Feeding at the Breast and Expressed Milk Feeding: Associations with Otitis Media and Diarrhea in Infants

Protective Characteristics of Human Breast Milk on Early Childhood Otitis Media: A Narrative Review

Introduction: Human breast milk (HBM) contains a complex and dynamically changing variety of factors that contribute to the infant's developing immune system's ability to fight upper respiratory tract infections, including otitis media (OM). We sought to summarize the current evidence on the protective characteristics of HBM, through direct or donated feeding, toward early childhood OM. Methods: For this narrative review, we performed a literature search on OM in the context of HBM feeding in the PubMed, Embase, and Google Scholar databases, between January 1, 2008, and July 1, 2023. Results: Immunoglobulin A (IgA) provides a short-term immunity of 2-3 days against otopathogens causing OM. IgA-mediated immunity is effective against OM up to 7 months of age if breastfeeding continues. The role of transferred IgM and IgG in HBM is unclear. Although there is a potential protective value of microRNA, hormones, oligosaccharides, stem cells, and interleukins present in HBM, their role is unclear. Any duration of breastfeeding is superior to no breastfeeding in OM risk reduction, with a big variability among studies (odds ratio 0.23-0.81, depending on the duration). Duration of breastfeeding ≥6 months was found to be the most effective in OM risk reduction, but there was no evidence of continued benefits after 2 years of age. Expressed breastfeeding was not shown to be more beneficial. The protective values of donor HBM against OM are still undetermined. Conclusion: HBM has numerous components that contribute to protection against early childhood OM.

Fresh Parent's Own Milk for Preterm Infants: Barriers and Future Opportunities

While direct at-the-breast feeding is biologically optimal, Neonatal Intensive Care Unit (NICU) admission due to infant immaturity or illness often necessitates the expression and storage of parent's milk. The provision of freshly expressed (never stored) parent's own milk to preterm infants is not widely prioritized, and this article provides an exploration of NICU practices and their implications for feeding premature or ill infants with parent's own milk. In this article, we discuss the potential biological benefits of fresh parent's own milk, highlighting its dynamic components and the changes incurred during storage. Research suggests that fresh milk may offer health advantages over stored milk. The authors advocate for further research, emphasizing the need for standardized definitions. Research is needed on the biological impact of fresh milk, both short- and long-term, as well as defining and understanding healthcare economics when using fresh milk.

Experiences of expressed human milk feeding: A qualitative study

OBJECTIVE

The objective of this study was to understand and describe the breastfeeding experiences of Chinese women with a high proportion of expressed human milk feeding.

METHODS

A qualitative descriptive design was used to describe the usual practices of expressed human milk feeding among breastfeeding women. We conducted semi-structured, in-depth, one-to-one interviews with participants (N = 25) who had a high proportion of expressed human milk feeding. Thematic analysis was used to analyze the data.

RESULTS

We identified three main themes: a sense of control, a sense of security, and milk expression challenges. Participants described that expressed human milk feeding provided a greater sense of control over their time and provided more freedom as they were no longer restricted by their infant's feeding schedule. Furthermore, knowing the amount of milk and having a stored milk supply provided a sense of security. However, providing expressed human milk can be time-consuming and has a lower intimacy level when compared with direct breastfeeding.

CONCLUSION

Expressed human milk feeding can provide a greater sense of control and was used as an immediate solution to direct breastfeeding problems. However, some participants experienced challenges in expressed human milk feeding, and some preferred breastfeed directly. Therefore, it is crucial to strengthen the breastfeeding support provided in the early postpartum period to ensure that all breastfeeding persons can breastfeed directly.

Beyond ingredients: Supramolecular structure of lipid droplets in infant formula affects metabolic and brain function in mouse models

Human milk beneficially affects infant growth and brain development. The supramolecular structure of lipid globules in human milk i.e., large lipid globules covered by the milk fat globule membrane, is believed to contribute to this effect, in addition to the supply of functional ingredients. Three preclinical (mouse) experiments were performed to study the effects of infant formula mimicking the supramolecular structure of human milk lipid globules on brain and metabolic health outcomes. From postnatal day 16 to 42, mouse offspring were exposed to a diet containing infant formula with large, phospholipid-coated lipid droplets (structure, STR) or infant formula with the same ingredients but lacking the unique structural properties as observed in human milk (ingredient, ING). Subsequently, in Study 1, the fatty acid composition in liver and brain membranes was measured, and expression of hippocampal molecular markers were analyzed. In Study 2 and 3 adult (Western-style diet-induced) body fat accumulation and cognitive function were evaluated. Animals exposed to STR compared to ING showed improved omega-3 fatty acid accumulation in liver and brain, and higher expression of brain myelin-associated glycoprotein. Early exposure to STR reduced fat mass accumulation in adulthood; the effect was more pronounced in animals exposed to a Western-style diet. Additionally, mice exposed to STR demonstrated better memory performance later in life. In conclusion, early life exposure to infant formula containing large, phospholipid-coated lipid droplets, that are closer to the supramolecular structure of lipid globules in human milk, positively affects adult brain and metabolic health outcomes in pre-clinical animal models.

Disability and in-hospital breastfeeding practices and supports in Ontario, Canada: a population-based study

BACKGROUND

Breastfeeding provides infants with nutrients required for optimal growth and development. We aimed to examine breastfeeding practices and supports that promote exclusive breastfeeding during the birth hospital stay among birthing parents with physical disabilities, sensory disabilities, intellectual or developmental disabilities, and multiple disabilities compared with those without a disability.

METHODS

This population-based cohort study was done in Ontario, Canada. We accessed and analysed health administrative data from ICES and the Better Outcomes Registry & Network. We included all birthing parents aged 15-49 years who had a singleton livebirth between April 1, 2012, and March 31, 2018. The study outcomes were breastfeeding practices and supports that promoted exclusive breastfeeding during the birth hospital stay, conceptualised based on WHO-UNICEF Baby Friendly Hospital Initiative guidelines. Individuals with a physical disability, sensory disability, intellectual or developmental disability, or two or more (multiple) disabilities, identified using diagnostic algorithms, were compared with individuals without disabilities on the opportunity to initiate breastfeeding, in-hospital breastfeeding, exclusive breastfeeding at hospital discharge, skin-to-skin contact, and provision of breastfeeding assistance. Relative risks (RRs) were estimated using modified Poisson regression.

