Umbilical cord care: a pilot study comparing topical human milk, povidone-iodine, and dry care

OBJECTIVE: To compare the incidence of omphalitis among three groups, each using a different type of newborn cord care: povidone-iodine, dry care, and topical human milk. DESIGN: Case control. SETTING: A large urban university hospital in Turkey and participant homes after discharge. PARTICIPANTS: 150 healthy, full-term newborns and their mothers. INTERVENTIONS: Umbilical cord care consisted of one of three methods: topical application of povidone-iodine twice daily, topical application of mother's milk twice daily, or dry care (keeping the cord dry and clean). MAIN OUTCOME MEASURE: Outcome was measured in terms of the presence or absence of omphalitis and the number of days elapsed before cord separation. An ongoing questionnaire was administered by telephone every other day after the participants left the hospital. In addition to demographic information, the cord separation day and any signs of omphalitis were recorded in the questionnaire. RESULTS: There were no significant differences between the three groups in terms of omphalitis occurrence. Two cases of omphalitis were observed (one in the human milk group, one in the povidone-iodine group). Interestingly, babies in the dry care or topical human milk group had shorter cord separation times than those in the povidone-iodine group. CONCLUSION: The cultural practice of applying human milk to the umbilical cord stump appears to have no adverse effects and is associated with shorter cord separation times than are seen with the use of antiseptics.     

Does fortification of pasteurized donor human milk increase the incidence of necrotizing enterocolitis among preterm neonates? A randomized controlled trial

Objective: To compare the effect of fortified pasteurized donor human milk (PDHM) versus unfortified PDHM on the incidence of necrotizing enterocolitis (NEC) and immediate outcome among preterm neonates.

Methods: This randomized controlled trial (RCT) conducted in a tertiary care teaching hospital, south India included 80 healthy preterm neonates randomized to two groups (Group A and B). Neonates in Group A and B were fed with fortified PDHM and unfortified PDHM, respectively. Neonates in both groups were managed uniformly as per standard NICU protocol. The primary outcome was the incidence of NEC and the secondary outcomes included severity of NEC, incidence of sepsis, mortality, duration of hospital stay, number of days to reach full enteral feeds and weight gain. Neonates were followed up for 28 days or discharge whichever was earlier.

Results: The baseline maternal and neonatal characteristics in both groups were comparable. There was no increase in incidence of NEC in fortified PDHM group compared to unfortified PDHM group (2.5 versus 7.5%, p?=?.31). Severity of NEC, incidence of sepsis, mortality, duration of hospital stay, number of days to reach full enteral feeds and weight gain were also similar in both groups.

Conclusions: Standard fortification of PDHM does not increase the incidence of NEC among preterm neonates.     

A new formula for premature infants: effects on growth and nutritional status

Objective: Nutritional management influences immediate survival as well as subsequent growth and development of low birth weight and very low birth weight infants. Preterm infant formula (PTF) is used when there is an inadequate supply of mother’s milk or when the mother is unable to breastfeed and donor breast milk is unavailable. The purpose of this prospective multicenter study was to evaluate short-term effects on nutritional status (auxological and biochemical parameters) in a population of premature infants who received a preterm infant formula.

Methods: Ninety-seven preterm infants with a birth weight between 500?g and 2000?g and a gestational age of 25–34 weeks postmenstrual age were randomly assigned to received a new preterm infant formula (Nutribèn Pre), and their nutritional status were compared to 75 fortified human milk (FHM) fed infants.

Results: No significant differences were observed between FHM and Nutribèn Pre fed infants in terms of growth, feeding tolerance and biochemical profiles.

Conclusion: Nutribèn Pre is a valid, effective and safe alternative for the nutrition of preterm infants.     

