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1.
Lima; Perú. Ministerio de Salud; 1 ed; 20190600. 83 p. tab, ilus.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1006511

RESUMO

La publicación describe los estándares, procesos técnicos y operativos para la implementación,funcionamiento y promoción de bancos de leche humana y centros de recolección de leche humana extraída y donada en el Perú, así como los procedimientos para procura, procesamiento, prescripción,distribución, administración y manipulación de la leche humana donada, según estándares internacionales de calidad.


Assuntos
Bancos de Leite , Promoção da Saúde , Normas Técnicas , Extração de Leite
3.
Nutrients ; 11(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30987136

RESUMO

The influence of types of human milk (HM)-raw own mother's milk (OMM), pasteurized OMM, and donor milk (DM)-was evaluated for growth in premature infants fed exclusively HM with controlled nutritional intakes using daily individualized HM fortification (IHMF). Growth and nutritional intakes were prospectively collected in preterm infants (<32 weeks) fed IHMF and compared in infants fed predominantly (≥75%) OMM and DM. The influence of HM types (raw OMM, pasteurized OMM, and DM) on growth were also evaluated in the whole population. One-hundred and one preterm infants (birth weight 970 ± 255 g, gestational age 27.8 ± 1.9 weeks) were included. Energy (143 ± 8 vs. 141 ± 6 kcal/kg/day; p = 0.15) and protein intakes (4.17 ± 0.15 vs. 4.15 ± 0.14 g/kg/day; p = 0.51) were similar in both groups. Infants receiving predominantly OMM (n = 37), gained significantly more weight (19.8 ± 2.0 vs. 18.2 ± 2.2 g/kg/day; p = 0.002) and length (1.17 ± 0.26 vs. 0.99 ± 0.36 cm/week; p = 0.020) than those fed predominantly DM (n = 33). Stepwise multivariate analysis (n = 101) suggests that raw OMM was the major determinant of growth, contributing 22.7% of weight gain. Length gain was also related to OMM (raw + pasteurized) intakes, explaining 4.0% of length gain. In conclusion, at daily controlled similar protein and energy intakes, OMM had significant beneficial effects on weight and length versus DM in VLBW infants. This difference could be partially explained by the use of raw OMM.


Assuntos
Aleitamento Materno , Extração de Leite , Alimentos Fortificados , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Leite Humano , Valor Nutritivo , Ganho de Peso , Peso ao Nascer , Desenvolvimento Infantil , Ingestão de Energia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Proteínas do Leite/administração & dosagem , Estado Nutricional , Pasteurização , Gravidez , Estudos Prospectivos , Fatores de Tempo
5.
Public Health Nurs ; 36(3): 370-378, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30740776

RESUMO

OBJECTIVE: To explore women's experience with continuing breastfeeding when they returned to work. DESIGN AND SAMPLE: A cross-sectional study was conducted. Participants were female employees at the University of Seville who gave birth in the last 10 years while working at University. MEASURES: A questionnaire in Spanish was used to collect information on sociodemographic variables, employment characteristics, continued breastfeeding behavior after returning to work and the dimensions of the validated scale the Workplace Breastfeeding Support Scale (WBSS). RESULTS: A total of 197 women responded, consisting of 53.8% faculty and 46.2% administrative staff. Almost all the women had breastfed their children (92.9%). The proportion of women who continued to breastfeed after they returned to work was 51.3%. The main reason given for interrupting lactation was the challenge of reconciling family and work (53.1%). Faculty members took more breaks for breastfeeding (p = 0.002) and were able to arrange their breaks more easily (p < 0.001). Since it was easier for them to find a quiet place to pump breast milk (p = 0.025), they were more likely to continue breastfeeding after returning to work than were administrative staff (59.8% vs. 41.1%, p < 0.009). CONCLUSION: A designated lactation space and amenities should be provided in order to extend the duration of breastfeeding.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Extração de Leite/psicologia , Extração de Leite/estatística & dados numéricos , Mulheres Trabalhadoras/estatística & dados numéricos , Local de Trabalho/organização & administração , Adulto , Estudos Transversais , Emprego/estatística & dados numéricos , Feminino , Humanos , Espanha , Inquéritos e Questionários , Universidades
6.
Anim Sci J ; 90(3): 445-452, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30656804

