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Journal of Human Lactation, Ahead of Print.
Introduction:Cyclobenzaprine is a skeletal muscle relaxant primarily used in the treatment of pain. Its use during lactation is a matter of concern as its level of exposure to infants through human milk is still unknown.Main issue:The aim of this study was to determine cyclobenzaprine concentrations in the milk samples collected from two lactating mothers.Management:The present study describes the analysis of cyclobenzaprine in human milk using liquid chromatography mass spectrometry, which determined the drug concentration-time profiles in human milk.Conclusion:This study shows low levels of concentrations of cyclobenzaprine in human milk with calculated relative infant dose of 0.5%. However, due to the sedative properties of cyclobenzaprine, regular clinical assessment of the infant is recommended to evaluate for long-term effects.

Journal of Human Lactation, Ahead of Print.
Background:When an exclusively breastfed infant develops hematochezia, the pediatrician may recommend elimination of dairy and soy products from a mother’s diet, but there is limited scientific evidence to indicate that altering the maternal diet will lead to resolution of the problem.Research aim:To estimate the likelihood that maternal dairy and soy avoidance will resolve rectal bleeding in an exclusively breastfed infant.Methods:This was a prospective, longitudinal, one-group pre/post study involving mothers of exclusively breastfed infants at least 2 weeks but less than 6 months of age with a positive stool guaiac test in the absence of an intestinal lesion or other explanation for the blood. Participants agreed to follow a dairy and soy elimination/rechallenge protocol, maintain a food diary, and have their infant re-tested at 3-week intervals to determine the outcome of the dietary changes. One participant was lost to follow-up, leaving a final sample size of N = 19.Results:All infants continued to test positive for blood in the stool after their mothers eliminated foods containing dairy or soy. Therefore, 0% (0/19) of infants responded to their mother’s restricted diet, 95% confidence interval (one-sided [0%, 15%]).Conclusion:Given these results, we must call into question the rationale for advising breastfeeding mothers to eliminate dairy and soy from their diet in response to their infant’s unexplained rectal bleeding.

Journal of Human Lactation, Ahead of Print.
Background:When an exclusively breastfed infant develops hematochezia, the pediatrician may recommend elimination of dairy and soy products from a mother’s diet, but there is limited scientific evidence to indicate that altering the maternal diet will lead to resolution of the problem.Research aim:To estimate the likelihood that maternal dairy and soy avoidance will resolve rectal bleeding in an exclusively breastfed infant.Methods:This was a prospective, longitudinal, one-group pre/post study involving mothers of exclusively breastfed infants at least 2 weeks but less than 6 months of age with a positive stool guaiac test in the absence of an intestinal lesion or other explanation for the blood. Participants agreed to follow a dairy and soy elimination/rechallenge protocol, maintain a food diary, and have their infant re-tested at 3-week intervals to determine the outcome of the dietary changes. One participant was lost to follow-up, leaving a final sample size of N = 19.Results:All infants continued to test positive for blood in the stool after their mothers eliminated foods containing dairy or soy. Therefore, 0% (0/19) of infants responded to their mother’s restricted diet, 95% confidence interval (one-sided [0%, 15%]).Conclusion:Given these results, we must call into question the rationale for advising breastfeeding mothers to eliminate dairy and soy from their diet in response to their infant’s unexplained rectal bleeding.

Journal of Human Lactation, Ahead of Print.
Background:Despite advances in prevention of mother-to-child HIV transmission, infants in Africa remain at risk of HIV acquisition from inappropriate feeding practices.Research aims:To assess maternal knowledge and predictors of appropriate infant feeding practices among HIV-infected mothers attending a tertiary facility in Kano, Nigeria.Method:A cross section of 203 HIV-positive mothers were interviewed using structured, pretested survey questionnaires. Knowledge scores and infant feeding practices were analyzed. Multivariate logistic regression was employed to ascertain independent correlates of infant feeding practices in the study sample.Results:Over a third (37.4%) of the participants were aware of the risk of HIV transmission through breastfeeding. The proportion of participants with good, fair, and poor knowledge of recommended feeding options for HIV-exposed infants was 4.4%, 73.4%, and 22.2%, respectively. About three in four participants (73.9%) breastfed their index infants exclusively for the first six months. Approximately 7.4% of respondents practiced mixed feeding (breastfeeding plus infant formula). Counseling on infant feeding (Adjusted Odds Ratio [AOR] = 2.16, 95% Confidence Interval [CI] = [1.58, 4.15]) and hospital delivery (AOR = 3.02, 95% CI = [2.67, 7.84]) predicted appropriate infant feeding practice.Conclusion:Appropriate infant feeding practices were significantly associated with prior infant feeding counseling and delivery in a hospital setting. HIV-infected mothers in this setting should receive counseling on infant feeding early in their pregnancy and be educated on the importance of hospital delivery.

