Amendment to 2010 Italian guidelines for the establishment and operation of a donor human milk bank.

The present paper is an amendment to the recent Italian Guidelines of human milk banking published in 2010. Working Group on Guidelines (Panel) of the Italian Association of Human Milk Banks (AIBLUD) states, in accordance with the European Union Comission's Amending Directive of January 2011, that the hard plastic feeding bottles used in the collection, storage and pasteurization of the human milk should be Bisphenol A (BPA) free. Until new evidence are available polycarbonate feeding bottles should not be used for collection, storage and pasteurization of human milk. The paper summarizes the former and current European Commission Directives and shows the related amending changes to the 2010 Italian Human Milk Banking Guidelines.

Early enteral feeding with human milk for VLBW infants.

In a NICU early enteral feeding is usually possible only when the newborn clinical conditions permit it. Because of the frequent need of umbilical/central catheters, they usually start with parenteral feeding and/or with minimal enteral feeding (trophic feeding). This kind of management is even more frequent in VLBWIs, in which the risk of NEC is very high. In this work we describe a model of early enteral exclusive feeding (EEEF) based on the use of banking human milk followed by mother milk. In the Centre of Neonatology of Trento, as in other Centers, the newborns weighing less than 750g or with a GE< 27 weeks, are treated with parenteral nutrition and minimal enteral feeding. The newborn weighing 750-1249g and with GE > 26 weeks define a group in which we find critical neonates, who can not be treated with enteral feeding, and neonates whose clinical conditions permit EEEF. In particular, in a period of 16 years (1994-2009) in Trento, 308 newborns weighing 750-1249 g and GE > than 26 weeks were admitted. The 90,9 % has been treated with prenatal steroids, the 91,9 % was inborn, the 96,1% survived. In the 59,1 % of the cases (175) we gave EEEF. We could continue with a complete EEEF in the 40,2 % of the total (119 cases). The characteristics of these neonates and our centre management, based mainly on early use of banking human milk and mother milk, are detailed described.

Enteral feeding: how, when, how much?

In a NICU early enteral feeding is usually possible only when the newborn clinical conditions permit it. Because of the frequent need of umbilical/central catheters, they usually start with parenteral feeding and/or with minimal enteral feeding (trophic feeding). This kind of management is even more frequent in VLBWIs, in which the risk of NEC is very high. In this work we describe a model of early enteral exclusive feeding (EEEF) based on the use of banking human milk followed by mother In the Centre of Neonatology of Trento, as in other milk. Centers, the newborns weighing less than 750 g or with a GE <27 weeks, are treated with parenteral nutrition and minimal enteral feeding. The newborn weighing 750-1249g and with GE >26 weeks define a group in which we find critical neonates, who can not be treated with enteral feeding, and neonates whose clinical conditions permit EEEF. In particular, in a period of 16 years (1994-2009) in Trento, 308 newborns weighing 750-1249 g and GE >26 weeks were admitted. The 90.9% has been treated with prenatal steroids, the 91.9% was inborn, the 96.1% survived. In the 59.1% of the cases (175) we gave EEEF. We could continue with a complete EEEF in the 40.2% of the total (119 cases). The characteristics of these neonates and our centre management, based mainly on early use of banking human milk and mother milk, are detailed described.

[Handicaps due to perinatal causes in Trento newborn infants (1979-1988)]. / L'handicap da cause perinatali nel neonato trentino (anni 1979-1988).

A survey on perinatal handicaps must follow some standards: a) homogeneous population; b) univoc method of evaluation; c) 7 years follow-up; d) case control study. From ethnic and geographical point of view, Trentino is in a favorable condition; all pathologic cases come in the only 3th Level Center (Trento), and all neurological evaluations were made from the same specialist up to primary school. Now case control survey is starting. In district of Trento neonates without congenital malformations have risk for severe residual handicaps of 0.08%; under 1500 g the risk is 6.5% while in the group 1500-2499 the risk is 0.53%. A better prevention program during pregnancy and in Intensive Care Unity may reduce the severe outcome in the 1500-2499 group of neonates.

[A case of rupture of the stomach in a premature twin infant]. / Un caso di rottura dello stomaco in gemello prematuro.

The authors review the predisposing and causing factors of gastric rupture in neonatal age. The importance of early diagnosis and immediate surgical treatment is stressed. A case is reported.