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Introduction: Despite the widely recognised benefits of breastfeeding, preterm newborns globally exhibit lower breastfeeding rates compared to term infants. This study aims to ascertain the prevalence of breast milk feeding among VLBW infants and to evaluate the factors associated with successful breast milk feeding in this specific population. Materials and methods: A cross-sectional study was conducted involving 111 mothers who gave birth to premature infants with birth weights less than 1500 g between March and December 2020. This investigation took place in two tertiary Neonatal Intensive Care Units. Data encompassing maternal, perinatal, and neonatal characteristics were extracted from medical records and subjected to analysis using SPSS version 25. Results: Among the 111 participating mothers, only 44 (39.6%) successfully provided expressed breast milk (EBM) for their infants' initial feeds, and a mere 31 (28.0%) sustained adequate EBM provision until their infants attained full enteral feeding. The achievement of a successful breast milk feeding establishment demonstrated substantial correlations with higher maternal income (p = 0.023) and the timing of initiating enteral feeds (p = 0.037). Conclusion: The prevalence of breast milk feeding initiation and establishment among VLBW infants was found to be remarkably low. The potential influence of the demanding Covid-19 pandemic context during the study period cannot be ignored. It is imperative to intensify efforts to investigate the underlying causes to facilitate the swift and effective implementation of quality improvement interventions. Future research initiatives are essential to uncovering additional confounding factors that might influence the successful rate of breast milk feeding among VLBW infants. [ABSTRACT FROM AUTHOR]

Aim: This study aims to compare the efficacy of 10% dextrose (10%D) and expressed breast milk (EBM) in relieving heel prick pain in neonates assessed by premature infant pain profile-revised (PIPP-R). Settings and Design: This study was done in the neonatal intensive care unit under the department of pediatrics, hospital-based prospective, randomized controlled trial. Subjects and Methods: The study includes neonates born between ≥34 weeks and ≤42 weeks of gestational age. The 72 enrolled neonates were randomized into two intervention groups (EBM and 10%D). One milliliter of test solution was given to the baby 30 s before the heel prick. Pain reactions were scored using the PIPP-R scoring system, and two independent observers were chosen, who were blinded to what intervention was given. Results: For the EBM solution, the mean PIPP-R at 0 s was 7.19 ± 2, 5.5 ± 1.5 at 30 s, and 4.28 ± 1.65 at 60 s. For the 10%D solution, the mean PIPP-R at 0 s was 4.97 ± 1.42, 2.36 ± 1.44 at 30 s, and 1.69 ± 1.53 at 60 s. The difference in the mean PIPP-R between the two groups was statistically significant, and the 10%D group majority had only minimal pain throughout the procedure. Conclusions: Compared to the EBM group, 10%D significantly lowered the mean PIPP-R score, giving good pain relief and less procedural discomfort. [ABSTRACT FROM AUTHOR]

Background Expression of breast milk is a strategy to ensures continuous breastfeeding during temporary separation of infant from the mother. Handling and storage of expressed breast milk (EBM) should be based on established recommendations because these practices can affect milk quality and safety. Objective To describe perceptions and practices of EBM handling and storage, compare with commonly used recommendations and associated factors influencing these practices among mothers in Jakarta, Indonesia, Methods Mothers who practiced expressed breastfeeding (EBF) to their 6-12 weeks-old infants completed questionnaires about their peceptions and practices on how they handle and storage EBM. The differences in perceptions and practices about expressed breastfeeding management were analyzed using the Chi-square or Fisher's exact test. Results Among 30 mothers, 14/30 gave EBF exclusively, 19/30 used breast pump, and 26/30 expressed ³6 times/day. Infants in this study received expressed milk 5-10 times per day. Maternal age and resource of information were factors significantly associated with mother’s perceptions, while maternal age, education, and parity were significantly associated with the practices of EBM handling and storage. Conclusion This study reveals inconsistent perceptions and practices on expressed milk handling and storage by the mothers. They have good knowledge about the theoretical aspects of expressed breastfeeding, but some other techniques are poor, which can be detrimental to the health of the infants. Further study is needed to find more efficient and optimal methods of expressed milk handling and storage, necessitating thoughtful consideration of better practices and recommendations.

Abstract Background Worldwide, many guidelines recommend the use of expressed breast milk (EBM) and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia. However, the impact of both practices on neonatal hypoglycemia is unclear. This study aims to determine the effectiveness of EBM and maternal expression of breast milk in preventing and treating neonatal hypoglycemia. Methods We registered our review in PROSPERO (CRD42022328072). We systematically reviewed five databases and four clinical trial registries to identify randomized controlled trials (RCT), non-randomized studies of intervention (NRSI), and cohort studies that compared infants who received EBM to infants who did not, and similar study designs that compared infants whose mothers expressed breast milk to infants whose mothers did not. Two independent reviewers carried out screening, data extraction, and quality assessment. The quality of included RCT, NRSI, and cohort studies were respectively assessed with the Cochrane Risk of Bias 2, Risk Of Bias In Non-randomised Studies—of Interventions, and the Newcastle–Ottawa Scale tools. Results from studies on EBM were synthesized separately from those on maternal expression of breast milk. Meta-analysis was undertaken using Revman 5.4. and fixed-effect models. Results None of the ten included studies was specifically designed to determine the effect of EBM or maternal expression of breast milk on neonatal hypoglycemia. The effect of EBM on neonatal hypoglycemia was not estimable. There was no difference in the risk of hypoglycaemia among neonates whose mothers expressed breast milk compared to those whose mothers did not [RR (95%CI); one RCT: 0.92 (0.77, 1.10), high-certainty evidence; one cohort: 1.10 (0.74, 1.39), poor quality study]. Conclusions There is insufficient evidence to determine the effectiveness of EBM for preventing or treating neonatal hypoglycemia. Limited data suggests maternal breast milk expression may not alter the risk of neonatal hypoglycemia. High-quality randomized controlled trials are needed to determine the effectiveness of EBM and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia.

