scholarly journals Establishing a novel community-focussed lactation support service: a descriptive case series

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Samantha Griffin ◽  
Jo Watt ◽  
Sophie Wedekind ◽  
Solange Bramer ◽  
Yasmin Hazemi-Jebelli ◽  
...  
Keyword(s):  
Human Milk ◽  
Maternal Mental Health ◽  
Case Series ◽  
Third Sector ◽  
Support Service ◽  
Non Profit ◽  
Milk Bank ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Uk

Abstract Background Although breastfeeding is widely acknowledged as protecting both infant and maternal health postnatally, a partial or complete shortfall of maternal milk can occur for a range of reasons. In this eventuality, the currently available options for feeding infants are screened donor human milk (DHM), infant formula or unscreened shared human milk. In the UK, DHM has only been widely available in specific clinical contexts for the last 40 years, mainly to reduce the risk of necrotising enterocolitis in extremely preterm infants alongside optimal support for maternal lactation and breastfeeding. The Hearts Milk Bank (HMB) was established in 2017 as an independent, non-profit human milk bank that aimed to ensure equitable, assured access to screened DHM for neonatal units. As a result of the generosity of mothers, a surplus of DHM rapidly became available and together with lactation support, has since been provided to families with a healthcare referral. This programme has now been formalised for families facing lactational challenges, and DHM stocks are permanently maintained to meet their needs. Case series This case series describes the clinical paths of four families who accessed lactation support and DHM from the HMB, along with a description of the process for community provision. To date, the HMB has supported over 300 families. Working collaboratively with key stakeholders, the HMB team has developed a prioritisation strategy based on utilitarian ethical models, protocols that ensure safe handling and appropriateness of use, broader donor recruitment parameters that maintain safety with a pragmatic approach for full term healthy infants, and a process to ensure parents or carers have access to the knowledge needed to give informed consent and use DHM appropriately. Conclusions Stakeholders, including parents, healthcare professionals, and milk banks, will need to discuss priorities for both DHM use and research gaps that can underpin the equitable expansion of services, in partnership with National Health Service (NHS) teams and third-sector organisations that support breastfeeding and maternal mental health.

Rectal bleeding in extremely preterm infants associated with oral sildenafil therapy: A case series

2019 ◽  
Vol 56 (1) ◽  
pp. 163-164 ◽  
Author(s):  
Rossella Iannotta ◽  
Milena Tana ◽  
Francesca Priolo ◽  
Velia Purcaro ◽  
Giovanni Vento ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Rectal Bleeding ◽  
Case Series ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals The gut microbiome of extremely preterm infants randomized to the early progression of enteral feeding

2021 ◽  
Author(s):  
Ariel A. Salas ◽  
Kent A. Willis ◽  
Waldemar A. Carlo ◽  
Nengjun Yi ◽  
Li Zhang ◽  
...  
Keyword(s):  
Human Milk ◽  
Microbial Diversity ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Gut Microbiome ◽  
Mode Of Delivery ◽  
Early Feeding ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Early Progression

Abstract Background Early progression of feeding could influence the development of the gut microbiome. Methods We collected fecal samples from extremely preterm infants randomized to receive either early (feeding day 2) or delayed (feeding day 5) feeding progression. After study completion, we compared samples obtained at three different time points (week 1, week 2, and week 3) to determine longitudinal differences in specific taxa between the study groups using unadjusted and adjusted negative binomial and zero-inflated mixed models. Analyses were adjusted for a mode of delivery, breastmilk intake, and exposure to antibiotics. Results We analyzed 137 fecal samples from 51 infants. In unadjusted and adjusted analyses, we did not observe an early transition to higher microbial diversity within samples (i.e., alpha diversity) or significant differences in microbial diversity between samples (i.e., beta diversity) in the early feeding group. Our longitudinal, single-taxon analysis found consistent differences in the genera Lactococcus, Veillonella, and Bilophila between groups. Conclusions Differences in single-taxon analyses independent of the mode of delivery, exposure to antibiotics, and breastmilk feeding suggest potential benefits of early progression of enteral feeding volumes. However, this dietary intervention does not appear to increase the diversity of the gut microbiome in the first 28 days after birth. Trial Registration ClinicalTrials.gov identifier: NCT02915549. Impact Early progression of enteral feeding volumes with human milk reduces the duration of parenteral nutrition and the need for central venous access among extremely preterm infants. Early progression of enteral feeding leads to single-taxon differences in longitudinal analyses of the gut microbiome, but it does not appear to increase the diversity of the gut microbiome in the first 28 days after birth. Randomization in enteral feeding trials creates appealing opportunities to evaluate the effects of human milk diets on the gut microbiome.

