Newborn gunky eye breast milk

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Efficacy and safety of breast milk eye drops in infants with eye discharge

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Randomized Controlled Trial

. 2021 Apr;110(4):1322-1329.

doi: 10.1111/apa.15628. Epub 2021 Feb 25.

Tetsu Sugimura¹, Tomoko Seo², Nami Terasaki¹, Yukiko Ozaki³, Noriko Rikitake¹, Rumiko Okabe³, Masami Matsushita³

Affiliations

¹ Department of Pediatrics and Allergology, Sugimura Children's Medical Clinic, Chikugo City, Japan.
² Department of Pediatrics, Green Woods Children's Clinic, Okazaki City, Japan.
³ Department of Pediatrics, Kurume University School of Medicine, Kurume City, Japan.

PMID: 33098117
DOI: 10.1111/apa.15628

Randomized Controlled Trial

Tetsu Sugimura et al. Acta Paediatr. 2021 Apr.

. 2021 Apr;110(4):1322-1329.

doi: 10.1111/apa.15628. Epub 2021 Feb 25.

Authors

Tetsu Sugimura¹, Tomoko Seo², Nami Terasaki¹, Yukiko Ozaki³, Noriko Rikitake¹, Rumiko Okabe³, Masami Matsushita³

Affiliations

¹ Department of Pediatrics and Allergology, Sugimura Children's Medical Clinic, Chikugo City, Japan.
² Department of Pediatrics, Green Woods Children's Clinic, Okazaki City, Japan.
³ Department of Pediatrics, Kurume University School of Medicine, Kurume City, Japan.

PMID: 33098117
DOI: 10.1111/apa.15628

Abstract

Aim: Breast milk (BM) contains various protective components, such as immunoglobulins, lactoferrin, lysozyme, oligosaccharides and immune cell subsets. We evaluated the effectiveness of BM eye drops in infants with eye discharge in a randomised controlled study.

Methods: Subjects were breastfed infants aged ≤180 days, with eye discharge. We randomly assigned patients to receive eye drops of BM or sodium azulene sulphonate hydrate 0.02% ophthalmic solution (OS). The patients received drop of BM or OS for 7 days. Improvement score of eye discharge in the groups was compared using a non-inferiority test.

Results: The number of patients improved eye discharge was 119/155 (76.8%) and 119/157 (75.8%) in BM and OS groups, respectively. There were no significant differences between groups. The improvement score in eye discharge was 1.76 ± 0.91 in the BM group and 1.71 ± 0.96 in the OS group. The BM group was considered non-inferior to the OS group.

Conclusions: This study demonstrated that BM is no less effective than OS in infants with eye discharge aged ≤6 months. The results suggested that the use of breast milk as eye drops could be considered as a first-line treatment for infants aged ≤6 months with eye discharge.

Keywords: breast milk; eye discharge; eye drops; infant; non-inferiority test.

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Breastfeeding a newborn | What to expect in the first week

The first week of a baby's life is a wonderful but hectic time, especially if you haven't breastfed before. Our breastfeeding tips will help you settle in as quickly as possible

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The first time after childbirth, mothers are often confused. The body is still recovering, and you are already starting to get to know your newborn baby. The emotional state during this period can be unstable, especially between the second and fifth day, when many women have milk ¹ and at the same time postpartum depression begins ² . In addition, people around often expect (and demand) that a woman come to her senses as soon as possible and become a “super mom”. But the best thing to do this first week is just to be with your baby and get breastfeeding going.

When should I start breastfeeding my newborn?

Try to breastfeed your baby within the first hour after birth. When the baby latch onto the breast and begins sucking rhythmically, it stimulates the mammary gland cells and starts milk production. ¹ It is not for nothing that this time is called the “magic hour”!

“Ideally, the baby should be placed on the mother's stomach immediately after birth so that it can immediately attach to the breast. He won't necessarily eat, but he should be able to,” explains Cathy Garbin, an internationally recognized expert on breastfeeding.

