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Abramson J, Szatkowski L, Bains M, Orton E, Budge H, Spruce M, Ojha S. Effects of implementation of a care bundle on rates of necrotising enterocolitis and own mother's milk feeding in the East Midlands: protocol for a mixed methods impact and process evaluation study. BMJ Open 2024; 14:e078633. [PMID: 38816042 PMCID: PMC11141194 DOI: 10.1136/bmjopen-2023-078633] [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: 08/08/2023] [Accepted: 02/29/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Prevention of necrotising enterocolitis (NEC) is vital for improving neonatal outcomes. Feeding own mother's milk helps prevent NEC. Rates of own mother's milk feeding in the East Midlands are lower than the national average and the incidence of NEC is higher. The East Midlands Neonatal Operational Delivery Network (EMNODN) has created a care bundle to improve these in babies born at <32 weeks' gestation, the group at the highest risk of NEC. The bundle was introduced in September 2022 and embedded by December 2022. We will evaluate its effectiveness and conduct a process evaluation to understand barriers and facilitators to implementation. METHODS AND ANALYSIS We will conduct a retrospective cohort study (workstream 1) using data from the National Neonatal Research Database (NNRD). We will identify infants receiving any own mother's milk on day 14 and at discharge, and cases of severe NEC. We will aggregate outcomes by birth month and use interrupted time series analysis to estimate an incidence rate ratio for changes after the care bundle was embedded, relative to pre-implementation. We will model data from all other NNRD units and assess whether there are any concurrent changes to exclude confounding due to other events.We will apply the RE-AIM framework (workstream 2), supplemented by the Consolidated Framework for Implementation Research and Framework for Implementation Fidelity, to conduct a mixed methods evaluation in EMNODN units. We will triangulate data from several sources, including questionnaires and semistructured interviews with parents and healthcare professionals, and data from patient records. ETHICS AND DISSEMINATION The study has approval from the South East Scotland Research Ethics Committee 01 and the Health Research Authority and Health and Care Research Wales (IRAS 323099). Results will be disseminated via scientific journals and conferences, to neonatal service commissioners and through public-facing infographics. TRIAL REGISTRATION NUMBER NCT05934123.
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Affiliation(s)
- Janine Abramson
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lisa Szatkowski
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Manpreet Bains
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Elizabeth Orton
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Helen Budge
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Shalini Ojha
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Liu Y, Yu X, Zhang G, Xie C, Li Y, Mu P, Chen S, Chen Y, Huang S. Preterm Birth and Infantile Appendicitis. Pediatrics 2023; 152:e2023063815. [PMID: 38018230 DOI: 10.1542/peds.2023-063815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To investigate the potential association between preterm birth and infantile appendicitis. METHODS We conducted a retrospective, multicenter, matched case-control study. This study included consecutive patients <1 year of age with surgery- or autopsy-confirmed appendicitis, admitted between December 2007 and May 2023. For each case, 10 healthy infants were randomly selected and matched by age. Infants were categorized as neonates (0 to 28 days) or older infants (>28 days and <1 year). RESULTS The study included 106 infants diagnosed with appendicitis (median age 2.4 months) and 1060 age-matched healthy controls. In the univariate analysis, preterm birth was significantly associated with the development of appendicitis within the first year of life (odds ratio [OR], 4.23; 95% confidence interval [CI], 2.67-6.70). Other factors associated with a higher risk of infantile appendicitis included being male (OR, 1.91; 95%CI, 1.25-2.94), weight-for-age z-score (OR, 0.72; 95%CI, 0.64-0.81), and exclusively fed on formula (OR, 2.95; 95%CI, 1.77-4.91). In multivariable analyses, preterm remained significantly associated with appendicitis (adjusted OR, 3.32; 95%CI, 1.76-6.24). Subgroup analysis revealed that a preterm birth history increased the risk of appendicitis in both neonates (adjusted OR, 4.56; 95%CI, 2.14-9.71) and older infants (adjusted OR, 3.63; 95%CI, 1.72-7.65). However, preterm did not significantly influence the incidence of appendiceal perforation. CONCLUSIONS Preterm infants have an increased risk of appendicitis during the first year of life. A preterm birth history may help improve the timely diagnosis of infantile appendicitis.
