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Parker LA. Use of Donor Human Milk in Populations Other than Preterm Very Low Birthweight Infants: Where Are We Now? J Perinat Neonatal Nurs 2024; 38:238-240. [PMID: 39074319 DOI: 10.1097/jpn.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
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2
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Brown A, Griffin S, Weaver G, Shenker N. Receiving screened donor human milk as part of a community-based lactation support programme reduces parental symptoms of anxiety and depression. MATERNAL & CHILD NUTRITION 2024:e13686. [PMID: 38898718 DOI: 10.1111/mcn.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
Infant feeding decisions and maternal mental health are closely tied. Donor human milk (DHM) protects premature infant health and development and can reduce hospital stays. Recent qualitative research has highlighted that having the option for an infant to receive DHM can also support parental wellbeing through reducing concerns about infant health and supporting feeding preferences. However, no quantitative study has examined this relationship. In this study, anxiety and depression scores were measured before and after receiving DHM using the Hospital Anxiety and Depression Scale for 80 parents (77 mothers, 3 fathers) who had sought DHM from a community-facing milk bank. Reasons for seeking DHM included maternal cancer, maternal and infant health complications, insufficient glandular tissue, and low milk supply. Open-ended questions explored the experience of receiving milk. Milk bank records were used to match details of milk given (volume, duration, exclusivity, lactation support given) with survey responses. Both anxiety and depression scores significantly reduced after receiving milk. Although greater lactation support and longer duration of milk predicted a greater decrease in scores, in a regression analysis, only volume of milk given remained a significant predictor. Almost all parents agreed that being able to access DHM supported their wellbeing predominantly through reducing anxieties around infant health but also through feeding choices being respected and the support given at difficult times. The findings add important considerations to the literature considering when and for whom DHM should be used and the complex interplay between infant feeding and mental health.
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Affiliation(s)
- Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea, UK
- Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, UK
| | - Sam Griffin
- The Human Milk Foundation, Victory Road, Berkhamsted, UK
| | - Gillian Weaver
- The Human Milk Foundation, Victory Road, Berkhamsted, UK
| | - Natalie Shenker
- The Human Milk Foundation, Victory Road, Berkhamsted, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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3
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Brockway M. The role of antibiotic exposure and the effects of breastmilk and human milk feeding on the developing infant gut microbiome. Front Public Health 2024; 12:1408246. [PMID: 38903564 PMCID: PMC11187292 DOI: 10.3389/fpubh.2024.1408246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life followed by complementary foods and sustained breastfeeding for at least 2 years, underscoring its pivotal role in reducing infant mortality and preventing various illnesses. This perspective delves into the intricate relationship between breastfeeding practices, early life antibiotic exposure, and infant gut microbiome development, highlighting their profound influence on child health outcomes. Antibiotics are extensively prescribed during pregnancy and childhood, disrupting the microbiome, and are related to increased risks of allergies, obesity, and neurodevelopmental disorders. Breastfeeding is a significant determinant of a healthier gut microbiome, characterized by higher levels of beneficial bacteria such as Bifidobacterium and lower levels of potential pathogens. Despite widespread recognition of the benefits of breastfeeding, gaps persist in healthcare practices and support mechanisms, exacerbating challenges faced by breastfeeding families. This highlights the pressing need for comprehensive research encompassing breastfeeding behaviors, human milk intake, and their impact on infant health outcomes. Additionally, promoting awareness among healthcare providers and families regarding the detrimental effects of unnecessary formula supplementation could facilitate informed decision-making and bolster exclusive breastfeeding rates. Moreover, donor human milk (DHM) is a promising alternative to formula, potentially mitigating disruptions to the infant gut microbiome after antibiotic exposure. Overall, prioritizing breastfeeding support interventions and bridging research gaps are essential steps towards improving child health outcomes on a global scale.
