Prevalência de aleitamento materno exclusivo após internação em unidade de cuidados neonatais
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OBJECTIVES: Define the prevalence of exclusive breastfeeding among patients that received discharge in breastfeeding, exclusive or complementing with formula, 15 days after discharge from the neonatal unit and the related factors. METHODS: Observational, descriptive, prospective study, including newborns hospitalized in the Neonatal Unit who were discharged in breastfeeding, exclusive or mixed with formula, during the period from May to July, 2019. Fifteen days after hospital discharge, it was made a phone contact to the mother asking about the type of feeding in that moment. RESULTS: The prevalence of exclusive breastfeeding 15 days after hospital discharge was 62.3%. Birthweight and gestational age were significantly higher and the length of stay was smaller in the group being exclusively breastfed 15 days after discharge (p<0.05). There was a positive correlation between exclusive breastfeeding by hospital discharge and exclusive breastfeeding 15 days after discharge (p<0.05). CONCLUSION: Initiating and maintaining breastfeeding for newborns who need hospitalization for healthcare is a challenge and requires all the efforts in terms of structure and process. Factors such as birthweight, gestational age and length of hospital stay have influence on the prevalence of breastfeeding after discharge. Exclusive breastfeeding by the hospital discharge has favored breastfeeding 15 days after discharge.Keywords:
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We tested the hypothesis that the use of supplemental oxygen (sO2) at discharge from the NICU in extremely preterm neonates is associated with a greater risk of neurodevelopmental impairment (NDI) at 18 months corrected gestational age (CGA) than the risk of NDI of those neonates discharged in room air. Four hundred twenty-four charts were retrospectively reviewed from infants born at <27 weeks and transferred to Nationwide Children's Hospital from December 1, 2004 to June 14, 2010. Use of sO2 was evaluated on day of life (dol) 28, at 36 weeks post-menstrual age (PMA), and at discharge. Logistic regression was used to identify postnatal risk factors associated with sO2 at discharge and NDI. At dol 28, 96 % of surviving patients received sO2, and therefore had bronchopulmonary dysplasia (BPD) by definition from a National Institutes of Child Health and Human Development workshop. At 36 weeks PMA, 89 % continued on sO2 (moderate/severe BPD), and at discharge, 74 % continued on sO2. When factors associated with NDI were examined, the need for mechanical ventilation ≥28 days (adjOR = 3.21, p = 0.01), grade III-IV intraventricular hemorrhage (IVH) (adjOR = 4.61, p < 0.01), and discharge at >43 weeks PMA (adjOR = 2.12, p = 0.04) were the strongest predictors of NDI at 18 months CGA. There was no difference in Bayley Scales of Infant Development, third edition composite scores between patients with no/mild BPD and patients with moderate/severe BPD (cognitive p = 0.60, communication p = 0.53, motor p = 0.19) or those scores between patients on and off oxygen at discharge (cognitive p = 0.58, communication p = 0.70, motor p = 0.62).The need for sO2 at discharge is not associated with an increased risk of NDI in these patients. The strongest predictors of poor neurodevelopmental outcome in this population were prolonged positive pressure support, grade III-IV IVH, and discharge at >43 weeks PMA.
Bronchopulmonary Dysplasia
Toddler
Hospital discharge
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Objective To update the evidence published in a previous systematic review and meta-analysis that compared the effect of breastfeeding on risk of coeliac disease (CD). Material and methods A systematic review of observational studies published between 1966 and May 2004 on the subject was conducted in 2005. This update is a systematic review of observational studies published between June 2004 and April 2011. Pubmed, EMBASE and Cinahl were searched for published studies that examined the association between breastfeeding and CD. Results After duplicates were removed 90 citations were screened. Four observational studies were included in the review. Two of three studies which had examined the duration of breastfeeding and CD reported significant associations between longer duration of breastfeeding and later onset of CD (OR ranged from 0.18 to 0.665). Breastfeeding during the introduction of gluten to the infant was reported to have a protective effect in two studies. Conclusions Our findings support previous published findings that breastfeeding seems to offer a protection against the development of CD in predisposed infants. Breastfeeding at time of gluten introduction is the most significant variable in reducing the risk. Timing of gluten
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To assess of the time of breastfeeding initiation, identify reasons for delay, if any and to assess if any prelacteal feeds were offered.An observational study was conducted among the inpatients of a tertiary care centre in Bhubaneswar, India. A total of 385 mothers, without contraindications to breastfeeding were interviewed at the earliest after childbirth.Only 36.4% mothers initiated breastfeeding "timely." Those who had undergone vaginal delivery scored better than cesarean sections with 41.3% (CI 95%; P = 0.016). Rooming in helped at 37.6% (CI 95%; P = 0.006). Multiparous homemakers from nuclear families and those who had previously breast fed initiated earlier than their counterparts. Less than 5% (CI 95%; P = 0.056) offered prelacteal feeds, mostly water.Our study reveals an alarming decline in the timely initiation of breastfeeding in Odisha, India from 68.5% to 41.6%.
