Mood stabilizers during breastfeeding: a systematic review of the recent literature.

OBJECTIVE: This review examined the safety of mood stabilizers in exposed breastfed infants. METHODS: PubMed was searched for English language reports between 1 January 1995 and 30 August 2015 by using combinations of key words breastfeeding, lactation, postpartum period, puerperium, mood stabilizers, lithium, lamotrigine, valproate, carbamazepine, and oxcarbazepine. Case reports, case series, and prospective or cross-sectional studies including relevant data such as relative infant dose, milk-to-plasma ratio, infant drug plasma levels, and adverse events were identified. RESULTS: A total of 26 of 604 relevant reports in PubMed were included in the study. These reports included lamotrigine (122 cases in 12 reports), lithium (26 cases in five reports), carbamazepine (64 cases in five reports), valproate (nine cases in three reports), and oxcarbazepine (two cases in two reports). Of 26 reports, one report included both carbamazepine and valproate. The reports suggest that a considerable amount of lithium and lamotrigine are excreted into breast milk. There is a paucity of data on valproate and oxcarbazepine; however, the infant/maternal ratio of serum drug concentration seems to be lower in valproate exposure compared to other mood stabilizers. The incidence of adverse events in infants exposed to mood stabilizers is reported to be very low. CONCLUSIONS: The current data suggest that mood stabilizers can be prescribed without any adverse events in most infants in lactating women. The available reports also suggest a low prevalence rate of laboratory abnormalities including hepatic, kidney, and thyroid functions in the infants. Additional studies examining short-term and especially long-term effects of mood stabilizers on breastfed infants are required.

Interim guidelines for the evaluation and testing of infants with possible congenital Zika Virus infection: United States, 2016

CDC has developed interim guidelines for health care providers in the United States who are caring for infants born to mothers who traveled to or resided in an area with Zika virus transmission during pregnancy. These guidelines include recommendations for the testing and management of these infants. Guidance is subject to change as more information becomes available; the latest information, including answers to commonly asked questions, can be found online (http://www.cdc.gov/zika).

Confort y nivel de ruido en ventilación no invasiva con interfase helmet en lactantes / Comfort and noise level in infants with helmet interface

OBJETIVOS: Evaluar el grado de bienestar y el nivel de ruido en lactantes que reciben asistencia respiratoria con interfase tipo helmet. Pacientes y método: Estudio analítico, observacional y descriptivo en el que se incluye a todos los lactantes (entre 1 y 12 meses de edad) con helmet ingresados en una UCIP entre el 1 de noviembre del 2013 y el 31 de marzo del 2014. Para la valoración del bienestar se utilizó la Escala de Confort Pediátrica (ECP). Los niveles de ruido fueron medidos con el sonógrafo HIBOK 412. Se realizaron mediciones 3 veces al día. RESULTADOS: Se incluyó a 27 pacientes con bronquiolitis (edad mediana 54 días; rango: 10 - 256). La puntuación mediana de ECP en el primer día fue de 21 puntos (rango: 14-28). Se observó una mejoría en el bienestar objetivado por una disminución progresiva de las puntuaciones, con una reducción máxima del 22% desde las primeras horas (puntuación de 23) al quinto día (puntuación de 18). La cifra mínima de ruido interno fue de 42dB, la máxima fue de 78dB. Las cifras de ruido externo se correlacionan con las de ruido interno tomadas en el mismo momento. No se observaron diferencias en el grado de bienestar del paciente, ni en el ruido en función del tipo de dispositivo de ventilación empleado. CONCLUSIONES: El helmet es una interfase bien tolerada. La puntuación COMFORT obtenida permite mantener a los niños con un grado entre cómodo y muy cómodo. Los niveles de ruido medidos se encuentran dentro del rango máximo de ruido permitido por la Organización Mundial de la Salud

