‘I was told not to do it but…’: Infant feeding practices amongst HIV-positive women in southern Thailand

Background and objectivesmothers living with HIV are encouraged not to breastfeed as it can transmit HIV to their infants. However, there is little known about how Thai women with HIV perceive and experience their infant feeding practices. This paper explores the breastfeeding experiences among Thai women living with HIV in southern Thailand.Methodssemi-structured interviews and drawing methods were used with 30 HIV-positive women in rural communities of southern Thailand. Thematic analysis was used for data analysis.FindingsHIV-positive mothers had ambivalent feelings about not being able to breastfeed their infants. They perceived themselves as a ‘contaminated mother’. Healthcare centres and hospitals supply free infant formula for HIV-positive mothers up to one and a half years. Despite this, many mothers had to deal with some difficulties. Some infants developed an allergy to the infant formula. The free infant formula was not sufficient for some infants and the mothers had to find alternative means for the well-being of their infants: many mothers relied on condensed milk whereas some fed mashed banana. The women made every effort to fulfill their ideology of being a good and responsible mother.Conclusionthis paper contributes a conceptual understanding about the lived experiences of breastfeeding among women living with HIV in southern Thailand. The findings have implications for midwifery care and health policy. The provision of different options of feeding should be made available to infants along with accessible resources and professional support and guidance.     

A new formula for premature infants: effects on growth and nutritional status

Objective: Nutritional management influences immediate survival as well as subsequent growth and development of low birth weight and very low birth weight infants. Preterm infant formula (PTF) is used when there is an inadequate supply of mother’s milk or when the mother is unable to breastfeed and donor breast milk is unavailable. The purpose of this prospective multicenter study was to evaluate short-term effects on nutritional status (auxological and biochemical parameters) in a population of premature infants who received a preterm infant formula.

Methods: Ninety-seven preterm infants with a birth weight between 500?g and 2000?g and a gestational age of 25–34 weeks postmenstrual age were randomly assigned to received a new preterm infant formula (Nutribèn Pre), and their nutritional status were compared to 75 fortified human milk (FHM) fed infants.

Results: No significant differences were observed between FHM and Nutribèn Pre fed infants in terms of growth, feeding tolerance and biochemical profiles.

Conclusion: Nutribèn Pre is a valid, effective and safe alternative for the nutrition of preterm infants.     

Resident Physicians' Knowledge of Breastfeeding and Infant Growth

Background: It is well documented that breastfed infants grow differently from formula‐fed infants. The purpose of this study was to assess resident physicians' knowledge of breastfeeding and infant growth. Methods: A cross‐sectional, self‐administered survey was administered to family medicine and pediatric resident physicians from three large, hospital‐based public and private programs in North Carolina. Results: One hundred and seven (46%) of 235 residents completed the study, representing 55 percent of family medicine residents and 39 percent of pediatric residents. Ninety‐nine percent of participants reported frequently or always plotting infant growth at well‐child visits. None reported plotting breastfed babies on a chart specific to breastfeeding. Only 5 percent of participants knew that breastfed infants grew at a slower velocity than formula‐fed infants after 4 months of age. This knowledge was not significantly related to specialty, year of training, or gender; it was significantly related to breastfeeding experience (p < 0.04). Of the residents who did not have personal experience with breastfeeding, 99 percent answered incorrectly compared with 88 percent of those who had some personal experience in breastfeeding. Conclusions: In this sample of family medicine and pediatric residents, almost all were unaware that breastfed infants grow at slower rates after 4 months of age. Since the frequency of breastfeeding is increasing in the United States, it is important that physicians be able to monitor the growth of breastfed infants accurately and provide expert counseling for breastfeeding mothers.     

Congenital chylothorax

The objective of this paper is a retrospective study of all infants treated for congenital chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts of all infants with congenital chylothorax admitted to RCH over a period of 13 years, June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August 1998 inclusive, were reviewed including management outcome and complications. There were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants were managed antenatally. Fifteen infants presented immediately after birth. Seven were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely. Regular infant feeding formula and/or breast milk were used successfully in 12 infants, while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen infants were mechanically ventilated with 75% of them ventilated for < or = 28 days. Fifteen infants received total parenteral nutrition (TPN), and in 80% for < or = 32 days. Hydropic infants had longer duration of mechanical ventilation and hospital stay with mean (range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62) and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with failure in four. Sepsis and bronchopulmonary dysplasia were the main complications. The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated congenital chylothorax in term, and preterm infants is good even in the presence of hydrops. Breast milk and/or regular infant feeding formula should be used initially before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery should be considered if conservative management of congenital chylothorax fails after 4-5 weeks.     

