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Outcome of infants born at < 32 weeks' gestation in a single-centre level III neonatology unit - relation to feeding strategy.
Kiechl-Kohlendorfer, U, Biermayr, M, Pupp Peglow, U, Griesmaier, E
The Journal of international medical research. 2018;(12):5107-5116
Abstract
OBJECTIVE This study aimed to determine survival, neonatal morbidity, and outcomes at 1 and 2 years in children who were born very preterm, and to analyse any relation to enteral feeding. METHODS We performed a prospective, observational study on very preterm infants (range: 23-31 weeks' gestation) born at Innsbruck Medical University Hospital, Austria, between 2007 and 2014 (n = 557). RESULTS The overall survival rate was 94.6%. Survival rates were 77.8%, 78.6%, 90.9%, and 90.9% among those born at 24, 25, 26, and 27 weeks, and 97.3%, 95.3%, 98.3%, and 100% among those born at 28, 29, 30, and 31 weeks of gestation, respectively. The overall prevalence of chronic lung disease among survivors was 7.3%. The prevalence of necrotizing enterocolitis requiring surgery, intraventricular haemorrhage grades 3 and 4, and severe retinopathy of prematurity was 3.1%, 2.1%, and 6.2%, respectively. There was no difference in short-term morbidity or neurodevelopmental outcome at 1 or 2 years of corrected age between infants who were fed with human milk at discharge and those who were formula-fed. CONCLUSION In the current study, mortality and short-term morbidity rates were low. No differences regarding feeding strategy were detected.
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In vivo assessment of number of milk duct orifices in lactating women and association with parameters in the mother and the infant.
Jütte, J, Hohoff, A, Sauerland, C, Wiechmann, D, Stamm, T
BMC pregnancy and childbirth. 2014;:124
Abstract
BACKGROUND In vitro and in vivo analyses differ between the number of milk ducts found in the lactating breast, and there is a lack of knowledge as to whether or not external factors in the mother or the child affect the number of ductal orifices. The aim of this study was to determine the number of milk duct orifices in vivo and to investigate the possible influence of variable parameters in mother and infant. STUDY DESIGN Prospective clinical trial. In 98 breastfeeding women we investigated the nipple surface in order to identify the number of milk duct orifices using Marmet's manual milk expression technique. In addition mothers were interviewed on different parameters of birth and breastfeeding. RESULTS Every nipple had 3.90 ± 1.48 milk duct orifices on average. There was no significant difference between left and right breasts. The use of a breast pump in addition to breastfeeding did not have any effect on the number of ductal orifices. Multiparous women exhibited more ductal orifices (8.5 ± 3.0) as compared to primipara (7.1 ± 2.7). Boys were associated with significantly more ductal orifices in their mother's right breast (4.2 ± 1.7) than girls (3.5 ± 1.4). Furthermore boys were breastfed for longer per session. A shorter birth height of males correlated with more ductal orifices in left nipples. Fluid intake of mothers was associated with a higher number of ductal orifices. Restless infant behavior could not be explained by less milk duct orifices. Pain in the breast during breastfeeding did not have an influence on ductal orifices either. Psychological criteria, such as duration of maternity leave and total intended breastfeeding period, did not affect the number of orifices in the papilla mammaria of breasts during lactation. CONCLUSION For the first time an in vivo investigation of the number of ductal orifices in lactating women was conducted non-invasively and associations with variables in the mother and the child, birth parameters in infants, and breastfeeding parameters in mothers and children were assessed. We conclude that the number of activated ductal orifices on the surface of the nipple is primarily associated with functional aspects.
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Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study.
