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Aim: This scoping review aimed to identify and appraise the effectiveness and impact of breastfeeding promotion interventions conducted across Portuguese- speaking sovereign countries. Methods: Using the PRISMA-ScR guidelines, we searched 14 electronic databases for publications published through 31 July 2023. The search terms were designed to find studies promoting breastfeeding or exclusive breastfeeding in pre- defined Portuguese- speaking countries. Results: Of the 5263 papers initially retrieved, 30 interventional studies on breastfeeding met the inclusion criteria across three countries: Brazil (N = 26), Portugal (N = 2) and Guinea Bissau (N = 2). Participants ranged from pregnant women, mothers, mother-infant pairs, healthcare professionals, and school children. Overall, the interventions increased exclusive breastfeeding and better breastfeeding practices, such as a higher duration of breastfeeding. The interventions positively affected maternal breastfeeding self-efficacy, knowledge and perception. Only four studies used a theoretical framework. Conclusion: While the results were often statistically significant, no study had an outcome close to the recommended UNICEF and WHO goal of 70% breastfeeding at six months. The need to determine what works for the recommended six months postpartum period is critical for maximising children's health in Portuguese- speaking countries. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to review the role that donor human milk plays in caring for very low birth weight (VLBW) infants. Methods: This review focussed on academic papers and background information published in English and French up to 8 August 2021. Results: Donor human milk provides a useful bridge to successful breastfeeding in hospitalised neonates and does not have a negative impact on the use of mother's own milk and breastfeeding rates at discharge. It helps to prevent key complications of prematurity, particularly necrotising enterocolitis up to 36 weeks of postmenstrual age, which is more common in infants fed formulas based on cows' milk. When it is carefully fortified, it supports the postnatal growth of the majority of very preterm infants. Well‐organised, accessible human milk banks are required to cover the needs of hospitalised infants, and donor human milk must be prioritised for patients who derive the greatest health benefit from it. These include very preterm infants and those born at term, or near term, with surgical digestive malformations or congenital heart disease. Conclusion: Safe, high‐quality donor human milk, which is distributed by well‐organised human milk banks, is essential for the most vulnerable hospitalised neonates. [ABSTRACT FROM AUTHOR]

Aim: To explore the content, experiences and outcomes of interventions designed to increase early skin‐to‐skin contact (SSC) in high‐income settings. Methods: A mixed‐methods systematic review was undertaken across six bibliographic databases. References of all included studies were hand‐searched. All papers were quality appraised using a mixed‐method appraisal tool. A narrative synthesis was used to synthesise both quantitative and qualitative findings. Results: Database searches generated 1221 hits, and two studies were identified via hand‐searching. Ten studies were included; most (n = 7) were designed to improve SSC following a caesarean section, and half were of low/poor quality. Outcomes related to SSC prevalence and/or duration (n = 7), breastfeeding prevalence, (n = 4) and six explored mothers' and/or health professionals' experiences of the intervention. While the interventions had 'some' impact on the prevalence of SSC, the duration was often limited and not in line with WHO recommendations. Breastfeeding rates (exclusive/any) were found to improve but generally not to a significant extent. Mother and healthcare professionals were positive about the interventions, with barriers to implementation noted. Most interventions targeted healthcare professionals, rather than mothers. Conclusion: High‐quality interventions that increase SSC in line with WHO recommendations, and that target both health professionals and parents are needed. [ABSTRACT FROM AUTHOR]

Aim: There are no specific recommendations for using a mother's fresh milk for her preterm infant. We reviewed the available evidence on its collection, storage and administration.Methods: The working group of the French Neonatal Society on fresh human milk use in preterm infants searched the MEDLINE database and Cochrane Library up to June 2017 for papers published in English or French. They specifically analysed 282 papers providing information on prospective, retrospective and clinical studies and examined guidelines from various countries.Results: The review concluded that fresh mother's own milk should be favoured in accordance with the latest recommendations. However, it must be carried out under stringent conditions so that the expected benefits are not offset by risks related to different practices. The working group has summarised the best conditions for feeding preterm infants with human milk, balancing high nutritional and immunological quality with adequate virological and bacteriological safety. Professionals must provide parents with the necessary conditions to establish breastfeeding, together with specific and strong support.Conclusion: Based on their review, the working group has made specific recommendations for using fresh mother's own milk under careful conditions, so that the expected benefits are not offset by risks related to practices. [ABSTRACT FROM AUTHOR]

Aim: This paper integrates clinical expertise to earlier research about the behaviours of the healthy, alert, full-term infant placed skin-to-skin with the mother during the first hour after birth following a noninstrumental vaginal birth.Method: This state-of-the-art article forms a link within the knowledge-to-action cycle, integrating clinical observations and practice with evidence-based findings to guide clinicians in their work to implement safe uninterrupted skin-to-skin contact the first hours after birth.Results: Strong scientific research exists about the importance of skin-to-skin in the first hour after birth. This unique time for both mother and infant, individually and in relation to each other, provides vital advantages to short- and long-term health, regulation and bonding. However, worldwide, clinical practice lags. A deeper understanding of the implications for clinical practice, through review of the scientific research, has been integrated with enhanced understanding of the infant's instinctive behaviour and maternal responses while in skin-to-skin contact.Conclusion: The first hour after birth is a sensitive period for both the infant and the mother. Through an enhanced understanding of the newborn infant's instinctive behaviour, practical, evidence-informed suggestions strive to overcome barriers and facilitate enablers of knowledge translation. This time must be protected by evidence-based routines of staff. [ABSTRACT FROM AUTHOR]

