Treatment of neonatal hypoglycaemia: more frequent latching onto the breast versus supplementary feeding with formula; retrospective study of patient files

OBJECTIVE: To evaluate the effects of frequent latching versus supplementary feeding of breastfed infants with hypoglycaemia on blood glucose concentrations and breastfeeding. DESIGN: Retrospective study of patient files. METHOD: All breastfed infants born in the period of investigation (June 1st 2004-April 30th 2005) by artificial or breech delivery were included. In the group with supplementary feeding (June 1st 2004 until December 12th 2004) mild neonatal hypoglycaemia, defined as glucose concentrations between 1.8 and 2.5 mmol/l, with symptoms, or between 1.3 and 1.7 mmol/l, without symptoms, was treated with supplementary feeding with formula. In the group with more frequent latching (December 13th 2004-April 30th 2005) mild neonatal hypoglycaemia (defined as glucose levels of 1.8-2.1 mmol/l) was treated with more frequent latching without supplementary feeding. The change in feeding policy (mid December 2004) was introduced because of excessive numbers of supplementary feedings, which jeopardized breastfeeding. Blood glucose determinations were carried out with the HemoCue B-glucose system. Risk factors for hypoglycaemia were listed, enabling the assessment of data of neonates who did not run an increased risk of hypoglycaemia, a kind of 'control group'. RESULTS: 232 newborn infants were included: 158 in the supplementary feeding group and 74 in the group with more frequent latching. In the supplementary feeding group, 63% (100/158) of the children developed hypoglycaemia, versus 55% (41/77) in the group with more frequent latching. The latter had lower blood glucose concentrations than the supplementary feeding group. This difference was only significant for infants without risk factors: the mean difference in lowest glucose concentration between supplementary feeding and more frequent latching in the group without risk factors was 0.50 mmol/L (SD: 0.69; 95% CI: 0.06-0.93; p = 0.03) versus 0.20 mmol/l (SD: 0.79; 95% CI: -0.05-0.45; p = 0.14) in the group with risk factors. Supplementary feedings decreased by 39% (95% CI: 28-50). The number of infants discharged with breastfeeding only increased by 14% (95% CI: 2-26). Symptomatic hypoglycaemic episodes were not found in the group with supplementary feeding or in the group with more frequent latching. CONCLUSION: Frequent latching instead of supplementary (formula) feeding in infants with mild neonatal hypoglycaemia was associated with lower blood glucose concentrations but with higher percentages of breastfeeding only at discharge.     

Breastfeeding patterns in Puerto Rico.

In the 1950s, Puerto Rico began an active industrialization program. We used data from the 1982 Puerto Rico Fertility and Family Planning Assessment to describe the trend in the incidence of breastfeeding in Puerto Rico over time and to ascertain some of its determinants. From 1946 through 1982, 5,884 infants were born among this statistically representative sample of reproductive-aged women. The proportion of infants who had ever been breastfed was 59 percent for births before 1960 (mean duration = 7.8 months), dropped to 25 percent for infants born from 1970 to 1974 (mean duration = 4.9), and rose to 38 percent for births delivered from 1980 to 1982 (mean duration = 3.4). Prior breastfeeding experience was an important determinant of breastfeeding a newborn. Infants of mothers who had breastfed a previous baby were 7.3 times more likely to be breastfed (95% confidence interval = 6.6, 8.0) compared with infants of mothers who had not previously breastfed. The 38 percent of infants who were breastfed in Puerto Rico in the early 1980s is below the 74 percent to 97 percent reported in Latin America and below the 54 percent reported in the United States for the same period. This study provides baseline data for any future intervention strategies.     

Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitization during the first year of life

Aims   To investigate the effect of Caesarean section on gastrointestinal symptoms, atopic dermatitis and sensitization to nutritional allergens in infants.
Methods   A total of 865 healthy full-term neonates with parental history of allergy participating in the prospective German Infant Nutritional Intervention Program (GINI) were exclusively breastfed during the first four months of life and had a one year follow-up. Data were obtained by follow-up visits at age 1, 4, 8, and 12 months, weekly diaries for the first six months, and measurement of total and specific IgE at birth and 12 months.
Results   Infants born by Caesarean section (147/865, 17%) had a greater risk of diarrhoea (OR_adj 1.46, 95% CI 1.022–2.10) and sensitization to food allergens, both in adjusted (OR_adj 2.06, 95% CI 1.123–3.80) and stratified analyses (by cord blood IgE). Caesarean delivery was not associated with colicky pain and atopic dermatitis.
Conclusion   Caesarean delivery might be a risk factor for diarrhoea and sensitization in infants with family history of allergy. Further research in this area seems warranted as choosing Caesarean section becomes increasingly popular.     

