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Donor human milk for very low birth weights: patterns of usage, outcomes, and unanswered questions.

Curr Opin Pediatr; 27(2): 172-6, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25689453


PURPOSE OF REVIEW: Donor milk usage in the United States has increased substantially over the past 10 years. Between 2007 and 2011, donor milk use in level 3 and 4 neonatal ICUs increased from 25 to 45%. RECENT FINDINGS: Most centers have written protocols based on birth weight or gestational age, and give donor milk in an effort to prevent necrotizing enterocolitis. The evidence for protection against necrotizing enterocolitis using bovine-fortified donor milk vs. formula is limited, although the exclusive human milk diet seems to offer protection compared to diets containing formula. Adequate growth can be achieved with donor milk fortified with either bovine or human milk-derived fortifiers, but use of additional fortification and protein supplementation may be required. Several randomized trials of donor milk vs. formula are ongoing in the very low birth weight population in North America that can answer important questions. SUMMARY: Further research is needed before donor milk and the exclusive human milk diet are considered the standard of care.

Donated breast milk stored in banks versus breast milk purchased online.

Can Fam Physician; 61(2): 143-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25676644


QUESTION: One of my patients asked if she could buy human milk on the Internet to feed her infant if the need arose. Is using donated breast milk from the milk bank safer than buying it online? ANSWER: The World Health Organization and the American Academy of Pediatrics recommend the use of donated breast milk as the first alternative when maternal milk is not available, but the Canadian Paediatric Society does not endorse the sharing of unprocessed human milk. Human breast milk stored in milk banks differs from donor breast milk available via the Internet owing to its rigorous donor-selection process, frequent quality assurance inspections, regulated transport process, and pasteurization in accordance with food preparation guidelines set out by the Canadian Food Inspection Agency. Most samples purchased online contain Gram-negative bacteria or have a total aerobic bacteria count of more than 10(4) colony-forming units per millilitre; they also exhibit higher mean total aerobic bacteria counts, total Gram-negative bacteria counts, coliform bacteria counts, and Staphylococcus spp counts than milk bank samples do. Growth of most bacteria species is associated with the number of days in transit, which suggests poor collection, storage, or shipping practices for milk purchased online.

Effect of digestion and storage of human milk on free fatty acid concentration and cytotoxicity.

J Pediatr Gastroenterol Nutr; 59(3): 365-73, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24840512


OBJECTIVES: Fat is digested in the intestine into free fatty acids (FFAs), which are detergents and therefore toxic to cells at micromolar concentration. The mucosal barrier protects cells in the adult intestine, but this barrier may not be fully developed in premature infants. Lipase-digested infant formula, but not fresh human milk, has elevated FFAs and is cytotoxic to intestinal cells, and therefore could contribute to intestinal injury in necrotizing enterocolitis (NEC), but even infants exclusively fed breast milk may develop NEC. Our objective was to determine whether stored milk and milk from donor milk (DM) banks could also become cytotoxic, especially after digestion. METHODS: We exposed cultured rat intestinal epithelial cells or human neutrophils to DM and milk collected fresh and stored at 4°C or -20°C for up to 12 weeks and then treated for 2 hours (37°C) with 0.1 or 1 mg/mL pancreatic lipase and/or trypsin and chymotrypsin. RESULTS: DM and milk stored 3 days (at 4°C or -20°C) and then digested were cytotoxic. Storage at -20°C for 8 and 12 weeks resulted in an additional increase in cytotoxicity. Protease digestion decreased, but did not eliminate cell death. CONCLUSIONS: Present storage practices may allow milk to become cytotoxic and contribute to intestinal damage in NEC.

Evaluación de la recolección domiciliaria realizada por un banco de leche humana de un hospital universitario de Brasil. / [Evaluation of home collection performed by a human milk bank in a university hospital in Brazil].

