Lílian Córdova do Espírito Santo

Uso de mamadeira no primeiro mês de vida: determinantes e influência na técnica de amamentação

OBJETIVO: Analisar a incidencia e os determinantes do uso de mamadeira no primeiro mes de vida e possiveis efeitos dessa pratica na tecnica de amamentacao. METODOS: Estudo transversal aninhado em uma coorte contemporânea de Porto Alegre, RS, de junho a novembro de 2003. Durante um mes foram acompanhados 211 pares de mae e crianca. A influencia do uso de mamadeira sobre a tecnica de amamentacao foi avaliada comparando-se as frequencias de cinco itens desfavoraveis ao posicionamento mae/crianca e tres itens desfavoraveis a pega da crianca; e as medias do numero de itens desfavoraveis entre as duplas que iniciaram o uso mamadeira no primeiro mes e as que nao o fizeram. A regressao logistica estimou o grau de associacao das variaveis com os desfechos, utilizando modelo hierarquizado. RESULTADOS: Aos sete dias, 21,3% das criancas usavam mamadeira e, aos 30 dias, 46,9%. Coabitacao com a avo materna esteve associada com uso de mamadeira tanto aos sete quanto aos 30 dias. Tambem estiveram associados ao uso de mamadeira aos sete dias: a mae ser adolescente e trauma mamilar na maternidade. Os outros dois fatores associados ao uso de mamadeira aos 30 dias foram trauma mamilar aos sete dias e uso de chupeta aos sete dias. Nao houve associacao entre tecnica de amamentacao ensinada na maternidade e uso de mamadeira, mas aos 30 dias, criancas que usavam mamadeira apresentaram tecnica menos adequada as que sugavam so no peito. CONCLUSOES: Os resultados mostram que a mamadeira foi bastante utilizada no primeiro mes de vida, principalmente: em criancas com maes adolescentes e com trauma mamilar, cujas avos maternas estavam presentes no domicilio e que faziam uso de chupeta. Alem dos efeitos negativos ja conhecidos, a mamadeira pode influenciar negativamente a tecnica de amamentacao.

Effect of Intervention to Improve Breastfeeding Technique on the Frequency of Exclusive Breastfeeding and Lactation-Related Problems

This randomized clinical trial compared frequencies of exclusive breastfeeding and lactationrelated problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward, and 137 controls. The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days (79.7% vs 82.5%, respectively) and 30 days (60.8% vs 53.3%). There was no difference between groups in the frequency of sore nipples at 7 and 30 days, in breast engorgement and mastitis, and in the quality of breastfeeding technique at 30 days. Therefore, a single intervention at maternity was not sufficient to improve breastfeeding technique, increase exclusive breastfeeding rates, and reduce the incidence of breastfeeding problems during the first month.

Influência da técnica de amamentação nas freqüências de aleitamento materno exclusivo e lesões mamilares no primeiro mês de lactação

OBJETIVO: Investigar a influencia da tecnica de amamentacao nas frequencias de aleitamento materno exclusivo e de lesoes mamilares no primeiro mes de lactacao. METODOS: Foram pesquisados parâmetros desfavoraveis a amamentacao (cinco relacionados ao posicionamento mae/bebe e tres a pega do bebe) em 211 maes/bebes na maternidade e, aos 30 dias, no domicilio. Foram comparadas as frequencias desses parâmetros entre as duplas com e sem amamentacao exclusiva aos 7 e 30 dias, e entre as maes com e sem lesoes mamilares na maternidade. RESULTADOS: O numero de parâmetros desfavoraveis na maternidade foi semelhante nas duplas com e sem amamentacao exclusiva aos 7 e 30 dias. Porem, aos 30 dias, foi, em media, menor nas duplas em amamentacao exclusiva, tanto no posicionamento (1,7±1,2 versus 2,2±1,1; p = 0,009) quanto na pega (1,0±0,6 versus 1,4±0,6; p < 0,001). O numero de parâmetros desfavoraveis de pega na maternidade foi semelhante entre as mulheres com e sem lesao mamilar, porem as mulheres sem essa complicacao apresentaram um numero maior de parâmetros desfavoraveis de posicionamento (2,0±1,4 versus 1,4±1,2; p = 0,04). CONCLUSOES: As frequencias de amamentacao exclusiva no primeiro mes e de lesoes mamilares nao foram influenciadas pela tecnica de amamentacao na maternidade, mas houve associacao entre melhor tecnica aos 30 dias e pratica da amamentacao exclusiva. Novos estudos poderao elucidar se uma melhora da tecnica ao longo do tempo seria responsavel pela manutencao da amamentacao exclusiva ou se a introducao de mamadeira exerceria efeito negativo na tecnica.

