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Mother's own milk (MOM) is ideal for infant growth and health. When MOM is unavailable, donor human milk (DHM), rather than infant formula, is recommended for at-risk, preterm or sick neonates (NN), in view of its protective effects. Human milk banks (HMB) collect, secure, process and distribute DHM. In Switzerland, there is insufficient and unequal access to DHM in the absence of a national policy framework. With the support of the State of Vaud, the CHUV and the Interregional Blood Transfusion of the Swiss Red Cross will open the first HMB in Romandy in 2022. This HMB offers an innovative system in Switzerland, based on complementary expertise, in order to guarantee the quality and safety of DHM and to support the promotion of breastfeeding and human milk donation.Le lait maternel (LM) est idéal pour la croissance et la santé des nourrissons. En l’absence de LM, le lait de donneuses (LD) est préférable au lait artificiel pour les nouveau-nés (NN) à risques, prématurés ou présentant certaines pathologies, au vu de ses effets protecteurs. Les banques de lait (BL) collectent, sécurisent, traitent et distribuent le LD. Il existe en Suisse une insuffisance et une inégalité d’accès au LD, faute de cadre national. Avec le soutien de l’État de Vaud, le CHUV et la Transfusion interrégionale de la Croix-Rouge suisse ouvriront en 2022 la première BL romande. Cette BL propose un système novateur en Suisse, fondé sur une complémentarité d’expertises, afin d’optimiser la qualité et la sécurité du LD et de soutenir la promotion de l’allaitement et du don.

Voluntary, non-remunerated donations are fundamental principles with anonymity regarding donations of elements and products of the human body in France. Blood donation was a model to organize donation of organs, hematopoietic stem cell or gamete. These principles, which at first glance appear to be intangible, commonly accepted and transposable between the different types of donation, though reveal singularities regarding to a collective imagination, a biological reality, evolution of society, medicine and science. Through the study of these different principles applied to donated human body parts, this article aims to highlight the ethical limitations of a single principlist approach. The notions of anonymity, consent, voluntariness, non for profit, under their universal aknowledge, reveal variability of interpretation and scope due to the heterogeneous characteristics, implications and purposes between these donations of different elements and the uses made of them.

Donation of fresh breastmilk in neonatology is subject to guidelines set out in a 1997 memorandum and recommendations issued in 2005. The results of a survey carried out in 2013 show that practices in this area vary greatly from one neonatology unit to another. There is a clear need to adopt a national consensus regarding the conditions of this donation in neonatology, in order to adapt and standardise practices.

To reach nutritional standards, human milk has to have 2g/dL of protein. In 2013, Lafeber stated that when human milk is fortified up to 2g/dL, it may increase its osmolality up to 500 mOsm/kg. He also warned that care must be taken when adding a drug or vitamins to human milk.We studied, for the first time, the impact of adding multivitamins (ADEC) on human fortified milk osmolality.The osmolality of 36 pasteurized, fortified human milk samples was measured. The amount of milk required as a solvent to maintain osmolality below 500 mOsm/kg was then determined.The osmolality of 2mL of fortified human milk reached up to 750 mOsm/kg when the multivitamins ADEC was added. The osmolality decreased proportionately as the solution was diluted and if vitamins are added in two half-doses each time. It is only with 20mL of milk that the osmolality lowers to its initial rate of 430 mOsm/kg. The stronger the milk's fortification is, the greater impact it has on the milk's osmolality.New nutritional recommendations for premature infants are needed. In the meantime, when the fortified milk intake is under 20mL, it is preferable to extend parenteral intakes with fat-soluble vitamins or reduce doses of vitamins in milk. Also, we should use enriched human milk as a fortifier and be cautious with indiscriminate fortification or when adding drugs and electrolyte solutions.

