Association Between Exclusive Breastfeeding and Infant Health Outcomes in Pakistan.

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.

Factors associated with exclusive breastfeeding in Israel during the COVID-19 pandemic: a subset of the IMAgiNE EURO cross-sectional study.

BACKGROUND: Evidence has shown that restrictions during the COVID-19 pandemic have negatively affected breastfeeding support and outcomes in hospitals in many countries. The aims of the study were to describe exclusive breastfeeding rates and identify factors associated with exclusive breastfeeding at hospital discharge among women who gave birth during the COVID-19 pandemic in Israel. METHODS: A cross-sectional online anonymous survey based on WHO standards for improving quality of maternal and newborn care in health facilities was conducted among a sample of women who gave birth to a healthy singleton infant in Israel during the pandemic (between March 2020 and April 2022). The socio-ecological approach was employed to examine intrapersonal, interpersonal, organizational, and community/society factors associated with exclusive breastfeeding at hospital discharge according to women perspectives. RESULTS: Among the 235 Israeli participants, 68.1% exclusively breastfed, 27.7% partially breastfed, and 4.2% did not breastfeed at discharge. Results of the adjusted logistic regression model showed that factors significantly associated with exclusive breastfeeding were the intrapersonal factor of multiparity (adjusted OR 2.09; 95% Confidence Interval 1.01,4.35) and the organizational factors of early breastfeeding in the first hour (aOR 2.17; 95% CI 1.06,4.45), and rooming-in (aOR 2.68; 95% CI 1.41,5.07). CONCLUSIONS: Facilitating early breastfeeding initiation and supporting rooming-in are critical to promoting exclusive breastfeeding. These factors, reflecting hospital policies and practices, along with parity, are significantly associated with breastfeeding outcomes and highlight the influential role of the maternity environment during the COVID-19 pandemic. Maternity care in hospitals should follow evidence-based breastfeeding recommendations also during the pandemic, promoting early exclusive breastfeeding and rooming-in among all women, with particular attention to providing lactation support to primiparous women. TRIAL REGISTRATION: Clinical Trials NCT04847336.

COVID-19 Pediatric Vaccination Attitudes Among Parents in Ohio.

INTRODUCTION: This study aimed to examine factors associated with parental intention to vaccinate children against COVID-19 in Ohio following pediatric vaccine approval in October 2021. METHOD: Online anonymous surveys were distributed between November 2021 and January 2022 to parents in Ohio. RESULTS: Surveys were completed by 581 parents of whom 43.5% reported they intended to vaccinate their children against COVID-19, whereas 56.5% did not intend to vaccinate their children. Perceiving a lack of support by health care providers was significantly associated with not intending to vaccinate children against COVID-19 (p < .001). DISCUSSION: Survey results from parents in Ohio indicate that perceived health care provider support and parents' attitudes about pediatric COVID-19 vaccination influenced their intent to vaccinate their children. Hence, health care providers working with families need to focus on educating parents regarding the importance and safety of vaccination.

Factors associated with exclusive breastfeeding at discharge during the COVID-19 pandemic in 17 WHO European Region countries.

