Breast Milk Intake Research Articles

The Effect of Route of Administration and Vehicle on the Pharmacokinetics of THC and CBD in Adult, Neonate, and Breastfed Sprague-Dawley Rats.

Introduction: Basic pharmacokinetic (PK) and pharmacodynamic models of the phytocannabinoids Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are critical for developing translational models of exposure and toxicity. The neonatal period is a particularly important time to study the effects of cannabinoids, yet there are few studies of cannabinoid PKs by different routes such as direct injection or breast milk ingestion. To study this question, we have developed a translationally relevant rodent model of perinatal cannabinoid administration by measuring plasma levels of THC and CBD after different routes and preparations of these drugs. Materials and Methods: Adult animals and pups were injected with THC or CBD either intraperitoneally or subcutaneously, and plasma was analyzed by liquid chromatography-tandem mass spectrometry to measure cannabinoid levels collected at specified intervals. We also tested the effect of preparation of the drug using an oil-based vehicle (sesame oil) and an aqueous vehicle (Tween). Finally, we measured the plasma levels of cannabinoids in neonatal pups that were transmitted through breast milk after intraperitoneal injection to nursing dams. Results: We observed differences in the PK profiles of cannabinoids in adults and neonatal pups that were dependent on the route of administration and type of vehicle. Cannabinoids prepared in aqueous vehicle, injected intraperitoneally, resulted in a high peak in plasma concentration, which rapidly decreased. In contrast, subcutaneous injections using sesame oil as a vehicle resulted in a slow rise and low plateau in plasma concentration. Intraperitoneal injections with sesame oil as a vehicle resulted in a slower rise compared with aqueous vehicle, but an earlier and higher peak compared with subcutaneous injection. Finally, the levels of THC and CBD that were similar to direct subcutaneous injections were measured in the plasma of pups nursing from intraperitoneally injected dams. Conclusions: The route of administration and the preparation of the drug have important and significant effects on the PK profiles of THC and CBD in rats. These results can be used to create different clinically relevant exposure paradigms in pups and adults, such as short high-dose exposure or a low-chronic exposure, each of which might have significant and varying effects on development.

Analisa Faktor yang Mempengaruhi Kejadian Ikterik pada Neonatus

Jaundice is a symptom that is common in newborns. This jaundice usually disappears by the end of the first week or no later than the first ten days. This study aims to analyze the factors that influence the incidence of jaundice in neonates. This study used the literature review method by searching journals using three databases: PubMed, Google Scholar, and SpringerLink. Journal inclusion criteria published 2016 - 2021. Research results of jaundice in neonates. Factors that influence the incidence of neonatal jaundice in the Asian region, especially Southeast Asia, are maternal and perinatal. Maternal factors include gestational age, complications, pregnancy (incompatibility, ABO blood group, Rh and DM), type of delivery, and race. Perinatal factors include neonatal asphyxia, infection, birth trauma, low intake of breast milk, low birth weight (LBW), gender, and medication. The management of neonatal jaundice includes exposing the baby to the sun, phototherapy, adequate nutritional intake, and adequate breastfeeding. For this reason, health education and support from the husband and family are needed for the mother so that the baby does not experience jaundice.

ISLAMIC AND MEDICAL PARENTING EDUCATION AS AN EFFORT TO PREVENT STUNTING: A STUDY ON BREASTFEEDING MOTHERS IN YOGYAKARTA

As a country with a majority Muslim population, it is alleged that the level of understanding of the Indonesian Muslim community towards the verses of the Qur'an is low. The religiosity potential of people who have strong religious beliefs has not been utilized as a means of socializing the urgency of exclusive breastfeeding. One of the districts in Yogyakarta (Kulonprogo), has a high stunting rate in children, as a result of a lack of intake of breast milk in infants. This article aims to show the form of understanding of Yogyakarta Muslim mothers towards the verses of breastfeeding in the Qur'an and the factors of understanding these verses. This research uses a qualitative descriptive approach. Participants in the study consisted of 90 people, namely breastfeeding mothers in the districts of Sleman, Bantul, Kulonprogo, Gunung Kidul), and the city of Yogyakarta. The case study approach used data analysis. The low understanding of mothers about the commands and benefits of breastfeeding in the Qur'an has been caused by the low role of religious scholars/resources in bringing up the topic of breastfeeding commands, breastfeeding is part of worship in the Qur'an. This research has provided a new perspective in breastfeeding research that has so far been seen from a health perspective. This research seeks to combine health and religious approaches in understanding the benefits of breastfeeding. This paper recommends that it is necessary to optimize the role of Islamic scholars in studying the command to breastfeed in the Qur'an.

