Search Results (157)

Background: Cow’s milk-derived fortifier (CMDF) is widely used to improve the nutritional adequacy of human milk for very preterm infants. Although generally well-tolerated, feeding difficulties may occur during CMDF use. Characterizing these events and their associated clinical factors may improve the understanding of feeding tolerance in routine neonatal practice. Objective: To characterize documented adverse feeding events among infants receiving donor human milk (DHM) and CMDF and to identify clinical characteristics associated with these events. Methods: This retrospective nationwide cohort study used the Japanese Human Milk Bank Database. Infants receiving DHM and CMDF were included. Clinical characteristics were compared between infants with and without documented adverse feeding events, and multivariable logistic regression was used to evaluate associated factors. Results: Among the 2587 infants receiving DHM and CMDF, 2476 had available adverse-event information. Adverse feeding events were documented in 315 infants (12.7%), most commonly abdominal distension, increased gastric residuals, vomiting, and suspected cow’s milk protein allergy. Infants with documented adverse feeding events had lower gestational age and birth weight and required longer to reach an enteral feeding volume of 100 mL/kg/day. In multivariable analysis, delayed achievement of 100 mL/kg/day remained associated with documented adverse feeding events, whereas gestational age, birth weight, and sex were not independently associated. Routine clinical variables showed limited discriminatory ability (AUC 0.611). Conclusions: Most infants receiving CMDF had no documented adverse feeding events. Slower progression to an enteral feeding volume of 100 mL/kg/day was associated with documented adverse feeding events; however, the temporal relationship among feeding progression, CMDF initiation, and adverse events could not be established. These findings should therefore be considered hypothesis-generating rather than predictive and require prospective validation. Full article

Background: Secondhand exposure to heated tobacco products (HTPs) is increasingly common, but its impact on human milk composition is unclear. We investigated whether secondhand exposure to HTP aerosols affects major human milk components and cotinine concentrations in lactating women. Methods: This observational study included 15 lactating women whose household members used HTPs (secondhand HTP exposure group) and 33 lactating women who did not live with any smokers (non-exposed group). Human milk was analyzed for macronutrients, total solids, energy, lactoferrin, secretory immunoglobulin A (sIgA), calcium, inorganic phosphorus, zinc, and cotinine. Cotinine was measured in all women in the secondhand HTP exposure group and in three women in the non-exposed group. Results: Background characteristics did not differ significantly between groups. No significant differences were observed in lipid, protein, total solids, energy, true protein, lactoferrin, calcium, inorganic phosphorus, or zinc. Carbohydrate concentration differed significantly between the non-exposed and secondhand HTP exposure groups (non-exposed vs. secondhand HTP exposure: 8.20 vs. 8.10 g/dL, p = 0.032), although the absolute difference was small. sIgA tended to be higher in the secondhand HTP exposure group (non-exposed vs. secondhand HTP exposure: 1244 vs. 1706 μg/mL, p = 0.072). Cotinine concentrations did not differ significantly between groups; qualitative cotinine tests were negative in all samples. Conclusions: Secondhand exposure to HTPs was not associated with clear differences in major human milk components or cotinine concentrations. However, the findings should be interpreted cautiously because of the small sample size and limited cotinine assessment. Larger studies with objective exposure assessment and infant follow-up are needed. Full article

Background/Objectives: Early enteral feeding in preterm infants remains controversial because, despite promoting intestinal maturation, concerns about necrotizing enterocolitis (NEC) persist. Donor human milk (DHM) is recommended when the mother’s milk is unavailable, but the optimal initiation timing is unclear. This study evaluated the association between DHM initiation timing and outcomes in very-low-birth-weight (VLBW) infants in Japan. Methods: This multicenter retrospective cohort study used data from a national human milk bank registry (2018–2023) and the Neonatal Research Network of Japan (NRNJ; 2022). Infants with birth weight <1500 g were categorized by DHM initiation timing (≤24, 25–48, or >48 h), with infants in the NRNJ cohort serving as the comparison group. The primary outcome observed was NEC incidence, including all stages; secondary outcomes included in-hospital mortality and time to full enteral feeding. Bayesian regression models were applied. Detailed feeding data were unavailable in the NRNJ cohort. Results: Among 2962 infants, NEC incidence was low across groups. NEC occurred in 1.31% of the ≤24 h DHM group and 1.83% of the NRNJ group, with mortality rates of 4.53% and 6.23%, respectively. Although NEC incidence was numerically lower in the ≤24 h DHM group, estimates were imprecise because of limited events. Early DHM initiation was associated with lower in-hospital mortality and earlier full enteral feeding, particularly in infants with <1000 g birth weight. Conclusions: Early DHM initiation was associated with lower mortality and earlier achievement of full enteral feeding in VLBW infants without elevated NEC risk. However, because detailed feeding information was unavailable in the comparison cohort, these associations should be interpreted cautiously. Given the observational design and heterogeneous nutritional exposures, further prospective studies are warranted. Full article

