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Background: We aimed to systematically review articles that reported selenium (Se) concentrations in human milk (HM)., Methods: using PRISMA guidelines we searched MEDLINE and Embase using the terms "human milk and Selenium". All clinical trials and systematic reviews were retrieved., Results: Out of 1141 articles, we reviewed 76 full-text articles, excluding 26. Thus, 50 articles were included in meta-analyses. Most studies (N = 31) did not specify whether milk was from mothers of preterm (PT) or fullterm (T) infants. In the other 19 studies, 1 examined PT-EHM, 15 T-EHM, and 3 both PT-EHM and T-EHM. In most studies, Se concentrations were highest in colostrum or until 3 months of lactation, then declined. Metaanalyzed means of PT-EHM or T-EHM provide estimates of Se intake a little higher than those reported to date, but still lower than current recommendations of intake., Conclusion: This study provides clinicians with useful estimates of Se intake in breast-fed infants., (© 2024. The Author(s).)

Background: Nipple dimensions may be an important factor in breastfeeding (BF) initiation success. Objective: To establish standards of nipple/areola dimensions in early BF and to determine whether maternal age, gestational age (GA), parity, cup size, previous BF experience, and early (<2 hours) BF affect nipple dimensions (assessed on the second day of BF). Design/Methods: A total of 205 consecutive BF women were enrolled. They were all Caucasians, and had uncomplicated pregnancies, labors, and vertex vaginal deliveries. Measurements (immediately before and after BF) of nipple length and diameter and of prefeeding areolas were by sliding calipers. Results: In average, there were no significant differences between right (R) and left (L) side dimensions, except for post-BF nipple length, and post-BF horizontal nipple diameter (significantly higher on the L side). Both R and L nipple length correlated positively with maternal age, gravidity, parity, number of previously breastfed infants, and cumulative number of BF months. Early (<2 hours) first BF did not correlate with increased nipple length. Pre-BF nipple length correlated significantly with post-BF nipple length on both sides. There were significant differences between pre- and post- BF values in terms of nipple length (longer length post-BF), but not in terms of nipple diameter. In stepwise regression analysis, where pre-BF nipple length was the dependent variable, and parity (or maternal age, or previous BF), early first BF, and GA were independent variables, parity, maternal age, gravidity, or previous BF experience were positively and significantly associated with nipple length ( p  < 0.001). The correlation maternal age-nipple length remained significant in primigravida mothers. Conclusions: This study provided a set of standards for nipple and areola dimensions on day 2 of BF in Caucasian women. The only areola/nipple dimension significantly affected by BF is the nipple length. Increasing parity, maternal age, or previous BF experience is significantly associated with increased nipple length.

Objective: To conduct a systematic review of the effect of freezing and thawing on the macronutrients and energy composition of human milk (HM). Design: Systematic review conducted in May 2019, including all studies reporting macronutrients and energy composition of HM, according to a search of MEDLINE, EMBASE, and Google Scholar using the keywords: HM, breast milk, macronutrients, fat, lipid, protein, carbohydrates, energy, calories, freezing, thawing, and of the references in studies identified as potentially relevant. Meta-analyses were conducted in all the studies that reported one or more of the following: total energy, true protein, fat, and carbohydrates. They were reported according to following groups of freezing duration: 1-7 days, 8-30 days, 31 days-3 months, and >3 months. They were calculated and expressed as weighted averages with pooled standard deviations. Results: Eight studies remained in the final analysis. Regression analyses did not find any significant increase or decrease over time of protein content, lactose content, fat content, or energy content of milk. Conclusions: No dramatic changes in macronutrients and energy contents of milk are expected to occur within the first few months of freezing.

Objective: We examined the influence of maternal body mass index (BMI), and of breast and nipple anatomic variations, on breastfeeding difficulties and duration. Methods: In this prospective observational study, we collected demographic and anthropometric data from 109 mothers of full-term newborns. Women were classified as underweight, normal weight, overweight, and obese using the World Health Organization definitions and were otherwise healthy. Breast anthropometrics assessments were recorded after delivery and during hospitalization. Latching difficulties were collected as reported by the mothers. Breastfeeding duration was assessed by phone interview at 3, 6, 1 year, or more postdelivery. Results: The four prepregnancy BMI groups included 12 underweight, 59 normal weight, 20 overweight, and 18 obese women. The higher the BMI group, the larger the breast was ( p  = 0.005). In univariate regression, nipple diameter, nipple length, and areola diameter correlated significantly with breast size. The overall rate of latching difficulties was 15.5%, without significant differences among all four BMI groups. In multivariate analysis, the higher the BMI group the lower was the likelihood of breastfeeding at 6 months of age (odds ratio [OR] = 0.88, 95% confidence interval [CI]: 0.79-0.99), and the higher the birth order the higher was the likelihood of breastfeeding at 6 months of age (OR = 3.36, 95% CI: 1.44-7.83). Early latching difficulties predicted shorter breastfeeding duration. Conclusion: We conclude that high prepregnancy BMI has a negative impact on breastfeeding initiation and duration.