Background Expression of breast milk is a strategy to ensures continuous breastfeeding during temporary separation of infant from the mother. Handling and storage of expressed breast milk (EBM) should be based on established recommendations because these practices can affect milk quality and safety. Objective To describe perceptions and practices of EBM handling and storage, compare with commonly used recommendations and associated factors influencing these practices among mothers in Jakarta, Indonesia, Methods Mothers who practiced expressed breastfeeding (EBF) to their 6-12 weeks-old infants completed questionnaires about their peceptions and practices on how they handle and storage EBM. The differences in perceptions and practices about expressed breastfeeding management were analyzed using the Chi-square or Fisher's exact test. Results Among 30 mothers, 14/30 gave EBF exclusively, 19/30 used breast pump, and 26/30 expressed = 6 times/day. Infants in this study received expressed milk 5-10 times per day. Maternal age and resource of information were factors significantly associated with mother's perceptions, while maternal age, education, and parity were significantly associated with the practices of EBM handling and storage. Conclusion This study reveals inconsistent perceptions and practices on expressed milk handling and storage by the mothers. They have good knowledge about the theoretical aspects of expressed breastfeeding, but some other techniques are poor, which can be detrimental to the health of the infants. Further study is needed to find more efficient and optimal methods of expressed milk handling and storage, necessitating thoughtful consideration of better practices and recommendations. [ABSTRACT FROM AUTHOR]

Human Breast Milk (HBM) is widely acknowledged as the best nutritional source for neonates. Data indicates that, in 2019, 83.2% of infants in the United States received breast milk at birth, slightly reducing to 78.6% at 1 month. Despite these encouraging early figures, exclusive breastfeeding rates sharply declined, dropping to 24.9% by 6 months. This decline is particularly pronounced when direct breastfeeding is challenging, such as in Neonatal Intensive Care Units (NICU) and for working mothers. Given this, it is vital to explore alternative breast milk preservation methods. Technologies like Holder Pasteurization (HoP), High-Temperature Short-Time Pasteurization (HTST), High-Pressure Processing (HPP), UV radiation (UV), and Electric Pulses (PEF) have been introduced to conserve HBM. This review aims to enhance the understanding of preservation techniques for HBM, supporting the practice of extended exclusive breastfeeding. It explicitly addresses microbial concerns, focusing on critical pathogens like Staphylococcus aureus, Enterococcus, Escherichia coli, Listeria monocytogenes, and Cytomegalovirus, and explores how various preservation methods can mitigate these risks. Additionally, the review highlights the importance of retaining the functional elements of HBM, particularly its immunological components such as antibodies and enzymes like lysozyme and Bile Salt Stimulated Lipase (BSSL). The goal is to provide a comprehensive overview of the current state of HBM treatment, critically assess existing practices, identify areas needing improvement, and advocate for extended exclusive breastfeeding due to its vital role in ensuring optimal nutrition and overall health in infants.

Background: Worldwide, many guidelines recommend the use of expressed breast milk (EBM) and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia. However, the impact of both practices on neonatal hypoglycemia is unclear. This study aims to determine the effectiveness of EBM and maternal expression of breast milk in preventing and treating neonatal hypoglycemia. Methods: We registered our review in PROSPERO (CRD42022328072). We systematically reviewed five databases and four clinical trial registries to identify randomized controlled trials (RCT), non-randomized studies of intervention (NRSI), and cohort studies that compared infants who received EBM to infants who did not, and similar study designs that compared infants whose mothers expressed breast milk to infants whose mothers did not. Two independent reviewers carried out screening, data extraction, and quality assessment. The quality of included RCT, NRSI, and cohort studies were respectively assessed with the Cochrane Risk of Bias 2, Risk Of Bias In Non-randomised Studies—of Interventions, and the Newcastle–Ottawa Scale tools. Results from studies on EBM were synthesized separately from those on maternal expression of breast milk. Meta-analysis was undertaken using Revman 5.4. and fixed-effect models. Results: None of the ten included studies was specifically designed to determine the effect of EBM or maternal expression of breast milk on neonatal hypoglycemia. The effect of EBM on neonatal hypoglycemia was not estimable. There was no difference in the risk of hypoglycaemia among neonates whose mothers expressed breast milk compared to those whose mothers did not [RR (95%CI); one RCT: 0.92 (0.77, 1.10), high-certainty evidence; one cohort: 1.10 (0.74, 1.39), poor quality study]. Conclusions: There is insufficient evidence to determine the effectiveness of EBM for preventing or treating neonatal hypoglycemia. Limited data suggests maternal breast milk expression may not alter the risk of neonatal hypoglycemia. High-quality randomized controlled trials are needed to determine the effectiveness of EBM and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia. [ABSTRACT FROM AUTHOR]

Background/Aims: The rate of exclusive breastfeeding among working mothers is low, and can be attributed to the perception of inadequate breast milk, lack of knowledge about expression, limited time to express and lack of support from workplace leaders. This study aimed to determine the effectiveness of educational videos on milk management in improving working women's knowledge, attitudes and self-efficacy in expressing breast milk. Methods: This study used a quasi-experimental design, with a sample of 100 participants selected for a cluster randomised trial. The intervention group (n=50) watched educational videos on expressed breast milk and were mentored through a WhatsApp group, while the control group (n=50) received regular education for pregnant women working in urban areas. Data on the participants knowledge, attitude and self-efficacy were collected via questionnaires both before and after the intervention. The data were analysed using the Mann-Whitney test. Results: The intervention group had higher knowledge, attitude and self-efficacy scores after watching the educational videos and being mentored (P=0.001). Conclusions: Educational videos and mentoring can be used by healthcare professionals to provide education and support for working women, to encourage breast milk expression and exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

Abstract Background Breastfeeding in infancy has immunological and nutritional benefits. The actual status of breastfeeding in childcare facilities is unclear. However, it is expected to vary in every facility and region. This study aimed to explore what the staff of childcare facilities perceive of breastfeeding and how they feel about handling breast milk. Methods The study was conducted from May 2012 to September 2015. A list of childcare facilities in three cities in Japan was compiled. A questionnaire was sent to the facilities by mail asking whether or not they provided breastfeeding care and whether or not they would participate in the study. Semi‐structured interviews were conducted with the staff members of childcare facilities that consented to the study. The transcribed text was analyzed by thematic analysis. Results Of the 211 facilities sent, 55 responded, and 21 of these facilities were implementing breastfeeding. Interviews were conducted at four facilities for those who agreed to be interviewed. The researchers extracted three categories of breastfeeding factors at childcare facilities: the value that caregivers see in breastfeeding, difficulties associated with breastfeeding in childcare facilities, and devices and elements for breastfeeding by childcare facilities. Although facility staff acknowledged the nutritional and psychosocial benefits of breast milk, they also felt the administrative difficulties and mental burden of handling expressed breast milk. Conclusion This study revealed that for the childcare facility staff, breastfeeding was positioned as a means of communication and reassurance to the mother, and the immunological and nutritional benefits of breast milk.

Background: Mother-to-child transmission of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) has become a matter of great concern in post-partum wards and neonatal units. With little prior experience of this novel infection, there are contradictory findings in the literature regarding breastfeeding androoming-in for newborns of mothers with COVID-19 disease. To assess the transmission risk of SARS-CoV- 2 in neonates who were fed expressed breast milk of COVID-19 positive mothers. Methods: This prospective study included 16 neonates born to COVID-19 positive mothers. The neonates were nursed in a neonatal unit separate from their mother. Expressed breast milk was fed by health care givers ensuring proper safety measures. Nasal and throat swabs of neonates were tested twice for SARS CoV-2, firstly, at 48 h of life and secondly, before discharge. Results: Pneumonia was present in 3 (20%) mothers, and C- reactive protein was raised in 9 (60 %) mothers. Birth weight was low in 8 (50%) neonates. Respiratory distress syndrome and meconium aspiration syndrome were present in two and one newborns, respectively. Nasal and throat swabs of all 16 newborns tested negative for SARS-CoV- 2 infection twice, at 48 h of life and before discharge. Conclusion: Expressed breast milk feeding can be considered safe in neonates born to COVID-19 positive mothers. Even sick mothers with COVID-19 can continue to express breast milk after ensuring proper safety measures.

