Lactation Insufficiency Research Articles

Exploring Current Practices, Challenges, and Innovations in the Nutrition and Feeding of Neonates, Including the Use of Human Milk, Fortifiers, and Formula: A Clinical Study

ABSTRACT Background: Neonatal nutrition plays a crucial role in the growth and development of infants, particularly in the neonatal intensive care unit (NICU) where specialized care is essential. This study aims to explore current practices, challenges, and innovations in the nutrition and feeding of neonates, focusing on the utilization of human milk, fortifiers, and formula. Materials and Methods: A retrospective clinical study was conducted at a tertiary care NICU over a period of two years. Data were collected from medical records of neonates admitted to the unit. Information regarding feeding practices, types of milk (human milk, fortified human milk, or formula), fortification protocols, and associated clinical outcomes were analyzed. Results: A total of 150 neonates were included in the study. The majority (85%) received some form of human milk during their NICU stay, with 60% exclusively receiving human milk. Among those receiving human milk, 40% required fortification with a human milk fortifier due to inadequate growth parameters. Formula supplementation was necessary in 25% of cases due to maternal lactation insufficiency or medical contraindications to human milk. The mean duration of parenteral nutrition was 10 days, with a median time to full enteral feeds of 14 days. Infants receiving exclusively human milk demonstrated a lower incidence of necrotizing enterocolitis (NEC) compared to those receiving formula (5% vs. 12%, P < 0.05). Conclusion: Human milk remains the preferred source of nutrition for neonates in the NICU setting, associated with lower rates of NEC and improved clinical outcomes. However, fortification with human milk fortifiers or supplementation with formula is often necessary to meet the nutritional requirements of preterm infants. Further research is needed to optimize fortification protocols and improve long-term outcomes in this vulnerable population.

An extensive investigation into the bioactive component of breast milk, lactation, and clinical application of Galactagogues: A review

Nowadays, people are becoming more and more conscious of the link between nutrition, diet, and health. This bond is established from birth. In addition to being thought of as the finest nutrition for a newborn to preserve its physical and nutritional well-being, breastfeeding is usually seen as the best choice for a baby during the early stages of life. The American College of Obstetricians and Gynecologists (ACOG) advises breastfeeding exclusively for six months, after which the mother and child may decide to continue nursing in addition to introducing supplemental meals for the remainder of the baby's first year or beyond. Since breast milk includes a variety of bioactive ingredients, including proteins, vitamins, nucleotides, oligosaccharides, immunoglobulin, and some minerals, it is often regarded as the major nutritional supply for babies. A crucial opportunity for intervention to improve breastfeeding success is when inadequate supply of breast milk is often identified as the primary reason for early breastfeeding cessation. When non-drug breastfeeding support approaches fail to improve a persistently poor milk production, mothers frequently turn to drugs called galactagogues for assistance. Galactagogues function by interfering with the complex hormonal balance that controls breastfeeding, specifically with regard to prolactin and oxytocin. The available data about the effectiveness and safety of pharmacological treatments for lactation insufficiency is assessed in this narrative review. The majority of research has focused on the use of domperidone, and studies have indicated that there are modest short-term improvements for breast milk production. While there is less evidence supporting metoclopramide safety and efficacy than there is for domperidone, metoclopramide functions similarly to domperidone, thus in the event that domperidone is ineffective, it may be a good alternative for therapy. Lack of information on alternative medicines, such as metformin, oxytocin, prolactin, and herbal remedies, renders their clinical usage unreasonable. The study points out important gaps in the data and makes recommendations for possible future research topics related to galactagogues' impact on nursing.

Physiological DNA damage promotes functional endoreplication of mammary gland alveolar cells during lactation

Lactation insufficiency affects many women worldwide. During lactation, a large portion of mammary gland alveolar cells become polyploid, but how these cells balance the hyperproliferation occurring during normal alveologenesis with terminal differentiation required for lactation is unknown. Here, we show that DNA damage accumulates due to replication stress during pregnancy, activating the DNA damage response. Modulation of DNA damage levels in vivo by intraductal injections of nucleosides or DNA damaging agents reveals that the degree of DNA damage accumulated during pregnancy governs endoreplication and milk production. We identify a mechanism involving early mitotic arrest through CDK1 inactivation, resulting in a heterogeneous alveolar population with regards to ploidy and nuclei number. The inactivation of CDK1 is mediated by the DNA damage response kinase WEE1 with homozygous loss of Wee1 resulting in decreased endoreplication, alveologenesis and milk production. Thus, we propose that the DNA damage response to replication stress couples proliferation and endoreplication during mammary gland alveologenesis. Our study sheds light on mechanisms governing lactogenesis and identifies non-hormonal means for increasing milk production.

