Antenatal breastmilk expression in late pregnancy to improve lactation for women with gestational hyperglycemia: a review / 中华围产医学杂志

Women with gestational hyperglycemia tend to encounter breastfeeding difficulties, which may lead to breastfeeding failure or short duration of breastfeeding. Antenatal breastmilk expression, stimulating or massaging the breasts during pregnancy to produce milk and to collect and store colostrum, is beneficial to lactogenesis, thereby reducing formula feeding, promoting the transition to exclusive breastfeeding and increasing the exclusive breastfeeding rate. This review summarizes the safety and feasibility of antenatal breastmilk expression for women with gestational hyperglycemia, aiming to provide breastfeeding guidance for this population.

Maternal lactation initiation behavior / 中华围产医学杂志

The initiation of lactation is the critical initial event contributing to breastfeeding. It is of great significance for maternal lactation and neonatal access to breast milk. However, various factors limit the successful initiation of lactation and increase the risk of poor neonatal prognosis. We provide an overview of the mechanism, significance, method, time, and factors that influence lactation initiation behavior, and summarize related guidelines aiming to gain more insight into the lactation initiation behavior to promote maternal lactation and improve neonatal prognosis.

A Landscape Analysis of Human Milk Banks in India

Objective: To evaluate the existing status of human milk banks in India with reference toinfrastructure, human resources, funding mechanisms, operating procedures and qualityassurance. Methods: A pretested questionnaire was administered to 16 out of 22 human milkbanks across India, operational for more than one year prior to commencing the study.Results: 11 (69%) milk banks were in government or charitable hospitals; only 2 (12.5%)were established with government funding. 8 (50%) had a dedicated technician and only1(6%) had more than five lactation counsellors. Milk was collected predominantly frommothers of sick babies and in postnatal care wards followed by pediatric outpatientdepartments, camps, satellite centers, and homes. 10 (63%) reported gaps between donormilk demand and supply. 12 (75%) used shaker water bath pasteurizer and cooled the milkmanually without monitoring temperature, and 4 (25%) pooled milk under the laminar airflow.10 (63%) tracked donor to recipient and almost all did not collect data on early initiation,exclusive breastfeeding or human milk feeding. Conclusion: Our study reports the gaps ofmilk banking practices in India, which need to be addressed for strengthening them. Gapsinclude suboptimal financial support from the government, shortage of key human resources,processes and data gaps, and demand supply gap of donor human milk.

Quality of human milk expressed in a human milk bank and at home / Qualidade do leite humano ordenhado em banco de leite e no domicílio

Abstract Objective: To evaluate the quality of the human milk expressed at home and at a human milk bank. Methods: This a retrospective, analytical, and observational study, performed by assessing titratable acidity records and the microbiological culture of 100 human milk samples expressed at home and at a human milk bank, in 2014. For the statistical analysis, generalized estimating equations (GEE) and the chi-squared test were used. Results: When comparing the two sample groups, no significant difference was found, with 98% and 94% of the samples being approved among those collected at the milk bank and at home, respectively. No main interaction effect between local and titratable acidity records (p = 0.285) was observed, and there was no statistically significant difference between the expected and observed values for the association between the collection place and the microbiological culture results (p = 0.307). Conclusions: The quality of human milk expressed at home and at the milk bank are in agreement with the recommended standards, confirming that the expression of human milk at home is as safe as expression at the human milk bank, provided that the established hygiene, conservation, storage, and transport standards are followed.

Resumo Objetivo: Avaliar a qualidade do leite humano ordenhado em domicílio e no Banco de Leite Humano. Métodos: Estudo retrospectivo, feito por meio da avaliação dos registros da acidez titulável e dos resultados de cultura microbiológica de 100 amostras de leite humano ordenhado em domicílio e em um Banco de Leite Humano, no ano de 2014. Para análises estatísticas foram utilizadas as Equações de Estimação Generalizadas (Generalized Estimating Equations - GEE) e o teste Qui-quadrado. Resultados: Na comparação dos dois grupos de amostras, não foi detectada diferença significativa, sendo que 98% e 94% das amostras foram aprovadas entre as coletadas no Banco de Leite e em domicílio, respectivamente. Não foi observado efeito principal de interação entre local e grau de acidez titulável (p = 0,285) e não se constatou diferença estatisticamente significante entre os valores observados e esperados para associação entre local de coleta e o resultado da cultura microbiológica (p = 0,307). Conclusões: A qualidade do leite humano ordenhado em domicílio e no Banco de Leite Humano estão de acordo com o padrão preconizado, comprovando que a ordenha de leite humano em domicílio é tão segura quanto a ordenha no Banco de Leite Humano, desde que sejam seguidas as normas de higiene, conservação, armazenamento e transporte estabelecidas.

