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Lactation and breastfeeding are core components of reproductive health care and obstetrical providers should be familiar with common complications that may arise in lactating individuals. While many breastfeeding challenges are best addressed by a lactation consultant, there are conditions that fall out of their scope and require care from a clinician. The objective of this chapter is to review common complications of breastfeeding and lactation including inflammatory conditions, disorders of lactogenesis, dermatologic conditions, and persistent pain with lactation. [ABSTRACT FROM AUTHOR]

Becoming a parent changes one's life, and existential questions arise. Time and being oscillate between joy and powerlessness, vulnerability, and self-confidence, between harmony and unpreparedness. Breastfeeding, one of the first skills new mothers try to master, can be joyful and painful. The aim of this study was to develop a deeper understanding of the phenomenon of initial breastfeeding complications as they are lived and experienced by mothers and how these mothers can be supported. Twelve mothers were interviewed, and a phenomenological lifeworld approach was used. Nourishing an infant and having initial breastfeeding complications can be understood by the essence and its constituents. Expectations are fulfilled, and expectations come to naught when complications are experienced such as wavering between powerlessness and joy and finding solutions through resistance. The results suggest that lifeworld-led caring may lead to deepened acknowledgment and the possibility for mothers to feel supported in their extreme situations. [ABSTRACT FROM AUTHOR]

Background The percentage of exclusive breastfeeding in Indonesia on 2018 dropped from 39.8% in infants aged 0 months to 15.3% in infants aged 5 months. According to the 2018 Indonesian Basic Health Research Survey (Riskesdas), an average of 37.3% of infants were exclusively breastfed until the age of 6 months. This rate is far from the target of 80% by Ministry of Health of Indonesia. Objective To assess for an association between postpartum counseling and the practice of exclusive breastfeeding in Indonesia. Methods This retrospective cohort study used data from the 2017 Indonesian Demographic and Health Survey (IDHS). The sample comprised 258 infants aged 6 months. Postpartum counseling and other variables were analyzed for possible associations with exclusive breastfeeding by Chisquare test; risk ratios (RR) with 95% confidence intervals (CI) were calculated. Logistic regression test was used to analyze for adjusted odds ratios. Results In 6 months period, the percentage of subjects who received postpartum counseling was 59.7% and who exclusively breastfed was 18.8%. There was no significant association between postpartum lactation counseling and exclusive breastfeeding. However, there were significant associations between exclusive breastfeeding and not using currently as well as maternal residence in rural areas. Conclusion Postpartum counseling on breastfeeding lacks a significant association with exclusive breastfeeding practice at 6 months of age. Therefore, the Ministry of Health should reevaluate the implementation of its counseling services. [ABSTRACT FROM AUTHOR]

Purpose: During the time of breastfeeding, a third of all women contract (or: fall ill in) mastitis—the leading cause of precocious weaning. Recent studies indicate that probiotics intake may prevent mastitis by altering the breast's bacterial flora. The aim of this study was to examine whether probiotic milk intake during pregnancy is associated with less breastfeeding complications and longer breastfeeding duration. Methods: This study included 57,134 women, with live singleton term births, participating in the Norwegian Mother and Child Cohort Study. Probiotic milk intake during the first half of pregnancy was self-reported in a validated food frequency questionnaire at gestational week 22. At 6 month postpartum, women reported complications, including mastitis, and duration and exclusivity of breastfeeding. The association between probiotic milk intake and breastfeeding complications and duration was studied by adjusted logistic regression models. Results: Probiotic milk intake was associated with increased risk for mastitis [adjusted odds ratio (aOR) 1.09, 95% confidence interval (CI) 1.02–1.16] and for any breastfeeding problems during the first month (aOR 1.19, 95% CI 1.10–1.21). However, cessation of predominant (aOR 0.95, 95% CI 0.91–0.96) or any (aOR 0.79, 95% CI 0.75–0.84) breastfeeding earlier than at 4 months was less frequent in probiotic milk consumers than in non-consumers. Conclusions: Even though probiotic milk intake during the first half of pregnancy was statistically associated with increased risk for breastfeeding complications, including mastitis, the association is probably not causal. Probiotics intake was namely associated with longer breastfeeding duration and there was indication of socioeconomic confounding. Further studies, i.e., large randomized-controlled trials, are needed to understand the association between probiotic intake and breastfeeding complications. [ABSTRACT FROM AUTHOR]

Background: Multiple resources aid the interprofessional health care team when recommending medications for lactating patients. Varying degrees of breastfeeding compatibility and safety are recommended in different resources. New Food and Drug Administration labeling for lactation is being phased in to provide more consistent language in safety recommendations. Objective: The objective of this study is to evaluate lactation recommendations for select medications from different drug information resources to determine the compatibility recommendations for lactating patients. Methods: The breastfeeding recommendations for 19 medications were analyzed in 10 drug information resources. Each drug was reviewed in each resource and the published recommendations evaluated. Results:Medications and Mothers' Milk 18th Edition and LactMed had the most medications listed as compatible with breastfeeding, with Lexicomp Online, Drugs in Pregnancy and Lactation Online, and Epocrates following. LactMed stands out from the group with an average of 15.1 references per medication and number of references ranging from 0 to 58. Date ranges of references used by select resources varied. References to support recommendations ranged from 1979 to 2018 for the select resources. Conclusion and Relevance: Variation continues to exist across resources with regard to recommendations for medication safety in lactation. LactMed represents the most up-to-date and comprehensive review of literature in this review. When making decisions regarding medication use during lactation, health care professionals should consider reviewing data behind the recommendations and consulting multiple resources. [ABSTRACT FROM AUTHOR]

Background: Nipple pain is the second most common reason for early weaning, exceeded only by the insufficient milk supply. Nipple fissures can bring other problems, acting also as a portal for bacteria and leading to mastitis. This work proposes the breast protector composite development using materials with tissue repair and moisturizing properties, aligned with a low‐cost procedure, aiming not only to relieve pain, but also to heal the nipple fissures caused by breastfeeding. Materials and methods: For the dressings, production was used Natural Latex extracted from the rubber tree and glycerol. The Samples were evaluated chemically and physically by the techniques of Scanning Electron Microscopy, Fourier transform infrared spectroscopy, mechanical traction, and contact angle. The samples were also biologically evaluated by the hemolytic and cytotoxic activity assays. Results: From the physical‐chemical assays, the matrix with glycerol has high pore density; the natural latex and glycerol do not covalently interact, indicating that the glycerol can be released; the glycerol addition makes the matrix more elastic but fragile, and increase the wettability. From the biological assays, both materials showed no hemolytic effects; and the cytotoxicity results showed that glycerol did not present cytotoxicity in the fibroblasts, but show a dose‐dependent influence in the keratinocytes. Conclusion: The material developed for application in breast fissures has mechanical properties similar to those found for materials for dermal applications, present high wettability and pore density. Furthermore, the material showed no cytolytic activity and the tests with skin cell cultures demonstrated the biocompatibility. [ABSTRACT FROM AUTHOR]

