Transmission of cytomegalovirus via breast milk in low birth weight and premature infants: a systematic review and meta-analysis

Background This study aimed to investigate the transmission of cytomegalovirus (CMV) via breast milk in low birth weight (LBW) and premature infants and its effects. Methods PubMed, Medline, Cochrane Library, and Embase were searched for studies (without language and time restriction) published before March 27, 2020, that examined the effect of CMV transmitted by breast milk on LBW and premature infants. The rates of breast milk-acquired CMV infection, CMV-related symptoms, and CMV-related sepsis-like syndrome (CMV-SLS) in LBW and premature infants were pooled from each study. Results Eighteen studies with 1920 LBW and premature infants were included. The pooled CMV infection rate from breast milk for infants fed untreated breast milk was significantly higher than those fed frozen breast milk [19.3, 95% confidence interval (CI) = 11.8–29.9% vs. 13.5, 95% CI = 8.0–22.0%, P < 0.01). Similarly, the pooled CMV infection rate for infants fed untreated breast milk was significantly higher than those with mixed feeding (P < 0.0001). The mixed feeding group had a significantly lower rate of CMV-related symptoms than the other groups (2.4%, P < 0.01). Conclusions These findings suggested a higher CMV infection rate in LBW or premature infants fed untreated breast milk than other feeding groups. Studies on the long-term outcomes of CMV infection transmitted from breast milk are needed to address the optimal feeding practice.

NUTRITIONAL PROBLEMS AND FACTORS FORMING HEALTH STATUS OF CHILDREN OVER THEIR FIRST YEAR

Purpose: to investigate the impact of the type of feeding on the incidence and physical development of infants. Material and methods. During a year, 250 children of the first year of life under control received different types of feeding (breast milk and milk formulas, differing in composition). Physical development was assessed according to the generally accepted measurement technique in terms of absolute values, monthly increases in anthropometric indicators and mass-growth indices. Outpatient records of children, protocols of examination of a 1-year-old child were studied. The inclusion criteria for the main group of infants were: breastfeeding for at least 9 months; the age of children up to 1 year. The second comparison group included children who received mixed feeding, which includes probiotics. Results. In the girls of the second group, who received mixed feeding with probiotics (7100.0±95.9 g), the weight gain in the first year was significantly higher than the weight gain in the girls who received breast milk and standard formula - 6671 , 0±72.6 g. and 6733.3±91.8 g, respectively. Despite the fact that there were no significant differences in the medians of body weight and height in children of the main group and the comparison groups, it was found that children in the main group were overweight / obese at the age of 2 months had twice as less indicators than children who received mixed feeding. Breastfed children began to sit without support much earlier, on average at 7.6±0.05 months after birth, and children of the other two groups who are bottle-fed, on average, at 8.0±0.13 and 8,1±0.12 months, respectively (p <0.05). When studying the most common diseases of children over their first year of life, depending on the type of feeding, the following results were found out: acute intestinal infections made up the largest share in both groups, 7.7±2.34% of children in the I group, and 11.7±2.93% of children in the II group (p = 0.3905). Conclusion. The study has demonstrated that breastfeeding in the first year of life reduces the risk of overweight and ensures harmonious physical development, neuropsychic development, cuts down the frequency of infectious diseases, alimentary disorders, functional digestive disorders, and contributes to the normalization of intestinal microflora. It is also important to introduce optimal combinations of feeding methods for young children and adding probiotics.

Association Between Mental Health and Feeding Methods among 1- Month Postpartum Women in Japan: A Cross-Sectional Study

