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Changes in breastfeeding initiation and duration in Peru, 1977-1986.

Both breastfeeding initiation and duration increased in Peru during 1977-86. Although one would have expected that the average incidence and duration of breastfeeding would have declined as a result of changes in population characteristics, the potential for an overall decline was more than overcome by changes in behavior. A net increase in initiation and duration is shown for all subgroups of interest. The largest absolute increases are documented for children who, in 1977, were the least likely to be breastfed and who were breastfed for the shortest durations.

Adolescent↗

Breast feeding practices in a teaching hospital of Calcutta before and after the adoption of BFHI (Baby Friendly Hospital Initiative).

A comparative study has been made on two groups of 102 mothers each who delivered children in the postnatal ward of obstetrics and gynaecology department of Calcutta National Medical College before and after the introduction of BFHI (Baby Friendly Hospital Initiative). The study revealed that only 14.3% of the babies who were delivered normally were given their first breast feed in time, the ideal time of half an hour, while not a single baby delivered by caesarean section were given their breast feed within the stipulated time period of 4-6 hours. However, there has been a significant overall reduction in the time gap between the birth and the first breast feed in all types of delivery. BFHI has also made significant reduction of prelacteal feeds and in-between feeds in the newborns especially those delivered normally. The fact that babies of first order and those delivered by caesarean section are lagging behind as far as exclusive breast feeding is concerned has been highlighted in the study.

Breast Feeding↗

Serum cortisol levels are related to moods of elation and dysphoria in new mothers.

Serum cortisol levels were measured in 163 women on the third day after childbirth. Significantly elevated levels of cortisol were found to be associated with the "blues," and significantly lower levels characterized women who exhibited mild hypomania (the "highs"). Low levels of cortisol were independently associated with epidural anesthesia, while elevated levels were related to assisted delivery. There was no significant association with breast or bottle feeding. Changes in serum cortisol were thus found to parallel the mild bidirectional changes in affect that frequently follow childbirth.

Adult↗

Development of bacterial and bifidobacterial communities in feces of newborn babies.

Microbial 16S rDNA from babies' fecal samples were amplified by PCR, and analysed by denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. PCR-DGGE profiles were used to follow in time the colonization of the intestine by bacteria. Four healthy babies, one baby who received antibiotics and their parents participated to the present study to determine the extent to which administration of antibiotics can modify the bacterial colonization of neonatal human gut and verify the influence of parental factors on the formation of the fecal bacterial community. In the healthy babies, Escherichia coli or bacteria belonging to Clostridium spp. were the initial colonizers rapidly followed by Bifidobacterium, Bacteroides, Clostridium, Streptococcus, Enterococcus and Actinomyces. Bifidobacterium species appeared already after five days in the breast-fed babies while there was a delay in the baby who received a formula based diet during only one day after birth. In each baby two or three bifidobacterial species including B. infantis were found. The observed variations in species were not associated with the feeding changes. The comparison of DGGE profiles of the babies and their parents patterns showed bands with equal migration suggesting a vertical transmission determined by genetic and environmental factors. The brief appearance of pioneer bacteria determined as being E. coli and Enterococcus spp. in the profile from the baby under antibiotic therapy, was succeeded by a small stable community consisting of Ruminococcus species. No Bifidobacterium sequences were detectable in this antibiotic-treated baby in spite of a partly breast-milk diet.

Journal Article↗

Maternal intention and actual behavior in infant feeding at one month postpartum.

Five-hundred and ninety-one mothers completed a follow-up questionnaire at one month postpartum. The total breastfeeding rate declined from 83.4% before discharge to 50.8% at one month. One-hundred and fifty-three (25.9%) mothers exclusively breastfed, 147 (24.9%) mothers mixed fed, and 291 (49.2%) mothers formula fed their babies at that time. Among the mothers who initially intended to exclusively breastfeed, 39.3% changed to formula feeding, while 7.1% of the mothers who intended to mix feeding and 4.8% of the mothers who intended to formula feed changed to exclusive breastfeeding at one month postpartum. Nine percent of the breastfeeding mothers weaned within the 1st week, 9.2% weaned between the 1st and 2nd week, 8.4% weaned between the 2nd and 3rd week, while another 14.8% weaned between the 3rd and 4th week. Milk insufficiency, maternal tiredness, not knowing whether the infant had enough to eat and breast problems were the four major reasons for changing feeding method from breastfeeding to formula feeding. Positive breastfeeding attitude, non-employment and husband's approval of breastfeeding was negatively associated with changing feeding behavior from breastfeeding to formula feeding within one month postpartum. In conclusion, successful breastfeeding not only depends on factors related to the mother, but also on her environment. Education regarding breastfeeding should be provided to the entire family including the mother and father. The workplace needs to be more accommodating to breastfeeding mothers, so that they can continue breastfeeding after returning to work.

