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.

Thai novice nurses' lived experiences and perspectives of breastfeeding and human milk in the Neonatal Intensive Care Unit (NICU).

BACKGROUND: Breastfeeding and human milk have well-documented health benefits for newborn infants, particularly those who are sick. However, breastfeeding rates and human milk feeding among infants in neonatal intensive units (NICU) in Thailand are still low; thus, breastfeeding promotion and support are required for Thai mothers of premature infants. Newly graduated nurses can play a critical role within the healthcare support system and can have a significant impact on improving breastfeeding practices in the NICU. The objective of this study was to investigate the lived experiences and perspectives of Thai novice nurses on supporting breastfeeding and human milk feeding in the NICU. METHODS: The study was conducted between March 2021 and May 2022 at three medical centers in the central region of Thailand. This study employed a descriptive phenomenological approach to explore Thai novice nurses' experiences and perspectives on breastfeeding. Purposive sampling was used to invite Thai novice nurses who have work experience in providing breastfeeding support to NICU mothers and their infants to participate in online interviews using a video conference platform (Zoom). Semi-structured questions were used to interview study participants in their native language. Data were analyzed using Colaizzi's method of data analysis to identify emergent themes. Member checks, peer debriefing, and self-reflection were applied to ensure the validity and trustworthiness of the study results. Back-translation was also used as a quality and accuracy assurance. RESULTS: A total of thirteen novice nurses agreed to participate in the study. All were female, and their ages ranged from 21 to 24 years old at the time of the interview. The researchers identified five major themes related to the overall study objectives and research questions. They are: positive attitude toward breastfeeding and human milk, facing breastfeeding challenges at work, self-confidence rooted in experience, professional skill needs, and requiring further support. CONCLUSIONS: Our results suggest that breastfeeding education plays a vital role in encouraging new nurses to provide breastfeeding support to mothers of preterm infants. Establishing breastfeeding support training and innovative learning strategies can be crucial in developing appropriate breastfeeding practice guidelines and policies to support Thai breastfeeding mothers in the NICU.

A Systemic Review of the Difference Between Diets for Preterm Infants Containing Raw Mother's Own Milk and Frozen or Pasteurized Mother's Own Milk.

BACKGROUND: Raw, never stored or pasteurized mother's own milk (MOM) is not always available to feed preterm infants; however, storage and pasteurization of MOM diminishes some bioactive components. It can be difficult to feed raw MOM to preterm infants due to transportation and storage of small volumes that might be pumped away from the infant, and a concern that they might harbor bacteria. However, the higher availability of bioactive components in raw MOM may provide benefits to preterm infants compared to frozen or pasteurized MOM. RESEARCH AIM: To systematically review and summarize the results of studies on feeding raw MOM versus frozen or pasteurized MOM to preterm infants born at less than 37 weeks of gestation. METHODS: Four databases were searched (Cochrane, Embase, Ovid MEDLINE, and Web of Science) for this systematic review. Of 542 studies identified, nine met inclusion criteria and were critically evaluated using the quality assessment tool for quantitative studies by the Effective Public Health Practice Project. Studies were organized using the Breastfeeding Challenges Facing Preterm Mother-Infant Dyads theoretical framework. RESULTS: Included studies evaluated the outcomes of preterm infants fed raw versus pasteurized MOM (n = 7, 77.8%) or raw versus frozen MOM (n = 2, 22.2%). Researchers found that raw MOM did not increase infant infections and may have improved health and growth outcomes for study participants. CONCLUSION: There is laboratory evidence supporting the safety and efficacy of the use of raw MOM for preterm infants. A raw MOM diet is recommended for preterm infants by professional organizations. Despite this, it may not be universally prioritized and could require purposeful implementation by each institution. Further research is needed to pursue the potential benefits of a raw MOM diet for preterm infants.

Community Practices, Published Guidelines, and Evidence Base Surrounding Breast Milk Handling and Storage: A Qualitative Study.

