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American Family Physician Sep 2018All major health organizations recommend breastfeeding as the optimal source of infant nutrition, with exclusive breastfeeding recommended for the first six months of...
All major health organizations recommend breastfeeding as the optimal source of infant nutrition, with exclusive breastfeeding recommended for the first six months of life. After six months, complementary foods may be introduced. Most organizations recommend breastfeeding for at least one year, and the World Health Organization recommends a minimum of two years. Maternal benefits of breastfeeding include decreased risk of breast cancer, ovarian cancer, postpartum depression, hypertension, cardiovascular disease, and type 2 diabetes mellitus. Infants who are breastfed have a decreased risk of atopic dermatitis and gastroenteritis, and have a higher IQ later in life. Additional benefits in infants have been noted in observational studies. Clinicians can support postdischarge breastfeeding by assessing milk production and milk transfer; evaluating an infant's latch to the breast; identifying maternal and infant anatomic variations that can lead to pain and poor infant weight gain; knowing the indications for frenotomy; and treating common breastfeeding-related infections, dermatologic conditions, engorgement, and vasospasm. The best way to assess milk supply is by monitoring infant weight and stool output during wellness visits. Proper positioning improves latch and reduces nipple pain. Frenotomy is controversial but may reduce pain in the short term. The U.S. Preventive Services Task Force recommends primary care interventions to support breastfeeding and improve breastfeeding rates and duration.
Topics: Adolescent; Adult; Breast Feeding; Child Development; Female; Humans; Infant; Infant, Newborn; Nipples; Social Support; Time Factors
PubMed: 30215910
DOI: No ID Found -
Anales de Pediatria Jan 2022Perinatal Palliative Care is a model of care designed to prevent and treat the physical, spiritual, emotional, and social needs of fetuses and newborn infants with...
Perinatal Palliative Care is a model of care designed to prevent and treat the physical, spiritual, emotional, and social needs of fetuses and newborn infants with life-threatening or life-limiting conditions. The care extends to the infant's family. It is delivered by an interdisciplinary team to improve the quality of life from the time of diagnosis (possibly in utero) into death and bereavement (days, months or years later). To guarantee the access of this vulnerable population to high quality palliative care, structured programs and protocols need to be further developed in tertiary hospitals that treat highly complex obstetric and neonatal pathologies. Basic training is required for all the professionals involved.
Topics: Bereavement; Child; Female; Humans; Infant; Infant, Newborn; Palliative Care; Perinatal Care; Pregnancy; Quality of Life
PubMed: 34998731
DOI: 10.1016/j.anpede.2021.10.003 -
Seminars in Fetal & Neonatal Medicine Dec 2018Necrotizing enterocolitis (NEC) is the most common serious gastrointestinal morbidity in preterm infants. A number of risk factors for NEC have been reported in the... (Review)
Review
Necrotizing enterocolitis (NEC) is the most common serious gastrointestinal morbidity in preterm infants. A number of risk factors for NEC have been reported in the literature. With the exception of decreasing gestational age, decreasing birth weight and formula feeding, there is disagreement on the importance of reported risk factors with uncertain causality. Causal risk factors may be observed at any time before the onset of NEC, including prior to an infant's birth. The purpose of this review is to examine the existing literature and summarize risk factors for NEC. This review may be helpful in understanding the epidemiology of NEC and inform the measurement and assessment of risks factors for NEC in research studies and quality improvement projects.
