Weeks Of Breastfeeding Research Articles

7013 An Inpatient Perspective: Hyperprolactinemia and Granulomatous Mastitis

Abstract Disclosure: A. Le: None. J. Wade: None. K. Martz: None. D. Girgis: None. M. Shahlapour: None. M.H. Horani: None. Introduction: Mastitis is a highly prevalent condition impacting thousands of women every year. Most commonly associated with lactation, mastitis is estimated to impact 2-20% of lactating women particularly in the first 4-6 weeks of breastfeeding (Wilson et al., 2020). The majority of cases are associated with bacterial infection with Staphylococcus aureus precipitated by nipple trauma and hyperlactation in the setting of genetic predispositions and disturbances to the human milk microbiota (Fernández et al., 2020). In rare cases, mastitis is seen outside of the context of lactation. One cause of non-lactational mastitis is idiopathic granulomatous mastitis (IGM). The pathogenesis of IGM is poorly understood, but there has been a rare association between IGM and hyperprolactinemia reported in the literature (Nikolaev et al., 2016). Case Presentation: In January 2022, A 20 year old female with past medical history of type 2 diabetes mellitus and hypertension, initially presented to the emergency department with complaints of headache. Patient’s history is notable for two years of amenorrhea and periodic nipple discharge. MRI scan of the head revealed a 1.6 cm pituitary macroadenoma which correlated with a markedly elevated prolactin level at 533.3. She was discharged with a prescription for Cabergoline 0.5 mg BID. In July 2022, the patient presented to the ED complaining of severe left breast pain with associated discharge for 4 days. She admitted to being non-adherent to Cabergoline treatment since April 2022 due to lack of endocrine follow-up. CT of the breast at that time showed a 3.8 cm subareolar abscess. Aspiration of the abscess revealed non-purulent fluid and cultures of the aspirate were negative. In February 2023, patient presented for right breast pain with a similar workup to previous hospitalization. MRI of the brain revealed a 1.6 cm sellar mass is unchanged since January 2022. Prolactin level was elevated at 652.4. Patient stated she has been off Cabergoline for the prior 5 months. She was subsequently seen for right and left mastitis 3 times over the next 12 months. Upon endocrine consultation, the patient was counseled on the importance of Cabergoline treatment in regression of future mastitis episodes, and the patient has subsequently not returned to our service. Conclusion: This case demonstrates the rare association between prolactin secreting pituitary adenomas and granulomatous mastitis that clinicians need to consider in order to avert delays in treatment and unnecessary hospitalizations. Specifically, when working up a patient with a history of IGM and prolactinemia, it is imperative to monitor prolactin levels periodically over an extended course of time with appropriate MRI imaging of the pituitary gland to assess for regression of prolactinoma and episodes of IGM. Presentation: 6/1/2024

Socioeconomic Impact of Livestock Farming: A Case Study of Baitadi and Darchula Districts, Nepal

Dairy is the oldest staple food, along with fruits and vegetables, for humans. This study investigated the socioeconomic factors influencing milk and dairy production in Baitadi and Darchula districts, Shailyashikhar municipality, and Dilasaini rural municipality, Nepal. Among the 5384 livestock farmers, 100 livestock farmers were randomly selected for the investigation. The findings demonstrated the existence of a subsistence agricultural system for livestock farming with small landholdings. There is a dominance of males over females in decision-making, and workload is common for females. There is a unique practice of management for milk produced during the first three weeks of lactation: 99% of people do not consume milk for 19.81±4.597 mean days; 96% of people do not sell milk; 53% do not sell ghee; 73% of parents refuse to give their kids cow's milk during the first three weeks of breastfeeding; and 16% do not consume ghee because of their tradition. There are various problems in livestock farming, i.e., feed management, low land holding, disease, cost of production, less government support, and lack credit. Feed management was ranked first, whereas lowland holding was ranked second. Worms are the most common disease causing organism seen in livestock in the study area because of the lack of access to improved and well-sanitized barns. Herbal plants are commonly used in disease management. Sociocultural factors directly affect livestock production. Different traditional beliefs, a lack of improved breeds, disease, and feed management have direct impacts on milk production. Int. J. Appl. Sci. Biotechnol. Vol 12(3): 166-179.

