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To understand the formation of initial gut microbiota, three initial fecal samples were collected from two groups of two breast milk-fed (BM1) and seven formula milk-fed (FM1) infants, and the compositional changes in gut microbiota were determined using metagenomics. Compositional change analysis during week one showed that Bifidobacterium increased from the first to the third fecal samples in the BM1 group (1.3% to 35.1%), while Klebsiella and Serratia were detected in the third fecal sample of the FM1 group (4.4% and 34.2%, respectively), suggesting the beneficial effect of breast milk intake. To further understand the compositional changes during progression from infancy to childhood (i.e., from three weeks to five years of age), additional fecal samples were collected from four groups of two breast milk-fed infants (BM2), one formula milk-fed toddler (FM2), three weaning food-fed toddlers (WF), and three solid food-fed children (SF). Subsequent compositional change analysis and principal coordinates analysis (PCoA) revealed that the composition of the gut microbiota changed from an infant-like composition to an adult-like one in conjunction with dietary changes. Interestingly, overall gut microbiota composition analyses during the period of progression from infancy to childhood suggested increasing complexity of gut microbiota as well as emergence of a new species of bacteria capable of digesting complex carbohydrates in WF and SF groups, substantiating that diet type is a key factor in determining the composition of gut microbiota. Consequently, this study may be useful as a guide to understanding the development of initial gut microbiota based on diet.

Background: The amounts of micronutrients in the diets of infants, and the factors that influence them needs to be monitored at the population level in order to avert detrimental developmental defects that impose lifetime-limitations on an infant’s regulatory and defense systems. This study therefore, sought to evaluate if increasing levels of the toxic metals, Hg, Pb and Cd in breast milk will result in reducing amounts of the micronutrients Zn, Se and Cu in breast milk. Methods: Breast milk samples of 114 women living in two mining areas (57 women each) in Ghana, whose babies’ amounts of breast milk intake at three months postpartum, and amounts of toxic metals had previously been determined in a prospective study, were analyzed for micronutrients by a combination of acid and microwave digestion, and quantifications were by two different modes (hydrogen and helium) of Octapole Reaction System Inductively Coupled Plasma Mass Spectrometer (7500 ce. Agilent), equipped with an ASX-510 Auto-sampler (Cetac). Results: All the breast milk specimen collected contained detectable amounts of Cu, Zn, both at levels less than have been previously reported, and Se. For specimen that did not contain Pb the amount of Se ranged from about 110 to 245 ng/g of milk, however, as the amount of Pb increased, the corresponding highest detected amount of Se reduced steeply, resulting in a right-angle triangle-shaped scatter plot. Similar relationships were observed between other toxic metals and micronutrients studied. A curve fitting regression analysis showed significant quadratic and cubic relationships between the amounts of Hg and Se, as well as between Pb, As and Cu. Conclusion: The results clearly suggest a double burden of malnutrition in these mining areas, where high loads of maternal toxic metals in breast milk, related significantly with a progressive reduction in the amounts of the micronutrients Cu and Se in breast milk, potentially reducing in infants’ intake of these micronutrients.

To gain new insights into the potential of mother-to-child transmission of Zika virus (ZIKV) through breast milk or breastfeeding practices, we systematically searched regional and international databases and screened 1,658 non-duplicate records describing women with suspected or confirmed ZIKV infection, intending to breastfeed or give breast milk to an infant. Fourteen studies met our inclusion criteria and inform this analysis. These studies reported on 97 mother-children pairs who provided breast milk for ZIKV assessment. Seventeen breast milk samples from different women were found positive for ZIKV via RT-PCR, and ZIKV replication was found in cell cultures from five out of seven breast milk samples from different women. Only three out of six infants who had ZIKV infection were breastfed, no evidence of clinical complications were found to be associated with ZIKV RNA in breast milk. This review updates our previous report by synthesizing the evidence from 12 new articles and we find no evidence of mother-to-child transmission through breast milk intake or breastfeeding. As the certainty of the present evidence is low, additional studies are still warranted to completely understand any potential of transmission of ZIKV through breastfeeding.