Aim: In parallel with falling smoking rates, use of the oral moist tobacco product snus increases among women in reproductive age. We report an update on prevalence and effects of maternal use of snus and nicotine replacement therapy (NRT) during pregnancy and breastfeeding.Methods: A literature search of human studies in Medline, PubMed and EMBASE was conducted from September 2016 to May 2018, with stepwise screening of abstracts and subsequent relevant full-text papers for inclusion in Scandinavian and English languages.Results: Based on three studies, the prevalence of snus use in pregnancy was up to 3.4% in the first trimester and 2.1% in the third trimester. In 12 studies, we found increased risk of several adverse effects, especially preterm delivery, stillbirth and small for gestational age associated with maternal snus use during pregnancy. Knowledge on effects of NRT during pregnancy was conflicting and inconclusive in 10 studies. We did not identify any studies on prevalence or potential health effects of snus or NRT during breastfeeding.Conclusion: Few studies with updated data on the prevalence and adverse health effects of maternal use of snus and NRT during pregnancy were found. No studies during breastfeeding were identified. [ABSTRACT FROM AUTHOR]

Performing a frenotomy on tongue-tied infants is controversial, particularly with regard to breastfeeding issues. This paper reviews the literature to bring together clinical experiences and scientific evidence in this field. I found that some tongue-tied babies may exhibit breastfeeding problems, while others may feed perfectly. The literature suggests that medical breastfeeding-related problems should be the only relevant criteria to guide the decision-making for a frenotomy in infancy. The advantages and disadvantages of either a wait and see position or surgical approach are addressed.Conclusion: The cornerstones for best practice are the meticulous examination, correct diagnosis and classification of tongue-tied infants. [ABSTRACT FROM AUTHOR]

Aim: To synthesise the current evidence for the associations between breastfeeding and dental caries, with respect to specific windows of early childhood caries risk.Methods: Systematic review, meta-analyses and narrative synthesis following searches of PubMed, CINAHL and EMBASE databases.Results: Sixty-three papers included. Children exposed to longer versus shorter duration of breastfeeding up to age 12 months (more versus less breastfeeding), had a reduced risk of caries (OR 0.50; 95%CI 0.25, 0.99, I(2) 86.8%). Children breastfed >12 months had an increased risk of caries when compared with children breastfed <12 months (seven studies (OR 1.99; 1.35, 2.95, I(2) 69.3%). Amongst children breastfed >12 months, those fed nocturnally or more frequently had a further increased caries risk (five studies, OR 7.14; 3.14, 16.23, I(2) 77.1%). There was a lack of studies on children aged >12 months simultaneously assessing caries risk in breastfed, bottle-fed and children not bottle or breastfed, alongside specific breastfeeding practices, consuming sweet drinks and foods, and oral hygiene practices limiting our ability to tease out the risks attributable to each.Conclusion: Breastfeeding in infancy may protect against dental caries. Further research needed to understand the increased risk of caries in children breastfed after 12 months. [ABSTRACT FROM AUTHOR]

Aim: To update a previous systematic review and meta-analyses about the effect of breastfeeding promotion interventions on child growth.Methods: Studies evaluating the effect of any type of breastfeeding promotion intervention on child weight, length (or height) and weight/height (or BMI) were screened. Papers published between 2006 and 2014 were checked using the following databases: PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, Lilacs and SciELO.Results: Sixteen studies were added to 19 other studies identified in the previous review, resulting in 35 studies. Meta-analyses of studies reporting on mean weight, length, weight/length or BMI showed that the interventions had no impact on weight or length/height z scores [pooled effect: 0.03 (95% confidence interval: -0.06;0.12) and 0.03 (95% confidence interval: -0.02;0.08), respectively] and had a modest, but significant, reduction in body mass index/weight-for-height z scores [z score mean difference: -0.06 (95% confidence interval: -0.12;0.00)], which was limited to studies from low- and high-incomes settings. For all three outcomes, there was important heterogeneity among studies, which should be taken into account when interpreting the results.Conclusion: Breastfeeding promotion interventions were not associated with significant changes in weight or length, but led to a modest, albeit significant, reduction in body mass index/weight-for-height z scores. [ABSTRACT FROM AUTHOR]

The biology of human milk and lactation helps understand the physiology of breastfed infants. The compositional and biological effects of human milk lipids have received considerable interest regarding their modulating effects on growth, metabolism and functions of the cardiovascular, immune and nervous system. Conclusion: This paper describes key aspects of a scientific workshop focused on current knowledge, unresolved questions and future research needs in the area of human milk lipids and their physiological effects in infants. [ABSTRACT FROM AUTHOR]

