Factors Associated with Provider Practices Related to Infant Feeding in Primary Care Settings: Results from a Pilot Survey.

In 2020, only 25.6% of dyads in the US were exclusively breastfeeding at six months. Previous research has shown that breastfeeding continuation improves when patients receive both prenatal and postpartum support. Additionally, breastfeeding self-efficacy can be directly impacted by interactions with primary healthcare providers. To facilitate improved lactation support and positive interactions with providers related to infant feeding in the primary care setting, a 49-question survey was utilized to conduct a retrospective, cross-sectional study. Using multiple regression analysis, the researchers tested a model to determine if certain factors could predict patients receiving lactation education in the primary care setting. The full model was statistically significant and accounts for 81.8% of the variance (R2 = 0.818, F (7, 21) = 9.015, p < 0.001, CI = 0.728 to 0.910). Variables that contributed significantly to the model included provider age, provider years of experience in maternal-child health, population density of the practice, and average provider preparedness and comfort with lactation support and medical management. As the only modifiable predictor significantly contributing to the model, future research is necessary to develop educational interventions to improve provider preparedness and comfort with lactation support and medical management. Such interventions may significantly improve the frequency of lactation education in primary care settings.

Surgical Performance of En Bloc Total Capsulectomy Breast Implant Removal With Uninterrupted Breastfeeding.

INTRODUCTION: A 28-year-old woman was able to maintain lactation for her 21-month-old child through the process of an En Bloc Total Capsulectomy Breast Implant Removal. This case study is important as it exemplifies collaborative care to achieve maintenance of lactation through a surgical procedure. MAIN ISSUE: The participant was providing human milk to her 21-month-old child 4 times per day through breastfeeding and pumping and bottle feeding, and desired to continue lactation through explant surgery. The participant was experiencing Breast Implant Illness, yellowing of the skin and whites of the eyes, bottoming out of the right implant, severe capsular contracture of the right implant causing constant pain, limited mobility of the right arm and shoulder, and concern about an active recall on the brand implant she received. MANAGEMENT: The lactation management began 3 weeks prior to the procedure with the participant expressing enough milk prior to the surgery to allow for human milk feeding from a bottle during the 7-day recovery period as desired. The surgical team and IBCLC selected an appropriate bra for recovery to allow for both appropriate surgical site healing and ease of access for pumping. Exclusive pumping was utilized until surgical drains were removed, after which the participant was able to reintroduce breastfeeding. CONCLUSION: En Bloc Total Capsulectomy Breast Implant Removal can be performed while an individual is lactating without complication, given the appropriate multidisciplinary support. A temporary reduction of ease and efficiency of milk removal is possible post-operatively, in this case resolving within 24 hr.

Comparison of the Effectiveness of Four Commercial DNA Extraction Kits on Fresh and Frozen Human Milk Samples.

For-profit donor human milk organizations have DNA-based proprietary methodology for testing incoming milk for adulteration with other species' milk. However, there is currently no standardized methodology for extracting DNA from human milk. Microbiome research has shown that DNA purity and quantity can vary depending on the extraction methodology and storage conditions. This study assessed the purity and quantity of DNA extracted from four commercially available DNA extraction kits-including one kit that was developed for human milk. This study was for method validation only. One donor provided a 90 mL human milk sample. The sample was aliquoted into 70 × 1 mL microcentrifuge tubes. Aliquots were randomized into one of three categories: fresh extraction, extraction after freezing, and extraction after purification and storage at room temperature. DNA was analyzed for purity and quantity using a NanoDrop Spectrophotometer. Results confirmed differences in DNA purity and quantity between extraction kits. The Plasma/Serum Circulating DNA Purification Mini Kit (Norgen Biotek, ON, Canada) provided significantly more DNA, and consistent purity as measured by 260/280 and 260/230 ratios. DNA quantity and purity were similar between fresh and frozen human milk samples. These results suggest that DNA purity and quantity is highest and most consistent when extracted from human milk using the Plasma/Serum Circulating DNA Purification Mini Kit amongst the kits tested in this study. Standardized methodology for extracting DNA from human milk is necessary for improvement of research in the field of human milk. To do this, future studies are recommended for optimization of DNA extraction from human milk using larger sample sizes and multiple donor parents.

