He was…. His childhood years were spent on a farm between Royal and Moneta, Iowa, where he received his education, graduating from Everly High School in…. She passed away November 6, in Cheyenne, Wy. The family moved to Graettinger where she went to school and graduated in Alberta was united in…. Donna lived in Spencer, attending and graduating from Spencer High School, in After graduation, Donna attended business school, and…. Olivet Home in Minneapolis. She was 91 years old. One of nine children who grew up during the Depression in a small family home with a big garden, Doris….
Her childhood years were spent in the Verdigre area, where she received her early education. The family later moved to the Rossie area, where she…. She was raised and received her early education in Spencer graduating from high school in Following her graduation, she worked in Cherokee for a short…. His childhood years were spent in Fostoria, Iowa, where he received his education, later graduating from Okoboji High School.
He was raised and received his early education in Sioux Center, Iowa, and then moved to Spencer, Iowa, when he was 11, finishing his education and graduating in Spencer. His childhood years were spent in the Sutherland area where he attended school and graduated from Sutherland….
Frank was raised in Nebraska and graduated from Central High in Omaha. Her childhood years were spent in the Sutherland, IA area, where she attended country school and graduated from Sutherland High School in After graduation she…. She received her early education there and after graduating from high school she attended Alberta College in Edmonton. A highlight of her…. Growing up, he lived in several small towns, including Kanab, Utah, Mesquite,…. She grew up in Sloan, Iowa where….
Helen Lorrene Leith, 97, passed away October 6, She was the second of three daughters. Helen graduated from Albert City High School in Helen married James Leith September 16th, He was a lifelong member of the Lutheran…. Her childhood years were spent in the Varina area, where she received early education at St. Columbkille Catholic School in Varina, graduating in She continued…. He graduated from Alta High School in…. She was the youngest of three children.
Lois graduated Pomeroy High School, May On February 21 st , , Lois was united in marriage to Carl Brown. Her childhood years were spent in Copenhagen where she attended school. After graduation Victoria met Ellsworth Stoffel while he was in the military. They married on May 4, in…. What does the Lord require of you but to do justice, love kindness and walk humbly with your God. This is how Gretchen tried to live. Gretchen graduated from….
After his schooling, he worked for several area farmers…. She received her education and graduated from Peterson High School in She married Sheridan Hollman Blaue in Carolyn attended the Barbizon School of Modeling in New…. Margie Ada Rouse was born August 22, , on the family farm north of Ayrshire. She was the 5 th child of a family of When in 8 th grade she won the Palo Alto County spelling contest.
Using Fisher's Exact test, differences in respondent perceptions of material image and message across material performance level was determined. Vincent Brothers, 44, estranged husband arrested. The collection includes scripts and production material for produced and unproduced films and television programs, and playscripts Michael often…. Bicksler, Anna Doris Flath. As a child, she was given the honor of owning the small…. March 7, - July 14,
She graduated from Ayrshire High…. He was raised and received his early education here, graduating from Spencer, High School in He also…. Her childhood years were spent in Spencer, where she received her education, graduating from Spencer High School. She received her early education at a country school and graduated from Royal in After her schooling, she worked at Fishing….
She was raised and attended school in Redwood, graduating in Y, graduating…. She was the second child of eight children, born to Charles Leon Lon De…. He was raised in Sioux City, Iowa where he received his early education and graduated from high school. Lawrence Wayne Smith, the son of Arlie R. His childhood years were spent in Plainfield, Iowa, where he received his education, graduating from Plainfield High School. She continued her education at the CE School of…. His childhood years were spent in the Emmetsburg area where he attended school and graduated from Emmetsburg High School in Two children were born from her 1 st marriage:….
Sarah was raised on a farm southwest of Spencer and graduated from Spencer High School in Following graduation, she attended Iowa Lakes Community College and…. Joyce Ann Kruse Sabel, age 56 was born on November 24, She passed away on August 23, , at Kavanagh Hospice House due to ovarian cancer after fighting it for nearly seven years. Her early education started in a country school three miles from her home.
The first couple of years she got to and from school by riding a horse behind her…. Dorothy passed from this life on August 16, She is survived by her son Larry and daughter-in-law Kay…. Her siblings were Virginia, Shirley, Jim and Mary. She worked after…. Her childhood years were spent in Kansas, where she received her education graduating from Quinter High School. After high school, she continued her education at…. He was the son of Alvin and Mary Linnemann Pitts.
Soon after graduating from Highview High School, Jim joined the Air Force and served during the Korean conflict until when he returned home to the family farm. Dave was born on Dec. He farmed for 20 years outside Spencer, Iowa, before owning and…. He spent his entire life on the family farm with the exception of 2…. Her childhood years were spent in Lakefield, where she received her education, graduating from Lakefield High School in After her schooling, she worked at….
Clarian was born March 5, to Clarence W. She died July 23, at Northshire Nursing Home. Clarian was educated in Spencer schools, graduating from Spencer High in That fall she entered Chillicothe MO …. Merrill went to his eternal home early in the morning of Saturday, July 21, The son of Irvin and Joye Tripplet Schallau, Richard was born the sixth of ten children on February 6, at the family home west of Sutherland, Iowa.
He attended Quimby…. His childhood years were spent in Norwalk, Iowa until when…. Her childhood years were spent in the Everly area where she attended a rural school and graduated from Everly High School. Following graduation, she pursued a…. Donald Heiter, Jr. His childhood years were spent in Spencer, where he received his education, graduating from Spencer High School in He attended CE School of….
Her childhood years were spent in Honolulu where she attended school.
After graduating high school, she worked at the Dole Pineapple…. Joseph Walter Morris suddenly passed on July 11, doing what he loved. In Joseph remarried to Alauna Telbot. They resided in Spencer, IA, where Joseph…. She exited this world quietly and peacefully, in her sleep as her mother before her,…. She graduated from Estherville High School in and…. The family will hold a memorial service July 20, at P. Her family moved to the Dickens, Iowa, area when she was four years old.
His childhood years were spent in Granville, where he received his education at Granville St. Joseph School. He was raised in the Royal area where he attended country school and later graduated from Royal High School. David was surrounded by friends and family. He graduated from Spencer High School. His father taught him all about hard work and he began working with his father at the age of 15 at the local lumberyard, Spencer…. Her childhood years were spent in Armstrong , Iowa , where she received her education, graduating from Armstrong High School in His parents passed away when he was young, and good friends of the family, Alva and Ella Trimble,….
