Use of probiotics in the NICU: Evaluating the stability of a three-strain probiotic blend in various media for enteral feeding

2021 ◽  
pp. 1-6
Author(s):  
M. Schimmoeller ◽  
K. Wulf ◽  
C. Walker ◽  
B. Barrett-Reis ◽  
M. Vurma
Keyword(s):  
Human Milk ◽  
Saline Water ◽  
Feeding Tube ◽  
Health Care Facilities ◽  
Published Data ◽  
Sterile Water ◽  
Cell Counts ◽  
Preterm Formula ◽  
The Stability ◽  
Probiotic Delivery

BACKGROUND: There is little published data on how to prepare probiotic supplements for enteral delivery in the NICU. The objective of this study was to determine how a three-strain probiotic blend (Bb-02, TH-4 ® and BB-12 ®) would behave when mixed and held for 4 hours with saline water, sterile water, dextrose 5% in water (D5W), 24 kcal preterm formula, and human milk. METHODS: A packet of a three-strain probiotic supplement was mixed with 3 ml of saline water, sterile water, D5W, 24 kcal preterm formula, and human milk (tested at 3 ml and 2 ml). Samples were stored at room temperature for 60 minutes then refrigerated for 180 minutes. Probiotic survival, using quantitative enumeration, and pH were monitored over 4 hours. Samples were passed through a 5 French (Fr) feeding tube at the end of the study to evaluate viscosity. RESULTS: The largest variation in total cell count from 0-time was sterile water with a + 0.26 log(CFU)/mL change at 90 minutes and typical variation is considered±0.50 log units indicating no significant change between samples in 4 hours. Saline water had the lowest final pH at 4.88. All samples easily passed through a 5 Fr feeding tube. CONCLUSION: The study showed minimal change in cell counts across solutions for 4 hours of storage, indicating health care facilities may be able to prepare probiotic supplements with a variety of solutions in pharmacies or milk rooms. This allows greater flexibility for probiotic delivery to preterm infants.

scholarly journals A Systematic Review and Meta-Analysis of Human Milk Feeding and Short-Term Growth in Preterm and Very Low Birth Weight Infants

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2089
Author(s):  
Machiko Suganuma ◽  
Alice R. Rumbold ◽  
Jacqueline Miller ◽  
Yan Fong Chong ◽  
Carmel T. Collins
Keyword(s):  
Systematic Review ◽  
Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Very Low Birth Weight ◽  
Meta Analysis ◽  
Poor Quality ◽  
Low Birth Weight Infants ◽  
Preterm Formula ◽  
Meta Analyses

Human milk (HM) is the gold standard for feeding infants but has been associated with slower growth in preterm infants compared with preterm formula. This systematic review and meta-analysis summarises the post-1990 literature to examine the effect of HM feeding on growth during the neonatal admission of preterm infants with birth weight ≤1500 g and/or born ≤28 weeks’ gestation. Medline, PubMed, CINAHL, and Scopus were searched, and comparisons were grouped as exclusive human milk (EHM) vs. exclusive preterm formula (EPTF), any HM vs. EPTF, and higher vs. lower doses of HM. We selected studies that used fortified HM and compared that with a PTF; studies comparing unfortified HM and term formula were excluded. Experimental and observational studies were pooled separately. The GRADE system was used to evaluate risk of bias and certainty of evidence. Forty-four studies were included with 37 (n = 9963 infants) included in the meta-analyses. In general, due to poor quality studies, evidence of the effect of any HM feeds or higher versus lower doses of HM was inconclusive. There was a possible effect that lower doses of HM compared with higher doses of HM improved weight gain during the hospital admission, and separately, a possible effect of increased head circumference growth in infants fed EPTF vs. any HM. The clinical significance of this is unclear. There was insufficient evidence to determine the effects of an exclusive HM diet on any outcomes.