Breastfeeding is a practice directly related to the health of the mother and especially the baby. Despite being a natural process, many mothers report difficulties with breastfeeding. This study aimed to seek scientific evidence on the issue: "Can a mother with more confidence in breastfeeding exclusively breastfeed her baby for 06 months?". We conducted a systematic review with a search in five electronic databases, and included four cohort studies for evaluation. We conducted a qualitative analysis of the results, considering the methodological differences and lack of data, and were unable to perform meta-analysis. Confidence in breastfeeding was evaluated by using the Breastfeeding Self-Efficacy Scale. The studies analyzed showed statistically significant association between the practice of breastfeed and confidence in breastfeeding. The application of a scale to evaluate trust and identify mothers at risk for early weaning appeared to be a reliable measurement tool, capable of facilitating action planning by health professionals. The evidence showed association between mothers with higher levels of confidence in breastfeeding and exclusive breastfeeding for 6 months, but these results could not be generalized because of the heterogeneity of the population. [ABSTRACT FROM AUTHOR]

Introduction: Due to the importance of breastfeeding, we decided to conduct a study to examine the relationship between breastfeeding self-efficacy and quality of life.Materials and Methods: This study was a cross-sectional study, which was carried out on 547 breastfeeding mothers that had 2-6 months old infants. The participants were selected randomly, and the sociodemographic characteristics questionnaire, Dennis' breastfeeding self-efficacy scale, and WHO's Quality of Life (WHOQOL) questionnaire were completed through interview. The multivariate linear regression model was used for data analysis.Findings: The means (standard deviations) of breastfeeding self-efficacy score and quality of life score were 134.5 (13.3) and 67.7 (13.7), respectively. Quality of life and all of its dimensions were directly and significantly related to breastfeeding self-efficacy. According to the results of multivariate linear regression analysis, there was a relationship between breastfeeding self-efficacy and the following variables: environmental dimension of quality of life, education, spouse's age, spouse's job, average duration of previous breastfeeding period and receiving breastfeeding training.Discussion and Conclusion: Findings showed that there is direct and significant relationship between breastfeeding self-efficacy and quality of life. Moreover, it seems that the development of appropriate training programs is necessary for improving the quality of life of pregnant women, as it consequently enhances breastfeeding self-efficacy. [ABSTRACT FROM AUTHOR]

Introduction Breast augmentation using polyacrylamide hydrogel (PAAG) has been routinely used in the past as a minimal invasive procedure. However, several patients undergoing this procedure have started to report complications. We report a case of breast augmentation using PAAG leading to a delayed infection and breastfeeding complication. Clinical case A 36-year-old Danish female who was treated with PAAG fifteen years earlier, presented with difficulty in breastfeeding and fistulation. Clinical evaluation revealed structural deformity of the right breast and a 5 × 5 mm skin defect. Mammography showed diffuse microcalcification density grade 4. Ultrasound and MRI displayed inhomogeneous gelatinous material in both breasts diffused into the pectoralis major muscle. Initial management involved aspiration of the material. The patient developed infection and was subjected to modified radical debridement removing the PAAG. The patient healed without any further complications. Discussion The prevalence of PAAG mediated breast augmentation related complications are increasing. The most prominent complication being late infections, breast hardening and subsequent breastfeeding difficulties. In this case, the difficulty in breastfeeding was induced by the PAAG within the breast tissue. The inhomogeneous gelatinous material was surgically removed leading to complete remission. Conclusion Long-term complications, among others breast feeding difficulty, in women treated with PAAG are increasing and need appropriate management strategy. PAAG mediated breast augmentation may cause irreversible damage to the breast in healthy women necessitating complex debridement. [ABSTRACT FROM AUTHOR]

Mealtimes are a common source of stress for families. Examining factors related to problem eating may provide markers by which to identify families requiring assistance and salient targets for treatment. The current study investigated parenting practices and cognitions, generalisation of child behavioural issues, and early feeding history as they relate to problem eating in typically developing young children. We compared a community sample of 105 parents of 1.5-6-year-old children via survey and observation with 96 parents seeking treatment for their child's problem eating. History of problems with breastfeeding, χ(1) = 3.88, p = .049, and the transition to solids, χ(1) = 7.27, p = .007, were more common among problem eaters than comparisons. Problem eaters had a greater number of problem behaviours outside of mealtimes, F(1181) = 10.88, p = .001, though not more frequently than comparisons and not to clinical levels, F(1181) = 1.81, p = .181. Parents of problem eaters reported more unhelpful mealtime parenting strategies, F(1155) = 22.59, p < .001, yet general parenting style was similar by group, F(1187) = 0.42, p = .527. Parents' cognitions about mealtimes, F(1155) = 119.81, p < .001, including mealtime-specific self-efficacy, F(1155) = 171.30, p < .001, were poorer amongst problem eaters, and were the only factors to predict problem eating in the total sample. General parenting self-efficacy was poorer in parents of problem eaters (Behaviour: F(1187) = 42.36, p < .001; Setting: F(1187) = 10.64, p = .001). Evidence of feeding issues in infancy may support early detection of and intervention for later problem eating. The significance of broader child behaviour is less clear. Parent factors, particularly those specific to mealtimes, and cognitive in nature (including mealtime parenting self-efficacy) clearly differentiated the groups, and represent important targets for intervention. [ABSTRACT FROM AUTHOR]

Severe Acute Malnutrition, both medical and social disorder, is specifically associated with loss of body fat and wasting of skeletal muscles. Besides, socio-economic and poor economic conditions factors viz. poverty, social exclusion, poor public health, lack of exclusive breast feeding are leading causes for occurrence of SAM. Infants are most vulnerable as their nutritional needs are higher for growth and development. Till 70s case-fatality rates for SAM were higher, but, with the laying down of WHO guidelines there were drastic improvements. Under these guidelines, besides medical treatment, importance of environment and psychosocial interventions was also stressed upon. Later, a community-based model was laid down which was basically a framework for an integrated publichealth response to acute malnutrition, treating most patients as outpatients and reserving inpatient care for patients with complications. These guidelines were well accepted and adopted nationally and internationally. This approach management was divided into initial, rehabilitation and follow-up phases and has been found very effective in reducing SAM mortality. Therefore with an effective community based program for early detection and treatment, most children with SAM can be cared for at home itself and these community care centres can be reserved for children with SAM with medical complications. [ABSTRACT FROM AUTHOR]