“Hold your baby and let him find the breast on his own and put the nipple in his mouth. This is called the breast-seeking reflex. On the Internet you can watch videos that show what this process looks like. If the baby does not latch on to the nipple, the midwife will help to properly attach it to the breast. But for starters, it’s good to give the baby the opportunity to do it on their own. In this case, the optimal position for the mother is reclining. ”

Don't spend that special first hour of your baby's life weighing and swaddling, or at least wait until he's suckling for the first time. Enjoy hugs and close skin-to-skin contact. This promotes the production of oxytocin, the love hormone, in you and your baby, and oxytocin plays a key role in the delivery of breast milk, colostrum. ³

“As soon as the obstetricians were convinced that our son was healthy, the three of us — me, my husband and our baby — were left to give us the opportunity to get to know each other. It was a very special hour - an hour of awkwardness, turbulent emotions and bliss. During this time, I breastfed my son twice, ”recalls Ellie, a mother of two from the UK.

Did you know that breastfeeding helps to recover after childbirth? This is because oxytocin stimulates uterine contractions. In the first hours after childbirth, this contributes to the natural release of the placenta and reduces blood loss. ⁴

What if the birth did not go according to plan?

If you had a cesarean section or other complications during childbirth,
You can still make skin-to-skin contact with your baby and breastfeed him in the first hours after birth.

“If you can't hold your baby, have your partner do it for you and make skin-to-skin contact with the baby. This will give the baby a sense of security, care and warmth so that he can hold on until you recover, ”Katie advises.

If the baby is unable to breastfeed, it is advisable to start expressing milk as early as possible and do so as often as possible until the baby is able to feed on its own. “While breastfeeding in the first hours after birth lays an excellent foundation for the future, it is not so important,” Cathy reassures. “It is much more important to start lactation so that in the future, if necessary, you can start breastfeeding.”

To start milk production, you can express milk manually or use a breast pump that can be given to you at the hospital. ⁵ And with expressed precious colostrum, it will be possible to feed the child. This is especially important if the baby was born premature or weak, since breast milk is extremely healthy.

If a baby was born prematurely or has a medical condition and cannot be breastfed immediately, this is no reason not to continue breastfeeding. “I have worked with many new mothers who were unable to breastfeed their baby for the first six weeks due to preterm labor or other reasons. Nevertheless, all of them later successfully switched to breastfeeding,” says Kathy.

Does the baby latch on correctly?

Correct breastfeeding is essential for successful breastfeeding ⁶ , as it determines how effectively the baby will suckle milk and hence grow and develop. Latching on the breast incorrectly can cause sore or damaged nipples, so don't hesitate to ask your doctor to check that your baby is properly attached to the breast, even if you are told that everything is fine and you do not see obvious problems - especially while you are in the hospital.

“While I was in the hospital, I called the doctor at every feed and asked me to check if I was breastfeeding correctly,” says Emma, mother of two from Australia. - There were several cases when it seemed to me that everything seemed to be right, but it was painful to feed, and the doctor helped me take the baby off the breast and attach it correctly. By the time I was discharged, I had already learned to do it confidently.”

When applying to the breast, point the nipple towards the palate. This will allow the baby to take the nipple and part of the areola under it into their mouth. It will be easier for him to suck if he has both the nipple and part of the areola around in his mouth. ⁶

“When a baby latch on properly, it doesn't cause discomfort and it causes a pulling sensation, not pain,” Cathy explains. - The baby's mouth is wide open, the lower lip may be slightly turned outward, and the upper one lies comfortably on the chest. The body language of the child indicates that he is comfortable. There isn't much milk at this early stage, so you probably won't notice your baby swallowing, but he will suckle a lot and nurse frequently."

How often should a newborn be fed?

The frequency and duration of breastfeeding in the first week can vary greatly. “The first 24 hours of life are completely different for different children. Someone sleeps a lot (after all, childbirth is tiring!), And someone often eats, says Katie. - Such a variety greatly confuses young mothers. Everyone gives different advice, so it's important to remember that every mother and child is different."

