Breastfeeding preterm born infant: Chance and challenge

Efficacy and safety of domperidone and metoclopramide on human milk production in postpartum mothers: a bayesian network meta-analysis of randomized controlled trials

BACKGROUND

Breastfeeding is the most advantageous nutrition for infants because of its many health benefits. However, lactation insufficiency is a prevalent issue among women, particularly those who give birth prematurely. Galactagogues, such as domperidone and metoclopramide, have been reported and may be beneficial for lactation insufficiency. However, the optimal pharmacological galactagogue remains unclear.

METHODS

The PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library databases were searched from their inception to April 23, 2023. The primary aim of this research was to assess the efficacy and safety of domperidone and metoclopramide using Bayesian network meta-analysis. The efficacy outcome was the increased breast milk volume (in mL/day). The safety outcome was the frequency of maternal drug-related adverse events during the study period.

RESULTS

Seventeen randomized controlled trials were included in the final analyses. Preterm mothers who took domperidone had a greater increase in breast milk volume than those who took metoclopramide or placebo (domperidone vs. metoclopramide: MD = 82.84, 95% CI: 37.04-118.95; domperidone vs. placebo: MD = 88.30, 95% CI: 59.48-118.62). However, in the term mothers, domperidone did not show the above benefit compared with metoclopramide or placebo (domperidone vs. metoclopramide: MD = 93.67, 95% CI: -186.11-375.59; domperidone vs. placebo: MD = 126.25, 95% CI: -49.91-304.55). Both in preterm and term mothers, metoclopramide was no better than the placebo. There was no difference in the frequency of maternal drug-related adverse outcomes among domperidone, metoclopramide, and placebo.

CONCLUSION

Domperidone increased the daily breast milk volume in mothers of preterm infants, without serious adverse events. However, this conclusion is limited due to the small sample sizes in the studies analyzed.

The effect of foot reflexology on the volume and composition of breast milk in mothers of premature infants hospitalized in the neonatal intensive care unit: a randomized controlled trial

BACKGROUND

One of the important problems for mothers after the birth of a premature infant is a decrease in milk production. This study aimed to investigate the effect of foot reflexology on the volume and composition of breast milk in mothers of premature infants hospitalized in the neonatal intensive care unit.

METHODS

This randomized clinical trial was conducted on 76 primiparous mothers whose premature infants up to 34 weeks were hospitalized in the neonatal intensive care unit of Ayatollah Rouhani Hospital from February 2023 to November 2023. Mothers in the intervention group received foot reflexology for 20 min on both feet (ten minutes per foot) for seven consecutive days every morning. On the first and seventh days of the study, both groups were compared in terms of milk volume (ml), triglycerides, cholesterol, albumin, total protein, and calcium (mg/dl).

RESULTS

The mean difference in breast milk characteristics before and after the intervention in the control and intervention groups were as follows: in terms of breast milk volume 12.43 and 23.51 ml, triglyceride 418.37 and 406.21, cholesterol 5.48 and 3.67, albumin 1.02 and 0.35, total protein 1.89 and 4.59, calcium was -3.54 and -1.83 mg/dL; the net difference in breast milk volume in the intervention group compared to the control group increased, which was not statistically significant but was significant in terms of value. No significant difference was observed in other components of breast milk.

CONCLUSION

In this single-center study, foot reflexology massage showed a trend towards increasing the volume of breast milk, total protein and calcium, although it was not statistically significant. Therefore, it needs further investigation.

TRIAL REGISTRATION

IRCT, IRCT20221220056872N1. Registered 22 January 2023- prospective registered, https://irct.behdasht.gov.ir/trial/67512 .

Experiences of breastfeeding among mothers of preterm infants during their infants' hospital stay: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to synthesize the existing qualitative evidence on the breastfeeding experiences of mothers of hospitalized preterm infants.

INTRODUCTION

Breastfeeding is crucial for the well-being and development of preterm infants born before 37 weeks' gestation. Mothers of preterm infants often face challenges that make breastfeeding particularly complex. Understanding mothers' breastfeeding experience is important for health care professionals, as it enables them to provide appropriate support and assistance. The qualitative evidence synthesis regarding the breastfeeding experiences of mothers of preterm infants in hospital settings is a valuable area of research that has not been documented.

INCLUSION CRITERIA

This review will consider all qualitative studies that explore mothers' experiences of breastfeeding and mother's own milk management for their hospitalized infants. Mothers of preterm infants who provide their own milk to their infants will be considered, regardless of their age, gravidity, parity, singleton/multiple pregnancies, gender identity, marital status, social status, or preterm infant's gestational age.

