The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis

Several potential risk factors have been identified in the etiopathogenesis of febrile seizures (FS), including the type and extent of breastfeeding (BF). Given the lack of conclusive data, this study aims to systematically evaluate the evidence on the association between BF and FS. We conducted a systematic review and meta-analysis according to PRISMA guidelines. The search was conducted using descriptors for FS, BF, and formula feeding in MEDLINE, Embase, and Web of Science databases. We included observational studies that compared the incidence of FS between those who had ever breastfed and those who were formula fed. The study protocol was registered on the PROSPERO platform under the number CRD42023474906. A total of 1,893,079 participants from 8 datasets were included. Our main analysis showed no significant association of any type of BF on the incidence of FS compared with formula-fed children (OR: 0.84; CI: 0.67-1.04; I2 = 78%; Cochran's Q = 0.0001), although meta-regression showed that BF was associated with a lower incidence of FS in preterm infants. Our secondary outcome showed a significantly reduced incidence of FS in children who received BF exclusively (OR: 0.80; CI: 0.65-0.99; I2 = 70%; Cochran's Q = 0.02).    Conclusion: There was no significant reduction in the incidence of FS in those who were breastfed compared to formula feeding. However, our meta-regression analysis indicated an association between BF and a lower incidence of FS in preterm infants. Additionally, children who exclusively received BF had a significantly reduced incidence of FS. These findings should be further investigated in prospective cohorts. What is Known: • Breastfeeding can modify risk factors for febrile seizures, such as susceptibility to viral and bacterial infections, micronutrient deficiencies, and low birth weight. • However, studies have shown conflicting results regarding the impact of breastfeeding on febrile seizures. What is New: • When comparing any breastfeeding pattern with no breastfeeding, there is no significant difference in the incidence of febrile seizures. • When comparing exclusive breastfeeding with no breastfeeding, there may be a decrease in the occurrence of febrile seizures.

Breastfeeding is associated with enhanced intestinal gluconeogenesis in infants

BACKGROUND

Breastfeeding (BF) confers metabolic benefits to infants, including reducing risks of metabolic syndrome such as obesity and diabetes later in life. However, the underlying mechanism is not yet fully understood. Hence, we aim to investigate the impacts of BF on the metabolic organs of infants.

METHODS

Previous literatures directly studying the influences of BF on offspring's metabolic organs in both animal models and humans were comprehensively reviewed. A microarray dataset of intestinal gene expression comparing infants fed on breastmilk versus formula milk was analyzed.

RESULTS

Reanalysis of microarray data showed that BF is associated with enhanced intestinal gluconeogenesis in infants. This resembles observations in other mammalian species showing that BF was also linked to increased gluconeogenesis.

CONCLUSIONS

BF is associated with enhanced intestinal gluconeogenesis in infants, which may underpin its metabolic advantages through finetuning metabolic homeostasis. This observation seems to be conserved across species, hinting its biological significance.

Es Niño o Niña?: Gender Differences in Feeding Practices and Obesity Risk among Latino Infants

Background

Obesity prevalence is significantly higher among Latino boys than girls. Weight status at 12 mo, a significant predictor of childhood obesity, is associated with feeding practices during infancy.

Objectives

The objectives were to examine breastfeeding and formula-feeding practices overall and by infant gender and to examine relations among infant gender, milk-feeding practices, and obesity risk among Latino infants over the first year of life.

Methods

Latino mother-infant dyads (n = 90) were recruited from a pediatric clinic. Mothers were interviewed at regular intervals (infants aged 2, 4, 6, and 9 mo), and 24-h feeding recalls were conducted when infants were aged 6 and 9 mo. Infants' lengths and weights were retrieved from clinic records to calculate weight-for-length percentiles. A bivariate analysis was conducted to compare feeding practices by gender and mediation analysis to test whether feeding practices mediated the relation between gender and obesity risk.

Results

The majority (80%) of mothers were born outside the United States. In early infancy, mixed feeding of formula and breastfeeding was common. At 6 and 9 mo of age, milk-feeding practices differed, with formula feeding more common for boys than girls. At 12 mo, 38% of infants experienced obesity risk (≥85th weight-for-length percentile). Infants' obesity risk increased by 18% per 1 oz increase in powdered formula intake. Formula intake among boys was on average 1.42 oz (in dry weight) higher than that among girls, which, in turn, mediated their increased obesity risk (IERR = 1.27, 95% confidence interval: 1.02, 1.90).

Conclusions

The increased obesity risk among Latino boys compared with girls at 12 mo was explained by higher rates of formula feeding at 6 and 9 mo of age. Future investigations of cultural values and beliefs in gender-related feeding practices are warranted to understand the differences in obesity risk between Latino boys and girls.

Parents' experiences of infant and young child feeding during the COVID-19 pandemic in Ireland

OBJECTIVE

The WHO has urged member states to develop preparedness plans for infant and young child feeding (IYCF) during emergencies. Ireland has no such plan. We aimed to identify the needs of caregivers in Ireland with regards IYCF during the COVID-19 pandemic.

DESIGN

Online survey conducted in May-June 2020.

SETTING

Ireland, during the first period of severely restricted movement due to COVID-19 (lockdown).

PARTICIPANTS

Respondents (n 745) were primary caregivers of a child under 2 years; they were primarily well educated and likely of higher socio-economic status.

RESULTS

Among those who breastfed, being unable to access breast-feeding support groups and being unable to access in-person, one-to-one breast-feeding assistance were the biggest challenges reported. Nearly three quarters of those who had their babies during lockdown reported these challenges: 72·8 % and 68·8 %, respectively. For those using formula, the main challenges were structural in nature; approximately two-thirds of those who had their baby prior to lockdown feared there would be formula shortages and a third were unable to purchase formula due to shortages.

CONCLUSIONS

Regardless of how their babies were fed, parents in Ireland experienced multiple challenges with infant feeding during the COVID-19 crisis. Breast-feeding should be protected, supported and promoted, particularly during an infectious disease pandemic. Additionally, assurances around supply of infant formula could reduce parental stress during a pandemic or emergency. An IYCF in emergencies plan would clearly set out how we could best support and protect the nutrition of the most vulnerable members of our population.

Does the feeding method affect the quality of infant and maternal sleep? A systematic review

Breastfeeding brings many benefits to both mother and infant. Although, many women stop breastfeeding their infants too soon. The perceived association between breastfeeding and sleep may influence their decision to terminate breastfeeding. In our systematic review, we focused on mapping the relationship between infant feeding method and total sleep time (TST), number of nocturnal awakenings, awakenings after sleep onset (WASO) of mothers and infants and sleep quality of mothers. We searched four databases according to selected keywords and inclusion criteria - articles published in peer-reviewed journals between 2012 and 2022; English language; a sample consisting of mothers, infants, or both (without psychiatric and health problems); a comparison of the sleep quality of breastfed and formula-fed children or breastfeeding and formula-fed mothers. We read 260 full texts of selected articles. A total of 35 articles were included in this review. Due to significant heterogeneity, meta-analysis was not possible to accomplish. The results are processed according to narrative synthesis. Most studies agree that breastfed infants wake up more often at night. Total sleep time and time spent awake during the night (WASO) did not differ between breastfed and non-breastfed infants. We observed identical results in sleep variables among mothers. Additionally, there was no difference in maternal sleep quality. The synthesis revealed that the results may have differed due to using subjective, objective methods or the infant's age. It is important to remember that night waking is a more complex concept. Infants wake for many reasons, not just due to breastfeeding. The narrative synthesis indicated that the chosen study design, measurement method, the variables, and the infant's age could influence outcomes. In addition, other variables appeared that may affect the entire process. Therefore, we recommend that attention be paid to this in future studies.

Breastfeeding and the quality of the sibling relationship

OBJECTIVE

To examine the association between the type of breastfeeding practiced and the quality of the sibling relationship.

DESIGN

Cross-sectional study.

METHOD

Participants were recruited between July and December 2019 through parenting associations and parenting support groups. They comprised a total of 149 mothers with two children between 2 and 7 years of age, who had practiced the same type of feeding with both children. Sibling relationship quality was assessed using the conflict/rivalry and warmth dimensions of the Parents' Expectations and Perceptions of Sibling Relationships with their Children (PEPC-SRQ) questionnaire. Analyses of covariance were used to identify any differences in these two dimensions of the PEPC-SRQ between the study groups (formula feeding, breastfeeding, non-prolonged breastfeeding, prolonged breastfeeding and tandem breastfeeding).

RESULTS

No significant differences were observed between any of the groups regarding the conflict/rivalry dimension; in contrast, significant differences were found in the warmth dimension between the breastfeeding and formula feeding groups.

CONCLUSIONS

Breastfeeding, regardless of its duration and simultaneity, was associated with higher scores in the dimension of warmth of the sibling relationship.

IMPLICATIONS FOR PRACTICE

This information should be considered by healthcare professionals when providing advice on breastfeeding.