Journal of Human Lactation, Ahead of Print.
Background:According to the Baby Friendly Hospital Initiative, when supplementary feeding occurs, mothers should be counseled on the use and risks of feeding bottles and teats. To help support this initiative it is important to understand the supplementation practices of Internationally Board Certified Lactation Consultants (IBCLC)®.Research aims:To determine (1) if the location of an IBCLC’s practice has any impact on supplemental feeding methods; (2) the preferred methods of and the main reasons for supplementation; (3) the level of an IBCLC’s confidence with supplemental feeding methods; (4) who is making supplemental feeding decisions; and (5) if there are geographical differences among supplementation choices and reasons for supplementation.Methods:An exploratory, descriptive, cross sectional survey of IBCLCs was conducted to generate data about their use of supplemental feeding methods. The survey was sent via email invitation through the International Board of Lactation Consultant’s Board of Examiners, with a response rate of 11.5% (N = 2,308).Results:There was no standard method of supplementation among participants. Participants indicated that they were confident advising mothers on alternative feeding methods. Only 17.6% (n = 406) of participants reported that the IBCLC was the caregiver who recommended the method of supplementation used. The majority of participants believed the Supplemental Feeding Tube Device SFTD) best preserves the breastfeeding relationship, and this was their preferred method of supplementation. However, the bottle was ranked as the number one method used in the United States, Australia, and Canada. The use of alternative feeding methods may be overwhelming to the mother.Conclusion:Supplementation by alternative feeding methods might help preserve the breastfeeding relationship and help reach the World Health Organization’s goal of increasing exclusive breastfeeding rates.

Journal of Human Lactation, Ahead of Print.
Background:Chemerin and dermcidin, which have antimicrobial properties, are molecules that are also related to insulin resistance and inflammation.Research aims:The aims were to determine the amounts of chemerin and dermcidin in the milk and blood of mothers with gestational diabetes, and to compare the amounts of chemerin and dermcidin in the milk and blood of mothers with and without diabetes.Methods:This was a two-group nonrandomized longitudinal study with a convenience sampling of mothers without gestational diabetes (n = 27) and mothers with gestational diabetes (n = 26). Human milk and blood samples were obtained from these mothers during colostrum, transitional, and mature milk periods. The amount of chemerin and dermcidin in these samples was measured by enzyme-linked immunosorbent assay.Results:The presence of chemerin and dermcidin was first detected in human milk. The amounts of chemerin and dermcidin in the blood of all the mothers were greater in the colostrum period and lowest in the mature period. The amount of chemerin and dermcidin in the milk of all the mothers was greater than that in the blood. The amounts of chemerin and dermcidin were significantly increased in both blood and human milk within the gestational age samples.Conclusions:Chemerin and dermcidin may contribute to the protection of infants from infections during infancy. Increased amounts of these molecules found within the gestational diabetes group may also prevent adverse maternal and fetal outcomes.

Pre-pubescent girls with chest burns are at risk of complication associated with scarring and impairment in breast development. This case illustrates how burn injuries in childhood in a first-time mother have ...

Help us celebrate that the #ILCA18 conference is now available in the Knowledge Center by enjoying two conferences for one. For a very limited time, register for the #ILCA19 full in-person conference package and receive 60 days of online access to up to 19 select CERPs from #ILCA18.* Register now! By registering now, your in-person […]

Women are the fastest-growing population in carceral facilities in Canada. Most incarcerated women are mothers, with above-average parity. The incarceration of women has implications not only for women’s healt...

