INSECTICIDES IN HUMAN BREAST MILK

Abstract. Fifty samples of human breast milk were analysed by gas chromatography and thin layer chromatography for DDT (dichlordiphenyltrichloraethan), hexachlorobenzol, benezene-hexachlorides, dieldrin, aldrin and heptachlorepoxide. The three first substances were found in all samples in amounts varying from quite small up to eleven times the WHO recommended maximum for cow milk. The other substances were found in fewer milk samples, however, in some of these samples they were found in relatively high amounts. In Norway, only DDT has been investigated earlier (4), and compared to that study, there has been no significant change in the mean concentration of DDT in human breast milk during the last five years. The insecticide content was highest in colostrum and decreased with increasing duration of lactation. Considerable fluctuations in the content of insecticides were recorded in repeated milk samples collected from the same woman a few days apart. The percentage of samples with insecticide content higher than that permitted for cow's milk was greater in May/June (79%) than in early April (54%). The significance of these findings is discussed.     

LONGITUDINAL CHANGES IN SELENIUM CONTENT OF BREAST MILK

ABSTRACT. The selenium (Se) contents of human milk, serum and hair obtained from 22 lactating mothers were measured by fluorometric analysis. The Se contents in 41 milk samples from different stages of lactation were obtained longitudinally from 10 mothers. They showed a large variance of individual samples at any stage of studies. The highest Se level was found in colostrum (median 80 ng/ml); subsequently, Se content declined significantly during the first month of lactation and then came to a plateau level (median 17–18 ng/ml). No positive correlation of Se content was found between the serum and the milk samples at three months of lactation. No positive correlation of Se content was found between the hair and the milk samples obtained from lactating mothers.     

HOW MUCH BREAST MILK DO BABIES NEED?

Whitehead, R. G., Paul, A. A. and Cole, T. J. (MRC Dunn Nutrition Unit, Cambridge, U.K.). How much breast milk do babies need? Acta Paediatr Scand, Suppl. 299: 43, 1982.—A reassessment of the breast milk requirements of young babies at different ages has been made from a statistical analysis of energy intake data collected prospectively in Cambridge, U.K. and from data derived from a literature survey of cross-sectional food energy intakes of infants from Canada, Sweden, the U.K. and USA. In contrast to the slow progressive linear decline in energy requirements per kg body-weight that has previously been assumed, measured intakes have been shown to fall more rapidly in the first six months of life. Thereafter they then rise again as the baby becomes more active. These findings are of fundamental importance to a realistic assessment of the adequacy of breast milk as the sole source of food in the first six months of life. The data show that typical breast milk intakes found in the industrialized countries can satisfy infant energy needs for healthy growth for much longer than would be indicated by current international dietary recommendations. A discussion of the physiological interpretation of the results is included as is an appraisal of their practical significance both to breast and bottle feeding practices.     

MATERNAL DIET AND FATTY ACID PATTERN OF BREAST MILK

ABSTRACT. The effect of habitual maternal diet on the fatty acid composition of breast milk was evaluated by conducting a dietary survey of lactating mothers and by analyzing their breast milk samples. The mean energy intake of the mothers was 9.8 MJ during the first survey week (20 mothers, 6-8 weeks post partum) and 8.6 MJ during the second survey week (13 mothers, 17-22 weeks post partum). Protein, fat and carbohydrate intake comprised 16%, 39% and 45% of the total energy intake, respectively. The breast milk samples contained 3.8% fat. Half of the fatty acids of the diets and breast milk were saturated (S), and one third were monoenoic. Polyunsaturated (P) fatty acids comprised 15% in the diets and 13% in the breast milk. The average P/S ratio was 0.3 both in the diets and breast milk samples. Carbohydrate intake correlated negatively ( p <0.05) with arachidic acid of breast milk, and both protein and fat intakes correlated positively ( p <0.05) with palmitic acid of breast milk. The maternal diet had no effect on the total fat content of breast milk. A positive correlation was found between the saturated ( p <0.05) and polyunsaturated ( p <0.01) fatty adds of maternal diet and breast milk. As to the single fatty acids, the only significant correlation was found with linoleic acid ( p <0.01). However, the variation of linoleic acid intake explained only about 27% of the variation occurring in the breast milk.     