Comparison of renal growth in breast fed and artificial fed infants: a cross-sectional study

INTRODUCTION

Renal growth in infancy determines renal function in adulthood and can easily be assessed via infant renal volume. Renal growth is influenced by many endogenous and exogenous factors among which nutrition is of prime importance. Worldwide, infants get their nutrition either from breast milk or formula, both of which have controversial roles in kidney growth and development.

METHODS

A cross-sectional study was done on healthy infants in the Pediatric Nephrology Department of Mayo Hospital, Lahore. These infants were either breastfed or artificially fed and their kidney volumes were noted to determine any significant difference in kidney size. Both informed and written consent was taken before data collection and the data was analyzed using SPSS version 26.

RESULTS

Out of 80 infants included in our study, 55% were male and 45% were female. The mean age was 8.9 months and the mean weight was 7.6 kg. The mean total kidney volume was 45.38 cm³ and the mean relative kidney volume was 6.12 cm³/kg. No statistical difference in relative renal volume was found between breastfed and artificially fed infants.

CONCLUSION

The present study aimed to compare the renal volume and thus renal growth in breastfed versus formula-fed infants. No statistical significance was found in relative renal volume between breastfed and artificially fed infants.

Relationship Between Human Milk Feeding Patterns and Growth in the First Year of Life in Infants with Congenital Heart Defects

The purpose of this study was to determine the relationship between patterning of human milk feeding and growth of infants with congenital heart defects in the first year of life. Inclusion criteria for this prospective cohort study included infants 0-21 days, who had undergone or had planned neonatal corrective or palliative surgery prior to hospital discharge, and whose mothers planned to feed human milk. Data on anthropometric measures (weight, length, head circumference) and infant milk type (human milk, formula, other) were collected at nine time points (0.5, 1, 2, 3, 4, 6, 8, 10, 12 months). Anthropometric data were converted to weight-for-age, length-for-age, head circumference-for-age, and weight-for-length Z-scores using World Health Organization growth reference data. Cluster analysis identified three milk type feeding patterns in the first year: Infants fed human milk only with no formula supplementation, infants fed human milk who then transitioned to a mix of human milk and formula, and infants who fed human milk and transitioned to formula only. General linear models assessed the effect of milk type feeding patterns on growth parameters over time. No effect of milk type pattern × time was found on longitudinal changes in weight-for-age (p for interaction = 0.228), length-for-age (p for interaction = 0.173), weight-for-length (p for interaction = 0.507), or head circumference-for-age (p for interaction = 0.311) Z-scores. In this cohort study, human milk alone or combined with infant formula supported age-appropriate growth in infants with congenital heart defects in the first year.

Exploring the Feasibility and Acceptability of Providing Caregivers Who Formula-feed with Smaller Infant Bottles in a Primary Care Clinic

OBJECTIVES

Larger bottle size is associated with faster weight gain in infants, but little is known about acceptability and feasibility of providing bottles in primary care clinics.

METHODS

We randomized parent-infant dyads (N = 40) to receive a set of 4-ounce bottles or to continue using their own bottles. Demographic and anthropometric information were collected at enrollment and one follow-up visit 1-5 months later. The primary aim was to assess feasibility and acceptability of the intervention strategy. We compared components of bottle feeding, including usual bottle sizes used, number and volume of feeds with Wilcoxon rank-sum tests, and changes in weight-for-age and weight-for-length z-scores during the study period with t-tests, using p < 0.05 as an indicator of statistical significance.

RESULTS

Of participants randomized to receive bottles, 90% were using the 4oz bottles at follow up. The intervention group reported a significantly lower median bottle size (4oz) than the control group (8oz) at follow up, and parents reported acceptability and continued use of the bottles.

CONCLUSIONS FOR PRACTICE

An intervention to provide smaller bottles was feasible, mostly acceptable, resulted in lower median bottle size. Further research is needed to determine whether it represents a novel way to prevent rapid infant weight gain.

Stressful life events in pregnancy: A risk factor for exclusive breastfeeding among high-income mothers

OBJECTIVE

The aim of this study was to examine the association between prenatal stressful life events in pregnancy and breastfeeding initiation, exclusivity, and duration, defined according to the WHO.

STUDY DESIGN

Feeding practices were prospectively collected from 425 puerperae living in an industrialized area of Northeast Italy starting on the second day post-partum, when they filled out the Life Experience Survey (LES, 1978).

RESULTS

In this sample, analysis revealed that at discharge 65/358 (18.16 %) puerperae presented with a negative LES score and 293/358 (81.84 %) with a positive LES score. Puerperae with negative LES scores were more likely to adopt formula at discharge, either to complement breast milk or to substitute breast milk altogether (16/65; 24.62 % vs 43/293; 14.68 %; RR = 1.64 and 95 % CI: 1.01-2.70), and they were also more likely to adopt exclusive formula feeding at the 3rd month of life (8/48; 16.66 % versus 18/242; 7.44 %; RR = 2.03 and 95%CI: 1.06-3.86). At the 6th month of life, there were significantly less puerperae with a negative LES score who were breastfeeding exclusively (1/48; 2.08 vs 44/249; 17.67 %; RR = 0.11 and 95 % CI: 0.01-0.84) and correspondingly there were significantly more puerperae with a negative LES score who were using formula feeding with weaning practices (20/48; 41.67 % vs 35/249; 14.06 %; RR =3.14 and 95 % CI: 1.82-5.04).

CONCLUSIONS

Identification of specific barriers to breastfeeding related to negative life events in pregnancy may help direct providers' anticipatory guidance to improve breastfeeding rates in high-risk populations.

Poly- and perfluoroalkyl substances (PFAS) exposure through infant feeding in early life

BACKGROUND AND AIMS

Per- and polyfluoroalkyl substances (PFAS) are non-degradable, man-made-chemicals with an elimination half-life of multiple years, causing accumulation in the environment and humans with potential harmful effects. However, longitudinal PFAS levels in human milk, daily PFAS intake and the association with infant plasma PFAS levels have never been reported. We investigated longitudinal PFOA and PFOS levels in human milk and the daily PFAS intake through infant feeding in the first 3 months of life, the most important determinants and the correlation with PFAS plasma levels at age 3 months and 2 years.

METHODS

In 372 healthy term-born Dutch infants, we determined PFOA and PFOS levels in human milk given at age 1 and 3 months, in 6 infant formula brands and in infant plasma at 3 months and 2 years, using liquid-chromatography-electrospray-ionization-tandem-mass-spectrometry(LC-ESI-MS/MS). We studied the associations between daily PFAS intake and predictive characteristics by multiple regression models.

RESULTS

PFOA and PFOS levels in human milk decreased between 1 and 3 months after delivery, regardless whether breastfeeding was given exclusively(EBF) or in combination with formula feeding. PFOA and PFOS could not be detected in any formula feeding. Daily PFAS intake(ng/kg) was highest in EBF-infants. Higher amount of human milk, older maternal age, lower parity and first-time breastfeeding were associated with higher daily intake. Daily PFAS intake in early life was strongly correlated with PFAS plasma levels at age 3 months and 2 years(R = 0.642-0.875, p < 0.001).

CONCLUSIONS

Human milk contains PFOA and PFOS, in contrast to formula feeding. Daily PFOA and PFOS intake in early life is highest in exclusively breastfed infants and it is highly correlated with infant's plasma levels throughout infancy. Our findings show that breastfeeding is an important PFAS exposure pathway in the first months of life, with unknown but potential adverse effects. Knowing the important health benefits of breastfeeding, our findings warrant more research about the health outcomes in later life.

Differences in infant feeding practices between Indian-born mothers and Australian-born mothers living in Australia: a cross-sectional study

Background

Immigrant children from low- and middle-income countries (e.g. India) have higher obesity rates than children from high-income countries (e.g. Australia). Infant feeding practices are a key modifiable risk factor to prevent childhood obesity. This study compared infant feeding practices such as breastfeeding, infant formula feeding, timing of introduction to other liquids and solids of Indian-born versus Australian-born mothers living in Australia.

Methods

Data of children aged between 0–24 months from the 2010–2011 Australian National Infant Feeding Survey were analysed. Infant feeding practices between Indian-born mothers (n = 501) and Australian-born mothers (n = 510) were compared. Multiple regression models with adjustments for covariates, such as maternal demographic factors, were conducted.

Results

Compared to infants of Australian-born mothers, infants of Indian-born mothers were breastfed for 2.1 months longer, introduced solids 0.6 months later and water 0.4 months later (p < 0.001). Moreover, infants of Indian-born mothers were 2.7 times more likely to be currently breastfeeding, 70% less likely to currently consume solids and 67% less likely to consume solids before six months (p < 0.001). In contrast, infants of Indian-born mothers were introduced to fruit juice 2.4 months earlier, water-based drinks 2.8 months earlier and cow’s milk 2.0 months earlier than infants of Australian-born mothers (p < 0.001). Additionally, infants of Indian-born mothers were 2.7 times more likely to consume fruit juice (p < 0.001) than the infants of Australian-born mothers.

