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Brody N, Oakes C, Huang H, Stansfield BK. Urine sodium concentration and 28-day weight velocity in preterm infants: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:787-792. [PMID: 38958590 DOI: 10.1002/jpen.2668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/10/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Urine sodium concentration has been suggested as a marker to guide enteral sodium supplementation in preterm infants; however, no previous data have demonstrated relationships between urine sodium concentration and postnatal growth. METHODS We performed a single-center retrospective cohort study on 224 preterm infants admitted to the neonatal intensive care unit at the Children's Hospital of Georgia between January 2010 and July 2022. Spot urine sodium was measured in preterm infants (<34 weeks postmenstrual age [PMA]) between days of life (DOLs) 7 and 28. Our exposure of interest was spot urine sodium concentration (milliequivalents per liter) obtained between postnatal days 7 and 28, and our primary outcome was weight velocity (grams per kilograms per day) determined at DOL 28. Statistical relationships were assessed by multivariate analysis with subgroup comparisons by Student t test and analysis of variance. RESULTS In 224 preterm infants (199 ± 17 days, 56% male, 71% Black), urine sodium concentration did not associate with weight velocity at DOL 28 and 36 weeks PMA. Urine sodium concentration was weakly associated with gestational age at birth, and Black preterm infants had higher urine sodium values when compared with "other," but not White preterm infants. CONCLUSION Spot urine sodium during the first month of life does not associate with weight velocity at DOL 28 or 36 weeks PMA.
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Affiliation(s)
- Natalia Brody
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Georgia, Augusta, Georgia, USA
| | - Chelsea Oakes
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Georgia, Augusta, Georgia, USA
| | - Hanwen Huang
- Division of Biostatistics, Data Science, and Epidemiology, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Brian K Stansfield
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Georgia, Augusta, Georgia, USA
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Li H, Chen X, Chen L, Li J, Liu X, Chen C, Xie D, Yuan J, Tao E. Case report: Acute severe hyponatremia-induced seizures in a newborn: a community-acquired case and literature review. Front Pharmacol 2024; 15:1391024. [PMID: 38957388 PMCID: PMC11218545 DOI: 10.3389/fphar.2024.1391024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Severe neonatal hyponatremia represents a critical electrolyte imbalance with potentially severe neurological outcomes, a condition rarely documented in community-acquired, full-term newborns. This report underscores a unique case of a 23-day-old, previously healthy, full-term male neonate experiencing severe hyponatremia that precipitated seizures, underscoring the urgency of prompt recognition and intervention. The neonate presented with symptoms including vomiting, groaning, chills, fixed staring, and limb tremors. Critical findings upon admission encompassed hypothermia, hypotension, tachycardia, and tachypnea accompanied by significant weight loss. The clinical presentation was marked by dehydration, lethargy, weak crying, a fixed gaze, irregular breathing, and coarse lung sounds, yet a distended abdomen, hypertonic limb movements, and recurrent seizures were observed. Immediate interventions included establishing IV access, rewarming, mechanical ventilation, seizure management, volume expansion, dopamine for circulatory support, and initiation of empirical antibiotics. Diagnostic evaluations revealed a sodium ion concentration of 105.9 mmol/L, while amplitude-integrated electroencephalography (aEEG) detected pronounced seizure activity characterized by a lack of sleep-wake rhythmicity, noticeable elevation in both the lower and upper amplitude margins, and a sustained decrease in the lower margin voltage dropping below 5 μV, presenting as sharp or serrated waveforms. The management strategy entailed rapid electrolyte normalization using hypertonic saline and sodium bicarbonate, anticonvulsant therapy, and comprehensive supportive care, with continuous aEEG monitoring until the cessation of seizures. Remarkably, by the third day, the neonate's condition had stabilized, allowing for discharge in good health 10 days post-admission. At a 16-month follow-up, the child exhibited no adverse neurological outcomes and demonstrated favorable growth and development. Our extensive review on the etiology, clinical manifestations, aEEG monitoring, characteristics of seizures induced by severe neonatal hyponatremia, treatment approaches, and the prognosis for seizures triggered by severe hyponatremia aims to deepen the understanding and enhance clinical management of this complex condition. It stresses the importance of early detection, accurate diagnosis, and customized treatment protocols to improve outcomes for affected neonates. Additionally, this review accentuates the indispensable role of aEEG monitoring in managing neonates at elevated risk for seizures. Yet, the safety and efficacy of swiftly administering hypertonic saline for correcting severe hyponatremia-induced seizures necessitate further investigation through medical research.
