Human lactation is a dynamic physiological process that produces a complex biological fluid that provides nutritive and nonnutritive factors for an optimal child growth and well-being. Several factors play a formidable role in maternal breast milk production with respect to quality, and quantity, which will adequately sustain the child for at least the first 6 months after delivery. Evidence has shown majority of new mothers who wished to immediately commence exclusive breastfeeding after birth as recommended by the WHO, are unable to initiate lactation immediately. In view of this lactation insufficiency, health-care personnel have not only been campaigning on appropriate breastfeeding education but also offer early lactation support such as encouraging liberal fluid intake, dietary modifications, and in a worst-case scenario, administering agents/drugs such as galactogogue. Orthodox galactogogues in current use are either hormonal or antipsychotics; most of them have relative efficacy and safety limitations. Risperidone is an atypical antipsychotic which has been used for decades with established safety in lactating mothers and the highest propensity to induce galactorrhea as a secondary effect when compared to other antipsychotics that are currently being used as galactogogues. We call the attention of the medical community in conducting further researches on its possible adoption as a galactogogue, using this review as an insight.
Galactogogues ; lactation ; Low Breast Milk ; peripartum ; risperidone

PURPOSE: We aimed to compare the clinical findings, including morbidity, duration of parenteral nutrition, and length of hospital stay between very low birth weight infants (VLBWIs) fed bovine milk-based formula (BOV) and VLBWIs fed human breast milk (HBM) in a neonatal intensive care unit (NICU). METHODS: VLBWIs admitted to the NICU of Dongsan Medical Center, Keimyung University, were enrolled. Infants born from March to August 2014 (n=28) were fed BOV (the BOV group), and those born from September to December 2014 (n=18) were fed HBM (the HBM group). Pasteurized (heating at 62.5degrees C for 30 minutes) donor human milk was used if the mother's own milk was not available because of insufficient breast milk production. RESULTS: The gestational age (28.0+/-1.7 weeks vs. 27.8+/-1.4 weeks) and birth weight (1,055+/-265 g vs. 1,175+/-187 g), of the infants in the BOV and HBM, groups were similar. In addition, perinatal characteristics were similar between the groups. The duration of parenteral nutrition (36.4 days vs. 24.1 days, P=0.038), length of hospital stay (74.3 days vs.61.1 days, P=0.037), and incidence of nosocomial sepsis (53.6% vs. 22.2%, P=0.035), significantly differed between the BOV and HBM groups. Furthermore, the frequency of feeding intolerance was higher in the BOV group than in the HBM group, but this difference was not significant. Perinatal cytomegalovirus infection was not detected in any of the infants fed pasteurized donor human milk. CONCLUSION: Human-breast-milk-based diet for VLBWIs significantly reduces the incidence of nosocomial sepsis, duration of parenteral nutrition, and length of hospital stay.
Birth Weight ; Breast* ; Cytomegalovirus Infections ; Diet* ; Gestational Age ; Humans ; Humans* ; Incidence ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Length of Stay ; Milk ; Milk, Human* ; Parenteral Nutrition ; Sepsis ; Tissue Donors

Iron-deficiency anemia (IDA) is the most frequent hematologic and nutritional disorder in children. The risk factors associated with IDA in children are rapid growth with inadequate dietary iron, low birth weight, premature birth, perinatal bleeding, early cow's milk intake, and breastfeeding beyond 6 months without iron supplementation. Blood loss is also an important cause of IDA. Most children with IDA are asymptomatic and may go undiagnosed. The diagnosis of IDA is confirmed by microcytic hypochromic anemia and a low level of serum ferritin. Monitoring the response to iron supplementation is a reasonable intervention for a clinically stable child with mild anemia and inadequate iron intake. IDA must be differentiated from the anemia that arises from chronic disease and thalassemia. Oral iron is usually recommended as first-line therapy. Parenteral iron is indicated in cases of poor compliance or failure of oral iron, intestinal malabsorption, or chronic bleeding.
Anemia ; Anemia, Hypochromic ; Anemia, Iron-Deficiency* ; Breast Feeding ; Child* ; Chronic Disease ; Compliance ; Diagnosis* ; Ferritins ; Hemorrhage ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Iron ; Iron, Dietary ; Milk ; Nutrition Disorders ; Premature Birth ; Risk Factors ; Thalassemia