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Affiliation(s)
- Yakun Liu
- General Surgery Department, Children's Hospital of Soochow University, Soochow, Jiangsu, China
| | - Xiaoxiao Yu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Guoqing Zhang
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Chuanping Xie
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yang Li
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Pengfei Mu
- Department of Neonatal Surgery, Jinan Children's Hospital, Jinan, Shandong, China
- Department of Pediatric Surgery, Children's Hospital of Shandong University, Jinan, Shandong, China
| | - Shuai Chen
- Department of Neonatal Surgery, Jinan Children's Hospital, Jinan, Shandong, China
- Department of Pediatric Surgery, Children's Hospital of Shandong University, Jinan, Shandong, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shungen Huang
- General Surgery Department, Children's Hospital of Soochow University, Soochow, Jiangsu, China
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Amoo TB, Popoola T, Lucas R. Promoting the practice of exclusive breastfeeding: a philosophic scoping review. BMC Pregnancy Childbirth 2022; 22:380. [PMID: 35501834 PMCID: PMC9063230 DOI: 10.1186/s12884-022-04689-w] [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] [Received: 12/01/2021] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background The World Health Organization recommends exclusive breastfeeding for the first 6 months of an infant’s life and continued breastfeeding for 2 years. The global rate of exclusive breastfeeding is low at 33%. Thus, it is important to identify philosophical and theory-based strategies that can promote exclusive breastfeeding. The aim of the study was to identify philosophical schools of thought and theories used in research on promoting the practice of exclusive breastfeeding. Methods A scoping review using Arksey and O'Malley's framework explored the phenomenon of exclusive breastfeeding practice promotion. Searches were conducted using CINAHL Plus full-text, PubMed, APA PsycInfo, and Academic Search Premier. Search terms included theory, philosophy, framework, model, exclusive breastfeeding, promotion, support, English, and publication between 2001—2022. Results The online search yielded 1,682 articles, however, only 44 met the inclusion criteria for the scoping review. The articles promoting exclusive breastfeeding used pragmatism (n = 1) or phenomenology (n = 2) philosophies and theories of self-efficacy (n = 10), theory of planned behaviour (n = 13), social cognitive theories (n = 18) and represented 16 countries. Theories of self-efficacy and planned behaviour were the most used theories. Conclusions This review suggests that theories and models are increasingly being used to promote exclusive breastfeeding. Orienting exclusive breastfeeding programmes within theoretical frameworks is a step in the right direction because theories can sensitize researchers and practitioners to contextually relevant factors and processes appropriate for effective exclusive breastfeeding strategies. Future research should examine the efficacy and effectiveness of theory-informed exclusive breastfeeding programmes over time. Such information is important for designing cost-effective EBF programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04689-w.
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Affiliation(s)
| | - Tosin Popoola
- School of Nursing, Victoria University of Wellington, Wellington, New Zealand
| | - Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, CT, USA
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4
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Jandová M, Měřička P, Fišerová M, Landfeld A, Paterová P, Hobzová L, Jarkovská E, Kacerovský M, Houška M. Quantitative Risk Assessment of Bacillus cereus Growth during the Warming of Thawed Pasteurized Human Banked Milk Using a Predictive Mathematical Model. Foods 2022; 11:foods11071037. [PMID: 35407124 PMCID: PMC8997632 DOI: 10.3390/foods11071037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023] Open
Abstract
Bacillus cereus is relatively resistant to pasteurization. We assessed the risk of B. cereus growth during warming and subsequent storage of pasteurized banked milk (PBM) in the warmed state using a predictive mathematical model. Holder pasteurization followed by storage below −18 °C was used. Temperature maps, water activity values, and B. cereus growth in artificially inoculated PBM were obtained during a simulation of manipulation of PBM after its release from a Human Milk Bank. As a real risk level, we chose a B. cereus concentration of 100 CFU/mL; the risk was assessed for three cases: 1. For an immediate post-pasteurization B. cereus concentration below 1 CFU/mL (level of detection); 2. For a B. cereus concentration of 10 CFU/mL, which is allowed in some countries; 3. For a B. cereus concentration of 50 CFU/mL, which is approved for milk formulas. In the first and second cases, no risk was detected after 1 h of storage in the warmed state, while after 2 h of storage, B. cereus concentrations of 102 CFU/mL were occasionally encountered. In the third case, exceeding the B. cereus concentration of 102 CFU/mL could be regularly expected after 2 h of storage. Based on these results, we recommend that post-pasteurization bacteriological analysis be performed as recommended by the European Milk Bank Association (EMBA) and using warmed PBM within 1 h after warming (no exceptions).
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Affiliation(s)
- Miroslava Jandová
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
- Department of Histology and Embryology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic
- Correspondence: ; Tel.: +420-739-569-340
| | - Pavel Měřička
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
| | - Michaela Fišerová
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
| | - Aleš Landfeld
- Food Research Institute Prague, 102 00 Prague, Czech Republic; (A.L.); (M.H.)
| | - Pavla Paterová
- Department of Clinical Microbiology, University Hospital Hradec Králové, 500 05 and Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic;
| | - Lenka Hobzová
- Department of Hospital Hygiene, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Eva Jarkovská
- Department of Pediatrics, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Marian Kacerovský
- Department of Obstetrics and Gynecology, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Milan Houška
- Food Research Institute Prague, 102 00 Prague, Czech Republic; (A.L.); (M.H.)
