Bruce W. Hollis, Carol L. Wagner, Cynthia R. Howard, Myla Ebeling, Judy R. Shary, Pamela G. Smith, Sarah N. Taylor, Kristen Morella, Ruth A. Lawrence, Thomas C. Hulsey.
Mostrando entradas con la etiqueta Lactancia materna. Mostrar todas las entradas
Mostrando entradas con la etiqueta Lactancia materna. Mostrar todas las entradas
2.10.15
19.5.13
Association between total duration of breastfeeding and iron deficiency.
Maguire JL, Salehi L, Birken CS, Carsley S, Mamdani M, Thorpe KE, Lebovic G,
Khovratovich M, Parkin PC; TARGet Kids! collaboration.
MSc, FRCPC, Department of Pediatrics, St Michael's Hospital, 30 Bond St,
15CC-014, Toronto ON M5B 1W8 Canada. jonathon.maguire@utoronto.ca.
OBJECTIVE: To determine whether there is an association between the total breastfeeding duration and iron stores, iron deficiency, and iron deficiency anemia in healthy urban children.
METHODS: A cross-sectional study of healthy children, aged 1 to 6 years, seen for primary health care between December 2008 and July 2011 was conducted through the TARGet Kids! practice-based research network. Univariate and adjusted regression analyses were used to evaluate an association between total breastfeeding duration and serum ferritin, iron deficiency, and iron deficiency anemia.
RESULTS: Included were 1647 healthy children (median age 36 months) with survey, anthropometric, and laboratory data. An association was found between increasing duration of breastfeeding and lower serum ferritin (P = .0015). Adjusted logistic regression analysis revealed the odds of iron deficiency increased by 4.8% (95% confidence interval: 2%-8%) for each additional month of breastfeeding.
Exploratory analysis suggested an increasing cumulative probability of iron deficiency with longer total breastfeeding duration with an adjusted odds ratio of 1.71 (95% confidence interval: 1.05-2.79) for iron deficiency in children breastfed over versus under 12 months of age. The relationship between total breastfeeding duration and iron deficiency anemia did not meet statistical significance.
CONCLUSIONS: Increased total breastfeeding duration is associated with decreased iron stores, a clinically important association warranting additional investigation.
12.4.13
Pacifier Restriction and Exclusive Breastfeeding.
- Laura R. Kair, MDa,
- Daniel Kenron, MSIEb,
- Konnette Etheredge, RN, MSNc,
- Arthur C. Jaffe, MDa, and
- Carrie A. Phillipi, MD, PhDa
ABSTRACT
OBJECTIVE: We tested the hypothesis that removing pacifiers from routine distribution in our mother-baby unit (MBU) would be associated with greater breastfeeding initiation or exclusivity during the birth hospitalization.METHODS: We retrospectively compared exclusive breastfeeding, breastfeeding plus supplemental formula feeding, and exclusive formula feeding rates for 2249 infants admitted to the MBU at our university teaching hospital during the 5 months before and 8 months after restriction of routine pacifier distribution. Formula supplementation, if not medically indicated, was discouraged per standard practice, but access to formula was not restricted.RESULTS: Of the 2249 infants, 79% were exclusively breastfed from July through November 2010, when pacifiers were routinely distributed. During the 8-month period after pacifier restriction, this proportion decreased significantly to 68% (P < .001). A corresponding increase from 18% to 28% was observed in the number of breastfed infants receiving supplemental formula feeds in the same period (P < .001). During the study period, the proportion of exclusively formula-fed infants increased from 1.8% to 3.4% (P < .05).CONCLUSIONS: Restricting pacifier distribution during the newborn hospitalization without also restricting access to formula was associated with decreased exclusive breastfeeding, increased supplemental formula feeding, and increased exclusive formula feeding. Because high-quality, prospective medical literature addressing pacifier use and breastfeeding does not conclusively show an adverse relationship in women who are motivated to breastfeed, more studies are needed to help determine what effect, if any, pacifiers have on breastfeeding initiation and exclusivity in the immediate newborn period.
20.9.12
Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding
Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. The Cochrane Library 2012, Issue 7
Abstract
Background
Objectives
Search methods
Selection criteria
Data collection and analysis
Main results
Authors' conclusions
Plain language summary
Effect of pacifier use on duration of breastfeeding in full-term infants
Our review concluded that for mothers who are motivated to breastfeed their infants, pacifier use before or after breastfeeding was established did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. The review provided moderate evidence from three randomised controlled trials (involving 1915 babies) comparing unrestricted with restricted pacifier use by healthy, full-term breastfeeding infants; two of the trials (1302 babies) were included in the analysis. However, there is a widespread belief that pacifiers may interfere with breast milk production and lead to discontinuation of breastfeeding.
21.2.12
Breastfeeding the late preterm infant (340/7 to 366/7 weeks gestation)
Purpose
1. Allow the late preterm infant to breastfeed and/or
breastmilk feed to the greatest extent possible.
2. Heighten awareness of difficulties that late preterm infants
and their mothers may experience with breastfeeding.
3. Offer strategies to anticipate, identify promptly, and
manage breastfeeding problems that the late preterm
infant and mother may experience in the inpatient and
outpatient settings.
4. Prevent medical problems such as dehydration, hypoglycemia, hyperbilirubinemia, and failure to thrive in
the late preterm infant.
5. Maintain awareness of mothers’ needs, understanding
of current plans, and ability to cope.
