Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health

Neurologists' and obstetricians' perspectives and current practices in breastfeeding counseling in women with epilepsy

OBJECTIVES

In this study, we aimed to characterize practice patterns of neurologists and obstetricians in breastfeeding (BF) counseling in women with epilepsy (WWE) and explore factors that may influence physician counseling behaviors.

METHODS

We conducted a cross-sectional study of neurologists and obstetricians via an anonymous survey from September 2021 until November 2021. A survey was developed to explore the following areas in WWE: current physicians' BF counseling patterns, physician-specific factors affecting BF counseling, and patient-specific factors and their impact on BF counseling. Descriptive statistics were generated for each survey question. Responses from neurologists and obstetricians were compared. Odds ratios (OR) and confidence intervals (CI) were calculated to assess factors that influence BF counseling in WWE.

RESULTS

A total of 185 physicians participated in the study and consisted of 91 (49.2 %) neurologists, 83 (44.8 %) obstetricians, and 11 (6 %) participants from other specialties. Ninety-four percent (94 %) of neurologists and 92 % of obstetricians indicated that they provide BF safety counseling to WWE primarily during preconception and occasionally during pregnancy. Fifty-six percent of obstetricians reported being very comfortable with BF counseling in WWE, compared to 68 % of neurologists. Both groups rated research and clinical practice guidelines as two factors that have major impact on BF counseling; however, less than half (45 %) of neurologists are very familiar with the current literature and only a quarter (24 %) of obstetricians are very familiar with current literature regarding safety of BF in WWE. Regarding barriers to BF counseling, relative to neurologists, obstetricians believe that delivery of conflicting opinions among medical specialists about BF safety is a barrier that may impede effective BF counseling in WWE [OR = 2.78 (95 % CI: 1.30,5.95), adjusted p value (P = 0.008)].

SIGNIFICANCE

Variable knowledge of current literature in BF in WWE and low comfort levels in BF counseling among various specialists, as well as perceived inadequate data and clinical practice guidelines, may contribute to suboptimal BF counseling and impact health outcomes in WWE and their children.

The effect of breastfeeding education given through the teach-back method on mothers' breastfeeding self-efficacy and breastfeeding success: a randomized controlled study

BACKGROUND

An individualized education using visual aids, allowing the woman to demonstrate what she has learned, and providing the opportunity for the woman to ask questions are important in terms of breastfeeding self-efficacy, breastfeeding success, and the sustainability of the education. This study is original in evaluating the effectiveness and sustainability of breastfeeding education provided through the teach-back method in terms of breastfeeding self-efficacy and success in a short period of time. Therefore, the aim of this study is to examine the impact of teach-back method on mothers' breastfeeding self-efficacy and breastfeeding success.

MATERIALS AND METHODS

This is a randomized controlled study. The population of this study consisted of women who gave birth in the obstetrics and gynecology department of a state hospital located in Çorlu, in the northwest region of Turkey, between March 2022 and August 2022. The sample of this study consisted of a total of 100 postpartum women, with 50 participants in the experimental group and 50 participants in the control group, who gave birth in the obstetrics and gynecology department of Çorlu State Hospital. Computer-assisted simple randomization was employed to ensure the homogeneous distribution of the women into the experimental and control groups. The women in the experimental group received education and counseling services using the Teach-Back Method, based on the content of the prepared Breastfeeding Education Guide. The control group mothers, on the other hand, received standard breastfeeding education and counseling services. The data were collected through face-to-face interviews during the first 24 h postpartum and at the 1-month follow-up visits. In the study, the data collection tools used were a Personal Information Form, LATCH Breastfeeding Assessment and Evaluation Scale, Postpartum Breastfeeding Self-Efficacy Scale (short form), and the Teach-Back Observation Tool. In the evaluation of the research findings, the SPSS (Statistical Package for the Social Sciences) version 25.0 (IBM Corp., Armonk, NY, USA) program was used for statistical analyses. Descriptive, graphical, and statistical methods were employed to examine whether the scores obtained from each continuous variable followed a normal distribution. The Kolmogorov-Smirnov test was used to assess the normality of the scores derived from a continuous variable using statistical methods.

RESULTS

In the study, no significant difference was found in the distribution of the socio-demographic characteristics of the participants according to the study groups. In the experimental group, which received training with the tell-what-you-learned method, the mothers' average EÖYÖ scores before the training, at the 24th hour after the training and at the 1st month after the training were 46.41 ± 11.26, respectively; It was determined to be 66.23 ± 6.94 and 67.84 ± 6.27. In the measurements made during the follow-up, it was determined that there was a significant difference in the study group's EÖYÖ score averages (p < 0,001). For mothers in the experimental group, the average LATCH score of the mothers before training, 24 h after training and 1 month after training was 7.73 ± 1.81, respectively; It was determined that these values were 8.66 ± 1.61 and 9.95 ± 0.30, and there was a significant difference in the mean LATCH scores of the study group in the measurements made during the follow-up (p < 0.001).

CONCLUSIONS

Breastfeeding education provided through the teach-back method is more effective in increasing both breastfeeding success and breastfeeding self-efficacy when compared to standard breastfeeding education.

TRIAL REGISTRATION

Iran Randomized Clinical Trial Center IRCT20220509054795N2 Date of first registration: 10/11/2022.

Current research progress, opportunities, and challenges of Limosillactobacillus reuteri-based probiotic dietary strategies

Limosillactobacillus reuteri (L. reuteri), a type of Lactobacillus spp., stands out as the most extensively researched probiotic. Its remarkable intestinal adhesion has led to widespread applications in both the food and medical sectors. Notably, recent research highlights the probiotic efficacy of L. reuteri sourced from breast milk, particularly in influencing social behavior and mitigating atopic dermatitis. In this review, our emphasis is on surveying recent literature regarding the promotion of host's health by L. reuteri. We aim to provide a concise summary of the latest regulatory effects and potential mechanisms attributed to L. reuteri in the realms of metabolism, brain- and immune-related functions. The mechanism through which L. reuteri promotes host health by modulating the intestinal microenvironment primarily involves promoting intestinal epithelial renewal, bolstering intestinal barrier function, regulating gut microbiota and its metabolites, and suppressing inflammation and immune responses. Additionally, this review delves into new technologies, identifies shortcomings, and addresses challenges in current L. reuteri research. Finally, the application prospects of L. reuteri are provided. Therefore, a better understanding of the role and mechanisms of L. reuteri will contribute significantly to the development of new probiotic functional foods and enable precise, targeted interventions for various diseases.

Personalized Nutrition with Banked Human Milk for Early Gut Microbiota Development: In Pursuit of the Perfect Match

The correct initial colonization and establishment of the gut microbiota during the early stages of life is a key step, with long-lasting consequences throughout the entire lifespan of the individual. This process is affected by several perinatal factors; among them, feeding mode is known to have a critical role. Breastfeeding is the optimal nutrition for neonates; however, it is not always possible, especially in cases of prematurity or early pathology. In such cases, most commonly babies are fed with infant formulas in spite of the official nutritional and health international organizations' recommendation on the use of donated human milk through milk banks for these cases. However, donated human milk still does not totally match maternal milk in terms of infant growth and gut microbiota development. The present review summarizes the practices of milk banks and hospitals regarding donated human milk, its safety and quality, and the health outcomes in infants fed with donated human milk. Additionally, we explore different alternatives to customize pasteurized donated human milk with the aim of finding the perfect match between each baby and banked milk for promoting the establishment of a beneficial gut microbiota from the early stages of life.

Breastfeeding Intention and Breastfeeding Postpartum Outcomes between High-Risk and Low-Risk Pregnant Women: A Greek Prospective Cohort Study

BACKGROUND

This prospective cohort study, conducted from pregnancy to six months postpartum and grounded in STROBE methodology, quantitatively explores the relationship between antenatal breastfeeding intentions and subsequent breastfeeding outcomes among high-risk pregnant women, compared to a low-risk pregnancy group.

METHODS

The study was conducted in one of the largest public hospitals in Attica that provides care to pregnant women, enrolling 380 participants divided into high-risk (n = 200) and low-risk (n = 180) cohorts. Data were collected over 20 months (starting from the end of May 2020 until January 2022), spanning from pregnancy to six months postpartum, via comprehensive questionnaires.

RESULTS

Statistical analysis revealed a pronounced correlation between prenatal breastfeeding intentions and actual breastfeeding behaviors across both groups. Specifically, 81.1% of women in the high-risk group and 82.5% in the low-risk group expressed intentions of exclusively breastfeeding during pregnancy. By six months postpartum, 54.9% of the high-risk and 64.3% of the low-risk pregnancy group managed to sustain breastfeeding. Extended antenatal hospitalization emerged as a statistically significant factor (p = 0.045) negatively impacting exclusive breastfeeding intentions among high-risk pregnancies.

CONCLUSION

The findings illuminate the critical influence of antenatal intentions on breastfeeding outcomes, particularly among high-risk pregnancies. Moreover, the study identifies the detrimental effect of prolonged hospital stays on breastfeeding aspirations. These insights underscore the necessity for nuanced, supportive interventions aimed at bolstering breastfeeding rates, thereby advancing maternal and neonatal health objectives aligned with World Health Organization recommendations.