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Flacking R, Tandberg BS, Niela-Vilén H, Jónsdóttir RB, Jonas W, Ewald U, Thomson G. Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review. Int Breastfeed J 2021; 16:88. [PMID: 34838104 PMCID: PMC8627052 DOI: 10.1186/s13006-021-00435-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Most qualitative research on breastfeeding the preterm or low-birthweight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants. Methods A systematic review using meta-ethnographic methods was conducted. Search strategies involved a comprehensive search strategy on six bibliographic databases, citation tracking and reference checking. The analysis involved a reciprocal level of translation and a line of argument synthesis. Results Searches identified 1774 hits and 17 articles from 14 studies were included, representing the views of 697 mothers. A positive breastfeeding experience was identified as being ‘attuned’. Three themes and eight sub-themes were developed to describe what characterizes attuned breastfeeding. ‘Trusting the body and what it can do’, concerned how attuned breastfeeding was facilitated through understanding the bodily responses and capacity and feeling comfortable with holding the infant and to breastfeed. ‘Being emotionally present – in the here and now’ described the importance of feeling relaxed and reassured. ‘Experiencing mutual positive responses’, illuminated how attunement was related to feelings of mutuality - when the mother recognises the infant’s cues, responds to these signals and receives a positive response from the infant. The key factors to facilitate attuned breastfeeding were opportunities for prolonged close physical contact with the infant, positive relationships with and support from staff and peers, and being facilitated to breastfeed when the infant showed feeding cues. Conclusions This study provides new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units’ design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother’s physical and emotional states and the infant’s behavioural responses and physiological signals should guide the process towards positive breastfeeding practices.
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Affiliation(s)
- Renée Flacking
- School of Health and Welfare, Dalarna University, Falun, Sweden.
| | - Bente Silnes Tandberg
- Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
| | | | - Rakel B Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Uwe Ewald
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gill Thomson
- School of Health and Welfare, Dalarna University, Falun, Sweden.,School of Community Health & Midwifery, Maternal and Infant Nutrition and Nurture (MAINN) research unit, University of Central Lancashire, Preston, UK
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6
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Aros-Vera F, Chertok IRA, Melnikov S. Emergency and disaster response strategies to support mother-infant dyads during COVID-19. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2021; 65:102532. [PMID: 34458086 PMCID: PMC8386097 DOI: 10.1016/j.ijdrr.2021.102532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Accepted: 08/21/2021] [Indexed: 06/06/2023]
Abstract
The COVID-19 pandemic has produced an unprecedented global health crisis. Vulnerable populations, such as breastfeeding mother-infant dyads, are in a particularly delicate situation. Before, during, and after birth mothers and their infants could be exposed to the virus. Due to fear of infection transmission, there has been an increase in separation of COVID-positive mothers and their infants and a decline in breastfeeding, despite research supporting the provision of mother's milk for her infant. During this crisis, evidence-based education counseling and resources can support healthful infant feeding which is necessary for short- and long-term infant growth and development. Using a framework of disaster preparedness and response, we delineate operational guidelines and policy recommendations to support maternal-infant dyads during the COVID pandemic outbreak. Key recommendations include promotion of breastfeeding and milk expression, avoiding the use of formula, engaging healthcare providers in supporting lactation, and incorporating evidence-based breastfeeding and lactation protocols and practices in disaster preparedness and disaster response plans.
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Affiliation(s)
- Felipe Aros-Vera
- Department of Industrial and Systems Engineering, Ohio University, 1 Ohio University, Athens, OH, 45701, USA
| | - Ilana R Azulay Chertok
- Associate Director of Nursing Research and Scholarship, Ohio University, 1 Ohio University, Athens, OH, 45701, USA
| | - Semyon Melnikov
- Department of Nursing, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Abstract
Mother's own milk (MOM) feeding is a cost-effective strategy to reduce risks of comorbidities associated with prematurity and improve long-term health of infants hospitalized in the Neonatal Intensive Care Unit (NICU). Significant racial and socioeconomic disparities exist in MOM provision in the NICU, highlighting the importance of developing strategies to reduce these disparities. Mothers of infants in the NICU experience many health concerns which may negatively impact lactation physiology. Objective measures of lactation physiology are limited but may assist in identifying mothers at particular risk. Several strategies to assist mothers of hospitalized infants are essential, including maternal education, qualified lactation professionals, early and frequent milk expression with a hospital-grade double electric breast pump, and providing support for transitioning to direct breastfeeding prior to discharge from the NICU.
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Quitadamo PA, Palumbo G, Cianti L, Lurdo P, Gentile MA, Villani A. The Revolution of Breast Milk: The Multiple Role of Human Milk Banking between Evidence and Experience-A Narrative Review. Int J Pediatr 2021; 2021:6682516. [PMID: 33623528 PMCID: PMC7872774 DOI: 10.1155/2021/6682516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 02/05/2023] Open
Abstract
The review recalls the importance of breast milk and deepens the theme of human milk banking, a virtuous reality that is expanding all over the world but is still little known. In the last 15 years, modern biological technologies have crystallized the concept of uniqueness and irreproducibility of human milk, by establishing three new principles: first: human milk: a "life-saving" drug; second: human milk: the best food for preterm infants; and third: human milk: the main component of premature infant care. Our experience teaches us that human milk banking plays many roles that need to be known and shared.
