New Studies

Title: Optimizing the Use of Human Milk Cream Supplement in Very Preterm Infants: Growth and Cost Outcomes.

In: Nutrition in Clinical Practice 2020 Aug;35(4):689-696. doi: 10.1002/ncp.10423. Epub 2019 Oct 22.

Authors: Lindsey A Knake, Brian C King, Laura A Gollins, Nancy M Hurst, Joseph Hagan, Steven L Ford, Amy B Hair.

Abstract: "Background: An exclusive human milk-based diet has been shown to decrease necrotizing enterocolitis and improve outcomes for infants ≤1250 g birth weight. Studies have shown that infants who received an exclusive human milk diet with a donor-human milk-derived cream supplement (cream) had improved weight and length velocity when the cream was added to mother's own milk or donor-human milk when energy was <20 kcal/oz using a human milk analyzer. Our objective was to compare growth and cost outcomes of infants ≤1250 g birth weight fed with an exclusive human milk diet, with and without human milk cream, without the use of a human milk analyzer. Methods: Two cohorts of human milk-fed premature infants were compared from birth to 34 weeks postmenstrual age. Group 1 (2010-2011) received a donor-human milk fortifier, whereas Group 2 (2015-2016) received donor-human milk fortifier plus the commercial cream supplement, if weight gain was <15 g/kg/d. Results: There was no difference in growth between the 2 groups for weight (P = 0.32) or head circumference (P = 0.90). Length velocity was greater for Group 1 (P = 0.03). The mean dose of donor-human milk fortifier was lower in Group 2 (P < 0.001). Group 2 saved an average of $2318 per patient on the cost of human milk products (P < 0.01). Conclusions: Infants receiving a human milk diet with cream supplementation for growth faltering achieve appropriate growth in a cost-effective feeding strategy. Keywords: cream; enteral nutrition; human milk; human milk fortifier; human milk supplement; neonates."

Abstract only: https://onlinelibrary.wiley.com/doi/abs/10.1002/ncp.10423

Title: Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk.

In: Breastfeeding Medicine May 2020; 15(5): 297–303.

Authors: Alan Lucas, John Boscardin and Steven A. Abrams.

Abstract: "Objective: An increasingly common practice is to feed preterm infants a base diet comprising only human milk (HM), usually fortified with a cow's milk (CM)-derived fortifier (CMDF). We evaluated the safety of CMDF in a diet of 100% mother's own milk (MOM) against a HM-derived fortifier (HMDF). To date, this has received little research attention. Study Design: We reanalyzed a 12-center randomized trial, originally comparing exclusive HM feeding, including MOM, donor milk (DM), and HMDF, versus a CM exposed group fed MOM, preterm formula (PTF), and CMDF1. However, for the current study, we performed a subgroup analysis (n = 114) selecting only infants receiving 100% MOM base diet plus fortification, and fed no DM or PTF. This allowed for an isolated comparison of fortifier type: CMDF versus HMDF to evaluate the primary outcomes: necrotizing enterocolitis (NEC) and a severe morbidity index of NEC surgery or death; and several secondary outcomes. Results: CMDF and HMDF groups had similar baseline characteristics. CMDF was associated with higher risk of NEC; relative risk (RR) 4.2 (p = 0.038), NEC surgery or death (RR 5.1, p = 0.014); and reduced head circumference gain (p = 0.04). Conclusions: In neonates fed, as currently recommended with a MOM-based diet, the safety of CMDF when compared to HMDF has been little researched. We conclude that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death. Keywords: human milk, infant feeding, human nutrition, fortifiers, human milk-derived fortifier, cow's milk-derived fortifier, necrotising enterocolitis."

Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232708/

Title: Necrotizing Enterocolitis Reduction Using an Exclusive Human-Milk Diet and Probiotic Supplementation in Infants With 1000-1499 Gram Birth Weight.

In: Nutrition in Clinical Practice 2020 Apr;35(2):331-334. doi: 10.1002/ncp.10394. Epub 2019 Sep 4.

Authors: Ray Sato, Solyvattey Malai, Behzad Razmjouy.

Abstract: "Background: Necrotizing enterocolitis (NEC) is a major complication confronting clinicians caring for premature infants. This investigation compares clinical outcomes before and after quality improvement-program interventions in a population of premature infants at intermediate risk for NEC. Methods: This study is a retrospective single-center chart review of infants admitted with a birth weight of 1000-1499 g, excluding major congenital anomalies, over a 6-year period, beginning with implementation of a donor breast-milk program when mother's own milk was not available. Infants were separated into 2 epochs, before (July 2012-December 2013) and after (April 2014-June 2018) introduction of human milk-derived fortifier (Prolacta) and a daily probiotic (FloraBABY) supplement. Results: Comparing 140 preintervention infants with 265 postintervention infants, NEC was significantly lower in the postintervention group: 5.2% vs 1.1% (P = 0.046). Somatic growth was similar in both epochs. Conclusions: Quality-improvement initiatives utilizing an exclusive human-milk diet and daily probiotic supplementation were associated with a decreased incidence of NEC in infants with a birth weight of 1000-1499 g. Implementation of the NEC reduction bundle did not affect infant growth. Keywords: human milk; necrotizing enterocolitis; premature infant; probiotics; quality improvement."

Abstract only: https://onlinelibrary.wiley.com/doi/abs/10.1002/ncp.10394

Quote of the Day

“It is important to note that most complex motor skills consist of sequences of movements (Diedrichsen & Kornysheva, 2015; Hikosaka, Nakamura, Sakai, & Nakahara, 2002; Willingham, 1998). To regain a lost motor skill (e.g., lost through a stroke) not only every single movement of this skill, but also its implementation as a sequence has to be relearned. The inseparable connection between learning motor skills and sequences makes the understanding of sequence learning important for clinical rehabilitation.”

Title: The importance of different learning stages for motor sequence learning after stroke.

In:  Human Brain Mapping 2020 Jan;41(1):270-286.  doi: 10.1002/hbm.24793. Epub 2019 Sep 14.

Authors:  Christiane Dahms, Stefan Brodoehl, Otto W. Witte, Carsten M. Klingner. 

Open access:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268039/

On Motor Sequence Learning

“It’s like the ABCs - - I have to start at the beginning of the song to remember the whole thing.”

— John Prine (1946-2020) speaking in 2019 on the challenges of remembering the lyrics to his many songs. Prine passed in 2020 from COVID-19.

When a baby has not yet learned the oral grasp of the nipple-areolar complex (the latch), or when a baby has not yet relearned how to latch, clinicians often recommend skin-to-skin contact ad lib, beginning with the infant held upright and against the chest, between the breasts. Providing the infant with this rich sensory milieu often facilitates the infant’s self-orchestrated, reflexive creeping movements from the mother’s upper chest down to the breast, i.e., starting at the beginning of the sequence. Infants will often move down to the breast in early hunger, even when held by another adult or an older sibling, and even when the infant is exclusively bottle-fed.

Supporting the infant in beginning the feeding sequence in this manner is often highly effective for healthy term infants, particularly in youngest infants during early learning at the breast. However, in assisting exclusively bottle-fed infants in a hoped-for transfer of learning from skilled bottle-feeding to the acquisition of breastfeeding skills, it is common to observe the older infant who moves in skin-to-skin contact on the chest and down to the breast, and who then struggles with the stimuli of the nipple-areolar complex.

Over the years, we eventually achieve an impressive repertoire of feeding and drinking skills, although we periodically display a performance plateau, a period of time during the learning process in which no overt changes in performance occur. The older baby often displays a preference for a particular style of sippee-cup for a period time, accepting one style of sippee-cup and refusing another style by turning away or pushing the novel object away. For weeks if not months, the older baby and toddler will display “utensil confusion” when learning how to differentiate the proper movements for fork-eating and spoon-eating, struggling to pierce the food with a spoon, as if the spoon is enough like the fork to readily use the spoon in the manner of a fork.

Following the infant’s learning experience with an artificial nipple (a pacifier/soother/dummy or a bottle nipple/teat), there is often a behavioral display by the infant of difficulty in returning to the breast. This breach in the sequencing of movements toward the breast can be measured in real time as a prolonged reaction time to the stimuli of the nipple-areolar complex; a prolonged movement time for achieving and sustaining the oral grasp of the nipple-areolar complex; a prolonged response time; as well as an inhibition of return — the delay in responding to the previously orienting stimulus/stimuli.

Sequencing in motor learning is heavily studied in the cognitive sciences. Included in the studies below is a sequencing study with stroke patients. I wish to emphasize that stroke patients who receive inpatient rehabilitation services typically receive both physical therapy and occupational therapy twice daily in morning and afternoon sessions, as well as daily speech therapy. Stroke patients and patients with traumatic brain injuries (TBIs) receive skilled guidance in relearning how to speak, guidance in how to feed themselves with utensils and swallow carefully without aspirating, and guidance in relearning how to ambulate after a lifetime of skilled performance of these skills.

Health insurance companies are expected to cover the medical expenses of daily physical therapy, daily occupational therapy, and daily speech therapy toward a patient’s recovery of function. In contrast, a number of health insurance companies in the U.S. do not readily cover the fees for educated and trained infant feeding specialists such as IBCLCs who are assisting infants in learning the oral grasp of the nipple-areolar complex, as well as learning effective sucking skills for adequate milk transfer toward adequate and optimal growth. The Patient Protection and Affordable Care Act was signed into law in 2010. Why does this marked disparity in reimbursement continue to exist among various patient populations in the U.S.?

Some new studies in sequence learning:

Title: Sequence learning in the human brain: A functional neuroanatomical meta-analysis of serial reaction time studies.

In: Neuroimage 2020 Feb 15;207:116387. doi: 10.1016/j.neuroimage.2019.116387. Epub 2019 Nov 22.

Authors: Karolina Janacsek, Kyle F. Shattuck, Kaitlyn M. Tagarelli, Jarrad A.G. Lum, Peter E. Turkeltaub, Michael T. Ullman.

Abstract: “Sequence learning underlies numerous motor, cognitive, and social skills. Previous models and empirical investigations of sequence learning in humans and non-human animals have implicated cortico-basal ganglia-cerebellar circuitry as well as other structures. To systematically examine the functional neuroanatomy of sequence learning in humans, we conducted a series of neuroanatomical meta-analyses. We focused on the serial reaction time (SRT) task. This task, which is the most widely used paradigm for probing sequence learning in humans, allows for the rigorous control of visual, motor, and other factors. Controlling for these factors (in sequence-random block contrasts), sequence learning yielded consistent activation only in the basal ganglia, across the striatum (anterior/mid caudate nucleus and putamen) and the globus pallidus. In contrast, when visual, motor, and other factors were not controlled for (in a global analysis with all sequence-baseline contrasts, not just sequence-random contrasts), premotor cortical and cerebellar activation were additionally observed. The study provides solid evidence that, at least as tested with the visuo-motor SRT task, sequence learning in humans relies on the basal ganglia, whereas cerebellar and premotor regions appear to contribute to aspects of the task not related to sequence learning itself. The findings have both basic research and translational implications. Keywords: Basal ganglia; Implicit learning; Procedural memory; Sequence learning; Serial reaction time (SRT) task; Striatum.”

Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268039/

Title: The posterior parietal cortex mediates early offline-rather than online-motor sequence learning.

In: Neuropsychologica 2020 Jul 9;107555. doi: 10.1016/j.neuropsychologia.2020.107555. Online ahead of print.

Authors: Bettina Pollok, Ariane Keitel, Maike Foerster, Geraldine Moshiri, Katharina Otto, Vanessa Krause.

Abstract: “Learning of new motor skills occurs particularly during training on a task (i.e. online) but has been observed between training-blocks lasting up to days after the end of the training (i.e. offline). Offline-learning occurs as further improvement in task performance indicated by increased accuracy and/or faster responses as well as less interference with respect to a distracting condition. Successful motor learning requires the functional interplay between cortical as well as subcortical brain areas. While the involvement of the primary motor cortex in online-as well as early offline-learning is well established, the functional significance of the posterior parietal cortex (PPC) is less clear. Since the PPC may act as sensory-motor interface, a causal involvement in motor learning is conceivable. In order to characterize the functional significance of the left PPC for motor sequence learning, transcranial direct current stimulation (tDCS) was applied either immediately prior to, during or immediately after training on a serial reaction time task (SRTT) in a total of 54 healthy volunteers. While the analysis did not provide evidence for a significant modulation of reaction times during SRTT training (i.e. online-learning), cathodal tDCS decelerated reaction times of the learned sequences as compared to anodal and sham stimulation 30 min after the end of training. The findings suggest that cathodal tDCS over the left parietal cortex interferes with the reproduction of learned sequences.”

Abstract only: https://www.sciencedirect.com/science/article/abs/pii/S0028393220302281?via%3Dihub

Title: The importance of different learning stages for motor sequence learning after stroke.

In: Human Brain Mapping 2020 Jan;41(1):270-286. doi: 10.1002/hbm.24793. Epub 2019 Sep 14.

Authors: Christiane Dahms, Stefan Brodoehl, Otto W. Witte, Carsten M. Klingner.

