Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
BackgroundA human-milk-based diet is the best option for nutritional therapy for preterm and/or sick newborns.Research aimThe study aims were to restructure the reimbursement rates to hospitals in Poland for infants’ tube feedings to favor the use of donor human milk over formula for newborns who required supplementation of expressed mother’s milk and evaluate the results of the financing change during the first year of implementation (2018).MethodsFinancial data from hospitals were collected (2015–2016) by the Human Milk Bank Foundation using a data sheet designed by the Agency for Health Technology Assessment and Tariff System. We used data to restructure the reimbursement rates to hospitals for infants’ tube feedings and implemented the changes in late 2017. The National Health Fund was requested to share reported data in 2018 concerning tube feeding services.ResultsMore than half (61%) of NICUs introduced human milk tube feeding for newborns. It was provided to participants (N = 5,530), most frequently to seriously ill preterm infants (66.6%). Of these infants, 2,323 were fed donor human milk. Only 1,925 newborns received formula tube feeding. However, there were large differences in frequency of services reported among various parts of the country.ConclusionsBased on our knowledge, Poland is the only European country where the reimbursement cost for human-milk-based nutritional therapy has been implemented in a manner intended to increase the quality of health care services for preterm newborns. Equal reimbursement for expressed mother’s milk and donor milk did not appear to cause overuse of donor milk based on our analysis of the 2018 data.

Journal of Human Lactation, Ahead of Print.
BackgroundMothers with anatomic variability (e.g., shorter, wider nipples; denser areolas) may experience breastfeeding challenges disproportionately.Research aimTo examine whether variations in breast anatomy are associated with risk for early breastfeeding challenges.MethodsParticipants included mothers < 6 weeks postpartum. Nipple base width, nipple length, and areolar density were measured on the right and left breast separately. Experiences with early breastfeeding challenges were determined through a combination of maternal report and clinical assessment.ResultsParticipants (N = 119) had an average nipple diameter of 23.4 (SD = 3.0) mm for left nipples and 23.5 (SD = 3.0) mm for right nipples (range = 10–34 mm). Average nipple length was 8.5 (SD = 3.2) mm for left breasts and 9.1 (SD = 3.2) mm for right breasts (range = 5–20 mm); 35% of participants had dense areolas on the left breast and 36% had dense areolas on the right breast. The combination of wider and longer nipples was associated with greater risk for difficulties with latch; the combination of wider nipples and denser areolas was associated with greater risk for sore nipples. For participants with more dense areolas, shorter and wider nipples were associated with greater risk for low milk supply and slow infant weight gain. For participants with less dense areolas, longer and wider nipples were associated with greater risk for low milk supply and slow infant weight gain.ConclusionFurther research is needed to understand how measures of breast anatomy can be used to guide targeted intervention efforts.

Journal of Human Lactation, Ahead of Print.
BackgroundRates of exclusive breastfeeding in Australia lag behind international targets. Reasons for non-exclusive breastfeeding are poorly understood.Research aimsTo describe demographic profiles of participants reporting different feeding practices, and reasons for not exclusively breastfeeding to 6 months.MethodsDemographics for 2888 mothers (5340 children) and reasons for 1879 mothers (3018 children) from the Mothers and Their Children’s Health Study (a sub-study of the Australian Longitudinal Study on Women’s Health) were examined using descriptive statistics and multivariable regression.ResultsOnly 34.4% of children were exclusively breastfed to 6 months. Five non-exclusive feeding practices were identified: never breastfed (3.9%), breastfed < 6 months (20.8%), and breastfed to 6 months but had formula (6.8%), solids (24.5%), or both formula and solids (9.7%). Mothers of children who received < 6 months of human milk were more likely to have a lower education, be overweight/obese, smoke, and live in cities (compared to mothers of children exclusively breastfed). Reasons for never breastfeeding and for breastfeeding < 6 months were primarily insufficient milk and breastfeeding difficulties (e.g., latching issues). Reasons for introducing solids were primarily cues for solids (e.g., showing interest). Reasons for formula were insufficient milk and practical considerations (e.g., return to work). Reasons for both solids and formula were diverse, including insufficient milk, weaning cues, and practical considerations.ConclusionsMothers who did not exclusively breastfeed to 6 months were a heterogeneous group, indicating that both targeted and universal strategies are required to increase rates of exclusive breastfeeding. Support should encompass the broad range of feeding practices.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
In 1900, 13% of infants in the United States died before their first birthday, most of dehydration from diarrhea. As part of a nationwide effort to “save the babies,” pediatricians focused on several endeavors—experimenting with commercially made infant-food products; working with dairy farmers to clean up cows’ milk; lobbying to pass municipal and state legislation regulating the dairy industry; and devising mathematical “formulas” that represented instructions to chemists on how to “humanize” cows’ milk for the needs of a particular infant. Pediatricians dubbed the latter endeavor “percentage feeding” and, from the 1890s to the 1920s, they deemed percentage feeding a lifesaving scientific achievement. The complex, virtually infinite array of mathematical formulas that comprised this infant-feeding system is the origin of the word “formula” as used today to describe artificial baby milk.

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.

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.