Newborn Feeding Research Articles

675 The childbirth experience survey (CBEX): an analysis of qualitative survey data

In collaboration with community research partners, a national cross-sectional online Childbirth Experience Survey of pregnant and postpartum birthing people (CBEX) was conducted in 2016. The antepartum-postpartum survey includes items across 19 domains (including patient expectations, preferences and outcomes), and identified 23 childbirth-specific postpartum patient-reported outcomes (PROs) that were predictors of hospital satisfaction. It is currently being offered in 12 California hospitals to identify hospital-specific opportunities for improvement in care. We analyzed postpartum qualitative survey responses to validate the CBEX domains and to assess for any potential new domains. This was an exploratory analysis of qualitative survey data. Using Atlas.ti, we mapped participant responses to the 19 domains and 23 key childbirth-specific PROs. A total of 547 postpartum surveys were completed between October 30, 2018 and September 7, 2020. Of the completed surveys, 175 patients responded to the question, “Is there anything else you would like to share about your birth experience?” Patients could provide multiple comments. A total of 235 comments were analyzed and mapped to the 19 domains (Table 1). Qualitative responses highlighted issues in several subdomains: 1) interventions in labor: pressure from the care team to be induced comparable to pressure about cesareans; 2) pain management: issues related to epidural effectiveness, timing, dosage and education; 3) empathy and respect: issues related to students and residents; and 4) newborn feeding: rough physical handling of patients by nurses, specifically during lactation consults. Postpartum patient comments were entirely mapped to existing CBEX domains, confirming its content validity. These nuances emphasize the importance of patient input into research development and suggest the need for further refinement of topics to be explored and developed into standardized items. The potential for expanding CBEX subdomains and developing additional standardized items will be explored with community research partners.

Islamic Beliefs About Milk Kinship and Donor Human Milk in the United States.

Milk kinship is an Islamic belief that human milk creates a kinship between the breastfeeding woman and her nonbiological nursing infant (as well as the woman's biological nursing infants) prohibiting future marriages between "milk brothers and sisters." As such, Muslim families in the Western world may be reluctant to use donor human milk from human milk banks given the anonymity and multiplicity of donors. Health care providers for the mother-newborn dyad should be aware of this belief to have respectful, informed conversations with Muslim families and appropriately advocate for healthy newborn feeding. With this article, we outline the basis of milk kinship in Islamic beliefs, explore religious and bioethical interpretations of milk kinship, and provide information for physicians and other health care workers to become more knowledgeable about this practice.

Eficacia de 2 intervenciones para la alimentación oral independiente en pretérminos

IntroductionOral feeding of pre-term newborns (PTNB) is hampered by their immaturity and intercurrent diseases, which can prolong their hospital stay. The objective of this study was to assess the effectiveness of a program that combines tactile, kinesthetic and oral stimulation (T+K+OS) compared to another intervention based on exclusively oral stimulation (OS), in the time necessary to achieve independent feeding and hospital discharge. Patients and methodsA clinical study of 2 randomized groups (OS vs. T+K+OS) was carried out on 42 PTNB with gestational age between 27-32 weeks and birth weight>900g. The stimulation programs were carried out in sessions of 15min, for 10 days. ResultsThe PTNBs in the T+K+OS group achieved independent oral feeding earlier, compared to the OS group (24.9±10.1 vs. 34.1±15.6 days, P=.02). An analysis of covariance was performed, which confirmed that the birth weight and gestational age covariates had significant effects on time to reach suction feeding (birth weight: F[1, 38]=5.79; P=.021; gestational age: F[1, 38]=14.12; P=.001) and that once its effect was controlled, the intervention continued to have a significant effect (F[1, 38]=6.07; P=.018). The T+K+OS group, compared to the OS group, achieved an earlier hospital discharge (39±15 vs. 45±18 days), although the differences were not significant (P=.21). ConclusionsCombined therapies that include T+K+OS are more effective than OS alone, in order to achieve independent oral feeding in PTNBs.