Salud Publica Mex; 56(3): 245-50, 2014 May-Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-25272175


OBJECTIVE: Evaluation of procedures during household milking and transport of human milk associated with their quality control. MATERIALS AND METHODS: 48 donors registered in the Human Milk Bank of the Clinics Hospital of the Federal University at Uberlândia. Observations were made during home visits. A checklist was elaborated according to the technical standards for human milk banks, been associated with physical-chemical, and microbiological controls. The chi-square test, logistic regression and Spearman test (p< 0.05) were used for data analysis. RESULTS: The results suggest that most donors assimilated the guidelines of the milk bank staff and procedures were satisfactorily performed. CONCLUSION: It could be demonstrated that milking and home collection are safe and effective ways for obtaining donated human milk.

O diálogo entre saúde e política externa na cooperação brasileira em bancos de leite humano / The dialog between health and foreign policy in Brazilian cooperation in human milk banks

Ciênc. Saúde Colet; 22(7)jul. 2017.
Artigo em Português | LILACS | ID: biblio-859962


O leite materno é a principal forma de alimentação nos primeiros anos da infância. Na impossibilidade deste tipo de amamentação, surgem alternativas secundárias, como os bancos de leite humano. No caso brasileiro, a adoção desta fonte teve início em 1943, com a instituição do primeiro banco de leite. A partir de então, passando por diferentes fases, foi desenvolvido um modelo nacional que culminou na criação da Rede Brasileira de Bancos de Leite Humano. Como consequência, diversos projetos de cooperação internacional iniciam a partir disso, sendo o modelo brasileiro relevante principalmente para países em desenvolvimento. O objetivo central desta análise é compreender o que motiva o Brasil a promover os bancos de leite internacionalmente. Para realizá-lo, busca-se entender o relacionamento entre saúde e política externa, expressa aqui em termos de soft power, posto que as duas pastas dialogaram nesses atos. Entre os resultados estão expressos ganhos em ambas as áreas e a afirmação da saúde como um fim a ser alcançado no grupo de interesses nacionais do caso.
Biblioteca responsável: BR2260

Annotation and structural analysis of sialylated human milk oligosaccharides.

J Proteome Res; 10(2): 856-68, 2011 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-21133381


Sialylated human milk oligosaccharides (SHMOs) are important components of human milk oligosaccharides. Sialic acids are typically found on the nonreducing end and are known binding sites for pathogens and aid in neonates' brain development. Due to their negative charge and hydrophilic nature, they also help modulate cell-cell interactions. It has also been shown that sialic acids are involved in regulating the immune response and aid in brain development. In this study, the enriched SHMOs from pooled milk sample were analyzed by HPLC-Chip/QTOF MS. The instrument employs a microchip-based nano-LC column packed with porous graphitized carbon (PGC) to provide excellent isomer separation for SHMOs with highly reproducible retention time. The precursor ions were further examined with collision-induced dissociation (CID). By applying the proper collision energy, isomers can be readily differentiated by diagnostic peaks and characteristic fragmentation patterns. A set of 30 SHMO structures with retention times, accurate masses, and MS/MS spectra was deduced and incorporated into an HMO library. When combined with previously determined neutral components, a library with over 70 structures is obtained allowing high-throughput oligosaccharide structure identification.

Development of an annotated library of neutral human milk oligosaccharides.

J Proteome Res; 9(8): 4138-51, 2010 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-20578730


Human milk oligosaccharides (HMOs) perform a number of functions including serving as prebiotics to stimulate the growth of beneficial intestinal bacteria, as receptor analogues to inhibit binding of pathogens, and as substances that promote postnatal brain development. There is further evidence that HMOs participate in modulating the human immune system. Because the absorption, catabolism, and biological function of oligosaccharides (OS) have strong correlations with their structures, structure elucidation is key to advancing this research. Oligosaccharides are produced by competing enzymes that provide the large structural diversity and heterogeneity that characterizes this class of compounds. Unlike the proteome, there is no template for oligosaccharides, making it difficult to rapidly identify oligosaccharide structures. In this research, annotation of the neutral free oligosaccharides in milk is performed to develop a database for the rapid identification of oligosaccharide structures. Our strategy incorporates high performance nanoflow liquid chromatography and mass spectrometry for characterizing HMO structures. HPLC-Chip/TOF MS provides a sensitive and quantitative method for sample profiling. The reproducible retention time and accurate mass can be used to rapidly identify the OS structures in HMO samples. A library with 45 neutral OS structures has been constructed. The structures include information regarding the epitopes such as Lewis type, as well as information regarding the secretor status.