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Affiliation(s)
- Meredith Brockway
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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4
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Shenker NS, Griffin S, Hamill‐Keays J, Thomson M, Simpson J, Weaver G. Understanding the current and future usage of donor human milk in hospitals: An online survey of UK neonatal units. MATERNAL & CHILD NUTRITION 2023; 19:e13526. [PMID: 37400943 PMCID: PMC10483937 DOI: 10.1111/mcn.13526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 07/05/2023]
Abstract
The use of donor human milk (DHM) where there is a shortfall of maternal milk can benefit both infant and maternal outcomes but DHM supply is not always assured. This study aimed to understand current DHM usage in UK neonatal units and potential future demand to inform service planning. An online survey was disseminated to all UK neonatal units using Smart Survey or by telephone between February and April 2022 after development alongside neonatal unit teams. Surveys were completed by 55.4% of units (108/195) from all 13 Operational Delivery Networks. Only four units reported not using DHM, and another two units only if infants are transferred on DHM feeds. There was marked diversity in DHM implementation and usage and unit protocols varied greatly. Five of six units with their own milk bank had needed to source milk from an external milk bank in the last year. Ninety units (84.9%) considered DHM was sometimes (n = 35) or always (n = 55) supportive of maternal breastfeeding, and three units (2.9%) responded that DHM was rarely supportive of breastfeeding. Usage was predicted to increase by 37 units (34.9%), and this drive was principally a result of parental preference, clinical trials and improved evidence. These findings support the assumption that UK hospital DHM demand will increase after updated recommendations from the World Health Organization (WHO) and the British Association of Perinatal Medicine. These data will assist service delivery planning, underpinned by an ongoing programme of implementation science and training development, to ensure future equity of access to DHM nationally.
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Affiliation(s)
- Natalie S. Shenker
- Department of Surgery and CancerImperial College London, IRDBLondonUK
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
| | - Samantha Griffin
- Department of Surgery and CancerImperial College London, IRDBLondonUK
| | - Jonathan Hamill‐Keays
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
| | - Merran Thomson
- Neonatal UnitHillingdon Hospitals NHS Foundation TrustUxbridgeUK
| | - Judith Simpson
- Neonatal Intensive Care UnitRoyal Hospital for ChildrenGlasgowUK
| | - Gillian Weaver
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
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5
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Gray K, Ryan S, Churchill M, Harder VS. The Association Between Type of Supplementation in the Newborn Nursery and Breastfeeding Outcomes at 2 and 6 Months of Age. J Hum Lact 2022; 39:245-254. [PMID: 35730582 DOI: 10.1177/08903344221105810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Supplementation in the newborn nursery has been associated with shorter breastfeeding duration. However, supplementation may at times be necessary. RESEARCH AIM To determine the association between type of supplementation in the newborn nursery (mother's own milk, formula, donor human milk) and breastfeeding outcomes at 2 and 6 months of age. METHODS This was a prospective, longitudinal, observational multi-group cohort study. In total, 2,343 surveys were sent to parents who, prior to delivery, indicated intent to exclusively breastfeed. Participants were grouped by type of nursery supplementation. Surveys asked about breastfeeding outcomes when infants were 2 and 6 months old. Our final analytic sample included data from 1,111 healthy newborns ≥ 35 weeks. We used multiple logistic regression to compare future breastfeeding outcomes for infants who were exclusively directly breastfed or who received supplementation during their birth hospitalization. RESULTS Both the donor human milk and formula groups had decreased breastfeeding at 2 and 6 months compared to the exclusively directly breastfed group. Notably, for infants who received formula compared to donor human milk, the odds of breastfeeding at 2 and 6 months were 74% and 58% lower, respectively (OR = 0.26, 95% CI [0.12, 0.56] at 2 months; OR = 0.42, 95% CI [0.19, 0.94] at 6 months). The donor human milk group had lower odds of breastfeeding at both follow up times compared to the mother's own milk group. CONCLUSION Among those who intend to breastfeed, supplementation with donor human milk instead of formula in the newborn nursery may support longer breastfeeding.