Abstract: “The task of learning predefined sequences of interrelated motor actions is of everyday importance and has also strong clinical importance for regaining motor function after brain lesions. A solid understanding of sequence learning in stroke patients can help clinicians to optimize and individualize rehabilitation strategies. Moreover, to investigate the impact of a focal lesion on the ability to successfully perform motor sequence learning can enhance our comprehension of the underlying physiological principles of motor sequence learning. In this article, we will first provide an overview of current concepts related to motor sequence learning in healthy subjects with focus on the involved brain areas and their assumed functions according to the temporal stage model. Subsequently, we will consider the question of what we can learn from studies investigating motor sequence learning in stroke patients. We will first focus on the implications of lesion location. Then, we will analyze whether distinct lesion locations affect specific learning stages. Finally, we will discuss the implications for clinical rehabilitation and suggest directions for further research. Keywords: motor cortex, motor rehabilitation, plasticity, sequence learning, stroke.”

Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268039/pdf/HBM-41-270.pdf

New Studies

Title: Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial.

In: Journal of Advanced Nursing 2020 Mar;76(3):888-902. doi: 10.1111/jan.14274.

Authors: Cristina Franco-Antonio, Julián F Calderón-García, Esperanza Santano-Mogena, Sergio Rico-Martín, Sergio Cordovilla-Guardia.

Abstract: "Aims: To evaluate the effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum in mothers who began breastfeeding in the first hour after birth and to explore the role of general and breastfeeding self-efficacy in this relationship. Design: A multi-centre randomized controlled clinical trial. Methods: Data were collected from February 2018 - March 2019. Women were randomly assigned to an intervention group that received a brief motivational intervention (N = 44) or a control group that was offered standard education on breastfeeding (N = 44). Survival analysis techniques were carried out with a follow-up of 6 months. In addition, the roles of breastfeeding and general self-efficacy in the association between BMI and breastfeeding duration were explored through mediation/moderation analysis. Results: Among 88 randomized patients (mean age, 32.82 years), 81 (92.04%) completed the trial. The survival analyses of exclusive breastfeeding and breastfeeding (exclusive and non-exclusive) showed reductions in the risk of abandonment in the intervention group of 63% (aHR: 0.37 [0.22-0.60] p < .001) and 61% (aHR: 0.39 [0.20-0.78] p = .008), respectively. We found that self-efficacy acted as a moderator of the effect of brief motivational intervention on breastfeeding self-efficacy. A discrete indirect effect of brief motivational intervention through increased breastfeeding self-efficacy was found on breastfeeding duration, with an index of moderated mediation of 0.08 (95% CI: 0.02-0.19). Greater positive variations in the breastfeeding self-efficacy scores during follow-up predicted exclusive and non-exclusive breastfeeding duration. Conclusion: A brief motivational intervention conducted in the immediate postpartum period increases breastfeeding and exclusive breastfeeding duration in the first 6 months. Although breastfeeding self-efficacy seems to moderate the effect of brief motivational intervention on the increase in breastfeeding duration, other factors may influence its effectiveness. Further studies could focus on exploring how brief motivational intervention works and whether it also works for pregnant mothers who have not yet decided whether to breastfeed. Impact: Brief motivational intervention could be introduced as part of routine care of women who begin breastfeeding to improve the low rates of exclusive breastfeeding at 6 months postpartum."

Full text: https://onlinelibrary.wiley.com/doi/full/10.1111/jan.14274

Title: Duration of breastfeeding and maternal-related factors in Iran, systematic review and meta-analysis.

In: Journal of Pediatric Nursing 2020 Jun 15;S0882-5963(19)30667-0. doi: 10.1016/j.pedn.2020.04.011.

Authors: Hosein Dalili, Mamak Shariat, Fatemeh Nayeri, Zahra Emami, Roya Sahebi, Leyla Sahebi.

Abstract: "Background: Although the benefits of breastfeeding are commonly approved, there remains a significant discrepancy between maternal practices and World Health Organization (WHO) guidelines in some countries. Objectives: We had two aims in this study; average duration of breastfeeding, and its maternal determinants. Data sources: A web-based citation index was used for citing documents. Study eligibility criteria and participants: We included observational studies evaluating breastfeeding duration among children who were at least two years old and not older than five were included in Iran. Synthesis methods: The pooled mean and mean differences were considered. Heterogeneity was evaluated with the I2 statistic. Results: The pooled mean of breastfeeding duration was calculated at 17.31 months. Children with younger mothers and lower birth orders had shorter durations of breastfeeding. Women with a high school and higher education level had early cessation of breastfeeding in comparison with less educated women. Limitations: The main limitation of the current study was lack of librarian assistance. Conclusions: The pooled mean of breastfeeding duration in Iranian children aged 2-5 was less than WHO recommendations. Accurate identification of the effect a mother's level of education has on duration of lactation requires standardized categorization. Implications of key findings: Raising awareness among women can be an effective strategy in increasing the duration of lactation."

Abstract only: https://pubmed.ncbi.nlm.nih.gov/32553476/

Title: Breastfeeding Duration Is Associated With WIC Site-Level Breastfeeding Support Practices.

In: Journal of Nutrition Education and Behavior 2020 Jul;52(7):680-687. doi: 10.1016/j.jneb.2020.01.014. Epub 2020 Mar 11.

Authors: Stacy Gleason, Margaret K Wilkin, Linnea Sallack, Shannon E Whaley, Catherine Martinez, Courtney Paolicelli.

Abstract: "Objective: To describe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) site-level breastfeeding support practices and associations with breastfeeding outcomes. Design: Secondary analysis of WIC Infant and Toddler Feeding Practices Study-2, including data from interviews with caregivers of infants and interviews and surveys with staff from 27 WIC state agencies and 80 study sites. Participants: A total of 1,235 mothers of breastfed infants participating in the WIC Infant and Toddler Feeding Practices Study-2. Main outcome measure: Any and fully breastfeeding 2, 6, and 12 months postpartum. Analysis: Descriptive statistics described WIC site-level breastfeeding supports. Multilevel mixed modeling of breastfeeding at 2, 6, and 12 months, controlling for site- and participant-level characteristics. Results: Five WIC site-level supports were significantly and independently associated with any and fully breastfeeding: access to breastfeeding peer counselors, access to International Board Certified Lactation Consultants, postnatal home visits, allowing any WIC staff member to provide breast pump education, and having a policy not to provide formula during the first 30 days postpartum. Likelihood of any and fully breastfeeding increased with each additional site-level support present (odds ratio = 1.09, 95% confidence interval, 1.06-1.12; and odds ratio = 1.26, 95% confidence interval, 1.21-1.31, respectively). Conclusions and implications: Positive associations between site-level supports and breastfeeding at 2, 6, and 12 months were observed. Additional research is needed to understand how site-level supports interrelate and whether specific combinations are more effective, and to identify variations in implementation of breastfeeding supports."

Abstract only: https://pubmed.ncbi.nlm.nih.gov/32171671/

New Papers: COVID-19, Fungal Species in Human Milk, Exercise-Induced 3′-Sialyllactose in Human Milk, and More

Title: Maternal transmission of SARS‐COV‐2 to the neonate, and possible routes for such transmission: A systematic review and critical analysis.

In: British Journal of Obstetrics and Gynecology 12 June 2020. https://doi.org/10.1111/1471-0528.16362

Authors: Kate F Walker, Keelin O’Donoghue, Nicky Grace, Jon Dorling, Jeannette L Comeau, Wentao Li, Jim G Thornton.

Abstract: "Background: Early reports of COVID‐19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding, is this practise justified? Objective: To estimate the risk of the neonate becoming infected with SARS‐COV‐2 by mode of delivery, type of infant feeding and mother‐infant interaction. Search Strategy: Two biomedical databases were searched between September 2019 ‐ June 2020. Selection Criteria: Case reports or case series of pregnant women with confirmed COVID‐19, where neonatal outcomes were reported. Data Collection and Analysis: Data was extracted on mode of delivery, infant infection status, infant feeding and mother‐infant interaction. For reported infant infection a critical analysis was performed to evaluate the likelihood of vertical transmission. Main Results: We included 49 studies which included 666 neonates and 655 women where information was provided on the mode of delivery and the infant’s infection status. 28/666 (4%) neonates had confirmed COVID‐19 infection postnatally. Of the 291 women who delivered vaginally, 8/292 (2.7%) neonates were positive. Of the 364 women who had a Caesarean birth, 20/374 (5.3%) neonates were positive. Of the 28 neonates with confirmed COVID‐19 infection, 7 were breast fed, 3 formula fed, 1 was given expressed breast milk and in 17 neonates the method of infant feeding was not reported. Conclusions: Neonatal COVID‐19 infection is uncommon, uncommonly symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or allowed contact with the mother."

ScienceDaily news release: https://www.sciencedaily.com/releases/2020/06/200615140859.htm

Open access: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.16362

Title: Exclusive breastfeeding can attenuate body-mass-index increase among genetically susceptible children: A longitudinal study from the ALSPAC cohort.

In: PLOS Genetics June 11, 2020. https://doi.org/10.1371/journal.pgen.1008790 Authors: Yanyan Wu, Stephen Lye, Cindy-Lee Dennis, Laurent Briollais.

Abstract: "Poor maternal environments, such as under- or overnutrition, can increase the risk for the development of obesity, type 2 diabetes and cardiovascular disease in offspring. Recent studies in animal models have shown that maternal exercise before and during pregnancy abolishes the age-related development of impaired glucose metabolism, decreased cardiovascular function and increased adiposity; however, the underlying mechanisms for maternal exercise to improve offspring’s health have not been identified. In the present study, we identify an exercise-induced increase in the oligosaccharide 3′-sialyllactose (3′-SL) in milk in humans and mice, and show that the beneficial effects of maternal exercise on mouse offspring’s metabolic health and cardiac function are mediated by 3′-SL. In global 3′-SL knockout mice (3′-SL−/−), maternal exercise training failed to improve offspring metabolic health or cardiac function in mice. There was no beneficial effect of maternal exercise on wild-type offspring who consumed milk from exercise-trained 3′-SL−/− dams, whereas supplementing 3′-SL during lactation to wild-type mice improved metabolic health and cardiac function in offspring during adulthood. Importantly, supplementation of 3′-SL negated the detrimental effects of a high-fat diet on body composition and metabolism. The present study reveals a critical role for the oligosaccharide 3′-SL in milk to mediate the effects of maternal exercise on offspring’s health. 3′-SL supplementation is a potential therapeutic approach to combat the development of obesity, type 2 diabetes and cardiovascular disease."

ScienceDaily press release: https://www.sciencedaily.com/releases/2020/06/200611152438.htm

Open access: https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1008790

Title: Human milk mycobiota composition: relationship with gestational age, delivery mode, and birth weight.

In: Beneficial Microbes 2020 Mar 27;11(2):151-162. doi: 10.3920/BM2019.0158. Epub 2020 Jan 28.

Authors: M Dinleyici, V Pérez-Brocal, S Arslanoglu, O Aydemir, S Sevuk Ozumut, N Tekin, Y Vandenplas, A Moya, E C Dinleyici.

Abstract: "Intestinal and human milk microbiota studies during infancy have shown variations according to geographical location, delivery mode, gestational age, and mother-related factors during pregnancy. In this study, we performed metagenomic mycobiota analyses of 44 transient and mature human milk among five different groups: mothers of normal spontaneous delivery-term (NS-T), caesarean delivery-term (CS-T), premature (PT), small for gestational age (SGA), and large for gestational age (LGA) infants. Fungi were detected in 80 out of the 88 samples. Regarding the number of observed fungal species, the NS-T group was more homogeneous (less variable) comparing the other groups (P<0.05). In the transient human milk samples, the most abundant species were Saccharomyces cerevisiae (33.3%) and Aspergillus glaucus (27.4%). While A. glaucus (33.7%) was second most abundant species in mature milk, S. cerevisiae disappeared (P<0.01) and Penicillium rubens became the most abundant species (35.5%) (P<0.05). Among the NS-T group, the most abundant species was Malassezia globosa in both transient and mature milk. In contrast, S. cerevisiae was the most abundant species in transient human milk (45.0%) in the CS-T group, but it disappeared in mature milk (P<0.01). In transient milk, M. globosa was only represented 6.0-9.0% of taxa in the PT, SGA, and LGA groups (P<0.05). In transient and mature milk in the PT, SGA and LGA groups, the most abundant species were A. glaucus and P. rubens. In mature milk samples, P. rubens is more abundant in CS-T group, PT group and LGA group, than the NS-T groups (P<0.05 for all). Although fungi constitute only a very small part of the human milk microbiome, we observed some changes that the human milk mycobiota composition varies in caesarean delivery, premature, SGA and LGA groups, comparing the normal spontaneous delivery, as well as differences between transient and mature human milk. Keywords: human milk, microbiota, mycobiota, fungi, delivery mode, caesarean, prematurity"

Abstract only: https://www.wageningenacademic.com/doi/abs/10.3920/BM2019.0158

Title: Exercise-induced 3′-sialyllactose in breast milk is a critical mediator to improve metabolic health and cardiac function in mouse offspring [Debbie's note: both humans and mice were included in this study].