RESUMO

Microbiota of the gut, milk, and cowshed environment were examined at two dairy farms managed by automatic milking systems (AMS). Feed, rumen fluid, feces, milk, bedding, water, and airborne dust were collected and the microbiota on each was assessed by Illumina MiSeq sequencing. The most abundant taxa in feed, rumen fluid, feces, bedding, and water were Lactobacillaceae, Prevotellaceae, Ruminococcaceae, Ruminococcaceae, and Lactobacillaceae, respectively, at both farms. Aerococcaceae was the most abundant taxon in milk and airborne dust microbiota at farm 1, and Staphylococcaceae and Lactobacillaceae were the most abundant taxa in milk and airborne dust microbiota at farm 2. The three most prevalent taxa (Aerococcaceae, Staphylococcaceae, and Ruminococcaceae at farm 1 and Staphylococcaceae, Lactobacillaceae, and Ruminococcaceae at farm 2) were shared between milk and airborne dust microbiota. Indeed, SourceTracker indicated that milk microbiota was related with airborne dust microbiota. Meanwhile, hierarchical clustering and canonical analysis of principal coordinates demonstrated that the milk microbiota was associated with the bedding microbiota but clearly separated from feed, rumen fluid, feces, and water microbiota. Although our findings were derived from only two case studies, the importance of cowshed management for milk quality control and mastitis prevention was emphasized at farms managed by AMS.


Assuntos
Microbiologia do Ar , Ração Animal/microbiologia , Criação de Animais Domésticos , Bactérias/isolamento & purificação , Bactérias/patogenicidade , Roupas de Cama, Mesa e Banho/microbiologia , Roupas de Cama, Mesa e Banho/veterinária , Extração de Leite/métodos , Bovinos , Indústria de Laticínios/métodos , Poeira , Fazendas , Fezes/microbiologia , Abrigo para Animais , Leite/microbiologia , Rúmen/microbiologia , Microbiologia da Água , Animais , Feminino , Qualidade dos Alimentos , Mastite Bovina/prevenção & controle , Controle de Qualidade
7.
Neonatal Netw ; 38(1): 34-38, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30679254

RESUMO

PURPOSE: To assess the effect of a quality improvement (QI) bundle on improving breast milk output among very low birth weight (VLBW) mothers. DESIGN: Before and after nonrandomized QI project. SAMPLE: Mothers who delivered a VLBW infant in October and November 2015 were the prospective cohort. Those who delivered a VLBW infant in August and September 2015 were the retrospective cohort. The QI bundle consisted of early expression of milk, use of breast pumps, frequent expressions, videos, and regular counseling. This bundle was done for the prospective cohort. OUTCOMES MEASURES: Quantity of expressed breast milk on day 7. RESULTS: There were 13 mothers in the retrospective cohort and 18 mothers in the prospective one. The mean birth weight (1297.80 and 1207.70 g, p = .19) and gestation (32.5 and 31.5 wk, p = .27) were similar. There was a significant increase in the milk output on day 7 in the prospective group 113.6 ± 45 vs 182 ± 63 mL (p = .001).


Assuntos
Aleitamento Materno/métodos , Extração de Leite/métodos , Aconselhamento , Recém-Nascido de Baixo Peso , Leite Humano , Adulto , Aconselhamento/métodos , Aconselhamento/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Índia , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Masculino , Comportamento Materno , Leite Humano/química , Leite Humano/metabolismo , Avaliação de Processos e Resultados (Cuidados de Saúde) , Educação de Pacientes como Assunto/métodos , Melhoria de Qualidade
8.
Matern Child Nutr ; 14 Suppl 6: e12567, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30592163

RESUMO

There are limited data available about the prevalence of human milk (HM) sharing and selling in the general population. We aimed to describe attitudes toward HM selling among participants in a qualitative-interview study and prevalence of HM sharing and selling among a national sample of U.S. mothers. Mothers (n = 41) in our qualitative-interview study felt that sharing or donating HM was more common than selling; none had ever purchased or sold HM. Three themes related to HM selling emerged from this work: questioning the motives of those selling HM, HM selling limits access to HM to those with money, and HM selling is a legitimate way to make money. Some mothers had reservations about treating HM as a commodity and the intentions of those who profit from the sale of HM. Nearly all participants in our national survey of U.S. mothers (94%, n = 429) had heard of infants consuming another mother's HM. Approximately 12% had provided their milk to another; half provided it to someone they knew. Fewer mothers (6.8%) reported that their infant had consumed another mother's HM; most received this HM from someone they knew. A smaller proportion of respondents (1.3%) had ever purchased or sold HM. Among a national sample of U.S. mothers, purchasing and selling HM was less common than freely sharing HM. Together, these data highlight that HM sharing is not uncommon in the United States. Research is required to create guidelines for families considering HM sharing.


