Breast Milk Intake Research Articles

Description of breastfeeding on hyperbilirubinemia infants with light therapy in the perinatology room of Muhammadiyah Hospital Taman Puring

<p><strong><em>Background</em></strong><em>: Hyperbilirubinemia is a condition where excessive bilirubin builds up in the blood, causing yellowing of the skin, sclera, and nails. Hyperbilirubinemia is a common finding in newborns and will start appearing clinically in newborns when blood bilirubin levels are 5 – 7 mg/dl. hyperbilirubinemia can be caused by several factors, including gestational age, birth weight, blood type, breast milk intake, prematurity, and congenital diseases or disorders. </em></p><p><strong><em>Objectives</em></strong><em>: to describe how breastfeeding could help reduce bilirubin levels in infants with hyperbilirubinemia receiving light therapy in the Perinatology Room at Muhammadiyah Hospital Taman Puring. </em></p><p><strong><em>Methods</em></strong><em>: the research used a qualitative descriptive approach, collecting data through interviews, observations, and documentation</em>. <em>The inclusion criteria in this research are: hyperbilirubinemia infants with phototherapy, exclusive breastfeeding, no comorbidities and parents willing to have their infants become case study subjects.</em> <em>The study involved three infants aged 3-7 days with hyperbilirubinemia who were given breastfeeding and light therapy. </em></p><p><strong><em>Results</em></strong><em>: showed that infants who underwent light therapy for 24 to 48 hours, combined with breastfeeding tailored to their fluid needs based on body weight (169 ml/day for a 2700-gram baby, 320 ml/day for a 3200-gram baby, and 465 ml/day for a 3150-gram baby), experienced a significant reduction in bilirubin levels. </em></p><p><strong><em>Conclusions</em></strong><em>: breastfeeding and light therapy resulted in a notable decrease in serum bilirubin levels in hyperbilirubinemia infants. The study recommended that nurses promote exclusive breastfeeding and ensure the breastfeeding process was effective and met the infants’ needs to help lower bilirubin levels.</em></p>

Description of breastfeeding on hyperbilirubinemia infants with light therapy in the perinatology room of Muhammadiyah Hospital Taman Puring

<p><strong><em>Background</em></strong><em>: Hyperbilirubinemia is a condition where excessive bilirubin builds up in the blood, causing yellowing of the skin, sclera, and nails. Hyperbilirubinemia is a common finding in newborns and will start appearing clinically in newborns when blood bilirubin levels are 5 – 7 mg/dl. hyperbilirubinemia can be caused by several factors, including gestational age, birth weight, blood type, breast milk intake, prematurity, and congenital diseases or disorders. </em></p><p><strong><em>Objectives</em></strong><em>: to describe how breastfeeding could help reduce bilirubin levels in infants with hyperbilirubinemia receiving light therapy in the Perinatology Room at Muhammadiyah Hospital Taman Puring. </em></p><p><strong><em>Methods</em></strong><em>: the research used a qualitative descriptive approach, collecting data through interviews, observations, and documentation</em>. <em>The inclusion criteria in this research are: hyperbilirubinemia infants with phototherapy, exclusive breastfeeding, no comorbidities and parents willing to have their infants become case study subjects.</em> <em>The study involved three infants aged 3-7 days with hyperbilirubinemia who were given breastfeeding and light therapy. </em></p><p><strong><em>Results</em></strong><em>: showed that infants who underwent light therapy for 24 to 48 hours, combined with breastfeeding tailored to their fluid needs based on body weight (169 ml/day for a 2700-gram baby, 320 ml/day for a 3200-gram baby, and 465 ml/day for a 3150-gram baby), experienced a significant reduction in bilirubin levels. </em></p><p><strong><em>Conclusions</em></strong><em>: breastfeeding and light therapy resulted in a notable decrease in serum bilirubin levels in hyperbilirubinemia infants. The study recommended that nurses promote exclusive breastfeeding and ensure the breastfeeding process was effective and met the infants’ needs to help lower bilirubin levels.</em></p>

Coupling Pre- and Postnatal Infant Exposures with Physiologically Based Pharmacokinetic Modeling to Predict Cumulative Maternal Levetiracetam Exposure During Breastfeeding.

