2/13/2016

The Zika virus and breastfeeding in nine paragraphs


1. e-lactancia has classified the Zika virus as low risk, compatible with breastfeeding, with no risk for breastfeeding or the infant.

2. The Zika virus is a Flavivirus which is mainly transmitted by the bite of the Aedes mosquitoes from infected carriers (humans and various animals).
                                        
3. Sexual transmission as well as vertical transmission from mother to child (placental and perinatal) has been documented sporadically.

4. The relationship between placental transmission and congenital microcephaly is being researched.

5. Possible transmission via transfusion is also a concern.

6. Although Zika virus RNA has been found in breast milk, transmission of the infection through breastfeeding has not been documented.

7. Viral infection is asymptomatic in 75% of cases. Only one in four people develop symptoms which are generally benign, with few complications in adults and children, including infants, and which rarely require hospitalization.

8. In the case of two infants who had tested positive for the virus, presumably after perinatal transmission, one was asymptomatic and the other had mild symptoms with doubtful links to the virus. Both infants, as well as their mothers, progressed favorably (Besnard, 2014).

9. Given the benefits of breastfeeding, expert committees – the Centers for Disease Control and Prevention (CDC) – recommend breastfeeding even in areas where there the Zika virus is present.


For more detailed information, containing nine bibliographical references, please consult the e-lactancia.org entry on the compatibility of breastfeeding withthe Zika virus prepared by pediatricians from APILAM (Association for the promotion and scientific and cultural research of breastfeeding)

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We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org

2/04/2016

APILAM sponsors the “Breastfeeding in public" photo prize

Winning photo of the 2014
APILAM "Breastfeeding in public” prize
- The “Breastfeeding in public" prize consists of 600€ and a copy of the book  Tú eres la mejor madre del mundo (You are the best mother in the world), signed by the author, the pediatrician José María Paricio.

-The prize sponsored by APILAM is part of the 20th "Marina Alta Breastfeeding" photo competition, with more than 6,000€ distributed over 17 prizes.

For the third year running, APILAM is participating in the 20th "Marina Alta Breastfeeding" photo competition organized by Grup Nodrissa, sponsoring the "Breastfeeding in public” prize of 600€ and a copy of the book Tú eres la mejor madre del mundo (You are the best mother in the world), signed by the author, the pediatrician José María Paricio.

With the "Breastfeeding in public” prize, the not-for-profit organization APILAM seeks to contribute to the normalization and visibility of breastfeeding in public places: in a shop, a bank, a conference, a public swimming pool, a waiting-room, at a circus, in an airport, at a demonstration, in a queue at the market or a polling station, in a television studio, in Parliament

It is little wonder that many women and their babies are discriminated against for exercising a right, to breastfeed in public.

The “Marina Alta Breastfeeding” photo competition has 17 prizes sponsored by associations, city councils, businesses, support groups and the Valencian government.

Photos will be accepted until 31st March and the prizes will be given on 18th June 2016.  The rules of the competition and the participation form can be found here and here.


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We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org

1/25/2016

Nine million searches in e-lactancia.org in 2015. Discover how many by country

In 2015 APILAM´s e-health project e-lactancia.org received more than nine million searches on the compatibility of breastfeeding with medicines, illnesses, plants and medical procedures. 

 Three million more searches than in 2014, carried out by more than 1.5 million people from 184 countries. 

In this infographic we have prepared you can find the number of searches made by country!


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We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org

1/10/2016

Happy new year, happy breastfeeding


APILAM wishes you a very happy new year full of successful, happy and informed breastfeeding with the silk-screen print “Midnight feeding” by the Inuit artist Mary Okheena.

“Midnight feeding”(1991) forms part of the Telasmos museum collection, one of APILAM’s projects which seeks to collect everything which represents or is related to breastfeeding: stamps, coins, paintings, sculptures, advertizing, health pamphlets, posters, photos…

In 2015 the APILAM team updated 229 products  in e-lactancia.org, APILAM’s e-health project on the compatibility of breastfeeding with medical procedures, medicines and other products, and participated in more than 40 conferences, congresses, workshops and courses about breastfeeding for health and non-health professionals, and for mothers and fathers.

