Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org

Search the Community

Showing results for tags 'breastfeeding'.



More search options

  • Search By Tags

    Type tags separated by commas.
  • Search By Author

Content Type


Forums

  • 99nicu
    • Partners and Sponsors
    • Feedback and support
  • GENERAL NEONATAL CARE
    • prenatal care and fetal growth
    • resuscitation
    • fluid and electrolyte balance
    • nutrition
    • drug treatment and analgesia
    • nursing the neonate
    • family support
    • practical procedures
    • technical equipment
  • NEONATAL MORBIDITY
    • pulmonary disorders
    • cardiovascular problems
    • neurology
    • infections
    • gastroenterology
    • hematology
    • metabolic disorders
    • disorders of the genitourinary tract
    • ophtalmology
    • orthopedic problems
    • dermatology
    • neonatal malignancies
  • ORGANISATION OF NEONATAL CARE
    • education, organisation and evaluation
    • ethical and legal aspects
  • MESSAGE BOARD
    • Job Board
    • Reviews
    • Congresses and courses
    • Other notes

Blogs

  • Department of Brilliant Ideas
  • My blog, Gaza, Palestine
  • Blog selvanr4
  • Blog ali
  • Neonatology Research Blog
  • Blog JACK
  • Blog MARPSIE
  • Blog Christina Arent
  • Blog docspaleh
  • HIE and brain death
  • emad shatla's Blog
  • Medhaw
  • DR.MAULIK SHAH
  • keith barrington's neonatalresearch.org
  • sridharred15's Blog
  • Petra's Blog
  • Abel
  • All Things Neonatal
  • Dr Alok Sharma
  • Simulation and Technology Enhanced Learning as a Tool to Improve Neonatal Outcomes
  • Hesham Tawakol
  • spotted: NICU
  • Bubbly Girl in NICU
  • Narongsak Nakwan
  • Dr. Rajeev Malhotra
  • Smells like DR spirit
  • Ravi Agarwal

Collections

  • 99nicu
  • How everything works
  • Terms and conditions

Categories

  • Pharmacopedia

Categories

  • Gastrointestinal Quizzes
  • Neurology Quizzes
  • Pulmonary Quizzes

Find results in...

Find results that contain...


Date Created

  • Start

    End


Last Updated

  • Start

    End


Filter by number of...

