**4. Successful breastfeeding**

economic benefits. These qualities are especially important in preterm infants due to their vulnerability [5]. Sometimes it is contrasted with the lack of education, education, conviction and eventually the infrastructure that provides spaces to stimulate and encourage breastfeeding through manual extraction or with artifacts that facilitate the extraction in the neonatal

A prospective study investigated the frequency of use of breast milk for the delivery of preterm infants of a high-risk neonatal unit. These are 244 preterm infants and were performed at a Hospital Friends of Children. The observed frequency of breast milk use at discharge from the neonatal unit was 94.6%. The finding that preterm infants were receiving breast milk reflects a well-structured program to promote breastfeeding of preterm infants at this institution, which is based on an interdisciplinary team to provide adequate support to mothers [6].

With regard to the physiology of the creation of breast milk should be taken into account the stage of embryology. From that period on, the basic components of the genesis of the organs

In the intrauterine period the amniotic fluid contains amino acids, proteins, vitamins, minerals, hormones and growth factors. Although the concentration of these nutrients is much lower than that found in human milk, the large volumes of amniotic fluid ingested (up to one liter per day in the last stage of gestation, considerably more than the newborn after birth). Have a significant impact on growth and maturation of both the fetus and the fetal intestine. This makes it beneficial for his extrauterine life especially in the period of prematurity. Animal studies and limited human observations suggest that ingested amniotic fluid accounts for approximately 15% of fetal growth. The stage of prematurity, less than 37 weeks gestational age, affects the milk of mothers who give birth prematurely as it differs from women who give birth at term. The milk of the premature newborn, according to studies, is initially in concentration higher in proteins, fats, free amino acids and sodium, but during the first weeks after the birth these levels decrease. Keep in mind that the mineral content of preterm milk is similar to that of full-term milk, with the following exceptions: calcium is significantly lower in preterm milk than term milk and apparently does not seem to increase in over time.

With respect to carbohydrates in breast milk, lactose is the main carbohydrate. This disaccharide is an important source of energy, according to studies, it is relatively low in colostrum (first secretion of the mammary gland) and increases over time with more dramatic increases in preterm milk. Complex oligosaccharides are the second most abundant carbohydrate in breast milk. These oligosaccharides of human milk (HMO) are not digestible by host glycosidases

units. These are the place of breast milk, extraction.

**2. A historical perspective**

**2.1. Body research methods**

44 Selected Topics in Breastfeeding

**3. Physiology**

are developed.

The success of breastfeeding lies in the interaction that is received from the mother–child binomial, the stimulation of the mammary gland and the coordinated hormonal aspects in the mother's organism.

In turn, several randomized and quasi-experimental studies have investigated the influence of early postnatal contact on the initiation or continuation of breastfeeding and, in some cases, on other aspects of the interaction between mother and child. Studies of early contact in suction focused on comparing two groups of newborns assigned (by decision of the midwife and the mother) to a "contact" group or a "separation" group immediately after delivery. The 38 newborns of the first group were in contact with their mother from the time of delivery for at least 1 hour. After an average of 49 minutes, 24 of them nursed correctly. The 34 newborns of the second group started contact immediately after delivery, but they separated from it at 20 minutes and returned with their mother another 20 minutes later. Only 7 of them breastfed effectively, and the difference was significant (p < 0.001) [7]. The contact is significant at the time of breastfeeding precociously.

Numerous previous studies about the importance of early contact of mothers with their newborns and the permanence of effective breastfeeding is demonstrated in the following investigations between the years 1980 and 1990. Four studies show that early contact produced a significant increase in the prevalence of breastfeeding after 2 or 3 months [8–11]. One study only found an effect after one week [12], and in two studies no significant effects were found [13, 14]. Sosa et al. studied 40 Guatemalan mothers, randomly distributed in a group with early contact and a control group, followed by home visits [8]. Early contact began after delivery of the placenta and suture of the episiotomy, and lasted 45 minutes. According to the study of Sosa, the control group had their first contact 24 hours after delivery. Three months later, 72% of mothers with early contact performed breastfeeding to their son/daughter, and only 42% did not, in the control group. The mean duration of lactation was 196 days (six and a half months) in the group with early contact and 104 days (three and a half months) in the control group (p < 0.05). According to the study by De Château and Wiberg they studied 40 primiparous women in Sweden [9]. The mothers were randomly assigned to a control group to another intervention group with "extra contact" (15 to 20 minutes of suction and skin-to-skin contact during the first hour after delivery). At 3 months, 58% of the mothers in the additional contact group continued to breastfeed, compared to 26% in the control group (p < 0.05). Mothers with more contact spent more time kissing and looking at their children's eyes, while they smiled more and cried less. The study by Thomson, Hartsock and Larson compared the effect of early contact, initiated 15 to 30 minutes after delivery and continued for 15 to 20 minutes, with routine contact less than 5 minutes immediately after delivery, followed by a separation of 12 to 24 hours, in 30 primiparas who were destined to breastfeed [10]. Two months after delivery, breastfeeding without milk supplements was more common in the early contact group than in the control group (9/15 versus 3/15, p < 0.05). According to the study by Ali and Lowry they compared routine contact (starting around 9 a.m.) with early contact (45 minutes immediately after delivery, and then separation until 9 a.m.) in 74 Jamaican mothers, randomized [12]. The prevalence of complete breastfeeding was higher in the group with early contact, both at 6 weeks (76 versus 49%, p < 0.02) and at 12 weeks (57 versus 27%, p < 0.05). Observed at 12 weeks, mothers with early contact talked more with their children, and got up and followed them in greater proportion when someone took the baby. Strachan-Lindenberg, Cabrera and Jiménez studied the effect of early contact, the promotion of breastfeeding and joint accommodation on the initiation and continuation of breastfeeding in the Nicaraguan primipara [12].

