PubMed Baby Friendly

How Does the United States Rank According to the World Breastfeeding Trends Initiative?

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How Does the United States Rank According to the World Breastfeeding Trends Initiative?

J Perinat Neonatal Nurs. 2018 Jan 29;:

Authors: Cadwell K, Turner-Maffei C, Blair A, Brimdyr K, OʼConnor B

Abstract
The World Breastfeeding Trends Initiative is an assessment process designed to facilitate an ongoing national appraisal of progress toward the goals of the United Nations Children's Fund (UNICEF)/World Health Organization (WHO) Global Strategy for Infant and Young Child Feeding. More than 80 countries have completed this national assessment, including the United States of America. This article describes the process undertaken by the US World Breastfeeding Trends Initiative team, the findings of the expert panel related to infant and young child feeding policies, programs, and practices and the ranking of the United States compared with the 83 other participating nations. Identified strengths of the United States include data collection and monitoring, especially by the Centers for Disease Control and Prevention, the US Baby-Friendly Hospital Initiative, and the United States Breastfeeding Committee. The absence of a national infant feeding policy, insufficient maternity protection, and lack of preparation for infant and young children feeding in emergencies are key targets identified by the assessment requiring concerted national effort.

PMID: 29381567 [PubMed - as supplied by publisher]

A systematic approach to diagnosing intra-thoracic tuberculosis in children.

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A systematic approach to diagnosing intra-thoracic tuberculosis in children.

J Infect. 2017 Jun;74 Suppl 1:S74-S83

Authors: Perez-Velez CM, Roya-Pabon CL, Marais BJ

Abstract
Children suffer a huge and often underappreciated burden of disease in tuberculosis (TB) endemic countries. Major hurdles include limited awareness among health care workers, poor integration of TB into maternal and child health approaches, diagnostic difficulties and a lack of child-friendly treatment options. Accurate disease diagnosis is particularly difficult in young and vulnerable children who tend to develop paucibacillary disease and are unable to produce an expectorated sputum sample. In addition, access to chest radiography is problematic in resource-limited settings. Differentiating between TB exposure and M. tuberculosis infection, and especially between M. tuberculosis infection and TB disease is crucial to guide clinical management. TB represents a dynamic continuum from well-contained "latent" infection to incipient and ultimately severe disease. The clinical spectrum of disease in children is broad and can be confused with a myriad of common infections. We provide a pragmatic 4-step approach to diagnose intra-thoracic TB in children and demonstrate how classifying clinical, radiological and laboratory findings into recognised clinical syndromes may provide a more refined diagnostic approach, even in resource-limited settings.

PMID: 28646966 [PubMed - indexed for MEDLINE]

Baby-friendly hospital practices are associated with duration of full breastfeeding in primiparous but not multiparous Iranian women.

Baby-friendly hospital practices are associated with duration of full breastfeeding in primiparous but not multiparous Iranian women.

Matern Child Nutr. 2018 Jan 24;:

Authors: Zarshenas M, Zhao Y, Binns CW, Scott JA

Abstract
There is evidence that the Baby-Friendly Hospital Initiative (BFHI) results in improved breastfeeding outcomes in Western countries, but little is known of its impact in Middle-Eastern countries. This study investigated the impact of BFHI practices on duration of full breastfeeding in a cohort of 700 Iranian mothers recruited between June 2014 and March 2015 from maternity hospitals in Shiraz and followed-up prospectively for 6 months. At baseline, mothers self-reported exposure to 7 of the BFHI Ten Steps to Successful Breastfeeding (Steps 3 to 9). Data on breastfeeding outcomes were collected at baseline, 1, 3, 4, and 6 months postpartum. Cox regression analysis was conducted to determine the impact of individual and cumulative BFHI Steps on the duration of full breastfeeding, defined as the number of weeks since discharge that an infant received only breast milk and no complementary formula or food. Mothers reported experiencing on average 3.9 (SD 1.13, range 1 to 7) Steps, and only 28% of infants were fully breastfed at 6 months. There was a protective inverse relationship for primiparous (p for trend = .022) but not multiparous mothers (p for trend = .069), between the number of Steps a woman was exposed to and the likelihood of her discontinuing full breastfeeding within 6 months postpartum. Greater exposure to BFHI practices potentially could increase primiparous mothers' chances of fully breastfeeding to 6 months. Continual monitoring of the BFHI Steps and repeated education of healthcare staff are required to ensure that Iranian mothers receive adequate breastfeeding support.

