Background: Necrotizing enterocolitis (NEC) is a frequent cause of mortality and morbidity in very low birth weight (VLBW) infants. Human milk (HM) feeding has been associated with lower risk of NEC. However, mothers of VLBW infants often experience insufficient milk production, resulting in mixed feedings of HM and formula. Moreover, medical complications often limit the volume of feeding they can be given.Objective: To determine if high proportions of (50% or greater) HM enteral feeding within the first 14 days of life are protective against NEC.Method: This was a prospective cohort study of VLBW infants who were grouped according to the HM proportion of enteral feeding in the first 14 days: <50% (low human milk, LHM, n ¼ 46) and X50% (high human milk, HHM, n ¼ 156). The outcome of interest was development of NEC (Bell stage 2 or 3). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) and to assess potential confounding due to perinatal risk factors.Result: Two hundred and two infants were studied. Confirmed NEC occurred in 5/46 (10.6%) of the LHM group, as compared with 5/156 (3.2%) of the HHM. Gestational age was the only perinatal factor associated with risk of NEC. After adjustment for gestational age, HHM was associated with a lower risk of NEC ((OR ¼ 0.17, 95% CI: 0.04 to 0.68), P ¼ 0.01). Conclusion:Enteral feeding containing at least 50% HM in the first 14 days of life was associated with a sixfold decrease in the odds of NEC.

Birth outcomes of two groups of socially disadvantaged mothers at risk for adverse birth outcomes, one receiving prebirth assistance from a certified doula and the other representing a sample of birthing mothers who elected to not work with a doula, were compared. All of the mothers were participants in a prenatal health and childbirth education program. Expectant mothers matched with a doula had better birth outcomes. Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a doula throughout the pregnancy may have increased the mother's self-efficacy regarding her ability to impact her own pregnancy outcomes.

OBJECTIVE. Although it is well documented that breastfeeding promotes health and development of very low birth weight (VLBW) infants, lactation initiation among mothers of VLBW infants is low. Mothers are anxious about the health of their children, and medical staff may be reluctant to promote breastfeeding out of concern for increasing that anxiety. Therefore, the purpose of this study was to examine whether mothers of VLBW infants who initially planned to formula feed were different in terms of their level of anxiety and maternal stress compared with mothers who had planned to breastfeed their infants. The aims of this study were to (1) determine whether counseling mothers of VLBW infants who had initially planned to formula feed on the benefits of breast milk would increase their stress and anxiety levels, (2) assess whether mothers who initially had not planned to breastfeed changed their plans after counseling to provide breast milk, and (3) measure the amount of breast milk expressed by mothers who initially planned to formula feed. Their results were compared with those of mothers of VLBW infants who initially planned to breastfeed. METHODS. Initial plan to breastfeed (initial breastfeed group [IBG]; n = 115) or formula feed (initial formula feed group [IFG]; n = 81) was determined before counseling. All participants received counseling on infant health benefits, collection and storage of breast milk, and breast pump procurement. Maternal anxiety was measured using the State-Trait Anxiety Inventory (STAI), which was administered to mothers before and after counseling and every 2 weeks until infant discharge. Maternal stress was measured after counseling with the Parental Stressor Scale: NICU. Infant breast milk intake was measured throughout hospitalization. An exit questionnaire that pertained to the perceived benefits and efforts of expressing milk was administered close to the time of infant discharge. RESULTS. After lactation counseling, 100% of the IBG and 85% of the IFG initiated breast milk expression (used the electric breast pump in the hospital) for a total lactation initiation rate of 94%. After adjustment for the mothers who initiated milk expression but did not provide any breast milk, the lactation initiation rate for the entire group was 84%. Non-Hispanic black mothers and Non-Hispanic white mothers initiated milk expression at similarly high rates (95% vs 93%). Also, milk expression initiation was similar for low-income and non–low-income mothers (95% vs 92%). IFG and IBG STAI and Parental Stressor Scale: NICU scores were not significantly different, and there were no significant differences between groups in the change in anxiety after counseling. In addition, the mean difference scores (after counseling − before counseling) for STAI anxiety “state” were not significantly different between groups, even when controlling for “trait” anxiety. State anxiety declined during the first 6 weeks of infant hospitalization in a similar manner for both groups. Maternal trait but not state anxiety scores were inversely correlated with total infant breast milk intake. Breast milk intake (mL/kg per day) was greater in the infants of mothers in the IBG compared with the IFG at each week during the first month and for their entire hospital stay. Infant breast milk intake increased from weeks 1 to 3 in both groups and continued to rise in the fourth week for the IBG. However, breast milk intake declined at week 4 for the IFG. IBG infants received breast milk for 83% of the total fed hospital days (days that feedings were given) compared with 44% of total fed days for the IFG. The proportion of enteral intake that was breast milk was also greater for the IBG compared with IFG during the first 4 weeks and for the total hospitalization. However, the mothers in IFG were able to provide at least 50% of their infants' enteral intake for the first 3 weeks, 48.8% for the fourth week, and 32.8% of the enteral intake for the entire hospitalization. Infants of low-income women received significantly lower amounts of breast milk than did infants of non–low-income mothers. Race and income accounted for 36% of the variance in breast milk intake. Of the 184 mothers who initiated breast milk expression, 72 (39%) completed the exit questionnaire. Infant health benefits were the most common reasons cited by both groups for expressing milk. The most common reasons that both groups reported for ceasing milk expression were (1) low milk supply, (2) returning to work or school, and (3) inability to pump as often as needed. Almost all of the mothers reported that pumping was worth the effort (IBG 100%, IFG 87%), and 100% said that they were glad that the staff helped them with milk expression. CONCLUSION. Counseling mothers of VLBW infants increases the incidence of lactation initiation and breast milk feeding without increasing maternal stress and anxiety.

This paper calls for researchers and treatment providers to increase their recognition of the role that family and family functioning has for understanding the incidence and impact of substance abuse. Substance abuse is identified as a family problem by exploring its occurrence within families as well as its impact on marital relationship, family violence, and child abuse and neglect. The impact of substance abuse on the roles of spouses and parents are examined, as is the impact of substance abuse on children at various developmental stages.The role of the family as participant in active substance abuse as well as a valuable treatment resource is also explored. Finally, the authors present recommendations for increasing the focus on family in substance abuse research.

Trigeminal neuralgia was the focus of a recent workshop convened by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute of Dental and Craniofacial Research (NIDCR). The workshop brought together basic scientists, clinicians, epidemiologists, and patient advocates. New research directions for epidemiology, diagnosis and assessment, pain mechanisms, and treatment were identified. (The workshop was held in Rockville MD on September 14, 1999, with financial support from NINDS, NIDCR, the NIH Office of Rare Diseases, and the NIH Pain Research Consortium.)