Maternal malnutrition causes long-lasting alterations in feeding behavior and energy homeostasis in offspring. It is still unknown whether both, the endocannabinoid (eCB) machinery and the lipid metabolism are implicated in long-term adaptive responses to fetal reprogramming caused by maternal undernutrition. We investigated the long-term effects of maternal exposure to a 20% standard diet restriction during preconceptional and gestational periods on the metabolically-relevant tissues hypothalamus, liver, and perirenal fat (PAT) of male and female offspring at adulthood. The adult male offspring from calorie-restricted dams (RC males) exhibited a differential response to the CB1 antagonist AM251 in a chocolate preference test as well as increased body weight, perirenal adiposity, and plasma levels of triglycerides, LDL, VLDL, bilirubin, and leptin. The gene expression of the cannabinoid receptors Cnr1 and Cnr2 was increased in RC male hypothalamus, but a down-expression of most eCBs-metabolizing enzymes (Faah, Daglα, Daglβ, Mgll) and several key regulators of fatty-acid β-oxidation (Cpt1b, Acox1), mitochondrial respiration (Cox4i1), and lipid flux (Ppar?) was found in their PAT. The female offspring from calorie-restricted dams exhibited higher plasma levels of LDL and glucose as well as a reduction in chocolate and caloric intake at post-weaning periods in the feeding tests. Their liver showed a decreased gene expression of Cnr1, Pparα, Ppar?, the eCBs-degrading enzymes Faah and Mgll, the de novo lipogenic enzymes Acaca and Fasn, and the liver-specific cholesterol biosynthesis regulators Insig1 and Hmgcr. Our results suggest that the long-lasting adaptive responses to maternal caloric restriction affected cannabinoid-regulated mechanisms involved in feeding behavior, adipose β-oxidation, and hepatic lipid and cholesterol biosynthesis in a sex-dependent manner. [ABSTRACT FROM AUTHOR]

Purpose: To study the effects of frenulotomy on nipple pain, latch and the success in exclusive breastfeeding (EBF) at 3-month follow-up.Methods: A prospective cross-sectional study of 328 mother-infant pairs with both tongue-tie and breastfeeding problems was performed. Nipple pain and latch were evaluated using numeric rating scale and LATCH score, respectively, and compared between pre and post-operatively at 24 h and 1 week. The success rate of EBF was assessed at 3 months after frenulotomy.Results: Nipple pain score were significantly decreased (median difference = 3 and 4, P < 0.001) and LATCH score were significantly increased (mean difference = 1.92 and 2.13, P < 0.001) at 24 h and 1 week post-operatively. At 3 months, a success rate of EBF was 66.67 %. Multivariable analysis clustering by maternal age of 18 years was performed. Factors that were significantly (P < 0.05) associated with the success were: girls, age at surgery ≤24 h, higher number of children in family, low birth weight, tongue-tie severity, nipple grading, LATCH score ≥8 and nipple sensation at 1 week after surgery.Conclusion: Frenulotomy could significantly reduce nipple pain and increase LATCH score in tongue-tied infants with breastfeeding difficulty. Several factors are positively associated with the success of EBF. Tongue-tie severity, LATCH score and nipple sensation were the factors that can be modified by frenulotomy. [ABSTRACT FROM AUTHOR]

Introduction: Major myth regarding neonatal pain suggests that neonates because of their neurological immaturity do not experience pain. Although exact mechanism is not known, it is proposed that breast feeding through combination of various senses and the closeness of the infant’s mother, saturates the senses thus reducing perception of noxious stimuli.The objectives of this study was to investigate the analgesic effect of breastfeeding during blood sampling through heel lance in healthy term neonates. Material and Methods: This was aRandomized controlled trial done in a Tertiary level Neonatal Intensive Care Unit. Sixty healthy term newborns, undergoing heel prick were included in study. Neonates were randomly assigned to two groups: Group I (breastfed) with; Group II (not breast fed). Babies were given heel prick and crying time, Heart rate, SpO2 and BP monitored. Changes in various physiological parameters following a heel prick were studied in two groups. Results: Neonates in both groups expressed pain by crying, increase in heart rate, fall in transcutaneous oxygen saturation and rise in blood pressure. Compared to control group, the babies who were breast fed were found to have lesser crying time (40.04 sec and 69.09 sec respectively, p<0.05) and lesser rise in heart rate (rise of 21.78 and 34.46 bpm respectively, p<0.03). In the breast fed group there was a trend to a lesser decrease in oxygen saturation and lesser rise in blood pressure though this was not statistically significant. Conclusion: Breast feeding offers a quick and effective means of reducing pain in neonates during routine neonatal procedures. [ABSTRACT FROM AUTHOR]

The problems of suction in newborns give rise to multiple consequences for both the mother and the newborn. The objective of this paper is to present a case of ankyloglossia (“tongue-tie”) and the suction problems that were treated by a multidisciplinary team. The subject is a 17-day-old male patient, with ankyloglossia and suction problems during breastfeeding (pain in the breastfeeding mother, poor weight gain, and long breastfeeds). The patient followed the circuit established in our centre between the services of Oral and Maxillofacial Surgery and Breastfeeding and Speech Therapy and Orofacial Rehabilitation (CELERE). The evolution following the breastfeeding sessions, the myofunctional stimulation, and the lingual frenotomy was very favourable, thereby solving the suction problems that the newborn presented. All our patients receive breastfeeding sessions and myofunctional therapy as treatment. We know that a frenotomy is not always necessary and we believe that the stimulation of sucking before and after the surgical intervention is important in order to improve the final result. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of prelacteal feeding among mothers of Pakistan and to find out the various concepts behind this practice and fundamentally to establish the association of prelacteal feeding with breastfeeding outcomes. Background: In Pakistan, many efforts have been done to emphasize the nutritional importance and adequacy of breast milk for the newborns. Despite such efforts, it has been witnessed on multiple occasions that prior to the commencement of breastfeeding, prelacteal feeds are introduced by the mothers to their young ones. Prelacteal feed (PLF) are food supplements that are given to newborns orally. Design: Qualitative, descriptive, cross sectional Survey. Setting: The Lady Dufferin Hospital (LDH) and Jinnah Medical College hospital (JMCH). Methods: Study includes 400 Mothers including young mothers and data was collected with use of a pre-assessed authenticated questionnaire. Results: A large group of, both educated and uneducated, mothers knew about PLF administration (90.5%). Out of these, 70% mothers routinely give prelacteal feeds, with readymade ghutti and honey being the most widely used supplements, 19.5% and 37.2% respectively .However their reasons for doing so differed significantly. Family tradition (27.8%) and religious credence (21.8%) are the most popular reasons for practicing prelacteal feeding. The other minor reasons are breast milk insufficiency, prevention of dehydration, hypoglycaemia, preparation of the gastrointestinal tract for digestion and to quench thirst. However, majority of the subjects were aware of the benefits of breastfeeding and 99% mothers breastfed their children. Conclusions: Regardless of the fact that mothers understand the significance of breast milk, most mothers routinely and unnecessarily give prelacteal feeds. Therefore, mothers should be discouraged for the unsafely administration of prelacteal feeds and re-emphasized about the importance and nutritional adequecy of breastfeeding. [ABSTRACT FROM AUTHOR]