Objective: To observe the effect of fortification of expressed human breast milk with olive oil and skimmed milk in improving weight gain in very low birth weight neonates and shortening their length of hospital stay. Study Design: A comparative prospective study. Place and Duration of Study: Combined Military Hospital Lahore, from Mar 2018 to Mar 2019. Methodology: Neonates admitted with very low birth weight and gestational age of

Suzan Gad,1 Mohamed M Sheta,2 Abeer I Al-khalafawi,3 Heba A Abu El-Fadl,1 Maha Anany,1 Shaimaa Sahmoud,1 Mona Karem Amin1 1Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt; 2Pediatrics and Neonatology Department, Mansoura General Hospital, Mansoura, Egypt; 3Neonatology Department, Saqr Hospital, MOH, Ras Alkheima, United Arab EmiratesCorrespondence: Mohamed M ShetaPediatrics and Neonatology Department, Mansoura General Hospital, Mansoura, EgyptTel +971-559-865-166Email sheta99999@yahoo.comBackground: The health benefits of breastfeeding are well known. However, some ill babies including those admitted to the neonatal intensive care unit (NICU) cannot be directly breastfed. In this situation, expressed breast milk (EBM) can be used. However, breast milk is not always sterile and may be contaminated by many microorganisms. EBM contamination is probably attributed to improper technical and hygienic factors and may pose significant threats to the newborn baby. The present study aimed to document the prevalence of EBM contamination in NICU and to uncover the relevant risk factors.Subjects and Methods: The study included 118 mothers who could express breast milk for their own neonates admitted to the NICU. A checklist was used to document the steps the mothers followed during expression of milk and all steps of handling until the EBM reached the NICU. A 1 mL sample of EBM was obtained and sent to the microbiology laboratory within 20 minutes. Data obtained from the present study are expressed as number and percentage or mean ± standard deviation (SD). Statistical calculations were computed using SPSS 25.Results: In the present study, 106 (89.8%) out of the assessed 118 EBM samples were contaminated. Hygienic factors related to EBM contamination included hand only wash, possible recontamination of hands during turning taps off, lack of using cotton pads or cloth piece on nipple and breast cleaning by water only. Other factors related to EBM contamination included container cleaning by water only, fresh milk refrigeration after > 4 hours, adding freshly expressed warm breast milk to refrigerated milk expressed earlier in the same day, milk transport in plastic bags with ice packs and longer transportation time. In the contaminated samples, the most commonly isolated organisms included Staphylococcus aureus (55.7%),Staphylococcus epidermidis (21.7%) and Enterobacter (11.6%).Conclusion: The present study identified bacterial contamination in about 90% of EBM samples delivered to NICU infants. Factors related to EBM contamination include hygienic, storage and transport factors.Keywords: breastfeeding, expressed breast milk, NICU

Expression and cold storage of human milk is a common practice. Current guidelines for cold storage of expressed milk do not take into account the impact on the milk microbiome. Here, we investigated the impact of cold storage on viable bacterial populations in human milk. Freshly expressed milk samples (n = 10) were collected and analysed immediately, stored at 4 °C for four days, −20 °C for 2.25 months and 6 months, and −80 °C for 6 months. Samples were analysed using propidium monoazide (PMA; a cell viability dye) coupled with full-length 16S rRNA gene. An aliquot of each sample was additionally analysed without PMA to assess the impact of cold storage on the total DNA profile of human milk. Cold storage significantly altered the composition of both the viable microbiome and total bacterial DNA profile, with differences in the relative abundance of several OTUs observed across each storage condition. However, cold storage did not affect the richness nor diversity of the samples (PERMANOVA all p > 0.2). Storage of human milk under typical and recommended conditions results in alterations to the profile of viable bacteria, with potential implications for infant gut colonisation and infant health. [ABSTRACT FROM AUTHOR]

Abstract The COVID-19 pandemic has had a significant impact on the operation of donor human milk banks in various countries such as China, Italy and India. It is understandable that this impact on operations of donor human milk might hamper the capability of these milk banks to provide sufficient pasteurized donor milk to neonates who need it. Contrary to developed world, predominant donors in developing nations are mothers of hospitalised neonates who have a relatively long period of hospital stay. This longer maternal hospital stay enhances the feasibility of milk donation by providing mothers with access to breast pumps to express their milk. Any excess milk a mother expresses which is above the needs of their own infant can be voluntarily donated. This physical proximity of milk banks to donors may help continuation of human milk donation in developing nations during the pandemic. Nevertheless, protocols need to be implemented to i) ensure the microbiological quality of the milk collected and ii) consider steps to mitigate potential consequences related to the possibility of the donor being an asymptomatic carrier of COVID-19. We present the procedural modifications implemented at the Comprehensive Lactation Management Centre at Lady Hardinge Medical College in India to promote breastfeeding and human milk donation during the pandemic which comply with International and National guidelines. This commentary provides a perspective from a milk bank in India which might differ from the perspective of the international donor human milk banking societies.

Background: Breastfeeding in infancy has immunological and nutritional benefits. The actual status of breastfeeding in childcare facilities is unclear. However, it is expected to vary in every facility and region. This study aimed to explore what the staff of childcare facilities perceive of breastfeeding and how they feel about handling breast milk. Methods: The study was conducted from May 2012 to September 2015. A list of childcare facilities in three cities in Japan was compiled. A questionnaire was sent to the facilities by mail asking whether or not they provided breastfeeding care and whether or not they would participate in the study. Semi‐structured interviews were conducted with the staff members of childcare facilities that consented to the study. The transcribed text was analyzed by thematic analysis. Results: Of the 211 facilities sent, 55 responded, and 21 of these facilities were implementing breastfeeding. Interviews were conducted at four facilities for those who agreed to be interviewed. The researchers extracted three categories of breastfeeding factors at childcare facilities: the value that caregivers see in breastfeeding, difficulties associated with breastfeeding in childcare facilities, and devices and elements for breastfeeding by childcare facilities. Although facility staff acknowledged the nutritional and psychosocial benefits of breast milk, they also felt the administrative difficulties and mental burden of handling expressed breast milk. Conclusion: This study revealed that for the childcare facility staff, breastfeeding was positioned as a means of communication and reassurance to the mother, and the immunological and nutritional benefits of breast milk. The perception of handling breastfeeding milk by childcare facility staff was explored by the qualitative study. Childcare facility staff felt the administrative difficulties and mental burden of handling expressed breast milk. However, breastfeeding was positioned as a means of communication and reassurance to the mother, and the immunological and nutritional benefits of breast milk. [ABSTRACT FROM AUTHOR]

