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Schinkel ER, Nelson ER, Kim JH, Perrin MT, Dyer R, Elango R, Bode L, Dallas DC, Lueangsakulthai J, Briere CE, Taylor SN. Point-of-care human milk concentration by passive osmosis: comprehensive analysis of fresh human milk samples. J Perinatol 2024:10.1038/s41372-024-01988-2. [PMID: 38760580 DOI: 10.1038/s41372-024-01988-2] [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: 01/17/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE Preterm infants need enrichment of human milk (HM) for optimal growth. This study evaluated a novel, point-of-care human milk concentration (HMC) process for water removal from fresh HM samples by passive osmotic concentration. STUDY DESIGN Nineteen fresh HM samples were concentrated by incubation with the HMC devices for 3 h at 4 °C. Pre- and post-concentration HM samples were compared by HM properties for: pH, osmolality, macronutrients, enzyme activity, bioactive, and total cell viability. RESULTS Passive osmotic concentration reduced HM volume by an average of 16.3% ± 3.8% without a significant effect on pH or cell viability. Ten of the 41 HM components did not differ significantly (p > 0.05) between pre- and post-concentration samples. Twenty-three increased within the expected range by volume reduction. Six increased more than expected, two less than expected, and none decreased significantly. CONCLUSION Passive osmotic concentration of fresh HM can concentrate HM components by selective removal of water. HM osmolality and pH remained within neonatal feeding parameters.
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Affiliation(s)
- Elizabeth R Schinkel
- Mother's Milk is Best Inc., R&D, 100 Business Park Drive, Unit #5, Tyngsboro, MA, 01879, USA.
| | - Elizabeth R Nelson
- Mother's Milk is Best Inc., R&D, 100 Business Park Drive, Unit #5, Tyngsboro, MA, 01879, USA.
| | - Jae H Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, 27412, USA
| | - Roger Dyer
- Analytical Core for Metabolomics and Nutrition, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
| | - Rajavel Elango
- Analytical Core for Metabolomics and Nutrition, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H, 3V4, Canada
| | - Lars Bode
- Bode Lab, Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego, CA, 92093, USA
| | - David C Dallas
- Dallas Lab, Nutrition Program, College of Health, Oregon State University, Corvallis, OR, 97331, USA
| | - Jiraporn Lueangsakulthai
- Dallas Lab, Nutrition Program, College of Health, Oregon State University, Corvallis, OR, 97331, USA
| | - Carrie-Ellen Briere
- Briere Lab, Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, 01003, USA
- Institute for Nursing Research and Evidence-Based Practice, Connecticut Children's, Hartford, CT, 06106, US
| | - Sarah N Taylor
- Division of Neonatology, Yale School of Medicine, New Haven, CT, 06520, USA
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2
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Brockway M, Mcleod S, Kurilova J, Fenton TR, Duffett‐Leger L, Benzies KM. Breastfeeding self-efficacy predicts breastmilk feeding in preterm infants at discharge from the neonatal intensive care unit. Nurs Open 2022; 10:1863-1870. [PMID: 36527730 PMCID: PMC9912448 DOI: 10.1002/nop2.1450] [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: 09/08/2021] [Revised: 02/11/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
AIM To examine the association between breastfeeding self-efficacy (BSE) and breastmilk feeding at discharge from the neonatal intensive care unit among mothers of preterm infants. DESIGN Secondary analysis of the Family Integrated Care (FICare) cluster randomized controlled trial. METHODS Data from 221 mothers of preterm infants who participated in the standard care group of the trial were analysed. BSE at admission was assessed using the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Breastmilk feeding was assessed using 24 hr maternal recall at discharge. RESULTS Mothers who were exclusively breastmilk feeing their infants at discharge had statistically significantly higher mean BSES-SF scores at admission (68.4, SD = 13.7) than those providing a combination of breastmilk and formula or only formula (59.6, SD = 14.7; p < .001). Multivariable logistic regression showed that higher BSE at admission, maternal birth in Canada, and absence of diabetes were statistically significant predictors of exclusive breastmilk feeding at discharge.
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Affiliation(s)
- Meredith Brockway
- Faculty of NursingUniversity of CalgaryCalgaryCanada,Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
| | - Samantha Mcleod
- Northern Alberta Neonatal ProgramRoyal Alexandra HospitalEdmontonCanada
| | - Jana Kurilova
- Faculty of NursingUniversity of CalgaryCalgaryCanada
| | - Tanis R. Fenton
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | | | - Karen M. Benzies
- Faculty of NursingUniversity of CalgaryCalgaryCanada,Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada,Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
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3
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Kilbride HW, Vohr BR, McGowan EM, Peralta-Carcelen M, Stringer K, Das A, Archer SW, Hintz SR. Early neurodevelopmental follow-up in the NICHD neonatal research network: Advancing neonatal care and outcomes, opportunities for the future. Semin Perinatol 2022; 46:151642. [PMID: 35842320 PMCID: PMC11068160 DOI: 10.1016/j.semperi.2022.151642] [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] [Indexed: 10/31/2022]
Abstract
At the inception of the Eunice Kennedy Shriver National Institute of Child Health and Development Neonatal Research Network (NRN), provision of care for extremely preterm (EPT) infants was considered experimental. The NRN Follow-up Study Group, initiated in 1993, developed infrastructure with certification processes and standards, allowing the NRN to assess 2-year outcomes for EPT and to provide important metrics for randomized clinical trials. This chapter will review the NRN Follow-up Study Group's contributions to understanding factors related to improved neurodevelopmental, behavioral, and social-emotional outcomes of EPT infants. We will also discuss follow up challenges, including reassessing which outcomes are most meaningful for parents and investigators. Finally, we will explore how outcome studies have informed clinical decisions and ethical considerations, given limitations of prediction of complex later childhood outcomes from early neurodevelopmental findings.
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Affiliation(s)
- Howard W Kilbride
- Department of Pediatrics, Children's Mercy-Kansas City and the University of Missouri-Kansas City, 2401 Gillham Road, 3rd Floor Annex, Kansas City, MO.
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | - Elisabeth M McGowan
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | | | - Kimberlly Stringer
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Stephanie Wilson Archer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Susan R Hintz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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4
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Otim P, Elobu EA, Mbiine R, Kakembo N, Komakech D. The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000377. [DOI: 10.1136/wjps-2021-000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/14/2022] [Indexed: 11/04/2022] Open
Abstract
BackgroundBowel obstruction is a common surgical emergency in newborns. One-fourth of neonates with obstruction suffer postoperative complications, with high mortality, especially in low-income countries. Factors attributed to mortality include prematurity, late presentation and associated multiple congenital anomalies. The prevalence and the predictors of mortality in our setting have not been well studied. We aimed to describe the early postoperative outcomes and to determine the predictors of mortality among neonates with bowel obstruction.MethodsWe conducted a prospective cohort study during 4 months, when we recruited postoperative neonates from the pediatric surgery unit of Mulago Hospital. We collected data on demographics, clinical presentations, maternal characteristics, the surgical procedure performed, postoperative outcomes, etc. After follow-up for 2 weeks, we analyzed the data using Cox proportional hazards regression models of predictors of mortality.ResultsA total of 76 neonates were recruited, with a male-to-female ratio of 2.2:1. The age ranged from 1 to 26 days, a median of 3 [interquartile range (IQR): 2, 7]. About 67.1% had birth weights ranging between 2.5 kg and 3.5 kg, a mean of 2.8 [standard deviation(SD)=0.64]; 76.3% were termed; with anorectal malformation (ARM), 31.6% as the leading cause, followed by jejunoileal atresia (JIA), 25%. Nearly 55.3% of neonates developed complications; 53.9% with post-operative fever, 15.8% had wound sepsis. The mortality rate was 44.7% (34/76) and was highest among cases of JIA, 41.2%. The predictors of mortality included prematurity, fever at admission, breastfeeding status, and mother’s parity as well as the cadre of healthcare providers (p<0.005).ConclusionsARM is the predominant cause of bowel obstruction among neonates, followed by JIA. The morbidity and mortality due to bowel obstruction among neonates are unacceptably high. The major predictors of mortality were prematurity, fever at admission, and the cadre of the healthcare providers.
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5
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Perrin MT, Friend LL, Sisk PM. Fortified Donor Human Milk Frequently Does Not Meet Sodium Recommendations for the Preterm Infant. J Pediatr 2022; 244:219-223.e1. [PMID: 35093320 DOI: 10.1016/j.jpeds.2022.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/17/2022] [Indexed: 12/18/2022]
Abstract
We measured the sodium content of donor human milk (DHM) and calculated the estimated intake at a feeding volume of 160 mL/kg/day. The mean sodium content of unfortified DHM was 102.0 mg/L (4.4 mEq). Because <1% of bovine-fortified samples met the recommended sodium content, infants born preterm who are fed predominantly DHM likely require additional sodium.