In: Nature Metabolism 29 June 2020. https://doi.org/10.1038/s42255-020-0223-8

Authors: Johan E. Harris, Kelsey M. Pinckard, Katherine R. Wright, Lisa A. Baer, Peter J. Arts, Eaman Abay, Vikram K. Shettigar, Adam C. Lehnig, Bianca Robertson, Kendra Madaris, Tyler J. Canova, Clark Sims, Laurie J. Goodyear, Aline Andres, Mark T. Ziolo, Lars Bode & Kristin I. Stanford.

Abstract: "Poor maternal environments, such as under- or overnutrition, can increase the risk for the development of obesity, type 2 diabetes and cardiovascular disease in offspring. Recent studies in animal models have shown that maternal exercise before and during pregnancy abolishes the age-related development of impaired glucose metabolism, decreased cardiovascular function and increased adiposity; however, the underlying mechanisms for maternal exercise to improve offspring’s health have not been identified. In the present study, we identify an exercise-induced increase in the oligosaccharide 3′-sialyllactose (3′-SL) in milk in humans and mice, and show that the beneficial effects of maternal exercise on mouse offspring’s metabolic health and cardiac function are mediated by 3′-SL. In global 3′-SL knockout mice (3′-SL−/−), maternal exercise training failed to improve offspring metabolic health or cardiac function in mice. There was no beneficial effect of maternal exercise on wild-type offspring who consumed milk from exercise-trained 3′-SL−/− dams, whereas supplementing 3′-SL during lactation to wild-type mice improved metabolic health and cardiac function in offspring during adulthood. Importantly, supplementation of 3′-SL negated the detrimental effects of a high-fat diet on body composition and metabolism. The present study reveals a critical role for the oligosaccharide 3′-SL in milk to mediate the effects of maternal exercise on offspring’s health. 3′-SL supplementation is a potential therapeutic approach to combat the development of obesity, type 2 diabetes and cardiovascular disease."

ScienceDaily news release: https://www.sciencedaily.com/releases/2020/06/200629120220.htm

Abstract only: https://www.nature.com/articles/s42255-020-0223-8

New Papers

Title: The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis.

In: Nutrients 2020 May 6;12(5):E1322. doi: 10.3390/nu12051322.

Authors: Emma Altobelli, Paolo Matteo Angeletti, Alberto Verrotti, Reimondo Petrocelli.

Abstract: "Background: Premature infants receiving breastfeed have a lower incidence of NEC than those fed preterm formula. This study aimed: (1) to update a systematic review and meta-analyses to evaluate the relationship between feeding and necrotizing enterocolitis (NEC) in low weight premature infants; (2) to conduct meta-regression analyses by subgroups; (3) to describe geographical distribution of milk banks in the world. Methods: Papers included in the meta-analysis were updated as of June 2019. Relative risks were used as a measure of effect size. Random effect models were used to account for different sources of variation among studies. For milk banks, the data reviewed by the literature were integrated with the information collected from countries' institutional sites and milk bank networks. Results: Thirty-two papers were included in meta-analysis: six randomized controlled trials (RCTs) and 26 observational studies (OS). The census has found 572 milk banks around in the world. Brazil has the most active milk banks. RCTs meta-analysis indicates a risk reduction of NEC using human milk respect to formula: Relative risk (RR) = 0.62 (0.42-0.93). Seven OS compared quantities lower than human milk or higher than the 50th quantile showing a risk reduction of NEC:RR = 0.51 (0.31-0.85); 3 OS that evaluated human milk versus mixed feeding showing that human milk has a protective role on the development of NEC:RR = 0.74 (0.63-0.91). Results of subgroups analysis show that the risk reduction is statistically significant only for studies in which premature infants are given both their own and donated breastmilk. Conclusions: The possibility of preserving human milk and promoting donations guarantees an improvement in the health of newborns."

Open access: https://www.mdpi.com/2072-6643/12/5/1322

Title: Effect on splanchnic oxygenation of breast milk, fortified breast milk, and formula milk in preterm infants.

In: Pediatric Research 2020 May 7.

Authors: Carlo Dani, Caterina Coviello, Simona Montano, Giulia Remaschi, Chiara Petrolini, Chiara Strozzi, Elena Maggiora, Miriam Sabatini & Diego Gazzolo.

Abstract: "Enteral feeding induces mesenteric hemodynamic changes in preterm infants, which may vary according to the milk used. Our aim in this study was to evaluate changes of splanchnic regional oxygenation (rSO2S) measured by near-infrared spectroscopy (NIRS) in infants fed with mother’s own milk (MOM), fortified human milk (FHM), or preterm formula (PTF). Methods: Infants born at 25–31 weeks of gestational age (n = 54) received a bolus of MOM, FHM, or PTF. rSO2S and splanchnic fractional oxygen extraction ratio (FOES) were recorded 60 min before (T0), and 30 min (T1) and 120 min (T2) after the beginning of bolus feeding. Results: In the MOM group, rSO2S and FOES did not change during the study period. In the FBM group, rSO2S decreased from T0 to T1 and increased from T1 to T2, while FOES changed in reverse. In the PTF group, rSO2S decreased from T0 to T1 and from T1 to T2, while FOES changed in reverse. Conclusions: Splanchnic oxygenation was not affected by MOM feeding, was transiently decreased by FBM feeding, and was persistently decreased by PTF. These results suggest that preterm infants who received PTF have higher splanchnic tissue oxygen extraction compared to those who received MOM or FBM. Impact: Human milk feeding is associated with a lower splanchnic energy expenditure than preterm formula feeding. Fortified human milk transiently increases splanchnic energy expenditure. Preterm formula should be used only in the absence of human milk."

Abstract only: https://doi.org/10.1038/s41390-020-0935-14

Title: The Protective Effects of 2'-Fucosyllactose Against E. Coli O157 Infection Are Mediated by the Regulation of Gut Microbiota and the Inhibition of Pathogen Adhesion.

In: Nutrients 2020 May 1;12(5). pii: E1284. doi: 10.3390/nu12051284.

Authors: Yuanyifei Wang, Yan Zou, Jin Wang, Hui Ma, Bowei Zhang, Shuo Wang.

Abstract: "As the richest component in human milk oligosaccharides (HMOs), 2'-fucosyllactose (2'-FL) can reduce the colonization of harmful microbiota in vivo, thus lowering the risk of infection; however, the mechanism for this is still unclear. In this study, a model of Escherichia coli O157 infection in healthy adult mice was established to explore the effect of 2'-FL intervention on E. coli O157 colonization and its protective effects on mice. The results showed that 2'-FL intake reduced E. coli O157 colonization in mice intestine by more than 90% (p < 0.001), and it also reduced intestinal inflammation, increased the content of fecal short-chain fatty acids, and enhanced intestinal barrier function. These beneficial effects were attributed to the increased expression of mucins such as MUC2 (increased by more than 20%, p < 0.001), and inhibition of E. coli O157 cell adhesion (about 30% reduction, p < 0.001), and were associated with the modulation of gut microbiota composition. 2'-FL significantly increased the abundance of Akkermansia, a potential probiotic, which may represent the fundamental means by which 2'-FL enhances the expression of mucin and reduces the colonization of harmful bacteria. The current study may support the use of 2'-FL in the prevention of foodborne pathogen infections in humans."

Open access: https://www.mdpi.com/2072-6643/12/5/1284

New Studies & More

Two new studies, a review article, and a hypothesis & theory paper:

Title: Clinical and Sociodemographic Factors Associated With Human Donor Milk Supplementation in Term Newborns.

In: Hospital Pediatrics 2020 May 1. pii: hpeds.2019-0259. doi: 10.1542/hpeds.2019-0259. [Epub ahead of print]

Authors: McKittrick MM, Khaki S, Gievers L, Larson IA.

Abstract: "OBJECTIVES: To identify differences between healthy term newborns supplemented with human donor milk (HDM) and those supplemented with infant formula. We hypothesized that sociodemographic and clinical distinctions exist between newborns receiving different milk types. METHODS: This retrospective study included term newborns admitted to the postpartum unit between March 2017 and April 2019 with ≥1 supplemental feeding with HDM or formula for indications other than hypoglycemia. Maternal and newborn data were abstracted from the electronic medical record. RESULTS: Five hundred eighty-four dyads met inclusion criteria. More newborns received supplementation with formula than with HDM (57.7% vs 42.3%; P < .001). Infants undergoing phototherapy who required supplementation were more likely to receive HDM (P < .001). Newborns born to white and non-Hispanic mothers were more likely to receive HDM than those born to African American (adjusted odds ratio [aOR] 5.6; P = .007), Hispanic (aOR 3.0; P = .001), or Asian American mothers (aOR 2.7; P = .007). Newborns born to primiparous women (aOR 1.6; P = .03), those born to women with private insurance (aOR 3.7; P < .001), and those born via cesarean delivery (aOR 2.0; P < .001) were more likely to receive HDM. HDM use was more likely in primary English- or Spanish-speaking households (aOR 8.5; P = .009). Newborns receiving their first supplemental feeding during the day (aOR 1.9; P = .001) were more likely to be supplemented with HDM. CONCLUSIONS: There are clinical and sociodemographic differences between healthy term newborns supplemented with HDM and formula. These findings reveal that there are disparities in current supplementation practices for healthy newborns."

Abstract only: https://hosppeds.aappublications.org/content/early/2020/04/29/hpeds.2019-0259.long

Title: Levels of Octachlorostyrene in Mothers' Milk and Potential Exposure Among Infants in Sendai City, Japan 2012.

In: International Journal of Environmental Research and Public Health 2020 Apr 28;17(9). pii: E3064. doi: 10.3390/ijerph17093064.

Authors: Soleman SR, Fujitani T, Fujii Y, Harada KH.

Abstract: "Persistent organic pollutants can accumulate inside the human body, including in mothers' milk, which may affect infant development. This cross-sectional study aimed to examine selected persistent organic pollutants in the milk of 100 mothers in Sendai city, Miyagi Prefecture, Japan. We used gas-chromatography-electron capture negative chemical ionization-mass spectrometry to check for octachlorostyrene, dechlorane (Dec) plus, Dec 602, Dec 603, and Dec 604. Octachlorostyrene was detected in 86 samples at more than the method detection limit (84 pg g-lipid-1) but no dechloranes were above the method detection limit (1 ng mL-1 for dechlorane plus, Dec 602, and Dec 603; 20 ng mL-1 for Dec 604). The mean octachlorostyrene concentration was 461&nbsp;pg&nbsp;g-lipid-1, the median was 337 pg g-lipid-1, and the standard deviation 450 pg g-lipid-1. No baseline characteristics were associated with octachlorostyrene level except for mother's occupation (stay-at-home mother, 353 ± 327 pg g-lipid-1; others, 531 ± 509 pg g-lipid-1). Octachlorostyrene was also significantly negatively correlated with lipid content (r = -0.35, p = 0.0004). However, the maximum intake of octachlorostyrene among infants in this study (3.5 ng/kg/day) was under the acceptable daily intake (30 ng/kg/day, derived from 12-month study in rats), and is therefore unlikely to pose a health risk."

Open access: https://www.mdpi.com/1660-4601/17/9/3064

Title: α-L-Fucosidases and their applications for the production of fucosylated human milk oligosaccharides.

In: Applied Microbiology and Biotechnology 2020 May 1. doi: 10.1007/s00253-020-10635-7. [Epub ahead of print]

Authors: Li Wan, Yingying Zhu, Wenli Zhang & Wanmeng Mu.

Abstract: "α-L-Fucosidases (EC 3.2.1.51), catalyzing the hydrolysis of fucosides and/or the transfer of fucosyl residue, have been characterized and modified into a trans-fucosylation mode or, further, engineered to function as “fucosynthase”, which can be employed for the enzymatic synthesis of bioactive glycans, including fucosylated human milk oligosaccharides (HMOs). More than half of HMOs are fucosylated and have attracted ever-increasing interest because of their excellent physiological functions on breast-fed infants. To date, the characterization of novel fucosidases and molecular modification of these enzymes have been extensively studied to efficiently synthesize valuable fucosylated compounds. Herein, we discuss the advantages and challenges of different strategies for the production of HMOs and compare various donor/acceptor substrates used for the synthesis of fucosylated HMOs and their biomimetics. The implementation of trans-fucosylation patterns investigated in this paper via well-designed fucosidase mutants and proper reaction conditions may lead to development of an excellent platform, serving both fundamental studies and industrial-scale processes, for valuable carbohydrates synthesis. Key Points: • Highlights different approaches for the production of human milk oligosaccharides. • Summarizes α-L-fucosidases and their mutants in enzymatic synthesis of fucosylated human milk oligosaccharides and the biomimetics. • Concludes future perspectives on methods for improving fucosylated compounds synthesis.

Abstract only: https://link.springer.com/article/10.1007/s00253-020-10635-7

Title: Integrating the Ecosystem Services Framework to Define Dysbiosis of the Breastfed Infant Gut: The Role of B. infantis and Human Milk Oligosaccharides.

