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Dupont C, Bocquet A, Brancato S, Chalumeau M, Darmaun D, de Luca A, Feillet F, Frelut ML, Guimber D, Lapillonne A, Linglart A, Peretti N, Roze JC, Siméoni U, Turck D, Chouraqui JP. Cow's milk-based infant formula supplements in breastfed infants and primary prevention of cow's milk allergy: A commentary of the Committee on Nutrition of the French Society of Pediatrics. Arch Pediatr 2023; 30:591-594. [PMID: 37709607 DOI: 10.1016/j.arcped.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/07/2023] [Indexed: 09/16/2023]
Abstract
The role of nutritional interventions for the primary prevention of cow's milk allergy (CMA) remains debated as well as the role of early introduction of allergenic foods, which is largely encouraged from the beginning of complementary feeding. Considering the introduction of cow's milk protein (CMP), current recommendations suggest avoidance of any cow's milk formula (CMF) supplements in breastfed infants in the maternity ward. By contrast, based on poor evidence, some authors support systematic supplements of CMP in breastfed children at risk of allergy from the first week of life. The Committee on Nutrition of the French Society of Pediatrics considers that such a proposal requires more clinical studies and mainly randomized and placebo-controlled clinical trials before becoming a recommendation.
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Affiliation(s)
- Christophe Dupont
- Paris Descartes University, Pediatric gastroenterology, Clinique Marcel Sembat, Ramsay Group, Boulogne Billancourt, France.
| | - Alain Bocquet
- French association of ambulatory paediatrics, France
| | - Sandra Brancato
- Institut de Recherche pour le Développement, Brignon, France
| | - Martin Chalumeau
- Paris Descartes University, APHP Necker-Enfants Malades hospital, Paris, France
| | | | - Arnaud de Luca
- Tours University and Inserm UMR 1069, 37000 Tours, France
| | | | | | - Dominique Guimber
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, INSERM U995, 59037 Lille, France
| | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades hospital, Paris, France; CNRC, Baylor College of Medicine, Houston, TX, USA
| | - Agnès Linglart
- Paris-Sud, University, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Noel Peretti
- Pediatric Nutrition, University Pediatric Hospital of Lyon and INSERM U1060, CarMeN laboratory; Claude Bernard Lyon-1 University, F-69008 France
| | - Jean-Christophe Roze
- Neonatology and pediatric intensive care unit, Univesity hospital of Nantes and UMR 1280 INRA, Nantes University. France
| | - Umberto Siméoni
- Division of Pediatrics and DOHaD Lab, Woman, Mother and Child Department, Centre Hospitalier Universitaire Vaudois (CHUV), 21 rue du Bugnon, 1011 Lausanne, Switzerland
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, INSERM U995, 59037 Lille, France
| | - Jean-Pierre Chouraqui
- Paediatric Division of Nutrition and Gastro-enterology, Pediatric Department, Grenoble-Alpes University Hospital (CHUGA), Grenoble, France
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Jones RA, Elhindi J, Lowe G, Henry L, Maheshwari R, Culcer MR, Pasupathy D, Melov SJ. Investigating short-stay admission to a neonatal intensive care unit as a risk factor for reduced breast feeding at discharge in infants ≥36 weeks' gestation: a retrospective cohort study. BMJ Open 2023; 13:e075658. [PMID: 37857543 PMCID: PMC10603420 DOI: 10.1136/bmjopen-2023-075658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE This study aims to determine the effect of infant-mother separation following a short-stay (≤72 hours) admission to a Level 5 neonatal unit versus no admission on infant-feeding outcomes at hospital discharge. DESIGN Retrospective cohort study. SETTING An Australian Level 5 neonatal unit within a tertiary referral hospital. PARTICIPANTS Mothers and their infants born between 1 January 2018 and 31 December 2020 had a short-stay admission to the neonatal unit or no admission. All participants met admission criteria to the postnatal ward and were discharged home at ≤72 hours (n=12 540). Postnatal ward admission criteria included ≥36 weeks' gestation and birth weight ≥2.2 kg. MAIN OUTCOME MEASURES Infant feeding at discharge from hospital. Multivariate logistic regression analysis was conducted, adjusting for confounders associated with known breastfeeding issues. These included age, ethnicity, parity, obesity, socioeconomic score, hypertensive disorders of pregnancy, diabetes, infant gestation and birthweight centile, caesarean section birth, postpartum haemorrhage and skin-to-skin contact. RESULTS Of the 12 540 live births meeting inclusion criteria, 1000 (8%) infants were admitted to the neonatal unit. The primary reasons for admission were suspicion of sepsis (24%), maternal diabetes (19%) and jaundice (16%). We found a reduction in full breast feeding at hospital discharge in cases of a short admission to the neonatal unit compared with no admission (aOR 0.40; 95% CI 0.34 to 0.47; p<0.001). We identified that women of different ethnicities had differing levels of risk for formula supplementation at hospital discharge. The ethnic grouping least likely to be fully breast feeding at discharge was Southeast Asian women (aOR 0.47; 95% CI 0.39 to 0.57; p<0.001). CONCLUSIONS Identifying mother-infant dyads at risk of non-exclusive breast feeding at hospital discharge will help target resources for practice improvement.