Chronic Health Risk for Chinese Adults and Breastfed Infants on Dietary Exposure to Chlorothalonil and Its Main Metabolite.

This study presents the first nationwide study on the chronic health risks of chlorothalonil and its metabolite (4-OH-chlorothalonil) for Chinese adults and breastfed infants via dietary intake. The determination of chlorothalonil and 4-OH-chlorothalonil in dietary samples was accomplished by cold-induced liquid-liquid extraction using liquid chromatography─high-resolution mass spectrometry. Chlorothalonil and 4-OH-chlorothalonil were detected in 43.1 and 46.1% of total dietary samples, respectively, while only 4-OH-chlorothalonil was detected in 100% of breast milk samples. Chlorothalonil and 4-OH-chlorothalonil residues in dietary samples of Northwest China and Shandong regions were higher in comparison to those of other regions. No correlation between 4-OH-chlorothalonil residues in breast milk and adult daily dietary intake to total chlorothalonil indicates the presence of other exposure routes besides dietary exposure. Furthermore, a residue analysis of 4-OH-chlorothalonil in breast milk between urban and rural areas in all sampling locales showed no statistical difference (p > 0.05). The findings of this study reveal that the chronic health risks caused by dietary exposure to chlorothalonil and 4-OH-chlorothalonil are low for Chinese adults and breastfed infants.

Corrigendum: Effect of pectoralis major myofascial release massage for breastfeeding mothers on breast pain, engorgement, and newborns' breast milk intake and sleeping patterns in Korea: a randomized controlled trial.

This corrects the article "Effect of pectoralis major myofascial release massage for breastfeeding mothers on breast pain, engorgement, and newborns’ breast milk intake and sleeping patterns in Korea: a randomized controlled trial" in Volume 29 on page 66.

Metabolizable Energy Content of Breastmilk Supports Normal Growth in Exclusively Breastfed Icelandic Infants to Age 6 Months

BackgroundNeither the global population nor individual countries have reached the World Health Organization (WHO) target of ≥50% of infants exclusively breastfed (EBF) until 6 mo. This may partly be because of the perceptions of insufficient milk and energy supply to meet rapid growth and development needs. ObjectivesIn a longitudinal observational study, we aimed to determine whether breastmilk energy content is sufficient to support growth during EBF until 6 mo. MethodsA sample of 27 EBF infants was dosed with doubly labeled water (DLW) at 5.6 mo to measure body composition, breastmilk intake, energy intake, and the metabolizable energy (ME) content of their mother’s breastmilk over the following week. Z-scores were calculated for anthropometry using WHO reference data and for fat-free mass (FFM) and fat mass (FM) using United Kingdom reference data. ResultsAnthropometric z-scores from birth indicated normal weight and length growth patterns. At ∼6 mo, the mean ± standard deviation (SD) FFM z-score was 0.22 ± 1.07, and the FM z-score was 0.78 ± 0.70, significantly >0. In the 22 infants with acceptable data, the mean ± SD measured intake of breastmilk was 983 ± 170 g/d and of energy, 318 ± 60 kJ/kg/d, equivalent to 75.9 ± 14.3 kcal/kg/d. The mean ME content of breastmilk was 2.61 kJ/g [standard error (SE) 0.1], equivalent to 0.62 kcal/g (SE 0.02). Mothers were positive toward breastfeeding, on paid maternity leave (planned mean 10 mo), and many (56%) had received specialized breastfeeding support. ConclusionsThe evidence from this study confirms that when mothers are motivated and supported without economic restraints, breastmilk intake and the energy supplied by breastmilk to EBF infants at 6 mo of age is sufficient to support normal growth patterns. There was no evidence of constraint on FFM, and other studies show that high FM in EBF infants is likely to be transient. These data further support the recommendation for EBF ≤6 mo of age for body composition.This trial was registered at clinicaltrials.gov as NCT02586571.