In: Frontiers in Nutrition 2020 Apr 14;7:33. doi: 10.3389/fnut.2020.00033. eCollection 2020.

Authors: Duar RM, Henrick BM, Casaburi G, Frese SA.

Abstract: "Mounting evidence supports a connection between the composition of the infant gut microbiome and long-term health. In fact, aberrant microbiome compositions during key developmental windows in early life are associated with increased disease risk; therefore, making pertinent modifications to the microbiome during infancy offers significant promise to improve human health. There is growing support for integrating the concept of ecosystem services (the provision of benefits from ecosystems to humans) in linking specific microbiome functions to human well-being. This framework is widely applied in conservation efforts of macro-ecosystems and offers a systematic approach to guide restoration actions aimed to recover critical ecological functions. The aim of this work is to apply the ecosystem services framework to integrate recent studies demonstrating stable alteration of the gut microbiome of breastfed infants when Bifidobacterium longum subsp. infantis EVC001, a gut symbiont capable of efficiently utilizing human milk oligosaccharides into organic acids that are beneficial for the infant and lower intestinal pH, is reintroduced. Additionally, using examples from the literature we illustrate how the absence of B. infantis results in diminished ecosystem services, which may be associated with health consequences related to immune and metabolic disorders. Finally, we propose a model by which infant gut dysbiosis can be defined as a reduction in ecosystem services supplied to the host by the gut microbiome rather than merely changes in diversity or taxonomic composition. Given the increased interest in targeted microbiome modification therapies to decrease acute and chronic disease risk, the model presented here provides a framework to assess the effectiveness of such strategies from a host-centered perspective."

Open access: https://www.frontiersin.org/articles/10.3389/fnut.2020.00033/full

New Studies

Title: No long‐term effect of oral stimulation on the intra‐oral vacuum in healthy premature infants.

In: Acta Paediatrica 2020 Apr 7. doi: 10.1111/apa.15289. [Epub ahead of print]

Authors: Skaaning D, Kronborg H, Brødsgaard A, Solmer R, Pryds O, Carlsen EM.

Abstract: "AIM: Exclusive breastfeeding is recommended for the first 6 months of life, but the breastfeeding rate in premature infants is low. We examined the effect of oral stimulation on infant's strength of suction and the relation between this intra-oral vacuum and breastfeeding duration. METHOD: Between 2016 and 2018, 211 infants in a Danish neonatal unit were randomised 1:1 and of these 108 to oral stimulation intervention and 103 to control. Suction was measured as peak vacuum at enrolment and a corrected age of 6 weeks. Breastfeeding duration was registered. RESULTS: Vacuum increased from enrolment to a corrected age of 6 weeks in all infants, and no effect of oral stimulation intervention was demonstrated P = .08. Infants born ≤32 gestational weeks had lower vacuum compared with infants born after, 350 vs 398 mbar P < .001. For infants born after 32 gestational weeks, the odds ratio for exclusive breastfeeding at 6 months was 1.99 per 100 mbar increase in vacuum P = .01. CONCLUSION: In our study, infant's intra-oral vacuum increased with age and was not affected by the oral stimulation intervention. For infants born after 32 gestational weeks, the exclusive breastfeeding rate was positively associated with a strong vacuum."

Abstract only: https://onlinelibrary.wiley.com/doi/abs/10.1111/apa.15289

Title: Association Between Breastfeeding and Ovarian Cancer Risk.

In: JAMA Oncology 2020 Apr 2:e200421. doi: 10.1001/jamaoncol.2020.0421. [Epub ahead of print]

Authors: Babic A, Sasamoto N, Rosner BA, Tworoger SS, Jordan SJ, Risch HA, Harris HR, Rossing MA, Doherty JA, Fortner RT, Chang-Claude J, Goodman MT, Thompson PJ, Moysich KB, Ness RB, Kjaer SK, Jensen A, Schildkraut JM, Titus LJ, Cramer DW, Bandera EV, Qin B, Sieh W, McGuire V, Sutphen R, Pearce CL, Wu AH, Pike M, Webb PM, Modugno F, Terry KL.

Abstract: "Importance: Breastfeeding has been associated with a reduced risk of epithelial ovarian cancer in multiple studies, but others showed no association. Whether risk reduction extends beyond that provided by pregnancy alone or differs by histotype is unclear. Furthermore, the observed associations between duration and timing of breastfeeding with ovarian cancer risk have been inconsistent. Objective: To determine the association between breastfeeding (ie, ever/never, duration, timing) and ovarian cancer risk overall and by histotype. Design, Setting, and Participants: A pooled analysis of parous women with ovarian cancer and controls from 13 case-control studies participating in the Ovarian Cancer Association Consortium was performed. Odds ratios (ORs) and 95% CIs of the overall association were calculated using multivariable logistic regression and polytomous logistic regression for histotype-specific associations. All data were collected from individual sites from November 1989 to December 2009, and analysis took place from September 2017 to July 2019. Exposures: Data on breastfeeding history, including duration per child breastfed, age at first and last breastfeeding, and years since last breastfeeding were collected by questionnaire or interview and was harmonized across studies. Main Outcomes and Measures Diagnosis of epithelial ovarian cancer. Results: A total of 9973 women with ovarian cancer (mean [SD] age, 57.4 [11.1] years) and 13 843 controls (mean [SD] age, 56.4 [11.7] years) were included. Breastfeeding was associated with a 24% lower risk of invasive ovarian cancer (odds ratio [OR], 0.76; 95% CI, 0.71-0.80). Independent of parity, ever having breastfed was associated with reduction in risk of all invasive ovarian cancers, particularly high-grade serous and endometrioid cancers. For a single breastfeeding episode, mean breastfeeding duration of 1 to 3 months was associated with 18% lower risk (OR, 0.82; 95% CI, 0.76-0.88), and breastfeeding for 12 or more months was associated with a 34% lower risk (OR, 0.66; 95% CI, 0.58-0.75). More recent breastfeeding was associated with a reduction in risk (OR, 0.56; 95% CI, 0.47-0.66 for <10 years) that persisted for decades (OR, 0.83; 95% CI, 0.77-0.90 for ≥30 years; P for trend = .02). Conclusions and Relevance: Breastfeeding is associated with a significant decrease in risk of ovarian cancer overall and for the high-grade serous subtype, the most lethal type of ovarian cancer. The findings suggest that breastfeeding is a potentially modifiable factor that may lower risk of ovarian cancer independent of pregnancy alone."

Abstract only: https://jamanetwork.com/journals/jamaoncology/article-abstract/2763398

Title: Longer shared parental leave is associated with longer duration of breastfeeding: a cross-sectional study among Swedish mothers and their partners.

In: BMC Pediatrics 2020 Apr 14;20(1):159. doi: 10.1186/s12887-020-02065-1.

Authors: Grandahl M, Stern J, Funkquist EL.

Abstract: "Background: Breastfeeding is associated with health benefits for both the mother and infant and is therefore important to support; moreover, parental leave is a beneficial factor for breastfeeding. The Swedish parental leave is generous, allowing each parent to take 90 days; additionally, a further 300 days can be taken by either parent. Generally, mothers take 70% of the parental leave days, mainly during the first year. However, breastfeeding duration has declined in the last decade, and it is not known how shared parental leave is associated with the duration of breastfeeding. Aim: To investigate how parental leave is associated with the duration of exclusive and partial breastfeeding of the infant during the first 12 months after birth. An additional aim was to describe infants’ and parents’ characteristics and mode of birth in association with the duration of exclusive and partial breastfeeding. Methods: This cross-sectional study was part of the Swedish Pregnancy Planning Study, conducted in Sweden in 2012–2015. The parents were recruited at 153 antenatal clinics in nine counties. In total, 813 couples completed a follow-up questionnaire 1 year after birth. Linear regression models were used to analyse the association between parental leave and the duration of breastfeeding. Results: Infants were exclusively breastfed for, on average, 2.5 months (range 0–12 months) and partially breastfed, on average, 7 months (range 0–12 months). Most of the parental leave was taken by the mother (mean = 10.9 months) during the infant’s first 12 months, while the partner took 3 months, on average. The parental leave (used and planned) during the infant’s first 24 months were, on average, 21 months. In the multivariate linear regression analysis, mothers’ and partners’ high level of education (p < 0.001, p = 0.044, respectively), mothers’ higher age (p = 0.049), non-instrumental vaginal birth (p = 0.004) and longer parental leave for the first 24 months (p < 0.001) were associated with longer duration of partial breastfeeding. Conclusion: The duration of partial breastfeeding was associated with higher parental educational level, higher age, non-instrumental vaginal birth and longer parental leave."

Open access: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02065-1

Title: A detailed exploration of early infant milk feeding in a prospective birth cohort study in Ireland: combination feeding of breastmilk and infant formula and early breastfeeding cessation.

In: British Journal of Nutrition 2020 Apr 14:1-28. doi: 10.1017/S0007114520001324. [Epub ahead of print]

Authors: Hemmingway A, Fisher D, Berkery T, Dempsey E, Murray DM, Kiely ME.

Abstract: “Breastfeeding initiation and continuation rates in the United Kingdom and Ireland are low relative to many European countries. As a core outcome of the prospective COMBINE birth cohort study (Cork, Ireland), we aimed to describe infant milk feeding practices in detail and examine the prevalence and impact of combination feeding of breastmilk and infant formula on breastfeeding duration. COMBINE recruited 456 nulliparous mothers (2015-2017) for maternal-infant follow-up via interview at hospital discharge (median [IQR] 3 [2, 4] days, n=453), 1 (n=418), 2 (n=392), 4 (n=366), 6 (n=362) and 9 (n=345) months of age. Median (IQR) maternal age was 32 (29, 34) years, 97% of mothers were of white ethnicity, 79% were Irish-born and 75% were college educated. Overall, 75% breastfed to any extent at discharge and 44% breastfed solely. At 1, 2, 4, 6 and 9 months respectively, 40%, 36%, 33%, 24% and 19% breastfed solely. Combination feeding of breastmilk and infant formula was common at discharge (31%) and 1 month (20%). Reasons for combination feeding at 1 month included perceived/actual hunger (30%), healthcare professional advice (31%) and breastfeeding difficulties (13%). Of mothers who breastfed to any extent at discharge, 45% stopped within 4 months. Mothers who combination fed were more likely to cease breastfeeding than those who breastfed solely (relative risk 2.3 by 1 month and 12.0 by 2 months). These granular data provide valuable insight to early milk feeding practices and indicate that supporting early breastfeeding without formula use may be key to the successful continuation of breastfeeding.”

Full text of accepted manuscript: https://www.cambridge.org/core/services/aop-cambridge-re/content/view/187EE6966FDE01532C8F2326A2DFDADE/S0007114520001324a.pdf/detailed_exploration_of_early_infant_milk_feeding_in_a_prospective_birth_cohort_study_in_ireland_combination_feeding_of_breastmilk_and_infant_formula_and_early_breastfeeding_cessation.pdf

Title: Late weaning and maternal closeness, associated with advanced motor and visual maturation, reinforce autonomy in healthy, 2-year-old children.

In: Scientific Reports 2020 Mar 23;10(1):5251. doi: 10.1038/s41598-020-61917-z.

Authors: Villar J, Ochieng R, Staines-Urias E, Fernandes M, Ratcliff M, Purwar M, Barros F, Horta B, Cheikh Ismail L, Albernaz E, Kunnawar N, Temple S, Giuliani F, Sandells T, Carvalho M, Ohuma E, Jaffer Y, Alison Noble J, Gravett M, Pang R, Lambert A, Bertino E, Di Nicola P, Papageorghiou A, Stein A, Bhutta Z, Kennedy S.

Abstract: "We studied neurodevelopmental outcomes and behaviours in healthy 2-year old children (N = 1306) from Brazil, India, Italy, Kenya and the UK participating in the INTERGROWTH-21st Project. There was a positive independent relationship of duration of exclusive breastfeeding (EBF) and age at weaning with gross motor development, vision and autonomic physical activities, most evident if children were exclusively breastfed for ≥7 months or weaned at ≥7 months. There was no association with cognition, language or behaviour. Children exclusively breastfed from birth to <5 months or weaned at >6 months had, in a dose-effect pattern, adjusting for confounding factors, higher scores for "emotional reactivity". The positive effect of EBF and age at weaning on gross motor, running and climbing scores was strongest among children with the highest scores in maternal closeness proxy indicators. EBF, late weaning and maternal closeness, associated with advanced motor and vision maturation, independently influence autonomous behaviours in healthy children."

Open access: https://www.nature.com/articles/s41598-020-61917-z.pdf

Title: Satisfaction of mothers regarding human milk donation.

