Nipple shield use in the maternity ward increases risk of exclusive breastfeeding interruption in the first six months of infant's life.

OBJECTIVE: The objective of this study was to investigate the association between use of silicone nipple shields in the maternity ward and exclusive breastfeeding interruption in the first 6 months of the infant's life. DESIGN: Cohort study. SETTING: Interviews were conducted personally at the mother's home at 1 and 6 months postpartum and by telephone at 2 and 4 months. PARTICIPANTS: 287 mother-infant dyads. METHODS: Lactating mothers were randomly selected at two maternity wards (one public, one private) in Porto Alegre, Brazil. Data were analyzed using Kaplan-Meier survival curves and Cox multivariate regression. The outcome of interest was exclusive breastfeeding interruption before 6 months of the infant's life. FINDINGS: Nipple shields were used by 6.2 % of the women in the public maternity ward and by 25.8 % of those in the private setting. Median duration of exclusive breastfeeding was 11 days (95 %CI 0.0-36.9) among women who used the accessory vs. 89 days (95 %CI 60.8-117.2) among those who did not. Nipple shield use in the maternity ward was associated with exclusive breastfeeding interruption before 6 months of infant's life (adjusted risk ratio = 1.47; 95 %CI 1.01-2.15). The risk was higher in the first months of breastfeeding, ranging from 2.0 to 1.47 in the first and sixth months, respectively. CONCLUSIONS: The use of silicone nipple shields in the maternity ward increased the risk of exclusive breastfeeding interruption before 6 months of the infant's life, especially in the first months. These findings suggest caution in recommending this accessory to new mothers.

The Ethics of Ancient Lactation and the Cult of the Perfect Breastfeeding Mother.

Breastfeeding is a key issue found in ancient sources that resonates with public debates today, affecting women in different parts of the world and of all social classes. The aim of this research was to identify breastfeeding narratives in ancient medical and philosophical texts from the 1st to the 6th century CE that address ethical issues in the medical management and social perception of new mothers. We examined 15 literary sources and one funerary inscription on lactation and critically evaluated the ancient idea of the perfect breastfeeding mother versus the non-breastfeeding mother. We then discussed our historical data in terms of objectivity and significance in relation to contemporary attitudes towards motherhood and lactation, e.g., (1) the cult of the perfect, breastfeeding mother in contemporary lactation education and (2) the onset of conditions which may affect normal breastfeeding, such as dysphoric milk ejection reflex (D-MER), breastfeeding aversion response (BAR) or post-partum depression. The analysis of the results showed that in both ancient and contemporary postnatal health care: (1) good mothering is associated with breastfeeding and (2) alternative feeding methods are acknowledged, but never as the best, natural option. Finally, our analysis shows that public health policies on breastfeeding and mothers' own knowledge of their bodies are contested between nursing theories, social expectations and economic factors.

Status and influencing factors of delayed onset of lactogenesis Ⅱ in mothers of preterm infants / 中华围产医学杂志

Objective:To investigate the incidence of delayed onset of lactogenesis Ⅱ (DOL Ⅱ) in mothers of preterm infants and its influencing factors.Methods:This retrospective cohort study involved women who delivered prematurely at the Department of Obstetrics of the First Affiliated Hospital of Zhengzhou University from September 2021 to March 2022. Demographic and perinatal data of the subjects were collected. According to lactation outcome on the third day after delivery, these women were divided into DOL Ⅱ and non-DOL Ⅱ groups. The two groups' differences in general conditions were compared, and the potential factors influencing DOL Ⅱ were also analyzed. Chi-square test, two independent samples t-test, Mann-Whitney U test, and logistic regression analysis were used for statistical analysis. Results:There were 286 mothers of premature infants enrolled in this study, and 73 (25.5%) of them experienced DOL Ⅱ. The other 213 cases without DOL Ⅱwere included as the non-DOL Ⅱ group. Univariate analysis showed significant differences between the DOL Ⅱ and non-DOL Ⅱ groups in the following aspects: the proportion of women with adverse pregnancy history [28.8% (21/73) vs 41.8% (89/213), χ2=3.89], the proportion of primiparas [60.3% (44/73) vs 38.0% (81/213), χ2=10.93], the incidence of hypertensive disorders of pregnancy [35.6% (26/73) vs 16.4% (35/213), χ2=11.92], the time to initiate breastfeeding after birth[5.0 h (3.0-7.0 h) vs 4.0 h (2.0-5.0 h), Z=－4.27], and the frequency of breastfeeding or pumping within 48 h after delivery [7.0 times (6.0-9.0 times) vs 9.0 times (7.0-11.0 times), Z=－3.62] (all P<0.05). Multivariate logistic regression showed that primipara ( OR=2.720, 95% CI: 1.485-4.982), hypertensive disorders of pregnancy ( OR=3.178, 95% CI: 1.609-6.274), the time to initiate breastfeeding ( OR=1.394, 95% CI: 1.211-1.604) and the frequency of breastfeeding/pumping within 48 h after delivery ( OR=0.861, 95% CI: 0.772-0.962) were independent influencing factors for DOL Ⅱ (all P<0.05). Conclusions:?The factors that influence the occurrence of DOL Ⅱ in preterm mothers are primipara hypertensive disorders of pregnancy, breastfeeding initiation time after delivery, and the frequency of breastfeeding or pumping within 48 h postpartum.

