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Human milk feeding has generally been described using a heteronormative and cisnormative paradigm focusing on a mother and child dyad with the child nursing at the mother's breast and the father in a supportive role. However, there has been a paradigm shift that has emerged from the LGBTQI+ community that recognizes dynamic gender identities, gender roles, sexual orientations, and diverse family structures. Social workers can best provide support to people with dynamic and diverse gender roles and a variety of family structures. The purpose of this paper is to provide an overview of social work best practices, including de-sexed and gender-inclusive language, gender-affirming, and trauma-informed care in supporting lactation and infant feeding for LGBTQI+ families. This paper acknowledges and describes terminology that promotes equity and inclusivity in human milk feeding and provides examples of information and anticipatory guidance that social workers can use to protect, promote, and support human milk feeding in the LGBTQI+ community. [ABSTRACT FROM AUTHOR]

Cow's milk protein allergy (CMPA) affects 2% to 3% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding health care providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. A total of 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care. [ABSTRACT FROM AUTHOR]

Introduction: Baby-led weaning (BLW) is a growing method for parents to introduce food to their kids. As advisers who affect the decisions of parents, health practitioners have significant obligations in this regard. Objective: We aim to identify existing literature on the knowledge, perceptions, and attitudes of health professionals toward BLW. Methods: We carried out a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. After registering with Open Science Framework, published articles were retrieved from EBSCOhost, PubMed, SciELO, ScienceDirect, Open Grey, and the Portuguese Scientific Open Access Repository. Primary studies with full-text availability in English, Spanish, or Portuguese, and no data publication limitations were included. Results: The final sample included seven publications conducted in five countries published between 2012 and 2022. Only one study employed a hybrid methodology showing incongruent practices in parents/health professionals on BLW, whereas most studies employed a quantitative approach. Regarding BLW, it is recognized that there is a dearth of evidence, consensus, and advice. Conclusion: Despite benefits, health professionals hesitate to recommend BLW due to insufficient study and safety concerns, warranting more research. Hence, our scoping review demonstrated that BLW is a scientifically under-researched subject, indicating a significant research gap that must be filled in the future. [ABSTRACT FROM AUTHOR]

Background: Donor human milk is recommended when infants are unable to be fed their mother's own milk or require supplementation. For-profit companies use technologies to create human milk products for infants in the neonatal intensive care setting without consistent guidelines and regulatory frameworks in place. This commercialization of human milk is inadequately conceptualized and ill-defined. Research Aims: The aim of this study is to conceptualize and define the commercialization of human milk and discuss the need for policy guidelines and regulations. Method: Using a concept analysis framework, we reviewed the literature on the commercialization of human milk, analyzed the antecedents and potential consequences of the industry, and developed a conceptual definition. The literature review resulted in 13 relevant articles. Results: There has been a surge in the development and availability of human milk products for vulnerable infants developed by for-profit companies. Commercialized human milk can be defined as the packaging and sale of human milk and human milk components for financial gain. Factors contributing to the commercialization of human milk include an increased demand for human milk, and consequences include potential undermining of breastfeeding. The lack of guidelines and regulations raises concerns of equity, ethics, and safety. Conclusion: The industry is rapidly growing, resulting in an urgent need for consistent guidelines and regulatory frameworks. If left unaddressed, there could be potential risks for donor milk banking, the future of breastfeeding, and infant and maternal health. [ABSTRACT FROM AUTHOR]

Objective: Characterize the interventions and assistance employed by a cleft nurse navigator (CNN) which have mediated improvement in care equity at our institution. Design: Retrospective study. Setting: Academic tertiary care center. Patients, Participants: Patients presenting with cleft lip and/or cleft palate presenting between August 2020 and August 2021 with exclusions for syndromic diagnosis, Pierre-Robin sequence, late (> 6 months) presentation, and prior cleft surgery at outside institutions. Interventions: Multidisciplinary cleft nurse navigator program Main Outcome Measure(s): Family interactions with the CNN by phone, text, and email across the first year of life including feeding support, nasoalveolar molding (NAM) assistance, appointment scheduling, financial assistance, addressing perioperative concerns, and facilitating physician consults. Patient weight and surgical timing were also recorded. Results: Sixty-nine patients were included with a total of 639 interactions between the CNN and families. Scheduling support (30%), addressing perioperative concerns (22%), and feeding support (20%) were the most common interactions. Feeding support and NAM assistance were heavily distributed in the first 3 months of life compared to after 3 months (P <.001). Median age at first contact was 1 week (range: 22 weeks gestation-14 weeks). There was no difference in the proportion of families receiving feeding support, NAM assistance, or scheduling assistance based on insurance status or race (P >.05 for all). Conclusions: Scheduling assistance, addressing perioperative concerns, and feeding support are the predominant methods by which the CNN interacts with and assists families of patients with cleft conditions. CNN service distribution is largely equitable between demographic groups. [ABSTRACT FROM AUTHOR]

Objective: To examine the current trends and practices across disciplines for feeding infants with cleft palate with or without cleft lip and to describe provider training within this area Design: Prospective survey Setting: ACPA approved cleft palate teams and healthcare providers in the United States and Canada Participants: Interdisciplinary providers that regularly provide feeding services to infants with cleft palate Intervention: 50-item survey designed and distributed electronically via the ACPA Main Outcome Measures: Information on provider demographics and practice patterns Results: 76 respondents included providers in North America that have either currently or previously served on a cleft palate team. The majority of respondents were in speech-language pathology (49%) or nursing (38%) disciplines, worked in an outpatient setting (70%), and received no information (68%) regarding cleft palate feeding in their academic training. While specific practice patterns were relatively consistent across the respondent cohort, provider characteristics were significantly associated with squeezing the Haberman (p =.013) and likelihood of collaboration with other providers when counseling parents/caregivers (p =.039). Conclusions: While provider characteristics varied, there were similar practice patterns observed across disciplines. Future research is needed explore training related to feeding knowledge as well as practice patterns in locations with a lower patient volume. [ABSTRACT FROM AUTHOR]

Drawing on the work of Layton and Duffy, and Williams, Davey and Johnstone, this paper examines the infant formula marketing system. Using a Systems of Provisioning approach, marketing system failure as a result of regulatory intervention at the intersection of two systems is conceptualized - the infant health system and the infant formula marketing system. Positive population-based outcomes for breast feeding rates and negative stigmatizing outcomes at an individual consumer level occur as the two provisioning systems respond to regulatory interventions. The mechanisms are identified whereby intervention restricts participant choice and coevolution of the marketing system contributing to the failure. Taking a Systems of Provisioning approach, we advance the understanding of marketing system failure, and we recommend co-design processes involving multiple stakeholders as a way forward to remedy such occurrences. [ABSTRACT FROM AUTHOR]

