Composition of Microbiota in Transient and Mature Human Milk: Significant Changes in Large for Gestational Age Group.

The composition of the human milk (HM) microbiota and, consequently, the microorganisms that are passed on to the infant through breastfeeding, can be influenced by various factors such as the mother's health and diet, gestational age, delivery mode, lactation stage, method of infant feeding, and geographical location. The aim of the Human Milk-Gest Study was to compare the microbiota of transient (postpartum 7-15 days) and mature HM (postpartum 45-90 days) of 44 mothers, and to investigate any potential changes associated with preterm birth, mode of delivery, and birth weight in relation to gestational age. The data were classified into five study groups: normal spontaneous delivery-term (NS-T) newborns, cesarean delivery-term (CS-T) newborns, preterm (PT) newborns (with a gestational age of less than 37 weeks), small for gestational age (SGA) newborns, and large for gestational age (LGA) newborns. An analysis of differential abundance was conducted using ANCOM-BC to compare the microbial genera between transient and mature HM samples as well as between other study groups. A significant difference was detected between HM samples at different sampling times and between the study groups (p < 0.01). In transient HM samples, Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group compared to the NS-T, CS-T, PT, and SGA groups. In mature HM samples, Burkholderiaceae_uc, Ralstonia, Pelomonas, and Klebsiella were significantly dominant in the LGA group compared to the NS-T, CS-T, and PT groups, while Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group compared to the SGA group. Differences were also detected between the transient and mature HM samples in the CS-T, PT, SGA, and LGA groups, but no differences occurred in the NS-T groups. In conclusion, we showed that Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group in transient HM and continued in mature HM. The body mass index (BMI) of the mothers in the LGA group was not >30 at conception, however, the maternal BMI at birth and maternal weight gain during pregnancy were higher than in the other groups. The nutritional composition of HM is specifically designed to meet infant nutritional requirements during early life. Evaluating the effects of HM microbiota on infant microbiota composition and short- and long-term health effects in larger studies would be useful.

Vegan/vegetarian diet and human milk donation: An EMBA survey across European milk banks.

The nutritional adequacy of human milk (HM) from vegan/vegetarian mothers has been a matter of debate, and a variety of recommendations regarding the eligibility of these mothers as human milk donors exists. According to the latest evidence, HM from vegans/vegetarians is similar in its composition to that from omnivores, however, some differences may be observed regarding vitamin B12 and omega-3 fatty acids concentrations. Maternal supplementation of these compounds has been proven effective in increasing their HM concentration. With this survey, we aimed to explore the practices currently in use in European human milk banks (HMBs) regarding potential donors following vegan/vegetarian diets. The online survey was distributed to European HMBs between January and July 2022. A total of 188 HMBs were contacted, and 118 replied (response rate 63%). Vegan and vegetarian mothers were recommended supplements of vitamin B12 to be accepted as donors in 27% and 26% of HMBs, respectively. Additional omega-3 fatty acid supplementation was required in 8% HMBs. In the remaining HMBs, these mothers were either systematically excluded or included regardless of supplementation. The dosage of the recommended supplements was extremely variable. Fifty-one percent of HMBs were following recommendations to guide their practice, national or local recommendations mainly. Great variability in European HMBs practices towards potential donors following vegan/vegetarian diets exists. Some of these practices can result in loss of donors and/or in potential nutritional deficiencies. Standardised evidence-based recommendations on this issue and their implementation in daily HMB practice are needed.

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.

Oral Ibuprofen Versus Oral Paracetamol in Pain Management During Screening for Retinopathy of Prematurity: A Prospective Observational Study.

Screening examinations for retinopathy of prematurity (ROP) are critical to reduce ROP-related vision loss; however, the procedure is painful and uncomfortable, and topical anesthetics do not completely suppress the pain responses. The number of safe and effective pharmacological options to reduce pain during eye examinations for ROP screening in preterm infants is limited. This study compared the efficacy of oral ibuprofen and oral paracetamol in reducing pain during screening for ROP in preterm infants. This prospective observational study was conducted at a tertiary-care neonatal intensive care unit. Forty-four preterm infants with gestational age of 32 weeks and less undergoing ROP screening were included. Each enrolled infant received either oral ibuprofen 10 mg/kg (n = 22) or oral paracetamol 10 mg/kg (n = 22) 1 hour before eye examination. The primary outcome measure was pain assessed by the Neonatal Pain, Agitation, and Sedation Scale (N-PASS). Secondary outcome measures were tachycardia, bradycardia, desaturations, and crying time. The groups were similar for gestational age, birth weight, and postnatal age at examination (P > .05). The mean N-PASS scores were not significantly different between the oral ibuprofen and oral paracetamol groups (8.64 ± 1.57 vs 8.50 ± 1.71, respectively, P = .605). Moreover, no significant intergroup differences were observed in the crying time and the incidence of tachycardia/bradycardia and desaturation (P > .05). Ibuprofen or paracetamol administered orally before ROP screening in preterm infants had similar analgesic effects and did not significantly alleviate pain during eye examination.