She spent her childhood in Marathon, IA. As a child she loved anything her Grandpa Jones liked. She graduated in and then spent a year in Minneapolis, MN where she studied…. Her childhood years were spent in Massachusetts, where she received her education graduating from Lancaster, MA. He was raised in Everly, where he attended school and graduated from Everly High School, in Tom entered into the military on April 12,…. Patricia E. Her childhood years were spent in Escanaba, where she received her education, graduating from Escanaba High School in After high school, she worked as a secretary for Triple….
He attended Wayne State and graduated with a Bachelor Degree in…. His childhood years were spent in the Marathon, IA area where he attended school. He graduated from Storm Lake High…. She graduated from Odebolt High School in and earned a teaching certificate. Her childhood years were spent in Sutherland, where she received her education, graduating from Sutherland Consolidated Schools.
She later continued her education at…. At the age of 4 she moved to Agoura, CA where she grew up and graduated from high school. He was raised and received his early education here, graduating from Spencer High School. Following graduation, he entered into the military on March 20, , serving in the U. Her childhood years were spent on a farm north east of Greenville, IA. She attended school in Linn Grove for 2 years and then Greenville where…. Her childhood years were spent in Sioux Rapids, where she received her education, graduating from Sioux Rapids High School.
He was raised in the Peterson. He attended Brooke rural school and then Aurelia High School, graduating in After high school Dennis entered into the military on…. She was the youngest of the six kids and was born on the day the oldest child, John, graduated from high school. Dede received the Sacrament of Holy Baptism on….
Her childhood years were spent in Sutherland, Iowa, where she received her education, graduating from Sutherland High School in She was baptized and…. His devotion and strong faith supported him in his struggle and finally gave him peace. She received her education in the Ayrshire school system. Her younger years were spent in Terril, Iowa.
At nearly 40 years old she returned to school and became a registered nurse. He attended college in Mankato, MN and…. Irene received her early education at St. Anthony's School in Hospers, Iowa. She was the fourth of nine children born to the Miller family. She spent her childhood on the family farms tagging along with older brothers Bob and Jim and caring for her….
Dodge, Iowa. His childhood years were spent in Whittemore, Ames, and Emmetsburg, Iowa, where he received his education, graduating from…. She was raised on a farm northeast of Webb. She graduated from Spencer High School in Dave was born July 5, in Spencer, IA. He was the fourth of seven children of Norval and Emma Crew. Dave spent his childhood on a farm near Webb, IA and worked diligently in his families farming and hog operations. He graduated from Gillette Grove High School. While in…. In her early years, she worked as a Midwife.
Her childhood years were spent in Spencer, Iowa, where she received her education, graduating from Spencer High…. He has a brother Jeff Brenda. Her childhood years were spent on a farm near Granville, Iowa, where she received her education at Paullina Schools and later moved to Everly, where she…. As a young child, her family moved to Sherburn, MN. She received her early education and graduated from Sherburn High School in Maxine continued her education at….
Nellie was the youngest of their four children. Her older brothers were Andrew, Roswell and Wellington Jack. Growing up, Nell lived in different areas where her…. She was raised and educated in Milford, graduating in Dorothy attended and graduated from Mankato College in Minnesota. Her childhood years were spent in…. Leland Carl Franke Jr. She grew up in Mason City , where she attended school. Shirley was the oldest of five children. She and her family lived around Sac City and Lake View and later on a farm near…. She attended school in Pierson , Iowa , through the 8 th grade.
He was the oldest of six children. He graduated from Spencer High School in and spent his adult…. She was raised on a dairy farm east of Fostoria, across the road from her grandparents. Mary attended country school, passing her exams early, and then graduated from Spencer High School at age…. His childhood years were spent in the small town of Sioux Rapids, where he attended elementary school with his four sisters and one brother.
He was a good…. They lived on a farm southwest of Webb, Iowa for many years, moving to the Sioux Rapids area in LaVonne attended Garfield-Webb school for eleven years,…. Maxine graduated from Spencer High School in Maxine met Roger in He was the oldest of three boys in the Fox Family. John graduated from Spencer High School where he spoke at his high school graduation; He attended Kirkwood community college for a period of….
June was the oldest of five daughters. She attended and graduated from Paullina High School. He received his early education and graduated from Gillett Grove High School. Our Brother and Cousin, Richard Rich Marousek, 70 years, passed peacefully on March 3, , after a one-year battle against lung cancer. Rich attended grade school in…. He was raised and received his early education there, graduating from high school.
After high school, John entered into the U. Military on September 15,…. Deb graduated from high school in Vicksburg and attended Western Michigan University with a major in business and a minor in music. He was born on January 1, , in Vientiane, Laos. Mai was a free-spirited person who enjoyed spending time with his children, grandchildren, family….
Her childhood years were spent in Spencer where she received her education. Following her schooling, she worked at Stubs House of Plenty for several years and…. Following high school, she attended a trade school in Omaha, Nebraska, to learn…. Robert L. He attended St. Boniface School. Later, he worked for Goodwill Industries.
Jack was proud of making rugs at home with his mother on his own loom. She was raised in the Oyens and Remsen area and received her education at St. Catherine's school in Oyens. On February 18th, , Rita passed away…. His childhood years were spent in Royal, Iowa, where he received his education, graduating from Royal High School. He attended rural schools and graduated in from Primghar High School.
He was called into military service in the fall of She attended school there and graduating from Hartley High School. She spent most of her young life in Hampton and later moved to Spencer. She met Garold McGuire while living in Spencer. They became…. His parents were Alphonse Heinrichs and Christina Wernimont. Corkey spent his childhood in Carroll County, Iowa, where he graduated from 8 th grade at St. Peter and…. She grew up on a farm near Washta, where she attended country school and then attended Quimby High School, graduating in She attended York College….
Bill Leroy Quist, A. A Big Red to some of his childhood cohorts, was born June 27, They lived on a farm south of Royal. Cleo attended Willow Creek country school for the first eight years of her schooling. She then attended high school in Royal, graduating in Cleo and her close…. He attended the Royal Community School. He passed away on January 11, at the Pocahontas Hospital. Went to school to get an Associate Degree from Iowa…. His childhood years were spent in the Anita area, where he attended country school and later attended Anita High School.
He later…. Her family moved to Cherokee, Iowa,…. James F. At the age of 5, his family moved to Iowa where Ollie received his early education in country schools and later graduated from Calumet High School. He continued his education at Buena…. For most of her youth, she lived on a farm where she attended country school in Allendorf, Iowa, and later graduated from Little Rock High School. He furthered his education at Iowa State…. Robert received his early education at Humboldt Schools.