Conclusion

Significant differences exist in infant feeding practices of Indian-born and Australian-born mothers (some health promoting and some potentially obesogenic). The evidence of early introduction of sweetened fluids in infants of Indian-born mothers provides an opportunity to support parents to delay introduction to promote optimal infant growth..

An exploration of pregnant women and mothers' attitudes, perceptions and experiences of formula feeding and formula marketing, and the factors that influence decision-making about infant feeding in South Africa

Background

Despite strong evidence showing the lifelong benefits of breastfeeding for mothers and children, global breastfeeding practices remain poor. The International Code of Marketing of Breastmilk Substitutes is an internationally agreed code of practice, adopted by the World Health Assembly in 1981, to regulate promotion of commercial formula, and is supported by legislation in many countries. However, marketing of formula remains widespread and contributes to mother’s decisions to formula feed. We present South African data from a multi-country, mixed-methods study exploring women’s decision-making about infant feeding and how this was influenced by exposure to formula marketing.

Methods

Using a consumer-based marketing approach, focus group discussions (FGDs) were conducted with pregnant women and mothers of children aged between 0 and 18 months in two urban sites in South Africa. Participants were purposively selected according to their child’s age, infant feeding practices and socioeconomic status. Ten FGDs were conducted during February 2020 with a total of 69 participants. Thematic analysis was used to analyse the data with NVivo v.12 software.

Results

Despite being encouraged by health professionals to breastfeed and intending to do so, many mothers chose to give formula in the early weeks and months of their child’s life. Mothers reported breastfeeding challenges as the most frequent reason for initiating infant formula, stating that family members and health professionals recommended formula to solve these challenges. Although participants described few advertisements for infant formula, advertisements for ‘growing-up’ formulas for older children were widespread and promoted brand recognition. Mothers experienced other marketing approaches including attractive packaging and shop displays of infant formula, and obtained information from social media and online mothers’ groups, which influenced their choice of formula brand. Mothers reported strong brand loyalty derived from previous experiences and recommendations. Health professionals frequently recommended formula, including recommending specific formula brands and specialist formulas.

Conclusion

Global formula companies use multifaceted marketing methods to promote a strong narrative portraying formula feeding as a positive lifestyle choice. Positive, coordinated efforts are required to counter pro-formula messaging and change the narrative to support breastfeeding as an aspirational choice. In particular, health professionals must stop supporting the formula industry.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12784-y.

African American Mothers' Decision to Discontinue Breastfeeding and Switch to Formula

After initiating breastfeeding, some African American mothers find adjusting to the demands challenging and discontinue breastfeeding. To learn about decisions switching to formula, we conducted a secondary analysis of qualitative interviews with African American mothers ≥ 18 years old. Data were analyzed using thematic analysis guided by the social cognitive theory. We identified four key themes that reflect personal, behavioral, and environmental factors: (1) simplicity of formula, (2) diverse support networks, (3) early breastfeeding is most important, and (4) lack of access to breastfeeding support resources. To increase breastfeeding duration among African American mothers, it is essential for interventions to be comprehensive including various strategies such as education regarding the physical aspects of breastfeeding, exposure to African American breastfeeding mothers, and active involvement of support persons. More research among African American mothers is needed to identify effective opportunities for change in cultural, social, and structural systems that impede successful breastfeeding.

The effect of feeding patterns on serum zonulin levels in infants at 3-4 months of age

Zonulin so far is the only known endogenous modulator of intercellular tight junctions which regulate the intestinal permeability. Breastfeeding is considered to enhance the integrity of the gastrointestinal tract; however, limited data are available about the effect of feeding patterns on intestinal permeability. We aimed to investigate the potential association between the mode of feeding (breast versus formula milk) and the serum zonulin levels as a marker of intestinal permeability. One hundred fifty-seven full-term, healthy infants, born after an uncomplicated pregnancy, were enrolled within 72-96 h of life. Blood samples from 105 infants were obtained at 3 to 4 months of life. Serum zonulin levels were measured by ELISA. Out of 105 infants, 52.4% (55) were female, and 58.1% (61) were delivered by caesarian section at a mean gestational age of 38.9 (SD ± 1.0) weeks. At the time of blood sampling, median age was 3.4 (IQR 3.20-3.50) months, and mean weight was 6332 (SD ± 692) gr. Infants were divided in three groups according to the feeding patterns: exclusive breastfeeding (n = 42), mixed feeding (n = 41), and cow's milk formula (n = 22). The feeding pattern had no impact on infants' serum zonulin levels. Moreover, zonulin levels were not affected by infant's clinical and epidemiological characteristics such as body weight or family history of autoimmune disease.Conclusion: In our study, different feeding patterns were not associated with serum zonulin levels in healthy infants at 3-4 months of age. What is Known: • Serum zonulin is upregulated in conditions with increased intestinal permeability • Breast milk favors the physiological decline of the intestinal permeability after birth in the neonates What is New: • Serum zonulin levels were not affected by the feeding pattern (breast milk versus formula) in infants at 3-4 months of age • Clinical and epidemiological characteristics of infants had no impact on zonulin levels.

Examining patterns of postnatal feeding in relation to infant's weight during the first year

BACKGROUND

There is mixed evidence regarding specific infant feeding behaviors and later risk for overweight and obesity. We sought to detect underlying patterns in duration of breastfeeding, introduction of solid foods and sweetened beverages, in order to understand the relation to later weight.

METHODS

Patterns of postnatal feeding were examined among infants enrolled in the Infant Feeding Practices Study II (N = 3033). At monthly intervals, mothers reported on the duration of any and exclusive breastfeeding, age of solid food and sweetened beverage introduction, and reported infant weight at ages 9- and 12-months. Latent profile analysis was used to empirically derive patterns of postnatal feeding and examine associations with weight z-scores at 9 and 12 months.

RESULTS

Two profiles emerged: (1) Short breastfeeding duration and early introduction to solid foods and sweetened beverages (Short BF/Early Introduction; 53%) and (2) longer breastfeeding duration and later introduction to solid foods and sweetened beverages (Longer BF/Later Introduction; 43%). Infants in the Shorter BF/Early Introduction profile had significantly greater weight z-scores at 9 (M = 0.18) and 12 months (M = 0.26), compared to those in the Longer BF/Later Introduction profile (M = -0.21; M = -0.17, respectively).

CONCLUSIONS

Overall, shorter BF duration and earlier food and sweetened beverage introduction is associated with higher weight z-scores at 9 and 12 months. Early intervention should aim to promote breastfeeding and later introduction of solids and discourage consumption of sweetened beverages. These postnatal patterns of feeding behaviors provides important context to inform targeted interventions aimed at reducing risk for later obesity.

Factors Associated with Infant Feeding Choices Among Women with HIV in Botswana

INTRODUCTION

In resource-constrained settings, infant feeding decisions among women with HIV (WHIV) must balance the risk of infant HIV acquisition from breastfeeding with increased mortality associated with formula feeding. WHO guidelines recommend countries principally promote a single feeding method for WHIV, either breastfeeding or formula feeding. In 2016, Botswana revised its policy of formula feeding for infants born to WHIV, instead promoting exclusive breastfeeding during the first 6 months of life.

METHODS

We sought to understand factors influencing infant feeding choices among WHIV by administering a questionnaire to pregnant and postpartum WHIV (2013-2015) participating in a clinical trial in Botswana (the Mpepu Study). Logistic regression analyses were used to identify factors associated with infant feeding choices.

RESULTS

Of 810 surveyed participants, 24.0% chose breastfeeding and 76.0% chose formula feeding. Women were more likely to choose formula feeding if advised by a health worker to formula feed (aOR 1.90; 95% CI 1.02-3.57) or if they harboured doubts about the potency of antiretroviral treatment (ART) to prevent infant HIV acquisition (aOR 9.06; 95% CI 4.78-17.17). Women who reported lack of confidence in preparing infant formula safely (aOR 0.09; 95% CI 0.04-0.19) or low concerns about infant HIV acquisition (aOR 0.35; 95% CI 0.22-0.55) were significantly less likely to formula feed.

DISCUSSION

Perceptions about ART effectiveness, social circumstances and health worker recommendations were key influencers of infant feeding choices among WHIV. Health system factors and maternal education interventions represent ideal targets for any programmatic actions aiming to shape informed decision-making towards HIV-free survival of infants.

Influencers of women's choice and experience of exclusive formula feeding in hospital

OBJECTIVES

Explore what influenced women's decision to exclusively formula feed, and their experiences with formula feeding within a maternity hospital environment.

DESIGN

This mixed methods study used a cross-sectional exploratory survey design. Short surveys were administered by telephone in the postpartum period. Content analysis revealed common themes for responses to open-ended questions on what influenced women's choice and experience with formula feeding. Descriptive statistics were used for demographic characteristics, and frequencies conducted on some themes.