Objective: An efficient method for measuring maternal milk production is needed. Our objectives were to: (1) validate a milk production rate (MPR) protocol in exclusively breastfeeding mothers; (2) determine MPR change following 48 hours of increased breast emptying; (3) assess agreement between MPR and infant test-weighing; and (4) characterize MPR in early postpartum exclusively breastfeeding mothers. Materials and Methods: N = 23 mothers emptied both breasts hourly over 3 hours (h0, h1, h2, and h3). We estimated steady-state MPR as mean (h2 and h3). Subset A mothers (n = 5) also completed MPR measurements after 48 hours of increased breast emptying. Subset B mothers (n = 16) also test-weighed for 48 hours. We used paired t-test to examine within-participant change in hourly milk yield and MPR; and we used Bland-Altman analysis to compare 24-hour milk production (g/24 hours) measured using test-weight versus MPR. Results are reported as mean ± standard deviation or (±95% limits of agreement). Results: Mothers were 54 ± 14 days postpartum. Paired difference in h3–h2 hourly milk yield was not significantly different (p > 0.05, 3 ± 10 g/hour). In Subset A (n = 5), MPR declined from 50 ± 13 to 43 ± 16 g/hour (p = 0.003) following 48 hours of increased breast emptying. In Study B (n = 16), mean infant test-weighed intake (TW) was 717 ± 119 g/24 hours, and mean MPR was 1,085 ± 300 g/24 hours. Mean difference (MPR-test-weigh) and mean ratio (MPR/test-weigh) significantly increased as MPR increased (p 20 g/24 hours, n = 12), mean MPR = 48 ± 12 g/hour (range, 35–78 g/hour). Conclusion: MPR is a valid measure of current maternal milk production capacity, but is not accurate for evaluating infant intake in exclusively breastfeeding dyads.

Despite the many benefits of breast milk, mothers taking medication are often uncertain about the risks of drug exposure to their infants and decide not to breastfeed. Physiologically based pharmacokinetic models can contribute to drug‐in‐milk safety assessments by predicting the infant exposure and subsequently, risk for toxic effects that would result from continuous breastfeeding. This review aimed to quantify breast milk intake feeding parameters in term and preterm infants using literature data for input into paediatric physiologically based pharmacokinetic models designed for drug‐in‐milk risk assessment. Ovid MEDLINE and Embase were searched up to July 2, 2019. Key study reference lists and grey literature were reviewed. Title, abstract and full text were screened in nonduplicate. Daily weight‐normalized human milk intake (WHMI) and feeding frequency by age were extracted. The review process retrieved 52 studies. A nonlinear regression equation was constructed to describe the WHMI of exclusively breastfed term infants from birth to 1 year of age. In all cases, preterm infants fed with similar feeding parameters to term infants on a weight‐normalized basis. Maximum WHMI was 152.6 ml/kg/day at 19.7 days, and weighted mean feeding frequency was 7.7 feeds/day. Existing methods for approximating breast milk intake were refined by using a comprehensive set of literature data to describe WHMI and feeding frequency. Milk feeding parameters were quantified for preterm infants, a vulnerable population at risk for high drug exposure and toxic effects. A high‐risk period of exposure at 2–4 weeks of age was identified and can inform future drug‐in‐milk risk assessments.

Saliva and urine are the two main body fluids sampled when breast milk intake is measured with the2H oxide dose-to-mother technique. However, these two body fluids may generate different estimates of breast milk intake due to differences in isotope enrichment. Therefore, we aimed to assess how the estimated amount of breast milk intake differs when based on saliva and urine samples and to explore whether the total energy expenditure of the mothers is related to breast milk output. We used a convenience sample of thirteen pairs of mothers and babies aged 2–4 months, who were exclusively breastfed and apparently healthy. To assess breast milk intake, we administered doubly labelled water to the mothers and collected saliva samples from them, while simultaneously collecting both saliva and urine from their babies over a 14-d period. Isotope ratio MS was used to analyse the samples for2H and18O enrichments. Mean breast milk intake based on saliva samples was significantly higher than that based on urine samples (854·5v. 812·8 g/d,P= 0·029). This can be attributed to slightly higher isotope enrichments in saliva and to a poorer model fit for urine samples as indicated by a higher square root of the mean square error (14·6v. 10·4 mg/kg,P= 0·001). Maternal energy expenditure was not correlated with breast milk output. Our study suggests that saliva sampling generates slightly higher estimates of breast milk intake and is more precise as compared with urine and that maternal energy expenditure does not influence breast milk output.