Banked preterm versus banked term human milk to promote growth and development in very low birth weight infants.

Cochrane Database Syst Rev; (6): CD007644, 2010 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-20556782


BACKGROUND: Human milk banking has been available in many countries for the last three decades. The milk provided from milk banking is predominantly term breast milk, but some milk banks provide preterm breast milk. There are a number of differences between donor term and donor preterm human milk. OBJECTIVES: To determine the effect of banked preterm milk compared with banked term milk regarding growth and developmental outcome in very low birth weight infants (infants weighing less than 1500 g). SEARCH STRATEGY: We used the standard methods of the Cochrane Neonatal Review Group, including a search of the Cochrane Neonatal Group specialized register and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, January 2010). We searched the computerised bibliographic databases MEDLINE (1966 to February 2010), EMBASE (1988 to February 2010) and Web of Science (1975 to February 2010). We searched reference lists of all selected articles, review articles and the Oxford Database of Perinatal Trials. We also searched abstracts from neonatal and pediatric meetings (PAS electronic version from 2000 to 2009, ESPR hand search from 2000 to 2009). We applied no language restrictions. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing banked donor preterm milk with banked donor term milk regarding growth and developmental outcomes in very low birth weight infants DATA COLLECTION AND ANALYSIS: We planned to perform assessment of methodology regarding blinding of randomisation, intervention and outcome measurements as well as completeness of follow-up. We planned to evaluate treatment effect using a fixed-effect model using relative risk (RR), relative risk reduction, risk difference (RD) and number needed to treat (NNT) for categorical data and using mean, standard deviation and weighted mean difference (WMD) for continuous data. We planned an evaluation of heterogeneity. MAIN RESULTS: No studies met the inclusion criteria. AUTHORS' CONCLUSIONS: There are no randomised trials that compare preterm banked milk to banked term milk to promote growth and development in very low birth weight infants.

Breast milk donation and social support: reports of women donors.

Rev Lat Am Enfermagem; 18(3): 381-9, 2010 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20721427


The study aimed to characterize the behavior of human milk donation and to describe the informal social and formal institutional support, according to reports from women donors. It is an exploratory, cross-sectional, descriptive study using domicile interviews based on structured and semi-structured scripts. The participants were 36 women enrolled in two human milk banks of the public health system of the Federal District. Statistical analysis of quantitative data and categorical content analysis of qualitative data were performed. Categories of reasons that most influenced the frequency of expressing were: food, time availability, negative emotions and fluid intake. The manual expressing technique was reported as predominant. The use of breast shells was cited by almost a third of the donors. Most frequent suggestions for improving institutional support were more attention and support from the milk banks for the donor. The study may serve as a stimulus for the implementation of technical and political strategies to encourage this practice.

Serum phenylalanine in preterm newborns fed different diets of human milk, / Fenilalanina plasmática em recém-nascidos pré-termo alimentados com diferentes dietas de leite humano,

J Pediatr; 90(5): 518-522, Sep-Oct/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-723168


