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1.
BMJ Open ; 10(5): e033101, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32404385

RESUMO

INTRODUCTION: Mothers with diabetes face unique challenges associated with breastfeeding initiation and maintenance. Antenatal breastmilk expression (BME) may be suggested to mothers, including mothers with diabetes, to improve breastfeeding, maternal, and infant outcomes postpartum. However, there have been few evaluations of the potential harms and benefits of this practice. The objective of our scoping review will be to broadly examine the literature describing maternal and infant outcomes of antenatal BME. METHODS AND ANALYSIS: This scoping review will address the research question: 'Among women who engaged in antenatal BME, what maternal and infant outcomes have been evaluated?' A search of published and unpublished studies available in English will be conducted in February 2020 using the following databases: Medline (OVID), Embase (OVID), CINAHL (EBSCOHost), and Cochrane Database of Systematic Reviews (OVID). A search of the British Library E-Theses Online Services (EThOS) database and OpenGrey will be conducted to identify relevant grey literature. This scoping review will use a five-step framework to guide the selection, extraction, and analysis of eligible studies. Clinical consultation will be included as a sixth step to our methodology. Literature reporting on the effect of antenatal BME on maternal and infant outcomes, breastfeeding initiation and duration, and the experiences of women who have engaged in the practice will be considered. The data will be summarised with attention paid to high-risk obstetrical populations such as women with diabetes. Our results will be reported as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. ETHICS AND DISSEMINATION: Research ethics board approval will not be required due to the nature of the study's methodology. The results of this review will be disseminated through peer-reviewed publication and presentation at relevant conferences. TRAIL REGISTRATION NUMBER: Open Science Framework (osf.io/gfp2q).


Assuntos
Aleitamento Materno/métodos , Extração de Leite/métodos , Diabetes Gestacional/epidemiologia , Período Pós-Parto/fisiologia , Extração de Leite/efeitos adversos , Feminino , Humanos , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Saúde Materna/estatística & dados numéricos , Gravidez , Gravidez de Alto Risco/fisiologia , Projetos de Pesquisa , Fatores de Risco
2.
Breastfeed Med ; 14(10): 705-711, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31483146

RESUMO

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.


Assuntos
Aleitamento Materno/métodos , Extração de Leite , Mama , Inflamação , Dor , Adulto , Pesos e Medidas Corporais/métodos , Mama/patologia , Mama/fisiopatologia , Extração de Leite/efeitos adversos , Extração de Leite/instrumentação , Extração de Leite/métodos , Feminino , Humanos , Inflamação/diagnóstico , Inflamação/etiologia , Mamilos/patologia , Tamanho do Órgão , Avaliação de Resultados em Cuidados de Saúde , Dor/diagnóstico , Dor/etiologia
4.
Matern Child Nutr ; 14(1)2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28752645

RESUMO

Caesarean section is associated with weaker newborn suction pressure. This nonblinded, randomized trial explored the effect of suction pressures generating by a breast pump on mothers' onset of lactation and milk supply after caesarean section. A high pressure group (-150 mmHg), a low pressure group (-100 mmHg), and a control group (none) were generated under computer random assignment with concealed allocation in 2 tertiary hospitals. The breast pumping began within 2 hr after caesarean operation (6 times a day and 30 min per time) until onset of lactation. The primary outcomes were the timing of onset of lactation, milk supply, and mother's satisfaction in lactation, using both intention-to-treat and per-protocol analyses. The secondary endpoints were the pumping-related pain, nipple injury, and maternal fatigue. All 164 women randomized were included in analysis. The breast pumping at -150 mmHg optimally advanced the timing of the onset of lactation and increased daytime milk supply. The pumping also appeared to boost mothers' confidence in lactation. The results in the per-protocol population (n = 148) were consistent with those of intention-to-treat population (n = 164). However, the pumping aggravated maternal nipple pain and fatigue, though there was no statistical significance. The findings suggest that a higher pumping pressure within the range of normal vaginally born infant suction could promote onset of lactation and milk supply among mothers giving birth by caesarean section. The pumping could also enhance mothers' confidence in breastfeeding.


