Potential Epigenetic Effects of Human Milk on Infants' Neurodevelopment

The advantages of human milk feeding, especially in preterm babies, are well recognized. Infants' feeding with breast milk lowers the likelihood of developing a diverse range of non-communicable diseases later in life and it is also associated with improved neurodevelopmental outcomes. Although the precise mechanisms through which human milk feeding is linked with infants' neurodevelopment are still unknown, potential epigenetic effects of breast milk through its bioactive components, including non-coding RNAs, stem cells and microbiome, could at least partly explain this association. Micro- and long-non-coding RNAs, enclosed in milk exosomes, as well as breast milk stem cells, survive digestion, reach the circulation and can cross the blood-brain barrier. Certain non-coding RNAs potentially regulate genes implicated in brain development and function, whereas nestin-positive stem cells can possibly differentiate into neural cells or/and act as epigenetic regulators in the brain. Furthermore, breast milk microbiota contributes to the establishment of infant's gut microbiome, which is implicated in brain development via epigenetic modifications and key molecules' regulation. This narrative review provides an updated analysis of the relationship between breast milk feeding and infants' neurodevelopment via epigenetics, pointing out how breast milk's bioactive components could have an impact on the neurodevelopment of both full-term and preterm babies.

The impact of maternal- and neonatal-associated factors on human milk's macronutrients and energy

OBJECTIVES

To test the impact of specific maternal- and neonatal-associated factors on human milk's macronutrients and energy.

METHODS

This study was conducted with the use of a human milk analyzer (HMA, MIRIS, Uppsala, Sweden). Six hundred and thirty samples of raw milk and 95 samples of donor pasteurized milk were delivered from a total of 305 mothers.

RESULTS

A significant inverse correlation of fat, protein and energy content with gestational age and birth weight was established. Fat and energy were lower in colostrum, increased in transitional milk and decreased on the 30th day's mature milk compared to transitional. The rate of protein decline from colostrum to mature milk was lower in premature deliveries compared to that of full-terms, resulting in greater contents of protein in preterm mature milk. The upmost amounts of carbohydrates were found in mature milk of preterm deliveries. A positive correlation was found between maternal age and fat contents. In women with higher post-pregnancy BMI levels greater analogies of fat and energy were presented. In women suffering diet-controlled gestational diabetes (GD), lower protein and higher fat and energy levels were found.

CONCLUSIONS

Prematurity, maternal age, diet-controlled GD and high post-pregnancy BMI levels were found to impose statistical significant effect on milk's macronutrients and energy.

Mother's breast milk supplemented with donor milk reduces hospital and health service usage costs in low-birthweight infants

OBJECTIVE

to compare hospital and health service usage costs of feeding low-birthweight (LBW) infants predominantly with their mother's milk, supplemented with donor milk, with donor milk and preterm formula.

DESIGN

prospective matching study.

SETTING

tertiary public perinatal centre, neonatal intensive care unit (NICU) and donor human milk bank.

PARTICIPANTS

100LBW infants (Group I) fed predominantly with their mother's milk from the first hour of life, supplemented (mainly for the first week of life) with donor milk, were matched on a 1:1 basis with 100LBW infants (Group II) who were fed with donor milk for the first 3 weeks of life followed by preterm formula until hospital discharge. Individualised targeted fortification of human milk was implemented in both study groups.

FINDINGS

the costs of hospitalisation, doctor visits and prescription drugs for viral infections until 8 months of age were calculated for each infant. Infants fed predominantly with their mother's milk had significantly shorter hospital stays and lower hospitalisation costs. In Group I infants, the duration of enteral gavage feeding was shorter, resulting in significantly lower costs. Up to 8 months of age, Group I infants experienced fewer episodes of viral infections, and the cost of each doctor visit and drug prescription was lower for these infants.

CONCLUSIONS

feeding LBW infants predominantly with their mother's milk reduces hospital and health service usage costs.

IMPLICATIONS FOR PRACTICE

feeding LBW infants predominantly with their mother's milk, supplemented with donor milk, followed by exclusive breast feeding seems to result in potential savings in hospital and health service usage costs.