Abstract Bottle‐fed infants are at higher risk for rapid weight gain compared with breastfed infants. Few studies have attempted to disentangle effects of feeding mode, milk composition and relevant covariates on feeding interactions and outcomes. The objective of the present study was to compare effects of breastfeeding directly at the breast versus bottle‐feeding expressed breast milk on feeding interactions. Mothers with

Bottle‐fed infants are at higher risk for rapid weight gain compared with breastfed infants. Few studies have attempted to disentangle effects of feeding mode, milk composition and relevant covariates on feeding interactions and outcomes. The objective of the present study was to compare effects of breastfeeding directly at the breast versus bottle‐feeding expressed breast milk on feeding interactions. Mothers with <6‐month‐old infants (n = 47) participated in two counterbalanced, feeding observations. Mothers breastfed their infants directly from the breast during one visit (breast condition) and bottle‐fed their infants expressed breast milk during the other (bottle condition). Masked raters later coded videos using the Nursing Child Assessment Parent–Child Interaction Feeding Scale. Infant intake was assessed. Mothers self‐reported sociodemographic characteristics, infant feeding patterns (i.e. percentage of daily feedings from bottles) and level of pressuring feeding style. Mother and infant behaviours were similar during breast and bottle conditions. Percent bottle‐feeding moderated effects of condition on intake (P = 0.032): greater percent bottle‐feeding predicted greater intake during the bottle compared with breast condition. Effects of feeding mode were not moderated by parity or pressuring feeding style, but, regardless of condition, multiparous mothers fed their infants more than primiparous mothers (P = 0.028), and pressuring feeding style was positively associated with infant intake (P = 0.045). Findings from the present study do not support the hypothesis that feeding mode directly impacts dyadic interaction for predominantly breastfeeding mothers and infants, but rather suggest between‐subject differences in feeding experiences and styles predict feeding outcomes for this population. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of expression mode: electric breast pump or hand expression, and timing of sample collection: pre‐ and post‐milk ejection on human milk (HM) bacterial DNA profiles. Methods and results: Three HM samples from the same breast were collected from 30 breastfeeding mothers: a pre‐milk ejection pump‐expressed sample (pre‐pump), a post‐milk ejection pump‐expressed sample (post‐pump) and a post‐milk ejection hand‐expressed sample (post‐hand). Full‐length 16S rRNA gene sequencing was used to assess milk bacterial DNA profiles. Bacterial profiles did not differ significantly based on mode of expression nor timing of sample collection. No significant differences were detected in the relative abundance of any OTUs based on expression condition (pre‐pump/ post‐pump and post‐pump/post‐hand) with univariate linear mixed‐effects regression analyses (all P‐values > 0·01; α = 0·01). Similarly, no difference in richness was observed between sample types (number of observed OTUs: post‐pump/post‐hand P = 0·13; pre‐pump/post‐pump P = 0. 45). Conclusion: Bacterial DNA profiles of HM did not differ according to either expression method or timing of sample collection. Significance and Impact of the Study: Hand or pump expression can be utilized to collect samples for microbiome studies. This has implications for the design of future HM microbiome studies. [ABSTRACT FROM AUTHOR]

Background: Mothers with diabetes are less likely to achieve successful breastfeeding. Antenatal breastmilk expression (ABE) may facilitate earlier breastfeeding, but feasibility of introducing ABE and its acceptance among Scandinavian women have previously not been investigated. Methods: This observational trial was conducted between the 1 January 2019 and the 12 March 2020 in Tromsø, Norway. We aimed to determine the feasibility of ABE in terms of practicality and acceptability among women with medically (metformin or insulin) treated diabetes. Women were invited to participate during antenatal visits from 32 weeks gestation. Participants received instruction and started ABE from gestation week 37 + 0. Participants, and their infants, were followed until 6–8 weeks after birth. We collected data on breastfeeding rates, infant hypoglycemia, transfer to the neonatal unit, and the women's overall experience and satisfaction with antenatal breastmilk expression. Results: Twenty-eight of 34 (82%) invited women consented to participate. All started ABE from week 37 + 0, and continued until hospital admission. No women reported any discomfort or side effects. Labor was induced at 38 weeks gestation. Twenty-four women brought harvested colostrum to the maternity ward, which was given to their infants during the first 24 h of life. Breastfeeding rates at discharge were 24/28 (86%) and 21/27 (78%) at 6–8 weeks after delivery. Seven (25%) infants were transferred to the neonatal unit; four because of hypoglycemia. Maternal satisfaction assessed 6–8 weeks after delivery revealed that all participants felt positive about the ABE, but one woman would not recommend it to other pregnant women. Conclusions: Implementing a structured ABE guideline for women with medically treated diabetes was feasible. The intervention was associated with high level of satisfaction among study participants. No obvious side effects were observed, and breastfeeding rates at discharge and 6–8 weeks after delivery were higher than in comparable studies. Trial registration: The study was registered at the research study registry at the University Hospital of North Norway (Nr 2018/7181). [ABSTRACT FROM AUTHOR]

Background: Mother-to-child transmission of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) has become a matter of great concern in post-partum wards and neonatal units. With little prior experience of this novel infection, there are contradictory findings in the literature regarding breastfeeding and rooming-in for newborns of mothers with COVID-19 disease. To assess the transmission risk of SARS-CoV- 2 in neonates who were fed expressed breast milk of COVID-19 positive mothers. Methods: This prospective study included 16 neonates born to COVID-19 positive mothers. The neonates were nursed in a neonatal unit separate from their mother. Expressed breast milk was fed by health care givers ensuring proper safety measures. Nasal and throat swabs of neonates were tested twice for SARS CoV-2, firstly, at 48 h of life and secondly, before discharge. Results: Pneumonia was present in 3 (20%) mothers, and C- reactive protein was raised in 9 (60 %) mothers. Birth weight was low in 8 (50%) neonates. Respiratory distress syndrome and meconium aspiration syndrome were present in two and one newborns, respectively. Nasal and throat swabs of all 16 newborns tested negative for SARS-CoV- 2 infection twice, at 48 h of life and before discharge. Conclusion: Expressed breast milk feeding can be considered safe in neonates born to COVID-19 positive mothers. Even sick mothers with COVID-19 can continue to express breast milk after ensuring proper safety measures. [ABSTRACT FROM AUTHOR]