Cytomegalovirus (CMV) is one of the most commonly encountered viral pathogens in newborn infants and is found in 0.3-2.4% of all live births. It has been demonstrated that 40-96% of seropositive mothers shed the virus via their breast milk. Breast milk containing CMV can cause almost one-third of CMV infections occurring in infants. A case of postnatal CMV infection in an extremely premature infant (gestational age 24(+5) weeks, birth weight 750 g) transmitted via breast milk is presented. For neonatal intensive care unit (NICU) management of severe thrombocytopenia, anemia, and sepsis syndrome, the infant received repeated transfusions of platelets; intravenous (IV) immunoglobulins; and gamma-irradiated, filtrated packed red cells and was fed her mother's breast milk since the second week of life. CMV infection was diagnosed with positive CMV immunoglobulin M (IgM) and positive urine CMV culture at the second month of life. Considering the negative CMV IgM and urine CMV culture at birth, postnatally-acquired CMV infection was suspected and confirmed with completely identical nucleotide sequence alignments of the infantile blood isolate and the maternal breast milk isolate. To our knowledge, this is the first case of proven postnatal CMV infection transmitted via breast milk in an extremely premature infant in Korea.
Anemia ; Base Sequence ; Birth Weight ; Breast ; Cytomegalovirus ; Cytomegalovirus Infections ; Humans ; Immunoglobulin M ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Korea ; Live Birth ; Milk, Human ; Mothers ; Parturition ; Systemic Inflammatory Response Syndrome ; Thrombocytopenia ; Viruses

Cytomegalovirus (CMV) is one of the most commonly encountered viral pathogens in newborn infants and is found in 0.3-2.4% of all live births. It has been demonstrated that 40-96% of seropositive mothers shed the virus via their breast milk. Breast milk containing CMV can cause almost one-third of CMV infections occurring in infants. A case of postnatal CMV infection in an extremely premature infant (gestational age 24(+5) weeks, birth weight 750 g) transmitted via breast milk is presented. For neonatal intensive care unit (NICU) management of severe thrombocytopenia, anemia, and sepsis syndrome, the infant received repeated transfusions of platelets; intravenous (IV) immunoglobulins; and gamma-irradiated, filtrated packed red cells and was fed her mother's breast milk since the second week of life. CMV infection was diagnosed with positive CMV immunoglobulin M (IgM) and positive urine CMV culture at the second month of life. Considering the negative CMV IgM and urine CMV culture at birth, postnatally-acquired CMV infection was suspected and confirmed with completely identical nucleotide sequence alignments of the infantile blood isolate and the maternal breast milk isolate. To our knowledge, this is the first case of proven postnatal CMV infection transmitted via breast milk in an extremely premature infant in Korea.
Anemia ; Base Sequence ; Birth Weight ; Breast ; Cytomegalovirus ; Cytomegalovirus Infections ; Humans ; Immunoglobulin M ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Korea ; Live Birth ; Milk, Human ; Mothers ; Parturition ; Systemic Inflammatory Response Syndrome ; Thrombocytopenia ; Viruses

Despite a sharp decline in the prevalence of iron deficiency anemia (IDA) during the past several decades owing to better nutrition and iron-fortified foods, IDA continues to remain the most common disorder in the world. From about 4 months of age, iron stores are insufficient to maintain the rapidly expanding blood volume associated with normal growth. If there is no steady dietary supply, iron stores become depleted and IDA develops. It is known that iron deficiency (ID) may impair not only physical activity but also mental functions such as learning. Children with ID are found to have more psychomotor deficits and achieve lower scores in aptitude tests than those with normal iron status. Therefore, the detection and treatment, or preferably prevention of ID and IDA is imperative during late infancy, when increased vulnerability to ID coincides with the rapid growth and differentiation of the brain. The diagnosis of IDA is confirmed by the findings of a hemoglobin level <11 g/dL and low iron stores (serum ferritin level <12 microg/L, transferrin saturation <16%). Iron status should be evaluated in children who have risk factors for IDA such as low birth weight, premature baby, exclusive breastfeeding beyond 6 months of life, and weaning to whole milk and complementary foods without iron-fortified foods. With the management of underlying cause, oral iron therapy should be given to replenish iron stores. Parenteral therapy may be used in children who cannot tolerate or absorb oral preparations.
Anemia, Iron-Deficiency ; Aptitude Tests ; Blood Volume ; Brain ; Breast Feeding ; Child ; Ferritins ; Hemoglobins ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Iron ; Learning ; Milk ; Motor Activity ; Prevalence ; Risk Factors ; Transferrin ; Weaning