Determinants of optimum exclusive breastfeeding duration in rural India: a mixed method approach using cohort and content analysis design

BackgroundDespite established benefits, exclusive breastfeeding (EBF) rate remains poor in India. This study measured the rate of early initiation of breastfeeding and EBF up to 42 days postpartum period and the reasons associated with early interruption of it.MethodsIn this study we followed a cohort 319 mother-newborn dyads, on a scheduled day of each week for six postpartum weeks (42 postpartum days), during May 2017 – March 2019. We used standard maternal 24 h recall method to collect data on newborn feeding practices. Additionally, using content the analysis method, we analysed the data captured through open ended question on current breastfeeding practice and reasons to identify the sociocultural facilitators/barriers of exclusive breastfeeding .ResultsOf the retained 306 newborns, early initiation of breastfeeding rate was 60% (184/306), whereas, EBF rate was 47% (143/306). Mothers’ educational level did not emerge as a risk for unsuccessful breastfeeding practices, whereas, father being not the major earner of the family (Relative risk [RR] 2.4; 95% Confidence interval [CI] 1.7,3.3), mothers who did not believe that effect of breastfeeding is longstanding (RR 1.8; 95% CI 1.3, 2.1) emerged as a risk for unsuccessful EBF practices. Lack of self-conviction about EBF among mothers; significant family members’ influence; cultural beliefs; emerged as major socio-environmental barriers of early interruption of exclusive breastfeeding. Repeated counselling by the healthcare provider particularly focusing on exclusive breastfeeding, supportive family environment in terms of the elders being aware of the positive health outcomes of it, and prior positive experience emerged as the socio-environmental facilitators for successful EBF until 42 postpartum days.ConclusionsWe conclude that the socio-environmental causes need to be addressed through the present healthcare delivery system for ensuring better infant feeding outcome.

Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child.

Breastfeeding is a gold standard of feeding of newborns and infants. Tandem breastfeeding (TBF) is feeding two children of different ages at the same time. The knowledge about the composition of human milk in prolonged lactation is still scarce. Milk from tandem breastfeeding women and after weaning was examined. Milk samples were collected from 13 TBF mothers. A 24-h milk collection was done. Analyses of fat, protein, carbohydrate and energy content were performed using MIRIS. Sociodemographic characteristics of TBF mothers was done. Higher fat content, energy value and total protein concentration was found in TBFM milk during tandem breastfeeding, than in milk after weaning the older child. The carbohydrate content remained stable. The composition of breastmilk, in terms of macronutrients, changes after weaning, taking into account the nutritional requirements of the younger child. The milk of nursing mothers in tandem did not show diurnal variability in individual components. These findings suggest an adaptive role of human milk to nutrient requirements of newborn and older children. The results may support the promotion of long breastfeeding, including tandem breastfeeding.

NURSES' PERCEPTIONS ABOUT THE FEEDING OF PRETERM NEWBORNS

ABSTRACT Objective: to analyze nurses' perceptions about the feeding of preterm newborns and their motivations in using feeding methods during hospitalization in the neonatology unit. Method: descriptive study with a qualitative approach. Data collection was carried out between July 2019 and January 2020, using semi-structured interviews with 30 nurses from a neonatology unit. The analysis of interview data was carried out using lexicographical textual analysis, the descending hierarchical classification, and similarity analysis through IRaMuTeQ - R Interface software. Results: 876 text segments were analyzed in the descending hierarchical classification, retaining 86.3% of the total for the creation of five classes that resulted from content participation. The similarity analysis of the words representing the nurses' perception about oral feeding and the choice of feeding method led to three central cores, represented by the words: think, give, bottle. Conclusion: Nurses recognize the importance of continuing education and training in the assessment of oral skills. The reason for choosing the feeding method is often based on criteria such as preference, speed, and ease.

Approach to feeding problems in babies with cleft lip and/or palate

Cleft lip and/or palate is one of the most common craniofacial congenital anomalies and is most common in the orofacial region. The incidence of this congenital anomaly in newborn babies is around 15%. Although the pathogenesis of these congenital malformations is not fully known, there is evidence that both dietary and genetic fac- tors play a role, and this evidence is increasing day by day. Children with cleft lip and/or palate may be malnourished after birth due to nutritional difficulties. Children with these deformities are often impaired in growth compared to healthy children. A multidisciplinary approach is mandatory for the evaluation of these babies. Feeding newborns with cleft lip and/or palate in the beginning is a major concern for parents. Nutritional interventions such as breastfeeding, modified bottles and/or nipple, occlu- sive pads and maternal counseling and support are needed, so this article aims to review some nutritional issues and adaptations in this regard.

Correlation of facial anthropometry data of late preterm newborns and oral feeding readiness.

