[Prevalence and determinants of breastfeeding: the Zorrotzaurre study]. / Prevalencia y determinantes de la lactancia materna: estudio Zorrotzaurre.

INTRODUCTION: Introduction and objectives: breastfeeding (BF) is a feeding method that provides multiple benefits for the health of infants and their mothers. This study aimed to determine the prevalence of BF during the first year of life of children of women who gave birth in a private clinic in Biscay, Basque Country, Spain, and to identify the facilitating determinants and reasons for abandonment. Method: an observational, descriptive, longitudinal and prospective study in a random sample of 453 newborns (NBs) recruited between 2016 and 2017. Results: in all, 366 women agreed to participate in all the study phases. The prevalence of exclusive breastfeeding (EBF) was 51.7 % at baseline, 77.1 % at discharge, and 21.6 % after sixth months; and that of BF, 87.1 % at the beginning, 48.4 % at month six, and 20.6 % at one year. The facilitating factors of EBF were: at the beginning, not using a nest or breast pump; 15 days of satisfaction with LM and not using a pacifier or breast pump; 4 months of satisfaction with LM; 6 months attending Lactation Support Groups (GAL) and not introducing complementary feeding (CA); and those of LM at 1 year, attending GAL. The main reasons for abandonment were: own initiative, incorporation to work, and little weight gain by the NB. Conclusions: one in 5 newborns received EBF up to 6 months and BF up to one year. It would be necessary to promote strategies that favor breastfeeding, such as eliminating the nest, advising against breast pumps and pacifiers at the beginning, starting CA from the sixth month, and organizing GALs during the first year.

INTRODUCCIÓN: Introducción y objetivos: la lactancia materna (LM) es un método de alimentación infantil que aporta múltiples beneficios para la salud de los lactantes y las madres. Este estudio pretende determinar la prevalencia de la LM durante el primer año de vida de los hijos/as de una serie de mujeres que dan a luz en una clínica privada de Bizkaia, e identificar los determinantes facilitadores y los motivos de abandono. Método: estudio observacional, descriptivo, longitudinal y prospectivo de una muestra aleatoria de 453 recién nacidos (RN), reclutada entre 2016 y 2017. Resultados: en total, 366 mujeres aceptaron participar en todas las fases de estudio. La prevalencia de la lactancia materna exclusiva (LME) fue del 51,7 % al inicio, del 77,1 % al alta y del 21,6 % al sexto mes; y la de la LM, del 87,1 % al inicio, del 48,4 % al sexto mes y del 20,6 % al año. Los factores facilitadores de la LME fueron: al inicio, no utilizar nido ni sacaleches; 15 días de satisfacción con la LM y no utilizar chupete ni sacaleches; 4 meses de satisfacción con la LM; 6 meses de acudir a Grupos de Apoyo a la Lactancia (GAL) y no introducir alimentación complementaria (AC); los de la LM al año, acudir a GAL. Los principales motivos de abandono fueron: la iniciativa propia, la incorporación al trabajo y la escasa ganancia de peso del RN. Conclusiones: uno de cada 5 RN recibieron LME hasta los 6 meses y LM hasta el año. Sería necesario promover estrategias que favorezcan el amamantamiento, como: suprimir el nido, desaconsejar el sacaleches y el chupete al inicio, iniciar la AC a partir del sexto mes y organizar GAL durante el primer año.

Effect of nipple shield use on milk removal: a mechanistic study.

BACKGROUND: Concerns about reduced milk transfer with nipple shield (NS) use are based on evidence from studies with methodological flaws. Milk removal during breastfeeding can be impacted by infant and maternal factors other than NS use. The aim of this study was to control electric breast pump vacuum strength, pattern and duration across multiple study sessions to determine if NS use reduces milk removal from the breast. METHODS: A within-subject study with two groups of breastfeeding mothers (infants < 6 months) were recruited; Control Group (CG): no breastfeeding difficulties; Pain Group (PG) used NS for persistent nipple pain. Mothers completed three randomised 15 min pumping sessions using the Symphony vacuum curve (Medela AG); no NS, fitted NS, and a small NS. Sessions were considered valid where the applied vacuum was within 20 mmHg of the set vacuum. Milk removal was considered as pumped milk volume, and also percentage of available milk removed (PAMR), which is calculated as the pumped volume divided by the estimated milk volume stored in the breast immediately prior to pumping. RESULTS: Of 62 sessions (all: n = 31 paired sessions) a total of 11 paired sessions from both PG (n = 03) and CG (n = 08) were valid (subset) with and without a fitted NS. Only 2 small shield sessions were valid and so all small shield measurements were excluded. Both pumped volumes and PAMR were significantly lower with NS use for all data but not for subset data. (All: Volume and PAMR median: no NS: 76.5 mL, 69%, Fitted NS: 32.1 mL, 41% respectively (volume p = 0.002, PAMR p = 0.002); Subset: Volume and PAMR median: no NS: 83.8 mL, 72%; Fitted NS: 35.2 mL, 40% (volume p = 0.111 and PAMR p = 0.045). The difference in PAMR, but not volume, was statistically significant when analysed by linear mixed modelling. A decrease of 10 mmHg was associated with a 4.4% increase in PAMR (p = 0.017). CONCLUSIONS: This experimental data suggests that nipple shield use may reduce milk removal. Close clinical monitoring of breastfeeding mothers using nipple shields is warranted.

