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PubMed2002

World Health Assembly recommends exclusive breastfeeding for first six months.

Exclusive breastfeeding means that the infant receives only breast milk (from his or her mother or a wet nurse or expressed breast milk) and no other liquids or complementary foods with the exception of undiluted drops or syrups consisting of vitamin and mineral supplements or medicines. During this period water is not permitted. The resolution (WHA 54.2) urges Member States to support exclusive breastfeeding for first six months as a global public health recommendation and to provide safe and appropriate complementary foods, with continued breastfeeding for up to two years or beyond. Breastfeeding Promotion Network of India (BPNI) has issued guidelines for breastfeeding and complementary feeding.

Breast Feeding↗

PubMed1996

Effect of fortifying breast milk on gastric emptying.

A study was performed to determine if the addition of a fortifier to expressed breast milk (EBM) affected gastric emptying in low birthweight infants. Using ultrasonography, the gastric emptying of EBM alone was compared with that containing a fortifier, in a blind, crossover study. Twenty two low birthweight infants were studied: median (range) gestation 31.5 weeks (28-37); birthweight 1495 g (1000-2480 g). The gastric antral cross-sectional area (ACSA) was measured by ultrasonography before each feed and then sequentially after its completion until the ACSA returned to its pre-feed value. The half emptying time was calculated as the time taken for the ACSA to decrease to half the maximum increment. The mean difference (standard error) between half emptying times for EBM alone and for EBM with added fortifier was not significant: 1.48 (4.9) minutes. These data show that fortifying breast milk does not affect gastric emptying and suggests that the practice is unlikely to affect feed tolerance in low birthweight infants.

Cross-Over Studies↗

PubMed1979

Bacteriological monitoring of unheated human milk.

To assess the bacteriological quality of unpooled expressed breast milk, a pilot bottle sample of each donation was examined before the milk was given to the neonate. Provided the milk did not contain greater than 2500 organisms/ml or potential pathogens it was used unheated. Milk containing between 2500 and 5000 organisms/ml and no potential pathogens was used after pasteurisation. Using these criteria, 67% of 460 donations were acceptable. However, because the bacteriological quality varied, 45% of domiciliary donations were discarded compared with only 29% of those from hospital.

Bacteriological Techniques↗

PubMed1992

Feeding preterm infants a formula containing C20 and C22 fatty acids simulates plasma phospholipid fatty acid composition of infants fed human milk.

Thirty-four premature infants weighing less than 1500 grams at birth were fed preterm formula (formula), preterm infant formula manufactured to contain a balance of C20 and C22 omega 6 and omega 3 fatty acids within the range characteristic of human milk (LCPE-formula) or their mothers' expressed breast milk (EBM). Blood samples were obtained during the first week of life and after 28 days of feeding to determine the effect of feeding C20 and C22 omega 6 and omega 3 fatty acids on plasma lipids. Fatty acid analyses of red blood cell phospholipids indicated few differences between dietary treatment and age. Fatty acid content of plasma cholesterol esters indicated a high plasma cholesterol linoleate level for infants fed formula and a reduced content of C20 and C22 omega 6 and omega 3 fatty acids. For infants fed the modified formula (LCPE-formula) the levels of 20:4 omega 6, 20:5 omega 3 and 22:6 omega 3 were higher than observed for the formula group and similar to those observed for infants fed EBM. By the fifth week of life, feeding the modified formula resulted in plasma phospholipid levels of C20 and C22 omega 6 and omega 3 fatty acids similar to levels of C20 and C22 omega 6 and omega 3 fatty acids found in infants fed EBM and significantly higher than levels characteristic of infants fed formula. It is concluded that infants fed LCPE-formula illustrate an overall balance between C20 and C22 omega 6 to omega 3 fatty acids in the plasma similar to that characteristic of infants fed human milk.

Fatty Acids↗

PubMed1993

[Breast feeding of premature infants].

A study was conducted among 56 women in order to discover factors which might motivate them to breast-feed their premature infants. At three months of age, 54% of the infants were breast-fed. At six the figure was 29% and at nine months 25%. Low birth weight, low gestational age and the severity of neonatal complications were associated with short duration of lactation. If the mother smoked, the mean lactation period was three months compared with 5.5 months in a non-smoking mother, even if the child was critically ill. The lactation period was longer among mothers with a higher education. If the mother expressed milk more than five times a day the lactation period was likely to be long. The most frequent reason for cessation of milk production was declining volume of milk. Women who deliver prematurely should start to express breast milk preferably within the first days after delivery. Information and encouragement enhance milk yield and prolong the breast-feeding period.

