Breast-feeding and health in the 1980s: a global epidemiologic review

Pre-lacteal feeding practice and associated factors among mothers having children aged less than six months in Dilla town, Southern Ethiopia

BACKGROUND

Pre-lacteal feeding, the introduction of liquids or non-breast milk foods before establishing regular breastfeeding, poses significant risks to newborns, depriving them of vital nutrients and the protective benefits of colostrum while exposing them to infection hazards. Despite breast milk being a renewable and comprehensive source of infant nutrition for the first six months of life, prevalent in many low income country are pre-lacteal feeds such as honey, sugar-water, jiggery water, castor oil, and goat's milk. These practices, widespread in such regions, carry potential risks of infection and aspiration. The objective of this study is to assess the prevalence of pre-lacteal feeding and identify associated factors among mothers with children under six months in Dilla Town, Southern Ethiopia.

METHOD

A community-based cross-sectional study took place in Dilla town, southern Ethiopia, spanning from June 20 to August 20, 2022. The study included a total of 372 participants, selected through simple random sampling for kebele and systematic random sampling for individual participants. Data was collected using interviewer-administered structured questionnaires and subsequently coded, entered, cleaned, and edited using SPSS version 23.0 software. The presentation of data utilized tables and figures, followed by a logistic regression analysis to identify potential factors associated with pre-lacteal feeding. The significance level was set at a p-value less than 0.05 for the final model.

RESULT

The prevalence of pre-lacteal feeding practice was 176 (47.3%) in the study area and having no maternal education (AOR = 3.68, 95% CI; [1.01-5.84] colostrum avoidance (AOR = 4.20, 95% CI; [2.03-6.86] and lack of breast feeding counseling (AOR = 2.00, 95% CI; 1.40-2.57), were factors associated with pre-lacteal feeding practices.

CONCLUSION AND RECOMMENDATION

Pre-lacteal feeding practice among mothers of children aged less than 6 months in Dilla town was found to be higher than the national prevalence. No formal education, colostrum avoidance, lack of breastfeeding counseling, were factors associated with pre-lacteal feeding practices. So awareness creation activities on the risks of PLF (pre-lacteal feeding) and improving breastfeeding counseling targeted to all mothers and care givers including their families within the study area is vital.

Syntaxin interacts with arachidonic acid to prevent diabetes mellitus

Syntaxin regulates pancreatic β cell mass and participates in insulin secretion by regulating insulin exocytosis. In addition, syntaxin 4 reduces IFNγ and TNF-α signaling via NF-ĸB in islet β-cells that facilitates plasma glucose sensing and appropriate insulin secretion. Arachidonic acid (AA) has potent anti-inflammatory actions and prevents the cytotoxic actions of alloxan and streptozotocin (STZ) against pancreatic β cells and thus, prevents the development of type 1 diabetes mellitus (induced by alloxan and STZ) and by virtue of its anti-inflammatory actions protects against the development of type 2 diabetes mellitus (DM) induced by STZ in experimental animals that are models of type 1 and type 2 DM in humans. AA has been shown to interact with syntaxin and thus, potentiate exocytosis. AA enhances cell membrane fluidity, increases the expression of GLUT and insulin receptors, and brings about its anti-inflammatory actions at least in part by enhancing the formation of its metabolite lipoxin A4 (LXA4). Prostaglandin E2 (PGE2), the pro-inflammatory metabolite of AA, activates ventromedial hypothalamus (VMH) neurons of the hypothalamus and inhibits insulin secretion leading to reduced glucose tolerance and decreases insulin sensitivity in the skeletal muscle and liver. This adverse action of PGE2 on insulin release and action can be attributed to its (PGE2) pro-inflammatory action and inhibitory action on vagal tone (vagus nerve and its principal neurotransmitter acetylcholine has potent anti-inflammatory actions). High fat diet fed animals have hypothalamic inflammation due to chronic elevation of PGE2. Patients with type 2 DM show low plasma concentrations of AA and LXA4 and elevated levels of PGE2. Administration of AA enhances LXA4 formation without altering or reducing PGE2 levels and thus, tilts the balance more towards anti-inflammatory events. These results suggest that administration of AA is useful in the prevention and management of DM by enhancing the action of syntaxin, increasing cell membrane fluidity, and reducing VMH inflammation. Docosahexaenoic acid (DHA) has actions like AA: it increases cell membrane fluidity; has anti-inflammatory actions by enhancing the formation of its anti-inflammatory metabolites resolvins, protectins and maresins; interacts with syntaxin and enhance exocytosis in general and of insulin. But the DHA content of cell membrane is lower compared to AA and its content in brain is significant. Hence, it is likely DHA is important in neurotransmitters secretion and regulating hypothalamic inflammation. It is likely that a combination of AA and DHA can prevent DM.

Human Breast Milk: From Food to Active Immune Response With Disease Protection in Infants and Mothers

Breastfeeding is associated with long-term wellbeing including low risks of infectious diseases and non-communicable diseases such as asthma, cancer, autoimmune diseases and obesity during childhood. In recent years, important advances have been made in understanding the human breast milk (HBM) composition. Breast milk components such as, non-immune and immune cells and bioactive molecules, namely, cytokines/chemokines, lipids, hormones, and enzymes reportedly play many roles in breastfed newborns and in mothers, by diseases protection and shaping the immune system of the newborn. Bioactive components in HBM are also involved in tolerance and appropriate inflammatory response of breastfed infants if necessary. This review summarizes the current literature on the relationship between mother and her infant through breast milk with regard to disease protection. We will shed some light on the mechanisms underlying the roles of breast milk components in the maintenance of health of both child and mother.

When law and science part ways: the criminalization of breastfeeding by women living with HIV

Stigma and discrimination are a constant reality for the 37.7 million people living with human immunodeficiency virus (HIV) around the globe. Fear over vertical transmission has fuelled HIV criminalization: laws that target people living with HIV for acts deemed to be a transmission risk. Research has now shown that many of these behaviours, including breastfeeding, pose an extremely low risk of transmission when people have proper medical care, access to treatment and open relationships with medical professionals. Yet, we are witnessing a wave of criminal cases against women living with HIV for breastfeeding, an act which is actively promoted worldwide as the best infant feeding strategy. In this review, we will place the criminalization of breastfeeding within the context of current medical recommendations and cultural views of breastfeeding. We will highlight the criminal cases against women living with HIV for breastfeeding around the globe and the criteria for justifiable criminalization. Finally, we will provide recommendations for moving towards decriminalization, removing this barrier to HIV prevention, treatment and care.

