Application of Statistical Analysis and Machine Learning to Identify Infants' Abnormal Suckling Behavior.

OBJECTIVE: Identify infants with abnormal suckling behavior from simple non-nutritive suckling devices. BACKGROUND: While it is well known breastfeeding is beneficial to the health of both mothers and infants, breastfeeding ceases in 75 percent of mother-child dyads by 6 months. The current standard of care lacks objective measurements to screen infant suckling abnormalities within the first few days of life, a critical time to establish milk supply and successful breastfeeding practices. MATERIALS AND METHODS: A non-nutritive suckling vacuum measurement system, previously developed by the authors, is used to gather data from 91 healthy full-term infants under thirty days old. Non-nutritive suckling was recorded for a duration of sixty seconds. We establish normative data for the mean suck vacuum, maximum suck vacuum, suckling frequency, burst duration, sucks per burst, and vacuum signal shape. We then apply computational methods (Mahalanobis distance, KNN) to detect anomalies in the data to identify infants with abnormal suckling. We finally provide case studies of healthy newborn infants and infants diagnosed with ankyloglossia. RESULTS: In a series of case evaluations, we demonstrate the ability to detect abnormal suckling behavior using statistical analysis and machine learning. We evaluate cases of ankyloglossia to determine how oral dysfunction and surgical interventions affect non-nutritive suckling measurements. CONCLUSIONS: Statistical analysis (Mahalanobis Distance) and machine learning [K nearest neighbor (KNN)] can be viable approaches to rapidly interpret infant suckling measurements. Particularly in practices using the digital suck assessment with a gloved finger, it can provide a more objective, early stage screening method to identify abnormal infant suckling vacuum. This approach for identifying those at risk for breastfeeding complications is crucial to complement complex emerging clinical evaluation technology. CLINICAL IMPACT: By analyzing non-nutritive suckling using computational methods, we demonstrate the ability to detect abnormal and normal behavior in infant suckling that can inform breastfeeding intervention pathways in clinic.Clinical and Translational Impact Statement: The work serves to shed light on the lack of consensus for determining appropriate intervention pathways for infant oral dysfunction. We demonstrate using statistical analysis and machine learning that normal and abnormal infant suckling can be identified and used in determining if surgical intervention is a necessary solution to resolve infant feeding difficulties.

Massive open online course on breastfeeding during the COVID-19 pandemic in Mexico.

BACKGROUND: COVID-19 virus was reported to be transmitted through breastfeeding (BF), creating the need for rapidly available, standardized information and training for health personnel and the community about BF as an urgent action to reduce misinformation and unethical promotion of breast milk substitutes (BMS). In Mexico, a massive open online course (MOOC) was designed and implemented to protect, promote and support BF in emergency contexts. METHODS: MOOC registration consisted of collection of quantitative data regarding participant characteristics, MOOC coverage, scores achieved and completion rates. A multiple linear regression analysis was performed to relate the absolute and relative skills earned in the MOOC to participant characteristics. In addition, factors associated with completion rate and dissemination of information from the MOOC were analyzed using multiple logistic regression and presented as odds ratios. RESULTS: During a period of 19 months, 52,426 participants across the country, including health personnel and general population, entered the Cursos en Linea del Instituto Mexicano del Seguro Social (CLIMSS) platform, of which 50.5% completed the MOOC. The level of participation was maintained from January 2021 to early 2022 when the perception of the risk of getting sick from COVID-19 and quarantining decreased. In adjusted analysis, completion rate was associated with being older or belonging to a health institution; furthermore, residing in the north of the country doubled the odds of completing the MOOC (odds ratio 2.24; 95% confidence interval 1.95-2.56). CONCLUSIONS: A MOOC can be a useful training strategy to disseminate information, especially in emergencies where physical distancing is important and reaching the largest possible population is required.

Associations Between Breastfeeding, Maternal Emotional Availability, and Infant-Mother Attachment: The Role of Coparenting.