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Affiliation(s)
- Pasqua Anna Quitadamo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Giuseppina Palumbo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Liliana Cianti
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Paola Lurdo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Maria Assunta Gentile
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Villani
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
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Mansen K, Nguyen TT, Nguyen NQ, Do CT, Tran HT, Nguyen NT, Mathisen R, Nguyen VD, Ngo YTK, Israel-Ballard K. Strengthening Newborn Nutrition Through Establishment of the First Human Milk Bank in Vietnam. J Hum Lact 2021; 37:76-86. [PMID: 32833551 PMCID: PMC7907997 DOI: 10.1177/0890334420948448] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tuan T Nguyen
- 1311 Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | | | - Chung T Do
- Alive & Thrive Southeast Asia, FHI 360, Danang, Vietnam
| | - Hoang T Tran
- Danang Hospital for Women and Children, Danang, Vietnam
| | | | - Roger Mathisen
- 1311 Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | - Vinh D Nguyen
- Maternal and Child Health Department, Vietnam Ministry of Health, Hanoi, Vietnam
| | - Yen T K Ngo
- Danang Department of Health, Danang, Vietnam
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10
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Bramer S, Boyle R, Weaver G, Shenker N. Use of donor human milk in nonhospitalized infants: An infant growth study. MATERNAL AND CHILD NUTRITION 2021; 17:e13128. [PMID: 33404169 PMCID: PMC7988867 DOI: 10.1111/mcn.13128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
When mother's own milk (MOM) is unavailable or insufficient, donor human milk (DHM) is recommended as the next best alternative for low birthweight infants. DHM use for healthy, term infants is increasing, but evidence for growth and tolerability is limited. This retrospective study evaluated growth in term infants in the community who received DHM from a UK milk bank. Mothers of infants receiving DHM between 2017 and 2019 were contacted (n = 49), and 31 (63.2%) agreed to participate. Fourteen infants received DHM as a supplement to other feeds (MOM and/or infant formula) and 17 were exclusively fed DHM where breastfeeding was impossible (range: 3–6 weeks). Growth was assessed by deriving z‐scores using the WHO standard for infant growth and compared with 200 exclusively breastfed infants. Multivariate regression analysis revealed no feeding method‐specific association between z‐score and age, nor between weight and age, suggesting that z‐scores and growth velocity were not affected by feeding exclusive MOM, supplemental DHM or exclusive DHM. DHM was well‐tolerated with no adverse events that led to early cessation. After receiving supplemental DHM group, 63% of infants whose mothers had no physical barrier to breastfeeding (5/8 infants) were exclusively breastfed. This novel study reports adequate growth outcomes of healthy nonhospitalized infants receiving DHM, either as the sole milk source or supplement. Prospective studies are needed to confirm whether DHM is a suitable feeding alternative for term infants in the community, optimal durations, as well as the impact of DHM availability on breastfeeding rates and maternal mental health. DHM recipients were compared with the who infant growth standard (World Health Organization, 2020) by deriving z‐scores. The WHO Anthro Macro (World Health Organization, 2011 ) was used to calculate weight‐for‐age, length‐for‐age and head circumference‐for‐age z‐scores; z‐scores are the standard deviation of an infant's anthropometric measurements when compared with the WHO standard for infant growth and are gender and age specific.
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Affiliation(s)
- Solange Bramer
- Imperial College London Medical School, St Mary's Hospital, London, UK
| | - Robert Boyle
- Department of Paediatrics, Imperial College London, St Mary's Hospital, London, UK
| | - Gillian Weaver
- The Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Herts, UK
| | - Natalie Shenker
- The Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Herts, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Silva MDB, de Oliveira RDVC, da Silveira Barroso Alves D, Melo ECP. Predicting risk of early discontinuation of exclusive breastfeeding at a Brazilian referral hospital for high-risk neonates and infants: a decision-tree analysis. Int Breastfeed J 2021; 16:2. [PMID: 33397423 PMCID: PMC7783998 DOI: 10.1186/s13006-020-00349-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background Determinants at several levels may affect breastfeeding practices. Besides the known historical, socio-economic, cultural, and individual factors, other components also pose major challenges to breastfeeding. Predicting existing patterns and identifying modifiable components are important for achieving optimal results as early as possible, especially in the most vulnerable population. The goal of this study was building a tree-based analysis to determine the variables that can predict the pattern of breastfeeding at hospital discharge and at 3 and 6 months of age in a referral center for high-risk infants. Methods This prospective, longitudinal study included 1003 infants and was conducted at a high-risk public hospital in the following three phases: hospital admission, first visit after discharge, and monthly telephone interview until the sixth month of the infant’s life. Independent variables were sorted into four groups: factors related to the newborn infant, mother, health service, and breastfeeding. The outcome was breastfeeding as per the categories established by the World Health Organization (WHO). For this study, we performed an exploratory analysis at hospital discharge and at 3 and at 6 months of age in two stages, as follows: (i) determining the frequencies of baseline characteristics stratified by breastfeeding indicators in the three mentioned periods and (ii) decision-tree analysis. Results The prevalence of exclusive breastfeeding (EBF) was 65.2% at hospital discharge, 51% at 3 months, and 20.6% at 6 months. At hospital discharge and the sixth month, the length of hospital stay was the most important predictor of feeding practices, also relevant at the third month. Besides the mother’s and child’s characteristics (multiple births, maternal age, and parity), the social context, work, feeding practice during hospitalization, and hospital practices and policies on breastfeeding influenced the breastfeeding rates. Conclusions The combination algorithm of decision trees (a machine learning technique) provides a better understanding of the risk predictors of breastfeeding cessation in a setting with a large variability in expositions. Decision trees may provide a basis for recommendations aimed at this high-risk population, within the Brazilian context, in light of the hospital stay at a neonatal unit and period of continuous feeding practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-020-00349-x.