Objective: To observe the effect of fortification of expressed human breast milk with olive oil and skimmed milk in improving weight gain in very low birth weight neonates and shortening their length of hospital stay. Study Design: A comparative prospective study. Place and Duration of Study: Combined Military Hospital Lahore, from Mar 2018 to Mar 2019. Methodology: Neonates admitted with very low birth weight and gestational age of <34 weeks were included in study. Sixty babies were enrolled using non-probability consecutive sampling; random number table used to allocate them into a fortify-cation group and a control group. The control group received expressed milk alone, while olive oil oneml twice daily and skimmed milk one gram in every third feed were added to expressed milk in the fortification group. Results: The study comprised of 60 neonates, with 30 in each of the groups. Weight gain was 24.83 ± 5.63 in the fortification group and 11.72 ± 3.95 in the control group (p≤0.001). Mean hospital stay was 20.57 ± 16.511 in the fortification group and 27.67 ± 8.89 in the control group (p≤0.043). Conclusion: Olive oil and skimmed milk fortification of breast milk was effective for weight gain and reducing length of hospital stay in very low birth weight neonates. [ABSTRACT FROM AUTHOR]

Introduction: Expressed breast milk is the practice of squeezing breast milk for the purpose of further use. Infant and young child feeding is very important in promoting healthy growth and development, particularly during the first two years of child's life. The awareness of mothers regarding expressed breast milk has a direct impact on the life of infants and feeding practices. The study aimed to find out possible determinants of awareness regarding expressed breast milk among mothers. Methods: Descriptive cross-sectional study was conducted among 255 mothers from January 2020 to May 2020 by using probability simple random sampling technique. A validated and pre-tested semi-structured interview schedule was used. The data was collected data and analysed. Results: Mean age of mothers was 26 years. 54.1% of the respondents had low awareness regarding expressed breast milk. After adjustment some of the variables such as age of respondents (AOR = 0.03, CI = 0.01 - 0.08, p < 0.001), religion (AOR = 0.36, CI = 0.14 - 0.99, p < 0.001) and educational status of respondents (AOR = 4.40, CI = 1.72 - 11.26, p < 0.001), were significantly associated with level of awareness regarding expressed breast milk. Conclusions: More than half of the mothers had low awareness regarding expressed breast milk. Age of the respondents, religion and educational status were found to be associated factors that influence mother's awareness regarding expressed breast milk. It is recommended to concerned authority to conduct awareness program regarding expressed breast milk among mothers. [ABSTRACT FROM AUTHOR]

Objective: There is a need to support healthcare providers, including physician-mothers at all training levels, related to breastfeeding and expressing breast milk. This study was designed to understand the attitudes and preferences of lactating employees regarding current lactation resources at an academic medical center. Methods: Cross-sectional survey. Respondents reported their satisfaction with current lactation resources on scale of 0 [complete dissatisfaction] to 100 [complete satisfaction]. Respondents were asked to identify greatest priorities for improvements to existing lactation spaces. Results: 304 (34.2%) respondents, of whom 69.3% anticipated using a lactation room in the next 5 years. Satisfaction with the current status of lactation rooms was low (mean score 37.8; SD 25.3). Accessible and proximal lactation spaces were highest priorities. More than 50% of respondents indicated daily use of a "nontraditional" lactation space. Conclusion: This study demonstrates the current state of healthcare providers' lactation-related experiences and highlights priorities for improvement, particularly provision of adequate lactation spaces. [ABSTRACT FROM AUTHOR]

Introduction: Retinopathy of prematurity (ROP) has been widely acknowledged to be the primary cause of preventable childhood blindness in developing countries. However, the procedure for screening is extremely painful. In this study, we attempted to relieve the pain experienced by these babies using breast milk alone or in combination with oral paracetamol. Materials and Methods: A total of 120 preterm neonates were randomized into three groups: (Group A - control group = 40, Group B - breast milk group = 40, and Group C - oral paracetamol + breast milk = 40). Group B received 2 ml expressed breast milk (EBM) through a sterile syringe orally 2 min prior to procedure, Group C received syrup paracetamol, 15 mg/kg 30 min prior to procedure and EBM as in Group B. Pain experienced was measured by the premature infant pain profile (PIPP) score 20 s prior, during and 2 min after procedure. All procedures were video recorded. The video recorder and analyzer were both blinded to the intervention. Results: PIPP scores before the procedure (PIPP 1) in Groups A, B, and C were 4.09 ± 2.44, 3.25 ± 1.71, and 3.45 ± 2.20. Postprocedure PIPP score (PIPP 2) increased to 15.74 ± 2.42 in Group A, 15.44 ± 2.05 in Group B, and 15.83 ± 1.36 in Group C. There was no significant statistical difference in pain scores in the intervention groups (Groups B and C) compared to the control group (Group A), P = 0.724. PIPP scores recorded postprocedure in Groups A, B, and C were, 7.72 ± 3.43, 6.87 ± 3.46, and 7.85 ± 3.37 indicating residual pain. Conclusion: The procedure of ROP screening causes significant pain, with persistence of residual pain in premature neonates. However, there was no statistical difference in the pain scores noted in the intervention Groups B and C in comparison to the control Group A. [ABSTRACT FROM AUTHOR]

Objectives: Infants with congenital heart disease and increased pulmonary blood flow frequently suffer from feeding difficulties and growth failure. Providing expressed breast milk by spoon has been hypothesised to decrease energy expenditure in these infants as compared to breastfeeding. This study assessed the effect of supplemental feeding of expressed breast milk on weight gain in infants with unoperated congenital heart disease., Method: This was a prospective open-label randomised control trial. In total, 50 infants with post tricuspid left to right shunt were enrolled in the study. In the intervention group, apart from breastfeeding, a minimum predetermined volume of expressed breast milk was targeted to be given by spoon. 30-50 kcal/kg/day was given by expressed breast milk by spoon-feeding. In the control group, the infants were given at least 8 feeds per 24 hours by direct breastfeeding. Both groups were followed up for 1 month and assessed for weight gain., Result: Despite a high rate of protocol breach in both groups (30% overall), infants in the intervention group had better weight gain at one-month follow-up compared to those in the control group, 780 ± 300 versus 530 ± 250 gm (p = 0.01)., Conclusion: In infants with left to right shunts, supplemental feeding of expressed breast milk by spoon along with breastfeeding resulted in significantly higher average weight gain at 30 days compared to the control group who received breastfeeding alone. Future studies with larger sample sizes and longer follow-ups need to be done to confirm the findings of this study.