Assuntos
Leite Humano , Obtenção de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Adulto , Atitude , Conscientização , Extração de Leite , Comércio/economia , Feminino , Humanos , Lactente , Comportamento Materno , Inquéritos e Questionários , Estados Unidos
9.
Matern Child Nutr ; 14 Suppl 6: e12566, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30592165

RESUMO

Expressed human milk can be donated or sold through a variety of channels, including human milk banks, corporations or individuals, or peer-to-peer milk sharing. There is a paucity of research regarding the nutrient and bioactive profiles of expressed human milk exchanged through commerce-free scenarios, including peer-to-peer milk sharing. The study objective was to evaluate the macronutrient, antimicrobial protein, and bacteria composition in expressed human milk acquired via commerce-free arrangements. Expressed human milk samples were collected from the following commerce-free scenarios: milk expressed for a mother's or parent's own infant (MOM; N = 30); unpasteurized milk donated to a non-profit milk bank (BANKED; N = 30); milk expressed for peer-to-peer milk sharing (SHARED; N = 31); and health professional-facilitated milk sharing where donors are serologically screened and milk is dispensed raw (SCREENED; N = 30). Analyses were conducted for total protein, lactose, percent fat and water, lysozyme activity, immunoglobulin A (IgA) activity, total aerobic bacteria, coliform, and Staphylococcus aureus. No bacterial growth was observed in 52/121 samples, and 15/121 had growth greater than 5.0 log colony-forming units/mL. There was no evidence of differences by groups (p > .05) in lactose, fat, water, lysozyme activity, sIgA activity, aerobic bacteria, coliforms, and S. aureus. Mean protein values (95% confidence interval) were 1.5 g/dL (1.4, 1.6) for BANKED, 1.4 g/dL (1.3, 1.5) for MOM, 1.6 g/dL (1.5, 1.7) for SCREENED, and 1.5 g/dL (1.4, 1.6) for SHARED, which was not significantly different (p = .081). This research contributes to growing literature on the risks and benefits of uncompensated, peer-to-peer milk sharing.


Assuntos
Anti-Infecciosos/análise , Proteínas do Leite/análise , Leite Humano/química , Leite Humano/microbiologia , Nutrientes/análise , Bactérias Aeróbias/isolamento & purificação , Extração de Leite , Enterobacteriaceae/isolamento & purificação , Gorduras/análise , Feminino , Humanos , Imunoglobulina A/análise , Lactose/análise , Bancos de Leite , Muramidase/análise , Projetos Piloto , Staphylococcus aureus/isolamento & purificação , Doadores de Tecidos
10.
PLoS One ; 13(12): e0208650, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30532278

RESUMO

Perceived low milk supply is a common reason for introducing supplementary feeds, which in turn serves to further diminish the milk supply. Current methods of measuring milk production and milk transfer from the breast to the infant are inaccessible to the mothers. There is a need for an inexpensive, portable device to enable mothers to measure milk transfer to either confirm their milk production is adequate or identify breastfeeding issues early. The aim of this study was to examine changes in bioimpedance spectroscopy associated with milk removal from the human lactating breast using an electric breast pump. Thirty lactating women participated in 2 research sessions performed in random order over 2 weeks. Milk flow rate and volume were measured during pumping. All mothers completed 24-hour milk profiles. Breasts were monitored using bioimpedance spectroscopy. Analysis was performed using linear mixed effects models to investigate the relationship between both proportional change in membrane capacitance (Cm) and R0/R∞ with milk removal. There was an inverse relationship between R0/R∞ and milk removed (p<0.001). A positive relationship was also observed between Cm and both volume of milk removed (P<0.001) and percentage of available milk removed (p<0.001). This study has shown that changes in bioimpedance are related to the volume of milk removed from the breast during pumping. This modality may hold promise for the measurement of the effectiveness of the breastfeeding infant in removing milk from the breast.


