Search Results (58)

Background: Necrotizing enterocolitis (NEC) remains a leading cause of morbidity and mortality in very low birthweight (VLBW) infants. Human milk feeding and standardized feeding protocols are protective, but clinical practice varies, particularly in fortifier choice. Whether human milk-derived fortifiers reduce NEC risk compared with cow milk-derived fortifiers remains unclear. Methods: We conducted a systematic state-of-evidence review and meta-analysis, searching PubMed, Web of Science, and Scopus through July 2025. Eligible studies included RCTs and observational cohorts of VLBW infants comparing an exclusive human milk diet (EHMD) including human milk-derived fortifiers to cow milk-derived diets. Two reviewers independently screened and extracted data. Both RCTs and observational studies were included to evaluate consistency of effect estimates across designs and to account for heterogeneity in control group feeding practices. Pooled odds ratios (ORs) with 95% CIs were calculated using a Sidik–Jonkman random-effects model. Sensitivity analyses by study design and exclusion of infant formula from controls were performed. Results: Twenty studies (five RCTs, 15 observational; n = 6794 infants) met inclusion criteria, most enrolling infants born ≤1250 g. Compared with cow milk-containing diets, EHMD was associated with lower odds of Bell Stage ≥ 2 NEC (OR: 0.59; 95% CI: 0.42, 0.81; p < 0.001; n = 4625) and surgical NEC (OR: 0.43; 95% CI: 0.32, 0.58; p < 0.0001; n = 4754). In direct comparisons of fortifier type with a base diet of human milk, estimates suggested lower odds of Bell Stage ≥ 2 NEC by 35% (OR: 0.65; 95% CI: 0.44, 0.97; p = 0.03, n = 2102) and surgical NEC by 49% (OR: 0.51; 95% CI: 0.26, 0.98; p = 0.04; n = 1659) with human milk-derived fortifiers. Effect estimates were generally consistent across study designs, although precision and statistical significance varied. Conclusions: EHMD with human milk-derived fortifiers was associated with lower odds of medical and surgical NEC in VLBW infants, with most evidence from infants born ≤1250 g, reflecting current clinical use in the highest-risk population. Although the number and sample sizes of RCTs remain limited, the consistency of effect estimates across both RCTs and observational studies, together with significance of pooled analyses, strengthens confidence in these findings. Pragmatic and registry-based studies using standardized fortification protocols may provide the most efficient pathway to strengthen the evidence base. Full article

Background: Human milk (HM) is the optimal nutrition for preterm infants, but supplementation is often required to meet their unique nutritional needs. Donor human milk (DHM) and preterm formula are commonly used alternatives, yet their impacts on bone metabolism and clinical outcomes remain incompletely defined. Objective: To compare the effects of exclusive mother’s own milk (MOM), MOM supplemented with DHM, and MOM supplemented with preterm formula on bone metabolism markers, growth milestones, and clinical outcomes in very preterm and very low birth weight (VLBW) infants. Methods: We conducted a retrospective review of medical records for infants born at <32 weeks’ gestation or <1500 g birth weight between January 2018 and June 2023. Feeding groups included exclusive MOM (N = 135), MOM + DHM (N = 74), and MOM + Formula (N = 54). Biochemical markers were assessed at baseline and on days 7, 14, and 28. Multivariate regression analyses evaluated predictors of growth and clinical outcomes. Results: Infants in the MOM group had significantly lower gestational age and birth weight, with higher rates of respiratory morbidity. Time to full enteral feeding and duration of parenteral nutrition were longer in the MOM group, but feeding regimen was not an independent predictor of these outcomes. By day 14, the MOM group had higher alkaline phosphatase levels and lower phosphorus levels compared to mix feeding groups, but these differences resolved by day 28. Calcium levels varied between groups but remained within normal ranges. Necrotizing Enterocolitis (NEC) incidence did not differ significantly across feeding regimens and was primarily associated with longer parenteral nutrition duration. Conclusions: Supplementation of MOM with either DHM or preterm formula supported adequate growth and bone metabolism without increasing NEC risk. Feeding regimen did not independently influence time to full enteral feeding or length of hospitalization, which were driven primarily by infant maturity and clinical status. Both DHM and preterm formula are viable supplements to MOM, ensuring nutritional adequacy without adverse bone health effects. Prospective studies are needed to evaluate long-term outcomes of these feeding strategies. Full article

