Breast Milk Sodium Research Articles

High-precision micro-total analysis of sodium ions in breast milk

Measuring sodium ion concentration in breast milk can provide crucial health information for both mother and infant, including early signs of low-grade infection and reduced milk supply. Traditional sensing methods are slow, bulky, expensive, and require skilled operators. Here, we develop a coverslip-sized, high-precision lab-on-a-chip device that processes and detects sodium ions in human breast milk. The device uses micro-electrodialysis to extract sodium ions into a simple acceptor solution with 92 ± 3 % efficiency and employs a graphene ion-selective sensor for high-performance quantification. We demonstrate a straightforward calibration strategy, enabling the device to measure breast-milk sodium ion levels in 141 seconds, with accuracy comparable to inductively coupled plasma mass spectrometry. Our approach offers a promising pathway to efficient, point-of-care diagnosis of conditions associated with metal-ion levels in complex liquid-biopsy samples.

Determination of sodium, chlorine, and bromine concentrations in breast milk using neutron activation: Correlation, regression, and machine learning predictions

Breast milk plays a vital role in infant health, providing essential nutrients that directly impact nutrition and development. Understanding its elemental composition, as well as the relationships among these elements, is crucial for assessing its nutritional adequacy. This study focused on determining the concentrations of sodium (Na), chlorine (Cl), and bromine (Br) in the breast milk of lactating mothers in Tehran, Iran, during early lactation. The primary objectives were to analyze the concentrations of these elements, investigate their interrelationships, and employ machine-learning techniques to predict their concentrations in breast milk. Neutron activation analysis (NAA) was used to precisely measure the levels of Na, Cl, and Br, while statistical methods, including correlation and regression analyses, were applied to further explore these relationships. Machine-learning models, specifically Random Forest and Linear Regression, were utilized to predict the concentrations of these elements based on their interdependencies. The study revealed mean concentrations of 5.12 mg/g for Na, 8.14 mg/g for Cl, and 11.84 mg/kg for Br in the breast milk samples. A strong positive correlation was observed between Na and Cl (r = 0.976, p < 0.001), while moderate positive correlations were found between Na and Br (r = 0.558, p < 0.001) and Cl and Br (r = 0.606, p < 0.001). Multiple regression models showed that 94.7 % of the variance in Na concentration could be explained by Cl and Br levels (R-squared = 0.947), with a strong positive association between Cl and Na, and a slight inverse relationship between Br and Na. A similar model for Cl concentrations showed strong predictive power, with Na being a significant predictor. However, the model for Br concentrations explained a smaller proportion of variance (R-squared = 0.318), suggesting that additional factors influencing Br levels were not captured in this study. Furthermore, multicollinearity was observed between Na and Cl (VIF = 20.675), indicating potential interactions between these elements. This study highlights the significant correlations between Na, Cl, and Br in breast milk, with particularly strong predictive models for Na and Cl concentrations. The findings also suggest the need for further investigation into the factors affecting Br concentrations. Overall, this research provides valuable insights into the elemental composition of breast milk and its implications for infant nutrition and health.

Correlation between Mothers Breast Milk Sodium and Baby's Serum Sodium and Renal Functions across Seasons

Correlation between Mothers Breast Milk Sodium and Baby's Serum Sodium and Renal Functions across Seasons

Breastfeeding associated hypernatraemia: clinical presentations, complications and outcome in a subset of Sudanese neonates.

A descriptive cross-sectional hospital-based study was conducted with the objectives to study clinical presentations, complications and outcomes of breastfeeding-associated hypernatraemia (BFAHN) in full-term neonates admitted to Ibrahim Malik Teaching Hospital, Khartoum, Sudan, during the period September 2017-2019. Eighty-four neonates with BFAHN were enrolled in the study. Collected demographic data of the neonates and their mothers included age at presentation, gender, birth weight, current weight, mode and place of delivery, maternal age, parity, education level, time of starting breastfeeding, presenting symptoms and signs, complications and outcome. The prevalence of the BFAHN was 15.5%. The mean age at presentation was 9.38 ± 5.95 days, range of 2-27 days and 59.5% were males. Most of them delivered vaginally (85.7%) and in hospital (63.1%). The mothers were multigravida in 58% and with a mean age of 28.14 ± 6.68 years and 3/4th of them started breastfeeding within the first hour. The most common symptoms and signs were fever, poor feeding, decreased urine output, jaundice, dehydration and loss of weight more than 10% of birth weight. The mortality rate was 21.4%. Complications included acute kidney injury in 82.1%, two patients needed peritoneal dialysis, one-third developed convulsions and two patients had intracranial bleeding. Factors associated with the development of the BFAHN were excessive loss of weight, multigravida, low maternal education level and vaginal delivery. Associated factors for death included thrombocytopenia, convulsions and severe hypernatraemia. Breast-milk sodium levels in mothers of 10 of the patients were high compared to 10 controls.