Background: Expressed breast milk (EBM) is the best alternative to direct breastfeeding. However, expressing breast milk requires good milk handling and storage practices to preserve EBM safety and integrity. Mothers require handling and storage guidance, and many seek this from the internet and online support groups. Aim: This study aimed at exploring EBM handling and storage practices within an online exclusively expressing community and comparing these with both internet resources and evidence-based research. Methods: A naturalistic observational design was used. Content analysis was undertaken on 10,000 posts from an Australian Facebook peer-support community for women who exclusively express breast milk. Women's questions, reported practices, and advice for EBM handling and storage were analyzed thematically and compared with both guidelines and evidence-based research. Findings: There were 460 posts on EBM handling and storage. Three key themes emerged: "How should I store my EBM?," "How long can I store my EBM?," and "How do I use my EBM?" The greatest consistency and agreement between recommendations and community practices were found for storage methods, whereas the least was found for storage times. EBM handling and storage practices were influenced by factors such as EBM value, convenience, and cost, leading to occasional deviations from consistent practice recommendations. Conclusion: To facilitate safe EBM handling and continuation of expression, guidelines should be updated so they are consistent, align with current evidence, and cater to mothers' cost, convenience, and milk wastage concerns. Health care providers can partner with women to evaluate online information to empower mothers in their decision making.

The investigation of serum phenylalanine levels based on infant feeding method: a cross-sectional study of children less than two years old with phenylketonuria (PKU).

BACKGROUND: Clinical advice may suggest discontinuing breastfeeding after the diagnosis of phenylketonuria in infants as the only effective way to monitor the newborn's intake and accurate measurement of phenylalanine (Phe). This study aims to investigate the prevalence and duration of breastfeeding, as well as its effect on serum Phe levels in infants with phenylketonuria at Education and Therapy Medical Center, Be'sat Hospital, Iran. METHODS: We conducted a cross-sectional study of 34 children under two years old diagnosed with phenylketonuria between September 2018 and December 2022. Infants were categorized as breastfed and non-breastfed (bottle-fed) based on their feeding method after diagnosis. Data on age at diagnosis, medical records, demographic information, and anthropometric indices were collected, and infants with incomplete data or mixed feeding (formula + breast milk) were excluded from the study. RESULTS: Of 94 infants managed in our hospital, 34 had complete medical records. Among the all patients 13 (38%) continued to be breastfed combined with phenylalanine-free amino acid-based protein substitute, while 21 (62%) were did not receive breast milk. The mean duration of breastfeeding was 2.57 ± 0.59 (1-3) months. The mean age at diagnosis was 22.6 ± 18.4 days. Phenylalanine concentrations at diagnosis were mean 10, SD 5.44; range 4-24 mg/dL [0.22-1.33 µmol/L] in the breastfed group and mean 14.3, SD 10.2; range 5-37 mg/dL [0.27-2.05 µmol/L] in the non-breastfed group.Non-breastfed infants had lower serum Phe levels than breastfed infants: mean 3.76, SD 2.10; range 1-7 mg/dL [0.05-0.38 µmol/L] and mean 4.89, SD 3.68; range 2-19 mg/dL [0.11-1.05 µmol/L], respectively, although not statistically significant [(t (34) = 118.0, P = 0.51]. Also we found no significant associations in body measurements for weight, height, and head circumference at birth and final assessment. CONCLUSIONS: In conclusion, during treatment, there were no statistically significant associations between breastfeeding and serum Phe levels with growth in children with phenylketonuria.

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.

Premarket Notifications and Patents for Breast Pumps Before and After the ACA.

This study investigates whether ACA policies to increase access to breast pumps and lactation care were associated with innovation in the market for breast pumps.

Milk Biomarkers of Secretory Activation in Breast Pump-Dependent Mothers of Preterm Infants: An Integrative Review.

Background: Lack of mother's own milk (MOM) at discharge from the neonatal intensive care unit (NICU) is a global problem and is often attributable to inadequate MOM volume. Evidence suggests that the origins of this problem are during the first 14 days postpartum, a time period that includes secretory activation (SA; lactogenesis II, milk coming in). Objectives: To describe and summarize evidence regarding use of MOM biomarkers (MBMs) as a measure of SA in pump-dependent mothers of preterm infants in the NICU and to identify knowledge gaps requiring further investigation. Methods: An integrative review was conducted using Whittemore and Knafl methodology incorporating the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. A search using electronic databases MEDLINE (through PubMed) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) and reference lists of included articles was conducted. Results: Of the 40 articles retrieved, 6 met the criteria for inclusion. Results revealed the following five findings: (1) Achievement of SA defined by MBMs is delayed and/or impaired in mothers of preterm infants. (2) MBMs are associated with pumped MOM volume. (3) Achievement of SA defined by MBMs is associated with pumping frequency. (4) Delayed and/or impaired achievement of SA defined by MBMs may be exacerbated by maternal comorbidities. (5) There is a lack of consensus as to which MBM(s) and analysis techniques should be used in research and practice. Conclusions: MBMs hold tremendous potential to document and monitor achievement of SA in mothers of preterm infants, with multiple implications for research and clinical practice.

