Being There: The Development of the International Code of Marketing of Breast-milk Substitutes, the Innocenti Declaration and the Baby-Friendly Hospital Initiative.

Margaret Isabirye Kyenkya (photo) grew up in Uganda with five bothers and six sisters. Her Bachelor of Arts was in Social Work and Social Administration (Makerere University, Uganda), and was followed by a Masters in Sociology, (Nairobi University), and a Certificate in Mother and Child Health (International Child Health Institute, London). Her PhD focused on Hospital Administration inspired by the WHO/UNICEF Baby Friendly Hospital Initiative. She has worked as a researcher, the founder of Non-Governmental Organizations, a Senior United Nations Officer (New York Headquarters and several regions), a Manager in the United States Agency for International Development-funded National Health and Nutrition Projects, and a governmental Health and Nutrition Adviser. A certified trainer in a number of health and nutrition areas, a breastfeeding counselor, and a retired La Leche League Leader, Dr. Kyenkya has significantly influenced the course of lactation support and promotion globally. She stated, "My most precious and valued occupation is that of a mother [of five] and grandmother [of eight]." Dr. Kyenkya currently lives in Atlanta, Georgia, in the United States. (This interview was conducted in-person and transcribed verbatim. It has been edited for ease of readability. MK refers to Margaret Kyenkya; KM refers to Kathleen Marinelli.).

Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Growth and Change in the Journal of Human Lactation: A Content Analysis 1985-2018.

BACKGROUND: A professional association journal should reflect the needs of its organization, its readers, and the field it represents. Evaluating the needs that the Journal of Human Lactation has met, and those it has not, is essential if it is to remain relevant to its readers. AIMS: (1) Describe the characteristics of articles published from 1985 through 2018. (2) Describe content intended to educate lactation support providers and clinicians. (3) Explore the ways the content has illustrated the growth and development of lactation knowledge, and (4) identify the reoccurring content threads consistent throughout the 34 years. METHODS: A prospective mixed methods approach incorporating a quantitative content analysis and a qualitative thematic analysis was used. Frequency distributions were done on all the variables extracted from published articles (N = 1586). The second level of analysis identified themes using an iterative and consensus approach. RESULTS: Mirroring the growth in the lactation field, the volume of research articles published each year has increased along with the percent of research articles per issue. Research methods have become more diverse. The international scope and relevance, while always present, has been steadily increasing. Threads identified were; striving for international scope, advancing lactation education, developing a body of knowledge that informs clinical practice in lactation, and creating a centralized place for multidisciplinary research about lactation. CONCLUSION: The body of work published in the Journal of Human Lactation parallels the development of the lactation specialty. We have highlighted areas for improvement and possible further study.

An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse.

Breastfeeding and the place of sleep for the mother and the infant have been controversial internationally due to reported concerns regarding infant deaths despite the known benefits of exclusive and prolonged breastfeeding, which are increased by breastfeeding at night. The aims of this integrated analysis were to (a) review breastfeeding and maternal and infant sleep research literature via historical, epidemiological, anthropological, and methodological lenses; (b) use this information to determine where we are currently in safeguarding both infant lives and breastfeeding; and (c) postulate the direction that research might take from this point forward to improve our knowledge and inform our policy and practice. Despite well-meaning but unsuccessful campaigns in some countries to dissuade parents from sleeping with their babies, many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. Taking cultural contexts and socio-ecological circumstances into consideration, data supports policies to counsel parents and caregivers on safe sleep practices, including bed-sharing in non-hazardous circumstances, particularly in the absence of parental smoking, recent parental alcohol consumption, or sleeping next to an adult on a sofa. Further research with appropriate methodology is needed to drill down on actual rates of infant deaths, paying close attention to the definitions of deaths, the circumstances of the deaths, and confounding factors, in order to ensure we have the best information with which to derive public health policy. Introduction and use of the concept of "breastsleeping" is a plausible way to remove the negative connotations of "co-sleeping" and redirect ongoing data-driven discussions and education of best practices of breastfeeding and sleep.

ABM Clinical Protocol #16: Breastfeeding the Hypotonic Infant, Revision 2016.

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Daily Breastmilk Volume in Mothers of Very Low Birth Weight Neonates: A Repeated-Measures Randomized Trial of Hand Expression Versus Electric Breast Pump Expression.

