Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
Background:Human colostrum has been used in a number of investigations when preterm human infants cannot, for any reason, breastfeed directly from their mothers. One of the growing fields in these investigations is colostrum therapy, which consists of exposing the oropharyngeal mucosa of these preterm newborns to small amounts of raw colostrum.Research Aim:To critically review the scientific evidence about colostrum therapy in premature infants and to explore its influences on the immune system.Methods:This systematic review was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). The following databases were searched for potentially eligible studies up to March 10, 2021: Medline, Scopus, Web of Science, Cochrane Library, Embase. Two reviewers independently screened all titles, abstracts, and full texts for eligibility.Results:A total of 12 studies with 996 participants were included. A significant difference in lactoferrin levels in the urine was found (SMD 0.70; 95% CI [0.03,1.36]; p = .04; I² = 65% two studies, 112 participants, very low-quality evidence).Conclusion:Colostrum seems to result in increasing lactoferrin levels in the urine of premature newborns after 1 week of intervention.Clinical Trial Registration:The study was registered at PROSPERO with the number CRD42017073624, submitted on August 9, 2017.

Journal of Human Lactation, Ahead of Print.
Background:There is an increasing prevalence of expressed human milk feeding. The reasons for expressed human milk feeding of healthy term infants may differ from those for preterm infants. The process of adopting expressed human milk feeding for healthy full-term infants has not been well-described in the existing literature.Research Aim:To describe the reasons for, and antecedents to, expressed human milk feeding among Chinese women who used a high proportion of expressed human milk for feeding.Methods:A descriptive, prospective cross-sectional qualitative design was used. Participants (N = 25) who used a high proportion of expressed human milk feeding were recruited from a larger perspective cohort study in two public hospitals in Hong Kong. Semi-structured, in-depth, one-to-one interviews were conducted 2017–2018. Data collection and thematic analysis were guided by the Breastfeeding Self-Efficacy Theory.Results:The authors conducted thematic analysis and identified six core themes: (1) perceived maternal roles; (2) breastfeeding role models; (3) negative feedback from social networks; (4) negative direct breastfeeding experiences; (5) expressed human milk feeding as a solution to a problem; and (6) advice from health care professionals to express human milk. These themes were consistent with the four antecedents of the Breastfeeding Self-Efficacy Theory (e.g., physiological and affective state, vicarious experiences, performance accomplishments, and verbal persuasion).Conclusions:The main reason for participants to feed expressed human milk was experiencing difficulties with direct breastfeeding. Expressed human milk feeding was used as an immediate solution for breastfeeding problems. Strengthening breastfeeding support in the early postpartum period may decrease the perceived need for human milk expression.

Journal of Human Lactation, Ahead of Print.
Background:The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991 to promote breastfeeding through hospital policy. Researchers have reported breastfeeding improvements after hospitals became “Baby-Friendly.” In Hong Kong, the first public hospital was designated as a Baby-Friendly Hospital in 2016.Research Aim:To examine the influence of the BFHI on breastfeeding by comparing breastfeeding outcomes in a study cohort recruited before the implementation of the BFHI and a cohort recruited after its implementation.Methods:This was a quasi-experimental interrupted time-series design. Two cohorts of mother-infant pairs (N = 2369) were recruited immediately postpartum from four public hospitals in Hong Kong and followed up prospectively. Comparisons were made in five of the BFHI steps experienced in both cohorts and the duration of any and exclusive breastfeeding.Results:A higher proportion of participants from the post-implementation cohort breastfed and breastfed exclusively at all follow-up periods. Participants in the pre-BFHI cohort, on average experienced 3.10 (SD = 1.42) of the BFHI steps, whereas the participants in the post-BFHI cohort experienced 3.59 (1.09) of the BFHI steps. Half of the participants discontinued any breastfeeding by 13 weeks in the pre-BFHI cohort; more than half in the post-BFHI cohort were still breastfeeding at 6 months postpartum (p < .001). Giving only human milk in the first 48 hr of delivery and not providing pacifiers or bottles were associated with lower risk of not exclusive breastfeeding in both cohorts.Conclusion:Implementation of the BFHI was associated with improvements in breastfeeding practices and outcomes.