Monitoring of the Main Reasons for Early Abandonment of Breastfeeding during the First Six Months of Life: A Secondary Analysis.

The rate of six-month-old infants exclusively breastfed in Spain remains below the recommended rate. This study aimed to explore in detail the evolution of feeding during the first six months of life of a group of newborns, as well as to identify the reasons reported by the mothers for feeding change. A secondary analysis of two prospective longitudinal observational studies was conducted. In both studies, women participants, during the clinical puerperium, opted for exclusive breastfeeding for their newborns. The participants were followed up during the infants' first six months. A sample size of 314 participants was obtained, of which 77.1% (n = 232) were of Spanish origin, and 51% (n = 160) were primiparous. The prevalence of exclusive breastfeeding at six months was 55.4% (n = 174). During the first four months of life, the main reason for early abandonment of breastfeeding was the perception of insufficient milk production. After the fourth month, the predominant reason was starting work. Statistically significant differences were observed between the reasons for giving up and the total weeks of exclusive breastfeeding (p < 0.001) and total weeks of breastfeeding (p = 0.002). Early weaning from breastfeeding is a multifactorial phenomenon. However, depending on the moment cessation occurs, some reasons predominate over others and, in many cases, can be prevented. These results indicate the need to continue investing efforts to promote and protect breastfeeding in Spain.

Quantifying the Association between Pump Use and Breastfeeding Duration

To quantify the extent to which pump use is associated with breastfeeding duration. We conducted a cross-sectional analysis of weighted CDC Pregnancy Risk Assessment Monitoring System data from Maine, Michigan, New Mexico, and Utah between 2016 and 2021. Included respondents had a live-born infant at survey completion, initiated breastfeeding, and had non-missing data for reported pump use and breastfeeding duration. Using Cox proportional hazard regression, we quantified the hazard of breastfeeding cessation and median duration (weeks) of breastfeeding by pump use. Pump use was suspected to be differentially impacted by race and ethnicity; an interaction was tested in our regression model. Our sample included 19,719 mothers (weighted N= 723,808) with mean age (SD) 29.5 years (5.6). Mothers with age <18 years, Medicaid enrollment, race and ethnicity other than non-Hispanic White, lower income or education, and unmarried status demonstrated lower pump use (p<0.001). Pump use was associated with 37% lower hazard of breastfeeding cessation (aHR 0.63; 95% CI: 0.56-0.70) and 21 additional weeks of breastfeeding on average. The association varied by race and ethnicity (significant interaction observed between pump use and non-Hispanic Black mothers, p=0.013); stratified analysis demonstrated the lowest hazard of breastfeeding cessation among non-Hispanic Black and Native American pump users (aHR 0.47 [0.40-0.54] and 0.51 [0.37-0.70], respectively). Pump use was associated with longer breastfeeding duration; the greatest magnitudes of association were found among non-Hispanic Black and Native American participants, groups disproportionately affected by breastfeeding inequities. Future research examining the context around and causal impact of pump use on breastfeeding outcomes is needed.

