Human Breast Milk: From Food to Active Immune Response With Disease Protection in Infants and Mothers

Human milk oligosaccharide secretion dynamics during breastfeeding and its antimicrobial role: A systematic review

BACKGROUND

Human milk oligosaccharides (HMOs) are bioactive components of breast milk with diverse health benefits, including shaping the gut microbiota, modulating the immune system, and protecting against infections. HMOs exhibit dynamic secretion patterns during lactation, influenced by maternal genetics and environmental factors. Their direct and indirect antimicrobial properties have garnered significant research interest. However, a comprehensive understanding of the secretion dynamics of HMOs and their correlation with antimicrobial efficacy remains underexplored.

AIM

To synthesize current evidence on the secretion dynamics of HMOs during lactation and evaluate their antimicrobial roles against bacterial, viral, and protozoal pathogens.

METHODS

A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library focused on studies investigating natural and synthetic HMOs, their secretion dynamics, and antimicrobial properties. Studies involving human, animal, and in vitro models were included. Data on HMO composition, temporal secretion patterns, and mechanisms of antimicrobial action were extracted. Quality assessment was performed using validated tools appropriate for study design.

RESULTS

A total of 44 studies were included, encompassing human, animal, and in vitro research. HMOs exhibited dynamic secretion patterns, with 2'-fucosyllactose (2'-FL) and lacto-N-tetraose peaking in early lactation and declining over time, while 3-fucosyllactose (3-FL) increased during later stages. HMOs demonstrated significant antimicrobial properties through pathogen adhesion inhibition, biofilm disruption, and enzymatic activity impairment. Synthetic HMOs, including bioengineered 2'-FL and 3-FL, were structurally and functionally comparable to natural HMOs, effectively inhibiting pathogens such as Pseudomonas aeruginosa, Escherichia coli, and Campylobacter jejuni. Additionally, HMOs exhibited synergistic effects with antibiotics, enhancing their efficacy against resistant pathogens.

CONCLUSION

HMOs are vital in antimicrobial defense, supporting infant health by targeting various pathogens. Both natural and synthetic HMOs hold significant potential for therapeutic applications, particularly in infant nutrition and as adjuncts to antibiotics. Further research, including clinical trials, is essential to address gaps in knowledge, validate findings, and explore the broader applicability of HMOs in improving maternal and neonatal health.

Dynamics of antimicrobial proteins' expression and their bactericidal activity in mouse milk

Mother's milk is considered as "complete edible immune system." It contains macro- and micronutrients required to maintain infant growth and provides an excellent source for innate and adaptive immune proteins that not only protects infants from enteropathogens but also aid in the initial colonization of gut microbiota. In this study, we analyzed the milk of C57BL/6J dams and found significant changes in the composition of antimicrobial and immune proteins throughout the lactation period. Innate immune proteins, serum amyloid A, soluble CD14, and notably lipocalin-2 were detected in milk at high quantities. These proteins were substantially reduced in the milk from MyD88-deficient dams. Further, adaptive immune proteins, specifically IgA and IgG, exhibit a distinct shift during postpartum lactation stages. While IgG is the dominant immunoglobulin in milk at day 5 postpartum, by day 15 its levels were surpassed by IgA whose levels increased over time. The administration of TLR4 ligand LPS to WT dams significantly increased the aforementioned milk innate and adaptive proteins. Surprisingly, the milk from WT dams suppressed E. coli growth more effectively than milk collected from LPS-treated mice; such suppression, however, was completely lost upon boiling. Intriguingly, IgA, but not Lcn2, serves as a predominant factor in inhibiting E. coli proliferation, suggesting the critical role of IgA in regulating microbial colonization in the neonatal gut. Collectively, our findings provide insight into the dynamics of various immune proteins present in breast milk and highlight their pivotal roles in determining neonatal immune responses and microbial colonization at early stage.

Factors Influencing Exclusive Breastfeeding Amongst Arab Mothers in Israel: Social, Cultural, and Occupational Aspects

Background: Exclusive breastfeeding (EB), feeding an infant solely breast milk, has been recommended worldwide due to its health benefits for infants and mothers. However, EB rates remain low, due to several socio-demographic, occupational, and cultural factors. Objectives: Our aim was to investigate the factors associated with EB amongst Arab mothers living in Israel, i.e., age, education, religiosity, employment status, and the number of children which impact breastfeeding practices. Methods: Data were collected through surveys from Arab mothers of different religious and geographical backgrounds. Results: The findings revealed that older maternal age, higher levels of religiosity, and an increased number of children were positively associated with EB. Employment reduced EB. Muslim mothers were more likely to combine breastfeeding with formula; Christian and Druze mothers showed higher EB rates. Geographical disparities were also noted. Conclusions: This study highlights the complex interplay of socio-demographic and cultural factors that impact breastfeeding practices amongst Arab mothers in Israel, with significant implications for policy development and maternal support programs. We underscore the importance of incorporating religious and cultural considerations into breastfeeding promotion strategies. Public health initiatives should target support for working mothers by advocating extended maternity leave and breastfeeding-friendly workplace policies. Furthermore, community-based interventions should engage family members in supporting breastfeeding mothers.

Impact of Western diet on milk miRNAs and target genes in offspring adipose tissue: modulation by betaine during suckling

OBJECTIVE

We investigated how a maternal Western diet (WD) affects milk microRNA (miRNA) profile and associates with metabolic programming in adipose tissues in pups. We also explored the impact of betaine supplementation during suckling, as betaine levels are reported to be reduced in WD-fed dams' milk.

METHODS

A microarray analysis was performed to profile miRNA expression in dams' milk. Betaine levels were measured in the milk of dams and the plasma of their offspring. We also analyzed the expression of miRNA target genes in white and brown adipose tissues through gene expression analysis.

RESULTS

Our findings confirm decreased betaine levels in the milk of WD-fed dams and the plasma of their offspring. The miRNA screening identified 37 deregulated miRNAs (36 downregulated), with the following 6 as the most relevant: miR-223-3p; miR-32-5p; let-7i-5p; miR-140-5p; miR-29a-3p; and miR-29c-3p (downregulated). Some of their target genes were upregulated in brown and white adipose tissues, particularly those related to thermogenesis and browning. Betaine supplementation in pups demonstrated a slight protective effect in females by enhancing thermogenic capacity.

CONCLUSIONS

Our results underscore the profound impact of a maternal WD on milk miRNA composition, potentially influencing gene expression, thermogenesis, and adiposity in the offspring, with sex-related differences.

Safety and Efficacy of Vaccination During Lactation: A Comprehensive Review of Vaccines for Maternal and Infant Health Utilizing a Large Language Model Citation Screening System

Newborns are born with an immature immune system, making them susceptible to infections early in life. Human milk provides essential nutrients and immunological factors that support infant immunity. Maternal vaccination during lactation has the potential to enhance these benefits by triggering an immune response in the mother, potentially extending protection to her child. However, lactating individuals are often excluded from vaccine trials, leading to uncertainties about vaccine safety and efficacy during the postpartum period. This study critically evaluates the effectiveness of vaccines in enhancing the immune-supporting properties of human milk and assesses their safety and efficacy for lactating mothers and their infants. By examining potential benefits alongside safety concerns, we aim to provide a comprehensive understanding of postpartum vaccination's impact on maternal and infant health. We utilized large-language models (LLMs) to enhance the review process and performed a structured literature search across Ovid/Medline, Embase, and Clarivate Analytics using terms like "breastfeeding", "postpartum", and "vaccination". A three-stage screening process involving human and LLM-assisted evaluation focused on postpartum vaccines and their implications for maternal and infant health. We identified 73 studies covering vaccines against COVID-19, cholera, influenza, pertussis, pneumococcal, rabies, polio, rotavirus, rubella, varicella, typhoid, smallpox, and yellow fever. Most vaccines, such as those for COVID-19 and influenza, appear safe and effective for postpartum use without requiring precautionary measures. However, caution is advised with vaccines such as the yellow fever vaccine, where temporary breastfeeding cessation is recommended. Overall, this review underscores the compatibility of most vaccines with lactation and suggests its benefits for both mother and infant.

Non-exclusive breastfeeding is associated with pneumonia and asthma in under-five children: an umbrella review of systematic review and meta-analysis

BACKGROUND

Despite numerous reviews examining the impact of exclusive breastfeeding on preventing childhood pneumonia and asthma, a comprehensive and up-to-date synthesis is lacking. This umbrella review aims to consolidate the current evidence on the link between non-exclusive breastfeeding and the risk of pneumonia and asthma in under-five children.