Impact of a strategy to prevent the introduction of non-breast milk and complementary foods during the first 6 months of life: A randomized clinical trial with adolescent mothers and grandmothers

INTRODUCTION Although the disadvantages of introducing non-breast milk and the early introduction of complementary foods are known, such practices are common worldwide. OBJECTIVE To evaluate the efficacy of counseling about breastfeeding and complementary feeding in preventing the introduction of non-breast milk and complementary foods in the first 6 months. METHODS This randomized clinical trial enrolled 323 adolescent mothers and their newborns and 169 maternal grandmothers; 163 mothers and 88 grandmothers received five counseling sessions on breastfeeding while in the hospital and at 7, 15, 30, and 60 days, and one session on complementary feeding at 120 days. Data about infant feeding were collected monthly. The impact was evaluated by comparing the Kaplan-Meier survival curves for the time of introduction of non-breast milk and complementary foods of the control and intervention groups. Median time of introduction of milk was calculated in the two groups. RESULTS The survival curves showed that the intervention postponed the introduction of non-breast milk and complementary foods. At 4 months, 41% (95% CI, 32.8-49.2) of the infants in the control group received complementary foods in comparison to 22.8% (95% CI, 15.9-29.7) of the intervention group. Counseling postponed the introduction of non-breast milk, which occurred at 95 days (95% CI, 8.7-111.3) in the control group and at 153 days (95% CI, 114.6-191.4) in the intervention group. CONCLUSIONS Counseling sessions on infants first 4 months were an efficacious strategy to prevent the introduction of non-breast milk and complementary foods in the 6 months of life.

Counselling sessions increased duration of exclusive breastfeeding: a randomized clinical trial with adolescent mothers and grandmothers

Background Considering that adolescent mothers may be more vulnerable to discontinuing exclusive breastfeeding (EBF) before 6 months and that their mothers may exert a negative influence on this practice, this study was conducted with the objective of evaluating the efficacy of breastfeeding counselling for adolescent mothers and their mothers in increasing EBF duration. Methods A clinical trial was performed in 323 adolescent mothers with newborns and their mothers randomized in four groups: (1) not living with mother, without intervention; (2) not living with mother, with intervention; (3) living with mother, without intervention, (4) living with mother, with intervention. The intervention consisted of five counselling sessions directed to mother and grandmother, in the maternity hospital and on follow-up. Information about feeding practices during the newborn’s first six months of life was collected monthly by telephone. Intervention’s efficacy was measured through Cox regression and comparison of exclusive breastfeeding medians and survival curves for the different groups. Results The intervention increased the duration of EBF by67 days for the group which included grandmothers (HR = 0.64; CI 95% = 0.46-0.90) and 46 days for the group which did not include grandmothers (HR = 0.52; CI 95% = 0.36-0.76). Conclusions Counselling sessions in the first four months of children’s lives proved to be effective in increasing EBF duration among adolescent mothers. Trial registration ClinicalTrials.gov NCT00910377.

Reduction of unnecessary intake of water and herbal teas on breast-fed infants: a randomized clinical trial with adolescent mothers and grandmothers.

PURPOSE To evaluate the efficacy of counseling sessions on breast-feeding for adolescent mothers and maternal grandmothers on the reduction of unnecessary water and herbal teas intake on breast-fed infants. METHODS A randomized clinical trial was conducted involving adolescent mothers, newborn infants, and maternal grandmothers allocated into four groups: mother and grandmother not cohabitating, without intervention; mother and grandmother not cohabitating, with intervention directed only toward mother; mother and grandmother cohabitating, without intervention; and mother and grandmother cohabitating, with intervention directed toward both. The intervention consisted of six counseling sessions on breastfeeding: in the maternity ward, and after birth on days 7, 15, 30, 60, and 120 at home. The data about feeding practices were collected by telephone every month until the end of the sixth month of the babys life. The effect of the intervention was measured by comparing the medians and the survival curves for initiation of water and/or tea intake in the first 6 months of life, and Cox regression was used to estimate its magnitude. RESULTS The intervention had a positive effect for the group in which the adolescent mothers cohabitated with the babys grandmother (hazard ratio = .53; 95% confidence interval = .35-.80), and also for the group in which they did not cohabitate with the babys grandmother (hazard ratio = .48; 95% confidence interval = .31-.76). By comparing the medians of the time of initiation of water and/or tea intake between control and intervention groups, it was observed that the intervention postponed the use of these liquids in 67 days in the group in which mothers and grandmothers cohabitated and in 44 days in the group in which they did not live together. CONCLUSION Multiple counseling sessions on infant feeding in the first 4 months postpartum for adolescent mothers and maternal grandmothers, when they cohabitate, proved to be an effective strategy to postpone the unnecessary water and/or tea intake of breast-fed infants.

