Instruções em bulas destinadas ao uso de medicamentos para dispepsia e constipação durante a lactação / Instructions in package inserts intended for the use of medicines for dyspepsia and constipation during lactation / Instrucciones en prospectos destinados al uso de medicamentos para la dispepsia y el estreñimiento durante la lactancia

Introdução: A segurança e eficácia do uso de medicamentos durante a lactação são preocupações para mães e profissionais de saúde. Esta pesquisa analisa as orientações das bulas de medicamentos comumente prescritos para dispepsia e constipação, que visa fornecer informações essenciais para orientar as decisões terapêuticas durante esse período crucial da maternidade. Objetivos: Analisar as informações das bulas sobre contraindicações de medicamentos para dispepsia e constipação durante a amamentação, verificando se estão de acordo com as evidências científicas. Métodos: Medicamentos para dispepsia e constipação foram selecionados de acordo com a classificação da Anatomical Therapeutic Chemical (ATC) e o registro ativo no Brasil. A presença de contraindicações para o uso de medicamentos nas bulas do profissional de saúde e do paciente foi comparada com as informações contidas no manual técnico do Ministério da Saúde, Medicamentos e Leite Materno, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria e Reprotox. Resultados: Nenhuma informação sobre o uso durante a amamentação foi encontrada em 20,0 e 24,3% das bulas para dispepsia e constipação, respectivamente. A concordância entre as bulas dos medicamentos para dispepsia e as fontes consultadas foi baixa (27,2% das bulas contraindicavam o medicamento na lactação, enquanto nas fontes o percentual de contraindicação variou de 0 a 8,3%). Com relação a medicamentos para constipação, 26,3% das bulas os contraindicavam, enquanto nas fontes o percentual variou de 0 a 4,8%. Conclusões: O estudo mostrou que pelo menos duas em cada dez bulas para dispepsia e constipação não fornecem informações adequadas sobre o uso desses medicamentos em lactentes, e também que houve baixa concordância entre o texto das bulas e as fontes de referência quanto à compatibilidade do medicamento com a amamentação.

Introduction: The safety and effectiveness of medication use during lactation are concerns for mothers and healthcare professionals. This research analyzes the instructions on the leaflets of medications commonly prescribed for dyspepsia and constipation, which aims to provide essential information to guide therapeutic decisions during this crucial period of motherhood. Objectives: To analyze the information in package inserts about contraindications of drugs for dyspepsia and constipation during breastfeeding, verifying whether these are consistent with scientific evidence. Methods: Drugs for dyspepsia and constipation were selected according to the Anatomical Therapeutic Chemical (ATC) classification and active registry in Brazil. The presence of contraindications for the use of medications in the health professional's and patient's package inserts was compared with the information in the technical manual of the Ministry of Health, Medications and Mothers' Milk, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria and Reprotox. Results: No information about use during breastfeeding was found in 20.0 and 24.3% of leaflets for dyspepsia and constipation, respectively. The agreement between the leaflets of medications for dyspepsia and the sources consulted was low (27.2% of the leaflets contraindicated the medication during lactation, while in the sources the percentage of contraindication varied from 0 to 8.3%). In relation to medicines for constipation, 26.3% of the leaflets contraindicated them, while in the sources the percentage ranged from 0 to 4.8%. Conclusions: The study pointed out that at least two out of every ten package inserts for dyspepsia and constipation do not provide adequate information on the use of these drugs in infants, and also shows low concordance between the text of the package inserts and the reference sources regarding compatibility of the drug with breastfeeding.

Introducción: La seguridad y eficacia del uso de medicamentos durante la lactancia son preocupaciones para las madres y los profesionales de la salud. Esta investigación analiza las instrucciones contenidas en los prospectos de medicamentos comúnmente recetados para la dispepsia y el estreñimiento, con el objetivo de proporcionar información esencial para guiar las decisiones terapéuticas durante este período crucial de la maternidad. Objetivos: Analizar la información contenida en los prospectos sobre las contraindicaciones de los medicamentos para la dispepsia y el estreñimiento durante la lactancia, verificando si estas son consistentes con la evidencia científica. Métodos: Se seleccionaron medicamentos para la dispepsia y el estreñimiento de acuerdo con la clasificación ATC y el registro activo en Brasil. Se comparó la presencia de contraindicaciones para el uso de medicamentos en los prospectos del profesional de la salud y del paciente con la información del manual técnico del Ministerio de Salud, Medicamentos y Leche Materna, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria y Reprotox. Resultados: No se encontró información sobre su uso durante la lactancia en el 20% y el 24,3% de los prospectos para dispepsia y estreñimiento, respectivamente. La concordancia entre los prospectos de los medicamentos para la dispepsia y las fuentes consultadas fue baja (el 27,2% de los prospectos contraindicaba el medicamento durante la lactancia, mientras que en las fuentes el porcentaje de contraindicación variaba del 0% al 8,3%). Con relación a los medicamentos para el estreñimiento, el 26,3% de los prospectos los contraindicaba, mientras que en las fuentes el porcentaje osciló entre el 0% y el 4,8%. Conclusiones: El estudio señaló que al menos dos de cada diez prospectos para dispepsia y estreñimiento no brindan información adecuada sobre el uso de estos medicamentos en lactantes, y también muestra la baja concordancia entre el texto de los prospectos y la referencia. fuentes sobre la compatibilidad del fármaco con la lactancia.

