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.
BackgroundWhen mothers are confronted with milk supply problems, taking domperidone is regularly suggested. However, domperidone has been associated with sudden cardiac death and caution in prescribing is advised. In 2016, a multidisciplinary group of authors from a tertiary academic hospital (Erasmus MC) published a clinical protocol in a leading Dutch physicians’ journal to support Dutch family physicians in prescribing domperidone to stimulate lactation.Research aimTo explore consumer and health care provider perspectives and experiences regarding the prescribing of domperidone for lactation insufficiency following publication of a national clinical protocol.MethodsA cross-sectional qualitative study was performed using semi-structured interviews (N = 40) based on a topic list covering the prescribing process. Participants were mothers (n = 18) who had been advised to try domperidone to boost their milk supply between November 2016 and May 2018, their International Board Certified Lactation Consultants (n = 9), and their family physicians (n = 15). Another group of participants (mothers; n = 6) answered short questionnaires. All interviews were recorded, transcribed and analyzed using ATLAS.ti software. The resulting list of codes was organized according to the topics.ResultsIn the process leading to domperidone use to stimulate lactation, participant family physicians relied on the IBCLC, pharmacist, or mother to guide the prescription of domperidone, often citing the published national clinical protocol as back up. The medical safeguards incorporated in the protocol (e.g., taking medical history, physical exam, performing electrocardiograms, limiting dosage) were usually not implemented.ConclusionsThough the availability of a national clinical protocol in which the prescribing of domperidone for lactation is supported appeared to increase the willingness of participant family physicians to prescribe, gaps were identified between clinical practice and this clinical protocol for prescribing domperidone.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundInsulin, leptin, and adiponectin regulate energy balance and may influence infant growth via their presence in human milk. Maternal body mass index has been associated with human milk insulin, leptin, and adiponectin concentrations, but results are inconsistent. Maternal serum hormone concentrations and fat mass may better characterize human phenotype and be more appropriate predictors of human milk insulin, leptin, and adiponectin.Research aimTo examine the associations of human milk insulin, leptin, and adiponectin with their concentrations in maternal circulation and with maternal fat mass.MethodsInsulin, leptin, and adiponectin were measured in serum and human milk at 1 month postpartum in 25 women. Total body fat mass and fat-free mass were measured using bioelectrical impedance analysis. Linear regression modeling was used to examine associations of serum hormone concentrations or fat mass with human milk insulin, leptin, and adiponectin after adjusting for covariates.ResultsSerum insulin (p = .007), leptin (p < .001), and adiponectin (p < .001) were each associated with their respective concentrations in human milk. Fat mass was positively associated with insulin (p = .005) and leptin (p < .001), but not with adiponectin (p = .65), in human milk.ConclusionsHuman milk insulin, leptin, and adiponectin were positively associated with their concentrations in serum, and human milk insulin and leptin were associated with maternal fat mass. Future research is needed to elucidate the role of human milk hormones in infant energy balance and growth.

Journal of Human Lactation, Ahead of Print.
Douglas A. Johnson began his career as a human rights activist while earning his undergraduate degree in philosophy (1975) at Macalester College in the United States. He lived at Gandhi’s ashram in India to study nonviolent organizing (1969 to 1970). He served as the director of the Third World Institute in Minneapolis, MN, USA (1973–1979), which functioned as the international social justice program of the Archdiocese of Minneapolis and St. Paul. Johnson’s work included creating and running a political collective; leading development study tours into villages in Guatemala and Honduras; and investigating how transnational companies (e.g., Nestlé) were penetrating the developing world. He was the co-founder of the Infant Formula Action Coalition (INFACT), elected national chairperson (1977–1985), and appointed as Executive Director (1978–1984). His role included representing INFACT before national and international organizations, the human milk substitute industry, the US Congress and Executive Branch, and the press. He initiated and coordinated the first international grass-roots consumer boycott (against Nestlé) in ten nations. He was also a co-founder of the International Nestlé Boycott Committee and the International Baby Food Action Network (IBFAN). He earned a Master’s in Public and Private Management at Yale University (1988). Then he became the first Executive Director of the Center for Victims of Torture, in Minneapolis (1988–2012), the first treatment center for torture victims in the US. Since 2013, he has been teaching human rights theory and practice, and sharing lessons he has learned, as a Lecturer in Public Policy at the Harvard Kennedy School, Harvard University (US). (This interview was conducted via Zoom and transcribed verbatim. It has been edited for ease of readability. DJ refers to Doug Johnson and LD refers to Laura Duckett.)

