Tecnologias educacionais direcionadas ao aleitamento materno produzidas na pós-graduação em enfermagem brasileira / Educational technologies directed to breastfeeding produced in brazilian nursing graduate / Tecnologías educativas orientadas a la lactancia materna producidas en programas de posgrado en enfermería brasileños

Objetivo: Conhecer as tecnologias educacionais voltadas à prática do aleitamento materno desenvolvidas por enfermeiros. Método: Revisão Integrativa realizada nas bases de dados da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e Biblioteca Digital Brasileira de Teses e Dissertações, em dezembro de 2021. Inicialmente foram identificados 313 trabalhos, após aplicados critérios de inclusão e exclusão foram selecionados 13 estudos para a amostra. Resultados: Verificou-se as seguintes tecnologias: álbum seriado, iconografia 3D, rádio, telefone, literatura de cordel, websites e simuladores realísticos de baixa fidelidade. Os estudos visaram desenvolver, avaliar ou validar tecnologias educacionais voltadas para o aleitamento materno no que diz respeito aos benefícios quando se trata do manejo correto. Conclusão: As tecnologias educacionais têm sido alvo no desenvolvimento de pesquisas em Enfermagem, contribuindo para a promoção do aleitamento materno, beneficiando mães e bebês e dinamizando o processo de cuidar.

Objective: To learn about educational technologies related to breastfeeding practice. Methods: Integrative Review conducted in the Coordination for the Improvement of Higher Education Personnel (CAPES) and Brazilian Digital Library of Theses and Dissertations (BDTD) databases, from December 2019 to December 2021. Initially, 313 studies were identified, and after applying the inclusion and exclusion criteria, 13 studies were selected for the sample. Results: The following technologies were verified: serialized album, 3D iconography, radio, telephone, string literature, websites, and low fidelity realistic simulators. The studies aimed to develop, evaluate, or validate educational technologies focused on breastfeeding with regard to the benefits when it comes to the correct management. Conclusion: Educational technologies have been a target in the development of nursing research, contributing to the promotion of breastfeeding, benefiting mothers and babies and streamlining the care process.

Objetivo: Conocer las tecnologías educativas orientadas a la práctica de la lactancia materna. Métodos: revisión integradora realizada en las bases de datos Coordinación para el Perfeccionamiento del Personal de Educación Superior (CAPES) y la Biblioteca Digital Brasileña de Tesis y Disertaciones (BDTD), desde diciembre de 2019 hasta diciembre de 2021. Inicialmente se identificaron 313 estudios, luego de aplicar los criterios de inclusión y exclusión, se seleccionaron 13 estudios para la muestra. Resultados: se verificaron las siguientes tecnologías: álbum en serie, iconografía 3D, radio, teléfono, literatura de cuerdas, sitios web y simuladores realistas de baja fidelidad. Los estudios tuvieron como objetivo desarrollar, evaluar o validar tecnologías educativas orientadas a la lactancia materna en cuanto a beneficios en cuanto a un correcto manejo se refiere. Conclusión: Las tecnologías educativas han sido un objetivo en el desarrollo de la investigación en enfermería, contribuyendo a la promoción de la lactancia materna, beneficiando a madres y bebés y agilizando el proceso de atención.

Em ratos, interrupção precoce da amamentação causa alterações no estômago e intestino

Estudos feitos por pesquisadoras do Instituto de Ciências Biomédicas (ICB) da USP mostram que ratos desmamados precocemente apresentam um aumento nos indicadores de crescimento do estômago e uma retração nas taxas de crescimento do intestino. “Essas mudanças, que podem se estender até a fase adulta, se tornam gatilhos para o desenvolvimento de algumas doenças gastrointestinais”, afirma a professora Patrícia Gama, coordenadora do Laboratório de Biologia dos Epitélios Digestivos e diretora do ICB.

Encontro com Especialistas - Agosto Dourado 2023

Encontro com a Especialista Sônia Venâncio, Coordenadora da Atenção à Saúde da Criança e do Adolescente (CACRIAD/DGCI/SAPS/Ministério da Saúde). Agosto Dourado 2023 - Apoie a Amamentação: faça a diferença para mães e pais que trabalham.

