Prevalence of problematic feeding in young children born prematurely: a meta-analysis

BACKGROUND

Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm.

METHODS

Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000-2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks' gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study.

RESULTS

There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33-51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding.

CONCLUSION

Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth.

SYSTEMATIC REVIEW REGISTRATION NUMBER

Not applicable.

[Occupational exposures, diet and storing: Recommendations to reduce environmental pollutants in breastfeeding]

The pollution of the planet also reaches the breastfeeding ecosystem, one of the most intimate and inviolable that links us as an animal species to the rest of mammals. Nursing mothers may be concerned about whether the quality of their milk will be adequate for their baby and whether environmental pollutants through work, diet, and storing may adversely affect their child. Breast milk is a source of exposure to environmental pollutants, and at the same time it counteracts much of the effects of these exposures. An approach based on the principles of reality and precaution of environmental health to avoid, reduce or eliminate the production and use of harmful chemicals during pregnancy and lactation would improve the human and planetary health for the offspring.

[Pharmacological treatment of non-severe hypertension during pregnancy, postpartum and breastfeeding]

Hypertension (HTN) in pregnancy is defined as systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg. Based on the values, it is classified as non-severe (< 160/110 mmHg) and severe (≥ 160/110 mmHg). Before starting treatment in non-severe HTN, white- coat HTN should be ruled out. If outpatient management is possible, pharmacological initiation is suggested with sustained high values, avoiding < 120/80 mmHg. Safe drugs during pregnancy are methyldopa, labetalol, and nifedipine-retard. The use of nifedipine-XL or amlodipine can be considered with a lower level of evidence of safety. Diuretics, atenolol, and other beta-blockers for antihypertensive purposes is not recommended in this period. Renin-angiotensin-aldosterone system inhibitors are strictly contraindicated. In postpartum and breastfeeding, the same therapeutic regimen used during pregnancy can be maintained, trying early withdrawal of methyldopa. During puerperium, amlodipine and enalapril are safe, with minimal excretion in breast milk.

Effects of early intake of amino acid on the neurodevelopmental outcomes in very low birth weight infants at correct age of 20 months and school age

BACKGROUND

Inadequate nutrition leads to poor neurodevelopmental outcomes in very low-birth weight infants (VLBWIs). This study aimed to investigate the beneficial effects of early amino acid intake on the neurodevelopmental outcomes in VLBWIs at 20 months of correct age and school age.

METHODS

The information of VLBWIs that received amino acid intake were retrospectively analyzed in this study. The cases in early group (EAA) received amino acid within 24 h, but the cases in standard group (SAA) after 48 h post-natal. The body weight, height, and Bayley score of the infants at correct age of 20 months were compared between groups. And the cognitive outcomes at school age were evaluated using Wechsler Intelligence Scale and Das-Naglieri cognitive assessment system.

RESULTS

There were no differences at baseline characteristics of the VLBWIs between EAA and SAA groups. Compared with the SAA group, the infants in EAA group had shorter time to regain birth weight (P < 0.05). The head circumference, MDI, and PDI in EAA group at 20 months of correct age were significantly higher than that in SAA group (both P < 0.05). According to the Wechsler scale and Das-Naglieri scores, the infants in EAA group had markedly improved cognitive outcomes compared with those in SAA group (all P < 0.05).

CONCLUSION

The results of this study revealed that early amino acid intake within 24 h could significantly improve the neurodevelopmental and cognitive outcomes in VLBWIs at 20 months of correct age and school age.

[Predictive capacity for breastfeeding and determination of the best cut-off point for the breastfeeding self-efficacy scale-short form]

INTRODUCTION

The most widely used tool for assessing breastfeeding self-efficacy is the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). This study asses the relationship between the BSES-SF score and the risk of breastfeeding (BF) cessation and determine the cut-off point in the scale score that optimizes detection of this risk in primary health care pediatric consultations.

