Jennifer Ingram

Interactions between parents and infants, and the development of independence in the common marmoset (Callithrix jacchus)

Detailed observations were made of the parent-infant interactions of five adult pairs and 31 infant common marmosets (Callithrix jachus), housed in captive family groups. Records of parental measures were taken up to 4 months old and comparisons made between infants in similar social situations. These comparisons investigate sex differences, birth-order variations, those between singleton and twin infants, parental variation and the proportion of time that older siblings carry infants. Correlations between the measures reveal that both parents are responsible for promoting and regulating increasing infant independence. In the discussion, comparisons are made with other parent-infant studies and problems of the adaptiveness of the Callitrichid social system considered.

Metoclopramide or domperidone for increasing maternal breast milk output: a randomised controlled trial

Objective To compare the effects of metoclopramide and domperidone on the breast milk output of mothers with infants in neonatal intensive care. Design Double-blind randomised controlled trial. Setting Tertiary level neonatal intensive care unit (NICU). Sample Eighty mothers expressing breast milk for their infants (mean gestational age 28 weeks) based in NICU and the amounts expressed fell short of the prescribed target. Intervention Mothers were randomised to receive domperidone or metoclopramide for 10 days (10 mg three times a day). Outcome measures Total milk volume daily for up to 10 days before the medication, 10 days during the trial and up to 10 days after medication. Adverse side effects were also recorded. Results Mothers produced more milk in the domperidone group and achieved a mean of 96.3% increase in milk volume (mean increase/pretrial volume) compared with a 93.7% increase for metoclopramide. After adjusting for the amount of milk produced prior to medication, the mean amount of milk produced while taking medication for those on domperidone was 31.0 ml/24 h (95% CI −5.67 to 67.6) greater than the mean for those on metoclopramide. Seven mothers taking metoclopramide reported side effects and three taking domperidone; a further eight women (of 29) who had a follow-on prescription for metoclopramide also reported side effects. Conclusions Oral domperidone and metoclopramide increased the volume of milk produced by mothers who are expressing to feed their babies in NICU. There were small differences in milk output between the two medications and in the incidence of side effects, but the differences were non-significant.

Hormonal predictors of postnatal depression at 6 months in breastfeeding women

Postnatal depression occurs in 10-15% of postpartum women. Studies have shown associations with endogenous hormone levels (oestrogen, progesterone, cortisol and thyroxin) and with autoimmune thyroid dysfunction. Breastfeeding has not been shown to increase the risk of developing postpartum depression. A prospective study involving 54 breastfeeding mothers of mixed parity and similar socio-economic status and education used bivariate analysis to look for associations between hormone levels and postnatal depression. Total oestradiol, total progesterone, prolactin and thyrotropin (TSH) levels were determined at four time points (ante- and postnatally) from finger-prick blood spots by fluoro-immunoassay. EPDS and life event check lists were completed at 6 months postpartum. Ten women were screened positive for sub-clinical depression (score≥10). Bivariate analysis showed that antenatal prolactin and postpartum progesterone levels were significantly associated with postnatal depression at 6 months (p=0.03). Only the result for progesterone persisted in a multiple logistic regression, which controlled for life events. Women with lower progesterone levels in the immediate postnatal period were more likely to be depressed at 6 months.

Husbandry and observation methods of a breeding colony of marmosets (callithrix jacchus) for behavioural research

By allowing families to increase in size, co-operation between parents and adolescents in infant care was encouraged. Young adult pairs were subsequently created with these marmosets which had experience of handling infants to provide a stable basis for breeding 2nd and 3rd generation marmosets in captivity.

Breastfeeding: it is worth trying with the second baby.

Mothers who experience breastfeeding difficulties with their first babies and give up breastfeeding are less likely to breastfeed subsequent babies than mothers who do not experience such difficulties. We carried out a longitudinal study of 22 mothers in which milk output was measured at 1 week and 4 weeks after giving birth to their first and second babies. Significantly more breast milk was produced at 1 week for the second lactation (an increase of 31% [95% CI 11-51%]) and the net increase was greatest for those with the lowest milk output on the first occasion (90% [30-149%]). They spent less time feeding their second baby (a decrease of 20% [-34 to -5%]). This increased efficiency of milk transfer was also evident at 4 weeks. Health professionals should encourage women to breastfeed all their children, whatever their experience with their first child.

