[Effect of adding fortifiers and protein supplements on the osmolality of donated maternal milk]. / Efecto de la adición de fortificantes y de módulo de proteínas en la osmolalidad de la leche materna donada.

INTRODUCTION AND OBJECTIVES: The fortification of maternal milk (MM) is a standard practice in order to achieve the requirements needed for the growth and development of the premature newborn. However, its osmolality could increase. According to the American Paediatrics Academy, it is recommended not to exceed 450 mOsm/kg (approximately 400 mOsm/L) in the diet of the infant, even though the safety limit is estimated to be between 400 and 600 mOsm/kg. The aim of this study is to determine the osmolality of thawed and fortified donated MM (DMM). METHOD: An analysis was performed on DMM of 6 healthy mothers, without fortifying, and with 4 levels of fortification. Measurement of the samples was carried out in triplicate at 0, 4, 9, and 24hours after their preparation. They were stored refrigerated (2-8°C) between measurements. The study groups were: (A) Non-fortified DMM; (B) DMM with vitamins added; (C) with the addition of a fortifier; (D) with the addition of a low-dose protein formula; and (E) with the addition of a high-dose protein formula. The osmolality determinations were carried out using a freezing-point osmometer. The data analysis was performed using R software (v.3.5.1). RESULTS: A total of 30 samples were analysed with 360 measurements. The osmolality of the DMM at t=0h was 301 mOsm/kg (SD 5.2) and slightly increased with time to 308.11 mOsm/kg (SD 5.21) after 24hours (t=24h), being maintained within the safety limits. The addition of vitamins (Group B) did not significantly increase the osmolality. The addition of a fortifier (C) and a low dose (D) or high dose (E) protein formula produced an increase in the baseline osmolality that increased statistically significantly in time (P=.007), but with no differences between the C, D, and E types. There were differences between the osmolality at t=0 with the fortification according to the manufacturer's data sheet (339 mOsm/l) and the findings in our laboratory (432.33 mOsm/l). CONCLUSION: The osmolality values found in the thawed DMM samples were similar to those of other studies. The fortification of the DMM samples and their storage refrigerated at 2-8°C for 24h increased the osmolality, but keeping them within the safety limits.

What is the impact of mother's bed incline on episodes of decreased oxygen saturation in healthy newborns in skin-to-skin contact after delivery: Study protocol for a randomized controlled trial.

BACKGROUND: Early mother-child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn's prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns' breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother's bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. METHODS: The study participants will be full-term healthy mother-newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother's bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO2 ≤ 90%. Secondary outcomes are the mean SO2 level, the number of newborns who experience episodes of SO2 ≤ 85%, the time to SSC discontinuation due to abnormal SO2 or HR, and episodes of HR < 111 beats per minute (bpm) or > 180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. DISCUSSION: A simple intervention such as modifying mother's bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn's hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02585492 . Registered on 22nd October 2015. PROTOCOL VERSION: 2 (30th June 2015).

Unidad de Valoración del Riesgo de Muerte Súbita Familiar: Experiencia en la comunidad valenciana / Family Sudden Death Risk-Assessment Unit: Experience at the Valencian Community

La muerte súbita se define como el fallecimiento inesperado que acontece antes de una hora desde el inicio de los síntomas, este tipo de muerte tiene un alto impacto social, mediático y económico. La primera causa es la de origen cardíaco y dentro de estas la cardiopatía isquémica es la más frecuente, pero las cardiopatías familiares (canalopatías y miocardiopatías) son porcentualmente más importantes en niños y jóvenes, donde representan la primera causa de muerte súbita cardíaca. Estas cardiopatías familiares tienen un claro sustrato genético que justifica la indicación de un adecuado estudio de los familiares de los fallecidos. De acuerdo a los datos de la población española del censo de 2013 (46,7 millones de habitantes) en la comunidad valenciana, que representa el 10% de esta población, se estima que residen 20000 personas con alguna cardiopatía familiar potencialmente letal. Dada la importancia y el impacto social de la muerte súbita de origen cardíaco, y puesto que la autopsia médico-legal tiene limitaciones para diagnosticar la enfermedad subyacente en este tipo de muertes, la estrategia más oportuna es el enfoque multidisciplinar, motivo por el cual en el año 2008 se creó la Unidad de Muerte Súbita Familiar y Cardiopatías Familiares en esta región

The sudden death is defined as the unexpected death that occurs within an hour of the onset of symptoms. This type of death has a high social, media and economic impact. The first cause is of cardiac origin, and within this, the ischemic heart disease is the most frequent, but family heart diseases (channelopathies and cardiomyopathies) are more important in children and young people, where they represent the first cause of sudden cardiac death. These family heart diseases have a clear genetic substrate that justifies the indication of an adequate study of the relatives of the deceased. According to the data of the Spanish population of the 2013 census (46.7 million inhabitants) in the Valencian Community, which represents 10% of this population, it is estimated that there are 20.000 people with some potentially lethal heart disease. Given the importance and the social impact of sudden death of cardiac origin, and since the medical-legal autopsy has limitations to diagnose the underlying disease in these types of deaths, the most opportune strategy is the multidisciplinary approach, which is why in 2008, the Family Sudden Death and Family Heart Diseases Unit was created in this region