METHODS

Secondary data analysis of the LAyDI study. It is a cohort study. It was carried out through a research network of primary care pediatricians (PAPenRed). A newborn was recruited every month for one year by 210 pediatricians. The cohort was followed for 24 months. Mothers responded to the BSES-SF at the first visit. General pregnancy and delivery data were collected and assessed to determine whether breastfeeding was exclusive or supplemented during the first six months.

RESULTS

n = 1,845. The area under the ROC curve for the exclusive BF was 0.790 (0.765-0.815) the first month and 0.760 (0.734-0.786) the second month. For four and six months, as well as for any age in mothers who give supplemented BF, the Area Under the Curve was less than 0.75 and its predictive capacity was not considered to be good. For a sensitivity of 80% in detecting mothers at risk of BF cessation with the BSES-SF, the cut-off score was 58.

CONCLUSIONS

Mothers with a BSES-SF score below 58 points in primary health care, are at risk of early withdrawal of exclusive BF within two months.

Longitudinal interrelationship between HIV viral suppression, maternal weight change, breastfeeding, and length in HIV-exposed and uninfected infants participating in the Kabeho study in Kigali, Rwanda

PURPOSE

The health of infants that are HIV-exposed and -uninfected (HEU) is a major public health concern as HIV becomes a chronic condition. We investigate the interrelationship between maternal viral suppression, maternal weight status, breastfeeding, and infants that are HEU.

METHODS

The Kabeho study followed 502 HEU infants in Kigali, Rwanda, for 24 months from 2013 to 2014. We use a structural equation modeling approach to investigate the dynamic relationships between viral suppression, maternal weight change, breastfeeding, and infant length-for-age z-score (LAZ) as defined by the WHO.

RESULTS

Older mothers are more likely to be virally suppressed and to breastfeed. Viral suppression and the mother being on antiretroviral treatment for longer were related to lower infant LAZ at three months. A more positive maternal weight change was related to higher infant LAZ at the end of each period. At 12 months, a higher infant LAZ was related to increased probability of continued breastfeeding. At 18 months, continued breastfeeding was related to lower LAZ, and food shortages were related to higher LAZ.

CONCLUSION

There is a complex interrelationship between viral suppression, maternal weight change, breastfeeding, and infant LAZ. These relationships demonstrate the link between maternal and infant health in the context of HIV.

The Role of Children's Dietary Pattern and Physical Activity in the Association Between Breastfeeding and BMI at Age 5: The GECKO Drenthe Cohort

Objectives

Breastfeeding is protective against childhood obesity, but the role of childhood lifestyle in this association is unclear. We investigated whether physical activity and dietary pattern at age 5 differed between breastfed and non-breastfed children, and how they relate to Body Mass Index (BMI) Z-scores.

Methods

1477 children of the Dutch GECKO Drenthe birth cohort were included. At one month, children were categorized as breastfed (receiving breast milk exclusively or in combination with formula milk) or non-breastfed (receiving formula milk exclusively). At age 5, height and weight were objectively measured, physical activity was measured by ActiGraph GT3x and dietary patterns were assessed with a parent-reported food pattern questionnaire, assessing the consumption frequency of selected food items at seven occasions over the day.

Results

Non-breastfed children had higher BMI Z-scores (0.36 ± 0.90 vs. 0.20 ± 0.80 SD, p = 0.002), more frequently consumed sugar-sweetened beverages (25.0 ± 10.5 vs. 22.5 ± 9.71 times per week, p < 0.001), and consumed relatively less whole-wheat or brown bread (p = 0.007). Differences in sugar-sweetened beverage consumption were most pronounced during main meals. Total fruit consumption, sedentary time and moderate-to-vigorous physical activity levels did not differ between the groups. Multivariable adjusted linear regression analyses showed that the differences in BMI-z score between non-breastfed and breastfed children were not explained by the differences in sugar-sweetened beverages or type of bread consumed.

Conclusions

Infant breastfeeding itself is indicative of healthy dietary behaviors in early life, and is also more likely to be followed by a favorable dietary pattern at toddler age. However, the differences in dietary habits between breastfed and non-breastfed children did not explain the difference in BMI Z-score at the age of 5.

