Infants Receiving Breast Milk Research Articles

Effects of breastfeeding training programmes for midwives on breastfeeding outcomes: a systematic review and meta-analysis

BackgroundAppropriate breastfeeding training for midwives is necessary to enhance their knowledge, attitude, and practice (KAP). However, evidence surrounding the effects of midwife breastfeeding training programmes is insufficient to draw a conclusion of its effectiveness on breastfeeding initiation, duration, and rates.ObjectiveThe aim of this systematic review was to identify, summarise, and critically analyse the available literature to evaluate the effects of midwife breastfeeding training programmes on the midwives’ KAP towards breastfeeding and breastfeeding initiation, duration and rates among postnatal mothers.MethodsNine English and six Chinese databases were searched with relevant key words. The methodological quality of the included studies were assessed by two reviewers independently using the Joanna Briggs Institute critical appraisal checklists.ResultsNine English and one Chinese articles were included in this review. Five articles investigating midwives’ KAP towards breastfeeding reported positive results (p < 0.05). The meta-analysis revealed that breastfeeding training programmes significantly improved midwives’ breastfeeding-related knowledge and skills (standardised mean difference = 1.33; 95% confidence interval, 0.98 to 1.68; p < 0.01; I2 = 36%), as well as their attitude towards breastfeeding (p < 0.05). An additional five articles measured the effects of breastfeeding training programmes on the initiation, duration, and rates of breastfeeding among postnatal mothers. Following the implementation of a breastfeeding training programme for midwives, mothers had significantly longer durations of exclusive breastfeeding (p < 0.05), fewer breastfeeding challenges (p < 0.05) (e.g. breast milk insufficiency), and higher satisfaction with breastfeeding counselling (p < 0.01), and fewer infants received breast milk substitutes in their first week of life without medical reasons (p < 0.05) in the intervention group compared with the control group. However, no significant effects were seen on the initiation and rates of breastfeeding after implementation of the programmes.ConclusionsThis systematic review has demonstrated that midwife breastfeeding training programmes could improve midwives’ KAP towards breastfeeding. However, the breastfeeding training programmes had limited effects on breastfeeding initiation and rates. We suggest that future breastfeeding training programme should incorporate counselling skills alongside breastfeeding knowledge and skills training.Review registrationThis systematic review has been registered in the International prospective register of systematic reviews (PROSPERO) (ID: CRD42022260216).

ADIYAMAN İLİNDE BEBEKLİK DÖNEMİNDE BESLENME ALIŞKANLIĞINI ETKİLEYEN FAKTÖRLERİN DEĞERLENDİRİLMESİ

Breast milk is the ideal nutritional source that contains all kinds of nutritional values such as protein, fat, iron and vitamins that the baby needs for the first 6 months. The aim of this study was to evaluate the attitudes and behaviors of families in terms of breast milk and nutrition during infancy. Our study was conducted with mothers who had babies between 0-24 months in Adıyaman University Training and Research Hospital between March 15 and July 15, 2018. A total of 1010 mothers were administered a questionnaire consisting of 45 questions prepared by us to determine the sociodemographic data and breastfeeding status of infants and parents. In the study group consisting of mothers with low education and income levels, the mean age of mothers was 29.47 ± 5.61 (18-45) years, and the percentage of mothers working was 10.6%. The distribution of babies between boys and girls was 54.3% - 45.7%. The percentage of infants receiving breast milk in the first half hour was 53.6%, the percentage of breastfeeding alone in the first six months was 69.7%, and the first food given in the supplementary food period was 37.9%, yoghurt. In our study, the rate of breastfeeding after delivery was found to be high. However, the rate of continuing to breastfeed, including the first six months, was found to be low.