Although breastfeeding ensures optimal infant development and maternal health, mothers taking medications may abandon breastfeeding because of uncertainties regarding toxicity to infants. Current methods in predicting infant risk to maternal medication exposure do not account for breastfeeding-related variability or in utero exposure via the umbilical cord (UC). Previously, our workflow integrated variability in infant anatomy and physiology, breast milk intake volume, and drug concentrations in breast milk using physiologically based pharmacokinetic (PBPK) modeling. The upper area under the curve ratio (UAR) was then calculated to assess infant risk from maternal drug. Herein, we enhanced this workflow by coupling pre- and postnatal exposures to predict the overall levetiracetam exposure in breastfeeding infants. A published pediatric PBPK model of levetiracetam was used to simulate an infant population (n = 100). Daily infant doses were simulated using a weight-normalized milk intake model to calculate volumes ingested across age groups, alongside literature-derived or simulated milk concentrations across maternal doses to predict infant concentrations. Published UC concentrations were used to develop a cord-coupled neonatal model (CCM), which was integrated with the PBPK and milk intake models and evaluated by comparing observed and simulated infant blood concentrations using a 90% prediction interval (PI). UC concentration data from 14 mothers were used to develop the CCM. A total of 16 paired (known milk concentrations) and two unpaired (unknown milk concentrations) individual infant concentrations were identified for evaluating the model along with population values of 64 infants from two age groups (2-4 and 7-31days). The CCM improved the predictions overall compared with the original workflow, largely due to improvements for the youngest age group evaluated. Overall, 83% (10 of 12) of the individual infant plasma concentrations were successfully captured within the 90% PI for the paired, quantifiable (i.e. above the limit of quantification) evaluation datasets. After administration of a maternal dose of levetiracetam 2000mg, the calculated UAR ranged from 0.13 to 0.27 for the 95th percentile infants. To our knowledge, this is the first report to combine prenatal levetiracetam exposures from the UC and postnatal exposures from breastfeeding to predict overall infant drug exposure. The results indicate that infant exposure in infants aged 0-7 days may approach therapeutic levels of levetiracetam in the highest-risk infants (i.e. 95th percentile), with a low likelihood of adverse effects based on published clinical studies. This integrated modeling approach provides a more holistic analysis of neonatal exposures. It can be applied in future studies to derive the UAR of drugs administered during breastfeeding to identify infants at risk of potential toxicity.

The Effect of the 2023 Turkey-Syria Earthquakes on the Sixth-Month Breastfeeding Rate of Infants: A Single-Centre Cohort Study

Background: We investigated the effect of earthquakes on the six-month breast milk intake rate in infants. Methods: In this single-centre prospective cohort study, 35 mother-baby dyads who were in the earthquake zone during the February 6, 2023, Turkey-Syria earthquakes were included as the study group, while 29 mother-baby dyads who were not in the earthquake zone were included as the control group. The physical, environmental, and social characteristics of the settlements after the earthquake, along with the nutritional characteristics of the infants, were evaluated through questionnaires during interviews and online assessments. The Breastfeeding Self-Efficacy Form and the Edinburgh Postnatal Depression Scale were administered to the mothers, and their scores were calculated. Results: No significant difference was found between the exclusive breastfeeding rates at six months in the study and control groups [18 (62.9%) vs. 22 (61.9%), n (%), P = 0.95]. The breastfeeding self-efficacy score was significantly higher in the study group [64 (33 - 70) vs. 54 (31 - 70), median (min-max), P = 0.02]. Although the Edinburgh Postpartum Depression Scale (EPDS) score was higher in the control group [10 (0 - 21) vs. 7 (0 - 26), median (min-max)], this difference was not statistically significant. Conclusions: In general, earthquakes do not affect breastfeeding rates in infants at six months. The continuation of breastfeeding, supported by increased resilience in difficult conditions, enhances breastfeeding self-efficacy and provides protection for the mother-baby dyad. Breastfeeding should be continued and supported during natural disasters.

