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1.  Solomon's Wisdom 
Breastfeeding Medicine  2014;9(6):279-280.
doi:10.1089/bfm.2014.9982
PMCID: PMC4074737  PMID: 24967947
2.  Impact of Breastfeeding Self-Efficacy and Sociocultural Factors on Early Breastfeeding in an Urban, Predominantly Dominican Community 
Breastfeeding Medicine  2014;9(6):301-307.
Abstract
Background: Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4–6 weeks postpartum in our community.
Subjects and Methods: Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4–6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from “1” (exclusive formula feeding) to “5” (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4–6 weeks.
Results: We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4; p<0.05) and then decreased by 4–6 weeks (2.9±1.4 to 2.5±1.44; p<0.05), without significant change between WBN and 4–6 weeks. Higher levels of education [β=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [β=0.35 (0.57, 1.8)], foreign birth [β=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [β=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)].
Conclusions: Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.
doi:10.1089/bfm.2014.0015
PMCID: PMC4074742  PMID: 24902047
3.  Lactation Stage-Related Expression of Sialylated and Fucosylated Glycotopes of Human Milk α-1-Acid Glycoprotein 
Breastfeeding Medicine  2014;9(6):313-319.
Abstract
Background: Because terminal sugars of α-1-acid glycoprotein (AGP) are reported to be involved in anti-inflammatory and immunomodulatory processes, their expressions might have an influence on the proper function of immune system of newborns. Here, relative amounts of sialylated and fucosylated glycotopes on human milk AGP over normal lactation were investigated.
Materials and Methods: AGP concentration and relative amounts of its sialylated and fucosylated glycovariants were analyzed in early colostrum, colostrum, and transitional and mature milk samples of 127 healthy mothers by lectin–AGP enzyme-linked immunosorbent assay using α2,3- and α2,6-sialic acid and α1,2-, α1,3-, and α1,6-fucose specific biotinylated Maackia amurensis, Sambucus nigra, Ulex europaeus, Tetragonolobus purpureus, and Lens culinaris lectins, respectively.
Results: AGP concentration in human milk was about 30 times lower than in plasma of lactating mothers and decreased gradually over lactation. Milk AGP showed significantly higher expression of sialylated and fucosylated glycotopes in comparison with those of plasma AGP. Milk AGP glycovariants containing α2,6-sialylated and α1,6- and α1,2-fucosylated glycotopes showed the highest relative amounts in early colostrums. With progression of lactation, the expressions of glycotopes α1,2-fucosylated decreased starting from Day 4 and those of α2,6-sialylated and α1,6-fucosylated from Day 8 of lactation, whereas the level of α2,3-sialyl-glycotope was almost constant over 45 days of lactation. In contrast, the expression of α1,3-linked fucose on AGP was low in colostrums and significantly higher in transitional and mature milk.
Conclusions: The relative amounts of sialylated and fucosylated glycovariants of human hindmilk AGP significantly varied between Days 2 and 45 of normal lactation.
doi:10.1089/bfm.2014.0011
PMCID: PMC4074750  PMID: 24892765
4.  Knowledge and Beliefs About Breastfeeding Are Not Determinants for Successful Breastfeeding 
Breastfeeding Medicine  2014;9(6):308-312.
Abstract
A cross-sectional prospective study was performed to assess knowledge and attitude toward breastfeeding among mothers in a tertiary hospital in Malaysia and its influence on their breastfeeding practices. Two hundred thirteen women who had delivered healthy babies at term were enrolled. A structured questionnaire containing demographic data and the Iowa Infant Feeding Attitude Score were used, followed by a telephone interview after 8 weeks to determine the feeding outcome. Women of Malay ethnicity with higher education level who had received breastfeeding counseling had a significantly more favorable attitude toward breastfeeding. Ethnicity was found to be a significant determinant in the success of breastfeeding, whereas returning to work was a major reason for discontinuing breastfeeding. In ensuring a successful breastfeeding practice, apart from knowledge and attitude, issues surrounding culture and traditions as well as improving deliverance of readily available support should be addressed.
doi:10.1089/bfm.2013.0124
PMCID: PMC4074751  PMID: 24893127
5.  ABM Clinical Protocol #4: Mastitis, Revised March 2014 
Breastfeeding Medicine  2014;9(5):239-243.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
doi:10.1089/bfm.2014.9984
PMCID: PMC4048576  PMID: 24911394
6.  Influence of Partner Support on an Employed Mother's Intention to Breastfeed After Returning to Work 
Breastfeeding Medicine  2014;9(4):222-230.
