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García-Lara NR, Escuder-Vieco D, Cabrera-Lafuente M, Keller K, De Diego-Poncela C, Jiménez-González C, Núñez-Ramos R, Flores-Antón B, Escribano-Palomino E, Alonso-Díaz C, Vázquez-Román S, Ureta-Velasco N, Cruz-Bértolo JDL, Pallás-Alonso CR. Clinical Impact of Supplementation with Pasteurized Donor Human Milk by High-Temperature Short-Time Method versus Holder Method in Extremely Low Birth Weight Infants: A Multicentre Randomized Controlled Trial. Nutrients 2024; 16:1090. [PMID: 38613123 PMCID: PMC11013736 DOI: 10.3390/nu16071090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Nosocomial infections are a frequent and serious problem in extremely low birth weight (ELBW) infants. Donor human milk (DHM) is the best alternative for feeding these babies when mother's own milk (MOM) is not available. Recently, a patented prototype of a High-Temperature Short-Time (HTST) pasteurizer adapted to a human milk bank setting showed a lesser impact on immunologic components. We designed a multicentre randomized controlled trial that investigates whether, in ELBW infants with an insufficient MOM supply, the administration of HTST pasteurized DHM reduces the incidence of confirmed catheter-associated sepsis compared to DHM pasteurized with the Holder method. From birth until 34 weeks postmenstrual age, patients included in the study received DHM, as a supplement, pasteurized by the Holder or HTST method. A total of 213 patients were randomized; 79 (HTST group) and 81 (Holder group) were included in the analysis. We found no difference in the frequency of nosocomial sepsis between the patients of the two methods-41.8% (33/79) of HTST group patients versus 45.7% (37/81) of Holder group patients, relative risk 0.91 (0.64-1.3), p = 0.62. In conclusion, when MOM is not available, supplementing during admission with DHM pasteurized by the HTST versus Holder method might not have an impact on the incidence of catheter-associated sepsis.
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Affiliation(s)
- Nadia Raquel García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Diana Escuder-Vieco
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Marta Cabrera-Lafuente
- Department of Neonatology, La Paz University Hospital, 28046 Madrid, Spain; (M.C.-L.); (C.J.-G.); (E.E.-P.)
- Institute for Health Research–IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
| | - Kristin Keller
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Cristina De Diego-Poncela
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
| | - Concepción Jiménez-González
- Department of Neonatology, La Paz University Hospital, 28046 Madrid, Spain; (M.C.-L.); (C.J.-G.); (E.E.-P.)
- Institute for Health Research–IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
| | - Raquel Núñez-Ramos
- Department of Pediatric Nutrition, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Beatriz Flores-Antón
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Esperanza Escribano-Palomino
- Department of Neonatology, La Paz University Hospital, 28046 Madrid, Spain; (M.C.-L.); (C.J.-G.); (E.E.-P.)
- Institute for Health Research–IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
| | - Clara Alonso-Díaz
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Sara Vázquez-Román
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Noelia Ureta-Velasco
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Javier De La Cruz-Bértolo
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
- Clinical Research Platform IC+12, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen Rosa Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
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Ureta-Velasco N, Montealegre-Pomar A, Keller K, Escuder-Vieco D, Fontecha J, Calvo MV, Megino-Tello J, Serrano JCE, García-Lara NR, Pallás-Alonso CR. Associations of Dietary Intake and Nutrient Status with Micronutrient and Lipid Composition in Breast Milk of Donor Women. Nutrients 2023; 15:3486. [PMID: 37571421 PMCID: PMC10421487 DOI: 10.3390/nu15153486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
The influence of the diet and nutritional status of milk donors on the nutritional composition of donor human milk (DHM) is unknown. The present study aimed to determine the nutritional profile of DHM and the associations between donors' dietary intake and nutritional status and the micronutrient and lipid composition in DHM. For this purpose, 113 donors completed a food frequency questionnaire, provided a five-day weighed dietary record, and collected milk for five consecutive days. Nutrient determinations in donors' erythrocytes, plasma, urine, and milk were performed. Multiple linear regressions were conducted for the evaluation of the associations. We highlight the following results: DHM docosahexaenoic acid (DHA) was positively associated with donors' plasma DHA content and donors' DHA intake (R2 0.45, p < 0.001). For every 1 g/day DHA intake, an increase of 0.38% in DHA content and 0.78% in total omega-3 content was observed in DHM (R2 0.29, p < 0.001). DHM saturated fatty acids were positively associated with erythrocyte dimethyl acetals, plasma stearic acid, trans fatty acids intake, and breastfeeding duration and negatively associated with erythrocyte margaroleic acid (R2 0.34, p < 0.01). DHM cholecalciferol was associated with plasma cholecalciferol levels and dairy intake (R2 0.57, p < 0.01). Other weaker associations were found for free thiamin, free riboflavin, pyridoxal, dehydroascorbic acid, and the lipid profile in DHM. In conclusion, the diet and nutritional status of donors influence the fatty acid profile and micronutrient content of DHM.
