Milk Feeding Research Articles

Modulating Gastrointestinal Microbiota in Preweaning Dairy Calves: Dose-Dependent Effects of Milk-Based Sodium Butyrate Supplementation.

Sodium butyrate (SB), an essential nutritional additive for livestock, has drawn notable interest for its potential for enhancing microbiota development in ruminant animals. This study aimed to assess SB's effects on ruminal and intestinal microbiota when added to milk for preweaning dairy calves nearing 45 days old. We administered SB in the calves' milk at four levels: 0 g/d (control), 4.4 g/d (low), 8.8 g/d (medium), and 17.6 g/d (high). After a six-week trial with ten replicates per group, ruminal fluid and fecal samples were collected for 16S rRNA sequencing, specifically targeting the V3-V4 regions to analyze microbiota. The results indicated an enhancement in ruminal microbiota, particularly in community richness, with low-level SB supplementation but minimal benefits from medium and high levels of supplementation. Increasing the level of SB supplementation had a negative impact on intestinal microbiota, affecting community richness and some potentially beneficial bacterial genera. However, low SB supplementation could positively adjust the communication between ruminal and intestinal microbiota. Overall, this study suggests feeding milk supplemented with a low level of SB to suckling calves close to an older age to promote ruminal microbiota development.

Comparative Efficacy of Breastfeeding or Feeding of Breast Milk on Blood Sampling Pain Relief in Full-Term Neonates: A Systematic Review and Meta-Analysis.

Objectives: To evaluate the efficacy of breastfeeding or feeding of breast milk in reducing blood sampling pain in full-term neonates by comparing with other intervention measures. Methods: Related literature was searched from PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials (Central). Only randomized controlled trials (RCTs), which reported the effect of breastfeeding or feeding of breast milk on blood sampling pain in full-term neonates, were eligible. The primary outcome was set as pain score on scales, and the secondary outcomes as physiological and behavioral indicators. The risk of bias in included studies was assessed by the Cochrane Collaboration's tool. Data analysis was performed using RevMan 5.4.1. Main Results: A total of 17 RCTs were included. Breastfeeding showed a stronger effectiveness in reducing blood sampling pain, compared with nonintervention, placebo, mother's holding, breast milk odor, mother's heartbeat, music therapy, skin-to-skin, and Eutectic Mixture of Local Anesthetics ointment. However, the efficacy of glucose or sucrose (12.5%-30% concentration) seems better than breastfeeding. When compared with other interventions, feeding of breast milk yielded different results. Its effect was only stronger than placebo (sterile water or distilled water), massage, or nonintervention. Conclusions: Breastfeeding might be effective for alleviating blood sampling pain in full-term neonates. Its effect is second only to that of glucose/sucrose. The efficacy of feeding of breast milk in reducing blood sampling pain in full-term neonates might not be guaranteed.

Effect of harvesting strategy of second-cut orchardgrass silage on feed intake, digestion, and milk production in dairy cows.

We investigated the effects of regrowth interval and first-cut timing on the dietary characteristics of second-cut orchardgrass silage and feed intake and milk production in dairy cows fed second-cut orchardgrass silage. The second-cut grasses were harvested 7w after the first-cut at the early stage (E7w) or at the heading stage (H7w), or harvested 6w after the first-cut at the early stage (E6w) from orchardgrass sward, and then ensiled. We evaluated the effect of regrowth interval by comparing E7w and E6w, and the effect of first-cut timing by comparing E7w and H7w. Six multiparous Holstein cows were used in a replicated 3×3 Latin square design, with three dietary treatments: diets containing E7w, E6w, or H7w silage at 30% dietary dry matter. We observed that feeding E6w silage instead of E7w silage increased fiber digestibility, dry matter intake, and milk production; however, the first-cut timing (E7w vs. H7w) did not affect nutrient content and digestibility, feed intake, or lactation performance. These results show that harvesting at short regrowth intervals for second-cut orchardgrass can be an effective strategy for improving feed utilization and milk yield; however, the first-cut timing for second-cut orchardgrass has little impact.

PremieFeed: Investigating Preterm Infant Feeding Behaviors, Growth, and Caregiver Experiences in the First Weeks After NICU Discharge.

