Search Results (5)

Gestational diabetes mellitus (GDM) has been associated with suboptimal breastfeeding outcomes, including low milk supply, and the aetiology of this is not well understood. As postpartum frequency of milk removal is critical to the establishment of milk production, we compared the early feeding patterns of breastfeeding women with and without GDM. Women with GDM (n = 54) and without GDM (n = 54) provided detailed birth and feeding data within 48 hours of birth and at one and three weeks postpartum and measured their 24 h milk production. Sociodemographic characteristics were similar between groups (p > 0.05), and GDM was associated with an earlier birth gestation (38.5 ± 0.7 vs. 39.5 ± 0.2 weeks, p < 0.001). The median timing of breastfeeding initiation was < 1 h for both groups, yet breastfeeding frequency in the first 24 h was lower in the GDM group (5.9 ± 3.5 vs. 7.8 ± 4.4, p = 0.016). Both in-hospital commercial milk formula supplementation (57% vs. 26%, p < 0.001) and delayed secretory activation beyond day 4 postpartum (32% vs. 7%, p = 0.003) were more prevalent in the GDM group. Combined breastfeeding and breast expression frequencies were similar between groups in the first 24 h (p = 0.48) and at one week (p = 0.46) and three weeks postpartum (p = 0.05). Low milk production (<600 mL/24 h) was more prevalent in the GDM group, i.e., 19/50 (38%) compared to those without GDM, i.e., 8/50 (16%), (p = 0.006). Furthermore, four participants with GDM had weaned/withdrawn due to low milk supply, i.e., 23/54 (43%). The prevalence of low milk supply, despite frequent breastfeeding and breast expression across the first three weeks postpartum, suggests that endocrine factors may impair the autocrine control of milk production in some women with GDM. Full article

Breastfeeding self-efficacy (BSE), defined as a mother’s confidence in her ability to breastfeed, has been confirmed to predict the uptake of exclusive breastfeeding (EBF). Early experiences during the birth hospital stay, especially in-hospital formula feeding (IHFF), can impact both EBF and maternal breastfeeding confidence. Therefore, our objective was to examine the association between IHFF and EBF outcomes and investigate whether this association is influenced by BSE. The study included 778 infants from a larger cohort study conducted in 2021, with a one-year follow-up in rural areas of Sichuan Province, China. We used a causal mediation analysis to estimate the total effect (TE), natural direct (NDE), and nature indirect effects (NIE) using the paramed command in Stata. Causal mediation analyses revealed that IHFF was negatively associated with EBF (TE odds ratio = 0.47; 95% CI, 0.29 to 0.76); 28% of this association was mediated by BSE. In the subgroup analysis, there were no significant differences in the effects between parity subgroups, as well as between infant delivery subgroups. Our study found that IHFF hindered later EBF and that BSE mediated this association. Limiting the occurrence of in-hospital formula feeding or improving maternal breastfeeding self-efficacy is likely to improve exclusive breastfeeding outcomes. Full article

As preterm birth rates are globally increasing, together with research on preterms’ peculiar needs, neonatologists are still facing the challenge of how to properly feed them. The need to strike a balance between excessive catch-up growth and extrauterine growth retardation, both leading to adverse outcomes, is made even more difficult by the broad range of preterms’ needs. Although mother’s fresh milk is undoubtedly the best nourishment, its availability during hospital stay is often lower than recommended, and its fortification at discharge is still an open issue. Formula milks are available as an alternative to breast milk. However, choosing the right formula requires a thorough evaluation of the infant’s perinatal history and targets. Last but not least, adequate timing and initiation of weaning in premature babies are still a poorly explored matter. This narrative review aims at evaluating the multitude of issues to consider when feeding preterms in the three stages of their first life: in-hospital care, discharge, and, eventually, weaning. Given the current absence of internationally shared guidelines, understanding the potential pitfalls of preterms’ nutrition could help us trace the right path for the right preterm. Full article

Background: Mother’s own milk (MOM) improves in-hospital outcomes for preterm infants. If unavailable, donor milk (DM) is often substituted. It is unclear if DM vs. formula to supplement MOM is associated with improved in-hospital outcomes in term/late preterm surgical infants with gastroschisis or intestinal atresia. Methods: This retrospective study included infants born ≥33 weeks gestational age (GA) with a birth weight of >1500 g who were admitted to a quaternary neonatal intensive care unit (NICU). Using Chi square and Mann-Whitney u testing, we compared hospital outcomes (length of stay, parenteral nutrition and central line days) before and after a clinical practice change to offer DM instead of formula in this surgical population. Results: Baseline characteristics were similar between eras for the 140 infants (median GA 37 weeks). Fewer infants in DM era were receiving formula at discharge (50.0% vs. 31.4%, p = 0.03). In sub-analyses including only small bowel atresia and gastroschisis infants, the median length of stay (35 vs. 25, p < 0.01) and the central line days (28 vs. 20, p < 0.01) were lower in the DM era. Conclusion: In this retrospective study, offering DM instead of formula was associated with less formula feeding at discharge, and in infants with gastroschisis or small bowel atresia, shorter length of stay and central line days. Full article

A prospective cohort study was conducted in Shiraz in the south west of Iran to investigate breastfeeding from birth to six months of age. Mothers were recruited in a face-to-face interview within 48 h of giving birth in three public and two private hospitals (n = 700). They were then followed-up at 4, 12, 16, and 26 weeks postpartum in local Maternal and Child Health Clinics. Upon being discharge from hospital, 98.7% of mothers were breastfeeding and 74.3% were ‘fully’ breastfeeding, but only 29.9% of mothers had breastfed ‘exclusively’ since birth. The median duration of ‘full’ breastfeeding was 13 weeks and less than 1 week for exclusive breastfeeding. In a multivariable Cox proportional hazard regression, after adjustment, shorter durations of ‘exclusive’, ‘full’, and ‘any’ breastfeeding were associated with the introduction of a pacifier. The in-hospital use of formula and prelacteal feeds were also associated with a shorter duration of full and any breastfeeding. Breastfeeding on demand at 3 months and beyond was associated with a longer duration of breastfeeding. The risk factors associated with the premature discontinuation of breastfeeding identified in this study are all related to the “Ten steps to successful breastfeeding” and the Baby Friendly Hospital Initiative (BFHI). The principles that the BFHI provide are reaffirmed in this study as the basis for future breastfeeding promotion programs. Full article