Perceptions of Mothers with Preterm Babies towards Donor Breast Milk at Women and Newborn Hospital,Lusaka Zambia

Breast milk offers essential nutrients crucial for the development of the preterm immune system, thus reducing the incidence of infection and mortality often associated with prematurity. In the absence of breast milk, the preferred option is donated breast milk, the best alternative for hospitalized neonates whose mothers have insufficient breast milk or are unavailable. In Zambia, donor breast milk is unavailable. Instead, the protocol recommends the administration of formula milk. However, the use of formula milk in preterm babies is associated with an increased risk of necrotizing enterocolitis and sepsis. Zambia needs to establish a donor milk bank, hence the need to understand the perception of mothers towards donated breast milk. A qualitative descriptive case study utilized 10 focus group discussions with in-depth interviews, purposively selected using a variation strategy. Data was thematically analysed. Participants demonstrated potential acceptance to donor breast milk utilization, as more nutritional compared to formula despite lack of awareness. Concerns related to safety, quality, fear of disease transmission and discomfort feeding from a different bloodline were identified as hinderance to possible utilisation. These perceptions underscore the importance of educational initiatives aimed at dispelling myths and misconceptions surrounding donor breast milk and establishing donor breast milk programs. Therefore, the study recommends educational initiatives tailored to raise awareness to mothers about donor breast milk.

Application of Hazard Vulnerability Analysis Based on Kaiser Model in Neonatal Breast Milk Management

Objective:To analyze the existing risks in breast milk management at the neonatal department and provide corresponding countermeasures.Methods:22 risk events were identified in 7 risk links in the process of bottle-feeding of breast milk.Hazard Vulnerability Analysis based on the Kaiser model was applied to investigate and evaluate the risk events.Results:High-risk events include breast milk quality inspection,hand hygiene during collection,disinfection of collectors,cold chain management,hand hygiene during the reception,breast milk closed-loop management,and post-collection disposal.Root cause analysis of high-risk events was conducted and breast milk management strategies outside the hospital and within the neonatal department were proposed.Conclusion:Hazard Vulnerability Analysis based on the Kaiser model can identify and assess neonatal breast milk management risks effectively,which helps improve the management of neonatal breast milk.It is conducive to the safe development and promotion of bottle feeding of breast milk for neonates,ensuring the quality of medical services and the safety of children.

Identification of Lactobacillus and Bifidobacterium 16S rRNA Gene in Breast Milk of Some Healthy Women in Kinshasa (DR Congo)

Breast milk is important for infant health. Some of its benefits are due to the presence of a specific population of bacteria in the microflora. However, the microbiome of breast milk is influenced by many parameters such as maternal diet, breastfeeding and geographic location. Culture and non-culture methods have been used in studies of this bacterial population worldwide. But in the DR Congo, there was no study reporting the use of culture-independent techniques to characterize the bacterial diversity of human milk. The aim of this study was to identify the bacterial 16S rRNA gene from two genera Lactobacillus and Bifidobacterium. The 16S rRNA gene was also identified from four species: Lactobacillus reuteri, Lactobacillus rhamnosus, Bifidobacterium longum and Bifidobacterium lactis. This analytical cross-sectional study was conducted in Kinshasa. Breast milk from some healthy women was collected from February 2 to 28, 2018. A culture-independent protocol using the classical polymerase chain reaction (PCR) was used to identify the bacterial 16S rRNA gene. The 68 samples of breast milk were collected in a sterile condition. The bacteria-specific ribosomal gene 16S rRNA was detected in 91.18% of Lactobacillus and 32.35% of Bifidobacterium at genus level. At of species level, only Lactobacillus reuteri 16S rRNA gene was identified in 89.71%. The 16S rRNA gene from the other species could not be amplified. There was also an association between educational level and the presence of Bifidobacterium and Lactobacillus 16S rRNA genes in the breast milk (p = 0.008*, p Conclusion: This study demonstrates the presence of the bacterial 16S rRNA gene from Lactobacillus and Bifidobacterium in breast milk at the genus and Lactobacillus reuteri at species level. A further study on the diet, use of antibiotics during pregnancy and lactation practice will provide a better understanding of the microflora of breast milk.