Guideline Summaries
Academy of Breastfeeding Medicine
Texto completo en : http://www.bfmed.org/Media/Files/Protocols/Protocol%2010%20Revised%20English%206.11.pdf
1. Allow the late preterm infant to breastfeed and/or
breastmilk feed to the greatest extent possible.
2. Heighten awareness of difficulties that late preterm infants
and their mothers may experience with breastfeeding.
3. Offer strategies to anticipate, identify promptly, and
manage breastfeeding problems that the late preterm
infant and mother may experience in the inpatient and
outpatient settings.
4. Prevent medical problems such as dehydration, hypoglycemia, hyperbilirubinemia, and failure to thrive in
the late preterm infant.
5. Maintain awareness of mothers’ needs, understanding
of current plans, and ability to cope.
5.2.12
Exclusive breastfeeding duration and cardiorespiratory fitness in children and adolescents.
Am J Clin Nutr February 2012 vol. 95 no. 2 498-505
- Idoia Labayen,
- Jonatan R Ruiz,
- Francisco B Ortega,
- Helle M Loit,
- Jaanus Harro,
- Inga Villa,
- Toomas Veidebaum, and
- Michael Sjostrom
- Un estudio desarrollado por la UPV/EHU y el Instituto Karolinska de Estocolmo ha concluido que los niños y adolescentes que han recibido lactancia materna tiene un 6% menos de riesgo cardiovascular y presentan mejores valores en capacidad aeróbica, niveles de colesterol, inflamación o presión sistólica.,Los estudios han sido publicados por Idoia Labayen, profesora de nutrición en la Facultad de Farmacia en la UPV/EHU en la edición de enero de la revista “American Journal of Clinical Nutrition” y en “Archives of Pediatrics and Adolescent Medicine”.Para la realización de las distintas pruebas, la investigación ha contado con la colaboración de personal médico sueco y estonio que ha realizado exámenes de salud a 1.025 niños de 9 y 10 años, y 971 adolescentes de 15 y 16 años en sus respectivos países. De forma previa al estudio, se les preguntaba a las madres si sus hijos habían sido exclusivamente alimentados mediante lactancia materna y, de haberlo hecho, durante cuánto tiempo.En las pruebas, además de tomar talla y peso, se realizaron análisis de sangre en los que se detectaron los valores de inflamación o el fibrinógeno, cuya presencia se relaciona con una mayor coagulación de la sangre, lo que aumenta el riesgo de arterosclerosis. Asimismo, se midió la capacidad aeróbica de los participantes mediante pruebas de esfuerzo.A falta de estudios posteriores sobre periodos de lactancia más largos que lo confirmen, la investigación en la que ha participado Labayen indica que los beneficios máximos de la lactancia materna se alcanzan a los tres meses ya que no se aprecian diferencias significativas entre el tercer y sexto mes. A partir del sexto mes, además, los niños ya no se alimentan exclusivamente de leche, sino que empiezan a diversificar su alimentación.Desde la universidad, han destacado que este estudio en niños y adolescentes suecos y estonios "habría sido difícil de realizar en España porque normalmente en este país las madres no suelen llegar a cumplir esos tres meses de lactancia". Por el contrario, en los países nórdicos "se favorece mucho la existencia de lactancia materna, con bajas maternales de hasta dos años además de ayudas sanitarias de enfermeras que se desplazan a las casas a ayudar y recomendar a las madres sobre la mejor manera de dar el pecho".Labayen ha indicado que en España, "aunque muchas madres lo intentan, se da un fracaso elevadísimo en los primeros quince días, cuestión que se podría resolver con un adecuado asesoramiento y apoyo a las madres lactantes". Además, ha resaltado que las madres también abandonan esta práctica en el tercer mes porque "tienen que empezar a trabajar". No obstante, ha apuntado que, "al menos", en el caso de España "hay buenas leches de fórmula", si bien "no mejoran la salud cardiovascular".A juicio de la investigadora, la lactancia materna "puede llegar a ser una cuestión de vida o muerte en muchos lugares del tercer mundo en donde se multiplican los problemas que puede haber con la preparación y esterilización de un biberón".La colaboración de este equipo europeo investigador ha estado centrada en el estudio de la influencia en la salud de los momentos inmediatamente anterior y posterior al parto, además de en la lactancia materna. En los próximos meses, pretenden dirigir el peso de sus investigaciones hacia los niños que al nacer con menos peso tienen un mayor riesgo de padecer alguna enfermedad cardiovascular. Sus investigaciones intentarán conocer si ese mayor riesgo, de algún modo, puede ser compensado con la lactancia materna. Además, el equipo seguirá observando al grupo de niños suecos y estonios que han participado en el estudio sobre lactancia para conocer las posibles variaciones en su riesgo cardiovascular a medida que vayan creciendo.
29.8.11
Non-pharmacologic management of procedure-related pain in the breastfeeding infant.
Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #23: Non-pharmacologic management of procedure-related pain in the breastfeeding infant. Breastfeed Med 2010 Dec;5(6):315-9.
Major Recommendations
Soothing the Newborn
There are several techniques that have been shown to provide pain relief for newborns (0–28 days of age) undergoing painful procedures. In breastfed newborns, breastfeeding itself is the preferred method to alleviate procedural pain. In addition to being safe, effective, natural, and without added cost, it provides an additional opportunity to promote and support breastfeeding. The individual components of breastfeeding (sucking, sweet taste, and warm contact) may be used separately or, preferably, in combinations when breastfeeding itself is not possible.
