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Kalathingal T, Manerkar S, Mondkar J, Kalamdani P, Patra S, Kaur S, Khandekar H. Comparison of Two Pumping Strategies to Improve Exclusive Breastfeeding at Discharge in Mothers of VLBW Infants with Low Milk Output - A Pilot Randomized Controlled Trial. Indian J Pediatr 2024; 91:906-912. [PMID: 37794310 DOI: 10.1007/s12098-023-04859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES To compare the effect of two strategies of breast pumping -power pumping (PP) vs. routine pumping (RP) over one week in mothers of very low birth weight (VLBW) infants with low milk output to improve breastfeeding rates at discharge. METHODS Mothers with low milk output, defined as inability to express sufficient breastmilk to meet the feeding requirements of their infant on or after post-natal day 14, were randomized to receive power pumping vs. routine pumping - once daily for 7 d coupled with routine lactation support and hand expression 3 hourly in both groups. The primary outcome was exclusive breastfeeding at discharge. RESULTS There was no difference in the two pumping strategies with respect to exclusive breastfeeding rates [61.1% in PP vs. 50% in RP group; (p = 0.477, RR 1.2; 95% CI 0.76 to 2.17)]. Median milk volume pumped in the individual power pumping session on 7th day of intervention was significantly higher than that in the individual routine pumping session on the 7th day (50 mL vs. 27 mL, p = 0.014). The cumulative median milk volume expressed per individual pumping session over the 7 sessions of power pumping was also higher than that with routine pumping (305 mL vs. 213 mL, p = 0.054). CONCLUSIONS In this pilot trial, expressed milk volume was significantly higher after each individual power pumping session compared to routine pumping. However, the exclusive breastfeeding rates at discharge were similar in the two groups.
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Affiliation(s)
- Thaslima Kalathingal
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Swati Manerkar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
| | - Jayashree Mondkar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Pavan Kalamdani
- Ex-faculty, Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Saikat Patra
- Ex-faculty, Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Samandeep Kaur
- Ex-faculty, Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Himani Khandekar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
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Shama S, Asbury MR, Kiss A, Bando N, Butcher J, Comelli EM, Copeland JK, Greco A, Kothari A, Sherman PM, Stintzi A, Taibi A, Tomlinson C, Unger S, Wang PW, O'Connor DL. Mother's milk microbiota is associated with the developing gut microbial consortia in very-low-birth-weight infants. Cell Rep Med 2024:101729. [PMID: 39243753 DOI: 10.1016/j.xcrm.2024.101729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/30/2024] [Accepted: 08/16/2024] [Indexed: 09/09/2024]
Abstract
Mother's milk contains diverse bacterial communities, although their impact on microbial colonization in very-low-birth-weight (VLBW, <1,500 g) infants remains unknown. Here, we examine relationships between the microbiota in preterm mother's milk and the VLBW infant gut across initial hospitalization (n = 94 mother-infant dyads, 422 milk-stool pairs). Shared zero-radius operational taxonomic units (zOTUs) between milk-stool pairs account for ∼30%-40% of zOTUs in the VLBW infant's gut. We show dose-response relationships between intakes of several genera from milk and their concentrations in the infant's gut. These relationships and those related to microbial sharing change temporally and are modified by in-hospital feeding practices (especially direct breastfeeding) and maternal-infant antibiotic use. Correlations also exist between milk and stool microbial consortia, suggesting that multiple milk microbes may influence overall gut communities together. These results highlight that the mother's milk microbiota may shape the gut colonization of VLBW infants by delivering specific bacteria and through intricate microbial interactions.
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Affiliation(s)
- Sara Shama
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Translational Medicine Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle R Asbury
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Departments of Physiology & Pharmacology, and Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Alex Kiss
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Evaluative and Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Nicole Bando
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Translational Medicine Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - James Butcher
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada; Ottawa Institute of Systems Biology, Ottawa, ON, Canada
| | - Elena M Comelli
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Julia K Copeland
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, ON, Canada
| | - Adrianna Greco
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Translational Medicine Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Akash Kothari
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Translational Medicine Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Philip M Sherman
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Cell Biology Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Alain Stintzi
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada; Ottawa Institute of Systems Biology, Ottawa, ON, Canada
| | - Amel Taibi
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Christopher Tomlinson
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Translational Medicine Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Division of Neonatology, Izaak Walton Killam Hospital, Halifax, NS, Canada; Department of Pediatrics, Sinai Health, Toronto, ON, Canada; Rogers Hixon Ontario Human Milk Bank, Toronto, ON, Canada
| | - Pauline W Wang
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, ON, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Translational Medicine Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, Sinai Health, Toronto, ON, Canada; Rogers Hixon Ontario Human Milk Bank, Toronto, ON, Canada.
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Blomqvist YT, Olsson E. Experiences of breast milk donors in Sweden: balancing the motivation to do something good with overcoming the challenges it entails. Int Breastfeed J 2024; 19:60. [PMID: 39217315 PMCID: PMC11365258 DOI: 10.1186/s13006-024-00668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/24/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Infants requiring neonatal care often face initial breastfeeding challenges, leading them to receive expressed breast milk from their mother or donor milk. While emphasizing the mother's own milk as the gold standard for infant nutrition, the utilization of donor milk stands as the preferred alternative over infant formula due to its numerous benefits. To facilitate the provision of donor milk to preterm and ill infants in neonatal units, the active participation of women willing to contribute their breast milk is crucial. This study aims to enhance the understanding of women's experiences in the donation process, thereby contributing to efforts aiming at alleviating the shortage of donated breast milk by improve the care and support for breast milk donors. METHODS This descriptive qualitative study took an inductive approach based on individual semi-structured interviews conducted during 2021 with 15 breast milk donors in Sweden. The data were analysed with thematic analysis. RESULTS Two themes were identified in the analysis: motivation to donate and challenges to overcome. Many of the women struggled to overcome the apparent challenges of not only starting the process of donating breast milk but also maintaining it. Despite the strain, they were motivated to donate their breast milk and seeking information by themselves to do something important for someone else. Only a few of the women talked about the financial benefits of donating breast milk; donating seemed to be mostly based on altruistic reasons. CONCLUSIONS Despite the challenges posed by COVID-19 restrictions, time consumption, and the hard work of sterilizing pump utensils, women continued to donate their milk driven by altruism. To enhance donor support and increase milk donation, several improvements are suggested: providing comprehensive information and resources, simplifying the donation process, offering flexible scheduling, and recognizing donors' contributions.
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Affiliation(s)
- Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden.
- Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden.
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Taylor SN. Evidence-based nutrition for the very preterm infant in 2024. J Pediatr (Rio J) 2024:S0021-7557(24)00103-7. [PMID: 39218032 DOI: 10.1016/j.jped.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Fucile S, Snider L, O'Brien K, Smith L, Dow K. A parent-administered sensorimotor intervention for oral feeding in infants born preterm: A randomized clinical study. Dev Med Child Neurol 2024. [PMID: 39101659 DOI: 10.1111/dmcn.16046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/19/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024]
Abstract
AIM To evaluate the effect of a parent-administered sensorimotor intervention (PASI) program on developmental outcomes of infants born preterm during their stay in the neonatal intensive care unit (NICU). METHOD A randomized clinical study was conducted with 94 infants (mean gestational age 31 weeks [SD 2.2 weeks]; 1658 g [SD 478 g]; 49 males, 45 females) initially enrolled and randomly assigned to an experimental or a control group. Infants in the experimental group received a PASI, consisting of tactile input to oral structures, trunk/limbs, and non-nutritive sucking for 15 minutes, once a day, for 10 days. Infants in the control group received standard care. Outcomes included attainment of complete oral feeds, occurrence of direct breastfeeding at hospital discharge, and motor function assessed using the Test of Infant Motor Performance (TIMP). RESULTS A total of 80 infants completed the study. Infants in the experimental group achieved complete oral feeds sooner (11.9 [SD 4.3] vs 15.3 [SD 6.5] days, p = 0.013), and a greater number of them received direct breastfeeds (22 vs 12, p = 0.010) than controls. Infants in both groups had equivalent motor functions scores on the TIMP (46.9 [SD 4.8], 46.8 [SD 8.4], p = 0.961). INTERPRETATION A PASI program may enhance an infant's oral feeding skills. These findings provide evidence to advocate for the institution of PASI in NICUs.
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Affiliation(s)
- Sandra Fucile
- School of Rehabilitation Therapy, Queen's University Kingston, Kingston, ON, Canada
- Department of Pediatrics, Queen's University Kingston, Kingston, ON, Canada
| | - Laurie Snider
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Karel O'Brien
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Lorraine Smith
- Department of Pediatrics, Queen's University Kingston, Kingston, ON, Canada
| | - Kimberly Dow
- Department of Pediatrics, Queen's University Kingston, Kingston, ON, Canada
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Batta A, McGowan EC, Tucker R, Vohr B. Social determinants of health and language outcomes in preterm infants with public and private insurance. J Perinatol 2024:10.1038/s41372-024-02082-3. [PMID: 39085435 DOI: 10.1038/s41372-024-02082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 07/10/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE To evaluate associations of maternal social determinants of health (SDOH) with language outcomes of preterm infants with public and private insurance. STUDY DESIGN Single center study of 375 neonates born ≤ 28 weeks. Perinatal characteristics were collected, and the Bayley III was administered at 18-24 months. Primary outcome was language scores of <85. Bivariate and multivariable analyses were used to compare groups. RESULTS Mothers with public insurance had higher rates of psychosocial risk factors. In regression analysis, People of Color (aOR 2.4, 1.47-4.04), non-English speaking household (aOR 4.05, 1.47-11.15) and public insurance (aOR 2.03, 1.18-3.49) significantly increased the odds of having a language composite score of <85, whereas breast milk (aOR 0.47, 0.28-0.79) was protective. CONCLUSIONS Preterm infants with public insurance are at increased risk of exposure to multiple SDOH which are independently associated with language delay at 18-24 months.
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Affiliation(s)
- Arya Batta
- Department of Pediatrics, Division of Neonatal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA
| | - Elisabeth C McGowan
- Department of Pediatrics, Division of Neonatal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA
| | - Richard Tucker
- Department of Pediatrics, Division of Neonatal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA
| | - Betty Vohr
- Department of Pediatrics, Division of Neonatal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA.
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Mo I, Lapillonne A, van den Akker CHP, Khashu M, Johnson MJ, McElroy SJ, Zachariassen G. Nutritional management after necrotizing enterocolitis and focal intestinal perforation in preterm infants. Pediatr Res 2024:10.1038/s41390-024-03386-y. [PMID: 38992154 DOI: 10.1038/s41390-024-03386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 06/04/2024] [Accepted: 06/16/2024] [Indexed: 07/13/2024]
Abstract
Nutritional management of preterm infants recovering from necrotizing enterocolitis (NEC) or focal intestinal perforation (FIP) is challenging, especially in infants managed surgically. The logistics of how, when, and what to feed are unclear and current nutritional practices are primarily based on physiological principles and consensus opinion in individual units, rather than high-quality evidence. The aim of this narrative review is to summarize the literature on nutritional management after NEC or FIP in preterm infants: when to restart enteral nutrition, type of enteral nutrition to use, and how to advance nutrition. We also discuss treatment of micronutrient deficiencies, cholestasis, replacement of stoma losses, and optimal time of stoma closure. In conclusion, there are in sufficient high-quality studies available to provide evidence-based recommendations on the best nutritional practice after NEC or FIP in preterm infants. A local or national consensus based early nutrition guideline agreed upon by a multidisciplinary team including pediatric surgeons, pediatricians/neonatologists, nurses, and nutritionists is recommended. Further studies are urgently needed. IMPACT: There is no good quality evidence or nutritional standard across neonatal units treating infants after medical or surgical NEC or FIP. With this review we hope to start providing some consistency across patients and between providers treating patients with NEC and FIP. Mother's own milk is recommended when restarting enteral nutrition after NEC or FIP. In the absence of high-quality evidence, a consensus based early nutrition guideline agreed upon by a multidisciplinary team is recommended. Nutritional research projects are urgently needed in NEC and FIP patients.