Advancing breastfeeding promotion: leveraging integrative natural galactagogues and unveiling their potential roles-Insights from a 19-year Taiwan nationwide registry to address lactation insufficiency in postpartum women.

Lactation insufficiency is a prevalent challenge for nursing mothers globally. There is a growing interest in the use of herbal galactagogues for enhancing lactation, but their therapeutic efficacy and underlying mechanisms need thorough investigation. This study aims to investigate the efficacy and mechanisms of action of herbal galactagogues in addressing lactation insufficiency by utilizing real-world data and employing a network analysis approach. Our retrospective study used Taiwan's Longitudinal Health Insurance Database 2000 (LHID2000) to identify 490 patients diagnosed with lactation insufficiency from 2000 to 2018. We analyzed demographic characteristics, co-existing diseases, and prescription patterns for both users and non-users of Chinese herbal products (CHP). Additionally, we utilized a network analysis approach to explore potential compounds and targets in the most frequently used CHP, the Wang Bu Liu Xing and Lu Lu Tong herb pair (WLHP) combination. Out of 490 patients, 81% were CHP users. There were no significant differences in demographic characteristics between CHP users and non-users, but we observed a notable divergence in the prevalence of co-existing diseases. A detailed examination of CHP prescriptions revealed the predominance of WLHP, prompting further investigation. Comprehensive analysis identified 29 major compounds in WLHP, which were associated with 215 unique targets. Intersection analysis revealed 101 overlapping targets between WLHP and lactation, suggesting their potential as therapeutic targets for lactation insufficiency treatment. Topological analysis of the protein-protein interaction (PPI) network identified 13 hub genes potentially crucial for the therapeutic effect of WLHP. Functional enrichment analysis showed that these targets were involved in critical lactation regulation pathways, including the PI3K-Akt signaling pathway, prolactin signaling pathway, estrogen signaling pathway, and AMPK signaling pathway. This study emphasizes the potential of CHP, specifically the WLHP combination, in managing lactation insufficiency. The multi-compound, multi-target approach of WLHP and its interaction with key biological processes and signaling pathways offer valuable insights into the underlying mechanisms of its therapeutic effects. These findings warrant further experimental validation and can guide future research and clinical applications of CHP in lactation insufficiency treatment.

Abstract A061: Grb7 is dispensible for normal development and ERBB2-driven mammary tumorigenesis, but maternal Grb7 deletion causes lactational insufficiency

Abstract Growth factor receptor-bound 7 (Grb7) is an adaptor protein implicated in signal transduction downstream of multiple receptor tyrosine kinases, including ERBB, FGFR and PDGFR pathways. Experimental studies have implicated Grb7 in regulating cell proliferation, survival, migration, and invasion through its large repertoire of protein-protein interactions. Here, we describe the generation and characterization of a Grb7 knockout (KO) mouse. These mice are viable and fertile. A lacZ knock-in reporter was used to visualize Grb7 promoter activity patterns in adult tissues, indicating widespread Grb7 expression in glandular epithelium, the central nervous system and other tissues. The sole defect observed in these animals was a failure of Grb7 KO females to successfully raise pups to weaning age, a phenotype that was independent of both paternal and pup genotypes. These data suggest a regulatory role for Grb7 in mammary lactational physiology. Grb7 is genomically adjacent to ERBB2 and commonly co-amplified with ERBB2 in human breast cancer. This adaptor protein physically interacts with ERBB2 and has been implicated in oncogenic signal propagation to intracellular pathways. We intercrossed Grb7 KO and MMTV-Neu mice to determine whether Grb7 is required for ERBB2-driven tumorigenesis. Surprisingly, there was no difference in time to tumor detection between cohorts, indicating that Grb7 is not obligately required for ERBB2-driven tumorigenesis. In conclusion, despite a considerable body of literature suggesting key roles for Grb7 in signal transduction pathways involved in both normal and malignant processes, our analysis of Grb7 KO mice demonstrates that Grb7 is largely dispensable for both development and ERBB2-driven tumorigenesis. These data raise the possibility that other Grb family members, Grb10 and Grb14, might compensate for Grb7 loss. Accordingly, a comprehensive assessment of all Grb family members may be needed to fully clarify their physiological roles. Citation Format: Kristopher A. Lofgren, Peter Feiszt, Paraic A. Kenny. Grb7 is dispensible for normal development and ERBB2-driven mammary tumorigenesis, but maternal Grb7 deletion causes lactational insufficiency [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr A061.