To correlate nine facial anthropometric measurements with the readiness for oral feeding of late preterm newborns using an orogastric tube. Observational study, carried out in two institutions in Maceió, Alagoas. Fifty-two newborns participated. A single measuring of nine facial measurements and daily measuring of the interface area for fixing the tube was performed. For readiness assessment, the Premature Oral Feeding Readiness Assessment Scale was used. An average readiness of 28.81 (± 3.18) was observed in the first evaluation and 30.65 (± 3.23) in the second. Most facial measurements are correlated with weight. There was a positive and slight correlation between glabella-subnasale distance and readiness. No correlation was observed between the area of the tube fixation interface and facial measurements. It is concluded that the glabella-subnasale measurement is positively correlated with the readiness for oral feeding in late preterm newborns who used an orogastric tube for feeding.

The effect of antenatal care on colostrum avoidance in pastoralists: The case of Afar, Northeast Ethiopia.

Breastfeeding is sufficient for infants in the first 6 months of life and is important to maintain maternal health. Evidences revealed that neonatal mortality is higher among children who received colostrum as compared to those who are deprived of colostrum. Therefore, this study aimed to assess the factors associated with colostrum avoidance practice among pastoralists in Afar Regional State, Northeast Ethiopia. A community-based cross-sectional study was conducted on 1188 mother-child pairs in Afar Regional State in June 2016. Univariable and multivariable logistic regression analyses were carried out to identify the predictors of colostrum avoidance. Statistical significance was declared at P-value <.05. About 40% of children deprived of colostrum. Mothers aged 20 to 34 years (AOR: 1.79; 95% CI: 1.18, 2.73), not attending antenatal checkup (AOR: 1.82; 95% CI: 1.64, 2.85), receiving prelacteal feeding (AOR: 2.21; CI: 1.88, 3.93) and late initiation of breastfeeding (AOR: 2.71; 95% CI: 2.02, 3.65) were positively associated with colostrum avoidance. Nearly 4 in 10 children deprived of colostrum. Therefore, promoting antenatal care and strengthening service-based counseling on proper newborn feeding practices will be important to improve colostrum feeding.

Character of feeding newborns in perinatal center. Problems of first week

The key to shaping the health of the future generation are the start timing of breastfeeding. In a single-center observational study in the Department of physiology of the newborn Perinatal Center, the nature of breastfeeding and problems in breast-feeding in mothers of healthy newborns in the first days after birth were evaluated. An analysis of the promotion and support of breastfeeding in 103 pairs (mother infant) during hospital stay in accordance with WHO recommendations was conducted. Women were polled on socio-demographic issues (age, marital status, education, method of delivery), gestational age of infants, antropometry, Apgar score and infant feeding method. 71% of newborn were exclusively breastfed. Problems with breastfeeding were found in 41.7% of women. The most often meet: hypogalactia (17.48%) and cracked nipples (8.74%). All women received advice on how to eliminate their causes. The importance of providing permanent specialized professional support in breastfeeding to overcome the difficulties of matters after discharge from the hospital has been proved.

Prevalence and factors associated with tea consumption in the first month of life in a birth cohort in the Northeast Region of Brazil

Abstract Objectives: to determine the prevalence and analyze the factors associated with newborns drinking tea in a birth cohort. Methods: A cross-sectional study with nested prospective cohort was conduct with 329 puerperal women and their newborns in Vitória da Conquista, Bahia. Sociodemographic and information about the newborn's diet and mothers/babies was obtained at a maternity and 30 days after birth, at home visits. The prevalence ratios (PR) and its respective confidence intervals (CI95%) were estimated with Poisson regression models according to the hierarchical conceptual model. Results: the prevalence of tea consumption up to 30 days of life was 34.6% (CI95%=29.7; 40.0%). The sociodemographic and maternal characteristics associated with the outcome were not having a partner (PR = 1.39; CI95%=1.03-1.88), more than eight years of schooling (PR=1.38; CI95%=1.03-1.84), lower income (PR=2.21; CI95%=1.31-3.73), primiparous (PR=1.48; CI95%=1.01-2.17) and does not have any experience with breastfeeding before (PR=2.25; CI95%=1.48-3.41). As for the child, there was a higher prevalence of tea consumption than among those who received artificial milk in the first month of life (PR= 2.10; CI95%=1.62-2.73). Conclusions: the offer of tea in the first month of life was high. Tea consumption was positively associated with sociodemographic, maternal and newborn feeding factors.