Background/Objectives: Accurate estimation of caloric intake from breastfeeding is essential for understanding infant nutrition during early life. However, most existing models rely on fixed assumptions and do not reflect the natural variability in feeding behaviors and human milk composition. This study aims to provide a realistic estimation of breast milk (BM) caloric intake throughout infancy using a probabilistic approach based on empirical data. Methods: A probabilistic model was developed using four variables: feeding frequency, volume per feeding, caloric density, and infant weight. Systematic reviews were conducted to inform the input values of the first three variables, and meta-analyses were performed when feasible. Infant weight was based on World Health Organization (WHO) growth standards. Variables were stratified by age and integrated into the model through appropriate probability distributions. Monte Carlo simulations were conducted to estimate caloric intake per kilogram of body weight, expressed both per day and per feeding, across all age groups. Results: The model showed a progressive decline in daily caloric intake per kilogram with age, consistent with decreasing feeding frequency and the introduction of complementary foods. In contrast, caloric intake per feeding increased with age. These findings align with WHO energy intake targets during exclusive breastfeeding and reflect expected physiological changes in infant growth and feeding behavior. Conclusions: This study provides a probabilistic framework for estimating BM caloric intake across infancy, accounting for interindividual and age-related variability. It offers a valuable research tool to support future studies on infant nutrition and feeding behavior using realistic, data-driven assumptions. Full article

Background/Objectives: Freeze-dried high-temperature short-time pasteurized human milk fortifiers offer potential for exclusive human milk feeding in preterm infants while providing necessary nutritional supplementation. However, clinical data on safety, tolerability, and growth outcomes remain limited. This study evaluated donor milk fortification compared to conventional bovine protein-based fortification. Methods: We conducted a prospective non-interventional observational cohort study with a retrospectively matched comparison cohort at University Children’s Hospital of Nuremberg. Preterm infants ≥ 30 weeks gestational age requiring mother’s own milk fortification were included. The exposed cohort (n = 32) received freeze-dried high-temperature short-time pasteurized donor milk fortifier at 1.6–4.8 g/100 mL of mother’s own milk; the matched comparison cohort (n = 32) received bovine protein-based fortifier. Primary outcomes included feeding tolerance, safety parameters, and anthropometric measurements. Cohorts were matched for birth weight (±10%), gestational age (±5 days), and fortified feeding. Results: Baseline characteristics were not significantly different: gestational ages 32.8 ± 1.0 versus 33.0 ± 1.2 weeks; birth weights 1900 ± 380 g versus 1840 ± 370 g. Excellent feeding tolerance was demonstrated across >3100 feedings. No necrotizing enterocolitis, abdominal complications, or serious adverse events occurred. Blood glucose, triglycerides, and urea remained normal. Birth weights, lengths, and head circumferences showed no significant differences. Discharge parameters including weight, length, head circumference, and length of stay were also not significantly different. Conclusions: Freeze-dried human milk fortification demonstrates excellent safety and tolerability in preterm infants ≥ 30 weeks gestational age, achieving anthropometric outcomes not significantly different to bovine protein-based fortification. However, the suboptimal protein-to-energy ratio may limit applicability for very low birth weight infants. Therefore, freeze-dried high-temperature short-time pasteurized human milk fortification is suggested to provide appropriate nutritional supplementation for preterm infants with a birth weight over 1500 g. Full article

Background: Small for gestational age neonates represent a population at risk of growth failure or deviant growth patterns and long-term metabolic complications. Breastfeeding has been identified as a critical factor in promoting healthier growth and long-term metabolic health in both full-term and preterm appropriate for gestational age infants, but similar studies in small for gestational age infants are limited. The aim of this narrative review is to assess the impact of breastfeeding on growth and body composition in small for gestational age neonates. Methods: The PubMed and Google Scholar databases were screened for the relevant literature. The following terms, were used: “low birth weight”, “in utero growth restriction”, “small for gestational age”, “human milk”, and “growth”. The initial screening identified 57 relevant studies. Thirteen of them fulfilled the eligibility criteria and were included in this narrative review. Results: In preterm small for gestational age neonates, human milk nutrition was associated with healthier catch-up growth without excessive fat accumulation. Fortification strategies were associated with enhanced growth outcomes without increased incidence of neonatal morbidities. In the context of full-term, small for gestational age neonates, exclusive breastfeeding has been demonstrated to be associated with healthy catch-up growth. Furthermore, human milk nutrition has been shown to mitigate the predisposition of these children to obesity and cardiometabolic complications. Conclusions: According to the limited extant literature, human milk feeding has been identified as a potentially protective factor for small for gestational age neonates, promoting healthier growth patterns and long-term cardiometabolic health. However, larger prospective studies are needed to evaluate human milk feeding and human milk fortification in association with growth and long-term outcomes in small for gestational age infants. Full article