The WHO recommends exclusive breastfeeding for 6 months, but despite interventions, breastfeeding rates remain stubbornly low. Financial voucher incentives have shown promise but require a biomarker for validation of intake. This study aimed to develop a simple biochemical assay of infant urine that would tell if an infant was receiving any breast milk to validate maternal report. Urine samples were collected and snap frozen from 34 infants attending with minor illness or feeding problems, of whom 12 infants were exclusively breastfed, nine exclusively formula fed, and 11 mixed breast/formula fed. High‐performance anion exchange chromatography was used to identify discriminating patterns of monosaccharide composition of unconjugated glycans in a sequence of three experiments. The absolute concentration of all human milk oligosaccharides measured blind could detect “any breastfeeding” only with a sensitivity of 48% and specificity of 78%. Unblinded examination of N‐acetylglucosamine (GlcNAc) measured as GlcNH2 after hydrolysis of GlcNAc improved sensitivity to 75% at the expense of a specificity of 28%. Estimation of the relative abundance of GlcNH2 (GlcNH2[%]) or the ratio of GlcNH2 to endogenous mannose (Man) improved accuracy. In a further blind experiment, the GlcNH2/Man ratio with a cut‐off of 1.5 correctly identified all those receiving “any breast milk,” while excluding exclusively formula fed infants. The GlcNH2/Man ratio in infant urine is a promising test to provide biochemical confirmation of any breastfeeding for trials of breastfeeding promotion.

Saliva and urine are the two main body fluids sampled when breast milk intake is measured with the 2H oxide dose-to-mother technique. However, these two body fluids may generate different estimates of breast milk intake due to differences in isotope enrichment. Therefore, we aimed to assess how the estimated amount of breast milk intake differs when based on saliva and urine samples and to explore whether the total energy expenditure of the mothers is related to breast milk output. We used a convenience sample of thirteen pairs of mothers and babies aged 2–4 months, who were exclusively breastfed and apparently healthy. To assess breast milk intake, we administered doubly labelled water to the mothers and collected saliva samples from them, while simultaneously collecting both saliva and urine from their babies over a 14-d period. Isotope ratio MS was used to analyse the samples for 2H and 18O enrichments. Mean breast milk intake based on saliva samples was significantly higher than that based on urine samples (854·5 v. 812·8 g/d, P = 0·029). This can be attributed to slightly higher isotope enrichments in saliva and to a poorer model fit for urine samples as indicated by a higher square root of the mean square error (14·6 v. 10·4 mg/kg, P = 0·001). Maternal energy expenditure was not correlated with breast milk output. Our study suggests that saliva sampling generates slightly higher estimates of breast milk intake and is more precise as compared with urine and that maternal energy expenditure does not influence breast milk output.

Guidelines recommend breastfeeding in cystic fibrosis (CF) but breastfeeding rates decline rapidly in CF. We initiated a quality improvement project to improve breastfeeding in CF by incorporating International Board-Certified Lactation Consultants (IBCLC) into the initial CF-diagnosis visit to support mothers who were breastfeeding at diagnosis. In the preintervention group, only 8/14 (57%) continued to provide breast milk after the first visit, whereas postintervention, 16/17 (94%) mothers continued to do so (P = 0.03). The duration of any (or partial) breastfeeding increased to an average of 7.7 months from an average of 6.4 months preintervention (P = 0.45). The weight z score and weight-for-length z score at diagnosis showed no change at 6 or 12 months (all comparisons P value >0.05). We conclude that mothers who met with the IBCLC were less likely to quit breastfeeding and hypothesize that lactation support to mothers can prolong the duration of breastfeeding in infants with CF.

Neonatal intensive care practices have resulted in marked improvements in the survival of premature infants; however, they remain at significant risk for adverse neurodevelopmental outcomes. The impact of current nutritional practices on brain development following early extra-uterine exposure in premature infants is not well known. We performed a systematic review to investigate nutritional effects on postnatal brain development in healthy term and prematurely born infants utilizing advanced magnetic resonance imaging tools. Systematic screen yielded 595 studies for appraisal. Of these, 22 total studies were selected for inclusion in the review, with findings summarized in a qualitative, descriptive fashion. Fat and energy intake are associated with improved brain volume and development in premature infants. While breast milk intake and long-chain polyunsaturated fatty acid supplementation has been proven beneficial in term infants, the impact in preterm infants is less well understood.