The success of breastfeeding corresponds without a doubt to policies, in health centers, written that contemplates the necessary steps for a successful breastfeeding, assuring that the practice of early nursing is maintained and assistance to the mother of a premature newborn is priority in the promotion of early milk extraction. These policies focus on: training the personnel in the technique and practice of early breastfeeding and extraction, informing the mothers of the benefit, encouraging them to breastfeed within the hour following the birth and promoting the creation and establishment of support groups for the Breastfeeding in

Support for Breastfeeding

47

http://dx.doi.org/10.5772/intechopen.80383

The risk factors that lead to the failure of access to breast milk related to the mother and the newborn, the clear majority are presented together. Although, the problems raised do not contemplate the suspension of breast milk if one way to solve them is to continue breastfeeding.

According to some problems that appear in the prematurity stage, the Breastfeeding Section of the American Academy of Pediatrics issued a policy statement that represents a significant change from the previous statements in its recommendation that all premature babies should receive human milk, pasteurized breast milk instead of premature infant formula the preferred alternative cannot provide adequate volume. The current recommendation, according to the studies, is based on an extraordinary variety of benefits that breast milk provides to highly vulnerable newborns such as premature infants, including the reduction of late onset infection rates, necrotizing enterocolitis (NEC) and retinopathy of prematurity, fewer read-

Preterm infants receiving breast milk have lower rates of metabolic syndrome, lower blood pressure and low density lipoprotein levels and less resistance to insulin and leptin when

What has been shown in different studies is that the most determining benefit is that feeding with human milk decreases the appearance of NEC, given its high prevalence (5–10% of all newborns with birth weight < 1500 grams), high mortality and morbidity, long-term complications such as stenosis, cholestasis, short bowel syndrome and poor growth and alterations in neurodevelopment. According to these results, it is understood that there is a dose–response effect of feeding with breast milk. For example, breast milk >50 ml/kg/day reduces the risk of late-onset infection and NEC compared to <50 ml/kg/day, and for every 10 ml/kg/day increase in milk, there is a 5% reduction in the recurrent hospitalization rate. According to studies, the mechanisms by which breast milk protects the premature newborn against NEC are probably multifactorial. Human milk IgA, lactoferrin, lysozyme, bile salt stimulating lipase, growth factors and HMOs provide protective benefits that could contribute to the reduction of NEC. Clinicaltrials.gov (NCT00854633) published a multicenter randomized clinical trial, concerning bovine lactoferrin treatment, which decreased late-onset sepsis but not NEC in preterm infants. Recombinant human lactoferrin assays are currently being carried out in preterm infants. In animal models, epidermal growth factor (EGF) and pooled HMOs prevent NEC, but have not yet been tested in premature infants. These studies are carried out in order to evaluate the

missions in the first year of life and better results of neurodevelopment.

they reach adolescence, compared to premature infants who receive formula.

neonatal hospitalization units.

**5. Risk factors**

Immediately after delivery, the mothers were assigned to a control group, with complete separation until discharged (12 to 24 hours after delivery), or to an early contact group, in which mother and child were in contact for 45 days. Minutes immediately after delivery and then completely separated until discharged. Full breastfeeding, 1 week later, was significantly more prevalent in the group with early contact than in the control group, but no differences were observed at 4 months. It was not adjusted for age, although about half of the mothers were teenagers. A meta-analysis of these seven studies concluded that early contact had a positive effect on the duration of breastfeeding at 2 or 3 months (p < 0.05). However, it warns that "the effect of the size between the studies was heterogeneous", and some studies included other interventions (guidance on breastfeeding, presence of the father during the early contact), which could have contributed independently to increase breastfeeding [15]. A cross-sectional study of 726 primiparae in the USA. A study found that the prevalence of exclusive breastfeeding in the hospital was lower if the first blowjob took place between 7 and 12 hours after delivery (adjusted odds ratio = 0.5, 95% confidence interval). More than 12 hours after delivery (adjusted OR = 0.2; 95% CI, 0.1–0.4) [16].

The success of breastfeeding corresponds without a doubt to policies, in health centers, written that contemplates the necessary steps for a successful breastfeeding, assuring that the practice of early nursing is maintained and assistance to the mother of a premature newborn is priority in the promotion of early milk extraction. These policies focus on: training the personnel in the technique and practice of early breastfeeding and extraction, informing the mothers of the benefit, encouraging them to breastfeed within the hour following the birth and promoting the creation and establishment of support groups for the Breastfeeding in neonatal hospitalization units.