O efeito conjunto de gemelaridade e prematuridade no aleitamento materno exclusivo na alta hospitalar / The joint effect of twinning and prematurity on exclusive breastfeeding at hospital discharge / El efecto conjunto de la gemelaridad y la prematuridad en la lactancia materna exclusiva al momento del alta hospitalaria

Objetivo: estimar a prevalência de Aleitamento Materno Exclusivo (AME) entre gemelares pré-termos e investigar o efeito de nascer gemelar e pré-termo no AME na alta hospitalar. Método: coorte prospectiva de recém-nascidos em uma instituição localizada no Rio de Janeiro, no período de 13 de março de 2017 a 12 de outubro de 2018. Dados coletados em questionário e prontuário médico. Foi utilizado DAG para construção do modelo conceitual, análise exploratória dos dados e regressão logística múltipla. Resultados: a prevalência de AME na alta hospitalar de gemelares pré-termos foi de 47,8%. Pré-termos apresentaram maior chance de não estarem em AME na alta hospitalar. Não gemelares apresentaram maior chance de não estarem em AME na alta hospitalar. Conclusão: pouco mais da metade dos gemelares pré-termo não estavam em AME na alta hospitalar. Prematuros tiveram maior chance de não estarem em AME. Não gemelares pré-termo apresentaram maior chance de não estarem em AME.

Objective: to estimate the prevalence of Exclusive Breastfeeding (EBF) in preterm twins and to investigate the effect of twin and preterm birth on EBF at hospital discharge. Method: prospective cohort of newborns in an institution located in Rio de Janeiro, from March 13, 2017, to October 12, 2018. Data collected through a questionnaire and medical records. A DAG was used to build the conceptual model, exploratory data analysis and multiple logistic regression. Results: prevalence of EBF at hospital discharge of preterm twins of 47.8%. Preterm infants were more likely to not be on EBF at hospital discharge. Non-twins were more likely to not be on EBF at hospital discharge. Conclusion: just over half of preterm twins were not on EBF at hospital discharge. Preterm infants had a greater chance of not being on EBF. Preterm non-twins were more likely to not be on EBF.

Objetivo: estimar la prevalencia de Lactancia Materna Exclusiva (LME) entre gemelos prematuros y investigar el efecto de nacer gemelo y prematuro en la LME al momento del alta hospitalaria. Método: cohorte prospectiva de recién nacidos en una institución ubicada en Rio de Janeiro, entre 13//marzo/2017 y 12/octubre/2018. Los datos se recolectaron mediante cuestionario y expediente médico. Se utilizó DAG para la construcción del modelo conceptual, análisis exploratorio de los datos y regresión logística múltiple. Resultados: la prevalencia de LME en el alta hospitalaria de gemelos prematuros fue del 47,8%. Los prematuros tuvieron mayor probabilidad de no estar en LME en el alta hospitalaria. Los no gemelares tuvieron mayor probabilidad de no estar en LME en el alta hospitalaria. Conclusión: poco más de la mitad de los gemelos prematuros no estaban en LME en el alta hospitalaria. Los prematuros tuvieron mayor probabilidad de no estar en LME. Los no gemelos prematuros presentaron mayor probabilidad de no estar en LME.

Continued Breastfeeding in a Birth Cohort in the Western Amazon of Brazil: Risk of Interruption and Associated Factors.

BACKGROUND: Continued breastfeeding reduces infant mortality and provides nutritional, immunological, and developmental benefits for the child. OBJECTIVES: A prospective cohort study conducted in 2015 followed 608 children who were breastfed between 6 and 24 months. The study assessed the risk of breastfeeding interruption at 12, 18, and 24 months, as well as the factors associated with this outcome, in a cohort of newborns in Rio Branco, using the life table method. METHODS: The factors associated with breastfeeding cessation and their 95% confidence intervals (CI95%) were analyzed using both crude and adjusted Cox proportional hazards regression in a hierarchical model. The risks of breastfeeding cessation at 12, 18, and 24 months were 19%, 65%, and 71%, respectively. RESULTS: Factors positively associated with the risk of breastfeeding cessation include the use of a pacifier before 6 weeks of age (HR = 1.62; CI: 95% 1.24-2.11) and the use of a bottle during the first year of life (HR = 1.41; CI: 95% 1.11-1.78). Maternal return to work after the birth of the baby (HR = 0.78; CI: 95% 0.62-0.97) was found to be negatively associated with the risk of breastfeeding interruption. CONCLUSIONS: Early pacifier use before 6 weeks and the introduction of a bottle in the first year affect continued breastfeeding. Maternal employment was associated with reduced risk of breastfeeding cessation, contrary to most studies.