CRP levels in extremely low birth weight (ELBW) septic infants

OBJECTIVE

Testing the validity of C-reactive protein (CRP) in extremely low birth weight (ELBW) infants.

METHODS

During a five-year period, 483 infants with probable (36%) and definite sepsis (64%) were enrolled in the study.

RESULTS

ELBW infants with definitive sepsis had CRP levels comparable with full-terms (p=0.992). However, the highest (hs) values were observed in infants >2500 g, 24 h after the septic work up whereas in those with birth weight (BW) <1000 g after 48 h. Highest CRP levels of infants with early sepsis were similar to those of the late onset ones (p=0.825). The causative microorganism had a strong influence on CRP values, as Gram negative germs produced significantly higher CRP levels in comparison to infants with Gram positive sepsis.

CONCLUSIONS

Highest CRP values in <1000 g infants increase in levels comparable to full terms, but with a 24-h delay.

The role of maternal anxiety in the early postpartum period: screening for anxiety and depressive symptomatology in Greece

BACKGROUND

From birth to the first year postpartum, there is a critical period for the development of affective disorders. Maternal anxiety has received little attention even though it is associated with a number of adverse outcomes. Symptoms of anxiety often comorbid with depression and pertain a significant role in the maintenance of postpartum distress. The purpose of this study is to assess anxiety and depressive symptomatology in a Greek population and to examine their relationship. This study investigated the demographic and socio-psychological factors that are associated with the onset of the symptoms of postpartum distress.

METHOD

The study was conducted at the perinatal hospital Elena Venizelou in Greece. Two hundred thirty-five mothers met the inclusion criteria and participated in the study. The state-trait inventory was administered to screen symptoms of anxiety. It incorporates the state subscale that measures symptoms of temporal anxiety, and trait subscale that measures personality predisposition to anxiety. The Edinburgh postpartum depression scale (EPDS) inventory was administered to screen for symptoms of depression. The first assessment was conducted in 2-3 days after labor and the follow-up assessment was conducted in 3 months postpartum by telephone. A standard survey questionnaire was used for the purposes of collecting the demographic data.

RESULTS

Symptoms of postpartum depression had 14.5% of mothers on the first screening and 4.6% at the follow-up (EPDS >or= 14). State anxiety symptoms were manifested by 22.9% of the sample on the first screening and 12.6% at the follow-up. Trait anxiety symptoms exhibited 24.6% of the sample on the first screening and 14.3% at the follow-up. There was comorbidity between the symptoms of anxiety and depression. The comorbidity was evident even when the anxiety subscale of the EPDS was removed. State anxiety was correlated with primiparity, admission to the NICU and negative experience of labor. Trait anxiety was correlated with the marital status of the mother. The symptoms of depression were correlated with the young age of the mother and negative experience of labor.

CONCLUSION

Symptoms of maternal anxiety are common after labor in Greece and persist in the early postpartum period. This finding suggests that the impact of maternal anxiety should be considered when studying postpartum distress. The comorbidity amongst anxiety and depressive symptomatology persisted at 3 months postpartum making women more vulnerable to postpartum distress. Given this result screening prior to hospital discharge is essential as it can provide an indication of the mothers who are susceptible to developing affective disorders.

Cold agglutinin syndrome and hemophagocytosis in systemic leishmaniasis

A 3-year-old male child with high fever, hepatosplenomegaly, pancytopenia, haemolysis, striking histiocytosis and hemophagocytosis in bone marrow aspiration and high titre of cold agglutinin is described. Cold agglutinins were defined as polyclonal IgM with anti-I specificity. Diagnosis of visceral leishmaniasis was made on the basis of typical Leishman-Donovan bodies found in the patient's bone marrow, high titre of anti-leishmania antibodies and excellent response to treatment. Visceral leishmaniasis must be considered in the differential diagnosis of diseases with histiocytosis. Cold agglutinin syndrome may contribute to the haemolytic process which exists in leishmania-donovani infection.