Infant Feeding Research Articles

Tadābīr-i-Navmawlūd (Child Health Care): A Holistic Framework in Unani System of Medicine for Child Well-Being

Infancy, the critical phase from birth to early childhood, holds immense importance, with each day contributing significantly to a child's development. Globally, approximately four million neonatal deaths occur annually, with 98% of these taking place in developing countries. In these regions, many newborns succumb to mortality at home, often under the care of mothers, family members, and traditional birth attendants. In Unani Medicine, this stage is associated with the temperament known as Mizāj Ḥārr Raṭb (hot and moist), highlighting a period of rapid growth and developmental milestones. Comprehensive neonatal and child care guidelines, referred to as Tadābīr-i-Navmawlūd, encompass various aspects, including newborn care, infant feeding, management of dentition, and therapeutic principles and treatments for children.Renowned Unani scholars such as Ibn Sīnā, Zakariyya Rāzī, Ali Ibn Abbas Majūsī, Ibn Rushd, and Ibn Hubal Baghdādī have extensively discussed these topics in classical Unani texts like Al-Qānūn fi’l Ṭibb, Kitāb al-Manṣūrī, Kāmil al-Ṣanāʻa, Kitāb al-Kulliyat, and Kitāb al-Mukhtārāt fi’l Ṭibb. Their writings outline regimens and medicinal practices aimed at promoting the health and well-being of newborns, infants, and children. Keywords: Unani medicine, Tadābīr-i-Navmawlūd, child health care, infancy, Amrāḍ-i-Aṭfāl.

Passenger parenting, role conflict and guilt: the transition to parenthood from new and experienced fathers

ABSTRACT The transition to parenthood brings simultaneous joy and challenge for fathers. Past research focused on experiences of fathers up to one-year post-birth of the first child, however the latter years of this transition and the reflective evaluation beyond this timeframe remain largely unexplored. Fifteen semi-structured interviews were conducted to examine experiences of fathers in Australia with children in the early childhood stage (aged 0-8). Experiences of fathers currently within the initial transition to parenthood reflected past research. Reflections of fathers who were looking back at transition to parenthood showed novel insights that appear to be unavailable to fathers parenting ‘in-the-moment’. Diminished mental health was experienced by fathers and their partners during transition to parenthood. Guilt and feelings of being ill-equipped for parenthood were common. Difficulty adopting authentic parenting and work roles was accompanied with conflict in partner relationships. Fathers proposed socializing and exercising as valued coping strategies. The concept ‘passenger parenting’ was coined to make sense of fathers’ lack of agency and voice. Fathers require support in carving out authentic parenting roles fostering active participation in decisions such as infant feeding, breadwinning across early years parenting, and understanding the longer-term changes in relationship dynamics in preparation for transition to parenthood and beyond.

Transition to competent oral feeding in preterm infants: Analyzing timing and determinants.

The achievement of oral feeding competence (OFC) is a challenge in preterm infants and can be affected by several factors. The aim of our study was to determine the time elapsed to development of OFC in very low birth weight (VLBW, weight <1500g) preterm infants and to identify factors associated with greater difficulty in achieving this skill. Observational, longitudinal and prospective study in VLBW infants over a period of 7 years (2016-2022). We collected data on perinatal variables, feeding practices and complications associated with prematurity. We analyzed the number of days needed to achieve OFC and which variables predicted greater delay in achieving OFC. We included 145 VLBW infants with a median gestational age (GA) of 29 weeks with a weight of 1247g. Oral feeding was initiated at 33.6 weeks (SD, 1.2) and full oral feeding was achieved at 35.9 weeks (SD, 1.9). The median time to achievement of OFC was 15 days (8-22.5). The variables associated with longer delay of OFC were severe combined morbidity (24 vs 14 days; P<.001) and moderate/severe bronchopulmonary dysplasia (23 vs 14 days; P<.001). In infants without severe combined morbidity, we found no differences in the days elapsed to achievement of OFC between those born before or after 28 weeks of GA (P=.131). Our findings highlight the importance of structuring the transition to oral feeding and identifying the most at-risk group, which in our study were infants with severe morbidity associated with prematurity, for the purpose of targeting potential interventions.

