East Meets West: Effect of Acupuncture on Lactation and Maternal Quality of Life.

Objective: To evaluate the impact of acupuncture as part of a traditional Chinese medicine (TCM) treatment plan on lactation and maternal well-being in pump-dependent mothers of hospitalized neonates during the first 30 days after delivery. Study Design: This single-center study was conducted in a level IV regional neonatal intensive care unit with access to integrative health services. Sixty-six mothers were prospectively enrolled in two nonparallel groups: (1) Standard lactation support and (2) standard lactation support augmented with acupuncture. Daily pump volumes were documented. Participants completed a quality-of-life (QOL) survey at baseline and neonatal day of life 30. A linear model was constructed, adjusting for increased milk production over time. Results: Acupuncture was associated with increased milk production at all time points: Day 10 (p = 0.0002), day 14 (p < 0.0001), day 21 (p < 0.0001), and day 30 (p < 0.0001). Acupuncture was associated with an increase in three of five QOL components: psychological/child's health (p = 0.0006), family/friend relationship (p = 0.0006), and health/functioning (p = 0.02). Conclusion: Mothers receiving acupuncture reported enhanced milk supply and improved QOL. The limited sample size restricts the broad applicability of the results; nonetheless, this study paves the way for further research on the advantages of merging Eastern and Western treatments to enhance human lactation.

Barcode scanning of human milk and enteral formulas improves efficiency and patient safety: A 7-year review.

BACKGROUND: Safe handling of human milk (HM) and enteral formulas for patients of all ages is critical in healthcare. Barcode scanning is commonly used to reduce errors. The purpose of this study was to evaluate the impact of barcode scanning for HM and formulas on patient safety. METHODS: Scanning is used at the time of feeding preparation for HM, facility-prepared formulas, and ready-to-feed enteral formulas for patients of all ages to confirm the feeding matches the provider order, record lot numbers, and ensure expired items are not used. HM feedings are scanned at the time of administration and discharge to ensure the correct milk is being provided to the correct patient. All formulas dispensed as samples to hospital inpatients and outpatients are scanned to record patient and product information in the event of a recall. RESULTS: Seven-year data showed that scanning has prevented HM misadministration 1226 times. Data for 2 and a half years of fortifier and formula scanning show 480 errors have been prevented. The results show benefits for both patient safety and staff efficiency. CONCLUSION: The benefits of barcode scanning systems in healthcare are well documented. Beyond the scanning of HM, scanning of fortifiers and formulas can improve patient safety by preventing misadministration for patients of all ages. Systems that offer features such as calculating fortified HM and formula recipes, tracking product lot numbers, and verifying correct products to the provider order can further improve safety as well as efficiency.

Does Feeding Previously Frozen (Thawed) Fortified Human Milk Increase the Incidence of Lactobezoar (Milk Curd) Obstruction? A Retrospective Cohort Study in One Large Neonatal Intensive Care Unit.

BACKGROUND: Current recommendations suggest that it is appropriate to store human milk (HM) for up to 24 hours following fortification despite any changes that may occur in fortified HM over time. However, a recent publication suggested fortified frozen HM should be thawed and fed within 12 hours of fortification due to the risk of lactobezoar or milk curd obstruction. OBJECTIVE: This study investigated whether lactobezoar (milk curd) formation increased when frozen fortified HM was thawed and fed within 12 hours vs 12 to 24 hours postfortification in the neonatal intensive care unit (NICU) at Children's Hospital of Orange County to determine if practice changes were warranted. DESIGN: This study was a retrospective cohort study. PARTICIPANTS/SETTING: All infants admitted to the Children's Hospital of Orange County NICU for calendar years 2018-2019 who were fed fortified human milk (n = 802) were included in the study. EXPOSURE VARIABLE: Feedings using previously frozen (thawed) fortified HM. MAIN OUTCOME MEASURE: Lactobezoar or milk curd formation. STATISTICAL ANALYSIS: Descriptive analyses were used for statistical analysis. RESULTS: Of the 107,602 feedings prepared with fortified thawed HM, 68% (72,602) were used within 12 hours of preparation and 32% (34,499) were stored for 12 to 24 hours before administration. The NICU at Children's Hospital of Orange County did not identify any lactobezoar formation or milk curd obstruction in either group. CONCLUSIONS: Data from this study support recommendations for a maximum storage time for thawed, fortified HM of 24 hours.