METHODS

A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, and Google Scholar to identify systematic review and meta-analysis (SRM) studies evaluating the effect of exclusive breastfeeding on preventing childhood pneumonia and asthma globally. The latest search was conducted on January 25/2025. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews Two (AMSTAR-2) tool. A weighted inverse variance random-effects model was employed to generate pooled estimates. Summary effect estimates were expressed using odds ratios (OR) with 95% confidence intervals (CI). We evaluated the quality of evidence for each association using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, categorising it as convincing (class I), highly suggestive (class II), suggestive (class III), and weak (class IV).

RESULTS

Twelve SRMs, including 270 primary studies with over ten million participants, were analysed. The random-effects model revealed a highly suggestive association between non-exclusive breastfeeding and an increase in the risk of pneumonia (OR 2.34; 95% CI 1.89, 2.78, GRADE: highly suggestive). Similarly, there was highly suggestive evidence that non-exclusive breastfeeding was associated with a 29% higher risk of childhood asthma (OR 1.21; 95% CI 1.07, 1.34, GRADE: highly suggestive).

CONCLUSION

Our results highlighted that non-exclusive breastfeeding is associated with an increased risk of pneumonia and asthma in under-five children. These findings emphasise the critical role of exclusive breastfeeding in reducing the risk of respiratory health issues, highlighting the need for policies and initiatives that promote breastfeeding as a key strategy for improving children's health outcomes.

Protective effects of human breast milk-derived exosomes on inflammatory bowel disease through modulation of immune cells

Human breast milk (HBM)-derived exosomes play a crucial role not only in infant nutrition but also in modulating inflammation, immunity, and epithelial cell protection. This study investigated how HBM-derived exosomes regulate immune cell development and function. The exosomes promoted the differentiation of naïve CD4+ T cells into Treg and Th2 cells while suppressing their differentiation into Th17 and Th1 cells. They also enhanced the proliferation of intestinal epithelial Caco-2 cells and reduced apoptosis in dextran sulfate sodium (DSS)-damaged caco-2 cells. In a DSS-induced colitis mouse model, the exosomes significantly alleviated disease severity, as evidenced by improvements in colon length, disease activity index, and histology grades. Furthermore, the exosomes normalized CD4+ T cell subsets in the spleen, mesenteric lymph nodes, and colon, restoring levels comparable to controls. These findings suggest that HBM-derived exosomes hold promise as a potential therapeutic strategy for inflammatory bowel disease by modulating T-cell responses and protecting intestinal epithelial cells.

Impact of Maternal Exposure to SARS-CoV-2 on Immunological Components of Breast Milk

COVID-19, caused by SARS-CoV-2, has become a global public health threat. Although no replication-competent virus has been found in breast milk samples, breastfeeding practices during the pandemic were impacted. It is well known that breast milk is adapted to meet the needs of infants, providing the appropriate amounts of nutrients and various bioactive compounds that contribute to the maturation of the immune system and antioxidant protection, safeguarding infants against diseases. While its composition is variable, breast milk contains immune cells, antibodies, and cytokines, which have anti-inflammatory, pro-inflammatory, antiviral, and antibacterial properties that strengthen infant immunity. Since COVID-19 vaccines have not yet been approved for infants under six months of age, newborns rely on the passive transfer of antibodies via the placenta and breast milk to protect them against severe SARS-CoV-2 infection. Several studies that analyzed breast milk samples in the context of COVID-19 have demonstrated that a strong antibody response is induced following maternal infection with SARS-CoV-2. Therefore, this review aims to provide a comprehensive overview of the impact of maternal exposure to SARS-CoV-2 through natural infection and/or vaccination on the immunological composition of breast milk based on the studies conducted on this topic.

Common infections in children aged 6 months to 7 years after high prenatal exposure to perfluoroalkyl substances from contaminated drinking water in Ronneby, Sweden

BACKGROUND

Perfluorinated alkyl substances (PFAS) are suggested to impair immune function in children. Previous studies investigating associations between prenatal PFAS exposure and common infections were performed in background-exposed populations whilst studies from high-exposed populations are lacking.

OBJECTIVES

To investigate the association between prenatal PFAS exposure from contaminated drinking water and common infections in children aged 6 months to 7 years in Ronneby, Sweden.

METHODS

The cohort included 17,051 children, born 2003-2013, to mothers residing in Blekinge County at least one year within the five years before childbirth. Primary care diagnoses of infections in eyes, ears, respiratory- and urinary tract were retrieved from the Blekinge Healthcare Register. The residential history of the mothers served as a proxy for prenatal exposure; very high, high, intermediate, and background. We estimated hazard ratios (HR) by Cox proportional hazards regression with the Andersen and Gill extension for recurring events.

RESULTS

We observed an increased risk for ear infections (HR 1.28; 95% CI 1.03-1.58) in children with very high prenatal PFAS exposure, as well as suggestive but non-significant associations with eye- and urinary tract infections. Children with intermediate prenatal exposure had a reduced risk of eye infections (HR 0.86; 95% CI 0.77-0.95). No increased risk of respiratory tract infections was observed in any of the exposure categories.

DISCUSSION

This study was the first to investigate the association between high prenatal PFAS levels and common infections diagnosed in primary care, and it adds to a growing body of evidence of the potential immunotoxicity of early-life PFAS exposure.

T lymphocytes in human milk: Their role in immune system maturation through maternal microchimerism

Breastfeeding promotes the trafficking of immune cells and soluble factors from the mother to the neonate during lactation, resulting in maternal microchimerism. Human milk is abundant in T lymphocytes, but little is known about their priming and actions in neonatal mucosal tissues and their role in conferring immune tolerance in early life. This review summarises recent findings on the characteristics of human milk T cells compared to their counterparts in maternal and neonatal blood. We discuss how bioactive components of human milk, such as cytokines, hormones, and miRNA, may modulate the immune suppressive function of this cell subset. We shed light on the presence and possible functions of regulatory T cells (Tregs) in the breastfeeding triad of mother, human milk, and neonate, and how this subset of T lymphocytes may contribute to the prevention of immune pathologies, such as allergies and autoimmune diseases, later in life through human milk-induced maternal microchimerism in the newborn.

Age-specific kinetics of neutralizing antibodies and infection enhancement among ≤1 year-old Indian infants

Background

Infants born to dengue-immune mothers acquire maternal antibodies to dengue. Maternal antibodies decline over time, making infants susceptible to primary dengue infections. Another important concern is the role of maternal antibodies in causing antibody-dependent enhancement (ADE) during primary infections. In this study, we aimed to investigate the kinetics of dengue virus (DENV)-neutralizing antibodies and infection-enhancing activity in Indian infants.

Methods

Healthy infants at birth (cord blood), and at 3, 6, 9, and 12 months of age (n=32/group) were included in this cross-sectional study. Serum samples were tested for neutralizing antibodies using the foci-reduction neutralization test and enhancing antibodies using the ADE assay against DENV1-4 serotypes.

Results

Neutralizing antibody positivity declined with the increasing age of the infants. Undetectable levels of neutralizing antibodies to DENV1-4 serotypes were reported in 84% of infants by 9 months. Significantly lower neutralizing antibody titers were also reported in 9-month-old infants compared to that in 6-month-old infants and infants at birth. Comparable levels of enhancement of DENV1-4 infection at a particular dilution to at least one serotype were noted in infants at 3 and 6 months of age. Fold enhancement of DENV1-4 infection was found to be highest in 6-month-old infants at a dilution of 1:20. In summary, our data suggests that DENV infection-enhancing activity aligns with the decline of neutralizing antibodies.

Conclusion

Our study indicates that maternally acquired neutralizing antibodies could be protective until 6 months of age and capable of facilitating ADE on exposure to dengue infections in later months of life.

Association between prenatal exposure to maternal metal and trace elements and Streptococcus infection: A prospective birth cohort in the Japan Environment and Children's Study

BACKGROUND

Streptococcus infection is a common and potentially severe bacterial infection which remains a global public health challenge, underscoring the necessity of investigating potential risk factors.

AIMS

The present study aims to assess the association between metal and trace element exposure and Streptococcus infection using a prospective nationwide birth cohort, the Japan Environment and Children's Study (JECS).