Infant feeding and post-weaning health: Evidence from turn-of-the-century London

Evidence on the post-weaning benefits of early-life breastfeeding is mixed, and highly context-dependent. Moreover, this evidence is drawn almost exclusively from modern settings, limiting our understanding of the relationship between breastfeeding and subsequent health in the past. We provide novel evidence on the nature and reach of these post-weaning benefits in a historical setting, drawing on a rich new longitudinal dataset covering nearly 1000 children from the Foundling Hospital, an orphanage in turn-of-the-century London. We find that even after the cessation of breastfeeding, ever-breastfed status reduced mortality risk and raised weight-for-age in infancy, that exclusive breastfeeding conferred additional benefits, and that breastfeeding duration had little impact. We also find a U-shaped pattern in weight-for-age by time since weaning, indicating a deterioration in health shortly after weaning, followed by a recovery. The early post-weaning advantages associated with breastfeeding, however, did not persist into mid-childhood. This indicates that any protective effects of earlier breastfeeding attenuated with age, and suggests a strong role for catch-up growth. This study contributes to the data and empirical settings available to explore the relationship between infant feeding and post-weaning health, and helps shed light on the contribution of changing breastfeeding norms to trends in health in twentieth-century Britain.

Antihistamine use during breastfeeding with focus on breast milk transfer and safety in humans: A systematic literature review

Current data on use of antihistamines during breastfeeding and risks to the breastfed infant are insufficient. The aim of this systematic review was to provide an overview of studies measuring the levels of antihistamines in human breast milk, estimating the exposure for breastfed infants and/or reporting possible adverse effects on the breastfed infant. An additional aim was to review the antihistamine product labels available in the European Union (EU) and the United States. We searched seven online databases and identified seven human lactation studies that included 25 mother-infant pairs covering cetirizine, clemastine, ebastine, epinastine, loratadine, terfenadine and triprolidine. In addition, one study investigated the impact of chlorpheniramine or promethazine on prolactin levels among 17 women, and one study investigated possible adverse drug reactions in 85 breastfed infants exposed to various antihistamines. The relative infant dose was below 5% for all antihistamines, ranging from 0.3% for terfenadine to 4.5% for clemastine. Most product labels of the 10 antihistamines with available information in both the EU and the United States reported lack of evidence and recommended to avoid use during breastfeeding. The knowledge gap on antihistamines and lactation is extensive, and further human studies are warranted to ensure optimal treatment of breastfeeding women with allergy.

Distinct Changes Occur in the Human Breast Milk Microbiome Between Early and Established Lactation in Breastfeeding Guatemalan Mothers

Human breast milk contains a diverse community of bacteria, but as breast milk microbiome studies have largely focused on mothers from high income countries where few women breastfeed to 6 months, the temporal changes in the breast milk microbiome that occur during later lactation stages have not been explored. For this cross-sectional study, microbiota from breast milk samples of Mam-Mayan mothers living in eight remote rural communities in the Western Highlands of Guatemala were analyzed. All mothers delivered vaginally and breastfed their infants for 6 months. Breast milk from 76 unrelated mothers was used to compare two lactation stages, either “early” (6–46 days post-partum, n = 33) or “late” (109–184 days post-partum, n = 43). Breast milk microbial communities were assessed using 16S ribosomal RNA gene sequencing and lactation stages were compared using DESeq2 differential abundance analysis. A total of 1,505 OTUs were identified, including 287 which could be annotated as putative species. Among several maternal factors, lactation stage explained microbiome variance and inertia in ordination with the most significance (p < 0.001). Differential abundance analysis identified 137 OTUs as significantly higher in either early or late lactation. These included a general shift from Staphylococcus and Streptococcus species in early lactation to Sphingobium and Pseudomonas species in late lactation. Species enriched in early lactation included putative commensal bacteria known to colonize the infant oral and intestinal tracts whereas species enriched in late lactation had a uniform functional trait associated with aromatic compound degradation. Differentially abundant species also included several species which have not previously been reported within breast milk, such as Janthinobacterium agaricidamnosum, Novosphingobium clariflavum, Ottowia beijingensis, and Flavobacterium cucumis. These discoveries describe temporal changes to the breast milk microbiome of healthy Guatemalan mothers from early to late lactation. Collectively, these findings illustrate how studying under-represented human populations might advance our understanding of factors that modulate the human milk microbiome in low and middle income countries (LMIC).

Extended Prophylaxis With Nevirapine Does Not Affect Growth in HIV-Exposed Infants

BACKGROUND

Effects of prolonged nevirapine prophylaxis exposure on growth among HIV-exposed uninfected (HEU) infants are unknown. This study examines the impact of extended nevirapine prophylaxis from 6 weeks to 6 months on the growth of HEU infants followed for 18 months and also identifies correlates of incident wasting, stunting, underweight, and low head circumference in the HPTN 046 trial.

METHODS

Intention-to-treat analysis examined the effect of extended nevirapine exposure on: weight-for-age Z-score, length-for-age Z-score, weight-for-length Z-score, and head circumference-for-age Z-score. Multivariable linear mixed-effects and Cox proportional hazard models were used to compare growth outcomes between the study arms and identify correlates of incident adverse growth outcomes, respectively.

RESULTS

Compared to placebo, extended prophylactic nevirapine given daily from 6 weeks to 6 months did not affect growth in HEU breastfeeding (BF) infants over time (treatment × time: P > 0.05). However, overall growth declined over time (time effect: P < 0.01) when compared with WHO general population norms. Male sex was associated with higher risk of all adverse growth outcomes (P < 0.05), whereas short BF duration was associated with wasting (P = 0.03). Maternal antiretroviral therapy exposure was protective against underweight (P = 0.02). Zimbabwe tended to have worse growth outcomes especially stunting, compared to South Africa, Uganda and Tanzania (P < 0.05).

CONCLUSIONS

It is reassuring that prolonged exposure to nevirapine for prevention-of-mother-to-child HIV transmission does not restrict growth. However, targeted interventions are needed to improve growth outcomes among at-risk HEU infants (i.e., male sex, short BF duration, lack of maternal antiretroviral therapy exposure, and resident in Zimbabwe).

Emerging Research Paradigm for Infant Drug Exposure Through Breast Milk

Background:

Information on drug secretion into milk is insufficient due to the exclusion of lactating women from clinical trials and drug development processes. As a result, non-adherence to the necessary drug therapy and discontinuation of breastfeeding occur, even if the predicted level of infant exposure is low. In contrast, inadvertent infant exposure to drugs in breast milk continues to happen due to lack of rational risk assessment, resulting in serious toxicity cases including death. This problem is multifactorial, but one of the key elements is the lack of pharmacokinetic information on drug secretion into milk and resultant infant exposure levels, the first line of evidence for risk assessment.

Methods:

Basic PK principles in drug excretion into milk were explained. The literature was scanned to identify approaches for PK data acquisition in this challenging field.