METHODS

This review will follow the JBI approach for qualitative systematic review. The search strategy aims to find both published and unpublished studies, with no date limit. A search of PubMed, CINAHL (EBSCOhost), and Embase (EBSCOhost) will be undertaken to identify articles on the topic. Studies published in English will be considered for inclusion in this review. Two independent reviewers will evaluate the methodological validity of the selected papers before incorporating them into the review. Data synthesis will be conducted using the meta-aggregation approach, and synthesized findings will be assessed using the ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42024501454.

Breastfeeding Barriers for Preterm Infants in Neonatal Intensive Care Unit Environments: A Systematic Assessment and Meta-Analysis

Background: Breast milk is vital for the growth and development of preterm infants. However, in Neonatal Intensive Care Units (NICUs), mothers often encounter significant challenges in breastfeeding. Objective: This study aims to systematically evaluate the barriers to breastfeeding in NICUs, thereby providing evidence-based support for clinical practices. Methods: A comprehensive search was conducted in the Cochrane Library, PubMed, Web of Science, Embase, and Scopus databases, up to September 2023. Meta-analysis was performed using Stata 15.0, applying fixed or random effects models to calculate odds ratios (OR) and their 95% confidence intervals (CI). Study quality was assessed using the Newcastle-Ottawa Scale for cases and cohorts and the Agency for Healthcare Research and Quality standards for cross-sectional studies. Heterogeneity was evaluated using Cochran's chi-squared test (Cochran's Q) and I2 statistics, and publication bias was assessed through funnel plots and symmetry tests. Results: A total of 32 studies were included, encompassing 96,053 preterm infants. The main barriers to breastfeeding in preterm infants included: low gestational age (OR = 1.36, 95% CI: 1.06-1.75), lower maternal education (OR = 1.64, 95% CI: 1.39-1.93), insufficient breast milk (OR = 2.09, 95% CI: 1.39-1.93), multiple births (OR = 1.615, 95% CI: 1.18-2.210), smoking (OR = 2.906, 95% CI: 2.239-3.771), and single motherhood (OR = 1.439, 95% CI: 1.251-1.654). Conclusion: This study underscores the need for individualized breastfeeding support strategies in NICUs, taking into account the diverse backgrounds of mothers. Future research should focus on unraveling the underlying mechanisms affecting breastfeeding in preterm infants, with the goal of enhancing breastfeeding rates and improving developmental outcomes.

Construction and validation of nursing diagnoses for premature newborns

OBJECTIVE

To build and validate nursing diagnoses based on the International Classification of Nursing Practice (ICNP®) for premature newborns admitted to the Neonatal Intensive Care Unit.

METHOD

Methodological study based on the Brazilian method for developing subsets: use of specialized nursing language terms, construction of diagnostic statements and content validation of the statements by 40 specialist nurses. Those with a Content Validity Index (CVI) ≥ 0.80, organized according to Wanda Horta's basic human needs theory, were considered valid.

RESULTS

146 nursing diagnosis statements were constructed and 145 (93.3%) diagnoses were validated, with a predominance of the human need for cutaneous-mucosal integrity.

CONCLUSION

The specificity of neonatal care is evident when these diagnoses are presented and validated in order to support nurses in their clinical reasoning and decision-making.

The effect of orally consumed Lactuca sativa syrup on human milk volume and weight gain in the preterm infant: a randomized controlled clinical trial

Human milk feeding can support premature infants to thrive. Yet those with premature infants can be challenged in human milk production. Considering this, and the use of potentially harmful human milk enhancers, the present study was conducted with the aim of determining the effect of orally consumed Lactuca sativa (L. sativa) syrup (lettuce extract) on human milk volume and subsequent weight gain in the preterm infant. Extracts from lettuce and other plants such as silymarin are already evidenced to be safe for use during lactation and have other therapeutic effects in humans. Yet this is the first study of its kind. This parallel randomized clinical trial included lactating participants with their preterm infants who were born at < 32 weeks' gestation and admitted to an intensive care unit. Convenience sampling was used to recruit participants. Eligible participants were allocated to groups randomly: intervention (n = 47), placebo (n = 46), and control (n = 47). The intervention group received one tablespoon of Lactuca sativa (L. sativa) syrup, and the placebo group received one tablespoon of placebo syrup 3 times a day for 1 week. Those in the control group did not receive any herbal or chemical milk-enhancing compounds. Routine care was provided to all three groups. Participants recorded their milk volume for 7 days in a daily information recorder form. Infant weight was measured prior to the intervention, and on the third, fifth and seventh days of the intervention period. There was a statistically significant difference observed in the adjusted mean volume of milk on the fourth and fifth days between the intervention, placebo, and control groups (P < 0.05). The adjusted mean milk volume of those in the intervention group on the first day was significantly higher than those in the control group and those in the placebo group. On the second day, the adjusted mean milk volume of those in the intervention group was higher than in those from the control group; and on the fourth day it was higher than in those from both the control and placebo groups; on the fifth day it was higher than in those in the placebo group; on the sixth day it was higher than in those in the control group and on the seventh day it was higher than in those in the control group (P < 0.05). There was no statistically significant difference in terms of the mean changes (with or without adjustment) in the weight of preterm infants between any of the groups. Lactuca sativa (L. sativa) syrup increases the volume of human milk production and no specific side effects have been reported in its use. Therefore, Lactuca sativa syrup can be recommended for use as one of the compounds that increase human milk volume.