METHODS

The JECS obtained data from over 100,000 pregnancies through 15 Regional Centres across Japan. We assessed toxic metal and trace element levels among pregnant mothers and Streptococcus infection among their children, born between 2011 and 2014, at age three to four. Analysis was performed using univariable and multivariable logistic regressions, as well as Quantile g-computation. We also conducted quartile regressions to assess the effects of higher serum selenium levels and potential interactions between selenium and mercury.

RESULTS

Among 74,434 infants and their mothers, univariable and multivariable regression analyses found that selenium and mercury each had an inverse association with Streptococcus infection incidence. Quantile g-computation analysis yielded results consistent with the primary regression analyses. Quartile regression suggested that serum selenium levels above the third quartile were inversely associated with later Streptococcus infection incidence, but no interaction between selenium and mercury was found.

CONCLUSIONS

These findings imply that maternal selenium exposure may have protective effects on Streptococcus infection among children. Further studies should explore the role of pediatric selenium in immune responses to infectious diseases, especially Streptococcus infection.

Infant respiratory infections modulate lymphocyte homing to breast milk

Introduction

Chemokines and their receptors are essential for leukocyte migration to several tissues, including human milk. Here, we evaluated the homing of T and B lymphocyte subsets to breast milk in response to ongoing respiratory infections in the nursing infant.

Methods

Blood and mature milk were collected from healthy mothers of nurslings with respiratory infections (Group I) and from healthy mothers of healthy nurslings (Group C). Total lymphocyte, T and B cells, their subset numbers, and the expression of the homing receptors CCR5, CCR6, CCR10, and CXCR3 in these cells were evaluated in milk. Maternal serum and milk chemokine, cytokine, and IgA and IgG antibody levels were also quantified.

Results

All milk lymphocyte numbers were greater in Group I than in Group C. All CD4 T-cell subsets expressing CCR5, CCR6, and CXCR3 were higher in Group I. Within the CD8 T-cell subsets, only CCR6 and CXCR3 were higher in Group I, while CCR5 expression was higher in Group I exclusively for activated CD8 T cells. Group I showed greater numbers of all CCR6+ B-cell subsets and CXCR3+ naive B cells and plasma cells than did Group C. Infection of the nurslings promoted increased CCL20, CXCL10, IL-6, IL-8, total IgA, and IgG levels in the milk.

Conclusion

Respiratory infections in nursing infants stimulate an increase in cytokines and chemokines in breast milk, facilitating the recruitment and activation of lymphocytes. This process may promote immunological tolerance and help in the maturation of the infant's immune system, providing an additional strategy for passive maternal-infant protection.

Association between Exclusive Breastfeeding and the Incidence of Childhood Nephrotic Syndrome

OBJECTIVE

To assess the relationship between breastfeeding and the risk of developing nephrotic syndrome using a population-based nationwide birth cohort in Korea.

STUDY DESIGN

This nationwide cohort study utilized data from the National Health Information Database and the National Health Screening Program for Infants and Children. The study included all children born between January 1, 2010, and December 31, 2018, who underwent their first health screening, which included a specific questionnaire on breastfeeding between 4 and 6 months of age. Associations between nephrotic syndrome and exclusive breastfeeding were estimated using adjusted hazard ratios (aHR) derived from Cox proportional hazards models, adjusted for sociodemographic variables, with follow-up until the occurrence of nephrotic syndrome, 8 years postindex date, death, or December 31, 2022, whichever was first.

RESULTS

The study population comprised 1 787 774 children (median follow-up: 7.96 years; IQR: 6.31-8.00 years), including 612 556 exclusively breastfed and 1 175 218 formula-fed children. Exclusive breastfeeding was associated with a decreased risk of developing nephrotic syndrome (aHR: 0.80; 95% CI: 0.69-0.93). Subgroup analysis stratified by sex mirrored the overall findings, although statistical significance was not observed in girls (boys: aHR, 0.75; 95% CI, 0.62-0.92; girls: aHR, 0.87; 95% CI, 0.70-1.09). Sensitivity analysis confirmed these results.

CONCLUSIONS

Exclusive breastfeeding was associated with a 20% reduced risk of developing nephrotic syndrome up to 8 years of age.

The Interaction of Race and Pregnancy Intentions on Breastfeeding Initiation Rates and Duration in the United States

Background: Unintended pregnancy increases adverse perinatal health outcomes. Limited studies exist on the influence of pregnancy intention on breastfeeding. This study examines the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Methods: Using the National Survey of Family Growth (2017-2019), we categorized breastfeeding into three categories (never breastfed, breastfed for 6 months or less, and breastfed for more than 6 months). Multinomial logistic regression and probability marginal effects were estimated across racial categories (Hispanics, non-Hispanic [NH] White, Black, and NH-others or multiracial). Results: The probability (Pr.) of never breastfeeding was the greatest among NH-Black women for all pregnancy intentions-both intended (Pr.: 0.34), mother-only (Pr.: 0.27), father-only (Pr.: 0.45), ambivalent (Pr.: 0.55), and neither intended (Pr.: 0.37). The probability of breastfeeding for 6 months or less is highest for Hispanics for both intended (Pr.: 0.41), NH-White for mother-only intended (Pr.: 0.49), Hispanics for father-only intended (Pr.: 0.56), ambivalent pregnancy intentions (Pr.: 0.60), and NH-others or multiracial for neither intended pregnancies (Pr.: 0.48). The probability of breastfeeding for more than 6 months is highest for NH-others or multiracial for both intended (Pr.: 0.50), ambivalent (Pr.: 0.49), and neither intended (Pr.: 0.36), while highest for NH-Black for mother-only intended (Pr.: 0.43). Conclusions: Our study demonstrates the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Owing to the high volume of unintended pregnancies in the United States, the current study might help maternal and child healthcare providers understand the interaction between race and pregnancy intentions on breastfeeding initiation and duration in the United States.

Detection and quantification of miRNA 148a expression in infant formulas

MiRNA 148a, which is associated with various biological processes such as immunity and cell differentiation, is one of the most abundant miRNAs in breast milk. This study aimed to determine the amount of miRNA 148a in different infant formulas, which are used for infants who cannot receive breast milk. The study analyzed 20 formulas, including stage one infant formulas (0-6 months of age), stage two follow-up formulas (6-12 months of age), stage three toddler formulas (above 12 months of age), and premature ones, analyzing miRNA 148a expression and qPCR miRNA gene expression, with significance set at p < 0.05. The expression levels of miRNA 148a in different infant formulas were compared, and no statistically significant difference was observed (p > 0.05). Also, there was no difference in relative miRNA 148a expression across formulas with and without probiotics (p > 0.05). Protein levels in probiotic formulas (0 month-1 year+) were positively correlated with relative miRNA 148a expression (p = 0.022). Although miRNA 148a expression has been shown to be present in formulas, it has been revealed that the amount is low compared to breast milk in line with the literature. In this direction, it is important to increase current data on the mechanisms of action of miRNAs in breast milk and the efforts to ensure that infant formulas reach a composition closest to breast milk in line with their biological effects. PRACTICAL APPLICATION: The miRNAs found in exosomal compounds in human breast milk are very diverse in terms of number and health effects, and can control various biological processes in cells, including immunity, cell differentiation, and apoptosis. One of these is miRNA 148a, which is the most abundant in human breast milk. For this reason, in this study, the miRNA 148a content of infant formulas, which are commonly used in healthy babies who cannot receive enough human breast milk (breastfeeding recommended for at least 6 months and up to 2 years) for a valid reason, was analyzed. In conclusion, miRNA expression has been detected in infant formulas, but it has been shown that this expression is at a low level.

Beyond nutrition: Exploring immune proteins, bioactive peptides, and allergens in cow and Arabian camel milk

Bovine milk has dominated the dairy segment, yet alternative milk sources are gaining attention due to perceived superior health benefits, with immune proteins and bioactive peptides (BPs) contributing to these benefits. Fractionation affects protein recovery and composition. Here, the cream fraction resulted in the highest yield of proteins, identifying 1143 camel and 851 cow proteins. The cream fraction contained a significantly higher concentration of immune system-related proteins. Straightforward filtration and protein precipitation methods achieved average BP detections of 170 and 177, compared to 31 by a solvent-solvent extraction method. Considering potentially allergenic proteins, 53 (camel) and 52 (cow) were identified. Of these, 62 % of the potential allergens in cow, had orthologous counterparts in camel milk. However, the major milk allergen β-lactoglobulin (β-Lg) was not detected in camel milk. Our results provide a comprehensive proteomic resource of camel and cow milk products, mapping potential allergens and BPs that affect health.