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Affiliation(s)
- Noelia Ureta-Velasco
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (N.R.G.-L.); (C.R.P.-A.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Adriana Montealegre-Pomar
- Epidemiología Clínica, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá 110231, Colombia;
| | - Kristin Keller
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Diana Escuder-Vieco
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Javier Fontecha
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain; (J.F.); (M.V.C.); (J.M.-T.)
| | - María V. Calvo
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain; (J.F.); (M.V.C.); (J.M.-T.)
| | - Javier Megino-Tello
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain; (J.F.); (M.V.C.); (J.M.-T.)
| | - José C. E. Serrano
- Department of Experimental Medicine, Faculty of Medicine, University of Lleida, 25008 Lleida, Spain;
| | - Nadia Raquel García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (N.R.G.-L.); (C.R.P.-A.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen R. Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (N.R.G.-L.); (C.R.P.-A.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
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Ureta-Velasco N, Keller K, Escuder-Vieco D, Fontecha J, Calvo MV, Megino-Tello J, Serrano JCE, Romero Ferreiro C, García-Lara NR, Pallás-Alonso CR. Human Milk Composition and Nutritional Status of Omnivore Human Milk Donors Compared with Vegetarian/Vegan Lactating Mothers. Nutrients 2023; 15:nu15081855. [PMID: 37111074 PMCID: PMC10146700 DOI: 10.3390/nu15081855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Women of childbearing age in Western societies are increasingly adopting vegetarian diets. These women are sometimes rejected as milk donors, but little about the composition of their milk is known. The present study aimed to compare the intake, nutritional status, and nutritional composition of human milk from omnivore human milk donors (Donors) and vegetarian/vegan lactating mothers (Veg). Milk, blood, and urine samples from 92 Donors and 20 Veg were used to determine their fatty acid profiles, as well as vitamins and minerals. In a representative sample of both groups, we also determined the lipid class profile as a distribution of neutral and polar lipids, the molecular species of triacylglycerols, and the relative composition of phospholipids in their milk. A dietary assessment was conducted with a five-day dietary record (while considering the intake of supplements). We highlight the following results, expressed as the mean (SE), for the Veg vs. Donors: (1) Their docosahexaenoic acid (DHA) intake was 0.11 (0.03) vs. 0.38 (0.03) g/day; the plasma DHA was 0.37 (0.07) vs. 0.83 (0.06)%; and the milk DHA was 0.15 (0.04) vs. 0.33 (0.02)%. (2) Their milk B12 levels were 545.69 (20.49) vs. 482.89 (4.11) pM; 85% of the Veg reported taking B12 supplements (mean dose: 312.1 mcg/day); and the Veg group showed no differences with Donors in terms of total daily intake or plasma B12. (3) Their milk phosphatidylcholine levels were 26.88 (0.67) vs. 30.55 (1.10)%. (4) Their milk iodine levels were 126.42 (13.37) vs. 159.22 (5.13) mcg/L. In conclusion, the Vegs' milk was shown to be different from the Donors' milk, mainly due to its low DHA content, which is concerning. However, raising awareness and ensuring proper supplementation could bridge this gap, as has already been achieved for cobalamin.