Relationship Between the Rates of Breast Milk Production of Preterm Mothers in the First Week Post-Delivery and Continuation of Breastfeeding Through Discharge

BackgroundMothers of preterm infants born between 26- and 35-weeks’ gestation often report challenges with maintaining a pumping schedule and experience perceptions of low milk supply, both of which may contribute to early termination of breastfeeding within the first few weeks.PurposeThe purpose of this study was to assess the relationship between the amount of expressed milk volumes in the first 2 weeks after delivery and infant’s continuing to receive mother’s milk at hospital discharge. These results were part of a larger study that examined multiple maternal variables that may impact the amount of milk volumes and continuation of breastfeeding in the preterm infant admitted to the NICU.MethodsMothers of infants (N = 37) in the NICU were recruited for this correlational, longitudinal study. Data was collected at 24–48 hours post-delivery, at 2 weeks, at 4 weeks from mothers participating in the study and from infant chart reviews.Results/OutcomesMothers who reported higher expressed milk volumes at 3 days post-delivery had consistently higher volumes of expressed breast milk and a higher percentage of continued breastfeeding at hospital discharge. There was no statistically significant relationship between breastfeeding self-efficacy scores, socio-demographic variables, or pumping frequency and the percentage of infants receiving breast milk at hospital discharge. Overall, 76.4% of the infants enrolled in the study were receiving 100% of their intake with fortified mother’s milk at hospital discharge.Discussion/Implications for PracticeThe use of a breast pump log in the first 2 weeks to monitor milk volumes may assist in predicting mothers who are at risk of lower milk supply and early discontinuation of breastfeeding.

Dental caries and associated risk factors in 13- to 18-month-old infants receiving breast or formula milk feeding: A cross-sectional study.

The association between breast milk feeding and dental caries risk in children remains controversial. Moreover, it is unclear whether risk factors for caries differ between breast milk-fed and formula milk-fed infants. To investigate dental caries in 13- to 18-month-old infants receiving breast milk or formula milk feeding and associated risk factors. One hundred and sixty-six 13- to 18-month-old infants were recruited from a tertiary hospital in Bangkok, Thailand. Information on feeding practices, demographics, and potential risk factors was collected using a caregiver questionnaire. Carious lesions were identified by visual and tactile examination. The Chi-squared test, Mann-Whitney U test, and logistic regression model were used for statistical analysis. The prevalence of caries in breast milk- and formula milk-fed infants was 31.8% and 36.0%, respectively, with no statistically significant difference (p=.579). Among all children, having dental plaque deposition on more than one third of the crown (adjusted OR (aOR): 15.11%; 95% CI: 6.11-37.35) and sleeping while milk feeding (aOR: 2.20%; 95%CI: 1.01-4.77) were associated with dental caries. In subgroup analysis, however, sleeping while milk feeding increased caries risk in the formula milk-fed group only (aOR: 2.95%; 95%CI: 1.07-8.12). The type of milk feeding was not associated with dental caries, whereas dental plaque and sleeping while milk feeding increased the odds of having dental caries in this population.

Nutritional practices and growth of preterm infants in two neonatal units in the UK and Malaysia: a prospective exploratory study

ObjectiveTo explore differences in nutritional practices and growth outcomes among preterm infants in neonatal units in Malaysia and the UK.DesignProspective exploratory study of infants born at <34 weeks gestational age...

Differences in Sensorimotor Development Among U.S. Infants Receiving Breastmilk and/or Formula in the First 6-Months From the PediaTrac™ Project

ObjectivesAchieving sensorimotor (SEM) milestones is one measure of early infant brain development promoted through higher docosahexaenoic acid (DHA) levels. Both breastmilk and formula contain DHA, with a global level of 0.32% in breastmilk and many formula brands. However, a 2017 study of Midwestern U.S. mothers found significantly lower breastmilk DHA levels. It was thus hypothesized that infants fed formula would have higher SEM scores. The objective of this study was to measure differences in SEM development between infants fed breastmilk, formula, or a combination in participants of the PediaTrac™ Project. PediaTrac is a web-based measure providing longitudinal, real time, multidomain data on infant and toddler growth and development at time periods corresponding to well child visits. MethodsUsing PediaTrac, data were collected from 548 caregiver-infant dyads across multiple Midwestern sites. Caregivers reported the primary nutrition source as breastfeeding, formula or combination. Their responses to gross and fine motor function questions were used to create a SEM composite, Percent of Maximum Possible (POMP) score at newborn (NB), 2-, 4- and 6-months. Data were analyzed via ANOVA and Tukey test using SPSS. ResultsInfants fed formula had statistically higher mean SEM scores at NB (M = 0.618Formula, M = 0.590Breast, p = 0.017), 2- (M = 0.706Formula, M = 0.680Breast, p = 0.006) and 6-months (M = 0.727Formula, M = 0.696Breast, p = 0.014) compared to breastfed infants. Mean SEM scores of combination fed infants were higher than breastfed infants at 2- (M = 0.701Combination, M = 0.680Breast, p = 0.184), 4- (M = 0.684Combination, M = 0.673Breast, p = 0.573) and 6-months (M = 0.704Combination, M = 0.696Breast, p = 0.895), despite no significant differences between scores. ConclusionsFormula fed infants showed consistently higher SEM scores than breastfed infants in the first 6-months. These findings contradict previous research, indicating a need for further investigation into variables contributing to these discrepancies such as maternal breastmilk DHA concentrations, socioeconomic factors, site specific confounds, accuracy of parent reports of motor development, etc. Funding SourcesEunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health. EMU College of Health & Human Services Research Support Award.