Abstract
Background: Despite the increasing number of large companies complying with the demands for a breastfeeding-friendly workplace, providing on-site lactation support, some mothers still find continuing to breastfeed a challenge. We postulated that greater support and encouragement from the partner would be independently predictive of whether the mother would take advantage of workplace milk expression breaks and lactation rooms and continue to breastfeed after returning to work. To evaluate this hypothesis, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan.
Subjects and Methods: Six hundred eight working mothers in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan who had access to dedicated lactation rooms at the workplace were interviewed. Questionnaire content included female employee demographics, employment characteristics, partner-related characteristics, and breastfeeding behavior after returning to work following the birth of their most recently born child.
Results: The partner's initial support of the choice to breastfeed and encouragement to use the lactation room and milk expression breaks and the mother's perception of the partner's support for baby care were significant predictors of the intention to continue to breastfeed after returning to work, after adjusting for the employed mother's demographics and employment characteristics, supporting our hypothesis.
Conclusions: These findings suggest that antenatal education or activities provided by the workplace should include the partner, which may improve workplace breastfeeding rates.
doi:10.1089/bfm.2013.0127
PMCID: PMC4025622  PMID: 24650363
7.  ABM Clinical Protocol #1: Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014 
Breastfeeding Medicine  2014;9(4):173-179.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
doi:10.1089/bfm.2014.9986
PMCID: PMC4026103  PMID: 24823918
8.  Initiation of Complementary Feeding and Duration of Total Breastfeeding: Unlimited Access to Lactation Consultants Versus Routine Care at the Well-Baby Clinics 
Breastfeeding Medicine  2014;9(4):196-202.
Abstract
Introduction: Breastfeeding has several advantages for both mother and child. Lactation consultants may promote prolonged breastfeeding, but little is known about their impact on the initiation of complementary feeding.
Subjects and Methods: Dietary intake during the initial complementary feeding period from 5 to 6 months was collected on mother–infant pairs who had unlimited access to lactation consultants along with those mother–infant pairs who received routine care at the well-baby clinics. The total duration of breastfeeding in each study population was also recorded, and total breastfeeding durations of infants receiving complementary foods from 4 months and those exclusively breastfed for 6 months in each of the two study populations were compared.
Results: Higher proportion of infants of mothers with unlimited access to lactation consultants were fed vegetable and vegetable purées (p=0.05) and more than one food type (p=0.05) at 5 months. Furthermore, a lower percentage of them had three meals per day at 6 months (p=0.001) compared with those receiving routine care at the well-baby clinics. Infants exclusively breastfed for 6 months all had similar duration of total breastfeeding.
Conclusions: Mother–infant pairs with unlimited access to lactation consultant had slower introduction of complementary foods at the initial complementary feeding period, according to number of infant's meals at 6 months of age. Furthermore, those exclusively breastfed for 6 months had more prolonged breastfeeding compared with mothers who began complementary feeding at 4 months regardless of exposure to lactation consultants.
doi:10.1089/bfm.2013.0094
PMCID: PMC4066226  PMID: 24621390
9.  Is Breastfeeding Protective for Blood Pressure in Schoolchildren? A Cohort Study in Northeast Brazil 
Breastfeeding Medicine  2014;9(3):149-156.
Abstract
Objective: This study assessed the influence of breastfeeding and nutritional status of full-term infants on blood pressure at school age.