Antiretroviral drugs are primarily used to treat people living with HIV but can also reduce the risk of transmission. The first application of this prophylactic approach was in the prevention of mother-to-child transmission, which comprises three components: 1) antiretroviral therapy during pregnancy to reduce maternal viral load, 2) pre-exposure prophylactic treatment of the fetus in utero and intrapartum, and 3) postexposure neonatal treatment. This has resulted in a sharp reduction in mother-to-child transmission, to well below 1 % in France today. "Treatment as prevention" (TASP) is now widely recommended to prevent sexual transmission to partners of people living with HIV articularly when a couple wishes to have children. Achieving and sustaining undetectable viral load is an important means of reducing the risk of sexual transmission in serodiscordant couples and also of controlling the pandemic worldwide. The other uses of antiretroviral drugs to protect HIV-negative people at risk include post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). Prevention has both individual and collective dimensions and involves several components, including behavioral changes, serological testing, and use of antiretrovirals.

International audience; The multifactorial nature of perinatal growth is now well established. The perinatal environment modulates each infant's genetic potential. Antenatal nutrition is dependent on maternal nutrition and is also subject to environmental factors such as tobacco smoke, which can significantly impact infant development. Current neonatal nutritional guidelines, aimed primarily at ensuring good nutrient tolerance, may no longer be optimal. Indeed, they can lead to malnutrition and growth retardation, and attempts to "catch up" through increased protein and calorie intake may have unwanted effects. Current data point to critical time windows during which nutritional optimization might improve infant development. New approches could help to prevent adult diseases of developmental origin.

In France, human milk banks pasteurize milk for the mother's own hospitalized baby (personalized milk) and for donation. There is specific legislation regulating the activity of human milk banks with bacterial screening of donor milk before and after pasteurization. Milk should be tested for Staphylococcus aureus and total aerobic flora. Any sample of milk positive for aerobic flora and/or S. aureus before and/or after pasteurization should be discarded. The real pathogenicity of the total aerobic flora is actually debated as well as the usefulness of systematic postpasteurization screening. The aim of this study was to quantify milk losses related to prepasteurization contamination by total aerobic flora in a regional milk bank, to identify losses due to contamination with S. aureus or aerobic flora, and to analyze differences between centers.This was a prospective observational study conducted in the regional human milk bank of the Nord-Pas-de-Calais area in France. Data were collected from six major centers providing 80% of the milk collected between June 2011 and June 2012. Variables were the volumes of personalized milk collected by each center, volumes of contaminated milk, and the type of bacteria identified.During the study period, the regional human milk bank treated 4715 L (liters) of personalized milk and 508 L (10.8%) were discarded due to bacteriological screening. Among these 508 L, 43% were discarded because of a prepasteurization contamination with aerobic flora, 55% because of a prepasteurization contamination with S. aureus, and 2% because of other pathogenic bacteria. Postpasteurization tests were positive in 25 samples (0.5%). Only five of these 25 samples were positive before pasteurization and in all cases with S. aureus. A total of 218 L were destroyed because of prepasteurization contamination with total aerobic flora, while the postpasteurization culture was sterile. There was a great difference between centers in the percentage of discarded milk and the type of contamination. The percentage of discarded milk varied from 4 to 16% (P0.001) and the percentage of prepasteurization positive samples with aerobic flora from 0 to 70% (P0.001). Costing 80 €/L in France, this represented an economic loss of €17,440.A significant volume of milk is discarded because of contamination with total aerobic flora found only in prepasteurization tests. Reassessment of the French regulations with regard to microbiological safety could save human milk to cover the needs of a larger group of preterm babies.

Even though breastfeeding rates have increased in France, a sharp decline occurs rapidly in the first month. Lack of professional support is often held responsible, since many problems could be avoided if mothers were given adequate support. Continuing research into the physiology of breastfeeding shows a wide range of interindividual variations in anatomy, physiology, and normal breastfeeding patterns. An understanding of the physiology of lactation contributes to providing breastfeeding mothers with appropriate support and enabling them to have a successful breastfeeding experience. It allows health professionals to help mothers resolve their difficulties with an evidence-based guidance.

Acute scrotum is unusual during the neonatal period. Testicular torsion is a surgical emergency aimed at salvaging the affected testis. Epididymo-orchitis is the main differential diagnosis, but few cases have been described in the newborn. Here, we report the case of a late-preterm infant who presented with late-onset group B streptococcal sepsis revealed by unilateral epididymo-orchitis.

