Breast-fed Infants Research Articles

Correlation Between Feeding Pattern and Duration of Hospital Stay in Pneumonia of Infants Below 6 Months of Age

<i>Introduction</i>: Pneumonia is the most common respiratory disorder among infants and one of the leading causes of hospital admission. Various feeding patterns have multiple impacts on pneumonia and recovery from it. Breast milk provides some protective properties against respiratory tract and gastrointestinal illness to protect infants during the first year of life. This study aimed to find an association between feeding patterns and duration of hospital stay due to pneumonia in infants below 6 months of age. <i>Methodology</i>: This cross-sectional study was conducted in the Department of Paediatrics, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from February, 2019 to August, 2020. In our study, 200 infants below 6 months of age admitted with pneumonia in the Department of Paediatrics in Shaheed Suhrawardy Medical College Hospital, Dhaka were enrolled according to selection criteria. <i>Result</i>: Maximum incidence was seen in the 3 to 4 months of age, e.g.40.0% & 36.30% in girls and boys respectively, mean age of the pneumonia patient was 2.9±1.5 months. Out of 200 cases, 55.0% cases were male and 45.0% were female. Among all infants 93.75% of exclusively breastfed infants needed ≤10 days, and 27.88% of non-exclusive breastfed infants needed>10 days in the hospital for recovery from pneumonia. In both cases, the p-value was 0.001. <i>Conclusion</i>: Exclusive breastfed infants have shorter and non-exclusive breastfed infants have longer hospital stays due to pneumonia below 6 months of age.

The Effect of Cannabis Consumption During Lactation on the Macronutrient Concentrations in Breast Milk.

Introduction: Human breast milk macronutrients play a vital role in the development of breastfed infants and are known to be influenced by several factors. There is limited information on the influence of cannabis use during lactation on these macronutrients. Given the rising use of cannabis among lactating women with its widespread legalization, this study aimed to examine the association of cannabis use during lactation on breast milk macronutrients. Materials and Methods: A cross-sectional study design was used and 637 breast milk samples with measured macronutrients were utilized. Of these, 165 samples that had detectable cannabis metabolites were defined as the study group, and 472 samples from mothers who did not report cannabis use and from mothers who reported cannabis use but did not have measurable metabolites of cannabis in their milk samples were defined as the control group. Multivariable linear regression models were used to assess the association of presence of cannabis metabolites with protein, carbohydrates, fat, and calories in breast milk. Results: Greater protein levels (95% confidence interval [CI]: 0.112-0.376; p < 0.001) and lower fat levels (95% CI: -0.217, -0.018; p = 0.020) were found in the milk exposed to cannabis compared with reported nonexposure. The presence of cannabis was associated with an increase of 0.244 mg/dL in protein and a reduction of 11% in fats in breast milk. The levels of energy and carbohydrates were not significantly different among the two groups. Conclusions: This study demonstrated a statistically significant association between the presence of metabolites of cannabis in breast milk and protein and fat concentrations in breath milk. Further studies are required toward building the body of evidence to determine safety of cannabis use during lactation.

Population pharmacokinetic modeling of paired plasma-breast milk lamivudine data for estimation of infant exposure in breastfeeding mother-infant pairs.

Around 1.2 million women living with HIV give birth annually, majority of whom will breastfeed their infants while receiving antiretroviral therapy (ART). Lamivudine, a component of first-line ART regimens crosses from maternal plasma to breast milk, with measurable concentrations in some breastfed infants. Wide variability in plasma-to-breast milk transfer has been reported within- or across studies, probably due to differences in sampling framework. This work sought to characterize the milk-to-plasma transfer of lamivudine, quantify inter-patient variability and associated factors, and predict exposure of a breastfed infant. We explored data from an observational pharmacokinetic study that included 35 Ugandan mothers and their infants. Mothers received lamivudine doses of 150 mg twice daily or 300 mg once daily as part of their antiretroviral regimen. Pharmacokinetic sampling was undertaken across two visits approximately 8 weeks apart, providing 248 maternal plasma, 256 breast milk-, and 151 infant blood concentrations, measured across a 24-h sampling interval. A one-compartmental model best described the plasma disposition of lamivudine, with first-order absorption, interindividual variability on clearance and volume of distribution, and a proportional residual error model. A lag in time of plasma-to-breast milk drug accumulation was described using an effect compartment model with a milk-to-plasma ratio of 1.77. An estimated daily infant dose of 179.3 μg/kg (range: 125.8, 282.3) closely predicted the observed infant steady-state concentrations and translated into 3.34% (2.13, 7.20) and 3.35% (1.10, 7.15) of the standard daily maternal dose in visits 1 and 2, respectively. The established modeling framework can be extended to other drugs.

