The myofascial release as neuromotor support to improve the ineffective sucking ability in term infants: a preliminary study.

BACKGROUND: Breastfeeding plays a primary role in the events that characterize the development of the relationship between a mother and her newborn. However, this essential process sometimes does not fully cover the nutritional requirements of the newborn due to altered biomechanical sucking skills. In this context, adequate osteopathic treatment associated with neuromotor facilitation techniques could play a promoting role. METHODS: This study evaluated the effect of the osteopathic approach using myofascial release on 26 infants with ineffective sucking ability, identified by the POFRAS scale and LATCH score, compared with 26 untreated similar infants. After the procedure was initially performed in the hospital, the strategy based on basic neuromotor patterns was taught to the parents to be continued at home. The effects were measured at hospital discharge, during the first outpatient visit, which occurred after about seven days, and at one month of life. RESULTS: The number of valid and continuous suctions, initially less than five per feed in both groups, at the first outpatient check-up was significantly higher (p < 0.00001) in the treated group. Exclusive breastfeeding, initially present in all enrolled children, was maintained mainly in treated children, both at discharge (p < 0.003), at outpatient follow-up (p < 0.00001), and at one month of life (p < 0.00001). Differences in growth and health conditions were not found between the groups. CONCLUSION: We believe that osteopathic treatment associated with neuromotor facilitation techniques can optimize newborns' sucking skills, improving the acquisition and duration of breastfeeding.

Laid-back breastfeeding: knowledge, attitudes and practices of midwives and student midwives in Ireland.

BACKGROUND: Despite concerted efforts by policy developers, health professionals and lay groups, breastfeeding rates in Ireland remain one of the lowest in world, with 63.6% of mothers initiating breastfeeding at birth, dropping to 37.6% of mothers breastfeeding exclusively on hospital discharge. Nipple trauma and difficulties with baby latching are major contributors to the introduction of formula and discontinuation of breastfeeding. Research shows laid-back breastfeeding (LBBF) significantly reduces breast problems such as sore and cracked nipples, engorgement, and mastitis as well as facilitating a better latch. Although the benefits of LBBF are well documented, this position does not seem to be routinely suggested to mothers as an option when establishing breastfeeding. This study aims to determine midwives' and student midwives' knowledge, attitudes, and practices of using laid-back breastfeeding in Ireland. METHOD: A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021. RESULTS: Two hundred and fifty-three valid responses were received from nine maternity units. Most participants (81.4%) were aware of laid-back breastfeeding. However, only 6.8% of respondents cited it as the position they most frequently use. Over one-third (38.34%) had never used this position with mothers. Those more likely to suggest LBBF had personal experience of it, were lactation consultants or working towards qualification, or had participated in specific education about LBBF. Barriers included lack of education, confidence, time, and experience. Further issues related to work culture, a tendency to continue using more familiar positions and concerns about mothers' anatomy and mothers' unfamiliarity with LBBF. CONCLUSION: Although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers' and babies' intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.

Maternal Concerns in Home Care for the Premature Newborn: An Integrative Review.

OBJECTIVE: To identify and analyze the scientific literature, both national and international, concerning the primary maternal concerns about caring for premature newborns at home. METHODS: This integrative review is based on the guiding question: "What scientific publications from 2012 to 2021 address maternal concerns about the care of premature newborns at home?". Searches were conducted in the electronic databases: Embase, Medline, Web of Science, Lilacs, Scielo, and Cochrane Library. RESULTS: A total of 21 articles were identified. The qualitative analysis showed that maternal concerns pertained to breastfeeding, hygiene, sunbathing practices, managing infant colic, identifying signs, symptoms, and clinical changes, temperature control, and the third phase of the kangaroo method. CONCLUSIONS: Maternal uncertainties underscore the importance of enhancing strategies focused on supporting families and ensuring continued care for neonates at home.

Improving Early Colostrum Administration to Very Low Birth Weight Infants in a Level 3 Neonatal Intensive Care Unit: A Quality Improvement Initiative.