Joined

  • Start

    End


Group


First name


Last name


Occupation


Affiliation


Location


Interests


Twitter


Facebook


LinkedIn


Skype

Found 5 results

  1. This is another hot topic out there as centers around the world struggle to determine how best to manage the mother who has contracted COVID-19 in pregnancy. There are resources out there already such as the CDC which states the following. The World Health Organization also has this to say as of yesterday. The question though is where do these recommendations come from? How strong is the evidence? Let’s begin with another Coronavirus Do you remember SARS? This was another coronavirus. Wong SF et al published Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome in 2004 in which they described the outcomes of 12 women infected with the coronavirus causing SARS. In this study they sampled Evidence of perinatal transmission of virus was assessed by SARS-associated coronavirus reverse-transcriptase polymerase chain reaction (SARS-CoV RT-PCR) and viral culture on cord blood, placenta tissue, and amniotic fluid at or after delivery. None of the tested infants were found to have infection nor were any of the tissues or fluids positive. They did not test breast milk specifically but as none of the infants developed SARS one could infer that if the other samples were negative so were the breastmilk samples. The conclusion after the SARS epidemic is that vertical transmission does not occur. Moving on to COVID-19 It may surprise you but there is very little out there on breastmilk and COVID-19. Having said that, there is very little data on pregnancy and COVID-19 so the question then is how strong is the evidence for lack of transmission in breastmilk? There is really one study by Chen H et al Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The authors looked at 9 women presenting in the third trimester and examined outcomes from pregnancy. All of the infants were delivered via c-section and in 6 of the 9 samples of breastmilk were obtained and sampled for COVID-19. The good news was that none of the samples tested positive for the virus. I suppose the result shouldn’t be that surprising as the virus causing SARS is similar and also has not been demonstrated to lead to neonatal infection. The question then is whether one should freely breastfeed their newborn if they are known to be positive for COVID-19. Getting back to the earlier recommendations from the CDC, they read as pretty firm. Looking at the sum total of evidence I think it is safe to say we don’t have a lot of data to go by. What we have though in this situation is to look at risk/benefit. To the best of our knowledge, the COVID-19 is not transmitted into the fetus and after birth does not get into breastmilk. Both of these things appear to be quite good but as the virus spreads and more pregnant women contract the virus we may see as we get a larger sample that it is possible but I suspect this is a virus that simply doesn’t transmit to breastmilk. What if we banned breastfeeding in suspect or confirmed patients? The potential loss of immunoglobulins against COVID-19 is a real risk for the infant as they continue to live in the same home as the mother. How do we know that such antibodies exist? As for as I know for COVID-19 this hasn’t been proven yet but in the SARS epidemic a case report demonstrated that antibodies against this virus were indeed in breastmilk; SARS and pregnancy: a case report. Given that the viruses are part of the same class I would imagine the same would hold true with the new coronavirus. They may not be born with the virus but if they are receiving passive immunity from the mother that needs to be considered given that we have nothing effective (at the moment) to treat anyone. An alternative is to use donor breast milk but if we go down that road, our supplies will be exhausted before long. Weighing everything and using the best data we have at the moment my bias would be continue breastfeeding albeit with the recommendations for droplet precautions and hand hygiene as the CDC suggests. Stay safe out there everyone.
  2. This document has been drafted by Dr Riccardo Davanzo, Chair of the Technical Panel on Breastfeeding (TAS) of the Ministry of Health (MOH), and Prof. Fabio Mosca, President of the Italian Society of Neonatology (SIN), with the collaboration of Dr Guido Moro, President of AIBLUD (Human Milk Banking Association of Italy), Dr Fabrizio Sandri, Secretary of SIN and Prof. Massimo Agosti, President of the SIN Breastfeeding Commission. https://www.uenps.eu/2020/03/16/sars-cov-2-infection-sin-recommendations-endorsed-by-uenps/?utm_source=Social&utm_medium=Post&utm_campaign=UENPS_Congress_Awareness&fbclid=IwAR125OOwyNmMpZjY30YXo23GEISvYUFoTu6RMlWYBhjDcISIWRo3EoBMTUU 14marzo.SIN_UENPS0.pdf
  3. The metabolic syndrome describes the development as an adult of centripetal obesity, high blood pressure, high triglycerides, elevated blood sugar and low HDL cholesterol. These constellation of problems significantly increase the risk of cardiovascular disease, stroke and diabetes. The origins of this syndrome may begin in the newborn period as previous research has noted an association with infants who are born SGA and development of insulin resistance later in life as in the paper Insulin resistance in young adults born small for gestational age (SGA). A relationship to the metabolic syndrome has been also noted in the paper Small for gestational age and obesity related comorbidities. The theory here is that conditions in utero in which the fetus is chronically deprived of blood flow and nutrition lead to a tendency towards insulin resistance. The body is essentially trying to use any energy it is receiving to stay alive in an environment in which resources are scarce. Given that situation, resisting the effects of insulin by preventing storage of this needed energy serves a useful purpose but in the long run may be detrimental as the body become programmed to resist the effects of this hormone. What if this programming could be overcome? Breast milk certainly has many incredible properties and as we learn more we discover only more applications. My previous post on putting breast milk in the nasal cavity is just one such example (Can intranasal application of breastmilk cure severe IVH?). In 2019 Dr. Hair and Abram's group looked at this with respect to insulin resistance and with potential extrapolation to the metabolic syndrome in their paper Premature small for gestational age infants fed an exclusive human milk-based diet achieve catch-up growth without metabolic consequences at 2 years of age. Texas Children's Hospital uses an exclusive human milk diet for premature infants with the following criteria GA of <37 weeks, BW of ≤1250 g, with the diet maintained until approximately 34 weeks PMA. Exclusive human milk is provided through a combination of mother's own milk and Prolacta instead of a bovine based human milk fortifier. In this study they were able to prospectively track 51 preterm infants of which 33 were AGA and 18 SGA. The first visit (visit 1) was performed at 12–15 months CGA and the second visit (visit 2) was at 18–22 months CGA. The question at hand was whether these children would