Efficacy and safety of acupuncture for postpartum hypogalactia: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Postpartum hypogalactia (PH) is prominent during lactation and may negatively impact the mother's or infant's health. Acupuncture is widely used to increase maternal breast milk production. However, the effects of acupuncture on PH remain unclear. Therefore, this review aimed to evaluate the efficacy and safety of acupuncture in individuals with PH.

MATERIALS AND METHODS

Articles on potentially eligible randomized controlled trials (RCTs) on acupuncture for PH published from database inception to October 2023 were retrieved from the PubMed, Web of Science, Cochrane Library, EMBASE, EBSCO, Scopus, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP databases. Two reviewers independently screened the records, extracted essential information, and evaluated the methodological quality of the RCTs using the revised Cochrane risk-of-bias (RoB) tool. The primary outcome was a change in serum prolactin (PRL) levels before and after treatment. Secondary outcomes included milk secretion volume (MSV), total effective rate (TER), mammary fullness degree (MFD), and exclusive breastfeeding rate (EBR). Meta-analyses were performed using RevMan v5.4. Finally, the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool.

RESULTS

This study included 19 RCTs involving 2,400 participants. The included studies were classified as having an unclear to high RoB. Our findings indicated that, overall, acupuncture showed a significant effect in increasing serum PRL levels (standardized mean differences [SMDs] = 1.09, 95% confidence interval [CI]: 0.50, 1.68), MSV (SMD = 1.69, 95% CI: 0.53, 2.86), TER (relative risk [RR] = 1.25, 95% CI: 1.10, 1.42), and EBR (RR = 2.01, 95% CI: 1.07, 3.78) compared to that in the control group; however, no difference in MFD (SMD = 1.17, 95% CI: -0.09, 2.42) was observed. In the subgroup analysis, acupuncture combined with Chinese herbs or conventional treatment was significantly more effective in increasing serum PRL levels, MSV, and TER than did Chinese herbs or conventional treatment alone. Moreover, acupuncture alone resulted in significantly higher serum PRL levels compared to Chinese herbs; however, this benefit was not observed for TER and MFD. The quality of evidence was critically low.

CONCLUSION

Acupuncture may effectively increase milk secretion in women with PH. However, owing to the low quality of evidence, further rigorously designed studies are warranted to confirm our findings.

Exploring the Impact of Extra Virgin Olive Oil on Maternal Immune System and Breast Milk Composition in Rats

Maternal breast milk plays a key role in providing newborns with passive immunity and stimulating the maturation of an infant's immune system, protecting them from many diseases. It is known that diet can influence the immune system of lactating mothers and the composition of their breast milk. The aim of this study was to establish if a supplementation during the gestation and lactation of Lewis rats with extra virgin olive oil (EVOO), due to the high proportion of antioxidant components in its composition, has an impact on the mother's immune system and on the breast milk's immune composition. For this, 10 mL/kg of either EVOO, refined oil (control oil) or water (REF group) were orally administered once a day to rats during gestation and lactation periods. Immunoglobulin (Ig) concentrations and gene expressions of immune molecules were quantified in several compartments of the mothers. The EVOO group showed higher IgA levels in both the breast milk and the mammary glands than the REF group. In addition, the gene expression of IgA in mammary glands was also boosted by EVOO consumption. Overall, EVOO supplementation during gestation and lactation is safe and does not negatively affect the mother's immune system while improving breast milk immune composition by increasing the presence of IgA, which could be critical for an offspring's immune health.

The Role of Maternal Secretor Status and Human Milk Oligosaccharides on Early Childhood Development: A Systematic Review and Meta-Analysis

Background: Breast milk is the gold standard of infant nutrition, delivering nutrients and bioactive molecules as needed to support optimal infant growth and cognitive development. Increasing evidence links human milk oligosaccharides (HMOs) to these early childhood development milestones. Aims: To summarize and synthesize the evidence relating to HMOs and infant brain development, physical growth, and cognitive development. In addition, HMO concentrations in secretor and nonsecretor mothers were compared via a meta-analysis. Study Design: A systematic review and meta-analysis were carried out in accordance with the PRISMA statement. This review used three databases (PubMed, Scopus, and Web of Science) and was limited to English-language articles published between 2000 and June 30, 2023. Results: The initial searches yielded 245 articles, 27 of which were included in the systematic review and 12 in the meta-analysis. The meta-analysis revealed a substantial between-study heterogeneity, I2 = 97.3%. The pooled effect was 0.21 (95% CI: -0.41 to 0.83; p = 0.484), indicating that secretors had higher HMO concentrations, although this difference was not statistically significant. At one month of age, 2'FL, 3FL, and 3'SL play an important role in brain maturation and thus play a critical role in cognitive development. Secretors produce higher concentrations of 2'FL and 3'SL, explaining the benefits to infants of secretor mothers. Growth velocity was correlated to fucosylated and sialylated HMO concentrations, with lower concentrations linked to stunting. Conclusions: According to evidence from the systematically reviewed articles, HMOs are essential for a child's early development, but the extent to which they have an impact depends on maternal secretor status.

The impact of ever breastfeeding on children ages 12 to 36 months: A secondary data analysis of the standardization study of the Dominican system for evaluating early childhood development

Extensive research has shown that breastfeeding offers many benefits to children, including advantages in lifelong health, physical development, cognitive function, behavior, and brain development, compared to those not breastfed. In the Dominican Republic, the prevalence of exclusive breastfeeding among infants aged 0-6 months remains low, and the lack of a surveillance system has made it challenging to measure the impact of breastfeeding on early childhood development (ECD). This study aims to address the effect of ever breastfeeding on ECD. We conducted secondary data analysis from the Dominican System for Measuring Early Childhood Development (SIMEDID), a screening tool adapted and validated to the Dominican context that measures four areas of development: gross-motor, fine-motor, language, and socioemotional development. The data from SIMEDID can be cross-analyzed with other datasets generated by the National Institute for Early Childhood Comprehensive Care (INAIPI) that include information about breastfeeding. The children were evaluated during the standardization study of SIMEDID. To determine the breastfeeding impact, we: 1) conducted an analysis of covariance using ECD scores as dependent variables and ever breastfed as the independent variable, with age and sex as covariates (previously confirmed with an analysis of variance indicating the relevance of age and sex at birth in ECD); 2) analyzed the relative risk (RR) of developmental delay by breastfeeding status. We studied a sample of 699 Dominican children aged 12-36 months who receive services at INAIPI (the government institution responsible for administering comprehensive early childhood services). The results show that ever breastfed children had higher scores in overall ECD than those who were not; higher scores in language and fine motor development primarily drove this effect. The never breastfed group had a greater risk of developmental delay in fine motor and socioemotional development. These findings underscore the importance of promoting and supporting breastfeeding to improve child neurodevelopmental outcomes. This is particularly relevant in low-resource settings, where mothers may need additional support. Moreover, the study's results provide evidence of SIMEDID's validation, which can help inform future research and evidence-based decision-making toward optimal ECD in similar contexts.

Effect of folA gene in human breast milk-derived Limosilactobacillus reuteri on its folate biosynthesis

Introduction

Folate supplementation is crucial for the human body, and the chemically synthesized folic acid might have undesirable side effects. The use of molecular breeding methods to modify the genes related to the biosynthesis of folate by probiotics to increase folate production is currently a focus of research.

Methods

In this study, the folate-producing strain of Limosilactobacillus reuteri B1-28 was isolated from human breast milk, and the difference between B1-28 and folA gene deletion strain ΔFolA was investigated by phenotyping, in vitro probiotic evaluation, metabolism and transcriptome analysis.

Results

The results showed that the folate producted by the ΔFolA was 2-3 folds that of the B1-28. Scanning electron microscope showed that ΔFolA had rougher surface, and the acid-producing capacity (p = 0.0008) and adhesion properties (p = 0.0096) were significantly enhanced than B1-28. Transcriptomic analysis revealed that differentially expressed genes were mainly involved in three pathways, among which the biosynthesis of ribosome and aminoacyl-tRNA occurred in the key metabolic pathways. Metabolomics analysis showed that folA affected 5 metabolic pathways, involving 89 different metabolites.

Discussion

In conclusion, the editing of a key gene of folA in folate biosynthesis pathway provides a feasible pathway to improve folate biosynthesis in breast milk-derived probiotics.

Human Breast Milk: The Role of Its Microbiota and Metabolites in Infant Health

This review explores the role of microorganisms and metabolites in human breast milk and their impact on neonatal health. Breast milk serves as both a primary source of nutrition for newborns and contributes to the development and maturation of the digestive, immunological, and neurological systems. It has the potential to reduce the risks of infections, allergies, and asthma. As our understanding of the properties of human milk advances, there is growing interest in incorporating its benefits into personalized infant nutrition strategies, particularly in situations in which breastfeeding is not an option. Future infant formula products are expected to emulate the composition and advantages of human milk, aligning with an evolving understanding of infant nutrition. The long-term health implications of human milk are still under investigation.