Objective: To evaluate phenylalanine plasma profile in preterm newborns fed different human milk diets. Methods: Twenty-four very-low weight preterm newborns were distributed randomly in three groups with different feeding types: Group I: banked human milk plus 5% commercial fortifier with bovine protein, Group II: banked human milk plus evaporated fortifier derived from modified human milk, Group III: banked human milk plus lyophilized fortifier derived from modified human milk. The newborns received the group diet when full diet was attained at 15 ± 2 days. Plasma amino acid analysis was performedon the first and last day of feeding. Comparison among groups was performed by statistical tests: one way ANOVA with Tukey's post-test using SPSS software, version 20.0 (IBM Corp, NY, USA), considering a significance level of 5%. Results: Phenylalanine levels in the first and second analysis were, respectively, in Group I: 11.9 ± 1.22 and 29.72 ± 0.73; in Group II: 11.72 ± 1.04 and 13.44 ± 0.61; and in Group III: 11.3 ± 1.18 and 15.42 ± 0.83 μmol/L. Conclusion: The observed results demonstrated that human milk with fortifiers derived from human milk acted as a good substratum for preterm infant feeding both in the evaporated or the lyophilized form, without significant increases in plasma phenylalanine levels in comparison to human milk with commercial fortifier. .
Objetivo: Avaliar o perfil plasmático do aminoácido fenilalanina em recém-nascidos pré-termo alimentados com diferentes dietas de leite humano. Métodos: Foram estudados 24 recém-nascidos pré-termo de muito baixo peso, distribuídos em três grupos com diferentes dietas: Grupo I: leite humano de banco com 5% de aditivo comercial para leite humano com proteína de origem bovina (LHB-AC); Grupo II: leite humano de banco com aditivo de leite humano modificado evaporado (LHB-E); e Grupo III: leite humano de banco com aditivo de leite humano modificado liofilizado (LHB-L). Os recém-nascidos receberam a dieta definida para o grupo quando alcançaram dieta plena por 15 ± 2 dias. A análise do aminoácido plasmático foi feita no primeiro e último dias da dieta. A comparação entre os grupos foi realizada por meio do teste ANOVA de uma via, seguido pelo pós-teste de Tukey, utilizando-se o software SPSS (IBM Corp, NY, EUA), versão 20.0, e considerando um nível de significância de 5%. Resultados: As concentrações plasmáticas do aminoácido fenilalanina na primeira e segunda análises foram, respectivamente, no Grupo I (LHB-AC) 11,9±1,22 e 29,72±0,73; no Grupo II (LHB-E) 11,72±1,04 e 13,44±0,61; e no Grupo III 11,3±1,18 e 15,42±0,83 umol/L. Conclusão: Os resultados encontrados demonstram que o leite humano com aditivos do próprio leite humano comportou-se como um bom substrato para alimentação do recém-nascido pré-termo, tanto na forma evaporada como liofilizada, sem levar a aumentos significativos na concentração plasmática de fenilalanina em comparação ao leite humano com aditivo comercial. .
Biblioteca responsável: BR1.1

Nursing consultation in homecare for the milk bank of Antonio Pedro College Hospital: a space for educative actions

Online braz. j. nurs. (Online); 12(suplementar)out. 2013.
Artigo em Inglês, Espanhol, Português | LILACS | ID: lil-698483


Aim: To develop a standard instrument for nursing consultations with regard to homecare; to characterize the consultations in homecare, to establish its articulation with educational activities performed by the nurse and; to analyze the practice of this consultation, considering the point-of-view of the donor woman. Method: This is a descriptive research which adopts a qualitative approach. It was based on the scenario of a human breast milk bank at Antonio Pedro College Hospital in Niterói, Brazil. 22 women were interviewed which involved answering a semi-structured questionnaire. The data were grouped into two categories. Results: Analytical categories: home visits and the educative practice of the nurse; the home nursing consultation from the perspective of the nurturing woman. A standard instrument for nursing consultations was produced. Conclusion: The educational actions of the nurse during homecare have three main focuses: the motivation to breastfeed, the necessary caring for the baby and the mother, and the safe procedure when it comes to collecting human milk...
Biblioteca responsável: BR1342.1

Genomics of lactation: role of nutrigenomics and nutrigenetics in the fatty acid composition of human milk.