Toward Supplementation Guidelines for Vegan Complementary Feeding.

Previously published recommendations for vegetarian (including vegan) diets for children have highlighted the need for vitamin B12 supplementation. Increased attention to several other key nutrients (including iodine, vitamin D, calcium, and iron) has also been recommended. However, an overview focusing on supplementation guidelines, specifically for vegan infants, has not been published, and a potential requirement for iodine and/or selenium supplementation in (some) vegan infants has not been discussed. Vegan complementary feeding should be supplemented (particularly with 5 μg/day of vitamin B12 and 10 μg/day of vitamin D). Iodine should be supplemented (up to 110 μg/day) if the intake of breast milk and infant formula is low, and selenium supplementation (5 μg/day) should be considered in regions with low soil selenium levels. Caution is required to avoid excessive intakes of iodine and particularly selenium. Supplements for vegan infants are on the market, and observational studies are urgently needed to assess the nutrient intake (including supplements) and status in vegan infants.

Preterm infant attachment is independent of breast milk intake during neonatal care

Background Following preterm birth, breast milk feeding is recommended because it confers broad health benefits to preterm infants. Breast milk has been suggested to promote secure attachment in infancy, but this is uncertain. Elucidating the relationship between breast milk intake and infant attachment is crucial for supporting parents of preterm infants to make feeding choices and providing accurate counselling when breast milk is not available. We aimed to investigate if breast milk exposure during neonatal care associates with attachment outcomes derived from infants’ responses to the Still-Face Paradigm (SFP) at nine months of age. Methods We studied 77 preterm (< 33 weeks’ gestation) and 71 term infants. Preterm infant feeding data were collected from birth until hospital discharge. Infant responses to the SFP were videocoded at nine months corrected age. Infants’ distress, fretfulness, attentiveness to caregivers and attachment classification were compared between preterm infants who received exclusive breast milk for ≥ 75% of inpatient days, those who received exclusive breast milk for < 75% of inpatient days, and term infants. Milk intake thresholds were chosen based on our previous work demonstrating positive associations between breast milk intake and MRI markers of brain maturation. Results There were no significant differences in infant distress, fretfulness, attentiveness to caregivers (p-values > 0.19), or in the odds of secure versus insecure attachment classification (relative risk ratio = 0.57–0.89, p-values = 1.00) between preterm infants with high or low breast milk exposure, or term comparators. Conclusions Attachment outcomes at nine months were similar between term and preterm infants, and breast milk exposure did not associate with attachment in the preterm group. Although breast milk feeding has clear benefits, these findings may alleviate some of the pressures experienced by parents who are unable to provide breast milk for infants cared for in the neonatal unit.

Exposure and potential risks of thirteen endocrine- disrupting chemicals in pharmaceuticals and personal care products for breastfed infants in China

Ingestion of breast milk represents the primary exposure pathway for endocrine-disrupting chemicals (EDCs) in newborns. To elucidate the associated risks, it is essential to quantify EDC levels in both breast milk and infant urine. This study measured the concentrations of 13 EDCs, including parabens (methyl paraben (MP), ethyl paraben (EP), propyl paraben (PP), iso-propyl paraben, butyl paraben, and iso-butyl paraben), bisphenols (bisphenol A (BPA), bisphenol F, bisphenol S, bisphenol AF, and bisphenol Z), triclosan (TCS), and triclocarban, in breast milk and infant urine to assess their potential health effects and endocrine disruption risks. In total, 1 014 breast milk samples were collected from 20 cities across China, along with 144 breast milk samples and 134 urine samples from a mother-infant cohort in Hangzhou. The EDCs were detected using ultra-high-performance liquid chromatography-triple quadrupole mass spectrometry. Endocrine-disrupting potency was evaluated using a predictive method based on EDC affinity for 15 hormone receptor proteins. The toxicological priority index (ToxPi), incorporating population exposure data, was employed to assess health risks associated with exposure to multiple EDCs. Among the 13 EDCs, MP, EP, PP, BPA, and TCS were detected in over 50 % of breast milk samples, with the highest median concentrations observed for MP (0.37 ng/mL), EP (0.29 ng/mL), and BPA (0.17 ng/mL). Across the 20 cities, 0 %–40 % of infants had a hazard index (HI) exceeding 1. Based on affinity prediction analysis and estimated exposure, cumulative endocrine disruption risk intensity was ranked as MP > TCS > BPA > EP > PP. This research highlights the extensive exposure of Chinese infants to EDCs, offering a detailed analysis of their varying endocrine disruption potencies and underscoring the significant health risks associated with EDCs in breast milk.