Symptomatic zinc deficiency can occur in exclusively breast-fed infants. We report a case in a 5-month-old infant.A 5-month-old exclusively breast-fed boy presented with persistent erythema of breech since the age of 2 months as well as perioral and acral erythematous scaly lesions. Laboratory investigations revealed low zinc levels in the infant's serum, the mother's plasma zinc level was normal, and breast milk zinc was low. Rapid healing occurred after oral zinc supplementation.Zinc deficiency in breast-fed infants is a rare disease caused by a low level of zinc in the mother's milk. The clinical features resemble those of acrodermatitis enteropathica. Oral zinc supplementation is required until weaning.

Exclusive breastfeeding is recommended up to 6 months of age, and may be continued in combination with a more diversified diet until 2 years of age. It represents the ideal natural diet for the newborn. The current change of maternity care policy and the adherence to the Baby Friendly Hospital Initiative (BFHI) project, have been associated with a significant improvement of patient information. This positive aspect combined with the effect of perinatal education were major contributors for breastfeeding promotion. This article presents the physiology of breastfeeding and its practical aspects, useful for the family doctor. The doctor plays a central role both in the information, which might influence the choice of breastfeeding, and also in the support of the mother or her baby. The duration of breastfeeding represents the new goal to be emphasized. Lactating mothers should be encouraged to consult competent caregivers, including the family doctor in case of breastfeeding difficulties.

The superiority of human milk over its substitutes is no longer questioned, especially for the feeding of premature babies or newborns hospitalised in neonatology. Milk banks organise the collection, conservation, treatement and distribution of human milk. The objective is however to encourage the direct donation of raw milk, avoiding the need for freezing and pasteurisation, in order to preserve its properties as best as possible.

Exclusive breastfeeding is recommended up to 6 months of age, and may be continued in combination with a more diversified diet until 2 years of age. It represents the ideal natural diet for the newborn. The current change of maternity care policy and the adherence to the Baby Friendly Hospital Initiative (BFHI) project, have been associated with a significant improvement of patient information. This positive aspect combined with the effect of perinatal education were major contributors for breastfeeding promotion. This article presents the physiology of breastfeeding and its practical aspects, useful for the family doctor. The doctor plays a central role both in the information, which might influence the choice of breastfeeding, and also in the support of the mother or her baby. The duration of breastfeeding represents the new goal to be emphasized. Lactating mothers should be encouraged to consult competent caregivers, including the family doctor in case of breastfeeding difficulties.

We report a case of clonidine poisoning in a breastfed newborn. At 2 days of life, this boy presented a consciousness deficit with drowsiness, hypotonia, and suspected generalized seizures. There were no cardiorespiratory problems outside of progressive central apneas beginning the 5th day. Further initial investigations were normal (extensive biological exams, cranial ultrasonography and transfontanellar Doppler, electroencephalography, and brain MRI study), excluding the main causes of neonatal hypotonia (encephalitis, infection, metabolic disorder). However, new medical questioning revealed maternal daily intake of 0.15 mg clonidine for hypertension during and after pregnancy. Since it was impossible to quantify clonidine quantification in newborn serum and breast milk, a weaning test was performed the 9th day. Twenty-four hours after cessation of breastfeeding, complete regression of symptoms was obtained. Poisoning by clonidine after fetal and neonatal exposure through breast milk is rare but severe enough to simulate a neurological disease. Diagnosis is based on the search for drug use and the cessation of breastfeeding if doubt persists. Recovery of normal examination results is then rapid and complete.

