Expressed Breast Milk Analysis: Role of Individualized Protein Fortification to Avoid Protein Deficit After Preterm Birth and Improve Infant Outcomes

Background: Expressed breast milk (EBM) protein content is highly variable between mothers and often below published values that are still used for EBM protein fortification strategies. This approach may result in significant protein deficit and suboptimal protein energy (P/E) ratio. The study aim was to determine whether individualized EBM protein analysis and fortification will reduce preterm infant protein deficits and improve growth and neurodevelopmental outcome.Study Methods: In a single-center randomized, blinded study of infants born at 24 0/7–29 6/7 weeks, mother-specific protein values measured by a milk analyzer were used to individualize infant-specific protein intake (interventional group, IG), and compared this to a standardized protein fortification scheme based on published values of EBM protein content of 1.4 g/dL (control group, CG). For IG, milk analyzer protein values of mother's EBM were used to adjust protein content of the EBM. The CG EBM protein content was adjusted using the standard published value of 1.4 g/dL and not based on milk analyzer values. EBM protein content, protein intake, protein/energy (P/E) ratio, weight (WT), head circumference (HC), length (L), growth velocity (GV) from 2 to 6 weeks of age, WT, HC and L Z-Scores at 32- and 35-weeks PMA, and lean body mass (35 weeks PMA skin fold thickness) were measured. Neurodevelopment was assessed by Bayley III at average 24 months corrected gestational age (CGA).Results: EBM protein content before fortification was significantly below published values of 1.4 g/dL at all time points in both CG and IG. CG protein deficit was significantly decreased and progressively worsened throughout the study. Individualized protein fortification in IG avoided protein deficit and optimized P/E ratio. Although no significant change in short-term GV (at 6 weeks of age) was seen between groups, IG infants born at <27 weeks had significant improvements in WT and L z-scores, and leaner body mass at 32 and 35 weeks PMA. IG exhibited significantly improved cognitive scores at 24 months CGA.Conclusions: Infant-specific protein supplementation of mother's EBM optimized P/E ratio by eliminating protein deficit and improved growth z scores at 32- and 35-weeks PMA and neurocognitive testing at 24 months.

Protocol for RCT: Effectiveness of Traditional Breast Stimulations as Adjuvant Techniques to Breast Milk Expression on Lactational and Maternal Outcomes

Background: Mothers of infants who are dependent on expressed breast milk often find difficulty to express adequate quantity of breast milk to ensure exclusive breast feeding to their babies and it has become a major stress factor among these mothers. Many cost-effective adjuvant techniques are proved to be very useful in improving the quantity and quality of expressed breast milk. Objective: To determine the effect of two traditional breast stimulation techniques such as warm compress and breast massage as adjuvant to breast milk expression on maternal and lactational outcomes. Methodology: A hospital-based cross over trial will be considered to compare the effects of two interventions such as breast massage and warm compress, adjuvant to breast milk expression method (breast pump) on lactational outcomes (Quantity and quality of expressed breast milk) and maternal outcomes (Nipple pain, anxiety and experience of breast milk expression). The setting of the study will be selected tertiary level hospital of New Delhi. Approval from Institutional the Ethical approval is obtained from Institutional Ethical Committee, DMIMS (DMIMS (DU)/IEC/2017-18/6979) and also from the institutional ethical committee of armed forces medical services hospital of New Delhi where the study will be conducted. The data collected will be entered to an electronic data sheet and analysis will be done using SPSS. Expected Results: There will be a positive impact of interventions on locational outcomes such as quantity of expressed breast milk and quality of expressed breast milk. There will be a positive impact of interventions on maternal outcomes such as nipple pain. Anxiety and breast milk expression experience. This nurse led interventions will be made as a part of hospital policy to provide routine care to the mothers who are expressing breast milk in hospital settings. Conclusion: Conclusion will be drawn after the analysis of data collected from the predetermined sample size. The findings of the study will be published in an open access peer reviewed journal.

