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Albalawi S, AlObari R, AlMidani E, Malkawi R, Abosaleh D, Qarni S, Subrayan S, Almuteiry S, Abel-Reyes L, Alhazaa B, Alhuthil R. Enhancing nutritional formula expiry monitoring: A quality improvement project in a tertiary-level hospital in Riyadh, Saudi Arabia. Nutr Clin Pract 2024. [PMID: 38887959 DOI: 10.1002/ncp.11172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Nutrition is a vital part of any treatment plan. This may include providing nutritional formulas during hospitalization and afterward. However, reported incidents showed that we had issues with nutritional formula expiry monitoring at our hospital with low compliance to Joint Commission International Standards (MMU.3.1): "There is a process for storage of medications and nutritional products that require special consideration." Therefore, a "Nutritional Formula Expiry Monitoring" project was created to decrease hospital safety incidents related to expired nutritional formulas from an average of 28 in 2015 to zero by 2018. MATERIALS AND METHODS A quality improvement model was developed to map the existing formula processes. Several proposed ideas were tested including performing a hospital-wide audit to examine possible risks and practices, developing a hospital policy, flow charts, forms, and audit tools, and providing educational presentations. RESULTS A total of 40 units in the hospital were included in the implementation. After implementing all the change ideas, the system for monitoring the expiry of the nutritional formula was standardized, and the number of reported incidents related to the nutritional formula decreased from 28 in the third quarter of 2015 to one in the first quarter of 2018. CONCLUSION This project provided step-by-step instructions for improving storing, delivering, and monitoring of nutritional formula. Consequently, the incidences of expired formula and cost wasting were successfully decreased, which increased safe administration and prevented patients from receiving expired nutritional formula. This project can be implemented in various healthcare settings.
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Affiliation(s)
- Sawsan Albalawi
- Department of Nutrition Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Rania AlObari
- Department of Quality Management, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Eyad AlMidani
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Rafat Malkawi
- Department of Quality Management, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dima Abosaleh
- Department of Nutrition Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sozan Qarni
- Department of Food Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sasikalan Subrayan
- Department of Quality Management, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Saif Almuteiry
- Department of Nutrition Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Leodevina Abel-Reyes
- Department of Nutrition Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Bader Alhazaa
- Department of Supply Chain Management, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Raghad Alhuthil
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Unger SL, O'Connor DL. Review of current best practices for human milk banking. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 4:e13657. [PMID: 38752309 PMCID: PMC11184574 DOI: 10.1111/mcn.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 06/19/2024]
Abstract
Mother's/parent milk is the optimal way to feed infants and when unavailable, supplemental donor human milk is preferred. A safe supply of donor human milk should be available for all low birthweight infants for whom it has been shown to reduce morbidity. Human milk banking has been in existence for more than a century, although largely shut down during the 1980s, primarily due to fears of human immunodeficiency virus transmission. With renewed security in milk banking, has come an exponential growth in human donor milk use. Guidelines for milk banking have been published in many countries including Australia, France, India, Italy, Spain, Switzerland, the United Kingdom and the nonprofit organization PATH. The European Milk Bank Association and the Human Milk Banking Association of North America have also published recommendations for milk banks throughout Europe and North America, respectively. Although there is variability among these guidelines, there is general consensus on quality control measures required to provide a supply of safe donor milk. These measures include effective donor screening, safe collection, transport and storage of milk, standardized pasteurization and bacteriological testing. Operational considerations are also critical, such as appropriate training for staff, equipment maintenance and cleaning, protocol and record keeping and inspection and accreditation. Clearly delineating these key quality control measures provides an excellent foundation for establishing international guidelines. Acceptable modifications must be established for low- and middle-income countries that do not have sufficient resources; overly burdensome guidelines may make establishing a milk bank unnecessarily prohibitive. This review presents a summary of current best practices for human milk banking.