Impact of breastfeeding and formula feeding on immune cell populations and blood cell parameters: an observational study

OBJECTIVE

Breastfeeding is associated with improved health outcomes in infancy and throughout adulthood as breast milk encompasses diverse immune-active factors that affect the ontogeny of the immune system in breastfed (BF) infants. Nevertheless, the impact of infant feeding on the immune system is poorly understood, and a comprehensive understanding of immune system development in human infants is lacking. In this observational study, we addressed the effects of different infant feeding approaches on cell populations and parameters in the peripheral blood of infants to gain insight into the innate and adaptive arms of the immune system.

METHODS

Using flowcytometric analysis, we performed complete blood counts and immunoprofiling of peripheral blood collected from BF and formula-fed (FF) infants at different ages.

RESULTS

Our results showed that the blood of BF infants had a higher frequency of leukocytes and erythrocytes in early infancy. The hemoglobin concentration was enhanced in BF infants. However, the platelet count was comparable regardless of feeding regimen.

CONCLUSIONS

We observed immunophenotypic differences between the two populations of infants, mirrored by improved frequency of innate and adaptive immune cells in BF infants.

The Lack of an Association of Breastfeeding with the Development of Childhood Intussusception: A Nationwide Birth Cohort Survey in Japan

Background: This study investigated the association between feeding practices and the development of childhood intussusception. Materials and Methods: We conducted secondary data analyses using the Longitudinal Survey of Newborns in the 21st Century in Japan. We performed multivariable logistic regression analyses to examine the association between feeding practice and intussusception development in children aged between 6 and 18 months. We used the following variables as potential confounders: gender, gestational age, birth weight, singleton or multiple births, parity, maternal age at delivery, maternal smoking status, and paternal smoking status. Furthermore, we performed multivariable logistic regression analyses to examine the association between breastfeeding duration and intussusception development. Results: In total, 31,802 children were analyzed in this study. The annual incidence of intussusception was 1.6 cases per 1,000 children aged between 6 and 18 months. No significant association was found between exclusive breastfeeding and the development of intussusception, compared with exclusive formula feeding (odds ratio, 1.64; 95% confidence interval, 0.32-30.0). Furthermore, no significant association was observed between breastfeeding duration and intussusception development. Conclusions: Our findings demonstrated no association between breastfeeding and the development of childhood intussusception.

Analysis of the presence of natural killer cell subpopulations in preterm human milk: A first approach

Several immune cell populations are transferred to the newborn through breast milk, including natural killer (NK) cells, which are critical for innate defense and regulation of the immune response, especially in preterm infants. The aim of this study was to analyze the presence of NK cell subpopulations in different types of preterm breast milk. The study quantified the presence of NK cell subpopulations by flow cytometry using the relative expression of CD56 and CD16 markers in colostrum, transitional and mature milk samples from preterm mothers. Flow cytometry analysis revealed the presence of five NK cell subpopulations, but unlike those reported in peripheral blood, CD56dimCD16+ and CD56-CD16+ populations are predominantly present in preterm milk, only the CD56brightCD16dim population is increased in mature milk. Analysis of NK cell subpopulations in preterm milk revealed a pattern of NK cell presence in preterm breast milk with predominantly cytotoxic phenotypes in relation to CD16 marker expression.

The Effect of a Community-Based Complementary Feeding Education Program on the Nutritional Status of Infants in Polokwane Municipality, Limpopo Province, South Africa

BACKGROUND

Appropriate complimentary feeding (CF) has the potential to improve growth and development in infants from 6 months to 2 years of age. This study's aim was to assess the effect of a CF education program on the nutritional status of infants aged 3-12 months in the Polokwane Municipality.

METHODS

A longitudinal (non-randomized), quasi-experimental intervention study was conducted among 187 caregivers. The caregiver-infant pairs (CIPs) in the intervention group (n = 95) received CF education and a six-month telephone follow-up support. The CIPs in the control group (n = 94) received no intervention. We collected data at baseline and end line using structured questionnaires. Intervention effectiveness was evaluated by comparing mean changes in anthropometric measurements between intervention and control groups using difference-in-difference analysis. Per protocol, analysis was run.

RESULTS

The results show that the children in the intervention group gained more weight after the intervention, were taller, and the mid-upper arm circumference (MUAC) increased more than in the control group. At baseline, the weight of infants was 7.37 ± 0.83 and 6.69 ± 0.13 kg in the intervention and control. At end line, significant weight and length gain were observed in the intervention group (difference-in-difference (DID) = 1.82 kg, p < 0.001) and (DID = 7.78 cm, p < 0.01), respectively. The intervention group showed significant gain in MUAC of 1.68 cm (p = 0.047), with no noticeable effect on the head circumference at end line; DID (0.16 cm; p = 0.950).

CONCLUSIONS

Community-based nutrition intervention programs can effectively improve the anthropometric nutritional status of children aged 3-12 months.

Epigenetic and Immune Mechanisms Linking Breastfeeding to Lower Breast Cancer Rates

This review shows how mammary stem cells (MaSCs) influence breast development, breastfeeding, and breast cancer risk. MaSCs, which can differentiate into various cell types, are vital for breast tissue health, but also disease development in breast tissue. Research shows that breastfeeding affects MaSCs, offering protection against breast cancer through various mechanisms. Hormonal changes such as increased prolactin concentration, oxytocin secretion, lower progesterone levels, and reduced exposure to estrogen during lactation promote apoptosis in potential cancer cells, boost immune surveillance, and modulate inflammation. Key findings reveal that pregnancy at an earlier age and extended breastfeeding reduce MaSC numbers, lowering cancer risk. Additionally, breastfeeding induces various epigenetic changes, such as DNA methylation and histone modification, which provide long-term protection against the development of cancer. Components of breast milk, like alpha-lactalbumin and lactoferrin, contribute by promoting cancer cell apoptosis and inhibiting tumor growth. The dual benefits of breastfeeding are reduced breast cancer risk for mothers and immunological advantages for infants. Multicenter epidemiology research has focused particular attention on longer breastfeeding duration associated with a reduced risk of triple-negative breast cancer. This review offers comprehensive evidence that breastfeeding protects against breast cancer through various biological, hormonal, and molecular mechanisms, showing the importance of promoting breastfeeding as a natural cancer prevention method. This article reviews the role of mammary stem cells in breast development, lactation, and breast cancer.

The effect of virtual reality on the breastfeeding process: a randomized controlled study

OBJECTIVE

The aim of this study was to determine the effect of breastfeeding training given with virtual reality (VR) to postpartum mothers after cesarean section delivery on breastfeeding success and breastfeeding self-efficacy.

STUDY DESIGN

The research was designed as a prospective randomized controlled study. In total, 66 women were included in the study, with 31 in the control group and 35 in the intervention group. The study included mothers who had no vision or hearing impairments and no neurological disorder, who had received breastfeeding counseling during pregnancy, and who had given birth by cesarean delivery to a healthy baby. The control group received standard breastfeeding training while the intervention group watched a breastfeeding video with VR in the 4th and 24th hours after cesarean delivery. Research data were collected with the sociodemographic information form, LATCH Breastfeeding Charting System and Documentation Tool and the Breastfeeding Self-Efficacy Scale.

RESULTS

As a result of the research, the women in the intervention group were found to have higher mean scores for the Breastfeeding Self-Efficacy Scale in the 4th and 24th hours compared to the control group. Mean LATCH scores were also higher in the intervention group compared to the control group. There were linear correlations between the Breastfeeding Self-Efficacy Scale scores and LATCH Scale scores.

CONCLUSION

Breastfeeding self-efficacy and breastfeeding success of mothers who received breastfeeding training with VR at 4th and 24th hours after cesarean delivery were higher than mothers who received standard breastfeeding training.

CLINICAL TRIALS NUMBER

NCT06256822.

Topical review: Lactation and use of DMTs in women with MS

One in three females with multiple sclerosis (MS) becomes pregnant after diagnosis. In the postpartum period, there is a risk of rebound inflammatory activity. This risk can likely be reduced with breastfeeding, as well as with early initiation of effective therapies that have low therapeutic lag. To guide patients in their choices surrounding breastfeeding and MS therapies, clinicians must be familiar with how best to protect against relapses, to ensure infant safety, and to support breastfeeding choices. This topical review provides a broad framework on lactation in women with MS. It seeks to reframe guidelines around caring for the maternal-infant dyad, and for diverse populations living with MS. It also provides updated data on the effects of lactation in women with MS and the limited data on transfer of disease-modifying therapies (DMTs) into breastmilk. The ultimate goal is to support informed shared decision-making between clinicians and patients regarding breastfeeding during the high-risk postpartum period.