Isolation and identification of microplastics in infant formulas - A potential health risk for children

Microplastics (MPs) are plastic particles between 0.1 and 5,000 µm in size that can contaminate food. Unfortunately, to date, little attention has been paid to analyzing the presence of such particles in baby foods. The present study aimed to determine the degree of contamination of infant formula with MPs. A total of thirty products were subjected to analysis. The research methodology used included the isolation of plastic particles, identification and characterization of MPs using advanced microscopic and spectroscopic techniques. Microplastics were detected in all tested samples. The most frequently identified polymers were polyamide, polyethylene, polypropylene, and poly(ethylene terephthalate). The particles exhibited diverse forms, including fibers, fragments, and films, displaying a range of colors such as colorless, black, and brown particles. Furthermore, the daily intake of MPs by children fed exclusively infant formula was estimated to be approximately 49 ± 32 MPs. This poses a potential health risk for the youngest.

Unveiling the gut-eye axis: how microbial metabolites influence ocular health and disease

The intricate interplay between the gut microbiota and ocular health has surpassed conventional medical beliefs, fundamentally reshaping our understanding of organ interconnectivity. This review investigates into the intricate relationship between gut microbiota-derived metabolites and their consequential impact on ocular health and disease pathogenesis. By examining the role of specific metabolites, such as short-chain fatty acids (SCFAs) like butyrate and bile acids (BAs), herein we elucidate their significant contributions to ocular pathologies, thought-provoking the traditional belief of organ sterility, particularly in the field of ophthalmology. Highlighting the dynamic nature of the gut microbiota and its profound influence on ocular health, this review underlines the necessity of comprehending the complex workings of the gut-eye axis, an emerging field of science ready for further exploration and scrutiny. While acknowledging the therapeutic promise in manipulating the gut microbiome and its metabolites, the available literature advocates for a targeted, precise approach. Instead of broad interventions, it emphasizes the potential of exploiting specific microbiome-related metabolites as a focused strategy. This targeted approach compared to a precision tool rather than a broad-spectrum solution, aims to explore the therapeutic applications of microbiome-related metabolites in the context of various retinal diseases. By proposing a nuanced strategy targeted at specific microbial metabolites, this review suggests that addressing specific deficiencies or imbalances through microbiome-related metabolites might yield expedited and pronounced outcomes in systemic health, extending to the eye. This focused strategy holds the potential in bypassing the irregularity associated with manipulating microbes themselves, paving a more efficient pathway toward desired outcomes in optimizing gut health and its implications for retinal diseases.

Human Milk Microbiome-A Review of Scientific Reports

One of the most important bioactive components of breast milk are free breast milk oligosaccharides, which are a source of energy for commensal intestinal microorganisms, stimulating the growth of Bifidobacterium, Lactobacillus, and Bacteroides in a child's digestive tract. There is some evidence that maternal, perinatal, and environmental-cultural factors influence the modulation of the breast milk microbiome. This review summarizes research that has examined the composition of the breast milk microbiome and the factors that may influence it. The manuscript highlights the potential importance of the breast milk microbiome for the future development and health of children. The origin of bacteria in breast milk is thought to include the mother's digestive tract (entero-mammary tract), bacterial exposure to the breast during breastfeeding, and the retrograde flow of breast milk from the infant's mouth to the woman's milk ducts. Unfortunately, despite increasingly more precise methods for assessing microorganisms in human milk, the topic of the human milk microbiome is still quite limited and requires scientific research that takes into account various conditions.

Biomarker-based text messages to promote lactation success in mothers of critically Ill infants: a randomized controlled pilot study

OBJECTIVE

Infrequent breast pumping limits mother's own milk production in mothers of infants admitted to the neonatal intensive care unit. We aimed to determine the feasibility and benefit of biomarker-based personalized text messages on pumping frequency and milk sodium levels. A secondary aim examined lactation outcomes.

STUDY DESIGN

In this randomized controlled pilot study, 51 mothers were randomized to receive personalized text messages regarding pumping frequency or standard care.

RESULTS

There were no differences in pumped milk volume or sodium level, however, there was a trend towards the intervention group pumping more frequently, which was significant on day 5 (p = 0.035), and they lactated nearly 9 days longer. Post-hoc analysis found the intervention group tended to be more likely to pump ≥ 500 mL by day14 (p = 0.08), a marker of long-term lactation success.

CONCLUSION

Personalized biomarker-based text messages are feasible and may support lactation in mothers of critically ill infants.

Relationship Between Maternal Age and Macronutrient Content of Colostrum

BACKGROUND

Little is known about the relationship between maternal age and the macronutrient content of colostrum.

RESEARCH AIMS

This study aimed to evaluate the relationship between maternal age and human milk macronutrient content by comparing the concentrations of lactose, proteins, and lipids in the colostrum of women with younger, moderate, and advanced maternal age.

METHODS

An observational, cross-sectional study was designed to compare the macronutrient concentrations in the colostrum of women aged < 20 years, 20 to 34 years, and > 34 years (younger, moderate, and advanced maternal age, respectively; n = 33 per group). For each participant, 3 ml of colostrum was collected by manual extraction from the right breast at 10 am, 39-48 hr after delivery, and analyzed using a Miris Human Milk Analyzer. Macronutrient concentrations were compared between the groups using analysis of variance. P < 0.05 was considered significant.

RESULTS

Mothers with moderate maternal age had a higher colostrum lipid concentration than those with younger or advanced maternal age (2.3 mg, SD = 1.4 mg vs. 1.5 mg, SD = 1.0 mg vs. 1.6 mg, SD = 0.9 mg, respectively; p = 0.007). Lactose and protein contents in the analyzed samples did not differ among the three study groups.

CONCLUSION

This study lends support to the potential variation of lipids in colostrum by maternal age and suggests individual adaptation to the nutritional components of milk to the needs of the infant may be beneficial.

Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study

BACKGROUND

Enteral feeding is an essential part of the management of infants with gastroschisis. We hypothesized that exclusive breast milk is associated with improved neonatal outcomes.

METHODS

We conducted a retrospective review of infants with uncomplicated gastroschisis through the Canadian Pediatric Surgery Network (CAPSNet) and Canadian Neonatal Network (CNN). The primary outcome was time to full enteral feeds.

RESULTS

We identified 411 infants with gastroschisis treated at CAPSNet centres from 2014 to 2022. 144 patients were excluded due to gestational age <32 weeks, birth weight <1500 g, other congenital anomalies, or complicated gastroschisis. Of the remaining 267 participants, 78% (n = 209) received exclusive breast milk diet in the first 28 days of life, whereas 22% (n = 58) received supplemental or exclusive formula. Infants who received exclusive breast milk experienced higher time to reach full enteral feeding (median 24 vs 22 days, p = 0.047) but were more likely to have undergone delayed abdominal closure (32% vs 17%, p = 0.03). After adjustment, there were no significant differences between groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay. Infants who received supplemental or exclusive formula had a similar risk of necrotizing enterocolitis (4% vs 3%) but were less likely to transition to exclusive breast milk at discharge (73% vs 11%, p < 0.001).

CONCLUSION

Early use of exclusive breast milk in infants with uncomplicated gastroschisis is associated with similar outcomes compared to supplemental or exclusive formula. Patients who received supplemental or exclusive formula were unlikely to transition to exclusive breastfeeding by discharge.

LEVEL OF EVIDENCE

Level IIb (Individual Cohort Study).

Theoretical approaches in the development of interventions to promote breastfeeding: A scoping review

PROBLEM AND BACKGROUND

There is a low world rate of exclusive breastfeeding and a short duration of breastfeeding. More studies have constructed interventions to improve breastfeeding behavior, but the actual effect is not significant.

AIM

The purpose of this review is identifying the ways that various theories have an influence on theory-based breastfeeding intervention studies.

METHODS

A scoping review using Arksey and O'Malley's framework explored breastfeeding promotion practices. PubMed, The Cochrane Library, Web of Science, Embase, and CINAHL databases were searched from database creation to March 9, 2024. Building on previous research, key terms were used to search the literature. Data analysis involved descriptive and interpretive summaries of theories used and the proposed interventions.

FINDINGS

An online search yielded 906 articles, with 28 meeting the inclusion criteria for the scoping review, including 5 reviews and 23 articles. Reviews demonstrated that interventions based on theories were more effective. Articles promoting breastfeeding used theories of self-efficacy (n = 9), theory of planned behavior (n = 8), social cognitive theory (n = 5) and individual and family self-management theory (n = 1). These theories were used in developing specific content of the intervention program (n = 20, 86.9%), constructing the framework of the program (n = 10, 43.5%), and evaluating outcomes (n = 19, 82.6%). Most interventions focused on education, professional support, and/or peer support for breastfeeding.

CONCLUSION AND DISCUSSION

Theory can guide decisions and play a role in selecting a methodology or lens. Researchers should make deliberate choices in the use of a theory that relates to aspects of breastfeeding behavior. Future interventions based on theories should be more varied and effective and need to consider families' and social factors.

Efficacy and safety of a synbiotic infant formula for the prevention of respiratory and gastrointestinal infections: a randomized controlled trial

BACKGROUND

Early life nutrition is crucial for the development of the gut microbiota that, in turn, plays an essential role in the maturation of the immune system and the prevention of infections.

OBJECTIVES

The aim of this study was to investigate whether feeding synbiotic infants and follow-on formulas during the first year of life reduces the incidence rate (IR) of infectious diarrhea compared with standard formulas. Secondary endpoints included the IR of other infectious diseases as well as fecal milieu parameters.