Effect of Feeding Strategies on the Development of Fulminant Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) causes significant neonatal morbidity. A subset of infants experience precipitous decline and death from fulminant-NEC (F-NEC). We sought to determine the effect of feeding practices on the development of this more virulent form of NEC. Premature neonates developing Bell's stage II or III NEC between May 2011 and June 2017 were reviewed. Infants were stratified as having NEC or F-NEC, defined as NEC-totalis or NEC causing rapid decline and death within 72 hours. Risk factors extracted included demographics, gestational age, and weight at NEC diagnosis. Feeding data extracted included age at first feed, caloric density, type of feed (breast milk or formula), and whether full volume feeds were reached. Univariate analysis and multivariate analysis were performed. A total of 98 patients were identified, of which 80 were included. In total, 57 patients had NEC and 23 had F-NEC. Reaching full volume feeds was associated with F-NEC on both univariate and multivariate analysis (37.9 vs. 4.5%; odds ratio: 67, 95% confidence interval: 6.606-2041, p = 0.003). Infants developing F-NEC achieved full feeds earlier (22.5 vs. 19.8 days, p = 0.025) on univariate but not multivariate analysis. There was no difference in the rates of NEC and F-NEC among infants receiving breast milk (standard or fortified) or formula (standard or increased caloric density; p = 0.235). Among premature neonates with NEC, reaching full volume feedings was associated with a nearly 70-fold increased risk of F-NEC. Assuming it was possible to predict an infant's development of NEC, alternative feeding regimens might reduce the risk of F-NEC in this population.

Young infants’ exposure to organophosphate esters: Breast milk as a potential source of exposure

Organophosphate esters (OPEs) are applied as both flame retardants and plasticizers to a variety of consumer items such as home furnishings, construction materials, and children’s products. While some assessments have characterized exposure among toddlers and young children, little is known about the OPE exposure among infants, who are a vulnerable population due to their rapid development. Here, we collected spot urine samples from 6-week-old (n = 100) and 12-month-old infants (n = 63), with about half of the infants evaluated at both ages (n = 52), to characterize OPE exposure and determine what factors contributed to higher exposures. Five of six OPE metabolites analyzed were detected frequently (>70%). Diphenyl phosphate was detected in every urine sample, while bis(2-chloro-isopropyl) phosphate (BCIPP) was the most abundant metabolite measured overall. Concentrations of bis(1-chloro-2-propyl) 1-hydroxy-2-propyl phosphate (BCIPHIPP) and BCIPP [i.e., metabolites of tris(2-chloro-isopropyl) phosphate (TCIPP)] were significantly greater among 6-week-old infants compared to 12-month-olds, while levels of other OPE metabolites were not statistically different in the first year of life. OPE metabolites were generally correlated with one another in samples collected at each age (rs = 0.25–0.75; p < 0.05), and except BCIPHIPP, concentrations of the same metabolite were correlated over time (rs = 0.41–0.53; p < 0.05). Breastfeeding at 6 weeks of age and owning a larger number of children’s products were associated with increased concentrations of urinary BDCIPP. Infants who were currently receiving breast milk had higher levels of TCIPP metabolites; urinary BCIPP concentrations were 6.2 times higher in infants receiving breast milk at 6 weeks of age, and BCIPHIPP levels were 2.2 times higher for 12-month-old infants receiving breast milk (10β = 7.2; 95% CI: 1.6–32.1 and 10β = 3.2; 95% CI: 1.2–8.1, respectively). Differences in the predominant TCIPP metabolite associated with breastfeeding may suggest differences in metabolism with age. Cumulatively, our results suggest levels of OPE exposure may be higher for infants than other age groups, including toddlers and older children.