Background/Objectives: The initiation and maintenance of breastfeeding depend on internal and external factors that can either support or hinder its success. This study aimed to examine the association between hospital-based perinatal practices and the duration of exclusive breastfeeding among Mexican mothers of infants under one year of age. Methods: An analytical cross-sectional study was conducted in Guadalajara, Mexico, using a structured questionnaire developed in Google Forms and distributed via social media managed by healthcare professionals. Elegible participants were mothers of infants aged 6 to 12 months. Data were collected between March and November 2022 and included information on infant feeding at six months, sociodemographic and obstetric characteristics, breastfeeding education, hospital-based practices, and professional support during birth. A sample size of 323 participants was estimated on a 95% confidence level, 30% expected prevalence, and 5% margin of error. Statistical analyses included chi-square tests, odds ratios, Mann–Whitney U tests, and multivariate analyses. Results: A total of 326 mothers participated. Exclusive breastfeeding lasted less than six months for 63.5% of infants, while 36.5% were exclusively breastfed from birth to six months. Bottle use in the hospital, provision of human milk substitutes during the hospital stay, and at discharge were significantly associated with shorter exclusive breastfeeding duration (p < 0.001). Predictors of not achieving six months of exclusive breastfeeding included primiparity, delayed initiation beyond the first postpartum hour, and lack of continuous rooming-in. Conclusions: Hospital-based practices significantly influence exclusive breastfeeding duration. Strengthening maternity care policies may improve adherence to recommended feeding practices. Full article

Background: Human milk (HM) offers critical short- and long-term benefits for preterm and very low birth weight (VLBW) infants. In 2021, a human milk bank (HMB) was established at the IRCCS Giannina Gaslini Institute, aiming to improve HM feeding rates in this vulnerable population. Methods: We retrospectively analyzed feeding data from 442 VLBW infants (BW < 1500 g) admitted between 2018 and 2024. Data were drawn from the Vermont Oxford Network and Italian Neonatal Network registries. Feeding modalities—exclusive HM, infant formula milk (IM), and mixed feeding (MF)—were recorded and analyzed before and after HMB introduction. Results: Before 2021, MF was predominant, with exclusive HM rates below 10%. Following HMB implementation, exclusive HM feeding increased significantly, reaching 47.2% in 2024 (p < 0.0001). Regression analysis showed a positive trend for HM (+4.84%/year, p = 0.05), and a declining trend for IM (−1.96%/year) and MF (−2.88%/year). Projections suggest HM rates may exceed 58% by 2030. Conclusions: The introduction of the HMB was associated with a significant shift in feeding practices, increasing HM use and reducing IM exposure among VLBW infants. These findings underscore the importance of institutional strategies such as donor milk availability, lactation support, and maternal education in optimizing neonatal nutrition. Ongoing efforts are essential to sustain and extend these improvements beyond NICU discharge, ensuring the long-term benefits of human milk for preterm infants. Full article

Background: Understanding the patterns of milk intake in the neonatal intensive care unit (NICU) will allow opportunities to intervene to improve mother’s milk supply. Objective: To quantify the type and volume of milk intake in premature infants throughout the NICU stay. Methods: This retrospective observational cohort study included infants born and admitted to the NICU at <33 weeks gestation from January 2014 to December 2017 who did not have contraindications for receiving mother’s own milk (MOM). Daily volume of MOM, pasteurized donor milk (PDM), and formula throughout the NICU stay were collected. Infants were categorized as exclusive human milk diet (EHM) if they consumed MOM and PDM or mixed diet if they consumed formula and MOM and/or PDM. Demographics, feeding outcomes, growth outcomes, and neonatal morbidities were collected. Results: Of 195 study infants, 133 (32%) received EHM. Cumulative volume and percent of MOM intake were greater in the EHM group compared to the mixed diet group. Age of first colostrum administration to infant was earlier in the EHM group than the mixed diet group (3.1 vs. 4.9, p = 0.013). By the second week of life, the EHM group received 100% of their feeds as MOM but the maximum MOM received in the mixed diet group was 63%. There was no difference in other feeding or neonatal outcomes between the groups. Conclusion: The EHM group received colostrum earlier than those who received a mixed diet with formula and reached full MOM by the second week of life. This represents the opportunity to address challenges of milk supply of mothers with premature infants in the NICU in the first two weeks after birth. Full article