Breast Feeding↗

Effect of dietary ribonucleotides on infant immune status. Part 2: Immune cell development.

The objective of this study was to determine whether dietary ribonucleotides alter immune cell phenotypes or function in the first year of life. Newborn term infants in a double-blind, 12-mo, multicenter trial were randomized to cow milk formula groups with (FN, n = 138) or without (F, n = 147) 72 mg/L supplemental ribonucleotides. A nonrandomized HMF cohort (n = 192) was concurrently enrolled. Eighty-eight immune blood cell types were characterized by flow cytometry. Data were analyzed by multivariate ANOVA (MANOVA), ANOVA, and repeated measures analysis (RMA), with adjustments made for multiple comparisons. Ribonucleotide feeding changed subpopulations of T and natural killer (NK) cells. FN had higher numbers and percentages of memory/effector (M/E) cytotoxic/suppressor (CD45R0(+)CD8(+), RMA) T, Fas(+) M/E (CD45R0(+)CD95(+)CD3(+), 6 mo) T, and CD56(+)CD16(-) NK cells (CD56(+)CD16(-)CD3(-)CD8(-), 12 mo), and higher percentages of M/E helper (CD45R0(+)CD4(+), RMA) T, Tc1 (IFN gamma(+)CD4(-)CD3(+), RMA), total interferon (IFN)gamma T (IFN gamma(+)CD4(+/-)CD3(+), RMA), Th2 (IL-4(+)CD4(+)CD3(+), 7 mo), and CD57(+) NK-T cells (CD57(+)CD56(-)CD3(+), 6 mo, 7 mo) compared with F. Percentages of naive helper T (CD45RA(+)CD4(+), 12 mo) and numbers and percentages of CD56(+) NK-T cells (CD56(+)CD16(-)CD3(+)CD8(-), 2 mo, 6 mo) were lower in FN than F. Percentages of M/E cytotoxic/suppressor, Th2, and CD56(+)CD16(-) NK cells in FN were significantly higher than F but were not different from HMF, whereas F was significantly lower than HMF. Ribonucleotide supplementation of infant formula supported increased T-cell maturation and affected immunoregulatory NK cell subsets. These FN-associated immune cell profiles either did not differ from those infants fed HMF or tended to be more like those fed HMF than those fed F.

Analysis of Variance↗

The relationship between infants' preceding appetite, illness, and growth performance and mothers' subsequent feeding practice decisions.

Data from a longitudinal study of 153 low-income Peruvian infants were used to examine (i) whether infant characteristics such as appetite, illness and past growth performance are related to subsequent changes in their feeding practices (e.g. addition of non-human milks, solid foods, weaning), and (ii) whether this relationship depends on maternal characteristics such as feeding exposure and experience (MFEE). With one exception, infants were breastfed from birth. Feeding practices during the first month of life were related to practices throughout infancy. Most mothers changed their practices once (61%) or twice (34%) from birth to 6 months. Low weight gains from 1 to 2 (P < 0.003) and 2 to 3 (P < 0.04) months were identified as significant predictors of feeding changes during the following months, using logistic regression models that also adjusted for MFEE, infant gender, previous practice, and previous practice change. The interaction between past weight gain and MFEE (objective ii) was not statistically significant in the logistic regression models. However, when analyzed separately, the relationships between low weight gains and subsequent feeding changes were observed for high but not low MFEE mothers. The prevalences of anorexia and infection (diarrhea, respiratory, and/or fever), and poor length gain during the previous month were not related to subsequent changes in feeding practices. These results suggest that poor growth influences feeding practices from 2 to 4 months, when exclusive breastfeeding is recommended.

Appetite↗

Breast-milk fat concentrations of rural African women. 1. Short-term variations within individuals.