Journal of Human Lactation, Ahead of Print.
BackgroundHospitalization in neonatal intensive care units with a single-family room design enables continuous maternal presence, but less is known regarding the association with milk production and breastfeeding.Research aimTo compare maternal milk production, breastfeeding self-efficacy, the extent to which infants received mother’s milk, and rate of direct breastfeeding in a single-family room to an open bay neonatal intensive care unit.MethodsA longitudinal, prospective observational study comparing 77 infants born at 28– 32° weeks gestational age and their 66 mothers (n = 35 infants of n = 30 mothers in single family room and n = 42 infants of n = 36 mothers in open bay). Comparisons were made on milk volume produced, the extent to which infants were fed mother’s milk, and rate of direct breastfeeding from birth to 4 months’ corrected infant age. Breastfeeding self-efficacy was compared across mothers who directly breastfed at discharge (n = 45).ResultsFirst expression (6 hr vs. 30 hr, p < .001) and first attempt at breastfeeding (48 hr vs. 109 hr, p < .001) occurred significantly earlier, infants were fed a greater amount of mother’s milk (p < .04), and significantly more infants having single-family room care were exclusively directly breastfed from discharge until 4 months’ corrected age; OR 6.8 (95% CI [2.4, 19.1]). Volumes of milk produced and breastfeeding self-efficacy did not differ significantly between participants in either units.ConclusionTo increase the extent to which infants are fed mother’s own milk and are exclusively directly breastfed, the design of neonatal intensive care units should facilitate continuous maternal presence and privacy for the mother–infant dyad.

Journal of Human Lactation, Ahead of Print.
BackgroundHuman milk contains appetite-regulating hormones that may influence infant growth and obesity risk.Research aimsWe evaluated whether leptin, peptide tyrosine-tyrosine (PYY), glucagon-like peptide-1 (GLP-1), and ghrelin concentrations in human milk (1) changed during feeding (from foremilk to hindmilk) and during the first 6 months of infancy; (2) were explained by maternal factors; and (3) were associated with infant anthropometrics and growth.MethodsMother–infant dyads (N = 22) participated. Samples of foremilk and hindmilk at 1 month postpartum were collected and analyzed for leptin, PYY, GLP-1, and ghrelin via radioimmunoassay and milkfat percentage estimated via creamatocrit. Samples were also collected in mothers (n = 15) who breastfed through 6 months. Anthropometrics were obtained on all mother–infant dyads at 1 month and all infants at 6 months and 12 months.ResultsAt 1 month, milk GLP-1 and milkfat concentration increased from foremilk to hindmilk (p ≤ .05) while leptin and PYY concentrations remained stable during feeding. Milk hormone concentrations and milkfat tended to decline overtime, with lower leptin, PYY, and ghrelin at 6 months versus 1 month (p < .05). At 1 month, milk leptin and milkfat content were associated with maternal markers of adiposity (r = 0.49–0.78, p < .001); whereas, milk PYY was correlated with maternal serum PYY concentration (r = 0.672, p = .001). Average 1-month milk concentrations of GLP-1 and leptin were negatively associated with weight-for-age z-scores at 6 months (r = −0.46, p < .05) and 12 months (r = −0.49, p < .05), respectively.ConclusionThe content of certain appetite-regulating hormones in human milk may be influenced by maternal factors and play a role in infant growth; much needs to be learned about their role in the obesity protection of breastfed infants.