PURPOSE: Extremely low birth weight infants (ELBWIs) have a high risk of acquiring cytomegalovirus (CMV) infection via breast milk and consequently developing serious symptoms. We evaluated whether freeze-thawing or pasteurization could prevent postnatal CMV infection transmitted through breast milk in ELBWIs. MATERIALS AND METHODS: Medical records of 385 ELBWIs with whole milk feeding, and freeze-thawed or pasteurized breast milk feeding were reviewed retrospectively. Postnatally acquired CMV infection was defined as an initial negative and a subsequent positive on follow-up urine CMV DNA polymerase chain reaction screening tests. The incidence, clinical characteristics, symptoms, sequelae, and long-term outcome at corrected age [(CA): 2 years of CMV infection] were analyzed. RESULTS: While no infant developed CMV infection with whole milk (0/22) or pasteurized breast milk (0/62) feeding, postnatal CMV infection was diagnosed in 8% (27/301) of ELBWIs who were fed freeze-thawed breast milk. Gestational age in the CMV group was significantly lower than the control group. In 82% (22/27) of cases, CMV infection was symptomatic and was associated with increased ventilator days and > or =moderate bronchopulmonary dysplasia (BPD). Neurodevelopmental outcome and growth status at CA 2 years were not different between the study groups. Lower gestational age and freeze-thawed breast milk feeding >60% of total oral intake during the first 8 postnatal weeks were independent risk factors for acquiring postnatal CMV infection. BPD (> or =moderate) was the only significant adverse outcome associated with this CMV infection. CONCLUSION: Pasteurization but not freeze-thawing of breast milk eradicated the postnatal acquisition of CMV infection through breast milk.
Adult ; Breast Feeding ; Bronchopulmonary Dysplasia ; Cytomegalovirus/*isolation & purification ; Cytomegalovirus Infections/epidemiology/prevention & control/*transmission ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; *Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infectious Disease Transmission, Vertical/*prevention & control ; Male ; Milk, Human/chemistry/*virology ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Retrospective Studies ; Risk Factors

Necrotizing enterocolitis (NEC) is one of the most critical morbidities in preterm infants. The incidence of NEC is 7% in very-low-birth-weight infants, and its mortality is 15 to 30%. Infants who survive NEC have various complications, such as nosocomial infection, malnutrition, growth failure, bronchopulmonary dysplasia, retinopathy of prematurity, and neurodevelopmental delays. The most important etiology in the pathogenesis of NEC is structural and immunological intestinal immaturity. In preterm infants with immature gastrointestinal tracts, development of NEC may be associated with a variety of factors, such as colonization with pathogenic bacteria, secondary ischemia, genetic polymorphisms conferring NEC susceptibility, anemia with red blood cell transfusion, and sensitization to cow milk proteins. To date, a variety of preventive strategies has been accepted or attempted in clinical practice with regard to the pathogenesis of NEC. These strategies include the use of breast feeding, various feeding strategies, probiotics, prebiotics, glutamine and arginine, and lactoferrin. There is substantial evidence for the efficacy of breast feeding and the use of probiotics in infants with birth weights above 1,000 g, and these strategies are commonly used in clinical practice. Other preventive strategies, however, require further research to establish their effect on NEC.
Anemia ; Arginine ; Bacteria ; Birth Weight ; Breast Feeding ; Bronchopulmonary Dysplasia ; Colon ; Cross Infection ; Enterocolitis, Necrotizing ; Erythrocyte Transfusion ; Gastrointestinal Tract ; Glutamine ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Ischemia ; Lactoferrin ; Malnutrition ; Milk Proteins ; Polymorphism, Genetic ; Prebiotics ; Probiotics ; Retinopathy of Prematurity