Breastfeeding outcomes among early-term and full-term infants

Feeding Practices of Preterm Low Birthweight Infants Up to 6 Months: A Comparison Between Kangaroo and Conventional Care

OBJECTIVE

The objective of this study is to compare feeding practices of low birthweight (LBW) infants, according to type of care received during and after hospital discharge: Kangaroo Care (KC) and Conventional Care (CC).

METHODS

Prospective cohort study was conducted at a university hospital (Brazil) between 2019 and 2021. The sample consisted of 65 LBW infants (weight ≤ 1800 g)-46 in KC and 19 in CC. KC includes breastfeeding (BF) guidance and support to parents at hospital and after discharge. Data collection was performed at hospital discharge, and at the 4th and 6th month of corrected gestational age (CGA). Consumption of 27 foods was analyzed in the last 2 periods of the follow-up and expressed in relative frequency. Three indicators were analyzed: exclusive breastfeeding (EBF), mixed BF, and introduction of liquid and solid foods.

RESULTS

Groups had similar health characteristics, except for the weight at hospital discharge and the Score for Neonatal Acute Physiology - Perinatal (SNAPPE II) score that were lower in KC group. We found higher frequency of EBF among KC at hospital discharge (CC = 5.3% vs KC = 47.8%; P = 0.001). The higher frequency of mixed BF was observed in KC at 4 months of CGA (CC = 5.6% vs KC = 35.0%; P = 0.023), and at 6 months of CGA (CC = 0.0% vs KC = 24.4%; P = 0.048). Consumption of solid foods (4th month of CGA = 25.9%, 6th month of CGA = 91.2%) and liquids (4th month of CGA = 77.6%, 6th month of CGA = 89.5%) were similar between groups.

CONCLUSIONS

In KC, SNAPPE II scores were lower and frequency of EBF was higher at hospital discharge and frequency of mixed BF was higher over 6 months. Early supply of infant formula, liquid and solid foods were similar in both groups.

Breastfeeding Duration and Exclusivity Among Early-Term and Full-Term Infants: A Cohort Study

Background

As compared to full-term infants (39-41 weeks of gestation), early-term infants (37-38 wk) are at increased risk of adverse outcomes, including shorter exclusive breastfeeding (EB) duration and continued breastfeeding.

Objectives

To compare early-term with full- and late-term infants regarding the prevalence of EB at 3 mo and any breastfeeding at 12 mo.

Methods

Data sets from two population-based birth cohorts conducted in the city of Pelotas, Brazil, were combined. Only term infants (37 0/7 through 41 6/7 weeks of gestation) were included in the analyses. Early-term infants (37 0/7 through 38 6/7 wk) were compared to the remaining term infants (39 0/7 through 41 6/7 wk). Information on breastfeeding was gathered through maternal interviews at the 3-mo and 12-mo follow-ups. The prevalence of EB at 3 mo and any breastfeeding at 12 mo with 95% CIs were calculated. Crude and adjusted prevalence ratios (PRs) were obtained through Poisson regression.

Results

A total of 6395 infants with information on gestational age and EB at 3 mo and 6401 infants with information on gestational age and any breastfeeding at 12 mo were analyzed. There was no difference between early-term infants and the remaining term infants regarding the prevalence of EB at 3 mo (29.2% and 27.9%, respectively) (P = 0.248). Prevalence of any breastfeeding at 12 mo was lower in early-term infants than among those born between 39 0/7 and 41 6/7 weeks of gestation (38.2% compared with 42.4%) (P = 0.001). In the adjusted analysis, the PR for any breastfeeding at 12 mo was 15% lower in the early-term group than in the remaining term infants (PR = 0.85; 95% CI: 0.76-0.95) (P = 0.004).

Conclusions

The prevalence of EB at 3 mo was similar among term infants. Nonetheless, in comparison with the remaining infants born at term, early-term infants were at increased risk of having been weaned before reaching 12 mo of age. Curr Dev Nutr 2023;xx:xx.

