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.
Background:During pumping, storage, and pasteurization human milk is exposed to light, which could affect the concentrations of light-sensitive vitamins. Currently, milk banks do not regulate light exposure.Research Aim:The aim of this paper was to determine the influence of light exposure during pumping, storage, and pasteurization on (1) macronutrients, (2) select water-soluble vitamins, and (3) select fat-soluble vitamins.Methods:All 13 participants donated 4 milk samples each. Each sample underwent 1 of 4 treatments: raw and light protected, raw and light exposed, pasteurized and light protected, and pasteurized and light exposed. Samples were analyzed for macronutrients and Vitamins B1, B2, retinol, γ-tocopherol, α-tocopherol, and β-carotene.Results:β-carotene concentrations were not influenced by light exposure. Vitamin B1 was significantly (p < 0.05) affected by light-exposure (M = 0.23, SD = 0.01mg/L) compared to light-protected (M = 0.27, SD = 0.01mg/L) samples. Vitamin B2 concentrations were reduced (p < 0.05) by light-exposure in raw (M = 62.1, SD = 0.61µg/L) and pasteurized (M = 73.7, SD = 0.72µg/L) samples compared to light-protected raw samples (M = 99.7, SD = 0.66µg/L). No other tested nutrients were affected by light exposure.Conclusions:If milk is exposed to excessive amounts of light, Vitamins B1 and B2 concentrations may degrade below the current Adequate Intake recommendations for infants 0–6 months of age, increasing the risk of insufficient vitamin supply to the exclusively human milk-fed infant. Thus, pumped or processed human milk should be protected from light to preserve milk vitamin concentrations.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation.Research Aim:To systematically review the available global literature on the frequency of lactational mastitis, and to summarize the evidence on risk factors for lactational mastitis. We also describe gaps in the evidence and identify priority areas for future research.Methods:We systematically searched and screened 6 databases and included 26 articles, conducted meta-analysis of disease frequency, and narratively synthesized evidence on risk factors.Results:In 11 (42%) articles researchers reported a measure of disease frequency; 5 (19%) reported risk factors, and 10 (39%) included both. Overall, the quality of studies was low, related to suboptimal measurement of disease frequency, high risk of bias, reverse causality, and incomplete adjustment for confounding. Meta-analysis was based on 3 studies (pooled incidence between birth and Week 25 postpartum: 11.1 episodes per 1,000 breastfeeding weeks; 95% CI [10.2–12.0]); with high heterogeneity across contexts and highest incidence in the first four weeks postpartum. Researchers assessed 42 potential risk factors; nipple damage was the most frequently studied and strongly associated with mastitis. There was a scarcity of studies from low-resource settings.Conclusions:Lactational mastitis is a common condition, but the wide variability in incidence across contexts suggested that a substantial portion of this burden might be preventable. Provision of care to breastfeeding women at risk for or affected by mastitis is currently constrained due to a critical lack of high quality epidemiological evidence about its incidence and risk factors.

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.
Background:Since 25 August, 2017 over 693,000 Rohingya have been forced from Myanmar due to mass violence, seeking refuge in neighboring Bangladesh. Nutritional surveys during 2017 revealed worrying levels of malnutrition and poor infant feeding practices, including high numbers of infants not exclusively breastfeeding. Infants under 6 months who are not exclusively breastfed are particularly vulnerable to morbidity and mortality and require specialized feeding support, especially in emergency contexts.Research Aim:To describe Save the Children International’s experiences supporting wet nursing, relactation, and artificial feeding for non-breastfed infants under 6 months in the Rohingya Response, Bangladesh.Methods:A retrospective analysis was conducted of routine program data and documentation from Save the Children International’s infant and young child feeding in emergencies interventions for the Rohingya Response, Bangladesh, from November 2017 to April 2018. The study population were infants under 6 months identified as not breastfed during the initial assessment (N = 15).Results:Although wet nursing was attempted with all infants, it was successful with 6 (40%) of the infants. Additionally, 1 (6.7%) infant’s mother was able to successfully relactate. The remaining infants ended up requiring feeding with human milk substitutes.Conclusion:Gaps exist in operational guidance to support non-breastfed infants with wet nursing and relactation in emergency settings, as well as on how to operationalize safe human milk substitute programming in line with national policies and regulations. There is an urgent need to address this gap to protect the lives of non-breastfed infants in emergencies worldwide.

Journal of Human Lactation, Ahead of Print.
Knowledge of sampling methods is essential to design quality research. Critical questions are provided to help researchers choose a sampling method. This article reviews probability and non-probability sampling methods, lists and defines specific sampling techniques, and provides pros and cons for consideration. In addition, issues related to sampling methods are described to highlight potential problems.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
In the late 19th century, physicians in the United States and Europe grew concerned about an increasingly visible subset of infant mortality: sudden infant death. Over the next 100 years, physicians worked variably to combat the problem, modifying and refining their conceptions of sudden infant mortality many times over the process. Physicians’ overlapping revisions of sudden infant mortality ultimately helped to produce the categorization of Sudden Infant Death Syndrome (SIDS), and their ensuing, fluctuating efforts to resolve this problem shed light on social and medical perceptions of the roles that biology, the environment, and infant care practices played in sudden infant death. SIDS’s official medical classification was a watershed; not only did the formal medical label establish its “authenticity” as a medical phenomenon, but the label also asserted the inexplicability of (at least some) sudden infant death episodes while simultaneously conveying that affected parents were deserving victims of a tragic loss. In the modern history of sudden infant death in the United States, breastfeeding, in particular, was understood variably as a possible cause for unnecessary infant mortality in the decades surrounding 1900; inconsequential to the occurrence of SIDS in the mid 1900s; and finally as an important and healthful way to reduce the risk for SIDS beginning in the late 1900s.

Journal of Human Lactation, Ahead of Print.
On September 10, I had the pleasure of interviewing my friend and colleague David Lawson Clark, the legal advisor for infant and young child nutrition and expert on the International Code of Marketing of Breast-milk Substitutes at UNICEF. A native of Scotland, David began his career as an attorney with the Scottish Development Agency and subsequently worked for the United Nations Interregional Crime and Justice Research Institute in Rome, Italy. Since 1995, David has assisted more than 60 countries in drafting legislation to implement the International Code of Marketing of Breastmilk Substitutes and has been instrumental in bringing a human rights-based approach to the protection, promotion, and support of breastfeeding. He has contributed to the development of international policy guidelines in the area of HIV and infant feeding and infant feeding in emergencies, and has provided guidance on issues around international trade agreements and intellectual property rights. David has written and contributed to many articles and publications on health and nutrition policy, developed courses and training materials on the implementation of the International Code and maternity protection, and has facilitated numerous workshops on the issue. (LGS refers to Dr. Laurence Grummer-Strawn and DC are the verbatim responses of David Clark)

Journal of Human Lactation, Ahead of Print.