The relationship between prenatal attachment and postnatal adaptation, maternal anxiety and breast milk sodium level

ObjectiveTo investigate the relationship between maternal-fetal attachment and breast milk sodium (BMS) levels. MethodsThis prospective case-control study was conducted at Baskent University. Third-trimester low-risk pregnancies were included in the study. After obtaining informed consent, the Prenatal Attachment Inventory (PAI), and the State-Trait Anxiety Inventory 1 (STAI 1) and STAI 2 were administered. After delivery, BMS values were measured at regular intervals. ResultsThe mean age of the mothers and the mean gestational age were 29.6 ± 3.4 years and 38.4 ± 0.9 weeks, respectively. The mean STAI -1, STAI-2, and PAI scores were 38.2 ± 7.1, 38.8 ± 6.9, and 41.6 ± 10, respectively. When the study group was classified according to BMS levels, no differences were observed between the groups in terms of pregnancy STAI-1, pregnancy STAI-2, Muller PAI, and STAI-1 scores of the 5th, 15th, and 30th days. There was no correlation between the BMS levels on the 5th −15th days and pregnancy STAI-1, Pregnancy STAI-2, Muller PAI, and the STAI-1 scores of the 5th-10th-30th days. However, the BMS level on the 30th day had a positive significant correlation with the STAI-1 score on the 15th day (r = 0.473, p= .006). Additionally, the STAI-1 scores on the 30th day showed that there was a significant correlation with STAI-1 on the 5th day (r = 0.416, p= .015), STAI-1 on the 15th day (r = 0.497, p= .003), and breast milk sodium levels on the 30th day (r = 0.615, p< .001). ConclusionWe found no relationship between PAI scores and BMS levels on the 5th-10th-30th day but STAI scores on the 15th day and 30th day had a positive correlation with BMS levels on the 30th day. STAI-1 and STAI-2 scores during pregnancy were positively correlated with STAI scores in the postnatal period.

The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production

Previous studies focusing on the association between gestational diabetes and breastfeeding duration have been inconclusive. We aimed to determine whether maternal gestational hyperglycemia is associated with the duration of breastfeeding and the concentrations of markers linked to breastmilk production. Data from the prospective, multiethnic Growing Up in Singapore Towards Healthy Outcomes study were used to assess the association of fasting plasma glucose (FPG) and 2-h postglucose challenge (2hPG) measured at 26-28 wk of gestation with duration of breastfeeding and concentrations of protein, lactose, citrate, sodium, potassium, and zinc in breastmilk 3 wk postpartum. Of the 1035 participants, 5.2% and 9.5% had elevated FPG and 2hPG, respectively, consistent with a diagnosis of gestational diabetes mellitus based on International Association of Diabetes and Pregnancy Study Groups criteria. FPG≥5.1 mmol/L was associated with a crude reduction in median breastfeeding duration of 2.3 mo. In a model adjusted for maternal prepregnancy BMI and intention to breastfeed, FPG≥5.1 mmol/L predicted earlier termination of any breastfeeding (adjusted HR: 1.47; 95% CI: 1.04, 2.08) but not full breastfeeding (adjusted HR: 1.08; 0.76, 1.55). 2hPG≥8.5 mmol/L was not significantly associated with the durations of any (adjusted HR: 0.86; 95% CI: 0.62, 1.19) or full (adjusted HR: 0.85; 95% CI: 0.62, 1.18) breastfeeding. Maternal FPG was significantly and positively associated with breastmilk sodium (adjusted coefficient: 1.28; 95% CI: 1.08, 1.51) and sodium-to-potassium ratio (adjusted coefficient: 1.29; 95% CI: 1.08, 1.54) but not with other measured breastmilk components. Women with FPG≥5.1 mmol/L during pregnancy breastfeed for a shorter duration. Future work involving measurement of milk production is needed to determine whether low milk production predicts breastfeeding duration among women with elevated FPG. This trial was registered at www.clinicaltrials.gov as NCT01174875.