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Affiliation(s)
- Maíra Domingues Bernardes Silva
- Human Milk Bank at the National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF) of the Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
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12
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Saeed OB, Haile ZT, Chertok IA. Association Between Exclusive Breastfeeding and Infant Health Outcomes in Pakistan. J Pediatr Nurs 2020; 50:e62-e68. [PMID: 31862130 DOI: 10.1016/j.pedn.2019.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The infant mortality rate in Pakistan is one of the highest in the world with most cases attributed to diarrheal or respiratory diseases. Exclusive breastfeeding for the first 6 months of life is recommended by the World Health Organization to achieve optimal growth and health, however, in Pakistan the rate of exclusive breastfeeding by mothers is <40%. The aim of this study was to investigate the relationship of exclusive breastfeeding, diarrhea, acute respiratory infections and fever among infants under the age of 6 months. DESIGN AND METHODS The cross-sectional study analyzed secondary data from the 2017-18 Pakistan Demographic and Health-Survey. The sampling frame for the current study consisted of last-born children who were under the age of 6 months. The study sample consisted of 1033 infants under the age of 6 months. RESULTS The prevalence of exclusive breastfeeding was 53.6%. Compared to infants who were not breastfed exclusively, infants who were had lower odds of diarrhea, acute respiratory infection, and fever. The observed association was independent of potential confounders. CONCLUSIONS Exclusive breastfeeding reduces the odds of childhood illnesses. Plausible explanations for the observed association may be related to human milk's contents including necessary nutrients to fulfill an infant's needs within first months of life. Additionally, continued exposure to breastfeeding also reduces exposure to other contaminated foods to ensure adequate nutrition for the infant. PRACTICE IMPLICATIONS The findings have important implications for educating families and healthcare providers about the benefits of exclusive breastfeeding for optimal child health outcomes.
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Affiliation(s)
- Omar Babar Saeed
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, United States of America.
| | - Zelalem T Haile
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Dublin, OH, United States of America.
| | - Ilana Azulay Chertok
- School of Nursing, College of Health Sciences and Professions, Ohio University, Athens, OH, United States of America.
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13
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Abstract
BACKGROUND Working mothers face unique barriers to breastfeeding, despite the compelling evidence of its benefits. The aim of this study was to describe exclusive breastfeeding (EBF) rate of working mothers and associated factors. METHODS Cross-sectional study was carried out in Mansoura District, Egypt from 1 July to 31 December 2017 among working mothers attending health care facilities for vaccinating their infants aged 6 months. Data were collected using a questionnaire covering sociodemographic and occupational data; breastfeeding supportive workplace facilities; antenatal and natal care; infant's data; and EBF practice. RESULTS EBF rate was 14.1%. Independent predictors were being still on work leave, return to work 4 months after childbirth, working as farmer/manual worker and in trades and business, and being self/family employed. CONCLUSIONS EBF rate is low among working mothers. There is a need to extend maternity leave and provide promoting workplace facilities.
