Overcoming Rooming-In Barriers : a Survey on Mothers' Perspectives

Background: The importance of rooming-in in promoting breastfeeding initiation and continuation within the 10 Steps for Successful Breastfeeding is widely acknowledged. However, adherence to this practice by healthcare facilities is lower than that of other Steps. A deeper knowledge of maternal rooming-in experience has been advocated to identify the most effective rooming-in policies, thus enabling mothers to have a positive experience when practicing it in the postpartum period. Aim: To investigate maternal knowledge of rooming-in and the most frequently encountered barriers and possible facilitators of adherence to the practice, according to their experience. Study Design and Methods: We enrolled mothers who delivered healthy term or late preterm infants during the month of January 2019 in a tertiary referral center for neonatal care in Milan, Italy. At discharge, a structured interview about mothers' rooming-in experience was administered by healthcare professionals. Basic subjects' characteristics and mode of feeding were recorded. Results: The enrolled population included 328 mothers and 333 neonates. The great majority of mothers knew of rooming-in and 48.2% practiced it continuously. The 86.3% of mothers was aware of the beneficial effects of rooming-in; promotion of mother-infant bonding, increased confidence in taking care of the baby and ability to recognize baby's feeding cues were the most frequently cited, whereas improving breastfeeding was reported by a limited number of mothers, unless they were asked a specific question about it. The main reported obstacles were fatigue (40.5%) and cesarean section related difficulties (15.5%); night was the most critical time of the day for rooming-in. Strategies suggested by mothers for improving rooming-in were increased assistance to the dyad, organizational and structural changes and the possibility to have a family member during the night. Additionally, mothers who adhered to rooming-in practice continuously during hospital stay had a higher exclusive breastfeeding rate at discharge compared to mothers who did not. Conclusions: Our study contributes to a deeper knowledge of maternal rooming-in experience in an Italian tertiary maternity. We underline the importance of providing a tailored support to the mother-infant dyad in order to overcome rooming-in barriers perceived by mothers and promote a positive rooming-in experience

Congenital midline cervical cleft: clinical approach to a congenital anterior neck defect

Numerous malformations can affect the anterior part of the neck presenting at birth as a real diagnostic challenge for the pediatrician or the primary care physician who initially evaluate the baby. Congenital midline cervical cleft represents a rare defect of the midline neck, which is sometimes wrongly diagnosed as a thyroglossal duct anomaly, dermoid cyst, branchial cleft anomaly or "birthmark". A prompt clinical diagnosis and surgical treatment during early infancy are essential to ensure both functional and aesthetic outcome. We report on a case of a female neonate with a midline cervical cleft diagnosed immediately after birth. The main features of other congenital anomalies of the anterior neck are also discussed referring to their embryologic origin

Breastfeeding difficulties and risk for early breastfeeding cessation

Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding singleton healthy term newborns at hospital discharge were enrolled and, at three months post-delivery, were administered a questionnaire on their breastfeeding experience. Association among neonatal/maternal characteristics, breastfeeding difficulties and support after hospital discharge, and type of feeding at three months was assessed using multivariate binary logistic regression analysis. We enrolled 792 mothers, 552 completed the study. Around 70.3% of mothers experienced breastfeeding difficulties, reporting cracked nipples, perception of insufficient amount of milk, pain, and fatigue. Difficulties occurred mostly within the first month. Half of mothers with breastfeeding issues felt wellsupported by health professionals. Maternal perception of not having a sufficient amount of milk, infant\u2019s failure to thrive, mastitis, and the return to work were associated with a higher risk of nonexclusive breastfeeding at three months whereas vaginal delivery and breastfeeding support after hospital discharge were associated with a decreased risk. These results underline the importance of continued, tailored professional breastfeeding support

Dynamics of phosphorus in soils and of nutrients in canopies of deciduous beech forests differing in tree species diversity