The Practice of Breastfeeding in Public and its Associated Factors Among Egyptian Mothers

Introduction: The practice of breastfeeding in public (BFP) is associated with the perceived social norms. No sufficient knowledge is available regarding this practice, the attitudes related, and the significant associated factors in Egypt. Aim: To assess the prevalence of BFP, attitudes, barriers, and enabling factors. Methods: A cross-sectional study was conducted in Dakahlia Governorate, Egypt, including breastfeeding mothers whose babies were ≤12 months of age. A predesigned validated interviewer-administered questionnaire was used to collect data. Results: The study included 400 participants, 72.8% of them had practiced breastfeeding in public at least once. Regression analysis showed that being urban, high socioeconomic standard, having babies who were of normal birthweight and not the first in order were significant predictors of higher prevalence of BFP. Also, positive mother's attitude and having a family member who also practiced BFP were independent significant predictors. Finally, mothers who practiced breastfeeding in public are less likely to have supportive families' attitude. The most common causes of not practicing BFP is men's presence (94%), followed by husband disagreement (78.5%), absence of breast cover (69.3%), or feeling embarrassed (63.2%). Conclusion: Breastfeeding in public is a frequent practice among the studied mothers. Underlying factors associated with BFP can help guide tailored health education message to nursing mothers. Privacy was the keyword behind not practicing BFP.

Factors Associated with Breastfeeding Initiation and Duration in Greece: Data from the Hellenic National Nutrition and Health Survey

Despite its well-documented benefits, breastfeeding rates and duration worldwide do not meet the recommended goals set by the World Health Organization. Data on infant feeding, socio-demographic, lifestyle and perinatal factors were used from 490 mothers (and 958 children), participants at the Hellenic National Nutrition and Health Survey between 2013−2015. Clustered multiple logistic regression and multilevel mixed-model regression analyses were performed to identify factors associated with breastfeeding initiation and duration, respectively. Maternal lower education [Odds Ratio (OR): 2.29, 95% Confidence intervals (95% CI): 1.30−4.04; p = 0.004], smoking during pregnancy (OR: 3.08, 95% CI: 1.64−5.77; p < 0.001), caesarean section (OR = 3.26, 95% CI: 1.83−5.83; p < 0.001), prematurity (OR = 2.74, 95% CI: 1.40−5.37; p = 0.003) and higher birth order (OR = 1.30, 95% CI: 1.04−1.62; p = 0.020) were associated with increased odds of not initiating breastfeeding. Living in rural areas [beta coefficient b = −27.93, p = 0.043], smoking during pregnancy (b = −64.47, p < 0.001), caesarean section (b = −28.76, p = 0.046) and prematurity (b = −46.67, p = 0.048) were significantly associated with shorter breastfeeding duration. Children born chronologically closer to the survey were more likely to breastfeed and for longer periods. Educational promotion and enhancement of breastfeeding awareness that account for maternal exposures are required. Prevention of prematurity and avoidance of unnecessary caesarean section is crucial, while additional breastfeeding support is needed when preterm birth occurs, or caesarean section cannot be avoided.

Associations of maternal exposure to fine particulate matter with preterm and early-term birth in high-risk pregnant women

Background

Environmental pollution is a risk factor for adverse birth outcomes, especially preterm birth (PTB) and early-term birth (ETB). It has been revealed that exposure to fine particulate matter (PM_2.5) during pregnancy increase the prevalence of PTB. However, the relationship between PM_2.5 exposure and ETB has not been elucidated. In high-risk pregnancies, whether PM_2.5 exposure will bring higher risk of PTB and ETB than in normal pregnancies is still unclear, and the susceptible exposure window is obscure. Therefore, it is worthy of assessing the risk on PTB and ETB and identifying the susceptible exposure windows of PM_2.5 exposure in high-risk pregnant women.