BACKGROUND: Breastfeeding is a parenting practice that combines close intimate contact with the opportunity to be sensitive and responsive to the infant, and may have direct and indirect relations with infant attachment. However, researchers have produced inconsistent findings, suggesting there may be other mechanisms involved. Coparenting may play a significant role, as it has been consistently associated with mother-infant relationships. RESEARCH AIMS: The aims of this study were to examine: (1) whether breastfeeding would be directly associated with infant-mother attachment; (2) whether this association was also indirect, through mothers' quality of caregiving; and (3) whether partners' coparenting support moderates breastfeeding's indirect association with attachment. METHODS: This was a prospective, longitudinal study that drew data from a larger NIH-funded study on sleep and family relationships (R01HD052809). Mothers reported on their feeding practices and coparenting relationships. Independent observations were used to assess mothers' emotional availability toward infants. A separate team of observers assessed infant-mother attachment. RESULTS: Exclusive breastfeeding during the first 6 months, and longer duration of any breastfeeding across the 1st year, were directly associated with more secure infant-mother attachment. These associations were also indirect, through maternal emotional availability. Coparenting was a significant moderator, such that the influence of longer breastfeeding duration on improved emotional availability, and, in turn, on more secure attachment, was significant only for mothers who perceived coparenting quality to be low. CONCLUSION: Findings highlighted the importance of breastfeeding on both the quality of mothering and infant attachment, but also emphasized that coparenting support may be particularly important for mothers who are unable to breastfeed.

Social Transfers for Exclusive Breastfeeding (STEB) Intervention in Lao People's Democratic Republic: Protocol for a Randomized Controlled Trial.

BACKGROUND: Children in Lao People's Democratic Republic (Lao PDR) receive suboptimal nutrition because of low breastfeeding rates, undermining their developmental potential. While major public health campaigns have attempted to increase breastfeeding rates, they have been largely unsuccessful. One explanation for these unsuccessful interventions is the economic and financial constraints faced by mothers. A potential solution for alleviating these pressures is providing social transfers to support breastfeeding; defined as a cash or in-kind transfer. Capitalizing on key strategies used in previous social transfer programs, we will assess the effectiveness of social transfer intervention for increasing exclusive breastfeeding rates in Vientiane, Lao PDR. OBJECTIVE: This study aims to conduct a randomized controlled trial (RCT) designed to assess whether social transfers can increase exclusive breastfeeding rates in Vientiane Capital, Lao PDR. METHODS: A prospective, parallel cluster-RCT was conducted among 300 mothers who recently gave birth and initiated breastfeeding. Enrolling 100 participants for each intervention arm provided us with 80% power to detect an increase in exclusive breastfeeding from the anticipated 21% in the control arm to 40% in either of the 2 intervention arms. Mother-infant dyads were enrolled at approximately 1 month post partum. Follow-up visits will occur at 6 months, 1 year, 2 years, and 3 years post partum; with the ambition to extend the follow-up period. Mother-infant dyads were enrolled between August 2022 and April 2023 with follow-up until 3 years post partum (2026). A local study team comprised of 2 nurses and 2 laboratory technicians is responsible for enrollment and follow-up of participants. Participants were randomly assigned to one of three groups during the baseline, 1-month visit: (1) control group, no social transfer; (2) intervention group 1, an unconditional social transfer at 6 months post partum; and (3) intervention group 2, a social transfer at 6 months post partum conditional upon mothers exclusively breastfeeding. All groups received educational materials supporting mothers to exclusively breastfeed. The primary end point will be exclusive breastfeeding at 6 months post partum. Secondary end points will include exclusive and complementary breastfeeding duration, childhood wasting and stunting, child growth, maternal and infant stress, predictors of early breastfeeding cessation, intestinal inflammation, anemia, maternal weight loss, maternal blood pressure, maternal anxiety, and GRIT personality score. Questionnaires and physical examinations were used to collect information. RESULTS: As of November 2023, the study has enrolled 300 participants. Study participation is ongoing until December 2026 at minimum. Over the study lifetime, 93% have completed all visits. CONCLUSIONS: We see potential for a long-term program that may be implemented in other low- or lower-middle-income countries with only minor modifications. The RCT will be used as a basis for observational studies and to investigate the impact of human milk on child fecal microbiota and growth. TRIAL REGISTRATION: ClinicalTrials.gov NCT05665049; https://clinicaltrials.gov/study/NCT05665049. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54768.

Iranian Women's Experiences of Breastfeeding Support during the COVID-19 Pandemic: A Qualitative Study.