Daily iron supplementation does not impact on prevalence of exclusive breastfeeding or growth in young breastfed Gambian infants

BackgroundIn a randomised placebo-controlled trial among exclusively breastfed rural Gambian infants aged 6–10 weeks at randomisation, daily iron supplementation for 14 weeks improved iron status. This secondary analysis explores the...

Assessing neonatal nurses: transitioning preterm infants to oral feeding - a multicenter cross-sectional study

BackgroundIn Egypt, approximately 10% of preterm deliveries occur between 32 and fewer than 37 weeks, leading to high neonatal intensive care unit (NICU) admissions. Preterm infants often face oral feeding difficulties due to immature development, which can lead to extended hospital stays and increased health risks.AimTo assess neonatal nurses’ performance in terms of the transition to oral feeding in preterm infants, focusing on knowledge, practices, and attitudes.MethodsA descriptive, quantitative, multicenter, cross-sectional study was conducted across 16 hospitals in five governorates in Egypt from November 2023 to March 2024 involving 553 neonatal nurses. The data were collected through a self-administered questionnaire assessing knowledge and attitudes and through an observed checklist for nurses’ practices. The study used statistical methods, including binary logistic regression, to analyze the data.ResultsThe findings revealed significant knowledge gaps among nurses, particularly in terms of oro-motor function, suck-swallow-breathe patterns, and nonnutritive sucking. A total of 64.6% of the nurses had unsatisfactory knowledge, 58.6% had unsatisfactory practices, and 45% had a negative attitude toward the oral feeding transition. Key predictors of satisfactory practices included higher education levels, full-time employment, and positive attitudes.ConclusionThis study highlights critical gaps in neonatal nurses’ knowledge and practices regarding the transition to oral feeding in preterm infants. Addressing these gaps through targeted educational interventions and ongoing support is essential for improving care quality and outcomes for infants. The findings revealed that a substantial proportion of nurses lacked adequate knowledge of critical areas, such as oro-motor function, the suck-swallow-breathe pattern, and nonnutritive sucking. These knowledge deficits could hinder the ability of nurses to provide optimal care during this crucial transition.

Preoperative Oral Feeding in Infants with Congenital Heart Disease Within the First Month of Life is Associated with a Higher Likelihood of Freedom From Tube Feeding at Time of Postoperative Discharge.

Though several studies have demonstrated that preoperative oral feeding (PO) can be safe in patients with congenital heart disease, they are commonly prohibited from doing so, potentially precluding the development of such skills. We sought to determine whether preoperative oral feeding is associated with freedom from tube feeding at postoperative discharge. Single-center, observational study including patients in the first month of life (≤ 30days of age) who underwent a single cardiac surgery between 7/1/2017-6/30/2022 and survived to discharge. Preoperative PO was defined as any oral intake up to the day of cardiac surgery. General demographics and peri-operative characteristics were analyzed. A total of 235 patients were included of which 178 (78%) PO fed preoperatively, and 171 (73%) were discharged taking full PO. Those discharged without tube feeds received more preoperative oral feeds, were less likely to have a chromosomal abnormality/genetic syndrome, had lower STAT categories, and were less likely to have postoperative complications, vocal cord dysfunction or prolonged mechanical ventilation. Multivariate analysis found that any preoperative PO [odds ratio (OR) of 2.78 (CI 1.48, 5.24, p-value = 0.002)] and increasing amounts of PO were predictive of full PO intake at discharge [≤ 20ml/kg/day (OR 2.06, CI 1.03, 4.14, p-value = 0.042) and > 20ml/kg/day (OR 4.07, CI 1.88, 8.84, p-value = 0.004)]. Preoperative oral feeding is a strong predictor of discharging with full PO intake after cardiac surgery in the first month of life and that it may also improve with increasing volumes. Multi-institutional analyses are warranted.