The Galactagogue Effect of Maternal Ingestion of Corn-Based Preparations: A Preliminary Study.

Background: Low human milk production frequently occurs in mothers of premature children with low birth weights who require intensive care. Research Aims: To investigate whether corn-based preparations increase human milk production in women with insufficient milk volumes. Method: This was an intervention study evaluated whether there was an increase in human milk production after a mother's consumption of corn-based preparations. The participants included women with hypogalactia and mothers of infants in neonatal and pediatric intensive care units. The corn-based preparations included green corn cakes and sweet hominies. A total of 35 mother-infant pairs participated in this study. Each mother served as their own control. The study took place over 2 weeks, and data were collected at baseline and after the intervention. At baseline, a socioeconomic questionnaire was used to collect information regarding maternal food consumption, volume of milk expressed, and infant weight and length. All evaluations, except for questionnaire administration, were performed during the intervention phase, when the lactating women ingested the corn-based preparations. Results: A significantly higher average volume of milk was expressed in the intervention period (397.6 ± 182.6 mL/day) compared to baseline (343.6 ± 155.8 mL/day) on the paired t-test (p < 0.001) analysis. Neither energy nor macronutrients consumed correlated with milk volume. Conclusion: The tested corn-based preparations acted as galactagogues and could be used to stimulate milk production in lactating women.

Adaptation of a clinical reasoning model for use in inflammatory conditions of the lactating breast: a retrospective mixed-methods study.

Background: Many potential factors associated with Inflammatory Conditions of the Lactating Breast (ICLB) have been reported in the literature, by lactating mothers and clinicians. Clinicians, including general practitioners, lactation consultants and physiotherapists, require a clinical reasoning model that summarises associated or linked factors, to aid in the assessment, treatment, and prevention of ICLB. Thus, we aimed to adapt the existing Breastfeeding Pain Reasoning Model (BPRM), for use in the management of ICLB, using prior research and clinical audit data to guide adaptation. The existing BPRM categorises contributing factors for breastfeeding nipple pain, rather than ICLB. Methods: Factors linked with ICLB were identified from prior research and considered for inclusion into the existing model. Clinical data from a retrospective audit of ICLB patient notes at a private physiotherapy practice were also examined. Any factors identified from prior research that could not be identified in the clinical notes were not considered for inclusion into the existing model. Additional factors from the clinical notes that appeared repeatedly were considered for inclusion into the adaptation of the BPRM. A draft adapted model was created comprising all eligible factors, considering their counts and percentages as calculated from the clinical data. The research team iteratively examined all factors for appropriate categorisation and modification within the adapted model. Results: Prior research and data from 160 clinical notes were used to identify factors for inclusion in the adapted model. A total of 57 factors, 13 pre-existing in the BPRM and 44 extra identified from the prior research or clinical audit, comprised the draft adapted model. Factor consolidation and terminology modification resulted in a total of 34 factors in the final proposed adapted ICLB model. The three main categories, CNS modulation, External influences and Local stimulation, from the existing model were maintained, with one minor terminology change to the former Local stimulation category, resulting in 'Local influences' category. Terminology for five subcategories were modified to better reflect the types of factors for ICLB. The most common factors in the adapted model, calculated from the clinical audit population of mothers with ICLB, were employment (85%), high socioeconomic status (81%), antibiotic use during breastfeeding (61%), history of an ICLB (56%), any breast pump use (45%), multiparity (43%), birth interventions (35%), decreased milk transfer (33%), breastfeeding behaviour and practices (33%), nipple pain (30%) and fit and hold (attachment and positioning) difficulty (28%). Conclusion: An ICLB-specific linked factors model is proposed in this paper. Clinicians treating mothers with ICLB can use this model to identify influencing and determining factors of ICLB clinical presentations and provide targeted education and effective treatment plans.