Results:

This review describes the feasibility to develop such approaches, and the knowledge gaps that still exist. A combination of population pharmacokinetics approach (to estimate averages and variations of drug concentration profiles in milk) and physiologically-based pharmacokinetics modeling of infants (to predict the population profiles of infant drug exposure levels) appears useful.

Conclusions:

In order to facilitate participant enrollment and PK data acquisition in a timely manner, networks of investigators become crucial.

Protective Effect of Breastmilk against Infection

There is strong evidence that breastfeeding protects infants against infection in environments where clean water cannot be guaranteed, leading to substantial reductions in morbidity and mortality. This is particularly evident in the protection against gastrointestinal disease, although there is also evidence for protection against respiratory infection and otitis media. The evidence for a protective effect of breastfeeding against infection in developed countries has been more controversial, with criticisms being levelled at the methodology of many studies. Evidence is presented from a study in a developed country that met key methodological criteria to show that breastfeeding for 13 weeks offers substantial and continuing protection against gastrointestinal illness. Smaller, but still potentially important, protective effects against respiratory illness also occur. The results add strong support to policies that promote breastfeeding in both developed and developing countries.

Infection and Disease: The Impact of Early Weaning

Although the protective effect of breastfeeding against infectious diseases has been long suspected, it has only recently been adequately quantified This article reviews the available epidemiologic evidence. Breastfeeding provides marked protection against diarrhoeal morbidity and severity (as measured by its duration, level of dehydration, or case-fatality rate), and mortality. This is true for acute watery diarrhoea as well as for dysentery and persistent diarrhoea. A dose-response pattern is observed: the risk level for children receiving both breastmilk and artificial milk is between that of exclusively breasfed children and that of completely weaned children. Even the introduction of water or herbal teas to a previously exclusively breasfed infant increases the risk of morbidity and mortality. The protection is greatest for young infants, and the period immediately after weaning seems to carry the highest risk. Although breastfeeding does not seem to have an appreciable effect on the incidence of acute respiratory infections as a whole, there is evidence of an effect on the incidence of pneumonia, on the incidence of hospitalization for pneumonia, and on mortality from respiratory infections. The level of protection against pneumonia, however, is lower than that against diarrhoea. Breastfeeding also protects against onus media and other infections, including neonatal sepsis, meningitis, and bacteraemia, although the number of relevant studies is small. A simulation exercise shows that a 40% reduction in the prevalence of nonbreastfeeding would prevent up to 15% of diarrhoea deaths and 7% of pneumonia deaths occurring in regions with a short breastfeeding duration, such as urban Latin America. In regions where breastfeeding durations are longer, the emphasis should be on maintaining these high rates and increasing the proportion of young infants who are exclusively breastfed. The present review confirms that breastfeeding promotion is an essential child survival strategy.

Prenatal and Postnatal Mother-to-Child Transmission of Acculturation's Health Effects in Hispanic Americans

BACKGROUND

Hispanic Americans consistently exhibit an intergenerational increase in the prevalence of many noncommunicable chronic physical and mental disorders.

METHODS

We review and synthesize evidence suggesting that a constellation of prenatal and postnatal factors may play crucial roles in explaining this trend. We draw from relevant literature across several disciplines, including epidemiology, anthropology, psychology, medicine (obstetrics, neonatology), and developmental biology.

RESULTS

Our resulting model is based on evidence that among women, the process of postmigration cultural adjustment (i.e., acculturation) is associated, during pregnancy and after delivery, with psychological and behavioral states that can affect offspring development in ways that may alter susceptibility to noncommunicable chronic disease risk in subsequent-generation Hispanic Americans. We propose one integrated process model that specifies the biological, behavioral, psychological, and sociocultural pathways by which maternal acculturation may influence the child's long-term health. We synthesize evidence from previous studies to describe how acculturation among Hispanic American mothers is associated with alterations to the same biobehavioral systems known to participate in the processes of prenatal and postnatal developmental programming of disease risk. In this manner, we focus on the concepts of biological and cultural mother-to-child transmission across the prenatal and postnatal life phases. We critique and draw from previous hypotheses that have sought to explain this phenomenon (of declining health across generations). We offer recommendations for examining the transgenerational effects of acculturation.

CONCLUSION

A life course model with a greater focus on maternal health and well-being may be key to understanding transgenerational epidemiological trends in minority populations, and interventions that promote women's wellness may contribute to the elimination or reduction of health disparities.

Is the evidence of breast feeding protection against coeliac disease real?

Many recent studies discredit breastfeeding protection against coeliac disease. We will try to answer the question: "Is the evidence of breast feeding protection against coeliac disease real?"

Breastfeeding and autoimmunity: Programing health from the beginning

Breast milk is not only a completely adapted nutrition source for the newborn but also an impressive array of immune-active molecules that afford protection against infections and shape mucosal immune responses. Decisive imprinting events might be modulated during the first months of life with potential health long-term effects, enhancing the importance of breastfeeding as a major influence on the immune system correct development and modifying disease susceptibility. The aim of this review was to clarify the link between breastfeeding and autoimmune diseases, inquiring the related mechanisms, based on data available in the literature. Being breastfed was associated with a lower incidence of diabetes, celiac disease, multiple sclerosis and asthma, explained by the protection against early infections, anti-inflammatory properties, antigen-specific tolerance induction, and regulation of infant's microbiome. The protective role of human milk in idiopathic juvenile arthritis, rheumatoid arthritis, and inflammatory bowel diseases remains controversial. On the other hand, the breastfeeding mother faces a health-challenging period in life. High levels of prolactin may lead either to the development of autoimmune diseases in susceptible mothers or exacerbations of current immune-mediated disorders. These features raise the question if mothers with autoimmune diseases, mainly systemic lupus erythematosus, should avoid breastfeeding.

Feeding practices and nutritional status of HIV-exposed and HIV-unexposed infants in the Western Cape

Background

Optimal infant- and young child-feeding practices are crucial for nutritional status, growth, development, health and, ultimately, survival. Human breast milk is optimal nutrition for all infants. Complementary food introduced at the correct age is part of optimal feeding practices. In South Africa, widespread access to antiretrovirals and a programme to prevent mother-to-child transmission of HIV have reduced HIV infection in infants and increased the number of HIV-exposed uninfected (HEU) infants. However, little is known about the feeding practices and nutritional status of HEU and HIV-unexposed (HU) infants.

Objective

To assess the feeding practices and nutritional status of HIV-exposed and HIV-unexposed (HU) infants in the Western Cape.

Design

Prospective substudy on feeding practices nested in a pilot study investigating the innate immune abnormalities in HEU infants compared to HU infants. The main study commenced at week 2 of life with the nutrition component added from 6 months. Information on children's dietary intake was obtained at each visit from the caregiver, mainly the mother. Head circumference, weight and length were recorded at each visit. Data were obtained from 6-, 12- and 18-month visits. World Health Organization feeding practice indicators and nutrition indicators were utilised.

