ABSTRACT. Objective. To estimate fat and energy contents of human milk during prolonged lactation.Methods. Thirty-four mothers, of term, healthy, growing children, who had been lactating for >1 year (12-39 months) were recruited. Control subjects were 27 mothers, of term infants, who had been lactating for 2 to 6 months. Fat contents of the milk samples were estimated as creamatocrit (CMT) levels. Energy contents of the milk were measured with a bomb calorimeter.Results. The groups did not differ in terms of maternal height and diet, infant birth weight, gestational age, or breastfeeding frequency. They differed significantly in terms of maternal age, maternal weight, and BMI. The mean CMT levels were 7.36 ؎ 2.65% in the short-duration group and 10.65 ؎ 5.07% in the long-lactation group. The mean energy contents were 3103.7 ؎ 863.2 kJ/L in the short-duration group and 3683.2 ؎ 1032.2 kJ/L in the long-duration group. The mean CMT levels and mean energy contents were correlated significantly with the duration of lactation (R 2 ‫؍‬ 0.22 and R 2 ‫؍‬ 0.23, respectively). In multivariate regression analysis, CMT levels (or energy contents) were not influenced by maternal age, diet, BMI, or number of daily feedings but remained significantly influenced by the duration of lactation.Conclusions. Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant. T he optimal duration of breastfeeding is unknown. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months and a total duration of Ն1 year to obtain the "full benefits of breastfeeding." 1 Among frequently recognized long-term benefits of breastfeeding are reductions in cardiovascular risks in adulthood. 1,2 These reductions were challenged by a retrospective epidemiologic study of men born in 1920 to 1930 in Hertfordshire, England, which suggested that the beneficial effects of breastfeeding on cardiovascular risks existed as long as weaning was performed before 1 year of age; after that time, continued breastfeeding was associated paradoxically with increased cardiovascular risks. 2 Moreover, a study by Leeson et al 3 suggested that prolonged breastfeeding might lead to unwelcome outcomes and might even increase cardiovascular risks in adulthood.In developed countries, a minority of women continue to lactate for Ͼ1 year; in one study from Italy, 17% of mothers were still breastfeeding at 12 months after delivery. 4 The energy contribution of human milk (HM) to the diet of partially breastfed children beyond the first year of life is unknown, because there are no data on the amounts of HM consumed by these children and the nutritional content of HM after prolonged breastfeeding is little known. In particular, the fat and energy contents of HM after prolonged breastfeeding have not been analyz...

Stopping the COVID-19 pandemic and its socio-economic consequences is only possible with a multifaceted strategy, including mass vaccination. Studies have been conducted mainly in adults, and data on the pediatric population is relatively limited. However, it appears that vaccination in children and adolescents is highly effective and safe. Despite the apparent benefits of vaccinating this age group, there are some medical and ethical concerns. Based on the above considerations, the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Pediatricians (ECPCP) assessed the current situation and presented recommendations for international and national authorities, pediatricians, and pediatric societies regarding vaccination against SARS-CoV-2 in children and adolescents.

The COVID-19 pandemic and global lockdown have had drastic socioeconomic and psychological effects on countries and people, respectively. There has been limited access to health care and education. These negative consequences have had a significant impact on the well-being of children and adolescents. Therefore, the EAP and the ECPCP are requesting state, health, and education authorities as well as European pediatric societies and the healthcare professionals that special attention be given to this population and the problems they face as a result of the pandemic.

Many fetal anomalies can be detected by ultrasound examination. The antenatal diagnosis of pathological disorders in the fetus can complicate management plans.We report here a.case of bilateral chylothorax with pericardial effusion diagnosed antenataly. CASE REPORTA 25-year-old woman, gravida 2, para 1, was referred for diagnostic ultrasonography at 34 weeks' gestation because of a rapid increase in fundal height, abdominal discomfort and mild respiratory distress. Her past history and family history were unremarkable.Her first pregnancy ended in the normal birth of a healthy 3 OOO g infant, following an uncomplicated pregnancy.The present pregnancy has been complicated by fever at 12 weeks' gestation, for which she was admitted to hospital. Investigation did not reveal the source of the pyrexia. She was treated with Ampicillin for 4 days; Ultrasound examination at weeks 17 and 22 of gestation disclosed normal fetal growth.At weeks' gestation, a linear array ultrasound (ADR realtime scanner, Model 2130) examination disclosed polyhydramnios, bilateral fetal pleural effusions with bilateral lung collapse (Fig. 1). Four normal-sized heart chambers were seen with hydropericard (pericardial effusion). The biparietal diameter was 92 mm. Fetal kidneys, stomach, bladder and extremities seemed normal. Laboratory investigations reported a rhesus-positive blood group, negative serological test for syphilis and negative titers for toxoplasmosis. A second ultrasound examination, performed 24 hours after admission, revealed thickening of the thoracic and abdominal walls and ascites; fetal liver enlargement and edema. On account of these findings of impending fetal death and unfavorable cervical score, pregnancy was terminated by cesarean section.A 3 OOO g male infant was delivered in a state of asphyxia, depressed at birth and with an Apgar score of 3 at one minute. Physical examination revealed numerous hemangiomata on the scalp, edema of the scrotum and a slight hepatosplenomegaly; heart sounds were distant and a 2-316 systolic murmur was auscultated. Following endo-tracheal intubation and assisted ventilation his condition improved. During the next hours, thoracocentesis was performed twice, withdrawing 40 ml from the left thoracic cavity and 70 ml from the right side. The fluid was serous, with a lipid concentration of 500 mg%. In spite of intensive treatment which included diuretics, blood transfusion, bicarbonate, assisted ventilation and repeated thoracocentesis, the infant became cyanotic, severely acidotic and died 36 hours after birth, from cardiac arrest. Autopsy revealed an en!arged thymus (20 g) with a huge hemangioma on it, hemangiomata over the liver and effusion in the pleural pericardium and peritoneal cavities. DISCUSSIONFluid is most frequently seen in the thoracic cavity in association with non-immune hydrops, Turner's Syndrome, Down's Syndrome (4, 7) and collapsed lungs. The appearance of fluid in the fetal chest as an isolated finding is diagnostic for Congenital Chylothorax. Other fluid accumulations, wi...

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