Electronic supplementary material

The online version of this article (10.1007/s10995-020-03063-6) contains supplementary material, which is available to authorized users.

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial

OBJECTIVE

To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education.

METHOD

Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05.

RESULTS

A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05).

CONCLUSION

It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.

Assessment of nitric oxide metabolites concentrations in plasma, saliva, and breast milk and their relationship in lactating women

Nitric oxide (NO) plays a role in many biological mechanisms. The amounts of physiologically produced NO are associated with the concentrations of its metabolites nitrate and nitrite. This study investigated whether there is any association between the concentrations of NO metabolites nitrate, nitrite, and nitrosylated species (RXNO) in mature breast milk, saliva, and plasma in healthy lactating women (N = 30). We hypothesized that the NO metabolites concentrations in plasma are associated with those found in saliva and in breast milk. NO metabolites concentrations were measured using chemiluminensce-based assays. Nitrate concentrations in breast milk are twice as much as plasma concentrations, whereas nitrate concentrations in saliva are about eightfold higher (both P < 0.001). Similar differences were found when nitrite concentrations were taken into consideration. RXNO concentrations in breast milk were negligible, and RXNO concentrations in saliva were approximately sixfold higher than those found in plasma samples (P < 0.0001). Nitrate concentrations in plasma are associated with nitrate concentrations in saliva (rs = 0.474, P = 0.004). However, no significant association was found between nitrate concentrations in breast milk and in plasma (P > 0.05). Our results show a significant association between nitrate concentrations in plasma with those found in saliva, whereas all other relationships were not significant. In conclusion, this report shows for the first time that the physiological concentrations of NO metabolites in human breast milk are probably independent of circulating NO metabolites concentrations and may depend mostly on endogenous NO synthesis in the breast. These findings may have clinical implications for newborns and lactating women.

Mobile Phone Applications to Support Breastfeeding Among African-American Women: a Scoping Review

BACKGROUND

Racial disparities persist with respect to breastfeeding. The use of health e-technology is increasing, with promise for a role in improving breastfeeding outcomes.

OBJECTIVE

We undertook a scoping review of both individual breastfeeding apps and the literature on breastfeeding apps to map the available evidence on app-based breastfeeding support for African-American mothers.

DESIGN

A systematic search of online databases identified 241 English language papers published on or before June 2020 that included e-technology in support of breastfeeding. We included those that (1) described individual human subjects research studies utilizing any research design, (2) described app-based breastfeeding support, and (3) could be pertinent for African-American mothers, and assessed for inclusion and relevance for this population. We also searched app stores for breastfeeding apps, and evaluated features with a rubric. Our aim was to identify if gaps exist relative to breastfeeding support for African-Americans.

RESULTS

Of the 15 publications meeting inclusion criteria, 9 focused on app development, 4 examined user experience, and 3 examined breastfeeding outcomes with use of an app (one study overlapped categories). The percentage of African-American participants ranged from 100% (2 studies) to none (7 studies); 3 studies (20%) focused on African-American mothers' breastfeeding experience. Of 77 apps that met inclusion criteria, just one was both breastfeeding-focused by content and targeted for African-Americans by picture predominance.

CONCLUSIONS

The quality of studies was generally high and many included African-American participants, but research focused on breastfeeding apps specifically for African-American mothers/parents is limited, creating a meaningful gap in the literature.

Managing pregnancy in COVID-19 pandemic: A review article

The outbreak Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a highly contagious and lethal beta coronavirus SARS-CoV-2, which has spread fast to encroach the entire globe and hence declare pandemic. Pregnancy alters body physiology and immune systems, can have worse effects of some respiratory infections and due to limited research and published data we still are in dilemma of appropriate management guidelines This article covers the updated guidelines for infection prevention and control (IPC), screening, sampling, antenatal visit schedules, risk scoring, triaging, supportive care, delivery, postpartum care and care of the newborn. This article aims to provide up-to-date information as per recent guidelines of various association which would serve as guidance in managing pregnant women and newborn with suspected or confirmed COVID-19. All the published papers till date, NCPRE, WHO Interim guidelines, RCOG, FOGS GCPRI, Medical Council of India, ICMR, MOFHW, CDC, ACOG guidelines are referred to compile this article to reach to a conclusion of evidence based management of pregnant ladies during COVID-19 pandemic. This article covers the not only infection prevention and control (IPC) guidelines, but also screening and sampling guidelines, antenatal visit schedules, risk scoring, triaging but also in-patient supportive care, delivery, postpartum care and care of the newborn. Data are very limited and hence very difficult to accurately define clinical management strategies and needs to be constantly updated.

