Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis.

OBJECTIVE: To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition. METHODS: Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program. RESULTS: The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%). CONCLUSION: The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.

Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis

ABSTRACT OBJECTIVE To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition. METHODS Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program. RESULTS The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%). CONCLUSION The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.

Effect of an educational intervention on the breastfeeding technique on the prevalence of exclusive breastfeeding / Efeito de uma intervenção educativa sobre a técnica de amamentação na prevalência do aleitamento materno exclusivo

Abstract Objectives: to evaluate the effect of an intervention directed to the breastfeeding technique in the prevalence of exclusive breastfeeding in the first month of life. Methods: this is a quasi-randomized intervention study conducted in a public maternity ward accredited in the Baby-Friendly Hospital Initiative. The intervention consisted of individual orientations on the breastfeeding technique in the first 48 hours after delivery, with the help of a breast model, doll, and movie. The control group was oriented by researchers about the importance of breastfeeding, and received hospital orientations. Data were collected in the maternity ward, and at the end of the first month in the hospital's outpatient service by implementing a questionnaire, observing the baby's breastfeeding technique and examining breasts. Results: the prevalence of exclusive breastfeeding in the first month of life of the infant was 76.6% in the experimental group, and 52.2% in the control group. RR=1.46 (CI95%=1.16-1.84); NNT=4.09; p=0.001. The trained women presented a correct breast-feeding technique in 64.04%, much higher when compared to those who did not receive training (15.11%;RR=4.87[CI95%=2.93-8.34]; NNT=1.96;p<0.001). Conclusions: the use of audiovisual resources, use of instruments (model breast and doll), and type of individualized approach contributed to an increased prevalence of exclusive breastfeeding up to 30 days after delivery.

Resumo Objetivos: avaliar o efeito de uma intervenção direcionada à técnica de amamentação na prevalência de aleitamento materno exclusivo no primeiro mês de vida. Métodos: foi realizado um estudo de intervenção quasi randomizado em uma maternidade pública, credenciada como Amigo da Criança. A intervenção consistiu em orientações individuais sobre a técnica de amamentação nas primeiras 48 horas após o parto, com ajuda de seio cobaia, boneca e filme. O grupo controle foi orientado sobre a importância do aleitamento materno pelas pesquisadoras, além das orientações fornecidas pelo hospital. A coleta de dados ocorreu na maternidade e ao final do primeiro mês em serviço ambulatorial do hospital, mediante a aplicação de um questionário, observação da mamada e exame das mamas. Resultados: a prevalência do aleitamento materno exclusivo, no primeiro mês de vida do lactente, foi de 76,6% no grupo experimental e 52,2% no grupo controle. RR=1,46 (IC95%=1,16-1,84); NNT=4,09; p=0,001. As mulheres que sofreram a intervenção, apresentaram técnica correta de amamentação em proporção significativamente maior que os controles: 64,04% vs 15,11%, RR= 4,87 [IC95%= 2,93-8,34] NNT= 1,96; p<0,001. Conclusões: a utilização de recursos audiovisuais, uso de instrumentos (seio cobaia e boneca) e tipo de abordagem individualizada contribuíram para o aumento da prevalência do aleitamento materno exclusivo até 30 dias pós parto.

Factors associated with the use of the Child Health Handbook in a large city of the Brazilian Northeast, 2009. / Fatores associados ao uso da Caderneta de Saúde da Criança em uma cidade de grande porte do nordeste brasileiro, 2009.

This study aimed to investigate the factors associated with mothers reading the Child Health Handbook (CHH) and health professionals completing this instrument, in Feira de Santana, Bahia, 2009. This is a cross-sectional study with the application of 727 forms to mothers of children under one year of age. The outcomes studied were mother reading the CHH and health professionals completing weight and height measures. We performed a logistic regression analysis with p ≤ 0.05. The prevalence of reading, weight and height were, respectively, 81.1%, 68.9% and 47.3%. Mothers with a higher level of education had a greater chance of reading the CHH. Recording weight and height was more prevalent in mothers who were under 35 years of age. Performing childcare in areas of the Family Health Program or the Community Health Workers was positively associated with the height's record, despite the low prevalence of records. Child age greater than six months was positively associated with all outcomes. It demonstrated the underutilization of CHH by mothers and health professionals, which indicates the need for training of health professionals and guidance to mothers on the importance and management of this issue.