A mother-centered evaluation of breast pumps.

Existing literature outlines mothers' negative experiences with breast pumps, yet a gap exists of which breast pump characteristics are important to mothers. Identifying which breast pump characteristics are important to breast pumping mothers, and any variation between mothers who do or do not work outside of the home, will help identify user needs. A survey collected information on mothers' experiences with breast pumps and impressions of their characteristics. Latent Class Analysis (LCA) was used to determine whether there were possible groupings of impressions of these characteristics. The LCA identified a two-class model with mothers' age as a significant covariate. Portability, ease of use, low-weight, fast milk extraction, comfortability, low-noise, and discreet were all found to be important to one group of mothers, while only portability, ease of use, fast milk extraction, and comfortability were found to be important to another group of mothers. Mothers' work status was not a significant covariate but did predict class membership when considered as a grouping variable in conjunction with age. Breast pumping mothers' needs were found to differ based on their work status and age together, and collecting and considering these different needs is vital to creating redesigns that improve mothers' breast pumping experience.

Breast shield design impacts milk removal dynamics during pumping: A randomized controlled non-inferiority trial.

INTRODUCTION: While many studies have investigated the importance of optimizing pumping patterns for milk removal, the influence of breast shield design on milk removal has not been the focus of extensive investigation. This study aimed to determine the effectiveness of breast shields with either a 105° or a 90° flange opening angle on breast drainage and milk volume expressed during pumping. MATERIAL AND METHODS: This study was a cross-over, randomized controlled non-inferiority trial (Registration; NCT03091985). Mothers (n = 49) of breastfeeding infants participated in the study over two study sessions. Participants were randomly assigned to pump both breasts simultaneously for 15 minutes with either the 105° or 90° breast shield in the first session, and the other shield in the second session. Effectiveness (breast drainage) and efficiency (volume expressed) of both breast shields were assessed after 15 minutes of pumping. Intention-to-treat and per protocol analyses were performed to determine if the 105° breast shield was non-inferior to the 90° breast shield for breast drainage and volume expressed. Perceived comfort was assessed via questionnaire. RESULTS: The 105° breast shield was both non-inferior and superior compared to the standard 90° shield for breast drainage (intention-to-treat, 3.87% (0.01-7.72), P = .049) and volume expressed (intention-to-treat, 9.14 mL (1.37-16.91), P=.02). In addition, the 105° shield was rated as feeling more comfortable (P < .001) and as having an improved fit to the breast (P < .001) compared to the 90° shield. CONCLUSIONS: Expressing with the 105° breast shield was more efficient, effective and comfortable compared to the 90° shield. Breast shield design can significantly impact pumping outcomes, and an opening angle of 105° improves both the dynamics and comfort of milk removal.

The Associations Between Light Exposure During Pumping and Holder Pasteurization and the Macronutrient and Vitamin Concentrations in Human Milk.

