Review concludes that specific recommendations are needed to harmonise the provision of fresh mother's milk to their preterm infants.

AIM: There are no specific recommendations for using a mother's fresh milk for her preterm infant. We reviewed the available evidence on its collection, storage and administration. METHODS: The working group of the French Neonatal Society on fresh human milk use in preterm infants searched the MEDLINE database and Cochrane Library up to June 2017 for papers published in English or French. They specifically analysed 282 papers providing information on prospective, retrospective and clinical studies and examined guidelines from various countries. RESULTS: The review concluded that fresh mother's own milk should be favoured in accordance with the latest recommendations. However, it must be carried out under stringent conditions so that the expected benefits are not offset by risks related to different practices. The working group has summarised the best conditions for feeding preterm infants with human milk, balancing high nutritional and immunological quality with adequate virological and bacteriological safety. Professionals must provide parents with the necessary conditions to establish breastfeeding, together with specific and strong support. CONCLUSION: Based on their review, the working group has made specific recommendations for using fresh mother's own milk under careful conditions, so that the expected benefits are not offset by risks related to practices.

[An update on lactation physiology and breastfeeding]. / Actualisation des connaissances concernant la physiologie de l'allaitement.

Even though breastfeeding rates have increased in France, a sharp decline occurs rapidly in the first month. Lack of professional support is often held responsible, since many problems could be avoided if mothers were given adequate support. Continuing research into the physiology of breastfeeding shows a wide range of interindividual variations in anatomy, physiology, and normal breastfeeding patterns. An understanding of the physiology of lactation contributes to providing breastfeeding mothers with appropriate support and enabling them to have a successful breastfeeding experience. It allows health professionals to help mothers resolve their difficulties with an evidence-based guidance.

[Breastfeeding in a population of preterm infants: a prospective study in a university-affiliated hospital]. / Allaitement maternel du nouveau-né prématuré : évaluation prospective dans une maternité universitaire.

AIMS: To evaluate mothers' breastfeeding intention at birth and the breastfeeding rate at hospital discharge and at 3 months of life in a population of preterm infants. To study the relation between gestational age and the breastfeeding rate at birth. To analyze sociodemographic and neonatal factors that could influence breastfeeding rate. METHODS: We present a prospective study concerning preterm infants born between November 1st 2006 and April 20th 2007 at Brest University Hospital. Exclusion criteria were: death during hospitalization and neurological or digestive diseases not allowing enteral feeding. The following data were extracted from medical charts: birth weight, gestational age, medical care in the neonatal period, delivery circumstances, and feeding mode at hospital discharge. Mothers were asked their sociodemographic status and their intention to breastfeed. Parents were contacted 3 months later to determine the feeding mode at that time. Risk factors were studied for single births through univariate and multivariate analysis. RESULTS: We recruited 149 mother-infant dyads. There were 9 lost to follow-up at 3 months. Breastfeeding rates were: 69.13% (range: 61.7-76.5) at birth, 57.82% (range: 49.8-65.8) at hospital discharge, and 33.57% (range: 25.9-41.7) at 3 months. There was an inverse relation between breastfeeding rate and gestational age: OR=0.07 (0; 0.50). Other factors significantly associated with a high breastfeeding rate were: mother's high level of education: OR=3.19 (1.39; 7.33) and low birth weight: OR=0.20 (0.08; 0.53). CONCLUSION: Our breastfeeding rates are lower than recommended by WHO. Mothers of late preterm infants or with a low socioeconomic status should benefit from supportive care.

[Pilot study of early breastfeeding difficulties of term newborns: incidence and risk factors]. / Etude pilote des difficultés de mise en place de l'allaitement maternel des nouveau-nés à terme, en maternité: incidence et facteurs de risque.

OBJECTIVES: To identify the incidence and risk factors of breastfeeding difficulties in maternity using 3 indicators: excess neonatal weight loss in maternity (EWL>or=10%), delayed onset of lactation (DOL>or=72 h) and suboptimal infant breastfeeding behaviour (SIBB=IBFAT score60 ml (OR=2.36). CONCLUSION: Difficulties in the breastfeeding initiation are not uncommon. Influencing factors are not always modifiable. Breastfeeding couples considered at risk should be recognized and should benefit from a special lactation guidance in maternity and from a post-discharge follow-up.