Abstract Background Sick newborns in neonatal units who are unable to breastfeed are fed expressed breast milk. In Sri Lanka, most mothers stay in hospital throughout baby’s stay to provide this milk freshly. In other countries mothers go home, express breast milk at home and bring it to hospital. There are concerns about the safety of transported expressed milk if used in a tropical middle-income country. The aim of this paper is to compare and contrast advice offered by different hospitals and organizations on how to express, store and transport breast milk safely. Methods We assessed guidelines used by hospital staff of the four Level 3 neonatal units in Melbourne, Australia, National Health Service UK, guidelines and training manuals of the Human Milk Banking Association of North America, the World Health Organization and an information leaflet from Family Health Bureau, Sri Lanka. Information on breast milk expression, storage and transport provided by the guidelines were tabulated under seven topics: general information; container for milk collection; hand expression; using a pump for expression; storage; thawing / warming; and transport of expressed breast milk. The AGREE II tool was used to assess the guidelines written for hospital staff. Results There was considerable agreement on most recommendations provided by these sources, but no single source covered all topics in full. Most recommend hand expression as the initial method for expressing of breast milk, followed by breast pump use, except the Sri Lankan recommendations which strongly discourages the use of breast pumps. Durations of storage under various conditions are generally similar in the different recommendations. Most guidelines recommend a ‘cool box’ or container with ice or freezer packs for transportation of milk. Conclusion A single document containing recommendations on all aspects of expressing, storing and transporting breast milk should be available for each unit, with the same basic information for mothers and the healthcare staff and further technical details for staff if required. The Sri Lankan recommendations need to be updated based on current worldwide practices and further studies are needed to establish a safe method of transport of expressed breast milk in Sri Lanka.

Background: In Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive breastfeeding. As Ready Made Garment (RMG) factories have been the largest employer of low income women in Bangladesh, the objective of our study was to explore the barriers and facilitators of breastfeeding and perceptions about use of expressed breast milk among mothers who worked in the RMG sector. Methods: This formative research was conducted during July–September 2015 in two slums of Dhaka among RMG workers who were mothers and the caregivers of 0–12 month old infants. Qualitative data was obtained from purposively selected participants of 8 in-depth interviews and 4 focus group discussions (mothers and caregivers), and 2 key informant (RMG factory official) interviews. Mothers were from multiple RMG factories while factory officials were from a single factory. Thematic analysis was conducted. Results: The main themes of qualitative exploration were knowledge and experience of breastfeeding; structural barriers (home and workplace); consequences of inadequate breastfeeding; and perception and experience of using expressed breast milk. Despite knowledge both of the benefits of breast milk and of the importance of breastfeeding for 6 months, most mothers introduced formula as early as 2 months to prepare for their return to work. Barriers such as excessive workload, inadequate crèche facilities at work, and lack of adequate caregivers at home impeded exclusive breastfeeding. Mothers and caregivers had very little knowledge about the use of expressed breast milk and were concerned about contamination. Conclusion: As RMG factories are the largest employer of low-income women in Bangladesh, facilitating RMG factory working mothers' ability to use breast milk could help to promote infant health and help women remain in the workforce. [ABSTRACT FROM AUTHOR]

There is an increasing number of mothers expressing their breastmilk, which presents new issues for infant feeding. A primary concern is handling, storage, and warming of expressed breastmilk. A scoping review was undertaken to explore online guidelines for handling and storage of expressed human breastmilk which are readily accessible to Australian mothers. Six common terms and questions regarding expressed breastmilk handling and storage were run through Google, Bing, and Yahoo search engines, and government health websites, informal milk sharing sites, and other sites frequently referenced on social media breastfeeding support pages. The top ten most cited resources were comparatively analysed. Only two of the resources were Australian based. There was a great variance in the guidelines offered for both handling and storage of expressed breastmilk. The most conservative storage recommendations for fresh breastmilk were up to 4 h at room temperature and 72 h in the refrigerator. The least conservative recommendations allowed fresh breastmilk to be stored at room temperature for up to 10 h and in the refrigerator for up to 8 days, albeit strictly dependent on the temperature of the room and cleanliness of the expression. The majority of recommendations cited the same primary source. All resources stated that thawed milk should never be refrozen. There are minimal Australian-based guidelines, and even less primary research, in the expressed breastmilk handling and storage space. The resources readily available to women in the community setting vary in ease of comprehension and can cause confusion. [ABSTRACT FROM AUTHOR]

Food safety during pregnancy and postpartum is important for preventing foodborne diseases, while pregnant women are considered vulnerable due to their immunomodulatory condition. The current study aimed to investigate the self-reported food safety knowledge and practices of pregnant women and postpartum mothers in Slovenia using an online questionnaire and to compare the results with nonpregnant women as a control group. The study was conducted with 426 women, of whom 145 were pregnant, 191 were not pregnant, and 90 were postpartum. The online questionnaire consisted of questions related to food safety risk perception, hand hygiene, food purchase, food storage, food preparation and handling of infant formula and breast milk. The results showed that women generally have basic knowledge of proper food handling and are aware of food safety, but some specific gaps were identified in food handling at home, especially concerning microbiological risks. However, the results showed that pregnant women performed better than the postpartum group, and both groups performed significantly better than the nonpregnant group. The media was most frequently cited as a source of food safety information, especially by the pregnant group. Trained health workers should also inform women on how to ensure food safety in the home environment.

Expressed breast milk (EBM) has been advocated as an effective way for encouraging and maintaining lactation when the mother is separated from the baby for a while. Storing EBM at room temperature in several hours before consuming, frequently found in Indonesia. Based on WHO guidelines EBM can last for 6 to 8 hours in room temperature. But currently there hasn't been study in tropical country especially Indonesia for the guidelines. Assesing microbiological quality of EBM on room temperature, including bacterial growth and major bacterial found on EBM for health care and society recommendations. An observational study of 30 expressed breast milk samples provided by 30 healthy women with term baby below 6 month old. EBM were collected by electric breast pump swing model. The samples were kept sterile and laid at plates for 2 hours, 4 hours and 6 hours in room temperature (26o- 32oC) and used drop plate technique on several culture media. Data was analyzed by Chi-square and paired sample T-test. Thirty of unheated fresh EBM from 30 lactating mothers were stored at room temperature, examined for the degree of bacterial contamination at 0 hour, 2 hours, 4 hours, and 6 hours. All the EBM samples were contaminated at 2 hour. There were strong correlation between 2 hours storing with 4 hours storing (p=0.004) and total colony (p=0.000). There were also significant difference between bacterial colony and the duration itself (p=0.026). Bacterial species identified was Coagulase-negative Staphylococcus (CNS), Escherichia coli, Klebsiella pneumoniae and Streptococcus faecalis, range of growth 109 cfu/ml - 63 x 109 cfu/mm3 after 6 hour of storage. Evaluation result that the EBM exposed at room temperature (30-36 0C) for more than two hour reduce the quality and do not recommended to be given to the infants because bacterial counts > 104 cfu/ml and the present of pathogens E. coli, Streptococcus faecalis and Klebsiella pneumoniae. [ABSTRACT FROM AUTHOR]

