Distribuição de leite humano ordenhado / Distribución de la leche humana extraída / Expressed human milk distribution

Esta Norma Técnica tem por objetivo estabelecer os critérios a serem observados na distribuição do leite humano ordenhado, visando a garantia da qualidade em Bancos de Leite Humano e sua certificação.

Esta Norma Técnica tiene por objetivo establecer los criterios que deben observarse en la distribución de leche humana extraída para garantizar la calidad de los Bancos de Leche Humana y su certificación.

Controle de temperatura de caixas isotérmicas / Temperature control of isothermal boxes

Esta Norma Técnica tem por objetivo estabelecer as orientações necessárias para o controle de temperatura das caixas isotérmicas utilizadas no transporte do leite humano ordenhado, visando a garantia da qualidade em Bancos de Leite Humano e Postos de Coleta de Leite Humano e sua certificação.

rBLH enfrentando a Covid-19

Destaque no site da Rede Global de Bancos de Leite Humano, com o propósito de ampliar o intercâmbio de saberes e práticas assistenciais em aleitamento materno e banco de leite humano no âmbito do Sistema Único de Saúde do Brasil, frente à atual emergência epidemiológica decorrente do Coronavírus.

Medo do coronavírus provoca queda na doação de leite materno

Com a situação de pandemia de coronavírus, a coleta domiciliar de leite materno sofreu uma queda de 35%. A situação é preocupante, pois muitos recém-nascidos internados na rede pública de saúde precisam desse alimento para sobreviver.

[Prevention, diagnosis and treatment of necrotising enterocolitis in newborns less than 32 weeks at birth in Spain]. / Prevención, diagnóstico y tratamiento de la enterocolitis necrosante en recién nacidos menores de 32 semanas al nacimiento en España.

OBJECTIVES: To describe preventive, diagnostic and therapeutic strategies regarding necrotising enterocolitis in Spain and to identify the strengths, areas of further improvement, and future research lines. METHODS: Two questionnaires on the management of preterm infants less than 32 weeks, at risk of, or with diagnosed necrotising enterocolitis, were distributed among selected representatives of the surgeons and neonatologists of the Spanish Neonatal Network (SEN1500) participant hospitals with a Paediatric Surgery Department. RESULTS: Percentage of response was 77.1% of contacted surgeons and 88.6% of neonatologists. There is a written protocol on the diagnosis and medical management of necrotising enterocolitis in 52% of the hospitals, and as regards surgical treatment in 33%. There is wide access to donor bank milk and to staff dedicated to breastfeeding promotion (87%). On the contrary, only 52% of the centres perform delayed cord clamping, and probiotics are used in just 23%. The use of abdominal ultrasound is increasing. There are no large differences as regards duration of antibiotic use and bowel rest, whereas there was as regards antibiotic selection, surgical indication, and type of intervention. CONCLUSIONS: As regards prevention, delayed cord clamping and extended access to donor milk are two possible aspects of further improvement. The observed discrepancies noted in diagnostic and therapeutic aspects are common in precisely the areas where evidence in the literature is weakest.

Banco de leche humana de Neuquén: evaluación de tecnología sanitaria, análisis de costos y del impacto en la equidad / Human Milk Bank of Neuquén: health technology assessment, cost and equity impact analysis

RESUMEN INTRODUCCIÓN Ante la creación del Banco de Leche Humana (BLH) de Neuquén, que distribuye 480 litros por año a Instituciones sanitarias públicas y privadas, se realizó una evaluación de tecnología sanitaria a fin de comparar la leche humana pasteurizada (LHP) con leche de fórmula en niños prematuros y con bajo peso al nacer. MÉTODOS Se analizó la eficacia, la seguridad, los costos completos y el potencial impacto en la equidad. Un equipo multidisciplinario realizó una búsqueda bibliográfica. El análisis de costos incluyó el equipamiento con amortización, mantenimiento y validación, costos de insumos, gastos en serologías a donantes, servicios generales, recursos humanos, etc. Se estimó el costo total y por mililitro de leche. Se identificaron puntos específicos para monitorear el impacto en la equidad, principalmente relacionados con los determinantes sociales de la salud de donantes y beneficiarios. RESULTADOS Se encontró evidencia heterogénea de calidad moderada a baja, que sugiere que la LHP es una intervención segura y eficaz. Alimentando a 33 niños con leche de fórmula se espera provocar un caso extra de enterocolitis necrotizante (ECN) en esta población. DISCUSIÓN Además de reducir el riesgo de ECN, la estrategia de BLH podría favorecer la concientización sobre la importancia de la lactancia materna en la comunidad, otorgando beneficios a la población general que pueden resultar difíciles de captar en ensayos clínicos y evaluaciones económicas.