Construction and validation of risk prediction model for delayed onset of lactogenesis stage Ⅱ following cesarean section / 中华围产医学杂志

Objective:To explore the risk factors of delayed onset of lactogenesis stage Ⅱ(DOL Ⅱ) after cesarean section, and to establish a risk prediction model.Methods:This study involved 330 women who underwent cesarean section in the First Affiliated Hospital of Zhengzhou University from September 2021 to January 2022 and were further divided into DOL Ⅱ group ( n=104) or non-DOL Ⅱ group ( n=226). All clinical data were compared. Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors of DOL Ⅱ after cesarean section to establish the risk prediction model and draw nomogram. The predictive validity of the model was evaluated by the area under the receiver operating curve (AUC) and the goodness of fit was verified by Hosmer-Lemeshow test. Another 129 women who underwent cesarean section in our hospital from February to March 2022 were recruited for external validation. Results:The incidence of DOL Ⅱ in the model development and validation cohort were 31.5%(104/330) and 31.0%(40/129), respectively . In the model developing cohort, significant differences were shown in the constituent ratio of different groups of pre-pregnant body mass index {lean:[9.7%(22/226) vs 3.8%(4/104)]; fit: [66.8%(151/226) vs 62.5%(65/104)]; overweight or obsess:[23.5%(53/226) vs 33.7%(35/104)]}, the proportion of primiparas [50.4%(114/226) vs 61.5%(64/104)], breastfeeding education during pregnancy [64.2%(145/226) vs 40.4%(42/104)] and maternal separation [36.3%(82/226) vs 50.0%(52/104)], and the gestational age at delivery[38.0(36.0-39.0) vs 37.0(35.0-38.5) weeks] and frequency of breastfeeding within 48 h post-delivery [6.0(3.0-9.0) vs 2.0(0.5-5.0)] between the DOL Ⅱ and non-DOI Ⅱ group (all P<0.05). The predictors included in the model were pre-pregnancy overweight or obese ( OR=4.040, 95% CI:1.196-13.651), primipara ( OR=1.866, 95% CI:1.079-3.227), breastfeeding education during pregnancy ( OR=0.582, 95% CI:0.339-1.000), and frequency of breastfeeding within 48 h after delivery ( OR=0.791, 95% CI:0.720-0.857). The Hosmer-Lemeshow test showed that P=0.814 and the AUC was 0.784(95% CI:0.731-0.837). The Youden index was 1.504 with a sensitivity of 0.769 and a specificity of 0.735. While for the external validation, Hosmer-Lemeshow test showed that P=0.260 and the AUC was 0.751(95% CI:0.661-0.840). The Youden index was 1.460 with a sensitivity of 0.775 and a specificity of 0.685. Conclusion:The risk prediction model for DOL Ⅱ developed in this study has a good consistency and predictive performance, which can provide a reference for clinical screening of mothers at high risk of DOL Ⅱ following cesarean section.

Effects of pre-pregnancy body mass index, gestational weight gain and early feeding behavior on lactogenesis stage Ⅱ: a prospective study / 中华围产医学杂志