Topics: Enterocolitis, Necrotizing; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Risk Factors
PubMed: 30115546
DOI: 10.1016/j.siny.2018.07.005 -
Nutrients Mar 2020The increase in allergy prevalence observed in recent decades may be a consequence of early intestinal dysbiosis. The intestinal microbiota is formed in the first 1000... (Review)
Review
The increase in allergy prevalence observed in recent decades may be a consequence of early intestinal dysbiosis. The intestinal microbiota is formed in the first 1000 days of life, when it is particularly sensitive to various factors, such as the composition of the mother's microbiota, type of delivery, infant's diet, number of siblings, contact with animals, and antibiotic therapy. Breastfeeding and vaginal birth favorably affect the formation of an infant's intestinal microbiota and protect against allergy development. The intestinal microbiota of these infants is characterized by an early dominance of , which may have a significant impact on the development of immune tolerance. is a species commonly isolated from the intestines of healthy breastfed infants and from human milk. This review outlines the most important environmental factors affecting microbiota formation and the importance of species (with a particular emphasis on ) in microbiota modulation towards anti-allergic processes. In addition, we present the concept, which assumes that infant formulas containing specific probiotic strains and prebiotic oligosaccharides may be useful in allergy management in non-breastfed infants.
Topics: Bifidobacterium breve; Breast Feeding; Dysbiosis; Female; Gastrointestinal Microbiome; Humans; Hypersensitivity; Infant; Infant, Newborn; Male; Oligosaccharides; Prebiotics
PubMed: 32235348
DOI: 10.3390/nu12040946 -
Nature Medicine May 2023Nirsevimab is an extended half-life monoclonal antibody specific for the prefusion conformation of the respiratory syncytial virus (RSV) F protein, which has been...
Nirsevimab is an extended half-life monoclonal antibody specific for the prefusion conformation of the respiratory syncytial virus (RSV) F protein, which has been studied in preterm and full-term infants in the phase 2b and phase 3 MELODY trials. We analyzed serum samples collected from 2,143 infants during these studies to characterize baseline levels of RSV-specific immunoglobulin G antibodies and neutralizing antibodies (NAbs), duration of RSV NAb levels following nirsevimab administration, the risk of RSV exposure during the first year of life and the infant's adaptive immune response to RSV following nirsevimab administration. Baseline RSV antibody levels varied widely; consistent with reports that maternal antibodies are transferred late in the third trimester, preterm infants had lower baseline RSV antibody levels than full-term infants. Nirsevimab recipients had RSV NAb levels >140-fold higher than baseline at day 31 and remained >50-fold higher at day 151 and >7-fold higher at day 361. Similar seroresponse rates to the postfusion form of RSV F protein in nirsevimab recipients (68-69%) compared with placebo recipients (63-70%; not statistically significant) suggest that while nirsevimab protects from RSV disease, it still allows an active immune response. In summary, nirsevimab provided sustained, high levels of NAb throughout an infant's first RSV season and prevented RSV disease while allowing the development of an immune response to RSV.
Topics: Humans; Infant; Infant, Newborn; Infant, Premature; Respiratory Syncytial Virus Infections; Antibodies, Viral; Respiratory Syncytial Virus, Human; Antibodies, Neutralizing; Immunity
PubMed: 37095249
DOI: 10.1038/s41591-023-02316-5 -
BMC Psychology Nov 2019Extremely premature infants (those born before 28 weeks' gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For...
BACKGROUND
Extremely premature infants (those born before 28 weeks' gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For parents, their child's grave medical condition and prolonged hospitalization are stressful and psychologically disruptive. This study aimed at exploring the needs of psychosocial support of parents of extremely premature infants, and how the NICU as an organization and its staff meets or fails to meet these needs.
METHOD
Sixteen open-ended interviews were conducted with 27 parents after their infant's discharge from the NICU. Inductive content analysis was performed.
RESULTS
Four themes were identified: Emotional support (with subthemes Empathic treatment by staff, Other parents as a unique source of support, Unclear roles of the various professions); Feeling able to trust the health care provider; Support in balancing time spent with the infant and other responsibilities; Privacy. Parents of extremely premature infants needed various forms of emotional support at the NICU, including support from staff, professional psychological help and/or companionship with other patients' parents. Parents were highly variable in their desire to discuss their emotional state with staff. The respective roles of nursing staff, social workers and psychologists in supporting parents emotionally and identifying particularly vulnerable parents appeared unclear. Parents also needed to be able to maintain a solid sense of trust in the NICU and its staff. Poor communication with and among staff, partly due to staff discontinuity, damaged trust. Parents struggled with perceived pressure from staff to be at the hospital more than they could manage and with the limited privacy of the NICU.
