ABSTRACT
BACKGROUND: Factors associated with successful provision of mother's own milk (MOM) for premature infants in a Japanese neonatal intensive care unit (NICU) context are not well known. OBJECTIVE: We determined the independent risk factors for low milk volume at day 4 postpartum and formula feeding at the time of NICU discharge. METHODS: We reviewed the medical records of mothers who delivered at < 32 weeks' gestation. We determined maternal, premature infant, and milk expression variables predictive of (1) day 4 postpartum milk volume being less than the cohort median and (2) formula feeding at the time of NICU discharge, reported as adjusted odds ratios (95% confidence interval). RESULTS: Among 85 dyads, median (quartile range) milk volume on day 4 postpartum was 153 (34-255) mL. The rate of formula feeding at discharge was 42%. Mothers delivering by cesarean (vs vaginal) delivery had 4.3-fold (1.5-12.4) greater odds of day 4 milk volume < median (P < .01). Pregnancy-induced hypertension, delayed milk expression initiation, and low pumping frequency were strongly associated with cesarean delivery. Subsequently, mothers with day 4 milk volume < median (vs ≥ median) had 7.1-fold (2.6-19.5) greater odds of formula feeding at discharge (P < .01). CONCLUSION: Cesarean delivery is associated with lower milk volume on day 4 but may represent a composite of underlying risk factors for low milk volume in the early postpartum period. Further, low milk volume on day 4 is a strong correlate of lack of exclusive breast milk feeding at NICU discharge.
Subject(s)
Breast Feeding/statistics & numerical data , Infant, Very Low Birth Weight , Maternal Behavior , Milk, Human/metabolism , Obstetric Labor, Premature , Adult , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Japan , Lactation , Male , Mother-Child Relations , Pregnancy , Retrospective StudiesABSTRACT
BACKGROUND: From animal studies, it is known that mastitic inflammation of the mammary lobes can produce proinflammatory cytokines and can damage the milk fat globule (MFG). OBJECTIVE: To investigate, in women, whether MFG and interleukin (IL)-6 differences are observed between mastitic milk (MM) and healthy milk (HM) of a mother. METHODS: MM was obtained from the specific nipple pore leading to the mastitic lobe of 17 women; HM was obtained from the other breast. Milk sampling occurred at days 0 (pre-treatment), 1, and 2 (post-treatment). MFG size and IL-6 were measured by laser light scattering and enzyme-linked immunosorbent assay, respectively. We analyzed MFG and IL-6 differences between HM and MM, whether any differences occurred over time with treatment, and whether differences were observed between mothers with systemic symptoms (fever/malaise, Group A) or without systemic symptoms (Group B). RESULTS: On day 0, MM had higher MFG size (P < .01) and IL-6 levels (P < .001) than HM. This difference significantly decreased over time with treatment for both MFG size (P < .01) and IL-6 (P < .05). On day 0, Group A mothers had significantly larger MFG size (P < .01) and IL-6 (P < .001) than Group B. CONCLUSIONS: MM contains larger MFG and higher IL-6 levels than milk from the healthy breast. This difference is larger if accompanied by systemic symptoms of mastitis (fever/malaise). These changes decreased over time with treatment. Therefore, early initiation of appropriate treatment may be useful in limiting the processes that contribute to alterations in MFG size and IL-6.
Subject(s)
Glycolipids/chemistry , Glycoproteins/chemistry , Interleukin-6/metabolism , Mastitis/metabolism , Milk, Human , Adult , Anti-Inflammatory Agents/therapeutic use , Biomarkers/metabolism , Case-Control Studies , Combined Modality Therapy , Enzyme-Linked Immunosorbent Assay , Female , Humans , Lipid Droplets , Massage , Mastitis/physiopathology , Mastitis/therapy , Milk, Human/chemistry , Milk, Human/metabolism , Severity of Illness Index , Treatment OutcomeABSTRACT
Certain chemotherapeutic agents subject cells to oxidative stress, thereby promoting adverse effects. However, the molecular machinery governing 5-fluorouracil (5-FU)-mediated myelotoxicity is obscure. The purpose of this study was to clarify whether 5-FU-induced myelotoxicity is a cause of oxidative stress. Treatment of mice with 5-FU (75 mg/kg, i.p.) caused a significant induction of haem oxygenase-1 and a decrease in glutathione contents in bone marrow cells, both of which are the indicators of oxidative stress. The 5-FU-mediated decrease in the myeloid colony formation was intensified in Nrf2(-/-) mice, in which antioxidant proteins were down-regulated. N-Acetylcysteine reversed the 5-FU-induced decreases in the glutathione content, number of bone marrow cells per femur and myeloid colony formation. Results from the present study reveal that 5-FU induces oxidative stress in bone marrow, which is involved, at least in part, in myelotoxicity in mice. Therefore, Nrf2-dependent genes as well as glutathione levels in bone marrow could be therapeutic targets for decreasing such side-effects in 5-FU-based chemotherapy.