Cow's milk protein allergy (CMPA) is the first allergy that affects infants. In this population, the incidence rate reaches 7.5%. The multiplicity and aspecificity of the symptoms makes its diagnosis sometimes complicated, especially in the delayed type (gastrointestinal, dermatological, and cutaneous). CMPA symptoms can develop in exclusively breastfed infants with an incidence rate of 0.5%. It, therefore, raises questions about sensitization to cow's milk proteins through breast milk. Transfer of native bovine proteins such as β-lactoglobulin into the breast milk is controversial: some authors have found bovine proteins in human milk but others point to cross-reactivity between human milk proteins and cow's milk proteins. However, it seems that a small percentage of dietary proteins can resist digestion and become potentially allergenic. Moreover, some authors suspect the transfer of some of these dietary proteins from the maternal bloodstream to breast milk, but the mechanisms governing sensitization are still being studied. Theoretically, CMPA diagnosis is based on clinical observations, prick-test or patch-test results, and cow's milk-specific IgE antibody concentration. A positive food challenge test usually confirms the diagnosis. No laboratory test is available to make a certain diagnosis, but the detection of eosinophil cationic protein (ECP) in the mother's milk, for example, seems to be advantageous since it is linked to CMA. Excluding cow's milk from the mother's diet is the only cure when she still wants to breastfeed. Usually, cow's milk proteins are reintroduced after 6 months of exclusion. Indeed, the prognosis for infants is very good: 80% acquire a tolerance before the age of 3 or 4 years. Mothers should not avoid dairy products during pregnancy and breastfeeding as preventive measures against allergy.

To study the maturation of breast milk by the course of immunoglobulins A, G and M during the first three weeks of breast feeding.This longitudinal and prospective survey took place from August to October, 2007, in Libreville, the capital of Gabon. The population comprised women with no significant medical history who had given birth in the obstetrics department of Center Hospital of Libreville. Women who delivered at home, had stillbirths, or infants positive for HIV hepatitis B virus were excluded. Three samples were taken, on D1 for colostrum, D7 for the transitional milk and D21 for mature milk. Immunoglobulins were determined by nephelometry, with the Turbox Plus(®) system from Diagnostica Orion. Variables were compared with Spearman's non-parametric test. The survey of the kinetic has been made from the test of Friedman's test was used to assess the kinetics. Significance was set at p0.05.This survey included 60 mother-child pairs. The mean IgA concentration on D1 was 13.4 ± 5.9 g/L. This concentration fell very quickly by the end of the first week, to 2.3 ± 2.0 g/L on D8, and then stabilized through D21. This rapid drop explains the need for early breast feeding after birth. On the other hand, IgG and IgM concentrations varied less and about one-sixth as high as the IgA. This finding confirms that they were minor components of breast milk.This work shows the importance of the early immune protection provided by the mother to her child during the first week of life.

More than 120 genotypes have been identified among the Papillomavirus (HPV) family. These viruses are ubiquitary with skin or mucous membrane tropism and cause various pathologies from wart to neoplasia. HPV family is classified according to their tropism. Genital HPV infection is considered as the most frequent sexually transmitted disease in the world. Seventy-five percent of women will be in contact with HPV at least one time in their life. HPV is usually transmitted through direct skin-to-skin contact, more often during penetrative genital contact. Other types of genital contact in the absence of penetration can lead to HPV infection, but those routes of transmission are much less common than sexual intercourse. However, virgins (2 % of cases) and young children can present HPV infection, suggesting other routes of transmission than sexual intercourse. HPV infection could occur during delivery; vaginal deliveries appear to promote this transmission in comparison with cesarean section. But cesarean section do not completely protect against contamination risk. In utero, vertical transmission has been suggested by different studies but with lack of evidence. HPV infection can be detected on inanimate objects, such as clothing or environmental surfaces. However, transmission is not known to occur by this route. More detailed knowledges of the transmission route of HPV infection will enable to get prevention more effective.

Numerous maternal lipophilic compounds are eliminated into milk during lactation, their concentrations reflecting fetal in utero exposure. Some of them are endocrine disruptors. Their role in the occurrence of genital malformation, dysfunction or cancer has been suggested. We wanted to study the exposure of our population and its potential association with cryptorchidism, as few clinical studies are available.Over three years, we screened for cryptorchidism all boys born alive at or above 34 weeks of gestational age, in two maternity wards (CHU Nice, CHG Grasse). Cryptorchid boys were matched with two controls. Nursing mothers provided a colostrum sample that was screened for 15 compounds known for their antiandrogenic and/or anti estrogenic properties, including dichloro-diphenyl-trichloro-ethylene (DDE), polychlorinated biphenyls (PCBs), dibutylphthalate (DBP) (metabolite monobutylphthalate-mBP) and hexachlorobenzene (HCB).Out of 6246 boys, 102 were cryptorchid (1.6%). All available colostrums (56 for cryptorchid and 69 for controls) were contaminated. Median concentrations of DDE, PCBs, HCB and phthalates were higher though not significantly in cryptorchid versus controls. Cryptorchid boys were more likely to be classified in the most contaminated groups for DDE and SigmaPCBs, with a trend for mBP. Odds ratio (OR) for cryptorchidism was increased for the highest score of SigmaPCB, with a trend only for DDE versus the lowest score of those components. Our results are similar to those of a Scandinavian study with comparable design.Our results show the universal contamination of milk with endocrine disruptors in our area, and support the association between congenital cryptorchidism and fetal exposure to PCBs and possibly DDE, alone or in association with other chemicals.

