Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant

Parker, Margaret G.; Stellwagen, Lisa M.; Noble, Lawrence; Kim, Jaehwan; Poindexter, Brenda B.; Puopolo, Karen M.; Newborn,

doi:10.1542/peds.2021-054272

Cited by 133 publications

(99 citation statements)

References 131 publications

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“…As one of the human milk bioactive components, hMEVs are expected to be safe for oral consumption, and without toxicity, supporting its use as a nutraceutical/therapeutic agent. Perhaps one potential use of isolated hMEVs would be human milk fortification [ 206 , 207 ] to enhance the beneficial effects of maternal breastmilk or donor milk or to improve infant formula. For preterm infants, especially whose with very low birth weight, this could help reduce their high risk of morbidity and mortality [ 207 , 208 ].…”

Section: Challenges and Clinical Implicationsmentioning

confidence: 99%

Human Milk Extracellular Vesicles: A Biological System with Clinical Implications

Chutipongtanate

Morrow

Newburg

2022

Cells

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The consumption of human milk by a breastfeeding infant is associated with positive health outcomes, including lower risk of diarrheal disease, respiratory disease, otitis media, and in later life, less risk of chronic disease. These benefits may be mediated by antibodies, glycoproteins, glycolipids, oligosaccharides, and leukocytes. More recently, human milk extracellular vesicles (hMEVs) have been identified. HMEVs contain functional cargos, i.e., miRNAs and proteins, that may transmit information from the mother to promote infant growth and development. Maternal health conditions can influence hMEV composition. This review summarizes hMEV biogenesis and functional contents, reviews the functional evidence of hMEVs in the maternal–infant health relationship, and discusses challenges and opportunities in hMEV research.

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Section: Challenges and Clinical Implicationsmentioning

confidence: 99%

Human Milk Extracellular Vesicles: A Biological System with Clinical Implications

Chutipongtanate

Morrow

Newburg

2022

Cells

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“…Very preterm infants born before 32 weeks’ gestation are vulnerable to both undernutrition and impaired neurodevelopment [ 6 , 7 ]. The current standard of nutritional care for these infants is a human milk diet, based on the established health benefits of human milk, with fortification added to meet this population’s high nutrient needs [ 8 ]. Standard fortification—adding a fixed quantity of multicomponent fortifier based on average reference values for macronutrient content—is practiced routinely, but this strategy does not achieve target nutrient intakes for all infants [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Associations of Macronutrient Intake Determined by Point-of-Care Human Milk Analysis with Brain Development among very Preterm Infants

et al. 2022

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Point-of-care human milk analysis is now feasible in the neonatal intensive care unit (NICU) and allows accurate measurement of macronutrient delivery. Higher macronutrient intakes over this period may promote brain growth and development. In a prospective, observational study of 55 infants born at <32 weeks’ gestation, we used a mid-infrared spectroscopy-based human milk analyzer to measure the macronutrient content in repeated samples of human milk over the NICU hospitalization. We calculated daily nutrient intakes from unfortified milk and assigned infants to quintiles based on median intakes over the hospitalization. Infants underwent brain magnetic resonance imaging at term equivalent age to quantify total and regional brain volumes and fractional anisotropy of white matter tracts. Infants in the highest quintile of energy intake from milk, as compared with the lower four quintiles, had larger total brain volume (31 cc, 95% confidence interval [CI]: 5, 56), cortical gray matter (15 cc, 95%CI: 1, 30), and white matter volume (23 cc, 95%CI: 12, 33). Higher protein intake was associated with larger total brain (36 cc, 95%CI: 7, 65), cortical gray matter (22 cc, 95%CI: 6, 38) and deep gray matter (1 cc, 95%CI: 0.1, 3) volumes. These findings suggest innovative strategies to close nutrient delivery gaps in the NICU may promote brain growth for preterm infants.

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“…MOM can provide newborns with energy, the nutrients required for growth, essential microbes, and other beneficial bioactive components, such as HM oligosaccharides and immunoglobulins (2). It can also reduce short-term complications, such as neonatal necrotizing enterocolitis (NEC), chronic lung diseases, retinopathy of prematurity, late-onset sepsis, and more significantly, it promotes neurodevelopment in the long term (3)(4)(5). Donor milk (DM) is recommended by many international agencies, such as the World Health Organization, to feed vulnerable infants as the suboptimal option when MOM is not available (6).…”

Section: Introductionmentioning

confidence: 99%

Effects of a WeChat Mini-Program on Human Milk Feeding Rates in a Neonatal Intensive Care Unit During the COVID-19 Pandemic

Jiang

Xue

et al. 2022

Front. Pediatr.

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ObjectiveWe investigated changes in maternal daily milk pumping frequency and milk volume per expression and their derived lactation indicators, as well as human milk (HM) feeding status with a focus on amount and rates in preterm infants admitted to the neonatal intensive care unit (NICU) after using a WeChat mini-program during the 2019 coronavirus (COVID-19) pandemic.MethodsThe study was conducted with 482 mothers and their 544 babies. We prospectively enrolled mothers and infants with birth weight <1,500 g or gestational age <32 weeks born in 2020, and retrospectively included the same population in 2019. All study subjects were classified into three subgroups: pre-pandemic (PP, 2019), early pandemic (EP, January to April 2020), and late pandemic (LP, May to December 2020). From 1 January 2020, mothers recorded in an online pumping diary using the WeChat mini-program. We obtained the infants’ feeding information from an online database for analysis.ResultsMaternal lactation indicators did not change significantly. However, 56.7% (139/245) of mothers achieved milk volume ≥500 ml/day (CTV) in PP, 58.9% (33/156) in EP, and a slight increase to 60.7% (91/150) in LP. Maternal pumping frequency remained about eight times/day. In LP, daily milk volume was higher than the other two periods from day 4, and mothers achieved CTV by day 12, which was achieved in the other two groups by 13–14 days. There were several statistical differences in the amount and rates of feeding between the groups, particularly about HM and donor milk feeding, with the vast majority being decreased during EP, while during LP they returned to PP levels. Pleasingly, the median average daily dose of HM at 1–28 days was highest in LP (LP, 87.8 vs. PP, 75.5 or EP, 52.6 ml/kg/day, Pcorrected < 0.001). In addition, most categorical feeding indicators decreased in EP and recovered in LP.ConclusionAn education model based on the WeChat program could aid lactation education and management in mothers of preterm infants to maintain healthy lactation. The model, together with optimized management strategies, can ensure that the HM feeding rate is not compromised in vulnerable high-risk infants during NICU hospitalization in a public health emergency, like the COVID-19 pandemic.

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Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant

Cited by 133 publications

References 131 publications

Human Milk Extracellular Vesicles: A Biological System with Clinical Implications

Human Milk Extracellular Vesicles: A Biological System with Clinical Implications

Associations of Macronutrient Intake Determined by Point-of-Care Human Milk Analysis with Brain Development among very Preterm Infants

Effects of a WeChat Mini-Program on Human Milk Feeding Rates in a Neonatal Intensive Care Unit During the COVID-19 Pandemic

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