Breastfeeding or Human Milk
When available, breastfeeding should be the first choice to alleviate procedural pain in neonates undergoing a single painful procedure, such as venipuncture or heel lance (Codipietro, Ceccarelli, & Ponzone, 2008; Carbajal et al., 2003; Gray et al., 2002). Breastfeeding should not be discontinued prior to the procedure. Studies show that when breastfeeding was stopped shortly before a painful procedure, no significant differences were found (compared to control groups) in outcomes in terms of the orogustatory, emotional, tactile, or thermal experience (Gradin, Finnstrom, & Schollin, 2004). When breastfeeding is not possible, whether because of the unavailability of the mother or difficulties with breastfeeding, consider the use of expressed human milk by dropper, syringe, or bottle, which has been shown to soothe newborns experiencing procedural pain (Mathew & Mathew, 2003; Upadhyay et al., 2004; Taddio et al., 2008; Shah, Aliwalas, & Shah, 2006). Administration of human milk can also be combined with sucking, by dipping a pacifier (dummy) in the milk, as described below for sucrose.
Although some studies have demonstrated the efficacy of human milk alone (Upadhyay et al., 2004; Shah, Aliwalas, & Shah, 2007), human milk may not be equivalent to breastfeeding because of breastfeeding's multicomponent experience. Breastfeeding throughout the painful procedure is likely to be superior to human milk alone on the basis of synergism between the components of breastfeeding (Gradin, Finnstrom, & Schollin, 2004; Shah, Aliwalas, & Shah, 2007).
Skin-to-Skin Contact
Coordinating a breastfeeding session with the timing of the procedure is best, but, if this is not possible, skin-to-skin contact can comfort infants undergoing a procedure such as a heel lance. Skin-to-skin contact also gives the mother a caretaking role during the procedure that is unobtrusive, and by diminishing infant stress, it can increase maternal confidence as to her value to the infant (Gray, Watt, & Blass, 2000).
Parental contact and sucrose may act synergistically to reduce pain in neonates. Therefore if feasible, this combination can be employed (Schechter et al., 2007). Sucrose taste—first studied 20 years ago—is readily available for increasing the efficacy of other non-pharmacologic techniques (Gradin, Finnstrom, & Schollin, 2004). Sucrose administration is covered in more detail in the section below. Sucrose and pacifier can both be combined with the skin-to-skin component of parental contact.
Sucrose and Sucking (in Combination or Separately)
Sucrose taste has been shown to be effective analgesia for newborns and young infants for minor procedures, but not for more painful experiences like bladder catheterizations:
Sucrose and pacifier. The combination of oral sucrose and pacifier or non-nutritive sucking is remarkably soothing (Blass & Watt, 1999). This technique offers pain reduction to infants undergoing a wide variety of painful procedures, including heel lance, umbilical or percutaneous venous or arterial catheter insertion, central venous line placement, subcutaneous or intramuscular injection, lumbar puncture, circumcision, and endotracheal suction (Anand, 2001; Stevens, Yamada, & Ohlsson, 2004; Stevens et al., 2005). Because pain reduction achieved when using both sucrose and non-nutritive sucking is similar to that with breastfeeding, using a pacifier (dummy) dipped in 24% sucrose (by weight) solution whenever breastfeeding is not possible is an effective option (Blass & Watt, 1999; Akman et al., 2002). Sucrose administration should begin 2 minutes prior to the procedure. If use of a pacifier is not an available or acceptable option, sucrose can also be combined with sucking by dipping a clean, gloved (or non-gloved parental) finger in the sucrose solution. If sucking a pacifier or finger is not an option, administer a sucrose solution orally before the procedure (Anand, 2001). When parents are present, they should be educated that sweet substances other than breast milk and pacifiers both are recommended in the newborn period only for procedural pain.
Glucose versus sucrose. Glucose has also been shown to be an acceptable and effective alternative analgesic (Axelin et al., 2009; Idam-Siuriun et al., 2008). Taste difference is not a factor. Studies in rat (Blass & Shide, 1994) and human (Okan et al., 2007) newborns have not shown a preference for sucrose over glucose. The commercial availability of sucrose (table sugar) may have increased its use.
Sucrose by syringe. If use of a pacifier is not possible, administer 0.5–2mL of a 24% sucrose solution orally via syringe 2 minutes before the painful procedure (Anand, 2001; Shann, 2007). Several 24% sucrose solutions are commercially available. Sucrose administered by oro- or nasogastric tube is not analgesic.
Pacifier alone. While pacifiers alone may decrease crying associated with painful procedures, they do not have the same effect on physiological parameters such as heart rate or vagal tone (Taddio, 2001: Porges & Lipsitt, 1993). Moreover, sucking a pacifier has been found to reduce pain only when the suck rate exceeds 30 sucks/minute (Stevens, Yamada, & Ohlsson, 2004). A pacifier (or clean gloved or parental finger) should be used as the sole soothing intervention only if breastfeeding, human milk, sucrose (or glucose), and skin-to-skin contact are unavailable because non-nutritive sucking has consistently been found to be better than no intervention at all (Pinelli, Symington, & Ciliska, 2002).
Sucrose better than human milk? At least one study indicates that sucrose is more effective than human milk, when both are administered orally via syringe, at reducing infants' cry time, recovery time (heart rate peak returns to baseline), and change in heart rate (Ors et al., 1999). The sugar in human milk is lactose, which has been shown to be an ineffective analgesic agent (Blass & Shide, 1994). The analgesic component of human milk may be attributed to its fat content or other constituent
Y SIGUE.../...
