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Zunza M, Young T, Cotton M, Slogrove A, Mbuagbaw L, Kuhn L, Thabane L. Evaluating interactive weekly mobile phone text messaging plus motivational interviewing for breastfeeding promotion among women living with HIV, giving normal birth at a primary healthcare facility in South Africa: a feasibility randomised controlled trial. BMJ Open 2023; 13:e073385. [PMID: 37816561 PMCID: PMC10565338 DOI: 10.1136/bmjopen-2023-073385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES We assessed the feasibility of an appropriately powered randomised trial by evaluating whether participants could be recruited and retained, and sought preliminary information on exclusive breastfeeding rates. SETTING Primary healthcare facility, serving a rural community. PARTICIPANTS Women initiating breast feeding within 24 hours of giving birth, on antiretroviral treatment and aged ≥18 years. INTERVENTIONS We randomised mother-infant pairs to receive weekly text messaging encouraging exclusive breast feeding plus in-person individual motivational interviews post partum at weeks 2, 6 and 10, or standard infant feeding counselling. OUTCOME MEASURES The feasibility endpoints included number of participants who consented to participate and number with complete evaluation of infant feeding practices at study visits. Exploratory endpoints included number of participants who exclusively breast fed at 24 weeks post partum and number of participants adhering to study protocol. RESULTS Of 123 mothers screened, 52 participants consented for participation. We recruited an average of five participants per month over 11 months. Most participants were unemployed (75%), had some high school education (84%) and had disclosed their HIV status to someone close (88%). About 65% participants completed outcome evaluation at week 10, decreasing to 35% at week 24. Twenty participants had the week 24 visit planned between 20 March and August 2020, during COVID-19 lockdown. Of these, 4 completed the visit telephonically, 16 were lost to follow-up. Exclusive breastfeeding rate remained relatively high across both groups through week 24. The difference in exclusive breastfeeding rates between the intervention and control groups was minimal: rate difference 22.2% (95% CI -20.1% to 64.5%). CONCLUSIONS With a large eligible target population, recruitment targets could be achieved for a large trial. Strategies to retain participants, such as remote monitoring and in-person follow-up visits, will be essential. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02949713) and Pan African Clinical Trial Registry (PACTR201611001855404).
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Affiliation(s)
- Moleen Zunza
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Taryn Young
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mark Cotton
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Amy Slogrove
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Lawrence Mbuagbaw
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Louise Kuhn
- Gertude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Lehana Thabane
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Improving Exclusive Breastfeeding Behavior of Primipara Mothers With Lactation Education and Individualized Counseling Intervention. CLINICAL LACTATION 2022. [DOI: 10.1891/cl-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IntroductionNew mothers often need support to establish and maintain breastfeeding, and they may find it difficult to access breastfeeding resources locally. Therefore, postpartum lactation education and counseling of primipara mothers were given by integrating into their routine follow-ups in the family health center. This study was conducted to determine the effect of lactation education and individual counseling intervention integrated into the routine follow-up visits of primipara mothers in family health centers on exclusive breastfeeding rates and breastfeeding behaviors during the first 6 months postpartum.MethodsA two-factor, pretest–posttest, controlled, semi-experimental, prospective study was conducted. The study was conducted in three family health centers in a city on the north coast of Turkey. The interviews with the primipara mothers were performed between the 24th and 72nd hours and at the 1st, 3rd, 4th, 6th months postpartum.ResultsThe rates of giving exclusive breastfeeding to the infants in the first 6 months were 68% in the study group and 38% in the control group, exhibiting a statistically significant difference between the groups with regard to breastfeeding frequency (p =.001).ConclusionsIt was determined that the education and counseling integrated into the existing health system were effective in increasing the EBF rates and breastfeeding behaviors of primipara mothers in the first 6 months after birth.