IMPACT OF THE STATE OF THE INFANT HEALTH ON THE TIMING OF BIEKOST

To determine the optimal timing of the introduction of complementary foods and their impact on the health status of infants during the first year of life, a study was conducted on the basis of 7 children’s clinics in the city of St. Petersburg. Materials and methods. At stage I, there was conducted a random survey of 534 mothers, whose infants received breast milk up to a year and later. At stage II, the data on the child’s health groups were copied from the account form 112 /U “History of the development of the child”. Results. 81.1% of mothers were found to begin to give vegetable complementary foods at the age of 4-6 months. Vegetable puree was given to children of health groups I and II on time, as well as to children who have chronic diseases at the stage of compensation (health group III). For children with chronic diseases at the stage of sub- and decompensation (IV and V health groups), vegetable complementary foods were introduced into the diet after the recommended period. 71.5% of mothers gave grain complementary foods on time, 24.5% - later. In all children, regardless of health group, most mothers introduced porridge into the diet in a timely manner. Most mothers introduced mashed potatoes, as well as other protein products, including cottage cheese, egg yolk, and mashed fish later regardless of the state of health of the child. 24.9% of mothers introduced meat puree, 22.8% women cottage cheese, 30.0% egg yolk, and 17.9% fish puree earlier. The majority of mothers did not introduce fermented milk products on time: only 35.5% of mothers started introducing them on time, 46.8% - later. 61.4% administered whole milk earlier, and mothers introduced it into the diet of healthy children (I and II health groups) at the prescribed time, and in children with chronic diseases (III-V groups) later than recommended. Conclusion There is a relationship between the state of the child’s health and the timing of the introduction of complementary foods: vegetable puree and whole milk, children with chronic diseases are introduced later.

Exploring Breastfeeding Knowledge and Attitudes among Noncaregivers: A Narrative Review.

Exclusive breastfeeding to 6 months with continued breastfeeding up to 2 years and beyond are well-established infant feeding recommendations based on evidence that breastfeeding has unparalleled maternal and infant health benefits as well as environmental and economic benefits. As with many high-income countries, breastfeeding rates remain suboptimal with only a quarter of Canadian and European infants receiving breast milk exclusively for the first 6 months. Breastfeeding promotion efforts have largely targeted caregivers in the prenatal and postnatal period; however, breastfeeding outcomes have been shown to be associated with broader sociocultural factors. Noncaregivers play an influential role in infant feeding at both an individual level (e.g., cues and input from health care practitioners and caregivers' social networks; as future parents) as well as a broader population level (sociocultural norms and policy decisions). This paper outlines recent research on breastfeeding knowledge and attitudes of noncaregivers by population subgroup. Positive correlations have been identified between breastfeeding attitudes, infant feeding knowledge, breastfeeding exposure, and breastfeeding intention among different subgroups; however, key knowledge gaps, lack of exposure to breastfeeding, and negative public perceptions of breastfeeding persist. Dietitians can advocate for breastfeeding promotion strategies that consider the role of noncaregivers to address sociocultural norms around breastfeeding.

In-Hospital Feeding Practices of Infants Born to Mothers With Gestational Diabetes Mellitus or Type 2 Diabetes Mellitus: Evaluating Policy Implementation Effectiveness.

Women with diabetes in pregnancy may experience unique breastfeeding challenges. Few studies have examined the effectiveness of hospital policy to support breastfeeding in this patient population. This study aimed 1) to describe infant feeding practices of mother-infant pairs with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy before and after introduction of an in-hospital policy and, 2) to compare feeding practices before and after policy introduction. A retrospective chart audit of mother-infant pairs (n=120) was performed: 60 at 1 year before and 60 after policy introduction. The primary outcome was provision of breast milk at discharge; a chi-square test was completed to compare pre- and postpolicy groups. Secondary outcomes included participant and infant feeding characteristics. There was no significant difference in the number of infants receiving breast milk at discharge between pre- (58% [35 of 60]) and postpolicy (58% [35 of 60]) groups (p=0.64). The number of infants receiving breast milk exclusively throughout the hospital stay also did not differ by group (37% [22 of 60] before; and 43% [26 of 60] after; p=0.39). Information for each feed was infrequently recorded in charts for the method of feeding (34% [704 of 2,064]), infant state (96% [1,991 of 2,064]) and feeding description (96% [1,987 of 2,064]). This practice-based research has highlighted a need for continuation of this work, examining an in-hospital policy to support breastfeeding in those with GDM or type 2 diabetes in pregnancy. Initially, feedback could be collected from health-care providers to understand perceived facilitators and barriers to policy application and the use of job aids (e.g. record keeping tools).

