A Comparison of the Timing of Hand Expressing of Human Milk With Breast Massage to Standard Care for Mothers of Preterm Infants: An Exploratory Pilot Using a Randomized Controlled Design.

BACKGROUND: Globally, 10% of all births are preterm. Access to human milk via manual breast expression is required to reduce the incidence of adverse outcomes related to prematurity. However, there is little evidence to recommend optimum timing to commence breast expression in mothers of preterm infants or the most effective method. RESEARCH AIMS: (1) To test feasibility of recruitment and compliance to the protocol and (2) to determine influence of using hand expressing and breast massage on milk production, engorgement, mastitis, and breastfeeding status at 3 months. METHODS: This study was an exploratory parallel two-group, pilot randomized controlled trial. Mothers of preterm infants at a metropolitan maternity hospital in Queensland Australia (N = 31) were randomized to receive either hand expressing and breast massage within the 1st hr of birth or standard care, hand expressing within 6 hr of birth, to determine the influence on milk production, engorgement, mastitis, and breastfeeding status at 3 months. RESULTS: Feasibility targets were not met; however, valuable learning from this trial uncovered barriers facing midwives in the birth suite to commencing expressing in the 1st hr of birth. There was no difference in occurrence of secondary outcomes, although trends support future study. CONCLUSIONS: Overall, unpredictability of preterm birth influenced our ability to recruit participants. Important directions for future study design would benefit from incorporating expressing times up to 6 hr with a replicable breast massage.

800 IU versus 400 IU per day of vitamin D3 in term breastfed infants: a randomized controlled trial from an LMIC.

This open-label, block-randomized controlled trial compared the effect of 800 IU/day and 400 IU/day of oral vitamin D3 supplementation in reducing vitamin D insufficiency (VDI) among healthy-term breastfed infants at 14 weeks of postnatal age. All eligible infants were randomized to receive either 800 or 400 IU/day of oral vitamin D3 (starting within the first week until 14 weeks). The primary outcome was the proportion of infants with VDI (25-OH-D < 20 ng/ml) at 14 weeks. Secondary outcomes were vitamin D deficiency (VDD, < 12 ng/ml), severe VDD (< 5 ng/ml), anthropometry, biochemical or clinical rickets, and any adverse events related to vitamin D toxicity (VDT). Among 102 enrolled infants, the distribution of baseline variables (including cord 25-OH-D levels; 13.0 versus 14.2 ng/ml) was similar in both groups. On intention-to-treat analysis, the proportions of infants with VDI at 14 weeks were significantly lower in the 800 IU group compared to those in the 400 IU group [24% versus 55%; RR 0.44; 95% CI: 0.25-0.76]. The proportions of infants with elevated parathormone (6% versus 26.5%; p = 0.012) and severe VDD (0% versus 12.2%; p = 0.033) were significantly lower in the 800 IU group. Clinical rickets developed in three (6.2%) infants in the 400 IU group. No infant developed VDT.      Conclusions: Daily oral supplementation with 800 IU of vitamin D3 resulted in an almost 50% reduction in the proportion of infants with VDI and prevented the occurrence of severe VDD at 14 weeks of age compared to 400 IU with no evidence of vitamin D toxicity.     Trial Registration: Clinical Trial Registry of India (CTRI/2019/02/017374). What is Known: • Breastfeeding is the ideal source of nutrition for healthy-term breastfed infants; however, vitamin D content of breastmilk is suboptimal. • AAP recommends daily oral supplementation of 400 IU of vitamin D to all healthy-term breastfed infants; however, trials from high-income countries support insufficiency of this dose in maintaining serum 25-OH-D levels >20 ng/ml with no such information from low-middle-income countries. What is New: • 800 IU/day of oral vitamin D3 supplementation among term breastfed infants significantly reduces vitamin D insufficiency at 14 weeks' age as compared to the recommended dose of 400 IU/day. • This higher supplemental dose is safe with no evidence of vitamin D toxicity.

A aplicação da laserterapia no tratamento de traumas mamilares: revisão de literatura / Application of laser therapy in the treatment of nipple traumas: a literature review / Aplicación de laserterapia en el tratamiento del traumatismo del pezón: revisión de literatura

OBJETIVO: Identificar na literatura científica a aplicação da laserterapia de baixa intensidade no tratamento de traumas mamilares em puérperas. MÉTODO: Trata-se de uma revisão integrativa da literatura. O levantamento das publicações ocorreu no período de setembro a novembro de 2020, utilizando os descritores "low-level light therapy" e "laser therapy", além da palavra-chave: "nipple trauma", nas bases de dados da PubMed, EMBASE, CINAHL, Scopuse Web of Science.Após a leitura e análise dos artigos, 3 artigos foram selecionados para a amostra final. RESULTADOS: Os dados analisados compuseram dois eixos temáticos denominados: "Uso da laserterapia no alívio da dor mamilar" e "Uso da laserterapia na cicatrização de fissuras mamilares". CONCLUSÃO: A aplicação da laserterapia resultou na diminuição da dor e boa regeneração tecidual mamilar, contribuindo para manutenção do aleitamento materno.