Breast Milk:Its Role in Early Development of the Immune System and Long-Term Health

Breast milk is the best source of nutrition that provides the energy and nutrients needed for the ideal growth and development of newborns and infants. Besides, breast milk includes various bioactive compounds, which protects infants against infectious agents and antigens and contributes to immune maturation, organ development and microbial colonization. Breast milk is dynamic;the composition of the nutrients and the content of immunological active compounds may change in each stage of lactation. During the early stages of lactation, biological and immunological active compounds provide additional support to the development of the neonatal immune system. After these stages, the composition of breast milk continues to provide appropriate energy and nutrients according to the infant needs, in order to protect neonatal immune system and maintain the development and growth of infants. Immunological maturation during the fetal life and the first months of life is provided by immunoglobulins in breast milk, which are among the most important immune protective factors and transferred to infants through breastfeeding. Due to their biological characteristics, Secretory Immunoglobulin A (SIgA) antibodies are the most important antibodies in breast milk, which provide the first defense against the antigens in the intestines of infants. In addition to antibodies, enzymes, including active leukocytes, cytokines, oligosaccharides, lactoferrin, lysozyme and lactoperoxidase, as well as biological and immunological factors, such as hormones, growth factors, bioactive peptides, nucleotides and fatty acids are transferred to infants through breastfeeding. There is now a growing body of evidence suggesting that breastfeeding protects infants against many infections such as gastrointestinal system and respiratory tract infections, strengthens immune system and provides protective effects against allergic and autoimmune diseases in later life.

Breast Milk Lead and Cadmium Levels in Suburban Areas of Nanjing,China

Objective To evaluate levels of lead(Pb) and cadmium(Cd) in the breast milk in the second postpartum month,to investigate the relationship between Pb/Cd levels in breast milk and some sociodemographic parameters,and to explore whether these levels affect the infants' physical status or the mothers' psychological status(postpartum depression).Methods A cross-sectional study was conducted between November 2009 and December 2010.Altogether 170 healthy mothers were enrolled from Nanjing Maternity and Child Health Care Hospital.The inclusion criteria were:voluntary to participate in this study,healthy,with no chronic disease,breastfeeding in the second postpartum month,living in a suburban but not non-industrial area of Nanjing,and not occupationally exposed to toxic metals.All the mothers completed a questionnaire and were evaluated based on the Edinburgh Postpartum Depression Scale(EPDS) to identify the risk of postpartum depression.Pb and Cd levels in breast milk were determined by inductively coupled plasma mass spectroscopy.The infants of these mothers were examined for their z scores of weight for age,length for age,head circumference for age,and body mass index for age.Results The median breast milk levels of Pb and Cd were 40.6 μg/L and 0.67 μg/L,respectively.In 164(96.5%) of the 170 samples,Pb levels were higher than the limit reported by the World Health Organization(> 5 μg/L).Breast milk Cd level was > 1 μg/L in 54(31.8%) mothers.The mothers with a history of anemia had a higher breast milk Pb level than those without a history of anemia(41.1 μg/L vs.37.9 μg/L,P = 0.050).The median breast milk Cd level in those who were active and passive smokers during pregnancy was significantly higher than that in non-smokers(0.88 μg/L vs.0.00 μg/L,P = 0.025).The breast milk Cd level in the mothers not taking iron and vitamin supplements for 2 months postpartum was higher than in those taking the supplements(iron supplement:0.74 μg/L vs.0.00 μg/L,P = 0.025;vitamin supplement:0.78 μg/L vs.0.00 μg/L,P = 0.005).Breast milk Cd level at the second postpartum month was negatively correlated with the z scores of head circumference(r = 0.248,P = 0.042) and weight for age at birth(r = 0.241,P = 0.024) in girls.No correlation was found between the breast milk Pb/Cd levels and the EPDS scores.Conclusion Considering the high levels of Pb and Cd in breast milk in this study,breast milk monitoring programs are necessary.