Major Recommendations
Soothing the Newborn
There are several techniques that have been shown to provide pain relief for newborns (0–28 days of age) undergoing painful procedures. In breastfed newborns, breastfeeding itself is the preferred method to alleviate procedural pain. In addition to being safe, effective, natural, and without added cost, it provides an additional opportunity to promote and support breastfeeding. The individual components of breastfeeding (sucking, sweet taste, and warm contact) may be used separately or, preferably, in combinations when breastfeeding itself is not possible.
Breastfeeding or Human Milk
When available, breastfeeding should be the first choice to alleviate procedural pain in neonates undergoing a single painful procedure, such as venipuncture or heel lance (Codipietro, Ceccarelli, & Ponzone, 2008; Carbajal et al., 2003; Gray et al., 2002). Breastfeeding should not be discontinued prior to the procedure. Studies show that when breastfeeding was stopped shortly before a painful procedure, no significant differences were found (compared to control groups) in outcomes in terms of the orogustatory, emotional, tactile, or thermal experience (Gradin, Finnstrom, & Schollin, 2004). When breastfeeding is not possible, whether because of the unavailability of the mother or difficulties with breastfeeding, consider the use of expressed human milk by dropper, syringe, or bottle, which has been shown to soothe newborns experiencing procedural pain (Mathew & Mathew, 2003; Upadhyay et al., 2004; Taddio et al., 2008; Shah, Aliwalas, & Shah, 2006). Administration of human milk can also be combined with sucking, by dipping a pacifier (dummy) in the milk, as described below for sucrose.
Although some studies have demonstrated the efficacy of human milk alone (Upadhyay et al., 2004; Shah, Aliwalas, & Shah, 2007), human milk may not be equivalent to breastfeeding because of breastfeeding's multicomponent experience. Breastfeeding throughout the painful procedure is likely to be superior to human milk alone on the basis of synergism between the components of breastfeeding (Gradin, Finnstrom, & Schollin, 2004; Shah, Aliwalas, & Shah, 2007).
Skin-to-Skin Contact
Coordinating a breastfeeding session with the timing of the procedure is best, but, if this is not possible, skin-to-skin contact can comfort infants undergoing a procedure such as a heel lance. Skin-to-skin contact also gives the mother a caretaking role during the procedure that is unobtrusive, and by diminishing infant stress, it can increase maternal confidence as to her value to the infant (Gray, Watt, & Blass, 2000).
Parental contact and sucrose may act synergistically to reduce pain in neonates. Therefore if feasible, this combination can be employed (Schechter et al., 2007). Sucrose taste—first studied 20 years ago—is readily available for increasing the efficacy of other non-pharmacologic techniques (Gradin, Finnstrom, & Schollin, 2004). Sucrose administration is covered in more detail in the section below. Sucrose and pacifier can both be combined with the skin-to-skin component of parental contact.
Sucrose and Sucking (in Combination or Separately)
Sucrose taste has been shown to be effective analgesia for newborns and young infants for minor procedures, but not for more painful experiences like bladder catheterizations:
Sucrose and pacifier. The combination of oral sucrose and pacifier or non-nutritive sucking is remarkably soothing (Blass & Watt, 1999). This technique offers pain reduction to infants undergoing a wide variety of painful procedures, including heel lance, umbilical or percutaneous venous or arterial catheter insertion, central venous line placement, subcutaneous or intramuscular injection, lumbar puncture, circumcision, and endotracheal suction (Anand, 2001; Stevens, Yamada, & Ohlsson, 2004; Stevens et al., 2005). Because pain reduction achieved when using both sucrose and non-nutritive sucking is similar to that with breastfeeding, using a pacifier (dummy) dipped in 24% sucrose (by weight) solution whenever breastfeeding is not possible is an effective option (Blass & Watt, 1999; Akman et al., 2002). Sucrose administration should begin 2 minutes prior to the procedure. If use of a pacifier is not an available or acceptable option, sucrose can also be combined with sucking by dipping a clean, gloved (or non-gloved parental) finger in the sucrose solution. If sucking a pacifier or finger is not an option, administer a sucrose solution orally before the procedure (Anand, 2001). When parents are present, they should be educated that sweet substances other than breast milk and pacifiers both are recommended in the newborn period only for procedural pain.
Glucose versus sucrose. Glucose has also been shown to be an acceptable and effective alternative analgesic (Axelin et al., 2009; Idam-Siuriun et al., 2008). Taste difference is not a factor. Studies in rat (Blass & Shide, 1994) and human (Okan et al., 2007) newborns have not shown a preference for sucrose over glucose. The commercial availability of sucrose (table sugar) may have increased its use.
Sucrose by syringe. If use of a pacifier is not possible, administer 0.5–2mL of a 24% sucrose solution orally via syringe 2 minutes before the painful procedure (Anand, 2001; Shann, 2007). Several 24% sucrose solutions are commercially available. Sucrose administered by oro- or nasogastric tube is not analgesic.
Pacifier alone. While pacifiers alone may decrease crying associated with painful procedures, they do not have the same effect on physiological parameters such as heart rate or vagal tone (Taddio, 2001: Porges & Lipsitt, 1993). Moreover, sucking a pacifier has been found to reduce pain only when the suck rate exceeds 30 sucks/minute (Stevens, Yamada, & Ohlsson, 2004). A pacifier (or clean gloved or parental finger) should be used as the sole soothing intervention only if breastfeeding, human milk, sucrose (or glucose), and skin-to-skin contact are unavailable because non-nutritive sucking has consistently been found to be better than no intervention at all (Pinelli, Symington, & Ciliska, 2002).
