Lançamento da Campanha do Doação de Leite Humano 2024 do Ministério da Saúde

No dia 06 de março de 2024, foi realizado a campanha nacional de incentivo ao aleitamento 2024, com o Slogan “Doe leite materno: vida cada gota recebida”. A meta para 2024 é ampliar mais 5% a oferta de leite materno a recém-nascidos internados nas unidades neonatais do país.

The relationship between earthquake-induced post-traumatic stress disorder and breastfeeding attitude and behavior.

BACKGROUND: This study aimed to investigate the prevalence and severity of post-traumatic stress disorder (PTSD) and analyze the relationship between PTSD and breastfeeding attitudes and behaviors among breastfeeding mothers and women with children aged 0-24 months, all of whom had experienced the earthquake. METHODS: In this cross-sectional survey, a face-to-face questionnaire was administered to 173 earthquake survivors in Adiyaman, Turkey, during June and July 2023. The PTSD Checklist-Civilian scale was used to assess the presence of PTSD, while the Breastfeeding Attitudes of the Evaluation Scale (BAES) was employed to evaluate breastfeeding behaviors in mothers. RESULTS: Significantly higher PTSD scores (47.6 ± 17.4) were found among women staying in tents, while lower scores (37.0 ± 16.4) were observed in those who continued breastfeeding. 78.6% of women reported decreased breast milk because of the earthquake. Mothers with reduced milk supply had higher PTSD scores (46.1 ± 17.3). Breastfeeding training was associated with higher BAES scores (106.8 ± 56.8) and lower PTSD scores (32.5 ± 11.0). A significant negative correlation was observed between the PTSD score and BAES (r = -0.742; p < 0.001). CONCLUSIONS: The study demonstrated that breastfeeding may protect mothers against PTSD in the aftermath of earthquakes, emphasizing the importance of breastfeeding education. The higher frequency and severity of PTSD observed among earthquake survivor mothers residing in tents underscores the importance of promptly transitioning to permanent housing after the earthquake.

The neighborhood food environment modifies the association between infant feeding and childhood obesity.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) issues infant formula to infants who are not fully breastfed, and prior research found elevated obesity risk among children receiving lactose-reduced infant formula with corn syrup solids (CSSF) issued by WIC. This study was conducted to evaluate associations between a broader set of specialty infant formulas issued by WIC and child obesity risk, whether neighborhood context (e.g. neighborhood food environment) modifies associations, and whether racial/ethnic disparities in obesity are partly explained by infant formula exposure and neighborhood context. METHODS: WIC administrative data, collected from 2013-2020 on issued amount (categorical: fully formula fed, mostly formula fed, mostly breastfed, fully breastfed) and type of infant formula (standard cow's milk formula, and three specialty formulas: any CSSF, any soy-based formula, and any cow's milk-based formula with added rice starch) and obesity at ages 2-4 years (defined as a Body Mass Index z-score ≥ 95th percentile according to World Health Organization growth standard) were used to construct a cohort (n = 59,132). Associations of infant formula exposures and race/ethnicity with obesity risk were assessed in Poisson regression models, and modification of infant feeding associations with obesity by neighborhood context was assessed with interaction terms. RESULTS: Any infant formula exposure was associated with significantly higher obesity risk relative to fully breastfeeding. Receipt of a CSSF was associated with 5% higher obesity risk relative to the standard and other specialty infant formulas (risk ratio 1.05, 95% confidence interval 1.02, 1.08) independent of breastfeeding duration and receipt of other specialty infant formulas. The association between CSSF and obesity risk was stronger in neighborhoods with healthier food environments (10% higher risk) compared to less healthy food environments (null). Racial/ethnic disparities in obesity risk were robust to adjustment for infant formula exposure and neighborhood environment. CONCLUSIONS: Among specialty infant formulas issued by WIC, only CSSFs were associated with elevated obesity risk, and this association was stronger in healthier food environments. Future research is needed to isolate the mechanism underlying this association.