THE CONTRIBUTION OF BREAST-FEEDING TO THE DEPURATION OF DDE

The presence of persistent organic halogens (POHs) in maternal plasma and milk has been recognized since the 1970s. Yet, the presence of these compounds in human milk poses a still undetermined risk to the health of mother and child. The vertical transfer of POHs during either pregnancy or after birth during breast-feeding remains a concern. The paucity of data on maternal plasma contaminant levels before and after long periods of breast-feeding poses a serious problem for researchers attempting to model contaminant changes in maternal plasma and contaminant transfer via milk to the baby. This issue is of clinical concern since there is inadequate data to model infant exposure to POHs, leading to uninformed decisions about risks and benefits of breast-feeding. To address this issue we carried out a longitudinal analysis of the association between maternal plasma p,p'-DDE (1,1-dichloro-2,2- bis(p-chlorophenyl) ethylene) load and breast-feeding duration and parity. This pesticide residue was chosen because it is both an ubiquitous and abundant POH. The women recruited for the study were 34.4 + 2.8 yr and had breast-fed an average of 2.1 children a total of 64.6 + 32.6 weeks when they were sampled at the end of the study. A questionnaire was used to determine the mother's breast-feeding activity. We found that the women had very low levels of p,p'-DDE in their plasma and milk compared to other populations in the world and that the trend in Canada towards lower contaminant loads has been sustained in our study population. The regression of change in plasma p,p'-DDE with breast-feeding duration is significant (p &lt; 0.01, F = 15.80, and n=12). We found that maternal plasma p,p'-DDE levels changed by 0.0057 μg/L for every week of breast-feeding. Thus, women breast-feeding their infants lost, on average, 30 μg of this contaminant per week. These results suggest that maternal depuration of p,p'-DDE via breast-feeding is a significant cause of maternal contaminant loss and contaminant accumulation in the baby.

The Umbilical Cord Creatine Flux and Time Course of Human Milk Creatine across Lactation.

(1) Background: The aim of the present paper was to study fetal and infant creatine (Cr) supply to improve nutrition and neuroprotection in term and especially in preterm infants. The primary outcomes were the placental Cr flux at the end of pregnancy and the time course of human milk (HM) Cr. (2) Methods: The estimation of placental Cr flux was based on umbilical arterial and venous cord blood Cr in 10 term infants after elective caesarian section. HM Cr, creatinine (Crn), and macronutrients were measured longitudinally in 10 mothers across the first 6 months of breastfeeding. (3) Results: At the end of pregnancy, the mean fetal Cr flux was negative (-2.07 mmol/min). HM Cr was highest in colostrum, decreased significantly within the first 2 weeks of breastfeeding (p < 0.05), and did not change significantly thereafter. HM Cr was not correlated with HM Crn or macronutrient composition. (4) Conclusions: The present data suggest that fetal endogenous Cr synthesis covers the needs at the end of pregnancy. However, high colostrum Cr and HM Cr levels, independent of macronutrient composition, suggest that there may be a critical Cr demand immediately after birth that needs to be covered by enteral supply.

Breastfeeding initiation and duration among people with mild chronic hypertension: a secondary analysis of the Chronic Hypertension and Pregnancy trial