Results

This paper collected the clinical data of 7974 singletons, high-risk pregnant women in Peking University First Hospital from 2014 to 2018, and analyzed them using logistic regression and stratified analysis. We observed that exposure to high-level (≥ 75 µg/m³) of PM_2.5 during the third trimester of pregnancy increases the risk of PTB and ETB (PTB: odds ratio[OR] = 1.43, 95% confidence interval [CI]:1.05–1.93. ETB: OR = 1.29, 95%CI: 1.09–1.54). Furthermore, the effects of each 10ug/m³ increase in PM_2.5 on PTB and ETB were significant during the third trimester (PTB: OR = 1.35, 95%CI:1.16–1.58. ETB: OR = 1.12, 95%CI:1.02–1.22) and the entire pregnancy (PTB: OR = 6.12, 95%CI:4.27–8.89. ETB: OR = 1.96, 95%CI:1.59–2.43) in the high-level exposure group.

Conclusions

These results suggest that high-level PM_2.5 exposure during pregnancy is associated with high risk of PTB and ETB in high-risk pregnancies. The third trimester of pregnancy is speculated to be the susceptible exposure window.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41021-022-00239-0.

The Use of the "Early Weight Loss Nomograms" as Compared to a Standard Weight Loss Percentage Protocol Will Decrease Postnatal Formula Supplementation

Introduction: We compared the number of babies who needed formula supplementation, based on the "Early Weight Loss Nomograms," with the hypothetical outcomes that would have occurred in the same cohort if they had been managed according to a "weight loss percentage" protocol. Subjects and Methods: This study included 308 newborns. Supplemental formula was provided to babies whose weight loss was more than the 95th percentile according to the "Early Weight Loss Nomograms." Pathological weight loss was defined as when a weight loss was >5% at the 24th hour or >8% at the 48th hour. The number of babies who would have needed formula supplementation according to those two strategies were compared. Results: The mean postnatal first-second day weight losses for vaginal and cesarean deliveries were 3.06% versus 4.7% and 4.5%, versus 5.8%, respectively, and were significantly higher for babies born by cesarean section (p = 0.001). We found that 89.4% of vaginal deliveries and 89.2% of babies born by cesarean section were exclusively breastfed when the nomograms were in use. If the daily weight loss strategy would be applied instead of the nomograms to the study cohort, the rate of exclusive breastfeeding would be significantly lower for babies born by cesarean section (64.2% versus 89.2%) (p = 0.001). Conclusions: The use of the Early Weight Loss Nomograms will decrease the rate of formula supplementation.

Factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women: a multi-centre study

OBJECTIVE

To identify factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women.

DESIGN

Prospective cohort of mothers and infants born from 2008 to 2012: the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study.

SETTING

General community setting in four Canadian provinces.

PARTICIPANTS

In total, 3455 pregnant women from Vancouver, Edmonton, Winnipeg and Toronto between 2008 and 2012.

RESULTS

Of 3010 participants included in the current study, the majority were Canadian-born (75·5 %). Breast-feeding initiation rates were high in both non-Canadian-born (95·5 %) and Canadian-born participants (92·7 %). The median breast-feeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breast-feeding initiation and continuation were older maternal age, higher maternal education, living with their partner and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breast-feeding initiation, but not continuation at 6-month postpartum. Factors associated with non-initiation of breast-feeding and cessation at 6-month postpartum were maternal smoking, living with a current smoker, caesarean birth and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breast-feeding initiation and lower odds of breast-feeding continuation at 6 months, and older maternal age and recruitment site were associated with breast-feeding continuation at 6 months.

CONCLUSIONS

Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breast-feeding initiation rates, breast-feeding initiation and continuation are more strongly associated with socio-demographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breast-feeding continuation in both groups and may indicate geographic disparities in breast-feeding rates nationally.

Duration of Breastfeeding in Late Preterm Infants: Maternal and Infant Factors

BACKGROUND

More than 550,000 late preterm infants are born each year in Indonesia. These infants, born between 34^0/7-36^6/7 weeks, have more complications than term infants. Breastfeeding is considered the most optimal nutrition for newborn infants. Two groups of factors are important for successful breastfeeding: infant and maternal factors. The infant factors can be evaluated using the Infant Breastfeeding Assessment Tool and the maternal aspects with the Breastfeeding Self-Efficacy Scale-Short Form.