OBJECTIVE: To identify in the scientific literature the application of low-level laser therapy in the treatment of nipple traumas in puerperal women. METHOD: This is an integrative literature review.The survey of publications took place from September to November2020, using the descriptors "low-level light therapy" and "laser therapy", in addition to the keyword"nipple trauma", in the PubMed, EMBASE, CINAHL, Scopus and Web of Science databases.After reading and analyzing the articles, 3 were selected for the finalsample. RESULTS: The analyzed data composed two thematic axes, namely: "The use of laser therapy for nipple pain relief" and "The use of laser therapy in the healing of nipple fissures". CONCLUSION: The application of laser therapy resulted in pain reduction and in good nipple tissue regeneration, contributing to the maintenance of breastfeeding.

OBJETIVO: Identificar en la literatura científica la aplicación de laserterapia de baja intensidad en el tratamiento del traumatismo del pezón en mujeres posparto. MÉTODO: Se trata de una revisión integradora de la literatura. El levantamiento de publicaciones se realizó de septiembre a noviembre de 2020, utilizando los descriptores "low-level light therapy" y "laser therapy", además de la palabra clave: "nipple trauma", en las bases de datos de PubMed, EMBASE, CINAHL, Scopus y Web of Science. Después de leer y analizar los artículos, se seleccionaron 3 artículos para la muestra final. RESULTADOS: Los datos analizados comprendieron dos ejes temáticos denominados: "Uso de laserterapia para aliviar el dolor del pezón" y "Uso de laserterapia para la cicatrización de las grietas del pezón". CONCLUSIÓN: La aplicación de laserterapia dio como resultado una disminución del dolor y una buena regeneración del tejido del pezón, contribuyendo al mantenimiento de la lactancia.

Eliminating postnatal HIV transmission in high incidence areas: need for complementary biomedical interventions.

The rate of mother-to-child transmission (MTCT) of HIV from breastfeeding is increasing relative to other causes of MTCT. Early effective preconception and antenatal antiretroviral therapy (ART) reduces intrauterine and intrapartum MTCT, whereas maternal post-partum HIV acquisition, untreated maternal HIV, and suboptimal postnatal maternal ART adherence increase the risk of MTCT through breastfeeding. Although the absolute number of cases of MTCT acquired through breastfeeding is decreasing, the rate of decrease is less than the decrease in intrauterine and intrapartum MTCT. Unless current strategies are universally applied, they might not be sufficient to eliminate MTCT due to breastfeeding. Urgent action is needed to evaluate and implement additional preventive biomedical strategies in high HIV prevalence and incidence settings to eliminate MTCT from breastfeeding. Preventive strategies include: pre-exposure prophylaxis in breastfeeding women who have an increased risk of acquiring HIV; postnatal reinforcement strategies, such as maternal retesting for HIV, maternal care reinforcement, and prophylaxis in infants exposed to HIV via breastmilk; and active (vaccine) or passive immunoprophylaxis with long-acting broadly neutralising antibodies.

Low- level laser: cost of therapy fornipple trauma / Laser de baixa intensidade: custo da terapia no trauma mamilar

Abstract Objectives: to measure the micro-cost of local laser therapy (LL) and transcutaneous laser therapy application by Irradiation Laser Intravascular of Blood (ILIB) to treat nipple trauma and compare the most effective and efficient alternative treatment. Methods: a cross-sectional analytical and quantitative study with analysis on the micro absorption cost, implemented as a clipping, from a randomized clinical trial that used two types of laser therapy to treat nipple trauma due to breastfeeding. The sample consisted of 101 nipple lesions. Patients were randomized into three groups (Control - CG, Local Laser -LLG and ILIB-ILIBG). Materials used, direct labor (DL) and laser equipment were predictors of costs. The delta calculation (effect size) was the indicator for measuring effectiveness and efficiency. Results: after three sessions, the average final cost was R$ 40.04for CG, R$ 53.55for LLG and R$ 67.29for ILIBG. After three sessions of treatment, ILIBG showed a great reduction in the lesion area, but with a higher cost (p<0.05). Conclusions: ILIBG had a better effect on healing the nipple trauma when compared to CG and LLG, even though it is more expensive, it suggests a positive cost-benefit and the most effective and efficient alternative treatment.

Resumo Objetivos: mensurar o microcusteio da aplicação de Laserterapia Local (LL) e trans-cutânea por Irradiation Laser Intravascular of Blood (ILIB) no tratamento de traumas mamilares e comparar a alternativa de tratamento mais eficaz e eficiente. Métodos: estudo transversal analítico do tipo quantitativo com análise de microcusteio de procedimento por absorção, implementado como recorte, de um ensaio clínico rando-mizado que utilizou duas modalidades de laserterapia para tratamento de traumas mamilares ocasionados pela amamentação. A amostra foi composta de 101 lesões mamilares. As pacientes foram aleatorizadas em três grupos (Controle - GG, Laser Local - GLL e ILIB -GILIB). Foram preditores de custos os materiais consumidos, Mão de obra Direta (MoD) e o equipamentos de laser O cálculo Delta (tamanho do efeito) foi o indicador para a medida da eficácia e eficiência. Resultados: após três sessões, a média do custo final foi de R$ 40,04 para o GC, R$ 53,55 para o GLL e R$ 67,29 para o GILIB. Após três sessões de tratamento, GILIB apresentou maior redução da área da lesão, contudo custo mais elevado (p<0,05). Conclusão: o GILIB teve efeito melhor na cicatrização dos traumas mamilares quando comparado com o GC e GLL, mesmo sendo mais caro sugere um custo benefício positivo e a alternativa de tratamento mais eficaz eficiente.

