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PubMed2005

Fat and energy contents of expressed human breast milk in prolonged lactation.

OBJECTIVE: To estimate fat and energy contents of human milk during prolonged lactation. METHODS: Thirty-four mothers, of term, healthy, growing children, who had been lactating for >1 year (12-39 months) were recruited. Control subjects were 27 mothers, of term infants, who had been lactating for 2 to 6 months. Fat contents of the milk samples were estimated as creamatocrit (CMT) levels. Energy contents of the milk were measured with a bomb calorimeter. RESULTS: The groups did not differ in terms of maternal height and diet, infant birth weight, gestational age, or breastfeeding frequency. They differed significantly in terms of maternal age, maternal weight, and BMI. The mean CMT levels were 7.36 +/- 2.65% in the short-duration group and 10.65 +/- 5.07% in the long-lactation group. The mean energy contents were 3103.7 +/- 863.2 kJ/L in the short-duration group and 3683.2 +/- 1032.2 kJ/L in the long-duration group. The mean CMT levels and mean energy contents were correlated significantly with the duration of lactation (R2 = 0.22 and R2 = 0.23, respectively). In multivariate regression analysis, CMT levels (or energy contents) were not influenced by maternal age, diet, BMI, or number of daily feedings but remained significantly influenced by the duration of lactation. CONCLUSIONS: Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant.

Breast Feeding↗
PubMed1998

Compression stimuli increase the efficacy of breast pump function.

OBJECTIVE: The dynamics of milk ejection and also prolactin concentration in the blood during milk expression by means of a breast pump were studied in 82 lactating women. STUDY DESIGN: The design of the breast pump used in this study is new. It is based on the correlation with the amplitude, duration and frequency of vacuum and compression stimuli formed by the baby's mouth apparatus during the suckling process. RESULTS: It was found that during continuous co-action of the vacuum and compression stimuli at a frequency of 1 cycle per second, the rate of milk ejection from the breast changed periodically. The highest rates of milk ejection coincided with the greatest rises in intramammary pressure. When the compression stimulus was turned off, leaving only the vacuum, the period of the first rise in pressure increased 1.5-2 fold, with a 1.5-2 fold reduction in the milk ejection rate as compared with the normal function of the breast pump. The basal prolactin level on day 3 and 5 post delivery in women who used a breast pump was not significantly different from that of puerperal women who only breast-fed their babies. Prolactin concentration in the blood of puerperal women did not change within the 5-6 min of expression and stimulation with the breast pump. The prolactin level began to increase by the 10th minute, whereas by the 25th minute it exceeded the initial concentration 1.3-1.5-fold. CONCLUSION: It is suggested that by introducing a tactile component to the mechanism of the breast pump, milk secretion is enhanced, as well as stimulating the breast milk flow. This directly improves the dynamics of breast milk expression.

Adolescent↗
PubMed1989

Increasing breast milk production for premature infants with a relaxation/imagery audiotape.

Many women whose premature infants are hospitalized in a newborn intensive care unit choose to express breast milk for their babies. Yet anxiety, fatigue, and emotional stress are powerful inhibitors of lactation. To facilitate the breast-feeding experience, intervention mothers were given a 20-minute audio cassette tape based on relaxation and visual imagery techniques. At a single follow-up expression of milk at the hospital approximately 1 week after enrollment, they expressed 63% more breast milk than a randomized group of control mothers. The fat content of the breast milk in the two groups was not significantly different. Among a small group of mothers whose infants were receiving mechanical ventilation, the increase in milk volume compared with that of control mothers was 121%. Longer-term effects of the relaxation/imagery approach (such as extending the duration of breast-feeding or reducing parental stress after hospital discharge) and the physiologic basis for the increased volume of expressed milk (improved milk production v more efficient milk ejection) are appropriate topics for future research.

Female↗
PubMed1977

Drip breast milk: it's composition, collection and pasteurization.