OBJECTIVE: To improve our human milk practices by increasing early and sustained use of colostrum as oral immune therapy (OIT) in very low birthweight (VLBW) infants admitted at a level 3 neonatal intensive care unit. STUDY DESIGN: Using the Institute for Healthcare Improvement's Model for Improvement, several interventions aimed at increasing early OIT administration were implemented. Four key drivers included: optimizing evidence-based OIT guidelines, personnel alignment and engagement, optimal electronic health record use for ordering practices, and timely lactation consultant involvement. The primary outcome measure was early OIT administration, whereas secondary outcome measures examined all OIT administration and human milk at discharge. Process measures included the percentage of staff members who were compliant with OIT protocol. RESULTS: Early OIT administration increased from a baseline mean of 6% to 55% in the 12-month study period. Percentage of total (early and late) OIT administration to VLBW infants increased from a baseline of 21% to 85%. Average human milk at discharge for VLBW infants remained at 44%, without significant improvement. CONCLUSIONS: A multidisciplinary quality improvement initiative led to significant improvement in OIT administration to infants at a level 3 neonatal intensive care unit.

The Effect of Mandala Activity and Technology-Based Breastfeeding Program on Breastfeeding Self-Efficacy and Mother-Infant Attachment of Primiparous Women: A Randomized Controlled Study.

The use of art therapy methods such as mandala is becoming increasingly popular in mother-infant health education and counseling. The aim of the study was to evaluate the effect of a mandala and technology-based breastfeeding program on women's breastfeeding self-efficacy and attachment between mother and infant. This randomized controlled, single-blind, and parallel-group trial design was conducted in foundation university hospital. The study was completed by 66 women and their infants (intervention group: n = 33; control group: n = 33). The women who are at the 32-37th gestational week in the intervention group participated in the mandala and technology-based breastfeeding (including Zoom and WhatsApp platforms) program. They received three education module via WhatsApp. Women in control group received routine care. The Maternal Attachment scale and Breastfeeding Self-efficacy Scale were applied in the first week and second month postpartum. Growth follow-ups of the infants were evaluated in the first week, first month and second month postpartum. The registration number of this study on ClinicalTrials.gov is NCT05199298. In the second month postpartum, it was determined that the women in the intervention group had higher Breastfeeding Self-efficacy and Maternal Attachment scale scores compared to the control group (p < 0.05). Also, the rates of breastfeeding in the intervention group were higher than in the control group. Mandala and technology-based breastfeeding program increased women's breastfeeding self-efficacy and maternal attachment. Health care professionals should make use of technology-based educations to give holistic care in maternal and infant health.

Breastfeeding in Phenylketonuria: Changing Modalities, Changing Perspectives.

Phenylketonuria (PKU) management aims to control phenylalanine (Phe) intakes. In newborns and infants this implies possible titration of Human milk (HM) with supplementation of Phe-free formula. HM benefits, better if prolonged, are well known in healthy populations, suggesting it may be used in PKU patients. Despite that, the current literature does not define recommendations on how best perform it in such a population. The main purpose of this study was to evaluate nutrition approaches in newborns and infants affected by PKU and to define if differences can influence the duration of breastfeeding. Data from 42 PKU infants were reviewed. Of these, 67% were breastfed with the use of three different approaches. The type of approach used impacted the duration of breastfeeding, which was longer when using a pre-measured amount of Phe-free formula administered prior to HM. This is the first study to suggest a specific method for breastfeeding in PKU. Considering widely known breastfeeding benefits, both for patients and their mothers, our data should encourage adequate awareness on how to choose correct breastfeeding modalities.

Proteomic Analysis of Human Milk Reveals Nutritional and Immune Benefits in the Colostrum from Mothers with COVID-19.

Despite the well-known benefits of breastfeeding and the World Health Organization's breastfeeding recommendations for COVID-19 infected mothers, whether these mothers should be encouraged to breastfeed is under debate due to concern about the risk of virus transmission and lack of evidence of breastmilk's protective effects against the virus. Here, we provide a molecular basis for the breastfeeding recommendation through mass spectrometry (MS)-based proteomics and glycosylation analysis of immune-related proteins in both colostrum and mature breastmilk collected from COVID-19 patients and healthy donors. The total protein amounts in the COVID-19 colostrum group were significantly higher than in the control group. While casein proteins in COVID-19 colostrum exhibited significantly lower abundances, immune-related proteins, especially whey proteins with antiviral properties against SARS-CoV-2, were upregulated. These proteins were detected with unique site-specific glycan structures and improved glycosylation diversity that are beneficial for recognizing epitopes and blocking viral entry. Such adaptive differences in milk from COVID-19 mothers tended to fade in mature milk from the same mothers one month postpartum. These results suggest that feeding infants colostrum from COVID-19 mothers confers both nutritional and immune benefits, and provide molecular-level insights that aid breastmilk feeding decisions in cases of active infection.

