Milk Formula Research Articles

Building resilience in the infant formula milk supply chain

In recent years, Infant Formula Milk (IFM), a vital source of nutrition for infants lacking breast milk in their first two years, has been plagued by diverse and severe global supply chain disruptions. These challenges have triggered shortages, compromised product quality, and threatened food security, leading to dire health consequences and even fatalities among infants. However, despite the criticality of IFM, current research is lacking in terms of how to build or improve the resilience of IFM supply chains. This paper presents a detailed framework for building a resilient IFM supply chain. A key pillar of this framework is a comprehensive analysis of potential hazards. Using the Hazard and Operability Analysis (HAZOP) method, 91 potential hazards were identified across the entire IFM supply chain. Subsequently, a clustering method identified 17 critical risks with irreversible consequences for infant health and supply chain flow. Finally, mitigation strategies that combine traditional approaches with 4.0 technology-enabled solutions are proposed. Adapting this framework can provide valuable insights for IFM supply chain stakeholders, enabling them to secure the vital flow of this life-sustaining product and safeguard the health and well-being of infants.

Targeted quantification and untargeted exploration of furan and derivatives in infant food by headspace extraction-gas chromatography-Q Exactive Orbitrap mass spectrometry

The aim of the present study was to assess the performance and complementarity of methods capable of both quantifying furan, 2-Methylfuran (2-MF) and 3-Methylfuran (3-MF) in infant foods, but also to comprehensively explore other furan derivatives. It is more particularly a question of validating and comparing the couplings of the two headspace extraction methods most used for the analysis of furan compounds − Headspace Solid Phase Microextraction (HS-SPME) and Static HeadSpace (SHS) – with gas chromatography hyphenated to a high-resolution mass detector (Q Exactive-Orbitrap MS) which allows both targeted quantification and suspect screening. Firstly, the accuracy profile approach was implemented to assess, validate and compare HS-SPME- and SHS-GC-Q Exactive-Orbitrap MS for the quantification of furan in two model infant foods, apple puree and first infant formula. SHS-GC-Q Exactive-Orbitrap MS, showed better accuracy (uncertainty < 17.2 % vs 22.5 % for HS-SPME GC-Q Exactive-Orbitrap MS) and better sensitivity (LOQ < 2.8 vs LOQ < 4.0 µg/kg) over a broader validation range (2–100 µg/kg vs 5–100 µg/kg in apple puree). Secondly, SHS-GC-Q Exactive-Orbitrap MS was assessed and validated by accuracy profile for the quantification of 2-MF and 3-MF, with performance close to those for furan except for 3-MF in apple puree. Thirdly, SHS-GC-Q Exactive-Orbitrap MS was used to quantify the levels of these compounds in 20 commercial samples (n = 3) belonging to the four main categories of infant food (infant formulae, fruit purees, infant cereals, vegetable/fish baby meals). Furan was quantified in 75 % of the samples, with maximum levels in the vegetable/fish-based infant foods (up to 127 µg/kg) while 2-MF and 3-MF were quantified in 45 % and 15 % of products respectively, with maximum levels of 14.1 µg/kg in follow-on formula 3rd age and 9.2 µg/kg in apple puree. Finally, SHS- and HS-SPME-GC-Q Exactive-Orbitrap MS data of the 20 infant products were processed in suspect screening mode using Compound DiscovererTM software. Coupling with HS-SPME, it made it possible to identify 13 additional furan derivatives, i.e. 5 more than with SHS. The relevance and safety status of the compounds identified are discussed.