Background/Objectives: Maternal milk feeding in the NICU (neonatal intensive care unit) for very low birth weight (VLBW) infants mitigates the effects of preterm birth. This single-center retrospective study analyzed data from VLBW infants born between 2005 and 2019 and investigated the impact on morbidity of exposure to Mother’s Own Milk (MOM), donor human milk (DHM), preterm formula (PF), during NICU hospitalization. The assessed outcomes included necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and late-onset sepsis (LOS). The study also examined the impact of a human milk-based feeding protocol on these outcomes, adjusting for confounding factors. Methods: Statistical analysis involved correlation tests and odds ratios to assess associations between feeding types and outcomes. Results: Surgical NEC occurred in 10% of infants fed exclusively with PF, 1.3% of those fed with DHM, and was completely absent in infants fed exclusively or partially with MOM. ROP across all stages was observed in 24.3% of cases, with severe ROP at 4.7%, and PF feeding was associated with a higher risk of severe ROP; the incidence of LOS was lower in infants fed human milk (−22%/−66%) compared to 10% in formula-fed infants. BPD affected 25.5% of infants, with moderate-to-severe BPD in 22.2%. The association between NEC, LOS, and feeding was statistically significant, even after adjusting for covariates. The type of milk had a significant impact on the incidence of severe forms of all outcomes (p < 0.001). The rate of exclusive MOM feeding increased over time, reaching 45% in 2018–2019. Conclusions: These findings highlight the role of human milk in preventing NEC and LOS, in reducing the risk of severe ROP and BPD, and in promoting MOM feeding, with rates increasing significantly when DHM is available. Full article

Breast milk is rich in bioactive components, especially human milk oligosaccharides (HMOs), which are crucial for establishing gut microbiota. The 2′-FL (2-Fucosyllactose), one of the most abundant oligosaccharides in breast milk, functions as a selective prebiotic. Objective: To examine the effect of adding 2′-FL (2-Fucosyllactose) to an infant formula containing prebiotic galacto-oligosaccharides (GOSs) and fructo-oligosaccharides (FOSs) on the gut microbiome of healthy formula-fed infants. Methods: This study enrolled infants from three groups: an HMO experimental group (n = 29), a GOS/FOS control group (n = 30), and an exclusively breastfed (breast milk [BM]) reference group (n = 28). Fecal samples from the three groups in the first and fourth months of life were analyzed. The V3 and V4 regions of the 16S rRNA gene were amplified and sequenced on the Illumina MiSeq. ANOVA, Kruskal–Wallis, richness indices (Chao1, Shannon), UniFrac distances, and the Adonis tests were used to perform statistical analyses on the relative abundance of phyla and genera, as well as the alpha and beta-diversity of the gut microbiota. Results: After intervention, Actinobacteriota emerged as the predominant phylum in both the HMO (60.4%) and BM (46.6%) groups. Bifidobacterium and Escherichia-Shigella were identified as the two most abundant bacterial genera in both groups. Nevertheless, the statistical analysis showed that the relative abundance of Bifidobacterium in the HMO formula-fed group after intervention was similar to that in the BM group (p > 0.05). Infants in the HMO and GOS/FOS groups showed higher relative abundance of [Ruminococcus]_gnavus_group bacteria compared to those in the BM group. Groups fed with infant formula demonstrated higher alpha-diversity of gut microbiota compared to breastfed infants (p < 0.05), at the time of admission as well as after the intervention. Beta-diversity was significantly different among the three groups, according to type of feeding. Infants fed a 2′-FL-supplemented infant formula exhibited growth comparable to that of breastfed infants throughout the intervention period, demonstrating that the formula was both safe and well tolerated. Conclusions: Adding 2′-FL to an infant formula containing 4 g/L of GOS + FOS resulted in a stronger bifidogenic effect compared to the formula without 2′-FL. Full article

