RESUMO
Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field. Thus, with inspiration from the simplified environmental sciences framework of Kaufman and Curl, Working Group 5 of the BEGIN Project developed a translational framework for science in human lactation and infant feeding, which includes 5 nonlinear, interconnected translational stages, T1: Discovery; T2: Human health implications; T3: Clinical and public health implications; T4: Implementation; and T5: Impact. The framework is accompanied by 6 overarching principles: 1) Research spans the translational continuum in a nonlinear, nonhierarchical manner; 2) Projects engage interdisciplinary teams in continuous collaboration and cross talk; 3) Priorities and study designs incorporate a diverse range of contextual factors; 4) Research teams include community stakeholders from the outset through purposeful, ethical, and equitable engagement; 5) Research designs and conceptual models incorporate respectful care for the birthing parent and address implications for the lactating parent; 6) Research implications for real-world settings account for contextual factors surrounding the feeding of human milk, including exclusivity and mode of feeding. To demonstrate application of the presented translational research framework and its overarching principles, 6 case studies are included, each illustrating research gaps across all stages of the framework. Applying a translational framework approach to addressing gaps in the science of human milk feeding is an important step toward the aligned goals of optimizing infant feeding across diverse contexts as well as optimizing health for all.
Assuntos
Lactação , Leite Humano , Feminino , Lactente , Humanos , Aleitamento Materno , Fenômenos Fisiológicos da Nutrição do Lactente , Saúde PúblicaRESUMO
The purpose of this study is to identify sources and acceptability of infant-feeding advice among participants in the US-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Focus groups are used to identify sources of infant-feeding advice and factors that contribute to acceptance of or resistance to that advice among 65 WICeligible mothers (34 English speaking and 31 Spanish speaking). The mothers primarily rely on experienced family and friends for advice and frequently use their own intuition to find solutions that work to solve real or perceived infant-feeding problems. Professional advice is perceived as credible when caregivers exhibit characteristics similar to those of experienced family and friends: confidence, empathy, respect, and calm. Using this information, it may be possible for WIC staff to make programmatic modifications to increase their ability to promote optimal infant-feeding behaviors in this population, thereby contributing to the reduction in the prevalence of childhood overweight.
Assuntos
Aleitamento Materno/psicologia , Cuidado do Lactente/psicologia , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Assistência Pública , Adulto , California , Criança , Ciências da Nutrição Infantil/educação , Aconselhamento , Comportamento Alimentar , Feminino , Grupos Focais , Serviços de Alimentação , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Hispânico ou Latino/educação , Hispânico ou Latino/psicologia , Humanos , Lactente , Cuidado do Lactente/métodos , Transtornos da Nutrição do Lactente/prevenção & controle , Recém-Nascido , Masculino , Mães/educação , Sobrepeso/prevenção & controleRESUMO
Using data from 242 exclusively breastfeeding mother-infant pairs, newborn elimination patterns were analyzed. Sensitivity (Se) and Specificity (Sp) of day 4 (72-96 hours) wet and soiled output, in addition to the timing of onset of lactation, in identifying cases of breastfeeding inadequacy (defined as neonatal weight loss >or= 10% of birth weight) were examined. The usefulness of 2 measures in parallel was also explored. Median number of diapers (wet, soiled) on days 1, 4, and 7, respectively, was 2, 3; 5, 4; and 7, 6. The most efficient day 4 predictor of breastfeeding inadequacy was soiled diaper output
Assuntos
Fraldas Infantis/estatística & dados numéricos , Recém-Nascido/metabolismo , Transtornos da Lactação/diagnóstico , Lactação/fisiologia , Aleitamento Materno , Defecação/fisiologia , Reações Falso-Positivas , Feminino , Humanos , Comportamento do Lactente , Recém-Nascido/urina , Masculino , Curva ROC , Sensibilidade e Especificidade , Micção/fisiologiaRESUMO
OBJECTIVE: Our goal is to test the efficacy of a family-based, multi-component intervention focused on infants of African-American (AA) mothers and families, a minority population at elevated risk for pediatric obesity, versus a child safety attention-control group to promote healthy weight gain patterns during the first two years of life. DESIGN, PARTICIPANTS, AND METHODS: The design is a two-group randomized controlled trial among 468 AA pregnant women in central North Carolina. Mothers and study partners in the intervention group receive anticipatory guidance on breastfeeding, responsive feeding, use of non-food soothing techniques for infant crying, appropriate timing and quality of complementary feeding, age-appropriate infant sleep, and minimization of TV/media. The primary delivery channel is 6 home visits by a peer educator, 4 interim newsletters and twice-weekly text messaging. Intervention families also receive 2 home visits from an International Board Certified Lactation Consultant. Assessments occur at 28 and 37weeks gestation and when infants are 1, 3, 6, 9, 12, and 15months of age. RESULTS: The primary outcome is infant/toddler growth and likelihood of overweight at 15months. Differences between groups are expected to be achieved through uptake of the targeted infant feeding and care behaviors (secondary outcomes) and change in caregivers' modifiable risk factors (mediators) underpinning the intervention. CONCLUSIONS: If successful in promoting healthy infant growth and enhancing caregiver behaviors, "Mothers and Others" will have high public health relevance for future obesity-prevention efforts aimed at children younger than 2years, including interventional research and federal, state, and community health programs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01938118, August 9, 2013.