Assuntos
Extração de Leite , Espectroscopia Dielétrica/instrumentação , Adulto , Mama/metabolismo , Espectroscopia Dielétrica/métodos , Capacitância Elétrica , Feminino , Humanos , Lactação/metabolismo , Leite Humano/metabolismo , Sistemas Automatizados de Assistência Junto ao Leito , Adulto Jovem
11.
JAMA ; 320(10): 977-978, 2018 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-30208459
12.
Rev. pesqui. cuid. fundam. (Online) ; 10(3): 656-662, jul.-set. 2018. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-906239

RESUMO

Objetivo: Descrever a captação, aproveitamento e o perfil das doadoras de Leite Humano em um Banco de leite de um município do Estado do Paraná. Métodos: Estudo epidemiológico de corte transversal com abordagem quantitativa. Os dados foram coletados entre janeiro e fevereiro de 2015, a partir de fichas arquivadas no primeiro ano de funcionamento, 2013-2014. Resultados: As doadoras eram da faixa etária de 26 a 32 anos, casadas, do lar, tinham 1 ou 2 filhos, foram indicadas por serviços de saúde e a principal motivação para a doação foi o excesso de leite. A média de leite doado foi de 1,4 litros, a maioria na fase madura. Houve perda significativa de leite devido a sujidade. Conclusão: Faz-se necessário, o desenvolvimento de ações para a captação de doadoras, para diminuição das perdas de leite e para educação permanente dos profissionais de saúde envolvidos, a fim de otimizar o funcionamento do serviço


Objetivo: Describir la recopilación, el uso y el perfil de la leche humana de donantes en un banco de leche una ciudad de Paraná. Metodos: Estudio epidemiológico de corte transversal con enfoque cuantitativo. Los datos fueron recogidos entre enero y febrero de 2015, a partir de registros archivados en el primer año de funcionamiento, 2013-2014. Resultados: Los donantes eran del grupo de edad de 26-32 años de edad, casado, tenía su casa 1 o 2 niños, fueron indicados por servicios de salud y la principal motivación para la donación fue el exceso de leche. La leche donada promedio fue de 1,4 litros, sobre todo en la fase de madurez. Había una pérdida significativa de la leche debido a la suciedad. Conclusión: Es necesario, por el desarrollo de acciones para atraer donantes para reducir la pérdida de la leche y la educación de los profesionales de la salud involucrados con el fin de optimizar el funcionamiento del servicio de continuar


Objective: The study's goal has been to describe the collection, utilization and profile of human milk donors in a milk bank of a municipality of Paraná State. Methods: It is a cohort epidemiological study with quantitative approach. Data were collected from January to February 2015, based on records filed in the first year of operation, 2013-2014. Results: Donors belonged to age group from 26 to 32 years old; they were married; they had either 1 or 2 children, and have been indicated by health services, where the primary motivation for the donation was the breast milk excess. The donated milk average amount was 1.4 liter (most in the mature phase). There was a significant loss of milk due to dirtiness. Conclusion: It is necessary the development of actions in order to attract donors, reduce milk loss and provide ongoing education for the health professionals involved, aiming to optimize the service operation


Assuntos
Humanos , Feminino , Adulto , Bancos de Leite/economia , Bancos de Leite , Bancos de Leite/estatística & dados numéricos , Aleitamento Materno , Extração de Leite/economia
13.
Rev. bras. promoç. saúde (Impr.) ; 31(2): 1-7, 22/06/2018.
Artigo em Inglês, Português | LILACS | ID: biblio-906971