Hypernatremic Dehydration Risk Factors in Newborns: Prospective Case-Controlled Study.

The prevalence of hypernatremic dehydration (HND) has increased in recent years most likely due to insufficient intake of breast milk as the most important factor. This study aimed to investigate risk factors of HND. In this study, 47 neonates whom were diagnosed to have HND were included in the study group and 96 healty neonates whom were included in the control group. While demographic data of the patients were recorded, mothers were asked to fill out the sociodemographic/ psychosocial data form, Edinburgh Postpartum Depression Scale(EPDS) and STAI I and II State and Trait Anxiety Scale. Breast milk sodium concentrations were studied from mothers of all infants. The relationship between the development of neonatal HND and risk factors affecting this condition were evaluated. Being the first-born baby of the family was found to be a significant risk factor for HND. Breast milk sodium concentration was 25.8±7.9 mmol/L in the HND group which was significantly higher than the control group. Median depression score was similar in both groups and there was no statistical difference in terms of groups. The anxiety score was higher in the control group compared to the study group. There was no difference in terms of other sociodemographic / psychosocial data of mothers. Primiparity or insufficient breastfeeding may result in elevated breast milk sodium levels and related neonatal HND. Breastfeeding support should principally target primiparous women to improve breastfeeding outcomes like as especially HND.

Relationship of Maternal and Neonatal Variables With Breastmilk Sodium

To determine breastmilk sodium changes in the first 72 hours after birth and to correlate maternal and neonatal variables with maternal breastmilk sodium. We enrolled 245 mothers and their exclusively breast-fed neonates in this prospective cohort study. Singleton, inborn babies of greater than 34 weeks gestation, who were exclusively breastfed for the first 72 hours were included. Babies who required neonatal intensive care unit (NICU) admission, top up feeds or discharged before 72 hours were excluded. Study outcomes were changes in breast milk sodium in the first 72 hours and association of high maternal breast milk sodium with various maternal and neonatal variables. Mean (SD) breastmilk sodium steadily declined over the first 72 hours [53.5 (19.2), 38.5 (19.0) and 22.2 (10.6) mmol/L at 24, 48, 72 hours, respectively]. Breastfeeding £8 times per 24 hours in the first three days was the only factor significantly associated with high breastmilk sodium (P=0.008). Maternal age, gravida, mode of delivery, significant neonatal weight loss, hypernatremia, neonatal morbidities like fever, irritability, lethargy and poor suck had no significant correlation with high breastmilk sodium. Breastmilk sodium shows a steady decline in the first 72 hours after delivery. Feeding ≤8 times per day is associated high breastmilk sodium at 72 hours of age.

Profile and pattern of infants with mothers having lactation failure

Background: Breastfeeding mothers face various kinds of problems to breastfeeding. Literature on the frequency and outcome of perceived breast milk insufficiency in mothers of hospitalized neonates in India is patchy and scanty.Methods: Neonates weighing 1000 grams or more, and their mothers willing to breastfeed formed the study population. Relevant history was taken and clinical examination was performed along with anthropometry of the baby at the time of enrolment in the study. Mothers of neonates were also interviewed. Breast milk was also analyzed for sodium level by ion selective electrophoresis. Weight, head circumference and height were measured at each visit.Results: Of total 285 mothers, 188 mothers (65.9%) said that their milk formation was not sufficient and remaining 97 mothers said that their milk formation was sufficient to fulfil the needs of newborn. Breast milk sodium level was &gt;16 mmol/L in 142 (75.5%) mothers in the crisis group as compared to 21 (21.6%) in the non crisis group. Babies in the crisis group weighed significantly less at admission as well as discharge. The proportion of sick babies, use of bottles/pacifiers and pre lacteal feeds was significantly higher in the crisis group. The velocity of growth of neonates after discharge in both the groups was comparable.Conclusions: Lactation failure was more common among those mothers who were involved in delayed initiation of breastfeeding. Structured counselling sessions with reinforcement on lactation support were proved to be useful to mitigate the situation.

