Higher Breast Milk Research Articles

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.

Sertraline, citalopram and paroxetine in lactation: passage into breastmilk and infant exposure.

This study aimed to investigate the plasma and breastmilk concentrations for sertraline, citalopram and paroxetine for assessment of the Milk/Plasma (M/P) ratio and Absolute Infant Dose (AID), and to determine actual infant drug exposure through breastfeeding. Subsequently, informed recommendations will be formulated regarding the advisability of breastfeeding in women undergoing treatment with the three most widely used antidepressants. A pharmacokinetic study in lactating women and their infants using sertraline, citalopram or paroxetine was performed. Paired breastmilk and plasma samples and single point infant plasma samples were collected to determine antidepressant concentrations. An Area Under the Curve (AUC) based approach with the trapezoidal rule was used to calculate M/P ratios and AID for all three antidepressants by combining all measured concentrations for the same dose. Thirty-seven lactating women and their infants participated in this study. 111 paired breastmilk and plasma samples and 37 single point infant plasma samples were collected. Detectable concentrations of sertraline, citalopram and paroxetine were present in all breastmilk samples. For sertraline and citalopram M/P ratio is above one, indicating higher breastmilk than plasma concentrations, however, drug exposure by breastmilk did not lead to detectable plasma drug levels in any of the 15 infants for sertraline, for nine (out of 13) infants for citalopram and for eight (out of nine) infants for paroxetine. Given the well-known benefits of breastfeeding, our findings support breastfeeding of infants by mothers who are taking sertraline, citalopram or paroxetine is safe. Sertraline and paroxetine are the preferred antidepressants during breastfeeding, reaching mostly undetectable infant drug levels.

Breast milk oxytocin and s-IgA modulate infant biomarkers and social engagement; The role of maternal anxiety

Breastfeeding has long been known to improve infants' health and mental development and to enhance the mother-infant bond, but much less research focused on the biological composition of breast milk and its associations with the infant's biomarkers and social development. In this exploratory study, we measured oxytocin (OT) and secretory immunoglobulin-A (s-IgA), the most abundant antibody in breast milk, and evaluated their associations with the same biomarkers in infant saliva and, consequently, with infant social engagement behavior. Fifty-five mother-infant dyads were home-visit and OT and s-IgA were assessed from breast milk and from infant saliva before and after a free-play interaction. Infant social behavior was coded offline using the Coding Interactive Behavior (CIB) and maternal anxiety self-reported. A path model revealed that mother's breast milk s-IgA impacted child social engagement via its links with child OT. In parallel, maternal breast milk OT was linked with infant social behavior through its association with the infant's immunity. This path was moderated by maternal anxiety; only in cases of high anxiety breast milk OT was positively connected to infant s-IgA. Our study, the first to measure OT and s-IgA in both breast milk and infant saliva in relation to observed social behavior, underscores the need for much further research on the dynamic interplay between breast milk composition, infant biomarkers, maternal mental health, and infant social outcomes. Results may suggest that biological systems in breast milk integrate to prepare infants to function in their social ecology through bio-behavioral feedback loops that signal the degree of stress in the environment.

Breastmilk cadmium levels and estimated infant exposure: a multicenter study of associated factors in a resource-limited country

BackgroundDespite the undisputed benefits of breastfeeding, infants might become exposed to xenobiotics that could be excreted into breast milk following maternal exposure. This study was conducted to assess breastmilk cadmium levels among lactating women in Palestine, a resource-limited country. Estimated daily intake (EDI) of cadmium via breastmilk was also calculated and predictors of high breastmilk cadmium levels and high infant exposure via breastmilk were identified.MethodsThis multicenter study was conducted using a descriptive-analytical design. The lactating women were recruited from different maternity and public health clinics in all regions of Palestine. Demographic variables and exposure to sources of cadmium were collected in an interviewer-administered questionnaire. Foremilk samples (about 5 mL) were collected in polyethylene tubes using the hand-expression technique. The breast milk samples were collected in the period between December 2020 and March 2021. A pre-validated method using inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify breastmilk cadmium levels. EDI values were calculated from the quantified breastmilk cadmium levels.ResultsBreastmilk samples were obtained from 256 lactating women. The mean breastmilk cadmium level was 0.34 (SD: 0.33) μg / L and the mean EDI of cadmium via breastmilk was 0.059 (SD: 0.058) µg / kg per body weight / day. Breastmilk cadmium levels were quantified in 92.6% of the breastmilk samples. Of the breastmilk samples, 13 (5.1%) had cadmium levels above those reported as “normal” by the World Health Organization (WHO). Multiple linear regression showed that higher breastmilk cadmium levels and higher EDI were predicted by being a smoker, living in a refugee camp, living close to an industrial area, living close to disposal of wastes, living close to paint shops, living in a house with peeling / chipping paint, frequent use of cosmetics, frequent use of hair dyes, and not using vitamins.ConclusionThe breastmilk cadmium levels and infant exposure were predicted by maternal exposure to sources of cadmium. The findings reported in this study are valuable to antenatal and postnatal healthcare service providers. More studies are needed to plan and implement measures to reduce breastmilk cadmium levels and infants’ exposure to cadmium via breastmilk.