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Affiliation(s)
- Sharon L. Unger
- Department of PediatricsSinai HealthTorontoOntarioCanada
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Rogers Hixon Ontario Human Milk BankTorontoOntarioCanada
- Division of NeonatologyIWK HospitalHalifaxNova ScotiaCanada
| | - Deborah L. O'Connor
- Department of PediatricsSinai HealthTorontoOntarioCanada
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Rogers Hixon Ontario Human Milk BankTorontoOntarioCanada
- Translational MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
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3
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Keneh NK, Kenmoe S, Bowo-Ngandji A, Akoachere JFTK, Kamga HG, Ndip RN, Ebogo-Belobo JT, Kengne-Ndé C, Mbaga DS, Tendongfor N, Assam JPA, Ndip LM, Esemu SN. Methicillin-Resistant Staphylococcus aureus Carriage among Neonate Mothers, Healthcare Workers, and Environmental Samples in Neonatal Intensive Care Units: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2024; 2024:5675786. [PMID: 38623471 PMCID: PMC11018372 DOI: 10.1155/2024/5675786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/12/2023] [Accepted: 03/07/2024] [Indexed: 04/17/2024]
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). The MRSA colonization of neonates, attributed to various sources, including mothers, healthcare workers, and environmental surfaces, can lead to severe infection, prolonged hospital stays, and even death, imposing substantial economic burdens. Given the pressing need to mitigate MRSA spread in these vulnerable environments, further examination of the subject is warranted. This systematic review is aimed at synthesizing available evidence on MRSA carriage proportions among mothers of newborns, healthcare workers, and environmental surfaces in NICUs. Methodology. We included observational studies published in English or French from database inception to March 21, 2023. These studies focused on MRSA in nonoutbreak NICU settings, encompassing healthy neonate mothers and healthcare workers, and environmental surfaces. Literature search involved systematic scanning of databases, including Medline, Embase, Web of Science, Global Health, and Global Index Medicus. The quality of the selected studies was assessed using the Hoy et al. critical appraisal scale. The extracted data were summarized to calculate the pooled proportion of MRSA positives, with a 95% confidence interval (CI) based on the DerSimonian and Laird random-effects model. Results A total of 1891 articles were retrieved from which 16 studies were selected for inclusion. Most of the studies were from high-income countries. The pooled proportion of MRSA carriage among 821 neonate mothers across four countries was found to be 2.1% (95% CI: 0.3-5.1; I2 = 76.6%, 95% CI: 36.1-91.5). The proportion of MRSA carriage among 909 HCWs in eight countries was determined to be 9.5% (95% CI: 3.1-18.4; I2 = 91.7%, 95% CI: 87.1-94.6). The proportion of MRSA carriage among HCWs was highest in the Western Pacific Region, at 50.00% (95% CI: 23.71-76.29). In environmental specimens from five countries, a pooled proportion of 16.6% (95% CI: 3.5-36.0; I2 = 97.7%, 95% CI: 96.6-98.4) was found to be MRSA-positive. Conclusion With a significant heterogeneity, our systematic review found high MRSA carriage rates in neonate mothers, healthcare workers, and across various environmental surfaces in NICUs, posing a potential risk of nosocomial infections. Urgent interventions, including regular screening and decolonization of MRSA carriers, reinforcing infection control measures, and enhancing cleaning and disinfection procedures within NICUs, are crucial. This trial is registered with CRD42023407114.
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Affiliation(s)
- Nene Kaah Keneh
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | - Hortense Gonsu Kamga
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaoundé, Cameroon
| | - Roland Ndip Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | - Nicholas Tendongfor
- Department of Public Health and Hygiene, University of Buea, P.O. Box 63, Buea, Cameroon
| | | | - Lucy Mande Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
| | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
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Mousavi ZE, Hunt K, Koolman L, Butler F, Fanning S. Cronobacter Species in the Built Food Production Environment: A Review on Persistence, Pathogenicity, Regulation and Detection Methods. Microorganisms 2023; 11:1379. [PMID: 37374881 DOI: 10.3390/microorganisms11061379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
The powdered formula market is large and growing, with sales and manufacturing increasing by 120% between 2012 and 2021. With this growing market, there must come an increasing emphasis on maintaining a high standard of hygiene to ensure a safe product. In particular, Cronobacter species pose a risk to public health through their potential to cause severe illness in susceptible infants who consume contaminated powdered infant formula (PIF). Assessment of this risk is dependent on determining prevalence in PIF-producing factories, which can be challenging to measure with the heterogeneity observed in the design of built process facilities. There is also a potential risk of bacterial growth occurring during rehydration, given the observed persistence of Cronobacter in desiccated conditions. In addition, novel detection methods are emerging to effectively track and monitor Cronobacter species across the food chain. This review will explore the different vehicles that lead to Cronobacter species' environmental persistence in the food production environment, as well as their pathogenicity, detection methods and the regulatory framework surrounding PIF manufacturing that ensures a safe product for the global consumer.
