Growth of Very Preterm Infants in a Low-Resourced Rural Setting after Affiliation with a Human Milk Bank

The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.

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Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz008 ◽

2019 ◽

Vol 109 (5) ◽

pp. 1373-1379 ◽

Cited By ~ 6

Author(s):

Mandy B Belfort ◽

Erika M Edwards ◽

Lucy T Greenberg ◽

Margaret G Parker ◽

Danielle Y Ehret ◽

...

Keyword(s):

Weight Gain ◽

Human Milk ◽

Infant Formula ◽

Preterm Infants ◽

Z Score ◽

Score Change ◽

Very Preterm Infants ◽

Very Preterm ◽

Head Growth ◽

Formula Diets

ABSTRACT Background The benefits of human milk for hospitalized preterm infants are well documented, but the extent to which current human milk diets adequately support growth is uncertain. Objectives 1) To quantify differences in weight gain and head growth between very preterm infants fed human milk compared with infant formula; and 2) to describe trends in the magnitude of these differences over time Methods We studied infants from 777 US NICUs in the Vermont Oxford Network database. We included all surviving infants 23–29 weeks of gestation or 401–1500 g birth weight (maximum gestational age 32 wk) and excluded infants discharged >42 weeks of gestation or with congenital anomalies. In diet-growth analyses, we included infants born 2012–2016 (n = 138,703) to reflect current practice. In trend analyses, we included a 10-y cohort (n = 263,367). We categorized diet at NICU discharge/transfer as: 1) human milk only (no formula or fortifier); 2) human milk with formula or fortifier (mixed); or 3) infant formula only. Outcomes were weight and head circumference z-score change from birth to discharge relative to a fetal reference. Results Diet at discharge/transfer was human milk only for 18,274 (6.6%), mixed for 121,621 (44%), and formula only for 137,067 (49%). Weight deviated more from the fetal reference for infants fed both human milk diets compared with formula only (weight z-score change for infants fed human milk only, −0.88; mixed, −0.82; formula only −0.80; P < 0.0001 for diet overall). There were also differences by diet in head z-score change (human milk only, −0.52; mixed, −0.49; formula only, −0.45; P < 0.0001 for diet overall). The magnitude of these differences has diminished substantially over 10 y. Conclusions Very preterm infants receiving human milk compared with infant formula diets have a slower weight gain and head growth at hospital discharge.

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DIAGNÓSTICOS DE ENFERMAGEM DE MULHERES NUTRIZES ATENDIDAS NO BANCO DE LEITE HUMANO

Enfermagem em Foco ◽

10.21675/2357-707x.2019.v10.n1.1396 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Nathália Carolina Tomazelli Crespo ◽

Rosimere Ferreira Santana ◽

Valdecyr Herdy Alves ◽

Audrey Vidal Pereira ◽

Giovanna Rosario Soanno Marchiori ◽

...

Keyword(s):

