Topical treatment with fresh human milk versus emollient on atopic eczema spots in young children: a small, randomized, split body, controlled, blinded pilot study.

BACKGROUND: Public health nurses report on effects of fresh human milk as treatment for conjunctivitis, rhinitis and atopic eczema (AE), the latter being highly prevalent in early childhood. Emollients and topical corticosteroids are first line treatment of AE. As many caregivers have steroid phobia, alternative treatment options for mild AE are of interest. The aim of this small pilot study was to assess the potential effects and risks of applying fresh human milk locally on eczema spots in children with AE. METHODS: This was a split body, controlled, randomized and physician blinded pilot study, of children with AE with two similar contralateral eczema spots having a mother breastfeeding the child or a sibling. Fresh expressed milk and emollient was applied on the intervention spot and emollient alone on the control area, three times a day for four weeks. The severity and area of the eczema spots was evaluated weekly, and samples from milk and the spots were analysed weekly with respect to bacterial colonisation. RESULTS: Of nine patients included, six completed the study. Mean age at inclusion was 18.5 months. The spots examined were localized on the arms, legs or cheeks. The spots were similar in severity, but differed in area. In one patient the eczema ceased after inclusion. In four patients both control and intervention areas increased during the intervention. The relative change in eczema area compared to baseline showed less increase in the intervention spots in two patients, whereas the opposite was observed in three. In four children Staphylococcus aureus was found in their eczema once or more. In three of the 28 human milk samples, Staphylococcus aureus, alfa haemolytic streptococci or coagulase negative staphylococci were detected. Staphylococcus aureus was found once both in human milk and in the eczema spots, no clinical signs of infection were however observed. No secondary infection due to milk application was detected. CONCLUSION: In this small pilot study, no effect was found on eczema spots treated with topical application of fresh human milk. (ClinicalTrials.gov Identifier, NCT02381028 ).

[Do women with Caesarean section have to choose between pain relief and breastfeeding?]. / Må keisersnittspasienter velge mellom smertebehandling og amming?

BACKGROUND: The Caesarean section is a unique surgical procedure in that physicians postoperatively not only have to cater to the mothers' need for analgesics, but must also take into account the impact of this medication on the infant. Too cautious prescription of strong analgesics postoperatively may have untoward consequences, such as immobilisation and delayed onset of breastfeeding. MATERIAL AND METHOD: A questionnaire on procedures for standard postoperative analgesics after Caesarean section was sent to the 46 Norwegian hospitals with anaesthesiology departments organized in conjunction with delivery units. 38 questionnaires were returned to us. RESULTS: Most of these hospitals routinely prescribe both Paracetamol (95%) and NSAID (90%) in postoperative care immediately after Caesarean section. However, only 61% routinely prescribed an opioid. INTERPRETATION: When the mother is most in need of opioid analgesics, lactation is barely established. Therefore, even if traces of opioids are absorbed into the mother's milk, the doses will be very small and the infant's oral bioavailability at this time is likely to be low. Consequently, there is little evidence to support a policy of overly restrictive use of opioids.

[Human milk, immune responses and health effects]. / Morsmelk, immunrespons og helseeffekter.

BACKGROUND: Besides providing optimal nutrition to infants, human milk contains a multitude of immunological components. These components are important for protection against infections and also support the development and maturation of the infant's own immune system. This review focuses on the function of some classical immunocomponents of human milk. Relevant studies are presented that describe health benefits of human milk for the child and of lactation for the mother. MATERIAL AND METHODS: Relevant articles were found mainly by searching PubMed. RESULTS AND INTERPRETATION: Humoral and cellular components of human milk confer protection against infections in the respiratory--, gastrointestinal--and urinary tract. Human milk also protects premature children from neonatal sepsis and necrotizing enterocolitis. There is evidence that human milk may confer long-term benefits such as lower risk of certain autoimmune diseases, inflammatory bowel disease and probably some malignancies. Human milk possibly affects components of the metabolic syndrome. Recent studies demonstrate long-term health benefits of lactation also for the mother. A reduced incidence of breast cancer is best documented. An increasing number of studies indicate protection against ovarian cancer, rheumatoid arthritis and type II diabetes.