Fenómeno de Raynaud en el pezón durante la lactancia: serie de casos / Fenómeno de Raynaud en el pezón durante la lactancia: serie de casos

El fenómeno de Raynaud consiste en la contracción excesiva de los vasos sanguíneos en respuesta a diversos estímulos y, si bien suele comprometer las extremidades, existen otras localizaciones menos frecuentemente afectadas. Este trabajo se enfoca en describir las características de una serie de mujeres con fenómeno de Raynaud en el pezón. Mediante revisión de historias clínicas y comunicación directa con las pacientes, se recopilaron y analizaron los datos de 12 mujeres con Raynaud del pezón entre 2016 y 2023. Se evaluaron variables como edad, síntomas, desencadenantes, tratamientos y duración de los síntomas. En esta serie de casos, el fenómeno de Raynaud del pezón en mujeres lactantes se manifestó con mayor frecuencia en primigestas alrededor del décimo día posparto; el dolor fue intenso, en la mayoría mejoró con tratamientos locales y/o farmacológicos, y no limitó la duración de la lactancia materna.

Raynaud's phenomenon consists of excessive contraction of the blood vessels in response to various stimuli; although it usually affects the extremities, other locations are less frequently involved. This study focused on describing the characteristics of a series of women with Raynaud's phenomenon of the nipple. Through medical record review and direct communication with patients, data from 12 women diagnosed with Raynaud's phenomenon of the nipple between 2016 and 2023 were collected and analyzed. The following variables were assessed: age, symptoms, triggering factors, treatment, and duration of symptoms. In this case series, Raynaud's phenomenon of the nipple in breastfeeding women was more common among primiparous women around 10 days after delivery; pain was severe and, in most cases, improved with local and/or drug treatment, and did not limit the duration of breastfeeding.

Addressing Infant and Young Child Feeding Recommendations From a Planetary Health Perspective.

Current international infant and young child (IYC) feeding recommendations consider nutrition and health but not environmental impacts. Only a handful of countries have dietary guidelines that provide quantitative recommendations for food groups of environmental concern. This study aimed to perform a narrative review of the environmental impacts of commercial milk formula compared with breastfeeding and to analyze the degree to which current country-specific IYC feeding recommendations are aligned with sustainable dietary targets. A mixed-methods review was conducted, including the following: 1) a narrative review of the environmental impact of commercial milk formula compared with breastfeeding and 2) a comparison of recommended intake of meats and dairy for children IYC based on country-specific dietary guidelines compared with the EAT-Lancet Commission dietary targets (ELCT) for children 24 mo or older and adults and if the ELCT should be adjusted for the energy needs of IYC. Formula feeding has a greater environmental impact (∼48% higher carbon footprint) than exclusive breastfeeding. Available country-specific dietary guidelines for meat and dairy products in children IYC are, in general, at or below the upper limits of the ELCT recommended ranges for older children and adults but are in most cases above the upper limit when adjusting for the energy needs of IYC. Exclusive breastfeeding should be protected and promoted not only as the healthier but also as the most sustainable alternative. Available complementary dietary feeding recommendations of nonprocessed meat and dairy fall below current ELCT for older children and adults. Given that IYC require a more nutrient-dense diet than older children and adults and considering the small quantities they consume, we recommend using the unadjusted ELCT as reference for IYC feeding while specific international consumption recommendations are developed for this age group.

Content validation of the nursing diagnosis "Insufficient breast milk production (00216)".

PURPOSE: To review and validate the elements of the nursing diagnosis (ND) "Insufficient breast milk production" (00216) based on the literature and expert consensus, and to construct operational definitions (ODs) for its defining characteristics (DCs). METHODS: It is a methodological study carried out in two phases. In the first phase, a scoping review was conducted, and in the second, a committee of experts reviewed the elements' content. Items with a Content Validity Index ≥0.8 were validated for relevance, clarity, and precision. Discussions were conducted until a consensus was reached on all items and criteria evaluated. The Ethics Committee approved the study. FINDINGS: The final scoping review sample consisted of 61 articles, and 19 experts evaluated the content of the ND. All DCs were revised. Three at-risk populations, three associated conditions, and one related factor were added. Three elements had their category changed, and an element was deleted. Experts also validated ODs developed for all DCs. CONCLUSION: "Insufficient breast milk production (00216)" was validated by experts. This study improved the ND through literature and expert consensus. New elements were added, and existing ones were revised. IMPLICATIONS FOR NURSING PRACTICE: This study improves this ND based on scientific evidence and clinical expertise and potentially improves nurses' diagnostic accuracy through ODs.

OBJETIVO: Revisar e validar os elementos do Diagnóstico de Enfermagem "Produção insuficiente de leite materno (00216)", com base na literatura e no consenso de especialistas, e construir definições operacionais para suas características definidoras. MÉTODO: Estudo metodológico realizado em duas fases. Na primeira fase foi realizada uma revisão da literatura e na segunda um comitê de especialistas revisou o conteúdo dos elementos. Os itens com Índice de Validade de Conteúdo ≥ 0,8 foram validados quanto à relevância, clareza e precisão. As discussões foram conduzidas até que se chegasse a um consenso sobre todos os itens e critérios avaliados. O estudo foi aprovado por Comitê de Ética em Pesquisa. RESULTADOS: A amostra final da revisão foi composta por 61 artigos e 19 especialistas avaliaram o conteúdo do diagnóstico de enfermagem. Todas as características definidoras foram revisadas. Foram acrescentadas três populações de risco, três condições associadas e um fator relacionado. Três elementos tiveram sua categoria alterada e um elemento foi excluído. Os especialistas também validaram as definições operacionais desenvolvidas para todas as características definidoras. CONCLUSÃO: "Produção insuficiente de leite materno (00216)" foi validado por especialistas. Este estudo melhorou o diagnóstico de enfermagem por meio da literatura e do consenso de especialistas. Novos elementos foram adicionados e os existentes foram revisados. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Este estudo melhora o diagnóstico de enfermagem estudado com base em evidências científicas e experiência clínica, assim como tem potencial para melhorar a precisão diagnóstica dos enfermeiros por meio do desenvolvimento de definições operacionais.