The family moved to Spencer when Robert was He graduated from Spencer…. His childhood years were spent on a ranch outside of Elmont, ND, where he received his early education at country schools, later graduating from Elmont High…. She was raised on a farm southwest of Everly, graduating from Everly as valedictorian of the class of His childhood years were spent in Fostoria, where he received his education, graduating from Milford High School. After his schooling, he learned…. His childhood years were spent in Spencer, where he received his education. Following his schooling, he worked as a truck driver for several….
Her childhood years were spent in Peterson, where she received her education, graduating from Peterson High School in She worked as a waitress…. His childhood years were spent in Pocahontas, Iowa, where he received his education, graduating from Pocahontas High School. After his schooling, he…. His childhood years were spent in Cedar Rapids area, where he received his education and graduated from George Washington High School in Cedar….
His childhood years were spent in the Peterson area where he attended school,…. He received his early education in Dows. Following their marriage, they…. He was raised and received his early education there, graduating from Sutherland High School. After graduation he ran the Champlain gas station for a few years. In …. Her childhood years were spent on the family farm near…. She received her early education through the 5 th grade in rural Waterman 4…. He was baptized, confirmed, and learned to make homemade ice cream at the Rossie United Church of Christ.
Terry attended Greenville-Rossie and Clay Central schools in…. The family moved to rural Hartley when June was a teen. She graduated from Hartley High School in …. His childhood years were spent near Mary Hill, west of Cherokee. Just 10 days short of her 86 th birthday. Her childhood years were spent in the Hampton area where she attended school, graduating from Hampton High School.
She then attended Iowa State…. Burdette entered the military in and served with the…. Her childhood years were spent in Hungary and Germany. Sue moved to the United States in and later became a U. Citizen in She received her education in…. Her childhood years were spent in the Spencer area, where she attended school and graduated from Spencer High School in She then attended Ft.
Dodge Beauty Academy in…. March 16, - October 29, January 19, - October 28, June 12, - October 21, January 25, - October 21, May 1, - October 20, March 2, - October 18, May 3, - October 18, December 11, - October 15, This group will begin at p. October 7, - October 15, January 20, - October 14, November 7, - October 12, January 27, - October 11, May 30, - October 10, June 7, - October 6, February 13, - October 6, May 23, - October 5, June 15, - October 5, On July 6, , Larry married Joan Uhe and to….
August 16, - October 5, November 16, - October 3, He graduated from Spencer High School in May of November 26, - October 2, Steven served his country with…. August 13, - October 1, September 23, - September 30, March 25, - September 26, June 21, - September 26, July 12, - September 23, April 5, - September 22, April 27, - September 21, Klaas married…. February 26, - September 16, November 13, - September 16, February 11, - September 16, March 4, - September 13, February 7, - September 11, December 16, - September 10, April 14, - September 7, October 15, - September 6, April 21, - September 6, July 18, - September 5, January 1, - August 30, February 22, - August 30, March 26, - August 29, April 25, - August 24, March 20, - August 23, March 16, - August 20, Eula married Dale Belken on April 7, in….
November 11, - August 17, February 5, - August 10, July 10, - August 10, August 11, - August 9, September 20, - August 7, July 26, - August 5, Breeze, Douglas, Jr. Breger, June. Breitborde, Charles Nathan. Brekke, Norman R. Brekke, Ramona Aileen Grundt. Bremer, George F. Bremer, James R. Bremmer, Larry. Brendon, William John. Brennan, Betty. Brennan, Frank Joseph. Brennan, John Francis. Brennan, Julie. Brennan, William C. Brenneman, Ecaterina. Brenner, Delores Francis.
Brenner, Donald J. Brenner, Evelyn M. Brenner, Harold William. Brenner, Marsha. Brenner, Maryellen Fisher. Brenner, Sidney. Brent, Daniel Bernstein. Brent, Roger Irwin. Breshears, Charles Ray. Bresnahan, Letha Kathleen. Brethour, Albert Henry. Breton, Kay Anderson. Brewer, Beulah L.
Brewer, Darral G. Brewer, Floyd 'Reg'. Brewer, Jack Wayne. Brewer, Louise M. Brewer, Mamie Maxine. Brewer, Norha Bliss. Brewer, Olga N. Brewer, Roy M. Brewer, Sean. Brewster, Donald E. Brewster, Donna F. Brewster, Ella Louise. Brewster, Wilma Mae Jochumsen. Breyer, Lois Mae Farwell. Brice, Gilbert E. Brice, Marguerite Anne. Briceno, Maria Alba. Brick, Daniel Stephen. Brickley, Mark Andrew. Bride, Tracy Rae Viles. Bridewell, Carolyn. Bridge, David. Bridgen, Gregory Russell. Bridges, Dorothy Dean Simpson. Bridges, Lawrence Clayton. Bridges, Lois Rae McElhaney.
Bridges, Merwin Charles. Bridges, Ollie Childers. Bridges, Truman Junior. Bridston, John Taylor. Brier, Leslie G. Brierley, Gretchen Suzanne. Briggs, Delores Alice Palmer. Briggs, Kenneth. Briggs, Leta Clinton. Briggs, Michael. Briggs, Stanley M. Briggs, Vilma Marie Ebsen Dolan.
Briggs, William Joseph. Briggs, William O. Brigham, Barbara Paull. Brigham, Vivian A. Bright, Sandra Jean Nichols. Bright, Thomas Nobel.
bridedayapp.com/wp-includes/2019-08-02/1275-cenar-en-sabadell.php Bright, William R. Brigner, Eugene A. Briley, Charles B. Brill, Loida S. Brilliant, Ira F. Briner, Ryan J. Murdered by Javier Acevedo, 17; rec. Brink, Haruko Mutsu. Brinkley, Herbert Lee. Brinley, Thomas M. Gustine National Cem. Briones, Gilbert Richard. Briones, Rebecca K. Brisbine, Lorentz Robert. Briscoe, Jaqueline. Briseno, Ricardo. Bristol, Marjorie Mae Mattson. Bristow, Vera G. Britian, Rosco. Brito, Lupe A. Britt, Alta May. Britt, Ellen R. Britt, Thelma J. Britt, William Gabriel. Died Pleasanton,. Britt, William H. Brittain, Norris E.
Britton, Frederick James. Britzman, Freddie "Ferd". Brix, Bonnie Lee. Brixexy, Blanche Haden. Brixey, Orville O. Brizuela, Annamarie. Brizuela, Antoinette. Brizuela, Janet Moreno. Broadbent, Marvin. Cape Co. Broadland, Russell Jerome. Broberg, Tyler David.