Breastfeeding practices and infant growth: a longitudinal study in Rio de Janeiro, Brazil, 1999/2001

Various studies have shown significant differences in growth patterns between breastfed and formula-fed infants. This paper aims to evaluate the effect of predominant breastfeeding duration on anthropometric profile and to detect determinants associated with growth in Brazilian infants. Four hundred and seventy nine infants were studied in a health center in Rio de Janeiro through a longitudinal study with four follow-up waves at 0.5, 2, 6, and 9 months. The response variables were body weight and length, collected according to a standardized procedure. Data analysis was performed having longitudinal mixed-effects model as the main statistical procedure. Gestational age, birth weight, and birth length were positively associated with weight and length gains. The positive effect showed that the longer breastfeeding lasts, the greater the weight gains. Infants born through vaginal delivery presented lower weight gains than those born by cesarean delivery. The results emphasize the need for health programs encouraging breastfeeding practices up to the sixth month of life.     

Effects of hospital policies and practices on initiation and duration of breastfeeding

Background   The aim of this study was to verify if hospital policies and practices, independently of main maternal sociodemographic determinants, influence initiation and duration of breastfeeding.
Methods   The study was carried out at the Immunization Centre of Messina where all infants born in the four maternity wards of Messina are vaccinated, using a structured questionnaire, constructed in conformity with the methodology suggested by the WHO.
Results   Data analysis, performed by non-parametric and multivariate analysis of variance and by Kaplan–Meier curves, showed that the highest probability rate ( P  < 0.001) of initiation and duration of breastfeeding, independently of maternal age, parity, education levels, smoke and work was found in infants born in a University Hospital, characterized by earlier times of first suckling, longer hospital stay and higher rate of exclusive breastfeeding at discharge.
Conclusion   Our data emphasize the role and responsibility of hospital policies and practices in the promotion, and in the duration of breastfeeding.     

Breastfeeding in Depressed Mother-Infant Dyads

Depressed versus non-depressed mothers were interviewed on their breastfeeding practices and perceptions of their infants' feeding behavior when their infants were eight-months-old. The depressed mothers less often breastfed, they stopped breastfeeding their infants significantly earlier in infancy and they scored lower on a breastfeeding confidence scale. Independent of maternal depression, mothers who breastfed rather than bottle fed their infants had higher confidence levels and rated their infants as less alert and less irritable during feedings.     

Increasing breastfeeding rates in New York City, 1980–2000

Our objective was to determine temporal patterns of breastfeeding among women delivering infants in New York City (NYC) and compare national breastfeeding trends. All hospitals in NYC with obstetric units were contacted in May and June 2000 to provide information on the method of infant feeding during the mother’s admission for delivery. Feeding was categorized as “exclusive breastfeeding,” “breast and formula,” or “exclusive formula.” The first two categories were further grouped into “any breastfeeding” in the analysis. Hospitals were classified as “public” and “private,” and patients were classified by insurance type as “service” and “private.” Data between public and private hospitals and service and private patients were compared. Breastfeeding trends over time were compared by using previous iterations of the same survey. Of 16,932 newborns, representing approximately 80.0% of all reported live births in the city during the study period, 5,305 (31.3%) were exclusively breastfed, 6,189 (36.6%) were fed a combination of breast milk and formula, and the remaining 5,438 (32.1%) were exclusively formula-fed. Infants born in private hospitals were 1.6 times more likely to be exclusively breastfed compared with infants discharged from public hospitals (33% vs. 21%, respectively). Similarly, private patients were more likely than service patients to exclusively breastfeed their infants (39.6% vs. 22.9%, respectively) and to use a combination of breast and formula (i.e., any breastfeeding) (73.6% vs. 62.0%, respectively). From 1980 to 2000, the proportion of exclusive breastfeeding increased from 25.0% to 31.0%, the percentage of combined feeding increased from 8.0% to 37.0%, and the percentage of any breastfeeding increased from 33.0% to 68.0%. NYC has more than doubled the rate of breastfeeding since 1980. However, there is much progress to be made, and continued efforts are vital to maintain current gains in breastfeeding, improve the rates further, and prolong the duration of breastfeeding. at the time of the research.     