"Drip breast milk" is that milk which spontaneously drips from the contralateral breask during the suckling of an infant. Biochemically and immunologically, pooled drip milk resembled pooled mature expressed breast milk, although it has a lower fat concentration. About 15% of lactating women are capable of producing drip milk; volumes produced are up to 188 ml/donor/day. A milk bank is described which processes 1400 liters of drip milk/yr. Heat treatment of this milk with a semi-automated holder pasteurizer caused a 21% reduction in IgA concentration and a 36% reduction in lysozyme activity, as well as a decrease in the ability of the milk to inhibit the growth of E. coli. In comparison with boiling, pasteurization was as effective in reducing total bacterial content provided the milk initially contained fewer than 10(6) bacteria/ml.

Electrolytes↗
PubMedDate not supplied

Metabolic bone disease in very-low-birth-weight infants: assessment, prevention, and treatment by neonatal nurse practitioners.

OBJECTIVE: To describe the current practice of neonatal nurse practitioners in assessing skeletal health and preventing and treating metabolic bone disease in very-low-birth-weight infants. DESIGN: Descriptive, retrospective survey. PARTICIPANTS: Neonatal nurse practitioners in the continental United States were systematically randomly selected. A 64% response rate was obtained (112). MAIN OUTCOME MEASURES: Responses to questions about assessing skeletal health and preventing and treating metabolic bone disease in very-low-birth-weight infants. RESULTS: Current practice of neonatal nurse practitioners includes assessing skeletal health of very-low-birth-weight infants on the 7th (47.3%) or 14th (19.6%) day of life, with subsequent assessments every 7 (63.3%) or 14 (18.8%) days. Neonatal nurse practitioners (85.1%) estimate the incidence of metabolic bone disease at less than 15%. Neonatal nurse practitioners initiate total parenteral nutrition (99%), provide parenteral calcium and phosphorous in ratios of 1.3-1.7:1 (9%), and add powdered fortifier (90.1%) and liquid fortifier (25.2%) to expressed breast milk. All respondents use formulas made for premature infants. Physical therapy is used by 46.8% of neonatal nurse practitioners. CONCLUSIONS: Neonatal nurse practitioners underestimate the incidence of metabolic bone disease. Parenteral calcium and phosphorous are given but in quantities that differ from the recommended ratio. Most neonatal nurse practitioners use formulas made for premature infants and add powdered fortifier to expressed breast milk. Although physical therapy is prescribed, more research on its effect on bone mineralization is warranted before this practice is recommended without reservation.

Bone Diseases, Metabolic↗
PubMed1998

Necrotizing enterocolitis after gastroschisis repair: a preventable complication?

BACKGROUND: Necrotizing enterocolitis (NEC) has been documented in up to 20% of infants after repair of gastroschisis and is responsible for significant morbidity. NEC is reported to occur up to 10 times more in preterm infants receiving standard formula compared with those who have been fed exclusively with breast milk. Does breast milk confer a similar protection against NEC in infants who have undergone surgery for gastroschisis? METHODS: All newborns with gastroschisis delivered between 1990 and 1996 and treated in a single neonatal unit were analyzed retrospectively. Clinical data, details of feeding regimens, and episodes of definite NEC were recorded. RESULTS: Of 60 infants with gastroschisis, 6 (10%) died but none had evidence of NEC. Of the remaining 54 infants, clinical and radiological signs of NEC developed in 8 (15%). All recovered with medical treatment including the three patients with recurrent episodes. NEC developed in none of the 12 babies exclusively fed with expressed breast milk (EBM) in contrast to 1 (5%) of the 19 who received both EBM and formula, and 7 (30%) of the 23 who were fed solely on formula. There was no significant difference in gestation, incidence of primary versus silo closure, or incidence of intestinal atresia/stenosis in those with NEC (n=8) compared with those without (n=46), but birth weight in the NEC group was lower. NEC was less likely to develop in infants who received EBM than those who were exclusively formula fed (P < .02). CONCLUSION: After gastroschisis repair, feeding with maternal expressed breast milk may help to protect the infant from developing NEC.

Abdominal Muscles↗
PubMed2006

A comparative study of nonpharmacological methods to reduce pain in neonates.

