explanatory sequential mixed methods study to investigate if FICare improves maternal BSE and rates of breastmilk feeding in moderate and late preterm infants at discharge from the NICU. In phase 1, we will calculate the mean difference between admission and discharge BSE scores for the intervention group. Mothers who score in the top and bottom 20th percentile of change scores will be invited to participate in a semi-structured telephone interview exploring maternal experiences with infant feeding in the NICU. We will conduct inductive thematic analysis to identify and describe the facilitators and barriers of FICare on maternal feeding experiences. Once data saturation is achieved and themes have been established, phase 2 will revisit the quantitative data to determine whether FICare was impactful on BSE and breastmilk feeding rates. Findings from the qualitative and quantitative phases will be integrated to determine how infant feeding experiences on FICare units work to improve or detract from maternal BSE and rates of breastmilk feeding.DiscussionFICare may help to improve maternal BSE and rates of breastmilk feeding in moderate and late preterm infants. Improved breastmilk feeding outcomes can have a substantial impact on overall infant health, developmental outcomes, and maternal-infant bonding and will help to improve long-term health outcomes for moderate and late preterm infants.Trial registration(NCT02879799). Registered May 27, 2016 protocol version June 9, 2016 Version 2.

Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis.

The aim of this study is to investigate etiological agents, patterns of antimicrobial resistance and predictors of mortality in culture proven neonatal sepsis. This is a twenty-four month retrospective cohort study of infants with culture proven sepsis. Demographic data, type of isolates and its sensitivity pattern were recorded. Multidrug resistant gram-negative isolates were defined as resistance to any three of five antibiotic classes: extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones and piperacillin-tazobactam. A total of 183 case with culture positive sepsis were identified. Early onset sepsis occurred in 59% of cases. The majority of isolates (56.2%) were gram-positive but the most common individual isolates were klebsiella spp. (31.1%), Staphylococcus aureus (24.5%) and coagulase-negative staphylococci (CONS) (22.9%). The pathogen mix in early-onset did not differ from late-onset sepsis. High rates of multidrug resistance were observed in klebsiella spp. (49.1%), Escherichia coli (50%), citrobacter spp (50%), acinetobacter spp. (28.5%), pseudomonas spp. (100%) isolates. Methicillin resistance prevailed in 16.6% of coagulase-negative staphylococci, 24.4% of Staphylococcus aureus and 62.5% of enterococcus spp. Multivariate analysis revealed invasive ventilation and early onset sepsis to be independently associated with increased risk of mortality in contrast to breast milk feeding which is associated with decreased risk of mortality. A high degree of antimicrobial resistance underscores the need to understand the pathogenesis of resistance, curtail the irrational prescription of antibiotics in neonates and the requirement for measures to prevent it in low-income and middle-income countries.

Legal Briefs: Was This Case of Necrotizing Enterocolitis Preventable?

A 28 1/7 week gestational age male infant with a birthweight of 1,280 g was born to a 23-year- old gravida 3, para 0-0-2-0 woman. The pregnancy was uneventful until the night before delivery when she developed preterm labor. She received 1 dose of betamethasone 8 hours before delivery. She also received 3 doses of penicillin for unknown group B Streptococcus status. Artificial rupture of membranes occurred a few hours before birth and the amniotic fluid was clear. The birth was via normal spontaneous vaginal delivery. The placenta appeared grossly normal, but subsequent pathologic examination showed mild chorioamnionitis. The infant’s Apgar scores were 8 at 1 minute and 9 at 5 minutes of age. The infant was clinically stable and treated with continuous positive airway pressure. The infant had a normal complete blood cell (CBC) count and was started on antibiotics because of preterm labor. The infant also received intravenous fluids at 80 mL/kg per day. On day 1, caffeine was initiated and phototherapy was started because the infant’s bilirubin was 8.1 mg/dL (138.5 μmol/L). At that time, the infant’s weight was down 11% from birthweight. On day 2, a percutaneous intravenous central catheter (PICC) was placed. On day 3, the infant’s weight loss was down 13% from birthweight and his sodium was 151 mEq/L (151 mmol/L) with a blood urea nitrogen of 30 mg/dL (10.7 mmol/L). The infant was started on trophic breast milk feedings of 1.5 mL every 3 hours. With the intravenous fluids being infused at 122 mL/kg per day, the total volume of fluids was 154 mL/kg per day. The infant did not receive probiotics. As the feedings increased, the volume infused diminished. The plaintiff neonatologist thought that the infant should have had his hydration status better managed to prevent dehydration and that it was inappropriate …