Br J Nutr; 118(3): 161-168, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28831952


Human milk covers the infant's nutrient requirements during the first 6 months of life. The composition of human milk progressively changes during lactation and it is influenced by maternal nutritional factors. Nowadays, it is well known that nutrients have the ability to interact with genes and modulate molecular mechanisms impacting physiological functions. This has led to a growing interest among researchers in exploring nutrition at a molecular level and to the development of two fields of study: nutrigenomics, which evaluates the influence of nutrients on gene expression, and nutrigenetics, which evaluates the heterogeneous individual response to nutrients due to genetic variation. Fatty acids are one of the nutrients most studied in relation to lactation given their biologically important roles during early postnatal life. Fatty acids modulate transcription factors involved in the regulation of lipid metabolism, which in turn causes a variation in the proportion of lipids in milk. This review focuses on understanding, on the one hand, the gene transcription mechanisms activated by maternal dietary fatty acids and, on the other hand, the interaction between dietary fatty acids and genetic variation in genes involved in lipid metabolism. Both of these mechanisms affect the fatty acid composition of human milk.

Comparação entre suplementos homólogos do leite humano e um suplemento comercial para recém-nascidos de muito baixo peso / Comparison between homologous human milk supplements and a commercial supplement for very low birth weight infants

J Pediatr; 88(2): 119-124, mar.-abr. 2012. ilus
Artigo em Português | LILACS | ID: lil-623456


OBJETIVOS: Descrever a metodologia de preparo de dois aditivos, líquido e em pó, derivados do leite humano e comparar a constituição com aditivo comercial FM85®. MÉTODOS: Foram utilizadas 40 amostras de leite humano para o preparo dos suplementos líquido e em pó. Ambos passaram por três fases de preparo: desnate, evaporação e retirada da lactose. Após essas fases, o suplemento líquido está pronto, e o em pó necessita da quarta fase - a liofilização. Em cada amostra dos suplementos líquido e em pó, foram adicionados, respectivamente, 80 mL (grupo I) e 100 mL (grupo II) de pool de leite humano de banco. Para comparação, 20 amostras de 100 mL do pool foram acrescidas de 5 g do suplemento FM85® (Nestlé) (grupo III). Realizaram-se análises de hidratos de carbono, proteína, lipídios, cálcio, fósforo, sódio, osmolalidade e conteúdo calórico, considerando diferença significativa p < 0,05. RESULTADOS: Os grupos I, II e III mostraram, respectivamente, os seguintes resultados: proteínas = 1,81, 2,38 e 1,96 g/dL (p < 0,001); hidratos de carbono = 6,70, 7,25 e 10,06 g/dL (p = 0,006); gordura = 3,75, 3,75 e 3,73 g/dL (p = 0,96); cálcio = 36,92, 44,75 e 79,37 mg/dL (p = 0,001); fósforo = 20,02, 23,28 e 56,30 mg/dL (p = 0,02); sódio = 14,32, 14,40 e 20,33 mEq/L (p = 0,143); osmolalidade = 391,45, 412,47 e 431, 00 mOsmol/kgH2O (p = 0,074); e conteúdo calórico = 67,78, 72,27 e 81,65 kcal (p = 0,001). CONCLUSÃO: Os aditivos estudados diferem significativamente do aditivo comercial FM85® em alguns de seus constituintes, e a sua constituição pode ou não atender às quantidades de nutrientes propostas pelas recomendações mais recentes.
OBJECTIVES: To describe the methodology for the preparation of two additives derived from human milk, liquid and powdered, and to compare this composition with the commercial additive FM85®. METHODS: For the preparation of the liquid and powdered supplements, 40 samples of human milk were used. Both supplements have been through three preparation phases: skimming, evaporation and lactose removal. After these phases, the liquid supplement is ready, and the powdered requires a fourth phase - lyophilization. To each sample of the liquid and powdered supplements were added, respectively, 80 mL (group I) and 100 mL (group II) of pooled banked human milk. For comparison, 20 samples of 100 mL of the pool were added to 5 g of the FM85® supplement (Nestlé) (group III). Analyses of carbohydrates, protein, lipids, calcium, phosphorus, sodium, osmolality and caloric content were performed, considering a significant difference p < 0.05. RESULTS: Groups I, II, and III showed, respectively, the following results: protein = 1.81, 2.38 and 1.96 g/dL (p < 0.001); carbohydrates = 6.70, 7.25 and 10.06 g/dL (p = 0.006); fat = 3.75, 3.75 and 3.73 g/dL (p = 0.96); calcium = 36.92, 44.75 and 79.37 mg/dL (p = 0.001); phosphorus = 20.02, 23.28 and 56.30 mg/dL (p = 0.02); sodium = 14.32, 14.40 and 20.33 mEq/L (p = 0.143); osmolality = 391.45, 412.47 and 431.00 mOsmol/kgH2O (p = 0.074); and caloric content = 67.78, 72.27 and 81.65 kcal (p = 0.001). CONCLUSION: The studied additives differ significantly from the commercial additive FM85® in some of its components, and its composition may or may not meet the quantity of nutrients suggested by the most recent recommendations.
Biblioteca responsável: BR1.1

