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La méconnaissance des lactariums en France
Abstract
The main objective of this study was to better define awareness surrounding milk banks in the female French population. An additional objective was to establish the criteria justifying or discouraging milk donation in these populations. Knowledge of milk banks (existence, role, services) as well as motivation to donate breast milk were evaluated in 3 groups of females: 50 students, 47 breastfeeding mothers and 19 milk donor mothers. The results show that mothers appear well informed about the existence of milk banks whereas students are not. The major motivations to donate milk are altruistic or beliefs about milk production. Not donating milk is justified through a fear about breastfeeding difficulties as well as beliefs relative to the milk quantity and quality. The results indicate the need for diffusing better information about the existence and role of milk banks.
... Female milk donation was little known by the donors, only 16.2% had known about the existence of the lactarium in the department; similar to that found by Gelano et al. 3 While in a survey conducted in France, it was found that mothers seem to be well informed about the existence of lactarium. 5 According to Hitte et al lack of information was a barrier to milk donation 8 . Thus, it would be beneficial to strengthen information, education, communication of all women on the existence and importance of the milk bank. ...
... 13 A study conducted in France showed that the main obstacle to donating milk was the fear of difficulty with breastfeeding as well as beliefs about the quantity or quality of milk. 5 At the end of the donation, the average amount of milk collected per donor was 613 ml, with extremes of 50 ml and 3020 ml. Compared to that found by Colomina et al it was lower, they found that the median amount of milk collected was 3.1l (1.3-8.3l). ...
Background: The functioning of a milk bank begins with the donation of milk from women donors. The objective of our study was to describe the demographic profile of mothers who donate milk and their practice of donating milk in the neonatology department at the hospital Center Androva Mahajanga. Methods: This is a prospective, descriptive study over a 7-month period, from August 2019 to February 2020. Were included all healthy breastfeeding women who agreed to donate excess breast milk. Results: The participation rate of breastfeeding women in milk donation was 6.6%. Vaginal delivery was the most common (85.9%). The majority had no knowledge about milk donation (83.8%). Manual breast pumping was the most used (43.8%). The average total amount of milk collected by a mother from the beginning to the end of the donation was 613 ml. The average duration of donation by a mother was 6.4 days. Conclusions: The participation and knowledge of mothers on the donation of women's milk was low, although it can improve the survival of newborns.
... Une seule étude s'intéresse au même objectif que le nôtre [18]. Elle regroupe des étudiantes, des femmes venant d'accoucher et des donneuses au lactarium ; seule la catégorie des femmes venant d'accoucher a été retenue. ...
Des études montrent que lorsque le lait maternel est indisponible pour certains enfants (prématurés), l’utilisation de lait de donneuses prime sur les laits artificiels. Seulement l’accès à ce lait est restreint par manque de dons. L’objectif de l’étude est de comprendre pourquoi les dons de lait sont insuffisants, sur Bordeaux.
There is large disparity when comparing breastfeeding initiation rates between French (53%) and German (90%) women. For this reason, this study investigated women's motivation to breastfeed and bottle feed in both countries. The authors examined the decision making process of these women through asking 126 French women and 80 German women, all first time mothers, to indicate the reasons for their feeding choice and to report at which time they had made their final decision. Results show important differences between the justifications given for the feeding choice decisions of these two groups of mothers. In particular, justifications concerned: breastfeeding advantages for the baby, practicality, and implications on the father-child relationship. In addition, half of the participants reported that the feeding decision was made very early in the pregnancy; thus, highlighting the importance of providing clear and consistent information on breastfeeding during antenatal courses offered to French mothers.
An ultrasonic technique was used to compare gastric emptying after a feed of expressed breast milk and formula milk in a blind, cross over study of preterm infants. Fourteen infants (median gestational age 33 weeks) were studied on 46 occasions. Each infant received a nasogastric feed of either expressed breast milk or formula milk, and the alternative at the next feed. Real time ultrasound images of the gastric antrum were obtained and measurements of antral cross sectional area (ACSA) were made before the feed and then sequentially after its completion until the ACSA returned to its prefeed value. The half emptying time (50% delta ACSA) was calculated as the time taken for the ACSA to decrease to half the maximum increment. On average, expressed breast milk emptied twice as fast as formula milk: mean 50% delta ACSA expressed breast milk 36 minutes; formula milk 72 minutes. The technique was reproducible and there was no significant difference between the emptying rates of feeds of the same type for an individual infant. These data show that breast milk has a major effect on gastric emptying, which may have important implications for preterm infants who have a feed intolerance due to delayed gastric emptying.