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Affiliation(s)
- Hala Samir Abou-ElWafa
- Occupational Health and Industrial Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Abdel-Hady El-Gilany
- Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Public Health and Preventive Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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14
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Santacruz-Salas E, Aranda-Reneo I, Hidalgo-Vega Á, Blanco-Rodriguez JM, Segura-Fragoso A. The Economic Influence of Breastfeeding on the Health Cost of Newborns. J Hum Lact 2019; 35:340-348. [PMID: 30508488 DOI: 10.1177/0890334418812026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Breastfeeding provides health benefits for women and newborns. However, few studies have explored how these health benefits translate into economic savings. RESEARCH AIM This study aimed to estimate the healthcare costs savings generated by exclusive breastfeeding for healthy newborns. METHODS We designed a longitudinal two-group observational study that included healthy women and newborns ( N = 236) in Toledo, Spain. Over the first 6-months of the infants' lives, we reviewed their clinical histories to determine their consumption of healthcare resources and the type of nutrition provided. The sample was categorized into two groups: exclusive breastfeeding ( n = 46) and non-exclusive breastfeeding for 6 months ( n = 190). Two-part regression models were applied to determine whether there were differences in healthcare costs between the groups. RESULTS The average age of the women was 32 ( SD: 5.3). The average birth weight of the newborns was 3.3 kg. ( SD: 0.38). At 6 months, 19.5% ( n = 46) of the women breastfed exclusively, 28.4% ( n = 67) combined breastfeeding with formula, and 45.8% ( n = 108) used formula only. Healthcare costs during follow-up reached €785.58 (44% for specialized care, 42% for primary care, 9.8% for medical emergencies, 3% for medications and approximately 1% for medical tests). The statistical analysis estimated a lower healthcare cost of between €454.40 and €503.50 for exclusively breastfed newborns. CONCLUSION Breastfeeding generated savings in healthcare costs; therefore, it could be a cost-efficient option compared with alternatives. Researchers who evaluate the efficiency of strategies that promote breastfeeding can contribute to the sustainability of health services.
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Affiliation(s)
- Esmeralda Santacruz-Salas
- 1 Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| | - Isaac Aranda-Reneo
- 2 Faculty of Social Sciences, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| | - Álvaro Hidalgo-Vega
- 3 Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - José M Blanco-Rodriguez
- 4 Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Antonio Segura-Fragoso
- 1 Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
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15
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Gross MS, Taylor HA, Tomori C, Coleman JS. Breastfeeding with HIV: An Evidence-Based Case for New Policy. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:152-160. [PMID: 30994076 PMCID: PMC7053566 DOI: 10.1177/1073110519840495] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy (cART) status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities.
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Affiliation(s)
- Marielle S Gross
- Marielle S. Gross, M.D., M.B.E., is a Hecht-Levi postdoctoral research fellow in the Berman Institute of Bioethics at Johns Hopkins University where she recently completed residency training in Gynecology & Obstetrics. She attended medical school at the University of Florida, and previously completed degrees in Philosophy, Jewish Ethics and Bioethics at Columbia University, the Jewish Theological Seminary, and New York University, respectively. Holly A. Taylor, Ph.D., M.P.H., is a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics and Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Cecilia Tomori, Ph.D., studied biology and education at Swarthmore College and obtained her Ph.D. in Anthropology from the University of Michigan in 2011. She completed a postdoctoral fellowship at Johns Hopkins School of Public Health and served as faculty there between 2013-2017. Jenell S. Coleman, M.D., M.P.H., is associate professor in the Johns Hopkins School of Medicine Department of Gynecology and Obstetrics with a joint appointment in the Department of Medicine and is the medical director of the John's Hopkins Women's Health Center. Dr. Coleman earned her M.D. from the University of Pennsylvania School of Medicine and completed Ob/Gyn residency at the University of California, Los Angeles. She completed a fellowship in reproductive infectious diseases at the University of California, San Francisco and received an M.P.H. from the University of California, Berkeley
| | - Holly A Taylor
- Marielle S. Gross, M.D., M.B.E., is a Hecht-Levi postdoctoral research fellow in the Berman Institute of Bioethics at Johns Hopkins University where she recently completed residency training in Gynecology & Obstetrics. She attended medical school at the University of Florida, and previously completed degrees in Philosophy, Jewish Ethics and Bioethics at Columbia University, the Jewish Theological Seminary, and New York University, respectively. Holly A. Taylor, Ph.D., M.P.H., is a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics and Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Cecilia Tomori, Ph.D., studied biology and education at Swarthmore College and obtained her Ph.D. in Anthropology from the University of Michigan in 2011. She completed a postdoctoral fellowship at Johns Hopkins School of Public Health and served as faculty there between 2013-2017. Jenell S. Coleman, M.D., M.P.H., is associate professor in the Johns Hopkins School of Medicine Department of Gynecology and Obstetrics with a joint appointment in the Department of Medicine and is the medical director of the John's Hopkins Women's Health Center. Dr. Coleman earned her M.D. from the University of Pennsylvania School of Medicine and completed Ob/Gyn residency at the University of California, Los Angeles. She completed a fellowship in reproductive infectious diseases at the University of California, San Francisco and received an M.P.H. from the University of California, Berkeley