Efeito da colostroterapia e do leite materno no estabelecimento da microbiota de recém-nascidos prematuros / Effect of breast milk and oropharyngeal administration of colostrum on the establishment of the microbiota of preterm newborns

A colonização inicial da microbiota humana é de suma importância, desempenhando um papel fundamental no desenvolvimento imunológico, nutricional, metabólico e neurológico. Recémnascidos prematuros e de baixo peso muitas vezes precisam permanecer internados em unidades de terapia intensiva e frequentemente a dieta enteral trófica é limitada, devido à imaturidade do sistema digestivo ou estado clínico do recém-nascido. Nesse contexto, a amamentação é importante para o desenvolvimento do recém-nascido e para a colonização inicial do trato gastrointestinal. Além disso, a administração de colostro como imunoterapia oral já foi descrita como uma terapia segura, viável e bem tolerável por recém-nascidos. Sendo assim, este projeto avaliou o efeito da administração de leite materno, seja através da dieta ou colostroterapia, no desenvolvimento da microbiota oral e intestinal de recém-nascidos prematuros. Foi realizado um estudo longitudinal e observacional, onde foram recrutados 20 neonatos prematuros para a análise da microbiota oral e 56 para a análise da microbiota intestinal. Foram coletadas amostras de saliva e fezes dos neonatos, e leite materno das mães destes neonatos, e realizado sequenciamento do gene 16S rRNA destas amostras, além da dosagem de imunoglobulina A (IgA) nas fezes dos recém-nascidos. Para análise estatística, foi utilizado o software SPSS e R Studio, adotando significância de 5% para os testes. O leite materno de mães de recém-nascidos prematuros apresenta composição que muda ao longo do tempo, com aumento de Staphylococcus e Streptococcus e diminuição de Corynebacterium 1. A colostroterapia possui efeito benéfico sobre a microbiota oral, com aumento de gêneros como Staphylococcus, Bifidobacterium e Bacteroides. Adicionalmente, existe diferença na microbiota intestinal quando diferentes proporções de leite materno são oferecidas durante a primeira semana de vida, além de maiores níveis de IgA total nas amostras de fezes de neonatos que receberam maiores proporções de leite materno

The initial colonization of the human microbiota is of paramount importance, playing a fundamental role in immunological, nutritional, metabolic, and neurological development. Premature and low-birth-weight newborns often need to remain hospitalized in intensive care units and often enteral trophic diet is limited due to the immaturity of the digestive system or the newborn's clinical status. In this context, breastfeeding is important for the newborn's development and for the initial colonization of the gastrointestinal tract. Furthermore, the administration of colostrum as oral immunotherapy has been described as a safe, viable and well-tolerable therapy for newborns. Therefore, this project evaluated the effect of administering breast milk, either through diet or administration of colostrum, on the development of the oral and intestinal microbiota of preterm newborns. A longitudinal and observational study was carried out, where 20 premature neonates were recruited for the analysis of the oral microbiota and 56 for the analysis of the intestinal microbiota. Samples of saliva and feces were collected from the newborns, and breast milk from the mothers of these newborns, and 16S rRNA gene sequencing was performed from these samples, in addition to the dosage of immunoglobulin A (IgA) in the feces of the newborns. For statistical analysis, SPSS and R Studio software were used, adopting a significance of 5% for the tests. Breast milk from mothers of premature newborns has a composition that changes over time, with an increase in Staphylococcus and Streptococcus and a decrease in Corynebacterium 1. Administration of colostrum has a beneficial effect on the oral microbiota, with an increase in genera such as Staphylococcus, Bifidobacterium and Bacteroides. Additionally, there is a difference in the intestinal microbiota when different proportions of breast milk are offered during the first week of life, in addition to higher levels of total IgA in stool samples from newborns who received higher proportions of breast mil

Unusual case of prolonged breastfeeding in an orthodontic patient: clinical and psychosocial implications / Amamentação prolongada em paciente ortodôntico: implicações clínicas e psicossociais

Case report: This article presents the case of an 11-year-old patient who sought orthodontic treatment, complaining of crooked teeth. In anamnesis, an emotional and physical dependence was reported regarding the act of breastfeeding. Considerations on the diagnosis, psychological implications, and clinical approach in this rare case were addressed. An orthodontic treatment and myofunctional therapy were performed to resolve the occlusal and functional aspects of the patient. Psychological therapy for the child and her mother was required to handle emotional sequelae. Conclusion: Multidisciplinary treatment was prescribed. Dentists should be aware of this need in cases of patients with special characteristics for treatment beyond oral problems. In orthodontics, this may be the difference between effective treatment outcomes or not.