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.

Fluorinated liquid-crystal monomers in paired breast milk and indoor dust: A pilot prospective study

Fluorinated liquid-crystal monomers (FLCMs), one class of emerging persistent, bioaccumulative and toxic (PBT) compounds, are widely used in liquid-crystal displays (LCDs). As a result, they have been found in the environment and serum from occupational workers. However, little is known about their occurrence in non-occupational exposing populations. Herein, we provided an evaluation of the health risks of FLCMs for infants based on breastfeeding exposure and dust ingestion. The detection frequencies (DF) of FLCMs in indoor dust and breast milk was 100 %, with median concentrations of 12.00 ng/g dry weight (dw) and 133.40 ng/g lipid weight (lw), respectively. 1-butoxy-2,3-difluoro-4-(trans-4-propylcyclohexyl)benzene (BDPrB) was the predominant pollutant in indoor dust and human breast milk. Significant positive correlations were observed between the dust concentrations of seven FLCMs including BDPrB, and their breast milk concentrations (r = 0.275–0.660, P < 0.05). Further, associations were also found in some demographic and behavioral factors and concentrations of some FLCMs (P < 0.05). The highest EDI of ∑FLCMs was observed for infants who were < 1 month of age, with a median breast milk intake of 700.35 ng/kg bw/day, in which 1-ethoxy-2,3-difluoro-4-(trans-4-propylcyclohexyl)benzene (EDPrB), BDPrB, and 4′-[(trans, trans)-4′-butyl[1,1′-bicyclohexyl]-4-yl]-3,4-difluoro-1,1′-biphenyl (BBDB) collectively contributed 94.4 % of the total EDIs. Notably, the lactational intake of FLCMs was higher than that of some environmental pollutants (EPs). Overall, our results suggest higher exposure risks for infants and breastfeeding is the predominant exposure route for daily intake of FLCMs for infants.

Equally Good Neurological, Growth, and Health Outcomes up to 6 Years of Age in Moderately Preterm Infants Who Received Exclusive vs. Fortified Breast Milk-A Longitudinal Cohort Study.

Moderately preterm infants (32-36 weeks of gestational age) have an increased risk of worse health and developmental outcomes compared to infants born at term. Optimal nutrition may alter this risk. The aim of this study was to investigate the neurological, growth, and health outcomes up to six years of age in children born moderately preterm who receive either exclusive or fortified breast milk and/or formula in the neonatal unit. In this longitudinal cohort study, data were collected for 142 children. Data were collected up to six years of age via several questionnaires containing questions about demographics, growth, child health status, health care visits, and the Five to Fifteen Questionnaire. Data on the intake of breast milk, human milk fortification, formula, and growth during hospitalization were collected from the children's medical records. No statistically significant differences in neurological outcomes, growth, or health at six years of age were found between the two groups (exclusive breast milk, n = 43 vs. fortified breast milk and/or formula, n = 99). There is a need for research in larger populations to further assess potential effects on health and developmental outcomes when comparing the use of exclusive versus fortified breast milk for moderately preterm infants during neonatal hospitalization.

Development of QuEChERS coupled with UHPLC–MS/MS for simultaneous determination of eight neonicotinoid pesticides in breast milk

A speedy and hypersensitive method was built to detect eight neonicotinoid insecticides (neonics) in breast milk by ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). The breast milk was extracted with a mixture of acetonitrile and water and purified with primary secondary amine (PSA) and C18. The recovery of the method ranged from 74.3 to 105.9% with relative standard deviations (RSDs) of less than 10%, and the limit of detection ranged from 0.05 to 0.18ng/mL. Among 32 samples obtained from women 1month postpartum, thiamethoxam and imidacloprid were the most frequently detected neonics. Moreover, thiacloprid and imidaclothiz were not detected in any samples. The concentrations of neonics in breast milk ranged from 1.90 to 149.95ng/mL. Considering the toxic effects on mammals and even humans, infants who are exposed to neonics through ingestion of breast milk should receive extensive attention in future studies.