Increased duration of breastfeeding improves maternal cardiovascular health and may be especially beneficial in high-risk populations, such as those with chronic hypertension. Others have shown that individuals with hypertension are less likely to breastfeed, and there has been limited research aimed at supporting breastfeeding goals in this population. The impact of perinatal blood pressure control on breastfeeding outcomes among people with chronic hypertension is unknown. This study aimed to evaluate whether breastfeeding initiation and short-term duration assessed at the postpartum clinic visit differed according to perinatal blood pressure treatment strategy (targeting blood pressure <140/90 mm Hg vs reserving antihypertensive treatment for blood pressure ≥160/105 mm Hg). We performed a secondary analysis of the Chronic Hypertension and Pregnancy trial. This was an open-label, multicenter, randomized trial where pregnant participants with mild chronic hypertension were randomized to receive antihypertensive medications with goal blood pressure <140/90 mm Hg (active treatment) or deferredtreatment until blood pressure ≥160/105 mm Hg (control). The primary outcome was initiation and duration of breastfeeding, assessed at the postpartum clinic visit. We performed bivariate analyses and log-binomial and cumulative logit regression models, adjusting models for variables that were unbalanced in bivariate analyses. We performed additional analyses to explore the relationship between breastfeeding duration and blood pressure measurements at the postpartum visit. Of the 2408 participants from the Chronic Hypertension and Pregnancy trial, 1444 (60%) attended the postpartum study visit and provided breastfeeding information. Participants in the active treatment group had different body mass index class distribution and earlier gestational age at enrollment, and (by design) were more often discharged on antihypertensives. Breastfeeding outcomes did not differ significantly by treatment group. In the active and control treatment groups, 563 (77.5%) and 561 (78.1%) initiated breastfeeding, and mean durations of breastfeeding were 6.5±2.3and 6.3±2.1weeks, respectively. The probability of ever breastfeeding (adjusted relative risk, 0.99; 95% confidence interval, 0.93-1.05), current breastfeeding at postpartum visit (adjusted relative risk, 1.01; 95% confidence interval, 0.94-1.10), and weeks of breastfeeding (adjusted odds ratio, 0.87; 95% confidence interval, 0.68-1.12) did not differ by treatment group. Increased duration (≥2 vs <2 weeks) of breastfeeding was associated with slightly lower blood pressure measurements at the postpartum visit, but these differences were not significant in adjusted models. In a secondary analysis of the cohort of Chronic Hypertension and Pregnancy trial participants who attended the postpartum study visit and provided breastfeeding information (60% of original trial participants), breastfeeding outcomes did not differ significantly by treatment group. This suggests that maintaining goal blood pressure <140/90 mm Hg throughout the perinatal period is associated with neither harm nor benefit for short-term breastfeeding goals. Further study is needed to understand long-term breastfeeding outcomes among individuals with chronic hypertension and how to support this population in achieving their breastfeeding goals.

Vine Regression with Bayes Nets: A Critical Comparison with Traditional Approaches Based on a Case Study on the Effects of Breastfeeding on IQ.

Regular vines (R‐vines) copulas build high dimensional joint densities from arbitrary one‐dimensional margins and (conditional) bivariate copula densities. Vine densities enable the computation of all conditional distributions, though the calculations can be numerically intensive. Saturated continuous nonparametric Bayes nets (CNPBN) are regular vines. Computing regression functions from the vine copula density is termed vine regression. The epicycles of regression–including/excluding covariates, interactions, higher order terms, multicollinearity, model fit, transformations, heteroscedasticity, bias–are dispelled. One simply computes the regressions from the vine copula density. Only the question of finding an adequate vine copula remains. Vine regression is applied to a data set from the National Longitudinal Study of Youth relating breastfeeding to IQ. The expected effects of breastfeeding on IQ depend on IQ, on the baseline level of breastfeeding, on the duration of additional breastfeeding and on the values of other covariates. A child given two weeks breastfeeding can expect to increase his/her IQ by 1.5–2 IQ points by adding 10 weeks of breastfeeding, depending on values of other covariates. A child given two years breastfeeding can expect to gain from 0.48–0.65 IQ points from 10 additional weeks. Adding 10 weeks breastfeeding to each of the 3,179 children in this data set has a net present value $50,700,000 according to the Bayes net, compared to $29,000,000 according to the linear regression.