Assuntos
Negro ou Afro-Americano/educação , Educação em Saúde/organização & administração , Mães/educação , Obesidade Infantil/etnologia , Obesidade Infantil/prevenção & controle , Adolescente , Adulto , Aleitamento Materno , Desenvolvimento Infantil , Comportamento Alimentar , Feminino , Humanos , Lactente , North Carolina , Poder Familiar , Projetos de Pesquisa , Sono , Televisão , Aumento de Peso , Adulto JovemRESUMO
BACKGROUND: It has been documented that growth patterns differ between breastfed and formula-fed infants. Some investigators have suggested that these differences may be related to differences in zinc nutriture. OBJECTIVE: The objective of this study was to examine the effect of zinc supplementation on growth, morbidity, and motor development in healthy, term, breastfed infants. DESIGN: We conducted a randomized double-blind intervention comparing zinc supplementation (5 mg/d as zinc sulfate) with placebo in breastfed infants aged 4-10 mo. Growth and indexes of body composition and gross motor development were measured monthly from 3 to 10 mo. Morbidity data were collected weekly. RESULTS: Eighty-five infants were enrolled, and 70 completed the study. The baseline characteristics, attained weight or length at 10 mo, growth velocity, gross motor development, and morbidity did not differ significantly between groups, even after control for potentially confounding variables. CONCLUSIONS: The dietary zinc intake of these breastfed infants appeared to be adequate, given that zinc supplementation did not affect growth, development, or risk of infection (although sample size for detection of differences in development or infection was limited). Previously described differences in growth between breastfed and formula-fed infants in such populations do not appear to be due to differences in zinc nutriture.
Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Crescimento/efeitos dos fármacos , Fenômenos Fisiológicos da Nutrição do Lactente , Leite Humano/química , Destreza Motora/efeitos dos fármacos , Zinco/farmacologia , Análise de Variância , Antropometria , Aleitamento Materno , Distribuição de Qui-Quadrado , Desenvolvimento Infantil/fisiologia , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Lactente , Controle de Infecções , Masculino , MorbidadeRESUMO
Focus groups were used to examine relationships among maternal beliefs, feeding intentions, and infant-feeding behaviors among 65 Women, Infants and Children-eligible (28 English-speaking and 37 Spanish-speaking) mothers. Participants shared common beliefs that breast-feeding was beneficial; nevertheless, many believed that early introduction of formula and solid foods was unavoidable in certain situations. Medical providers and Women, Infants and Children staff were sources of infant-feeding information, and the Spanish-speaking mothers attempted to adhere to the guidance. However, the English-speaking mothers often ignored this advice if it was not perceived as working for the family's circumstances. Mothers, believing that providers would not understand that they were compelled to reject infant-feeding recommendations, would not ask for assistance when facing difficulties. Instead, mothers relied on relatives and others for infant-feeding guidance. Educational efforts should acknowledge mothers' true circumstances, target support to each situation, and emphasize the health value of complementary foods rather than their association with infant motor development.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Cooperação do Paciente/psicologia , Pobreza , Adulto , Aleitamento Materno/epidemiologia , Tomada de Decisões , Feminino , Grupos Focais , Humanos , Lactente , Cuidado do Lactente , Recém-Nascido , DesmameRESUMO
Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with breastfeeding initiation, exclusivity, and duration; lactation physiology; common breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding outcomes worldwide will continue.
Assuntos
Aleitamento Materno , Promoção da Saúde/métodos , Lactação/fisiologia , Aconselhamento , Medicina Baseada em Evidências , Feminino , Saúde Global , HumanosRESUMO
OBJECTIVES: To document the occurrence of Candida colonization and mammary candidosis among lactating women, risk factors for Candida colonization, and the relationship between Candida colonization and breastfeeding at 9 weeks postpartum. DESIGN: Prospective cohort study. SETTING: Private practice clinic in Reno, Nevada. PARTICIPANTS: 100 lactating women and their infants, and 40 nonpregnant, nonlactating women (controls). PROCEDURE: At 2 weeks postpartum, skin and milk samples were collected from the lactating women and oral samples were collected from their infants. Skin samples were collected from control subjects. All samples were cultured for Candida species. Lactating women were recontacted by phone at 9 weeks postpartum to assess infant feeding practices. MAIN OUTCOME MEASURE: Colonization with Candida species. RESULTS: None of the control subjects tested positive for Candida colonization. Of the lactating women, 23% tested positive for Candida and 20% had mammary candidosis. Risk factors for colonization of the mother were bottle use in the first 2 weeks postpartum and pregnancy duration of > 40 weeks. Of the 100 infants, 20% tested positive for Candida. Risk factors for colonization of the infant were bottle use in the first 2 weeks postpartum and presence of siblings. Among women who tested positive at 2 weeks, 43% were still breastfeeding at 9 weeks postpartum compared to 69% of the women who did not test positive (p < .05). CONCLUSION: Avoidance of bottle use early postpartum may reduce the risk of mammary candidosis. Mammary candidosis is related to early termination of breastfeeding.