Crosstalk between Breast Milk N-Acetylneuraminic Acid and Infant Growth in a Gut Microbiota-Dependent Manner.

The healthy growth of infants during early life is associated with lifelong consequences. Breastfeeding has positive impacts on reducing obesity risk, which is likely due to the varied components of breast milk, such as N-acetylneuraminic acid (Neu5Ac). However, the effect of breast milk Neu5Ac on infant growth has not been well studied. In this study, targeted metabolomic and metagenomic analyses were performed to illustrate the association between breast milk Neu5Ac and infant growth. Results demonstrated that Neu5Ac was significantly abundant in breast milk from infants with low obesity risk in two independent Chinese cohorts. Neu5Ac from breast milk altered infant gut microbiota and bile acid metabolism, resulting in a distinct fecal bile acid profile in the high-Neu5Ac group, which was characterized by reduced levels of primary bile acids and elevated levels of secondary bile acids. Taurodeoxycholic acid 3-sulfate and taurochenodeoxycholic acid 3-sulfate were correlated with high breast milk Neu5Ac and low obesity risk in infants, and their associations with healthy growth were reproduced in mice colonized with infant-derived microbiota. Parabacteroides might be linked to bile acid metabolism and act as a mediator between Neu5Ac and infant growth. These results showed the gut microbiota-dependent crosstalk between breast milk Neu5Ac and infant growth.

The Impact of Infant Feeding Regimen on Cow's Milk Protein Allergy, Atopic Dermatitis and Growth in High-Risk Infants during the First 6 Months of Life: The Allergy Reduction Trial.

The development of early-onset cow's milk protein allergy and atopic dermatitis during the first months of life is multifactorial, including both genetic and nutritional aspects. This study aims to assess the impact of different feeding patterns on the incidence of cow's milk protein allergy, atopic dermatitis, and growth among infants with a family history of allergy. A total of 551 high-risk infants were randomly recruited from 3 European countries in three feeding regimens: exclusive breastfeeding, partially hydrolyzed formula, or standard formula with intact protein either exclusively or supplementary to breastfeeding. During the first 6 months of intervention, amongst infants with a family history of atopic dermatitis, 6.5% of partially hydrolyzed formula-fed infants and 22.7% of exclusively breastfed infants (p = 0.007) presented with atopic dermatitis respectively. Growth as assessed by weight increase did not differ between the aforementioned groups. Although cow's milk protein allergy was not related to the different milk feeding regimens in the whole cohort, when adjusting for high breast milk intake, the respective incident was significantly lower in the infants consuming partially hydrolyzed formula (p < 0.001). This data indicates that a specific partially hydrolyzed formula could serve as a more appropriate complement to breast milk compared to a standard intact protein formula in high-risk infants, to reduce the incidence of atopic dermatitis.

Breast Milk Exposure is Associated With Cortical Maturation in Preterm Infants.