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Ahmed KY, Agho KE, Page A, Arora A, Ogbo FA. Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review. BMJ Open 2021; 11:e048700. [PMID: 34400457 PMCID: PMC8370540 DOI: 10.1136/bmjopen-2021-048700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE In Ethiopia, despite the implementation of several interventions to improve infant and young child feeding (IYCF) practices, no published studies have highlighted the most effective IYCF interventions in the country. This systematic review investigated the impacts of various interventions on IYCF in Ethiopia. SOURCE OF INFORMATION A systematic search was conducted on seven computerised bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) to locate experimental or quasi-experimental studies published between the year 2000 and May 2021. STUDY ELIGIBILITY CRITERIA Interventional studies that measured IYCF indicators (early initiation of breast feeding (EIBF), exclusive breast feeding (EBF), the introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet) as outcome variables were included. STUDY APPRAISAL AND SYNTHESIS All included studies were examined for biases related to interventional studies (ie, selection bias, performance bias, attrition bias, detection bias and reporting bias). Author reports of effect size measures were used to narratively report the findings of each study. RESULTS Of the 23 eligible studies, 14 studies were quasi-experimental and 9 studies were cluster randomised trials (CRTs). Eight quasi-experimental studies had a serious risk of bias, while two CRTs had a high risk of bias. Four studies for EBF and six studies for EIBF showed significant impacts of policy advocacy, health service strengthening, interpersonal communication, community mobilisation and mass media campaigns. Six studies for MDD and three studies for MMF indicated significant effects of community-level and health facility complementary feeding promotions on infants and young children. Interventions that delivered in combination increased the impacts in improving EIBF, MDD and MMF compared with a single intervention. CONCLUSION Our review showed that 12 out of 21 eligible studies that implemented in the form of community-level and health facility interventions improved EIBF, EBF, and/or MDD in Ethiopia. PROTOCOL REGISTRATION NUMBER PROSPERO, CRD42020155519.
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Affiliation(s)
- Kedir Y Ahmed
- Department of Public Health, Samara University, Samara, Afar, Ethiopia
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- School of Health Sciences, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- School of Health Sciences, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- Oral Health Services, Sydney Dental Hospital, Surry Hills, New South Wales, Australia
- Health Equity Laboratory, Campbelltown, New South Wales, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
- Barmera Medical Clinic (Lake Bonney Private Medical Clinic), Barmera, South Australia, Australia
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Benova L, Siddiqi M, Abejirinde IOO, Badejo O. Time trends and determinants of breastfeeding practices among adolescents and young women in Nigeria, 2003-2018. BMJ Glob Health 2021; 5:bmjgh-2020-002516. [PMID: 32764127 PMCID: PMC7412589 DOI: 10.1136/bmjgh-2020-002516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/27/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Optimal breastfeeding practices have far-reaching health and economic benefits. Evidence suggests disparities in breastfeeding practices by maternal age-groups, with younger mothers often having lower rates of breastfeeding initiation, continuation and exclusivity compared with older mothers. There is limited knowledge of trends and factors associated with breastfeeding practices, particularly among adolescent and younger mothers in Nigeria. We examine key breastfeeding practices in Nigeria over a 15-year period, comparing adolescent mothers to young women. Methods We used four Nigeria Demographic and Health Surveys collected between 2003 and 2018. We constructed six key breastfeeding indicators to cover the time period of breastfeeding from initiation to child age 24 months in women of three maternal age groups at the time of birth: young adolescents (<18 years), older adolescents (18–19.9 years) and young women (20–24.9 years). We used logistic regression to examine the association between maternal age group and select breastfeeding behaviours on the 2018 survey. Results Analysis showed an increase in optimal breastfeeding practices across the four surveys and among all maternal age groups examined. Adolescent mothers had consistently lower prevalence for three of the six key breastfeeding indicators: early initiation of breastfeeding, exclusive breastfeeding <6 months and no prelacteal feed. Compared with young women, adolescent mothers had a higher prevalence of continued breastfeeding at 1 and 2 years. In multivariate analysis, we found that maternal age group was not associated with early breastfeeding initiation or with exclusive breastfeeding <6 months. However, several sociodemographic (ethnicity, region of residence) and healthcare-related (mode of delivery, antenatal care, postnatal breastfeeding counselling) factors were strongly associated with these two practices. Conclusions In Nigeria, there is need to better support breastfeeding and nutritional practices in adolescents and young women focusing on ethnic groups (Hausa, Fulani, Kanuri/Beriberi) and geographic regions (South East) that are lagging behind.