AIM

To determine whether the Infant Breastfeeding Assessment Tool or the Breastfeeding Self-Efficacy Scale-Short Form was more predictive of successful breastfeeding among late preterm infants.

METHODS

This study was conducted in the Academic Teaching Hospital in Surabaya, Indonesia in March-July 2017. Mothers who delivered their infant between a gestational age of 34^0/7 and 36^6/7 weeks were included.

RESULTS

Fifty-four single born participant mother-infant pairs were included. The mean total Breastfeeding Self-Efficacy Scale-Short Form score was 57.8 (SD = 8.9). The mean Infant Breastfeeding Assessment Tool score was 8.3 (SD = 1.8). There was a significant correlation between the total Breastfeeding Self-Efficacy Scale-Short Form score and the Infant Breastfeeding Assessment Tool score (p = .020, r = 0.316). The Breastfeeding Self-Efficacy Scale-Short Form was significantly higher in the participant (mothers) of the infants breastfed ≥ 4 months, compared to < 4 months, 61.59 (SD = 5.78) versus 51.78 (SD = 11.64; p = .001). No correlation was found between the duration of breastfeeding and Infant Breastfeeding Assessment Tool score (p = .087).

CONCLUSION

Maternal factors were more important for successful breastfeeding in these late preterm infants than infant factors in our sample.

Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study

BACKGROUND

Despite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors.

METHODS

Using a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes.

RESULTS

Almost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum.

CONCLUSION

This study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.

The influence of gestational age at term on breastfeeding: a cohort study

OBJECTIVE

To identify the effect of the category gestational age at term on breastfeeding in he first hour of life, the duration of exclusive breastfeeding, and practice of breastfeeding twelve months from birth.

METHOD

Single cohort, with a one-year prospective follow-up of 541 children. A hierarchical analysis was performed, with models adjusted per Cox regression, considering critical p < 0.05.

RESULTS

During raw analysis there was a statistical difference on breastfeeding in the first hour of life (RR = 1.54; CI 95% = 1.12-2.12; p = 0.008). However, in the final analysis, there was no association between gestational age at term and breastfeeding in the first hour of life, duration of exclusive breastfeeding, and the practice of breastfeeding twelve months from birth. Secondarily, higher age and education, cesarean section, birth at private services, and the need for resuscitation were observed to have a negative influence. Duration of previous pregnancy favored breastfeeding in the first hour of life. Using baby bottle and pacifier was negative for breastfeeding in the first year of life.

CONCLUSION

There was no association between the category gestational age at term and breastfeeding. The association of outcomes pointed out by the scientific literature have been confirmed.

The effects of mother's education on achieving exclusive breastfeeding in Indonesia

BACKGROUND

Even though the Indonesian government have set regulations for maintaining exclusive breastfeeding practices, the coverage remains low. The study aims to analyze the effects of mother's education level on the coverage of exclusive breastfeeding in Indonesia.

METHODS

This study used data from the 2017 Nutrition Status Monitoring Survey. It covered data of 53,528 children under 5 years old (7-59 months) as the samples. Variables included exclusive breastfeeding status, mother's education level, mother's age, marital status, employment status, gender, residence, under five's age and gender. A binary logistics regression was performed in the final test.

RESULTS

Mothers who graduated from elementary school were 1.167 times more likely to perform exclusive breastfeeding compared to mothers who never attended schools. Additionally, those who graduated from junior high school had 1.203 times possibilities to give exclusive breastfeeding compared to mothers without educational records. While, mothers who graduated from high school were 1.177 times more likely to perform exclusive breastfeeding compared to those without educational records. Mothers who graduated from tertiary education had 1.203 times more possibilities to perform exclusive breastfeeding compared to mothers who were never enrolled to schools. Other variables also became affecting predictors on exclusive breastfeeding, such as mother's age, mother's employment status, child's age, and residence.

CONCLUSIONS

The mother's education level positively affects exclusive breastfeeding practice in Indonesia.