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Affiliation(s)
- Ingrid Mo
- Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
| | - Alexandre Lapillonne
- Department of Neonatology, Necker-Enfants Malades Hospital, EHU 7328 PACT, University of Paris Cite, Paris, France
- CNRC Baylor College of Medicine, Houston, Texas, USA
| | - C H P van den Akker
- Department of Pediatrics-Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Minesh Khashu
- Department of Neonatology, University Hospitals Dorset NHS Foundation Trust, Dorset, United Kingdom
| | - Mark J Johnson
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Steven J McElroy
- Department of Pediatrics, Division of Neonatology, University of California Davis, Sacramento, CA, USA
| | - Gitte Zachariassen
- Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark.
- Hans Christian Andersen Children's Hospital, Department of Neonatology, Odense University Hospital, 5000, Odense, Denmark.
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Zivaljevic J, Jovandaric MZ, Babic S, Raus M. Complications of Preterm Birth-The Importance of Care for the Outcome: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1014. [PMID: 38929631 PMCID: PMC11205595 DOI: 10.3390/medicina60061014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Preterm-born children are susceptible to problems of adaptation in the early neonatal period, as well as the emergence of consequences due to the immaturity of the respiratory, cardiovascular, and especially cerebrovascular systems. The authors searched PubMed, Scopus, the Cochrane Library, and Web of Science for articles that were available in their entirety and published in English between 1990 and 2024 in peer-reviewed journals using keywords relevant to the manuscript topic. Analyzing the requested studies and manuscripts, adequate articles describing the stated problem were used. The last trimester of pregnancy is the most important period in brain development. Brain growth is at its most intense, and nerve cells are created, multiply, and migrate, creating numerous connections between them and receptors. During this period, the baby is protected from the influence of external environmental factors. When a baby is born, it leaves its protected environment and very often requires intensive treatment to survive. In these circumstances, the immature nervous system, which is in a sensitive stage of development, is overloaded with numerous external stimuli, continuous light, noise, inappropriate positioning, and repeated painful reactions due to necessary diagnostic and therapeutic procedures and the unavoidable absence of the mother and the family, which cause stress that threatens proper programmed development. Minimally invasive therapeutic procedures and the presence of parents during hospitalization play a significant role in reducing the consequences for a premature child.
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Affiliation(s)
- Jelica Zivaljevic
- Department of Neonatology, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miljana Z. Jovandaric
- Department of Neonatology, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Sandra Babic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Misela Raus
- Department of Neonatology, University Children’s Hospital, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Mulinge MM, Abisi HK, Kabahweza HM, Okutoyi L, Wamalwa DC, Nduati RW. The Role of Maternal Secretor Status and Human Milk Oligosaccharides on Early Childhood Development: A Systematic Review and Meta-Analysis. Breastfeed Med 2024; 19:409-424. [PMID: 38577928 DOI: 10.1089/bfm.2023.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background: Breast milk is the gold standard of infant nutrition, delivering nutrients and bioactive molecules as needed to support optimal infant growth and cognitive development. Increasing evidence links human milk oligosaccharides (HMOs) to these early childhood development milestones. Aims: To summarize and synthesize the evidence relating to HMOs and infant brain development, physical growth, and cognitive development. In addition, HMO concentrations in secretor and nonsecretor mothers were compared via a meta-analysis. Study Design: A systematic review and meta-analysis were carried out in accordance with the PRISMA statement. This review used three databases (PubMed, Scopus, and Web of Science) and was limited to English-language articles published between 2000 and June 30, 2023. Results: The initial searches yielded 245 articles, 27 of which were included in the systematic review and 12 in the meta-analysis. The meta-analysis revealed a substantial between-study heterogeneity, I2 = 97.3%. The pooled effect was 0.21 (95% CI: -0.41 to 0.83; p = 0.484), indicating that secretors had higher HMO concentrations, although this difference was not statistically significant. At one month of age, 2'FL, 3FL, and 3'SL play an important role in brain maturation and thus play a critical role in cognitive development. Secretors produce higher concentrations of 2'FL and 3'SL, explaining the benefits to infants of secretor mothers. Growth velocity was correlated to fucosylated and sialylated HMO concentrations, with lower concentrations linked to stunting. Conclusions: According to evidence from the systematically reviewed articles, HMOs are essential for a child's early development, but the extent to which they have an impact depends on maternal secretor status.
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Affiliation(s)
- Martin M Mulinge
- Department of Biochemistry, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Hellen K Abisi
- Department of Biochemistry, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Hellen M Kabahweza
- Department of Pediatric Hematology & Oncology, Joint Clinical Research Centre, Kampala, Uganda
| | - Lydia Okutoyi
- Department of Health Care Quality, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton C Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Ruth W Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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10
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Elgersma KM, Engel ML, Ramel SE, Davis JA, McKechnie AC, Pfister KM. Human milk, breastfeeding, and early neurodevelopmental outcomes for infants with critical CHD. Cardiol Young 2024:1-9. [PMID: 38738385 DOI: 10.1017/s1047951124025228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Human milk improves neurodevelopment for preterm infants, but relationships between human milk and neurodevelopment for infants with critical CHD are unknown. We aimed to (1) explore associations between human milk/direct breastfeeding and neurodevelopment at 1-year and 2-year follow-up and (2) describe patterns of human milk (maternal, donor) and commercial formula during hospitalisation in the first year of life.This retrospective cohort study included infants who underwent surgery for CHD < 6 months old. The primary outcome was neurodevelopment via Bayley Scales of Infant Development-IV. Analysis included adjusted linear regression for associations between exclusive human milk while inpatient during the first 6 months or any direct breastfeeding while inpatient during the first year of life and 1-year Bayley-IV scores. Models were adjusted for race, insurance type, genetic diagnosis, and length of stay.Of 98 eligible infants, 40% followed up at 1 year; 27% at 2 years. There were differences in follow-up related to demographics (race, ethnicity) and social determinants of health (insurance type, distance from clinic). In adjusted models, infants who directly breastfed had 13.18 points higher cognition (95% CI: 0.84-25.53, p = 0.037); 14.04 points higher language (2.55-25.53, p = 0.018); and 15.80 points higher motor scores (3.27-28.34, p = 0.015) at 1-year follow-up. Infants fed exclusive human milk had 12.64 points higher cognition scores (-0.53-25.82, p = 0.059).Future investigation into nutrition and neurodevelopment in the context of critical CHD is warranted. As neurodevelopmental follow-up becomes standard of care in this population, efforts are needed to mitigate disparities in access to this care.
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Affiliation(s)
| | - Melissa L Engel
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Sara E Ramel
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jessica A Davis
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne C McKechnie
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Katie M Pfister
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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Holzapfel LF, Unger JP, Gordon P, Yang H, Cluette-Brown JE, Gollins LA, Hair AB, Martin CR. Fatty acid concentrations in preterm infants fed the exclusive human milk diet: a prospective cohort study. J Perinatol 2024; 44:680-686. [PMID: 38082071 PMCID: PMC11090710 DOI: 10.1038/s41372-023-01841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Quantify blood fatty acids and growth outcomes in preterm infants fed the exclusive human milk diet. METHODS A prospective cohort study of 30 infants 24-34 weeks gestation and ≤1250 g fed the exclusive human milk diet. Blood fatty acids were quantified at two time points. Comparisons were made using two-sample t-tests and Wilcoxon rank sum. RESULTS Donor human milk-fed (n = 12) compared to mother's own milk-fed infants (n = 18) from birth to after 28 days of life, had an increased interval change of linoleic to docosahexaenoic acid ratio (5.5 vs. -1.1 mole percent ratio, p = 0.034). Docosahexaenoic and eicosapentaenoic acid interval changes were similar between groups. The arachidonic acid change was similar between groups (-2.3 vs. -0.9 mole percent, p = 0.37), however, both experienced a negative change across time. At 36 weeks postmenstrual age, growth velocities were similar for groups. CONCLUSION An exclusive human milk diet maintains birth docosahexaenoic and eicosapentaenoic acid concentrations. However, the postnatal deficit in arachidonic acid was not prevented.
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Affiliation(s)
- Lindsay F Holzapfel
- Department of Pediatrics, Division of Neonatology, McGovern Medical School at the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, USA.
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | - Jana P Unger
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Pam Gordon
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Clinical Research Nutrition Center, Texas Children's Hospital, Houston, TX, USA
| | - Heeju Yang
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Joanne E Cluette-Brown
- Department of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Laura A Gollins
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Amy B Hair
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Camilia R Martin
- Division of Neonatology, Weill Cornell Medicine, New York, NY, USA
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12
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Mira A, Coo S, Bastías R. Mother's mental health and the interaction with her moderate preterm baby in the NICU. J Reprod Infant Psychol 2024; 42:299-314. [PMID: 35635499 DOI: 10.1080/02646838.2022.2077921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Moderate preterm infants, born between 320/7 and 336/7 weeks, represent a significant number of preterm-born infants; however, they remain a poorly studied group despite their vulnerability. The objective of this correlational study is to describe the impact of having a moderate preterm infant hospitalised in the NICU on the mothers' mental health and how this relates to the interaction between the dyad. METHOD During the hospitalisation period, 85 moderate preterm mother-infant dyads participated in this study. The participants provided self-reports of depression, parental stress, and skin to skin and breastfeeding practices. Also, mother-infant interaction was assessed in the NICU with an observational scale. RESULTS Mothers evidenced high levels of stress and depressive symptoms during the hospitalization. The stress experienced by these women was significant, although weakly, associated with the interaction with their babies; and mothers of small for gestational age babies showed difficulties in this area. CONCLUSIONS The results of this study could represent a contribution to a better understanding of the relation between the characteristics of moderate preterm babies, maternal emotional wellbeing, and the quality of mother-infant interactions in NICU settings.
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Affiliation(s)
- Andrea Mira
- Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Santiago, Chile
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Soledad Coo
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Rodolfo Bastías
- Unidad de Neonatología, Hospital Luis Tisné T., Servicio de Salud Metropolitana Oriente, Santiago, Chile
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13
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Ninan K, Liyanage SK, Murphy KE, Asztalos EV, McDonald SD. Long-Term Outcomes of Multiple versus a Single Course of Antenatal Steroids: A Systematic Review. Am J Perinatol 2024; 41:395-404. [PMID: 36724821 DOI: 10.1055/s-0042-1760386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple courses versus a single course of antenatal corticosteroids (ACS) have been associated with mild respiratory benefits but also adverse outcomes like smaller head circumference and birth weight. Long-term effects warrant study. We systematically reviewed long-term outcomes (≥1 year) in both preterm and term birth after exposure to preterm multiple courses (including a rescue dose or course) versus a single course. We searched seven databases from January 2000 to October 2021. We included follow-up studies of randomized controlled trials (RCTs) and cohort studies with births occurring in/after the year 2000, given advances in perinatal care. Two reviewers assessed titles/abstracts, articles, quality, and outcomes including psychological disorders, neurodevelopment, and anthropometry. Six follow-up studies of three RCTs and two cohort studies (over 2,860 children total) met inclusion criteria. Among children born preterm, randomization to multiple courses versus a single course of ACS was not associated with adjusted beneficial or adverse neurodevelopmental/psychological or other outcomes, but data are scant after a rescue dose (120 and 139 children, respectively, low certainty) and nonexistent after a rescue course. For children born at term (i.e., 27% of the multiple courses of ACS 5-year follow-up study of 1,728 preterm/term born children), preterm randomization to multiple courses (at least one additional course) versus a single course was significantly associated with elevated odds of neurosensory impairment (adjusted odds ratio = 3.70, 95% confidence interval: 1.57-8.75; 212 and 247 children, respectively, moderate certainty). In this systematic review of long-term outcomes after multiple courses versus a single course of ACS, there were no significant benefits or risks regarding neurodevelopment in children born preterm but little data after one rescue dose and none after a rescue course. However, multiple courses (i.e., at least one additional course) should be considered cautiously: after term birth, there are no long-term benefits but neurosensory harms. KEY POINTS: · We systematically reviewed the long-term impact of multiple versus a single course of ACS.. · Long-term follow-up data were scant after a rescue dose and absent after one rescue course of ACS.. · In children born preterm, multiple courses of ACS were not associated with long-term benefits/harms.. · In children born at term, multiple courses of ACS were associated with neurosensory impairment.. · Preterm administration of multiple courses of ACS should be considered cautiously..