Journal of Human Lactation, Ahead of Print.
IntroductionThere is limited information about problems of feedback inhibition of lactation which should be considered as a rare cause of breast engorgement. We report the management of excessive breast engorgement in a mother with a presumptive diagnosis of a defect in the feedback inhibition of lactation.Main issueThe participant, who had been discharged on postpartum Day 2 while breastfeeding her infant, was readmitted to the hospital the next day with engorgement of the breasts and cessation of milk flow. Pumping and application of cold dressings alone did not work effectively. The severity of the symptoms decreased only after the addition of an anti-inflammatory drug and a prolactin inhibitor.ManagementThe participant received breastfeeding counseling, family-centered care, and support for pumping equipment. An anti-inflammatory drug was started and a low dose prolactin inhibitor was given. The difficulty was the management of extensive and painful breast engorgement and the re-establishment of milk flow. At postpartum Day 14, the participant and her infant were discharged with effective breastfeeding status.ConclusionsThe recognition of a problem in the feedback inhibition of lactation as a cause of breast engorgement is important because it may be unresponsive to classical treatment methods resulting in cessation of milk flow. With the cautious use of low-dose cabergoline, in addition to other treatment strategies, milk flow can be reduced in a controlled manner while ensuring the continuity of milk production. An early diagnosis, interdisciplinary approach, and a close follow-up of the mother–infant pair are essential for preserving lactation.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundBreastfeeding rates in Ireland are among the lowest in the world. Improving the prevalence of breastfeeding is an objective of the Irish Health Service Executive, with the recognition that this would improve public health. Polish people represent the largest immigrant group in Ireland, and Polish women are more likely to initiate breastfeeding than Irish women.Research aimsThis study had two aims: (1) to describe the breastfeeding experiences and attitudes among Polish mothers living in Ireland, and (2) to explore similarities and differences in infant feeding experiences, attitudes, and beliefs among Polish and Irish women, as perceived by Polish women.MethodsSemi-structured interviews were conducted in Polish with Polish mothers (N = 16) who had lived in Ireland for 10 years or less. Interviews were audio recorded, transcribed, and translated into English. Data were analyzed using qualitative thematic analysis. Coding was a cyclical process; codes were amended and refined through iterative reading of the transcripts. Themes were developed through categorization of codes and via in-depth discussion between two analysts.ResultsThree major themes were developed after analyzing the data. First, there is no universal correct way to provide support for infant feeding; women would like individualized support based on their infant-feeding decisions. Second, breastfeeding is an inherent part of Polish culture and formula feeding is part of Irish culture. Finally, the Irish social environment is supportive of breastfeeding and breastfeeding in public is acceptable in Ireland.ConclusionsAlthough the Irish social environment is supportive of breastfeeding, the infant-formula culture is a barrier to breastfeeding. Future research should explore ways to change societal attitudes towards breastfeeding in Ireland.

Journal of Human Lactation, Ahead of Print.
BackgroundCross-jurisdictional sharing is gaining traction as an option for increasing the effectiveness and efficiency of public health services in local health departments.Research aimAssess whether breastfeeding initiation among participants in the Special Supplemental Nutrition Program for Women, Infants and Children changed with the addition of a trained breastfeeding specialist funded by cross-jurisdictional integration.MethodsA longitudinal retrospective comparative difference in difference design using state-based program data, pre- and post-integration was undertaken. Three local county health departments (n = 5) that fully integrated into one Community Health Board during January 2015, and four neighboring Community Health Boards (n = 4) that did not integrate, were included.ResultsControlling for confounders and interactions, the relative rate of change over time in breastfeeding initiation rates was greater in the integrated jurisdiction than neighboring Community Health Boards, but not statistically significant. When the integrated Community Health Board’s original three local health departments were considered separately, the relative rate of change over time in breastfeeding rates was greater for one local health department in comparison to three neighbor Community Health Boards (p = .037, .048, and .034, respectively).ConclusionsThe addition of a specialized breastfeeding nutritionist led to improved breastfeeding initiation rates. The increase was significant only in the largest original local health department, which also had the lowest breastfeeding initiation rate pre-merger. The greatest positive change was seen in this local health department where the specialist staff was physically located. Public health staff specialization can lead to increases in economic efficiency and in improved delivery of public health services.

Journal of Human Lactation, Ahead of Print.
BackgroundAlthough mother’s own milk decreases prematurity-associated morbidities, mothers of infants born preterm and very low birth weight experience a significantly shorter lactation duration. Little is known regarding factors associated with lactation cessation during the hospitalization of a very low birth weight infant.Research aimTo determine demographic, social, and personal factors associated with lactation cessation by 6-weeks postpartum in mothers delivering very low birth weight infants.MethodsWe used a retrospective, longitudinal, two-group comparison design using data from a randomized control study. Mothers of very low birth weight infants (N = 142) were enrolled from a labor and delivery unit associated with a Level 4 neonatal intensive care unit. Demographic, social, and health information was obtained from the medical records. Participants were surveyed regarding lactation goals, experience, and reason(s) for cessation.ResultsParticipants who did not continue lactating for more than 6 weeks were more likely to be unemployed (p = .019), Medicaid eligible (p = .009), less educated (p < .031), smoke (p = .002), provide less skin-to-skin care (p = .007), and to delay the decision to provide their milk to their infant (p = .007). After Bonferroni adjustment, only minutes of skin-to-skin care remained statistically significant. Insufficient maternal milk production was the most common reason for lactation cessation.ConclusionWhile the etiology of lactation cessation is often non-modifiable, strategies aimed at maintaining mother’s own milk production, smoking cessation, increasing skin-to-skin care, and promoting an earlier decision to lactate, may prolong lactation duration in this vulnerable population.This RCT was registered (2012-00071) with ClinicalTrials.com on 6/28/2013.