In 2015 the e-lactancia.org website received  more than 9 million consultations carried out by more than a million and half individuals.

In addition, APILAM’s pediatricians have answered via email an average of ten daily personalized consultations on the compatibility of breastfeeding with plants, diseases, medicines and other products.

In 2016 APILAM will continue to update the e-lactancia.org website, disseminating information about the goodness and beauty of breastfeeding, as well as seeking funding to ensure that our project to promote, protect and raise awareness on breastfeeding is sustainable on a long term basis.

Happy new year, happy breastfeeding and many thanks to all the individuals, associations and institutions who have supported APILAM’s project with their backing and donations.

Dr. José María Paricio Talayero

President of APILAM

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We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org



11/08/2015

150 updates in e-lactancia from January to October 2015

Over the last ten months, pediatricians from APILAM have been updating and revising e-lactancia.org regarding the compatibility of breastfeeding with 150 medical procedures, drugs, herbs, and other products.

Mastitis, ginseng, breast enlargement and reduction, cannabis, X- rays, rosehip oil, camphor, venlafaxine, folic acid and bone marrow donation are among the 150 entries which have been updated or added between January and October 2015 in e-lactancia.org.
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We need funds to continue researching and reporting the benefits and beauty of breastfeeding. You can collaborate with the project by donating to e-lactancia.org

2/04/2015

e-lactancia on your smartphone’s home screen

Many of you have asked for an e-lactancia app for your smartphone. We are delighted to tell you that we are working on it.

In the meantime, as an appetizer, this post will explain how to put an icon on your smartphone screen with direct access to e-lactancia as shown in this image

Icons to access e-lactancia

This can be achieved via different web browsers available for iPhone, iPad, Android and Windows Phone. The following simple steps explain how to do it:


With Google Chrome:



1. Enter the e-lactancia.org address into the browser’s address bar
2. Press the icon with three dots situated in the upper right corner
3. Select the option "Add to home screen" 
4. Enter a title (the text which will appear below the icon) and press “add”.






With Mozilla Firefox:
1. Enter the e-lactancia.org address into the browser’s address bar
2. Press the button with three verticle dots at the top right
3. Select the option “Pages”
4. In the new menu, select the option “Add to home screen”
5. Firefox will automatically add an icon to your screen.

                                                                  


With Opera Mini:

1. Enter the e-lactancia.org address into the browser’s address bar
2. Press the little star on the right of the address bar 3. In the drop down menu, select the option "Add to home screen"









Notes:
The icon which is created won’t have the beautiful e-lactancia logo :-(
The option to create direct access only works with Opera MINI. The Opera browser (the normal one, not the mini version) does not support this option at the moment.


With Safari:
1. Enter the e-lactancia.org address into the browser’s address bar
2. Press the Share button in the upper right (a little box with an arrow pointing upwards).
3. Choose the option "add direct access to home screen”
4. Enter a title (the text which will appear below the icon) and press “add”.

Note: Safari, the default browser for iPad and iPhone will create an icon featuring a “photo” of the website, instead of using our beautiful logo :-(


We hope that this brief guide will be useful and will allow you to access information in e-lactancia more easily from your mobile phones.

Written by Javier Vicente, developer of e-lactancia.org in APILAM
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We require funding in order to continue researching and disseminating information. You can help e-lactancia.org by making a donation



2/19/2013

Breastfeeding in infants suffering from chylothorax


This article discusses the possibility of using fat free breastmilk in the treatment of a disease fortunately rare: chylothorax.

We used an appropriate 
language 
to reduce the complexity to non-professionals without sacrificing outreach to spread among professionals (residents and specialist of Pediatrics, Neonatology and Pediatric surgery and nursing staff of neonatal and pediatric units). The discussion in the subject may be not as deep as to wake the interests in experts versed in the matter.



Definition

Chylothorax is extravasation of chylous  lymph of the lymphatic system into the pleural space.