PMID: 29363885 [PubMed - as supplied by publisher]

Oxytocin Receptor Antagonist (Atosiban) in the Threat of Preterm Birth: Does It Have Any Effect on Breastfeeding in the Term Newborn?

Oxytocin Receptor Antagonist (Atosiban) in the Threat of Preterm Birth: Does It Have Any Effect on Breastfeeding in the Term Newborn?

Breastfeed Med. 2018 Jan 22;:

Authors: López Gómez L, Marín Gabriel MA, Encinas B, de la Cruz Troca JJ, Rodríguez Marrodán B

Abstract
AIM: Oxytocin is a hormone involved in the mechanism of breastfeeding, uterine contractions, and social relationships. Atosiban (competitive oxytocin antagonist) is one of the most commonly used tocolytics for the threat of preterm labor in Europe. The aim of this study is to determinate if the administration of atosiban has any influence in the type of feeding in the term newborn at discharge. The secondary objective is to verify its effectiveness for the prevention of preterm delivery and in the possibility of applying treatment to complete lung maturation.
MATERIALS AND METHODS: Retrospective cohort study carried out in a tertiary University Hospital distinguished by WHO-UNICEF as a Baby-Friendly Hospital Initiative. The analysis included 264 women exposed to atosiban during a period of 4 years. One hundred met inclusion criteria. Unexposed infants born right after and before the exposed ones were selected as the not exposed subgroup (n = 200).
RESULTS: Among women treated with atosiban, 82% maintained exclusively breastfed (EBF), 8% had mixed breastfeeding, and 10% had formula feeding at discharge. In the nonexposed group, 82% maintained EBF, 9.5% had mixed breastfeeding, and 8.5% had formula feeding at discharge (p = 0.84). 97.5% of pregnant women treated with atosiban received corticosteroid for lung maturation, and 49.5% completed gestation with term newborns.
CONCLUSION: There were no significant differences in the type of feeding at discharge between the atosiban group and the nonexposed group. In most cases, the administration of tocolytic therapy allowed to complete lung maturation.

PMID: 29356563 [PubMed - as supplied by publisher]

Using 24-Hour Weight as Reference for Weight Loss Calculation Reduces Supplementation and Promotes Exclusive Breastfeeding in Infants Born by Cesarean Section.

Using 24-Hour Weight as Reference for Weight Loss Calculation Reduces Supplementation and Promotes Exclusive Breastfeeding in Infants Born by Cesarean Section.

Breastfeed Med. 2018 Jan 22;:

Authors: Deng X, McLaren M

Abstract
BACKGROUND AND OBJECTIVES: To promote exclusive breastfeeding, supplements are not recommended without medical indications such as clinical evidence of dehydration. Loss of ≥10% of birth weight (BW) often triggers supplementation due to nursery staff's concern for dehydration. Studies have demonstrated that transplacental passage of maternal intrapartum intravenous fluids for anesthesia may inflate BW. Researchers have proposed using newborn's 24-hour weight (24HW), after fluid diuresis, as preferred reference for weight loss calculation. The mother-infant unit at Hartford Hospital, a Baby-Friendly Hospital, implemented this recommendation into routine practice in March 2014. This study was conducted to evaluate this practice change's safety and effectiveness in decreasing supplementation.
METHODS: We performed a retrospective chart review on healthy full-term newborns delivered by C-section in 12 months before (n = 404) and a 12-month period after (n = 263) incorporating the 24HW into routine practice. Overall supplementation rate, maximum weight loss, length of stay (LoS), and peak transcutaneous bilirubin (TcB) were compared.
RESULTS: Overall supplementation rate decreased from 43.6% pre- to 27.4% postintervention and in first-time mothers from 51.9% to 31.0%. Among infants losing ≥10% of BW, the supplementation rate decreased from 63.9% to 26.2%. There was no significant increase in maximum weight loss, peak TcB level, or LoS overall or in those with ≥10% weight loss from birth.
CONCLUSION: Routine use of 24HW as the reference for newborn weight loss calculation reduced supplementation and did not increase untoward effects during the hospital stay.