Quantification of persistent organic pollutants in breastmilk and estimated infant intake, Norway.

Persistent organic pollutants (POPs) are environmental contaminants that can accumulate in human tissues and pose potential health risks. Despite global efforts to reduce their prevalence, follow-up studies are needed to see if the measures are successful. Since most infants in Norway are breastfed for the first 6 months of life, monitoring POP contamination in breastmilk is important for children's health and development. This study aims to evaluate the current levels of various POPs in women's breastmilk in Innlandet County, Norway. A cross-sectional study was conducted measuring concentrations of 35 different POPs, including polychlorinated biphenyls (PCBs), chlordanes (ChlDs), hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs), Mirex, and brominated flame retardants in 120 breastmilk samples. The study analysed the impact of maternal age, parity, pre-pregnancy BMI, and infant age on POPs levels and compared the estimated daily intake per body weight of infants to existing health guidelines. The detected percentages for PCBs were 100%, for DDTs 98.3%, and for ChlDs 98.3%. The highest median concentration was found for ΣPCBs (26.9 ng/g lw). Maternal age, parity, and infant age were significant determinants of POP concentrations. Most infants exceeded the health-based guidance values for ΣPCB, and 6.4% percent did so for ΣHCHs. Despite lower POPs concentrations in breastmilk than in earlier studies, many breastfed infants are still exposed to levels exceeding health-based guidance values. Although the study's design had limitations, the study provides updated population-based data on POPs in breastmilk. Continued monitoring and research are necessary to understand and mitigate potential health risks associated with POPs.

Biological effects of combinations of structurally diverse human milk oligosaccharides

Human milk oligosaccharides (HMOs) are a diverse group of structures and an abundant bioactive component of breastmilk that contribute to infant health and development. Preclinical studies indicate roles for HMOs in shaping the infant gut microbiota, inhibiting pathogens, modulating the immune system, and influencing cognitive development. In the past decade, several industrially produced HMOs have become available to fortify infant formula. Clinical intervention trials with manufactured HMOs have begun to corroborate some of the physiological effects reported in preclinical studies, especially modulation of the gut microbiota in the direction of breastfed infants. As more HMOs become commercially available and as HMOs have some shared mechanisms of action, there is a need to better understand the unique and differential effects of individual HMOs and the benefits of combining multiple HMOs. This review focuses on the differential effects of different HMO structural classes and individual structures and presents a scientific rationale for why combining multiple structurally diverse HMOs is expected to exert greater biological effects.

Population pharmacokinetic modelling of cetirizine concentrations in human breast milk-A contribution from the ConcePTION project.

Cetirizine is an antihistamine commonly used to treat allergic rhinitis and other allergic conditions. Cetirizine is often prescribed to breastfeeding mothers although there is limited information on infant exposure via breast milk. The aim of this study was to develop a popPK model based on data from a lactation study to predict cetirizine breast milk concentrations and estimate the relative infant dose (RID) in a breastfed infant. A popPK model was developed in NONMEM on data from a human lactation study including 35 women using cetirizine or levocetirizine while breastfeeding. Serial samples of breast milk were collected (n = 205) and the cetirizine concentrations quantified using a validated LC-MS/MS method. A one-compartment model of cetirizine in breast milk was developed and employed to calculate the relative infant dose (RID). Covariates related to the maternal characteristics and breastfeeding patterns were evaluated in the model; only milk sampling pumping duration was found to be a significant covariate, with an increasing pumping duration leading to an increased apparent milk volume of distribution (Vm). The mean RID was 1.99% with the highest RID being 3.36% at Cmax. PopPK modelling could be used to estimate infant exposure to cetirizine via breast milk. The low predicted exposure in infants supports that cetirizine is compatible with breastfeeding.