| | - Cecilia Tomori
- Marielle S. Gross, M.D., M.B.E., is a Hecht-Levi postdoctoral research fellow in the Berman Institute of Bioethics at Johns Hopkins University where she recently completed residency training in Gynecology & Obstetrics. She attended medical school at the University of Florida, and previously completed degrees in Philosophy, Jewish Ethics and Bioethics at Columbia University, the Jewish Theological Seminary, and New York University, respectively. Holly A. Taylor, Ph.D., M.P.H., is a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics and Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Cecilia Tomori, Ph.D., studied biology and education at Swarthmore College and obtained her Ph.D. in Anthropology from the University of Michigan in 2011. She completed a postdoctoral fellowship at Johns Hopkins School of Public Health and served as faculty there between 2013-2017. Jenell S. Coleman, M.D., M.P.H., is associate professor in the Johns Hopkins School of Medicine Department of Gynecology and Obstetrics with a joint appointment in the Department of Medicine and is the medical director of the John's Hopkins Women's Health Center. Dr. Coleman earned her M.D. from the University of Pennsylvania School of Medicine and completed Ob/Gyn residency at the University of California, Los Angeles. She completed a fellowship in reproductive infectious diseases at the University of California, San Francisco and received an M.P.H. from the University of California, Berkeley
| | - Jenell S Coleman
- Marielle S. Gross, M.D., M.B.E., is a Hecht-Levi postdoctoral research fellow in the Berman Institute of Bioethics at Johns Hopkins University where she recently completed residency training in Gynecology & Obstetrics. She attended medical school at the University of Florida, and previously completed degrees in Philosophy, Jewish Ethics and Bioethics at Columbia University, the Jewish Theological Seminary, and New York University, respectively. Holly A. Taylor, Ph.D., M.P.H., is a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics and Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Cecilia Tomori, Ph.D., studied biology and education at Swarthmore College and obtained her Ph.D. in Anthropology from the University of Michigan in 2011. She completed a postdoctoral fellowship at Johns Hopkins School of Public Health and served as faculty there between 2013-2017. Jenell S. Coleman, M.D., M.P.H., is associate professor in the Johns Hopkins School of Medicine Department of Gynecology and Obstetrics with a joint appointment in the Department of Medicine and is the medical director of the John's Hopkins Women's Health Center. Dr. Coleman earned her M.D. from the University of Pennsylvania School of Medicine and completed Ob/Gyn residency at the University of California, Los Angeles. She completed a fellowship in reproductive infectious diseases at the University of California, San Francisco and received an M.P.H. from the University of California, Berkeley
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16
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Banked Human Milk and Quantitative Risk Assessment of Bacillus cereus Infection in Premature Infants: A Simulation Study. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2019; 2019:6348281. [PMID: 30863469 PMCID: PMC6378033 DOI: 10.1155/2019/6348281] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/31/2018] [Indexed: 11/17/2022]
Abstract
Background Banked human milk (BHM) offers potential health benefits to premature babies. BHM is pasteurized to mitigate infectious risks, but pasteurization is ineffective against sporulating bacteria such as Bacillus cereus. Sepsis related to Bacillus cereus in premature infants is severe and can often be fatal. Even if a causal link has never been established, BHM has been suggested as a potential source of infection in premature infants. Objective Our aim was to estimate the potential risk of Bacillus cereus infection in preterm infants caused by the ingestion of contaminated pasteurized BHM using different post-pasteurization release criteria (i.e., 9 sampling of 100 microliters versus the HMBANA guideline of 1 sampling of 100 microliters per pool). Methods In the absence of scientific evidence regarding the risk of Bacillus cereus infection by the ingestion of BHM in premature infants, risk assessment using Monte Carlo simulation with the exponential dose-response model was performed. Three scenarios of infectious risk (annual incidence rate of 0.01%, 0.13%, and 0.2%) with 18 variations of the B. cereus virulent dose (from 0.5 CFU/ml to 200 CFU/ml) were simulated. Results The mean risk differential between the two methods of post-pasteurization bacteriological control for realistic infectious doses of 30 to 200 CFU/ml ranges from 0.036 to 0.0054, 0.47 to 0.070, and 0.72 to 0.11 per million servings, for each of the three scenarios. Conclusion Simulation highlights the very small risk of Bacillus cereus infection following the ingestion of pasteurized BHM, even in the worst case scenarios, and suggests that a 100-microliter sample for post-pasteurization culture is sufficient.