Human milk cream, a lipid-rich fraction obtained during milk defatting, is typically discarded despite its potential for individualized nutritional strategies. This study evaluated the effects of Holder pasteurization (HoP) and storage conditions (refrigeration and freezing) on the microbiological profile and lipid stability of human milk–derived cream. Cream fractions from six mothers of preterm infants were analyzed for bacterial counts using Columbia Nalidixic Acid and MacConkey agar, with isolate identification by MALDI-TOF MS, and for lipid stability through free fatty acids (FFAs), triacylglycerol (TAGs) composition by GC-FID, and peroxide values (PV) determined by a rapid photometric method. Raw cream showed stable total bacterial counts across storage conditions, with a reduction in Gram-negative bacteria after freezing, while HoP samples exhibited no detectable bacterial growth. Lipolysis was significantly higher in raw cream, with increased FFAs after 72 h refrigeration, whereas HoP samples maintained lower and more stable FFA levels. TAG profiles remained largely stable under refrigeration but were significantly altered during frozen storage in raw samples, suggesting membrane disruption and selective hydrolysis; these changes were attenuated in HoP samples. PV increased over time in both groups, indicating progressive primary lipid oxidation, although values remained within moderate ranges. Overall, HoP improved microbiological safety and lipid stability, supporting the potential use of human milk cream as a controlled lipid source for individualized fortification in preterm infants. Full article

Background: The translocation of diet-derived antigens from the maternal intestine to breast milk represents a primary gateway for neonatal immune priming, yet the structural basis for why certain proteins survive this transit while others do not remains poorly understood. This review introduces the “Survivor Peptide” hypothesis, proposing that specific food allergens possess intrinsic “stability architectures” that enable them to resist maternal digestion and navigate the gut–mammary axis to reach the infant in an immunologically active form. Methods: We analyzed the current literature regarding the detection and structural characteristics of food allergens in human milk. Integrating evidence from 26 major sources, we performed an in silico structural analysis of five representative “survivor” proteins: Gal d 1 (egg white), Bos d 5 (cow’s milk), Gal d 6 (egg yolk), Tri a 19 (wheat), and tropomyosin (Der p 10-mite/shellfish). High-resolution 3D models were retrieved from the Protein Data Bank and AlphaFold2, and then visualized in UCSF ChimeraX to map stability anchors, including disulfide bonds and hydrophobic clusters, against solvent-accessible IgE-binding epitopes. Results: We identified and categorized allergens into distinct Molecular Resilience Architectures: the “Covalent Cage” (Gal d 1), defined by dense disulfide stapling, the “Glycoprotein Shield” (Gal d 6), utilizing yolk-matrix structural anchors, the “Topological Shield” (Bos d 5), characterized by a stable β-barrel, and “Coiled-Coil Rigidity” (Der p 10). These frameworks protect large, immunogenic fragments that maintain the spatial arrangement required for IgE cross-linking. Conclusions: Allergen persistence in the gut–mammary axis is dictated by a protein’s intrinsic structural architecture. Identifying these stability fingerprints provides a unified theory for allergen persistence and offers a path for refining component-resolved diagnostics and neonatal oral tolerance strategies. Full article

Human milk fat globules (MFGs)’ size characterization is key for evaluating milk quality and processing effects. Laser diffraction (LD) is widely used for particle size analysis but provides limited morphological information. This study applied image-based morphometric analysis (IBMA) to characterize MFGs’ size and shape distributions in human milk and compared the results with LD measurements. Milk samples from 12 women delivering term and preterm infants were analyzed. LD was performed using a Mastersizer 3000 (Malvern Panalytical, Malvern, UK) and IBMA using a Morphologi 4 (Malvern Panalytical, Malvern, UK), acquiring 2D images at 20× magnification covering particle sizes from ~1.5 to 130 µm. IBMA classified MFGs as individual particles (IP) (HS circularity ≥ 0.920; circle equivalent diameter < 25 µm) or agglomerates (HS circularity < 0.920; solidity < 0.970), extracting descriptors including circularity, elongation, and solidity. IP predominated, while agglomerates represented ~15% of particles. Number-mean diameters (D[1,0]) were 4.91 µm (total), 4.36 µm (IP), and 8.00 µm (agglomerates). Volume-weighted particle diameters (D[4,3]) were 7.21 µm for IP and 14.02 µm for agglomerates. The highest level of agreement between methods was observed for IP D[4,3], although minor differences may be clinically relevant. IBMA and LD provide complementary information; however, IBMA uniquely enables the characterization of MFG structural organization, including the identification of agglomerates, which cannot be resolved by LD. This added level of structural detail may have important implications for understanding the digestibility of human milk, particularly in preterm populations. Full article