Receipt of Breast Milk by Gestational Age – United States, 2017 (P11-060-19)

Abstract Objectives Breast milk is the optimal source of infant nutrition. For the nearly 1 in 10 infants born prematurely in the United States annually, breast milk is especially beneficial, helping prevent sepsis and necrotizing enterocolitis (NEC) and promoting neurological development. Though the importance of breast milk for preterm infants has been established, national estimates of feeding practices by gestational age are unavailable. Our objective was to describe receipt of breast milk among preterm and term infants delivered in the United States in 2017. Methods Birth certificate data from 48 states and the District of Columbia (n = 3,194,873; 82.7% of all births) were analyzed to describe receipt of breast milk before birth certificate completion among extremely preterm (20-27 weeks), early preterm (28-33 weeks), late preterm (34-36 weeks) and term infants (≥ 37 weeks) with further stratification by maternal and infant characteristics. Results The prevalence of infants receiving breast milk was 83.9% overall and varied by gestational age: 71.3% (extremely preterm), 76.0% (early preterm), 77.3% (late preterm), and 84.6% (term). Disparities in receipt of breast milk by maternal race/ethnicity were noted across gestational ages. Infants delivered to black or American Indian/Alaska Native mothers were the least likely to have received breast milk while those delivered to white, Hispanic, and Asian mothers were more likely to have received breast milk. Differences in receipt of breast milk by other maternal sociodemographic factors also persisted similarly across gestational ages. Among late preterm and term infants, receipt of breast milk was lower for those admitted to the neonatal intensive care unit (NICU) than those not admitted to the NICU. Conclusions Fewer preterm than term infants received breast milk in the first few days of life. Optimal hospital policies and practices that support breast milk feeding and ensure availability of donor milk for high-risk infants may help improve infant nutrition and reduce infant morbidity and mortality. Mothers of infants admitted to the NICU may need additional support given the challenges associated with having a medically fragile infant such as mother-infant separation and extended infant hospitalization. Funding Sources Centers for Disease Control and Prevention, Oak Ridge Institute for Science and Education.

Ultrasound assessment of gastric emptying time in preterm infants: A prospective observational study.

In paediatric anaesthesia, pre-operative fasting should be short to prevent discomfort, hunger, thirst and metabolic disorders. Current European guidelines recommend pre-operative fasting times of 4 h for breast milk and 6 h for formula milk in infants, whereas some national guidelines allow both until 4 h before anaesthesia. We evaluated the gastric emptying times of preterm infants after breast milk and formula milk, hypothesising that the mean gastric emptying time would be less than 4 h. A prospective, observational, noninterventional cohort study. Neonatal ICU of a university hospital from August to September 2017. Twenty-two infants with a postmenstrual mean ± SD (range) age of 35 ± 2 (32 to 40) weeks were included. Based on their prescription plan, 10 infants received breast milk and 12 received formula milk with a total volume of 50 ± 16 (24 to 70) ml. Gastric emptying was examined by sonographic measurements of the gastric antral area (GAA) before (FT0) and hourly after breast milk or formula milk feeding (FT1 to FT3). Estimated gastric emptying time after enteral feeding with breast milk and formula milk in preterm infants. The GAA of the preterm infants initially increased and subsequently decreased after feeding. GAA correlated significantly with fasting time (r = -0.53, P < 0.0001). At FT3 [199 ± 16 (175 to 225) min], GAA was 0.57 (0.42 to 0.91) cm and showed no difference compared with FT0. Using a linear regression model, the calculated mean gastric emptying time was 218 min. The study shows that the mean gastric emptying time after enteral feeding with breast milk and formula milk is less than 4 h in preterm infants. These results support our current national fasting regimen of 4 h for any milk composition in infants before anaesthesia. German registry of clinical studies (DRKS-ID: DRKS 00013893).

