Breastfeeding,
how...
Preterm
infants
Espy KA,
Senn TE. Incidence and correlates of breast milk
feeding in hospitalized preterm infants. Soc Sci
Med 2003;57:1421-8
In this study,
the clinical charts of 151 pre-term infants (34 weeks
gestational age or less) admitted in a neonatal intensive
care unit of a regional hospital in the USA were reviewed.
About 51% of the infants were fed formula exclusively.
On average, the remaining infants received at least
one breastmilk feeding per day for 44% of their hospital
stay. Higher maternal age and an Apgar score higher
than 6 at 5 minutes were the two factors associated
with a higher probability of breastmilk feeding.
Community-based
promotion
Bhandari
N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK;
Infant Feeding Study Group. Effect of commun-ity-based
promotion of exclusive breastfeeding on diarrhoeal illness
and growth: a cluster randomised controlled trial. Lancet
2003;361:1418-23
This study
assessed the feasibility, effectiveness, and safety
of an educational intervention to promote exclusive
breastfeeding for 6 months in India. Eight pair-matched
communities were randomised; one of each pair received
the intervention and the other received none. In the
intervention communities, health and nutrition workers
were trained to counsel mothers for exclusive breastfeeding
at multiple opportunities. After training, 1,115 infants
were enrolled, 552 in the intervention and 473 in the
control communities. At 3 months, exclusive breastfeeding
reached 79% in the intervention and 48% in the control
communities. The 7-day diarrhoea prevalence was lower
in the intervention communities at 3 months (about 30%
less) and 6 months (about 15% less). The mean weights
and lengths and the proportion of malnourished infants
did not differ between groups. Promotion of exclusive
breastfeeding till 6 months through existing primary
health care services is feasible, reduces the risk of
diarrhoea, and does not lead to growth faltering.
Graffy J,
Taylor J, Williams A, Eldridge S. Randomised controlled
trial of support from volunteer counsellors for mothers
considering breastfeeding. BMJ 2004; 328:26-31
Is providing
support on breastfeeding enough to help mothers to breastfeed?
This randomised controlled trial was carried out in
32 general practices in London and south Essex to investigate
whether offering volunteer support from counsellors
would result in more women breastfeeding. The intervention
did not significantly increase the prevalence of any
breastfeeding to 6 weeks: 65% (218/336) in the intervention
group and 63% (213/336) in the control group. Neither
duration of breastfeeding nor time of introduction of
formula feeds differed significantly. However, only
20% of women in the intervention group had at least
one postnatal visit, 43% had postnatal telephone contacts
and 38% had no postnatal contact at all. About 73% of
women who contacted (visit and phone) counsellors postnatally
rated them as very helpful and said that the most helpful
advice came from counsellors rather than from other
sources. Person-to-person contact is the best way to
maximize breastfeeding support.
In-hospital
education of mothers
Labarere
J, Bellin V, Fourny M, Gagnaire JC, Francois P,Pons
JC. Assessment of a structured in-hospital educational
intervention addressing breastfeeding: a prospective
randomised open trial. BJOG 2003;110:847-52
Is just one
session on breastfeeding education enough? To determine
whether a single one-to-one in-hospital education session
could increase the rate of breastfeeding at 17 weeks,
a randomised trial was conducted in a maternity hospital
in France. 106 mother-infant pairs were allocated to
the intervention group (a structured, one-to-one in-hospital
education session) and 104 to the control group (usual
verbal encouragement). The rate of any breastfeeding
(34.4% vs. 40.2% in the control group) and of exclusive
breastfeeding (14.0% vs. 14.4%) at 17 weeks was not
significantly different. Guidance provided by maternity
staff should be reinforced by a long-term, multifaceted
support programme in countries with a low to intermediate
rate of breastfeeding.
Human
milk banks
Azema E,
Callahan S. Breast milk donors in France: a portrait
of the typical donor and the utility of human milk banking
in the French breastfeeding context. J Hum Lact
2003;19:199-202
One important
constraint to the establishment of human milk banks
is the availability of donors. While the characteristics
of blood donors are well known, those of lactating women
who decide to donate their milk are largely unknown.
Seventeen milk banks in France were contacted and eight
accepted to participate in a study examining donor characteristics.
The results showed that among 103 donors, the majority
were women with strong support at home; more than a
half worked outside of the home particularly in health
and social services. Only 11.7% reported practical problems
in donating their milk. The main reasons for giving
their milk were altruism and an optimistic attitude;
close to 60% indicated having "too much milk".
This study can give leads for the recruitment of potential
donors of breastmilk.
Working
mothers
Galtry J.
The impact on breastfeeding of labour market policy
and practice in Ireland, Sweden, and the USA. Soc
Sci Med 2003;57:167-77
International
recommendations advise exclusive breastfeeding for 6
months. There would be considerable potential for labour
policy and practice, particularly maternity/parental
leave provisions, to positively influence breastfeeding
practice. Taking the case studies of Ireland, Sweden,
and the United States, this paper concludes that both
socio-cultural support and labour market/health/early
childhood policy are important if high rates of both
breastfeeding and women's employment are to be achieved
in industrialised countries.
