No abstract

No abstract

Background: The World Health Organization supports and recognizes the benefits of breastfeeding, at least 6 months or more, for both a mother and her baby. A common cause for cessation of breastfeeding is the development of mastitis typically caused by a clogged milk duct. Literature is limited on physical therapy's role in reducing clogged milk ducts and subsequent mastitis. Study Design: A case report Case Description: This case describes a 33-year-old woman who was referred to physical therapy following unsuccessful treatment for breastfeeding complications that included daily bilateral clogged milk ducts and mastitis. The patient participated in a comprehensive physical therapy approach consisting of patient education, moist heat, therapeutic ultrasound, manual techniques, and cryotherapy. Outcomes: A retrospective review of 5 physical therapy visits over 3 weeks was completed. The patient reported no recurrence of mastitis and the ability to manage and decrease the recurrence of clogged milk ducts. The patient's number of daily clogged milk ducts and reported success with breastfeeding improved. At 6 months post-discharge, the patient reported she was able to continue breastfeeding and had no recurrence of mastitis. Discussion: Physical therapists may have a potential role in treating clogged milk ducts and subsequent mastitis in postpartum women where there is a lack of availability of lactation resources. A video abstract is available (see Supplemental Digital Content 1, available at: http://links.lww.com/JWHPT/A84).

Primary Subject area Neonatal-Perinatal Medicine Background Resuscitation care planning for extremely low gestational age neonates (ELGANs) continues to be one of the most complex, ethically charged areas within paediatrics. Objectives This study sought to determine the current attitudes and practices of neonatologists in Canada, and to assess the moral distress associated with resuscitation decisions in the ELGAN population and current practices in an era of improved neonatal outcomes. It also aimed to explore the perspectives of adopting a shared decision-making approach, where further data with regard to best interests and prognosis are gathered in an individualized manner. Design/Methods This was a descriptive study employing an electronic survey constructed in REDCap®. The survey was distributed to neonatologists working in Level III NICUs across Canada and responses were collected from March to May 2020. Results 65 total survey responses were received. 78% of neonatologists expressed at least some moral distress when parents request non-resuscitation between 24 weeks 0 days and 24 weeks 6 days. Prognostic uncertainty with regard to individualized long-term outcome in an era with increased chances of morbidity-free survival was the most prominent factor identified as contributing to moral distress. 70% felt they would feel less moral distress deciding about goals of care after assessing the baby’s response to an initial trial of resuscitation at birth, and preferred an individualized approach to palliation decisions based on postnatal course and assessment, rather than making the decision based primarily on gestational age. Conclusion While most current practices support the option of non-resuscitation for infants born at less than 25 weeks, there is growing evidence of moral distress among Canadian neonatologists that suggests the consideration of resuscitation at 24 weeks and above is a more realistic approach in the current era of improved outcomes. Furthermore, our results suggest that Canadian neonatologists are ethically more comfortable developing plans for care postnatally, with more evidence to support prognostication, instead of antenatally, based solely on gestational age.