Invited Commentary: Effect of Breastmilk After Congenital Heart Surgery.

Human breastmilk offers immunologic bene fi ts to neonates. It provides antibodies and stimulates neonatal immune system development. 1 Lactoferrin, lactadherin, bile salt stimulating lipase, milk fat globule, and epidermal growth factor increase protection from bacterial and viral infections. These bene fi ts have been increasingly demonstrated in population-based studies over the past three decades. The Millennium Cohort Study from the United Kingdom showed the bene fi t of exclusive breastfeeding in the prevention of gastrointestinal or chest infection in over 15 000 infants. 2 In preterm and very low birth weight newborns, population studies on breastmilk showed lower risks of late-onset sepsis and necrotizing enterocolitis (NEC). 3 There are emerging data on the long-term effect of breastmilk on cardiovascular health. Lucas and colleagues from the United Kingdom followed pre-mature neonates born under birth weight of 1,850 g since 1984 for long-term effects of diet on health. 4 A 25-year follow-up study from this cohort showed higher biventricular end-diastolic volume and right ventricular function for those who had been exclusively breastmilk-fed compared to those exclusively formula-fed. 5 Breastmilk was postulated to affect cardiovascular development via its vascular endothelial growth factors. Finally, the American Board of Pediatrics recommended exclusive breastmilk for a minimum of six months of age. Speci fi c