The relationship between hypernatremia and breast milk sodium levels in newborns with hypernatremic dehydration

Objectives: Breast-feeding with high sodium content milk may cause hypernatremic dehydration in neonates (NHD). The number of cases with NHD tends to increase particularly in the higher temperature seasons. In this prospective case-control study, the relationship between NHD and breast milk sodium (Na) levels and demographic features of NHD were investigated during the summer season. Methods: The study included term newborns admitted to the neonatal intensive care unit of our hospital with the diagnosis of hypernatremic dehydration between June 2009 and October 2009. Serum sodium level ≥ 150mEq/L was accepted as hypernatremia. Among 109 NHD patients, breast milk sodium level was evaluated in 50 cases. Term infants without hypernatremic dehydration were taken as the control group (50 cases). Results: Postnatal age at admission ranged between 2 and 12 days and mean serum Na concentration was 152 mEq/L (150-173 mEq/L). A significant weight loss of &amp;gt;10% was determined in 85% of cases. Breast milk Na was significantly higher in the hypernatremic group (24.3 ± 20.3 mEq/L) compared to the control group (12.6 ± 6.79 mEq/L) (p &amp;lt; 0.001). In primiparous mothers, the mean breast milk Na level was statistically higher than that of multipara mothers (21.16 ± 19.9 mEq/L vs 15.48 ± 9.96 mEq/L, p &amp;lt; 0.016). Conclusions: In this study, we demonstrated that high breast milk sodium level was closely related with NHD and being a primiparous mother appeared as a significant factor for high breast milk sodium content. In this respect, all pregnant women especially primiparous should be educated about infant nutrition and neonatal dehydration. Health care providers should emphasize importance of frequent milking and more fluid intake, especially in summer.

Energy supply nutrients and mineral composition analysis in breast milk in Lanzhou urban

Objective To analyze the energy supply nutrients (protein, fat and lactose) and mineral elements (calcium, copper, iron, zinc, magnesium, sodium, potassium) supplied in breast milk from the resident of Lanzhou, and investigate the problems of those energy supply nutrients and mineral elements in breast milk of this population so that to provide basis for breast feeding. Methods Breast milk from 1 215 mothers whose babies were fed totally by the breast milk and grew well was collected and assayed for the contents of protein, fat, lactose, calcium, copper, iron, zinc, magnesium, sodium and potassium in Lanzhou region. The optimal range for breast feeding was set by normal distribution method. The results were compared with the breast milk from other internal region in order to clarify the contents difference. Results The prevalence of mother-milk-fed in this region was 48.5%. The normal ranges (unit: g/100 g) of fat, lactose and protein were 1.57-5.11, 6.58-7.16 and 0.79-1.35, and the normal ranges of calcium, copper, iron, zinc, magnesium, sodium and potassium were 5.25-7.83 mmol/L, 5.66-8.28 mmol/L, 0.14-0.3 mmol/L, 15-64.48 μmol/L, 0.98-1.62 mmol/L, 1.92-18.82 mmol/L, 7.95~17.31 mmol/L in the high quality breast milk. Compared with the other internal region, the normal ranges of the protein, fat and lactose in Lanzhou were lower. The contents of protein, fat, lactose, calories, calcium, copper, zinc and sodium in the breast milk from the whole investigated population were significantly lower compared with breast milk of high quality (P<0.01). Conclusion The quality of breast milk in Lanzhou is not so good. The contents of various nutrients in breast milk should be improved to a proper level by appropriate ways so that to improve the growth and development of the baby. Key words: Breast milk; Protein; Fat; Lactose; Constant trace element