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Affiliation(s)
- Zeinab Ebrahimzadeh Mousavi
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
- School of Biosystems and Food Engineering, University College Dublin, Belfield, Dublin 4, D04 V1W8 Dublin, Ireland
- Department of Food Science and Engineering, Faculties of Agriculture and Natural Resources, University of Tehran, Karaj 6719418314, Iran
| | - Kevin Hunt
- School of Biosystems and Food Engineering, University College Dublin, Belfield, Dublin 4, D04 V1W8 Dublin, Ireland
| | - Leonard Koolman
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Francis Butler
- School of Biosystems and Food Engineering, University College Dublin, Belfield, Dublin 4, D04 V1W8 Dublin, Ireland
| | - Séamus Fanning
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
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5
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Kontopodi E, Arslanoglu S, Bernatowicz-Lojko U, Bertino E, Bettinelli ME, Buffin R, Cassidy T, van Elburg RM, Gebauer C, Grovslien A, Hettinga K, Ioannou I, Klotz D, Mileusnić-Milenović R, Moro GE, Picaud JC, Stahl B, Weaver G, van Goudoever JB, Wesolowska A. "Donor milk banking: Improving the future". A survey on the operation of the European donor human milk banks. PLoS One 2021; 16:e0256435. [PMID: 34411191 PMCID: PMC8376009 DOI: 10.1371/journal.pone.0256435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Provision of donor human milk is handled by established human milk banks that implement all required measures to ensure its safety and quality. Detailed human milk banking guidelines on a European level are currently lacking, while the information available on the actual practices followed by the European human milk banks, remains limited. The aim of this study was to collect detailed data on the actual milk banking practices across Europe with particular emphasis on the practices affecting the safety and quality of donor human milk. MATERIALS AND METHODS A web-based questionnaire was developed by the European Milk Bank Association (EMBA) Survey Group, for distribution to the European human milk banks. The questionnaire included 35 questions covering every step from donor recruitment to provision of donor human milk to each recipient. To assess the variation in practices, all responses were then analyzed for each country individually and for all human milk banks together. RESULTS A total of 123 human milk banks completed the questionnaire, representing 85% of the European countries that have a milk bank. Both inter- and intra-country variation was documented for most milk banking practices. The highest variability was observed in pasteurization practices, storage and milk screening, both pre- and post-pasteurization. CONCLUSION We show that there is a wide variability in milk banking practices across Europe, including practices that could further improve the efficacy of donor human milk banking. The findings of this study could serve as a tool for a global discussion on the efficacy and development of additional evidence-based guidelines that could further improve those practices.
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Affiliation(s)
- Eva Kontopodi
- Amsterdam UMC, Emma Children’s Hospital, Human Milk Bank, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
- Food Quality and Design Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Sertac Arslanoglu
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Urszula Bernatowicz-Lojko
- Human Milk Bank Foundation, Warsaw, Poland
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Enrico Bertino
- City of Health and Science Hospital, Neonatal Care Unit of the University, Turin, Italy
| | | | - Rachel Buffin
- Neonatal Intensive Care Unit, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Tanya Cassidy
- School of Nursing, Psychotherapy, Community Health, Dublin City University, Dublin, Ireland
| | - Ruurd M. van Elburg
- Amsterdam UMC, Emma Children’s Hospital, Human Milk Bank, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Corina Gebauer
- Abteilung Neonatologie Klinik und Poliklinik für Kinder und Jugendliche, Leipzig, Germany
| | - Anne Grovslien
- Neonatal Unit, Milk Bank, Oslo University Hospital, Oslo, Norway
| | - Kasper Hettinga
- Food Quality and Design Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Ioanna Ioannou
- Human Milk Bank, Elena Venizelou Maternity Hospital, Athens, Greece
| | - Daniel Klotz
- Center for Pediatrics, Division of Neonatology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Guido E. Moro
- Italian Association of Human Milk Banks (AIBLUD), Milan, Italy
| | - Jean-Charles Picaud
- Neonatal Intensive Care Unit, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- CarMeN Unit, INSERM U1060, INRA U1397, Claude Bernard University Lyon 1, Pierre Bénite, France
| | - Bernd Stahl
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Gillian Weaver
- International Human Milk Banking Consultant, The Human Milk Foundation, Hertfordshire, United Kingdom
| | - Johannes B. van Goudoever
- Amsterdam UMC, Emma Children’s Hospital, Human Milk Bank, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Aleksandra Wesolowska
- Human Milk Bank Foundation, Warsaw, Poland
- Laboratory of Human Milk and Lactation Research, Regional Human Milk Bank of the Holy Family Hospital, Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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Gad S, Sheta MM, Al-Khalafawi AI, Abu El-Fadl HA, Anany M, Sahmoud S, Amin MK. Expressed Breast Milk Contamination in Neonatal Intensive Care Unit. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:307-313. [PMID: 34211314 PMCID: PMC8242104 DOI: 10.2147/phmt.s311632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
Background The health benefits of breastfeeding are well known. However, some ill babies including those admitted to the neonatal intensive care unit (NICU) cannot be directly breastfed. In this situation, expressed breast milk (EBM) can be used. However, breast milk is not always sterile and may be contaminated by many microorganisms. EBM contamination is probably attributed to improper technical and hygienic factors and may pose significant threats to the newborn baby. The present study aimed to document the prevalence of EBM contamination in NICU and to uncover the relevant risk factors. Subjects and Methods The study included 118 mothers who could express breast milk for their own neonates admitted to the NICU. A checklist was used to document the steps the mothers followed during expression of milk and all steps of handling until the EBM reached the NICU. A 1 mL sample of EBM was obtained and sent to the microbiology laboratory within 20 minutes. Data obtained from the present study are expressed as number and percentage or mean ± standard deviation (SD). Statistical calculations were computed using SPSS 25. Results In the present study, 106 (89.8%) out of the assessed 118 EBM samples were contaminated. Hygienic factors related to EBM contamination included hand only wash, possible recontamination of hands during turning taps off, lack of using cotton pads or cloth piece on nipple and breast cleaning by water only. Other factors related to EBM contamination included container cleaning by water only, fresh milk refrigeration after > 4 hours, adding freshly expressed warm breast milk to refrigerated milk expressed earlier in the same day, milk transport in plastic bags with ice packs and longer transportation time. In the contaminated samples, the most commonly isolated organisms included Staphylococcus aureus (55.7%),Staphylococcus epidermidis (21.7%) and Enterobacter (11.6%). Conclusion The present study identified bacterial contamination in about 90% of EBM samples delivered to NICU infants. Factors related to EBM contamination include hygienic, storage and transport factors.
