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We followed 858 children from birth to one year of age to determine whether the presence of polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) in breast milk affected their growth or health. Neither chemical showed an adverse effect on weight or frequency of physician visits for various illnesses, although differences were seen between breast-fed and bottle-fed children, with bottle-fed children being heavier and having more frequent gastroenteritis and otitis media. Children of mothers with higher levels of DDE were breast-fed for markedly shorter times, but adjustments for possible confounders and biases did not change the findings. In absence of any apparent effect on the health of the children, we speculate that DDE may be interfering with the mother's ability to lactate, possibly because of its estrogenic prop-

The authors measured polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) in maternal serum, cord blood, placenta, and serial samples of breast milk from 868 women. Almost all samples of breast milk showed detectable levels of both chemicals. Overall, values for DDE in this study are within the range of those found previously, whereas those for PCBs are somewhat higher. Possible causes of variation in levels were investigated. For DDE, older women, Black women, cigarette smokers, and women who consumed sport fish during pregnancy had higher levels; only age and race showed large effects. For

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Breastfeeding and human milk are widely recognized as optimal for human infants. However, if donor milk is used when mother's own milk is not available, some questions arise concerning the effects of storage, handling, and heat processing on the unique components of human milk. Holder pasteurization (62.5 degrees C for 30 minutes) of banked human milk is the method of choice to eliminate potential viral contaminants such as human immunodeficiency virus, human T-lymphoma virus, and cytomegalovirus, as well as tuberculosis and other bacterial contaminants, while maintaining the greatest possible complement of its unique bioactive factors. This article reviews some of the critical components of human milk and what is currently known about the effects of Holder pasteurization on their biological activity.

This descriptive study documents nurses' breastfeeding knowledge and attitudes. The nursing staffs of 27 private pediatric practices in North Carolina were surveyed. The 42-item questionnaire included questions about who was responsible for breastfeeding support, what staff nurses knew and believed about breastfeeding, and where their breastfeeding education was obtained. The response rate was 59% (134 out of 227). Only 5% responded that a breastfeeding patient experiencing problems would be referred to a physician, whereas 81% selected a lactation consultant, and 38% selected a member of the nursing staff. Knowledge scores ranged from 19 to 33 (out of 33). Attitude scores ranged from 10 to 30 (out of 30). Only 46% of respondents reported having received breastfeeding education in their training programs; 85% had received on-the-job training. The nurses surveyed were involved in breastfeeding support, yet many had incorrect information and negative attitudes toward breastfeeding.

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Donor milk has been used to successfully treat a number of medical conditions in infants. This article highlights 3 such success stories describing the use of human milk in cases of velocardiofacial syndrome, very-low-birth weight, and failure to thrive. In 2002, more than 300 infants and young children and 15 adults received donor milk from 6 milk banks in the United States and I milk bank in Canada. Donor milk is often used to ensure optimal outcomes in full term or preterm infants until their own mother's milk volume is sufficient to meet their needs. However, human milk may be a lifesaving therapy for infants and young children with unusual medical conditions.