Objective:To investigate the influence of pre-pregnancy body mass index (BMI), gestational weight gain and early feeding behavior on delayed onset of lactogenesis stage Ⅱ(DOL Ⅱ).Methods:This was a prospective study involving puerperae from Women's Hospital of Nanjing Medical University from March 2020 to June 2020. Demographic data and delivery data were obtained using questionnaires and breastfeeding behavior and milk secretion were followed up every day after delivery. According to whether the lactation initiation was longer than 72 h or not, all subjects were divided into DOL Ⅱ group or non-DOL Ⅱ group. Differences in general condition and breastfeeding between the two groups were compared using independent sample t-test, Chi-square test, and Mann-Whitney U test. Multivariate logistic regression analysis was used to analyze the risk factors of DOL Ⅱ. Results:During the study period, a total of 390 cases were enrolled and 334 cases among them were analyzed due to lost of follow-up in 56 cases. The incidence of DOL Ⅱ was 19.2% (64/334). Univariate analysis showed that body mass index [lean:18.8% (12/64) vs 13.3% (36/270); fit:56.2% (36/64) vs 74.8% (202/270); overweight: 25.0% (16/64) vs 11.9% (32/270); χ2=9.78], mode of delivery [vaginal delivery: 37.5% (24/64) vs 52.6% (142/270); cesarean section: 62.5% (40/64) vs 47.4% (128/270); χ2=4.71], nipple type score in LATCH score [2.0 (1.0-2.0) vs 2.0 (2.0-2.0), U=－2.08], frequency of breastfeeding in 24 h [(6.3±3.0) vs (8.3±3.6) times per day, t=－3.94], adding formula within 24 h [71.9% (46/64) vs 56.3% (152/270), χ2=5.20] and the proportion of attending breastfeeding clinic during pregnancy [73.4% (47/64) vs 85.6% (231/270), χ2=5.44] were significantly different between the DOL Ⅱ and non-DOL Ⅱ groups (all P<0.05). Multivariate logistic regression analysis showed that pre-pregnancy overweight was an independent risk factor for DOL Ⅱ ( OR=2.240, 95% CI:1.020-4.918, P=0.044), either was pre-pregnancy overweight with appropriate gestational weight gain ( OR=5.595, 95% CI:1.492-20.985, P=0.011), while breastfeeding frequency within 24 h ( OR=0.867, 95% CI: 0.780-0.963, P=0.008) and attending breastfeeding clinic during pregnancy ( OR=0.377, 95% CI: 0.173-0.820, P=0.014) were independent protective factors for DOL Ⅱ. Conclusions:Women who were overweight before pregnancy are more likely to suffer from DOL Ⅱ. Extra guidance should be given to this population during early breastfeeding. Attending prenatal breastfeeding consultation and increasing the frequency of breastfeeding in the early postpartum period may prevent DOL.

Evaluation of breast pathologies in puerperal women assisted at a philanthropic hospital in Presidente Prudente (SP), Brazil: longitudinal cohort

Breast milk is the main source of nourishment for the healthy growth and development of newborns up do six months, and after that, it serves as a supplement up to two years. The act of breastfeeding, in addition to being an important means of forming an affective bond between the mother and infant, also promotes maternal, social and environmental benefits. Although its importance has been proven, it is known that there are several reasons that lead to the early interruption of breastfeeding, including breast complications. Our aim was to determine the incidence of complications related to breastfeeding in puerperal women seen at Hospital Regional, a philanthropic hospital in Presidente Prudente (SP) and the possible factors that led to their appearance as well. Methods: A quantitative-qualitative longitudinal study was carried out with puerperal women cared for at Hospital Regional of Presidente Prudente. A structured interview was administered in three stages: the first during the puerperal women's hospitalization and the others, through telephone contact at respectively 30 and 90 days after delivery, to monitor breastfeeding. Results: Of the total number of patients interviewed, 24.3% had some breast complications resulting from breastfeeding. Still in the immediate postpartum period at 30 days, this proportion reached 42.23%, decreasing at 90 days to 17.47%. Furthermore, of the puerperal women that showed any complication, 74% of them were single, 54% had brown skin color, 42.9% had completed high school and 52% were primiparous. Moreover, the patients who had a Cesarean section (53,8%) showed more complications than the ones who had natural childbirth (35,1%).

Giant lactating adenoma.

Lactating adenoma is a rare benign breast lesion that most often presents as a small (up to 3 cm), solid, well-circumscribed, solitary, painless, mobile, lobulated mass. The highest incidence occurs in primiparous women (20 to 40 years old) during the third trimester of pregnancy. However, in the rare case presented herein, in addition to its giant size (more than 10 centimeters on palpation), this lactating adenoma is distinctive due to the presence of multiple nodules, poorly defined ultrasonographic margins, worrisome radiologic features, growth since early pregnancy, presence of infarction and association with chronic mastitis. From the clinical-radiologic perspective, the differential diagnoses included abscess associated with puerperal mastitis, phyllodes tumor, and galactocele. Biopsy was performed, and pathologic examination revealed the classic characteristics of lactating adenoma with multiple infarcted areas, leading to an unexpected confirmed case of giant lactating adenoma.