COVID-19 Disease in Presenting to the Pediatric Emergency Department: A Multicenter Study of 8886 Cases.

BACKGROUND: The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population. METHODS: This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded. RESULTS: A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU. CONCLUSION: Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.

Does antenatal corticosteroid therapy improve neonatal outcomes in late preterm birth?

BACKGROUND: Infants who are born at 34°/7 to 366/7 weeks of gestation (late preterm) are at greater risk for respiratory and other neonatal morbidities. The objective of this study was to examine the effects of the administration of antenatal corticosteroids (ACS) to women at risk for late preterm delivery on the incidence of neonatal outcomes. METHOD: This was a prospective cohort study of singleton gestations at risk of imminent delivery between 34°/7 and 366/7 weeks. Neonatal outcomes were compared between mothers who received ACS and those who did not. The primary outcome was the rate of composite respiratory morbidity defined as the need for treatment within 72 h of life (continuous positive airway pressure or high flow nasal cannula for least 2 h or supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least four continuous hours or mechanical ventilation). RESULTS: During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (aOR 0.63 95% CI 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57 95% CI 0.35-0.94), and transient tachypnea of the newborn (aOR 0.48 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery, and duration of hospitalization. CONCLUSION: Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.

Does antenatal corticosteroid therapy improve neonatal outcomes in late preterm birth?

BACKGROUND: Infants who are born at 340/7 to 366/7 weeks of gestation (late preterm) are at greater risk for respiratory and other neonatal morbidities. The objective of this study was to examine the effects of administration of antenatal corticosteroids (ACSs) to women at risk for late preterm delivery on the incidence of neonatal outcomes. METHODS: This was a prospective cohort study of singleton gestations at risk of imminent delivery between 340/7 and 366/7 weeks. Neonatal outcomes were compared between mothers who received ACS and those who did not. Primary outcome was the rate of composite respiratory morbidity defined as the need for treatment within 72 h of life (continuous positive airway pressure or high flow nasal cannula for least 2 h or supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least four continuous hours or mechanical ventilation). RESULTS: During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57, 95% CI 0.35-0.94) and transient tachypnea of newborn (aOR 0.48, 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64, 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery and duration of hospitalization. CONCLUSION: Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.

Antenatal Steroids and Acute Kidney Injury in Preterm Infants.

OBJECTIVE: The aim of this study was to identify the effects of antenatal steroids (ANS) on acute kidney injury (AKI) in very low birth weight (VLBW) preterm infants. STUDY DESIGN: We performed a retrospective cohort study of VLBW infants admitted to a tertiary-care neonatal intensive care unit between January 2016 and June 2019. Infants were divided into no ANS, partial ANS, and complete ANS groups. Serum creatinine (SCr) levels and rates of AKI during the first 2 weeks of life were compared. RESULTS: During the study period, 335 infants met our inclusion criteria. Among no, partial, and complete ANS groups, there were significant differences in rates of stages 2 and 3 AKI (17, 11, and 6%, respectively). Logistic regression analysis revealed that complete ANS course was associated with lower rates of AKI (odds ratio [OR] = 0.41 95% confidence interval [CI]: 0.20-0.83) and stages 2 and 3 AKI (OR = 0.205 95% CI: 0.075-0.563) compared with no ANS. Infants in complete ANS group had significantly lower SCr at 72 hours of life and at discharge, SCr peak was compared with infants in no ANS group. CONCLUSION: In VLBW infants, complete ANS exposure may be associated with improved renal function and decreased risk for AKI compared with no ANS. KEY POINTS: · The effects of antenatal steroid treatment on renal function in preterm infants are not clear.. · A complete course of antenatal steroid decreases the risk for acute kidney injury in preterm infants.. · Infants who are not exposed to antenatal steroids need closer observation of their renal function..