Expressed breast milk (EBM) is commonly supplemented with commercially prepared human milk fortifier to meet the additional nutritional needs of preterm infants. The optimal milk intake at which to introduce fortification is unknown. The objective of this systematic review was to compare the effect of early fortification (EF) versus that of delayed introduction of human milk fortifier (DF) on short-term outcomes including growth, feeding intolerance, length of hospital stay, and maturity at discharge in very-low-birth-weight infants. The search was carried out until March 2019 using 5 electronic databases (PubMed, Ovid Medline, Web of Science, Ovid Embase, and the Cochrane Library). The search was supplemented with a search of the clinical trial registry and reference lists. Eligible studies involved randomized controlled trials that had been designed to compare EF against DF using multi-nutrient fortifier for infants of a birth weight of <1,500 g who were fed exclusively or predominantly EBM. Four authors independently screened the studies for eligibility. A total of 1,972 articles were screened; 2 studies met the inclusion criteria and were included with a total number of participants of 171. The definition of EF and DF was not consistent between the 2 studies. There was no significant impact of EF versus DF on all outcomes. In conclusion, current data are limited and do not provide evidence on the optimal time to start fortification. The definition of EF and DF needs to be agreed upon and further larger randomized controlled trials are required. [ABSTRACT FROM AUTHOR]

• The total fat content of expressed breast milk and its fatty acid composition is unlikely to be affected by any storage or handling processes. • The lipid classes of breast milk are affected by storage, pasteurization, and various thawing and warming methods perhaps due to the presence of lipases. • There are needs for developing modern technologies for more precise measurements of the changes to breast milk fat composition. This review evaluated the effect of various storage and handling conditions on the fat composition of expressed breast milk (EBM). Three databases PubMed, Embase and Scopus were searched in April 2019 with words from the three key components: human milk, handling process (i.e. storage and/or pasteurization), and fatty acid composition. The comparisons were EBM subjected to handling processes versus fresh EBM or versus EBM subjected to another handling processes. Both intervention and observational studies were included, and the outcomes measured included total fat and lipid classes of the EBM. We included 42 studies (43 reports), 41 of which were assessed to be of good quality. Relative changes to the fat composition of EBM subjected to handling processes were calculated based on the data provided in the included studies, and the results were synthesized narratively. The total fat content and total fatty acid composition of EBM was not generally influenced by storage and handling process, with most changes less than 10%, which is likely a result of methodological variation. A reduction in EBM triglyceride concentration and concomitant increase in free fatty acid concentration were seen after exposing to various conditions, probably due to endogenous lipase. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 3-month-old Japanese girl tested positive for severe acute respiratory coronavirus 2 (SARS-CoV-2) by real-time reverse transcriptase-polymerase chain reaction (RTPCR). Topics include the reverse transcriptase-polymerase chain reaction tests on nasopharyngeal, and the oropharyngeal swab specimens taken from the infant and her mother were tested repeatedly as close contact cases.

Storing EBM at room temperature in several hours before consuming, frequently found in Indonesia. Based on Academy of Breastfeeding Medicine guidelines EBM can last for 6 to 8 hours in room temperature (25°C or 77°F). However, currently there hasn't been study in tropical country especially Indonesia for the guidelines. This study aimed to assess microbiological qua lity of EBM on room temperature, including bacterial growth and major bacterial found on EBM for health care and society recommendations. An observational study of 30 expressed breast milk samples provided by 30 healthy women with term baby below 6 month old. The samples were kept sterile and laid at plates for 0 hours, 2 hours, 4 hours and 6 hours in room temperature (26°-32°C) and used drop plate technique on several culture media. Data was analyzed by Chi-square and paired sample T-test. Thirty of unheated fresh EBM from 30 lactating mothers were stored at room temperature, examined for the degree of bacterial contamination at 0 hour, 2 hours, 4 hours, and 6 hours. All the EBM samples were contaminated at 2 hour. Bacterial species identified was Coagulase-negative Staphylococcus (CNS), Escherichia coli, Klebsiella pneumoniae and Streptococcus faecalis, range of growth 109 cfu/ml-63 x 109 cfu/mm3 after 6 hour of storage. The EBM exposed at room temperature (30-36°C) for more than two hour reduce the quality and do not recommended to be given to the infants. [ABSTRACT FROM AUTHOR]

Expressed breast milk (EBM) is the gold standard of infant nutrition, but is not always available for use for preterm infants in the NICU setting. Donor breast milk (DBM) is often a preferred alternative for preterm and very low birth weight (VLBW) infants when maternal milk is not available. This article discusses the composition of DBM, reviews its advantages compared to formula, discusses challenges related to its long-term use, and identifies strategies to utilize DBM in the context of total nutritional management of preterm and VLBW infants. We will use a framework of WHO, WHAT, WHERE, WHEN, and WHY to answer the questions: who gets DBM, why use DBM, where does DBM come from, what is in DBM, and when may DBM use be challenged. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine bacteriological stability of a probiotic mixture dispersed in various diluents. The commercially available probiotic (Infloran®), containing Bifidobacterium bifidum (109 CFU/250 mg tablet) and Lactobacillus acidophilus (109 CFU/250 mg tablet), was dispersed within expressed breast milk, sterile water, and infant formula and examined at temperatures of 4 and 21 °C. When stored at 4 °C, significant decreases (P < 0.05) in the level of L. acidophilus and B. bifidum were observed in expressed breast milk and sterile water after a 6-h period. However, when stored in infant formula, both strains remained stable over a 12-h period. When stored at 21 °C, a significant decrease (P < 0.05) was observed in the level of L. acidophilus in sterile water, expressed breast milk and infant formula throughout a 12-h period. However, no significant decrease was observed overtime in B. bifidum in all three diluents at this temperature.Conclusion: Our findings suggest that, when stored at 4 °C, this probiotic product can remain at a stable condition for 6 h in sterile water and infant formula; however, the viability of the probiotic decreases significantly after this period of time. Administration of this probiotic in sterile water can be an acceptable alternative to dispersion and administration in expressed breast milk. What is Known: • Administration of probiotics containing lactobacilli and bifidobacteria has become more widespread in neonatology, mainly as prophylaxis for the prevention of necrotising entercolitis in preterm infants. • Probiotic reconstitution, from its powder base, is not standardized and various diluents, including sterile water, breast milk, and infant formula, have been used. What is New: • When stored at 4 °C, a probiotic containing lactobacilli and bifidobacteria remains at a stable microbological condition for up to 6 h in sterile water. • Administration of this probiotic dispersed in sterile water, followed by an EBM feed, can be an acceptable alternative to dispersion and administration in EBM. [ABSTRACT FROM AUTHOR]

Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW) infants. The following were the primary recommendations of the panel: (1) enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2) early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3) routine use of nasogastric tubes is not advisable; (4) preterm infants can be fed while on ventilator or continuous positive airway pressure; (5) routine evaluation of gastric residuals and abdominal girth should be avoided; (6) expressed breast milk (EBM) is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7) EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8) standard fortification is effective and safe but does not fulfill the high protein needs; (9) use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10) optimizing weight gain in preterm infants prevents long-term cardiovascular complications; (11) checking for optimal weight and sucking/swallowing ability is essential prior to discharge of preterm infants; and (12) appropriate counseling and regular follow-up and monitoring after discharge will help achieve better long-term health outcomes. This consensus summary serves as a useful guide to clinicians in addressing the challenges and providing optimal nutrition to preterm LBW infants.

