Breastmilk erythropoietin and mother-to-child HIV transmission through breastmilk

Miller, M. ,Iliff, P., Stoltzfus, J. Humphrey, J. The Lancet 360 1246-1248, 2002


Since the majority of babies who are breastfed by HIV positive mothers do not acquire the infection, the authors ask, what protects the 85% of breastfed babies of HIV-infected mothers who do not become infected? They propose that the hormone, erythropoietin (EPO), present in large quantities in human milk, may play an important role in the prevention of transmission during breastfeeding.


Although EPO is known to have a role in stimulating the production of red blood cells in response to hypoxia, and raises blood haemoglobin concentration, it is the fact that EPO receptors are present in both the intestinal and the mammalian epithelial tissues that raise the prospect of its role in the prevention of viral transmission. In animal studies, EPO is known to promote gastric mucosal growth and maintain gut integrity. The Coutsoudis studies have shown that gut integrity may play an important role in the prevention of transmission of the HIV virus during breastfeeding. This study takes the hypothesis further by suggesting that the hormone EPO plays a specific role by helping to maintain the epithelial layers of both the mammary glands and the intestinal system and thus prevent viral "leakage." The authors suggest there might be a pharmacological role for EPO since formula feeding as an alternative presents a greater risk for infant mortality.


Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory. Smith JP, Thompson JF, Ellwood DA, Aust N Z J Public health 26: 543-551, 2002


Early cessation of breastfeeding due to supplementation with infant formula, or weaning onto formula or the early introduction of solids is associated with significant hospitalization costs. This Australian study from the Australian Capital Territory looked at the cost of treating infant and childhood illnesses associated with early cessation or reduced use of breastmilk. Hospital costs were estimated for the treatment of gastrointestinal illness, respiratory illness, otitis media, eczema and necrotising enterocolitis.


For the Australian Capital Territory, the study attributes an additional one to two million dollars per year. The authors note that these costs are minimum estimates as they exclude "numerous other chronic or common illnesses and out-of-hospital health care costs." They recommend that increased rates of exclusive breastfeeding will be cost-effective for the public health system.


Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study. Mikiel-Kostyra M, Mazur K, Boltruszko I., Acta Paediatr 91: 1301-1306, 2002


This Polish study is yet another confirming the benefits of mother-infant skin-to-skin contact immediately after birth. Using a prospective cohort study design 1250 Polish children were followed for three years to determine the influence on breastfeeding practice of skin-to-skin contact after delivery. Infants who were kept with their mothers for at least 20 minutes were exclusively breastfed for 1.35 months longer and weaned 2.10 months later than infants who received no such contact after birth.


In conclusion, extensive mother-infant skin-to-skin contact lasting more than 20 minutes after delivery, increases the duration of exclusive breastfeeding.


The impact of breastmilk on infant and young child health.  Oddy WH., Breastfeeed Rev 10: 5-18, 2002


The importance of breastfeeding is emphasized in this excellent review highlighting the valuable constituents and their roles in the promotion of infant health and beyond.


~  Human milk provides specific and non-specific factors that have long term consequences for early metabolism and disease prevention.


~  Human milk enhances the immature immunologic system of the neonate and strengthens host defense mechanisms against infective and foreign agents.


~  Human milk has bioactive factors actively stimulating the infant’s immune system — hormones, growth factors, colony stimulating factors and specific nutrients.


~  Human milk reduces the incidence of disease in infancy.


~  Human milk has factors, which promote gastrointestinal mucosal maturation, decease the incidence of infection, alter gut microflora, and have immunomodulatory and anti-inflammatory functions such as hormones, growth factors and cytokines.


~  Human milk feeding reduces an infant’s exposure to foreign dietary antigens.


~  Human milk provides ongoing protection against illness after cessation of breastfeeding.


~  Human milk alone can provide optimal development.


"All mothers should be encouraged and supported to continue breastfeeding for six months and beyond in order to promote good health for their infants."


Being born in Manitoba: a look at perinatal health issues.  Martens PJ, Derksen S, Mayer T, Walld R. Can J Publ Health 93: S33-38, 2002


To examine the health of newborns in Manitoba born between 1989 and 1994, the Manitoba Centre for Health Policy looked at preterm birth weight and mode of infant feeding. Using data from the Population Health Research Data Repository and the longitudinal Survey of Children and Youth, 1996, the conclusion confirmed the economic link such surveys have made, that of reduced economic well- being and reduced birth weight.


Manitoba’s breastfeeding rates continue to increase. A mean rate of 78 per cent reflects a range of 64 per cent to 87 per cent in the Regional Health Authorities and 66 per cent to 90 per cent in the Winnipeg Community Areas. Additionally, of those initiating breastfeeding, 42 per cent breastfed for six months or longer.


Howard RC, Howard FM, Lanphear B, Eberly S, deBlieck EA, Oakes D, Lawrence RA. Randomized Clinical Trial of Pacifier Use and Bottle-Feeding or Cupfeeding and Their Effect on Breastfeeding. Pediatrics 111: 511-518, 2003


To determine the effect of artificial nipples on breastfeeding duration. 700 breastfed newborns were randomly put into one of four intervention groups: bottle/early pacifier, bottle/late pacifier, cup/early pacifier, or cup/late pacifier. Breastfeeding and artificial nipple use data were collected at delivery and at 2, 5, 10, 16, 24, 38, and 52 weeks’ postpartum.


The results support the World Health Organization recommendations which discourage the use of pacifiers and bottle feeding.


They found:

Supplemental feedings, regardless of method (cup or bottle), had a detrimental effect on breastfeeding duration. Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers. There were no differences in cup versus bottle groups for breastfeeding duration.  They concluded that, "Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding. These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period."


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