PARTICIPANTS AND SETTING

English-speaking women who chose to exclusively formula feed, and attended a tertiary maternity hospital in Australia were invited to participate; 102 women were interviewed.

FINDINGS

Themes that influenced women to choose exclusive formula feeding were: 'Previous breastfeeding challenges', 'social and societal issues' including convenience, comfort, and trust in formula, and 'maternal health' including medical issues and medications, breast physiology and mental health. Themes from the formula feeding experience in hospital were: 'Supportive' elements such as midwifery care, convenience, and resources, and 'hindering' elements such as a perceived breastfeeding agenda and systemic barriers.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Previous breastfeeding difficulties were a common influence on exclusive formula feeding in subsequent pregnancies, highlighting the importance of adequate support during the primary lactation/infant feeding experience. Greater comfort and confidence levels with formula feeding and a sense of trust in formula were also influential. Some maternal medications, conditions, or physiological circumstances were perceived by women as impacting breastfeeding or breastmilk, signposting the importance of antenatal screening and assessment to support women's options and decisions regarding infant feeding. A perception of professional and organisational preferences for breastfeeding over formula feeding contributed to some women feeling judged for their choice. This reminds midwives to consider the complex intersection of factors that influence infant feeding decisions and ensure all mothers are respected and fully supported.

Influence of infants' feeding patterns and duration on mothers' postpartum depression: A nationwide birth cohort -The Japan Environment and Children's Study (JECS)

BACKGROUND

Breastfeeding is increasingly being promoted worldwide. Although several studies have examined breastfeeding and postpartum depression, contradictory results concerning their relationship have been found. This study investigated the influence of the feeding patterns of 1- to 6-month-old infants on maternal postpartum depression, as well as the influence of activities performed by mothers during feeding on postpartum depression.

METHODS

We used data from parents and children who participated in the Japan Environment and Children's Study (JECS). The data were from 71,448 mothers who did not show depressive symptoms at 1 month postpartum.

RESULTS

The group that continued exclusive breastfeeding for 6 months postpartum had a lower risk of postpartum depression compared with those who adopted other feeding patterns. Regardless of the pattern or duration of feeding, the group that maintained eye contact or talked to their baby during feeding had a lower risk of postpartum depression compared with the group that performed other activities. Furthermore, the group that continued both exclusive breastfeeding for 6 months and maintained eye contact or talked to their babies during feeding had an odds ratio of 0.69 for postpartum depression (95% confidence interval: 0.61-0.79), the lowest of any group.

LIMITATIONS

All variables were measured using a self-administered questionnaire.

CONCLUSIONS

It may be possible to control the onset of postpartum depression by recommending breastfeeding to new mothers, providing them with appropriate information on how to interact with their babies, and offering them support.

TRIAL REGISTRATION

UMIN000030786.

Maternal Depressive Symptoms and Infant Feeding Practices at Hospital Discharge: Findings from the Born in Queensland Study

INTRODUCTION

This study aims to explore association between maternal depressive symptoms and infant feeding practice at hospital discharge.

METHODS

Data were obtained from a birth cohort study based in Australia that linked to health administrative records. Maternal demographic data, mental health status derived from the Edinburgh Postnatal Depression Scale (EPDS), feeding practices of livebirths of at least 400 g or gestation periods of at least 20 weeks recorded during July-December 2015 were included (n = 14,658). Logistic regression models were performed to test association between presence of depressive symptoms and exclusive breast or formula feeding within 24 h prior to hospital discharge while adjusting for covariates known to be associated with breastfeeding.

RESULTS

About 12% of women self-reported having depressive symptoms (EPDS score ≥ 10). Although only 7% of women (n = 1012) exclusively formula fed their babies, having depressive symptoms was associated with a 51% higher likelihood of exclusive formula feeding at hospital discharge. The association remains significant after adjustment for maternal age, gestational weeks, number of previous pregnancies, socioeconomic and partner status (p < 0.001) and all other covariates (p = 0.009).

CONCLUSIONS FOR PRACTICE

Having depressive symptoms was associated with increased likelihood of exclusive formula feeding. Routine measurement post-delivery and early management of maternal depressive symptoms may influence infant feeding practice and reduce prevalence of exclusive formula feeding at hospital discharge.

Factors affecting early-life intestinal microbiota development

OBJECTIVES

This paper reviews the published evidence on early-life intestinal microbiota development, as well as the different factors influencing its development before, at, and after birth. A literature search was done using PubMed, Cochrane and EMBASE databases. A growing body of evidence indicates that the intrauterine environment is not sterile as once presumed, but that maternal-fetal transmission of microbiota occurs during pregnancy. The consecutive order of bacteria with which the gastrointestinal tract is colonized will influence the outcome of community assembly and the ecological success of individual colonizers. The genetic background of the infant may also strongly influence microbial colonization of the gastrointestinal tract. The composition and development of infant gut microbiota can be influenced by many prenatal factors, such as maternal diet, obesity, smoking status, and use of antibiotic agents during pregnancy. Mode of delivery is generally accepted as a major factor determining the initial colonization. Breast milk stimulates the most balanced microbiome development for the infant, mainly because of its high content of unique oligosaccharides. Feeding is another important factor to determine intestinal colonization. Compared with breastfed infants, formula-fed infants have an increased richness of species. Initial clinical studies show that infant formulas supplemented with specific human milk oligosaccharides (HMOs) -2´-fucosyllactose alone or in combination with lacto-n-neotetraose are structurally identical to those in breast milk. HMOs increase the proportion of infants with a high bifidobacterial-dominated gut microbiota typical of that observed in breastfed infants, lead to plasma immune marker profiles similar to those of breast-fed infants and to lower morbidity and antibiotics use. Further clinical studies with the same, others or more HMOs are needed to confirm these clinical effects. A growing number of studies have reported on how the composition and development of the microbiota during early life will affect risk factors related to health up to and during adulthood. If exclusive breastfeeding is not possible, the composition of infant formula should be adapted to stimulate the development of a bifidobacterial-dominated gut microbiota typical of that observed in breastfed infants. The main components in breast milk that stimulate the growth of specific bifidobacteria are HMOs.

The cost and affordability of growing and feeding a baby in Nova Scotia

OBJECTIVE

This paper examines the affordability of a basic nutritious diet for low-income families in Nova Scotia over three developmental periods (pregnancy, perinatal, early infancy) using economic simulations that include food costing and secondary data.

METHODS

The cost of a nutritious food basket was determined from a random sample of grocery stores in Nova Scotia (n = 21), along with the cost of infant formula (n = 29) and prenatal vitamins and vitamin D drops (n = 15), from randomly selected pharmacies. The monthly funds remaining to purchase a basic nutritious diet were calculated for several household scenarios, after deducting essential living expenses from net incomes. Each scenario included either a pregnant woman or a breastfed or formula-fed infant at 3 months, and either Income Assistance, Federal Maternity Benefits based on minimum wage employment, or a $15/h wage.

RESULTS

Income Assistance and Federal Maternity Benefits, based on minimum wage, were inadequate to purchase a basic nutritious diet during pregnancy or in early infancy whether breastfeeding or formula feeding. All household scenarios faced significant potential monthly deficits if they were to purchase a basic nutritious diet.

CONCLUSION

Minimum wage and income security programs are inadequate for the purchase of a basic nutritious diet throughout the prenatal, perinatal, and early infancy periods in Nova Scotia, emphasizing risk of food insecurity as a critical issue for young families facing income constraints. Adequate maternity protection is required to support access to food and nutrition essential for maternal and infant health.

Typologies of postnatal support and breastfeeding at two months in the UK: Research participant commentary

Emmott et al. (2020) presented in this journal an analysis of different types of postnatal support that mothers in the UK experience and their relationship to breastfeeding status at two months. This paper is a commentary by two participants in the study. It draws on the research literature alongside recent lived experiences of breastfeeding and formula feeding in the UK to question and expand on Emmott et al.'s analysis. It highlights how a decision to stop breastfeeding in the current UK context may lead to experiencing a lack of support from healthcare professionals. We argue that a family-centred approach to infant feeding should acknowledge the benefits and costs of all infant feeding methods and enable all families to be fully informed and supported in feeding their babies.

Does maternal smoking in pregnancy explain the differences in the body composition trajectory between breastfed and formula-fed infants?

