Journal of Human Lactation - online first articles

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.

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.
Late preterm infants have lower breastfeeding rates than term infants, yet few published interventions or guidelines exist to guide hospitals in managing them in the non-intensive nursery setting. Here we describe the development and implementation of an interdisciplinary, hospital-based, breastfeeding support program among late preterm infants not requiring intensive care. The Early Bloomer Program includes an order set applied at birth, immediate lactation consultation, availability of donor milk, parent education on late preterm infants, hand expression teaching and kit including spoon and video link, and daily interdisciplinary team huddles. The program was developed with staff input using Diffusion of Innovation Theory, and implemented first among early adopters before expanding to all postpartum nurses. Nursing staff received education on late preterm infant physiology and feeding, and trainings on the Early Bloomers program through various learning modalities during the year leading up to implementation. To further understand the strengths and weakness of the program, we surveyed nurses (n = 43). Nurses reported that they were more attentive to the needs of late preterm infants, more confident in their care, and more aware of possible complications and feeding needs. Areas noted in need of improvement included lack of overnight lactation consults and little involvement of labor and delivery staff in the program. The Early Bloomers program increased confidence in care and was well received by nurses. Well-designed clinical studies are needed to identify effective breastfeeding support practices for late preterm infants.

Journal of Human Lactation, Ahead of Print.
Background:Improving breastfeeding practices is a worldwide priority. Pharmacists have the opportunity to actively promote breastfeeding and educate parents as well as the general public about its benefits.Research Aims:The aims of this study are to investigate Jordanian pharmacists’ present breastfeeding support practices and perceptions regarding their need for education and training in breastfeeding support.Methods:To examine sociodemographic characteristics of community pharmacists in Jordan and their current breastfeeding support practices and educational needs, a descriptive cross-sectional online (self-report) survey was conducted. Through social media, pharmacists working in community pharmacies in Jordan were recruited between August 2021 and February 2022. The level of breastfeeding support participants had been provided with was measured using eight items in a 5-point Likert scale ranging from 5 (Always) to 1 (Never). Each participant self-reported the frequency of advice/information given to breastfeeding women in each of these areas. Univariate and multivariable linear regression models were used to identify factors associated with the level of breastfeeding support.Results:Participants (N = 381) reported a high level of breastfeeding support, but expressed a need for training and education for further improvement. The breastfeeding support score of female participants was found to be 0.12 higher than that of males (Beta = 0.12, p = .02), 0.16 higher in married participants compared to non-married participants (Beta = 0.16, p = .03), and 0.10 higher in participants working in rural areas compared to those working in urban areas (Beta = 0.10, p = .04).Conclusion:While community pharmacists generally report a high level of breastfeeding support, our findings revealed demographic differences. Attention to specific areas of need might enhance what pharmacists could offer; however, additional research would be required to guide the specific educational content.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Introduction:Human lactation should be taken into account as an important issue for the international agenda. Despite advances in lactation information and knowledge, insufficient milk production is still a concern for mothers and health practitioners, including International Board Certified Lactation Consultants and others. Primary hypogalactia, or insufficient milk production is uncommon, but should be considered when there is poor weight gain and decreased urine output in infants despite good latch-on and suckling, or anatomic differences in the physical exam of the lactating breast.Main Issue:This case series presents three cases illustrating insufficient milk production resulting in infants who experienced significant dehydration and poor weight gain.Management:Primary hypoplasia was diagnosed by means of a thorough interview and physical examination that entailed a consultation with a physician who was also an International Board Certified Lactation Consultant.Conclusion:Awareness of an infant’s feeding needs and proper evaluation of a child’s health status is paramount if health care providers are to identify the important factors contributing to breastfeeding problems. In some instances, breastfeeding goals cannot be achieved, and then the provider’s role becomes support in coming to terms with persistent insufficient milk production, and coordinating appropriate supplementation to meet each baby’s nutritional needs.

Journal of Human Lactation, Ahead of Print.
Background:Wet nursing and human milk banks are vital sources of human milk for infants unable to breastfeed.Research Aim:This study aims to determine the knowledge and opinions of neonatal intensive care unit nurses regarding wet-nursing and human milk banks in Türkiye.Methods:This descriptive cross-sectional study was conducted with 219 neonatal intensive care unit nurses using an online survey comprising 20 questions. The data were collected between August and September 2021.Results:Among the participants, 64.4% (n = 141) expressed that they would be a wet-nurse and 59.8% (n = 131) would search for a wet-nurse if necessary. Some, 47.0% (n = 103) of participants did not know if there were any human milk banks in Türkiye, 53.9% (n = 118) would like to be a donor if human milk banks were established, and 71.7% (n = 157) stated that the establishment of human milk banks should be supported. Religious concerns were the basis for reluctance to donate milk to human milk banks for 60% (n = 51) of the participants. Knowledge was greater and opinions about wet-nursing and human milk banks were more positive for participants with higher education, more time in the neonatal intensive care unit, or work at a tertiary care center.Conclusion:The approaches of neonatal intensive care unit nurses towards personally being wet-nurses and milk sharing were generally positive, although more information about human milk banks is needed. Religious beliefs are an important consideration when providing information about milk sharing.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:With improvement in a population’s welfare, its food consumption patterns may change, including those of nursing mothers. This, in turn, could influence their human milk composition.Research Aim:To investigate the secular trend in macronutrient composition of mature human milk from mothers of healthy, full-term infants in urban populations in Indonesia from 1974 and 2019.Method:We compared the macronutrient composition of mature human milk of healthy full-term infants from 1974 and 2019. The data from 2019 used the Human Milk Analyzer MIRIS to quantify the milk’s carbohydrate, fat, and protein content, while the historical data used methods available at that time, that is, methods described by Benedict, Gerber and Kjeldahl, respectively.Results:There were no significant differences in carbohydrate, protein and fat content across categories of maternal nutritional status in the respective periods. However, the fat content of human milk from 2019 was significantly higher than that of 1974 (4.7 g/dl, SD = 1.7 g/dl vs. 3.3 g/dl, SD = 1.1 g/dl; p < 0.001), while its carbohydrate content was significantly lower (6.2 g/dl, SD = 2.1 g/dl vs. 7.1 g/dl, SD = 0.2 g/dl; p < 0.001). There was no difference in the protein content between the two periods (1.4 g/dl, SD = 0.5 g/dl vs. 1.6 g/dl, SD = 0.3 g/dl; p = 0.491).Conclusion:The mature human milk from 2019 has a higher fat and total energy content but lower carbohydrate content than those observed 4 decades ago. The protein content remained the same.