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Affiliation(s)
- Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC.
| | - Linda L Friend
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC
| | - Paula M Sisk
- Neonatal Intensive Care Unit, Forsyth Medical Center, Winston-Salem, NC
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6
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Quifer-Rada P, Aguilar-Camprubí L, Padró-Arocas A, Gómez-Sebastià I, Mena-Tudela D. Impact of COVID-19 Pandemic in Breastfeeding Consultations on LactApp, an m-Health Solution for Breastfeeding Support. Telemed J E Health 2022; 28:1449-1457. [PMID: 35333627 DOI: 10.1089/tmj.2021.0586] [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: 11/13/2022] Open
Abstract
Introduction: Breastfeeding is an unquestionable right of mothers and their children; however, it is not a one-woman job. For breastfeeding to succeed, women must have access to appropriate support and guidance. The COVID-19 pandemic and subsequent restriction measures and lockdown to reduce community spread of the disease have negatively impacted breastfeeding support from health services and thus, in mothers' breastfeeding experiences. Objective: The present study aims at evaluating the impact of the COVID-19 pandemic on breastfeeding consultations in LactApp (a mobile application [app] for m-Health focused on breastfeeding support, www.lactapp.com) during the COVID-19 pandemic. Materials and Methods: We conducted an observational, descriptive, and retrospective study with LactApp data recorded between July 2018 and March 2021, including 9,151,456 queries classified in 48 topics among 137,327 active users. We used the Interrupted time series model to evaluate the increase of the number of queries consulted and active users due to the COVID-19 pandemic. Wilcoxon test was used to study the increase of certain topics due to the COVID-19 pandemic. Results: LactApp active users increased by 12,092 users (p < 0.001) during the COVID-19 outbreak and confinement and queries consulted in LactApp also significantly increased by 10,899 queries per month after the pandemic outbreak. The breastfeeding topics that significantly increased are those related to growth spurts, breastfeeding stages, breastfeeding technique, breast pain and mastitis, problems with infants not gaining weight correctly, hypogalactia, increased milk demand, and relactation. These findings are important to understand the potential of online tools when face-to-face professional support is unavailable. Conclusions: Critical issues in breastfeeding establishment were highly consulted and significantly increased in the app during the pandemic. We believe that LactApp was a useful tool for breastfeeding support when women could not obtain appropriate support elsewhere. LactApp might be considered a powerful tool to identify critical issues of breastfeeding and trends in an automatized manner.
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Affiliation(s)
- Paola Quifer-Rada
- LactApp Women's Health, Barcelona, Spain.,Department of Endocrinology & Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Ignasi Gómez-Sebastià
- LactApp Women's Health, Barcelona, Spain.,Computer Science Department, Universitat Politècnica de Catalunya, Barcelona, Spain
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Franco-Antonio C, Santano-Mogena E, Chimento-Díaz S, Sánchez-García P, Cordovilla-Guardia S. A randomised controlled trial evaluating the effect of a brief motivational intervention to promote breastfeeding in postpartum depression. Sci Rep 2022; 12:373. [PMID: 35013506 PMCID: PMC8748452 DOI: 10.1038/s41598-021-04338-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Postpartum depression (PPD) is the most frequent psychiatric complication during the postnatal period. According to existing evidence, an association exists between the development of PPD and the maintenance of breastfeeding. A brief motivational intervention (bMI), based on the motivational interview, seems effective in promoting breastfeeding. The objective of this study was to analyse the impact of a bMI aiming to promote breastfeeding on the development of PPD and explore the mediating/moderating roles of breastfeeding and breastfeeding self-efficacy in the effect of the intervention on developing PPD. Eighty-eight women who gave birth by vaginal delivery and started breastfeeding during the immediate postpartum period were randomly assigned to the intervention group (bMI) or control group (breastfeeding education). Randomisation by minimisation was carried out. The breastfeeding duration was longer in the intervention group (11.06 (± 2.94) weeks vs 9.02 (± 4.44), p = 0.013). The bMI was associated with a lower score on the Edinburgh Postnatal Depression Scale, with a regression β coefficient of - 2.12 (95% CI - 3.82; - 0.41). A part of this effect was mediated by the effect of the intervention on the duration of breastfeeding (mediation/moderation index β = - 0.57 (95% CI - 1.30; - 0.04)). These findings suggest that a bMI aiming to promote breastfeeding has a positive impact preventing PPD mainly due to its effectiveness in increasing the duration of breastfeeding.
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Affiliation(s)
- C Franco-Antonio
- Nursing Department, Nursing and Occupational Therapy College, Universidad de Extremadura, Cáceres, Spain
- Health and Care Research Group (GISyC), Universidad de Extremadura, Cáceres, Spain
| | - E Santano-Mogena
- Nursing Department, Nursing and Occupational Therapy College, Universidad de Extremadura, Cáceres, Spain.
- Health and Care Research Group (GISyC), Universidad de Extremadura, Cáceres, Spain.
| | - S Chimento-Díaz
- Health and Care Research Group (GISyC), Universidad de Extremadura, Cáceres, Spain
| | - P Sánchez-García
- Health and Care Research Group (GISyC), Universidad de Extremadura, Cáceres, Spain
- Medical and Surgical Therapy Department, Nursing and Occupational Therapy College, Universidad de Extremadura, Cáceres, Spain
| | - S Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, Universidad de Extremadura, Cáceres, Spain
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8
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Hill DR, Chow JM, Buck RH. Multifunctional Benefits of Prevalent HMOs: Implications for Infant Health. Nutrients 2021; 13:3364. [PMID: 34684364 PMCID: PMC8539508 DOI: 10.3390/nu13103364] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022] Open
Abstract
Breastfeeding is the best source of nutrition during infancy and is associated with a broad range of health benefits. However, there remains a significant and persistent need for innovations in infant formula that will allow infants to access a wider spectrum of benefits available to breastfed infants. The addition of human milk oligosaccharides (HMOs) to infant formulas represents the most significant innovation in infant nutrition in recent years. Although not a direct source of calories in milk, HMOs serve as potent prebiotics, versatile anti-infective agents, and key support for neurocognitive development. Continuing improvements in food science will facilitate production of a wide range of HMO structures in the years to come. In this review, we evaluate the relationship between HMO structure and functional benefits. We propose that infant formula fortification strategies should aim to recapitulate a broad range of benefits to support digestive health, immunity, and cognitive development associated with HMOs in breastmilk. We conclude that acetylated, fucosylated, and sialylated HMOs likely confer important health benefits through multiple complementary mechanisms of action.
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Affiliation(s)
| | | | - Rachael H. Buck
- Abbott Nutrition, 3300 Stelzer Road, Columbus, OH 43219, USA; (D.R.H.); (J.M.C.)
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9
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Vandenberg LN. Endocrine disrupting chemicals and the mammary gland. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2021; 92:237-277. [PMID: 34452688 DOI: 10.1016/bs.apha.2021.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Development of the mammary gland requires coordination of hormone signaling pathways including those mediated by estrogen, progesterone, androgen and prolactin receptors. These hormones play important roles at several distinct stages of life including embryonic/fetal development, puberty, pregnancy, lactation, and old age. This also makes the gland sensitive to perturbations from environmental agents including endocrine disrupting chemicals (EDCs). Although there is evidence from human populations of associations between EDCs and disruptions to breast development and lactation, these studies are often complicated by the timing of exposure assessments and the latency to develop breast diseases (e.g., years to decades). Rodents have been instrumental in providing insights-not only to the basic biology and endocrinology of the mammary gland, but to the effects of EDCs on this tissue at different stages of development. Studies, mostly but not exclusively, of estrogenic EDCs have shown that the mammary gland is a sensitive tissue, that exposures during perinatal development can produce abnormal mammary structures (e.g., alveolar buds, typically seen in pregnant females) in adulthood; that exposures during pregnancy can alter milk production; and that EDC exposures can enhance the response of the mammary tissue to hormones and chemical carcinogens. Other studies of persistent organic pollutants have shown that EDC exposures during critical windows of development can delay development of the gland, with lifelong consequences for the individual. Collectively, this work continues to support the conclusion that EDCs can harm the mammary gland, with effects that depend on the period of exposure and the period of evaluation.
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Affiliation(s)
- Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States.
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10
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Supporting Breastfeeding in 2021 and Beyond-Lessons from the Pandemic. Pediatr Rep 2021; 13:289-301. [PMID: 34205900 PMCID: PMC8293422 DOI: 10.3390/pediatric13020037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 01/20/2023] Open
Abstract
The COVID-19 pandemic has affected maternal and infant health globally both directly from infection with the SARS-CoV-2 virus and indirectly from changes in health care resulting from social, economic, and health care policies unique to each country. The developing countries have to share the disproportionate burden on maternal and infant health. In this review, we discuss the uncertainties resulting from SARS-CoV-2 infection in pregnancy, vertical transmission of the virus, and its effects on breastfeeding of the newborn. The problems of families and communities caring for mothers with COVID-19 and its impact on breastfeeding in newborns are discussed. The challenges posed by the pandemic have forced us to think and devise innovative solutions, including telemedicine help for antenatal counseling, breastfeeding education, and lactation support. Optimal utilization of resources and technology to find creative solutions at the individual and the community level will help in facilitating maternal-infant bonding soon after birth. Appropriate health care policies to support pregnant and lactating mothers will go a long way in meeting healthy child development goals.
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11
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Oliveira MM, Trevilato TMB, Segura-Muñoz SI, Aragon DC, Alves LG, Nadal M, Marquès M, Domingo JL, Sierra J, Camelo JS. Essential and toxic elements in human milk concentrate with human milk lyophilizate: A preclinical study. ENVIRONMENTAL RESEARCH 2020; 188:109733. [PMID: 32574850 PMCID: PMC7479503 DOI: 10.1016/j.envres.2020.109733] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/22/2020] [Indexed: 05/02/2023]
Abstract
Concentrated human milk (HM-concentrate) can be obtained from the simple and inexpensive method of donated breast milk direct lyophilization. A previous study reported that HM-concentrate contains the adequate amount of main macro- and micronutrients for use as a nutritional resource for preterm infants with very low birth weight admitted to neonatal intensive care units. However, further details need to be elucidated about HM-concentrate composition, particularly its content of essential and potentially toxic trace elements. Therefore, this study aimed to determine the concentration of essential and toxic elements in human milk considered baseline (HM-baseline) and HM-concentrate, as well as to quantify changes in concentration of these elements after the HM concentration process. The concentration of Aluminum, Arsenic, Cadmium, Chromium, Iron, Mercury, Manganese, Nickel, Lead, Selenium, Tin, and Thallium was analyzed by inductively coupled plasma-mass spectrometry (ICP-MS). Moreover, Bayesian linear mixed effect models were applied to estimate the mean difference between HM-baseline and HM-concentrate samples. After comparison (HM-concentrate versus HM-baseline), a significant increase in concentration was observed only for Manganese (0.80 μg/L; 95% CrI [0.16; 1.43]) and Selenium (6.74 μg/L; 95% CrI [4.66; 8.86]), while Lead concentration (-6.13 μg/L; 95% CrI [-8.63; -3.61]) decreased. This study provides latest and reliable information about HM composition. After milk concentration by lyophilization, there was a significant increase only in the essential elements Manganese and Selenium. The essential micronutrient content in HM-concentrate was similar or higher than that in preterm mothers' milk, which suggests it is viable for nutritional support of preterm infants. In addition, the low concentrations of potentially toxic elements in HM-concentrate indicates that it is safe for consumption by premature newborns.