FINDINGS

Our cohort included 634 111 birthing parents, of whom 54 476 (8·6%) had a physical disability, 19 227 (3·0%) had a sensory disability, 1048 (0·2%) had an intellectual or developmental disability, 4050 (0·6%) had multiple disabilities, and 555 310 (87·6%) had no disability. Individuals with intellectual or developmental disabilities were less likely than those without a disability to have an opportunity to initiate breastfeeding (adjusted RR 0·82, 95% CI 0·76-0·88), any in-hospital breastfeeding (0·85, 0·81-0·88), exclusive breastfeeding at hospital discharge (0·73, 0·67-0·79), skin-to-skin contact (0·90, 0·87-0·94), and breastfeeding assistance (0·85, 0·79-0·91). Those with multiple disabilities were less likely to have an opportunity to initiate breastfeeding (0·93, 0·91-0·96), any in-hospital breastfeeding (0·93, 0·92-0·95), exclusive breastfeeding at hospital discharge (0·90, 0·87-0·93), skin-to-skin contact (0·93, 0·91-0·95), and breastfeeding assistance (0·95, 0·92-0·98). Differences for individuals with a physical or sensory disability only were mostly non-significant.

INTERPRETATION

Our findings show disparities in breastfeeding outcomes between individuals without a disability and individuals with intellectual or developmental disabilities or multiple disabilities, but not individuals with physical or sensory disabilities. There is a need for further research on the factors that contribute to breastfeeding intentions, practices, and supports in people with intellectual or developmental disabilities and multiple disabilities, especially factors that affect breastfeeding decision making.

FUNDING

National Institutes of Health and the Canada Research Chairs Program.

Exclusive breastmilk pumping: A concept analysis

AIM

To analyze and examine the concept of exclusive breast pumping (EP).

BACKGROUND

Breastmilk is the ideal nutrition for infants, yet when breastfeeding is unsuccessful, parents resort to informal breastmilk sharing, artificial formula feeding, or EP. A growing proportion of families exclusively pump yet they often receive guidance from social media rather than healthcare providers because healthcare providers are uninformed about this feeding method.

DATA SOURCE

Cumulative Index of Nursing and Allied Health Literature, PubMed, and Google Scholar databases were searched using the following keywords: human milk express*, breast express*, breast milk express, breastmilk express*, exclusive pump, exclusive breast pumping, and exclusive expression.

REVIEW METHODS

Concept analysis design using Walker and Avant's method.

RESULTS

Three defining attributes of (1) absence of direct breastfeeding, (2) breastmilk expression, (3) and an enduring infant feeding pattern of feeding expressed breastmilk only via a bottle were identified. All three attributes are required to confirm the presence of the concept of exclusive pumping. Definitions, antecedents, consequences, and empirical referents are described. Model and contrary cases are discussed.

CONCLUSION

This exclusive pumping concept analysis allows for consistency in terminology in practice and research. EP is a feeding method which can increase the proportion of infants who are fed breastmilk and may reduce the risks that arise from artificial formula feeding.

Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months

OBJECTIVE

To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States.

DESIGN

A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019.

PARTICIPANTS

We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion.

MEASUREMENTS

The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences.

RESULTS

Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]).

CONCLUSION

Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.

Breastfeeding initiation and duration and acute otitis media among children less than two years of age in Jordan: results from a case-control study

BACKGROUND

Acute otitis media (AOM) is one of the most common infectious diseases that affects children. Breastfeeding has been linked to a lower risk of AOM in the first three years of childhood. The aim of this study was to identify the association between exclusive breastfeeding and the development of acute otitis media (AOM) and investigate the influence of breastfeeding duration on the presence of AOM.

METHODS

In a retrospective case-control study, a sample of 98 children (cases) who were diagnosed with AOM and 98 children (controls) who were not diagnosed with AOM and were younger than two years old were selected from the Jordan University Hospital. Medical records were used to identify children with AOM. For both the case and control groups, the children's mothers completed a self-administered questionnaire about factors linked to the incidence of AOM.The type of feeding and the duration of breastfeeding were assessed using a validated questionnaire.

RESULTS

The data indicated that among children who developed AOM, 23.5%were artificiallyfed, while 22.4% and 13.3% were exclusively breastfed for 3 months and 6 months, respectively. Approximately 70.7% of the children without AOM were exclusively breastfed for 6 months, compared with only 29.3% of the children without AOM who were exclusively breastfed for 3 months.Logistic regression revealed that nonexclusive breastfeeding, exclusive breastfeeding for 3 months, and exclusive breastfeeding for 6 months were protective factors against AOM (OR = 0.23, 0.18, and 0.25, respectively; P < 0.05). A short duration of exclusive breastfeeding was considered a risk factor for the development of AOM (OR = 1.7, P < 0.05).

CONCLUSIONS

The escalation of AOM is tightly connected to the early introduction of formula feeding in the first six months of life. Breastfeeding had a protective impact on the occurrence of AOM. Understanding factors that are associated with the occurrence of AOM in children may support the role of public health institutions and primary health care in the prevention and reduction of AOM episodes and the need for national health strategies to promote breastfeeding.

Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada

OBJECTIVES

To examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months.

DESIGN

Pooled data from two prospective cohort studies SETTING: Three Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada.

PARTICIPANTS

337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum.

EXCLUSIONS

pregnancy loss or participation in prior related study; Study B: preterm birth (<34 weeks); plan to move outside Toronto; not intending to feed human milk; hospitalisation of mother or baby at 2 weeks postpartum.

PRIMARY AND SECONDARY OUTCOME MEASURES

Main exposure variable: any use of expressed human milk at 2 weeks postpartum.

OUTCOMES

cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum.

RESULTS

All participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84).

TRIAL REGISTRATION NUMBERS

NCT03400605, NCT03589963.

Neonatal Adverse Events' Trigger Tool Setup With Random Forest

OBJECTIVE

This study aimed to develop a trigger tool for detection of neonatal adverse events (AEs) and to validate its effectiveness.

STUDY DESIGN

Random forest (RF) algorithm was used to build the predictive model by analyzing data from the medical records of 782 neonates in our previous study. Thirteen variables for each patient were used to predict neonatal AEs. Next, the critical variables were selected based on recursive elimination of variables to form the list of triggers. Then, a trigger tool with those triggers was established and tested by reviewing medical records. The positive predictive value of individual triggers and of the entire tool was evaluated.