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on health systems worldwide has been associated with less attention to maternal support in breastfeeding. The objective of this study was to explore the experiences of breastfeeding mothers, during the COVID-19 pandemic, and the impact of the pandemic on breastfeeding initiation and maintenance. Materials and Methods: A qualitative, descriptive study was conducted by means of in-depth semi-structured interviews. The study participants included 28 mothers who had children aged 0 to 12 months, lived in Guilan Province, Iran, and had breastfed their children at least once after March 2021. Conventional content analysis was performed simultaneously with data collection. Results: Data analysis led to the extraction of three main categories and nine subcategories: in the shadow of peace (receiving correct information from reliable sources, observing health and quarantine principles, and enjoying the awareness of not having COVID-19 [both the mother and the infant]), under the stress (information poverty, invalid and stressful information, and stressful association of underlying diseases), and in the delusion of exposure (refusal to breastfeed, and non-compliance with recommendations). Conclusions: Mothers' breastfeeding experiences during the COVID-19 pandemic indicate factors such as receiving or not receiving breastfeeding support, quarantine and the resulting stress, and exposure to conflicting information. Mothers felt that their experience with breastfeeding during the pandemic encouraged them to continue breastfeeding, but it is important to support breastfeeding mothers. Monitoring and supporting vulnerable groups such as breastfeeding mothers, for mental health problems during the COVID-19 pandemic, should be considered during the planning phase.

Vortioxetine Exposure During Pregnancy and Lactation: A Japanese Case Study of Neonatal Implications and Quantitative Milk and Plasma Analyses.

Background: Information about influences of vortioxetine on pregnant women and neonates during perinatal period is almost unknown. Case Presentation: The case was a 28-year-old Japanese woman in her first pregnancy, treated for depression with vortioxetine (20 mg daily) among other medications. At 36 weeks of gestation, she was admitted for premature rupture of the membranes and delivered a girl with no apparent congenital anomalies. Immediately after birth, the neonate required brief respiratory support due to her dyspnea and poor muscle tone. Her respiratory condition improved in 6 days after delivery, and she demonstrated normal developmental progress afterward. Maternal plasma and breast milk samples, collected 4 days postpartum, revealed vortioxetine concentrations of 11.4 ng/mL and 9.3 ng/mL, respectively. The calculated relative infant dose (RID) was estimated at 0.32%. After discharge from hospital, the infant presented no detectable drug-related adverse effects, with over 50% of nutrition derived from breastfeeding. Conclusion: This case showed minimal transfer of vortioxetine into breast milk, reflected in a low RID. The findings suggest limited neonatal exposure to the drug, with no adverse developmental effects observed in the infant. However, the case also indicated the potential for vortioxetine use during pregnancy to contribute to the onset of severe neonatal asphyxia. Further research is needed for a comprehensive understanding of its impact on neonatal health.

The neighborhood food environment modifies the association between infant feeding and childhood obesity.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) issues infant formula to infants who are not fully breastfed, and prior research found elevated obesity risk among children receiving lactose-reduced infant formula with corn syrup solids (CSSF) issued by WIC. This study was conducted to evaluate associations between a broader set of specialty infant formulas issued by WIC and child obesity risk, whether neighborhood context (e.g. neighborhood food environment) modifies associations, and whether racial/ethnic disparities in obesity are partly explained by infant formula exposure and neighborhood context. METHODS: WIC administrative data, collected from 2013-2020 on issued amount (categorical: fully formula fed, mostly formula fed, mostly breastfed, fully breastfed) and type of infant formula (standard cow's milk formula, and three specialty formulas: any CSSF, any soy-based formula, and any cow's milk-based formula with added rice starch) and obesity at ages 2-4 years (defined as a Body Mass Index z-score ≥ 95th percentile according to World Health Organization growth standard) were used to construct a cohort (n = 59,132). Associations of infant formula exposures and race/ethnicity with obesity risk were assessed in Poisson regression models, and modification of infant feeding associations with obesity by neighborhood context was assessed with interaction terms. RESULTS: Any infant formula exposure was associated with significantly higher obesity risk relative to fully breastfeeding. Receipt of a CSSF was associated with 5% higher obesity risk relative to the standard and other specialty infant formulas (risk ratio 1.05, 95% confidence interval 1.02, 1.08) independent of breastfeeding duration and receipt of other specialty infant formulas. The association between CSSF and obesity risk was stronger in neighborhoods with healthier food environments (10% higher risk) compared to less healthy food environments (null). Racial/ethnic disparities in obesity risk were robust to adjustment for infant formula exposure and neighborhood environment. CONCLUSIONS: Among specialty infant formulas issued by WIC, only CSSFs were associated with elevated obesity risk, and this association was stronger in healthier food environments. Future research is needed to isolate the mechanism underlying this association.