Use of an Ambulatory Infusion Pump in a 12-Year-Old with Salmonella Osteomyelitis

DICP ◽  
1989 ◽  
Vol 23 (5) ◽  
pp. 379-381
Author(s):  
Allen J. Vaida ◽  
Chantel J. Mattiucci ◽  
Steven A. Shapiro ◽  
Linda A. Gusenko ◽  
Anna M. King
Keyword(s):  
Cost Saving ◽  
Antibiotic Therapy ◽  
Infusion Pump ◽  
Medication Administration ◽  
Sterile Water ◽  
Home Therapy ◽  
Parenteral Antibiotic ◽  
The Family ◽  
The Stability ◽  
Salmonella Osteomyelitis

A 12-year-old girl with sickle cell hemoglobinopathy presented with a Salmonella osteomyelitis of her right humerus requiring six weeks of parenteral antibiotic therapy. Home therapy was evaluated. Due to the frequency of the medication administration (every six hours) and the apprehension of the family members, a Pharmacia-Deltec CADD-VT Infusion Pump was chosen for drug administration. Based on the stability of ampicillin, 1.3 g q6h was administered to provide a minimum of 1 g for the last dose of a 24-hour cycle. Ampicillin 6 g contained in 100 mL of sterile water for injection provided a 60 mg/mL solution with an osmolarity of 347 mOsmol. The pump was programmed to deliver 22 mL of solution over one hour, every six hours. A keep-vein-open rate of 0.2 mL/h maintained line patency. A 100 mL cassette of solution prepared daily was replaced on the pump by a home therapy nurse each morning. At the end of six weeks of therapy, the osteomyelitis was eradicated. We found the use of an ambulatory infusion pump an effective, convenient, and cost-saving method of treatment for our patient.

scholarly journals Efforts to emulate human milk oligosaccharides

2007 ◽  
Vol 98 (S1) ◽  
pp. S74-S79 ◽  
Author(s):  
Rosa María Espinosa ◽  
Martha Taméz ◽  
Pedro Prieto
Keyword(s):  
Breast Milk ◽  
Human Milk ◽  
Current Knowledge ◽  
Biological Effects ◽  
Historical Context ◽  
Published Data ◽  
Human Milk Oligosaccharides ◽  
Milk Oligosaccharides ◽  
Fast Analysis ◽  
Chemical Structures

Research on human milk oligosaccharides (HMO) began with the characterisation of their chemical structures and is now focused on the elucidation of their biological roles. Previously, biological effects could only be investigated with fractions or structures isolated from breast milk; consequently, clinical observations were limited to comparisons between outcomes from breast-fed infants and their formula-fed counterparts. In some cases, it was inferred that the observed differences were caused by the presence of HMO in breast milk. Presently, analytical techniques allow for the fast analysis of milk samples, thus providing insights on the inherent variability of specimens. In addition, methods for the synthesis of HMO have provided single structures in sufficient quantities to perform clinical studies with oligosaccharide-supplemented formulae. Furthermore, studies have been conducted with non-mammalian oligosaccharides with the purpose of assessing the suitability of these structures to functionally emulate HMO. Taken together, these developments justify summarising current knowledge on HMO to further discussions on efforts to emulate human milk in regard to its oligosaccharide content. The present account summarises published data and intends to provide an historical context and to illustrate the state of the field.

scholarly journals SARS-CoV-2 and human milk: what is the evidence?

2020 ◽  
Author(s):  
Kimberly A. Lackey ◽  
Ryan M. Pace ◽  
Janet E. Williams ◽  
Lars Bode ◽  
Sharon M. Donovan ◽  
...  
Keyword(s):  
Public Health ◽  
Human Milk ◽  
Vertical Transmission ◽  
Published Data ◽  
Single Study ◽  
Public Health Challenges ◽  
Specific Igg ◽  
Health Communities ◽  
Human Coronaviruses ◽  
Novel Coronavirus

ABSTRACTThe novel coronavirus SARS-CoV-2 has emerged as one of the most compelling and concerning public health challenges of our time. To address the myriad issues generated by this pandemic, an interdisciplinary breadth of research, clinical, and public health communities has rapidly engaged to collectively find answers and solutions. One area of active inquiry is understanding the mode(s) of SARS-CoV-2 transmission. While respiratory droplets are a known mechanism of transmission, other mechanisms are likely. Of particular importance to global health is the possibility of vertical transmission from infected mothers to infants through breastfeeding or consumption of human milk. However, there is limited published literature related to vertical transmission of any human coronaviruses (including SARS-CoV-2) via human milk and/or breastfeeding. Results of the literature search reported here (finalized on April 17, 2020) revealed a single study providing some evidence of vertical transmission of human coronavirus 229E; a single study evaluating presence of SARS-CoV in human milk (it was negative); and no published data on MERS-CoV and human milk. We identified 12 studies reporting human milk tested for SARS-CoV-2; one study detected the virus in one milk sample, and another study detected SARS-CoV-2 specific IgG in milk. Importantly, none of the studies on coronaviruses and human milk report validation of their collection and analytical methods for use in human milk. These reports are evaluated here, and their implications related to the possibility of vertical transmission of coronaviruses (in particular, SARS-CoV-2) during breastfeeding are discussed.