Sucrose better than human milk? At least one study indicates that sucrose is more effective than human milk, when both are administered orally via syringe, at reducing infants' cry time, recovery time (heart rate peak returns to baseline), and change in heart rate (Ors et al., 1999). The sugar in human milk is lactose, which has been shown to be an ineffective analgesic agent (Blass & Shide, 1994). The analgesic component of human milk may be attributed to its fat content or other constituent
Y SIGUE.../...
28.3.11
Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding
Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding
Jaafar SH, Jahanfar S, Angolkar M, Ho JJ
Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD007202. DOI: 10.1002/14651858.CD007202.pub2
Effect of pacifier use on duration of breastfeeding in full-term infants
Breast milk is superior to other baby foods in providing balanced nutrition and protection against allergy and infection to newborns. Breastfeeding is recommended by the World Health Organization, exclusively in the first six months and then as a dietary supplement. Breastmilk production and supply are maintained by frequent suckling of the breast and nipple stimulation. A pacifier is a non-nutritive sucking device used to calm an infant that has become a cultural norm in many parts of the world. However there is a widespread belief that pacifiers may interfere with breast milk production and lead to discontinuation of breastfeeding.
Our review concluded that for mothers who are motivated to breastfeed their infants, pacifier use before or after breastfeeding was established did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. The review provided moderate evidence from three randomised controlled trials (involving 1915 babies) comparing pacifier use and no pacifier use by healthy, full-term breastfeeding infants; two of the trials (1302 babies) were included in the analysis. However, there is a widespread belief that pacifiers may interfere with breast milk production and lead to discontinuation of breastfeeding.
Abstract
Background
To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast milk production and shorten duration of breastfeeding; however, this remains unclear.
Objectives
To assess the effect of pacifier use versus no pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).
Selection criteria
Randomised and quasi-randomised controlled trials comparing pacifier use versus no pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.
Data collection and analysis
Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
Main results
We found three trials (involving 1915 babies) for inclusion in the review but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.00; 95% confidence interval (CI) 0.95 to 1.06), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.97 to 1.02), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).
Authors' conclusions
Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.
Jaafar SH, Jahanfar S, Angolkar M, Ho JJ
Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD007202. DOI: 10.1002/14651858.CD007202.pub2
Effect of pacifier use on duration of breastfeeding in full-term infants
Breast milk is superior to other baby foods in providing balanced nutrition and protection against allergy and infection to newborns. Breastfeeding is recommended by the World Health Organization, exclusively in the first six months and then as a dietary supplement. Breastmilk production and supply are maintained by frequent suckling of the breast and nipple stimulation. A pacifier is a non-nutritive sucking device used to calm an infant that has become a cultural norm in many parts of the world. However there is a widespread belief that pacifiers may interfere with breast milk production and lead to discontinuation of breastfeeding.
Our review concluded that for mothers who are motivated to breastfeed their infants, pacifier use before or after breastfeeding was established did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. The review provided moderate evidence from three randomised controlled trials (involving 1915 babies) comparing pacifier use and no pacifier use by healthy, full-term breastfeeding infants; two of the trials (1302 babies) were included in the analysis. However, there is a widespread belief that pacifiers may interfere with breast milk production and lead to discontinuation of breastfeeding.
Abstract
Background
To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast milk production and shorten duration of breastfeeding; however, this remains unclear.
Objectives
To assess the effect of pacifier use versus no pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).
Selection criteria
Randomised and quasi-randomised controlled trials comparing pacifier use versus no pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.
Data collection and analysis
Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
Main results
We found three trials (involving 1915 babies) for inclusion in the review but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.00; 95% confidence interval (CI) 0.95 to 1.06), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.97 to 1.02), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).
Authors' conclusions
Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.
18.12.10
Effects of breastfeeding in children of women taking antiepileptic drugs.
Effects of breastfeeding in children of women taking antiepileptic drugs.
Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; NEAD Study Group
Neurology. 2010 Nov 30;75(22):1954-60. Epub 2010 Nov 24.
BACKGROUND: Breastfeeding is known to have beneficial effects, but there is concern that breastfeeding during antiepileptic drug (AED) therapy may be harmful to cognitive development. Animal and human studies have demonstrated that some AEDs can adversely affect the immature brain. However, no investigation has examined effects of breastfeeding during AED therapy on subsequent cognitive abilities in children.
METHODS: The Neurodevelopmental Effects of Antiepileptic Drugs Study is an ongoing prospective multicenter observational investigation of long-term effects of in utero AED exposure on cognition. Between 1999 and 2004, we enrolled pregnant women with epilepsy who were taking a single AED (carbamazepine, lamotrigine, phenytoin, or valproate). We recently reported on differential AED effects on age 3 year cognitive outcomes. In this report, we focus on the effects of breastfeeding during AED therapy on age 3 cognitive outcomes in 199 children.
RESULTS: A total of 42% of children were breastfed. IQs for breastfed children did not differ from nonbreastfed children for all AEDs combined and for each of the 4 individual AED groups. Mean adjusted IQ scores (95% confidence intervals) across all AEDs were breastfed = 99 (96-103) and nonbreastfed = 98 (95-101). Power was 95% to detect a half SD IQ effect in the combined AED analysis, but was inadequate within groups.
CONCLUSIONS: This preliminary analysis fails to demonstrate deleterious effects of breastfeeding during AED therapy on cognitive outcomes in children previously exposed in utero. However, caution is advised due to study limitations. Additional research is needed to confirm this observation and extend investigations to other AEDs and polytherapy.
PMID: 21106960 [PubMed - in process]
Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; NEAD Study Group
Neurology. 2010 Nov 30;75(22):1954-60. Epub 2010 Nov 24.
