Breast Milk Feeding Research Articles

Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China

BackgroundChina has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China.MethodsIntermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the “KMC group”, those who did not were enrolled in the “No KMC group”. Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates.ResultsAmong the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)).ConclusionsIntermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.

Breastmilk Feeding Practices Are Associated with the Co-Occurrence of Bacteria in Mothers’ Milk and the Infant Gut: the CHILD Cohort Study

Gut microbiota play a critical role in infant health. It is now accepted that breastmilk contains live bacteria from endogenous and exogenous sources, but it remains unclear whether these bacteria transfer to the infant gut and whether this process is influenced by breastmilk feeding practices. Here, we show that certain bacteria, including Streptococcus spp. and Veillonella dispar, co-occur in mothers' milk and their infants' stool, and co-occurrence is reduced when infants receive pumped breastmilk. The relative abundances of commonly shared species are positively correlated between breastmilk and stool. Overall, gut microbiota composition is strongly associated with breastfeeding exclusivity and duration but not breastmilk feeding mode (nursing versus pumping). Moreover, breastmilk bacteria contributed to overall gut microbiota variation to a similar extent as other modifiers of the infant microbiome, such as birth mode. These results provide evidence that breastmilk may transfer bacteria to the infant gut and influence microbiota development.

Estimating daily intakes of manganese due to breast milk, infant formulas, or young child nutritional beverages in the United States and France: Comparison to sufficiency and toxicity thresholds

BackgroundAlthough manganese (Mn) is an essential nutrient, recent research has revealed that excess Mn in early childhood may have adverse effects on neurodevelopment. MethodsWe estimated daily total Mn intake due to breast milk at average body weights by reviewing reported concentrations of breast milk Mn and measurements of body weight and breast milk intake at 3 weeks, 4.25 months, 7 months, and 18 months. We compared these figures to the Mn content measured in 44 infant, follow-up, and toddler formulas purchased in the United States and France. We calculated Mn content of formula products made with ultra-trace elemental analysis grade water (0 μg Mn/L) and with water containing 250 μg Mn/L, a concentration which is relatively high but less than the World Health Organization Health-based value of 400 μg Mn/L or the United States Environmental Protection Agency Health Advisory of 350 μg Mn/L. ResultsEstimated mean daily Mn intake from breast milk ranged from 1.2 μg Mn/kg/day (3 weeks) to 0.16 μg Mn/kg/day (18 months), with the highest intakes at the youngest age stage we considered, 3 weeks. Estimated daily Mn intake from formula products reconstituted with 0 μg Mn/L water ranged from 130 μg Mn/kg/day (3 weeks) to 4.8 μg Mn/kg/day (18 months) with the highest intakes at 3 weeks. Formula products provided 28–520 times greater than the mean daily intake of Mn from breast milk for the 4 age stages that we considered. Estimated daily Mn intake from formula products reconstituted with water containing 250 μg Mn/L ranged from 12 μg Mn/kg/day to 170 μg Mn/kg/day, which exceeds the United States Environmental Protection Agency Reference Dose of 140 μg Mn/kg/day for adults. ConclusionsMn deficiency is highly unlikely with exclusive breast milk or infant formula feeding, but established tolerable daily intake levels for Mn may be surpassed by some of these products when following labeled instructions.

Expressed Breast Milk Feeding: Knowledge and Attitude of Employed Mothers

Expressed Breast Milk Feeding: Knowledge and Attitude of Employed Mothers

HUBUNGAN PENGETAHUAN DAN SIKAP IBU DENGAN PEMBERIAN ASI EKLUSIF DI WILAYAH KERJA UPT PUSKESMAS MERAL KABUPATEN KARIMUN PROVINSI KEPULAUAN RIAU TAHUN 2018