Mothers Falling Asleep During Infant Feeding.

Falling asleep while feeding (FAF) infants is common. Our primary objectives were to examine (1) maternally reported prevalence of FAF and if planned; (2) association between FAF and sociodemographic factors, feeding method, and sleep location; and (3) if receipt of education about safe sleep and bedsharing risks was associated with FAF. In the Social Media and Risk-reduction Training study, US mothers of newborns were randomized to educational messaging promoting infant safe sleep or breastfeeding. We analyzed data from 1259 mothers who responded to the postpartum survey (mean infant age, 11.2 weeks). We used generalized estimating equation logistic regression models to examine the extent that sociodemographic characteristics, feeding type, usual nighttime feeding location, and intervention group were associated with FAF. A total of 28.2% of mothers reported FAF usually or sometimes in the last 2 weeks, 83.4% of whom reported that FAF was unplanned. There were no differences in the odds of FAF by sociodemographic factors. Compared with mothers whose nighttime feeding location was their bed, mothers who reported feeding in a chair were less likely to FAF (33.6% versus 16.8%; adjusted odds ratio, 0.41; 95% confidence interval, 0.31-0.56). FAF was reported less frequently by mothers who received safe sleep interventions (15.6%), compared with mothers who received breastfeeding interventions (33.0%; adjusted odds ratio, 0.40; 95% confidence interval, 0.25-0.65). FAF is reported commonly among US mothers and is predominantly unplanned. Mothers who received safe sleep messaging were less likely to report FAF. New parents need guidance on planning for optimal safety during infant feeding.

Human milk fat globule size distributions: comparison between laser diffraction and 3D confocal laser scanning microscopy

Milk fat globules (MFGs) in human milk provide energy to breastfed infants and support infant development. Accurate measurements of MFG size distributions are important to better understand MFG function and origin, as well as the influence of MFG size on milk composition analysis methods. Nevertheless, commonly used laser diffraction systems have never been thoroughly validated for size distribution measurements in human milk. Here, we introduce a new method for determining the size distribution of milk fat globules in human milk, using 3D confocal laser scanning microscopy (CLSM) in combination with fluorescent labeling of MFGs. We validate and compare 3D CLSM to laser diffraction (Mastersizer 2000, Malvern Panalytical), using polystyrene microsphere size standards. Next, we apply both methods to evaluate MFG size distributions in human milk. We show that 3D CLSM can be used to obtain more accurate size distributions between 500 nm and 10 μm compared to laser diffraction. Importantly, MFG size distributions obtained with 3D CLSM contain no secondary population around 1 μm, in contrast to laser diffraction measurements. This suggests that the bimodal MFG distribution obtained by laser diffraction can be an artifact of the built-in fitting algorithm, instead of an actual feature of human milk. This work demonstrates that care should be taken when interpreting size distributions of MFGs measured with laser diffraction and that 3D CLSM is an accurate alternative for measuring size distributions in lactation and dairy research.

Using PBPK modeling to supplement clinical data and support the safe and effective use of dolutegravir in pregnant and lactating women.