General practitioners' management of mastitis in breastfeeding women: a mixed method study in Australia.

BACKGROUND: Mastitis is a common reason new mothers visit their general practitioner (GP). In Australia, the Therapeutic Guidelines: Antibiotic provides practical advice to GPs managing a range of infections, including mastitis. It is not known if Australian GPs prescribe antibiotics and order investigations as recommended for the management of mastitis. METHODS: A convergent mixed methods design integrated quantitative analysis of a general practice dataset with analysis of interviews with GPs. Using the large-scale primary care dataset, MedicineInsight, (2021-2022), antibiotics prescribed and investigations ordered for mastitis encounters were extracted. Mastitis encounters were identified by searching 'Encounter reason', 'Test reason' and 'Prescription reason' free text field for the term 'mastitis'; 'granulomatous mastitis' was excluded. Clinical encounters for mastitis occurring within 14 days of a previous mastitis encounter were defined as belonging to the same treatment episode. Semi-structured interviews were conducted with 14 Australian GPs using Zoom or telephone in 2021-2022, and analysed thematically. The Pillar Integration Process was used to develop a joint display table; qualitative codes and themes were matched with the quantitative items to illustrate similarities/contrasts in findings. RESULTS: During an encounter for mastitis, 3122 (91.7%) women received a prescription for an oral antibiotic; most commonly di/flucloxacillin ([59.4%]) or cefalexin (937 [27.5%]). Investigations recorded ultrasound in 303 (8.9%), blood tests (full blood examination [FBE]: 170 [5.0%]; C-reactive protein [CRP]: 71 [2.1%]; erythrocyte sedimentation rate [ESR]: 34 [1.0%]) and breast milk or nipple swab cultures in approximately 1% of encounters. Analysis using pillar integration showed consistency between quantitative and qualitative data regarding mastitis management. The following themes were identified: - GPs support continued breastfeeding. - Antibiotics are central to GPs' management. - Antibiotics are mostly prescribed according to Therapeutic Guidelines. - Analgesia is a gap in the Therapeutic Guidelines. - Low use of breast milk culture. CONCLUSIONS: Prescribing antibiotics for mastitis remains central to Australian GPs' management of mastitis. Interview data clarified that GPs were aware that antibiotics might not be needed in all cases of mastitis and that delayed prescribing was not uncommon. Overall, GPs followed principles of antibiotic stewardship, however there is a need to train GPs about when to consider ordering investigations.

The impact of continuous and intermittent supportive counseling on self-efficacy and continuation of breastfeeding in lactating women affected by COVID-19: a quasi-experimental trial.

BACKGROUND: Promoting exclusive breastfeeding can have a great effect in reducing the complications and mortality rate of mother and child. OBJECTIVE: The study aimed to compare the effects of continuous and intermittent supportive counselling on the self-efficacy and continuity of breastfeeding among Lactating mothers with COVID-19. METHODS: The study was a semi-experimental research method and was conducted on 73 mothers with COVID-19 who were hospitalized in Ayatollah Mousavi Hospital in Zanjan, Iran from May 2021 to April 2022. In the continuous counselling group, counselling was provided daily for 14 days, while in the intermittent counselling group, counselling was provided once a week for four weeks. Breastfeeding continuity was assessed based on the World Health Organization's classification, and breastfeeding self-efficacy was measured using Dennis' standard breastfeeding self-efficacy questionnaire (BSE) up to four months after delivery. The data were analyzed using chi-square tests, independent t-tests, paired t-tests, analysis of variance with repeated measures, and survival analysis (Kaplan-Meier) with a 95% confidence level. RESULTS: The survival analysis revealed that the cessation of exclusive breastfeeding occurred in 17 cases within the continuous counselling group and in 22 cases within the intermittent counselling group. The rates of continuation for exclusive breastfeeding were 52.8% and 40.5% in the continuous and intermittent counselling group respectively. However, no statistically significant differences were observed in the continuation of breastfeeding and the trend of changes in the mean scores of breastfeeding self-efficacies between the continuous and intermittent counselling groups. Furthermore, comparing the change in breastfeeding self-efficacy scores between the one-month and four-month follow-ups within the continuous counselling group, a statistically significant increase was observed. CONCLUSION: The results indicated no difference in the effectiveness of continuous and intermittent counseling methods in improving breastfeeding continuity in women with COVID-19. Further research is needed to explore the long-term effects of different counseling approaches on breastfeeding outcomes during crises. TRIAL REGISTRATION: The study was registered on the Iranian Registry of Clinical Trials website on 29/06/2021 with the registration code IRCT20150731023423N19. It can be accessed via this link: https://irct.behdasht.gov.ir/user/trial/55391/view .