This study aimed to longitudinally investigate the preterm infant feeding regimens, feeding behaviors, effect on infant growth, and caregiver perceptions and experiences with feeding in the first 4 weeks following hospital discharge. Preterm infants face high nutritional risk due to their underdeveloped gastrointestinal systems and feeding coordination. Caregivers of preterm infants were recruited to participate in a weekly telephone survey for the first 4 weeks following the infant's hospital discharge. Responses for infant feeding behaviors and caregiver experiences were scored on a 3-point Likert scale. Growth and feeding data were collected from the infant's first neonatal intensive care unit (NICU) developmental follow-up visit. Twenty-four caregivers completed the study. Changes in feeding regimens were common (8/24 infants; 33%), with the percentage of infants receiving any human milk feedings decreasing from 70% at hospital discharge to 54% at 4 weeks post-discharge. Poor infant feeding skills were weakly associated with poor caregiver feeding experiences, and 46% of caregivers reported contacting their healthcare provider with feeding-related questions. Thirty-eight percent of infants required nutritional intervention at NICU developmental follow-up visit. Infants who received fortified feedings during the first 4 weeks after hospital discharge grew an average of 2.5 g/day faster than infants who did not receive fortified feedings. The postdischarge period for preterm infants is characterized by feeding regimen changes, a decrease in human milk use, and caregiver questions about feeding. Future studies should further investigate the period after hospital discharge to enable better feeding support for preterm infants and their caregivers.

Breast Milk Feeding Initiation among Pregnant Persons with Hepatitis C Virus Infection – Surveillance for Emerging Threats to Pregnant People and Infants Network

Breast Milk Feeding Initiation among Pregnant Persons with Hepatitis C Virus Infection – Surveillance for Emerging Threats to Pregnant People and Infants Network

Urinary biomarkers of exposure to toxic and essential elements: A comparison of infants fed with human milk or formula.

Early-life exposure to nonessential (toxic) and essential trace elements can influence child development. Although infant formula powders and the water used to reconstitute them can contain higher concentrations of many elements compared with human milk, the influence of feeding mode on reliable biomarkers of infant exposure has rarely been demonstrated. We evaluated associations between urinary biomarkers and feeding mode (exclusively human milk, exclusively formula, or combination-fed) for four toxic (arsenic, cadmium, nickel, and uranium) and three essential elements (cobalt, molybdenum, and selenium) using general linear models. A total of 462 participants from the rural New Hampshire Birth Cohort Study were on average 6 weeks old between July 2012 and March 2019 and had urine samples, 3-day food diaries, and relevant covariate data available. In adjusted models, urinary arsenic was 5.15 (95% confidence interval = 4.04, 6.58), molybdenum was 19.02 (14.13-25.59), and selenium was 1.51 (1.35-1.68) times higher in infants fed exclusively with formula compared with infants fed exclusively with human milk. By contrast, urinary uranium was 0.59 (0.46-0.75) and cobalt was 0.78 (0.65-0.95) times lower with formula feeding than human milk feeding. Our findings suggest that infant exposure to several potentially toxic elements varies by feeding mode, as concentrations of reliable urinary biomarkers were higher with formula or human milk, depending on the element. Importantly, exposure to arsenic increased with household tap water arsenic regardless of feeding mode, suggesting that all infants could be at risk in populations with high concentrations of arsenic in drinking water.

Effect of Steam Pressure Toasting Duration on Snowbird Faba Bean Seeds and the Impact on the Intestinal and Metabolic Characteristics in Dairy Cows

The response of feedstuffs to thermal processing depends on the type of feed and the thermal processing methods being applied. Steam pressure toasting (SPT) has been used to modify the nutrient degradability and enhance the nutritional quality of pulses, including faba bean seeds (FBS). Strategic feeding approaches are essential for balancing diets and maintaining adequate nutrition, especially in high-performing ruminants. This research aimed to determine the effects of SPT duration in FBS on the intestinal and metabolic characteristics of dairy cows. Faba Bean seeds (three harvesting years) were processed at 121 °C for 0, 30, 60, 90, and 120 min. Rumen degradation and intestinal digestion were determined using the in situ and modified in vitro three-step techniques. The true protein supplied to the small intestine was also determined using the NRC and DVE systems. Our results showed a reduced total digested DM (TDDM) with longer SPT duration (quadratic, p = 0.02). The intestinally digested crude protein (IADP) increased from 62 to 220 g/kg DM with 0 to 120 min of SPT, respectively (p < 0.01), whereas the total tract digestible starch (TDSt) gradually decreased from 321 to 182 g/kg DM based on SPT time (p < 0.01). On the other hand, the truly digested protein in the small intestine (DVE) and the total metabolizable protein (MP) increased from 138 to 282 g/kg DM and 129 to 282 g/kg DM, respectively, with 0 to 120 min of SPT (quadratic, p < 0.01). The Feed Milk Value (FMV), based on both the DVE/OEB and NRC dairy nutrition systems, also increased with SPT (Quadratic, p < 0.01). The processing of FBS with SPT at 121 °C effectively reduced the highly degradable protein fraction in the rumen, shifting to a higher rumen undegraded protein (RUP) which was able to reach the small intestine. In the current study, the total MP, DVE, and FMV in dairy cows showed an overall increase with SPT in FBS.

