Changes in breast skin temperature during the course of breastfeeding

Inaudible components of the human infant cry influence haemodynamic responses in the breast region of mothers

Distress vocalizations are fundamental for survival, and both sonic and ultrasonic components of such vocalizations are preserved phylogenetically among many mammals. On this basis, we hypothesized that ultrasonic inaudible components of the acoustic signal might play a heretofore hidden role in humans as well. By investigating the human distress vocalization (infant cry), here we show that, similar to other species, the human infant cry contains ultrasonic components that modulate haemodynamic responses in mothers, without the mother being consciously aware of those modulations. In two studies, we measured the haemodynamic activity in the breasts of mothers while they were exposed to the ultrasonic components of infant cries. Although mothers were not aware of ultrasounds, the presence of the ultrasounds in combination with the audible components increased oxygenated haemoglobin concentration in the mothers' breast region. This modulation was observed only when the body surface was exposed to the ultrasonic components. These findings provide the first evidence indicating that the ultrasonic components of the acoustic signal play a role in human mother-infant interaction.

Thermal physiology of the lactating nipple influences the removal of human milk

The nipple has a critical role in successful breastfeeding. Nipple trauma or pain may negatively impact breastfeeding duration which has significant public health implications. The aim of this study was to examine changes in nipple temperature during breastfeeding and pumping within participants. Thirty lactating women participated in two pumping (electric breast pump) and one breastfeeding session. Nipple temperature of both breasts was monitored for two minutes before and after each session with the non-pumped/non-suckled nipple temperature recorded throughout each session. The mean increase in nipple temperature after milk removal by the infant was 1.0 ± 1.6 °C (range −3.2–3.2) and after expression was 1.8 ± 1.4 °C (range −0.9–6.1). Nipple temperature pre expression was significantly lower than post expression (Pre 32.6 ± 1.6, Post 34.3 ± 1.3, p < 0.001) with no difference between the two pumping sessions. For every 1 °C rise in temperature an additional 10 mL of milk was removed on average. The breastfed nipple temperature was significantly lower pre feed than post feed (Pre 32.4 ± 1.6, Post 33.2 ± 1.2 p = 0.01) with a significant but smaller change in nipple temperaturecompared to pumping (Breastfeed 1.0 ± 1.6, Pumping 1.7 ± 1.4, p = 0.03). Nipple temperature increases during pumping and breastfeeding suggesting the breasts have a similar physiological response to different stimuli. Further, the increased temperature potentially plays a role in effective milk removal.

Cutaneous perfusion of the human lactating breast: a pilot study with laser Doppler perfusion monitoring

OBJECTIVE

Knowledge on the hemodynamics of the human lactating breast contributes to our understanding of lactation physiology, as well as the development and management of breastfeeding problems. The objective of this pilot study was to investigate whether laser Doppler perfusion monitoring (LDPM) can be employed to measure physiological changes in mammary cutaneous perfusion during milk extraction.

APPROACH

We evaluated mammary cutaneous perfusion with LDPM in nine lactating women during milk extraction in both the ipsilateral ('milk extracting') and contralateral ('passive') breast. Fourier domain filtering of the LDPM signal was applied to correct for the influence of the periodic tissue movement caused by the breast pump.

MAIN RESULTS

Cutaneous perfusion increased temporary during 23.7  ±  18.9 s by 18%-74% for all women who sensed their milk ejection reflex (n  =  6) in both the ipsilateral and contralateral breast. For those women who did not sense a milk ejection reflex (n  =  3), the changes in cutaneous perfusion were less outspoken (maximally 26%).

SIGNIFICANCE

This pilot study provides new insights into mammary hemodynamics and demonstrates that LDPM is a promising method for the further investigation of physiological changes in mammary cutaneous perfusion during milk ejection. Objective feedback on the occurrence and progression of milk ejection can support lactation research in general, maternal breastfeeding confidence, and may be an early indicator for the development of breastfeeding problems.

Effect of Timing of the First Bath on a Healthy Newborn's Temperature

OBJECTIVE

To determine if a healthy newborn's age in hours (3, 6, or 9 hours after birth) affects thermoregulatory status after the first bath as indicated by axillary and skin temperatures.