BACKGROUND: Exclusive breastfeeding is the optimal infant nutrition, providing infants immunoprotection against many diseases including SARS-CoV-2 infection. Restrictions during the COVID-19 pandemic may have negatively affected breastfeeding practices in maternity care facilities. The aims of the study were to examine exclusive breastfeeding rates at discharge over time and to identify factors associated with exclusive breastfeeding during the pandemic. METHODS: A cross-sectional survey was conducted among mothers who gave birth in a maternity care facility in the World Health Organization (WHO) European Region countries during the COVID-19 pandemic. The socio-ecological model was employed to examine intrapersonal, interpersonal, organizational, and community/society factors associated with maternal report of exclusive breastfeeding at the time of discharge. RESULTS: There were 26,709 participating mothers from 17 European Region countries who were included in the analysis. Among the mothers, 72.4% (n = 19,350) exclusively breastfed and 27.6% (n = 7,359) did not exclusively breastfeed at discharge. There was an overall decline in exclusive breastfeeding rates over time (p = 0.015) with a significantly lower rate following the publication of the WHO breastfeeding guidelines on 23 June 2020 (AOR 0.88; 95% CI 0.82, 0.94). Factors significantly associated with exclusive breastfeeding outcomes in the logistic regression analysis included maternal age, parity, education, health insurance, mode of birth, inadequate breastfeeding support, lack of early breastfeeding initiation, lack of full rooming-in, birth attendant, perceived healthcare professionalism and attention, facility room cleanliness, timing of birth, and location of birth. CONCLUSIONS: Results from the study indicate the decline in exclusive breastfeeding rates in the WHO European Region during the COVID-19 pandemic. Using the socio-ecological model to identify factors associated with breastfeeding outcomes facilitates an integrated and holistic approach to address breastfeeding needs among women across the region. These findings demonstrate the need to augment breastfeeding support and to protect exclusive breastfeeding among mother-infant dyads, in an effort to reverse the declining exclusive breastfeeding rates. The study highlights the need to educate mothers and their families about the importance of exclusive breastfeeding, reduce maternal-infant separation, increase professional breastfeeding support, and follow evidence-based practice guidelines to promote breastfeeding in a comprehensive and multi-level manner. TRIAL REGISTRATION NUMBER: Clinical Trials NCT04847336.

Maternal Self-Confidence and Breastfeeding after Participating in a Program about Infant Prone Positioning.

PURPOSE: Maternal self-confidence facilitates infant growth and new mother role development. Infant ability to breastfeed and maternal breastfeeding self-confidence are imperative to helping mothers meet their breastfeeding goals. Consistent opportunity for infant movement in the prone position has been shown to improve breastfeeding ability; however, families report a lack of knowledge of how to safely support this activity. Perceptions of maternal self-confidence, infant development, and breastfeeding success upon completion of an infant prone positioning program with focus on posture, movement, and connection were studied. STUDY DESIGN AND METHODS: Qualitative interviews were conducted among breastfeeding mothers in three states to explore maternal perceptions of learning about infant prone positioning. RESULTS: Thirty-five mothers who completed an infant prone positioning program shared their perceptions of infant interaction, prone play and positioning, and breastfeeding self-confidence. Four primary themes were identified from the analysis: maternal knowledge and self-confidence; strategies and practices learned; breastfeeding benefits of infant prone positioning; and motivation for program participation. CLINICAL IMPLICATIONS: Our findings support consideration of teaching new mothers about prone positioning to enhance self-confidence in mothering, breastfeeding skills, infant development, and maternal-infant dyad bonding.

Association Between Prenatal Smoking and Gestational Diabetes Mellitus.

OBJECTIVE: To evaluate whether there is an association between prenatal smoking and gestational diabetes mellitus (GDM). METHODS: We conducted a secondary data analysis using data from the Pregnancy Risk Assessment Monitoring System from 2009 to 2015. Outcome measures included self-reported GDM and change in smoking status during pregnancy (nonsmoker, quit smoking, reduced the amount smoked, smoked the same or more). Multivariable logistic regression analyses were performed to estimate the association between prenatal smoking and GDM status, adjusted for maternal age, race-ethnicity, prepregnancy body mass index (BMI) categories (underweight, normal [referent group], overweight, and obese), and gestational weight gain (inadequate, normal [referent group], and excessive), overall and stratified by prepregnancy BMI and gestational weight gain subgroups. RESULTS: A total of 222,408 women were included; 5.3% (n=12,897) had GDM. Most (48.1%) women had normal prepregnancy BMI, and 43.1% had excessive gestational weight gain. Mothers who continued to smoke the same or greater number of cigarettes or reduced the number of cigarettes smoked had higher odds of GDM (adjusted odds ratio [OR] 1.46, 95% CI 1.25-1.71 and OR 1.22, 95% CI 1.08-1.38, respectively). Smoking the same or more cigarettes was associated with higher odds of GDM in all subgroups of prepregnancy BMI or gestational weight gain. CONCLUSION: Prenatal smoking is associated with higher odds of GDM, after adjusting for known risk factors, and stratifying by prepregnancy BMI and gestational weight gain. Reducing smoking during pregnancy might reduce the risk of GDM and could be an additional reason for promoting smoking cessation among pregnant women.