Current Practices Related to Feeding Preterm Neonates with Expressed Breast Milk: A Pilot Project

A pilot project was conducted to assess current practices related to feeding pretermneonates with expressed breast milk. The present project was conducted with the objectives to assess current practices related to feeding preterm neonates with expressed breast milk admitted in tertiary level hospital, North India. Practices related to expressed breast milk feeding in preterm neonates was assessed in 4 steps. In step one of Information and current practices related to expression of breast milk among mothers was assessed. Practices in neonatal unit revealed that 92% of mothers had knowledge about feeding schedule of babies. In context to infection control practices 96% mothers washed hands, 92% wore gown, and all mothers (100%) used boiled utensils. Eighty two percent mothers expressed milk at least eight times in 24hour including once during night. Feeding detail of preterm neonates revealed that amount of expressed breast milk fed was very less as compare to enteral feed calculated per day

Protein supplementation of human milk for promoting growth in preterm infants.

Preterm infants require high protein intake to achieve adequate growth and development. Although breast milk feeding has many benefits for this population, the protein content is highly variable, and inadequate to support rapid infant growth. This is a 2018 update of a Cochrane Review first published in 1999. To determine whether protein-supplemented human milk compared with unsupplemented human milk, fed to preterm infants, improves growth, body composition, cardio-metabolic, and neurodevelopmental outcomes, without significant adverse effects. We used the standard search strategy of Cochrane Neonatal to search CENTRAL, MEDLINE via PubMed, Embase, and CINAHL (February 2018). We also searched clinical trials databases, conference proceedings and the reference lists of retrieved articles for randomised controlled trials (RCT) and quasi-randomised trials. Published and unpublished RCTs were eligible if they used random or quasi-random methods to allocate hospitalised preterm infants who were being fed human milk, to additional protein supplementation or no supplementation. Two review authors independently abstracted data, assessed risk of bias and the quality of evidence at the outcome level, using GRADE methodology. We performed meta-analyses, using risk ratio (RR) for dichotomous data, and mean difference (MD) for continuous data, with their respective 95% confidence intervals (CIs). We used a fixed-effect model and had planned to explore potential causes of heterogeneity via subgroup or sensitivity analyses. We included six RCTs, involving 204 preterm infants. Low-quality evidence showed that protein supplementation of human milk increased in-hospital rates of growth in weight (MD 3.82 g/kg/day, 95% CI 2.94 to 4.7; five RCTs, 101 infants; I² = 73%), length (MD 0.12 cm/wk, 95% CI 0.07 to 0.17; four RCTs, 68 infants; I² = 89%), and head circumference (MD 0.06 cm/wk, 95% CI 0.01 to 0.12; four RCTs, 68 infants; I² = 84%). There was no evidence of a clear difference in rate of growth of skin fold thickness between the supplemented and unsupplemented groups (triceps MD 0.06 mm/wk, 95% CI -0.09 to 0.21; one RCT, 20 infants; or subscapular MD 0.00 mm/wk, 95% CI -0.17 to 0.17; one RCT, 20 infants). Protein supplementation led to longer hospital stays (MD 18.5 days, 95% CI 4.39 to 32.61; one RCT, 20 infants; very low-quality evidence), and higher blood urea nitrogen concentrations compared to the unsupplemented group (MD 0.95 mmol/L, 95% CI 0.81 to 1.09; four RCTs, 81 infants; I² = 56%). Very low-quality evidence did not show that protein supplementation clearly increased the risk of feeding intolerance (RR 2.70, 95% CI 0.13 to 58.24; one RCT, 17 infants), or necrotizing enterocolitis (RR 1.11, 95% CI 0.07 to 17.12; one RCT, 76 infants), or clearly altered serum albumin concentrations (MD 2.5 g/L, 95% CI -5.66 to 10.66; one RCT, 11 infants), compared with the unsupplemented groups. No data were available about the effects of protein supplementation on long-term growth, body mass index, body composition, neurodevelopmental, or cardio-metabolic outcomes. Low-quality evidence showed that protein supplementation of human milk, fed to preterm infants, increased short-term growth. However, the small sample sizes, low precision, and very low-quality evidence regarding duration of hospital stay, feeding intolerance, and necrotising enterocolitis precluded any conclusions about these outcomes. There were no data on outcomes after hospital discharge. Our findings may not be generalisable to low-resource settings, as none of the included studies were conducted in these settings.Since protein supplementation of human milk is now usually done as a component of multi-nutrient fortifiers, future studies should compare different amounts of protein in multi-component fortifiers, and be designed to determine the effects on duration of hospital stay and safety, as well as on long-term growth, body composition, cardio-metabolic, and neurodevelopmental outcomes.