Retinol (vitamin A) and riboflavin (vitamin B2) administration and metabolism in very low birth weight infants.

The combination of marginal hepatic retinol stores at delivery and the reduction of daily retinol dose due to complications with the delivery system places the VLBW infant receiving parenteral nutrition at high risk for retinol deficiency during the first month of life. This has serious health implications because retinol is essential during this period for normal growth and repair of the pulmonary tissue in VLBW infants. Enterally fed VLBW infants, on the other hand, receive relatively higher doses of retinol from vitamin-supplemented premature infant formula and fortified breast milk. Equally serious is the problem of monitoring vitamin A status in infants receiving supplemental doses of vitamin A. It seems clear that while plasma vitamin A levels are the most easily available method of monitoring vitamin A status, further studies are necessary to determine if these levels correlate with hepatic content. This is of particular concern since liver disease is common in VLBW infants and vitamin A hepatotoxicity has been described in a cohort of 41 patients receiving therapeutic doses of the vitamin. While further research of daily enteral and parenteral retinol requirements of VLBW infants should continue, formulation of a specific VLBW parenteral vitamin supplement should also be developed.     

The unknown human infant

What is physiological? It is often difficult to answer this kind of question in the field of human reproduction. That is why we propose to take, as a reference, a population of one hundred infants whose lifestyle is, in many respects, different from the standard Western norm. They were born at home without any drugs, share the mother's bed, were breastfed for more than a year, and so on. This study raises questions such as: --Is the neonatal loss of weight physiological? --What are the physiological sleep-wake patterns of the human infant? --Are the transitional phenomena normal stages of human development? --Why are some infants ill when their mother loses weight?     

Administrative Petition to Relieve the Health Hazards of Promotion of Infant Formulas in the U.S.

ABSTRACT: This is a summary of a 180-page Administrative Petition to the FDA and the DHHS to alleviate domestic formula misuse and to provide informed infant feeding choices, especially among low-income, minority women. This summary documents the low and declining rates of breastfeeding among poor women, and the illnesses and costs of medical treatment in formula-fed infants in the U.S. The practices of the infant formula industry and their effects on the attitudes of medical caregivers towards breastfeeding are described. The Petition, with over 500 references, was filed on June 17, 1981. It is available from Room 2323, Raybum House Office Bldg., Washington D.C. 20500.     

Early aggressive nutrition for the premature infant

Nutrition for sick newborn infants, both term and preterm, has been evolving since the first published report of use of total parenteral nutrition (TPN) in an infant. The more preterm infants have posed an even greater challenge, because optimal timing for use of enteral nutrition is an additional factor for completing their nutritional demands. Although benefiting the immune system among other physiological benefits, human milk has many nutritional gaps for the premature infant. The development of premature infant formulas and milk fortifiers has helped fill these gaps, but questions still exist about safety and efficacy of human milk versus formula. This article will focus on the use of TPN as well as early initiation of enteral feedings and the challenges this brings.     

Perinatal care regionalization and low birth weight infant mortality rates in Alaska

OBJECTIVE: The purpose of this study was to determine the extent to which the failure of non-tertiary care hospitals to appropriately triage and refer pregnant women and newborns contributes to low birth weight infant death in Alaska. STUDY DESIGN: Birth certificates from 1993 to 1997 were reviewed for all 2809 infants who were born at less than 2500 g. Death certificates and maternal and infant medical charts were reviewed for all 168 infant deaths that occurred during this time. RESULTS: Mother-infant pairs who received all care at Alaska's single tertiary care center had a lower mortality rate than those who received some care at a non-tertiary care center (risk ratio, 1.5; 95% confidence interval, 0.86-2.6). Despite this, only 4% of deaths among low birth weight infants (all <1500 g) were associated with care decisions at non-tertiary centers; none of these deaths involved intentional inappropriate retention of infants or mothers. CONCLUSION: Further emphasizing perinatal care regionalization (including for infants 1500-2499 g birth weight) is unlikely to substantially decrease low birth weight infant mortality rates.     

The Risks of Not Breastfeeding for Mothers and Infants

Health outcomes in developed countries differ substantially for mothers and infants who formula feed compared with those who breastfeed. For infants, not being breastfed is associated with an increased incidence of infectious morbidity, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction, and the metabolic syndrome. Obstetricians are uniquely positioned to counsel mothers about the health impact of breastfeeding and to ensure that mothers and infants receive appropriate, evidence-based care, starting at birth.Key words: Breastfeeding, Antenatal care, Infant health outcomes, LactationHealth outcomes differ substantially for mothers and infants who formula feed compared with those who breastfeed, even in developed countries such as the United States. A recent meta-analysis by the Agency for Healthcare Research and Quality reviewed this evidence in detail¹:

• For infants, not being breastfed is associated with an increased incidence of infectious morbidity, including otitis media, gastroenteritis, and pneumonia, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome (SIDS).
• Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis (NEC).
• For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome.