Household food insecurity is negatively associated with achievement of prenatal intentions to feed only breast milk in the first six months postpartum.

Household food insecurity (HFI) has been associated with suboptimal breastfeeding practices. Postpartum factors reported by caregivers include stressful life circumstances and maternal diet quality concerns. It is unknown whether prenatal breast milk feeding intentions, a well-established predictor of breastfeeding outcomes, differ by HFI status. We explored associations between HFI and prenatal intentions to feed any and only breast milk in the first 6 months postpartum, and achievement of these intentions. We utilized data from self-identified biological mothers with children 6-12 months of age who responded to a retrospective, cross-sectional online infant feeding survey conducted in Nova Scotia, Canada. HFI (yes/no) was assessed using the Household Food Security Survey Module. Prenatal intentions to feed any and only breast milk were assessed based on responses to five options for infant milk feeding plans. Achievement of intentions was assessed by breast milk and formula feeding practices in the first 6 months. Multivariable logistic regressions were conducted, adjusting for maternal socio-demographics. Among 459 respondents, 28% reported HFI; 88% intended to feed any breast milk and 77% intended to feed only breast milk, with no difference by HFI status. Of those intending to feed any breast milk, 99% succeeded, precluding further analysis. Among mothers who intended to provide only breast milk, only 51% achieved their intention, with lower odds among those with HFI (aOR 0.54, 95% CI 0.29-0.98). HFI was not associated with intentions for feeding breast milk in the first 6 months postpartum, but mothers with HFI were less likely to achieve their intention to provide only breast milk. Further research is needed to understand the underlying reasons for this and to guide intervention designs to address HFI and help mothers reach their breastfeeding goals.

Effects of Live Saccharomyces cerevisiae Yeast Administration in Periparturient Dairy Cows

Dairy cows face several challenges during the transition period, and the administration of live yeast might be useful to mitigate this stressful condition. In the current study, the effects of live yeast administration on milk production, feed intake, and metabolic and inflammatory conditions were evaluated. Multiparous Holstein cows were enrolled in this randomized controlled trial and received either a control diet (CTR, n = 14) or the control diet plus 4 g/d of live Saccharomyces cerevisiae yeast (LSC, n = 14) from −21 to 56 days relative to calving. Dry matter intake, milk yield and composition, and rumination time were monitored daily. Blood samples were collected at −21, −7, 3, 14, 28, 42, and 56 days relative to calving to evaluate the metabolic profile. Fecal samples were collected at 56 days relative to calving to measure volatile fatty acids and feed digestibility. No differences between groups were observed in dry matter intake. Compared with CTR, rumination time was lower in LSC in after calving. Although there were no differences in milk components between groups, LSC had greater milk yield in the last three weeks of the study than CTR. No differences were observed in inflammatory markers or other plasma metabolites, except for β-hydroxybutyrate, which was higher in LSC, and reactive oxygen metabolites (ROMs), which were lower in LSC. Overall, these outcomes suggest that live yeast supplementation had some positive effects on milk yield and oxidative status.

Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula

Maternal milk feeding of extremely preterm infants during the birth hospitalization has been associated with better neurodevelopmental outcomes compared with preterm formula. For infants receiving no or minimal maternal milk, it is unknown whether donor human milk conveys similar neurodevelopmental advantages vs preterm formula. To determine if nutrient-fortified, pasteurized donor human milk improves neurodevelopmental outcomes at 22 to 26 months' corrected age compared with preterm infant formula among extremely preterm infants who received minimal maternal milk. Double-blind, randomized clinical trial conducted at 15 US academic medical centers within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants younger than 29 weeks 0 days' gestation or with a birth weight of less than 1000 g were enrolled between September 2012 and March 2019. Preterm formula or donor human milk feeding from randomization to 120 days of age, death, or hospital discharge. The primary outcome was the Bayley Scales of Infant and Toddler Development (BSID) cognitive score measured at 22 to 26 months' corrected age; a score of 54 (score range, 54-155; a score of ≥85 indicates no neurodevelopmental delay) was assigned to infants who died between randomization and 22 to 26 months' corrected age. The 24 secondary outcomes included BSID language and motor scores, in-hospital growth, necrotizing enterocolitis, and death. Of 1965 eligible infants, 483 were randomized (239 in the donor milk group and 244 in the preterm formula group); the median gestational age was 26 weeks (IQR, 25-27 weeks), the median birth weight was 840 g (IQR, 676-986 g), and 52% were female. The birthing parent's race was self-reported as Black for 52% (247/478), White for 43% (206/478), and other for 5% (25/478). There were 54 infants who died prior to follow-up; 88% (376/429) of survivors were assessed at 22 to 26 months' corrected age. The adjusted mean BSID cognitive score was 80.7 (SD, 17.4) for the donor milk group vs 81.1 (SD, 16.7) for the preterm formula group (adjusted mean difference, -0.77 [95% CI, -3.93 to 2.39], which was not significant); the adjusted mean BSID language and motor scores also did not differ. Mortality (death prior to follow-up) was 13% (29/231) in the donor milk group vs 11% (25/233) in the preterm formula group (adjusted risk difference, -1% [95% CI, -4% to 2%]). Necrotizing enterocolitis occurred in 4.2% of infants (10/239) in the donor milk group vs 9.0% of infants (22/244) in the preterm formula group (adjusted risk difference, -5% [95% CI, -9% to -2%]). Weight gain was slower in the donor milk group (22.3 g/kg/d [95% CI, 21.3 to 23.3 g/kg/d]) compared with the preterm formula group (24.6 g/kg/d [95% CI, 23.6 to 25.6 g/kg/d]). Among extremely preterm neonates fed minimal maternal milk, neurodevelopmental outcomes at 22 to 26 months' corrected age did not differ between infants fed donor milk or preterm formula. ClinicalTrials.gov Identifier: NCT01534481.

Economic and Clinical Impact of Using Human Milk-Derived Fortifier in Very Low Birth Weight Infants.

Background: Implementation of exclusive human milk (EHM) feeding defined as mother's own milk or donor human milk fortified with human milk-derived fortifiers can place an economic burden on institutions. Methods: Retrospective study of very low birth weight (VLBW) infants before and after the implementation of EHM feedings. Neonatal demographics and clinical outcomes including necrotizing enterocolitis, severe retinopathy of prematurity, bronchopulmonary dysplasia, late-onset sepsis, days on parenteral nutrition (PN), and length-of-stay were collected. The net cost to the institution was estimated using published data. Results: Sixty-four infants in the pre-EHM period and 57 infants in the post-EHM period were enrolled. Net product acquisition cost in 2020 and 2021 was $884,823. The EHM feeding guideline led to a reduction in the mean length of stay and mean days of PN use by 6.3 and 6.8 days per infant, respectively. This led to a cost saving of $1,813,444 ($31,815 per infant). No significant difference in incidence of short-term morbidities was observed. Combining the cost avoidance from clinical outcomes, the estimated financial impact over 2 years excluding insurance reimbursement was an estimated $ 913,840 ($16,032 per infant). Conclusion: Implementation of EHM-based feeding in VLBW infants is a cost-effective option for neonatal intensive care units that can result in reduced length of stay and days on PN without adversely impacting short-term morbidities.

Representation Matters: Content Analysis of Breastfeeding Images in a Commercial Stock Image Bank.