Development of a Protocol for the Direct Breastfeeding of Premature Infants in Neonatal Intensive Care Units.

PURPOSE: This study aimed to develop a direct breastfeeding protocol for premature infants admitted to neonatal intensive care units (NICUs) and investigate its efficacy. BACKGROUND: Direct breastfeeding increases the amount and duration of breastfeeding. However, NICUs have low direct feeding rates owing to medical staff anxiety, lack of knowledge and experience, and fear of overwork. Accordingly, this study developed a protocol for direct breastfeeding in the NICU and evaluated its effect. METHODS: The protocol was developed through a literature review, expert validation, and preliminary investigation. Its application effects were identified using a nonexperimental, evidence-based research design targeting premature infants, their mothers, and NICU nurses. RESULTS: The protocol comprised 5 areas and 23 items. Application of the protocol resulted in continuous weight gain of the infants and increased self-efficacy in the mothers' direct breastfeeding ( t = 3.219, P = .004). Significant increases were noted in NICU nurses' direct breastfeeding activities ( t = 3.93, P < .001), breastfeeding rates in the NICU ( P = .037), and direct breastfeeding rates ( P = .007). CONCLUSIONS: Results underscore the value of an evidence-based protocol for improving breastfeeding rates in premature infants. This study highlights the need for continuous nursing education on protocol applications and human resource support.

Attributes That Increase Vulnerabilities to Reduced Human Milk Feeding Outcomes Among Babies With Cleft Lip and Palate in the Neonatal Intensive Care Unit.

OBJECTIVE: The purpose of this study was to identify infant and maternal factors associated with reduced human milk feeding among infants in a neonatal intensive care unit (NICU) with cleft lip with or without cleft palate (CL ± P). METHOD: Data collected on mothers and infants admitted to the NICU with CL ± P from the 2018 National Vital Statistics System were used for this study. Chi-square tests of independence and independent-samples t tests were used to compare categorical variables and continuous variables, respectively, among two groups of infants admitted to the NICU with CL ± P-those who did and did not receive human milk feeding at discharge. RESULTS: The sample included 660 infants admitted to the NICU with CL ± P, of which 353 received human milk at discharge. Significant differences were found between the two groups for marital status, mother's education, maternal smoking record, total number of prenatal visits, multiparity record, gestational age, birth weight, and use of assisted ventilation. CONCLUSIONS: Results indicated that, as a function of human milk feeding at discharge, mothers and their infants admitted to the NICU with CL ± P exhibited differences across infant and maternal factors. These findings further our understanding of this sample of mothers and infants with CL ± P while potentially identifying determinants to human milk feeding. This study provides insight into infant and maternal characteristics that may be associated with barriers to human milk feeding.

Effect of Nurse Support in the Immediate Postpartum Period on Mothers' Breastfeeding Self-Efficacy Levels in Turkey: A Quasi-Experimental Study.

OBJECTIVES: This study aimed to determine the effect of nurse-based breastfeeding support during the immediate postpartum period on mothers' breastfeeding self-efficacy levels. METHODS: A quasi-experimental study was conducted with 256 mothers in the immediate postpartum period (128 in the intervention group who received nurse-based breastfeeding support and routine care and 128 in the control group who received routine care) during February-June 2018. Data were collected using the Mother-Infant Data Sheet, the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and the Nurse-Parent Support Tool (NPST). RESULTS: BSES-SF and NPST mean scores of mothers in the intervention group were higher than those of mothers in the control group (p < 0.01). While the association between breastfeeding self-efficacy and nurse support was low in the control group (0.271), it was rather high in the intervention group (0.693) (p < 0.05). It was found that nurse support explained 48% of the variance in breastfeeding self-efficacy in the intervention group, but only 7.3% of the variance in breastfeeding self-efficacy in the control group. CONCLUSIONS FOR PRACTICE: The results of the study indicate that nurse support for mothers in the immediate postpartum period based on breastfeeding training has a positive impact on breastfeeding self-efficacy.

Characterization of Three Cases of Primary Hypogalactia in Jalisco, Mexico.

