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Maryanne T Perrin - One of the best experts on this subject based on the ideXlab platform.
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Accuracy and Reliability of Infrared Analyzers for Measuring Human Milk Macronutrients in a Milk Bank Setting
Current developments in nutrition, 2019Co-Authors: Maryanne T Perrin, Jannette Festival, Shaina Starks, Lesley Mondeaux, Elizabeth A. Brownell, Amy VickersAbstract:Background: Infrared (IR) analysis is an emerging technology that may be a useful tool for Milk Banks to manage the nutrient variability in donor human Milk. Objective: To evaluate the accuracy, reliability, and comparability of commercial infrared analyzers for measuring human Milk macronutrients in a Milk Bank setting. Methods: Three nonprofit Milk Banks received blinded test kits of human Milk that had been assessed using reference methods. Four infrared instruments were used to measure macronutrients as follows: 1 filtered mid-IR, 2 Fourier-transformed full-spectra mid-IR, and 1 near-IR. Twenty-five unique samples were read concurrently for the accuracy arm. An identical sample was read daily for 1 mo for the reliability arm. Results: Values for R2 describing relationships with reference methods for total fat, crude protein, and lactose, were as follows: filtered mid-IR, 0.98, 0.94, and 0.48; Fourier-transformed full-spectra mid-IR, 0.97, 0.93, and 0.36 for instrument 1 and 0.98, 0.98, and 0.31 for instrument 2; and near-IR 0.93, 0.93, and 0.12. There was no significant difference between instruments for crude protein and total fat measurements. There were significant differences in carbohydrate measurements between instruments. For 1 mo of daily measurements in the reliability arm, CVs for filtered mid-IR were =4.6%, for Fourier-transformed full spectra mid-IR were =1.7%, and for near-IR were =5.1%. Conclusions: Infrared analysis is an accurate and reliable method for measuring crude protein and total fat in a Milk Bank setting. Carbohydrate measurements are less accurate and are significantly different between instruments, which will likely lead to differences in derived calorie values.
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macronutrient variability in human Milk from donors to a Milk Bank implications for feeding preterm infants
PLOS ONE, 2019Co-Authors: Ashley John, Lisa M Maillart, Andrew J Schaefer, Erin Hamilton Spence, Maryanne T PerrinAbstract:BACKGROUND AND OBJECTIVE: The composition of human Milk varies widely and impacts the ability to meet nutrient requirements for preterm infants. The purpose of this study is to use a large dataset of Milk composition from donors to a Milk Bank to: (1) describe the macronutrient variability in human Milk and how it contributes to the ability to meet the protein and calorie targets for the preterm infant using fortification with commercially available multi-nutrient fortifiers; (2) assess how temporal versus subject effects explain macronutrient variability; (3) determine how macronutrient variability contributes to the nutrient distribution in pooled donor Milk. METHODS: This is a retrospective, observational study that analyzes the macronutrient data of 1,119 human Milk samples from 443 individual donors to a Milk Bank. We test fortification strategies with potential basic, intermediate, and high protein and calorie commercial fortifiers. Additionally, we simulate the random pooling of multiple donors to model the impact of macronutrient variability on pooled donor Milk. RESULTS: Fat was the most variable nutrient and accounted for 80% of the difference in calories. A subject-effect predicted more of the variability after 4 weeks postpartum in all macronutrients (R2 > = 0.50) than a time-effect (R2 < = 0.28). When pooling multiple donors, variability was reduced by increasing the number of donors randomly selected for a pool or targeted pooling based on macronutrient analysis of donor pools. Over 75% of mature Milk samples fortified with a basic protein fortifier did not meet daily protein targets of 3.5 g/kg without exceeding volumes of 160 ml/kg/day. CONCLUSION: There is a strong individual signature to human Milk that impacts the pooling of donor Milk, and the ability to meet protein and energy requirements for the preterm infant with basic and intermediate protein and calorie fortifiers.
Carmen Rosa Pallás-alonso - One of the best experts on this subject based on the ideXlab platform.
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High-Temperature Short-Time Pasteurization System for Donor Milk in a Human Milk Bank Setting.
Frontiers in microbiology, 2018Co-Authors: Diana Escuder-vieco, Carmen Rosa Pallás-alonso, Irene Espinosa-martos, Juan M. Rodríguez, Nieves Corzo, Antonia Montilla, Pablo Siegfried, Leónides FernándezAbstract:Donor Milk is the best alternative for the feeding of preterm newborns when mother’s own Milk is unavailable. For safety reasons, it is usually pasteurized by the Holder method (62.5oC for 30 min). Holder pasteurization results in a microbiological safe product but impairs the activity of many biologically active compounds such as immunoglobulins, enzymes, cytokines, growth factors, hormones or oxidative stress markers. High-temperature short-time (HTST) pasteurization has been proposed as an alternative for a better preservation of some of the biological components of human Milk although, at present, there is no equipment available to perform this treatment under the current conditions of a human Milk Bank. In this work, the specific needs of a human Milk Bank setting were considered to design an HTST equipment for the continuous and adaptable (time-temperature combination) processing of donor Milk. Microbiological quality, activity of indicator enzymes and indices for thermal damage of Milk were evaluated before and after HTST treatment of 14 batches of donor Milk using different temperature and time combinations and compared to the results obtained after Holder pasteurization. The HTST system has accurate and simple operation, allows the pasteurization of variable amounts of donor Milk and reduces processing time and labor force. HTST processing at 72oC for, at least, 10 s efficiently destroyed all vegetative forms of microorganisms present initially in raw donor Milk although sporulated Bacillus sp. survived this treatment. Alkaline phosphatase was completely destroyed after HTST processing at 72 and 75oC, but γ-glutamil transpeptidase showed higher thermoresistance. Furosine concentrations in HTST-treated donor Milk were lower than after Holder pasteurization and lactulose content for HTST-treated donor Milk was below the detection limit of analytical method (10 mg/L). In conclusion, processing of donor Milk at 72oC for at least 10 s in this HTST system allows to achieve the microbiological safety objectives established in the Milk Bank while having a lower impact regarding the heat damage of the Milk.