BACKGROUND: During pumping, storage, and pasteurization human milk is exposed to light, which could affect the concentrations of light-sensitive vitamins. Currently, milk banks do not regulate light exposure. RESEARCH AIM: The aim of this paper was to determine the influence of light exposure during pumping, storage, and pasteurization on (1) macronutrients, (2) select water-soluble vitamins, and (3) select fat-soluble vitamins. METHODS: All 13 participants donated 4 milk samples each. Each sample underwent 1 of 4 treatments: raw and light protected, raw and light exposed, pasteurized and light protected, and pasteurized and light exposed. Samples were analyzed for macronutrients and Vitamins B1, B2, retinol, γ-tocopherol, α-tocopherol, and ß-carotene. RESULTS: ß-carotene concentrations were not influenced by light exposure. Vitamin B1 was significantly (p < 0.05) affected by light-exposure (M = 0.23, SD = 0.01mg/L) compared to light-protected (M = 0.27, SD = 0.01mg/L) samples. Vitamin B2 concentrations were reduced (p < 0.05) by light-exposure in raw (M = 62.1, SD = 0.61µg/L) and pasteurized (M = 73.7, SD = 0.72µg/L) samples compared to light-protected raw samples (M = 99.7, SD = 0.66µg/L). No other tested nutrients were affected by light exposure. CONCLUSIONS: If milk is exposed to excessive amounts of light, Vitamins B1 and B2 concentrations may degrade below the current Adequate Intake recommendations for infants 0-6 months of age, increasing the risk of insufficient vitamin supply to the exclusively human milk-fed infant. Thus, pumped or processed human milk should be protected from light to preserve milk vitamin concentrations.

Promotion of early breast milk expression among mothers of preterm infants in the neonatal ICU in an obstetrics and gynaecology hospital: a best practice implementation project.

INTRODUCTION: The supply of breast milk to preterm infants is low. It is important to adopt strategies to promote early, frequent and effective expression of breast milk. OBJECTIVES: The aim of this best practice implementation project was to promote early breast milk expression among mothers of preterm infants in the neonatal ICU in an obstetrics and gynaecology hospital. METHODS: The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool were used in this project. Questionnaire surveys and interviews were used for baseline and follow-up audits. RESULTS: An overall improvement was observed after the implementation of various strategies. The compliance regarding education provided to healthcare professionals, and mothers after delivery, as well as mothers' access to breast pump increased to 100%. The compliance concerning mothers' education before delivery rose from 0 to 77%. A remarkable increase from 23 to 87% was observed for compliance related to expression of breast milk within 6 h following delivery. The compliance of expression for 8-12 times daily in the first 48 h after delivery also experienced dramatic improvement from 0 to 50%. CONCLUSION: The current project has demonstrated that the implementation of evidence-based practice was effective in promotion of early breast milk expression among mothers of preterm infants in the neonatal ICU. The role of a nurse specialist in breastfeeding, involvement of multidisciplinary staff and utilization of online networking software were highlighted in this project. Future audits may be undertaken to evaluate the long-term effect of the implementation.

Interchanging Breast Pump Kit Brands Alters Breast Pump Suction Pressure.

Background: Postpartum mothers express and store breast milk using a hospital-grade pump and manufacturer-specific kit (flanges, bottles, tubing, valves, and membranes). After hospital discharge, mothers may attempt to interchange kits from different manufacturers. The objective of this study is to determine whether pump performance is affected by the use of a different manufacturer's kit. Materials and Methods: Suction pressure was tested using kits and six pumps from three manufacturers (Ameda, Medela, and Spectra). Pump settings (speed and vacuum strength) simulated maximum, minimum, and commonly used median settings. Suction pressure (mmHg) was measured using an analog gauge and repeated six times for each pump-kit combination. Measurements were compared using repeated measures analysis of covariance (ANCOVA) to determine whether kit was an independent predictor of suction pressure. Results: The kit type was a significant independent predictor (p < 0.05) of suction pressure for all at medium vacuum strength and many at maximum and minimum vacuum strengths. Upon further analysis interchanging kits resulted in both significantly increased and decreased suction pressures compared to the manufacturer-specific kit. Conclusion: Breast pump kits generate variable suction pressures when interchanged between pumps from different manufacturers. Interchanging combinations of kits and breast pumps could potentially lead to low milk expression due to ineffective suction pressure or increased discomfort from excessive pressure. The results of this study emphasize the importance of maternal education regarding the use of manufacturer-specific kits and breast pumps.

Comparison of maternal milk ejection characteristics during pumping using infant-derived and 2-phase vacuum patterns.