Family care reduces the incidence of neonatal sepsis: A systematic review and meta-analysis.

Family-involved care in the neonatal intensive care unit (NICU) helps to alleviate neonatal anxiety and promotes breastmilk intake, body growth and neurological development, but its effect on reducing the incidence of neonatal sepsis is not known. We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate whether neonates receiving family care have a lower incidence of neonatal sepsis compared to neonates receiving standard NICU care. MEDLINE, Embase, Web of Science, and CENTRAL were searched for RCTs that compared preterm neonates receiving family care vs. standard NICU care. From 126 articles that were identified and screened, 34 full-text articles were assessed for eligibility, and 5 RCTs were included. The primary outcome was the development of sepsis. The RevMan 5.4 software was used to conduct the Meta-analysis. The metanalysis, based on 5 RCTs demonstrated that neonates receiving family-involved care had significantly lower incidence of sepsis (12.0% vs. 16.3%), increased body weight, and reduced length of hospital stay compared to those receiving standard NICU care. This study suggests that family-involved care in NICU can (i) reduce the incidence of neonatal sepsis, (ii) improve growth, and (iii) reduce the length of hospital stay. This study highlights the need for evaluating whether family-involved care improves other neonatal outcomes.

The "Breastfeeding Paradox" as a Guide for the Assessment of Premature Infants Growth: It Is More Than Just Weigh-Ins.

One of the neonatologist's greatest challenges is ensuring that the premature infant has adequate growth and is provided with a correct supply of nutrients. Thanks to the establishment of the INTERGROWTH-21st Preterm Postnatal Growth Standards, created longitudinally and prospectively on healthy premature babies, it now appears evident that preterms' growth follows a pattern different from that of a fetus of the same gestational age. In addition to growth, defined solely as weight gain, further significance must be given to the quality of growth, that is, lean mass apposition. This should be evaluated in every clinical setting, using repeated standardized length and head circumference measurements, not only whether sophisticated dedicated equipment is available. Mother's milk, in addition to the countless already-known benefits, is also the perfect nourishment for premature babies, promoting lean mass apposition. In addition, with a still unclear mechanism called the "breastfeeding paradox," breast milk intake promotes preterms' neurocognitive development, even despite an initial lower weight gain. Since breast milk cannot always meet preterm infants' nutritional needs, breast milk fortification during hospitalization is a common practice. However, no clear benefit in continuing breast milk fortification after discharge has been demonstrated. When addressing the growth of a premature infant fed with human milk, the "breastfeeding paradox" must be taken into consideration to avoid excessive and unjustified supplementation of formula milk, both during the hospital stay and after discharge.

A randomized controlled trial of pectoralis major myofascial release massage for breastfeeding mothers: breast pain, engorgement, and newborns' breast milk intake and sleeping patterns.

Supportive interventions to improve breastfeeding practice are needed in nursing. This study investigated the effects of pectoralis major myofascial release massage (MRM) on breast pain and engorgement among breastfeeding mothers and on breast milk intake and sleep patterns among newborns. Breastfeeding mothers who had delivered between 37 and 43 weeks and had 7-to 14-dayold newborns were recruited from a postpartum care center in Gunpo, Korea. Participants were randomized to the MRM or control group. The outcome variables were breast pain and breast engorgement among breastfeeding mothers and breast milk intake and sleep time among newborns. The experimental treatment involved applying MRM to separate the pectoralis major muscle and the underlying breast tissue in the chest. After delivery, the first MRM session (MRM I) was provided by a breast specialist nurse, and the second (MRM II) was administered 48 hours after MRM I. Following MRM, breast pain (MRM I: t=-5.38, p&lt;.001; MRM II: t=-10.05, p&lt;.001), breast engorgement (MRM I: right, t=-1.68, p =.100; left, t=-2.13, p=.037 and MRM II: right, t=-4.50, p&lt;.001; left, t=-3.74, p&lt;.001), and newborn breast milk intake (MRM I: t=3.10, p=.003; MRM II: t=3.09, p=.003) differed significantly between the groups. MRM effectively reduced breast engorgement and breast pain in breastfeeding mothers, reducing the need for formula supplementation, and increasing newborns' breast milk intake. Therefore, MRM can be utilized as an effective nursing intervention to alleviate discomfort during breastfeeding and to improve the rate of breastfeeding practice (clinical trial number: KCT0002436).