Factors Influencing Health Professionals' Decisions Regarding the Indication of Infant Formula: A Qualitative Exploration in Uruguay.

BACKGROUND: Health systems are fundamental to the promotion and protection of breastfeeding. Health professionals have a pivotal influence on families' infant feeding decisions and may act as facilitators or barriers to adequate breastfeeding practices. RESEARCH AIM: To explore factors influencing health professionals' decisions regarding the indication of infant formula in Montevideo, the capital of Uruguay, an emerging Latin American country. METHOD: This was a qualitative study based on semi-structured interviews with 30 health professionals (neonatologists, pediatricians, family doctors, and nurses) working in primary and secondary care in both private and public health institutions. The interviews were audio-recorded, transcribed, and analyzed using content analysis based on deductive-inductive coding. RESULTS: The narratives of the participants identified maternity wards as the healthcare sites where the indication of infant formula occurs most frequently. Motives underlying the indication of infant formula by health professionals were diverse. The type of birth and the conditions of the child and the mother were the most relevant in secondary care, whereas maternal work was the main determining factor in primary care. A wide range of factors encouraging and discouraging the indication of infant formula were identified by health professionals in primary and secondary healthcare locations, which were related to all the levels of influence of the socioecological model. CONCLUSIONS: Strategies to reduce the use of infant formula in Uruguay should include improving the support and guidance provided to families in the maternity ward, strengthening the implementation and monitoring of the Baby-Friendly Hospital Initiative, and improving the current maternity leave regulations.

Factors affecting infant feeding choices with a focus on barriers to exclusive breastfeeding in Western Jamaica: a qualitative study.

BACKGROUND: Despite the many benefits of exclusive breastfeeding to infants and mothers, only 33% of Jamaican infants are exclusively breastfed up to the recommend six months. This study was conducted to identify factors affecting mothers' feeding choices focusing on barriers to exclusive breastfeeding of infants six weeks to less than six months old. METHODS: A qualitative study consisting of four focus group discussion sessions was conducted among 22 mothers attending postnatal clinics in western Jamaica from May to August 2016. The transcripts were coded by three independent coders and content analysis conducted to generate themes. RESULTS: Four themes were identified namely, perceived advantages of breastfeeding centered mainly on the benefits of breastfeeding for the infant and mother, perceived barriers of breastfeeding highlighting physical pain and fatigue, supplementing culturally acceptable complementary foods and herbal remedies, and cultural norms including perception of how breastfeeding affects a woman's body, societal sources of breastfeeding information, satiation of infants, and family and other support. Mothers overwhelmingly agreed that breastfeeding was inexpensive, allowed them to bond with their infants and was good for the overall health and intellectual development of the infants. They identified painful nipples, engorged breasts, lack of sleep, physical exhaustion and pressure to return to work as barriers to breastfeeding. Mothers named a number of complementary foods, such as pumpkin, carrots, potato, banana, and chocho (Chayote), that were culturally accepted for feeding infants in Jamaica and discussed herbs that were considered to aid in infants' nutrition and overall health. Other cultural factors that were noted to influence exclusive breastfeeding were mothers feeling that breastfeeding would help their bodies, especially their bellies, go back to their pre-maternity figure, sources of breastfeeding information in the society including the internet, belief that breast milk alone does not satisfy babies, and family and other support. CONCLUSION: Mothers in this study identified unique challenges to exclusive breastfeeding that if addressed, would help to increase exclusive breastfeeding so that the World Health Organization's exclusive breastfeeding recommendations can be achieved.

Commercial milk formula marketing entry points: setting the course of infant and young child feeding trajectories.

BACKGROUND: There is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF. METHODS: Women of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels. RESULTS: Hospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding. CONCLUSIONS: The cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford.

Association between Exclusive Breastfeeding and the Incidence of Childhood Nephrotic Syndrome.