Objective: To assess the characteristics of popular videos on YouTube about the feeding of infants with cleft lip and palate (CLP) and analyze the adequacy of information provided by them. Design: A cross-sectional design was used. Methods: YouTube was systematically searched for consecutive relevant videos about the feeding of infants with CLP, using predefined keyword combinations, without any limitations on language or duration. Scrutiny of the top 50 videos for each keyword combination was performed and a self-designed data-extraction sheet was used. A content adequacy index was developed by an expert group, and used to assess content adequacy, classifying it into categories from excellent to poor. Results: From an initial retrieval of 200 videos, 42 were included in the final assessment. The videos originated from nine different countries, with more than half coming from the USA and in English. Five of the videos came from the channel of the American Cleft Palate-Craniofacial Association. Content adequacy analysis showed that no video could be classified as excellent, while 33.3% were classified as optimal, 21.4% as suboptimal and 45.2% as poor. Conclusions: The content adequacy of the majority of videos on YouTube, relating to the feeding of infants with CLP was inadequate, with only one third of them achieving optimal content adequacy. Efforts must be made to develop informative and standardized videos for social media and video-sharing platforms, perhaps through professional associations to ensure that families with an infant with CLP receive appropriate information. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Human Lactation is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To identify physical environmental factors influencing family involvement in feeding in New Zealand neonatal units. Background: Infant oral feeding development is critical for both short-term feeding skills and longer term neurodevelopmental outcomes. The neonatal environment is well-known as challenging for neuroprotection due to negative sensory exposure. The impact of environmental factors on oral feeding in New Zealand (NZ) neonatal units is currently unexplored, and knowledge of this could allow for evidence-based unit design. Methods: Focused ethnography at five neonatal units, a national survey of NZ neonatal professionals (n = 102), and five focus groups were carried out. Current oral feeding practice, and beliefs, experiences, and opinions of unit staff and family about these practices were explored. Data were analyzed using qualitative content analysis. Results: Units were providing the best experience to families that they could with the resources they had available. Lack of physical space, lack of privacy, limited on-site accommodation for families, and lack of coordination between maternity and neonatal services were identified as impacting on family's comfort and sense of homeliness on the unit. Unit staff used furniture, screens, and external accommodation providers to support families where they could. Conclusions: The physical design of neonatal units in New Zealand provides barriers to family's spending time privately developing oral feeding. Solutions are proposed to increase the size of bedspaces, provide single-family rooms, create greater on-site family accommodation options, combine maternity and neonatal healthcare, and improve family comfort and therefore connection with their infant. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effect of lullabies and classical music on preterm neonates' cerebral oxygenation, vital signs, and comfort during orogastric (OG) tube feeding. Methods: This was a parallel-group pretest-posttest randomized controlled study. The research was conducted between December 2020 and May 2022. The sample consisted of 51 preterm neonates hospitalized in the neonatal intensive care unit (NICU) of Selçuk University Faculty of Medicine Hospital in Konya, Türkiye. Participants were randomized into three groups (17 preterm infants in each group). The first group listened to lullabies sung by their mothers and the second group listened to classical music during OG tube feeding. The control group received routine care with no music. Data were collected using a Neonatal Identification Information Form, Physiological Parameters and rSO2 Monitoring Form, and the Newborn Comfort Behavior Scale (Comfort-Neo). The study was registered on the ClinicalTrials database (NCT05333575). Results: The lullaby group had stable peak heart rates and oxygen saturation levels (p =.002). Both lullaby and classical music groups had significantly higher cerebral oxygenation levels than the control group. The classical music group had the highest cerebral oxygenation level (p =.001). Both lullaby and classical music groups had significantly higher mean Comfort-Neo scores than the control group. The classical music group had the highest mean Comfort-Neo score (p =.040). Conclusion: Preterm neonates who listen to lullabies and classical music are likely to have higher cerebral oxygen and comfort levels. Listening to lullabies helps stabilize vital signs. These results suggest that healthcare professionals should encourage parents to get their preterm neonates to listen to lullabies and classical music. [ABSTRACT FROM AUTHOR]

The study examines the influence of a diversified diet, changes in the consistency of introduced foods, and the method of meal preparation during infancy on the development of sensitization and/or allergy in toddlers. Introducing more product groups into the diet reduced the risk of allergy at 6 months of age (adjusted odds ratio [aOR] = 0.17; 95% confidence interval [CI] 0.04-0.71; P = 0.015) and at 12 months (aOR = 0.14; 95% CI 0.03-0.57; P = 0.006). Children with allergy and/or sensitization had been introduced to fewer product groups at 6 months (P = 0.003; P < 0.001; P = 0.008) and at 12 months (P = 0.001, P < 0.001; P = 0.001) compared with those without allergy and/or sensitization. Children with allergy and/or sensitization were fed ready-made, ie, purchased, products significantly more often than self-prepared foods compared with children without allergy and/or sensitization (P = 0.001; P = 0.006). Allergic and/or sensitized children tended to be switched to solids later (11 vs 10 months, P = 0.041; P = 0.037) (12 vs 10 months, P = 0.013) than children without sensitization and/or allergy. The earlier introduction of a varied diet reduced the risk of allergy and/or sensitization. Delaying the introduction of solid foods and using ready-made products instead of self-prepared ones increases the risk of allergy in toddlers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate feeding efficiency and weight gain in infants with cleft palate fed using 1 of the 2 specialty feeders. Design: Retrospective cohort study. Setting: Cleft palate clinic in a tertiary pediatric hospital. Participants: Infants with cleft palate (with or without cleft lip) fed using the Medela SpecialNeeds® Feeder (n = 39) or the Dr. Brown's® Specialty Feeding System (n = 16) and who had documented feeding and growth data available from the time of initial assessment in the first month of life and at subsequent follow-up between 2 and 4 months. Primary Outcome Measure: Feeding velocity (mL/min). Secondary Outcomes Measures: Calorie velocity (kcal/min), weight gain, and complications associated with poor feeding. Results: No statistically significant differences in feeding or calorie velocities were identified between infants with cleft palate fed with the Medela SpecialNeeds® feeder and those fed with the Dr. Brown's® feeder. Mean weight z-scores by month did not differ significantly between the 2 bottle groups at the time of initial assessment (P =.84) and follow-up (P =.20). Mean weight z-scores by month for the infants included in this study fell below the 50th percentile. The proportion of infants who developed otitis media, reflux requiring treatment, or who required hospital admission for nasogastric (NG) feeds did not differ significantly between the 2 groups. Conclusions: Despite being adequately powered for the primary outcome, no significant differences were identified between infants fed with the Medela or the Dr. Brown's feeders in terms of feeding velocity, calorie velocity, weight gain, or complications. [ABSTRACT FROM AUTHOR]

The article describes the case of a four-month-old female with a one-month history of progressive inspiratory stridor, respiratory distress, and feeding problems and was diagnosed with patent ductus arteriosus, on the first day of life. Topics discussed include the two episodes of sepsis suffered by the patient during her hospitalization, the intubation of the patient, and finding on histopathologic examination.