Dr. Julie Ware recaps experiences and takeaways from the December 2018 conference: Eliminating Disparities in Breastfeeding and Infant Mortality

Journal of Human Lactation, Ahead of Print.
Background:Fathers’ involvement has been identified as a significant predictor in maternal breastfeeding outcomes. Its benefits have been well-documented, but limited studies have examined its influencing factors.Research aim:To investigate factors influencing fathers’ involvement in their partners’ breastfeeding.Methods:A descriptive correlational design was used. Data were collected from 151 fathers from four obstetrics wards of a public hospital in Singapore from October 2016 to December 2016. Self-administered questionnaires were used to examine factors such as fathers’ knowledge and involvement in breastfeeding, attitudes towards breastfeeding, and perceived improvements of knowledge and attitudes for fathers’ involvement in breastfeeding on the discharge day of their partners’ and 2 weeks post-birth. Data were analyzed using IBMSPSS24.0.Results:Fathers’ involvement in their partners’ breastfeeding yielded a moderate to high mean score. The multiple linear regression analysis showed that five independent factors significantly influenced fathers’ involvement in their partners’ breastfeeding: (1) perceived approval of family members and friends in fathers’ breastfeeding involvement; (2) knowledge regarding breastfeeding and their involvement; (3) perceived behavioral control for fathers’ breastfeeding involvement; (4)marital relationship; and (5) perceived improvements of knowledge and attitudes 2 weeks post-birth.Conclusions:The study provided evidence on the significant factors that influenced fathers’ involvement in their partners’ breastfeeding, which can be used to guide healthcare professionals when providing appropriate support to facilitate fathers’ involvement. Future studies should continue to evaluate fathers’ involvement in breastfeeding longitudinally so that relevant support can be rendered.

ILCA continued its efforts to increase maternity protection, including advocacy for nursing breaks for mothers, at the recent International Labour Organization (ILO) Centennial Celebration. The ILO, founded 100 years ago, exists to set labor standards, develop policies and devise programs promoting decent work for all women and men. Established as the first specialized agency of […]

In order to meet World Health Organization recommendations for breastfeeding, many women need to combine breastfeeding with return to work or study. Barriers are often encountered when returning to work or stu...

Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring pro...

ENGAGE at ILCA’s 2019 Annual Conference in Atlanta, Georgia, United States on 24 – 27 July. How will #ILCA19 Change Your Practice? We asked past attendees and here is what they had to say: Learn from the leading experts around the globe. “I really appreciated the opportunity to learn at this conference. There was a […]

Hidden Markov models of haplotype inheritance such as the Li and Stephens model allow for computationally tractable probability calculations using the forward algorithm as long as the representative reference ...

National surveys in the Kingdom of Saudi Arabia continue to show rates of breastfeeding below global recommendations. Delay of timely or early initiation of breastfeeding is common in the community. Current ap...

We study the problem of identifying differentially mutated subnetworks of a large gene–gene interaction network, that is, subnetworks that display a significant difference in mutation frequency in two sets of ...

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundMetabolic and hormonal disturbances are associated with sleep disturbances and delayed onset of lactogenesis II.Research AimsThe aim of this study was to measure sleep using wrist actigraphy during gestation weeks 22 and 32 to determine if sleep characteristics were associated with blood glucose, body mass index, gestational related disease, delayed onset of lactogenesis II, or work schedule.MethodsDemographic data were collected at study intake from primiparous women who wore a wrist actigraph during gestation weeks 22 (n = 50) and 32 (n = 44). Start and end sleep time, total nighttime sleep, sleep efficiency, wake after sleep onset, and sleep fragmentation were measured. Night to night variability was assessed with the root mean square of successive difference. Blood glucose levels, body mass index, and gestational disease data were abstracted from medical charts. Timing of lactogenesis II was determined by survey.ResultsBetween gestation week 22 and 32, sleep efficiency decreased and fragmentation increased (p < .05). During gestation week 32, blood glucose was negatively correlated with sleep duration, and positively related to fragmentation (p < .05). Women who experienced delayed lactogenesis II had lower sleep efficiency and greater fragmentation (p < .05), and greater night-to-night variability in sleep start and end time, efficiency, and duration during gestation week 32 (p < .05).ConclusionWomen with better sleep efficiency and more stable nightly sleep time are less likely to experience delayed onset of lactogenesis II. Interventions to improve sleep may improve maternal health and breastfeeding adequacy.