OBJECTIVE: To assess the relationship between breastfeeding and the risk of developing nephrotic syndrome using a population-based nationwide birth cohort in Korea. STUDY DESIGN: This nationwide cohort study utilized data from the National Health Information Database and the National Health Screening Program for Infants and Children. The study included all children born between January 1, 2010, and December 31, 2018, who underwent their first health screening, which included a specific questionnaire on breastfeeding between 4 and 6 months of age. Associations between nephrotic syndrome and exclusive breastfeeding were estimated using adjusted hazard ratios (aHR) derived from Cox proportional hazards models, adjusted for sociodemographic variables, with follow-up until the occurrence of nephrotic syndrome, 8 years postindex date, death, or December 31, 2022, whichever was first. RESULTS: The study population comprised 1 787 774 children (median follow-up: 7.96 years; IQR: 6.31-8.00 years), including 612 556 exclusively breastfed and 1 175 218 formula-fed children. Exclusive breastfeeding was associated with a decreased risk of developing nephrotic syndrome (aHR: 0.80; 95% CI: 0.69-0.93). Subgroup analysis stratified by sex mirrored the overall findings, although statistical significance was not observed in girls (boys: aHR, 0.75; 95% CI, 0.62-0.92; girls: aHR, 0.87; 95% CI, 0.70-1.09). Sensitivity analysis confirmed these results. CONCLUSIONS: Exclusive breastfeeding was associated with a 20% reduced risk of developing nephrotic syndrome up to 8 years of age.

Factores asociados a la duración de la lactancia materna en niños menores de 2 años en el Perú 2021-2022

Introducción: La duración de la lactancia materna es crucial para la salud infantil, sin embargo, la prevalencia ha disminuido en los últimos años, situando a los niños en una población de riesgo. Objetivo: Determinar los factores asociados a la duración de la lactancia materna en niños menores de 2 años en el Perú 2021-2022. Metodología: Estudio analítico transversal, a través del análisis secundario de datos de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2021 y 2022. El tamaño muestral fue de 4951 niños/niñas con sus respectivas madres. Se evaluaron factores infantiles y maternos utilizando el Estadístico F corregida para el análisis bivariado con una significancia estadística p<0,05 y un intervalo de confianza al 95%. Finalmente, para medir la asociación se calculó la razón de prevalencia cruda (RPc) y la razón de prevalencia ajustada (RPa) mediante la Regresión de Poisson con varianza robusta. Resultados: El 85,3% tuvo una duración de 0-6 meses y solo el 14,7% tiene una duración hasta los 23 meses. El no contacto piel a piel precoz bebe-madre (p <0,01) (RPa 1,19) y el consumo de bebidas diferentes a la leche materna los primeros 3 días de nacido (p <0,01) (RPa 0,66) se asociaron con una duración hasta los 6 meses de lactancia materna. Las madres adolescentes tuvieron un 30,7% de duración de lactancia materna de 6 meses (p<0,01) (RPa 2,49), por el contrario, el lugar de residencia rural, el grado no superior y un menor ingreso económico permiten una lactancia materna por más de 6 meses. Discusión: Los resultados asocian no recibir contacto piel a piel precoz bebe-madre, edad materna igual o menor de 18 años, grado superior, lugar de residencia urbano y mayor ingreso económico con una menor duración de lactancia materna en niños menores de 2 años.

Introduction: The duration of breastfeeding is crucial for child health; however, the prevalence has decreased in recent years, placing children in a population at risk. Objective: To determine the factors associated with the duration of breastfeeding in children under 2 years of age in Peru 2021-2022. Methodology: Cross-sectional analytical study, through the secondary analysis of data from the Demographic and Family Health Survey (ENDES) of 2021 and 2022. The sample size was 4951 children with their respective mothers. Infant and maternal factors were evaluated using the F-statistic corrected for bivariate analysis with a statistical significance of p<0.05 and a 95% confidence interval. Finally, to measure the association, the crude prevalence ratio (cPR) and the adjusted prevalence ratio (aPR) were calculated using Poisson regression with robust variance. Results: 85.3% had a duration of 0-6 months and only 14.7% had a duration of up to 23 months. Early baby-mother skin-to-skin non-contact (p <0.01) (aPR 1.19) and consumption of beverages other than breast milk in the first 3 days of birth (p <0.01) (aPR 0.66) were associated with a duration of breastfeeding up to 6 months. Adolescent mothers had a 30.7% duration of breastfeeding of 6 months (p<0.01) (aPR 2.49), on the contrary, the place of rural residence, the non-higher grade and a lower economic income allow breastfeeding for more than 6 months. Discussion: The results were associated with not receiving early skin-to-skin contact between the baby and the mother, maternal age equal to or less than 18 years, higher grade, urban place of residence and higher economic income with a shorter duration of breastfeeding in children under 2 years of age.

¿Hay asociación de obesidad infantil con duración de lactancia materna, empleo y escolaridad parental o conformación familiar?. Estudio lontigudinal