Brobisky Betty Lorraine. Brock, Beryl E. Brock, Mary M. Brock, Rixie Virginia. Brockett, Anna Rita Jones. Brockmann, Earl Edward. Brocksieper, Loraine F. Brockus, Sondra. Brockway, Andrew Harold. Brockway, Dorothy. Brockway, Wilhelm M. Brodaric, Rosemary. Brodbeck, Mary Theresa Pieser. Broderick, Marvis Jean. Brodeur, Dora M. Brodie, Greg. Mobile home fire - Riverside National Cemetery. Brodigan, Alan Bernard. Brody, Bertha. Broeffle, James. Broeffle, James Patrick.
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Bronley, Harry. Bronson, Keith Ross. Bronson, Robert W. Bronstein, Albert Jack. Brookes, William Thomas. Brooks, Audrey. Brooks, Betty. Brooks, Betty Rae Bradbury. Brooks, Craig Douglas, Sr. Brooks, Elmina Pastor Roberts. Brooks, Gerald Thomas. Brooks, James Lee. Brooks, Leslie Francis. Brooks, Margaret Marie Hemingway. Brooks, Rand. Brooks, Ruth Ennis. Brooks, Stephen. Brooks, Sue Ellen Lair. Broomfield, Jacqueline LaRae.
Brophy, Roy T. Brophy, Sheila Marian Tubbs. Brosell, Patsy Irenea. Brosemer, Annie Rebecca Chamberlain. Brosh, Anna Marie. Brossard, Marla. Broswhser, Arline Palmer. Brotea, John. Brothers, Cindy. Brothers, Joanie Harper. Vincent Brothers, 44, estranged husband arrested. Brothers, Lyndsey. Brothers, Marques. Brothers, Marshall. Brotherton, Arlayne Mellon. Brotman, Edward James. Brouillette, Helen Gould Miller. Broussard, Irene Ruby Usher. Brower, Monty W. Brower, Rogeer M. Brown, - Ann. Brown, Alan G. Brown, Andre 'Rosey'. Brown, Barbara Jean Alfinito. Brown, Bernard Joseph. Brown, Betty Lu.
Brown, Bobby Lee Dr. Brown, Brian. Brown, Buford Otis. Brown, Burnetta Jean. Brown, Carole Ann. Brown, Cary Duane. Brown, Charles Ray. Brown, Claude Augustus, Jr. Simi Valley, CA Reardon.
Brown, Coy Franklin. Brown, Curtis. Brown, Daniel E. United Methodist, Camarillo, CA. Brown, Daryl Roy. Brown, David Wesley. Brown, Debra. Brown, Debra Denise. Brown, Devin. Brown, Diane G. Brown, Dionne Monique. Brown, Donald. Brown, Donald Eugene. Brown, Dorothy Sullivan. Brown, Dwight Devon. Brown, Edward Jr. Brown, Edward Murray. Brown, Edwin Curtis. Brown, Ellis C. Brown, Eloise. Brown, Ernest Eugene. Brown, Eugene Edward. Brown, Freeman Libby Jr. Brown, Herbert Townsend. Brown, Irene. Brown, Irene Laverne.
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Brown, Sally Fontes. Brown, Sandra K. Brown, Shari. Brown, Shirley. Brown, Stanford Eugene. Brown, Stephanie. Brown, Thomas. Brown, Thomas Monroe. Brown, Tommy Ray. Brown, Velda May Baldwin. Brown, Vicki Lynne Freeman. Brown, Virginia. Brown, Wilhelmine Minnie. Brown, William E. Brown, William Lloyd. Brown, Winnie Gyngard. Brown, Zella S. Browne, Ann Mack Kenzie.
Browne, Gladys Frances. Browne, Nelson Wayne.
Brownell, Barbara. Brownell, Fred S. Brownell, Larry Lee. Brownell, Robert. Brownell, Steven. Browning, Clark. Browning, Robert Allan. Browning, Rosalie Mae. Brown-Kight, Mackenzie Tayler. Browns, Verna Inez. Broxton, Elsie. Broxton, Howell Leslie. Broyles, Eura Euprates. Broyles, Mona V. Broyles, Warren Harold, Sr. Brozowsky, Miles Boothe 'Skip'. Brubaker, Evelyn. Brubaker, Marie. Brubaker, Vivian I. Brucato, Carol Jean. Bruce, Davilee. Bruce, Robert. Bruce, William. Brucker, Frank R.
Brucker, Virginia Catherine Schuck. Brude, Dorothy. Bruder, Francis. Bruder, James F. Brueland, Glenn Roy. Bruer, Paula Jean Lawler. Additional milk and blood samples are collected from mothers and infants per site between 1 and 3. Exclusive breastfeeding is required through 3.
The volume of milk consumed by infants is measured with deuterated water at each time point to determine actual infant nutrient intakes. The RVs will be constructed as percentile reference curves so that samples from other surveys and studies can be readily compared. Knowledge of human milk composition is critical for establishing dietary guidelines and the nutritional standards for breast milk substitutes. While human milk composition has been studied over many decades, it has nevertheless not been well defined. Lack of robust characterization of human milk components has been due to several limitations: the number of components to be analyzed; limitations in milk and data collection methods; and the lack of standardized, comparative studies in recent years.
Human milk is known to be highly variable, influenced by stage of lactation, time of day, genetics, maternal diet, and environment. Nevertheless, the role of each of these influences has not been well defined for the many components of human milk. And it is not clear how variable or consistent the composition of human milk is across populations. Reviews of breastfeeding intervention studies have shown that breastfeeding education and support, given during prenatal and postpartum periods with routine care by health professionals or non-health professionals, significantly increase exclusive breastfeeding and initiation of breastfeeding.
The availability and use of digital technologies have rapidly increased globally. Digital technologies bring the opportunity to educate and influence mothers, health professionals and the wider community. From looking at previous interventions, we will identify key elements to consider i. With recent changes to the nutritional strategies for preterm infants, early initiation of enteral nutrition is becoming a standard practice. For Japan, this all started about 20 years ago with a multicenter prospective study on early enteral feeding within 24 hours of birth.
The results were excellent: infants on early enteral feeding had lowered risks for chronic lung disease, necrotizing enterocolitis and cholestasis; they also showed better weight gain and cognitive development at 6 years of age. Initiating enteral feeding within 24 hours of birth was not difficult in those days as it was common practice to use another mother's unpasteurized milk.
With increasing awareness of disease transmission via unpasteurized breast milk, the practice of early enteral feeding was abolished. A new multicenter prospective study is currently under way to inform on the standardization of enteral nutrition using donor human milk DHM for very preterm infants. The other current challenge on infant nutrition is how to move toward an exclusive human milk diet.