Setting

Tygerberg Academic Hospital, Western Cape. Mothers were recruited from the postnatal wards.

Subjects

Forty-seven mother-infant pairs, 25 HEU and 22 HU infants, participated in this nutritional substudy. Eight (17%) infants, one HU and seven HEU, were lost to follow-up over the next 12 months. The HEU children were mainly Xhosa (76%) and HU were mainly mixed race (77%).

Results

The participants were from poor socio-economic backgrounds. In both groups, adherence to breastfeeding recommendations was low with suboptimal dietary diversity. We noted a high rate of sugar- and salt-containing snacks given from a young age. The HU group had poorer anthropometric and nutritional indicators not explained by nutritional factors alone. However, alcohol and tobacco use was much higher amongst the HU mothers.

Conclusion

Adherence to breastfeeding recommendations was low. Ethnicity and cultural milieu may have influenced feeding choices and growth. Further research is needed to understand possible reasons for the poorer nutritional and anthropometric indicators in the HU group.

The effect of breastfeeding on lung function at 12 and 18 years: a prospective cohort study

The objective was to assess associations between duration of total and exclusive breastfeeding and lung function up to adolescence.A birth cohort (Melbourne Atopy Cohort Study) of 620 infants with a family history of allergic disease was recruited. Mothers were encouraged to breastfeed exclusively for 6 months. Lung function was assessed at 12 and 18 years of age. Associations between breastfeeding and lung function were investigated using multivariable linear regression and path analysis was used to assess the potential mediating factors.Duration of breastfeeding (total and exclusive) was not associated with most assessed lung function outcomes. However, there was a trend for increased pre-bronchodilator mid-expiratory flow (MEF) at both 12 (adjusted mean difference (95% CI) per week of breastfeeding of 10 (-1-20) mL·s(-1)) and 18 years (11 (-1-22) mL·s(-1)) (p-values of 0.07 and 0.08, respectively). There was a strong indirect effect of height on these observed associations.Duration of breastfeeding does not appear to greatly influence lung function outcomes in children with a family history of allergic diseases. Longer duration of exclusive breastfeeding may be associated with an increase in MEF, partly due to greater attained height of the child.

The Use of Nipple Shields: A Review

INTRODUCTION

A nipple shield is a breastfeeding aid with a nipple-shaped shield that is positioned over the nipple and areola prior to nursing. Nipple shields are usually recommended to mothers with flat nipples or in cases in which there is a failure of the baby to effectively latch onto the breast within the first 2 days postpartum. The use of nipple shields is a controversial topic in the field of lactation. Its use has been an issue in the clinical literature since some older studies discovered reduced breast milk transfer when using nipple shields, while more recent studies reported successful breastfeeding outcomes. The purpose of this review was to examine the evidence and outcomes associated with nipple shield use.

METHODS

A literature search was conducted in Ovid MEDLINE, OLDMEDLINE, EMBASE Classic, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL. The primary endpoint was any breastfeeding outcome following nipple shield use. Secondary endpoints included the reasons for nipple shield use and the average/median length of use. For the analysis, we examined the effect of nipple shield use on physiological responses, premature infants, mothers' experiences, and health professionals' experiences.

RESULTS

The literature search yielded 261 articles, 14 of which were included in this review. Of these 14 articles, three reported on physiological responses, two reported on premature infants, eight reported on mothers' experiences, and one reported on health professionals' experiences.

CONCLUSION

Through examining the use of nipple shields, further insight is provided on the advantages and disadvantages of this practice, thus allowing clinicians and researchers to address improvements on areas that will benefit mothers and infants the most.

Population PK modelling and simulation based on fluoxetine and norfluoxetine concentrations in milk: a milk concentration-based prediction model

AIMS

Population pharmacokinetic (pop PK) modelling can be used for PK assessment of drugs in breast milk. However, complex mechanistic modelling of a parent and an active metabolite using both blood and milk samples is challenging. We aimed to develop a simple predictive pop PK model for milk concentration-time profiles of a parent and a metabolite, using data on fluoxetine (FX) and its active metabolite, norfluoxetine (NFX), in milk.

METHODS

Using a previously published data set of drug concentrations in milk from 25 women treated with FX, a pop PK model predictive of milk concentration-time profiles of FX and NFX was developed. Simulation was performed with the model to generate FX and NFX concentration-time profiles in milk of 1000 mothers. This milk concentration-based pop PK model was compared with the previously validated plasma/milk concentration-based pop PK model of FX.

RESULTS

Milk FX and NFX concentration-time profiles were described reasonably well by a one compartment model with a FX-to-NFX conversion coefficient. Median values of the simulated relative infant dose on a weight basis (sRID: weight-adjusted daily doses of FX and NFX through breastmilk to the infant, expressed as a fraction of therapeutic FX daily dose per body weight) were 0.028 for FX and 0.029 for NFX. The FX sRID estimates were consistent with those of the plasma/milk-based pop PK model.

CONCLUSIONS

A predictive pop PK model based on only milk concentrations can be developed for simultaneous estimation of milk concentration-time profiles of a parent (FX) and an active metabolite (NFX).

Persistent effects of early infant diet and associated microbiota on the juvenile immune system

Early infant diet has significant impacts on the gut microbiota and developing immune system. We previously showed that breast-fed and formula-fed rhesus macaques develop significantly different gut microbial communities, which in turn are associated with different immune systems in infancy. Breast-fed animals manifested greater T cell activation and proliferation and harbored robust pools of T helper 17 (TH17) cells. These differences were sustained throughout the first year of life. Here we examine groups of juvenile macaques (approximately 3 to 5 y old), which were breast-fed or formula-fed in infancy. We demonstrate that juveniles breast-fed in infancy maintain immunologic differences into the fifth year of life, principally in CD8(+) memory T cell activation. Additionally, long-term correlation networks show that breast-fed animals maintain persistent relationships between immune subsets that are not seen in formula-fed animals. These findings demonstrate that infant feeding practices have continued influence on immunity for up to 3 to 5 y after birth and also reveal mechanisms for microbial modulation of the immune system.

Excessive crying at 3 months of age and behavioural problems at 4 years age: a prospective cohort study

Background

Excessive crying in early infancy has been associated with behavioural problems among preschool children from high income countries but studies in low income and middle income countries are scarce.

Methods

The 2004 Pelotas Birth Cohort is a population-based study planned to enrol all live births occurring in Pelotas that year and comprises 4231 children who so far have been followed up at 3, 12, 24, 48 and 72 months of age. Several familial, maternal and child characteristics were gathered in every follow-up. At the 3-month follow-up, infants whose mothers perceived them as crying more than others of the same age were classified as ‘crying babies’. Child behavioural problems were assessed through the Child Behavior Checklist (CBCL) applied to the mother at the 48-month follow-up. Crude and adjusted ORs with 95% CIs were calculated by logistic regression.