Optimal dosing in pregnant and lactating women requires an understanding of the pharmacokinetics in the mother, fetus, and breastfed infant. Physiologically-based pharmacokinetic (PBPK) modeling can be used to simulate untested scenarios and hence supplement clinical data to support dosing decisions. A PBPK model for the antiretroviral dolutegravir (mainly metabolized by UGT1A1) was verified using reported exposures in non-pregnant healthy volunteers, pregnant women, and the umbilical cord, lactating mothers, and breastfed neonates. The model was then applied to predict the impact of UGT1A1 phenotypes in extensive (EM), poor (PM), and ultra-rapid metabolizers (UM). The predicted dolutegravir maternal plasma and umbilical cord AUC in UGT1A1 PMs was 1.6-fold higher than in EMs. The predicted dolutegravir maternal plasma and umbilical cord AUC in UGT1A1 UMs mothers was 1.3-fold lower than in EMs. The predicted mean systemic and umbilical vein concentrations were in excess of the dolutegravir IC90 at 17, 28, and 40 gestational weeks, regardless of UGT1A1 phenotype, indicating that the standard dose of dolutegravir (50 mg q.d., fed state) is generally appropriate in late pregnancy, across UGT1A1 phenotypes. Applying the model in breastfed infants, a 1.5-, 1.7-, and 2.2-fold higher exposure in 2-day-old neonates, 10-day-old neonates, and infants who were UGT1A1 PMs, respectively, compared with EMs of the same age. However, it should be noted that the exposure in breastfed infants who were UGT1A1 PMs was still an order of magnitude lower than maternal exposure with a relative infant daily dose of <2%, suggesting safe use of dolutegravir in breastfeeding women.

Coparenting Approach to Being Successful Exclusively Breastfeeding

Breast milk is the first nutrient for infants because it contains essential nutrients for growth and development, so exclusive breastfeeding can prevent the risk of stunting and wasting in children. The lack of breastfeeding in infants is a threat to the long-term growth and development of children. Effective coparenting strongly impacts breastfeeding success rates because of its positive energy. Developing effective coparenting during the transition to becoming a parent is very helpful in the process of carrying out the role of parent, resolving conflict and supporting one's partner in raising children. The study aimed to analyze the success of Coparenting Approach to Being Successful Exclusively Breastfeeding. This research method is an observational study with an analytic cross-sectional design using a quantitative approach; the population in this study was 393 people in the Glagahagung Community Health Center Working Area sampling with a purposive sampling technique, based on inclusion and exclusion criteria where a number of respondents were exclusively breastfeeding with a total of 78 respondents. The results showed family support p value = 0.000, technological advances p value = 0.000, and lifestyle p value = 0.000. Based on the results show that the regression coefficient for family support is .716, this shows that increasing the family support variable will increase the coparenting approach variable in the success of providing EBF by .716, the trends and lifestyle regression coefficient is -.452, so this shows that trend and lifestyle variables reduce the influence on the coparenting approach in the success of providing EBF.

Determination of PAH Contamination in Breast Milk Samples from Hungarian Volunteering Mothers, Using HPLC-FLD.

(1) The evidence is mounting that polycyclic aromatic hydrocarbons (PAHs) are a class of hazardous organic compounds with established carcinogenic and toxic properties. Humans may be exposed to PAHs through several different routes, including diet, inhalation, and dermal contact. There is also a possibility that they could transfer into breast milk following maternal exposure, which could potentially endanger breastfeeding infants. (2) The objective of this study was to ascertain the concentration of polycyclic aromatic hydrocarbons (PAHs) in breast milk samples from 50 Hungarian mothers, employing high-performance liquid chromatography with fluorescence detection (HPLC-FLD). An Incremental Life Risk Calculation (IRCL) model estimated the carcinogenic risk to infants. (3) Total PAH concentrations ranged from 0 to 78 ng/mL, with fluorene (5.3 ng/mL), phenanthrene (3.2 ng/mL), and pyrene (2.5 ng/mL) being the most abundant. PAHs were detected in 48 of the 50 samples, with phenanthrene present in 92% of samples. Dibenzo (a,h)anthracene was not detected. (4) According to the model measurements, most of the samples were within acceptable risk levels; however, 2 samples out of 50 posed a higher risk. Statistical analysis of questionnaires completed by the mothers indicated that factors such as diet, residence, and education may influence PAH levels in breast milk.

Interactions between the human milk oligosaccharide 2'-fucosyllactose and Bifidobacterium longum subspecies infantis in influencing systemic immune development and function in piglets.

