Hazel Gardner

Infant Feeding Practices of Emirati Women in the Rapidly Developing City of Abu Dhabi, United Arab Emirates

Rapid economic and cultural transition in the United Arab Emirates (UAE) has been accompanied by new challenges to public health; most notably a rapid rise in chronic disease. Breastfeeding is known to improve health outcomes in adulthood, is associated with reduced risk of developing chronic disease, and is therefore an important public health issue for this rapidly increasing population. Factors associated with infant feeding practices were examined in a cohort of 125 Emirati women and their infants, with data collected at birth and 3, 6 and 15 months postpartum by questionnaires and interviews. Participants were recruited in the Corniche Hospital, the main maternity hospital in the city of Abu Dhabi. Factors affecting the duration of breastfeeding and the introduction of complementary foods were investigated using univariate and multivariate statistics. Recommended infant feeding practices, such as exclusive breastfeeding for the first six months of life and timely introduction of appropriate complementary foods, were poorly adhered to. Factors implicated in early cessation of breastfeeding included: time to first breastfeed, mother’s education level, employment status and early introduction of complementary foods.

Changes in milk composition associated with pethidine-PCEA usage after Caesarean section

Abstract The effect of pethidine as patient‐controlled epidural analgesia (PCEA) on specific biochemical components in breast milk in relation to the timing of secretory activation is not well investigated. The aim of this study was to compare biochemical timing of secretory activation between women who had a vaginal (V) or Caesarean birth with pethidine‐PCEA (CBP). Several milk samples were collected daily from 36 mothers (17 V, 19 CBP) for the first 265 h post‐partum. Protein and lactose concentrations and Na+ and K+ ion levels were measured. Samples were assigned to three time periods: 0–72, >72–165 and >165–265 h post‐partum for statistical analyses. Data were analyzed using linear mixed effect models. In the first 72 h post‐partum, the mean difference in lactose concentration was 5 gL−1 higher in group V (P < 0.05). From >72–165 h post‐partum, protein and Na+ concentrations were lower in group V (P = 0.05, P = 0.02), and K+ levels were higher in group V (P < 0.001). From >165–265 h post‐partum, there were no significant differences between the groups. Biochemically, secretory activation had occurred by 72 h post‐partum in both groups. There were greater variations in measured biochemical components observed within group CBP initially. However, by 165 h post‐partum, there were no differences in the biochemical components between the groups. This suggests that effects of pethidine‐PCEA are diminished by 72 h post‐partum and undetected by 165 h.

Breastmilk Production in the First 4 Weeks after Birth of Term Infants

Breastmilk provides the ideal nutrition for the infant, and exclusive breastfeeding is recommended for the first 6 months. Adequate milk production by the mother is therefore critical, and early milk production has been shown to significantly affect milk production during established lactation. Previous studies indicate that milk production should reach the lower limit of normal for established lactation (440 mL per day) by day 11 after birth. We have used test-weighing of term infants before and after each breastfeed over 24 h to measure milk production in the first 4 weeks of lactation in mothers with and without perceived breastfeeding problems to provide information on how often milk production is inadequate. Between days 11 and 13, two-thirds of the mothers had a milk production of less than 440 mL per day, and between days 14 and 28, nearly one-third of the mothers had a milk production of less than 440 mL per day. The high frequency of inadequate milk production in early lactation and the consequence of suboptimal milk production in later lactation if left untreated suggest that objective measurement of milk production can identify mothers and infants at risk and support early intervention by a lactation specialist.

Asynchronous milk ejection in human lactating breast: case series.

Background: Milk production is under the influence of autocrine control such that the rate of milk synthesis decreases as the breast fills with milk. Effective elimination of milk from the alveoli via the milk ejection reflex will therefore result in increased milk synthesis. It has been assumed that milk ejection occurs in all alveoli simultaneously; however, animal studies have indicated that full alveoli eject milk sooner than less full alveoli, suggesting heterogeneous emptying of the mammary gland. Objective: The aim of this study was to determine whether milk ejection occurs asynchronously in the human lactating breast. Methods: Retrospective analysis of videos made of ultrasound monitoring of milk ducts during pumping. Six video clips (4 women) of ultrasound monitored milk ejections showed obvious differences in the timing of milk flow between different main milk ducts. Duct diameter was simultaneously measured every second in 2 different ducts that drained 2 separate lobes of the breast. Results: For 5 of 6 ultrasound duct monitoring sessions, both duct dilation and visualization of milk flow in the 2 separate main milk ducts differed by 2 to 8 seconds. For the remaining woman, milk was observed to eject from 1 part of the lobe, and when not removed, it flowed in a retrograde fashion into a different part of the lobe. Conclusion: Asynchrony of milk ejection occurs in the human lactating breast, suggesting that the timing of myoepithelial cell response differs, resulting in heterogeneous emptying of the gland.