Background: Upper lip tie (ULT) articles have been recorded in Medline since 1998, while "labial frenum" articles have been recorded since 1946., Objective: to study the existing medical literature on ULT (or labial frenum or fraenum) as they relate to breastfeeding., Materials and Methods: Medline search engine was used to determine and subsequently retrieve all articles published on ULT from 1946 to 2018. Key-words of upper lip tie OR labial frenum were used for the search. We also used Google Scholar and Embase to widen our search, and used the PRISMA criteria for systematic reviews (SRs). Articles were classified as case reports (or series), reviews, editorials (or opinions), cohort studies, clinical trials (nonrandomized), randomized controlled trials (RCT), and SRs according to Medline's own classification. We systematically summarized all articles published to date., Results and Conclusion: No RCT were found, and the evidence for routine ULT release in infants with breastfeeding difficulties is poor. The classification system proposed by Kotlow has not been found reliable both in terms of inter and intraobserver agreement and in terms of predicting the severity of the breastfeeding difficulties.

Background: Cytomegalovirus (CMV)-infected human milk (HM) can lead to significant CMV morbidity and mortality in preterm very-low-birth weight infants. The eradication of CMV in HM while preserving its properties poses a major clinical challenge., Objective: We aimed to compare two methods used to neutralize the virus in HM, one recognized as partially effective (freezing) and another not tested to date (microwave exposure)., Materials and Methods: We sampled HM from 31 CMV-seropositive mothers whose infants were hospitalized at the Lis Maternity Hospital. Fifteen samples that were positive for CMV antigen were divided into five 5 mL aliquots: the first a control, the second was frozen at -20°C for 1 day, the third was frozen at -200°C for 3 days, and the fourth and fifth aliquots were exposed for 30 seconds to microwave radiation at a low-power setting (500 W) and high-power setting (750 W), respectively., Results: Only microwave radiation at a high-power setting led to complete neutralization of CMV in all samples. Low-power microwave irradiation had a 13% failure rate while 3-day freezing and 1-day freezing had failure rates of 7% and 20%, respectively., Conclusion: It is possible to eradicate CMV successfully in HM by using microwave radiation at a high-power setting. Further studies are needed to evaluate the effect of microwave heating on breast milk properties.

Background: Little is known about circadian variations of macronutrients content of expressed preterm human milk (HM). This study evaluated diurnal variations of macronutrients and energy content of preterm HM over the first 7 weeks of lactation and tested the hypothesis that values obtained during a morning sample are predictive of those obtained from an evening sample., Materials and Methods: Expressed HM was obtained from 32 mothers of preterm infants (26-33 weeks in gestational age), who routinely expressed all their milk every 3 hours from the beginning of the second to the seventh week after delivery. One aliquot was obtained from the first morning expression and the second from the evening expression. Energy and macronutrients contents were measured using an HM analyzer., Results: Mean fat and energy contents of all samples obtained during the whole period were significantly higher in evening samples (p < 0.0001). There were no significant differences between morning and evening carbohydrates and protein contents. Concentrations of protein, carbohydrates, and fat from morning samples were predictive of evening concentrations to different extents (R(2) = 0.720, R(2) = 0.663, and R(2) = 0.20, respectively; p < 0.02). The predictability of evening values by morning values was not influenced by the week of lactation at sampling or by individual patients. In repeated-measures analysis of variance performed on 11 patients who completed the whole 7-week period, over time, there was a significant decrease in fat, energy, and protein contents, whereas carbohydrates content remained unchanged. Day-night differences remained significant only for fat content., Conclusions: Circadian variations in fat and energy concentrations of HM are consistent over the first 7 weeks of lactation. There are no consistent circadian variations in HM protein and carbohydrates. Over a given day, there are little variations in protein and carbohydrates content, but fat concentrations are more variable, and evening values are less well predicted by morning sample analysis than values for protein or carbohydrates.

Background: The Hertfordshire study suggested that age of weaning and methods of infant feeding may influence adult serum low-density lipoprotein cholesterol (LDL-C) and mortality from ischemic heart disease in men. Although breastfeeding <1 year appeared to be protective compared with formula, prolonged breastfeeding (>1 year) was associated with increased LDL-C and mortality. This study tested the effect of breastfeeding duration on lipid profile in young adults., Materials and Methods: Adult volunteers whose mothers could recall the age at which their child was weaned were recruited. We excluded patients with known dyslipidemia, dyslipidemia in a first-degree relative, obesity (body mass index [BMI] >30 kg/m(2)), pregnant or within 3 months of a previous pregnancy, subjects taking medications that may affect lipid profile, or subjects with a chronic medical condition. Nutritional questionnaires and number of weekly hours of exercise were recorded. Lipid profiles were obtained after a night fast., Results: The three groups (no breastfeeding, breastfeeding 0-6 months, or breastfeeding >9 months) did not differ in terms of age, gender, BMI, level of education, amount of exercise, and dietary style. By stepwise background multiple regression analysis taking into account exercise, nutritional habitus, age, BMI, gender, and socioeconomic status, blood lipids were not affected by duration of breastfeeding., Conclusions: Duration of breastfeeding does not affect lipid profiles in young adults. These findings do not support negative messages on the long-term effect of prolonged lactation generated by the Hertfordshire study.

Objective: The aim of the current study was to determine whether secular changes have occurred in the breastfeeding literature, in terms of number and type of yearly published articles and impact factor of journals publishing these articles., Research Design and Setting: In order to evaluate all Medline articles related to breastfeeding, we used the Internet URL www.ncbi.nlm.nih.gov/entrez and searched for articles recorded from January 1, 1992 through December 31, 2011 using as a key word "breast milk," "breast feeding," or "human milk." We specifically studied randomized controlled trials (RCTs), clinical trials, case reports, meta-analyses, letters to the editor, reviews, systematic reviews, practice guidelines, and editorials., Results: There was a linear increase over the years in all articles recorded, from approximately 1,100/year in 1992 to 2,100/year in 2011 (i.e., an approximately 1.9-fold increase [R(2)=0.995, p=0.001]). Concomitant with the yearly increase in the number of published RCTs per year, there was a linear increase in the number of journals publishing articles on breastfeeding per year (from approximately 20 in 1992 to >60 in 2011 [R(2)=0.811, p<0.001]) but an overall decrease in the average impact factor every year (R(2)=0.202, p=0.047). However, the ratio of high-quality articles selected (RCTs+meta-analyses+systematic reviews+CR)/low-quality articles (reviews+editorials+letters to the editor+case reports) increased significantly over time in favor of the former., Conclusions: There was a linear increase in the number of publications related to the field of breastfeeding and human milk, and the ratio of high-quality/low-quality articles improved over time, indicating a relative and absolute increase in the number of articles usually considered as being of high quality. There was a significant increase in the number of journals publishing breastfeeding-related articles, with a significant decrease of average impact factor of those journals.

Introduction: Breastfeeding has a positive influence on physical and mental development. Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder with major social, familial, and academic influences. The present study aimed to evaluate whether ADHD is associated with a shorter duration of breastfeeding., Subjects and Methods: In this retrospective matched study, children 6-12 years old diagnosed at Schneider's Children Medical Center (Petach Tikva, Israel) with ADHD between 2008 and 2009 were compared with two control groups. The first one consisted of healthy (no ADHD) siblings of ADHD children; the second control group consisted of children without ADHD who consulted at the otolaryngology clinic. A constructed questionnaire about demographic, medical, and perinatal findings, feeding history during the first year of life, and a validated adult ADHD screening questionnaire were given to both parents of every child in each group., Results: In children later diagnosed as having ADHD, 43% were breastfed at 3 months of age compared with 69% in the siblings group and 73% in the control non-related group (p=0.002). By 6 months of age 29% of ADHD children were breastfed compared with 50% in the siblings group and 57% in the control non-related group (p=0.011). A stepwise logistic regression that included the variables found to be significant in univariate analysis demonstrated a significant association between ADHD and lack of breastfeeding at 3 months of age, maternal age at birth, male gender, and parental divorce., Conclusions: Children with ADHD were less likely to breastfeed at 3 months and 6 months of age than children in the two control groups. We speculate that breastfeeding may have a protective effect from developing ADHD later in childhood.

Purpose: Ankyloglossia ("tongue-tie") occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms., Methods: Twenty-five mothers of healthy infants with ankyloglossia were recruited because of sore nipples. Infants were randomized to either of 2 sequences: (1) frenotomy, breast-feeding, sham, breast-feeding (n = 14) or (2) sham, breast-feeding, frenotomy, breast-feeding (n = 11). The mothers as well as all personnel taking care of the child after each sham or frenotomy procedure were masked as to the study sequence. In every sequence, and after each sham or frenotomy procedure, a standardized latch score and pain score were obtained from the mother., Results: There was a significant decrease in pain score after frenotomy than after sham (P = .001). There was also a nearly significant improvement in latch after the frenotomy in these mothers (P = .06)., Conclusion: Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties.

Purpose: Very little is known about the prevalence of regurgitations in human milk-fed infants in the first days of life. The authors aimed to compare the frequency of regurgitations in formula- and breastfed infants in the first 2 days of life. It was hypothesized that human milk-fed infants experience less episodes of regurgitations than their formula-fed counterparts. DESIGN, SAMPLE, AND OUTCOME VARIABLES: Thirty-two (32) infants were formula fed and 31 were breastfed. In both groups, infants were fed ad libitum, as soon as the mother was ready to feed the infant. All regurgitations were noted on a collection form., Results: The number of regurgitations per infant in the first 48 hours of life was similar in breastfed (range 0 to 7) and formula-fed infants (range 0 to 8). There was also no difference in the number of regurgitations in the first or second 24-hour period. Eighteen of 31 of infants in the breastfed group and 17/32 in the formula fed groups had at least one episode of regurgitation during the 48-hour period., Conclusions: Contrary to this hypothesis, human milk feeding did not confer a "protection" on regurgitations in these young neonates.

Objective: To estimate fat and energy contents of human milk during prolonged lactation., Methods: Thirty-four mothers, of term, healthy, growing children, who had been lactating for >1 year (12-39 months) were recruited. Control subjects were 27 mothers, of term infants, who had been lactating for 2 to 6 months. Fat contents of the milk samples were estimated as creamatocrit (CMT) levels. Energy contents of the milk were measured with a bomb calorimeter., Results: The groups did not differ in terms of maternal height and diet, infant birth weight, gestational age, or breastfeeding frequency. They differed significantly in terms of maternal age, maternal weight, and BMI. The mean CMT levels were 7.36 +/- 2.65% in the short-duration group and 10.65 +/- 5.07% in the long-lactation group. The mean energy contents were 3103.7 +/- 863.2 kJ/L in the short-duration group and 3683.2 +/- 1032.2 kJ/L in the long-duration group. The mean CMT levels and mean energy contents were correlated significantly with the duration of lactation (R2 = 0.22 and R2 = 0.23, respectively). In multivariate regression analysis, CMT levels (or energy contents) were not influenced by maternal age, diet, BMI, or number of daily feedings but remained significantly influenced by the duration of lactation., Conclusions: Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant.

Aim of the study In preterm infants, the use of human milk is associated with unique benefits. However, successful breast feeding rates and prolonged breastfeeding duration is often reduced in preterm infants. Nevertheless, early initiation of breast expression after birth is believed to be one of the major variables that should improve the odds of successful breastfeeding. Hence, we aimed to assess correlation between timing of milk expression initiation and volume produced in regards to mode-of-delivery. Materials and methods Prospective, observational study. Mothers delivering infants weighing < 1500 g measured 24-h milk volumes on days 1–7, 14, and 21. Results Mothers delivering vaginally (N = 11) expressed milk sooner (3.82 ± 5.03 h) than mothers in the cesarean group (N = 42; 11.5 ± 9.1 h). There were no significant differences in daily number of expressions (i.e. day 1 3.6 ± 1.6 versus 2.5 ± 2.1, p = .125) or daily volume (i.e. day 1 – 7.5 ± 6.1 ml versus 11.6 ± 22.9 ml, p = .563), until day 6 from which, both were lower in the cesarean group (i.e. day 21 – number − 6.0 ± 1.3 versus 4.6 ± 1.7, p = .029; volume – 796 ± 465ml versus 435 ± 368ml, p = .018). Expressed volume initially did not correlate with earlier expression, however, latter expressed volume inversely correlated with earlier expression. In multivariate-analysis, mode of delivery, gestational age, and daily number of expressions were correlated with volumes on day 21 (p = .001). Conclusions Earlier human-milk expression is related to volumes on the second and the third week of lactation. This is overwhelmed by delivery mode, and by frequent milk expression from day 2. When early milk expression is not possible, more frequent milk expression might help increasing volumes. [ABSTRACT FROM AUTHOR]