An Innovative Prenatal Lactation Intervention to Improve Human Milk and Breastfeeding Outcomes

In the United States and globally, it is well documented that human milk and breastfeeding rates at discharge from the NICU are suboptimal. This presentation describes an innovation prenatal lactation intervention to improve human milk and breastfeeding outcomes. As part of standard prenatal care, families will have the opportunity to participate in group prenatal care (centering model). In addition, all families will receive a personalized 1:1 prenatal lactation intervention tailored to their newborn’s diagnosis. The concept is that all families (regardless of their prenatal preference for newborn feeding) receive the same evidence-based human milk and breastfeeding information. The content is tailored to how human milk is a life-saving medical intervention based on their newborn’s diagnosis. Through the Center for Fetal Diagnosis and Treatment, families are scheduled for a 1:1 personalized prenatal lactation consultation as part of their routine prenatal care. There is no charge to the family for this service. The consultation last on average 60 minutes or more, dependent on the families’ learning needs. Families have the opportunity to practice with pump assembly and operation, and a personalized plan is developed based on any lactation risk factors and the newborn’s diagnosis. Implementation of an innovative prenatal lactation intervention has resulted in pumping initiation rates of 99% in our institution. In addition, our human milk rates at discharge are well over 75%. We will also share newly published, diagnosis-specific outcomes for infants with congenital diaphragmatic hernia as well as spina bifida. This model is replicable in other institutions. This can lead to improved human milk and breastfeeding outcomes during the NICU stay and beyond.

The Question of Whether to Use Supplementation in Infants

The Academy of Breastfeeding Medicine’s protocol on supplementation states that weight loss is not an automatic marker for the need for supplementation in infants but is an indicator for additional evaluation. Excessive weight loss may be an indication of inadequate milk transfer or low milk production, but before automatically ordering formula supplementation, a thorough evaluation of the feeding session should be completed. Feeding issues need to be addressed as soon as possible because formula supplementation is not always medically indicated. Conversely, if formula supplementation is needed, it should be provided. The Newborn Weight Tool (NEWT) was created to allow health care providers plot a newborn’s weight and compare it with a large sample of newborns during the first days of life. It is a visual indicator of feeding success. Use the NEWT for any infant identified as having excess weight loss before ordering formula supplementation. The NEWT was initially implemented during daily interdisciplinary patient care rounds as a decision-making tool offering evidence to guide the plan of care. The team plots the weights on the tool and proposes a feeding plan based on results. Use of the NEWT has evolved, moving from the conference room during rounds to the bedside, becoming a collaborative and informed decision-making process between parents and the care team. Between Fiscal Years 2018 and 2019, breastfeeding exclusivity rates increased from 55% to 62%. We attribute this improvement in part to use of the NEWT. After implementation of the NEWT, the number of infants medically supplemented with formula for weight loss decreased to an average of 3 per month. We continue to use the NEWT and collect data related to those infants who are medically supplemented with formula to reverse weight loss. Implementing this innovative way to evaluate breastfeeding success has led to autonomy in nursing practice and empowers nurses with evidence to drive best newborn feeding practices. It has also led to earlier interventions for feeding issues that can affect length of stay as well as readmission rates for dehydration.

Minimum Acceptable Diet and Associated Factors Among HIV-Exposed Children Aged 6-24 Months in Debre Tabor Town, Ethiopia.

IntroductionMinimum acceptable diet is a composite indicator of minimum dietary diversity and minimum meal frequency. World Health Organization’s newborn child feeding and HIV guidelines suggestbeginning complementary nourishments at six months, and breastfeeding for HIV-exposed children. HIV infected mothers may be more sensitive on feeding practices to protect their children from contracting the disease. On the other hand, HIV infection is associated with higher risk food insecurity which may affect feeding practices of children. But in Ethiopia, there is lack of evidence on extent of minimum acceptable diet of HIV-exposed children. Therefore, the objective of this study was to assess minimum acceptable diet and associated factors among HIV-exposed 6–24 months aged children.MethodsAn institution-based cross-sectional study was conducted in health institutions of Debre Tabor town. The study was conducted on 287 mother-child pairs attending antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) at public health facilities. Descriptive statistics like frequency, proportions, mean and standard deviation were computed. Multi-variable logistic regression was run to identify independent predictors of the outcome variable (minimum acceptable diet). A p-value <0.05 was used to declare statistical significance.ResultsAbout 76% (95% CI: 70.8–80.8) and 58.2% (95% CI: 53.0–68.3) children were fed with appropriate meal frequency and recommended dietary diversity, respectively. One hundred (34.8%) (95% CI: 29.3–40.4) of children were fed a minimum acceptable diet and 59.9% (95% CI: 54.0–65.9) of children consumed iron rich or fortified food. Out of the total, 203 (71.0%) (95% CI: 66.1–76.2) of the mothers had good knowledge on minimum dietary diversity and meal frequency feeding practices. In multi-variable logistic regression poor knowledge with AOR = 0.32, 95% CI: 0.17–0.58, maternal workload with AOR = 0.38, 95% CI: 0.19–0.75 and inadequate information about child feeding from health care providers with AOR = 0.46, 95% CI: 0.26–0.81 were statistically significant predictors of minimum acceptable diet.ConclusionThe study revealed that the proportion of children who received minimal acceptable diet was lower than that of WHO recommendation for good practice. Knowledge, maternal workload and information related to complementary feeding were associated with low minimum acceptable diet.

