Breastfeeding success and its relation to maternal pain, behaviour, mental health, and social support.

OBJECTIVE: We aimed to understand the maternal experience of breastfeeding onset and how psychological, social and clinical variables as pain during breastfeeding, may interfere with it. METHODS: A cross-sectional study investigated 395 post-delivery women able to breastfeed from 48 hours to 6 days for unpleasant breastfeeding, maternal stress during pregnancy and postnatal mental state. Social Readjustment Rating Scale evaluated prenatal maternal stress. Perceived Maternal Parenting Self-Efficacy Scale, Pain Catastrophizing Scale - Parent version, and Edinburgh Postnatal Depression Scale evaluated maternal mental state. RESULTS: Unpleasant breastfeeding experience showed to be positively related to the longer number of days the pain lasts; late onset of breastfeeding; less search for information about pregnancy and baby care (p < .01); lower catastrophizing behaviour towards infant´s stress and C-section delivery (p < .04). Pain levels were positively correlated to longer periods of pain, later onset of antenatal consultations and depression (p < .05). Binary logistic regression pointed to the effects of lower self-efficacy and pain in breastfeeding, higher depression levels, gestational stress, labour adversities and success in breastfeeding. CONCLUSIONS: The relationship among maternal perceived self-efficacy, anxious and depressive thoughts, catastrophizing behaviours, and unpleasant breastfeeding need to be evaluated to elucidate the best health professional intervention.

Adaptation and validation of the EVENDOL scale to assess pain in neonates in Portuguese language.

BACKGROUND: EVENDOL scale (from the French Evaluation Enfant Douleur) is used to evaluate pain in children in any situation covering a wider age group than other pain scales (birth up to seven years). This study aimed to evaluate pain in hospitalized newborns, to adapt and validate the EVENDOL to Brazilian Portuguese. STUDY DESIGN: Cross-sectional, cross-cultural adaptation and validation study in a convenience sample from a tertiary hospital, Brazil. EVENDOL was translated and tested for reliability and validity using the PIPP and NFCS scales for comparison. For reliability testing, two observers independently evaluated 117 nociceptive procedures from 87 newborns. Internal consistency coefficient Cronbach's alpha, internal class agreement coefficient, and Kappa factor were appropriately measured. RESULTS: The scale's internal consistency reached a value of 0.82, and the estimates of internal consistency and reliability also reached acceptable or very good values. Two-way ANOVA determined statistically significant effect of gestational age on the total score of the EVENDOL (F = 4.14; p = 0.045), younger infants had the lowest values, as lower values of Apgar-5° minute lowered the indicator "Interaction with the Environment" (F = 5.066; p = 0.027). CONCLUSIONS: EVENDOL proved to be an easily applied tool and it was psychometrically robust, reliable and valid for use with both premature and term hospitalized newborns, who were clinically stable, being Apgar score and gestational age relevant factors. It is a reliable method of identifying pain in babies who need more support from the hospital staff and now is available for use in Portuguese language. TWEETABLE ABSTRACT: The EVENDOL pain scale is now validated for babies born at term and prematurely in Portuguese Language allowing its use in all Lusophone countries.

Frequency of HLA-DQ, susceptibility genotypes for celiac disease, in Brazilian newborns.

BACKGROUND: The frequency of HLA-DQ2 and DQ8 predisposing genotypes for celiac disease (CD) has shown significant variation among different world regions and has not been previously determined among the highly interbred Brazilian population. The aim of this study was to investigate the frequency of these genotypes among Brazilian newborns (NB). METHODS: We typed DQA1*05 - DQB1*02 (DQ2.5) and DQA1*03 - DQB1*03:02 (DQ8) alleles in 329 NB using qPCR technique. Subsequently we confirmed our results by PCR-SSP using a reference kit which further identified DQ2.2 (DQA1*02:01 - DQB1*02). RESULTS: Among the 329 NB, using qPCR technique: 5 (1.52%) carried both DQ2.5 and DQ8 variants; 58 (17.63%) carried only DQ2.5 (DQA1*05 and DQB1*02) and 47 (14.29%) carried only the DQ8 (DQA1*03 and DQB1*03:02) variant. The use of the PCR-SSP method yielded further information; among the 329 samples: 34 (10.34%) tested positive for DQ2.2 and among the 47 previously DQ8 positives samples, we found 10 (3.04%) that also tested positives for DQ2.2. CONCLUSION: 43.7% of the analyzed individual tested positive for at least one of the CD predisposing HLA-DQ genotypes in our group of Brazilian NB. The highest frequency was found for DQ2.5 positive subjects (17.6%) followed by DQ8 (11.3%); DQ2.2 (10.3%); DQ8 and DQ2.2 (3.0%); DQ2.5 and DQ8 (1.5%). We found no positive sample for DQ2.5 associated with DQ2.2.