Is it safe to express milk before giving birth?

Some women, especially with diabetes, are recommended to express milk while still pregnant and to save it for their newborn, yet no evidence exists for this practice.

A study published in today’s Lancet aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy.

pregnancy-466129_1920 The study found that expressing while pregnant is safe for women with diabetes in low-risk pregnancies in late pregnancy (from around 36 weeks). After studying over 600 women, the authors found no increase in early births or admissions to neonatal intensive care. However, one in four women couldn’t collect any colostrum.

Before the trial, researchers had only run three small studies of expressing colostrum while pregnant, and no randomised trials for women without diabetes.

The authors advice to women with questions about expressing while pregnant is to ask their health care professional about their individual situation.

Read more at The Conversation

Full reference: Forster, Della A et al. | Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial | The Lancet , Volume 389 , Issue 10085 , 2204 – 2213

Skin-to-skin contact improves breastfeeding of healthy babies

Early skin-to-skin contact improves breastfeeding of healthy full-term babies. | National Institute for Health Research

Skin-to-skin contact is the direct contact between a naked baby and the mother’s bare chest. It can occur before or after the baby is cleaned following birth.

This review found that about a quarter more women who have this contact with their babies are still breastfeeding at one to four months after birth compared with those who don’t. The evidence that skin-to-skin contact may also help to stabilise the baby’s heart and breathing rates and blood sugar levels after birth was based on fewer trials and less strong.

These findings support UK good practice to promote immediate skin-to-skin contact after birth to improve breastfeeding rates. It remains one of the important steps recommended by NICE and UNICEF aimed at improving the low rates of breastfeeding in the UK. Other measures include providing a favourable environment, support and education.

Full reference: Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11:CD003519.

Early Solid Food Introduction: Role in Food Allergy Prevention and Implications for Breastfeeding

Abrams, E.M. et al. The Journal of Pediatrics | Published online: 3 March 2017

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Food allergy is estimated to affect 2%-10% of the population worldwide.1 The US Centers for Disease Control and Prevention reported an increase in food allergy prevalence in the US from 3.4% to 5.1% between 1997 and 2011.2 As a result, the focus in food allergy research has shifted from treatment to prevention

Read the abstract here

Risk Factors for Poor Feeding in Infants with Congenital Heart Disease, and a Novel Improvement Approach

Indramohan, G. et al. Journal of Pediatric Nursing. Published online: 4 February 2017

Highlights: 

  • Infants with complex congenital heart disease are at risk for poor oral feeding.
  • Specific factors associated with poor oral feeding are identified.
  • Oral motor intervention may decrease hospital length of stay.
  • Oral motor intervention may decrease feeding tube requirements.
  • Screening bedside laryngoscopy may identify vocal cord dysfunction.

Read the full abstract here

The Speed of Increasing milk Feeds: RCT Protocol

Abbott, J. et al. BMC Pediatrics. Published: 28 January 2017

Background: In the UK, 1–2% of infants are born very preterm (<32 weeks of gestation) or have very low birth weight (<1500 g). Very preterm infants are initially unable to be fed nutritional volumes of milk and therefore require intravenous nutrition. Milk feeding strategies influence several long and short term health outcomes including growth, survival, infection (associated with intravenous nutrition) and necrotising enterocolitis (NEC); with both infection and NEC being key predictive factors of long term disability.

Currently there is no consistent strategy for feeding preterm infants across the UK. The SIFT trial will test two speeds of increasing milk feeds with the primary aim of determining effects on survival without moderate or severe neurodevelopmental disability at 24 months of age, corrected for prematurity. The trial will also examine many secondary outcomes including infection, NEC, time taken to reach full feeds and growth.

Read the full protocol here

Infant formula feeding practices in a prospective population based study

Smith, H.A. et al. BMC Pediatrics. Published online: 8 December 2016

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Background: It is recommended that formula-fed infants are given standard whey-based infant formula throughout the first year of life, unless otherwise advised by healthcare professionals. To our knowledge it has not yet been explored if parents are using a whey-based infant formula throughout the first 12 months of life. Reasons for parental choice of formula are also unknown. Therefore, the objective of this paper was to describe parental administration of whey-based and non whey-based infant formula in the first year of life.

 

Conclusion: The majority of parent(s) commence their infants on whey-based formula, but most change to non whey-based formula before 12 months of age. Parental perception of infant satiety and not healthcare advice was the most common reason for changing from a whey-based to a non whey-based infant formula. Additional research is now required to investigate the effect of whey-based and non whey-based infant formula on infant growth.

Read the full article here

Intervention for Pediatric Feeding Disorders: Systematic Review

Sharp, W. et al. The Journal of Pediatrics. Published online: 8 November 2016

Objective: To assess models of care and conduct a meta-analysis of program outcomes for children receiving intensive, multidisciplinary intervention for pediatric feeding disorders.

Study design: We searched Medline, PsycINFO, and PubMed databases (2000-2015) in peer-reviewed journals for studies that examined the treatment of children with chronic food refusal receiving intervention at day treatment or inpatient hospital programs. Inclusion criteria required the presentation of quantitative data on food consumption, feeding behavior, and/or growth status before and after intervention. Effect size estimates were calculated based on a meta-analysis of proportions.

Results: The systematic search yielded 11 studies involving 593 patients. Nine articles presented outcomes based on retrospective (nonrandomized) chart reviews; 2 studies involved randomized controlled trials. All samples involved children with complex medical and/or developmental histories who displayed persistent feeding concerns requiring formula supplementation. Behavioral intervention and tube weaning represented the most common treatment approaches. Core disciplines overseeing care included psychology, nutrition, medicine, and speech-language pathology/occupational therapy. The overall effect size for percentage of patients successfully weaned from tube feeding was 71% (95% CI 54%-83%). Treatment gains endured following discharge, with 80% of patients (95% CI 66%-89%) weaned from tube feeding at last follow-up. Treatment also was associated with increased oral intake, improved mealtime behaviors, and reduced parenting stress.

Conclusions: Results indicate intensive, multidisciplinary treatment holds benefits for children with severe feeding difficulties. Future research must address key methodological limitations to the extant literature, including improved measurement, more comprehensive case definitions, and standardization/examination of treatment approach.

Read the abstract here