Breast milk exposure is associated with improved neurocognitive outcomes following preterm birth but the neural substrates linking breast milk with outcome are uncertain. We tested the hypothesis that high versus low breast milk exposure in preterm infants results in cortical morphology that more closely resembles that of term-born infants. We studied 135 preterm (<32 weeks' gestation) and 77 term infants. Feeding data were collected from birth until hospital discharge and brain magnetic resonance imaging (MRI) was performed at term-equivalent age. Cortical indices (volume, thickness, surface area, gyrification index, sulcal depth, and curvature) and diffusion parameters (fractional anisotropy [FA], mean diffusivity [MD], radial diffusivity [RD], axial diffusivity [AD], neurite density index [NDI], and orientation dispersion index [ODI]) were compared between preterm infants who received exclusive breast milk for <75% of inpatient days, preterm infants who received exclusive breast milk for ≥75% of inpatient days and term-born controls. To investigate a dose response effect, we performed linear regression using breast milk exposure quartile weighted by propensity scores. In preterm infants, high breast milk exposure was associated with reduced cortical gray matter volume (d=0.47, 95% confidence interval [CI]=0.14 to 0.94, p=0.014), thickness (d=0.42, 95% CI=0.08 to 0.84, p=0.039), and RD (d=0.38, 95% CI=0.002 to 0.77, p=0.039), and increased FA (d=-0.38, 95% CI=-0.74 to -0.01, p=0.037) after adjustment for age at MRI, which was similar to the cortical phenotype observed in term-born controls. Breast milk exposure quartile was associated with cortical volume (ß=-0.192, 95% CI=-0.342 to -0.042, p=0.017), FA (ß=0.223, 95% CI=0.075 to 0.372, p=0.007), and RD (ß=-0.225, 95% CI=-0.373 to -0.076, p=0.007) following adjustment for age at birth, age at MRI, and weighted by propensity scores, suggesting a dose effect. High breast milk exposure following preterm birth is associated with a cortical imaging phenotype that more closely resembles the brain morphology of term-born infants and effects appear to be dose-dependent. ANN NEUROL 2023;93:591-603.

Predictors of Breast Milk Zinc Levels Among Breastfeeding Women in Palestine: a Cross-Sectional Study.

Zinc is one of the most important essential micronutrients that is needed for the normal growth, development, and maintaining the health of human beings. Previous studies showed that zinc deficiency was highly prevalent among pregnant and lactating women. This cross-sectional study was conducted to determine breast milk zinc levels among breastfeeding women in Palestine and to identify the predictors of breast milk zinc levels. Breast milk samples were obtained from breastfeeding women who visited maternity and primary healthcare centers. Zinc levels were determined using inductively coupled plasma mass spectrometry. Breast milk zinc levels were determined in 390 breast milk samples. The mean breast milk zinc level in all samples was 0.15 ± 0.09mg per 100mL. Breast milk zinc levels declined with postpartum time from 0.22 ± 0.011 at ≤ 1month postpartum to 0.09 ± 0.009mg per 100mL at > 9months postpartum (p-value < 0.001). Multiple linear regression showed that high breast milk zinc levels were predicted by younger maternal age, postpartum time, being employed, frequent consumption of multivitamins/minerals, and practicing exclusive breastfeeding. In conclusion, the breast milk zinc levels quantified among breastfeeding women in Palestine were comparable to those previously reported among non-malnourished women elsewhere. The findings of this study are informative to pediatricians, gynecologists, nurses/midwives, breastfeeding advisors/counselors, nutritionists, and policymakers who might be interested in designing and implementing interventions to improve breast milk zinc levels.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection Versus Vaccination in Pregnancy: Implications for Maternal and Infant Immunity.

BackgroundSARS-CoV-2 infection has been associated with adverse maternal and neonatal outcomes, yet uptake of SARS-CoV-2 vaccines during pregnancy and lactation has been slow. As a result, millions of pregnant and lactating women and their infants remain susceptible to the virus.MethodsWe measured Spike-specific immunoglobulin G (anti-S IgG) and A (anti-S IgA) in serum and breastmilk (BM) samples from 3 prospective mother-infant cohorts recruited in two academic medical centers. The primary aim was to determine the impact of maternal SARS-CoV-2 immunization vs infection and their timing on systemic and mucosal immunity.ResultsThe study included 28 mothers infected with SARS-CoV-2 in late pregnancy (INF), 11 uninfected mothers who received 2 doses of the BNT162b2 vaccine in the latter half of pregnancy (VAX-P) and 12 uninfected mothers who received 2 doses of BNT162b2 during lactation (VAX-L). VAX dyads had significantly higher serum anti-S IgG compared to INF dyads (p < .0001), while INF mothers had higher BM: serum anti-S IgA ratios compared to VAX mothers (p = .0001). Median IgG placental transfer ratios were significantly higher in VAX-P compared to INF mothers (p < 0.0001). There was a significant positive correlation between maternal and neonatal serum anti-S IgG after vaccination (r = 0.68, p = 0.013), but not infection.ConclusionsBNT161b2 vaccination in late pregnancy or lactation enhances systemic immunity through serum anti-S Ig, while SARS-CoV-2 infection induces mucosal over systemic immunity more efficiently through BM Ig production. Next generation vaccines boosting mucosal immunity could provide additional protection to the mother-infant dyad. Future studies should focus on identifying the optimal timing of primary and/or booster maternal vaccination for maximal benefit.