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Affiliation(s)
- Haiting Li
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Xiyang Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Linlin Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Jie Li
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Xixi Liu
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Caie Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Dengpan Xie
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Junhui Yuan
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Enfu Tao
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
- Department of Science and Education, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
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Schinkel ER, Nelson ER, Kim JH, Perrin MT, Dyer R, Elango R, Bode L, Dallas DC, Lueangsakulthai J, Briere CE, Taylor SN. Point-of-care human milk concentration by passive osmosis: comprehensive analysis of fresh human milk samples. J Perinatol 2024:10.1038/s41372-024-01988-2. [PMID: 38760580 DOI: 10.1038/s41372-024-01988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE Preterm infants need enrichment of human milk (HM) for optimal growth. This study evaluated a novel, point-of-care human milk concentration (HMC) process for water removal from fresh HM samples by passive osmotic concentration. STUDY DESIGN Nineteen fresh HM samples were concentrated by incubation with the HMC devices for 3 h at 4 °C. Pre- and post-concentration HM samples were compared by HM properties for: pH, osmolality, macronutrients, enzyme activity, bioactive, and total cell viability. RESULTS Passive osmotic concentration reduced HM volume by an average of 16.3% ± 3.8% without a significant effect on pH or cell viability. Ten of the 41 HM components did not differ significantly (p > 0.05) between pre- and post-concentration samples. Twenty-three increased within the expected range by volume reduction. Six increased more than expected, two less than expected, and none decreased significantly. CONCLUSION Passive osmotic concentration of fresh HM can concentrate HM components by selective removal of water. HM osmolality and pH remained within neonatal feeding parameters.
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Affiliation(s)
- Elizabeth R Schinkel
- Mother's Milk is Best Inc., R&D, 100 Business Park Drive, Unit #5, Tyngsboro, MA, 01879, USA.
| | - Elizabeth R Nelson
- Mother's Milk is Best Inc., R&D, 100 Business Park Drive, Unit #5, Tyngsboro, MA, 01879, USA.
| | - Jae H Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, 27412, USA
| | - Roger Dyer
- Analytical Core for Metabolomics and Nutrition, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
| | - Rajavel Elango
- Analytical Core for Metabolomics and Nutrition, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H, 3V4, Canada
| | - Lars Bode
- Bode Lab, Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego, CA, 92093, USA
| | - David C Dallas
- Dallas Lab, Nutrition Program, College of Health, Oregon State University, Corvallis, OR, 97331, USA
| | - Jiraporn Lueangsakulthai
- Dallas Lab, Nutrition Program, College of Health, Oregon State University, Corvallis, OR, 97331, USA
| | - Carrie-Ellen Briere
- Briere Lab, Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, 01003, USA
- Institute for Nursing Research and Evidence-Based Practice, Connecticut Children's, Hartford, CT, 06106, US
| | - Sarah N Taylor
- Division of Neonatology, Yale School of Medicine, New Haven, CT, 06520, USA
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Segar JL, Jetton JG. Fluid and electrolyte management in the neonate and what can go wrong. Curr Opin Pediatr 2024; 36:198-203. [PMID: 37962361 PMCID: PMC10932865 DOI: 10.1097/mop.0000000000001308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent advances in understanding fluid and electrolyte homeostasis during the newborn period, including heightened recognition of fluid overload and acute kidney injury contributing to poor clinical outcomes. Particular attention is given towards the care of extremely preterm infants. RECENT FINDINGS Emerging data demonstrate (i) disproportionally large transepidermal water loss in the extremely preterm population, (ii) the relationship between postnatal weight loss (negative fluid balance) and improved outcomes, (iii) the frequency and negative effects of dysnatremias early in life, (iv) the role of sodium homeostasis in optimizing postnatal growth, and (v) the deleterious effects of fluid overload and acute kidney injury. SUMMARY As clinicians care for an increasing number of preterm infants, understanding progress in approaches to fluid and electrolyte management and avoidance of fluid overload states will improve the care and outcomes of this vulnerable population. Further translational and clinical studies are needed to address remaining knowledge gaps and improve current approaches to fluid and electrolyte management.
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Affiliation(s)
- Jeffrey L. Segar
- Sections of Neonatology, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI53226
| | - Jennifer G. Jetton
- Pediatric Nephrology, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI53226
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Parker LA, Koernere R, Fordham K, Bubshait H, Eugene A, Gefre A, Bendixen M. Mother's Own Milk Versus Donor Human Milk: What's the Difference? Crit Care Nurs Clin North Am 2024; 36:119-133. [PMID: 38296370 DOI: 10.1016/j.cnc.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Mother's own milk (MOM) is known to decrease complications in preterm infants and when unavailable, it is recommended that preterm very low-birth weight infants be fed donor human milk (DHM). Due to the pasteurization, processing, and lactation stage of donors, DHM does not contain the same nutritional, immunologic, and microbial components as MOM. This review summarizes the differences between MOM and DHM, the potential effects on health outcomes, and the clinical implications of these differences. Finally, implications for research and clinical practice are discussed.