The article describes the case of a 32-day-old female infant who experienced poor feeding, mild cough, lack of appetite decreased activity, and sub febrile fever. Topics discussed include vital signs at admission to the hospital, mechanisms in the etiology of respiratory virus-associated neurological complications, and potential causes of hyponatremia, which is said to increase the disease severity in infants hospitalized with respiratory syncytial virus (RSV) infection.

Purpose: The present study was conducted to determine the effect of odor stimulation with breast milk (BM) applied to premature newborns before and during enteral feeding on feeding cues, transition time to oral feeding and abdominal perfusion. Design: This study was a parallel group pretest-post test randomised controlled trial (RCT). Methods: The study was conducted in the neonatal intensive care unit (NICU) in Türkiye. Study data were collected from 32 premature newborns between October 2020 and December 2021. Newborns were randomly assigned to either intervention (n = 16) or control (n = 16) groups. Odor stimulation with BM was applied to newborns in the intervention group (IG) before and during enteral feeding for 3 days. Data were collected with the Newborn Information Form, Abdominal Perfusion Follow-up Form, and Feeding Cues Follow-up Form. Yates corrected and Fisher chi-squared test, Mann-Whitney U test, Cohen Kappa statistics, Permanova analysis, and Wilcoxon test were used in the analysis. The study was registered in ClinicalTrials.gov (NCT04843293). Results: The frequency of feeding cues in newborns who were exposed to the odor of BM, was higher than in the control group (CG) (p <.05). The transition times to oral feeding were similar in newborns in the IG and CG (p >.05). Abdominal perfusion level of newborns in the IG was higher than the CG (p <.05), and the level of abdominal perfusion showed a significant difference in terms of group*time interaction (p <.05). Conclusion: Our findings suggest that odor stimulation with BM will be beneficial in improving the digestive functions of premature newborns. [ABSTRACT FROM AUTHOR]

Breastfeeding rates in urban Malaysian mothers are below World Health Organization (WHO) targets. Our prospective survey identified breastfeeding prevalences at 3, 6, and 12 months of 85.5%, 77%, and 60%, respectively. Combined (direct and expressed) breastfeeding significantly sustained longer-term breastfeeding. Efforts should be focused on mothers of Indian ethnicity and on expression after one month postpartum. [ABSTRACT FROM AUTHOR]

This article focuses on young low-income mothers' engagement with, and management of, potentially conflicting discourses within the context of maternal foodwork. Findings from qualitative, longitudinal interviews with 13 UK women illustrate the performance of identity and family work, in relation to infant feeding and wider maternal practices. Each participant was interviewed twice, once prior to, and then following, the birth of their first baby. We identify three rhetorical strategies. Adopting and resisting allow for the acceptance or rejection of prominent infant feeding discourses. Under reframing, young women transform the encouragement to breastfeed, subverting or reversing official discourses. Reframing thus provides an alternative means to appropriate and deploy versions of good motherhood, drawing on women's lived realities and local maternal cultures, alongside wider experiences of building and managing family relationships. [ABSTRACT FROM AUTHOR]

Infant A was born at term with an antenatal diagnosis of gastroschisis. His parents were well informed about the condition and understood that he would require surgery. However, at delivery, his bowel was found to be severely compromised. Infant A returned from theatre with only four centimeters of small bowel. This is physiologically devastating and easily qualifies as ultrashort bowel syndrome (USBS). Whilst the prognosis from ultrashort bowel syndrome is greatly improving, the condition continues to carry a significant risk of mortality and morbidity, in part attributable to treatment itself. The cornerstone of management of USBS is provision of intravenous parenteral nutrition (PN). This is not a physiologically normal route of nutrition; it is a medical treatment. Infant A's parents questioned whether continuation of active treatment was appropriate. If a treatment is not in the patient's best interests, then it can be argued it is not justified to administer it. Decisions about quality of life are intensely personal. Where there is a significant burden of treatment, even when there is a potential for increased survival, whether the course of treatment is in the child's best interests must be taken with huge emphasis on the parental perspective and their family values. For well-informed, realistic parents who are welcoming of the full picture of information and implications of their decision, I argue that parents are best placed to make the decision for their child. Long-term PN for USBS may well be a medically encouraged treatment. However, it should not be medically mandated. [ABSTRACT FROM AUTHOR]

This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P =.009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P =.024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P =.032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings. [ABSTRACT FROM AUTHOR]