Exclusive breastfeeding deals with breast milk feeding for the baby aged 1 day to 6 months old with no additional or complementary foods or drinks, except drugs, vitamins and minerals. The activity of exclusive breastfeeding done by the postpartum mothers in Riau Islands Province is quite small compared to the national realizations. Meral is noted to be the region with lowest percentage of infants’ exclusive breast feeding among other regions in Karimun in 2016 by the percentage of only 14.53%. The purpose of this study is to investigate the correlation of knowledge levels of postpartum mothers and their attitudes toward the exclusive breastfeeding for their baby particularly. This research used analytic survey method with cross sectional approach at the working area of Meral Health Center of Karimun conducted in April-June 2018.Thepopulation in this research 377 mothers and sample of 79 respondents selected by quota sampling technique with questionnaire instrument. The result of bivariate analysis using chi square with p value 0.004 (0.004<0.05) and p value 0.007 (0.007<0.05). The conclusion that there is a significant correlation between mother’s knowledge levels to do exclusive breastfeeding. Conversely, it is also confirmed that there is a significant correlation between their attitudes and exclusive breastfeeding for their baby. Therefore, it is hoped all parties to be more concerned about the importance of exclusive breastfeeding and to support the newborn mothers’ to do the exclusive breastfeeding for their baby.

Holder Pasteurization Inactivates SARS-CoV-2 in Human Breast Milk

Background: SARS-CoV-2, the etiological agent causing the COVID-19 pandemic, has quickly developed to be a major public health issue. Recently, SARS-CoV-2 RNA has been detected in human breast milk samples of infected mothers, raising concerns regarding the safety of breastfeeding upon infection. We here explored the possibility of viral inactivation in human milk samples by holder pasteurization. Methods: We spiked individual breast milk samples with five SARS-CoV-2 isolates, heated them to 63°C for 30 minutes, and determined the residual infectivity by TCID 50 titration. Findings: Infectious SARS-CoV-2 in breast milk is inactivated by holder pasteurization. Interpretation Holder pasteurization provides an alternative and safe option for infected mothers to continue feeding breast milk to their infants during active SARS-CoV-2 infection. Funding: Horizon 2020, the German Research Foundation, the Baden-Wurttemberg Stiftung. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval by the ethics commission of Hanover Medical School, Hanover, Germany and the ethics committee of Ulm University. All mothers provided written informed consent for the collection of samples and subsequent analysis.

Early fortification of enteral feedings for infants

BACKGROUND:An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet.OBJECTIVE:The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier.STUDY DESIGN:A multi-center retrospective cohort study of the outcomes of infants of 500– 1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus <60 mL/kg/day (early) of enteral feeding volume.RESULTS:Median±IQR range for gestational age (27.6±3.4 vs 27.0±2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9±2.6 vs 13.3±2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification.CONCLUSION:The study results suggested that early HM fortification appears to positively affect growth for infants whose human milk feedings are fortified with a human milk based fortifier without adverse effects. The incidence of CLD was also reduced in the early fortification group.

Missed Nursing Care During Labor and Birth and Exclusive Breast Milk Feeding During Hospitalization for Childbirth.

The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Labor and birth nurses in three states were surveyed about missed nursing care and their maternity units' adherence to the AWHONN (2010) nurse staffing guidelines for care during labor and birth, using the Perinatal Misscare Survey. Nursing responses were aggregated to the hospital level and estimated associations between missed nursing care, nurse staffing, and hospitals' exclusive breast milk feeding rates were measured using The Joint Commission's Perinatal Care Measure (PC-05). Surveys from 512 labor nurses in 36 hospitals were included in the analysis. The mean exclusive breast milk feeding rate was 53% (range 13%-76%). Skin-to-skin care, breastfeeding within 1 hour of birth, and appropriate recovery care were on average occasionally missed (2.33 to 2.46 out of 4; 1 = rarely, 2 = occasionally, 3 = frequently, or 4 = always) and were associated with PC-05 [B(CI) -17.1(-29, -6.3), -17.9(-30.5, -6.2), and -15.4(-28.7, -2.1), respectively]. Adherence with overall staffing guidelines was associated with PC-05 [12.9(3.4, 24.3)]. Missed nursing care was an independent predictor of PC-05 [-14.6(-26.4, -2.7)] in a multilevel model adjusting for staffing guideline adherence, perceived quality, mean age of respondents, and nurse burnout. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. These results support exclusive breast milk feeding (PC-05) as a nurse-sensitive quality indicator.

What Is the Burden of Care of Nasoalveolar Molding?