Breast Milk and Necrotizing Enterocolitis in Congenital Heart Disease: A Case-Control Study.

Background: Necrotizing enterocolitis (NEC) is a complication that can affect infants with congenital heart disease (CHD). The objective of this study is to determine whether breast milk, which is associated with decreased incidence of NEC in preterm infants, is protective in infants with CHD. Methods: Retrospective case-control study of infants ≥ 33 weeks gestational age with CHD who underwent cardiac surgery during their admission to the Infant Cardiac Unit from 2008 to 2017. Cases were defined as infants with modified Bell's stage ≥ II NEC. Controls were matched by date of birth, gestational age, and pre- or postcardiac surgery feed initiation. Results: A total of 926 infants with gestational age ≥ 33 weeks and CHD were admitted; 18 cases of NEC were identified and compared with 84 controls. Breast milk intake was higher in controls, but this difference was not statistically significant. Single ventricle (SV) physiology was identified as an independent risk factor for NEC by multivariable analysis. Analysis of infants with SV physiology demonstrated that median age at time of surgery was 9 days (interquartile range [IQR], 7-12) in NEC cases and 5 days (IQR, 4-9) in controls (P = .02). Conclusions: While this study is inconclusive with regard to feeding composition and risk of NEC in infants with CHD, the trend toward greater intake of breast milk in the control group suggests that breast milk may be protective for these infants. Infants with SV physiology are at high risk for NEC. Earlier time to stage I palliation may be a modifiable risk factor for NEC.

Early-life exposure to per- and polyfluoroalkyl substances: Analysis of levels, health risk and binding abilities to transport proteins

Per- and polyfluoroalkyl substances (PFAS) can pass through the placenta and adversely affect fetal development. However, there is a lack of comparison of legacy and emerging PFAS levels among different biosamples in pregnant women and their offspring. This study, based on the Shanghai Maternal–Child Pairs Cohort, analyzed the concentrations of 16 PFAS in the maternal serum, cord serum, and breast milk samples from 1,076 mother-child pairs. The placental and breastfeeding transfer efficiencies of PFAS were determined in maternal-cord and maternal-milk pairs, respectively. The binding affinities of PFAS to five transporters were simulated using molecular docking. The results suggested that PFAS were frequently detected in different biosamples. The median concentration of perfluorooctane sulfonate (PFOS) was the highest at 8.85 ng/mL, followed by perfluorooctanoic acid (PFOA) at 7.13 ng/mL and 6:2 chlorinated polyfluorinated ether sulfonate at 5.59 ng/mL in maternal serum. The median concentrations of PFOA were highest in cord serum (4.23 ng/mL) and breast milk (1.08 ng/mL). PFAS demonstrated higher placental than breastfeeding transfer efficiencies. The transfer efficiencies and the binding affinities of most PFAS to proteins exhibited alkyl chain length-dependent patterns. Furthermore, we comprehensively assessed the estimated daily intakes (EDIs) of PFAS in breastfeeding infants of different age groups and used the hazard quotient (HQ) to characterize the potential health risk. EDIs decreased with infant age, and PFOS had higher HQs than PFOA. These findings highlight the significance of considering PFAS exposure, transfer mechanism, and health risks resulting from breast milk intake in early life.