Background: Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality. Objectives: To explore how PND influences neonatal feeding and care practices among women in the early postnatal period in rural Western Kenya. Design: A cross-sectional study. Methods: Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya. They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale. Results: Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and challenging relationships with partners/other family members. Feeding difficulties due to perceived insufficient breastmilk were a particular challenge for mothers with features of PND, who were more likely to introduce complementary feeds. Maternal health-seeking decisions were influenced by high financial cost, long waiting times and poor interactions with health care providers that induced stress and fear among mothers. Maternal caregiving capacity was influenced by her ability to juggle other household duties, which was difficult for mothers with features suggestive of PND. Support from friends and relatives positively impacted maternal mood and caregiving ability. Conclusion: Mothers experienced many stress-inducing events in the perinatal period which potentially exacerbated features of PND in the immediate postnatal period. Women with features of PND were particularly vulnerable to these stressors that influenced infant caregiving practices. Addressing the socio-economic challenges and health system gaps that include scale up of compassionate and respectful care for women during pregnancy and childbirth, as well as early screening and intervention of PND, through enhanced referral pathways between health facilities and community support structures, could mitigate against the impact of PND on neonatal caregiving. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is recommended for infants through 6 months of age, when solid foods are introduced, and continued until 12 months of age. However, many mothers in the United States discontinue breastfeeding at an early age and return to work following childbirth. The purpose of this study was to identify individual and organizational factors associated with breastfeeding practices in a sample of employed mothers who participated in the Infant Feeding Practices Study II. Methods: A secondary analysis was conducted on a sample of 953 employed mothers who completed the Infant Feeding Practices Study II between 2005 and 2007. The analysis compares infant feeding status (breastfeeding/feeding pumped milk vs. not breastfeeding/feeding pumped milk) over a 12-month period, using generalized linear mixed modeling (GLMM). Findings: Generalized linear mixed modeling (GLMM) revealed that working mothers who were employed part-time (≤34 hours/week) were 97% more likely to continue breastfeed compared with mothers employed full-time over the 12-month follow-up period (OR = 1.97, p =.002). Mothers who perceived high levels of breastfeeding support in the workplace were 178% more likely to continue breastfeeding compared with those with low levels of perceived support (OR = 2.78, p <.001). Conclusions: Prenatal breastfeeding only feeding intentions, non-smoking, part-time employment, and higher levels of perceived breastfeeding support in the workplace were significant predictors of breastfeeding/feeding pumped milk at all time points. Application to Practice: Occupational health nurses may be able to address barriers to breastfeeding in the workplace and improve supportive workplace practices to promote continued breastfeeding in employed mothers consistent with national and international recommendations. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to estimate the prevalence of common mental health difficulties in parents who have an infant with Gastroesophageal Reflux Disease (GORD), and to identify psychological predictors of parental anxiety, depression, and well-being, as a platform for subsequent intervention development. Methods: Parents of infants with GORD (N = 309) completed online psychometric measures of potential predictors (self-compassion, illness appraisals, and illness uncertainty), potential confounders (sleep quality, relationship satisfaction, social support, and infant feeding satisfaction), and mental health outcomes (anxiety, depression, and wellbeing). The outcome measures were repeated eight-weeks later (N = 103). Results: At the first time-point, 66% of participants exceed the clinical cut off for generalised anxiety disorder and 63% exceeded that for a depressive disorder. Both had significantly reduced eights-weeks later. Greater self-compassion predicted lower anxiety and depression, and better well-being, in both cross-sectional and longitudinal data, including when all confounders were controlled for. Illness uncertainty and illness appraisals were less consistent predictors. No robust differences were found between parents of infants with silent GORD and those with GORD with visible regurgitation. Conclusions: Parents of infants with GORD showed high rates of anxiety and depression, which were elevated compared to those that have been found in perinatal and general population samples. Self-compassion was a consistent predictor of better mental health and has promise as a proximal intervention target. Future research could benefit from examining the efficacy of a compassion-focussed intervention in this population. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Human Lactation is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Preterm neonates are not able to breastfeed due to immature sucking swallow reflexes and are kept on an alternative method of feeding until they are able to do so. The time to reach full oral feeds and breastfeed, the duration of feeding, and spillage are important parameters that need to be observed so that a baseline value can be provided, which can help healthcare professionals see the progression and appropriateness of feeding preterm neonates. Objective: To assess the duration of feeding, spillage, weight changes, days to reach full oral feeds, full breastfeed, and length of hospitalization among preterm neonates. Material and Methods: A descriptive study was carried out on 106 preterm neonates in the step-down unit of the NICU, PGIMER, Chandigarh. The variables under study were duration of feeding, spillage, weight changes, days to reach full oral feeds, days to reach full breastfeed, and length of hospitalization. The tools for data collection used were a socio-demographic profile along with a clinical profile of neonates, a neonatal assessment, and an observation sheet to record spillage and duration of feeding. The methods of data collection used were observation and biophysiological methods. Weight was assessed by the infant weighing scale present in the unit (in grams) and to measure spillage, a bib was used, and its pre- and post-feeding weight was measured on a diaper weighing machine. The values are expressed in grams. The data were collected from July 2021 to November 2021. The data are analyzed using the SPSS version 23.0. Results: The results showed that neonates took an average of mean ± SD (range) 15.0 ± 3.12 (10−26) min to complete one feeding session, and spillage was around 1.37± 0.3 (0.8−2.3) g. The transition time to full oral feeds was 8.01 ± 7.21 (1–44) days, and the average time to reach full breastfeed was 26.7 ± 12.1 (5−56) days. Conclusion: The present study has provided valuable data on duration of feeding and spillage that serves as a guide for the amount of milk that can be added to the prescribed feed. The information is also helpful in educating the parents to be patient while feeding the baby and wait for at least 3 weeks to 2 months to reach full breastfeed. Gestational age at birth and birth weight affect (negative correlation) the time to reach full oral feeds, breastfeed, and length of hospital stays (p <.05). [ABSTRACT FROM AUTHOR]

Slum environment may pose risk to child health and nutrition. This study assessed the risks of anemia among under five-year-old children, five years after implementing a nutrition education and counseling intervention in two urban slums in Nairobi, Kenya. A cross-sectional study was conducted in May 2018 as a follow-up of a randomized controlled study carried out between 2012–2015. A trained nurse measured hemoglobin levels of 438 children from households which participated in the initial study. Multivariate logistic regression was conducted to identify risks of anemia. The mean (+ SD) age of the children was 55.9 (5.3) months and mean (+ SD) hemoglobin was 10.7 (1.5) g/dL. Anemia prevalence was 59.8%, 33.9% had mild, 24.7% moderate, and 1.2% severe anemia. Absence of home toilet (AOR = 3.31; 95% CI, 1.20–9.09), household which paid to use a toilet facility (AOR = 1.86; 95% CI, 1.12–3.08), child's frequency of eating colored fruits and vegetables (AOR = 0.28; 95% CI, 0.08–0.96), meat and meat products (AOR = 0.31; 95% CI, 0.23–6.01), number of meals a child aged <15years ate a day preceding the study (AOR = 1.49; 95% CI, 1.14–1.98), and a mother who had a history of anemia (AOR = 2.89; 95% CI, 1.22–12.01), were factors significantly associated with child's anemia status. The environment of urban informal settings influences child anemia status. Further studies with interventions are therefore required in order to improve sanitation facilities and access to meats, fruits, and vegetables in urban slums through innovative kitchen gardens and small animal husbandry. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine differences in human milk feeding outcomes among infants admitted to a neonatal intensive care unit (NICU) with and without cleft lip and palate (CLP). Method: Data were used from a sample of infants admitted to the NICU with and without CLP from the 2018 National Vital Statistics System. For baseline comparisons, Chi-square tests of independence were used to compare categorical variables, and independent samples t tests were used for continuous variables. Logistic regression models were performed to determine the odds of human milk feeding at discharge in infants admitted to the NICU with CLP. Results: The total sample included 345,429 infants admitted to the NICU, of which 660 had CLP. Significant differences were found among the following variables when baseline comparisons were made between infants admitted to the NICU with and without CLP: mother's race, mother's education, maternal smoking record, childbirth delivery method, presence of maternal pre-pregnancy diabetes, five-minute APGAR score, multiparity record (having more than one baby at birth), gestational age, and gestational weight. After controlling for baseline differences, results indicated reduced odds of human milk feeding at discharge in infants admitted to the NICU with CLP compared to those without CLP (OR =.543; 95% CI.455,.648). Conclusion: Results suggest reduced odds of human milk feeding at discharge among infants admitted to the NICU with CLP compared to those without CLP. These findings emphasize the necessity of awareness and facilitation of human milk feeding in this population. [ABSTRACT FROM AUTHOR]