The Associations Between Light Exposure During Pumping and Holder Pasteurization and the Macronutrient and Vitamin Concentrations in Human Milk.

BACKGROUND: During pumping, storage, and pasteurization human milk is exposed to light, which could affect the concentrations of light-sensitive vitamins. Currently, milk banks do not regulate light exposure. RESEARCH AIM: The aim of this paper was to determine the influence of light exposure during pumping, storage, and pasteurization on (1) macronutrients, (2) select water-soluble vitamins, and (3) select fat-soluble vitamins. METHODS: All 13 participants donated 4 milk samples each. Each sample underwent 1 of 4 treatments: raw and light protected, raw and light exposed, pasteurized and light protected, and pasteurized and light exposed. Samples were analyzed for macronutrients and Vitamins B1, B2, retinol, γ-tocopherol, α-tocopherol, and ß-carotene. RESULTS: ß-carotene concentrations were not influenced by light exposure. Vitamin B1 was significantly (p < 0.05) affected by light-exposure (M = 0.23, SD = 0.01mg/L) compared to light-protected (M = 0.27, SD = 0.01mg/L) samples. Vitamin B2 concentrations were reduced (p < 0.05) by light-exposure in raw (M = 62.1, SD = 0.61µg/L) and pasteurized (M = 73.7, SD = 0.72µg/L) samples compared to light-protected raw samples (M = 99.7, SD = 0.66µg/L). No other tested nutrients were affected by light exposure. CONCLUSIONS: If milk is exposed to excessive amounts of light, Vitamins B1 and B2 concentrations may degrade below the current Adequate Intake recommendations for infants 0-6 months of age, increasing the risk of insufficient vitamin supply to the exclusively human milk-fed infant. Thus, pumped or processed human milk should be protected from light to preserve milk vitamin concentrations.

Supplementation of Maternal Diets with Docosahexaenoic Acid and Methylating Vitamins Impacts Growth and Development of Fetuses from Malnourished Gilts.

BACKGROUND: Like many species, pregnant swine mobilize and repartition body nutrient stores during extreme malnutrition to support fetal development. OBJECTIVE: The objective of this study was to model chronic human maternal malnutrition and measure effects of methylating-vitamins (MVs, containing choline, folate, B-6, B-12, and riboflavin) and docosahexaenoic acid (DHA) supplementation on fetal growth and development. METHODS: Pregnant gilts (n = 24) were either fully nourished (2.0 kg/d) with a corn-plus-isolated-soy-protein basal diet (control) supplemented with MVs and DHA or nourishment was restricted throughout gestation. Basal diet fed to malnourished gilts was reduced progressively from 50% to 70% restriction (1.0 to 0.6 kg/d) and was supplemented following a 2 (±MVs) x 2 (±DHA) factorial design. Full-term c-sections were performed to assess impacts on low and normal birth weight (LBW/NBW) fetuses (n = 238). RESULTS: Body weight gain of malnourished gilts was 10% of full-fed control dams (P < 0.05), but offspring birth weight, length, girth, and percentage of LBW fetuses were not different between treatments. The number of pigs per litter was reduced by 30% in malnourished control dams. Fetal brain weights were reduced by 7% compared to positive controls (P < 0.05). Micronutrient supplementation to malnourished dams increased fetal brain weights back to full-fed control levels. Dams with DHA produced offspring with higher DHA concentrations in brain and liver (P < 0.05). Plasma choline concentration was 4-fold higher in fetuses from unsupplemented malnourished dams (P < 0.0001). Global DNA methylation status of fetuses from restricted dams was higher than in control fetuses, including brain, liver, heart, muscle, and placenta tissues (P < 0.05). Addition of DHA increased methylation in LBW fetal brains (P < 0.05). CONCLUSIONS: Despite the mobilization of maternal stores, malnourished litters displayed reduced brain development that was fully mitigated by micronutrient supplementation. Severe maternal malnutrition increased global DNA methylation in several fetal tissues that was unaltered by choline and B-vitamin supplementation.