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Affiliation(s)
- Kiran Ninan
- Department of Obstetrics and Gynecology, McMaster University, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Sugee K Liyanage
- Department of Obstetrics and Gynecology, McMaster University, Ontario, Canada
| | - Kellie E Murphy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth V Asztalos
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, McMaster University, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
- Department of Radiology, McMaster University, Ontario, Canada
- Division of Maternal-Fetal Medicine, McMaster University, Ontario, Canada
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14
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Quitadamo PA, Zambianco F, Palumbo G, Wagner X, Gentile MA, Mondelli A. Monitoring the Use of Human Milk, the Ideal Food for Very Low-Birth-Weight Infants-A Narrative Review. Foods 2024; 13:649. [PMID: 38472762 DOI: 10.3390/foods13050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 03/14/2024] Open
Abstract
Aware of the utmost importance of feeding premature babies-especially those of lower weight-with human milk, as well as the need to monitor this important element of neonatal care, we focused on four aspects in this review. First of all, we reviewed the beneficial effects of feeding premature infants with breast milk in the short and long term. Secondly, we performed a quantitative evaluation of the rates of breastfeeding and feeding with human milk in Very-Low-Birth-Weight infants (VLBWs) during hospitalization in the Neonatal Intensive Care Unit (NICU) and at discharge. Our aim was to take a snapshot of the current status of human milk-feeding care and track its trends over time. Then we analyzed, on the one hand, factors that have been proven to facilitate the use of maternal milk and, on the other hand, the risk factors of not feeding with breast milk. We also considered the spread of human milk banking so as to assess the availability of donated milk for the most vulnerable category of premature babies. Finally, we proposed a protocol designed as a tool for the systematic monitoring of actions that could be planned and implemented in NICUs in order to achieve the goal of feeding even more VLBWs with human milk.
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Affiliation(s)
- Pasqua Anna Quitadamo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Federica Zambianco
- San Raffaele Faculty of Medicine, University of San Raffaele Vita-Salute, 20132 Milan, MI, Italy
| | - Giuseppina Palumbo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Xavier Wagner
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Université Paris Cité, 79279 Paris, France
| | - Maria Assunta Gentile
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Antonio Mondelli
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
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15
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Salam SS, Rahman AE, Mhajabin S, Mazumder T, Majid T, Samad Talha MTU, Haider R, Chowdhury AT, Islam S, Ameen S, Jabeen S, Balen J, Arifeen SE, Nahar Q, Anumba DO. Perception and experiences of adolescent mothers and communities in caring for their preterm babies: findings from an in-depth study in rural Bangladesh. BMC Pregnancy Childbirth 2024; 24:145. [PMID: 38368364 PMCID: PMC10874081 DOI: 10.1186/s12884-024-06345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND A significant concern for Bangladesh is the high prevalence of adolescent pregnancy and the associated negative consequences for mother and baby, including a teen-related increased risk of preterm birth (PTB). Bangladesh also has one of the highest incidences of PTB (19%). Despite these high numbers of adolescent pregnancies and PTB, little is reported about the experiences of adolescent mothers in caring for their preterm babies, and the interventions needed to support them. The aim of this study was to explore gaps and opportunities for improved care for preterm babies among adolescent mothers and communities in rural Bangladesh. METHODS We conducted a qualitative study in rural villages of Baliakandi sub-district of Bangladesh. Data collection involved in-depth interviews with adolescent mothers of premature and term babies, adult mothers with premature babies, and family members (n = 36); focus groups with community members (n = 5); and key informant interviews with healthcare providers (n = 13). Adolescent mothers with term and adult mothers with PTBs were included to elicit similarities and differences in understanding and care practices of PTB. A thematic approach was used for data analysis. RESULTS We explored two major themes- perceptions and understanding of PTB; care practices and care-seeking for illnesses. We observed gaps and variations in understanding of preterm birth (length of gestation, appearance, causes, problems faced) and care practices (thermal management, feeding, weight monitoring) among all, but particularly among adolescents. Immediate natal and marital-kins were prominent in the narratives of adolescents as sources of informational and instrumental support. The use of multiple providers and delays in care-seeking from trained providers for sick preterm babies was noted, often modulated by the perception of severity of illness, cost, convenience, and quality of services. Health systems challenges included lack of equipment and trained staff in facilities to provide special care to preterm babies. CONCLUSION A combination of factors including local knowledge, socio-cultural practices and health systems challenges influenced knowledge of, and care for, preterm babies among adolescent and adult mothers. Strategies to improve birth outcomes will require increased awareness among adolescents, women, and families about PTB and improvement in quality of PTB services at health facilities.
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Affiliation(s)
| | - Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shema Mhajabin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tapas Mazumder
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Tamanna Majid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Rajib Haider
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anika Tasneem Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharmin Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shafiqul Ameen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Julie Balen
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- School of Allied and Public Health Professions, Canterbury Christ Church University, Kent, UK
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilly Oc Anumba
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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16
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Feragne M, Tucker R, Mayne J, Vohr B. Language outcomes at 18-24 months of preterm infants from US Spanish- and English-speaking homes. Acta Paediatr 2024; 113:239-246. [PMID: 37874258 DOI: 10.1111/apa.17006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
AIM To evaluate the association of Spanish compared to English primary household language on preterm (PT) infants' language outcomes in the United States and to examine associations with socio-economic factors. METHODS This was a retrospective cohort of PT infants born <32 weeks gestation from Spanish-speaking (n = 95) and English-speaking homes (n = 1030) born 2005-2019. Language (primary outcome) and cognitive and motor skills (secondary outcomes) were measured using the BSID-III at 18-24 months corrected age. Group differences were evaluated using bivariate comparisons and logistic regression analyses. RESULTS Mothers reporting Spanish-speaking homes had higher rates of public insurance and lower educational achievement. Group newborn characteristics were similar. Preterm infants from Spanish-speaking homes had significantly lower BSID-III language composite, cognitive composite, receptive and expressive scores compared to infants from English-speaking homes. Logistic regression modelling identified independent negative effects of Spanish-speaking household OR 3.26 (CI 1.89-5.62) and public insurance OR 2.31 (CI 1.71-3.12) with a protective benefit derived from breast milk OR 0.68 (CI 0.50-0.92) when adjusting for medical morbidities, socio-economic factors and gestational age. CONCLUSION Public health policies and interventions in the United States should target language and cognitive outcomes of PT infants from Spanish-speaking homes.
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Affiliation(s)
- Megan Feragne
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Richard Tucker
- Women and Infants Hospital, Providence, Rhode Island, USA
| | - Julia Mayne
- Women and Infants Hospital, Providence, Rhode Island, USA
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Betty Vohr
- Women and Infants Hospital, Providence, Rhode Island, USA
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
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17
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Patel AL, Tan A, Bucek A, Janes J, McGee K, Mulcahy D, Meier P, Johnson TJ. Where does the time go? Temporal patterns of pumping behaviors in mothers of very preterm infants vary by sociodemographic and clinical factors. Front Nutr 2024; 11:1278818. [PMID: 38352705 PMCID: PMC10861725 DOI: 10.3389/fnut.2024.1278818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Background Mothers of very preterm (<32 weeks gestational age [GA]) infants are breast pump dependent and have shorter duration of milk provision than mothers of term infants. The opportunity (i.e., time) cost of pumping and transporting mother's own milk (MOM) from home to the NICU may be a barrier. There is a paucity of data regarding how much time mothers actually spend pumping. Objective To investigate the variation in pumping behavior by postpartum week, maternal characteristics, and infant GA. Methods Prospectively collected pump log data from mothers enrolled in ReDiMOM (Reducing Disparity in Mother's Own Milk) randomized, controlled trial included pumping date and start time and end time of each pumping session for the first 10 weeks postpartum or until the infant was discharged from the NICU, whichever occurred first. Outcomes included number of daily pumping sessions, number of minutes spent pumping per day, and pumping behaviors during 24-h periods, aggregated to the postpartum week. Medians (interquartile ranges) were used to describe outcomes overall, and by maternal characteristics and infant GA. Results Data included 13,994 pump sessions from 75 mothers. Maternal characteristics included 55% Black, 35% Hispanic, and 11% White and 44% <30 years old. The majority (56%) of infants were born at GA 28-31 weeks. Mothers pumped an average of less than 4 times per day, peaking in postpartum week 2. After accounting for mothers who stopped pumping, there was a gradual decrease in daily pumping minutes between postpartum weeks 2 (89 min) and 10 (46 min). Black mothers pumped fewer times daily than non-Black mothers after the first 2 weeks postpartum. Conclusion On average mothers pumped less intensively than the minimum recommendation of 8 times and 100 min per day. However, these pumping behaviors represent significant maternal opportunity costs that should be valued by the institution and society at large.
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Affiliation(s)
- Aloka L. Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Amelia Tan
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Amelia Bucek
- Northwestern University, Chicago, IL, United States
| | - Judy Janes
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Katie McGee
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Delaney Mulcahy
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Paula Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL, United States
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18
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Rossholt ME, Bratlie M, Wendel K, Aas MF, Gunnarsdottir G, Fugelseth D, Pripp AH, Domellöf M, Størdal K, Stiris T, Moltu SJ. Effect of arachidonic and docosahexaenoic acid supplementation on quality of growth in preterm infants: A secondary analysis of a randomized controlled trial. Clin Nutr 2023; 42:2311-2319. [PMID: 37856920 DOI: 10.1016/j.clnu.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND & AIMS A balanced supply of arachidonic acid (ARA) and docosahexaenoic acid (DHA) may be crucial for quality of growth in preterm infants. This secondary analysis of a randomized controlled trial aimed to determine the effect of enhanced ARA and DHA supplementation on growth and body composition in infants born before 29 weeks of gestation. Furthermore, we aimed to study associations between human milk feeding, growth patterns and body composition. METHODS The ImNuT-trial randomized 121 infants to receive a daily supplement with medium chain triglycerides (control) or 100 mg/kg ARA and 50 mg/kg DHA (ARA:DHA group) from the second day of life until 36 weeks postmenstrual age. Growth and body composition were evaluated up to 3 months corrected age. RESULTS The ARA:DHA group showed better linear growth from birth to term equivalent age compared to the control group; mean difference in z score change from birth for length was 0.74 ([95% CI, 0.17-1.3]; p = 0.010). There were no differences in growth and body composition outcomes at 3 months corrected age between the groups. An increase in z score for weight after 36 weeks postmenstrual age and breastfeeding at 3 months corrected age were the strongest positive predictors of fat mass% at 3 months corrected age (both, p < 0.001). CONCLUSION Early enhanced supplementation of ARA and DHA may be beneficial with respect to somatic growth in very preterm infants. CLINICAL TRIAL REGISTRATION The trial has been registered on www. CLINICALTRIALS gov, ID: NCT03555019.
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Affiliation(s)
- Madelaine Eloranta Rossholt
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Marianne Bratlie
- Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, Norway
| | - Kristina Wendel
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Marlen Fossan Aas
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Gunnthorunn Gunnarsdottir
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Pediatric Neurology, Oslo University Hospital, Norway
| | - Drude Fugelseth
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umea University, Sweden
| | - Ketil Størdal
- Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, Norway; Pediatric Research Institute, Institute of Clinical Medicine, University of Oslo, Norway
| | - Tom Stiris
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Sissel Jennifer Moltu
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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19
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Vohr BR. Advances in Our Understanding Neurodevelopmental Benefits of Both Mother's Milk and Infant Formula Supplemented with Bovine Milk Fat Globule Membrane and Bovine Lactoferrin. J Pediatr 2023; 261:113529. [PMID: 37263522 DOI: 10.1016/j.jpeds.2023.113529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Betty R Vohr
- Department of Pediatrics, Women & Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, Rhode Island.
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20
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Talebiyan S, Belfort MB. Human Milk Fortification for Very Preterm Infants: Toward Optimal Nutrient Delivery, Neonatal Intensive Care Unit Growth, and Long-Term Outcomes. Clin Perinatol 2023; 50:625-641. [PMID: 37536768 DOI: 10.1016/j.clp.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Human milk is the preferred diet for very preterm infants due to short-term and long-term benefits for health and neurodevelopment. Fortification of human milk is required to deliver sufficient nutrients to attain recommended growth targets during the neonatal hospitalization. Intrinsic variability in human milk composition poses a challenge in clinical practice because some infants fail to meet recommended nutrient intakes even with existing approaches of standard (fixed-dose) and adjustable fortification. Individually targeted fortification is an emerging strategy to minimize nutrition delivery gaps through application of point-of-care human milk analysis and has potential to improve growth and related outcomes.