Fatores associados ao uso da Caderneta de Saúde da Criança em uma cidade de grande porte do nordeste brasileiro, 2009 / Factors associated with the use of the Child Health Handbook in a large city of the Brazilian Northeast, 2009

Resumo O objetivo do estudo foi averiguar os fatores associados à leitura da Caderneta de Saúde da Criança (CSC) pelas mães e a seu preenchimento pelos profissionais de saúde, em Feira de Santana (Bahia), em 2009. Estudo transversal com aplicação de 727 formulários às mães de crianças menores de um ano. Os desfechos estudados foram: leitura materna da caderneta e preenchimento de medidas de peso e comprimento, por profissionais de saúde. Realizou-se análise de regressão logística com valor de p ≤ 5%. A prevalência de leitura, medidas de peso e comprimento foram, respectivamente, 8,1%, 68,9% e 47,3%. Maior escolaridade materna associou-se a maiores chances de leitura. Registros de peso e comprimento foram mais prevalentes em mães com idade < 35 anos. Realizar puericultura em áreas do Programa de Saúde da Família ou dos Agentes Comunitários de Saúde associou-se positivamente com anotações do comprimento, apesar das baixas prevalências dos registros. Idade da criança ≥ 6 meses associou-se a todos os desfechos. Demonstrou-se a subutilização da CSC por mães e profissionais de saúde, indicativos da necessidade de medidas educativas com treinamentos dos profissionais de saúde e orientações às mães sobre a importância e o manejo da mesma.

Abstract This study aimed to investigate the factors associated with mothers reading the Child Health Handbook (CHH) and health professionals completing this instrument, in Feira de Santana, Bahia, 2009. This is a cross-sectional study with the application of 727 forms to mothers of children under one year of age. The outcomes studied were mother reading the CHH and health professionals completing weight and height measures. We performed a logistic regression analysis with p ≤ 0.05. The prevalence of reading, weight and height were, respectively, 81.1%, 68.9% and 47.3%. Mothers with a higher level of education had a greater chance of reading the CHH. Recording weight and height was more prevalent in mothers who were under 35 years of age. Performing childcare in areas of the Family Health Program or the Community Health Workers was positively associated with the height’s record, despite the low prevalence of records. Child age greater than six months was positively associated with all outcomes. It demonstrated the underutilization of CHH by mothers and health professionals, which indicates the need for training of health professionals and guidance to mothers on the importance and management of this issue.

[Maternal intention to breastfeed: a systematic review]. / Intenção materna de amamentar: revisão sistemática.

This study seeks to identify the factors associated with maternal intention to breastfeed (MIB) in pregnant women. A systematic review of articles in the Medical Literature Analysis and Retrieval System Online (PubMed/Medline) and the Latin American and Caribbean Literature in Health Sciences (Lilacs) databases was conducted. Two independent reviewers performed the search, using the "Medical Subject Headings" and "Key words in Science and Health" vocabulary, referring to: breastfeeding, intention, and pregnant women. Research articles in English, Portuguese and Spanish that analyzed MIB as an outcome were selected. The studies were classified by methodological quality, using a scale that considered internal and external validity criteria, with a maximum score of 30 points. Nine articles were selected, with a methodological quality varying from 12 to 21 points. The studies assessed 68 variables; 35 of which were associated with MIB. The characteristics associated with MIB found in two or more studies were: primiparity, higher level of schooling and older maternal age, prior experience with breastfeeding, not smoking, and living with a partner. Knowledge of the characteristics associated with MIB represents a fundamental step in the planning of actions that seek to increase the duration of breastfeeding.