Genetic Variants in the ELOVL5 but not ELOVL2 Gene Associated with Polyunsaturated Fatty Acids in Han Chinese Breast Milk

The present study was designed to examine the contributions of the fatty acid elongase （ELOVL） gene polymorphisms to the levels of polyunsaturated fatty acids （PUFAs） in breast milk. Two hundred and nine healthy Han Chinese mothers were included in the study. Carriers of minor alleles of SNPs （rs2397142 and rs9357760） in ELOVL5 were associated with higher levels of linoleic acid （LA）, dihomo-γ-linolenic acid （DGLA）, arachidonic acid （AA）, docosatetraenoic acid （DTA）, docosahexenoic acid （DHA）, while in rs209512 of ELOVL5 the carriers of minor alleles had lower levels of DTA compared to major homozygote alleles （P ranged from 0.004-0.046）, and genetically explained variability ranged from 3.2% for eicosapentaenoic acid （EPA） to 6.0% for LA. Our findings demonstrated that common variation in ELOVL5 gene encoding rate-limiting enzymes in the metabolism of PUFAs contribute to the PUFAs in breast milk.

Determination of the Fatty Acid Profile of Breast Milk from Nursing Mothers in Bungoma County, Kenya

The fatty acid profile in breast milk of nursing mothers who participated in a Cohort for Vitamin A (COVA) study at the fourth and ninth month of lactation was investigated. Breast milk samples were collected by manual expression and stored at - 20°C until analysis. The fat was extracted from the milk and methylated using the American Oil Chemists’ Society (AOCS) Official Methods with modifications. The separation, identification and quantification of the fatty acid methyl esters was performed by gas chromatography coupled with mass spectrometry (GC-MS). Fat contents of human milk increased significantly between the fourth and ninth month of lactation 0.38 and 1.21 mg·mL-1 respectively;P 0.05) than the average percent of the total unsaturated FAs (48.93%). Similarly, at the 9th month the percentage average of the total saturated fatty acids (15.18%) was significantly lower (P < 0.05) than the average percent of the total unsaturated FAs (31.05%). The results obtained in this study demonstrated that the fat content in breast milk significantly increased in the 9th compared to the 4th month of lactation. The fatty profile was also significantly different with the omega 6 being the dominant at the 9th month compared with the omega - 9 being dominant at the 4th month of lactation.

Identification and characterization of resistance and pathogenicity of Enterococcus spp.in samples of donor breast milk

BACKGROUND Breast milk is the primary source of nutrition for newborns.Hospitalized babies frequently need nutritional support from Human Milk Banks.As bacterial species of the genus Enterococcus are part of the microbiota of healthy donors,they may contaminate samples of pumped breast milk.AIM To identify and characterize the bacterial virulence and resistance in samples isolated from the nipple-areolar region,hands,and breast milk aliquots from donors at the Human Milk Bank of Municipal Hospital EsauMatos in the city of Vitória da Conquista,Bahia State,Brazil.METHODS The personal hygiene and sanitation of donors were analyzed with the aim of identifying possible reasons for contamination of pumped milk.Cutaneous samples as well as aliquots of unpasteurized and pasteurized milk from 30 participants were obtained.Each Enterococcus spp.isolate underwent a disk diffusion susceptibility test and molecular biology techniques to determine resistance and virulence genes.RESULTS Enterococcus spp.were identified in 30%of donors(n=9),and 11 specimens were isolated.Resistance to tetracycline was highly prevalent,being detectable in 63%of the isolates(n=7)and followed by intermediate sensitivity to ciprofloxacin,observed in 27%of the specimens(n=3).The efaA gene was found in 63%(n=7)of the isolates,while the ace gene was detected in 27%(n=3).CONCLUSION This study illustrates the importance of microbiological monitoring by Human Milk Banks and the need for alternatives to prevent the presence of Enterococcus spp.in hospital settings.