World Health Organization recommends exclusive breastfeeding for infants for the first 6 months of life, followed by introduction of nutritious complementary foods alongside breastfeeding. Breast milk remains a significant source of nourishment in the second half of infancy and beyond; however, it is not clear whether more breast milk is always better. The present study was designed to determine the association between amount of breast milk intake at 9-10 months of age and infant growth and development by 12-18 months of age. The study was nested in a randomized controlled trial conducted in Malawi. Regression analysis was used to determine associations between breast milk intake and growth and development. Mean (SD) breast milk intake at 9-10 months of age was 752 (244) g/day. Mean (SD) length-for-age z-score at 12 months and change in length-for-age z-score between 12 and 18 months were -1.69 (1.0) and -0.17 (0.6), respectively. At 18 months, mean (SD) expressive vocabulary score was 32 (24) words and median (interquartile range) skills successfully performed for fine, gross, and overall motor skills were 21 (19-22), 18 (16-19), and 38 (26-40), respectively. Breast milk intake (g/day) was not associated with either growth or development. Proportion of total energy intake from breast milk was negatively associated with fine motor (β = -0.18, p = .015) but not other developmental scores in models adjusted for potential confounders. Among Malawian infants, neither breast milk intake nor percent of total energy intake from breast milk at 9-10 months was positively associated with subsequent growth between 12 and 18 months, or development at 18 months.

Exclusive breastfeeding is recommended during the first 6 months of life; thereafter, continued breastfeeding along with nutritious complementary foods is recommended. Continued breastfeeding contributes a substantial proportion of nutrient needs and promotes healthy growth and development, but the quantity of breast milk consumed may be highly variable and little is known about the factors associated with breast milk intake after 6 months of age. The present study was conducted to assess factors associated with breast milk intake of Malawian infants at 9-10 months of age. Breast milk intake was measured using the dose-to-mother deuterium oxide dilution method in a subsample of 358 Malawian infants who were participating in a randomized controlled trial of lipid-based nutrient supplements. Regression analysis was used to assess associations between breast milk intake and several maternal and infant variables. Mean (standard deviation) breast milk intake was 752 (244) g day(-1) . In multiple regression, breast milk intake was positively associated with infant weight (+62 g per kg body weight, P

The WHO recommends that exclusive breastfeeding should last up to 6 mo. However, human milk intake of Sri Lankan infants has not been quantified scientifically.The objectives of this study were to measure the human milk intake of Sri Lankan infants during the first 6 mo of age and to document the breastfeeding practices of their mothers.Forty-eight healthy mother-infant dyads were randomly recruited for this cross-sectional study at well-baby clinics. Milk intake was measured using the deuterium oxide-to-the-mother technique over a period of 2 wk. Information on breastfeeding practice and living standards of the participants were gathered using an interviewer-administered questionnaire.Human milk intake was 672 ± 123 g ⋅ d(-1) (mean ± SD), 776 ± 212 g ⋅ d(-1), and 801 ± 51 g ⋅ d(-1) for infants2 mo, 2 to4 mo, and 4-6 mo of age, respectively. The milk intakes were not different among the age groups. Maternal body composition, age, or parity had no effects on milk intake of the infants. However, mother's education : P0.05, r = 0.35), infant's age (P0.05, r = 0.30), and body mass index (P0.05, r = 0.41 : positively correlated with the milk intake. Over 63% of mothers had commenced breastfeeding within 30 min of delivery. About 60% of the mothers were feeding the baby 6-10 times during the daytime and81% intended to continue exclusive breastfeeding until 6 mo of age.This study, for the first time, documented the adequacy of breast-milk intake among Sri Lankan infants and the nutrition status of the mothers.

