Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Researchers and practitioners continue to debate the most appropriate assessment, diagnostic, and treatment practices for ankyloglossia (tongue-tie). Health care workers struggle to provide evidence-based care in the absence of consistent standards.Research aim:The aims of this pilot study were to qualitatively (a) evaluate the knowledge of, and attitudes toward tongue-tie and (b) describe how they shaped referral pathways and the establishment of practice patterns of frontline practitioners (pediatric dentists, speech-language pathologists, pediatric chiropractors, and International Board Certified Lactation Consultants).Methods:We recruited clinicians (N = 9) using nonprobability purposive sampling. Participants were interviewed using survey schedules adjusted to reflect their specialty area. Semistructured interviews were transcribed and coded using manual and inductive coding techniques common in grounded theory. Themes were iteratively developed using memoing techniques, in which observations and potential concepts were recorded using the aforementioned codes.Results:Participants were familiar with a variety of protocols and assessment tools, but did not consistently use them. No formal training about the management of tongue-tie was received through their degree programs. Instead they pursued self-guided study. Interprofessional consensus guided opinions about tongue-tie best practices, and referral pathways reflected these consensuses. International Board Certified Lactation Consultants were viewed as pivotal to the care of infants with tongue-tie while primary care physicians—primarily pediatricians—were omitted from referral pathways.Conclusion:Lack of formalized training, professional consensus about best practices, and insufficient resources for assessing and treating tongue-tie led participants to incomplete referral pathways and personal interpretations of the data through the lens of anecdotal evidence.

Journal of Human Lactation, Ahead of Print.
Background:Researchers and practitioners continue to debate the most appropriate assessment, diagnostic, and treatment practices for ankyloglossia (tongue-tie). Health care workers struggle to provide evidence-based care in the absence of consistent standards.Research aim:The aims of this pilot study were to qualitatively (a) evaluate the knowledge of, and attitudes toward tongue-tie and (b) describe how they shaped referral pathways and the establishment of practice patterns of frontline practitioners (pediatric dentists, speech-language pathologists, pediatric chiropractors, and International Board Certified Lactation Consultants).Methods:We recruited clinicians (N = 9) using nonprobability purposive sampling. Participants were interviewed using survey schedules adjusted to reflect their specialty area. Semistructured interviews were transcribed and coded using manual and inductive coding techniques common in grounded theory. Themes were iteratively developed using memoing techniques, in which observations and potential concepts were recorded using the aforementioned codes.Results:Participants were familiar with a variety of protocols and assessment tools, but did not consistently use them. No formal training about the management of tongue-tie was received through their degree programs. Instead they pursued self-guided study. Interprofessional consensus guided opinions about tongue-tie best practices, and referral pathways reflected these consensuses. International Board Certified Lactation Consultants were viewed as pivotal to the care of infants with tongue-tie while primary care physicians—primarily pediatricians—were omitted from referral pathways.Conclusion:Lack of formalized training, professional consensus about best practices, and insufficient resources for assessing and treating tongue-tie led participants to incomplete referral pathways and personal interpretations of the data through the lens of anecdotal evidence.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Although breastfeeding is a major public health priority and provides numerous benefits, women veterans encounter many barriers to initiating and sustaining breastfeeding. Women veterans are a growing population with unique health care needs related to exposures and injuries experienced during military service. These military experiences are linked to health diagnoses known to impact postpartum health behaviors, such as breastfeeding.Research aim:The aim of this study was to identify factors associated with breastfeeding at 4 weeks postpartum among women veterans.Methods:We used 2016-to-2018 survey data from women veterans (N = 420), interviewed before and after delivery, who were enrolled in maternity care coordination at a national sample of Veterans Health Administration facilities. Using the social ecological model, logistic regression was employed to explore the relationship between breastfeeding at least 4 weeks and postpartum and maternal/infant characteristics, interpersonal dynamics, community influences, and system factors.Results:The rate of breastfeeding at 4 weeks postpartum was 78.6% among this sample of veterans. Self-employed participants were 2.8 times more likely to breastfeed than those who were employed outside the home. Participants who had been deployed at any point in their military career were twice as likely to breastfeed compared with those who never deployed. In this study sample, race independently predicted lower rates of breastfeeding, with African American participants being 48% less likely to breastfeed as compared with white participants.Conclusion:Our analysis suggests significant racial disparities in breastfeeding within veteran populations utilizing Veterans Health Administration, despite access to multiple sources of support from both the Veterans Health Administration and the community.