"Donor milk banking: Improving the future". A survey on the operation of the European donor human milk banks.

BACKGROUND: Provision of donor human milk is handled by established human milk banks that implement all required measures to ensure its safety and quality. Detailed human milk banking guidelines on a European level are currently lacking, while the information available on the actual practices followed by the European human milk banks, remains limited. The aim of this study was to collect detailed data on the actual milk banking practices across Europe with particular emphasis on the practices affecting the safety and quality of donor human milk. MATERIALS AND METHODS: A web-based questionnaire was developed by the European Milk Bank Association (EMBA) Survey Group, for distribution to the European human milk banks. The questionnaire included 35 questions covering every step from donor recruitment to provision of donor human milk to each recipient. To assess the variation in practices, all responses were then analyzed for each country individually and for all human milk banks together. RESULTS: A total of 123 human milk banks completed the questionnaire, representing 85% of the European countries that have a milk bank. Both inter- and intra-country variation was documented for most milk banking practices. The highest variability was observed in pasteurization practices, storage and milk screening, both pre- and post-pasteurization. CONCLUSION: We show that there is a wide variability in milk banking practices across Europe, including practices that could further improve the efficacy of donor human milk banking. The findings of this study could serve as a tool for a global discussion on the efficacy and development of additional evidence-based guidelines that could further improve those practices.

Human Milk Virome Analysis: Changing Pattern Regarding Mode of Delivery, Birth Weight, and Lactational Stage.

The human milk (HM) microbiota is a significant source of microbes that colonize the infant gut early in life. The aim of this study was to compare transient and mature HM virome compositions, and also possible changes related to the mode of delivery, gestational age, and weight for gestational age. Overall, in the 81 samples analyzed in this study, reads matching bacteriophages accounted for 79.5% (mainly Podoviridae, Myoviridae, and Siphoviridae) of the reads, far more abundant than those classified as eukaryotic viruses (20.5%, mainly Herpesviridae). In the whole study group of transient human milk, the most abundant families were Podoviridae and Myoviridae. In mature human milk, Podoviridae decreased, and Siphoviridae became the most abundant family. Bacteriophages were predominant in transient HM samples (98.4% in the normal spontaneous vaginal delivery group, 92.1% in the premature group, 89.9% in the C-section group, and 68.3% in the large for gestational age group), except in the small for gestational age group (only ~45% bacteriophages in transient HM samples). Bacteriophages were also predominant in mature HM; however, they were lower in mature HM than in transient HM (71.7% in the normal spontaneous vaginal delivery group, 60.8% in the C-section group, 56% in the premature group, and 80.6% in the large for gestational age group). Bacteriophages still represented 45% of mature HM in the small for gestational age group. In the transient HM of the normal spontaneous vaginal delivery group, the most abundant family was Podoviridae; however, in mature HM, Podoviridae became less prominent than Siphoviridae. Myoviridae was predominant in both transient and mature HM in the premature group (all C-section), and Podoviridae was predominant in transient HM, while Siphoviridae and Herpesviridae were predominant in mature HM. In the small for gestational age group, the most abundant taxa in transient HM were the family Herpesviridae and a species of the genus Roseolovirus. Bacteriophages constituted the major component of the HM virome, and we showed changes regarding the lactation period, preterm birth, delivery mode, and birth weight. Early in life, the HM virome may influence the composition of an infant's gut microbiome, which could have short- and long-term health implications. Further longitudinal mother-newborn pair studies are required to understand the effects of these variations on the composition of the HM and the infant gut virome.

SARS-CoV-2 associated multisystem inflammatory syndrome in children (MIS-C). A single center's experience.