OXTR rs53576 Variation with Breast and Nipple Pain in Breastfeeding Women

BackgroundThirty percent of women who seek professional breastfeeding support require assistance with ongoing breast and nipple pain and < 50% of women report resolution of their pain. It is unknown if there is a molecular risk for ongoing breast and nipple pain during breastfeeding. Aim –To evaluate associations among breast and nipple pain sensitivity and candidate pain sensitivity single-nucleotide polymorphisms [SNPs], (COMT rs6269, rs4633, rs4818, rs4680 and OXTR rs2254298, rs53576) in breastfeeding women. Design - A secondary analysis of a pilot randomized controlled trial of a pain self-management intervention conducted over 6 weeks postpartum. Setting and Participants - Sixty women were recruited from two hospital settings after birth. Methods – All participants underwent standardized mechanical somatosensory testing for an assessment of pain sensitivity and provided baseline buccal swabs for genetic analysis. At 1, 2, and 6 weeks postpartum, women self-reported breast and nipple pain severity using a visual analogue scale. Results - Women with the minor allele OXTR rs53576 reported 8.18-fold higher breast and nipple pain severity over time. For every 1-unit increase in Mechanical detection threshold and windup ratio, women reported 16.51-fold and 4.82-fold higher breast and nipple pain severity respectively. Six women with the OXTR rs2254298 minor allele reported allodynia. Conclusion - The presence of OXTR alleles in women with enhanced pain sensitivity suggests a phenotype of genetic risk for ongoing breast and nipple with potential for pain-associated breastfeeding cessation. Somatosensory testing identified women who reported higher breast and nipple pain during the first weeks of breastfeeding.

A Study to Find the Prevalence of Breast Engorgement among Lactating Mothers

Introduction: Breast engorgement problem was common in early days and also after weeks of breast feeding. This frequent problem can happen to lactating mother who don’t or can’t breast feed as well as those who do. It is usually caused by an imbalance between milk supply and infant demand, if engorgement left untreated it can lead to potentially serious issues including painful blebs, plugged milk ducts or mastitis. Aim: The study aimed to find out the prevalence of breast engorgement among lactating mothers with vaginal delivery, Lower segmental caesarean section. Materials and Method: A total of 90 women were selected from SaveethaHospital and Saveetha Rural Health Centre, based on the inclusion criteria Saveetha Hospital and Saveetha Rural Health Centre, based on the inclusion criteria of Lactating mothers with Breast Engorgement and pain for atleast 2-3 days who underwent vaginal delivery or lower segmental caesarean section. Exclusion criteria were lactating mothers with soft breast and non lactating mothers and other breast problems. After getting the consent from mothers and after explaining the Six Point Self-rated Engorgement Scale(SPES) and Visual Analogue Scale(VAS). They were asked to rate their level of engorgement and pain. The materials used were VAS and SPES. Results: The study showed that the prevalence of breast engorgement among lactating mothers was 65%-75%. Conclusion: The study concluded that the prevalence of breast engorgement among lactating mothers was 65%-75%. Breast engorgement is a major issue in the lactating mothers can leads to many problems like blocked milk ducts, feeding difficulties, a depressed milk ejection reflex, infection, inflammation of the breast and sore/cracked nipples.

Antiretroviral Drug Concentrations in Breastmilk, Maternal HIV Viral Load, and HIV Transmission to the Infant: Results From the BAN Study.

Concentration of antiretroviral (ARV) drug found in plasma, and amounts of drug excreted into breastmilk, may affect HIV viral load and potentially perinatal HIV transmission. In this cohort study with 2-phase sampling, we included mothers randomized to postpartum maternal ARVs or daily infant nevirapine during 28 weeks of breastfeeding in the Breastfeeding, Antiretrovirals, and Nutrition study. Among these, we included all mothers who transmitted HIV to their infants between 2 and 28 weeks and 15% of mothers who did not (n = 27 and 227, respectively). Spearman correlation coefficients (r) were used to assess the correlation between maternal plasma and breastmilk ARV concentration. Associations between the median effective drug concentration (EC50) and detectable maternal viral load (plasma: >40 copies per milliliter, breastmilk: >56 copies per milliliter) were assessed using mixed-effects models. Cox models were used to estimate the association between maternal or infant plasma drug concentration and breastmilk HIV transmission from 2 to 28 weeks. All ARV compounds exhibited substantial correlations between maternal plasma and breastmilk concentrations (r: 0.85-0.98, P-value <0.0001). Having plasma drug concentration above the EC50 was associated with lower odds of having detectable HIV RNA [maternal plasma odds ratio (OR) 0.64, 95% confidence interval (CI): 0.45 to 0.91; breastmilk OR 0.22, 95% CI: 0.14 to 0.35] and a reduced rate of breastmilk HIV transmission (hazard ratio 0.40, 95% CI: 0.18 to 0.93). Having breastmilk drug concentration above the EC50 was also associated with lower odds of having detectable maternal HIV RNA (plasma OR 0.62, 95% CI: 0.45 to 0.85; breastmilk OR 0.42, 95% CI: 0.29 to 0.59). Ensuring adequate drug concentration is important for viral suppression and preventing breastmilk HIV transmission.