母乳喂养与婴儿幽门螺杆菌感染的前瞻性研究

目的研究母乳喂养与婴儿幽门螺杆菌（H.pylori）感染的相关性和H.pylori阳性母亲婴儿H.pylori的感染率。方法通过对2005年1月-2005年12月出生的中山市城镇婴儿的父母提供标准化问卷调查，随机选择经济生活条件好和依从性好的家庭进入研究。婴儿分为母亲H.pylori阳性组（50例）和母亲H.pylori阴性组（100例），又各自分为母乳喂养组和非母乳喂养组。用ELISA方法检测母亲分娩前及婴儿出生后1-2 d、6月、12月粪便幽门螺杆菌抗原（HpSA）。结果母亲H.pylori阳性组婴儿HP感染率均高于母亲H.pylori阴性组（P〈0.05）；无论母亲是否H.pylori阳性，母乳喂养组和非母乳喂养组婴儿H.pylori感染率差异均无统计学意义（P〉0.05）。结论婴儿H.pylori感染与H.pylori阳性母亲有关，可能通过密切接触传播，与母乳喂养无关。     

Body fat distribution, serum glucose, lipid and insulin response to meals in Alström syndrome

Background  Alström syndrome is an autosomal recessive condition characterized by obesity, insulin resistance and hypertriglyceridaemia. Responses to fat and carbohydrate ingestion are important in planning dietetic advice and may help to explain the mechanism of metabolic disorder in the syndrome.
Methods  After a 12-h fast, five Alström subjects received a 3.1 MJ (742 kcal), 75.8% fat breakfast on day 1, and a 3.3 MJ (794 kcal), 77.5% carbohydrate breakfast on day 2. Serum glucose, triglyceride and insulin levels were measured at baseline, and 2 and 3.5 h post-meal. Abdominal computerized tomography in three subjects and magnetic resonance imaging in one demonstrated distribution of abdominal fat.
Results  Body fat was distributed subcutaneously, as well as viscerally. There were no changes in serum glucose, insulin or triglycerides after the high fat meal. Triglycerides remained stable after the high carbohydrate meal but glucose and log insulin levels increased [8.4 ± 4.1 to 13.4 ± 6.9 mmol L⁻¹ ( P  < 0.05) and 2.6 ± 0.27 to 3.15 ± 0.42 pmol L⁻¹ ( P  < 0.05), respectively].
Conclusions  Dietetic advice in Alström syndrome must include calorie restriction to reduce obesity, which is predominantly subcutaneous. This study has shown that low carbohydrate advice may prove more effective than fat restriction in control of hyperglycaemia and hyperinsulinism. A single high energy meal does not exacerbate hypertriglyceridaemia.     

Breastfeeding in Depressed Mother-Infant Dyads

Depressed versus non-depressed mothers were interviewed on their breastfeeding practices and perceptions of their infants' feeding behavior when their infants were eight-months-old. The depressed mothers less often breastfed, they stopped breastfeeding their infants significantly earlier in infancy and they scored lower on a breastfeeding confidence scale. Independent of maternal depression, mothers who breastfed rather than bottle fed their infants had higher confidence levels and rated their infants as less alert and less irritable during feedings.     

Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux

Infants with gastroesophageal reflux disease (GERD) who are breastfed have significantly shorter clinical episodes of the condition than artificially fed infants. The purpose of this study was to identify the knowledge about the benefits of breastfeeding in mothers of babies 0-12 months of age with gastroesophageal reflux. A non-probabilistic sample was taken among patients from various private radiological centers. Sixty mothers completed a self-administered questionnaire, with a median age of 26 years and an educational level of 14 years. Seventy one percent breastfed their last baby, but only 18.6% practiced exclusive breastfeeding. The pediatrician suggested formula to 53.3% of the mothers, and 64% of the mothers were told to combine breast milk with vegetables as treatment for the GERD. Inadequate knowledge about the benefits of breastfeeding was exhibited by 27% of the mothers. Mothers of infants with GERD need education on the importance of breastfeeding. Further research is necessary on the factors which impact the duration of breastfeeding in this population.     