Introducción: Aunque la causa de la obesidad infantil es multifactorial, se sabe que la lactancia materna (LM) podría ser un elemento protector. Objetivo: Determinar la asociación de obesidad en los niños con la duración de la LM, escolaridad y tipo de empleo de padres y conformación familiar en un grupo de niños de Encarnación-Paraguay. Metodología: estudio longitudinal, retrospectivo y descriptivo con componente analítico realizado con 200 niños de ambos sexos. Se evaluó estado nutricional a los 2, 4 y 6 años, duración de LM, agrupación familiar según nivel de escolaridad y tipo de empleo (Grupo A: hasta 6° grado de la Educación Escolar Básica (EEB) y trabajo informa; 2)Grupo B: hasta 3° de EEB y empleados públicos/comerciales; 3)Grupo C: educación terciaria y cargos jerárquicos o dueños de corporaciones.Se consideró valor de p<0,05 como significativo. Resultados: 50%(n=100) fueron varones, 96,5%(n=193) del área urbana, 70%(n=140) con familia nuclear, 73%(n=146) fueron familias del grupo B. Tuvo LM ≤4 meses el 5,5%(n=11), hasta 6 meses 9%(n=18), 7 a 11 meses el 20,5%(n=41), LM continuada (≥1 año) el 63,5%(n=127). Presentaron obesidad el 14,5%, 18% y 18,5% a los 2, 4 y 6 años respectivamente. Hubo mayor obesidad a los 4 años con LM <6 meses (42,9% vs 16,1% Chi2 p=0,02), no así a los 2 o 6 años. Sin asociación significativa de obesidad con tipo de empleo y escolaridad de los padres o con presencia de pareja (Chi2 p≥0,05). Conclusión: La duración de lactancia materna menor a 6 meses se asocia con mayor frecuencia de obesidad a los 4 años.

Introduction: Although the cause of childhood obesity is multifactorial, it is known that breastfeeding (BF) could be a protective element. Objective: To determine the association of obesity in children with the duration of BF, parental educational levels and types of employment and family formation in a group of children from Encarnación, Paraguay. Methodology: This was a longitudinal, retrospective and descriptive study with an analytical component carried out in 200 children of both sexes. Nutritional status was evaluated at 2, 4 and 6 years, duration of BF. Families were grouped according to parental education levels and types of employment (Group A: up to 6th grade of Elementary Education [EE] and informal economy work; Group B: up to 12th grade of EE and public/commercial employment; Group C: tertiary education and managerial employment positions or business ownership. A value of p <0.05 was considered significant. Results: 50% (n=100) were men, 96.5% (n=193) from urban areas, 70% (n=140) came from nuclear families, 73% (n=146) were families from group B. BF duration was ≤4 months 5.5% (n=11), up to 6 months 9% (n=18), 7 to 11 months 20.5% (n=41), continued BF (≥1 year) 63 .5%(n=127). 14.5%, 18% and 18.5% were obese at 2, 4 and 6 years respectively. There was greater obesity at 4 years with BF <6 months (42.9% vs 16.1% Chi2 p=0.02), but not at 2 or 6 years. No significant association of obesity with parental employment or educational level or with the presence of a partner (Chi2 p≥0.05). Conclusion: Breastfeeding duration of less than 6 months is associated with a higher frequency of obesity at 4 years of age.

Exclusive breastfeeding and length of hospital stay in premature infants at a Brazilian reference center for kangaroo mother care

Abstract Objective: To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in pre-term infants undergoing or not the Kangaroo-Mother Care Method (KMC). Methods: A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders. Results: 115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85-109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76-0.86) compared to the non-KMC group. Conclusions: The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals.

Análisis de Factores Maternos que Afectan la Lactancia Materna Exclusiva en Ecuador

La lactancia materna exclusiva (LME) ha sido considerada por varios organismos internacionales como la solución para combatir la desnutrición infantil, la cual es considerada como un problema de salud pública. Bajo este contexto, la presente investigación busca encontrar cuáles son los determinantes de la LME en el Ecuador, y mostrar cómo influye el nivel educativo de la madre sobre la duración de la lactancia materna exclusiva. Para cumplir dicho objetivo se emplea un modelo probabilístico obteniendo como resultado que el nivel de instrucción de la madre, la etnia, el quintil de ingresos, el género del recién del bebé y la edad de la madre juegan un papel importante sobre la duración de la lactancia materna en el Ecuador. En el caso del nivel de instrucción se encuentra que las mujeres con una educación superior tienen menos probabilidad de dar LME, por seis meses o más, que las madres sin un nivel de educación.

Exclusive breastfeeding (EBF) has been considered by several international organizations as the solution to combat child malnutrition, which is considered a public health problem. In this context, the present research seeks to find the determinants of EBF in Ecuador, and to show how the mother's educational level influences the duration of exclusive breastfeeding. In order to fulfill this objective, a probabilistic model was used, obtaining as a result that the mother's level of education, ethnicity, income quintile, gender of the newborn and the mother's age play an important role in the duration of breastfeeding in Ecuador. In the case of educational level, it is found that women with higher education are less likely to breastfeed for six months or more than mothers with no education.

O aleitamento materno exclusivo (AME) tem sido considerado por várias organizações internacionais como a solução para combater a desnutrição infantil, que é considerada um problema de saúde pública. Neste contexto, esta investigação tem como objetivo encontrar os determinantes do AME no Equador, e mostrar como o nível educacional da mãe influencia a duração do aleitamento materno exclusivo. Para cumprir este objetivo, é utilizado um modelo probabilístico, com o resultado de que o nível de educação da mãe, a etnia, o quintil de rendimentos, o sexo do recém-nascido e a idade da mãe desempenham um papel importante na duração do aleitamento materno no Equador. No caso do nível de educação, verifica-se que as mulheres com educação superior têm menos probabilidades de amamentar durante seis meses ou mais do que as mães sem educação.