This systematic review aims to evaluate nasoalveolar molding (NAM) in the context of burden of care defined as physical, psychosocial, or financial burden on caregivers. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 5 databases were searched from inception through December 24, 2019, for keywords and subject headings pertaining to cleft lip and/or palate and NAM. Clinical studies on NAM with reference to physical (access to care, number of visits, distance traveled), psychosocial (caregiver perceptions, family interactions, breast milk feeding), and financial (direct and indirect costs) burden were included. Study selection was performed by 2 independent reviewers. The search identified 1107 articles and 114 articles remained for qualitative synthesis. Burden of care domains were discussed but not measured in 43% of articles and only 25% assessed burden of care through a primary outcome. Of these, 20 articles reported on physical, 8 articles on psychosocial, and 12 articles on financial burden. Quality of evidence is limited by study design and risk of bias. Nasoalveolar molding has been indiscriminately associated with burden of care in the literature. Although NAM may not be the ideal treatment option for all patients and families, the physical considerations are limited when accounting for the observed psychosocial advantages. Financial burden appears to be offset, but further research is required. Teams should directly assess the impact of this early intervention on the well-being of caregivers and advance strategies that improve access to care.

Faecal calprotectin levels during the first year of life in healthy children.

A high faecal calprotectin (FC) level is a non-invasive marker for inflammatory bowel disease. Nevertheless, healthy infants have elevated levels of FC with large variations. The aim of our study was to determine the levels of FC and associated factors in healthy infants aged 0-12 months. Infants younger than 1 year of age were in the follow-up programme of the Well Child Unit. Data on the clinical characteristics, including birth, anthropometric measurements and feeding types of infants in the unit, were obtained from their personal health records. One fresh stool sample was collected from each infant. ELISA was used to measure FC. We included 84 infants younger than 1 year of age. The median FC value was 313 μg/g. The FC levels were greater in the youngest (0-30 days) group of infants than in the oldest (181-365 days) group (P < 0.001). The FC levels were higher in infants delivered by caesarean section than in those delivered vaginally (P = 0.016). The levels were also higher in infants who were solely breastfed than in those who received mixed feeding (breast milk and formula) during the first 6 months of life (P = 0.030). The FC levels in this group of infants were high, especially in the first month of life. Several birth and environmental factors influenced the FC values. Further studies with a larger cohort of infants and serial assessment of FC over time are required to better understand the patterns of this biomarker during infancy.

1869-P: Elevated Maternal BCAAs during Gestation and Lactation Reprograms Offspring’s Glucose Regulation

Maternal nutrition impacts neonate development and can have long-lasting physiological effects. Newborns from obese and type 2 diabetes (T2D) mothers are at a higher risk of developing metabolic deficits later in life. Women with gestational diabetes (GD) or T2D often have elevated serum branched chain amino acids (BCAAs), one of the most accurate predictors of insulin resistance (IR) in adults. Since BCAAs are actively taken up by the placenta, fetuses are exposed to elevation of BCAAs in their mothers. Additionally, newborns can be exposed to high BCAA levels via breast milk or formula feeding. Interestingly, BCAAs levels are higher in breast milk from obese mothers and some infant formulas have higher BCAA content than average breast milk. However, the direct impact of BCAA overnutrition in utero and early postnatal life on newborn predisposition to obesity and T2D is poorly understood. To investigate the effects of exposure to high BCAA levels during gestation and postnatally, we fed female mice during pregnancy and lactation two different isocaloric diets with equal total protein content, but one of the diets enriched in BCAAs. Their offsprings was weaned onto normal or high fat (HFD) diets and evaluated for changes in body composition and systemic metabolic regulation over a six-month period. We found that maternal BCAA supplementation triggered hyperglycemia and impaired insulin secretion in newborns. Progeny from mothers fed the high BCAA diet exhibited elevated fasting glucose levels, reduced insulin secretion, and striking reductions in glucose tolerance and insulin sensitivity, which were exacerbated by HFD supplementation. These findings suggest that early exposure to BCAA overnutrition has a strong dysregulating effect on systemic glucose metabolism. We will provide insights into the molecular underpinnings at play. Disclosure J. Tzeng: None. A. Aguillard: None. D. Lorenzo: None. Funding American Diabetes Association (1-19-JDF-081 to D.L.); National Institute of Diabetes and Digestive and Kidney Diseases (DK072476-15225-UNC01)

Neonatal diet alters fecal microbiota and metabolome profiles at different ages in infants fed breast milk or formula