METHODS

In this double-blind, controlled trial, 460 healthy, 1-mo-old infants were randomly assigned to receive a synbiotic [galacto-oligosaccharides (GOS)/Limosilactobacillus fermentum CECT 5716] (IF, n = 230) or a control formula (CF, n = 230) until 12 mo of age. A reference group of breastfed infants (HM, n = 80) was included. Data on infections were recorded throughout the study period and stool samples were collected at 4 and 12 mo of age.

RESULTS

IR of infectious diarrhea during the first year of life was 0.60 (CF), 0.56 (IF), and 0.29 (HM), with no statistically significant difference between groups. The IR of lower respiratory tract infections, 1 of the secondary endpoints, however, was lower in IF than in CF [0.79 compared with 1.01, IR ratio = 0.77 (0.60-1.00)]. Additionally, fecal pH was significantly lower at 4 mo (P < 0.0001), whereas secretory IgA was significantly higher at 12 mo of age (P = 0.015) in IF compared with CF.

CONCLUSIONS

Although no difference is observed in the incidence of diarrhea, consumption of a synbiotic formula containing L. fermentum CECT5716 and GOS in infancy may reduce the incidence of lower respiratory tract infections and affect the immune system and fecal milieu. Additional research is warranted to further investigate the potential interaction of the gut-lung axis. This trial was registered at clinicaltrials.gov as NCT02221687.

Breastfeeding's protective role in alleviating breast cancer burden: a comprehensive review

Breastfeeding, an essential aspect of infant care, has garnered recognition beyond its immediate health benefits, revealing a profound and lasting impact on women's health. Emerging research has unveiled a compelling relationship between breastfeeding and its enduring role in reducing the risk of ovarian cancer. This narrative review aims to comprehensively examine the lifelong impact of breastfeeding on ovarian cancer prevention, transcending infancy and delving into the mechanisms and implications for women's health. Epidemiological evidence consistently demonstrates an inverse association between breastfeeding and the risk of ovarian cancer. Prolonged durations of breastfeeding correlate with a significant reduction in the likelihood of developing ovarian malignancies, underscoring the protective influence of sustained lactation. The mechanisms underlying breastfeeding's impact on ovarian cancer prevention involve hormonal modulation and cellular changes. Breastfeeding contributes to reduced ovulatory cycles and oestrogen exposure, mitigating hormonal influences linked to ovarian cancer development. Moreover, the cellular alterations induced by breastfeeding within the ovarian microenvironment create an environment less conducive to malignant transformations. In conclusion, this paper consolidates evidence demonstrating breastfeeding's enduring impact on reducing ovarian cancer risk. It emphasizes the need for continued research, supportive interventions, and societal engagement to promote breastfeeding practices. Embracing breastfeeding not only provides immediate health benefits but also represents a formidable strategy in lifelong ovarian cancer prevention, offering a promising pathway towards enhanced women's health and well-being.

Bovine milk microbiota: Key players, origins, and potential contributions to early-life gut development

BACKGROUND

Bovine milk is a significant substitute for human breast milk and holds great importance in infant nutrition and health. Apart from essential nutrients, bovine milk also contains bioactive compounds, including a microbiota derived from milk itself rather than external sources of contamination.

AIM OF REVIEW

Recognizing the profound impact of bovine milk microorganisms on future generations, our review focuses on exploring their composition, origins, functions, and applications.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Some of the primary microorganisms found in bovine milk are also present in human milk. These microorganisms are likely transferred to the mammary gland through two pathways: the entero-mammary pathway and the rumen-mammary pathway. We also elucidated potential mechanisms by which milk microbiota contribute to infant intestinal development. The mechanisms include the enhancing of the intestinal microecological niche, promoting the maturation of immune system, strengthening the intestinal epithelial barrier function, and interacting with milk components (e.g., oligosaccharides) via cross-feeding effect. However, given the limited understanding of bovine milk microbiota, further studies are necessary to validate hypotheses regarding their origins and to explore their functions and potential applications in early intestinal development.

The Impact of Religious Beliefs on Early Lactation in Israeli Mothers

Objective: To explore the influence of religious beliefs and faith on breastfeeding initiation among mothers in Israel. Materials and Methods: The study, conducted from February 2022 to July 2023 at Bnai Zion Medical Center (located in Haifa district) and Laniado hospital (located in Netanya, Sharon plain), included mothers and their partners who voluntarily completed questionnaires. The survey, comprising 26 questions, delves into religion, faith, religiosity, and infant feeding approaches, while considering various socioeconomic and health-related factors. Results: Religious and secular mothers exhibited a higher inclination toward exclusive breastfeeding compared with the traditional mothers (p < 0.001). Notably, more maternal education years were associated with more exclusive breastfeeding (odds ratio [OR] 1.59; 95% confidence interval [CI] 1.09-2.32; p = 0.017). However, older age of youngest sibling (OR 0.56; 95% CI 0.32-0.98; p = 0.041), cesarean delivery (OR 0.64; 95% CI 0.44-0.94; p = 0.023), and no desire to breastfeed during pregnancy (OR 0.67; 95% CI 0.57-0.80; p < 0.001) emerged as significant factors decreasing exclusive breastfeeding. Conclusion: The study indicates that the level of religiosity and prenatal intention to breastfeed impact breastfeeding practices, along with maternal education, age of the youngest sibling, and delivery mode. These insights provide valuable guidance for initiatives aimed at boosting breastfeeding rates, particularly in sectors where rates are comparatively low.

The transgenerational effects of maternal low-protein diet during lactation on offspring

Environmental factors such as diet and lifestyle can influence the health of both mothers and offspring. However, its transgenerational transmission and underlying mechanisms remain largely unknown. Here, using a maternal lactation-period low-protein diet (LPD) mouse model, we show that maternal LPD during lactation causes decreased survival and stunted growth, significantly reduces ovulation and litter size, and alters the gut microbiome in the female LPD-F1 offspring. The transcriptome of LPD-F1 metaphase II (MII) oocytes shows that differentially expressed genes are enriched in female pregnancy and multiple metabolic processes. Moreover, maternal LPD causes early stunted growth and impairs metabolic health, which is transmitted over two generations. The methylome alteration of LPD-F1 oocytes can be partly transmitted to the F2 oocytes. Together, our results reveal that LPD during lactation transgenerationally affects offspring health, probably via oocyte epigenetic changes.

Isolation and Identification of Chicken-Derived Lactic Acid Bacteria: In Vitro Probiotic Properties and Antagonistic Effects against Salmonella pullorum, Staphylococcus aureus, and Escherichia coli

The development of probiotics capable of quickly colonizing the intestines of animals is important in promoting the healthy growth of livestock. The aim of this study was to screen lactic acid bacteria (LAB) from the intestinal microbiota of chickens with potential applications, and to evaluate their probiotic properties and antagonistic abilities against Salmonella pullorum, Staphylococcus aureus, and Escherichia coli. The results showed that a total of 79 strains with the characteristics of LAB were isolated from the chicken cecum microbiota, of which 7 strains exhibited strong inhibitory activity against S. pullorum, S. aureus, and E. coli. Performing 16s rDNA sequencing revealed that these seven strains were Lactiplantibacillus pentosus (n = 1), Lactiplantibacillus plantarum (n = 3), Lactiplantibacillus paraplantarum (n = 1), Lactiplantibacillus argentoratensis (n = 1), and Lactiplantibacillus fabifermentans (n = 1). Among them, L. pentosus R26 and L. plantarum R32 exhibited superior antibacterial activity. These two strains demonstrated high lactic acid production ability, with survival rates of 86.29% and 87.99% after 3 h of treatment at pH 1.5, 86.66% and 85.52% after 3 h of treatment with 0.5% bile salts, 90.03% and 88.16% after 2 h of treatment with simulated gastric fluid, and 98.92% and 98.22% after 2 h of treatment with simulated intestinal fluid, respectively. Co-cultivation with L. pentosus R26 for 24 h resulted in 50% of the pathogens being antagonized, while almost complete inhibition was observed following 72 h of co-cultivation. In conclusion, L. pentosus R26 and L. plantarum R32 exhibited high antibacterial activity and acid production capability, while also demonstrating satisfactory tolerance to low pH values and high concentrations of bile salts and digestive fluid. The probiotic characteristics and stress resistance of L. pentosus R26 were slightly superior to those of L. plantarum R32, indicating its potential for development as a probiotic.

Exploring the profound link: Breastfeeding's impact on alleviating the burden of breast cancer - A review

Breastfeeding has emerged as a critical factor in understanding and potentially mitigating the risk of breast cancer among women. This review delves into the intricate relationship between breastfeeding and breast cancer, elucidating the biological mechanisms, protective effects, and broader implications for public health. Epidemiological evidence consistently demonstrates a correlation between breastfeeding and a reduced risk of breast cancer, with longer durations of lactation showing a dose-dependent decrease in risk. The biological nexus between breastfeeding and breast cancer involves hormonal changes and the elimination of potentially damaged cells, influencing breast tissue and potentially mitigating carcinogenesis. Moreover, breastfeeding appears to impact tumor subtypes and aggressiveness, particularly demonstrating associations with lower risks of hormone receptor-negative and certain aggressive breast cancer subtypes. Recognizing the significance of breastfeeding in reducing breast cancer risk has profound public health implications, necessitating comprehensive support, education, and policies to encourage and facilitate breastfeeding.