Can Breastfeeding Prevent Long-Term Overweight and Obesity in Children? A Population-Based Cohort Study.

The aims of this study were to assess the impact of exclusive breastfeeding up to 6 months of age on reducing the incidence of overweight and obesity in children up to 10 years of age and to estimate the annual incidence of obesity and overweight in the study population. Our retrospective cohort analysis using electronic health records included children from zero to ten years old, born between 1 January 2006 and 31 December 2022, followed up at the Unidade Local de Saúde de Matosinhos (ULSM). Information on their comorbidity history was collected, and positive or negative control results were defined. In the first year of life, around 29% of the children on exclusive breastfeeding were obese and 20% were overweight. This trend was reversed by the age of 9. Asthma and allergic rhinitis were used as positive control outcomes and allergic dermatitis as a negative control outcome. There seems to be no relationship between exclusive and non-exclusive breastfeeding and the development of overweight or obesity at the age of 10. The results showed that breastfeeding is associated with a lower risk of asthma in the future.

The lingual frenulum, ankyloglossia, and breastfeeding. / Frenillo lingual, anquiloglosia y lactancia materna.

Between 1997 and 2012, the diagnoses of ankyloglossia and the indication for frenotomy increased by ˃800%. About 38% of diagnosed cases are surgically treated. Breastfeeding promotion includes evaluating maternal hereditary and personal history of breastfeeding, breast structure, endocrinological physiology, emotional well-being of the mother, breastfeeding technique, quality and quantity of milk, and the newborn's ability to latch on and suckle. Frenotomy would be indicated when restriction of tongue function causes difficulties that have not resolved after thorough evaluation and counseling to correct other causes. Frenotomy can have complications: feeding and respiratory difficulties, pain, weight loss, vascular or nerve damage, and delayed diagnosis of other underlying pathologies. It does not always solve breastfeeding difficulties. Interdisciplinary teamwork reduces the frequency of unnecessary frenotomies.

Entre 1997 y 2012 los diagnósticos de anquiloglosia y la indicación de frenotomía aumentaron ˃800 %. Alrededor del 38 % de los casos diagnosticados son intervenidos quirúrgicamente. La promoción de la lactancia materna incluye la evaluación de antecedentes hereditarios y personales maternos de lactancia, estructura mamaria, fisiología endocrinológica, equilibrio emocional de la madre, técnica de amamantamiento, calidad y cantidad de leche, capacidad del recién nacido de prenderse y succionar. La frenotomía estaría indicada cuando la restricción de la función lingual provoca dificultades que no se han resuelto luego de una evaluación exhaustiva y del asesoramiento para corregir otras causas encontradas. Las frenotomía puede tener complicaciones: problemas en la alimentación, respiratorios, dolor, pérdida de peso, daños vasculares o nerviosos, y retraso en el diagnóstico de otras patologías subyacentes. No siempre soluciona las dificultades de la lactancia. El trabajo en equipo interdisciplinario disminuye la frecuencia de las frenotomías innecesarias.

Factors associated with exclusive breastfeeding in " Near Miss " neonates in Brazil.

Objective: To assess the association between sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in near miss neonates in maternity hospitals. Methods: This is a prospective cohort of live births from the survey "To be born in Brazil" conducted between 2011 and 2012. The weighted number of newborns who met the neonatal near miss criteria was 832. Exclusive breastfeeding at hospital discharge and 45 days after delivery were dependent variables of the study. The sociodemographic and perinatal factors of the puerperal women and hospital practices to encourage breastfeeding were independent variables. The data were analyzed with Poisson regression and set with p value<0.05. Is exclusive breastfeeding in neonatal near misses associated with factors related to sociodemographic conditions, maternal characteristics and the organization of health services? Results: Data from 498 women and their children were analyzed. Mothers with incomplete primary education were more likely (36%) to have exclusive breastfeeding (RR: 1.36; 95% CI: 1.06-1.74) at discharge. Women who did not offer the breast to the newborn in the joint accommodation (65%) were less likely to be breastfeeding exclusively (RR: 0.65; 95% CI: 0.56-0.75) at discharge. Variables that increased the probability of exclusive breastfeeding after 45 days of delivery were primiparity (RR: 1.36; 95% CI: 1.08-1.69) and having the newborn in the delivery room (RR: 1.90; 95% CI: 1.12-3.24). Conclusion: Exclusive breastfeeding in neonatal near misses was associated with maternal characteristics and important hospital practices, such as being breastfed in the joint accommodation and the newborn being in the mother's lap in the delivery room.