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Affiliation(s)
- Suzan Gad
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Mohamed M Sheta
- Pediatrics and Neonatology Department, Mansoura General Hospital, Mansoura, Egypt
| | | | - Heba A Abu El-Fadl
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Maha Anany
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Shaimaa Sahmoud
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Mona Karem Amin
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
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Rodrigo R, Badanasinghe N, Abayabandara-Herath T, Forster DA, Amir LH. Bacterial Growth in Expressed Mother's Milk Stored and Transported Under Different Simulated Conditions in a Tropical Country. Breastfeed Med 2021; 16:300-308. [PMID: 33404292 DOI: 10.1089/bfm.2020.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Research on how storage and transport of expressed human milk in a tropical country affect the milk bacterial count is limited. Materials and Methods: A cross-sectional descriptive study of 50 mothers of infants in a Sri Lankan tertiary neonatal unit was performed. Expressed mother's milk was divided into three bottles and kept under varied environmental conditions to simulate different storage and transport methods. Initial bacterial culture of milk was performed <30 minutes after expression, with further cultures at predetermined times. Bottles A and B were stored at room temperature and in a cool bag for the first 6 hours, respectively, and then refrigerated; and bottle C was refrigerated for 24 hours, transported in a cool bag for 6 hours, and rerefrigerated until 72 hours. Total colony counts >105 colony-forming units (CFU)/mL of viable microorganisms or >104 CFU/mL of either Enterobacteriaceae or Staphylococcus aureus were considered positive. Results: Initial culture was positive in 30% (15/50) of samples; majority, 87% (13/15), of these were S. aureus. For bottle A, 26% (13/50), 36% (18/50), 34% (17/50), and 26% (13/50) of samples were positive at 4, 6, 24, and 72 hours, respectively. For bottle B, positive cultures were found in 26% (13/50) and 17% (8/47) of samples at 24 and 72 hours, respectively. For bottle C, results were similar to bottle B. Conclusions: Transportation of expressed mother's milk for 4 hours in a tropical climate using a low-cost cool bag, with refrigeration at other times, maintained acceptable bacterial counts for up to 72 hours after expression. Hygienic practices at collection are extremely important as most samples with significant bacterial growth were positive on initial culture.
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Affiliation(s)
- Ranmali Rodrigo
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | | | | | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
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Differences in Current Procedures for Handling of Expressed Mother's Milk in Danish Neonatal Care Units. Adv Neonatal Care 2019; 19:452-459. [PMID: 31764133 DOI: 10.1097/anc.0000000000000663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mother's own milk (MOM) is preferred when feeding preterm infants. When expressed mother's milk is stored and handled, there is a risk of bacterial contamination, decreased immunological activity, and less nutritional potential. PURPOSE The aim of this study was to investigate current routines when handling MOM in Danish neonatal intensive care units (NICUs). METHODS A survey was sent to all 17 NICUs in Denmark in which current practices regarding human milk handling, storage, and preparation were evaluated. Furthermore, one question sought to establish when mother's milk was believed to be colostrum. Respondents of the survey were neonatal nurses. RESULTS All 17 units responded to the survey. Only 5 of 17 units answered that human colostrum was defined as milk from the first week after birth. Refrigerator storage time varied between 24 and 72 hours. In 6 of 17 units, parents were in charge of mixing milk and fortifier. Heating of human milk was done by using microwave ovens in 4 of 17 of the units. IMPLICATIONS FOR PRACTICE This national survey established that there is significant variability in the way mother's milk is handled. Some of the procedures performed may affect the quality of the milk. It is important to implement evidence-based practice regarding storage and handling of expressed mother's milk to ensure that the quality of the milk is the best possible alternative for all preterm infants. IMPLICATIONS FOR RESEARCH Prospective studies are needed to examine the association between handling of human milk and changes in composition and nutritional potential of the milk.
