Difference between breast milk jaundice and breast-feeding jaundice: literature review

Evidence shows that the different etiologies of neonatal jaundice, including breastfeeding and breast milk jaundice, have many different aspects. Therefore, the present study aims to conduct a literature review to compare breastfeeding and breast milk jaundice, ehich will furtherly help physicians and healthcare practitioners to have adequate information to properly establish an accurate diagnosis. The precise cause of breast milk jaundice is unclear. The majority of the suggested etiologies include factors found in human breast milk. Other theories point to possible genetic defects in the infected neonates. It has been reported that pregnane-3a,20ß-diol, epidermal growth factor, interleukin (IL)1ß, alpha-fetoprotein, and ß-glucuronidase are several factors that are solid constituents of the breast milk which may attribute to the development of this jaundice. Reports showed that breast milk jaundice usually develops in 20-30% of U.S. neonates, and most of whom are breastfed. Moreover, studies showed that more than one-third of infants on breastfeeding will eventually have high serum bilirubin levels that are ≥5 mg/dl. Evidence showed that the diagnosis should be considered when the levels of serum bilirubin exceed 5 mg/dl. Breast milk jaundice will usually fade away with no interventions, and in some cases, phototherapy inauguration and breast milk discontinuation might be needed. In breastfeeding jaundice, serum bilirubin levels usually peak within the first five or six days of life due to wrong or inadequate breastfeeding practices, and the management should be done by correcting these habits, while phototherapy might be applied when the bilirubin levels exceed 18-20 mg/dl.

Access to and Quality of Healthcare for Pregnant and Postpartum Women During the COVID-19 Pandemic

Introduction: During the COVID-19 pandemic, obstetric care has adopted new precautions to ensure services can be maintained for pregnant women. The aim of this study was to describe access to and quality of obstetric care for pregnant and postpartum women during the COVID-19 pandemic and to identify factors that predict quality of care at this time.Methods: Between May 3 and June 28, 2020, we recruited women who were pregnant or within the first 6 months after delivery to participate in an online survey. This included questions on access to obstetric healthcare (type and place of health care provider, changes to obstetric appointments/services, appointment preferences) and the Quality of Prenatal Care Questionnaire (QPCQ).Results: Of the 917 eligible women, 612 (67%) were pregnant and 305 (33%) were in the first 6 months after delivery. Sixty-two percent (n = 571) reported that COVID-19 had affected their healthcare; appointments were rearranged, canceled or occurred via virtual means for 29% (n = 166), 29% (n = 167), and 31% (n = 175) of women, respectively. The majority preferred to physically attend appointments (74%; n = 676) and perceived the accompaniment of birth partners as important (77%; n = 471). Sixty-two percent (n = 380) were permitted a birth partner at delivery, 18% (n = 111) were unsure of the rules while 4% (n = 26) were not permitted accompaniment. During pregnancy, QPCQ was negatively associated with disruption to obstetric services including exclusion or uncertainty regarding birth partner permissions [F(7, 433) = 11.5, p < 0.001, R2 = 0.16] while QPCQ was negatively associated with inadequate breastfeeding support postpartum [F(1, 147) = 12.05, p = 0.001, R2 = 0.08].Conclusion: Pregnant and postpartum have experienced disruption in their access to obstetric healthcare. Perceived quality of obstetric care was negatively influenced by cancellation of appointment(s), suspension of services and exclusion of birth partners at delivery. During this time, continuity of care can be fulfilled via virtual and/or phone appointments and women should receive clear guidance on changes to services including birth partner permissions to attend delivery.

Exchange blood transfusion in neonates with severe hyperbilirubinemia in a lower-middle-income country: can we minimise the incidence?

Our descriptive study examines the clinical profile of referred neonates who underwent exchange blood transfusion (EBT) and identifies possible interventions at peripheral hospitals to decrease their severe hyperbilirubinemia. Among the 38 neonates enrolled, the following were identified as potential clinical gaps in management: early discharge within 24 h of birth (57%); non-availability of ABORh blood grouping (43%); lack of anti-D immunoprophylaxis (75%); pathological weight loss because of inadequate breastfeeding (42%); and low usage of phototherapy. Because of late recognition, the mean age at admission was 5.4 ± 3.3 days, levels of total serum bilirubin (TSB) were 516.4 ± 123.1 µmol/L, and acute bilirubin encephalopathy (ABE) was seen in 45% of neonates. Rh iso-immunisation (39.5%), ABO iso-immunisation (21%) and sepsis (8%) were major risk factors for severe hyperbilirubinaemia. Quality prenatal screening identifying at-risk newborns, preventing early discharge after birth, a bilirubin nomogram risk assignment before discharge and assuring early recognition of hyperbiliubinaemia by parents may well minimise the incidence of EBT.

Factor of Interesting in Breastfeed Mother With Milk Formula In District of Buleleng, Bali

Providing formula milk is still the biggest obstacle in the success of exclusive breastfeeding. Bali Province reported as a province in Indonesia with the highest use of formula milk. This study aims to look at the percentage and factors of interest of breastfeeding mothers on formula milk. The method used is a mixed-method with questionnaire sheets and interviews. The results show the proportion of formula milk interest is 25.48%. Factors that increase interest in formula milk are higher education 3.03 times (CI 1.18-7.81: p0.02), duration of work more than 6 hours 12.22 times (CI 5.95-25.09: p 0.01), and not giving Exclusive Breastfeeding 5.85 times (CI 2.94-11.65; p 0.01). While the absence of promotion of formula reduces interest by up to 77% (OR 0.23 CI 0.13-0.42; p 0.01). The reason for the interest in formula milk is that mothers must work so that there is no time for breastfeeding, inadequate breastfeeding, and time off It is enough. Better guidance on how to store breast milk should be prioritized for working mothers not only an understanding of the benefits of breastfeeding. Health workers should review government regulation No. 33 of 2012 regarding exclusive breastfeeding to support breastfeeding and limit the use of formula milk.

A Case Study of Biological Nurturing

Introduction: This case of a mother and her two children, born 20 years apart, highlights how Biological Nurturing (BN) supported a woman in meeting her personal breastfeeding goals. We know lack of breastfeeding support contributes to early weaning. Applying the principles of BN (unrestricted and laid-back breastfeeding) enabled this mother to return to breastfeeding without supplements. Main Issue: After giving birth to her first son prematurely in 1997, the dyad was separated, and formula introduced. These interventions, combined with inadequate breastfeeding support, resulted in low milk supply and unplanned weaning by week six. In 2017, a full term sibling baby girl was born, with breastfeeding again beginning with concerns of low milk supply. Management Consultation with an International Board Certified Lactation Consultant successfully addressed common breastfeeding problems, including vasospasm and insufficient milk supply. Continuous emotional support helped this mother overcome perceived insufficient milk supply. Introducing BN led to breastfeeding without supplementation, by enabling the dyad to experience enjoyment, comfort and feeding autonomy. Conclusion: While the repeated experience of insufficient milk supply two decades apart constituted a psychological barrier to exclusive breastfeeding, BN enabled reaching this mother’s breastfeeding goals. BN appears to be a powerful tool for both breastfeeding initiation and overcoming breastfeeding difficulties, potentially setting new best practice standards.