“Colostrum is thicker than mature breast milk and is produced in smaller quantities, but it provides many benefits. When the baby eats colostrum, he learns to suck, swallow and breathe until milk begins to flow in more volume, ”explains Cathy.

Milk usually arrives on the second or fourth day after birth. Until this time, the baby is applied to the breast 8-12 times a day (and sometimes more often!), including at night. ⁷ Feeding may take 10-15 minutes at this stage, or 45 minutes or even an hour, as the baby is just beginning to develop the muscles and coordination needed to suckle effectively.

“At first, the intensity of feeding is very high, often higher than many people realize, and this is shocking to most new mothers,” says Cathy. - Sometimes mom has no time to go to the toilet, take a shower and have a snack. It usually comes as a surprise."

Camille, a mother from Australia, experienced this. “The first week, Frankie ate every two hours, day and night, and each time it took half an hour to an hour to feed,” she recalls. “My husband and I were completely exhausted!”

Do I need to feed my newborn on a schedule?

The good news is that frequent feeding promotes lactation and stimulates milk production. ⁷ The more your baby eats, the more milk you will have. Therefore, forget about feeding your newborn on a schedule - this way he will have less chance of feeding. Try to feed your baby when he signals that he is hungry ⁸ :

tossing and turning in her sleep;
opens eyes;
turns his head if he feels a touch on his cheek;
sticks out tongue;
groans;
licks lips;
sucks fingers;
is naughty;
whimpers;
is crying.

Crying is the last sign of hunger, so when in doubt, just offer your baby the breast. If he bursts into tears, it will be more difficult to feed him, especially at first, when both of you are just learning how to do it. As your baby grows, he will likely eat less frequently and take less time to feed, so breastfeeding will seem more predictable.

Does breastfeeding hurt?

You may have heard that breastfeeding is not painful at all, but in fact, in the first days, many new mothers experience discomfort. And this is not at all surprising, given that the nipples are not used to such frequent and strong sucking.

“Breastfeeding can be uncomfortable for the first couple of days – your body and your baby are just getting used to it. If a baby eats for too long and does not latch well, the sensations are almost the same as from unworn new shoes, Cathy compares. Just as tight shoes can rub your feet, improper suckling can damage your nipples. Prevention is always better than cure, so if the pain persists after a few days of feeding, contact a lactation consultant or healthcare professional. ”

Maria, a mother from Canada, agrees: “Although my son seemed to latch onto the breast well, he damaged his nipples while feeding, and I was in pain. As it turned out, the reason was a shortened frenulum of the tongue. The breastfeeding specialists at our city clinic have been of great help in diagnosis and treatment.”

In addition, you may experience period cramps during the first few days after breastfeeding, especially if this is not your first baby. This is the so-called postpartum pain. The fact is that oxytocin, which is released during breastfeeding, contributes to further contraction of the uterus to restore its normal size. ⁴

When milk arrives, the breasts usually become fuller, firmer and larger than before delivery. In some women, the breasts swell, harden and become very sensitive - swelling of the mammary glands occurs. ¹⁰ Frequent breastfeeding relieves these symptoms. For more breast care tips, read our article What is Breast Swelling?

How often does the newborn urinate and defecate?

What goes into the body must go back out. Colostrum
has a laxative effect, helping to eliminate meconium - the original feces. It looks a little scary - black and sticky, like tar. ¹¹ But don't worry, it won't always be like this. Breastfed babies usually have a slightly sweet smell of stool.

How many times a day you will have to change diapers and what the contents should look like, see below.

Day one

Frequency: once or more.
Colour: greenish black.
Texture: sticky like tar.

Day two

Frequency: twice or more.
Colour: dark greenish brown.
Texture: less sticky.

Day three

Frequency: twice or more.
Colour: greenish brown to brownish yellow.
Texture: non-sticky.

Fourth day and then the entire first month

Frequency: twice or more.
Color: yellow (feces should turn yellow no later than by the end of the fourth day).
Texture: grainy (like mustard with grains interspersed). Leaky and watery.