Factors Associated with Breastfeeding Initiation and Continuation at Two Months Postpartum in American Indian Women: An Exploratory Analysis.

This study aimed to determine the prevalence of breastfeeding initiation and continuation at two months postpartum in American Indian (AI) mothers in South Dakota and to identify factors associated with breastfeeding. Using logistic regression, data from the South Dakota Pregnancy Risk Assessment Monitoring System were used to investigate the relationship between binary breastfeeding initiation and continuation outcomes and maternal behaviors and experiences including access to health care, safe sleep practices, ability to handle life events, depression, and sources of breastfeeding information. Higher odds of initiation were seen for factors including access to health care services, ability to handle life events, and sources of breastfeeding information, while lower odds were seen for factors including safe sleep. Higher odds of continuation were seen among mothers who reported not taking long to get over setbacks and among mothers who reported no postpartum depression, while lower odds of continuation were seen among mothers practicing safe sleep. Several modifiable factors were identified as reasons for stopping breastfeeding. This information about factors associated with higher odds of breastfeeding initiation and continuation at two months postpartum can be used to inform interventions, programs, and policies designed to support breastfeeding among AI women and to guide future research in this area.

Anemia in Breastfeeding Women and Its Impact on Offspring's Health in Indonesia: A Narrative Review.

Anemia in breastfeeding women is a neglected global health issue with significant implications for maternal and child health. Despite its widespread occurrence and adverse effects, this problem remains largely unknown and overlooked on the global health agenda. Despite efforts to improve health access coverage and provide iron and folic acid supplementation, anemia persists. This underscores the need for a comprehensive approach to address the problem. Urgent action must be taken to prioritize education and awareness campaigns, ensure access to nutritious food, and enhance healthcare services. Education programs should focus on promoting iron-rich diets, dispelling cultural myths, and providing practical guidance. Improving healthcare services requires increasing availability, ensuring a consistent supply of iron supplements, and providing adequate training for healthcare providers. A successful implementation relies on a strong collaboration between the government, healthcare providers, and community. It is crucial that we acknowledge that high coverage alone is insufficient for solving the issue, emphasizing the importance of targeted interventions and a strategic implementation. By adopting a comprehensive approach and addressing the underlying causes of anemia, Indonesia can make significant progress in reducing its prevalence and improving the overall health of its population, particularly among breastfeeding women.

Patterns of Human Milk Oligosaccharides in Mature Milk Are Associated with Certain Gut Microbiota in Infants.