Relato de caso: Este artigo apresenta o caso de uma paciente de 11 anos que procurou tratamento ortodôntico com queixa de "dentes tortos". Na anamnese, foi relatada dependência emocional e física da criança em relação ao ato de amamentar. Considerações sobre diagnóstico, implicações psicológicas, abordagem clínica neste raro caso foram abordadas. Foi realizado tratamento ortodôntico e terapia miofuncional para resolução dos aspectos oclusais e funcionais do paciente. Um acompanhamento psicológico para crianças e sua mãe foi necessária para abordar sequelas emocionais inerentes. Conclusão: Um tratamento multiprofissional foi instituído e o dentista deve estar atento a essa necessidade nos casos de pacientes com características especiais, visando uma abordagem além dos problemas bucais. Na Ortodontia, essa pode ser a diferença entre os resultados eficazes do tratamento ou não.

Interventions for preventing mastitis after childbirth.

BACKGROUND: Despite the health benefits of breastfeeding, initiation and duration rates continue to fall short of international guidelines. Many factors influence a woman's decision to wean; the main reason cited for weaning is associated with lactation complications, such as mastitis. Mastitis is an inflammation of the breast, with or without infection. It can be viewed as a continuum of disease, from non-infective inflammation of the breast to infection that may lead to abscess formation. OBJECTIVES: To assess the effectiveness of preventive strategies (for example, breastfeeding education, pharmacological treatments and alternative therapies) on the occurrence or recurrence of non-infective or infective mastitis in breastfeeding women post-childbirth. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (3 October 2019), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials of interventions for preventing mastitis in postpartum breastfeeding women. Quasi-randomised controlled trials and trials reported only in abstract form were eligible. We attempted to contact the authors to obtain any unpublished results, wherever possible.  Interventions for preventing mastitis may include: probiotics, specialist breastfeeding advice and holistic approaches.   DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included 10 trials (3034 women). Nine trials (2395 women) contributed data. Generally, the trials were at low risk of bias in most domains but some were high risk for blinding, attrition bias, and selective reporting. Selection bias (allocation concealment) was generally unclear. The certainty of evidence was downgraded due to risk of bias and to imprecision (low numbers of women participating in the trials). Conflicts of interest on the part of trial authors, and the involvement of industry funders may also have had an impact on the certainty of the evidence. Most trials reported our primary outcome of incidence of mastitis but there were almost no data relating to adverse effects, breast pain, duration of breastfeeding, nipple damage, breast abscess or recurrence of mastitis. Probiotics versus placebo Probiotics may reduce the risk of mastitis more than placebo (risk ratio (RR) 0.51, 95% confidence interval (CI) 0.35 to 0.75; 2 trials; 399 women; low-certainty evidence). It is uncertain if probiotics reduce the risk of breast pain or nipple damage because the certainty of evidence is very low. Results for the biggest of these trials (639 women) are currently unavailable due to a contractual agreement between the probiotics supplier and the trialists. Adverse effects were reported in one trial, where no woman in either group experienced any adverse effects. Antibiotics versus placebo or usual care The risk of mastitis may be similar between antibiotics and usual care or placebo (RR 0.37, 95% CI 0.10 to 1.34; 3 trials; 429 women; low-certainty evidence). The risk of mastitis may be similar between antibiotics and fusidic acid ointment (RR 0.22, 95% CI 0.03 to 1.81; 1 trial; 36 women; low-certainty evidence) or mupirocin ointment (RR 0.44, 95% CI 0.05 to 3.89; 1 trial; 44 women; low-certainty evidence) but we are uncertain due to the wide CIs. None of the trials reported adverse effects. Topical treatments versus breastfeeding advice The risk of mastitis may be similar between fusidic acid ointment and breastfeeding advice (RR 0.77, 95% CI 0.27 to 2.22; 1 trial; 40 women; low-certainty evidence) and mupirocin ointment and breastfeeding advice (RR 0.39, 95% CI 0.12 to 1.35; 1 trial; 48 women; low-certainty evidence) but we are uncertain due to the wide CIs. One trial (42 women) compared topical treatments to each other. The risk of mastitis may be similar between fusidic acid and mupirocin (RR 0.51, 95% CI 0.13 to 2.00; low-certainty evidence) but we are uncertain due to the wide CIs. Adverse events were not reported. Specialist breastfeeding education versus usual care The risk of mastitis (RR 0.93, 95% CI 0.17 to 4.95; 1 trial; 203 women; low-certainty evidence) and breast pain (RR 0.93, 95% CI 0.36 to 2.37; 1 trial; 203 women; low-certainty evidence) may be similar but we are uncertain due to the wide CIs. Adverse events were not reported. Anti-secretory factor-inducing cereal versus standard cereal The risk of mastitis (RR 0.24, 95% CI 0.03 to 1.72; 1 trial; 29 women; low-certainty evidence) and recurrence of mastitis (RR 0.39, 95% CI 0.03 to 4.57; 1 trial; 7 women; low-certainty evidence) may be similar but we are uncertain due to the wide CIs. Adverse events were not reported. Acupoint massage versus routine care Acupoint massage probably reduces the risk of mastitis compared to routine care (RR 0.38, 95% CI 0.19 to 0.78;1 trial; 400 women; moderate-certainty evidence) and breast pain (RR 0.13, 95% CI 0.07 to 0.23; 1 trial; 400 women; moderate-certainty evidence). Adverse events were not reported. Breast massage and low frequency pulse treatment versus routine care Breast massage and low frequency pulse treatment may reduce risk of mastitis (RR 0.03, 95% CI 0.00 to 0.21; 1 trial; 300 women; low-certainty evidence). Adverse events were not reported. AUTHORS' CONCLUSIONS: There is some evidence that acupoint massage is probably better than routine care, probiotics may be better than placebo, and breast massage and low frequency pulse treatment may be better than routine care for preventing mastitis. However, it is important to note that we are aware of at least one large trial investigating probiotics whose results have not been made public, therefore, the evidence presented here is incomplete. The available evidence regarding other interventions, including breastfeeding education, pharmacological treatments and alternative therapies, suggests these may be little better than routine care for preventing mastitis but our conclusions are uncertain due to the low certainty of the evidence. Future trials should recruit sufficiently large numbers of women in order to detect clinically important differences between interventions and results of future trials should be made publicly available.