In: Archives de Pédiatrie 2020 Apr 10. pii: S0929-693X(20)30024-5. doi: 10.1016/j.arcped.2020.02.002. [Epub ahead of print]

Authors: 2020 Apr 8. pii: S0929-693X(20)30082-8. doi: 10.1016/j.arcped.2020.03.005. [Epub ahead of print]

Abstract: "In France, human milk banks are in charge of the collection, analysis, processing, and distribution of human milk to neonatology centers for preterm infants. Knowledge of what motivates mothers to donate their milk could lead to better communication regarding human milk donation. A satisfaction survey was conducted among mothers who were donating their milk to a human milk bank. In total, 214 mothers answered a questionnaire in the presence of the collector during a home visit. The median age of the mothers was 31 years (18–46), mainly high school (19%) or university (65%) graduates, and the median duration of donation was 3 months (0.5–22). At the time of the study, the median age of infants was 3 months (0.5–25), and 88% of infants were exclusively breastfed. About three quarters of mothers were motivated by willingness to help others, a quarter of them being especially sensitive to premature neonatal care; 30% of mothers were motivated by having a high supply of milk. Around 25% of mothers were given information on human milk donation during pregnancy, and two thirds after delivery, mainly by the maternity ward midwives (53.4%) or by collectors during their visit (14.1%). Most mothers (72%) found the human milk donation process easy and most of them (92.5%) were willing to donate their milk again after their next pregnancy. This survey shows that more than 90% of mothers are satisfied with donation to human milk banks. However, efforts should be made to provide information on breastfeeding and human milk donation to the general population and health professionals."

Abstract only: https://www.sciencedirect.com/science/article/pii/S0929693X20300828?via%3Dihub

500 Women Scientists

I found the following language from the "About Us" page of the 500 Women Scientists' website to be especially important and beautiful.

“500 Women Scientists is a grassroots organization started by four women who met in graduate school at CU Boulder and who maintained friendships and collaborations after jobs and life took them away from Boulder. Immediately following the November 2016 election, we published an open letter re-affirming our commitment to speak up for science and for marginalized communities in science. More than 20,000 women of STEM and supporters from more than 100 countries have signed in support of 500 Women Scientists, pledging to build an inclusive scientific community dedicated to training a more diverse group of future leaders in science and to use the language of science to bridge divides and enhance global diplomacy.

Since 2016, we have gathered our support network of women scientists and got to the work of confronting the threads of racism, misogyny, xenophobia, and anti-science rhetoric that were during the 2016 U.S. election. While our initial pledge still resonates today, we are not the same people who wrote that pledge in 2016. As we build 500 Women Scientists, we continue to evolve along the way. We continue to confront the shameful history of science being used to harm people - and the participation of the scientific community in this harm. We are still learning to use our voices to speak out against the injustices we see in science and in society. We are grappling with our privilege. We are learning that building a truly inclusive and intersectional movement is messy and painful but critically important. We are here to do the work and we welcome all individuals who support our mission to join us!

https://500womenscientists.org

New Studies

Some new studies, beginning with this study from Taiwan:

Title: The association of macronutrients in human milk with the growth of preterm infants.

In: PLoS One 2020 Mar 26;15(3):e0230800. doi: 10.1371/journal.pone.0230800. eCollection 2020.

Authors: Lin YH, Hsu YC, Lin MC, Chen CH, Wang TM.

Abstract: "BACKGROUND: Breast milk is the optimal choice for feeding premature babies. However, the prevalence rate of extrauterine growth restriction in preterm infants remains high. OBJECTIVES: The purpose of this study was to analyze the macronutrients present in human milk and the correlation with the growth of in-hospital preterm infants. METHODS: This prospective study is based on data from 99 in-hospital preterm infants younger than 37 weeks of gestational age on an exclusively human milk diet. Infants who had previously received parenteral nutrition were eligible, but they had to have reached full enteral feeding at the time that the samples were taken. A total of 3282 samples of raw human milk or donor pasteurized milk were collected. The levels of lactose, protein, fat, and energy in the samples were measured using a Miris human milk analyzer. The primary outcome was weight growth velocity (g/kg/day) which was obtained using two-point approach. RESULTS: The mean (±standard deviation) macronutrient composition per 100 mL of milk was 7.2 (±0.3) g of lactose, 1.1 (±0.2) g of true protein, 3.5 (±0.9) g of fat, and 66.9 (±6.5) kcal of energy. The protein concentration in human milk had a positive, significant correlation with body weight gain, with a coefficient of 0.41 (p < 0.001). After adjusting for gestational age, postmenstrual age, small-for-gestational age, intraventricular hemorrhage, patent ductus arteriosus or congestive heart failure, duration of total parenteral nutrition support, bottle feeding or use of orogastric tube, and ventilator support, total daily protein intake was associated with body weight growth (p < 0.001). CONCLUSION: Both the protein concentration in human milk and the daily total protein intake had a positive correlation with the body weight gain of premature infants. Routine analysis of breast milk and individualized fortification might be indicated to optimize the growth of preterm infants."

Open access: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230800

From China:

Title: Quantitative Phosphoproteomics of Milk Fat Globule Membrane (MFGM) in Human Colostrum and Mature Milk: New Insights into Changes in Protein Phosphorylation during Lactation.

In: Journal of Agricultural and Food Chemistry 2020 Mar 25. doi: 10.1021/acs.jafc.9b06850. [Epub ahead of print]

Authors: Yang M, Deng W, Cao X, Wang L, Yu N, Zheng Y, Wu J, Wu R, Yue X.

Abstract: "Phosphorylation is a widespread post-translational protein modification, important in various biological processes. However, milk fat globule membrane (MFGM) phosphoproteins have not been explored systematically in human milk. Here, we used quantitative phosphoproteomics to analyze phosphorylation sites in human MFGM proteins, and their differences at different stages of lactation; 305 phosphorylation sites on 170 proteins and 269 phosphorylation sites on 170 proteins were identified in colostrum and mature MFGM, respectively. Among these, 71 phosphorylation sites on 48 proteins were differentially expressed between the different stages of lactation. Osteopontin in human MFGM was the most heavily phosphorylated protein, with a total of 39 identified phosphorylation sites. Our results shed light on phosphorylation sites, composition, and biological functions of MFGM phosphoproteins in human colostrum and mature milk, and supply novel insights into the crucial roles of protein phosphorylation during infant development."

Abstract only: https://pubs.acs.org/doi/10.1021/acs.jafc.9b06850

From New Zealand:

Title: Utilization of galacto- and fructo-oligosaccharides for growth by co-cultures of bifidobacterial species characteristic of the infant gut.

In: Applied and Environmental Microbiology 2020 Mar 27. pii: AEM.00214-20. doi: 10.1128/AEM.00214-20. [Epub ahead of print]

Authors: Sims IM, Tannock GW. Abstract: "Bifidobacterial species are common inhabitants of the gut of human infants during the period when milk is a major component of the diet. Bifidobacterium breve, Bifidobacterium bifidum, Bifidobacterium longum subspecies longum, and B. longum subspecies infantis have been detected frequently in infant feces, but subsp. infantis may be disadvantaged numerically in the gut of infants in westernized countries. This may be due to the different durations of breast milk feeding in different countries. Supplementation of the infant diet or replacement of breast milk using formula feeds is common in western countries. Formula milks often contain galacto- and/or fructo-oligosaccharides ('GOS', 'FOS', respectively) as additives to augment the concentration of oligosaccharides in ruminant milks, but the ability of subsp. infantis to utilize these potential growth substrates when in competition with other bifidobacterial species is unknown. We compared the growth and oligosaccharide utilization of GOS and FOS by bifidobacterial species in pure and co-culture. Short chain GOS and FOS (degree of polymerization [DP] 2 and 3) were favored growth substrates for strains of B. bifidum and B. longum subsp. longum, whereas both B. breve and B. longum subsp. infantis had ability to utilize both short and longer chain GOS and FOS (DP 2-6). B. breve was nevertheless numerically dominant over subsp. infantis in co-cultures. This was probably related to the slower use of GOS of DP3 by subsp. infantis, indicating that the kinetics of substrate utilization is an important ecological factor in the assemblage of gut communities. Importance: The kinds of bacteria that form the collection of microbes (the microbiota) in the gut of human infants may influence health and well-being. Knowledge of how the composition of the infant diet influences the assemblage of the bacterial collection is therefore important because dietary interventions may offer opportunities to alter the microbiota with the aim of improving health. Bifidobacterium longum subspecies infantis is a well-known bacterial species, but under modern child-rearing conditions it may be disadvantaged in the gut. Modern formula milks often contain particular oligosaccharide additives that are generally considered to support bifidobacterial growth. However, studies of the ability of various bifidobacterial species to grow together while using these oligosaccharides have not been conducted. These kinds of studies are essential for developing concepts of microbial ecology related to the influence of human nutrition on the development of the gut microbiota."

Abstract only: https://aem.asm.org/content/early/2020/03/23/AEM.00214-20

From the U.S.:

Title: The human milk oligosaccharides 2'-fucosyllactose and 6'-sialyllactose protect against the development of necrotizing enterocolitis by inhibiting toll-like receptor 4 signaling.

In: Pediatric Research 2020 Mar 27. doi: 10.1038/s41390-020-0852-3. [Epub ahead of print]

Authors: Sodhi CP, Wipf P, Yamaguchi Y, Fulton WB, Kovler M, Niño DF, Zhou Q, Banfield E, Werts AD, Ladd MR, Buck RH, Goehring KC, Prindle T Jr, Wang S, Jia H, Lu P, Hackam DJ. Abstract: "BACKGROUND: Necrotizing enterocolitis (NEC) develops through exaggerated toll-like receptor 4 (TLR4) signaling in the intestinal epithelium. Breast milk is rich in non-digestible oligosaccharides and prevents NEC through unclear mechanisms. We now hypothesize that the human milk oligosaccharides 2'-fucosyllactose (2'-FL) and 6'-sialyllactose (6'-SL) can reduce NEC through inhibition of TLR4 signaling. METHODS: NEC was induced in newborn mice and premature piglets and infant formula was supplemented with 2'-FL, 6'-SL, or lactose. Intestinal tissue was obtained at surgical resection. HMO inhibition of TLR4 was assessed in IEC-6 enterocytes, mice, and human tissue explants and via in silico modeling. RESULTS: Supplementation of infant formula with either 2'-FL and/or 6'-SL, but not the parent sugar lactose, reduced NEC in mice and piglets via reduced apoptosis, inflammation, weight loss, and histological appearance. Mechanistically, both 2'-FL and 6'-SL, but not lactose, reduced TLR4-mediated nuclear factor kappa light-chain enhancer of activated B cells (NF-kB) inflammatory signaling in the mouse and human intestine. Strikingly, in silico modeling revealed 2'-FL and 6'-SL, but not lactose, to dock into the binding pocket of the TLR4-MD2 complex, explaining their ability to inhibit TLR4 signaling. CONCLUSIONS: 2'-FL and 6'-SL, but not lactose, prevent NEC in mice and piglet models and attenuate NEC inflammation in the human ileum, in part through TLR4 inhibition. IMPACT: Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in premature infants that occurs in the setting of bacterial colonization of the gut and administration of formula feeds and activation by the innate immune receptor toll-like receptor 4 (TLR4). Breast milk prevents NEC through unclear mechanisms. We now show that breast milk-enriched human milk oligosaccharides (HMOs) that are derived from lactose prevent NEC through inhibition of TLR4.The human milk oligosaccharides 2'-FL and 6'-SL, but not the backbone sugar lactose, prevent NEC in mice and piglets.2'-FL and 6'-SL but not lactose inhibited TLR4 signaling in cultured enterocytes, in enteroids derived from mouse intestine, and in human intestinal explants obtained at the time of surgical resection for patients with NEC.In seeking the mechanisms involved, 2'-FL and 6'-SL but not lactose were found to directly bind to TLR4, explaining the inhibition and protection against NEC.These findings may impact clinical practice by suggesting that administration of HMOs could serve as a preventive strategy for premature infants at risk for NEC development." Abstract only: https://www.nature.com/articles/s41390-020-0852-3

From Indonesia:

Title: Potency of Back Massage and Acupressure on Increasing of Prolactin Hormone Levels in Primipara Postpartum; Consideration for Midwifery Care.

In: Enfermeria Clinica 30 Suppl 2, 577-580 Mar 2020.

Authors: Anita N, Ahmad M, Usman AN, Sinrang AW, Alasiry E, Bahar B.

Abstract: “OBJECTIVE: The purpose of this study was to determine potency of back massage and acupressure in increasing prolactin hormone in primiparous postpartum mothers given back massage with acupressure. Hopefully back massage and acupressure can be considered to be practiced in midwifery care. METHODS: The subjects in this study consisted of 30 primipara first day postpartum mothers who had previously performed a pretest by taking blood samples as much as 3 ccs from peripheral veins to check prolactin hormone levels using the human Enzyme-Linked Immuno-Sorbet Assay (ELISA) Kit at the Hasanuddin University Research Laboratory Makassar, then respondents were asked to fill in the table self-report containing the frequency of breastfeeding in 24h for 3 days. The intervention was given in the form of back massage and acupressure therapy at points LU1, CV17, and SI1 on the body 1 time a day every morning with a duration of 30min for 3 consecutive days then blood was taken on day 4, namely the median cubital vein on the anterior arm to measure the level of the prolactin hormone using ELISA KIT and compared the prolactin hormone before and after the intervention. Data were processed using paired T-tests. RESULTS: The treatment of back massage and acupressure in primiparous postpartum mothers had a significant effect on increasing levels of the hormone prolactin. CONCLUSION: Back massage and acupressure therapy are able to increase levels of the hormone prolactin so that this therapy can be given to postpartum and breastfeeding mothers to [increase] breast milk production and can be considered practiced in midwifery care.”