Despite the nutritional and health benefits of breast milk, breast milk can serve as a vector for mother-to-child HIV transmission. Most HIV-infected infants acquire HIV through breastfeeding. Paradoxically, most infants breastfed by HIV-positive women do not become infected. This is potentially attributed to anti-HIV factors in breast milk. Breast milk of HIV-negative women can inhibit HIV infection. However, the HIV-inhibitory activity of breast milk from HIV-positive mothers has not been evaluated. In addition, while significant differences in breast milk composition between transmitting and nontransmitting HIV-positive mothers have been correlated with transmission risk, the HIV-inhibitory activity of their breast milk has not been compared. This knowledge may significantly impact the design of prevention approaches in resource-limited settings that do not deny infants of HIV-positive women the health benefits of breast milk. Here, we utilized bone marrow/liver/thymus humanized mice to evaluate the in vivo HIV-inhibitory activity of breast milk obtained from HIV-positive transmitting and nontransmitting mothers. We also assessed the species specificity and biochemical characteristics of milk's in vivo HIV-inhibitory activity and its ability to inhibit other modes of HIV infection. Our results demonstrate that breast milk of HIV-positive mothers has potent HIV-inhibitory activity and indicate that breast milk can prevent multiple routes of infection. Most importantly, this activity is unique to human milk. Our results also suggest multiple factors in breast milk may contribute to its HIV-inhibitory activity. Collectively, our results support current recommendations that HIV-positive mothers in resource-limited settings exclusively breastfeed in combination with antiretroviral therapy. [ABSTRACT FROM AUTHOR]

ABSTRACT Here we report bone phosphate oxygen (δ18Op) values from perinates/neonates and infants (<3.5 years; n = 32); children (4-12 years; n = 12); unsexed juveniles (16-18 years; n = 2); and adult bones ( n = 17) from Wharram Percy, North Yorkshire, England, in order to explore the potential of this method to investigate patterns of past breastfeeding and weaning. In prior studies, δ15N and δ13C analyses of bone collagen have been utilized to explore weaning age in this large and well-studied assemblage, rendering this material highly appropriate for the testing and development of this alternative method targeting the inorganic phase of bone. Data produced reveal 18O-enrichment in the youngest perinatal/neonatal and infant samples, and an association between age and bone δ18Op (and previously-published δ15N values), with high values in both these isotope systems likely due to breastfeeding. After the age of 2-3 years, δ18Op values are lower, and all children between the ages of 4 and 12, along with the vast majority of sub-adults and adults sampled (aged 16 to >50 years), have δ18Op values consistent with the consumption of local modern drinking water. The implications of this study for the reconstruction of weaning practices in archaeological populations are discussed, including variations observed with bone δ15Ncoll and δ18Op co-analysis and the influence of culturally-modified drinking water and seasonality. The use of this method to explore human mobility and palaeoclimatic conditions are also discussed with reference to the data presented. Am J Phys Anthropol 157:226-241, 2015. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Adequate nutrition during infancy is essential to ensure the growth, health, and development of children to their full potential. Even with its known advantages, breastfeeding rates are sub-optimal the world over. Objectives are to identify the reasons mothers give for stopping exclusive breastfeeding, to know the common breastfeeding problems and intervention factors effecting breastfeeding. Methods: a prospective survey was conducted on mothers delivered in RLJH & RC attached to SDUMC, Kolar from January 2011 to December 2011 or 500 mothers (whichever is earlier). These mothers and relatives were counselled immediately after delivery about the merits of breastfeeding. A 3-step questionnaire is followed. Conclusion: Our study recorded an increasing trend towards initiation of breastfeeding. Mothers parents and in-laws were found to be influential in the decision making process of child rearing practices. Postnatal counselling brought down top feeding for the first 3 days. Timely intervention in the form of postnatal counselling to both family and the mother was found to be effective. Primigravida status was noted to significantly affect breastfeeding. Psychological factors, social beliefs, caesarean section and breast and nipple problems are significant reasons that mothers give for not breastfeeding exclusively. Cultural and traditional practices have considerable implications on breastfeeding, and in the overall well-being and health of the mother and the infant. Breastfeeding programs should take into account traditional beliefs and concepts when communicating with families about practices such as food restriction and food avoidance. [ABSTRACT FROM AUTHOR]

Copyright of Acta Pediátrica Española is the property of Ediciones Mayo 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.)

Copyright of Acta Pediátrica Española is the property of Ediciones Mayo 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.)

Purpose: to evaluate the accuracy of the "Assessment sucking scale to newborn in breastfeeding". Methods: this is a diagnostic study. The "Assessment sucking scale to newborn in breastfeeding" was drawn from an existing instrument, has been validated. The study included 152 mothers / newborn hospitalized in rooming in care. The study was divided into two stages, the first stage adaptation of the instrument and the second validation of the "Assessment sucking scale to newborn in breastfeeding" itself. For comparison between the instruments, it was considered as the gold standard "Protocol assessment of breastfeeding" proposed by UNICEF. Statistical analysis was applied to test the association chi square (first stage) and building the "Receiver Operating Characteristics" curve (second stage). Results: in the first phase, the "Assessment sucking scale to newborn in breastfeeding" was drawn from the behavior of newborns who were associated with breastfeeding, consisting of items posture, movement and cupping tongue and jaw movement. However, in the second stage, it was found that "Assessment sucking scale to newborn in breastfeeding" has a poor accuracy and is not a predictor of the behavior of the newborn in the breastfeeding. Conclusion: the "Assessment sucking scale to newborn in breastfeeding" cannot be considered a predictor of behavior newborn in the breastfeeding. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a global disease with increase in concern with growing morbidity and mortality after drug resistance and co-infection with HIV. Mother to neonatal transmission of disease is well known. Current recommendations regarding management of newborns of mothers with tuberculosis are variable in different countries and have large gaps in the knowledge and practices. We compare and summarize here current recommendations on management of infants born to mothers with tuberculosis. Congenital tuberculosis is diagnosed by Cantwell criteria and treatment includes three or four anti-tubercular drug regimen. Prophylaxis with isoniazid (3-6 months) is recommended in neonates born to mother with TB who are infectious. Breastfeeding should be continued in these neonates and isolation is recommended only till mother is infectious, has multidrug resistant tuberculosis or non adherent to treatment. BCG vaccine is recommended at birth or after completion of prophylaxis (3-6 months) in all neonates. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study in children with cleft palate only (CPO) is to (1) explore the prevalence of feeding problems on a retrospective basis, (2) investigate rates of nasogastric (NG) feeding, (3) examine the prevalence of associated disorders and/or syndromes (AssD/S), (4) investigate if there are certain risk factors associated with feeding difficulties, NG feeding, and failure of breastfeeding, and (5) investigate the effect of palatoplasty on feeding difficulties. Materials and methods: In total, 90 questionnaires were included in this study. The medical records were reviewed. Results: Feeding difficulties were reported in 67 % ( n = 60) of all cases. NG feeding was given in 32 % ( n = 28) of all children. Forty-nine children (54 %) have associated malformations. There is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. The severity of the cleft is significantly related to the prevalence of AssD/S. After palatoplasty, feeding difficulties improved in 79 % of the CPO children. Conclusions and clinical relevance: First, our results clearly indicate that children with CPO are at high risk of developing feeding difficulties (67 %); NG feeding is often necessary (32 %). Second, our results also indicate that the more severe the cleft, the more likely the chance for AssD/S. Third, the severity of the cleft is significantly related to the prevalence of AssD/S. Fourth, there is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. Fifth, improvement of feeding difficulties after surgery supports the importance of the soft palate closure in relation to sucking patterns and feeding skills. [ABSTRACT FROM AUTHOR]