Assuntos
Extração de Leite/efeitos adversos , Cesárea/efeitos adversos , Lactação , Satisfação do Paciente , Autoimagem , Adulto , Povo Asiático , China , Fadiga/etiologia , Fadiga/fisiopatologia , Fadiga/prevenção & controle , Feminino , Humanos , Análise de Intenção de Tratamento , Mamilos/lesões , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/prevenção & controle , Pacientes Desistentes do Tratamento , Período Pós-Parto , Gravidez , Pressão/efeitos adversos , Índice de Gravidade de Doença , Centros de Atenção Terciária , Adulto Jovem
5.
Breastfeed Med ; 12(7): 398-400, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28622480

RESUMO

Several components of breast milk show circadian variability. It is likely that at least some of these macronutrients, hormones, and micronutrients produce circadian stimuli that enhance the well-being of breast-fed infants. Future research should determine whether high-risk infants benefit if breast milk is given during the same circadian phase as it was expressed.


Assuntos
Extração de Leite/métodos , Cronoterapia/métodos , Ritmo Circadiano/fisiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Proteínas do Leite/química , Leite Humano/química , Alimentação com Mamadeira , Extração de Leite/efeitos adversos , Ingestão de Energia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Lactação/fisiologia , Micronutrientes/química , Leite Humano/imunologia , Valor Nutritivo
6.
Lancet ; 389(10085): 2204-2213, 2017 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-28589894

RESUMO

BACKGROUND: Infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia, admission to a neonatal intensive care unit (NICU), and not being exclusively breastfed. Many clinicians encourage women with diabetes in pregnancy to express and store breastmilk in late pregnancy, yet no evidence exists for this practice. We aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy. METHODS: We did a multicentre, two-group, unblinded, randomised controlled trial in six hospitals in Victoria, Australia. We recruited women with pre-existing or gestational diabetes in a singleton pregnancy from 34 to 37 weeks' gestation and randomly assigned them (1:1) to either expressing breastmilk twice per day from 36 weeks' gestation (antenatal expressing) or standard care (usual midwifery and obstetric care, supplemented by support from a diabetes educator). Randomisation was done with a computerised random number generator in blocks of size two and four, and was stratified by site, parity, and diabetes type. Investigators were masked to block size but masking of caregivers was not possible. The primary outcome was the proportion of infants admitted to the NICU. We did the analyses by intention to treat; the data were obtained and analysed masked to group allocation. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000217909. FINDINGS: Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [<1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [<1%] of 315). INTERPRETATION: There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation. FUNDING: Australian National Health and Medical Research Council.


Assuntos
Extração de Leite/métodos , Diabetes Gestacional , Gravidez em Diabéticas , Adulto , Aleitamento Materno/estatística & dados numéricos , Extração de Leite/efeitos adversos , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Hipoglicemia/etiologia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/métodos , Fatores Socioeconômicos
7.
Public Health Nutr ; 20(3): 492-503, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27692019

RESUMO

OBJECTIVE: To investigate the prevalence and predictors of expressed breast-milk feeding in healthy full-term infants and its association with total duration of breast-milk feeding. DESIGN: Prospective cohort study. SETTING: In-patient postnatal units of four public hospitals in Hong Kong. SUBJECTS: A total of 2450 mother-infant pairs were recruited in 2006-2007 and 2011-2012 and followed up prospectively for 12 months or until breast-milk feeding had stopped. RESULTS: Across the first 6 months postpartum, the rate of exclusive expressed breast-milk feeding ranged from 5·1 to 8·0 % in 2006-2007 and from 18·0 to 19·8 % in 2011-2012. Factors associated with higher rate of exclusive expressed breast-milk feeding included supplementation with infant formula, lack of previous breast-milk feeding experience, having a planned caesarean section delivery and returning to work postpartum. Exclusive expressed breast-milk feeding was associated with an increased risk of early breast-milk feeding cessation when compared with direct feeding at the breast. The hazard ratio (95 % CI) ranged from 1·25 (1·04, 1·51) to 1·91 (1·34, 2·73) across the first 6 months. CONCLUSIONS: Mothers of healthy term infants should be encouraged and supported to feed directly at the breast. Exclusive expressed breast-milk feeding should be recommended only when medically necessary and not as a substitute for feeding directly at the breast. Further research is required to explore mothers' reasons for exclusive expressed breast-milk feeding and to identify the health outcomes associated with this practice.