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9
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Almutawif Y, Hartmann B, Lloyd M, Lai CT, Rea A, Geddes D. Staphylococcus aureus Enterotoxin Production in Raw and Pasteurized Milk: The Effect of Selected Different Storage Durations and Temperatures. Breastfeed Med 2019; 14:256-261. [PMID: 30844297 DOI: 10.1089/bfm.2018.0227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction:S. aureus is one of the most prevalent potential pathogenic bacteria found in DHM. Some strains produce heat stable enterotoxins that are able to survive pasteurization. These enterotoxins have been associated with gastritis and potentially necrotizing enterocolitis in preterm infants. The aim of this study is to assess the impact of different storage temperatures on Staphylococcus aureus growth and enterotoxin A and B production in raw and Holder pasteurized donor human milk (DHM). Materials and Methods: Raw and pasteurized DHM were inoculated with enterotoxin A and B producing S. aureus. Samples were incubated at 4°C (10 days), 21°C, and 37°C (18 hours). Bacterial growth and enterotoxin A and B were quantified. Results:S. aureus count increased in pasteurized DHM. Bacterial count decreased in the raw milk when incubated at 21°C and 4°C and slightly increased when incubated at 37°C. Enterotoxins A and B were only detected in pasteurized DHM at 37°C from 9 hours onward. Conclusion: This study showed that raw milk is capable of suppressing S. aureus growth compared to pasteurized DHM. It also provides a measure of assurance of the safety of raw and pasteurized DHM when refrigerated or left at room temperature for a few hours.
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Affiliation(s)
- Yahya Almutawif
- 1 Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia.,2 Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, Australia.,3 Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Australia
| | - Benjamin Hartmann
- 4 Perron Rotary Express Milk Bank, King Edward Memorial Hospital, Subiaco, Australia.,5 Centre for Neonatal Research and Education, The University of Western Australia, Crawley, Australia.,6 School of Paediatrics, Faculty of Health Sciences, The University of Western Australia, Crawley, Australia
| | - Megan Lloyd
- 2 Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, Australia.,3 Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Australia.,6 School of Paediatrics, Faculty of Health Sciences, The University of Western Australia, Crawley, Australia.,7 School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Ching Tat Lai
- 8 Faculty of Science, School of Molecular Sciences, The University of Western Australia (M310), Crawley, Australia
| | - Alethea Rea
- 9 Centre for Applied Statistics, The University of Western Australia, Crawley, Australia
| | - Donna Geddes
- 8 Faculty of Science, School of Molecular Sciences, The University of Western Australia (M310), Crawley, Australia
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10
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Evaluation of Key Factors Impacting Feeding Safety in the Neonatal Intensive Care Unit: A Systematic Review. Adv Neonatal Care 2019; 19:11-20. [PMID: 29933341 DOI: 10.1097/anc.0000000000000516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Individualized feeding care plans and safe handling of milk (human or formula) are critical in promoting growth, immune function, and neurodevelopment in the preterm infant. Feeding errors and disruptions or limitations to feeding processes in the neonatal intensive care unit (NICU) are associated with negative safety events. Feeding errors include contamination of milk and delivery of incorrect or expired milk and may result in adverse gastrointestinal illnesses. PURPOSE The purpose of this review was to evaluate the effect(s) of centralized milk preparation, use of trained technicians, use of bar code-scanning software, and collaboration between registered dietitians and registered nurses on feeding safety in the NICU. METHODS/SEARCH STRATEGY A systematic review of the literature was completed, and 12 articles were selected as relevant to search criteria. Study quality was evaluated using the Downs and Black scoring tool. FINDINGS/RESULTS An evaluation of human studies indicated that the use of centralized milk preparation, trained technicians, bar code-scanning software, and possible registered dietitian involvement decreased feeding-associated error in the NICU. IMPLICATIONS FOR PRACTICE A state-of-the-art NICU includes a centralized milk preparation area staffed by trained technicians, care supported by bar code-scanning software, and utilization of a registered dietitian to improve patient safety. These resources will provide nurses more time to focus on nursing-specific neonatal care. IMPLICATIONS FOR RESEARCH Further research is needed to evaluate the impact of factors related to feeding safety in the NICU as well as potential financial benefits of these quality improvement opportunities.
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Rodrigo R, Amir LH, Forster DA. Review of guidelines on expression, storage and transport of breast milk for infants in hospital, to guide formulation of such recommendations in Sri Lanka. BMC Pediatr 2018; 18:271. [PMID: 30107831 PMCID: PMC6092763 DOI: 10.1186/s12887-018-1244-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/06/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Sick newborns in neonatal units who are unable to breastfeed are fed expressed breast milk. In Sri Lanka, most mothers stay in hospital throughout baby's stay to provide this milk freshly. In other countries mothers go home, express breast milk at home and bring it to hospital. There are concerns about the safety of transported expressed milk if used in a tropical middle-income country. The aim of this paper is to compare and contrast advice offered by different hospitals and organizations on how to express, store and transport breast milk safely. METHODS We assessed guidelines used by hospital staff of the four Level 3 neonatal units in Melbourne, Australia, National Health Service UK, guidelines and training manuals of the Human Milk Banking Association of North America, the World Health Organization and an information leaflet from Family Health Bureau, Sri Lanka. Information on breast milk expression, storage and transport provided by the guidelines were tabulated under seven topics: general information; container for milk collection; hand expression; using a pump for expression; storage; thawing / warming; and transport of expressed breast milk. The AGREE II tool was used to assess the guidelines written for hospital staff. RESULTS There was considerable agreement on most recommendations provided by these sources, but no single source covered all topics in full. Most recommend hand expression as the initial method for expressing of breast milk, followed by breast pump use, except the Sri Lankan recommendations which strongly discourages the use of breast pumps. Durations of storage under various conditions are generally similar in the different recommendations. Most guidelines recommend a 'cool box' or container with ice or freezer packs for transportation of milk. CONCLUSION A single document containing recommendations on all aspects of expressing, storing and transporting breast milk should be available for each unit, with the same basic information for mothers and the healthcare staff and further technical details for staff if required. The Sri Lankan recommendations need to be updated based on current worldwide practices and further studies are needed to establish a safe method of transport of expressed breast milk in Sri Lanka.