scholarly journals Nordic study on human milk fortification in extremely preterm infants: a randomised controlled trial—the N-forte trial

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053400
Author(s):  
Georg Bach Jensen ◽  
Fredrik Ahlsson ◽  
Magnus Domellöf ◽  
Anders Elfvin ◽  
Lars Naver ◽  
...  
Keyword(s):  
Breast Milk ◽  
Human Milk ◽  
Preterm Infants ◽  
Ethical Review ◽  
Human Breast Milk ◽  
Human Breast ◽  
Preterm Formula ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Randomised Controlled

IntroductionThe mortality rate of extremely low gestational age (ELGA) (born <gestational week 28+0) infants remains high, and severe infections and necrotising enterocolitis (NEC) are common causes of death. Preterm infants receiving human milk have lower incidence of sepsis and NEC than those fed a bovine milk-based preterm formula. Despite this, fully human milk fed ELGA infants most often have a significant intake of cow’s milk protein from bovine-based protein fortifier. The aim of this study is to evaluate whether the supplementation of human milk-based, as compared with bovine-based, nutrient fortifier reduces the prevalence of NEC, sepsis and mortality in ELGA infants exclusively fed with human milk.Methods and analysisA randomised-controlled multicentre trial comparing the effect of a human breast milk-based fortifier with a standard bovine protein-based fortifier in 222–322 ELGA infants fed human breast milk (mother’s own milk and/or donor milk). The infants will be randomised to either fortifier before reaching 100 mL/kg/day in oral feeds. The intervention, stratified by centre, will continue until the target postmenstrual week 34+0. The primary outcome is a composite of NEC, sepsis or death. Infants are characterised with comprehensive clinical and nutritional data collected prospectively from birth until hospital discharge. Stool, urine, blood and breast milk samples are collected for analyses in order to study underlying mechanisms. A follow-up focusing on neurological development and growth will be performed at 2 and 5.5 years of age. Health economic analyses will be made.Ethics and disseminationThe study is conducted according to ICH/GCP guidelines and is approved by the regional ethical review board in Linköping Sweden (Dnr 2018/193-31, Dnr 2018/384-32). Results will be presented at scientific meetings and published in peer-reviewed publications.Trial registration numberThe study was registered with ClinicalTrials.gov NCT03797157, 9 January 2019.

scholarly journals Case Report: Treatment of Extremely Preterm Infants With Birthweight Below 300 g: Case Series

2021 ◽  
Vol 9 ◽  
Author(s):  
Yoshihiko Shitara ◽  
Satsuki Kakiuchi ◽  
Takeo Mukai ◽  
Kohei Kashima ◽  
Motohiro Kato ◽  
...  
Keyword(s):  
Best Practices ◽  
Low Birthweight ◽  
Clinical Course ◽  
Case Series ◽  
Hepatic Rupture ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurodevelopmental Impairment ◽  
Parental Counseling ◽  
Extremely Low Birthweight

Reports on the birth of infants weighing &lt;300 g are quite rare and little is known about the best practices in treating such micropreemies. Therefore, we report here on three cases of low birthweight infants weighing &lt;300 g, of whom two infants survived. The birthweights and gestational ages were ranging 279–293 g and 22 + 6/7 – 23 + 6/7 weeks, respectively. All the infants had severe fetal growth restriction and prematurity. The infant in case 1 died of hepatic rupture, perhaps due to birth trauma, which emphasized the need for less invasive obstetric procedures including en caul delivery. The infant in case 2 managed to survive through severe prematurity secondary to hydrops fetalis. However, complications followed soon as tracheal granulation tissue was formed with neurodevelopmental impairment. The infant in case 3 was born recently and her clinical course was less remarkable without severe complications, despite having the least gestational age and birthweight among the three patients. The improved care protocols for extremely low birthweight infants over these years through experiential learning including that with cases 1 and 2 may have ensured the better outcome of case 3. Accumulating evidence and recording the experience of such cases with continuous constructive discussion can contribute to better outcomes and appropriate parental counseling for extremely small babies in the future.