Pharmacological management of common lactation problems

AbstractThe importance of breastfeeding is well recognised with benefits for both the mother and infant. Despite these benefits, women often cease breastfeeding prematurely after experiencing common problems such as breast and nipple pain or low breast milk supply in the early weeks of breastfeeding. Some mothers stop breastfeeding while taking medications to treat these conditions because of unfounded concern or inappropriate advice from healthcare providers. Most of these conditions can be managed without the need to stop breastfeeding. This review provides pharmacists with an understanding of common breastfeeding problems and outlines evidence‐based pharmacological management strategies for women experiencing these complications. All health professionals need to support mothers to continue breastfeeding for as long as they desire, and pharmacists have a unique role and a clear responsibility to provide up‐to‐date, evidence‐based information to empower breastfeeding mothers in their decision making to ensure breastfeeding is not stopped without good reason.

Effect of Application of Cabbage Leaves on Breast Engorgement among Postnatal Women−A Literature Review

The aim of researcher is to evaluate the effect of application of cabbage leaves on breast engorgement among postnatal women. Breast engorgement is a common physiological problem for lactating women that is caused by the sudden increase in the volume of the breast milk due to lymphatic and vascular congestion with interstitial oedema during the first two weeks of breast feeding. Adequate management of engorgement is important for successful long-term lactation. The goal of treatment of breast engorgement is to relieve discomfort and control swelling. The women were receiving Pharmacological and non-pharmacological methods like expression of breast milk, using of breast Pump binder, nipple shield, hot and cold application. Some of these methods are costly or may cause discomfort to women. So, natural therapy can be advised to the women in low cost which can be used easily even at home without guidance like cabbage leaves.

Longitudinal Study of Stable Isotope Compositions of Maternal Milk and Implications for the Palaeo-Diet of Infants

The classic interpretation of stable isotope data from young children in an archaeological context is based on the hypothesis that the nitrogen isotope ratios present in breast milk remain identical throughout the breastfeeding period. This exploratory study assesses the changes in the nitrogen and carbon isotope ratios in maternal milk and in the nails of the mother and child, with the aim to evaluate the impact of variations in the stable isotope ratios in maternal milk on the tissues of children, and consequently on the reconstruction of the palaeo-diet of young children. The results show that the isotopic composition of maternal milk diminishes in relation to the mother's tissues like nails and, by extrapolation, bones. The δ15N values of the milk vary little during the weeks of breastfeeding, but this is not the case for carbon, which varies considerably during the course of breastfeeding and weaning and does not seem to be linked to the mother's diet and/or to the height and weight of the child. The difference between the δ15N values recorded for the mother's and child's nails is less than 2‰, which is lower than the values often cited in bioarchaeological literature. In addition, the data from this study does not confirm the hypothesis of a significant increase in heavy isotopes in the nails of newborn babies in relation to those of their mother at childbirth.

The effect of breastfeeding on lung function at 12 and 18 years: a prospective cohort study.