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Affiliation(s)
- Leslie A Parker
- College of Nursing, University of Florida, Box 100187 College of Nursing, Gainesville, FL, USA.
| | - Rebecca Koernere
- College of Nursing, University of Florida, Box 100187 College of Nursing, Gainesville, FL, USA
| | - Keliy Fordham
- College of Nursing, University of Florida, Box 100187 College of Nursing, Gainesville, FL, USA
| | - Hussah Bubshait
- College of Nursing, University of Florida, Box 100187 College of Nursing, Gainesville, FL, USA
| | - Alissandre Eugene
- College of Nursing, University of Florida, Box 100187 College of Nursing, Gainesville, FL, USA
| | - Adrienne Gefre
- College of Nursing, University of Florida, Box 100187 College of Nursing, Gainesville, FL, USA
| | - Marion Bendixen
- College of Nursing, University of Florida, Box 100187 College of Nursing, Gainesville, FL, USA
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Konukbay D, Kapan E, Yildiz D. Determining Knowledge and Opinions of Neonatal Intensive Care Unit Nurses on Wet-Nursing and Human Milk Banks: A Cross-Sectional Study in Türkiye. J Hum Lact 2023; 39:636-647. [PMID: 37728004 DOI: 10.1177/08903344231196559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Wet nursing and human milk banks are vital sources of human milk for infants unable to breastfeed. RESEARCH AIM This study aims to determine the knowledge and opinions of neonatal intensive care unit nurses regarding wet-nursing and human milk banks in Türkiye. METHODS This descriptive cross-sectional study was conducted with 219 neonatal intensive care unit nurses using an online survey comprising 20 questions. The data were collected between August and September 2021. RESULTS Among the participants, 64.4% (n = 141) expressed that they would be a wet-nurse and 59.8% (n = 131) would search for a wet-nurse if necessary. Some, 47.0% (n = 103) of participants did not know if there were any human milk banks in Türkiye, 53.9% (n = 118) would like to be a donor if human milk banks were established, and 71.7% (n = 157) stated that the establishment of human milk banks should be supported. Religious concerns were the basis for reluctance to donate milk to human milk banks for 60% (n = 51) of the participants. Knowledge was greater and opinions about wet-nursing and human milk banks were more positive for participants with higher education, more time in the neonatal intensive care unit, or work at a tertiary care center. CONCLUSION The approaches of neonatal intensive care unit nurses towards personally being wet-nurses and milk sharing were generally positive, although more information about human milk banks is needed. Religious beliefs are an important consideration when providing information about milk sharing.
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Affiliation(s)
- Dilek Konukbay
- Department of Pediatric Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Türkiye
| | - Emine Kapan
- Department of Pediatric Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Türkiye
| | - Dilek Yildiz
- Department of Pediatric Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Türkiye
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Marin T, Dowell SH, Wright K, Mansuri A, Mann PC. Late-Onset Hyponatremia in Premature Infants. J Perinat Neonatal Nurs 2023; 37:325-331. [PMID: 37115978 DOI: 10.1097/jpn.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Late-onset hyponatremia (LOH) frequently affects premature infants 2 or more weeks of age due to inadequate sodium intake and excessive kidney loss. Late-onset hyponatremia typically occurs in infants who are physiologically stable and is defined as serum sodium of 132 mEq/L or less or between 133 and 135 mEq/L if receiving sodium supplementation. Recent evidence suggests that spot urine sodium levels may improve the recognition of LOH, as low levels of excreted urine reflect a total body sodium deficit and negative balance. Untreated LOH may result in poor somatic growth, neurodevelopmental delay, higher incidence of bronchopulmonary dysplasia, and more severe retinopathy of prematurity. The primary prevention of LOH is to maintain serum sodium between 135 and 145 mEq/L; however, there are currently no formal protocols guiding sodium supplementation. The purpose of this article is to present on overview of LOH pathophysiology and its effect on somatic growth, neurodevelopment outcomes, and other related sequelae. We further discuss general management strategies and describe a protocol for sodium supplementation that is presently undergoing an evaluation for effectiveness.