BACKGROUND: Breastfeeding is known to have beneficial effects, but there is concern that breastfeeding during antiepileptic drug (AED) therapy may be harmful to cognitive development. Animal and human studies have demonstrated that some AEDs can adversely affect the immature brain. However, no investigation has examined effects of breastfeeding during AED therapy on subsequent cognitive abilities in children.
METHODS: The Neurodevelopmental Effects of Antiepileptic Drugs Study is an ongoing prospective multicenter observational investigation of long-term effects of in utero AED exposure on cognition. Between 1999 and 2004, we enrolled pregnant women with epilepsy who were taking a single AED (carbamazepine, lamotrigine, phenytoin, or valproate). We recently reported on differential AED effects on age 3 year cognitive outcomes. In this report, we focus on the effects of breastfeeding during AED therapy on age 3 cognitive outcomes in 199 children.
RESULTS: A total of 42% of children were breastfed. IQs for breastfed children did not differ from nonbreastfed children for all AEDs combined and for each of the 4 individual AED groups. Mean adjusted IQ scores (95% confidence intervals) across all AEDs were breastfed = 99 (96-103) and nonbreastfed = 98 (95-101). Power was 95% to detect a half SD IQ effect in the combined AED analysis, but was inadequate within groups.
CONCLUSIONS: This preliminary analysis fails to demonstrate deleterious effects of breastfeeding during AED therapy on cognitive outcomes in children previously exposed in utero. However, caution is advised due to study limitations. Additional research is needed to confirm this observation and extend investigations to other AEDs and polytherapy.
PMID: 21106960 [PubMed - in process]
1.5.10
Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.
Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.
Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB.
Cochrane Database Syst Rev. 2010 Mar 17;3:CD004015
BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions. OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases. SEARCH STRATEGY: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers. SELECTION CRITERIA: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained. MAIN RESULTS: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective. AUTHORS' CONCLUSIONS: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.
Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB.
Cochrane Database Syst Rev. 2010 Mar 17;3:CD004015
BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions. OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases. SEARCH STRATEGY: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers. SELECTION CRITERIA: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained. MAIN RESULTS: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective. AUTHORS' CONCLUSIONS: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.
17.1.10
The Long-Term Effects of Breastfeeding on Child and Adolescent Mental Health: A Pregnancy Cohort Study Followed for 14 Years
Prolongar la lactancia beneficiaría la salud mental de un hijo hasta la adolescencia. Así lo señala el equipo de Wendy H. Oddy, del Instituto de Investigación en Salud Infantil Telethon, en West Perth, tras realizar una investigación en la que han participado 2.366 hijos de colaboradores en el estudio Raine (Western Australia Pregnancy Cohort Study), que evaluó la salud mental de cada niño a los 2, 5, 8, 10 y 14 años.
Y es que la lactancia ayudaría a los bebés a superar mejor el estrés y hasta reforzaría el apego entre la madre y el hijo, dos beneficios de largo plazo.
De la muestra analizada el 11% nunca había recibido leche materna, el 38% la había tomado por menos de seis meses y la mitad, durante seis meses o más.
Las madres que optaron por la lactancia por menos de seis meses eran más jóvenes, tenían menos educación formal, eran más pobres, estaban más estresadas y fumaban más que aquellas que optaron por el amamantamiento prolongado. Además, esas mujeres eran más propensas a sufrir depresión posparto y sus bebés solían tener problemas de desarrollo.
Las diferencias se observaron en la conducta que se internaliza, que es aquella en la que se interioriza la negatividad, como la depresión, y en la conducta que se exterioriza, como la agresión. La conducta mejoraba por cada mes adicional de lactancia prolongada.
La lactancia por seis meses o más se mantuvo asociada positivamente con la salud mental y el bienestar de los niños y los adolescentes tras controlar la influencia de los factores sociales, económicos y psicológicos, además de las experiencias en los primeros años de vida.
El equipo concluyó que "las intervenciones orientadas a aumentar la duración de la lactancia beneficiarían la salud mental y adolescente en el largo plazo".
Y es que la lactancia ayudaría a los bebés a superar mejor el estrés y hasta reforzaría el apego entre la madre y el hijo, dos beneficios de largo plazo.
De la muestra analizada el 11% nunca había recibido leche materna, el 38% la había tomado por menos de seis meses y la mitad, durante seis meses o más.
Las madres que optaron por la lactancia por menos de seis meses eran más jóvenes, tenían menos educación formal, eran más pobres, estaban más estresadas y fumaban más que aquellas que optaron por el amamantamiento prolongado. Además, esas mujeres eran más propensas a sufrir depresión posparto y sus bebés solían tener problemas de desarrollo.
Las diferencias se observaron en la conducta que se internaliza, que es aquella en la que se interioriza la negatividad, como la depresión, y en la conducta que se exterioriza, como la agresión. La conducta mejoraba por cada mes adicional de lactancia prolongada.
La lactancia por seis meses o más se mantuvo asociada positivamente con la salud mental y el bienestar de los niños y los adolescentes tras controlar la influencia de los factores sociales, económicos y psicológicos, además de las experiencias en los primeros años de vida.
El equipo concluyó que "las intervenciones orientadas a aumentar la duración de la lactancia beneficiarían la salud mental y adolescente en el largo plazo".
8.3.09
Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study
Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study
Lane Strathearn, MBBS, , Abdullah A. Mamun,, Jake M. Najman, and Michael J. O'Callaghan, MBBS,
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 483-49
OBJECTIVES. We explored whether breastfeeding was protective against maternally perpetrated child maltreatment.