Results

Prevalence of excessive crying at 3 months was 11.9% (10.9% to 13.0%). Among children with excessive crying at 3 months the proportion in the clinical range for CBCL total, internalising and externalising problems at 4 years of age was 31.2%, 12.9% and 37.5%, respectively, against 20.6%, 6.8% and 29.6%, respectively, among non-crying babies. After controlling for confounders crying babies presented increased risk of being in clinical range of CBCL total (OR=1.34; 1.03 to 1.74), internalising (OR=1.55; 1.09 to 2.21) and externalising problems (OR=1.29; 1.01 to 1.64) than infants without excessive crying.

Conclusions

Excessive crying in early infancy may represent one important risk factor for developing behavioural problems in later phases of early childhood.

The impact of breastfeeding on lung development and function: a systematic review

With the global trend of increasing asthma and allergic disorders there is strong interest regarding early life nutrition as a potentially modifiable risk factor for lung disease. This systematic review includes 10 studies that assessed the effect of breastfeeding on lung growth and function. The review found breastfeeding to be beneficial for lung function, with the most consistent effect on increased forced vital capacity. There was no clear evidence that the relationship between breastfeeding and lung function was mediated through other factors. Furthermore, the findings from the few studies that investigated if maternal asthma modified the effect of breastfeeding on lung function were inconsistent. Further research is needed to determine the specific details such as duration and type (exclusive vs partial) of breastfeeding that leads to improved lung function.

Safety considerations: breastfeeding after transplant

Organ transplant is an effective treatment for end-stage organ failure. For women, restoration of organ function can restore fertility and the ability to successfully carry a pregnancy. Posttransplant pregnancies have been reported among recipients of all types of solid organ transplants via case and center reports plus registry data. Stable graft function is dependent on prevention of rejection, currently accomplished by using maintenance immunosuppressant medications, to which the fetus is exposed in utero. Common among neonatal outcomes in transplant recipients are preterm and low-birth-weight infants. Emotional, nutritional, and immunologic benefits of breastfeeding have been well-documented and could be valuable for these newborns. Concern must be directed at the effects of the child's exposure to immunosuppressive agents excreted into the breast milk. Breastfeeding could be considered in transplant recipients if it can be shown that the level of exposure does not result in risks to the newborn, immediately and throughout childhood. Despite concerns of health care professionals, some recipients have chosen to breastfeed. Breastfeeding after transplant must be approached with consideration of many issues, and the potential risks require further study. This review focuses on benefits of breastfeeding, common immunosuppressive agents used in organ transplant recipients, a summary of the reports of women who have breastfed their infants while on immunosuppressive therapy and the published studies on breastfeeding and immunosuppressive agents. Recommendations are provided to guide health care professionals to help mothers receiving immunosuppressive agents to make informed choices about breastfeeding their infants.

Prevalence of infant formula advertisements in parenting magazines over a 5-year span

Marketing of infant formula contributes to a decreased likelihood to breastfeed. This study established the prevalence of infant formula advertisements in two popular US parenting magazines and explored trends in infant formula advertisement prevalence from 2007 to 2012.

METHODS

Advertisements were analyzed using a comprehensive coding schematic.

RESULTS

We established a high proportion of 0.43 advertisements per page of content in both magazines and observed a significant increase in infant formula advertisement prevalence beginning in 2009.

CONCLUSIONS

Infant formula companies use aggressive marketing in parenting magazines. Nurses who are well-trained in breastfeeding best practices can offer new mothers evidence-based information on the benefits of breastfeeding.

Assessing infant breastfeeding beliefs among low-income mexican americans

Focus groups were conducted with low-income, pregnant women and new mothers receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) along with their male partners and their mothers. All participants were Hispanics of Mexican American origin. The topics for the focus-group discussions were breastfeeding beliefs and perceptions. All participants were aware of the benefits of breastfeeding. Participants identified time, embarrassment, and pain as barriers to breastfeeding; discussed decision-making efforts regarding breastfeeding; identified cultural beliefs related to breastfeeding; and discussed the lack of care-provider support for breastfeeding.

Professionally mediated peer support and early breastfeeding success

Social support interventions that incorporate professionally mediated peer support (PMPS) for improved breastfeeding outcomes were compared with no special breastfeeding support. Fifty-five breastfeeding mothers participated. The breastfeeding outcomes of duration, completeness, satisfaction, and exclusive breastfeeding were compared at 6 weeks postpartum among an experimental group that received PMPS, and among younger community (YC) and older community (OC) groups that received no special breastfeeding support. The PMPS group exclusively breastfed for a significantly longer duration than the YC group. At 6 weeks, mothers in both community groups who had weaned were significantly less satisfied with their breastfeeding experiences than the mothers who were still nursing their babies. Professionally mediated peer support can improve the early breastfeeding outcomes of duration of exclusive breastfeeding and satisfaction with breastfeeding.

The health care cost implications of overweight and obesity during childhood

OBJECTIVE

To investigate whether childhood overweight at age 4-5 increases publicly funded health care costs during childhood, and to explore the role of timing and duration of overweight on health costs.

DATA SOURCES

The Longitudinal Study of Australian Children (2004-2008) and linked records from Medicare, Australia's public health insurance provider (2004-2009).

STUDY DESIGN

The influence of overweight status on non-hospital Medicare costs incurred by children over a 5-year period was estimated using two-part models and one-part generalized linear models (GLM). All models controlled for demographic, socioeconomic, and parental characteristics.

PRINCIPAL FINDINGS

Being overweight at age 4-5 is associated with significantly higher pharmaceutical and medical care costs. The results imply that for all children aged 4 and 5 in 2004-2005, those who were overweight had a combined 5-year Medicare bill that was AUD$9.8 million higher than that of normal weight children. Results from dynamic analyses show that costs of childhood overweight occur contemporaneously, and the duration of overweight is positively associated with medical costs for children who became overweight after age 5.

CONCLUSIONS

This study reveals that the financial burden to the public health system of childhood overweight and obesity occurs even during the first 5 years of primary school.

Long-term follow-up of babies exposed to azathioprine in utero and via breastfeeding

BACKGROUND

Recommendations on breastfeeding under thiopurines are inconsistent due to limited data.

AIM

To assess the risk of infections in offspring breastfed by mothers receiving azathioprine (AZA) for inflammatory bowel disease (IBD).

METHODS

Babies, who were breastfed from their mothers treated either with or without AZA were included from a local pregnancy-registry. Women were asked by structured personal interview on general development, infections, hospitalisations and vaccinations of their offspring.