Human Milk ◽

Sleep Pattern ◽

No Donors ◽

Tissue Integrity ◽

Disturbed Sleep ◽

Nursing Diagnosis ◽

Milk Bank ◽

Las Mujeres ◽

Human Milk Bank ◽

Milk Banks

Objetivo: conhecer o perfil de Diagnósticos de Enfermagem em mulheres nutrizes atendidas no Banco de Leite Humano. Metodologia: estudo descritivo, com 30 mulheres atendidas no Banco de Leite Humano entre doadoras e não doadoras. Os dados foram coletados nos meses de março a maio de 2012. A análise se deu por meio de estatística descritiva. Resultados: os diagnósticos foram descritos para dois grupos: Não doadoras: Disposição para conhecimento melhorado (100,0%), Risco de infecção (80,9%), Integridade Tissular prejudicada (80,9%), Padrão de sono prejudicado (76,1%), Conhecimento deficiente (66,6%), Ansiedade (52,3%); Em Doadoras: Padrão de sono prejudicado (77,7%) e Ansiedade (55,5%). Conclusão: a taxonomia diagnóstica encontra-se de acordo com a população estudada. Validou-se a necessidade do uso dessa tecnologia como um sistema padrão de linguagem.Descritores: Bancos de leite; Diagnóstico de enfermagem; Cuidados de enfermagem; Saúde da mulher; Aleitamento materno.NURSING DIAGNOSIS IDENTIFIED IN WOMEN AT THE HUMAN MILK BANKObjective: to know the profile of Nursing Diagnosis in women hosted in the Human Milk Bank. Methodology: descriptive study, with 30 women attended at the Human Milk Bank between donors and no donors. Data were collected from March to May 2012. The analysis was done through simple descriptive statistics. Results: diagnosis were described for two groups: No donors: Readiness for enhanced knowledge (100.0%), Risk for infection (80.9%), Impaired tissue integrity (80.9%), Disturbed sleep pattern (76.1%), Deficient knowledge (66.6%), Anxiety (52.3%); In Donors: Disturbed sleep pattern (77.7%) and Anxiety (55.5%). Conclusion: the diagnostic taxonomy is in agreement with the studied population. The need to use this technology as a standard language system was validated.Descriptors: Milk banks; Nursing diagnosis; Nursing care; Women’s health; Breastfeeding.ENFERMERÍA DE DIAGNÓSTICO IDENTIFICADOS EN MUJERES ASISTIDA EN BANCO DE LECHE HUMANAObjetivo: conocer el perfil de los diagnósticos de enfermería de las mujeres dio la bienvenida al Banco de Leche Humana. Metodology: estúdio descriptivo, con 30 mujeres atendidas enel Banco de Leche Humana entre los donantes y no donantes. Los datos fueron recolectados entre marzo y mayo de 2012. El análisis se realizó utilizando estadísticas descriptivas simples. Resultados: los diagnósticos han sido descritos por dos grupos: No donantes: Disposición para mejorar los conocimientos (100%), Riesgo de infección (80,9%), Deterioro de la integridade cutánea (80,9%), Trastorno del patrón de sueño (76, 1%), Conocimientos deficientes (66,6%), Ansiedad (52,3%); Em Donantes: Trastorno del patrón de sueño (77,7%) y Ansiedad (55,5%). Conclusión: la taxonomía diagnóstica es función de la población estudiada. Han verificado la necesidad de la utilización de esta tecnología como un sistema estándar de lenguaje.Descriptores: Bancos de leche; Diagnóstico de enfermería; Atención de enfermería; Salud de lamujer; Lactancia materna.

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Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020823 ◽

2021 ◽

Vol 18 (2) ◽

pp. 823

Author(s):

Manuela Cardoso ◽

Daniel Virella ◽

Israel Macedo ◽

Diana Silva ◽

Luís Pereira-da-Silva

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Fat Mass ◽

Study Protocol ◽

Milk Composition ◽

Fixed Dose ◽

Very Preterm Infants ◽

Very Preterm ◽

Pea Pod

Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.

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Representations of women milk donors on donations for the human milk bank

Cadernos Saúde Coletiva ◽

10.1590/1414-462x201600020029 ◽

2016 ◽

Vol 24 (2) ◽

pp. 139-144 ◽

Cited By ~ 4

Author(s):

Wanessa Debôrtoli de Miranda ◽

Maria Cristina Passos ◽

Maria Imaculada de Fátima Freitas ◽

Palmira de Fátima Bonolo

Keyword(s):

High School ◽

Human Milk ◽

Social Representation ◽

Prenatal Period ◽

Structured Interviews ◽

Milk Bank ◽

Social Representation Theory ◽

Human Milk Bank ◽

Milk Banks ◽

Representations Of Women

Abstract Human milk banks (HMBs) have difficulty maintaining and increasing their stocks, and the number of women enrolling as members remains low. The present qualitative study, based on social representation theory, aimed to understand women’s representations of the milk donation experience. The data were collected through semi-structured interviews conducted in 2013. In total, 12 women aged 18 to 39 years old participated in the study. Most were primiparous, married or living with a partner, housewives, completed high school, and belonged to lower economic classes. Four categories emerged from the testimonies: human milk donation; representations about human milk banks (HMB); the importance of breastfeeding for the baby and for one's conceptualization as a mother; and prenatal care and donation awareness. The main reasons for donating were representations that value breastfeeding, human milk, and the donation act. These mothers had difficulties donating, but the rewarding feeling, the value of this practice, and the support they received from people important to them helped with the donation. The findings related to the value of the donation and breastfeeding provide ways to effectively encourage and motivate potential donors, achieving comprehensive care starting from the prenatal period.