Utilização de leite materno em lactário por bebês internados em unidades de terapia intensiva / Utilización de la leche materna en lactario de bebés ingresados en unidades de cuidados intensivos / Use of breast milk from milk dispensary by babies in neonatal intensive care units

OBJETIVO: Avaliar a quantidade de leite materno coletado e com destino à Unidade de Terapia Intensiva (UTI) Neonatal, em um hospital amigo da criança, no Sul do Brasil. MÉTODOS: Estudo observacional, transversal e analítico, realizado no lactário do Hospital Geral de Caxias do Sul, no período de julho a dezembro de 2016. Foram coletados dados da quantidade de leite materno, considerando: entrada total para todos os setores, entrada e saída com destino à UTI Neonatal, desprezos por alta/óbito, degelo vencido e validade expirada. As variáveis categóricas estão apresentadas em números absolutos e percentuais e variáveis contínuas, como média ± desvio padrão. Realizou-se análise estatística através do programa Statistical Package for Social Sciences (SPSS), versão 20.0, considerando significância estatística p<0,05. RESULTADOS: O valor de entrada total no lactário foi de 177.053 mL, a entrada de leite materno para a UTI Neonatal apresentou-se em 153.898 mL, e teve como saída 87,21% desse volume. Os números de desprezo representaram 4,04, 1,14 e 0,55%, respectivamente, sendo por alta/óbito, degelo e validade. A média diária do semestre de esgota para a UTI Neonatal foi 836,40±382,67 mL, e a média diária de utilização de leite materno para a UTI Neonatal de 729,44±341,54 mL. CONCLUSÃO: O lactário apresentou alta porcentagem de esgota e utilização de leite materno e baixo desprezo, demonstrando bom controle de armazenamento e sua importância dentro do hospital amigo da criança. (AU)

OBJECTIVE: To assess the amount of breast milk collected and destined for the Neonatal Intensive Care Unit (ICU) at a baby-friendly hospital in the South of Brazil. METHODS: An analytical, observational cross-sectional study, carried out in the milk dispensary of Caxias do Sul General Hospital, in the period from July to December 2016. Data on the amount of breast milk was collected, considering: total intake for all hospital units, entry and exit of milk destined for the Neonatal ICU, and discarded amounts due to discharge/death, expired thaw and expired validity. Categorical variables are presented in absolute numbers and percentages and continuous variables as mean ± standard deviation. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 20.0, considering p<0.05 as statistical significance level. RESULTS: The total milk intake to the milk dispensary was 177,053 mL; the breast milk entry to the Neonatal ICU was 153,898 mL, and 87.21% of this volume was used. The disposal figures due to discharge/death, thaw and validity represented 4.04, 1.14 and 0.55%, respectively. The mean daily milk expression in the semester for the Neonatal ICU was 836.40 ± 382.67 mL, and the mean daily consumption of human milk for the Neonatal ICU was 729.44 ± 341.54 mL. CONCLUSION: The milk dispensary presented a high percentage of human milk expresstion and consumption and a low disposal, demonstrating a good storage control and its value within the baby-friendly hospital. (AU)

OBJETIVO: Evaluar la cantidad de leche materna extraída y destinada a la Unidad de Cuidados Intensivos (UCI) Neonatal de un hospital amigo del niño en el Sur de Brasil. MÉTODOS: Estudio observacional, transversal y analítico realizado en el lactario del Hospital General de Caxias del Sur en el período entre julio y diciembre de 2016. Se recogieron los datos de la cantidad de leche materna considerando la entrada total para todos los sectores, la entrada y salida para la UCI Neonatal, el desprecio por la alta/el óbito, el deshielo caducado y la validez espirada. Las variables categóricas se presentan con valores absolutos y porcentuales y las variables continuas con la media ± desviación típica. Se realizó un análisis estadístico a través del programa Statistical Package for Social Sciences (SPSS) versión 20.0 con la estadística significativa de p<0,05. RESULTADOS: El valor de la entrada total en el lactario ha sido de 177.053 ml, la entrada de la leche materna para la UCI Neonatal ha sido de 153.898 ml y la salida del 87,21% de ese volumen. Los números del desprecio representaron el 4,04, 1,14 y el 0,55%, respectivamente, por la alta/el óbito, el deshielo y la validez. La media diaria del semestre de la leche agotada para la UCI Neonatal ha sido de 836,40±382,67 ml y la media de la utilización de la leche materna para la UCI Neonatal a diario de 729,44±341,54 ml. CONCLUSIÓN: El lactario presentó alto porcentaje de la leche agotada y de la utilización de la leche materna y bajo desprecio lo que señala un buen control de almacenamiento y su importancia para el hospital amigo del niño. (AU)

Effects of various processes and lactation time on macronutrients in breast milk / 中华围产医学杂志