RESUMO

OBJETIVO: Avaliar a quantidade de leite materno coletado e com destino à Unidade de Terapia Intensiva (UTI) Neonatal, em um hospital amigo da criança, no Sul do Brasil. MÉTODOS: Estudo observacional, transversal e analítico, realizado no lactário do Hospital Geral de Caxias do Sul, no período de julho a dezembro de 2016. Foram coletados dados da quantidade de leite materno, considerando: entrada total para todos os setores, entrada e saída com destino à UTI Neonatal, desprezos por alta/óbito, degelo vencido e validade expirada. As variáveis categóricas estão apresentadas em números absolutos e percentuais e variáveis contínuas, como média ± desvio padrão. Realizou-se análise estatística através do programa Statistical Package for Social Sciences (SPSS), versão 20.0, considerando significância estatística p<0,05. RESULTADOS: O valor de entrada total no lactário foi de 177.053 mL, a entrada de leite materno para a UTI Neonatal apresentou-se em 153.898 mL, e teve como saída 87,21% desse volume. Os números de desprezo representaram 4,04, 1,14 e 0,55%, respectivamente, sendo por alta/óbito, degelo e validade. A média diária do semestre de esgota para a UTI Neonatal foi 836,40±382,67 mL, e a média diária de utilização de leite materno para a UTI Neonatal de 729,44±341,54 mL. CONCLUSÃO: O lactário apresentou alta porcentagem de esgota e utilização de leite materno e baixo desprezo, demonstrando bom controle de armazenamento e sua importância dentro do hospital amigo da criança. (AU)


OBJECTIVE: To assess the amount of breast milk collected and destined for the Neonatal Intensive Care Unit (ICU) at a baby-friendly hospital in the South of Brazil. METHODS: An analytical, observational cross-sectional study, carried out in the milk dispensary of Caxias do Sul General Hospital, in the period from July to December 2016. Data on the amount of breast milk was collected, considering: total intake for all hospital units, entry and exit of milk destined for the Neonatal ICU, and discarded amounts due to discharge/death, expired thaw and expired validity. Categorical variables are presented in absolute numbers and percentages and continuous variables as mean ± standard deviation. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 20.0, considering p<0.05 as statistical significance level. RESULTS: The total milk intake to the milk dispensary was 177,053 mL; the breast milk entry to the Neonatal ICU was 153,898 mL, and 87.21% of this volume was used. The disposal figures due to discharge/death, thaw and validity represented 4.04, 1.14 and 0.55%, respectively. The mean daily milk expression in the semester for the Neonatal ICU was 836.40 ± 382.67 mL, and the mean daily consumption of human milk for the Neonatal ICU was 729.44 ± 341.54 mL. CONCLUSION: The milk dispensary presented a high percentage of human milk expresstion and consumption and a low disposal, demonstrating a good storage control and its value within the baby-friendly hospital. (AU)


OBJETIVO: Evaluar la cantidad de leche materna extraída y destinada a la Unidad de Cuidados Intensivos (UCI) Neonatal de un hospital amigo del niño en el Sur de Brasil. MÉTODOS: Estudio observacional, transversal y analítico realizado en el lactario del Hospital General de Caxias del Sur en el período entre julio y diciembre de 2016. Se recogieron los datos de la cantidad de leche materna considerando la entrada total para todos los sectores, la entrada y salida para la UCI Neonatal, el desprecio por la alta/el óbito, el deshielo caducado y la validez espirada. Las variables categóricas se presentan con valores absolutos y porcentuales y las variables continuas con la media ± desviación típica. Se realizó un análisis estadístico a través del programa Statistical Package for Social Sciences (SPSS) versión 20.0 con la estadística significativa de p<0,05. RESULTADOS: El valor de la entrada total en el lactario ha sido de 177.053 ml, la entrada de la leche materna para la UCI Neonatal ha sido de 153.898 ml y la salida del 87,21% de ese volumen. Los números del desprecio representaron el 4,04, 1,14 y el 0,55%, respectivamente, por la alta/el óbito, el deshielo y la validez. La media diaria del semestre de la leche agotada para la UCI Neonatal ha sido de 836,40±382,67 ml y la media de la utilización de la leche materna para la UCI Neonatal a diario de 729,44±341,54 ml. CONCLUSIÓN: El lactario presentó alto porcentaje de la leche agotada y de la utilización de la leche materna y bajo desprecio lo que señala un buen control de almacenamiento y su importancia para el hospital amigo del niño. (AU)


Assuntos
Humanos , Recém-Nascido , Lactente , Unidades de Terapia Intensiva Neonatal , Bancos de Leite , Extração de Leite , Leite Humano
14.
Nutrients ; 10(6)2018 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-29795005