Low Content of Cyclosporine A and Its Metabolites in the Colostrum of Post-Transplant Mothers.

The rate of post-transplant mothers who breastfeed while on immunosuppression is progressively increasing. Data on breastfeeding while on cyclosporine-based regimens are limited. Therefore, we assessed the amount of cyclosporine and its metabolites that might be ingested by a breastfed infant by measuring the concentration of cyclosporine and its metabolites in the colostrum of seven post-transplant mothers. The mean concentration of cyclosporine in the colostrum was 22.40 ± 9.43 mcg/L, and the estimated mean daily dose of the drug was 1049.22 ± 397.41 ng/kg/24 h. Only three metabolites (AM1, DHCsA, and THCsA) had mean colostrum amounts comparable to or higher than cyclosporine itself, with the daily doses being 468.51 ± 80.37, 2757.79 ± 1926.11, and 1044.76 ± 948.56 ng/kg/24 h, respectively. Our results indicate a low transfer of cyclosporine and its metabolites into the colostrum in the first two days postpartum and confirm the emerging change to the policy on breastfeeding among post-transplant mothers. A full assessment of the safety of immunosuppressant exposure via breastmilk will require further studies with long-term follow-ups of breastfed children.

Individual and community level factors associated with anemia among lactating mothers in Ethiopia using data from Ethiopian demographic and health survey, 2016; a multilevel analysis.

BACKGROUND: Maternal anemia is a worldwide public health problem especially in developing countries including Ethiopia. The anemia burden among lactating mothers was higher in Africa particularly in Ethiopia, and scant attention was paid. To date, there is limited evidence on community level determinants of anemia among lactating mothers in Ethiopia. This study, therefore, aimed to assess the prevalence and factors associated with anemia among lactating mothers in Ethiopia. METHODS: Secondary data analysis was employed using the 2016 Ethiopian Demographic and Health Survey. A total weighted sample of 4658 lactating women was included. A multilevel logistic regression model was used to identify individual and community level determinants of anemia during lactation. Finally, the adjusted odds ratio with a 95% confidence interval was reported. RESULTS: The overall prevalence of anemia was 28.3% (95% CI; 26.7, 30.0) with the higher regional prevalence in Somali (68.3%) and Afar (47.2%) regions. Current modern contraceptive use [AOR = 0.71; 95% CI: 0.58, 0.87], Poorer [AOR = 0.77; 95% CI: 0.61, 0.98], middle [AOR = 0.74; 95% CI: 0.56, 0.97], rich [AOR = 0.64; 95% CI: 0.46, 0.85], and richest [AOR = 0.66; 95% CI: 0.43, 0.98] wealth index, being working within the 12 months preceding the survey [AOR = 0.77; 95% CI: 0.64, 0.92], and taking iron during pregnancy [AOR = 0.82; 95% CI: 0.68, 0.98] were associated with lower odds of anemia. Whereas, being female household head [AOR = 1.22; 95% CI: 1.01, 1.49], having two births [AOR = 1.27; 95% CI: 1.04, 1.55] and three to four births [AOR = 1.53; 95% CI: 1.14, 2.06] within 5 years, and higher community illiteracy level [AOR = 1.06; 95% CI: 1.06, 1.70] were associated with the increased odds of anemia during lactation. CONCLUSION: In this study the prevalence of anemia among lactating mothers was high. It was affected by both individual and community level factors. Therefore, focusing on family planning services especially on modern contraceptive methods, iron supplementation during pregnancy, child spacing, and improving community literacy could decrease anemia during lactation.

Infants' Vitamin D Nutritional Status in the First Year of Life in Northern Taiwan.