RESULTS

A group of 11 mothers taking AZA (median 150 mg/d) during pregnancy and lactation and another of 12 patients without using any immunosuppressive therapy breastfed 15 babies each for median 6 months and 8 months, respectively. Median age of children at time of interview was 3.3 and 4.7 years, respectively. All offspring showed age-appropriate mental and physical development. Infections were commonly seen childhood diseases. Similar rates were observed for most of the various infections between offspring with and without azathioprine exposure during breastfeeding. However, common cold more than two episodes/year and conjunctivitis were numerically more often reported in the group without AZA exposure. In an exploratory analysis no difference in the rate of hospitalisations was seen between exposed (0.06 hospitalisations/patient year) versus non-exposed children (0.12 hospitalisations/patient year, p=0.8)

CONCLUSION

Our study which reports the largest number of babies breastfed with exposure to AZA suggests that breastfeeding does not increase the risk of infections.

Relationship of exclusive breast-feeding to infections and growth of Tanzanian children born to HIV-infected women

OBJECTIVE

We examined the relationships between exclusive breast-feeding and the risks of respiratory, diarrhoea and nutritional morbidities during the first 2 years of life among children born to women infected with HIV-1.

DESIGN

We prospectively determined the incidence of respiratory illnesses, diarrhoea, fever, hospitalizations, outpatient visits and nutritional morbidities. Generalized estimating equations were used to estimate the relative risks for morbidity episodes and Cox proportional hazards models to estimate the incidence rate ratios of nutritional morbidities.

SETTING

Dar es Salaam, Tanzania.

SUBJECTS

The sample consisted of 666 children born to HIV-infected women.

RESULTS

The 666 children were followed for 2 years. Exclusive breast-feeding was associated with lower risk for cough (rate ratio (RR) = 0·49, 95 % CI 0·41, 0·60, P < 0·0001), cough and fever (RR = 0·44, 95 % CI 0·32, 0·60, P < 0·0001) and cough and difficulty breathing or refusal to feed (RR = 0·31, 95 % CI 0·18, 0·55, P < 0·0001). Exclusive breast-feeding was also associated with lower risk of acute diarrhoea, watery diarrhoea, dysentery, fever and outpatient visits during the first 6 months of life, but showed no effect at 6-24 months of life. Exclusive breast-feeding did not significantly reduce the risks of nutritional morbidities during the first 2 years of life.

CONCLUSIONS

Exclusive breast-feeding is strongly associated with reductions in the risk of respiratory and diarrhoea morbidities during the first 6 months of life among children born to HIV-infected women.

Survival and health benefits of breastfeeding versus artificial feeding in infants of HIV-infected women: developing versus developed world

Infant feeding policies for HIV-infected women in developing countries differ from policies in developed countries. This article summarizes the epidemiologic data on the risks and benefits of various infant feeding practices for HIV-infected women living in different contexts. Artificial feeding can prevent a large proportion of mother-to-child HIV transmission but also is associated with increases in morbidity and mortality among exposed-uninfected and HIV-infected children. Antiretroviral drugs can be used during lactation and reduce risks of transmission. For most of the developing world, the health and survival benefits of breastfeeding exceed the risks of HIV transmission, especially when antiretroviral interventions are provided.

Breastfeeding protects against infectious diseases during infancy in industrialized countries. A systematic review

Firstly, this review was performed to assess the effect of breastfeeding on infections during infancy in industrialized countries. Secondly, the effect of duration and exclusiveness of breastfeeding were explored. Studies were identified using Medline, Cochrane Library, Science Citation Index and by a manual search from bibliographies of articles from August 1986 to January 2008. Follow-up, case-control and randomized controlled trial (RCT) studies performed in an industrialized country, published in English, with breastfeeding as a determinant, with overall infections, gastrointestinal or respiratory tract infections as a major outcome, and at least 40 participants in the study were included. Using Bauchner's criteria published in a review in 1986, two reviewers and a peer reviewer assessed the internal validity of those studies. Twenty-one studies that met the inclusion and internal validity criteria were included. These included 16 follow-up and four case-control studies and one RCT. Four out of five studies observed decreased effects on overall infections in breastfed infants. With regard to gastrointestinal infections, six out of eight studies suggested that breastfeeding had a protective effect. Thirteen out of 16 studies concluded that breastfeeding protects infants against respiratory tract infections. Five studies combined duration and exclusiveness of breastfeeding. All studies observed a protective dose/duration-response effect on gastrointestinal or respiratory tract infections. These studies strongly suggest that breastfeeding protects infants against overall infections, gastrointestinal and respiratory tract infections in industrialized countries. The optimal duration of exclusive breastfeeding for protection against infectious diseases needs to be studied in more detail.

Cronobacter (Enterobacter sakazakii): an opportunistic foodborne pathogen

Cronobacter spp. (Enterobacter sakazakii) are a recently described genus that is comprised of six genomospecies. The classification of these organisms was revised based on a detailed polyphasic taxonomic study. Cronobacter spp. are regarded as ubiquitous organisms having been isolated from a wide variety of foods. These bacteria are opportunistic pathogens and are linked with life-threatening infections in neonates. Clinical symptoms of Cronobacter infection include necrotizing enterocolitis, bacteremia, and meningitis, with case fatality rates of 50-80% being reported. Contaminated powdered infant formula has been epidemiologically linked with infections. Recently, infections among immunocompromised adults, mainly the elderly, have also been reported. A high tolerance to osmotic stress and elevated temperatures contribute to the survival of Cronobacter spp. in dried foods such as powdered infant formula. Controlling the organism in the production environment, thereby reducing dissemination, necessitates the provision of suitable diagnostic tools. Studies demonstrated that a high degree of variability exists amongst the phenotypic-based methods used to identify Cronobacter spp. However, advances in molecular detection and subtyping techniques have significantly improved the identification and characterization of Cronobacter spp. The dose required to induce infection has yet to be determined. In vitro virulence studies have shown that Cronobacter spp. may survive in macrophage cells and efficiently attach to and invade epithelial cell lines. The production of exopolysaccharide may contribute to the formation of biofilm and active efflux pumps promote resistance to antimicrobial agents such as bile salts and disinfectants. A holistic approach combining techniques such as comparative genome analysis, proteomics, and in vivo challenges could help unravel the complex interactions between this pathogen and its host. These data would help identify those properties in Cronobacter spp. which enable the bacterium to survive in the production environment and infect vulnerable neonates via the food chain.