The Impact of Storage Conditions on the Stability of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis Bb12 in Human Milk

2017 ◽  
Vol 12 (9) ◽  
pp. 566-569 ◽  
Author(s):  
Anastasia Mantziari ◽  
Juhani Aakko ◽  
Himanshu Kumar ◽  
Satu Tölkkö ◽  
Elloise du Toit ◽  
...  
Keyword(s):  
Human Milk ◽  
Lactobacillus Rhamnosus ◽  
Storage Conditions ◽  
Lactobacillus Rhamnosus Gg ◽  
Bifidobacterium Animalis ◽  
The Stability ◽  
The Impact

scholarly journals Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: a randomized non-inferiority trial

2018 ◽  
Vol 44 (1) ◽  
Author(s):  
Simonetta Costa ◽  
Luca Maggio ◽  
Giovanni Alighieri ◽  
Giovanni Barone ◽  
Francesco Cota ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Donor Human Milk ◽  
Preterm Formula

Role of Antibiotic Lock Therapy for the Treatment of Catheter-Related Bloodstream Infections

2009 ◽  
Vol 32 (9) ◽  
pp. 678-688 ◽  
Author(s):  
Jose L Del Pozo
Keyword(s):  
Antimicrobial Agents ◽  
Therapeutic Option ◽  
Bloodstream Infections ◽  
Resistance Pattern ◽  
Published Data ◽  
Sufficient Power ◽  
Lock Therapy ◽  
Antibiotic Lock ◽  
The Stability ◽  
Systemic Antibiotics

Catheter-related bloodstream infections are often difficult to treat because they are caused by organisms that embed themselves in a bio film layer on the catheter surface, resulting in an increased resistance to antimicrobial agents. Systemic antibiotics are usually administered but, although generally effective in eliminating circulating bacteria, they frequently fail to sterilize the line, leaving the patient at a continuing risk of complications or recurrence. A successful approach to managing these infections requires making an appropriate decision regarding whether the catheter should be removed or retained using antibiotic lock therapy; and choosing the type and duration of antimicrobial therapy based on the type of organism and its resistance pattern. Studies that have evaluated antibiotic lock therapy have varied in the types of antibiotics and concentrations used, the addition of heparin to the solutions, and dwell times in the catheter lumen. Guidelines from the Infectious Diseases Society of America include use of antibiotic lock therapy as a therapeutic option for intraluminal infections when the device is not removed and, although not routine, as prophylaxis for catheter-related infection in select patient populations. However, there are no published guidelines on the concentration of heparin or antibiotics that should be used, and minimal published data on the stability of heparin combinations with antibiotics. It is to be hoped that antibiotic locks will be subject to randomized controlled trials of sufficient power to confirm or refute their use.

Factors Affecting Choice of Working Stresses for High-Temperature Service

1933 ◽  
Vol 1 (3) ◽  
pp. 99-102
Author(s):  
P. G. McVetty
Keyword(s):  
High Temperature ◽  
Published Data ◽  
Creep Tests ◽  
Fundamental Study ◽  
Factors Affecting ◽  
Creep Characteristics ◽  
The Stability ◽  
Safe Working

Abstract This paper discusses the various methods which have been proposed to determine safe working stresses for high-temperature service. The question of the stability of alloys during the test and in subsequent service is considered, with particular emphasis upon probable changes in creep characteristics during long exposure to stress and temperature. It is shown that published data in general do not admit of extrapolation, and that attempts to estimate total creep in service from such data are not usually satisfactory. The author stresses the need for more fundamental study of the laws governing creep rather than creep tests of many different materials.

How to Prevent Errors – Safety Issues with Patient-Controlled Analgesia (Part 2); Potential for Confusing Dakin's Solution with Sterile Water

2005 ◽  
Vol 40 (3) ◽  
pp. 210-213 ◽  
Author(s):  
Michael R. Cohen
Keyword(s):  
Medication Errors ◽  
Web Sites ◽  
Health Care Facilities ◽  
Inservice Training ◽  
Sterile Water ◽  
Patient Controlled Analgesia ◽  
Safety Issues ◽  
Care Facilities ◽  
Fail Safe ◽  
E Mail

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL SAFE or via E-mail at [email protected] . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.

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