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Affiliation(s)
- Mariana M Oliveira
- Department of Pediatrics, Childreńs Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Tânia M B Trevilato
- Section of Metals and Rare Diseases, Laboratory of Pediatrics, Clinics Hospital of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Susana I Segura-Muñoz
- Laboratory of Ecotoxicology and Environmental Parasitology, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Childreńs Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Larissa G Alves
- Human Milk Bank, Clinics Hospital of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Martí Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Reus, Catalonia, Spain
| | - Montse Marquès
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Reus, Catalonia, Spain
| | - José L Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Reus, Catalonia, Spain
| | - Jordi Sierra
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Reus, Catalonia, Spain; Laboratory of Soil Science, Faculty of Pharmacy, Universitat de Barcelona, Catalonia, Spain
| | - José Simon Camelo
- Department of Pediatrics, Childreńs Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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12
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Wesolowska A, Bernatowicz-Lojko U, Sinkiewicz-Darol E, Pawlus B, Golicki D. Implementation of the Reimbursement Cost of Human-Milk-Based Neonatal Therapy in Polish Health Care Service : Practical and Ethical Background. J Hum Lact 2020; 36:426-435. [PMID: 32491973 DOI: 10.1177/0890334420909815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A human-milk-based diet is the best option for nutritional therapy for preterm and/or sick newborns. RESEARCH AIM The study aims were to restructure the reimbursement rates to hospitals in Poland for infants' tube feedings to favor the use of donor human milk over formula for newborns who required supplementation of expressed mother's milk and evaluate the results of the financing change during the first year of implementation (2018). METHODS Financial data from hospitals were collected (2015-2016) by the Human Milk Bank Foundation using a data sheet designed by the Agency for Health Technology Assessment and Tariff System. We used data to restructure the reimbursement rates to hospitals for infants' tube feedings and implemented the changes in late 2017. The National Health Fund was requested to share reported data in 2018 concerning tube feeding services. RESULTS More than half (61%) of NICUs introduced human milk tube feeding for newborns. It was provided to participants (N = 5,530), most frequently to seriously ill preterm infants (66.6%). Of these infants, 2,323 were fed donor human milk. Only 1,925 newborns received formula tube feeding. However, there were large differences in frequency of services reported among various parts of the country. CONCLUSIONS Based on our knowledge, Poland is the only European country where the reimbursement cost for human-milk-based nutritional therapy has been implemented in a manner intended to increase the quality of health care services for preterm newborns. Equal reimbursement for expressed mother's milk and donor milk did not appear to cause overuse of donor milk based on our analysis of the 2018 data.
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Affiliation(s)
- Aleksandra Wesolowska
- 37803 Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Medical University of Warsaw, Department of Medical Biology, Warsaw, Poland.,Human Milk Bank Foundation, Warsaw, Poland
| | - Urszula Bernatowicz-Lojko
- Human Milk Bank Foundation, Warsaw, Poland.,4960449770 Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Poland.,Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Elena Sinkiewicz-Darol
- 4960449770 Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Poland
| | - Beata Pawlus
- Human Milk Bank Foundation, Warsaw, Poland.,111473 Regional Human Milk Bank, Neonatal Unit, Holy Family Specialist Hospital, Warsaw, Poland
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Gray KD, Messina JA, Cortina C, Owens T, Fowler M, Foster M, Gbadegesin S, Clark RH, Benjamin DK, Zimmerman KO, Greenberg RG. Probiotic Use and Safety in the Neonatal Intensive Care Unit: A Matched Cohort Study. J Pediatr 2020; 222:59-64.e1. [PMID: 32418818 PMCID: PMC7321859 DOI: 10.1016/j.jpeds.2020.03.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the prevalence of probiotic administration in infants born preterm over time, as well as the association between probiotic administration and select adverse outcomes. STUDY DESIGN We performed a multicenter cohort study of infants 23-29 weeks of gestational age admitted to 289 neonatal intensive care units from 1997 to 2016. We evaluated the type of probiotics given and prevalence of exposure to probiotics over time and by site. We matched infants exposed to probiotics by several factors to unexposed infants receiving enteral feeds on the same postnatal day. We performed conditional logistic regression to evaluate the association between probiotics exposure and adverse outcomes, including necrotizing enterocolitis (NEC), bloodstream infections, meningitis, and death. RESULTS Of 78 076 infants, 3626 (4.6%) received probiotics. Probiotic use increased over the study period and varied among neonatal intensive care units. We matched 2178 infants exposed to probiotics to 33 807 without exposure. Probiotic administration was associated with a decrease in NEC (OR 0.62, 95% CI 0.48-0.80) and death (OR 0.52, 95% CI 0.39-0.70), an increase in Candida infection (OR 2.23, 95% CI 1.29-3.85), but no increase in bloodstream infection (OR 0.86, 95% CI 0.70-1.05) or meningitis (OR 1.18, 95% CI 0.40-3.46). CONCLUSIONS Probiotic use increased over time and was associated with decreased odds of NEC and death. Prospective, randomized-controlled studies of specific probiotic products are needed to further investigate the safety and efficacy of probiotics in preterm infants.
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Affiliation(s)
- Keyaria D Gray
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | | | | | | | | | | | | | | | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC; and.
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Health Care Costs Associated to Type of Feeding in the First Year of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134719. [PMID: 32630048 PMCID: PMC7369965 DOI: 10.3390/ijerph17134719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Breastfeeding is associated with lower risk of infectious diseases, leading to fewer hospital admissions and pediatrician consultations. It is cost saving for the health care system, however, it is not usually estimated from actual cohorts but via simulation studies. METHODS A cohort of 970 children was followed-up for twelve months. Data on mother characteristics, pregnancy, delivery and neonate characteristics were obtained from medical records. The type of neonate feeding at discharge, 2, 4, 6, 9 and 12 months of life was reported by the mothers. Infectious diseases diagnosed in the first year of life, hospital admissions, primary care and emergency room consultations and drug treatments were obtained from neonate medical records. Health care costs were attributed using public prices and All Patients Refined-Diagnosis Related Groups (APR-DRG) classification. RESULTS Health care costs in the first year of life were higher in children artificially fed than in those breastfed (1339.5€, 95% confidence interval (CI): 903.0-1775.0 for artificially fed vs. 443.5€, 95% CI: 193.7-694.0 for breastfed). The breakdown of costs also shows differences in primary care consultations (295.7€ for formula fed children vs. 197.9€ for breastfed children), emergency room consultations (260.1€ for artificially fed children vs. 196.2€ for breastfed children) and hospital admissions (791.6€ for artificially fed children vs. 86.9€ for breastfed children). CONCLUSIONS Children artificially fed brought about more health care costs related to infectious diseases than those exclusively breastfed or mixed breastfed. Excess costs were caused in hospital admissions, primary care consultations, emergency room consultations and drug consumption.
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Liu J, Parker MG, Lu T, Conroy SM, Oehlert J, Lee HC, Gomez SL, Shariff-Marco S, Profit J. Racial and Ethnic Disparities in Human Milk Intake at Neonatal Intensive Care Unit Discharge among Very Low Birth Weight Infants in California. J Pediatr 2020; 218:49-56.e3. [PMID: 31843218 PMCID: PMC7042029 DOI: 10.1016/j.jpeds.2019.11.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine how infant and maternal factors, hospital factors, and neighborhood-level factors impact or modify racial/ethnic disparities in human milk intake at hospital discharge among very low birth weight infants. STUDY DESIGN We studied 14 422 infants from 119 California Perinatal Quality Care Collaborative neonatal intensive care units born from 2008 to 2011. Maternal addresses were linked to 2010 census tract data, representing neighborhoods. We tested for associations with receiving no human milk at discharge, using multilevel cross-classified models. RESULTS Compared with non-Hispanic whites, the adjusted odds of no human milk at discharge was higher among non-Hispanic blacks (aOR 1.33 [1.16-1.53]) and lower among Hispanics (aOR 0.83 [0.74-0.93]). Compared with infants of more educated white mothers, infants of less educated white, black, and Asian mothers had higher odds of no human milk at discharge, and infants of Hispanic mothers of all educational levels had similar odds as infants of more educated white mothers. Country of birth and neighborhood socioeconomic was also associated with disparities in human milk intake at discharge. CONCLUSIONS Non-Hispanic blacks had the highest and Hispanic infants the lowest odds of no human milk at discharge. Maternal education and country of birth were the biggest drivers of disparities in human milk intake, suggesting the need for targeted approaches of breastfeeding support.