A randomized study was done to compare non pharmacological methods to reduce the pain of heel pricks in 104 stable term neonates. Non-nutritive sucking (NNS), rocking, massage, sucrose (20 percent), distilled water (DW) and expressed breast milk (EBM) were used as pain reducing agents. Duration of cry and Douleur Aiguë du Nouveau né (DAN) score were used to assess pain. Physiological parameters were also recorded before and after the stimulus. At 30 seconds after the stimulus, the pain scores were lowest in the sucrose group but this was not sustained at 1, 2 and 4 minutes. At 2 and 4 minutes pain scores were lowest in the NNS and rocking groups as compared to sucrose, distilled water, expressed breast milk and massage. The total duration of crying was also lowest in the NNS and rocking groups. Physiological parameters were comparable in all groups. Babies who were in Prechtl State 1 and 2 (sleeping) at the time of stimulus showed significantly lesser response to pain compared to babies who were awake. This was seen in all the intervention groups. In conclusion, our study suggests that rocking or giving a baby a pacifier are more effective non-pharmacological analgesics than EBM, DW, sucrose or massage for the pain of heel pricks in neonates. A calm or sleeping state before a painful procedure also appears to decrease crying and pain scores.

Analgesia↗
PubMed1989

The effect of foster feeding and bottle feeding expressed breast-milk on the susceptibility of guinea-pig infants to influenza virus.

Infant guinea-pigs born to mothers immunized against influenza virus by infection during pregnancy were reared from birth by non-immune foster mothers. As a control for the effects of fostering, a similar group were fostered to immune mothers. Fostering, regardless of the immune state of the foster-mother, increased the susceptibility of the infant to upper respiratory tract infection. Increased susceptibility was associated with ablation of the infants IgM and IgA antibody responses and reduced secretion of transplacentally acquired IgG antibody in nasal secretions. In the reciprocal experiment, infants of non-immune mothers fostered to immune mothers cleared virus more rapidly than their peers who were fed by their own mothers. This protective effect was associated with an enhanced nasal IgM and IgA antibody response. Infants of immune mothers separated from their mothers at birth and hand-reared on a cow's-milk-based formula feed suffered an increased susceptibility to the virus similar to that seen in fostered infants. Addition of a pool of expressed milk from a group of immune mothers, including their own, to the feed of hand-reared infants did not reduce their susceptibility. However, a further group of infants fed a non-cellular whey fraction of the same milk pool secreted significantly lower titres of virus. This increased protection was associated with elevated levels of IgG antibody secretion into nasal washes early in infection.

Animal Nutritional Physiological Phenomena↗
PubMed1985

Statement on human milk banking. Nutrition Committee, Canadian Paediatric Society.

If expressed human breast milk is used certain considerations and precautions are needed depending on the donor. Appropriate safety standards and procedures should be used by all milk banks. Screening of donors of breast milk must include history-taking for acute or chronic infections and drug use. Expressed breast milk should be stored at 3 degrees C to 4 degrees C if it is to be used within 48 hours and at -20 degrees C or lower if it is to be stored for more than 48 hours. Because of the dangers of microbiologic contamination pooled milk should be pasteurized before use. Although the standards are empiric, it has been suggested that breast milk that is free of pathogens and has a total bacterial colony count of less than 10(7)/L at the time of sampling is safe to use. Breast milk expressed by an infant's own mother can be used without banking procedures, but the safety precautions, apart from pasteurization, still apply.

Canada↗
PubMed2004

Increased osmolality of breast milk with therapeutic additives.