Subjects and Methods: This was a cross-sectional study nested in a cohort of 375 infants recruited at birth between 1993 and 1994 in the state of Pernambuco, Brazil. A sample of 213 8-year-old children had their blood pressure measured. A multivariate linear regression analysis was used to identify the influence of low birth weight and breastfeeding duration on blood pressure, adjusting for socioeconomic conditions, maternal nutritional status, eating habits, growth rate (0–6 months), and the children's anthropometry at 8 years.
Results: Mean values of children's blood pressure were significantly higher with lower duration of breastfeeding. Higher per capita family income, maternal body mass index and height, child's weight and length at birth, and child anthropometric dimensions at 8 years of age were associated with higher levels of blood pressure. The multivariate linear regression analysis showed that children who were breastfed for less than 40 days had higher systolic blood pressures, explaining 2.2% of its variation. Anthropometry at 8 years of age explained the higher variance in systolic blood pressure (12.6%) with emphasis on waist circumference (9.5%), followed by per capita income (3.2%) and maternal height (2.1%). Birth weight and length had no influence on blood pressure levels in this age group.
Conclusions: Children's waist circumference, duration of breastfeeding, socioeconomic conditions, and maternal nutritional status influenced blood pressure levels of schoolchildren born full term, rather than low birth weight.
doi:10.1089/bfm.2013.0118
PMCID: PMC3993031  PMID: 24380584
10.  Breastfeeding Infants with Phenylketonuria in the United States and Canada 
Breastfeeding Medicine  2014;9(3):142-148.
Abstract
Objective: This study described the prevalence and duration of mothers' breastfeeding infants with phenylketonuria (PKU) and explored factors related to duration of breastfeeding as a surrogate for breastfeeding success.
Subjects and Methods: Descriptive analysis as performed from an international Internet survey of mothers (n=103) who met the inclusion criteria: (1) at least 21 years of age, (2) able to read and write in English, (3) child with PKU, and (4) living in the United States or Canada.
Results: Of the 103 mothers, 89 (86%) initiated breastfeeding immediately following delivery, whereas 14 (14%) chose bottle feeding. In comparison to breastfeeding after delivery, significantly fewer mothers breastfed after diagnosis (McNemar's χ2=30.33, p<0.001; n=72 vs. n=89). Breastfeeding duration ranged from less than 1 month to 24 months with one modal duration category (n=20, 22%) at less than 1 month. The timing of the addition of commercial infant formula to supplement breastfeeding or expressed mothers' milk was associated with a shorter duration of breastfeeding among infants with PKU: χ2 (42, n=73)=88.13, p<0.001.
Conclusions: PKU is treated with phenylalanine (Phe) restriction. Breastfeeding infants with PKU is challenging in part because Phe intake is difficult to determine precisely. We studied breastfeeding duration in infants with PKU and factors associated with success. Further research should identify the unique needs of mothers' breastfeeding infants with PKU to guide the development of interventions specific to these mothers to support their efforts to continue breastfeeding after the diagnosis of PKU.
doi:10.1089/bfm.2013.0092
PMCID: PMC3993072  PMID: 24350704
11.  Taste of Milk from Inflamed Breasts of Breastfeeding Mothers with Mastitis Evaluated Using a Taste Sensor 
Breastfeeding Medicine  2014;9(2):92-97.
Abstract
Background: The refusal of infants to suckle from a breast that is inflamed with mastitis suggests that the taste of the milk has changed. However, the taste of milk from a breast with mastitis has never been empirically determined. The present study compares the taste of milk from breastfeeding mothers with or without mastitis and identifies specific changes in the taste of milk from mothers with mastitis.
Subjects and Methods: The intensity of four basic tastes (sourness, saltiness, bitterness, and umami) of breastmilk from 24 healthy mothers at 3–5 days and at 2–3, 4–5, and 8–10 weeks postpartum and from 14 mothers with mastitis was determined objectively using a taste sensor. The intensity of each basic taste and the concentrations of main taste substances in milk were compared between the inflamed breasts and the normal breasts of control mothers or the contralateral asymptomatic breast of mothers with unilateral mastitis.