RESULTS

Data from 782 neonates, including 297 patients with and 485 patients without AEs, were collected to build the original RF model. Then, the 6 most important variables, including diarrhea, antibiotic use, fever, death, skin damage, and suspected necrotizing enterocolitis, were selected to establish a neonate-focused trigger tool. The forest with the 6 variables predicted AEs with a sensitivity of 70.7%, a specificity of 92.0%, and an error rate of 16.1%. In a validation study of the trigger tool, 655 neonates with birth weights ≥1500 g were enrolled, and review of their medical records revealed 1709 triggers and 1172 unique AEs. The 3 most common AEs identified were skin damage, iatrogenic diarrhea, and environmental factor-related fever. The total positive predictive value of the trigger tool was 0.686.

CONCLUSIONS

The neonate-focused trigger tool developed using the RF algorithm efficiently and reliably identifies AEs among hospitalized neonates with birth weights ≥1500 g.

Association of Infant Feeding Methods and Excess Weight from Birth to Age 6

Objective: To examine the associations between human milk feeding method (at the breast versus bottle) and measures of child adiposity during the first 6 years of life. Study Design: Women 12 months' postpartum who delivered a singleton, liveborn infant at >24 weeks gestation completed a survey assessing infant feeding methods and sociodemographics. Mothers were recontacted when the child was 6 years old for a follow-up study assessing growth (N = 269). Children were categorized as ever or never having excess weight using weight-for-age z-scores (WAZ), weight-for-height z-scores (WHZ), and body mass index-for-age z-scores (BMIZ) from birth to 6 years. Modified Poisson regression estimated associations between the duration of each feeding method (exclusive and combined) with excess weight status. Mixed-effect models estimated associations between feeding methods and trajectories of the outcomes. Results: For all feeding practices, increasing duration (in months) was unassociated with the risk of ever having excess weight by age 6 years. Based on mixed models, longer duration of feeding human milk by any method was associated with lower BMIZ (adj β for 6-12 months versus 0-3 months = -0.50, 95% CI: -0.99 to -0.01) and also with the shape of the BMIZ trajectory curve. No other associations between feeding methods and excess weight outcomes were observed. Conclusions: Longer duration of feeding human milk was associated with lower average BMIZ in early childhood but feeding at the breast and feeding expressed milk were not clearly associated with the outcomes when considered separately. Larger studies would help clarify the associations between these specific feeding methods and outcomes. IRB17-00876.

Human Milk for the Term Newborn

Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity.

Effect of digestion on stability of palivizumab IgG1 in the infant gastrointestinal tract

BACKGROUND

Potentially, orally administered antibodies specific to enteric pathogens could be administered to infants to prevent diarrheal infections, particularly in developing countries where diarrhea is a major problem. However, to prevent infection, such antibodies would need to resist degradation within the gastrointestinal tract.

METHODS

Palivizumab, a recombinant antibody specific to respiratory syncytial virus (RSV), was used in this study as a model for examining the digestion of neutralizing antibodies to enteric pathogens in infants. The survival of this recombinant IgG1 across digestion in 11 infants was assayed via an anti-idiotype ELISA and RSV F protein-specific ELISA. Concentrations were controlled for any dilution or concentration that occurred in the digestive system using mass spectrometry-based quantification of co-administered, orally supplemented, indigestible polyethylene glycol (PEG-28).

RESULTS

Binding activity of Palivizumab IgG1 decreased (26-99%) across each phase of in vivo digestion as measured by both anti-idiotype and RSV F protein-specific ELISAs.

CONCLUSION

Antibodies generated for passive protection of the infant gastrointestinal tract from pathogens will need to be more resistant to digestion than the model antibody fed to infants in this study, or provided in higher doses to be most effective.

IMPACT

Binding activity of palivizumab IgG1 decreased (26-99%) across each phase of in vivo infant digestion as measured by both anti-idiotype and RSV F protein-specific ELISAs. Palivizumab was likely degraded by proteases and changes in pH introduced in the gut. Antibodies generated for passive protection of the infant gastrointestinal tract from pathogens will need to be more resistant to digestion than the model antibody fed to infants in this study, or provided in higher doses to be most effective. The monoclonal antibody IgG1 tested was not stable across the infant gastrointestinal tract. The observation of palivizumab reduction was unlikely due to dilution in the gastrointestinal tract. The results of this work hint that provision of antibody could be effective in preventing enteric pathogen infection in infants. Orally delivered recombinant antibodies will need to either be dosed at high levels to compensate for digestive losses or be engineered to better resist digestion. Provision of enteric pathogen-specific recombinant antibodies to at-risk infants could provide a new and previously unexplored pathway to reducing the infection in infants. The strategy of enteric recombinant antibodies deserves more investigation throughout medicine as a novel means for treatment of enteric disease targets.

Infant Feeding Practices During the First Postnatal Year and Risk of Asthma and Allergic Disease During the First 6 Years of Life

Background: Breastfeeding may protect against childhood asthma and allergic diseases. Studies have not focused on the mode of feeding human milk and followed children to school age although feeding human milk from a bottle rather than the breast may alter the risk of disease. Materials and Methods: At 12 months' postpartum, women in the Moms2Moms study (Columbus, OH) completed a survey assessing sociodemographic and infant feeding behaviors. At 6 years' postpartum, they completed a survey and pediatric medical records were abstracted to assess asthma and allergic disease diagnoses. Logistic regression models were used to estimate associations between infant feeding behaviors and asthma or allergic disease. Results: Of 285 children, 16% had asthma and 44% ever had ≥1 allergy diagnosis. Longer durations of each infant feeding behavior were not clearly associated with increased odds of asthma or allergic disease by age 6. Results suggested that longer durations of breast milk feeding (regardless of the mode of feeding) may be related to a lower risk of food allergy (e.g., odds ratio [OR]1-month, adjusted = 0.96, 95% confidence interval [CI] = 0.87-1.05; OR12-month, adjusted = 0.57, 95% CI = 0.19-1.74), but that the mode of feeding (regardless of the substance fed) may be more meaningful for environmental allergies (e.g., exclusive direct breast milk feeding OR12-month, adjusted = 0.32, 95% CI = 0.06-1.81). However, effect estimates were imprecise and CIs included the null. Conclusions: Although no clear associations between mode of breast milk feeding (breast versus expressed) and asthma and allergy outcomes were observed, future research with larger samples should further evaluate these associations.