Feeding Infants: Choice-Specific Considerations, Parental Obligation, and Pragmatic Satisficing.

Health institutions recommend that young infants be exclusively breastfed on demand, and it is widely held that parents who can breastfeed have an obligation to do so. This has been challenged in recent philosophical work, especially by Fiona Woollard. Woollard's work critically engages with two distinct views of parental obligation that might ground such an obligation-based on maximal benefit and avoidance of significant harm-to reject an obligation to breastfeed. While agreeing with Woollard's substantive conclusion, this paper (drawing on philosophical discussion of the 'right to rear') argues that there are several more moderate views of parental obligation which might also be thought to ground parental obligation. We first show that an obligation to breastfeed might result not from a general obligation to maximally benefit one's child, but from what we call 'choice-specific' obligations to maximise benefit within particular activities. We then develop this idea through two views of parental obligation-the Dual Interest view, and the Best Custodian view-to ground an obligation to exclusively breastfeed on demand, before showing how both these more moderate views fail. Finally, we argue that not only is there no general obligation to breastfeed children, but that it is often morally right not to do so. Since much advice from health institutions on this issue implies that exclusive breastfeeding on demand is the best option for all families, our argument drives the feeding debate forward by showing that this advice often misrepresents parents' moral obligations in potentially harmful ways.

"I can't provide what my child needs": Early feeding experiences of caregivers of children with craniofacial microsomia.

PURPOSE: Craniofacial microsomia (CFM) is a congenital condition that can be associated with feeding challenges in infants. As part of the larger 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program, this study described caregivers' early feeding experiences. DESIGN AND MATERIALS: US-based caregivers of 34 children with CFM participated in remote narrative interviews. Two authors completed inductive thematic analysis in an iterative process until consensus was reached. RESULTS: Caregivers' narratives outlined the inherent challenges of feeding an infant with special healthcare needs. The first theme 'Navigating Challenges and Managing Expectations' describes the distress participants experienced when they were unable to breastfeed and the negative emotional effect of switching to formula. The second theme 'Making Adaptations' outlines the methods participants tried, including breast pumps and feeding tubes. The third theme 'Accessing Support' describes participants' interactions with healthcare providers and challenges accessing feeding support. The final theme 'Growing from Adversity' recounts participants' relief once their child established a feeding pattern and the personal growth gained from their experiences. CONCLUSIONS: Caregivers reported several feeding related challenges associated with CFM, many of which negatively affected their wellbeing. Negative consequences were particularly pronounced in cases where caregivers' feeding experiences differed from their expectations. Participants identified challenges in accessing reliable feeding information and support. Despite difficult experiences, caregivers cited some positive outcomes, including increased confidence and resilience. PRACTICE IMPLICATIONS: Holistic feeding information and support for families affected by CFM should be inclusive of several feeding methods to improve care delivery, child health, and the caregiver experience.

Breastfeeding experience and anxiety in mothers with covid-19 in the postnatal period: a qualitative study.

BACKGROUND: The fear, panic, and uncertainties arising during the Covid-19 period have caused many questions about breastfeeding. This study was conducted to investigate breastfeeding and anxiety in mothers with Covid-19. METHODS: The phenomenological research type study was conducted in Istanbul between August and November 2021. The sample of the research consists of women who breastfeed after birth and who had Covid-19. Both content and descriptive analysis were used to analyze the data. RESULTS: The data were analyzed under three main themes. Under the theme of the impact of Covid-19 on breastfeeding, mothers experienced situations like decreased or increased breastfeeding frequency, cessation of breastfeeding, isolation, anxiety about transmission, and expression of milk. They reported that their anxiety in the breastfeeding process was related to the health of the baby, baby care, decreased milk or not breastfeeding, and the Covid-19 period. They used practices such as receiving spousal and professional support, paying attention to isolation, effective communication with the baby, and praying as methods of coping with anxiety. CONCLUSION: The study demonstrated that factors like transmission anxiety, decreased breastfeeding frequency, and isolation affected breastfeeding, and mothers were most concerned about the baby's health. In situations such as pandemics, protecting mother and baby health is important and a priority area. More quantitative and qualitative studies on the subject are needed.

Development of a workplace breastfeeding support practice model in South Africa.