Comparison of Inductively Coupled Plasma Optical Emission Spectrometry with an Ion Selective Electrode to Determine Sodium and Potassium Levels in Human Milk

Sodium (Na), potassium (K), and the ratio Na:K in human milk (HM) may be useful biomarkers to indicate secretory activation or inflammation in the breast. Previously, these elements have been measured in a laboratory setting requiring expensive equipment and relatively large amounts of HM. The aim of this study was to compare measurements of Na and K in HM using inductively coupled plasma optical emission spectrometry (ICP-OES) with small portable ion selective electrode probes for Na and K. Sixty-five lactating women donated 5 mL samples of HM. Samples were analyzed with two ion selective probes (Na and K) and also ICP-OES. The data were analyzed using paired t-test and Bland–Altman plots. Na concentrations were not significantly different when measured with ion selective electrode (6.18 ± 2.47mM; range: 3.59–19.8) and ICP-OES (5.91 ± 3.37 mM; range: 2.59–21.5) (p = 0.20). K concentrations measured using the ion selective electrode (11.7 ± 2.21 mM: range: 7.69–18.1) and ICP-OES (11.1 ± 1.55 mM: range: 7.91–15.2) were significantly different (p = 0.01). However, the mean differences of 0.65 mM would not be clinically relevant when testing at point of care. Compared to ICP-OES, ion selective electrode is sufficiently accurate to detect changes in concentrations of Na and K in HM associated with secretory activation and inflammation in the mammary gland.

Hourly Breast Expression to Estimate the Rate of Synthesis of Milk and Fat

Objective measurement of the rate of synthesis of breast milk and fat in breastfeeding mothers requires test-weighing of each breastfeed and the measurement of each expression from each breast over 24 h, with the collection of milk samples before and after each breastfeed and expression. We sought an abbreviated technique for measuring these rates of synthesis. Participants completed a 24-h breastfeeding milk profile, and expressed their breasts on arrival at the research room and each hour thereafter for 3 h (4 expressions). The hourly rate of milk synthesis, as measured by the yield of milk from the fourth expression, was closely related to the hourly rate of milk synthesis calculated from the 24-h milk profile. The hourly rate of fat synthesis, calculated from the fat content of small samples of the first and last milk expressed during the fourth expression, was different from the rate of fat synthesis calculated from the fat content and volumes of all the breastfeeds and expressions during the 24-h milk profile. The study confirms the use of an abbreviated technique to measure the rate of breast milk synthesis, but is not reliable as a measure of the rate of fat synthesis for an individual.

Normal Human Lactation: closing the gap

With the exception of infant growth, there are no well-defined parameters describing normal human lactation. This represents a major gap in the continuum of care that does not exist for other major organs. Biological normality occurs naturally and is characterized by well-integrated function. We have proposed a definition that highlights four key elements that describe parameters for biological normality: comfort, milk supply, infant health, and maternal health. Notwithstanding the current limitations, published data have been collated to provide preliminary markers for the initiation of lactation and to describe objective tests once lactation is established. Reference limits have been calculated for maternal markers of secretory activation, including progesterone in maternal blood and total protein, lactose, sodium, and citrate in maternal milk. Objective measurements for established lactation, including 3-hourly pumping and 24-hour milk production, together with pre-feed to post-feed milk fat changes (a useful indicator of the available milk removed by the infant) have been outlined. Considered together with the parameters describing normal function, this information provides a preliminary objective framework for the assessment of human lactation.

Milk ejection patterns remain consistent during the first and second lactations

Milk ejection is a critical physiological process for successful lactation in humans and without it little milk can be removed. Individual milk ejection patterns have been shown to remain consistent between breasts at different lactation stages and using different vacuum patterns with an electric breast pump. Little is known about the milk ejection characteristics during the second lactation period in the same mother. The objective of this study was to examine milk ejection characteristics in the same woman over two lactations.