Results: The transition from colostrum to mature milk was accompanied by changes in the taste of the milk, such as decreased saltiness and umami and increased bitterness and sourness. Umami and saltiness increased in milk from inflamed breasts. Contents of sodium, glutamate, and guanosine monophosphate increased in milk from inflamed breasts.
Conclusions: Tastes that were specifically associated with inflamed breasts appeared to include an increase in umami and saltiness, which might have resulted from an increased content in factors associated with umami and sodium.
doi:10.1089/bfm.2013.0084
PMCID: PMC3934511  PMID: 24350703
12.  Secular Trends in Impact Factor of Breastfeeding Research Publications over a 20-Year Period 
Breastfeeding Medicine  2014;9(2):98-100.
Abstract
Objective: The aim of the current study was to determine whether secular changes have occurred in the breastfeeding literature, in terms of number and type of yearly published articles and impact factor of journals publishing these articles.
Research Design and Setting: In order to evaluate all Medline articles related to breastfeeding, we used the Internet URL www.ncbi.nlm.nih.gov/entrez and searched for articles recorded from January 1, 1992 through December 31, 2011 using as a key word “breast milk,” “breast feeding,” or “human milk.” We specifically studied randomized controlled trials (RCTs), clinical trials, case reports, meta-analyses, letters to the editor, reviews, systematic reviews, practice guidelines, and editorials.
Results: There was a linear increase over the years in all articles recorded, from approximately 1,100/year in 1992 to 2,100/year in 2011 (i.e., an approximately 1.9-fold increase [R2=0.995, p=0.001]). Concomitant with the yearly increase in the number of published RCTs per year, there was a linear increase in the number of journals publishing articles on breastfeeding per year (from approximately 20 in 1992 to >60 in 2011 [R2=0.811, p<0.001]) but an overall decrease in the average impact factor every year (R2=0.202, p=0.047). However, the ratio of high-quality articles selected (RCTs+meta-analyses+systematic reviews+CR)/low-quality articles (reviews+editorials+letters to the editor+case reports) increased significantly over time in favor of the former.
Conclusions: There was a linear increase in the number of publications related to the field of breastfeeding and human milk, and the ratio of high-quality/low-quality articles improved over time, indicating a relative and absolute increase in the number of articles usually considered as being of high quality. There was a significant increase in the number of journals publishing breastfeeding-related articles, with a significant decrease of average impact factor of those journals.
doi:10.1089/bfm.2013.0090
PMCID: PMC3934512  PMID: 24283959
13.  Role of Oral Antibiotics in Treatment of Breastfeeding Women with Chronic Breast Pain Who Fail Conservative Therapy 
Breastfeeding Medicine  2014;9(2):63-72.
Abstract
Background: Although breast pain remains a common cause of weaning, controversy exists regarding the etiology of chronic pain. Prospective studies are needed to define optimal treatment regimens. We evaluated patient history, exam, and bacterial cultures in breastfeeding women with chronic breast pain. We compared pain resolution and breastfeeding complications in patients responding to conservative therapy (CTX) (n=38) versus those in patients failing CTX and receiving oral antibiotic treatment (OTX) (n=48).
Subjects and Methods: We prospectively enrolled 86 breastfeeding women with breast pain lasting greater than 1 week and followed up patients through 12 weeks.
Results: Higher initial breast (p=0.012) and nipple pain severity (p=0.004), less response to latch correction (p=0.015) at baseline visit, and breastmilk Staphylococcus aureus growth (p=0.001) were associated with failing CTX. Pain type was not associated with failure of CTX. When culture results were available at 5 days, breast pain remained higher (p<0.001) in patients failing CTX and starting antibiotics. OTX patients then had more rapid breast pain reduction between 5 and 14 days (score of 3.1 vs. 1.3; p<0.001). By 4 weeks there was no difference (1.8/10 vs. 1.4/10; p=0.088) in breast pain level between groups. Median length of OTX was 14 days. At 12 weeks, weaning frequency (17% vs. 8%; p=0.331) was not statistically different.