“There’s a Little Bit of Tension There:” Perspectives of Mothers and Early Childhood Educators on Breastfeeding in Child Care Centers

ABSTRACT Objective: To explore mothers’ and early childhood (EC) educators’ experiences of breastfeeding/breast milk provision and breastfeeding support in child care centers (CCCs) in the United States (U.S.). Design: We conducted one-time, semi-structured phone interviews with mothers and EC educators to examine perceptions of support, accommodations, and barriers to breastfeeding in CCCs. We administered a background survey to assess participant characteristics and quantify perceived degree of breastfeeding support in the workplace (mothers) and CCCs (mothers and EC educators). Setting: U.S.-based CCCs Participants: 50 working mothers using CCCs for their infants and 22 EC educators Results: Interview themes and background surveys reflected neutral feelings toward breastfeeding support received (mothers) and provided (EC educators) in CCCs. Maternal expectations for breastfeeding support in CCCs were generally low; workplace and social support for breastfeeding were perceived as the most important factors impacting breastfeeding. EC educators’ capacity to offer breastfeeding support was constrained by CCC infant feeding regulations, inadequate breastfeeding training, and time limitations. Tensions arose when mothers attempted to manage low milk supply at the CCC level by requesting EC educators to individualize feeding or milk storage practices for their infant. Conclusions: Breastfeeding efforts of working mothers are undermined in multiple settings, including the workplace and CCCs. Improving breastfeeding outcomes for this population requires structural/policy changes that: 1) maximize opportunities for continued, direct breastfeeding and maternal/infant proximity and 2) enforce evidence-based CCC feeding protocols and standards and EC educator lactation training.

Infant feeding for women with an eating disorder: An interpretative phenomenological analysis.

Mothers with eating disorders can face additional challenges with infant feeding, and there is evidence they are likely to cease breastfeeding earlier than intended. However, there is little research exploring this. The present study used interpretative phenomenological analysis to explore the lived experience of infant feeding for mothers suffering from or recovering from an eating disorder. Semistructured interviews were conducted with six women-five who had breastfed and one who formula-fed. The women experienced two incompatible worlds-motherhood and an eating disorder. Tensions were sometimes resolved by reducing eating disordered behaviour alongside immersion in motherhood. Two participants did not find infant feeding particularly important for their journey into motherhood. Four recounted a positive shift in their relationship to their body through breastfeeding and felt their embodied experience of mothering provided a route out of eating disordered behaviour. However, doubts about their mothering and infant feeding capabilities could be amplified by feeling mistrusted by others and by the relative silence around eating disorders within maternity care services. Respectful dialogue with health care professionals was particularly valued where this occurred. Although long-term outcomes for the participants are unknown, the study suggests women with a history of eating disorders can form successful breastfeeding relationships and may be motivated to engage in collaborative risk assessment. However, they need support in managing emotional challenges. Training around eating disorders for maternity care professionals is likely to be useful for enhancing confidence in engaging mothers proactively to share concerns about eating, weight and body shape.

Investigating infant feeding development in wild chimpanzees using stable isotopes of naturally shed hair.

Measuring the relative contributions of milk and non-milk foods in the diets of primate infants is difficult from observations. Stable carbon (δ13C) and nitrogen (δ15N) isotopes in hair can be used to physiologically track infant feeding through development, but few wild studies have done so, likely due to the difficulty in collecting hair non-invasively. We assessed infant feeding at different ages in wild chimpanzees (Pan troglodytes) at Ngogo, Uganda using δ13C and δ15N of keratin in 164 naturally shed hairs from 29 infants (61 hairs), 6 juveniles (7 hairs), 28 mothers (67 hairs) and 14 adult males (29 hairs). Hairs were collected when they stuck to feces during defecation or from the ground after chimpanzees groomed or rested. We could not distinguish between the hairs of infants and mothers using strand length and diameter. Infants 1-2 years old were most enriched in 13C and 15N and showed means of 1.1‰ in δ13C and 2.1‰ in δ15N above their mothers. Infants at 2 years had hair δ13C values like those of their mothers, which suggests infants began relying more heavily on plants around this age. While mother-infant δ13C and δ15N differences generally decreased with offspring age, as is expected when infants rely increasingly more on independent foraging through development, milk seemed to remain an important dietary component for infants older than 2.5 years, as evidenced by continuing elevated δ15N. We showed that stable carbon and nitrogen isotopes in naturally shed hairs can feasibly detect trophic level differences between chimpanzee infants and mothers. Since it can mitigate some of the limitations associated with behavioral and fecal stable isotope data, the use of hair stable isotopes is a useful, non-invasive tool for assessing infant feeding development in wild primates.