Breastfeeding in primiparous women - expectations and reality: a prospective questionnaire survey.

BACKGROUND: Breastfeeding provides the optimal nutrition for infants and offers numerous benefits for both mother and child. The World Health Organisation recommends exclusive breastfeeding during the first 6 months of life and the introduction of complementary feeding between the fifth and seventh months of life. There is a discrepancy between breastfeeding recommendations and the actual duration of breastfeeding. The aim of this study was to analyse breastfeeding behaviour in primiparous women in order to be able to provide support for mothers. METHODS: In this prospective, questionnaire-based study conducted between 2020 and 2022, primiparous women were asked to complete three questionnaires at three defined survey time points (routine prepartum presentation, postpartum hospitalization, completed sixth month of life). RESULTS: A total of 140 women were included and returned all three questionnaires. Fifty-eight percent performed breastfeeding exclusively at least until their baby had reached the age of 6 months, whereas 20% already stopped within the first 6 months. The main reasons given for early cessation were insufficient milk supply and inadequate infant weight gain. A comprehensive level of prepartum knowledge had a significant positive effect on participants' sense of confidence with breastfeeding. Sociodemographic factors such as age and educational level were also associated with breastfeeding behaviour, but significant corresponding differences in the duration of breastfeeding were not observed. Women with postpartum midwifery care breastfed significantly longer (p < 0.05). CONCLUSIONS: Breastfeeding behaviour and duration are influenced by multiple factors. Although certain sociodemographic factors are unalterable, comprehensive prepartum knowledge transfer and postpartum midwifery care have a positive impact on breastfeeding behaviour. TRIAL REGISTRATION: The study was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) on 6 December 2022 (DRKS00030763).

Breastfeeding practices among patients managed by a comprehensive cardio-obstetrics program.

Objective: To evaluate breastfeeding intent, rates at discharge, and continued breastfeeding at follow-up in patients managed in a comprehensive cardio-obstetrics program stratified by severity of maternal cardiac disease.Study Design: Retrospective cohort of patients managed by a comprehensive cardio-obstetrics program at the University of Alabama at Birmingham (UAB). Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team and delivered at UAB. The primary outcome was the breastfeeding rate on discharge from the delivery-associated hospitalization. Secondary outcomes included intent to breastfeed on admission and breastfeeding at the postpartum visit. Baseline characteristics and rates were compared between patients with less severe (mWHO I - II/III) vs. more severe (mWHO III - IV) maternal cardiac disease.Results: 147 patients were included: 85 (57.8%) mWHO class I - II and 62 (42.2%) mWHO class III-IV. Patients with more severe maternal cardiac disease had higher rates of chronic hypertension (22.6% vs. 9.4%; p = 0.027), lower gestational age at delivery (36.4 vs 37.7 weeks; p = 0.008), and higher rates of NICU admission (31.2% vs. 14.1%; p = 0.013). There were no significant differences between mWHO class I-II vs. mWHO class III-IV in intent to breastfeed upon admission to the delivery-associated hospitalization (84.7% vs. 82.3%; p = 0.67), breastfeeding rates upon discharge from the delivery-associated hospitalization (90.6% vs. 87.1%; p = 0.50), or breastfeeding rates at the postpartum visit (54.1% vs. 48.5%; p = 0.60).Conclusions: Despite potential barriers in this high-risk population, over 85% of patients breastfed upon discharge from the delivery-associated hospitalization. However, breastfeeding rates dropped by 40% at the postpartum visit. Strategies to support breastfeeding in the post-partum period in patients with maternal cardiac disease are imperative.

Management of epilepsy during pregnancy and lactation.