Journal of Human Lactation, Ahead of Print.
BackgroundA primary role of human donor milk banks is to provide pasteurized human milk for the sick and preterm infant populations and to support the mothers of these infants as they establish their own milk supply. The results of human milk pasteurization continue to be studied to provide information that enables optimal nutrition in this sick and preterm population.Research aimsThe aims of our study were to determine macronutrient characteristics (fat, protein, carbohydrate) and energy content of human milk donated to the Christchurch Women’s Hospital Human Milk Bank in New Zealand, and the influence of Holder pasteurization on this macronutrient composition.MethodsThis was a retrospective, pre/post pasteurization observational design to describe the macronutrient content within two groups of donors, mature preterm PDM (n = 13; 21%) and mature term PDM (n = 50; 79%). Sixty three samples of human milk donated to the human milk bank by 27 registered participants (mothers of preterm and term infants) were analyzed. This analysis took place July–September 2018 using a human milk analyzer before and after Holder pasteurization (62.5 °C for 30 min).ResultsPreterm milk contained on average 76 kcal/100 ml energy, 4.0 g/100 ml fat, 1.1 g/100 ml protein and 8.2 g/100 ml total carbohydrate; and mature term milk contained 68 kcal/100 ml energy, 3.5 g/100 ml fat, 0.8 g/100 ml protein and 7.9 g/100 ml total carbohydrate. Wide variation between single, donor-pooled samples was demonstrated and there was no major result of pasteurization.ConclusionThis research adds to the evidence regarding the macronutrient content of preterm and term milk and that these values are unaffected by Holder pasteurization. The variance in individual pooled donor human milk indicates the importance of determining the nutrient composition of donated milk to inform fortification procedures.

Journal of Human Lactation, Ahead of Print.
IntroductionHuman milk cannot currently be considered a major source of COVID-19 infection. On the other hand, it can contain specific antibodies that could modulate a possible newborn infection by SARS-CoV-2.Main issueA 32-year-old pregnant woman, gestational age 37 and 3/7 weeks, was admitted with a flu-like syndrome caused by COVID-19. The female newborn was appropriate for gestational age, with a birth weight of 2,890 g, length 48 cm, and head circumference 34 cm.ManagementThe mother–infant dyad remained in the rooming-in unit during hospitalization, exclusively breastfeeding and following World Health Organization recommendations for contact and airway precautions. On the 3rd day after delivery, two mother’s milk samples (3 and 5 mL) were collected by hand expression. The samples were centrifuged for 10 min twice consecutively to separate fat, which was removed, and the remaining material was transferred to another tube to determine anti-SARS-CoV-2 Immunoglobulin A and Immunoglobulin G (ELISA, Kit EUROIMMUN AG, Luebeck, Germany). Anti-SARS-CoV-2 Immunoglobulin A was detected in the two samples evaluated, whose values were 2.5 and 1.9, respectively. No anti-SARSCoV-2 immunoglobulin G was detected. The exclusively-breastfed infant remained well through 45 days of age.ConclusionThe presence of SARS-CoV-2 Immunoglobulin A in the milk of mothers infected with COVID-19 may be related to protection against the transmission and severity of the disease in their infants.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundPrevious qualitative researchers have shown that Chinese American mothers experienced high rates of suboptimal breastfeeding, especially early introduction of other foods before the recommended 6-month period of exclusive breastfeeding.Research aims(1) To explore attitudes that Chinese American mothers have about the meaning and practice of exclusive breastfeeding; (2) to evaluate the extent of family pressure and support to maintain exclusive breastfeeding; and (3) to examine the influence of breastfeeding self-efficacy and the intention to continue exclusive breastfeeding.MethodGuided by the theory of planned behavior, this descriptive cross-sectional prospective online survey was conducted with Chinese American breastfeeding mothers (N = 401). Participants’ attitudes, subjective norms, and perceived behavioral control for exclusive breastfeeding behaviors were measured.ResultsThe M (SD) age of participants was 29.14 (SD = 6.90). Just over 50% reported receiving family support for exclusive breastfeeding. While participants had positive attitudes about exclusive breastfeeding and the value of colostrum, 64% (n = 257) had already introduced foods other than mother’s own milk before their infant was 6-months old. Participants also expressed concern that their infants did not receive enough nutrition from exclusive mother’s milk. Participants with more than one child had significantly greater intention to continue exclusive breastfeeding compared to participants with only one child. Perception of approval by others for exclusive breastfeeding and breastfeeding self-efficacy were significantly related to behavioral intention to continue exclusive breastfeeding.ConclusionSuboptimal infant feeding is a problem for Chinese American women and may also be a problem for mothers in other ethnic groups. We found a lack of adherence with standard recommendations for sustaining 6-months of exclusive breastfeeding.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.