In France, 53% of women choose to breast-feed. But only a few data concerning breastfeeding duration and the reasons of ending it exist. Therefore, the authors of the study followed 126 primaparas during six months after birth. The aim of this study was to assess the breastfeeding rate on the day of birth, after three months and six months, and to examine why women had to stop nursing before six months as recommended by World Health Organization and United Nations Children's Fund. Results show that a good part of primiparas choose to breast-feed, and that difficulties related to breastfeeding are mostly responsible for interruption before three months, while, after three months, women stop breastfeeding to go back to work. A better postnatal accompaniment appears to be a priority.
In a prospective multicentre study on 926 preterm infants formally assigned to their early diet, necrotising enterocolitis developed in 51 (5.5%). Mortality was 26% in stringently confirmed cases. In exclusively formula-fed babies confirmed disease was 6-10 times more common than in those fed breast milk alone and 3 times more common than in those who received formula plus breast milk. Pasteurised donor milk seemed to be as protective as raw maternal milk. Among babies born at more than 30 weeks' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk; it was 20 times more common in those fed formula only. Other risk factors included very low gestational age, respiratory disease, umbilical artery catheterisation, and polycythaemia. In formula-fed but not breast-milk-fed infants, delayed enteral feeding was associated with a lower frequency of necrotising enterocolitis. With the fall in the use of breast milk in British neonatal units, exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year. About 100 of these infants would die.
The effects of fortified human milk feedings on the urinary excretion of lactoferrin, lysozyme, secretory component, IgA, and secretory IgA antibodies to Escherichia coli O antigens were investigated in very low birth wt infants. Infants were maintained on either a human milk or a cow's milk preparation. The amounts of each immune factor that were ingested and excreted were quantified during balance studies conducted at 2.5 and 5 wk of age. Serum levels of these immune factors were similar in both feeding groups. The urinary excretion of all factors except lysozyme was 7- to 150-fold greater in infants fed human milk than in those fed cow's milk formula. IgA was the only factor for which the amount of the factor excreted correlated with the amount ingested. Fragments as well as whole molecules of lactoferrin were found in the urine of the infants fed human milk, but the molecular sizes of the excreted proteins exceeded those normally filtered by the kidneys. Therefore, the genesis of the enhanced levels of host defense factors in the urine of infants fed human milk is not clear. Gastrointestinal absorption and subsequent renal excretion as well as enhanced production of immune factors in the infant's urinary tract are possible explanations.
In a prospective controlled study the anti-infective properties of breast-milk were evaluated in 70 high-risk low-birth-weight infants. 32 babies (group I) were given fresh expressed breast-milk during the day and milk formula at night. 38 infants (group II) received only milk formula and served as controls. The two groups were matched for other factors that could influence the occurrence of infection. The incidence of infections was significantly less (p < 0.01) in babies who received breast-milk.
Preterm infants are immunologically immature at birth. Previous studies have demonstrated that human milk protects against infection in full-term infants, but there are few studies of its effect for preterm infants.
To examine the effect of human milk feedings on infection incidence among very low birth weight (VLBW) infants during their initial hospitalization.
The sample consisted of 212 consecutive VLBW infants admitted to the Georgetown University Medical Center neonatal intensive care unit (NICU) during 1992-1993 and surviving to receive enteral feeding. Type of feeding (human milk vs formula), presence of infection and sepsis/meningitis (clinical signs and positive cultures for pathogenic organisms), and potential confounding variables were abstracted from medical records. Multiple logistic regression was used to control for confounders.
The incidence of infection (human milk [29.3%] vs formula [47.2%]) and sepsis/meningitis (human milk [19.5%] vs formula [32.6%]) differed significantly by type of feeding. Major risk factors for infection were similar in both groups. Human milk feeding was independently correlated with a reduced odds of infection (odds ratio [OR] = 0.43; 95% confidence interval [CI]: 0.23-0.81), controlling for gestational age, 5-minute Apgar score, mechanical ventilation days, and days without enteral feedings; and was independently correlated with a reduced odds of sepsis/meningitis (OR = 0.47, 95% CI:0.23-0. 95), controlling for gestational age, mechanical ventilation days, and days without enteral feedings.
The incidence of any infection and sepsis/meningitis are significantly reduced in human milk-fed VLBW infants compared with exclusively formula-fed VLBW infants.