BACKGROUND: Globally, mothers have identified work as one of the main obstacles to exclusive and continued breastfeeding. The support a woman receives in her workplace in terms of workplace arrangements can be critical to enable women to continue breastfeeding. This study aimed to develop and assess the face validity of a practice model to support exclusive and continued breastfeeding in workplaces in the Western Cape, South Africa. METHODS: An explanatory, sequential, mixed-method research design, was conducted (June 2017 to March 2019) in three distinct phases. Phase one employed a quantitative, descriptive, cross-sectional study design. Phase 2 used a qualitative, multiple case study. Phase three involved the development and face validity of a practice model to support exclusive breastfeeding in workplaces. The face validity included two Delphi rounds for experts to provide input on the draft practice model. This paper will only report on phase 3 of the study. The practice model was developed, drawing on the analysis of data from phases one and two and using programme theory approaches and a logic model. RESULTS: The practice model was positively perceived. Participants viewed it as informative, well designed and easy to follow, even for those not knowledgeable about the subject. It was viewed as an ideal tool, if accompanied by some training. Participants were positive that the model would be feasible and most commended the tiered approach to implementation. They felt that workplaces would be more open to a step-by-step approach to implementation and if only a few activities are implemented it would be a start to make the work environment more conducive for breastfeeding employees. There were mixed opinions regarding commitment; a few participants mentioned commitment as a challenge they anticipated in the male-dominant environments in which they worked. The provision of space for breastfeeding at the workplace was also highlighted as a potential challenge. CONCLUSIONS: Advocacy around creating an enabling workplace environment for breastfeeding is needed. The practice model has the potential to be internationally relevant, locally applied and may be of particular use to workplaces that want to initiate and/or strengthen breastfeeding support.

Nexus between postpartum depression and exclusive breastfeeding practices among lactating mothers in Assosa Town, West Ethiopia.

Background: Across the globe, breastfeeding stands out as a highly effective strategy for reducing infant and child morbidity and mortality. Concurrently, postpartum depression (PPD) emerges as a notable public health issue, adversely affecting both exclusive breastfeeding (EBF) practices for infants and the fulfillment of parenting roles. Despite the lack of substantial evidence in Ethiopia and the specific study areas, indicating the association between PPD and EBF practices, this study endeavors to fill this gap. The primary objective is to examine the correlation between PPD and EBF practices, along with exploring other pertinent factors, in Assosa Town, West Ethiopia. Methods: A community-based cross-sectional study was carried out from 7 March to 5 April 2019. The study involved the recruitment of 462 participants through a systematic random sampling method. Data collection was facilitated by conducting a structured and pre-tested questionnaire. To screen for PPD, we used the Edinburgh Postnatal Depression Scale (EPDS) tool. This tool, EPDS, was used solely as a screening tool and not for diagnostic purposes. The collected data were entered into Epi-Data version 3.1 and subsequently exported to SPSS version 24 for comprehensive statistical analysis. Bivariate and multivariate logistic regression analyses were performed to assess the association between independent variables and dependent variables. Odds ratios, along with their 95% confidence intervals (CIs), were calculated to ascertain the presence and strength of any associations. Statistical significance was acknowledged at a p-value of <0.05. Results: The overall prevalence of EBF practices was found to be 58.2% (95% CI: 51.4-65.7), while the prevalence of PPD was 18.7% (95% CI: 15.94-26.7). Among mothers without PPD, the prevalence of EBF practices was notably higher at 62.4% (95% CI: 55.9-65.2%) compared to mothers experiencing PPD, where the prevalence was 31.3% (95% CI: 24.7-32.5%). Mothers who experienced PPD exhibited 51% reduced odds of practicing EBF compared to their counterparts (AOR = 0.49. 95% CI: 0.25-0.8). Furthermore, factors such as having a higher family monthly income (AOR = 8.7, 95% CI: 4.2-17.2), being multiparous (AOR = 5.8, 95% CI 4.9-10.8), attending antenatal care (ANC) visits (AOR = 4.9, 95% CI: 3.4-14.1), opting for vaginal delivery (AOR = 9.8, 95% CI: 5.6-17.4), and receiving husband's support (AOR = 5.3, 95% CI: 4.6-12.7) demonstrated a statistically significant positive association with EBF practices. Conclusion: In this study, a substantial number of mothers demonstrated suboptimal EBF practices during the first 6 months of their infants' lives. Consequently, the findings underscore a clear association between PPD and EBF. Thus, it is imperative to intensify efforts in the early detection and treatment of PPD, enhance household income, advocate for ANC, and encourage active husband involvement to bolster EBF practices.