Recent Progress in Human Milk Oligosaccharides and Its Antiviral Efficacy

Gastrointestinal (GI)-associated viruses, including rotavirus (RV), norovirus (NV), and enterovirus, usually invade host cells, transmit, and mutate their genetic information, resulting in influenza-like symptoms, acute gastroenteritis, encephalitis, or even death. The unique structures of human milk oligosaccharides (HMOs) enable them to shape the gut microbial diversity and endogenous immune system of human infants. Growing evidence suggests that HMOs can enhance host resistance to GI-associated viruses but without a systematic summary to review the mechanism. The present review examines the lactose- and neutral-core HMOs and their antiviral effects in the host. The potential negative impacts of enterovirus 71 (EV-A71) and other GI viruses on children are extensive and include neurological sequelae, neurodevelopmental retardation, and cognitive decline. However, the differences in the binding affinity of HMOs for GI viruses are vast. Hence, elucidating the mechanisms and positive effects of HMOs against different viruses may facilitate the development of novel HMO derived oligosaccharides.

Transcriptomic Changes and Regulatory Networks Associated with Resistance to Mastitis in Xinjiang Brown Cattle

Xinjiang brown cattle are highly resistant to disease and tolerant of roughage feeding. The identification of genes regulating mastitis resistance in Xinjiang brown cattle is a novel means of genetic improvement. In this study, the blood levels of IL-1β, IL-6, IL-10, TNF-α, and TGF-β in Xinjiang brown cattle with high and low somatic cell counts (SCCs) were investigated, showing that cytokine levels were higher in cattle with high SCCs. The peripheral blood transcriptomic profiles of healthy and mastitis-affected cattle were constructed by RNA-seq. Differential expression analysis identified 1632 differentially expressed mRNAs (DE-mRNAs), 1757 differentially expressed lncRNAs (DE-lncRNAs), and 23 differentially expressed circRNAs (DE-circRNAs), which were found to be enriched in key pathways such as PI3K/Akt, focal adhesion, and ECM-receptor interactions. Finally, ceRNA interaction networks were constructed using the differentially expressed genes and ceRNAs. It was found that keynote genes or mRNAs were also enriched in pathways such as PI3K-Akt, cholinergic synapses, cell adhesion molecules, ion binding, cytokine receptor activity, and peptide receptor activity, suggesting that the key genes and ncRNAs in the network may play an important role in the regulation of bovine mastitis.

Lactation induction for transgender women and transfeminine people in health care: a scoping review

There are countless proven benefits of breastfeeding, and the demand for such a right in health for transfeminine people is rarely addressed in the literature, reinforcing inequities in health. The article aims to conduct a scoping review of lactation induction for transfeminine people in the health care context. Systematic literature review in six selected databases, looking for articles with terms related to lactation and transfeminine people. Data were extracted and analyzed, summarizing the main results in tables. Three hundred ninety articles were found. After the exclusion of the duplicates there was a selection by title/abstract and a following selection by the full reading of the remaining articles, considering the pre-determined exclusion and inclusion criteria. Twenty-one articles were included, published between 2018 and 2023. Among them, six are case reports with unprecedented information on the topic, and the others are publications in various formats. Lactation induction was achieved in all the case reports. There is a fragile and recent body of evidence affirming the success of lactation induction in transgender women. There is a necessity to support this demand by health professionals and robust studies to optimize necessary interventions.

Microbiome: Mammalian milk microbiomes: sources of diversity, potential functions, and future research directions

Graphical abstract

Abstract

Milk is an ancient, fundamental mammalian adaptation that provides nutrition and biochemical communication to offspring. Microbiomes have been detected in milk of all species studied to date. In this review, we discuss: (a) routes by which microbes may enter milk; (b) evidence for proposed milk microbiome adaptive functions; (c) variation in milk microbiomes across mammals; and (d) future research directions, including suggestions for how to address outstanding questions on the viability and functionality of milk microbiomes. Milk microbes may be sourced from the maternal gastrointestinal tract, oral, skin, and mammary gland microbiomes and from neonatal oral and skin microbiomes. Given the variety of microbial sources, stochastic processes strongly influence milk microbiome assembly, but milk microbiomes appear to be influenced by maternal evolutionary history, diet, environment, and milk nutrients. Milk microbes have been proposed to colonize the neonatal intestinal tract and produce gene and metabolic products that influence physiology, metabolism, and immune system development. Limited epidemiological data indicate that early-life exposure to milk microbes can result in positive, long-term health outcomes. Milk microbiomes can be modified by dietary changes including providing the mother with probiotics and prebiotics. Milk replacers (i.e. infant formula) may benefit from supplementation with probiotics and prebiotics, but data are lacking on probiotics' usefulness, and supplementation should be evidence based. Overall, milk microbiome literature outside of human and model systems is scarce. We highlight the need for mechanistic studies in model species paired with comparative studies across mammals to further our understanding of mammalian milk microbiome evolution. A broader study of milk microbiomes has the potential to inform animal care with relevance to ex situ endangered species.

Lay summary

Milk is an ancient adaptation that supports the growth and development of mammalian neonates and infants. Beyond its fundamental nutritional function, milk influences all aspects of neonatal development, especially immune function. All kinds of milks so far studied have contained a milk microbiome. In this review, we focus on what is known about the collection of bacterial members found in milk microbiomes. Milk microbiomes include members sourced from maternal and infant microbiomes and they appear to be influenced by maternal evolutionary history, diet, milk nutrients, and environment, as well as by random chance. Once a neonate begins nursing, microbes from milk colonize their gut and produce byproducts that influence their physiology, metabolism, and immune development. Empirical data on milk microbiomes outside of humans and model systems are sparse. Greater study of milk microbiomes across mammals will expand our understanding of mammalian evolution and improve the health of animals under human care.

Exploring Health Providers' Perspective Regarding the Needs of Adolescent Mothers During Breastfeeding: A Qualitative Study

Background

The prevalence of breastfeeding is less common among adolescent mothers than adult mothers. These mothers experience various issues during breastfeeding. The present study aimed to explore the normative needs of adolescent mothers during breastfeeding from health care providers' perspective.

Methods

This qualitative content analysis study was conducted from October 2022 until June 2023. 14 health care providers who had worked in the field of breast milk were purposefully selected with maximum variation. Face-to-face semi-structured interviews were conducted and sampling continued until data saturation. Data analysis was performed using Graneheim and Lundman's method with MAXQDA software version 10.

Results

The main concepts obtained from the data were classified into one theme entitled, "comprehensive support", and seven categories including "need to correct wrong traditional beliefs", "educational and counseling needs", "providing quality services", "need for psychological support", "need for protective laws", "financial needs", and "the need for social network support".

Conclusion

Adolescent mothers in Iran have various needs during breastfeeding, and they require the assistance of their families, healthcare providers, and the government to fulfill them. Therefore, it is also recommended that policymakers in the health system should design policies to accommodate the requirements of this group of mothers. In addition to policy development in the health system, the infrastructure required for policy and law to be executed should be considered.

Microbiological risk assessment and resistome analysis from shotgun metagenomics of bovine colostrum microbiome

Colostrum is known for its nutraceutical qualities, probiotic attributes, and health benefits. The aim of this study was to profile colostrum microbiome from bovine in rural sites of a developing country. The focus was on microbiological safety assessments and antimicrobial resistance, taking into account the risks linked with the consumption of raw colostrum. Shotgun sequencing was employed to analyze microbiome in raw buffalo and cow colostrum. Alpha and beta diversity analyses revealed increased inter and intra-variability within colostrum samples' microbiome from both livestock species. The colostrum microbiome was mainly comprised of bacteria, with over 90% abundance, whereas fungi and viruses were found in minor abundance. Known probiotic species, such as Leuconostoc mesenteroides, Lactococcus lactis, Streptococcus thermophilus, and Lactobacillus paracasei, were found in the colostrum samples. A relatively higher number of pathogenic and opportunistic pathogenic bacteria were identified in colostrum from both animals, including clinically significant bacteria like Clostridium botulinum, Pseudomonas aeruginosa, Escherichia coli, and Listeria monocytogenes. Binning retrieved 11 high-quality metagenome-assembled genomes (MAGs), with three MAGs potentially representing novel species from the genera Psychrobacter and Pantoea. Notably, 175 antimicrobial resistance genes (ARGs) and variants were detected, with 55 of them common to both buffalo and cow colostrum metagenomes. These ARGs confer resistance against aminoglycoside, fluoroquinolone, tetracycline, sulfonamide, and peptide antibiotics. In conclusion, this study describes a thorough overview of microbial communities in buffalo and cow colostrum samples. It emphasizes the importance of hygienic processing and pasteurization in minimizing the potential transmission of harmful microorganisms linked to the consumption of colostrum.