Journal of Human Lactation, Ahead of Print.
Background:The SARS-CoV-2 pandemic and its influence on peripartum processes worldwide led to issues in breastfeeding support.Research Aim:The aim of this study was to describe breastfeeding behavior and peripartum in-hospital management during the pandemic in Germany and Austria.Methods:This study was a descriptive study using a combination of secondary longitudinal data and a cross-sectional online survey. Registry data from the prospective multicenter COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS) cohort study (longitudinal, medical records of 1,815 parent-neonate pairs with confirmed SARS-CoV-2 infection during pregnancy) and a cross-sectional online survey of CRONOS hospitals’ physicians (N = 67) were used for a descriptive comparison of feeding outcomes and postpartum management.Results:In 93.7% (n = 1700) of the cases in which information on the neonate's diet was provided, feeding was with the mother’s own milk. Among neonates not receiving their mother’s own milk, 24.3% (n = 26) reported SARS-CoV-2 infection as the reason. Peripartum maternal SARS-CoV-2 infection, severe maternal COVID-19 including the need for intensive care unit (ICU) treatment or invasive ventilation, preterm birth, mandatory delivery due to COVID-19, and neonatal ICU admission were associated with lower rates of breastfeeding. Rooming-in positively influenced breastfeeding without affecting neonatal SARS-CoV-2 frequency (4.2% vs. 5.6%). CRONOS hospitals reported that feeding an infant their mother’s own milk continued to be supported during the pandemic. In cases of severe COVID-19, four of five hospitals encouraged breastfeeding.Conclusion:Maintaining rooming-in and breastfeeding support services in the CRONOS hospitals during the pandemic resulted in high breastfeeding rates.

Journal of Human Lactation, Ahead of Print.
Background:Evidence is lacking on the phenomenon of peer-to-peer human milk-sharing in the Middle East, specifically, in Israel.Research Aims:This study aimed to uncover peer-to-peer human milk-sharing in Israel, learn about how and whether donors engage in safe milk handling and storage practices, and assess knowledge about human milk and breastfeeding among this milk-sharing population. We also aimed to investigate donors’ selectiveness in their decisions about to whom they donate their milk and their perceptions about the sale and purchase of human milk.Methods:We conducted a semi-structured online survey, including both closed- and open-ended questions and used mixed methods to analyze responses descriptively. We used non-probability sampling to obtain a broad sample of human milk donors.Results:Out of 250 completed surveys, most participants (87.2%, n = 218) reported engaging in safe milk-sharing practices and were generally knowledgeable about the health risks associated with milk-sharing. Participant religiosity was associated with somewhat lower hygiene practices (r = −0.15, p ≤ .05). Most of the participants (81.7%, n = 190) were against the sale of human milk. Participants generally expressed no preference about the recipient of their milk, with some exceptions.Conclusion:The milk-handling and storage practices of the participants in this study suggest a need to improve knowledge and awareness of safe milk storage temperature and the importance of washing hands before pumping milk, particularly within the religious sector. We propose that guidelines about safe milk-sharing practices be written and adopted by the Israeli Ministry of Health, and communicated through pediatricians, family doctors, nurses in Mother and Child Clinics (In Hebrew: Tipat Halav), and social media.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Parents who express milk by pumping often feel this is judged as inferior to direct breastfeeding by healthcare providers, leaving parents feeling unsupported. Healthcare provider attitudes can influence decisions about human milk feeding directly at the chest. Yet, there is a gap in knowledge regarding lactation care provider attitudes about pumping.Research Aim:To explore the attitudes and feelings of lactation care providers about pumping.Method:A qualitative descriptive design was utilized. Researchers conducted semi-structured interviews with a convenience sample of 15 lactation care providers in the United States, recruited via social media. Data were analyzed using thematic analysis.Results:Four themes emerged: (1) I Support You, (2) But It’s Not the Same, (3) Frustration with Social Media, and (4) Changing Perspectives. Participants held positive attitudes toward pumping as a tool to meet human milk feeding goals. They strived to provide judgement-free support but stressed the importance of setting realistic expectations and sharing the difference in benefits and work between direct breastfeeding and pumping. Providers held negative attitudes about the portrayal of pumping on social media. The participants’ perspectives were that, while there has been stigma surrounding pumping in the past, views are changing.Conclusion:Lactation care providers strive to provide judgement-free support for pumping, but communicating challenges about pumping may be perceived negatively by parents. More research is needed on lactation care provider education on pumping, interventions to reduce bias, and how these affect providers’ pumping beliefs, attitudes, and provision of judgement-free delivery of care.

Journal of Human Lactation, Ahead of Print.