INTRODUCTION: Human lactation should be taken into account as an important issue for the international agenda. Despite advances in lactation information and knowledge, insufficient milk production is still a concern for mothers and health practitioners, including International Board Certified Lactation Consultants and others. Primary hypogalactia, or insufficient milk production is uncommon, but should be considered when there is poor weight gain and decreased urine output in infants despite good latch-on and suckling, or anatomic differences in the physical exam of the lactating breast. MAIN ISSUE: This case series presents three cases illustrating insufficient milk production resulting in infants who experienced significant dehydration and poor weight gain. MANAGEMENT: Primary hypoplasia was diagnosed by means of a thorough interview and physical examination that entailed a consultation with a physician who was also an International Board Certified Lactation Consultant. CONCLUSION: Awareness of an infant's feeding needs and proper evaluation of a child's health status is paramount if health care providers are to identify the important factors contributing to breastfeeding problems. In some instances, breastfeeding goals cannot be achieved, and then the provider's role becomes support in coming to terms with persistent insufficient milk production, and coordinating appropriate supplementation to meet each baby's nutritional needs.

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.

Successes of a Focused Mothers' Own Milk (MOM) Program in Counteracting Unintended Effects of a Donor Milk Program on MOM Rates at Discharge.

Background: Avoidance of early formula feeding (EFF) and advancement of mother's own milk (MOM) in very low birth weight (VLBW) infants are important health influencers to decrease serious morbidities. Objective: To present the challenges and feeding strategy successes implemented to counteract a decline in MOM at discharge after initiation of donor milk (DM) to avoid EFF in racially and ethnically diverse VLBW infants. Patients and Methods: Retrospective review of prospectively tracked inborn surviving VLBW infants and their mothers admitted to neonatal intensive care unit from 2010 to 2020 during three feeding strategy implementations baby friendly (BF), DM program, and MOM bundle. Analysis included type of feeding (MOM, DM, or formula) and maternal with descriptive and comparative statistical analysis as indicated. Results: Analysis included 616 VLBW infants. Initiation of BF program resulted in 58.5% of infants discharged on MOM with 41.5% exposed to EFF. Initiation of the DM program resulted in a decline in EFF to 5% and decline in MOM at discharge to 26%. MOM bundle strategy resulted in an increase in MOM at discharge to 41% with sustained EFF exposure 0%. MOM at discharge varied among maternal racial and ethnic backgrounds in all epochs. Early DM use was not different among mothers by race or ethnicity with DM by African American (AA) mothers 89% > White mothers 83% > Other/Hispanic mothers 75%. MOM at discharge was lowest for AA mothers 33% < Hispanic mothers 40% < White mothers 55% < Asian/Other mothers at 60%. Conclusion: Changes in VLBW feeding strategies to avoid EFF utilizing DM can be successful among diverse maternal racial and ethnic populations. Nursing and maternal education coupled with early lactation support and attention to maternal individual long-term feeding plans were critical to improve MOM at discharge among mothers of all racial-ethnic backgrounds for successful attainment of MOM utilization in term corrected VLBW infants at discharge.

Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023).

Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.

An Integrative Review of Breastfeeding and Homelessness.

OBJECTIVE: To synthesize the current literature surrounding breastfeeding and homelessness, and to determine the impact of disparities in this population. DATA SOURCES: An integrative search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and using the search terms "breastfeeding" and "homelessness" throughout electronic databases PubMed, CINAHL, and Scopus. STUDY SELECTION: Inclusion criteria were articles published in English from January 2007 to September 2022. Exclusion criteria were studies published more than 15 years ago, studies published in a language other than English, opinion articles, and irrelevance to breastfeeding and homelessness. The initial search yielded 100 results. After removing duplicates and articles because of irrelevance, the final number of articles for this synthesis was seven. DATA EXTRACTION: Data were extracted from each article, critically appraised using Joanna Briggs Institute criteria, and summarized in a table of evidence. DATA SYNTHESIS: Three common themes were identified: Decreased Breastfeeding Initiation Rates and Duration in the Homeless Population, Impact of Community and Clinical Support, and Breastfeeding Practices Influenced by Individual Factors. CONCLUSION: Providers and nurses should refer patients to the Special Supplemental Nutrition Program for Women, Infants, and Children; use techniques to instill a parent's intent to breastfeed; provide early breastfeeding education; promote breastfeeding initiation within 1 hour of birth; and encourage peer support groups. Although current researchers provide insight into potential barriers and interventions, more research is needed to gain additional data on how to overcome identified barriers to breastfeeding.

Comparative Assessment of Exclusive Breastfeeding Rates From 24-Hour Recall and Since Birth Methods in Southwestern Pennsylvania Using Ecological Momentary Assessment.

