Greetings All,

Using lay terminology in our patient teaching, we often discuss the cognitive need for task-specific practice (practice specificity, or practice that is specific to the task) while infants are engaged in sensory-perceptual-motor learning toward motor control in the acquisition of breastfeeding skills.  Motor skill acquisition has long been studied in the cognitive sciences, as well as the acquisition and specificity of language and other forms of learning.  

The ambiguity of language is a controversial topic in our field in regard to the similar-sounding but different credentials held by those who provide support for infant feeding on any level.  The 2018 change in UNICEF/WHO's Ten Steps to Successful Breastfeeding was a controversial change in regard to the less clear language currently found in Step 9, versus the precise language used in Step 9 from the Ten Steps' inception in 1986 until the change in Step 9's language in early 2018.  

This first study examined the ambiguous use of the term "human milk fortifier", finding "a need for more specific language and clearer communication." 

Title:  Parent and Provider Perspectives on the Imprecise Label of "Human Milk Fortifier" in the NICU.

In:  Nutrients 2020 Mar 9;12(3). pii: E720. doi: 10.3390/nu12030720.

Authors:  Canvasser J, Hair AB, Kim JH, Taylor SN.

Abstract:  "In the critical care of preterm infants, feeding is complex and potentially harmful to an immature gastrointestinal system. Parents have expressed the desire to be fully informed about what is being fed to their child, as this places them in the best position to nurture their child's health. In the parent-engaged setting of the Necrotizing Enterocolitis Symposium, NICU parents expressed concern and confusion about how cow's milk product and donor human milk product both carry the label 'Human Milk Fortifier' (HMF). Accordingly, two online surveys were developed to characterize how the label HMF is used and interpreted in the NICU by parents and providers. Of 774 United States participants, only 21.9% of providers reported consistently describing the source of HMF to parents, and only 20.6% of parents whose child received an HMF product report knowing the source. Parents expressed that they were 'not given information' regarding HMF, while both parents and healthcare providers expressed that 'the label (HMF) is misleading'. This study documents the ambiguity around the label HMF as well as the need for more specific language and clearer communication."

Open access:  https://www.mdpi.com/2072-6643/12/3/720/htm



Title:  Potential Effects of Indole-3-Lactic Acid, a Metabolite of Human Bifidobacteria, on NGF-induced Neurite Outgrowth in PC12 Cells.

In:  Microorganisms 2020 Mar 12;8(3). pii: E398. doi: 10.3390/microorganisms8030398.

Authors:  Wong CB, Tanaka A, Kuhara T, Xiao JZ.

Abstract:  "Gut microbiota-derived tryptophan metabolites such as indole derivatives are an integral part of host metabolome that could mediate gut-brain communication and contribute to host homeostasis. We previously reported that infant-type Human-Residential Bifidobacteria (HRB) produced higher levels of indole-3-lactic acid (ILA), suggesting the former might play a specific role in microbiota-host crosstalk by producing ILA in human infants. Nonetheless, the biological meaning of bifidobacteria-derived ILA in infant health development remains obscure. Here, we sought to explore the potential role of ILA in neuronal differentiation. We examined the neurite outgrowth and acetylcholinesterase (AchE) activity of PC12 cells following exposure to ILA and NGF induction. We found that ILA substantially enhanced NGF-induced neurite outgrowth of PC12 cells in a dose-dependent manner, and had the most prominent effect at 100 nM. Significant increases in the expression of TrkA receptor, ERK1/2 and CREB were observed in ILA-treated PC12 cells, suggesting ILA potentiated NGF-induced neurite outgrowth through the Ras/ERK pathway. Additionally, ILA was found to act as the aryl hydrocarbon receptor (AhR) agonist and evoked NGF-induced neurite outgrowth in an AhR-mediated manner. These new findings provide clues into the potential involvement of ILA as the mediator in bifidobacterial host-microbiota crosstalk and neuronal developmental processes."

Open access:  https://www.mdpi.com/2076-2607/8/3/398



Title:  Triacylglycerol containing Medium-chain Fatty Acids: Comparison of Human Milk and Infant Formulas on Lipolysis during in vitro Digestion.

In:  Journal of Agricultural and Food Chemistry 2020 Mar 18. doi: 10.1021/acs.jafc.9b07481. [Epub ahead of print]

Authors:  Yuan T, Geng Z, Dai X, Zhang X, Wei W, Wang X, Jin Q.