Most infants born to human immunodeficiency virus ( HIV)-infected women escape HIV infection. Infants evade infection despite an immature immune system and, in the case of breastfeeding, prolonged repetitive exposure. If infants become infected, the course of their infection and response to treatment differs dramatically depending upon the timing ( in utero, intrapartum, or during breastfeeding) and potentially the route of their infection. Perinatally acquired HIV infection occurs during a critical window of immune development. HIV's perturbation of this dynamic process may account for the striking age-dependent differences in HIV disease progression. HIV infection also profoundly disrupts the maternal immune system upon which infants rely for protection and immune instruction. Therefore, it is not surprising that infants who escape HIV infection still suffer adverse effects. In this review, we highlight the unique aspects of pediatric HIV transmission and pathogenesis with a focus on mechanisms by which HIV infection during immune ontogeny may allow discovery of key elements for protection and control from HIV. [ABSTRACT FROM AUTHOR]

Abstract: The acquisition of cognitive, sensory-motor and social emotional functions depend on a proper development of the Central Nervous System (CNS). This set of functions, known as intelligence, allows a better adaptation to the environment. In the last decades, an increase in the average of intelligence has been reported. However, such an increase cannot be observed in an equivalent way in economically and social underprivileged regions. Children from those regions are in great risk of being affected by mental retardation or impaired cognitive development. In later life they will, probably, be unable to transform and improve themselves and their communities, perpetuating the poverty of the region. Therefore, knowledge of factors involved in CNS development is a matter of health closely related to social improvement. Malnutrition throughout pregnancy and breastfeeding is clearly identifiable as a cause of damage in CNS development. Vitamin B1 (Thiamine) is a micronutrient important to the growth and maturity of the CNS. Thiamine shortcoming may affect 50% of pregnant women. Thiamine function in cerebral development is still not well known. There is a gap in the literature regarding systematical research about the blood thiamine concentration throughout the periods of gestation and breastfeeding. These studies are relevant in populations with a high level of nutritional vulnerability, because in a follow up offspring cognitive exam they could reveal if the maternal thiamine deficiency is related to child CNS impairment. This paper introduce the hypothesis that thiamine shortcoming during pregnancy and breastfeeding is directly related to cognitive impairment of child. Data about the neurophysiological role of thiamine, consequences of its shortcoming in experimental models, populations under the risk of thiamine shortcoming are presented. The hypothesis that maternal thiamine shortcoming causes damage related to child cognitive development needs to be considered. Thus, thiamine shortcoming during gestation and breastfeeding and its effects on children must be studied in many populations in order to know the magnitude of the problem and to indicate actions to overcome it. [Copyright &y& Elsevier]

Inflammatory bowel disease (IBD) is frequent in women during their peak reproductive years. Accordingly, a significant number of questions and uncertainties arise from this population regarding the risk of transmission of IBD to the offspring, the impact of the disease and therapies on the fertility, the role of the disease on the course of the pregnancy and the mode of delivery, the impact of the therapy on the pregnancy and fetal development as well as breastfeeding. The safety of medical therapy during pregnancy and lactation is a major concern for both pregnant women and their partners as well as for physicians. As a general rule, it can be stated that the benefit of continuing medical therapy in IBD during pregnancy outweighs the potential risks in the vast majority of instances. This article will review recent developments on this topic consistent with the European Crohn's and Colitis Organization guidelines. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: To improve the knowledge about the management of epileptic adolescents during the pregnancy, childbirth and the breastfeeding. Development: The epilepsy is the most frequent neurological disorder in the adolescence and it is too the more common neurological affectation with necessity of continuous treatment with drugs along all the pregnancy. However, still are present some doubts about the effect of the pregnancy on the epilepsy, as well as the influence of the epilepsy on the pregnancy, in the possibility of affectation in the offspring, in the possible complications at the moment of the childbirth and limitations about the breastfeeding. Is very important that the professionals with responsibility with the care of epileptic adolescents, have knowledge about the possible evolution of the epilepsy during the pregnancy, the conditions that may have influence in the presentation of the seizures in this period of time, the selection of the antiepileptic drugs and their effects on the pregnancy and on the conduct around the childbirth and the breastfeeding in this especial group of patients. Conclusions: The medical conduct foreseeing the possibility of unexpected pregnancy and the accurate information of the patients and relatives about the reproductive health are the principal for to get a correct conduct in epileptic adolescents. [ABSTRACT FROM AUTHOR]

Abstract: The Data and Safety Monitoring Board (DSMB) for the Breastfeeding, Antiretrovirals, and Nutrition study, a clinical trial aimed to prevent postnatal HIV transmission, recommended halting randomization to the enhanced standard-of-care (control) arm. The 67 mother–infant pairs on the control arm and less than 21weeks postpartum at the time of the DSMB recommendation were read a script informing them of the DSMB decision and offering them the maternal or infant antiretroviral interventions for the remainder of the 28-week breastfeeding period. This paper describes the BAN study response to the DSMB decision and what the women on the control arm chose, when given a choice to start the maternal or infant antiretroviral interventions. [Copyright &y& Elsevier]

