**6. Promotion of breastfeeding**

safety, toxicity and efficacy of talactoferrin in reducing the incidence of nosocomial infections in preterm infants. Even the support and authenticity are being evaluated in the United States. On the other hand, it is believed that microbial colonization plays an important role in the risk of NEC. Breastfeeding is one of the many factors that influence the composition of the intestinal microbiota in full-term infants; Limited studies suggest that diet may have a lesser effect on the composition of the gut microbiota in the premature baby than other factors (such as the administration of antibiotics). The new bioinformatics tools to correlate the wide range of fecal metabolites and fecal microbiota offer great promise to understand the factors that influence the premature baby's microbiota. Studies to date suggest that metabolites that differ between infants fed human milk and those fed formula that are most closely associated with the conformation of the microbiota include sugars and fatty acids. It is unknown whether these metabolites differ functionally in the extremely premature newborn and in what way. Other potential benefits of human milk to premature infants have been studied with mixed results. There do not appear to be consistent benefits of human milk in premature infants in relation to feeding tolerance, time to full enteral feeding, or allergic/atopic outcomes. Providing human milk has been postulated to decrease parental anxiety, increase skinto-skin contact and parent-infant bonding, but data to support these hypotheses are limited. The provision of human colostrum in the form of oral care for intubated premature infants has been proposed as a method of stimulating the oropharyngeal-associated lymphatic tissue and altering the oral microbiota, but data to support this intervention are Lacking [17].

48 Selected Topics in Breastfeeding

Studies of the benefits of human milk in premature infants to date have predominantly compared mother's own milk to premature infant formula. Whether pasteurized donor human milk (which generally is provided by women who delivered at term) provides similar or superior protection is unclear. In premature infants receiving only mother's own milk or pasteurized donor human milk (no formula), increasing amounts of mother's own milk correlate with better weight gain and less NEC. A meta-analysis in 2007 concluded that formula feeding was associated with both increased short term growth and increased incidence of NEC compared to donor human milk feeding number needed to harm 33 with no differences in long term growth or Neurodevelopment [18]. However, of the 8 studies included in the meta-analysis, 7 were published before 1990, during which time nutritional comparisons were limited. For example, several of the reviewed studies did not include formulas designed for premature infants and none included nutrient-enriched donor milk. One study, initiated in 1982 followed a cohort of premature infants that received either premature infant formula or unfortified donor human milk with the latter group showing decreased blood pressure and improved lipoprotein profiles as adolescents. In the single included study published since 1990, infants whose mothers were unable to provide sufficient milk for their extremely premature infants (< 30 weeks gestation) were randomly assigned to receive supplementation with either premature infant formula or nutrient-enriched donor human milk; donor human milk led to slower weight gain but did not decrease episodes of sepsis, or ROP, length of hospital stay or mortality compared to supplementation with premature infant formula.

The incidence of NEC decreased in the group of human milk donors to almost half compared to the formula group, but this did not reach statistical significance due to the small sample size. It is noteworthy in this study that, despite the increase in supplementation in the donor

#### **6.1. Measures to promote progress in the increase of exclusive breastfeeding**

The following evidence-based recommendations should be applied at the appropriate scale in order to achieve progress on the 2025 global target for exclusive breastfeeding.

	- Maintaining the effectiveness of the initiative of hospitals friendly to the child requires institutionalization in the health system to allow certification and recertification of hospitals, as well as continued investments in training, monitoring and supervision of health personnel.
	- Sustainability also requires monitoring progress and measuring the number and proportion of non-domiciliary deliveries that take place in hospitals and other health centers that are child-friendly.
	- The promotion of breastfeeding and the corresponding support measures should be integrated throughout the spectrum of maternal and child health care, especially in the prenatal and puerperal periods.
	- It is necessary to ensure that there is a strong link between the strategies in the centers and in the community. The influence on exclusive breastfeeding of health-based programs, such as the child-friendly hospital initiative, may decrease when women return home and need community support.
	- It is necessary to provide ongoing family and community support through community leaders and various other communication channels.
	- In countries with low rates of hospital delivery, community support can be provided through home visits or support groups.
	- Communication channels and messages must be adapted to the context based on the literacy levels of the recipients, their use of the different means of communication, as well as their access to them, and contact with health professionals. Behavioral change messages