Feeding Infants at the Breast or Feeding Expressed Human Milk: Long-Term Cognitive, Executive Function, and Eating Behavior Outcomes at Age 6 Years

OBJECTIVE

To examine how expressed milk feeding diverges from feeding at the breast in its association with neurodevelopment and behavior. We hypothesized that longer and exclusive feeding at the breast only (ie, no formula, no feeding expressed milk) would be associated with the optimal cognitive developmental, executive function, and eating behaviors and that expressed milk feeding would be associated with less-optimal outcomes.

STUDY DESIGN

The Moms2Moms cohort (Ohio, US) reported infant feeding practices at 12 months postpartum and children's global cognitive ability, executive function, and eating behaviors at 6 years. Linear and log-binomial regression models estimated associations with durations of feeding at the breast, expressed milk, human milk (modes combined), and formula.

RESULTS

Among 285 participants, each month of exclusive feeding at the breast only was associated with a decreased risk of clinically meaningful executive function (working memory) deficit (adjusted relative risk [RR] 0.78, 95% CI 0.63-0.96) but was unassociated with inhibition (adjusted RR 0.92, 95% CI 0.85-1.01). Feeding expressed milk was not clearly related to executive function outcomes. No associations with global cognitive ability were observed. Weak associations were observed with eating behaviors for some feeding practices.

CONCLUSIONS

Feeding at the breast may offer advantages to some aspects of executive function that expressed milk may not. Large, prospective studies exploring mechanisms could further distinguish the effect of feeding mode from that of nutrients.

Breast milk contains probiotics with anti-infantile diarrhoea effects that may protect infants as they change to solid foods

Infants often experience complementary food-induced diarrhoea (CFID), which occurs when infants switch from breast milk to solid foods. The relative abundances of Prevotella and Rothia were higher in stools of infants with CFID, while the relative abundances of Enterococcus and Escherichia were higher in healthy infants. The abundance of Lactobacillus spp. normally found in breast milk fed to infants with CFID was significantly reduced, and Enterococcus spp. were less abundant when diarrhoea occurred. Furthermore, Lactobacillus and Enterococcus were present as shared bacteria in both mother and infant, and they were considered potential anti-CFID probiotics as their relative abundances in breast milk were negatively correlated to infant CFID. Kyoto encyclopedia of genes and genomes (KEGG) functional analysis showed that the function of amino acid metabolism differed between infants with CFID and healthy infants. Therefore, CFID might be related to the decomposition of proteins in food supplements. The screening revealed seven hydrolytic casein and five hydrolytic casein and rice protein isolates from 320 suspected Lactobacillus and Enterococcus isolates. The animal experiments demonstrated that a mixture of five isolates effectively hydrolysed the casein and rice protein and prevented diarrhoea in young rats. Thus, the occurrence of CFID was found to be closely related to the intestinal and breast milk microbiota, and bacteria that could assist in the digestion of cereal proteins were involved in CFID.

Breastfeeding results in better hearing in newborns compared to bottle-feeding

BACKGROUND AND AIM

Transient evoked otoacoustic emissions (TEOAEs) are a validated technique in newborn hearing screening that is regularly used in many countries. It reflects normal hearing or at least no more than 30 dB HL hearing loss. Breastfeeding has many advantages and some studies have demonstrated that it prevents otitis media by means of opening the Eustachian tube and clearing mucus in the middle ear which is perhaps also combined with immunological effects. A few studies have related how newborn feeding can vary the pass rate to TEOAE. The goal of this study was to investigate the relationship between newborn feeding and TEOAE newborn hearing screening results.

METHODS

Data were retrospectively collected from healthy vaginally delivered newborns of gestational age >37 weeks and body weight > 2.5 kg at the maternity ward. Newborn feeding history was compared with the pass rate to TEOAE performed within the 1st 48 h of life.

RESULTS

The study group included 12,866 newborns. In this group, significant differences were found based on the feeding method (breastfeeding was found to be better than formula, P<0.0001).

CONCLUSIONS

Breastfeeding improves newborn hearing screening results with TEOAE.

RELEVANCE FOR PATIENTS

Lies in the fact that breastfed children respond better to the test and need to repeat it fewer times, avoiding problems such as loss to follow-up and additional work.

Associations between infant and young child feeding practices and acute respiratory infection and diarrhoea in Ethiopia: A propensity score matching approach

BACKGROUND

Acute respiratory infection (ARI) and diarrhoea are the leading causes of childhood morbidity and mortality in Ethiopia. Understanding the associations between infant and young child feeding (IYCF) and ARI and diarrhoea can inform IYCF policy interventions and advocacy in Ethiopia. This study aimed to investigate the relationship between IYCF practices and ARI and diarrhoea in Ethiopian children.

METHODS

This study used the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037), and 2016 (n = 3861). The association between IYCF practices and (i) ARI and (ii) diarrhoea were investigated using propensity score matching and multivariable logistic regression models. The IYCF practices include early initiation of breastfeeding, exclusive breastfeeding (EBF), predominant breastfeeding, introduction of complementary foods, continued breastfeeding at two years and bottle feeding.

RESULTS

Infants and young children who were breastfed within 1-hour of birth and those who were exclusively breastfed had a lower prevalence of ARI. Infants who were exclusively and predominantly breastfed had a lower prevalence of diarrhoea. Early initiation of breastfeeding (Odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.72, 0.92) and EBF (OR: 0.65; 95% CI: 0.51, 0.83) were associated with lower risk of ARI. Bottle-fed children had higher odds of ARI (OR: 1.36; 95% CI: 1.10, 1.68). Early initiation of breastfeeding and EBF were associated with lower odds of diarrhoea (OR: 0.88; 95% CI: 0.79, 0.94 for Early initiation of breastfeeding and OR: 0.51; 95% CI: 0.39, 0.65 for EBF). Infants who were predominantly breastfed were less likely to experience diarrhoea (OR: 0.69; 95% CI: 0.53, 0.89).