CONCLUSIONS
The complex and individual psychosocial needs of parents of extremely preterm infants present many challenges for the NICU and its staff. Increasing staffing and improving nurses' competence in addressing psychosocial aspects of neonatal care would help both nurses and families. Clarifying the roles of different professions in supporting parents and developing their teamwork would lessen the burden on nurses. Communicating with parents about their needs and informing them early in their NICU stay about available support would be essential in helping them cope with their infant's hospitalization.
Topics: Adult; Female; Humans; Infant; Infant Care; Infant, Extremely Premature; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Kangaroo-Mother Care Method; Male; Parent-Child Relations; Parents; Psychosocial Support Systems; Qualitative Research
PubMed: 31783784
DOI: 10.1186/s40359-019-0354-4 -
Anales de Pediatria (Barcelona, Spain :... Jun 2016Breastmilk is the best food for newborns and infants. The nutritional stores of a lactating woman may be more or less depleted as a result of the pregnancy and the loss...
Breastmilk is the best food for newborns and infants. The nutritional stores of a lactating woman may be more or less depleted as a result of the pregnancy and the loss of blood during childbirth. Lactation raises nutrient needs, mainly because of the loss of nutrients, first through colostrum and then through breastmilk. Breastmilk volume varies widely. The nutrients present in this milk come from the diet of the mother or from her nutrient reserves. The conversion of nutrients in food to nutrients in breastmilk is not complete. To have good nutritional status the breastfeeding woman has to increase nutrient intake. Human breastmilk has a fairly constant composition, and is only selectively affected by the diet of the mother. The fat content of breastmilk varies somewhat. The carbohydrate, protein, fat, calcium and iron contents do not change much, even if the mother is short of these in her diet. A mother whose diet is deficient in thiamine and vitamins A and D, however, produces less of these in her milk. The mother should be given advice on consuming a mixed diet. At each postnatal visit, both the mother and the baby should be examined, and advice on the diets of both mother and infant should be provided. A satisfactory gain in the infant's weight is the best way to judge the adequacy of the diet of the infant. Mothers should not receive less than 1800 calories per day.
Topics: Breast Feeding; Dietary Supplements; Female; Humans; Infant; Infant, Newborn; Lactation; Maternal Nutritional Physiological Phenomena; Nutritional Requirements
PubMed: 26383056
DOI: 10.1016/j.anpedi.2015.07.024 -
Revista Brasileira de Terapia Intensiva 2021To present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit.
OBJECTIVE
To present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit.
METHODS
We employed a mixed methods design with a systematic review of the literature and recommendations based on scientific evidence and the opinions of physiotherapists with neonatal expertise. The research included studies published between 2010 and 2018 in the MEDLINE® and Cochrane databases that included newborns (preterm and term) and infants (between 28 days and 6 months of age) hospitalized in the intensive care unit and submitted to sensory motor stimulation methods. The studies found were classified according to the GRADE score by five physiotherapists in different regions of Brazil and presented at eight Scientific Congresses held to discuss the clinical practice guidelines.
RESULTS
We included 89 articles to construct the clinical practice guidelines. Auditory, gustatory and skin-to-skin stimulation stand out for enhancing vital signs, and tactile-kinesthetic massage and multisensory stimulation stand out for improving weight or sucking.
CONCLUSION
Although all modalities have good ratings for pain or stress control, it is recommended that sensory motor stimulation procedures be tailored to the infant's specific needs and that interventions and be carried out by expert professionals.