AIM: To evaluate the changes in the osmolality of expressed breast milk (EBM) after the addition of seven additives and four proprietary fortifiers commonly used during neonatal intensive care. METHODS: The osmolality of 5 ml EBM was measured with increasing doses of 6% NaCl, caffeine, sodium ironedetate, folic acid, and multivitamin drops. Sodium acid phosphate and chloral hydrate were added to 8 ml EBM, and the fortifiers were added to standard volumes of EBM. Dose-effect curves were plotted, and the volume of milk that must be added to the above additives to maintain osmolality below 400 mOsm/kg was calculated. RESULTS: The osmolality of the pure additives ranged from 242 to 951 mOsm/kg. There was a significant increase in the osmolality of EBM with increasing doses of all additives except caffeine. The osmolality of EBM with many additives in clinically used dosages potentially exceeded 400 mOsm/kg. The greatest increase occurred with sodium ironedetate syrup, where the osmolality of EBM increased to 951.57 (25.36) mOsm/kg. Proprietary fortifiers increased the osmolality of EBM to a maximum of 395 mOsm/kg. CONCLUSION: Routine additives can significantly increase the osmolality of EBM to levels that exceed current guidelines for premature infant feeding. A simple guide for clinical use is presented, which indicates the amount of milk required as diluent if hyperosmolality is to be avoided.

Dose-Response Relationship, Drug↗
PubMed2002

Effects of different fluids on the relationship between swallowing and breathing during nutritive sucking in neonates.

This study in 10 term infants investigated the effects of different fluids on the coordination between swallowing and breathing during bottle feedings. Sucking pressure, swallowing, breathing and O(2) saturation were examined in each infant during bottle feedings with breast milk, formula and distilled water. When receiving breast milk, the infants showed a significantly higher breathing rate than with the other liquids. Swallows followed by inspiration were demonstrated less often with breast milk compared with formula or distilled water. In conclusion, expressed breast milk is suitable for neonates because better coordination between swallowing and breathing could be obtained and subclinical aspiration could be prevented.

Bottle Feeding↗
PubMed2002

Factors associated with weaning in the first 3 months postpartum.

OBJECTIVE: To determine the demographic, behavioral, and clinical factors associated with breastfeeding termination in the first 12 weeks postpartum. STUDY DESIGN: This was a prospective cohort study. POPULATION: Breastfeeding women in Michigan and Nebraska were interviewed by telephone at 3, 6, 9, and 12 weeks postpartum or until breastfeeding termination. OUTCOMES MEASURED: We measured associations of demographic, clinical, and breastfeeding variables with weaning during the first 12 weeks postpartum. RESULTS: A total of 946 women participated; 75% breastfed until 12 weeks. Women older than 30 years and women with at least a bachelor's degree were more likely to continue breastfeeding in any given week. Mastitis, breast or nipple pain, bottle use, and milk expression in the first 3 weeks were all associated with termination. Beyond 3 weeks, women who expressed breast milk were 75% less likely to discontinue breastfeeding than women who did not. Women who used a bottle for some feedings during weeks 4 to 12 were 98% less likely to discontinue breastfeeding than women who did not use a bottle. "Not enough milk" was the most common reason given for termination in weeks 1 through 3 (37%) and weeks 4 through 6 (35%); "return to work" was the most common reason given in weeks 7 through 9 (53%) and weeks 10 through 12 (58%). CONCLUSIONS: Younger women and less educated women need additional support in their breastfeeding efforts. Counseling and assistance should be provided to women with pain and mastitis. Exclusive breastfeeding for the first 3 weeks should be recommended. After the first 3 weeks, bottles and manual expression are not associated with weaning and may improve the likelihood of continuing breastfeeding, at least until 12 weeks.

Breast Feeding↗
PubMed1979

Breast milk and breast feeding in very low birthweight infants.

The feeding of 17 babies weighing less than 1500 g was examined retrospectively. 12 babies started breast feeding at a mean weight of 1324 g and 10 of them were fully breast fed by a mean weight of 1600 g. Their weight gains were comparable with bottle-fed babies receiving expressed breast milk. Practical aspects of breast feeding were considered to be: a knowledgeable maternal and nursing attitude, close mother and baby contact, early expression of breast milk, and early suckling. The increased incidence of breast feeding by mothers of both low birthweight and term babies ensures regular supplies of fresh breast milk. Therefore, sterilisation or storage of breast milk there is unnecessary.

Breast Feeding↗