Preparation and validation of a predictive model of breastfeeding initiation in the first hour of life.

OBJECTIVE: The objective was to develop and validate a predictive model of initiation of breastfeeding in the first hour after delivery. METHODS: Retrospective cohort study on women who gave birth between 2013 and 2018 in Spain. For data collection, an ad hoc questionnaire was designed to be filled in by the mothers, which was distributed to the different Spanish breastfeeding associations which, in turn, shared it with their associate partners. The development of the predictive model was made on a cohort of 3218 women (2/3) and was validated on a cohort of 1609 women (1/3). Mothers whose children were admitted to hospital at the time of birth were excluded. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC). RESULTS: 81.0 % (2608) women started breastfeeding in the first hour in the derivation cohort, and 80.1 % (1289) in the validation cohort. The predictive factors in the final model were: the highest number of children and skin-to-skin contact at birth as flattering factors, while dystocic delivery reduced the likelihood of the onset of breastfeeding. The predictive ability (ROC AUC) in the derivation cohort was 0.89 (CI 95 %: 0.87-0.90), while in the validation cohort it was 0.89 (CI 95 %: 0.87-0.92). CONCLUSIONS: This three-variable predictive model has excellent predictive ability in both the derivation cohort and the validation cohort. This model can identify women who are at high risk of non-initiating breastfeeding within the first hour after delivery.

General practitioners' management of mastitis in breastfeeding women: a mixed method study in Australia.

BACKGROUND: Mastitis is a common reason new mothers visit their general practitioner (GP). In Australia, the Therapeutic Guidelines: Antibiotic provides practical advice to GPs managing a range of infections, including mastitis. It is not known if Australian GPs prescribe antibiotics and order investigations as recommended for the management of mastitis. METHODS: A convergent mixed methods design integrated quantitative analysis of a general practice dataset with analysis of interviews with GPs. Using the large-scale primary care dataset, MedicineInsight, (2021-2022), antibiotics prescribed and investigations ordered for mastitis encounters were extracted. Mastitis encounters were identified by searching 'Encounter reason', 'Test reason' and 'Prescription reason' free text field for the term 'mastitis'; 'granulomatous mastitis' was excluded. Clinical encounters for mastitis occurring within 14 days of a previous mastitis encounter were defined as belonging to the same treatment episode. Semi-structured interviews were conducted with 14 Australian GPs using Zoom or telephone in 2021-2022, and analysed thematically. The Pillar Integration Process was used to develop a joint display table; qualitative codes and themes were matched with the quantitative items to illustrate similarities/contrasts in findings. RESULTS: During an encounter for mastitis, 3122 (91.7%) women received a prescription for an oral antibiotic; most commonly di/flucloxacillin ([59.4%]) or cefalexin (937 [27.5%]). Investigations recorded ultrasound in 303 (8.9%), blood tests (full blood examination [FBE]: 170 [5.0%]; C-reactive protein [CRP]: 71 [2.1%]; erythrocyte sedimentation rate [ESR]: 34 [1.0%]) and breast milk or nipple swab cultures in approximately 1% of encounters. Analysis using pillar integration showed consistency between quantitative and qualitative data regarding mastitis management. The following themes were identified: - GPs support continued breastfeeding. - Antibiotics are central to GPs' management. - Antibiotics are mostly prescribed according to Therapeutic Guidelines. - Analgesia is a gap in the Therapeutic Guidelines. - Low use of breast milk culture. CONCLUSIONS: Prescribing antibiotics for mastitis remains central to Australian GPs' management of mastitis. Interview data clarified that GPs were aware that antibiotics might not be needed in all cases of mastitis and that delayed prescribing was not uncommon. Overall, GPs followed principles of antibiotic stewardship, however there is a need to train GPs about when to consider ordering investigations.

Anemia in Breastfeeding Women and Its Impact on Offspring's Health in Indonesia: A Narrative Review.

