Search Results (131)

Background: Neonatal jaundice is common and can cause severe hyperbilirubinemia if untreated. The early identification of at-risk newborns is challenging despite the existing guidelines. Objective: This study aimed to identify the key maternal and neonatal risk factors for jaundice requiring phototherapy using machine learning. Methods: In this study hospital, phototherapy was administered following the American Academy of Pediatrics (AAP) guidelines when a neonate’s transcutaneous bilirubin level was in the high-risk zone. To identify the risk factors for phototherapy, we retrospectively analyzed the electronic medical records of 8242 neonates admitted between 2017 and 2022. Predictive models were trained using maternal and neonatal data. XGBoost showed the best performance (AUROC = 0.911). SHAP values interpreted the model. Results: Mode of delivery, neonatal feeding indicators (including daily formula intake and breastfeeding frequency), maternal BMI, and maternal white blood cell count were strong predictors. Cesarean delivery and lower birth weight were linked to treatment need. Conclusions: Machine learning models using perinatal data accurately predict the risk of neonatal jaundice requiring phototherapy, potentially aiding early clinical decisions and improving outcomes. Full article

Background and Objective: Large language model (LLM)–based chatbots are increasingly utilized by postpartum individuals seeking guidance on breastfeeding. However, the chatbots’ content quality, readability, and alignment with clinical guidelines remain uncertain. This study was conducted to evaluate and compare the quality, readability, and factual accuracy of responses generated by three publicly accessible AI chatbots—ChatGPT-4o Pro, Gemini 2.5 Pro, and Copilot Pro—when prompted with common maternal questions related to breast-milk supply. Methods: Twenty frequently asked breastfeeding-related questions were submitted to each chatbot in separate sessions. The responses were paraphrased to enable standardized scoring and were then evaluated using three validated tools: ensuring quality information for patients (EQIP), the simple measure of gobbledygook (SMOG), and the global quality scale (GQS). Factual accuracy was benchmarked against WHO, ACOG, CDC, and NICE guidelines using a three-point rubric. Additional user experience metrics included response time, character count, content density, and structural formatting. Statistical comparisons were performed using the Kruskal–Wallis and Wilcoxon rank-sum tests with Bonferroni correction. Results: ChatGPT-4o Pro achieved the highest overall performance across all primary outcomes: EQIP score (85.7 ± 2.4%), SMOG score (9.78 ± 0.22), and GQS rating (4.55 ± 0.50), followed by Gemini 2.5 Pro and Copilot Pro (p < 0.001 for all comparisons). ChatGPT-4o Pro also demonstrated the highest factual alignment with clinical guidelines (95%), while Copilot showed more frequent omissions or simplifications. Differences in response time and formatting quality were statistically significant, although not always clinically meaningful. Conclusions: ChatGPT-4o Pro outperforms other chatbots in delivering structured, readable, and guideline-concordant breastfeeding information. However, substantial variability persists across the platforms, and none should be considered a substitute for professional guidance. Importantly, the phenomenon of AI hallucinations—where chatbots may generate factually incorrect or fabricated information—remains a critical risk that must be addressed to ensure safe integration into maternal health communication. Future efforts should focus on improving the transparency, accuracy, and multilingual reliability of AI chatbots to ensure their safe integration into maternal health communications. Full article

Breast milk is the optimal nutrition for infants, yet lactation insufficiency remains a common cause of early breastfeeding cessation. Moringa oleifera has been traditionally used as a galactagogue due to its rich micronutrient and phytosterol content. This systematic review assessed the effects of Moringa leaf supplementation on prolactin levels and breast milk volume in postpartum mothers with lactation insufficiency. A systematic search following PRISMA guidelines, was conducted for randomized controlled trials involving healthy postpartum women supplemented with Moringa oleifera. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. Eight studies met the inclusion criteria, with intervention durations ranged from 3 to 10 days. Moringa supplementation increased significantly breast milk volume by up to 400 mL/day compared to controls. Serum prolactin levels also rose significantly with a mean increase of 231.72 ng/mL Most studies exhibited low to moderate risk of bias, though one study exhibited high risk due to lack of binding and subjective outcome measurement. Moringa oleifera leaf supplementation appears to enhance lactation by increasing milk volume and prolactin levels in postpartum mothers. However, further longer-term studies are needed to establish optimal dosing, sustained effectiveness, and safety. Full article