Assuntos
Extração de Leite/efeitos adversos , Fenômenos Fisiológicos da Nutrição do Lactente , Mães/estatística & dados numéricos , Alimentação com Mamadeira , Cesárea/efeitos adversos , Feminino , Hong Kong , Humanos , Lactente , Fórmulas Infantis , Recém-Nascido , Período Pós-Parto , Gravidez , Estudos Prospectivos , Fatores de Tempo
8.
Matern Child Health J ; 20(9): 1895-903, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27067707

RESUMO

Objectives Lactational mastitis frequently leads to a premature abandonment of breastfeeding; its development has been associated with several risk factors. This study aims to use a decision tree (DT) approach to establish the main risk factors involved in mastitis and to compare its performance for predicting this condition with a stepwise logistic regression (LR) model. Methods Data from 368 cases (breastfeeding women with mastitis) and 148 controls were collected by a questionnaire about risk factors related to medical history of mother and infant, pregnancy, delivery, postpartum, and breastfeeding practices. The performance of the DT and LR analyses was compared using the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity and accuracy of both models were calculated. Results Cracked nipples, antibiotics and antifungal drugs during breastfeeding, infant age, breast pumps, familial history of mastitis and throat infection were significant risk factors associated with mastitis in both analyses. Bottle-feeding and milk supply were related to mastitis for certain subgroups in the DT model. The areas under the ROC curves were similar for LR and DT models (0.870 and 0.835, respectively). The LR model had better classification accuracy and sensitivity than the DT model, but the last one presented better specificity at the optimal threshold of each curve. Conclusions The DT and LR models constitute useful and complementary analytical tools to assess the risk of lactational infectious mastitis. The DT approach identifies high-risk subpopulations that need specific mastitis prevention programs and, therefore, it could be used to make the most of public health resources.


Assuntos
Aleitamento Materno/efeitos adversos , Árvores de Decisões , Modelos Logísticos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Aleitamento Materno/estatística & dados numéricos , Extração de Leite/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Recém-Nascido , Lactação , Mastite/diagnóstico , Mastite/etiologia , Mamilos/lesões , Período Pós-Parto , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco
9.
Midwifery ; 33: 82-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26552341

RESUMO

OBJECTIVE: this paper describes the use of breast pumps amongst a group of mothers of healthy term infants in Melbourne, Australia, between birth and six months post partum. DESIGN: a prospective cohort study; data were collected using structured questionnaires. PARTICIPANTS: 1003 postpartum women who had given birth to healthy infants at term were recruited from three Melbourne maternity hospitals between July 2009 and April 2011. Data were collected by face-to-face interview at recruitment and by telephone interview three and six months later. FINDINGS: at recruitment (24 to 48 hours post partum), 60% (605/1003) of women already had a breast pump. At two weeks post partum expressing was common; 62% (290/466) of women had expressed by this time, with 40% (186/466) doing so several times a day. By six months post partum 83% (754/911) of the women had a breast pump and 40% (288/715) were expressing, although most just occasionally. The most common reasons for any expressing in the first six months were 'to be able to go out and leave the baby' (35%; 268/772); milk supply 'not enough'(27%; 207/772); and having 'too much' milk (19%; 147/772). The increasing popularity of expressing breast milk to feed infants is not driven by women returning to the workforce, as only 10% of women (80/772) expressed because they had returned to paid employment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: health professionals should be aware that in some settings breast pump use is common in the first six months, and this is not always related to maternal workforce participation.