Comparison Effectiveness Breast Milk and Dry Sterile Gauze to Treatment Umbilical Cord

Infection of the umbilical cord has been the cause of illness and death constantly in different countries. Each year 500,000 infants die from neonatal tetanus and 460,000 infants die from bacterial infections. One way that is currently being developed is the use breast milk. Various kinds of content of nutrients and substances that exist in breast milk may reduce the risk of incidence of the infection so that the baby can avoid the incidence of umbilical cord infection. This type of research is quasy experiments with static group comparison. The research data are obtained by researchers using observation sheet, then the data are tabulated. Results of the observation of the time required in the treatment of breast milk and umbilical cord using dry Sterile gauze then compare and conclusions draw an average release time of each media. From the results, the average time of the release of the umbilical cord using breast milk is for 127.41 hours and the average time of the release of the umbilical cord using dry Sterile gauze is for 157.38 hours. From the results of correlation Mann Whitney test with significance level α = 0.05 is obtained significance value (p) of 0.00. It takes a more active research and in a greater scope to conduct more studies in the use of breast milk to use for umbilicard cord of the baby. That requires the active participation of various stakeholders to provide support in implementing it.

Maternal Body Composition and Its Relationship to Infant Breast Milk Intake in Rural Pakistan

Some women in rural Pakistan are chronically undernourished, and consequently underweight. Concerns have been expressed that the degree of undernourishment might be sufficiently severe to affect lactation performance. We have obtained data on maternal body composition and infant breast milk intake using stable isotope methods in a group of thirty three mother and infant pairs at approximately six months of age. The maternal body mass index ranged from 16.6 to 29.1 kg·m-2. In this population we found that exclusive breast-feeding tended to be associated with lower maternal body fat, and that there was no evidence for compromised lactational performance due to malnourishment. Finally we note that when our data is combined with that from other studies there may be a generalised negative correlation between breast milk intake and maternal body fat.

Microbiological safety of expressed breast milk for preterm admitted to neonatal unit in China

Objective To determine the degrees and types of bacterial contamination in home-expressed mother's milk for preterm admitted to neonatal unit in China. Methods The present paper was a descriptive study enrolled a total of 75 human breast milk samples from February 2nd to March 1st 2015. The primary outcome was microbiological features of breast milk samples collected at home. A sample of more than 104 colony-forming units/mL is considered as the significantly bacterial contaminated breast milk. Results Among the milk samples obtained from the mothers of 75 neonatal babies,69. 3% had substantial bacterial growth. This high contamination rate could be due to the Chinese tradition of avoiding bathing for one month after childbirth.Conclusion Un-processed breast milk expressed by mothers in home was not safe for high risk preterm babies. Health care needs to pay attention to the risk of that in China. Good hygienic practice and strict process control for breast expression,including collection,transportation and storage should be developed for Chinese mothers of hospitalized preterm infants.

Mineral compositions in breast milk of healthy Chinese lactating women in urban areas and its associated factors

Background Optimal mineral intakes are important for infant growth and development. However, data on mineral compositions of breast milk in Chinese women are scarce, and most were acquired before 1990. The objectives of this study were three-fold： （1） to investigate the mineral compositions of Chinese healthy mothers＇ breast milk in different lactation stages; （2） to explore correlations among mineral concentrations in breast milk; and （3） to explore the associated factors affecting mineral compositions in breast milk. Methods The inductively coupled plasma mass spectrometry （ICP-MS） was used to analyze mineral concentrations in breast-milk of 444 healthy lactating women from three cities in China. A questionnaire was used to survey socio- demographic characteristics and pregnancy history. Food intakes by lactating women were measured using both food frequency questionnaire and one cycle of 24-hour dietary recall. Results Mineral compositions of breast milk varied in different regions. Concentrations of most minerals were higher in the first one or two months of lactation, and then decreased with time, except for magnesium and iron. Inter-mineral correlations existed among several minerals. The calcium-to-phosphorus ratio was above 2：1 in each lactation stage. Women with caesarean section had higher concentration of iodine in the transitional milk （349.9 pg/kg） compared to women with natural delivery （237.5 pg/kg, P〈0.001）. Dietary mineral intakes, supplements, food intake frequencies in the recent 6 months, maternal age and maternal BMI did not show significant correlations with concentrations of milk minerals （all P 〉0.05）. Conclusions Milk minerals decreased with time, and changed most rapidly in the first one or two months of lactation. Caesarean section might affect the iodine level in transitional milk. Chin Med J 2014;127 （14）： 2643-2648

