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Objectives: Beginning in February 2022, the United States faced an infant formula shortage that severely impacted access and affordability. Little is known about how this shortage impacted infant feeding intentions among expectant mothers. Our study sought to determine the impact of the formula shortage on prenatal feeding intentions and to understand expectant mothers' feelings and perceived stress related to the shortage. Methods: This cross-sectional, exploratory, observational study of pregnant women (n = 57) residing in New York City utilized a self-administered online survey in May–July 2022. Results: The results indicate that ten (17.5%) respondents changed their feeding intentions during the infant formula shortage for months 0–3 or 3–6 of infancy to include more breastfeeding than originally intended. These mothers also reported significantly higher stress levels related to the shortage than their non-changing peers. Conclusions for practice: Our results suggest that the formula shortage influenced feeding intentions among a subset of surveyed expectant mothers. The stress associated with the shortage influenced prenatal feeding intentions to include more breastfeeding than intended prior to the shortage. Prenatal healthcare providers should consider the availability of infant formula as one of myriad factors that influence infant feeding intentions, and that the stress associated with whether infant formula is readily available may influence these intentions as well. Significance: Numerous factors, including social, cultural, and economic influences, can shape prenatal infant feeding intentions. Our results suggest that availability of infant formula may be an additional element in this decision-making process. Our study found that the 2022 infant formula shortage influenced expectant mothers to include more breastfeeding in their feeding plans than they had originally intended as a result of the shortage. To our knowledge, there has been no research published that examines the effect of an infant formula shortage on the feeding intentions of expectant mothers. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the impact of the COVID-19 pandemic and associated stay-at-home orders on the breastfeeding experiences of U.S. people a identify facilitators and barriers to breastfeeding during this period, and to assess the effects of maternal stress and misinformation on breastfeeding practices. Methods: U.S. women with infants were selected through purposive and convenience sampling. An online survey, distributed during summer 2020, measured changes in infant feeding practices, maternal stress levels, use of lactation support resources, and the influence of misinformation on feeding decisions. Quantitative data were analyzed using descriptive statistics, and qualitative responses underwent thematic analysis. Results: Our sample (n = 1,861) revealed that 34% of U.S. women realized the pandemic affected their feeding practices, 544 women provided qualitative data. Major themes from qualitative analysis included ease of breastfeeding at home, bonding, increased breastfeeding duration, and challenges like limited access to lactation support. Logistic regressions highlighted demographic influences on breastfeeding practices, with no significant effects found related to the child's age or women's income on changes in feeding practices. Conclusions for Practice: The COVID-19 pandemic substantially impacted breastfeeding experiences of U.S. women, yielding insights for future policy and healthcare practices. The findings underscore the potential benefits of telehealth lactation support services and flexible remote work environments for breastfeeding people. Clear and scientifically-grounded communication regarding breastfeeding, mental health support, and policy development, are essential to promote equitable and flexible work and maternity leave options for breastfeeding people especially during global health crises. Significance: This study provides new insights into how the COVID-19 pandemic's stay-at-home orders uniquely impacted breastfeeding practices among a large and diverse sample of U.S. women across various regions, income levels, and racial/ethnic backgrounds. By capturing a wide range of experiences, we address a critical gap in understanding the effects of sudden societal changes on breastfeeding across different demographics. Our findings highlight both facilitators—such as increased time at home leading to easier breastfeeding, stronger mother-infant bonding, and extended breastfeeding duration—and barriers—including limited access to lactation support and heightened maternal stress. The diversity of our sample enhances the applicability of our results to inform maternal and child health policies and practices. We underscore the potential benefits of telehealth lactation services and flexible remote work policies in enhancing breastfeeding outcomes and reducing health inequities, emphasizing the need for supportive measures that promote breastfeeding, especially during global health crises. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Hormonal changes during pregnancy may cause various changes in biological, physiologic and psychosocial areas. The main objective of this study was to analyze the relationship between dietary habits, psychological well‐being, sleep quality and biochemical parameters of pregnant women.The study was conducted on a total of 93 patients who applied to Ankara Koru Sincan Hospital Gynecology and Obstetrics Outpatient Clinic for routine pregnancy control between November–December 2023, were between the ages of 18–45, had a live singleton fetus, had no diagnosed psychiatric disease or chronic disease, and agreed to participate in the study. Anthropometric measurements and biochemical findings of the individuals were recorded with a questionnaire including the psychological well‐being scale (PWBS) and Pittsburgh sleep quality index (PSQI).According to the study, PSQI scores during the second and third trimesters are significantly higher than the first trimester. It was observed that while individuals have bad sleep quality during the second and third trimesters, they have good sleep quality during the first trimester (χ2 = 14.736; P < 0.001). In the biochemical results, the thyroid‐stimulating hormone (TSH) value in the second trimester was higher (P > 0.05). Weight gain during pregnancy, age and trimester have a negative effect on sleep quality.When the effects of lifestyles and eating habits of pregnant women on the process are considered, there is a relationship between smoking/alcohol consumption, less physical activity, poor eating habits, sleep quality and depressive symptoms. Factors such as age, educational background, trimester period and other basic sociodemographic variables are also involved. [ABSTRACT FROM AUTHOR]

Human milk feeding has generally been described using a heteronormative and cisnormative paradigm focusing on a mother and child dyad with the child nursing at the mother's breast and the father in a supportive role. However, there has been a paradigm shift that has emerged from the LGBTQI+ community that recognizes dynamic gender identities, gender roles, sexual orientations, and diverse family structures. Social workers can best provide support to people with dynamic and diverse gender roles and a variety of family structures. The purpose of this paper is to provide an overview of social work best practices, including de-sexed and gender-inclusive language, gender-affirming, and trauma-informed care in supporting lactation and infant feeding for LGBTQI+ families. This paper acknowledges and describes terminology that promotes equity and inclusivity in human milk feeding and provides examples of information and anticipatory guidance that social workers can use to protect, promote, and support human milk feeding in the LGBTQI+ community. [ABSTRACT FROM AUTHOR]

Aim: Extremely premature infants receive nutrition and medication through nasogastric tubes. Breastmilk given accordingly is subject to fat loss. This study aimed to investigate whether this could also apply to vitamin D. Methods: A questionnaire investigated vitamin D administration at a level III neonatal intensive care unit in Sweden in 2021. Feeding simulations with breastmilk and various vitamin D mixtures were done accordingly. After administration, vitamin D3 concentration was analysed using chromatography with mass spectrometry, followed by repeated simulations with vitamin D mixtures without breastmilk in 2023. Results: The questionnaire was completed by 10 persons. Vitamin D was administered as drops using an enteral syringe and a nasogastric tube in conjunction with a breastmilk meal. In the feeding simulations, vitamin D3 concentration after administration was significantly higher using a syringe alone compared to standard administration. When vitamins were administered according to standard but without breastmilk, 100% of the vitamin D and 40% of the multivitamins were lost. The vitamins adhered to the material, mainly in the nasogastric tube. Conclusion: Our findings indicate that standard vitamin D supplementation in the neonatal intensive care unit may be unpredictable when administered by enteral syringe and nasogastric tube. We suggest using direct oral administration whenever possible. [ABSTRACT FROM AUTHOR]

Cow's milk protein allergy (CMPA) affects 2% to 3% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding health care providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. A total of 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care. [ABSTRACT FROM AUTHOR]

Summary: Community‐based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community‐based diet and obesity‐related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60–69%) occurred in the prenatal period and early infancy (0–3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood. [ABSTRACT FROM AUTHOR]