“She deserves the best. So how can I feed her the best?” Complementary food introduction practices among young mothers with a history of child maltreatment

PurposeTo explore the practices, experiences, and needs of young mothers with a history of maltreatment who are introducing their children to complementary foods. Design and methodsIn-depth interviews (n = 9) were conducted with young mothers (19–23 yrs) who had childhood histories of abuse and neglect (maltreatment). Interviews were transcribed verbatim and analyzed using a five-step thematic analysis approach. ResultsThematic analysis resulted in three themes: (1) Practices and sources of information, (2) Providing the best, and (3) Feeding challenges. Participants' primary sources of nutrition information were family or foster parents and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) educators. Participants expressed wanting to give their children healthy food and to change the cycle by not repeating some of their own childhood food experiences. Finally, participants sometimes struggled with food affordability. ConclusionsThe study highlights the need for additional support for young maltreated mothers, including access to healthy foods and education about infant feeding. Practice implicationsYoung maltreated mothers are in need of trauma-informed and strengths-based complementary feeding information and support with basic needs. Universal trauma-informed care has the potential to prevent re-traumatization and improve patient care and nutrition education.

Exploring the relationship between child temperament, maternal psychiatric symptoms, family environment and infant feeding.

Infant temperament is assumed to be primarily innate. However, newer research suggests that maternal affection impacts ratings of temperament and environmental factors, including feeding method, can also influence infant temperament. This study investigates child temperament and its relationships with maternal psychiatric symptoms, environmental variables and feeding method longitudinally in a cohort of children followed from 6 to 72 months. Differences in temperament by feeding group are also investigated. We hypothesized that maternal psychiatric symptoms, environmental stressors, and impaired family dynamics would have negative impact on child temperament, whereas breastfeeding would have a positive impact on child temperament. Mothers' ratings of child's temperament, own psychiatric symptomatology, environmental stresses and family cohesion were obtained in 504 mother-infant dyads via rating scales completed by mothers. Infants were breastfeed (BF), fed soy-based infant formula (SF) or dairy-based infant formula (MF). Linear mixed effect models investigated the relationship of variables on child's temperament while controlling for significant covariates and repeated measurements. Mothers in this study did not endorse clinical-level psychiatric symptomatology; however, when adjusted for significant covariates, higher psychiatric symptomatology significantly correlated with environmental stressors, impaired family dynamics and elevations in temperament ratings of infants' adaptability and mood. There were no lasting differences for temperament between feeding groups. However, some significant transient increases in rhythmicity and adaptability were found between SF and BF children. Positive relationships between family environment stressors and maternal psychiatric ratings were found. Transient differences were found in child temperament based upon feeding method.

Geographical equity in Ethiopian infant feeding practices: a secondary analysis of a birth cohort study

ObjectivesTo assess the geographical equity in Ethiopian infants’ exclusive breastfeeding at 5 months and dietary diversity at 12 months and whether social factors explained the spatial inequities.DesignSecondary analysis of a...

Exclusive breastfeeding practices and factors affecting them in urban areas of Uttar Pradesh