Tertiary care
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The aims of this PhD thesis were: 1. Primarily to investigate the effect, of adding human milk fortifier to mother's milk while breastfeeding very preterm infants after hospital discharge, on growth until 1 year corrected age (CA) 2. Secondarily to describe breastfeeding rate and factors associated with breastfeeding among very preterm infants at hospital discharge. 3. To describe possible feeding-problems during the intervention-period, and allergic diseases during the first year of life, among very preterm infants related to their nutrition after hospital discharge. 4. To describe the content of macronutrients in human milk from mothers delivering very preterm. This PhD thesis is based on a prospective, randomized, and controlled interventional birth cohort study. A total of 633 very preterm infants with a gestational age (GA) ≤ 32 + 0 weeks were recruited consecutively from July 2004 until August 2008 of whom 157 were excluded due to diseases or circumstances influencing nutrition. Further 156 refused participation in the interventional part of the study, but data on breastfeeding, weight, and some epidemiological data until discharge were available. Results on breastfeeding rate at discharge were therefore based on data from 478 infants, and parents of 320 infants accepted participation in the intervention study. Of these 320 infants, 207 were exclusively breastfed and they were shortly before hospital discharge randomized to either breastfeeding without (group A) or with fortification (group B) until 4 months CA. Infants (n = 113) who were bottle-fed at discharge (group C) were given a preterm formula (PF) until 4 months CA. Infants were examined at the outpatient clinics at term, and at 2, 4, 6, and 12 months CA, where parameters on growth, allergic diseases, possible feeding problems, blood-samples, and milk samples were obtained. Data on duration of exclusively breastfeeding and time of introduction to formula and/or complementary food were also recorded. Among the 478 infants 60% (n = 285) were exclusively breastfed, 35% (n = 167) were exclusively bottle-fed, and 5% (n=26) were both breast- and bottle-fed at discharge. Compared to mothers in lower social groups and mothers who smoked, mothers in higher social groups and "non-smokers" were significantly (p = 0.000 and p = 0.003 respectively) more often breastfeeding their very preterm infants at discharge. Single birth infants tended more often to be breastfed (p = 0.09). Infant age at discharge and duration of hospitalization did not influence breastfeeding at discharge. Increase in weight Z-score from birth to discharge was largest in the bottle-fed group compared to the breastfed group (p = 0.000), probably due to feeding practice the last week(s) of hospitalization. In the intervention study, 207 exclusively breastfed very preterm infants were randomized to group A (n = 102) and B (n = 105) respectively. The duration of breastfeeding was not influenced by fortification of mother's milk after hospital discharge. There was no significant difference on growth comparing group A and B at 12 months CA. Both boys and girls in group C achieved catch-up in weight and length earlier as compared to group A and B. Per protocol (PP) analysis showed that girls, but not boys, were longer and had a larger head circumference but were not heavier in group B (n = 51) compared to group A (n = 73) at 2 and 4 months CA (p<0.05). Protein-concentration in mothers' milk declined significantly from 2 weeks (1.8 g/100 ml) to 6 weeks after birth (1.4 g/100 ml) and declined further to 1.2 g/100 ml 12 weeks after birth. The incidence and the prevalence at 12 months CA of recurrent wheezing was 39.2% and 32.7% respectively, while atopic dermatitis was 18.0% and 12.1% respectively. Predisposition to allergic disease increased the risk of developing atopic dermatitis (p = 0.04) (OR 2.6 (95% CI 1.0-6.4)), and the risk of developing recurrent wheezing (p = 0.02) (OR 2.7 (95% CI 1.2-6.3)). Boys had an increased risk of developing recurrent wheezing (p = 0.003) (OR 3.1 (95% CI 1.5-6.5)). In conclusion breastfeeding can successfully be established in very preterm infants. Fortification of human milk after hospital discharge while breastfeeding was possible without influencing the duration of breastfeeding. Fortification in the amount given in this study did, however, not affect growth significantly at 1 year of age. An increased amount of protein was correlated with increased BUN-values indicating a better growth potential. Fortification of mother's milk or preterm formula was not associated with an increased risk of developing allergic diseases. Future follow-up of this cohort investigating e.g. growth, allergic diseases, and neuropsychological development is planned at 6 years of age. The definition of optimal growth and nutrition of preterm infants is though still a question for debate and further investigations are needed.