The Role of Breastfeeding in Acute Respiratory Infections in Infancy

BACKGROUND

Acute respiratory infections (ARIs) affect the respiratory tract, are often caused by viruses such as respiratory syncytial virus and rhinovirus, and present symptoms such as coughing, fever, respiratory distress, and breathing difficulty. The global adherence to exclusive breastfeeding (BF) for the first 6 months of life has reached 44%, supported by the World Health Organization and United Nations International Children's Emergency Fund efforts. BF provides vital nutrients and contributes to infant immune system development, protecting against infections. The role of BF in preventing and reducing complications of ARIs in infants is gaining attention, prompting a review of current data and future research needs. This review aims to summarize the evidence on the role of BF in reducing the risk and severity of ARIs in infants, elucidate the adaptations in breast milk composition during infections, and identify relevant research needs.

METHODS AND RESULTS

Human milk (HM) is rich in immunoglobulins, antimicrobial peptides, and immunomodulatory factors that protect against various pathogens, including respiratory viruses. Several studies have demonstrated that BF is associated with a significant reduction in hospitalization, oxygen requirements, and mortality in infants with ARIs. The effectiveness of BF varies according to the specific respiratory virus, and a longer duration of exclusive BF appears to enhance its protective effect. It is documented that the composition of HM adjusts dynamically in response to infections, fortifying the infant's immune defenses. Specific immunological components of HM, including leukocytes and immunoglobulins, increase in response to infection in the infant, contributing to the enhancement of the immune defense in infants. Immune-boosting microRNAs enhance immune transfer to the infants and promote early gut maturation, and the HM microbiome along with other factors modifies the infant's gut microbiome and immune system.

CONCLUSIONS

BF defends infants from respiratory infections, and the investigation of the microRNAs in HM offers new insights into its antiviral properties. The promotion of BF, especially in vulnerable communities, is of paramount importance in alleviating the global burden of ARIs in infancy.

Breastfeeding: science and knowledge in pediatric obesity prevention

The increasing prevalence of childhood obesity worldwide is a significant concern due to its link to severe health issues in adulthood, such as non-communicable diseases (NCDs). To address this issue, this review evaluates the effectiveness of various preventive measures for childhood obesity, focusing on maternal nutrition and breastfeeding. The study underscores the criticality of the periconceptional period, where the diets of both parents can influence epigenetic modifications that impact the child's metabolic pathways and obesity risks. Breastfeeding is a potent protective mechanism against early-onset obesity, significantly enhancing the infant's metabolic and immune health by modifying DNA methylation and gene expression. Furthermore, the perspective underscores the significance of the Mediterranean diet during the periconceptional period and lactation. This diet can effectively prevent gestational complications and improve breast milk quality, fostering optimal infant development. Recognizing that obesity results from genetic, epigenetic, environmental, and social factors, the paper advocates for a comprehensive, multidisciplinary approach from the earliest stages of life. This approach champions a balanced maternal diet, exclusive breastfeeding, and timely introduction to complementary foods. In conclusion, addressing pediatric obesity requires a multifaceted strategy emphasizing improving prenatal and postnatal nutrition. Further research is necessary to understand the epigenetic mechanisms influenced by nutrition and their long-term effects on children's health. This will help refine interventions that curb the obesity epidemic among future generations.

Factors Influence Breastfeeding Duration after High Risk and Low Risk Pregnancies

BACKGROUND

Breastfeeding provides vital nutrients and fosters maternal-infant bonding, benefiting both mother and child. However, breastfeeding duration is influenced by various factors, especially in women of high-risk pregnancy. This study aims to identify predictors of breastfeeding duration among women of high-risk and low-risk pregnancy, focusing on exclusive and mixed feeding practices.

METHODS

Conducted at a public hospital in Attica, Greece, this 20-month prospective cohort study (May 2020-January 2022) included 380 pregnant women, divided into high-risk and low-risk groups. The final sample of 157 women, after excluding non-breastfeeding participants, was assessed across five phases from prenatal to six months postpartum using interviews, calls, and surveys. Multiple linear regression identified key predictors, with statistical methods applied.

RESULTS

Results revealed birth weight as a consistent significant predictor of breastfeeding duration. For women with high-risk pregnancy, additional factors like infant gender, jaundice, and early introduction of solid foods influenced breastfeeding duration. The mixed breastfeeding model for women with high-risk pregnancy explained 72.9% of the variance. Exclusive and mixed breastfeeding models for women with low-risk pregnancy also highlighted birth weight's influence.

CONCLUSION

The findings highlight the important role of birth weight and other specific factors in determining breastfeeding duration among women of high-risk and low-risk pregnancy. Further research is needed to validate these findings across diverse populations.

Maternal influences on offspring food allergy

The prevalence of allergies has been globally escalating. While allergies could appear at any age, they often develop in early life. However, the significant knowledge gap in the field is the mechanisms by which allergies affect certain people but not others. Investigating early factors and events in neonatal life that have a lasting impact on determining the susceptibilities of children to develop allergies is a significant area of the investigation as it promotes the understanding of neonatal immune system that mediates tolerance versus allergies. This review focuses on the research over the recent 10 years regarding the potential maternal factors that influence offspring allergies with a view to food allergy, a potentially life-threatening cause of anaphylaxis. The role of breast milk, maternal diet, maternal antibodies, and microbiota that have been suggested as key maternal factors regulating offspring allergies are discussed here. We also suggest future research area to expand our knowledge of maternal-offspring interactions on the pathogenesis of food allergy.

Importance of Human Breast Milk in the Early Colonization of Streptococcus mutans

Background and objectives: The development of the oral microbiome begins in the prenatal stage. Breast milk contains antimicrobial proteins, microorganisms, metabolites, enzymes, and immunoglobulins, among others; therefore, differences have been noted in the type of microorganisms that colonize the oral cavity of children who are breastfed compared to those who are formula-fed. Our objective was to establish the relationship between breastfeeding, formula feeding, or mixed feeding (breastfeeding and formula) with the presence of S. mutans in a population of children under 6 months of age. Materials and Methods: The patients were recruited from the Child Care Center of Ciudad Juárez, Chihuahua, and from the pediatric dentistry postgraduate clinics of the Autonomous University of Ciudad Juárez; children exclusively fed maternally, with formula, and/or mixed were included. Those who had been fed within the previous hour were excluded. The sample was taken with a smear of the jugal groove using a sterile micro-brush. For the identification of Streptococcus mutans, a culture of Mitis Salivarius Agar (Millipore) was used. Results: 53.3% corresponded to females and 46.7% to males, 36.7% corresponded to maternal feeding, 23.3% corresponded to formula feeding, and 40% corresponded to mixed feeding. In 90% of the infants, the parents indicated that they did not perform oral hygiene. The CFU count showed that infants who were exclusively breastfed had an average of 9 × 10 CF/mL, formula-fed infants had an average of 78 × 10 CFU/mL, and those who had mixed feeding 21 × 10 CFU/mL. Conclusions: According to the results obtained, it was possible to corroborate that exclusive breastfeeding limits the colonization of Streptococcus mutans compared to those infants who receive formula or mixed feeding; these results could have a clinical impact on the dental health of infants by having a lower presence of one of the main etiological factors involved in dental caries and the type of microbiome established in the oral cavity.