DESIGN

Quasi-experimental, mixed-model (between subjects and within subjects) design with hours of age as the nonrepeated variable and prebath and postbath temperatures as the repeated variables.

SETTING

Family-centered care unit at an urban hospital in the southwestern United States.

PARTICIPANTS

Healthy newborns (N = 75) 37 weeks or more completed gestation.

METHODS

Mothers chose time of first bath based on available time slots (n = 25 newborns in each age group). Research nurses sponge bathed the newborns in the mothers' rooms. Axillary temperature, an index of core temperature, was measured with a digital thermometer, and skin temperature, an index of body surface temperature, was measured with a thermography camera. Temperatures were taken before the bath; immediately after the bath; and 5, 30, 60, and 120 minutes after the bath. Immediately after the bath, newborns were placed in skin-to-skin care (SSC) for 60 or more minutes.

RESULTS

We found a difference (p = .0372) in axillary temperatures between the 3- and 9-hour age groups, although this difference was not clinically significant (0.18 °F [0.10 °C]). We found no statistically significant differences in skin temperatures among the three age groups. Regardless of age group, axillary and skin temperatures initially decreased and then recovered after the bath.

CONCLUSION

For up to 2 hours postbath, axillary and skin temperatures were not different between healthy newborns bathed at 3, 6, or 9 hours of age. Thermography holds promise for learning about thermoregulation, bathing, and SSC.

Does Changing Newborn Bath Procedure Alter Newborn Temperatures and Exclusive Breastfeeding?

PURPOSE

This evidence-based practice project evaluated effects of changing timing/character of initial newborn baths on infant temperatures and breastfeeding status.

BACKGROUND

The hospital protocol for initial bathing procedures was updated: immersion baths; 12 hours postpartum; family included.

METHODS

Staff nurse champions provided staff training. The evaluation included three seven-week periods (2016-2017) and three measures: adherence, temperature stabilization, and exclusive breastfeeding.

RESULTS

Of 1,205 38-week healthy newborns, 322 were born preimplementation (Pre), 486 after (Post), and 397 during maintenance (M). Adherence to bath timing increased and was maintained: 28 percent Pre; 83 percent Post; 85 percent M. Almost 100 percent of newborns had stable temperatures. Breastfeeding exclusivity rates did not change (ps greater than or equal to .05): baths less than 12 hours: 79 percent Pre, 74 percent Post, and 68 percent M; baths 12 hours: 68 percent Pre, 71 percent Post, and 73 percent M.

IMPLICATIONS

Changing bath time/character for healthy newborns maintained thermoregulation and exclusive breastfeeding rates. Nurses changed practice quickly, maintaining adherence over time.

Effect of warm breastshields on breast milk pumping

The effect of using a warm breastshield on the efficiency, effectiveness, and comfort of expressing milk with an electric breast pump was assessed. The authors tested a standard breastshield at 25°C and a breastshield warmed to 39°C on 25 mothers using their maximum comfortable vacuum or -125 mm Hg. Using a warm breastshield effectively warmed the nipple and areola and, combined with maximum comfortable vacuum, decreased the time to remove 80% of the total milk yield and increased the percentage of available milk removed after 5 minutes of expression, with no change in the percentage of available milk removed after 15 minutes of expression compared with an ambient-temperature breastshield. The data confirmed that use of the mother's maximum comfortable vacuum was more efficient than a vacuum of -125 mm Hg. Using a warm breastshield with an electric breast pump was comfortable and improved the efficiency of milk removal.

Latching-on and suckling of the healthy term neonate: breastfeeding assessment

Increasing breastfeeding duration and exclusivity is an acknowledged public health priority. Breastfeeding problems, especially with the healthy term neonate latching-on or feeding with a suboptimal latch, are common reasons for early breastfeeding termination when they result in inadequate breastfeeding, poor milk transfer, and sore nipples. This article describes clinical strategies for systematic latch-on and suckling assessment with the goal of improving the skills of clinicians who provide care for breastfeeding women.