Hospital discharge
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A follow-up study, to compare the short-term outcome of preterms, in two hospitals in Al Qassim region, Saudi Arabia.Preterms admitted in two hospitals, 47 in hospital A and 36 in hospital B, were followed from admission until one month after discharge. Preterms were compared on gestational age, birth weight, birth head circumference and length of stay. Outcome measures were weight gain per day, feeding patterns on discharge and feeding patterns one month after discharge compared with the feeding of normal infants (200 infants) at the age of 6 weeks.No difference was found between the two hospitals on admission in gestational age, mean birth weight, birth head circumference and length of stay. Mean weight gain per day was significantly higher in hospital A, 9.56 (± 19.7) gm, compared to 1.22 (± 29.47) gm in hospital B. (P=0.049). But the proportion of exclusive breast fed infants, one month after discharge was higher in hospital B, 37.5% compared to 13.2% in hospital A. (p=0.0224).Our study showed that there is a clear hospital level difference in the same region, in the short-term outcome. This emphasizes that outcome should be continuously followed and that differences should be evaluated in perinatal audit procedure.
Neonatology
Hospital discharge
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Background. Available evidence suggests that prolonged and exclusive breastfeeding is associated with lower infant weight and length by 6 to 12 months of age. This evidence, however, is based on observational studies, which are unable to separate the effects of feeding mode per se from selection bias, reverse causality, and the confounding effects of maternal attitudinal factors. Design/Methods. A cluster-randomized trial in the Republic of Belarus of a breastfeeding promotion intervention modeled on the World Health Organization (WHO)/UNICEF Baby-Friendly Hospital Initiative versus control (then current) infant feeding practices. Healthy, full-term, singleton breastfed infants (n = 17 046) weighing ≥2500 g were enrolled soon after birth and followed up at 1, 2, 3, 6, 9, and 12 months old for measurements of weight, length, and head circumference. Data were analyzed according to intention-to-treat, while accounting for within-cluster correlation. To assess the potential for bias in observational studies of breastfeeding, we also analyzed our data as if we had conducted an observational study by ignoring treatment, combining the 2 randomized groups, and comparing 1378 infants weaned in the first month and those breastfed for the full 12 months of follow-up with either ≥3 months (n = 1271) or ≥6 months (n = 251) of exclusive breastfeeding. Results. Infants from the experimental sites were significantly more likely to be breastfed (to any degree) at 3, 6, 9, and 12 months and were far more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%). Mean birth weight was nearly identical in the 2 groups (3448 g, experimental; 3446 g, control). Mean weight was significantly higher in the experimental group by 1 month of age (4341 vs 4280 g). The difference increased through 3 months (6153 g vs 6047 g), declined slowly thereafter, and disappeared by 12 months (10564 g vs 10571 g). Analysis by z scores confirmed that infants in both groups gained more weight than the WHO/Centers for Disease Control and Prevention reference, with no evidence of undernutrition in the control group. Length followed a similar pattern. In the observational analyses, infants weaned in the first month were slightly lighter and shorter at birth and their weight-for-age and length-for-age z scores declined by 1 month, but they caught up to both experimental and the other observational groups by 6 months and were heavier and longer by 12 months. Among infants in the 2 prolonged and exclusive breastfeeding groups, weight-for-age z scores fell slightly between 3 and 12 months; length-for-age fell below the reference by 6 months with catch-up to the reference by 12 months. Head circumference showed no significant differences at any age between the 2 trial groups or among the observational groups. Conclusions. Our data, the first in humans based on a randomized experiment, suggest that prolonged and exclusive breastfeeding may actually accelerate weight and length gain in the first few months, with no detectable deficit by 12 months old. These results add support to current WHO and UNICEF feeding recommendations. Our observational analysis showing faster weight and length gains with early weaning and slower gains with prolonged and exclusive breastfeeding may reflect unmeasured confounding differences or a true biological effect of formula feeding.