PMID: 29356561 [PubMed - as supplied by publisher]

Exploring the Experiences of Middle Income Mothers in Practicing Exclusive Breastfeeding in Nairobi, Kenya.

Exploring the Experiences of Middle Income Mothers in Practicing Exclusive Breastfeeding in Nairobi, Kenya.

Matern Child Health J. 2018 Jan 18;:

Authors: Wainaina CW, Wanjohi M, Wekesah F, Woolhead G, Kimani-Murage E

Abstract
Objectives To establish exclusive breastfeeding (EBF) practice, women are encouraged to initiate breastfeeding of their newborns within one hour of delivery and breastfeed exclusively for the first 6 months of the infant's life. Research in Kenya has shown evidence of a reduced rate of EBF with an increase in socio-economic class (SES). This study explores the experiences of middle-income women so as to understand their attitudes and practices of EBF and to contribute toward the Baby Friendly Hospital (BFHI) and Baby Friendly Community Initiatives (BFCI) programs in Kenya. Methods A qualitative study using nine in-depth interviews and two focus group discussions were conducted with middle-income women with a child < 2 years. Thematic content analysis was used to analyze the data. Results The majority of the women interviewed did not achieve EBF and this was attributed to many challenges that they encountered such as; inadequate workplace support including short maternity leave, lack of designated breast feeding facilities flexible hours and breastfeeding breaks. Support structures were highlighted as either inadequate or lacking while the internet was preferred by most of the women for breastfeeding information. Mass media was seen as more credible, though some women indicated that there was lack of depth in the information it provided. Conclusion The study showed that majority of women were unable to EBF for the first 6 months. Women experienced inadequate social, healthcare and workplace support and preferred online sites for information on breastfeeding than the healthcare professionals or mass media. Recommendation There is need to implement policies at the workplace that promote a breastfeeding friendly environment. There is also a need for more research on role of mass media in promotion of optimal breastfeeding practices, especially how to reach this population. There is a need for continued advocacy on social support including spousal, relatives, and other community members at the community level.

PMID: 29349653 [PubMed - as supplied by publisher]

Factors Associated with Not Breastfeeding and Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi Arabia.

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Factors Associated with Not Breastfeeding and Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi Arabia.

Children (Basel). 2018 Jan 03;5(1):

Authors: Azzeh FS, Alazzeh AY, Hijazi HH, Wazzan HY, Jawharji MT, Jazar AS, Filimban AM, Alshamrani AS, Labani MS, Hasanain TA, Obeidat AA

Abstract
The objective of the study was to find the determinants related to not breastfeeding (BF) and others related to the delay in the early initiation of BF in the Mecca region, Saudi Arabia. A cross-sectional study in the Maternity and Children Hospital and primary healthcare centers was performed. A questionnaire was filled by dietitians to 814 asymptomatic Saudi mothers. Determinants related to not BF and the delay in the early initiation of BF were determined by binary logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were determined. Significant factors associated with not BF were not rooming-in infants in the mother's room (OR: 2.37; 95% CI: 1.66-3.41) and using a pacifier (OR: 1.62; 95% CI: 1.13-2.33). The most significant determinant of the early initiation of BF was the initiation of bottle feeding (OR: 18.16; 95% CI: 10.51-31.4), followed by not rooming-in infants in the mother's room (OR: 2.2; 95% CI: 1.52-3.18), initiation of partial feeding (OR: 1.89; 95% CI: 1.3-2.74), uninformed mothers regarding the importance of BF (OR: 1.56; 95% CI: 1.04-2.35), and cesarean sections (OR:1.42; 95% CI: 1.02-1.98). Risk factors affecting BF and the early initiation of BF in Mecca City should be highlighted in national campaigns to increase mothers' awareness and promote BF practice.