Assuntos
Aleitamento Materno , Extração de Leite/estatística & dados numéricos , Mães , Adulto , Aleitamento Materno/estatística & dados numéricos , Extração de Leite/efeitos adversos , Extração de Leite/instrumentação , Estudos de Coortes , Tomada de Decisões , Feminino , Humanos , Lactente , Recém-Nascido , Leite Humano , Mães/psicologia , Período Pós-Parto , Gravidez , Vitória
11.
Matern Child Nutr ; 12(2): 291-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25134622

RESUMO

For mothers with breastfeeding difficulties, pumping can be recommended to help establish milk production. However, pumping may present some barriers to successful breastfeeding. Mothers with milk supply concern may be at higher risk of barriers to successful breastfeeding. No previous studies have described experiences of pumping among mothers with milk supply concern. We conducted 10 focus groups of 56 mothers who had milk supply concern in the first month after birth. A paid, trained facilitator led groups in a semi-structured approach. Sessions were audiorecorded and transcribed verbatim. The transcripts were coded independently by two investigators and analysed using grounded theory. We identified five themes related to the experience of pumping among mothers with milk supply concern: (1) additional control over breastfeeding from pumping: 'I would feed and then give him … whatever I could manage to pump to him'. (2) Painful experience: 'The first time I pumped my boobs hurt so bad'. (3) Pumped volume affected milk supply concern: 'Pump and there was hardly anything coming out that's when I started to worry'. (4) Pumping interfered with other nurturing activities: 'While you're pumping, you can't touch the baby'. (5) Frustration from inconsistent provider advice: 'They told me to pump … and then said, "That's going to cause your milk to increase too much" '. Mothers had positive and negative experiences with pumping. Clinicians should assess a mother's experience shortly after she initiates pumping, as further management and counselling may be necessary to avoid barriers to successful breastfeeding.


Assuntos
Aleitamento Materno , Extração de Leite/psicologia , Leite Humano , Mães/psicologia , Extração de Leite/efeitos adversos , Extração de Leite/instrumentação , Aconselhamento , Feminino , Grupos Focais , Educação em Saúde , Humanos , Lactente , Recém-Nascido , Lactação
13.
Cochrane Database Syst Rev ; (7): CD010408, 2014 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-25074749

RESUMO

BACKGROUND: Some women with diabetes in pregnancy are encouraged to express and store colostrum prior to birthing. Following birth, the breastfed infant may be given the stored colostrum to minimise the use of artificial formula or intravenous dextrose administration if correction of hypoglycaemia is required. However, findings from observational studies suggest that antenatal breast milk expression may stimulate labour earlier than expected and increase admissions to special care nurseries for correction of neonatal hypoglycaemia. OBJECTIVES: To evaluate the benefits and harms of the expression and storage of breast milk during late pregnancy by women with diabetes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2014). SELECTION CRITERIA: All published and unpublished randomised controlled trials comparing antenatal breast milk expressing with not expressing, by pregnant women with diabetes (pre-existing or gestational) and a singleton pregnancy. DATA COLLECTION AND ANALYSIS: Two review authors independently evaluated reports identified by the search strategy. MAIN RESULTS: There were no published or unpublished randomised controlled trials comparing antenatal expressing with not expressing. One randomised trial is currently underway. AUTHORS' CONCLUSIONS: There is no high level systematic evidence to inform the safety and efficacy of the practice of expressing and storing breast milk during pregnancy.