The oligosaccharide 2'-fucosyllactose (2'-FL) is a predominant component of human milk, serving as a prebiotic for gut microbiota and influencing immune development in infants. Bifidobacterium longum subspecies infantis (B. infantis) is a commensal bacterium found in breastfed infants. Both 2'-FL and a specific strain of B. infantis, Bi-26™, are commercially available. This study investigates the potential synbiotic relationship between 2'-FL and Bi-26™ on immune development. Two-day-old piglets (n = 53) were randomized in a 2 × 2 design, receiving either a commercial milk replacer ad libitum without (CON) or with 1.0 g/L 2'-FL (FL). Piglets in each diet were further randomized to receive either glycerol stock alone or Bi-26™ (109 CFU) (BI and FLBI) orally once daily. On postnatal day (PND) 34/35, animals were euthanized, and blood was collected for serum cytokine analysis. Additionally, peripheral blood mononuclear cells (PBMCs) were isolated for ex vivo stimulation and flow cytometry analysis. Serum and ex vivo cytokines were analyzed using a multivariate model. All other outcomes were analyzed using a two-way ANOVA, considering prebiotic and probiotic fixed effects. The significance level was set at a p value <0.05, with trends reported for 0.05 < p < 0.1. Immune cell populations in PBMCs were unaffected by the experimental treatment. However, serum interleukin (IL)-1RA, IL-1β, IL-12, and IL-18 were all higher (p < 0.05) in the FL group than in the CON group. In isolated PBMCs, lipopolysaccharide (LPS) stimulation resulted in higher IL-1RA and a trend for higher IFN-γ secretion in the FL group vs. the CON group. 2'-FL stimulates a balanced cytokine profile in healthy piglets without changing immune cell populations. When immune cells are stimulated ex vivo with LPS, 2'-FL primes T-cells for a proinflammatory response, which is moderated by co-administration of Bi-26™.

Impact of Milk pH and Fat Content on the Prediction of Milk-to-Plasma Ratio: Knowledge Gap and Considerations for Lactation Study Design and Interpretation.

Different empirical lactation models have been published to predict the milk-to-plasma (M/P) ratio of drugs to gain knowledge on the extent of drug distribution to the breastmilk. M/P ratios will likely vary across the lactation period due to differences in physiological milk pH and fat content, which are not routinely reported in clinical lactation pharmacokinetic studies. This work aims to evaluate the sensitivity of two (a theory-based phase distribution and a log-transformed regression) lactation models for M/P prediction at different physiological milk pH and fat content. A literature search was conducted to collate reported M/P ratios for different drugs and their physicochemical parameters required for the prediction of the M/P ratio. Two distribution models were used for M/P ratio predictions. The M/P ratio of drugs was predicted under the physiological milk pHs of 6.8, 7.0, 7.2, and 7.4 and at of 1%, 3%, and 6% fat content. Calculated M/P ratios were compared with the observed M/P ratios. A total of 200 M/P ratios for 130 compounds (40 acids and 90 bases) were collected from clinical studies and included in the analysis. For both model, precision decreases and bias increases outside the milk pH range 7.0-7.2 and fat contents more than 3%. Significant variability exists in the observed M/P ratios. Both milk pH and fat content are important parameters for model prediction. Calculated M/P ratios are influenced by multiple covariates, including milk pH and fat content. The phase distribution model is less sensitive to these covariates than the log-transformed model, especially for acidic compounds. For complex matrices such as breastmilk, the actual physiological parameters of the sampled milk, at least milk fat and pH, and their distributions are required covariates to improve the prediction outcomes, design lactation pharmacokinetic studies, and inform the potential breastfed infant dose.