[Pilot epidemiologic study of transmission of cytomegalovirus from mother to preterm infant by breastfeeding]. / Transmission du cytomégalovirus par le lait maternel cru aux enfants prématurés: étude épidémiologique pilote.

UNLABELLED: Transmission of cytomegalovirus (CMV) infection from mothers to preterm infants during breastfeeding may be symptomatic and long term consequences are unknown. This study evaluated the kinetics of CMV load in breastmilk and the rate of postnatal CMV transmission via breastmilk from mothers to their preterm infants. METHODS: Prospective study of mother-child pairs after preterm delivery before 33 weeks. Exclusion of donor breast milk and of CMV-seropositive blood products. Material used was maternal CMV serostatus, ear swab of the infant at birth, weekly screened breast milk and children's urine by rapid viral culture. RESULTS: During a 5-month period 28 mother-infant pairs with 34 preterm infants were studied. Eighteen women (64.3%) were CMV-seronegative at birth; breastmilk samples and the infants' urine remained CMV-negative. Eight of the 10 seropositive mothers, who had 11 preterm infants, excreted CMV into breast milk (80%). CMV excretion into breast milk was detected during the first week after delivery in 66% cases and was at its peaked between 3 to 5 weeks after delivery. Out of the 7 CMV-exposed infants, CMV transmission was confirmed in only one asymptomatic case. Total quantity of breast milk intake did not seem discriminative for CMV transmission. CONCLUSION: In CMV-seropositive mothers of preterm infants a high incidence of CMV excretion into breast milk was detected. Despite this high rate, symptomatic infection did not occur. However, potential risk and severity of infection may be difficult to establish. Because breastfeeding is beneficial, new procedures for gentle virus inactivation of seropositive breast milk should be assessed.

[Breastfeeding and drugs]. / Allaitement maternel et médicaments.

Breastfeeding offers several advantages for the mother and infant. Taking drugs while breastfeeding however creates a dilemma for practitioners and often leads to a contraindication or interruption of breastfeeding. There are however very few drugs which present clinically significant risk for the breastfed child. When the mother has to take drugs, the decision to initiate or continue breastfeeding or not must be made with special care after evaluating the individual benefit/risk ratio resulting from breastfeeding and drug exposure. Evidence-based medicine is the key. The purpose of the present review is 1) to present the epidemiological data available concerning undesirable effects in infants breastfed by mothers taking drugs and on the attitude of prescribers and patients in the event of exposure to drugs while breastfeeding; 2) to analyze the pharmacokinetic data to determine the appropriate management approach in particular clinical situations; 3) to present data concerning certain drugs and sources of information useful for further study.

[Neonatal exchange transfusion with irradiated whole blood. Preliminary results]. / L'exsanguino-transfusion néonatale avec sang total irradié. Résultats préliminaires.

Some clinical manifestations following exchange transfusion (ET) could result from graft versus host disease secondary to the introduction of viable foreign T lymphocytes: skin rash, fever, acute and sometimes bloody diarrhea or enterocolitis. Between February 1985 and January 1989 the blood used for 31 ET was irradiated at 40 grays. We compared the manifestations occurring during the days following ET to those occurring after 44 previous ET with non irradiated blood during the period January 1981 to January 1985. From 1981 to 1985, 13 of 44 infants developed problems within 3 days following ET: an erythematous macular skin rash in 4; gastrointestinal manifestations (diarrhea, vomiting and rectal bleeding, necrotizing enterocolitis) in 7; both skin lesions and a gastrointestinal problem in 2. Since 1985, 27 infants had no problems whereas only 4 developed gastrointestinal or cutaneous manifestations: NEC in a preterm infant, abdominal distension with rectal bleeding, fever and petechial rash in 2 infected infants. These data show a dramatic decrease of complications since the irradiation of blood products has been started: 30% with non irradiated, 13% with irradiated blood.