Neonatal diet has a large influence on child health and might modulate changes in fecal microbiota and metabolites. The aim is to investigate fecal microbiota and metabolites at different ages in infants who were breastfed (BF), received dairy-based milk formula (MF), or received soy-based formula (SF). Fecal samples were collected at 3 (n=16, 12, and 14, respectively), 6 (n=20, 19, and 15, respectively), 9 (n=12, 11, and 12, respectively), and 12 mo (n=14, 14, and 15, respectively) for BF, MF, and SF infants. Infants that breastfed until 9 mo and switched to formula were considered as no longer breastfeeding at 12 mo. Microbiota data were obtained using 16S ribosomal RNA sequencing. Untargeted metabolomics was conducted using a Q-Exactive Hybrid Quadrupole-Orbitrap mass spectrometer. The data were analyzed using R (version 3.6.0) within the RStudio (version 1.1.463) platform. At 3, 6, and 9 mo of age BF infants had the lowest α-diversity, SF infants had the highest diversity, and MF was intermediate. Bifidobacterium was 2.6- to 5-fold lower in SF relative to BF infants through 1 y of life. An unidentified genus from Ruminococcaceae higher in the SF (2%) than in the MF (0.4%) and BF (0.08%) infants at 3 mo of age was observed. In BF infants higher levels of butyric acid, d-sphingosine, kynurenic acid, indole-3-lactic acid, indole-3-acetic acid, and betaine were observed than in MF and SF infants. At 3 mo Ruminococcaceae was positively correlated to azelaic, gentisic, isocitric, sebacic, and syringic acids. At 6 mo Oscillospira was negatively correlated with 3-hydroxybutyric-acid, hydroxy-hydrocinnamic acid, and betaine whereas Bifidobacterium was negatively associated with 5-hydroxytryptamine. At 12 mo of age, Lachnospiraceae was negatively associated with hydroxyphenyllactic acid. Infant diet has a large impact on the fecal microbiome and metabolome in the first year of life.This study was registered at clinicaltrials.gov as NCT00616395.

Growth Changes in Pre-Term and Full-Term Infants over the First 6-months of Life from the PediaTrac™ Project

Abstract Objectives Changes in body weight, length and head circumference have long been indicators of infant growth and development. PediaTrac™ is a web-based measure designed to engage caregivers in the gathering of longitudinal, real-time, multi-domain data on infant/toddler growth and development at time periods corresponding to well-child visits. The purpose of this study was to assess the changes in growth (weight, length, head circumference) between the newborn and 6 m time periods for both term and pre-term (&amp;lt;37 weeks gestational age) infants as influenced by type of feeding (breast milk versus formula). Methods PediaTrac™ was used to gather data from caregivers and their infants across multiple sites (Michigan and Ohio).To date, 370 caregivers of both pre-term and term infants have completed PediaTrac™ regarding their infants’ growth and development. They reported their infant's body weight, length and head circumference, as well as the type of liquid nutrition their infants received at birth and 6 m. Caregiver responses were managed using REDCap, a secure platform for building and managing online databases and surveys. Data were analyzed using both R and SPSS. Results PediaTrac™ was used to gather data from caregivers and their infants across multiple sites (Michigan and Ohio). To date, 370 caregivers of both pre-term and term infants have completed PediaTrac™ regarding their infants’ growth and development. They reported their infant's body weight, length and head circumference, as well as the type of liquid nutrition their infants received at birth and 6 m. Caregiver responses were managed using REDCap, a secure platform for building and managing online databases and surveys. Data were analyzed using both R and SPSS. Conclusions By 6 m of age, fewer caregivers were feeding their infants breast milk. However, there were no significant differences in weight between infants fed breast milk and those fed formula. Funding Sources Eunice Kennedy Shriver National Institute of Child Health &amp; Human Development of the National Institutes of Health. Eastern Michigan University College of Health and Human Services Research Support Award.