Allergy consists in the different manifestations resulting from immune reactions triggered by food or respiratory allergens. Both its frequency and severity are increasing. The easiest intervention process for allergy prevention is the reduction of the allergenic load which, for a major allergen such as peanuts, has to begin in utero. The primary prevention strategy relies first on the detection of at risk newborns, i.e. with allergic first degree relatives. In this targeted population, as well as for the general population, exclusive breastfeeding is recommended until the age of 6 months. The elimination from the mother's diet of major food allergens potentially transmitted via breast milk may be indicated on an individual basis, except for peanut, which is systematically retrieved. In the absence of breastfeeding, prevention consists in feeding at-risk newborns until the age of 6 months with a hypoallergenic formula, provided that its efficiency has been demonstrated by well-designed clinical trials. Soy based formulae are not recommended for allergy prevention. Complementary feeding should not be started before the age of 6 months. Introduction of egg and fish into the diet can be made after 6 months but the introduction of potent food allergens (kiwi, celery, crustaceans, seafood, nuts, especially tree nuts and peanuts) should be delayed after 1 year. This preventive policy seems partially efficacious on early manifestations of allergy but does not restrain the allergic march, especially in its respiratory manifestations. Probiotics, prebiotics as well as n-3 fatty polyunsaturated acids have not yet demonstrated any definitive protective effect.

Cytomegalovirus can be detected in breast milk of almost all seropositive women. Postnatally acquired CMV infection through human milk feeding occurs as soon as the third week in premature infants. Even if this infection is often limited to serologic conversion, two other clinical presentations were reported. The more severe, a sepsis like syndrome, occurs more frequently among the more premature neonate. Neutropenia, thrombocytopenia, cholestasis and mild increase in inflammatory markers depict the more frequent form. In both presentation, clinical signs and laboratory abnormalities are transient. Until now, no significant impact on long term outcome was reported, nonetheless studies focusing on that topic are scarce and a longer follow up might be required to ascertain the good outcome. Holder pasteurization inactivates CMV, meanwhile freezing-thawing does not.

Despite the benefits of human milk fortification, nutrients of human milk are not sufficient to cover the greater needs of very low birth weight and to ensure a growth similar to that of premature infants fed with preterm formula. These differences could be related to the variation in the macronutrient composition of expressed breast milk with lower protein and energy content. Unfortunately there is unusually no information on macronutrients composition prior human milk fortification. With such data, it would be possible to individualize the fortification. In order to use adjustable fortification of human milk, we have assessed a rapid and simple method using full spectrum infrared laser technology (Milkoscan) to analyze human milk composition. We describe the variation in concentration of protein, lipid and energy in the human milk received in our neonatal unit. Then we evaluate the benefit of adjustable fortification of human milk compared with standard fortification. After standard fortification the variability of protein and lipid remains with a risk of protein deficiency or excess and a risk of energy deficiency. After adjustable human milk fortification based on human milk analysis using Milkoscan, we observe a more stable protein content and a lower amount of added fortifier decreasing the risk of hyperosmolarity. Furthermore, the energy content is higher following of the fat human milk adjusted content. Up to now, our preliminary results suggest that individualized fortification of human milk improves growth rate in preterm infants (21 g/kg/d) to a level close to formula fed infants.