Objectives To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. Methods The authors studied 4062 surviving very preterm infants born < 32 weeks’ gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. Results Infants’ mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: −2.0, −1.8, and −1.5; head z: −1.3, −1.2 and −1.1 for exclusive human milk, mixed and exclusive formula respectively). Conclusion Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding is considered the best nutrition for infants, including born preterm due to containing optimal ingredients for development and growth. Breast milk is a rich source of nutrients, it also contains diverse types of bacteria, which play a role in infant's gastrointestinal tract colonization and preserving mammary health. Composition of human milk varies depending on numerous maternal and infant factors. Aim of the study: The aim of the study was to summarize the current knowledge about the content of nutrients, bioactive factors and microbiota diversity in human milk depending on various factors. Materials and methods: The work is a review of 26 mainly English-language scientific publications from 1989-2024 posted on the PubMed platform. Results: Milk composition changes in addition to several factors. Depending on postnatal age: preterm milk has higher content of protein, fat and immunological factors and lower concentration of lactose than term milk. Depending on milk maturity: Colostrum is higher in protein but lower in lactose, fat and energy than mature milk. Human milk is also a source of viable bacteria important for developing infant's gut microbiota, but the diversity of bacterial strains in milk may vary. Depending on mode of delivery: milk of mothers after spontaneous labour contents more probiotic vaginal- and enteric-associated bacteria, while milk of mothers after C-section has more skin-associated microbiota. Depending on mother's weight: milk of overweight mothers is lower in probiotic- and higher in pathogenic bacteria. Alcohol, nicotine, and some medications also have negative impact on produced milk. Conclusions: Human milk varies from woman to woman and its composition depends on several factors. Postnatal and gestational stage, delivery mode, mother's weight and certain substances have been found to be important factors influencing the constitution of breast milk, including nutrients, microbiota and volume of milk. [ABSTRACT FROM AUTHOR]

Breastfeeding is the optimal form of infant nutrition and remains a critical topic of discussion. In the case of lactation problems, women can be assisted by plant galactagogues designed to induce, sustain, and increase lactation. Reports on the popularity, awareness and knowledge of galactagogues are limited. Therefore, this study aimed to analyze the use of galactagogues in the diet among breastfeeding women. The online survey was conducted using anonymized questionnaires, with results collected in the Spring of 2021. Fifty-two women aged 20 to 50 who fed naturally participated in the study, with 69% of respondents being familiar with galactagogues and 42% having used them. The most often indicated herbs were fennel (68%) and anise (45%). Galactagogues were used as ready-to-use herbal lactation mixes (73%). Women found them effective in stimulating lactation (82%) and purchased them in pharmacies (64%) or herbal stores (36%). Respondents were encouraged to use galactagogues by media (32%) and family and friends (45%). Women reported that greater knowledge (57%) would be essential to effectively encourage galactagogues. Breastfeeding women were positive about using plant-based galactagogues and considered them effective. A critical barrier identified by those not using galactagogues was their need for knowledge. The information campaign for pregnant women should include galactagogues as lactation-stimulating herbs. [ABSTRACT FROM AUTHOR]

Zinc and selenium are essential minerals for human nutrition. Reliable biomarkers of zinc status and selenium status in humans are therefore important. This work investigates a novel portable X-ray fluorescence (XRF) method with the ability to rapidly assess zinc and selenium in nail clippings. This approach used a mono-energetic X-ray beam to excite characteristic X-rays from the clippings. Nail clippings were obtained from the Mother and Infant Nutrition Investigation (MINI), a study designed to assess nutrition in a population of women and their breastfed children in New Zealand. Twenty mother-infant pairings were selected to provide nail clippings at two time points (visit 1 at 3 months postpartum; visit 2 at 6 months postpartum). Nail clippings from each mother-infant pairing were divided into three groupings of clippings prior to analysis: those obtained from a big toe of the mother, those from the other toes of the mother, and those from the toes and fingers of the infant. Clippings were prepared and mounted prior to XRF measurement, providing four distinct fragments from each clipping grouping. These fragments were assessed by XRF using a measurement time of either 300 s (visit 1) or 180 s (visit 2). XRF results were determined through both an automated system output and an analysis of the X-ray energy spectrum. Following this assessment of zinc and selenium with the non-destructive XRF method, clippings were measured for zinc and selenium concentration using a "gold standard" technique of inductively coupled plasma mass spectrometry (ICP-MS). Mean ICP-MS concentrations ranged from 122 μg/g to 127 μg/g for zinc, and from 0.646 μg/g to 0.659 μg/g for selenium. Precision, assessed by a relative standard deviation of measurement, was superior for ICP-MS relative to XRF. For both zinc and selenium, XRF results were compared with ICP-MS concentrations. Linear equations of best fit were determined for each comparison between XRF and ICP-MS results. Coefficients of determination (r2) were stronger for zinc (from 0.74 to 0.95) than selenium (from 0.53 to 0.70). A decrease in XRF measurement time from 300 s to 180 s did not appear to adversely affect the correlation between XRF and ICP-MS results. Using the mono-energetic portable XRF method, the correlation of XRF zinc results with ICP-MS zinc concentrations was improved over previous findings, and selenium measurement was reported for the first time. The method may prove useful for future applications to trace element analysis using nail clippings as a biomarker. [ABSTRACT FROM AUTHOR]

AbstractSources of milk fat globule membrane (MFGM) are desirable to include in infant milk formula (IMF) to mimic the composition and functionality of human milk MFGM. MFGM in its natural form consists of a trilayer structure containing lipids (e.g., cholesterol, phospholipids, gangliosides, ceramides), proteins (e.g., butyrophilin, xanthine oxidase, mucin-1, adipophilin) and glycans (e.g., sialic acid). Components of MFGM have been associated with various biological benefit areas including intestinal, neurocognitive, and immune health. There are many aspects to consider when supplementing IMF with MFGM ingredients, of which the major ones are highlighted and critiqued in this review from an industrial research perspective. Features include compositional unknowns, discussion on how best to incorporate MFGM to IMF, analytical method needs, biological function unknowns, and considerations on how best to communicate MFGM in different contexts. It is hoped that by identifying the key scientific gaps outstanding in this subject area, collective efforts can proceed to ensure the potential impact of MFGM on infant health is realized. [ABSTRACT FROM AUTHOR]

Background: Human breast milk is a complex biological fluid containing multifaceted biological compounds that boost immune and metabolic system development that support the short- and long-term health of newborns. Recent literature suggests that human breast milk is a substantial source of nutrients, bioactive molecules, and exosomes. Objectives: This review examines the factors influencing exosomes noted in human milk and the impacts of exosomes on infant health. Furthermore, it discusses potential future prospects for exosome research in dietetics. Methods: Through a narrative review of the existing literature, we focused on exosomes in breast milk, exosome components and their potential impact on exosome health. Results: Exosomes are single-membrane extracellular vesicles of endosomal origin, with an approximate radius of 20–200 nm. They are natural messengers that cells secrete to transport a wide range of diverse cargoes, including deoxyribonucleic acid, ribonucleic acid, proteins, and lipids between various cells. Some studies have reported that the components noted in exosomes in human breast milk could be transferred to the infant and cause epigenetic changes. Thus, it can affect gene expression and cellular event regulation in several tissues. Conclusions: In this manner, exosomes are associated with several pathways, including the immune system, oxidative stress, and cell cycle, and they can affect the short- and long-term health of infants. However, there is still much to learn about the functions, effectiveness, and certain impacts on the health of human breast milk exosomes. [ABSTRACT FROM AUTHOR]