Donor human milk (DHM) provided by human milk banks is considered the optimal feeding alternative to mother’s own milk for premature or medically compromised infants. Before distribution, DHM is subjected to Holder pasteurization (HoP) by milk banks to eliminate potential pathogens. In this study, FT-IR, GC and GC-MS were applied to characterize changes in the volatile organic compounds (VOCs) and lipid components of human milk (HM) samples that were treated by HoP. FT-IR analysis revealed changes in specific band regions, indicating modifications to triglycerides and fatty acid (FA) organization and possible disruption of the milk fat globule membrane. There was also an increase in ester groups, suggesting that HoP increases lipid oxidation. GC analysis showed a reduction in long-chain FAs, including certain omega-3 and omega-6 polyunsaturated FAs (PUFAs). GC-MS analysis showed that HoP-treated samples contained higher levels of alkanes, aldehydes, aromatics and ketones than raw HM. Conversely, other compounds, including furans, and alkynes, were found exclusively in pasteurized HM. These results show that HoP affects the lipid and VOC components of HM, highlighting the need for research into alternative pathogen elimination strategies in human milk bank practices. Full article

Human milk is the optimal standard for neonatal nutrition, particularly for preterm infants. Several conditions associated with oxidative stress (OS) may be transmitted from mother to infant through milk, making the preservation of milk quality essential. When maternal milk is unavailable, donor human milk (DM) is commonly used and treated with Holder pasteurization (HoP) to ensure microbiological safety, although this process may affect bioactive components. This study aimed to evaluate the impact of HoP on OS biomarkers, specifically total antioxidant power (TAP) and 15-F2t-isoprostane, using colorimetric and ELISA methods as cost-effective alternatives to analytical gold standards. Twenty paired DM and HoP samples from the Human Milk Bank of Sant’Anna Hospital (Turin, Italy) were analyzed. No significant differences were observed in TAP levels between DM and HoP samples. In contrast, 15-F2t-isoprostane concentrations were significantly lower in DM compared to pasteurized milk (3.16 (1.59–5.27) vs. 0.76 (0.62–1.54), p-value < 0.001). This reduction remained consistent after stratification by sampling day. These findings suggest that HoP may reduce oxidative stress markers in donor milk, potentially limiting neonatal exposure to maternal oxidative imbalance. Although this effect could offer protective benefits for vulnerable preterm infants, further studies are needed to clarify the clinical implications of HoP on redox status and neonatal outcomes. Full article

Neonatal health requires precise lipid quantification in human milk to ensure proper nutritional development. Traditional manual methods, such as the creamatocrit, are limited by human-induced bias and significant measurement uncertainty. This study presents a low-cost Computer Vision System acting as an automated optical sensing modality for estimate the cream fraction (c) using advanced Machine Learning regression, which is subsequently used to derive fat and energy quantification through established analytical equations. The system is optimized for the Gold-LED spectrum, which enhances the dynamic range to 226 a.u. for robust feature extraction. We evaluated 28 distinct ML regression models across three feature spaces (Gray Scale, RGB, and Combined). The results, based on 6400 samples, demonstrate that the Rational Quadratic GPR model achieved the highest predictive stability with a coefficient of determination of $R^2=0.867$. This computational framework achieved a 57.5% reduction in relative error compared to manual benchmarks. SHAP analysis indicates that the model selectively attributes higher importance to Red channel intensities and Blue contrast gradients, which correspond to the optical scattering characteristics of lipid globules. These findings validate the system as a stable sensing modality for non-invasive quantification. The proposed architecture integrates cost-effective hardware with high-precision analytical modeling, offering a reagent-free and operationally feasible alternative for standardized nutritional assessment in neonatal intensive care units and milk banks. Full article

