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Introduction: Fortified expressed breast milk (FEBM) is a standard of care for premature and low birth weight neonates, but comes with an elevated risk of a rare but re‐emergent pathology called milk curd obstruction (MCO). Little is known about normal sonographic appearances of bowel contents in this feeding setting, making the recognition of abnormalities difficult. Thus, we aimed to describe appearances that may be considered typical pre‐ and post‐fortifier inclusion. Methods: Ten neonates of <32 weeks' gestation or a birth weight of <1,800 g recruited from Auckland City Hospital Neonatal Intensive Care between 1/5/2019 and 10/9/2019 received bowel ultrasounds within 24 h before and 10–14 days after starting FEBM. Bowel contents in six abdominal regions were assigned scores of 1–6 based on increasing solidification. Results: Lower gestational age was correlated with more solid contents on the pre‐fortifier ultrasound (P = 0.02). Fortifier was significantly associated with increasing solidity, particularly in the left abdomen (P < 0.001). The left lower quadrant and rectum accounted for much of this change (P = 0.012 and P = 0.002). One subject who subsequently developed a clinical picture consistent with early MCO had uniquely demonstrated non‐rectal solid contents (score 6). The interobserver kappa score for two assessors was 0.91 (95% CI 0.94–0.99) on still images. Conclusion: This small cohort demonstrated increasing bowel content solidification after breast milk fortification using a novel ultrasound scoring system with good interobserver agreement. Non‐rectal solid contents (score 6) appeared atypical. Ultrasound shows promise for its non‐irradiating diagnostic utility in the setting of early milk curd disease evaluation of the premature neonate. [ABSTRACT FROM AUTHOR]

Objective: To develop a rapid method for analysing polyphenols, which are potentially active antioxidants against neonatal oxidative stress, from small human milk (HM) volumes. Methods: Acid and alkaline extractions were compared using two dyes: Folin-Ciocalteu and Fast Blue BB. Linearity, sensitivity, recovery percentage, polyphenol content, precision, and stability were assessed in 14 HM samples and compared using the KruskalWallis H test (p<0.05). The best technique was applied to 284 HM samples to determine their polyphenolic content and its association with maternal diet by multifactorial linear regression. Results: Acidic extraction successfully recovered the gallic acid reference standard, whereas alkaline extraction overestimated it. Calibration curves for all methods were linear (R²>0.96) up to 500 mg/L. All bicarbonate-based Folin-Ciocalteu methods assayed were stable and repeatable, whereas Fast Blue BB-based variants were not. HM polyphenols (mean=94.68 mg/L) positively correlated to the dietary intake of hydroxycinnamic acids, the most consumed polyphenolic family in this population. Conclusions: A bicarbonate-based Folin-Ciocalteu micromethod allowed the accurate determination of polyphenols in HM, which might be useful for translational research settings and HM banks. [ABSTRACT FROM AUTHOR]

Objective: to identify the knowledge about breastfeeding of women who participate in virtual groups hosted on Facebook. Method: qualitative research, with an exploratory and descriptive nature, conducted from September to November 2020, with 15 women who participate in groups registered on Facebook that address the theme of breastfeeding. Data were collected using Google Forms and, subsequently, submitted to content analysis. Results: the participants demonstrated knowledge about the benefits of breastfeeding, latching and the correct positioning at the breast. They understand the concept of exclusive breastfeeding and free demand. The recurrent speech as a motivator for participating in the virtual groups is based on the search for knowledge. Conclusion: health education has its importance reaffirmed by the participants when they pointed out that the information on breastfeeding was predominantly obtained through health services and strategies, such as courses/pregnant women's groups. [ABSTRACT FROM AUTHOR]