Prevalence and Determinants of Exclusive Breastfeeding Among Mothers of Children Aged 6-24 Months in the Aseer Region

Background Exclusive breastfeeding (EBF) is crucial for infant and maternal health, providing optimal nutrition and immune protection for infants while reducing maternal postpartum depression and cancer risk. However, global trends show an early cessation of breastfeeding and the introduction of other foods. This study aims to determine the prevalence and factors influencing EBF among mothers in the Aseer region of Saudi Arabia. Methodology A cross-sectional study using a multistage cluster sampling approach was conducted from January to March 2024 in primary healthcare centers across the Aseer region. Participants included mothers of children aged 6-24 months attending primary healthcare centers for immunizations or routine check-ups. A pretested structured questionnaire, developed after an extensive literature review and expert consultation, was used to interview consenting participants. The questionnaire covered sociodemographic data, obstetric and medical history, child data, EBF practices, maternal knowledge and perception of breastfeeding, counseling about breastfeeding, antenatal care, breastfeeding support, and barriers and motivators of EBF. Results A total of 1,008 eligible mothers were included. Only 131 (13%) fulfilled the World Health Organization criteria for EBF. Moreover, 257 (25.5%) mothers initiated breastfeeding within the first hour after delivery, and 387 (38.4%) exclusively breastfed for six months or more. EBF was less frequent among mothers with higher education (8%, n = 2) compared to those with lower education (23%, n = 23, p = 0.017). EBF was also less frequent among mothers who delivered via cesarean section (7.9%, n = 28) compared to those who had a vaginal delivery (15.8%, n = 103, p = 0.001). Conversely, EBF was more common among mothers with more than five pregnancies (15.8%, n = 45) compared to those with one to two pregnancies (9.4%, n = 37, p = 0.023). EBF was also more common among mothers who had breastfed more than four children (16.7%, n = 39) compared to those who had not (12.1%, n = 49, p = 0.048). Finally, EBF was more common among mothers without postpartum complications (13.4%, n = 131) or whose infants had no birth complications (13.4%, n = 128) compared to their respective counterparts (p = 0.029 and p = 0.048, respectively). Conclusions This study found a low prevalence of EBF in the Aseer region, despite high maternal knowledge and positive perceptions. Factors such as low education, medical barriers, unemployment, and high parity were associated with increased EBF rates. Interventions should focus on improving workplace support and increasing maternal awareness of EBF recommendations.

Maternal-Fetal Microchimerism: Impacts on Offspring's Immune Development and Transgenerational Immune Memory Transfer

Maternal-fetal microchimerism is a fascinating phenomenon in which maternal cells migrate to the tissues of the offspring during both pregnancy and breastfeeding. These cells primarily consist of leukocytes and stem cells. Remarkably, these maternal cells possess functional potential in the offspring and play a significant role in shaping their immune system development. T lymphocytes, a cell population mainly found in various tissues of the offspring, have been identified as the major cell type derived from maternal microchimerism. These T lymphocytes not only exert effector functions but also influence the development of the offspring's T lymphocytes in the thymus and the maturation of B lymphocytes in the lymph nodes. Furthermore, the migration of maternal leukocytes also facilitates the transfer of immune memory across generations. Maternal microchimerism has also been observed to address immunodeficiencies in the offspring. This review article focuses on investigating the impact of maternal cells transported within maternal microchimerism on the immune system development of the offspring, as well as elucidating the effector functions of maternal cells that migrate through the placenta and breast milk to reach the offspring.

Anti-cancer potential of casein and its derivatives: novel strategies for cancer treatment

Cancer is one of the leading causes of death worldwide, with over 10 million fatalities annually. While tumors can be surgically removed and treated with chemotherapy, radiotherapy, immunotherapy, hormonal therapy, or combined therapies, current treatments often result in toxic side effects in normal tissue. Therefore, researchers are actively seeking ways to selectively eliminate cancerous cells, minimizing the toxic side effects in normal tissue. Caseins and its derivatives have shown promising anti-cancer potential, demonstrating antitumor and cytotoxic effects on cells from various tumor types without causing harm to normal cells. Collectively, these data reveals advancements in the study of caseins and their derivative peptides, particularly providing a comprehensive understanding of the molecular mechanism of action in cancer therapy. These mechanisms occur through various signaling pathways, including (i) the increase of interferon-associated STAT1 signaling, (ii) the suppression of stemness-related markers such as CD44, (iii) the attenuation of the STAT3/HIF1-α signaling, (iv) the down-expression of uPAR and PAI-1, (v) the loss of mitochondrial membrane potential and reduced intracellular ATP production, (vi) the increase of caspase-3 activity, and (vii) the suppression of TLR4/NF-кB signaling. Therefore, we conclude that casein could be an effective adjuvant for cancer treatment.

Enteral plasma supports brain repair in newborn pigs after birth asphyxia

Newborns exposed to birth asphyxia transiently experience deficient blood flow and a lack of oxygen, potentially inducing hypoxic-ischaemic encephalopathy and subsequent neurological damage. Immunomodulatory components in plasma may dampen these responses. Using caesarean-delivered pigs as a model, we hypothesized that dietary plasma supplementation improves brain outcomes in pigs exposed to birth asphyxia. Mild birth asphyxia was induced by temporary occlusion of the umbilical cord prior to caesarean delivery. Motor development was assessed in asphyxiated (ASP) and control (CON) piglets using neonatal arousal, physical activity and gait test parameters before euthanasia on Day 4. The ASP pigs exhibited increased plasma lactate at birth, deficient motor skills and increased glial fibrillary acidic protein levels in CSF and astrogliosis in the putamen. The expression of genes related to oxidative stress, inflammation and synaptic functions was transiently altered in the motor cortex and caudate nucleus. The number of apoptotic cells among CTIP2-positive neurons in the motor cortex and striatal medium spiny neurons was increased, and maturation of preoligodendrocytes in the internal capsule was delayed. Plasma supplementation improved gait performance in the beam test, attenuated neuronal apoptosis and affected gene expression related to neuroinflammation, neurotransmission and antioxidants (motor cortex, caudate). We present a new clinically relevant animal model of moderate birth asphyxia inducing structural and functional brain damage. The components in plasma that support brain repair remain to be identified but may represent a therapeutic potential for infants and animals after birth asphyxia.

Breastfeeding Intention and Breastfeeding Postpartum Outcomes between High-Risk and Low-Risk Pregnant Women: A Greek Prospective Cohort Study

BACKGROUND

This prospective cohort study, conducted from pregnancy to six months postpartum and grounded in STROBE methodology, quantitatively explores the relationship between antenatal breastfeeding intentions and subsequent breastfeeding outcomes among high-risk pregnant women, compared to a low-risk pregnancy group.

METHODS

The study was conducted in one of the largest public hospitals in Attica that provides care to pregnant women, enrolling 380 participants divided into high-risk (n = 200) and low-risk (n = 180) cohorts. Data were collected over 20 months (starting from the end of May 2020 until January 2022), spanning from pregnancy to six months postpartum, via comprehensive questionnaires.

RESULTS

Statistical analysis revealed a pronounced correlation between prenatal breastfeeding intentions and actual breastfeeding behaviors across both groups. Specifically, 81.1% of women in the high-risk group and 82.5% in the low-risk group expressed intentions of exclusively breastfeeding during pregnancy. By six months postpartum, 54.9% of the high-risk and 64.3% of the low-risk pregnancy group managed to sustain breastfeeding. Extended antenatal hospitalization emerged as a statistically significant factor (p = 0.045) negatively impacting exclusive breastfeeding intentions among high-risk pregnancies.

CONCLUSION

The findings illuminate the critical influence of antenatal intentions on breastfeeding outcomes, particularly among high-risk pregnancies. Moreover, the study identifies the detrimental effect of prolonged hospital stays on breastfeeding aspirations. These insights underscore the necessity for nuanced, supportive interventions aimed at bolstering breastfeeding rates, thereby advancing maternal and neonatal health objectives aligned with World Health Organization recommendations.

Evaluation of the Development of Post-Vaccination Immunity against Selected Bacterial Diseases in Children of Post-Solid-Organ-Transplant Mothers

Pregnancy after organ transplantation is considered high-risk and requires supervision in specialized centers. The impact of immunosuppression on the developing fetus is still the subject of research. It has been shown that it affects lymphocyte populations in the first year of life. For this reason, researchers suggest postponing mandatory infant vaccinations. The aim of the study was to analyze the influence of intrauterine exposure of the fetus to immunosuppression on the immunogenicity of protective vaccinations against selected bacterial pathogens. The ELISA method was used to determine the concentration of post-vaccination IgG antibodies against diphtheria, tetanus, pertussis, tuberculosis, H. influenzae type B, and S. pneumoniae in 18 children of mothers who underwent organ transplantation. The results were compared with the control group (n = 21). A comparison of the incidence of adverse post-vaccination reactions between the analyzed groups was also performed. There were no statistically significant differences in the immunogenicity of the analyzed vaccines between children of mothers who underwent organ transplantation and the age-matched general pediatric population. There were no differences in the incidence of adverse post-vaccination reactions between the analyzed groups. The obtained results do not indicate the need to modify the current protective vaccination schemes against bacterial pathogens in children of mothers who underwent organ transplantation.

Spatio-temporal distributions and determinants of diarrhea among under-five children in Ethiopia

Objective

The purpose of this study was to evaluate the spatio-temporal pattern of Ethiopia's childhood diarrheal disease and identify its contributing factors.