experience catch up growth at 2 years of age and secondly what their levels of insulin might look like at these times. Higher insulin levels might correlate with levels of insulin resistance with higher levels being needed to maintain euglycemia. As a measure of insuline resistance the authors used the calculation of the Non-fasting homeostatic model of assessment-insulin resistance (HOMA-IR) = (insulin × glucose)/22.5 which has been validated elsewhere. Protein intakes were equal for both groups at about 4 g/kg of human milk protein. The Results Please The SGA group had greater weight gain between visit 1 and 2 as evidenced by a significant difference in the change in BMI z-score, AGA −0.21±0.84 vs.SGA 0.25±1.10. I suppose this isn't too shocking as we know that many babies born SGA experience catch up growth after discharge. What is surprising and once again speaks to the power of breast milk is the impact observed on insulin levels and resistance to the same as measured by the HOMA-IR (AGA babies are the left column and SGA the right). The adjusted p vlaues for glucose were 0.06 with insulin and HOMA-IR being 0.02. What does this mean? Well, these are not fasting insulin levels which would be ideal but what it does say is that at fairly comparable glucose levels the level of insulin is higher in former AGA babies and the level of insulin resistance lower in the SGA infants! This result is quite the opposite of what previous studies have shown as referenced above. Aren't these growth restricted infants supposed to have had insulin resistance in utero and been programmed for life to have insulin resistance and as adults develop the metabolic syndrome? This study falls short of making any claims about the latter as these infants are only two years of age. What this study provides though is certainly a raised eyebrow. There will be those of course that look at the size of the study and dismiss it as being too small but at the very least this study will lead to further work in this area. This paper though adds to the mystery around the potential impacts of breast milk and certainly provides strength to the thought that perhaps breastmilk should be the exclusive source of nutrition for preterm infants in the NICU. While I understand that not all women are able to produce enough for their own infants or may choose not to for a variety of reasons, with access to donor milk supply this could become a reality. The cost savings to the health care system by preventing insulin resistance would be many fold greater than the cost of donor milk in the newborn period. Another intriguing question will be whether use of an exclusive human milk diet with use of only mother's own milk will have similar effects or even greater impact on glucose homestasis later in life. I think the authors are to be commended for their dedication to work in this field and I certainly look forward to the next publication from this group.
  4. I woke up this morning and as I do everyday, scanned the media outlets for news that would be of interest to you the reader. Most of the time I am searching for items of interest that I hope will get people thinking about ways to improve care but once in awhile I come across something that elicits a strong emotional reaction and today was the day. CNN released the following article today entitled Are there unintended consequences to calling breast-feeding 'natural'? The premise of the article is that by reinforcing that breastfeeding is natural we may hamper initiatives to increase vaccination in many parts of the world and in particular North America I would think. The idea here is that if we firmly entrench in women's heads that natural is better then this will strengthen the conviction that we should not vaccinate with these "man made" unnatural vaccines. I am sorry to be dramatic about this but I think the argument is ridiculous and in fact dangerous. The Definition of Natural "existing in nature and not made or caused by people : coming from nature" From the Mirriam Webster dictionary Breastfeeding satisfies this definition pure and simple and there is nothing that anyone should say to suggest otherwise no matter what the motive is. The shift from formula to breastfeeding has been predicated on this notion and a plethora of literature on the subject demonstrating reductions in such things as infections of many kinds, diarrhoea, atopic disease in the first year of life as examples. In my world of premature infants additional reductions in NEC, bloody stools, have been seen and more recently in some cases improved neurodevelopmental outcomes. In this case of irresponsible journalism a better approach if you were wanting to use the natural argument with respect to vaccines is to promote just that. Vaccines are Natural Someone will no doubt challenge me on this point as it would be a fair comment to say that there are artificial substances added to vaccines but there is no question the organisms that we vaccinate against are natural. Think about this for a moment. All of the vaccines out there are meant to protect us against organisms that exists in NATURE. These are all bacteria or viruses that have likely existed on this planet of ours for millions of years. They are found everywhere and in many cases what we are doing when we give such vaccines are providing parts of or weakened versions of these natural organisms in order for us the human to mount a protective response. This protective response is NATURAL. If we didn't vaccinate and came across the fully virulent pathogen in NATURE our bodies would do exactly what they do when a vaccine is given to us. Our immune system would mount a response to the organism and start producing protective antibodies. Unfortunately in many cases this will be too little too late as the bacteria or virus will cause it's damage before we have a chance to rid ourselves of this natural organism. This is the basis of vaccination. Allow our bodies a chance to have protection against an organism that we haven't been exposed to yet so that when it comes we have a legion of antibodies just waiting to attach this natural organism. CNN Didn't Get It Right In the article which is based on a paper entitled the Unintended Consequences of Invoking the “Natural” in Breastfeeding Promotion by Jessica Martucci & Anne Barnhill the authors admit that the number of families that this actually would impact is small. the question then is why publish this at all. Steering families away from thinking that breastfeeding is natural is wrong. Plain and simple. If the goal is to improve vaccination rates, focus on informing the public about how NATURAL vaccinations actually are and don't drag breastfeeding down in order to achieve such goals. Hopefully someone out there linked to CNN will see this as this is one upset blogger at the moment...
  5. I guess breastfeeding is a matter of debate outside Sweden too. I came across a very nice review on "Being baby friendly: evidence-based breastfeeding support". Naturally, the review is within the ADC paywall... but if you can't access it from your NICU - ask your hospital library to get it. http://fn.bmj.com/content/early/2014/10/07/archdischild-2013-304873.short?g=w_fn_ahead_tab
×
×
  • Create New...