The objective was to assess associations between duration of total and exclusive breastfeeding and lung function up to adolescence.A birth cohort (Melbourne Atopy Cohort Study) of 620 infants with a family history of allergic disease was recruited. Mothers were encouraged to breastfeed exclusively for 6 months. Lung function was assessed at 12 and 18 years of age. Associations between breastfeeding and lung function were investigated using multivariable linear regression and path analysis was used to assess the potential mediating factors.Duration of breastfeeding (total and exclusive) was not associated with most assessed lung function outcomes. However, there was a trend for increased pre-bronchodilator mid-expiratory flow (MEF) at both 12 (adjusted mean difference (95% CI) per week of breastfeeding of 10 (-1-20) mL·s(-1)) and 18 years (11 (-1-22) mL·s(-1)) (p-values of 0.07 and 0.08, respectively). There was a strong indirect effect of height on these observed associations.Duration of breastfeeding does not appear to greatly influence lung function outcomes in children with a family history of allergic diseases. Longer duration of exclusive breastfeeding may be associated with an increase in MEF, partly due to greater attained height of the child.

Understanding the importance of collecting qualitative data creatively.

Understanding the importance of collecting qualitative data creatively.

Planned early delivery versus expectant management of the term suspected compromised baby for improving outcomes.

Planned early delivery versus expectant management of the term suspected compromised baby for improving outcomes.

Extended pre-exposure prophylaxis with lopinavir–ritonavir versus lamivudine to prevent HIV-1 transmission through breastfeeding up to 50 weeks in infants in Africa (ANRS 12174): a randomised controlled trial

Strategies to prevent postnatal mother-to-child transmission of HIV-1 in Africa, including infant prophylaxis, have never been assessed past 6 months of breastfeeding, despite breastfeeding being recommended up to 12 months after birth. We aimed to compare the efficacy and safety of infant prophylaxis with the two drug regimens (lamivudine or lopinavir-ritonavir) to prevent postnatal HIV-1 transmission up to 50 weeks of breastfeeding. We did a randomised controlled trial in four sites in Burkina Faso, South Africa, Uganda, and Zambia in children born to HIV-1-infected mothers not eligible for antiretroviral therapy (CD4 count >350 cells per μL). An independent researcher electronically generated a randomisation schedule; we then used sequentially numbered envelopes to randomly assign (1:1) HIV-1-uninfected breastfed infants aged 7 days to either lopinavir-ritonavir or lamivudine (paediatric liquid formulations, twice a day) up to 1 week after complete cessation of breastfeeding or at the final visit at week 50. We stratified the randomisation by country and used permuted blocks of four and six. We used a study label on drug bottles to mask participants, study physicians, and assessors to the treatment allocation. The primary outcome was infant HIV-1 infection between age 7 days and 50 weeks, diagnosed every 3 months with HIV-1 DNA PCR, in the modified intention-to-treat population (all who attended at least one follow-up visit). This trial is registered with ClinicalTrials.gov, number NCT00640263. Between Nov 16, 2009, and May 7, 2012, we enrolled and randomised 1273 infants and analysed 1236; 615 assigned to lopinavir-ritonavir or 621 assigned to lamivudine. 17 HIV-1 infections were diagnosed in the study period (eight in the lopinavir-ritonavir group and nine in the lamivudine group), resulting in cumulative HIV-1 infection of 1.4% (95% CI 0.4-2.5) and 1.5% (0.7-2.5), respectively. Infection rates did not differ between the two drug regimens (hazard ratio [HR] of lopinavir-ritonavir versus lamivudine of 0.90, 95% CI 0.35-2.34; p=0.83). Clinical and biological severe adverse events did not differ between groups; 251 (51%) infants had a grade 3-4 event in the lopinavir-ritonavir group compared with 246 (50%) in the lamivudine group. Infant HIV-1 prophylaxis with lopinavir-ritonavir was not superior to lamivudine and both drugs led to very low rates of HIV-1 postnatal transmission for up to 50 weeks of breastfeeding. Infant pre-exposure prophylaxis should be extended until the end of HIV-1 exposure and mothers should be informed about the persistent risk of transmission throughout breastfeeding. INSERM/National Agency for Research on AIDS and Viral Hepatitis (including funds from the Total Foundation), European Developing Countries Clinical Trials Partnership, Research Council of Norway.