Methods

We conducted analyses on secondary data from four Ethiopian Demographic and Health Surveys conducted between 2000 and 2016. Moran's I was used to determine spatial dependence and spatial models were used to evaluate variables associated with diarrhea in under-five children at the zonal level.

Results

Childhood diarrhea showed spatial clustering in Ethiopia (Moran's I; p < 0.05). The spatial regression model revealed significant factors at the zonal level: children born at home (e θ = 1.355, 95% CI: 1.052-1.544, p < 0.001), low birth weight (e θ = 1.18, 95% CI: 1.017-1.691, p < 0.05), and unimproved source of water (e θ = 0.8568, 95% CI: 0.671-1.086, p < 0.01).

Conclusion

The prevalence of diarrhea among under-five children varied over time by zone, with the Assosa, Hundene, and Dire Diwa zones having the highest rates. Home births and low birth weight contributed to the prevalence of childhood diarrhea. In high-risk zones of Ethiopia, reducing childhood diarrhea requires integrated child health interventions and raising awareness about the potential hazards associated with unimproved water sources.

Maternal immunoglobulin G affects brain development of mouse offspring

Maternal immunoglobulin (Ig)G is present in breast milk and has been shown to contribute to the development of the immune system in infants. In contrast, maternal IgG has no known effect on early childhood brain development. We found maternal IgG immunoreactivity in microglia, which are resident macrophages of the central nervous system of the pup brain, peaking at postnatal one week. Strong IgG immunoreactivity was observed in microglia in the corpus callosum and cerebellar white matter. IgG stimulation of primary cultured microglia activated the type I interferon feedback loop by Syk. Analysis of neonatal Fc receptor knockout (FcRn KO) mice that could not take up IgG from their mothers revealed abnormalities in the proliferation and/or survival of microglia, oligodendrocytes, and some types of interneurons. Moreover, FcRn KO mice also exhibited abnormalities in social behavior and lower locomotor activity in their home cages. Thus, changes in the mother-derived IgG levels affect brain development in offsprings.

Human Milk-The Biofluid That Nourishes Infants from the First Day of Life

Human milk is a biofluid with a unique composition among mammalian milks. Besides this milk's major components, its bioactive compounds, like hormones, immune factors, and oligosaccharides, are unique and important for infant growth and development. The best form of nutrition for term and preterm infants is the mother's own milk. However, in the absence of the mother's own milk, donor milk should be made available. Milk banks support neonatal intensive care units by providing preterm infants with human milk that generally has reasonable nutritive value for this sensitive population. However, neither mother's own milk nor donor milk has sufficient energy content for the growth of preterm babies, so adequate human milk supplementation is crucial for their progress. Due to the different characteristics of human breast milk, as well as ubiquitous environmental pollutants, such as microplastics, new methods are required for monitoring the quality and characteristics of human milk, which will lay a solid foundation for the further development and progress of human milk research.

Pre-Operative Immunonutrition Enhances Postoperative Outcomes and Elevates Tumor-Infiltrating Lymphocyte Counts in Colorectal Cancer Patients: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

This study (CRD42023464989) aimed to explore the effects of pre-operation immunonutrition on safety and immune related factors in colorectal cancer patients undergoing surgery.

METHODS

We systematically searched PubMed, Embase, and Wanfang databases to collect all clinical randomized controlled trials of the application of pre-operation immunonutrition for patients with colorectal cancer, published until July 2023. The primary outcomes were safety and immune related factors.

RESULTS

A total of 16 studies were finally included. Preoperative immunonutrition could reduce the postoperative infection rate (risk ratio (RR) = 0.56, 95% confidence interval (CI): 0.36, 0.88; p = .01), and wound infection rate (RR = 0.44, 95% CI: 0.27, 0.70; p < .001) in patients with colorectal cancer. For length of stay (mean difference (MD) = -1.10, 95% CI: -2.70, 0.49; p = .17), it was similar between groups. Meanwhile, patients in the pre-operation immune nutrition group also had significantly increased infiltrative lymphocytes CD16+ (MD = 0.04, 95% CI: 0.02, 0.06; p < .001), and CD56+ (MD = 0.05, 95% CI: 0.03, 0.06; p < .001) cells in the tumor tissues, compared to the control group.

CONCLUSION

Immunonutrition intervention has the potential to reduce postoperative infectious complications and improve tumor infiltrative lymphocytes in patients with colorectal cancer undergoing surgery.

Exploring the profound link: Breastfeeding's impact on alleviating the burden of breast cancer - A review

Breastfeeding has emerged as a critical factor in understanding and potentially mitigating the risk of breast cancer among women. This review delves into the intricate relationship between breastfeeding and breast cancer, elucidating the biological mechanisms, protective effects, and broader implications for public health. Epidemiological evidence consistently demonstrates a correlation between breastfeeding and a reduced risk of breast cancer, with longer durations of lactation showing a dose-dependent decrease in risk. The biological nexus between breastfeeding and breast cancer involves hormonal changes and the elimination of potentially damaged cells, influencing breast tissue and potentially mitigating carcinogenesis. Moreover, breastfeeding appears to impact tumor subtypes and aggressiveness, particularly demonstrating associations with lower risks of hormone receptor-negative and certain aggressive breast cancer subtypes. Recognizing the significance of breastfeeding in reducing breast cancer risk has profound public health implications, necessitating comprehensive support, education, and policies to encourage and facilitate breastfeeding.

Breast Milk Enema and Meconium Evacuation Among Preterm Infants: A Randomized Clinical Trial

Importance

Delayed meconium evacuation and delayed achievement of full enteral feeding among premature infants are associated with poor short- and long-term outcomes. Identifying a more effective and safer enema for meconium evacuation is imperative for improving neonatal care.

Objective

To examine whether breast milk enemas can shorten the time to complete meconium evacuation and achievement of full enteral feeding for preterm infants.

Design, Setting, and Participants

This randomized, open-label, parallel-group, single-center clinical trial was conducted from September 1, 2019, to September 30, 2022, among 286 preterm infants with a gestational age of 23 to 30 weeks in the neonatal ward of the Shengjing Hospital of China Medical University in Shenyang.

Interventions

Preterm infants were randomly assigned to receive either breast milk enemas or normal saline enemas 48 hours after birth.

Main Outcome and Measures

The primary outcomes were time to complete meconium evacuation and time to achieve full enteral feeding. Secondary outcomes were duration of hospitalization, weight at discharge, and duration of total parenteral nutrition. Intention-to-treat and per-protocol analyses were conducted.

Results

In total, 286 preterm infants (mean [SD] gestational age, 198.8 [7.9] days; 166 boys [58.0%]) were eligible and included in this study. A total of 145 infants were randomized to the normal saline group, and 141 were randomized to the breast milk group. The time to achieve complete meconium evacuation was significantly shorter in the breast milk group than in the normal saline group (-2.2 days; 95% CI, -3.2 to -1.2 days). The time to achieve full enteral feeding was also significantly shorter in the breast milk group than in the normal saline group (-4.6 days; 95% CI, -8.0 to -1.2 days). The duration of total parenteral nutrition was significantly shorter in the breast milk group than in the normal saline group (-4.6 days; 95% CI, -8.6 to -1.0 days). There were no clinically notable differences in any other secondary or safety outcomes between the 2 groups.

Conclusions and Relevance

In this randomized clinical trial testing the effects of breast milk enema on meconium evacuation, breast milk reduced the time to achieve complete meconium evacuation and achieve full enteral feeding for preterm infants with a gestational age of 23 to 30 weeks. Subgroup analyses highlight the need for tailored interventions based on gestational age considerations.

Trial Registration

isrctn.org Identifier: ISRCTN17847514.

Environmental chemical TCPOBOP exposure alters milk liposomes and offspring growth trajectories in mice

Exposure to environmental endocrine disruptors (EEDs) has become a global health concern, and EEDs are known to be potent inducers of constitutive androstane receptor (CAR). 1,4-bis [2-(3,5-dichloropyridyloxy)] benzene (TCPOBOP, hereafter abbreviated as TC), a specific ligand for CAR, has been considered as a potential EED. Here, we analyzed the effect of TC exposure to female mice on the histological morphology of their alveoli in the basic unit of lactation. We quantified differences in the milk metabolome of the control and TC-exposed group while assessing the correlations between metabolites and neonatal growth. Mammary histological results showed that TC exposure inhibited alveolar development. Based on the milk metabolomic data, we identified a total of 1505 differential metabolites in both the positive and negative ion mode, which indicated that TC exposure affected milk composition. As expected, the differential metabolites were significantly enriched in the drug metabolism pathway. Further analyses revealed that differential metabolites were significantly enriched in multiple lipid metabolic pathways, such as fatty acid biosynthesis, suggesting that most differential metabolites were concentrated in lipids. Simultaneously, a quantitative analysis showed that TC exposure led to a decrease in the relative abundance of total milk lipids, affecting the proportion of some lipid subclasses. Notably, a portion of lipid metabolites were associated with neonatal growth. Taken together, these findings suggest that TC exposure may affect milk lipidomes, resulting in the inability of mothers to provide adequate nutrients, ultimately affecting the growth and health of their offspring.