Breastfeeding and Medication Use in Kidney Disease

Pregnancy in CKD is a condition fraught with challenges including multiple medications, high-risk pregnancy followed by maternal and fetal compromise such as preterm delivery, and low birth weight infant. Breastfeeding is unique in its impact on the mother and the baby, their bonding, and future health implications impacting the society. Breast milk is produced specific for the infant by the biological mother. It changes in composition with lactation stage and leads to optimal growth of the baby including establishing circadian rhythms, getting protective antibodies, and establishing a healthy gut microbiome. Multiple hormones influence the composition of the milk. Lactation is maintained by removal of the milk. Blood-milk barrier allows for the specific composition of milk by transporting different sized molecules through different mechanisms. It is safe to assume that most medications will be found in some amount in human milk; however, the impact of that is usually not enough to justify stopping breastfeeding. When the mother's milk is not available, formula or donor milk can be considered. There are resources to guide the use of medications during lactation that the providers should be aware of and use, to guide medication and breastfeeding recommendations.

Branched-chain amino acids, history of gestational diabetes, and breastfeeding: The Bogalusa Heart Study

BACKGROUND AND AIMS

To examine the associations between history of gestational diabetes mellitus (GDM) and breastfeeding with branched-chain amino acids (BCAA) and their metabolites in later life.

METHODS AND RESULTS

638 women (mean age 48.0 y) who had participated in the Bogalusa Heart Study and substudies of pregnancy history had untargeted, ultrahigh performance liquid chromatography-tandem mass spectroscopy conducted by Metabolon© on serum samples. Metabolites were identified that were BCAA or associated with BCAA metabolic pathways. History of GDM at any pregnancy (self-reported, confirmed with medical records when possible) as well as breastfeeding were examined as predictors of BCAA using linear models, controlling for age, race, BMI, waist circumference, and menopausal status. None of the BCAA differed statistically by history of either GDM or breastfeeding, although absolute levels of each of the BCAA were higher with GDM and lower with breastfeeding. Of the 27 metabolites on the leucine, isoleucine and valine metabolism subpathway, 1-carboxyethylleucine, 1-carboxyethyvaline, and 3-hydroxy-2-ethylpropionate were higher in women with a history of GDM, but lower in women in women with a history of breastfeeding. Similar results were found for alpha-hydroxyisocaproate, 1-carboxyethylisoleucine, and N-acetylleucine.

CONCLUSIONS

GDM and breastfeeding are associated in opposite directions with several metabolites on the BCAA metabolic pathway.

Effectiveness and safety of auriculotherapy for breastfeeding: a systematic review

OBJECTIVE

To summarize and critically evaluate the evidence pertaining to the effectiveness and safety of auriculotherapy for breastfeeding.

METHODS

We performed a systematic search of 10 databases from their inception dates to May 15, 2017. Randomized controlled trials evaluating the effectiveness and safety of auriculotherapy for breastfeeding were included. Risk of bias was assessed using the Cochrane risk of bias tool.

RESULTS

This review included 31 randomized controlled trials with 5389 participants. Owing to the obvious clinical or statistical heterogeneity, a Meta-analysis was not conducted. Twenty-nine studies compared auriculotherapy plus routine care with routine care alone. No consistent adjunctive effect of auriculotherapy was observed in increasing the volume of milk production (9 studies showed significant results in favor of auriculotherapy and 5 did not) and serum prolactin level (7 studies showed significant results in favor of auriculotherapy and 2 did not), and in facilitating the initiation of milk secretion (10 studies showed significant results in favor of auriculotherapy and 7 did not). Two studies compared auriculotherapy with no treatment. Auriculotherapy as a monotherapy showed significant effects in increasing serum prolactin level and facilitating the onset of milk secretion; however, it was limited and inconclusive because only two studies were included in this comparison. The subgroup analysis of women who underwent cesarean delivery showed inconsistent results with respect to all outcomes. No serious adverse events were reported with the use of auriculotherapy. The methodological quality of the included studies was generally poor.

