Recent Advances in of BREAST FEEDING : Dr Sharda Jain

1. Dr. Sharda Jain
Sec General DGF
Director : Lifecare Centre Lifecare IVF
Recent Advances in of
BREAST
FEEDING

2. The Golden hour of
Breast Feeding

3. The Golden hour
Defined as the first hour of post-natal
life.
Care in these initial hours of life can
provide a healthy future for newborns.
Sharma. Matern Health Neonatol Perinatol. 2017; 3: 16.

4. THE GOLDEN HOUR –NUTRITION
 Breast Feeding to be initiated within the GOLDEN HOUR
 Pasteurized Donor Human Milk to be used whenever
mother’s milk is not available
 Avoid formula feeds or bovine based feeds in the GOLDEN HOUR

5. Recommendation

7. Golden Hour Nutrition is CRITICAL for newborns

8. 16% of neonatal lives can be saved if all babies were breastfed from day 1.
22% if breastfeeding were started within the first hour.
Neonatal mortality was also shown to increase markedly as delay in
initiation increased.
41.6% of new-born infants are receiving human milk feeding within 1 hour
of birth.
1. Edmond K et al Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics 2006;117:380-386
2. Ministry of Health and Family Welfare, Government of India. National Family Health Survey India IV. http://rchiips.org/NFHS/ nfhs4.shtml. Accessed January 8, 2018.

9. 1. http://data.unicef.org/nutrition/iycf

10. Source: NHFS-4, 2017
Rural ?
50%
Private Govt.
Urban
72%
Status of LSCS births
50%

11. INFANTS BORN BY CESAREAN SECTION
are four times less likely to receive breastfeeding
within first hour of birth than vaginally delivered infants.
Source: NHFS-4, 2017
42%
58%
Newborns fed human milk
Within 1st hour Beyond 1st hour
LSCS: A persistent barrier to early initiation of breastfeeding
Rowe-Murray HJ et al. Birth. 2002 Jun;29(2):124-31.

12. Babies delivered vaginally were enriched with
species of beneficial commensal genera (68.3%)
Vs.
Gut microbiota of babies delivered by caesarean
section were dominated by genera associated with
hospital environment and hospitalized
preterm babies
Challenges for LSCS babies
Shao Y et. al, Nature. 2019 Sep 18
In the neonatal period, differential microbial colonization clearly relates to
“Mode of Delivery”

13. Access to optimal volume of HM
 By day 6, only 20% in the CS group had
regained their birth weight compared with
40% in the NVD group
 Formula-fed infants are subjected to
excessive loads of water and substrate

14. Choice of feeds
Bovine milk-based
formula
Human milk
(EBM / DHM)

15. Donor Human milk
Breastfeeding
Right choice of feed

16.  Feeding type significantly influenced the gut microbiota
composition and predictive functional profile.
 The formula microbial profile was distinct than those
observed in MOM and DHM, suggesting that DHM favors
an intestinal microbiome more similar to MOM.
Gut microbiota profile
Parra-Llorca et al. Front. Microbiol. 9:1376.

17. Benefits for baby
Improved gut flora for stronger immunity
Seamless transition to breastfeeding
Higher neurocognitive scores (IQ)

18. Benefits for parents
Reduced hospitalization expenses
Lower risk of re-hospitalisation
Lower risk of developing
metabolic syndrome

19. Benefits for Hospital
Encourages breastfeeding
Compliance to recommendations
Improved outcomes

20. GOLDEN HOUR Nutrition
Many names, same purpose
Trophic Feeds
Minimal
Enteral Feeds
(MEF)
Minimal
Enteral
Nutrition
(MEN)
Gut Stimulating
Feeds
Small Volume
Feeds
Early Enteral
Nutrition

21. Why trophic feeds???
Dealing with an immature and unused gut
Objective: Maturation of gut (GUT Priming)

22. Human Milk is BEST
& LARGEST source
Human Milk is
PROTECTIVE
against these
infections
Microbiota in GUT

23. Human milk stimulates maturation of the gut
Provides rich source of pre & pro biotics
Strong anti-infectious effects from
immunoglobulins
Protects against sepsis, NEC and death
Promotes post-natal growth and organ
development.
Importance of
trophic feeding with
human milk

24. Should be initiated within 1st hour of birth
•Term Infants
•If hemodynamically stable(Normal Heart
rate and RR)
WHEN TO START TROPHIC FEEDS?

25. Following are the risks if non-human milk
source is used as trophic feeds:
a. Emesis
b. Distended Abdomen
c. NEC
d. Longer days on IV nutrition
e. Infections/Sepsis
What not to use for trophic feeds
Bovine Milk
Based Feeds
Human Milk is always the safest and
strongest source of nutrition for newborns

26. Difference between human milk and bovine milk
Adapted from: Breastfeeding Counselling: A Training Course Geneva
EFA – Essential Fatty acids

27. The Golden hour – Nutrition
Ip S, Chung M et al.. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153
(Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022). AHRQ Publication No. 07-E007.
https://news.sanfordhealth.org/womens/pregnancy/the-golden-hour-giving-your-newborn-the-best-start/
Babies who are fed human milk within the
Golden Hour have LOWER RATES of
Ear Infection Asthma Diabetes
Childhood
Leukaemia
Sudden
Infant Death
Syndrome

28. The Golden hour – Nutrition
Flaherman et al. Pediatrics. 2013 Jun; 131(6):
1059–1065.
Babies who are fed formula within the
Golden Hour have HIGHER RISKS of
Infections Gastroenteritis and
Diarrhea
Necrotizing Enterocolitis Obesity and Diabetes
Repeated hospital
admissions
Increased hospital
costs

29. 1
Mothers Own Milk
(MOM)
2
Donor Human Milk
(If MOM is not
available)
Recommendations for trophic feeds
What to use?

31. The “Prime fit” for golden hour nutrition
NeoLact 70 Prime – for GUT Priming
100%
HUMAN MILK
BASED
GUT PRIMING IMMUNOGLOBULINS &
HMO’S
FASTER FEED
ADVANCEMENTS
AVOIDS FORMULA
USAGE
1 sachet + 5 mL water

32. Lower volume feeds during golden hour / trophic
feeds
No cold chain maintenance
Maintains 100% human milk diet for baby
Seamless transition to breastfeeding without
exposure to bovine protein
Short term therapy for all new-borns (term/
preterm) to cover gap till breastfeeding is initiated

34. NeoLact 70
Retains
Immunoglobulins

35. Donor Enrolment Process

36. THANK YOU