CONCLUSION

The recommended best practices for preventing ARI and diarrhoeal diseases in infants and young children namely: the early initiation of breastfeeding, EBF and avoidance of bottle feeding should be institutionalized and scale-up in Ethiopia as part of implementation science approach to cover the know-do-gaps.

Reliability of Maternal Recall of Feeding at the Breast and Breast Milk Expression 6 Years After Delivery

Background: The reliability of long-term maternal recall of breastfeeding has been assessed previously, but not maternal milk expression (pumping) and child consumption of expressed milk. Objective: To examine the reliability of maternal recall of feeding at the breast, maternal milk expression, and child consumption of expressed milk 6 years after delivery using the Brief Breastfeeding and Milk Expression Recall Survey (BaByMERS). Methods: At 12 months postpartum, women who delivered a singleton, live-born infant at >24 weeks of gestation at a major U.S. academic hospital completed BaByMERS. Five years later, they were recontacted to complete the same questionnaire. Kappa statistics (κ), intraclass correlation coefficient (ICC), and Bland/Altman plots examined agreement. Sociodemographics were examined through stratified comparisons. Results: Of 299 women who completed both questionnaires, 35% had a postgraduate education and 82% identified as white/Caucasian. Kappa statistics showed substantial agreement for ever breastfeeding or feeding breast milk (combined) (κ = 0.71, 95% confidence interval [CI]: 0.44-0.98) and ever feeding at the breast (κ = 0.76, 95% CI: 0.62-0.89). Recall for duration of feeding at the breast was excellent (ICC = 0.96, 95% CI: 0.95-0.97), and of maternal milk expression was slightly less so (ICC = 0.83, 95% CI: 0.80-0.97). Maternal minority race/ethnicity, lower educational attainment, unmarried marital status, public/no health insurance, and smoking were associated with lower reliability; these differences were usually small and not consistent across all feeding practices. Conclusions: Maternal recall of contemporary lactation and infant feeding using BaByMERS was strongly reliable 6 years after delivery. BaByMERS may be useful to collect recall data, with attention to subpopulations that may exhibit lower recall reliability.

Breast Milk Feeding Practices and Barriers and Supports Experienced by Mother–Infant Dyads With Cleft Lip and/or Palate

Objective:

To examine trends in breast milk provision and to characterize the breast milk feeding practices experienced by mother–infant dyads with cleft lip and/or palate (CL/P) in a large US sample.

Design:

Cross-sectional study.

Methods:

An online survey was distributed through cleft-related social media sites in the United States and in a single cleft lip and palate clinic. Statistical analyses included Kruskal-Wallis H tests and post hoc Mann-Whitney tests to examine group differences based on cleft type and prenatal versus postnatal cleft diagnosis. Linear regression was used to estimate associations between obtained variables.

Participants:

One hundred fifty biological mothers of infants (8-14 months of age) with CL/P (15% cleft lip, 29% cleft palate, 56% cleft lip and palate).

Results:

Forty-six percent of mothers of infants with CL/P provided breast milk to their infant for at least 6 months. Five percent of infants ever fed at breast, and 43% received pumped breast milk via bottle. The most commonly reported supports included lactation consultants, nurses, feeding therapists, and online support groups. Feeding therapy was received by 48% of infants.

Conclusions:

A lower percentage of mothers of infants with CL/P reported providing breast milk compared to national estimates of the general population of infants without clefting. Results suggested there are multiple barriers, as well as numerous medical and psychosocial supports that facilitated breast milk feeding success. Implications for care are discussed.

Improved Estimation of Breastfeeding Rates Using a Novel Breastfeeding and Milk Expression Survey

Background: Increasing the proportion of infants who are breastfed and extending breastfeeding duration are high-priority U.S. goals. Evaluation of progress is based on federal survey data, but federal survey questions do not reflect contemporary feeding practices. Materials and Methods: Our objective was to evaluate the Brief Breastfeeding and Milk Expression Recall Survey (BaByMERS) in estimating breast milk feeding and milk expression practices and compare to estimates from simultaneously administered federal survey questions. We surveyed women with child(ren) younger than the age of 6 years attending a large children's hospital for urgent or primary care. We estimated the proportions who participated in various breast milk feeding and milk expression practices and the durations of each and examined agreement between the surveys. We compared respondents with high versus low disagreement using log-binomial regression. Results: Of 225 respondents, 51% had less than a Bachelor's degree, and 44% identified as a race other than white. Similar proportions on each survey reported ever having breastfed or fed breast milk (84%). Proportions still breastfeeding or feeding breast milk at 6 and 12 months differed slightly by survey. Dyads (9%) who fed at the breast and fed expressed milk for nonidentical periods had estimates for the duration of breastfeeding or feeding breast milk that were lower per the federal survey. Respondents who answered the federal survey before the BaByMERS were more likely to provide discrepant responses (risk ratio = 3.40, 95% confidence interval: 1.18-9.80). Conclusions: This study offers further validation of brief interviewer-administered questions to collect quality data recalled about infant feeding and lactation for research purposes.

Childhood otitis media: Relationship with daycare attendance, harsh parenting, and maternal mental health

Psychological stress has been linked to developmental problems and poor health in children, but it is unclear whether it is also related to otitis media (OM). As part of a long-term study surveying the characteristics of childcare and development in Taiwan, we analyzed the relationship between OM and sources of psychological stress in children, such as poor maternal mental health and harsh parental discipline. We analyzed the data of 1998 children from the "Kids in Taiwan: National Longitudinal Study of Child Development & Care (KIT) Project" at the age of 3 years. Using bivariate and multivariate logistic regression models, we tested several risk factors as potential independent predictors of two outcomes: parent-reported incidence of OM and child health. The proportion of children who had developed OM in the first 3 years of their life was 12.5%. Daycare attendance (odds ratio [OR]: 1.475; 95% confidence interval [CI]: 1.063-2.046), poor maternal mental health (OR: 1.913; 95% CI: 1.315-2.784), and harsh parental discipline (OR: 1.091; 95% CI: 1.025-1.161) correlated with parent-reported occurrence of OM. These findings suggest that providing psychosocial support to both parents and children might be a novel strategy for preventing OM.