Integration of Health Information Systems Using HL7: A Case Study.

Stud Health Technol Inform; 234: 188-194, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28186039


Interoperability is a prerequisite for health information systems (HIS) that will reduce waste of unnecessary costs, errors, delays, and futile repetition. Many previous studies had proposed different approaches in the attempt to solve interoperability challenges. In this paper, we report our experiences in using Health Level 7 (HL7) standard and adopting the Common Gateway Model for exchanging heath data. The benefits and challenges of using standards for data interoperability are also described.

Evaluación de los bancos de leche humana de Paraná-BR: un estudio comparativo / Avaliação de bancos de leite humano no Paraná - BR: um estudo comparativo / Evaluation of Human Milk Banks in Paraná - BR: a comparative study

Artigo em Inglês, Espanhol, Português | LILACS | ID: lil-639353


Human milk banks (HMB) are designed to provide quality natural food to newborns. Objectives: To evaluate and compare the structure and processes of eight HMB RDC-171/2006 based on the of Paraná and the Manual of Operation of HMB of ANVISA. Method: Survey of normative and comparative assessment, in which was applied the benchmarking techniques of and systematic observation and questionnaire to eight coordinators of HMB in 2009. Results: There are better practices in different HMB, as well as deficiencies relating to personnel, training, physical structure, documentation, records, availability of standard operating procedures (SOP). Discussion: There is a need to hire employees, according to legal requirements, documentation updated and available; managerial and technical training, provision of essential physical and material resources, development and delivery of SOP and supervision. Conclusion: In general, HMB present structural and that require managerial deficiencies and investment of the management, having as reference the current regulations and best practices identified.
Bancos de leche humana (BLH) buscan ofrecer alimento natural de calidad a los recién-nacidos. Objetivos: Evaluar y comparar la estructura y procesos de ocho BLH paranaenses con base en la RDC-171/2006 y en el Manual de Funcionamiento de BLH de la ANVISA. Método: Pesquisa de evaluación normativa y comparativa, donde se aplicó el benchmarking y las técnicas de observación sistemática y un cuestionario a ocho coordinadores de BLH en 2009. Resultado: Hay mejores prácticas en diferentes BLH, así como deficiencias relativas a personal, capacitación, estructura física, documentación, registros, disponibilidad de procedimientos operacionales patrón (POP). Discusión: Hay necesidad de contratar funcionarios, de acuerdo a las exigencias legales; documentación actualizada y disponible, entrenamiento gerencial técnico; suministro de recursos materiales y físicos esenciales; elaboración y disponibilidad de POP y supervisión. Conclusión: En general, los BLH presentan deficiencias estructurales y gerenciales que requieren inversión de la gestión, teniendo como referencia las normativas vigentes y las mejores prácticas identificadas.
Bancos de leite humano (BLH) visam oferecer alimento natural de qualidade a recém-nascidos. Objetivos: avaliar e comparar a estrutura e processos de oito BLH paranaenses com base na RDC-171/2006 e no Manual de Funcionamento de BLH da ANVISA. Método: Pesquisa de avaliação normativa e comparativa, em que se aplicou o benchmarking e as técnicas de observação sistemática e questionário a oito coordenadores de BLH em 2009. Resultado: Há melhores práticas em diferentes BLH, bem como deficiências relativas a pessoal, capacitação, estrutura física, documentação, registros, disponibilidade de procedimentos operacionais padrão (POP). Discussão: Há necessidade de contratação de funcionários, consoante às exigências legais; documentação atualizada e disponível; treinamento gerencial e técnico; provisão de recursos materiais e físicos essenciais; elaboração e disponibilização de POP e supervisão. Conclusão: Em geral, os BLH apresentam deficiências estruturais e gerenciais que requerem investimento da gestão, tendo como referência as normativas vigentes e as melhores práticas identificadas.
Biblioteca responsável: BR1342.1