Human milk oligosaccharides (HMOs) are complexes that play a crucial role in shaping the early-life gut microbiota. This study intends to explore whether HMO patterns are associated with the gut microbiota of infants. We included 96 Chinese breastfeeding mother-infant dyads. Breast milk and infant faecal samples were collected and tested. With milk 2'-fucosyllactose, difucosyllactose, and lacto-N-fucopentaose-I as biomarkers, we divided the mothers into secretor and non-secretor groups. HMO patterns were extracted using principal component analysis. The majority (70.7%) of mothers were categorised as secretor and five different HMO patterns were identified. After adjustment, the infants of secretor mothers exhibited a lower relative abundance of Bifidobacterium bifidum (ß = -0.245, 95%CI: -0.465~-0.025). An HMO pattern characterised by high levels of 3-fucosyllactose, lacto-N-fucopentaose-III, and lacto-N-neodifucohexaose-II was positively associated with the relative abundance of Bifidobacterium breve (p = 0.014), while the pattern characterised by lacto-N-neotetraose, 6'-sialyllactose, and sialyllacto-N-tetraose-b was negatively associated with Bifidobacterium breve (p = 0.027). The pattern characterised by high levels of monofucosyl-lacto-N-hexaose-III and monofucosyl-lacto-N-neohexaose was positively associated with Bifidobacterium dentium (p = 0.025) and Bifidobacterium bifidum (p < 0.001), respectively. This study suggests that HMO patterns from mature breast milk were associated with certain gut microbiota of breastfed infants.

Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis.

Early childhood caries (ECC) is a growing public health concern worldwide. Although numerous systematic reviews have been published regarding the association between breastfeeding and early childhood caries (ECC), the results remain inconclusive and equivocal. This systematic review synthesises the evidence on the association between breastfeeding and ECC. Five electronic databases and backward citation chasing were performed from inception until May 2023. A total of 31 studies (22 cohort studies and 9 case-control studies) were included in this review. The meta-analysis of the case-control studies showed statistically significant fewer dental caries in children who were breastfed for < 6 months compared to those who were breastfed for ≥6 months (OR = 0.53, 95% CI 0.41-0.67, p < 0.001). There was a statistically significant difference in dental caries between children who were breastfed for <12 months and those who were breastfed for ≥12 months (RR = 0.65, 95% CI 0.50-0.86, p < 0.002). Similarly, there was a statistically significant difference in dental caries in children who were breastfed for < 18 months compared to those who were breastfed for ≥18 months (RR = 0.41, 95% CI 0.18-0.92, p = 0.030). Nocturnal breastfeeding increases the risk of ECC compared with no nocturnal breastfeeding (RR = 2.35, 95% CI 1.42-3.89, p < 0.001). The findings suggest breastfeeding for more than 12 months and nocturnal breastfeeding increase the risk of ECC.

Breastfeeding, Gestational Diabetes Mellitus, Size at Birth and Overweight/Obesity in Early Childhood.

Background: Breastfeeding appears to reduce the risk of childhood overweight/obesity. However, it remains unclear whether this protective effect persists among high-risk populations. This study aims to investigate the association of breastfeeding with the risk of overweight/obesity in early childhood and whether this association is altered by gestational diabetes mellitus (GDM) or size at birth. Methods: Feeding practices during the first 12 months of age and weight and length at 12-36 months of age were collected. Full breastfeeding includes exclusive and predominant breastfeeding. Children with body mass index (BMI) values greater than 1 standard deviation from the mean of sex- and age-specific BMI were classified as overweight/obese. Multiple generalized estimating equations models were applied to analyze the associations of full breastfeeding duration with overweight/obesity risk. Results: Among all participants (n = 9329), infants with a longer full-breastfeeding duration had a reduced risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Infants exposed to GDM and those born large for gestational age (LGA) had a higher risk of overweight/obesity in early childhood. Among infants of mothers with GDM (n = 1748), infants with full breastfeeding for greater than 6 months (aOR: 0.58; 95% CI: 0.44, 0.78) showed a decreased risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Among LGA infants (n = 1279), infants with full breastfeeding for 3-5 months (aOR: 0.66; 95% CI: 0.57, 0.76) and greater than 6 months (aOR: 0.70; 95% CI: 0.56, 0.88) showed a decreased risk of overweight/obesity in early childhood. Similar results were observed among LGA infants of mothers with GDM. Conclusions: Initiating and prolonging breastfeeding would reduce the risk of overweight/obesity in early childhood, and LGA infants and infants born to mothers with GDM would experience greater benefits.