Background: The rate of predominant breastfeeding was 51.3% at 1 month postpartum, even though 93.4% of Japanese mothers expressed a desire to predominantly breastfeed during pregnancy. A wide range of historical, socioeconomic, cultural, and individual factors, as well as mental health, affect breastfeeding practices. However, the relationship between breastfeeding and mental health—depressive symptoms—has been controversial. Purpose: The aim of this study was to identify factors relationship including mental health and the feeding methods adopted by mothers at 1 month postpartum in Japan. Methods: A cross-sectional study was conducted at 2 Tokyo area hospitals between July and October 2014. We recruited a total of 560 eligible women. The participants included 392 women without severe illnesses or low birth weight babies at 1 month postpartum. The feeding methods were “mainly breastfeeding” (exclusively or mostly breastfeeding) and “mixed feeding and formula only”. Depressive symptoms as a mental health were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Multiple logistic regression analysis clarified the factors associated with mainly breastfeeding. Results: The mean (SD) age for the categories of mainly breastfeeding and mixed feeding and formula only was 33.0 (5.1) and 33.9 (5.5) years, respectively (p = 0.085). Women who were mainly breastfeeding at 1 month postpartum were more likely to be multiparous (adjusted odds ratio [AOR]: 1.80, CI:1.11 - 2.94), had EPDS score < 9 (AOR:1.87, CI:1.09 – 3.20), and had been desirous of breastfeeding from their pregnancy (AOR: 7.73, CI: 4.68 – 12.74). Conclusion: Our results suggested that healthcare providers should focus on the relationship between feeding methods and new mothers’ mental health. Further research must identify effective care strategies for women who desire to breastfeed exclusively.

Mixed Infant Feeding Is Not Associated With Increased Risk of Decelerated Growth Among WIC-Participating Children in Southern California

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition assistance to half of infants born in the United States. The nationally representative WIC Infants and Toddler Feeding Practices Study-2 (ITFPS-2) reported a caloric deficit at 7 months among infants receiving WIC mixed feeding packages, suggesting these infants may be at risk for growth deceleration/faltering.Methods: Longitudinal administrative data collected prospectively from WIC participants in Southern California between 2010 and 2019 were used (n = 16,255). Infant lengths and weights were used to calculate weight-for-length (WLZ), weight-for-age (WAZ) and length-for-age (LAZ) z-scores at different time points. Growth deceleration/faltering was determined at 9, 12, 18, and 24 months by the change in z-score from the last measurement taken ≤ 6 months of age. Infant feeding was categorized by the food package (breastfeeding, mixed feeding, and formula feeding) infants received from WIC at 7 months. Poisson regression models were used to evaluate the association between WIC infant package at 7 months and deceleration/faltering at 9, 12, 18, and 24 months.Results: The proportion of infants displaying decelerated/faltering growth was low for all infant food package groups. Receiving the WIC mixed feeding package at 7 months of age was not associated with WLZ, WAZ, and LAZ deceleration/faltering growth.Conclusions: Growth deceleration/faltering rates were very low among WIC participating children in Southern California, highlighting the critical role of nutrition assistance in supporting adequate growth in early childhood.

Feeding in the first six months of life is associated with the probability of having bronchiolitis: a cohort study in Spain

Background Breastfeeding is associated with lower incidence and severity of lower respiratory tract disease. However, little is known about the relationship between feeding type and breastfeeding duration with bronchiolitis in a child’s first year. Methods A prospective cohort study of 969 newborn babies were followed-up for 12 months to determine breastfeeding duration, feeding type, feeding trajectory, and bronchiolitis episodes at Marqués de Valdecilla University Hospital, Spain in 2018. Type of feeding was recorded by interviewing mothers at the time of hospital discharge and at 2, 4, 6, 9 and 12 months of life, in three categories: breastfeeding, mixed feeding and infant formula. Type of feeding at hospital discharge refers to feeding from birth to discharge. In any other times studied, it refers to feeding in the last 24 h. The association between the feeding type and bronchiolitis was analysed using logistic regression. Poisson regression was used to evaluate the association between feeding type and the number of bronchiolitis episodes with Kaplan-Meier estimators presenting the cumulative probability of suffering bronchiolitis. The results were adjusted for mother and child characteristics. Results Our data shows exclusive breastfeeding and mixed breastfeeding reduce the number of episodes of bronchiolitis. Regarding feeding at 4 months, exclusive breastfeeding reduced by 41% the number of episodes of bronchiolitis (adjusted incidence Ratio (aIR) 0.59, 95% CI 0.46, 0.76) and mixed feeding by 37% (aIR 0.63, 95% CI 0.47, 0.86). Moreover, changing from exclusive breastfeeding to mixed feeding increased the incidence of bronchiolitis compared with continuing exclusive breastfeeding. An early swap to mixed breastfeeding before months 2 or 4, was associated with a reduced the number of episodes of bronchiolitis, (aIR 0.53, 95% CI 0.39, 0.73 if introduction of mixed breastfeeding before month 2, and aIR 0.61, 95% CI 0.45, 0.83 if introduction of mixed breastfeeding before month 4), when compared with infant formula alone. Conclusions Any breastfeeding was associated with lower incidence of bronchiolitis and number of episodes of bronchiolitis in the first year of life. Consequently, promoting programmes facilitating exclusive or mixed breastfeeding would be a relevant measure in the prevention of bronchiolitis.