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Affiliation(s)
- Saharnaz Talebiyan
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 221 Longwood Avenue BL-341, Boston, MA 02115, USA
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 221 Longwood Avenue BL-341, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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21
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Ding L, Chen Y, Zhang W, Song J, Yao X, Wan Y, Huang R. Effect of family integrated care on breastfeeding of preterm infants: A scoping review. Nurs Open 2023; 10:5950-5960. [PMID: 37306324 PMCID: PMC10416000 DOI: 10.1002/nop2.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
AIMS The aims are to describe the key components of family integrated care intervention for preterm infants in the neonatal intensive care unit (NICU) and assess the impact on breastfeeding outcomes for those infants. DESIGN A scoping review. METHODS We conducted a systematic study search based on the databases, including PubMed, Scopus, Cochrane, Web of Science, MEDLINE, CINAHL, CNKI and Wanfang Database in December 2022. The search time ranged from database establishment to 31 December 2022. Papers by manual searching were also listed on the references. We adopted Joanna Briggs Institute Reviewer's Manual methodology and followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to conduct the review. Two independent reviewers filtered the papers, extracted data and synthesized the findings. A table was used to extract data and synthesize results. RESULTS After systematic searching, 11 articles that implemented family integrated care (FIcare) were finally included in this scoping review. By analysing the implementation of this nursing model, we identified seven main components: NICU staff training, parent education, parent participation in infants' care, parent involvement in medical plans, peer support, NICU environmental support and mobile app for parents. Based on the extracted breastfeeding data, this scoping review concludes that family integrated care shows a positive effect on increasing breastfeeding rates at discharge. Through this scoping review, we find that family integrated care is feasible and it can support breastfeeding of preterm infants. Further studies will be needed to provide more evidence that family integrated care could facilitate breastfeeding of preterm infants. IMPACT This scoping review provides evidence for the positive role of family integrated care on breastfeeding outcomes. The analysis may contribute to the implementation of family integrated care. NO PATIENT OR PUBLIC CONTRIBUTION No further public or patient contribution was made in view of the review-based nature of the research.
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Affiliation(s)
- Lijing Ding
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yanli Chen
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Wenyan Zhang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jianqi Song
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiao Yao
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yue Wan
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Rong Huang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
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22
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Chao AS, Matak P, Pegram K, Powers J, Hutson C, Jo R, Dubois L, Thompson JW, Smith PB, Jain V, Liu C, Younge NE, Rikard B, Reyes EY, Shinohara ML, Gregory SG, Goldberg RN, Benner EJ. 20-αHydroxycholesterol, an oxysterol in human breast milk, reverses mouse neonatal white matter injury through Gli-dependent oligodendrogenesis. Cell Stem Cell 2023; 30:1054-1071.e8. [PMID: 37541211 PMCID: PMC10625465 DOI: 10.1016/j.stem.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/21/2023] [Accepted: 07/12/2023] [Indexed: 08/06/2023]
Abstract
White matter injuries (WMIs) are the leading cause of neurologic impairment in infants born premature. There are no treatment options available. The most common forms of WMIs in infants occur prior to the onset of normal myelination, making its pathophysiology distinctive, thus requiring a tailored approach to treatment. Neonates present a unique opportunity to repair WMIs due to a transient abundance of neural stem/progenitor cells (NSPCs) present in the germinal matrix with oligodendrogenic potential. We identified an endogenous oxysterol, 20-αHydroxycholesterol (20HC), in human maternal breast milk that induces oligodendrogenesis through a sonic hedgehog (shh), Gli-dependent mechanism. Following WMI in neonatal mice, injection of 20HC induced subventricular zone-derived oligodendrogenesis and improved myelination in the periventricular white matter, resulting in improved motor outcomes. Targeting the oligodendrogenic potential of postnatal NSPCs in neonates with WMIs may be further developed into a novel approach to mitigate this devastating complication of preterm birth.
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Affiliation(s)
- Agnes S Chao
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Pavle Matak
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Kelly Pegram
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - James Powers
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Collin Hutson
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Rebecca Jo
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Laura Dubois
- Duke Proteomics and Metabolomics Shared Resource, Center for Genomics and Computational Biology, School of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - J Will Thompson
- Duke Proteomics and Metabolomics Shared Resource, Center for Genomics and Computational Biology, School of Medicine, Duke University Medical Center, Durham, NC 27710, USA; Department of Pharmacology and Cancer Biology, School of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - P Brian Smith
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Vaibhav Jain
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710, USA
| | - Chunlei Liu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA 94720, USA; Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Noelle E Younge
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Blaire Rikard
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Estefany Y Reyes
- Department of Immunology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Mari L Shinohara
- Department of Immunology, Duke University School of Medicine, Durham, NC 27710, USA; Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Simon G Gregory
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710, USA
| | - Ronald N Goldberg
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA
| | - Eric J Benner
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, The Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710, USA.
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23
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Yackobovitch-Gavan M, Atia Shmueli S, Morag I. Neurodevelopmental Outcomes Among Infants Born Preterm Fed With Mother's Own Milk: A Comparison of Singletons and Twins. J Pediatr 2023; 259:113484. [PMID: 37196779 DOI: 10.1016/j.jpeds.2023.113484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To examine associations between early exposure to mother's own milk (MOM) and neurodevelopmental outcomes among preterm infants, and to compare these associations between singletons and twins. STUDY DESIGN Retrospective cohort study that included low-risk infants born at <32 weeks gestational age. Nutrition was documented over a 3-day period at mean ages of 14 and 28 days of life; an average of the 3 days was calculated. The Griffiths Mental Development Scales (GMDS) were administered at 12 months corrected age. RESULTS Preterm infants (n = 131) with median gestational age of 30.6 weeks were included; 56 (42.7%) were singletons. On days 14 and 28 of life, 80.9% and 77.1% were exposed to MOM, respectively. Exposure rate was comparable, but MOM intake (mL/kg/day) was higher among singletons than among twins (P < .05). At both time points, MOM-exposed infants scored higher on personal-social, hearing-language, and total GMDS assessments than nonexposed infants. These differences were significant for the entire cohort and for twins (P < .05). MOM intake correlated with total GMDS score for both singletons and twins. Any exposure to MOM was associated with additional 6-7 points on total GMDS score or 2-3 additional points for every 50 mL/kg/day of MOM. CONCLUSIONS The study supports the positive association between early MOM exposure among low-risk preterm infants and neurodevelopmental outcomes at 12 months corrected age. The differential effects of MOM exposure on singletons vs twins need further exploration.
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Affiliation(s)
- Michal Yackobovitch-Gavan
- Sackler Faculty of Medicine, Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel; The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| | - Sarit Atia Shmueli
- Sackler Faculty of Medicine, Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Iris Morag
- Department of Pediatrics, Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Zerifin, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Quitadamo PA, Zambianco F, Palumbo G, Copetti M, Gentile MA, Mondelli A. Trend and Predictors of Breastmilk Feeding among Very-Low-Birth-Weight Infants in NICU and at Discharge. Nutrients 2023; 15:3314. [PMID: 37571252 PMCID: PMC10421341 DOI: 10.3390/nu15153314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Mothers' own milk (MOM) for premature babies is considered a life-saving drug for its proven protective action against the complications of prematurity and for effects on outcome in the short and long term, especially neurological ones. We studied the use of MOM for infants weighing <1500 g for a period of 5 years, evaluating the trend over time and the impact of some variables on human milk feeding performance. Statistical comparisons concerned the rate of feeding with breast milk during a stay in an NICU and at discharge with respect to two types of variables: (1) maternal and neonatal characteristics (gestational age, birth weight, type of pregnancy (whether single or twin), maternal age) and (2) feeding characteristics (time of the start of minimal enteral feeding and availability of MOM, days until the achievement of full enteral feeding). Group comparisons were performed using ANOVA or t-test for continuous variables and Pearson chi-squared test or Fisher exact test for categorical variables. We observed an increase, between 2017 and 2021, in MOM use (p = 0.003). The availability of the own mothers' milk occurred, on average, on the fourth day of life and improved over the years. The start of minimal enteral feeding (MEF) with human milk averaged 1.78 days, and 54.3% of VLBWs received MEF with donor milk on the first day of life. The average percentage of feeding with the mothers' milk at discharge was 47.6%, with 36.1% of exclusive MOM and an increase from 45.8% in 2017 (33.3% exclusive) to 58.82% (41.18% exclusive) in 2021. The mean average daily growth of the weight improved (p < 0.001) during this period, and there was no statistical difference between infants fed with maternal milk and those fed with bank milk. Older maternal age, early-start feeding with maternal milk and low gestational age had a statistically significant impact on feeding with MOM at discharge.
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Affiliation(s)
- Pasqua Anna Quitadamo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Federica Zambianco
- San Raffaele Faculty of Medicine, University of San Raffaele Vita-Salute, 20132 Milano, Italy;
| | - Giuseppina Palumbo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Massimiliano Copetti
- Statistical Department, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Maria Assunta Gentile
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Antonio Mondelli
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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25
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Ericson J, Ahlsson F, Wackernagel D, Wilson E. Equally Good Neurological, Growth, and Health Outcomes up to 6 Years of Age in Moderately Preterm Infants Who Received Exclusive vs. Fortified Breast Milk-A Longitudinal Cohort Study. Nutrients 2023; 15:nu15102318. [PMID: 37242201 DOI: 10.3390/nu15102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
Moderately preterm infants (32-36 weeks of gestational age) have an increased risk of worse health and developmental outcomes compared to infants born at term. Optimal nutrition may alter this risk. The aim of this study was to investigate the neurological, growth, and health outcomes up to six years of age in children born moderately preterm who receive either exclusive or fortified breast milk and/or formula in the neonatal unit. In this longitudinal cohort study, data were collected for 142 children. Data were collected up to six years of age via several questionnaires containing questions about demographics, growth, child health status, health care visits, and the Five to Fifteen Questionnaire. Data on the intake of breast milk, human milk fortification, formula, and growth during hospitalization were collected from the children's medical records. No statistically significant differences in neurological outcomes, growth, or health at six years of age were found between the two groups (exclusive breast milk, n = 43 vs. fortified breast milk and/or formula, n = 99). There is a need for research in larger populations to further assess potential effects on health and developmental outcomes when comparing the use of exclusive versus fortified breast milk for moderately preterm infants during neonatal hospitalization.
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Affiliation(s)
- Jenny Ericson
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, 791 82 Falun, Sweden
- Department of Pediatrics, Falu Hospital, 791 82 Falun, Sweden
| | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, 752 36 Uppsala, Sweden
| | - Dirk Wackernagel
- Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Emilija Wilson
- Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden
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26
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Huang R, Wan Y, Yao X, Wang H, Cai C, Xu Y, Jiang H. Predictive factors of exclusive breastfeeding attrition at Week 6 post-partum among mothers of preterm infants based on the theory of planned behaviour. MATERNAL & CHILD NUTRITION 2023; 19:e13470. [PMID: 36567573 PMCID: PMC10019043 DOI: 10.1111/mcn.13470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
Breastfeeding plays an important role in the growth and development of preterm infants, and exclusive breastfeeding (EBF) in the first 6 weeks post-partum is the key to continuous breastfeeding. This study was designed to explore the influencing factors that contribute to breastfeeding attrition among mothers of preterm infants at Week 6 post-partum based on the theory of planned behaviour (TPB). We herein adopted a prospective observational study design in which 97 mothers who exclusively breastfed at Week 6 post-partum at a tertiary specialised hospital in Shanghai from June 2021 to February 2022 were taken as the EBF group, and 179 mothers without EBF were assigned to the EBF attrition group. Through an extensive literature review and expert consultation, we determined the possible factors influencing EBF attrition, analysed those factors that showed statistical significance in our univariate analysis by applying binary logistic regression, and constructed a nomogram model for predicting EBF attrition. The results revealed that negative breastfeeding sentiment (odds ratio [OR] = 1.006; 95% confidence interval [CI], 1.000-1.011) generated a greater risk of breastfeeding attrition. However, positive breastfeeding sentiment (OR = 0.991; 95% CI, 0.983-0.999), social and professional support (OR = 0.993; 95% CI, 0.987-0.999), breastfeeding control (OR = 0.945; 95% CI, 0.896-0.996), knowledge (OR = 0.893; 95% CI, 0.799-0.998), and intention to EBF at Week 6 post-partum (OR = 0.522; 95% CI, 0.276-0.988) were the protective factors and facilitated the development of our nomogram model. The Hosmer-Lemeshow goodness-of-fit test generated a χ2 value of 11.344 (p = 0.183) and an area under the curve of 0.822 (95% CI, 0.771-0.873). The C-index was 0.800 in the internal bootstrap validation, indicating that the nomogram model possessed favourable predictive accuracy and discrimination.