Population pharmacokinetic modelling of primaquine exposures in lactating women and breastfed infants.

Current guidelines advise against primaquine treatment for breastfeeding mothers to avoid the potential for haemolysis in infants with G6PD deficiency. To predict the haemolytic risk, the amount of drug received from the breast milk and the resulting infant drug exposure need to be characterised. Here, we develop a pharmacokinetic model to describe the drug concentrations in breastfeeding women using venous, capillary, and breast milk data. A mother-to-infant model is developed to mimic the infant feeding pattern and used to predict their drug exposures. Primaquine and carboxyprimaquine exposures in infants are <1% of the exposure in mothers. Therefore, even in infants with the most severe G6PD deficiency variants, it is highly unlikely that standard doses of primaquine (0.25-1 mg base/kg once daily given to the mother for 1-14 days) would cause significant haemolysis. After the neonatal period, primaquine should not be restricted for breastfeeding women (Clinical Trials Registration: NCT01780753).

Risk of transmission of HIV to infants during breast/chest feeding when mothers/birthing parents living with HIV are on antiretroviral therapy: a protocol for a rapid review.

INTRODUCTION: HIV is a major public health issue affecting millions globally. Women and girls account for 46% of new HIV infections in 2022 and approximately 1.3 million females become pregnant every year. Vertical transmission of HIV from persons living with HIV (PLHIV) to infants may occur through different modalities, such as through breast/chest feeding. Notably, 82% of PLHIV who chose to breast/chest feed are on antiretroviral therapy (ART) when feeding their infants. Precise estimates of the risk of postpartum transmission to infants during breast/chest feeding at varying viral load levels remain a significant gap in the literature. METHODS AND ANALYSIS: A rapid systematic search of electronic databases will be conducted from January 2005 to the present, including Medline, Embase and Global Health. The objective of this rapid review is to explore and assess the available evidence on the effect of varying viral load levels on the risk of HIV transmission to infants during breast/chest feeding when the birthing or gestational parent living with HIV is on ART. Study characteristics will be summarised and reported to support the narrative summary of the findings. The focus will be on the absolute risk of HIV transmission from birthing parent to infant during chest/breast feeding. The findings will also be stratified by month, including the risk of HIV transmission for 6 months and greater than 6 months postpartum. We will ascertain the risk of bias using A Measurement Tool to Assess Systematic Reviews 2, Quality of Prognosis Studies and Downs and Black checklist for the appropriate study type. A summary score will not be calculated, rather the strengths and limitations of the studies will be narratively described. ETHICS AND DISSEMINATION: No human subjects will be involved in the research. The findings of this rapid review will inform a future systematic review and will be disseminated through peer-reviewed publications, presentations and conferences. PROSPERO REGISTRATION NUMBER: CRD42024499393.

Infant and young child feeding practice among mothers-child pair in irrigated and non-irrigated areas of Dangila district, Northwest Ethiopia, 2020: a community based comparative cross-sectional study.