Several behavioral change theories posit that normative influences contribute to breastfeeding behaviors and disparities. Given that media has historically presented a narrow view of what is deemed normative in human milk feeding, this study describes who and what is represented in breastfeeding images available in a stock image bank, and whether differences exist based on the breastfeeding parent's skin color. Using content analysis, the most relevant 2% (n = 2284) of breastfeeding and lactation images in Adobe Stock were coded for 60 variables within 12 categories, such as skin color, ability, setting, skin exposure, etc. Descriptive statistics were used to characterize the sample, and the Chi-square test of independence and Mann-Whitney U test were used to compare images of breastfeeding parents with light and non-light skin color. Most images portrayed breastfeeding parents and breastfed children with light colored skin, only one child, an infant-aged child, and no other person. Scant images included accessories considered non-normative. Light skin parents were more frequently depicted with a wedding ring compared to non-light skin parents. Non-light skin parents were more often photographed outdoors compared to light skin parents. Images of light skin parents more frequently showed breast skin, whereas images of non-light skin parents more often showed nipple and/or areola skin. The paucity of diverse people and portrayals of breastfeeding in many ways mirror, and may even perpetuate, societal breastfeeding challenges and inequities. These findings highlight an immediate need for an expanded library of images showcasing a wider variety of breastfeeding experiences.

Effects of evaporative cooling systems on the performance of lactating sows in a tropical climate.

This study evaluated litter performance, behavioral and physiological parameters, and milk characteristics of sows submitted to different thermal environments. Fifty sows were distributed in a completely randomized design with two treatments: an evaporative cooling system (ECS) and a conventional system (CS). Sow and its litter were characterized as an experimental unit. The animals were weighed at equalization and weaning. Feed intake, milk production, and bromatological characteristics of milk were measured; the sows respiratory rate, rectal, and surface temperature were monitored. Litter uniformity was determined at equalization and weaning. Behaviors of the sows and litters were monitored for 24 h on the 7th and 15th day of lactation. Temperature and relative humidity inside the maternity was 25.00 to 28.00 °C and 26.00 to 32.55 °C and 30.00 to 70.00% and 70.00 to 88.00%, respectively, considering ECS and CS. Nutritional quality of the milk remained stable during lactation in both systems evaluated. ECS improved the average weight of the piglets, weaning weight, and daily milk production by 0.038, 0.699, and 2.31 kg/day, respectively. Sows housed in the ECS had a reduction in physiological parameters and, increase in inactive alert behavior (1.79 percentage points) and breastfeeding behavior. Piglets showed a decrease of 2.43% in the range of feedings at night and 0.15% during the day. ECS provided better comfort to the sows at the expense of the CS and, consequently, better litter performance.

Metagenomics reveals the temporal dynamics of the rumen resistome and microbiome in goat kids

BackgroundThe gut microbiome of domestic animals carries antibiotic resistance genes (ARGs) which can be transmitted to the environment and humans, resulting in challenges of antibiotic resistance. Although it has been reported that the rumen microbiome of ruminants may be a reservoir of ARGs, the factors affecting the temporal dynamics of the rumen resistome are still unclear. Here, we collected rumen content samples of goats at 1, 7, 14, 28, 42, 56, 70, and 84 days of age, analyzed their microbiome and resistome profiles using metagenomics, and assessed the temporal dynamics of the rumen resistome in goats at the early stage of life under a conventional feeding system.ResultsIn our results, the rumen resistome of goat kids contained ARGs to 41 classes, and the richness of ARGs decreased with age. Four antibiotic compound types of ARGs, including drugs, biocides, metals, and multi-compounds, were found during milk feeding, while only drug types of ARGs were observed after supplementation with starter feed. The specific ARGs for each age and their temporal dynamics were characterized, and the network inference model revealed that the interactions among ARGs were related to age. A strong correlation between the profiles of rumen resistome and microbiome was found using Procrustes analysis. Ruminal Escherichia coli within Proteobacteria phylum was the main carrier of ARGs in goats consuming colostrum, while Prevotella ruminicola and Fibrobacter succinogenes associated with cellulose degradation were the carriers of ARGs after starter supplementation. Milk consumption was likely a source of rumen ARGs, and the changes in the rumen resistome with age were correlated with the microbiome modulation by starter supplementation.ConclusionsOur data revealed that the temporal dynamics of the rumen resistome are associated with the microbiome, and the reservoir of ARGs in the rumen during early life is likely related to age and diet. It may be a feasible strategy to reduce the rumen and its downstream dissemination of ARGs in ruminants through early-life dietary intervention.ALjrPAe7hUkeePWTGYd3KaVideo

Analysis of the Fecal Metabolomic Profile in Breast vs. Different Formula Milk Feeding in Late Preterm Infants.