Risk factors and outcomes of vitamin D deficiency in very preterm infants

BackgroundVitamin D is essential for bone health and immune system. Vitamin D deficiency (VDD) poses a high-risk to very preterm (VP) infants. This study aimed to evaluate the risk factors associated with VDD in VP infants and its potential clinical outcomes. MethodsA retrospective cohort study was conducted on VP infants admitted to the neonatal intensive care unit of a specialized tertiary hospital in Seoul, Republic of Korea, between January 2018 and June 2022. Serum 25-hydroxyvitamin D (25(OH)D) levels and other biochemical parameters were measured between 4 and 6 weeks of age. VDD was defined as a serum 25(OH)D level <20 ng/mL. Prenatal and postnatal risk factors and clinical outcomes were compared between the VDD and non-VDD groups. ResultsOf the 82 VP infants analyzed, 27 (32.9%) were diagnosed with VDD. The VDD group exhibited a significantly longer duration of parenteral nutrition (PN) compared to the non-VDD group (adjusted odds ratio [OR] = 1.12; 95% confidence interval [CI]: 1.008–1.245). Breast milk intake was lower in the VDD group than in the non-VDD group (adjusted OR = 0.976, 95% CI, 0.955–0.999). Notably, calcium levels were significantly lower in the VDD group, while parathyroid hormone levels were significantly higher, compared with the non-VDD group. Additionally, the rickets severity score was higher in the VDD group than in the non-VDD, although the difference was not statistically significant. ConclusionsProlonged PN duration and low breast milk intake significantly increased the risk of VDD in VP infants.

Education on the Importance of Breast Milk and Complementary Foods for Breast Milk (MPASI) as an Effort to Prevent Stunting

Stunting is a form of growth failure (growth faltering) due to the accumulation of nutritional deficiencies that last for a long time starting from pregnancy until the age of 24 months. Optimal nutritional intake for newborns by providing exclusive breast milk as the main food until the age of 6 months and then continuing until the age of 2 years accompanied by appropriate and high-quality complementary foods will prevent stunting in toddlers. One important effort to prevent stunting is by empowering the community, especially parents, to pay attention to the intake of breast milk and complementary foods for their babies. By providing knowledge to the public about the importance of correct breastfeeding and MPASI, it is hoped that the public can change their behavior to prioritize exclusive breastfeeding and correct MPASI. This community service method uses an educational approach through outreach with a total of 139 participants who live in five villages in Jatigede District, Sumedang Regency, West Java. Socialization involving experts gave results that there was an increase in participants' knowledge as measured using pre-test and post-test instruments. The percentage of participants who experienced an increase in knowledge from 139 participants, the results obtained were 118 participants (85%) experienced an increase in knowledge about breast milk and complementary foods, and 19 people (14%) had the same knowledge before and after socialization while 2 people (1%) gained The score decreased during the post-test due to several factors, including some participants who did not have time to complete the post-test questionnaire due to having to do other work

Evaluation of breastfeeding behaviors and complementary feeding practices of Turkish and Syrian refugee mothers.

Objectives: The purpose of this study was to compare breastfeeding and related factors (age, level of education, age at first pregnancy, etc.), and complementary feeding practices between Syrian refugee and native Turkish mothers. Material and methods: This descriptive-comparative study examined the nutritional characteristics of infants aged 9 to 60 months whose mothers were Turkish or Syrian refugees who attended Kızıltepe State Hospital between January 2022 and July 2022. Results: 204 mothers (126 Turkish and 78 Syrian) who had a child aged 9-60 months were included. The average age of the mothers was 27.60 ± 5.17 years for Turkish citizens and 28.91 ± 5.62 for Syrian refugees, without significant difference between the two groups (p: 0.091). Postpartum breastfeeding was 91.3% and breastfeeding duration was 12 (0-24) months in Turkish citizens; in Syrian refugees, breastfeeding was 84.6% and average breastfeeding time was 9 (0- 24) months (respectively, breast milk intake p: 0.144, uptake time p: 0.161; no statistical difference). Breastfeeding training was received by 23.8% of Turkish citizens and 5.1% of Syrian refugees; there was a significant difference between the two groups (p: 0.001). Conclusion: In refugee groups, infant and maternal nutrition practices are disrupted. Working in conjunction with local and international organizations and state agencies that give help to refugee groups, the appropriate interventions, initiatives, supports, and awareness-raising activities would strive to improve practices in mother and baby nutrition and narrow gaps.