Nährstoffvorräte, -konzentrationen und -umsätze im Boden sowie Nährstoffeinträge durch Deposition und Kronenraumaustausch wurden weltweit in den verschiedensten Waldökosystemen intensiv untersucht. In Studien über Wälder der gemäßigten Zonen lag der Schwerpunkt hinsichtlich der Makronährstoffe auf Kohlenstoff und Stickstoff, während Phosphor (P) eher in tropischen Wäldern von Interesse war. Im Zuge zunehmender Stickstoffdeposition ist bzw. könnte P jedoch ein wachstumslimitierender Faktor vieler Wälder der gemäßigten Zonen werde. Außerdem wird der Klimawandel diese Ökosysteme und ihre Nährstoffumsätze beeinflussen. Um auf diese Veränderungen vorbereitet zu sein, wird die Einrichtung von Mischwäldern empfohlen, da diese störungsresistenter und belastbarer seien als Monokulturen. In großen Teilen Mitteleuropas wird die potentielle natürliche Vegetation von der Buche (Fagus sylvatica L.) dominiert. Deshalb wird vermutet, dass Buchenmischwälder im Hinblick auf den Klimawandel einen hohen ökologischen und ökonomischen Wert haben. Über die Auswirkungen zunehmender Baumartendiversität auf Bodennährstoffe und Nährstoffkreisläufe in gemäßigten Buchenwäldern ist jedoch wenig bekannt. Untersuchungen zum Einfluss der Baumartenzusammensetzung auf P-Vorräte und -konzentrationen im Boden und den P-Umsatz fehlen fast ganz.Die vorliegende Doktorarbeit verglich die P-Vorräte und -konzentrationen im Boden und den P-Umsatz reiner Buchenbestände mit denen von Mischbeständen, untersuchte die Phosphatsorptionskapazität und den -transport in Waldböden und verglich die Deposition und den Kronenraumaustausch von P und anderen Nährstoffen reiner Buchenbestände mit denen von Mischbeständen. Das Untersuchungsgebiet lag im Nationalpark Hainich, der Teil des größten zusammenhängenden Laubwaldgebiets Deutschlands ist. Es konnte in drei verschiedene Bestandestypen bezüglich der Baumartendiversität eingeteilt werden: (1) Buche als Hauptbaumart; (2) Buche, Linde und Esche als Hauptbaumarten; (3) Buche, Linde, Esche, Ahorn und Hainbuche als Hauptbaumarten.Die Vorräte und Konzentrationen sowohl von anorganischem als auch besonders von organisch gebundenem P waren geringer in den Böden reiner Buchenbeständen als in denen der Mischbestände. Diese Unterschiede konnten jedoch hauptsächlich den niedrigeren Tongehalten der reinen Buchenbestände zugeschrieben werden, wohingegen die Baumarten eine geringere Rolle in der P-Speicherung dieser Böden spielten. Der P-Eintrag mit der Blattstreu in den Boden zeigte eine klare Tendenz, mit steigender Baumartendiversität zuzunehmen. Die Umsatzzeit von P in der organischen Auflage war kürzer in Mischbeständen als in reinen Buchenbeständen. Folglich wurde der Eintrag und Umsatz von den Baumarten beeinflusst. Jedoch wurde die Zusammensetzung der Bodenbiota und damit die Streuzersetzung sicherlich auch durch den niedrigeren pH-Wert, die geringere Basensättigung (BS) und Kationenaustauschkapazität (KAK) der reinen Buchenbestände beeinflusst.Die Bodenproben konnten an Hand ihres Phosphatsorptionsverhaltens in zwei Gruppen eingeteilt werden: für die Proben mit niedrigem pH und geringem Tongehalt war tendenziell eine lineare Anpassung am besten, wohingegen für die Proben mit höheren pH-Werten und größeren Tongehalten eine Anpassung an die Freundlich Gleichung besser war. Folglich scheint die kleinräumige Heterogenität der Bodeneigenschaften im Untersuchungsgebiet, das Sorptionsverhalten der Bodenproben beeinflusst zu haben. Die Desorption des zugegebenen Phosphats war unvollständig. Die Anwendung eines Transportmodells auf unsere Daten zeigte, dass der Phosphattransport in den untersuchten Waldböden mit dieser Art von Adsorptions-/Desorptionsmodell nicht gut beschrieben werden konnte. Dies lag wahrscheinlich an weiteren Prozessen wie Fällung und Lösung, die in diesem Modell nicht berücksichtigt wurden.Die Deposition von Nährstoffen und von versauernd wirkenden Verbindungen aus der Luft war in den reinen Buchenbeständen am höchsten, da diese verglichen mit den Mischbeständen höher waren und rauere Kronen hatten. Die Kronenraumauswaschung von Phosphat, Kalium, Kalzium und Magnesium war in den Mischbeständen am höchsten, wohingegen Protonen und Mangan hauptsächlich aus den reinen Buchenkronen ausgewaschen wurden. Die Unterschiede der Baumarten im Ionenstatus und in der Physiologie könnten die beobachteten Unterschiede im Kronenraumaustausch erklären. Dennoch beeinflussten auch die Bodeneigenschaften die Kronenraumaustauschprozesse. Der geringe pH-Wert der reinen Buchenbestände führt zu hoher Manganmobilität im Boden und folglich zu erhöhter Manganaufnahme durch die Bäume. Außerdem führt die geringe BS zu verringerter Aufnahme von Kalium, Kalzium und Magnesium in den reinen Buchenbeständen. Durch die baumartenspezifischen Unterschiede im Ionenstatus sowie die unterschiedlichen Bodeneigenschaften hatten die Buchen höhere Mangan- und geringere Kalium-, Kalzium- und Magnesiumgehalte in ihren Blättern als die anderen Baumarten, was zu den beschriebenen Auswaschungsraten führte.Die Ergebnisse der vorliegenden Doktorarbeit zeigen, dass es schwer ist, die Effekte der Baumartendiversität auf Boden-P und Nährstoffkreisläufe von denen der Bodeneigenschaften klar zu trennen. Die Böden der Waldbestände unterschieden sich ursprünglich in einigen Bodeneigenschaften, v.a. im Tongehalt. Jedoch ist bekannt, dass Bäume Bodeneigenschaften beeinflussen können, die schnellen Veränderungen unterliegen (pH-Wert, BS und KAK). Folglich wurden die Unterschiede zwischen den reinen Buchenbeständen und den Mischbeständen im Laufe der Zeit noch ausgeprägter. Zusammenfassend lässt sich sagen, dass die Baumarten sowohl eine direkte als auch eine indirekte Rolle in der Nährstoffspeicherung und den -kreisläufen der untersuchten Waldbestände spielten. Sie hatten einen Einfluss auf Bodeneigenschaften, die wiederum zu Veränderungen in der P-Speicherung und dem -transport, dem Umsatz von organischem Material und der Kronenraumauswaschung von Ionen führten