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Affiliation(s)
- Noelia Ureta-Velasco
- Department of Neonatology, Research Institute i+12, 12 de Octubre University Hospital, Complutense University of Madrid, 28041 Madrid, Spain
| | - Kristin Keller
- "Aladina-MGU"-Regional Human Milk Bank, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Diana Escuder-Vieco
- "Aladina-MGU"-Regional Human Milk Bank, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Javier Fontecha
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain
| | - María V Calvo
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain
| | - Javier Megino-Tello
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain
| | - José C E Serrano
- Department of Experimental Medicine, Faculty of Medicine, University of Lleida, 25008 Lleida, Spain
| | - Carmen Romero Ferreiro
- Scientific Support Unit, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Nadia Raquel García-Lara
- Department of Neonatology, Research Institute i+12, 12 de Octubre University Hospital, Complutense University of Madrid, 28041 Madrid, Spain
- "Aladina-MGU"-Regional Human Milk Bank, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen R Pallás-Alonso
- Department of Neonatology, Research Institute i+12, 12 de Octubre University Hospital, Complutense University of Madrid, 28041 Madrid, Spain
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Ureta-Velasco N, Keller K, Escuder-Vieco D, Serrano JCE, García-Lara NR, Pallás-Alonso CR. Assessment of Iodine Concentration in Human Milk from Donors: Implications for Preterm Infants. Nutrients 2022; 14:nu14204304. [PMID: 36296988 PMCID: PMC9612023 DOI: 10.3390/nu14204304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Preterm infants are particularly vulnerable to developing iodine deficiency. Donor human milk (DHM) is the preferred feeding option if the mother’s own milk (MOM) is not available, but information on DHM iodine concentration (DHMIC) is lacking. Hence, we aimed to assess DHMIC to further evaluate the adequacy of iodine provision in preterm infants. Finally, associations that might influence DHMIC were studied. In 113 donors, we measured iodine intake by evaluating dietary records for five consecutive days with the DIAL® Software. From the second day of dietary record, donors provided human milk samples (at least one per day) for four consecutive days. Daily human milk samples were analyzed for DHMIC. A DHMIC ≥ 200 µg/L was considered an adequate iodine content for preterm infants. DHMIC and urine iodine concentration (UIC) were determined using ICP-MS. In our study, 83.2% of donors had a full-term infant. Breastfeeding time range was 1.5−49.4 months. During the dietary record, 55.8% took iodine-containing supplements, providing 40−200 µg/day of iodine. The medians (p25, p75) UIC and DHMIC were 112.4 (75.8, 160.1) and 148.5 (97.6, 206.1) µg/L, respectively. In this iodine-sufficient population, 70% had a DHMIC of <200 µg/L. Donors’ intake of iodine-containing supplements was associated with higher DHMIC.
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Affiliation(s)
- Noelia Ureta-Velasco
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
- Correspondence: ; Tel.: +34-913901929
| | - Kristin Keller
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - Diana Escuder-Vieco
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - José C. E. Serrano
- Department of Experimental Medicine, Medicine Faculty, Lleida University, 25008 Lleida, Spain
| | - Nadia Raquel García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - Carmen R. Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
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Rodríguez-López J, De la Cruz Bértolo J, García-Lara NR, Núñez Vecino JL, Soriano-Ramos M, Asla Elorriaga I, Román Echevarría L, Pellicer A, Marín Huarte N, Vento M, Parra-Llorca A, Cabañas F, González Sánchez R, García-Algar Ó, Martín-Ancel A, Copons Fernández C, González Carrasco E, Beato M, Pallás-Alonso CR. Mother's Bed Incline and Desaturation Episodes in Healthy Term Newborns during Early Skin-to-Skin Contact: A Multicenter Randomized Controlled Trial. Neonatology 2021; 118:702-709. [PMID: 34695832 DOI: 10.1159/000519387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Early skin-to-skin contact (ESSC) is associated with rare, sudden, unexpected postnatal collapse episodes. Placing the newborn in ESSC closer to an upright position may reduce the risk of airway obstruction and improve respiratory mechanics. This study assessed whether a greater inclination of the mother's bed during ESSC would reduce the proportion of healthy term newborns (HTNs) who experienced episodes of pulse oximeter saturation (SpO2) <91%. METHODS We conducted a multicenter randomized controlled trial comparing the effect of the mother's bed incline, 45° versus 15°, on desaturation in HTNs during ESSC. Before delivery on 1,271 dyads, randomization was conducted, and stringent criteria to select healthy mothers and term newborns were monitored until after birth. Preductal SpO2 was continuously monitored between 10 min and 2 h after birth. The primary outcome was the occurrence of at least one episode of SpO2 <91%. RESULTS 254 (20%) mother-infant dyads were eligible for analysis (45°, n = 126; 15°, n = 128). Overall, 57% (95% confidence interval [CI]: 51%-63%) of newborns showed episodes of SpO2 <91%. The proportion of infants with SpO2 <91% episodes was 52% in 45° and 62% in 15° (relative risk: 0.80; 95% CI: 0.6-1.07). CONCLUSIONS We did not show that a high mother bed inclination during ESSC led to significantly fewer HTNs who experienced episodes of SpO2 <91%. Desaturation episodes from 10 min to 2 h after birth occurred in more than half of HTNs.