Análisis de factores maternos que afectan la lactancia materna exclusiva en Ecuador / Analysis of maternal factors affecting exclusive breastfeeding in Ecuador / Análise dos factores maternos que afectam o aleitamento materno exclusivo no Equador

La lactancia materna exclusiva (LME) ha sido considerada por varios organismos internacionales como la solución para combatir la desnutrición infantil, la cual es considerada como un problema de salud pública. Bajo este contexto, la presente investigación busca encontrar cuáles son los determinantes de la LME en el Ecuador, y mostrar cómo influye el nivel educativo de la madre sobre la duración de la lactancia materna exclusiva. Para cumplir dicho objetivo se emplea un modelo probabilístico obteniendo como resultado que el nivel de instrucción de la madre, la etnia, el quintil de ingresos, el género del recién del bebé y la edad de la madre juegan un papel importante sobre la duración de la lactancia materna en el Ecuador. En el caso del nivel de instrucción se encuentra que las mujeres con una educación superior tienen menos probabilidad de dar LME, por seis meses o más, que las madres sin un nivel de educación

Exclusive breastfeeding (EBF) has been considered by several international organizations as the solution to combat child malnutrition, which is considered a public health problem. In this context, the present research seeks to find the determinants of EBF in Ecuador, and to show how the mother's educational level influences the duration of exclusive breastfeeding. In order to fulfill this objective, a probabilistic model was used, obtaining as a result that the mother's level of education, ethnicity, income quintile, gender of the newborn and the mother's age play an important role in the duration of breastfeeding in Ecuador. In the case of educational level, it is found that women with higher education are less likely to breastfeed for six months or more than mothers with no education.

Desigualdad en las prácticas de lactancia y alimentación complementaria en la Argentina, según nivel de ingresos del hogar en 2018-19 / Inequality in breastfeeding and complementary feeding practices in Argentina by household income level in 2018­2019

Introducción. La calidad de la alimentación es un derecho vinculado con la supervivencia, el crecimiento saludable, la prevención de enfermedades crónicas y malnutrición en todas sus formas. El objetivo de este trabajo fue analizar las prácticas de lactancia y de alimentación de menores de 2 años de áreas urbanas de la Argentina en 2018-19, según el nivel de ingreso de los hogares. Población y métodos. Estudio secundario con datos de la 2da. Encuesta Nacional de Nutrición y Salud 2018-19. Se analizaron indicadores de lactancia y alimentación complementaria, según metodología de la Organización Mundial de la Salud (OMS) y Unicef. Se estratificó según nivel de ingresos del hogar. Resultados. El análisis incluyó 5763 menores de 24 meses. Aunque el 97 % fue alguna vez amamantado, solo el 47 % de los menores de 6 meses tuvo lactancia exclusiva el día previo y el 48 % mantenía la lactancia luego del año, con mayor prevalencia en los niños/as de menores ingresos. En el día previo, el 23 % de los niños/as de 6 a 23 meses no consumió ninguna verdura o fruta; el 60 % consumió alimentos no saludables y el 50 %, bebidas dulces. Las bebidas dulces y la ausencia de frutas y verduras fueron mayores en aquellos de hogares de menores ingresos. Conclusión. La calidad de la alimentación de los niños/as dista de las recomendaciones y está condicionada por los ingresos. En los sectores empobrecidos, es menor el inicio temprano de la lactancia, la diversidad alimentaria mínima y el consumo de frutas y verduras, y es mayor el consumo de bebidas dulces.

Introduction. Diet quality is a right related to survival, healthy growth, prevention of chronic diseases, and malnutrition in all its forms. The objective of this study was to analyze breastfeeding and feeding practices in children younger than 2 years from urban areas of Argentina in 2018­2019 according to their household income level. Population and methods. Secondary analysis of data of the Second National Survey on Nutrition and Health (ENNyS2) of 2018­2019. Breastfeeding and complementary feeding indicators proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) were analized. Data were stratified by household income level. Results. The analysis included 5763 children younger than 24 months old. Although 97% was ever breastfed, only 47% of infants younger than 6 months were exclusively breastfed the previous day and 48% continued with breastfeeding after 1 year old, with a higher prevalence in low-income children. The previous day, 23% of children aged 6 to 23 months did not eat any fruit or vegetable, 60% consumed unhealthy foods, and 50% consumed sweet beverages. The consumption of sweet beverages and the absence of fruit and vegetables were higher in low-income households. Conclusion. The quality of children's diet is far from the recommendations and is conditioned by income. Early initiation of breastfeeding, minimum dietary diversity, fruit and vegetable consumption are lower and sweet beverage consumption is greater in impoverished sectors.

Raynaud's Phenomenon of the Nipple: Epidemiological, Clinical, Pathophysiological, and Therapeutic Characterization.

Raynaud's phenomenon of the nipple is a possible cause of pain and breastfeeding cessation in lactating women. However, there are still few studies on the characterization of this manifestation. Thus, we aim to develop a systematic review of the literature carried out between January 1992 and January 2024 in PubMed, Scopus, Web of Science, Virtual Health Library (VHL), and Portal de Periódicos da CAPES. Of the 438 articles, 19 met the eligibility criteria. The findings were divided by heuristic questions into two groups: "Epidemiological, pathophysiological, and clinical characterization of Raynaud's Phenomenon of the nipple" and "Treatment of Raynaud's Phenomenon of the nipple". Raynaud's phenomenon of the nipple is commonly primary, being more prevalent in the postpartum period, in women with a mean age of 32 years. The main triggers appear to be stress and temperature change. Generally, it is associated with a change in color and pain during breastfeeding. A calcium channel blocker was the most used medication with or without non-pharmacological measures.