Neonatal jaundice (NNJ) is a leading cause of death in the early neonatal period, disproportionately affecting newborns in sub-Saharan Africa. In a setting without access to rapid assessment via transcutaneous bilirubin meter, we sought to determine how closely the diagnosis and treatment of neonatal jaundice at an urban district hospital aligned with retrospective assessment and treatment recommendations using the BiliApp (based on the UK NICE Guideline CG98). This retrospective chart review study aimed to identify: (1) What percent of admissions within 8 days of birth to the Mother and Baby Unit (MBU) at our study site were admitted for a primary diagnosis of neonatal jaundice, and what characterized those admissions? (2) How did treatment provided compare to the recommendations of the United Kingdom NICE Guideline CG98 via the “BiliApp”? and (3) Among those with jaundice, what factors were associated with an increased likelihood of severity indicative of the need for blood exchange therapy? The charts of all neonates admitted to the MBU at Suntreso Government Hospital (SGH), in Kumasi, Ghana, in 2020 were reviewed by trained research assistants. Data were collected regarding demographics, reason for admission, diagnostic markers (e.g., serum bilirubin level), treatments performed in the hospital, and outcome. Data were analyzed using Stata 18.0. There were 1059 newborns admitted to the MBU in 2020 at less than 8 days of age. A total of 179 (16.9%) were admitted with a primary diagnosis of neonatal jaundice. According to the BiliApp, 29.4% (n = 50) of newborns admitted for jaundice had bilirubin levels that were normal or below the phototherapy threshold for their gestational age on admission; 25.3% (n = 43) were at or near the threshold for phototherapy; 21.2% (n = 36) were above the phototherapy threshold; and 24.1% (n = 41) were above the blood exchange therapy threshold. The BiliApp recommended no treatment for 21.2% (n = 36) of newborns, repeated assessment for 33.6% (n = 57), phototherapy for 21.2% (n = 36), and exchange therapy for 24.1% (n = 41). By comparison, 8.2% (n = 14) of neonates admitted for jaundice received no treatment, 77.8% (n = 133) received phototherapy only, and 14.0% (n = 24) received both phototherapy and exchange therapy. Without sufficient data on G6PD status and parent/newborn blood type to include in the analysis, the biggest risk factors for a BiliApp recommendation of exchange therapy included serum bilirubin level (OR 1.01, p < 0.001) and gestational age (OR 0.51, p < 0.001), even after controlling for breastfeeding and male sex of the newborn. Without access to rapid assessment tools, many providers in low-resource settings are put in a position to presumptively treat newborns suspected of having jaundice, rather than waiting for serum lab tests to return. Given the cost of transcutaneous bilirubin meters, additional options for rapid diagnostic testing are warranted. Full article