Many infants consume both human milk and infant formula (mixed-fed); however, few studies have investigated how mixed feeding affects the gut microbiome composition and metabolic profiles compared to exclusive breastfeeding or formula feeding. Herein, how delivery mode and early nutrition affect the microbiome and metabolome of 6-week-old infants in the STRONG Kids2 cohort was investigated. Fecal samples were collected from exclusively breastfed (BF; n = 25), formula-fed (FF; n = 25) or mixed-fed (MF; n = 25) participants. Within each feeding group, infants were either delivered vaginally (VD; n = 13) or by Cesarean section (CS; n = 12). Feeding mode affects the fecal microbiome diversity, composition, and functional potential, as well as metabolomic profiles regardless of delivery mode. Alpha and beta diversity of MF differed from that of BF (p < 0.05) but were comparable to FF infants. Functional analyses have shown 117 potential metabolic pathways differed between BF and FF, 112 between BF and MF, and 8 between MF and FF infants (p < 0.05, q < 0.10). Fecal metabolomic profiles of MF and FF clustered together and separated from BF infants. In total, 543 metabolites differed between BF and FF, 517 between BF and MF, and 3 between MF and FF (p < 0.05, q < 0.10). Delivery mode affected overall microbial composition (p = 0.022) at the genus level and 24 potential functional pathways, with 16 pathways being higher in VD than CS infants (p < 0.05, q < 0.10). Metabolomic analysis identified 47 differential metabolites between CS and VD, with 39 being lower in CS than VD (p < 0.05, q < 0.10). In summary, fecal microbiota composition and function and metabolite profiles of 6-week-old MF infants are closer to FF than BF infants. Full article

Background/Objectives: Adequate folate intake is required in preterm infants for rapid growth and development, but there is little evidence to back recommendations. We aimed to assess folate status in preterm infants at discharge and in early infancy, according to exposure to folate sources, particularly in those exclusively/predominantly breastfed. Methods: A prospective, multicenter, observational cohort study was conducted in the UK, involving 45 preterm infants <33 weeks’ gestational age (GA) exclusively/predominantly fed human milk when approaching NICU (Neonatal Intensive Care Unit) discharge. Serum folate levels were measured near NICU discharge (T1) and at 2–3 months corrected age (T2). Folate status was categorized per WHO (World Health Organization) guidelines: deficiency (<6.8 nmol/L), possible deficiency (6.8–13.4 nmol/L), normal (13.5–45.3 nmol/L), and elevated (>45.3 nmol/L). Nutritional information on feed and supplements was collected from hospital notes and maternal interviews. Results: Thirty-two infants (71%) received parenteral nutrition. Twelve infants (32%) remained exclusively breastfed at T2. No infant from the whole cohort had a serum folate concentration <13.5 nmol/L at either time point. A proportion of infants had serum folate concentrations >45.3 nmol/L: 14/45 (31%) at T1, 19/37 (42%) at T2, and 7/37 (16%) at both time points. Elevated concentrations were seen particularly in infants who received folic acid supplements or nutrition containing folic acid, such as parenteral nutrition and breastmilk fortifiers. Conclusions: Folate deficiency was not observed in this cohort; folate concentrations were high and in line with those observed in healthy term infants. Further research is needed to assess the high folate concentrations in premature babies and whether they may have any adverse clinical impact. Full article

An exclusive human milk diet (EHMD) and standardized feeding protocols are two critical methods for safely feeding very low birth weight (VLBW) infants. Our institution initiated a standardized feeding protocol for all VLBW infants in 2018. In this protocol, a human milk fat modular was used only reactively when an infant had poor weight gain, fluid restriction, or hypoglycemia. As part of our NICU quality improvement program, internal utilization review data revealed a potential opportunity to improve growth and reduce costs. While maintaining the EHMD, a simple feeding guideline process change could provide cost savings without sacrificing caloric density or growth. We examined this process change in pre-post cohorts of VLBW infants. Methods: Our revised feeding protocol, established in October 2021, called for a human milk fat modular (Prolact CR) to be added to all infant feeding when parenteral nutrition (PN) and lipids were discontinued. The human milk fat modular concentration is 4 mL per 100 mL feed, providing approximately an additional 2 kcal/oz. We tracked data to compare (1) the use of the human milk fat modular, (2) the use of the human milk +8 fortifier, (3) overall growth before and after feeding protocol changes, and (4) cost differences between protocols. Results: Thirty-six VLBW infants were followed prospectively upon the introduction of the revised feeding protocol. In the revised era, the need for human milk +8 fortifier decreased from 43% to 14%. The decrease in the cost of a more costly fortifier provided a cost savings of USD 2967.78 on average per infant. Overall growth improved from birth to discharge, with severe malnutrition declining from 3.3% to 2.7% and moderate malnutrition declining from 37% to 8%. Conclusions: With the proactive use of a human milk fat modular in a standardized feeding protocol, our VLBW infants showed improved growth, lower malnutrition rates, and decreased use of higher caloric fortifiers. Full article