Background: Milk ejection characteristics remain consistent throughout 12 months of lactation in women who expressed breastmilk with an electric breast pump. In addition these characteristics appear to remain constant when women are breastfeeding or pumping suggesting that milk ejection is a robust physiological response. It is not known whether the stimulation of an infant at the breast in the early post partum period influences milk ejection patterns or whether this is a programmed event. However, as more data become available on the mechanisms involved in infant feeding, pumping patterns mimicking the infant more closely may provide enhanced results. The objective of this study was to compare milk ejection characteristics obtained when using a novel infant-derived pumping pattern with an established 2-phase pattern. Methods: A convenience sample of ten lactating mothers, 1 to 40 weeks of lactation with normal milk production were recruited in 2015. Each participated in two pumping sessions in which either a 2-phase pattern or infant-derived pattern were randomly assigned. Milk volume and milk ejection characteristics were recorded and the percentage of available milk removed (PAMR) was calculated. Statistical analysis used linear mixed effects modeling to determine any differences between breasts and pump patterns with the consideration of individual variability as a random effect. Results: The number of milk ejections and milk ejection characteristics did not differ between patterns. Milk volumes removed were 53.6 ± 28.5 ml (PAMR 58.2 ± 28.4) for the 2-phase pattern and and 54.2 ± 26.3 ml (PAMR 52.2 ± 22.3) for the infant derived pattern. Peak milk flow rates were positively associated with the available milk (p = 0.0003) and PAMR (p = 0.0001), as was the volume of milk removed during each milk ejection (p = 0.001 and p = 0.0001). Conclusion: An experimental pumping pattern designed to resemble infant sucking characteristics did not alter milk ejection characteristics or milk removal parameters compared with an established 2-phase pattern. Theses findings provide further evidence that milk ejection is a robust physiological response.

Physical Analysis of the Breast After Direct Breastfeeding Compared with Hand or Pump Expression: A Randomized Clinical Trial.

Background: Expressing human milk using commercially available pumps has increased. Most women use mechanical means to transfer their milk at some point during lactation. Yet, there is very little quantification of any breast tissue changes that occur when using mechanical devices to facilitate milk transfer. Objective: Women comfortable with breastfeeding were recruited to participate in a study to measure physical changes of the breast with a variety of human milk transfer modalities under close observation. Materials and Methods: Direct breastfeeding with their infant, hand expression, and mechanical milk transfer using two commonly available breast pumps were utilized over four milk transfer sessions with each participant. Each participant directly breastfed on the first milk transfer session and the remaining modalities were randomized. Measurements were taken before and after each modality using digital calipers. Participants completed a modified pain scale after each observation. Measurements taken after breastfeeding were used as the control for data interpretation for each participant. After a 20-minute rest period, breast tissue was again examined, and tissue appearance was recorded. Within-subject modality differences were calculated, and paired analysis mean difference and standard error of the mean are presented. Results: Fifty eligible women were approached with 92% participating. The "before" measurements were not significant for all the modalities. The "after" measurements were significantly different at p < 0.003 for breast pumps but not for breastfeeding or hand expressing. Many participants indicated pain with pumping. Conclusion: Mechanical pump use correlated with significantly increased length and diameter of the nipple compared with the post-breastfeeding and hand expressing dimensions. Pump use correlated with significant pain scores and resulted in localized inflammatory changes. Understanding how pumps affect breast tissue is helpful in improving experiences with breast pumps and may improve breastfeeding outcomes. Additional research is needed to better understand ramifications of long-term use of breast pumps.

Comparative Assessment of Excretion of Milk from Two Breast Pumps with Different Vacuum Strength and Duration.

BACKGROUND: Breastfeeding is the best source of food for the newborn. In a situation wherein it is not possible to breastfeed a baby, it may be necessary to express milk from the mother's breast using a breast pump. To achieve lactation success before a baby's suckling can ensure the effective extraction of milk, breast pumps must meet specific biomechanical requirements. However, the parameters of the vacuum stimuli by which milk is expressed remain nonoptimized. SUBJECTS AND METHODS: Forty-nine lactating women of 21-30 years of age who volunteered to be included in this study were examined. Women had been lactating and breastfeeding normally for 6-7 days. A new method was developed to compare the amount of milk ejected by vacuum pulses of different amplitudes or duration. RESULTS: It was found that for most nursing women, the vacuum stimuli with amplitude of about 190 mm Hg, duration of 0.7 second, and frequency of 1 impulse/s are optimal for removing milk from the breast of a woman. CONCLUSIONS: Optimization of the amplitude and duration of the vacuum stimuli increased the efficacy of the breast pump.

Detection of Milk Ejection Using Bioimpedance Spectroscopy in Lactating Women during Milk Expression Using an Electric Breast Pump.