Human milk as "chrononutrition": implications for child health and development.

Human biology follows recurring daily rhythms that are governed by circadian cues in the environment. Here we show that human milk is a powerful form of "chrononutrition," formulated to communicate time-of-day information to infants. However, 85% of breastfed infants in the US consume some milk that does not come directly from the breast but is pumped and stored in advance of feeding. Expressed milk is not necessarily circadian-matched (e.g., an infant might drink breastmilk pumped in the evening on the following morning). Ingesting mistimed milk may disrupt infants' developing circadian rhythms, potentially contributing to sleep problems and decreased physiological attunement with their mothers and environments. Dysregulated circadian biology may compromise infant health and development. Despite wide-ranging public health implications, the timing of milk delivery has received little empirical study, and no major pediatric or public health organization has issued recommendations regarding the circadian-matching of milk. However, potential adverse developmental and health consequences could be ameliorated by simple, low-cost interventions to label and circadian-match stored milk. The current paper reviews evidence for human milk as chrononutrition and makes recommendations for future research, practice, and policy.

The Microbiome and Metabolome of Preterm Infant Stool Are Personalized and Not Driven by Health Outcomes, Including Necrotizing Enterocolitis and Late-Onset Sepsis.

The assembly and development of the gut microbiome in infants have important consequences for immediate and long-term health. Preterm infants represent an abnormal case for bacterial colonization because of early exposure to bacteria and frequent use of antibiotics. To better understand the assembly of the gut microbiota in preterm infants, fecal samples were collected from 32 very low birth weight preterm infants over the first 6 weeks of life. Infant health outcomes included health, late-onset sepsis, and necrotizing enterocolitis (NEC). We characterized bacterial compositions by 16S rRNA gene sequencing and metabolomes by untargeted gas chromatography-mass spectrometry. Preterm infant fecal samples lacked beneficial Bifidobacterium spp. and were dominated by Enterobacteriaceae, Enterococcus, and Staphylococcus organisms due to nearly uniform antibiotic administration. Most of the variance between the microbial community compositions could be attributed to the baby from which the sample derived (permutational multivariate analysis of variance [PERMANOVA] R2 = 0.48, P < 0.001), while clinical status (health, NEC, or late-onset sepsis) and overlapping times in the neonatal intensive care unit (NICU) did not explain a significant amount of variation in bacterial composition. Fecal metabolomes were also found to be unique to the individual (PERMANOVA R2 = 0.43, P < 0.001) and weakly associated with bacterial composition (Mantel statistic r = 0.23 ± 0.05, P < 0.05). No measured metabolites were found to be associated with necrotizing enterocolitis, late-onset sepsis, or a healthy outcome. Overall, preterm infant gut microbial communities were personalized and reflected antibiotic usage.IMPORTANCE Preterm infants face health problems likely related to microbial exposures, including sepsis and necrotizing enterocolitis. However, the role of the gut microbiome in preterm infant health is poorly understood. Microbial colonization differs from that of healthy term babies because it occurs in the NICU and is often perturbed by antibiotics. We measured bacterial compositions and metabolomic profiles of 77 fecal samples from 32 preterm infants to investigate the differences between microbiomes in health and disease. Rather than finding microbial signatures of disease, we found that both the preterm infant microbiome and the metabolome were personalized and that the preterm infant gut microbiome is enriched in microbes that commonly dominate in the presence of antibiotics. These results contribute to the growing knowledge of the preterm infant microbiome and emphasize that a personalized view will be important to disentangle the health consequences of the preterm infant microbiome.

A Multidisciplinary Quality Improvement Approach Increases Breastmilk Availability at Discharge from the Neonatal Intensive Care Unit for the Very-Low-Birth-Weight Infant.