56 Iron deficiency is common in extreme preterm infants despite prophylactic iron supplementation

Abstract Background Iron deficiency (ID) in childhood is linked to adverse neurodevelopmental outcomes in the long-term. Extremely premature infants (EPI; born &amp;lt; 28 weeks gestation) are more susceptible to ID due to a multitude of factors including lower iron reserves at birth, rapid growth, immature erythropoiesis, and multiple phlebotomy tests during hospital stay. Therefore, professional societies advise prophylactic iron therapy for these infants from 2-6 weeks age until 6-12 months. However, there is paucity of data on the iron status in EPI receiving this prophylactic iron supplementation. Objectives To investigate the prevalence and risk factors associated with ID in EPI. Design/Methods A retrospective cohort study analyzed a Provincial database of EPIs born between 2005-2018. Infants with congenital malformations, chromosomal anomalies and blood disorders were excluded. All included infants received prophylactic iron supplementation from 2-4 weeks of chronological age that was recommended to continue at discharge until 9-12 months corrected age (CA). At 4-6 months CA, these infants underwent blood testing. ID was defined as serum ferritin &amp;lt; 20mcg/L at 4 months CA or SF &amp;lt; 12mcg/L at 6 months CA. Through a univariate analysis using single-variable logistic regression, factors linked to ID were identified. Those with a p-value &amp;lt; 0.20 progressed to a multivariable model, retaining variables with a p-value &amp;lt; 0.05. Results Of 146 infants, 45.9% had ID. ID group had lower mean ferritin (16.4 µg/L vs 50.0 µg/L, p &amp;lt; .001) and reticulocyte hemoglobin equivalent (28.4pg vs 31.6pg, p &amp;lt; .001) compared to the non-ID group. ID prevalence reduced from 59.7% in 2005-2011 to 40.3% in 2012-2018 cohort. Exclusive or partial breastfeeding at 4-6 months CA was protective against ID (Odds: 0.2, p = 0.003). Iron therapy at 4-6 months CA was not protective in the final model. Notably, 27.4% stopped iron therapy before 4-6 months CA, and exclusive formula-fed infants had notably lower iron intake than breastfed infants (66.1% vs 99.1%, p = 0.006). Conclusion Nearly half of the EPI exhibited ID at 4-6 months CA despite prophylactic iron supplementation. About a quarter discontinued therapy before reaching this age. Breastfeeding at this age was protective against ID. This high prevalence of ID in EPI underscores the need of future studies to discern strategies to mitigate ID in this vulnerable population.

HIV postnatal prophylaxis and infant feeding policies vary across Europe: results of a Penta survey.

This survey was conducted to describe current European postnatal prophylaxis (PNP) and infant feeding policies with the aim of informing future harmonized guidelines. A total of 32 senior clinicians with relevant expertise, working in 20 countries within the European Region, were invited to complete a REDCap questionnaire between July and September 2023. Twenty-three of the 32 invited paediatricians responded, representing 16/20 countries. There were multiple respondents from the same country for Italy (n = 5), the UK (n = 2), Germany (n = 2) and France (n = 2). All countries use risk stratification to guide PNP regimen selection. Nine out of 16 countries reported three risk categories, six out of 16 reported two, and one country reported differences in categorization. Criteria used to stratify risk varied between and within countries. For the lowest risk category, the PNP regimen reported ranged from no PNP to up to four weeks of one drug; the drug of choice reported was zidovudine, apart from one country which reported nevirapine. For the highest risk category, the most common regimen was zidovudine/lamivudine/nevirapine (20/23 respondents); regimen duration varied from twoto six weeks with variation in recommended dosing. Guidelines support breastfeeding for infants born to people living with HIV in eight out of 16 countries; in the other eight, guidelines do not support/specify. Guidelines and practice for PNP and infant feeding vary substantially across Europe and within some countries, reflecting the lack of robust evidence. Effort is needed to align policies and practice to reflect up-to-date knowledge to ensure the vertical transmission risk is minimized and unnecessary infant HIV testing and PNP avoided, while simultaneously supporting families to make informed decisions on infant feeding choice.

Metal availability shapes early life microbial ecology and community succession.