Osteopathic manipulative treatment to improve exclusive breast feeding at 1 month.

OBJECTIVE: Previous studies have assessed breastfeeding-support programmes. Among these, osteopathic manipulative treatment (OMT) is a frequently used approach, although without strong evidence of efficacy. METHODS: A double-blind randomised controlled trial was conducted between July 2013 and March 2016. Breastfed term infants were eligible if one of the following criteria was met: suboptimal breastfeeding behaviour, maternal cracked nipples or maternal pain. The infants were randomly assigned to the intervention or the control group. The intervention consisted of two sessions of early OMT, while in the control group, the manipulations were performed on a doll behind a screen. The primary outcome was the exclusive breastfeeding rate at 1 month, which was assessed in an intention-to-treat analysis. Randomisation was computer generated and only accessible to the osteopath practitioner. The parents, research assistants and paediatricians were masked to group assignment. RESULTS: One hundred twenty-eight mother-infant dyads were randomised, with 64 assigned to each group. In each group, five infants were lost to follow-up. In the intervention group, 31 of 59 (53%) of infants were still exclusively breast fed at 1 month vs 39 of 59 (66%) in the control group, (OR 0.55, 95% CI 0.26 to 1.17; p=0.12). After adjustment for suboptimal breastfeeding behaviour, caesarean section, use of supplements and breast shields, the adjusted OR was 0.44 (95% CI 0.17 to 1.11; p=0.08). No adverse effects were reported in either group. CONCLUSION: OMT did not improve exclusive breast feeding at 1 month. TRIAL REGISTRATION NUMBER: NCT01890668.

Transient Effect of Infant Formula Supplementation on the Intestinal Microbiota.

Breastfeeding is the gold standard for feeding infants because of its long-term benefits to health and development, but most infants in the United States are not exclusively breastfed in the first six months. We enrolled 24 infants who were either exclusively breastfed or supplemented with formula by the age of one month. We collected diet information, stool samples for evaluation of microbiotas by 16S rRNA sequencing, and blood samples for assessment of immune development by flow cytometry from birth to 6 months of age. We further typed the Bifidobacterium strains in stool samples whose 16S rRNA sequencing showed the presence of Bifidobacteriaceae. Supplementation with formula during breastfeeding transiently changed the composition of the gut microbiome, but the impact dissipated by six months of age. For example, Bifidobacterium longum, a bacterial species highly correlated with human milk consumption, was found to be significantly different only at 1 month of age but not at later time points. No immunologic differences were found to be associated with supplementation, including the development of T-cell subsets, B cells, or monocytes. These data suggest that early formula supplementation, given in addition to breast milk, has minimal lasting impact on the gut microbiome or immunity.

Colostrum avoidance practice among primipara mothers in urban Northwest Ethiopia. A cross-sectional study.