The baby's urine should be light yellow. On average, babies urinate once a day for the first two days. Starting around the third day, the number of wet diapers increases to three, and from the fifth day onwards, diapers have to be changed five times a day or more often. In addition, during the first few days, the weight of wet diapers increases. ¹¹

Is the baby getting enough breast milk?

Since very little milk is produced at first,
You may feel that your baby is not getting enough milk. But if you feed your baby on demand, you will produce exactly as much milk as he needs. If you want to keep the process under control, be guided by the frequency of diaper changes given above. If your baby soils less diapers, check with your doctor.

“For the first three or four weeks, most babies just eat and sleep. If the child is worried and constantly asks for a breast, you should consult with your doctor, ”recommends Katie.

Sometimes the baby may vomit after feeding. If the vomit is the color of milk, this is not a cause for concern. But if there are orange, red, green, brown or black blotches in it, or the child vomits with a "fountain", consult a doctor. You should also consult a doctor if the baby has a high temperature, the fontanel (soft spot on the head) has sunk, blood is found in the stool, and also if the weight recorded at birth has not recovered within two weeks. ¹¹

But if there are no frightening symptoms and the baby is growing at a normal pace, it means that he has enough milk. Soon you will both get used to breastfeeding and establish a more stable routine.

For the next step in breastfeeding, see Breastfeeding in the First Month: What to Expect.

Literature

1 Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia 2007;12(4):211-221. - Pang, W.W., Hartmann, P.I., "Lactation initiation in the lactating mother: secretory differentiation and secretory activation." G Mammary Gland Biol Neoplasia. 2007;12(4):211-221.

2 Shashi R et al. Postpartum psychiatric disorders: Early diagnosis and management. Indian J Psychiatry . 2015; 57( Suppl 2): S 216– S 221. - Shashi R. et al., Postnatal mental disorders: early diagnosis and treatment. Indian J Saikiatri. 2015; 57(App 2):S216-S221.

3 Moberg KU, Prime DK. Oxytocin effects in mothers and infants during breastfeeding. Infant . 2013;9(6):201-206. - Moberg K, Prime DK, "The effects of oxytocin on mother and child during breastfeeding." Infant. 2013;9(6):201-206.

4 Sobhy SI, Mohame NA. The effect of early initiation of breast feeding on the amount of vaginal blood loss during the fourth stage of labor. J Egypt Public Health Assoc . 2004;79(1-2):1-12. - Sobhi SI, Moham NA, "Early initiation of breastfeeding and its impact on vaginal bleeding in the fourth stage of labor." G Egypt Public Health Assoc. 2004;79(1-2):1-2.

5 Meier PP et al. Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology. J Perinatol . 2016;36(7):493. - Meyer P.P. et al., Breastpump Selection: A Scientific Approach to Customizing Pumping Technology. J Perinatol (Journal of Perinatology). 2016;36(7):493-499.

6 Cadwell K. Latching - On and Suckling of the Healthy Term Neonate: Breastfeeding Assessment. J Midwifery & Women ’ s 2007;52(6):638-642. — Cadwell, K. , "Latching and sucking in healthy newborns: evaluation of breastfeeding." W Midwifery Women Health. 2007;52(6):638-642.

7 Kent JC et al. Principles for maintaining or increasing breast milk production. 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Milk Production". J Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.

8 Australian Breastfeeding Association [ Internet ]. Feeding cues ; 2017 Sep [ cited 2018 Feb ]. - Australian Breastfeeding Association [Internet], Feed Ready Signals; September 2017 [cited February 2018]

9 Jacobs A et al. S3-guidelines for the treatment of inflammatory breast disease during the lactation period. Geburtshilfe Frauenheilkd . 2013;73(12):1202-1208. - Jacobs A. et al., "Guidelines S -3 for the management of inflammatory breast disease during breastfeeding." Geburtskhilfe und Frauenheilkünde. 2013;73(12):1202-1208.