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Affiliation(s)
- Jessica Liu
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Margaret G Parker
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Tianyao Lu
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Shannon M Conroy
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - John Oehlert
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
| | - Henry C Lee
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA.
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Timing of First Milk Expression to Maximize Breastfeeding Continuation Among Mothers of Very Low-Birth-Weight Infants. Obstet Gynecol 2020; 133:1208-1215. [PMID: 31135736 DOI: 10.1097/aog.0000000000003258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the time of first milk expression among mothers of very low-birth-weight (VLBW, 1,500 g or less) infants that predicts the maximal duration of mother's milk provision during hospitalization in the neonatal intensive care unit (NICU). METHODS We performed a secondary analysis and studied 1,157 mother-VLBW infant pairs in nine Massachusetts hospitals born from January 2015 until December 2017. We determined the cut-point for timing of first milk expression after delivery that was associated with the highest probability of any and exclusive provision of mother's milk for the infant at NICU discharge or transfer using recursive partitioning. We estimated hazard ratios (HRs) comparing the probability of continued provision of mother's milk during the hospitalization between mothers who initiated milk expression before compared with after the cut-point (within 8 hours after delivery [referent] vs 9-24 hours), adjusting for gestational age, birth weight, maternal race and ethnicity, and clustering by hospital and plurality in Cox proportional hazards models. RESULTS Sixty-eight percent of mothers first expressed milk within 8 hours after delivery. First milk expression at 9-24 hours was associated with lower odds of any mother's milk provided to the infant on day 7 (adjusted odds ratio [aOR] 0.39 [0.24-0.60]) and discharge or transfer (aOR 0.45 [0.33-0.62]), compared with expression within 8 hours. Findings were similar for exclusive mother's milk. Mothers who first expressed 9-24 hours stopped providing milk earlier in the neonatal hospitalization (adjusted HR 1.64 [1.33-2.01]) compared with mothers who first expressed within 8 hours. CONCLUSION Using a data-driven approach, we identified that first milk expression within 8 hours was superior to 9-24 hours with respect to maximal duration of provision of mother's milk for hospitalized VLBW infants. Randomized control trials are needed to further establish the causal relationship between timing of first milk expression and long-term lactation success among mothers of VLBW infants.
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Human Milk Feeding in Preterm Infants: What Has Been Done and What Is to Be Done. Nutrients 2019; 12:nu12010044. [PMID: 31877960 PMCID: PMC7020077 DOI: 10.3390/nu12010044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 11/17/2022] Open
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What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief. Adv Neonatal Care 2019; 19:383-393. [PMID: 30893096 DOI: 10.1097/anc.0000000000000602] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Benefits of exclusive human milk diets for preterm and low birth-weight infants are well established. Despite known benefits, supporting mothers in the provision of mother's own milk for high-risk infants is challenging. Lactation support in the neonatal intensive care unit (NICU) is highly variable. Lactations consultants (LCs) are often shared between postpartum units and the NICU, potentially increasing LC workload with less time spent with high-risk mothers. Furthermore, less than half of NICUs in the United States staff an international board-certified lactation consultant. Limited understanding exists regarding impacts of NICU-specific lactation support on breastfeeding outcomes. PURPOSE The purpose of this evidence-based practice brief is to synthesize the literature on the impact of NICU-specific lactation support, LCs who work exclusively in the NICU, and provide guidance about how NICU staffing with LCs solely focused on supporting mothers of high-risk infants impacts breastfeeding outcomes for low birth-weight infants. SEARCH STRATEGY CINAHL PLUS, PubMed, Cochrane Library, and OVID databases were searched using key words and restricted to English language. FINDINGS During hospitalization, NICUs staffed with dedicated board-certified LCs have increased potential to yield improved breastfeeding rates through hospital discharge, increased proportion of infants who receive mother's own milk, and increased duration of breastfeeding or human milk expression through hospital discharge. IMPLICATIONS FOR PRACTICE Human milk nutrition is related to improved outcomes for high-risk infants. Neonatal intensive care unit-specific lactation support can potentially optimize maternal breastfeeding practices and improve outcomes for high-risk infants. IMPLICATIONS FOR RESEARCH There is a need for further studies pertaining to NICU-specific lactation consultants and influences on breastfeeding outcomes.
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Boghossian NS, Geraci M, Lorch SA, Phibbs CS, Edwards EM, Horbar JD. Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation. Pediatrics 2019; 144:peds.2019-1106. [PMID: 31405887 PMCID: PMC6813804 DOI: 10.1542/peds.2019-1106] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers. METHODS Infants 22 to 29 weeks' gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and Hispanic versus white infants by birth year. We tested temporal differences in mortality and morbidity rates between white and African American or Hispanic infants using a likelihood ratio test on nested binomial regression models. RESULTS Disparities for certain care practices such as antenatal corticosteroids and for some in-hospital outcomes have narrowed over time for minority infants. Compared with white infants, African American infants had a faster decline for mortality, hypothermia, necrotizing enterocolitis, and late-onset sepsis, whereas Hispanic infants had a faster decline for mortality, respiratory distress syndrome, and pneumothorax. Other morbidities showed a constant rate difference between African American and Hispanic versus white infants over time. Despite the improvements, outcomes including hypothermia, mortality, necrotizing enterocolitis, late-onset sepsis, and severe intraventricular hemorrhage remained elevated by the end of the study period, especially among African American infants. CONCLUSIONS Racial and ethnic disparities in vital care practices and certain outcomes have decreased. That the quality deficit among minority infants occurred for several care practice measures and potentially modifiable outcomes suggests a critical role for quality improvement initiatives tailored for minority-serving hospitals.
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Affiliation(s)
- Nansi S. Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Marco Geraci
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Scott A. Lorch
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;,Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ciaran S. Phibbs
- Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California;,Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington, Vermont;,Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont; and,Department of Pediatrics, College of Medicine, University of Vermont, Burlington, Vermont
| | - Jeffrey D. Horbar
- Vermont Oxford Network, Burlington, Vermont;,Department of Pediatrics, College of Medicine, University of Vermont, Burlington, Vermont
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20
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Grases-Pintó B, Torres-Castro P, Abril-Gil M, Castell M, Rodríguez-Lagunas MJ, Pérez-Cano FJ, Franch À. A Preterm Rat Model for Immunonutritional Studies. Nutrients 2019; 11:nu11050999. [PMID: 31052461 PMCID: PMC6566403 DOI: 10.3390/nu11050999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/14/2022] Open
Abstract
Neonates are born with an immature immune system, which develops during the first stages of life. This early immaturity is more acute in preterm newborns. The aim of the present study was to set up a preterm rat model, in which representative biomarkers of innate and adaptive immunity maturation that could be promoted by certain dietary interventions are established. Throughout the study, the body weight was registered. To evaluate the functionality of the intestinal epithelial barrier, in vivo permeability to dextrans was measured and a histomorphometric study was performed. Furthermore, the blood cell count, phagocytic activity of blood leukocytes and plasmatic immunoglobulins (Ig) were determined. Preterm rats showed lower erythrocyte and platelet concentration but a higher count of leukocytes than the term rats. Although there were no changes in the granulocytes’ ability to phagocytize, preterm monocytes had lower phagocytic activity. Moreover, lower plasma IgG and IgM concentrations were detected in preterm rats compared to full-term rats, without affecting IgA. Finally, the intestinal study revealed lower permeability in preterm rats and reduced goblet cell size. Here, we characterized a premature rat model, with differential immune system biomarkers, as a useful tool for immunonutritional studies aimed at boosting the development of the immune system.
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Affiliation(s)
- Blanca Grases-Pintó
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain.
- Nutrition and Food Safety Research Institute (INSA·UB), 08921 Santa Coloma de Gramenet, Spain.
| | - Paulina Torres-Castro
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain.
- Nutrition and Food Safety Research Institute (INSA·UB), 08921 Santa Coloma de Gramenet, Spain.
| | - Mar Abril-Gil
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain.
- Nutrition and Food Safety Research Institute (INSA·UB), 08921 Santa Coloma de Gramenet, Spain.
| | - Margarida Castell
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain.
- Nutrition and Food Safety Research Institute (INSA·UB), 08921 Santa Coloma de Gramenet, Spain.
| | - María J Rodríguez-Lagunas
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain.
- Nutrition and Food Safety Research Institute (INSA·UB), 08921 Santa Coloma de Gramenet, Spain.
| | - Francisco J Pérez-Cano
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain.
- Nutrition and Food Safety Research Institute (INSA·UB), 08921 Santa Coloma de Gramenet, Spain.
| | - Àngels Franch
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain.
- Nutrition and Food Safety Research Institute (INSA·UB), 08921 Santa Coloma de Gramenet, Spain.
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Santacruz-Salas E, Aranda-Reneo I, Hidalgo-Vega Á, Blanco-Rodriguez JM, Segura-Fragoso A. The Economic Influence of Breastfeeding on the Health Cost of Newborns. J Hum Lact 2019; 35:340-348. [PMID: 30508488 DOI: 10.1177/0890334418812026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Breastfeeding provides health benefits for women and newborns. However, few studies have explored how these health benefits translate into economic savings. RESEARCH AIM This study aimed to estimate the healthcare costs savings generated by exclusive breastfeeding for healthy newborns. METHODS We designed a longitudinal two-group observational study that included healthy women and newborns ( N = 236) in Toledo, Spain. Over the first 6-months of the infants' lives, we reviewed their clinical histories to determine their consumption of healthcare resources and the type of nutrition provided. The sample was categorized into two groups: exclusive breastfeeding ( n = 46) and non-exclusive breastfeeding for 6 months ( n = 190). Two-part regression models were applied to determine whether there were differences in healthcare costs between the groups. RESULTS The average age of the women was 32 ( SD: 5.3). The average birth weight of the newborns was 3.3 kg. ( SD: 0.38). At 6 months, 19.5% ( n = 46) of the women breastfed exclusively, 28.4% ( n = 67) combined breastfeeding with formula, and 45.8% ( n = 108) used formula only. Healthcare costs during follow-up reached €785.58 (44% for specialized care, 42% for primary care, 9.8% for medical emergencies, 3% for medications and approximately 1% for medical tests). The statistical analysis estimated a lower healthcare cost of between €454.40 and €503.50 for exclusively breastfed newborns. CONCLUSION Breastfeeding generated savings in healthcare costs; therefore, it could be a cost-efficient option compared with alternatives. Researchers who evaluate the efficiency of strategies that promote breastfeeding can contribute to the sustainability of health services.