Abstract only: https://www.elsevier.es/es-revista-enfermeria-clinica-35-articulo-potency-back-message-acupressure-on-S1130862119305625

Coronavirus 2019 (COVID-19) Information Resources

ILCA's Resource Page for Skilled Lactation Providers on COVID-19: https://ilca.org/covid-19/

The Academy of Breastfeeding Medicine's Statement on Coronavirus 2019 (COVID-19): https://www.bfmed.org/abm-statement-coronavirus

La Leche League International's current sheet on Coronavirus & Breastfeeding: https://lllusa.org/wp-content/uploads/2020/03/Coronavirus-sheet.pdf

The United States Lactation Consultant Association also provides information resources on COVID-19: https://uslca.org/covid19-breastfeeding

New Studies

Using lay terminology in our patient teaching, we often discuss the cognitive need for task-specific practice (practice specificity, or practice that is specific to the task) while infants are engaged in sensory-perceptual-motor learning toward motor control in the acquisition of breastfeeding skills. Motor skill acquisition has long been studied in the cognitive sciences, as well as specificity in the acquisition of language and other forms of learning.

The ambiguity of language is a controversial topic in our field in regard to the similar-sounding but different credentials held by those who provide support for infant feeding on any level. The 2018 change in UNICEF/WHO's Ten Steps to Successful Breastfeeding was a controversial change in regard to the less clear language currently found in Step 9, versus the precise language used in Step 9 from the inception of the Ten Steps in 1986 until the change in Step 9's language in early 2018.

This first study examined the ambiguous use of the term "human milk fortifier", finding "a need for more specific language and clearer communication."

Title: Parent and Provider Perspectives on the Imprecise Label of "Human Milk Fortifier" in the NICU.

In: Nutrients 2020 Mar 9;12(3). pii: E720. doi: 10.3390/nu12030720.

Authors: Canvasser J, Hair AB, Kim JH, Taylor SN.

Abstract: "In the critical care of preterm infants, feeding is complex and potentially harmful to an immature gastrointestinal system. Parents have expressed the desire to be fully informed about what is being fed to their child, as this places them in the best position to nurture their child's health. In the parent-engaged setting of the Necrotizing Enterocolitis Symposium, NICU parents expressed concern and confusion about how cow's milk product and donor human milk product both carry the label 'Human Milk Fortifier' (HMF). Accordingly, two online surveys were developed to characterize how the label HMF is used and interpreted in the NICU by parents and providers. Of 774 United States participants, only 21.9% of providers reported consistently describing the source of HMF to parents, and only 20.6% of parents whose child received an HMF product report knowing the source. Parents expressed that they were 'not given information' regarding HMF, while both parents and healthcare providers expressed that 'the label (HMF) is misleading'. This study documents the ambiguity around the label HMF as well as the need for more specific language and clearer communication."

Open access: https://www.mdpi.com/2072-6643/12/3/720/htm

Title: Potential Effects of Indole-3-Lactic Acid, a Metabolite of Human Bifidobacteria, on NGF-induced Neurite Outgrowth in PC12 Cells.

In: Microorganisms 2020 Mar 12;8(3). pii: E398. doi: 10.3390/microorganisms8030398.

Authors: Wong CB, Tanaka A, Kuhara T, Xiao JZ.

Abstract: "Gut microbiota-derived tryptophan metabolites such as indole derivatives are an integral part of host metabolome that could mediate gut-brain communication and contribute to host homeostasis. We previously reported that infant-type Human-Residential Bifidobacteria (HRB) produced higher levels of indole-3-lactic acid (ILA), suggesting the former might play a specific role in microbiota-host crosstalk by producing ILA in human infants. Nonetheless, the biological meaning of bifidobacteria-derived ILA in infant health development remains obscure. Here, we sought to explore the potential role of ILA in neuronal differentiation. We examined the neurite outgrowth and acetylcholinesterase (AchE) activity of PC12 cells following exposure to ILA and NGF induction. We found that ILA substantially enhanced NGF-induced neurite outgrowth of PC12 cells in a dose-dependent manner, and had the most prominent effect at 100 nM. Significant increases in the expression of TrkA receptor, ERK1/2 and CREB were observed in ILA-treated PC12 cells, suggesting ILA potentiated NGF-induced neurite outgrowth through the Ras/ERK pathway. Additionally, ILA was found to act as the aryl hydrocarbon receptor (AhR) agonist and evoked NGF-induced neurite outgrowth in an AhR-mediated manner. These new findings provide clues into the potential involvement of ILA as the mediator in bifidobacterial host-microbiota crosstalk and neuronal developmental processes."

Open access: https://www.mdpi.com/2076-2607/8/3/398

Title: Triacylglycerol containing Medium-chain Fatty Acids: Comparison of Human Milk and Infant Formulas on Lipolysis during in vitro Digestion.

In: Journal of Agricultural and Food Chemistry 2020 Mar 18. doi: 10.1021/acs.jafc.9b07481. [Epub ahead of print]

Authors: Yuan T, Geng Z, Dai X, Zhang X, Wei W, Wang X, Jin Q.

Abstract: "Medium-chain triacylglycerol (MCT) is widely used in infant formula (IF) to provide medium-chain fatty acids (MCFAs) for infants with special fat absorption requirements. However, MCFAs naturally present in human milk are medium-and long-chain triacylglycerols (MLCTs). This study investigated the effect of TAG-containing MCFAs (MLCT vs. MCT) on lipolysis by comparison of human milk and IFs containing 0, 20, 30, and 55% of MCT (IF 1 to IF 4) using an in vitro digestion model. Rabbit Gastric Lipase (RGL) showed an extent of digestion within the expected range which was selected as the alternative to human gastric lipase. All IFs showed lower lipolysis degree compared with human milk. There was no significant difference (p = 0.175) among IFs supplemented with MCT at the end of intestinal digestion. In addition, the digestion of IFs with different MCT contents led to different free fatty acid profiles, which may have health effects in infants."

Abstract only: https://pubs.acs.org/doi/abs/10.1021/acs.jafc.9b07481

Title: Maternal activation of the EGFR prevents translocation of gut-residing pathogenic Escherichia coli in a model of late-onset neonatal sepsis.

In: Proceedings of the National Academy of Sciences of the United States of America (PNAS) 2020 Mar 16. pii: 201912022. doi: 10.1073/pnas.1912022117. [Epub ahead of print]

Authors: Knoop KA, Coughlin PE, Floyd AN, Ndao IM, Hall-Moore C, Shaikh N, Gasparrini AJ, Rusconi B, Escobedo M, Good M, Warner BB, Tarr P, Newberry RD. Abstract: "Late-onset sepsis (LOS) is a highly consequential complication of preterm birth and is defined by a positive blood culture obtained after 72 h of age. The causative bacteria can be found in patients' intestinal tracts days before dissemination, and cohort studies suggest reduced LOS risk in breastfed preterm infants through unknown mechanisms. Reduced concentrations of epidermal growth factor (EGF) of maternal origin within the intestinal tract of mice correlated to the translocation of a gut-resident human pathogen Escherichia coli, which spreads systemically and caused a rapid, fatal disease in pups. Translocation of Escherichia coli was associated with the formation of colonic goblet cell-associated antigen passages (GAPs), which translocate enteric bacteria across the intestinal epithelium. Thus, maternally derived EGF, and potentially other EGFR ligands, prevents dissemination of a gut-resident pathogen by inhibiting goblet cell-mediated bacterial translocation. Through manipulation of maternally derived EGF and alteration of the earliest gut defenses, we have developed an animal model of pathogen dissemination which recapitulates gut-origin neonatal LOS."

Open access: https://www.pnas.org/content/early/2020/03/10/1912022117.long

Title: Longitudinal characterization of bifidobacterial abundance and diversity profile developed in Thai healthy infants.

In: Archives of Microbiology 2020 Mar 17. doi: 10.1007/s00203-020-01856-5. [Epub ahead of print]

Authors: Kongnum K, Taweerodjanakarn S, Hongpattarakere T.

Abstract: "The early bifidobacterial colonization and development of infant gut is considered crucial for the immediate and lifelong health of human host. This study longitudinally analyzed and characterized fecal bifidobacterial profiles in association with feeding regimens observed in six infants during 5 months after birth. The dominant fecal microbiota of bifidobacteria, lactobacilli/enterococci, clostridia, bacteroides and eubacteria were specifically enumerated using fluorescent in situ hybridization (FISH) technique. Breastfeeding exhibited close association with the predomination of bifidobacteria with the highest relative abundance of 32-70% detected in both infants with exclusive breastfeeding. The nested PCR-DGGE technique revealed high diversity existing within a bifidobacterial species with multiple strain variants of B. bifidum, B. longum, B. breve and B. dentium continuously detected in feces of exclusively breast- and combination-fed infants over the period of 5 months. Contrarily, B. breve, B. adolescentis, B. dentium, B. bifidum, B. faecale, B. kashiwanohense and B. lactis detected in all exclusively formula-fed infants seem to be transient species. The persisting strains seem to derive primarily from maternal breastmilk as demonstrated by PCR-DGGE profiles of human milk and feces from three mother-infant pairs. The results suggested the pivotal role of breastfeeding regimen in supporting colonization and succession of bifidobacteria in infant gut."

Abstract only: https://link.springer.com/article/10.1007%2Fs00203-020-01856-5

New Study on the Impact of Oligosaccharide 2'FL in Human Infants

Earlier studies in animals have shown a relationship between the oligosaccharide 2'FL and greater neurodevelopment. This first study in a human population has correlated infant intake of 2'FL with enhanced cognitive development, with a particular benefit to infants' early exposure to human milk.

This link to the ScienceDaily press release includes a discussion by the first author of the study. https://www.sciencedaily.com/releases/2020/02/200212150143.htm

Study title:  Human milk oligosaccharide 2’-fucosyllactose links feedings at 1 month to cognitive development at 24 months in infants of normal and overweight mothers.

Open access: PLOS ONE, 2020; 15 (2): e0228323 DOI: 10.1371/journal.pone.0228323 PLOS ONE, 2020; 15 (2): e0228323 DOI: 10.1371/journal.pone.0228323

Authors: Paige K. Berger, Jasmine F. Plows, Roshonda B. Jones, Tanya L. Alderete, Chloe Yonemitsu, Marie Poulsen, Ji Hoon Ryoo, Bradley S. Peterson, Lars Bode, Michael I. Goran. 

New Studies & a Review Article

Title: Supplementation of Mother's Own Milk With Donor Milk in Infants With Gastroschisis or Intestinal Atresia: A Retrospective Study.

In: Nutrients 2020 Feb 24;12(2). pii: E589. doi: 10.3390/nu12020589.

Authors: Rebecca Hoban, Supriya Khatri, Aloka Patel, Sharon L Unger.

Abstract: "BACKGROUND: Mother's own milk (MOM) improves in-hospital outcomes for preterm infants. If unavailable, donor milk (DM) is often substituted. It is unclear if DM vs. formula to supplement MOM is associated with improved in-hospital outcomes in term/late preterm surgical infants with gastroschisis or intestinal atresia. METHODS: This retrospective study included infants born ≥33 weeks gestational age (GA) with a birth weight of >1500 g who were admitted to a quaternary neonatal intensive care unit (NICU). Using Chi square and Mann-Whitney u testing, we compared hospital outcomes (length of stay, parenteral nutrition and central line days) before and after a clinical practice change to offer DM instead of formula in this surgical population. RESULTS: Baseline characteristics were similar between eras for the 140 infants (median GA 37 weeks). Fewer infants in DM era were receiving formula at discharge (50.0% vs. 31.4%, p = 0.03). In sub-analyses including only small bowel atresia and gastroschisis infants, the median length of stay (35 vs. 25, p < 0.01) and the central line days (28 vs. 20, p < 0.01) were lower in the DM era. CONCLUSION: In this retrospective study, offering DM instead of formula was associated with less formula feeding at discharge, and in infants with gastroschisis or small bowel atresia, shorter length of stay and central line days."

Open access: https://www.mdpi.com/2072-6643/12/2/589/htm

Title: A Novel Endogenous Antimicrobial Peptide CAMP 211-225 Derived From Casein in Human Milk.

In: Food & Function 2020 Feb 27. doi: 10.1039/c9fo02813g. [Epub ahead of print]

Authors: Xing Wang, Yazhou Sun, Fei Wang, Lianghui You, Yan Cao, Ranran Tang, Juan Wen, Xianwei Cui.