Comparing Alternative Breast Milk Feeding Questions to U.S. Breastfeeding Surveillance Questions

Background: Most mothers in the United States express their milk, which is then bottle fed to their infants. The National Immunization Survey (NIS), used to report national breastfeeding prevalence, asks about infant breast milk consumption, regardless of whether it is consumed at the mother's breast or from a bottle. The NIS data are often erroneously interpreted, however, to mean prevalence of at-the-breast feeding. We hypothesized that over half of infants classified as breastfed at 3, 6, and 12 months by the NIS questions would also be consuming expressed breast milk. Materials and Methods: A convenience sample of 456 mothers of infants 19-35 months of age recruited through ResearchMatch.org completed an online infant-feeding questionnaire. The questionnaire included both the NIS questions and more-detailed questions about feeding mode, distinguishing between at-the-breast and bottle. Results: Based on responses of our sample to the NIS questions, it could be interpreted that 74%, 64%, and 39% of mother-infant dyads were at-the-breast feeding at 3, 6, and 12 months, respectively. However, at each time point, most infants consumed at least some breast milk from a bottle. As infants got older, the proportion of breast milk consumed from a bottle increased. Conclusions: In this U.S. sample, the predominant breast milk feeding style involves both at-the-breast and expressed breast milk feeding. Future research and national surveillance should consider including separate measures of maternal breast milk expression and infant consumption of expressed breast milk to enable meaningful exploration of maternal and infant outcomes associated with these asynchronous behaviors.

Risk of childhood otitis media with focus on potentially modifiable factors: A Danish follow-up cohort study

INTRODUCTION

Otitis media is the primary cause of antibiotic prescription in children. Two-thirds of all children experience at least one episode of otitis media before the age of 7 years. The aim of this study was to characterise the attributable effect of several modifiable risk exposures on the risk of >3 episodes of otitis media at age 18 months and 7 years within a large prospective national birth cohort.

METHODS

The study used the Danish National Birth Cohort comprising information about otitis media and risk exposures from more than 50,000 mother-child pairs from the period 1996-2002. Logistic regression models were used to estimate odds ratios for the risk factors and to calculate the population attributable fraction.

RESULTS

Short time with breastfeeding, early introduction to daycare, cesarean section, and low compliance to the national vaccination program were all associated with an increased risk of >3 episodes of otitis media at 18 months of age and at 7 years of age. The fraction of children with otitis media attributed from breastfeeding lasting for less than 6 months was 10%. Introduction to daycare before the age of 12 months attributed with 20% of the cases of >3 episodes of otitis media.

CONCLUSIONS

Short duration of breastfeeding, early introduction into daycare, cesarean section, and low compliance with the national vaccination program increased the risk of experiencing >3 episodes of otitis media at 18 months, and at 7 years of age. These are factors that all can be modulated.

Factors affecting the outcome of adenoidectomy in children treated for chronic otitis media with effusion

OBJECTIVE

The aim of this cohort was to determine potential risk factors, concerning the effectiveness of adenoidectomy in the treatment of chronic otitis media with effusion in children.

METHODS

Ninety six children with chronic otitis media with effusion treated with adenoidectomy were enrolled in this study. A thorough medical history was taken, including family history of otologic disease, parental smoking habits and breast feeding history. Radiographic palatal airway size was measured preoperatively, whereas the presence of allergy was also investigated. All patients were, postoperatively, followed up for a period of two years, in three month intervals. Disease course was classified as "complete remission", "improvement" or "consistence", in every postoperative evaluation, according to strictly established criteria.

RESULTS

Children's age proved to be a significant factor in the postoperative outcome of adenoidectomy, as a treatment of chronic otitis media with effusion, especially when comparing patients being over and under the fifth year of age. Also, the presence of allergy, family history of otologic disease and palatal airway size, all proved to influence postoperative outcome in a statistical significant way (p<0.05). On the other hand, child's sex, passive smoking, breast feeding and previous acute otitis media infections did not seem to alter the efficacy of adenoidectomy.

CONCLUSION

Adenoidectomy remains a cornerstone in the treatment of chronic otitis media with effusion in children. Results document that young age, presence of allergy predisposition, otologic family history and small palatal airway can be important drawbacks and should be intensively sought for and taken into account, during treatment planning.

Cognitive Testing of the Brief Breastfeeding and Milk Expression Recall Survey

BACKGROUND

Major U.S. federal maternal and child health surveys collect an infant feeding history for children under 6 years of age using survey questions that have changed little over decades. Yet, infant feeding and lactation practices have changed with the increasing popularity of milk expression (pumping).

SUBJECTS AND METHODS

Cognitive interviews were conducted to test the 9-item Brief Breastfeeding and Milk Expression Recall Survey (BaByMERS) with a diverse sample of 15 U.S. mothers of children 1-5 years of age. A 42-item coding scheme was applied to identify interviewer and respondent problems in fielding and answering the questions. Problems were examined in relation to demographics and infant feeding and lactation history.

RESULTS

The extent of problems was modest. Of 42 possible problem codes, only 9 were identified as actual problems for one or more respondents on one or more questions. The most common problems involved uncertainty about the timing of when one started expressing milk, making a mental shift to realize that maternal milk expression and the child's consumption of that milk could be distinct concepts, and difficulty with certain terms or phrases. Problems tended to arise among mothers with more complex infant feeding or lactation histories, who also tended to be those with higher levels of education.

CONCLUSIONS

BaByMERS is a promising, brief tool for collecting a recalled infant feeding or lactation history among mothers with young children. Future research can evaluate additional characteristics of the tool to further confirm its utility for large epidemiological studies of maternal and child health.

Modes of Infant Feeding and the Risk of Childhood Asthma: A Prospective Birth Cohort Study

OBJECTIVE

To determine whether different modes of infant feeding are associated with childhood asthma, including differentiating between direct breastfeeding and expressed breast milk.

STUDY DESIGN

We studied 3296 children in the Canadian Healthy Infant Longitudinal Development birth cohort. The primary exposure was infant feeding mode at 3 months, reported by mothers and categorized as direct breastfeeding only, breastfeeding with some expressed breast milk, breast milk and formula, or formula only. The primary outcome was asthma at 3 years of age, diagnosed by trained healthcare professionals.