Evaluation of the effectiveness of different types of enteral nutrition in premature infants

Introduction. Optimal nutrition of premature baby should ensure him adequate growth without metabolic and other complications in the short term, with the realization of genetic potential and development in the long-term perspective. The most valuable product for such infants is breast milk, which has nutritional, immunological, psychological, social and economic benefits over milk mixtures. However, in all cases, it is not possible to feed a premature infant with suckling breast milk (difficult conditions are menses, the presence of contraindications for breastfeeding). In such circumstances, the physician poses the question of choosing a mixture of enteral nutrition that would provide the body of a premature baby with all the necessary nutrients, allow for adequate growth rates of increase in feeding volume and minimize the development of complications.The aim of the study. To analyze the outcomes of children with very low body weight at birth, depending on the nature of the enteral nutrition.Materials and methods. Clinical and laboratory examination of 68 premature infants with very low body weight at birth (1000 g-1500 g) was conducted. Of the 24 children (Group I), enteral nutrition was carried out from the first hours of life with breast milk, in the 44 (second group) newborns - early enteral nutrition with a mixture of PreNAN Gold. Exclusion criteria: congenital malformations and abnormalities requiring surgical intervention, conditions delaying the early onset of enteral nutrition.A daily clinical assessment of the general condition of newborns, neurological status, weighing, monitoring of growth parameters, head circumference and abdomen were carried out. All children were thoroughly examined before each feeding for the purpose of identifying symptoms of tolerance to enteral nutrition, monitoring the results of laboratory and additional research methods in accordance with the protocols for the provision of newborns approved by the orders of the Ministry of Health of Ukraine.Results and discussion. Part of the children of the second group for 4-5 days of life, in addition to the mixture, began to receive and strained breast milk (they are classified in IIa subgroups). The weight loss of newborns who fed with the PreNAN Gold blend was probably lower compared to those in Group I infants. The average increase in the daily volume of enteral nutrition during the first week of life did not differ significantly in all groups of children. The achievement of full volume of enteral nutrition was most rapidly observed in newborn infants receiving breast milk. However, body weight gain was better for babies on artificial feeding. Cases of intolerance to enteral nutrition were almost the same in all infant groups, but the incidence of necrotizing enterocolitis did not differ with all types of enteral nutrition. In newborns who received PreNAN Gold, the stomach did not contain pathological impurities. Data from laboratory studies in Group II (total protein, urea, creatinine) were within the age range. Allergic reactions were not registered.Conclusions. The use of the PreNAN Gold blend for the feeding of prematurely born infants with a very low body weight at birth allows them to fully provide their body with all necessary nutrients, allow them to maintain proper rates of increase in feeding volume, promote adequate body weight gain, minimize the development of NEC and disturb the tolerance to enteral food. The mixture is well tolerated by infants, does not cause allergic reactions, the liquid form simplifies its use.

Eating Patterns and Food Choices of Latvian Infants during Their First Year of Life.

Introduction: Pregnancy, infancy, and early childhood are periods of rapid growth and development. The role of nutrition is very important during these critical growth and development periods. The aim of the study was to investigate infant feeding practices through the first year of life in Latvia, and to compare feeding practices with nutritional guidelines in Latvia and other European countries. Methods: We analysed cross-sectional study data from food frequency questionnaires with additional questions on breastfeeding and complementary feeding introduction. A total of 266 infants from all Latvian regions from birth to 1-year-old were included in the study. Breastfeeding rates were assessed by month of age. Complementary feeding was assessed using three age groups (0–3.9 months, 4–6.9 months, and 7–12.9 months), whereas two groups were used to assess food frequency and portion sizes (0–5.9 months and 6–12.9 months). Results: The breastfeeding rate during the first month of life was 89%. At 6 months, 68% of infants received breast milk, but by 12 months, only 45% still received breast milk. Complementary foods were introduced at a mean age of 5 months (standard deviation = 1). Before 4 months of age, 9% of infants were receiving complementary food, the majority (85%) between 4 and 6 months of age. There were 6% of infants who were introduced to complementary foods after 7 months of age. First complementary food choices were mainly porridge (64%), vegetables (21%), and fruits (10%). After 6 months of age, foods from almost all food groups were present in each infant diet at least once per day, such as vegetables (85%), potatoes (85%), fruits (81%), dairy (78%), and meat (73%), less than once per day—grains (88%), fats (73%), cow’s milk (66%), eggs (45%), fish (36%), and legumes (28%). Conclusion: Breastfeeding rate during first months of life is high in Latvia. Breastfeeding was sustained at the age of 6 months, in the highest rate among Baltic countries. However, only 45% continued breastfeeding at the age of 12 months, in accordance with WHO recommendations. A guideline on complementary feeding is followed by the majority of parents. There are deviations from guidelines in inclusion of some foods in the diet and frequency of consumption.