The gut microbiota plays a critical role in human health and disease. Microbial community assembly and succession early in life are influenced by numerous factors. In turn, assembly of this microbial community is known to influence the host, including immune system development, and has been linked to outcomes later in life. To date, the role of host-mediated nutritional immunity and metal availability in shaping microbial community assembly and succession early in life has not been explored in depth. Using a human infant cohort, we show that the metal-chelating protein calprotectin is highly abundant in infants. Taxa previously shown to be successful early colonizers of the infant gut, such as Enterococcus, Enterobacteriaceae, and Bacteroides, are highly resistant to experimental metal starvation in culture. Lactobacillus, meanwhile, is highly susceptible to metal restriction, pointing to a possible mechanism by which host-mediated metal limitation shapes the fitness of early colonizing taxa in the infant gut. We further demonstrate that formula-fed infants harbor markedly higher levels of metals in their gastrointestinal tract compared to breastfed infants. Formula-fed infants with high levels of metals harbor distinct microbial communities compared to breastfed infants, with higher levels of Enterococcus, Enterobacter, and Klebsiella, taxa which show increased resistance to the toxic effects of high metal concentrations. These data highlight a new paradigm in microbial community assembly and suggest an unappreciated role for nutritional immunity and dietary metals in shaping the earliest colonization events of the microbiota.IMPORTANCEEarly life represents a critical window for microbial colonization of the human gastrointestinal tract. Surprisingly, we still know little about the rules that govern the successful colonization of infants and the factors that shape the success of early life microbial colonizers. In this study, we report that metal availability is an important factor in the assembly and succession of the early life microbiota. We show that the host-derived metal-chelating protein, calprotectin, is highly abundant in infants and successful early life colonizers can overcome metal restriction. We further demonstrate that feeding modality (breastmilk vs formula) markedly impacts metal levels in the gut, potentially influencing microbial community succession. Our work suggests that metals, a previously unexplored aspect of early life ecology, may play a critical role in shaping the early events of microbiota assembly in infants.

Impact of Bifidobacterium longum Subspecies infantis on Pediatric Gut Health and Nutrition: Current Evidence and Future Directions.

Background: the intestinal microbiota, a complex community vital to human health, is shaped by microbial competition and host-driven selective pressures. Among these microbes, Bifidobacterium plays a crucial role in early gut colonization during neonatal stages, where Bifidobacterium longum subspecies infantis (B. infantis) predominates and is particularly prevalent in healthy breastfed infants. Objectives: as we embark on a new era in nutrition of the pediatric population, this study seeks to examine the existing understanding regarding B. infantis, encompassing both preclinical insights and clinical evidence. Methods: through a narrative disceptation of the current literature, we focus on its genetic capacity to break down various substances that support its survival and dominance in the intestine. Results: using "omics" technologies, researchers have identified beneficial mechanisms of B. infantis, including the production of short-chain fatty acids, serine protease inhibitors, and polysaccharides. While B. infantis declines with age and in various diseases, it remains a widely used probiotic with documented benefits for infant and child health in numerous studies. Conclusions: the current scientific evidence underscores the importance for ongoing research and clinical trials for a deeper understanding of B. infantis's role in promoting long-term health.

Investigating the Transfer of Lisinopril into Human Milk: A Quantitative Analysis.

Lisinopril is commonly prescribed to manage conditions such as hypertension and heart failure. While concerns about fetal toxicity have traditionally limited the use of lisinopril in women of reproductive age, recent ACOG guidelines promote aggressive treatment of hypertension, which may require the use of pharmacologic agents not previously considered in the postpartum period. We aimed to estimate infant exposure to maternal lisinopril via breastmilk and report the tolerance of the breastfed infant. Five volunteers taking lisinopril provided samples of their human milk and their associated health information for research through the InfantRisk Center Human Milk Biorepository. The milk pharmacokinetics of lisinopril were measured using liquid chromatography-mass spectrometry. The mean milk concentration of lisinopril was 0.49 ng/mL per 10 mg daily dose. The Relative Infant Dose (RID) was 0.06% for lisinopril, more than 100 times lower than the standard 10% safety threshold. The minimal transfer of lisinopril into human milk in this study suggests the drug is unlikely to pose a clinically significant risk to healthy breastfed infants.