Epilepsy is a group of neurological diseases characterized by susceptibility to recurrent seizures. Antiseizure medications (ASMs) are the mainstay of treatment, but many antiseizure medications with variable safety profiles have been approved for use. For women with epilepsy in their childbearing years, the safety profile is important for them and their unborn children, because treatment is often required to protect them from seizures during pregnancy and lactation. Since no large randomized controlled trials have investigated safety in this subgroup of people with epilepsy, pregnancy registries, cohort and case-control studies from population registries, and a few large prospective cohort studies have played an important role. Valproate, in monotherapy and polytherapy, has been associated with elevated risk of major congenital malformations and neurodevelopmental disorders in children born to mothers who took it. Topiramate and phenobarbital are also associated with elevated risks of congenital malformations and neurodevelopmental disorders, though the risks are lower than those of valproate. Lamotrigine and levetiracetam are relatively safe. Insufficient data exist to reach strong conclusions about the newest antiseizure medications such as eslicarbazepine, perampanel, brivaracetam, cannabidiol, and cenobamate. Besides antiseizure medications, other treatments such as vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation are likely safe. In general, breastfeeding does not appear to add any additional long term risks to the child. Creative ways of optimizing registry enrollment and data collection are needed to enhance patient safety.

Early Life Nutrition Factors and Risk of Acute Leukemia in Children: Systematic Review and Meta-Analysis.

Acute leukemia commonly occurs in young children with peak incidence at the age of 2-5 years. However, the etiology is still unclear and many preventable risk factors still deserve to be reviewed. The focus of this systematic review and meta-analysis is to summarize the evidence concerning early life nourishment (breastfeeding, early life diet), neonatal vitamin K administration and the risk of acute leukemia. All epidemiological studies published up to June 2023 and assessing diet-related risk factors for childhood acute leukemia were identified in two electronic databases (PubMed and Web of Science), with no limits on publication year or language. A total of 38 studies (37 case-control studies and 1 study with pooled analysis) were included. The published risk estimates were combined into a meta-analysis using the Generic Inverse Variance method. The current evidence shows that breastfeeding (yes vs. no) has a protective effect against acute lymphoblastic leukemia (odds ratio = 0.85; 95% CI, 0.76-0.94). Evidence related to the role of other studied factors (foods and supplements) is inconclusive. Further research into the potential role of diet in early life and the risk of acute leukemia is needed to develop prevention strategies at population level. Review Registration: PROSPERO registration no. CRD42019128937.

Global lessons for strengthening breastfeeding as a key pillar of food security.

Breastfeeding is identified as a central pillar of food security by the World Health Organization, however globally significant challenges remain in achieving breastfeeding targets for early initiation, exclusive breastfeeding for 6 months, and continued breastfeeding for 2 years and beyond. Inadequate support in health systems, poor maternity protections and workplace policies, and insufficient regulation of commercial milk formulas, among other barriers, continue to undermine this key pillar across nations. This paper highlights the central importance of breastfeeding for food security across diverse global settings by examining three case studies: Honduras, Pakistan and the USA. The cases highlight the complex layering and intersections of key challenges that threaten breastfeeding in the era of pandemics, the climate crisis, conflict and global inequality. Lessons drawn from these case studies, combined with additional insights, reinforce the importance of multisectorial collaboration to scale up investment in creating equitable, enabling environments for breastfeeding. These structural and systems approaches can successfully strengthen the breastfeeding ecosystem to ensure greater first food system resilience in the face of global crises, which compound maternal and infant vulnerabilities. Additionally, the cases add urgency for greater attention to prioritizing breastfeeding and incorporating IYCF-E protocols into disaster preparedness and management into the policy agenda, as well as ensuring that first food security is considered in energy policy. An integrated approach to policy change is necessary to recognize and strengthen breastfeeding as a pivotal part of ensuring food security across the globe.

[Conditions for performing CT and MRI scans in pregnant and lactating patients]. / Att tänka på vid neuroradiologisk diagnostik av gravida och ammande.

Many women are pregnant during several percent of their lives. Occasionally, there is a need for neuroradiological examinations during pregnancy or lactation. In our clinical work, we regularly see that female patients are being withheld relevant diagnostic scans during pregnancy, due to insufficient knowledge or an unbalanced comparison between benefits and risks. This article describes the current knowledge regarding conditions for performing CT and MRI scans in pregnant and lactating patients, including the use of contrast media. PET scans and reactions to contrast media are briefly mentioned, but interventional radiology is not discussed.