Rapid assessment of current infant feeding practices in São José do Rio Preto, São Paulo, Brazil

This paper describes a rapid assessment of current infant feeding practices conducted during a mass immunization campaign in an urban area of S?o José do Rio Preto, S?o Paulo State, Brazil. Parents or guardians of all infants (<1 year) attending the 8 randomly-selected health centers were interviewed. Median duration of breastfeeding practices was estimated by probit analysis. Of the 719 infants, 692 (96.2%) began breastfeeding, and only 63 (8.9%) were in exclusive breastfeeding. Median duration of total breastfeeding (exclusive plus partial) was 205.93 days. Infants born by cesarean section showed a higher risk of early weaning: OR (95%CI)=1.51 (1.09-2.09) after adjusting for confounding variables (mother's educational level, gestational age, birth weight, whether breastfed). Median duration of total breastfeeding was higher among infants born by vaginal delivery (227.38 days; 95%CI=195.19-271.16) as compared to cesarean section (192.84 days; 95%CI=128.23-273.34). Early introduction of weaning foods such as water/herbal tea and cow's milk was observed with a median age at introduction of 30 days. These findings indicate the need to improve strategies by the public health services to promote exclusive breastfeeding.     

Psychosocial and economic factors associated with infant feeding intentions of adolescent mothers

The infant feeding intentions of 64 primiparous, adolescent females, ages 14–18 years, were studied to assess factors which differentiated those who chose breastfeeding from those who did not. The study population consisted of 43 Hispanic, 9 black, 7 non-Hispanic white, and 5 Filipino or Southeast Asian subjects interviewed after delivery. Among the Hispanics, 31 primarily spoke Spanish, and 12 primarily spoke English. A total of 72% intended to breastfeed, and 22% planned to exclusively formula feed. Those teens who intended to breastfeed were significantly older, more often married, more likely to be Hispanic and Spanish speaking, and less likely to have been in school during the pregnancy. In addition, teens were more likely to choose breastfeeding if they had been breastfed themselves or exposed to other women who breastfed. These data suggest that the younger, non-Hispanic, single teen who is enrolled in school and lacking exposure to breastfeeding is the most in need of breastfeeding-promotion programs.     

Factors that Influence Breastfeeding Decisions among Special Supplemental Nutrition Program for Women, Infants, and Children Participants from Central Louisiana

Although human milk provides optimal nutrition for infants, fewer than one third of US infants are breastfed exclusively for 6 months or more. The objectives of this study were to determine the factors that have the greatest impact on the decisions to breastfeed, and to determine the effect of formula provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the initiation and duration of breastfeeding among WIC participants in a rural parish in central Louisiana. A cross-sectional study was done between September 2007 and March 2008 among 130 WIC participants. Approximately half (51%) of the participants reported breastfeeding their youngest child for a mean of 15.7±14.9 weeks, with more white mothers breastfeeding than did African-American mothers or other races (P<0.01). Significantly more people reported that incentives provided to encourage breastfeeding did not affect their decision to breastfeed than those who said incentives affected their decision to breastfeed (P<0.029). Finally, study participants who were breastfed as a child were significantly more likely to breastfeed their children than those who were not breastfed as a child (P<0.022). The majority (96%) of the participants in this study indicated that WIC is providing effective and clear education about the benefits of breastfeeding, and that this advice influenced their decision to breastfeed their children. These findings underscore the importance of emphasizing the health benefits of breastfeeding to increase initiation and duration rates among WIC participants.     