Journal of Human Lactation, Ahead of Print.
Background:The feeding patterns of healthy newborns have been poorly described.Research Aim:To determine the feeding patterns of healthy term newborns soon after birth, and if these differed with sex, gestation, and mode of birth.Methods:This study was a prospective, longitudinal observational cohort study. Term, appropriately grown newborns (N = 66) were fed according to maternal choice and details were recorded. Data were analyzed using generalized Poisson regression for feeding frequencies, and mixed model regression of log-transformed data for durations.Results:The participants completing the study had a M = 3589 g (SD = 348 g) birthweight, with a gestation age of M = 40.1 (1.2) weeks. All participants were breastfed; 23 (35%) also received expressed human milk and 10 (15%) received formula. Participants had fewer feeding sessions on Day 1, (M = 7.3 [1.9] sessions/day) increasing to (M = 9.4 [2.4] sessions/day) by Day 3, then reducing to (M = 9.0 [2.2] sessions/day) on Day 5, p < .001. The overall duration of breastfeeding sessions varied widely (Mdn = 29 [range = 1–447] min). Feed frequency but not duration was higher in males than females (M = 8.9, SE = 0.2 vs. 8.1, 02, sessions/day, p = .03), in newborns born ≥ 40 weeks’ gestation (M = 8.9, SE = 0.3 vs. 8.2, 02, sessions/day, p = .04), and in newborns born by Caesarean section (M = 9.4, SE = 0.3 vs. 8.4, 02, sessions/day, for vaginal birth, p = .003).Conclusion:Feeding patterns of healthy term newborns vary widely, but frequency increases during the first 3 days, and is greater in males, newborns born late term, and born by Caesarean section.Clinical Trial Registration:The Australian and New Zealand Clinical Trials Registry Ref: ACTRN12615000986572. The study protocol is available online: http://hdl.handle.net/2292/32066

Journal of Human Lactation, Ahead of Print.
Background:Because of its many benefits, exclusive breastfeeding for 6 months is a common public health goal. However, only 44% of infants aged 0–6 months are exclusively breastfed worldwide and, in the United States, only 26% of infants are exclusively breastfed for 6 months. The restrictions imposed during the COVID-19 pandemic may have reduced these rates even further.Research Aim:To examine the differences in breastfeeding exclusivity and satisfaction before and during the COVID-19 pandemic.Methods:A cross-sectional, two-group survey design was used. Parents (N = 110) of infants born April 1 to December 31, 2019 (pre-pandemic; n = 69), or April 1 to December 31, 2020 (during the pandemic; n = 41), who received lactation support services from an urban academic breastfeeding clinic were surveyed.Results:Respondents who gave birth in 2020 (pandemic year) were no less likely to exclusively breastfeed for the first 6 months of their infant’s life compared to respondents who gave birth in 2019 (pre-pandemic year). After multivariable logistic regression, the odds of high breastfeeding satisfaction were 73% lower in respondents with infants born in 2020 than in respondents with infants born in 2019 (OR = 0.27, 95% CI [0.08, 0.89]). The strongest contributor to high breastfeeding satisfaction was a prenatal breastfeeding visit with an International Board Certified Lactation Consultant.Conclusions:Future research is needed to identify the specific pandemic-related factors that led to the difference in breastfeeding satisfaction between the two groups and to confirm the impact of prenatal International Board Certified Lactation Consultant visits on breastfeeding satisfaction.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding self-efficacy as a construct has been theoretically and empirically linked to exclusive breastfeeding in studies globally using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). However, its application in the Middle East and North Africa region is limited, as it has not been validated.Research Aims:To psychometrically validate the BSES-SF among a sample of mothers in the United Arab Emirates.Methods:We psychometrically evaluated the Arabic version of the BSES-SF using a sample of mothers (N = 457) residing in the United Arab Emirates. We used translation techniques, item-test and item-total correlations, confirmatory factor analysis, tests of reliability, and tests of validity.Results:Item-test correlations of scale items ranged from 0.67 to 0.84, while item-total correlations ranged from 0.58 to 0.81. The confirmatory factor model assessed the 14-item scale to be unidimensional with satisfactory model fit indices. Our findings suggested the Arabic-language version of the BSES-SF was a reliable measure (α = 0.95) with strong construct and discriminant validity. BSES-SF scores significantly predicted exclusive breastfeeding (aOR = 1.04; 95% CI [1.02, 1.08]) and exclusive duration (β = .06; 95% CI [0.4, 0.08]), which suggested strong predictive, validity after adjusting for parity, maternal age, maternal education, and study site.Conclusions:We have provided rigorous evidence that the BSES-SF is a valid and reliable measure of breastfeeding self-efficacy among Arabic-speaking women in the UAE. Interventions designed specifically to increase breastfeeding self-efficacy among Arabic-speaking women may be a mechanism to increase the suboptimal rates of breastfeeding exclusivity occurring in much of the MENA region.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Pacific Islanders in the United States have lower initiation rates and shorter duration of exclusive breastfeeding compared to other racial/ethnic groups.Research Aim:To describe infant feeding beliefs and experiences of Marshallese living in the United States.Methods:We used a prospective and cross-sectional exploratory, descriptive qualitative design with Marshallese participants (N = 36) residing in the United States between July 2019 and July 2020. Data were collected at 6–8 weeks postpartum. Our qualitative analytic approach integrated inductive and deductive techniques.Results:Participants’ mean age was 27.1 years (SD = 6.1), and 88.9% (n = 32) were born in the Marshall Islands. A majority of participants were single, widowed, or in an unmarried partnership (n = 28, 77.8%). Most participants had a high school education or lower (n = 30, 83.3%). Mean household size was 7.2 (SD = 2.8). Fewer than half of participants had no health insurance (n = 14, 38.9%), and almost all participants (91.7%) did not work at the time of data collection. Two themes emerged: 1) infant feeding initiation and practices; and 2) concerns over breastfeeding in public. The majority of participants’ infants received both human milk and formula. Participants described beliefs that breastfeeding in public was against American customs, which influenced their decision about breastfeeding in public.Conclusions:Our study was the first to document infant feeding beliefs and experiences of Marshallese living in the United States at 6–8 weeks postpartum. Findings will inform future health education programs.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding is beneficial to infants. However, cesarean section is reported to be a risk factor for unsuccessful breastfeeding.Research Aims:(1) To extract discriminating data from texture analysis of breast ultrasound images in the immediate postpartum period; and (2) to compare the analysis results according to delivery mode.Methods:A cross-sectional, prospective non-experimental design with a questionnaire and observational components was used. Participants (N = 30) were women who delivered neonates at a center from September 2020 to December 2020. The participants underwent ultrasound examination of bilateral breasts 7–14 days after delivery. Ultrasound images were collected for texture analysis. A questionnaire about breastfeeding patterns was given to the participants on the day of the ultrasound examination.Results:No significant differences were found in texture analysis between the breasts of participants who had undergone Cesarean section and vaginal deliveries. The mean volume of total human milk produced in 1 day was significantly greater in the vaginal delivery group than in the cesarean section group (M = 350.87 ml, SD = 183.83 vs. M = 186.20 ml, SD = 184.02; p = .017). The pain score due to breast engorgement measured subjectively by participants was significantly lower in the vaginal delivery group than in the cesarean section group (M = 2.8, SD = 0.86 vs. M = 3.4, SD = 0.63; p = .047).Conclusion:Texture analysis of breast ultrasound images did not demonstrate difference between the cesarean section and vaginal delivery groups in the immediate postpartum period; nevertheless, cesarean section was independently associated with less successful breastfeeding.

