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Acta Paediatr ; 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31799756


AIM: To assess, at national level, the implementation of eight principles for infant- and family-centred developmental care (IFCDC) in neonatal units. A European expert group established eight 'Principles of care' in 2018 that define neurodevelopmental and family-centred care. METHODS: The implementation of each principle was assessed by a survey sent to level-III Spanish units. A principle was considered to be implemented if all answers to the principle-associated questions were positive. RESULTS: The response rate was 84.5% (65/77). No unit had implemented eight principles. Principle 1 (free parental access) was implemented in 21.5% of the centres; Principle 2 (psychological support) 40%; Principle 3 (pain management) 7.7%; Principle 4 (environmental influences) 29%; Principle 5 (postural support) 84.6%; Principle 6 (kangaroo-care) 67.7%; Principle 7 (breastfeeding) 23% and Principle 8 (sleep protection) in 46%. In units attending ≥50 very low birth weight (VLBW) infants, four or more principles had been implemented in 31% vs 13% <50 VLBW neonates (odds ratio 3.0 CI 95% 0.9-10.1, P .07). CONCLUSION: The principle with the highest implementation was related to newborn body positioning. Pain management was the principle with lowest implementation. More principles for IFCDC tend to be implemented in units providing care for a higher number of VLBW infants.

Breastfeed Med ; 11(2): 91-3, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26800010


OBJECTIVE: Although under certain circumstances it is necessary to express milk, there are not many recommendations about the ideal storage conditions for human milk. The objectives of this study were to analyze the effects on Dornic acidity of frozen storage at -20 °C in three types of milk: raw donor milk, mother's own raw milk, and pasteurized donor milk. METHODS: Forty-three samples of raw donor milk, 40 samples of pasteurized donor milk, and 16 samples of mother's own milk were analyzed. Dornic acidity was measured at time 0, before freezing. The remaining aliquots were frozen and analyzed after 1, 2, 3, and 4 weeks and after 2 and 3 months. RESULTS: In raw donor milk, the median acidity at the start was 3 °D (interquartile range [IQR] 2-3 °D); after 3 months, it was 5 °D (IQR 3-7 °D), with a significant increase in acidity after the second week. In mother's own milk, the mean acidity at the start was 3 °D (IQR 2-4 °D) and 7 °D (IQR 4-8 °D) at 3 months. The increase was significant after the third week. In pasteurized donor milk, the mean acidity was 3 °D (IQR 2-3 °D) at the start and 2 °D (IQR 2-3 °D) at the end. When comparing the three types of milk, there were significant differences from the first week between the two types of raw milk and the pasteurized milk (p < 0.01), but not between the two raw milks (p = 0.77). CONCLUSIONS: Dornic acidity in unpasteurized milk significantly increases with the duration of freezing, probably due to the action of lipases, which is lost with pasteurization. It would be advisable to reduce the length of freezing time for unpasteurized milk.

Bactérias Aeróbias/crescimento & desenvolvimento , Congelamento , Ácido Láctico/metabolismo , Leite Humano/química , Pasteurização , Contagem de Colônia Microbiana , Feminino , Conservação de Alimentos , Humanos , Bancos de Leite , Proteínas do Leite/metabolismo , Leite Humano/microbiologia , Mães , Fatores de Tempo
J Hum Lact ; 32(4): NP73-NP75, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26116636


BACKGROUND: There is no uniformity among milk banks on milk acceptance criteria. The acidity obtained by the Dornic titration technique is a widely used quality control in donor milk. However, there are no comparative data with other acidity-measuring techniques, such as the pH meter. OBJECTIVE: The objective of this study was to assess the correlation between the Dornic technique and the pH measure to determine the pH cutoff corresponding to the Dornic degree limit value used as a reference for donor milk quality control. METHODS: Fifty-two human milk samples were obtained from 48 donors. Acidity was measured using the Dornic method and pH meter in triplicate. Statistical data analysis to estimate significant correlations between variables was carried out. The Dornic acidity value that led to rejecting donor milk was ≥ 8 Dornic degrees (°D). RESULTS: In the evaluated sample size, Dornic acidity measure and pH values showed a statistically significant negative correlation (τ = -0.780; P = .000). A pH value of 6.57 corresponds to 8°D and of 7.12 to 4°D. CONCLUSION: Donor milk with a pH over 6.57 may be accepted for subsequent processing in the milk bank. Moreover, the pH measurement seems to be more useful due to certain advantages over the Dornic method, such as objectivity, accuracy, standardization, the lack of chemical reagents required, and the fact that it does not destroy the milk sample.