Intestinal microbiota development and gestational age in preterm neonates

The intestinal microbiota is an important contributor to the health of preterm infants, and may be destabilized by a number of environmental factors and treatment modalities. How to promote the development of a healthy microbiota in preterm infants is largely unknown. We collected fecal samples from 45 breastfed preterm very low birth weight (birth weight < 1500 g) infants from birth until 60 days postnatal age to characterize the intestinal microbiota development during the first weeks of life in preterm infants. Fecal microbiota composition was determined by 16S rRNA amplicon sequencing. The main driver of microbiota development was gestational age; antibiotic use had strong but temporary effects and birth mode had little influence. Microbiota development proceeded in four phases indicated by the dominance of Staphylococcus, Enterococcus, Enterobacter, and finally Bifidobacterium. The Enterococcus phase was only observed among the extremely premature infants and appeared to delay the microbiota succession. The results indicate that hospitalized preterm infants receiving breast milk may develop a normal microbiota resembling that of term infants.

Early Initiation of Breastfeeding and Its Association in Rural Areas of Burkina Faso

Background: The global recommendations of the WHO and UNICEF are that all infants should start breastfeeding within one hour of birth. It is low-cost and has substantial potential to reduce neonatal and early infant morbidity. The objectives of the study were to investigate rate of early initiation of breastfeeding and to identify potential associated factors. Methods: A community based cross-sectional study design was conducted in three districts of Burkina Faso. Cluster sampling was used. The data were collected by using a structured and pretested interview questionnaire. The associations between early initiation and independent variables were tested using the Chi-square test. Crude Odds ratios (COR) with 95% confidence intervals were used. Results: Percentage of children who were put to the breast within one hour of birth was fair (41%). Having more than 2 antenatal care visits was found to be 1.43 times more likely to initiate breastfeeding early, COR: 1.4, 95% CI: [1.14 - 1.81], p < 0.001. Receiving advices, during pregnancy, on early initiation of breastfeeding, child feeding and child growth, were found to be more likely to initiate breastfeeding early, respectively COR: 1.52, 95% CI: [1.25 - 1.80]; 1.39, 95% CI: [1.15 - 1.67] and 1.39, 95% CI: [1.15 - 1.67], with p < 0.001. Mothers having skilled delivery were found to be more likely to initiate breastfeeding early, COR: 1.47, 95% CI: [1.20 - 1.79], p < 0.001. Conclusions: This study demonstrates that delayed initiation of breastfeeding continues to be a problem in rural areas of Burkina Faso, as only four in 10 newborn infants received breast milk within the first hour of birth. The results show that receiving advices on early initiation of breastfeeding, child growth and feeding and skilled delivery were found to be more likely to initiate breastfeeding within one hour of delivery. Therefore improving the skills of health providers and, mother individual counselling and strengthening community-based support, are critical to improve timely initiation of breastfeeding.