Assuntos
Extração de Leite/efeitos adversos , Colostro , Diabetes Mellitus , Hipoglicemia/terapia , Doenças do Recém-Nascido/terapia , Gravidez em Diabéticas , Feminino , Humanos , Recém-Nascido , Gravidez
14.
BMC Pregnancy Childbirth ; 14: 195, 2014 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-24902596

RESUMO

BACKGROUND: The purpose of this study was to identify potential predisposing factors associated with human infectious mastitis. METHODS: We conducted a case-control study among breastfeeding women, with 368 cases (women with mastitis) and 148 controls. Data were collected by a questionnaire designed to obtain retrospective information about several factors related to medical history of mother and infant, different aspects of pregnancy, delivery and postpartum, and breastfeeding practices that could be involved in mastitis. Bivariate analyses and multivariate logistic regression model were used to examine the relationship between mastitis and these factors. RESULTS: The variables significantly- and independently-associated with mastitis were cracked nipples (P < 0.0001), oral antibiotics during breastfeeding (P < 0.0001), breast pumps (P < 0.0001), topical antifungal medication during breastfeeding (P = 0.0009), mastitis in previous lactations (P = 0.0014), breast milk coming in later than 24 h postpartum (P = 0.0016), history of mastitis in the family (P = 0.0028), mother-infant separation longer than 24 h (P = 0.0027), cream on nipples (P = 0.0228) and throat infection (P = 0.0224). CONCLUSIONS: Valuable factors related to an increased risk of infectious mastitis have been identified. This knowledge will allow practitioners to provide appropriate management advice about modifiable risk factors, such as the use of pumps or inappropriate medication. They also could identify before delivery those women at an increased risk of developing mastitis, such as those having a familial history of mastitis, and thus develop strategies to prevent this condition.


Assuntos
Aleitamento Materno/efeitos adversos , Mastite/etiologia , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Aleitamento Materno/estatística & dados numéricos , Extração de Leite/efeitos adversos , Candidíase/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Masculino , Mastite/epidemiologia , Mastite/genética , Mastite/microbiologia , Ejeção Láctea , Mamilos/lesões , Período Pós-Parto , Recidiva , Estudos Retrospectivos , Fatores de Risco , Dermatopatias Infecciosas/epidemiologia , Espanha/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Infecções Urinárias/epidemiologia , Doenças Vaginais/epidemiologia , Doenças Vaginais/microbiologia
15.
J Hum Lact ; 30(1): 62-72; quiz 110-2, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24166052

RESUMO

BACKGROUND: Benefits of using a breast pump are well documented, but pump-related problems and injuries and the associated risk factors have not been reported. OBJECTIVES: This study aimed to describe breast pump-related problems and injuries and identify factors associated with these problems and injuries. METHODS: Data were from the Infant Feeding Practices Study II; mothers were recruited from a nationally distributed consumer opinion panel. Mothers were asked about breast pump use, problems, and injuries at infant ages 2, 5, and 7 months. Survival analysis was used to identify factors associated with pump-related problems and injuries. RESULTS: The sample included 1844 mothers. About 62% and 15% of mothers reported pump-related problems and injuries, respectively. The most commonly reported problem was that the pump did not extract enough milk and the most commonly reported injury was sore nipples. Using a battery-operated pump and intending to breastfeed less than 12 months were associated with higher risks of pump-related problems and injury. Learning from a friend to use the pump was associated with lower risk of pump-related problems, and using a manual pump and renting a pump were associated with a higher risk of problems. CONCLUSION: Our results suggest that problems and injuries associated with breast pump use can happen to mothers of all socioeconomic characteristics. Breastfeeding mothers may reduce their risks of problems and injury by not using battery-operated pumps and may reduce breast pump problems by not using manual pumps and by learning breast pump skills from a person rather than following written or video instructions.