We have had instances where infants suffered milk allergy or ileus due to fatty acid calcium stone with the use of bovine milk-based fortifier. We have been successful in lyophilizing MOM with no detectable contamination. Worldwide prevalence of exclusive breastfeeding has improved over the past decades. Although a similar rise has been observed in Malaysia, the practice is still not widespread. This presentation aims to examine breastfeeding rates in Malaysia and to explore barriers and motivators towards exclusive breastfeeding.
Findings from periodical National Health and Morbidity Surveys NHMS have reported increasing rates over the past two decades in ever-breastfeeding at Exclusive breastfeeding was more common among Malay mothers, housewives, and mothers with lower educational levels; while mothers from rural areas tend to breastfeed longer than their urban counterparts.
NHMS also reported that majority of mothers A qualitative study on successful exclusive breastfeeding pratices among mothers found that motivating factors include psychosocial, emotional, economic, adequate information on breastfeeding, and religion; whereas hindering factors were biophysical perceived insufficient supply , physiological changes, inconvenience, returning to work, and lack of facilities. In conclusion, although prevalence of breastfeeding in Malaysia is increasing, there are still large proportions of infants who are not breastfed.
Considerations that may aid in successful exclusive breastfeeding include social support and access to lactation consultant early on during the breastfeeding period. Background: Breastfeeding supports early and long-term development and can reduce disease-related morbidity. Methods: A multidisciplinary working group developed evidence-based, practical guidelines targeting mothers, healthy infants, and infants with specific needs.
Guidelines referenced existing domestic and international practices, while considering the current situation in contemporary China. Results: Guidelines were targeted 3 stages. In neonatology, the guideline includes intervention measures to promote early breastfeeding and early milk secretion, skin contact etc. In pediatrics, the guideline addresses assessment of breastfeeding efficacy, applications of growth curves, use of the Human Breastfeeding Assessment Scale and insufficient milk secretion, cow's milk protein allergy and poor growth, etc.
Conclusions: The guidelines provide scientific support for the actions promoted by the Ministry of Health and should play an important role in breastfeeding promotion in China. Background: Late preterm infants LPIs are at greater risk of short- and long-term morbidity than are term infants TIs. However, whether breastfeeding can reduce the adverse effect of late preterm birth on various diseases remains unclear. Hypothesis: Breastfeeding can modify the adverse effects of late preterm birth on hospitalization for respiratory and gastrointestinal infection from 6 to 18 months of age.
Methods: Data were extracted from a nationwide longitudinal survey of Japanese children. We next stratified the infants by breastfeeding status exclusively breastfeeding vs. Results: LPIs were more likely to be hospitalized for respiratory and gastrointestinal infection aOR, 1. Stratification by breastfeeding status showed that LPIs had a higher risk of hospitalization for respiratory infection in both strata. Conversely, a higher risk of hospitalization for gastrointestinal infection was observed only in the partially breastfeeding and formula-feeding stratum.
Exclusive breastfeeding seems to reduce the adverse effect of late preterm birth on gastrointestinal infection. The human milk microbiome consists of myriad types of bacteria, the presence and composition of which have varied across cohorts and studies. Variation has been associated with factors such as stage of lactation, maternal BMI, delivery mode, and maternal diet. Another major consideration in understanding this variation is understanding and controlling for potential effects of sampling and methodological differences on the results obtained.
To better understand biological, behavioral, and environmental factors contributing to the variation seen in the milk microbiome, the INSPIRE study was conducted. Milk, maternal saliva, and infant feces were collected using standardized protocols and supplies, and detailed information regarding maternal dietary intake, social and behavioral patterns, and family structure was collected in 11 different locations around the world.
Milk from each location was shipped to two laboratories Spain and USA , where DNA from the milk samples were extracted using similar protocols, amplified using PCR primers targeting hypervariable regions of the 16S rRNA gene, sequenced, and data analyzed to characterize the milk samples' bacterial compositions. Results from both laboratories suggest that Staphylococcus and Streptococcus were present in almost all milk samples, but more extensive sets of core bacteria were present in some of the cohorts.
Importantly, substantial intra- and inter-cohort variability existed in bacterial community membership within and among cohorts. Variation in the milk bacterial community was also associated with many factors, including the intake of various foods; for instance, relative abundance of Proteobacteria was higher in milk produced by women who consumed meat than those that did not. The past decade has experienced an immense increase in research on human milk oligosaccharides HMOs , a group of over unconjugated complex glycans that, together, represent the third most abundant solid component of human milk.
Our continuously evolving analytical platform allows us to generate reliable HMO composition data from less than a drop of milk — and from several hundred milk samples per week. This high-throughput approach has enabled us, together with our collaborators from around the world, to investigate which maternal genetic and environmental factors influence HMO composition as well as how HMO composition impacts health and development of infants and mothers.
In parallel to our analytical platform that enables HMO analyses for hypotheses-generating cohort studies, we developed a preparative platform to extract HMOs from pooled donor human milk for efficacy testing in suitable in vitro and in vivo models. We carefully ensure that our HMO preparations are very low in lactose, salt, and endotoxin contaminations, which might otherwise compromise research results. After initial efficacy testing of pooled HMOs, we apply a multi-dimensional chromatography approach for the stepwise fractionation of HMOs to determine structure-function relationships.
So far, this approach of combining association data from human cohort studies with efficacy data from in vitro and in vivo testing has taught us that sometimes specific HMOs are required to exert an effect that is highly structure-specific, dose-dependent, and likely receptor-mediated. Presenting Author: Carolyn M. The link between food and health is complex, particularly for the developing neonate, as the period after birth is the time when long term programming is occurring in the neurologic, immune and metabolic regulatory systems.
Breastfeeding is known to have short- and long-term benefits, and we have previously reported profound differences between breast-fed and formula-fed infants with respect to growth trajectory, immunological development, succession of the gut microbiome and metabolism that indicate development of unique metabolic phenotypes as a consequence of diet.
While the world health organization WHO advises that no other food other than human milk be introduced before 6 months of age, many infants are supplemented with formula or encouraged to consume complementary foods even before 4 months of age. To date, not much is known about the impact of other foods introduced during the first 6 months on the microbiome and metabolism. To investigate how complementary feeding affects the gut microbiome and overall host metabolism, fecal microbial ecology combined with comprehensive metabolic profiling of serum and feces were analyzed in breast- and formula- fed infants.