BACKGROUND: SARS-CoV-2 related multisystem inflammatory syndrome in children (MIS-C) is a newly defined clinical entity in pediatric ages resembles Kawasaki Disease or toxic shock syndrome. Here we aimed to raise awareness about this SARS-CoV-2 related syndrome. METHODS: Children diagnosed with MIS-C and followed in Pediatric Clinic between November 2020 and January 2021, were included in study. Data about patients' demographic characteristics, clinical and laboratory findings, treatment and outcomes were collected from medical records. RESULTS: The median age of 20 children with MIS-C was 80.5 months, 11 of them were male. The most common symptoms at admission were fever (100%), abdominal pain (70%), myalgia (50%), and rash (50%). Lymphopenia, elevated inflammatory markers and cardiac enzymes were their main laboratory findings. Cardiac involvement (90%) consisted of myopericarditis, valvulitis, left ventricular dysfunction, and coronary arteritis. Symptoms mimicking acute appendicitis and ileus were due to gastrointestinal involvement (50%). Macular rash on the trunk, erythema on upper eyelids were striking. Empiric antibiotics and intravenous immunoglobulin were used in all patients, glucocorticoids (90%), anti-thrombotic (65%) and vasoactive (45%) agents were used according to severity of disease. Response to IVIG treatment was poor, whereas glucocorticoids have dramatic affect. Seven patients (35%) were monitored in intensive care unit, none of them required intubation, mechanic ventilation or ECMO. The median recovery time, that is, the period when fever subside and inflammatory markers returned to normal was 9.5 days. CONCLUSIONS: Glucocorticoids has critical role in treatment of MIS-C, early recognition and treatment may decrease need for intensive care by providing rapid recovery.

Colonización e infección por un microorganismo poco frecuente en una unidad de cuidados intensivos neonatales: tres recién nacidos prematuros con Elizabethkingia meningoseptica / Colonization and infection with a rare microorganism in a neonatal intensive care unit: three preterm infants with Elizabethkingia meningoseptica

Elizabethkingia meningoseptica es un bacilo gramnegativo ampliamente distribuido en la naturaleza pero poco frecuente en humanos que se presenta en infecciones intrahospitalarias. Los avances en las instalaciones de cuidados intensivos neonatales y el uso de dispositivos médicos sofisticados fortalecen la capacidad infecciosa invasiva del microorganismo. Las manifestaciones clínicas suelen incluir bacteriemia primaria, meningitis, neumonía intrahospitalaria, bacteriemia relacionada con el uso de catéteres intravasculares e infecciones gastrointestinales y de las vías biliares. Es posible que, en entornos con recursos limitados, la falta de sistemas de diagnóstico mejorados sea una de las causas por las que no se notifican todas esas infecciones. Resulta bastante difícil distinguir entre colonización e infección, y el patrón de sensibilidad a los antibióticos es diferente. Por consiguiente, los médicos deben realizar el diagnóstico preciso para así evitar el tratamiento incorrecto. En este artículo, describimos tres casos de recién nacidos con diagnóstico de infección y colonización por E. meningoseptica con el objetivo de destacar la importancia del diagnóstico y el tratamiento oportunos de esta bacteria poco frecuente pero letal que ya está presente en las unidades de cuidados intensivos

Elizabethkingia meningoseptica is a widespread gram-negative bacillus in the environment, but a arely reported human pathogen presenting mostly as nosocomial infections. Advances in neonatal intensive care facilities and usage of sophisticated medical devices strengthen the invasive infectious potential of the microorganism. Clinical manifestations usually include primary bacteremia, meningitis, nosocomial pneumoniae, intravascular catheter-related bacteremia and gastrointestinal and biliary tract infections. Lack of improved diagnostic systems in resource constrained settings, might be a cause of underreporting of such infections. Discrimination between colonization and infection is quite difficult, and it has an unusual antibiotic susceptibility pattern. Therefore clinicians should pay special attention to accurate diagnosis in order to prevent mistreatment. Here we report three newborn cases with the diagnosis of E. meningoseptica infection and colopnization, with the aim of drawing attention to the diagnosis and management of this rare but lethal bacteria that is already present in the intensive care unit environment

Colonization and infection with a rare microorganism in a neonatal intensive care unit: three preterm infants with Elizabethkingia meningoseptica. / Colonización e infección por un microorganismo poco frecuente en una unidad de cuidados intensivos neonatales: tres recién nacidos prematuros con Elizabethkingia meningoseptica.