Assuntos
Extração de Leite/efeitos adversos , Mama/lesões , Adulto , Extração de Leite/instrumentação , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Estudos Longitudinais , Análise Multivariada , Modelos de Riscos Proporcionais , Fatores de Risco , Inquéritos e Questionários
16.
BMC Pregnancy Childbirth ; 13: 212, 2013 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-24246046

RESUMO

BACKGROUND: Expressing breast milk has become increasingly prevalent, particularly in some developed countries. Concurrently, breast pumps have evolved to be more sophisticated and aesthetically appealing, adapted for domestic use, and have become more readily available. In the past, expressed breast milk feeding was predominantly for those infants who were premature, small or unwell; however it has become increasingly common for healthy term infants. The aim of this paper is to systematically explore the literature related to breast milk expressing by women who have healthy term infants, including the prevalence of breast milk expressing, reported reasons for, methods of, and outcomes related to, expressing. METHODS: Databases (Medline, CINAHL, JSTOR, ProQuest Central, PsycINFO, PubMed and the Cochrane library) were searched using the keywords milk expression, breast milk expression, breast milk pumping, prevalence, outcomes, statistics and data, with no limit on year of publication. Reference lists of identified papers were also examined. A hand-search was conducted at the Australian Breastfeeding Association Lactation Resource Centre. Only English language papers were included. All papers about expressing breast milk for healthy term infants were considered for inclusion, with a focus on the prevalence, methods, reasons for and outcomes of breast milk expression. RESULTS: A total of twenty two papers were relevant to breast milk expression, but only seven papers reported the prevalence and/or outcomes of expressing amongst mothers of well term infants; all of the identified papers were published between 1999 and 2012. Many were descriptive rather than analytical and some were commentaries which included calls for more research, more dialogue and clearer definitions of breastfeeding. While some studies found an association between expressing and the success and duration of breastfeeding, others found the opposite. In some cases these inconsistencies were compounded by imprecise definitions of breastfeeding and breast milk feeding. CONCLUSIONS: There is limited evidence about the prevalence and outcomes of expressing breast milk amongst mothers of healthy term infants. The practice of expressing breast milk has increased along with the commercial availability of a range of infant feeding equipment. The reasons for expressing have become more complex while the outcomes, when they have been examined, are contradictory.


Assuntos
Alimentação com Mamadeira , Extração de Leite/estatística & dados numéricos , Índice de Massa Corporal , Aleitamento Materno , Extração de Leite/efeitos adversos , Extração de Leite/métodos , Emprego , Feminino , Humanos , Lactente , Mamilos/lesões , Dor/etiologia , Privacidade , Nascimento a Termo , Fatores de Tempo
17.
Aesthetic Plast Surg ; 37(5): 931-5, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23846021

RESUMO

BACKGROUND: Late seroma is a rare complication that may occur after a prosthetic breast augmentation. "Seroma" is a generic term used to indicate a serous clear fluid collection, which can develop in surgically dissected areas. A seroma can be defined as "late" if this complication occurs at least 4 months after surgery. Several possible etiologies have been proposed. METHODS: A 39-year-old old woman with breast implants presented with a huge enlargement of her right breast. Clinical and instrumental evaluation ruled out infection. The swelling was attributed to the presence of fluid adjacent to her implant and aspirated. Nonremission of the fluid collection after aspiration led the authors to surgical removal of the prosthesis, fluid drainage, and capsulectomy. The serous fluid and a portion of the removed capsule was subjected to chemical, cytologic, microbiologic, and anatomopathologic analysis. RESULTS: At the chemical evaluation, the sample of the seroma appeared to be an exudate. Cytologic examination of the fluid showed a large number of neutrophil cells but no malignant cells. Microbiologic evaluation and pathologic findings of the serum sample showed neither the presence of infection nor that of neoplastic infiltration. The postoperative period was uneventful, and the woman experienced no recurrence within 21 months after surgery. CONCLUSION: This report describes a case of late-onset implant seroma associated with a postpartum breast pump. The authors believe this case could be useful in diagnosing this rare complication and understanding its management. It also may serve to make physicians and nurse practitioners aware of the need for prompt evaluation and treatment.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Extração de Leite/efeitos adversos , Transtornos Puerperais/etiologia , Seroma/etiologia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Transtornos Puerperais/diagnóstico , Seroma/diagnóstico , Fatores de Tempo
18.
Arch Dis Child Fetal Neonatal Ed ; 97(1): F18-23, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21747129