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Affiliation(s)
- Rong Huang
- Department of Nursing, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yue Wan
- Department of Nursing, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiao Yao
- Department of Nursing, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Hao Wang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital South CampusShanghaiChina
| | - Chen‐ting Cai
- Nursing Department, School of MedicineTongji UniversityShanghaiChina
| | - Yi‐ting Xu
- Department of Nursing, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Hui Jiang
- Department of Nursing, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
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27
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Nommsen-Rivers L, Black MM, Christian P, Groh-Wargo S, Heinig MJ, Israel-Ballard K, Obbagy J, Palmquist AEL, Stuebe A, Barr SM, Proaño GV, Moloney L, Steiber A, Raiten DJ. An equitable, community-engaged translational framework for science in human lactation and infant feeding-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 5. Am J Clin Nutr 2023; 117 Suppl 1:S87-S105. [PMID: 37173062 DOI: 10.1016/j.ajcnut.2023.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field. Thus, with inspiration from the simplified environmental sciences framework of Kaufman and Curl, Working Group 5 of the BEGIN Project developed a translational framework for science in human lactation and infant feeding, which includes 5 nonlinear, interconnected translational stages, T1: Discovery; T2: Human health implications; T3: Clinical and public health implications; T4: Implementation; and T5: Impact. The framework is accompanied by 6 overarching principles: 1) Research spans the translational continuum in a nonlinear, nonhierarchical manner; 2) Projects engage interdisciplinary teams in continuous collaboration and cross talk; 3) Priorities and study designs incorporate a diverse range of contextual factors; 4) Research teams include community stakeholders from the outset through purposeful, ethical, and equitable engagement; 5) Research designs and conceptual models incorporate respectful care for the birthing parent and address implications for the lactating parent; 6) Research implications for real-world settings account for contextual factors surrounding the feeding of human milk, including exclusivity and mode of feeding. To demonstrate application of the presented translational research framework and its overarching principles, 6 case studies are included, each illustrating research gaps across all stages of the framework. Applying a translational framework approach to addressing gaps in the science of human milk feeding is an important step toward the aligned goals of optimizing infant feeding across diverse contexts as well as optimizing health for all.
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Affiliation(s)
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - M Jane Heinig
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Julie Obbagy
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Washington, DC, USA
| | - Aunchalee E L Palmquist
- Department of Maternal & Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison Stuebe
- Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | | | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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28
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Pados BF. State of the Science on the Benefits of Human Milk for Hospitalized, Vulnerable Neonates. Nurs Womens Health 2023; 27:121-140. [PMID: 36871597 DOI: 10.1016/j.nwh.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023]
Abstract
Research on human milk has increased dramatically in recent years. The purpose of this review is to describe the literature on the health benefits of human milk for hospitalized, vulnerable neonates. PubMed, CINAHL, and Embase were searched for research articles reporting the health outcomes of hospitalized neonates who were exposed to human milk. Human milk, particularly a mother's own milk, has the potential to reduce the risk of death and the risk and severity of necrotizing enterocolitis, infection, retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, kidney disease, and liver disease. Dose and timing of human milk is important, with more human milk and earlier introduction having a greater impact on health. When a mother's own milk is not available, donor human milk provides benefits over infant formula.
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29
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Johnson TJ, Meier PP, Robinson DT, Suzuki S, Kadakia S, Garman AN, Patel AL. The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:416. [PMID: 36979974 PMCID: PMC10046918 DOI: 10.3390/children10030416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.
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Affiliation(s)
- Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Paula P. Meier
- College of Nursing, Rush University, Chicago, IL 60612, USA
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Daniel T. Robinson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sumihiro Suzuki
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Suhagi Kadakia
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Andrew N. Garman
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Aloka L. Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
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30
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Cordova-Ramos EG, Melvin P, Kalluri NS, Peña MM, Belfort MB, Parker MG. Association of Primary Language with Provision of Mother's Milk Among Very-Low-Birthweight Infants in Massachusetts. Breastfeed Med 2023; 18:116-123. [PMID: 36576788 PMCID: PMC9969892 DOI: 10.1089/bfm.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Racial/ethnic inequities in mother's milk provision for hospitalized preterm infants persist. The extent to which primary language contributes to these racial/ethnic inequities is unknown. Objective: Examine associations of maternal race/ethnicity and primary language with (1) any/exclusive mother's milk at hospital discharge and (2) the time to cessation of mother's milk provision during the hospitalization. Methods: We examined 652 mother/very-low-birthweight (VLBW) infant dyads at 9 level 3 neonatal intensive care units in Massachusetts from January 2017 to December 2018. We abstracted maternal race/ethnicity and language from medical records, and examined English and non-English-speaking non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic mothers of any race. We examined associations of race/ethnicity and language with (1) any/exclusive mother's milk at discharge (yes/no) using mixed-effects logistic regression and (2) cessation of mother's milk during the hospitalization using cox proportional hazard models, adjusting for gestational age, birthweight, and accounting for clustering by plurality and hospital. Results: Fifty-three percent were English-speaking NHW, 22% English-speaking NHB, 4% non-English-speaking NHB, 14% English-speaking Hispanic, and 7% non-English-speaking Hispanic. Compared with English-speaking NHW, NHB mothers (English adjusted odds ratio [aOR] 0.28 [0.17, 0.44]; and non-English-speaking aOR 0.55 [0.19, 0.98]), and non-English-speaking Hispanic mothers (aOR 0.29 [0.21, 0.87]) had lower odds of any mother's milk at discharge. In time-to-event analyses, non-English-speaking Hispanic (adjusted hazard ratio [aHR] 4.37 [2.20, 6.02]) and English-speaking NHB mothers (aHR 3.91 [1.41, 7.61] had the earliest cessation of mother's milk provision. Conclusion: In Massachusetts, maternal primary language was associated with inequities in mother's milk provision for VLBW infants with a differential effect for NHB and Hispanic mothers.
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Affiliation(s)
- Erika G. Cordova-Ramos
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Patrice Melvin
- Office of Health Equity and Inclusion, and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikita S. Kalluri
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle-Marie Peña
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret G. Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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31
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Zheng Z, Shen W, Tang LX, Zhang R, Cheng R, Wang SN, Chen DM, Chen C, Lin XZ. High-proportion breast milk feeding is associated with a reduction in the incidence of IVH in very preterm infants. Front Neurol 2023; 13:993985. [PMID: 36742049 PMCID: PMC9889932 DOI: 10.3389/fneur.2022.993985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
Objective To investigate the protective effect of high-proportion breast milk feeding (>50%) on intraventricular hemorrhage (IVH) in very preterm infants (VPIs). Methods This was a retrospective secondary analysis of a prospective multi-center study, which included 604 VPIs from six hospitals in eastern China between September 2019 and December 2020. The 604 VPIs were divided into two groups according to whether IVH occurred. High-proportion breast milk feeding was defined as breast milk accounting for 51-100% of the total feeding amount both within 7 days and throughout the hospitalization. The IVH grades and the rate of high-proportion breast milk feeding were analyzed. Furthermore, to explore the relationship between high-proportion breast milk feeding and IVH grading, the VPIs' general information, perinatal factors, growth, and nutritional status during hospitalization, and related complications were compared between the two groups. Results High-proportion breast milk feeding was reported in 63.41% of the VPIs. Furthermore, IVH grades I-II and III-IV were noted in 39.73% (240/604) and 1.66% (10/604) of the VPIs, respectively. Univariate analysis revealed that IVH occurrence in VPIs is influenced by perinatal factors, invasive respiratory therapy, high-proportion breast milk feeding, start feeding with breast milk, the cumulative amount of early parenteral nutrition, postnatal complications, physical growth, and other factors (P < 0.05). After adjustments for gestational age, birth weight, and possible influencing factors through binary logistic regression analysis, the results revealed that high-proportion breast milk feeding and and start feeding with breast milk were associated with a lower total incidence of IVH. Further stratification showed that high-proportion breast milk feeding was associated with a lower incidence of grade I-II IVH. Similarly, after adjusting for the same factors, breast milk feeding >50% in the 1st week was associated with a decreased incidence of total IVH and further stratification showed that it was associated with a lower incidence of grade I-II IVH. Conclusion High-proportion breast milk feeding and breast milk feeding more than 50% of total intake during the 1st week might be protective factors for IVH grade I-II in VPIs, which further verified the neuroprotective effect of breast milk. In clinical practice, the construction of breast milk banks should be strengthened, breast milk feeding should be encouraged in neonatal intensive care units, and efforts should be made to increase breast milk feeding rates to improve the outcomes of VPIs.
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Affiliation(s)
- Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Women and Children's Hospital, Xiamen, Fujian, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Women and Children's Hospital, Xiamen, Fujian, China,Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Li-Xia Tang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Women and Children's Hospital, Xiamen, Fujian, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Rui Cheng
- Department of Neonatology, Children' Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, Fujian, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China,*Correspondence: Chao Chen ✉
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Women and Children's Hospital, Xiamen, Fujian, China,Xin-Zhu Lin ✉
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Borràs-Novell C, Herranz Barbero A, Balcells Esponera C, López-Abad M, Aldecoa Bilbao V, Izquierdo Renau M, Iglesias Platas I. Influence of maternal and perinatal factors on macronutrient content of very preterm human milk during the first weeks after birth. J Perinatol 2023; 43:52-59. [PMID: 35931800 PMCID: PMC9839448 DOI: 10.1038/s41372-022-01475-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify changes in macronutrient content of very preterm human milk associated with perinatal factors. STUDY DESIGN Milk macronutrients were measured on weeks 1, 2, 4 and 8 with mid-infrared transmission spectrometers. RESULT We assessed 625 samples (from 117 mothers and 130 very preterm infants). Average concentrations were: protein 1.3 ± 0.3 g/dl, carbohydrates 7.3 ± 0.6 g/dl, fat 3.7 ± 1.0 g/dl and energy 296.0 ± 41.0 kJ/dl (70.7 kcal/dl). Gestational age negatively correlated with protein (rho: -0.307, p < 0.001) and energy (r: -0.193, p = 0.003). Advanced maternal age, gestational age and intrauterine growth restriction were independently associated with milk protein content over the first 4 weeks (adjusted R2: 0.113, p = 0.002). CONCLUSION These findings may help neonatologists identify patients fed Mother´s Own Milk who are at increased risk of poor postnatal growth.
