Breastfeeding Determinants in Healthy Term Newborns.

Breastfeeding is the normative standard for infant feeding. Despite its established benefits, different factors can affect breastfeeding rates over time. The purpose of this study was to evaluate breastfeeding determinants in healthy term newborns during the first three months of life. A prospective, observational, single-center study was conducted in the nursery of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. The mother-baby dyads that were admitted to the Clinic in January and February 2017 were enrolled. Only healthy term babies with birth weight ≥10th percentile for gestational age were included. Data were collected through medical records and questionnaires administered during the follow-up period. Then, we fitted univariate and multivariate logistic models and calculated odds ratios. 746 dyads were included but 640 completed the study. The factors found to be favoring breastfeeding were a previous successful breastfeeding experience, a higher level of education of the mother, attending prenatal classes, no use of pacifier, rooming in practice, and breastfeeding on demand. Factors acting negatively on breastfeeding were advanced maternal age, non-spontaneous delivery, perception of low milk supply, mastitis, and nipple fissures. This study highlights the need to individualize the assistance provide to breastfeeding mothers, paying special attention to personal experiences.

Incidence of Mastitis in the Neonatal Period in a Traditional Breastfeeding Society: Results of a Cohort Study.

BACKGROUND: Mastitis is a painful problem experienced by breastfeeding women, especially in the first few weeks postpartum. There have been limited studies of the incidence of mastitis from traditionally breastfeeding societies in South Asia. This study investigated the incidence, determinants, and management of mastitis in the first month postpartum, as well as its association with breastfeeding outcomes at 4 and 6 months postpartum, in western Nepal. SUBJECTS AND METHODS: Subjects were a subsample of 338 mothers participating in a larger prospective cohort study conducted in 2014 in western Nepal. Mothers were interviewed during the first month postpartum and again at 4 and 6 months to obtain information on breastfeeding practices. The association of mastitis and determinant variables was investigated using multivariable logistic regression, and the association with breastfeeding duration was examined using Kaplan-Meier estimation. RESULTS: The incidence of mastitis was 8.0% (95% confidence interval, 5.1%, 10.8%) in the first month postpartum. Prelacteal feeding (adjusted odds ratio = 2.76; 95% confidence interval, 1.03, 7.40) and cesarean section (adjusted odds ratio = 3.52; 95% confidence interval, 1.09, 11.42) were associated with a higher likelihood of mastitis. Kaplan-Meier estimation showed no significant difference in the duration of exclusive breastfeeding among the mothers who experienced an episode of mastitis and those who did not. CONCLUSIONS: Roughly one in 10 (8.0%) women experienced mastitis in the first month postpartum, and there appeared to be little effect of mastitis on breastfeeding outcomes. Traditional breastfeeding practices should be encouraged, and the management of mastitis should be included as a part of lactation promotion.

Breastfeeding, retinoids, and postpartum depression: a new theory.

Postpartum depression (PPD) is an international public health problem affecting at least 1 in 8 mothers. Known risk factors include: giving birth to a preterm or low birth weight infant, babies with greater symptoms of illness at age 4-6 weeks, formula feeding, younger maternal age, smoking, and fatigue. Prolonged breastfeeding is associated with a reduced risk of PPD but the mechanisms are not well understood. Interventions for PPD focusing on psychosocial risk factors have been largely unsuccessful, suggesting that the condition has a mainly biological basis. The hypothesis proposed for consideration is that breastfeeding protects against PPD by maintaining endogenous retinoids (vitamin A-related compounds) below a threshold concentration. In fact, breast milk is rich in retinoids; pregnant women accumulate retinoids in liver and breast in preparation for lactation; there is increasing evidence that retinoids in higher concentration are associated with cognitive disturbances and mood disorders, including depression and suicide; and prolonged lactation reduces maternal stores of retinoids. Consistent with this hypothesis, it is estimated that an amount of vitamin A is transferred from mother to infant during the first six months of exclusive breastfeeding equivalent to 76% of a dose known to cause acute vitamin A poisoning in an adult. Breastfeeding may thus have evolutionary-adaptive functions for both mother and infant, transferring vital nutrients to an infant unable to feed itself, yet at the same time providing a natural means of reducing potentially toxic concentrations of retinoids in the mother.

Psychological stress and breast diseases during lactation.