10 Lawrence RA, Lawrence RM. Breastfeeding: A guide for the medical profession. 7th ed. Maryland Heights MO, USA: Elsevier Mosby; 2010. 1128 p . - Lawrence R.A., Lawrence R.M., "Breastfeeding: A guide for healthcare professionals." Seventh edition. Publisher Maryland Heights , Missouri, USA: Elsevier Mosby; 2010. P. 1128.

Composition of breast milk | What is breast milk made of?

Breast milk is rich in nutrients that nourish and protect your baby. But did you know that its composition changes over time? Find out what breast milk is made of and how it adapts to your baby's needs.

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Breast milk is a baby's very first food, so of course
contains essential nutrients - carbohydrates, proteins, fats, and water to keep the body hydrated. ¹ All this is true. But mother's milk is not just a food product, and it performs not only nutritional functions.

What is breast milk made of?

Each serving of breast milk contains many other ingredients, many of which are unique.

Millions living cells. These include white blood cells, which are responsible for strengthening the immune system, and stem cells, which promote the growth and repair of organs. ²
More than 1000 proteins ³ that help the baby's body grow and develop, strengthen his immune system, form and protect brain neurons.
All proteins in breast milk consist of amino acids . There are more than 20 types of them in milk, and they also include nucleotides, the content of which rises at night. Scientists suggest that they can have a hypnotic effect. ^4.5
More than 200 complex sugars - oligosaccharides ⁶ that act as prebiotics needed to maintain a healthy microflora in the intestines of the child. In addition, they prevent infections from entering the bloodstream and reduce the risk of brain inflammation.
More than 40 enzymes ⁷ . Enzymes serve as catalysts for chemical reactions in the body. Breast milk enzymes stimulate digestion and immunity, and help the baby's body absorb iron.
Growth factors contributing to the normal development of the body. ¹ They affect the state of many organs and systems, including internal organs, blood vessels, nervous system and glands responsible for the production of hormones.
By the way, hormones in the composition of breast milk are many! ⁷ These smart chemicals are responsible for the exchange of information between tissues and organs, ensuring their normal functioning. Some hormones control appetite, others sleep, and some are even responsible for strengthening the bond between mom and baby.
Vitamins & Minerals - Nutrients that support normal growth and function of organs and the formation of teeth and bones. ¹
Antibodies or immunoglobulins. There are five main types of antibodies, and all of them are present in breast milk. ⁸ Antibodies neutralize bacteria and viruses, protecting the child's body from infections and diseases.
You may have heard of long chain fatty acids which play a key role in the formation of the child's nervous system and the development of the brain and eyes. ⁹ So, they are also present in breast milk!
1400 species miRNA . It is believed that they control gene expression, prevent and stop the development of diseases, support the immune system of the child, and also affect the change in the structure of the mother's breast. ¹⁰

This long list includes only a subset of the ingredients in breast milk—and scientists are discovering new ingredients in the meantime. Interestingly, the content of these ingredients varies depending on the age and needs of the child.

Let's start from the beginning...

In the early days: colostrum

The first milk that is produced immediately after the birth of a baby is called colostrum. This thick, sticky liquid is often referred to as "liquid gold," and not just for its yellow or orange color. Colostrum performs an important function of nourishing and protecting the fragile body of a newborn baby.

Very little milk is produced at first - only 40-50 ml per day ¹¹ . But the stomach of a newborn is very tiny, so this is quite enough. In addition, colostrum is very well digested. And the small volume is more than offset by its high-quality composition.

Composition of colostrum

Colostrum contains the same substances as breast milk in the following weeks, but in a different ratio, according to the needs of the newborn.

Colostrum, for example, is sometimes called nature's vaccine for its high levels of antibodies and white blood cells. After the child leaves safe mother's womb, the first milk helps to protect it from infections and diseases.

