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.     

Case Report of the Management of Milk Blebs

The formation of a milk bleb during breastfeeding is frequently associated with nipple pain that may affect the breastfeeding success of the mother–infant dyad. Early cessation of breastfeeding may occur when pain is ongoing. Timely evaluation and diagnosis and effective management are imperative to prevent tissue damage and lingering symptoms. In this case report, we evaluate the unique challenges of the diagnosis and management of milk blebs, including nonpharmacologic and pharmacologic treatment.     

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.     

Best Practices to Limit Contamination of Donor Milk in a Milk Bank

Human milk donated to a milk bank can become contaminated in a number of ways, but processes exist to eradicate pathogenic bacterial growth. Donor human milk may be cultured before or after pasteurization or both. The purpose of this article is to describe standard operations of the Mothers' Milk Bank of the Children's Hospital of Philadelphia, best practices to limit the bacterial contamination of donor human milk, and implications for future research.     

Improved outcomes of feeding low birth weight infants with predominantly raw human milk versus donor banked milk and formula

Objectives: To investigate the benefits of treating low birth weight infants predominantly with mother’s own raw milk and early initiation of breastfeeding (raw human milk/breast-fed infants), in comparison to feeding only with donor banked milk (until the third week of life) and afterwards a preterm formula until hospital discharge (donor banked/formula-fed infants).

Methods: One hundred and ninety-two predominantly raw human milk-fed infants (70% of raw and 30% of donor milk) were matched to 192 donor/formula-fed ones (on 1:1 ratio). Aggressive nutrition policy and targeted fortification of human milk were implemented in both groups.

Results: The two groups show similar demographic and perinatal characteristics. Predominantly raw milk-fed infants regained earlier their birth weight, suffered less episodes of feeding intolerance and presented a higher body length and head circumference at discharge (p?<?0.001). Those treated mainly with their mothers’ milk were able to initiate breastfeeding almost 2 weeks earlier compared to those fed with donor milk who achieved to be bottle-fed later on post-conceptual age (p?<?0.001). Infants being breastfed until the 8th month of life conducted less visits for a viral infection to a pediatrician compared to those in the other group (p?<?0.001).

Conclusions: Feeding predominantly with mother’s raw milk seems to result in optimal neonatal outcomes.     

The creamatocrit,fat and energy concentration in human milk produced by mothers of preterm and term infants

Objective: The objective of this study was to investigate the composition of breast milk which had been gathered from mothers for over first 2 weeks of lactation and to compare the changes in composition of preterm and term milk. Methods: A prospective, single center study was provided in Warsaw, Poland. The samples of breast milk from 22 mothers who had delivered prematurely and 39 mothers who had given birth to term infants were collected. The creamatocrit, energy and fat concentration were estimated in each participant’s breast milk sample twice a day (morning and night hours). Results: The lowest creamatocrit, calories and fat concentration was indicated in the preterm milk obtained in the morning (4.86%, 663.8 kcal/L and 33.6?g/L, respectively). The highest milk parameters were observed in the night samples of full-term milk and measured (9.6%, 919.7 kcal/L, and 60.7?g/L, respectively). No significant differences in analysed parameters were observed between preterm and full-term milk (p?>?0.05). In summary, creamatocrit, calories and lipid concentration in breast milk shows the daily differences. Colostrum and mature milk from mothers of preterm neonates differed from colostum and mature milk from mothers of term neonates. They had lipid contents, creamatocrit level and calorific value.     

A metabolomic study of preterm and term human and formula milk by proton MRS analysis: preliminary results

Abstract

Objective: To investigate changes in global metabolic profile between: 1 – breast milk and formula milk, 2 – breast milk from mothers delivering at different gestational age (GA) collected within one week from delivery, and then week by week until term equivalent age.

Methods: Proton magnetic resonance spectroscopy (MRS) was used to analyze the water-soluble and lipid fractions extracted from 50 milk samples, 46 human milk at different GA, from 23 weeks of gestation until term equivalent age and four different formula milks.

Results: The formula milk for premature infants was the most similar to breast milk of preterm babies. Breast milk showed higher lactose concentrations than formula milk, that conversely presented higher galactose 1-phosphate and maltose concentrations. Mother’s milk of very preterm babies (23–25?wks of GA) showed a different metabolic profile from preterm infants ≥29?wks of GA with a subsequent trend to similarity around the 30th week of post-natal age. Breast milk from preterm infants of 29–34?wks, collected up to 40?wks of post-natal age showed a temporal change over the first three weeks of lactation, approaching to zero with the achievement of term age.

Conclusions: Metabolome is a promising tool to study human and artificial milk global metabolic profile.     

Experiences of Women Who Donated Human Milk

Objective

To examine the experiences of women who donated breast milk to a hospital-based milk bank regulated under the policies and procedures set forth by the Human Milk Banking Association of North America (HMBANA).

Outcomes Associated With Type of Milk Supplementation Among Late Preterm Infants

Objective

To assess whether type of milk supplementation provided to breastfeeding late preterm infants was associated with hospital length of stay (LOS) or breastfeeding status at discharge.

Abstracts of papers and posters presented at the 29th Annual Conference of the Society for Reproductive and Infant Psychology

(none present)     

Facilitating Milk Donation in the Context of Perinatal Palliative Care

The option to donate milk within the context of perinatal palliative care allows pregnant women to be involved in medical decision making before birth. In this article we examine how a perinatal bereavement program engages women and families in the process of milk donation when the deaths of their newborns are anticipated. We include two case examples to offer insight into the complexities within the patient experience of milk donation after perinatal loss.     

Human milk fatty acids composition is affected by maternal age

Human colostrums and transition milk were collected from women under the age of 37 years and women aged 37 years and older. Transition milk of the younger group had lower fat content and 10-fold higher concentrations of omega 6?FA, eicosadecanoic, and arachdonic acids. Gestational age affected the colostrum concentration of total fat and omega 3 and omega 6?FA composition only in the older group. We concluded that age may be a factor in the FA composition of human milk. This should be taken into account when planning diets for pregnant women of different ages.     

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.