Background: The maternal microbiota serve as a key regulator of neonatal immune development and early-life health outcomes. This systematic review aims to find out how the makeup of the maternal microbiota affects newborn immunity and the risk of allergies, identify which microbes are linked to a higher or lower chance of allergies, and assess treatments that could improve newborn immune health. Methods: We conducted a systematic search in PubMed, MEDLINE, and Web of Science, adhering to the PRISMA guidelines. We included randomized controlled trials (RCTs), cohort studies, and observational studies that looked at how the makeup of the maternal microbiota affects newborn immune responses or allergic outcomes in early life. We conducted a systematic search, and the quality of the studies was evaluated using the GRADE system and tools to check for bias (RoB 2, Newcastle–Ottawa Scale, MINORS). Results: We included a total of 74 studies. The main findings showed that having a cesarean delivery and using certain antibiotics during pregnancy increased the risk of allergies, while breastfeeding, taking probiotics, and changing the mother’s diet helped to protect against allergies. Maternal stress had a negative association with the microbiota composition (OR = 1.9–2.4) and neonatal immune regulation. Moreover, the study noted significant geographic variation in the microbiota’s influence, underscoring the importance of contextualized interventions. Conclusions: The composition of the maternal microbiota has a major impact on neonatal immunity and the risk of early-life allergy. Adverse factors include cesarean birth, antibiotic exposure, and maternal stress, all of which have been associated with alterations in neonatal immunity. More studies are required to validate promising microbiota-targeted strategies and develop evidence-based guidelines to improve maternal and neonatal immune health. Full article

Background: Effective prevention of SIDS/SUID requires a multidimensional approach. It is essential to provide targeted support for marginalized families, improve access to healthcare services, and implement policies aimed at reducing social and economic inequalities. The parallel effective way to reduce the risk of sudden unexpected infant death is through increased awareness of proper infant care. Despite the guidelines available in many countries, the risk of infant death from non-medical causes is still reported. The aim of the study was to assess awareness regarding an infant’s sleep environment and safe sleep practices among Polish caregivers. Methods: The survey was conducted among 451 mothers of infants under 18 months of age. The survey questionnaire was prepared, which consisted of single- and multiple-choice questions with closed and open answers assessing safe sleep practices. Results: Analysis of the survey responses showed that most mothers in the sample (88.9%) were aware that the supine position is the safest. According to the survey, 74.5% of respondents believed that infants should not sleep in the same bed as parents or siblings. In addition, 78.3% of those women stated that infants should sleep separately in their own bed. Despite this knowledge, almost 37.76% of female respondents still put their infants to sleep in their parents’ bed. As many as 98.4% of respondents knew that any items should not be placed in an infant’s crib. Despite this knowledge, a third of respondents still placed additional items in their baby’s crib. In the study 90.7% of women believed that breastfeeding should begin within the first hour after birth. Conclusions: Knowledge of safe sleep recommendations, including sleep environment, sleep position, and spatial organization, does not always translate into proper caregiving practices. Understanding caregivers’ motivations and how they perceive medical information is critical to effective prevention of infant sleep safety. Full article

Newborn screening (NBS) is leading to the diagnosis of a large number of children with late-onset Pompe disease (LOPD), yet many remain asymptomatic until later years. A high-protein, low-carbohydrate diet is recommended for adults with LOPD. Nutrition guidelines are not available for young children. Methods: 37 children with LOPD aged 1–6 years participated. Early diet history, feeding practices, and 24 h dietary intake were collected via questionnaire. Anthropometric measurements, blood creatine kinase (CK), blood urea nitrogen (BUN)/creatinine ratio, and urine glucose tetrasaccharide (Glc4) were collected at clinic visits. A subset of 19 children received a clinical feeding assessment (CFA). Results: All patients derived their nutrition orally. Breastfeeding was successfully initiated in 73% of infants. Body weight ranged between 3 and 99% and height ranged from 4 to 97%. A tendency to be overweight and obese was noted in older children with LOPD. A total of 24% of the children who had CFA were diagnosed with dysphagia that was typically mild in severity and rarely affected their ability to eat a normal diet. Limiting added sugar and processed foods was the most widely used dietary practice followed by encouraging protein. Protein intake was three–four times higher than the recommended dietary intake (RDA). A high BUN/creatinine ratio was observed in some children, which may indicate incompatibility with protein intake and need for individualizing the diet. Conclusions: The results of this study provide a framework for developing future nutrition guidelines for children with LOPD by performing an individualized assessment of dietary intake, growth, feeding/swallowing, and laboratory parameters. Full article