Factors associated with exclusive breastfeeding during postpartum in Lanzhou city, China: a cross-sectional study.

Aim: Breastfeeding generates short-term and long-term benefits for both mother and child. Exclusive breastfeeding (EBF) is promoted in China for years, but its practice still lags far behind the international average, even among low- and middle- income countries. This study aimed to investigate factors associated with EBF during postpartum. Methods: This study was conducted in a tertiary referral hospital in Gansu Province, Northwest China from October 2019 to April 2020. 3,738 postnatal women were finally included and each of them completed an elaborately designed questionnaire. Infant feeding patterns (EBF or not) and reasons for NEBF (non-exclusive breastfeeding) were collected. The feeding knowledge score was based on 17 questions in relation to breastfeeding. The total score ranges from 0 to 17. Higher score means better understanding about breastfeeding knowledge. Multivariate logistic regression models were used to determine associated factors of EBF during postpartum. A subgroup analysis was conducted to investigate the association between feeding knowledge score and exclusive breastfeeding. Results: Six weeks after childbirth, 1891 mothers (50.6%) maintained EBF. Among the NEBF mothers, 57.01% (n = 1,053) of them stopped exclusive breastfeeding due to self-perceived lack of breast milk production. Factors associated with NEBF were higher maternal age, ethnic minorities and cesarean section. Protective factors of EBF included multipara, positive feeding attitude and high breastfeeding knowledge score. In subgroup analysis, we found the breastfeeding knowledge score had a significant impact on the mothers of Han nationality, underwent cesarean or natural delivery, both primiparous and multiparous, and those with positive attitude towards breastfeeding (p < 0.05). Conclusion: We need a comprehensive and individualized framework of strategies to support children, mothers and their families. During puerperium, improving maternal knowledge of breastfeeding is beneficial to EBF practice. However, for ethnic minorities and those with less active breastfeeding attitudes, breastfeeding knowledge is of limited use, more researches are needed to explore the uncovered reasons, so that more personalized interventions could be developed for them.

Household environment and animal fecal contamination are critical modifiers of the gut microbiome and resistome in young children from rural Nicaragua.

BACKGROUND: Early life plays a vital role in the development of the gut microbiome and subsequent health. While many factors that shape the gut microbiome have been described, including delivery mode, breastfeeding, and antibiotic use, the role of household environments is still unclear. Furthermore, the development of the gut antimicrobial resistome and its role in health and disease is not well characterized, particularly in settings with water insecurity and less sanitation infrastructure. RESULTS: This study investigated the gut microbiome and resistome of infants and young children (ages 4 days-6 years) in rural Nicaragua using Oxford Nanopore Technology's MinION long-read sequencing. Differences in gut microbiome diversity and antibiotic resistance gene (ARG) abundance were examined for associations with host factors (age, sex, height for age z-score, weight for height z-score, delivery mode, breastfeeding habits) and household environmental factors (animals inside the home, coliforms in drinking water, enteric pathogens in household floors, fecal microbial source tracking markers in household floors). We identified anticipated associations of higher gut microbiome diversity with participant age and vaginal delivery. However, novel to this study were the significant, positive associations between ruminant and dog fecal contamination of household floors and gut microbiome diversity. We also identified greater abundance of potential pathogens in the gut microbiomes of participants with higher fecal contamination on their household floors. Path analysis revealed that water quality and household floor contamination independently and significantly influenced gut microbiome diversity when controlling for age. These gut microbiome contained diverse resistome, dominated by multidrug, tetracycline, macrolide/lincosamide/streptogramin, and beta-lactam resistance. We found that the abundance of ARGs in the gut decreased with age. The bacterial hosts of ARGs were mainly from the family Enterobacteriaceae, particularly Escherichia coli. CONCLUSIONS: This study identified the role of household environmental contamination in the developing gut microbiome and resistome of young children and infants with a One Health perspective. We found significant relationships between host age, gut microbiome diversity, and the resistome. Understanding the impact of the household environment on the development of the resistome and microbiome in early life is essential to optimize the relationship between environmental exposure and human health. Video Abstract.