Our results highlight the need for a greater understanding of how the introduction of complementary foods shape immunity and metabolism in the developing neonate. Boner University of Verona — Department of Paediatrics. Background: Evidence of the mechanisms by which breastfeeding may improve allergic outcomes in early childhood has not been elucidated.
Objective: The aim of this study was to investigate relationships between levels of immune mediators in colostrum and mature milk and infant outcomes in the first year of life. Samples were analysed for immune components. Hepatocyte growth factor was protective for common cold incidence at 12 months. Whereas transforming growth factor 2 was associated with a higher risk of eczema. Conclusions: Data from this study suggests that differences in the individual immune composition of HM may have an influence on early life infant health outcomes.
Background: Our prior studies have shown that the Old Order Mennonite OOM population has a lower prevalence of allergic diseases and asthma than the general U. Objective: To determine if there is variation in breast milk immune composition between OOM, a low allergy risk population with long breastfeeding duration, and a control group from urban Rochester ROC.
Levels were compared between groups and across components using parametric and non-parametric methods to analyze the impact of various maternal exposures on milk composition. Additionally, clustering analysis was performed to identify clusters of cytokines, HMOs and specific IgA. Several bacteria-specific IgAs clustered together E. Conclusion: To our knowledge this is the first multi-component characterization of breast milk between mothers with different lifestyles. OOM milk is richer in many immune components, which together with longer breastfeeding duration may provide protection against allergic diseases.
Methods: Healthy children from the GUSTO cohort participated in repeated neurodevelopmental assessments between 6 and 54 months. Children fed directly at the breast performed better at the deferred imitation task at 6 months 0. Conclusions: These modest significant associations suggest that the nutritional content of breast milk may improve general child cognition, while feeding infants directly at the breast may benefit memory.
Presenting Author: Courtney L. Co-Authors: Michelle K. Background: Human milk, which harbors a diverse microbiome, is an early and consistent source of bacteria to infants. However, there are no data or inconsistent results on whether or how the human milk microbiome HMM is related to maternal characteristics age, parity, time postpartum, birth mode , household environments household composition, animal exposure , and social and behavioral patterns diversity of caregivers, intensity of maternal-infant interactions, and breastfeeding.
Methods: Human milk samples, demographic, and survey data were collected via standardized procedures. Results: HMM alpha diversity and the relative abundance of specific genera e. Conclusion: Our results identify multiple external influences on HMM diversity and community composition and provide initial evidence suggesting that HMM diversity and composition may reflect short- and long-term environmental exposures, possibly priming infants for the worlds in which they are reared.
Presenting Author: Melanie W. Background: Some infants have excessive weight gain during the first months of exclusive breastfeeding. HMO composition has been shown to be associated with infant growth and body composition. Results: All infants were included in the initial analysis.
Three mothers of HW and two mothers of NW infants were non-secretors.
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Furthermore, percentage fat mass was negatively associated with diversity, evenness and LNH. Conclusions: These data support that HMO composition is related to both infant growth and body composition. Furthermore, they suggest that maternal BMI has an effect on HMO composition with potential impact on infant health and disease.
It has been known for several decades that maternal vitamin deficiencies can lead to low vitamin concentrations in milk. In , we suggested that in lactation micronutrients can be categorized into two groups. Group I micronutrients include all the B vitamins except folate, all the fat soluble vitamins, iodine, selenium, and probably choline. The concentration of these nutrients in milk is correlated with maternal status, and maternal deficiency can lead to infant depletion.
Conversely, maternal supplementation can increase their concentration in milk. There are fewer Type II micronutrients; folate, iron, minerals such as iron, copper and zinc, and calcium. Status or intake of the mother, including supplementation, does not affect levels of these nutrients in milk, so the mother may become more depleted during lactation while her infant is protected. There are still many questions around this general classification scheme, however.
How deficient does the mother have to be before milk concentrations fall low enough to adversely affect infant status? There are few data on this question for several reasons; reluctance to question the nutritional quality of milk, difficulties related to milk sampling and analysis protocols, and lack of reference values for milk micronutrients and infant status.
Similarly, data are sparse concerning the effects of maternal supplementation on milk micronutrients and infant status. For some vitamins, maternal supplementation during pregnancy may be most important so that the infant accumulates adequate stores in utero. For others, milk concentrations are responsive if the mother is supplemented during lactation, with the amount of response differing among vitamins. In this presentation we will share data on milk composition of women in many countries, some of whom were participants in maternal supplementation or food fortification studies.
The potential effects of maternal nutrient supplementation on human milk lipids, proteins and oligosaccharides HMOs are poorly understood. Women were randomly assigned to receive daily either: 1 iron-folic acid pregnancy ; 2 multiple micronutrients pregnancy and lactation ; or 3 LNS pregnancy and lactation. Breast milk samples were collected at 6 months postpartum and analyzed for milk fatty acids Oaks et al. Prostaglandins Leukot Essent Fatty Acids. J Nutr LNS increased breast milk alpha-linolenic acid levels in Ghana, but not Malawi.
There was no effect in either site on other milk fatty acids including DHA. Milk DHA levels were 2—3 times higher than the worldwide average, likely due to frequent fish consumption. This presentation will discuss other factors related to levels of these milk constituents, and their association with infant growth and inflammation.
Co-Authors: N. Moossavi, A. Becker, P. Mandhane, S. Turvey, T. Moraes, D. Lefebvre, P. Subbarao, M. Background: Among diverse mammalian species, maternal milk synthesis and nursing behavior can differ between male and female offspring. This has rarely been studied in humans. Objective: To assess whether breastfeeding differed by infant sex in two large prospective birth cohorts. Sex differences were evaluated by two-sided t-test and multivariable regression. Results: Breastfeeding initiation rates were Breastfeeding initiation did not differ between mothers of daughters versus sons.
These sex differences persisted in multivariable models, and were similar in magnitude to the effect estimates for established predictors of breastfeeding, such as parity, maternal overweight, post-secondary education, and method of delivery. Conclusions: Results from two distinct human cohorts suggest that mothers sustain lactation longer for daughters than for sons, consistent with evidence from other mammalian species. Further research is needed to explore the biological and social factors underlying these sex differences.
Meanwhile, it is important to consider infant sex in human milk and lactation research. Presenting Author: Nurul Husna M. Background: Breastfeeding involves complex biological and behavioral signaling between mothers and infants. In a randomized controlled trial we found that the use of relaxation therapy by breastfeeding mothers led to reduced maternal stress and increased infant sleep duration, with more optimal infant weight gain. Home visits HV were performed at 2—3 HV1 , HV2 and 12—14 HV3 weeks to measure maternal stress, breast milk composition and infant behavior and growth.