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.

An Observational Study on Effect of High Human Milk Intake on Oxidative Status of VLBW Infants

Background: Preterm infants are at high risk of oxidative stress injuries from various conditions such as low antioxidant capacity, relatively hyperoxia state outside utero, and possible immaturity of many organs. Human milk is an ideal nutrition and medication for these infants. It has antioxidative effects from both enzymatic and non-enzymatic constituents. Objective: To evaluate the beneficial effects of human milk on oxidative status and antioxidant capacity in very-low birth weight infants. Materials and Methods: The present research was a prospective cohort study conducted between January and December 2017. Preterm birthweight less than 1,500 grams were enrolled. Infants were divided into two groups based on breastmilk intake proportion, more than 50% or less than 50% of milk intake. Oxidative status was assessed using plasma malondialdehyde (MDA), and total antioxidant status (TAS) was assessed using Trolox equivalent antioxidant capacity (TEAC). Results: Nineteen (19) VLBW infants were enrolled. Six infants (32%) were in low breastmilk intake group and 13 infants (68%) received breastmilk 50% or more of total enteral intake. Plasma MDA at D1, D7, and D28 were 6.49±5.76, 9.49±6.77, and 6.96±4.84 μM in the low breastmilk intake group, and 8.68±4.44, 8.82±5.01, and 5.71±2.74 in the high breastmilk intake group (p&gt;0.05). Plasma TAS at D1, D7, and D28 were 4.06±0.87, 6.73±2.07, and 7.59±2.03 mmol of Trolox equivalence/L in the low breastmilk intake group, and 8.2±1.55, 7.4±2.29, and 6.58±1.9 mmol of Trolox equivalence/L in the high breastmilk intake group (p&gt;0.05). There was no difference in patient characteristics regarding gender, gestational age, birthweight, mode of delivery, surfactant use, duration of mechanical ventilation, or duration of oxygen supplementation. Conclusion: The present study was unable to demonstrate the differences of plasma MDA and total antioxidant capacity in VLBW infants. Therefore, further studies using more sensitive markers were suggested. Keywords: VLBW, Very low birth weight, Preterm, Oxidative stress, Human milk

The impact of maternal obesity and breast milk inflammation on developmental programming of infant growth.

Background:Little is known about how maternal obesity impacts breast milk (BM) composition and how BM composition may impact growth. We sought to determine the role of maternal body mass index (BMI) on BM inflammatory and oxidative stress markers and to delineate the role of these BM markers on infant growth.Methods:This was a secondary analysis of 40 mother-infant dyads. We first assessed the association between maternal BMI and BM marker (omega-6:omega-3 polyunsaturated fatty acid ratio (n-6:n-3 PUFA), leptin, interleukin (IL)-8, IL-6, IL-1β and malondialdehyde (MDA)) concentration at one (V1) and four (V4) months postpartum. We then examined the association between BM markers on infant growth trajectory from birth to seven months.Results:Higher maternal BMI was associated with higher BM n-6:n-3 PUFA (V1 β=0.12, 95% CI 0.01, 0.2; V4 β=0.13, 95% CI 0.01, 0.3) and leptin (V1 β=107, 95% CI 29, 184; V4 β=254, 95% CI 105, 403) concentrations. Infants exposed to high BM n-6:n-3 PUFA had higher BMI z-scores over time (p=0.01). Higher BM leptin was associated with lower infant percent fat mass at V4 (β=−9, 95% CI −17, −0.6). Infants exposed to high BM IL-8, IL-6, or IL-1β had higher weight z-scores over time (IL-8 p<0.001; IL-6 p<0.001; IL-1β p=0.02). There was no association between BM MDA and maternal BMI or infant growth.Conclusions:Higher maternal BMI is associated with higher BM n-6:n-3 PUFA and leptin concentrations. In addition, higher BM n-6:n-3 PUFA and inflammatory cytokines were associated with accelerated weight gain in infancy.

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

Retinopathy of prematurity risk factors: Does human milk prevent retinopathy of prematurity?