Elizabethkingia meningoseptica is a widespread gram-negative bacillus in the environment, but a rarely reported human pathogen presenting mostly as nosocomial infections. Advances in neonatal intensive care facilities and usage of sophisticated medical devices strengthen the invasive infectious potential of the microorganism. Clinical manifestations usually include primary bacteremia, meningitis, nosocomial pneumoniae, intravascular catheter-related bacteremia and gastrointestinal and biliary tract infections. Lack of improved diagnostic systems in resource constrained settings, might be a cause of underreporting of such infections. Discrimination between colonization and infection is quite difficult, and it has an unusual antibiotic susceptibility pattern. Therefore clinicians should pay special attention to accurate diagnosis in order to prevent mistreatment. Here we report three newborn cases with the diagnosis of E. meningoseptica infection and colopnization, with the aim of drawing attention to the diagnosis and management of this rare but lethal bacteria that is already present in the intensive care unit environment.

Elizabethkingia meningoseptica es un bacilo gramnegativo ampliamente distribuido en la naturaleza pero poco frecuente en humanos que se presenta en infecciones intrahospitalarias. Los avances en las instalaciones de cuidados intensivos neonatales y el uso de dispositivos médicos sofisticados fortalecen la capacidad infecciosa invasiva del microorganismo. Las manifestaciones clínicas suelen incluir bacteriemia primaria, meningitis, neumonía intrahospitalaria, bacteriemia relacionada con el uso de catéteres intravasculares e infecciones gastrointestinales y de las vías biliares. Es posible que, en entornos con recursos limitados, la falta de sistemas de diagnóstico mejorados sea una de las causas por las que no se notifican todas esas infecciones. Resulta bastante difícil distinguir entre colonización e infección, y el patrón de sensibilidad a los antibióticos es diferente. Por consiguiente, los médicos deben realizar el diagnóstico preciso para así evitar el tratamiento incorrecto. En este artículo, describimos tres casos de recién nacidos con diagnóstico de infección y colonización por E. meningoseptica con el objetivo de destacar la importancia del diagnóstico y el tratamiento oportunos de esta bacteria poco frecuente pero letal que ya está presente en las unidades de cuidados intensivos.

Prevalencia de microorganismos patógenos respiratorios durante dos temporadas consecutivas de virus sincicial respiratorio en un centro de atención de alta complejidad / Prevalence of respiratory pathogens during two consecutive respiratory syncytial virus seasons at a tertiary medical care center

Objetivo. Determinar el perfil etiológico de la infección de vías respiratorias bajas (IVRB) en los neonatos durante la temporada de virus sincicial respiratorio (VSR) y definir las características de esta y otras infecciones. Métodos. Estudio retrospectivo con neonatos hospitalizados por IVRB durante dos temporadas de VSR, con reacción múltiple en cadena de la polimerasa en tiempo real. Se revisaron los datos relevantes y se compararon las características de la infección por VSR con las de otros microorganismos. Resultados. Entre 224 pacientes, 160 (71 %) fueron positivos para, al menos, un agente causal potencial. Entre ellos, el 65 % tenía VSR y el 15 %, más de un agente (coinfección). En el grupo con VSR, hubo más dificultad respiratoria (p < 0,01), radiografías de tórax anormales (p < 0,01), requerimiento de atención en terapia intensiva (p < 0,01) y más días de oxigenoterapia (p < 0,01). No obstante, hubo menos casos de fiebre al ingreso y menos días de antibioticoterapia (en ambos, p < 0,01), y la duración de la hospitalización no fue más prolongada. Los pacientes con coinfección requirieron atención en terapia intensiva en mayor medida que los demás (25 % contra 6,5 %, p < 0,01). Conclusión. Este estudio demostró que el VSR fue más frecuente en los neonatos hospitalizados por IVRB durante la temporada y condujo a una evolución más grave que otros microorganismos patógenos detectados. Posiblemente la gravedad de la infección por VSR se viera aumentada por la presencia de una coinfección y radiografía de tórax anormal.

Aim: To determine the etiological profiles of lower respiratory tract infection (LRI) in neonates during respiratory syncytial virus(RSV) season, and to define the clinical features of RSV-related infection and others. Methods: The retrospective study included newborn infants who were hospitalized for LRI during the two consecutive RSV seasons, and then tested for possible etiological agent by multiplex real-time polymerase chain reaction. All relevant data were reviewed, and the clinical characteristics of RSV-related infection were compared to those of others. Results: Of 224 patients, 160 (71 %) were positive for at least one potentially causative agent. Of them, 65 % had RSV, and 15 % had more than on ecausative agent (co-infection). The RSV group had more the findings of respiratory distress (p< 0.01), abnormal chest radiography (p< 0.01), need for intensive care (p< 0.01), and duration of oxygen requirement (p< 0.01) but less fever on admission and duration of antibiotic use (for both, p< 0.01), and no longer hospital stay. Need of intensive care nursery was more common in patients with co-infection than others (25 % vs. 6.5 %, p< 0.01). Conclusion: This study highlighted that RSV was the most frequent agent in neonates hospitalized for LRI during the season, with a more severe clinical course than other detected pathogens. The disease severity of RSV infection may have seemed to be increased by the presence of coinfection and abnormal chest radiography.