Abstract: "A large number of bioactive peptides derived from breast milk have been identified to be multifunctional having anti-inflammatory, immunoregulatory and antimicrobial activities. Here, we report that an endogenous peptide located at β-casein 211-225 amino acid from human breast milk (hereafter called CAMP211-225) presents specific antimicrobial activity against pathogenic E. coli and Y. enterocolitica. CAMP211-225 is a novel peptide that occurs at higher levels in preterm milk than in term milk. The minimal inhibitory concentrations (MIC) of CAMP211-225 against E. coli and Y. enterocolitica are 3.125 μg ml-1 and 6.25 μg ml-1, respectively, and the antimicrobial activity of CAMP211-225 was also confirmed by a disk diffusion assay. Further studies using fluorescence staining, scanning electron microscopy and a DNA-binding assay revealed that CAMP211-225 kills bacteria through a membrane-disrupting mechanism, but not by binding to intracellular nucleic acids. Neonatal necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease in neonatal intensive care units. In our study, CAMP211-225 administration effectively reduced ileal mucosa damage in an experimental NEC mice model. These results suggest that the antimicrobial peptide CAMP211-225 may have potential value in the prevention and treatment of neonatal infections."

Abstract only: https://pubs.rsc.org/en/content/articlelanding/2020/FO/C9FO02813G#!divAbstract

Title: Chlorinated Paraffins in Human Milk from Urban Sites in China, Sweden, and Norway.

In: Environmental Science & Technology 2020 Feb 26. doi: 10.1021/acs.est.9b06089. [Epub ahead of print]

Authors: Yihui Zhou, Bo Yuan, Elisabeth Nyberg, Ge Yin, Anders Bignert, Anders Glynn, Jon Øyvind Odland, Yanling Qiu, Yajie Sun, Yongning Wu, Qianfen Xiao, Daqiang Yin, Zhiliang Zhu, Jianfu Zhao, Åke Bergman.

Abstract: "Short-, medium-, and long-chain chlorinated paraffins (SCCPs, MCCPs, and LCCPs) were analyzed in human milk from the Yangtze River Delta (YRD) and Scandinavia. Individual samples were collected from Shanghai, Jiaxing, and Shaoxing (China), Stockholm (Sweden), and Bodø (Norway), between 2010 and 2016. Mean concentrations (range) of SCCPs, MCCPs, and LCCPs in samples from the YRD were 124(<LOD-676), 146(<LOD-1260), and 19.1(<LOD-184) ng g-1 fat, respectively, which all were significantly (p<0.05) higher than 15.9(<LOD-120), 45.0(<LOD-311), and 5.50(<LOD-29.0) ng g-1 fat, respectively, in samples from Scandinavia. MCCPs predominate in most samples, and LCCP concentrations exceed reported for PBDEs in human milk from the same regions. This study is the first to confirm LCCP exposure via breast-feeding. Principal Component Analysis showed that the YRD samples were more influenced by SCCPs than the Scandinavian samples, which mirrors different exposures to CPs between the regions. Due to a large variation in concentrations among individuals, SCCP intake via breastfeeding indicated a potential health concern for the 90th percentile among Chinese infants. Further, CP concentrations in the YRD samples from first-time mothers were on average three times higher than from second-time mothers. In order to limit the worldwide CP contamination, the inclusion of SCCPs as POPs in the Stockholm Convention needs to be followed up by inclusion of MCCPs and LCCPs as well."

Abstract only: https://pubs.acs.org/doi/10.1021/acs.est.9b06089

A review article:

Title: Bioactive Factors in Human Breast Milk Attenuate Intestinal Inflammation during Early Life.

In: Nutrients 2020, 12(2), 581; https://doi.org/10.3390/nu12020581

Authors: Julie D. Thai, Katherine E. Gregory.

Abstract: "Human breast milk is well known as the ideal source of nutrition during early life, ensuring optimal growth during infancy and early childhood. Breast milk is also the source of many unique and dynamic bioactive components that play a key role in the development of the immune system. These bioactive components include essential microbes, human milk oligosaccharides (HMOs), immunoglobulins, lactoferrin and dietary polyunsaturated fatty acids. These factors all interact with intestinal commensal bacteria and/or immune cells, playing a critical role in establishment of the intestinal microbiome and ultimately influencing intestinal inflammation and gut health during early life. Exposure to breast milk has been associated with a decreased incidence and severity of necrotizing enterocolitis (NEC), a devastating disease characterized by overwhelming intestinal inflammation and high morbidity among preterm infants. For this reason, breast milk is considered a protective factor against NEC and aberrant intestinal inflammation common in preterm infants. In this review, we will describe the key microbial, immunological, and metabolic components of breast milk that have been shown to play a role in the mechanisms of intestinal inflammation and/or NEC prevention."

Open access: https://www.mdpi.com/2072-6643/12/2/581/htm

Quote of the Day

“Difficulties in the ability to accurately switch between tasks are consistently reflected by increased error rates and increased reaction times on correct trials. Such “switch costs” are thought to arise from persistence of the task set from previous trials and consequent interference with task set reconfiguration: the ability to implement a new task set in advance of subsequent trials.”

From Neural Correlates for Task Switching in the Macaque Superior Colliculus in the Journal of Neurophysiology 118 (4), 2156-2170  2017 Oct 1.

Study authors: Jason L. Chan, Michael J. Koval, Kevin Johnston, Stefan Everling.

More from this study: “Task-switching behavior and superior colliculus (SC) activity were investigated in nonhuman primates performing randomly interleaved pro- and anti-saccade tasks. Here, we report error rate and reaction time switch costs in macaque monkeys and associated differences in stimulus-related activity of saccade-related neurons in the SC. These results provide a neural correlate for task switching and suggest that the SC is modulated by task-switching processes and may reflect the completion of task set reconfiguration.”

Open access: https://journals.physiology.org/doi/full/10.1152/jn.00139.2017

New Studies

Title: Different Effects of Premature Infant Formula and Breast Milk on Intestinal Microecological Development in Premature Infants.

In: Frontiers in Microbiology 2020 Jan 17;10:3020. doi: 10.3389/fmicb.2019.03020. eCollection 2019.

Authors: Chen C, Yin Q, Wu H, Cheng L, Kwon JI, Jin J, Han T, Che H.

Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978717/

Title: Influence of sulfonated and diet-derived human milk oligosaccharides on the infant microbiome and immune markers.

In: The Journal of Biological Chemistry 2020 Feb 3. pii: jbc.RA119.011351. doi: 10.1074/jbc.RA119.011351. [Epub ahead of print]

Authors: Quin C, Vicaretti SD, Mohtarudin NA, Garner AM, Vollman DM, Gibson DL, Zandberg WF.

Abstract: https://www.ncbi.nlm.nih.gov/pubmed/32014993

Title: Human Cytomegalovirus Reactivation During Lactation: Impact of Antibody Kinetics and Neutralization in Blood and Breast Milk.

In: Nutrients 2020 Jan 28;12(2). pii: E338. doi: 10.3390/nu12020338.

Authors: Lazar K, Rabe T, Goelz R, Hamprecht K.

Abstract: https://pubmed.ncbi.nlm.nih.gov/32012818-human-cytomegalovirus-reactivation-during-lactation-impact-of-antibody-kinetics-and-neutralization-in-blood-and-breast-milk/

Title: Microbiome Composition in Pediatric Populations from Birth to Adolescence: Impact of Diet and Prebiotic and Probiotic Interventions.

In: Digestive Diseases and Sciences 2020 Jan 31. doi: 10.1007/s10620-020-06092-x. [Epub ahead of print]

Authors: Davis EC, Dinsmoor AM, Wang M, Donovan SM.

Abstract: https://pubmed.ncbi.nlm.nih.gov/32002758-microbiome-composition-in-pediatric-populations-from-birth-to-adolescence-impact-of-diet-and-prebiotic-and-probiotic-interventions/

Title: Vitamin B12 concentrations in milk from Norwegian women during the six first months of lactation.

In: European Journal of Clinical Nutrition 2020 Jan 30. doi: 10.1038/s41430-020-0567-x. [Epub ahead of print]

Authors: Sigrun Henjum, Mari Manger, Daniela Hampel, Anne Lise Brantsæter, Setareh Shahab-Ferdows, Nasser E. Bastani, Tor A. Strand, Helga Refsum & Lindsay H. Allen.

Open access: https://www.nature.com/articles/s41430-020-0567-x

Title: Effects of Launaea taraxacifolia and resveratrol on milk yield and serum prolactin and oxytocin levels: a lactogenic study.

In: International Journal of Veterinary Science & Medicine 2019 Dec 17;7(1):71-77. doi: 10.1080/23144599.2019.1694307. eCollection 2019.

Authors: Sani NA, Kawu MU, Bako IG.

Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968715/

New Study: Antimicrobial and Anti-Inflammatory Effects of Glycerol Monolaurate (GML) in Human Milk versus Bovine Milk and Commercial Infant Formula

In this new open access study, researchers examined glycerol monolaurate (GML) in whole pasteurized human milk versus bovine milk and commercial infant formula for antimicrobial and anti-inflammatory activities on Staphylococcus aureus, Bacillus subtilis, Clostridium perfringens, and Escherichia coli.

Human milk samples contained approximately 3000µg/ml of GML, in contrast to 150μg/ml in bovine milk and no GML in infant formula. Researchers found that GML fights infections by the above-mentioned harmful bacteria while allowing beneficial bacteria to thrive.

Title: Glycerol Monolaurate Contributes to the Antimicrobial and Anti-inflammatory Activity of Human Milk.

In: Scientific Reports 2019 Oct 10;9(1):14550. doi: 10.1038/s41598-019-51130-y.

Authors: Schlievert PM, Kilgore SH, Seo KS, Leung DYM.

Open access: https://www.nature.com/articles/s41598-019-51130-y

The press release in ScienceDaily, which mentions that a patent application is underway for GML as a beneficial additive to cows' milk and infant formula: https://www.sciencedaily.com/releases/2019/10/191010075428.htm

New Human Milk Studies

Three new studies and one new review article:

Title: Breastfeeding is associated with children's dietary diversity in Brazil.

In: Ciencia & Saude Coletiva 2019 Oct 28;24(11):4345-4354. doi: 10.1590/1413-812320182411.29312017. eCollection 2019.

Authors: Bortolini GA, Giugliani ERJ, Gubert MB, Santos LMP.

Abstract: "The aim of this study was to describe food consumption patterns in Brazilian children aged 6-24 months and to assess differences between breastfed children who do not consume non-human milks, breastfed children who consume non-human milks, and non-breastfed children. This study used data from the Brazilian National Demographic and Health Survey (2006). The food consumption patterns of 1,455 children were assessed using a food frequency questionnaire. One indicator adopted in this study was the healthy diverse diet. The association between breastfeeding and food consumption was tested using multivariate Poisson regression. At the interview, 15.8% of the children were breastfed without consuming non-human milk, 30.7% consumed breast milk in conjunction with non-human milk, and 53% were not breastfed anymore. Over half consumed the recommended foods, 78% consumed foods rich in sugar, fat, and salt, and only 3.4% were on a healthy diverse diet. The breastfed children who did not consume non-human milks were almost five times more likely to be on a healthy diverse diet and were 19% less likely to consume foods rich in sugar, fat, and salt than the breastfed children who also consumed non-human milks and the non-breastfed children."

Open access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232019001104345&lng=en&nrm=iso&tlng=en

Title: Metabolism of the predominant human milk oligosaccharide fucosyllactose by an infant gut commensal.

In: Science Reports 2019 Oct 28;9(1):15427. doi: 10.1038/s41598-019-51901-7.

Authors: James K, Bottacini F, Contreras JIS, Vigoureux M, Egan M, Motherway MO, Holmes E, van Sinderen D.

Abstract: "A number of bifidobacterial species are found at a particularly high prevalence and abundance in faecal samples of healthy breastfed infants, a phenomenon that is believed to be, at least partially, due to the ability of bifidobacteria to metabolize Human Milk Oligosaccharides (HMOs). In the current study, we isolated a novel strain of Bifidobacterium kashiwanohense, named APCKJ1, from the faeces of a four-week old breastfed infant, based on the ability of the strain to utilise the HMO component fucosyllactose. We then determined the full genome sequence of this strain, and employed the generated data to analyze fucosyllactose metabolism in B. kashiwanohense APCKJ1. Transcriptomic and growth analyses, combined with metabolite analysis, in vitro hydrolysis assays and heterologous expression, allowed us to elucidate the pathway for fucosyllactose metabolism in B. kashiwanohense APCKJ1. Homologs of the key genes for this metabolic pathway were identified in particular in infant-derived members of the Bifdobacterium genus, revealing the apparent niche-specific nature of this pathway, and allowing a broad perspective on bifidobacterial fucosyllactose and L-fucose metabolism."

Open access: https://www.nature.com/articles/s41598-019-51901-7

Title: Characterization and probiotic properties of Lactobacilli from human breast milk.

In: 3 Biotech 2019 Nov;9(11):398. doi: 10.1007/s13205-019-1926-y. Epub 2019 Oct 12.

Authors: Jamyuang C, Phoonlapdacha P, Chongviriyaphan N, Chanput W, Nitisinprasert S, Nakphaichit M.