Estimating carbon and water footprints associated with commercial milk formula production and use: development and implications of the Green Feeding Climate Action Tool

Estimating carbon and water footprints associated with commercial milk formula production and use: development and implications of the Green Feeding Climate Action Tool

Comparative Effect of Breast Milk and Infant Formulae on Neonatal Gut Microbiome within Katsina Metropolis

Study’s Novelty/ Excerpt This study explored the impact of breast milk versus infant formula on the gut microbiota of neonates in Katsina metropolis, revealing significant differences in bacterial composition and fecal pH between the two groups. Exclusively breastfed infants exhibited a lower fecal pH (5.09±0.1) and higher weights, with similar levels of Escherichia spp. and Bifidobacterium spp., while formula-fed infants showed a higher fecal pH (5.9±0.1) and differences in Escherichia spp. loads. Despite advances in infant formula enrichment, the study underscores the distinct influence of breast milk on neonatal gut microbiota composition and health. Full Abstract Numerous studies conducted in recent years have highlighted the intricate nature of the neonatal gut microbiome, influenced by various intrinsic and extrinsic factors. One significant factor in this regard is the type of feeding, which has a substantial impact on the development of intestinal microbiota in early infancy. This study aimed to compare the effects of breast milk and infant formulae on the gut microbiota of newborns in Katsina metropolis. Faecal samples were obtained from 46 neonates (33 exclusively breastfed, 10 formula-fed, and 3 mix-fed) and analyzed using a culture-dependent method. Colony enumerations and pH measurements were conducted for comparison between the groups. The mean weight of the participants was 2.88±0.1 kg, with exclusively breastfed infants (BFI) weighing significantly more (p = 0.03) than formula-fed infants (FFI). The bacteria selected for analysis (Bifidobacterium spp., Staphylococcus spp., Escherichia spp., and Lactobacillus spp.) were present in all feeding groups. Among BFI, similar levels of Escherichia spp. and Bifidobacterium spp. (61.17 CFU/g and 61.38 CFU/g respectively) were observed. Staphylococcus spp. constituted the majority of the bacterial load (32%) in both BFI and FFI groups. Apart from Escherichia spp. (p = 0.01), no significant differences were noted in the levels of all cultured bacteria across the feeding groups. The disparity in Escherichia spp. load was evident between BFI and MFI (p = 0.01), as well as FFI and MFI (p = 0.02) only. There was no overall significant correlation between bacterial load and mode of delivery within the feeding groups (p = 0.6). The average faecal pH of breastfed infants (5.09±01) was significantly lower (p = &lt;0.001) compared to the formula-fed group (5.9±0.1). Despite advancements in enriching infant formulae with probiotics and other bifidogenic substances, subtle differences in fecal bacterial load compared to breast milk persist, highlighting the significant influence of both feeding methods on the composition and functionality of the neonatal gut microbiome

HPLC-QQQ-MS/MS-based authentication and determination of free and bound sialic acids content in human, bovine, sheep, goat milk, and infant formula.

An accurate method for qualitative and quantitative analysis of lipid-bound (LB), protein-bound (PB), oligosaccharides-bound, and free sialic acids in milk was developed by using high-performance liquid chromatography -triple quadrupole-tandem mass spectrometer. The profile of free and bound sialic acids in milk (human, bovine, goat, and sheep) and infant formula (IF) was examined in the present study. Human milk contains only N-acetylneuraminic acid (Neu5Ac) and was mainly present in the form of oligosaccharide-bound. The content of total Neu5Ac (T-Neu5Ac), free and bound Neu5Ac in human milk decreased with the prolongation of lactation. The most intriguing finding was the increase in the proportion of PB and LB sialic acids. The sialic acids in bovine and sheep milk were mainly PB and oligosaccharides-bound Neu5Ac. T-Neu5Ac in goat milk (GM) was 67.44-89.72µg/mL and was mainly PB Neu5Ac, but total N-glycolylneuraminic acid (T-Neu5Gc) content of GM can be as high as 100.01µg/mL. The concentration of T-Neu5Gc in sheep and GM was significantly higher than that of bovine milk (BM). T-Neu5Gc content of GM -based IF was 264.86µg/g, whereas T-Neu5Gc content of BM -based IF was less (2.26-17.01µg/g). Additionally, our results found that there were also sialic acids in IF ingredients, which were mainly bound with protein and oligosaccharides, primarily derived from desalted whey powder and whey protein concentrate.