Human milk is the gold standard for infant nutrition, but when it is not available or insufficient to satisfy the needs of the infant, formula milk is proposed as an effective substitute. A prospective observational cohort study was conducted on late preterm infants fed with breast and two different formula milks. On this basis, they were divided into three groups: group FMPB (fed with formula + postbiotic), group FM (fed with standard formula), and group BM (breastfed). Stool samples for a metabolomic study were collected at T0 (5-7 days after birth), T1 (30 days of life), and T2 (90 days of life), giving rise to 74 samples analyzed via liquid chromatography coupled with high-resolution mass spectrometry. The T0, T1, and T2 LC-MS raw data were processed for Partial Least Square Discriminant Analysis (PLS-DA), followed by a statistical analysis. This preliminary study highlighted a good overlapping between the fecal metabolome of breast and substitute feeding systems, confirming the efficacy of the formula preparations as breast milk substitutes. Moreover, several similarities were also detected between the FMPB and BM metabolome, highlighting that the addition of a postbiotic to standard formula milk could be more effective and considered a better alternative to breast milk.

Effects of dietary palmitic acid and oleic acid ratio on milk production, nutrient digestibility, blood metabolites, and milk fatty acid profile of lactating dairy cows

Adequate energy supply is a crucial factor for maintaining the production performance in early lactating cows. Adding fatty acids to diets can improve energy supply, while the effect could be related to the chain length and degree of saturation of fatty acids. This study was conducted to evaluate the effect of different ratios of palmitic acid (C16:0) to oleic acid (cis-9 C18:1) on the production performance, nutrient digestibility, blood metabolites and milk fatty acids profile in early lactating dairy cows. Seventy-two multiparous Holstein cows (63.5 ± 2.61 d in milk) blocked by parity (2.39 ± 0.20), body weight (668.3 ± 20.1 kg), body condition score (3.29 ± 0.06), and milk yield (47.9 ± 1.63 kg) were used in a completely randomized design. Cows were divided into 3 groups with 24 cows in every group. Cows in 3 treatments were provided iso-energy and iso-nitrogen diets, whereas the C16:0 to cis-9 C18:1 ratio was different: (1) 90.9% C16:0 + 9.1% cis-9 C18:1 (90.9:9.1); (2) 79.5% C16:0 + 20.5% cis-9 C18:1 (79.5:20.5); (3) 72.7% C16:0 + 27.3% cis-9 C18:1 (72.7:27.3). Fatty acids were added at 1.3% in dry matter basis. Although the dry matter intake fat-corrected milk yield and energy-corrected milk yield were not affected, the milk yield, milk protein yield and feed efficiency increased linearly with the increasing of cis-9 C18:1 ratio. The milk protein percentage and milk fat yield did not differ among treatments, whereas the milk fat percentage tended to decrease linearly with the increasing of cis-9 C18:1 ratio. The lactose yield increased linearly and lactose percentage tended to increase linearly with increasing cis-9 C18:1 ratio, whereas the percentage of milk total solids and somatic cell count decreased linearly. Though the changes of body condition score were not affected by treatments, the body weight loss decreased linearly with the increasing of cis-9 C18:1 ratio. The effect of treatment on nutrient digestibility was limited, except a linear increase in ether extract and neutral detergent fiber digestibility with the increasing of cis-9 C18:1 ratio. There was a linear increase in the concentrations of plasma glucose, whereas the triglyceride and nonesterified fatty acid concentration decreased linearly with the increasing of cis-9 C18:1 ratio. As the cis-9 C18:1 ratio increased, the concentration of de novo fatty acids decreased quadratically, while the mixed and preformed fatty acids increased linearly. In conclusion, increasing cis-9 C18:1 ratio could increase production performance and decrease body weight loss by increasing nutrient digestibility, and the ratio had the most powerful beneficial effect on early lactating cows suggested by 72.7:27.3.