Health risk assessments of heavy metals and trace elements exposure in the breast milk of lactating mothers in the Northeastern Iran.

Mother's breast milk is a natural and complete food for infants but can be a main source of exposure to toxic pollutants. These pollutants can negatively affect the health of the infant. Therefore, conducting biomonitoring surveys is essential to evaluate such health effects in toxicological research. This study aimed to estimate the probable health risks for infants exposed to essential and non-essential trace elements through breast milk ingestion. This descriptive-analytical, cross-sectional study was performed on 90 breastfeeding mothers referred to the health centers in Mashhad, Iran in January 2021. The health risk assessments (carcinogenic and non-carcinogenic risk) were estimated using chronic daily intake (CDI), hazard quotient (HQ), hazard index (HI), and lifetime carcinogenic risk (CR), which were recommended by the US Environmental Protection Agency (US EPA). The results of the HQ values of trace elements through ingestion exposure for arsenic (90%), copper (90%), zinc (40%), and iron (10%) exceeded the threshold of HQ, and arsenic (66.59%), copper (16.91%), and zinc (9.68%) and iron (4.57%) had the highest contribution to increasing the HI index. The average value of CR was 5. 08 × 10-3. Chromium and iron showed significant relationships (P<0.05) with education level and disease background in this study, and the concentration of chromium, iron, and zinc in the breast milk samples significantly changed during lactation stages (P<0.05). Overall, the risk of carcinogenicity through exposure to breast milk for infants was higher than the safety level of US EPA risk. Therefore, there could be a potential health risk of trace elements, particularly arsenic, copper, and zinc for infants in Mashhad, Iran through the consumption of mothers' breast milk. More efforts are required to control and reduce routes of receiving trace elements in breastfeeding mothers by the competent authorities.

Efektifitas Tindakan Frenektomy Pada Bayi Tongue Tie Dengan Kemampuan Menyusu

Tongue tie cases at the Columbia Asia Surgical Hospital in Semarang in the last two years have experienced an increase, where in 2021 there were 438 cases and in 2022 there were 447 cases. Tongue tie babies have a poor breastfeeding mechanism, this is caused by limited tongue movement, so tongue tie babies cannot attach properly when breastfeeding. These conditions result in the maximum intake of breast milk not being obtained and the mother feeling uncomfortable due to sore nipples which can cause premature cessation of breastfeeding. This study aims to analyze the effectiveness of frenectomy in tongue tie babies with breastfeeding ability. This research is a type of quasi-experimental research with a one group pretest-posttest design. The population in this study were tongue-tie babies without complications who were still being hospitalized at the Columbia Asia Surgical Hospital in Semarang. Using a purposive sampling technique, a sample of 30 babies was obtained. The instruments used in this study were LATCH and ATLFF scores. Data analysis was performed using univariate analysis and bivariate analysis. The results of the study showed that the Frenectomy procedure was effective in increasing the ability to suckle in tongue tie babies, the Wilcoxon test results were obtained (pvalue 0.000 &lt;0.05), where all (100%) tongue tie babies experienced an increase in the ability to suckle after a frenectomy. The action of a frenectomy is effective in increasing the ability to suckle, this can be due to the fact that with a frenectomy the mobility of the tongue increases, so that the baby can latch on properly, can swallow milk well, the mother feels comfortable while breastfeeding because the nipples are not painful.

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

BackgroundEnteral feeding is an essential part of the management of infants with gastroschisis. We hypothesized that exclusive breast milk is associated with improved neonatal outcomes. MethodsWe 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. ResultsWe 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). ConclusionEarly 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 EvidenceLevel IIb (Individual Cohort Study).