Many studies demonstrated that human milk is the recommended source of enteral nutrition in preterm infants providing several benefits with regards to feeding tolerance, immunity and cognitive development However, neurological immaturity and associated clinical conditions prevent them from suckling effectively. Therefore, mother's milk must be expressed, stored and transported to the neonatal unit and could be contaminated. The microbiological quality of human milk was evaluated on each donation to the neonatal intensive care unit of the University of Liege, Belgium from November 1, 2003 to January 31, 2005. In all, 5842 samples from 176 mothers were included in the study. Samples were classified according to the exclusive presence of coagulase negative Staphylococcus and their number (less or more than 104 germs per ml) or to contamination with pathogens. More than 50% of analyzed milks had to be pasteurized (46%;104 coagulase negative Staphylococcus per ml) or to be discarded (7% pathogen contamination). The incidence of pasteurisation tends to increase during the summer, suggesting a seasonal influence. Maternal profiles were established longitudinally. Among the 60 mothers whose at least one sample had pathogen contamination, 27% had a contamination occurring only during a few days, but 73% had more than 50% of their samples discarded. This study suggest the need to promote the use and the financial support of intrahospital human milk bank units to support the safe use of raw and pasteurised human milk in preterm infants.

Staphylococcus aureus is often responsible for late septic infections, more rarely of toxinic ones, occurring in neonatal period. We report a case of staphylococcal scalded skin syndrome and bullous impetigo in newborn twins infected by breast milk from their asymptomatic mother. This transmission was confirmed by molecular biology method. This case emphasizes the potential part of the mother in staphylococcal nosocomial infections and the complexity of toxinic mechanisms.

Breast milk contains hormones, growth factors, cytokines, cells, etc., and offers many advantages over cow's milk or soy protein infant formulae. The composition of breast milk is influenced by gestational and postnatal age. Prevalence of breastfeeding in France is one of the lowest in Europe: in 2003, only 58% of infants were breastfed when leaving the maternity ward, for a median duration of 10 weeks. Breastfeeding allows normal growth until at least 6 months of age, and can be prolonged until the age of 2 years or more, provided that complementary feeding is started after 6 months. Breastfeeding is associated with slightly enhanced performance on tests of cognitive development. Exclusive breastfeeding for at least 3 months is associated with a lower incidence and severity of diarrhoea, otitis media and respiratory infection. Exclusive breastfeeding for at least 6 months is associated with a lower incidence of allergic disease in at-risk infants (infants with at least one first-degree relative presenting with allergy). Breastfeeding is also associated with a lower incidence of obesity during childhood and adolescence, as well as with a lower incidence of hypertension and hypercholesterolemia in adulthood. Maternal infection with hepatitis B and C virus is not a contraindication to breastfeeding, as opposed to HIV infection and galactosemia. A supplementation with vitamin D and K is necessary in the breastfed infant. Very few medications contraindicate breastfeeding. Premature babies can be breastfed and/or receive mother's milk and/or bank milk, provided they receive energy, protein and mineral supplements. Return to prepregnancy weight is earlier in breastfeeding mothers. Breastfeeding is also associated with a decreased risk of breast and ovarian cancer in the premenopausal period, and of hip fractures and osteoporosis in the postmenopausal period.

Transmission of cytomegalovirus (CMV) infection from mothers to preterm infants during breastfeeding may be symptomatic and long term consequences are unknown. This study evaluated the kinetics of CMV load in breastmilk and the rate of postnatal CMV transmission via breastmilk from mothers to their preterm infants.Prospective study of mother-child pairs after preterm delivery before 33 weeks. Exclusion of donor breast milk and of CMV-seropositive blood products. Material used was maternal CMV serostatus, ear swab of the infant at birth, weekly screened breast milk and children's urine by rapid viral culture.During a 5-month period 28 mother-infant pairs with 34 preterm infants were studied. Eighteen women (64.3%) were CMV-seronegative at birth; breastmilk samples and the infants' urine remained CMV-negative. Eight of the 10 seropositive mothers, who had 11 preterm infants, excreted CMV into breast milk (80%). CMV excretion into breast milk was detected during the first week after delivery in 66% cases and was at its peaked between 3 to 5 weeks after delivery. Out of the 7 CMV-exposed infants, CMV transmission was confirmed in only one asymptomatic case. Total quantity of breast milk intake did not seem discriminative for CMV transmission.In CMV-seropositive mothers of preterm infants a high incidence of CMV excretion into breast milk was detected. Despite this high rate, symptomatic infection did not occur. However, potential risk and severity of infection may be difficult to establish. Because breastfeeding is beneficial, new procedures for gentle virus inactivation of seropositive breast milk should be assessed.