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Affiliation(s)
- Cristina Borràs-Novell
- Neonatology Department. BCNatal - Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | - Ana Herranz Barbero
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Carla Balcells Esponera
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Miriam López-Abad
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Victoria Aldecoa Bilbao
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Izquierdo Renau
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Iglesias Platas
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain ,grid.416391.80000 0004 0400 0120Neonatal Intensive Care Unit, Norfolk and Norwich University Hospital, Norwich, UK
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Salvatori G, De Rose DU, Clemente M, Gentili C, Verardi GP, Amadio P, Reposi MP, Bagolan P, Dotta A. How much does a liter of donor human milk cost? Cost analysis of operating a human milk bank in Italy. Int Breastfeed J 2022; 17:90. [PMID: 36539788 PMCID: PMC9764658 DOI: 10.1186/s13006-022-00530-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To date, 40 Human Milk Banks (HMB) have been established in Italy; however, recent cost analysis data for operating an HMB in Italy are not available in the literature. METHODS This study was a cross-sectional study performed at "Bambino Gesù" Children's Hospital in Rome, Italy in 2019. We assessed the one-year operational costs and, the per liter unit costs at our HMB. RESULTS During the 2019 year we collected 771 l of human milk supplied by 128 donors. The total cost was € 178,287.00 and the average cost was € 231.00 per liter. € 188,716.00 would have been spent had the maximum capacity for 904 l been reached. We found a significant difference (€ 231.00 vs € 209.00 per liter, p = 0.016) comparing the cost for collected liters in the year 2019 and the cost for the maximum capacity of the bank for that year of activity. Analyzing each cost item that determines the charge of donor human milk (DHM), the highest costs are the salaries of medical and paramedical staff, and then the costs related to transporting. If the HMB works at maximum capacity and manages a greater number of liters of milk, this can represent an important saving. Conversely, the price of consumables is modest (i.e., the price of a single-use kit for breast pumps was € 0.22 per unit). CONCLUSION The costs for a liter of DHM are quite high, but they must be related to the benefits, especially for preterm infants. Comparing the cost for collected liters in 2019 and the costs for the 2019 maximum capacity of the HMB, we calculated how much fixed costs of collection and distribution of DHM can be reduced, by increasing the volume of milk collected. To the best of our knowledge, this is the first complete cost analysis for an Italian Milk Bank. A thorough analysis could help to abate fixed costs and reduce the cost of a liter of DHM. The centralization of DHM can allow savings, rather than creating small HMBs scattered throughout the territory that would operate with lower milk volumes.
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Affiliation(s)
- Guglielmo Salvatori
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Domenico Umberto De Rose
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Maria Clemente
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Life and Reproductive Sciences, Verona Hospital, Verona, Italy
| | - Cristina Gentili
- grid.414125.70000 0001 0727 6809Finance Control, Internal Control, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Giovanni Paride Verardi
- grid.414125.70000 0001 0727 6809Finance Control, Internal Control, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Patrizia Amadio
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Maria Paola Reposi
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Pietro Bagolan
- grid.414125.70000 0001 0727 6809Neonatal Surgery Unit, Medical and Surgical Department of Fetus - Newborn – Infant, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
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Zhao T, Griffith T, Zhang Y, Li H, Hussain N, Lester B, Cong X. Early-life factors associated with neurobehavioral outcomes in preterm infants during NICU hospitalization. Pediatr Res 2022; 92:1695-1704. [PMID: 35338349 PMCID: PMC9509490 DOI: 10.1038/s41390-022-02021-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to investigate the influence of early-life pain/stress and medical characteristics on neurobehavioral outcomes in preterm infants. METHODS A prospective cohort study was conducted with 92 preterm infants (28-32 weeks gestational age [GA]). Early-life pain/stress was measured via the Neonatal Infant Stressor Scale (NISS) during the first 28 days of NICU hospitalization. Neurobehavioral outcomes were evaluated using the NICU Network Neurobehavioral Scale at 36-38 weeks post-menstrual age. Functional regression and machine learning models were performed to investigate the predictors of neurobehavioral outcomes. RESULTS Infants experienced daily acute pain/stress (24.99 ± 7.13 frequencies) and chronic events (41.13 ± 17.81 h). Up to 12 days after birth, both higher acute and chronic NISS scores were associated with higher stress scores; and higher chronic NISS scores were also related to lower self-regulation and quality of movement. Younger GA predicted worse neurobehavioral outcomes; GA < 31.57 weeks predicted worse stress/abstinence, self-regulation, and excitability; GA < 30.57 weeks predicted poor quality of movement. A higher proportion of maternal breastmilk intake predicted better self-regulation, excitability, and quality of movement in older GA infants. CONCLUSIONS Preterm infants are vulnerable to the impact of early-life pain/stress. Neurobehavioral outcomes are positively associated with increased GA and higher maternal breastmilk intake. IMPACT During the first 12 days of life, preterm infant neurobehavioral outcomes were vulnerable to the negative impact of acute and chronic pain/stress. Future research is warranted to investigate the long-term effects of early-life pain/stress on neurobehavioral outcomes. Gestational age remains one of the critical factors to predict neurobehavioral outcomes in preterm infants; older gestational age significantly predicted better neurobehavioral outcomes. Feeding with a higher proportion of maternal breastmilk predicted better neurobehavioral outcomes. Future research is warranted to investigate how maternal breastmilk may buffer the negative effects of early-life pain/stress on neurobehavioral outcomes.
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Affiliation(s)
- Tingting Zhao
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Thao Griffith
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Yiming Zhang
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Hongfei Li
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Naveed Hussain
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Barry Lester
- Brown Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA.
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
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The impact of a Donor Human Milk Program on the provision of mothers' own milk at discharge in very low birth weight infants. J Perinatol 2022; 42:1473-1479. [PMID: 35864217 DOI: 10.1038/s41372-022-01439-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine the effect of a donor human milk (DHM) program on mothers' own milk feedings at discharge for very low birth weight (VLBW) infants. STUDY DESIGN A single center retrospective analysis of feeding outcomes in preterm infants. Data were assigned as: (1) pre DHM era (2) Bridge DHM era (3) Full DHM era. Each era was divided into infants <1500 g (n = 724) or ≥1500 g (n = 784). RESULTS Both the percentage of mothers' own milk feeds and percent of infants exclusively receiving mothers' own milk at discharge were increased in the <1500 g (p = 0.003, p = 0.002) and the ≥1500 g group (p = 0.007, p = 0.004) respectively, following the introduction of DHM for VLBW infants. CONCLUSION Practice changes that accompany a donor milk program likely play a prominent role in the provision of mothers' own milk and exclusivity of breast milk feedings at discharge for very low birth weight infants.
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Effect of an exclusive human milk diet on feeding tolerance in preterm infants. J Perinatol 2022; 42:1070-1075. [PMID: 35184144 DOI: 10.1038/s41372-022-01348-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the time to full enteral feeds in preterm infants fed exclusive human milk (EHM) - mother's own milk (MOM) fortified with human milk-based fortifier (HMBF), to those who received partial human milk (PHM) - MOM fortified with bovine milk-based fortifier (BMBF), and exclusive formula. STUDY DESIGN A single-center retrospective study of infants with birth weight <1250 g from 2013 to 2018. Data on feeding, growth and other short-term neonatal morbidities were collected. RESULTS On regression analysis, time to full enteral feeds was significantly higher in PHM compared to EHM group (β-coefficient 4.14, 95% CI 0.00-8.29) and formula-fed group compared to EHM (β-coefficient 4.3, 95% CI 0.32-8.20). No significant differences in growth velocity, length of stay and other morbidities were found between the groups. CONCLUSION Infants in EHM had better feeding tolerance and reached their enteral feed goals sooner compared to PHM and formula-fed groups.
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Asztalos EV, Kiss A. Early Breast Milk Volumes and Response to Galactogogue Treatment. CHILDREN 2022; 9:children9071042. [PMID: 35884026 PMCID: PMC9315761 DOI: 10.3390/children9071042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the effect of galactogogue management in mothers of very preterm infants with varying breast milk volumes prior to initiating this treatment. Data were utilized from 90 women who participated in a trial employing domperidone. Three groups were formed according to their breast milk volumes (based on their infants’ birth weight) at the time of randomization and study entry to the trial protocol: (1) ≤100 mL/kg/d; (2) 101–200 mL/kg/d; and (3) ≥201 mL/kg/d. Breast milk volumes were evaluated at the 14- and 28-day study treatment periods. All three groups showed a significant volume increase and volume percent increase both at the 14-day measure and also the 28-day measure. Mothers who started in the two lower volume groups showed the greatest % volume change overall, with 356.2% in the ≤100 mL/kg/d and 106.1% in the 101–200 mL/kg/d groups, compared to those mothers in the higher group of ≥201 mL/kg/d, showing a change of 45.2%, where p = 0.001. Mothers producing varying low volumes were able to demonstrate an effect from the use of domperidone and increase their volumes as much as three-hundred-fold over 14- and 28-day study periods. However, those mothers whose volumes were ≤100 mL/kg/d continued to maintain low absolute milk volumes, putting these mothers at ongoing risk of ceasing lactation.
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Affiliation(s)
- Elizabeth V. Asztalos
- Sunnybrook Health Sciences Centre, Department of Paediatrics, University of Toronto, Toronto, ON M4N 3M5, Canada
- Correspondence:
| | - Alex Kiss
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
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Belfort MB, Knight E, Chandarana S, Ikem E, Gould JF, Collins CT, Makrides M, Gibson RA, Anderson PJ, Simmer K, Tiemeier H, Rumbold A. Associations of Maternal Milk Feeding With Neurodevelopmental Outcomes at 7 Years of Age in Former Preterm Infants. JAMA Netw Open 2022; 5:e2221608. [PMID: 35816314 PMCID: PMC9280396 DOI: 10.1001/jamanetworkopen.2022.21608] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Maternal milk feeding may have unique long-term neurodevelopmental benefits in very preterm infants. OBJECTIVE To examine the extent to which maternal milk feeding after very preterm birth is associated with cognitive, academic, and behavioral outcomes at school age. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study assessed 586 infants born at less than 33 weeks' gestation at 5 Australian perinatal centers and enrolled in the Docosahexaenoic Acid for Improvement of Neurodevelopmental Outcomes study (January 1, 2001, to December 31, 2005) who were evaluated at a corrected age of 7 years. The statistical analysis was completed on January 19, 2022. EXPOSURES Maternal milk intake, including mean volume (milliliters per kilogram per day) during neonatal hospitalization and total duration (in months). MAIN OUTCOMES AND MEASURES Neurodevelopmental outcomes at 7 years of age were (1) IQ (Wechsler Abbreviated Scale of Intelligence), (2) academic achievement (Wide Range Achievement Test, Fourth Edition), (3) symptoms of attention-deficit/hyperactivity disorder (ADHD) (Conners Third Edition ADHD Index, parent reported), (4) executive function (Behavior Rating Inventory of Executive Functioning, parent reported), and (5) behavior (Strengths and Difficulties Questionnaire, parent reported). RESULTS A total of 586 infants (mean [SD] gestational age at birth, 29.6 [2.3] weeks; 314 male [53.6%]) born to 486 mothers (mean [SD] age, 30.6 [5.5] years; 447 [92.0%] White) were included. Mean (SD) maternal milk intake in the neonatal intensive care unit was 99 (48) mL/kg daily, and mean (SD) maternal milk duration was 5.1 (5.4) months. Mean (SD) full-scale IQ was 98.5 (13.3) points. After covariate adjustment, higher maternal milk intake during the neonatal hospitalization was associated with higher performance IQ (0.67 points per additional 25 mL/kg daily; 95% CI, 0.10-1.23 points), reading scores (1.14 points per 25 mL/kg daily; 95% CI, 0.39-1.89 points), and math scores (0.76 points per 25 mL/kg daily; 95% CI, 0.14-1.37 points) and fewer ADHD symptoms (-1.08 points per 25 mL/kg daily; 95% CI, -1.96 to -0.20 points). Longer duration of maternal milk intake was associated with higher reading (0.33 points per additional month; 95% CI, 0.03-0.63 points), spelling (0.31 points per month; 95% CI, 0.01-0.62 points), and math (0.30 points per month; 95% CI, 0.03-0.58 points) scores. Maternal milk was not associated with improved full-scale IQ, verbal IQ, executive function, or behavior. Most associations were stronger among infants born at lower gestational ages, particularly less than 30 weeks (interaction P values <.01). CONCLUSIONS AND RELEVANCE In this cohort study of preterm infants, maternal milk feeding during the neonatal hospitalization and after discharge were associated with better school-age performance IQ and academic achievement and with a reduction in ADHD symptoms, particularly among infants born at less than 30 weeks' gestation.