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants.It may protect infants against many metabolic diseases,predominantly obesity and type 2 diabetes.Diabetes mellitus(DM)is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood.Breastfeeding protects against infant mortality and diseases,such as necrotizing enterocolitis,diarrhoea,respiratory infections,viral and bacterial infection,eczema,allergic rhinitis,asthma,food allergies,malocclusion,dental caries,Crohn's disease,and ulcerative colitis.It also protects against obesity and insulin resistance and increases intelligence and mental development.Gestational diabetes has short and long-term impacts on infants of diabetic mothers(IDM).Breast milk composition changes in mothers with gestational diabetes.AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15,2022,in this review.RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms.Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM.Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term,the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.CONCLUSION We need more comprehensive research to prove these effects.Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding,every effort should be made to encourage them to breastfeed.

Operating procedures of traditional Chinese medicine breast massage

Traditional Chinese medicine breast massage,also known as breast Tuina or manual expression of breast milk,is a technique of using certain manipulations to act on specific positions or acupoints of the breast to promote blood and lymphatic circulation of breast and facilitate the discharge of stagnant milk.This technique is widely used in China to treat breastfeeding problems such as breast engorgement,mastitis,and postpartum hypogalactia.In this article,we introduce the definition and standardization process of breast massage,elaborate the operating procedures of breast massage in detail,and summarize and discuss the current situation of its clinical application,so as to provide a reference for its wide application and in‑depth research.

Outsourcing Breast Milk

我们对于母乳喂养对小宝宝带来的好处耳熟能详。可是由于心理压力或身体疾病而产奶不理想等原因,不少母亲担心自己的宝宝不能随时品尝到营养口味俱佳的母乳,于是替代式喂养方式卷土重来,是天使,还是恶魔?尽管多方争执不断,但美国的一些公司已经开始尝试向市场投放母乳产品,并且前景看好。相信在不久的将来,任何人只要跑到便利店就可以购买到经过消毒的母乳产品。

Glucose and Insulin Levels are Increased in Obese and Overweight Mothers’ Breast-Milk

Objective: To analyze the relationships between mothers’ pre-pregnancy body mass index (BMI) and levels of glucose and insulin in breast-milk. Methods: Participants were 32 breast-feeding mothers who were assigned to either normal weight (group 1: n = 21, BMI between 18.5 and 24.9 kg/m2) or overweight/obese (group 2: n = 11, BMI ≥ 25 kg/m2) based on their pre-pregnancy BMI. Breast-milk samples were collected at six weeks postpartum. Glucose and insulin concentrations were measured in the breast-milk samples. To control for any extreme dietary influences on breast-milk glucose concentrations, mothers completed 24-hour food recalls. Results: Mean milk-glucose values of groups 1 and 2 were 32.6 ± 21.8 mg/dL and 51.9 ± 20.5 mg/dL respectively. Milk-borne insulin values were 4.5 ± 7.6 μIU/mL and 30.1 ± 56.3 μ IU/mL, respectively. Independent-samples t tests found that glucose levels of group 2 were greater than those of group 1, t(30) = 2.43, p = 0.02;and milk-borne insulin was greater in group 2 than in group 1, t(30) = 2.075, p = 0.05. Mothers’ pre-pregnancy BMI was found correlated with both breast-milk glucose (r = 0.483, p = 0.005) and insulin (r = 0.565, p = 0.001). Conclusion: This study found that in comparison with normal weight mothers, over-weight/ obese mothers have higher concentrations of glucose and insulin in their breast-milk. Further studies are needed to explain the underlying mechanisms, and possible consequences of infant exposure to higher levels of glucose and insulin in breast-milk.

