Probiotics May Help Colic in Breastfed But Not Formula Fed Babies

MedicalResearch.com Interview with:

Dr Valerie Sung MBBS (Hons) FRACP MPH PhD Department of Paediatrics The University of Melbourne Murdoch Childrens Research Institute Parkville, Australia

Dr. Sung

Dr Valerie Sung MBBS (Hons) FRACP MPH PhD
Department of Paediatrics
The University of Melbourne
Murdoch Childrens Research Institute
Parkville, Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Infant colic is excessive crying in babies less than 3 months old with no underlying medical cause. It affects 1 in 5 newborns, is very distressing, and is associated with maternal depression, Shaken Baby Syndrome, and early cessation of breastfeeding. Up to now, there has been no single effective treatment for colic. The probiotic Lactobacillus reuteri DSM 17938 has recently shown promise but results from trials have been conflicting. In particular, a previous trial from Australia, the largest in the world so far, did not find the probiotic to be effective in both breastfed and formula-fed infants with colic.

This international collaborative study, which collected raw data from 345 infants from existing trials from Italy, Poland, Canada and Australia, confirms Lactobacillus reuteri to be effective in breastfed infants with colic. However, it cannot be recommended for formula-fed infants with colic.

Compared to a placebo, the probiotic group was two times more likely to reduce crying by 50 per cent, by the 21st day of treatment, for the babies who were exclusively breastfed. The number needed to treat for day 21 success in breastfed infants was 2.6.

In contrast, the formula fed infants in the probiotic group seemed to do worse than the placebo group, but the numbers for this group were limited.

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Should Money Be Used To Encourage Breastfeeding?

MedicalResearch.com Interview with:
“Breastfeeding welcome here” by Newtown grafitti is licensed under CC BY 2.0
Clare Relton, PhD
School of Health and Related Research
University of Sheffield, Sheffield, England

MedicalResearch.com: What are the key findings of your report?

Response: Our five year research project explored whether offering financial incentives (shopping vouchers) for breastfeeding increased breastfeeding. We studied what happened to breastfeeding rates at 6 to 8 weeks post-partum in areas in England with low (<40%) breastfeeding prevalence. Our cluster randomized clinical trial (which included 10 010 mother-infant dyads) showed that areas with the financial incentive had significantly higher rates of breastfeeding at 6 to 8 weeks (37.9% vs 31.7%) compared to usual care.

The financial incentive scheme was widely acceptable to healthcare providers (midwives, health visitors, doctors) and mothers. The financial incentives made it easier for everyone to discuss breastfeeding and mothers reported feeling valued (supported and rewarded) for breastfeeding.

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Affordable Care Act Linked To Increased Duration of BreastFeeding

MedicalResearch.com Interview with:
“Babies at Brunch!” by TJ DeGroat is licensed under CC BY 2.0
Kandice A. Kapinos, Ph.D.
Economist
Professor
RAND Corporation
Pardee RAND Graduate School

MedicalResearch.com: What is the background for this study?

Response: In the U.S., we have relatively high rates of breastfeeding initiation – about 80% of mothers will attempt breastfeeding, but rates drop off precipitously in the first few months of an infant’s life. There are tremendous health benefits for both the mother and child from breastfeeding and estimates of significant cost savings from diseases prevented from breastfeeding. However, breastfeeding can be difficult, especially when you need to return to work or school. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months, but only 22% of mothers breastfeed exclusively for 6 months.

My coauthors, Tami Gurley-Calvez and Lindsey Bullinger, and I were interested in evaluating provisions in recent healthcare legislation (the Affordable Care Act) that required private insurers to cover lactation support services, including breast pumps and visits with lactation consultants, without cost-sharing.

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C-Section and Formula-Fed Babies Have Different Microbiome From Breastfed or Vaginal Births

MedicalResearch.com Interview with:

Anita Kozyrskyj, PhD, Professor Dept Pediatrics Faculty of Medicine & Dentistry, University of Alberta Edmonton, AB   

Dr. Kozyrskyj

Anita Kozyrskyj, PhD, Professor
Dept Pediatrics
Faculty of Medicine & Dentistry, University of Alberta
Edmonton, AB   

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The first year of an infant’s life is a critical time for the development of his or her gut microbiome. Gut microbes not only help infants digest food, but they also “train” their developing immune system. An infant’s environment, from the type of birth and infant diet to use of antibiotics, has a large impact in determining which microbes are present. Frequently these early life exposures occur together. Using data from AllerGen’s CHILD birth cohort and a new analytical approach —called Significance Analysis of Microarrays—we quantified changes to gut microbiota throughout the first year of life according to common combinations of early life exposures.