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Affiliation(s)
- Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Manahil Siddiqi
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | | | - Okikiolu Badejo
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Baker R, Evans E, Fielden A, Arnott B. Healthcare professionals' perspectives on infant feeding support in paediatric inpatients: single-centre qualitative study. BMJ Paediatr Open 2021; 5:e001247. [PMID: 34746446 PMCID: PMC8559122 DOI: 10.1136/bmjpo-2021-001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/03/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To provide information on baseline knowledge, skills and attitudes (KSA) of paediatric staff to formulate a plan for improving infant feeding support in hospitals. DESIGN Semistructured interviews assessed baseline infant feeding KSA and experiences in 14 paediatric health professionals of various grades (medical students, healthcare assistants, ward nurses and specialist nurses). Audio recordings were transcribed verbatim and underwent thematic analysis. An online questionnaire gathered descriptive statistics about participants. SETTING A single large hospital trust, North East England. RESULTS Seven major themes were identified in KSA: culture and trends, roles and working practice, training and resources, the health professional, understanding the parent, effective communication and the challenges of feeding the ill child.Staff discussed various organisational and personal barriers to acquiring infant feeding support training and experience, and to delivering feeding support. Staff were keen to support families with feeding but often felt constrained by a belief that this required specialist knowledge and skills. Although staff believed they actively promoted breastfeeding-friendly messages, it was evident that marketing communications and personal experiences inadvertently influenced their approach to families. CONCLUSIONS The development of clear, evidence-based infant feeding education and training for paediatric staff delivered by experienced mentors is warranted. Training should cover background theory, delivering practical support, communication skills and creating a baby-friendly hospital environment. UNICEF Baby Friendly Standards would be suitable to inform content. Training is likely to be received positively by staff and benefit women and babies in this setting.
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Affiliation(s)
- Rosie Baker
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Amy Fielden
- Newcastle University, Newcastle upon Tyne, UK
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Rabbani A, Padhani ZA, A Siddiqui F, Das JK, Bhutta Z. Systematic review of infant and young child feeding practices in conflict areas: what the evidence advocates. BMJ Open 2020; 10:e036757. [PMID: 32928852 PMCID: PMC7488834 DOI: 10.1136/bmjopen-2020-036757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/16/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Breast feeding in conflict settings is known to be the safest way to protect infant and young children from malnourishment and increased risk of infections. This systematic review assesses the evidence on infant and young child feeding (IYCF) practices in conflict settings. METHODOLOGY We conducted a search in PubMed and CENTRAL and also searched for grey literature from the year 1980 to August 2019. We included studies conducted in settings inflicted with armed conflict; which comprised settings undergoing conflict, as well as, those within 5 years of its cessation. Studies were included if they discussed IYCF practices, barriers, programmes and guidelines to promote and improve IYCF practices. Two review authors independently evaluated and screened studies for eligibility and extracted data; followed by a descriptive and thematic analysis. RESULTS We included 56 studies in our review including 11 published articles and 45 reports from grey literature and broadly classified into four predetermined sections: epidemiology (n=24), barriers/enablers (n=18), programmes/interventions (n=15) and implementation guidelines (n=30). Epidemiological evidence shows that IYCF practices were generally poor in conflict settings with median prevalence of exclusive breast feeding at 25%, continued breast feeding at 29%, bottle feeding at 58.3%, introduction to solid, semisolid or soft foods at 71.1% and minimum dietary diversity at 60.3%.IYCF practices were affected by displacement, stress, maternal malnutrition and mental health, family casualties and free distribution of breast milk substitutes. To improve IYCF, several interventions were implemented; including, training of health workers, educating mothers, community networking and mobilisation, lactation-support service, baby friendly hospital initiative, mother-baby friendly spaces and support groups. CONCLUSION The evidence suggests that IYCF practices are generally poor in conflict inflicted settings. However, there is potential for improvement by designing effective interventions, responsibly disseminating, monitoring and implementing IYCF guidelines as prescribed by WHO development partners, government and non-government organisations with dedicated funds and investing in capacity development.