Evaluation of Maternal Risk Factors for Neonatal Hypernatremic Dehydration: A Systematic Review.

Neonatal hypernatremic dehydration (NHD) is a severe condition associated with neonatal morbidity and mortality. The present study evaluated maternal risk factors, including duration of maternal hospitalisation, primiparity, caesarean section, and pregnancy complications, as well as social factors, such as depression, fatigue, and inadequate support for NHD. PubMed, Cochrane Library, International Scientific Indexing, Scopus, and Google Scholar were the databases searched until 2023. Articles written in English or Persian focusing on the relationship between maternal risk factors and NHD among neonates and providing sufficient information on NHD were included in this study. On the other hand, articles whose abstracts were only available were excluded. The extracted data were presented in Excel software with the following titles: authors' names, year, type of study, study location, and maternal risk factors. The methodological quality of the articles was determined using the quality assurance tool for the diagnostic accuracy score (QUADAS). Of the 58 searched articles, 16 were investigated, which included five prospective, seven cross-sectional, and four retrospective articles. Maternal risk factors for NHD included labour and delivery complications, childbirth complications, factors causing insufficient breast milk intake (including breast milk insufficiency, nipple problems, wrong breastfeeding techniques, breast disorders, types of feeding, and breastfeeding training/counselling in pregnancy), as well as delivery and the postpartum period. Maternal problems in pregnancy and delivery, breast disorders, breastfeeding status, maternal knowledge, and lactation skills are the most common maternal risk factors for NHD. Timely (antenatal) identification and proper management of maternal risk factors help reduce the incidence and severity of NHD complications.

Maternal Ezetimibe Concentrations Measured in Breast Milk and Its Use in Breastfeeding Infant Exposure Predictions.

Lactating mothers taking ezetimibe, an antihyperlipidemic agent, may be hesitant to breastfeed despite the known benefit of breastfeeding to both mother and infant. Currently, no data exist on the presence or concentration of ezetimibe and its main active metabolite, ezetimibe-glucuronide (EZE-glucuronide), in human breast milk. Voluntary breast milk samples containing ezetimibe and EZE-glucuronide were attained from lactating mothers taking ezetimibe as part of their treatment. An assay was developed and validated to measure ezetimibe and EZE-glucuronide concentrations in breast milk. A workflow that utilized a developed and evaluated pediatric physiologically based pharmacokinetic (PBPK) model, the measured concentrations in milk, and weight-normalized breast milk intake volumes was applied to predict infant exposures and determine the upper area under the curve ratio (UAR). Fifteen breast milk samples from two maternal-infant pairs were collected. The developed liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay showed an analytical range of 0.039-5.0 ng/mL and 0.39-50.0 ng/mL for ezetimibe and EZE-glucuronide, respectively. The measured concentrations in the breast milk samples were 0.17-1.02 ng/mL and 0.42-2.65 ng/mL of ezetimibe and EZE-glucuronide, respectively. The evaluated pediatric PBPK model demonstrated minimal exposure overlap in adult therapeutic dose and breastfed infant simulated area under the concentration-time curve from time zero to 24h (AUC24). Calculated UAR across infant age groups ranged from 0.0015 to 0.0026. PBPK model-predicted ezetimibe and EZE-glucuronide exposures and UAR suggest that breastfeeding infants would receive non-therapeutic exposures. Future work should involve a 'mother-infant pair study' to ascertain breastfed infant plasma ezetimibe and EZE-glucuronide concentrations to confirm the findings of this work.