Knowledge and attitude of antenatal women attending tertiary care hospital regarding breastfeeding

Background: Breastfeeding is the most natural way of infant feeding to satisfy nutritional, metabolic and psychological needs of the baby. Breastfeeding significantly reduces the risk of death especially from diarrhoea and pneumonia in infants as compared to formula fed babies. Breastfeeding has advantage to both the baby and the mother. Early initiation of breastfeeding lowers the mother’s risk of postpartum haemorrhage and anaemia, boosts mother’s immune system and reduces the incidence of diabetes and cancer.Methods: All women attending Jayanagar General Hospital for ante-natal checkups during study period were interviewed personally by an investigator after obtaining an informed consent. Data regarding socio-demographic details and data on knowledge, attitude of breastfeeding were collected by using a pre-tested semi- structured questionnaire.Results: The sample of the present study comprised of 204 antenatal women of whom 89.7% belonged to age group less than or equal to 30 years. Majorities 73.5% of them were Muslims .Most of the participants 87.7% were unemployed. Almost 72.54% of the participants were multipara. Almost 42.2% of the participants were of the opinion that the duration of breastfeeding is 2 years or more. 65.7% of the participants stated that complementary feeding should be started after 6 months. Knowledge about technique of expressed breast milk was poor.Conclusions: Multiparous women have better knowledge than primipara regarding breastfeeding. Socio demographic characteristics such as age, parity found to be significantly associated with knowledge. There is a need for counselling primi antenatal women regarding breastfeeding associated with knowledge. There is a need for counselling primi antenatal women regarding breastfeeding.

STATISTICAL ANALYSIS OF EXCLUSIVE BREASTFEEDING (EBF) AMONG MOTHERS IN AMUKOKO, NIGERIA

This study assessed mothers’ knowledge on, the practice of, and factors that influence exclusive breastfeeding in the initial 6 months after birth. A descriptive cross-sectional research design and purposive sampling technique were used to pick 323 mothers that attended immunization at Community Health Project Amukoko and who had at least 1 child and a well-structured self-administered questionnaire was used to collect data from them. Data collected were analyzed using frequency distribution, Chi-square test, t-test and Analysis of Variance (ANOVA) were used to test significant differences in the knowledge of EBF and demographic characteristics with the aid of Statistical Package for Social Sciences (SPSS). The results show that the mean age of the mothers is 29.47 (18 - 47 years). The rate of exclusive breastfeeding was found to be 72.1% and the knowledge of mothers on exclusive breastfeeding was very good (81.81%). The mode of delivery, introduction of prelacteal feed and introduction of water before breastfeeding have significant related to the practice of exclusive breastfeeding (p < 0.05). The study concluded that most of the mothers had good knowledge on exclusive breastfeeding, exclusive breastfeeding rate at six months, mode of delivery, offering of prelacteal feed and introducing of water before breastfeeding is significantly associated with exclusive breastfeeding. The study recommended healthier talks and support from health care workers on breastfeeding for mothers and the use of expressed breast milk promoted among mothers.

Breastfeeding initiation among women with chronic hypertension superimposed on pregestational diabetes mellitus

OBJECTIVE: To compare breastfeeding (BF) initiation among 317 women with chronic hypertension (CHTN) and 106 women with CHTN superimposed on pregestational diabetes (CHTN-DM) who intended exclusive or partial BF. METHODS: Retrospective cohort study of women who delivered at≥34 weeks of gestation. At discharge, exclusive BF was defined by direct BF or BF complemented with expressed breast milk (EBM), partial BF was defined by formula supplementation. RESULTS: CHTN and CHTN-DM groups were similar in prior BF experience (42 vs 52%), intention to BF exclusively (89 vs 79%) and intention to partially BF (11 vs 21%). Women in the CHTN group were younger (31 vs 33y), more likely primiparous (44 vs 27%), and who delivered vaginally (59 vs 36%) at term (85 vs 75%). Women in the CHTN-DM group had higher repeat cesarean rates (32 vs 18%), preterm birth (25 vs 15%), neonatal hypoglycemia (42 vs 14%) and NICU admission (38 vs 16%). At discharge, exclusive BF rates among CHTN was higher (48 vs 19%), while rates of partial BF (34 vs 44%) and FF (18 vs 37%) were lower than in the CHTN-DM group. BF initiation (exclusive plus partial BF) occurred in 82%of CHTN and in 63%of CHTN-DM. CONCLUSION: Although intention to BF was similar, BF initiation rates were higher for the CHTN compared to the CHTN-DM group. Exclusive BF was low in the CHTN and even lower in the CHTN-DM group signaling the need for targeted interventions if BF initiation rates are to be improved.