An retrospective audit of patients with polycystic ovary syndrome: the effects of a reduced glycaemic load diet

Background  Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and chronic anovulation. The aim of this retrospective audit was to determine the patient profile, including anthropometrics, biochemistry and symptoms, and to evaluate the influence of a dietary intervention in women with PCOS.
Methods  Data were collected retrospectively from dietetic and medical records from all PCOS patients ( n  = 88) who attended a dietetic consultation from July 2004 to July 2006. As standard clinic practice, a reduced glycaemic load diet had been prescribed, with energy reduction in overweight patients. Follow-up data were available for 59 patients.
Results  Fifty-eight patients had a body mass index (BMI) ≤ 24.9 kg m⁻² and 30 had a BMI ≥ 25 kg m⁻². Thirty-six patients, with a BMI ≤ 24.9 kg m⁻², self-reported central weight gain at their initial appointment. Over two-thirds of patients self-reported one or more of the following symptoms: carbohydrate cravings, hypoglycaemia, tiredness and hunger. At the follow-up appointment, BMI and waist circumference significantly decreased in overweight patients ( P  < 0.05). Seventy-one percent of women self-reported hypoglycaemia initially; this was reduced to 13% at follow-up ( P  < 0.01).
Conclusions  The audit indicated a low glycaemic load diet in combination with medication may contribute to an improvement in symptom relief in patients with PCOS.     

Breastfeeding duration in two generations

OBJECTIVE: To assess the intergenerational repetition of breastfeeding duration in a cohort of adolescent mothers who had been prospectively followed up since birth. METHODS: All hospital births occurred in Pelotas (N=5,914), a Southern Brazilian city, in 1982 were studied prospectively. The cohort was visited in 1984 and 1986, and information on feeding practices was gathered. In 2001, a search was conducted in the Live Birth Information System and adolescents born in 1982 who gave birth between January 1995 and March 2001 were identified. Parous adolescents answered a detailed questionnaire on pregnancy-related variables and breastfeeding duration for each child. For multiparous adolescents, the information from the first live born child was used. Poisson regression with robust adjustment of the variance was used in the univariate and multivariable analysis. RESULTS: A total of 446 parous adolescents belonging to the 1982 cohort were identified, of which 420 (94.2%) were interviewed. After adjustment for confounding variables, mothers who had not been breastfed presented a relative risk of 1.34 (95% CI: 0.35; 5.18) of not breastfeeding their children, compared to mothers who were ever breastfed. Similarly, adolescents who were breastfed for less than one month were slightly - but not significantly - more likely to fail to breastfeed their own infants (RR=1.64; 95% CI: 0.70; 4.03). The proportion of adolescent mothers who breastfed for less than six months was higher among those who were themselves breastfed for less than one month (PR=1.29; 95% CI: 1.02; 1.62)]. CONCLUSIONS: Duration of breastfeeding is slightly higher among infants whose mother was breastfed.     

Determinants of breastfeeding duration in Peninsular Malaysia

The health benefits of breastfeeding to infants and mothers have been well recognised. This study applies linear regression analysis to assess the determinants of breastfeeding duration of first born using data from the Second Malaysian Family Life Survey. The proportion of women who breastfed their first child is 82 percent, of which 97 percent reported their breastfeeding duration. The distribution of breastfeeding duration has a mean of 5.7 months and a median of two months. Important determinants of breastfeeding duration include maternal age, ethnicity, period of first birth, husband's occupation and work status of the woman.     

Predictors of Breastfeeding Duration among Women in Kuwait: Results of a Prospective Cohort Study

The purposes of this paper are to report the prevalence of breastfeeding to six months among women in Kuwait and to determine the factors that are associated with the duration of breastfeeding. A cohort of 373 women recruited from maternity wards in four hospitals in Kuwait city were followed from birth to 26 weeks postpartum. The association of any and full breastfeeding duration and predictor variables were explored using multivariate Cox’s proportional hazards models. At six months, 39% of all infants were receiving some breast milk and only 2% of infants had been fully breastfed to 26 weeks. Women born in other Arab countries were less likely to discontinue breastfeeding than women born in Kuwait. Other factors positively associated with breastfeeding duration were level of maternal education, higher parity, infant being demand fed in hospital and a preference for breastfeeding on the part of the infant’s father and maternal grandmother. The introduction of a pacifier before four weeks of age and the mother intending to return to work by six months were negatively associated with duration. These findings present a number of opportunities for prolonging breastfeeding duration in Kuwait.     

Drinking and smoking at 3 months postpartum by lactation history

A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied). Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.     

Drinking and smoking at 3 months postpartum by lactation history

Summary. A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied.) Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.