El objetivo del trabajo fue describir la aplicación de la técnica de dilución isotópica con deuterio de dosis a la madre para determinar la ingesta de leche materna y la composición corporal de las madres, en distintos tipos de lactancia. El método analítico se aplicó en cuatro casos modelo de pares madre-lactante en los cuales las madres recibieron una dosis oral de agua deuterada, recolectándose 6 muestras de saliva de ambos durante 15 días. El enriquecimiento de deuterio se determinó en un espectrómetro FTIR-Shimadzu-Affinity obteniéndose la ingesta de leche materna (ILM) y de agua de otras fuentes (Fd). Se observó una variación del enriquecimiento de deuterio en la saliva del lactante, asociada al tipo de lactancia recibida, siendo mayor en el caso de lactancia materna exclusiva (LME). Asimismo, a medida que aumentó Fd, disminuyó ILM. Además, fueron determinadas el agua corporal, la masa libre de grasa y la masa grasa materna. La transferencia de las habilidades técnicas y del conocimiento a través de metodologías innovadoras para determinar la ingesta de leche materna es de utilidad como herramienta de evaluación de la alimentación del lactante y para investigar en qué medida la lactancia natural es reemplazada por la ingesta de otros alimentos. Mejorar la estimación de la LME contribuye al conocimiento de la recomendación de OMS y UNICEF de mantener la misma hasta el sexto mes de vida., The aim of this study was to describe the application of the dose-to-themother deuterium-oxide turnover technique to determine the breast milk intake and body composition of mothers in different types of breastfeeding. This analytical method was performed in four mother-infant pairs at 4 months from birth. Mothers received an oral dose of deuterated water, collecting 6 samples of saliva from mother and baby during a period of 15 days. Deuterium enrichment was determined in a Shimadzu FTIR-spectrometer-Affinity to obtain the intake of breast milk and water from non-breast milk sources. In this study, a variation of the enrichment of deuterium in the saliva of the infant was observed, being higher when the infant was exclusively breastfed. As non-breast milk water increased, the intake of human milk decreased. Furthermore, maternal total body water, fat free mass and fat mass were determined. To improve technical skills and knowledge through innovative methods of breast milk measurement can be useful as an assessment tool for evaluating infant feeding and investigating the extent to which breast milk is being replaced by the consumption of other foods in order to estimate exclusive breastfeeding in the future. This would contribute to the knowledge of maintaining breastfeeding until the sixth month of life, as it is recommended by WHO and UNICEF., O objetivo deste estudo foi descrever a aplicação da técnica de diluição isotópica com deutério de dose â mãe para determinar a ingestão de leite materno e a composição corporal das mães, em diferentes tipos de aleitamento. O método analítico foi aplicado em quatro casos modelo de pares mães-lactante nos quais as mães receberam uma dose oral de água deuterada, coletando-se 6 amostras de saliva de ambos (mães e lactantes) durante 15 días. O enriquecimento de deutério foi determinado em um espectrômetro FTIR-Shimadzu- Affinity, sendo obtida a ingestão de leite materno (ILM) e de água proveniente de outras fontes (Fd). Observou-se uma variação do enriquecimento de deutério na saliva do lactante, associada ao tipo de aleitamento recebido, sendo maior no caso de aleitamento materno exclusivo (AME). Também, na medida que aumentou Fd, diminuiu ILM. Além disso, a água corporal, a massa livre de gordura y a massa gorda materna foram determinadas. A transferência das habilidades técnicas e do conhecimento através de metodologias inovadoras para determinar a ingestão de leite materno é de utilidade como ferramenta de avaliação da alimentação do lactante e para investigar em que medida o aleitamento natural é substituído pela ingestão de outros alimentos. Melhorar a avaliação do AME contribui ao conhecimento da recomendação da OMS e UNICEF de manter a mesma até o sexto mês de vida., Instituto de Investigaciones en Humanidades y Ciencias Sociales