The Impact of Neonatal Service ReOrganisation on Feeding of Preterm Infants (&lt;34 Weeks): A Prospective Cohort Study in a Regional Neonatal Unit from 1992 to 2010

Objectives: To describe Neonatal Intensive Care Unit (NICU) feeding practices during the neonatal period and explore predictors of any breast milk feeding at discharge among very preterm infants admitted before and after re-organisation of neonatal services in a region of the UK. Methods: Data on feeding of preterm infants (<34+0 weeks) at four time-points in the neonatal period and at discharge were collected prospectively on 1018 infants admitted to a regional NICU over a 19-year period. These data were subjected to unadjusted and adjusted analyses and time trends calculated before and after the transition. Results: Initiation of breast milk feeding in preterm infants increased throughout the study. However, the proportion of infants receiving breast milk declined steadily through the neonatal period and beyond. Before re-organisation, breast milk feeding (any) at discharge increased year-by-year (slope coefficient for trend 0.127, p<0.001). After re-organisation, the trend slowed down/decelerated (slope coefficient for trend 0.071, p 0.32). Any breast milk feeding at day 7 of life, singleton pregnancy, and length of hospital stay were associated with any breast milk feeding at discharge. Conclusions: Breast milk feeding of preterm infants increased in line with secular trends. However, this trend fell away following neonatal service reorganisation. This finding suggests that service providers and commissioners should monitor infant feeding trends in NICUs against national trends, as a benchmark of maternal and infant wellbeing and service delivery. The early predictors of any breast milk feeding at discharge found in this study need further research to validate their usefulness.

Risk Factors Associated With Bordetella pertussis Among Infants ≤4 Months of Age in the Pre-Tdap Era: United States, 2002-2005.

In the United States, infants have the highest reported pertussis incidence and death rates. Improved understanding of infant risk factors is needed to optimize prevention strategies. We prospectively enrolled infants ≤4 months of age with incident-confirmed pertussis from 4 sites during 2002-2005 (preceding pertussis antigen-containing vaccination recommendations for adolescents/adults); each case-patient was age and site matched with 2 control subjects. Caregivers completed structured interviews. Infants and their contacts ≥11 years of age were offered serologic testing for IgG; being seropositive was defined as ≥94 antipertussis toxin IgG enzyme-linked immunosorbent assay units per milliliter. Enrolled subjects (115 case-patients; 230 control subjects) had 4396 contacts during incubation periods; 83 (72%) case-patients had ≥1 contact with prolonged (≥5 days) new cough in primary or secondary households. In multivariable analysis, the odds for pertussis were higher for infants with primary/secondary household contacts who had a prolonged new cough, compared with infants who did not. These contacts included mother [adjusted matched odds ratio (aMOR), 43.8; 95% confidence interval (CI), 6.45-298.0] and ≥1 nonmother contact (aMOR, 20.1; 95% CI, 6.48-62.7). Infants receiving breast milk with 0-1 formula feedings daily had decreased pertussis odds (aMOR, 0.27; 95% CI, 0.08-0.89), compared with those receiving more formula. Of 41 tested case-patients, 37 (90%) were seropositive. Pertussis in infants was associated with prolonged new cough (≥5 days) in infants' household contacts. Findings suggest that breastfeeding protects against pertussis and warrants recommendation with pertussis prevention strategies, which currently include pertussis vaccination of pregnant mothers and infants' close contacts.

Cross‐Nursing in a Peruvian Peri‐urban Area

Despite recommendations that mothers should avoid the cross‐nursing of their infants (the occasional nursing by another woman) due to the risk of transmitting diseases such as HIV, this practice occurs.MethodsA cohort of 179 pregnant women and their toddlers living in a peri‐urban area of Lima, Peru was enrolled during the 3rd trimester of pregnancy. After birth, a total of 179 newborn infants were followed up until 6 months of age. Field workers visited the homes weekly to collect information about the infant for the previous seven days. Mothers were asked about the infant's health and feeding practices (breastfeeding, use of any liquids or foods, type of food).ResultsAbout 45% of the mothers (n=81) reported that their infants received breast milk from another woman during their first 6 months of life. Of those who were cross‐nursed, the frequency of days exposed ranged from one day (35%), between 2 to 7 days (40%), and 8 to 31 days (25%). The exposure occurred as early as the second day of life and as late as the six‐month birthday. Infants were most frequently cross‐nursed by their aunt (69%), followed by their neighbor (11%) and great aunts (11%). Grandmothers were also reported as breastfeeding the infant.ConclusionsAlthough this study provided data about one specific area of Peru, the population included migrants from other areas of the country; it is likely that this feeding behavior is common throughout Peru. More information is required to understand the practice of cross‐nursing and develop training to help health professionals effectively counsel mothers about the risks of this infant feeding practice.Support or Funding InformationCanadian Institutes of Health Research