A Study of Breastfeeding Practices, SARS-CoV-2 and Its Antibodies in the Breast Milk of Mothers Confirmed with COVID-19

Background: There have been no confirmed cases of vertical transmission of the 2019 novel coronavirus disease (COVID-19) from mother to child through breastfeeding, but the possibility of COVID-19 transmission to neonates through breast milk has been postulated. Studies on the presence of the ribonucleic acid (RNA) of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in breast milk have shown inconsistent results, and the risk of transmission through breast milk remains unverified. Furthermore, the presence of SARS-CoV-2 antibodies in breast milk, as well as the impacts of prolonged mother-child separation and the cessation of breastfeeding practices due to quarantine control measures have not been reported. Methods: This paper presents the interim results of a multi-center longitudinal study being carried out in Wuhan City of Hubei Province in China. The study began on 10 February 2020, with the aim to describe the short- and medium-term health and developmental outcomes of neonates born to mothers with confirmed/suspected COVID-19. As of 1 April 2020, 24 pairs of pregnant women confirmed with COVID-19 and their neonates (including one pair of twins), 19 pairs of pregnant women suspected with COVID-19 but found to be Polymerase chain reaction (PCR) negative and their neonates, and 21 pairs of pregnant women who were not confirmed with or suspected of COVID-19 and their neonates (control group admitted to hospital due to non-COVID-19 related pregnancy/neonatal complications, including one pair of twins) have been recruited for the study. Telephone follow-up was conducted until 30 April 2020 to collect information on breastfeeding practices, and the length of mother-child separation. Fortyfour breast milk samples were collected from 16 of the 24 mothers with confirmed COVID-19 and tested for the SARS-CoV-2 nucleic acid and antibodies (IgM and IgG). Findings: Among the 24 mothers confirmed with COVID-19, 12 cases presented with symptoms predelivery and 12 cases presented with symptoms during the delivery or post-delivery. The average number of days from the onset of symptoms until recovery with negative PCR testing was 16·4 ± 15·6 days (range 3–62 days). The average mother-child separation time was 36·7 ± 21·1 days, significantly longer than that of the suspected/PCR negative group (16·6 ± 13·1 days) and control group (10·5 ± 8·2 days). Both the COVID-19 confirmed (58·3%) and suspected (52·6%) groups presented significantly lower rates of breastfeeding as compared with the control group (95·2%). Ten out of 14 confirmed mothers who fed their babies with expressed breast milk began expressing breast milk after delivery, but did not initiate feeding breast milk to their baby until between 22–29 days after delivery, primarily due to strict isolation and quarantine measures. Forty-four breast milk samples were collected from 16 of the 24 confirmed mothers. All breast milk samples tested negative for the SARS-CoV-2 nucleic acid. Samples were collected from mothers between 3–79 days from the onset of COVID-19 symptoms. Thirty-eight breast milk samples underwent antibody testing and all tested negative for IgG. Twenty-one breast milk samples from 8 women tested positive for IgM, while the remaining 17 samples from 11 women tested negative. The IgM positive samples were collected on average 30·8 ± 19·4 days from the onset of COVID-19 symptoms, while IgM negative samples were collected on average 43·4 ± 21·3 days after the onset of symptoms. Interpretation: There was no evidence of SARS-CoV-2 in any collected samples of the breast milk. While the IgM antibody was detected in the breast milk of some mothers with confirmed COVID-19, IgG was not detected in the breast milk of any mothers. A longer follow-up period is likely needed to detect IgG antibody. Breastfeeding practices were severely impacted during the COVID-19 epidemic, as the Chinese national guidelines called for suspension of breastfeeding among both confirmed and suspected/PCR negative mothers. Our study also found late initiation of breastfeeding or feeding expressed breast milk to infants even among mothers who were not confirmed with or suspected of COVID-19. Considering the lack of evidence for transmission of SARS-CoV-2 through breast milk, health care workers should provide adequate breastfeeding counseling and support along with appropriate hygiene precautions to all pregnant women and their families. Funding Statement: The study was funded by the Hong Kong Committee for UNICEF. Declaration of Interests: The authors of this paper have no conflict of interest. Ethics Approval Statement: All procedures performed in the study involving the collection of human samples were in accordance with the ethical standards approved by the Ethical Committee of Hubei Provincial Maternal and Child Health Hospital (NO. 2020–IEC–XM010). All participants gave their written permission for both their own and their children’s involvement in the study.

Early versus late fortification of breast milk in preterm infants: a systematic review and meta-analysis.