must be adapted to specific barriers and motivating factors at the national or subnational level in relation to exclusive breastfeeding that is identified. Individual counseling and peer counseling are effective, but group counseling also improves rates of exclusive breastfeeding, and a combination of these approaches appears to be particularly effective [19]. Support for mothers can come from people—professionals or not—properly trained, and reaches its maximum effectiveness when both health centers and community members offer information and coherent messages, practical support and referral to the appropriate services.

The implementation of a program to promote breastfeeding in the NICU has a marked positive effect on the rate of exclusive early breastfeeding after discharge. Exclusive breastfeeding is the most effective intervention to reduce infant mortality, and infant mortality in low-

Support for Breastfeeding

51

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

With this bibliographic review it is clear that the use of promotional strategies is a resource that improves behavior against breastfeeding. This support helps to improve health and exercise greater control over newborn and own care. This is achieved through different actions aimed at promoting education, communication, public policies, legislation, community development, and training, among others. The summary of the effectiveness of interventions for support in breastfeeding according to the evidence lies in education in breastfeeding pregnant women and mothers, support by peers, implementation of the Baby-Friendly Hospital

Probably effective are professional support, early attachment promotion in maternity wards, mass media strategies. According to the literature the less effective interventions are the deliv-

As we learn more evidence in support of breastfeeding mothers with hospitalized newborns

[1] Sisk P, Lambeth T. Necrotizing Enterocolitis and growth in preterm infants fed predominantly maternal milk, pasteurized donor milk, or preterm formula: A retrospective

[2] Kumar R, Singhal A. Optimizing nutrition in preterm low birth weight infants-consensus

[3] Ingram J, Johnson D, Greenwood R. Breastfeeding in Bristol: Teaching good positioning,

[4] Mathur N, Dhingra D. Breastfeeding. Indian Journal of Pediatrics. 2014;**81**(2):143-149

[5] Schandler S, Thomas C, Cohen M. Spatial learning deficits in preschool children of alcoholics. Alcoholism, Clinical and Experimental Research. 1995;**19**(4):1067-1072

[6] Nascimento M, Issler H. Aleitamento materno em prematuros: manejo clínico hospita-

study. American Journal of Perinatology. 2017;**34**(7):676-683

and support from fathers and families. Midwifery. 2002;**18**(2):87-101

ery of promotional packages for breastfeeding and delivery of printed material [24].

income countries is estimated to prevent 13 per cent of children under five [18].

policy and the mother of WHO and UNICEF [23].

better survival will have these patients [25].

Address all correspondence to: patriciatrivino@uach.cl

summary. Frontiers in nutrition. 2017;**26**(4):20

lar. The Journal of Pediatrics. 2004;**80**

Instituto de Enfermería UACh, Valdivia, Chile

**Author details**

**References**

Patricia Triviño Vargas

	- Countries are urged to enforce laws, regulations or other measures that are legally enforceable in order to implement the International Code of Marketing of Breast-milk Substitutes, as well as to actively monitor for possible violations and establish and apply effective sanctions in case of violation [20].
	- Labor policies should support all working women both in the formal economy and the informal economy sector - to continue breastfeeding their children upon return to work (e.g., through day care centers in the center) of work, breaks for breastfeeding or milk extraction, and comfortable and intimate areas in which women can express and store milk safely).
	- In addition to training on infant and young child feeding practices, it is necessary to strengthen training in problem solving and counseling, and to identify mechanisms for monitoring and mentoring professionals after training.
	- Be aware of the differences in skill profiles and information needs among the different types of health professionals.