BACKGROUND: The issue of Infant and Young Child Feeding practices was widespread; it was estimated that infants were not exclusively breastfed in the first six months of life. Complementary foods were frequently provided too soon or too late, and they were often nutritionally deficient. Even, there are nutrition-sensitive activities like irrigation schemes, evidence on infant and young child feeding practices between irrigated and non-irrigated areas is scarce or limited. OBJECTIVE: To assess the prevalence of infant and young child feeding practices among 0-23 months of age children in irrigated and non-irrigated areas of Dangila District, North-west Ethiopia, 2020. METHODS: A community based comparative cross-sectional study was conducted from Dec 1, 2020, to Jun 1, 2020. A stratified sampling technique was implemented to select 823 mothers with children age 0-23 months from irrigated (411) and non-irrigated (412) kebeles. Data were collected using structured questionnaires. Multivariable logistic regression was used to identify the associated factors of infant and young child feeding practice. Adjusted odds ratios with a 95% CI were used to determine the degree of association between the independent and outcome variables. A p-value < 0.05 was used as a cutoff point to declare statistically significant variables with the outcome variable. RESULTS: Among 823 households visited, 802 respondents with a response rate of 97.8% in irrigated and 96.11% in non-irrigated areas gave complete responses. The overall prevalence of good IYCF practice was 62.5% (95% CI: 34.2, 41.3), and it shows a significant difference between irrigated (72.2%) and non-irrigated areas (52.8%). Moreover, the study identified that education primary and above (AOR = 1.889, 95% CI: 1.38, 2.648) knowledge above mean (AOR = 2.347, 95% CI: 1.555, 3.542), positive attitude (AOR = 1.716, 95% CI: 1.139, 2.587), PNC follow-up (AOR = 1.606, 95% CI: 1.154, 2.360), women's decision-making power (AOR = 1.840, 95% CI: 1.226, 2.763), and multiple delivery (AOR = 0.352, 95% CI: 0.213, 0.583) were significant factors for IYCF among 0-23 month-old children. CONCLUSION AND RECOMMENDATIONS: The infant and young child feeding practice among 0-23 month-old children was better in an irrigated area than in a non-irrigated area. Promoting irrigation practices, empowering women, and strengthening postnatal care are recommended interventions to increase infant, young, and child feeding practices in the study area.

Application of Statistical Analysis and Machine Learning to Identify Infants' Abnormal Suckling Behavior.

OBJECTIVE: Identify infants with abnormal suckling behavior from simple non-nutritive suckling devices. BACKGROUND: While it is well known breastfeeding is beneficial to the health of both mothers and infants, breastfeeding ceases in 75 percent of mother-child dyads by 6 months. The current standard of care lacks objective measurements to screen infant suckling abnormalities within the first few days of life, a critical time to establish milk supply and successful breastfeeding practices. MATERIALS AND METHODS: A non-nutritive suckling vacuum measurement system, previously developed by the authors, is used to gather data from 91 healthy full-term infants under thirty days old. Non-nutritive suckling was recorded for a duration of sixty seconds. We establish normative data for the mean suck vacuum, maximum suck vacuum, suckling frequency, burst duration, sucks per burst, and vacuum signal shape. We then apply computational methods (Mahalanobis distance, KNN) to detect anomalies in the data to identify infants with abnormal suckling. We finally provide case studies of healthy newborn infants and infants diagnosed with ankyloglossia. RESULTS: In a series of case evaluations, we demonstrate the ability to detect abnormal suckling behavior using statistical analysis and machine learning. We evaluate cases of ankyloglossia to determine how oral dysfunction and surgical interventions affect non-nutritive suckling measurements. CONCLUSIONS: Statistical analysis (Mahalanobis Distance) and machine learning [K nearest neighbor (KNN)] can be viable approaches to rapidly interpret infant suckling measurements. Particularly in practices using the digital suck assessment with a gloved finger, it can provide a more objective, early stage screening method to identify abnormal infant suckling vacuum. This approach for identifying those at risk for breastfeeding complications is crucial to complement complex emerging clinical evaluation technology. CLINICAL IMPACT: By analyzing non-nutritive suckling using computational methods, we demonstrate the ability to detect abnormal and normal behavior in infant suckling that can inform breastfeeding intervention pathways in clinic.Clinical and Translational Impact Statement: The work serves to shed light on the lack of consensus for determining appropriate intervention pathways for infant oral dysfunction. We demonstrate using statistical analysis and machine learning that normal and abnormal infant suckling can be identified and used in determining if surgical intervention is a necessary solution to resolve infant feeding difficulties.

Pink colored breast milk! Serratia marcescens infection, series of 4 cases.

