ABM Position Statement: Paid Maternity Leave-Importance to Society, Breastfeeding, and Sustainable Development.

Background: Paid maternity leave benefits all of society, reducing infant mortality and providing economic gains. It is endorsed by international treaties. Paid maternity leave is important for breastfeeding, bonding, and recovery from childbirth. Not all mothers have access to adequate paid maternity leave. Key Information: Paid leave helps meet several of the 17 United Nations' Sustainable Development Goals (2, 3, 4, 5, 8, and 10), including fostering economic growth. A family's expenses will rise with the arrival of an infant. Paid leave is often granted with partial pay. Many low-wage workers earn barely enough to meet their needs and are unable to take advantage of paid leave. Undocumented immigrants and self-employed persons, including those engaging in informal work, are often omitted from maternity leave programs. Recommendations: Six months of paid leave at 100% pay, or cash equivalent, should be available to mothers regardless of income, employment, or immigration status. At the very minimum, 18 weeks of fully paid leave should be granted. Partial pay for low-wage workers is insufficient. Leave and work arrangements should be flexible whenever possible. Longer flexible leave for parents of sick and preterm infants is essential. Providing adequate paid leave for partners has multiple benefits. Increasing minimum wages can help more families utilize paid leave. Cash benefits per birth can help informal workers and undocumented mothers afford to take leave. Equitable paid maternity leave must be primarily provided by governments and cannot be accomplished by employers alone.

Recommended Core Competencies for Specialists Practicing Breastfeeding and Lactation Medicine.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using genderinclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.

Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.

Pharmacokinetics of amlodipine besylate at delivery and during lactation.

BACKGROUND: Amlodipine is rarely used in the treatment of pregnant hypertensive women due to limited pharmacokinetic data during pregnancy and the postpartum period. OBJECTIVE: To evaluate the pharmacokinetics of amlodipine besylate in the peri-partum period including quantities of placental passage, breast milk excretion and infant exposure. STUDY DESIGN: This was a prospective study of pregnant women who were prescribed 5 mg of amlodipine daily for treatment of chronic hypertension and delivered at term. Cord and maternal blood samples were collected at delivery. On postpartum day 2, six paired maternal plasma and breast milk samples were obtained at 4, 6, 8, 12, 15 and 24 h following amlodipine dosing. Infant plasma samples were collected 24-48 h after delivery. All samples were analyzed for amlodipine concentration. A one compartment, first-order model was used to calculate pharmacokinetic estimates for maternal plasma. RESULTS: Of the 16 patients enrolled in the study, 11 had cord blood and maternal serum collected at delivery, of which only 6 produced sufficient breast milk for sampling. Amlodipine was detected in infant cord blood plasma with a mean concentration of 0.49 ±â€¯0.29 ng/mL compared to mean maternal serum level of 1.27 ±â€¯0.84 ng/mL. Amlodipine concentrations in both in breast milk and infant plasma were undetectable at the lower limit of assay detection (<0.1 ng/mL). In the immediate postpartum period, the amlodipine elimination half-life was 13.7 ±â€¯4.9 h, the area under the curve was 53.4 ±â€¯19.8 ng*h/mL and the peak concentration was 2.0 ±â€¯1.0 ng/mL. CONCLUSIONS: Amlodipine does cross the placenta in measurable quantities, but is not detected in breast milk or infant plasma at 24-48 h of life indicating that it is likely safe to use during the peripartum period.

Maternal human immunodeficiency virus infection and congenital transmission of cytomegalovirus.

OBJECTIVES: To determine the frequency of congenital cytomegalovirus (CMV) infection in infants born to human immunodeficiency virus (HIV)-infected mothers and assess risk factors that may facilitate intrauterine transmission of CMV, including the role of perinatal HIV infection. METHODS: Retrospective cohort study of infants who were born to HIV-infected mothers at Parkland Memorial Hospital and screened for congenital CMV infection according to a standard nursery protocol between February 1, 1997 and May 31, 2005. RESULTS: During the 8-year study period that included 125,781 live births, there were 367 infants (0.3%) born to 303 HIV-infected mothers. Of 333 HIV-exposed infants who were screened for CMV, 10 (3%) had congenital CMV infection and 6 (60%) of these were identified only because of the CMV screening protocol. Four (1%) infants were infected with HIV, and none of these was CMV-infected. Compared with CMV-uninfected infants, CMV-infected, HIV-exposed newborns had lower mean birth weight (2508 versus 3148 g, P < 0.01), lower gestational age (37 vs. 39 weeks, P < 0.01), and higher median maternal HIV viral load at the start of prenatal care (15,411 vs. 2209 copies/mL, P = 0.02). CMV-infected infants were more likely to be born to mothers who were diagnosed with HIV during the pregnancy or at delivery (P = 0.03). CONCLUSIONS: The prevalence of congenital CMV infection among HIV-exposed newborns was 3%. Screening of these infants for CMV would allow identification of infants who are at risk for delayed onset of hearing loss and other neurodevelopmental impairment.

Pulse oximetry screening at 4 hours of age to detect critical congenital heart defects.

