Comparison of two methods for cleaning breast pump milk collection kits in human milk banks.

BACKGROUND: Appropriate decontamination of breast pump milk collection kits (BPKs) is critical to obtain safe milk for infants and to avoid discarding donor human milk (DHM). AIM: To evaluate two strategies for BPK decontamination by assessing microbial cultures and the proportion of discarded DHM, according to the criteria of the National Institute for Health and Care Excellence for pre-pasteurization cultures. METHODS: Prospective comparative study, allocation ratio 1:1, microbiologist-blind. PARTICIPANTS: 47 new donors in a human milk bank in Madrid. INTERVENTIONS: Study group (N=21): BPKs washed with water and detergent after each use and further steam decontamination within a microwavable bag. Control group (N=26): washing, rinsing and drying only. Five samples: first sample by hand expression and four samples (one per week) collected using the same pump and method. OUTCOMES: Primary: proportion of DHM discarded due to contamination. Secondary: comparison of the microbiota between samples obtained by hand expression and breast pump in both groups. FINDINGS: In total, 217 milk samples were collected: 47 by hand expression and 170 by pump expression (78 from study group). Steam decontamination of BPKs using a microwavable bag after washing resulted in a lower proportion of discarded DHM samples (1.3% vs 18.5%, P<0.001) and samples contaminated with Enterobacteriaceae (1.3% vs 22.8%, P<0.001) and Candida spp. (1.3% vs 14.1%, P<0.05) compared with samples collected with BPKs that were washed but not steam decontaminated. There were no differences in bacterial contamination between samples obtained using steam decontaminated BPKs and those obtained by hand expression. CONCLUSIONS: Steam decontamination of BPKs using a microwavable bag after washing decreases the amount of discarded DHM and the number of samples with potentially pathogenic bacteria.

[Effect of freezing on the "creamatocrit" measurement of the lipid content of human donor milk]. / Medida por crematocrito del contenido calórico de la leche materna donada congelada.

OBJECTIVE: To determine, by the creamatocrit measurement, the effect on the fat content of raw and pasteurized donor milk of freezing during 3 months at -20 °C. METHODS: The evolution of the creamatocrit measurement (following Lucas technique) on frozen (-20 °C), raw and pasteurized human milk, was analyzed during 3 months. RESULTS: The fat content of raw milk (n=44) was 3.19 g/dl at the beginning and 2.86 g/dl after 3 months frozen (p=0.02). In pasteurized milk (n=36) fat content at the first determination was 2.59 g/dl and 2.20 g/dl after 1 month frozen (p=0.01). Afterwards there were no significant changes up to 3 months frozen. Variability was observed in the intermediate values. CONCLUSIONS: A reduction on the fat content measurement of raw and pasteurized donor human milk after freezing was observed. Freezing does not inactivate the milk lipase but does destroy the fat globule. Creamatocrit measurement may not be the best method to determine the fat content of processed human milk.

[Incidence of unplanned extubations in a neonatal intensive care unit. A before and after study]. / Frecuencia de extubaciones no programadas en una unidad de cuidados intensivos neonatales. Estudio antes y después.

INTRODUCTION: Unplanned extubations (UE) of mechanically ventilated newborns involves an undesirable increase in morbidity and mortality. OBJECTIVE: A 2-stage study compared the frequency of UE in a Neonatal Intensive Care Unit before and after the implementation of a program of preventive measures to decrease UE. PATIENTS AND METHODS: A before and after prospective study included all mechanically ventilated newborns participating in the 2 stage study from May-December 2011 and June-December 2012. In stage 1, the rate of UE per 100 intubated patient days was calculated and the characteristics of unplanned extubated newborns, circumstances of UE occurrence and need for re-intubation were studied. Consequently, a program of preventive measures for UE was designed and implemented, with the same variables being analysed in stage 2. RESULTS: No differences were found in patient characteristics during the two stages. Stage 1, incidence of UE was 5/100 intubated patient days; Stage 2, 4.5 UE/100 intubated patient days (P=.657). In both stages, most UE occurred during patient handling with re-intubation incidence at 77.4% and 67.7%, respectively. The combined rate of both stages during summer months of July, August and September was 6.2 UE/100 intubation days, in contrast with the remaining months of both stages: UE incidence rate, 3.4 UE/100 intubation days (p=.043). CONCLUSIONS: The implementation of a preventive measures program did not significantly reduce the incidence of UE. The summer period showed the highest incidence of UE.