Hypertension disorders of pregnancy affect almost 10% of pregnancies. Most hypertensive disorders associated with pregnancy, including chronic hypertension and gestational hypertension, often persist into the postpartum period. Thus, many breastfeeding mothers require ongoing antihypertensive treatment with antihypertensive medications while nursing. This highlights the importance of understanding the efficacy, safety, and potential adverse effects of antihypertensive therapy in breastfeeding mothers. Unfortunately, research in this area is limited, and references in clinical guidelines remain sparse. Our review aims to provide a comprehensive summary of the current knowledge on antihypertensive medications during breastfeeding, drawing from available research and evidence-based guidelines. This article discusses all groups of antihypertensive drugs, presenting societies’ recommendations and available clinical data. Based on the available literature, calcium channel blockers (extended-release nifedipine as the first choice) and beta-blockers (labetalol, metoprolol) appear to be the drugs of choice. Our review highlights the need for further research to evaluate the long-term safety of antihypertensive medications during breastfeeding, improve clinical guidelines, and ensure optimal treatment for nursing mothers. Full article

Background/Objectives: Breastfeeding multiple birth infants (MBIs) poses unique challenges that require tailored support; however, research on these mothers’ experiences is limited. This study explored the breastfeeding journeys of Australian mothers of MBIs, highlighting barriers, facilitators, and support needs. Methods: Data were collected via an online survey (May–August 2024) and included quantitative data on breastfeeding initiation, duration, and challenges, as well as qualitative insights into mothers’ experiences. Thematic analysis was used to identify key themes, and statistical analyses were used to compare breastfeeding outcomes by parity. Results: While most mothers (87%) had an antenatal intention to breastfeed, they faced barriers such as latching difficulties (56%), inadequate milk supply (49%), and sore nipples (47%). Preterm births (58%) and neonatal unit admissions delayed the breastfeeding initiation. Most mothers (99%) used electric breast pumps to boost milk supply (68%) and enable expressed breast milk feeding by other caregivers (65% of mothers). While 72% were satisfied with hospital breastfeeding support and some mothers received excellent hands-on support, others felt neglected due to busy staff or conflicting advice. Mothers frequently reported that breastfeeding guidance was geared toward singletons, leaving them unprepared for the challenges of feeding multiples. Mothers’ suggestions for improving care included specialised guidance, better access to lactation support, and in-home practical support to alleviate the burden of feeding and expressing. Additionally, mothers reported that healthcare professionals should be trained to offer practical, non-judgemental support to help mothers navigate the elaborate challenges of breastfeeding MBIs. Conclusions: This study underscores the need for early postpartum support and tailored guidelines to enhance MBI breastfeeding outcomes and maternal-infant well-being. Full article

Background/Objectives: Breastfeeding is a cornerstone of infant nutrition, promoting optimal development and health benefits for both mother and child. Despite high initiation rates in Poland (97%), exclusive breastfeeding (EBF) drops sharply, reaching only 4% by six months postpartum. The aim of this study is to identify factors associated with breastfeeding practices and barriers to exclusive breastfeeding (EBF) among Polish women during the postpartum period, with particular emphasis on the role of medical personnel support and maternal stress levels. Methods: A cross-sectional observational study, adhering to STROBE guidelines, was conducted from January to May 2023. The study included 1092 Polish women, surveyed using the Computer-Assisted Web Interview (CAWI) methodology. The women exclusively breastfeeding accounted for 79% (n = 863) of the study group. The remaining women supplemented their child with modified milk (n = 229; 21%). Statistical analyses were performed using IBM SPSS Statistics (Version 26.0), and logistic regression to assess associations between variables and breastfeeding outcomes. Results: Logistic regression analysis indicated that in the women experiencing low or medium stress, none of the analysed support factors significantly influenced the likelihood of exclusive breastfeeding discontinuation. However, women experiencing high stress, receiving counselling for effective breastfeeding (OR = 0.467; 95% CI: 0.232–0.941; p = 0.033) and assistance with proper breastfeeding (OR = 0.424; 95% CI: 0.220–0.819; p = 0.011) were associated with a lower likelihood of introducing formula feeding. The main reported reasons for early breastfeeding cessation included breast health issues, mental exhaustion, lack of medical support and infant-related difficulties. Conclusions: The findings allow us to underscore the urgent need for targeted interventions to improve breastfeeding rates in Poland. New evidence indicates that women experiencing higher levels of stress require increased support from medical personnel in order to breastfeed exclusively. Full article

