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Women, breastfeeding, and cholesterol levels
Vol. 160, No. 1 January 2012 The 4 children with dilated cardiomyopathy continued to have high NT-pro BNP values and left ventricular dilatation. Two of these patients underwent heart transplantation within the subsequent year. There was no evidence of chronic myocarditis in the 2 explanted hearts. In our experience, serial NT-pro BNP contributed to decision making in the scenario of acute myocarditis. Patients with myocarditis present with high NT-pro BNP levels (mean, 29 858.6; range, 18 527-35 000) and show a steep decrease after 6 months (mean, 468.16; range, 70-1799) and 12 months (mean, 132.0; range, 70-280).
the prevalence of exclusive breastfeeding failure by postnatal day 7 in our center, where previous surveys4 show that 9.3% of individuals fail to exclusively breastfeed within the first week of life. We believe that there is an increasing need to clarify whether the mother’s lipid profile may be a factor associated with early breastfeeding cessation. We are very grateful to Berta Verd for editorial assistance.
Sergio Verd, MD Hospital De La Santa Cruz San Pablo Paediatrics Barcelona, Spain
Elisabeth Mlczoch, MD Farnaz Darbandi-Mesri, MD Doris Luckner, MD Ulrike Salzer-Muhar Division of Pediatric Cardiology Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna, Austria 10.1016/j.jpeds.2011.08.065
Aina Escobar, MD Ruth Dıez, MD Department of Pediatrics Hospital son Llatzer Palma de Mallorca, Spain 10.1016/j.jpeds.2011.09.013
References
Reference 1. Teele SA, Allan KC, Laussen PC, Newburger JW, Gauvreau K, Thiagarajan RR. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 2011;158:638-43.
Women, breastfeeding, and cholesterol levels To the Editor: Vrijkotte et al report positive associations between maternal triglyceride levels and birthweight, but not between total cholesterol (TC) levels and birthweight during early pregnancy.1 A careful reading of their work reveals that women who did not breastfeed had significantly higher TC levels. Correspondingly, mothers with longer duration of breastfeeding (1-3 months) showed higher TC values compared with mothers who breastfeed for <1 month. To our knowledge, this is a new finding, and it is in line with other researchers. High TC is a component of the metabolic syndrome, and the metabolic syndrome may curtail breastfeeding,2 with difficulty initiating lactogenesis. Furthermore, the concentration of cholesterol in plasma is markedly lower in lactating rats with higher milk fat content.3 This observation prompted us to perform an evaluation. Unfortunately, the routine blood work for pregnant women in Spain and most other countries usually does not include a lipid profile. However, some physicians and patients elect to use the opportunity to perform additional tests. We report data from 13 mother-infant dyads for whom early breastfeeding outcomes had been ascertained and hypercholesterolemia in pregnancy had been identified. By postnatal day 7, 3 of 13 babies (23%) of mothers with hypercholesterolemia had ceased exclusive breastfeeding. This figure exceeds by 2-fold
1. Vrijkotte TG, Algera SJ, Brouwer IA, van Eijsden M, Twickler MB. Maternal triglyceride levels during early pregnancy are associated with birth weight and postnatal growth. J Pediatr 2011. epub ahead of print. 2. Ram KT, Bobby P, Hailpern SM, Lo JC, Schocken M, Skurnick J, et al. Duration of lactation is associated with lower prevalence of the metabolic syndrome in midlife—SWAN, the study of women’s health across the nation. Am J Obstetr Gynecol 2008;198:2688.e1-6. 3. Bettzieche A, Brandsch C, Eder K, Stangl GI. Lupin protein acts hypocholesterolemic and increases milk fat content in lactating rats by influencing the expression of genes involved in cholesterol homeostasis and triglyceride synthesis. Mol Nutr Food Res 2009;53:1134-42. 4. Verd S. Can sunlight exposure affect early breastfeeding cessation? J Paediatr Child Health 2006;42:480-1.