BACKGROUND: There are no randomized trials comparing early exclusive hand expression (HE) with early exclusive electric pump expression (electric expression [EE]) for milk removal in mothers of very low birth weight (VLBW) infants. SUBJECTS AND METHODS: Mothers of VLBW infants were randomized to exclusively HE or EE for the first 7 days postpartum. Daily volumes of milk were compared between groups for the first 28 days, adjusting for repeated measures. RESULTS: The HE (n=12) and the EE (n=14) groups did not differ with respect to age, parity, single versus multiple gestation, or number of expression sessions per day. There were 728 values for daily milk volumes in the first 28 days, including 105 HE and 623 EE. Mothers using exclusive HE had significantly (p<0.05) less cumulative daily milk production throughout the first 7 days postpartum compared with exclusive EE. Mean cumulative milk production among mothers using HE in the first postpartum week remained approximately half that of those using the electric pump throughout the first 28 days, without evident catch up. In multivariable analysis, each postpartum day was associated with an adjusted increase of 50 mL of human milk/day during the first 7 days postpartum and an increase of 13 mL/day between postpartum Days 8 and 28. After adjusting for repeated measures, number of expression sessions per day, and postpartum day, EE was associated with an advantage in milk production of 119 mL/day during the first 28 postpartum days compared with HE. CONCLUSIONS: Compared with mothers using EE, mothers using HE had significantly less cumulative daily milk production during the first 7 days postpartum. This trend continued after the intervention had been discontinued, and the great majority of expressions in both groups were with EE. Further research to confirm and expand these findings is warranted.

ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015.

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

ABM clinical protocol #1: guidelines for blood glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates, revised 2014.

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

The Effect of a Donor Milk Policy on the Diet of Very Low Birth Weight Infants.

BACKGROUND: Use of donor milk (DM) to supplement mother's own milk (MOM) in the neonatal intensive care unit (NICU) is steadily increasing based on health and developmental benefits to premature infants. A paucity of data exists documenting the effect of DM use on the diet of very low birth weight (VLBW) infants related to the implementation of a DM policy. OBJECTIVE: This study aimed to compare VLBW enteral intake type in the first 28 days of life before versus after establishing a DM policy. METHODS: This single-center pre-post prospective cohort study included all inborn infants ≤ 1500 grams in a level 4 NICU remaining hospitalized at 28 days and admitted either before (pre-DM period, October 2009-March 2010) or after (DM period, October 2010-September 2012) implementing a DM policy. The feeding protocol was unchanged in both periods. Collected data included maternal/infant demographics, infant clinical data, and daily volume of enteral intake as MOM, DM, and formula. The proportion of enteral feeds from these sources during the first 28 days of life was compared pre-DM versus DM. RESULTS: Compared to pre-DM baseline, formula exposure was significantly decreased, and human milk exposure and proportion of diet as human milk increased. The proportion of infants fed exclusively human milk increased. Exposure to and proportion of diet as MOM was unchanged. Infants were fed earlier in the DM period. CONCLUSION: Establishment of a DM policy was associated with reduced exposure to formula, promoting an exclusively human milk diet, with earlier initiation of feeds and no decrease in use of MOM.

ABM clinical protocol #2: Guidelines for hospital discharge of the breastfeeding term newborn and mother: "The going home protocol," revised 2014.

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Independent predictors of human milk receipt at neonatal intensive care unit discharge.

OBJECTIVE: The aim of this study is to construct a predictive model for very low birth weight (VLBW) infants' receipt of mother's own milk within 24 hours before neonatal intensive care unit (NICU) discharge. STUDY DESIGN: Vermont Oxford Network (VON) clinical data were analyzed retrospectively for VLBW infants admitted between 2002 and 2012 at an inner city, level IV NICU with a well-established lactation program. Bivariate analyses compared infant characteristics between recipients and nonrecipients of human milk before 24 hours of NICU discharge. Independent predictors identified in the bivariate analyses (p ≤ 0.05), were eligible for inclusion into a multivariable logistic regression model. RESULTS: We observed a 60.4% human milk feeding rate at NICU discharge. Multiple independent maternal (black race and Hispanic ethnicity) and clinical factors (need for mechanical ventilation, patent ductus arteriosus, late-onset sepsis, or discharge to home on a cardiorespiratory monitor) positively predicted the outcome. CONCLUSIONS: Our results were inconsistent with previous studies and suggest that a strong NICU lactation program in combination with a community-based peer counselor program may increase rates of human milk receipt among VLBW infants born to black/Hispanic mothers and those with more complicated neonatal courses.