Background: In preterm infants, IV administration of fat is less well tolerated compared to intake via the enteral route, often resulting in hypertriglyceridemia. It is therefore recommended that parenteral fat intake should not exceed 3.5 to 4.0 g/kg/d whereas human milk can provide up to 8 g/kg/d. It is unknown whether such hypertriglyceridemic conditions are caused by a uniform increase of all fatty acids or it is linked to an elevation of distinct fatty acids due to an unbalanced intake. Obviously, both scenarios could potentially influence the formulation of novel lipid solutions for preterm infants. Objective of this exploratory study was to compare fatty acid profiles between a) different nutritional sources and corresponding plasma samples, b) plasma of infants fed breast milk versus those receiving lipid emulsion, and c) plasma of infants with normal versus elevated triglyceride levels. Methods: Forty-seven preterm infants < 36 weeks of gestation were included; fatty acid profiles were measured in serum samples and corresponding nutritional sources (breast milk and lipid emulsion) using gas chromatography/mass spectrometry. Results: Compared to breast milk levels, plasma contained significantly lower C8:0, C10:0, C12:0, C14:0, C19:1n9, C18:3n3 (p < 0.0001). In contrast, relative abundance of C16:0, C18:0 and C20:4n6 was higher in plasma than in corresponding breast milk samples (p < 0.001) and lipid emulsion (p < 0.01). Compared to the corresponding lipid emulsion, the abundance of C18:2n6 and C18:3n3 was significantly lower in plasma (p < 0.001). Fatty acid profiles in plasma of infants fed breast milk compared to lipid emulsion were not markedly different. Hypertriglyceridemic samples showed elevated levels for C18:1n9 and C16:0 when compared with normotriglyceridemic samples. Conclusions: Our study reveals that lipid levels in plasma show both depletion and enrichment of distinct fatty acids which do not seem to be closely related to dietary intake. A more detailed understanding of fatty acid flux rates is needed, like the understanding of amino acid metabolism and is supported by the finding that hypertriglyceridemia might be a state of selective fatty acid accumulation. This would allow to develop more balanced diets for intensive care and potentially improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Recent changes in the infant feeding guidelines for women living with HIV from high-income countries recommend a more supportive approach focusing on shared decision-making. Limited information is available on the infant feeding knowledge of women living with HIV and how healthcare providers engage with them in this context. This multicenter, longitudinal, mixed methods study aims to get a comprehensive and nuanced understanding of infant feeding knowledge among women living with HIV of Nordic and non-Nordic origin living in Nordic countries, and their interaction with healthcare providers regarding infant feeding planning. Methods: Pregnant women living with HIV in Denmark, Finland, and Sweden were recruited in 2019–2020. The Positive Attitudes Concerning Infant Feeding (PACIFY) questionnaire was completed in the 3rd trimester (T1), three (T2), and six (T3) months postpartum. Women who completed the quantitative survey were also invited to participate in qualitative semi-structured interviews at T1 and T3. Results from the survey and interviews were brought together through merging to assess for concordance, complementarity, expansion, or discordance between the datasets and to draw meta-inferences. Results: In total, 44 women living with HIV completed the survey, of whom 31 also participated in the interviews. The merged analyses identified two overarching domains: Knowledge about breastfeeding in the U = U era and Communications with healthcare providers. The women expressed confusion about breastfeeding in the context of undetectable equals untransmittable (U = U). Women of Nordic origin were more unsure about whether breastfeeding was possible in the context of U = U than women of non-Nordic origin. Increased postpartum monitoring with monthly testing of the mother was not seen as a barrier to breastfeeding, but concerns were found regarding infant testing and infant ART exposure. Infant feeding discussions with healthcare providers were welcome but could also question whether breastfeeding was feasible, and many participants highlighted a need for more information. Conclusions: Healthcare providers caring for women living with HIV must have up-to-date knowledge of HIV transmission risks during breastfeeding and engage in shared decision-making to optimally support infant feeding choices. [ABSTRACT FROM AUTHOR]

Human milk oligosaccharides (HMOs) are essentially unaffected by the digestive enzymes of the nursling and are known for their ability to enrich certain microbial species in the infant gut microbiota, in particular bifidobacteria. HMO metabolism has been studied in various bifidobacterial species such as B. breve, B. bifidum, and B. longum subsp. infantis. In the current study, we describe different ial growth abilities elicited by twenty-three newly isolated Bifidobacterium pseudocatenulatum strains on particular HMOs, such as 2'-fucosyllactose (2'FL), 3-fucosyllactose (3FL), lacto-N-tetraose (LNT), and lacto-N-neotetraose (LNnT). Through gene-trait matching and comparative genome analysis, we identified genes involved in the degradation of fucosylated HMOs in this strain set, while we employed a transcriptomic approach to facilitate the identification and characterization of genes and associated enzymes involved in LNT metabolism by strain B. pseudocatenulatum MM0196. A total of 252 publicly available genomes of the B. pseudocatenulatum taxon were screened for homologs of the glycosyl hydrolases (GHs) identified here as being required for selected HMO metabolism. From this analysis, it is clear that all members of this species possess homologs of the genes involved in LNT degradation, while genes required for degradation of fucosylated HMOs are variably present. IMPORTANCE Our findings allow a better understanding of the complex interaction between Bifidobacterium and its host and provide a roadmap toward future applications of B. pseudocatenulatum as a probiotic with a focus on infant health. Furthermore, our investigations have generated information on the role of HMOs in shaping the infant gut microbiota, thus also facilitating applications of HMOs in infant nutrition, with potential extension into the mature or adult gut microbiota. Supplementation of HMOs is known to result in the modulation of bacterial communities toward a higher relative abundance of bifidobacteria, which in turn enforces their ability to modulate particular immune functions and strengthen the intestinal barrier. This work may therefore inspire future studies to improve the formulation of neonatal nutritional products, aimed at facilitating the development of a healthy digestive and immune system and reducing the differences in gut microbiota composition observed between breastfed and formula-fed babies or full-term and preterm infants. [ABSTRACT FROM AUTHOR]

Background: Trans and/or non-binary parents experience structural exclusion in family healthcare and there is a need for specialist training for healthcare professionals so that they are able to create a gender inclusive environment. Aim: As part of a continued effort to address health inequity this study explores the body experiences of infant feeding within trans and non binary communities. Method: Semi structured interviews were conducted with seven trans or non-binary parents, based in the United Kingdom, who have experienced chestfeeding or breastfeeding. Results: A reflexive thematic analysis was utlitised to identify three main themes which centered around baby, body and support in health care settings. Parents were informed of the benefits of their milk and were strongly motivated by their child's needs. However, body feeding was emotionally and physically challenging. Conclusion: Person-centered care with consistent attention to language is required when supporting lactation. [ABSTRACT FROM AUTHOR]

Background • Feeding intolerance (FI) refers to frequent feeding disruptions, that can adversely affect the growth, nutritional status, and long-term neurodevelopmental outcomes of preterm infants (born at 37 ≤ weeks of gestation). This review evaluated the efficacy of herbal medicine (HM) for FI compared to conventional treatments. Methods • An extensive search across 11 databases was conducted, including English, Chinese, and Korean databases, from August 1 to December 7, 2023. Our inclusion criteria were randomized clinical trials (RCTs) that compared the efficacy of HM with conventional treatments against conventional treatments alone. Statistical analyses involved calculating the mean difference (MD), standardized mean difference (SMD), and risk ratio (RR) with a 95% confidence interval (CI), and assessing the bias risk (RoB 2) using Review Manager Version 5.4 software. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) rating system. Results • The meta-analysis showed that combined HM treatments exhibited superior outcomes compared to conventional treatments alone. The time to achieve full enteral feeding (n = 638, random effects MD: −2.91, 95% CI: −4.13 to −1.69), duration of FI (n = 366, fixed effects MD: −1.58, 95% CI: −2.01 to −1.16), and total effective rate (n = 774, random effects RR: 1.26, 95% CI: 1.11 to 1.42) improved with HM. Mild adverse events, such as diarrhea and increased defecation frequency, occurred in 4.17% of the HM combined group, compared to 1.42% in the conventional treatment group. Conclusions • The findings suggest that combining HM with conventional treatments could be more effective for FI, suggesting HM as an early intervention for FI in preterm infants. Further research on the efficacy and safety of HM in preterm infants is necessary. [ABSTRACT FROM AUTHOR]

• Minimum dietary diversity is associated with a lower risk of childhood underweight. • Consuming dairy, eggs, fruits, and vegetables lowers the risk of underweight. • Children exclusively fed mother's breast milk are more likely to be malnourished. A lack of consumption of a diversified diet is associated with poor physical and cognitive development in children. Evidence on the relationship between minimum dietary diversity (MDD) and childhood malnutrition remains inconclusive in India. We hypothesized that children aged 6 to 23 months on a diversified diet (five out of eight defined foods and beverages) are less likely to be malnourished (stunting, wasting, and underweight) compared to their counterparts who are not on a diversified diet. This cross-sectional study was based on the 2019-2021 National Family Health Survey of India, comprising a weighted sample of 57,714 children aged 6 to 23 months. Multilevel logistic regression was conducted for data analysis. The results showed a significant protective effect of dietary diversity on underweight (odds ratios [OR] = 0.91; 95% confidence intervals [CI]: 0.86-0.96). In addition, children who did not consume eggs (OR = 1.09; 95% CI; 1.03-1.15), dairy products (OR = 1.22; 95% CI: 1.17-1.27), or fruits and vegetables (OR = 1.11; 95% CI: 1.06-1.17) were more likely to be underweight than children who did. Children who did not consume dairy products, fruits, and vegetables were also more likely to be stunted and wasted. However, we did not find significant associations of MDD with wasting and stunting. Nutritional interventions promoting daily consumption of dairy products, eggs, fruit, and vegetables are recommended to address the growing problem of childhood malnutrition in India. Regions with higher rates of malnutrition and those lacking MDD, such as Uttar Pradesh and Rajasthan, should be prioritized. [Display omitted] The present study includes 57,714 children aged 6 to 23 months. The results reveal that achieving minimum dietary diversity (consumption of five or more food categories out of the eight recommended by WHO) is associated with a reduced risk of underweight in children. Daily consumption of at least one serving of dairy products, one serving of eggs or lean meats, half a serving of fruit, and two to three servings of vegetables is recommended to reduce childhood underweight. [ABSTRACT FROM AUTHOR]

Breastmilk confers empirical benefits for preterm infants, however direct breastfeeding rates in this population remain low. For preterm infants, it may be useful to assess the volume of breastmilk transferred from mother to baby when breastfeeding, particularly during transition to oral feeding when breastfeeding attrition is high. Establishing breastfeeding in preterm infants is complex and without knowledge of milk intake during breastfeeds there is risk of inaccurate feed supplementation with subsequent effects on growth and nutrition. Here we review the evidence for clinical assessments of breastfeeding in preterm infants including test weighing, use of isotope labelled water and clinical observation tools designed to estimate adequacy of breastfeeds. Test weighing is a validated measurement, however requires rigorous protocols and further investigation in small infants. Use of isotope labelled water is a validated technique but, due to sampling requirements, reflects intake over days and weeks instead of individual feeds. Clinical observation tools assessed in preterm infants, have not been shown to reflect volumes of breastmilk intake. While current methods have limitations, the goal is to identify measurement tools to be used as temporary aids to facilitate transition to direct breastfeeding while minimising risk of inaccurate supplementation. [ABSTRACT FROM AUTHOR]

Summary: Human breast milk is a complex fluid rich in bioactive molecules crucial for infant growth and development. Global health organisations recommend exclusive breastfeeding to optimise infant health. In cases where maternal milk is unavailable, donor breast milk from human milk banks (HMBs) serves as an essential alternative. Currently, human breast milk preservation relies on Holder pasteurisation (HoP), which, while effective at pathogen inactivation, can compromise breast milk's nutritional and biological properties. High‐pressure processing (HPP) is an alternative pasteurisation method that utilises high pressure to kill pathogens without degrading nutrition. This study examined HPP's impact on donor breast milk lipids, sugars and antioxidants. Metabolomics reveals diverse bioactive compounds, including lipids, polyphenols and polyketides, elucidating breast milk's complexity. Some lipid subclasses respond to HPP; ceramides decreased under both treatments, while fatty aldehydes and esters increased under specific HPP conditions. Additionally, we quantified oxidised lipids, notably dietary oxysterols (DOxS), known for pro‐oxidant and pro‐inflammatory properties. These findings enhance understanding of HPP targeted approaches and breast milk's complexity, contributing to innovative milk preservation techniques that could advance specialised infant nutrition and assist donor milk banking systems. [ABSTRACT FROM AUTHOR]

Background: Current research separately analyzed the connection between postpartum depression, fatigue, sleep and infant development. However, depression, fatigue and sleep quality often coexisted as adverse symptoms in postpartum women and influenced infant development together. This study explored the maternal postpartum symptoms on infant growth. Methods: Our study included 224 pairs of singleton full‐term mothers and their infants who underwent routine pediatric outpatient clinics. Latent profile analysis was applied to identify the latent classes based on mothers' postpartum depression, fatigue and sleep profile characteristics. We evaluated the maternal adverse symptoms and infant development using multivariable logistic regressions. Results: Totally, 224 pairs of eligible mothers (28.85 ± 4.43 years) and infants (30.93 ± 3.26 days) participated in this study. Latent profile analysis identified 3 latent groups: mild (58.04%), moderate (34.37%), and severe (7.59%) postpartum adverse symptoms. Postpartum adverse symptoms were associated with delayed development in the baby's motor level (χ2 = 6.572, p =.037) and weight‐for‐length (χ2 = 9.652, p =.008). After controlling for mother and infant related factors, postpartum adverse symptoms remained a risk factor for infant motor level (odds ratio [OR]: 4.35; 95% confidence interval [CI]: 1.25–15.08) and weight‐for‐length (OR: 5.53; 95% CI: 1.55–19.74). Conclusions: Maternal postpartum depression, fatigue and sleep quality are associated with infant development. Clinically, mothers with these symptoms should be intervened timely to avoid the aggravation of maternal symptoms, which affect baby's development. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus is the most common medical condition in pregnancy, disproportionately affecting overweight or obese women and those from non-White populations. The lack of standardised screening and diagnostic consensus contributes to varying prevalence. Conventional risk factor-based screening can leave women undiagnosed, leading to increased risk of harm. If diet and lifestyle modifications fail to achieve glycaemic targets, prompt treatment should be initiated to manage glucose levels. A planned birth is crucial to ensure the best outcomes. Postpartum, women need screening for type 2 diabetes and other cardiometabolic risk factors, enrollment in diabetes prevention programmes, and counselling on the increased risk of future cardiometabolic disease for themselves and their offspring, highlighting the importance of ongoing prevention and management strategies. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. Mare milk has a unique protein composition that makes it a preferred option for adult and infant nutrition. Several functional properties have been attributed to this milk, but with little current evidence. In fact, knowledge on mare milk composition is still limited. In particular, studies addressing the performance of mare milk proteins during human gastrointestinal digestion are scarce, which limits the understanding of mare milk nutritional quality and functionality. For this reason, the present study describes the digestibility of mare milk proteins and the release of peptides as affected by management and lactation stage, factors which are known to affect milk composition. Mare milk samples from 3 different farms collected during 6 mo of lactation (n = 54) were subjected to a static in vitro gastrointestinal model to measure peptide release and protein digestibility. In the present study, a detailed description of protein and individual amino acid behavior during the digestion process was given. For the first time, digestion of the 2 equine β-lactoglobulin isoforms (I and II) was described individually. In addition, it was found that lactation stage and management system can significantly affect protein digestibility and peptide release during gastrointestinal digestion of mare milk. Presumably, differences in the composition of mare milk influence the protein structure and enzyme accessibility, which might have an impact on digestion behavior. Although no specific bioactive peptides were identified, several precursors of previously described bioactive peptides were found. These findings could support the idea of mare milk as a food with added value. [ABSTRACT FROM AUTHOR]

Context Combining or supplementing breastfeeding with formula feeding, also called mixed milk feeding (MMF), is a common infant feeding practice. However, there is no well-established MMF evidence-base for informing and guiding parents. A better understanding of the reasons why mothers practice MMF may facilitate identification of efficient strategies for supporting exclusive breastfeeding, and/or opportunities to prolong breastfeeding, at least partially. Objective An updated systematic literature review was undertaken with the primary aim of gaining a deeper understanding of the reasons why mothers choose MMF. Data Sources Six databases were searched for relevant articles published in English from January 2012 to January 2022. Data Extraction Two reviewers independently performed the screenings and data extraction, and any differences were resolved by a third reviewer. Data from 138 articles were included, 90 of which contained data on MMF reasons/drivers, and 60 contained data on infant age and/or maternal demographic factors associated with MMF. Data Analysis A total of 13 different unique MMF drivers/reasons were identified and categorized according to whether the drivers/reasons related to perceived choice, necessity, or pressure. Risk of bias was evaluated using the Quality Assessment Tool of Diverse Studies and the JBI Systematic Reviews tool. Several different terms were used to describe and classify MMF across the studies. The most commonly reported reasons for MMF were related to a perception of necessity (39% of drivers, eg, concerns about infant's hunger/perceived breast milk insufficiency or breastfeeding difficulties), followed by drivers associated with perceived choice (34%; eg, having more flexibility) and perceived pressure (25%; eg, returning to work or healthcare professionals' advice). This was particularly true for infants aged 3 months or younger. Conclusion The key global drivers for MMF and their distribution across infant age and regions were identified and described, providing opportunities for the provision of optimal breastfeeding support. A unified definition of MMF is needed in order to enable more comparable and standardized research. Systematic Review Registration PROSPERO registration no. CRD42022304253. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine the demographic data, mortality, and morbidity of early- and late-neonatal sepsis cases, the etiologic agents in these cases, and the antibiotic susceptibility of these agents. Methods: This study was conducted retrospectively in a tertiary neonatal intensive care unit (NICU). The demographic, clinical, and laboratory data of newborns diagnosed with culture-proven sepsis within 24 months were evaluated. Results: Two hundred and eleven culture data points belonging to 197 infants were evaluated. Forty percent of the infants had a history of premature birth. The most common clinical findings were respiratory distress and feeding intolerance. Coagulase-negative staphylococci (CoNS) were detected most frequently as early- and late-sepsis agents. The most common Gram-negative bacteria detected as late-sepsis agents were Klebsiella spp. and Escherichia coli (E. coli). The overall mortality rate was 10%. Conclusions: Neonatal sepsis continues to have high mortality rates in tertiary NICUs. CoNS was the most common agent, highlighting the importance of developing and maintaining personnel training and handwashing practices. It will be important to consider the resistance rates of Klebsiella spp., the most common Gram-negative agent in late-onset sepsis (LOS) cases, to commonly used antibiotics in empirical treatments. [ABSTRACT FROM AUTHOR]

Introduction: According to current knowledge, at birth, the pineal gland and melatonin receptors are already present and the suprachiasmatic nucleus is largely functional, and noradrenaline, the key pineal transmitter, can be detected in the early foetal period. It is still unclear why the pineal gland is not able to start its own pulsatile synthesis and secretion of melatonin in the first months of life, and as a result, infants during this time are dependent on an external supply of melatonin. Method: The causes and consequences of this physiological melatonin deficiency in human infancy are examined in a systematic review of the literature, in which 40 of 115 initially selected publications were evaluated in detail. The references of these studies were checked for relevant studies on this topic. References from previous reviews by the author were taken into account. Results: The development and differentiation of the pineal gland, the pinealocytes, as the site of melatonin synthesis, and the development and synaptic coupling of the associated predominantly noradrenergic neural pathways and vessels and the associated Lhx4 homebox only occurs during the first year of life. Discussion: The resulting physiological melatonin deficiency is associated with sleep disorders, infant colic, and increased crying in babies. Intervention studies indicate that this deficiency should be compensated for through breastfeeding, the administration of nonpooled donor milk, or through industrially produced chrononutrition made from nonpooled cow's milk with melatonin-poor day milk and melatonin-rich night milk. [ABSTRACT FROM AUTHOR]

Due to their underdeveloped physiological maturity, preterm infants often face challenges related to sucking, breathing, and swallowing coordination during initial feeding. This lack of coordination may lead to episodes of apnea and choking, resulting in unstable vital signs. Preterm infants with this issue must gradually learn oral feeding skills appropriate to their developmental stage. Registered nurses play a critical role in assessing the right time to transition from tube to oral feeding and in providing a safe and positive oral feeding experience. In this article, three validated assessment tools for feeding premature infants are introduced, accompanied by clinical research data demonstrating their use in clinical practice. These three tools include: (1) the Neonatal Oral Motor Assessment Scale, which is applied to evaluate oral motor skills using observations of nonnutritive sucking and the sucking state during the two minutes before feeding; (2) the Premature Oral Feeding Readiness Assessment Scale, which is used to assess readiness for oral feeding in preterm infants; and (3) the Early Feeding Skills assessment, which is used to evaluate the oral feeding skills of preterm infants. These tools aid nurses in helping preterm infants achieve independent oral feeding, facilitating earlier discharge and return to home. The clinical implications and effectiveness of these tools are also discussed to provide to nurses the means and confidence necessary to apply them appropriately in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is the ideal nutrition for infants and protects infants and mothers from a range of adverse health outcomes during their lifespan. In Denmark, while the breastfeeding initiation rate is high, only 14% of mothers meet the World Health Organization's recommendation of exclusive breastfeeding at six months. Furthermore, a notable social inequity exists among those who achieve this recommendation. Knowledge of effective interventions to reduce breastfeeding inequity is limited. A previous hospital-based intervention succeeded in increasing breastfeeding duration. However, most breastfeeding support is provided in Danish municipalities by health visitors. This called for adapting the intervention to the health visiting program and developing an intensified intervention addressing the social inequity in breastfeeding. This article describes the adaptation and development process of a municipality-based intervention. Methods: During a 15-month period in 2020–21, the municipal intervention was iteratively developed using a three-stage framework for developing complex health interventions described by Hawkins et al. The three stages were 1) need assessment and stakeholder consultation, 2) co-production and 3) prototyping. The process was inspired by O'Cathain et al.'s principles for a user-centred, co-created and theory- and evidence-based approach, involving parents and health visitors. Results: In stage 1, we identified the needs and priorities of the target groups of the intervention. In stage 2, the intervention was developed through action research design and inspired by Duus' 'learning cycles' as the method to enhance motivation and ownership and to strengthen the implementation process by creating a joint room for learning and reflection with health visitors and developers. In stage 3, the intervention was tested for feasibility and usefulness during a 2.5-month period accompanied by monthly dialogue meetings with health visitors and developers. In this period, the intervention was refined based on the gathered experiences and was subsequently prepared for evaluation. Conclusion: The description of the development of this complex intervention, aimed at increasing breastfeeding duration and reducing inequity, offers breastfeeding practitioners and researchers a transparent foundation for continuously improving breastfeeding support and a methodology for complex intervention development. Trial registration: Registered at Clinical Trials NCT05311631. [ABSTRACT FROM AUTHOR]

Background: Chest physiotherapy for airway clearance is not recommended in children hospitalized with bronchiolitis. The updated Cochrane meta-analysis suggests that slow expiratory techniques could slightly improve clinical severity, but the evidence certainty is low and the clinical significance of this change is unknown. We investigated whether the prolonged slow expiration technique (PSET) would impact the 24-h food intake of these children. Methods: We conducted a two-arm double-blind randomized controlled trial. Hospitalized children aged from 1 to 12 months, bottle-fed or diversified and referred for airway clearance were included. Both groups received upper airway clearance at inclusion and standard treatments. The experimental group received PSET including rhinopharyngeal unclogging and targeted unprovoked cough. The primary outcome was the 24-h food intake. Clinical severity, vomit episodes and sleep quality were also recorded. An ordinary least squares linear regression for quantitative variables was modelled for between-group comparisons. Results: From January 9, 2019, to December 1, 2022, 42 children were randomized with a 1:1 ratio (mean age: 5.0 (± 2.9) months). The 24-h food intake did not differ between groups (estimate: 1.8% (95%CI -7.0 to 10.6); p = 0.68). PSET had no effect on SpO2, clinical severity, RR and HR at the follow-up assessments (5 min, 30 min and 24 h after intervention), nor on the number of vomit episodes, total sleep time and SpO2 during sleep. Conclusions: PSET did not affect food intake or the 24-h course of bronchiolitis more than standard treatment in children hospitalized for moderate bronchiolitis. Trial registration: NCT03738501 registered on 13/11/2018, Slow Expiratory Technique to Improve Alimentation in Children With Bronchiolitis (BRONCHIOL-EAT); https://classic.clinicaltrials.gov/ct2/show/NCT03738501. [ABSTRACT FROM AUTHOR]

Aim: This study explores the experiences and perspectives of women with a Body Mass Index (BMI) ≥ 25 kg/m2 on infant feeding. Subject and methods: Women with a BMI ≥ 25 kg/m2 have lower rates of initiating, maintaining and exclusive breastfeeding than women with a BMI < 25 kg/m2. There is limited qualitative research on this topic, particularly for women living with overweight (BMI ≥ 25 kg/m2-29.9 kg/m2). Eighteen women with a BMI ≥ 25 kg/m2 living in the North East of England and an infant under eighteen months of age participated in a semi-structured interview concerning infant feeding practices during May and June 2021. Participants were recruited through social media platforms. An inductive thematic analysis was undertaken to analyse the interview data. Results: Two overarching themes were identified: lower confidence and a perceived negative judgement from others for living with higher weight. These themes reduced women's confidence in their ability to breastfeed and led to negative experiences or avoidance of public feeding. Difficulties with latching and positioning in relation to body shape also reduced confidence in breastfeeding further. Due to these barriers, women felt that they required additional, tailored support to achieve breastfeeding. Conclusion: Improving breastfeeding support for women with a BMI ≥ 25 kg/m2 requires a whole systems approach involving education systems, healthcare professionals and the community. The impact of terminology, such as labelling a women's pregnancy 'high risk', on women's breastfeeding confidence needs to be considered further. [ABSTRACT FROM AUTHOR]

Introduction: Baby-led weaning (BLW) is a growing method for parents to introduce food to their kids. As advisers who affect the decisions of parents, health practitioners have significant obligations in this regard. Objective: We aim to identify existing literature on the knowledge, perceptions, and attitudes of health professionals toward BLW. Methods: We carried out a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. After registering with Open Science Framework, published articles were retrieved from EBSCOhost, PubMed, SciELO, ScienceDirect, Open Grey, and the Portuguese Scientific Open Access Repository. Primary studies with full-text availability in English, Spanish, or Portuguese, and no data publication limitations were included. Results: The final sample included seven publications conducted in five countries published between 2012 and 2022. Only one study employed a hybrid methodology showing incongruent practices in parents/health professionals on BLW, whereas most studies employed a quantitative approach. Regarding BLW, it is recognized that there is a dearth of evidence, consensus, and advice. Conclusion: Despite benefits, health professionals hesitate to recommend BLW due to insufficient study and safety concerns, warranting more research. Hence, our scoping review demonstrated that BLW is a scientifically under-researched subject, indicating a significant research gap that must be filled in the future. [ABSTRACT FROM AUTHOR]

Rationale, Aims, and Objective Methods Results Conclusion Breastfeeding provides optimal nutrition for infants, and health literacy significantly influences breastfeeding rates. This study aimed to develop a tool to assess the breastfeeding health literacy levels of pregnant women.This methodologically structured study was conducted with 590 pregnant women who visited the pregnancy follow‐up clinic between January and April 2024 and met the sampling criteria. Data were collected using a participant form and the Health Literacy Scale for Breastfeeding for Pregnant Women (BFHLS). To assess the BFHLS validity, the content validity index (CVI) and factor analysis were used, while the reliability was evaluated using the test–retest method, item‐total score correlation, and Cronbach's alpha reliability coefficient.The BFHLS for pregnant women is structured into four dimensions, comprising 25 items. To assess the scale's stability, test–retest measurements were conducted with a minimum interval of 2 weeks, revealing no significant difference in mean scores (p > 0.05). The CVI for each item was 99%. The corrected item‐total correlations ranged from 0.48 to 0.92, and Cronbach's alpha value was determined to be 0.96.The BFHLS developed for pregnant women is a valid and reliable tool. Higher scores on the scale indicate a greater level of breastfeeding health literacy in pregnant women. This scale can effectively be used to assess the breastfeeding health literacy levels of pregnant women. [ABSTRACT FROM AUTHOR]

This study examines which factors influence the preferences of mothers seeking advice on the use of infant formula in feeding practices. The effects of their close social circle, medical professionals and social network forums on feeding choices were evaluated. Data were collected from 638 questionnaires from mothers and were statistically analyzed. Our findings suggest that age may influence the preference to seek advice from a close social circle over consulting with medical professionals (p-value = 0.019 < 0.05). The educational level and the number of children impact the preferences of using infant formula over combining it with breastfeeding (p-value = 0.000 < 0.05 and p-value = 0.004 < 0.05, respectively). The research contributes to the understanding of the complex interplay between various demographic and socioeconomic factors and the decision-making process of mothers based on multiple social and digital sources of influence. The research presents valuable insights for healthcare policymakers and professionals in supporting mothers and providing them with up-to-date information. Feeding information can be distributed through all the communication channels that were examined in this study to benefit different socio-economic groups and to contribute to the well-being of infants in the long-run. [ABSTRACT FROM AUTHOR]

Human breast milk (HBM) is the "gold standard" for infant nutrition. When breast milk is insufficient or unavailable, infant milk formula (IMF) can provide a safe and nutritious alternative. However, IMFs differ considerably from HBM in composition and health function. We compared the digestibility and potential health functions of IMF containing low cream (LC-) or high cream (HC-) with pooled HBM. After simulated infant digestion of these samples, the bioavailability of key nutrients and immunomodulatory activities were determined via cell-based in vitro assays. A Caenorhabditis elegans leaky gut model was established to investigate cream effects on gut health. Distinct differences were observed in peptide diversity and sequences released from HC-IMF compared with LC-IMF during simulated digestion (p < 0.05). Higher levels of free fatty acids were absorbed through 21-day differentiated Caco-2/HT-29MTX monolayers from HC-IMF, compared with LC-IMF and HBM (p < 0.05). Furthermore, the immune-modulating properties of HC-IMF appeared to be more similar to HBM than LC-IMF, as observed by comparable secretion of cytokines IL-10 and IL-1β from THP-1 macrophages (p > 0.05). HC-IMF also supported intestinal recovery in C. elegans following distortion versus LC-IMF (p < 0.05). These observations suggest that cream as a lipid source in IMF may provide added nutritional and functional benefits more aligned with HBM. [ABSTRACT FROM AUTHOR]

Background: Despite the many benefits of exclusive breastfeeding to infants and mothers, only 33% of Jamaican infants are exclusively breastfed up to the recommend six months. This study was conducted to identify factors affecting mothers' feeding choices focusing on barriers to exclusive breastfeeding of infants six weeks to less than six months old. Methods: A qualitative study consisting of four focus group discussion sessions was conducted among 22 mothers attending postnatal clinics in western Jamaica from May to August 2016. The transcripts were coded by three independent coders and content analysis conducted to generate themes. Results: Four themes were identified namely, perceived advantages of breastfeeding centered mainly on the benefits of breastfeeding for the infant and mother, perceived barriers of breastfeeding highlighting physical pain and fatigue, supplementing culturally acceptable complementary foods and herbal remedies, and cultural norms including perception of how breastfeeding affects a woman's body, societal sources of breastfeeding information, satiation of infants, and family and other support. Mothers overwhelmingly agreed that breastfeeding was inexpensive, allowed them to bond with their infants and was good for the overall health and intellectual development of the infants. They identified painful nipples, engorged breasts, lack of sleep, physical exhaustion and pressure to return to work as barriers to breastfeeding. Mothers named a number of complementary foods, such as pumpkin, carrots, potato, banana, and chocho (Chayote), that were culturally accepted for feeding infants in Jamaica and discussed herbs that were considered to aid in infants' nutrition and overall health. Other cultural factors that were noted to influence exclusive breastfeeding were mothers feeling that breastfeeding would help their bodies, especially their bellies, go back to their pre-maternity figure, sources of breastfeeding information in the society including the internet, belief that breast milk alone does not satisfy babies, and family and other support. Conclusion: Mothers in this study identified unique challenges to exclusive breastfeeding that if addressed, would help to increase exclusive breastfeeding so that the World Health Organization's exclusive breastfeeding recommendations can be achieved. [ABSTRACT FROM AUTHOR]

Background: Tropical oils such as palm and coconut oils are renowned for their high saturated fat content and culinary versatility. However, their consumption has sparked debate regarding their health benefits and production concerns. The purpose of this review was to map existing evidence on the health benefits and challenges associated with the consumption of tropical oils. Method: The recommendations for conducting a scoping review by Arksey and O'Malley were followed. PubMed, Dimensions AI, Central, JSTOR Google, Google Scholar, and ProQuest databases were searched for relevant papers. The predetermined keywords used were Consumption" AND "Tropical oil," as well as "Health benefits" OR "Health challenges" AND "Tropical Countries." Peer-reviewed and grey literature published in English were eligible for this review. Result: Tropical oils, such as palm and coconut oils, provide health benefits including essential vitamins (A and E) that enhance ocular health, boost immunity, and support growth. They are also recognised for their role in managing high blood sugar, obesity, and cholesterol levels, while offering antioxidant and anti-inflammatory properties. These oils have wound-healing abilities and are commonly used in infant nutrition and traditional cooking. Nevertheless, prolonged and repeated use of tropical oils to high temperature can degrade vitamin E, whereas excessive intake may result in overdose. Health concerns include oxidative risks, diabetes, cancer, coronary heart disease, high blood pressure, and acrylamide formation due to production challenges excessive consumption. Additional issues include obesity, suboptimal oil production, misconceptions, regulatory obstacles, and preferences for alternative fats. Conclusion: This review suggest that tropical oils provide essential health benefits, including vitamins and antioxidant properties, but pose significant health risks and production challenges, particularly when exposed to high temperatures and through excessive intake. Guidelines on the consumption of tropical oils in the tropical regions are necessary to regulate their consumption. [ABSTRACT FROM AUTHOR]

Background: The benefits of exclusive breastfeeding (EBF) have been universally documented, with evidence of positive impacts on a child's optimal growth, development, and survival. However, EBF practices in Nepal have fluctuated and declined over the last 25 years. In addition to the individual factors of mothers and infants, EBF practices are affected by multiple community-level factors. Understanding these factors is essential for designing breastfeeding promotion programs to improve child nutritional status in Nepal. This study investigated the individual- and community-level determinants of EBF practices among young infants aged 0–5 months in Nepal. Method: We used the dataset from the Nepal Demographic and Health Survey 2022. Information on EBF in the past 24 h was available for 540 infants aged 0–5 months. A multilevel mixed-effect logistic regression was used to identify individual- and community-level factors associated with EBF among infants aged 0–5 months in Nepal. Results: The 24-hour prevalence of EBF among infants aged 0–5 months was 57.46% (95% confidence interval (CI): 52.18, 62.57). The infant's age was inversely associated with EBF prevalence at the individual level. Compared with infants aged < 1 month, infants aged three months (adjusted odds ratio (AOR): 0.14, 95% CI: 0.05, 0.40), four months (AOR: 0.11, 95% CI: 0.04, 0.28), and five months (AOR: 0.07, 95% CI: 0.03, 0.20) were less likely to receive EBF. At the community level, community-level variables such as ≥ 4 ANC visits coverage, maternal employment status, and poverty level were generated by aggregating the individual characteristics in a cluster and were categorized using quartiles into low ("< 25%"), moderate (25–75%), and high (≥ 75%). Mothers from communities with moderate ≥ 4 ANC visits (AOR: 3.30, 95% CI: 1.65, 6.57) and high ≥ 4 ANC visits (AOR: 2.70, 95% CI: 1.40, 5.22) coverage had higher odds of EBF practices than did those from communities with low ≥ 4 ANC visits coverage. Similarly, communities with moderate (AOR: 2.67, 95% CI: 1.34, 5.30) and high (AOR: 2.34, 95% CI: 1.10, 4.99) levels of maternal employment status and moderate levels of poverty (AOR: 2.20, 95% CI: 1.13, 4.28) were associated with a higher likelihood of EBF practices. Subnational level variation was evident, with infants in Lumbini province having lower odds of EBF (AOR: 0.32, 95% CI: 0.13, 0.77) relative to Koshi province. Approximately 9% of the variation in EBF practices was observed among mothers while mapping across clusters in this study. Conclusion: Various individual- and community-level factors influence the uptake of EBF in Nepal, underscoring the need to improve the approaches and strategies of EBF programs. This study highlighted the significant association of community-level factors (≥ 4 ANC visits coverage, poverty level, and maternal employment status) with EBF among infants under 6 months. It revealed approximately 9% variability in EBF across clusters. Future efforts to promote EBF should focus on older infants and communities with low poverty levels and low coverage of recommended ≥ 4 ANC visits. Furthermore, context-specific adaptation of such efforts might be required considering the variation observed between the communities in the present study. [ABSTRACT FROM AUTHOR]

Understanding the human milk metabolome can help inform infant nutrition and health. Untargeted metabolomics was used to study breast milk from 31 healthy participants to assess the shared metabolites in milk from participants with various backgrounds and understand how different demographic, health, and environmental factors impact the milk metabolome. Breast milk samples were analyzed by four separate UPLC-MS/MS methods. Metabolite Set Enrichment Analysis was used to study the most and least variable metabolites. The associations between participant factors and the metabolome were assessed with redundancy analyses. Among all 31 participants and between each untargeted UPLC-MS/MS method, 731 metabolites were detected, of which 389 were shared among all participants. Of the shared metabolites, lactose was the least and lactobionate the most variable metabolite. In the biological super pathway analysis, xenobiotics were the most variable metabolites. Infant age, maternal age, number of live births, and pre-pregnancy BMI were associated with the milk metabolome. In conclusion, the most variable metabolites originate from environmental exposures while the well-conserved core metabolites are linked to cell metabolism or are crucial for infant nutrition and osmoregulation. Understanding the variability of the breast milk metabolome can help identify components that are crucial for infant nutrition, growth, and development. [ABSTRACT FROM AUTHOR]

Background: On 6 February 2023, an Mw 7.8 earthquake struck southern and central Türkiye and north-western Syria, affecting the lives of 4.6 and 2.5 million children, respectively. In such crises, infants who are dependent on commercial milk formula (CMF) face increased vulnerability to diseases and malnutrition as safe preparation of CMF becomes difficult and sometimes impossible. The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) provides guidance on protecting and supporting recommended infant and young child feeding and minimizing the risks that come with CMF feeding. In addition, the International Code of Marketing of Breastmilk Substitutes (the Code) ensures adequate nutrition for infants by protecting and promoting breastfeeding and ensuring the proper usage of CMF. This study aims to document violations of the Code and the OG-IFE during the earthquake relief efforts to help strengthen infant and young child feeding emergency responses and inform future disaster relief policies. Methods: Data was collected from 6 February to 10 March 2023 through Internet sources. Social media, news websites, and the Emergency Nutrition Network forum were used for data collection. Turkish content was translated into English for analysis, with a focus on donation-related information and Code violations related to baby food and infant feeding. Results: A total of 40 reports on CMF, complementary food, and feeding equipment donations were collected. Three main types of violations of the OG-IFE and the Code were identified, with the majority of them being incidences of individuals, humanitarian organizations, and government agencies seeking or accepting donations. Infant formula companies continued to violate the Code by donating large quantities of CMF and feeding equipment to the Turkish Red Crescent, government agencies, and disaster relief infant and young child feeding (IYCF) coordination authorities. Conclusions: These incidents reflected a systematic violation of the Code and non-compliance with the OG-IFE. Globally accepted IYCF standards and recommendations were not consistently followed due to fragmented early responses. There is a critical need to step up efforts to ensure appropriate and safe IYCF practice protecting and supporting breastfed and non-breastfed infants in emergencies. [ABSTRACT FROM AUTHOR]

The modular nutrients are mixtures or isolated macronutrients that can be enriched with micronutrients. Modules are generally added in pediatrics, to the formula or to enteral preparations, to increase the energy intake or some specific nutrient. The existing carbohydrate modules are: maltodextrins, cereals, corn starch. The protein modules comprise; the formula concentration as well as the addition of fortifiers and finally, the lipid modules are made up of vegetable oil, medium chain triglycerides and mixed mixtures. The osmolarity must be considered depending on the type of formula and module to be used, carbohydrate modules are generally the ones that increase osmolarity the most. The usefulness of adding nutritional modules in current pediatrics persists and is a beneficial tool in various pathologies and nutritional status. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the frequency and clinical features of the late preterm infants with feeding intolerance. MATERIASL AND METHODS: Medical records of 426 infants with gestational age of 340/7- 366/7 weeks were retrospectively reviewed for the study. Clinical and demographic features of late preterm infants and episodes of feeding intolerance were recorded. RESULTS: A total of 54 late preterm infants with feeding intolerance were evaluated and compared with 178 infants without feeding intolerance. Baseline demographics were similar between groups. Mean duration of intolerance period was 2.3 ± 1.2 days. Time to full enteral feeding was significantly longer in late preterm infants with feeding intolerance when compared with infants without feeding intolerance (8 ± 2.3 vs 5.2 ± 1.7 days, respectively, p<0.001). Breastfeeding rates were similar between the groups. Rate of prokinetic use in the feeding intolerance group was 37%. There were no differences between the time to full enteral feeding and the duration of parenteral nutrition between prokinetic users and non-users. CONCLUSIONS: Although the gestational ages of late preterm infants are close to term and their size is relatively large, they are not like term infants. These infants should be followed closely in terms of feeding problems as well as many morbidities. [ABSTRACT FROM AUTHOR]

