Recommendations for the establishment and operation of a donor human milk bank.

In Europe, an increasing number of human milk banks (HMBs) collect donor human milk to feed preterm infants when their mother's milk is not available or not enough. Moreover, donor milk is a bridge to breastfeeding, with positive clinical and psychological advantages for both mother and infant. Italy, with 41 HMBs actively operating in 2022, has the highest number of HMBs in Europe. The process of human milk donation is complex, so activity of HMBs must be regulated according to well-established rules. The present recommendations have been prepared as a tool to standardize the organization, management, and procedures of HMBs operating in Italy and to determine the minimal essential requirements to establish new HMBs. This article covers all the aspects of human milk donation and human milk banking, including general recommendations, donor recruitment and screening, expression, handling and storage of donor human milk, milk screening, and milk treatment (pasteurization). A pragmatic approach was taken to drafting the recommendations. Items for which there was consensus or robust published evidence on which to base recommendations were included. When there were differences that could not be resolved by reference to published research, a statement of explanation based on the expert opinion of the authors (all members of the Italian Association of Human Milk Banks) was included. Implementation of these recommendations can contribute to promotion of breastfeeding.

Eating disorders and psychopathological traits in obese preadolescents and adolescents.

OBJECTIVE: to investigate the presence of eating disorders (ED) and psychopathological traits in obese preadolescents and adolescents compared to normal-weight peers. DESIGN: Overweight/obese patients aged 11 to 14 y and normal-weight peers' data collected by means of self-report questionnaires administered to parents and children. SETTING: Clinical Nutrition Units in the Municipalities of Rome, Naples, Gallipoli and Atri, Italy. SUBJECTS: 376 preadolescents and adolescents. Patients were 187 (93 boys, BMI=27.9±;4.1; 94 girls, BMI=28.1±4.5); normal-weight controls were 189 subjects (94 boys, BMI=19.4±1.4; 95 girls, BMI=19.5±1.5). MEASURES OF OUTCOME: eating disorder behaviors, psychopathological traits and symptoms estimated by means of the eating disorders scales (EDI-2) and psychopathological scales (CBCL 4-18). RESULTS: Patients reached higher scores than controls in most of the eating disorders scales and psychopathological scales. Twenty-one (11.2%) patients were considered at risk of developing an eating disorder and 75 (40%) presented social problems. With regard to weight status, age-group and gender, main significant interaction effects were seen in social problems (F= 6.50; p<0.05) and ineffectiveness (F= 4.15; p<0.05). CONCLUSIONS: Findings from our study demonstrate that in preadolescence and adolescence, obesity is significantly associated to some traits typical of ED and to psychological problems in general. Although no inference can be made with regard to direction of causality, it is possible to conclude that overweight preadolescents and adolescents can be prone to display problematic traits more commonly associated to eating disorders and to present a high degree of mental distress.

Focus on prevention, diagnosis and treatment of hypertension in children and adolescents.

The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem. This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children's gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child's age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention of high blood pressure is based on correct lifestyle and nutrition, starting from childhood age. The treatment of primary hypertension in children is almost exclusively dietary/behavioral and includes: a) reduction of overweight whenever present b) reduction of dietary sodium intake c) increase in physical activity. Pharmacological therapy will be needed rarely and only in specific cases.

Malnutrition and dysfunctional mother-child feeding interactions: clinical assessment and research implications.

OBJECTIVES: To evaluate the effects of age and the presence of feeding pathologies on the relational modes during meals in a sample of mother-child pairs (n = 333), comparing groups of children in the first three years of life with normal development (ND-group, n = 211) and clinical groups of children who presented a diagnosis of feeding disorder and failure to thrive (FD-group, n = 122), and to show an association between specific symptomatic characteristics of the mother, of the child and the dysfunctional modes of their relationship during meals in a subgroup of mother-child pairs (n = 50), selected at random from the total clinical sample and paired with a control group chosen for this study. METHODS: All mother-child pairs in the sample were observed in twenty-minute video-recordings during a meal, using the procedure of the Feeding Scale in the Italian version. A subgroup of mothers, selected at random from the total clinical sample, and paired with a control group, were given two self-reporting instruments for the evaluation of their psychological symptom status: the Eating Attitude Test and the Symptom Checklist-90-Revised, as well as two instruments for the evaluation of the infant temperament and emotional/behavioral functioning: the Baby and Toddler Behavior Questionnaires (from 1 to 18 months) and the Child Behavior Checklist 1-1/2--5 (from 18 to 36 months). RESULTS: Analysis of variance showed that the FD-group present interactional dysfunctional patterns during feeding and raise higher scores in symptomatic characteristics both of the mother and of the child, compared to ND-group. A set of correlation analyses (Pearson coefficients) showed an association among specific symptomatic characteristics of the mothers (dysfunctional eating attitudes, anxiety, depression, hostility), of their children (in particular, anxiety/depression, somatic complaints and aggressive behavior) and of their dysfunctional relational modes during feeding (p < 0.05). CONCLUSIONS: Our study confirms that analysis of the individual characteristics of the child, of the mother and of their relationship during the development of feeding patterns in the first three years of the child's life is extremely important in the clinical assessment of early feeding disorders, in order to establish a valid diagnostic methodology and formulate strategies for targeted and effective intervention. Furthermore, the results emphasize the clinical utility of our research in early identification of infants and toddlers at risk for feeding problems.

Nutrient intake of Italian women during lactation.

OBJECTIVES: Very few data have been published concerning the actual energy and nutrient intakes of lactating women; in particular there have been no reports concerning Italian women. We report our findings on the energy and macronutrient intakes of a group of exclusively breast-feeding Italian women. Differences between the actual intakes and Italian Recommended Dietary Allowances are also discussed. SUBJECTS: Healthy lactating women aged 27-36 years were recruited in the three major geographical areas of Italy (North, Central, and South) METHODS: Dietary evaluation was based on two consecutive 24-hour recalls from each mother (dietary data, n = 125). Energy and nutrient intakes were estimated using a nutritional database. Statistical analysis was performed using parametric and non-parametric tests. RESULTS: Mean energy intakes for the whole country are below recommended values, while the protein intake, and the percentages of energy from fat and saturated fatty acids are higher than the recommended values. The amount of polyunsaturated fats is within the recommended intake. The percentage of energy from carbohydrates and the amount of fiber are lower than the recommended Italian levels. CONCLUSION: The results obtained in this sample of lactating women seem to point to a low energy intake associated with a moderate imbalance in the distribution of energy percentages from macronutrients.