Growth patterns are known to differ between breastfed and formula-fed infants, but little is known about the relative impact of maternal smoking in pregnancy v. feeding mode on growth trajectory in infancy. We conducted a secondary analysis of a trial, the Tolerance of Infant Goat Milk Formula and Growth Assessment trial involving 290 healthy infants, to examine whether smoking in pregnancy modified the association between feeding mode and body composition of infants. Fat mass (FM) and fat-free mass (FFM) were estimated at 1, 2, 3, 4, 6 and 12 months of age using bioimpedance spectroscopy. Formula-fed infants (n 190) had a higher mean FFM at 4 months (mean difference (MD) 160 g, 95 % CI 50·4, 269·5 g, P < 0·05)) and 6 months (MD 179 g, 95 % CI 41·5, 316·9 g, P < 0·05) compared with the breastfed infants (n 100). Sub-group analysis of breastfed v. formula-fed infants by maternal smoking status in pregnancy showed that there were no differences in the FM and FFM between the breastfed and formula-fed infants whose mothers did not smoke in pregnancy. Formula-fed infants whose mothers smoked in pregnancy were smaller at birth and had a lower FM% and higher FFM% at 1 month compared with infants of non-smoking mothers regardless of feeding mode, but the differences were not significant at other time points. Adequately powered prospective studies with an appropriate design are warranted to better understand the relative impact of maternal smoking, feeding practice and the growth trajectory of infants.

The new child food package is associated with reduced obesity risk among formula fed infants participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County, California, 2003-2016

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) changed the food packages provided to its participants in 2009, to better align them with the Dietary Guidelines for Americans. Previous research found that the 2009 WIC food package change was associated with reduced obesity risk, particularly among breastfed infants but also among those who were never breastfed. The objective of this study was to determine if the new child food package introduced in 2009, including more produce and whole grains for 1-4-year old children, was associated with healthier growth trajectories and reduced obesity risk at age 4 years among children who were exclusively formula fed during infancy.

METHODS

Administrative data on WIC-participating children in Los Angeles County, 2003-2016, were used (N = 74,871), including repeated measures of weight and length (or height); child's age, gender, and race/ethnicity; maternal education and language; and family poverty. Gender-stratified spline mixed models were used to examine weight-for-height z-score (WHZ) growth trajectories from 0 to 4 years and Poisson regression models were used to assess obesity (BMI-for-age > 95th percentile) at age 4. The main independent variable was duration of receipt (dose) of the new child package, categorized as 0, > 0 to < 1, 1 to < 2, 2 to < 3, 3 to < 4, and 4 years.

RESULTS

WHZ growth trajectories were similar for children across new child package dose groups. Boys and girls who were fully formula fed during infancy but received the new child food package for 4 years had a 7% (RR = 0.93; 95%CI = 0.89-0.98) and a 6% (RR = 0.94; 95%CI = 0.89-0.99) lower obesity risk, respectively, compared to children who received the new child food package for 0 years. There were no differences in obesity risk for children receiving < 4 years of the new child package vs. 0 years.

CONCLUSIONS

Providing healthy foods during childhood to children who were exclusively formula fed as infants was associated with modest improvements in obesity outcomes. While breastfeeding promotion should still be prioritized among WIC participants, providing healthy foods during childhood may provide health benefits to formula fed children, who comprise a sizeable proportion of children served by WIC.

The association of infant feeding patterns with food allergy symptoms and food allergy in early childhood

Background

The role of infant feeding for food allergy in children is unclear and studies have not addressed simultaneous exposures to different foods. The goal of this study was to analyze existing data on feeding practices that represent realistic exposure and assess the risk of food allergy symptoms and food allergy in children.

Methods

The Infant Feeding Practices Study II conducted by the CDC and US-FDA enrolled pregnant women and collected infant feeding information using nine repeated surveys. Participants were re-contacted after 6 years. Food allergy data were collected at 4, 9, 12, and 72 months. In total, 1387 participants had complete infant feeding pattern data for 6 months and information on food allergy symptoms and doctors’ diagnosed food allergy. Feeding patterns constituted six groups: 3-months of feeding at breast followed by mixed feeding, 3-months of breast milk and bottled milk followed by mixed feeding, 1-month of feeding at breast followed by mixed feeding, 6-months of mixed feeding i.e., concurrent feeding of breast milk, bottled milk and formula, 2–3 months of formula followed by formula and solid food, and formula and solid food since the first month. To estimate risks of food allergy, we used linear mixed models, controlling for potential confounders.

Results

Of the 328 children with food allergy symptoms in infancy and at 6 years, 52 had persistent symptoms from infancy. Children exposed to mixed feeding had a higher risk of food allergy symptoms (Risk Ratio [RR] 1.54; 95% Confidence Interval [CI] 1.04, 2.29) compared to 3-months of feeding at breast adjusted for confounding. No statistically significant risk of infant feeding patterns was found for doctors’ diagnosed food allergy. Paternal allergy posed a higher risk for food allergy symptoms (RR 1.36; 95% CI 1.01, 1.83). Prenatal maternal smoking increased the risk for doctors’ diagnosed food allergy (RR 2.97; 95% CI 1.53, 5.79).

Conclusions

Analysis of this prospective birth cohort suggest that introduction of multiple feeding source may lead to food allergy symptoms. Future efforts are needed to determine acceptable approaches to improve the ascertainment of food allergy in children and the role of infant feeding.

Emergency preparedness for infant and young child feeding in emergencies (IYCF-E): an Australian audit of emergency plans and guidance

Background

Australia experiences a high incidence of natural emergencies and Australian governments have committed significant investment into emergency preparedness and response. Amongst the population groups most vulnerable to emergencies are infants and young children with their vulnerability centering around their specific food and fluid needs. For this reason, the World Health Assembly has urged all member states to develop and implement infant and young child feeding in emergency (IYCF-E) plans in line with international guidance. This study aimed to determine the degree to which Australia has complied with this direction by conducting an audit of Australian emergency plans and guidance.

Methods

Australian Federal, State/Territory and a sample of Local government emergency plans and guidance were located via web searches. Documents were searched for key words to identify content dealing with the needs of infants and young children. Plans and guidance were also searched for content dealing with the needs of animals as a comparison.

Results

While plans and guidance contained numerous pointers to the desirability of having plans that address IYCF-E, there was a dearth of planning at all levels of government for the needs of infants and young children. Guidance related to heat waves contained information that could prove dangerous to infants. No agency at Federal or State/Territory had designated responsibility for IYCF-E or children in general. This was in stark contrast to the situation of animals for which there was widespread and comprehensive planning at all levels of government with clear designation of organisational responsibility.

Conclusions

Lack of planning for IYCF-E in Australia places infants and young children at serious risk of adverse health consequences in emergencies. Australian Federal, State/Territory and Local governments need to take action to ensure that IYCF-E plans and guidance are developed and deployed in line with international standards. The pathway to successful integration of animal welfare plans provides a method for a similar integration of IYCF-E plans. Government health authorities are best placed to lead and be responsible for IYCF-E in Australia. National governments internationally should similarly take action to ensure that their youngest, most vulnerable citizens are protected in emergencies.

A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow’s milk and processed to adjust for the nutritional needs of infants. However, cow’s milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow’s milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

The relationship between exclusive breastfeeding and infant development: A 6- and 12-month follow-up study

BACKGROUND

Breastfeeding offers several advantages for infants with research suggesting that it benefits development, including cognitive and language development. However, limited research has examined the benefits in infants under one year.

AIMS

To investigate the association between breastfeeding duration and infant development.

STUDY DESIGN

A longitudinal study conducted over 12 months.

SUBJECTS

Two hundred fifty-five mothers and their infants living in South Korea were seen at three time-points based on infants' age (4, 6, and 12 months).

OUTCOME MEASURES

Breastfeeding data were collected at 4 and 6 months. The Korea-Developmental Screening Test for Infants & Children was administered at 6 and 12 months to measure developmental milestones. We analyzed the relationship between breastfeeding duration in the first 6 months and infant development at 6 and 12 months using logistic regression analysis.

RESULTS

Compared to infants who did not breastfeed at all, infants who were exclusively breastfed until 4 months of age followed by mixed breastfeeding had a better communication and social interaction at 6 months, and better cognition, communication, and social interaction at 12 months. Exclusive breastfeeding until 6 months of age had no apparent impact on the outcomes at 6 and 12 months.

CONCLUSIONS

Exclusive breastfeeding up to 4 months of age followed by mixed breastfeeding might maximize the effects of infant development in their first year after birth. Breastfeeding programs should effectively communicate that exclusive breastfeeding for at least 4 months benefits infant development.

Infant feeding practices within a large electronic medical record database

Background

The emerging adoption of the electronic medical record (EMR) in primary care enables clinicians and researchers to efficiently examine epidemiological trends in child health, including infant feeding practices.

Methods

We completed a population-based retrospective cohort study of 8815 singleton infants born at term in Ontario, Canada, April 2002 to March 2013. Newborn records were linked to the Electronic Medical Record Administrative data Linked Database (EMRALD™), which uses patient-level information from participating family practice EMRs across Ontario. We assessed exclusive breastfeeding patterns using an automated electronic search algorithm, with manual review of EMRs when the latter was not possible. We examined the rate of breastfeeding at visits corresponding to 2, 4 and 6 months of age, as well as sociodemographic factors associated with exclusive breastfeeding.