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Affiliation(s)
- Jesús Rodríguez-López
- Department of Neonatology, Health Research Institute Imas12, Complutense University, Madrid, Spain
| | | | - Nadia Raquel García-Lara
- Department of Neonatology, Health Research Institute Imas12, Complutense University, Madrid, Spain
| | - José Luis Núñez Vecino
- Department of Neonatology, Health Research Institute Imas12, Complutense University, Madrid, Spain
| | - María Soriano-Ramos
- Department of Neonatology, Health Research Institute Imas12, Complutense University, Madrid, Spain
| | | | | | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | | | - Máximo Vento
- Division of Neonatology, Neonatal Research Group, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Anna Parra-Llorca
- Division of Neonatology, Neonatal Research Group, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Fernando Cabañas
- Department of Pediatrics and Neonatology, Quirónsalud Madrid University Hospital, Madrid, Spain
| | - Raquel González Sánchez
- Department of Pediatrics and Neonatology, Quirónsalud Madrid University Hospital, Madrid, Spain
| | - Óscar García-Algar
- Neonatology Unit, ICGON, IDIBAPS, Hospital Clinic-Maternitat, Barcelona, Spain
| | - Ana Martín-Ancel
- Neonatology Unit, Sant Joan de Déu University Hospital and Clínic University Hospital, Barcelona, Spain
| | | | | | - Maite Beato
- Neonatology Unit, Severo Ochoa University Hospital, Madrid, Spain
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García-Lara NR, Carbayo Jiménez T, Pérez Rivilla A, Pallás Alonso CR. Cruces de leche materna en las unidades neonatales. An Pediatr (Barc) 2019; 91:359-360. [DOI: 10.1016/j.anpedi.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022] Open
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Abstract
Inducing lactation in the absence of pregnancy (nonpuerperal lactation) is not always successful and, in many cases, only partial breastfeeding is achieved. Different protocols have been described, but scientific evidence and research are lacking in this area. The authors describe the case of a woman with a history of a miscarriage, for whom the lactation induction process was so effective that she became a milk donor even before she received her adopted child. She had not previously used hormone treatment. She was given domperidone as a galactogogue for 1 month. The pumping protocol began with a double electric breast pump combined with manual pumping 6 months before her child was delivered, and 3 months later, she was accepted as a donor by our milk bank. This highlights the importance of regular stimulation as a milk production mechanism. This is the first case of human milk donation in an adoptive mother described in the literature.
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Vázquez-Román S, Escuder-Vieco D, García-Lara NR, Alonso-Díaz C, Lora D, Martín-Pelegrina MD, Pallás-Alonso CR. Impact of Freezing Time on Dornic Acidity in Three Types of Milk: Raw Donor Milk, Mother's Own Milk, and Pasteurized Donor Milk. Breastfeed Med 2016; 11:91-3. [PMID: 26800010 DOI: 10.1089/bfm.2015.0178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Although under certain circumstances it is necessary to express milk, there are not many recommendations about the ideal storage conditions for human milk. The objectives of this study were to analyze the effects on Dornic acidity of frozen storage at -20 °C in three types of milk: raw donor milk, mother's own raw milk, and pasteurized donor milk. METHODS Forty-three samples of raw donor milk, 40 samples of pasteurized donor milk, and 16 samples of mother's own milk were analyzed. Dornic acidity was measured at time 0, before freezing. The remaining aliquots were frozen and analyzed after 1, 2, 3, and 4 weeks and after 2 and 3 months. RESULTS In raw donor milk, the median acidity at the start was 3 °D (interquartile range [IQR] 2-3 °D); after 3 months, it was 5 °D (IQR 3-7 °D), with a significant increase in acidity after the second week. In mother's own milk, the mean acidity at the start was 3 °D (IQR 2-4 °D) and 7 °D (IQR 4-8 °D) at 3 months. The increase was significant after the third week. In pasteurized donor milk, the mean acidity was 3 °D (IQR 2-3 °D) at the start and 2 °D (IQR 2-3 °D) at the end. When comparing the three types of milk, there were significant differences from the first week between the two types of raw milk and the pasteurized milk (p < 0.01), but not between the two raw milks (p = 0.77). CONCLUSIONS Dornic acidity in unpasteurized milk significantly increases with the duration of freezing, probably due to the action of lipases, which is lost with pasteurization. It would be advisable to reduce the length of freezing time for unpasteurized milk.