Vitamin D deficiency (VDD) and insufficiency (VDI) are common among exclusively breastfeeding infants. However, epidemiological evidence for the prevalence of VDD in infants during their first year of life in Taiwan has never been found. This trial determined the prevalence of VDD and VDI and the association between dietary vitamin D and vitamin D nutritional status in Northern Taiwan. A cross-sectional study was conducted on infants who returned to well-baby examinations from October 2012 to January 2014 in three hospitals: Shin Kong Wu Ho-Su Memorial Hospital, Taipei Medical University Hospital, and Shuang Ho Hospital. The specific vitamin D cut-off concentrations for VDD, VDI, and VDS are 25(OH)D3 levels ≤ 20, 21-29, and ≥ 30 (ng/mL). Overall, 481 infants' parents completed a questionnaire comprising questions related to vitamin D nutritional status, including weekly time outdoors, breastfeeding status, anthropometric measurement, and assessment of dietary intake, including milk and complementary food. The results revealed that 197 (41%) and 212 (44%) of infants in their first year of life had VDI and VDD, respectively, by the Endocrine Society guidelines. Breastfed infants had a higher prevalence of VDI (86.1%) than did mixed-fed (51.9%) and formula-fed (38.5%) infants (p < 0.001). The prevalence of VDD was 55.4% in infants aged under six months but increased to 61.6% in infants aged over six months. Infants in the VDI and VDD groups had the same anthropometrics as those in the vitamin D sufficiency (VDS) group. Our results revealed that 25(OH)D3 had a negative correlation with the intact parathyroid hormone (iPTH) when the serum 25(OH)D3 level ≤ 20 ng/mL (r = -0.21, p = 0.001). The VDS group had a higher total vitamin D intake than did the VDI and VDD groups, which was mainly obtained from infant formula. Our data revealed that dietary vitamin D intake and birth season were major indicators in predicting VDD. Lower dietary vitamin D intake and born in winter and spring significantly increased the odds ratio (OR) for VDI by 1.15 (95% CI 1.09-1.20) and 2.02 (95% CI 1.10-3.70), respectively, and that for VDD by 1.23 (95% CI 1.16-1.31) and 2.37 (95% CI 1.35-4.17) without covariates adjustment, respectively. Furthermore, ORs for VDI and VDD significantly differed after adjustment for covariates. In conclusion, the prevalence of VDI and VDD were high in infants during the first year of life. Breastfeeding infants had difficulty in obtaining sufficient vitamin D from diet. In cases where the amount of sun exposure that is safe and sufficient to improve vitamin D status is unclear, breastfed infants aged below one year old are recommended to be supplemented with vitamin D.

Iron Status of Infants in the First Year of Life in Northern Taiwan.

Iron deficiency (ID) and iron deficiency anemia (IDA) typically occur in developing countries. Notably, ID and IDA can affect an infant's emotion, cognition, and development. Breast milk is considered the best food for infants. However, recent studies have indicated that breastfeeding for more than six months increases the risk of ID. This study investigated the prevalence of ID and IDA, as well as the association between feeding type and iron nutritional status in northern Taiwan. A cross-sectional study was conducted on infants who returned to the well-baby clinic for routine examination from October 2012 to January 2014. Overall, 509 infants aged 1-12 months completed the iron nutritional status analysis, anthropometric measurement, and dietary intake assessment, including milk and complementary foods. The results revealed that 49 (10%) and 21 (4%) infants in their first year of life had ID and IDA, respectively, based on the World Health Organization criteria. Breastfed infants had a higher prevalence rate of ID and IDA than mixed-fed and formula-fed infants (p < 0.001). Regarding biomarkers of iron status, plasma hemoglobin (Hb), ferritin, and transferrin saturation (%) levels were significantly lower in ID and IDA groups. The prevalence of ID and IDA were 3.7% and 2.7%, respectively, in infants under six months of age, but increased to 20.4% and 6.6%, respectively, in infants above six months of age. The healthy group had a higher total iron intake than ID and IDA groups, mainly derived from infant formula. The total dietary iron intake was positively correlated with infants' Hb levels. Compared with formula-fed infants, the logistic regression revealed that the odds ratio for ID was 2.157 (95% confidence interval [CI]: 1.369-3.399) and that for IDA was 4.196 (95% CI: 1.780-9.887) among breastfed infants (p < 0.001) after adjusted for all confounding factors (including gestational week, birthweight, sex, body weight percentile, body length percentile, age of infants, mothers' BMI, gestational weight gain, education level, and hemoglobin level before delivery). In conclusion, our results determined that breastfeeding was associated with an increased the prevalence of ID and/or IDA, especially in infants above six months. This suggests that mothers who prolonged breastfeed after six months could provide high-quality iron-rich foods to reduce the prevalence of ID and IDA.

Culture of Methanogenic Archaea from Human Colostrum and Milk.

Archaeal sequences have been detected in human colostrum and milk, but no studies have determined whether living archaea are present in either of these fluids. Methanogenic archaea are neglected since they are not detected by usual molecular and culture methods. By using improved DNA detection protocols and microbial culture techniques associated with antioxidants previously developed in our center, we investigated the presence of methanogenic archaea using culture and specific Methanobrevibacter smithii and Methanobrevibacter oralis real-time PCR in human colostrum and milk. M. smithii was isolated from 3 colostrum and 5 milk (day 10) samples. M. oralis was isolated from 1 milk sample. For 2 strains, the genome was sequenced, and the rhizome was similar to that of strains previously isolated from the human mouth and gut. M. smithii was detected in the colostrum or milk of 5/13 (38%) and 37/127 (29%) mothers by culture and qPCR, respectively. The different distribution of maternal body mass index according to the detection of M. smithii suggested an association with maternal metabolic phenotype. M. oralis was not detected by molecular methods. Our results suggest that breastfeeding may contribute to the vertical transmission of these microorganisms and may be essential to seed the infant's microbiota with these neglected critical commensals from the first hour of life.

