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Background and AimsThe content of fatty acids (FA) in human milk may be influenced by maternal nutrition. We evaluated the role of a Mediterranean diet in influencing the content of FA in human milk among 282 breastfeeding mothers participating in the MEDIDIET study.Materials and MethodsMediterranean Diet Score (MDS), a composite index, was used to evaluate adherence to the Mediterranean diet. It includes 9 components (i.e., vegetables, fruit, cereals, legumes, monounsaturated to saturated FA ratio – MUFA/SFA, fish, dairy products, meat, and alcohol) and therefore potentially ranges from 0 (no adherence) to 9 (complete adherence) points. None of the mothers obtained the highest score due to the low alcohol consumption in the study population. Mothers were categorized in approximate tertiles of adherence: 0–3 (34.4%), 4 (26.2%), and 5–8 points (39.4%). The mean content of FA across categories of MDS was compared using ANOVA and test for trend.ResultsA high adherence of breastfeeding mothers to the Mediterranean diet was associated with lower content of SFA in human milk (42.58 ± 4.36 for MDS = 0–3, 42.58 ± 4.89 for MDS = 4, and 40.92 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend = 0.02). Conversely, a high adherence was associated with higher content of MUFA in human milk (43.27 ± 4.27 for MDS = 0–3, 43.27 ± 4.47 for MDS = 4, and 45.24 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), ω-3 FA (1.07 ± 0.25 for MDS = 0–3, 1.22 ± 0.49 for MDS = 4, and 1.31 ± 0.51% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), and the major types of ω-3 FA (i.e., α-linolenic acid – ALA, eicosapentaenoic acid – EPA, docosahexaenoic acid – DHA, docosapentaenoic acid – DPA). These associations were mainly driven by the adherence to the vegetables, MUFA/SFA, fish, and dairy products components of the Mediterranean diet.ConclusionA high adherence to the Mediterranean diet was associated with human milk showing a lower content of SFA and higher content of MUFA and ω-3 FA, including DHA. The Mediterranean diet may contribute in human milk production with higher content of specific FA which is directly involved in infant’s neural and visual development, as reported by previous studies.

Introduction: Knowledge about how a lactating woman's diet influences the composition of her breast milk is still very limited. In particular, no study has evaluated the role of adherence to the Mediterranean diet on human milk characteristics.Aim: We carried out an observational study to investigate the influence of mother adherence to a Mediterranean diet on her breast milk composition.Methods: Between 2012 and 2014, 300 healthy mothers, who exclusively breastfed their babies, were enrolled from five centers across Italy. During a visit to the hospital center 6 weeks after childbirth these women were asked to provide a sample of their freshly expressed breast milk and to answer a series of questions on personal characteristics and lifestyle factors. The application of a validated food frequency questionnaire allowed the collection of detailed dietary habits. Milk was collected and then stored until chemical analyses were performed. The study has been registered (Trial Registration: Dutch Trial register NTR3468). Descriptive analyses on baseline characteristics of mothers and babies were carried out on the participants, overall and stratified by center.Results: The participants had a mean age of 33 years (SD = 4.06), and a pre-pregnancy BMI of 22.3 Kg/m2 (SD = 3.22). Forty-seven percent gave birth to their first child, 40% to the second 13% to the third or subsequent child. Babies had a mean birth weight of 3,324 g (DS = 389), and a mean length of 51 cm (SD = 1.94). Fifty-three percent were males.Conclusion: The present work provides the general description and the characteristics of mothers and babies included in the MediDiet study.

Background/Objectives: One of the most effective strategies to mitigate morbidity associated with preterm birth is the use of human milk. The first choice is the mother’s milk; if that is not available, human milk donated to milk banks is the second choice. The recruitment of milk donors is essential for enhancing the effectiveness and efficiency of donation. This study aims to profile the donors of a southern Italian milk bank, examine how maternal and neonatal factors impacted the volume and duration of donation and analyze the trend over the last ten years. Materials and Methods: Data were collected from the milk bank database and hospitalization medical records, encompassing 593 donors and 13 years of activity of the Human Milk Bank from 2010 to 2022. Several variables were assessed: maternal characteristics—maternal age, employment status and the type of profession; pre and perinatal characteristics—type of delivery, parity, previous breastfeeding experience, birth weight and gestational age; milk donation characteristics—volume of milk donated and duration of donation. The trend of the characteristics was studied over time. Statistical correlations were conducted to assess the relationships between variables and the volume and duration of the milk donation. Results: In our cohort of donors, the most prevalent category consists of women over 30 years of age who are multiparous, have prior breastfeeding experience, are workers and have given birth to full-term babies. Maternal age and gestational age significantly influence both the volume and duration of milk donation. The type of delivery and occupation impact the volume of donated milk. There has been a decline in the number of donors over time. However, the trends in both the quantity and duration of milk donations have remained stable over the past decade, with the exception of the year immediately following the COVID-19 pandemic. Conclusions: We have outlined the prevailing average profile of the milk donor to a milk bank in Southern Italy. Factors impacting the volume and duration of donation, such as maternal age, occupation, type of delivery and gestational age, were identified. The volume and duration of donations have remained largely stable, with the exception of 2021, when the pandemic significantly reduced milk donations to the milk bank.