Akyüz-Ünsal Aİ, Key Ö, Güler D, Bekmez S, Sagus M, Akcan AB, Kurt-Omurlu İ, Anık A, Oruç-Dündar S, Türkmen M. Retinopathy of prematurity risk factors: Does human milk prevent retinopathy of prematurity? Turk J Pediatr 2019; 61: 13-19. The aim of this study was to investigate the risk factors for Retinopathy of Prematurity (ROP) development and the potential effect of human breast milk among these factors. For this purpose, infants admitted to a tertiary referral clinic for ROP screening and treatment between April 2013 and May 2015, were included in this retrospective study. The demographic data, accompanying diseases, previous surgery, type of feeding and duration of human breast milk intake were recorded. According to the ROP screening examination results, infants were divided into two groups as those with ROP (infants at any stage of ROP) and those without ROP. Relationship between the risk factors and ROP were evaluated. The comparison of 221 infants without ROP and 99 infants with ROP; revealed that gestational age at birth, birth weight, mechanical ventilation support, bronchopulmonary and cardiac diseases, hydrocephaly, any previous surgery, infections, steroid treatment percentages were high and human breast milk intake percentage was low among infants with ROP. Mean breast feeding time for infants with ROP (3.81 ± 2.33 month) was shorter than the infants without ROP (5.51 ± 1.43 month) (p < 0.001). In logistic regression analysis, the duration of breast feeding was inversely related with ROP (OR 0.744; 95% CI 0.621-0.891; p < 0,001). These results suggest that gestational age at birth and accompanying diseases are the main risk factors for the development of ROP. As the duration of the breast feeding of the infants without ROP was longer than the infants with ROP; breast feeding may have a preventive effect on ROP development.

Effect of innate antiviral glycoproteins in breast milk on seroconversion to rotavirus vaccine (Rotarix) in children in Lusaka, Zambia.

IntroductionRotavirus vaccines have been introduced into national immunization programmes to mitigate morbidity and mortality associated rotavirus diarrhoea. Lower vaccine effectiveness has however been noted in low-middle income countries, but little is known about the role of maternal components found in breast milk. This study assessed the effect of lactoferrin, lactadherin, and tenascin-c on rotavirus vaccine seroconversion.MethodsThis was a retrospective cohort study of 128 infants who had been fully immunized with Rotarix™. Serum samples were collected from the infant at baseline and one month after second rotavirus vaccine dose. Breast milk samples were collected from mothers at baseline. Standard ELISA was used to determine titres of rotavirus-specific immunologlobulin G and A in breast milk and serum as well as concentrations of lactoferrin, lactadherin, and tenascin-c. Poisson regression model with robust standard error was used to estimate the effect of breast milk components on seroconversion. The components were modelled on log base 2 so that the effect would be interpreted as a doubling of the concentration.ResultsIn a multivariable analysis adjusting for maternal age, maternal HIV status, seropositivity at baseline, sex, age of child at vaccination as well as breast milk IgA and IgG, we found evidence of independent effect of LA (Adjusted IRR = 0.95; 95% CI = 0.91–0.99; P = 0.019) on seroconversion while there was no evidence for TNC (Adjusted IRR = 1.00; 95% CI = 0.85–1.17; P = 0.967) and LF (Adjusted RR = 1.01; 95% CI = 0.96–1.05); P = 0.802). We explored the joint effects of the three components but we found no evidence (Adjusted RR = 0.95; 95% CI = 0.81; P = 0.535).ConclusionHigh breast milk concentrations of lactadherin might play a role in infant’s failure to seroconvert to rotavirus vaccines. Further research to understand this observed association is an important consideration.

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.

Evaluation of risk factors in MTCT among HIV-seropositive pregnant women in selected centers in Akure, South Western Nigeria