Solely human milk diets for preterm infants

Human milk provides not only ideal nutrition for infant development but also immunologic factors to protect from infection and inflammation. For the newborn preterm infant, the natural delivery of milk is not attainable, and instead pumped maternal milk, donor human milk, and human milk fortification are mainstays of clinical care. Current research demonstrates a decreased risk of necrotizing enterocolitis with maternal milk and donor human milk when individually compared to formula and with a complete human milk diet of maternal milk supplemented with donor human milk. The incidence of severe retinopathy of prematurity is decreased with an exclusive human milk diet, and this decrease is more pronounced with human milk-based compared to bovine milk-based human milk fortifier. The incidence of other morbidities such as late-onset sepsis and bronchopulmonary dysplasia is decreased with higher dose of human milk though significant differences are not apparent in exclusive human milk diet studies.     

Human milk banking in the volunteer sector: policy development and actuality in 1970s Australia

Objective

to describe the development of rigorous milk banking policies in the voluntary sector in Australia, 1975–1979, by the non-government organisation, the Nursing Mothers' Association of Australia (now the Australian Breastfeeding Association), and the eventual abandonment of milk banking by the organisation.

Design

historical article.

Setting

Australia in the years 1975–1979.

Conclusions

during the period in which the policy development described here took place, conducting a milk bank to the rigorous standards set by the organisation required too heavy an investment of hours by unpaid volunteer coordinators to be sustainable.

Implications for practice

in establishing and continuing a successful milk bank, models which depend less on volunteer hours may be more sustainable.     

人乳低聚糖与婴幼儿肠道健康研究进展

母乳中的低聚糖通过调节肠道内微生物菌群构成、抵御致病菌群对肠黏膜上皮细胞入侵及调控机体免疫反应等生理作用,维持婴幼儿肠道健康,并且对于一些肠道功能紊乱的疾病,如坏死性小肠结肠炎、腹泻等,也可有效预防及治疗.本文主要阐述近年来国内外有关人乳低聚糖与婴幼儿肠道健康方面的研究进展,进一步探讨人乳低聚糖与婴幼儿肠道健康的相关性...     

Human milk is the feeding strategy to prevent necrotizing enterocolitis!

Human milk is the preferred diet for preterm infants as it protects against a multitude of NICU challenges, specifically necrotizing enterocolitis. Infants who receive greater than 50% of mother’s own milk (MOM) in the 2 weeks after birth have a significantly decreased risk of NEC. An additional factor in the recent declining rates of NEC is the increased utilization of donor human milk (DHM). This creates a bridge until MOM is readily available, thus decreasing the exposure to cow milk protein. Preterm infants are susceptible to NEC due to the immaturity of their gastrointestinal and immune systems. An exclusive human milk diet compensates for these immature systems in many ways such as lowering gastric pH, enhancing intestinal motility, decreasing epithelial permeability, and altering the composition of bacterial flora. Ideally, preterm infants should be fed human milk and avoid bovine protein. A diet consisting of human milk-based human milk fortifier is one way to provide the additional nutritional supplements necessary for adequate growth while receiving the protective benefits of a human milk diet.     

Role of lycopene in preventing lipid peroxidation products,in commercial infant milk formula

Objectives: The aim of the study was to investigate whether lycopene from natural sources (tomato extract) is able to protect newborns milk formula, against oxidative damage caused by exposure to hydroxyl radicals, and is there a difference between milk substitutes from various sources.

Methods: Four commercial brands of infant milk formula: two of the formulas were dairy milk (A-d and B-d) and two were based on soy bean vegan milk (A-s and B-s), were exposed to ionizing radiation radical (·OH). Lipid peroxidation was determined by measuring malondialdehyde (MDA) using thiobarbituric acid reactive substance test (TBARS).

Results: When suspensions containing the four brands of formula were subjected to oxidizing media produced by ionizing radiation (hydroxyl radicals), lipid peroxidation increased linearly as a function of the irradiation dose (R?=?0.99). It was found that lycopene in a concentration of 0.6?mM, reduced the radiation damage only in the soy-based formula; decrease of ～40% of the damage achieved in B-s, and ～20% reduction in the damage caused to A-s, significantly p?<?0.01.

Conclusions: Lycopene in dairy milk did not protect against hydroxyl radicals; however, lycopene found to protect against hydroxyl radicals in soy milk. This result suggests different mechanisms of radical production that arises from high iron levels present in the soy milk and involving the high-valent iron peroxo species.