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Affiliation(s)
- Terri Marin
- Department of Nursing Science, Augusta University, College of Nursing, Augusta, Georgia (Dr Marin); and Departments of Pediatric Nephrology (Dr Mansuri) and Pediatrics, Division of Neonatology (Dr Mann), Medical College of Georgia, Augusta University (Mr Dowell and Ms Wright)
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Gates A, Hair AB, Salas AA, Thompson AB, Stansfield BK. Nutrient Composition of Donor Human Milk and Comparisons to Preterm Human Milk. J Nutr 2023; 153:2622-2630. [PMID: 37517552 DOI: 10.1016/j.tjnut.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Human milk is the preferred diet for very low birth weight (VLBW, <1500 g) infants. When mother's own milk is unable to meet the needs of VLBW infants, donor human milk (DHM) is the preferred alternative. Unfortunately, the composition of DHM remains elusive and no comparative studies between preterm human milk and DHM have been performed previously. OBJECTIVES We aimed to analyze the nutrient content of commercial pooled DHM and compare nutrient content in DHM with that of early and mature preterm human milk. METHODS We analyzed nutrient content in 15 DHM samples provided from 7 commercial milk banks including calories, carbohydrate, fat, protein, sodium, chloride, potassium, zinc, calcium, phosphorus, magnesium, and vitamin D and compared each nutrient to early (7 d of life) and mature (28 d of life) preterm human milk samples (n = 28-36 per nutrient, gestational age = 28 ± 3 wk). Protein-to-energy ratio and carbohydrate-to-nonprotein energy ratio were calculated for each sample and compared. RESULTS Mean values for all macro- and micronutrients in DHM are reported. In comparison to early or mature preterm human milk, DHM had significantly lower protein, sodium, chloride, potassium, and zinc content. Calorie, carbohydrate, calcium, phosphorus, magnesium, and vitamin D content did not differ statistically between DHM and early or mature preterm human milk. Fat content was modestly lower in early but not mature human milk when compared with DHM. CONCLUSIONS We provide mean values for several macro- and micronutrients for DHM and identify key differences between DHM and preterm human milk, which may be considered when designing human milk-based feeding plans. This study was registered at clinicaltrials.gov as NCT05742815.
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Affiliation(s)
- Amy Gates
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA
| | - Amy B Hair
- Department of Pediatrics, College of Medicine, Baylor University, Houston, TX
| | - Ariel A Salas
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Amy B Thompson
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA
| | - Brian K Stansfield
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA.
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Araya BR, Ziegler AA, Grobe CC, Grobe JL, Segar JL. Sodium and Growth in Preterm Infants: A Review. NEWBORN (CLARKSVILLE, MD.) 2023; 2:142-147. [PMID: 37614871 PMCID: PMC10445331 DOI: 10.5005/jp-journals-11002-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Aim This article is intended to review the relationship between sodium homeostasis and growth, outline reasons why preterm infants may become sodium deficient, and share data from our group and others regarding the potential benefits of dietary sodium supplementation. Background Despite tremendous efforts over the past 20 years to optimize neonatal nutrition, postnatal growth failure in preterm infants remains a significant problem. Compelling associations have been identified between in-hospital growth failure and cardiometabolic and neurodevelopmental disorders, heightening the need to further identify the optimal nutritional needs of preterm infants. Results The impact of sodium deficiency may have on somatic growth is poorly studied and reported upon within the human literature. In contrast, animal studies dating back almost 100 years highlight the nutritional importance of dietary sodium. Sodium homeostasis during early postnatal life is understudied and underappreciated by neonatologists. Conclusion Insufficient sodium intake during early life is likely a critical yet underappreciated contributor to growth failure. Total body sodium depletion may be an important risk factor driving complications of premature birth. Clinical significance Increased awareness of sodium homeostasis in preterm infants may improve outcomes in this population. Sodium intake recommendations are provided based on the interpretation of currently available literature.
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Affiliation(s)
- Benjamin R Araya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Alisha A Ziegler
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Connie C Grobe
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Justin L Grobe
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Jeffrey L Segar
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Perrin MT, Gutierrez Dos Santos B, Mansen K, Israel-Ballard K. Global neonatal care and access to human milk. J Pediatr (Rio J) 2022; 98:545-547. [PMID: 35908657 PMCID: PMC9617274 DOI: 10.1016/j.jped.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Maryanne T Perrin
- University of North Carolina Greensboro, Department of Nutrition, Greensboro, United States.
| | | | - Kimberly Mansen
- PATH; Maternal, Newborn and Child Health and Nutrition Program, Seattle, United States
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11
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Cautionary Tales: The Use of Human Milk in Infants Born Preterm. J Pediatr 2022; 244:12-14. [PMID: 35218768 DOI: 10.1016/j.jpeds.2022.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022]
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