“Breastfeeding at Night Is Awesome” Mothers’ Intentions of Continuation of Breastfeeding Extreme and Very Preterm Babies upon Discharge from a Kangaroo Mother Care Unit of a Tertiary Hospital in South Africa

Kangaroo mother care (KMC) is effective in increasing mothers’ initiation and maintenance of breastfeeding (BF) for extreme and very preterm (VLBW) infants. Although South Africa has implemented KMC for more than two decades, little is known about mothers’ perspectives on KMC. The purpose of this study was to describe the BF intentions and practices of mothers of VLBW infants at home following discharge and assess the role long stay in KMC has on their decision to BF beyond discharge. This qualitative study was conducted at the KMC unit of a tertiary hospital in Pretoria, South Africa. Focus group interviews were conducted with 38 mothers of VLBW infants who had transitioned from neonatal intensive care (NICU) to KMC. We analysed transcripts following the five steps for qualitative thematic data analysis. Mothers were knowledgeable of the importance and value of BF preterm infants and conceded that breast milk has advantages over formula. Mothers had positive feelings toward BF their preterm infants. The stay in KMC increased the direct BF of their preterm infants, mothers’ BF efficacy, and had a positive influence on mothers’ intentions to continue BF following discharge and to exclusively breastfeed for six months. Their BF intentions, efficacy, and practices were influenced by the skilful BF counselling, training, and support they received from the nursing staff. High intention to BF among these mothers is suggestive of their knowledge and confidence in BF for their VLBW infants. It is important that nursing staff in NICU and KMC appreciate the significant role they play in mothers’ readiness and confidence to breastfeed beyond discharge.

The Nonbacterial Microbiome: Fungal and Viral Contributions to the Preterm Infant Gut in Health and Disease

The intestinal microbiome is frequently implicated in necrotizing enterocolitis (NEC) pathogenesis. While no particular organism has been associated with NEC development, a general reduction in bacterial diversity and increase in pathobiont abundance has been noted preceding disease onset. However, nearly all evaluations of the preterm infant microbiome focus exclusively on the bacterial constituents, completely ignoring any fungi, protozoa, archaea, and viruses present. The abundance, diversity, and function of these nonbacterial microbes within the preterm intestinal ecosystem are largely unknown. Here, we review findings on the role of fungi and viruses, including bacteriophages, in preterm intestinal development and neonatal intestinal inflammation, with potential roles in NEC pathogenesis yet to be determined. In addition, we highlight the importance of host and environmental influences, interkingdom interactions, and the role of human milk in shaping fungal and viral abundance, diversity, and function within the preterm intestinal ecosystem.

Assessment of human milk in the era of precision health

PURPOSE OF REVIEW

Precision health provides an unprecedented opportunity to improve the assessment of infant nutrition and health outcomes. Breastfeeding is positively associated with infant health outcomes, yet only 58.3% of children born in 2017 were still breastfeeding at 6 months. There is an urgent need to examine the application of precision health tools that support the development of public health interventions focused on improving breastfeeding outcomes.

RECENT FINDINGS

In this review, we discussed the novel and highly sensitive techniques that can provide a vast amount of omics data and clinical information just by evaluating small volumes of milk samples, such as RNA sequencing, cytometry by time-of-flight, and human milk analyzer for clinical implementation. These advanced techniques can run multiple samples in a short period of time making them ideal for the routine clinical evaluation of milk samples.

SUMMARY

Precision health tools are increasingly used in clinical research studies focused on infant nutrition. The integration of routinely collected multiomics human milk data within the electronic health records has the potential to identify molecular biomarkers associated with infant health outcomes.

Supporting Premature Infants’ Oral Feeding in the NICU—A Qualitative Study of Nurses’ Perspectives

One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses’ experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: ‘A complex and long-lasting collaboration.’ The nurses wished to contribute to the parents’ understanding of the feeding process and their own role as parents in this process. The nurses’ intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents’ actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU.