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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall">The paper by de Morais et&#160;al&#46; in this journal shows that being born by cesarean section and being born preterm are risk factors for optimal infant feeding&#59; since both factors are negatively associated with exclusive breastfeeding up to the age of 6 months&#44; what is the recommended feeding by the World Health Organization&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Breastfeeding is evidence-based for the best feeding for all infants&#44; with limited exceptions such as infants suffering from galactosemia or infants born to a mother needing medication such as chemotherapy which will harm a healthy baby&#46; As a consequence&#44; every effort should be made to stimulate breastfeeding for as many infants and for as long as possible&#46; Governments should develop campaigns to improve the knowledge about the benefits of breastfeeding&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Campaigns focusing on breastfeeding benefits and supporting initiatives for working mothers are a key priority&#46; Advocacy to employers&#44; managers and supervisors in providing breastfeeding facilitations and breastfeeding program support is critical to successful breastfeeding practice among workers&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> According to data from Indonesia&#44; white-collar workers have better knowledge&#44; attitude&#44; and practice towards breastfeeding&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> de Morais correctly highlights a possible bias in their findings since their study is restricted to infants born in private practices&#46; This selected population represents only 20&#37; of the Brazilian population&#44; mostly from the highest socioeconomic classes&#44; and thus white-collar workers&#46; While many governments fail to promote breastfeeding&#44; the Brazilian Ministry of Health&#44; together with the National Health Surveillance Agency&#44; regulated from 2010 the implementation of breastfeeding support rooms in companies through a technical note aimed at women workers to comply with the recommendation of exclusive breastfeeding up to the first six months and supplemented up to two years or more&#46; Also&#44; in 2010 the Ministry of Health developed the &#8220;Supporting Working Women and Breastfeeding&#8221; strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> Brazilian legislation has a postpartum leave of up to four months and two half-hour intervals during working hours or the option to leave one hour early so that the mother can breastfeed her baby until the age of six months&#46; Brazil also has a very large network of milk banks&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0003" class="elsevierStylePara elsevierViewall">The reported incidence in the study by de Morais et&#160;al&#46; of preterm birth was about 10&#37;&#44; which is very similar to previous Brazilian studies and data from USA&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> The prevalence of &#34;very low birth weight&#34; can be estimated at about 4&#37;&#46; In 2020&#44; the World Health Organization &#38; UNICEF expanded the Baby-friendly Hospital Initiative&#44; promoting and supporting breastfeeding to small&#44; sick and preterm newborns&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> The Nutrition Committee of the European Society of Pediatric Gastroenterology&#44; Hepatology and Nutrition &#40;ESPGHAN&#41; recommends that mothers of late or moderately preterm infants should receive qualified&#44; extended lactation support and frequent follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Individualized feeding plans should be promoted&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> However&#44; there may be a role for enhanced nutritional support&#44; including the use of human milk fortifier&#44; enriched formula&#44; parenteral nutrition&#44; and&#47;or additional supplements&#44; depending on factors such as gestational age&#44; birth weight&#44; and significant comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Obviously&#44; further efforts should be made worldwide to inform mothers who delivered preterm about the advantages of breastfeeding&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">Brazil has a very high prevalence of cesarean section&#44; which was 79&#46;6&#37; in the present study&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> According to a World Health Observatory data repository&#44; the birth by cesarean section in Brazil is 55&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> In 2019 in the USA&#44; 31&#46;7&#37; of infants were born by cesarean section&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> In Belgium&#44; the prevalence of cesarean section is around 21&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> These data indicate that the cesarean section rate in Brazil is exaggerated&#46; Cesarean section changes neonatal gut colonization&#44; and it takes up to the age of 1 year before the differences related to birth disappear&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> These differences in gastrointestinal microbiota colonization are likely to have a long-term negative impact on health outcomes&#46; At 6&#8201;months of age&#44; children born by CS had a significantly higher BMI&#44; but this did not persist into future childhood&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> There was no evidence to support an association between mode of delivery and long-term risk of obesity in the child&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> Children delivered by cesarean section have a significantly increased risk of asthma&#44; systemic connective tissue disorders&#44; juvenile arthritis&#44; inflammatory bowel disease&#44; immune deficiencies&#44; and leukemia&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> Infants born by cesarean section are also predisposed to the perinatal administration of antibiotics&#46; Perinatal antibiotics exert highly selective effects on the resident gut microbiome&#44; which&#44; in turn&#44; lead to very specific alterations in susceptibility to TH2- or TH1&#47;TH17-driven lung inflammatory disease&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Whether cesarean section is associated with an increased risk for immune-mediated diseases is debated&#44; with the more recent literature showing a very small or no increased risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0016"><span class="elsevierStyleSup">16-19</span></a> The negative impact of cesarean section on later health outcomes is likely to be limited to the elective section and could not be confirmed for the emergency section&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The breastfeeding rate is higher in the case of an emergency section than when the section was planned&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0005" class="elsevierStylePara elsevierViewall">Every effort should be made to stimulate long-term breastfeeding as much as possible since a mother&#39;s milk is the best feeding for infants&#44; and it is associated with an improved long-term health outcome compared to formula-fed infants&#46; Since preterm delivery and elective cesarean section are associated with a decrease in breastfeeding prevalence&#44; efforts should be made to limit these risk factors&#46; High quality prenatal care will decrease preterm delivery&#46; The elective section should be avoided as much as possible&#46; The health care professional should discuss the increased risk of a long-term negative health impact associated with an elective cesarean section with the future parents&#46;</p></span>"
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Editorial
Breastfeeding and its risk factors
Yvan Vandenplas
Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Belgium
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall">The paper by de Morais et&#160;al&#46; in this journal shows that being born by cesarean section and being born preterm are risk factors for optimal infant feeding&#59; since both factors are negatively associated with exclusive breastfeeding up to the age of 6 months&#44; what is the recommended feeding by the World Health Organization&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Breastfeeding is evidence-based for the best feeding for all infants&#44; with limited exceptions such as infants suffering from galactosemia or infants born to a mother needing medication such as chemotherapy which will harm a healthy baby&#46; As a consequence&#44; every effort should be made to stimulate breastfeeding for as many infants and for as long as possible&#46; Governments should develop campaigns to improve the knowledge about the benefits of breastfeeding&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Campaigns focusing on breastfeeding benefits and supporting initiatives for working mothers are a key priority&#46; Advocacy to employers&#44; managers and supervisors in providing breastfeeding facilitations and breastfeeding program support is critical to successful breastfeeding practice among workers&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> According to data from Indonesia&#44; white-collar workers have better knowledge&#44; attitude&#44; and practice towards breastfeeding&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> de Morais correctly highlights a possible bias in their findings since their study is restricted to infants born in private practices&#46; This selected population represents only 20&#37; of the Brazilian population&#44; mostly from the highest socioeconomic classes&#44; and thus white-collar workers&#46; While many governments fail to promote breastfeeding&#44; the Brazilian Ministry of Health&#44; together with the National Health Surveillance Agency&#44; regulated from 2010 the implementation of breastfeeding support rooms in companies through a technical note aimed at women workers to comply with the recommendation of exclusive breastfeeding up to the first six months and supplemented up to two years or more&#46; Also&#44; in 2010 the Ministry of Health developed the &#8220;Supporting Working Women and Breastfeeding&#8221; strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> Brazilian legislation has a postpartum leave of up to four months and two half-hour intervals during working hours or the option to leave one hour early so that the mother can breastfeed her baby until the age of six months&#46; Brazil also has a very large network of milk banks&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0003" class="elsevierStylePara elsevierViewall">The reported incidence in the study by de Morais et&#160;al&#46; of preterm birth was about 10&#37;&#44; which is very similar to previous Brazilian studies and data from USA&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> The prevalence of &#34;very low birth weight&#34; can be estimated at about 4&#37;&#46; In 2020&#44; the World Health Organization &#38; UNICEF expanded the Baby-friendly Hospital Initiative&#44; promoting and supporting breastfeeding to small&#44; sick and preterm newborns&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> The Nutrition Committee of the European Society of Pediatric Gastroenterology&#44; Hepatology and Nutrition &#40;ESPGHAN&#41; recommends that mothers of late or moderately preterm infants should receive qualified&#44; extended lactation support and frequent follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Individualized feeding plans should be promoted&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> However&#44; there may be a role for enhanced nutritional support&#44; including the use of human milk fortifier&#44; enriched formula&#44; parenteral nutrition&#44; and&#47;or additional supplements&#44; depending on factors such as gestational age&#44; birth weight&#44; and significant comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Obviously&#44; further efforts should be made worldwide to inform mothers who delivered preterm about the advantages of breastfeeding&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">Brazil has a very high prevalence of cesarean section&#44; which was 79&#46;6&#37; in the present study&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> According to a World Health Observatory data repository&#44; the birth by cesarean section in Brazil is 55&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> In 2019 in the USA&#44; 31&#46;7&#37; of infants were born by cesarean section&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> In Belgium&#44; the prevalence of cesarean section is around 21&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> These data indicate that the cesarean section rate in Brazil is exaggerated&#46; Cesarean section changes neonatal gut colonization&#44; and it takes up to the age of 1 year before the differences related to birth disappear&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> These differences in gastrointestinal microbiota colonization are likely to have a long-term negative impact on health outcomes&#46; At 6&#8201;months of age&#44; children born by CS had a significantly higher BMI&#44; but this did not persist into future childhood&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> There was no evidence to support an association between mode of delivery and long-term risk of obesity in the child&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> Children delivered by cesarean section have a significantly increased risk of asthma&#44; systemic connective tissue disorders&#44; juvenile arthritis&#44; inflammatory bowel disease&#44; immune deficiencies&#44; and leukemia&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> Infants born by cesarean section are also predisposed to the perinatal administration of antibiotics&#46; Perinatal antibiotics exert highly selective effects on the resident gut microbiome&#44; which&#44; in turn&#44; lead to very specific alterations in susceptibility to TH2- or TH1&#47;TH17-driven lung inflammatory disease&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Whether cesarean section is associated with an increased risk for immune-mediated diseases is debated&#44; with the more recent literature showing a very small or no increased risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0016"><span class="elsevierStyleSup">16-19</span></a> The negative impact of cesarean section on later health outcomes is likely to be limited to the elective section and could not be confirmed for the emergency section&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The breastfeeding rate is higher in the case of an emergency section than when the section was planned&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0005" class="elsevierStylePara elsevierViewall">Every effort should be made to stimulate long-term breastfeeding as much as possible since a mother&#39;s milk is the best feeding for infants&#44; and it is associated with an improved long-term health outcome compared to formula-fed infants&#46; Since preterm delivery and elective cesarean section are associated with a decrease in breastfeeding prevalence&#44; efforts should be made to limit these risk factors&#46; High quality prenatal care will decrease preterm delivery&#46; The elective section should be avoided as much as possible&#46; The health care professional should discuss the increased risk of a long-term negative health impact associated with an elective cesarean section with the future parents&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="notep0001a">See paper by Morais et al&#46; in pages 241&#8211;247&#46;</p>"
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Article information
ISSN: 00217557
Original language: English
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