Breastfeeding Determinants in Healthy Term Newborns

Breastfeeding is the normative standard for infant feeding. Despite its established benefits, different factors can affect breastfeeding rates over time. The purpose of this study was to evaluate breastfeeding determinants in healthy term newborns during the first three months of life. A prospective, observational, single-center study was conducted in the nursery of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. The mother-baby dyads that were admitted to the Clinic in January and February 2017 were enrolled. Only healthy term babies with birth weight 6510th percentile for gestational age were included. Data were collected through medical records and questionnaires administered during the follow-up period. Then, we fitted univariate and multivariate logistic models and calculated odds ratios. 746 dyads were included but 640 completed the study. The factors found to be favoring breastfeeding were a previous successful breastfeeding experience, a higher level of education of the mother, attending prenatal classes, no use of pacifier, rooming in practice, and breastfeeding on demand. Factors acting negatively on breastfeeding were advanced maternal age, non-spontaneous delivery, perception of low milk supply, mastitis, and nipple fissures. This study highlights the need to individualize the assistance provide to breastfeeding mothers, paying special attention to personal experiences

Do a Few Weeks Matter? Late Preterm Infants and Breastfeeding Issues

The late preterm infant population is increasing globally. Many studies show that late preterm infants are at risk of experiencing challenges common to premature babies, with breastfeeding issues being one of the most common. In this study, we investigated factors and variables that could interfere with breastfeeding initiation and duration in this population. We conducted a prospective observational study, in which we administered questionnaires on breastfeeding variables and habits to mothers of late preterm infants who were delivered in the well-baby nursery of our hospital and followed up for three months after delivery. We enrolled 149 mothers and 189 neonates, including 40 pairs of twins. Our findings showed that late preterm infants had a low rate of breastfeeding initiation and early breastfeeding discontinuation at 15, 40 and 90 days of life. The mothers with higher educational levels and previous positive breastfeeding experience had a longer breastfeeding duration. The negative factors for breastfeeding were the following: Advanced maternal age, Italian ethnicity, the feeling of reduced milk supply and having twins. This study underlines the importance of considering these variables in the promotion and protection of breastfeeding in this vulnerable population, thus offering mothers tailored support