Difficulties in breastfeeding: ways to solve the problem

Introduction. Practical assistance of medical personnel to nursing women with difficulties in breastfeeding, joint search for solutions to the problem of hypogalactia contributes to the preservation of breastfeeding throughout the first year of a baby’s life.Purpose of the study. The frequency and nature of lactation disorders in women in the first weeks and months of breastfeeding were studied.Materials and methods. The attitude of women to various, including non-drug, methods of maintaining lactation was analyzed. The study was conducted following a survey of 58 women – patients of the perinatal center in the early postpartum period, 28 women whose children received breastfeeding/mixed feeding in the 1st year of life and 16 female employees of neonatological departments, whose children were also breastfed/mixed feeding in the 1st year of life. With women in groups 1 and 2 in the obstetric facility, there were talks about the benefits of breastfeeding and instructions on how to properly latch on the newborn to the breast. The respondents participated in the study only voluntarily.Results and discussion. Revealed approximately the same nature of lactation disorders in all groups. The predominance of women with hypogalactia after preterm birth was noted; breastfeeding up to one and a half to two years was observed in 4% of young women without chronic somatic pathology after the first spontaneous birth. Respondents of groups 1 and 3 showed high awareness and greater adherence to non-drug correction of hypogalactia in the form of the use of herbal tea. At the same time, some of the respondents in group 2 showed low motivation to maintain breastfeeding and were skeptical about any way to maintain lactation. Among the surveyed respondents, 47% (48 women out of 102) used herbal tea for a long time (3–6 weeks or more). All of them characterized as an effective lactogonic agent, and also noted a calmer behavior of the child, a decrease in intestinal colic and an improvement in the quality of night sleep.Conclusions. A data analysis of the survey of nursing mothers and women who had a breastfeeding experience showed that there is approximately the same pattern of lactation disorders regardless of the woman’s age, high or low awareness of breastfeeding issues.

Factors associated with non-compliance with breastfeeding recommendation: a retrospective survey in hepatitis B virus-infected mothers who had taken Nucleos(t)ide analogs during pregnancy

Background We encourage Hepatitis B virus-infected mothers to breastfeed postpartum, even when continuing pregnancy category B nucleos(t)ide analogs (NAs) treatment. However, a large proportion of the Hepatitis B virus-infected mothers were noncompliant with this breastfeeding recommendation. This study aimed to investigate the factors associated with noncompliance with breastfeeding recommendation in Hepatitis B virus-infected mothers who had received NAs treatment during pregnancy. Methods A total of 155 mothers with chronic hepatitis B receiving NAs treatment for preventing mother-to-child transmission during the late gestation period were included and divided into exclusive breastfeeding (n = 63), mixed feeding (n = 34), and artificial feeding (n = 58) groups according to the postpartum feeding methods. Independent variables associated with feeding methods were analyzed using logistic regression analysis. Results Compared to the breastfeeding and mixed feeding groups, the artificial feeding group had significantly more multiparity, later postpartum timing of stopping NAs treatment, and a lower proportion of having knowledge of NAs medications (all P < 0.05). In addition, multivariable logistic regression analysis confirmed that multiparity, later postpartum timing of stopping NAs treatment, and lacking knowledge of medication were independent factors associated with noncompliance with breastfeeding recommendation. Conclusions Hepatitis B virus-infected mothers who stopped NAs treatment at late postpartum period or had less knowledge of medication were more likely to be noncompliant with breastfeeding recommendation. Strengthening health education for participants taking NAs may be an important method to improve compliance with breastfeeding recommendation.