In addition, the protective properties of colostrum play an important role in strengthening the baby's digestive system. Colostrum protects and strengthens the mucosa of the gastrointestinal tract, which is highly permeable in newborns. ^12.13 This is especially important if the baby is born prematurely, as this increases the risk of necrotizing enterocolitis. ¹³

In addition, colostrum is rich in minerals and vitamins, and contains more vitamins A, E and K than in mature breast milk. The protein content is also increased. ¹ Colostrum also has a laxative effect, helping to eliminate meconium (original feces). ¹⁴

In the next few weeks: transitional milk

During the first week of a baby's life, about two to four days after birth, breast milk production increases. The breast becomes larger and firmer - milk begins to "come". On the third day, the baby consumes 300-400 ml of breast milk per day, and by the fifth day - already 500-800 ml. No wonder breasts seem bigger!

Milk produced from days 5 to 14 is called transitional milk. ¹⁵ As the name suggests, this period is the transition from colostrum to mature breast milk. It becomes thicker and lighter, the content of fat and lactose (natural sugar) increases in it, and the calorie content increases. All this makes transitional milk an ideal food for the rapidly growing body of a newborn.

But despite the change in structure, transitional milk still contains a large amount of antibodies, living cells, beneficial bacteria and other biologically active substances necessary for the health of the child. ¹⁵

After four weeks: mature milk

By the time the baby is four weeks old, breast milk
has reached full maturity. It is rich in proteins, sugar, vitamins and minerals, as well as all kinds of biologically active components - hormones, growth factors, enzymes and living cells. All this ensures healthy growth and development of the child. ⁷

After four weeks, the nutritional content and ingredient ratios of mature milk are generally fairly stable. However, the composition of milk at different times and in different feedings can still vary.

For example, if a mother or child is sick, the mother's body produces antibodies to the causative agents of this disease, and these antibodies pass into breast milk. And when the baby begins to explore the world and taste toys, the content of protective antibacterial enzymes in breast milk increases. ¹⁶ In other words, the composition of breast milk is adapted to the needs of the baby.

What are foremilk and hindmilk?

You may have noticed that milk becomes thicker towards the end of a feed. The fact is that as you feed, the fat content of milk gradually increases. This is due to the mechanical features of the movement of milk in the breast. The thick milk coming at the end of a feed is often referred to as "hind" milk, while the thinner milk at the beginning of a feed is often referred to as "fore". You might think that the transition from "front" milk to "back" occurs at some specific moment, but this is not so - the change in consistency occurs gradually. ¹⁵ Both milks are an essential part of a full serving and both are rich in vitamins, minerals, protein and sugar.

The fat content of milk depends on how full the breast is. At the beginning of feeding, the breasts may be fuller (and then the milk will be less fat) or less (and then the milk will be more fat). But do not worry about the amount of "forward" and "hind" milk - in general, every day the baby receives approximately the same amount of fat. ¹⁷

Composition of breast milk after six months

You may be wondering what happens to milk during prolonged breastfeeding
. Will the body be able to produce high quality mature milk for months or even years? Answer: do not underestimate the possibilities of the mother's breast!

Although it is indeed time to start solid foods at six months of age to replenish the baby's stores of certain nutrients, such as iron, ¹⁸ breast milk still plays a big role in his diet.

For example, at the age of seven months, a baby still receives 93% of its calories from breast milk. And even between 11 and 16 months, mother's milk provides the baby with about half of the daily calorie intake. ¹⁹

So rest easy, breastfeeding will benefit you and your baby for many months.

Literature

1 Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatric Clin North Am. 2013;60(1):49-74. Ballard O., Morrow AL, "Composition of breast milk: nutrients and biologically active factors". Pediatric Clean North Am. 2013;60(1):49-74.

2 Hassiotou F et al. Cells in human milk: state of the science. J Human Lact . 2013;29(2):171-182. — Hassiot F. et al., "Breast Milk Cells: What the Science Knows." J Human Lact (Journal of the International Lactation Consultants Association) . 2013;29(2):171-182.

3 Beck KL Comparative proteomics of human and macaque milk reveals species-specific nutrition during postnatal development. J Proteome Res . 2015;14(5):2143-2157. - Beck K.L. et al., "Comparative proteomics of human and macaque milk demonstrates species-specific nutrition during postnatal development." G Proteom Res. 2015;14(5):2143-2157.