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Affiliation(s)
- Ranmali Rodrigo
- Department of Paediatrics, University of Kelaniya, 6 Thalagolla Road, Ragama, 11010 Sri Lanka
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000 Australia
| | - Lisa H. Amir
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000 Australia
| | - Della A. Forster
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000 Australia
- Royal Women’s Hospital, Locked Bag 300, Parkville, VIC 3052 Australia
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Matthäus V, Haiden N, Abou-Dakn M, Berns M, Eglin K, Flemmer A, Gebauer C, Glanzmann R, Graf-Rohrmeister K, Grunert J, Hattinger-Jürgenssen E, Herber-Jonat S, Hofstätter E, Klotz D, Kujawa M, Liegl Y, Malzacher A, Peter C, Radke M, Sams E, Mader S. Empfehlungen zur Förderung von Frauenmilchbanken in Deutschland, Österreich und der Schweiz (D-A-CH-Raum). Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0447-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boué G, Cummins E, Guillou S, Antignac JP, Le Bizec B, Membré JM. Development and Application of a Probabilistic Risk-Benefit Assessment Model for Infant Feeding Integrating Microbiological, Nutritional, and Chemical Components. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:2360-2388. [PMID: 28403572 DOI: 10.1111/risa.12792] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 01/23/2017] [Accepted: 01/25/2017] [Indexed: 06/07/2023]
Abstract
A probabilistic and interdisciplinary risk-benefit assessment (RBA) model integrating microbiological, nutritional, and chemical components was developed for infant milk, with the objective of predicting the health impact of different scenarios of consumption. Infant feeding is a particular concern of interest in RBA as breast milk and powder infant formula have both been associated with risks and benefits related to chemicals, bacteria, and nutrients, hence the model considers these three facets. Cronobacter sakazakii, dioxin-like polychlorinated biphenyls (dl-PCB), and docosahexaenoic acid (DHA) were three risk/benefit factors selected as key issues in microbiology, chemistry, and nutrition, respectively. The present model was probabilistic with variability and uncertainty separated using a second-order Monte Carlo simulation process. In this study, advantages and limitations of undertaking probabilistic and interdisciplinary RBA are discussed. In particular, the probabilistic technique was found to be powerful in dealing with missing data and to translate assumptions into quantitative inputs while taking uncertainty into account. In addition, separation of variability and uncertainty strengthened the interpretation of the model outputs by enabling better consideration and distinction of natural heterogeneity from lack of knowledge. Interdisciplinary RBA is necessary to give more structured conclusions and avoid contradictory messages to policymakers and also to consumers, leading to more decisive food recommendations. This assessment provides a conceptual development of the RBA methodology and is a robust basis on which to build upon.
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Affiliation(s)
| | - Enda Cummins
- UCD School of Biosystems and Food Engineering, Dublin, Ireland
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Oza-Frank R, Kachoria R, Dail J, Green J, Walls K, McClead RE. A Quality Improvement Project to Decrease Human Milk Errors in the NICU. Pediatrics 2017; 139:peds.2015-4451. [PMID: 28077623 DOI: 10.1542/peds.2015-4451] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUD AND OBJECTIVE Ensuring safe human milk in the NICU is a complex process with many potential points for error, of which one of the most serious is administration of the wrong milk to the wrong infant. Our objective was to describe a quality improvement initiative that was associated with a reduction in human milk administration errors identified over a 6-year period in a typical, large NICU setting. METHODS We employed a quasi-experimental time series quality improvement initiative by using tools from the model for improvement, Six Sigma methodology, and evidence-based interventions. Scanned errors were identified from the human milk barcode medication administration system. Scanned errors of interest were wrong-milk-to-wrong-infant, expired-milk, or preparation errors. The scanned error rate and the impact of additional improvement interventions from 2009 to 2015 were monitored by using statistical process control charts. RESULTS From 2009 to 2015, the total number of errors scanned declined from 97.1 per 1000 bottles to 10.8. Specifically, the number of expired milk error scans declined from 84.0 per 1000 bottles to 8.9. The number of preparation errors (4.8 per 1000 bottles to 2.2) and wrong-milk-to-wrong-infant errors scanned (8.3 per 1000 bottles to 2.0) also declined. CONCLUSIONS By reducing the number of errors scanned, the number of opportunities for errors also decreased. Interventions that likely had the greatest impact on reducing the number of scanned errors included installation of bedside (versus centralized) scanners and dedicated staff to handle milk.
