An equitable, community-engaged translational framework for science in human lactation and infant feeding-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 5

Abstract

Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field. Thus, with inspiration from the simplified environmental sciences framework of Kaufman and Curl, Working Group 5 of the BEGIN Project developed a translational framework for science in human lactation and infant feeding, which includes 5 nonlinear, interconnected translational stages, T1: Discovery; T2: Human health implications; T3: Clinical and public health implications; T4: Implementation; and T5: Impact. The framework is accompanied by 6 overarching principles: 1) Research spans the translational continuum in a nonlinear, nonhierarchical manner; 2) Projects engage interdisciplinary teams in continuous collaboration and cross talk; 3) Priorities and study designs incorporate a diverse range of contextual factors; 4) Research teams include community stakeholders from the outset through purposeful, ethical, and equitable engagement; 5) Research designs and conceptual models incorporate respectful care for the birthing parent and address implications for the lactating parent; 6) Research implications for real-world settings account for contextual factors surrounding the feeding of human milk, including exclusivity and mode of feeding. To demonstrate application of the presented translational research framework and its overarching principles, 6 case studies are included, each illustrating research gaps across all stages of the framework. Applying a translational framework approach to addressing gaps in the science of human milk feeding is an important step toward the aligned goals of optimizing infant feeding across diverse contexts as well as optimizing health for all.

Keywords: human milk; infant feeding; lactation science; translational research.

FIGURE 1

A translational research framework for human lactation and infant feeding.

FIGURE 2

Contextual considerations.

FIGURE 3

Ethical, Legal, and Social Implications of human lactation and infant feeding research.

FIGURE 4

Growth trajectory for Baby L. Case Study Baby L. The Fenton growth chart depicts Baby L’s neonatal intensive care unit journey, highlighting nutrition milestones [162]. (A) Baby L was born at 25 0/7 wk gestational age, weighing 810 g, with parenteral nutrition initiated on the first day of life; (B) Weekly human milk analysis using mid-infrared spectroscopy was initiated; (C) Enteral feedings of expressed milk from the birthing parent were initiated; (D) Half fortification (1:50) using a concentrated liquid human milk fortifier with hydrolyzed protein was initiated; (E) Parenteral nutrition discontinued; (F) Full fortification (1:25) was initiated, with enteral feeds providing 150 mL/kg, 120 kcal/kg, and 3.8 g/kg protein; (G) Targeted fortification initiated using a liquid protein hydrolysate, with enteral feeds providing 150 mL/kg, 125 kcal/kg, and 4.3 g/kg protein; (H) Baby L was discharged from the NICU at 39 0/7 wk postmenstrual age, on a combination of expressed milk from the birthing parent and preterm infant formula due to a diminished supply.