4 Zhang Z et al. Amino acid profiles in term and preterm human milk through lactation: a systematic review. Nutrients. 2013;5(12):4800-4821. - Amino acid profile of milk after term and preterm birth: a systematic review. Nutrients. 2013;5(12):4800-4821.

5 Sánchez CL et al. The possible role of human milk nucleotides as sleep inducers. Nutr Neurosci. 2009;12(1):2-8. - Sanchez S.L. et al., "Nucleotides in breast milk may help the baby fall asleep. " Nutr Neurosai. 2009;12(1):2-8.

6 Moukarzel S, Bode L. Human milk oligosaccharides and the preterm infant: a journey in sickness and in health. Clin perinatol. 2017;44(1):193-207. - Mukarzel S., Bode L., "Breast milk oligosaccharides and the full-term baby: a path to illness and health." Klin Perinatol (Clinical perinatology). 2017;44(1):193-207.

7 Hamosh M. Bioactive factors in human milk. Pediatric Clinics. 2001;48(1):69-86. - Hamosh M., "Biological active factors of breast milk. Pediatrics clinics. 2001; 48 (1): 69-86.

902 8 Brandtzaeg P THE MUCOSAL and its integration with the mammary glands The J Pediatr 2010;156(2): S 8-15. - Brandtzeg P., "The mucosal immune system and its integration with the mammary glands". J Pediatrician (Journal of Pediatrics). 2010;156(2):S8-15.

9 Uauy R et al. Essential fatty acids in early life: structural and functional role. Proc Nutr Soc . 2000;59(1):3-15. - Wye R. et al., "Essential Fatty Acids of the First Days of Life: Structural and Functional Role". Nutr Soc. 2000;59(1):3-15.

10 Alsaweed M et al. Human milk cells and lipids conserve numerous known and novel miRNAs, some of which are differentially expressed during lactation. PLoS One . 2016;11(4): e 0152610. - Alsavid M. et al., "Breast milk cells and lipids retain many known and unknown miRNAs, many of which show differential expression during lactation." PLOS One. 2016;11(4):e0152610.

11 Neville MC et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr . 1988;48(6):1375-1386. - Neville M.S. et al., "Female Lactation Study: Milk Quantity in Lactating Women at the Beginning and Peak of Lactation." Am F Clean Nutr. 1988;48(6):1375-1386.

12 Marchbank T et al. Pancreatic secretory trypsin inhibitor is a major motogenic and protective factor in human breast milk. Am J Physiol Gastrointest Liver Physiol. 2009;296(4):G697-703. Marchbank T. et al., "Trypsin inhibitor in pancreatic secretion as the most important motogenic and protective factor in breast milk". Am Zh Physiol Gastrointest Liver Physiol. 2009;296(4):G697-703.

13 Herrmann K, Carroll K. An exclusively human milk diet reduces necrotizing enterocolitis. Breast Med. 2014;9(4):184-190. - Herrmann K, Carroll K, Exclusive breastfeeding reduces the risk of necrotizing enterocolitis. Brest Med (Breastfeeding Medicine). 2014;9(4):184-190.

14 Lawrence RA, Lawrence RM. Breastfeeding: A guide for the medical profession. 7th ed. Maryland Heights MO, USA: Elsevier Mosby; 2010. 1128 p - Lawrence R.A., Lawrence R.M., "Breastfeeding: A guide for healthcare professionals." Seventh edition. Publisher Maryland Heights , Missouri, USA: Elsevier Mosby; 2010. P. 1128.

15 Martin CR et al. Review of infant feeding: key features of breast milk and infant formula. Nutrients. 2016;8(5):279. - Martin S.R. et al., Review of Infant Feeding Issues: Key Features of Breast Milk and Infant Formula. Nutrients. 2016;8(5):279.

16 Montagne P et al. Changes in lactoferrin and lysozyme levels in human milk during the first twelve weeks of lactation. InBioactive components of human milk 2001 (pp. 241-247). Springer, Boston, MA. - Montagne, P. et al. "Changes in lactoferrin and lysozyme levels in breast milk during the first twelve weeks of lactation".

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