scholarly journals Exclusive Human Milk VS Preterm Formula: Randomized Trial in Extremely Preterm Infants

2011 ◽  
Vol 70 ◽  
pp. 4-4 ◽  
Author(s):  
E A Cristofalo ◽  
R J Schanler ◽  
C L Blanco ◽  
S Sullivan ◽  
R Trawoeger ◽  
...  
Keyword(s):  
Human Milk ◽  
Randomized Trial ◽  
Preterm Infants ◽  
Preterm Formula ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Children and young people who die by suicide: childhood-related antecedents, gender differences and service contact

BJPsych Open ◽  
2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Cathryn Rodway ◽  
Su-Gwan Tham ◽  
Saied Ibrahim ◽  
Pauline Turnbull ◽  
Nav Kapur ◽  
...  
Keyword(s):  
Young People ◽  
Case Series ◽  
Third Sector ◽  
Drug Misuse ◽  
Mortality Data ◽  
Suicide Rates ◽  
National Mortality ◽  
Self Harm ◽  
The Uk ◽  
Witnessing Domestic Violence

Background Worldwide suicide is commonest in young people and in many countries, including the UK, suicide rates in young people are rising. Aims To investigate the stresses young people face before they take their lives, their contact with services that could be preventative and whether these differ in girls and boys. Method We identified a 3-year UK national consecutive case series of deaths by suicide in people aged 10–19, based on national mortality data. We extracted information on the antecedents of suicide from official investigations, primarily inquests. Results Between 2014 and 2016, there were 595 suicides by young people, almost 200 per year; 71% were male (n = 425). Suicide rates increased from the mid-teens, most deaths occurred in those aged 17–19 (443, 74%). We obtained data about the antecedents of suicide for 544 (91%). A number of previous and recent stresses were reported including witnessing domestic violence, bullying, self-harm, bereavement (including by suicide) and academic pressures. These experiences were generally more common in girls than boys, whereas drug misuse (odds ratio (OR) = 0.54, 95% CI 0.35–0.83, P = 0.006) and workplace problems (OR 0.52, 95% CI 0.28–0.96, P = 0.04) were less common in girls. A total of 329 (60%) had been in contact with specialist children's services, and this was more common in girls (OR 1.86, 95% CI 1.19–2.94, P = 0.007). Conclusions There are several antecedents to suicide in young people, particularly girls, which are important in a multiagency approach to prevention incorporating education, social care, health services and the third sector. Some of these may also have contributed to the recent rise.

scholarly journals Thresholds for Resuscitation of Extremely Preterm Infants in the UK, Sweden, and Netherlands

PEDIATRICS ◽  
2018 ◽  
Vol 142 (Supplement 1) ◽  
pp. S574-S584 ◽  
Author(s):  
Dominic Wilkinson ◽  
Eduard Verhagen ◽  
Stefan Johansson
Keyword(s):  
Preterm Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Uk

How does the BAPM Framework for Practice on Perinatal Management of Extreme Preterm Birth Before 27 Weeks of Gestation impact delivery of Newborn Life Support? A Resuscitation Council UK response

2020 ◽  
Vol 105 (6) ◽  
pp. 672-674
Author(s):  
Joe Fawke ◽  
Robert J Tinnion ◽  
Victoria Monnelly ◽  
Sean B Ainsworth ◽  
Jonathan Cusack ◽  
...  
Keyword(s):  
Decision Making ◽  
Preterm Birth ◽  
Preterm Infants ◽  
Life Support ◽  
Perinatal Care ◽  
Perinatal Medicine ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Perinatal Management ◽  
The Uk

In October 2019, the British Association of Perinatal Medicine (BAPM) published a Framework1 and associated infographic2 for ‘Practice on Perinatal Management of Extreme Preterm Birth Before 27 Weeks of Gestation’. This outlined an approach, based on data from the UK and abroad, to assist clinicians in decision-making relating to perinatal care at ≤26+6 weeks gestation. Many frontline providers of delivery room care of extremely preterm infants will have completed a Resuscitation Council UK (RCUK) Newborn Life Support or Advanced Resuscitation of the Newborn Infant course. This RCUK response to the BAPM Framework highlights how this might impact on their approach.

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