Breastfeeding is the most important postnatal factor in metabolic and immunogenic programming of newborns’ health. When it is impossible to breastfeed the baby best efforts should be applied to maintain lactation in mother in order to feed the baby with expressed breast milk. Feeding with frozen expressed breast milk is as good as breastfeeding in its nutritional and biological values. Expressed breast milk (both native and thawed in 3–6 months) is testified to be safe nutrition in its microbiological features for a breastfed child. The article presents recent capabilities to maintain milk production in a nursing mother, sets forth conditions requiring a baby to be breastfed with expressed milk, either partial or exclisive, indicates medical alerts for breastfeeding. Data for safe and effective baby nursing with expressed breast milk is considered. The ways for creation individual breast milk “bank” and rules for storage of frozen milk are indicated. Authors present results of introduction of new technologies for breastfeeding maintenance. The use of up-to-date breast pumps created on the basis of the studies of lactation physiology and mechanisms by which a baby takes the milk from his mother’s breast, helps to improve efficiency of milk expression, simplifies this process a lot making it more comfortable and effective.Key words: newborns, breastfeeding, expressed breast milk, breast pumps, Individual breast milk «banking».

Objective: To explore longitudinal associations between bottle-feeding and maternal encouragement of infant bottle-emptying during the first 6 months of infancy.Design: Mothers completed questionnaires during the third trimester of pregnancy, then monthly during the first 6 months postpartum. Questionnaires assessed family demographics, maternal and infant weight status, infant feeding patterns and maternal encouragement of infant bottle-emptying.Setting: The Infant Feeding Practices Study 2, conducted by the US Centers for Disease Control and Prevention and the Food and Drug Administration.Subjects: Mothers (n 1776).Results: Repeated-measures regression was used to explore associations between bottle-feeding intensity (BFI; defined as the percentage of daily feedings that were from a bottle) and encouragement of bottle-emptying. Mothers who reported consistently high or consistently low BFI also exhibited consistently higher or lower frequency of encouraging their infants to empty the bottle (respectively) across the first 6 months of infancy, whereas mothers who reported increases in their BFI also exhibited concomitant increases in the frequency to which they encouraged their infants to finish the bottle. More frequent encouragement of bottle-emptying was also associated with feeding expressed breast milk (P<0·001), and lower parity (P=0·01), pre-pregnancy BMI (P=0·002) and infant birth weight (P=0·001).Conclusions: More frequent use of bottles for infant feeding was significantly associated with more frequent encouragement of bottle-emptying. Further research using causal designs is needed to better understand whether the use of bottles promotes this controlling feeding practice or whether mothers with more controlling feeding practices opt to bottle-feed. [ABSTRACT FROM AUTHOR]

Background: In spite of high rates of initiating breast milk feeding (BMF) among preterm infants, a significant rate of discontinuation occurs shortly after discharge. Aim: To investigate the effect of mode (direct feeding at the breast vs. expressing) and exclusivity (breast milk combined with formula vs. breast milk only) as well as maternal perceptions on the duration of BMF among preterm infants. Methods: The study included mothers whose infants were born before 32 weeks gestation, between January 2012 and August 2015 at Sheba Medical Center (SMC). Perinatal data were collected retrospectively from infants' computerized charts. Mothers were approached >12 months postpartum and were asked to complete a questionnaire. Those who agreed to participate were asked (during their visit to the follow-up clinic or by phone or mail) to complete a questionnaire regarding mode and duration of BMF as well as reasons for its discontinuation. Mothers were also asked about their pre-partum intentions to feed directly at the breast. Results: Out of 162 eligible mothers, 131 (80.8%) initiated BMF during their intensive care unit (ICU) hospitalization. Of these, 66 (50.3%) discontinued BMF earlier than six months postpartum. BMF ≥6 months was significantly associated with direct feeding at the breast, duration of exclusive BMF, and singleton birth. Regression analysis revealed that direct feeding at the breast (any or only) and duration of BMF exclusivity were the only significant variables associated with BMF duration (Odds ratio (OR) 5.5 and 95% confidence interval (CI) 2.00-15.37; OR 1.5 and 95% CI 1.25-1.88, respectively). Milk supply (inadequate or nonexistent) was the most commonly reported cause for BMF discontinuation <6 months. Direct feeding at the breast was significantly associated with BMF duration and was more common among singletons. Conclusions: Direct feeding at the breast and duration of exclusive BMF are associated with duration of BMF among infants born <32 weeks of gestational age (GA). These findings suggest that targeting these two factors may play a key role in prolonging BMF duration among preterm infants. [ABSTRACT FROM AUTHOR]

Objective: The objective of our study was to assess the pain associated with suctioning in preterm neonates on assisted ventilation and comparing the use of expressed breast milk (EBM), sucrose, and swaddling to alleviate pain. Methods: Study design: A randomized controlled clinical trial. Inclusion Criteria: Preterm neonates on assisted ventilation. Exclusion Criteria: Major congenital anomalies and severe encephalopathy. Study Duration and Site: 6 months in level III neonatal Intensive Care Unit. In the first phase, we used premature infant pain profile (PIPP) score to assess pain associated with suctioning in preterm neonates on assisted ventilation. In the second phase, the effect of EBM, swaddling, and sucrose on pain relief during suctioning in neonates on assisted ventilation was assessed. Results: There was a significant increase in pain associated with suctioning in preterm neonates on assisted ventilation (preprocedure PIPP score 7.90 ± 2.50; procedural PIPP score 13.63 ± 2.57; P < 0.05). The postintervention mean procedural PIPP score was not significantly different between the EBM, swaddling, and sucrose groups (P = 0.24). Conclusions: Suctioning is painful for preterm neonates on assisted ventilation. There was no difference between EBM, swaddling, and sucrose in relieving pain associated with suctioning. [ABSTRACT FROM AUTHOR]

To provide an updated synthesis of the current state of the evidence for the effectiveness of breast-feeding and expressed breast milk feeding in reducing procedural pain in preterm and full-term born infants. A systematic search of key electronic databases (PubMed, CINAHL, EMBASE) was completed. Of the 1032 abstracts screened, 21 were found eligible for inclusion. Fifteen studies reported on the use of breast-feeding or expressed breast milk in full-term infants and 6 reported on preterm infants. Direct breast-feeding was more effective than maternal holding, maternal skin-to-skin contact, topical anesthetics, and music therapy, and was as or more effective than sweet tasting solutions in full-term infants. Expressed breast milk was not consistently found to reduce pain response in full-term or preterm infants. Studies generally had moderate to high risk of bias. There is sufficient evidence to recommend direct breast-feeding for procedural pain management in full-term infants. Based on current evidence, expressed breast milk alone should not be considered an adequate intervention. [ABSTRACT FROM AUTHOR]