RESULTS

At 3 months of age, the distribution of feeding modes was 27% direct breastfeeding, 32% breastfeeding with some expressed breast milk, 26% breast milk and formula, and 15% formula only. At 3 years of age, 12% of children were diagnosed with possible or probable asthma. Compared with direct breastfeeding, any other mode of infant feeding was associated with an increased risk of asthma. These associations persisted after adjusting for maternal asthma, ethnicity, method of birth, infant sex, gestational age, and daycare attendance (some expressed breast milk: aOR, 1.64, 95% CI, 1.12-2.39; breast milk and formula, aOR, 1.73, 95% CI, 1.17-2.57; formula only: aOR, 2.14, 95% CI, 1.37-3.35). Results were similar after further adjustment for total breastfeeding duration and respiratory infections.

CONCLUSIONS

Modes of infant feeding are associated with asthma development. Direct breastfeeding is most protective compared with formula feeding; indirect breast milk confers intermediate protection. Policies that facilitate and promote direct breastfeeding could have impact on the primary prevention of asthma.

The Effect of Breastfeeding on Childhood Otitis Media

PURPOSE OF REVIEW

The purpose of this review is to summarize the literature regarding the association between breastfeeding and childhood otitis media (OM), with focus on the literature published within the past 5 years. The review comprises original articles and recent reviews.

RECENT FINDINGS

The effect of a protective effect of breastfeeding on the risk of OM is still being discussed. Within the past 5 years, 6 reviews and 15 original articles have been published. No randomized controlled trials have been published, and the diversity of exposure and outcome measures in the studies was significant. Also, we provide a summary of the recent literature on cost-benefit of breastfeeding and believed mechanism of protection against OM. Breastfeeding for more than 6 months seems to protect against OM during the first 6 years of life. Exclusive breastfeeding may have a more protective effect than non-exclusive breastfeeding. Introduction of formula feeding before the age of 6 months increased the risk of OM.

Pumping Milk Without Ever Feeding at the Breast in the Moms2Moms Study

BACKGROUND

More than 85% of contemporary lactating women in the United States express their milk at least sometimes. Some produce milk exclusively through pumping. We characterized women who pumped but never fed at the breast and compared their infant feeding practices with those of women who fed at the breast with or without pumping.

SUBJECTS AND METHODS

Study participants were those delivered at Ohio State University Wexner Medical Center in 2011 and completed a questionnaire at 12 months postpartum (n = 478). We used bivariate and multivariate approaches (survival analysis) to compare women who pumped but never fed at the breast with women who fed at the breast with or without pumping.

RESULTS

Women (n = 33, 6.9%) who pumped but never fed at the breast comprised a diverse group but were more likely to have delivered preterm and were of lower socioeconomic status on average. They initiated pumping and formula feeding earlier (median = day 1 after delivery) and were more likely to report difficulty making enough milk compared with women who fed at the breast with or without pumping. They had much shorter total duration of milk production (adjusted hazard ratio = 3.3, 95% confidence interval: 2.1, 5.2) after controlling for clinical and sociodemographic confounders.

CONCLUSIONS

Pumping without feeding at the breast is associated with shorter milk feeding duration and earlier introduction of formula compared with feeding at the breast with or without pumping. Establishing feeding at the breast, rather than exclusive pumping, may be important for achieving human milk feeding goals.

Hubungan Teknik, Frekuensi, Durasi Menyusui dan Asupan Energi dengan Berat Badan Bayi Usia 1-6 Bulan di Puskesmas Tasikmadu Kabupaten Karanganyar

Background: Weight is the first indicator for baby’s growth value. Eforts to increasing the baby’s weight is maximise the nutrients and mother’s milk as the primmary food for baby on 1-6 months. Objective: This research was conducedt to analyze relation factors with giving mother’s milk and the view of weight accomplishment. This factors such as technique, frequency, sucking duration and the intake of energy with baby’s weight on 1-6 months.Methods: Design in this reserach is cohort prostective to follwoing  the baby’s weight as long as 4 months. Sample in this research are baby’s mother on 1-6 months which was taken by purpossive sampling in the beginning of this research are 60 respondent and fall 14 respondent, 46 respondent were been analyze. Data analyze was obtained with chi square and multivariate with multiple logistic of regression test.Results: This research showed that  has relation betweeen breasfeeding technique with baby’s weight by p-value=0.003, there is relation between breasfeeding frequency with baby’s weight by p-value=0.018, there is relation between breasfeeding duration with baby’s weight by p-value=0,001, there is relation between the intake of energy with baby’s weight by p-value<0.001. The intake of energy has impact of the multivariate analyze from independent variable by exp (B) 38.822 it has means risk to 38.822 times will increasing weight if mothers’s intake energy is good.Conclusion: There are relation between technique, frequency, sucked  duration and the intake of the energy with baby’s weight on 1-6 months.ABSTRAKLatar Belakang: Berat badan merupakan indicator pertama dalam menilai pertumbuhan bayi. Upaya untuk meningkatkan berat badan bayi diperlukan gizi yang maksimal dan ASI merupakan makanan utama bagi bayi terutama pada usia 1-6 bulan.Tujuan: Penelitian ini bertujuan untuk mengnalisis faktor yang berkaitan dengan pemberian ASI dan dilihat pencapaian berat badan. Faktor yang dimaksud meliputi teknik, frekuensi, durasi menyusui dan asupan enegi dengan berat badan bayi usia 1-6 bulan.Metode: Desain dalam penelitian ini adalah kohort prostektif karena mengikuti berat badan bayi selama 4 bulan.  Sampel dalam penelitian ini adalah ibu yang memiliki bayi usia 1-6 bulan yang diambil secara purposive sampling pada titik awal penelitian berjumlah 60 responden dan dropout sebayak 14 responden sehingga yang dapat dianalisis sebesar 46 responden.  Analisis data secara bivariat dilakukan dengan chi square dan multivariate dengan uji regresi logistic ganda.Hasil: Dari hasil penelitian menunjukan hasil adanya hubungan antara teknik menyusui dan berat badan bayi dengan p value 0,003, ada hubungan antara frekuensi menyusui dengan berat badan bayi dengan p value 0,018 ada hubungan durasi menyusui dengan berat badan bayi dengan p value 0,001dan ada hubungan antara asupan energi dengan berat badan bayi dengan p value 0,000. Dari analisis multivariate dari keempat variabel bebas, asupan energi merupakan yang paling berpengaruh diantara variabel lainya dengan exp (B) sebesar 38,822 yang berarti jikaasupan energi ibu menyusui baik maka beresiko 38,822  kali mengalami kenaikan berat badan.Kesimpulan: Terdapat hubungan antara teknik, frekuensi, durasi menyusui dan asupan energi ibu dengan berat badan bayi usia 1-6 bulan.