Termination of breastfeeding in the first six months after childbirth is frequently caused by breastfeeding-related diseases and problems of the breast such as pain, milk stasis or mastitis. The aim of this study was to evaluate the relationship between psychological stress and the occurrence of breastfeeding associated disorders. In a prospective cohort study of 379 primiparous women without breast anomalies or diseases, psychometric data were collected from participants between the confirmation of the pregnancy and one year post-partum. Primarily, standardised questionnaires (PSQ, WHO QoL and F-SOZU K22) were used for data analysis while additional data was gathered in follow-up interviews. The subgroup analysis showed a significant relationship between stress and breastfeeding-related diseases. Women with pain, cracked nipples, milk stasis or mastitis reported a higher stress level than women without breast problems. Additionally, the majority of women with breast problems and increased psychological stress gave up breastfeeding sooner and, in contrast to the group without problems, indicated significantly more frequently that the milk quantity was insufficient. Breast diseases during lactation are associated with higher levels of psychological stress. Further studies are needed to examine the causes of the higher stress in order to develop strategies to prolong breastfeeding duration.

Women's experience of lactational mastitis--I have never felt worse.

BACKGROUND: Mastitis is a common problem for breastfeeding women in the postpartum period. METHODS: Ninety-four breastfeeding women participating in a case control study of mastitis provided a free text comment about their experience of mastitis. Women were recruited from the emergency department, wards or breastfeeding clinics of the Mercy Hospital for Women and the Royal Women's Hospital, Melbourne, in 2002-2004. RESULTS: The main themes which emerged from the free text comments were: acute physical illness; negative emotions; life disrupted; to continue breastfeeding or not? A minor theme was 'support for mastitis research'. DISCUSSION: Women with mastitis often experience a rapid onset physical illness accompanied by strong negative feelings, which leads some women to consider stopping breastfeeding while others are determined to persevere. General practitioners need to provide emotional support for women with mastitis and acknowledge that breastfeeding may be difficult for new mothers.

Women's experiences of managing mastitis.

The first paper in this series (last month), discussed study methodology and the measurement of the incidence of mastitis, which was shown to peak at four and 12 weeks. It concluded that the reporting pattern by women experiencing mastitis affects the measurement of reported incidence. This paper presents the qualitative data generated through interviews with 56 women. It analyses their theories of causation that may account for the two peaks in incidence. Factors most likely to contribute to the risk of developing mastitis were identified by women as incorrect positioning and incomplete emptying. Expressing by hand or pump, and hurried or infrequent feeding patterns, were also thought to be practices associated with mastitis. They considered that these practices were associated with social pressures such as the care of older children. The study concluded that respondents' theories about causation illustrate the interactive nature of anatomical, physiological, pathological and social risk factors. The two peaks in incidence occur at times when the intensity of this interaction increases. Existing research findings support these theories and present opportunities to change and develop professional practice.

[Mastitis puerperalis - causes and therapy]. / Mastitis puerperalis - Ursachen und Therapie. Ein Beitrag zum Umdenken.

Between 1995 and 2003 a total of 1 827 women suffering from puerperal mastitis was studied. Etiology of the disease was defined, white cell counts and microbiologic cultures were obtained. According to the results the illness was classified and treated. Since in all cases we found either simple congestion or non-infectious inflammation of the breast treatment consisted of intensified emptying of the breast by breast feeding every 2 hours and in some cases additional manual expression of milk. Antibiotics and bromocriptine were not used. In 1 826 cases fever and flue symptoms had resolved within 25-36 hours. Redness and soreness had resolved within 2-3 days. Relapse did not occur and none of the women developed an abscess. One woman had to be treated with antibiotics because the baby refused to nurse at the diseased breast and emptying had to be done by hand.

Lactation mastitis: a descriptive study of the experience.

This descriptive study of 31 women diagnosed with lactation mastitis in the midwestern United States investigated mastitis symptomatology, self-care and treatment, burden of mastitis, and symptom recurrence and complications. Data collected via telephone interviews soon after diagnosis and daily through the seventh day after symptom onset documented that symptom intensity was moderate, peaked on the second day, and lasted on average 3 to 4 days. Symptoms had greater impact on activities of daily living than on breastfeeding. Sources of advice for self-care included lactation consultants, nurses, nurse practitioners, physicians, family, and friends. Continued breastfeeding was the most frequently used of several self-care practices and was rated as highly effective. Follow-up at 2 and 6 weeks established mastitis recurrence as the most common complication. Breastfeeding women need specific information about mastitis causes, symptoms, and self-care strategies to help prevent and treat the condition.

The role of nitric oxide and prostaglandin signaling pathways in spinal nociceptive processing in chronic inflammation.