Journal of Human Lactation, Ahead of Print.
Background:The Coronavirus disease 2019 (COVID-19) pandemic emerged in December 2019 and spread rapidly worldwide. So far, evidence regarding the breastfeeding and rooming-in management of mothers with COVID-19 and their newborn infants is scarce.Research Aims:1) To assess the rate of exclusive breastfeeding at discharge among mothers with COVID-19 and their newborn infants managed either using a rooming-in or a separation regimen; and 2) to evaluate different neonatal outcomes, including the need for re-hospitalization related to COVID-19 among newborn infants in the two groups.Method:We conducted a retrospective two-group comparative observational study. The sample was participants with COVID-19 and their newborn infants (N = 155 dyads) between March 1, 2020, and April 30, 2021. Two time periods were outlined resulting from the two different clinical practices of mother–infant separation and rooming-in.Results:Within the sample, 145 (93.5%) were asymptomatic. All neonates had documented Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) test results, and six tested positive by reverse transcriptase polymerase chain reaction within 48 hr of life. The rate of exclusive breastfeeding was significantly higher (p < .0001) within the rooming-in group. Length of hospital stay was significantly lower (p = .001) within the rooming-in group.Conclusions:Protected rooming-in practice has proven to be safe and effective in supporting breastfeeding: None of the infants enrolled were hospitalized due to COVID-19 infection and the rate of exclusive breastfeeding at discharge was increased compared to those infants separated from their mothers.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:In 2019, 14.0% of infants in Thailand were exclusively breastfed up to 6 months of age. To increase exclusive breastfeeding, an objective assessment measure would be useful to maternity care providers for appraising the problems encountered by new mothers’ experiences with breastfeeding.Research Aims:To translate the Bristol Breastfeeding Assessment Tool from English into Thai; to assess the reliability and validity of the Thai Bristol Breastfeeding Assessment Tool; and to explore the relationship of a mother’s self-efficacy to successful breastfeeding.Methods:Using a methodological design, we purposively sampled 302 new mothers from two tertiary hospitals in Thailand who had given birth to a single baby with an uncomplicated vaginal birth. The Thai Bristol Breastfeeding Assessment Tool’s structure was examined using confirmatory factor analysis. Concurrent and convergent validity were assessed using the Thai LATCH instrument and Thai Breastfeeding Self-Efficacy Scale, respectively.Results:The inter-item Thai Bristol Breastfeeding Assessment Tool correlation coefficients were positive and strong. The correlation between scores of the Thai Bristol Breastfeeding Assessment Tool and Thai LATCH instrument were positive and strong and had acceptable concurrent validity. The confirmatory factor analysis model fit the Thai Bristol Breastfeeding Assessment Tool data perfectly and the Cronbach’s alpha coefficient had acceptable internal reliability.Conclusions:The Thai Bristol Breastfeeding Assessment Tool is a cross-culturally translated instrument equivalent to its English version and demonstrated acceptable validity and reliability. The instrument provides a mechanism for an objective assessment and monitoring system of optimal breastfeeding practices in Thai mothers with newborns.