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Affiliation(s)
- Karin Gray
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA.,The University of Vermont Children's Hospital, University of Vermont Medical Center, Burlington, VT, USA
| | - Stephanie Ryan
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA.,Legacy Randall Children's Hospital, Portland, OR, USA
| | - Martha Churchill
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Valerie S Harder
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA
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6
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Brown A, Shenker N. Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study. BMC Pregnancy Childbirth 2022; 22:455. [PMID: 35641919 PMCID: PMC9154035 DOI: 10.1186/s12884-022-04789-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Access to donor human milk (DHM) has primarily been based on the health and development outcomes of premature infants but there has been little examination of the broader impact of an infant receiving it upon parental mental health. Breastfeeding and mental health are closely tied with women who experience breastfeeding difficulties or are unable to meet their own breastfeeding goals often experiencing feelings of guilt, sadness and anger, alongside an increased risk of postnatal depression. The aim of the current study was to explore how experience of receiving DHM for their baby affected the wellbeing of parents. METHODS UK parents of infants aged 0 - 12 months who had received screened DHM from a milk bank (typically on the neonatal unit or in some cases in the community) completed an online questionnaire exploring their experiences. The questionnaire included Likert scale items examining perceived impact upon infant health, own wellbeing and family functioning alongside open-ended questions exploring perceptions of how receiving DHM affected wellbeing. RESULTS Almost all of the 107 participants (women = 102) agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family's wellbeing. Parents felt relieved that their infant was receiving DHM for health reasons but also due to the experience of being listened to, supported and having their infant feeding decisions facilitated. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby. Some parents did experience challenges, feeling guilty at receiving DHM, insecure that another woman was able to feed their baby when they could not, or negative reactions from family. Although the impact of receiving DHM upon breastfeeding was not measured, some women who were working to build their own milk supply noted that it helped motivate them to continue. CONCLUSIONS DHM may play an important role not only in protecting infant health and development but in supporting the mental health and wellbeing of mothers for whom their infant receiving human milk is important.
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Affiliation(s)
- A. Brown
- grid.4827.90000 0001 0658 8800School of Health and Social Care, Swansea University, Singleton Park, Swansea, UK ,grid.4827.90000 0001 0658 8800Centre for Lactation, Infant Feeding and Translation, Swansea University, Swansea, UK
| | - N. Shenker
- grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, London, UK
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Gomez J, Wardell D, Cron S, Hurst N. Relationship Between Maternal COVID-19 Infection and In-Hospital Exclusive Breastfeeding for Term Newborns. J Obstet Gynecol Neonatal Nurs 2022; 51:517-525. [PMID: 35661652 PMCID: PMC9120128 DOI: 10.1016/j.jogn.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the relationship between maternal COVID-19 infection and the odds of in-hospital exclusive breastfeeding for term newborns. Design Retrospective descriptive quantitative. Setting A large, urban hospital with more than 6,000 births annually. Sample Term newborns born between March 1, 2020, and March 31, 2021 (N = 6,151). Methods We retrospectively extracted data from electronic health records to evaluate the relationship of maternal COVID-19 infection with the odds of in-hospital exclusive breastfeeding using univariate analysis and logistic regression models. The covariates included insurance type, race/ethnicity, glucose gel administration, length of stay, newborn gestational age, newborn birth weight, and maternal COVID-19 infection. Results Maternal COVID-19 infection was not significantly related to the odds of in-hospital exclusive breastfeeding (p = .138) after adjustment for covariates in the logistic regression model. However, when newborns who received pasteurized donor human milk supplementation were excluded from the logistic regression model, maternal COVID-19 infection significantly decreased the odds of in-hospital exclusive breastfeeding (p = .043). Conclusion Maternal COVID-19 infection was not significantly related to the odds of in-hospital exclusive breastfeeding when newborns received donor human milk supplementation. Access to donor human milk for supplementation for term newborns may protect the odds of in-hospital exclusive breastfeeding.