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Affiliation(s)
- Esmeralda Santacruz-Salas
- 1 Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| | - Isaac Aranda-Reneo
- 2 Faculty of Social Sciences, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| | - Álvaro Hidalgo-Vega
- 3 Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - José M Blanco-Rodriguez
- 4 Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Antonio Segura-Fragoso
- 1 Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
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Gephart SM, Newnam KM. Closing the Gap Between Recommended and Actual Human Milk Use for Fragile Infants: What Will It Take to Overcome Disparities? Clin Perinatol 2019; 46:39-50. [PMID: 30771818 DOI: 10.1016/j.clp.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article describes the components of human milk and their value to reduce risk for necrotizing enterocolitis, disparities in access to human milk, potential relationships to care practices within the neonatal intensive care unit, and ways to overcome the disparity.
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Affiliation(s)
- Sheila M Gephart
- Community and Health Systems Science Division, College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721, USA.
| | - Katherine M Newnam
- College of Nursing, The University of Tennessee Knoxville, 1200 Volunteer Boulevard #361, Knoxville, TN 37996, USA
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Abstract
Multicenter groups have reported reductions in the incidence of necrotizing enterocolitis (NEC) among preterm infants over the past 2 decades. These large-scale prevalence studies have coincided with reports from multicenter consortia and single centers of modifications in practice using quality-improvement techniques aimed at either reducing NEC risk specifically or reducing risk of mortality and multiple morbidities associated with extreme prematurity. The modifications in practice have been based on mechanistic studies, epidemiologic association data, and clinical trials. Recent reports from centers modifying practice to reduce NEC are reviewed and select modified/modifiable practices discussed.
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Affiliation(s)
- C Michael Cotten
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University School of Medicine, Box 2739 DUMC, Durham, NC 27710, USA.
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Development of a human milk concentrate with human milk lyophilizate for feeding very low birth weight preterm infants: A preclinical experimental study. PLoS One 2019; 14:e0210999. [PMID: 30785913 PMCID: PMC6382113 DOI: 10.1371/journal.pone.0210999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/06/2019] [Indexed: 12/11/2022] Open
Abstract
Breast milk is considered the gold standard nutritional resource for very low birth weight (VLBW) infants in terms of nutrients and protective factors. If mother's milk is not available, the second choice is donated and fortified human milk (HM) from the Human Milk Bank (HMB). This study hypothesized that HM could be lyophilized and used as an additive to increase the levels of macronutrients and micronutrients available to VLBW infants. This study aimed to constitute a lyophilized HM concentrate and determine the osmolality and the concentration of macronutrients and micronutrients in HM samples at “baseline” and in “HM concentrates”, analyzed immediately (HMCI), and after 3 (HMC3m) and 6 (HMC6m) months of freezing. Osmolality was verified using the freezing point osmometric method. Macronutrient quantification was performed using the MIRIS Human Milk Analyzer. Micronutrients were determined by Flame Atomic Absorption Spectrophotometry and by the automated colorimetric method. Bayesian linear mixed effect models were adjusted using OpenBUGS to estimate mean differences and 95% credibility intervals (CrI) of osmolality and of macro- and micronutrients between the types of HM samples. A comparison of dosage values showed a significant increase between HM baseline and HMCI, HMC3m, and HMC6m. Comparing HM baseline and HMCI highlighted the increase in energy content and the concentration of carbohydrates and total lipids. The Ca and P contents increased and the levels of energy, total lipids, and Cu were reduced in HMC3m compared to HMCI. Ca, Mg, K, Zn, and P increased and the levels of energy, total lipids, and Cu were reduced in HMC6m, compared to HMCI. The present study confirms the possibility of formulation and utilization of the immediate concentrate. Partial stability of HM concentrates generated from freeze-drying of donated milk do not recommend storage.
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Racial and Ethnic Disparities in the Use of Mother's Milk Feeding for Very Low Birth Weight Infants in Massachusetts. J Pediatr 2019; 204:134-141.e1. [PMID: 30274926 DOI: 10.1016/j.jpeds.2018.08.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the extent to which maternal race/ethnicity is associated with mother's milk use among hospitalized very low birth weight (VLBW) infants and maternal receipt of hospital breastfeeding support practices (human milk prenatal education, first milk expression <6 hours after delivery, lactation consultation <24 hours, any skin-to-skin care <1 month). STUDY DESIGN We studied 1318 mother-VLBW infant pairs in 9 Massachusetts level 3 neonatal intensive care units (NICUs) between January 2015 and November 2017. We estimated associations of maternal race/ethnicity with any and exclusive mother's milk on day 7, on day 28, and at discharge/transfer and hospital practices. We estimated HRs comparing the probability of continued milk use over the hospitalization by race/ethnicity and tested mediation by hospital practices, adjusting for birth weight and gestational age and including hospital and plurality as random effects. RESULTS Mothers were 48% non-Hispanic white, 21% non-Hispanic black, and 20% Hispanic. Initiation of mother's milk was similar across groups, but infants of Hispanic mothers (hazard ratio [HR], 2.71; 95% CI, 2.05-3.59) and non-Hispanic black mothers (HR, 1.55; 95% CI, 1.17-2.07) stopped receiving milk earlier in the hospitalization compared with infants of non-Hispanic white mothers. Hispanic mothers had lower odds of providing skin-to-skin care at <1 month (OR, 0.61; 95% CI, 0.43-0.87) compared with non-Hispanic whites. CONCLUSIONS Hispanic and non-Hispanic black mothers were less likely than non-Hispanic white mothers to continue providing milk for their VLBW infants throughout the NICU stay.
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Ma B, McComb E, Gajer P, Yang H, Humphrys M, Okogbule-Wonodi AC, Fasano A, Ravel J, Viscardi RM. Microbial Biomarkers of Intestinal Barrier Maturation in Preterm Infants. Front Microbiol 2018; 9:2755. [PMID: 30487786 PMCID: PMC6246636 DOI: 10.3389/fmicb.2018.02755] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/29/2018] [Indexed: 12/24/2022] Open
Abstract
Intestinal barrier immaturity, or "leaky gut," is the proximate cause of susceptibility to necrotizing enterocolitis in preterm neonates. However, the impact of intestinal microbiota development on intestinal mucosal barrier maturation has not been evaluated in this population. In this study, we investigated a longitudinally sampled cohort of 38 preterm infants < 33 weeks gestation monitored for intestinal permeability (IP) and fecal microbiota during the first 2 weeks of life. Rapid decrease in IP indicating intestinal barrier function maturation correlated with significant increase in community diversity. In particular, members of the Clostridiales and Bifidobacterium were highly transcriptionally active, and progressively increasing abundance in Clostridiales was significantly associated with decreased intestinal permeability. Further, neonatal factors previously identified to promote intestinal barrier maturation, including early exclusive breastmilk feeding and shorter duration antibiotic exposure, associate with the early colonization of the intestinal microbiota by members of the Clostridiales, which altogether are associated with improved intestinal barrier function in preterm infants.
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Affiliation(s)
- Bing Ma
- Institute for Genome Sciences, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Elias McComb
- Institute for Genome Sciences, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Pawel Gajer
- Institute for Genome Sciences, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Hongqiu Yang
- Institute for Genome Sciences, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mike Humphrys
- Institute for Genome Sciences, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Adora C. Okogbule-Wonodi
- Department of Pediatrics and Child Health, Howard University College of Medicine, Washington, DC, United States
| | - Alessio Fasano
- Department of Pediatrics, Basic, Clinical and Translational Research, MassGeneral Hospital for Children, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jacques Ravel
- Institute for Genome Sciences, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rose M Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
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27
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Gephart SM, Moore EF, Fry E. Standardized Feeding Protocols to Reduce Risk of Necrotizing Enterocolitis in Fragile Infants Born Premature or with Congenital Heart Disease: Implementation Science Needed. Crit Care Nurs Clin North Am 2018; 30:457-466. [PMID: 30447806 DOI: 10.1016/j.cnc.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although a unit-adopted standardized feeding protocol (SFP) for neonates is standard of care, implementation strategies for SFPs vary across neonatal and pediatric intensive care. Besides improving growth and reducing feeding interruptions, SFPs reduce risk for necrotizing enterocolitis in infants with heart disease or born premature. The purpose of this article is to bridge the gap between recommended and actual care using SFPs.