Aware of the utmost importance of feeding premature babies—especially those of lower weight—with human milk, as well as the need to monitor this important element of neonatal care, we focused on four aspects in this review. First of all, we reviewed the beneficial effects of feeding premature infants with breast milk in the short and long term. Secondly, we performed a quantitative evaluation of the rates of breastfeeding and feeding with human milk in Very-Low-Birth-Weight infants (VLBWs) during hospitalization in the Neonatal Intensive Care Unit (NICU) and at discharge. Our aim was to take a snapshot of the current status of human milk-feeding care and track its trends over time. Then we analyzed, on the one hand, factors that have been proven to facilitate the use of maternal milk and, on the other hand, the risk factors of not feeding with breast milk. We also considered the spread of human milk banking so as to assess the availability of donated milk for the most vulnerable category of premature babies. Finally, we proposed a protocol designed as a tool for the systematic monitoring of actions that could be planned and implemented in NICUs in order to achieve the goal of feeding even more VLBWs with human milk.

Background: Donor human milk (DHM) is the best option for preterm nutrition when mother’s milk is unavailable. For its proven benefits on the life and health of premature babies, DHM should be part of the essential newborn care. The fortification of human milk is necessary to ensure adequate growth and consequent good neurodevelopment. Holder pasteurization is routinely practiced in human milk banks (HMBs) to ensure safety of DHM but can impact the macronutrient content. The aim of this study was to explore the effect of Holder pasteurization on fat, protein, lactose and energy content of DHM and compare our data with the literature. Methods: Protein, lactose, fats and energy of 100 DHM pools from 87 women were analyzed before and after Holder pasteurization using Miris HMA™ (Human Milk Analyzer, Miris AB, Uppsala, Sweden), with the infrared spectroscopic method. The mean macronutrient contents before and after Holder pasteurization were compared using paired t-tests, and the variations in the concentration of the components were calculated as Delta%. The data obtained were compared to other studies with the same purpose. Results: We observed a reduction in fat (3.12 ± 1.64 vs 2.55 ± 0.85, with Delta% -14.9 ± 13.0 and p-value < 0.0001), T protein (1.05 ± 0.26 vs 0.89 ± 0.20, with Delta% -8.9 ± 63.0 and p-value < 0.0001), energy content (61.38 ± 18.66 vs 55.00 ± 8.27, with Delta% -8.1 ± 9.4 and p-value 0.0001), while no significant changes were observed for lactose content (6.35 ± 0.80 vs 6.43 ± 0.58, with Delta% 6.5 ± 56.7 and p-value 0.3735). Data in the literature on the effect of Holder pasteurization on DHM macronutrients are variable, and the only constant element is the non-variation of the carbohydrate content. Conclusion: Holder pasteurization decreased protein, fat and energy content of DHM. The lactose content has not been affected after the Holder pasteurization. After having assessed a remarkable variation in the macronutrient content in comparison with other studies, the adjustable fortification, especially if based on the composition data, might be more accurate. In addition, despite the fact that Holder pasteurization is actually the method recommended by the international HMB guidelines, as it provides a compromise between microbiological safety and nutritional/biological quality of DHM, studies on alternative methods capable of treating DHM preserving the milk’s components are desirable.

COVID-19 pandemic since the end of 2019 spreads worldwide, counting millions of victims. The viral invasion, systemic inflammation, and consequent organ failure are the gravest features of coronavirus disease 2019 (COVID-19), and they are associated with a high mortality rate. The aim of this study is to evaluate the role of breast milk in the COVID-19 pandemic, analyzing its antiviral, anti-inflammatory, and immunoregulatory effects due to its bioactive components, so numerous and important for the protection of infants. The study tried to demonstrate that all the components of human milk are capable of performing functions on all the pathogenic events recognized and described in COVID-19 disease. Those human milk factors are well-tolerated and practically free of side effects, so breast milk should become a research topic to discover therapies even in this epidemic. In the first part, the mechanisms of protection and defense of the breast milk elements will be delineated; in the second section, it will describe the human milk effects in viral infections and it will be hypothesized how the known mechanisms could act in COVID infection.

The review recalls the importance of breast milk and deepens the theme of human milk banking, a virtuous reality that is expanding all over the world but is still little known. In the last 15 years, modern biological technologies have crystallized the concept of uniqueness and irreproducibility of human milk, by establishing three new principles: first: human milk: a “life-saving” drug; second: human milk: the best food for preterm infants; and third: human milk: the main component of premature infant care. Our experience teaches us that human milk banking plays many roles that need to be known and shared.