Journal of Human Lactation, Ahead of Print.
Background:Donor human milk supplementation for healthy newborns has increased. Racial-ethnic disparities in supplementation have been described in the neonatal intensive care unit but not in the well newborn setting.Research aim:The aim of this study was to identify maternal characteristics associated with donor human milk versus formula supplementation in the well newborn unit.Methods:This retrospective cohort study includes dyads of well newborns and their mothers (N = 678) who breastfed and supplemented with formula (n = 372) or donor human milk (n = 306) during the birth hospitalization at a single hospital in the midwestern United States. Maternal characteristics and infant feeding type were extracted from medical records. Chi-square and logistic regression were used to examine associations between maternal characteristics and feeding type.Results:Nonwhite women were less likely to use donor human milk. Compared to non-Hispanic white women, the largest disparity was with Hispanic (adjusted odds ratio [OR] = 0.28, 95% CI [0.12, 0.65]), then non-Hispanic black (adjusted OR = 0.32, 95% CI [0.13, 0.76]) and Asian women (adjusted OR = 0.34, 95% CI [0.16, 0.74]). Lower donor human milk use was associated with primary language other than English and public versus private insurance.Conclusion:The goal of improving public health through breastfeeding promotion may be inhibited without targeting donor human milk programs to these groups. Identifying the drivers of these disparities is necessary to inform person-centered interventions that address the needs of women with diverse backgrounds.

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.
In order to maximize profits from sales of breastmilk substitutes, manufacturers use a whole gamut of strategies to interfere with the effective implementation of policies that protect, promote, and support breastfeeding (e.g., the International Code of Marketing of Breastmilk Substitutes with its subsequent World Health Assembly resolutions and the Global Strategy on Infant and Young Child Feeding). Their strategies create, among other problems, personal and institutional conflicts of interest. Effective Conflict of Interest policies are therefore needed for ensuring that governments, international organizations, non-governmental organizations, and health professionals can protect their independence, integrity, and credibility in order to work in the best interests of children. Conflicts of interest are discussed by Dr Lida Lhotska and Dr Judith Richter, who have been actively involved in these issues internationally. Lida Lhotska holds a BSc in Biology and a PhD in Anthropology. Her international work spans over 25 years. She headed the Infant Feeding and Care team for UNICEF and subsequently joined the IBFAN-Geneva Infant Feeding Association team, always focusing on advancing the protection of breastfeeding through legal and other policy measures. Judith Richter has a multidisciplinary background combining knowledge in the humanities with health sciences (PhD Social Sciences; MA Development Studies; MSc Pharmaceutical Sciences). Her work as a freelance researcher for United Nations agencies, governments, and civil society organizations and networks has centered on safeguarding their capacity to hold transnational corporations accountable. In her interview, Judith Richter explains why conflict of interest regulation matters to health professionals working in the field of lactation.(MA = Maryse Arendt; LL = Lida Lhotska; JR = Judith Richter)