Anemia in breastfeeding women is a neglected global health issue with significant implications for maternal and child health. Despite its widespread occurrence and adverse effects, this problem remains largely unknown and overlooked on the global health agenda. Despite efforts to improve health access coverage and provide iron and folic acid supplementation, anemia persists. This underscores the need for a comprehensive approach to address the problem. Urgent action must be taken to prioritize education and awareness campaigns, ensure access to nutritious food, and enhance healthcare services. Education programs should focus on promoting iron-rich diets, dispelling cultural myths, and providing practical guidance. Improving healthcare services requires increasing availability, ensuring a consistent supply of iron supplements, and providing adequate training for healthcare providers. A successful implementation relies on a strong collaboration between the government, healthcare providers, and community. It is crucial that we acknowledge that high coverage alone is insufficient for solving the issue, emphasizing the importance of targeted interventions and a strategic implementation. By adopting a comprehensive approach and addressing the underlying causes of anemia, Indonesia can make significant progress in reducing its prevalence and improving the overall health of its population, particularly among breastfeeding women.

Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis.

Early childhood caries (ECC) is a growing public health concern worldwide. Although numerous systematic reviews have been published regarding the association between breastfeeding and early childhood caries (ECC), the results remain inconclusive and equivocal. This systematic review synthesises the evidence on the association between breastfeeding and ECC. Five electronic databases and backward citation chasing were performed from inception until May 2023. A total of 31 studies (22 cohort studies and 9 case-control studies) were included in this review. The meta-analysis of the case-control studies showed statistically significant fewer dental caries in children who were breastfed for < 6 months compared to those who were breastfed for ≥6 months (OR = 0.53, 95% CI 0.41-0.67, p < 0.001). There was a statistically significant difference in dental caries between children who were breastfed for <12 months and those who were breastfed for ≥12 months (RR = 0.65, 95% CI 0.50-0.86, p < 0.002). Similarly, there was a statistically significant difference in dental caries in children who were breastfed for < 18 months compared to those who were breastfed for ≥18 months (RR = 0.41, 95% CI 0.18-0.92, p = 0.030). Nocturnal breastfeeding increases the risk of ECC compared with no nocturnal breastfeeding (RR = 2.35, 95% CI 1.42-3.89, p < 0.001). The findings suggest breastfeeding for more than 12 months and nocturnal breastfeeding increase the risk of ECC.

Breastfeeding, Gestational Diabetes Mellitus, Size at Birth and Overweight/Obesity in Early Childhood.

Background: Breastfeeding appears to reduce the risk of childhood overweight/obesity. However, it remains unclear whether this protective effect persists among high-risk populations. This study aims to investigate the association of breastfeeding with the risk of overweight/obesity in early childhood and whether this association is altered by gestational diabetes mellitus (GDM) or size at birth. Methods: Feeding practices during the first 12 months of age and weight and length at 12-36 months of age were collected. Full breastfeeding includes exclusive and predominant breastfeeding. Children with body mass index (BMI) values greater than 1 standard deviation from the mean of sex- and age-specific BMI were classified as overweight/obese. Multiple generalized estimating equations models were applied to analyze the associations of full breastfeeding duration with overweight/obesity risk. Results: Among all participants (n = 9329), infants with a longer full-breastfeeding duration had a reduced risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Infants exposed to GDM and those born large for gestational age (LGA) had a higher risk of overweight/obesity in early childhood. Among infants of mothers with GDM (n = 1748), infants with full breastfeeding for greater than 6 months (aOR: 0.58; 95% CI: 0.44, 0.78) showed a decreased risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Among LGA infants (n = 1279), infants with full breastfeeding for 3-5 months (aOR: 0.66; 95% CI: 0.57, 0.76) and greater than 6 months (aOR: 0.70; 95% CI: 0.56, 0.88) showed a decreased risk of overweight/obesity in early childhood. Similar results were observed among LGA infants of mothers with GDM. Conclusions: Initiating and prolonging breastfeeding would reduce the risk of overweight/obesity in early childhood, and LGA infants and infants born to mothers with GDM would experience greater benefits.

Internet-based breastfeeding peer support for breastfeeding parents: An integrative review.