Breast Feeding↗

PubMed1978

Human milk bank in a district general hospital.

A human milk bank was organised in the special care baby unit of a district general hospital. The staff of the unit and members of a voluntary organisation helped to contact donors and arrange collection of milk samples. Over two years 2093 samples of expressed breast milk were collected from 187 donors and examined bacteriologically. Of these samples, 1171 (56%) grew no bacteria. If the organism count exceeded 2.5 X 10(6)/1 but was less than 1 X 10(9)/1 samples were subjected to mild heat treatment. If the count exceeded 1 X 10(9)/1 the milk was not fed to babies. Sixty-five babies received milk from the bank during the second year. Although these infants were vulnerable, mortality and morbidity were not adversely affected by the banked milk they received. The cost of establishing and running a human milk bank need not be high. Extensive resources such as extra staff and laboratory and transport facilities were not needed. Enthusiastic co-operation and good will between hospital staff, voluntary helpers, and donors contributed greatly to the success of the scheme.

Costs and Cost Analysis↗

PubMed1984

The calorie intake and weight gain of low birth weight infants fed on fresh breast milk or a special formula milk.

The calorie intake and weight gain of 24 low birth weight (LBW) infants, less than 33 weeks gestation and less than 1500 g birth weight, was studied prospectively. Fourteen infants were fed on a commercially available LBW formula milk and ten were fed on their own mother's fresh unpasteurised expressed breast milk (EBM). The difference between the two feeding groups in the intake of milk and calories was not significant, but from the third week onwards those fed on the LBW formula gained weight faster. The mean (+/- SEM) weight increments for weeks 3-6 (inclusive) for LBW formula and EBM fed infants was 189.3 (+/- 7.9) and 139.6 (+/- 11.1) g/wk respectively (P less than 0.001). The LBW formula was well tolerated and is a suitable feed for LBW infants. However some babies thrived well on fresh EBM and so we are continuing to encourage mothers who wish, to breast feed their own preterm infants. When such infants fail to thrive it is appropriate to supplement with a LBW formula.

Blood↗

PubMed1995

Bacterial contaminated breast milk and necrotizing enterocolitis in preterm twins.

A pair of preterm twins developed fatal necrotizing enterocolitis (NEC) in association with Staphylococcus epidermidis septicaemia after receiving contaminated expressed breast milk (EBM). S. epidermidis NEC can be associated with severe bowel inflammation, high morbidity and mortality. Breast milk is the most suitable nutrient for preterm infants but EBM should undergo regular screening for bacterial overgrowth. We urge caution before administering EBM found to be heavily contaminated with S. epidermidis to preterm infants.

Bacteremia↗

PubMed2006

Breast milk dioxins in Hong Kong and Pearl River Delta.

There are no previous reports from South China on chemically determined polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and dioxin-like polychlorinated biphenyls (PCBs) in human breast milk expressed as World Health Organization (WHO) toxic equivalents (TEQs). In a 2002-2003 WHO exposure study, 13 pools of breast milk comprising samples from 316 primiparous women in Hong Kong in 2002 were analyzed by gas chromatography/mass spectrometry for 29 PCDD/F and dioxin-like PCB congeners. Total WHO-TEQs ranged from 8.97 to 16.7 pg/g fat (weighted mean, 12.9 pg; weighted median, 13.4 pg). Variations in TEQs included positive associations with age (R2 = 0.73, p < 0.0005), higher consumption of dairy products and seafood, and lower TEQs in overseas mothers and ever-smokers. Congener profiles indicated geographic specificity of exposure in Hong Kong, mainland China, and overseas Asian countries, including higher proportions of PCB-TEQs (overseas) and PCDF-TEQs (mainland China). The median TEQs of PCDD/Fs (8.69 pg/g fat) and PCBs (4.73 pg/g fat) in Hong Kong were highest among the five Asian Pacific countries but lower than the levels for at least half of the European countries that participated in the WHO study. However, future international studies should incorporate mother's age in the design of the pooling strategy to allow standardization by other exposure factors and valid comparisons among different countries. The findings allow support for the WHO breast-feeding advisory. Trends in human dioxin levels in the region cannot yet be determined, and rigorous controls are needed to reduce emissions of dioxins and human exposure in mainland China.