Illicit drug use and sexually transmitted infections among young adults in the US: evidence from a nationally representative survey.

Young people aged 15-24 years account for half of all new sexually transmitted infections (STIs) in the United States. The aim of this study was to examine the cross-sectional associations of factors linked to STIs among US young adults (18-25 years). This study used the 2015-2018 pooled National Survey on Drug Use and Health data on 55,690 young adults. Almost 3.4% of the respondents reported having an STI in the past year. Among the participants, 38.4% used illicit drugs and 3.7% reported a history of delinquency in the past year. In the survey-weighted logistic regression model, odds for contracting STIs in the preceding year was higher among adults aged 22-25 versus 18-21 years (OR:1.26, 95%CI:1.12-1.42); male versus female (OR:2.44, 95%CI:2.11-2.82); non-Hispanic African American versus non-Hispanic White (OR:1.77, 95%CI:1.55-2.02); widowed/separated/divorced (OR:1.93, 95%CI:1.36-2.75) and never married (OR:1.29, 95%CI:1.07-1.55) versus married; full-time/part-time employed (aOR:1.17, 95% CI:1.04-1.31) compared to unemployed/other; history of delinquency (OR:2.31, 95%CI:1.89-2.83); and use of illicit drugs in the last year (OR:3.10, 95%CI:2.77-3.47). High incidence of illicit drug use by the young adults and its strong association with STI incidence in recent years warrant special attention. Tailored preventive measures should be focused on key predictors.

Development and Psychometric Testing of the Maternal Nipple Shield Satisfaction Scale.

BACKGROUND AND PURPOSE: Nipple shield use is common among breastfeeding mothers, yet no instrument measures maternal satisfaction. The new Maternal Nipple Shield Satisfaction Scale (MNSSS) was evaluated for reliability and validity. METHODS: The MNSSS for was tested in two phases: women (N = 128) using nipple shields in the previous 6 months and the second, women, (N = 57) within the first 3 weeks postpartum. RESULTS: From the original 21-item scale, content validity analysis, Cronbach's alpha, item to total correlation testing, exploratory factor analysis resulted in a one factor scale consisting of nine items with a Cronbach's alpha of .90. Convergent validity testing resulted in a small, but significant negative correlation. CONCLUSION: The MNSSS may be a useful instrument for examining satisfaction of women using nipple shields for breastfeeding.

Late onset sepsis: comparison between coagulase-negative staphylococci and other bacteria in the neonatal intensive care unit.

OBJECTIVE: To compare demographic and clinical features of neonates with late-onset sepsis due to coagulase-negative-staphylococcus with those due to other bacterial pathogens. STUDY DESIGN: Retrospective, population-based cohort study. Data on infants less than 90 days old diagnosed with late-onset bacterial sepsis in the neonatal intensive care unit were reviewed. Univariable and multivariable analysis were performed. RESULTS: Two hundred and sixteen sepsis episodes were identified: coagulase-negative-staphylococcus caused 113 (52.3%) and other pathogen 103 (47.7%). Patients with coagulase-negative-staphylococcus sepsis had lower gestational age and younger age at onset, higher rates of parenteral nutrition exposure and normal temperature, lower rates of necrotizing enterocolitis, meningitis and neutropenia than patients with sepsis caused by other pathogens. In multivariable analysis, parenteral nutrition was the only independent risk factor for coagulase-negative-staphylococcus sepsis (odds ratio: 3.5, 95% confidence interval: 1.4-8.6). CONCLUSIONS: Initial empiric treatment for suspected sepsis should be targeted for other pathogens than coagulase-negative-staphylococci and vancomycin treatment should be reserved for infants with specific risk factors and according to local antimicrobial susceptibility.