Turmeric Topical Application: An effective solution for reducing breast milk secretion delays in new mothers

Background: The problem of low coverage of exclusive breastfeeding is partly influenced by insufficient breast milk production. The percentage of exclusive breastfeeding in infants under six months of age in Central Kalimantan in 2020 was 52.98%. This percentage was among the lowest nationally. In 2021, the coverage of exclusive breastfeeding in infants under six months of age reached 56.8%, and in 2022 it did 60.5%. The figure in 2022 exceeded the set target, but several regencies/cities still had low coverage. Insufficient breast milk supply impacts on the nutritional status of the child. Low breast milk production also arises due to several other factors during breastfeeding, namely late initiation of breastfeeding, long breastfeeding time, sore nipples, breast pain and swelling, and inverted nipples. Aims: The study sought to measure the level of success of turmeric topical application in shortening the time it takes to initiate breast milk secretion. Methods: The study uses a true experimental posttest-only control group design. A subject of 50 mothers having full-term spontaneous deliveries and with normal breasts was used in the study. The sample was divided into two groups: control and intervention groups. The sample was selected using a matching process based on age, parity, and early initiation of breastfeeding. Subjects who met the inclusion criteria were offered whether they were willing to be given turmeric compresses after the delivery process. Subjects who were willing were included in the intervention group and those who were not willing were included in the control group. Age and parity in the intervention group were all taken, while the control group was selected to match the intervention group. The intervention group was given a treatment with a turmeric compress on the breasts for six hours. All participants were then observed for time of breast milk secretion initiation. In this experiment, we didn't perform blinding, but we managed it by having the midwife administer the turmeric compress just once during the delivery process before sending the client home. Following this, we recorded the results, specifically the initial breast milk release in both the intervention and the control group. Results: The average time periods it took to initiate breast milk secretion in the intervention and control groups were 509.96 minutes (8.5 hours) and 1573.76 minutes (26.2 hours), respectively. There was a significant difference (p = 0.023) in the time of breast milk secretion initiation of 1063.8 minutes or 17.73 hours between both groups. Conclusion: Applying a turmeric compress on the breasts of postpartum mothers may shorten the time it takes to initiate breast milk secretion. Received: 05 August 2024, Reviewed: 23 August 2024, Revised: 21 September 2024, Accepted: 13 October 2024.

Macronutrient Intake during Complementary Feeding in Very Low Birth Weight Infants Comparing Early and Late Introduction of Solid Foods: A Secondary Outcome Analysis.

Background/Objectives: Very low birth weight (VLBW) infants may require enhanced nutrition, even during complementary feeding. However, there are limited data on macronutrient intake during this period, particularly concerning the individual timing of the introduction of solid foods in a representative VLBW infant population. Methods: This prospective observational study analyzed macronutrient intake in VLBW infants with a gestational age < 32 weeks based on whether solid foods were introduced early (<17 weeks corrected age (CA)) or late (≥17 weeks corrected age) Nutritional intake was analyzed using a 24 h recall at 6 weeks CA and 3-day dietary records at 12 weeks, 6, 9, and 12 months CA. Results: In total, 115 infants were assigned to the early and 82 to the late group. The timing of solid food introduction did not affect macronutrient intake, except for a lower fat and higher carbohydrate intake (% of energy) in the early group at 12 weeks and 6 months CA: early vs. late, fat-12 weeks: 47.0% vs. 49.0%, 6 months: 39.2% vs. 43.3%; carbohydrates-12 weeks: 44.9% vs. 43.2%, 6 months: 51.3% vs. 48.0%. Apart from docosahexaenoic acid (DHA) and arachidonic acid (AA), dietary intake recommendations were met in both groups. While nutrient intakes varied significantly between breastfed and formula-fed infants, those with comorbidities exhibited similar nutrient intake levels compared to those without. Conclusions: Our findings suggest adequate macronutrient intakes in VLBW infants irrespective of the timing of solid introduction. However, there is a notable need to enhance dietary intakes of DHA and AA. Future research is crucial to assess whether current nutrient intakes are sufficient for VLBW infants with comorbidities.