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Affiliation(s)
- Reena Oza-Frank
- Center for Perinatal Research, .,Research Institute, and.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | | | | | - Jasmine Green
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio; and
| | - Krista Walls
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio; and
| | - Richard E McClead
- Quality Improvement Services, and.,Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio; and
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15
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Peters MD, McArthur A, Munn Z. Safe management of expressed breast milk: A systematic review. Women Birth 2016; 29:473-481. [DOI: 10.1016/j.wombi.2016.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/26/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
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16
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Haiden N, Pimpel B, Assadian O, Binder C, Kreissl A, Repa A, Thanhäuser M, Roberts C, Berger A. Comparison of bacterial counts in expressed breast milk following standard or strict infection control regimens in neonatal intensive care units: compliance of mothers does matter. J Hosp Infect 2016; 92:226-8. [DOI: 10.1016/j.jhin.2015.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Carroll K. Body dirt or liquid gold? How the 'safety' of donated breastmilk is constructed for use in neonatal intensive care. SOCIAL STUDIES OF SCIENCE 2014; 44:466-85. [PMID: 25051591 DOI: 10.1177/0306312714521705] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
When mothers of preterm infants are unable to produce sufficient volumes of breastmilk, neonatologists in many Western countries prescribe pasteurized donor breastmilk. Breastmilk has a paradoxical presence in the neonatal intensive care unit while it has therapeutic properties, it also has the potential to transmit disease. National health authorities and local neonatal intensive care unit policies each delimit the safety of donor milk by focusing on the presence or absence of pathogens. It is in this light that breastmilk from the human milk bank is both sought and legitimated to minimize safety concerns. This research uses data arising from an ethnographic study of two human milk banks and two neonatal intensive care units in the United States, and 73 interviews with milk donors, neonatal intensive care unit parents and clinicians. The primary research question framing the study was 'What are the underlying processes and practices that have enabled donor milk to be endorsed as a safe and legitimate feeding option in neonatal intensive care units?' This study is framed using three key principles of Latour's 'new critique', namely, adding to reality rather than debunking it, getting closer to data rather than turning away from fact and creating arenas in which to assemble. As a result, conceptions of donor milk's safety are expanded. This case study of donor milk demonstrates how Latour's new critique can inform science and technology studies approaches to the study of safety in health care.
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Blouin M, Coulombe M, Rhainds M. Specimen plastic containers used to store expressed breast milk in neonatal care units: a case of precautionary principle. Canadian Journal of Public Health 2014; 105:e218-20. [PMID: 25165843 DOI: 10.17269/cjph.105.4369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/23/2014] [Accepted: 03/29/2014] [Indexed: 11/17/2022]
Abstract
Breast milk is the only milk that meets both the nutritional and immunitary needs of infants. Since breastfeeding is widely promoted, public health measures to preserve the nutritional qualities of expressed breast milk (EBM) should be applied in hospital care settings. The Health Technology Assessment Unit (HTAU) of the Centre hospitalier universitaire de Québec was requested by the Neonatal Care Unit to assess the acceptability of a plastic specimen container, designed to harvest tissues and body fluids, for storing collected EBM. An evidence-based public health perspective approach was taken to evaluate the safety of the specimen container. The HTAU recommended that plastic specimen containers no longer be used for storing EBM and that other options should be evaluated for neonatal care units. These recommendations are in accordance with the public health precaution principle and with legal considerations.
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Affiliation(s)
- Mélissa Blouin
- Health Technology Assessment Unit, Direction of evaluation, quality and strategic planning, CHU de Québec.
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20
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NICU breast milk warming practices and the physiological effects of breast milk feeding temperatures on preterm infants. Adv Neonatal Care 2013; 13:279-87. [PMID: 23912021 DOI: 10.1097/anc.0b013e31829d8c3a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE No evidence-based standards exist for warming breast milk or determining the optimal milk temperature for preterm infants in the neonatal intensive care unit. In this study, we describe current nursing practices for warming breast milk and examine preterm infants' physiological responses to varying milk temperatures. SUBJECTS AND DESIGN Randomly selected experienced neonatal nurses (n = 61) were observed as they prepared and administered breast milk gavage feedings. METHODS We measured the temperature of water baths and breast milk at the beginning and end of the warming period. Physiological responses of the 33 preterm infants cared for by the nurses were observed before feedings and at 5 minutes and 30 minutes after the start of feedings. Gastric residuals were measured 3 hours after the feeds. RESULTS Water bath temperatures ranged from 23.3°C to 45.5°C at the start of warming and from 23.8°C to 38.4°C when milk was removed. Refrigerated milk was 3.8°C to 27.1°C and warmed to 21.8°C to 36.2°C at feeding time. Warming times ranged from 133 to 3061 seconds. Infant axillary temperatures increased at 5 and 30 minutes into the feedings (P < .05), while heart rate, respirations, and oxygen saturation showed no significant changes. CONCLUSIONS Further research is needed to clearly define the risks and benefits of warming infant feedings.