BACKGROUND: Mothers of very-low-birth-weight (VLBW) infants often struggle to establish and maintain a milk supply. Children's Hospital of Orange County (CHOC Children's) data from 2005 to 2011 showed that while the total percentage of all neonatal intensive care unit (NICU) babies being discharged on breastmilk had remained stable, the percentage of VLBW babies with breastmilk at discharge had declined. This information resulted in a quality improvement initiative to remove barriers and implement programs shown to have the greatest impact on initiating and sustaining lactation in this patient subset. The objective of this initiative was to increase breastmilk availability at discharge for the VLBW population. MATERIALS AND METHODS: A multidisciplinary program was initiated, which included NICU parent and staff education, clarification of roles, and improved access to pumping supplies. Physicians and nurses completed online education. An algorithm defining roles in lactation support was developed, and a resource team of trained bedside nurses was formed. Lactation consultant time was then refocused on the VLBW population. In addition, "Lactation Support" was added to the physician daily documentation to bring the topic to daily bedside rounds. Twice weekly lactation rounds between the lactation consultant and neonatologist addressed lactation concerns for each dyad. To address pumping issues, the loaner pump program was enhanced. RESULTS: To assess the effectiveness of the initiative, breastmilk availability at discharge for the VLBW population at CHOC Children's was compared from baseline (2011) to the end of June 2015. VLBW breastmilk availability at discharge upon project initiation was 58.7% and increased by 36% to a final rate of 80% by 2013--a rate sustained through the first 6 months of 2015. CONCLUSIONS: The results of this initiative suggest that a multidisciplinary approach, including education, changes in workflow, and redefinition of roles, is effective in improving breastmilk rates at discharge in the VLBW patient population.

Centralized breastmilk handling and bar code scanning improve safety and reduce breastmilk administration errors.

Safe handling and preparation of breastmilk within the hospital setting are often taken for granted, and the process may not be scrutinized until problems arise. Areas of concern focus on both risk of contamination of breastmilk feedings due to handling and fortification and risk of a breastmilk misadministration. In two phases, Children's Hospital of Orange County (Orange, CA) implemented centralized breastmilk handling and breastmilk bar code scanning. As a result of these process changes, reports of breastmilk administration errors decreased to zero. However, bar code scanning allowed for the tracking of near misses. During the first 6 months of breastmilk bar code scanning, 55 attempts to feed the wrong breastmilk to the wrong patient and 127 attempts to feed expired breastmilk were prevented. Our findings are consistent with current practice recommendations that support the use of centralized breastmilk handling and systems for proper identification of breastmilk.

Role of platelet-activating factor in pulmonary vascular remodeling associated with chronic high altitude hypoxia in ovine fetal lambs.

Platelet-activating factor (PAF) is implicated in pathogenesis of chronic hypoxia-induced pulmonary hypertension in some animal models and in neonates. Effects of chronic hypoxia on PAF receptor (PAF-R) system in fetal pulmonary vasculature are unknown. We investigated the effect of chronic high altitude hypoxia (HAH) in fetal lambs [pregnant ewes were kept at 3,801 m (12,470 ft) altitude from approximately 35 to 145 days gestation] on PAF-R-mediated effects in the pulmonary vasculature. Age-matched controls were kept at sea level. Intrapulmonary arteries were isolated, and smooth muscle cells (SMC-PA) were cultured from HAH and control fetuses. To determine presence of pulmonary vascular remodeling, lung tissue sections were subjected to morphometric analysis. Percentage medial wall thickness was significantly increased (P < 0.05) in arteries at all levels in the HAH lambs. PAF-R protein expression studied by immunocytochemistry and Western blot analysis on lung tissue SMC-PA demonstrated greater PAF-R expression in HAH lambs. PAF-R binding (femtomoles per 10(6) cells) in HAH SMC-PA was 90.3 +/- 4.08 and 66% greater than 54.3 +/- 4.9 in control SMC-PA. Pulmonary arteries from HAH fetuses synthesized >3-fold PAF than vessels from controls. Compared with controls SMC-PA of HAH lambs demonstrated 139% and 40% greater proliferation in 10% FBS alone and with 10 nM PAF, respectively. Our data demonstrate that exposure of ovine fetuses to HAH will result in significant upregulation of PAF synthesis, PAF-R expression, and PAF-R-mediated effects in pulmonary arteries. These findings suggest that increased PAF-R protein expression and increased PAF binding contribute to pulmonary vascular remodeling in these animals and may predispose them to persistent pulmonary hypertension after birth.