Using a new human milk fortifier to optimize human milk feeding among very preterm and/or very low birth weight infants: a multicenter study in China

BackgroundHuman milk fortifier (HMF) composition has been optimized recently. But clinical evidence of its safety and efficacy is limited in Chinese population. The aim of this study was to evaluate effects of a new HMF in growth, nutritional status, feeding intolerance, and major morbidities among very preterm (VPT) or very low birth weight (VLBW) infants in China.MethodsVPT/VLBW infants admitted from March 2020 to April 2021 were prospectively included in the experimental (new HMF, nHMF) group, who received a new powdered HMF as a breast milk feeding supplement during hospitalization. Infants in the control group (cHMF) admitted from January 2018 to December 2019, were retrospective included, and matched with nHMF group infants for gestational age and birth weight. They received other kinds of commercially available HMFs. Weight gain velocity, concentrations of nutritional biomarkers, incidence of major morbidities, and measures of feeding intolerance were compared between the two groups.ResultsDemographic and clinical characteristics of infants in nHMF and cHMF groups were comparable. Weight gain velocity had no significant difference between the nHMF (14.0 ± 3.5 g/kg/d) and the cHMF group (14.2 ± 3.8 g/kg/d; P = 0.46). Incidence of morbidities, including necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, culture-confirmed sepsis, and feeding intolerance during hospitalization between nHMF and cHMF, were similar (all P-values > 0.05). The time to achieve full enteral feeding [13.5 (10, 21) days] in the nHMF group was significantly shorter than that in the cHMF group [17 (12, 23) days, HR = 0.67, 95%CI: 0.49, 0.92; P = 0.01]. Compared with cHMF group, the decrease of blood urea nitrogen level over time in nHMF group was smaller (β = 0.6, 95%CI:0.1, 1.0; P = 0.01).ConclusionsThe new HMF can promote growth of preterm infants effectively without increasing the incidence of major morbidity and feeding intolerance. It can be used feasible in Chinese VPT/VLBW infants.Trial registrationThis study was registered on ClinicalTrials.gov (NCT04283799).

Considering the Influence of Social Determinants of Health on Parent Feeding Practices: A Case Example.

Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. SDOH can be grouped into 5 domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. SDOH impact people's health and quality of life but may also contribute to disparities in access to food, education, and healthcare. SDOH uniquely influence parent feeding practices in the neonatal intensive care unit (NICU) in a variety of ways, ranging from logistical considerations for parent visitation to cultural beliefs such as family perception of human milk feeding. A hypothetical case example of a preterm infant with a feeding disorder in the NICU is used to connect SDOH that influence prenatal health, parental lived experience, and postnatal medical care to maternal and infant outcomes with implications for feeding practices. Barriers and facilitators to successful feeding practices in the NICU and at discharge are considered for each SDOH domain. This case example increases awareness of SDOH and how they influence parent feeding practices in the NICU, focusing on the intersection of SDOH, parent stress, and oral feeding outcomes. Examples were provided for how to support applying findings into practice. By being creating a culture of SDOH awareness, NICU staff can assist families in overcoming barriers by putting supports in place to increase equitable participation in developmentally supportive feeding practices during the NICU stay.

Should Pre-Weaning Calf Diets Include Forage?

The present review article aimed to update and address the biological consequences of forage supply to pre-weaned dairy calves. Early growth and development of a calf play a great role in lifelong performance of the animal. Comprehension of these stages is an important progress achieved in calf nutrition today. Health, milk-solid feed intake and rumen development are the most important factors related to calf growth in pre- and post-weaning periods. It is well understood that fermentation by-products of grain-based starter feeds are essential for increased growth and absorptive capacity of the rumen papillae. In pre-weaned calves, two major hypotheses exist regarding forage feeding. The first hypothesis describes that the rumen was not completely developed in pre-weaned calves and forage supply during this period might increase gut fill and hence, decrease starter intake. It is believed that depressed starter intake may limit energy intake and finally suppress calf growth rate. The second hypothesis indicates that rumen pH may decline as calf age and starter intake increases. Accordingly, forage supplementation into calf starter diets could prevent further rumen pH decline and subsequent negative consequences while improving starter intake and calf growth. Because research data regarding these hypotheses are controversial, there is no universally accepted standard for feeding calves with forage as a part of starter diets. Many factors, such as milk feeding method, grain, forage type and experimental conditions, could affect calf response to dietary forage. However, there is an evidence that limited consumption of forage may be beneficial on rumen health and behavior of calves consuming highly processed (pelleted or finely ground) starter feed in pre-weaning period.
 Keywords: Forage; Growth performance; Pre-weaned calf; Rumen development

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

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