(1) Background: Exclusive breastfeeding is not only the cornerstone of a child’s healthy development, but it is also the most economical and planet-friendly way to feed an infant. This study aims to assess the current situation regarding breastfeeding in Romania. (2) Method: The authors searched five databases using the search terms “breastfeeding OR lactation” AND Romania. Studies have been limited to those published in English since 2000. In vitro animal studies, case studies, reviews, meta-analyses, book chapters, and guidelines were excluded. (3) Results: 19 studies were included in the final review. For the purpose of this systematic review, studies were subgrouped into studies on attitudes, practices, and behaviors regarding breastfeeding and the composition of human milk. This review demonstrates a slight tendency to increase interest in breastfeeding in Romania in the last years. Interventional studies conducted so far included mainly urban populations with good socioeconomic levels and a high level of education. Studies about the impact of early intervention in maternal education concluded that the level of education is positively correlated with the interest in education regarding breastfeeding. On the other hand, the Romanian population has similar characteristics to the European population in terms of the factors that influence human milk composition. (4) Conclusions: The review underlines strengths and weaknesses of the Romanian situation regarding breastfeeding and makes recommendations for future directions for research and health education. Full article

Human milk contains macronutrients possibly affecting infant and early childhood growth. Most studies suggest a sex-specific difference in macronutrient levels in favor of males, with a higher energy content from fat, lactose, and protein. Further, macronutrient levels may differ according to mixed or exclusive breastfeeding; however, the literature is inconsistent. Our aim was to investigate sex-specific differences in macronutrient content in exclusively breastfed infants in a Danish child cohort, and whether macronutrient levels differed between exclusive or mixed (breast and formula) breastfeeding. Participants were part of the prospective birth cohort Odense Child Cohort. Baseline characteristics were obtained from medical records. Weekly SMS questions were sent to the mothers until the cessation of breastfeeding, asking whether they were breastfeeding and/or formula feeding. Mothers delivered a milk sample at the planned 3–4-month examination of the infant. Macronutrient analyses were performed on 182 samples using mid-infrared transmission spectroscopy (Miris Human milk Analyzer). We included 150 mother–infant dyads with both macronutrient analysis, and SMS data on breastfeeding. Baseline characteristics did not differ according to sex. The median interquartile range (IQR) infant age at the time of sampling was 4.1 (3.7–4.5) months. A total of 39 males and 38 females were exclusively breastfed at the time of milk sampling, while 36 males and 37 females were mixed-fed. We found no significant sex-specific differences in macronutrients among exclusively breastfed infants. The median (IQR) levels for males and females, respectively, were; protein, 0.85 g/100 mL (0.77, 0.90), and 0.82 g/100 mL (0.80, 0.90), p = 0.91; lactose, 7.83 g/100 mL (7.70, 7.95), and 7.73 g/100 mL (7.53, 7.90), p = 0.17; fat, 3.23 g/100 mL (2.07, 4.37), and 3.07 g/100 mL (2.10, 3.60), p = 0.34; energy, 65.5 kcal/100 mL (54.17, 77.00), and 63 kcal/100 mL (56.00, 69.33), p = 0.13. Further, we found no significant differences in macronutrient content in human milk samples from exclusively versus mixed-feeding mothers either prior and after adjusting for confounders, p > 0.36. This study does not confirm the previous findings of sex-specific differences in macronutrients in human milk. It is still unknown if sex-specific formula products tailored to meet possible sex-specific requirements can optimize child growth. Further research on this topic is needed. Full article