ABSTRACT Background: Exclusive breastfeeding for the first 6 months is the recommended infant feeding practice, with established benefits. In India, exclusive breastfeeding rates have seen some improvement, but Uttar Pradesh has experienced a decline. Various factors influence breastfeeding practices, such as socio-cultural beliefs, maternal knowledge, and support. Considering urbanization, industrialization, and a significant migrant population, it is crucial to understand the determinants of breastfeeding practices in urban Uttar Pradesh. This study aimed to fill these knowledge gaps by examining factors influencing breastfeeding practices in the region. Methods: This cross-sectional study was conducted at Sharda Hospital’s Pediatrics Outpatient Department (OPD) in Uttar Pradesh over 1.5 years from January 1, 2019 to June 30, 2020. The minimum sample size of 96 was determined for the study. Study participants included 200 mothers with children aged 6 months to 2 years attending the Pediatrics OPD. Data were collected through a 42-item questionnaire administered by trained interviewers who ensured privacy and comfort. Data analysis was performed using Statistical Package for Social Sciences, including descriptive statistics and the Chi-square test for categorical variables (P &lt; 0.05). Results: The study involved 200 mothers with children aged 6 months to 2 years attending a Pediatrics OPD in Uttar Pradesh. Mothers aged 21–30 years (78%) were predominant. Among the children, 62.5% were male. Colostrum was given by 86% of mothers, and 40% introduced pre-lacteal feeds. Exclusive breastfeeding was practiced by 60% of mothers. The analysis did not show statistically significant differences based on socio-economic status, maternal education, or occupation (P &gt; 0.05). Conclusion: In conclusion, the findings from this study provide a comprehensive understanding of feeding practices among mothers in urban areas of Uttar Pradesh. While many mothers adhere to recommended practices, there is room for improvement in reducing pre-lacteal feeding and promoting exclusive breastfeeding.

The effect of web-based breastfeeding education given to primiparous pregnant women: a randomised controlled study.

This was a randomised controlled study to investigate the effect of web-based breastfeeding education given to primiparous pregnant women on postpartum breastfeeding. The study included a total of 120 primiparous pregnant women, including control group (n:60) and experimental group (n:60). The study was conducted in a district in northern Turkey. Only the pregnant women in the experimental group received web-based breastfeeding education. Descriptive statistics and independent two-sample t-test analysis were used to analyse the data and to compare the demographic characteristics and scale scores according to the groups. 'IOWA Infant Feeding Scale', "Edinburgh Depression Scale", "IMDAT", "Breastfeeding Self-Efficacy Scale", "Perception of Insufficient Milk Scale" and "Breastfeeding Motivation Scale" were administered to the experimental and control groups on the 7th day, 3rd month and 6th month after birth. Several factors, including breastfeeding motivation, breastfeeding self-efficacy, and the perception of milk sufficiency for the baby, were significantly different between the groups (p<0.001). A significant difference was found between the two groups in terms of mothers breastfeeding their babies within the first half hour after birth. All of the mothers in the experimental group breastfed their babies within the first half hour. Breastfeeding self-efficacy and motivation levels in the experimental group showed a statistically significant increase when compared to both pre-training levels and the control group. (Clinical Trials Number: NCT06443801).

Breastfeeding Trends Following the US Infant Formula Shortage.

Breastfeeding enhances maternal and child health, yet US breastfeeding rates remain below optimal levels and substantial disparities persist. The 2022 infant formula crisis had the potential to influence infant feeding practices due to formula shortages and fears about the safety of formula feeding in the wake of recalls. This report studies the evolution of breastfeeding-initiation trends during the infant formula crisis and compares the effects across subpopulations. This study analyzed 2016-2022 national birth certificate data from 47 states and the District of Columbia based on Bayesian structural time-series analysis to measure average changes in breastfeeding-initiation trends and a linear probability model to test for heterogeneous effects. During the 2022 infant formula crisis, average breastfeeding-initiation rates increased by 1.96 percentage points (pp) (95% credible interval, 1.68 pp to 2.23 pp) and remained elevated above historical levels at the end of the formula crisis. The increase was particularly pronounced among mothers with lower education levels, those receiving Special Supplemental Nutrition Program for Women, Infants, and Children assistance, residents of less populated counties, Medicaid recipients, and Black mothers, possibly due to their higher reliance on formula feeding. Populations meeting all of these sociodemographic criteria experienced the largest increase in breastfeeding initiation at 6.06 pp (95% confidence interval, 5.26 pp to 6.87 pp). Preexisting disparities in breastfeeding initiation declined in 2022. The infant formula crisis highlights the potential for addressing breastfeeding disparities and reducing associated child and maternal health risks through targeted interventions to promote breastfeeding.

Infant Feeding Disparities Amid the Formula Shortage: Where Do We Go From Here?