Results

Of the 8815 newborns, 1044 (11.8%) lacked breastfeeding information in their EMR. Rates of exclusive breastfeeding were 39.5% at 2 months, 32.4% at 4 months and 25.1% at 6 months. At age 6 months, exclusive breastfeeding rates were highest among mothers aged ≥40 vs. < 20 years (rate ratio [RR] 2.45, 95% confidence interval [CI] 1.62–3.68), urban vs. rural residence (RR 1.35, 95% CI 1.22–1.50), and highest vs. lowest income quintile (RR 1.18, 95% CI 1.02–1.36). Overall, immigrants had similar rates of exclusive breastfeeding as non-immigrants; yet, by age 6 months, among those residing in the lowest income quintile, immigrants were more likely to exclusively breastfeed than their non-immigrant counterparts (RR 1.43, 95% CI 1.12–1.83).

Conclusions

We efficiently determined rates and factors associated with exclusive breastfeeding using data from a large EMR database.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1633-9) contains supplementary material, which is available to authorized users.

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

BACKGROUND

The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC.

OBJECTIVE

The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort.

METHODS

This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age ≤30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1: 5 matched case-control cohort.

RESULTS

In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC.

CONCLUSIONS

Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC.

Infant feeding pattern in the first six months of age in USA: a follow-up study

Background

Infant feeding may consist of direct breastfeeding (DBF), pumping and bottle feeding (P&F), formula feeding (FF), solid food feeding (SFF), and any combination. An accurate evaluation of infant feeding requires descriptions of different patterns, consistency, and transition over time.

Methods

In United States of America, the Infant Feeding Practice Study II collected information on the mode of feeding on nine occasions in 12 months. We focused on the first 6 months with six feeding occasions. To determine the longitudinal patterns of feeding the latent class transition analyses was applied and assessed the transition probabilities between these classes over time.

Results

Over 6 months, 1899 mothers provided feeding information. In month 1 the largest latent class is FF (32.9%) followed by DBF (23.8%). In month 2, a substantial proportion of the FF class included SFF; which increases over time. A not allocated class, due to missing information was identified in months 1-3, transitions to SFF starting in month 4 (8.9%). In month 1, two mixed patterns exist: DBF and P&F combined with FF (13.9%) and DBF combined with P&F (18.7%). The triple combination of DBF, P&F, and FF (13.9%) became FF in month 2 (transition probability: 24.8%), and DBF in combination with P&F (transition probability: 49.1%). The pattern of DBF combined with P&F is relatively stable until month 4, when at least 50% of these infants receive solid food. Only 23-26% of the infants receive direct breastfeeding (DBF) in months 1-4, in month 5-6 SFF is added. Mothers who used FF were less educated and employed fulltime. Mothers who smoke and not residing in the west of the United States were also more likely to practice formula feeding.

Conclusion

Infant feeding is complex. Breastfeeding is not predominant and we additionally considered the mixed patterns of feeding. To facilitate direct breastfeeding, a substantial increase in the duration of maternal leave is necessary in the United States.

Factors Associated with Infant Feeding Methods after the Nuclear Power Plant Accident in Fukushima: Data from the Pregnancy and Birth Survey for the Fiscal Year 2011 Fukushima Health Management Survey

Objectives The objective of this study was to assess the frequency of and factors associated with infant feeding methods after the Fukushima nuclear power plant accident using data from the Fukushima Health Management Survey. Methods We conducted an anonymous self-administered questionnaire survey of 16,001 women who gave birth around the time of the Great East Japan Earthquake and registered their pregnancies at Fukushima Prefecture municipal offices between August 1, 2010 and July 31, 2011. The responses of 8366 women were analyzed. Chi square tests and multiple logistic regression analysis were used to compare various factors between women who had formula-fed their children because of concern regarding radioactive contamination or other reasons and those who had breastfed exclusively. Results The percentage of women who had breastfed exclusively was 30.9 %. The percentage of women who had both breastfed and formula-fed or formula-fed exclusively was 69.1 %, of which 20.3 % formula-fed because of concern regarding radioactive contamination of breast milk. The use of formula feeding because of concern about radioactive contamination was significantly higher in women who had resided within the evacuation area and those whose regular antenatal care had been interrupted. The use of formula feeding for other reasons was significantly higher in women who had resided within the evacuation area and lower for those who had willingly switched to another medical institution. Conclusions for Practice Our results suggest the importance of providing breastfeeding support to women who are forced to evacuate or whose antenatal care is interrupted after a disaster.

Flavor Perception and Preference Development in Human Infants

As most parents and caregivers are aware, feeding children a nutritionally balanced diet can be challenging. Children are born with a biological predisposition to prefer sweet and to avoid bitter foods such as green leafy vegetables. It has been hypothesized that this predisposition evolved to attract children to energy-dense foods while discouraging the consumption of toxins. Although this may have enhanced survival in environments historically characterized by food scarcity, it is clearly maladaptive in many of today's food environments where children are surrounded by an abundance of sweet-tasting, unhealthful foods and beverages that place them at risk for excessive weight gain. Because overweight or obese children tend to become overweight or obese adults who are at risk for a range of cardiovascular diseases, it is of primary importance to develop effective evidence-based strategies to promote the development of healthy eating styles. Fortunately, accumulating evidence suggests that, starting before birth and continuing throughout development, there are repeated and varied opportunities for children to learn to enjoy the flavors of healthful foods. Because flavors are transmitted from the maternal diet to amniotic fluid and breast milk, mothers who consume a variety of healthful foods throughout pregnancy and lactation provide their infants with an opportunity to learn to like these flavors. This in turn eases the transition to healthful foods at weaning. In contrast, infants fed formula learn to prefer its invariant flavor profile, which differs from breast milk, and may initially be less accepting of flavors not found in formula. This process can continue throughout weaning and into childhood if infants are repeatedly exposed to a variety of healthful foods, even if they initially dislike them. These early-life sensory experiences establish food preferences and dietary patterns that set the stage for lifelong dietary habits.

Does Breastfeeding Shape Food Preferences? Links to Obesity

The first 2 years of life have been recognized as a critical window for obesity prevention efforts. This period is characterized by rapid growth and development and, in a relatively short period of time, a child transitions from a purely milk-based diet to a more varied solid-food diet. Much learning about food and eating occurs during this critical window, and it is well-documented that early feeding and dietary exposures predict later food preferences, eating behaviors, and dietary patterns. The focus of this review will be on the earliest feeding experiences - breast- and formula-feeding - and the unique role of breastfeeding in shaping children's food preferences. Epidemiological data illustrate that children who were breastfed have healthier dietary patterns compared to children who were formula-fed, even after controlling for relevant sociodemographic characteristics associated with healthier dietary and lifestyle patterns. These dietary differences are underlined, in part, by early differences in the opportunities for flavor learning and preference development afforded by breast- versus formula-feeding. In particular, the flavors of the mothers' diet are transmitted from mother to child through the amniotic fluid and breastmilk. The flavors experienced in these mediums shape later food preferences and acceptance of the solid foods of the family and culture onto which the infant is weaned. All infants learn from flavor experiences in utero, but only breastfed infants receive the additional reinforcement and flavor learning provided by continued repeated exposure to a wide variety of flavors that occurs during breastfeeding. Given the numerous benefits of breastfeeding, promotion of breastfeeding during early infancy is an important focus for primary prevention efforts and should be combined with efforts to ensure that mothers consume healthy, varied diets during pregnancy and lactation, and expose their infants to a wide array of foods during weaning and solid-food feeding.

Association between Caesarean Delivery and Isolated Doses of Formula Feeding in Cow Milk Allergy

BACKGROUND

Cow milk allergy (CMA) is the most common food allergy in breastfed infants. The aim of this study is to verify whether certain perinatal factors may influence the development of CMA immunoglobulin E (IgE)+.

METHODS

A retrospective, observational study of case and control groups was carried out. Information was collected of patients with CMA IgE+ from our department during the years 1990-2013. Patients of the same age and sex were recruited for the control group. Information on the following variables was collected: sex, age, pregnancy tolerance, duration of pregnancy, type of delivery, isolated doses of formula feeding in hospital (FFH), duration of breastfeeding, and family history of allergy (defined as ≥1 first-degree family member with allergic disease). Statistical analysis was performed using multivariate logistic regression techniques.

RESULTS

A total of 211 cases were included in this study. Multivariate analysis showed an influence of duration of breastfeeding, FFH to be a risk factor (OR 4.94; 95% CI 2.68-9.08), especially in caesarean delivery (OR 11.82; 95% CI 2.64-47.50), and prematurity (OR 0.29; 95% CI 0.09-0.92) to be a protective factor.

CONCLUSIONS

Perinatal factors play a key role in the development of CMA IgE+, with an influence of breastfeeding duration, FFH and caesarean delivery as risk factors and prematurity as a protective factor. While family history had no important role, environmental factors were more decisive.