Equilíbrio Ácido-Base , Bancos de Leite/normas , Leite Humano/química , Aleitamento Materno/estatística & dados numéricos , Aleitamento Materno/tendências , Humanos
J Hum Lact ; 30(4): 436-41, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25122692


BACKGROUND: Substantial fat loss may occur during continuous feeding of human milk (HM). A decrease of fat loss has been described following homogenization. Well-established methods of homogenization of HM for routine use in the neonatal intensive care unit (NICU) would be desirable. OBJECTIVE: We compared the loss of fat based on the use of 3 different methods for homogenizing thawed HM during continuous feeding. METHODS: Sixteen frozen donor HM samples were thawed, homogenized with ultrasound and separated into 3 aliquots ("baseline agitation," "hourly agitation," and "ultrasound"), and then frozen for 48 hours. Aliquots were thawed again and a baseline agitation was applied. Subsequently, aliquots baseline agitation and hourly agitation were drawn into a syringe, while ultrasound was applied to aliquot ultrasound before it was drawn into a syringe. The syringes were loaded into a pump (2 mL/h; 4 hours). At hourly intervals the hourly agitation infusion was stopped, the syringe was disconnected and gently shaken. During infusion, samples from the 3 groups were collected hourly for analysis of fat and caloric content. RESULTS: The 3 groups of homogenization showed similar fat content at the beginning of the infusion. For fat, mean (SD) hourly changes of -0.03 (0.01), -0.09 (0.01), and -0.09 (0.01) g/dL were observed for the hourly agitation, baseline agitation, and ultrasound groups, respectively. The decrease was smaller for the hourly agitation group (P < .001). CONCLUSION: When thawed HM is continuously infused, a smaller fat loss is observed when syringes are agitated hourly versus when ultrasound or a baseline homogenization is used.

Nutrição Enteral/métodos , Lipídeos/análise , Leite Humano/química , Feminino , Congelamento , Humanos , Recém-Nascido , Bombas de Infusão
Breastfeed Med ; 8(1): 99-104, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23373435


BACKGROUND: Dornic acidity may be an indirect measurement of milk's bacteria content and its quality. There are no uniform criteria among different human milk banks on milk acceptance criteria. The main aim of this study is to report the correlation between Dornic acidity and bacterial growth in donor milk in order to validate the Dornic acidity value as an adequate method to select milk prior to its pasteurization. MATERIALS AND METHODS: From 105 pools, 4-mL samples of human milk were collected. Dornic acidity measurement and culture in blood and McConkey's agar cultures were performed. Based on Dornic acidity degrees, we classified milk into three quality categories: top quality (acidity <4°D), intermediate (acidity between 4°D and 7°D), and milk unsuitable to be consumed (acidity ≥ 8°D). Spearman's correlation coefficient was used to perform statistical analysis. RESULTS: Seventy percent of the samples had Dornic acidity under 4°D, and 88% had a value under 8°D. A weak positive correlation was observed between the bacterial growth in milk and Dornic acidity. The overall discrimination performance of Dornic acidity was higher for predicting growth of Gram-negative organisms. In milk with Dornic acidity of ≥ 4°D, such a measurement has a sensitivity of 100% for detecting all the samples with bacterial growth with Gram-negative bacteria of over 10(5) colony-forming units/mL. CONCLUSIONS: The correlation between Dornic acidity and bacterial growth in donor milk is weak but positive. The measurement of Dornic acidity could be considered as a simple and economical method to select milk to pasteurize in a human milk bank based in quality and safety criteria.

Ácido Láctico/análise , Bancos de Leite , Leite Humano/microbiologia , Doadores de Tecidos , Bactérias Aeróbias/crescimento & desenvolvimento , Contagem de Colônia Microbiana , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Bancos de Leite/estatística & dados numéricos , Leite Humano/química , Pasteurização/métodos , Gravidez
Int Breastfeed J ; 5: 4, 2010 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-20211005


BACKGROUND: Donor human milk banks are much more than simple centers for collection, storage, processing, and distribution of donor human milk, as they cover other aspects and represent a real opportunity to promote and support breastfeeding. The aim of our study is to assess the impact that opening a human milk bank has had on the proportion of infants receiving exclusive breast milk at discharge and other aspects related to feeding children with birth weight < or = 1500 g or < 32 weeks gestation admitted to the neonatal unit. METHODS: The study included babies of < or = 1500 g or < 32 weeks gestation. Fifty infants born from February to July in 2006, before the opening of the human milk bank, and 54 born from February to July in 2008, after its opening, met inclusive criteria. We collected data about days of hospital stay, hours of life when feeding was started, hours of life when full enteral feeding was attained, the type of milk received during admission, and the type of feeding on discharge. RESULTS: Children born in 2008 commenced feeding 16 hours earlier than those born in 2006 (p = 0.00). The proportion of infants receiving exclusive breast milk at discharge was 54% in 2006 and 56% in 2008 (p = 0.87). The number of days they received their mother's own milk during the first 28 days of life was 24.2 days in 2006, compared to 23.7 days in 2008 (p = 0.70). In 2006, 60% of infants received infant formula at least once in the first 28 days of life, compared to 37% in 2008 (p = 0.01). CONCLUSIONS: The opening of a donor human milk bank in a neonatal unit did not reduce the proportion of infants exclusively fed with breast milk at discharge, but did reduce the proportion of infants that received infant formula during the first four weeks of life. Also, having donor human milk available enables commencement of enteral feeding earlier.