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Affiliation(s)
- Sheila M Gephart
- Community and Health Systems Science, College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721, USA.
| | - Emily F Moore
- Regional cardiology program, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Emory Fry
- Cognitive Medical Systems, 9444 Waples Street, Suite 300, San Diego, CA 92121, USA
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28
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Wouk K, Chetwynd E, Vitaglione T, Sullivan C. Improving Access to Medical Lactation Support and Counseling: Building the Case for Medicaid Reimbursement. Matern Child Health J 2018; 21:836-844. [PMID: 27535132 DOI: 10.1007/s10995-016-2175-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective While the Affordable Care Act improves access to lactation services for many women across the US, low-income mothers in states without Medicaid expansion lack coverage for lactation support. As these states consider individual Medicaid reimbursement policies, the availability, effectiveness, and cost-benefit of lactation services must be evaluated. We conducted such an analysis for low-income mothers in North Carolina (NC), providing a model for other states. Methods First, we analyzed the distribution of NC International Board Certified Lactation Consultants (IBCLCs) and county-level breastfeeding rates among low-income infants. Logistic regression was used to examine the association between IBCLC density and 6-week breastfeeding duration. Finally, state advocates collaborated on a cost-benefit analysis of Medicaid coverage of IBCLCs. Results Maps of the NC breastfeeding support landscape indicate that IBCLCs are available to provide services to low-income women across the state. Compared to counties with no IBCLCs, those with high IBCLC density were found to have a 6-week breastfeeding prevalence ratio of 1.20 (95 % CI 1.12, 1.28). Medicaid reimbursement of IBCLCs showed an estimated annual cost savings of $2.33 million. Conclusions for Practice In one state without Medicaid expansion, we found that breastfeeding support resources are available across the state, high density IBCLC support is associated with increased breastfeeding by low-income mothers, and services are cost-effective. Our model for Medicaid reimbursement in NC provides a framework for states to improve equity in access to optimal lactation support.
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Affiliation(s)
- Kathryn Wouk
- Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina, CB#7445, Chapel Hill, NC, 27599, USA.
| | - Ellen Chetwynd
- Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina, CB#7445, Chapel Hill, NC, 27599, USA
| | - Thomas Vitaglione
- Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina, CB#7445, Chapel Hill, NC, 27599, USA.,Child Fatality Task Force, Raleigh, NC, USA
| | - Catherine Sullivan
- Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina, CB#7445, Chapel Hill, NC, 27599, USA
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29
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Cadwell K, Turner-Maffei C, Blair A, Brimdyr K, OʼConnor B. How Does the United States Rank According to the World Breastfeeding Trends Initiative? J Perinat Neonatal Nurs 2018; 32:127-135. [PMID: 29381567 DOI: 10.1097/jpn.0000000000000318] [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] [Indexed: 11/25/2022]
Abstract
The World Breastfeeding Trends Initiative is an assessment process designed to facilitate an ongoing national appraisal of progress toward the goals of the United Nations Children's Fund (UNICEF)/World Health Organization (WHO) Global Strategy for Infant and Young Child Feeding. More than 80 countries have completed this national assessment, including the United States of America. This article describes the process undertaken by the US World Breastfeeding Trends Initiative team, the findings of the expert panel related to infant and young child feeding policies, programs, and practices and the ranking of the United States compared with the 83 other participating nations. Identified strengths of the United States include data collection and monitoring, especially by the Centers for Disease Control and Prevention, the US Baby-Friendly Hospital Initiative, and the United States Breastfeeding Committee. The absence of a national infant feeding policy, insufficient maternity protection, and lack of preparation for infant and young children feeding in emergencies are key targets identified by the assessment requiring concerted national effort.
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Affiliation(s)
- Karin Cadwell
- Healthy Children Project, Inc, East Sandwich, Massachusetts
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30
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Gephart SM, Hanson C, Wetzel CM, Fleiner M, Umberger E, Martin L, Rao S, Agrawal A, Marin T, Kirmani K, Quinn M, Quinn J, Dudding KM, Clay T, Sauberan J, Eskenazi Y, Porter C, Msowoya AL, Wyles C, Avenado-Ruiz M, Vo S, Reber KM, Duchon J. NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis. Matern Health Neonatol Perinatol 2017; 3:23. [PMID: 29270303 PMCID: PMC5733736 DOI: 10.1186/s40748-017-0062-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/28/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs). PURPOSE The purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of NEC. METHODS Using the Translating Research into Practice (TRIP) framework, we conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations using GRADE criteria across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship. Sub-groups answered 5 key questions, reviewed 11 position statements and 71 research reports. Meta-analyses with random effects were conducted on effects of standardized feeding protocols and donor human milk derived fortifiers on NEC. RESULTS Quality of evidence ranged from very low (timely recognition) to moderate (feeding protocols, prioritize human milk, limiting antibiotics and antacids). Prioritizing human milk, feeding protocols and avoiding antacids were strongly recommended. Weak recommendations (i.e. "probably do it") for limiting antibiotics and use of a standard timely recognition approach are presented. Meta-analysis of data from infants weighing <1250 g fed donor human milk based fortifier had reduced odds of NEC compared to those fed cow's milk based fortifier (OR = 0.36, 95% CI 0.13, 1.00; p = 0.05; 4 studies, N = 1164). Use of standardized feeding protocols for infants <1500 g reduced odds of NEC by 67% (OR = 0.33, 95% CI 0.17, 0.65, p = 0.001; 9 studies; N = 4755 infants). Parents recommended that NEC information be shared early in the NICU stay, when feedings were adjusted, or feeding intolerance occurred via print and video materials to supplement verbal instruction. DISCUSSION Evidence for NEC prevention is of sufficient quality to implement. Implementation that addresses system-level interventions that engage the whole team, including parents, will yield the best impact to prevent NEC and foster its timely recognition.
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Affiliation(s)
- Sheila M. Gephart
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | | | | | | | | | | | - Suma Rao
- Banner Health, Banner University Medical Center-Phoenix, Phoenix, AZ USA
- Phoenix Perinatal Associates, Mesa, AZ USA
- Clinical Assistant Professor and Vice-Chair, Department of Pediatrics, The University of Arizona, Tucson, AZ USA
| | - Amit Agrawal
- Banner Health, Thunderbird Medical Center, Glendale, AZ USA
- Envision Physician Services, Lawrenceville, GA USA
| | - Terri Marin
- Augusta University College of Nursing, Athens, GA USA
| | - Khaver Kirmani
- Banner Health, Cardon Children’s Medical Center, Mesa, AZ USA
- Phoenix Perinatal Associates, Mesa, AZ USA
| | - Megan Quinn
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
- Banner Health, Cardon Children’s Medical Center, Mesa, AZ USA
| | - Jenny Quinn
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
- NorthBay Medical Center, Fairfield, CA USA
| | - Katherine M. Dudding
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | | | - Jason Sauberan
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA USA
| | - Yael Eskenazi
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | - Caroline Porter
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | | | - Christina Wyles
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | | | - Shayla Vo
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | - Kristina M. Reber
- Nationwide Children’s Hospital and The Ohio State Wexner Medical Center, Columbus, OH USA
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31
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Pirr S, Richter M, Fehlhaber B, Pagel J, Härtel C, Roth J, Vogl T, Viemann D. High Amounts of S100-Alarmins Confer Antimicrobial Activity on Human Breast Milk Targeting Pathogens Relevant in Neonatal Sepsis. Front Immunol 2017; 8:1822. [PMID: 29326708 PMCID: PMC5733341 DOI: 10.3389/fimmu.2017.01822] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022] Open
Abstract
Sepsis is a leading cause of perinatal mortality worldwide. Breast milk (BM) feeding is protective against neonatal sepsis, but the molecular mechanisms remain unexplained. Despite various supplementations with potential bioactive components from BM formula feeding cannot protect from sepsis. S100-alarmins are important immunoregulators in newborns preventing excessive inflammation. At high concentrations, the S100A8/A9 protein complex also has antimicrobial properties due to its metal ion chelation capacity. To assess whether BM contains S100-alarmins that might mediate the sepsis-protective effect of BM 97 human BM samples stratified for gestational age, mode of delivery and sampling after birth were collected and analyzed. S100A8/A9 levels were massively elevated after birth (p < 0.0005). They slowly decreased during the first month of life, then reaching levels comparable to normal values in adult serum. The concentration of S100A8/A9 in BM was significantly higher after term compared with preterm birth (extremely preterm, p < 0.005; moderate preterm, p < 0.05) and after vaginal delivery compared with cesarean section (p < 0.0005). In newborn s100a9−/− mice, enterally supplied S100-alarmins could be retrieved systemically in the plasma. To explore the antimicrobial activity against common causal pathogens of neonatal sepsis, purified S100-alarmins and unmodified as well as S100A8/A9-depleted BM were used in growth inhibition tests. The high amount of S100A8/A9 proved to be an important mediator of the antimicrobial activity of BM, especially inhibiting the growth of manganese (Mn) sensitive bacteria such as Staphylococcus aureus (p < 0.00005) and group B streptococci (p < 0.005). Depletion of S100A8/A9 significantly reduced this effect (p < 0.05, respectively). The growth of Escherichia coli was also inhibited by BM (p < 0.00005) as well as by S100A8/A9 in culture assays (p < 0.05). But its growth in BM remained unaffected by the removal of S100A8/A9 and was neither dependent on Mn suggesting that the antimicrobial effects of S100A8/A9 in BM are primarily mediated by its Mn chelating capacity. In summary, the enteral supply of bioavailable, antimicrobially active amounts of S100-alarmins might be a promising option to protect newborns at high risk from infections and sepsis.