CONCLUSION

Although some studies showed positive results, no definite conclusion about the effectiveness and safety of auriculotherapy for breastfeeding could be drawn, owing to the low methodological quality of the included studies and the heterogeneity among trials. Large-scale, well-designed studies are warranted on this topic.

Nursing student's knowledge about breastfeeding: Design and validation of the AprendeLact questionnaire

BACKGROUND

Breastfeeding is the best source of food that a mother can offer her child during the first months of life because it provides numerous benefits for both mother and baby. Despite breastfeeding being an innate act, it requires qualified health professionals for advice and support.

OBJECTIVES AND PARTICIPANTS

To design and validate a questionnaire to evaluate nursing student breastfeeding knowledge.

METHODS AND DESIGN

Cross-sectional study. Construction and validation of the questionnaire (content validity, test-retest reliability and internal consistency). Descriptive and bivariate analyses of socio-demographic variables and the questionnaire results.

RESULTS

Optimum results were obtained in terms of internal consistency (KR-20 = 0.9) and test-retest reliability (ICC = 0.925) with a samples of 144 participants (mean age of 22.69 years). Statistical significance were observed among the questionnaire score and academic year, clinical practice, type of breastfeeding in childhood, knowing about support groups and participating in a breastfeeding workshop or course.

CONCLUSION

A questionnaire on breastfeeding knowledge was validated. Nursing students progressively acquire breastfeeding skills as they advance in their undergraduate studies.

Exploring the use and experience of an infant feeding genogram to facilitate an assets-based approach to support infant feeding

BACKGROUND

A lack of perceived social support influences women's infant feeding behaviours. The Infant Feeding Genogram is a visual co-constructed diagram which details people/services that can provide support to women and can facilitate a connection between mothers and their existing assets landscape. The aim of this study is to explore women's and infant feeding helpers' experiences and use of an infant feeding genogram delivered to the intervention group of the "Assets-based infant feeding help Before and After birth (ABA)" randomised feasibility trial.

METHODS

103 primiparous mothers aged 16+ years were recruited to the trial (trial registration number) in two sites (Site A and Site B) with low breastfeeding prevalence in the UK. Infant feeding helpers (IFHs) co-constructed a genogram at the first antenatal meeting for the intervention group (n = 50), and then provided proactive, woman-centered support from ~ 32 weeks gestation to up to 5 months postnatal. Infant feeding helpers' and women's experiences of the infant feeding genogram were collected via interviews or focus groups. Completed genograms were shared with researchers. Content analysis of the genograms and qualitative data from the interviews and focus groups were analysed thematically.

RESULTS

Data comprised 32 completed genograms, and qualitative insights from all 13 infant feeding helpers (two focus groups; 4 interviews) and interviews with a purposive sample of 21 of 50 intervention group women between 4 and 21 weeks after birth. Content analysis of the genograms highlighted variations, with more personal, individualised genograms completed at Site B compared to Site A. The perceived impact of the genogram was related to the IFHs' application of the tool. The genogram was either used as intended to raise women's awareness of available assets and motivate help-seeking behaviour, or as a data collection tool with limited perceived utility. Negative and positive unintended consequences of genogram use were highlighted.

CONCLUSIONS

The genogram has the potential to offer a woman, family and community-centred approach that focusses on building assets for infant feeding. However, variations in genogram application indicate that revised training is required to clarify the purpose and ensure it is used as intended.

TRIAL REGISTRATION

ISRCTN ISRCTN14760978 ; Registered 30 January 2017.

Associated factors of pregnancy spacing among women of reproductive age Group in South of Iran: cross-sectional study

Background

Optimal pregnancy spacing is an important incidence in reproductive women’s health. Short or long pregnancy spacing leads to the greatest health, social and economic problems such as increase in maternal and infant mortality and morbidity, and adverse pregnancy outcomes. The aim of this study is to assess the mean of pregnancy spacing and associated factors of pregnancy spacing among women of reproductive age group with recurrent event analysis.

Methods

The fertility history of 1350 women aged 15–49 years was collected in this cross-sectional study. The women were selected through multistage random sampling method from a list of clinics in 2018. Some predictors were collected from their records and others were collected by face-to-face interview. The recurrent event survival analysis was used to explore the effect of predictors on pregnancy spacing. The R software program was used for analysis.

Results

There were nine predictors that had significant effect on pregnancy spacing. These predictors included the age of mother at marriage, mother’s BMI, contraception use, breast feeding duration of the previous child, the education level of husband, the sex preference of the mother, presence of abortion or stillbirth in the preceding pregnancies, income sufficiency, and mother’s awareness of optimum pregnancy interval. The most influential predictors; contraception use (HR = 2.34, 95%CI = 1.23 to 2.76, P < 0.001) and income sufficiency (HR = 2.046, 95%CI = 1.61 to 3.02, P = 0.018) lead to longer and son preference of mother (HR = 2.231, 95%CI = 1.24 to 2.81, P = 0.023) lead to shorter pregnancy spacing.

Conclusion

The up to date contraception tool should be at hand for couples to manage their pregnancy intervals. The unfavorable economic situation of a family leads to long pregnancy spacing. Despite the relative equality of the status of girls and boys in today’s societies, the desire to have a son child is still an important factor in shorter pregnancy spacing. The benefit of optimal pregnancy spacing should be more announced.

Impact of a blended learning program on community pharmacists' barriers, knowledge, and counseling practice with regard to preconception, pregnancy and lactation

BACKGROUND

Community pharmacists acknowledge to have an important role in providing pharmaceutical care during preconception, pregnancy and lactation. However, pharmacists' knowledge and counseling regarding this topic is still insufficient. Hence, educational initiatives are urgently needed.

OBJECTIVES

To assess the impact of a blended learning program ('intervention') on community pharmacists' barriers, knowledge, and counseling practice with regard to preconception, pregnancy and lactation.

METHODS

A pre-post study was performed in collaboration with 40 randomly selected pharmacies belonging to a large pharmacy chain in Belgium. All pharmacists employed in these pharmacies were eligible to participate in a blended learning program consisting of an e-learning and an on-site training day. Data were collected using online surveys, mystery shopping visits and pharmacy records. Pharmacy conversations were assessed on information gathering, dispensed product, and case-specific information. A retention knowledge test was completed 3-6 months after the intervention.

RESULTS

In total, 60 pharmacists completed the post-intervention surveys (response rate: 95%). The total number of barriers decreased after the intervention, while organizational barriers such as lack of privacy (73%) and lack of time (67%) became more prevalent. Pharmacists' short and long-term knowledge improved after the intervention (p ≤ 0.001), although knowledge declined again over time (p ≤ 0.001). During counseling, pharmacists more often spontaneously provided information about folic acid when dispensing a pregnancy test, and more often suggested the correct dose/dosage for the dispensed OTC-product against pregnancy-related nausea. However, poor information gathering, dosing errors and incomplete information were still observed.

CONCLUSION

The blended learning decreased pharmacists' barriers and improved their short- and long-term knowledge, while counseling practice only partially improved. Hence, the blended learning was insufficient to enhance pharmacists' information gathering competences and to fully implement pharmaceutical care services with regard to preconception, pregnancy and lactation.

Relationship Between Household Food Insecurity and Growth Disorders in Children Aged 3 to 6 in Qazvin City, Iran

PURPOSE

Food insecurity, which is the inability to obtain food or inadequate food consumption in terms of quality and quantity, has physical and psychological consequences on children's health. This study aimed to investigate the relationship between children's growth disorders and food insecurity in Qazvin city, Iran.

METHODS

A case-control study was conducted on 177 cases and 355 controls of children aged 3 to 6 years, who were referred to health centers in Qazvin city. The case group consisted of children with growth disorders. Data were obtained with the 18-item US Department of Agriculture questionnaire, a household socioeconomic questionnaire, a and growth monitoring card. The data were analyzed with using IBM SPSS Version 22.0, by independent sample t-test, chi-square test, and logistic regression.

RESULTS

A significant relationship was found between children's growth disorders and household food insecurity with (p<0.05, odds ratio [OR]=17.0, confidence interval [CI]=5.9, 48.8) and without hunger (p<0.05, OR=2.69, CI=1.4, 4.9). There were also significant relationships between children's growth disorders and socioeconomic status (p<0.05, OR=3.4, CI=1.4, 8.5), the duration of breastfeeding (p<0.05, OR=0.94, CI=0.9, 0.98), and children's ages (p<0.05, OR=0.94, CI=0.92, 0.96). Sex and birth order, and the age of the parents was not found to be significantly related with growth disorders.

CONCLUSION

Lower socioeconomic status and household food insecurity were the important predictors of children's growth disorders. Policymakers should focus more on promoting steady employment and income among family members. Nutritional education for mothers is also recommended, in order to better meet the nutritional needs of the children.

Peer support for disadvantaged parents: a narrative review of strategies used in home visiting health interventions in high-income countries

BACKGROUND

Disparities in health persist even in high-income countries, and healthcare systems do not reach disadvantaged families as needed. A number of home-visiting interventions in high-income countries offering peer support for parents have been implemented to bridge the gaps in health in a cost-effective way. The lack of standard for intervention design has however resulted in a large variety of the strategies used. The objective for this article is to conduct a review of peer support home visiting interventions for parents and children in high-income countries, aiming to assess the strategies used, their outcomes and the challenges faced by peer supporters.

METHODS

Relevant articles published in English between January 2004 and August 2019 were identified using PubMed, and reference lists were reviewed to identify additional articles. Studies were included if they reported on individual peer support health interventions, delivered at home to socioeconomically disadvantaged parents in high-income countries. Nineteen studies were found that met the inclusion criteria, and data were extracted on study characteristics, intervention design and outcomes. Data on intervention design was characterized iteratively to generate overarching categories of strategies used in the programs.

RESULTS

Most studies used healthcare facilities for recruitment, even when the interventions were not delivered by the formal healthcare system. The strategies used to engage supported parents included (1) connection in the form of emotional support, relationship building and matching for background, (2) flexibility in regards to content, intensity, location and mode of contact, and (3) linking through referrals and facilitation of other contacts. A number of significant quantifiable improvements could be demonstrated. Due to large heterogeneity of outcomes, meta-analyses were not viable. Peer supporters experienced challenges with involving other family members than the supported parent as well as with finding their role in relation to other support structures.

CONCLUSIONS

Peer support delivered as home visiting interventions have been used for hard-to-reach parents in a variety of high-income contexts and for a multitude of health concerns. Overall, despite variation in intervention design, the strategies employed followed common themes and were generally well received.

Geometric model to predict improvement after lingual frenulectomy for ankyloglossia

OBJECTIVES

Frenulectomy for ankyloglossia is an intervention that often improves breastfeeding quality for both the mother and infant. Current classification systems assess and identify patients with ankyloglossia, but they do not predict the degree of improvement after lingual frenulectomy. We propose an idealized geometric model to quantify the potential effect of frenulectomy for ankyloglossia.

METHODS

Our geometric model depicts the intact lingual frenulum as a triangular pyramid of mucosa on the floor of mouth. After incising one edge of the pyramid, as is performed during a frenulectomy, the structure unfolds to a two-dimensional diamond whose dimensions can be calculated. Utilizing this calculation, we can predict percent improvement in tongue extension after frenulectomy based off the original dimensions of the pyramid.

RESULTS

Our multivariable equation that allows for the calculation of the percent increase in tongue extension is based on the frenulum thickness, frenulum length, tongue length, and insertion point of the frenulum on the tongue. The initial height of the frenulum and the proximity of the frenulum insertion to the tip of the tongue had the largest impact on tongue extension, whereas frenulum width had the smallest impact.