Does the Opening of a Milk Bank in NICU Cancel the Incidence of NEC?

Several studies suggest that donor milk (DM) is effective in preventing necrotizing enterocolitis (NEC) in preterm infants and DM is widely used for this purpose when the mother’s milk (OMM) is unavailable, and the presence of a DMB (Donor Milk Bank) in NICU has indeed increased breast milk feeding.

Factors associated with infants receiving their mother's own breast milk on discharge from hospital in a unit where pasteurised donor human milk is available.

To determine the proportion of very preterm infants who were exclusively fed breast milk at the time of discharge home, before and after the availability of pasteurised donor human milk (PDHM). This was an observational retrospective cohort study with historical comparison, comparing two cohorts (<32 weeks gestational age or very low birthweight) before and after the availability of donor human milk. The main explanatory variable was the PDHM cohort: pre-PDHM or post-PDHM. The primary dichotomous outcome variable was defined as whether the baby was being fed with breast milk only at the time of discharge home, compared with those fed with artificial formula alone or mixed feeding (artificial formula and breast milk). There were 1088 babies in the pre-PDHM cohort and 330 in the post-PDHM cohort (total n = 1418). Following the introduction of PDHM, 56% (185/330) were exclusively fed breast milk at the time of hospital discharge and 57% (620/1088) in the pre-PDHM cohort. The availability of PDHM is not a significant predictor of feeding outcome upon discharge (P = 0.45) when adjusted for maternal age, log-transformed post-natal age at discharge home and any congenital abnormality. The availability of donor human milk in our unit is not associated with a decrease in the number of very preterm infants receiving mother's own breast milk at time of discharge home. Other factors that positively impact the successful establishment of breastfeeding in preterm babies were older maternal age, the absence of any congenital abnormality and a shorter duration of hospital stay.

Comparison the Effectiveness of Breastfeeding, Oral 25% Dextrose, Kangaroo-Mother Care Method, and EMLA Cream on Pain Score Level Following Heal Pick Sampling in Newborns: a randomized clinical trial.

BackgroundToday, it is considered that infants can feel pain, and it can have several adverse effects on their development. Although different interventions, such as skin-to-skin contact (kangaroo mother care method), glucose solutions, breastfeeding, and local anesthetic agents, have been evaluated to reduce infants’ pain, there is no clinical trial available to identify the best method.ObjectiveThe aim of this study was to compare the efficacy of four methods of relieving infants’ pain, i.e., breastfeeding, oral 25% dextrose, kangaroo mother care method (KMCM), and EMLA cream based on a pain score level following heal-prick sampling in term newborns.MethodsIn this double-blind, controlled, randomized clinical trial, full term, and healthy infants in Shahid Motahhari Hospital, Marvdasht, Shiraz Province, Iran were studied. Infants were randomly allocated to four groups of interventions, i.e., A: breast milk feeding (n=42), B: oral 25% dextrose (n=40), C: KMCM (n=38), and D: KMCM ointment (n=40). All interventions were applied 15 minutes before heel-prick sampling. To evaluate the pain level in infants, the Neonatal Infant Pain Scale (NIPS) questionnaire was used. The data were analyzed with SPSS version 16 by ANOVA and the chi-squared tests.ResultsOne hundred and sixty-one infants (93 males, 68 females) with an age range of 3 to 5 days were studied. There was no significant difference between the groups in terms of gender (p=0.113), weight (p=0.059), and baseline pain score level (p=0.904). The breastfeeding method showed the lowest pain score in comparison to the other interventions (A=5.52±2.22, B=6.45±1.88, C=6.84±1.96, D=7.37±1.95; p=0.001) after the heel-prick sampling.ConclusionIt seems that, among the four methods of interventions in this study, the most effective method of lowering perceived pain in infants undergoing painful procedures was proven to be breastfeeding.Trial RegistrationThis study is registered in the Iranian Registry of Clinical Trials with the registration number of IRCT20151201253256N1.FundingThis research was supported financially by the Research Council of the International Campus of Shiraz University of Medical Sciences.