Background: The burden of mother-to-child transmission (MTCT) of HIV remains a major challenge in Nigeria, the country ranks highest globally. About 10% of global HIV-infected individuals live in Nigeria, of which 58% are women. The study analyzed risk and cofactors of MTCT in healthcare centers of Akure, Ondo State, Nigeria, between November 2014 and April 2016. Methods: A total of 240 pregnant women aged 19–43 years were recruited for the study, 114 HIV-seropositive mean age 31.81 years and 126 HIV-seronegative mean age 29.05 years as controls. High vaginal sawbs, breast milk, oropharynx, and neonates' nares were collected using sterile cotton-tipped applicator and introducing each into thioglycollate fluid medium for growth. Bacterial isolates were characterized by the standard microbiological methods and API kits. HIV serostatus of each participant was determined by HIV-1/2 strip and confirmed by Abbott enzyme-linked immunosorbent assay procedure. Sexually transmitted infections were detected by the enzyme immunoassays using commercial kits. Results: A total of 2,148 bacterial isolates were recovered from both cohorts (911 from HIV-seropositive, 864 HIV-seronegative, and 373 from neonates' nares). Predominant pathogens recovered were Staphylococcus aureus, Pseudomonas aeruginosa, and diverse corynebacteria as commensals. Coinfection of HIV with other sexually transmitted diseases (STDs) was prominent. About 92.1% of patients received combination ART. Neonates mortality rate was 10.5 and 7.8% mothers were potential transmitters. Spontaneous vaginal delivery accounted 91.7% deliveries. Conclusion: Incidence of STDs among HIV-seropositive was 77.5 and 22.5% for HIV-seronegative. Incidence of spontaneous vaginal delivery was 91.7% in HIV-seropositive women and 10.5% mortality rate recorded for neonates and 7.8% transmission for mothers posed high risk of MTCT, which is epidemiological significant.

Phenotypic and phylogenetic relatedness of selected Staphylococcus aureus strains cultured from HIV seropositive mothers and their neonate's pair

Background: Staphylococcus aureus is a major pathogen to man and is invasive when the skin is breached as well as in trauma. The frequency and transmission of S. aureus was determined in high vaginal swabs (HVS), oropharynx, and breast milk of human immunodeficiency virus (HIV)-seropositive women to their neonates at healthcare centres, Ondo State, Nigeria between November 2014 and December 2015. Materials and Methods: A total of 114 HIV pregnant women were screened for S. aureus isolates in the HVS, oropharynx, and breast milk employing sterile cotton tipped applicator. The swabs were subsequently introduced into sterile thioglycollate medium and incubated at 37°C for 24 h. When growth was noticed, a loopful was introduced onto freshly prepared mannitol salt agar (MSA). Colonies of cocci that fermented mannitol on MSA were presumptively deemed as S. aureus, but confirmed as S. aureus isolates by the slide and tube agglutination tests in pooled human plasma. HIV seropositivity was determined by the HIV1/2 strip (Determine Test, Alere, London, England, UK) and confirmed as such by enzyme-linked immunosorbent assay (Abbot laboratories, Chicago, USA). Phenotypes were determined by susceptibility testing and phylogenetic relatedness by random amplified polymorphic DNA polymerase chain reaction. Results: Results showed that 50 (43.85%) were colonized by S. aureus; however, 4 (8%) showed mother-to-child transmission from the three sites. Although all isolates tested were resistant to nalidixic acid and penicillin, 93.75% of isolates were sensitive to imipemen. Conclusion: The study revealed a high frequency of colonization of S. aureus in HVS (64%), oropharynx (20%), and breast milk (16%). Horizontal transmission from mother to neonate was 8% while phylogroups showed similarities in genetic relatedness.

Exosomes in Human Breast Milk Promote EMT.

Pregnancy increases breast cancer risk for all women for at least 5 years after parturition. During weaning and involution, the breast microenvironment becomes tumor promotional. Exosomes provide cell-cell communication during physiologic processes such as lactation, but also in breast cancer. We determined whether molecules in milk exosomes from healthy lactating women modulate the development and progression of breast cancer. Thirteen nursing women provided three (transitional, mature, and wean) milk samples. Exosomes were extracted and MCF7 and MCF10A breast cells labeled. The expression of six proteins linked to breast cancer was measured. On the basis of the findings, TGFβ2 concentration in exosome samples was measured, breast cells incubated with the exosomes and effect (epithelial-mesenchymal transition, EMT) on EMT-related proteins [E-cadherin, α-smooth muscle actin (α-SMA), filamentous (F)-actin and vimentin] measured. Human milk exosomes entered benign and malignant breast cells. The greatest change in wean milk protein was in TGFβ2 (P = 0.01). Exosomes with a high (but not low) level of TGFβ2 led to EMT in both cancer and benign cells, based on (i) change in cell morphology, actin cytoskeleton, and loss of cell-cell junction structure and (ii) increased α-SMA and vimentin and decreased E-cadherin. TGFβ2 is significantly upregulated in breast milk exosomes during weaning/early involution. Breast milk exosomes containing high levels of TGFβ2 induce changes in both benign and malignant breast epithelial cells, consistent with the development and progression of breast cancer, suggesting a role for high TGFβ2-expressing breast milk exosomes in influencing breast cancer risk. Clin Cancer Res; 22(17); 4517-24. ©2016 AACR.