Assuntos
Aleitamento Materno/efeitos adversos , Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Candidíase/epidemiologia , Desmame , Adolescente , Adulto , Alimentação com Mamadeira , Estudos de Casos e Controles , Estudos de Coortes , Contagem de Colônia Microbiana , Escolaridade , Feminino , Humanos , Incidência , Lactação , Glândulas Mamárias Humanas/microbiologia , Nevada/epidemiologia , Paridade , Período Pós-Parto , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Fatores de TempoRESUMO
Mammary candidosis in lactating women is not well defined and is most often presumptively diagnosed by signs and symptoms. This study evaluates the sensitivity, specificity, positive predictive value, and likelihood ratios of signs and symptoms of mammary candidosis based on the presence of Candida species on the nipple/areola or in the milk. In this prospective cohort study, the nipple/areola skin and milk of 100 healthy breastfeeding mothers were cultured from each breast at 2 weeks postpartum, and mothers were interviewed regarding signs and symptoms associated with mammary candidosis between 2 and 9 weeks postpartum. Positive predictive value for Candida colonization was highest when there were 3 or more signs or symptoms simultaneously or when flaky or shiny skin of the nipple/areola was reported together or in combination with breast pain.
Assuntos
Doenças Mamárias/diagnóstico , Candida/isolamento & purificação , Candidíase/diagnóstico , Adulto , Doenças Mamárias/microbiologia , Doenças Mamárias/patologia , Candida albicans/isolamento & purificação , Candidíase/epidemiologia , Candidíase/patologia , Candidíase Cutânea/diagnóstico , Candidíase Cutânea/patologia , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Funções Verossimilhança , Leite Humano/microbiologia , Nevada/epidemiologia , Mamilos/microbiologia , Dor/etiologia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
The World Health Organization (WHO) Multicentre Growth Reference Study (MRGS) North American site was Davis, California. For the longitudinal cohort (0-24 months), 208 infants were enrolled between January and December 1999 from five area hospitals at which nearly all Davis women give birth. The target sample size was lower in the United States than in the other sites, because recruitment in the United States was restricted to mothers who were willing to exclusively breastfeed for at least 4 months and continue breastfeeding for at least 12 months. For the cross-sectional component, a mixed-longitudinal design was used, which required approximately 500 subjects. The subjects were recruited by going door-to-door, with the sampling scheme based on the distribution of the subjects of the longitudinal study within the city. The cross-sectional sample was recruited between January and July 2001. Major challenges during implementation were maintaining daily communication with hospital personnel and scheduling home visits.
Assuntos
Desenvolvimento Infantil , Implementação de Plano de Saúde , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos Transversais , Sistemas de Gerenciamento de Base de Dados/normas , Feminino , Crescimento e Desenvolvimento , Implementação de Plano de Saúde/normas , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Estudos Multicêntricos como Assunto , Controle de Qualidade , Padrões de Referência , Estados Unidos , Organização Mundial da SaúdeAssuntos
Ansiedade/prevenção & controle , Aconselhamento/métodos , Lactação/psicologia , Tocologia , Feminino , HumanosRESUMO
BACKGROUND: While hospital policies and medical issues are important factors in determining exclusive breastfeeding rates, medically unnecessary supplementation of infants is likely to be due, in part, to maternal request for formula. OBJECTIVES: The goal of this project was to gain an understanding of the facilitating factors and decision-making processes surrounding maternal request for formula in the early postpartum period. METHODS: A series of 12 focus groups were conducted among 97 English- and Spanish-speaking low-income participants in California's Supplementary Nutrition Program for Women, Infants, and Children (WIC). Mothers were asked to share their in-hospital infant-feeding experiences. RESULTS: The overarching theme that emerged was "lack of preparation" for what the early postpartum period would be like. Specifically, the decisions to formula feed fell into the following categories: inadequate preparation for newborn care (the need for rest and unrealistic expectations about infant behavior), lack of preparation for the process of breastfeeding, and formula as a solution to breastfeeding problems. Cultural factors were not mentioned as reasons for supplementation. CONCLUSION: Interventions to promote in-hospital exclusive breastfeeding must address mothers' real and perceived barriers, specifically mothers' expectations related to breastfeeding and infant behavior.