Negative Transmission of SARS-CoV-2 to Hand-Expressed Colostrum from SARS-CoV-2-Positive Mothers.

Aim: The objective of our study was to determine whether the SARS-CoV-2-positive mothers transmit the virus to their hand-expressed colostrum. Methods: This is an observational prospective study that included pregnant women who tested positive for SARS-CoV-2 by PCR test on a nasopharyngeal swab at the moment of childbirth and who wanted to breastfeed their newborns. A colostrum sample was obtained from the mothers by manual self-extraction. To collect the samples, the mothers wore surgical masks, washed their hands with an 85% alcohol-based gel, and washed their breast with gauze that was saturated with soap and water. Results: We obtained seven colostrum samples from different mothers in the first hours postdelivery. SARS-CoV-2 was not detected in any of the colostrum samples obtained in our study. Conclusion: In our study, breast milk was not a source of SARS-CoV-2 transmission. Hand expression (assuring that a mask is used and that appropriate hygienic measures are used for the hands and the breast), when direct breastfeeding is not possible, appears to be a safe way of feeding newborns of mothers with COVID-19.

Secretory immunoglobulin A from human milk hydrolyzes microRNA

For breast-fed infants, human milk is a source of various nutrients (e.g., proteins, peptides, antibodies) and bioactive components that promote neonatal growth and protect infants from viral and bacterial infection. Moreover, in terms of infant nutrition and protection the functions of many human milk components are very different from those of blood and other biological fluids of healthy adults. For example, catalytic antibodies ("abzymes") with synthetic activities (protein, oligosaccharide, and lipid kinase activities) have been found in human breast milk that are absent in the blood of healthy people. Abzymes with hydrolyzing functions have been detected not only in milk, but also in the blood of patients with autoimmune diseases. Obviously, feeding newborns human milk has a very specific role and it is a unique aspect of mammalian nutrition. Ribonuclease and DNase autoantibodies or abzymes are found in milk and blood of lactating women, but not in blood sera of healthy men and nonpregnant woman. Here, we present the first evidence that human milk secretory IgA molecules (sIgA) can effectively hydrolyze ribooligonucleotides containing 23 different bases [(pN)23 ribooligonucleotides] and 4 microRNAs: miR-9-5p, miR-219-2-3p, miR-137, and miR-219a-5p. Ribonuclease activity is an inherent property of sIgAs. We showed that 7 individual sIgAs hydrolyzed the ribooligonucleotides (pA)23, (pU)23, and (pC)23 nonspecifically and with comparable efficiency, whereas hydrolysis of the 4 microRNAs by sIgAs was site-specific. Sites of hydrolysis of 4 microRNAs by IgG from blood of patients with schizophrenia have been previously identified. The sites of hydrolysis of 4 microRNAs by sIgA-abzymes were very different from the previously identified sites of hydrolysis by IgG in patients with schizophrenia. In addition, in contrast to IgG, milk sIgAs efficiently hydrolyzed microRNAs in their loop and duplex regions.

Implementation of the Reimbursement Cost of Human-Milk-Based Neonatal Therapy in Polish Health Care Service : Practical and Ethical Background.