1. Detailed studies of variations in breast-milk fat concentrations were performed over 12 or 24 h periods on sixty rural Gambian women feeding on demand. The creamatocrit method (Lucas et al. 1978) was used. 2. The complex pattern of within-feed and between-feed changes in fat concentration was largely explained by differences in volume per feed and time interval between feeds. 3. No consistent difference in fat production between the breasts of each individual was found despite the local custom of starting all feeds on the right breast. 4. A marked diurnal variation in the mean fat concentration per feed was noted. On average the highest values occurred in the early morning, the lowest values in the late afternoon. 5. There was significantly greater between-individual than within-individual variation in the mean fat concentration per feed over 12 h (P less than 0.001). 6. A simple, rational and non-intrusive sampling procedure was devised for the estimation of whole-day mean fat levels based on the finding that the mean fat concentration of small samples of milk (0.25 ml) taken from both breasts before and after one specific feed of the day was closely correlated with 12 h and 24 h mean fat concentrations.

Breast Feeding↗

Breastfeeding among low-income, high-risk women.

Data from a state supported project providing multidiscipline (clinical social work, nursing, nutrition, obstetrics, and pediatrics) assistance to low-income women judged to be at high perinatal risk by medical and social history were analyzed regarding infant feeding decisions. Data from 2,124 subjects delivered from 1976 to 1985 were available for analysis. The population tended to be single (77%), black (66%), poorly educated (63% less than a high school education), and young (mean age 21.8 years). Thirty-six percent were primiparas. The decision to breastfeed was associated with white race, older maternal age, higher educational level, marriage, and earlier utilization of prenatal care. Prenatal infant feeding plans were compared with actual postpartum decisions for 1,168 women. Only 3 percent of those initially planning to bottle feed changed their minds postpartum and breastfed although 31 percent of those initially planning to nurse ultimately chose artificial feeding. Ten percent of women were initially undecided; one-third of this group ultimately breastfed, two-thirds bottle fed. Overall the percentage of women in the project who were breastfeeding rose from 15 percent to 22 percent from the early to later years of the project (p less than 0.0001).

Adolescent↗

High-density lipoprotein subclass distribution in premature newborns before and after the onset of enteral feeding.

Changes in high-density lipoprotein (HDL) subclass distribution were evaluated in a group of premature infants during the early postnatal period to ascertain whether enteral feeding brought about a rapid shift from neonatal to adult-like distributions. All infants were fed a combination of breast milk and formula. Cord blood of premature infants had a predominance of large, less dense (HDL2b)gge and a paucity of intermediate-sized (HDL3a)gge particles. Lack of a peak in the (HDL3a)gge is a characteristic feature for cord blood, whereas a prominent (HDL3a)gge peak is characteristic of adult plasma. After the start of enteral feeding, blood was obtained at two time-points: 6-14 days (sample A) and 17-32 days (sample B) postdelivery. With the onset of feeding, triglyceride increased significantly from an average of 34 mg/dl in cord blood to 120 mg/dl in sample B, and cholesterol increased from 86 to 112 mg/dl in the same period. Increases in plasma lipid concentrations were paralleled by a redistribution of subclasses such that three components of almost equal intensity were evident in sample B; these consisted of (HDL2b)gge, (HDL2a2)gge, and (HDL3b)gge. A paucity of (HDL3a)gge particles persisted even after onset of enteral feeding; thus, increases in plasma triglyceride and cholesterol per se are not sufficient to induce the adult-like distribution. It is suggested that development of the normal adult HDL subclass pattern is complex and is probably related to the development and interaction of several factors, including plasma enzymes involved in lipid hydrolysis and esterification, lipid exchange proteins, and hormonal status.

Age Factors↗

[Promotion of infant health. Experiences in a rural health center].

BACKGROUND: The evaluation of the feeding changes in the first months of life is used to estimate the achievement of more healthy practices, after a year of developing the infant health surveillance programme. METHODS: A retrospective study was carried out in a unit of Pediatrics of a Primary Health Center.... The clinical histories of children, born between 1-4-90 and 30-9-90 (group I, n = 55) and those of the children born between 1-4-89 and 30-9-89 (group II, n = 41) were reviewed. The evaluation ended the 30-3-91. Neonatal hospital morbidity, socio-familiar data, and the feeding practices during the first six months of life were studied. RESULTS: The mothers, who were 20 years or less at delivery, were 12 in the group I, and 2 in the group II. The proportion of housekeepers was near the 70% in both groups. Breast-feeding during the first month of life is 85,45% in group I and 53,66% in group II (p < 0.001). CONCLUSIONS: Increase of adolescent mothers and SO, higher number of children with possible psycho-social and health risks. Suitable social conditions for maternal participation in the activities of the Infant Health surveillance Programme. Health education is the most adequate method to establish a more healthy relation between mother and child.

Adolescent↗