Adolescent↗

PubMedDate not supplied

Macronutrient and energy content of breast milk of mothers delivering prematurely.

The protein, lactose, fat and energy contents of the fore-milk of mother with term (n = 23) and preterm (n = 29) infants were estimated on postpartum days 3, 7, 14 and 21. During the first 4 weeks of lactation, the mean (+/- SD) energy (Kcal/dl), protein (g/dl), fat (g/dl) and lactose (g/dl) levels of the preterm milk were: 56.39 (+/- 7.99), 2.17 (+/- 0.66), 2.30 (+/- 0.48) and 5.78 (+/- 0.99), respectively. The same for term milk were: 59.39 (+/- 8.30), 1.99 (+/- 0.70), 2.48 (+/- 0.53) and 6.24 (+/- 1.08), respectively. The differences in composition between the term and preterm milk were not significant. The composition of breast milk showed changes over the first 3 weeks of lactation. With increasing post-partum days, there was a decline in protein content while fat, lactose and energy contents increased. These trends were more pronounced for preterm milk than term milk. The macronutrient composition and energy estimates of preterm breast milk of Indian mothers in this study may be useful for calculation of nutritional intake by premature neonates fed on expressed breast milk.

Adolescent↗

PubMed1994

A randomised multicentre study of human milk versus formula and later development in preterm infants.

Whether breast milk influences later neurodevelopment has been explored in non-randomised studies, potentially confounded by social and demographic differences between feed groups. Here in a strictly randomised prospective multicentre trial, Bayley psychomotor and mental development indices (PDI and MDI) were assessed at 18 months postterm in survivors of 502 preterm infants assigned to receive, during their early weeks, mature donor breast milk or a preterm formula. These diets were compared as sole enteral feeds or as supplements to the mother's expressed breast milk. No differences in outcome at 18 months were seen between the two diet groups despite the low nutrient content of donor milk in relation to the preterm formula and to the estimated needs of preterm infants. These results contrast with those reported from our parallel two centre study that compared infants randomly assigned a standard term formula or the preterm formula during their early weeks; those fed standard formula, now regarded as nutritionally insufficient for preterm infants, were substantially disadvantaged in PDI and MDI at 18 months post-term. It is shown here that infants from that study fed solely on standard formula had significantly lower developmental scores at 18 months than those fed on donor breast milk in the present study; yet the standard formula had a higher nutrient content than the donor milk. Thus, donor milk feeding was associated with advantages for later development that may have offset any potentially deleterious effects of its low nutrient content for preterm infants. As these outcome advantages were not confounded by the social and educational biases usually associated with mothers' choice to breast feed, our data add significant support to the view that breast milk promotes neurodevelopment.

Child Development↗

PubMed2006

Adjustable fortification of human milk fed to preterm infants: does it make a difference?