Anatomical-physiological Remembrance
The lymphatic system is composed of numerous ducts or very fine lymphatic capillaries which converge into two thicker ducts, right or upper duct which collects lymph from the right parts of the head and trunk and right arm; and thoracic duct lymph collecting from the rest of the body. Both ducts just converge into the subclavian veins. The thoracic duct runs parallel to the superior vena cava and the aorta. In addition to carrying lymph, after meals, transports long-chain fatty acids, greatly increasing its volume to more than 5 times, depending on the amount and type of fat ingested.


Lymph is derived from a liquid blood extravasation into the interstitial tissues of the body. Most of the blood supply to the tissues through arteries and out through the capillaries to nourish and provide oxygen to the body cells back to the heart through the venous system, but some is trapped in the interstitial tissue and is collected by the lymphatic capillaries back to the heart. It is a parallel return system of support to the venous system.

Fats (most are triglycerides) that we eat are hydrolyzed (digested) by means of enzymes (lipases) and transformed into smaller pieces called fatty acids, so they can be absorbed by the intestinal cells. Lipase which makes this digestion is secreted by the pancreas. Newborns do not have a lot of pancreatic lipase, but you can find it in the saliva of the mouth and, in addition, in the mother's breastmilk, which helps digest fats.



Once digested and absorbed, if the fatty acids are not very large molecule (less than 14 carbon atoms: short and medium chain) they pass the portal vein to the liver with no further problems. If they are larger (long chain), they pass up the lymphatic system and the thoracic duct into the venous system. When the lymph is mixed with fat meals in the thoracic duct, is called chyle.
Thus the lymphatic system, in addition to draining lymph extravasated of the body, leads fats into the venous system of the intestine. The lymphatic system also has an immune function, of defense against infections and other attacks, which is not addressed here.


Etiology of chylothorax (causes)

The absence, malformation or ruptured thoracic duct causes the lymph not to drain into the venous system, making it to drain into the chest out and accumulating in the pleural space (space between the lungs and the lining of the pleura), promoting pleural effusion of chylous lymph (fat) called chylothorax that causes shortness of breath and loss of fat, protein and defenses in the body.

When the lymph carries more than 110 mg/dL of fat (triglycerides) in composition, we talk about chyle, which is a milky sap.

In the first months of life chylothorax can occur:

  1. After surgery of congenital malformations (heart disease, esophageal atresia, diaphragmatic hernia, etc..) In which the the thoracic duct is inadvertently transected (about 5% of cardiac surgery).
  2. In case of congenital malformations associated with other, chromosomal (Down's syndrome, for example) or not and in isolation (idiopathic).
  3. More uncommon, for the pipe (a catheter) in the subclavian or jugular veins, can pierce the thoracic duct.

Treatment

To relieve respiratory distress involving pleural effusion, pleural punctures are used and repeated aspirations or continuous drainage of chylothorax, with the drawback that the patient loses large amounts of fat, protein, minerals, lymphocytes and immunoglobulins (defenses) contained in that liquid. It is necessary to adequately replenish these losses.

Conservative treatments are associated (non-surgical) that essentially try to minimize or eliminate lymphatic flow through the thoracic duct and so, by keeping it in relative rest, get the spontaneous closure of the defect. They can be special diets or drug treatments.

Over 70% of patients improve with special formulas free or with low amount of long chain fatty acids and, instead, enriched with medium chain triglycerides (MCT). You can not give the usual milk formulas because tthey contain long-chain triglycerides.

Many services choose to stop breastfeeding because breast milk has about 75% fat in the form of long-chain triglycerides, whose absorption and transport overload the drainage system of the thoracic duct.






But it has proven totally successful a conservative treatment of chylothorax which consists on feeding whith defatted breast milk after centrifugation and removal of the fat layer.

It is a simple procedure available to many hospitals that can be achieved with a refrigerated centrifuge at 2 ° C at 3000 rpm for 15 minutes. It takes 1 hour to process 1 liter of milk. With fewer calories, it can be enriched with MCT and glucose. We must also add soluble vitamins.