Donor human milk versus infant formula for low-risk infants: a systematic review.

There is an increasing acceptance and use of donor human milk (DHM) in healthy infants. This review investigates the benefits and risks of mothers' own milk (MOM) supplementation with DHM compared to infant formula (IF) in moderate-late preterm (MLP) and early term (ET) infants. MEDLINE, EMBASE, CINAHL, Scopus, Cochrane CENTRAL and clinical trial registries were searched for studies published up to September 2023. The primary outcome was rates of exclusive breastfeeding (EBF). Certainty of evidence was assessed using GRADE framework. RoB1 and EPHPP were used to assess risk of bias for controlled trials and observational studies, respectively. Eleven studies involving total of 10,147 infants and six ongoing trials were identified. Studies were of low quality, and the certainty of evidence was assessed as very low. Three studies suggested benefits of DHM compared to IF on EBF at discharge, while two suggested no difference. No clear effect was observed on EBF duration, any breastfeeding, hypoglycemia and morbidity. No health risks were reported. The effect of supplementing MOM with DHM instead of IF on EBF and other health outcomes is unclear. High-quality studies are required to determine the potential benefits or risks of DHM supplementation in this population. We identified 11 relevant studies reporting on supplementation of mothers' own milk (MOM) with donor human milk (DHM) compared to infant formula (IF). Studies were of low quality, had heterogeneous outcome definitions and were geographically limited; all except two were observational studies. Limited evidence showed no clear difference on rates of exclusive breastfeeding and other health outcomes. No potential risks were reported. The increasing acceptance and use of DHM in healthy infants highlights the need for future high-quality studies.

Infant Feeding Pattern during the First Six Months of Age among Primipara Mothers

The exclusive breastfeeding (EBF) rates are low globally and in Saudi Arabia. This study aimed to identify the type of infant feeding practiced during the first six months of age and determine if there is an association between demographic characteristics and the type of breastfeeding. A descriptive cross-sectional survey was conducted on 401 primipara mothers who attended 15 primary health care centers (PHCCs)by using a self-administered questionnaire. Only 17.2% of infants were exclusively breastfed, and 65.8% were given mixed feeding in the first six months of life. The breastfeeding rate declined from 99.8% in the first month to 76.3% by six months, with a corresponding increase in the use of formula milk, plain water and dates from 31.7%, 24.9%, and 24.7% in the first month to 53.1%. 49.1%, and 32.7% in the six months, respectively. Mothers also used herbs, lump sugar, glucose water and honey every month. A chi-square test reveals no association between the demographic characteristics and type of breastfeeding (EBF, predominant breastfeeding and mixed feeding). The primipara mothers had low EBF rates indicating the need to provide culture-specific education, support and counselling.

Feeding modes and persistent diarrhea: A comparative case–control study in infants in Hodeida, Yemen

Objectives: Diarrhea is a major cause of morbidity and mortality among infants globally. Infant feeding practices influence diarrhea risk, but its relationship requires further investigation, especially in Yemen. This study aims to identify associations between feeding modes (breastfeeding, mixed feeding, formula, and goat milk) and persistent diarrhea in Yemeni infants. Material and Methods: A hospital-based case–control study was conducted from January to June 2020 in Hodeidah, Yemen. The cases were 240 infants aged 2–24 months with persistent diarrhea. Controls were 120 age-matched healthy infants. Caregiver interviews collected data on feeding practices. Odds ratios (OR) estimate relationships between exposures and persistent diarrhea. Results: We observed a protective effect of breastfeeding against persistent diarrhea, with breastfed infants having a significantly lower risk of developing persistent diarrhea compared to non-breastfed infants (OR: 0.43, 95% confidence interval [CI]: 0.27–0.68, P = 0.037). In addition, we found a significant association between goat milk consumption and persistent diarrhea, with infants who consumed goat milk having a higher risk of persistent diarrhea (OR: 4.67, 95% CI: 1.15–19.01, P = 0.009). While mixed feeding showed a potential increased risk of persistent diarrhea compared to exclusive breastfeeding, the wide CI indicated that this association was not statistically significant and required further research (OR: 1.86, 95% CI: 1.09–3.18). In contrast, the association between formula feeding and persistent diarrhea was inconclusive and not statistically significant (P = 0.938; OR: 0.867, 95% CI: 0.353–2.128), suggesting no significant relationship. These results highlight the protective effect of breastfeeding and the potential risks of goat milk consumption, while relationships between mixed/formula feeding and persistent diarrhea require more evidence. Conclusion: Certain feeding practices increase the risk of persistent diarrhoea in Yemeni infants. Promoting exclusive breastfeeding and complementary feeding guidance alongside tailored behavior change strategies, especially in rural communities can help address these modifiable risk factors.