Introduction: Exclusive breastfeeding (EBF) is recommended up to six months of age and is usually estimated by the 24-recall method which actually overestimates the real rate. EBF rate in Sri Lanka up to 4 months of age is 75% and up to 6 months of age is 51% according to data of the Sri Lanka Demographic & Health Survey 2006/07. Deuterium oxide dose-to-mother technique could be utilised for assessment of intake by babies of breastmilk as well as intake of water from sources other than breastmilk. Objective: To determine the actual EBF rates at 3 and 6 months of age of infants in Sri Lanka using deuterium oxide dose-to-mother technique. Method: Thirty healthy mother-infant dyads were followed up for a six month period from birth and breast milk intake was measured at 3 and 6 months using deuterium isotope analysis. Further, an interviewer administered questionnaire asked about the feeding history. Results: The average milk intake at 3 months was 772±134 g.d -1 (range 587-1057) and 800±174 g.d -1 (range 500-1113) at 6 months ( p =0.30). The non-milk oral intake at 3 months was 91±45 g.d -1 (range -2-166) and 128±63 g.d -1 (range 25-304) at 6 months (p=0.01). Breastfeeding practices revealed that only 40% (n=12) of mothers at 3 months and 30% (n=9) of mothers at 6 months were practising EBF. It confirmed that the EBF rate among study subjects was 50% at 3 months and 27% at 6 months, with the cut-off of 82.5 g.d -1 of non-milk oral intake. Conclusions : A decrease in EBF was noted between 3 and 6 months using deuterium oxide dose-to-mother technique. Further, the EBF rates in this study sample are much lower than the presently reported value for Sri Lanka using recall method. Sri Lanka Journal of Child Health , 2018; 47 (4): 311-315

Exclusive breast-feeding until 6 months is advised by the WHO as the best practice to feed infants. Yet, some studies have suggested a gap between energy requirements and the energy provided by human milk for many infants at 6 months. In order to assess the adequacy of WHO recommendations in 6-month-old Senegalese lactating infants, a comprehensive study was designed to measure human milk intake by the dose-to-the mother2H2O turnover method. Infants' energy intakes were calculated using daily breast milk intake and the energy content of milk was estimated on the basis of creamatocrit. Of the fifty-nine mother–infant pairs enrolled, fifteen infants were exclusively breast-fed (Ex) while forty-four were partially breast-fed (Part). Infants' breast milk intake was significantly higher in the Ex group (993 (sd135) g/d,n15) compared with the Part group (828 (sd222) g/d,n44,P= 0·009). Breast milk energy content as well as infants' growth was comparable in both groups. However, infants' energy intake from human milk was significantly higher (364 (sd50) kJ/kg per d (2586 (sd448) kJ/d)) in the Ex group than in the Part group (289 (sd66) kJ/kg per d (2150 (sd552) kJ/d),P

Exclusive breastfeeding is recommended during the first 6 months of life; thereafter, continued breastfeeding along with nutritious complementary foods is recommended. Continued breastfeeding contributes a substantial proportion of nutrient needs and promotes healthy growth and development, but the quantity of breast milk consumed may be highly variable and little is known about the factors associated with breast milk intake after 6 months of age. The present study was conducted to assess factors associated with breast milk intake of Malawian infants at 9-10 months of age. Breast milk intake was measured using the dose-to-mother deuterium oxide dilution method in a subsample of 358 Malawian infants who were participating in a randomized controlled trial of lipid-based nutrient supplements. Regression analysis was used to assess associations between breast milk intake and several maternal and infant variables. Mean (standard deviation) breast milk intake was 752 (244) g day(-1) . In multiple regression, breast milk intake was positively associated with infant weight (+62 g per kg body weight, P

The United States Environmental Protection Agency has identified quantification of trichloroethylene (TCE), an industrial solvent, in breast milk as a high priority need for risk assessment. Water and milk samples were collected from 20 households by a lactation consultant in Nogales, Arizona. Separate water samples (including tap, bottled, and vending machine) were collected for all household uses: drinking, bathing, cooking, and laundry. A risk factor questionnaire was administered. Liquid-liquid extraction with diethyl ether was followed by GC-MS for TCE quantification in water. Breast milk underwent homogenization, lipid hydrolysis, and centrifugation prior to extraction. The limit of detection was 1.5 ng/mL. TCE was detected in 7 of 20 mothers' breast milk samples. The maximum concentration was 6 ng/mL. TCE concentration in breast milk was significantly correlated with the concentration in water used for bathing (ρ = 0.59, p = 0.008). Detection of TCE in breast milk was more likely if the infant had a body mass index