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Affiliation(s)
- Sabine Pirr
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Manuela Richter
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany.,Children's Hospital "Auf der Bult", Hannover, Germany
| | - Beate Fehlhaber
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Julia Pagel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | | | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Dorothee Viemann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
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32
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Stuebe AM, Jegier BJ, Schwarz EB, Green BD, Reinhold AG, Colaizy TT, Bogen DL, Schaefer AJ, Jegier JT, Green NS, Bartick MC. An Online Calculator to Estimate the Impact of Changes in Breastfeeding Rates on Population Health and Costs. Breastfeed Med 2017; 12:645-658. [PMID: 28906133 DOI: 10.1089/bfm.2017.0083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We sought to determine the impact of changes in breastfeeding rates on population health. MATERIALS AND METHODS We used a Monte Carlo simulation model to estimate the population-level changes in disease burden associated with marginal changes in rates of any breastfeeding at each month from birth to 12 months of life, and in rates of exclusive breastfeeding from birth to 6 months of life. We used these marginal estimates to construct an interactive online calculator (available at www.usbreastfeeding.org/saving-calc ). The Institutional Review Board of the Cambridge Health Alliance exempted the study. RESULTS Using our interactive online calculator, we found that a 5% point increase in breastfeeding rates was associated with statistically significant differences in child infectious morbidity for the U.S. population, including otitis media (101,952 cases, 95% confidence interval [CI] 77,929-131,894 cases) and gastrointestinal infection (236,073 cases, 95% CI 190,643-290,278 cases). Associated medical cost differences were $31,784,763 (95% CI $24,295,235-$41,119,548) for otitis media and $12,588,848 ($10,166,203-$15,479,352) for gastrointestinal infection. The state-level impact of attaining Healthy People 2020 goals varied by population size and current breastfeeding rates. CONCLUSION Modest increases in breastfeeding rates substantially impact healthcare costs in the first year of life.
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Affiliation(s)
- Alison M Stuebe
- 1 Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Briana J Jegier
- 3 Department of Health Services Administration, D'Youville College , Buffalo, New York
| | | | - Brittany D Green
- 5 Department of Operations Business Analytics and Information Systems, University of Cincinnati , Cincinnati, Ohio
| | - Arnold G Reinhold
- 6 Alliance for the Prudent Use of Antibiotics, Boston, Massachusetts
| | - Tarah T Colaizy
- 7 Department of Neonatology, Carver College of Medicine, University of Iowa , Iowa City, Iowa
| | - Debra L Bogen
- 8 Department of Pediatrics, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Andrew J Schaefer
- 9 Department of Computational and Applied Mathematics, Rice University , Houston, Texas
| | | | - Noah S Green
- 1 Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Melissa C Bartick
- 11 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,12 Department of Medicine, Harvard Medical School , Boston, Massachusetts
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33
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Buckle A, Taylor C. Cost and Cost-Effectiveness of Donor Human Milk to Prevent Necrotizing Enterocolitis: Systematic Review. Breastfeed Med 2017; 12:528-536. [PMID: 28829161 DOI: 10.1089/bfm.2017.0057] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is a costly gastrointestinal disorder that mainly affects preterm and low-birth-weight infants and can lead to considerable morbidity and mortality. Mother's own milk is protective against NEC but is not always available. In such cases, donor human milk has also been shown to be protective (although to a lesser extent) compared with formula milk, but it is more expensive. This systematic review aimed at evaluating the cost of donor milk, the cost of treating NEC, and the cost-effectiveness of exclusive donor milk versus formula milk feeding to reduce the short-term health and treatment costs of NEC. MATERIALS AND METHODS We systematically searched five relevant databases to find studies with verifiable costs or charges of donor milk and/or treatment of NEC and any economic evaluations comparing exclusive donor milk with exclusive formula milk feeding. All search results were double screened. RESULTS Seven studies with verifiable donor milk costs and 17 with verifiable NEC treatment costs were included. The types of cost or charge included varied considerably across studies, so quantitative synthesis was not attempted. Estimates of the incremental length of stay associated with NEC were ∼18 days for medical NEC and 50 days for surgical NEC. Two studies claimed to report economic evaluations but did not do so in practice. CONCLUSIONS It is likely that donor milk provides short-term cost savings by reducing the incidence of NEC. Future studies should provide more details on cost components included and a full economic evaluation, including long-term outcomes, should be undertaken.
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Affiliation(s)
- Abigail Buckle
- Division of Health Sciences, University of Warwick , Coventry, United Kingdom
| | - Celia Taylor
- Division of Health Sciences, University of Warwick , Coventry, United Kingdom
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34
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LaPlante CD, Catanese MC, Bansal R, Vandenberg LN. Bisphenol S Alters the Lactating Mammary Gland and Nursing Behaviors in Mice Exposed During Pregnancy and Lactation. Endocrinology 2017; 158:3448-3461. [PMID: 28977596 PMCID: PMC5659700 DOI: 10.1210/en.2017-00437] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022]
Abstract
High doses of estrogenic pharmaceuticals were once prescribed to women to halt lactation. Yet, the effects of low-level xenoestrogens on lactation remain poorly studied. We investigated the effects of bisphenol S (BPS), an estrogen receptor (ER) agonist, on the lactating mammary gland; the arcuate nucleus, a region of the hypothalamus important for neuroendocrine control of lactational behaviors; and nursing behavior in CD-1 mice. Female mice were exposed to vehicle, 2 or 200 µg BPS/kg/d from pregnancy day 9 until lactational day (LD) 20, and tissues were collected on LD21. Tissues were also collected from a second group at LD2. BPS exposure significantly reduced the fraction of the mammary gland comprised of lobules, the milk-producing units, on LD21, but not LD2. BPS also altered expression of Esr1 and ERα in the mammary gland at LD21, consistent with early involution. In the arcuate nucleus, no changes were observed in expression of signal transducer and activator of transcription 5, a marker of prolactin signaling, or ERα, suggesting that BPS may act directly on the mammary gland. However, observations of nursing behavior collected during the lactational period revealed stage-specific effects on both pup and maternal nursing behaviors; BPS-treated dams spent significantly more time nursing later in the lactational period, and BPS-treated pups were less likely to initiate nursing. Pup growth and development were also stunted. These data indicate that low doses of BPS can alter lactational behaviors and the maternal mammary gland. Together, they support the hypothesis that pregnancy and lactation are sensitive to low-dose xenoestrogen exposures.
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Affiliation(s)
- Charlotte D. LaPlante
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts–Amherst, Amherst, Massachusetts 01003
| | - Mary C. Catanese
- Graduate Program in Neuroscience and Behavior, University of Massachusetts–Amherst, Amherst, Massachusetts 01003
| | - Ruby Bansal
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts–Amherst, Amherst, Massachusetts 01003
| | - Laura N. Vandenberg
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts–Amherst, Amherst, Massachusetts 01003
- Graduate Program in Neuroscience and Behavior, University of Massachusetts–Amherst, Amherst, Massachusetts 01003
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35
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Lima HK, Wagner-Gillespie M, Perrin MT, Fogleman AD. Bacteria and Bioactivity in Holder Pasteurized and Shelf-Stable Human Milk Products. Curr Dev Nutr 2017; 1:e001438. [PMID: 29955718 PMCID: PMC5998364 DOI: 10.3945/cdn.117.001438] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/17/2017] [Accepted: 08/01/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Historically, Holder pasteurization has been used to pasteurize donor human milk available in a hospital setting. There is extensive research that provides an overview of the impact of Holder pasteurization on bioactive components of human milk. A shelf-stable (SS) human milk product, created using retort processing, recently became available; however, to our knowledge, little has been published about the effect of retort processing on human milk. Objective: We aimed to assess the ability of retort processing to eliminate bacteria and to quantify the difference in lysozyme and secretory immunoglobulin A (sIgA) activity between Holder pasteurized (HP) and SS human milk. Methods: Milk samples from 60 mothers were pooled. From this pool, 36 samples were taken: 12 samples were kept raw, 12 samples were HP, and 12 samples were retort processed to create an SS product. All samples were analyzed for total aerobic bacteria, coliform bacteria, Bacillus cereus, sIgA activity, and lysozyme activity. Raw samples served as the control. Results: One raw sample and 3 HP samples contained B. cereus at the time of culture. There were no detectable bacteria in SS samples at the time of culture. Raw samples had significantly greater lysozyme and sIgA activity than HP and SS samples (P < 0.0001). HP samples retained significantly more lysozyme and sIgA activity (54% and 87%, respectively) than SS samples (0% and 11%, respectively). Conclusions: Human milk processed using Holder pasteurization should continue to be screened for the presence of B. cereus. Clinicians should be aware of the differences in the retention of lysozyme and sIgA activity in HP and SS products when making feeding decisions for medically fragile or immunocompromised infants to ensure that patients are receiving the maximum immune protection.
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Affiliation(s)
- Hope K Lima
- Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC
| | - Montana Wagner-Gillespie
- Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC
- WakeMed Mothers' Milk Bank, Cary, NC
| | - Maryanne T Perrin
- Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC
- Department of Nutrition, University of North Carolina, Greensboro, NC
| | - April D Fogleman
- Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC
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36
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Necrotizing enterocolitis: Battling an enigma. JAAPA 2017; 30:8-9. [PMID: 28682825 DOI: 10.1097/01.jaa.0000521145.55572.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Saleem B, Okogbule-Wonodi AC, Fasano A, Magder LS, Ravel J, Kapoor S, Viscardi RM. Intestinal Barrier Maturation in Very Low Birthweight Infants: Relationship to Feeding and Antibiotic Exposure. J Pediatr 2017; 183:31-36.e1. [PMID: 28159311 PMCID: PMC5367935 DOI: 10.1016/j.jpeds.2017.01.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To test the hypothesis that feeding and antibiotic exposures affect intestinal barrier maturation in preterm infants, we serially measured intestinal permeability (IP) biomarkers in infants <33 weeks gestation (gestational age [GA]) during the first 2 weeks of life. STUDY DESIGN Eligible infants <33 weeks GA were enrolled within 4 days of birth in a prospective study of IP biomarkers (NCT01756040). Study participants received the nonmetabolized sugars lactulose/rhamnose enterally on study days 1, 8, and 15 and lactulose/rhamnose were measured in urine by high-performance liquid chromatography. Serum zonulin and fecal alpha-1-anti-trypsin, 2 other IP markers, were measured by semiquantitative Western blot and ELISA, respectively. RESULTS In a cohort of 43 subjects, the lactulose/rhamnose ratio was increased on day 1 and decreased over 2 weeks, but remained higher in infants born at ≤28 weeks of gestation compared with IP in infants born at >28 weeks of gestation. Exclusive breastmilk feeding was associated with more rapid maturation in intestinal barrier function. A cluster analysis of 35 subjects who had urine samples from all time points revealed 3 IP patterns (cluster 1, normal maturation: n = 20 [57%]); cluster 2, decreased IP during the first week and subsequent substantial increase: n = 5 [14%]); and cluster 3, delayed maturation: n = 10 [29%]). There were trends toward more prolonged antibiotic exposure (P = .092) and delayed initiation of feeding ≥4 days (P = .064) in infants with abnormal IP patterns. CONCLUSIONS Intestinal barrier maturation in preterm infants is GA and postnatal age dependent, and is influenced by feeding with a maturational effect of breastmilk feeding and possibly by antibiotic exposures. TRIAL REGISTRATION ClinicalTrials.gov: NCT01756040.