Validez del cuestionario de consumo materno de alcohol para detectar la exposición prenatal / Validity of a maternal alcohol consumption questionnaire in detecting prenatal exposure

Introducción: El consumo de alcohol en mujeres embarazadas puede producir graves efectos adversos en el feto y el recién nacido principalmente a nivel de desarrollo neurológico y pondoestatural, englobados en el término FASD (acrónimo en inglés de trastorno del espectro alcohol fetal). El método de cribado más utilizado para detectar la exposición prenatal es el cuestionario, pero un estudio poblacional previo ha cuestionado la fiabilidad del método. El objetivo de este estudio es comparar la detección de la exposición prenatal al alcohol mediante el cuestionario de consumo y la presencia de biomarcadores en meconio. Metodología: Se estudiaron 62 muestras de meconio de recién nacidos cuyas madres negaron el consumo de alcohol durante el embarazo en el cuestionario realizado. Se llevó a cabo una determinación objetiva de la exposición del feto a alcohol utilizando el meconio del recién nacido como matriz biológica y los FAEE (fatty acid ethyl esters) como biomarcadores de exposición. Resultados: En el meconio de 10 de los 62 recién nacidos de mujeres que negaron el consumo de alcohol durante el embarazo en el cuestionario (16,12%), se obtuvieron valores totales de los FAEE analizados positivos (iguales o superiores a 2 nmol/g).Discusión: Los cuestionarios realizados como método de cribado para descartar la exposición a etanol durante el embarazo no deben considerarse una herramienta eficiente. Es necesaria la determinación de biomarcadores en matrices biológicas alternativas de la madre o del recién nacido. La detección precoz de la exposición prenatal permitirá a estos pacientes beneficiarse de un seguimiento y tratamiento con el que alcanzarán el mejor desarrollo neurológico posible(AU)

Introduction: Ethanol consumption by pregnant women can produce severe effects in the foetus and the newborn, mainly in neurological and weight-height development, and are included in the term FASD (Fetal Alcohol Spectrum Disorder). Questionnaires are the most used screening method to detect prenatal exposure, but a previous population study questioned its reliability. The objective of this study was to compare alcohol prenatal exposure detection by questionnaire compared with biomarkers in meconium. Methodology: Sixty two meconium samples from mothers who denied alcohol consumption during pregnancy by questionnaire were analysed. The objective analysis was made by determination of FAEEs (fatty acid ethyl esters) as exposure biomarkers in meconium as biological matrix. Results: In the meconium from 10 of 62 newborns from non-alcohol consuming mothers by questionnaire (16.12%) FAEE values were positive (minor=2 nmol/g). Discussion: Questionnaires as a screening method during pregnancy are not a reliable tool. It is necessary to identify prenatal exposure to alcohol as soon as possible by biomarkers analysis in biological matrices from the newborn or the mother. The early detection will allow these patients to benefit from follow up and treatment to reach the best possible neurological development(AU)

[Validity of a maternal alcohol consumption questionnaire in detecting prenatal exposure]. / Validez del cuestionario de consumo materno de alcohol para detectar la exposición prenatal.

INTRODUCTION: Ethanol consumption by pregnant women can produce severe effects in the foetus and the newborn, mainly in neurological and weight-height development, and are included in the term FASD (Fetal Alcohol Spectrum Disorder). Questionnaires are the most used screening method to detect prenatal exposure, but a previous population study questioned its reliability. The objective of this study was to compare alcohol prenatal exposure detection by questionnaire compared with biomarkers in meconium. METHODOLOGY: Sixty two meconium samples from mothers who denied alcohol consumption during pregnancy by questionnaire were analysed. The objective analysis was made by determination of FAEEs (fatty acid ethyl esters) as exposure biomarkers in meconium as biological matrix. RESULTS: In the meconium from 10 of 62 newborns from non-alcohol consuming mothers by questionnaire (16.12%) FAEE values were positive (≥ 2 nmol/g). DISCUSSION: Questionnaires as a screening method during pregnancy are not a reliable tool. It is necessary to identify prenatal exposure to alcohol as soon as possible by biomarkers analysis in biological matrices from the newborn or the mother. The early detection will allow these patients to benefit from follow up and treatment to reach the best possible neurological development.

Tratamiento preventivo para la migraña en niños: cuándo y cómo / Preventive therapy in migraine disorders: when and how

Conclusiones de los autores: aunque se han estudiado diversos fármacos en la profilaxis de la migraña en niños, la mayoría de los ensayos clínicos son de tamaño muestral pequeño y no están metodológicamente bien diseñados. Hay más datos de flunarizina y propranolol aunque la evidencia clínica no es consistente. Sobre el topiramato se concluye que su eficacia debe ser confirmada en más estudios bien diseñados. Comentario de los revisores: topiramato y flunarizina muestran una evidencia clínica aceptable en la reducción de la frecuencia de migraña y su intensidad en niños. La evidencia relativa a propranolol es controvertida, por lo que se reservaría como fármaco de segunda elección. Los tres fármacos son seguros. Para establecer una evidencia sólida sería prioritaria la realización de ensayos clínicos de gran tamaño y bien diseñados con los tres fármacos citados (AU)

Authors’ conclusion: despite the fact that several drugs to prevent migraines have been studied in children, most trials have small size and poor design. Flunarizine and propranolol are the best studied drugs although the clinical evidence is not consistent enough. In relation to topiramate, its effectiveness has to be confirmed in more adequately designed studies. Reviewers’ commentary: topiramate and flunarizine show acceptable evidence reducing frequency and intensity of migraines in children. Propranolol has controversial evidence, so it is advisable to keep it for second choice. All three drugs are safe. There is an urgent need to perform well designed and large trials to establish solid evidence with topiramate, flunarizine and propranolol (AU)