Background:Breastfeeding assessment in the hospital to determine adequacy of feeds remains controversial. Swallow evaluation is integral to current assessment tools, but the literature is not clear about whether the number of swallows is an accurate indicator of breast milk intake in early postpartum.Objectives:To determine the reliability and validity of swallows as a measure of breast milk intake in the first days of a newborn’s life.Methods:Thirty mother-baby dyads were observed at one breastfeeding; pre- and postfeed weights were done, bedside audible swallows were counted, and feeds were videotaped for independent rating. Milk intake was determined from weight change, adjusted for insensible water loss.Results:Number of swallows was significantly and positively correlated with breast milk intake ( r = .71). Number of swallows alone, however, accounted for only 50.8% ( R2= .508) of the variation in milk intake. Infant age was the best predictor of milk intake (βage= .56 vs βNo. swallows= .36), accounting for 68% of the variation in milk intake when combined with swallows. The majority of infants took in 10 g or less of breast milk (77%); length of feeds was variable. In-room (at bedside) lactation consultant (LC) and video rater LC swallow counts were significantly and positively correlated ( r = .93; P < .01). However, the 2 lactation consultant swallow numbers include clinically important discrepancies in a Bland-Altman analysis.Conclusions:Number of swallows was not supported as a reliable or valid indicator of milk intake and adequacy of a feed in the first few days of life.

A fenilcetonúria (PKU) ocorre na incapacidade para transformar fenilalanina em tirosina, trazendo efeitos tóxicos para o sistema nervoso central. Tradicionalmente, no tratamento da PKU, o aleitamento materno é substituído por fórmula láctea. Este estudo verificou os efeitos do aleitamento materno como fonte de fenilalanina no desenvolvimento de crianças com PKU. Participaram dez lactentes com PKU, que iniciaram o tratamento com a introdução de fórmula láctea antes dos 30 dias e que mantiveram o aleitamento materno por no mínimo 30 dias de vida após o início dos procedimentos. Os procedimentos basearam-se em estimar a ingestão de leite materno, com margem segura da concentração da fenilalanina, calculando o volume gástrico e oferecendo inicialmente fórmula láctea, seguida do aleitamento materno em demanda livre, em todas as mamadas. O tempo de amamentação variou de um mês e cinco dias a 14 meses. Os controles sanguíneos foram semanais. Se o nível sérico da fenilalanina estivesse >2 mg/dL e 6 mg/dL, aumentava-se a fórmula em 50%. Avaliou-se os níveis de fenilalanina, aplicou-se a Early Language Milestone Scale e Passos Básicos do Desenvolvimento. Foram considerados adequados aqueles lactentes que apresentaram índices normativos em todas as avaliações. Dos lactentes, 80% conseguiram manter limites seguros da fenilalanina e desenvolvimento nos índices normativos. Há viabilidade da continuidade do aleitamento materno no tratamento de crianças com PKU desde que os níveis de fenilalanina sejam rigorosamente controlados e que os efeitos do aleitamento materno para o desenvolvimento infantil sejam verificados.

Some women in rural Pakistan are chronically undernourished, and consequently underweight. Concerns have been expressed that the degree of undernourishment might be sufficiently severe to affect lactation performance. We have obtained data on maternal body composition and infant breast milk intake using stable isotope methods in a group of thirty three mother and infant pairs at approximately six months of age. The maternal body mass index ranged from 16.6 to 29.1 kg·m(-2). In this population we found that exclusive breast-feeding tended to be associated with lower maternal body fat, and that there was no evidence for compromised lactational performance due to malnourishment. Finally we note that when our data is combined with that from other studies there may be a generalised negative correlation between breast milk intake and maternal body fat.

The effect of different energy densities of complementary foods on breast milk consumption is not well understood. In this study, we tested the hypothesis that provision of fortified spread (FS), a micronutrient fortified, energy-dense (22 kJ/g), ready-to-use food, to Malawian infants would not decrease their breast milk intake more than a traditional corn + soy blended flour (CSB). Forty-four healthy 6-mo-old infant and mother pairs were enrolled in a prospective, parallel group, investigator-blinded, randomized controlled complementary feeding trial. Infants were randomized to receive 25 g/d of FS, 50 g/d of FS, or 72 g/d of CSB. The primary outcome was the difference in breast milk intake after 1 mo of complementary feeding as measured by the dose-to-mother deuterium oxide dilution technique. Outcomes were compared using repeated measures ANOVA. A total of 41 mother-infant pairs completed the study. At enrollment, 88% of the infants had received corn porridge. At baseline, the infants consumed 129 +/- 18 g.kg body wt(-1) x d(-1) (mean +/- SD) of breast milk. After 1 mo of complementary feeding with 25 g/d FS, 50 g/d FS, or 72 g/d CSB, their breast milk consumption was 115 +/- 18 g.kg body wt(-1) x d(-1), a significant reduction; however, the effects of the complementary foods did not differ from one another (F-value model = 4.33, P = 0.0008 for effect of time and P = 0.69 for effect of type of food). The results suggest that complementary feeding of Malawian infants with FS has the same effect on their breast milk intake as complementary feeding with traditional CSB porridge.