Within the framework of breast milk control the hygiene laboratory of Brest hospital isolates, on 3 January 1996 a strain of Enterobacter aerogenes secretory of cephalosporinase in the breast milk of a mother whose child was hospitalized in neonatalogy. On 15 April 1996 a new strain of E. aerogenes is isolated from another mother's breast milk. Until 18 August 1997, 21 samples of breast milk were tested positive to this bacteria. During the same period, E. aerogenes was isolated in 26 children under 1 year of age, 11 of which were infected and 15 colonized. The breast milk did not correspond to those of the mothers of the infected or colonized children. All the strains presented the same antibioresistance. The pulsed-field gel electrophoresis showed that the children's strains, those colonized or infected as well as those isolated in breast milk had the same restriction profile. The epidemiological study concerned the biberonnery-lactarium. The biberonnery's staff is the same as the staff of the lactarium. A portage was searched for among the members of the staff of these units, but without success. The search for E. aerogenes in the environment and in baby-food, others than breast milk was negative. Finally, we did not find any source for these contagions. The only hypothesis we have retained is that of a common source from the biberonnery-lactarium, but without being able to bring any proof to it. Following this epidemic, we have revised all the working modalities and practices with the staff of the biberonnery-lactarium.

Different types of human milks are given to preterm newborns (mother and bank milk). Their effect on neonatal growth is recalled. The usefulness and justification of dietetic supplements as well as appropriate quantities and practical aspects are discussed.

Lactose is the main source of energy supplied to the newborn mammalian in its mother's milk. Because of its lower sweeting power, lactose is unable to induce a reaction as does dextrose. Lactose does not lead to release of mediators such as endorphins or dopamine and is free of reward effects.

Authors report clinical, biological and endoscopic data of six children aged less 3 months with bloody stools while they were exclusively breast-fed.Two girls and four boys aged 1 to 2 months presented with isolated but recurrent rectal bleeding. All were explored by fiberoptic rectosigmoidoscopy between 1 and 3,2 months. Macroscopic aspects were congestion (6 cases), petechial and ecchymotic (4 cases), with normal mucosal areas (5 cases). Histopathology showed eosinophilic infiltrates in all 5 children with rectal biopsy. Evolution was satisfactory after cow's milk protein exclusion in maternal diet for five children and after weaning in 1. All children were weaned with protein hydrolysate. Cow's milk protein were later introduced without adverse reactions at 6 to 23 months.Food allergy can be considered in proctocolitis including exclusive breast-fed children. Evolution after maternal diet is, as usual, simple.

Symptomatic zinc deficiency can occur in exclusively breast-fed infants. We report a case in a preterm infant.A 3-months-old exclusively breast-fed premature infant presented with peri-orificial and acral eczematoid lesions. Laboratory investigations revealed lowered zinc levels in the infant's serum and in her mother's milk. A rapid healing occurred after oral zinc supplementation.Zinc deficiency in breast-fed infants is a rare disease caused by a low level of zinc in mother's milk. The clinical features resemble those of acrodermatitis enteropathica. Oral zinc supplementation is required until weaning.

The administration of drugs is very often compatible with breastfeeding. It is now possible to determine the safety of prescribing a drug during lactation, provided that the following data are available: transfer of the drug into breast milk, pharmacokinetic parameters of the drug, recommended dosages for the neonate and the child. With these data, it is mostly possible to prescribe antibiotics, analgesics, antitussive agents, etc. during breastfeeding. However, it is of utmost importance to known the situations at risk for prescribing drugs during lactation, in order to avoid them. Finally, a short summary will give more information about the importance of some vitamins, especially vitamin K, during lactation.