Formula Feeding Predisposes Gut to NSAID-Induced Small Intestinal Injury

Objectives

Breast feeding protects infants from many diseases, including necrotizing enterocolitis, peptic ulceration and infectious diarrhea. Conversely, maternal separation stress and Non-Steroidal Anti-Inflammatory Drugs (NSAID's) can induce intestinal injury and bleeding. This study aimed to evaluate in suckling rats if maternal separation/formula feeding leads to increased intestinal sensitivity to indomethacin (indo)-induced intestinal injury and to look at potential mechanisms involved.

Methods

Nine-day-old rats were dam-fed or separated/trained to formula-feed for 6 days prior to indo administration (5 mg/kg/day) or saline (control) for 3 days. Intestinal bleeding and injury were assessed by measuring luminal and Fecal Hemoglobin (Hob) and jejunal histology. Maturation of the intestine was assessed by measuring luminal bile acids, jejunal sucrase, serum corticosterone, and mRNA expression of ileal Apical Sodium-Dependent Bile Acid Transporter (ASBT).

Results

At 17 days, formula-fed indo-treated pups had a 2-fold increase in luminal Hb compared to formula-fed control pups and had evidence of morphological injury to the small intestinal mucosa as observed at the light microscopic level, whereas indo had no effect on dam-fed littermates. In addition, formula-fed rats had significant increases in luminal bile acid, sucrase specific activity, serum corticosterone, and expression of ASBT mRNA compared to dam-fed rats.

Conclusion

Maternal separation stress may cause early intestinal maturational changes induced by corticosteroid release, including increased epithelial exposure to bile acids. These maturational changes may have a sensitizing rather than protective effect against indo-induced injury in the new-born.

Looking for cues - infant communication of hunger and satiation during milk feeding

It is known that duration of breastfeeding and responsive feeding are associated with decreased risk of obesity. It is however, not clear whether breastfed infants signal more to mothers to facilitate responsive feeding, compared to formula fed, nor what communication cues are important during the feeding interaction. The present study aimed to explore feeding cues in milk-fed infants and to examine if such cues vary by mode of feeding. Twenty-seven mothers and infants were filmed while breastfeeding or formula feeding. Infants' age ranged from 3 to 22 weeks. Feeding cues were identified using a validated list of communication cues (NCAST). The frequency of each cue during the beginning, middle, and end of the meal was recorded. There were 22 feeding cues identified during the feeds, with significantly more frequent disengagement cues expressed than engagement cues. Significantly more frequent feeding cues were observed at the beginning than at the end of the meal showing that cue frequency changes with satiation. Breastfeeding infants exhibited more engagement and disengagement cues than formula fed infants. Supporting mothers to identify engagement and disengagement cues during a milk feed may promote more responsive feeding-strategies that can be acquired by mothers using different modes of feeding.

Middle East Consensus Statement on the Diagnosis and Management of Functional Gastrointestinal Disorders in <12 Months Old Infants

This paper covers algorithms for the management of regurgitation, constipation and infantile colic in infants. Anti-regurgitation formula may be considered in infants with troublesome regurgitation, while diagnostic investigations or drug therapy are not indicated in the absence of warning signs. Although probiotics have shown some positive evidence for the management of functional gastrointestinal disorders (FGIDs), the evidence is not strong enough to make a recommendation. A partially hydrolyzed infant formula with prebiotics and β-palmitate may be considered as a dietary intervention for functional constipation in formula fed infants. Lactulose has been shown to be effective and safe in infants younger than 6 months that are constipated. Macrogol (polyethylene glycol, PEG) is not approved for use in infants less than 6 months of age. However, PEG is preferred over lactulose in infants >6 months of age. Limited data suggests that infant formula with a partial hydrolysate, galacto-oligosaccharides/fructo-oligosaccharides, added β-palmitate may be of benefit in reducing infantile colic in formula fed infants in cases where cow's milk protein allergy (CMPA) is not suspected. Evidence suggests that the use of extensively hydrolyzed infant formula for a formula-fed baby and a cow's milk free diet for a breastfeeding mother may be beneficial to decrease infantile colic if CMPA is suspected. None of the FGIDs is a reason to stop breastfeeding.

Factors affecting breastfeeding duration in Greece: What is important?

AIM: To investigate factors associated with breastfeeding duration (BD) in a sample of mothers living in Greece.

METHODS: Four hundred and twenty-eight mothers (438 infants) were initially recruited in a tertiary University Hospital. Monthly telephone interviews (1665 in total) using a structured questionnaire (one for each infant) were conducted until the sixth postpartum month. Cox regression analysis was used to assess factors influencing any BD.

RESULTS: Any breastfeeding rates in the first, third, and sixth month of the infant’s life reached 87.5%, 57.0% and 38.75%, respectively. In the multivariate analysis, maternal smoking in the lactation period [hazard-ratio (HR) = 4.20] and psychological status (HR = 1.72), and the introduction of a pacifier (HR = 2.08), were inversely associated, while higher maternal education (HR_{university/collegevsprimary/high school} = 0.53, HR_{master’svsprimary/high school} = 0.20), and being an immigrant (HR = 0.35) were positively associated with BD.

CONCLUSION: Public health interventions should focus on campaigns against smoking during lactation, target women of lower educational status, and endorse the delayed introduction of pacifiers.

Impact of the Great East Japan Earthquake on feeding methods and newborn growth at 1 month postpartum: results from the Fukushima Health Management Survey

This study examined the effects of three disasters (the Great East Japan Earthquake of March 11, 2011, followed by a tsunami and the Fukushima Daiichi Nuclear Power Plant accident) on feeding methods and growth in infants born after the disasters. Using results from the Fukushima Health Management Survey, Soso District (the affected area where the damaged nuclear power plant is located) and Aizu District (a less-affected area located farthest from the plant) were compared. In this study, newborn and maternal background characteristics were examined, as well as feeding methods, and other factors for newborn growth at the first postpartum examination for 1706 newborns born after the disaster in the affected (n = 836) and less-affected (n = 870) areas. Postpartum examinations took place 1 month after birth. Feeding method trends were examined, and multivariate regression analyses were used to investigate effects on newborn mass gain. There were no significant differences in background characteristics among newborns in these areas. When birth dates were divided into four periods to assess trends, no significant change in the exclusive breastfeeding rate was found, while the exclusive formula-feeding rate was significantly different across time periods in the affected area (p = 0.02). Multivariate analyses revealed no significant independent associations of maternal depression and change in medical facilities (possible disaster effects) with other newborn growth factors in either area. No area differences in newborn growth at the first postpartum examination or in exclusive breastfeeding rates were found during any period. Exclusive formula-feeding rates varied across time periods in the affected, but not in the less-affected area. It is concluded that effective guidance to promote breast-feeding and prevent exclusive use of formula is important for women in post-disaster circumstances.

Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study

Background

Exclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa. We explored factors influencing the decision to exclusively breastfeed among HIV-positive mothers accessing interventions for prevention of mother-to-child transmission of HIV in selected sites of Zambia.

Methods

This exploratory qualitative study was embedded in research conducted on: HIV and infant feeding; choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia. Thirty HIV-positive mothers and six key informants were recruited from two health facilities providing mother-to-child HIV transmission prevention services. A semi-structured guide was used to conduct interviews, which were digitally recorded and simultaneously transcribed. Data coding and analysis was done with the support of QRS Nvivo 10 version software.

Results

Despite the known benefits of exclusive breastfeeding, gaps in understanding and potential for behaviour change remained. We found that information promoting exclusive breastfeeding may have been understood by mothers as instructions from the health care workers indicating how to feed their HIV-exposed babies rather than as an option for the mothers’ own informed-decision. This understanding influenced a mother’s perceptions of breast milk safety while on antiretroviral medicine, of the formula feeding option, and of the baby crying after breastfeeding. The meanings mothers attached to exclusive breastfeeding thus influenced their understanding of breast milk insufficiency, abrupt weaning and mixed feeding in the context of preventing mother-to-child transmission of HIV.

Conclusion

In order to enhance feeding practices for HIV-exposed infants, our study suggests a broader health campaign supporting all mothers to exclusively breastfeed.

Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis

AIM

To synthesise the evidence on the association between duration and exclusivity of breastfeeding and the risk of acute otitis media (AOM).

METHODS

Systematic review and meta-analysis following searching of PubMed, CINAHL and EMBASE electronic databases.

RESULTS

Twenty-four studies, all from the USA or Europe, met the inclusion criteria. In the pooled analyses, any form of breastfeeding was found to be protective for AOM in the first 2 years of life. Exclusive breastfeeding for the first 6 months was associated with the greatest protection (OR 0.57 95% CI 0.44, 0.75), followed by 'more vs less' breastfeeding (OR 0.67; 0.59, 0.76) and 'ever vs never' breastfeeding (OR 0.67; 0.56, 0.80).

CONCLUSION

This systematic review and meta-analysis provides evidence that breastfeeding protects against AOM until 2 years of age, but protection is greater for exclusive breastfeeding and breastfeeding of longer duration. Exclusive breastfeeding during the first 6 months was associated with around a 43% reduction in ever having AOM in the first 2 years of life. After 2 years of age, there is no evidence that breastfeeding protects against AOM; however, there were few studies and the evidence quality was low.