[Controversies and errors related to nutrition and breastfeeding. Guidelines for improvement]. / Controversias y errores en relación con la nutrición y la lactancia materna. Pautas para la mejora.

INTRODUCTION: Although the benefits of breastfeeding are clear and well documented, for both newborns and nursing mothers, breastfeeding rates worldwide are not optimal in many cases. There are multiple myths and errors related to breastfeeding: that certain foods cannot be consumed during breastfeeding, that, however, certain foods must be consumed to increase milk production, that composition of breast milk is not adequate in some cases, that breastfeeding is associated with more risk of suffering caries… Therefore, the objective of this article is to clarify the reality about these aspects of breastfeeding.

INTRODUCCIÓN: Aunque los beneficios de la lactancia materna son claros y están bien documentados tanto para los recién nacidos como para las madres lactantes, las tasas de lactancia materna a nivel mundial en muchos casos no son óptimas. Existen múltiples mitos y errores en relación con la lactancia materna, como que no pueden consumirse determinados alimentos, que deben consumirse determinados alimentos para aumentar la producción láctea, que la composición de la leche materna en algunos casos no es adecuada, que la lactancia materna se asocia a más riesgo de caries… Por todo ello, el objetivo de este artículo es aclarar la realidad acerca de estos aspectos sobre la lactancia materna.

Musculoskeletal Impairment: Causes of Pain with Breastfeeding Insight into 11 Cases.

Objective: To determine the possible relationship between pain experienced by mothers with breastfeeding and musculoskeletal impairment commonly seen in physiotherapy practice. Evidence-based principles of the evaluation and treatment of musculoskeletal impairment used in physiotherapy practice were applied and adapted to manage pain experienced by mothers with breastfeeding. Subjects and Methods: This report describes 11 mothers referred to a breastfeeding clinic for pain with breastfeeding. Mothers were initially assessed by a physician and a nurse clinician, both International Board-Certified Lactation Consultants, to rule out causes of breast or nipple pain. When the cause remained unexplained, it was deemed musculoskeletal, and mothers were referred to a physiotherapist for assessment and treatment with manual orthopedic therapy and mobilization of the myofascial system. Results: The physiotherapist's objective musculoskeletal assessment and mothers' impression showed an improvement in the overall clinical picture after the first appointment in most mothers. Pain was resolved or alleviated by 80% in five mothers after 1-3 weekly treatments. The most useful therapeutic approach was to make afflicted mothers aware of their posture to maintain spinal alignment and avoid shear posture (lateral displacement of the trunk). Shear posture is a consequence of sitting leaning to one side. This posture is exacerbated by thoracic rotation and flexion, for example, when turning the trunk and bending over the baby while giving the breast. Conclusion: Treating musculoskeletal impairment referred pain to the breast or nipple with physiotherapy practices used in a nonbreastfeeding clientele can help alleviate or resolve pain with breastfeeding.

Effectiveness of breast massage for the treatment of women with breastfeeding problems: a systematic review.

OBJECTIVES: The aim of this systematic review was to identify the effectiveness of breast massage as a treatment for women with breastfeeding problems. More specifically, the objective was to identify if breast massage as an intervention led to less pain or increased milk supply, or assisted in a reduction or resolution of blocked ducts, breast engorgement and mastitis. INTRODUCTION: Breastfeeding protects babies against many illnesses, and the health benefits for women have been well documented. However, breastfeeding rates steadily drop to approximately 15% by six months, which is the World Health Organization's recommended length of time for exclusive breastfeeding. Breastfeeding problems such as blocked ducts, breast engorgement and mastitis are major complications attributing to the decline in breastfeeding rates. Breast massage may relieve pain and resolve symptoms associated with conditions that contribute to discontinued breastfeeding. INCLUSION CRITERIA: This review considered both experimental and epidemiological study designs and included breastfeeding women of any age, parity or geographical location. The types of interventions considered for inclusion were any type of breast massage that was offered to women for breastfeeding problems. Comparators included the usual care provided to women with breastfeeding problems. Primary outcomes of interest were an increase in breast milk supply, reduction of breast pain, and symptom resolution of blocked ducts, engorgement and mastitis. Secondary outcomes included duration of breastfeeding. METHODS: Studies published from 1980 to 2017 in English and Japanese were considered for inclusion in this review. The databases searched with the majority of results included CINAHL, Cochrane Library, Embase, PubMed, Science Direct, Scopus and Web of Science. Search for unpublished studies included Google Scholar, ClinicalTrials.gov and ProQuest Dissertations and Theses. RESULTS: There were six studies included in this review: three randomized controlled trials and three quasi-experimental studies. There was considerable heterogeneity of study outcome measures, and the use of unvalidated tools in many of the studies led to the inability to pool the results. Furthermore, the heterogeneity of the interventions themselves coupled with small sample sizes for each study greatly decreased generalizability of the outcomes and reduced the overall effectiveness of the interventions. However, all included studies reported a reduction in pain regardless of the breast massage technique used. Overall, varying types of breast massage were helpful in reducing immediate pain and resolving symptoms. CONCLUSIONS: Overall, different types of breast massage were reported as effective in reducing immediate pain for the participants. However, the lack of detailed explanation of the breast massage technique and the extensive training needed to undertake the breast massage decrease the ability to replicate the results. These outcomes may be useful for healthcare professionals caring for women with breastfeeding problems. Future research needs include validating a universal measurement tool for breastfeeding problems and the need for more robust randomized controlled trials, particularly in vulnerable groups such as mothers of preterm infants. Longer follow-up periods are also suggested to establish if breast massage impacts breastfeeding duration.