Neonatal hypernatremic dehydration due to breast feeding was rarely reported in the French-language literature.The authors report hypernatremic dehydration in a 10-day-old exclusively breast-fed infant. The course was favorable. Insufficient breast milk production has been reported for 30 years.Early discharge from maternity units is frequent nowadays. Breast-fed newborns without a positive weight gain at discharge should be checked for their weight within the first ten days of life.

Lactation is an energy-demanding physiological process for the maternal organism and life-giving for the offspring. Likewise, exercise is an energy-demanding process. This review addresses the Compatibility of exercise during lactation. Human studies suggest no detrimental effect of exercise during lactation on milk composition and volume, infant growth and development, or maternal health. Studies also demonstrate improved cardiovascular fitness in lactating, exercising women and suggest a quicker return to pre-pregnancy body weight and a more positive sense of well-being, compared to sedentary controls. Findings from rodent studies, although of questionable value for humans, have generally shown no detrimental influence of exercise during pregnancy and lactation on pup growth and development. To date, findings suggest that exercise and lactation are compatible activities. Key words: maternal health, infant growth, breast milk composition, breast milk volume, cardiovascular fitness

This paper gives an overview of the environmental or background exposure of general population to dioxins, polychlorinated dibenzo-para-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF), originating from a variety of industrial and thermal processes and recognized as cancerous and toxic substances. The daily consumption of low-level contaminated food, mainly of animal origin, leads to the accumulation of dioxins in the human body. To determine the background exposure, human milk, adipose tissue or blood from many geographical locations (except France) have been used as bioindicators for body burden of dioxins. Human milk also allows the daily intake estimation of dioxins for breast-fed babies. Efforts should be made to minimize or avoid PCDD/PCDF emission in the environment.

Three types of infant formulas with reduced antigenic content are presently available: formulas with partially hydrolyzed proteins (hypoallergenic formulas), formulas with extensively hydrolyzed proteins, and amino-acids mixtures. There respective indications for preventing, postponing or treating allergic manifestations are presented, recalling that breast milk remains the best recommendation. Patent cow milk allergy requires extensively hydrolyzed proteins formulas.

Human milk as well as the milk of several mammalian species contains, beside major nutrients and anti-infectious and immunocompetent substances, a group of biologically active substances called "milk-borne trophic factors" or "growth modulators". Milk-borne trophic can be classified into three groups: hormones and trophic peptides; nucleotides, nucleosides and derived substances; and polyamines, especially spermine and spermidine. Certain hormones and peptides such as growth hormone, insulin, insulin like-growth factor I (IGF-I), epidermal growth factor (EGF), prolactin and growth hormone releasing factor (GHRF) can influence directly newborn's metabolism after intestinal absorption and promote growth and differentiation of several organs and target tissues. They could exert a cytoprotective effect against toxins and toxic substances and reduce the potential risk of necrotizing enterocolitis. Nucleotides are present in human milk at high levels, and are precursors of nucleic acids, which implies that they can enhance growth and differentiation of several organs and tissues, especially the liver. Nucleotides from milk enhance lipid metabolism, lipoprotein synthesis and liver cell function and regeneration. In addition, they have a determinant action on the development of the gut associated lymphoid tissue (GALT). Lastly, polyamines, mainly spermine and spermidine, are polycationic substances virtually present in all cells, whose concentration in human milk is about ten times higher than in infant formulae. In addition, spermine and spermidine levels increase markedly during the first 3 days of lactation reaching, after 1 week, plateau levels which are respectively 12 and eight times higher than the levels measured at day 0. Although several experimental studies have shown that polyamines from the milk of lactating mammals determine important mitogenic, metabolic and immunological effects promoting growth and differentiation of the immature gastrointestinal tract of the offspring, their beneficial effects on growth and differentiation of the gastrointestinal tract in humans remain hypothetical. As a consequence, enrichment of milk formulae in one or in several trophic factors is an important but complex goal. Its practical realization is not realistic today because of a too great number of incertitudes. The most important is related to potential beneficial or adverse effects emerging at short or at long term and to the individual interactions of these substances which could be agonist and antagonist because they are naturally present in milk as a "complex cocktail" whose composition changes during the lactation period.