PMID: 29301353 [PubMed]

Expressing Human Milk in the NICU: Coping Mechanisms and Challenges Shape the Complex Experience of Closeness and Separation.

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Expressing Human Milk in the NICU: Coping Mechanisms and Challenges Shape the Complex Experience of Closeness and Separation.

Adv Neonatal Care. 2018 Jan 03;:

Authors: Bujold M, Feeley N, Axelin A, Cinquino C

Abstract
BACKGROUND: Human milk has multiple benefits for human health; however, rates of infants receiving human milk at discharge in Canadian neonatal intensive care units (NICUs) are far below recommendations of the Baby Friendly Hospital Initiative supported by the Canadian Pediatric Association. Mothers of infants requiring NICU care usually need to express their milk, especially mothers of premature infants, since for some time their infant is unable to feed directly at the breast. Expressing human milk for an extended period can be challenging for mothers.
PURPOSE: To document maternal experiences expressing human milk for their infant in the NICU as a closeness or separation experience, and to discover what factors gave rise to these perceptions.
METHODS: In this descriptive qualitative cross-sectional study, 15 mothers whose infants were hospitalized in a level III NICU and who were expressing human milk audio recorded their thoughts and feelings with a smartphone application for 48 hours while they were expressing milk. A thematic content analysis was used to analyze data.
FINDINGS: Expressing human milk for their hospitalized infant was a difficult experience for all mothers, and most described both closeness and separation feelings while expressing milk. Their feelings fluctuated depending on their coping mechanisms, perceived challenges, as well as their location and environment. Mothers were all pursuing their goal of continued milk expression with various levels of motivation.
IMPLICATIONS FOR PRACTICE: NICUs should adopt a family-centered approach to care whereby mothers' care needs related to milk expression are addressed. Nurses can ask open-ended questions to explore how mothers are coping, and they can assist mothers to find effective coping strategies to minimize the challenges related to milk expression to promote mother-infant closeness.
IMPLICATIONS FOR RESEARCH: The impact of environment and location on mothers with hospitalized infants should be explored, as unit designs could be altered to foster closeness.

PMID: 29300195 [PubMed - as supplied by publisher]

Integrating Molecular Subclassification of Medulloblastomas into Routine Clinical Practice: A Simplified Approach.

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Integrating Molecular Subclassification of Medulloblastomas into Routine Clinical Practice: A Simplified Approach.

Brain Pathol. 2016 May;26(3):334-43

Authors: Kaur K, Kakkar A, Kumar A, Mallick S, Julka PK, Gupta D, Suri A, Suri V, Sharma MC, Sarkar C

Abstract
Medulloblastoma (MB) is composed of four molecular subgroups viz. WNT, SHH, groups 3 and 4, identified using various high-throughput methods. Translation of this molecular data into pathologist-friendly techniques that would be applicable in laboratories all over the world is a major challenge. Ninety-two MBs were analyzed using a panel of 10 IHC markers, real-time PCR for mRNA and miRNA expression, and FISH for MYC amplification. β-catenin, GAB1 and YAP1 were the only IHC markers of utility in classification of MBs into three subgroups viz. WNT (9.8%), SHH (45.6%) and non-WNT/SHH (44.6%). mRNA expression could further classify some non-WNT/SHH tumors into groups 3 and 4. This, however, was dependent on integrity of RNA extracted from FFPE tissue. MYC amplification was seen in 20% of non-WNT/SHH cases and was associated with the worst prognosis. For routine diagnostic practice, we recommend classification of MBs into three subgroups: WNT, SHH and non-WNT/SHH, with supplementation by prognostic markers like MYC for non-WNT/SHH tumors. Using this panel, we propose a new three-tier risk stratification system for MBs. Molecular subgrouping with this limited panel is rapid, economical, works well on FFPE tissue and is reliable as it correlates significantly with clinicopathological parameters and patient survival.

PMID: 26222673 [PubMed - indexed for MEDLINE]

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