Oral ibuprofen for the treatment of patent ductus arteriosus: further clarification To the Editor: Gokmen et al1 present data suggesting that oral ibuprofen might be more effective than intravenous preparations for the treatment of symptomatic patent ductus arteriosus. If confirmed, this could have many benefits and would have the additional advantage of also being less expensive and more available. To enable interpretation to our own populations, we would be grateful for clarification of a few points. The methods state the authors ‘‘achieved 94% power to detect a difference of 0.2650.’’ It is not clear what the units are and whether this is a post hoc power calculation. Was there an a priori power calculation, and was this recorded before commencement in a trial registry? Table I shows that 76.9% and 62% of the oral and intravenous groups, respectively, were >30 weeks gestation. This limits the generalizability of this important finding to populations in which it is rare to treat patent ductus arteriosus except in those born at <30 weeks, and means the study is relatively under-powered to detect 179
the prevalence of exclusive breastfeeding failure by postnatal day 7 in our center, where previous surveys4 show that 9.3% of individuals fail to exclusively breastfeed within the first week of life. We believe that there is an increasing need to clarify whether the mother’s lipid profile may be a factor associated with early breastfeeding cessation. We are very grateful to Berta Verd for editorial assistance.
Sergio Verd, MD Hospital De La Santa Cruz San Pablo Paediatrics Barcelona, Spain
Elisabeth Mlczoch, MD Farnaz Darbandi-Mesri, MD Doris Luckner, MD Ulrike Salzer-Muhar Division of Pediatric Cardiology Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna, Austria 10.1016/j.jpeds.2011.08.065
Aina Escobar, MD Ruth Dıez, MD Department of Pediatrics Hospital son Llatzer Palma de Mallorca, Spain 10.1016/j.jpeds.2011.09.013
References
Reference 1. Teele SA, Allan KC, Laussen PC, Newburger JW, Gauvreau K, Thiagarajan RR. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 2011;158:638-43.
Women, breastfeeding, and cholesterol levels To the Editor: Vrijkotte et al report positive associations between maternal triglyceride levels and birthweight, but not between total cholesterol (TC) levels and birthweight during early pregnancy.1 A careful reading of their work reveals that women who did not breastfeed had significantly higher TC levels. Correspondingly, mothers with longer duration of breastfeeding (1-3 months) showed higher TC values compared with mothers who breastfeed for <1 month. To our knowledge, this is a new finding, and it is in line with other researchers. High TC is a component of the metabolic syndrome, and the metabolic syndrome may curtail breastfeeding,2 with difficulty initiating lactogenesis. Furthermore, the concentration of cholesterol in plasma is markedly lower in lactating rats with higher milk fat content.3 This observation prompted us to perform an evaluation. Unfortunately, the routine blood work for pregnant women in Spain and most other countries usually does not include a lipid profile. However, some physicians and patients elect to use the opportunity to perform additional tests. We report data from 13 mother-infant dyads for whom early breastfeeding outcomes had been ascertained and hypercholesterolemia in pregnancy had been identified. By postnatal day 7, 3 of 13 babies (23%) of mothers with hypercholesterolemia had ceased exclusive breastfeeding. This figure exceeds by 2-fold
1. Vrijkotte TG, Algera SJ, Brouwer IA, van Eijsden M, Twickler MB. Maternal triglyceride levels during early pregnancy are associated with birth weight and postnatal growth. J Pediatr 2011. epub ahead of print. 2. Ram KT, Bobby P, Hailpern SM, Lo JC, Schocken M, Skurnick J, et al. Duration of lactation is associated with lower prevalence of the metabolic syndrome in midlife—SWAN, the study of women’s health across the nation. Am J Obstetr Gynecol 2008;198:2688.e1-6. 3. Bettzieche A, Brandsch C, Eder K, Stangl GI. Lupin protein acts hypocholesterolemic and increases milk fat content in lactating rats by influencing the expression of genes involved in cholesterol homeostasis and triglyceride synthesis. Mol Nutr Food Res 2009;53:1134-42. 4. Verd S. Can sunlight exposure affect early breastfeeding cessation? J Paediatr Child Health 2006;42:480-1.
Oral ibuprofen for the treatment of patent ductus arteriosus: further clarification To the Editor: Gokmen et al1 present data suggesting that oral ibuprofen might be more effective than intravenous preparations for the treatment of symptomatic patent ductus arteriosus. If confirmed, this could have many benefits and would have the additional advantage of also being less expensive and more available. To enable interpretation to our own populations, we would be grateful for clarification of a few points. The methods state the authors ‘‘achieved 94% power to detect a difference of 0.2650.’’ It is not clear what the units are and whether this is a post hoc power calculation. Was there an a priori power calculation, and was this recorded before commencement in a trial registry? Table I shows that 76.9% and 62% of the oral and intravenous groups, respectively, were >30 weeks gestation. This limits the generalizability of this important finding to populations in which it is rare to treat patent ductus arteriosus except in those born at <30 weeks, and means the study is relatively under-powered to detect 179