Efficacy of a Triple Anti-Infective Regimen for Prevention of Complications in Critically Ill Term Neonates

Background: Aim of the study was to analyze the use of a prophylactic multimodal anti-infective regimen including the probiotic Lactobacillus casei rhamnosus (LCR35) in critically ill term neonates with respect to complications and possible side effects. Methods: This was a retrospective observational STROBE compliant single-center cohort study of all term infants born between 2005 and 2015 that have been admitted within the first 24 hours of life to the neonatal intensive care unit (NICU) and having been hospitalized for at least 7 days. All neonates received a standardized prophylactic anti-infective treatment with enteral probiotics (LCR35), antifungal agents, and oral gentamycin over the study time starting at the first day of life. Perinatal and neonatal data were collected for descriptive analysis. Complications of neonatal intensive care therapy included late-onset necrotizing enterocolitis (NEC), multiple organ dysfunction syndrome (MODS), ventilator associated pneumonia (VAP), antibiotic-associated diarrhea (AAD), and late-onset sepsis (LOS). Results: Out of 2940 neonates admitted to the neonatal wards 403 fulfilled the inclusion criteria and comprised the study population. Median gestational age was 38 weeks and birth weight 3300 grams, median length of stay 10 days; 246 (61%) neonates needed ventilatory support and 334 (83%) received antibiotic treatment. None of the neonates developed NEC, MODS, VAP, or AAD. Sixteen (4.0%) neonates developed LOS. Blood cultures were all negative for LCR. Breast milk feeding was evident in 13% (2/16) of the neonates with LOS compared to 30% (121/387) in those without LOS (P = 0.055). Conclusions: Over an 11-year period use of a standardized prophylactic anti-infective regimen was safe and resulted in a very low incidence of predefined complications in critically ill term neonates.

Impact of Mother’s Own Milk on the Move (MOMM) Program on Breast Milk Feeding Rates at Discharge in a Freestanding Neonatal Intensive Care Unit

Impact of Mother’s Own Milk on the Move (MOMM) Program on Breast Milk Feeding Rates at Discharge in a Freestanding Neonatal Intensive Care Unit

Impact of Mother’s Own Milk on the Move (MOMM) Program on Breast Milk Feeding Rates at Discharge in a Freestanding Neonatal Intensive Care Unit

Background: Initiation of breastfeeding after delivery has been shown to increase long term breastfeeding rates. However, infant transport to a neonatal intensive care unit (NICU) away from the birthing center separates mother and baby. Obstacles such as decreased skin to skin contact, maternal stress related to transport of her baby to another hospital and inconsistent breastfeeding education and support impact a mother’s ability to provide breast milk. We developed Mother’s Own Milk on the Move (MOMM) program in 2014 to mobilize lactation support to mothers of infants transported to our NICU to improve …

“BILIK LAKTASI” UNIB: SEBUAH BENTUK DUKUNGAN TEMPAT KERJA TERHADAP SUKSES IBU PEKERJA MENYUSUI

According to Permenkes RI nomor 15 tahun 2013 on How Providing the Special Facility for Breastfeeding and or breast milk, Lactation Room or Nursing Room is a special room equipped with facilities for breastfeeding directly to the baby or breast milk and keep the milk, and or a counseling room for breastfeeding. Availability of lactation room is increased the positive image of University of Bengkulu in level of local, national, and international community as one of efforts to reach the quality of world class university. University of Bengkulu should be the pioneer of such this program in Bengkulu Province. Lactation room, called Bilik Laktasi, is 4.5 m x 8.5 m’s room that accommodate of maximum of 10 infants and breastfeeding mothers. This room is equipped with mattresses and toys, a refrigerator, cooling box, fan, dispenser, and other supporting facilities. A trained nanny will manage the room and standard operational procedurals are set for services. K eywords : Lactation Room, Breastfeedind, breastfeeding milk, working women, employer

Discharge breastmilk feeding rates in asymptomatic term newborns admitted to the neonatal intensive care unit for maternal chorioamnionitis

