Introduction: WHO recommends exclusive breastfeeding for 6 months and continue up to the age of 2 years or beyond. Our objective is to study the evolution of lactation indicators (length, start and maintenance up to 12 months percentages) in the last 12 years in our health center, recently accredited as BFHI, and the association of these indicators with different factors: prenatal education, childbirth (vaginal delivery or cesarean section) and hospital maternity (public or private).
Material and methods: Prospective descriptive cohort study with 803 infants born in two periods separated from each other 12 years: 2003-2004 and 2015-2016. Data collected by personal interview in pediatric health checks.
Results: Lactation length (median) has improved significantly in the second period (10 months) compared to first one (5 months; p <0.001); lactation percentages at birth and up to 12 months also improved (p <0.05). Attending prenatal education courses was the most significantly associated factor with these indicators in both periods; it was also significant the association with vaginal delivery (in first period) and public hospital maternity (in second period). These results are confirmed in the multivariate analysis.
Conclusions: There has been a significant improvement on our health center lactation indicators in these 12 years. Favorable factors to initiate and maintain breastfeeding are attending prenatal education courses (the most important), and childbirth by vaginal delivery and at a public hospital maternity.

Correspondencia: E. J. Jareño Roglán. Centro de Salud de Moncada. Avenida del Mediterráneo, s/n. 46113 Moncada. Valencia.
Correo electrónico: ejjarenyo@hotmail.com

Newborn immune protection mostly relies on maternal immune factors provided through milk. However, studies dealing with an in-depth profiling of the different immune compounds present in human milk and with the assessment of their natural variation in healthy women from different populations are very scarce. In this context, the objective of this work was the detection and quantification of a wide array of immune compounds, including innate immunity factors (IL-1β, IL-6, IL-12, INFγ, TNFα), acquired immunity factors (IL-2, IL-4, IL-10, IL-13, IL-17), chemokines (IL-8, Groα, MCP1, MIP1β), growth factors (IL-5, IL-7, EGF, G-CSF, GM-CSF, TGFβ2), and immunoglobulins (IgA, IgG, IgM), in milk produced by healthy women of different ethnicities living in different geographic, dietary, socioeconomic, and environmental settings. Among the analyzed factors (IgA, IgG, IgM, EGF, TGFβ2, IL-7, IL-8, Groα, and MIP1β) were detected in all or most of the samples collected in each population and, therefore, this specific set of compounds might be considered as a universal core of soluble immune factors in milk produced by healthy women worldwide.

J.M. Rodríguez. Departamento de Nutrición, Bromatología y Tecnología de los Alimentos. Universidad Complutense de Madrid. Ciudad Universitaria. 28040 Madrid. Correo electrónico: jmrodrig@ucm.es

Human milk is a complex fluid composed of a wide variety of substances. The data currently available suggest that, under physiological conditions, the number and concentration of these substances can vary depending on many factors (genetic background, ethnicity, geographic location, diet, postpartum time...). In this context, the aim of the INSPIRE project was to know the natural variability in the composition of human milk among healthy women that differ in their geographical location, ethnicity, diet and socio-economic situation. This article shows the general design of the study and the results obtained regarding human milk oligosaccharides (HMOs), one of the major components in this biological fluid and whose biological functions are very relevant to infant health. The results show a clear effect of the cohort (p <0.05) on the concentrations of almost all HMOs. In addition, maternal age, postpartum time, weight and body mass index were correlated with several HMOs. On the other hand, differences were observed in the profile of HMOs between populations that are ethnically similar but live in different places, which suggests that the environment may play a role in the regulation of the biosynthesis of certain HMOs.

Introduction: Breastfeeding pain constitutes one of the main causes of undesired weaning, but the studies about its etiopathogenesis are scarce. The objective of this work was to determine the incidence of breast pain during lactation and the risk factors involved in its development.
Subjects and methods: A prospective and observational study was conducted, including 63 mother-child pairs. The incidence and intensity of pain was evaluated (Visual Analog Scale [VAS]). The breastfeeding technique and ankyloglossia (tongue-tie) in the infant, among other risk factors potentially involved in pain, were systematically assessed and microbiological analysis of milk samples was also performed.
Results: Breast pain (VAS ≥3) lasting more than a week was reported in 65% of lactating mothers, and among them, 29% experienced pain for more than two months. The breastfeeding technique and ankyloglossia (tongue-tie) in the infant were not related with higher risk of pain, however, a positive milk culture was a very significant risk factor for breast pain (p <0.0001). The same species were isolated in samples of breastfeeding mothers with pain and without pain (Staphylococcus epidermidis, S. aureus, viridans group streptococci, Rothia mucilaginosa and Corynebacterium spp.), but their concentration was significantly higher in the pain group. Candida spp. were not isolated in any sample.
Conclusions: The microbiological analysis of milk samples is key to ensure an appropriate and effective breastfeeding pain management.

