Abstract
Concern about pasteurized human milk for consumption by the mother's own infant has important considerations when the mother has an infection incompatible with breastfeeding. The concern about fixing the milk is twofold: The eradication of organisms and the preservation of the protective qualities of the milk itself. Chantry et al. 1 in this issue have studied the effects of home treatment by high temperature (heat)/short time (HTST) pasteurization in the field in Africa where maternal HIV is common and infant mortality for infants not breastfed approaches 50% in the first year of life.
The HTST technique has been reported several times, including an article in this journal in 2007 that was not referenced. 2 It reported the HTST technique to be safe and preferable for milk banks. The authors of this current article performed rigorous tests to demonstrate the obliteration of the organisms as well as the stability of the infection protection properties of lactoferrin and lysozyme. The authors conclude that flash-heat may well be safe at home in developing countries during times of great risk for maternal-to-child transmission of HIV. This article should inspire other investigators to explore the use of HTST as a process for pasteurizing milk elsewhere in the world.
As the underlying parameters that contribute to the huge surge in obesity in all countries are sought, one notes that there is a difference in the first few years of life between infants who are breastfed as compared with bottle fed. Studies have investigated various parameters and noted that the mode of feeding (i.e., directly from the breast or pumped milk from a bottle) may have a role to play. Bartok 3 constructed a simple observational study to test just that question. She summoned 19 infants who were fed at the breast and 18 who received pumped breastmilk by bottle and followed their growth parameters for 6 months. Along with the standard measurements of weight, length, and head circumference, she also measured relative fat mass (% FM) using an air-displacement plethysmography system (Pea Pod®, Life Measurement, Inc., Concord, CA). The two groups were similar in weight, length, weight-for-age Z-scores, head circumference, fat mass, and % FM. The interesting observation was that the bottle-fed babies were three times more likely to exceed the 85th percentile for weight velocity from 4 to 6 months of age (33% vs. 10%, respectively), while it did not reach statistical significance in this small study. We publish it, however, to suggest that a collaborative study could quickly bring the cohort numbers up to about 75 in each group to become statistically significant. The bottle may have even more risk than we thought.
A group of investigators provide us with a rare look into the intent to breastfed in the very rural state of West Virginia (Chertok et al. 4 ). The years 2004, 2005, and 2006 were reviewed, which covered 52,899 live births. In that time, the intent to breastfeed remained steady at 48%, 49%, and 48%, whereas the rest of the country witnessed more breastfeeding. At the same time, the number of women who smoked during pregnancy increased, while smoking decreased elsewhere. As the authors continued to mine this data bank, interesting trends appeared that could help design a remedial approach. The education level is lower than the national average, for instance, and intent to breastfeed was lower among the less well educated. The demographics paralleled other studies that showed the better-educated, insured, married woman was more likely to breastfeed. The authors suggest that breastfeeding promotion should be targeted to the young, unmarried, uneducated, and Medicaid patients. Although this is not news, it justifies a targeted all-out-effort to promote breastfeeding to the highest-risk families in West Virginia.
Surgical colleagues from Saudi Arabia, Baslaim et al., 5 bring to our attention some interesting results of breastfeeding only on one breast. This phenomenon was first reported by the Chinese Tanka boat people in 1977. 6 The authors studied women in their clinic from 1998 to 2010. Fifty-four patients fed exclusively from one breast, and 21 others fed mostly from one breast. Some did this because of nipple retraction. Eighty-five percent of complaints were in the unsuckled breast, and only 15% in the suckled breast. The complaints about the unsuckled breast include generalized pain or heaviness, a mass with or without pain, or a nipple charge. Baslaim et al. 5 report various morbidities in the unsuckled breast and suggest that some of these problems could be prevented if the breast has been suckled. Let us hear from you, if you have made similar observations.
This issue of the journal also contains a review of current thinking on vitamin D deficiency by Haggerty. 7
Speaking out on a very thoughtful, provocative question—unintended consequences of the WIC formula rebate program—is the article by Jensen and Labbok. 8
Explorations into the science and benefits of breastfeeding are increasing rapidly. We welcome the opportunity to share this information with you in the journal.