Human Milk And Lactation

The Model Chapter on Infant and Young Child Feeding is intended for use in basic training of health professionals. It describes essential knowledge and basic skills that every health professional who works with mothers and young children should master. The Model Chapter can be used by teachers and students as a complement to textbooks or as a concise reference manual.

Proceedings of a symposium, satellite to the 24th International Congress of Physiological Sciences, University of Pennsylvania.

Human milk is uniquely tailored to meet infants’ specific nutritional requirements. However, it is more than just “milk”. This dynamic and bioactive fluid allows mother–infant signalling over lactation, guiding the infant in the developmental and physiological processes. It exerts protection and life-long biological effects, playing a crucial role in promoting healthy growth and optimal cognitive development. The latest scientific advances have provided insight into different components of human milk and their dynamic changes over time. However, the complexity of human milk composition and the synergistic mechanisms responsible for its beneficial health effects have not yet been unravelled. Filling this knowledge gap will shed light on the biology of the developing infant and will contribute to the optimization of infant feeding, particularly that of the most vulnerable infants. Greater understanding of human milk will also help in elucidating the best strategies for its storage and handling. The increasing knowledge on human milk’s bioactive compounds together with the rapidly-advancing technological achievements will greatly enhance their use as prophylactic or therapeutic agents. The current Special Issue aims to welcome original works and literature reviews further exploring the complexity of human milk composition, the mechanisms underlying the beneficial effects associated with breastfeeding, and the factors and determinants involved in lactation, including its promotion and support.

Human lactation has evolved to produce a milk composition that is uniquely-designed for the human infant. Not only does human milk optimize infant growth and development, it also provides protection from infection and disease. More recently, the importance of human milk and breastfeeding in the programming of infant health has risen to the fore. Anchoring of infant feeding in the developmental origins of health and disease has led to a resurgence of research focused in this area. Milk composition is highly variable both between and within mothers. Indeed the distinct maternal human milk signature, including its own microbiome, is influenced by environmental factors, such as diet, health, body composition and geographic residence. An understanding of these changes will lead to unravelling the adaptation of milk to the environment and its impact on the infant. In terms of the promotion of breastfeeding, health economics and epidemiology is instrumental in shaping public health policy and identifying barriers to breastfeeding. Further, basic research is imperative in order to design evidence-based interventions to improve both breastfeeding duration and women’s breastfeeding experience.

Now in its second edition, Drugs and Human Lactation is a comprehensive guide to the content and consequences of xenobiotics and micronutrients in human milk, and remains by far the most thorough and extensive work available on this subject. The excellent methodology used for the compilation of the 1st edition has been retained. It begins with an outline of the processes by which substances enter milk during its formation, the effects of drugs on the milk production process, the main determinants of drug excretion into milk and their disposition in the child. There follows an analysis of current data on 234 individual drugs, describing the extent of their passage into human milk, and assessing the risk to the suckling infant. Vitamins and essential trace elements, and radiopharmaceuticals are similarly reviewed. Also included is an account of the factors that influence the passage of environmental and occupational chemicals into milk. The result is a complete overview of what is known and proven, with clear pointers to matters which require further study, and brings the various subject areas up to date. Risks, uncertainties and false alarms which exist have been defined in such a way that they can be avoided. Once again, Drugs and Human Lactation provides a comprehensive guide to the content and consequences of substances in milk. The volume will provide a rational basis for making therapeutic decisions in women who seek to breast-feed. Reproductive Immunology on the first edition: ...a superbly written compendium of reliable information and sensible conclusions and recommendations.

The International Workshop on human lactation dedicated specifically to the topic of Maternal and Environmental Effects on Lactation repre sents the recent progress of research in human lactation. Only four years ago it was clear that we do not yet have sensitive research techniques specifically adapted to the study of human milk. This need was addressed by an NIH convened workshop in 1982, the concensus being that appropriate methods have to be developed for the study of the composition of human milk. The progress in the development of these techniques was the subject of the second workshop on human lactation, dedicated specifically to "Milk Components and Methodologies. " The workshop was held in Colorado in 1984 and resulted in the publication of the first volume in the series of "Human Lactation. " At the Colorado meeting it was readily apparent that considerable progress has been made in the development of sensitive techniques able to quantitate the bioactive components of human milk (enzymes, growth factors, immuno-protective agents) as well as the macro, micro and trace elements. At the Colorado workshop it became clear that these workshops greatly benefit the research of human lactation by enhancing communication and collaboration among the investigators in the field. As a result it was decided to have a future workshop about a year later on the topic of "Maternal-Environmental Effects on Human Lacta tion", and I was charged with chairing it.

Four years ago the National Institutes of Child Health and Human Development (NICHD) brought together a group of scientists to Belmont, Maryland to examine the status of human milk banking. During those deliberations, the idea was generated to organize a series of research conferences concerning human lactation and the composition and biological effects of human milk. The first one, organized by Robert G. Jensen from the University of Connecticut and Margaret C. Neville from the University of Colorado, dealt with methodologic issues. An additional meeting to explore the effects of maternal and environmental factors upon human lactation and the composition of human milk was organized by Margit Hamosh from Georgetown University and me, and was held in January, 1986 in Oaxaca, Mexico. Those meetings provided the foundation for the design of the present conference, 'The Effects of Human Milk Upon the Recipient Infant'. In addition to a grant from the NICHD, the conference was generously supported by Milupa AG from the Federal Republic of Germany; Wyeth Limited and Mead Johnson of Canada; and Ross Laboratories, Heinz USA, the Mead Johnson Nutritional Group, Wyeth International Limited, Gerber Products Company, the La Leche League International, Glaxo Incorporated and Sandoz Pharmaceutical Corporation from the United States.

Infant formulas are unique because they are the only source of nutrition for many infants during the first 4 to 6 months of life. They are critical to infant health since they must safely support growth and development during a period when the consequences on inadequate nutrition are most severe. Existing guidelines and regulations for evaluating the safety of conventional food ingredients (e.g., vitamins and minerals) added to infant formulas have worked well in the past; however they are not sufficient to address the diversity of potential new ingredients proposed by manufacturers to develop formulas that mimic the perceived and potential benefits of human milk. This book, prepared at the request of the Food and Drug Administration (FDA) and Health Canada, addresses the regulatory and research issues that are critical in assessing the safety of the addition of new ingredients to infants.