Inadequate Breastfeeding may lead to Severe Hypernatremia: A Case Report

Background: The benefits of breast feeding are well established worldwide. Inadequate breastfeeding may result in severe complications such as hypernatremic dehydration. This condition is rare and not well known. In this case report, we describe a case of severe hypernatremic dehydration revealed by fever with delayed consultation. Presentation of case: We report the case of an exclusively breastfed male newborn. He was referred on the 13th day of life because of lethargy and fever. He had a severe dehydration on clinical examination. Serum sodium was of 172 mmol/L. The breast milk sodium was high as compared to a volunteer control (85 mmol/L vs 19 mmol/L). Breastfeeding was temporarily suspended and reintroduced after 5 days with favorable evolution. Conclusion: Breast feeding associated hypernatremia can cause life-threatening complications in newborns. Prevention requires frequent and sufficient breastfeeding and weight gain monitoring during the first days of life.

Do mothers with high sodium levels in their breast milk have high depression and anxiety scores?

ObjectiveThis study aimed to assess the possible association of high breast milk sodium levels with postpartum depression and anxiety.MethodsA total of 150 mothers and their healthy, exclusively breastfed newborns aged 8 to 15 days were recruited. Mothers were asked to complete scales for evaluation of postnatal depression and anxiety following an interview for consent and sociodemographic data collection. Breast milk samples were obtained to measure sodium and potassium (K) levels.ResultsForty-nine mothers had higher than expected breast milk Na concentrations and a high Na/K ratio. These mothers scored significantly higher on the scales of postnatal depression and state anxiety (P = 0.018 and P = 0.048, respectively).ConclusionsThis study shows that compared to normal breast milk Na levels and Na/K ratio, high breast milk Na and high Na/K ratio, with possible serious consequences in infants, are associated with maternal depressive and anxious symptoms in the postpartum period.

Too salty: biochemical markers to validate maternal concern of breastmilk supply

Early concern over low milk supply is a significant predictor of early cessation of breastfeeding. Thus, identifying at-risk mother-infant dyads by eliciting these concerns at early postpartum visits may allow for interventions to prevent breastfeeding cessation. However, maternal concerns may represent either appropriate perception of suboptimal milk production or a misperception of suboptimal milk production in the setting of normal lactation. An objective, biochemical marker that distinguishes between these two would aid the clinician in identifying those at highest risk for failure—those with concern for low milk supply and truly suboptimal milk production. In this volume of The Journal, Murase et al demonstrate that an elevated ratio of breast milk sodium to potassium (Na:K) is found more commonly in mothers expressing milk supply concern. Used in this way, the elevated breast milk Na:K could be used to validate maternal concerns and coordinate appropriate support. Furthermore, an elevated Na:K at day 7 was assocated with a ~20% incidence of stopped breastfeeding at 60 days, irrespective of early maternal concerns. Thus, in addition to validating maternal concerns, this simple biochemical measure made at day 7 could help clinicians identify the mothers at highest risk of stopping breast feeding whether they have concerns or not. Clearly, the maturation of breast milk over the first week of life as dictated by the changes in mammary gene expression is dynamic and variable among breastfeeding mothers. This reports shows that Na:K is an objective measure of milk maturation, and a potential screening tool to target those who may benefit from interventions aimed at optimizing breastfeeding success. Article page 294 ▶ The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply ConcernThe Journal of PediatricsVol. 181PreviewWe report that, among exclusively breastfeeding mothers at day 7 postpartum, those with milk supply concerns were significantly more likely to exhibit biochemical evidence of less progress toward mature lactation (elevated ratio of breast milk sodium to potassium concentration). Furthermore, an elevated ratio of breast milk sodium to potassium concentration was predictive of early weaning. Full-Text PDF

Hypernatremia in the Neonate: Neonatal Hypernatremia and Hypernatremic Dehydration in Neonates Receiving Exclusive Breastfeeding.