Less
pain
Carbajal
R, Veerapen S, Couderc S, Jugie M, Ville Y. Analgesic
effect of breast feeding in term neonates: randomised
controlled trial. BMJ 2003;326:13
Is breastfeeding
effective for pain relief during venous puncture in
neonates? A study was carried out to compare the effect
of breastfeeding with that of oral glucose combined
with a pacifier, in 180 randomised, term newborns, 45
in each group. During venous puncture, infants were
either breastfed (group 1), held in their mother's arms
without breastfeeding (group 2), given a placebo (group
3), or given glucose and a pacifier (group 4). Video
recordings of the procedure were assessed by two observers
blinded to the purpose of the study. Median pain scores
for breastfeeding, held in mother's arms, placebo, and
30% glucose plus pacifier groups were 1, 10, 10, and
3 with one pain scale, and 4.5, 13, 12, and 4 with another
pain scale, with a significant difference among groups.
Breastfeeding effectively reduces response to pain during
minor invasive procedures in term neonates.
Mother-to-child
transmission of HIV
Jackson JB,
Musoke P, Fleming T, Guay LA, Bagenda D, Allen M, Nakabiito
C, Sherman J, Bakaki P, Owor M, Ducar C, Deseyve M,
Mwatha A, Emel L, Duefield C, Mirochnick M, Fowler MG,
Mofenson L, Miotti P, Gigliotti M, Bray D, Mmiro F.
Intrapartum and neonatal single-dose nevirapine compared
with zidovudine for prevention of mother-to-child transmission
of HIV-1 in Kampala, Uganda: 18-month follow-up of the
HIVNET 012 randomised trial. Lancet 2003;362:859-68
From November,
1997, to April, 1999, 313 HIV-1 infected pregnant women
were randomly assigned nevirapine (200 mg at labour
onset and 2mg/kg for babies within 72 hours of birth)
and the other 313 HIV-infected pregnant women zidovudine
(600 mg orally at labour onset and 300 mg every 3 hours
until delivery, and 4 mg/kg orally twice daily for babies
for 7 days); 99% of babies were breastfed (median duration
9 months). The estimated risks of HIV-1 transmission
in the zidovudine and nevirapine groups were 10.3% and
8.1% at birth; 20.0% and 11.8% by age 6-8 weeks; 22.1%
and 13.5% by age 14-16 weeks; and 25.8% and 15.7% by
age 18 months. Nevirapine was associated with a 41%
reduction in relative risk of transmission through to
age 18 months. The nevirapine regimen is simple,
inexpensive, well-tolerated, and has the potential to
significantly decrease HIV-1 perinatal transmission
in less-developed countries.
Leroy V,
Karon JM, Alioum A, Ekpini ER, van de Perre P, Greenberg
AE, Msellati P, Hudgens M, Dabis F, Wiktor SZ; West
Africa PMTCT Study Group. Postnatal transmission
of HIV-1 after a maternal short-course zidovudine peripartum
regimen in West Africa. AIDS 2003;17:1493-501
To assess
the postnatal transmission risk of HIV-1 after a maternal
short-course zidovudine regimen in a breastfeeding population,
data were pooled from two trials conducted in Côte
d’Ivoire and Burkina Faso. Consenting HIV-1 seropositive
women were randomized at 36-38 weeks’ gestation
to receive oral zidovudine or placebo. At age 24 months,
the risks for postnatal transmission were similar in
the zidovudine (9.8%, n = 254) and placebo groups (9.1%,
n = 225). Postnatal transmission occurred at a similar
rate between arms and therefore reduced the long-term
overall efficacy of this zidovudine regimen at age 24
months.
Cochrane
reviews - Early skin-to-skin contact
Anderson
GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin
contact for mothers and their healthy newborn infants.
Cochrane Database Syst Rev 2003;(2):CD003519
To assess
the effects of early skin-to-skin contact on breastfeeding,
behaviour, and physiology in mothers and their healthy
newborn infants, 17 studies, involving 806 participants,
were included in this systematic review. Early skin-to-skin
contact was found to have statistically significant
positive effects: more than twice the number of infants
were still breastfed at 1-3 months, breastfeeding duration
increased by 42 days on average, infant temperature
and blood glucose were better kept in the normal range,
infant crying was greatly reduced, and the scores of
maternal affectionate behaviour improved. No statistically
significant benefit of early skin-to-skin contact was
noted for other major clinical variables: breastmilk
maturation, maternal chest circumference, and infant
heart rate. Early skin-to-skin contact appears to have
some clinical benefit especially regarding breastfeeding
outcomes and infant crying, and has no apparent short
or long-term negative effects.
Prepared
by the Geneva Infant Feeding Association (GIFA),
a member of the International Baby Food Action Network
(IBFAN)
Editors:
Marina Ferreira Rea, Adriano Cattaneo. Bob Peck revised
and edited the text.
Copies
of Breastfeeding Briefs sent upon request to GIFA, Avenue
de la Paix 11, 1202 Geneva, Switzerland,
Fax: +41-22-798 44 43, or to UNICEF country offices.
Available
also in French, Spanish, Portuguese and Arabic.
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