RESUMO

OBJECTIVE: Breast pumping or hand expression may be recommended when newborns latch or suck poorly. A recent trial found worse outcomes among mothers who used a breast pump in the early postpartum period. The objective of this study was to compare bilateral electric breast pumping to hand expression among mothers of healthy term infants feeding poorly at 12-36 h after birth. DESIGN: Randomised controlled trial. SETTING: Well-baby nursery and postpartum unit. PATIENTS: 68 mothers of newborns 12-36 h old who were latching or sucking poorly were randomly assigned to either 15 min of bilateral electric pumping or 15 min of hand expression. MAIN OUTCOME MEASURES: Milk transfer, maternal pain, breastfeeding confidence and breast milk expression experience (BMEE) immediately after the intervention, and breastfeeding rates at 2 months after birth. RESULTS: The median volume of expressed milk (range) was 0.5 (0-5) ml for hand expressing mothers and 1 (0-40) ml for pumping mothers (p=0.07). Maternal pain, breastfeeding confidence and BMEE did not differ by intervention. At 2 months, mothers assigned to hand expression were more likely to be breastfeeding (96.1%) than mothers assigned to breast pumping (72.7%) (p=0.02). CONCLUSIONS: Hand expression in the early postpartum period appears to improve eventual breastfeeding rates at 2 months after birth compared with breast pumping, but further research is needed to confirm this. However, in circumstances where either pumping or hand expression would be appropriate for healthy term infants 12-36 h old feeding poorly, providers should consider recommending hand expression.


Assuntos
Aleitamento Materno , Extração de Leite/métodos , Comportamento Alimentar , Adulto , Atitude Frente a Saúde , Peso ao Nascer , Aleitamento Materno/psicologia , Extração de Leite/efeitos adversos , Extração de Leite/instrumentação , Extração de Leite/psicologia , Feminino , Idade Gestacional , Mãos , Humanos , Recém-Nascido , Lactação , Masculino , Leite Humano/metabolismo , Mães/psicologia , Avaliação de Resultados em Cuidados de Saúde , Dor/etiologia , Sucção/instrumentação , Sucção/métodos , Adulto Jovem
19.
J Res Health Sci ; 13(1): 43-7, 2012 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-23772006

RESUMO

BACKGROUND: Various reasons accounted for the infection of infants kept at Neonatal Intensive Care Unit (NICU). Expressed breast milk may be regarded as a source of infection in infants. This study investigated the source of bacterial contamination and the impact of educational interventions on the contamination of mothers' expressed breast milk (EBM) level whose infants are hospitalized at NICU. METHODS: Fifteen mothers used to express breast milking their infants admitted at NICU, involved in this study was conducted during October 2011-March 2012. Samples taken from hands, breast, pumps, breast milk, and milk storage containers and therefore 244 samples were prepared by sterile cotton swab and cultured on Blood Agar and EBM. After presenting enough training to mothers, cultures of the same positions were carried out again. Only those samples proved infected that number of their bacterial colonies exceeded 104 cfu / ml or even there was a growth of pathogenic organism. RESULTS: Before intervention 80% of mothers had infected by at least one sample that reduced to 36% after the intervention. Before intervention 25.4% of samples were contaminated; however after intervention, it reduced to 8.2%. The main source of contamination was milk containers and pumps; moreover, Pseudomonas, E-coli, and Klebsiella were among the most common bacteria of samples' contamination. CONCLUSION: The possibility of EBM contamination was relatively high but educational interventions might reduce the risk of prevalence.


Assuntos
Extração de Leite/métodos , Contaminação de Alimentos/prevenção & controle , Recém-Nascido Prematuro/imunologia , Leite Humano/microbiologia , Mães/educação , Extração de Leite/efeitos adversos , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal , Irã (Geográfico) , Leite Humano/fisiologia
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