Aims and Objectives:Evaluation of neonatal hypernatremia and hypernatremic dehydration in neonates receiving exclusive breastfeeding.Introduction:Neonatal hypernatremia is a serious condition in the newborn period. We present infants with hypernatremic dehydration due to breast milk (BM) hypernatremia. Hypernatremic dehydration in breast-fed newborns is usually secondary to insufficient lactation. We present the neonatal hypernatremia and hypernatremic dehydration encountered between January and December, 2012, its causes and treatment.Methodology:This was a retrospective study. We analyzed records of babies admitted to the Neonatal Intensive Care Unit who were investigated and found to have hypernatremia and whose mother's BM sodium (BM Na) was done.Inclusion Criteria:(1) Babies with serum Na >145 meq/l, (2) euglycemia, (3) normocalcemic, (4) no clinical and lab evidence of sepsis, (5) exclusive breast feeds.Exclusion Criteria:Neonates not satisfying any mentioned criterion.Results:BM Na correlated strongly with neonatal hypernatremia in exclusively breast-fed babies who did not otherwise have any risk factor.Conclusion:Elevated BM Na is an important etiological factor in neonatal hypernatremia.

Retinol, α-tocopherol, and selected minerals in breast milk of lactating women with full-term infants in South Korea.

BACKGROUND/OBJECTIVESThis study was performed to measure fat-soluble vitamins and minerals in breast milk of Korean lactating mothers who exclusively breastfed their babies.SUBJECTS/METHODSBreast milk samples were collected from 334 mothers. Concentrations of retinol and α-tocopherol were analyzed by high performance liquid chromatography ultraviolet spectrometry while concentrations of minerals were measured by inductively coupled plasma optical emission spectrometry.RESULTSRetinol and α-tocopherol contents of breast milk were 39.58 ± 19.64 µg/dL and 0.23 ± 0.13 mg/dL, respectively. Average sodium, potassium, calcium, phosphorus, and magnesium levels in breast milk were 11.11 ± 5.16, 38.56 ± 9.01, 27.87 ± 6.10, 13.56 ± 3.30, and 3.05 ± 0.65 mg/dL, respectively. Contents of trace elements such as iron, zinc, copper, and manganese were 40.26 ± 46.21, 98.40 ± 62.47, 24.09 ± 9.03, and 0.90 ± 1.63 µg/dL, respectively. Fat-soluble vitamin concentration was positively correlated with total fat in milk samples, but no significant differences were observed in levels of retinol, α-tocopherol, or minerals based on whether or not lactating women were taking dietary supplements.CONCLUSIONSMicronutrient contents of breast milk samples from Korean lactating women were comparable to those of other nations. Retinol and α-tocopherol levels were correlated and also with total fat in breast milk.

Effects of maternal dietary egg intake during early lactation on human milk ovalbumin concentration: a randomized controlled trial

There is limited understanding of how maternal diet affects breastmilk food allergen concentrations, and whether exposure to allergens through this route influences the development of infant oral tolerance or sensitization. To investigate how maternal dietary egg ingestion during early lactation influences egg protein (ovalbumin) levels detected in human breastmilk. In a randomized controlled trial, women were allocated to a dietary group for the first six weeks of lactation: high-egg diet (> 4 eggs per week), low-egg diet (one-three eggs per week) or an egg-free diet. Breastmilk samples were collected at 2, 4 and 6 weeks of lactation for the measurement of ovalbumin. The permeability of the mammary epithelium was assessed by measuring the breastmilk sodium : potassium ratio. Egg-specific IgE and IgG4 were measured in infant plasma at 6 weeks, and prior to the introduction of egg in solids at 16 weeks. Average maternal egg ingestion was associated with breastmilk ovalbumin concentration. Specifically, for each additional egg ingested per week, there was an average 25% increase in ovalbumin concentration (95% CI: 5-48%, P = 0.01). Breastmilk ovalbumin concentrations were significantly higher in the 'high-egg' group (> 4 eggs per week) compared with the 'egg-free' group (P = 0.04). However, one-third of women had no breastmilk ovalbumin detected. No detectable associations were found between mammary epithelium permeability and breastmilk ovalbumin concentrations. Infant plasma egg-specific IgG4 levels were also positively associated with maternal egg ingestion, with an average 22% (95% CI: 3-45%) increase in infant egg-specific IgG4 levels per additional egg consumed per week (P = 0.02). Increased maternal egg ingestion is associated with increased breastmilk ovalbumin, and markers of immune tolerance in infants. These results highlight the potential for maternal diet to benefit infant oral tolerance development during lactation.