Journal of Human Lactation, Ahead of Print.
Background:Stem/progenitor cells have been identified in human milk. However, characterization and percentages of cell subsets in human milk using hematopoietic stem and progenitor cell markers according to the differential expression of CD45, i.e., as CD45dim/+ (mainly hematopoietic stem/progenitor cells) and CD45- (mainly non-hematopoietic stem/progenitor cells), have not been assessed to date.Research aim:To characterize stem/progenitor-like cell phenotypes in human milk and to report the percentages of these cells at two different lactation stages compared to peripheral blood.Methods:Human milk samples paired with peripheral blood samples (N = 10) were analyzed by flow cytometry using CD45, CD34, CD133, CD38, and lineage-negative markers. The percentage of cell subsets was analyzed in colostrum (Day 3 postpartum) and transitional milk (Day 5/6 postpartum) and compared with the peripheral blood counterpart.Results:The percentage of CD45-CD34+ cells was predominant in both colostrum and transitional milk. The percentage of CD45+/highCD133+ cells was high in colostrum while the percentage of CD45-CD133+ cells was high in transitional milk. Furthermore, the median percentages of the CD45-CD34+, CD45-CD133+, and CD45dimCD133+ cell subsets were higher in colostrum than its peripheral blood counterpart (0.11% vs. 0.002%; 0.17% vs. 0.0005%; 0.09% vs. 0.05%, p = .04, respectively); also CD45-CD34-CD133+ and CD45dimCD34-CD133+ cell subsets were higher in colostrum than peripheral blood (1.32% vs. 0.0% and 2.4% vs. 0.06%, p = .04), respectively).Conclusion:Early human milk is an abundant reservoir of hematopoietic stem/progenitor-like cells in the CD45+/high population and non-hematopoietic stem/progenitor-like cells in the CD45- population.

Journal of Human Lactation, Ahead of Print.
In order to maximize profits from sales of breastmilk substitutes, manufacturers use a whole gamut of strategies to interfere with the effective implementation of policies that protect, promote, and support breastfeeding (e.g., the International Code of Marketing of Breastmilk Substitutes with its subsequent World Health Assembly resolutions and the Global Strategy on Infant and Young Child Feeding). Their strategies create, among other problems, personal and institutional conflicts of interest. Effective Conflict of Interest policies are therefore needed for ensuring that governments, international organizations, non-governmental organizations, and health professionals can protect their independence, integrity, and credibility in order to work in the best interests of children. Conflicts of interest are discussed by Dr Lida Lhotska and Dr Judith Richter, who have been actively involved in these issues internationally. Lida Lhotska holds a BSc in Biology and a PhD in Anthropology. Her international work spans over 25 years. She headed the Infant Feeding and Care team for UNICEF and subsequently joined the IBFAN-Geneva Infant Feeding Association team, always focusing on advancing the protection of breastfeeding through legal and other policy measures. Judith Richter has a multidisciplinary background combining knowledge in the humanities with health sciences (PhD Social Sciences; MA Development Studies; MSc Pharmaceutical Sciences). Her work as a freelance researcher for United Nations agencies, governments, and civil society organizations and networks has centered on safeguarding their capacity to hold transnational corporations accountable. In her interview, Judith Richter explains why conflict of interest regulation matters to health professionals working in the field of lactation.(MA = Maryse Arendt; LL = Lida Lhotska; JR = Judith Richter)

Journal of Human Lactation, Ahead of Print.
Background:Stem/progenitor cells have been identified in human milk. However, characterization and percentages of cell subsets in human milk using hematopoietic stem and progenitor cell markers according to the differential expression of CD45, i.e., as CD45dim/+ (mainly hematopoietic stem/progenitor cells) and CD45- (mainly non-hematopoietic stem/progenitor cells), have not been assessed to date.Research aim:To characterize stem/progenitor-like cell phenotypes in human milk and to report the percentages of these cells at two different lactation stages compared to peripheral blood.Methods:Human milk samples paired with peripheral blood samples (N = 10) were analyzed by flow cytometry using CD45, CD34, CD133, CD38, and lineage-negative markers. The percentage of cell subsets was analyzed in colostrum (Day 3 postpartum) and transitional milk (Day 5/6 postpartum) and compared with the peripheral blood counterpart.Results:The percentage of CD45-CD34+ cells was predominant in both colostrum and transitional milk. The percentage of CD45+/highCD133+ cells was high in colostrum while the percentage of CD45-CD133+ cells was high in transitional milk. Furthermore, the median percentages of the CD45-CD34+, CD45-CD133+, and CD45dimCD133+ cell subsets were higher in colostrum than its peripheral blood counterpart (0.11% vs. 0.002%; 0.17% vs. 0.0005%; 0.09% vs. 0.05%, p = .04, respectively); also CD45-CD34-CD133+ and CD45dimCD34-CD133+ cell subsets were higher in colostrum than peripheral blood (1.32% vs. 0.0% and 2.4% vs. 0.06%, p = .04), respectively).Conclusion:Early human milk is an abundant reservoir of hematopoietic stem/progenitor-like cells in the CD45+/high population and non-hematopoietic stem/progenitor-like cells in the CD45- population.