METHODS. A total of 7223 Australian mother-infant pairs were monitored prospectively over 15 years. In 6621 (91.7%) cases, the duration of breastfeeding was analyzed with respect to child maltreatment (including neglect, physical abuse, and emotional abuse), on the basis of substantiated child protection agency reports. Multinomial logistic regression was used to compare no maltreatment with nonmaternal and maternally perpetrated maltreatment and to adjust for confounding in 5890 cases with complete data (81.5%). Potential confounders included sociodemographic factors, pregnancy wantedness, substance abuse during pregnancy, postpartum employment, attitudes regarding infant caregiving, and symptoms of anxiety or depression.
RESULTS. Of 512 children with substantiated maltreatment reports, >60% experienced 
1 episode of maternally perpetrated abuse or neglect (4.3% of the cohort). The odds ratio for maternal maltreatment increased as breastfeeding duration decreased, with the odds of maternal maltreatment for nonbreastfed children being 4.8 times the odds for children breastfed for 4 months. After adjustment for confounding, the odds for nonbreastfed infants remained 2.6 times higher, with no association seen between breastfeeding and nonmaternal maltreatment. Maternal neglect was the only maltreatment subtype associated independently with breastfeeding duration.
CONCLUSION. Among other factors, breastfeeding may help to protect against maternally perpetrated child maltreatment, particularly child neglect
7.3.09
Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
M.M. Vennemann, MD, MPH, PDa , T. Bajanowski, MD, PDb , B. Brinkmann, MD, PDa , G. Jorch, MD, PDc , K. Yücesan, MDa , C. Sauerland, MScd , E.A. Mitchell, FRACP, DSce and the GeSID Study Group
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410
BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of
sudden infant death syndrome were very successful. In some countries the advice to
breastfeed is included in the campaigns’ messages, but in other countries it is not.
OBJECTIVE. To examine the association between type of infant feeding and sudden
infant death syndrome.
METHODS. The German Study of Sudden Infant Death is a case-control study of 333
infants who died of sudden infant death syndrome and 998 age-matched controls.
RESULTS.A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of
age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding
at the age of 1 month also reduced the risk of sudden infant death syndrome, but
after adjustment this risk was not significant. Being exclusively breastfed in the last
month of life/before the interview reduced the risk, as did being partially breastfed.
Breastfeeding survival curves showed that both partial breastfeeding and exclusive
breastfeeding were associated with a reduced risk of sudden infant death syndrome.
CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant
death syndrome by 50% at all ages throughout infancy. We recommend including
the advice to breastfeed through 6 months of age in sudden infant death syndrome
risk-reduction messages
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410
BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of
sudden infant death syndrome were very successful. In some countries the advice to
breastfeed is included in the campaigns’ messages, but in other countries it is not.
OBJECTIVE. To examine the association between type of infant feeding and sudden
infant death syndrome.
METHODS. The German Study of Sudden Infant Death is a case-control study of 333
infants who died of sudden infant death syndrome and 998 age-matched controls.
RESULTS.A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of
age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding
at the age of 1 month also reduced the risk of sudden infant death syndrome, but
after adjustment this risk was not significant. Being exclusively breastfed in the last
month of life/before the interview reduced the risk, as did being partially breastfed.
Breastfeeding survival curves showed that both partial breastfeeding and exclusive
breastfeeding were associated with a reduced risk of sudden infant death syndrome.
CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant
death syndrome by 50% at all ages throughout infancy. We recommend including
the advice to breastfeed through 6 months of age in sudden infant death syndrome
risk-reduction messages
26.10.08
Counseling to Promote Breastfeeding
Esta es una actualización de las recomendaciones del año 2003 para promover la lactancia materna.
La U.S. Preventive Services Task Force recomienda las intervenciones de atención primaria, durante el embarazo y tras el nacimiento, para fomentar y apoyar la lactancia materna. Grado: recomendacion B .
Después de evaluar más de 25 ensayos aleatorios de intervenciones sobre la lactancia materna, el grupo de la Task Force llegó a la conclusión de que las intervenciones coordinadas durante el embarazo, nacimiento e infancia pueden aumentar el inicio, la duración y la exclusividad de la lactancia materna. Las intervenciones que incluyen componentes de atención prenatal y postnatal son las más eficaces en la prolongación del amamantamiento.
La lactancia materna tiene importantes beneficios para la salud de los bebés y sus madres: los bebés que son amamantados tienen menos infecciones y erupciones cutáneas alérgicas y tienen menos probabilidades de tener síndrome de muerte súbita infantil. Una vez finalizada la lactancia, tienen también menos probabilidades de desarrollar asma, diabetes, obesidad y leucemia infantil. Las mujeres que amamantan tienen menos riesgo de diabetes tipo 2, cáncer de mama, y cáncer de ovario que las mujeres que nunca amamantaron. Las recomendaciones han sido publicadas en el número de octubre de "Annals of Internal Medicine" y, junto a algunos materiales para uso clínico, están disponibles en el sitio Web de AHRQ en http://www.ahrq.gov/clinic/prevenix.htm
Después de evaluar más de 25 ensayos aleatorios de intervenciones sobre la lactancia materna, el grupo de la Task Force llegó a la conclusión de que las intervenciones coordinadas durante el embarazo, nacimiento e infancia pueden aumentar el inicio, la duración y la exclusividad de la lactancia materna. Las intervenciones que incluyen componentes de atención prenatal y postnatal son las más eficaces en la prolongación del amamantamiento.