Increased Epstein–Barr virus in breast milk occurs with subclinical mastitis and HIV shedding

Epstein-Barr virus (EBV) in breast milk and subclinical mastitis (SCM) are both associated with human immunodeficiency virus (HIV) shedding and possibly with postnatal HIV transmission. The objective of this nested case-control study was to investigate the interplay between SCM and EBV replication in breast milk of HIV-infected mothers.The relationships between EBV deoxyribonucleic acid (DNA) shedding, HIV-1 ribonucleic acid (RNA) level, and SCM were explored in breast milk samples of Zambian mothers participating in the ANRS 12174 trial. Mammary gland inflammation was defined as a breast milk sodium to potassium ratio (Na/K) greater than 0.6 and further subclassified as either "possible SCM" (Na/K ratio 0.6-1.0) or SCM (Na/K ratio ≥ 1.0). Breast milk interleukin 8 (IL-8) was measured as a surrogate marker of mammary gland inflammation.EBV DNA was detected in breast milk samples from 42 out of 83 (51%) participants and was associated with HIV-1 shedding in breast milk (P = 0.006). EBV DNA levels were higher in samples with SCM and "possible SCM" compared to non-SCM breast milk samples (P = 0.06; P = 0.007). An EBV DNA level of >200 copies/mL was independently associated with SCM and "possible SCM" (OR: 2.62; 95%: 1.13-6.10). In patients with SCM, higher EBV replication in the mammary gland was associated with a lower induction of IL-8 (P = 0.013). Resistance to DNase treatment suggests that EBV DNA in lactoserum is encapsidated.SCM and decreased IL-8 responses are associated with an increased EBV shedding in breast milk which may in turn facilitate HIV replication in the mammary gland.

The relation between breast milk sodium to potassium ratio and maternal report of a milk supply concern at 7 days postpartum (1016.9)

It was previously shown that 27% of breastfeeding primparas report a milk supply concern at 7 days postpartum (d7). We examined whether milk Na:K, as a biomarker of progress toward mature milk production, is predicted by maternal report of a milk supply concern at d7. We used flame photometry to determine Na and K concentrations in d7 milk from the Early Lactation Success cohort, and defined elevated Na:K (↑Na:K) as &gt;75%tile. Of 406 mothers interviewed, 257 provided a milk sample, including 62 (24%) who reported a milk supply concern. Na:K ranged from 0.24 to 13.60 (median, 0.62) and was strongly correlated with formula use (Spearman r=0.21, p=0.0009). Subsequent analyses were restricted to the 197 mothers exclusively breastfeeding (EBF) at d7 (Na:K 75%tile=0.80). ↑Na:K occurred in 15/36 (42%) vs. 33/161 (20%) of mothers with vs. without a milk supply concern, respectively (p=0.008). This relation strengthened after adjustment for ethnicity: OR (95%CI), 2.8 (1.3‐6.0); and AOR (95%CI), 3.5 (1.5‐7.9). For nearly half of exclusively breastfeeding mothers, their report of milk supply concern is corroborated by elevated Na:K.

Development and evaluation of breastfeeding promotion program for mothers with breast engorgement following cesarean birth

This study was to develop a breastfeeding promotion program and to test effects of the program on levels of breast discomfort, breast size, sodium in breast milk, and type of feeding in mothers with breast engorgement following cesarean birth. A non-synchronized non-equivalent control group pretest-posttest design was used in this study. The participants were 70 postpartum mothers who were admitted to a postpartum care center and experienced breast engorgement following cesarean birth. The planned nursing intervention was the breastfeeding promotion program consisting of breast massage and 1:1 breastfeeding education, counseling, and support focusing on individualized problem solving provided for 10 days. Fifty-three women completed the program (experimental group 26, control group, 27). Measurements were level of breast discomfort, breast size, sodium in breast milk and type of feeding at pre and posttest. Women who participated in the program experienced lower scores for breast discomfort, greater decrease in breast size, lower levels of sodium in breast milk, and practiced breastfeeding more than those in the control group. Results indicate that this breastfeeding promotion program is effective in reducing breast engorgement and improving breastfeeding practices, and is therefore recommended to enhance breastfeeding promotion practice in postpartum care centers.