This systematic review and meta-analysis assessed the effects of early fortification (EF) versus late fortification (LF) of breast milk (BM) on growth of preterm infants. Randomized and quasi-randomized controlled trials (RCTs) dealing with the effects of EF versus LF on growth parameters, incidence of adverse events, and duration of hospital stay in preterm infants were included. Data were pooled using the RevMan 5.3 software. Quality of evidence for predefined outcomes was analyzed by GRADE. Available evidence (3 RCTs, 309 preterm infants) showed no statistically significant difference between EF and LF of BM for any of the growth parameters-weight (standardized mean difference (SMD) 0.13; 95% confidence interval (CI) - 0.09, 0.36); length (SMD 0.02; 95% CI - 0.20, 0.25); and head circumference (SMD - 0.10; 95% CI - 0.33, 0.12). Total parenteral nutrition days were similar. Duration of hospital stay was significantly higher with EF (MD 4.29; 95% CI 0.84, 7.75) with a trend of non-significant increase in feed intolerance and necrotizing enterocolitis (NEC).Conclusion: Very low quality evidence did not find any significant difference in growth parameters of preterm infants in association with EF or LF of BM. A significant increase in hospital stay and non-significant increase in feed intolerance and NEC were associated with EF.PROSPERO registration number: CRD42019139235What is Known:• Fortification of breast milk with essential macro- and micronutrients is necessary for optimization of nutrition in preterm infants.• There is no consensus regarding the breast milk feeding volume at which fortification should be initiated.What is New:• Very low quality evidence showed no significant difference between early and late fortification of breast milk on growth parameters of preterm infants.• Early fortification was associated with non-significant increase in feed intolerance and necrotizing enterocolitis and a significant increase in hospital stay.

Donor human milk programs in German, Austrian and Swiss neonatal units - findings from an international survey

BackgroundDonor human milk (DHM) has been recommended for premature infants if mothers’ own milk is not available. The aim of this study was to increase the knowledge about the utilization rate and handling of DHM among neonatal units in Germany, Austria und Switzerland.MethodsOnline survey of utilization rates and handling practices of DHM of all neonatal units within Germany, Austria and Switzerland providing care for premature infants less than 32 weeks of gestation.ResultsDHM utilization rate of 35% is low (50/142) within those 54% of units that responded to our survey (142/261). Only 26/50 units have DHM routinely integrated into their nutritional management protocols. Lacking access and difficult procurement were cited as the main obstacles for not using DHM. However, eight out of ten respondents currently not using DHM would like to introduce DHM in their unit if available. There were differences in most aspects of DHM handling including donor recruitment and screening, testing and treatment of milk microbiota and commencement of DHM utilization. Breastmilk feeding rates were increased in units utilizing DHM compared to those not utilizing DHM.ConclusionsDHM is underutilized in most neonatal units caring for premature infants within participating countries. Lacking access to DHM represents the main barrier for utilizing DHM for premature infants.

Does breastfeeding self-efficacy theory apply to mothers of moderate and late preterm infants? A qualitative exploration.

Breastmilk feeding reduces morbidities and improves outcomes related to prematurity. However, breastmilk feeding rates in preterm infants are substantially lower than those in term infants. Breastfeeding self-efficacy theory is a social change theory, which is predictive of exclusive breastmilk feeding at 2months postpartum in mothers of full-term infants. However, this theory has not been well explored in mothers of moderate and late preterm infants. To explore maternal experiences with feeding moderate (320/7 - 336/7 weeks' gestational age) and late preterm infants (340/7 - 366/7 weeks' GA) in neonatal intensive care units and assess applicability of breastfeeding self-efficacy theory. We conducted a qualitative descriptive exploration of maternal experiences with infant feeding in neonatal intensive care units. Using purposive, maximum variation sampling, we selected mothers of preterm infants born at 320/7 - 346/7 weeks, who experienced high mean differences in their BSE scores between admission and discharge. Fourteen mothers participated in semi-structured telephone interviews. Data were examined using thematic analysis. To explore and describe breastfeeding self-efficacy within the context of neonatal intensive care units, we super-imposed the four sources of information from breastfeeding self-efficacy theory onto the defined themes. Three main themes emerged: (a) institutional influences, (b) relationship with the pump and (c) establishing breastfeeding, with an emphasis on the importance of direct breastfeeding at discharge. Overlaying the four sources of information from breastfeeding self-efficacy highlighted the presence of three sources of information: verbal persuasion, performance accomplishment and physiologic/affective responses. Vicarious experience was not identified in maternal experiences with infant feeding. Our findings indicate that breastfeeding self-efficacy is an applicable theory for mothers of preterm infants. Healthcare providers need to be aware of the influence that institutional culture and policies may have on maternal breastfeeding self-efficacy and breastfeeding outcomes.