Purpose: To compare discharge breastmilk feeding rates among asymptomatic term newborns receiving 48-hour versus >48-hour antibiotics in the neonatal intensive care unit (NICU) and a cohort of well-baby nursery (WBN) newborns.Materials and methods: This retrospective review included asymptomatic term neonates admitted to the NICU due to maternal chorioamnionitis and a comparison group of WBN neonates between January 2012 and December 2015. Demographic, birth, feeding, and lactation consultant visit data were analyzed in univariate and multivariate models.Results: Among 272 NICU neonates, 237 (87%) received 48-hour antibiotics versus 35 (13%) who received >48-hour (h) antibiotics; a cohort of 428 WBN neonates was studied for comparison. Exclusive breastmilk feeding was seen in 14% of NICU versus 35% of WBN neonates (p < .01). Among NICU newborns, 48 h versus >48 h antibiotics was not associated with altered discharge breastmilk feeding (14 versus 14%; p = .89). On multivariate logistic regression analysis among NICU subjects, older maternal age (p < .01), lower parity (p = .02), first-feed breastmilk (p < .01), and more lactation consultant visits (p = .012) were associated with increased discharge breastmilk feeding.Conclusions: NICU admission for presumed early-onset sepsis due to maternal chorioamnionitis was associated with reduced discharge breastmilk feeding in asymptomatic term neonates, but prolonged antibiotic exposure was not. We speculate that demographic factors, such as maternal age and parity, may aid in focusing lactation consultant efforts to potentially improve NICU exclusive discharge breastmilk feeding rates.

Breast-feeding regulates immune system development via transforming growth factor-β in mice pups.

Breast milk contains important nutrients and immunoregulatory factors that are essential for newborn infants. Recently, epidemiological studies suggested that breast-feeding prevents a wide range of infectious diseases and lowers the incidence of infant allergic diseases. To examine the effects of breast milk on immunological development in infancy, we established an artificial rearing system for hand-feeding mice and compared mouse pups fed with either breast milk or milk substitute. All mice were killed at 14days of age and immune cells in the thymus, spleen, and small intestine were examined on flow cytometry. The number of thymocytes was higher whereas that of total immune cells of peripheral lymphoid tissues was lower in mice fed breast milk compared with milk substitute-fed mice. In peripheral lymphoid tissues, the proportion of B cells was higher and that of CD8+ T cells, macrophages, dendritic cells, and granulocytes was significantly lower in breast milk-fed mice. The same alteration in immune cells of the thymus and peripheral lymphoid tissues in milk substitute-fed mice was also observed in pups reared by mother mice treated with anti-transforming growth factor-β (anti-TGF-β) monoclonal antibody. Breast milk regulates the differentiation and expansion of innate and adaptive immune cells partly due to TGF-β. Hence, TGF-β in breast milk may be a new therapeutic target for innate immune system-mediated diseases of infancy.

Winging it: maternal perspectives and experiences of breastfeeding newborns with complex congenital surgical anomalies.

ObjectiveTo describe the experience of breastfeeding (inclusive of breast milk expression/pumping, provision of breast milk via devices, and at-breast feeding) among mothers of newborns with complex congenital surgical anomalies and the contexts under which pro-breastfeeding behaviors and attitudes are facilitated or compromised.Study DesignWe used qualitative description to analyze 23 interviews conducted with 15 mothers of newborns undergoing surgery for gastrointestinal, cardiac, or neural tube defects.ResultsBreastfeeding experiences were characterized by naivety regarding the importance and rationale for exclusive breast milk feedings and best practices to facilitate milk supply maintenance and transition to at-breast feeds. Maternal breastfeeding views and behaviors were impacted by indeterminate prenatal plans to breastfeed/provide breast milk, limited prior breastfeeding exposure and knowledge, and gaps in postnatal lactation support.ConclusionFuture research should investigate methods to improve exclusive breast milk feeding and facilitate transitions to at-breast feeds among mothers of newborns with surgical congenital anomalies, with consideration of identified barriers.

Prevalence and duration of breast milk feeding in very preterm infants: A 3-year follow-up study and a systematic literature review.