A human-milk-based diet is the best option for nutritional therapy for preterm and/or sick newborns. The study aims were to restructure the reimbursement rates to hospitals in Poland for infants' tube feedings to favor the use of donor human milk over formula for newborns who required supplementation of expressed mother's milk and evaluate the results of the financing change during the first year of implementation (2018). Financial data from hospitals were collected (2015-2016) by the Human Milk Bank Foundation using a data sheet designed by the Agency for Health Technology Assessment and Tariff System. We used data to restructure the reimbursement rates to hospitals for infants' tube feedings and implemented the changes in late 2017. The National Health Fund was requested to share reported data in 2018 concerning tube feeding services. More than half (61%) of NICUs introduced human milk tube feeding for newborns. It was provided to participants (N = 5,530), most frequently to seriously ill preterm infants (66.6%). Of these infants, 2,323 were fed donor human milk. Only 1,925 newborns received formula tube feeding. However, there were large differences in frequency of services reported among various parts of the country. Based on our knowledge, Poland is the only European country where the reimbursement cost for human-milk-based nutritional therapy has been implemented in a manner intended to increase the quality of health care services for preterm newborns. Equal reimbursement for expressed mother's milk and donor milk did not appear to cause overuse of donor milk based on our analysis of the 2018 data.

Improving Breastfeeding Practices: The Role of Community Breastfeeding Guardians (BFGs) in Lagos State

Abstract Objectives Research by the Alive &amp; Thrive Program (A&amp;T) in Nigeria to demonstrate that repeated exposures of pregnant women and mothers of infants to Breastfeeding Guardian (BFG) services - including counseling, home visits and problem solving – led to improvements in breastfeeding (BF) practices in intervention communities. Methods BFGs comprise community influencers such as teachers, religious leaders, and community health workers. BFGs were engaged, trained and equipped by A&amp;T to support pregnant women and lactating mothers with key messages at critical decision-making points about: ANC, breastfeeding management, early initiation of BF in the first hour of birth (6 contacts in 3rd trimester); and exclusive BF (EBF) including problem-solving (6 contacts in first six months). The intervention lasted 12 months and included counseling of pregnant women and home visit support for newly delivered mothers. Assessments of EI and EBF rates were conducted in 40 health facilities (HF) using Alive &amp; Thrive routine project data comparing rates pre and post BFG deployment. Key Informant Interviews (KII) were also conducted with pregnant women in their 3rd trimester and post-delivery with the same cohort targeting women with infants 4–8 months. Results EI rates improved from 72% to 93% while EBF rates improved from 67% to 84% across the 40 health facilities. Findings from KIIs indicated that support mothers received through the BFGs, such as home visits, were perceived to be helpful in preparing women for breastfeeding exclusively and managing challenges associated with feeding newborns. Fifty-three of 60 mothers interviewed said they were able to exclusively breastfeed for 6 months, and their infants had no cause to visit the clinic for treatment of any illnesses. Conclusions Repeated contacts by BFGs to support pregnant women and breastfeeding mothers at the community level could be effective in improving breastfeeding practices. It can also serve as a viable way of bridging the skilled health attendant gap in underserved communities. It would be interesting to observe how beneficial the BFGs innovation would be on a larger scale and longer term. Funding Sources The Bill and Melinda Gates Foundation.

Parental experiences and genetic counsellor roles in Pierre Robin sequence.

Pierre Robin sequence (PRS) is a craniofacial abnormality comprising micrognathia, glossoptosis and airway obstruction, which can impair the newborn's feeding and breathing. While there has been much research around the cause of PRS and most appropriate methods of care, understanding the psychosocial aspects of a PRS diagnosis from the parents' perspective is lacking. The aim of this study is to understand parental experiences of having a child diagnosed with PRS, as well as the role of genetic counselling in PRS. Fourteen semi-structured interviews were conducted with parents of children diagnosed with isolated PRS between 2 and 5years prior. From these 14 interviews, eleven transcripts were analysed to find common themes and experiences. The diagnosis was confusing and overwhelming for participants during emotionally sensitive periods and little was understood about the cause of their child's PRS. Those participants who did recall experiences with genetic services reported that they were minimal and uninformative. According to participant recollection, genetic counselling was rarely offered, despite there being a potential for this service in PRS. Genetic counselling would be a valuable source of information and support for parents both at the time of antenatal diagnosis, and potentially 6 to 12months later in the outpatient environment when these children are all routinely reviewed by their clinical care team.

Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study

IntroductionThe early initiation of breast feeding is a high-impact intervention that gives newborns a better chance of survival. We assess the barriers and facilitators influencing the practice of early breast...