Management of lactating breast abscesses by ultrasound-guided needle aspiration and continuation of breastfeeding: A pilot study.

INTRODUCTION: Needle aspiration of breast abscesses during lactation are currently recommended as an alternative to surgery only for moderate forms. In case of breast abscess, many patients stop breastfeeding on the advice of a health professional. We reviewed our experience of treatment of lactating breast abscesses by ultrasound-guided aspiration and suggest an algorithm of their management. We also analyzed the continuation of breastfeeding of these patients after advices from trained teams. MATERIEL AND METHODS: We conducted a retrospective study from April 2016 to April 2017, including 28 patients referred for a breast abscess during lactation at the Duroc Breast Imaging Center. A management by ultrasound-guided aspiration was proposed to each patient. We collected data about the breastfeeding between October 2018 and January 2019. RESULTS: A single aspiration was sufficient in 64.3% of cases. The delay between the occurrence of the abscess and the indication for drainage was significantly higher for patients who have needed finally surgical drainage (p = 0,0031). There were no difference of size of abscesses between patients receiving needle aspiration alone and those who have undergone surgery (p = 0,97). All patients who had been managed by needle aspiration continued breastfeeding after the treatment and 40% of the patients were still breastfeeding at 6 months. CONCLUSION: The management of lactating breast abscess by ultrasound-guided needle aspiration is an effective alternative to surgery. It appears to be effective regardless of the size of the abscess and is compatible with the continuation of breastfeeding. Our study has indeed shown that if they are well advised, the majority of patients continue breastfeeding so that it is essential that health professionals be better trained regarding the management of breastfeeding complications.

Simple actions to support breastfeeding can avoid unwanted weaning in infants younger than 6 months hospitalized for bronchiolitis: A before/after study (Bronchilact II).

BACKGROUND: Admission to hospital with bronchiolitis may adversely affect breastfeeding. Correct advice and support have been pointed out as a determining factor. OBJECTIVES: We conducted a telephone survey to evaluate a set of actions to promote breastfeeding during hospitalization for acute bronchiolitis. METHODS: Population: All patients 6 months of age or younger hospitalized with acute bronchiolitis and receiving at least partial breastfeeding were eligible for the study. Patients discharged home whose parents accepted to be contacted by phone were also included. INTERVENTION: We established a set of actions to promote breastfeeding (posters, flyers, staff training, and equipment) in all pediatric wards attending to these patients. COMPARISON: This was a cross-sectional study conducted during two epidemic seasons of bronchiolitis in a tertiary care hospital. Data on continued breastfeeding at 3 months (0.5-6; median, range) postdischarge were collected by telephone and compared with the same set of data collected from patients with bronchiolitis in the same setting the year before the intervention. OUTCOME: We conducted a telephone survey to evaluate whether some actions regarding breastfeeding might diminish the risk of unwanted weaning during hospitalization for bronchiolitis. The primary outcome was the proportion of stopped or reduced breastfeeding at discharge. Secondary objectives were to evaluate whether there were factors associated with breastfeeding modification. RESULTS: The results of the evaluation before intervention (phase 1) are published by Heilbronner et al. In Phase 1 of our study, 84 patients were included and 43 mothers (51%) reported that breastfeeding was modified by hospitalization of their child: 20.4% stopped, 14% switched to partial breastfeeding, and 16.6% reduced breastfeeding. These mothers stated that causes of breastfeeding disturbances were lack of support and advice (63%), followed by severity of the child's respiratory disease (32%), logistical hospital difficulties (30%), and personal organizational issues (9.3%). The intervention took place in September. After the intervention, 50 patients could be included in the study between October 1and December 31, 2016. Among them, 40 (80%) mothers kept breastfeeding as before, four (8%) stopped, four (8%) switched to partial breastfeeding, and two (4%) reduced breastfeeding without stopping. Bronchiolitis was more severe among patients with altered breastfeeding in terms of ventilatory support. CONCLUSION: Bronchiolitis is a high-risk event for breastfeeding disruption but interventions to promote breastfeeding might help to prevent the risk of unwanted weaning. More severe bronchiolitis probably poses the highest risk of weaning and the need for supplementary nutrition.

Prenatal stress and neonatal handling induce sex-specific changes in dendritic complexity and dendritic spine density in hippocampal subregions of prepubertal rats.

Maternal stress during gestation in humans and experimental animals can result in emotional and cognitive dysfunction in the offspring. To facilitate our understanding of the underlying neuronal changes induced by prenatal stress (PNS), the dendritic and synaptic development was analyzed in three-dimensionally reconstructed Golgi-impregnated neurons in the hippocampal formation of offspring from pregnant dams which were stressed from day 15-20 by varied stressors. The analysis was focused on prepubertal rats and on the comparison of stress vulnerabilities in male and female offspring. In the hippocampal CA1 region PNS increased spine density on pyramidal neurons only in males, which thereby reached the levels observed in control females. On granular neurons of the dentate gyrus, PNS altered spine-density, dendritic length and dendritic complexity in opposite directions in males and females. In the CA3 area, PNS resulted in shorter and less complex dendrites in both sexes compared with unstressed controls. Another aim was to assess whether neonatal environmental interventions, such as handling (H) during the first 10 postnatal days, can reverse PNS-induced neuronal changes. We show here for the first time that H can "reverse" or prevent PNS-induced changes in spine density and dendritic length and complexity in a sex-, region- and dendrite-specific manner. These findings indicate that the sex-specific changes of neuronal and synaptic features in the hippocampal formation may represent a neuronal substrate of the stress-induced behavioral alterations and that these changes can be partly "normalized" by neonatal interventions.