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Affiliation(s)
- Amna Rabbani
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Zahra A Padhani
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Faareha A Siddiqui
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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Mogensen N, Portman A, Mitchell K. Nonpharmacologic Approaches to Pain, Engorgement, and Plugging in Lactation: Applying Physical Therapy Techniques From Breast Cancer Care to Breastfeeding Patients. CLINICAL LACTATION 2020. [DOI: 10.1891/2158-0782.11.1.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IntroductionBreast and nipple pain is one of the most common reasons why mothers stop breastfeeding earlier than recommended. Once conditions such as subacute mastitis, oversupply, and dermatitis have been treated or ruled out, functional breast pain may persist.ReviewWe describe validated physical therapy techniques that may reduce chronic pain in breastfeeding. These techniques include lymphatic massage, reverse-pressure softening, kinesiology taping, neural mobilization, cupping, and therapeutic ultrasound.ConclusionWhile more commonly used in the breast cancer population after radiation and surgery, we propose these techniques may also prove efficacious in breastfeeding patients as well.
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Durmazoğlu G, Yenal K, Okumuş H. Maternal Emotions and Experiences of Mothers Who Had Breastfeeding Problems: A Qualitative Study. Res Theory Nurs Pract 2020; 34:3-20. [PMID: 31937633 DOI: 10.1891/1541-6577.34.1.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Many women are ceasing to breastfeed in the early period due to the breastfeeding problems and difficulties they perceive. Consequently, the approach and support of health professionals to mothers in the post-partum period is very important. The objective of the study is to determine the emotions and experiences of mothers who had breastfeeding problems by using Watson's Theory of Human Caring. METHODS The research is a descriptive and qualitative type of study. The data were collected from 20 women with the semi-structured interview method based on Watson's Theory. The data were analyzed according to the Caritas Processes of Watson's Theory. RESULTS It was determined that the health professionals did not show enough assistance, support and interest to the mothers who had breastfeeding problems and that the mothers expected respect, empathy, sincerity, understanding, trust, and assistance during this period. IMPLICATION FOR PRACTICE The use of the interview methods based on Watson's Theory of Human Caring in the determination of the difficulties and emotions experienced by the women who had breastfeeding problems will be a guide for the health professionals. It is thought that the approaches based on Watson's Caritas Processes that would be made to women who had breastfeeding problems would be effective for understanding their experience and emotions.
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Affiliation(s)
- Gamze Durmazoğlu
- Turkey Republic Health Ministry, Health Sciences University Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Kerziban Yenal
- School of Health, Nursing Department, European University of Lefke, Lefke, Turkish Republic of Northern Cyprus
| | - Hülya Okumuş
- Dokuz Eylul University Faculty of Nursing, İzmir, Turkey
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Higgins JPT, López-López JA, Becker BJ, Davies SR, Dawson S, Grimshaw JM, McGuinness LA, Moore THM, Rehfuess EA, Thomas J, Caldwell DM. Synthesising quantitative evidence in systematic reviews of complex health interventions. BMJ Glob Health 2019; 4:e000858. [PMID: 30775014 PMCID: PMC6350707 DOI: 10.1136/bmjgh-2018-000858] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022] Open
Abstract
Public health and health service interventions are typically complex: they are multifaceted, with impacts at multiple levels and on multiple stakeholders. Systematic reviews evaluating the effects of complex health interventions can be challenging to conduct. This paper is part of a special series of papers considering these challenges particularly in the context of WHO guideline development. We outline established and innovative methods for synthesising quantitative evidence within a systematic review of a complex intervention, including considerations of the complexity of the system into which the intervention is introduced. We describe methods in three broad areas: non-quantitative approaches, including tabulation, narrative and graphical approaches; standard meta-analysis methods, including meta-regression to investigate study-level moderators of effect; and advanced synthesis methods, in which models allow exploration of intervention components, investigation of both moderators and mediators, examination of mechanisms, and exploration of complexities of the system. We offer guidance on the choice of approach that might be taken by people collating evidence in support of guideline development, and emphasise that the appropriate methods will depend on the purpose of the synthesis, the similarity of the studies included in the review, the level of detail available from the studies, the nature of the results reported in the studies, the expertise of the synthesis team and the resources available.