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Affiliation(s)
| | | | | | | | - David Lora
- Department of Neonatology, Hospital 12 de Octubre , Madrid, Spain
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García-Lara NR, Escuder-Vieco D, Alonso Díaz C, Vázquez Román S, De la Cruz-Bértolo J, Pallás-Alonso CR. Type of homogenization and fat loss during continuous infusion of human milk. J Hum Lact 2014; 30:436-41. [PMID: 25122692 DOI: 10.1177/0890334414546044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Substantial fat loss may occur during continuous feeding of human milk (HM). A decrease of fat loss has been described following homogenization. Well-established methods of homogenization of HM for routine use in the neonatal intensive care unit (NICU) would be desirable. OBJECTIVE We compared the loss of fat based on the use of 3 different methods for homogenizing thawed HM during continuous feeding. METHODS Sixteen frozen donor HM samples were thawed, homogenized with ultrasound and separated into 3 aliquots ("baseline agitation," "hourly agitation," and "ultrasound"), and then frozen for 48 hours. Aliquots were thawed again and a baseline agitation was applied. Subsequently, aliquots baseline agitation and hourly agitation were drawn into a syringe, while ultrasound was applied to aliquot ultrasound before it was drawn into a syringe. The syringes were loaded into a pump (2 mL/h; 4 hours). At hourly intervals the hourly agitation infusion was stopped, the syringe was disconnected and gently shaken. During infusion, samples from the 3 groups were collected hourly for analysis of fat and caloric content. RESULTS The 3 groups of homogenization showed similar fat content at the beginning of the infusion. For fat, mean (SD) hourly changes of -0.03 (0.01), -0.09 (0.01), and -0.09 (0.01) g/dL were observed for the hourly agitation, baseline agitation, and ultrasound groups, respectively. The decrease was smaller for the hourly agitation group (P < .001). CONCLUSION When thawed HM is continuously infused, a smaller fat loss is observed when syringes are agitated hourly versus when ultrasound or a baseline homogenization is used.
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Sierra-Colomina G, García-Lara NR, Escuder-Vieco D, Alonso-Díaz C, Esteban EMA, Pallás-Alonso CR. Donor milk volume and characteristics of donors and their children. Early Hum Dev 2014; 90:209-12. [PMID: 24581867 DOI: 10.1016/j.earlhumdev.2014.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/18/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Little is known regarding the effect of the characteristics of donors and their children on the volume of donor milk delivered to a human milk bank (HMB). AIMS Our study aimed to determine the relationship between different social and demographic variables of donors and their infants with the volume of human milk delivered. METHODS We included donors accepted at the Hospital Doce de Octubre HMB from January 1st, 2009 until April 31st, 2013, and who had finished their donation. Data of social and demographic characteristics of the donors and their children, and the total volume of DHM given were obtained from our HMB database. Included variables were previous donors, donor age, number of children, place of residence, gestational age of the infant at birth, child's age at the start of the donation, hospital admission, and death of the infant. A linear regression model was used to study the relationship between independent variables that were significant in bivariate analysis and the volume of donated milk. RESULTS A total of 415 donations from 391 women were included. The median volume of milk delivered was 3.1l (IQR-interquartile range-1.3-8.3l). In the linear regression model, previous donors, smaller gestational age of children, and the start of donation at earlier stages of lactation were associated with a larger quantity of HMB donated (p≤0.001). CONCLUSION Previous donors, smaller gestational age of children, and the start of donation at earlier stages of lactation are associated with a larger quantity of milk donated to the HMB.
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Affiliation(s)
| | - Nadia Raquel García-Lara
- Department of Neonatology, 12 de Octubre Hospital, Madrid, Spain; SAMID (Spanish Collaborative Maternal and Children Research) Network, Spain.