Infant Feeding Disparities Amid the Formula Shortage: Where Do We Go From Here?

Decadal trends in the exclusive breastfeeding practices among working Indian mothers: a multi-level analysis

BackgroundExclusive breastfeeding (EBF) is defined as feeding infants only breast milk of the mother or a wet nurse for the first six months, without additional food or liquids except the oral rehydration solution or drops/syrups of vitamins, minerals or medicines. The working status of women in developed countries adversely affects the EBF rates, which calls for an assessment in rapidly developing countries like India. Therefore, the primary aim of the present study is to determine the prevalence of EBF using the data from the National Family Health Surveys (NFHS 3, 4, 5) conducted between 2005 and 06, 2015-16 and 2019-21 to estimate the likelihood EBF according to mothers’ employment status.MethodsWe did a secondary data analysis of the cross-sectional surveys. Exclusive breastfeeding was the primary dependent variable and defined as the percentage of youngest children under six months exclusively breastfed per last 24 h. The employment status of the mother was the primary independent variable and was coded dichotomously (yes/no). Chi-square analysis assessed the association of EBF with the outcome variable of interest. A multi-level modelling approach has been used for portioning variation in the prevalence of exclusive breastfeeding at different geographical levels.ResultsFrom NFHS rounds 3 to 5, the overall prevalence of exclusive breastfeeding was 47.45%, 54.85%, and 64.01% respectively. On segregating the women as per their employment status, the prevalence among employed women was 51.1%, 51.1%, and 60.3%, while in unemployed women the prevalence was 45.9%, 54.8%, and 67.3% respectively. The odds of practising EBF in NFHS-5 doubled since NFHS-3 (Adjusted Odds Ratio: 2; 95% Confidence Interval: 1.08, 3.67). Employed mothers had a significantly lower odds ratio (0.94, 0.91, 0.98) of practising exclusive breastfeeding. The likelihood increased when mothers were exposed to media, had normal BMI, and visited health centres > 4 times during pregnancy. The likelihood decreased in older mothers, birth of infant in a health facility, female gender of the child, and late initiation of breastfeeding.ConclusionsThe lower prevalence of exclusive breastfeeding among working mothers calls for an urgent need to improve policies around maternity benefits at workplaces.

Determinants of formula feeding among mothers with infants and young children in six Sub Sahara African countries: Multilevel analysis of data from demographic and health survey.

Formula feeding is providing infants with prepared formula as an alternative to or alongside breastfeeding. While breast milk is widely regarded as the optimal source of nutrition for infants, formula feeding is a common practice. The recommended approach is exclusive breastfeeding for the first six months, followed by the introduction of complementary foods after that period, which is crucial for child growth and development. Formal feeding has a negative impact on an infant's health, causing malnutrition and other illnesses. Therefore, this study was investigated to assess formula feeding and determinant factors among mothers with infants in six sub-Saharan African countries. A total weighted sample of 26,119 mothers with infants and young children less than two years was included in this study. The data were taken from a recent demographic and health survey in six sub-Sahara African countries. A multilevel, multivariable logistic regression model was used to identify the determinant factors associated with formula feeding. In the multivariable analysis, the adjusted odds ratio with a 95% CI was used to declare a statistically significant association with formula feeding among mothers with infants. In this study, the proportion of mothers with infants who use formula feeding was 17.1%. In multilevel logistic analysis (model III), the significant factors associated with formula feeding were the age of the mothers; 25-34 years (AOR = 1.3; 95% CI (1.2-1.41)), 35-49 years (AOR = 1.4; 95% CI (1.22-1.54)), multiple children (AOR = 1.4; 95% CI (1.23-1.77)), maternal educational status; secondary and higher (AOR = 2.4; 95% CI (2.11-2.66)), mother's employment status; (AOR = 1.24; 95% CI (1.14-1.5));, richer households (AOR = 1.2; 95% CI (1.10-1.36)), place of delivery (AOR = 2.1; 95% CI (1.83-2.44)), household media exposure (AOR = 1.5; 95% CI (1.3-1.68))place of residence (AOR = 1.97; 95% CI (1.79-2.17)), community illiteracy level (AOR = 1.17; 95% CI (1.02-1.34)), and community media exposure (AOR = 1.2; 95% CI (1.03-1.38)). Formula feeding among mothers with infants in Sub-Saharan Africa has emerged as a public health concern. The recommended approach is to promote exclusive breastfeeding for the first six months, followed by the introduction of complementary feeding after that period. Factors associated with formula feeding include older maternal age, secondary and higher education, delivery in health institutions, employment status, higher household income, twin births, urban residence, low community illiteracy rates, and increased community media exposure. Stakeholders and health policymakers should be focused on strategies to improve breast feeding and discourage infant formula feeding.