Delayed HIV detection among infants exposed to postnatal antiretroviral prophylaxis during breastfeeding

The objective of this study is to determine whether detection of HIV infection was delayed in infants exposed to antiretroviral prophylaxis to prevent HIV transmission during breastfeeding. The Breastfeeding, Antiretrovirals and Nutrition (BAN) study was a randomized trial of 2369 mother-infant pairs conducted from 2004 to 2010. In addition to an intrapartum regimen, all mother-infant pairs were randomly assigned to three antiretroviral intervention arms during 28 weeks of breastfeeding: no further antiretroviral prophylaxis (control arm); infant-daily nevirapine (nevirapine arm); and maternal zidovudine, lamivudine and either nevirapine, nelfinavir or lopinavir-ritonavir (maternal arm). After breastfeeding cessation counselling and stopping the antiretroviral interventions by 28 weeks, 28 infant HIV infections occurred. To determine whether these infections occurred during the breastfeeding and antiretroviral intervention phase but had delayed detection on the antiretroviral arms, we performed ultrasensitive (droplet digital PCR) HIV testing on infants with stored peripheral blood mononuclear cell (PBMC) specimens at 24 weeks (n = 9). Of the nine infants, all three on the infant nevirapine arm had detectable HIV DNA at 24 weeks, compared with two of four on the maternal antiretroviral arm and one of two on the control arm. For infants with detectable HIV at 24 weeks, the median delay in detection between the ultrasensitive and standard assays was 18.3 weeks for the nevirapine arm, 15.4 weeks for the maternal arm and 9.4 weeks for the control arm. The prolonged inability to detect HIV with standard assays in the context of postnatal antiretroviral prophylaxis suggests that early antiretrovirals may restrict HIV replication sufficiently to lead to missed diagnosis among infected infants. Therefore, repeat virologic testing is warranted beyond the WHO-recommended point of testing at 6 weeks after breastfeeding cessation.

Ibuprofen Concentrations in Human Mature Milk—First Data About Pharmacokinetics Study in Breast Milk With AOR-10127 “Antalait” Study

Analgesics are one of the most prescribed drugs during the postpartum period to prevent and treat pain and inflammatory disease. The focus on analgesics during breastfeeding has increased because of lack of information and fatal codeine intoxication in a breastfed neonate. Ibuprofen has an advantageous benefit-risk ratio profile compared with codeine. There is a lack of information on drug transfer into human milk, thus ibuprofen intake during breastfeeding may be debated. Consequently, there is a dilemma whether to terminate breastfeeding or drug therapy. The objective of this study was to determine the relative infant dose of ibuprofen. The first week after the delivery, each woman received ibuprofen to treat pain or inflammatory disorders (mean dose, 1012 ± 96 mg/d). Just after the third dose of ibuprofen, 1 milk sample and 2 blood samples were obtained after 1 week of breastfeeding. Ibuprofen concentrations in breast milk and blood were measured by using high-performance liquid chromatography. Twenty women were included after written informed consent, and 13 gave their breast milk and blood samples. The mean ibuprofen milk concentration was 360 ± 160 mcg/L. The mean fat milk concentration was 3.23 ± 1.15 g per 100 mL, and the mean milk protein concentration 0.87 ± 0.27 g per 100 mL. The ibuprofen transfer infant dose (theoretical infant dose) was 68 mcg·kg-1·d-1 (8-262 mcg·kg-1·d-1), and the relative infant dose was <0.38% (0.04%-1.53%) of the weight-adjusted maternal daily dose, which equals 0.2% of the infant dose. The results confirm that the transfer of ibuprofen into breast milk decreases with the protein concentration and the duration of lactation. These results suggest that the use of ibuprofen is compatible with prolonged breastfeeding after the early postpartum stage.