Conclusions: Initial pain severity and limited improvement to latch correction predicts failure of CTX. S. aureus growth is more common in women failing CTX. For those women not responding to CTX, OTX matched to breastmilk culture may significantly decrease their pain and is not associated with increased complications.
doi:10.1089/bfm.2013.0093
PMCID: PMC3934517  PMID: 24387034
14.  Employee Perception of Breastfeeding-Friendly Support and Benefits of Breastfeeding as a Predictor of Intention to Use Breast-Pumping Breaks After Returning to Work Among Employed Mothers 
Breastfeeding Medicine  2014;9(1):16-23.
Abstract
Background: Although increasing numbers of large companies are complying with demands for a breastfeeding-friendly workplace by providing lactation rooms and breast-pumping breaks, the effectiveness for intention to use breast-pumping breaks to express breast milk among employed mothers is uncertain. To explore the impact of employees' perceived breastfeeding support from the workplace and the benefits of breastfeeding on a woman's intention to use breast-pumping breaks after returning to work, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan.
Subjects and Methods: A structured questionnaire survey was administered to 715 working mothers employed in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan. Questionnaire content included female employee demographics, employment characteristics, and breastfeeding behavior after returning to work, as well as employees' perception of breastfeeding-friendly support and awareness of the benefits of breastfeeding when raising their most recently born child.
Results: Higher education (odds ratio [OR] 2.33), non–clean room worksite (OR 1.51), awareness of breast-pumping breaks (OR 4.70), encouragement by colleagues to use breast-pumping breaks (OR 1.76), and greater awareness of the benefits of breastfeeding (OR 1.08) were significant predictors of the use of breast-pumping breaks after returning to work, whereas the perception of inefficiency when using breast-pumping breaks reduced an employed mother's intention to use breast-pumping breaks (OR 0.55).
Conclusions: This study finds an association between an appreciation of the benefits provided by the employer and the likelihood of increased usage of breastfeeding breaks. Workplaces and employers can help employed mothers to understand the benefits of breastfeeding, which may increase the intention of the mother to take breast-pumping breaks after returning to work.
doi:10.1089/bfm.2013.0082
PMCID: PMC3903328  PMID: 24304034
15.  ABM Clinical Protocol #2: Guidelines for Hospital Discharge of the Breastfeeding Term Newborn and Mother: “The Going Home Protocol,” Revised 2014 
Breastfeeding Medicine  2014;9(1):3-8.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
doi:10.1089/bfm.2014.9996
PMCID: PMC3903163  PMID: 24456024
16.  Women's Perceptions of Breastfeeding Barriers in Early Postpartum Period: A Qualitative Analysis Nested in Two Randomized Controlled Trials 
Breastfeeding Medicine  2014;9(1):9-15.
Abstract
Objectives: This study examined women's perceptions of early infant feeding experiences and identified early postpartum barriers to successful breastfeeding.
Subjects and Methods: We conducted semistructured exit interviews at 6 months postpartum with a subsample of participants (n=67) enrolled in two randomized controlled trials of breastfeeding promotion. Study arms included (1) routine pre- and postnatal visits with an International Board Certified Lactation Consultant (IBCLC) (LC group), (2) electronically prompted guidance from prenatal care providers (EP group), (3) EP+LC combined, and (4) standard of care (control group). Interview transcripts were coded using grounded theory and analyzed in MAXqda. Code matrices were used to identify early postpartum breastfeeding barriers and were further examined in relation to treatment group using a mixed methods analysis.
Results: The majority of the participants reported experiencing at least one barrier to breastfeeding. Barriers to breastfeeding were more commonly reported in the early postpartum than late postpartum period. The most common barrier during the early postpartum period was the perception of inadequate milk supply (“lactational”) (n=18), followed by problems with latch, medical problems that were perceived as precluding breastfeeding, and medical staff and hospital practices. Participants frequently reported that the IBCLCs assisted them in anticipating, managing, and overcoming these barriers.