Bacteria and Bioactivity in Holder Pasteurized and Shelf-Stable Human Milk Products.

Background: Historically, Holder pasteurization has been used to pasteurize donor human milk available in a hospital setting. There is extensive research that provides an overview of the impact of Holder pasteurization on bioactive components of human milk. A shelf-stable (SS) human milk product, created using retort processing, recently became available; however, to our knowledge, little has been published about the effect of retort processing on human milk. Objective: We aimed to assess the ability of retort processing to eliminate bacteria and to quantify the difference in lysozyme and secretory immunoglobulin A (sIgA) activity between Holder pasteurized (HP) and SS human milk. Methods: Milk samples from 60 mothers were pooled. From this pool, 36 samples were taken: 12 samples were kept raw, 12 samples were HP, and 12 samples were retort processed to create an SS product. All samples were analyzed for total aerobic bacteria, coliform bacteria, Bacillus cereus, sIgA activity, and lysozyme activity. Raw samples served as the control. Results: One raw sample and 3 HP samples contained B. cereus at the time of culture. There were no detectable bacteria in SS samples at the time of culture. Raw samples had significantly greater lysozyme and sIgA activity than HP and SS samples (P < 0.0001). HP samples retained significantly more lysozyme and sIgA activity (54% and 87%, respectively) than SS samples (0% and 11%, respectively). Conclusions: Human milk processed using Holder pasteurization should continue to be screened for the presence of B. cereus. Clinicians should be aware of the differences in the retention of lysozyme and sIgA activity in HP and SS products when making feeding decisions for medically fragile or immunocompromised infants to ensure that patients are receiving the maximum immune protection.

Antidepressants that inhibit both serotonin and norepinephrine reuptake impair long-term potentiation in hippocampus.

RATIONALE: Monoamine reuptake inhibitors can stimulate expression of brain-derived neurotrophic factor (BDNF) and alter long-term potentiation (LTP), a widely used model for the synaptic mechanisms that underlie memory formation. BDNF expression is upregulated during LTP, and BDNF in turn positively modulates LTP. Previously, we found that treatment with venlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), but not citalopram, a selective serotonin reuptake inhibitor (SSRI), reduced LTP in hippocampal area CA1 without changing hippocampal BDNF protein expression. OBJECTIVES: We tested the hypothesis that combined serotonin and norepinephrine reuptake inhibition is necessary for LTP impairment, and we reexamined the potential role of BDNF by testing for region-specific changes in areas CA1, CA3, and dentate gyrus. We also tested whether early events in the LTP signaling pathway were altered to impair LTP. METHODS: Animals were treated for 21 days with venlafaxine, imipramine, fluoxetine, or maprotiline. In vitro hippocampal slices were used for electrophysiological measurements. Protein expression was measured by enzyme-linked immunosorbent assay (ELISA) and Western blotting. RESULTS: LTP was impaired only following treatment with combined serotonin and norepinephrine reuptake inhibitors (venlafaxine, imipramine) but not with selective serotonin (fluoxetine) or norepinephrine (maprotiline) reuptake inhibitors. BDNF protein expression was not altered by venlafaxine or imipramine treatment, nor were postsynaptic depolarization during LTP inducing stimulation or synaptic membrane NMDA receptor subunit expression affected. CONCLUSIONS: LTP is impaired by chronic treatment with antidepressant that inhibit both serotonin and norepinephrine reuptake; this impairment results from changes that are downstream of postsynaptic depolarization and calcium influx.