Background: Maternal depression may affect child feeding practices and growth. Objective: The objective of this study is to determine the relationship between child feeding practices and current maternal depression with malnutrition among young children in a rural community. Methods: This is a case–control study consisting of 52 Malay mothers of malnourished children (case) and 50 Malay mothers of well-nourished children (control) in Kuala Langat, Selangor, Malaysia. Structured questionnaires on child feeding practices and Beck Depression Inventory: Second Edition questionnaire were distributed to mothers. Results: Depressed mothers stopped exclusive breastfeeding (2.8 ± 2.1 months) earlier than non-depressed mothers (3.7 ± 2.0 months; p = 0.045). Binary logistic regression analysis showed current maternal depression was a primary contributor associated with risk of malnutrition in children (adjusted odds ratio: 2.5, 95% confidence interval: 1.08–6.09), and followed by the number of children (adjusted odds ratio: 1.3, 95% confidence interval: 1.02–1.77). Conclusion: Mothers who experienced depression were twice as likely to have malnourished children. Each additional child in the family will increase the risk of malnutrition by 1.3 times. Maternal depression is associated with child feeding practices and malnutrition among young children in the studied population. Preliminary screening to identify depression symptoms should be conducted to all mothers as early as the first trimester to prevent the incidence of malnutrition in children. [ABSTRACT FROM AUTHOR]

Objective: Various devices and techniques have been proposed to reduce feeding difficulties experienced by infants with cleft palate. The aim of this review is to identify and assess the scope and quality of evidence for these interventions. Methods: A systematic review of published literature evaluating feeding interventions for infants with cleft palate (with or without cleft lip) from database inception to 2021 was conducted using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using a methodological index for nonrandomized studies, Cochrane, or a measurement tool to assess systematic reviews 2 instruments, according to study type. Results: Fourteen studies met inclusion criteria, with the majority (71%) of studies consisting of second-level evidence. Included interventions were specialty bottles (21%), alternative feeding delivery systems (14%), obturators (14%), and educational programs (14%). Specialty bottles and palatal obturators did not appear to offer any substantial growth advantages compared to traditional bottles or no intervention, respectively. Designated education programs for the mothers of infants with clefts had a positive impact on infant growth. Conclusions: Overall evidence evaluating feeding interventions for infants with cleft palate was moderate to low. While it does not appear that specialized feeding delivery systems or palatal obturators significantly improve growth in infants with clefts compared to children without cleft conditions, education programs do appear to be beneficial. [ABSTRACT FROM AUTHOR]

Low breastfeeding rates are driven by multiple bio-psycho-social factors. Experience of breastfeeding is known to differ by maternal demographic factors (age, education and ethnicity) but there is less recognition of factors such as neurodivergence. This review, prospectively registered with PROSPERO (registration number: CRD42021271465), systematically identified qualitative research, commentaries and personal accounts related to Autistic mothers and infant feeding. Database searching identified 1225 records, with thematic synthesis undertaken on 22 (eight peer-reviewed studies and 14 grey literature) pieces. Our analysis identified that maternity and infant feeding services were built on a lack of understanding of Autistic needs, and were often inaccessible at a time when Autistic mothers already felt a loss of control and lack of social support. Specifically relating to breastfeeding, knowledge and determination were often high, and a minority of mothers reported positive breastfeeding experiences. However, sensory challenges, pain and interoceptive differences (exacerbated by a lack of support) made breastfeeding impossible for some. Infant formula was viewed as second-best to breastmilk, but a minority of mothers found the ritual of preparing bottles of formula positive. There is an urgent need for maternity and infant feeding services to accommodate the needs of Autistic mothers, including service design and staff training. [ABSTRACT FROM AUTHOR]

This article focuses on the practice of breastfeeding selfies, as a relational practice within online breastfeeding groups. I suggest that despite breastfeeding being upheld as the most superior infant feeding method, the practice has a paradoxical relationship to discourses of the "good mother" and the idealisation of motherhood more generally. This is due to the unashamed boldness of the practice, which flies in the face of notions of discretion, with their subsequent links to respectability. Breastfeeding selfies can be understood as gestures for something outside of the mother-infant dyad, therefore insisting on recognising the desire, needs and sociality of the mother. Furthermore, they move to position breastfeeding as a social, rather than an individual or solitary act. The desire for women to share their mothering experiences with other women challenges the individualising notion of the exclusive mother and, furthermore, can be understood as an invitation for intimacy with other women. Whilst the practice has the potential to be interpreted in a way which challenges much of the pernicious "good mother" discourses, it continues to be a practice marked in Whiteness, revealing the inequitable nature of online public spaces. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of oral stimulation and a supplemental nursing system on the time to full maternal breastfeeding and sucking success in preterm infants. The sample consisted of 70 preterm babies. Oral motor stimulation and a supplemental nursing system were applied to the preterm infants in the experimental group, while no intervention was applied to those in the control group. Significant differences were found between the two groups concerning transition time to oral feeding, transition weight, transition time to full maternal breast, discharge age, duration, and weight, LATCH mean scores, continuing to suck in the first month after discharge, and weight averages. Oral stimulation and a supplemental nursing system shortened the transition period to oral feeding and full breastfeeding, increased breastfeeding rates and the sustainability of breastfeeding, and did not affect the period of discharge and vital signs during feeding in preterm babies. [ABSTRACT FROM AUTHOR]

