Exclusive Breastfeeding in Health Personnel: Incidence and Barriers.

Exclusive breastfeeding for 6 months (EBF) in healthcare personnel is challenging due to work schedules, high workloads, or separation issues. This study aimed to evaluate the incidence and factors related to EBF in our hospital personnel. MATERIAL AND METHODS: This was a cross-sectional study. Female employees who took maternity leave within 2 years were approached. A questionnaire regarding factors associated with EBF was sent to participants. Factors associated with EBF were analyzed using logistic regression analysis. RESULTS: There were 110 mothers enrolled. The mean maternal age was 32.5 ± 4.21 years, 66.36% came from the nursing department, the infant's age was 6-24 months, and 46.4% of mothers had previous breastfeeding experience. Our EBF for 6 months rate was 63.6%. Breastfeeding attitude (OR = 1.12, 95%CI 1.08-1.38), perception of breastfeeding obstacle (OR = 1.45, 95%CI 1.26-1.66), breastfeeding behavior (OR = 1.17, 95%CI 1.08-1.26), and support from health system (OR = 1.09, 95%CI 1.01-1.19) were significantly associated with EBF. From multiple logistic regression models, perception of breastfeeding obstacles (aOR 1.55, 95%CI 1.27-1.90), breastfeeding behavior (aOR 1.12, 95%CI 1.01-1.24), and support from health care system (aOR 0.84, 95%CI 0.72-0.97) remain the significant factors associated with successful EBF. CONCLUSION: Successful EBF was prevalent in mothers who had good attitudes to breastfeeding, perceived low levels of obstacles, and had support from the health care system.

Effect of Electrical Breast Pump Loaning Project on Human Milk Feeding Practice in Preterm Neonates Less Than 32 Weeks of Gestation or Birth Weight Less Than 1,500 g.

Objective: Milk expression is the key step of milk production in mothers of preterm infants. Our hospital has started an electrical breast pump loaning program to improve human milk feeding rate in our patients. This study was aimed to assess the beneficial effect of the loaning program. Materials and Methods: This was an interrupted time-series study. In addition to general information, mothers in the intervention period received electrical breast pump before discharge. Maternal milk volume was recorded for 28 days, and 24-hour-feeding record and recall were used to determine breastfeeding rate at discharge and 6 months postpartum, respectively. Results: There were 40 mothers, 20 mothers in each group, who participated in this study. Maternal milk volume in the control group was 169.3 + 152.4, 329.5 + 241.6, 547.4 + 390.8, and 704.2 + 439.6 mL/day in first, second, third, and fourth week, respectively. Milk volume in the intervention group was 308.5 + 269.6, 454.1 + 281, 544.9 + 282.2, and 531.9 + 282.2 mL/day in first, second, third, and fourth week. Average frequency of milk expression was higher in the intervention group [5.15 (1) and 6.01 (1.49) times per day, p-value 0.04]. There were one (5%) and four (20%) infants in the control and intervention groups who were exclusively breastfed at discharge. At 6 months, eight (40%) infants from each group were still breastfed. Conclusion: Mothers in the pump loaning program had expressed milk more frequently. Even though maternal milk volume difference did not reach statistical significance, the intervention group had higher milk volume in the first 2 weeks postpartum. There was no difference in terms of feeding type both at discharge and 6 months postpartum.

LACHT syndrome (Mardini-Nyhan association) with tracheal stenosis in a Thai newborn.

LACHT syndrome, or Mardini-Nyhan association, is an ultra-rare disorder, diagnosed solely by the clinical characteristics of lung agenesis, complex cardiac defects, and thumb anomalies. Only 12 patients have been reported worldwide, and here, we report a new clinical diagnosis of LACHT syndrome. Our patient was a male full-term newborn with left lung agenesis, congenital heart defects including ventricular septal defect, right-sided aortic arch, with aberrant left subclavian artery and Kommerell diverticulum, as well as left preaxial polydactyly and hemivertebra. Our patient appears to be the second LACHT syndrome case to also suffer from tracheal stenosis, which has only been reported once before in conjunction with this syndrome. In light of this, tracheal stenosis may be a phenotype for LACHT syndrome.

Two Novel GATA1 Mutations in Transient Abnormal Myelopoiesis of Thai Neonates with Down Syndrome.

Children with Down syndrome (DS) are 150 times more likely to develop acute myeloid leukemia (ML-DS), compared with those without. One risk factor is transient abnormal myelopoiesis (TAM). Somatic truncating GATA1 mutations are found in most TAM patients and are markers for future ML-DS. We identified two novel frameshift mutations in our seven newborns with DS and TAM: a heterozygous mutation of 17 nucleotide duplication (c.154_170 dup) and a heterozygous 9-nucleotide deletion combined with a 2-nucleotide insertion (c.150_158delins CT). Both mutations introduced a truncated GATA1 protein. Thus, neonates with DS and TAM require frequent ML-DS monitoring.