OBJECTIVE: The purpose of this prospective study was to assess the feasibility and reliability of pulse oximetry screening to detect critical congenital heart defects in a newborn nursery. METHODS: The study was performed in a large urban hospital with an exclusively inborn population. Stable neonates who had a gestational age of >or=35 weeks and birth weight of >or=2100 g and in whom a critical congenital heart defect was not suspected were admitted to the newborn nursery. When the 4-hour pulse oximetry reading was <96%, pulse oximetry was repeated at discharge, and when the pulse oximetry reading remained at persistently <96%, echocardiography was performed. RESULTS: Of 15299 admissions to newborn nursery during the 12-month study period, 15233 (99.6%) neonates were screened with 4-hour pulse oximetry. Pulse oximetry readings were >or=96% for 14374 (94.4%) neonates; 77 were subsequently evaluated before discharge for cardiac defects on the basis of clinical examination. Seventy-six were normal, and 1 had tetralogy of Fallot with discontinuous pulmonary arteries. Pulse oximetry readings at 4 hours were <96% in 859 (5.6%); 768 were rescreened at discharge, and 767 neonates had a pulse oximetry reading at >or=96%. One neonate had persistently low pulse oximetry at discharge; echocardiography was normal. Although 3 neonates with a critical congenital heart defect had a 4-hour pulse oximetry reading of <96%, all developed signs and/or symptoms of a cardiac defect and received a diagnosis on the basis of clinical findings, not screening results. CONCLUSIONS: All neonates with a critical congenital heart defect were detected clinically, and no cases of critical congenital heart defect were detected by pulse oximetry screening. These results indicate that pulse oximetry screening does not improve detection of critical congenital heart defects above and beyond clinical observation and assessment. Our findings do not support a recommendation for routine pulse oximetry screening in seemingly healthy neonates.

Newborn hearing screening and detection of congenital cytomegalovirus infection.

OBJECTIVES: The objectives were to determine the frequency of congenital cytomegalovirus infection among newborns who did not pass hearing screening tests or had confirmed hearing loss and to determine how often abnormal hearing screening results were the only manifestation of congenital cytomegalovirus infection. METHODS: Retrospective chart review was performed for newborns who had abnormal hearing screening results and positive urine cytomegalovirus culture results at Parkland Memorial Hospital between September 1, 1999, and August 31, 2004. RESULTS: During the 5-year study period, 572 of 79047 newborns (7 of 1000 live births) did not pass hearing screening tests. Cytomegalovirus infection was identified in 24 (5%) of 483 tested infants and 16 (6%) of the 256 infants with subsequently confirmed hearing impairment. Of those 16 infants, 12 (75%) were identified as having congenital cytomegalovirus infection only because of failure to pass newborn hearing screening tests. CONCLUSIONS: Congenital cytomegalovirus infection was present for 6% of newborns with confirmed hearing impairment, and the majority of those infants were identified on the basis of abnormal newborn hearing screening results.

Evaluation of a transcutaneous jaundice meter following hospital discharge in term and near-term neonates.

OBJECTIVES: To evaluate performance of the Minolta JM-103 Jaundice Meter (JM) as a predictor of total serum bilirubin (TSB) in outpatient neonates during the first week postnatal, and to estimate the number of TSB determinations that might be avoided in clinical use. STUDY DESIGN: In neonates evaluated posthospital discharge, JM and TSB results were compared using linear regression and a Bland-Altman plot, and predictive indices were calculated for various JM cutoff values. Utilizing the 2004 American Academy of Pediatrics (AAP) guidelines, the ability of JM to predict risk zone status was determined. RESULTS: Overall correlation between JM and TSB was 0.77 (p<0.001; n=121). When TSB was >17 mg/dl, a cutoff value for JM of 13 mg/dl had a sensitivity of 1.0, and 50% of TSB determinations would be avoided. CONCLUSIONS: JM may facilitate outpatient management of hyperbilirubinemia by reducing the number of TSB determinations required; however, it does not provide a reliable substitute for laboratory measurement of TSB.

Pneumonia in term neonates: laboratory studies and duration of antibiotic therapy.

OBJECTIVES: To compare 2 days of antibiotic therapy (AT) to 4 days of AT in neonates with pneumonia and to assess the usefulness of neutrophil values (NV), C-reactive protein (CRP), and procalcitonin (PCT) in this population. DESIGN: The study population consisted of consecutive, eligible term neonates begun on AT for suspected pneumonia. Of 51 neonates, 26 qualified for randomization (14, 2-day group; 12, 4-day group). NV were obtained with the initial evaluation and 12 and 24 hours later. CRP and PCT were obtained 12 and 48 hours after the initial evaluation. RESULTS: None of the 12 neonates in the 4-day group developed recurrent respiratory symptoms. Three of the 14 neonates randomized to the 2-day group had recurrence of symptoms, resulting in study termination. NV, CRP, and PCT were similar in the 2- and 4-day groups. In the three neonates who developed respiratory symptoms, all absolute total neutrophil values and five out of nine absolute total immature neutrophil values were abnormal. However, all immature:total neutrophil values were normal, and CRP was strikingly elevated in only one neonate; only one of six PCT values was abnormal. In a secondary analysis of all 51 study neonates, CRP and PCT did not provide additional benefit over NV in differentiating neonates with pneumonia. CONCLUSIONS: Four days of AT appears to be adequate for selected term neonates with pneumonia; however, 2 days of AT appears to be inadequate for this population. Relative to NV, CRP and PCT appear to have a limited role.

Association of hypocalcemia with a change in gentamicin administration in neonates.

Aminoglycosides are administered frequently to neonates with suspected sepsis. We report the association of hypocalcemia in term and near-term neonates receiving gentamicin therapy for >/=4 days after a change in dosing from every 12 h to every 24 h. The possible association with a higher gentamicin dose and longer dosing interval is described.