Comparison of protein digestibility of human milk and infant formula using the INFOGEST method under infant digestion conditions.

Many improvements have been made to bring infant formula (IF) closer to human milk (HM) regarding its nutritional and biological properties. Nevertheless, the protein components of HM and IF are still different, which may affect their digestibility. This study aimed to evaluate and compare the protein digestibility of HM and IF using the infant INFOGEST digestion method. Pooled HM and a commercial IF were subjected to the infant INFOGEST method, which simulates the physiological digestion conditions of infants, with multiple directions, i.e. the curd state, gel images of SDS-PAGE, molecular weight distribution, free amino acid concentrations and in vitro protein digestion rate. HM underwent proteolysis before digestion and tended to have a higher protein digestion rate with finer curds during gastric digestion, than the IF. However, multifaceted analyses showed that the protein digestibility of HM and IF was not significantly different after gastrointestinal digestion. In conclusion, the infant INFOGEST method showed that the digestibility of HM and IF proteins differed to some extent before digestion and after gastric digestion, but not at the end of gastrointestinal digestion. The findings of this study will contribute to the refinement of IF with better protein digestibility in infant stomach.

Scientific opinion on the tolerable upper intake level for iron.

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the tolerable upper intake level (UL) for iron. Systematic reviews were conducted to identify evidence regarding high iron intakes and risk of chronic diseases, adverse gastrointestinal effects and adverse effects of iron supplementation in infancy, young childhood and pregnancy. It is established that systemic iron overload leads to organ toxicity, but no UL could be established. The only indicator for which a dose-response could be established was black stools, which reflect the presence of large amounts of unabsorbed iron in the gut. This is a conservative endpoint among the chain of events that may lead to systemic iron overload but is not adverse per se. Based on interventions in which black stools did not occur at supplemental iron intakes of 20-25 mg/day (added to a background intake of 15 mg/day), a safe level of intake for iron of 40 mg/day for adults (including pregnant and lactating women) was established. Using allometric scaling (body weight0.75), this value was scaled down to children and adolescents and safe levels of intakes between 10 mg/day (1-3 years) and 35 mg/day (15-17 years) were derived. For infants 7-11 months of age who have a higher iron requirement than young children, allometric scaling was applied to the supplemental iron intakes (i.e. 25 mg/day) and resulted in a safe level of supplemental iron intake of 5 mg/day. This value was extended to 4-6 month-old infants and refers to iron intakes from fortified foods and food supplements, not from infant and follow-on formulae. The application of the safe level of intake is more limited than a UL because the intake level at which the risk of adverse effects starts to increase is not defined.

Do various types of prelacteal feeding (PLF) have different associations with breastfeeding duration in Indonesia? A cross-sectional study using Indonesia Demographic and Health Survey datasets

IntroductionPrelacteal feeding (PLF) is anything other than breastmilk given to newborns in the first few days of birth and/or before breastfeeding is established. PLF comes in many forms and is...