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Cossey V, Vanhole C, Eerdekens A, Rayyan M, Fieuws S, Schuermans A. Pasteurization of mother's own milk for preterm infants does not reduce the incidence of late-onset sepsis. Neonatology 2013; 103:170-6. [PMID: 23258423 DOI: 10.1159/000345419] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 10/25/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Feeding preterm infants human milk has a beneficial effect on the risk of late-onset sepsis (LOS). Due to lack of microbiological standards, practices such as pasteurization of mother's own milk differ widely among neonatal intensive care units worldwide. OBJECTIVES To investigate whether pasteurization of mother's own milk for very-low-birth-weight (VLBW) infants influences the incidence and severity of infection-related outcomes. METHODS In this randomized controlled trial, preterm infants (gestational age <32 weeks and/or birth weight <1,500 g) received either raw or pasteurized mother's own milk during the first 8 weeks of life. The primary outcome was the incidence of proven LOS. A dose-response relation was verified, i.e. the dependence of the risk of sepsis on the actual and cumulative quantities of mother's own milk. RESULTS This study included 303 VLBW infants (mean birth weight: 1,276 g; mean gestational age: 29 weeks) whose baseline and nutritional characteristics were similar. The incidence of laboratory-confirmed sepsis was not statistically different in infants fed raw milk compared to infants who received pasteurized milk: 22/151 (0.15, CI: 0.08-0.20) and 31/152 (0.20, CI: 0.14-0.27), respectively (RR: 0.71; 95% CI: 0.43-1.17). A significant dose-response relation was observed between the adjusted quantity of enteral feeding and the risk of LOS, regardless of the type of feeding. CONCLUSION For preterm infants, pasteurization of mother's own milk shows a trend towards an increase in infectious morbidity, although no statistical significance was reached. Practices should focus on collection, storage and labeling procedures to ensure the safety and quality of expressed milk.
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Affiliation(s)
- Veerle Cossey
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium. veerle.cossey @ uzleuven.be
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Van Gysel M, Cossey V, Fieuws S, Schuermans A. Impact of pasteurization on the antibacterial properties of human milk. Eur J Pediatr 2012; 171:1231-7. [PMID: 22581208 DOI: 10.1007/s00431-012-1750-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/18/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Growing evidence favours the use of human milk for the feeding of preterm newborns based on its many beneficial effects. Despite the many benefits, human milk has been associated as a possible vehicle of transmission for a number of infections. Although pasteurization of human milk can diminish the risk of neonatal infection, it also significantly reduces the concentrations of immunological components in human milk due to thermal damage. In order to evaluate the impact of pasteurization on the antibacterial properties of human milk, we aimed to compare the capacity of raw and pasteurized human milk to inhibit bacterial proliferation. Therefore, a single milk sample was collected from ten healthy lactating mothers. Each sample was divided into two aliquots; one aliquot was pasteurized, while the other was kept raw. Both aliquots were inoculated either with Escherichia coli or Staphylococcus aureus and incubated at 37 °C during 8 h. Viable colony counts from the inoculated samples were performed at regular time points to compare the bacterial growth in both forms of breast milk. Relative to the tryptic soy broth control sample, both raw and pasteurized milk samples exhibited an inhibitory effect on the growth of E. coli and S. aureus. Compared with the raw portion, growth inhibition was significantly lower in the pasteurized milk at every time point beyond T0 (after 2, 4 and 8 h of incubation) (p = 0.0003 for E. coli and p < 0.0001 for S. aureus). CONCLUSION Our study shows that pasteurization adversely affects the antibacterial properties of human milk.
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Affiliation(s)
- Marjan Van Gysel
- Laboratory for Microbiology, Regional Hospital Sint-Maria, Halle, Belgium
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Cossey V, Johansson AB, de Halleux V, Vanhole C. The use of human milk in the neonatal intensive care unit: practices in Belgium and Luxembourg. Breastfeed Med 2012; 7:302-6. [PMID: 22283505 DOI: 10.1089/bfm.2011.0112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Human milk remains the preferred feeding for all infants, including premature and sick newborns. However, mother's milk is not sterile, and expressed milk can be a source of commensal and pathogenic microorganisms. Microbiological quality standards for the use of expressed human milk in hospitals are not available, unlike for donor or formula milk. METHODS To document current practices for the use of human milk in the neonatal intensive care units (NICU) in Belgium and Luxembourg, both for mother's own milk and donor milk, a questionnaire was sent to all 20 neonatal units. RESULTS Of the 19 units that completed the survey, 47% perform bacteriological testing of expressed milk. Applied bacterial count limits for the acceptable level of contamination differ among units, for both commensals and pathogens. Only six units have a device for pasteurizing milk at their disposal. Storage time in the refrigerator for fresh milk varies between 24 hours to 7 days before use. Access to donor milk is limited. CONCLUSIONS Routines for handling of human milk differ widely among NICUs in Belgium and Luxembourg. An assessment of current issues through a structured survey is a useful tool in the development of best practice guidelines.
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Affiliation(s)
- Veerle Cossey
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
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