| | - Diana Escuder-Vieco
- Department of Neonatology, 12 de Octubre Hospital, Madrid, Spain; SAMID (Spanish Collaborative Maternal and Children Research) Network, Spain
| | | | | | - Carmen Rosa Pallás-Alonso
- Department of Neonatology, 12 de Octubre Hospital, Madrid, Spain; SAMID (Spanish Collaborative Maternal and Children Research) Network, Spain
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Escuder-Vieco D, Garcia-Algar Ó, Pichini S, Pacifici R, García-Lara NR, Pallás-Alonso CR. Validation of a screening questionnaire for a human milk bank to determine the presence of illegal drugs, nicotine, and caffeine. J Pediatr 2014; 164:811-4. [PMID: 24388325 DOI: 10.1016/j.jpeds.2013.11.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 10/29/2013] [Accepted: 11/19/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To validate the health and lifestyle questionnaire answered by donors to a human milk bank with respect to the presence of illegal drugs, nicotine, and caffeine levels in donor milk. STUDY DESIGN A total of 400 human milk samples from 63 donors were analyzed by liquid chromatography tandem mass spectrometry for the presence of 14 illegal drugs, nicotine, and caffeine. Demographics and clinical and lifestyle data (illegal drugs, tobacco, and caffeinated beverage use) were collected from the required screening questionnaire of a human milk bank. The relationship between the 2 evaluation techniques was determined. RESULTS Illegal drugs were not found in donor milk. Nicotine (46.1 ng/mL) and cotinine (138.6 ng/mL) were quantified in one milk sample from a donor who did not report tobacco use in the questionnaire (1.6% false negative). Caffeine was detected in 45.3% (181/400) of the total milk samples, with a mean concentration of 496 ± 778 ng/mL. The sensitivity and specificity of the questionnaire to detect caffeine in donor milk was 46% and 77%, respectively. CONCLUSIONS The lifestyle questionnaire is reliable for the assessment of illicit drug use by donors to a human milk bank, but there are certain limitations regarding the identification of second-hand smoke exposure and the disclosure of consumption of caffeinated beverages. Data such as smoking habits of partners, type and volume of beverage or food containing caffeine, method of preparation, and time of day of consumption should be collected by the questionnaire.
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Affiliation(s)
- Diana Escuder-Vieco
- Department of Neonatology, Hospital 12 de Octubre, Madrid, Spain; SAMID Network (Spanish Collaborative Maternal and Child Health Research Network), Barcelona, Spain.
| | - Óscar Garcia-Algar
- SAMID Network (Spanish Collaborative Maternal and Child Health Research Network), Barcelona, Spain; URIE, Hospital del Mar, Institut Municipal d`Investigacio Medica (IMIM), Parc de Salut Mar, Barcelona, Spain
| | | | | | - Nadia Raquel García-Lara
- Department of Neonatology, Hospital 12 de Octubre, Madrid, Spain; SAMID Network (Spanish Collaborative Maternal and Child Health Research Network), Barcelona, Spain
| | - Carmen Rosa Pallás-Alonso
- Department of Neonatology, Hospital 12 de Octubre, Madrid, Spain; SAMID Network (Spanish Collaborative Maternal and Child Health Research Network), Barcelona, Spain
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García-Lara NR, Escuder-Vieco D, García-Algar O, De la Cruz J, Lora D, Pallás-Alonso C. Effect of freezing time on macronutrients and energy content of breastmilk. Breastfeed Med 2012; 7:295-301. [PMID: 22047109 PMCID: PMC3411345 DOI: 10.1089/bfm.2011.0079] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In neonatal units and human milk banks freezing breastmilk at less than -20 °C is the choice for preserving it. Scientific evidence in relation to the loss of nutritional quality during freezing is rare. Our main aim in this study is to determine the effect of freezing time up to 3 months on the content of fat, total nitrogen, lactose, and energy. Our secondary aim is to assess whether ultrasonic homogenization of samples enables a more suitable reading of breastmilk macronutrients with a human milk analyzer (HMA) (MIRIS, Uppsala, Sweden). METHODS Refrigerated breastmilk samples were collected. Each sample was divided into six pairs of aliquots. One pair was analyzed on day 0, and the remaining pairs were frozen and analyzed, one each at 7, 15, 30, 60, and 90 days later. For each pair, one aliquot was homogenized by stirring, and the other by applying ultrasound. Samples were analyzed with the HMA. RESULTS By 3 months from freezing with the two homogenization methods, we observed a relevant and significant decline in the concentration of fat and energy content. The modification of total nitrogen and lactose was not constant and of lower magnitude. The absolute concentration of all macronutrients and calories was greater with ultrasonic homogenization. CONCLUSIONS After 3 months from freezing at -20 °C, an important decrease in fat and caloric content is observed. Correct homogenization is fundamental for correct nutritional analysis.
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