The effect of in-hospital breast milk intake on the gut microbiota of preterm infants

The aim of this study was to explore the effect of in-hospital breast milk intake on the development of early gut microbiota in preterm infants in two dimensions: longitudinal over time and cross-sectional between groups. Researchers collected preterm infants' general data baseline characteristics, recorded their daily breast milk intake, probiotics, and antibiotics use, and collected their stool specimens at 1st week, 2ndweek, 3rd week and 4th week after birth. The researchers analyzed the effect of breast milk on gut microbiota of preterm infants by bioinformatics methods of intra-group longitudinal variation of gut microbiota structure and diversity in preterm infants and cross-sectional differences between >70% in-hospital breast milk intake (BM) group and ≤70% (PF) group. A total of 60 preterm infants were included in this study, and a total of 213 stool specimens were retained. BM had statistically different Shannon and Simpson indices between the first and fourth week after admission (P<0.05), both of them showed a lower diversity in the later week than in the previous week. The Shannon index and Simpson index of BM from week 3 onwards were statistically different from PF (P<0.05), and the Shannon index and Simpson index of BM were lower than those of PF. Significantly statistical differences (P<0.05) were found in the beta diversity of gut microbiota in preterm infants as time progressed, and both showed a lower beta diversity in the later week than in the preceding week. The dominant taxa of PF in the first postnatal week were Bifidobacterium animalis, etc., the dominant taxa of BM in the third postnatal week were Clostridium_sensu_stricto _1, etc. CONCLUSIONS: The development and evolution of gut microbiota in preterm infants' in-hospital period was a continuous, non-random process, and similar trends in species composition and changes in gut microbes emerged in preterm infants with different ratio of breast milk intake. In the NICU setting, alpha diversity was lower in preterm infants in the >70% breast milk intake group than in the ≤70% group when compared between groups at the same time, which may be related to delayed maturation of gut microbes and represents a more developmental gut time window.

Effect of breast milk intake volume on early behavioral neurodevelopment of extremely preterm infants

BackgroundThis study aimed to explore the effects of breast milk feeding volume on the early behavioral neurodevelopment of extremely preterm infants (gestational age < 28 weeks).MethodsThe study was conducted from 1 January 2021 to 31 March 2023. A total of 187 preterm infants from a neonatal intensive care unit (NICU) in a Grade III Class A hospital in Zhejiang, China, were divided based on the proportion of breast milk in their total enteral nutrition: high proportion (≥ 80%, including exclusive breast milk feeding), medium proportion (20% ~ < 80%), and low proportion (< 20%). The study investigated motor performance and behavioral neurodevelopment at 37 weeks of corrected gestational age, as well as the total incidence of intracranial hemorrhage within the first four weeks postpartum.ResultsThe low breast milk feeding group had significantly lower scores in infant motor performance (31.34 ± 5.85) and elicited item scores (19.89 ± 5.55) compared to the medium and high groups (33.52 ± 4.33, 22.13 ± 4.22; and 35.86 ± 5.27, 23.91 ± 4.98), p < 0.05, respectively. Despite no significant difference in behavioral ability, the low proportion group exhibited lower passive muscle tension and primitive reflex scores than the medium and high proportion groups. The high proportion group showed higher active muscle tension scores. Ultrasound results revealed varying incidences of intracranial hemorrhage: 72.9% in low, 52.5% in medium, and 19.6% in the high proportion groups.ConclusionsMedium to high levels of breast milk feeding contribute positively to motor and behavioral neurological development in extremely preterm infants and decrease the likelihood of ventricular hemorrhage. However, it does not have a significant effect on the development of behavioral abilities. Due to the limited sample size, the next step will be to expand the sample size and further investigate the extent of the impact on various aspects of the nervous system.

Investigation of Breast Milk Use in Early Childhood and Its Psychobiochemical Effects

Aim: The periods in which the infant is fed only by breast-feeding (food: breast milk), and the period in which the infant can stay in contact with breast milk (nutrient: breast milk + food X) maximum by breast-feeding, and KSS score distributions in these periods were investigated. Material and Methods: In the research; Individuals between the ages of 18-25 were asked questions about the early childhood-infancy periods, to determine the duration of breast milk intake and breastfeeding, and the distribution of the scores they received was examined by applying the KSS. The Cronbach Alpha coefficient (0.723) was calculated to determine the Turkish validity and reliability of the Kerns Secure Scale. The data were collected digitally, and the minimum sample size was determined as 176 people with the G*Power (v3.1.9.7) program. In the research, data belonging to 209 people were studied, and SPSS 26 statistical program was used to determine the data. p