The Antioxidant Capacity of Breast Milk and Plasma of Women with or without Gestational Diabetes Mellitus.

Women with gestational diabetes (GD) have reduced antioxidant capacity; however, the relationship between maternal diet, maternal biochemical capacity, breast milk concentration, and infant intake has not been adequately explored in the literature. An exploration of underlying mechanism(s) is warranted, particularly for nutrient antioxidants impacted by maternal intake. These nutrients may provide a means for modifying maternal and infant antioxidant capacity. Oxygen radical absorbance capacity (ORAC), alpha-tocopherol, ascorbic acid, and beta-carotene concentrations were measured in breast milk of women with and without GD. Plasma, three-day diet records, and breast milk were collected at 6 to 8 weeks postpartum. Student's t-test was used to compare breast milk ORAC, nutrient antioxidant concentration and plasma ORAC between women with and without GD. Pearson correlations were used to determine associations among antioxidant concentrations in breast milk and dietary antioxidant intake. Breast milk antioxidant concentrations were associated with maternal intake of beta-carotene (r = 0.629, p = 0.005). Breast milk and plasma ORAC and antioxidant vitamin concentrations were not significantly different between GD and NG women. Breast milk ORAC associated with breast milk alpha-tocopherol for NG (r = 0.763, p = 0.010), but not GD women (r = 0.385, p = 0.35), and with breast milk ascorbic acid for GD (r = 0.722, p = 0.043) but not NG women (r = 0.141, p = 0.70; interaction p = 0.041). In GD participants, breast milk ORAC was significantly associated with plasma ORAC (r = 0.780, p = 0.039). ORAC and antioxidant vitamin concentrations in breast milk in women with GD were comparable to women with NG; however, the relationships between breast milk ORAC and vitamin concentrations differed in GD versus NG women for alpha-tocopherol and ascorbic acid.

Appetite self-regulation in infancy - The role of direct breastfeeding

Infant feeding practices have a vital role to play in shaping the eating behaviour and overall health of individuals in both childhood as well as adulthood. A lesser-known advantage of breastfeeding in the global obesogenic environment, is its role in self-regulation of an infant’s appetite. Research demonstrates that children fed exclusively from the breast (that is, they are never bottle fed) develop the capacity for self-regulation of breastmilk intake – after all, mothers cannot possibly observe the quantity of milk the infant ingests. This encourages the infant to gain control, thus avoiding any overconsumption. On the other hand, bottle fed infants (whether mother’s milk or formula milk) are subjected to mother’s or other caregivers encouragement of bottle emptying. Since the regulation largely lies externally with the parent/caregiver on scheduled or timed feeding versus a cue feeding, this állows the possibility of such children being prevented from developing their own appetite responsiveness independently. Studies do find differences in satiety responses of children fed human milk with a bottle and those who were directly breastfed. Research has shown that directly breast-fed infants do not consume extra milk once their appetite stimulation phase ends. However, the teaching of bottle emptying during early infancy is positively associated with the weight gain. Such distinctions clearly emphasize the importance of breast feeding, but whether it is the milk composition (human or formula) or the mode of feeding (directly from breast or using bottle) that plays a bigger role in signalling appetite control warrants further examination. Considering that an infant’s weight gain or growth has a multifactorial causation, this review will highlight the association of direct breastfeeding with appetite signalling in infancy.

Infant Feeding, Gut Permeability, and Gut Inflammation Markers.