COVID-19 fear, vaccination hesitancy, and vaccination status in pregnant and breastfeeding women in Turkey.

This study aimed to determine the level of COVID-19 fear, vaccination, and vaccination hesitancy as well as the affecting factors in pregnant and breastfeeding women who participated in an online prenatal education in Turkey. The study, which was designed as descriptive cross-sectional, was conducted online with 360 pregnant and breastfeeding women from Istanbul. Data were collected through the Participant Information Form, Fear of COVID-19 Scale and Vaccine Hesitancy Scale in Pandemics. The rate of accepting the COVID-19 vaccine is 65.6%. The Fear of COVID-19 Scale was 16.215.54, and the Vaccine Hesitancy Scale in Pandemics mean score was 29.294.54. The COVID-19 fear of the women participating in this study was moderate, the level of vaccination hesitancy was low, and two-thirds of them were vaccinated. There is a need to organize special counseling and vaccination campaigns for pregnant and lactating women.

Untargeted Metabolomic Analysis of Lactation-Stage-Matched Human and Bovine Milk Samples at 2 Weeks Postnatal.

Epidemiological data demonstrate that bovine whole milk is often substituted for human milk during the first 12 months of life and may be associated with adverse infant outcomes. The objective of this study is to interrogate the human and bovine milk metabolome at 2 weeks of life to identify unique metabolites that may impact infant health outcomes. Human milk (n = 10) was collected at 2 weeks postpartum from normal-weight mothers (pre-pregnant BMI < 25 kg/m2) that vaginally delivered term infants and were exclusively breastfeeding their infant for at least 2 months. Similarly, bovine milk (n = 10) was collected 2 weeks postpartum from normal-weight primiparous Holstein dairy cows. Untargeted data were acquired on all milk samples using high-resolution liquid chromatography-high-resolution tandem mass spectrometry (HR LC-MS/MS). MS data pre-processing from feature calling to metabolite annotation was performed using MS-DIAL and MS-FLO. Our results revealed that more than 80% of the milk metabolome is shared between human and bovine milk samples during early lactation. Unbiased analysis of identified metabolites revealed that nearly 80% of milk metabolites may contribute to microbial metabolism and microbe-host interactions. Collectively, these results highlight untargeted metabolomics as a potential strategy to identify unique and shared metabolites in bovine and human milk that may relate to and impact infant health outcomes.

Immunomodulatory Effect of Infectious Disease of a Breastfed Child on the Cellular Composition of Breast Milk.

Recent studies suggest that the content of immune components in milk is influenced by the mother's health and also by the infant she feeds. We aimed to evaluate the effect of a child's respiratory tract infection on the cellular composition of breast milk (neutrophils, monocytes, eosinophils, lymphocytes, and their subpopulations). Twenty-six breastfeeding mothers whose children were hospitalized for respiratory tract infections were enrolled in the study. The control group consisted of 23 mothers of healthy children. Regarding the children, baseline laboratory blood tests were performed, and nasal swabs were taken for the presence of RS virus. In the next step, milk samples were collected from the mothers to assess the cellular composition of the milk, including neutrophils, monocytes, eosinophils, lymphocytes, and their subpopulations. Significantly higher percentages of T lymphocytes (helper and cytotoxic lymphocytes) were observed in the milk of the studied mothers. There was a significantly higher percentage of milk lymphocytes in the group of affected children with confirmed RSV etiology than in children with excluded RSV etiology. A significant positive correlation was observed between the duration of infection and the percentage of milk NK cells and between milk CD19 lymphocytes and the child's serum leukocytosis. This study may provide evidence of a link between cells in breast milk and disease in the breastfed infant. The severity of the infection, its duration, and the etiological agent of the infection may affect the cellular composition of milk.