BACKGROUND: Breast milk is the ideal and complete form of nutrition for infants colostrum contains all the necessary nutrients for infants' growth and development and antibodies that can protect from many childhood illnesses. Understanding the extent of and barriers to colostrum avoidance in Ethiopia is important for learning how to best improve optimal breastfeeding. No single study has been conducted on primigavida mothers in the country. Therefore, this study aimed to assess the rate of colostrum avoidance practice and associated factors among primigavida mothers. METHOD: A community- based cross-sectional study was conducted from March to April 2016 among (n = 398) randomly selected primigavida mothers in Bahir Dar city, northwest Ethiopia. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version25. Bivariate and multivariate logistic regression analyses were carried out. Odds ratio with 95% confidence interval was used to measure the strength of association. Statistical significance was declared at P-value ≤0.05. RESULTS: Out of 398 primipara mothers, 8.8% discarded colostrum. The most common reasons for discarding colostrum were; yellow and creamy (39.2%), bad for infant (35.2%), traditional/cultural reason (17.1%) and infant unable to feed (8.5%). Married mothers (AOR = 4.52, 95%CI: 1.13, 18.16), unemployed mothers (AOR = 3.46, 95%CI: 1.15, 10.51), mothers underwent normal delivery (AOR = 5.20, 95%CI: 1.87, 20.90) and mothers who initiated breastfeeding within 1 h (AOR = 2.79, 95%CI: 0.96, 8.16) were less likely to discard colostrum. CONCLUSION: The current study revealed that colostrum was discarded by 8.8% of primipara mothers. Primipara mothers who were married, unemployed, underwent normal delivery and initiated breastfeeding within 1 h were less likely to discard colostrum. These results suggest that multi-sectorial and multi-disciplinary approaches are needed to decrease colostrum avoidance among primipara mothers in Ethiopia.

Colostrum avoidance practice and associated factors among mothers of children aged less than six months in Bure District, Amhara Region, North West, Ethiopia: A community-based cross-sectional study.

INTRODUCTION: The World Health Organization and the United Nations International Children's Emergency Fund jointly recommend colostrum feeding immediately following delivery of the newborn. Colostrum avoidance is the practice of discarding colostrum at least once within the first three days after delivery of the newborn. Colostrum contains antibodies that protect the newborn against disease. Despite this fact, many Ethiopian mothers see colostrum feeding as a cause of neonatal morbidity and mortality, and they believe colostrum should be discarded to alleviate its effects. However, the cause of this misconception about colostrum is not well researched in Ethiopia, particularly in the study area. OBJECTIVE: To assess the prevalence of colostrum avoidance and associated factors among mothers of children aged less than six months in Bure district, Amhara Region, North West, Ethiopia. METHODS: A community-based cross-sectional study was conducted from March 1st to 30th, 2019 in Bure district. Structured questionnaires and face to face interviews were used to collect data from 621 study participants. Multistage sampling technique was used to select study participants. Data were entered into Epi Data version 4.2.0 and then exported to Statistical Package for the Social Sciences version 23. Bivariate and multivariate logistic regression analyses were performed to identify predictors of colostrum avoidance practice. RESULTS: Six hundred twenty-one (621) mothers of children aged less than six months participated. The prevalence of colostrum avoidance was 14.5% (95%CI; 11.5-17.4). The multivariate analysis indicated that home delivery [AOR = 3.350, (95%CI; 2.517-14.847)], giving birth through cesarean section [AOR = 3.368, (95%CI; 1.339-8.471)], no participation in an antenatal care group [AOR = 1.889, (95%CI; 1.144-3.533)], poor knowledge of mothers about colostrum [AOR = 3.44, (95%CI; 2.45-4.977)], and poor attitude of mothers towards colostrum [AOR = 3.053, (95%CI; 1.157-8.054)] were important predictors of colostrum avoidance practice. CONCLUSION AND RECOMMENDATIONS: Home delivery, giving birth through cesarean section, no participation in an antenatal care group, poor knowledge of mothers about colostrum, and poor attitude of mothers towards colostrum were significantly associated with colostrum avoidance practice. Therefore, health care workers in the district should promote institutional delivery, reduce the magnitude of cesarean section, encourage pregnant mothers to participate in an antenatal care group, and enhance maternal awareness about the merits of colostrum feeding. Moreover, health educations for mothers to have a positive attitude towards colostrum are important recommendations to be taken to prevent the further practice of colostrum avoidance.

Estratégias e ações do enfermeiro no incentivo ao aleitamento materno: revisão integrativa / Nursing strategies and actions on breastfeeding: integrative review / Estrategias y acciones de enfermería en lactancia materna: revisión integrativa

Objective:Identify the strategies and actions used by nurses to encourage breastfeeding. Method: integrative review conducted in the databases of the Virtual Health Library, Latin American and Caribbean Scientific and Technical Literature, Nursing Database and Medical Literature Analysis and Retrieval System Online, using the descriptors "nursing" AND "breastfeeding" AND "nursing care" AND "health education", January 2018. Results: the study consisted of 14 publications. Two categories emerged: "The practice of health education used by nurses to encourage breastfeeding" and "The promotion of family support as a strategy to encourage breastfeeding". Conclusion: this review showed how the strategies and actions used by nurses to encourage breastfeeding, the promotion of autonomy, health education actions, support network, strengthening the bond, prenatal consultations, guidelines, encouragement of family support. and counseling