Unlocking the Potential: A Systematic Literature Review on the Impact of Donor Human Milk on Infant Health Outcomes

Human mother milk is considered the most healthy and best source of nutrition for both premature and full-term infants, as it possesses many health benefits and is associated with its consumption. Some of the mothers are not able to produce an adequate quantity of milk to meet the required needs of the infants, particularly in cases involving premature births or facing challenges in breastfeeding. Especially for the most vulnerable premature infants, donor human milk (DHM) provides a helpful bridge for effective breastfeeding. Even with the advancement in baby formulas, no other dietary source can match the bioactive matrix of benefits found in human breast milk. This literature review discusses the risks associated with prematurity and explores the use of DHM in the care of premature infants. It helps prevent substantial preterm complications, especially necrotizing enterocolitis, bronchopulmonary dysplasia, and late-onset sepsis, which are more commonly seen in infants who are given formulated milk made from cow's milk. It gives insights into the benefits of DHM, such as immunological and nutritional benefits, which is a basic infant's need. When medical distress prevents mothers from producing enough breast milk for their infants, pasteurized human donor breast milk should be made accessible as an alternative feeding option to ensure infants remain healthy and nourished. A systematic literature search was conducted using PubMed and Google Scholar databases and other sources. A total of 104 articles were searched, of which 35 were included after identification, filters were applied, eligibility was checked, and references out of scope were excluded. Human milk banking should be incorporated into programs encouraging breastfeeding, highlighting lactation in mothers and only using DHM when required.

Trace elements in commercially available infant formulas in Iran: Determination and estimation of health risks

Infants are significantly more vulnerable to trace elements from their foods. The objective of the present study was to ascertain the concentrations of some trace elements namely; arsenic, cadmium, chromium, copper, nickel and lead in infant formulas sold in Iran and to estimate the potential health risks to the infants through consumption of these products. The mean concentrations of As, Cd, Cr, Cu, Ni and Pb in infant formula samples were 0.006, 0.040, 0.3980, 2.014, 0.166 and 0.285 mg/kg, respectively. The mean levels of the trace elements were in the following order: Cu > Cr > Pb > Ni > Cd > As. For arsenic, cadmium and copper, calculated EWIs (estimated weekly intakes) were within the PTWIs (provisional tolerated weekly intakes) recommended by FAO/WHO. For chromium, nickel and lead, the calculated EWIs were higher than the PTWIs in 88.8 %, 75 %, and 61.1 % of the formulas. HQs of Pb, Cu, Cd and As were above the safe limits, indicating health concerns from the consumption of some infant formulas. Based on the CR classification, CR values of some elements including Cd, Cr and Ni were above 1 × 10-4 in some brands, indicating that exposure to these elements from infant formulas may cause health risks. Therefore, regular monitoring of all the raw materials, stages of production and storage of infant formulas is essential to limit the exposure of this vulnerable age group to toxic trace elements.

Human milk microbiome: associations with maternal diet and infant growth

Introduction

Ingestion of human milk (HM) is identified as a significant factor associated with early infant gut microbial colonization, which has been associated with infant health and development. Maternal diet has been associated with the HM microbiome (HMM). However, a few studies have explored the associations among maternal diet, HMM, and infant growth during the first 6 months of lactation.

Methods

For this cross-sectional study, Mam-Mayan mother-infant dyads (n = 64) were recruited from 8 rural communities in the Western Highlands of Guatemala at two stages of lactation: early (6-46 days postpartum, n = 29) or late (109-184 days postpartum, n = 35). Recruited mothers had vaginally delivered singleton births, had no subclinical mastitis or antibiotic treatments, and breastfed their infants. Data collected at both stages of lactation included two 24-h recalls, milk samples, and infant growth status indicators: head-circumference-for-age-z-score (HCAZ), length-for-age-z-score (LAZ), and weight-for-age-z-score (WAZ). Infants were divided into subgroups: normal weight (WAZ ≥ -1SD) and mildly underweight (WAZ < -1SD), non-stunted (LAZ ≥ -1.5SD) and mildly stunted (LAZ < -1.5SD), and normal head-circumference (HCAZ ≥ -1SD) and smaller head-circumference (HCAZ < -1SD). HMM was identified using 16S rRNA gene sequencing; amplicon analysis was performed with the high-resolution ANCHOR pipeline, and DESeq2 identified the differentially abundant (DA) HMM at the species-level between infant growth groups (FDR < 0.05) in both early and late lactation.

Results

Using both cluster and univariate analyses, we identified (a) positive correlations between infant growth clusters and maternal dietary clusters, (b) both positive and negative associations among maternal macronutrient and micronutrient intakes with the HMM at the species level and (c) distinct correlations between HMM DA taxa with maternal nutrient intakes and infant z-scores that differed between breast-fed infants experiencing growth faltering and normal growth in early and late lactation.

Conclusion

Collectively, these findings provide important evidence of the potential influence of maternal diet on the early-life growth of breastfed infants via modulation of the HMM.

An optimized culturomics strategy for isolation of human milk microbiota

Viable microorganisms and a diverse microbial ecosystem found in human milk play a crucial role in promoting healthy immune system and shaping the microbial community in the infant's gut. Culturomics is a method to obtain a comprehensive repertoire of human milk microbiota. However, culturomics is an onerous procedure, and needs expertise, making it difficult to be widely implemented. Currently, there is no efficient and feasible culturomics method specifically designed for human milk microbiota yet. Therefore, the aim of this study was to develop a more efficient and feasible culturomics method specifically designed for human milk microbiota. We obtained fresh samples of human milk from healthy Chinese mothers and conducted a 27-day enrichment process using blood culture bottles. Bacterial isolates were harvested at different time intervals and cultured on four different types of media. Using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) analysis, we identified a total of 6601 colonies and successfully obtained 865 strains, representing 4 phyla, 21 genera, and 54 species. By combining CBA and MRS media, we were able to cultivate over 94.4% of bacterial species with high diversity, including species-specific microorganisms. Prolonged pre-incubation in blood culture bottles significantly increased the number of bacterial species by about 33% and improved the isolation efficiency of beneficial bacteria with low abundance in human milk. After optimization, we reduced the pre-incubation time in blood culture bottles and selected optimal picking time-points (0, 3, and 6 days) at 37°C. By testing 6601 colonies using MALDI-TOF MS, we estimated that this new protocol could obtain more than 90% of bacterial species, reducing the workload by 57.0%. In conclusion, our new culturomics strategy, which involves the combination of CBA and MRS media, extended pre-incubation enrichment, and optimized picking time-points, is a feasible method for studying the human milk microbiota. This protocol significantly improves the efficiency of culturomics and allows for the establishment of a comprehensive repertoire of bacterial species and strains in human milk.

Analysis of risk factors leading to multiple breast abscesses during lactation

We investigated 1805 cases of breast abscesses during lactation to estimate the risk factors for multiple breast abscesses during lactation. A total of 2000 cases of breast abscesses during lactation were investigated using an online questionnaire, and 1805 cases with complete data were analyzed. The survey response rate was 90%. According to the number of abscesses, the patients were divided into 2 groups: single breast abscess (number = 1298) and multiple breast abscess (number = 507). Pearson chi-square test was used to compare the 15 risk factors between the 2 groups. Risk factors with significant differences were substituted into a binary logistic regression model to analyze the independent risk factors associated with multiple breast abscesses during lactation. There were significant differences between the 2 groups in (1) weeks postpartum, (2) separated from the baby, (3) breastfeeding exclusivity, (4) nipple inversion, (5) fever, (6) breast redness/swelling, (7) nipple pain, (8) breast massage by nonmedical staff, with (1), (5), (6), and (8) being independent risk factors. Patients under 6 weeks postpartum, separated from the baby, not exclusively breastfeeding, having an inverted nipple on the affected side, fever, breast skin redness and swelling on the affected side, nipple pain, and having undergone a breast massage by nonmedical staff are more likely to develop multiple breast abscesses.

The gut-lung axis and asthma susceptibility in early life

Asthma is the most common chronic disease among children, with more than 300 million cases worldwide. Over the past several decades, asthma incidence has grown, and epidemiological studies identify the modernized lifestyle as playing a strong contributing role in this phenomenon. In particular, lifestyle factors that modify the maternal gut microbiome during pregnancy, or the infant microbiome in early life, can act as developmental programming events which determine health or disease susceptibility later in life. Microbial colonization of the gut begins at birth, and factors such as delivery mode, breastfeeding, diet, antibiotic use, and exposure to environmental bacteria influence the development of the infant microbiome. Colonization of the gut microbiome is crucial for proper immune system development and disruptions to this process can predispose a child to asthma development. Here, we describe the importance of early-life events for shaping immune responses along the gut-lung axis and why they may provide a window of opportunity for asthma prevention.

Clinical significance and main parameters promoting the breast‑feeding strategy (Review)

Breastfeeding provides numerous nutritional and immunological benefits, promotes neurological and cognitive development, and protects against chronic and infectious diseases, rendering it beneficial to the survival and well-being of infants. According to international recommendations, infants should be exclusively breastfed for the first 6 months. However, despite global health recommendations and funding initiatives, exclusive breastfeeding rates remain low worldwide. A number of studies attribute the low rates to factors that can be grouped into demographic, psychosocial, economic and midwifery factors, and outline the profile of each mother who opts to exclusively breastfeed her infant. In addition, the number of previous pregnancies, induced labor, the use of epidurals at birth or the possibility of the newborn being delivered prematurely, and the need for admission to an intensive care unit are the factors that reduce the likelihood of exclusive breastfeeding. Further research is required to understand the factors influencing the initiation and maintenance of exclusive breastfeeding, as international interventions have been ineffective. The aim of the present review was to provide an up-to-date summary of these various factors in an aim to assist health care professionals and policy makers in developing effective interventions with which to promote and support exclusive breastfeeding.