Considerable variation in the concentration of osteopontin in human milk, bovine milk, and infant formulas

Osteopontin (OPN) is a multifunctional bioactive protein that is implicated in numerous biological processes such as bone remodeling, inhibition of ectopic calcification, and cellular adhesion and migration, as well as several immune functions. Osteopontin has cytokine-like properties and is a key factor in the initiation of T helper 1 immune responses. Osteopontin is present in most tissues and body fluids, with the highest concentrations being found in milk. In the present study, ELISA for human and bovine milk OPN were developed and OPN concentration in human breast milk, bovine milk, and infant formulas was measured and compared. The OPN concentration in human milk was measured to approximately 138 mg/L, which corresponds to 2.1% (wt/wt) of the total protein in human breast milk. This is considerably higher than the corresponding OPN concentrations in bovine milk (approximately 18 mg/L) and infant formulas (approximately 9 mg/L). Moreover, bovine milk OPN is shown to induce the expression of the T helper 1 cytokine IL-12 in cultured human lamina propria mononuclear cells isolated from intestinal biopsies. Finally, the OPN concentration in plasma samples from umbilical cords, 3-mo-old infants, and pregnant and nonpregnant adults was measured. The OPN level in plasma from 3-mo-old infants and umbilical cords was found to be 7 to 10 times higher than in adults. Thus, the high levels of OPN in milk and infant plasma suggest that OPN is important to infants and that ingested milk OPN is likely to induce cytokine production in neonate intestinal immune cells.

Formula feeding is associated with increased hospital admissions due to infections among infants younger than 6 months in Manila, Philippines

This case control study evaluates the association between hospitalization due to infection and feeding practices among infants aged >or= 3 days to < 6 months. Mothers of 191 cases hospitalized for infections and 208 healthy controls were interviewed using a standardized questionnaire documenting infant-feeding history. Results given in odds ratio and 95% confidence intervals (OR, 95% CI) were adjusted for age, education, and place of delivery. Exclusively formula-fed infants were more likely to be hospitalized for any infection (3.7, 1.8-7.5), pneumonia (3.0, 1.2-7.4), and diarrhea (10.5, 2.5-41.9) compared to exclusively breastfed infants. Infants who did not receive any breast milk were more likely to be hospitalized for any infection (3.5, 2.1-5.9), neonatal sepsis (4.9, 1.3-18.3), pneumonia (2.8, 1.5-5.4), and diarrhea (19.6, 6.5-58.6) than infants who received any breast milk. This study showed a strong positive association between the intake of formula and/or nonbreast milk supplements and the risk of hospitalization for infectious causes.

Cytokines in human milk

Epidemiologic studies conducted in the past 30 years to investigate the protective functions of human milk strongly support the notion that breastfeeding prevents infantile infections, particularly those affecting the gastrointestinal and respiratory tracts. However, more recent clinical and experimental observations also suggest that human milk not only provides passive protection, but also can directly modulate the immunological development of the recipient infant. The study of this remarkable defense system in human milk has been difficult because of its biochemical complexity, the small concentration of certain bioactive components, the compartmentalization of some of these agents, the dynamic quantitative and qualitative changes of milk during lactation, and the lack of specific reagents to quantify these agents. However, a host of bioactive substances, including hormones, growth factors, and immunological factors such as cytokines, have been identified in human milk. Cytokines are pluripotent polypeptides that act in autocrine/paracrine fashions by binding to specific cellular receptors. They operate in networks and orchestrate the development and functions of immune system. Several different cytokines and chemokines have been discovered in human milk in the past years, and the list is growing very rapidly. This article will review the current knowledge about the increasingly complex network of chemoattractants, activators, and anti-inflammatory cytokines present in human milk and their potential role in compensating for the developmental delay of the neonate immune system.

Breastfeeding reduces the severity of respiratory syncytial virus infection among young infants: a multi-center prospective study

BACKGROUND

The objective of this study was to evaluate the effects of breastfeeding on the severity of respiratory syncytial virus infection in early infancy.

METHODS

A rapid test for respiratory syncytial virus (RSV) was administered by 16 general pediatricians from May 2002 to April 2005 in infants undergoing medical checkups for the common cold, all of whom were 100 days old or younger and had birthweights of more than 2500 g without underlying disease. Infants were divided into three groups: the Full breastfeeding group, the Partial group, and the Token group. RSV-positive cases were followed up for 10 days after the initial diagnosis and the following three points were investigated: (i) the incidence of hospitalization; (ii) the duration of hospitalization; and (iii) the incidence of requiring oxygen therapy.

RESULTS

RSV antigen was detected in 203 of the total of 892 cases, and these were diagnosed as cases of RSV infectious disease. Although there were no significant differences in the hospitalization rate among the three groups, there were significant differences in the duration of hospitalization and the rate of requiring oxygen therapy. Multivariate logistic regression revealed that the requirement of oxygen therapy was significantly lower in the Full breastfeeding group (P= 0.032; odds ratio, 0.256; 95% confidence interval, 0.074-0.892).

CONCLUSIONS

Breastfeeding reduces the severity of respiratory syncytial virus infection in early infancy.

Determinants of exclusive breastfeeding in South gujarat region of India

Objective

To estimate the situation of breastfeeding in Surat among infants and to determine variables associated to major risks for early weaning.

Design and settings

Mothers coming to the well baby clinic for immunization of infants at Government Medical College and Hospital were interviewed using pretested questionnaire.

Subjects

Mothers with their infants who have not completed one year of age.

Methods

In this cross sectional study, 498 mothers were selected for study from May to September, 2008. Survival analysis was the method used to calculate the prevalence and the median duration of breastfeeding. The Chi-square test was performed to compare the proportions; significance level was set at 5%. Odds ratio was used to measure the significance of association, with a 95% confidence interval. Logistic regression analysis was used to identify the risk factors for early weaning.

Results

The median length of exclusive breastfeeding was 6 months. Risk factors for early weaning were primiparity (OR = 3.01, 95% CI = 2.01- 4.51), consecutive delivery interval less than 24 months (OR = 1.79, 95% CI = 1.09 - 2.92), maternal age below 20 years (OR = 6.49, 95% CI = 2.69 - 15.61), and paternal occupation as labor (OR = 2.02, 95% CI = 1.36 - 3.00).

Conclusions

Exclusive breastfeeding practices are not in a better situation than at national level. The factors related to early weaning denote a weak breastfeeding support given by maternal and infant health services.

