Immediately after delivery breast milk is yellowish and sticky. This milk is called colostrum and is secreted for about 5 days, thereafter a transitional milk is produced which follows the production of mature milk from two weeks postpartum and the composition also differ.
The preterm milk contains more protein; the fore milk is rich in protein, lactose, vitamins, minerals and water; and the hind milk rich in fat and energy dense. The volume of breast milk produced differs by mothers and influenced by many factors. Under normal condition about 100 ml is available on the second day and this increased to about 500ml by the second week and some women are able to produce one liter a day.
Mature human milk contains protein in the range of 1.3 to 2.07gm/100ml. The whey casein ratio is roughly 80:20. The human whey mainly consists of alpha-lactalbumin, and components of anti-infective proteins such a secretory IgA, lysozyme, and lactoferin. The lactalbumin results in formation of softer gastric curd, reduces gastric emptying time, and an important component of the enzyme system in lactose synthesis. Human milk also has higher levels of free amino acids, cystine and taurine.
The fat content of human milk is 4-4.5gm/100ml, more in hind milk, the fatty acid composition is about 42% saturated, and 57% unsaturated and rich in long chain polyunsaturated fatty acids which are important in brain development and myelination. Human milk contains a non-specific bile salt stimulated lipase and contributes to the infant's fat digestion.
The major carbohydrate in the human milk is lactose, about 7gm/lOOml. Lactose furnishes about 40% of energy needs. It is metabolized into glucose and galactose, a constituent of galactolipids needed for the development of CNS. It facilitates calcium and iron absorption and promotes intestinal colonization with Lactobacillus bifidus,-its growth further encouraged by bifidus factor. L. bifidus maintains an acid milieu in the gastrointestinal tract, inhibiting the growth of pathogenic bacteria, fungi and parasites.
The vitamin concentrations in human milk are almost always adequate for infants' need. The mineral concentration is lower in human milk than the cow's milk and is thus better adapted. Calcium is more efficiently absorbed because of high calcium: phosphorus ratio (2:1). The bioavailability of iron is high.
Human milk is protective and immunomodulatory. The anti-infective properties in colostrum and breast milk have both soluble and cellular Components. The soluble components include immunoglobulins (IgA, IgM, IgG), lysozymes, lactoferin, the bifidus factor. The cellular components include macrophages. lymphocytes, neutrophil granulocytes and epithelial cells. The concentrations of these constituents are very high in colostrum, decreases in mature milk, which is due to dilution effect by increasing milk volume.
Comparison of Human, cow’s milk and standard formula:
Nutrients-----------Human Colostrum-:---Human mature milk:--Cow’s milk--:---Standard formula
Kcal/100ml------------------67----------:----------67------------:------------67---------:-------------67
CHO (Lactose- gm/dl)-----5.7---------:----------7.1------------:----------4.7---------:----------7.0-8.5
Protein (gm/dl)--------------2.9---------:--------1.06-------------:----------3.1--------:---------1.5-2.2
Whey : caesin--------------80:20-------:---------0----------------:--------18:82------:----------60:40
Fat (gm/dl)-----------------2.95---------:---------4.54------------:----------3.8--------:----------3.5-4.5
Sodium (g/1)--------------0.50----------:--------0.17------------:----------0.77-------:----------0.25
Potassium (g/l)------------0.74----------:--------0.51-----------:-----------1.43---------:---------0.80
Chloride (g/l)--------------0.59----------:--------0.37------------:------------1.08---------:-------0.57
Calcium (g/l)--------------0.48----------:--------0.34------------:-----------1.37-----------:-------46-73
Phosphorus (g/l)----------0.16----------:--------0.14------------:-----------0.91----------:-------32-56
Calcium/ Phosphorus-----3.1-----------:--------2.4-------------:------------1.5-----------:-------1.3-1.5
Magnesium (g/l)----------0.04----------:-------0.03-------------:-------------0.13----------:--------5.6
Copper (mg/1)------------1.34----------:-------0.51-------------:-------------0.10----------:-------0.40
Zinc (mg/l)----------------5.59----------:------1.18--------------:-------------3.90----------:--------5.0
Iodine (mg/l)---------------0------------:-------0.06--------------:------------0.08-----------:------0.01
Iron (mg/1)---------------1.0------------:------0.50--------------:-------------0.45-----------:------0.15
Vitamin A (mg/1)--------1.61----------:-------0.61--------------:-------------0.27----------:------1.5
Vitamin D (iu) -------------0------------:------4-100-------------:------------5-40-----------:-----41-50
Tocopherol (mg/l)--------14.8---------:--------2.4---------------:------------0.6-------------:-----8.liu
Thiamine (mg/l)----------0.02----------:-------0.14--------------:------------0.43-----------:------0.47
Riboflavin (mg/l)---------0.30---------:--------0.37--------------:-----------1.56------------:-----1.0
VitaminB6 (mg/l)---------0------------:--------0.18--------------:-----------0.51------------:------0.50
Nicotinic Acid (mg/l)----0.75---------:-------1.83---------------:-----------0.74------------:------6.7
Vitamin B12 (ug/l)-------0.06---------:-------0.34---------------:-----------2.48------------:------2.0
Pantothenic acid (mg/l)--1.83---------:-------2.46---------------:-----------3.4--------------:------3.0
Folic acid (ug/l)-----------5.0----------:-------14.0---------------:-----------90.0-------------:-----10-13
Vitamin C (mg/1) --------72-----------:-------52-----------------:-----------11----------------:------6.7
Osmolality--------------290-300-------:-------0-------------------:-----------0-----------------:----300-380
Benefits of breast-feeding:
Human milk is a living substance of great biological complexity. The benefits of breast milk are as follows:
> Human milk is species specific.
> The quantity and quality is optimum for the growth.
> The bioavailability of individual components is maximum.
> Breast milk is anti-infective and immunomodulatory.
> Exclusive breast-feeding is enough for the growth of infants up to 5 months of age.
> Breast-feeding helps the mother-infant bonding, protects mother from PPH and from some cancers like breast cancer and in avoiding early pregnancy.
> Breast-feeding helps family financially through avoiding cost of artificial feeding and treatment as artificial feeding put the child at risk of higher mortality and morbidity.
TEN STEPS OF SUCCESSFUL BREAST FEEDING (WHO recommendation):
The strategy is the Baby Friendly Hospital Initiative and each health facility should implement ten steps of successful breast-feeding for making the hospital “Baby Friendly". These include:
i) Have a written breast feeding policy that is routinely communicated to all health care staff.
ii) Train all health care staff in skills necessary to implement this policy.
iii) Inform all pregnant women about the benefits and management of breastfeeding.
iv) Help mothers initiating breast-feeding within a half-hour of birth.
v) Show mothers how to breast-feed, and how to maintain lactation even if they should be separated from their infants.
vi) Give newborn infants no food or drink other than breast milk unless medically indicated.
vii) Practice rooming in- allows mothers and infants to remain together - 24 hours a day.
viii) Encourage breast feeding on demand.
ix) Give no artificial teats or pacifiers (dummies or soothers) to breast feeding infants (As the infant will suffers from nipple confusion later)
x) Foster the establishment of breast feeding support groups and refers mothers to them on discharge from the hospital or clinic.
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