ABSTRACT INTRODUCTION Following the creation of the Human Milk Bank (HMB) of Neuquen, which distributes 480 liters per year to public and private health institutions, a health technology assessment was carried out in order to compare pasteurized human milk (PHM) with formula milk in premature and low birth weight children. METHODS Efficacy, safety, total costs and potential impact on equity were analyzed. A multidisciplinary team conducted a literature search. The cost analysis included equipment with depreciation, maintenance and validation, medical supplies, expenses in serology to donors, general services and human resources, among others. The total annual cost and the cost per milliliter were estimated. Specific points were identified to monitor the impact on equity, mainly related to social determinants of health of donors and beneficiaries. RESULTS Heterogeneous evidence of moderate to low quality suggests that PHM is a safe and effective intervention. Feeding 33 children with formula milk is expected to cause one extra case of necrotizing enterocolitis (NEC) in this population. DISCUSSION In addition to reducing the risk of NEC, the PHM strategy could raise awareness about the importance of breastfeeding in the community, giving benefits to the general population that may be difficult to capture in clinical trials and economic evaluations.

The Influence of Donor Milk Supplementation on Duration of Parenteral Nutrition in Preterm Infants.

BACKGROUND: Data are limited on the association between the use of donor human milk and improvements in feeding tolerance. OBJECTIVE: To determine the influence of the duration of parenteral nutrition on the growth and morbidity of the breastfed newborn when using donated human milk in the absence of mother's own milk. METHODS: We conducted a retrospective study before and after the intervention that compared two groups of newborns (N = 284; each group n = 142). We used a convenience sample of all newborns ≤32 weeks gestation consecutively admitted in a single unit before (Group 1 between December 2012 and May 2014) or after (Group 2 between October 2014 and December 2016) the availability of donor human milk. In Group 2, donor human milk was administered at least 3 to 4 weeks or until the baby weighed 1,500 g. Weight was recorded daily and length and head circumference weekly. Parenteral nutrition was continued until enteral feeding volume reached 120 ml/kg/day. Additional variables measured were the number of days with a central venous catheter, age that the enteral feeding volume reached 150 ml/kg/day, and duration of stay. RESULTS: The duration of parenteral feeding was the same before and after: 12 (8.23) and 11 (7.19) days (p = .822). The z scores for weight and height of newborns was lower in Group 2 = -1.8 (1.0) and -2.3 (1.1) and Group 1 = -1.2 (1.1) (p < .001) and -1.8 (1.4) (p = .005). CONCLUSION: We did not find an association between the administration of donor human milk as a supplement to mother's own milk and reduced number of days of parenteral nutrition. Back translation by Laurence Grummer-Strawn.

Milking the System: A Case Study of Donor Milk for a Child in Foster Care.

INTRODUCTION: Use of pasteurized donor milk is recommended in many situations when own mother's milk is not available. One existing knowledge gap is access to donor milk for infants in government custody (foster care). MAIN ISSUE: The focus of this case study is an infant born at 41 weeks who was discharged from the hospital into foster care. The infant soon developed failure to thrive due to formula intolerance. MANAGEMENT: After trying multiple formulas, which included elemental formulas, and hospitalization, the infant began pasteurized donor milk. Within 24 hr, the infant began gaining weight. Medicaid denied two authorization requests for payment, and the state's Department of Human Services ultimately agreed to cover the discounted donor milk fees until the infant reached 1 year of age. CONCLUSION: This foster child suffered through months of failure to thrive and hospitalization before receiving human milk feedings. This care violated ethical principles of beneficence, autonomy, and justice. State officials should review their policies and regulations for providing human milk to children in their care and facilitate access to that milk when needed.

Establishing an integrated human milk banking approach to strengthen newborn care.

The provision of donor human milk can significantly reduce morbidity and mortality among vulnerable infants and is recommended by the World Health Organization as the next best option when a mother's own milk is unavailable. Regulated human milk banks can meet this need, however, scale-up has been hindered by the absence of an appropriate model for resource-limited settings and a lack of policy support for human milk banks and for the operational procedures supporting them. To reduce infant mortality, human milk banking systems need to be scaled up and integrated with other components of newborn care. This article draws on current guidelines and best practices from human milk banks to offer a compilation of universal requirements that provide a foundation for an integrated model of newborn care that is appropriate for low- and high-resource settings alike.