Effects of Exclusive Breast Feeding for First Six Months of life on Children Weight, Height and Head Circumference in Sulaimani City, Kurdistan-Iraq and Compare with Other Types of Feeding

Breastfeeding (BF) serves as a complete nutritional source for the first six months of infant’s life. Breast milk contains all essential nutrients that necessary for the physiological growth and development of infants. The aim of this study was to compare the physiological growth of infants including weight, height and head circumference who were exclusively breastfed for 6 months and those who were given bottle-fed or mixed fed and to find a percentage of exclusive breastfeeding among mothers who contributed in this study in Sulaimani city. This study was carried out in Sulaimani city/ Kurdistan region of Iraq and the cases were enrolled between the first of October 2018 and first of October 2019. The infants’ weight, height and head circumstances were measured at different age levels (At age two, six, nine and fifteen months). The results of this study found that Among 198 mothers who were contributed in this study; 92 (46.5%) of mothers had EBF while 90 (45.5%) had mixed feeding and only 16 (8%) had exclusive formula feeding (EFF) in the first six months of baby’s life. Infant’s weight at age 2 months were no differences between types of feeding. However, at ages 6 and 9 were significantly high in infants who breastfed compared to formula fed but no differences were found between EBF and mixed feeding. At age 15 months weights of infants were again no differences were found between all types of feeding. For height parameter, infants who exclusively breastfed for six months were significantly higher than those of formula fed at age 2, 6, 9 and 15 months. Regarding head circumferences no significant differences between types of feeding at age 2 months were showed. Nevertheless, at age 6 and 15 months were significantly high in infants who breastfed than formula fed. The present study conclude that infants who breast fed for first six months of life have a higher weight, height and head circumferences than infants who exclusively formula fed. The percentage of EBF among Kurdish mothers were similar with other countries of Iraq but was low compared to the recommended rate of WHO.

Prevention of Mother-to-Child HIV Transmission in Nigeria: Six Years Experience from a Tertiary Institution

Background: In line with global standards and progress made in Prevention of Mother-to-Child Transmission (PMTCT), an assessment of the outcome of Early Infant Diagnosis in northern Nigeria is necessary to evaluate progress towards a zero Human immunodeficiency Virus (HIV) infection rate among children. Objectives: This study assessed the infection rate and risk factors for mother-to-child HIV transmission among HIV-exposed children in Kano, northwest Nigeria. Method: Using a retrospective cohort design, pregnant HIV-positive women and their exposed infants were recruited over a period of six years (2010 to 2016). Participants were enrolled during pregnancy or at delivery from the PMTCT clinic of a tertiary health facility in Kano, Nigeria. The main observations of the study were Early infant diagnosis positivity for HIV at 6 weeks and the risk factors for positivity. Results: Of the 1,514 infants studied, Early Infant Diagnosis was positive for HIV among 13 infants (0.86%). Infants whose mothers did not have antiretroviral therapy (adjusted Prevalence Ratio aPR = 2.58, 95%CI [1.85- 3.57]); who had mixed feeding (aPR = 12.06, 95%CI [9.86- 14.70]) and those not on antiretroviral prophylaxis (aPR = 20.39, 95%CI [16.04- 25.71]) were more likely to be infected with HIV. HIV-exposed infants on nevirapine and zidovudine prophylaxis accounted for 95% and 74%, respectively, and were less likely to be infected with HIV. Conclusion: HIV infection rate remains high among HIV-exposed infants whose mothers did not receive PMTCT services. Scaling up proven interventions of early commencement of antiretroviral treatment for mothers, adherence to antiretroviral prophylaxis and avoidance of mixed feeding among HIV-exposed infants would protect future generations from HIV infection.