The World Health Organization recommends deworming to reduce soil‐transmitted helminth (STH)‐attributable morbidity in women of reproductive age, including pregnant and lactating women, to reduce blood loss, iron deficiency anaemia and nutrient malabsorption. This study assessed the impact of maternal postpartum deworming with albendazole approximately 1 day after delivery on infant milk intake among a subset of 216 randomly selected mother–infant pairs recruited into a large trial in Peru. Infant milk intake was measured using the deuterium‐oxide method at 1‐ and 6‐month postpartum. Maternal STH infection was measured at 6‐month postpartum. At 1‐month postpartum, mean intake was 756 ± 16 and 774 ± 18 mL day−1 in the albendazole and placebo groups, respectively (mean difference: −18 mL day−1; 95% CI: −65, 30). At 6‐month postpartum, mean intake was 903 ± 16 and 908 ± 18 mL day−1 in the albendazole and placebo groups, respectively (mean difference: −5 mL day−1; 95% CI: −52, 43). There was no statistically significant difference in milk intake between groups at either time point. At 6‐month postpartum, mothers infected with Trichuris trichiura had infants with higher milk intakes (adjusted mean difference: 70 mL day−1; 95% CI: 20, 120) compared with uninfected mothers. However, there was no statistically significant difference in infant milk intake between mothers who had moderate‐and‐heavy intensity infection compared with the comparison group (mothers with no and light intensity infection). A lower prevalence and intensity of infection, and inclusion of uninfected mothers in both arms of the trial, resulting in effect dilution, may explain the null findings. [ABSTRACT FROM AUTHOR]

Objective: To analyze the composition of macronutrients present in the milk of mothers of preterm newborn infants (PTNB) — protein, fat, carbohydrate, and calories — by gestational age (GA), chronological age (CA) and maternal variables. Methods: Longitudinal study that analyzed 215 milk samples from the 51 mothers of PTNB admitted in three Neonatal Intensive Care Units of Rio de Janeiro from May/2013-January/2014. Milk collection was performed by pickup pump, on a fixed day of each week until discharge. The spectrophotometric technique with Infrared Analysis (MilkoScan Minor 104) was used for the quantitative analysis. A sample of 7 mL of human milk was taken from the total volume of milk extracted by the mother. The data was grouped by GA (25-27, 28-31, 32-36, 37-40 weeks) and by CA (zero to 4, 5-8, 9-12, 13-16 weeks). Results: Protein, carbohydrate, fat and calories did not show any pattern of change, with no difference among groups of GA. When the macronutrients were analyzed by groups of CA, protein decreased, with significant difference between the first two groups of CA. Carbohydrates, fat and calories presented increasing values in all groups, without significant differences. Weight gain during pregnancy, maternal hypertension and maternal age were associated with changes in fat and calories in the first moment of the analysis of milk. Conclusions: There was a significant decrease in the levels of protein during the first eight weeks after birth. CA may be an important factor in the composition of human milk. [ABSTRACT FROM AUTHOR]

Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children’s Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: “iniciativa hospital amigo da criança”, “hospital amigo da criança”, “baby friendly initiative hospital”, “aleitamento materno” and “breastfeeding”. The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country. [ABSTRACT FROM AUTHOR]

Background: Complementary and alternative medicine (CAM) could be one option to address perceived insufficient milk (PIM), but there are few data comparing the effectiveness, acceptability, and safety of various CAM therapies. The purpose of this study was to describe and compare, among women delivering at 34-376/7 weeks, the feasibility and acceptability of two CAM interventions for treatment of PIM: (1) a meditation/relaxation intervention via an MP3 (Apple iPod Shuffle©) player and (2) a commercially available combination-blend herbal supplement (Motherlove: More Milk Plus Alcohol Free®). Materials and Methods: After randomization, over 9 days, women received three home visits from a lactation consultant, recorded pre/post intervention test weights and expressed milk volume, tracked daily breastfeeding behavior, and completed an end-of-study interview about the interventions. Women in each group were offered the other group's intervention on study day 9. Breastfeeding status and intervention continuation were assessed at 2 months. Results: Of 183 women screened, 11 were eligible, enrolled into, and completed the 9-day trial. Six women were randomized to the herbal supplement and 5 to meditation. One participant (meditation) stopped breastfeeding on study day 8. At 2 months, 3 of 6 women assigned to the herbal supplement and 3 of 5 women assigned to meditation were still breastfeeding; 1 (herbal supplement) was exclusively breastfeeding. Most participants were adherent to the prescribed protocols for both interventions. Interventions were generally perceived as safe, with benefits not necessarily related to increased milk supply. Conclusion: Mothers of late preterm and early term infants who had PIM found the CAM interventions acceptable and safe. The effect of CAM therapies on breastfeeding outcomes, with and without in-home lactation assistance, requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: to identify the protective elements of breast milk that work in the prevention of gastrointestinal and respiratory diseases. Sources: the search was performed on Bireme, Lilacs, Medline and Scielo databases, using keywords breast milk, gastrointestinal disease and respiratory disease, with limits of languages (English, Portuguese and Spanish) and period (1996 to 2009). 46 papers were selected for achieving the objectives of this work. Summary of the findings: the IgA is the immunoglobulin with more protective capability against both types of disease, to survive the intestinal and respiratory mucosa. Breast milk also contains other immunoglobulins, antibodies, oligosaccharides, lipids, bioactive peptides, among other components with unique mechanisms that besides the protection against these diseases, stimulate the development of infants' immune systems. No other milk has these properties, and may even be the cause of these diseases. Campaigns and actions in Public Health to encourage breastfeeding should be continuously developed and encouraged considering all the benefits it provides. [ABSTRACT FROM AUTHOR]