Prevalence of respiratory pathogens during two consecutive respiratory syncytial virus seasons at a tertiary medical care center. / Prevalencia de microorganismos patógenos respiratorios durante dos temporadas consecutivas de virus sincicial respiratorio en un centro de atención de alta complejidad.

AIM: To determine the etiological profiles of lower respiratory tract infection (LRI) in neonates during respiratory syncytial virus(RSV) season, and to define the clinical features of RSV-related infection and others. METHODS: The retrospective study included newborn infants who were hospitalized for LRI during the two consecutive RSV seasons, and then tested for possible etiological agent by multiplex real-time polymerase chain reaction. All relevant data were reviewed, and the clinical characteristics of RSV-related infection were compared to those of others. RESULTS: Of 224 patients, 160 (71 %) were positive for at least one potentially causative agent. Of them, 65 % had RSV, and 15 % had more than on ecausative agent (co-infection). The RSV group had more the findings of respiratory distress (p< 0.01), abnormal chest radiography (p< 0.01), need for intensive care (p< 0.01), and duration of oxygen requirement (p< 0.01) but less fever on admission and duration of antibiotic use (for both, p< 0.01), and no longer hospital stay. Need of intensive care nursery was more common in patients with co-infection than others (25 % vs. 6.5 %, p< 0.01). CONCLUSIONS: This study highlighted that RSV was the most frequent agent in neonates hospitalized for LRI during the season, with a more severe clinical course than other detected pathogens. The disease severity of RSV infection may have seemed to be increased by the presence of coinfection and abnormal chest radiography.

Objetivo. Determinar el perfil etiológico de la infección de vías respiratorias bajas (IVRB) en los neonatos durante la temporada de virus sincicial respiratorio (VSR) y definir las características de esta y otras infecciones. Métodos. Estudio retrospectivo con neonatos hospitalizados por IVRB durante dos temporadas de VSR, con reacción múltiple en cadena de la polimerasa en tiempo real. Se revisaron los datos relevantes y se compararon las características de la infección por VSR con las de otros microorganismos. Resultados. Entre 224 pacientes, 160 (71 %) fueron positivos para, al menos, un agente causal potencial. Entre ellos, el 65 % tenía VSR y el 15 %, más de un agente (coinfección). En el grupo con VSR, hubo más dificultad respiratoria (p < 0,01), radiografías de tórax anormales (p < 0,01), requerimiento de atención en terapia intensiva (p < 0,01) y más días de oxigenoterapia (p < 0,01). No obstante, hubo menos casos de fiebre al ingreso y menos días de antibioticoterapia (en ambos, p < 0,01), y la duración de la hospitalización no fue más prolongada. Los pacientes con coinfección requirieron atención en terapia intensiva en mayor medida que los demás (25 % contra 6,5 %, p < 0,01). Conclusión. Este estudio demostró que el VSR fue más frecuente en los neonatos hospitalizados por IVRB durante la temporada y condujo a una evolución más grave que otros microorganismos patógenos detectados. Posiblemente la gravedad de la infección por VSR se viera aumentada por la presencia de una coinfección y radiografía de tórax anormal.

Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification.

Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that "Standard Fortification," which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of "Individualized Fortification" to optimize nutrient intake. "Adjustable Fortification" and "Targeted Fortification" are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.

Letter to the editor: clarifying some aspects and the terminology of individualized human milk fortification.

This letter has been written by the components of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification in response to a recent paper published by Mathes et al. (BMC Pediatr. 2018 May 8;18(1):154) with the aim of drawing attention to the importance of the use of a metabolic marker to adapt protein intake in preterm infants. EMBA Working Group on Human Milk Fortification clarifies further the terminology and some specific aspects regarding individualized human milk fortification. There are two types of individualized human milk fortification: Adjustable human milk fortification and Targeted human milk fortification. Advantages and disadvantages of these methods are summarized.