Maximizing the benefits of human milk feeding for the preterm infant

Donor human milk banking and the emergence of milk sharing

Donor human milk has emerged as the preferred substrate to feed extremely preterm infants, when mother's own milk is unavailable. This article summarizes the clinical data demonstrating the safety, efficacy, and cost-effectiveness of feeding donor human milk to premature babies. It describes the current state of milk banking in North America, as well as other parts of the world, and the differing criteria for donor selection, current pasteurization techniques, and quality control measures. A risk assessment methodology is proposed, which would allow milk banks globally to assess the safety of their process and respond appropriately to differing risk environments.

Smoking and caesarean deliveries: major negative predictors for breastfeeding in the mother-child cohort in Crete, Greece (Rhea study)

Although benefits of breastfeeding have been widely promoted and accepted, exclusive breastfeeding for the first 6 months of life is far from the norm in many countries. In a prospective mother-child cohort study in Crete, Greece ('Rhea' study), we assessed the frequency of breastfeeding and its socio-demographic predictors. Information on breastfeeding was available for a period of 18 months post-partum for a cohort of 1181 mothers and their 1208 infants. The frequency of exclusive and predominant breastfeeding in the first month post-partum was 17.8% and 3.4%, respectively, with almost three-quarters of women (73.6%) ceasing any breastfeeding after 4 months post-partum. Women were less likely to initiate breastfeeding if they had a caesarean delivery (CD), whereas they were more likely to initiate breastfeeding if they had a higher education or gave birth to a private clinic. Among women breastfeeding, those who had a CD, were ex-smokers or smokers during pregnancy had a statistically significant shorter duration of breastfeeding, whereas higher education and being on leave from work were associated with a longer duration of breastfeeding. Study findings suggest suboptimal levels of exclusive and any breastfeeding and difficulty maintaining longer breastfeeding duration. CD and smoking are common in Greece and are strong negative predictors for breastfeeding initiation and/or duration, necessitating targeting women at risk early in the prenatal period so as to have a meaningful increase of breastfeeding practices in future cohorts of mothers.

Human-milk feeding after NICU discharge

PURPOSE

Difficulty with breastfeeding is common, and challenges are particularly pronounced for mothers of ill or preterm infants. This study explores the breastfeeding experiences of mothers of these at-risk infants to determine their breastfeeding patterns and to better understand reasons they prematurely stop breastfeeding and/or human-milk feeding (HMF).

DESIGN

A qualitative, longitudinal, descriptive design was used.

SAMPLE

The sample consisted of 144 mothers whose preterm or ill infants were cared for in either an NICU or an intermediate care nursery in a large central Canadian city; 112 mothers completed data collection to six weeks after their infants were discharged from the hospital.

MAIN OUTCOME VARIABLE

The main outcome variable was continued breastfeeding or HMF of formerly ill or preterm infants at one and six weeks after their discharge from the hospital.

RESULTS

Of infants who were being fed mother's milk when discharged from the hospital, 71 percent continued to receive at least some mother's milk at six weeks after discharge. Mothers reported that their own physical and emotional problems, infant health concerns, and lack of time and support were reasons for discontinuing provision of human milk.

Prediction of initiation and duration of breast-feeding for neonates admitted to the neonatal intensive care unit

Women who desire to breast-feed their sick newborns often encounter obstacles, including insufficient support and education as well as unsupportive hospital practices. The purpose of this study was to describe maternal, neonatal, and outside influences associated with the intention, initiation, and duration of breast-feeding for women whose newborns were admitted to the neonatal intensive care unit. One hundred mothers were interviewed. Most mothers (67%) intended to breast-feed exclusively and this was significantly related to maternal characteristics such as age, education, parity, smoking and marital status, pre-breast-feeding experience, and the influences of the neonate's father and prenatal education. Seventy-eight mothers initiated pumping. Initiation was significantly related to maternal education, smoking, parity, previous breast-feeding experience, the neonate's physician, the neonate's father, and postpartum breast-feeding education. Fifty-four mothers were followed up by telephone after discharge until weaning. Thirty percent were exclusively breast-feeding at 2 weeks after discharge, and 15% were breast-feeding at 1 year. Duration of breast-feeding was significantly associated with education, marital status, ethnicity, income, assistance from nurses and lactation consultants, and feeding method along with milk type and milk volume at discharge. Increased family support, timely breast-feeding information, and a supportive neonatal intensive care unit environment are needed for women to succeed in breast-feeding their hospitalized newborns.