Intenção materna de amamentar: revisão sistemática / Maternal intention to breastfeed: a systematic review

Resumo O presente estudo tem como objetivo identificar os fatores associados à intenção materna para amamentar (IMA) em gestantes. Foi realizada revisão sistemática de estudos de bases de dados Medical Literature Analysis and Retrieval System Online (PubMed/Medline) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Dois revisores independentes buscaram artigos, com os “Medical Subject Headings” e os “Descritores em Ciência e Saúde”, referentes: ao aleitamento materno, à intenção e às gestantes. Foram incluídas pesquisas que apresentavam IMA como desfecho, em inglês, português e espanhol; e classificadas, quanto à qualidade metodológica, de acordo com critérios de validade interna e externa de uma pesquisa, com pontuação máxima de 30 pontos. Selecionou-se nove artigos, com qualificação metodológica entre 12 e 21 pontos, que investigaram 68 variáveis; 35 dessas se associaram à IMA. As características associadas à IMA em gestantes, relatadas em dois ou mais estudos, foram: primeira gestação, maior escolaridade e idade materna, experiência prévia com a amamentação, ausência do hábito de fumar e residir com o companheiro. O conhecimento das características associadas à IMA representa um passo fundamental no delineamento de ações que visem maior duração do aleitamento materno.

Abstract This study seeks to identify the factors associated with maternal intention to breastfeed (MIB) in pregnant women. A systematic review of articles in the Medical Literature Analysis and Retrieval System Online (PubMed/Medline) and the Latin American and Caribbean Literature in Health Sciences (Lilacs) databases was conducted. Two independent reviewers performed the search, using the “Medical Subject Headings” and “Key words in Science and Health” vocabulary, referring to: breastfeeding, intention, and pregnant women. Research articles in English, Portuguese and Spanish that analyzed MIB as an outcome were selected. The studies were classified by methodological quality, using a scale that considered internal and external validity criteria, with a maximum score of 30 points. Nine articles were selected, with a methodological quality varying from 12 to 21 points. The studies assessed 68 variables; 35 of which were associated with MIB. The characteristics associated with MIB found in two or more studies were: primiparity, higher level of schooling and older maternal age, prior experience with breastfeeding, not smoking, and living with a partner. Knowledge of the characteristics associated with MIB represents a fundamental step in the planning of actions that seek to increase the duration of breastfeeding.

Fatores de riscos maternos e de assistência ao parto para interrupção precoce do aleitamento materno exclusivo: estudo de coorte / Maternal risk factors and care delivery for early interruption of exclusive breastfeeding: cohort study / Materna factores de riesgo y la atención para la interrupción temprana de la lactancia materna exclusiva: um estudio de cohortes

É consensual a recomendação de aleitamento materno exclusivo (AME) nos primeiros seis meses de vida da criança e a manutenção da amamentação por dois anos de idade ou mais, mas há casos em que sua interrupção precoce pode ocorrer, tendo em vista diversas características maternas e de assistência ao parto. O objetivo deste estudo é identificar as características maternas e de assistência ao parto associadas à interrupção do aleitamento materno exclusivo (AME) em crianças menores de um mês. Trata-se de um estudo de coorte com 1.309 duplas mães-bebês atendidas em todos os hospitais do município, em dois meses consecutivos. Os resultados apontam que a prevalência de AME no primeiro mês foi de 59,3 porcento; foram identificados como fatores determinantes para a interrupção precoce da amamentação: primiparidade (RP igual 1,41; IC95 porcento igual 1,22 1,63), cansaço físico (RP igual 1,18; IC95 porcento igual 1,03 1,35), ausência de orientação de aleitamento materno no hospital(RP igual 1,53; IC95v igual 1,33 1,75), baixa escolaridade (RP igual 1,35; IC95 porcento igual 1,17 traço1,57) e baixa renda (RP igual 1,27; IC95v igual 1,09 1,47). Conclui-se que são necessárias medidas de intervenção visando o aumento das taxas de AME direcionadas às mulheres primíparas, de menor renda familiar e menor escolaridade, bem como orientação suficiente de aleitamento materno desde o pré-natal e apoio familiar às nutrizes nas tarefas domésticas para atenuar a interferência negativa do cansaço físico materno na prática do AME.