Dear Editor, In previous epidemics, it has been shown that the use of breast milk represents one of the first crucial measures to be taken in emergencies. On the occasion of the World Day for the Donation of Human Milk, which was celebrated on May 22, the Italian Society of Neonatology (SIN) reaffirmed the importance of Human Milk Banks (HMBs), reassuring mothers about the safety of donation at HMBs, also in this pandemic period. In the Neonatal Intensive Care Unit (NICU) of San Giovanni Rotondo, Italy, we found that the restrictive measures did not represent a reason to limit breastfeeding nor donation. We have been close to nursing and donating mothers, providing constant support from the HMB and NICU staff, with practical advice and psychological closeness. In particular, in the February-May period, the crucial one of the pandemic, 15 donors donated 91.25 liters. In comparison with the average of previous years of donation data to the HMB, the balance is even in favor of the current year. In fact, in 2019, in the same period, 12 mothers were recruited and 58.7 liters were collected and, in 2018, the donor women were 10 but they donated 119.5 liters. As manager of the HMB, I found it useful to report the experience of our HMB and our NICU on this specific aspect, and I hope that other HMBs can do the same. I believe that these testimonies can represent an element of hope, encouragement and reflection. Solidarity did not end with the lockdown.

For its specific qualitative characteristics human donor milk (DM) is the main alternative to preterm infants nutrition and growing. How several studies suggest child's physical and mental development is influenced by breastfeeding that prevents the necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis common in preterm newborns. Our research was conducted in NICU's Human Milk Bank (HMB) “Allattiamolavita.” Our study was based on macronutrients analysis (MA) of 100 DM samples taken until 10 days since childbirth and analyzed by spectroscopic infrared innovative method (MIRIS). This is a specific method to analyse fat (F), crude proteins (CP), true proteins (TP), carbohydrate (CHO), and total solids (TS). We also analyzed the 100 donors' clinic-metabolic profile by blood tests (PMT). Both data was collected between September 2015 and February 2018. The research was structured in two parts. In the first part we compared PMT with qualitative and quantitative characteristics of MA while in the second one we studied every DM macronutrient finding furthermore possible relations between them. Statistical Package for Social Sciences (SPSS-IBM 24) was used to compare data and reporting coefficient of determination using Spearman's Rho and Kendall's Tau. We also analyzed samples using Kolmogorov–Smirnov test, Student T-test, ANOVA, Whitney U-test, and chi-square test. Statistically significant correlations were noted between maternal serum proteins and CP—TP of DM. The research showed also significant correlations between azotaemia and TP and an inverse correlation between serum creatinine and CP. No statistically significant correlation was observed between donors' glycaemia and CHO. Mineral concentrations of DM emerged independent of blood minerals (P, Ca, Fe, Na). We also calculated a normal range for individual macronutrient of human transitional milk (TM) that was not established in literature yet. Our experience allowed us to underline that human milk is a privileged site compared to donors' clinical and metabolic disorders. Our analysis showed the major role of the HMB to provide DM to improve clinical status, growing, and neurocognitive short and long term outcome of preterm infants.

When own mother’s milk is not available, donor human milk (DHM) is the first choice in preterm infant feeding. Although worldwide strong efforts have been made to implement human milk (HM) donation, there is currently little available research on donors characteristics and their influence on volume and composition of DHM. The present study aimed to evaluate the relationship between social-demographic variables of donating mothers (age, residence, job, number of children), as well as gestational age and birth weight of their babies, and volume and composition of donated HM. The analysis of data revealed a statistically significant impact of maternal age and profession, as well as babies’ birth weight and donation duration, on the volume of milk donation, but no effect of donor’s place of residence. Gestational age also had an effect on the volume of milk donation, but the effect was not statistically significant (p-value on the verge of significance). Regarding milk composition, gestational age < 29 weeks, low birth weight and overall donation period were statistically correlated to higher protein content. Statistical analysis of other DHM components did not result significant except for carbohydrates, being their content inversely associated with birth weight, with p-value at the margin of significance.

The breast milk is the gold standard food for the feeding of the premature baby: it is the natural way to provide excellent nutritional, immunological, and biological nutriment so as to facilitate a healthy growth and the development of the infants. When the breast milk is not available, the alternative is represented by the donated milk. The mothers of premature infants are important opportunity if we consider the fact that they could devote some milk both because they provide a food which is closer to the needs of the vulnerable category of newborns and because it is, for the mothers, a way to overcome the detachment and the psychological trauma of a premature birth. There are no data on this kind of donation. The aim of the study is to evaluate the contribution of the milk donation to the HMB of CSS by women who gave birth to premature infants of gestational age

Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon form of panniculitis that occurs after fetal distress and involves fatty areas during the first weeks of life. This rare disorder is generally self-limiting and undergoes complete regression. However, it can be complicated with a potentially life-threatening hypercalcemia. We report a case of severe hypercalcemia due to SCFN occurring after serious perinatal hypoxic injury, which resolved by intravenous administration of pamidronate. This treatment was rapidly effective and well tolerated. We suggest that pamidronate could be the first-line therapy for severe hypercalcemia in SCFN.