Both nitric oxide (NO) and prostaglandins (PG) and their associated enzymes nitric oxide synthases (NOS) and cyclooxygenases (COX) (specifically COX-2) have been implicated in the development of hyperalgesia. This study examined the effects of naturally occurring chronic inflammation, chronic mastitis, on spinal nociceptive processing in sheep and focused on potential alterations in spinal PG and NO signaling pathways. Mechanical withdrawal thresholds were significantly lower in animals suffering from chronic inflammation (n=6) compared to control animals (n=6). Hyperalgesia was restricted to the side contralateral to the inflammation (decrease from ipsilateral side: hindlimb 33.2+/-5%, forelimb 19.4+/-5%). Neuronal NOS-immunoreactivity was significantly reduced bilaterally in lumbar and cervical spinal cord throughout laminae I-III (decrease 18.4+/-5% and 16.9+/-4%, respectively) and in lamina X (decrease 29.1+/-6% and 17.1+/-4%, respectively) in mastitic animals relative to control animals. No difference was detected in eNOS or iNOS-immunoreactivity or in NADPH-diaphorase staining, a marker of dynamically active NOS. RT-PCR failed to detect any change in levels of nNOS, eNOS, iNOS, COX-1 or COX-2 mRNAs. However, a marked increase in the PGE receptor, EP(3) (but not EP(2)) mRNA was detected in ipsilateral spinal cord tissue from animals with chronic inflammation. This increase in EP(3) receptor expression indicates that spinal PGs are important in the spinal response to chronic peripheral inflammation. Contralateral mechanical hyperalgesia may not be directly linked to changes in spinal EP(3) receptor mRNA expression, however, the bilateral changes in nNOS suggest that this pathway may contribute to the adaptive behavioural response observed.

Incidence of mastitis in breastfeeding women during the six months after delivery: a prospective cohort study.

OBJECTIVES: To estimate the incidence of mastitis in breastfeeding women during the first six months after delivery, and to identify the healthcare services used and treatments received by women with mastitis. DESIGN: A prospective cohort study with questionnaire and telephone follow-up. SETTING: A teaching hospital and the only private hospital offering obstetrics at the time of the study in the Lower Hunter Region, New South Wales. PARTICIPANTS: 1075 women in postnatal wards following delivery of a single infant who were breastfeeding at the time of recruitment. RESULTS: 233 women returned a questionnaire indicating they believed that they had developed mastitis during follow-up. Of these, 219 had mastitis by the study criteria, giving an estimated crude incidence of 20% (95% CI, 18%-22%) in the six months after delivery. Most cases of mastitis (75%) occurred within seven weeks after delivery. Multiple episodes of mastitis were reported by 63 women: 27 reported three or more episodes during six months. 160 women (73%) reported consulting a general practitioner about their mastitis. Despite National Health and Medical Research Council guidelines that antibiotics be continued for 10 days, 148 (87%) of the 170 women who were prescribed antibiotics for the first episode of mastitis took them for less than 10 days. CONCLUSIONS: A large proportion (20%) of women who were breastfeeding developed mastitis in the six months after delivery. As general practitioners are commonly consulted about mastitis, it is important that they know how to diagnose and treat this condition.

[Differential neuroleptic treatment of schizophrenic psychoses in puerperium: advantages of the atypical neuroleptic clozapine]. / Differentielle Neurolepsie bei schizophrenen Psychosen im Wochenbett: Vorteile des atypischen Neuroleptikums Clozapin.

Clozapine is an atypical neuroleptic drug characterised by specific pharmacological properties and clinical side effects, which are different from those observed with conventional neuroleptics such as drugs of the phenothiazine or butyrophenone classes. This report suggests a new clinical indication for clozapine, based on its negligible influence on plasma prolactin levels: the pharmacotherapy of schizophrenic psychoses in the post-partum period and in patients suffering from acute mastitis.

A descriptive study of lactation mastitis in long-term breastfeeding women.

This descriptive retrospective study surveyed women attending two lactation/breastfeeding conferences about their experiences with mastitis. One-third of the sample reported having mastitis while breastfeeding their last child. Episodes of mastitis occurred most often in the first three months postpartum; however, one-third occurred after six months and nearly one-quarter occurred after one year of breastfeeding. The outer upper quadrants of both breasts were found to be the most frequent sites of infection. The incidence of mastitis in the left and right breasts did not differ. More than one-third of the respondents did not contact their physician when they developed mastitis and and nearly half never used antibiotics for the infection. All respondents reported continuing to breastfeed through the infection. Mothers reported that the following factors (in order of importance) preceded their mastitis: fatigue, stress, plugged duct, change in the number of feedings, engorgement/stasis, an infection in the family, breast trauma and poor diet. Study findings indicate that the most important teaching areas for preventing mastitis are management and control of stress and fatigue.

[Recurrent mastitis with an unusual etiology]. / Rezidivierende Mastitis mit ungewöhnlicher Atiologie.

We present the diagnostic and therapeutic problems in a patient presenting with recurrent, refractory necrotising mastitis that was caused by artifacts.