Giant lactating adenoma

Lactating adenoma is a rare benign breast lesion that most often presents as a small (up to 3 cm), solid, well-circumscribed, solitary, painless, mobile, lobulated mass. The highest incidence occurs in primiparous women (20 to 40 years old) during the third trimester of pregnancy. However, in the rare case presented herein, in addition to its giant size (more than 10 centimeters on palpation), this lactating adenoma is distinctive due to the presence of multiple nodules, poorly defined ultrasonographic margins, worrisome radiologic features, growth since early pregnancy, presence of infarction and association with chronic mastitis. From the clinical-radiologic perspective, the differential diagnoses included abscess associated with puerperal mastitis, phyllodes tumor, and galactocele. Biopsy was performed, and pathologic examination revealed the classic characteristics of lactating adenoma with multiple infarcted areas, leading to an unexpected confirmed case of giant lactating adenoma.

Mucosal Immunity and Liver Metabolism in the Complex Condition of Lactation Insufficiency.

Lactation insufficiency is variously defined and includes the inability to produce milk, not producing enough milk to exclusively meet infant growth requirements, and pathological interruption of lactation (e.g., mastitis). Of women with intent-to-breastfeed, lactation insufficiency has been estimated to affect 38%-44% of newly postpartum women, likely contributing to the nearly 60% of infants that are not breastfed according to the World Health Organization's guidelines. To date, research and clinical practice aimed at improving feeding outcomes have focused on hospital lactation support and education, with laudable results. However, researchers' reports of recent rodent studies concerning fundamental lactation biology have suggested that the underlying pathologies of lactation insufficiency may be more nuanced than is currently appreciated. In this article, we identify mucosal biology of the breast and lactation-specific liver biology as two under-researched aspects of lactation physiology. Specifically, we argue that further scientific inquiry into reproductive state-dependent regulation of immunity in the human breast will reveal insights into novel immune based requirements for healthy lactation. Additionally, our synthesis of the literature supports the hypothesis that the liver is an essential player in lactation-highlighting the potential that pathologies of the liver may also be associated with lactation insufficiency. More research into these biologic underpinnings of lactation is anticipated to provide new avenues to understand and treat lactation insufficiency.

Risk Factors for Delayed Onset of Lactogenesis II Among Primiparous Mothers from a Brazilian Baby-Friendly Hospital.

BACKGROUND: Low milk supply is frequently reported as a reason for exclusive breastfeeding cessation. RESEARCH AIMS: To determine the occurrence of, and the risk factors associated with, delayed onset of lactogenesis II among primiparas seen at a Baby-Friendly Hospital in Brazil. METHOD: We conducted a prospective longitudinal observational cohort study of 224 primiparas who had a singleton delivery. Data were first collected at the hospital. We assessed the onset of lactogenesis on day four postpartum, based on maternal reports of changes in breast fullness. Breastfeeding practices and Edinburgh Postnatal Depression Scale were evaluated on day seven postpartum. Using Poisson regression, we assessed significant factors associated with delayed onset of lactogenesis II. RESULTS: Delayed lactogenesis II occurred in 18.8% (n = 42) of participants and was significantly associated with alcohol drinking during pregnancy (IRR = 2.710, 95% CI [1.469, 4.996]); Edinburgh Postnatal Depression Scale scores ≥ 10 (IRR = 2.092, 95% CI [1.118, 3.916]), and the age of the mother (IRR: 1.081, 95% CI [1.039, 1.125]). CONCLUSION: Postpartum depression and alcohol ingestion during pregnancy may be associated with lactogenesis II delay, but more research is needed to elucidate the directionality of these relationships. Older mothers are at risk of delayed lactogenesis II onset. The frequency of delayed lactogenesis in this population is similar to the rates seen in previous Latin America studies and much lower than the ranges seen in North America, possibly because of the low proportion of obesity and severe gestational diabetes in this sample.

Dynamics of pro- and anti-inflammatory cytokine changes in serum and assessment of their diagnostic utility during lactation impairment in pigs.