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Affiliation(s)
- Rachel Ann Jones
- Women's and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
| | - James Elhindi
- Reproduction and Perinatal Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Gemma Lowe
- Women's and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lynne Henry
- Women's and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rajesh Maheshwari
- Women's and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sarah J Melov
- Reproduction and Perinatal Centre, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
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Grzeskowiak LE, Saha MR, Ingman WV, Nordeng H, Ystrom E, Amir LH. Incidence, antibiotic treatment and outcomes of lactational mastitis: Findings from The Norwegian Mother, Father and Child Cohort Study (MoBa). Paediatr Perinat Epidemiol 2022; 36:254-263. [PMID: 34841537 DOI: 10.1111/ppe.12824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mastitis is a common and distressing maternal postpartum condition, but the relationship between mastitis timing and antibiotic treatment and breastfeeding outcomes and postnatal mental health is unclear. OBJECTIVES To describe the incidence of mastitis and treatment with antibiotics in first 6 months postpartum, and to investigate the impact of mastitis timing and antibiotic treatment on breastfeeding practices and postnatal mental health. METHODS This study is based on 79,985 mother-infant dyads in the Norwegian Mother, Father and Child Cohort Study (MoBa). Women were classified according to self-reported mastitis within first month ('early') or 1-6 months ('later') postpartum and antibiotic treatment. Breastfeeding outcomes included predominant or any breastfeeding and abrupt breastfeeding cessation until 6 months postpartum. Maternal mental health was assessed by self-report at 6 months postpartum. RESULTS The incidence of mastitis was 18.8%, with 36.8% reporting treatment with antibiotics. Women reporting early mastitis were less likely to report predominant breastfeeding (adjustedd relative risk [aRR] 0.92, 95% confidence interval [CI] 0.86, 0.99) and any breastfeeding for 6 months (aRR 0.97, 95% CI 0.96, 0.98) than women who did not report mastitis, and more likely to report abrupt breastfeeding cessation (aRR 1.37, 95% CI 1.23, 1.53). Late-onset mastitis was not associated with poorer breastfeeding outcomes. Among women reporting mastitis, the risk of abrupt breastfeeding cessation was higher in those also reporting antibiotic use. Mastitis was associated with an increased risk of mental health problems postpartum which was highest among those reporting no antibiotic use (aRR 1.29, 95% CI 1.18, 1.41), in contrast to those also reporting antibiotic use (aRR 1.08, 95% CI 0.96, 1.22). CONCLUSIONS Lactational mastitis and its associated treatment with antibiotics are common. Early (<1 month postpartum) mastitis appears to be a modest risk factor for suboptimal breastfeeding outcomes. In addition, mastitis is associated with poorer mental health.
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Affiliation(s)
- Luke E Grzeskowiak
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Moni R Saha
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Wendy V Ingman
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Eivind Ystrom
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department Mental Disorders, the Norwegian Institute of Public Health, Oslo, Norway.,PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia.,Breastfeeding Service, Royal Women's Hospital, Parkville, Victoria, Australia
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