Enhancing immune regulation in vitro: the synergistic impact of 3'-sialyllactose and osteopontin in a nutrient blend following influenza virus infection

Natural components of breast milk, human milk oligosaccharides (HMOs) and osteopontin (OPN) have been shown to have a variety of functional activities and are widely used in infant formulas. However, the preventive and therapeutic effects of both on influenza viruses are not known. In this study, antiviral assays using a human laryngeal carcinoma cell line (HEP-2) showed that 3'-sialyllactose (3'-SL) and OPN had the best antiviral ability with IC50 values of 33.46 μM and 1.65 μM, respectively. 3'-SL (10 μM) and OPN (4 μM) were used in combination to achieve 75% inhibition. Further studies found that the combination of 200 μg/mL of 3'-SL with 500 μg/mL of OPN exerted the best antiviral ability. The reason for this was related to reduced levels of the cytokines TNF-α, IL-6, and iNOS in relation to mRNA expression. Plaque assay and TCID50 assay found the same results and verified synergistic effects. Our research indicates that a combination of 3'-SL and OPN can effectively reduce inflammatory storms and exhibit anti-influenza virus effects through synergistic action.

The Effect of Oral Iron Supplementation/Fortification on the Gut Microbiota in Infancy: A Systematic Review and Meta-Analysis

(1) Background: Iron is an essential metal for the proper growth and neurodevelopment of infants. To prevent and treat iron deficiency, iron supplementation or fortification is often required. It has been shown, though, that it affects the synthesis of gut microbiota. (2) Methods: This paper is a systematic review and meta-analysis of the effect of oral iron supplementation/fortification on the gut microbiota in infancy. Studies in healthy neonates and infants who received per os iron with existing data on gut microbiota were included. Three databases were searched: PUBMED, Scopus, and Google Scholar. Randomized controlled trials (RCTs) were included. Quality appraisal was assessed using the ROB2Tool. (3) Results: A total of six RCTs met inclusion criteria for a systematic review, and four of them were included in the meta-analysis using both the fixed and random effects methods. Our results showed that there is very good heterogeneity in the iron group (I2 = 62%), and excellent heterogeneity in the non-iron group (I2 = 98%). According to the meta-analysis outcomes, there is a 10.3% (95% CI: -15.0--5.55%) reduction in the bifidobacteria population in the iron group and a -2.96% reduction for the non-iron group. There is a confirmed difference (p = 0.02) in the aggregated outcomes between iron and non-iron supplement, indicative that the bifidobacteria population is reduced when iron supplementation is given (total reduction 6.37%, 95%CI: 10.16-25.8%). (4) Conclusions: The abundance of bifidobacteria decreases when iron supplementation or fortification is given to infants.

Hierarchical Predictors of Mortality in Neonatal Sepsis at Jimma Medical Center, Ethiopia: A Case-Control Study

Background

Neonatal sepsis made the neonatal period the most perilous time for child survival, and it continued to cause preventable mortalities worldwide. These mortalities stem from the interaction of several factors that have not been sufficiently studied and, in some cases, remain overlooked. Thus, the study aims to investigate the predictors of mortality that arise from the interaction of these factors and quantitatively determine their etiologic fraction.

Methods

A case-control study with hierarchical data input was conducted at Jimma Medical Center (JMC) in Oromia, Ethiopia, spanning from May 2022 to July 2023. It employed logistic regression to calculate adjusted odds ratios (AORs) and their corresponding 95% confidence intervals (CI) at a significance level of p ≤ 0.05. The model adjusted odds ratios (ORs) for variables within each level and farther levels and presented an etiologic fraction (EF), indicating the proportion of neonatal mortality attributable to specific factors.

Results

The analysis of 67 cases and 268 controls unveiled significant predictors of mortality in sepsis that emerged from distal, intermediate, and proximal levels. In the final model, thus, rural residence [AOR 3.1; 95% CI (1.5, 6.3), p ≤ 0.01], prolonged labor [AOR 4.5; 95% CI (2.2, 9.3), p ≤ 0.01], prematurity [AOR 3.9; 95% CI (1.9, 7.9), P ≤ 0.0], gram-negative bacteremia [AOR 3.8; 95% CI (1.9, 7.6); P ≤ 0.01], convulsion [AOR 3.2; 95% CI (1.6, 6.4); P ≤ 0.03], low birth weight [AOR 2.7; 95% CI (1.3, 5.4); P≤0.01], and delayed breastfeeding [AOR 2.5; 95% CI (1.2, 4.9); P ≤ 0.01] attributed a variable percentage of mortality.

Conclusion

Factors emerging and interacting at distal (residence), intermediate (prolonged labor), and proximal (prematurity, birth weight, convulsion, bacterial etiology, and feeding) levels influence neonatal mortality in sepsis at JMC. Therefore, concurrently improving rural family characteristics, managing labor duration, strengthening diagnostic stewardship, and promoting essential newborn care can actively prevent and reduce these mortalities.

Complement in breast milk modifies offspring gut microbiota to promote infant health

Breastfeeding offers demonstrable benefits to newborns and infants by providing nourishment and immune protection and by shaping the gut commensal microbiota. Although it has been appreciated for decades that breast milk contains complement components, the physiological relevance of complement in breast milk remains undefined. Here, we demonstrate that weanling mice fostered by complement-deficient dams rapidly succumb when exposed to murine pathogen Citrobacter rodentium (CR), whereas pups fostered on complement-containing milk from wild-type dams can tolerate CR challenge. The complement components in breast milk were shown to directly lyse specific members of gram-positive gut commensal microbiota via a C1-dependent, antibody-independent mechanism, resulting in the deposition of the membrane attack complex and subsequent bacterial lysis. By selectively eliminating members of the commensal gut community, complement components from breast milk shape neonate and infant gut microbial composition to be protective against environmental pathogens such as CR.

Diet-gut microbiome interaction and ferulic acid bioavailability: implications on neurodegenerative disorders

PURPOSE OF THE REVIEW

Ferulic acid (FA), which occurs naturally as the feruloylated sugar ester in grains, fruits, and vegetables, is critical for combating oxidative stress and alleviating neurodegenerative diseases resulting from free radical-generated protein aggregates in brain cells. However, FA cannot be absorbed in conjugated form. Therefore, strategies to improve the bioavailability of FA are gaining more importance. Ferulic acid esterases (FAE) of the gut microbiota are critical enzymes that facilitate FA release from feruloylated sugar ester conjugates and influence systemic health. This review provides insight into a nutrition-based approach to preventing neurodegenerative disorders such as Alzheimer's and Parkinson's by altering the diversity of FAE-producing gut microbiota.

RECENT FINDINGS

The human gut is a niche for a highly dense microbial population. Nutrient components and the quality of food shape the gut microbiota. Microbiota-diet-host interaction primarily involves an array of enzymes that hydrolyse complex polysaccharides and release covalently attached moieties, thereby increasing their bio-accessibility. Moreover, genes encoding polysaccharide degrading enzymes are substrate inducible, giving selective microorganisms a competitive advantage in scavenging nutrients. Nutraceutical therapy using specific food components holds promise as a prophylactic agent and as an adjunctive treatment strategy in neurotherapeutics, as it results in upregulation of polysaccharide utilisation loci containing fae genes in the gut microbiota, thereby increasing the release of FA and other antioxidant molecules and combat neurodegenerative processes.

Alterations in the gut microbiota of toddlers with cow milk protein allergy treated with a partially hydrolyzed formula containing synbiotics: A nonrandomized controlled interventional study

Formulas containing intact cow milk protein are appropriate alternatives when human milk (HM) is not feasible. However, for babies with a physician-diagnosed cow milk protein allergy (CMPA), hydrolyzed formulas are needed. We conducted a 3-month, open-label, nonrandomized concurrent controlled trial (ChiCTR2100046909) between June 2021 and October 2022 in Qingdao City, China. In this study, CMPA toddlers were fed with a partially hydrolyzed formula containing synbiotics (pHF, n = 43) and compared with healthy toddlers fed a regular intact protein formula (IF, n = 45) or HM (n = 21). The primary endpoint was weight gain; the secondary endpoints were changes in body length and head circumference of both CMPA and healthy toddlers after 3-month feeding; and the exploratory outcomes were changes in gut microbiota composition. After 3 months, there were no significant group differences for length-for-age, weight-for-age, or head circumference-for-age Z scores. In the gut microbiota, pHF feeding increased its richness and diversity, similar to those of IF-fed and HM-fed healthy toddlers. Compared with healthy toddlers, the toddlers with CMPA showed an increased abundance of phylum Bacteroidota, Firmicutes, class Clostridia, and Bacteroidia, and a decreased abundance of class Negativicutes, while pHF feeding partly eliminated these original differences. Moreover, pHF feeding increased the abundance of short-chain fatty acid producers. Our data suggested that this pHF partly simulated the beneficial effects of HM and shifted the gut microbiota of toddlers with CMPA toward that of healthy individuals. In conclusion, this synbiotic-containing pHF might be an appropriate alternative for toddlers with CMPA.