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Affiliation(s)
- Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Betsy J Becker
- Department of Educational Psychology and Learning Systems, College of Education, Florida State University, Tallahassee, Florida, USA
| | - Sarah R Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Luke A McGuinness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa H M Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Collaboration for Leadership in Applied Health Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - James Thomas
- EPPI-Centre, Department of Social Science, University College London, London, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Bingham A, Laptook AR. Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Campbell T, Shackleton N. Pre-pregnancy body mass index and breastfeeding initiation, early cessation and longevity: evidence from the first wave of the UK Millennium Cohort Study. J Epidemiol Community Health 2018; 72:1124-1131. [DOI: 10.1136/jech-2017-209074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/20/2018] [Accepted: 08/17/2018] [Indexed: 11/04/2022]
Abstract
BackgroundInternational evidence indicates relationships between pre-pregnancy body mass index (BMI) and breastfeeding behaviours. This study aims to assess associations between key points in the breastfeeding trajectory (initiation, early cessation and longevity) and pre-pregnancy BMI in a recent, nationally representative British cohort. It also aims to explore in the British context potential moderation by mothers’ ethnic group.MethodsThe sample comprises 17 113 mothers from the UK Millennium Cohort Study who have information on pre-pregnancy BMI. Associations between pre-pregnancy BMI categories and breastfeeding initiation, early cessation and longevity are tested using logistic regression. Directed acyclic graphics identify appropriate minimal adjustment to block biasing pathways and classify total and direct effects.ResultsAfter adjusting for confounders, there are large differences in breastfeeding early cessation and longevity by pre-pregnancy BMI group. Differences in propensity to initiation are negligible. Having begun breastfeeding, overweight and obese mothers are more likely to cease in the first week and less likely to continue past 4 months. Observed potential mediators within pregnancy and delivery provide little explanation for relationships. Evidence for moderation by ethnicity is scant.ConclusionsThe causal mechanisms underlying relationships between pre-pregnancy overweight, obesity, and breastfeeding behaviours require further research. However, this study suggests pre-pregnancy BMI as one predictive measure for targeting support to women less likely to establish breastfeeding in the early days, and to continue beyond 4 months. The nature of support should carefully be considered and developed, with mind to both intended and potential unintended consequences of intervention given the need for additional investigation into the causes of associations.
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McAdams RM, Juul SE. Neonatal Encephalopathy: Update on Therapeutic Hypothermia and Other Novel Therapeutics. Clin Perinatol 2016; 43:485-500. [PMID: 27524449 PMCID: PMC4987711 DOI: 10.1016/j.clp.2016.04.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neonatal encephalopathy (NE) is a major cause of neonatal mortality and morbidity. Therapeutic hypothermia (TH) is standard treatment for newborns at 36 weeks of gestation or greater with intrapartum hypoxia-related NE. Term and late preterm infants with moderate to severe encephalopathy show improved survival and neurodevelopmental outcomes at 18 months of age after TH. TH can increase survival without increasing major disability, rates of an IQ less than 70, or cerebral palsy. Neonates with severe NE remain at risk of death or severe neurodevelopmental impairment. This review discusses the evidence supporting TH for term or near term neonates with NE.
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