Analysis of a Pharmacy Developed, Outpatient Lactation Consultant Initiated Domperidone Programme.

Domperidone is a commonly prescribed galactagogue used off-label for lactation insufficiency. Prescriber unfamiliarity or safety concerns can lead to therapeutic delay and potential early breastfeeding discontinuation. To facilitate access, the study site pharmacy department developed a Structured Administration and Supply Arrangement (SASA) for International Board-Certified Lactation Consultants (IBCLC) to screen and initiate domperidone using a checklist. To validate a domperidone screening tool via analysis of its use and compliance, together with a staff satisfaction survey. Records were extracted from the REDCap® database for women with documented domperidone supply between 06/05/2022 and 27/01/2023 and reviewed with medical records. A staff survey was distributed assessing compliance and attitudes towards the SASA. Records of supply revealed that 34% (17/50) of patients were referred to a physician, revealing a discrepancy between database documentation and checklists, as no referrals were documented. Overall staff satisfaction with the SASA was rated 4.6 out of 5. 77.7% (7/9) felt confident counselling and supplying domperidone with the SASA in place. 88.9% (8/9) felt confident using the checklist to identify the appropriateness of therapy and referral to a physician. The system in place allows the IBCLCs to initiate and supply domperidone in a timely manner to breastfeeding mothers with lactation insufficiency. The support tools, including domperidone SASA, REDCap® documentation database and the checklist domperidone as a Galactagogue Checklist, can be greatly appreciated by the LCs. Continued discussion with IBCLCs to refine and improve the SASA and associated education package will result in more consistent compliance.

AYURVEDIC MANAGEMENT OF STANYAKSHAYA WITH DARUHARIDRADIGANA KASHAYA W.S.R TO HYPO GALACTORRHEA - A CASE STUDY.

Stanyakshaya is a common threat, with primiparous women. Incidence has been estimated to range from 23% to 63% during the 1st 4 months after delivery. Emotional stress, anxiety and maternal illness are the various psychosomatic factors that influence lactation insufficiency. Due to which many lactating mothers use alternative food/milk instead of breastmilk which is harmful for baby’s health. Case report: A 25-year-old female, came with complaint of less amount of breast milk, is housewife by occupation was treated with Daruhradigana kashaya according to treatment regimen. Result & Discussion: It has promising result in the management of all the parameters which improved gradually and at the end of day forty all parameter in mother found within normal limits of Stanyakshaya. Drugs used in the treatment of Mandagni serving as Nidana of all diseases is corrected, which are having Deepaniya Pachana Guna and Madhur rasa vipak. The correction of Atisantarpana leads to normalization of Vat dosh. So, the Preenan from the diet is assimilated properly by which Jeevan was achieved with respect to Jataragni. Conclusion: It works in Rasa dhatwagni Vardhan which in turn helps in Rasa dhatu & its Upadhatu nirman and same should be corrected as Stanya is Upadhatu of Rasa dhatu. Same treatment plan may not be helpful in each and every patient of Stanyakshaya. The present study reporting a case of hypo-galactorrhea diagnosed and observed marked improvement. We hope further extended research on this problem.

Does planning to mixed feed undermine breastfeeding?