OBJECTIVES: To evaluate comfort and noise intensity using the COMFORT scale in infants who receive respiratory support with a helmet interface. PATIENTS AND METHODS: An observational descriptive study was conducted on all infants (1 to 12 months of age) admitted to a PICU from November 1st 2013 to March 31th 2014 and who received non-invasive ventilation with a helmet interface. Tolerance to the interface was assessed by use of the COMFORT scale. The intensity of the noise to which the infants were exposed was measured with a TES1350A HIBOK 412 sound-level meter. Three measurements were made every day. RESULTS: Twenty seven patients with bronchiolitis (median age: 54 days; range: 10 to 256) were included. Median COMFORT score in the first day was 21 points (14 - 28). An increase in patient comfort was found with a gradual decrease in the scores, with a maximum reduction of 22% from the first hours (score of 22) to the fifth day (score of 18). The minimum sound intensity registered was 42dB, and the maximum was 78dB. Background noise intensity was associated with noise intensity in the helmet. No differences were observed in COMFORT score and noise intensity between ventilator devices. CONCLUSIONS: Helmet interface was well tolerated by infants. COMFORT score results are an indicator that infants were comfortable or very comfortable. The measured noise intensity was in the safe range permitted by World Health Organization

Implementação da Estratégia Amamenta e Alimenta Brasil no município de Porto Alegre: percepções do tutor / Implementation of the strategy breastfeed and feed Brazil in the city of Porto Alegre: tutors perceptions

Os benefícios do aleitamento materno (AM) para a mãe e o recém-nascido são inúmeros. Da mesma forma, a introdução oportuna da alimentação complementar saudável (ACS) durante a infância influenciará na formação de hábitos alimentares saudáveis que repercutirão na saúde na vida adulta. Em 2012, o MS lançou a Estratégia Amamenta e Alimenta Brasil (EAAB) que tem como objetivo qualificar as ações de promoção do AM e da alimentação complementar saudável para crianças menores de dois anos de idade e aprimorar as competências e habilidades dos profissionais para a promoção do AM e da ACS no seu cotidiano de trabalho nas Unidades Básicas de Saúde. A operacionalização da EAAB envolve a formação de tutores, responsáveis por disseminar e dar continuidade aos objetivos e atividades da estratégia, acompanhando o trabalho das equipes das UBS de forma continua e regular. Trata-se de um estudo qualitativo do tipo exploratório descritivo, que têm o objetivo de conhecer as percepções do tutor da Estratégia Amamenta e Alimenta Brasil com relação à implementação da estratégia no município de Porto Alegre. A coleta de dados foi realizada por meio de entrevista semi estruturada com 13 tutores. Foi realizada análise de conteúdo do tipo temática. O projeto foi aprovado e registrado na Comissão de Pesquisa da Escola de Enfermagem da Universidade Federal do Rio Grande do Sul (nº 797.088) e ao Comitê de Ética e Pesquisa e da Prefeitura Municipal de Porto Alegre (nº 839.963) e com a aplicação do Termo de Consentimento Livre e Esclarecido, de acordo com a Resolução 466/2012. Da análise dos dados emergiram dois temas: 1- O processo de trabalho e as questões gerenciais e 2- A implementação da estratégia: avanços e desafios. (Continua)...

The benefits of breastfeeding (BF) for the mother and the newborn are countless. Similarly, the opportune introduction of healthy complementary feeding (HCF)during childhood will have influence onthe development of healthy eating habits which will have repercussions on their health in adulthood.In 2012, the MH launched the Strategy Feed and Breastfeed Brazil (EAAB) which aims to qualify the actions of the promotion of breastfeeding and healthy complementary eating for children under two years of age and to enhance the skills and abilities of professionalsfor the promotionof BF andof HCF in their daily work routine in Basic Health Units. The operationof EAABinvolves training tutors who are responsible for disseminating and maintaining the strategy’s objectives and activities by continuously and regularly following the work of the Basic Health Unit teams. This is a qualitative study, of the descriptive exploratory type, which aims to better understand the perceptions that tutors have of the Strategy Feed and Breastfeed Brazil,regarding the implementation of the strategy in the city of Porto Alegre.Data was collected from semi structured interviews with 13 tutors. It was performedcontent analysis of the thematic type. The project was approved and booked inthe Research Committee of the Federal University of Nursing of Rio Grande do Sul(nº 797.088), to the Ethics and Research Committee and to the Municipality of Porto Alegre(nº 839.963), and it had the application of the Informed Consent Form, in accordance with Resolution 466/2012. From the data analysis two themes emerged: (1) the process of labor and the management issues and (2) the implementation...

¿Es el hábito tabáquico un factor determinante en la lactancia materna? / Is the smoking habit a determining factor in breastfeeding?