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8
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Britten FL, Lai CT, Geddes DT, Callaway LK, Duncan EL. Is Secretory Activation Delayed in Women with Type Two Diabetes? A Pilot Study. Nutrients 2022; 14:nu14071323. [PMID: 35405936 PMCID: PMC9002373 DOI: 10.3390/nu14071323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Breastfeeding duration may be reduced in women with type 2 diabetes. Delayed secretory activation (SA) is associated with poorer breastfeeding outcomes; however, no prior studies have examined SA in women with type 2 diabetes. This pilot study aimed to assess SA in women with type 2 diabetes by assessing breastmilk constituents. Secondary aims were to assess breastfeeding rates postpartum, and contributory factors. (2) Methods: A prospective cohort of pregnant women with type 2 diabetes (n = 18) and two control groups with age- and parity-matched nondiabetic pregnant women (body mass index (BMI)) matched (n = 18) or normal-range BMI (n = 18)) were recruited. Breastmilk constituents (citrate, lactose, protein, and fat) were measured twice daily for 5 days postpartum and compared between groups. Associations between peripartum variables, breastmilk constituents, and breastfeeding at 4 months postpartum were explored. (3) Results: Women with type 2 diabetes had a slower increase in breastmilk citrate concentration postpartum, indicative of delayed SA, compared to both control groups. Higher predelivery insulin doses in women with type 2 diabetes were associated with increasing time to SA. Both women with type 2 diabetes and BMI-matched controls were less likely to fully breastfeed at 4 months, compared with normal-BMI controls. (4) Conclusion: SA is delayed in women with type 2 diabetes when compared to BMI-matched and normal-BMI women. Women with type 2 diabetes are less likely to fully breastfeed, at hospital discharge and by 4 months postpartum, compared to women with normal-BMI.
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Affiliation(s)
- Fiona L. Britten
- Department of Obstetric Medicine, Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia;
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4006, Australia
- Correspondence: ; Tel.: +(61)736-468-111
| | - Ching T. Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (D.T.G.)
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (D.T.G.)
| | - Leonie K. Callaway
- Department of Obstetric Medicine, Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia;
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4006, Australia
| | - Emma L. Duncan
- Department of Twin Research & Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 7EH, UK;
- Department of Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
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9
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Growth of Very Preterm Infants in a Low-Resourced Rural Setting after Affiliation with a Human Milk Bank. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9010080. [PMID: 35053701 PMCID: PMC8774553 DOI: 10.3390/children9010080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.
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10
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Riley J, Cherkerzian S, Benjamin C, Belfort MB, Sen S, Drouin K, Gregory K. Clinical Characteristics and Breastfeeding Outcomes in Term Dyads Following In-Hospital Supplementation with Pasteurized Donor Human Milk or Formula. Breastfeed Med 2021; 16:717-724. [PMID: 33872065 DOI: 10.1089/bfm.2020.0337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Pasteurized donor human milk (PDHM) supplementation for healthy infants is an emerging practice. Little is known about demographics or breastfeeding outcomes for dyads whose mothers choose PDHM versus formula. Research Aims: To identify relationships between in-hospital supplementation choice and (1) dyad characteristics and breastfeeding intent, and (2) breastfeeding outcomes at 1 month. Materials and Methods: This exploratory prospective cohort study surveyed healthy dyads requiring medically indicated supplementation. Participants completed questionnaires including demographics, breastfeeding intent, and self-efficacy during hospitalization, and self-efficacy and lactation outcomes at 1 month. Results: Of 39 participants, 24 (62%) supplemented with formula and 15 (38%) with PDHM. Formula dyads were more likely than PDHM dyads to have a delivery body mass index (BMI) ≥30 kg/m2 (58% versus 20%, p = 0.02), and less likely to have attained greater than a college degree (33% versus 7%, p = 0.02); formula dyads also reported lower breastfeeding intent scores (12.0 versus 15.5, p = 0.002). Breastfeeding self-efficacy scores were similar but decreased for both groups over 1 month. At 1 month, mothers who chose formula were more likely to continue to provide breast milk to their infants (84% versus 72%). Direct breastfeeding rates were similar (72% versus 68%); of participants directly breastfeeding at 1 month, PDHM dyads were 1.5 times more likely to provide maternal expressed milk. Conclusions: Differences in maternal education, BMI, and breastfeeding intent were found between feeding groups. Results suggest an association between PDHM choice and initial breastfeeding intent and breastfeeding self-efficacy and provision of maternal expressed milk at 1 month.