The role of human milk and sucrose on cariogenicity of microcosm biofilms.

This study investigated the effect of human milk, alone and associated with sucrose, in the cariogenicity of biofilms in a microcosm biofilm model and compared with the cariogenicity of sucrose and bovine milk. Microcosm biofilms were grown in enamel discs in 24-well plates. Six growth conditions were studied: DMM (chemically defined artificial saliva - negative control), DMM with 1% of sucrose (DMM+s) (positive control), human milk with DMM, human milk with DMM+s, bovine milk with DMM, and bovine milk with DMM+s. After 5 days, the outcome variables surface hardness change (%SHC), microbiological composition of biofilms, and pH of supernatant were analyzed. All groups had significantly lower hardness loss compared to the DMM group with 1% of sucrose. Human and bovine milk associated with sucrose showed higher hardness loss. The supernatant pH values after 6 hours of different treatments were similar for the groups sucrose and human milk associated with sucrose (p>0.05). After 18 hours at rest in pure DMM, an increase in the pH of the supernatant was observed. Higher values of total microorganisms count were found for sucrose and bovine milk groups compared to the group supplemented only by DMM. Bovine milk group showed greater amount of total aciduric microorganisms in comparison to human milk group. Within the limits of this study, it can be infered that both human and cow milks have some cariogenic potential, although differing from sucrose in terms of mineral loss.

Effect of LED therapy for the treatment nipple fissures: Study protocol for a randomized controlled trial.

INTRODUCTION: Poor positioning of the child in relation to the breast and improper suckling are the main causes of nipple fissure. Treatment options for nipple fissures include drug therapy with antifungal and antibiotics, topical applications of lanolin, glycerin gel, creams and lotions, the milk itself, hot compresses, and silicone nipple shields. Studies involving light-emitting diode (LED) therapy have demonstrated anti-inflammatory properties, the enhancement of the wound repair process, and the control of pain. As it does not cause discomfort, is relatively inexpensive and may impede the discontinuation of breastfeeding, phototherapy could be a viable option for the treatment of nipple fissures. AIM: The principal objective of the proposed study is to evaluate the effectiveness of LED therapy for the treatment of nipple fissures in postpartum mothers. MATERIALS AND METHODS: One hundred patients treated with a medical diagnosis of bilateral nipple trauma classified as nipple fissures or cracks will participate in the study, randomized into 2 groups: The control group will receive orientation regarding breast care and adequate breastfeeding techniques. The experimental group will receive the same orientation and phototherapy sessions using a device developed especially for the treatment of nipple trauma. Both groups will be followed up for 6 consecutive weeks.

High prevalence of anemia in 10-month-old breast-fed Japanese infants.

BACKGROUND: Anemia in infancy is still prevalent in developing countries. Commercial iron-fortified complementary foods or iron drops are not available in Japan, and breast-fed infants have a higher risk of anemia. We studied anemia screening in 10-month-old infants to determine whether breast-feeding is a risk factor for anemia. METHODS: Anemia screening was performed during regular health check for 10-month-old children at four local pediatric clinics in Shimane Prefecture, Japan. Venous blood was obtained for complete blood count. The clinical characteristics of each child were obtained via questionnaire. Anemia was defined as hemoglobin <11.0 g/dL. Children were categorized into anemia and no-anemia groups, and univariate analysis was conducted on comparison of the clinical variables. Multivariate logistic regression analysis for anemia was performed to adjust for several clinical variables. RESULTS: We analyzed data in 325 children. On univariate analysis, anemia was associated with breast-feeding, monthly bodyweight gain and gestational week. On multivariate logistic regression analysis, anemia was associated with feeding type and gestational week (OR of partial breast-feeding and formula feeding, 0.446; 95%CI: 0.208-0.957; and 0.223; 95%CI: 0.075-0.660, respectively, compared with exclusive breast-feeding, OR, 1.0; and gestational week, OR, 0.753; 95%CI: 0583-0.972). CONCLUSION: Breast-feeding is an important factor for anemia in 10-month-old Japanese infants. Breast-fed infants after 6 months of age may need iron supplements or iron-fortified complimentary foods.