PASSAGE OF CEPHALOSPORINS AND AMOXICILLIN INTO THE BREAST MILK

ABSTRACT. Kafetzis, D. A., Siafas C. A., Georgakopoulos P. A., and Papadatos C. J. (Second Department of Pediatrics University of Athens, and Third Department of Obstetrics and Gynecology, Maternity Hospital "Marika Iliadi", Athens, Greece). Passage of cephalosporins and amoxicillin into the breast milk. Acta Paediatr Scand, 70:285, 1981.–The concentrations of five cephalosporins and amoxicillin in breast milk were studied in 42 voluntarily participating lactating mothers using standard assay methods. Each mother received one single dose of 1 g of either an orally or intravenously administered antibiotic. Amoxicillin, cephalexin , and cefadroxil were given orally, and peak milk concentrations averaged 0.81±0.33 µg/ml at 5 hours, 0.50±0.23 ug/ml at 4 hours, and 1.64±0.73 µg/ml at 6 hours, respectively. Cephalothin, cephapirin and cefotaxime were given as an i.v. bolus injection, and peak milk concentrations at 2 hours averaged 0.47±0.14 ug/ml, 0.43±0.16 µg/ml and 0.32±0.09 ug/ml, respectively. The high concentrations of cefadroxil can be explained by its low rate of elimination and higher fat solubility. Milk/serum ratios for all antibiotics were increasing as serum concentrations were diminishing, especially with cephalothin and cephapirin whose serum concentrations are rapidly declining. The significance of bactericidal concentrations in breast milk remains to be evaluated.     

BREAST MILK THYROXINE AND NOT COW'S MILK MAY MITIGATE AND DELAY THE CLINICAL PICTURE OF NEONATAL HYPOTHYROIDISM

Abstract. Sack, J., Frucht, H., Amado, O., Brish, M. and Lunenfeld, B. (Institute of Endocrinology, the Chaim Sheba Medical Center, Tel Hashomer, Israel). Breast milk thyroxine and not cow's milk may mitigate and delay the clinical picture of neonatal hypothyroidism. Acta Paediatr Scand, Suppl. 277: 54, 1979.-Thyroxine concentration was measured in human milk and Cow's milk products by a specific radioimmunoassay. The mean (± S.E.M.) milk T4 concentration during the first 5 days postpartum was 0.7±0.3 µg/dl (n=11). The mean T4 concentration between 6–49 days postpartum rose to 3.1±0.2 µg/dl (n=108), falling after 50 days to a mean of 1.4±0.2 µg/dl (n=39). The mean (± S.E.M.) T3 concentration in breast milk in the first 50 days postpartum was 386±17 ng/dl (n=56). T4 concentration in cow's milk products was less than 0.3 µg/dl. Thyroxine concentration in 24 hours breast milk collection ranged from 0.7 to 7.7 µg/dl and the total T4 in this milk ranged from 0.7 to 28 µg/day. These data suggest that milk of human but not bovine origin may provide a significant exogenous source of T4 to the premature infant. This amount of exogenous T4 which is insufficient in preventing the proceeding of neonatal hypothyroidism, may delay the clinical recognition of this disorder. This once again emphasizes the importance of early screening for neonatal hypothyroidism.     

HUMAN COLOSTRAL AND BREAST MILK CELLS A Light and Electron Microscopic Study

Abstract. Colostrum and breast milk samples were obtained from 74 women, 18 of whom gave sequential samples. The mean total leukocyte count in colostrum was 3190 cells/mm³. Proportions of macrophages, polymorphs and lymphocytes varied widely; macrophages usually predominated. Serial sampling showed (1) a small fall in total counts through delivery, (2) a fall in total counts and the proportion of PMNs at the onset of lactation, (3) after 1 to 2 weeks of lactation the appearance of cytoplasmic fragments together with epithelial cells which later constituted the main cell type. It was estimated that the total number of leukocytes available to the neonate remained approximately constant during the first 2 weeks of lactation and fell thereafter. Functionally, morphologically and histochemically macrophages in colostrum and breast milk resembled macrophages elsewhere. Their ultrastructure was characterised by filiform surface projections, numerous endocytic vacuoles and lipid droplets in the cytoplasm.     