BACKGROUND: Accurate measurement of exclusive breastfeeding is important in maternal and child health research. Exclusive breastfeeding is often measured using the 24-hour recall or the since birth method for the first 6 months. These methods can produce different estimates, introducing problems in interpreting breastfeeding behavior and making accurate comparisons across settings or countries. RESEARCH AIM: Our aim was to compare the exclusive breastfeeding rates between the 24-hour recall and since birth methods among a diverse cohort of birthing people using the ecological momentary assessments method. In addition, we compared the exclusive breastfeeding rates between the two methods across race and other maternal characteristics. METHODS: This study is a secondary analysis using data from the Postpartum Mothers Mobile Study (PMOMS), a prospective longitudinal study which recruited participants during pregnancy and followed them for 12 months after delivery. Participants completed surveys in real-time via ecological momentary assessment. Individual exclusive breastfeeding rates from months 1-6 were computed using 24-hour recall and since birth methods for 284 participants. We calculated the percentage point difference between the two methods across child age and maternal characteristics. We used a two-sample test of proportions to determine if the differences observed in the proportions were significant. RESULTS: Exclusive breastfeeding rates from the 24-hour recall were higher than the since birth rates across all ages and maternal characteristics. The difference between the two methods at 3 months was 25.7 percentage points and at 6 months was a 17.2 percentage points. Irrespective of the method used to measure exclusive breastfeeding, White participants had higher exclusive breastfeeding rates than Black participants. CONCLUSION: The 24-hour recall and the since birth methods of assessing exclusive breastfeeding provided substantially different estimates. These findings highlight the importance of specificity in measuring and reporting exclusive breastfeeding.

Trend and Predictors of Breastmilk Feeding among Very-Low-Birth-Weight Infants in NICU and at Discharge.

Mothers' own milk (MOM) for premature babies is considered a life-saving drug for its proven protective action against the complications of prematurity and for effects on outcome in the short and long term, especially neurological ones. We studied the use of MOM for infants weighing <1500 g for a period of 5 years, evaluating the trend over time and the impact of some variables on human milk feeding performance. Statistical comparisons concerned the rate of feeding with breast milk during a stay in an NICU and at discharge with respect to two types of variables: (1) maternal and neonatal characteristics (gestational age, birth weight, type of pregnancy (whether single or twin), maternal age) and (2) feeding characteristics (time of the start of minimal enteral feeding and availability of MOM, days until the achievement of full enteral feeding). Group comparisons were performed using ANOVA or t-test for continuous variables and Pearson chi-squared test or Fisher exact test for categorical variables. We observed an increase, between 2017 and 2021, in MOM use (p = 0.003). The availability of the own mothers' milk occurred, on average, on the fourth day of life and improved over the years. The start of minimal enteral feeding (MEF) with human milk averaged 1.78 days, and 54.3% of VLBWs received MEF with donor milk on the first day of life. The average percentage of feeding with the mothers' milk at discharge was 47.6%, with 36.1% of exclusive MOM and an increase from 45.8% in 2017 (33.3% exclusive) to 58.82% (41.18% exclusive) in 2021. The mean average daily growth of the weight improved (p < 0.001) during this period, and there was no statistical difference between infants fed with maternal milk and those fed with bank milk. Older maternal age, early-start feeding with maternal milk and low gestational age had a statistically significant impact on feeding with MOM at discharge.

Breastfeeding Practices and Postpartum Depression in Mexican Women during the COVID-19 Pandemic: A Cross-Sectional Study.

Background: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant's first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 586 postpartum women who completed an online survey 4-8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 0.001, respectively). Conclusions: Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.

Development and evaluation of a kangaroo mother care implementation model in South Ethiopia.

AIM: To develop a model for increasing the coverage of kangaroo mother care (KMC), which involved ≥8 h of skin-to-skin contact per day and exclusive breastfeeding, for small babies with birth weight < 2000 g in South Ethiopia. METHODS: A mixed methods study was conducted between June 2017 and January 2019 at four hospitals and their catchment areas. Iterative cycles of implementation, program learning and evaluation were used to optimise KMC implementation models. The study explored the community-facility continuum of care and assessed the proportion of neonates with a birth weight less than 2000 g receiving effective KMC. RESULTS: Three KMC implementation models were tested with Model 2 being the final version. This model included enhanced identification of home births, improved referral linkages, immediate skin-to-skin care initiation in facilities and early contact after discharge. These improvements resulted in 86% coverage of effective facility-based KMC initiation for eligible babies. The coverage was 81.5% at discharge and 57.5% 7 days after discharge. The mean age of babies at KMC initiation was 8.2 days (SD = 5.7). CONCLUSION: The study found that the KMC implementation model was feasible and can lead to substantial population-level KMC coverage for small babies.