En España, las tasas de lactancia son bajas respecto a lo recomendado por la OMS. La relación entre tabaquismo y lactancia sigue siendo incierta, pero parece dificultarla. El objetivo de este estudio es clarificar el estado actual de la evidencia sobre la influencia del tabaquismo en la lactancia materna. Material y métodos. Revisión bibliográfica en Cochrane Library en español, PubMed, Cuiden y SCielo de publicaciones previas al año 2000. Resultados. Fumar se asocia con menores tasas de inicio de la lactancia y con una menor duración de la misma. La nicotina influye negativamente en la producción de leche, pero los factores sociales parecen ser los más influyentes en el éxito de la lactancia. La lactancia en mujeres fumadoras es más segura que combinar tabaquismo con fórmula artificial. La intervención educativa para modificar las actitudes maternas parece favorecer la lactancia en mujeres fumadoras. Conclusiones. Se necesitan más investigaciones sobre los efectos de la lactancia cuando la madre es fumadora. La lactancia materna es la opción más beneficiosa incluso en mujeres fumadoras (AU)

Lactation rates in Spain are lower than WHO recommendation. The relationship between smoking and breastfeeding is still uncertain but it looks to make it difficult. The aim of this study is to clarify the evidence state about the smoking influence on breastfeeding. Methods. Evidence review was conducted in Cochrane Library, PubMed, Cuiden and SCielo databases. Publications from year 2000 were considered. Results. Smoking is associated with lower rates in breastfeeding initiation and duration. Nicotine has a negative effect on milk production, but social factors seem to be the most important in breastfeeding success. Lactation in smoking women is safer than the smoke exposition combined with formula. Educative interventions to modify maternal attitude seems to facilitate breastfeeding in smoking women. Conclusions. Further investigation about breastfeeding in smoking women is needed. Breastfeeding is the best option even in smoking mothers (AU)

Non fatal injuries among infants: a pilot study.

OBJECTIVE: To determine the incidence, nature and the extent of infant injuries in two suburban and rural communities of Pakistan. METHODS: The cross-sectional study was conducted on a cohort of 310 infants in suburban and rural communities of Pakistan in September 2007. The information was collected from primary care-givers based on any injury that had occurred to their infants during the preceding 3 months that required treatment at home or in a hospital. RESULT: The incidence of non-fatal injury for infants up to 1-year-old was found to be 19 injuries per 100 person (child) years of exposure (95% CI 9.90 - 27.21). In suburban area, the rate was 26 injuries/100 person (child) years (95 % CI 15.37 - 35.71), while in rural area, it was 13 injuries/100 person (child) years of exposure (95 % CI 4.79-18.39). Altogether, 13 episodes of injury were reported among infants in both the communities. The male to female infant ratio for injury was 1:2.2. Suburban area had more than double injuries compared to the rural area. CONCLUSION: The magnitude of infant injuries was quite significant, especially among suburban and female children. There is a dire need to develop community-based interventions creating awareness on the matter.

El sueño en el primer año de vida: ¿cómo lo enfocamos? Presentación / Sleeping in the first year of life: How do we address it? Presentation

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Maternal supplementation for prevention and treatment of vitamin D deficiency in exclusively breastfed infants.

Current research links newborn and infant vitamin D deficiency with various clinical outcomes, including rickets, failure to thrive, type 1 diabetes, and other immune-related diseases. Breastfed infants are often at a greater risk of developing deficiency due to their mothers' low vitamin D status. Human milk reflects the vitamin D status of the mother and often contains inadequate levels of 25-hydroxyvitamin D for infant nutrition. In 2008 the American Academy of Pediatrics (AAP) recommended 400 IU of vitamin D supplementation of all infants. However, research has indicated low levels of compliance of vitamin D supplementation of breastfed infants and a high incidence of vitamin D deficiency in the United States. Many breastfeeding advocates believe that the AAP's recommendations undermine breastfeeding, implying that human milk is inadequate for infant nutrition. Lactating mothers are also reluctant to add any supplements to their breastmilk. The literature review will examine the effectiveness and safety of maternal vitamin D supplementation for prevention and/or treatment of vitamin D deficiency in breastfed infants and lactating mothers. This method of prevention and intervention provides pediatric providers and certified lactation consultants with an alternative approach for education, counseling, promotion of breastfeeding, and treatment to improve maternal and infant health.