Background: Previous research examined effects of human milk on the infant gut microbiota, but little attention has been given to the microbiota of lactating women. Research Aim: To determine associations between exclusive human milk feeding and gut microbiota characteristics in mothers and infants at 6-weeks postpartum. Methods: A sample of mother–infant dyads (N = 24) provided fecal samples and questionnaire responses at 6-weeks postpartum as part of the Pregnancy, EAting & POstpartum Diapers study. Deoxyribonucleic acid was extracted from stool samples, followed by (V4) 16S ribosomal ribonucleic acid gene amplicon sequencing. Alpha and beta diversity, in addition to taxa differences, were compared by human milk exposure status, exclusive versus non-exclusive. A subset of dyads (those exclusively fed human milk; n = 14) was analyzed for shared bifidobacterial species using polymerase chain reaction. Results: Alpha diversity was significantly lower in exclusively human milk-fed infants. Maternal lactation status (exclusive vs. partial) and Shannon diversity were associated in univariate analysis but were no longer associated in multivariable regression including body mass index category in the model. Beta diversity (Sorensen dissimilarity) of fecal samples from women and infants was significantly associated with human milk feeding. Of six infants with Bifidobacterium longum subspecies longum in their fecal samples, all their mothers shared the same species. Conclusion: Maternal gut microbiotas differ by lactation status, a relationship potentially confounded by body mass index category. Further research is needed to identify whether lactation directly influences the maternal gut microbiota, which may be another mechanism by which lactation influences health. [ABSTRACT FROM AUTHOR]

This study examined differences in observed mealtime behaviors between children preparing to transition to oral feeding and children with various other chronic illnesses using a standardized measure of mealtime beaviors. The parent-child mealtime relationship can become strained due to problematic mealtime behaviors that limit food intake, as well as inadvertent reinforcement of disruptive behavior by caregivers. Frequency/ rate of behaviors were compared between children with tube feeding (CwTF) and from previous studies of children with chronic illnesses using the Dyadic Interactive Nomenclature for Eating (DINE). Parents of CwTF used more coaxing, physical prompts, and reinforcement during meals, while parents of children with chronic illnesses used more direct commands and engaged in more parent talk. Findings support differences in parent-child mealtime interactions and eating behaviors across pediatric illness subgroups. [ABSTRACT FROM AUTHOR]

Marina Ferreira Rea is a Brazilian medical doctor. She has a masters and a doctorate degree in public health from the University of São Paulo (USP). She specialized in breastfeeding at Wellstart International, and completed post-doctoral research at Columbia University, New York, USA, focusing on working women and breastfeeding. She was a researcher at the Health Institute at Columbia University in New York, the Center for Population and Family Health, and at the postgraduate studies, Nutrition in Public Health, University of São Paulo, where she advised many students and published many articles and books (a few selected below). She was a Coordinator of International Breastfeeding Actions at the World Health Organization (Geneva), in the early 1990s, when actions like the Baby-Friendly Hospital Initiative, breastfeeding counseling, and other courses were started. During this same period, the World Alliance for Breastfeeding Action (WABA) and World Breastfeeding Week were initiated. In 1981 she participated in the launching of the International Code of Marketing of Breastmilk Substitutes. Marina Rea is a member of the International Baby Food Action Network and its Latin American policy committee, and is the founder of the International Baby Food Action Network (IBFAN) Brazil group. Since 2017, she has been a member of the IBFAN Global Council. She is now retired but continues to volunteer as an IBFAN member. She has two daughters and four grandchildren. A more detailed curriculum vitae in Portuguese can be found here: http://lattes.cnpq.br/8193850878281835 (MR = Marina Rea; MA = Maryse Arendt) [ABSTRACT FROM AUTHOR]

The article presents the discussion on the importance of human milk (HM) for the nutrition of newborns especially preterm infants. Topics include donor human milk (DHM) developing illnesses and infections in preterm infants leading to better outcomes both in the short- and long-term; and causing food outbreaks through the secretion of enterotoxins and degradative enzymes in the food ingested by the host.

Cleft patients may develop an abnormal opening (fistula) between the oral and the nasal cavities. Surgical repair minimizes the adverse effect on speech and feeding. However, an obturator prosthesis is a nonsurgical approach to help close the communication. The purpose of the case report presented is to show the clinical use of an intraoral digital impression in the fabrication of obturator/speech aid appliances in children with cleft lip and palate deformity. Minimal adjustments were needed, and patients and caregivers responded positively. Prostheses demonstrated good stability and retention at delivery. The use of digital technology seems to have several benefits as an alternative method for capturing impressions, especially in young children with cleft lip and palate deformity. [ABSTRACT FROM AUTHOR]

After initiating breastfeeding, some African American mothers find adjusting to the demands challenging and discontinue breastfeeding. To learn about decisions switching to formula, we conducted a secondary analysis of qualitative interviews with African American mothers ≥ 18 years old. Data were analyzed using thematic analysis guided by the social cognitive theory. We identified four key themes that reflect personal, behavioral, and environmental factors: (1) simplicity of formula, (2) diverse support networks, (3) early breastfeeding is most important, and (4) lack of access to breastfeeding support resources. To increase breastfeeding duration among African American mothers, it is essential for interventions to be comprehensive including various strategies such as education regarding the physical aspects of breastfeeding, exposure to African American breastfeeding mothers, and active involvement of support persons. More research among African American mothers is needed to identify effective opportunities for change in cultural, social, and structural systems that impede successful breastfeeding. [ABSTRACT FROM AUTHOR]

What is breastfeeding "success"? In this article, we challenge the traditional biomedical definition, instead centering visions of success described by breastfeeding mothers themselves. Using semi-structured interviews, quantitative surveys, and written narratives of 38 first-time mothers in the United States, we describe five common pathways through the first-year postpartum, a taxonomic distinction far more complex than a success–failure dichotomy: sustained breastfeeding, exclusive pumping, combination feeding, rapid weaning, and grinding back to exclusivity. We also explore the myriad ways in which mothers define and experience breastfeeding success, and in the process uncover the ways that cultural narratives—especially intensive mothering —color those experiences. Finally, we discuss how these experiences are shaped by infant feeding pathway. In doing so, we discover nuance that has gone unexplored in the breastfeeding literature. These findings have implications for supporting, promoting, and protecting breastfeeding in the United States and other high-income countries. [ABSTRACT FROM AUTHOR]