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17
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Pirr S, Richter M, Fehlhaber B, Pagel J, Härtel C, Roth J, Vogl T, Viemann D. High Amounts of S100-Alarmins Confer Antimicrobial Activity on Human Breast Milk Targeting Pathogens Relevant in Neonatal Sepsis. Front Immunol 2017; 8:1822. [PMID: 29326708 PMCID: PMC5733341 DOI: 10.3389/fimmu.2017.01822] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022] Open
Abstract
Sepsis is a leading cause of perinatal mortality worldwide. Breast milk (BM) feeding is protective against neonatal sepsis, but the molecular mechanisms remain unexplained. Despite various supplementations with potential bioactive components from BM formula feeding cannot protect from sepsis. S100-alarmins are important immunoregulators in newborns preventing excessive inflammation. At high concentrations, the S100A8/A9 protein complex also has antimicrobial properties due to its metal ion chelation capacity. To assess whether BM contains S100-alarmins that might mediate the sepsis-protective effect of BM 97 human BM samples stratified for gestational age, mode of delivery and sampling after birth were collected and analyzed. S100A8/A9 levels were massively elevated after birth (p < 0.0005). They slowly decreased during the first month of life, then reaching levels comparable to normal values in adult serum. The concentration of S100A8/A9 in BM was significantly higher after term compared with preterm birth (extremely preterm, p < 0.005; moderate preterm, p < 0.05) and after vaginal delivery compared with cesarean section (p < 0.0005). In newborn s100a9−/− mice, enterally supplied S100-alarmins could be retrieved systemically in the plasma. To explore the antimicrobial activity against common causal pathogens of neonatal sepsis, purified S100-alarmins and unmodified as well as S100A8/A9-depleted BM were used in growth inhibition tests. The high amount of S100A8/A9 proved to be an important mediator of the antimicrobial activity of BM, especially inhibiting the growth of manganese (Mn) sensitive bacteria such as Staphylococcus aureus (p < 0.00005) and group B streptococci (p < 0.005). Depletion of S100A8/A9 significantly reduced this effect (p < 0.05, respectively). The growth of Escherichia coli was also inhibited by BM (p < 0.00005) as well as by S100A8/A9 in culture assays (p < 0.05). But its growth in BM remained unaffected by the removal of S100A8/A9 and was neither dependent on Mn suggesting that the antimicrobial effects of S100A8/A9 in BM are primarily mediated by its Mn chelating capacity. In summary, the enteral supply of bioavailable, antimicrobially active amounts of S100-alarmins might be a promising option to protect newborns at high risk from infections and sepsis.
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Affiliation(s)
- Sabine Pirr
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Manuela Richter
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany.,Children's Hospital "Auf der Bult", Hannover, Germany
| | - Beate Fehlhaber
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Julia Pagel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | | | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Dorothee Viemann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
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18
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Buckle A, Taylor C. Cost and Cost-Effectiveness of Donor Human Milk to Prevent Necrotizing Enterocolitis: Systematic Review. Breastfeed Med 2017; 12:528-536. [PMID: 28829161 DOI: 10.1089/bfm.2017.0057] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is a costly gastrointestinal disorder that mainly affects preterm and low-birth-weight infants and can lead to considerable morbidity and mortality. Mother's own milk is protective against NEC but is not always available. In such cases, donor human milk has also been shown to be protective (although to a lesser extent) compared with formula milk, but it is more expensive. This systematic review aimed at evaluating the cost of donor milk, the cost of treating NEC, and the cost-effectiveness of exclusive donor milk versus formula milk feeding to reduce the short-term health and treatment costs of NEC. MATERIALS AND METHODS We systematically searched five relevant databases to find studies with verifiable costs or charges of donor milk and/or treatment of NEC and any economic evaluations comparing exclusive donor milk with exclusive formula milk feeding. All search results were double screened. RESULTS Seven studies with verifiable donor milk costs and 17 with verifiable NEC treatment costs were included. The types of cost or charge included varied considerably across studies, so quantitative synthesis was not attempted. Estimates of the incremental length of stay associated with NEC were ∼18 days for medical NEC and 50 days for surgical NEC. Two studies claimed to report economic evaluations but did not do so in practice. CONCLUSIONS It is likely that donor milk provides short-term cost savings by reducing the incidence of NEC. Future studies should provide more details on cost components included and a full economic evaluation, including long-term outcomes, should be undertaken.
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Affiliation(s)
- Abigail Buckle
- Division of Health Sciences, University of Warwick , Coventry, United Kingdom
| | - Celia Taylor
- Division of Health Sciences, University of Warwick , Coventry, United Kingdom
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19
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Delerue T, de Pontual L, Carbonnelle E, Zahar JR. The potential role of microbiota for controlling the spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in neonatal population. F1000Res 2017; 6:1217. [PMID: 28781766 PMCID: PMC5531162 DOI: 10.12688/f1000research.10713.1] [Citation(s) in RCA: 5] [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] [Accepted: 07/18/2017] [Indexed: 12/15/2022] Open
Abstract
The spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in the hospital and also the community is worrisome. Neonates particularly are exposed to the risk of ESBL-PE acquisition and, owing to the immaturity of their immune system, to a higher secondary risk of ESBL-PE-related infection. Reducing the risk of acquisition in the hospital is usually based on a bundle of measures, including screening policies at admission, improving hand hygiene compliance, and decreasing antibiotic consumption. However, recent scientific data suggest new prevention opportunities based on microbiota modifications.
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Affiliation(s)
- Thibaud Delerue
- Département de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 9300 Bobigny, France
| | - Loic de Pontual
- Service de pédiatrie, hôpital Jean-Verdier, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13, AP-HP, 93140 Bondy, France
| | - Etienne Carbonnelle
- Département de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 9300 Bobigny, France
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France
| | - Jean-Ralph Zahar
- Département de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 9300 Bobigny, France
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France
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