Objetivo: Identificar as estratégias e ações utilizadas pelo enfermeiro no incentivo ao aleitamento materno. Método: revisão integrativa realizada nas bases de dados da Biblioteca Virtual da Saúde, da Literatura Científica e Técnica da América Latina e Caribe, Base de Dados de Enfermagem e Medical Literature Analysis and Retrieval System Online, por meio dos descritores "enfermagem" AND "aleitamento materno" AND "cuidados de enfermagem" AND "educação em saúde", em janeiro de 2018. Resultados: o estudo foi composto por 14 publicações. Emergiu duas categorias: "A prática de educação em saúde utilizada por enfermeiros no incentivo ao aleitamento materno" e "A promoção do apoio familiar como estratégia de incentivo ao aleitamento materno". Conclusão: esta revisão evidenciou como estratégias e ações utilizadas pelo enfermeiro no incentivo ao aleitamento materno, a promoção da autonomia, ações de educação em saúde, rede de apoio, fortalecimento do vínculo, consultas de pré-natal, orientações, incentivo ao apoio familiar e aconselhamento

Objetivo: Identificar las estrategias y acciones utilizadas por las enfermeras para fomentar la lactancia materna. Método:revisión integral realizada en las bases de datos de la Biblioteca Virtual en Salud, Literatura Científica y Técnica de América Latina y el Caribe, Base de Datos de Enfermería y Análisis de Literatura Médica y Sistema de Recuperación en línea, utilizando los descriptores "enfermería" Y "lactancia materna" Y "atención de enfermería" Y "educación sanitaria", enero de 2018. Resultados:el estudio consistió en 14 publicaciones. Surgieron dos categorías: "La práctica de la educación sanitaria utilizada por las enfermeras para fomentar la lactancia materna" y "La promoción del apoyo familiar como una estrategia para fomentar la lactancia materna". Conclusión: Esta revisión mostró cómo las estrategias y acciones utilizadas por las enfermeras para fomentar la lactancia materna, la promoción de la autonomía, las acciones de educación para la salud, la red de apoyo, el fortalecimiento del vínculo, las consultas prenatales, las pautas, el estímulo del apoyo familiar y asesoramiento

Microbiota Supplementation with Bifidobacterium and Lactobacillus Modifies the Preterm Infant Gut Microbiota and Metabolome: An Observational Study.

Supplementation with members of the early-life microbiota as "probiotics" is increasingly used in attempts to beneficially manipulate the preterm infant gut microbiota. We performed a large observational longitudinal study comprising two preterm groups: 101 infants orally supplemented with Bifidobacterium and Lactobacillus (Bif/Lacto) and 133 infants non-supplemented (control) matched by age, sex, and delivery method. 16S rRNA gene profiling on fecal samples (n = 592) showed a predominance of Bifidobacterium and a lower abundance of pathobionts in the Bif/Lacto group. Metabolomic analysis showed higher fecal acetate and lactate and a lower fecal pH in the Bif/Lacto group compared to the control group. Fecal acetate positively correlated with relative abundance of Bifidobacterium, consistent with the ability of the supplemented Bifidobacterium strain to metabolize human milk oligosaccharides into acetate. This study demonstrates that microbiota supplementation is associated with a Bifidobacterium-dominated preterm microbiota and gastrointestinal environment more closely resembling that of full-term infants.

Negative Transmission of SARS-CoV-2 to Hand-Expressed Colostrum from SARS-CoV-2-Positive Mothers.