Human papillomavirus (HPV) DNA has been detected in the oral cavity of infants and breast cancer tissue, suggesting its vertical transmission through maternal milk. We determined whether HPV is detected in maternal milk and is vertically transmitted by breast-feeding. Informed consent was obtained, and maternal milk samples (n==80) were analysed for high-risk HPV DNA. In 43 women, this DNA was measured in the uterine cervix. In women with positive samples, this DNA was measured in the oral cavities of their children. The domain including HPV E6 and E7 was amplified by polymerase chain reaction using consensus primers, and HPV serotype determined by electrophoresis after restriction enzyme digestion. High-risk HPV-16 was detected in two of 80 samples (2.5%), and in these two cases, high-risk HPV was not detected in the uterine cervix or oral cavity of the child. It was concluded that the infection of HPV in maternal milk is rare (2/80); vertical transmission through maternal milk was not detected in this study (0/80). HPV infection through maternal milk may occur, but its likelihood is low. [ABSTRACT FROM AUTHOR]

Summary: Background: Breastfeeding is essential for child health and development in low-resource settings but carries a significant risk of transmission of HIV-1, especially in late stages of maternal disease. We aimed to assess the efficacy and safety of triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis in pregnant women infected with HIV. Methods: Pregnant women with WHO stage 1, 2, or 3 HIV-1 infection who had CD4 cell counts of 200–500 cells per μL were enrolled at five study sites in Burkina Faso, Kenya, and South Africa to start study treatment at 28–36 weeks'' gestation. Women were randomly assigned (1:1) by a computer generated random sequence to either triple antiretroviral prophylaxis (a combination of 300 mg zidovudine, 150 mg lamivudine, and 400 mg lopinavir plus 100 mg ritonavir twice daily until cessation of breastfeeding to a maximum of 6·5 months post partum) or zidovudine and single-dose nevirapine (300 mg zidovudine twice daily until delivery and a dose of 600 mg zidovudine plus 200 mg nevirapine at the onset of labour and, after a protocol amendment in December, 2006, 1 week post-partum zidovudine 300 mg twice daily and lamivudine 150 mg twice daily). All infants received a 0·6 mL dose of nevirapine at birth and, from December, 2006, 4 mg/kg twice daily of zidovudine for 1 week after birth. Patients and investigators were not masked to treatment. The primary endpoints were HIV-free infant survival at 6 weeks and 12 months; HIV-free survival at 12 months in infants who were ever breastfed; AIDS-free survival in mothers at 18 months; and serious adverse events in mothers and babies. Analysis was by intention to treat. This trial is registered with Current Controlled Trials, ISRCTN71468401. Findings: From June, 2005, to August, 2008, 882 women were enrolled, 824 of whom were randomised and gave birth to 805 singleton or first, liveborn infants. The cumulative rate of HIV transmission at 6 weeks was 3·3% (95% CI 1·9–5·6%) in the triple antiretroviral group compared with 5·0% (3·3–7·7%) in the zidovudine and single-dose nevirapine group, and at 12 months was 5·4% (3·6–8·1%) in the triple antiretroviral group compared with 9·5% (7·0–12·9%) in the zidovudine and single-dose nevirapine group (p=0·029). The cumulative rate of HIV transmission or death at 12 months was 10·2% (95% CI 7·6–13·6%) in the triple antiretroviral group compared with 16·0% (12·7–20·0%) in the zidovudine and single-dose nevirapine group (p=0·017). In infants whose mothers declared they intended to breastfeed, the cumulative rate of HIV transmission at 12 months was 5·6% (95% CI 3·4–8·9%) in the triple antiretroviral group compared with 10·7% (7·6–14·8%) in the zidovudine and single-dose nevirapine group (p=0·02). AIDS-free survival in mothers at 18 months will be reported in a different publication. The incidence of laboratory and clinical serious adverse events in both mothers and their babies was similar between groups. Interpretation: Triple antiretroviral prophylaxis during pregnancy and breastfeeding is safe and reduces the risk of HIV transmission to infants. Revised WHO guidelines now recommend antiretroviral prophylaxis (either to the mother or to the baby) during breastfeeding if the mother is not already receiving antiretroviral treatment for her own health. Funding: Agence nationale de recherches sur le sida et les hépatites virales, Department for International Development, European and Developing Countries Clinical Trials Partnership, Thrasher Research Fund, Belgian Directorate General for International Cooperation, Centers for Disease Control and Prevention, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and UNDP/UNFPA/World Bank/WHO Special Programme of Research, Development and Research Training in Human Reproduction. [Copyright &y& Elsevier]

Our laboratory has developed a murine model of lymphoma via breast milk transmission of MoMuLV-ts-1 (Moloney murine leukemia virus-temperature sensitive mutant-1). Uninfected offspring suckled from infected surrogate mothers become infected and develop lymphoma. Multiple gene integration sites of ts-1 into the infected mouse genome including tacc3, aurka, ndel1, tpx2, p53, and rhamm were identified, and mRNA expressions were quantitated. These genes produce centrosomal proteins, which may be involved in abnormal chromosomal segregation leading to aneuploidy ormultiploidy, thus causing lymphoma. Since there is no report to date on this retroviral model leading to centrosomal abnormality, and causing lymphoma development, this is a valuable and unique model to study the centrosomal involvement in lymphomagenesis. [ABSTRACT FROM AUTHOR]

Background: Monitoring of breastfeeding is vital. However, infant feeding practices are difficult to assess at the population level. Although significant efforts have been made towards the consistent measurement and reporting of breastfeeding, few countries have successfully implemented a system to do so. Many inaccuracies, inconsistencies and issues remain. This paper highlights the main issues relating to the methods and indicators used to monitor breastfeeding, particularly exclusive breastfeeding, at the population level. In doing so, it aims to support progress in this area. Discussion: Indicators are used primarily for comparative purposes and should be broadly consistent with recommended practice; regarding exclusive breastfeeding this is 'to six months'. There are limitations to both main methods used to measure and report on breastfeeding: current status (often 24-hour recall), and longer-term recall. Issues relate to how age is considered within the analysis and interpretation of data, including boundary points or cut offs, as well as how breastfeeding practices are reported against different ages, especially regarding whether to use the preposition 'to' or 'at'. Other issues include the conversion from weeks to months, as well as the 'regular' versus 'first' introduction of something other than breast milk, to signify the deviation from exclusive breastfeeding. Differences in how data are collected, and uncertainties around how data are interpreted, have led to the mixed and often inaccurate reporting of breastfeeding practices, particularly exclusive breastfeeding. Assuming a particular definition of exclusive breastfeeding, such as that of the World Health Organization, the period over which exclusive breastfeeding is measured and how it is determined in the survey are important in relation to indicator phrasing. Often compromises are made in data collected to report against exclusive breastfeeding, despite subsequent reporting of exclusivity. Summary: Indicators to report on breastfeeding must be carefully phrased. The commonly reported indicator exclusive breastfeeding at six months is redundant and should never be reported, while the more appropriate indicator exclusive breastfeeding to six months may not be sufficiently sensitive to change, and cannot be measured by current status methods alone. Importantly, indicators must accurately reflect the data collected to ensure valid comparisons between surveys. [ABSTRACT FROM AUTHOR]