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Affiliation(s)
- Jennifer Riley
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charis Benjamin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
| | - Kaitlin Drouin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katherine Gregory
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
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11
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Supplementation-based hypoglycemia guidelines including donor breast milk reduce NICU admission. J Perinatol 2021; 41:2088-2094. [PMID: 34006969 DOI: 10.1038/s41372-021-01069-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/22/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To study the effects of a supplementation-based hypoglycemia guideline including donor (DM) on NICU admission, exclusive breastfeeding, and blood glucose concentrations in infants at-risk for neonatal hypoglycemia (NH). PROJECT DESIGN We integrated DM, feeding supplementation, and reduced frequency of blood glucose testing into an NH bundle for term and late-preterm newborns. We then examined NICU admission rates and rates of exclusive breastfeeding at discharge. RESULTS NICU admission rates were reduced to 6% (-10%). Exclusive breastfeeding rates increased to 55% (+22%). Median cost of DM utilization was $13.73 per patient with an average volume of 50.8 ml/infant. DM supplementation resulted in similar times to last hypoglycemic episode and greater increases in blood glucose compared to expressed breast milk or breastfeeding alone (+9.6 mg/dL, p < 0.05). CONCLUSIONS A supplementation-based hypoglycemia guideline including donor milk may be an effective way to reduce NICU admissions for asymptomatic hypoglycemia and support mothers in achieving breastfeeding goals.
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12
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Von Kohorn I, Flaherman V. Human Milk for the Term Newborn. Clin Perinatol 2021; 48:513-531. [PMID: 34353578 DOI: 10.1016/j.clp.2021.05.005] [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: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Isabelle Von Kohorn
- Department of Pediatrics, Holy Cross Health, 1500 Forest Glen Road, Silver Spring, MD 20910, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, San Francisco, CA 94118, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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13
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Olonan-Jusi E, Zambrano PG, Duong VH, Anh NTT, Aye NSS, Chua MC, Kurniasari H, Moe ZW, Ngerncham S, Phuong NTT, Datu-Sanguyo J. Human milk banks in the response to COVID-19: a statement of the regional human milk bank network for Southeast Asia and beyond. Int Breastfeed J 2021; 16:29. [PMID: 33781285 PMCID: PMC8006108 DOI: 10.1186/s13006-021-00376-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization (WHO) recommendations on infant feeding in the context of COVID-19 uphold standing recommendations for breastfeeding, non-separation, and skin-to-skin contact, including the use of donor human milk when mother’s own milk is not available. Insufficient guidance on the use of donor human milk and the role of human milk banks in the pandemic response COVID-19 clinical management guidelines in seven countries in Southeast Asia are not aligned with WHO recommendations despite the lack of evidence of transmission through either breastmilk or breastfeeding. The use of safe donor human milk accessed through human milk banks is also insufficiently recommended, even in countries with an existing human milk bank, leading to a gap in evidence-based management of COVID-19. This highlights long-standing challenges as well as opportunities in the safe, equitable, and resilient implementation of human milk banks in the region. Conclusions This statement reflects the expert opinion of the Regional Human Milk Bank Network for Southeast Asia and Beyond on the need to revisit national guidelines based on the best evidence for breastfeeding during the COVID-19 pandemic, to incorporate human milk bank services in national obstetric and newborn care guidelines for COVID-19 where possible, and to ensure that operations of human milk banks are adapted to meet the needs of the current pandemic and to sustain donor human milk supply in the long-term. The Network also recommends sustained engagement with the global human milk bank community. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00376-2.