RESUMO

This study determined the effects of consuming a high-fructose corn syrup (HFCS)-sweetened beverage on breast milk fructose, glucose, and lactose concentrations in lactating women. At six weeks postpartum, lactating mothers (n = 41) were randomized to a crossover study to consume a commercially available HFCS-sweetened beverage or artificially sweetened control beverage. At each session, mothers pumped a complete breast milk expression every hour for six consecutive hours. The baseline fasting concentrations of breast milk fructose, glucose, and lactose were 5.0 ± 1.3 µg/mL, 0.6 ± 0.3 mg/mL, and 6.8 ± 1.6 g/dL, respectively. The changes over time in breast milk sugars were significant only for fructose (treatment × time, p < 0.01). Post hoc comparisons showed the HFCS-sweetened beverage vs. control beverage increased breast milk fructose at 120 min (8.8 ± 2.1 vs. 5.3 ± 1.9 µg/mL), 180 min (9.4 ± 1.9 vs. 5.2 ± 2.2 µg/mL), 240 min (7.8 ± 1.7 vs. 5.1 ± 1.9 µg/mL), and 300 min (6.9 ± 1.4 vs. 4.9 ± 1.9 µg/mL) (all p < 0.05). The mean incremental area under the curve for breast milk fructose was also different between treatments (14.7 ± 1.2 vs. -2.60 ± 1.2 µg/mL × 360 min, p < 0.01). There was no treatment × time interaction for breast milk glucose or lactose. Our data suggest that the consumption of an HFCS-sweetened beverage increased breast milk fructose concentrations, which remained elevated up to five hours post-consumption.


Assuntos
Bebidas Gaseificadas , Frutose/administração & dosagem , Xarope de Milho Rico em Frutose/administração & dosagem , Lactação/metabolismo , Fenômenos Fisiológicos da Nutrição Materna , Leite Humano/metabolismo , Administração Oral , Adulto , Extração de Leite , Estudos Cross-Over , Feminino , Frutose/farmacocinética , Glucose/metabolismo , Xarope de Milho Rico em Frutose/farmacocinética , Humanos , Lactose/metabolismo , Estado Nutricional , Oklahoma
15.
Adv Neonatal Care ; 18(3): 179-188, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29799821

RESUMO

BACKGROUND: Mother's own milk (MOM) provides significant health benefits to very low birth-weight infants (VLBW, ≤1500 g). However, 60% of African American (AA) women initiate lactation, and less than 35% provide MOM 6 months following the birth of their infant. Previous research focuses on term infants and is not specific to AA mothers of VLBW infants. PURPOSE: To qualitatively describe supports and barriers experienced by AA mothers while providing MOM for their VLBW infants. METHODS: In this qualitative, descriptive study, we conducted semistructured interviews with AA mothers who provided MOM for their VLBW infant. Interviews were transcribed and manually coded concurrently with enrollment until theoretical saturation was achieved. Infant charts were reviewed for demographics, and triangulation with notes from the medical record by bedside nurse lactation consultants and other providers was performed to increase validity. Member checks were completed to ensure true meaning of responses. RESULTS: Theoretical saturation was achieved after 9 interviews. Themes perceived to support provision of MOM included (1) Being a Mother; (2) Neonatal intensive care unit environment; (3) Community support; and (4) Useful resources. Themes that emerged as barriers to the provision of MOM were: (1) Maternal illness; (2) Milk expression; (3) Challenging home environment; and (4) Emotional distress. IMPLICATIONS FOR PRACTICE: African American mothers report supports similar to published data but faced challenges not previously reported. These factors warrant attention by professionals who support lactation in this population. IMPLICATIONS FOR RESEARCH: Future research will address perceived barriers to improve provision of MOM and the quality of the lactation journey of AA mothers of preterm infants.