maintenance of breastfeeding for two years or more, but there are cases that their early termination may occur, in view of various maternal characteristics and obstetric care. The aim of this study is to identify maternal characteristics and birth careassociated with discontinuation of exclusive breastfeeding (EBF) in children less than a month. This cohort study included 1.309 mother-baby pairs attended in all the municipality s hospitals, over two consecutive months. The results show that the prevalence of EBF in the first month was 59.3 percent, were identified as factors for early cessation of breastfeeding, parity (PR equal 1.41, 95 percent CI: 1.22-1.63) physical fatigue (PR equal 1.18, 95 percent CI: 1.03-1.35), absence of guidance from the hospital breastfeeding (PR equal 1.53, 95 percent CI: 1.33-1.75), low education (PR equal 1.35, 95 percent CI: 1.17-1.57) and poor (PR equal 1.27, 95 percent CI: 1.09-1.47). It follows that intervention measures are necessary in order to increase the rates of EBF directed primiparous women, lower income and less education, as well as sufficient guidance from the breastfeeding pre-natal care and family support for nursing mothers in housework to reduce the negative interference of maternal physical fatigue in the practice of AME.

En general se acepta la recomendación de la lactancia materna exclusiva (LME) en los primeros meses de vida de los niños y el mantenimiento de la lactancia materna por dos años de edad o más, pero hay casos en que su terminación anticipada se puede producir, en vista de las diversas características de las madres y la atención obstétrica. El objetivo de este estudio es identificar las características maternas y la atención de nacimiento asociados con la interrupción de la lactancia materna exclusiva (LME) en niños de menos de un mes. Se trata de una cohorte de 1.309 parejas madre-hijo, atendidos en todos los hospitales de la ciudad en dos meses consecutivos. Los resultados muestran que la prevalencia de lactancia materna exclusiva durante el primer mes fue 59,3por ciento, fueron identificados como factores para el abandono temprano de la lactancia materna, la paridad (RP igual 1,41, IC 95por ciento: 1,22 a 1,63), la fatiga física (RP igual 1,18, IC 95por ciento: 1,03 a 1,35), la falta de orientación de la lactancia materna hospitalaria (RP igual 1,53, IC 95por ciento: 1,33 a 1,75), bajo nivel de educación (RP igual 1,35, IC 95por ciento: 1,17 a 1,57) y pobres (RP igual 1,27, IC 95por ciento: 1,09 a 1,47). Se concluye que lãs medidas de intervención necesarias a fin de aumentar las tasas de lactancia materna exclusiva dirigida las mujeres primíparas, con bajos ingresos y menos educación, así como orientación suficiente para la lactancia de la ayuda prenatal y familiar a las madres en las tareas domésticas para mitigar la interferencia negativa de la fatiga física derivada de la maternidad en la práctica de la lactancia materna exclusiva.

Mastite lactacional / Lactational mastitis

A mastite lactacional, importante causa de desmame, é caracterizada por um processo inflamatório na mama, durante a lactação. Sua incidência variavel de 2 a 33 porcento, com maior ocorrência nas três primeiras semanas do puerpério. A principal causa da mastite lactacional é a estase do leite, associada à infecção. Em relação à fisiopatologia, quando se esgotam os mecanismos de proteção da lactante contra infecção e a estase não é resolvida, o processo inflamatório e o crescimento bacteriano se instalam. A aderência bacteriana pode ser facilitada pelo menor movimento do leite. Embora a simples presença de bactérias no leite não indique necessariamente infecção, o principal agente infeccioso é o Staphylococcus aureus. O diagnóstico geralmente é clínico, baseado em sintomas como dor, edema, calor e vermelhidão na área afetada da mama, podendo associar-se a manifestações sistêmicas, semelhantes às da síndrome gripal. O tratamento é baseado na remoção efetiva do leite da mama, antibioticoterapia, medicamentos sintomáticos e tratamento de suporte. Evitar a estase do leite é o aspecto mais importante no trabamento e prevenção. Para fins didáticos, neste estudo a mastite foi dividida como infecciosa, não-infecciosa e subclínica