CONCLUSION

Lingual frenulectomy has subjectively been reported to improve lingual tongue movement. Our mathematical model identifies multiple anatomic variables that lead to an increase in tongue extension after frenulectomy. Our model is the first step in supporting this subjective improvement with quantifiable measurements, and can allow for future validation studies.

Why I Can't Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother

A 26-year-old postpartum COVID-positive mother admitted in COVID isolation facility at a tertiary care center in India. Her primary physical concern was suture site pain and concerns related to expressed breast milk discarding. Her psychological concerns include distrust on COVID report, belief of unjust isolation, lack of family support, loneliness, feeling of not breast feeding her baby, fear, anxiety, anger, stress, and depression. She was concerned about the stigma anticipated for herself and her baby. Spiritually, she was concerned as she was not able to make harmony between herself and environment.

Prescribing for pregnancy: epilepsy

Topics for DTB review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.

Design, implementation and evaluation of an education course to promote professional self-efficacy for breastfeeding care

The objective of this study was to determine the effect of an education short course on professional' self-efficacy in the area of breastfeeding care. The intervention had a pre-post design. A total of 43 healthcare professionals attended the course. The Kirkpatrick model for the development, implementation and evaluation of education actions was used for a 4.5-h course. The aspects evaluated included professionals' satisfaction and learning regarding confidence to support lactating mothers, perceived transfer of knowledge to the workplace and organizational changes. Data were collected using self-administered questionnaires (participants, unit managers, and education planners), before and after the intervention. Participants' satisfaction with the education action was high in all of the aspects measured (greater than 3.9 in scores of 0-5). Professionals showed a significant increase in self-efficacy levels for supporting breastfeeding (Wilcoxon test p-value = < 0.05, before intervention: median = 55, [IQR] = 11; after intervention: median = 60, [IQR] = 14). Participants, managers and organizers of the course identified changes in the way that professionals cared for breastfeeding mothers. In conclusion, this educational intervention enhanced professional self-efficacy and performance in breastfeeding care.

Effect of feeding mode on infant growth and cognitive function: study protocol of the Chilean infant Nutrition randomized controlled Trial (ChiNuT)

BACKGROUND

A central aim for pediatric nutrition is to develop infant formula compositionally closer to human milk. Milk fat globule membranes (MFGM) have shown to have functional components that are found in human milk, suggesting that addition of bovine sources of MFGM (bMFGM) to infant formula may promote beneficial outcomes potentially helping to narrow the gap between infants who receive human breast milk or infant formula. The objective of the current study is to determine how the addition of bMFGM in infant formula and consumption in early infancy affects physical growth and brain development when compared to infants fed with a standard formula and a reference group of infants fed with mother's own milk.

METHODS

Single center, double-blind, and parallel randomized controlled trial. Planned participant enrollment includes: infants exclusively receiving breast milk (n = 200; human milk reference group; HM) and infants whose mothers chose to initiate exclusive infant formula feeding before 4 months of age (n = 340). The latter were randomized to receive one of two study formulas until 12 months of age: 1) cow's milk based infant formula that had docosahexaenoic (DHA) (17 mg/100 kcal) and arachidonic acid (ARA) (25 mg/100 kcal); 1.9 g protein/100 kcal; 1.2 mg Fe/100 kcal (Standard formula; SF) or 2) a similar infant formula with an added source of bovine MFGM (whey protein-lipid concentrate (Experimental formula; EF). Primary outcomes will be: 1) Physical growth (Body weight, length, and head circumference) at 730 days of age; and 2) Cognitive development (Auditory Event-Related Potential) at 730 days of age. Data will be analyzed for all participants allocated to each study feeding group.

DISCUSSION

The results of this study will complement the knowledge regarding addition of bMFGM in infant formula including support of healthy growth and improvement of neurodevelopmental outcomes.

TRIAL REGISTRATION

NCT02626143, registered on December 10th 2015.