The study aimed to characterize the behavior of human milk donation and to describe the informal social and formal institutional support, according to reports from women donors. It is an exploratory, cross-sectional, descriptive study using domicile interviews based on structured and semi-structured scripts. The participants were 36 women enrolled in two human milk banks of the public health system of the Federal District. Statistical analysis of quantitative data and categorical content analysis of qualitative data were performed. Categories of reasons that most influenced the frequency of expressing were: food, time availability, negative emotions and fluid intake. The manual expressing technique was reported as predominant. The use of breast shells was cited by almost a third of the donors. Most frequent suggestions for improving institutional support were more attention and support from the milk banks for the donor. The study may serve as a stimulus for the implementation of technical and political strategies to encourage this practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the serum and milk in active-smoking and nonsmoking mothers, and their infants’ insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels. Design and Setting: A cohort study conducted at a tertiary medical center. Subjects: Forty-four mothers (age range: 21–34 years) and their newborns (7 days old) were enrolled in the study. Mothers were interviewed and classified according to their smoking status into one of two groups: the active-smoking mothers (n = 21) and the nonsmoking mothers (n = 23). Results: There was no difference noted in either IGF-I, IGFBP-3 or IGF-I/IGFBP-3 ratios in serum and milk of mothers, and their infants’ serum samples according to maternal smoking. Conclusion: This study demonstrated that maternal smoking (5–10 cigarettes/day) did not influence the maternal and infant serum levels of IGF-I and IGFBP-3 as well as the breast milk levels of these peptides. Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: In mammals the composition of milk changes during early lactation showing a rapid decline in fat-soluble vitamins and a continuous increase in total lipids. Changes in the concentrations of carotenoids, vitamin A, α-tocopherol and total lipids in human milk (colostrum, transitory and mature milk) were studied to understand this not well characterised phenomenon. Methods: Colostrum, transitory and mature milk was collected from 21 women and analysed for carotenoids, vitamin A and α-tocopherol by HPLC. Results: Total lipids increased from the lowest levels in colostrum (1.5 ± 1.6 mg/ml) to the highest in transitory milk (3.6 ± 2.5 mg/ml, p < 0.01). Contrary to this, levels of total carotenoids (236.7 ± 121.9 ng/ml), vitamin A (1.02 ± 0.56 μg/ml) and α-tocopherol (11.8 ± 6.3 μg/ml) were highest in colostrum and declined significantly during the first weeks of lactation (63.2 ± 23.3 ng/ml, 0.33 ± 0.14 μg/ml, 2.7 ± 1.1 μg/ml, respectively; p < 0.001). Conclusions: The magnitude of decrease was not the same for all carotenoids and was dependent on the polarity of the carotenoid with the smallest decrease in the polar carotenoids. This might be due to differences in the distribution of carotenoids among plasma lipoproteins and might point to possible selective mechanisms being involved in the transfer of these components in early human milk.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Investigates the levels of cytokines in breast milk from allergic and nonallergic mothers. Materials and methods; Major cytokine in human breast milk.