No follow-up after positive newborn screening: medical neglect?

The current study examined medical professionals' behaviors related to reporting medical neglect when a family is noncompliant with follow-up services after a positive newborn screening result. Pediatric medical professionals within an urban medical campus were provided with five case vignettes in relation to different diseases. Medical professionals rated the severity of family noncompliance with follow-up services and indicated whether they would report suspected medical neglect to Child Protective Services (CPS). Physicians were more likely to report medical neglect than the other mandated reporters in the study. Logistic regression analyses found that medical professionals' perceptions of the severity of family noncompliance with services were significantly predictive of decisions to report medical neglect. Respondent gender and the method by which families were notified of screening results also significantly affected reporting behaviors in certain instances. Although all vignettes included information that met legal statutes for reporting neglect, medical professionals indicated that they would only report neglect 40-61% of the time across vignettes. Continued investigation of the rationale behind medical professionals' decision-making process and training protocols designed to improve mandated reporter knowledge and reporting behaviors are needed to further reduce bias and improve objectivity when considering ethical and professional obligations to report medical neglect.

[Prophylaxis of vitamin D deficiency--Polish recommendation 2009]. / Stanowisko Zespolu Ekspertów. Polskie zalecenia dotyczace profilaktyki niedoborów witaminy D - 2009.

Adequate vitamin D intake and its status are important not only for bone health and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. Basing on current literature review and opinions of National Consultants and experts in the field, polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women have been established.

Effectiveness of Community Health Workers (CHWS) in the Provision of Basic Preventive and Curative Maternal; Newborn and Child Health (MNCH) Interventions: A Systematic Review

Due to a shortage of health workers; many low income countries rely on community health workers (CHWs) for the provision of a wide range of primary health care services; both curative and preventive; including maternal newborn and child health (MNCH) interventions. Several systematic reviews have analysed the contribution of CHWs although none has specifically focused on their role in relation to MNCH. This review was designed to find evidence of the effectiveness of CHWs in providing basic preventive and curative MNCH interventions; and to identify the factors that are crucial to their performance. It was restricted to articles published from 1998-2008 in the eng language. It included studies with qualitative and quantitative designs. Six electronic databases were searched and data was extracted using a pretested data extraction form designed basing on the Centre for Reviews and Dissemination (CRD) guidelines (2008). A narrative synthesis approach was used. The quality of included studies was assessed using pretested validity assessment tools and the applicability of interventions was evaluated using the RE-AIM framework. After the filtering; 14 studies were critically appraised; and the majority (12/14) demonstrated that CHWs were effective at reducing neonatal/child mortality rates; promoting breastfeeding practices; increasing sulfadoxine-pyrimethamine (SP) coverage for intermittent preventive treatment of malaria in pregnancy (IPTp); they provided depot medroxy-progesterone acetate (DMPA) injections as safely as qualified staff; and treated malaria in children effectively; thereby reducing workload of health professionals at peripheral health facilities. Crucial factors to their performance included training; remuneration; inadequate medical supplies; and lack of career development structure. The review shows that CHWs can be effective at providing basic curative and preventive MNCH interventions. Developing country health systems can make use of this available resource to increase access of MNCH interventions

Assessment of breastfeeding and infant growth.

The purpose of this article is to provide information for health care professionals to guide the assessment of feeding and growth in breastfed infants. Tools to assist in the assessment of breastfeeding are discussed, as well as infant weight, infant test-weighing, elimination, and growth patterns. We present in detail the research surrounding the development of infant growth charts and the potential for inaccurate assessment.

SAFE discharge for infants with high-risk home environments.

Safe transitioning of high-risk infants from hospital to home requires these essential elements: (1) a thorough understanding and adherence to infant-identified discharge criteria; (2) the coordination and progression of educational activities that prepare families for care at home; (3) the appropriate identification and utilization of referral services, both during hospitalization and in the community; (4) the involvement of community healthcare providers well versed in the care and follow-up of infants born ill or prematurely; (5) the psychosocial adaptations parents make as they accept their role as independent caregiver. A family Social assessment, Advocacy by all healthcare team members for the safety and well-being of the infant, strong Family involvement, and accessible Environmental resources contribute to the success of a SAFE discharge.