Conclusions: Our findings underscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding.
doi:10.1089/bfm.2013.0063
PMCID: PMC3903167  PMID: 24304033
17.  A Case Control Study of Bacterial Species and Colony Count in Milk of Breastfeeding Women with Chronic Pain 
Breastfeeding Medicine  2014;9(1):29-34.
Abstract
Background: An infectious etiology for chronic breast pain in breastfeeding women continues to be debated. Although recent data suggest that Staphylococcus aureus and coagulase-negative Staphylococcus (CNS) may cause chronic breast pain, no studies have used quantitative cultures to address this question. In this study we compared bacterial species and colony counts between breastfeeding women with (cases) and without (controls) chronic pain.
Subjects and Methods: We enrolled 114 breastfeeding women in a prospective cohort study. Cases (n=61), breastfeeding women with breast pain for >1 week and no signs of acute infection, were matched with controls (n=53) by weeks postpartum and parity.
Results: More cases had a history of mastitis (14% vs. 2%, p=0.036), cracked nipples (64% vs. 17%, p=0.001), and other breastfeeding difficulties. Enterobacter species growth was less likely in cases (0% vs. 7.5%, p=0.029). Cases had a significantly higher growth of S. aureus (19.7% vs. 1.9%, p=0.003). CNS frequency was similar between groups (75% vs. 79%, p=0.626), but median colony count growth was significantly lower in cases (900 colony-forming units/mL vs. 5,000 colony-forming units/ml, p=0.003). Growth of CNS and S. aureus was negatively correlated (r=–0.265, p=0.004).
Conclusions: Higher S. aureus growth in cases supports a pathogenic role for S. aureus and reinforces the need for future antibiotic treatment studies in breastfeeding women with chronic pain. In contrast, similar CNS frequency between groups, lower CNS colony counts in cases, and a negative correlation between S. aureus and CNS growth suggest that neither CNS, nor its overgrowth, causes chronic breast pain.
doi:10.1089/bfm.2013.0012
PMCID: PMC3903327  PMID: 23789831
18.  Early Administration of Oropharyngeal Colostrum to Extremely Low Birth Weight Infants 
Breastfeeding Medicine  2013;8(6):491-495.
Abstract
Background: Human milk reduces morbidities in extremely low birth weight (ELBW) infants. However, clinical instability often precludes ELBW infants from receiving early enteral feeds. This study compared clinical outcomes before and after implementing an oropharyngeal colostrum (COL) protocol in a cohort of inborn (born at our facility) ELBW infants.
Study Design: This is a retrospective cohort study of inborn ELBW infants admitted to the Duke Intensive Care Nursery from January 2007 to September 2011. In November 2010, we initiated a COL protocol for infants not enterally fed whose mothers were providing breastmilk. Infants received 0.1 mL of fresh COL to each cheek every 4 hours for 5 days beginning in the first 48 postnatal hours. We assessed demographics, diagnoses, feeding history, and mortality and for the presence of medical necrotizing enterocolitis (NEC), surgical NEC, and spontaneous perforation. Between-group comparisons were made using Fisher's exact test or Wilcoxon rank sum testing where appropriate.
Results: Of the 369 infants included, 280 (76%) were born prior to the COL protocol (Pre-COL Cohort [PCC]), and 89 (24%) were born after (COL Cohort [CC]). Mortality and the percentage of infants with surgical NEC and spontaneous perforations were statistically similar between the groups. The CC weighed an average (interquartile range) of 1,666 (1,399, 1,940) g at 36 weeks versus 1,380 (1,190, 1,650) g for the PCC (p<0.001). In a multivariable analysis with birth weight as a covariable, weight at 36 weeks was significantly greater (37 g; p<0.01).