Milk fat globule membrane proteins are crucial in regulating lipid digestion during simulated in vitro infant gastrointestinal digestion

Products of lipolysis released during digestion positively affect the metabolism of newborns. In contrast to the 3-layer biological membranes covering human milk (HM) fat, the lipid droplets in infant milk formula (IMF) are covered by a single membrane composed of casein and whey proteins. To reduce the differences in lipid structure between IMF and HM, studies have used milk fat globule membrane (MFGM) components such as milk polar lipids (MPL) to prepare emulsions mimicking HM fat globules However, few studies have elucidated the effect of membrane proteins (MP) on lipid digestion in infants. In this study, 3 kinds of emulsions were prepared: One with MPL as the interfaced of lipid droplets (RE-1), one with membrane protein concentrate (MPC) (RE-2) as the interface of lipid droplets, and one with both MPL and MPC (1:2) as the co-interface of lipid droplets (RE-3). The interfacial coverage of the emulsions was confirmed by measuring the contents of MPL and MPC at the lipid droplet interface, and by confocal laser scanning microscopy analyzed. By controlling the homogenization intensity, the specific surface area of lipid droplets was controlled at the same level among the 3 emulsions. The stability constants of the emulsions varied, and RE-1 was the most stable. During simulated in vitro infant gastrointestinal digestion, the amount of free fatty acids (FFA) released from the lipid droplets was significantly higher from those with MPC at the interface (RE-2, RE-3) than from that with MPL at the interface (RE-1). The amount of FFA released at the end of intestinal digestion of RE-1, RE-2, and RE-3 was 255.00 ± 3.54 µmol,328.75 ± 5.30 µmol, 298.50 ± 9.19 µmol, respectively. Compared with the lipid droplets in RE-2, those with MPL at the interface (RE-1, RE-3) released more unsaturated fatty acids (USFAs) during digestion. The emulsifying activity index was highest in RE-3 (MPL and MPC co-interface). The presence of MPL at the emulsion interface increased the release of USFAs, while the presence of MPC increased the release of FFA. These results show that both MPL and MP are indispensable in the construction of MFGM. Understanding their effects on digestion can provide new strategies for the development of infant foods.

Soybean oil emulsion stabilized by phosphatidylcholine and whey protein isolate: impact on interfacial properties, physicochemical characteristics, and digestive properties

Abstract Liquid formula is a research hotspot of infant formula milk, but how to increase the physicochemical stability while maintaining the activity of nutritional components is a key bottleneck in product development. Phosphatidylcholine (PC) and whey protein isolate (WPI) are important components of infant formula, the effect of PC on the properties of WPI stable emulsion remains to be clarified. When the concentration of PC is 0.3 %, a solid intermolecular network is established, which enhances the elasticity and viscosity of the emulsion and has the best oxidation stability and storage stability. 0.3 % PC reduced the flocculation during digestion, and increased the digestibility of protein and fat (27.64 % and 82.45 %). In this study, compound emulsifier (WPI-PC) was used to establish a stable emulsion system, which provided reference for the development and utilization of functional dairy products.

Iodine Status of Infants and Toddlers under 2 Years of Age and Its Association with Feeding Behaviors and Maternal Iodine Status in Shanghai: A Quantile Regression Analysis.