Assuntos
Afro-Americanos/psicologia , Aleitamento Materno/psicologia , Cuidado do Lactente/métodos , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Mães/psicologia , Adulto , Extração de Leite , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Leite Humano , Pesquisa Qualitativa
16.
J Grad Med Educ ; 10(2): 223-225, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29686765

RESUMO

Background : Many female residents choose to start families during training, and they want to breastfeed their infants. Continuing lactation while balancing service and education demands can be challenging. Objective : We hypothesized that the presence of a dedicated and fully equipped lactation room with a hospital-grade pump (HGP) would increase ease and efficiency of lactation during residency. Methods : A quiet HGP was purchased for resident use, and it was stored in a designated room with a computer, telephone, and dictation system. Lactating residents provided information about pumping time and production using their own portable double electric pump (PP) versus the HGP based on the first pump of the morning (for consistency), averaged over the first month back from maternity leave. Results : Among 6 residents, lactation time with PP averaged 24 minutes (range, 15-40 minutes) versus 15.5 minutes with HGP (range, 10-32 minutes). Use of the HGP reduced total pumping time by 8.5 minutes (95% confidence interval 3.8-12.2, P = .045). Production volume increased from 6 ounces (range, 3.5-8.5 ounces) with PP to 8.8 ounces (range, 8-11 ounces) with HGP, for a mean increase of 2.8 ounces (95% confidence interval 1.2-4.3, P = .06) despite decreased lactation time. Conclusions : In our pilot, an HGP significantly decreased lactation time, while increasing expressed milk volume. Residents completed clinical and educational tasks while pumping. Providing an HGP and equipped lactation space helped residents continue breastfeeding and decreased the burden of lactation on patient care and educational tasks.


Assuntos
Aleitamento Materno , Extração de Leite/métodos , Médicas , Período Pós-Parto , Adulto , Feminino , Arquitetura Hospitalar , Humanos , Internato e Residência , Projetos Piloto , Privacidade , Fatores de Tempo
17.
Arch Pediatr ; 25(4): 274-279, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29656039

RESUMO

INTRODUCTION: Breast milk expression with a breast pump increases the risk of contaminating milk with pathogenic bacteria; how to decontaminate breast pumps is controversial. The aim of this study was to investigate maternal adherence to updated French guidance on the breast milk collection process, including breast pump decontamination, and to identify potential sources of increased bacterial counts in breast milk in order to improve prevention messages to mothers. METHODS: Descriptive prospective study conducted between November 2015 and April 2016 in a French tertiary perinatal center. Oral and written instructions on the breast milk collection process and breast pump decontamination were given to mothers by trained healthcare professionals. Mothers whose neonates were admitted to the neonatal care unit and expressing milk for the human milk bank were eligible if breast milk bacterial counts before pasteurization were≥106 colony-forming units (cfu)/mL for total aerobic flora or ≥104 cfu/mL for Staphylococcus aureus. Maternal adherence to the guidance was investigated with a questionnaire and a face-to-face interview. RESULTS: One hundred and fourteen mothers with neonates admitted to the neonatal care unit expressed milk for the milk bank; 44 (39%) were eligible and 29 (66%) included: most of them (76%) with increased counts of total aerobic flora in breast milk and 24% with increased counts of S. aureus. At least three divergences from the guidance provided were reported for 16 mothers (55%). The most frequent ones were inadequate storage of the breast pump collection kit (62%), ineffective decontamination of the breast pump collection kit (52%), inappropriate cleaning of the breast pump (48%), and inadequate breast milk transport from home to hospital (31%). CONCLUSION: Despite standardized instructions, mothers with increased bacterial counts in breast milk frequently declared several divergences from the guidance on the breast milk collection process. Giving mothers and any person of their choice repeated clear instructions with illustrated guidance, demonstrations, and practice may help improve the microbiological safety of expressed breast milk.


Assuntos
Extração de Leite , Leite Humano/microbiologia , Cooperação do Paciente , Adulto , Carga Bacteriana , Desinfecção/normas , Feminino , Inocuidade dos Alimentos , França , Humanos , Higiene/normas , Recém-Nascido , Bancos de Leite , Estudos Prospectivos
18.
Nutrients ; 10(2)2018 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-29461479

RESUMO

Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if the mother's own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCTs could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (three studies, risk ratio (RR) 0.89, 95% confidence interval (CI) 0.60-1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67-0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (three studies, RR 0.80, 95% CI 0.68-0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (two studies, RR 0.77, 95% CI 0.62-0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants.