Increased gut permeability and gut inflammation have been linked to the development of type 1 diabetes. Little is known on whether and how intake of different foods is linked to these mechanisms in infancy. We investigated whether the amount of breast milk and intake of other foods are associated with gut inflammation marker concentrations and permeability. Seventy-three infants were followed from birth to 12 months of age. Their diet was assessed with structured questionnaires and 3-day weighed food records at the age of 3, 6, 9, and 12 months. Gut permeability was assessed with the lactulose/mannitol test and fecal calprotectin and human β-defensin-2 (HBD-2) concentrations were analyzed from stool samples at the age of 3, 6, 9, and 12 months. The associations between foods and gut inflammation marker concentrations and permeability were analyzed using generalized estimating equations. Gut permeability and gut inflammation marker concentrations decreased during the first year of life. Intake of hydrolyzed infant formula ( P = 0.003) and intake of fruits and juices ( P = 0.001) were associated with lower intestinal permeability. Intake of fruits and juices ( P < 0.001), vegetables ( P < 0.001), and oats ( P = 0.003) were associated with lower concentrations of HBD-2. Higher intake of breast milk was associated with higher fecal calprotectin concentrations ( P < 0.001), while intake of fruits and juices ( P < 0.001), vegetables ( P < 0.001), and potatoes ( P = 0.007) were associated with lower calprotectin concentrations. Higher intake of breast milk may contribute to higher calprotectin concentration, whereas several complementary foods may decrease gut permeability and concentrations of calprotectin and HBD-2 in infant gut.

Behavior Change Communication and Breastfeeding Practices Measured by Deuterium-Oxide Turnover Method Among Infants Aged 4-5 Months in Rural Senegal

Breastfeeding promotion is widely recognized as one of the most cost-effective investments in promoting optimal child health, growth, and development. Several studies have shown that breastfeeding education and counseling interventions have a significant impact on improving breastfeeding practices, including exclusive breastfeeding (EBF) rates. However, very few studies have evaluated the association between breastfeeding education and infant breast milk intake. The objective of this study was to assess the contribution of behavior change communication provided by the Nutrition Enhancement Program (NEP) on improving infant breast milk intake and breastfeeding practices. A comparative cross-sectional study was conducted in 12 Local Communities in rural Senegal, of which 6 were located in the NEP intervention area and the remaining, in the non-intervention area. Breast milk intake and EBF were measured using the deuterium dose-to-mother isotope dilution (DTM) in 140 mother-infant (4-5 mo.) pairs. Breastfeeding and complementary feeding practices were also assessed by questionnaire. Student's t-test, ANOVA, chi-square test and McNemar test were used to compare means and percentages. A mixed model linear regression was performed to identify the associated factors of breast milk intake, measured by DTM. Breast milk intake was significantly higher in infants from the NEP area (994.7 ±197.3 g/d), compared to those from the non-NEP area (913.6 ± 222.8) g/d), p=0.023. Consumption of water from sources other than breast milk was not different between the groups. EBF rates measured by DTM were 37.0% and 28.4% in the NEP area and the non-NEP area, respectively. There was no difference on exclusive breastfeeding rate between the two areas regardless of evaluation method. Stunting and wasting were associated with lower milk intake of 107.1 g/d and 211.9 g/d, respectively. Mothers' participation in behavior change communication activities improved infants' breast milk intake, but not EBF rates. Lower breast milk consumption was associated with stunting and wasting.

The impact of swaddling upon breastfeeding: A critical review.

Many parents swaddle their infants to promote sleep and reduce night-waking, however lack of definitive evidence about the pros and cons of swaddling when breastfeeding hinders postnatal recommendations regarding this infant care practice. This review critically examines research conducted on the impact of swaddling upon breastfeeding. Only two recent studies on swaddling outcomes have reported infant feed-type, therefore the purpose of this paper is to consider the known effects of swaddling on breastfeeding babies and their mothers. We interpret the existing literature on swaddling in terms of impact on breastfeeding physiology and behaviour during the immediate post-natal period, and as infancy progresses. Infants swaddled immediately after birth show a delay in initial breastfeeding, less successful suckling at the breast, reduced intake of breastmilk and greater weight loss compared to un-swaddled babies. Swaddling visually obscures feeding cues and reduces crying, thereby eliminating two key feeding prompts typically used by parents/carers. As swaddled babies cry less, and are fed less frequently than un-swaddled babies some clinical trials position swaddling as a 'novel weight regulation tool' to combat obesity. However, in the case of breastfed babies, by reducing feed frequency swaddling may impede maternal milk production and thereby infant growth.