BACKGROUND: Pink coloration of breast milk is uncommon and it´s associated with colonization by Serratia marcescens, which is most frequently isolated in intensive care settings. Misinterpretation of the pink coloration may lead to premature cessation of breastfeeding. The objective is to present four cases of pink discoloration. METHODS: Two retrospective and two prospective cases of pink discoloration in breast milk are described, which were reported to the lead author. RESULTS: Four healthy mother-infant pairs with documented pink discoloration are presented. S. marcescens was isolated from breast milk samples. All four infants were asymptomatic and underwent enterobacteria cultures. The mothers received outpatient antibiotic treatment, and two infants received treatment as well. Subsequent cultures yielded negative results, and the pink discoloration ceased. All mothers successfully resumed breastfeeding. CONCLUSIONS: There are very few reported cases of pink breast milk in the global literature. Colonization by S. marcescens is not an indication for discontinuation of breastfeeding.

INTRODUCCIÓN: La coloración rosa de la leche materna es poco frecuente y está asociada a colonización por Serratia marcescens. Se aísla con mayor frecuencia en entornos de cuidados intensivos. La desinformación por la coloración rosa puede conducir a una terminación prematura de la lactancia. El objetivo es presentar cuatro casos de coloración rosa de la leche materna. MÉTODOS: Se describen dos casos retrospectivos y dos prospectivos de presentación de leche materna de color rosa. Los casos fueron reportados a la autora principal. RESULTADOS: Se presentan cuatro binomios sanos con reporte de coloración rosa. Se aisló S. marcescens en una muestra de leche materna. Los cuatro lactantes eran asintomáticos y tuvieron cultivos para la enterobacteria. Las madres fueron tratadas con antibiótico ambulatorio. Dos lactantes recibieron tratamiento. Todos los cultivos posteriores fueron negativos y la coloración rosa cesó. Todos reanudaron la lactancia materna de forma exitosa. CONCLUSIONES: Existen muy pocos casos de leche de color rosa reportados en la literatura mundial. La colonización por S. marcescens no es una indicación de suspensión de la lactancia.

Support Networks for Exclusive Breastfeeding (SNEB). A conceptual approach and characterization in Mexico.

BACKGROUND: This study focuses on the conceptualization and graphical characterization of Exclusive Breastfeeding Support Networks (EBSN) in Mexico. METHODS: Through a sample design stratified by federal entity with state significance at 95%, a questionnaire was administered online via Microsoft Forms to a representative sample of 2989 women whose primiparity occurred in Mexico. The questionnaire primarily focused on sociodemographic data of the mothers and the structure of their EBSNs during primiparity. RESULTS: In this work, EBSNs are defined as networks mainly composed of women, whose function is to share knowledge and experiences about breastfeeding, as well as to provide emotional and physical support to breastfeeding mothers, contributing to strengthening the emotional and caregiving bonds between mothers and their newborns. CONCLUSIONS: Sankey diagrams were employed for the characterization of EBSNs, revealing that the mother of the primipara is generally the main node, resulting in a network with greater flow and reach. Conversely, when the first node is not related to the primipara, the networks tend to be smaller and with less flow.

INTRODUCCIÓN: Este estudio se centra en la conceptualización y la caracterización gráfica de las Redes de Apoyo a la Lactancia Materna Exclusiva (RALME) en México. MÉTODOS: Mediante un diseño muestral estratificado por entidad federativa con significancia estatal al 95%, se aplicó un cuestionario en línea, a través de Microsoft Forms, a una muestra representativa de 2989 mujeres cuya primiparidad fue en México. El cuestionario se enfocó principalmente en datos sociodemográficos de las madres y en la estructura de sus RALME durante la primiparidad. RESULTADOS: En este trabajo se definen las RALME como redes compuestas mayormente por mujeres, cuya función es compartir conocimientos y experiencias sobre la lactancia, así como ofrecer apoyo emocional y físico a madres lactantes, contribuyendo a fortalecer los lazos afectivos y de cuidado entre las madres y sus recién nacidos. CONCLUSIONES: Para la caracterización de las RALME se utilizó el diagrama de Sankey, revelando que la madre de la primípara es generalmente el nodo principal, lo que resulta en una red con mayor flujo y alcance. Por el contrario, cuando el primer nodo no tiene parentesco con la primípara, las redes tienden a ser más reducidas y con menor flujo.