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Affiliation(s)
| | - Paul G Zambrano
- Alive & Thrive Southeast Asia/FHI 360, 1101, Quezon City, Philippines.
| | - Vu H Duong
- Alive & Thrive Southeast Asia/FHI 360, Hanoi, Vietnam
| | - Nguyen T T Anh
- Human Milk Bank, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Nant S S Aye
- Neonatal Intensive Care Unit, Central Women's Hospital, Yangon, Myanmar
| | - Mei Chien Chua
- Department of Neonatology and KK Human Milk Bank, KK Women's and Children's Hospital, Singapore, Singapore
| | - Hikmah Kurniasari
- Human Milk Bank Initiative Association of Indonesia, Jakarta, Indonesia
| | - Zaw Win Moe
- Neonatal Intensive Care Unit, Yankin Children's Hospital, Yangon, Myanmar
| | - Sopapan Ngerncham
- Siriraj Human Milk Bank, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nguyen T T Phuong
- Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang, Vietnam
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14
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Al-Kuraishy HM, Al-Gareeb AI, Atanu FO, El-Zamkan MA, Diab HM, Ahmed AS, Al-Maiahy TJ, Obaidullah AJ, Alshehri S, Ghoniem MM, Batiha GE. Maternal Transmission of SARS-CoV-2: Safety of Breastfeeding in Infants Born to Infected Mothers. Front Pediatr 2021; 9:738263. [PMID: 34956971 PMCID: PMC8696119 DOI: 10.3389/fped.2021.738263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/07/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a recent epidemic disease caused by severe acute respiratory syndrome virus type 2 (SARS-CoV-2). In pregnancy, SARS-Cov-2 infection creates additional alarm due to concerns regarding the potential for transmission from the mother to the baby during both the antenatal and postpartum times. In general, breastfeeding is seldom disallowed because of infection of the mother. However, there are few exceptions with regards to certain infectious organisms with established transmission evidence from mother to infant and the link of infection of a newborn with significant morbidity and mortality. It is confirmed that pregnant women can become infected with SARS-CoV-2, although the debate on the possible vertical transmission of SARS-CoV-2 infection during pregnancy is still open. In this regard, the literature is still poor. On the contrary, the information on the safety of breastfeeding even during infections seems reassuring when the mother takes the necessary precautions. However, there are still answered questions regarding the precautions to be taken during breastfeeding by COVID-19 patients. This paper reviews the existing answers to these and many other questions. This review therefore presents a summary of the present-day understanding of infection with SARS-CoV-2 and discusses the answers around the maternal transmission of COVID-19 and the potential threat of breastfeeding to babies born to infected pregnant mothers. In conclusion, intrauterine transmission of SARS-CoV-2 infection is less likely to occur during pregnancy. Most studies suggest that COVID-19 is not transmitted through breast milk. Correspondingly, COVID-19-infected neonates might acquire the infection via the respiratory route because of the postnatal contact with the mother rather than during the prenatal period. International organizations encourage breastfeeding regardless of the COVID-19 status of the mother or child as long as proper hygienic and safety measures are adhered to so as to minimize the chance of infant infection by droplets and direct contact with the infected mother. Pasteurized donor human milk or infant formula as supplemental feeding can be quite beneficial in the case of mother-infant separation till breastfeeding is safe.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyah University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyah University, Baghdad, Iraq
| | - Francis O Atanu
- Department of Biochemistry, Faculty of Natural Sciences, Kogi State University, Anyigba, Nigeria
| | - Mona A El-Zamkan
- Department of Food Hygiene and Control (Milk Hygiene), Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Hassan M Diab
- Department of Animal and Poultry Health and Environment, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Ahmed S Ahmed
- Department of Food Hygiene and Control (Milk Hygiene), Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Thabat J Al-Maiahy
- Department of Gynecology and Obstetrics, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Ahmad J Obaidullah