Keywords

Exclusive breastfeeding; Weaning; Antenatal care; Postnatal care; Education

O aleitamento materno nos programas brasileiros de pós-graduação em Pediatria: perfil das dissertações e teses elaboradas de 1971 a 2006

OBJETIVO:Traçar o perfil da produção sobre o tema "aleitamento materno" na pós-graduação stricto sensu em Pediatria no Brasil. MÉTODOS: Análise descritiva das dissertações e teses produzidas no período de 1971 a 2006 pelos programas reconhecidos pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. RESULTADOS:Os 12 programas produziram 1.494 obras, das quais 68 (4,55%) utilizaram o aleitamento materno como objeto de construção, sendo 50 em nível de mestrado e 18 de doutorado. A região Sudeste detém o maior número de Programas. Houve predominância dos estudos quantitativos. A Faculdade de Medicina de Ribeirão Preto, a Universidade de São Paulo e a Universidade Federal de São Paulo foram as que mais se dedicaram ao estudo do tema. Dois programas não apresentaram estudos sobre aleitamento materno. Os programas se diferenciaram quanto à especificidade dos estudos, geralmente quantificando e descrevendo o tema sob a ótica social e biológica, mas não foram explorados aspectos culturais que envolvem a prática do aleitamento materno. CONCLUSÕES:O número de obras produzidas não corresponde à importância da temática para a saúde da criança. A produção em aleitamento materno está concentrada no Sudeste, região que detém o maior número de Programas. Houve predominância dos estudos quantitativos, o que revela uma preocupação com a dimensão biológica da amamentação.

Breastfeeding duration and exclusivity associated with infants' health and growth: data from a prospective cohort study in Bavaria, Germany

AIM

To investigate the relationship between breastfeeding and infant health and to describe growth in the first 9 months.

METHODS

Mothers delivering a baby in April 2005 were recruited throughout Bavaria, Germany, for a prospective birth cohort study. These mothers reported breastfeeding data, health and growth data of 1901 infants assessed by a physician in questionnaires on day 2-6, and in months 2, 4, 6 and 9. Subjects were healthy term infants with a birth weight > or =2500 g. We compared 475 infants breastfed exclusively for > or =6 months (group A), 870 infants breastfed fully/exclusively > or =4 months, but not exclusively > or =6 months (group B) and 619 infants not breastfed/breastfed <4 months (group C).

RESULTS

In multivariate analysis > or =6 months of exclusive breastfeeding reduced significantly the risk for > or =1 episode of gastrointestinal infection(s) during months 1-9 compared to no/<4 months breastfeeding (adjusted odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.44-0.82). The application of the World Health Organization (WHO)-child growth standards showed lower weight-for-length z-scores in first days of life in group C versus groups A and B, whereas in months 6/7 group C showed the highest scores.

CONCLUSION

Differences in child growth depending on breastfeeding duration should be investigated further. Concerning health outcomes our findings support the recommendation for > or =6 months of exclusive breastfeeding.

Risk factors for neonatal infections in full-term babies in South Korea

PURPOSE

Since 1997, private postnatal care facilities (San-hu-jo-ri-won in Korean) have emerged to take the role of the family. As a result, neonates are now exposed to many people and are very vulnerable to infection. However, there has been no study on the influence of postnatal care facilities on neonatal infection. The aim of this study was to determine the risk factors of neonatal infection in full-term babies in Korea.

MATERIALS AND METHODS

We followed up 556 pregnant women and their babies for 4 weeks after their births at 2 hospitals in Seoul and Daejeon from October 2004 to September 2005. Among 512 full-term babies, 58 had infectious diseases. To determine the risk factors for infection, 53 infected neonates at 4-28 days of life and 413 healthy neonates were compared.

RESULTS

The incidence of neonatal infection at 4 to 28 days after birth was 10.5%. After adjusting the related factors, the number of siblings (OR = 2.05, 95% CI = 1.13-3.71 for 1 or more) and postnatal care facilities or home aides (OR = 1.91, 95% CI = 1.07-3.45) were significant risk factors. Formula or mixed feeding (OR = 1.66, 95% CI = 0.91-3.04) increased the risk of neonatal infection but it was not statistically significant.

CONCLUSION

When the newborns had siblings, stayed at postnatal care facilities, or were cared for by home aides, the risk of neonatal infections significantly increased. Further research on the feeding effect on neonatal infection and evaluation of prevention efforts are needed.

Effects of early, abrupt weaning on HIV-free survival of children in Zambia

BACKGROUND

In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt weaning at 4 months as compared with the standard practice has a net benefit for HIV-free survival of children.

METHODS

We enrolled 958 HIV-infected women and their infants in Lusaka, Zambia. All the women planned to breast-feed exclusively to 4 months; 481 were randomly assigned to a counseling program that encouraged abrupt weaning at 4 months, and 477 to a program that encouraged continued breast-feeding for as long as the women chose. The primary outcome was either HIV infection or death of the child by 24 months.

RESULTS

In the intervention group, 69.0% of the mothers stopped breast-feeding at 5 months or earlier; 68.8% of these women reported the completion of weaning in less than 2 days. In the control group, the median duration of breast-feeding was 16 months. In the overall cohort, there was no significant difference between the groups in the rate of HIV-free survival among the children; 68.4% and 64.0% survived to 24 months without HIV infection in the intervention and control groups, respectively (P=0.13). Among infants who were still being breast-fed and were not infected with HIV at 4 months, there was no significant difference between the groups in HIV-free survival at 24 months (83.9% and 80.7% in the intervention and control groups, respectively; P=0.27). Children who were infected with HIV by 4 months had a higher mortality by 24 months if they had been assigned to the intervention group than if they had been assigned to the control group (73.6% vs. 54.8%, P=0.007).

CONCLUSIONS

Early, abrupt cessation of breast-feeding by HIV-infected women in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infected infants.(ClinicalTrials.gov number, NCT00310726.)

Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound

OBJECTIVE

There is evidence that infants with ankyloglossia can experience breastfeeding difficulties including poor attachment to the breast, suboptimal weight gain, and maternal nipple pain, which may lead to early weaning of the infant. No studies have investigated the cause of these breastfeeding difficulties. The objective of this study was to determine the effectiveness of frenulotomy in infants experiencing persistent breastfeeding difficulties despite professional assistance by measuring changes in milk transfer and tongue movement during breastfeeding before and after frenulotomy.

PATIENTS AND METHODS

Twenty-four mother-infant dyads (infant age: 33 +/- 28 days) that were experiencing persistent breastfeeding difficulties despite receiving professional advice were recruited. Submental ultrasound scans (Acuson XP10) of the oral cavity were performed both before and >or=7 days after frenulotomy. Milk transfer, pain, and LATCH (latch, audible swallowing, type of nipple, comfort, and hold) scores were recorded before and after frenulotomy. Infant milk intake was measured by using the test-weigh method.

RESULTS

For all of the infants, milk intake, milk-transfer rate, LATCH score, and maternal pain scores improved significantly postfrenulotomy. Two groups of infants were identified on ultrasound. One group compressed the tip of the nipple, and the other compressed the base of the nipple with the tongue. These features either resolved or lessened in all except 1 infant after frenulotomy.

CONCLUSIONS

Infants with ankyloglossia experiencing persistent breastfeeding difficulties showed less compression of the nipple by the tongue postfrenulotomy, which was associated with improved breastfeeding defined as better attachment, increased milk transfer, and less maternal pain. In the assessment of breastfeeding difficulties, ankyloglossia should be considered as a potential cause.