{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:09:51Z","timestamp":1789063791256,"version":"build-2803163510"},"reference-count":79,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100010475","name":"American Society of Pediatric Otolaryngology","doi-asserted-by":"publisher","award":["839752"],"award-info":[{"award-number":["839752"]}],"id":[{"id":"10.13039\/100010475","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To delineate the impact of breast milk feeding (BMF) on the middle ear (ME) and nasopharyngeal (NP) microbiota of children with and without cleft palate with or without cleft lip (CP\u2009\u00b1\u2009L); to define differences in ME and NP bacterial composition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary children's hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Children aged &lt;24 months undergoing first bilateral myringotomy and tubes (BMTs). Groups included CP\u2009\u00b1\u2009L with BMF \u22653 months (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20096), CP\u2009\u00b1\u2009L with no BMF (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20095), controls with BMF \u22653 months (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200914), and controls with no BMF (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200914). Exclusions were immunodeficiency, genetic disorders, and antibiotic treatment \u226414 days prior.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>ME effusions (MEEs) and NP swabs were collected. Bacterial 16S rRNA gene sequencing was performed. Main outcome measures were abundance (additive-log ratio transformed), \u03b2-diversity (permutational multivariate analysis of variance), and \u03b1-diversity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      BMF was associated with increased\n                      <jats:italic toggle=\"yes\">Acinetobacter<\/jats:italic>\n                      (\u03b2\u2009=\u20091.46) in MEE. In the NP, BMF was associated with increased\n                      <jats:italic toggle=\"yes\">Haemophilus<\/jats:italic>\n                      (\u03b2\u2009=\u20092.40),\n                      <jats:italic toggle=\"yes\">Neisseria<\/jats:italic>\n                      (\u03b2\u2009=\u20092.39),\n                      <jats:italic toggle=\"yes\">Granulicatella<\/jats:italic>\n                      (\u03b2\u2009=\u20091.53),\n                      <jats:italic toggle=\"yes\">Gemella<\/jats:italic>\n                      (\u03b2\u2009=\u20091.86), and\n                      <jats:italic toggle=\"yes\">Prevotella<\/jats:italic>\n                      (\u03b2\u2009=\u20091.83), and decreased\n                      <jats:italic toggle=\"yes\">Staphylococcus<\/jats:italic>\n                      (\u03b2\u2009=\u2009\u22121.88). CP\u2009\u00b1\u2009L was associated with greater \u03b1-diversity (Tail \u03b2\u2009=\u20091.58; Shannon \u03b2\u2009=\u20091.30) and increased\n                      <jats:italic toggle=\"yes\">Gemella<\/jats:italic>\n                      (\u03b2\u2009=\u20092.13),\n                      <jats:italic toggle=\"yes\">Acinetobacter<\/jats:italic>\n                      (\u03b2\u2009=\u20091.81), and\n                      <jats:italic toggle=\"yes\">Pseudomonas<\/jats:italic>\n                      (\u03b2\u2009=\u20092.90) in MEE. In the NP, CP\u2009\u00b1\u2009L was associated with an increased abundance of\n                      <jats:italic toggle=\"yes\">Veillonella<\/jats:italic>\n                      (\u03b2\u2009=\u20093.48),\n                      <jats:italic toggle=\"yes\">Streptococcus<\/jats:italic>\n                      (\u03b2\u2009=\u20092.15), and\n                      <jats:italic toggle=\"yes\">Staphylococcus<\/jats:italic>\n                      (\u03b2\u2009=\u20091.74) and a decreased abundance of\n                      <jats:italic toggle=\"yes\">Afipia<\/jats:italic>\n                      (\u03b2\u2009=\u2009\u22121.58). Paired differences revealed more\n                      <jats:italic toggle=\"yes\">Staphylococcus<\/jats:italic>\n                      in MEE relative to the NP (\u03b2\u2009=\u2009\u22125.98) and a significant difference in \u03b2-diversity between the NP and MEE (\u03b2\u2009=\u20091.27). All\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BMF and CP\u2009\u00b1\u2009L may alter ME and NP microbiota. This represents a first step in the identification of factors that could improve ME health in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261483549","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:23:15Z","timestamp":1788841395000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Breast Milk Feeding and the Middle Ear Microbiome of Children With Cleft Palate"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5783-9198","authenticated-orcid":false,"given":"Amber D.","family":"Shaffer","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8297-1727","authenticated-orcid":false,"given":"Barbara 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