IntroductionKnowledge of the biology of human milk and the physiology of its production, secretion, and delivery is critical in deeply understanding the benefits of breastfeeding. Human breast milk is the optimal nutrition for infants because of its proven advantages for both the infant, and the mother. The World Health Organization (WHO), the American Academy of Pediatrics (AAP), and the American College of Obstetricians and Gynecologists (ACOG) all recommend breastfeeding for the first six months of age [1]. Breastfeeding is exceptionally superior, giving mothers and infants distinct and substantial physical, mental, and developmental health advantages [2].Poor breast milk production is the most frequent cause of breastfeeding failure. Reduced breast milk production may occur in many conditions, such as pre-term birth, illness of the mother or child, mother-infant separation, anxiety and emotional stress. All these circumstances act as powerful inhibitors of breastfeeding. Milk production can be increased in several ways, such as; psychological support and relaxation techniques [1]. Nonetheless, many mothers seek guidance from their physicians by asking for medical products to increase their breast milk supply, and galactagogues are often highly recommended.Galactagogues are pharmaceutical agents, foods, or herbal supplements that are used to support the initiation, continuation, or augmentation of breast milk production [3]; hence they are often prescribed when a mother has an inadequate milk supply. Usually these prescribed galactagogues are artificially made drugs, which may contain substances that cause unpleasant side effects. For example, Metoclopramide (commercially known as Reglan®) is one of the most commonly prescribed drugs for increasing milk supply. However, its side

The use of intravenous FishLEs in premature infants appears to be safe and reverses PNALD despite significant liver disease and intestinal failure. This therapy should be used in preterm infants with PNALD and followed long term to evaluate development.

The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW). Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF) was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants’ weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb), electrolytes, blood urea nitrogen (BUN) and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430), length 0.76 and 0.58 cm/week (P=0.0027), and head circumference of 0.59 and 0.5 cm/week (P=0.0217) in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls), P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers’ milk for preterm VLBW infants in developing countries with low resources.

Phototherapy is the most common method used to treat and prevent neonatal hyperbilirubinemia. Breastfeeding compared with formula feeding is associated with an increased risk of jaundice and kernicterus. The main mechanism is failure of successful initiation of breastfeeding. Breast failure jaundice usually leads to significant weight loss resulting in hyperbilirubinemia. The aim was to determine the relation between type of infant feeding and the efficacy of phototherapy for treatment of hyperbilirubinemia in term newborns. The authors included 90 full-term neonates diagnosed with nonhemolytic, unconjugated hyperbilirubinemia. According to their total bilirubin level, they received conventional phototherapy for treatment. They were divided into 3 groups according to type of feeding: group 1, mixed feeding (MF; breast and formula); group 2, formula feeding (FF; formula); and group 3, breastfeeding (BF). Rebound bilirubin was checked 24 hours after stopping phototherapy. The mean duration of phototherapy was more in the BF group, followed by the MF and FF groups (P < .01). There was a significant positive correlation between bilirubin level and weight loss at the start of phototherapy in the groups studied (r = 0.635; P < .001). Rebound bilirubin level was higher in BF followed by FF and MF newborns, with significant differences (P = .005). These results indicate that phototherapy effectively reduces bilirubin levels in BF newborns with hyperbilirubinemia. These infants show a significantly slower response to this treatment than FF or MF newborns. Prevention of breast milk failure would decrease weight loss, which is associated with high bilirubin at the start of phototherapy.