Objective: To study the causative factors responsible for avoidance of Breast Feeding in post-partum women attending the post-natal OPD in MH Rawalpindi. Design: Comparative cross sectional study. Setting: Dept of Gynae and Obstetrics, Military Hospital, Rawalpindi. Tertiary care centre from all the Pakistan dealing with other ranks of Pak Army. Duration: Nine months (From 01.01.2007 to 1.10.2007). Materials and Methods: Study was done on 1000 patients at post-natal Gynae OPD. Patients were divided into two groups of 500 each. Those patients who were exclusively breast feeding their babies were included in group-II while group-I included those patients who were not breast feeding their babies at all. Patients demographic data was entered on questionnaire and factors involved were interpreted. The most important causative factor responsible for avoidance of breast feeding in group-I were noted down. The mothers in group-II were enquired about that problem. Data was analyzed by using computer software programme SPSS version 11. Chi square test was used to see the significance of difference between group-I and group-II and results were considered significant if P value is less than 0.05. Results: The study showed that as compared to group-II causative factors involved in avoidance of breast feeding in group-I were pain at operated site 148, working women 38, Sick baby 26,Cracked nipples and mastitis 59, Breast abscess 4, Social Myths 58, Multiple Births 2, Inverted Nipples 5 and failure of proper counseling 160. Conclusions: Most of the factors responsible for avoidance of breast feeding are preventable and treatable. General population should be educated regarding the benefits of breast feeding in the mother and baby. Thus reducing mortality rate in woman and infants. [ABSTRACT FROM AUTHOR]

To investigate why breastfed infants are more likely to have prolonged jaundice than formula-fed infants. Serum unconjugated bilirubin (UCB), total cholesterol (TC) and triglyceride (TG) were measured for 102 infants of 1 month. Enrolled infants were 42 breastfed, 40 mixed-fed and 20 bottle-fed infants. Statistic analyses for relationship among UCB, TC, TG, perinatal factors and post-natal factors were performed for these infants. In correlation analyses UCB was correlated with peak transcutaneous bilirubin value in neonatal period (TcBn) (r = 0.612, P < 0.0001) and with TC (r = 0.383, P < 0.0001). When analyses of covariance (ANCOVA) for UCB were performed using TcBn as the covariate, the results indicated that there was neither significant main nor interaction effect of feeding method on UCB, and that main and interaction effects of TC on UCB were significant when TC was categorised into two groups (≤150 mg/dL and >150 mg/dL). It is suggested that both neonatal hyperbilirubinemia and subsequent higher plasma TC are associated factors for prolonged jaundice. [ABSTRACT FROM AUTHOR]

Abstract: Many guidelines for the prevention and management of neonatal hypoglycaemia focus on the sick infant admitted to the intensive care unit and pay scant attention to what is known about normal neonatal physiology. It is questionable whether treatment guidelines for low blood glucose levels for sick infants can be applied to a population of well infants on the postnatal ward, especially if such guidelines interfere with the establishment of breastfeeding, which has well recognised long and short term health benefits for mother and baby. What then of the baby who is at risk of abnormal postnatal adaptation, but is not unwell? Can the complications which occur in such infants, such as hypoglycaemia, be safely managed without resorting to admission to a baby unit? Can such vulnerable infants be safely managed in an environment that promotes mother and baby bonding and facilitates breastfeeding? [Copyright &y& Elsevier]

Background: Early postpartum discharge is a recent practice in France, but the influence of a shortened hospital stay on subsequent breastfeeding is unknown. The objective of the present study was to compare the breastfeeding mode after early discharge (ED) and conventional discharge (CD) from a hospital maternity unit. Methods: An observational study was conducted in a French university hospital among 135 breastfeeding mothers, who delivered between 1 January and 31 July 2006. Forty-five ED mothers were matched with 90 CD mothers on 13 criteria. A structured questionnaire was used to collect data regarding feeding practices at 10 weeks postpartum, the period corresponding to paid maternity leave. Results: Exclusive breast-, mixed, and bottle feedings were reported by, respectively, 35 (77.8%), three (6.7%) and seven (15.5%) ED mothers and 64 (71.1%), 12 (13.3%) and 14 (15.6%) CD mothers (no significant differences). Satisfaction with support for breastfeeding and reasons for switching to mixed or bottle feeding were comparable in the two groups. Multivariate analysis indicated that only the planned duration of breastfeeding and the mother's dissatisfaction with help significantly influenced breastfeeding prevalence. Conclusions: Early postpartum hospital discharge organized by skilled professionals is compatible with a satisfactory rate of exclusive breastfeeding up to the return to work. Formalized programs of instruction for perinatal professionals would help to reduce early abandonment. [ABSTRACT FROM AUTHOR]

Background: Nipple sore occurs in 11- 96% percent of breastfed mothers. It is one of incident causes for breastfeeding stop. One of the common treatment for nipple sore is Lanolin. According to approved efficacy of aloevera in sore healing, this study was performed to compare aloevera gel with Lanolin ointment in the nipple sore treatment. Methods: In a single blind clinical trial study that performed in Dr. Sheikh's Clinic in Mashhad, Iran, sampling was purposed. At first, procedures were explaned for mothers and were given writing consent. 50 nipple sore in each group (47 mothers with two nipple sore and six mother with only one nipple sore) were allocated randomly under treatment with two methods. First group used lanolin ointment and the second one were applied aloevera gel. Both of groups were educated about breastfeeding technique and how to use their drugs. The researcher completed Storr score before study, at 3th day and 7th day of study. Results: The mean nipple sore scoring in aloevera group in pretreatment day was 3.04, in 3th day, 1.26 and in 7th day was 0.26. In lanolin group the sore scoring was 3.1, 1.7 and 1.02 in pretreatment day, third day and the seventh day, respectively. There was no a significant difference between two groups in pretreatment day scoring (p=0.711) and there was a significant difference between them in 3th and 7th days (p=0.048, p= 0.003). Conclusions: Aloevera is more effective than lanolin in nipple sore healing. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to determine the association of smoking status as a risk factor for reduced initiation and duration of breastfeeding. METHODS: The Missouri Pregnancy Related Assessment and Monitoring System collected a stratified sample of new mothers in 2005. Surveys were mailed, with telephone follow-up, and completed within 2 to 12 months after delivery. Respondents were classified as nonsmokers, smokers who quit during pregnancy, light smokers (10 cigarettes per day), or moderate/heavy smokers (>10 cigarettes per day). Multivariable binomial regression and Cox proportional hazards models were used to assess breastfeeding initiation and duration according to smoking status. RESULTS: Overall, 1789 women participated (weighted response rate: 61%). Approximately 74% of the women ever breastfed; 31% of the women ever smoked while pregnant. Compared with nonsmokers, the moderate/heavy smokers and light smokers were less likely to initiate breastfeeding, after controlling for sociodemographic characteristics, the presence of other smokers in the household, alcohol use, mode of delivery, and infant hospitalization. Compared with nonsmokers, the moderate/heavy smokers, light smokers, and smokers who quit during pregnancy were more likely to wean over time, controlling for the same covariates. There were no significant differences between nonsmokers and smokers regarding reasons for not initiating or ceasing breastfeeding. CONCLUSIONS: Mothers who smoked initiated breastfeeding less often and weaned earlier than nonsmoking mothers. Incorporating knowledge of the association between smoking and breastfeeding into existing smoking-cessation and breastfeeding programs could provide opportunities to reduce perinatal exposure to tobacco smoke, improve interest in breastfeeding, and address other barriers to breastfeeding that smoking mothers may face. [ABSTRACT FROM AUTHOR]