Postpartum dysgalactia syndrome (PDS) in sows is a frequent and important clinical problem in the field. Currently, the diagnosis is based on physical examination performed during first days after the farrowing. The present study aimed at evaluation the dynamics of pro- and anti-inflammatory cytokine (IL-4, IL-6, IL-8, IL-10 and TNF-α) changes in serum of sows during peripartum period (day - 28 to + 28) and assessment of their diagnostic utility during lactation impairment in pigs. The study was done on 139 sows divided into 3 groups: clinically healthy sows, sows with lactation disorders, sows which had experienced difficult parturitions, lameness, etc. In order to measure the level of serum cytokines, the quantitative species-specific ELISA assays were used. The investigation demonstrated a different kinetics of changes of studied cytokines in sows from various groups. IL-6 and TNF-alfa shown high dynamic changes after farrowing in in sows. The levels of IL-8 and IL-10 were relatively stable in healthy sows, while in sows with peripartum disorders usually increased during lactation. However, the detailed examination revealed that investigated cytokines cannot be a useful early diagnostic markers of lactation impairments in sow. They do not allow to detect with high probability which sows are susceptible to lactation disorders before the parturition.

Regional and Facility Differences in Interventions for Mastitis by Australian Physiotherapists.

BACKGROUND: Little information has been documented regarding interventions for mastitis by Australian physiotherapists. It is currently not known if physiotherapy interventions vary across Australian regions and types of healthcare facilities. RESEARCH AIMS: (1) To identify the interventions used by Australian physiotherapists treating mothers with mastitis and (2) to determine the variability in interventions used across regions and facilities. METHODS: A retrospective observational design was used. A sample of case records of mothers with mastitis was identified (N = 192). These case records documented physiotherapy interventions for mastitis in hospitals and private physiotherapy practices in Western Australia (n = 77; 40.1%), Victoria (n = 76; 39.6%), and New South Wales (n = 39; 20.3%). An electronic data collection tool was designed to examine intervention variables. RESULTS: The physiotherapy interventions received by mothers included therapeutic ultrasound (n=175; 91.1%), education and advice (n = 160; 83.3%), and massage (n = 103; 53.6%). Therapeutic ultrasound parameters varied across regions and types of healthcare facilities. Mean documented therapeutic ultrasound intensity was approximately twice as high in New South Wales and Victoria than in Western Australia. CONCLUSIONS: Regional and facility differences exist in physiotherapy interventions for mastitis in Australia. Healthcare professionals who refer to physiotherapists for mastitis should be aware that interventions received may differ across regions and facility types.

Literature analysis of tuina therapy for postpartum hypogalactia based on CNKI database / 国际中医中药杂志

Objective To explore the characteristics and efficacy of manual treatment for postpartum hypogalactia.Methods To retrieve the CNKI from 2007 to 2017 on the massage and manual treatment for postpartum hypogalactia,and analyze its syndrome differentiation,acupoint selection,manipulation rules,treatment frequency,treatment courses and clinical efficacy.Results Among the 83 articles included,the massage therapy for postpartum hypogalactia were based on the diseases and syndromes,and the selection of acupoints was diverse and combined with local and distance such as Danzhong (CV 17),Rugen (ST 18),Shaoze (SI 1),Zusanli (ST 36),Pishu (BL 20).The therapy were rich in techniques which often use acupoint stimulation and manipulation.Conclusions Tuina therapy for postpartum hypogalactia is widely used with safety and reliablility.But the operational procedures and efficacy standards need to be further standardized.

Initial difficulties with breastfeeding technique and the impact on duration of exclusive breastfeeding / Dificuldades iniciais com a técnica da mamada e impacto na duração do aleitamento materno exclusivo

Abstract Objectives: the present study aimed to evaluate the influence of initial difficulties in breastfeeding on duration of exclusive breastfeeding. Methods: a prospective study with follow up of nursing mothers and their babies in the first six months of age. The studied population was randomly selected among the Brazilian public health system (SUS, Portuguese acronym) users in three hospitals. The breastfeeding observation protocol was used to collect initial data, which also included socio-demographic, prenatal assistance, delivery care, the postpartum period and the newborn variables. After hospital discharge, data were collected by phone. The multiple regression model was used for statistical analysis. Results: 175 mother-baby binomials were followed. Problems with breasts during the postpartum hospital stay (p= 0.030; OR=2.38; CI95%=1.02-5.48), maternal work outside home (p=0.027; OR=2.12; CI95%=1.03-4.31) and low maternal schooling level (p=0.017; OR=2.13; CI95%=1.10-4.06) were shown to be associated with the early interruption of exclusive breastfeeding before the child has completed 6 months of age. A family income lower than one minimum wage was a protective factor (p=0.048; OR=0.42; CI95%=0.17-0.97). Conclusions: socioeconomic aspects and difficulties in breastfeeding associated with problems with the puerperal breasts stood out as factors which restrict the duration of exclusive breastfeeding.