Well-posedness of the transport equation by stochastic perturbation

We consider the linear transport equation with a globally Holder continuous and bounded vector field. While this deterministic PDE may not be well-posed, we prove that a multiplicative stochastic perturbation of Brownian type is enough to render the equation well-posed. This seems to be the first explicit example of partial differential equation that become well-posed under the influece of noise. The key tool is a differentiable stochastic flow constructed and analysed by means of a special transformation of the drift of Ito-Tanaka type.Comment: Addition of new part

Preterm’s nutrition from hospital to solid foods : Are we still navigating by sight?

As preterm birth rates are globally increasing, together with research on preterms\u2019 peculiar needs, neonatologists are still facing the challenge of how to properly feed them. The need to strike a balance between excessive catch-up growth and extrauterine growth retardation, both leading to adverse outcomes, is made even more difficult by the broad range of preterms\u2019 needs. Although mother\u2019s fresh milk is undoubtedly the best nourishment, its availability during hospital stay is often lower than recommended, and its fortification at discharge is still an open issue. Formula milks are available as an alternative to breast milk. However, choosing the right formula requires a thorough evaluation of the infant\u2019s perinatal history and targets. Last but not least, adequate timing and initiation of weaning in premature babies are still a poorly explored matter. This narrative review aims at evaluating the multitude of issues to consider when feeding preterms in the three stages of their first life: in-hospital care, discharge, and, eventually, weaning. Given the current absence of internationally shared guidelines, understanding the potential pitfalls of preterms\u2019 nutrition could help us trace the right path for the right preterm

Unusual prenatal presentation of Rubinstein-Taybi syndrome: a case report

Rubinstein-Taybi syndrome (RTS) is a rare multiple congenital anomalies-intellectual disability syndrome. The diagnosis is made after birth and based on the detection of signs such as growth and developmental delay, minor facial anomalies, and broad thumbs and halluces. It is rare to suspect RTS during the prenatal period. We report here the approach to a patient with RTS whose pregnancy was complicated by multiple congenital anomalies. However, in the presence of the broad thumb and facial anomalies, we were able to suggest the correct diagnosis. The RTS was confirmed at birth and themolecular analysis of the major causative gene revealed a previously unreported heterozygous truncating mutation of CREBBP. This report provides new knowledge of the fetal phenotype of RTS

The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus

Background: The role of hemostasis in the closure of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective: To assess thromboelastography (TEG) at birth in very-low-birth-weight (VLBW) infants affected by PDA. Methods: This was an ancillary study of a prospective observational study aimed at defining the TEG profile in healthy VLBW infants in the first month of life. In this analysis, we included neonates of <33 weeks' gestational age (GA) with PDA and compared TEG traces based on (1) spontaneous closure versus the need for pharmacological treatment and (2) treatment response. We collected blood samples in the 1st day of life to perform recalcified native-blood TEG (reaction time, maximum amplitude, and lysis at 30 min [Ly30)]), standard coagulation tests, and a full blood count. Results: We enrolled 151 infants with a PDA at the first echocardiogram; 111 experienced spontaneous PDA closure while 40 required treatment. Mean GA was 29.7 \ub1 1.7 and 27.6 \ub1 2.1 weeks, and birth weight was 1,158 \ub1 256 and 933 \ub1 263 g in the 2 groups, respectively (p < 0.001). The hemostatic profile was similar between groups. Median hematocrit (44.6 and 48.7%; p = 0.01) and platelet count (187 and 216 7 103/\u3bcL; p = 0.04) were lower in the treated group, although differences lost significance after controlling for GA and illness severity in the multivariate analysis. Responders to PDA treatment (n = 20) had a significantly lower median Ly30 than nonresponders (0 and 0.7%; p = 0.02). Conclusion: TEG at birth does not predict spontaneous PDA closure in preterm newborns. Fibrinolysis is enhanced in nonresponders to PDA treatment; this observation warrants further investigation