Academic literature on the topic 'Breastmilk expression'

Background Antenatal breastmilk expression is recommended in many practice settings to overcome challenges to breastfeeding for women with diabetes. Aim This narrative literature review aimed to examine how antenatal breastmilk expression supports women with diabetes to breastfeed. Methods A search was undertaken of the CINAHL database, Scopus, Medline, Excerpta Medica DataBASE and the Cochrane Library to identify quantitative and qualitative primary research studies. Eight studies met the inclusion criteria. Results Findings were examined within a framework of informational, emotional and motivational and practical aspects of antenatal breastmilk expression. Information on infant wellbeing is important, as concerns about admission to neonatal care have emerged. However, for women at low risk of complications, their infants were not at greater risk of being admitted to neonatal care following antenatal expression in comparison to standard care, and there was no evidence of increased neonatal hypoglycaemia. Emotional support is important, as although the experience is rewarding it can also be challenging. Breastfeeding rates were higher following antenatal expression, although the differences were not always statistically significant. Practical aspects, including the optimum gestation at commencement, require further research. Conclusions Although the evidence is not conclusive on how antenatal breastmilk expression can support women with diabetes to breastfeed, the results are promising.

Rising number of mothers are expressing their breastmilk to feed their infants when away from them, which presents new issues for infant feeding. Having sound knowledge regarding expression, storage and use of breast milk is fi rst step towards promoting practice of expressed breast milk, which in turn promotes exclusive breastfeeding. Primary concern in this is handling, storage, and warming of expressed breastmilk. So all breastfeeding mothers should be motivated to learn different techniques of expression, storage and use of expressed breastmilk. The settings chosen for present study were 18 villages of Dachnipora block of district Anantnag (J&K) with a sample size of 50 mothers of infants. This setting was selected as per feasibility & availability of study subjects. A questionnaire was used for data collection. The study revealed that 46 percent of subjects had inadequate knowledge level, 54 percent had moderate knowledge level’ and none of subjects had adequate knowledge level regarding expression, storage and use of expressed breast milk. A signifi cant association of knowledge level of mothers of infants was found with demographic variables, parity and previous experience with expression and storage at p≤0.05 level and no association was found with variables like age, educational status, nature of job and monthly family income. To conclude, mothers of infants had insignifi cant level of knowledge about expression, handling, storage and use of expressed breast milk. If they are provided and supported with adequate and appropriate information from the beginning of their motherhood, they will make exclusive breastfeeding a success

MicroRNAs are short, non-coding oligonucleotides that regulate gene expression at the post-transcriptional level. These small molecules participate in the control of various cellular processes and signalling pathways. Since 2010 microRNAs have been recognized as a new bioactive component of breastmilk, which is an exceptionally rich source of these oligonucleotides. In infants fed with breastmilk, microRNAs are involved in the growth and proper development as well as maturation of the immune system. It has been demonstrated that microRNAs are resistant to harsh conditions during in vitro digestion in simulated gastrointestinal tract of a newborn and, therefore, may be absorbed by the intestinal cells. Protection against RNase activity and low pH is provided by exosomes, which are carriers of microRNAs in skim milk or by fat globules and milk cells. It has been reported that, in contrast to human milk, infant formulas contain only a few microRNAs, which have been derived from other organisms, such as cow or soy. It may be presumed that supplementing infant formulas with microRNAs identical with those which occur naturally in breastmilk may constitute a new way of designing artificial substitutes for human breastmilk.

Breastfeeding offers a broad spectrum of health benefits for infants. However, overnutrition and a steady increase in maternal obesity in the U.S. have made it harder for many mothers to produce and express breastmilk, and the quality of milk from obese mothers is also frequently compromised. Adipocytes, the primary cell type in the non-lactating breast, display a drastic morphological and functional change during lactation in mice. Lipid-filled adipocytes undergo lipolysis, and lipid droplets disappear to provide fatty acids and energy for breastmilk production. Once the animal stops lactation, these lipid-depleted adipocytes return as lipid-laden cells. This dynamic remodeling of the tissue is likely the result of active intercellular communications. Connexin43 (Cx43) is the most abundant connexin in the mammary adipose tissue that makes up the gap junctions for direct intercellular communications. Its expression is increased during lactation and reduced in obese mammary adipose tissue, which is resistant to lactation-induced remodeling. However, whether Cx43 is required for adipocyte remodeling and breastmilk production to support neonates’ growth has not been established. In this study, we used doxycycline-inducible adipocyte-specific Cx43-deleted mice and demonstrated that adipocyte Cx43 played a vital role in determining the carbohydrate levels in breastmilk, which may subsequently affect neonates’ growth.

Background: Knowing which methods of breastmilk expression are effective and acceptable is important to inform clinical guidelines and enable breastfeeding of infants, particularly premature, sick and low birth weight infants. Objectives: To evaluate the best available evidence on effects and acceptability of methods of breastmilk expression and inform guidelines and research priorities. Methods: Systematic review using Cochrane methods. Electronic databases (PubMed, CINAHL, Embase, Scopus, Cochrane Central) and references of included studies were searched (July 2018). Selection criteria were RCTs comparing breastmilk expression interventions against standard care or each other, in women who had given birth to premature or term infants. Primary outcomes were quantity of milk expressed, quality of milk expressed and maternal satisfaction. Risk of bias of included studies was assessed. Main results: One Cochrane systematic review (including 41 trials) and 10 additional RCTs were included. A total of 10,134 women and their infants, most premature, were randomised in the 51 included trials, performed in a range of high-, middle-, and low-income countries. 42 RCTs contributed outcomes (data or narrative) to the review synthesis, which reported 19 comparisons. Five comparisons evaluated pump versus hand expression, seven assessed different types of pumps/pumping, four evaluated instruction/education and support, and three pumping techniques or protocols relating to timing of expression (n=3). In most trials contributing data fewer participants than the number randomised were included in the analysis, with a maximum of 1533 women included. Overall risk of bias was unclear due to lack of methodological details reported. Lack of data prohibited GRADE, subgroup and sensitivity analyses. For quantity of milk expressed, there was evidence of higher mean volume in the manual pump group compared with the hand expression group. Considering quality of milk expressed: sodium and protein concentration measures indicated a lower milk quality for women who expressed using any manual pump compared with hand expression; and sodium concentrations were lower quality for women who expressed using a large electric pump compared to hand expression. There was a higher fat content in women who expressed using any method plus breast massage compared with no breast massage. Regarding maternal satisfaction, women who used the large electric pump compared with hand expression were less satisfied (when satisfaction was compared with instruction). Women using higher vacuum pressures with their electric pump reported a higher level of confidence at discharge and at one-month post discharge. Conclusion: The evidence for effective methods of expressing is not yet clear. Further RCTs are required to inform guidelines. The full range of interventions health practitioners suggest may have positive effects on quantity and quality of milk expressed should be evaluated in future trials, which should assess a standard set of clinical outcomes, cost and maternal satisfaction, using similar measures, and at similar timepoints. Future trial should assess if/how effects vary by characteristics of mother-infant dyads, including gestational age at birth, singleton versus multiples, time since birth, mode of birth, and health status of mothers.
Thesis (MPhil) -- University of Adelaide, Adelaide Medical School, 2019