Resumo Objetivos: avaliar a influência das dificuldades iniciais para amamentar sobre a duração do aleitamento materno exclusivo. Métodos: estudo prospectivo com acompanhamento de binômios mães-lactentes desde o nascimento até os 180 dias após o parto. A seleção do grupo estudado foi realizada de forma aleatória entre usuárias do Sistema Único de Saúde brasileiro, em três hospitais. A ficha de avaliação da mamada foi utilizada para coleta de dados iniciais que incluiu também dados sociodemográficos, da assistência pré-natal, da assistência ao parto, ao puerpério e ao recém-nascido. As informações após alta hospitalar foram obtidas por telefone. Utilizou-se modelo de regressão múltipla para a análise estatística. Resultados: foram acompanhados 175 binômios. A presença de problemas com as mamas na maternidade (p=0,030; OR=2,38; IC95%=1,02-5,48), o trabalho materno fora de casa (p=0,027; OR=2,12; IC95%=1,03-4,31) e o baixo nível de escolaridade materno (p=0,017; OR=2,13; IC95%=1,10-4,06) mostraram-se como fatores associados à interrupção precoce do aleitamento materno exclusivo antes dos seis meses. A renda familiar menor que um salário mínimo se mostrou como fator de proteção (p=0,048; OR=0,42; IC95%=0,17-0,97). Conclusões: aspectos socioeconômicos e dificuldades para amamentar relacionadas a problemas com a mama puerperal mostraram-se como fatores que restringem a duração da amamentação exclusiva.

Necrotizing fasciitis of breast in postpartum period: case report / Fasciíte necrotizante de mama no puerpério: relato de caso

Necrotizing fasciitis is an aggressive infection that affects subcutaneous and superficial fascia by necrosis, more often found in the abdominal wall, perineum and extremities. Rare cases have been described in the breast and the literature points to breastfeeding and previous breast procedures as risk factors for this condition. We present a 27-year-old patient in postpartum period who presented a right nipple fissure associated to breastfeeding, that evolved to a local aggressive infection with extensive necrosis of fascia and mammary parenchyma characterized as necrotizing fasciitis. Our aim is to highlight the importance of early diagnosis, especially to differentiate from puerperal mastitis which has a different pathophysiology and treatment, as well as the need for appropriate therapy consisting of surgical debridement and broad spectrum antibiotics in order to avoid further complications and death

Fasciíte necrotizante é uma infecção agressiva que acomete o subcutâneo e fáscias superficiais por necrose, mais frequentemente encontrada em parede abdominal, períneo e extremidades. Raros casos foram descritos na mama e a literatura aponta a amamentação e procedimentos mamários prévios como fatores de riscos para essa condição. Apresentamos uma paciente no puerpério, de 27 anos, que apresentou uma fissura no mamilo direito associada à amamentação e que evoluiu com infecção local agressiva, com necrose extensa de fáscias e parênquima mamário caracterizada como fasciíte necrotizante. O trabalho visa apresentar a importância do diagnóstico precoce, principalmente com diferenciação para as mastites puerperais que possuem fisiopatologia e tratamento distintos, assim como a necessidade do tratamento adequado com desbridamento cirúrgico e antibioticoterapia de amplo espectro para evitar maiores complicações e o óbito

Selected serum acute-phase proteins in peripartum sows and evaluation of their diagnostic usefulness.