Continued breastfeeding is important for infants'health, but it is unclear whether mixed feeding increases the risk of breastfeeding cessation. We aimed to explore associations of mixed feeding and lactation problems with early cessation of breastfeeding. We analysed data from mothers who completed the Scottish National Maternal and Infant Feeding Survey and had previously breastfed their infants. At age 8-12 weeks, mothers (N = 1974) reported their feeding history and intentions, lactation problems and reasons for giving formula milk. The main outcome measure was cessation of breastfeeding before 6-8 weeks and time to cessation. By 6 weeks, 65% had mixed fed at some point, 32% had ceased breastfeeding, 22% were currently mixed feeding and 46% were exclusively breastfeeding. Lactation problems before 2 weeks were common (65%), and strongly associated with stopping breastfeeding (relative risk [RR]: 3.23, 95% confidence interval [CI]: 2.0-5.3) and with mixed feeding (RR: 3.14, 95% CI: 2.5-4.0). However, even after adjustment for breastfeeding problems mothers who planned to mixed feed (RR: 3.39, 95% CI: 2.4-4.9) and those who introduced formula for practicalities (RR: 3.21, 95% CI: 2.3-4.4) were more likely to stop breastfeeding. These variables also predicted later lactation insufficiency (planned mixed feeding RR: 1.39, 95% CI: 1.0-2.0; formula for practicalities RR: 1.76, 95% CI: 1.3-2.3). Mothers who received specialist lactation support were less likely to cease breastfeeding (RR: 0.63, 95% CI: 0.5-0.9) but nonspecialist input was unrelated to risk of cessation (RR: 1.06, 95% CI: 0.2-4.9). In conclusion, choosing to mix feed an infant is strongly associated with stopping breastfeeding, even in the absence of lactation problems.

A scoping review on current technology-based approaches to support breastfeeding and informal human milk exchange practices.

Informal human milk exchange is the practice of donating and receiving expressed human milk based on mutual consent between the donor and receiver in the need of human milk for infants below 2 years old. Main concerns related to informal human milk exchange is related to milk siblings and safety handling of the expressed breastmilk. Even though there are countries which have policies and procedures related to human milk bank, informal milk exchange has not been given much attention. Compared to human milk bank, informal human milk exchange is not regulated. This study aims to identify the system focused on personalized breastfeeding tracking and monitoring, online discussion forum, web-based consultation, and breastfeeding station locator. Review of current applications in supporting breastfeeding practices was conducted based on the PRISMA-ScR framework. A literature search was conducted in Scopus and Google Scholar databases to identify articles published in English or Malay and containing systems/applications related to breastfeeding, milk sharing, milk exchange, milk siblings/kinship within the societal context. According to the scoping review, current scientific publications mostly focused on breast milk, breastfeeding, and milk banking concerns, with recurring themes including social reasons, lactation insufficiency, and unsolved nursing problems. These themes highlight the complexities and complexities of informal human milk exchange practices. Two reviewers screened the articles, and the data were extracted and narratively synthesized. During the primary database search, 360 articles were found based on the related titles, abstracts, and keywords. Seventy eight met the inclusion criteria and were finalized in this review. We found that most scholarly works focused on breast milk, breastfeeding and milk banking challenges and issues with recurrent themes i.e., societies, lactation inadequacy and unresolved nursing problems. Based on our literature search and to the best of our knowledge, there is no recent scoping reviews which focuses on technology-based approaches on informal human milk exchange. Findings from this scoping review is important for advancing research and practice in this field, as well as improving outcomes for individuals and families affected by informal human milk exchange.

A Conceptual Recapture of Stanya Kshaya and Role of Stanya-Janan Mahakashaya in its Management

Breast milk is the prime source of nourishment and immunity of the baby. Stanya Kshaya, which appears to be a fairly simple ailment but is really problematic for children's health, is one of the problems of present era. Lactation insufficiency is 30–40% prevalent in Asian and tropical nations like India. In Ayurveda certain herbs are specifically indicated for increasing breast milk and Acharya Charaka has described Stanya-janana Mahakashaya for it. Few explorations have been conducted regarding above, but no one has covered all aspects comprehensively thus this paper aim to collect and comprehensive review information available regarding concept of Stanya, its Kshaya and role of Stanya-janana Mahakashaya in its management. Methodology: This review is in a narrative format and done from literature and publications relevant to Stanya Kshaya and role of Stanya-janana Mahakashaya. Results: Stanya has been described in detail along with opinion of various Acharyas, Stanya sampata and the reasons for Stanyakshya mentioned then finally role of Stanya-janana Mahakashaya of Acharya Charaka which includes 10 herbs as- Veerana, Shali, Shasthik, Ekshuvalika, Darbha, Kusha, Kaasha, Gundra, Ithkata, Katruna. Drugs in this Kashaya help in increasing quantity of milk. Discussion: Stanya-janana Mahakashaya has active principles which increase quantity of milk, so can be used in Stanya Kshaya and leads to healthy Stanya.