Journal of Human Lactation, Ahead of Print.
In this issue’s Lactation Newsmakers: Documenting our History, we are featuring Elizabeth Hormann, who has been a force in breastfeeding advocacy globally for over a half century of counselling, teaching, and writing to create a better experience for breastfeeding mothers. Elizabeth Hormann was born and raised in the United States. She has a bachelor’s degree from Boston College (1967) and a master’s degree from Harvard University’s Graduate School of Education (1976). In 1972, she started training and lecturing at conferences, while raising her five breastfed children. Just after receiving her IBCLC in 1986, she changed continents moving to live and work in Germany. She was a role model, influencing the development of the IBCLC accreditation in Europe. Elizabeth Hormann was a pioneer in lecturing and sharing expertise during the 1980s, when there was a renewed interest in breastfeeding and a huge demand on breastfeeding education for health professionals. She helped to advance the Baby-Friendly Hospital Initiative (BFHI) in many countries, as a trainer and as an assessor. Over the years, she shared her expertise about relactation breastfeeding and infant feeding during emergencies. As the author and a translator of a number of breastfeeding books, her influence has been felt across Europe and Africa.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Galactagogues have been used for centuries to induce, maintain, or increase a mother’s milk supply. Recently, there has been an apparent increase in utilization and promotion of galactagogues, largely in the absence of data regarding their efficacy and safety. However, there is limited contemporary evidence about knowledge of these substances in the community or how and where individuals seek information.Research Aim:To evaluate knowledge about galactagogue use during breastfeeding among birth parents, including recognition of specific substances, perceptions of safety, and common information sources.Method:An online, prospective, cross-sectional survey of Australian birthing parents (N = 2055) who were currently breastfeeding or had previously breastfed their infants was conducted from September to December 2019. The survey included questions about recognition of galactagogues, perceptions of safety, and information-seeking behaviors.Results:Among participants, 47% (n = 882) were primiparous and 65% (n = 1,219) were currently breastfeeding. The most recognized galactagogues included lactation cookies (89%; n = 1,828), brewer's yeast (79%; n = 1,629), fenugreek (74%; n = 1,519), and domperidone (69%; n = 1,420). Respondents cited the internet (52%; n = 1,066), lactation support providers (46%; n = 951), midwives (42%; n = 873), general practitioners (39%; n = 802), and social media (35%; n = 714) as common information sources. Lactation support providers and breastfeeding helplines were commonly rated as helpful; whereas, general practitioners and community pharmacists were often rated as unhelpful. While most participants perceived galactagogues to be safe, herbal or dietary galactagogues were perceived to be safer than pharmaceutical galactagogues.Conclusions:Our Australian community survey of individuals with current or previous breastfeeding experience identified widespread recognition of galactagogue use, with participants reporting a broad range of information-seeking behaviors and generally perceiving galactagogues as being safe to use.

Journal of Human Lactation, Ahead of Print.
Background:Puerperal mastitis, as well as breast abscess, are common complications that can arise during the breastfeeding period. Acute-onset quadriplegia has been described as a complication of bacterial or viral infections. Here we report a case of puerperal breast abscess with transient acute-onset staphylococcal mediated quadriplegia.Main Issue:A 28-year-old lactating Caucasian woman presented at our tertiary perinatal center 31 days postpartum with weakness of all four limbs, the signs and symptoms of mastitis in her left breast and a possible breast abscess with redness, a painful breast lump, and fever. A few hours after admission, the participant developed a proximal quadriplegia.Management:The participant was admitted to the intensive care unit for monitoring. The neurologists treated her as a possible case of Guillain-Barré syndrome and administered intravenous immunoglobulin therapy for 5 days. The breast abscess was diagnosed via ultrasound and treated by regular aspiration of pus and intravenous antibiotic therapy with ampicillin and sulbactam as Staphylococcus aureus was isolated from breast abscess fluid. Fifteen days after the first symptoms the participant recovered completely and could breastfeed her son exclusively, even though she developed a galactocele on the affected side.Conclusion:We report a possible association between mastitis and abscess formation, common breastfeeding issues, and transient acute onset staphylococcal mediated quadriplegia. To the best of our knowledge this is the only case in the medical literature. Independent of the systemic complications, antibiotic treatment and regular abscess aspirations have proven to be a key strategy to the resolution of puerperal mastitis and breast abscess.