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Quality management in Human Milk Banks: a scope review

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2019-0640 ◽

2020 ◽

Vol 73 (suppl 6) ◽

Author(s):

Rosana Rodrigues Figueira Fogliano ◽

Elena Bohomol ◽

Mariana Cabral Schveitzer ◽

Kelly Pereira Coca ◽

Ana Cristina Freitas de Vilhena Abrão

Keyword(s):

Quality Management ◽

Human Milk ◽

Continuous Monitoring ◽

Quality Of Services ◽

Inclusion Criteria ◽

Management Interventions ◽

Milk Bank ◽

Human Milk Bank ◽

Milk Banks

ABSTRACT Objectives: to identify the main quality management interventions used by professionals working at Human Milk Banks. Methods: a scope review conducted at PubMed, VHL, Scopus, SciELO, CAPES thesis and Google Scholar databases. Primary studies were included that address quality improvement strategies to improve Milk Bank processes in Portuguese, English and Spanish. Results: search totaled 192 scientific studies, 17 of which met the objective of the study and inclusion criteria. The main quality management interventions used in the Human Milk Bank addressed tools for continuous improvement. Six were aimed at improving processes, one to prevent errors and failures and two to achieve continuous monitoring. Final Considerations: the tools used by professionals working in Human Milk Banks have demonstrated effectiveness in managing the quality of services.

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Cytotoxic Lactalbumin-Oleic Acid Complexes in the Human Milk Diet of Preterm Infants

Nutrients ◽

10.3390/nu13124336 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4336

Author(s):

Katherine E. Chetta ◽

Joseph L. Alcorn ◽

John E. Baatz ◽

Carol L. Wagner

Keyword(s):

Oleic Acid ◽

Human Milk ◽

Preterm Infants ◽

Frozen Storage ◽

Lipid Complex ◽

Acid Complex ◽

Very Preterm Infants ◽

Very Preterm ◽

Milk Casein ◽

Alpha Lactalbumin

Frozen storage is necessary to preserve expressed human milk for critically ill and very preterm infants. Milk pasteurization is essential for donor milk given to this special population. Due to these storage and processing conditions, subtle changes occur in milk nutrients. These changes may have clinical implications. Potentially, bioactive complexes of unknown significance could be found in human milk given to preterm infants. One such complex, a cytotoxic α-lactalbumin-oleic acid complex named “HAMLET,” (Human Alpha-Lactalbumin Made Lethal to Tumor cells) is a folding variant of alpha-lactalbumin that is bound to oleic acid. This complex, isolated from human milk casein, has specific toxicity to both carcinogenic cell lines and immature non-transformed cells. Both HAMLET and free oleic acid trigger similar apoptotic mechanisms in tissue and stimulate inflammation via the NF-κB and MAPK p38 signaling pathways. This protein-lipid complex could potentially trigger various inflammatory pathways with unknown consequences, especially in immature intestinal tissues. The very preterm population is dependent on human milk as a medicinal and broadly bioactive nutriment. Therefore, HAMLET’s possible presence and bioactive role in milk should be addressed in neonatal research. Through a pediatric lens, HAMLET’s discovery, formation and bioactive benefits will be reviewed.

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The fortification method relying on assumed human milk composition overestimates the actual energy and macronutrient intakes in very preterm infants

Maternal Health Neonatology and Perinatology ◽

10.1186/s40748-018-0090-4 ◽

2018 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Israel Macedo ◽

Luis Pereira-da-Silva ◽

Manuela Cardoso

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Milk Composition ◽

Very Preterm Infants ◽

Very Preterm

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

Italian Journal of Pediatrics ◽

10.1186/s13052-018-0532-7 ◽

2018 ◽

Vol 44 (1) ◽

Cited By ~ 5

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

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Donor Human Milk Protects against Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

10.20944/preprints201801.0107.v1 ◽

2018 ◽

Author(s):

Eduardo Villamor-Martínez ◽

Maria Pierro ◽

Giacomo Cavallaro ◽

Fabio Mosca ◽

Boris W. Kramer ◽

...

Keyword(s):

Systematic Review ◽

Human Milk ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Observational Studies ◽

Meta Analysis ◽

Very Preterm Infants ◽

Very Preterm ◽

Donor Human Milk ◽

Preterm Formula

Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if mother’s own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCT’s could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (3 studies, risk ratio [RR] 0.89, 95% confidence interval [CI] 0.60–1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67–0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (3 studies, RR 0.80, 95% CI 0.68–0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (2 studies, RR 0.77, 95% CI 0.62–0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants, but pasteurization of human milk reduces the benefit.

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