Humphrey, JH, Marinda, E, Mutasa, K, Moulton, LH, Iliff, PJ, Ntozini, R, Chidawanyika, H, Nathoo, KJ, Tavengwa, N, Jenkins, A, et al
BMJ (Clinical research ed.). 2010;:c6580
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Abstract
OBJECTIVES To estimate the rates and timing of mother to infant transmission of HIV associated with breast feeding in mothers who seroconvert postnatally, and their breast milk and plasma HIV loads during and following seroconversion, compared with women who tested HIV positive at delivery. DESIGN Prospective cohort study. SETTING Urban Zimbabwe. PARTICIPANTS 14 110 women and infants enrolled in the Zimbabwe Vitamin A for Mothers and Babies (ZVITAMBO) trial (1997-2001). MAIN OUTCOME MEASURES Mother to child transmission of HIV, and breast milk and maternal plasma HIV load during the postpartum period. RESULTS Among mothers who tested HIV positive at baseline and whose infant tested HIV negative with polymerase chain reaction (PCR) at six weeks (n=2870), breastfeeding associated transmission was responsible for an average of 8.96 infant infections per 100 child years of breast feeding (95% CI 7.92 to 10.14) and varied little over the breastfeeding period. Breastfeeding associated transmission for mothers who seroconverted postnatally (n=334) averaged 34.56 infant infections per 100 child years (95% CI 26.60 to 44.91) during the first nine months after maternal infection, declined to 9.50 (95% CI 3.07 to 29.47) during the next three months, and was zero thereafter. Among women who seroconverted postnatally and in whom the precise timing of infection was known (≤90 days between last negative and first positive test; n=51), 62% (8/13) of transmissions occurred in the first three months after maternal infection and breastfeeding associated transmission was 4.6 times higher than in mothers who tested HIV positive at baseline and whose infant tested HIV negative with PCR at six weeks. Median plasma HIV concentration in all mothers who seroconverted postnatally declined from 5.0 log(10) copies/mL at the last negative enzyme linked immunosorbent assay (ELISA) to 4.1 log(10) copies/mL at 9-12 months after infection. Breast milk HIV load in this group was 4.3 log(10) copies/mL 0-30 days after infection, but rapidly declined to 2.0 log(10) copies/mL and <1.5 log(10) copies/mL by 31-90 days and more than 90 days, respectively. Among women whose plasma sample collected soon after delivery tested negative for HIV with ELISA but positive with PCR (n=17), 75% of their infants were infected or had died by 12 months. An estimated 18.6% to 20.4% of all breastfeeding associated transmission observed in the ZVITAMBO trial occurred among mothers who seroconverted postnatally. CONCLUSIONS Breastfeeding associated transmission is high during primary maternal HIV infection and is mirrored by a high but transient peak in breast milk HIV load. Around two thirds of breastfeeding associated transmission by women who seroconvert postnatally may occur while the mother is still in the "window period" of an antibody based test, when she would test HIV negative using one of these tests. Trial registration Clinical trials.gov NCT00198718.
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Risk factors for late postnatal transmission of human immunodeficiency virus type 1 in sub-Saharan Africa.
Chasela, C, Chen, YQ, Fiscus, S, Hoffman, I, Young, A, Valentine, M, Emel, L, Taha, TE, Goldenberg, RL, Read, JS
The Pediatric infectious disease journal. 2008;(3):251-6
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Abstract
BACKGROUND We conducted secondary data analyses of a clinical trial (HIVNET 024) to assess risk factors for late postnatal transmission (LPT) of human immunodeficiency virus type 1 (HIV-1) through breast-feeding. METHODS Data regarding live born, singleton infants of HIV-1-infected mothers were analyzed. The timing of HIV-1 transmission through 12 months after birth was defined as: in utero (positive HIV-1 RNA results at birth), perinatal/early postnatal (negative results at birth, positive at 4-6 week visit), or LPT (negative results through the 4-6 week visit, but positive assays thereafter through the 12-month visit). HIV-1-uninfected infants were those with negative HIV-1 enzyme immunoassay results at 12 months of age, or infants with negative HIV-1 RNA results throughout follow-up. RESULTS Of 2292 HIV-1-infected enrolled women, 2052 mother/infant pairs met inclusion criteria. Of 1979 infants with HIV-1 tests, 404 were HIV-1-infected, and 382 had known timing of infection (LPT represented 22% of transmissions). Further analyses of LPT included infants who were breast-feeding at the 4-6 week visit (with negative HIV-1 results at that visit) revealed 6.9% of 1317 infants acquired HIV-1 infection through LPT by 12 months of age. More advanced maternal HIV-1 disease at enrollment (lower CD4 counts, higher plasma viral loads) were the factors associated with LPT in adjusted analyses. CONCLUSIONS In this breast-feeding population, 6.9% of infants uninfected at 6 weeks of age acquired HIV-1 infection by 12 months. Making interventions to decrease the risk of LPT of HIV-1 available and continuing research regarding the mechanisms of LPT (so as to develop improved interventions to reduce such transmission) remain essential.