AIM: To explore what Internet-based breastfeeding peer support offers to breastfeeding parents. DESIGN: Integrative review. DATA SOURCES AND REVIEW METHODS: A systematic literature search was conducted in March 2024 using the following electronic databases: CINAHL, The Cochrane Library, PubMed/MEDLINE and PsycINFO. Database searches yielded 717 results. Two researchers removed the duplicates (n = 256) and screened the remaining titles (n = 461), abstracts (n = 197) and full texts (n = 60) independently. Eventually, 19 studies were included in the review. The chosen studies had qualitative (n = 11), quantitative (n = 6), or mixed methods designs (n = 2) and were published between 2015 and 2024. Qualitative content analysis was conducted. RESULTS: The main categories were supplying support that is responsive to the needs of parents and belonging to a breastfeeding community. The parents looked for and received breastfeeding support, advice, information, emotional support, reassurance and access to shared experiences from various online breastfeeding peer support groups. The support groups helped them in their breastfeeding decisions, thus making a difference in their breastfeeding experience. The support groups created breastfeeding communities for these parents and they were able to bond with others, feel like they belonged and share experiences. Additionally, these breastfeeding communities helped to normalize various breastfeeding practices. CONCLUSION: Breastfeeding peer support groups can offer parents the support and guidance they seek and a sense that they are part of a breastfeeding community. However, it is vital these groups are efficiently moderated to ensure the advice parents receive is evidence-based and the support is encouraging. IMPACT: These findings show that well-moderated online breastfeeding peer support can offer parents high-quality support. It is essential for health care professionals to be aware of the various options available in order to recommend high-quality support groups for breastfeeding parents. REPORTING METHOD: PRISMA. PATIENT OR PUBLIC CONTRIBUTION: This was an integrative review therefore no patient or public contribution was necessary.

A longitudinal study of breastfeeding relationships at home during the COVID-19 pandemic: A grounded theory method.

AIMS: To describe the process of breastfeeding relationships among stay-at-home mother and infant dyads at 1, 3, 5 and 6 months. DESIGN: A longitudinal qualitative online survey design was used. METHODS: Data were obtained at 1, 3, 5 and 6 months from 26 breastfeeding mothers who stayed home with their infants and directly breastfed at least once a day for the first 6 months between June 2022 and August 2023. Mothers' written responses to 3 open-ended questions were analysed to assess breastfeeding experiences at home, thoughts/comments while directly breastfeeding and breastfeeding concerns/problems and strategies they used. Based on grounded theory, inductive content analysis was used to analyse the data. Trustworthiness of results was established by coding to consensus, formal peer debriefing and maintaining an audit trail. RESULTS: 'Breastfeeding Relationships at Home,' the core construct, was identified and organized the process of breastfeeding relationships into 5 domains: (1) mothers' emotional well-being while breastfeeding, (2) infant-led feeding, (3) alternatives to breastfeeding, (4) evaluation of breastfeeding and (5) changes in breastfeeding as infants grow older. CONCLUSION: Breastfeeding is not simply about feeding breast milk but also involves nurturing and developing a relationship between mother and infant. Across the domains, mutual responsiveness, a central element of the breastfeeding relationship was clear. Mothers who were committed to breastfeeding with embedded infant suckling reached emotional well-being in return for their engagement which has potential to reduce maternal stress and prevent postpartum depression. IMPACT: Findings from the current study add to nurses' knowledge about the relationship building process between stay-at-home mothers and their infants in the first 6 months of breastfeeding during the COVID-19 pandemic. Nurses must remain sensitive to aid the development of breastfeeding relationships in the home environment to maximize mutual responsiveness. PATIENT OR PUBLIC CONTRIBUTION: No patients or public involved.

Effect of Delayed Cord Clamping on Breastfeeding Behaviors During the First Breastfeed: A Randomized Controlled Study.

Objective: Delayed cord clamping (DCC) may increase the success of breastfeeding by improving neurological and cardiovascular function in neonates. In this study, we investigated the impact of DCC on breastfeeding behaviors, neonatal activity status, and maternal satisfaction during the first breastfeeding. Methods: This randomized controlled study was conducted in a tertiary hospital in Turkey with 100 term infants delivered by elective cesarean section with spinal anesthesia. The participants were randomly assigned to the early cord clamping (ECC) group or DCC group. The Infant Breastfeeding Assessment Tool (IBFAT) was used to assess infant alertness, breastfeeding behaviors, and maternal satisfaction with breastfeeding within the first 2 hours of life. Results: Scores on the IBFAT were significantly higher in the DCC group compared with the ECC group (p = 0.02). Maternal satisfaction with breastfeeding did not differ between the groups (p = 0.3). Infant alertness tended to be better in the DCC group, but the difference was not statistically significant (p = 0.08). Conclusion: The results of this study indicated that DCC was associated with more favorable breastfeeding behaviors compared with ECC.