La lactancia materna tiene importantes beneficios para la salud de los bebés y sus madres: los bebés que son amamantados tienen menos infecciones y erupciones cutáneas alérgicas y tienen menos probabilidades de tener síndrome de muerte súbita infantil. Una vez finalizada la lactancia, tienen también menos probabilidades de desarrollar asma, diabetes, obesidad y leucemia infantil. Las mujeres que amamantan tienen menos riesgo de diabetes tipo 2, cáncer de mama, y cáncer de ovario que las mujeres que nunca amamantaron. Las recomendaciones han sido publicadas en el número de octubre de "Annals of Internal Medicine" y, junto a algunos materiales para uso clínico, están disponibles en el sitio Web de AHRQ en http://www.ahrq.gov/clinic/prevenix.htm
14.1.08
Lactancia materna exclusiva y cáncer infantil
Lactancia materna exclusiva y cáncer infantil
Journal of Paediatrics and Child Health 44 (2008) 10–13
Juan A Ortega-García, Josep Ferrís-Tortajada, Alberto M Torres-Cantero, Offie P Soldin, Encarna Pastor Torres, Jose L Fuster-Soler, Blanca Lopez-Ibor and Luis Madero-López
Objetivo: Se ha sugerido que existe una asociación inversa entre la lactancia materna y el riesgo de cáncer en la infancia. Se investigó la asociación entre lactancia materna exclusiva y cáncer en la infancia (CI) en un estudio de casos y controles realizado en España.
Métodos: Se comparó la información que proporcionaron las madres sobre la lactancia materna en 187 niños de seis o más meses de edad con CI con la información de 187 hermanos emparejados por edad en el grupo control. La información se obtuvo a través de entrevistas personales utilizando
Resultados: La duración media de la lactancia materna exclusiva fue de 8,43 semanas en los casos y 11,25 semanas en los controles. Los casos se había alimentado con biberón con mayor frecuencia que los controles (OR: 1,8; IC 95%:1,1-2,8). Los casos fueron amantados significativamente con menor frecuencia durante al menos dos meses (OR 0,5; IC 95% 0.3–0.8), durante al menos cuatro meses (OR 0,5; IC 95% 0,3–0,8), y durante 24 semanas o más (OR 0.5; IC 95% 0.2–0.9).
Conclusiones: La lactancia materna se asocia de forma inversa con el cáncer infantil, la protección aumenta con la duración de la lactancia exclusiva. Deberían realizarse investigaciones adicionales sobre los posibles mecanismos que expliquen esta asociación. Mientras tanto, debería alentarse a las madres para que amamantaran a sus hijos.
8.1.08
Efecto de la lactancia materna prolongada y exclusiva en la talla, peso, adiposidad y tensión arterial a la edad de 6 años y medio.
Efecto de la lactancia materna prolongada y exclusiva en la talla, peso, adiposidad y tensión arterial a la edad de 6 años y medio: evidencias provenientes de un amplio ensayo clínico.
Kramer MS, Matush L, Vanilovich I, Platt RW, Bogdanovich N, Sevkovskaya Z, Dzikovich I, Shishko G, Collet JP, Martin RM, Davey Smith G, Gillman MW, Chalmers B, Hodnett E, Shapiro S; PROBIT Study Group.
Department of Pediatrics, McGill University Faculty of Medicine, Montreal, PQ, Canada. michael.kramer@mcgill.ca
Am J Clin Nutr. 2007 Dec;86(6):1717-21.
INTRODUCCIÓN: Las pruebas de que la lactancia materna protege frente a la obesidad y frente a otras enfermedades crónicas proviene casi únicamente de estudios observacionales, que tienen la limitación de los sesgos debidos a factores de confusión, sesgo de selección y publicación selectiva. OBJETIVO: Valoramos si una intervención diseñada para promover la lactancia materna exclusiva y prolongada tenía consecuencias en la talla, peso, adiposidad y tensión arterial a los 6 años y medio. MÉTODO: El Ensayo sobre la intervención de Promoción de la Lactancia Materna (estudio PROBIT) es un ensayo clínico aleatorizado por grupos sobre una intervención de promoción de lactancia materna basada en La Iniciativa de Hospitales Amigos de los Niños (OMS/UNICEF). Se incluyeron un total de 17.046 niños sanos amamantados, estos niños provenían de 31 maternidades de Bielorrusia y sus clínicas afiliadas; 13.889 niños (81.5%) se siguieron hasta los 6 años y medio realizándoles medidas duplicadas de las variables antropométricas y de tensión arterial. Se realizó un análisis por intención de tratar, con ajustes estadísticos por grupos en los hospitales o clínicas para permitir inferencias a nivel individual. RESULTADOS: La intervención experimental conllevó una mayor prevalencia de lactancia materna exclusiva a los 3 meses en el grupo experimental que en el grupo control (43,3% y 6,4% respectivamente; p< style=""> a lo largo de la infancia. No se observaron efectos significativos de la intervención en la talla, en el índice de masa corporal, ni en la medida de la cintura o cadera, tríceps o grosor del pliegue subescapular, ni en la tensión arterial sistólica o diastólica. CONCLUSIONES: La intervención de promoción de la lactancia maternal conllevó un aumento sustancial en la duración y exclusividad de la lactancia pero no redujo las medidas de adiposidad, no incrementó la talla ni disminuyó la tensión arterial a los 6 años y medio en el grupo experimental. Los beneficios que se han comunicado previamente sobre estos aspectos podrían ser consecuencia de los factores de confusión no controlados y del sesgo de selección.
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