We found that, compared to vaginally-born and breastfed infants, formula-fed or cesarean-delivered infants had different trajectories of microbial colonization in later infancy, which could have implications for their future health.

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Longer Breastfeeding Linked To Lower Risk of Endometriosis

MedicalResearch.com Interview with:

Leslie V. Farland, ScD Assistant Director of Epidemiologic Research Center for Infertility and Reproductive Surgery Brigham and Women's Hospital | Harvard Medical School  Instructor | Harvard T.H. Chan School of Public Health

Dr. Farland

Leslie V. Farland, ScD
Assistant Director of Epidemiologic Research
Center for Infertility and Reproductive Surgery
Brigham and Women’s Hospital | Harvard Medical School
Instructor | Harvard T.H. Chan School of Public Health

MedicalResearch.com: What is the background for this study?

Response: Endometriosis is chronic gynecologic condition that affects approximately ten percent of women. Women with endometriosis can experience painful menstrual periods, general chronic pelvic pain, and pain associated with intercourse. Currently we know very few modifiable risk factors for endometriosis.

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Babies Find Nipples To Nurse Because of Higher Areolar Temperature

MedicalResearch.com Interview with:
Francesca Volpe Psy.D and Prof. Vincenzo Zanardo Division of Perinatal Medicine, Policlinico Abano Terme Abano Terme, Italy
Francesca Volpe Psy.D and
Prof. Vincenzo Zanardo
Division of Perinatal Medicine, Policlinico Abano Terme
Abano Terme, Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Newborn infants, placed skin-to-skin on their mother’s chest instinctively have the ability to crawl to their mother’s breast, exploring with their hands and massaging the breast to support the first feed.  Left undisturbed, the infant will make several attempts until it finds and latches onto the nipple and begins to nurse.

What leads mammalian infants who are placed on their mothers’ chests to seek out, without any assistance, the nipple and to attach themselves to it to nurse is not fully understood. When we turned our attention to the thermal properties of the female’s nipple-areolar complex (NAC) in lactating mothers soon after birth, we found that it had a higher temperature and pH value and lower elasticity with respect to the surrounding breast skin. We hypothesised that the higher temperature could help the newborn infant to locate the nipple and to latch onto it, leading to the first sucking experience.  In addition, the diffusion of odorous molecules is presumably enhanced by the relatively high surface temperature of the areola in view of the rich supply of blood capillaries that irrigate the region. There is, in fact, some scientific evidence that show that infants respond to the odours released by the breasts of lactating women; breast odours, which are enhanced by the skin’s greater warmth, are another factor that facilitates breastfeeding by helping the infant to recognize its mother participating in the mother-to-infant bonding.

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Women From High Income Countries Less Likely To Exclusively Breastfeed

MedicalResearch.com Interview with:

Dr. Alison McFadden, PhD Senior Research Fellow School of Nursing & Health Sciences University of Dundee

Dr. McFadden

Dr. Alison McFadden, PhD
Senior Research Fellow
School of Nursing & Health Sciences
University of Dundee

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The World Health Organization recommends that infants should be breastfed exclusively until six months of age with breastfeeding continuing as an important part of the infant’s diet until he or she is at least two years old. Breastfeeding has an important impact on the short-term and long-term health of both infants and their mothers. There is good evidence that not breastfeeding increases mortality and morbidity due to infectious diseases. Not breastfeeding is also associated with increases in hospitalisation for problems such as gastroenteritis, respiratory disease, and ear infections, as well as higher rates of childhood diabetes, obesity and dental disease.

Breastfeeding is also important for women’s health. It’s been found that not breastfeeding is associated with increased risks of breast and ovarian cancer, and diabetes. Few health behaviours have such a broad-spectrum and long-lasting impact on population health, with the potential to improve life chances, health and well-being. It has been estimated that each year, 823,000 deaths in children under five years and 20,000 deaths from breast cancer could be prevented by near universal breastfeeding.

However, many women stop breastfeeding before they want to as a result of the problems they encounter. Current breastfeeding rates in many countries do not reflect the WHO recommendation. Only around 37% of babies under six months worldwide are exclusively breastfed, and in many high and middle income countries, the rates are much lower. Good care and support may help women solve these problems so that they can continue to breastfeed.

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Which Religious Group Breastfeeds More? Protestants or Catholics?