BACKGROUND: Inadequate nutrition leading to growth failure is common among premature infants. Although fortified breast milk (breast milk plus commercially prepared fortifier) is the preferred feeding, nutrient intakes achieved with fortified breast milk fall short of meeting nutrient needs. This is mainly due to inadequate protein content of fortifiers and variability in composition of expressed breast milk. OBJECTIVE: A new adjustable fortification regimen has been designed to ensure that protein needs of premature infants are met at all times. The new regimen encompasses increasing the amount of fortifier and adding extra protein to breast milk guided by periodic determinations of blood urea nitrogen (BUN). The study tested the hypothesis that infants fed according to the new regimen have higher protein intakes and improved weight gain compared to infants fed according to standard fortification regimen. METHODS: In a prospective, controlled trial, preterm infants with birth weights of 600-1750 g and gestational ages between 26 and 34 weeks were fed their own mother's milk or banked donor milk or both. Infants were randomly assigned before 21 days of age to either the new adjustable fortification regimen or the standard regimen. The study period began when feeding volume reached 150 ml/kg/day and ended when infants reached a weight of 2000 g. Standard fortification (STD) consisted in the use of the recommended amount of fortifier. Adjustable fortification (ADJ) consisted in the use, in addition to standard fortification, of extra fortifier and supplemental protein guided by twice-weekly BUN determinations. The primary outcome was weight gain, with serum biochemical indicators and nutrient intakes as secondary outcomes. RESULTS: Thirty-two infants completed the study as planned (16 ADJ, 16 STD). Infants receiving the ADJ regimen had mean protein intakes of 2.9, 3.2 and 3.4 g/kg/day, respectively, in weeks 1, 2 and 3, whereas infants receiving the STD regimen had intakes of 2.9, 2.9, 2.8 g/kg/day, respectively. Infants on the ADJ regimen showed significantly greater gain in weight (17.5+/-3.0 vs 14.4+/-3.0 g/kg/day, P<0.01) and greater gain in head circumference (1.4+/-0.3 vs 1.0+/-0.3; P<0.05) than infants on the STD regimen. Weight and head circumference gain were significantly (P<0.05) correlated with protein intake. No significant correlations were found between growth parameters and intake of fat and energy. There were no significant differences between groups in BUN and other serum chemical values. In the ADJ group, BUN concentrations increased significantly (P<0.001) over time but were not significantly higher than in the STD group. CONCLUSION: Premature infants managed with the new adjustable fortification regimen had significantly higher weight and head circumference gains than infants managed with standard fortification. Higher protein intake appears to have been primarily responsible for the improved growth with the adjustable regimen. The new fortification method could be a solution to the problem of protein undernutrition among premature infants fed human milk.

Blood Urea Nitrogen↗

PubMed2003

Inhibition of Staphylococcus aureus by the commensal bacteria of human milk.

AIMS: To study the bacterial diversity in expressed human milk with a focus on detecting bacteria with an antimicrobial activity against Staphylococcus aureus, known as a causative agent of maternal breast infections and neonatal infections. METHODS AND RESULTS: Random isolates (n = 509) were collected from breast milk samples (n = 40) of healthy lactating women, genotypically identified, and tested for antimicrobial activity against Staph. aureus. Commensal staphylococci (64%) and oral streptococci (30%), with Staph. epidermidis, Strep. salivarius, and Strep. mitis as the most frequent isolates, were the predominant bacterial species in breast milk. One-fifth of Staph. epidermidis and half of Strep. salivarius isolates suppressed growth of Staph. aureus. Enterococci (Ent. faecalis), isolated from 7.5% of samples, and lactic acid bacteria (LAB) (Lactobacillus rhamnosus, Lact. crispatus, Lactococcus lactis, Leuconoctoc mesenteroides), isolated from 12.5% of samples, were also effective against Staph. aureus. One L. lactis isolate was shown to produce nisin, a bacteriocin used in food industry to prevent bacterial pathogens and spoilage. CONCLUSIONS: Expressed breast milk contains commensal bacteria, which inhibit Staph. aureus. SIGNIFICANCE AND IMPACT OF THE STUDY: The strains inhibitory against the pathogen Staph. aureus have potential use as bacteriotherapeutic agents in preventing neonatal and maternal breast infections caused by this bacterium.

Antibiosis↗

PubMed1983

Energy balance and nitrogen balance in growing low birthweight infants fed human milk or formula.

Energy and nitrogen balances were measured in growing low birthweight infants fed either mother's expressed breast milk or a 20 kcal per ounce formula to determine whether or not there were differences between the two dietary groups in (1) the partition of energy among excretion, expenditure, and storage and (2) the relation of energy storage and nitrogen retention to weight gain. There were no significant differences between the human milk fed infants and formula fed infants in gross energy intake, metabolizable energy intake, nitrogen intake, or nitrogen retention. Energy expenditure was significantly lower in the human milk fed infants than in formula fed infants (221 kJ/(kg. day) and 244 kJ/(kg. day), respectively). There was no difference in mean energy storage between the two groups. Although weight gains were similar in both dietary groups, the ratio of energy storage to weight gain was significantly greater in infants fed with human milk (15.3 kJ/g, S.D. 2.0) than in infants fed formula (13.2 kJ/g S.D. 1.8). There was no significant difference between the two groups in the ratio of nitrogen stored to weight gain.

Body Weight↗

PubMed2005

Transmission of community-associated methicillin-resistant Staphylococcus aureus from breast milk in the neonatal intensive care unit.

Methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly common in neonatal intensive care units and can lead to severe outcomes. Baby C, of a set of quadruplets, died of MRSA sepsis. The surviving siblings were colonized with MRSA. Expressed breast milk was fed to all infants; tested breast milk samples were all MRSA-positive. Pulsed field gel electrophoresis results of isolates from the infants and breast milk were indistinguishable.

Adult↗

PubMed2006

Microbiological and biochemical assessment of the surface area of breast nipples and breast milk of lactating women in Calabar, southeastern Nigeria.

Microbiological and biochemical analyses of 59 breast nipple swab samples and 15 manually expressed breast milk samples of lactating mothers aged 15 to 40 years, was carried out using standard procedures. The incidence of bacterial species in swab samples was Staphylococus aureus (63.8%), Streptococcus sp (25.5%), Escherichia coli (6.4%) and Klebsiella sp (4.26%), indicating the poor sanitary status of the lactating mothers. S. aureus was recovered from only 1 (6.7%) of the milk samples, indicating that breast milk is relatively sterile. The nutritional values for the breast milk were 22.5 mg/ml (protein), 0.3 mg/ml (calcium), 3.5 mg/ml (sugar) and 300 microg/ml (vitamin A) in age group 15-20 years, and 16.4 mg/ml (protein), 0.16 mg/ml (calcium), 1.8 mg/ml (sugar) and 100 microg/ml (vitamin A) in the age group 36-40 years. In conclusion, the nutritive and antimicrobial properties of breast milk decrease with increasing age of lactating mothers. The need for public health enlightenment of lactating mothers regarding hygiene, and the provision of oral vitamin A supplement to infants, is discussed.

Adolescent↗

PubMed2000

Techniques for the storage of human breast milk: implications for anti-microbial functions and safety of stored milk.

UNLABELLED: Storage of human breast milk by freezing or refrigeration of milk with and without heating have been recommended. This can hardly be avoided because of the social circumstances of most mothers who are regularly separated from their infants because of work or schooling as well as the particular needs of some pre-term or sick babies to be fed with expressed breast milk. The greatest fear that has hindered the prospects of in-vitro storage of breast milk for any considerable period of time is the possibility of bacterial contamination and growth of infectious pathogens in the stored milk, thereby rendering them unsafe for human consumption. Bacteriological examination of refrigerated milks has proven their safety for human consumption for even up to 72 h. For a storage over longer periods up to 1 month, freezing at -20 degrees C could be recommended, but the most preferred method, especially for longer storage would be fresh freezing at -70 degrees C, if affordable or available. The expressed fears arising from increased titratable acidity of such stored milk samples have been unfounded, since it has been shown to be mainly attributable to levels of free fatty acids, rather than lactic acid, which might have been produced by bacterial fermentation of milk sugars. CONCLUSION: Evidence shows that temporary storage of human milk under appropriate conditions is not dangerous for babies and infants. This would further encourage the practice of prolonged exclusive breastfeeding and allow the families to reap its multi-fold benefits.

Bacterial Infections↗

PubMed1990

Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study.

OBJECTIVE: To study the effect of early diet on the development of allergic reactions in infants born preterm. DESIGN: Two randomised prospective trails. In trail A infants were randomly allocated banked donor milk or preterm formula as their sole diet or (separately randomised) as a supplement to their mother's expressed breast milk. In trial B infants were allocated term or preterm formula. A blind follow up examination was done 18 months after the expected date of birth. SETTING: Neonatal units of hospitals in Cambridge, Ipswich, King's Lynn, Norwich, and Sheffield. Outpatient follow up. PARTICIPANTS: 777 Infants with a birth weight less than 1850 g born during 1982 to 1984. MAIN OUTCOME MEASURES: Development of eczema, allergic reactions to food or drugs, and asthma or wheezing by nine and 18 months after term. Whenever possible the observations were confirmed by rechallenge or clinical examination. RESULTS: At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial. In the subgroup of infants with a family history of atopy, however, those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions (notably eczema) by 18 months (odds ratio 3.6; 95% confidence interval 1.4 to 9.1). CONCLUSIONS: Feeding neonates on formulas based on cows' milk, including those with a high protein content, did not increase the overall risk of allergy. Nevertheless, in the subgroup with a family history of atopy early exposure to cows' milk increased the risk of a wide range of allergic reactions, especially eczema.

Animals↗