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed M Ghoniem
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah, Saudi Arabia
| | - Gaber E Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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16
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Parker MG, Burnham LA, Kerr SM, Belfort MB, Perrin MT, Corwin MJ, Heeren TC. National Prevalence of Donor Milk Use Among Level 1 Nurseries. Hosp Pediatr 2020; 10:1078-1086. [PMID: 33144332 DOI: 10.1542/hpeds.2020-001396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Donor milk use has increased among very preterm infants because of mounting evidence of health benefits; however, the extent that donor milk is used among healthy term infants in level 1 nurseries is unclear. We aimed to determine (1) national prevalence of and (2) hospital factors associated with donor milk use in level 1 nurseries. METHODS Among 3040 US birthing hospitals, we randomly selected hospitals from each of 4 US regions (119 in northeast, 120 in Midwest, 116 in west, and 103 in south) for a total of 458 hospitals. We surveyed the nursing leaders of these hospitals from October to December 2017 regarding routine use of donor milk in the level 1 nursery (yes or no). To estimate national prevalence, we weighted responses according to the number of birthing hospitals within each region. We examined relationships between routine donor milk use in the level 1 nursery and hospital characteristics using multivariable logistic regression. RESULTS In total, 214 of 458 (47%) nursing leaders responded. The national prevalence of routine donor milk use in level 1 nurseries was 17.6%. Eighty-five percent of donor milk programs were ≤5 years old. Donor milk use occurred more often in hospitals with ≥1500 annual births (41.7%), compared to ≤500 annual births (6.3%) (adjusted odds ratio 7.8; 95% confidence interval 1.8-34.4), and in the west (30.9%), compared to the northeast (10.5%) (adjusted odds ratio 4.1; 95% confidence interval [1.1-14.9]). CONCLUSIONS Although there is limited evidence to support donor milk for healthy infants in the nursery, nearly one-fifth of level 1 US nurseries routinely used donor milk in 2017.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center and School of Medicine and .,Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Laura A Burnham
- Department of Pediatrics, Boston Medical Center and School of Medicine and
| | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - Maryanne T Perrin
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Michael J Corwin
- Department of Pediatrics, Boston Medical Center and School of Medicine and.,Slone Epidemiology Center, Boston University, Boston, Massachusetts
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Abstract
The coronavirus disease (COVID-19) pandemic has ramifications for the delivery of newborn nutrition and care services. World Health Organization recommends continuation of breastfeeding in these difficult times, with due precautions. If direct breastfeeding is not possible, milk expression should be explored. Pasteurized donor human milk from milk banks may be fed if mother’s own milk is not available. To universalize access to human milk, the Indian government has proposed the establishment of comprehensive lactation management centers/milk banks, lactation management units, and lactation support units at all levels of the public health system. Due to COVID-19, these centers are encountering additional challenges cutting across interventions of rooming in, breastfeeding, milk expression, and provision of donor milk and kangaroo mother care. We discuss issues faced and alleviation measures taken by these centres in relation to provision of an exclusive human milk diet for infants during the pandemic.
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Affiliation(s)
- Ruchika Chugh Sachdeva
- Maternal, Newborn, Child Health and Nutrition, PATH, New Delhi, India. Correspondence to: Ruchika Chugh Sachdeva, Deputy Director, Maternal, Newborn, Child Health and Nutrition, PATH 15th Floor, Gopal Das Bhawan, Barakhamba Road New Delhi- 110001, India.
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Suchandra Mukherjee
- Department of Neonatology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Jai Singh
- Department of Neonatology, District Hospital Chittorgarh, Rajasthan, India
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