Consistency in infants' behavioural signalling of satiation during bottle-feeding

BACKGROUND

Understanding the dynamics of feeding is essential for preventing accelerated weight gain during infancy, a risk factor for obesity.

OBJECTIVES

Because infants satiate on larger volumes of cow milk formula (CMF) than CMF enriched with the free amino acid glutamate (CMF + glu), we used this model system to determine whether infants displayed consistent behaviours despite satiating on lower volumes.

METHODS

In this laboratory-based, within-subject experimental study of ≤4-month-old infants (n = 41) and their mothers, infants were videotaped while feeding to satiation CMF on one test day and CMF + glu on the other, in counterbalanced order. Each video-recording was analysed frame-by-frame for frequency and timing of behaviours.

RESULTS

Infants' behaviours were consistent in types and frequency but were displayed sooner when feeding CMF + glu compared with CMF. The less responsive the mother's feeding style, the less consistent the infant displayed behaviours across the two formula meals (P = 0.05). Infants who spat up (a possible sign of overfeeding) consumed more formula (P = 0.01) and had less responsive mothers (P = 0.04) compared with the other infants.

CONCLUSIONS

Infants are consistent in their behavioural displays during feeding at this developmental age. Regulation of intake and signalling of satiation during bottle-feeding are associated with formula composition and maternal feeding style.

Breast-feeding and postpartum weight retention: a systematic review and meta-analysis

OBJECTIVE

Weight gained during pregnancy and postpartum weight retention might contribute to obesity in women of childbearing age. Whether breast-feeding (BF) may decrease postpartum weight retention (PPWR) is still controversial. The purpose of our systematic review and meta-analysis was to investigate the relationship between BF and PPWR.

DESIGN

Three databases were systematically reviewed and the reference lists of relevant articles were checked. Meta-analysis was performed to quantify the pooled standardized mean differences (SMD) of BF on PPWR by using a random-effect model. Heterogeneity was tested using the χ 2 test and I 2 statistics. Publication bias was estimated from Egger's test (linear regression method) or Begg's test (rank correlation method).

RESULTS

Among 349 search hits, eleven studies met the inclusion criteria for the meta-analysis. Seven studies were conducted in the USA, one in Brazil, one in France, one in Georgia and one in Croatia. Compared with formula-feeding, BF for 3 to ≤6 months seemed to have a negative influence on PPWR and if BF continued for >6 months had little or no influence on PPWR. In a subgroup meta-analysis, the results did not change substantially after the analysis had been classified by available confounding factors. There was no indication of a publication bias from the result of either Egger's test or Begg's test.

CONCLUSIONS

Although the available evidence held belief that BF decreases PPWR, more robust studies are needed to reliably assess the impact of patterns and duration of BF on PPWR.

Markets, breastfeeding and trade in mothers' milk

This introduction to a special issue on the economics of breastfeeding draws attention to the lack of economic justice for women. Human milk is being bought and sold. Commodifying and marketing human milk and breastfeeding risk reinforcing social and gender economic inequities. Yet there are potential benefits for breastfeeding, and some of the world's poorest women might profit. How can we improve on the present situation where everyone except the woman who donates her milk benefits? Breastfeeding is a global food production system with unsurpassed capacity to promote children's food security and maternal and child health, but it is side-lined by trade negotiators who seek instead to expand world markets for cow's milk-based formula. Regulators focus on potential risks of feeding donated human milk, rather than on health risks of exposing infants and young children to highly processed bovine milk. Similarly, policymakers aspire to provide universal health care access that may be unaffordable when two thirds of the world's children are not optimally nourished in infancy, resulting in a global double burden of infectious and chronic disease. Universal breastfeeding requires greater commitment of resources, but such investment remains lacking despite the cost effectiveness of breastfeeding protection, support and promotion in and beyond health services. Women invest substantially in breastfeeding but current policy - epitomised by the G20 approach to the 'gender gap' - fails to acknowledge the economic value of this unpaid care work. Economic incentives for mothers to optimally breastfeed are dwarfed by health system and commercial incentives promoting formula feeding and by government fiscal policies which ignore the resulting economic costs. 'The market' fails to protect breastfeeding, because market prices give the wrong signals. An economic approach to the problem of premature weaning from optimal breastfeeding may help prioritise global maternity protection as the foundation for sustainable development of human capital and labour productivity. It would remove fiscal subsidies for breast milk substitutes, tax their sale to recoup health system costs, and penalise their free supply, promotion and distribution. By removing widespread incentives for premature weaning, the resources would be available for the world to invest more in breastfeeding.

Parental feeding control in relation to feeding mode and growth pattern during early infancy

AIM

A high level of parental control of feeding and disturbed energy self-regulation has previously been suggested as a mechanism for the accelerated growth observed in formula-fed compared with breast-fed infants. This study explored factors associated with parental control of feeding in a population of formula-fed infants with high levels of self-regulation.

METHODS

We included 141 formula-fed and 72 breast-fed infants from a randomised controlled trial, who were prospectively followed from under 2 months of age to 12 months of age. Anthropometry was recorded at baseline, 4, 6 and 12 months of age. Parental feeding control was assessed using a Child Feeding Questionnaire at 4 and 12 months.

RESULTS

The formula-fed groups fully compensated for different energy and protein densities by regulating their volume intakes. Parents of formula-fed infants had a lower pressure to eat score at 12 months than parents of breast-fed infants. A high parental restrictive score at 12 months was associated with weight at 12 months and high parental pressure to eat score at 12 months with body mass index at 12 months. Neither were associated with feeding mode.

CONCLUSION

Formula-fed infants had a high level of energy self-regulation and were subjected to low parental control. Parental control of feeding was mainly influenced by infant growth.

Dietary exposures and allergy prevention in high-risk infants: a joint position statement of the Canadian Society of Allergy and Clinical Immunology and the Canadian Paediatric Society

Allergic conditions in children are a prevalent health concern in Canada. The burden of disease and the societal costs of proper diagnosis and management are considerable, making the primary prevention of allergic conditions a desirable health care objective. This position statement reviews current evidence on dietary exposures and allergy prevention in infants at high risk of developing allergic conditions. It revisits previous dietary recommendations for pregnancy, breastfeeding and formula-feeding, and provides an approach for introducing solid foods to high-risk infants. While there is no evidence that delaying the introduction of any specific food beyond six months of age helps to prevent allergy, the protective effect of early introduction of potentially allergenic foods (at four to six months) remains under investigation. Recent research appears to suggest that regularly ingesting a new, potentially allergenic food may be as important as when that food is first introduced. This article has already been published (Paediatr Child Health. 2013 Dec;18(10):545–54), and is being re-published with permission from the original publisher, the Canadian Paediatric Society.

Formula-fed infants have significantly higher fat-free mass content in their bodies than breastfed babies

AIM

Early nutrition may affect body composition development. This study assessed body composition changes in healthy term infants in the first four months of life, comparing the results for breastfed and formula-fed babies.

METHODS

A longitudinal, observational study was conducted with healthy term infants, who had a birth weight of more than 2500 g and were aged up to 3 weeks at enrolment. Infants were either exclusively breastfed or formula-fed. Growth and body composition were assessed by air-displacement plethysmography at enrolment and 4 months.

RESULTS

A total of 158 infants were enrolled (72 exclusively breastfed and 86 exclusively formula-fed). Body composition was similar between the two feeding groups at enrolment, but fat-free mass (4831 ± 538 g vs 4641 ± 461 g; p = 0.036) at 4 months and the fat-free mass changes between enrolment and 4 months (80.3 ± 16.4% vs 67.6 ± 18.4%; p < 0.001) were higher in formula-fed infants than breastfed ones.

CONCLUSIONS

Our findings suggest that formula-fed infants show different body composition development during the first 4 months of life to breastfed ones, with higher fat-free mass content.

Excess vitamin intake: An unrecognized risk factor for obesity

Over the past few decades, food fortification and infant formula supplementation with high levels of vitamins have led to a sharp increase in vitamin intake among infants, children and adults. This is followed by a sharp increase in the prevalence of obesity and related diseases, with significant disparities among countries and different groups within a country. It has long been known that B vitamins at doses below their toxicity threshold strongly promote body fat gain. Studies have demonstrated that formulas, which have very high levels of vitamins, significantly promote infant weight gain, especially fat mass gain, a known risk factor for children developing obesity. Furthermore, ecological studies have shown that increased B vitamin consumption is strongly correlated with the prevalence of obesity and diabetes. We therefore hypothesize that excess vitamins may play a causal role in the increased prevalence of obesity. This review will discuss: (1) the causes of increased vitamin intake; (2) the non-monotonic effect of excess vitamin intake on weight and fat gain; and (3) the role of vitamin fortification in obesity disparities among countries and different groups within a country.