Objective: Self-efficacy is important in supporting breastfeeding behaviors and enhancing breastfeeding practices. This study aimed to explore research trends, identify knowledge gaps, and provide a comprehensive overview of breastfeeding self-efficacy. Materials and Methods: Data were retrieved from the Scopus online database on March 20, 2024, encompassing articles published in English between 2000 and 2023. The search strategy focused on articles containing the keywords “self-efficacy,” “breastfeeding,” and “mother.” VOSviewer version 1.6.19 was then used to map the data and visually identify research clusters. Results: The analysis yielded a significant increase in breastfeeding self-efficacy research over the past 2 decades. The United States led in publication numbers (117 documents), while Canada dominated citations (2792 citations). Furthermore, the analysis identified 8 critical themes in 8 different clusters, encompassing various aspects of breastfeeding, including determinants, behaviors, interventions, and mental health considerations during lactation, and employed research methodologies. One crucial gap identified in this study pertains to low breastfeeding social support. This includes a lack of support from peer groups, social networks, and social media platforms. Addressing this gap can be a valuable reference point for developing future interventions to bolster breastfeeding self-efficacy. Conclusion: Bibliometric analysis contributes to exploring research trends, identifying knowledge gaps, and providing a comprehensive overview of breastfeeding self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Marshallese Pacific Islanders experience higher rates of obesity than other racial and/or ethnic communities. Despite the obesity rates experienced in this community, there are currently no childhood obesity prevention interventions designed for Marshallese Pacific Islanders in the United States. The purpose of this study is to assess the acceptability and feasibility of a culturally adapted group‐based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. Methods: A multi‐methods design was used to culturally adapt the Kokajjiriri intervention for Marshallese mothers in Arkansas (n = 17). In phase one, we conducted 24‐h dietary recalls with 20 Marshallese mothers to inform the cultural adaptation of the group‐based pediatric intervention, and then in phase two, we culturally adapted and piloted three sessions of the intervention to determine the acceptability and feasibility of the intervention. Results: Participants found the adapted intervention to be acceptable and feasible, found the location to be convenient and found the facilitator to be knowledgeable. Four themes emerged from the qualitative data: (1) Lactation Support; (2) Introducing Healthy Solids; (3) Rice Portion Control; and (4) Finding Resources. Conclusions: This is the first study to assess the acceptability and feasibility of a culturally adapted group‐based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. The results from this culturally adapted group‐based pediatric intervention, Kokajjiriri, will be used to inform future adaptations and implementation of the full intervention for Marshallese women and children. [ABSTRACT FROM AUTHOR]

Objective: Many parents experience lack of support and access to resources on how to prepare, handle, and provide formula milk to their infants. The purpose of this scoping review was to map and describe key information in existing research about how healthcare professionals receive information and how they inform and counsel parents about formula milk. Design: A scoping review fulfilling the PRISMA‐ScR checklist criteria used systematic searches targeting the study objective in the databases Embase, MEDLINE, and CINAHL on February 8th and 9th, 2022. Results: Six studies with 959 participants in total were included. The research designs were focus group studies with and without combining individual interviews, an individual interview study, a study consisting of individual interviews and ethnographic observations, a survey, and a two‐phase study consisting of a qualitative interview and a quantitative survey. Findings indicate lack of evidence‐based information provided about infant formula by health care professionals when they counsel parents on formula feeding. Conclusions: Few studies focus on how healthcare professionals inform and counsel parents about formula milk. Health authorities should provide more evidence‐based information to make formula feeding more feasible. Due to conflicting and omitted information, mothers often receive poor counselling on formula feeding. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To re-examine the evidence base that underpins the management of nasogastric tube safety in children • To recognise the consequences of delayed or missed feeds in children who receive nasogastric tube feeding • To enhance your understanding of what checks can be used to ensure a nasogastric tube is safe to use. Nasogastric tube feeding is generally considered safe provided a nasogastric aspirate with a pH ≤5.5, which indicates that the end of tube is correctly located in the stomach, can be obtained. When this is not possible, hospital attendance or admission is usually required so that an X-ray can be undertaken to check the tube’s position. This practice is based on an interpretation of the evidence that places undue importance on nasogastric aspirate pH testing before every use of a tube that is already in place, with potential negative consequences for children cared for in the community and their families. Following a re-examination of the evidence base, a revised approach is proposed in this article: when a child has a tube in place, provided its position has been confirmed as correct on initial placement using aspirate pH testing, nurses can use checks other than aspirate pH testing, alongside their clinical judgement, to determine whether it is safe and appropriate to use the tube. This proposed revised approach would reduce delayed or missed administration of fluids, feeds and medicines and enable more children to remain at home. [ABSTRACT FROM AUTHOR]

Objective: Describe the ear and hearing outcomes in Aboriginal infants in an Australian urban area. Design: Aboriginal infants enrolled in the Djaalinj Waakinj prospective cohort study had ear health screenings at ages 2-4, 6-8 and 12-18 months and audiological assessment at ∼12 months of age. Sociodemographic, environmental characteristics, otoscopy, otoacoustic emissions, tympanometry and visual reinforcement audiometry data were collected. Study Sample: 125 infants were enrolled in the study; 67 completed audiological assessment, 62, 54, and 58 of whom attended ear screenings at 2-4, 6-8 and 12-18 months. Results: Of the children that attended the audiological assessment, 36.5%, 50% and 64.3% of infants had otitis media (OM) at 2-4, 6-8 and 12-18 months. Using a 10 dB correction factor, 44.8% of infants had hearing loss (HL) (≥ 25 dB HL) at ∼ 12 months of age. More males (X2=5.4 (1df, p = 0.02)) and infants with OM at audiological assessment (X2=5.8 (1df, p = 0.02)) had HL. More infants that used a pacifier at 12-18 months of age had HL (X2=4.7 (1df, p = 0.03)). Conclusion: Aboriginal infants in an urban area have high rates of HL and OM, which requires early surveillance and timely treatment to reduce the medical and developmental impacts of OM and HL. [ABSTRACT FROM AUTHOR]

Background: Studies investigating the quality of the diet and dietary intake of children with Down syndrome (DS) are required because the features attributed to the syndrome can affect growth, development and quality of life. Methods: This cross‐sectional study was conducted with 77 Brazilian children with DS between 5 and 36 months of age receiving care at the multidisciplinary outpatient clinic of the University Hospital. Participants' sociodemographic, dietary and anthropometric data were collected from the care protocols. Dietary data were collected from 24‐h recalls and dietary practices were assessed according to the WHO dietary guidelines. Associations between inadequate feeding practices and demographic variables were assessed using logistic regression models. Results: Fruits, milk or infant formula, vegetables, beans and meat were among the five most consumed foods by the children investigated. Overall, we observed a high number of cases of early weaning (50.6%), low minimum dietary diversity (MDD; 40.3%), inadequate consistency for age (64.9%), early presence of ultra‐processed foods (76.6%), sugars and sweets (33.8%) in the diet of the children with DS. In the associations of inadequate feeding practices by age group, low MDD [odds ratio (OR): 18.6; 95% confidence interval (CI): 3.4; 57.1] and inadequate consistency (OR: 6.65; 95% CI: 1.8; 24.7) were more frequent among children aged below 12 months while this relationship was inverse for early introduction of sugar and sweets (OR: 0.04; 95% CI: 0.01; 0.29). Conclusion: Our findings showed a high number of cases of inadequate dietary practices in children with DS investigated, which could adversely affect the long‐term health of this population. [ABSTRACT FROM AUTHOR]

Background: In an Australian randomized controlled trial (RCT), two techniques for intrapartum fetal surveillance were compared: ST analysis (STan) as an adjunct to cardiotocography (CTG), compared with CTG alone. The aim was to determine whether CTG + STan could reduce emergency cesarean birth rates while maintaining or improving neonatal outcomes. Secondary aims were to compare clinical, economic, and psychosocial outcomes. The purpose of this paper was to present psychosocial outcomes from one cohort enrolled in the trial. Methods: The study was conducted at one tertiary referral hospital. Participants who had taken part in the trial from the outset were invited to complete a questionnaire between March 2018 and January 2020, approximately 8 weeks after giving birth. Outcomes included depression, psychological distress, health‐related quality of life, and infant feeding practices. Analysis was by intention to treat. Results: N = 207/527 participants completed the questionnaire (n = 113, STan; n = 94, CTG alone). Overall, no statistically significant or clinically meaningful differences were found in the two groups for symptoms of depression, psychological distress, quality of life, or infant feeding. A statistically significant difference was observed for the subscale of pain‐discomfort, where scores were higher on average in the CTG alone arm relative to that in the CTG + STan arm. Conclusions: Although STan as an adjunct to CTG constitutes a different clinical technology from CTG alone, both monitoring types appeared to produce similar results in terms of postnatal psychosocial outcomes for women. Findings from this study provide service users and staff with a comprehensive assessment of STan that can be used to make evidence‐informed decisions about monitoring options should STan become more widely available. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus in pregnant people remains a significant public health issue worldwide. The rate of perinatal transmission is 15% to 40% but can be decreased to less than 1% with appropriate antenatal management. Previous recommendations included a protease inhibitor-based antiretroviral therapy, infant prophylaxis, performance of cesarean section for uncontrolled viremia, and the use of formula for infant feeding. However, recent updates include first line of integrase inhibitor-based regimens and supporting parental choices for safe lactation. In this review, we summarize and provide updated recommendations for the care of people living with human immunodeficiency virus during pregnancy. [ABSTRACT FROM AUTHOR]