Other conservative treatments, not without side effects are:


  1. Total parenteral nutrition (artificial feeding through a vein) accompanied by total or partial fasting.
  2. Octreotide (a drug substance similar to the hormone somatostatin) which, by reducing intestinal absorption is also another option.




The average time of introduction of normal diet are 9 days (range 3-59) so you should know if you want to keep breastfeeding through regular extraction and frozen.

The best effectiveness of the various conservative treatments is still not clear.

Given the intrathoracic situation and fineness and delicacy of the thoracic duct (in adults is less than 4 mm in diameter), reconstructive surgery is a difficult choice and reserved for when conservative treatments have failed.




Use fat-modified breastmilk during the critical period, until the duct is closed  and chylous effusion ceases and then continue with full breastmilk, get benefit from the huge anti-infective properties of breast milk as the immunoglobulin A (IgA). In addition, lactoferrin and lysozyme are unaffected by the removal of fats, in fact negligible in children usually under continuous risk of infection.

In addition, mothers feel included and valued in the treatment of his son and motivated to maintain their lactation.

Dr. José María Paricio Talayero


Acknowledgements:
To Belen Abarca Sánchis, Neonatal ICU nurse at the Hospital Gregorio Marañón (Madrid), instructor of the LLL, mother and IBCLC, who asked me and suggested the preparation of this post.
To Breastfeeding Photo Contest Marina Alta from grup Nodrissa for the images of breastfeeding.
To all the people that with their suggestions, comments and discrepancies have helped to improve the quality and to better reflect the reality of a complex situation.
Drawings of the lymphatic system: Gerhard Wolf-Heidegger. Systematischen Atlas Anatomie des Menschen. Ed S.Karger. Basel, 1961


References

Biewer ES, Zürn C, Arnold R, Glöckler M, Schulte-Mönting J, Schlensak C, Dittrich S. 
J Cardiothorac Surg. 2010 Dec 13;5:127.

Medoff-Cooper B, Naim M, Torowicz D, Mott A. 
Cardiol Young. 2010 Dec;20 Suppl 3:149-53. 

Lumbreras Fernández J, Sánchez Díaz JI. 
An Pediatr (Barc). 2009 Mar;70(3):223-9. 

Prada Arias M, Rodríguez Barca P, Carbajosa Herrero MT, de Celis Villasana L, Viñals González F. 
An Pediatr (Barc). 2008 Aug;69(2):184-5.

Copons Fernández C, Benítez Segura I, Castillo Salinas F, Salcedo Abizanda S.
Quilotórax neonatal: etiología, evolución y respuesta al tratamiento.
[Neonatal chylothorax: aetiology, clinical course and efficacy of treatment].
An Pediatr (Barc). 2008 Mar;68(3):224-31.

Chan GM, Lechtenberg E.
J Perinatol. 2007 Jul;27(7):434-6.

Roehr CC, Jung A, Curcin OA, Proquitte H, Hammer H, Wauer RR. 
Ann Thorac Surg. 2005 Nov;80(5):1981-2.

Hamdan MA, Gaeta ML. 
Ann Thorac Surg. 2004 Jun;77(6):2215-7. 

Trish Whitehouse (La Leche League):
La leche de Bobby: Amamantar a un bebé con Quilotórax

Martínez Tallo E, Hernández Rastrollo R, Agulla Rodiño E, Sanjuán Rodríguez S, Campello Escudero E. 
Quilotórax neonatal y tratamiento conservador.
.Neonatal chylothorax and conservative treatment.    
An Esp Pediatr. 2002 May;56(5):448-51.

Al-Tawil K, Ahmed G, Al-Hathal M, Al-Jarallah Y, Campbell N. 
Am J Perinatol. 2000;17(3):121-6.

Yamamoto T, Koeda T, Tamura A, Sawada H, Nagata I, Nagata N, Ito T, Mio Y.
Acta Paediatr Jpn. 1996 Dec;38(6):689-91.


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