Topics: Brazil; Humans; Infant; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Massage; Physical Therapy Modalities
PubMed: 33886850
DOI: 10.5935/0103-507X.20210002 -
Breastfeeding Medicine : the Official... 2018Breastfeeding is an experience that only a mother and her infant(s) can share. Infants who can feed from the breast receive not only the best nutrition but also, due to... (Review)
Review
Breastfeeding is an experience that only a mother and her infant(s) can share. Infants who can feed from the breast receive not only the best nutrition but also, due to the close physical contact between mother and child, it is the optimal nurturance they can receive from their mother. When breastfeeding is trouble free, maternal well-being is uniquely heightened. However, breastfeeding remains a challenge for many mother-infant dyads and more so for those whose infants are born prematurely. This article introduces a conceptual model of the breastfeeding challenges facing preterm mother-infant dyads. It distinguishes between a maternal caregiving and an infant growth/development components. Within the maternal component, two primary elements are considered, that is, maternal behavioral and nutritional care. The two primary elements within the infant component include infant non-nutritional and nutritional growth/development. It is proposed that an improved understanding of the factors associated with these four elements and how they interplay with each other within individual dyads will facilitate the identification of the breastfeeding challenges facing these mother-infant entities. Due to the intimate relationships existing between a mother and her infant(s), it is further advanced that breastfeeding studies would be optimized if mother-infant pairs are studied as one entity rather than mother and infant separately. It is proposed that this conceptual model will assist health professionals develop personalized breastfeeding management plans for individual preterm mother-infant dyads, while furthering the development of evidence-based interventions to optimize their breastfeeding experiences.
Topics: Animals; Breast Feeding; Child Development; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Lactation; Maternal Behavior; Mother-Child Relations; Mothers; Nutritional Status; Stress, Psychological
PubMed: 29048210
DOI: 10.1089/bfm.2016.0206 -
BMC Pediatrics Mar 2019Premature infants are at risk for abnormal sensory development due to brain immaturity at birth and atypical early sensory experiences in the Neonatal Intensive Care...
BACKGROUND
Premature infants are at risk for abnormal sensory development due to brain immaturity at birth and atypical early sensory experiences in the Neonatal Intensive Care Unit. This altered sensory development can have downstream effects on other more complex developmental processes. There are currently no interventions that address rehabilitation of sensory function in the neonatal period.
METHODS
This study is a randomized controlled trial of preterm infants enrolled at 32-36 weeks postmenstrual age to either standard care or standard care plus multisensory intervention in order to study the effect of multisensory intervention as compared to standard care alone. The study population will consist of 100 preterm infants in each group (total n = 200). Both groups will receive standard care, consisting of non-contingent recorded parent's voice and skin-to-skin by parent. The multisensory group will also receive contemporaneous holding and light pressure containment for tactile stimulation, playing of the mother's voice contingent on the infant's pacifier sucking for auditory stimulation, exposure to a parent-scented cloth for olfactory stimulation, and exposure to carefully regulated therapist breathing that is mindful and responsive to the child's condition for vestibular stimulation. The primary outcome is a brain-based measure of multisensory processing, measured using time locked-EEG. Secondary outcomes include sensory adaptation, tactile processing, speech sound differentiation, motor and language function, measured at one and two years corrected gestational age.
DISCUSSION
This is the first randomized controlled trial of a multisensory intervention using brain-based measurements in order to explain the causal effects of the multisensory intervention on neural processing changes to mediate neurodevelopmental outcomes in former preterm infants. In addition to contributing a critical link in our understanding of these processes, the protocolized multisensory intervention in this study is therapist administered, parent supported and leverages simple technology. Thus, this multisensory intervention has the potential to be widely implemented in various NICU settings, with the opportunity to potentially improve neurodevelopment of premature infants.
TRIAL REGISTRATION
NIH Clinical Trials ( clinicaltrials.gov ): NCT03232931 . Registered July 2017.
Topics: Female; Humans; Infant, Newborn; Male; Electroencephalography; Infant, Premature; Intensive Care Units, Neonatal; Language Development; Motor Skills; Nervous System Physiological Phenomena; Neurodevelopmental Disorders; Parents; Randomized Controlled Trials as Topic
PubMed: 30890132
DOI: 10.1186/s12887-019-1455-1