The World Health Organization recommends exclusive breast milk feeding until 6months and continuing up to 2years of age; little is known about whether very preterm infants are fed in accordance with these recommendations. We aimed to describe the prevalence and duration of breast milk feeding in very preterm children and to systematically review internationally published data. We evaluated breast milk feeding initiation and duration in very preterm children born in 2 Portuguese regions (2011-2012) enrolled in the EPICE cohort and followed-up to the age of 3 (n=466). We searched PubMed® from inception to January 2017 to identify original studies reporting the prevalence and/or duration of breast milk feeding in very preterm children. 91.0% of children received some breast milk feeding and 65.3% were exclusively breast fed with a median duration of 2months for exclusive and 3months for any breast milk; only 9.9% received exclusive breast milk for at least 6months, 10.2% received any breast milk for 12months or more, and 2.0% for up to 24months. The literature review identified few studies on feeding after hospital discharge (n=9); these also reported a low prevalence of exclusive breast milk feeding at 6months (1.0% to 27.0%) and of any breast milk at 12months (8.0% to 12.0%). The duration of breast milk feeding among Portuguese very preterm infants was shorter than recommended. However, this appears to be common globally. Research is needed to inform strategies to promote continued breast milk feeding.

Early, regular breast-milk pumping may lead to early breast-milk feeding cessation.

To estimate the effect of early, regular breast-milk pumping on time to breast-milk feeding (BMF) and exclusive BMF cessation, for working and non-working women. Using the Infant Feeding Practices Survey II (IFPS II), we estimated weighted hazard ratios (HR) for the effect of regular pumping (participant defined) compared with non-regular/not pumping, reported at month 2, on both time to BMF cessation (to 12 months) and time to exclusive BMF cessation (to 6 months), using inverse probability weights to control confounding. USA, 2005-2007. BMF (n 1624) and exclusively BMF (n 971) IFPS II participants at month 2. The weighted HR for time to BMF cessation was 1·62 (95 % CI 1·47, 1·78) and for time to exclusive BMF cessation was 1·14 (95 % CI 1·03, 1·25). Among non-working women, the weighted HR for time to BMF cessation was 2·05 (95 % CI 1·84, 2·28) and for time to exclusive BMF cessation was 1·10 (95 % CI 0·98, 1·22). Among working women, the weighted HR for time to BMF cessation was 0·90 (95 % CI 0·75, 1·07) and for time to exclusive BMF cessation was 1·14 (95 % CI 0·96, 1·36). Overall, regular pumpers were more likely to stop BMF and exclusive BMF than non-regular/non-pumpers. Non-working regular pumpers were more likely than non-regular/non-pumpers to stop BMF. There was no effect among working women. Early, regular pumpers may need specialized support to maintain BMF.

The role of early years care providers in supporting continued breastfeeding and breast milk feeding

This paper discusses challenges faced by mothers who seek to continue breastfeeding and/or breast milk feeding (B/BMF) whilst using daytime childcare, and early years’ practitioners’ attitudes towards their role in the support of these feeding practices. The data-set being reported comes from a small-scale feasibility study that was conducted in the summer of 2015 at a childcare provider site in a highly deprived urban area of Scotland. Focus groups with B/BMF mothers, as well as with early years’ practitioners were conducted. We report data pertaining to where responsibility lies for facilitating continued B/BMF, and on the perception of practitioners’ attitudes, knowledge about, skills and providers’ facilities for B/BMF. We recommend that care providers actively engage prospective parents in a discussion about how they can support continued B/BMF. These original data are contextualised and critically discussed within the wider literature with special attention being paid to the concept of unintended consequences.

PREVENTION AND TREATMENT OF HYPOGALACTIA. THE ROLE OF LACTOGENIC AGENTS

According to the literature, hypogalactia is the main reason for premature termination of breastfeeding. The prevention and treatment of hypogalactia can significantly prolong breastfeeding. The article describes the hypogalactia preventing practice by delivering the lecturing courses for pregnant women during antenatal classes and preparation for childbirth, which led to significant differences in the duration of breastfeeding: 62% of women who attended the lectures and only 37% of women who did not attend courses on their own initiative (p &lt;0.001) were breastfeeding up to 1.5 years. Thus, antenatal prevention of hypogalactia, informing pregnant women about WHO guidelines (frequent breastfeeds, skin-to-skin contact, night feeding and expression of breast milk) can significantly prolong breastfeeding. In addition, the use of lactogenic agents can be useful. The article gives an overview of modern information on the efficacy and administration of lactogenic agents, both herbal and pharmacological in different countries. Special attention is paid to herbs: fennel, anise, nettle and cumin, which form a part of Lactaphytol® herbal tea that is widely used in Russia.