An Ecological Momentary Assessment of Primiparous Women's Breastfeeding Behavior and Problems From Birth to 8 Weeks

BACKGROUND

Primiparous women are at risk for early, unintended breastfeeding reduction and cessation. Breastfeeding patterns that contribute to these outcomes require further exploration. Research aim: This study aimed to describe early, "real-time" breastfeeding behaviors and perceived problems of primiparous women.

METHODS

First-time mothers intending to exclusively breastfeed downloaded a commercial infant-feeding app during their postpartum hospitalization. Women logged feedings and their breastfeeding experiences, as they occurred, through 8 weeks postpartum. Additional feeding and background data were collected via electronic medical records and questionnaires administered at enrollment and 2 and 8 weeks postpartum. Summary statistics were compiled to examine weekly breastfeeding behaviors and problems.

RESULTS

In this sample of 61 primarily highly educated, White women committed to breastfeeding, 38% ( n = 23) used formula during the postpartum hospitalization and 68% ( n = 34) used formula at least once by 2 weeks. Nine women stopped breastfeeding during the study. Women using any formula in the hospital and those with less positive baseline attitudes toward breastfeeding were less likely to be exclusively breastfeeding at 2 and 8 weeks, respectively ( p < .05). There was a trend toward declining at-breast feeds and high rates of milk expression during the study. Breastfeeding problems peaked at Week 2, with 81% of women ( n = 39) endorsing at least one problem at that time. The most prevalent problems included perception of inadequate milk, pain, latching, and inefficient feeds.

CONCLUSION

Interventions to address suboptimal breastfeeding in primiparous women should consider the pervasiveness of early milk expression and in-hospital formula supplementation in this population, as well as the trajectory of common problems.

The Effect of Breast Pump Use on Exclusive Breastfeeding at 2 Months Postpartum in an Inner-City Population

BACKGROUND

Breastfeeding is the optimal form of infant nutrition, yet national rates are below recommendations with persistent disparities. Breast pumps may address the reasons that mothers discontinue breastfeeding.

OBJECTIVES

To determine whether breast pump use increases exclusive breastfeeding at 1.5-3.5 months postpartum.

MATERIALS AND METHODS

We reviewed charts for maternal-infant descriptors and feeding type for infants born between November 2013 and June 2014 who received any breast milk at a visit <14 days of age in our inner-city pediatric practice. We compared feeding at 1.5-3.5 months between those with breast pump and those without breast pump.

RESULTS

Of the 905 infants with feeding type recorded, 487 (54%) received any breast milk, of whom 355 (72.9%) had a visit at 1.5-3.5 months [95.4% African American (AA)]. Rates of any breastfeeding (93.8% vs. 38.9%) and exclusive breastfeeding (50.0% vs. 17.8%) were significantly higher in non-AAs than in AAs. Due to small numbers of non-AAs, further analyses were conducted for AAs only. The rate of exclusive breastfeeding at 1.5-3.5 months (19.4% vs. 16.3%) was similar between those with a breast pump and those without a breast pump, whereas rates of any breastfeeding were higher among those with no breast pump (46.9% vs. 31.4%, p = 0.004). Also, among AA mothers, rates of feeding at the breast were lower (21.5% vs. 44.4%, p < 0.0001) and rates of feeding expressed breast milk were higher (16.6% vs. 8.2%, p = 0.02) among those with a breast pump versus those without a breast pump.

CONCLUSIONS

Although breast pumps were free, breast pump use among predominantly AA WIC-eligible mothers was not associated with increased rates of exclusive breastfeeding at 1.5-3.5 months postpartum.

Early Breast Milk Pumping Intentions Among Postpartum Women

INTRODUCTION

Milk expression has become common, but little is known about women's intentions and motivations for pumping. Our objectives were to measure, among newly postpartum women, intentions related to breast milk feeding and pumping, reasons for intending to pump, and timing of pumping initiation.

METHODS

We conducted a cross-sectional study at a large university hospital in 2015 using a convenience sample of 100 women before their discharge following delivery, who intended to feed their infant breast milk for at least 6 months.

RESULTS

All participants planned to feed their baby at the breast. Ninety-eight percent said that they would use a breast pump to express milk for their baby, with most of this subset (69%) intending to start within weeks of delivery. Over a quarter of participants (29%) had already initiated pumping or intended to initiate within the subsequent few days. Primiparae were more likely to report having already started pumping at the time of the interview. For all women, the most common reason for pumping was to keep up their milk supply. Women who started pumping while in the hospital also noted that they pumped to increase their milk supply and overcome latch difficulties.

CONCLUSIONS

The common intention to use a breast pump so early after delivery indicates a need for increased lactation support to reduce concerns about having an insufficient milk supply immediately following delivery. Additionally, clinicians who help facilitate breastfeeding should be aware of how early women intend to use a breast pump.

Mothers' Use of Social Media to Inform Their Practices for Pumping and Providing Pumped Human Milk to Their Infants

Despite U.S. mothers’ wide adoption of pumps and bottles to provide human milk (HM) to their infants, mothers lack comprehensive, evidence-based guidelines for these practices. Thus, some women use online sources to seek information from each other. We aimed to characterize the information women sought online about pumping. We used data provided by ~25,000 women in an open cohort within a discussion forum about parenting. We examined 543 posts containing questions about providing pumped HM cross-sectionally and longitudinally in three time intervals: prenatal, 0 through 1.5 months postpartum, and 1.5 to 4.5 months postpartum. We used thematic analysis with Atlas.ti to analyze the content of posts. During pregnancy, women commonly asked questions about how and where to obtain pumps, both out-of-pocket and through insurance policies. Between 0–1.5 months postpartum, many mothers asked about how to handle pumped HM to ensure its safety as fed. Between 1.5–4.5 months postpartum, mothers sought strategies to overcome constraints to pumping both at home and at work and also asked about stopping pumping and providing their milk. Women’s questions related to ensuring the safety of pumped HM represent information women need from health professionals, while their questions related to obtaining pumps suggest that women may benefit from clearer guidelines from their insurance providers. The difficulties women face at home and at work identify avenues through which families and employers can support women to meet their goals for providing HM.