Lactation impairment in sows is a frequent and significant clinical problem. Due to a complex aetiopathogenesis, early diagnosis of postpartum dysgalactia syndrome (PDS) is difficult and so far has usually been based on physical examination performed in the first days after farrowing. To date no data have been provided on the diagnostic usefulness of acute phase proteins (APP) in early diagnosis of peripartum disorders, including lactation disorders in sows. This study aimed at measuring the serum concentration of selected APP (C-reactive protein (CRP), haptoglobin (Hp), serum amyloid A (SAA) and pig major acute phase protein (Pig-MAP)) in sows with physiological and pathological course of the peripartum period and at evaluating the possibility of utilising the studied markers in the early diagnosis of lactation disorders. Also, the correlation between the studied APP serum concentration and production parameters was assessed. To the best of the authors' knowledge, the present study is the first such performed on sows. The experiment was conducted on 139 sows divided into three experimental groups based on the course of peripartum period: HEALTHY (n = 58) - clinically healthy sows, PDS (n = 45) - sows with milk production disorders, and OTHERS (n = 36) - sows which had experienced difficult parturitions, inflammations not connected with mammary glands (abscesses, hooves infections), or lameness. Thirteen serum samples from each sow were analysed, samples being taken on days -28 (-30 to -25), -14 (-16 to -11), -7 (-8 to -6), -5, -3, -1, 0 (parturition day), +1, +3, +5, +7, +14 and +28 (prior to or post farrowing). In order to measure the level of serum APP, commercial, quantitative ELISA tests were used. The results of the study indicate that the diagnosis made on the basis of the assessment of SAA levels on day 7 before the farrowing was not statistically different from the diagnosis made on the basis of the physical examination in the first days after the farrowing, that is the so-called "gold standard". The achieved results indicate that SAA may be a useful early marker of lactation impairments in sows, which allows detection of which sows are susceptible to lactation disorders with high probability even as early as one week before parturition.

Phone calls to an Australian pregnancy and lactation counselling service regarding use of galactagogues during lactation - the MotherSafe experience.

Galactagogues represent substances used to enhance breast milk production. Between 2001 and 2014 we identified 2034 phone calls regarding the use of galactagogues made to MotherSafe. The majority involved discussion of domperidone (n = 1884; 92.6%), with the remainder relating to metoclopramide (n = 153; 7.5%) or other herbal galactagogues (eg fenugreek, milk thistle; n = 262; 12.9%). A 50% decrease in total calls occurred from 2011 to 2014, while the percentage of calls regarding herbal galactagogues increased from 0% in 2001 to 23% in 2014. These findings support the need for more robust research surrounding the use of galactagogues in clinical practice.

[The effect of breast massage at different time in the early period after cesarean section].

Objective: To evaluate the effect of breast massage at different time in the early period on maternal lactation after cesarean section. Methods: 80 women delivered by cesarean section were randomly selected from maternity ward of a hospital in Shandong province during Jan. 2013 to Jan. 2015; which were divided into four groups, with 20 patients in each. Three groups received 3 times of breast massage every 24 hoursbeginning from 2, 12 and 24 h after cesarean section, respectively. The control group didn't receive any breast massage. The starting time and status of lactation were observed and recorded after cesarean section. 5 ml venous blood sample was drawn from each patient respectively at 2 h before cesarean, 6, 12, 24, 48 and 72 h after cesarean to test the level of serum prolactin. The lactation status of each group was compared. Results: The P(50) (P(25)-P(75)) of starting time of lactation of the three massage groups and control group were 3 (2-6) h, 4 (2-8) h, 4 (3-12) h and 4 (2-12) h, respectively, whose differences showed no statistical significance (H=3.32, P=0.345).The number of delivered women with adequate lactation 24 hours after cesarean was 10 in the group who received massage beginning from 2 h after cesarean; while the number was only 2 in the control group. The number of delivered women with adequate lactation 48 hours after cesarean was 18 in the group who received massage beginning from 2 h after cesarean; while the number was 8 in the control group. The differences showed statistical significances (P values were 0.021 and 0.008, respectively). The serum prolactin level in the group of delivered women who received massage from 2 h after cesarean was separately (195.9±78.5), (176.0±96.5), (216.4±110.0), (190.0±56.8) and (184.8±69.6) µg/L at 2, 12, 24, 48 and 72 h after cesarean, which were significantly higher than those in the control group (which were (128.8±40.6), (127.3±66.8), (162.2±58.8), (145.1±64.7) and (141.7±49.3) µg/L, respectively) (P=0.007). Conclusion: Breast massage beginning from 2 hours after cesarean section can effectively improve the lactation status of delivered women.