IG mothers were asked to listen daily to a relaxation tape for at least 2-weeks post-HV, including during a breastfeeding session at each HV. Cortisol, leptin, ghrelin and macronutrient content were measured in fore- and hindmilk samples. Conclusions: The relaxation intervention had effects on milk ghrelin, leptin and carbohydrate, raising the hypothesis that these may be biological signals mediating the observed intervention effects on infant behaviour and growth.
These results from an experimental study provide evidence on potential mother-infant signaling mechanisms for investigation in future studies. We hypothesized that the response of fully breastfeeding infants to HBV would differ as a function of both maternal and infant's vit D status as measured by circulating 25 OH D concentration.
Mothers were randomized to receive either vs. Conclusions: HBV titers of fully breastfeeding infants differed at 7 months of age by maternal vi tD treatment and not on the basis of infant vit D status. These findings suggest that the regulation of infant immune response to maternal signals differentially through her breast milk on the basis of maternal vit D status.
Background: The necessity of iodine supplementation in lactating mothers residing in countries with sustained salt iodization programs for iodine-sufficiency of breastfed infants remains unclear. Objective: The aim of the study was to investigate the effect of iodine supplementation on iodine status and growth parameters of lactating mothers and breastfed infants during the first year of infancy.
The primary outcomes were maternal and infant urinary iodine concentrations UICs , breast milk iodine concentrations BMICs , and infant growth parameters, measured at 1, 2, 4, 6, 9, and 12 months during routine health visits. Results: One hundred and eighty mother-newborn pairs participated between October and January Infant anthropometric measurements were similar between three arms of treatment group over the study period.
Objectives: To evaluate the effect of breastfeeding on long-term breast carcinoma, ovarian carcinoma, osteoporosis and type 2 diabetes mellitus and short-term lactational amenorrhoea, postpartum depression, postpartum weight change maternal health outcomes. Outcome estimates of odds ratios or relative risks or standardized mean differences were pooled. In cases of heterogeneity, subgroup analysis and meta-regression were explored. No conclusive evidence of an association between breastfeeding and bone mineral density was found. Exclusive breastfeeding and predominant breastfeeding were associated with longer duration of amenorrhoea.
Shorter duration of breastfeeding was associated with higher risk of postpartum depression. Evidence suggesting an association of breastfeeding with postpartum weight change was lacking. Conclusion: This review supports the hypothesis that breastfeeding is protective against breast and ovarian carcinoma, and exclusive breastfeeding and predominant breastfeeding increase the duration of lactational amenorrhoea.
There is evidence that breastfeeding reduces the risk of type 2 diabetes. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not evident. Background: Longer duration of breastfeeding has been associated with a lower risk of diabetes, breast and ovarian cancer, myocardial infarction and hypertension in women. Mexico has one of the lowest breastfeeding rates worldwide, therefore estimating the disease and economic burden of such rates is needed to influence public policy. Objective: Quantify the lifetime excess cases of maternal health outcomes, premature death, DALYs, direct costs and indirect costs attributable to suboptimal breastfeeding practices, using rates in Mexico in Results: The suboptimal scenario was associated with 5, more cases of ALL diseases, 1, additional premature deaths and 66, DALYs as well as Conclusions: Findings suggest that investments in strategies to enable more women to optimally breastfeed could result in important health and cost savings.
Breastfeeding has marked effects on maternal reproductive hormone levels and consistent evidence indicates that it reduces maternal risk of breast cancer. However, its association with other hormonally-related cancers such as endometrial and ovarian cancers is much less clear. Indeed, in its Continuous Update Project, the World Cancer Research Fund found there was insufficient evidence to evaluate whether there was an association with endometrial cancer and that evidence for an association with ovarian cancer was limited but suggestive of a decrease in risk We have conducted case-control analyses and pooled analyses of case-control and cohort studies to examine these relationships.
Using our results and those from the literature we have also calculated the proportions of ovarian and endometrial cancers that may be attributed to a lack of breastfeeding. Our ovarian cancer studies showed similarly protective associations with breastfeeding, results consistent with most, although not all, recent findings.
Our results therefore suggest that in addition to established benefits for babies, supporting women to commence and continue breastfeeding for recommended periods could also contribute to the prevention of these increasingly common cancers. Presenting Author: Julie P. Background: Breastfeeding supports child development through complex mechanisms that are not well understood. Numerous studies have compared how well breastfeeding and non-breastfeeding mothers interact with their child, but few examine how much interaction occurs.
Maternal sleep hours may be associated with nurturing care time. Methods: The study collected weekly time use data from mothers of infants aged 3—9 months recruited via mother's and baby groups, infant health clinics, and childcare services. Participants used an electronic device to record their hour time use for 7 days. Sociodemographic and feeding status data were collected by questionnaire.
Statistical analysis used linear mixed modeling and residual maximum likelihood analysis. Results: Breastfeeding and non-breastfeeding mothers had broadly similar socioeconomic and demographic characteristics. Breastfeeding was associated with more mother—child interaction time, a difference only partially explained by maternal employment hours or other interactive care activities. Older age of infant was associated with reduced maternal sleep hours. Conclusions: This study presents data suggesting that lactating mothers spent significantly more hours weekly on milk feeding and on carrying, holding, or soothing their infant than non-lactating mothers; and on providing childcare.
Understanding mechanisms by which child mental health and development benefits from breastfeeding and nurturing care may have important implications for policies and intervention strategies. Time pressures on mothers of older infants may have implications for maternal sleep, health and wellbeing. Background: Maternal metabolic diseases during pregnancy influence breast milk composition of nutrients and bioactive factors.
Lactational metabolic programming from altered breast milk composition is hypothesized to contribute to the risk of childhood obesity. Milk microRNA profile alterations may mediate regulation of early infant metabolism. Methods: Breast milk samples were collected at 2 weeks postpartum from a total of 36 mothers with maternal obesity 5 , gestational diabetes 5 , polycystic ovary syndrome 5 , and healthy controls 21 through a prospective observational cohort study of mother-baby dyads at the University of Michigan.
Results: A total of microRNAs were identified in the 36 milk samples. Potential actions of these microRNAs include regulation of adipocyte proliferation, fatty acid synthesis, glucose uptake, and potential biomarkers for childhood obesity based on current microRNA literature. Conclusions: The microRNA profile in human milk is influenced by maternal metabolic disease. Additional infant cohort outcome data is needed to determine potential clinical significance of microRNAs in metabolic programming. Co-Authors: Pamela D.