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Affiliation(s)
- Bushra Saleem
- Departments of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | | | - Alessio Fasano
- MassGeneral Hospital for Children, Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Laurence S. Magder
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Jacques Ravel
- Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD,Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Shiv Kapoor
- Departments of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Rose M. Viscardi
- Departments of Pediatrics, University of Maryland School of Medicine, Baltimore, MD,Corresponding author (No reprints): Rose M. Viscardi, M.D., University of Maryland School of Medicine, 110 S. Paca Street, 8th Floor, Baltimore, MD 21201, Telephone: (410) 706-1913; Fax: (410) 706-0404;
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38
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Cacho NT, Parker LA, Neu J. Necrotizing Enterocolitis and Human Milk Feeding: A Systematic Review. Clin Perinatol 2017; 44:49-67. [PMID: 28159209 DOI: 10.1016/j.clp.2016.11.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article summarizes evidence regarding whether a donor human milk (DHM) and/or an exclusively human milk (EHM) diet decreases the incidence of necrotizing enterocolitis (NEC) and the dose of human milk (HM) necessary to reduce the risk of NEC in premature infants. Additional research regarding protection afforded by DHM and EHM is necessary as well as research elucidating the exact dose of HM necessary for NEC risk reduction. Research is also needed to determine whether there is a dose-dependent effect of DHM, a combination of mother's own milk and DHM, and an EHM diet on NEC incidence.
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Affiliation(s)
- Nicole Theresa Cacho
- Division of Neonatology, Department of Pediatrics, University of Florida, 1600 Southwest Archer Road, HD-118, Gainesville, FL 32610, USA.
| | - Leslie A Parker
- Biobehavioral Nursing Science, College of Nursing, University of Florida, PO Box 100187, HPNP 2227, Gainesville, FL 32610-0187, USA
| | - Josef Neu
- Division of Neonatology, Department of Pediatrics, University of Florida, 1600 Southwest Archer Road, HD-112, Gainesville, FL 32610, USA
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39
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Bartick MC, Jegier BJ, Green BD, Schwarz EB, Reinhold AG, Stuebe AM. Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs. J Pediatr 2017; 181:49-55.e6. [PMID: 27837954 DOI: 10.1016/j.jpeds.2016.10.028] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/20/2016] [Accepted: 10/07/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the disease burden and associated costs attributable to suboptimal breastfeeding rates among non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs). STUDY DESIGN Using current literature on associations between breastfeeding and health outcomes for 8 pediatric and 5 maternal diseases, we used Monte Carlo simulations to evaluate 2 hypothetical cohorts of US women followed from age 15 to 70 years and their infants followed from birth to age 20 years. Accounting for differences in parity, maternal age, and birth weights by race/ethnicity, we examined disease outcomes and costs using 2012 breastfeeding rates by race/ethnicity and outcomes that would be expected if 90% of infants were breastfed according to recommendations for exclusive and continued breastfeeding duration. RESULTS Suboptimal breastfeeding is associated with a greater burden of disease among NHB and Hispanic populations. Compared with a NHW population, a NHB population had 1.7 times the number of excess cases of acute otitis media attributable to suboptimal breastfeeding (95% CI 1.7-1.7), 3.3 times the number of excess cases of necrotizing enterocolitis (95% CI 2.9-3.7), and 2.2 times the number of excess child deaths (95% CI 1.6-2.8). Compared with a NHW population, a Hispanic population had 1.4 times the number of excess cases of gastrointestinal infection (95% CI 1.4-1.4) and 1.5 times the number of excess child deaths (95% CI 1.2-1.9). CONCLUSIONS Racial/ethnic disparities in breastfeeding have important social, economic, and health implications, assuming a causal relationship between breastfeeding and health outcomes.
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Affiliation(s)
- Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Briana J Jegier
- Department of Health Services Administration, D'Youville College, Buffalo, NY
| | - Brittany D Green
- Department of Operations Business Analytics and Information Systems, University of Cincinnati, Cincinnati, OH
| | | | | | - Alison M Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill, NC
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Abstract
Own mother's milk is the first choice in feeding preterm infants and provides multiple short- and long-term benefits. When it is unavailable, donor human milk is recommended as the first alternative. Donor milk undergoes processing (i.e. pasteurization) to reduce bacteriological and viral contaminants but influences its bioactive properties with potentially fewer benefits than raw milk. However, there is no clinical evidence of health benefit of raw compared to pasteurized human milk, and donor milk maintains documented advantages compared to formula. Nutrient content of donor and own mother's milk fails to meet the requirements of preterm infants. Adequate fortification is necessary to provide optimal growth. There are significant challenges in providing donor milk for premature infants; therefore, specific clinical guidelines for human milk banks and donor milk use in the neonatal intensive care unit should be applied and research should focus on innovative solutions to process human milk while preserving its immunological and nutritional components. In addition, milk banks are not the only instrument to collect, process and store donor milk but represent an excellent tool for breastfeeding promotion.
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41
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Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, Bogen DL, Schaefer AJ, Stuebe AM. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. MATERNAL & CHILD NUTRITION 2017; 13:e12366. [PMID: 27647492 PMCID: PMC6866210 DOI: 10.1111/mcn.12366] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/02/2016] [Accepted: 07/20/2016] [Indexed: 12/29/2022]
Abstract
The aim of this study was to quantify the excess cases of pediatric and maternal disease, death, and costs attributable to suboptimal breastfeeding rates in the United States. Using the current literature on the associations between breastfeeding and health outcomes for nine pediatric and five maternal diseases, we created Monte Carlo simulations modeling a hypothetical cohort of U.S. women followed from age 15 to age 70 years and their children from birth to age 20 years. We examined disease outcomes using (a) 2012 breastfeeding rates and (b) assuming that 90% of infants were breastfed according to medical recommendations. We measured annual excess cases, deaths, and associated costs, in 2014 dollars, using a 2% discount rate. Annual excess deaths attributable to suboptimal breastfeeding total 3,340 (95% confidence interval [1,886 to 4,785]), 78% of which are maternal due to myocardial infarction (n = 986), breast cancer (n = 838), and diabetes (n = 473). Excess pediatric deaths total 721, mostly due to Sudden Infant Death Syndrome (n = 492) and necrotizing enterocolitis (n = 190). Medical costs total $3.0 billion, 79% of which are maternal. Costs of premature death total $14.2 billion. The number of women needed to breastfeed as medically recommended to prevent an infant gastrointestinal infection is 0.8; acute otitis media, 3; hospitalization for lower respiratory tract infection, 95; maternal hypertension, 55; diabetes, 162; and myocardial infarction, 235. For every 597 women who optimally breastfeed, one maternal or child death is prevented. Policies to increase optimal breastfeeding could result in substantial public health gains. Breastfeeding has a larger impact on women's health than previously appreciated.
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Affiliation(s)
- Melissa C. Bartick
- Department of MedicineCambridge Health AllianceCambridgeMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | | | - Brittany D. Green
- Department of Operations Business Analytics and Information SystemsUniversity of CincinnatiCincinnatiOhio
| | - Briana J. Jegier
- Department of Health Services AdministrationD'Youville CollegeBuffaloNew York
| | | | - Tarah T. Colaizy
- Department of NeonatologyCarver College of Medicine, University of IowaIowaIowa
| | - Debra L. Bogen
- Department of PediatricsUniversity of PittsburghPittsburghPennsylvania
| | - Andrew J. Schaefer
- Department of Computational and Applied MathematicsRice UniversityHoustonTexas
| | - Alison M. Stuebe
- Department of Obstetrics and Gynecology, School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
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42
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Martin VJ, Leonard MM, Fiechtner L, Fasano A. Transitioning From Descriptive to Mechanistic Understanding of the Microbiome: The Need for a Prospective Longitudinal Approach to Predicting Disease. J Pediatr 2016; 179:240-248. [PMID: 27634626 PMCID: PMC5479769 DOI: 10.1016/j.jpeds.2016.08.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/15/2016] [Accepted: 08/16/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - Alessio Fasano
- Department of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA.
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43
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Underwood MA. Missed Opportunities: The Cost of Suboptimal Breast Milk Feeding in the Neonatal Intensive Care Unit. J Pediatr 2016; 175:12-4. [PMID: 27263402 DOI: 10.1016/j.jpeds.2016.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/05/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Mark A Underwood
- Division of Neonatology, UC Davis School of Medicine, Sacramento, California.
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