Mastitis is a relatively common problem during lactation but the absence of specific tests frequently leads to errors both in the diagnosis and in the treatment. Consequently, milk cultures seem a key tool in order to know the actual epidemiology of this infec-tion, to get a correct diagnosis, and to prescribe the best treatment. In this part, six practical cases showing the usefulness of milk cultures for a correct diagnosis and treatment of problems arising during lactation are described. They reveal the contribution of milk cultures in reducing the use of unnecessary drugs during lactation.

Infectious mastitis is a common condition during lactation and constitutes one of the main causes of undesired weaning. This condition should be considered as a relevant public health issue, since it deprives the mother-infant pair from the wide range of health benefits that breastfeeding provides. Nevertheless, human mastitis remains to date widely underestimated because human milk cultures are not routinely performed and only acute mastitis cases with local and systemic symptoms are usually reported. The present work constitutes a review about risk factors for infectious mastitis among breastfeeding women, including some aspects related to medical history of mother and infant, pregnancy, delivery and postpartum, and breastfeeding practices. In this sense, to improve the knowledge about these factors will allow to provide appropriate management during breastfeeding and develop strategies to prevent this condition, so that many child-mother pairs fully enjoy the benefits of breastfeeding.

Diet and physical activity before and during pregnancy affect short- and long-term health of mother and child. Breastfeeding period is also a demanding time for the mother. There are clear data supporting the influence of the first thousand days in the life of a child in her future health and in the risk of chronic diseases. Nutrition is one of the major influences during this period. Nutrition advice during the pre-conception period as well as during pregnancy may enhance future health in the siblings. There is a need for certain nutrients more than increased energy requirements. Pediatricians have an important role as public health agents and needs to know how to provide accurate nutrition advice during pregnancy and lactation. This document attempts to fill this information gap and to develop appropriate protocols and counselling materials on maternal nutrition.

Introduction: The purpose of this study was to identify potential predisposing factors associated with human infectious mastitis.
Methods: We conducted a case-control study among breastfeeding women, with 368 cases (women with mastitis) and 148 controls. Data were collected by a questionnaire designed to obtain retrospective information about several factors related to medical history of mother and infant, different aspects of pregnancy, delivery and postpartum, and breastfeeding practices that could be involved in mastitis. Bivariate analyses and multivariate logistic regression model were used to examine the relationship between mastitis and these factors.
Results: The variables significantly- and independently-associated with mastitis were cracked nipples (p <0.0001), oral antibiotics during breastfeeding (p <0.0001), breast pumps (p <0.0001), topical antifungal medication during breastfeeding (p= 0.0009), mastitis in previous lactations (p= 0.0014), breast milk coming in later than 24 h postpartum (p= 0.0016), history of mastitis in the family (p= 0.0028), mother-infant separation longer than 24 h (p= 0.0027), cream on nipples (p= 0.0228) and throat infection (p= 0.0224).
Conclusions: Valuable factors related to an increased risk of infectious mastitis have been identified. This knowledge will allow practitioners to provide appropriate management advice about modifiable risk factors, such as the use of pumps or inappropriate medication. They also could identify before delivery those women at an increased risk of developing mastitis, such as those having a familial history of mastitis, and thus develop strategies to prevent this condition.

Introduction: The purpose of this study was to identify potential predisposing factors associated with human infectious mastitis.
Methods: We conducted a case-control study among breastfeeding women, with 368 cases (women with mastitis) and 148 controls. Data were collected by a questionnaire designed to obtain retrospective information about several factors related to medical history of mother and infant, different aspects of pregnancy, delivery and postpartum, and breastfeeding practices that could be involved in mastitis. Bivariate analyses and multivariate logistic regression model were used to examine the relationship between mastitis and these factors.
Results: The variables significantly- and independently-associated with mastitis were cracked nipples (p <0.0001), oral antibiotics during breastfeeding (p <0.0001), breast pumps (p <0.0001), topical antifungal medication during breastfeeding (p= 0.0009), mastitis in previous lactations (p= 0.0014), breast milk coming in later than 24 h postpartum (p= 0.0016), history of mastitis in the family (p= 0.0028), mother-infant separation longer than 24 h (p= 0.0027), cream on nipples (p= 0.0228) and throat infection (p= 0.0224).
Conclusions: Valuable factors related to an increased risk of infectious mastitis have been identified. This knowledge will allow practitioners to provide appropriate management advice about modifiable risk factors, such as the use of pumps or inappropriate medication. They also could identify before delivery those women at an increased risk of developing mastitis, such as those having a familial history of mastitis, and thus develop strategies to prevent this condition.

Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder characterized by recurrent mono-neuropathies related to minimal trauma o compression. HNPP usually manifests in adolescence or adulthood, being relatively exceptional at an earlier age. A 4-month-old boy with brachial plexopathy as early manifestation of HNPP is presented. Familiar anamnesis, as well as neurophysiological and molecular studies, stands out in early diagnostic suspicion. In this case, the early manifestation and its semiological characteristics accentuate its peculiarity.

Introduction: The postnatal period is important for intestinal microbiota establishment, which is involved with the intestinal development, prevention of pathogens colonization, digestion and synthesis of nutrients, as well as immune and neuronal systems maturation. Intestinal colonization takes place during the first days of life, being influenced by the method of delivery, type of lactation, and the environment. Furthermore, the microbiota composition and functionality might be influenced by maternal and neonatal diet. The objective of this review was to present scientific evidence published during the last years regarding the role of delivery methods, type of lactation, supplementation with pre and probiotics on neonatal intestinal microbiota composition.
Methods: In this work, more than 19 articles published dur­ing the last 15 years and obtained from different specialized databases (NCBI, Web of Science, Elsevier Journal, Science Direct) are included. We have analysed studies related to humans.
Results: The method of delivery and type of lactation might modify the intestinal microbiota in new-borns. Supplementation with probiotics increased the Bifidobacterium and Lactobacillus genera. More studies are needed to evaluate the effects of probiotics in the development and functionality of intestinal microbiota in the newborns. Supplementation with prebiotics may induce the production of secondary metabolites that are able to modulate the newborn epigenome's.
Conclusions: More studies are needed to elucidate the exact mechanisms that modifies in the microbiota composition and describe personalized nutritional strategies to enhance the newborn development.

In this part, the application of probiotics in preterm neonates and pregnant and lactating women is reviewed. There are few studies on the administration of probiotic strains to preterm infants, but, in general, they indicate that the rates of necroti­zing enterocolitis and septicemia are lower among those receiving probiotics. In addition, the probiotic strains used in studies of this type have been shown to be safe in these immunocompromised hosts. In fact, the rapid spread of the kangaroo mother method, in which preterm infants are exposed to the commensal and probiotic bacteria existing in human milk, confirms the benefits derived from early contact with such bacterial agents. With respect to preterm infants with short bowel syndrome, it proves surprising that the administration of D-lactate-producing lactobacilli leads to a more rapid alleviation of the symptoms when compared with strains that exclusively produce L-lactate. Finally, pregnant and lactating women constitute a population in which the use of probiotics seems particularly interesting since the modulation of their gastrointestinal, mammary and/or urogenital microbiotas may have an important impact on the health of the mother-infant dyad.

Introduction: Exclusive breastfeeding is the best method during the first six months of life of the infant, and is recommend­ed by the majority of organizations and institutions. However, the number of women who start and the duration are still very limited, and are easily influenced.

Material and methods: Mothers who gave birth in the hospital between the years 2001 and 2003 were interviewed after the birth of their children to ask about their choice of feeding method. The breastfeeding mothers were followed for the first six months to establish the duration of breast feeding and main causes for discontinuing it.

Results: In all, 69.9% of the 1166 mothers (1,185 live infants) intended to breastfeed, whereas 31.5% of 1,170 babies were bottle-fed with formula; 17.4% gave up breastfeeding during the first week; 3.8% gave it up between the first and fourth weeks; 12.7% between the fourth and twelfth weeks; and 13.8% continued breast feeding after week 24. The main causes for discontinuing were the failure of the breastfeeding technique (45.2%), natural causes (22.1%), return to work (11%) and diseases in the mother (8.6%). The main cause for discontinuing within the first 4 weeks was an incorrect technique (58.1% versus 41.3%), followed by diseases in the mother (17.4% versus 6%) and diseases in the infant (9.8% versus 2.4%).

Conclusions: Breastfeeding is influenced by many external factors, which could be modified through proper education of mothers and those around them, and through the introduction of institutional measures that support it.

Sleep is a basic physiological need for our health. Childhood is a relevant period because the child spends most of the day sleeping. Sleep, as a human behaviour, can be adjusted in order to learn to sleep well. And this process must be adaptive, because sleep in children is exposed to a slow maturation. And, therefore, it is essential that parents have a thorough knowledge of child and adolescents' sleep patterns. In children, parents must establish bedtime routines, usually providing "transitional objects" to facilitate sleep and environment association, and promote capability to initiate and maintain sleep independently. In teenagers, keeping sleep disciplines, restricting the use of computers and mobile phones at bedtime, are useful recommendations to improve sleep.