Conclusions: Initiating oropharyngeal COL in ELBW infants in the first 2 postnatal days appears feasible and safe and may be nutritionally beneficial. Further research is needed to determine if early COL administration reduces neonatal morbidity and mortality.
doi:10.1089/bfm.2013.0025
PMCID: PMC3868273  PMID: 23805944
19.  Increased Breastfeeding Rates in Black Women After a Treatment Intervention 
Breastfeeding Medicine  2013;8(6):479-484.
Abstract
There has been a considerable increase in rates of breastfeeding in the United States. Despite these trends, black women continue to fall below medical recommendations. Impoverished and poorly educated women also have a comparatively lower rate of breastfeeding. Provider encouragement and supportive interventions increase breastfeeding initiation among women of all backgrounds. The data presented come from a three-site randomized controlled bilingual depression treatment trial from 2005 to 2011 that examined the comparative effectiveness of interpersonal psychotherapy and a parenting education program. Breastfeeding education and support were provided for the majority of participants in each intervention. Breastfeeding status was queried at postpartum week 4. We found higher rates of breastfeeding in black women compared with those reported in national surveys. The black breastfeeding rate did not significantly differ from that of white or Hispanic women. American-born black women were just as likely to breastfeed as American-born white women, both at significantly greater rates than American-born Hispanic women. We also found no differences in breastfeeding rate in poorly educated and impoverished women. These data must be seen against the backdrop of a significant intervention to treat depression. Because breastfeeding interventions have been shown to increase breastfeeding rates, the support provided in our study likely increased rates in groups that lag behind.
doi:10.1089/bfm.2013.0051
PMCID: PMC3868278  PMID: 23971683
20.  ABM Clinical Protocol #5: Peripartum Breastfeeding Management for the Healthy Mother and Infant at Term, Revision 2013 
Breastfeeding Medicine  2013;8(6):469-473.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
doi:10.1089/bfm.2013.9979
PMCID: PMC3868283  PMID: 24320091
21.  TGF-β2, a Protective Intestinal Cytokine, Is Abundant in Maternal Human Milk and Human-Derived Fortifiers but Not in Donor Human Milk 
Breastfeeding Medicine  2013;8(6):496-502.
Abstract
Objective: This study compared cytokines (in particular transforming growth factor [TGF]-β2) and lactoferrin in maternal human milk (MHM), human-derived milk fortifier (HDMF), and donor human milk (DHM).
Materials and Methods: MHM was randomly collected from breastfeeding mothers who had no infectious illness at the time of milk expression. HDMF and DHM were products derived from human milk processed by Holder pasteurization. MHM samples were collected at different times (early/late) and gestations (preterm/term). Lactoferrin was analyzed by western blotting, and cytokines were quantified using commercial enzyme-linked immunosorbent assays. Significance was determined using analysis of variance.
Results: In the 164 samples analyzed, TGF-β2 concentrations in HDMF and preterm MHM (at all collection times) were fivefold higher than in DHM (p<0.05). Early preterm MHM had levels of interleukin (IL)-10 and IL-18, 11-fold higher than DHM (p<0.05). IL-6 in DHM was 0.3% of the content found in MHM. IL-18 was fourfold higher in early MHM versus late MHM regardless of gestational age (p<0.05). Lactoferrin concentration in DHM was 6% of that found in MHM.
Conclusions: Pasteurization decreases concentrations of most cytokines and lactoferrin in DHM. TGF-β2, a protective intestinal cytokine, has comparable concentrations in HDMF to MHM despite pasteurization.
doi:10.1089/bfm.2013.0017
PMCID: PMC3919475  PMID: 23869537
22.  Buying Human Milk via the Internet: Just a Click Away 
Breastfeeding Medicine  2013;8(6):474-478.
Abstract
Background: For past centuries, infants have been fed the milk of mothers who are not their own by latching to another woman's breast. Today, the majority of lactating women use electric pumps to extract milk from their breasts; thus, an infant now may be fed another woman's milk via a bottle or cup. The Internet is an emerging avenue to acquire pumped human milk. The purpose of our study was to participate in and describe the process of buying milk via the Internet. Our goal is to help those involved with the clinical care, research, and public health policy of mothers and infants better understand that families may be buying milk in this way.