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:Donor human milk supplementation for healthy newborns has increased. Racial-ethnic disparities in supplementation have been described in the neonatal intensive care unit but not in the well newborn setting.Research aim:The aim of this study was to identify maternal characteristics associated with donor human milk versus formula supplementation in the well newborn unit.Methods:This retrospective cohort study includes dyads of well newborns and their mothers (N = 678) who breastfed and supplemented with formula (n = 372) or donor human milk (n = 306) during the birth hospitalization at a single hospital in the midwestern United States. Maternal characteristics and infant feeding type were extracted from medical records. Chi-square and logistic regression were used to examine associations between maternal characteristics and feeding type.Results:Nonwhite women were less likely to use donor human milk. Compared to non-Hispanic white women, the largest disparity was with Hispanic (adjusted odds ratio [OR] = 0.28, 95% CI [0.12, 0.65]), then non-Hispanic black (adjusted OR = 0.32, 95% CI [0.13, 0.76]) and Asian women (adjusted OR = 0.34, 95% CI [0.16, 0.74]). Lower donor human milk use was associated with primary language other than English and public versus private insurance.Conclusion:The goal of improving public health through breastfeeding promotion may be inhibited without targeting donor human milk programs to these groups. Identifying the drivers of these disparities is necessary to inform person-centered interventions that address the needs of women with diverse backgrounds.

Journal of Human Lactation, Ahead of Print.
Background:Although breastfeeding is a major public health priority and provides numerous benefits, women veterans encounter many barriers to initiating and sustaining breastfeeding. Women veterans are a growing population with unique health care needs related to exposures and injuries experienced during military service. These military experiences are linked to health diagnoses known to impact postpartum health behaviors, such as breastfeeding.Research aim:The aim of this study was to identify factors associated with breastfeeding at 4 weeks postpartum among women veterans.Methods:We used 2016-to-2018 survey data from women veterans (N = 420), interviewed before and after delivery, who were enrolled in maternity care coordination at a national sample of Veterans Health Administration facilities. Using the social ecological model, logistic regression was employed to explore the relationship between breastfeeding at least 4 weeks and postpartum and maternal/infant characteristics, interpersonal dynamics, community influences, and system factors.Results:The rate of breastfeeding at 4 weeks postpartum was 78.6% among this sample of veterans. Self-employed participants were 2.8 times more likely to breastfeed than those who were employed outside the home. Participants who had been deployed at any point in their military career were twice as likely to breastfeed compared with those who never deployed. In this study sample, race independently predicted lower rates of breastfeeding, with African American participants being 48% less likely to breastfeed as compared with white participants.Conclusion:Our analysis suggests significant racial disparities in breastfeeding within veteran populations utilizing Veterans Health Administration, despite access to multiple sources of support from both the Veterans Health Administration and the community.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Introduction:Use of pasteurized donor milk is recommended in many situations when own mother’s milk is not available. One existing knowledge gap is access to donor milk for infants in government custody (foster care).Main issue:The focus of this case study is an infant born at 41 weeks who was discharged from the hospital into foster care. The infant soon developed failure to thrive due to formula intolerance.Management:After trying multiple formulas, which included elemental formulas, and hospitalization, the infant began pasteurized donor milk. Within 24 hr, the infant began gaining weight. Medicaid denied two authorization requests for payment, and the state’s Department of Human Services ultimately agreed to cover the discounted donor milk fees until the infant reached 1 year of age.Conclusion:This foster child suffered through months of failure to thrive and hospitalization before receiving human milk feedings. This care violated ethical principles of beneficence, autonomy, and justice. State officials should review their policies and regulations for providing human milk to children in their care and facilitate access to that milk when needed.