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To test the hypothesis that human milk fucosyloligosaccharides are part of an innate immune system, we addressed whether their expression (1) depends on maternal genotype and (2) protects breastfed infants from pathogens. Thus the relationship between maternal Lewis blood group type and milk oligosaccharide expression and between variable oligosaccharide expression and risk of diarrhea in their infants was studied in a cohort of 93 Mexican breastfeeding motherinfant pairs. Milk of the 67 Leab+ mothers contained more LNF-II (Lea) and 3-FL (Lex) (oligosaccharides whose fucose is exclusively a1,3- or a1,4-linked) than milk from the 24 Lea-b- mothers; milk from Lea-b- mothers contained more LNF-I (H-1) and 2'-FL (H-2), whose fucose is exclusively a1,2-linked. The pattern of oligosaccharides varied among milk samples; in each milk sample, the pattern was summarized as a ratio of 2-linked to non-2-linked fucosyloligosaccharides. Milks with the highest ratios were produced primarily by Lea-b- mothers; those with the lowest ratios were produced exclusively by Leab+ mothers (p<0.001). Thus maternal genetic polymorphisms expressed as Lewis blood group types are expressed in milk as varied fucosyloligosaccharide ratios. The four infants who developed diarrhea associated with stable toxin of Escherichia coli were consuming milk with lower ratios (4.4 0.8 [SE]) than the remaining infants (8.5 0.8; p<0.001). Furthermore, the 27 infants who developed moderate to severe diarrhea of any cause were consuming milk with lower ratios (6.1 0.9) than the 26 who remained healthy (10.5 1.9; p = 0.042). Thus, milk with higher 2-linked to non-2-linked fucosyloligosaccharide ratios affords greater protection against infant diarrhea. We conclude that specific oligosaccharides constitute a major element of an innate immune system of human milk. [ABSTRACT FROM AUTHOR]

Breastfeeding hospitalized infants can be difficult. The authors assessed the effectiveness of an International Board Certified Lactation Consultants (IBCLC) service to increase the proportion of infants given their own mother's milk (OMM) in a children's hospital neonatal intensive care unit (NICU). The charts of 350 randomly selected patients admitted the year before and after implementation of the service in July 1997 were abstracted. Factors significantly associated with infants being given OMM included infant sex, ethnicity, length of NICU stay, and 5-minute Apgar score. After comparison of the periods before and after pro-gram implementation, the proportion of NICU infants ever given their OMM was found to have increased from 31% to 47% (P = .002). This increase differed significantly in relation to infants' clinical status and/or management (5-minute Apgar score, length of NICU stay, and age at NICU admission) but not in relation to maternal factors. Mothers with infants in the NICU should have access to lactation counseling. J Hum Lact. 19(3):286-292. [ABSTRACT FROM AUTHOR]