Treatment experience and needs of older drug users in Bristol, UK

Recent publications raise concerns about meeting the treatment needs of an ageing drug-using population. At Bristol Drugs Project (BDP) we noted the absence of older users attending services beyond health centre-based opiate substitution therapy (OST). Twenty drug-users aged 55 or over were interviewed about their experience of treatment, barriers to further treatment, and what might encourage participation in our community drugs project. Thematic analysis revealed barriers as reluctance to be associated with younger drug users and a sense of shame at ‘still using at this age’. Assumptions that health professionals would interpret asking for medical help with other age-related symptoms as ‘merely seeking more medication’ prevented some from getting adequate pain relief and there was a tension between fear of detox and fear of drug dependency in old age. Most reported positive relationships with general practitioners (GPs) and BDP Shared Care workers in respect of their drug use, but others had felt stigmatized and inadequately treated within Tier 4 (mainly hospital) services which they attributed to their drug-user status. A focus group developed ideas for an age-specific support group to be piloted. Advocacy work and training for health professionals should be ongoing to improve treatment for older drug users.

Estimating discharge dates using routinely collected data: improving the preparedness of parents of preterm infants for discharge home

The length of stay for moderately preterm infants has progressively become shorter in the UK in recent years but staff still commonly inform parents that their baby will go home around their estimated date of delivery (EDD). Parents need as much notice as possible to prepare for the discharge of their baby, and to gain the necessary skills and knowledge to care for their infant safely. We report the use of routinely collected neonatal data to develop and implement a simple centile chart for date of discharge from hospital, which allows staff and parents to predict the likely discharge date more accurately for preterm infants, most of whom now go home more than 3 weeks before their EDD. This information allows better and timelier planning for discharge of such infants, by parents and staff.

G390 A feasability randomised controlled single blind parallel group trial for frenotomy in tongue tied breast fed babies with mild to moderate tongue tie

Frenotomy is increasingly being advocated for ‘tongue tied’ infants struggling to breast feed. Evidence for its efficacy is weak. Objective measures of tongue tie are limited. We aimed to determine if randomisation to day zero or day 5 for mild to moderately tongue tied infants would be acceptable to Mothers. We also wished to assess tongue tie using the LATCH score and the HATLFF short form score. Our study was set in a large “Baby Friendly” UK maternity hospital between 2011–2013 Term infants <2 weeks with mild to moderate tongue tie were offered randomisation to immediate or delayed frenotomy (with standard care) by the research midwife. Severity was judged by Hazelbaker Tool HATLFF short form score 6–12 and difficulty in breast feeding by LATCH score (<8) Primary outcome was breast feeding at 5 days and secondary outcomes of breast feeding self efficacy and pain scores. Final assessment was at 8 weeks. Researchers assessing outcomes were blinded to intervention status. Results: 107 infants were randomised 55 to intervention and 52 to comparison group. Five day outcome measures were obtained in 52 (100%) of the comparison and 53 (96%) of the intervention group. ITT analyses showed no difference in the primary outcome LATCH score. Frenotomy improved breast feeding self efficacy assessment. At 5 days there was a 7.5% increase in bottle feeding in the intervention group and 15% in the comparison group. After the day 5 clinic 44 of the comparison group (who were referred origninally with the expectation to have frenotomy) requested frenotomy. By 8 weeks only 6 (12%) were breast feeding without frenotomy. There were no adverse events. Conclusions: Feasability to sustain breastfeeding for 5 days in tongue tied infants is acheivable. Early frenotomy did NOT result in an objective improvement in breastfeeding at five days. But fewer Mothers switched to bottle feeds. This trial funded by NIHR-RFPB sets the scene for a potential multicentre trial using breast feeding at 8 weeks as the primary outcome. Our trial allowed us to further refine tools for assessing breast feeding and tongue tie (ongoing work.)