Exclusive Breastfeeding Measured by Deuterium-Oxide Turnover Method is Associated with Motor Development in Rural Senegalese Infants

BackgroundThe findings on the relationship between breastfeeding and children’s motor development are very poor, particularly in low and middle income countries, because of the use of inadequate measures of breastfeeding practices. ObjectivesTo assess the relationship between exclusive breastfeeding, measured by the deuterium-oxide turnover method (DTM), and the acquisition of motor development in a cohort of Senegalese children. MethodsOne hundred forty mother-infant (4–5 mo) pairs were recruited and monitored up to 18 mo. Breast milk intake and breastfeeding practices were measured by DTM. Six stages of motor development were assessed: “sitting without support,” “hands-and-knees crawling,” “standing with assistance,” “walking with assistance,” “standing alone,” and “walking alone.” Acquisition age of motor milestones between exclusively breastfed (EBF) and not exclusively breastfed (non-EBF) infants was compared using Student’s and Wilcoxon’s tests. Mixed linear regression, adjusted with confounding factors, was used to determine the association between EBF and motor development. ResultsOverall, 32.9% of infants were EBF at the enrollment at 4–5 mo of age. Breast milk intake of EBF infants was significantly higher than that of non-EBF infants (1039 ± 193 g/d compared with 915 ± 211 g/d; P < 0.01). At 4–5 mo of age, only “sitting without support” (67.4% compared with 47.9%, P = 0.02) and “hands-and-knees crawling” (17.4% compared with 4.3%, P = 0.01) were completed significantly in the EBF group. At 18 mo, all children had completed all 6 motor developmental milestones. However, their acquisition age was significantly earlier in the EBF group after adjustment. Non-EBF infants had a delay of 0.4 to 0.5 mo on the acquisition of the first 5 stages compared to EBF infants. For “walking alone,” no difference was found after adjustment. ConclusionsMotor skill acquisition is earlier in EBF infants compared to non-EBF infants. This finding highlights the need to strengthen the advocacy for EBF up to 6 mo.

The Volume of Breast Milk Intake in Infants and Young Children: A Systematic Review and Meta-analysis.

Objective: The objective of this study was to provide global breast milk intake estimates for infants and children from 0 to 3 years old. Materials and Methods: A systematic search of online databases (Embase, MEDLINE, and CENTRAL) was conducted and complemented with a manual search of additional databases (African Journals Online and LILACS), reference lists, and unpublished data. Studies with apparently healthy mothers and their children 0-3 years old worldwide were included. Random effects meta-analyses, subgroup analyses, and meta-regressions were conducted. Results: A total of 167 studies on breast milk intake were identified. The mean daily breast milk intake among all the studies included was 670 mL per day and 117 mL/kg per day. Breast milk intake was influenced by infant age, infant body weight, and breastfeeding practices. The deuterium dilution method tended to yield higher estimates than test-weighing methods. Breast milk intake over time was modeled with a nonlinear meta-regression: breast milk intake (mL/day) = 51-1.4 × days +180 × log(days). When restricting to studies involving healthy term infants exclusively breastfed up to 6 months, breast milk intake was 624 mL per day and 135 mL/kg per day at 1 month, 735 mL per day and 126 mL/kg per day at 3 months, 729 mL per day and 107 mL/kg per day at 6 months, and 593 mL per day and 61 mL/kg per day at 12 months. Conclusions: This review provides global breast milk intake estimates for infants and young children. It demonstrates differences in intakes according to region and measurement method, as well as longitudinal changes over the first year of life.