Breastfeeding in mothers with systemic lupus erythematosus.

Lupus; 25(9): 973-9, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26888577


INTRODUCTION: Breastfeeding is known to improve the well-being of a mother and her infant, and about half of all new mothers breastfeed, but it is unknown how breastfeeding is pursued in systemic lupus erythematosus (SLE; lupus) patients. We sought to determine the rate of breastfeeding and the factors influencing this among women with lupus. In addition, we reassessed the current safety data in lactation of lupus medications. METHODS: Data were collected from lupus patients enrolled in a prospective registry who fulfilled the 2012 SLICC criteria, had a live birth, and for whom postpartum breastfeeding status was known. Data included physician assessments of lupus activity and medications, breastfeeding intentions during pregnancy and practice following pregnancy. The safety of medications in breastfed infants was assessed through a comprehensive review of LactMed, a national database about medications in lactation. RESULTS: A total of 51 pregnancies in 84 women with lupus were included in the study. Half of the lupus patients (n = 25, 49%) chose to breastfeed. The rate of breastfeeding was not significantly affected by socioeconomic factors. In contrast, low postpartum lupus activity, term delivery, and a plan to breastfeed early in pregnancy were significantly associated with breastfeeding in lupus patients. In reviewing the most up-to-date data, the majority of lupus medications appear to have very minimal transfer into breast milk and are likely compatible with breastfeeding. CONCLUSION: Half of women with lupus breastfed and most desire to breastfeed. Hydroxychloroquine, azathioprine, methotrexate, and prednisone have very limited transfer into breast milk and may be continued while breastfeeding.

Variability of Criteria for Pasteurized Donor Human Milk Use: A Survey of U.S. Neonatal Intensive Care Unit Medical Directors.

JPEN J Parenter Enteral Nutr; 40(3): 326-33, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25267184


BACKGROUND: Use of donor human milk (DHM) is increasing, but criteria for its use are not well defined. MATERIALS AND METHODS: We conducted a 34-question Internet-based survey of medical directors of U.S. level 3 and level 4 neonatal intensive care units (NICUs), with the goal of describing specifics of policies developed to guide DHM use in U.S. NICUs. Respondents reported NICU characteristics and details of policies concerning DHM use. Policy-specified criteria for DHM use, if any, were described. Bivariate and multivariate analyses were used to identify NICU characteristics associated with DHM use. RESULTS: Respondents returned 153 (33%) surveys, with use of DHM reported by 91 (59%). Donor human milk use was more likely with more than 100 annual admissions <1500 g at birth (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1-4.7) and with Vermont-Oxford Network participants (OR, 4.6; 95% CI, 1.8-11.6). Among 72 NICUs reporting a written policy, criteria for providing DHM required birth weights varying from <1000 to <1800 g and/or gestational ages from <28 to <34 completed weeks, but criteria were reportedly waived in many circumstances. Policies regarding duration of DHM therapy were similarly varied. CONCLUSIONS: Criteria for initiating and continuing DHM vary widely among U.S. level 3 and level 4 NICUs. Donor human milk use is more frequent in NICUs with many very low-birth-weight admissions and among Vermont-Oxford Network participants. Further research is needed to define short- and long-term outcomes and cost benefits of DHM use in subgroups of NICU patients, particularly for uses other than necrotizing enterocolitis prevention.
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