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Affiliation(s)
- Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Emma Knight
- South Australian Health and Medical Research Institute Women and Kids, Adelaide, Australia
- University of Adelaide School of Public Health, Adelaide, Australia
| | - Shikha Chandarana
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, DC
| | - Emmanuella Ikem
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jacqueline F. Gould
- South Australian Health and Medical Research Institute Women and Kids, Adelaide, Australia
| | - Carmel T. Collins
- South Australian Health and Medical Research Institute Women and Kids, Adelaide, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute Women and Kids, Adelaide, Australia
| | - Robert A. Gibson
- South Australian Health and Medical Research Institute Women and Kids, Adelaide, Australia
| | - Peter J. Anderson
- Department of Pediatrics, The University of Melbourne, Royal Children’s Hospital, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Karen Simmer
- Centre for Neonatal Research and Education, School of Pediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Henning Tiemeier
- University of Adelaide School of Public Health, Adelaide, Australia
| | - Alice Rumbold
- South Australian Health and Medical Research Institute Women and Kids, Adelaide, Australia
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Twilhaar ES, Pierrat V, Marchand-Martin L, Benhammou V, Kaminski M, Ancel PY. Profiles of Functioning in 5.5-Year-Old Very Preterm Born Children in France: The EPIPAGE-2 Study. J Am Acad Child Adolesc Psychiatry 2022; 61:881-891. [PMID: 34508804 DOI: 10.1016/j.jaac.2021.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Very preterm born children are at risk for impairments in multiple neurodevelopmental domains, but outcomes vary between individuals. The present study aimed to distinguish subgroups with distinct profiles of functioning across motor, cognitive, behavioral, and psychosocial domains. These profiles were related to neonatal and social/environmental factors. METHOD The sample included 1977 children born very preterm (<32 weeks' gestation) in 2011 from the French population-based EPIPAGE-2 cohort. Using latent profile analysis, subgroups of children were distinguished based on their functioning at 5.5 years. The relation between outcome profiles and neonatal and social/environmental factors was tested using multivariable multinomial logistic regression analysis. RESULTS Four subgroups with distinct outcome profiles were distinguished: no deficit in any domain (45%); motor and cognitive deficits without behavioral/psychosocial deficits (31%); primarily behavioral and psychosocial deficits (16%); and deficits in multiple domains (8%). Male sex (odds ratio [OR] = 2.1-2.7), bronchopulmonary dysplasia (OR = 2.1-2.8), low parental education level (OR = 1.8-2.1), and parental non-European immigrant status (OR = 2.3-3.0) were independently associated with higher odds for all suboptimal outcome profiles compared to the favorable outcome profile. CONCLUSION Among 5.5-year-old very preterm born children, subgroups can be distinguished with distinct outcome profiles that vary in severity, type, and combinations of deficits. This information is important for the development of interventions that are tailored to the needs of large subgroups of children across multiple domains of functioning. General neonatal and social/environmental factors may be useful for early identification of very preterm born children at risk for general rather than domain-specific impairments.
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Affiliation(s)
- E Sabrina Twilhaar
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
| | - Véronique Pierrat
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Laetitia Marchand-Martin
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Valérie Benhammou
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Monique Kaminski
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Assistance Publique-Hôpitaux de Paris, Clinical Investigation Center P1419, Paris, France
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Rodrigues C, Zeitlin J, Zemlin M, Wilson E, Pedersen P, Barros H. Never‐breastfed children face a higher risk of suboptimal cognition at 2 years of corrected age: A multinational cohort of very preterm children. MATERNAL & CHILD NUTRITION 2022; 18:e13347. [PMID: 35294101 PMCID: PMC9218322 DOI: 10.1111/mcn.13347] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
In a cohort of children born very preterm (VPT), we investigated the association between breast milk feeding (BMF) initiation and its duration on cognitive development at 2 years of corrected age. Data were obtained from the Effective Perinatal Intensive Care in Europe population‐based prospective cohort of children born <32 weeks of gestation, in 11 European countries, in 2011–2012. The study sample included 4323 children. Nonverbal cognitive ability was measured applying the Parental Report of Children's Abilities, except for France where the problem‐solving domain of the Ages & Stages Questionnaire was used. Verbal cognition was based on the number of words the child could say. To determine the association between BMF (mother's own milk) and nonverbal and verbal cognition (outcome categorized as optimal and suboptimal), adjusted risk ratios (aRRs) were estimated fitting Poisson regression models, with inverse probability weights to account for nonresponse bias. Overall, 16% and 11% of the children presented suboptimal nonverbal and verbal cognition, respectively. Never BMF was associated with a significantly increased risk for suboptimal nonverbal (aRR = 1.29, 95% confidence interval [CI] = 1.09–1.53) and verbal (aRR = 1.45, 95% CI = 1.09–1.92) cognitive development compared with those ever breastfed, after adjustment for perinatal and sociodemographic characteristics. Compared with children breastfed 6 months or more, children with shorter BMF duration exhibited a statistically nonsignificant elevated aRR. VPT children fed with breast milk had both improved nonverbal and verbal cognitive development at 2 years in comparison with never breastfed, independently of perinatal and sociodemographic characteristics. This study encourages targeted interventions to promote BMF among these vulnerable children. In a European cohort of children born very preterm, 16% and 11% presented suboptimal nonverbal and verbal cognitive development, respectively. Never‐breastfed children faced a higher risk of having suboptimal nonverbal and verbal cognition at 2 years of corrected age when compared with those who were breastfed, independently of perinatal and sociodemographic characteristics. Breastfeeding support is a modifiable factor regardless of perinatal and sociodemographic characteristics, which reinforces the importance of specifically targeted interventions to protect, promote and support breast milk feeding in neonatal intensive care units and after discharge.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit, Instituto de Saúde Pública Universidade do Porto Porto Portugal
| | - Jennifer Zeitlin
- CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé) INSERM, INRA, Université de Paris Paris France
| | - Michael Zemlin
- Department of Neonatology and Pediatrics University Children's Hospital of Saarland Homburg Germany
| | - Emilija Wilson
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | | | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública Universidade do Porto Porto Portugal
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Klamer A, Toftlund LH, Grimsson K, Halken S, Zachariassen G. IQ Was Not Improved by Post-Discharge Fortification of Breastmilk in Very Preterm Infants. Nutrients 2022; 14:nu14132709. [PMID: 35807888 PMCID: PMC9268839 DOI: 10.3390/nu14132709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Very preterm infants are at increased risk of cognitive deficits, motor impairments, and behavioural problems. Studies have tied insufficient nutrition and growth to an increased risk of neurodevelopmental impairment; (2) Methods: Follow-up study on cognitive and neuropsychological development at 6 years corrected age (CA) in 214 very preterm infants, including 141 breastfed infants randomised to mother’s own milk (MOM) with (F-MOM) or without (U-MOM) fortification and 73 infants fed a preterm formula (PF-group), from shortly before discharge to 4 months CA. Infants with serious congenital anomalies or major neonatal morbidities were excluded prior to intervention. The Wechsler Intelligence Scale for Children IV was used for cognitive testing, and the children’s parents completed the Five to Fifteen Questionnaire (FTF); (3) Results: Post-discharge fortification of MOM did not improve either full-scale intelligence quotient (FSIQ) with a median of 104 vs. 105.5 (p = 0.29), subdomain scores, or any domain score on the FTF questionnaire. Compared to the PF group, the MOM group had significantly better verbal comprehension score with a median of 110 vs. 106 (p = 0.03) and significantly better motor skills scores on the FTF questionnaire (p = 0.01); (4) Conclusions: The study supports breastfeeding without fortification as post-discharge nutrition in very preterm infants, and it seems superior to preterm formula.
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Affiliation(s)
- Anja Klamer
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Correspondence:
| | - Line H. Toftlund
- Department of Paediatrics, Holbaek Hospital, 4300 Holbaek, Denmark;
| | - Kristjan Grimsson
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
| | - Susanne Halken
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
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42
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Buck CO, Montgomery AM. Long-Term Impact of Early Nutritional Management. Clin Perinatol 2022; 49:461-474. [PMID: 35659097 DOI: 10.1016/j.clp.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Catherine O Buck
- Department of Pediatrics, Yale School of Medicine, PO Box 208064, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Angela M Montgomery
- Department of Pediatrics, Yale School of Medicine, PO Box 208064, 333 Cedar Street, New Haven, CT 06520, USA. https://twitter.com/amontgom09
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43
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Nwanne OY, Rogers ML, McGowan EC, Tucker R, Smego R, Vivier PM, Vohr BR. High-Risk Neighborhoods and Neurodevelopmental Outcomes in Infants Born Preterm. J Pediatr 2022; 245:65-71. [PMID: 35120984 DOI: 10.1016/j.jpeds.2022.01.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study the association between neighborhood risk and moderate to severe neurodevelopmental impairment (NDI) at 22-26 months corrected age in children born at <34 weeks of gestation. We hypothesized that infants born preterm living in high-risk neighborhoods would have a greater risk of NDI and cognitive, motor, and language delays. STUDY DESIGN We studied a retrospective cohort of 1291 infants born preterm between 2005 and 2016, excluding infants with congenital anomalies. NDI was defined as any one of the following: a Bayley Scales of Infant and Toddler Development-III Cognitive or Motor composite score <85, bilateral blindness, bilateral hearing impairment, or moderate-severe cerebral palsy. Maternal addresses were geocoded to identify census block groups and create high-risk versus low-risk neighborhood groups. Bivariate and regression analyses were run to assess the impact of neighborhood risk on outcomes. RESULTS Infants from high-risk (n = 538; 42%) and low-risk (n = 753; 58%) neighborhoods were compared. In bivariate analyses, the risk of NDI and cognitive, motor, and language delays was greater in high-risk neighborhoods. In adjusted regression models, the risks of NDI (OR, 1.43; 95% CI, 1.04-1.98), cognitive delay (OR, 1.62; 95% CI, 1.15-2.28), and language delay (OR, 1.58; 95% CI, 1.15-2.16) were greater in high-risk neighborhoods. Breast milk at discharge was more common in low-risk neighborhoods and was protective of NDI in regression analysis. CONCLUSIONS High neighborhood risk provides an independent contribution to preterm adverse NDI, cognitive, and language outcomes. In addition, breast milk at discharge was protective. Knowledge of neighborhood risk may inform the targeted implementation of programs for socially disadvantaged infants.
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Affiliation(s)
- Ogochukwu Y Nwanne
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital, Providence, RI
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Elisabeth C McGowan
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital, Providence, RI
| | - Richard Tucker
- Department of Pediatrics, Women and Infants Hospital, Providence, RI
| | - Raul Smego
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | - Patrick M Vivier
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | - Betty R Vohr
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital, Providence, RI.
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44
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Wiggins JB, Trotman R, Perks PH, Swanson JR. Enteral Nutrition: The Intricacies of Human Milk from the Immune System to the Microbiome. Clin Perinatol 2022; 49:427-445. [PMID: 35659095 DOI: 10.1016/j.clp.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2012, the American Academy of Pediatrics stated that all preterm infant diets should consist of human milk (mother's own milk or pasteurized donor human milk). The clinical reasons supporting this policy are many, including reducing infections and retinopathy of prematurity, decreased neonatal intensive care unit length of stay, subsequent readmissions, a decrease in mortality, and improved neurodevelopmental outcomes. This article focuses on human milk, its composition and bioactive factors, and how it affects the gut-brain axis through the microbiome. We examine how differences between mother's own milk and pasteurized donor human milk affect the premature infant.
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Affiliation(s)
- Jaclyn B Wiggins
- Division of Neonatology, Department of Pediatrics, University of Virginia, Box 800386, Charlottesville, VA 22908, USA.
| | - Rachael Trotman
- Neonatal Intensive Care Unit, PO Box 800673, Nutrition Services, Ground Floor, UVA Main Hospital, 1215 Lee Street, Charlottesville, VA 22908-0673, USA
| | - Patti H Perks
- Neonatal Intensive Care Unit, PO Box 800673, Nutrition Services, Ground Floor, UVA Main Hospital, 1215 Lee Street, Charlottesville, VA 22908-0673, USA
| | - Jonathan R Swanson
- Division of Neonatology, Department of Pediatrics, University of Virginia, Box 800386, Charlottesville, VA 22908, USA
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45
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Brown A, Shenker N. Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study. BMC Pregnancy Childbirth 2022; 22:455. [PMID: 35641919 PMCID: PMC9154035 DOI: 10.1186/s12884-022-04789-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Access to donor human milk (DHM) has primarily been based on the health and development outcomes of premature infants but there has been little examination of the broader impact of an infant receiving it upon parental mental health. Breastfeeding and mental health are closely tied with women who experience breastfeeding difficulties or are unable to meet their own breastfeeding goals often experiencing feelings of guilt, sadness and anger, alongside an increased risk of postnatal depression. The aim of the current study was to explore how experience of receiving DHM for their baby affected the wellbeing of parents. METHODS UK parents of infants aged 0 - 12 months who had received screened DHM from a milk bank (typically on the neonatal unit or in some cases in the community) completed an online questionnaire exploring their experiences. The questionnaire included Likert scale items examining perceived impact upon infant health, own wellbeing and family functioning alongside open-ended questions exploring perceptions of how receiving DHM affected wellbeing. RESULTS Almost all of the 107 participants (women = 102) agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family's wellbeing. Parents felt relieved that their infant was receiving DHM for health reasons but also due to the experience of being listened to, supported and having their infant feeding decisions facilitated. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby. Some parents did experience challenges, feeling guilty at receiving DHM, insecure that another woman was able to feed their baby when they could not, or negative reactions from family. Although the impact of receiving DHM upon breastfeeding was not measured, some women who were working to build their own milk supply noted that it helped motivate them to continue. CONCLUSIONS DHM may play an important role not only in protecting infant health and development but in supporting the mental health and wellbeing of mothers for whom their infant receiving human milk is important.