Sex-Specific Life Course Changes in the Neuro-Metabolic Phenotype of Glut3 Null Heterozygous Mice: Ketogenic Diet Ameliorates Electroencephalographic Seizures and Improves Sociability.

We tested the hypothesis that exposure of glut3+/- mice to a ketogenic diet ameliorates autism-like features, which include aberrant behavior and electrographic seizures. We first investigated the life course sex-specific changes in basal plasma-cerebrospinal fluid (CSF)-brain metabolic profile, brain glucose transport/uptake, glucose and monocarboxylate transporter proteins, and adenosine triphosphate (ATP) in the presence or absence of systemic insulin administration. Glut3+/- male but not female mice (5 months of age) displayed reduced CSF glucose/lactate concentrations with no change in brain Glut1, Mct2, glucose uptake or ATP. Exogenous insulin-induced hypoglycemia increased brain glucose uptake in glut3+/- males alone. Higher plasma-CSF ketones (ß-hydroxybutyrate) and lower brain Glut3 in females vs males proved protective in the former while enhancing vulnerability in the latter. As a consequence, increased synaptic proteins (neuroligin4 and SAPAP1) with spontaneous excitatory postsynaptic activity subsequently reduced hippocampal glucose content and increased brain amyloid ß1-40 deposition in an age-dependent manner in glut3+/- males but not females (4 to 24 months of age). We then explored the protective effect of a ketogenic diet on ultrasonic vocalization, sociability, spatial learning and memory, and electroencephalogram seizures in male mice (7 days to 6 to 8 months of age) alone. A ketogenic diet partially restored sociability without affecting perturbed vocalization, spatial learning and memory, and reduced seizure events. We conclude that (1) sex-specific and age-dependent perturbations underlie the phenotype of glut3+/- mice, and (2) a ketogenic diet ameliorates seizures caused by increased cortical excitation and improves sociability, but fails to rescue vocalization and cognitive deficits in glut3+/- male mice.

Early leptin intervention reverses perturbed energy balance regulating hypothalamic neuropeptides in the pre- and postnatal calorie-restricted female rat offspring.

Pre- and postnatal calorie restriction is associated with postnatal growth restriction, reduced circulating leptin concentrations, and perturbed energy balance. Hypothalamic regulation of energy balance demonstrates enhanced orexigenic (NPY, AgRP) and diminished anorexigenic (POMC, CART) neuropeptide expression (PN21), setting the stage for subsequent development of obesity in female Sprague-Dawley rats. Leptin replenishment during the early postnatal period (PN2-PN8) led to reversal of the hypothalamic orexigenic:anorexigenic neuropeptide ratio at PN21 by reducing only the orexigenic (NPY, AgRP), without affecting the anorexigenic (POMC, CART) neuropeptide expression. This hypothalamic effect was mediated via enhanced leptin receptor (ObRb) signaling that involved increased pSTAT3/STAT3 but reduced PTP1B. This was further confirmed by an increase in body weight at PN21 in response to intracerebroventricular administration of antisense ObRb oligonucleotides (PN2-PN8). The change in the hypothalamic neuropeptide balance in response to leptin administration was associated with increased oxygen consumption, carbon dioxide production, and physical activity, which resulted in increased milk intake (PN14) with no change in body weight. This is in contrast to the reduction in milk intake with no effect on energy expenditure and physical activity observed in controls. We conclude that pre- and postnatal calorie restriction perturbs hypothalamic neuropeptide regulation of energy balance, setting the stage for hyperphagia and reduced energy expenditure, hallmarks of obesity. Leptin in turn reverses this phenotype by increasing hypothalamic ObRb signaling (sensitivity) and affecting only the orexigenic arm of the neuropeptide balance.

Necrotizing fasciitis: a rare manifestation of late-onset neonatal group B streptococcal infection.

Preterm infants have a risk factor of developing late-onset group B streptococcal (GBS) infection. A 62-day-old infant who was a former 25-week male infant presented with fever and an erythematous, warm and tender, soft tissue swelling in the right submandibular region. He was diagnosed with cellulitis. Within 72 hours, his lesion had rapidly progressed to necrotizing fasciitis. His blood culture grew penicillin-sensitive GBS. This reported case illustrates necrotizing fasciitis as a rare manifestation of late-onset neonatal GBS infection.