The number of erupted teeth as a risk factor for dental caries in eighteen-month-old children: a cross­sectional study.

BACKGROUND: Dental caries is one of the most common chronic diseases worldwide, affecting lifelong as well as children. Therefore, it is important to clarify factors related to early childhood caries (ECC) in a younger population in terms of caries prevention. However, the prevalence of ECC is low in developed countries in the twenty-first century and a large-scale survey is needed to clarify the risk factors. Furthermore, earlier tooth eruption is not taken into consideration in most studies of ECC, even though it may be a factor of ECC. The present study investigated the prevalence and risk factors of dental caries in children aged 18 months in a core city of Japan. METHODS: Findings from a total of 7351 children aged 18 months were analyzed. Anthropometric measurements of height and weight, as well as an oral examination and a microbiological caries-risk test, were performed. Additionally, a structured interview sheet was provided to the parents or guardians. Findings of dental caries at 18 months of age were evaluated using a logistic regression model. RESULTS: Of the enrolled children, 1.2% had experienced dental caries. Multivariable logistic regression analysis results indicated a significant association with dental caries at 18 months of age for the following factors: second child (OR = 1.78; 95% CI:1.08-2.93, P < 0.05), third and later child (OR = 2.08; 95% CI:1.12-3.89, P < 0.05), 12 or fewer erupted teeth (OR = 0.47; 95% CI:0.24-0.96, P < 0.05), 17 or more erupted teeth (OR = 4.37; 95% CI:1.63-11.7, P < 0.01), Cariostat score (+ + +) (OR = 3.99; 95% CI:1.29-12.31, P < 0.05), daily eating before bed (OR = 2.62; 95% CI: 1.55-4.45, P < 0.001), three or more snacks per day (OR = 2.03; 95% CI:1.15-3.58, P < 0.05), and breastfeeding (OR = 3.30; 95% CI:2.00-5.44, P < 0.001). CONCLUSIONS: These results suggest that the number of erupted teeth, as well as birth order, eating habits, and breastfeeding, are significant factors in dental caries occurrence at 18 months of age.

Determinants of early interruption of exclusive breastfeeding at Dollo Ado refugee camps, Dollo Ado district, Ethiopia.

Introduction: nearly three-quarters of infants younger than six months were not exclusively breastfed globally. Despite some research indicating what factors influence early exclusive breastfeeding interruption in Ethiopia's stable population, there is little evidence indicating what factors influence exclusive breastfeeding interruption in vulnerable populations such as refugee camps. Therefore, this study aimed to determine the factors that contributed to the early termination of exclusive breastfeeding in Ethiopian refugee camps in the Dollo Ado district. Methods: a case-control study was conducted at the Dollo Ado refugee camps from April 05th to 25th, 2017. The eligible 112 cases and 224 controls were identified using the 24-hour recall method. The information was gathered using an interviewer-administered questionnaire that was pretested and organized. Logistic regression analysis was computed to assess the effect of independent variables. Results: the determinants for early interruption of exclusive breastfeeding were not counseled about infant feeding during antenatal care follow-up (adjusted odds ratio (AOR =5.87, 95% CI [2.61-13.1]), not counseled about infant feeding during postnatal care service use (AOR= 4.33, 95% CI [2.71-10.8), breastfeeding problem (AOR= 5.62, 95% CI [4.55-15.2]) and late initiation of breastfeeding (AOR= 4.79, 95% CI [28-10.1]). Conclusion: in this study, early termination of exclusive breastfeeding was caused by breastfeeding problems and late commencement of breastfeeding, as well as not receiving infant feeding advice during antenatal care or postnatal care. The results of this study highlight the significance of concentrating on newborn and young child feeding counseling during prenatal and postnatal care services in order to promote exclusive breastfeeding. In addition, health providers should educate parents on the significance of starting exclusive breastfeeding on time and obtaining help right away if there is a problem, such as breast soreness or the infant refusing to eat due to oral trash, to avoid early exclusive breastfeeding interruption.