Abstract:  "Medium-chain triacylglycerol (MCT) is widely used in infant formula (IF) to provide medium-chain fatty acids (MCFAs) for infants with special fat absorption requirements. However, MCFAs naturally present in human milk are medium-and long-chain triacylglycerols (MLCTs). This study investigated the effect of TAG-containing MCFAs (MLCT vs. MCT) on lipolysis by comparison of human milk and IFs containing 0, 20, 30, and 55% of MCT (IF 1 to IF 4) using an in vitro digestion model. Rabbit Gastric Lipase (RGL) showed an extent of digestion within the expected range which was selected as the alternative to human gastric lipase. All IFs showed lower lipolysis degree compared with human milk. There was no significant difference (p = 0.175) among IFs supplemented with MCT at the end of intestinal digestion. In addition, the digestion of IFs with different MCT contents led to different free fatty acid profiles, which may have health effects in infants."

Abstract only:  https://pubs.acs.org/doi/abs/10.1021/acs.jafc.9b07481



Title:  Maternal activation of the EGFR prevents translocation of gut-residing pathogenic Escherichia coli in a model of late-onset neonatal sepsis.

In:  Proceedings of the National Academy of Sciences of the United States of America 2020 Mar 16. pii: 201912022. doi: 10.1073/pnas.1912022117. [Epub ahead of print]

Authors:  Knoop KA, Coughlin PE, Floyd AN, Ndao IM, Hall-Moore C, Shaikh N, Gasparrini AJ, Rusconi B, Escobedo M, Good M, Warner BB, Tarr P,  Newberry RD.

Abstract:  "Late-onset sepsis (LOS) is a highly consequential complication of preterm birth and is defined by a positive blood culture obtained after 72 h of age. The causative bacteria can be found in patients' intestinal tracts days before dissemination, and cohort studies suggest reduced LOS risk in breastfed preterm infants through unknown mechanisms. Reduced concentrations of epidermal growth factor (EGF) of maternal origin within the intestinal tract of mice correlated to the translocation of a gut-resident human pathogen Escherichia coli, which spreads systemically and caused a rapid, fatal disease in pups. Translocation of Escherichia coli was associated with the formation of colonic goblet cell-associated antigen passages (GAPs), which translocate enteric bacteria across the intestinal epithelium. Thus, maternally derived EGF, and potentially other EGFR ligands, prevents dissemination of a gut-resident pathogen by inhibiting goblet cell-mediated bacterial translocation. Through manipulation of maternally derived EGF and alteration of the earliest gut defenses, we have developed an animal model of pathogen dissemination which recapitulates gut-origin neonatal LOS."

Open access:  https://www.pnas.org/content/early/2020/03/10/1912022117.long



Title:  Longitudinal characterization of bifidobacterial abundance and diversity profile developed in Thai healthy infants.

In:  Archives of Microbiology 2020 Mar 17. doi: 10.1007/s00203-020-01856-5. [Epub ahead of print]

Authors:  Kongnum K, Taweerodjanakarn S, Hongpattarakere T.

Abstract:  "The early bifidobacterial colonization and development of infant gut is considered crucial for the immediate and lifelong health of human host. This study longitudinally analyzed and characterized fecal bifidobacterial profiles in association with feeding regimens observed in six infants during 5 months after birth. The dominant fecal microbiota of bifidobacteria, lactobacilli/enterococci, clostridia, bacteroides and eubacteria were specifically enumerated using fluorescent in situ hybridization (FISH) technique. Breastfeeding exhibited close association with the predomination of bifidobacteria with the highest relative abundance of 32-70% detected in both infants with exclusive breastfeeding. The nested PCR-DGGE technique revealed high diversity existing within a bifidobacterial species with multiple strain variants of B. bifidum, B. longum, B. breve and B. dentium continuously detected in feces of exclusively breast- and combination-fed infants over the period of 5 months. Contrarily, B. breve, B. adolescentis, B. dentium, B. bifidum, B. faecale, B. kashiwanohense and B. lactis detected in all exclusively formula-fed infants seem to be transient species. The persisting strains seem to derive primarily from maternal breastmilk as demonstrated by PCR-DGGE profiles of human milk and feces from three mother-infant pairs. The results suggested the pivotal role of breastfeeding regimen in supporting colonization and succession of bifidobacteria in infant gut."  

Abstract only:  https://link.springer.com/article/10.1007%2Fs00203-020-01856-5


Sending warmest regards during this exceedingly difficult time around the world, 

Debbie

Debra Swank, RN BSN IBCLC
Program Director
MoreThanReflexes Education
Elkins, West Virginia USA
http://www.MoreThanReflexes.org

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