Background: Mother-to-child transmission of the HIV remains the main source of HIV infection in children. Targeting pregnant women attending antenatal care follow-up provides a unique opportunity for implementing prevention of mother-to-child transmission programs against HIV infection in newborn babies. Objective: The objective of this study was to assess the prevalence of HIV infection and associated factors among infants born to HIV-positive mothers in the prevention of mother-to-child transmission clinic in the Gondar city health institutions, Northwest Ethiopia, 2021. Methods: Documents were reviewed at the facility. Infants who had been exposed to HIV were enrolled in the study from 1 May–20 June 2021 prevention of mother-to-child transmission service in Gondar health institutions. To collect data from the charts, a structured data extraction tool was developed. The data were entered and analyzed with SPSS version 25 software. Both bivariate and multivariate logistic regression models were fitted to identify factors associated with HIV infection. The crude and adjusted odds ratios with a 95% confidence interval were calculated to determine the significance level. Result: The prevalence of HIV infection among infants born to HIV-positive mothers at the prevention of mother-to-child transmission level was found to be 8.1% (95% confidence interval = 7.3–12.9). Mixed infant feeding practice (adjusted odds ratio=5.15, 95% confidence interval=1.82–14.56), mothers’ lack of education (adjusted odds ratio=3.43, 95% confidence interval=2.26–5.0), absence of antenatal care follow-up (adjusted odds ratio=1.82, 95% confidence interval=1.17–4.02), and home delivery (adjusted odds ratio=2.24, 95% confidence interval=2.10–7.45) were statistically significantly associated with infants’ HIV infection. Conclusion: The prevalence of HIV infection in babies born to HIV-positive mothers was found to be high. Significant factors include mixed infant feeding practice, mothers’ lack of education, antenatal care follow-up, and home delivery. We also proposed that skilled delivery care and community education could reduce HIV transmission from mother to child. [ABSTRACT FROM AUTHOR]

Aim : The aim of the study was to analyse the impact of delivery on breastfeeding at 6 months, with special focus on caesarean section combined with established breastfeeding at 2 months. Methods: Delivery mode and breastfeeding at 2 and 6 months were studied in a database of 130,993 infants from two Swedish counties between 1990–2011. Results: The difference in breastfeeding rates at 6 months between children delivered by caesarean section and children delivered vaginally was smaller in a subpopulation of children with established breastfeeding at 2 months compared to all children. The impact of delivery method on breastfeeding at 6 months was independent of child gender, mother's first child, maternal smoking and maternal education. Conclusions : Breastfeeding in mothers giving birth by caesarean section is more likely to continue until (at least) 6 months if established early (at 2 months). It may be worthwhile to promote breastfeeding for mothers who deliver by caesarean section. [ABSTRACT FROM AUTHOR]

Background: Dietary long-chain polyunsaturated fatty acids are known to benefit infant development. After birth, human milk provides arachidonic, eicosapentaenoic, and docosahexaenoic acids to the infant. Endocannabinoids are endogenous lipid mediators derived from the long-chain polyunsaturated fatty acids. Although the roles and the mechanisms of action are not fully understood, previous researchers have suggested that endocannabinoids might play a role in infant feeding behavior. Research Aims: To assess (i) maternal dietary intake of long-chain polyunsaturated fatty acids and (ii) their relationship to concentrations of fatty acids and derived endocannabinoids in human milk. Methods: For this exploratory-longitudinal study, participants (N = 24) provided dietary intake data and milk samples. Fatty acids and derived endocannabinoids: Arachidonylethanolamide, arachidonoylglycerol, docosahexaenoyl glycerol, eicosapentaenoyl ethanolamide, and eicosapenaenoyl glycerol were identified in their milk by liquid chromatography-mass spectrometry and correlations to dietary fatty acids were assessed. Results: Participants were not consuming recommended amounts of docosahexaenoic acid. Significant correlations (p ≤.05) were only found between dietary docosahexaenoic and eicosapentaenoic acids and the concentrations of these in human milk. Moreover, only dietary docosahexaenoic acid was correlated (p =.031) with its corresponding endocannabinoid, docosahexaenoyl glycerol. Conclusions: To the best of our knowledge, this may be one of the first studies evaluating relationships between dietary long-chain polyunsaturated fatty acids and multiple endocannabinoids in human milk. Our findings suggest that endocannabinoid concentrations could be modulated by dietary precursors. Future research studies can be designed based on these data to better elucidate the roles of endocannabinoids in human milk for infant health and development. [ABSTRACT FROM AUTHOR]

Objective: To examine feeding skills of infants with cleft palate with or without cleft lip (CP±L) using infant-driven feeding systems compared to healthy controls on standard bottles. Design: Cross-sectional cohort. Setting: Large pediatric academic medical center in the Midwestern United States. Participants: Infants with CP±L (n = 15) using the Dr. Brown's Specialty Feeding System and typically developing infants without CP±L (n = 15) using the Dr. Brown's Natural Flow Original or Options bottles. Main Outcome Measure(s): Bottle-feeding proficiency, duration, milk transfer, and signs of feeding difficulty. Results: Five-minute feeding proficiency differed significantly between groups with the control group taking 44% of the feed compared to 15% for the CP±L group on level 1 (P <.001) and 21% on level 2 (P <.001) nipples. Proportion of milk transfer was 96% ± 7% for controls and 75% ± 24% for the CP±L group (P =.013). Feeding duration (minutes) differed between the control group (13 ± 3) and the CP±L groups on each nipple level (level 1: 29 ± 16; P =.003; level 2: 32 ± 11; P =.001). Milk transfer rate (mL/min) was 9 ± 3 for control infants compared to 3 ± 1 for infants with CP±L on level 1 (P <.001) and 5 ± 1 on level 2 (P =.007). Coughing occurred in 40% of infants with CP±L and 27% of controls. Conclusions: Even when using specialty bottles, infants with CP±L differ from noncleft infants in feeding proficiency, duration, and overall intake. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the role of German pediatrician Marie-Elise Kayser (1885-1950) in promoting human milk banking in the 20th century. Also cited are Kayser's concept of milk banking, networking and organizational activities and advertising methods by human milk banks, and how insufficient feeding practices resulted in high infant mortality rate in Germany in the 1900s.