Risperidone as a galactogogue of choice in peripartum: A concise review

Human lactation is a dynamic physiological process that produces a complex biological fluid that provides nutritive and nonnutritive factors for an optimal child growth and well-being. Several factors play a formidable role in maternal breast milk production with respect to quality, and quantity, which will adequately sustain the child for at least the first 6 months after delivery. Evidence has shown majority of new mothers who wished to immediately commence exclusive breastfeeding after birth as recommended by the WHO, are unable to initiate lactation immediately. In view of this lactation insufficiency, health-care personnel have not only been campaigning on appropriate breastfeeding education but also offer early lactation support such as encouraging liberal fluid intake, dietary modifications, and in a worst-case scenario, administering agents/drugs such as galactogogue. Orthodox galactogogues in current use are either hormonal or antipsychotics; most of them have relative efficacy and safety limitations. Risperidone is an atypical antipsychotic which has been used for decades with established safety in lactating mothers and the highest propensity to induce galactorrhea as a secondary effect when compared to other antipsychotics that are currently being used as galactogogues. We call the attention of the medical community in conducting further researches on its possible adoption as a galactogogue, using this review as an insight.

Obesity-derived alterations in the lactating mammary gland: Focus on prolactin

Obesity is a modern pandemic with negative consequences in women's reproductive health. Women with overweight and obesity can develop mammary gland alterations that unable exclusive breastfeeding. Obesity associates with a disturbed lactating mammary gland endocrine environment including a decreased action of the hormone prolactin (PRL), the master regulator of lactation. The PRL receptor and the action of PRL are reduced in the mammary gland of lactating rodents fed an obesogenic diet and are contributing factors to impaired lactation in obesity. Also, treatment with PRL improves milk yield in women with lactation insufficiency. This review focuses on the impact of diet-induced obesity in the lactating mammary gland and how obesity impairs the lactogenic action of PRL. Although obesity alters lactation performance in humans and rodents, the responsible mechanisms have been mainly addressed in rodents.

Hormonal regulation of mammary gland development and lactation.

Lactation is critical to infant short-term and long-term health and protects mothers from breast cancer, ovarian cancer and type 2 diabetes mellitus. The mammary gland is a dynamic organ, regulated by the coordinated actions of reproductive and metabolic hormones. These hormones promote gland development from puberty onwards and induce the formation of a branched, epithelial, milk-secreting organ by the end of pregnancy. Progesterone withdrawal following placental delivery initiates lactation, which is maintained by increased pituitary secretion of prolactin and oxytocin, and stimulated by infant suckling. After weaning, local cytokine production and decreased prolactin secretion trigger large-scale mammary cell loss, leading to gland involution. Here, we review advances in the molecular endocrinology of mammary gland development and milk synthesis. We discuss the hormonal functions of the mammary gland, including parathyroid hormone-related peptide secretion that stimulates maternal calcium mobilization for milk synthesis. We also consider the hormonal composition of human milk and its associated effects on infant health and development. Finally, we highlight endocrine and metabolic diseases that cause lactation insufficiency, for example, monogenic disorders of prolactin and prolactin receptor mutations, maternal obesity and diabetes mellitus, interventions during labour and delivery, and exposure to endocrine-disrupting chemicals such as polyfluoroalkyl substances in consumer products and other oestrogenic compounds.

Effect of Feeding Shatavari (Asparagus racemosus) Root Powder on Quantity of Milk in Crossbred Cows

Background: Shatavari (Asparagus racemosus) recommended as a galactagogue in case of lactational insufficiency. Shatavari can also help to boost the immune system, ward off infection of the udder and reproductive organs in cows. It may also be used to reduce the stress of dairy cows and increase their producing ability, resulting in the production of clean and nutritious milk. Methods: The present research work was carried out at the Research cum Development Project, Mahatma Phule Krishi Vidyapeeth, Rahuri, Dist- Ahmednagar, Maharashtra. Twenty physically fit milking crossbred cows have been selected for the study and divided into four equal groups, five having five animals each. All the cows from treatment groups were fed as per ICAR (2013) feeding standard to meet the nutritional requirement. The experimental animals from group T1, T2, T3 and T4 were fed a diet containing shatavari root powder @ 0, 40, 80 and 120 gm/cow/day respectively for a period of 60 days. Result: At the time of milking, each cow’s daily milk output (kg) was recorded. The current study found that supplementing with shatavari root powder enhanced milk production significantly (P less than 0.05) over the control group (T1).

