Search

To investigate the association between the ganglion cell complex (GCC) thickness at early school-age and prematurity and other neonatal factors.Cross-sectional study. The sample included very preterm children with gestational age (GA) below 32 weeks or birthweight below 1500 g enrolled in a follow-up program (n = 101) and a comparison group of term-born children (n = 49). Ganglion cell complex (GCC) thickness was measured at 4-8 years using high-quality optical coherence tomography (OCT) images. Data on neonatal and postnatal features were extracted from clinical records; analyses included mixed linear models.Ganglion cell layer (GCL) and retinal nerve fiber layer (mRNFL) were thicker in term than in preterm born children (2.9 μm and 2.4 μm respectively, p 0.001). Within the preterm group, lower GA was associated with a decrease in total GCL (0.7 μm per week, p 0.001). Being small for GA was associated with further thinning in both layers (1.4 and 2.8 µm). Postnatal corticosteroids therapy and severe brain lesion were associated with thinning in the total GCL of 6 µm (p 0.001) and 4.1 µm (p = 0.002), respectively, and shock was associated with thinning in total mRNFL of 6 µm (p 0.001).Lower GA or birthweight are associated with thinning of GCC layers. When performing an OCT examination at school-age and a decrease in GCC thickness is observed, it may be relevant to ask about a history of prematurity, and further enquire about neonatal shock, postnatal corticosteroids therapy or severe brain lesion that are related to additional decrease in GCC thickness.

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%

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.

Resumen: Introducción: Los beneficios de la leche donada frente a la fórmula artificial están demostrados, sin embargo no se conoce la influencia de la apertura de un banco de leche en la práctica clínica habitual. El objetivo de este estudio fue medir el impacto en la práctica clínica de la disponibilidad de leche donada para la nutrición de los prematuros ≤ 32 semanas de edad gestacional. Métodos: Estudio antes-después de la apertura de un banco de leche. Se incluyeron los ≤ 32 semanas nacidos en el Hospital 12 de Octubre de julio-diciembre de 2005 y de enero-junio de 2008 (6 primeros meses tras la apertura del banco de leche). Resultados: La apertura del banco de leche permitió empezar 31 h antes (p

Objective: To determine, by the creamatocrit measurement, the effect on fat content of freezing raw and pasteurised donor milk at −20 °C for 3 months. Methods: The evolution of the creamatocrit measurement (following Lucas technique) on frozen (−20 °C), raw and pasteurised human milk, was analysed 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 pasteurised 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 pasteurised 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. Resumen: Objetivo: Determinar, mediante crematocrito, las modificaciones del contenido graso de la leche materna cruda y pasteurizada a lo largo de 3 meses de congelación. Método: Se analizó la evolución del crematocrito (fórmula de Lucas) en leche cruda y pasteurizada a lo largo de 3 meses de congelación a −20 °C. Resultados: La grasa en leche cruda (n = 44) fue 3,19 g/dl al inicio y 2,86 g/dl a los 3 meses de congelación (p = 0,02). En leche pasteurizada (n = 36), al inicio fue 2,59 g/dl y 2,20 g/dl al mes de congelación (p = 0,01), posteriormente, hasta los 3 meses, no hubo cambios significativos. Se observó variabilidad en los valores intermedios. Conclusiones: Se observó una disminución en la medida de la grasa tras congelación en leche cruda y pasteurizada. La congelación no impide la acción de la lipasa y también afecta al glóbulo de grasa. Probablemente, el crematocrito no sea el método óptimo para cuantificar la grasa en leche ya procesada.

Resumen: Objetivo: Determinar, mediante crematocrito, las modificaciones del contenido graso de la leche materna cruda y pasteurizada a lo largo de 3 meses de congelación. Método: Se analizó la evolución del crematocrito (fórmula de Lucas) en leche cruda y pasteurizada a lo largo de 3 meses de congelación a −20 °C. Resultados: La grasa en leche cruda (n = 44) fue 3,19 g/dl al inicio y 2,86 g/dl a los 3 meses de congelación (p = 0,02). En leche pasteurizada (n = 36), al inicio fue 2,59 g/dl y 2,20 g/dl al mes de congelación (p = 0,01), posteriormente, hasta los 3 meses, no hubo cambios significativos. Se observó variabilidad en los valores intermedios. Conclusiones: Se observó una disminución en la medida de la grasa tras congelación en leche cruda y pasteurizada. La congelación no impide la acción de la lipasa y también afecta al glóbulo de grasa. Probablemente, el crematocrito no sea el método óptimo para cuantificar la grasa en leche ya procesada. Abstract: 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.

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.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.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).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.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.

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.

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.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 (acidity4°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.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.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.

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.