Milk ejection is essential for effective milk removal during breastfeeding and pumping, and for continued milk synthesis. Many women are unable to accurately sense milk ejection to determine whether their infant is receiving milk or, when pumping, to switch the pump to a more effective expression pattern. To determine if changes in bioimpedance parameters are associated with milk ejection in the lactating breast during pumping. 30 lactating women participated in 2 pumping sessions within 2 weeks of each other. During pumping the breasts were monitored with bioimpedance spectroscopy (on either the pumped or the non- pumped breast), and milk flow rate and volume were measured simultaneously. All mothers completed 24-h milk productions. Linear mixed effects models were used to determine associations between milk flow rate and bioimpedance changes. Changes in bioimpedance parameters were greater at the first milk ejection when measured on the pumped breast (median (IQR): R zero: -7 (-17, -4,) % (n = 30); R infinity: -8 (-20, -2) % (n = 29); membrane capacitance: -24 (-59, -7) % (n = 27). Changes in bioimpedance detected in the non-pumped breast were lower at the first milk ejection, R zero: -3 (-8, -2) % (n = 25); R infinity: -5 (-8, -2) % (n = 23); membrane capacitance: -9 (-17, 15) % (n = 24). Smaller less consistent decreases in the bioimpedance characteristics were detected at the second milk ejection in both breasts. Bioimpedance parameters showed a consistent decrease associated with the first milk ejection when electrodes were placed on the pumped breast. Smaller decreases were observed when the non-pumped breast was monitored for the first and second milk ejection. There was wide variation in the magnitude of changes observed, and hence further development of the methodology is needed to ensure reliability.

Short-term efficacy of two breast pumps and impact on breastfeeding outcomes at 6 months in exclusively breastfeeding mothers: A randomised trial.

The provision of breast pumps is a potential strategy to increase breastfeeding duration. This trial compared the effectiveness and acceptability of two breast pumps in mothers exclusively breastfeeding (EBF) their healthy term infant. It also tested whether provision of pumps versus vouchers of equivalent value influenced breastfeeding or attainment of mothers' goals at 3 and 6 months. Mothers were randomised at 3- to 4-week post-partum (Beijing [n = 30], Moscow [n = 34], London [n = 45], New York [n = 3]) to groups A (Philips single-electric pump, Natural bottle), B (Medela Swing single-electric pump, Calma bottle), or C (Control; vouchers). At 6 weeks, group A and B mothers expressed for 10 min/breast; milk weight and opinions of pump/bottle were recorded. Feeding practices were assessed using questionnaires at 3 and 6 months. Milk weight/flow pattern did not differ between groups. Pump A scored significantly better for ease-of-use, cushion-feel, need-to-lean-forward, pleasant, comfort. At 3 and 6 months, %EBF or meeting their goal was not significantly different; (3 months: 86%, 85%, 84%; 6 months: 20%, 15%, 26%; meeting goal 24%, 17%, 27% for A, B, and C). Expressed breast milk (EBM) provision was higher in groups A and B (3 months: 76%, 76%, 24% (p < 0.001); 6 months: 83%, 87%, 32% (p < 0.001); and negatively predicted EBF at 6 months (OR no EBM 5.07, 95% CI [1.56, 16.5]). The pumps were equally effective for milk expression at 6 weeks. Pump provision did not significantly influence breastfeeding practices or attainment of goals but resulted in higher EBM provision, which was associated with lower EBF but not other breastfeeding categories at 6 months.

A prospective clinical study of Primo-Lacto: A closed system for colostrum collection.

BACKGROUND: Colostrum is the first nutritional liquid that comes out of the breast during lactation. Colostrum collection can be challenging due to the small volume produced, and because breast pumps are not designed for colostrum collection. Besides pumping colostrum, the generally accepted practice is to use any available container to hand-express colostrum. Transfer between containers may lead to contamination, higher chance of infection and loss of colostrum. Our aim was to understand if a dedicated colostrum collection system (Primo-Lacto, Maternal Life, LLC, Palo Alto, CA) is more effective than standard hospital practice. METHODS: Mothers who delivered preterm infants < 34 weeks gestation and mothers with non-latching infants were approached within 24 hours of delivery. Surveys were distributed to participating patients (n = 67), and nurses or lactation consultants (n = 89). Mothers compared ease of use, their confidence level and satisfaction with the amount collected during standard practice vs. the colostrum collection system. Nurses or lactation consultants compared ease of use, differences in colostrum loss and time invested collecting. Quantitative data were analyzed using the Wilcoxon signed rank test and qualitative data were analyzed with grounded theory methods. RESULTS: For mothers, ease of use and confidence were significantly better when they used the colostrum collection system than when they used the standard collection procedure, and this difference was true for both hand and pump expression (p<0.01). Nurses and lactation consultants perceived that ease of use was better, and percent of colostrum lost was significantly less with the colostrum collection system for both hand and pump expression. The collection times were not significantly different between the colostrum collection system and standard practice. CONCLUSION: The colostrum collection system is a tool to help facilitate successful colostrum collection and improve the experience both for clinicians and patients.