Characteristics and Related Factors to Breast Milk Production of Postpartum: Preliminary Study at Public Health Center of Semarang City

Approximately 38-63% of primiparous postpartum mothers experience lactation insufficiency, which has an impact on not breastfeeding their babies. The purpose of this study was to determine the characteristics and factors associated with postpartum mothers' milk production at the Public Health Center of Semarang City. This type of research is observational and cross-sectional design. The population of all postpartum women in Semarang City in October 2021, was taken by cluster random sampling at 8 selected health centers and a sample of 124 postpartum women. Methods of collecting data were questionnaires and data analysis with chi-square. The results of the research are the characteristics of mothers with an average age of 28 years, 56.5% of secondary education, 40% of primiparous parity, 59% of normal BMI, 92.7% of normal LILA, average age of the baby was 7 days, 82.3% of moderate anxiety level, 99.2% off good staff support, 58.9% of good surveillance worker support, 91.1% of good family support, 82.3% of more calorie intake of 2200 kcal, 62.1% of 1600 ml more fluid intake. There was a relationship between anxiety, family support, health volunteer support, calorie and fluid intake with breast milk production (p-value <0.05). There was no relationship between the support of health workers with postpartum mothers' milk production (p = 0.166). Mother’s psychological condition while breastfeeding, support from family, and health insurance are important things in increasing breast milk production as a continuation of breastfeeding and exclusive breastfeeding. In addition, calorie and fluid intake need to be considered to maintain the adequacy of mother's milk.

THE EFFECTS OF METHANOLIC LEAF EXTRACT OF GONGRONEMA LATIFOLIUM ON MILK YIELD AND SOME LACTOGENIC HORMONES IN LACTATING WISTAR RATS

Proper and exclusive breastfeeding is recommended during the early infancy stage of a child. Lactation insufficiency serves as a hinderance to this. Gongronema latifolium is an important medicinal plant known for its various therapeutic effects. The lactogenic effects of Gongronema latifolium used locally to boost lactation was investigated. Twenty Wistar dams were grouped into five groups (n=4); consisting of control group (1 ml/kg distilled water), standard drug group (metoclopramide 5 mg/kg), 200 mg /kg, 400 mg/kg and 800 mg/kg Gongronema latifolium methanolic extract groups. The pups were weighed 18 hours after the administration of Gongronema latifolium orally, to assess milk yield while the serum was gotten from the dams on the ninth day of administration. Toxicity study showed that the plant extract was non-toxic (LD50 > 5000 mg/kg) when administered orally. The leaf extract significantly increased the serum prolactin (p< 0.05). There was also significant increase in the milk yield in the group administered with Gongronema latifolium group versus the control group (7.28 ± 1.15 g/pup, 7.33 ± 1.08 g/pup and 9.68 ± 0.97 g/pup vs 5.5 ± 1.01 g/pup respectively). These lactogenic effects were also dose- dependent. The leaf extract had no significant effect on the oxytocin serum concentration of the lactating Wistar rats. The lactogenic effect Gongronema latifolium may be ascribed to the presence of phytochemicals such as Saponins (e.g., diosgenin, kaempferol, quercetin and silybin) that have phytoestrogenic effects that could promote milk synthesis, secretory differentiation and mammary epithelial cells proliferations.

Renal functions in term neonates with weight loss of more than 10% in early neonatal period - A cross sectional study