Assuntos
Alimentação Artificial , Aleitamento Materno , Extração de Leite , Displasia Broncopulmonar/prevenção & controle , Ejeção Láctea , Peso ao Nascer , Alimentação Artificial/efeitos adversos , Aleitamento Materno/efeitos adversos , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/etiologia , Feminino , Idade Gestacional , Humanos , Fórmulas Infantis , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Razão de Chances , Pasteurização , Gravidez , Fatores de Proteção , Fatores de Risco , Resultado do Tratamento
19.
MCN Am J Matern Child Nurs ; 43(2): 105-110, 2018 Mar/Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29470268

RESUMO

BACKGROUND: Although early initiation of human milk (HM) expression after birth is known to increase lactation success in mothers of very low birthweight (VLBW) infants, initiation is frequently delayed, potentially decreasing both short- and long-term HM production. Obstetrical (OB) nurses are typically the healthcare provider responsible for facilitating the initial HM expression session. As delays in initiation are common, it is likely that nurses experience obstacles to facilitation of an early initiation of HM expression. The purpose of this study was to determine barriers OB nurses perceive in facilitating early initiation of HM expression in mothers of VLBW infants. STUDY DESIGN AND METHODS: An online survey was administered to nurses from three tertiary care OB units in Florida to determine perceived barriers to early initiation of HM expression in mothers of VLBW infants. RESULTS: Eighty-three nurses completed the survey. The following barriers were identified: (1) lack of time and personnel to assist mothers with HM expression, (2) nurse's perception of the mother's acuity level, and (3) nurse's perception of maternal pain and stress. Discrepancies between nursing judgment, action, and knowledge of unit policies were evident. CLINICAL IMPLICATIONS: Obstetric nurses encounter barriers when facilitating early HM expression in mothers giving birth to VLBW infants. It is possible these barriers could be removed through improvements in education, use of innovative staffing strategies, and maintenance of evidence-based policies.


Assuntos
Extração de Leite/métodos , Mães/educação , Adulto , Aleitamento Materno/métodos , Extração de Leite/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso/metabolismo , Masculino , Pessoa de Meia-Idade , Leite Humano/metabolismo , Mães/psicologia , Gravidez , Inquéritos e Questionários
20.
Adv Neonatal Care ; 18(1): 38-48, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29300195

RESUMO

BACKGROUND: Human milk has multiple benefits for human health; however, rates of infants receiving human milk at discharge in Canadian neonatal intensive care units (NICUs) are far below recommendations of the Baby Friendly Hospital Initiative supported by the Canadian Pediatric Association. Mothers of infants requiring NICU care usually need to express their milk, especially mothers of premature infants, since for some time their infant is unable to feed directly at the breast. Expressing human milk for an extended period can be challenging for mothers. PURPOSE: To document maternal experiences expressing human milk for their infant in the NICU as a closeness or separation experience, and to discover what factors gave rise to these perceptions. METHODS: In this descriptive qualitative cross-sectional study, 15 mothers whose infants were hospitalized in a level III NICU and who were expressing human milk audio recorded their thoughts and feelings with a smartphone application for 48 hours while they were expressing milk. A thematic content analysis was used to analyze data. FINDINGS: Expressing human milk for their hospitalized infant was a difficult experience for all mothers, and most described both closeness and separation feelings while expressing milk. Their feelings fluctuated depending on their coping mechanisms, perceived challenges, as well as their location and environment. Mothers were all pursuing their goal of continued milk expression with various levels of motivation. IMPLICATIONS FOR PRACTICE: NICUs should adopt a family-centered approach to care whereby mothers' care needs related to milk expression are addressed. Nurses can ask open-ended questions to explore how mothers are coping, and they can assist mothers to find effective coping strategies to minimize the challenges related to milk expression to promote mother-infant closeness. IMPLICATIONS FOR RESEARCH: The impact of environment and location on mothers with hospitalized infants should be explored, as unit designs could be altered to foster closeness.


Assuntos
Aleitamento Materno , Extração de Leite , Leite Humano/fisiologia , Relações Mãe-Filho/psicologia , Adaptação Psicológica , Adulto , Aleitamento Materno/métodos , Aleitamento Materno/psicologia , Extração de Leite/métodos , Extração de Leite/psicologia , Canadá , Estudos Transversais , Meio Ambiente , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/normas , Masculino , Comportamento Materno
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