Subjects and Methods: We anonymously bought 102 human milk samples via the Internet. We characterized the outside box, packing materials, milk container, temperature and condition of the milk, and cost.
Results: We bought 2,131 ounces of milk at a total cost of $8,306. Eighty-nine percent of the milk arrived above the recommended frozen temperature of −20°C; 45% of it was even above the recommended refrigerator temperature (4°C). The mean surface temperature of the milk samples in each shipment was correlated with the cost of shipping, time in transit, and condition of the milk containers.
Conclusions: The prevalence and potential risks of this practice currently are unknown. Research related to milk quality and infant outcomes related to milk buying via the Internet is urgently needed.
doi:10.1089/bfm.2013.0048
PMCID: PMC4046749  PMID: 23971685
23.  Airports in the United States: Are They Really Breastfeeding Friendly? 
Breastfeeding Medicine  2014;9(10):515-519.
Abstract
Introduction: State and federal laws have been enacted to protect the mother's right to breastfeed and provide breastmilk to her infant. The Patient Protection and Affordable Care Act requires employers to provide hourly waged nursing mothers a private place other than a bathroom, shielded from view, free from intrusion. Minimum requirement for a lactation room would be providing a private space other than a bathroom. Workplace lactation accommodation laws are in place in 24 states, Puerto Rico, and the District of Columbia. These requirements benefit the breast-pumping mother in an office, but what about the breast-pumping mother who travels? Of women with a child under a year, 55.8% are in the workforce. A significant barrier for working mothers to maintain breastfeeding is traveling, and they will need support from the workplace and the community. This study aimed to determine which airports offer the minimum requirements for a breast-pumping mother: private space other than a bathroom, with chair, table, and electrical outlet.
Study Design: A phone survey was done with the customer service representative at 100 U.S. airports. Confirmatory follow-up was done via e-mail.
Results: Of the respondents, 37% (n=37) reported having designated lactation rooms, 25% (n=25) considered the unisex/family restroom a lactation room, 8% (n=8) offer a space other than a bathroom with an electrical outlet, table, and chair, and 62% (n=62) answered yes to being breastfeeding friendly.
Conclusions: Only 8% of the airports surveyed provided the minimum requirements for a lactation room. However 62% stated they were breastfeeding friendly. Airports need to be educated as to the minimum requirements for a lactation room.
doi:10.1089/bfm.2014.0112
PMCID: PMC4267407  PMID: 25313682
24.  Human Milk Glycoproteins Protect Infants Against Human Pathogens 
Breastfeeding Medicine  2013;8(4):354-362.
Abstract
Breastfeeding protects the neonate against pathogen infection. Major mechanisms of protection include human milk glycoconjugates functioning as soluble receptor mimetics that inhibit pathogen binding to the mucosal cell surface, prebiotic stimulation of gut colonization by favorable microbiota, immunomodulation, and as a substrate for bacterial fermentation products in the gut. Human milk proteins are predominantly glycosylated, and some biological functions of these human milk glycoproteins (HMGPs) have been reported. HMGPs range in size from 14 kDa to 2,000 kDa and include mucins, secretory immunoglobulin A, bile salt-stimulated lipase, lactoferrin, butyrophilin, lactadherin, leptin, and adiponectin. This review summarizes known biological roles of HMGPs that may contribute to the ability of human milk to protect neonates from disease.
doi:10.1089/bfm.2013.0016
PMCID: PMC3725943  PMID: 23697737
25.  ABM Clinical Protocol #18: Guidelines for Breastfeeding Infants with Cleft Lip, Cleft Palate, or Cleft Lip and Palate, Revised 2013 
Breastfeeding Medicine  2013;8(4):349-353.
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
doi:10.1089/bfm.2013.9988
PMCID: PMC3725852  PMID: 23886478

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