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Affiliation(s)
- A. Brown
- grid.4827.90000 0001 0658 8800School of Health and Social Care, Swansea University, Singleton Park, Swansea, UK ,grid.4827.90000 0001 0658 8800Centre for Lactation, Infant Feeding and Translation, Swansea University, Swansea, UK
| | - N. Shenker
- grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, London, UK
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46
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Zhao Y, Zhang Y, Liu C, Yan D, Dong P. Compositional Differences Between Preterm Milk of Different Gestational Ages with the Term Milk: A Comparative Lipidomic Study by LC‐MS/MS. EUR J LIPID SCI TECH 2022. [DOI: 10.1002/ejlt.202100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ying‐chun Zhao
- Department of Neonatology Children's Hospital of Shanghai 355 Luding Road Shanghai 200062 P. R. China
| | - Ying Zhang
- Department of Child Healthcare Children's Hospital of Fudan University National Children's Medical Center 399 Wanyuan Road Shanghai 201102 P. R. China
| | - Chun‐xue Liu
- Department of Child Healthcare Children's Hospital of Fudan University National Children's Medical Center 399 Wanyuan Road Shanghai 201102 P. R. China
| | - Dong‐yong Yan
- Department of Child Healthcare Children's Hospital of Fudan University National Children's Medical Center 399 Wanyuan Road Shanghai 201102 P. R. China
| | - Ping Dong
- Department of Child Healthcare Children's Hospital of Fudan University National Children's Medical Center 399 Wanyuan Road Shanghai 201102 P. R. China
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47
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de Weerth C, Aatsinki AK, Azad MB, Bartol FF, Bode L, Collado MC, Dettmer AM, Field CJ, Guilfoyle M, Hinde K, Korosi A, Lustermans H, Mohd Shukri NH, Moore SE, Pundir S, Rodriguez JM, Slupsky CM, Turner S, van Goudoever JB, Ziomkiewicz A, Beijers R. Human milk: From complex tailored nutrition to bioactive impact on child cognition and behavior. Crit Rev Food Sci Nutr 2022; 63:7945-7982. [PMID: 35352583 DOI: 10.1080/10408398.2022.2053058] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Human milk is a highly complex liquid food tailor-made to match an infant's needs. Beyond documented positive effects of breastfeeding on infant and maternal health, there is increasing evidence that milk constituents also impact child neurodevelopment. Non-nutrient milk bioactives would contribute to the (long-term) development of child cognition and behavior, a process termed 'Lactocrine Programming'. In this review we discuss the current state of the field on human milk composition and its links with child cognitive and behavioral development. To promote state-of-the-art methodologies and designs that facilitate data pooling and meta-analytic endeavors, we present detailed recommendations and best practices for future studies. Finally, we determine important scientific gaps that need to be filled to advance the field, and discuss innovative directions for future research. Unveiling the mechanisms underlying the links between human milk and child cognition and behavior will deepen our understanding of the broad functions of this complex liquid food, as well as provide necessary information for designing future interventions.
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Affiliation(s)
- Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, EN Nijmegen, The Netherlands
| | - Anna-Katariina Aatsinki
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Meghan B Azad
- Department of Pediatrics and Child Health, Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Frank F Bartol
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Lars Bode
- Department of Pediatrics and Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California San Diego, La Jolla, California, USA
| | - Maria Carmen Collado
- Department of Biotechnology, Institute of Agrochemistry and Food Technology-National Research Council (IATA-CSIC), Paterna, Valencia, Spain
| | - Amanda M Dettmer
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, College of Basic and Applied Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Meagan Guilfoyle
- Department of Anthropology, Indiana University, Bloomington, Indiana, USA
| | - Katie Hinde
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences, Center for Neuroscience, Brain Plasticity group, University of Amsterdam, Amsterdam, The Netherlands
| | - Hellen Lustermans
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, EN Nijmegen, The Netherlands
| | - Nurul Husna Mohd Shukri
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Sophie E Moore
- Department of Women & Children's Health, King's College London, St Thomas' Hospital, London, UK
- School of Hygiene and Tropical Medicine, Nutrition Theme, MRC Unit The Gambia and the London, Fajara, The GambiaBanjul
| | - Shikha Pundir
- The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Juan Miguel Rodriguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Carolyn M Slupsky
- Department of Nutrition and Department of Food Science and Technology, University of California, Davis, California, USA
| | - Sarah Turner
- Department of Community Health Sciences, Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Johannes B van Goudoever
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Anna Ziomkiewicz
- Department of Anthropology, Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, EN Nijmegen, The Netherlands
- Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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48
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Belfort MB, Inder TE. Human Milk and Preterm Infant Brain Development: A Narrative Review. Clin Ther 2022; 44:612-621. [PMID: 35307209 PMCID: PMC9133155 DOI: 10.1016/j.clinthera.2022.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE To review and synthesize the literature on human milk and structural brain development and injury in preterm infants, focusing on the application of quantitative brain magnetic resonance imaging (MRI) in this field. METHODS For this narrative review, we searched PubMed for articles published from 1990 to 2021 that reported observational or interventional studies of maternal milk or donor milk in relation to brain development and/or injury in preterm infants assessed with quantitative MRI at term equivalent age. Studies were characterized with respect to key aspects of study design, milk exposure definition, and MRI outcomes. FINDINGS We identified 7 relevant studies, all of which were observational in design and published between 2013 and 2021. Included preterm infants were born at or below 33 weeks' gestation. Sample sizes ranged from 22 to 377 infants. Exposure to human milk included both maternal and donor milk. No study included a full-term comparison group. Main MRI outcome domains were white matter integrity (assessed with diffusion tensor imaging, resting state functional connectivity, or semiautomated segmentation of white matter abnormality) and total and regional brain volumes. Studies revealed that greater exposure to human milk versus formula was associated with favorable outcomes, including more mature and connected cerebral white matter with less injury and larger regional brain volumes, notably in the deep nuclear gray matter, amygdala-hippocampus, and cerebellum. No consistent signature effect of human milk exposure was found; instead, the beneficial associations were regional and tissue-specific neuroprotective effects on the areas of known vulnerability in the preterm infant. IMPLICATIONS Evidence to date suggests that human milk may protect the preterm infant from the white matter injury and dysmaturation to which this population is vulnerable. Brain MRI at term equivalent age is emerging as a useful tool to investigate the effects of human milk on the preterm brain. When grounded in neurobiological knowledge about preterm brain injury and development, this approach holds promise for allowing further insight into the mechanisms and pathways underlying beneficial associations of human milk with neurodevelopmental outcomes in this population and in the investigation of specific milk bioactive components with neuroprotective or neurorestorative potential.
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49
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Maternal Milk Provision in the Neonatal Intensive Care Unit and Mother–Infant Emotional Connection for Preterm Infants. CHILDREN 2022; 9:children9020296. [PMID: 35205016 PMCID: PMC8870821 DOI: 10.3390/children9020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/21/2022]
Abstract
Maternal milk (MM) intake during neonatal intensive care unit (NICU) hospitalization is associated with improved neurodevelopment in preterm infants. Underlying mechanisms may include stronger mother–infant emotional connection. This paper examines associations between MM provision in the NICU with maternal connection to her infant using three factors validated in our sample: maternal sensitivity, emotional concern, and positive interaction/engagement. We studied 70 mothers of infants born <1500 g and/or <32 weeks’ gestation. Associations between MM provision and mother–infant connection were modeled using median regression adjusted for clustering. Mothers who provided exclusive MM (i.e., 100% MM, no other milk) reported higher levels of maternal sensitivity by a median score of 2 units (β = 2.00, 95% CI: 0.76, 3.24, p = 0.002) than the mixed group (i.e., MM < 100% days, other milk ≥1 days), as well as greater emotional concern (β = 3.00, 95% CI: −0.002, 6.00, p = 0.05). Among mothers of very preterm infants, greater milk provision was associated with greater maternal sensitivity, but also with greater emotional concern about meeting the infant’s needs. These findings highlight the importance of supporting MM provision and early infant care as an integrated part of lactation support. The findings may also provide insight into links between MM provision in the NICU and infant neurodevelopment.
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50
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Johnson TJ, Meier PP, Schoeny ME, Bucek A, Janes JE, Kwiek JJ, Zupancic JAF, Keim SA, Patel AL. Study protocol for reducing disparity in receipt of mother's own milk in very low birth weight infants (ReDiMOM): a randomized trial to improve adherence to sustained maternal breast pump use. BMC Pediatr 2022; 22:27. [PMID: 34996401 PMCID: PMC8739536 DOI: 10.1186/s12887-021-03088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Black very low birth weight (VLBW; < 1500 g birth weight) and very preterm (VP, < 32 weeks gestational age, inclusive of extremely preterm, < 28 weeks gestational age) infants are significantly less likely than other VLBW and VP infants to receive mother's own milk (MOM) through to discharge from the neonatal intensive care unit (NICU). The costs associated with adhering to pumping maternal breast milk are borne by mothers and contribute to this disparity. This randomized controlled trial tests the effectiveness and cost-effectiveness of an intervention to offset maternal costs associated with pumping. METHODS This randomized control trial will enroll 284 mothers and their VP infants to test an intervention (NICU acquires MOM) developed to facilitate maternal adherence to breast pump use by offsetting maternal costs that serve as barriers to sustaining MOM feedings and the receipt of MOM at NICU discharge. Compared to current standard of care (mother provides MOM), the intervention bundle includes three components: a) free hospital-grade electric breast pump, b) pickup of MOM, and c) payment for opportunity costs. The primary outcome is infant receipt of MOM at the time of NICU discharge, and secondary outcomes include infant receipt of any MOM during the NICU hospitalization, duration of MOM feedings (days), and cumulative dose of MOM feedings (total mL/kg of MOM) received by the infant during the NICU hospitalization; maternal duration of MOM pumping (days) and volume of MOM pumped (mLs); and total cost of NICU care. Additionally, we will compare the cost of the NICU acquiring MOM versus NICU acquiring donor human milk if MOM is not available and the cost-effectiveness of the intervention (NICU acquires MOM) versus standard of care (mother provides MOM). DISCUSSION This trial will determine the effectiveness of an economic intervention that transfers the costs of feeding VLBWand VP infants from mothers to the NICU to address the disparity in the receipt of MOM feedings at NICU discharge by Black infants. The cost-effectiveness analysis will provide data that inform the adoption and scalability of this intervention. TRIAL REGISTRATION ClinicalTrials.gov: NCT04540575 , registered September 7, 2020.
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Affiliation(s)
- Tricia J Johnson
- Department of Health Systems Management, Rush University, 1700 West Van Buren Street, TOB Suite 126B, Chicago, USA.
| | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, USA.,College of Nursing, Rush University, Chicago, USA
| | - Michael E Schoeny
- Department of Community, Systems and Mental Health Nursing, Rush University, Chicago, USA
| | - Amelia Bucek
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | - Judy E Janes
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | - Jesse J Kwiek
- Department of Microbiology, The Center for Retrovirus Research and the Infectious Disease Institute, The Ohio State University, Columbus, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, USA.,Harvard Medical School, Boston, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
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