Supplementation of n-3 fatty acids during pregnancy and lactation reduces maternal plasma lipid levels and provides DHA to the infants.

OBJECTIVE: Docosahexaenoic acid (DHA, 22:6 n-3) is considered an essential fatty acid for the fetus and newborn infant, but the optimal level of supply is not known. We studied the effect of supplementing pregnant and lactating women with marine n-3 polyunsaturated fatty acids (PUFAs) as compared to n-6 PUFAs related to maternal and infant lipid levels. STUDY DESIGN: Five hundred and ninety pregnant women in weeks 17-19 of pregnancy were recruited. They were given either 10 mL cod liver oil (n-3 PUFAs) or corn oil (n-6 PUFAs) daily until three months after delivery, and 341 women took part in the study until giving birth. RESULTS: Maternal supplementation with cod liver oil increased the concentration of DHA in maternal as well as infant plasma and umbilical tissue phospholipids, as compared to corn oil. The maternal plasma triacylglycerol increase during pregnancy was less pronounced in women supplemented with cod liver oil as compared to corn oil. The concentration of high-density lipoprotein (HDL)-cholesterol was unchanged during pregnancy in the cod liver oil group, whereas it decreased in the corn oil group, promoting a greater increase in the ratio of total cholesterol/HDL-cholesterol in the corn oil group. CONCLUSION: Maternal supplementation with n-3 fatty acids during pregnancy and lactation provides more DHA to the infant and reduces maternal plasma lipid levels compared to supplementation with n-6 fatty acids.

[Treatment of mastitis in general practice]. / Behandling av mastitt i allmennpraksis.

BACKGROUND: This article presents an update on causes and management of mastitis in general practice. MATERIAL AND METHODS: Published articles on the causes and management of mastitis were identified by Medline and Embase searches, and reviewed. In addition, clinical experience from The National Breast-Feeding Centre in Norway is included. RESULTS AND INTERPRETATION: Most studies report an incidence of mastitis of less than 20% though major methodological limitations make estimates difficult. Common symptoms of mastitis is a swollen, red, hot and painful breast, and systemic symptoms as fever occur frequently. Mastitis may be inflammatory or caused by microorganisms, and often secondary to milk stasis. Effective milk removal is a most essential part of the treatment and may make antibiotics superfluous. In most cases bacterial mastitis is caused by Staphylococcus aureus resistant to beta-lactamase sensitive antibiotics. Culture of the milk is necessary to determine the infecting organism and its antibiotic sensitivity. When antibiotics are warranted, dicloxacillin or cloxacillin are suggested as first-line drugs. The transfer of dicloxacillin/cloxacillin to breast milk is minimal. In most cases women with mastitis can continue to breast-feed also from the affected breast during treatment.

[Rooming-in in the maternity ward--are mothers satisfied?]. / Barna inne natt og dager barselkvinnene fornøyde?

BACKGROUND: 24-hour rooming-in in Norwegian maternity wards has been introduced as one of the "10 steps to successful breastfeeding", the basis for WHO/UNICEF Baby-Friendly Hospital Initiative. This step, optimal in order to get lactation off to a flying start, has lead to some worry about maternal fatigue. MATERIALS AND METHODS: Self-administrated questionnaires to health care personnel as well as to mothers in all Norwegian maternity wards were used to evaluate the impact of the Baby-Friendly Hospital Initiative. The same mothers were interviewed again 15 months later. RESULTS: Many (52%) felt tired after giving birth, but most (85%) were content with the care received. There was no difference in tiredness between mothers who chose to keep their babies with them and those who did not. Only 3.3% cited this at a main reason for tiredness. INTERPRETATION: Most mothers felt positive about keeping their infants with them at night. This demonstrates that Norwegian maternity wards generally have been able to implement 24 hour rooming-in in a caring way. Staff should offer to look after fussy babies without mothers demanding it and give the new mothers care and support in all possible ways.