Objective: To assess the breast milk intake and transfer of vitamin A (VA) from the mother to the breastfed child in lactating Mexican women from rural and urban areas. Methods: Milk intake was ass...

Background: In sub-Saharan Africa, the practice of breast-feeding infants is common. Records documenting the intake of breast milk amongst infants are limited. This study evaluated the association between maternal body composition and the intake of breast milk in infants from the pastoral communities within Pokot, Kenya. Methods: The study was conducted in 10 lactating mothers who were participating in a longitudinal study aimed at determining maternal body composition, iron stores and vitamin A status during the third trimester pregnancy and four months after they had given birth. Maternal and infant anthropometric measurements were made, and maternal blood samples were taken to determine serum retinol and ferritin levels. Infant milk intake and maternal fat-free mass (FFM) and percent body fat (% BF) were measured using ‘the dose to the mother method’. A measured deuterium oxide (2H2O) dose was given to the mother. Urine and breast milk from the mother, and saliva samples from the infant, were collected on days 1, 8 and 14 after dosing. Results: The mean (± SD) maternal mid upper arm circumference (MUAC) and body mass index (BMI) were 21.8 (0.9) cm and 18.6 (1.0) kg/height (m2), respectively. Infant weight and weight/age Z score were 4.956 (0.874) kg and –1.750 (0.77), respectively. Throughout the study, the infants gained 20 (4) g/day in body weight and had a milk intake of 555 (22) ml/day. The energy intake of the infant was 1,602 (148) kJ/day and was lower (p < 0.05) than the 2,404 (423) kJ/day estimated requirement by the FAO/WHO/UNU. The maternal FFM, %BF, Hb, Hct, ferritin and retinol were 32.8 (3.1) kg, 17.24 (7.0), 11.5 (1.3) g/dl, 33.9 (4.9), 16.2 (0.1) µg/l and 0.894 (0.16) µmol/l, respectively. Infant milk intake was significantly and positively correlated to maternal pregnancy triceps (r = 0.679) p < 0.05) and pregnancy MUAC (r = 0.725) p < 0.05). Maternal pregnancy MUAC was an important predictor of infant breast milk intake. Conclusion: Data on volume of breast milk consumed by the infants suggests, at least for this group of infants, that adequate growth may not be achieved. There is a possibility that lactating mothers practicing exclusive breast-feeding and living under harsh conditions may experience periods of low breast milk volume. Body composition and biochemical findings among this group of Pokot mothers indicate dietary inadequacies that require nutritional intervention.

Breast milk intake is recommended for late preterm infants. Many mothers provide expressed breast milk during hospitalization and anticipate transitioning their late preterm infant to full feedings at-breast after discharge. However, some infants take months to transition to full feedings at-breast. This article describes the case of a mother and her 35-week infant who transitioned to full feeding at-breast at 4 months after discharge. The clinical strategies to maintain maternal milk supply, use of hospital-grade scale, and importance of professional and community lactation support are discussed.

BACKGROUND The potential for small-quantity lipid-based nutrient supplements (LNS) to promote growth and development after 6 mo of age is currently being investigated. Because infants self-regulate energy intake, consumption of LNS may reduce breast milk intake and potentially decrease the beneficial effects of breast milk. OBJECTIVE The objective was to test the hypothesis that the breast milk intake of 9- to 10-mo-old rural Malawian infants receiving LNS would not be lower than that of infants receiving no supplementation. DESIGN This was a substudy of the International Lipid-based Nutrient Supplements (iLiNS) DOSE trial, in which 6-mo-old infants were randomly assigned to receive 10, 20, or 40 g LNS/d containing 56, 117, or 241 kcal/d, respectively, or no LNS until 18 mo of age. A subset was randomly selected to estimate breast milk intake at 9-10 mo of age with the dose-to-mother deuterium oxide dilution method. The noninferiority margin was