Maternal Allergic Disease Phenotype and Infant Birth Season Influence the Human Milk Microbiome.

Early infancy is a critical period for immune development. In addition to being the primary food source during early infancy, human milk also provides multiple bioactive components that shape the infant gut microbiome and immune system and provides a constant source of exposure to maternal microbiota. Given the potential interplay between allergic diseases and the human microbiome, this study aimed to characterise the milk microbiome of allergic mothers. Full-length 16S rRNA gene sequencing was performed on milk samples collected at 3 and 6 months postpartum from 196 women with allergic disease. Multivariate linear mixed models were constructed to identify the maternal, infant, and environmental determinants of the milk microbiome. Human milk microbiome composition and beta diversity varied over time (PERMANOVA R2 = 0.011, p = 0.011). The season of infant birth emerged as the strongest determinant of the microbiome community structure (PERMANOVA R2 = 0.014, p = 0.011) with impacts on five of the most abundant taxa. The milk microbiome also varied according to the type of maternal allergic disease (allergic rhinitis, asthma, atopic dermatitis, and food allergy). Additionally, infant formula exposure reduced the relative abundance of several typical oral taxa in milk. In conclusion, the milk microbiome of allergic mothers was strongly shaped by the season of infant birth, maternal allergic disease phenotype, and infant feeding mode. Maternal allergic disease history and infant season of birth should therefore be considered in future studies of infant and maternal microbiota. Trial Registration: ClinicalTrials.gov identifier: ACTRN12606000281594.

Differences between neonatal units with high and low rates of breast milk feeding for very preterm babies at discharge: a qualitative study of staff experiences

BackgroundBreast milk has significant benefits for preterm babies, but ‘very preterm’ babies are unable to feed directly from the breast at birth. Their mothers have to initiate and sustain lactation through expressing milk for tube feeding until their babies are developmentally ready to feed orally. There are wide disparities between neonatal units in England in rates of breast milk feeding at discharge. This study explored health professionals’ experiences of barriers and facilitators to their role in supporting breast milk feeding and breastfeeding for very preterm babies.Methods12 health professionals were interviewed, from four neonatal units in England with high or low rates of breast milk feeding at discharge. Interviews were analysed using comparative thematic analysis.ResultsFive themes were developed: ‘The role of the infant feeding specialist’, ‘Achieving a whole team approach to breast milk feeding’, ‘Supporting initiation of breastfeeding’ ‘Supporting long-term expressing’, ‘Supporting the transition to breastfeeding’. There were notable differences between neonatal units in the time allocated to specialist feeding support, the team’s sense of collective responsibility for supporting feeding, leadership, the use of external standards as levers for change, and training for the multi-disciplinary team. The feeding challenges faced by mothers of very preterm babies could be made worse where there was no joined-up working between neonatal and postnatal staff; inadequate facilities for mothers to stay with their babies; and when opportunities were missed to give information about the importance of early initiation of expressing and to support mothers’ confidence during the transition to direct breastfeeding.ConclusionsEffective support can be influenced by having a supernumerary post dedicated to infant feeding; strong leadership that champions breast milk feeding and breastfeeding within Family Integrated Care; maintaining accountability by using existing quality improvement tools and accredited standards for neonatal units; and training for the whole multi-disciplinary team that encourages and enables every member of staff to take an appropriate share of responsibility for consistently informing and assisting mothers with expressing and breastfeeding. Joined-up working between staff on antenatal and postnatal wards and neonatal units is important to enable integrated feeding support for the mother-baby dyad.