Purpose: This study was done to investigate the level of breastfeeding satisfaction, the relationship among knowledge about breastfeeding, attitude toward breastfeeding, self-efficacy of breastfeeding, intention of breastfeeding, and perceived social encouragement of breastfeeding and the factors influencing breastfeeding satisfaction in mothers 3~6 months after birth. Methods: For this descriptive research, 209 mothers who had been breastfeeding their babies agreed to participate in this study. Data on mother's satisfaction, knowledge, attitude, self-efficacy, intention, and perceived social encouragement regarding breastfeeding were collected by closed-ended questionnaires on September 14, 2007 at a contest for healthy breast-fed babies. Results: The major findings of this study were as follows: First, there were significant differences in the breastfeeding satisfaction level according to planned length of breastfeeding (F=10.43, p<.001). Second, there was a significant relationship between breastfeeding satisfaction and knowledge about breastfeeding (r=.37, p<.001), attitude toward breastfeeding (r=.62, p<.001), self-efficacy of breastfeeding (r=.66, p<.001), intention of breastfeeding (r=.40, p<.001), and perceived social encouragement of breastfeeding (r=.32, p< .001). Finally, the strongest factor affecting mothers' breastfeeding satisfaction was attitude toward breastfeeding (β=.38). Other factors included self-efficacy of breastfeeding ( =.36), knowledge about breastfeeding β (β=.14), perceived social encouragement of breastfeeding (β=.10), and planned length of breastfeeding (β=.10). Conclusion: This study suggests that nurses should help mothers improve breastfeeding satisfaction through promotion of knowledge about, attitudes toward, and self-efficacy of breastfeeding. [ABSTRACT FROM AUTHOR]

The author reflects on the prevention of postnatal transmission of HIV through breastfeeding. The author discusses various clinical trials and studies on the possible interventions to reduce and prevent HIV transmission through breastfeeding including the Mitra study by Kilewo and colleagues. The author suggests that the preference of intervention for prevention of perinatal and postnatal HIV transmission in women does not necessitate intervention for their own health.

Abstract: Docosahexaenoic acid (DHA) is a long-chain polyunsaturated fatty acid with activities in both infants and adults. The objective of the current work was to evaluate the published literature concerning the toxicological assessment of DHA-rich oils in animals and the safety profile of DHA consumption in humans. Structured literature searches concerning DHA toxicology and DHA effects on platelet function, lipid levels, oxidative potential, glycemic control, and immune function were conducted. The toxicological profile of DHA derived from single-cell organisms demonstrates that these oils are safe in rats (up to a consumption level of 3290mg/kgbody weight/d) in 90-d toxicology evaluations, as well as in reproductive and developmental toxicology studies. The maximum DHA level in human breast milk exceeds 1% of total fatty acids in high-fish-consuming populations. Consumption of DHA-rich human milk as sole source of nutrition provides approximately 315mg/d in infants 1–6 months of age, and appears to be a safe level of intake. DHA supplementation studies in adults have employed doses ranging from less than 1 to 7.5g/d, and have not resulted in any consistent adverse responses in platelet function, lipid levels, in vivo oxidation parameters, glycemic control, or immune function. In conclusion, DHA consumption does not result in consistent adverse events in infants or adults. Safe intake levels may be modeled on DHA intake from human milk in infants, and may be at least as high as the upper doses studied in adults. [Copyright &y& Elsevier]

Aim: To identify certain variables related to the infants' course that might have an impact on the mothers' decision to breastfeed. Patients and Method: Retrospective survey including all patients <1500 g birth weight (BW) treated between January 1, 2000 and December 31, 2005 at the Neonatal Intensive Care Unit of the Medical University of Vienna who were not transferred to another hospital. Multiple regression analysis of the following variables was carried out: gestational age (GA), BW, length of stay (LOS), parity, singleton or multiple gestation, sex and severe morbidity. Results: Of the 239 patients included, 142 (60%) were fed breast milk at the time of final discharge, 97 (40%) were fed formula. LOS was significantly correlated with the probability of being breastfed: the shorter it was, the higher was the probability of being breastfed at the time of final discharge (p = 0.0064 for singletons, p = 0.001 for multiples). Lower GA also increased the probability of being breastfed, but this was only statistically significant for multiples (p = 0.001). Conclusion: This study shows clearly that the most important influencing factor on the mothers' decision to continue breastfeeding is the LOS. Thus more emphasis should be put on encouraging mothers to continue lactation throughout their babies' hospital stay. [ABSTRACT FROM AUTHOR]

The article focuses on a study on the length of lactation on breast-feeding women and its associated postmenopausal risk factors. Multi-variable models were used as control for sociodemographic variables on examining the effect of the duration of lactation. Such risk factors include obesity, hypertension and diabetes. Dose-response relationships were found out in women with more than 12 months of lactation, suggesting a less case of hypertension, diabetes and cardiovascular diseases.

The article presents a study that investigates the operational feasibility and predictors of complete breast-feeding cessation (CBC) among human immunodeficiency virus (HIV)-positive breast-feeding women taking Prevention of Mother-to-Child Transmission (PMTCT) programs. The research was conducted at 3 government PMTCT sites in South Africa. Research results show that CBC by 24 weeks is uncommon at programmatic level. It also cites the need to identify and test activities that encourage CBC.

Postpartum depression (PPD) affects up to 15% of mothers. Recent research has identified several psychosocial and biologic risk factors for PPD. The negative short-term and long-term effects on child development are well-established. PPD is under recognized and under treated. The obstetrician and pediatrician can serve important roles in screening for and treating PPD. Treatment options include psychotherapy and antidepressant medication. Obstacles to compliance with treatment recommendations include access to psychotherapists and concerns of breastfeeding mothers about exposure of the infant to antidepressant medication. Further research is needed to examine systematically the short-term and long-term effect of medication exposure through breastmilk on infant and child development. [Copyright &y& Elsevier]