These findings suggest that infant feeding is an important modifiable risk factor for disease for both mothers and infants. The American College of Obstetricians and Gynecologists (ACOG) therefore recommends 6 months of exclusive breastfeeding for all infants.² The American Academy of Pediatrics (AAP)³ and the American Academy of Family Physicians (AAFP)⁴ similarly recommend exclusive breastfeeding for the first 6 months of life, continuing at least through the infant’s first birthday, and as long thereafter as is mutually desired. The World Health Organization (WHO) recommends at least 2 years of breastfeeding for all infants.In the United States, breastfeeding durations fall far short of these guidelines.⁵ In 2005, 74.2% of US infants were breastfed at least once after delivery, but only 31.5% were exclusively breastfed at age 3 months, and just 11.9% were exclusively breastfed at age 6 months. These rates show considerable regional variation, with the highest rates in the Pacific Northwest and the lowest rates in the Southeast. Although some of this variation reflects cultural differences, recent data suggest that variations in hospital practices account for a considerable proportion of disparities in breastfeeding duration.⁶ This suggests that improvements in the quality of antenatal and perinatal support for breastfeeding could have a substantial impact on the health of mothers and infants.This article reviews the health risks of not breastfeeding, for infants and for mothers, as well as the obstetrician’s role in counseling women regarding infant feeding and ensuring an optimal start for breastfeeding at birth.     

Breastfeeding Duration,Costs, and Benefits of a Support Program for Low‐Income Breastfeeding Women

Background: Breastfeeding can ameliorate some of the complex health issues faced by low‐income families. Women who breastfeed and their infants have lower health care costs compared with those who formula feed. Increasing the duration of breastfeeding is recognized as a national priority, particularly for low‐income women. This community‐based randomized clinical trial involving low‐income mothers compared usual care with an intervention comprising hospital and home visits, and telephone support by a community health nurse/peer counselor team for 6 months after delivery. Methods: Forty‐one women were recruited after delivery of a full‐term singleton infant and randomly assigned to intervention or usual care groups. Results: Women receiving the community health intervention breastfed longer than the women receiving usual care. The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group. The intervention cost ($301/mother) was partially offset by cost savings on formula and health care. Conclusions: Community health nurse and peer counselor support can increase breastfeeding duration in low‐income women, and has the potential to reduce total costs including the cost of support. (BIRTH 29:2 June 2002)     

Low birth weight and early weight gain in the metabolic syndrome: Consequences for infant nutrition

Emerging data indicate that being born small for gestational age (SGA) and rapid infant catch-up growth may play a significant role in the risk of developing type 2 diabetes (T2DM) and the metabolic syndrome (MS) many years later in life. The impact of these perinatal T2DM and MS risk factors may be more important than genetics in some parts of the world, including low-income countries. Breastfeeding for 3–6 months is associated with reduced risk of developing insulin resistance and the metabolic syndrome. Promotion of fast growth in SGA infants by nutrient-enriched formula increases risk of hypertension and the metabolic syndrome. While waiting for better knowledge of how to combat T2DM and MS with early-life interventions, breastfeeding should be recommended and enforced whenever possible, keeping in mind the health and nutritional status of the mother. Furthermore, promotion of fast weight gain in SGA infants by nutrient-enriched formula feeding should be used with caution. However, growth limitation by restriction of nutrition in SGA infants below general recommendations should not be recommended.     

Factors influencing the duration of exclusive breastfeeding in a group of Turkish women.

This study was conducted to evaluate the influence of demographic characteristics, hospital practices, maternal psychosocial factors, and knowledge about infant feeding and breast milk on duration of breastfeeding. The mothers of 91 healthy, term infants delivered at a university hospital between June 1998 and December 1998, and first seen in the well-child unit within 10 days of delivery, participated in the study. Forty-nine (54%) infants were exclusively breastfed at 4 months of age. Cox regression analysis showed a negative association between formula supplementation during the hospital stay and duration of exclusive breastfeeding. The median age for starting non-breast milk liquids was 1 month for those who received formula in the hospital and 3 months for those who did not (P = .001). The hospital practices were more predictive of the duration of exclusive breastfeeding in this study group than mothers' knowledge of infant feeding or psychosocial factors. Thus, hospital practices should be reevaluated.     