Gabrielle Palmer has written, taught, and campaigned about infant nutrition issues, particularly the unethical marketing of baby foods, since the 1970s. Her seminal book, The Politics of Breastfeeding: When Breasts are Bad for Business, has guided many breastfeeding advocates for over 40 years through three editions and multiple printings. As a breastfeeding counsellor during the 1970s, she helped establish the United Kingdom's advocacy pressure group Baby Milk Action. She worked as a volunteer in Mozambique during the 1980s. During the 1990s she co-directed the International Breastfeeding Practice and Policy course at the Institute of Child Health, University College London, until she went to live for 2 years in China. Over the years, she has worked for various health and development agencies, including serving as HIV and Infant Feeding Officer for the United Nations Children's Fund, New York, and also taught at The London School of Hygiene and Tropical Medicine (LSHTM). She is a mother and a grandmother. (This is a verbatim interview that has been edited for readability: MA = Maryse Arendt; GP = Gabrielle Palmer). [ABSTRACT FROM AUTHOR]

Objective: Despite its efficiency and benefits in treating patients with Robin sequence (RS), the pre-epiglottic baton plate (PEBP) is not widely used. However, its acceptance might improve with specific defined parameters for indication and proper design of the velar extension. We present our 13-year, single-center experience in treating infants with RS using PEBP, focusing on the description and insertion of an endoscopically guided PEBP design along with its complications and limitations. Design and Innovation: We recommend PEBP as primary treatment for RS, suggesting a new approach of design adjustment based on endoscopic findings of multilevel upper airway obstruction. Setting: Department of cleft lip and palate. Patients: Infants with isolated or syndromic RS, period 2010 to 2019. Interventions: Pre-epiglottic baton plate treatment, intravelar veloplasty, and hard palate closure after initial PEBP treatment. Results: We treated 132 infants (isolated RS, 111; syndromic RS, 21) with PEBP. All infants with isolated RS were discharged within an average of 8 days of PEBP therapy. For them, no tracheotomy or tongue–lip adhesion procedures were needed. Only 4 of the 20 infants discharged with a nasogastric tube needed it for >2 weeks. Intravelar veloplasty and palate closure were performed after 3 and 6 months of initiating PEBP treatment, respectively. Conclusions: Application of an orthodontic device in RS therapy has not been accepted worldwide. We hope that our learning curve and recommendations about PEBP will help the implementation of this highly effective and nonsurgical treatment option. [ABSTRACT FROM AUTHOR]

Objectives: This retrospective cohort study uses endoscopic assessment of the pharyngeal phase of swallowing in infants with laryngomalacia, to ascertain the impact of infant positioning on airway compromise and fluid dynamics during breastfeeding. The study aims to identify whether modification of infant positioning at the breast may improve the possibility of safe, successful breastfeeding in infants with laryngomalacia and concurrent breastfeeding difficulty. Methods: Twenty-three infants referred for noisy breathing and difficulty feeding were assessed with flexible endoscopic evaluation of swallowing (FEES) during breastfeeding. All had endoscopically confirmed laryngomalacia. During FEES, observations were made of clinical signs of airway compromise as well as endoscopically observable anatomical features and swallowing dynamics during breastfeeding, including tongue base position, view of laryngeal inlet and vocal folds, dynamic supraglottic soft tissue collapse, timing of milk flow into pyriform fossae/hypopharynx relative to sucking, and presence of penetration and/or aspiration. If airway and/or swallowing compromise was present, the infant's initial position at the breast was altered from supine or semi lateral decubitus position to semi-prone, with a description of the clinical and endoscopically observable changes that subsequently occurred. Results: Signs of dynamic airway obstruction and/or compromised airway protection with swallowing were present in 20 of the 23 infants (87%) in their initial supine or semi lateral decubitus position. These 20 infants were repositioned to semi-prone, with improvement and/or resolution of stridor and an improved ability to maintain latch in all infants. Continued endoscopic evaluation following positional change was possible in 16 infants, identifying anterior positioning of the tongue base, reduced dynamic supraglottic tissue collapse, reduced volume of milk flow into pyriform fossae during pauses in sucking and resolution of penetration and aspiration. Conclusion: This study has shown how alteration of breastfeeding position to semi-prone may improve dynamic airway obstruction and reduce aspiration risk in infants with laryngomalacia. [ABSTRACT FROM AUTHOR]

Background: Leptin and adiponectin, two adipokines involved in glucose and lipid metabolism, have been linked to regulation of growth in early infancy, energy balance, and metabolic disorders in childhood. The aim of this study was to determine if concentrations of leptin and adiponectin could be measured reliably in infants' saliva, to evaluate the degree of agreement with infant serum levels, and to explore their association with infant feeding status. Methods: A total of 34 infants were recruited after birth and followed for 20 weeks. After log-transformation of the values, a Bland-Altman graphical approach was used to summarize the direction of the difference between the serum and saliva values. Repeated measures mixed modeling was used to evaluate differences over time in these outcomes by feeding status. Results: Mean concentration of salivary leptin and adiponectin in infants was 3.7 (SD =.8) ng/mL and 2.9 (SD = 0.7) ng/mL, respectively. The degree of agreement between serum and saliva for log-transformed leptin and adiponectin values were relatively robust, albeit with a non-zero bias between the two methods, given that serum values were greater than corresponding saliva values for both adipokines in all infants. Each of the four repeated measures mixed models (one for each adipokine measure) had a significant main effect; however, the interaction between time and feeding status was not significant in any of the models. Conclusion: This study demonstrated that leptin and adiponectin can be measured in infant saliva, but in some cases leptin concentrations may be more difficult to detect. [ABSTRACT FROM AUTHOR]

Background: Lack of dietary diversity in complementary feeding contributes to nutrient gaps leading to undernutrition. Food-based strategies have been successfully used to enrich the complementary diets of infants and young children. However, context-specific recommendations based on an objective diet optimization are needed to formulate sound and practical nutritional guidelines. Objectives: The present study aimed to identify problem nutrients in complementary diets and formulate complementary feeding recommendations (CFRs) using linear programming analysis for children aged 6 to 23 months in the rural Philippines. Methods: A cross-sectional survey was conducted in the municipality of Mercedes, Philippines. Dietary intakes of breastfed children 6 to 8, 9 to 11, and 12 to 23 months of age (n = 297) were assessed using a multipass 24-hour recall method with 7-day food consumption frequency. A linear programming tool was used to identify the recommended nutrient intakes that could not be met within the existing local food patterns and develop CFRs that would best fulfill nutrient adequacy for 11 modeled micronutrients. Results: Problem nutrients in the current diets were iron and calcium in any age-group, zinc for 6 to 8 and 9 to 11 months old, and thiamine and folate for 12 to 23 months old children. Adoption of CFRs with 4 to 5 food groups in the diet would ensure the adequacy of 7 to 8 nutrients, depending on the age-group. Conclusion: Within the boundaries of local dietary patterns, adequacy for most nutrients could be achieved by promoting realistic servings of nutrient-dense foods and food groups. The linear programming results provide an evidence-based strategy in designing interventions to improve the quality of Filipino complementary diets. [ABSTRACT FROM AUTHOR]