It is crucial to provide adequate iodine nutrition to infants and toddlers for proper thyroid function and subsequent brain development. Infants are particularly vulnerable to iodine deficiency during the transition from a milk-based diet (breast milk and/or infant formula) to solid food. This study examines the current iodine levels of children during their first two years of life and investigates the association between these levels and feeding behaviors and the iodine status of their mothers in Shanghai, a city located in eastern China. A hospital-based cohort study was conducted to enroll mother-child pairs, where the child is aged 6-23 months, who visited community health service centers in the 16 districts of Shanghai, China. Data on socio-demographic factors and feeding behavior data were collected from the participants. The urinary iodine concentration (UIC) in both the young children and their mothers were analyzed. A total of 2282 mother-child pairs were included in this analysis. The median (p25-p75) UIC for lactating women, weaning women, and children were 121.3 μg/L (68.1-206.4 μg/L), 123.4 μg/L (58.4-227.2 μg/L), and 152.1 μg/L (75.8-268.3 μg/L), respectively. The UIC in children was found to be higher than that in their mothers (p < 0.001). Children who consumed less than 500 mL per day of formula milk in the last week had lower UICs compared with those who consumed 500 mL per day or more (p = 0.026). Furthermore, the children's UIC was positively correlated with the maternal UIC (rs = 0.285, p < 0.001). Multiple quantile regression analysis revealed a statistically significant positive association between maternal UIC and children's UIC between the 0.1 and 0.9 quantiles (all p < 0.001). We found that the iodine status of infants and toddlers, as well as of mothers, was sufficient. However, a large minority of children and mothers may be at risk of iodine deficiency. Furthermore, no associations between children's UIC and feeding behaviors were observed. Moreover, there was a positive correlation between the UIC of young children and their mothers.

A systematic review and meta-analysis of nutritional and dietary interventions in randomized controlled trials for skin symptoms in children with atopic dermatitis and without food allergy: An EAACI task force report.

This systematic review and meta-analysis aimed to consolidate evidence on dietary interventions for atopic eczema/dermatitis (AD) skin symptoms in children without food allergies, following PRISMA 2020 guidelines. Systematic review updates were conducted in May 2022 and June 2023, focusing on randomized placebo-controlled trials (RCTs) involving children with AD but without food allergies. Specific diets or supplements, such as vitamins, minerals, probiotics, prebiotics, symbiotics, or postbiotics, were explored in these trials. Exclusions comprised descriptive studies, systematic reviews, meta-analyses, letters, case reports, studies involving elimination diets, and those reporting on food allergens in children and adolescents. Additionally, studies assessing exacerbation of AD due to food allergy/sensitization and those evaluating elimination diets' effects on AD were excluded. Nutritional supplementation studies were eligible regardless of sensitization profile. Evaluation of their impact on AD clinical expression was performed using SCORAD scores, and a meta-analysis of SCORAD outcomes was conducted using random-effect models (CRD42022328702). The review encompassed 27 RCTs examining prebiotics, Vitamin D, evening primrose oil, and substituting cow's milk formula with partially hydrolyzed whey milk formula. A meta-analysis of 20 RCTs assessing probiotics, alone or combined with prebiotics, revealed a significant reduction in SCORAD scores, suggesting a consistent trend in alleviating AD symptoms in children without food allergies. Nonetheless, evidence for other dietary interventions remains limited, underscoring the necessity for well-designed intervention studies targeting multiple factors to understand etiological interactions and propose reliable manipulation strategies.

Current issue of import substitution of evaporated milk formulas for feeding children from birth

Current issue of import substitution of evaporated milk formulas for feeding children from birth

Massive open online course on breastfeeding during the COVID-19 pandemic in Mexico.

COVID-19 virus was reported to be transmitted through breastfeeding (BF), creating the need for rapidly available, standardized information and training for health personnel and the community about BF as an urgent action to reduce misinformation and unethical promotion of breast milk substitutes (BMS). In Mexico, a massive open online course (MOOC) was designed and implemented to protect, promote and support BF in emergency contexts. MOOC registration consisted of collection of quantitative data regarding participant characteristics, MOOC coverage, scores achieved and completion rates. A multiple linear regression analysis was performed to relate the absolute and relative skills earned in the MOOC to participant characteristics. In addition, factors associated with completion rate and dissemination of information from the MOOC were analyzed using multiple logistic regression and presented as odds ratios. During a period of 19 months, 52,426 participants across the country, including health personnel and general population, entered the Cursos en Linea del Instituto Mexicano del Seguro Social (CLIMSS) platform, of which 50.5% completed the MOOC. The level of participation was maintained from January 2021 to early 2022 when the perception of the risk of getting sick from COVID-19 and quarantining decreased. In adjusted analysis, completion rate was associated with being older or belonging to a health institution; furthermore, residing in the north of the country doubled the odds of completing the MOOC (odds ratio 2.24; 95% confidence interval 1.95-2.56). A MOOC can be a useful training strategy to disseminate information, especially in emergencies where physical distancing is important and reaching the largest possible population is required.