A Controlled Study on Baby-Friendly Communities in Italy: Methods and Baseline Data

AIM This study reports the research methods and baseline data of a project aimed at assessing the effect of an intervention based on the 7 Steps of the Baby Friendly Community Initiative (BFCI) on the rate of exclusive breastfeeding at 6 months in Italy. SUBJECTS AND METHODS In this controlled, nonrandomized study, nine Local Health Authorities were assigned to an early and nine to a late intervention group. Data on breastfeeding in infants followed up from birth to 12 months were gathered at baseline and in two subsequent rounds, after the 7 Steps were implemented in the early and late intervention groups, respectively. Step-down logistic regression analysis, corrected for the cluster effect, was used to compare breastfeeding rates between groups. RESULTS At baseline, there were no significant differences in breastfeeding rates at birth (n=1,781) and at 3 (n=1,854), 6 (n=1,601), and 12 (n=1,510; loss to follow-up, 15.2%) months between groups. At birth, 96% of mothers initiated breastfeeding, 72% exclusively (recall from birth). At 3 months, 77% of infants were breastfed, 54% exclusively with 24-hour and 46% with 7-day recall. At 6 months, the rate of any breastfeeding was 62%, with 10% and 7% exclusive breastfeeding with 24-hour and 7-day recall, respectively. At 12 months, 31% of the children continued to breastfeed. CONCLUSIONS The project is ongoing and will allow estimation of the effect of the BFCI.

Effectiveness of the Baby Friendly Community Initiative in Italy: a non-randomised controlled study

Objective To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months. Design Controlled, non-randomised trial. Setting 18 Local Health Authorities in 9 regions of Italy. Participants 5094 mother/infant dyads in 3 cohorts were followed up to 12 months after birth in 3 rounds of data collection: at baseline, after implementation of the intervention in the early intervention group and after implementation in the late intervention group. 689 (14%) dyads did not complete the study. Intervention Implementation of the 7 steps of the BFCI. Main outcome measures The rate of exclusive breast feeding at 6 months was the primary outcome; breast feeding at discharge, 3 and 12 months was also measured. Results The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account. Conclusions The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.

Association between the degree of implementation of the Brazilian Breastfeeding Network and breastfeeding indicators

O objetivo foi avaliar a implantacao da Rede Amamenta Brasil e seu impacto sobre indicadores de aleitamento materno (AM). Realizou-se analise de implantacao de segundo tipo, incluindo 56 unidades basicas de saude (UBS) de tres municipios brasileiros. Para a avaliacao do grau de implantacao, criou-se um escore para cada UBS baseado no cumprimento dos criterios de certificacao do Ministerio da Saude; para a analise dos efeitos da implantacao, foram pesquisadas as prevalencias de amamentacao exclusiva e de amamentacao. Verificou-se que 18 (32,1%) UBS cumpriam os quatro criterios preconizados para certificacao. Foram incluidas no estudo 1.052 criancas menores de um ano, sendo 563 menores de seis meses. Verificou-se que as UBS que cumpriam os quatro criterios de certificacao tiveram maior prevalencia de amamentacao exclusiva (44%), quando comparadas as demais UBS. Dificuldades para a implantacao da Rede Amamenta Brasil foram identificadas, e os indicadores de AM variaram de acordo com o numero de criterios de certificacao cumpridos pelas UBS.This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.

Percepçöes e sentimentos do pai quanto a sua presença na sala de partos

O estudo faz a analise das percepcoes e sentimentos dos pais que assistiram ao nascimento do seu filho bem como daqueles que nao tiveram esta oportunidade. Foi aplicado um instrumento estruturado com perguntas abertas e fechadas, junto a 138 pois em um hospital de ensino de Porto Alegre. A partir dos resultados, ficaram evidenciados os sentimentos de alegria dos pais que assistiram ao parto e de desejo por parte daqueles aos quais nao foi oferecida esta oportunidade. Sugere investigar as percepcoes e sentimentos da mulher e da equipe de atendimento quanto a presenca do pai em sala de parto.