Cronobacter sakazakii Infection from Expressed Breast Milk, Australia.

Cronobacter sakazakii neonatal infections are often epidemiologically linked to the consumption of contaminated powdered infant formula. We describe a case resulting from consumption of contaminated expressed breast milk, as confirmed by whole-genome sequencing. This case highlights potential risks associated with storage and acquisition of expressed breast milk.

Lactancia Materna y Nutrición

Sección del sitio del Ministerio de la Salud y Protección Social de Colombia que trae diversas informaciones y orientaciones acerca de la lactancia materna como ventajas y desventajas de esto proceso, conservación, transporte y extracción de la leche materna, alimentación complementaria, bancos de leche humana, entre otras informaciones. Además de eso, hay datos acerca del método canguro, lineamientos técnicos para la implementación de las salas amigas de la familia lactante en el entorno laboral, cartilla de la lactancia materna en emergencias.

"I Had One Job and That Was To Make Milk".

BACKGROUND: For very-low-birth-weight (VLBW) infants, breastfeeding may no longer be an immediate option. Mothers often turn to mechanically expressing their milk with a breast pump to provide their infants human milk. Research aim: This study aimed to describe mothers' experiences expressing milk for their VLBW infants in a level 3 neonatal intensive care unit. METHODS: Qualitative, phenomenological methods were used to better understand the milk expression experiences of 17 mothers of VLBW infants. In-depth interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using Colaizzi's seven-step protocol, and themes were identified to illustrate the lived experience of the mothers. RESULTS: Five global themes emerged from interviews with mothers. However, this article focuses on one global theme, "I had one job and that was to make milk," and the supporting subthemes: (1) "I was heartbroken," (2) "Pumping is a full-time thing," and (3) "I literally sacrificed nights." CONCLUSION: This study provides insight into the complex experience that mothers in the southeastern United States undergo when expressing milk for their VLBW infants.

The Mechanics of Breast Pumping: Compression Stimuli Increased Milk Ejection.

BACKGROUND: The use of breast pumps with a compression component has shown their higher efficacy compared with vacuum pumps. However, the direct role of the compression stimulus is not sufficiently proven in the removal of milk from the main milk ducts of the breast. The aim of this study was to determine the contribution pulsating compression component of the breast pump has on total volume milk ejection by vacuum and compression stimuli. SUBJECTS AND METHODS: Twenty-four lactating women of 21-30 years of age, who volunteered to be included in this study, were examined. Experimental breast pump with vacuum and compressive components were used to express breast milk. RESULTS: It was found that volume milk ejection together with vacuum and compression stimuli was 10-46% more than expressing only with vacuum stimuli. Average values were 40.5% ± 5% for expression only with vacuum stimuli and 59.5% ± 5% for expression with vacuum and compression stimuli. CONCLUSIONS: Compression stimuli increased the efficacy of the breast pump, which is not only due to the effective formation milk ejection reflex but also directly to an additional squeezing of milk from the breast.

Decontaminating breast pump kits: new guidance.

Various methods can be used to decontaminate breast pump milk collection kits and items related to infant feeding but they have some drawbacks and risks. In 2015, the Joint Working Group of the Healthcare Infection Society and Infection Prevention Society published guidance to support the safe decontamination of this equipment at home and in hospital. This article summarises its recommendations for health professionals to use and communicate to other groups, such as parents and carers.

Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology.

The majority of new mothers in the United States use breast pumps in the first 4 months postbirth in order to achieve their personal human milk feeding goals. Although these mothers seek guidance from health-care professionals with respect to the type and use of breast pumps, there are few evidence-based guidelines to guide this professional advice. This paper reviews the evidence to facilitate professional individualization of breast pump recommendations using three categories of literature: the infant as the gold standard to which the pump is compared; the degree of maternal breast pump dependency (for example, the extent to which the breast pump replaces the infant for milk removal and mammary gland stimulation); and the stage of lactation for which the pump replaces the infant. This review can also serve to inform public and private payers with respect to individualizing breast pump type to mother-infant dyad characteristics.