Breastfeeding after kidney transplantation remains a complex and underexplored topic, primarily due to concerns regarding the safety of immunosuppressive therapies during lactation. Individuals who have received kidney transplants face a higher likelihood of delivering preterm infants and giving birth to babies with a low birth weight when compared with the general population. In this context, breastfeeding is increasingly important because of its advantages for preterm infants. Despite the well-established benefits of breastfeeding for both the mother and infant, the traditional recommendation has been to avoid nursing due to potential drug transmission through breast milk. However, emerging evidence suggests that certain immunosuppressants may be compatible with breastfeeding, challenging long-standing clinical guidelines. In this review, we examine the current literature on the pharmacokinetics, safety profiles, and clinical outcomes associated with key immunosuppressive agents, including cyclosporine, tacrolimus, everolimus, azathioprine, corticosteroids, and belatacept. Our work highlights that all published reports to date on the studied treatments indicate that the amount of the drug reaching breast milk is considered safe for the child’s health. These conclusions, however, are derived from very short-term measurements and small numbers of patients. Therefore, we emphasize the need to design structured prospective studies to assess safety in the medium and long term. Our review aims to equip clinicians with the most up-to-date evidence on this topic, enabling them to make informed decisions regarding the compatibility of post-kidney transplant treatments with breastfeeding. Full article

Background: The complementary food introduction and consumption guidelines for atopic dermatitis and food allergy prevention have evolved; however, their impact on infant feeding practices remains unclear. This study aimed to analyze complementary food diversity trends in infants, identify vulnerable infants with limited food diversity, and examine the trends in infants with or without vulnerable factors over time. Methods: This study analyzed infants aged 9–12 months who participated in the food diversity survey, conducted as part of the National Health Screening Program in Korea from 2009 to 2020. The complementary food items included grains, vegetables, fruits, eggs, fish, and meats. Infants consuming “six” and “less than six” complementary food items were categorized into high- and low-food-diversity groups, respectively. The study employed logistic regression models to examine the trends in food diversity and vulnerable factors with an assessment of the interaction effects. Results: This study included 3,425,301 participants (51.5% male) aged 11.3 months (standard deviation, 0.8). The high-food-diversity prevalence significantly increased over time, from 30.8% in 2009 to 52.9% in 2020 (p < 0.001). Vulnerable infants included those with preterm birth, low birth weight, non-breastfeeding status, high socioeconomic status, non-Seoul residence at birth, any perinatal conditions, hospitalization due to wheezing, atopic dermatitis and food allergies. The high-diversity proportion increased significantly over the study period across all vulnerable factors (p for interaction < 0.001). However, no significant interactions were observed between the study years and vulnerable factors, except for food allergy (β Coefficient, −0.0117, p for interaction = 0.004). Conclusions: The increasing trends in high-complementary-food-diversity proportions highlight the substantial progress over the study period. However, persistent disparities in vulnerable populations underline the importance of targeted interventions, including tailored nutritional education and policies, that promote equitable dietary practices during early life. Full article

