Protecting Breast-feeding – Family physicians’ role

Verity H. Livingstone

Can Fam Physician. 1992 August; 38: 1871-1876

Many mothers express a desire to breast-feed but are unable to initiate successful lactation, overcome minor difficulties, or maintain an adequate milk supply due to hospital routines and lack of appropriate advice from health care professionals.

“Doulas” were traditional female assistants who helped mothers breast-feed. Physicians must assume this role and promote breast-feeding prenatally, protect it in hospital, and support it postnatally.

A tejes cikk a PubMed Central oldaláról vagy a Vancouver Breastfeeding Centre oldaláról letölthető
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Breast Milk – A vital defense against infection

Janice M. Vickerstaffjoneja, PhD

Can Fam Physician 1992;38:1849-1855.

The protective agents in colostrum and mature breast milk include specific antibodies, enzymes, leukocytes and their products, antibinding factors, antiviral factors, promoters of a protective intestinal microflora, and immune stimulators. These agents persist through the length of the infant’s digestive tract, are unaffected by gastric acid and digestive enzymes, are present throughout lactation, and protect by noninflammatory mechanisms.

The incidence and severity of infections in breast-fed infants are significantly lower than bottle-fed infants. Although this was originally thought to be the result of increased exposure to contamination from bottle-feeding, recent research shows that specific agents in breast milk protect the exclusively breast-fed baby from infection even when pathogenic microorganisms have been ingested.
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Growth of Breast-Fed and Formula-Fed Infants From 0 to 18 Months: The DARLING Study

Kathryn G. Dewey PhD, M. Jane Heinig MS, Laurie A. Nommsen MS, Janet M. Peerson MS, and Bo Lönnerdal PhD

PEDIATRICS Vol. 89 No. 6 June 1992, pp. 1035-1041

Anthropometric data were collected monthly from birth to 18 months as part of the Davis Area Research on Lactation, Infant Nutrition and Growth study, which followed infants who were either breast-fed or formula-fed during the first 12 months. The two cohorts were matched for parental socioeconomic status, education, ethnic group, and anthropometric characteristics and for infant sex and birth weight, and neither group was given solid foods before 4 months. While mean weight of formula-fed infants remained at or above the National Center for Health Statistics median throughout the first 18 months, mean weight of breast-fed infants dropped below the median beginning at 6 to 8 months and was significantly lower than that of the formula-fed group between 6 and 18 months.
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The determination of short-term breast volume changes and rate of synthesis of human milk using computerized breast measurement

SE Daly, JC Kent, DQ Huynh, RA Owens, BF Alexander, KC Ng, and PE Hartmann

Exp Physiol 1992;77;79-87

The feasibility of using sequential breast volume measurements as a method of studying short-term rates of milk synthesis in women has been established. We have developed a rapid Computerized Breast Measurement system for the determination of breast volume, based upon the Shape Measurement System.

A circle encompassing all the breast tissue is drawn in black face paint on the subject’s skin. Six patterns of sixty-four horizontal light stripes are projected onto the breast and chest wall surface. A CCD camera relays video images to a computer, which produces a model of the chest by active triangulation.
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Adequacy of energy intake among breastfed infants in the DARLING study

Dewey KG, Heinig MJ, Nommsen LA, Lönnerdal B.
J Pediatr. 1991 Oct;119(4):538-47.

Breast-fed infants grow less rapidly after the first 2 to 3 months of age than current standards. The DARLING study (Davis Area Research on Lactation, Infant Nutrition and Growth) was designed to evaluate whether this pattern should be considered “faltering” or is a normal outcome even under optimal conditions. Data on intake, growth, morbidity, activity, and motor development were collected longitudinally from infants who were breast fed for at least 12 months. Gross energy intake, calculated from 4-day records of milk and food intake at 3, 6, 9, and 12 months, averaged 91.4, 84.1, 86.7, and 91.8 kcal/kg per day, respectively, well below recommended amounts of metabolizable energy.
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Studies in human lactation: milk composition and daily secretion rates of macronutrients in the first year of lactation

JC Allen, RP Keller, P Archer and MC Neville

American Journal of Clinical Nutrition, Vol 54, 69-80

Time-dependent changes in milk composition and secretion from pregnancy through greater than or equal to 6 mo of exclusive breast-feeding were studied in 13 multiparous women. Concentrations and secretion rates of lipid, lactose, protein, sodium, chloride, potassium, total calcium, ionized calcium, magnesium, glucose, citrate, inorganic phosphate, creatinine, and urea and pH were analyzed longitudinally from day 6 until weaning commenced. The composition of the antepartum secretion was related to the permeability of the junctional complexes between mammary cells.

Significant increases in lactose, glucose, pH, and ionized calcium and significant decreases in protein, sodium, potassium, chloride, and calcium concentrations were observed between 1 and 6 mo.
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Nutrition During Lactation

Committee on Nutritional Status During Pregnancy and Lactation, Institute of Medicine, 1991

On the basis of a comprehensive literature review and analysis, Nutrition During Lactation points out specific directions for needed research in understanding the relationship between the nutrition of healthy mothers and the outcomes of lactation. Of widest interest are the committee’s clear-cut recommendations for mothers and health care providers.
The volume presents data on who among U.S. mothers is breastfeeding, a critical evaluation of methods for assessing the nutritional status of lactating women, and an analysis of how to relate the mother’s nutrition to the volume and composition of the milk.
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A diagnostic approach to breastfeeding problems

Verity Livingstone

The Canadian Journal of Pediatrics February 1990

One-third of breastfeeding mothers stop within the first two months because they cannot solve their infant feeding difficulties, not because they wish to stop breastfeeding. This early weaning rate is unacceptably high, according to current infant feeding recommendations. The World Health Organization suggests that weaning should not occur until the second year, yet less than 10% of infants in Canada are receiving breast milk by one year.

Breastfeeding problems include: infant failure to thrive, early supplementation due to inadequate milk supply, infant distress, or maternal discomfort and distress. The etiology or underlying cause(s) should be carefully identified before appropriate management is instituted and preventive measures taken.
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Peter G. Arthur, Janice Spruce, Peter E. Hartmann, and Trevor J. Jones

Q J Exp Physiol 1989;74;419-428

A Moire contouring method was used to measure changes in the volume of the breast between infant feeds. A tungsten-halogen light source obliquely illuminated the breast through a moving Moire grid to produce contour shadows on the breast. Photographs of the Moire topographs were analysed to obtain three-dimensional co-ordinates of transverse sections through the breast. The cross-sectional areas were calculated using the trapezoidal rule and volumes were calculated by multiplying these areas by their vertical separation.

The precision of the method was found to be dependent on the subject repositioning accurately.
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The Family Physician’s Role in Preventing Early Termination of Breastfeeding

Verity Livingstone
Can Fam Physician 1986;32:2162-2169


Despite the high rate of breastfeeding among mothers as they leave the hospital, early termination of breastfeeding continues to be a problem. A new mother needs considerable education, support and, often, early intervention, not only to initiate breastfeeding successfully, but also to prevent breastfeeding problems occuring and to continue breastfeeding successfully for several months. Knowledgeable health-care providers are the key to promoting and protecting breastfeeding, yet in the community, many of these mothers, lacking the support of such knowledgeable advisers, often terminate early.

Family physicians are in a key position to help teh nursing dyad.
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