Normally neonates lose 5-7% of their birth weight in the first week of life. Inadequate breastfeeding resulting from different factors may result in dehydration and excessive weight loss. Hypernatremic dehydration leading to acute kidney injury (AKI) is a well-known complication of lactational insufficiency in exclusively breast-fed babies progresses from pre-renal to intrinsic renal injury, if persistent. Acute kidney injury (AKI) is a complex disorder which has a clinical manifestations ranging from mild dysfunction to complete anuric kidney failure.To evaluate renal function tests (RFT) in term neonates with more than 10% weight loss within 7 days of life.To determine the frequency of acute kidney injury in term neonates with more than 10% weight loss within 7 days of life.1:To determine type of acute kidney injury (Prerenal, Renal); 2: Assess the percentage of dehydration in terms of percentage of weight loss (more than 10%, more than 15%); 3: Assess type of dehydration (hypernatremic, isonatremic, hyponatremic); 4: To assess type of dehydration with acute kidney injury.A hospital based prospective study was conducted on term neonates in a tertiary care hospital for period of 12 months from July 2019 to June 2020. Daily weight of all the neonates was recorded using electronic weighing machine. 103 new-borns presenting with weight loss of more than 10 % of birth weight within 7 days of life were enrolled as per convenient sampling technique without any bias. Neonates with congenital anomalies of kidney, sepsis, birth asphyxia and diabetes insipidus were excluded. Neonates were assessed by performing renal function test as a marker of dehydration. One hundred and three neonates with weight loss of more than 10% were enrolled in the study. Among them, 88 (85.4%) had prerenal AKI and 15 (14.5%) had renal AKI; 68(66%) neonates had dehydration of 10-15% while, 35 (34%) had dehydration of more than 15%. Most of the neonates 75(73.4%) had hypernatremic dehydration while 25(25%) and 3(1.5%) had isonatremic and hyponatremic dehydration respectively. 69, 16 and 3 neonates with prerenal AKI had Hypernatremia, isonatremia and hyponatremia respectively while 5 and 9 neonates with renal AKI had Hypernatremia and isonatremia respectively. None of the neonate had renal AKI with hyponatremia.: Hypernatremia is severe enough to cause prerenal AKI progressing to renal AKI in exclusively breast-fed babies without any associated comorbidities. Training of mothers, care givers and doctors and weight monitoring of breast-fed babies to identify at risk neonates is important in early diagnosis.

Stimulation of Lactation Using Acupuncture: A Case Study.

Introduction:Breastfeeding is a recognized preferred method of infant feeding; however, for many women, difficulties in breastfeeding result in termination before the recommended period of time. Acupuncture is suggested to be a promising option to treat lactation insufficiency and enhance the production of maternal milk.Main Issue:We have reported the case of a woman with lactation insufficiency due to Caesarean section and congenital unilateral invaginated nipple. Milk production started on the 3rd day following delivery. The newborn was not provided with any food or fluids other than mother’s milk. At 5 days of life, the newborn required long feeding periods and lost 4% of his birth weight, with the participant reporting lactation insufficiency described by the perception of inadequate milk production.Management:Despite the implementation of conventional measures to improve lactation, the difficulties in breastfeeding persisted. Acupuncture was tried on Day 6 of life, and enhanced milk production was observed, which could be measured as the volume of residual milk extracted using the breast pump each time after the newborn achieved satiety. After acupuncture treatment there was an augmentation of maternal milk production from both breasts and successful lactation.Conclusion:This case study provides information that might be useful for prospective investigation of acupuncture’s efficacy in women with lactation insufficiency.

Stanyakshya (insufficient lactation) and its management by an Ayurveda formulation: A case report

Introduction: Human milk is an indispensable need for infant survival. As it contains thousands of micronutrients, macronutrient, bioactive components, immunological factors that gives immense protection against infection and inflammation. In Ayurveda classics, Stanya (breast milk) has given a very pivotal place for baby. But currently many mothers are not fortunate enough to feed their new born due to deficient support from their health. After reviewing Ayurveda classics, it can be concluded that major cause of lactation insufficiency in Sutikaawastha(puerperium) is Agnimandya and Dhatu/Updhatukshaya. For such conditions, judicial selection of drugs is very important, as in Ayurveda number of Stanyajanana and Stanyavardhaka drugs (galactogogues) are mentioned for initiationand augmentation of milk production. Materials and Methods: Following is a case report of a 32-year-old female who was not able to feed her baby properly even after seven days of normal delivery. She was treated with a simple decoction of DeepenaPaachana drugs; Shatapushpa, Dhanyaka, KrishnaJeeraka etc. Results were assessed on the basis of subjective parameters; mother - Stanyapravriti in a day, baby - Shishurodana, Bharavridhi, Nidra etc. All the medications were given for 42 days and all the parameters were assessed and found with in normal limit. Conclusion: Main cause for insufficient milk production in this case and many more like this is Agnimandya at the level of Jatharagni as well as Dhatwagni also. By correcting condition of Agni,one can easily manage such cases, there is no need to give Stanyavardhana drugs to all the patients.

Chronic Lactation Insufficiency Is a Public Health Issue: Commentary on "We Need Patient-Centered Research in Breastfeeding Medicine" by Stuebe. Breastfeed Med 2021;16:349-350.

Chronic Lactation Insufficiency Is a Public Health Issue: Commentary on "We Need Patient-Centered Research in Breastfeeding Medicine" by Stuebe. Breastfeed Med 2021;16:349-350.