Cross-sectional examination of commercial milk formula industry funding of international, regional and national healthcare professional associations: protocol

IntroductionCommercial milk formula manufacturers often emphasise their role in supporting infant and young child nutrition and breastfeeding, but their commercial goals to increase volume and profit margin of formula sales...

Levelling up health in the early years: A cost-analysis of infant feeding and healthcare.

Although breastfeeding is recommended as the optimal form of nutrition in the first six months, it is not sustained as the predominant mode of feeding infants in Scotland. This study estimated the impact of infant feeding choices on primary and secondary healthcare service costs in a 13-year birth cohort. Using linked administrative datasets, in a retrospective cohort design of 502,948 singletons born in Scotland between 1997 and 2009, we estimated the cost of GP consultations and hospital admissions by area deprivation and mode of infant feeding up to 6-8 weeks for ten common childhood conditions from birth to 27 months. Additionally, we calculated the potential healthcare savings if all infants in the cohort had been exclusively breastfed at 6-8 weeks. Discounting of 1.5% was applied following current health economic conventions and 2009/10 used as the base year. Over the study period, the estimated cost of hospital admissions in the cohort was £111 million and £2 million for the 2% subset of the cohort with primary care records. Within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed (any) formula milk. At least £10 million of healthcare costs may have been avoided if formula-fed infants had been exclusively breastfed within the first 6-8 weeks of birth. This study using a representative birth cohort demonstrates how breastmilk can promote equitable child health by reducing childhood illness and healthcare utilisation in the early years.

"I could not find the strength to resist the pressure of the medical staff, to refuse to give commercial milk formula": a qualitative study on effects of the war on Ukrainian women's infant feeding.

During emergencies, breastfeeding protects infants by providing essential nutrients, food security, comfort, and protection and is a priority lifesaving intervention. On February 24, 2022, the war in Ukraine escalated, creating a humanitarian catastrophe. The war has resulted in death, injuries, and mass internal displacement of over 5 million people. A further 8.2 million people have taken refuge in neighboring countries, including Poland. Among those impacted are infants and young children and their mothers. We conducted a study to explore the infant feeding challenges and needs of Ukrainian women affected by the war. We conducted a qualitative descriptive study involving in-depth interviews (IDIs) with 75 war-affected Ukrainian mothers who had at least one infant aged less than 12 months at the time of the interview. Eligible mothers were either (1) living as Ukrainian refugees in Poland, having crossed the border from Ukraine on or after February 24, 2022, when the war started (n = 30) or (2) living in Ukraine as internally displaced persons or as residents in the community (n = 45). All interviews were audio-recorded (either transcribed or had responses summarized as expanded notes) and analyzed using qualitative thematic analysis using a two-step rapid analysis process. Participants in Ukraine who wanted to initiate breastfeeding right after birth faced opposition from healthcare workers at maternity hospitals. Ukrainian refugees who gave birth in Poland faced language barriers when seeking breastfeeding support. Half of the participants in Ukraine received commercial milk formula (CMF) donations even if they said they did not need them. Most respondents stated that breastfeeding information and support were urgently needed. Our data suggests that healthcare workers in Ukrainian maternity hospitals require additional training and motivation on delivering breastfeeding support. In addition, lactation consultants in maternity ward are needed in Ukraine, and interpretation support is needed for refugees to overcome language barriers. There is a need to control the indiscriminate donations of commercial milk formula and to ensure that complementary foods and commercial milk formula are available to those that need it. This study confirms the need for actions to ensure infant and young child feeding (IYCF) support is provided during emergencies.