MedicalResearch.com Interview with:
Jonathan Y. Bernard, PhD

Inserm UMRS 1153 – Centre for research in Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS)
Team ORCHAD: early Origin of the Child Health And Development
Hôpital Paul Brousse

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Despite the World Health Organization’s recommendations promoting breast feeding, wide variations in breast feeding initiation rates are observed among Western countries: some reach >95%, while others remain <80%. Many individual-level determinants of breast feeding are known, including maternal age, education, ethnicity, smoking and employment status. Less is known regarding cultural determinants, such as religion, which could be underlying and explain rate differences between and within countries.

We aimed at comparing countries’ breast feeding rates with the proportions of Catholics and Protestants. We thus carried out an ecological study by collating publicly available online data for 135 countries. We additionally gathered within-country data for 5 Western nations: France, Ireland, the UK, Canada and the USA.

We found that, in Western countries, the proportion of Catholics was negatively correlated with the rate of breast feeding. This was also observed within countries in France, Ireland, the UK and Canada. In the USA, where breast feeding rates vary hugely between states, race was an important confounder. Interestingly, we also found the correlation in non-Hispanic whites. All our findings hold even when we account for wealth indicators, such as gross domestic product per capita.

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Breastfeeding Important For Mothers’ Health As Well As Babies

MedicalResearch.com Interview with:

Melissa C. Bartick, MD, MSc Department of Medicine Cambridge Health Alliance Harvard Medical School Cambridge, MA

Dr. Melissa Bartick

Melissa C. Bartick, MD, MSc
Department of Medicine
Cambridge Health Alliance
Harvard Medical School
Cambridge, MA

MedicalResearch.com: What is the background for this study?

Response: This is the first study ever to combine maternal and pediatric health outcomes from breastfeeding into a single model.

We had published a cost analysis of suboptimal breastfeeding for pediatric disease in 2010, which found that suboptimal breastfeeding cost the US $13 billion in costs of premature death costs and medical expenses, and 911 excess deaths. We followed that up with a maternal cost analysis which found about $18 billion in premature death costs and medical expenses.

In both these studies, most of the costs were from premature death. We were unable to combine the results of these two studies because their methodologies were different, and both of them, especially the pediatric portion needed to be updated.

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Comparing Benefits of Donor Breast Milk to Formula For Very Low Birth Weight Babies

MedicalResearch.com Interview with:
Dr. Sharon Unger BSc, MD, FRCP

Staff Neonatologist at Mount Sinai Hospital
Associate Staff Neonatologist at The Hospital for Sick Children (SickKids)
Associate Professor in the Department of Paediatrics at the University of Toronto.
Medical Director of the Rogers Hixon Ontario Human Milk Bank and
Dr. Deborah L. O’Connor PhD, RD
Senior Associate Scientist in Physiology & Experimental Medicine
SickKids and Professor
Department of Nutritional Sciences at the University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Babies who are born very early (before 32 weeks’ gestation) and/or at very low weights (less than 1,500 grams) are among the most fragile of all paediatric patients, typically facing serious medical issues and requiring care in a Neonatal Intensive Care Unit (NICU). In addition to underdeveloped organs and risk of neurodevelopmental issues, preterm and very low birth weight babies are at risk of a severe bowel emergency called necrotizing enterocolitis, which involves the damage and potential destruction of the intestinal tissue. This disease affects approximately six per cent of very low birth weight infants each year, making it one of the most common causes of death and long-term complications in this population.

As a neonatologist and a PhD-trained dietitian, we have spent our careers working to improve outcomes for babies and supporting breastfeeding. While there is already strong evidence to suggest that breastfeeding is associated with a variety of benefits including reduced risk of childhood infections and may play a role in the prevention of overweight and diabetes, in healthy, full-term infants, we launched a research program a decade ago to figure out how to ensure the same advantage could be provided to vulnerable hospitalized infants, specifically very low birth weight infants.

Breastfeeding initiation rates in Canada are now at all-time high for healthy newborns, but for many reasons related to preterm birth, up to two thirds of mothers of very low birth weight infants are unable to provide a sufficient volume of breast milk to their infant. A variety of factors may limit breast milk production in these cases, including immaturity of the breast cells that make milk, maternal illness, breast pump dependency, and stress. In addition to the health benefits attributed to mother’s milk for full-term, healthy infants, previous studies have shown that use of mother’s milk in very low birth weight infants is associated with a reduction in necrotizing enterocolitis. It is also associated with a reduction in severe infection, improved feeding tolerance and more rapid hospital discharge.

Ten years ago, along with our inter-professional colleagues at 21 NICUs in the Greater Toronto and Hamilton areas, we began to examine whether using donor breast milk as a supplement to mother’s milk would improve health outcomes of very low birth weight infants when mother’s milk was not available.
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