Breast feeding practice among the rural women in selected villages of Dumuria upazilla, Khulna

The study attempted to describe the pattern of breast feeding practice among the rural women of Bangladesh with last child below 5 years of age living in the villages of Dumuria Upazilla. Due to small size of study group limited analysis were possible yet important variables such as the level of maternal education, age of starting complementary food, food used during weaning period, maternal knowledge of importance of colostrum and feeding of colostrum to the infant were considered. One of the important variables of the study was the level of the education of the respondents. As per the study, the majority (41.06%) of the respondents passed secondary level. Maximum 90.0% mothers gave breast milk, 4.4% gave honey, 4.4% gave others and minimum 1.2% gave mixed food just after delivery. Majority 46% started breast feeding after 4 hours, 44.8% had within 1 hour, 6.8% after 1st hours, 2.4% after 3 hours of delivery. Maximum 89.2% of the respondent fed exclusive breast feeding up to 1-2 months, 9.6% fed up to 3-4 months, and 1.2% fed up to 5-6 months. Maximum 48.4% fed breast milk for 3-4 months. Maximum 88.8% started complementary food within 6 months, 11.2% after 6 months.&#x0D; Mediscope Vol. 7, No. 1: Jan 2020, Page 25-30

Developmental assessments during the first 5 years of life in infants fed breast milk, cow's milk formula, or soy formula.

ObjectiveTo investigate the effects of infant feeding mode on childhood cognition and language as the differential effects of infant feeding on development remain understudied.MethodsBreastfed [BF, 174], cow's milk‐based formula‐fed [MF, 169], or soy protein‐based formula‐fed [SF, 161] children were longitudinally tested from age 3 to 60 months for neurodevelopment. Data were analyzed using mixed models while adjusting for multiple covariates. Sex differences were also assessed.ResultsStandard scores were within established norms for all groups. There were no differences in mental development to age 24 months, yet BF children had significantly higher motor development scores at age 3 months than SF children (99.1 versus. 97.2). BF children had significantly higher composite intelligence scores at 48 months than MF and SF children (113.4 versus. 109.6 and 108.4, respectively) and higher verbal intelligence scores than SF children at 48 (105.6 versus. 100.7) and 60 months (109.8 versus. 105.9). Greater total language scores at ages 36 and 48 months were found in BF children compared with children fed MF or SF (p < .001), with differences between sexes for auditory comprehension. Higher total language scores at age 60 months were found between BF and SF (105.0 versus. 100.1).ConclusionBreastfeeding was associated with small, statistically significant, differences between children ages 3 and 5 years in verbal intelligence, expressive communication, and auditory comprehension with the latter having potential sexual dimorphic effects. Yet, these differences remain small and may not be of clinical relevance. Overall, MF and SF did not significantly differ.

Proportionate Postnatal Growth in Preterm Neonates on Expressed Breast Milk Feeding With Selected Fortification.

Preterm neonates not fed an exclusive human-milk diet in the neonatal intensive care unit (NICU) show disproportionate postnatal growth. There are scant data on postnatal growth in neonates from India fed an exclusive expressed breast milk (EBM) diet. This study describes the postnatal changes in weight, length, and head circumference in preterm neonates given EBM with selected fortification. The study had a prospective observational design. Exclusive EBM feeding, early initiation, and standardized progression of feeds was followed. Fortification of breast milk with human milk fortifier (HMF) or liquid calcium phosphate and multivitamins (CALVIT) or hindmilk (HM) was done based on the gestational age. Monitoring for weight, length, and head circumference was done from admission to discharge. Ninety-three preterm neonates were included in the study, of which 34 (36.6%) were small for gestational age. Thirty-two (34.3%) neonates received EBM with HMF, 35 (35.7%) received EBM fortified with CALVIT and 26 (28%) neonates received HM fortification. There was a significant difference in the change in z-scores from birth to discharge for the weight, length, and head circumference (P= .001). The mean increase in daily weight ranged from 8.8 to 9.5 g/d, whereas weekly change in length was 0.8-0.9 cm/wk, and head circumference was 0.7 cm/wk. Postnatal growth of preterm neonates during NICU admission on exclusive EBM feeding with selected fortification resulted in a proportionate increase in weight, length, and head circumference.