Aim: The objective of our study was to determine whether the SARS-CoV-2-positive mothers transmit the virus to their hand-expressed colostrum. Methods: This is an observational prospective study that included pregnant women who tested positive for SARS-CoV-2 by PCR test on a nasopharyngeal swab at the moment of childbirth and who wanted to breastfeed their newborns. A colostrum sample was obtained from the mothers by manual self-extraction. To collect the samples, the mothers wore surgical masks, washed their hands with an 85% alcohol-based gel, and washed their breast with gauze that was saturated with soap and water. Results: We obtained seven colostrum samples from different mothers in the first hours postdelivery. SARS-CoV-2 was not detected in any of the colostrum samples obtained in our study. Conclusion: In our study, breast milk was not a source of SARS-CoV-2 transmission. Hand expression (assuring that a mask is used and that appropriate hygienic measures are used for the hands and the breast), when direct breastfeeding is not possible, appears to be a safe way of feeding newborns of mothers with COVID-19.

Promoting correct positioning and attachment in breastfeeding infants born by section cesarean in the La Fe Hospital in Spain: a best-practice implementation project.

AIM: The aim of this project was to assess compliance with evidence-based criteria that set out effective techniques for ensuring correct positioning and attachment in breastfeeding infants delivered by cesarean section in the La Fe University and Polytechnical Hospital of Valencia, Spain. METHODS: The current clinical pre/post audit was conducted in a convenience sample with no control group. First, five audit criteria from the JBI framework and Practical Application of Clinical Evidence System program were selected to assess correct positioning and attachment during breastfeeding. We then conducted a baseline audit to determine the degree of compliance with these criteria. Second, we used the Getting Research into Practice guidelines to help us identify obstacles to fulfillment of each criterion and to design and implement various strategies to improve compliance. Third, a follow-up audit was performed and the degree of compliance of each criterion was determined again. Finally, the barriers to implementation of the strategies were identified. RESULTS: Eighty-seven mothers and 20 midwives participated in the baseline audit and 93 mothers and 17 midwives took part in the follow-up audit. After implementation, the rates of compliance with the three maternal criteria (2, 3, and 4) significantly improved. These were guidance to women, breastfeeding support, and encouragement from families, which increased by 42, 49, and 51%, respectively. Furthermore, criterion 4 (professional training programs) reached 100% compliance. However, criterion 1 (skin-to-skin contact) only increased by 2%. Eight barriers were described, including a lack of knowledge of the skin-to-skin procedure, a hands-on approach to breastfeeding support, a lack of time or high workload, and differences in the breastfeeding support provided by different professionals. Implementing strategies such as assessment with the LATCH scale, continuing the support of breastfeeding mothers through working shift changes, and promoting the skin-to-skin procedure, proved to be effective. CONCLUSION: The current audit project significantly improved all our evidence-based criteria used to promote correct positioning and attachment during breastfeeding in women who had given birth by cesarean section. We accomplished this goal by developing several strategies which were accepted and implemented by all the midwives involved. Early, adequate, and ongoing support for breastfeeding women during postpartum hospitalization was key to the success of this project. It will be important to improve the skin-to-skin parameter in the surgical block in the near future to further consolidate and improve these results.

Adherence to Vitamin D Intake Guidelines in the United States.

BACKGROUND: The American Academy of Pediatrics (AAP) revised its infant vitamin D intake guidelines in 2008. We aimed to examine previously unexplored trends in meeting vitamin D intake guidelines among US infants since 2009 and whether there were differences across demographic subgroups. METHODS: We analyzed dietary recall data for infants 0 to 11 months in the 2009-2016 NHANES. We estimated the percentage meeting 2008 AAP vitamin D guidelines, defined as consuming ≥1 L of infant formula and/or receiving a vitamin D supplement of ≥400 IU. We used Poisson regressions to assess trends over time and differences across demographic subgroups. RESULTS: Overall, 27.1% (95% confidence interval [CI]: 24.3%-29.8%) of US infants in 2009-2016 met vitamin D intake guidelines, with nonbreastfeeding infants (31.1% [95% CI: 27.6%-34.5%]) more likely to meet guidelines than breastfeeding infants (20.5% [95% CI: 15.4%-25.5%]; P < .01). From 2009-2010 to 2015-2016, overall and for both breastfeeding and nonbreastfeeding infants, there were no significant changes over time in the percentage of infants who met the guidelines (P > .05). Among breastfeeding infants, those with a family income ≥400% of the federal poverty level, with a college graduate head of household, and with private insurance were more likely to meet guidelines. CONCLUSIONS: Among US infants, we observed no increase in meeting AAP vitamin D intake guidelines since 2009. Less than 40% of infants met guidelines in nearly all demographic subgroups. These findings suggest renewed consideration of how to best meet vitamin D intake guidelines.