Background: Breast milk provides nutrients, immune factors and other bioactive compounds, including cortisol, for the adequate growth and development of the infant. Environmental and maternal factors modify the composition of this complex and dynamic biological fluid. Objective: To characterize the immunological profile and cortisol concentration in breast milk, and to assess its potential relationship with maternal postnatal psychosocial distress during the first months postpartum.
Methods: Fifty-nine mothers collected breast milk samples at 2, 6 and 12 weeks postpartum and filled in mood questionnaires on experienced stress, anxiety and depression at 6 weeks postpartum. Immune factors were quantified by magnetic beads-based multiplex immunoassays, and cortisol levels by liquid chromatography-tandem mass spectrometry. Results: The concentration of most immunological factors decreased over time, especially between week 2 and 6 postpartum, while that of cortisol increased.
There were no relevant correlations between immune factors and cortisol concentrations in milk. Psychosocial distress did not correlate with any immune compound found in milk but it was positively related to milk cortisol concentration. Conclusions: Globally, the content of most immune components in breast milk decreases during lactation and they are not related to maternal psychosocial distress. In contrast, high maternal psychosocial distress experienced during breastfeeding is associated to high milk cortisol concentration.
Mother's own milk MOM reduces the risk of complications of prematurity during and after neonatal hospitalization. However, mothers of premature, very low birthweight infants produce lower MOM volumes than mothers who breastfeed healthy term infants. Etiologies of this disparity include biological and behavioral components. In addition, potentially most importantly, mothers of very preterm infants are breast pump-dependent for lactation initiation, a critical window when the breast is programmed for long-term MOM synthesis. However, optimal pumping behaviors are challenging when mothers of sick infants are still ill themselves in the post-partum period.
In this preterm population, it is well known that macronutrient composition, especially protein levels in early MOM, differs from term mothers, but seems relatively unaffected by maternal nutritional status or diet. However, new research suggests maternal diet and factors such as obesity may significantly affect other aspects of MOM, from fatty acid, hormone, and cytokine profiles to human milk oligosaccharides that may affect long-term infant health. However, preterm-specific data is lacking, making the study of maternal influence on MOM composition in this vulnerable population a research priority.
Mother's own milk MOM reduces the risk of potentially preventable complications of prematurity and their associated costs in VLBW infants, including necrotizing enterocolitis NEC , late onset sepsis sepsis , bronchopulmonary dysplasia BPD , neurodevelopmental problems and rehospitalization.
This protection is provided by myriad components that function synergistically via anti-inflammatory, antioxidant, immunomodulatory, growth-promoting, neuroprotective and gut-colonizing mechanisms. Many components are concentrated most highly in early lactation MOM and in MOM produced by the immature mammary gland following premature birth. When MOM is unavailable, donor human milk DHM is the recommended global alternative, in part because bovine formulas upregulate inflammation and oxidative stress and contribute to gut dysbiosis.
Presenting Author: Deborah L. Hospitalized infants with elevated nutritional requirements or fluid restriction, may require their mother's milk to be nutrient-enriched. In this talk, the evidence for routine nutrient fortification of mother's milk on short and long term health outcomes will be discussed and gaps in knowledge identified. The challenges associated with human milk nutrient fortification including variability in mother's milk and donor milk composition, variability in the nutritional requirements of hospitalized infants and adherence of fat to feeding tubes will be discussed as will potential solutions.
Finally the evidence in support of the use of hydrolyzed bovine-based, human milk-based fortifiers over intact bovine-protein fortifiers will presented. Secondary outcomes from the trial including a dichotomous mortality and morbidity index, fecal calprotectin e. For sick and vulnerable newborns, evidence shows that those that receive human milk early and exclusively, are more likely to survive.
Currently, over 35 countries have established systems to provide DHM through HMB, including a number in low- and middle-income countries such as Brazil and Vietnam. The following are actions that policy makers can take to strengthen systems to increase access to and intake of human milk for sick and vulnerable newborns: 1 Commit to developing, improving, and enforcing policies and legislation that protect, promote, and support the use of human milk for all newborns; 2 Invest in capacity-building in the optimal feeding of premature, sick and vulnerable newborns; 3 Integrate the provision of DHM from HMB into national strategies and policies as part of a comprehensive approach for newborn care; 4 Establish culturally appropriate national standards for establishing HMB, monitoring distribution and quality control of DHM, and ensuring equitable access to donor human milk; and 5 Ensure that policies and programs to increase access to and intake of DHM do not undermine breastfeeding.
Presenting Author: Sarah N. Co-Authors: Carol L. Background: Preterm birth presents a barrier to breastfeeding and often requires long-term maternal breast pumping and complicated regimens. A post-hospital discharge HD intervention of home hospital grade breast pump, baby weigh scale and pediatric clinic lactation counseling was developed to support mother's goal to sustain milk post-HD.
Methods: Fourteen pediatric clinics in 5 counties in South Carolina were randomized to provide lactation support or serve as control. Results were analyzed by quantitative and qualitative methods. Further analysis will evaluate the effect of the intervention components as well as maternal self-efficacy and attitudes regarding support. Background: Early initiation of milk expression within one hour following delivery has been shown to increase milk production in mothers of very low birth weight VLBW infants.
Objective: The aim of this QI project is to decrease the mean timing to first pumping for mothers of VLBW infants from 12 hours to 2 hours by standardizing the postpartum workflow by July Methods: An interdisciplinary obstetric-neonatal team used QI tools to identify barriers to early pumping initiation and develop a key driver diagram underscoring the following interventions.
Prior to delivery: centralizing supplies for pumping, educating mothers Neonatology consults and a video , and scripting nursing support. Intrapartum: assigned clinician roles to initiate pumping immediately after delivery, excluding mothers that receive general anesthesia. Postpartum: an electronic medical record field was created for easy charting of pumping initiation. Measures included: outcome- time to first pump, process- charting compliance, and balancing- postpartum event. Results: The xmr chart shows that the mean time to pumping initiation decreased from 12 hours to 2. The pre versus post implementation medians were 3.
Conclusions: QI methods significantly improved timing of pumping initiation. Ongoing data collection will evaluate impact on milk volume and donor milk usage. Co-Authors: Lisa K. Scheel, Andreas W. Background: Human mammary epithelial cells undergo major changes within the adult gland during key stages of development including pregnancy, lactation and subsequent involution. Previously, the plasticity of single resting non-pregnancy, non-lactating human mammary epithelial cells isolated from esthetic breast mammoplasties was interrogated by the use of a mammary organoid assay.
Mammary epithelial cells cultured under floating collagen gel conditions yield complex three-dimensional mammary organoids that resemble the morphological and cellular organization of the resting mammary gland Linnemann et al.