Barriers and benefits to breastfeeding with gestational diabetes

Gestational diabetes mellitus (GDM) is a disease of glucose intolerance during pregnancy and is associated with infant macrosomia, infant hypoglycemia, and increased risk of type 2 diabetes development for both mother and infant. Although breastfeeding potentially mitigates metabolic sequelae for both mother and her offspring, women with GDM are more likely to introduce formula and, therefore, are less likely to exclusively breastfeed, and some studies show less initiation and shorter breastfeeding duration as well. Therefore, women with GDM and their infants warrant investigation of methods by which to increase breastfeeding exclusivity and duration. Exploration of the barriers to breastfeeding for women with GDM demonstrate not only biologic complications such as maternal obesity, increased prevalence of cesarean section, and infant hypoglycemia, but also maternal report of less provider support of breastfeeding and reduced breastfeeding self-efficacy. Consequently, interventions designed to optimize breastfeeding outcomes in this high-risk population should not only focus on the biology but also on provider behavior and maternal social factors.     

HIV and infant feeding: issues in developed and developing countries

Women in developed countries who are human immunodeficiency virus (HIV)-positive generally feed their infants formula to avoid virus transmission via breastfeeding. However, for most of the world's women who are HIV positive, the choice of infant feeding method is not so clear. Poor socioeconomic and living conditions place infants on breast milk substitutes at higher risk of non-HIV infectious diseases as compared with breastfed infants. Mothers in these settings who are HIV positive must weigh the risks and benefits of breastfeeding to choose the best infant feeding option.     

How Are Babies Fed? A Pilot Study Exploring Primary School Children’s Perceptions of Infant Feeding

Abstract: Background: Breastfeeding is the optimal feeding method for human infants. In the United Kingdom some women do not initiate breastfeeding, and many commence formula milk feeding after a brief period of breastfeeding. Infant feeding perceptions may develop early in life, and this research aimed to explore infant feeding awareness among primary school children as a first step toward informing appropriate health education interventions. Method: Fifty‐six children aged 5/6, 7/8, and 10/11 years were recruited from three schools in southern England. Children were shown a series of drawings, and were read a story about a hungry newborn baby. A creative method, “draw, write and tell,” was developed for this research. Children were asked to finish the story, showing how they thought the baby might be fed. They were given the opportunity to verbally interpret their work. A constant comparison method was used to analyze the data. Results: Children were aware of formula milk, breastfeeding, and solid foods. Formula milk feeding was referred to more frequently than breastfeeding. Some children combined feeding methods. Children appeared to have gained their awareness in various settings. Conclusions: Children have a range of perceptions around infant feeding. They appear receptive to new ideas on the subject while of primary school age. An opportunity for education in primary schools arises to present breastfeeding to children as a normal way to feed a baby, but it is vital that education is evidence based and any interventions are evaluated. (BIRTH 38:4 December 2011)     

Asymptomatic neonatal contamination with herpes simplex virus

Frequent maternal vaginal and/or lesion cultures for herpes simplex virus (HSV) were obtained from a high-risk maternal population during the course of pregnancy and from oropharyngeal samples of their newborn infants on the first day of life to determine (1) the incidence of asymptomatic neonatal contamination with HSV and (2) the relationship of neonatal with maternal colonization. Four hundred ninety-nine maternal cultures were obtained from 85 patients. The mean number of cultures per patient was six with a range from one to 12. Thirty-three mothers had 41 positive cultures. Fifty-two women had 301 negative cultures. Cord blood HSV-enzyme-linked immunosorbent assay (ELISA) titers were not different in the two groups of infants (geometric mean titer 1152 and 800, respectively). One infant from each maternal group had a positive oropharyngeal HSV culture. Both infants were asymptomatic. One was delivered by elective cesarean section at term to a mother with four positive cultures obtained during pregnancy. Fetal membranes were intact until delivery. The second infant with a positive oropharyngeal culture on the first day of life was born vaginally to a mother with seven negative cultures during pregnancy. Repeat cultures on both infants during the first week of life were negative. These data indicate that asymptomatic neonatal contamination with HSV does occur in oropharyngeal samples obtained on the first day of life. The data also suggest that there is a poor relationship of viral excretion during pregnancy or the mode of delivery with neonatal contamination. Further data are required to determine the incidence of asymptomatic neonatal contamination and the relationship of maternal with neonatal cultures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relationship of Early Bonding to Initial Infant Feeding Patterns in Bottle-fed Newborns

To determine the relationship between early bonding in the immediate post-delivery period and initial infant feeding patterns in bottle-fed newborns, data were gathered from the charts of 85 full-term normal infants. Of the infants, 57 had an early, extra bonding experience in the postpartum recovery room; 28 did not. In comparing the bond and no-bond groups for weight loss and formula intake, the t -test analyses showed a statistically significant effect of bonding that was beneficial to infant status.