Breastfeeding Promotion
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Background: Ankyloglossia is due to the short lingual frenulum. It has been associated with an increased incidence of breastfeeding difficulties. The aim of our study was to determine the association between ankyloglossia and breastfeeding difficulties in healthy full term newborns.Methods: We assessed 504 full term newborns admitted in post-natal care ward for presence of ankyloglossia, severity and associated breast feeding difficulties using the Hazelbacker‘s tool, Kotlow classification and breastfeeding observation form respectively. Mother and baby were observed in postnatal ward for breastfeeding problems during their hospital stay for at-least 48 hours and thereafter till day seven of life in admitted babies and by telephonic contact if discharged earlier. All mothers were counselled regarding breastfeeding.Results: The incidence of AG was found to be 11.71% (59/504) with male predominance (Male: Female- 1.57:1). Breastfeeding difficulties were encountered in 13 (22.03%) neonates with AG. Majority of babies with breastfeeding difficulties had mild (Class I) ankyloglossia (69.2%) and rest had moderate AG. Breastfeeding difficulty was related to mother's position in 38.5%, baby's position in 30.8%, latching difficulty in 100%, suckling difficulty in 84.6% and associated with mother's breast problems in 23.1%. All these feeding problems were observed during 24-48hours, which persisted in 92.3% for 48-72 hours and 76.9% during 72-96 hours of life but were not observed on day of life seven on follow up.Conclusions: Breastfeeding problems associated with mild or moderate ankyloglossia are usually transient and it can be resolved with prompt and appropriate counseling, unless AG is complete or severe type.
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Abstract Background: Under modern health care, human breast milk is considered the healthiest form of milk for babies. It also promotes the health of both mother and infant and helps to prevent disease.1 WHO states that, the vast majority of mothers can and should breast feed, just as the vast majority of infants can and should be breast fed.5 Purpose: The current study has aimed to determine the breastfeeding success among postnatal mothers. Methods: A descriptive survey approach was conducted on 50 postnatal mothers who were in the postnatal wards of a selected hospital. Observational checklist with 26 items were utilized to collect data. Results: Through descriptive analysis it was found that majority (44%) of mothers were in the age group of 20 – 25 years. Majority (68%) were Hindus. In type of delivery 84% had full term normal delivery. With regards to parity, 44% were multis. In relation to sex of the baby, 68% were females. The condition of the mother and the baby after delivery was good and normal in 100%. An observational checklist on breastfeeding success shows that the success rate on breastfeeding was high. There were 4 items such as getting ready to feed, Latching on, Feed itself and after feed and each item had 4 to 8 specific items on observational checklists on breastfeeding which indicates that in most of the mothers breastfeeding was a success. By inferential statistics it was found that type of delivery is associated with breast feeding (P < 0.05). Since all other p values are more than 0.05 there was no association between those selected demographic variables with breast feeding at 5% level of significance. Conclusion:Breast feeding is an age-old practice among most of the post-natal mothers to feed their young ones. In India, most of the mothers, practice giving breast milk to babies for about 1 to 2 years. Assistance by the health workers is not much sought as most of the bystanders assist the mothers in breast feeding. In the present study also, we have come across mothers successfully breastfeeding their babies and they are contented.
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