Background: Human milk is considered an ideal diet for neonates, and every effort should be made to promote breastfeeding. Donor human milk (DHM) remains the best alternative for neonates when their mother’s own milk (MOM) is not available. We tried to determine whether having easy access to DHM from a Human Milk Bank (HMB) would reduce the pursuit to feed neonates MOM. Methods: A retrospective study was conducted on data from neonates consecutively admitted to the Neonatal Intensive and Intermediate Care Units of the Department of Neonatology of the Medical University of Bialystok between 1 January 2022 and 31 March 2025. The study period covered 2 years before the opening of the HMB and 1 year of its operation. No specific changes in feeding practices occurred simultaneously during the HMB’s first year of operation. Results: In the first year of operation of the HMB, we observed an increase in the percentage of neonates who (1) received mother’s own colostrum (71.88% vs. 52.28% (2023) and 52.05% (2022); p < 0.001), (2) were fed human milk during hospitalization (24.38% vs. 3.57% (2023) and 4.09% (2022); p < 0.001) and (3) were fed MOM at discharge (43.86% vs. 56.25%, p = 0.024). In total, 53.06% of neonates who received DHM were fed MOM at discharge. Conclusions: The possibility of using milk from the HMB did not limit the desire to feed neonates MOM but intensified it. Neonates were more likely to be fed MOM during the first feeding, throughout their hospitalization, and at discharge. It shows the strong potential of HMBs in improving feeding practices in Neonatal Intensive and Intermediate Care Units. Full article

Background/Objectives: Exclusive breastfeeding (EBF) at discharge from neonatal units is influenced by maternal, neonatal, and healthcare-related factors. Structured breastfeeding support may improve outcomes. This study aimed to assess the impact of specialized breastfeeding support provided by a pediatric nurse on EBF rates at discharge and to explore associated factors. Methods: A retrospective observational cohort study was conducted in a regional referral neonatal unit within the Spanish public healthcare system. Newborns admitted to the unit whose mothers intended to breastfeed were included. Two periods were compared: a pre-intervention period, April 2017–March 2019, (breastfeeding working group, written protocol, staff training, and donor human milk bank) and a post-intervention period, April 2019–March 2021, (incorporation of a lactation consultant and establishment of a Breastfeeding Committee). EBF at discharge and at 6 and 12 months was analyzed using descriptive statistics and multivariate logistic regression. Results: A total of 1136 newborns were included in the analysis. EBF at discharge increased from 39.6% in the pre-intervention period to 75.8% in the post-intervention period (p < 0.001). The post-intervention period was independently associated with EBF (OR 4.45; 95% CI: 3.45–5.75). Factors positively associated with EBF included participation in breastfeeding workshops, adequate milk expression frequency, initiation of breastfeeding at birth, and previous breastfeeding experience. Negative associations included hypogalactia, donor human milk use, and maternal pain. EBF rates were 38.5% at 6 months and 20.9% at 12 months. Conclusions: Specialized breastfeeding support within neonatal units was associated with a substantial increase in EBF at discharge, supporting its systematic integration into routine neonatal care. Full article

Background/Objectives: Breastfeeding has accompanied women since the beginning of time and, according to anthropological research, naturally ends between the age of 2 and 6. WHO (World Health Organization) recommends exclusive breastfeeding for about the first 6 months, with continued breastfeeding along with introducing appropriate complementary foods for up to 2 years of age or longer. Despite the increasing promotion of breastfeeding, women do not comply with the WHO guidelines and give up exclusive breastfeeding quickly, and long-term breastfeeding mothers still struggle with a lack of understanding in society. Methods: This work aims to expand the knowledge on the composition and antioxidant status of the milk of mothers breastfeeding past 12 months. Results: The basic composition of human milk changes depending on the stage of lactation. In women breastfeeding for more than a year, an increase in fat (p < 0.001) and magnesium (p < 0.001) was observed. A decreased concentration of leptin (p = 0.001), iron (p < 0.001), and iron-reducing capacity (p < 0.001) was also observed compared to milk from the initial stage of lactation. Conclusions: The milk of women breastfeeding for more than 12 months is a valuable food for the baby, maintaining its protection against free radicals and providing adequate nutrients. Full article

Colostrum harbors a highly diverse microbial community, predominantly composed of genera such as Staphylococcus, Streptococcus, Lactobacillus, Bifidobacterium, and Enterococcus. The composition and diversity of this microbiota are influenced by maternal factors—including age, body mass index, lactation activity, stress levels, and gestational diabetes—as well as external factors such as mode of delivery, antibiotic exposure, diet, and geographic location. This microbial community plays a critical role in maternal and neonatal health by contributing to early gut colonization, supporting digestion, promoting immune system development, and protecting against pathogenic microorganisms through mechanisms such as antimicrobial peptide production by lactic acid bacteria. The primary aim of this study was to evaluate the impact of mode of delivery on colostrum microbiota by comparing mothers who delivered vaginally with those who underwent cesarean section. Colostrum samples from 15 mothers were subjected to DNA extraction, high-throughput sequencing, and bioinformatic analyses to characterize microbial composition and predicted functional profiles. Although substantial inter-individual variability was observed, no statistically significant differences were detected in overall microbial diversity or community structure between the two delivery groups. However, distinct bacterial taxa and functional characteristics were identified that were specific to each mode of delivery, suggesting subtle delivery-related influences on colostrum microbiota composition. Full article