Innovative continuum of care to promote exclusive breast feeding in Pakistan: protocol of a pilot randomised controlled trial.

BACKGROUND: Breastmilk being the ideal nutrition from birth to 2 years and beyond has many health benefits for both newborn and mothers. This study will assess the feasibility and acceptability of a continuum of care programme, which is a health facility and community based till 6 months post partum to encourage ideal breastfeeding practices. METHODS AND ANALYSIS: A pilot randomised control trial having two-parallel arms of intervention and control groups was conducted in gynaecology and obstetrics department of Aziz Bhatti Shaheed Teaching Hospital with a community outreach component of 6 months. 50 women between 28 and 32 weeks of gestation fulfilling inclusion criteria will be allocated in 1:1 randomly into intervention and control groups through computer-generated random number generator software. 25 participants in intervention group will receive counselling and training on breast feeding during antenatal visits along with a family member of support by a trained female doctor within the hospital, at birth by a trained nurse and at home for 6 months by a trained lady health worker. It will be supported by reading materials and videos through a mobile phone WhatsApp application. The 25 participants in control group will receive the support already provided within the hospital and at home. The primary outcomes feasibility and acceptability will be determined at 6 months post partum from participants and providers by a semistructured questionnaire. The secondary outcomes are rates of infant early initiation and exclusive breast feeding at 2 weeks, 1, 3 and 6 months, Infant Feeding Attitude at 1 month and Breastfeeding Self-Efficacy at 3 months. Quantitative and qualitative data will be analysed via SPSS software V.20 and thematic analysis, respectively. CONCLUSION: This pilot randomised controlled trial (RCT) will guide the interventions for the definite RCT. ETHICS AND DISSEMINATION: Approved by institutional ethical committee, informed consent from all participants and results will be disseminated in peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05951868.

Effects of Nurse Staffing on Missed Breastfeeding Support in Maternity Units With Different Nurse Work Environments.

PURPOSE: To examine the effect of nurse staffing in varying work environments on missed breastfeeding teaching and support in inpatient maternity units in the United States. BACKGROUND: Breast milk is the optimal food for newborns. Teaching and supporting women in breastfeeding are primarily a nurse's responsibility. Better maternity nurse staffing (fewer patients per nurse) is associated with less missed breastfeeding teaching and support and increased rates of breastfeeding. We examined the extent to which the nursing work environment, staffing, and nurse education were associated with missed breastfeeding care and how the work environment and staffing interacted to impact missed breastfeeding care. METHODS: In this cross-sectional study using the 2015 National Database of Nursing Quality Indicator survey, maternity nurses in hospitals in 48 states and the District of Columbia responded about their workplace and breastfeeding care. Clustered logistic regression models with interactions were used to estimate the effects of the nursing work environment and staffing on missed breastfeeding care. RESULTS: There were 19 486 registered nurses in 444 hospitals. Nearly 3 in 10 (28.2%) nurses reported missing breastfeeding care. In adjusted models, an additional patient per nurse was associated with a 39% increased odds of missed breastfeeding care. Furthermore, 1 standard deviation decrease in the work environment was associated with a 65% increased odds of missed breastfeeding care. In an interaction model, staffing only had a significant impact on missed breastfeeding care in poor work environments. CONCLUSIONS: We found that the work environment is more fundamental than staffing for ensuring that not only breastfeeding care is not missed but also breastfeeding care is sensitive to nurse staffing. Improvements to the work environment support the provision of breastfeeding care. IMPLICATIONS FOR RESEARCH AND PRACTICE: Both nurse staffing and the work environment are important for improving breastfeeding rates, but the work environment is foundational.