BREAST MILK IRON—A DECLINING CONCENTRATION DURING THE COURSE OF LACTATION

Abstract. Siimes, M. A., Vuori E. and Kuiunen P. (Children's Hospital and Department of Public Health Science, University of Helsinki, Helsinki, Finland). Breast milk iron—a declining concentration during the course of lactation. Acta Pædiatr Scand, 68: 29, 1979.—The present investigation is the first longitudinal study of the concentration of iron in breast milk and is based on 229 milk samples obtained from 27 mothers during their period of lactation up to 9 months. The samples were collected at the beginning and at the end of each feed during a 24-h period to reflect as accurately as possible the actual concentration of iron. The median value declined during the course of lactation from 0.6 to 0.3 mg/l with a large range of values. The results indicate that the concentration is lower than is generally stated or is unusually low in Finnish mothers. As a consequence some infants may require iron supplementation during prolonged breast feeding although in general, the high bioavailability of breast milk iron prevents the development of iron deficiency.     

METABOLIC AND ENDOCRINE RESPONSES TO A MILK FEED IN SIX-DAY-OLD TERM INFANTS: DIFFERENCES BETWEEN BREAST AND COW'S MILK FORMULA FEEDING

ABSTRACT. Lucas, A., Boyes, S., Aynsley-Green, A. (Department of Paediatrics, John Radcliffe Hospital, Oxford) and Bloom, S. R. (Hammersmith Hospital, London, England). Metabolic and endocrine responses to a milk feed in six-day-old term infants: JMfferences between breast and cow's milk formula feeding. Acta Paediatr Scand, 70:195, 1981. – There is little information on the metabolic and endocrine responses to milk feeding in the neonatal period particularly in relation to the mode of nutrition and composition of the milk. Plasma concentrations of insulin, glucagon and gastric inhibitory polypeptide (GIP) together with blood levels of glucose, ketone bodies, pyruvate, lactate and glycerol were measured pre- and post-prandially in 79 healthy six-day-old term infants who had been either breast fed or fed on a modified cow's milk formula (Cow and Gate Premium) from birth. Formula fed infants had a greater insulin and GIP response to feeding and their basal and postprandial blood ketones were considerably lower than in breast fed infants. In addition a significantly greater post feed rise in both lactate and pyruvate concentrations was observed with formula feeding. These results may have significant implications regarding infant feeding and postnatal metabolism.     

IMMUNOGLOBULIN CONCENTRATIONS AND BACTERIAL ANTIBODY TITRES IN BREAST MILK FROM MOTHERS OF 'PRETERM' AND 'TERM' INFANTS

ABSTRACT. IgA, IgM and IgG concentrations and their bacterial antibodies to E. coli , group B streptococci and Brucella abortus were measured in human breast milk collected from the 1st 10th day post-partum from mothers delivered of 'preterm'infants (Premature Breast Milk or PBM) and from mothers delivered of term infants (Term Breast Milk or TBM). Reverse passive haemagglutination tests (RPH), rocket immuno-electrophoresis and mixed reverse passive antiglobulin haemagglutination tests (M_RPAH) were employed. PBM at 2-5 days post-partum (though not beyond this period) contained higher IgA levels than did TBM, and this difference persisted even when total IgA was expressed as a proportion of total milk protein: in contrast the IgM and IgG contents of PBM and TBM were the same at both these postnatal ages. The titre of IgA antibody to E. coli , which was absorbable only by the corresponding bacteria, showed no significant difference between PBM and TBM, whereas the titres of IgA reacting with Br. abortus and, to a lesser extent group B streptococci, were higher B PBM than those in TBM. However the IgA which reacted with Br. abortus and group B streptococci was not specific to those organisms but was absorbed by all three bacteria studied. It is speculated that the high IgA content of early preterm milk and perhaps the presence of especially high titres of what appears to be a non-specific or cross-reacting bacterial IgA in such milk, may be immunologically advantageous to low birthweight infants fed on their own mother's milk.     