Background/Objectives: Poor nutrition in early life represents a relevant public health issue globally. The current study aimed to characterize eating habits among preschoolers and investigate the relationship with parents’ nutritional status. Methods: A secondary analysis of a cross-sectional study carried out at the Child Dentistry Clinics of the Istituto Stomatologico Italiano, Milan, Italy, including 171 patients aged 12–71 months and their parents, was conducted. Demographic data, anthropometric measurements, and information on children’s eating habits were collected. Results: The duration of exclusive breastfeeding was 5.9 (±6.8) months in 65% of children, and complementary feeding began at a mean (±SD) of 6.2 (±1.7) months in accordance with present recommendations. In contrast, the consumption of fruit juice 3.2 (±2.9) times/week, a protein intake of 3.0 (±0.6) g/kg, and a sugar intake of 20 (±8)% were over guideline limits. Overweight/obese children were introduced to cow’s milk earlier (p = 0.033) and consumed a higher percentage of total fats (p = 0.026) whilst consuming a lower percentage of carbohydrates (p = 0.050). In terms of children with both parents being obese or overweight, they consumed more carbohydrates (p = 0.048). Finally, we found that birth weight correlated positively with maternal BMI (ρ = 0.159; p < 0.05). The number of offspring correlated positively with the weekly frequency of sugar-sweetened beverage consumption before 24 months (ρ = 0.282; p < 0.001) whilst correlating negatively with the age of cow’s milk introduction (ρ = −0.226; p < 0.01). Conclusions: Our findings, according to recommendations, suggest that the prevention of obesity needs to begin in infancy. As parents play a pivotal role in establishing children’s food choices, nutritional education aimed at families is needed. Full article

Background/Objectives: Optimal nutrition is essential for the health of breastfeeding women and their infants. This study aimed to assess food and nutrient intake and alignment with nutrition guidelines for breastfeeding women living in New Zealand. Methods: Seventy-six breastfeeding women were enrolled in the longitudinal Mother and Infant Nutrition Investigation study and completed a weighed four-day diet diary including supplement use at three months postpartum. The number of servings consumed for each food group were calculated based on the 2020 Eating and Activity Guidelines for New Zealand Adults. Nutrient intakes were compared to the nutrient reference values for Australia and New Zealand. Results: Overall, the percentages of women who met the recommended number of servings for fruits, vegetables, grain foods, meats and milk/milk products were 25%, 0%, 5%, 34%, and 13%, respectively. None of women met the current recommendations for all food groups. Many participants had intakes below the estimated average requirement or adequate intake and were at risk of nutrient inadequacy for vitamin E (55%), vitamin D (53%), manganese (61%), and selenium (55%). Conclusions: Breastfeeding women had a low alignment with the current dietary guidelines and were at risk of an inadequate intake of vitamin E, D, manganese, and selenium. Research to investigate the barriers and enablers of healthy food choices is needed. Full article

Promoting child well-being and development requires a multidimensional approach, including the right to adequate food practices. Socially vulnerable children are more exposed to adverse experiences, such as inadequate food consumption due to poverty. In this context, home-visiting programs are an important strategy for nutritional and health care education to provide relevant guidelines. This study describes breastfeeding and food consumption of children aged 0 to 24 months assisted by the Happy Child Program (Programa Criança Feliz—PCF) and aimed to investigate their association with socioeconomic factors and adherence to the program. This is an observational study, with a cross-sectional design, carried out with children assisted by the PCF in the Federal District, Brazil. Multivariate analysis was performed to identify sociodemographic and income factors, and household visits characteristics associated with breastfeeding, dietary diversity, and the consumption of ultra-processed food. A total of 301 children were assessed, 51.16% of whom were female. In 58.99% of households, the reference person was the mother; 86.20% were unemployed, and 27.08% had a low education degree. About 62.65% of beneficiaries lived on up to USD 200.00 per month and the majority faced food insecurity. The child’s age, and the mother’s current work situation were independently associated with the current breastfeeding situation, especially higher among women who did not work (p = 0.015). The minimum dietary diversity among children over 6 months old was 62.21% and presented a positive association with adherence to the program (p = 0.005). On the other hand, the consumption of ultra-processed foods was 77.21% and was associated with a longer follow-up time within the program (p = 0.047). The associations observed revealed the need to integrate family food choices and nutritional education into public policies for early childhood. Full article