There is strong evidence that using breastmilk substitutes disadvantages the infant, mother and community as a whole. There is also increasing evidence regarding the lactation process, breastfeeding inhibitors and enablers, and breastfeeding management options. However, there appears to be a gap between this evidence base and practice with breastfeeding rates being unacceptably low, especially following hospital discharge. This paper discusses barriers to the implementation of breastfeeding best practice using a framework of the research-to-practice pipeline: acceptance, applicable, available and able, acted upon, agreed to and adhered to. As blocks or restrictions to the flow of information or evidence may occur at any point along the pathway, researchers designing interventions to increase breastfeeding rates need to consider using multi-strategy interventions and target collaborative care across professions. Barriers to implementing evidence-based breastfeeding practices are common and wide ranging. These barriers should be considered when developing new breastfeeding services and research programmes. [ABSTRACT FROM AUTHOR]

An international effort is underway to develop a new international growth reference for assessing the growth of young children, especially breastfed infants who appear to falter relative to the currently recommended National Center for Health Statistics/World Health Organization reference. While limited data from high socioeconomic status children from different parts of the world suggest that their growth patterns are similar, there is no comprehensive study of breastfed infants. The WHO Multinational Study of Breastfeeding and Lactational Amenorrhea provides bi-weekly weights and 2-4 weekly length measurements on breastfed babies from selected sites in Australia, Chile, China, Guatemala, India, Nigeria and Sweden. Multi-level modelling was used to analyse between-site differences in the growth of approximately 120 infants per site, after adjustment for maternal stature and infant feeding pattern. All mothers were literate and mean educational levels were well above national averages, but the study was not restricted to infants of high socioeconomic status. Maternal education was significantly associated with infant weight only in India. The growth curves of infants from most sites were strikingly similar, but relative to the Australians (the reference category), the Chinese babies were about 3% shorter at 12 mo of age and the Indians up to 15% lighter. The present results suggest that breastfed babies from reasonably well-off families in different continents show very similar growth patterns. However, it is important that the growth of children from South and East Asian populations be rigorously assessed in the process of developing the new international growth reference. This paper discusses the relative importance of environmental versus genetic influences in the growth of young children and illustrates the complexities involved in the analysis of growth data. [ABSTRACT FROM AUTHOR]

Presents a direct challenge to a paper showing that breastfeeding appeared to have a marked stimulatory effect on the size of the infant thymus. History of debate surrounding the organ; Thymic size in breastfed and formula-fed infants; Sonographic assessment of thymic size.

Child obesity is becoming a serious public health concern, and major research effort is being devoted both to understand its aetiology and to improve the effectiveness of prevention strategies. Early growth patterns, both prenatally and postnatally, are emerging as important markers of later obesity risk, with rapid neonatal weight gain a clear risk factor for later obesity and metabolic syndrome. Thus, in two distinct senses child obesity is a growing problem. The paper summarises current evidence on growth pattern and obesity, relating it to infant feeding practice and appetite regulation, and highlights the areas in which public health interventions are feasible. Of the conclusions drawn, one involves a futuristic solution to child obesity where neonates are given an infusion of the hormone leptin to reset their appetite regulation. [ABSTRACT FROM AUTHOR]

This paper reports on two male infants with abnormally high levels of serum triacylglycerols (>15.00&ThickSpace;mmol/l) and massive accumulation of chylomicrons. Pathological lipidograms were observed during breastfeeding only and were typical of a&ThickSpace;rare chylomicronaemia syndrome. Laboratory abnormalities were detected accidentally in the otherwise healthy infants. An unrecognized modulating factor in fresh mother's milk caused transitory decreased activity of hydrolytic complex for chylomicrons and very-low-density lipoproteins, probably due to a dysfunction of lipoprotein lipase. The normalization of lipidograms suggested that the catalytic activity of lipoprotein lipase rapidly recovered after weaning. Pathogenesis moved more towards an immune disorder, to the production of (auto)antibodies against a component of the lipolytic system. Mother's milk should be substituted with banked donor human milk, but this is not an unambiguous demand. Conclusion: Fresh mother's milk caused a decrease in the activity of lipolytic enzyme (lipoprotein lipase). The massive hypertriacylglycerolaemia quickly disappeared after weaning. Two infants with this transient chylomicronaemia syndrome were asymptomatic. [ABSTRACT FROM AUTHOR]

The breastfed infant has limited sources of vitamin K, as it is transmitted poorly across the placenta and is present in very low concentrations in human milk. The author of this paper reports a concentration of vitamin K in human milk (0.517 ±; 1.521 μ-g/dl) that is about twice the average of earlier reports (0.25 μg/dl). About half of the increased concentration (0.235 ±; 0.144 μ/dl) is accounted for by vitamin K2 (menaquinone) rather than vitamin K1 (phylloquinone); the latter generally thought to be more important in human nutrition. The significance of these findings is discussed. [ABSTRACT FROM AUTHOR]