母乳喂养质量改进在NICU极低出生体重儿中的应用

目的 探讨母乳喂养质量改进对新生儿重症监护室(NICU)极低出生体重儿的影响。方法 选取2021年1月1日—2021年12月31日南京市妇幼保健院NICU收治的70例极低出生体重儿(VLBWI)作为研究对象,按组间基线资料均衡可比的原则分为观察组和对照组,每组35例。对照组采取常规母乳喂养管理和宣教方式,观察组在常规母乳喂养管理的基础上通过增设人力资源、完善管理制度、加强医务人员培训、加大产妇及家属的宣教力度及加强院感监测共五个方面进行母乳喂养质量改进,比较两组VLBWI住院期间母乳喂养情况、生长发育情况、静脉营养时长、住院时长及并发症发生情况。结果 两组一般资料比较差异无统计学意义(P>0.05),观察组首次亲母母乳喂养时间、恢复出生体质量时间较对照组提前,住院期间纯母乳喂养率、体质量增长速率较对照组有所提升,静脉营养持续时间及总住院时长较对照组有所缩短,喂养不耐受、坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)及视网膜病变(ROP)并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论 母乳喂养质量改进措施可提升NICU住院VLBWI纯母乳喂养率,促进其体质量的增长,缩短静脉营养持续时间及总住院时长,减少相关并发症的发生率。

直接稀释-电感耦合等离子体质谱法测定母乳中17种元素的含量

提出了直接稀释-电感耦合等离子体质谱法(ICP-MS)同时测定母乳中钒、铬、锰、钴、镍、铜、锌、砷、硒、锶、钡、钼、镉、锡、锑、汞、铅等17种元素含量的方法。取母乳0.5 mL,用含2%(体积分数)硝酸和0.01%(体积分数)四甲基氢氧化铵的0.01%(体积分数)曲拉通X-100溶液定容至10 mL,涡旋混匀,以转速4000 r·min^(-1)离心5 min,将上清液用0.45μm水相滤膜过滤,在动能歧视(KED)模式下采用ICP-MS测定滤液中上述17种元素的含量,在线加入含6μg·L^(-1)钪、锗、铑、铋的混合内标使用液。结果表明:各元素的质量浓度在一定范围内与所对应的信号强度与内标元素信号强度比呈线性关系,检出限(3s)为0.019~0.768μg·L^(-1);方法用于分析美国国家标准参考材料,除锌元素外,其他元素的测定值均在认定值的不确定度范围内,并且日内和日间的变异系数均小于13%;按照标准加入法进行回收试验,回收率为81.3%~119%。

分离自母婴粪便及母乳的短双歧杆菌耐药性研究

短双歧杆菌是人体肠道中常见的一种双歧杆菌,因其具有诸多益生特性被广泛关注,但是对其抗生素耐药性方面的研究严重不足。本研究以23株分离自母婴粪便及母乳的短双歧杆菌为研究对象,测定了菌株对14种常见抗生素的耐药性。研究发现,实验菌株对12种抗生素存在不同程度的耐药性,仅对氨苄西林和利奈唑胺敏感。全部实验菌株均对氯霉素、环丙沙星、卡那霉素、四环素、庆大霉素和新霉素具有耐药性。进一步分析发现,分离自L家庭母亲粪便的菌株对利福平、克林霉素和链霉素的耐药率显著高于婴儿粪便和母乳分离株。短双歧杆菌的耐药表型差异较大,即使是分离自同一个家庭和个体的菌株其耐药表型也不相同。研究为短双歧杆菌的安全性评价和应用提供了基础数据。

护士对母乳库运行障碍因素的质性研究

目的 探讨母乳库运行的障碍因素,为促进母乳库建设与发展提供参考。方法 采用描述性质性研究方法,对15名护士进行深入访谈,使用内容分析法分析访谈资料。结果 母乳库运行困境提炼出5个副主题,包括护士对捐赠母乳安全存担忧、产妇拒绝捐赠母乳、产妇亲属支持体系欠缺、母乳库及捐赠母乳宣教不到位、母乳库运行所需资源受限;母乳库运行建议提炼出5个副主题,包括严格把控捐赠母乳质量、加强母乳库及捐赠母乳知识宣教、提高医院对母乳库支持力度、联动社会力量促进母乳库发展、参考血库的运行模式。结论 母乳库运行需克服相关阻碍因素,保障捐赠母乳安全是母乳库运行的核心要点,加强母乳库宣传是母乳库运行的关键环节,依托社会力量是母乳库运行的长远之计。