Establishing a Foundation for Optimal Feeding Outcomes in the NICU.

Many infants in the NICU experience difficulties with oral feeding, which contribute to prolonged length of stay. Oral feeding is a complex task involving sensorimotor functioning of the face, mouth, and larynx, as well as coordination of sucking, swallowing, and breathing. The care provided in the NICU starting at birth sets the stage for future oral feeding. The purpose of this article is to describe strategies that will establish a positive foundation to support optimal oral feeding. Nurses can use these strategies to protect newborns from noxious stimuli and promote positive auditory, tactile, gustatory, and olfactory experiences to optimize neurodevelopment for the complex task of feeding.

Cesarean delivery and the risk of allergic rhinitis in children.

BACKGROUND: Cesarean delivery (C-section) may influence the infant microbiome and affect immune system development and subsequent risk for allergic rhinitis (AR). OBJECTIVE: To investigate the association between C-section and AR at ages 6, 8, and 10 years. METHODS: Data were collected prospectively through Kaiser Permanente Northern Californias (KPNC) integrated healthcare system. Children were eligible if they were born in a KPNC hospital and remained in the KPNC system for minimum 6 years (n = 117,768 age 6; n = 75,115 age 8; n = 40,332 age 10). Risk ratios (RR) for C-section and AR were estimated at each follow-up age and adjusted for important covariates, including intrapartum antibiotics, pre-pregnancy body mass index, maternal allergic morbidities, and breastfeeding. Subanalyses considered information on C-section indication, labor, and membrane rupture. RESULTS: After adjusting for confounders, we did not observe an association between C-section and AR at follow-up ages 6, 8, or 10 years (RR [CI]: 6 years, 0.98 [0.91, 1.04]; 8 years, 1.00 [0.95, 1.07]; 10 years, 1.03 [0.96, 1.10]). In stratified analyses, there was limited evidence that C-section increases the risk of AR in certain subgroups (eg, children of non-atopic mothers, second or higher birth order children), but most estimated risk ratios were consistent with no association. Estimated associations were unaffected by participant attrition, missing data, or intrapartum antibiotics. CONCLUSION: C-section delivery was not associated with AR at follow-up ages of 6, 8, or 10 years in a large contemporary US cohort.

Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks.

The nutritional and immunologic properties of human milk, along with clear evidence of dose-dependent optimal health outcomes for both mothers and infants, provide a compelling rationale to support exclusive breastfeeding. US women increasingly intend to breastfeed exclusively for 6 months. Because establishing lactation can be challenging, exclusivity is often compromised in hopes of preventing feeding-related neonatal complications, potentially affecting the continuation and duration of breastfeeding. Risk factors for impaired lactogenesis are identifiable and common. Clinicians must be able to recognize normative patterns of exclusive breastfeeding in the first week while proactively identifying potential challenges. In this review, we provide new evidence from the past 10 years on the following topics relevant to exclusive breastfeeding: milk production and transfer, neonatal weight and output assessment, management of glucose and bilirubin, immune development and the microbiome, supplementation, and health system factors. We focus on the early days of exclusive breastfeeding in healthy newborns ≥35 weeks' gestation managed in the routine postpartum unit. With this evidence-based clinical review, we provide detailed guidance in identifying medical indications for early supplementation and can inform best practices for both birthing facilities and providers.

A Guide to Feeding Term and Preterm Newborns.

The management of feeding term and preterm newborns encompasses knowing the physiologic mechanics of nutritive feeding and requirements for good somatic and neurodevelopmental growth. Feeding in newborns can be fraught with challenges that each individual infant-family unit presents. Management is multifactorial and requires fluidity as the infant progresses. Pediatricians are tasked with one of the most important responsibilities in the newborn period-partnering with families to ensure optimal feeding regimen and infant growth. This article's aim is to outline general recommendations on evidence-based feeding practices in term and preterm infants with a goal to help guide pediatricians create an optimal individualized feeding regimen and address some known hurdles. [Pediatr Ann. 2020;49(2):e71-e76.].