Objective To analyze Holder pasteurization,temperature and duration of frozen,duration of continuous breast milk pumping and types of pumping tube on macronutrients and total energy in breast milk and the circadian variation of macronutrients and energy content of breast milk.Methods Two hundred and two breast milk samples were collected from healthy mothers of 188 infants who were hospitalized in Department of Pediatrics,Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University from April 2016 to December 2016.Fat,protein,carbohydrate and energy contents of the breast milk samples were detected both before and after various processes to analyze the influence of Holder pasteurization,frozen storage conditions (temperature and time),duration of continuous pumping and types of pumping tube and to observe the variations within a single day.Paired t-test,repeated-measures analysis of variance,one-way analysis of variance and LSD-t test were used for statistical analysis.Results The contents of fat,protein and energy in breast milk were significantly decreased [(3.69 ± 0.98) vs (4.22 ± 1.00) g/dl,t=9.405;(2.12 ± 0.34) vs (2.21 ± 0.34) g/dl,t=4.785;(69.77±9.35) vs (74.94±9.53) kcal/dl (1 kcal=4.184 kJ),t=9.470],while the carbohydrate content was increased [(6.66±0.17) vs (6.62±0.17) g/dl,t=-3.442] after Holder pasteurization comparing with those before (all P＜0.01).Breast milk frozen at =80 ℃ had higher protein content than that frozen at-20 ℃ (Ftemperature=4.990,Ptemperature=0.027).Breast milk stored at-20 ℃ for 7,15,30,60 and 90 days showed significantly decreased fat,protein and energy contents as compared with those in fresh breast milk,while the carbohydrate contents in the breast milk samples stored at-20 ℃ for 15,30 and 60 days were significantly increased and that kept for 90 days were lower than those at 30 and 60 days (LSD-t test,P＜0.05).Compared with fresh breast milk,breast milk stored at-80 ℃ showed significantly decreased fat,protein and energy contents at 60 d and 90 d,but increased carbohydrate content at 60 d (LSD-t test,P＜0.05).Compared with fresh breast milk,breast milk which was pumped at 1,2 or 3 h through gastric tube (size 6,8 or 10) or transfusion connecting pipe had lower fat content (LSD-t test,P＜0.05).Compared with fresh milk,breast milk had lower energy content on condition that it was pumped through gastric tube size 6 at 2 or 3 h or through gastric tube size 8 or 10 or transfusion connecting pipe at 1,2 or 3 h (LSD-t test,P＜0.05).Breast milk secreted from 12:01 to 15:00 had higher fat and energy contents [(5.16±0.93) g/dl and (86.96±9.35) kcal/dl] than that secreted from 00:01 to 03:00[(4.54±0.75) g/dl and (80.77±7.75) kcal/dl],from 03:01 to 06:00 [(4.61 ±0.75) g/dl and (81.44±7.69) kcal/dl] or from 21:01 to 24:00 [(4.71 ± 0.88) g/dl and (82.44± 8.82) kcal/dl].Moreover,breast milk secreted from 09:01 to 12:00 had higher fat and energy contents [(5.01 ± 0.94) g/dl and (85.31 ± 9.62) kcal/dl] than that secreted from 00:01 to 03:00,and that secreted from 09:01 to 12:00 had higher fat contents than that secreted from 03:01 to 06:00 (LSD-t test,P＜0.05).Conclusions Fresh breast milk is better than processed milk to meet the infantile need for growth and development.

The effect of breastfeeding on spontan resolution of monosymptomatic enuresis

ABSTRACT Purpose The aim of this study was to examine whether the duration of breastfeeding during infancy was associated with the time of spontaneous resolution of monosymptomatic enuresis (SRME). Materials and Methods A total of 1500 people were surveyed at four centers. One hundred and eighty-one people with a history of monosymptomatic enuresis (ME) who received no treatment and had no day time symptoms were included in the study. The relationship between the duration of breastfeeding and SRME was assessed by considering the duration of breastfeeding as both continuous and categorical (cut-off value 5 months) variable. The multivariate general linear model was used to identify independent predictors such as gender, family history, and educational status of parents. Results Pearson correlation analysis of the age of SRME and duration of breastfeeding found no statistically significant relationship. However, there was a significant difference in the age of SRME of those who were breastfed for 5 months or less compared to those who were breastfed for more than 5 months. According to the multivariate analysis, gender and educational status of parents were not effective on the age of SRME. Stepwise linear regression model showed that breastfeeding for five months or less and family history could affect the age of SRME. The regression formula was: age of SRME=9.599 + (3.807×five months or less of breastfeeding) + (1.258×positive family history). Conclusions It was found that when breastfeeding lasted for more than 5 months, there was a positive contribution to SRME.