Circadian Variation of Immune Cell Populations in Preterm Human Milk: A Preliminary Study

Introduction: Breast milk contains both nutritional and non-nutritional components for the newborn, with some of the latter exhibiting marked diurnal variations in concentration. This study aimed to analyze the circadian behavior of specific immune cell populations and proinflammatory cytokines present in the transitional milk of premature infants. Methods: The study quantified cellular components, including stem and immune cells, using flow cytometry. Additionally, ELISA assays were employed to measure proinflammatory cytokine concentrations. Results: Flow cytometry analyses revealed a diurnal rise in the percentage of CD23+, CD32+, CD36+, CD2+, and Tγδ cell populations. Conversely, nocturnal increases were observed in the percentage of CD16+, CD19+, and CD4+ populations. Notably, CD3+ and CD8+ populations did not exhibit any rhythmic variations. Proinflammatory cytokine concentrations were found to be higher in daytime milk samples compared to those collected at night. Conclusion: This study demonstrates rhythmic fluctuations in both immune cell populations and proinflammatory cytokine concentrations within the transitional milk of premature mothers.

Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children

BACKGROUND

The aim of this study was to analyze the relationship between breastfeeding duration and adenoid size, snoring and acute otitis media (AOM).

METHODS

We analyzed the medical history of children admitted to the ENT outpatient clinic in 2022 and 2023, reported symptoms, ear, nose and throat (ENT) examination, and flexible nasopharyngoscopy examination of 145 children aged 3-5 years.

RESULTS

Breastfeeding duration of 3 and 6 months or more had a significant effect on the reduction of snoring (p = 0.021; p = 0.039). However, it had no effect on the adenoid size, mucus coverage and sleeping with an open mouth. Snoring was correlated with open mouth sleeping (p < 0.001), adenoid size with a 75% A/C ratio or more (p < 0.001), and adenoid mucus coverage in the Mucus of Adenoid Scale by Nasopharyngoscopy Assessment-MASNA scale (p = 0.009). Children who were breastfed for less than 3 months had more than a four-fold greater risk of snoring. There was a statistically significant correlation between AOM and gender (p = 0.033), breastfeeding duration in groups fed 1, 3 or 6 months or more (p = 0.018; p = 0.004; p = 0.004) and those fed with mother's breast milk 3 or 6 months or more (p = 0.009; p = 0.010). Moreover, a correlation was found between adenoid size and mucus coverage, tympanogram, and open-mouth sleeping (p < 0.001). Independent factors of snoring in 3- to 5-year-old children were breastfeeding duration of less than 3 months (p = 0.032), adenoid size with an A/C ratio of 75% or more (p = 0.023) and open mouth sleeping (p = 0.001).

CONCLUSIONS

Children breastfed for 3 and 6 months or more exhibited reduced rates of snoring. There was no effect of breastfeeding duration on adenoid size in children aged 3 to 5 years, suggesting that the link between breastfeeding duration and snoring is primarily associated with craniofacial development and muscle tone stimulation. A breastfeeding duration of 1 month or more plays a key role in reducing the rate of AOM. The mother's milk plays a protective role against AOM. The presence of mucus might be responsible for snoring in preschool children. A medical history of breastfeeding should be taken into consideration when snoring children are suspected of adenoid hypertrophy.

Understanding the Immunological Quality of Breast Milk in Maternal Overweight and Obesity

Maternal obesity, affecting many pregnant women globally, not only poses immediate health risks but also modulates breast milk composition. Obesity is linked to inflammation and oxidative stress, impacting breast milk's immune properties. This paper explores the intricate relationship between maternal metabolic disorders, such as obesity, and breast milk's immunological components. We conducted a thorough search for original and review articles published until 17 October 2023 in the PUBMED/Scopus database. This search included several terms related to human breast milk, immunological properties, and obesity. Articles were selected with the consensus of all authors. Maternal metabolic disorders have discernible effects on the composition of immune-related components in breast milk, such as immunoglobulins, lactoferrin, leptin, ghrelin, adiponectin, C-reactive protein, growth factors, extracellular vesicles, and lymphocytes. These changes in breast milk composition can significantly impact the newborn's immune system, with potential long-term health implications beyond the immediate postnatal period. Maternal metabolic health is a critical factor in shaping the health trajectory of the neonate through breastfeeding, although the full advantages of breastfeeding for children of mothers with obesity remain uncertain. Ongoing research aims to understand and unravel these links.

Protect the Microbiome: Be HOLISTIC

The newborn who requires intensive care hospitalization is forced into an external environment that can negatively impact the developing microbiome. The NICU nurse has a unique role that affects, and may even protect, the development of the newborn microbiome through daily nursing care. The purpose of this article is to inform neonatal nurses regarding common nursing interventions that can positively or negatively impact the developing microbiome. Evidence-based practices are presented and bundled to describe their impact the neonatal microbiome.

The Psychological Benefits of Breastfeeding: Fostering Maternal Well-Being and Child Development

The value of breastfeeding surpasses its utilitarian role in nourishing, encompassing profound psychological advantages for mothers and children. The orchestration of emotional bonds relies on the interplay of oxytocin and prolactin, fundamental hormones that underpin maternal attachment, mitigate postpartum depression, and cultivate self-confidence. Simultaneously, breastfeeding promotes infant development by fostering robust brain growth, bolstering immune defenses, and nurturing cognitive and emotional maturation - all of which are nurtured through maternal interactions. We must respond to the call for heightened advocacy of breastfeeding. This entails delivering education, easily accessible support, and creating an environment where breastfeeding is normalized. By dispelling misconceptions and eradicating stigmatization associated with breastfeeding, we can amplify awareness and empower mothers to make well-informed decisions for their newborns. These implications reverberate extensively. Enhanced maternal mental well-being and self-assurance form the bedrock of healthier family dynamics. At the same time, the dividends of cognitive, emotional, and immunological enrichment in children represent a more promising future. At a societal level, the embrace and promotion of breastfeeding cultivate an environment that places immense value on the health and happiness of both mothers and children. This journey is more profound than mere sustenance; it signifies a complex web of advantages. Elevating awareness and support for breastfeeding solidifies the global commitment to comprehensive maternal and child welfare and the flourishing of meaningful relationships.

Concurrent wasting and stunting among marginalised children in Sana'a city, Yemen: a cross-sectional study

Concurrent wasting and stunting (WaSt) is a serious form of malnutrition among young children, particularly vulnerable groups affected by the conflict. Understanding the prevalence and risk factors of WaSt among vulnerable children is important to develop effective intervention measures to reduce the burden of WaSt. The present study aimed to identify the prevalence of and risk factors for WaSt among marginalised children aged 6-59 months in Sana'a city, Yemen. A community-based cross-sectional design was conducted on a total sample size of 450 marginalised children aged 6-59 months who lived at home with their mothers. Multivariable logistic regression analysis was performed and the prevalence of WaSt was found to be 10⋅7 %. Children aged 24-59 months were protected from WaSt (adjusted odds ratio (AOR) 0⋅40, 95 % confidence interval (CI) 0⋅21, 0⋅75). A higher prevalence of WaSt was associated with male sex (AOR 2⋅31, 95 % CI 1⋅13, 4⋅71), no history of being breastfed (AOR 3⋅57, 95 % CI 1⋅23, 10⋅39), acute diarrhoea (AOR 2⋅12, 95 % CI 1⋅12, 4⋅02) and family income sources of assistance from others (AOR 2⋅74, 95 % CI 1⋅08, 6⋅93) or salary work (AOR 2⋅22, 95 % CI 1⋅10, 4⋅47). Continued breast- and bottle-feeding were not associated with WaSt in children aged 6-23 months. Mothers' age, education and work status, family size and drinking water source were not associated with WaSt. Overall, we found that the prevalence of WaSt among marginalised children remained high. Interventions to improve household income, hygienic conditions and child feeding practices are necessary to promote child growth.