Abstract: "Several studies have reported a complex microbial community in human breast milk. This community impacts the shape of the infant gut microbiota and consequently impacts host health. Lactobacillus is an important probiotic and has many applications in the functional food industry. This study isolated and evaluated the potential probiotic bacteria from human milk. Two Lactobacillus species, L. plantarum and L. pentosus, were isolated from the breast milk of Thai women. L. pentosus HM04-22, L. pentosus HM04-3, L. plantarum HM04-80, L. plantarum HM04-88 and L. plantarum HM01-1 showed good adhesion activity (> 55%) and resistance in gastric (pH 2) and bile (pH 8) conditions. Characterization of the probiotic properties indicated that all selected Lactobacillus isolates had anti-adhesion properties against Escherichia coli and Salmonella Typhimurium. Lactobacillus isolates protected Caco-2 cells from pathogen adhesion at 25–40%. In addition, the five selected strains presented anti-inflammatory properties by reducing interleukin (IL)-8 expression at 0.14 ± 0.16 to 0.52 ± 0.117-fold. However, the strains had no effect on the expression of tight junction genes, including zona occludens (ZO)-1, occludin and claudin-1. In conclusion, five selected Lactobacillus isolates from human milk were candidates for use as probiotics to promote health. However, more tests in animal models and clinical trials need to be performed."

Abstract only: https://link.springer.com/article/10.1007%2Fs13205-019-1926-y

Title (review article): Statistical Approaches in the Studies Assessing Associations between Human Milk Immune Composition and Allergic Diseases: A Scoping Review.

In: Nutrients 2019 Oct 10;11(10). pii: E2416. doi: 10.3390/nu11102416.

Authors: Blyuss O, Cheung KY, Chen J, Parr C, Petrou L, Komarova A, Kokina M, Luzan P, Pasko E, Eremeeva A, Peshko D, Eliseev V, Pedersen S, Azad MB, Jarvinen KM, Peroni DG, Verhasselt V, Boyle RJ, Warner JO, Simpson MR, Munblit D.

Abstract: "A growing number of studies are focusing on the associations between human milk (HM) immunological composition and allergic diseases. This scoping review aims to identify statistical methods applied in the field and highlight pitfalls and unmet needs. A comprehensive literature search in MEDLINE and Embase retrieved 13,607 unique records. Following title/abstract screening, 29 studies met the selection criteria and were included in this review. We found that definitions of colostrum and mature milk varied across the studies. A total of 17 out of 29 (59%) studies collected samples longitudinally, but only 12% of these used serial (longitudinal) analyses. Multivariable analysis was used in 45% of the studies, but statistical approaches to modelling varied largely across the studies. Types of variables included as potential confounding factors differed considerably between models. Discrimination analysis was absent from all studies and only a single study reported classification measures. Outcomes of this scoping review highlight lack of standardization, both in data collection and handling, which remains one of the main challenges in the field. Improved standardization could be obtained by a consensus group of researchers and clinicians that could recommend appropriate methods to be applied in future prospective studies, as well as already existing datasets."

Open access: https://www.mdpi.com/2072-6643/11/10/2416

Three New Studies on Human Milk

Title: Glycerol Monolaurate Contributes to the Antimicrobial and Anti-inflammatory Activity of Human Milk.

In: Scientific Reports 2019 Oct 10;9(1):14550. doi: 10.1038/s41598-019-51130-y.

Authors: Schlievert PM, Kilgore SH, Seo KS, Leung DYM.

Abstract: "Human milk has antimicrobial compounds and immunomodulatory activities. We investigated glycerol monolaurate (GML) in human milk versus bovine milk and infant formula for antimicrobial and anti-inflammatory activities. Human milk contained approximately 3000 µg/ml of GML, compared to 150 μg/ml in bovine milk and none in infant formula. For bacteria tested (Staphylococcus aureus, Bacillus subtilis, Clostridium perfringens, Escherichia coli), except Enterococcus faecalis, human milk was more antimicrobial than bovine milk and formula. The Enterococcus faecalis strain, which was not inhibited, produced reutericyclin, which is an analogue of GML and functions as a growth stimulant in bacteria that produce it. Removal of GML and other lipophilic molecules from human milk by ethanol extraction resulted in a loss of antibacterial activity, which was restored by re-addition of GML. GML addition caused bovine milk to become antimicrobial. Human milk but not bovine milk or formula inhibited superantigen and bacterial-induced IL-8 production by model human epithelial cells. GML may contribute beneficially to human milk compared to bovine milk or infant formula."

Full text: https://www.nature.com/articles/s41598-019-51130-y

Title: Human Milk Retains Important Immunologic Properties After Defatting.

In: JPEN Journal of Parenteral and Enteral Nutrition 2019 Oct 9. doi: 10.1002/jpen.1722. [Epub ahead of print]

Authors:: Jackson BA, Gregg BE, Tutor SD, Bermick JR, Stanley KP.

Abstract:

"Background: In neonatal chylothorax, thoracic lymphatic drainage is ineffective. The resultant effusions often require drainage, leading to a loss of immune components. Affected infants can be managed with formula or defatted human milk feedings low in long-chain triglycerides to decrease lymph production. We hypothesized that there is no significant difference in the immunological profile or antibacterial effect of full-fat and defatted human milk.”

"Methods: Milk from lactating mothers was divided into 1 aliquot that was defatted via centrifugation with the full-fat aliquot as control. Macronutrient content was analyzed with mid-infrared spectroscopy. Flow cytometry was used to measure immune cell populations. Lactoferrin, lysozyme, immunoglobulin (Ig)A, and IgG values were determined using enzyme-linked immunosorbent assay. The antibacterial properties were determined by inoculating paired full-fat and defatted milk samples with Escherichia coli or Streptococcus pneumoniae bacteria and performing colony counts."

"Results: Compared with full-fat milk, defatted milk demonstrated decreased total energy and fat and increased carbohydrate concentrations. Defatted milk demonstrated a significant decrease in all immune cell populations. There was no difference in IgA, IgG, lysozyme, or lactoferrin concentrations. Both aliquots demonstrated equivalent growth inhibition of E. coli and S. pneumoniae."

"Conclusions: Unexpectedly, defatted human milk contained significantly less leukocytes than full-fat milk. IgA, IgG, lysozyme, and lactoferrin concentrations were preserved. The ability of defatted milk to inhibit bacterial growth was unaffected, suggesting that the antibacterial benefits of human milk remain after the defatting process. Further investigation regarding the clinical effect of leukocyte loss in defatted milk is warranted."

Abstract only: https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1722

Title: Comparison of Oxidative Status of Human Milk, Human Milk Fortifiers and Preterm Infant Formulas.

In: Foods 2019 Oct 8;8(10). pii: E458. doi: 10.3390/foods8100458.

Authors: Pozzo L, Cirrincione S, Russo R, Karamać M, Amarowicz R, Coscia A, Antoniazzi S, Cavallarin L, Giribaldi M.

Abstract: "Preterm and low birth weight infants require specific nutrition to overcome the accumulated growth deficit, and to prevent morbidities related to postnatal growth failure. In order to guarantee an adequate nutrient-intake, mother's own milk, when available, or donor human milk, are usually fortified with additional nutrients, in particular proteins. Fortification with processed ingredients may result in additional intake in oxidative compounds, deriving from extensive heat treatments, that are applied during processing. The aim of the present work was to compare the in vitro antioxidant activity and oxidative compound content conveyed by different preterm infant foods and fortifiers, namely raw and pasteurized human milk, two different preterm infant formulas, three bovine milk-based fortifiers and two experimental donkey milk-based fortifiers. Univariate and multivariate statistical analyses revealed significant differences between the different products. The use of human milk minimizes the intake of dietary oxidative compound in comparison to infant formulas, irrespective of pasteurization or fortification, especially as far as malondialdehyde content is concerned. The addition of fortifiers to human milk increases its antioxidant capacity, and the choice of the protein source (hydrolysed vs. whole proteins) differently impacted the resulting total antioxidant capacity of the diet."

Full text: https://www.mdpi.com/2304-8158/8/10/458

Four New Studies

Some new studies, beginning with this open access study from New Zealand:

TItle: Feasibility of Standardized Human Milk Collection in Neonatal Care Units.

In: Scientific Reports 2019 Oct 4;9(1):14343. doi: 10.1038/s41598-019-50560-y.

Authors: Galante L, Vickers MH, Milan AM, Reynolds CM, Alexander T, Bloomfield FH, Pundir S.

Abstract: "Research in human lactation is a growing field. However, difficulties in studying human milk originate from the dynamicity of its composition. Using standardized collection protocols is mandatory to minimize variation and warrant comparability of findings across different studies. Yet, information on the feasibility of collecting human milk with standardized procedures, especially in neonatal units, are lacking. The present study aims to report on the feasibility and difficulties to collect human milk according to a standardized protocol, during early lactation from women who gave birth to preterm infants. Human milk was collected from 129 mothers of moderate- to late-preterm infants according to two variations of a standard protocol which differed for number of collection time-points. Collection rates and adherence to the sampling protocol were evaluated together with reason for missed collection. Collection of ≥1 sample was successful for 80% of the mothers. However adherence to the standard protocol was overall low (36% and 27%). Collection rates were different between the two protocol variations (73% against 92%, p ≤ 0.001). Amongst the reason for missed collection, low milk supply was the most recurrent (40%). Our findings show that while collecting human milk in neonatal units is achievable, obtaining standard and comparable samples results challenging." Full text: https://www.nature.com/articles/s41598-019-50560-y

Title: The chemical synthesis of human milk oligosaccharides: Lacto-N-tetraose (Galβ1→3GlcNAcβ1→3Galβ1→4Glc).

In: Carbohydrate Research 2019 Sep 25;486:107824. doi: 10.1016/j.carres.2019.107824. [Epub ahead of print]

Authors: Bandara MD, Stine KJ, Demchenko AV.

Highlights: "The total synthesis of lacto-N-tetraose has been completed using both linear and convergent synthesis approaches. The linear approach was proven to be more efficient in this application. New synthetic protocols for different glycosidic linkages have been developed and refined. New methods for obtaining individual HMO help to improve understanding their roles and boost practical applications."

Abstract only: https://www.sciencedirect.com/science/article/abs/pii/S0008621519304264?via%3Dihub

Title: Large scale production of lacto-N-biose I, a building block of type I human milk oligosaccharides, using sugar phosphorylases.

In: Bioscience, Biotechnology, and Biochemistry 2019 Sep 28:1-8. doi: 10.1080/09168451.2019.1670047. [Epub ahead of print]

Author: Nishimoto M.

Abstract: "Human milk oligosaccharides (HMOs) have drawn attention for their contribution to the explosive bifidobacterial growth in the intestines of neonates. We found that bifidobacteria can efficiently metabolize lacto-N-biose I (LNB), the major building blocks of HMOs, and we have developed a method to synthesize LNB by applying this system. We produced LNB on a kilogram scale by the method. This proved that, among the enterobacteria, only bifidobacteria can assimilate LNB, and provided the data that supported the explosive growth of bifidobacteria in neonates. Furthermore, we were also able to reveal the structure of LNB crystal and the low stability for heating at neutral pH, which has not been clarified so far. In this paper, using bifidobacteria and LNB as examples, I describe the research on oligosaccharide synthesis that was conducted by utilizing a sugar metabolism. Abbreviations: LNB: lacto-N-biose I; GNB: galacto-N-biose; HMOs: human milk oligosaccharides; GLNBP: GNB/LNB phosphorylase; NahK: N-acetylhexosamine 1-kinase; GalT: UDP-glucose-hexose-1-phosphate uridylyltransferase; GalE: UDP-glucose 4-epimerase; SP: sucrose phosphorylase."

Abstract only: https://www.tandfonline.com/doi/abs/10.1080/09168451.2019.1670047?journalCode=tbbb20

Title: No Association between Glucocorticoid Diurnal Rhythm in Breastmilk and Infant Body Composition at 3 Months.

In: Nutrients 2019 Oct 2;11(10). pii: E2351. doi: 10.3390/nu11102351.

Authors: Hollanders J, Dijkstra LR, van der Voorn B, Kouwenhoven SMP, Toorop AA, van Goudoever JB, Rotteveel J, Finken MJJ.

Abstract: "Objective: Glucocorticoids (GCs) in breastmilk have previously been associated with infant body growth and body composition. However, the diurnal rhythm of breastmilk GCs was not taken into account, and we therefore aimed to assess the associations between breastmilk GC rhythmicity at 1 month and growth and body composition at 3 months in infants. Methods: At 1 month postpartum, breastmilk GCs were collected over a 24-h period and analyzed by LC-MS/MS. Body composition was measured using air-displacement plethysmography at 3 months. Length and weight were collected at 1, 2, and 3 months. Results: In total, 42 healthy mother-infant pairs were included. No associations were found between breastmilk GC rhythmicity (area-under-the-curve increase and ground, maximum, and delta) and infant growth trajectories or body composition (fat and fat free mass index, fat%) at 3 months. Conclusions: This study did not find an association between breastmilk GC rhythmicity at 1 month and infant's growth or body composition at 3 months. Therefore, this study suggests that previous observations linking breastmilk cortisol to changes in infant weight might be flawed by the lack of serial cortisol measurements and detailed information on body composition."

Open access: https://www.mdpi.com/2072-6643/11/10/2351