Rat microbial biogeography and age-dependent lactic acid bacteria in healthy lungs

The laboratory rat emerges as a useful tool for studying the interaction between the host and its microbiome. To advance principles relevant to the human microbiome, we systematically investigated and defined the multitissue microbial biogeography of healthy Fischer 344 rats across their lifespan. Microbial community profiling data were extracted and integrated with host transcriptomic data from the Sequencing Quality Control consortium. Unsupervised machine learning, correlation, taxonomic diversity and abundance analyses were performed to determine and characterize the rat microbial biogeography and identify four intertissue microbial heterogeneity patterns (P1-P4). We found that the 11 body habitats harbored a greater diversity of microbes than previously suspected. Lactic acid bacteria (LAB) abundance progressively declined in lungs from breastfed newborn to adolescence/adult, and was below detectable levels in elderly rats. Bioinformatics analyses indicate that the abundance of LAB may be modulated by the lung-immune axis. The presence and levels of LAB in lungs were further evaluated by PCR in two validation datasets. The lung, testes, thymus, kidney, adrenal and muscle niches were found to have age-dependent alterations in microbial abundance. The 357 microbial signatures were positively correlated with host genes in cell proliferation (P1), DNA damage repair (P2) and DNA transcription (P3). Our study established a link between the metabolic properties of LAB with lung microbiota maturation and development. Breastfeeding and environmental exposure influence microbiome composition and host health and longevity. The inferred rat microbial biogeography and pattern-specific microbial signatures could be useful for microbiome therapeutic approaches to human health and life quality enhancement.

Human Milk-Derived Enterococcus faecalis HM20: A Potential Alternative Agent of Antimicrobial Effect against Methicillin-Resistant Staphylococcus aureus (MRSA)

The increasing global impact of skin diseases, fueled by methicillin-resistant Staphylococcus aureus (MRSA), emphasizes the necessity for alternative therapies with lower toxicity, such as lactic acid bacteria (LAB). This study aims to isolate potential LAB from human milk and evaluate their efficacy against MRSA using various methods, including well diffusion, microdilution, crystal violet assay, enzymatic characterization, SDS-PAGE, and scanning electron microscopy (SEM). Among the 26 LAB screened, the human milk-derived strain HM20 exhibited significant antimicrobial activity against S. aureus CCARM 3089 (MRSA), which is a highly resistant skin pathogen. Through 16S rRNA sequencing, strain HM20 was identified as closely related to Enterococcus faecalis ATCC 19433T, which was subsequently designated as Enterococcus faecalis HM20. The minimum inhibitory concentration (MIC) of the cell-free supernatant (CFS) of HM20 against S. aureus KCTC 3881 and S. aureus CCARM 3089 was determined to be 6.25% and 12.5%, respectively. Furthermore, the effective inhibition of biofilm formation in S. aureus KCTC 3881 and S. aureus CCARM 3089 was observed at concentrations of 12.5% and 25% or higher, respectively. The antibacterial effect of the CFS was attributed to the presence of organic acids, hydrogen peroxide, and bacteriocins. Additionally, the antimicrobial peptides produced by HM20 were found to be stable under heat treatment and analyzed to have a size below 5 kDa. SEM image observations confirmed that the CFS of HM20 caused damage to the cell wall, forming pores and wrinkles on S. aureus KCTC 3881 and S. aureus CCARM 3089. This comprehensive investigation on strain HM20 conducted in this study provides foundational data for potential developments in functional materials aimed at addressing skin infections and antibiotic-resistant strains in the future.

The Association between Term Chorioamnionitis during Labor and Long-Term Infectious Morbidity of the Offspring

Background: Chorioamnionitis during labor exposes the fetus to an intrauterine state that may alter the future immune response and may expose the offspring to future susceptibility to infectious disease. We evaluated the long-term pediatric infectious morbidity of children born at term to mothers who have chorioamnionitis during labor. Methods: This was a population-based cohort analysis including only term singleton deliveries at a regional tertiary hospital between the years 1991 and 2021. Offspring to mothers with and without a diagnosis of chorioamnionitis during labor were compared. Offspring hospitalizations up to the age of 18 years involving infectious morbidity were evaluated using the Kaplan-Meier survival curve and a Cox regression model to control possible confounders. Results: A total of 331,598 deliveries were included, 988 (0.3%) of which were of mothers diagnosed with chorioamnionitis during labor. All infectious morbidity rates included in the analysis were comparable between groups. The Kaplan-Meier survival curves were similar for both groups (log-rank = 0.881) and the multivariable analysis ascertained that chorioamnionitis during labor was not a risk factor for offspring's long-term infectious morbidity (HR 0.929, 95%CI 0.818-1.054, p = 0.254). Conclusions: In our cohort, term chorioamnionitis during labor was not associated with a higher risk of pediatric hospitalization due to infections. The infectious/inflammatory state during labor did not expose nor increase the susceptibility of the term offspring to future infectious morbidity.

Changes in the Immunology of Breast Milk From Obese or Overweight Women: a Brief Review

A systematic search was carried out through search platforms and specialized databases, such as Academic Google, PubMed, and Scopus, using thesauri: breast feeding, obesity, immunology, and human milk in English and Spanish, and those articles published from January 2000 to December 2021, in both languages. Only those reports that included quantitative data on immunological components in the milk of normal-weight and overweight women were considered. The PRISMA 2020 guides were used, and a total of 306 articles were reviewed, of which a total of 33 were included, according to the basic inclusion criteria. It was observed that in obese mothers, there is an increase in certain immune cells, such as B lymphocytes, cytotoxic T lymphocytes, and NK cells, and cytokines, such as IL-6 and IFN-γ; other alterations included the bacterial population and proteins with antibacterial action. Also, a decrease in growth factors such as TGF-β and IFG-1 was documented in overweight women. Immunoglobulin concentrations did not show substantial changes. This brief review shows that maternal overweight is associated with changes in the biochemical and immunological parameters of milk.

Association Between Exclusive Breastfeeding and Acute Respiratory Infections Among Infants Under the Age of 6 Months

Introduction: Acute respiratory infection (ARI) is the leading cause of childhood morbidity and mortality. Exclusive breastfeeding is considered the cornerstone of child health; however, the rate of exclusive breastfeeding is suboptimal in low- and middle-income countries (LMICs). This study aimed to assess the association between exclusive breastfeeding and ARI among infants under the age of 6 months in a LMIC. Methods: A secondary analysis of the 2014 Egypt Demographic Health Survey data was conducted. Mothers of infants under the age of 6 months (n = 1,340) were included. The outcome of interest was ARI symptoms among infants, defined by mother's report of a cough accompanied by fast or difficult breathing in the 2 weeks preceding the survey. The exposure variable was exclusive breastfeeding, defined by giving infants only breast milk during the first 6 months of life. Descriptive statistics and multivariate regression were performed. Results: Forty-one percent of the infants were exclusively breastfed and 9% had ARI symptoms. Exclusive breastfeeding reduced the odds of ARI symptoms (adjusted odds ratio [AOR] = 0.450, 95% confidence interval [CI]: 0.243-0.832). Infants of mothers 20-34 years of age (AOR = 0.421, 95% CI: 0.217-0.817) and ≥35 years (AOR = 0.308, 95% CI: 0.123-0.767) at childbirth were less likely to have symptoms of an ARI when compared with adolescent mothers. The likelihood of having ARI symptoms was higher among infants 2-3 months of age (AOR = 2.437, 95% CI: 1.093-5.435), and 4-5 months (AOR = 2.888, 95% CI: 1.193-6.992) compared with infants less than 2 months. Conclusion: Exclusive breastfeeding was protective against ARI symptoms among under-6-month infants, independent of potential confounders.

Assessing multiple factors affecting the gut microbiome structure of very preterm infants

The composition and diversity of the gut microbiota are essential for the health and development of the immune system of infants. However, there is limited information on factors that influence the gut microbiota of very preterm infants. In this study, we analyzed factors that affect the gut microbiota of very preterm infants. The stool samples from 64 very preterm infants with a gestational age less than 32 weeks were collected for 16S rRNA gene sequencing. The infants were divided according to the delivery mode, antibiotic use during pregnancy, and feeding methods. The abundance of Proteobacteria was high in both cesarean (92.7%) and spontaneous (55.5%) delivery groups and then shifted to Firmicutes after the first week of birth. In addition, Proteobacteria was also the dominant phylum of infant gut microbiome for mothers with antibiotic use, with more than 50% after the first week of birth. In comparison, the dominant phylum for mothers without antibiotic use was Firmicutes. Proteobacteria level was also high in breastfeeding and mixed-feeding groups, consisting of more than 90% of the community. By contrast, Proteobacteria was the dominant phylum at the first week of birth but then shifted to Firmicutes for the formula-fed group. The alterations of gut microbiota in infants can affect their health condition during growth. This study confirmed that the different feeding types, delivery modes, and use of antibiotics during pregnancy can significantly affect the composition of the gut microbiota of very preterm infants.