LACTOSE AND PROTEIN ABSORPTION FROM BREAST MILK AND COW'S MILK PREPARATIONS AND ITS INFLUENCE ON THE INTESTINAL FLORA Investigations on two Infants with an Artificial Anus

Abstract. Lactose and protein absorption from breast milk and a cow's milk preparation enriched up to 7% of lactose were studied in two infants with an artificial anus applied in the ascending colon region. The concentrations of protein, lactose, glucose and galactose were measured in the fistula stools. In addition, the stools were analysed microbiologically. There were relatively high concentrations of lactose and its decomposition products and low concentrations of protein and aminonitrogen in the fistula stools when breast milk was fed. When the cow's milk formula was applied, only traces of lactose but high amounts of protein were measured. The microbiological findings are in agreement with the hypothesis that the bacterial flora of the large intestine is influenced by the lactose and protein concentrations in the intestinal content which reach the large intestine.     

QUANTITATIVE DETERMINATION OF IMMUNOGLOBULINS, LYSOZYME, and CERTAIN ELECTROLYTES IN BREAST MILK DURING THE ENTIRE PERIOD OF LACTATION, DURING A 24-HOUR PERIOD, and IN MILK FROM THE INDIVIDUAL MAMMARY GLAND

ABSTRACT: Peitersen, B., Bohn, L., and Andersen, H. (The Children's Hospital, Fuglebakken and the Department of Clinical Chemistry, Bispebjerg Hospital, Copenhagen, Denmark). Quantitative determination of immunoglobulins, lysozyme, and certain electrolytes in breast milk during the entire period of lactation, for a 24-hour period, and in milk from the individual mammary gland. Acta Paediatr Scand, 64:709, 1975.–During a period commencing at birth and lasting for up to 27 months 193 milk samples have been collected from 29 mothers. The IgA globulin content was high immediately after birth, averaging 2.7 arb.U, decreasing to 0.3 arb.U within the first 2 to 3 weeks after birth, then remaining almost constant for the rest of the lactational period. In the case of IgG globulin, similar results were obtained, but the quantity was much smaller. IgM globulin was demonstrated in small quantities during the first 3 weeks of lactation. The lysozyme content varied considerably during the whole lactational period. Individual variations were found for all the immunoglobulins, while the concentration in the individual woman varied only slightly from day to day following in other respects the pattern described above. In 19 mothers IgA, IgG, IgM, lysozyme and electrolyte content were determined in serum and in milk from the right and the left breast on the same day. No difference in content was found between milk from the left and the right mammary gland. A positive correlation was found between the concentrations of IgA and sodium chloride in milk, between those of IgG in milk and serum, and between those of lysozyme in milk and serum. No variations were registered during the individual breast feeding, nor for the 24-hour period as a whole.     

FLUORIDE IN HUMAN MILK

ABSTRACT. Reported contents of fluoride (F) in human milk vary considerably. The aim of this study was to determine the F content in human milk under different levels of F intake using a silicon-facilitated microdiffusion technique, which had a good accuracy and precision. The mean F concentration of colostrum from mothers in a 1.0 ppm and a 0.2 ppm F area was 0.36±0.02 μmol/I (± SEM) and 0.28±0.02 μmol/I, respectively. The mean F concentration of mature milk from a 1.0 ppm F area was 0.37±0.04 μmol/I. Within the 1.0 ppm F area, the intra- and interindividual differences in F concentration were very small. No statistically significant difference in milk F concentration between the two areas was found. Consequently, breastfed infants living in a 1 ppm or a 0.2 ppm F area will have an approximately equal F intake of 5-10 μg per day, in spite of great differences in F intake among the nursing mothers.     

CONTAMINANTS IN HUMAN MILK

ABSTRACT. There is a paucity of information regarding excretion of contaminants in human milk, due to experimental difficulties and until recently a general lack of interest. Because of the high fat content of milk and as its acidity is higher than that of plasma, nearly all liposoluble and basic agents consumed by the mother will be excreted in the milk. Distinction must be made between, on the one hand drugs and social toxicants such as smoking and alcohol, whose intake can be stopped or limited during pregnancy and lactation, and ecological toxicants present in a polluted environment to which the mother is exposed. Cases have occurred of heavy prenatal and postnatal intoxication of infants with hexachlorobenzene in Turkey and methylmercury in Iraq due to consumption of fungicide-treated seed wheat by pregnant and lactating mothers. Recent attention has been concentrated on contamination of milk with organochlorine compounds such as DDT and PCB's, that are found in many parts of the world. The heaviest contamination with DDT has been found in Guatemala, resulting in suckling infants consuming many times the Acceptable Daily Intake of this compound proposed by WHO, with unknown future effects.