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Validation of a screening questionnaire for a human Milk Bank to determine the presence of illegal drugs, nicotine, and caffeine.
The Journal of pediatrics, 2013Co-Authors: Diana Escuder-vieco, Oscar Garcia-algar, Simona Pichini, Roberta Pacifici, Nadia Raquel García-lara, Carmen Rosa Pallás-alonsoAbstract: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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Clinical impact of opening a human Milk Bank in a neonatal unit
Anales de pediatria (Barcelona Spain : 2003), 2013Co-Authors: S. Vázquez-román, G. Bustos-lozano, M. López-maestro, J. Rodríguez-lópez, C. Orbea-gallardo, M. Samaniego-fernández, Carmen Rosa Pallás-alonsoAbstract:Abstract Introduction The benefits of donor human Milk compared with artificial formulas have been well demonstrated; nevertheless the impact on the clinical practice of opening a human Milk Bank within a neonatal unit has not yet been studied. The main aim of this study was to analyse the impact on the clinical practice of opening a human Milk Bank in a neonatal unit to provide donor human Milk for preterm infants ≤32 weeks of gestational age. Methods A before and after study of the opening of a human Milk Bank was performed. Preterm infants ≤32 weeks of gestational age born in the Hospital 12 de Octubre from July to December 2005 and January to June 2008 (firsts 6 months after opening the human Milk Bank) were included. Results After opening the human Milk Bank, enteral feedings began 31 h earlier ( p p p = 0.002). Enteral feedings were never started LM with artificial formula, the exposure to formula in the first 15 days of life was reduced from 50% to 16.6%, and its consumption during the first 28 days of life was significantly reduced. There was a higher consumption of own mother's Milk during the hospital stay, and a higher rate of exclusive breastfeeding at hospital discharge (54% vs 40%). Conclusions The availability of donor human Milk has led to quicker progression with enteral feedings and earlier withdrawal of parenteral nutrition. It has reduced the exposure to artificial formulas, and has also increased the intake of own mother's Milk during the hospital stay and the rate of exclusive breastfeeding at hospital discharge.
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Does opening a Milk Bank in a neonatal unit change infant feeding practices? A before and after study
International Breastfeeding Journal, 2010Co-Authors: María Isabel Utrera Torres, S. Vázquez-román, Carmen Medina López, Clara Alonso Díaz, Jaime Cruz-rojo, Elisa Fernández Cooke, Carmen Rosa Pallás-alonsoAbstract:Background Donor human Milk Banks are much more than simple centers for collection, storage, processing, and distribution of donor human Milk, as they cover other aspects and represent a real opportunity to promote and support breastfeeding. The aim of our study is to assess the impact that opening a human Milk Bank has had on the proportion of infants receiving exclusive breast Milk at discharge and other aspects related to feeding children with birth weight < or = 1500 g or < 32 weeks gestation admitted to the neonatal unit. Methods The study included babies of < or = 1500 g or < 32 weeks gestation. Fifty infants born from February to July in 2006, before the opening of the human Milk Bank, and 54 born from February to July in 2008, after its opening, met inclusive criteria. We collected data about days of hospital stay, hours of life when feeding was started, hours of life when full enteral feeding was attained, the type of Milk received during admission, and the type of feeding on discharge. Results Children born in 2008 commenced feeding 16 hours earlier than those born in 2006 (p = 0.00). The proportion of infants receiving exclusive breast Milk at discharge was 54% in 2006 and 56% in 2008 (p = 0.87). The number of days they received their mother's own Milk during the first 28 days of life was 24.2 days in 2006, compared to 23.7 days in 2008 (p = 0.70). In 2006, 60% of infants received infant formula at least once in the first 28 days of life, compared to 37% in 2008 (p = 0.01). Conclusions The opening of a donor human Milk Bank in a neonatal unit did not reduce the proportion of infants exclusively fed with breast Milk at discharge, but did reduce the proportion of infants that received infant formula during the first four weeks of life. Also, having donor human Milk available enables commencement of enteral feeding earlier.
Neena Modi - One of the best experts on this subject based on the ideXlab platform.
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macronutrient content of donor Milk from a regional human Milk Bank variation with donor mother infant characteristics
British Journal of Nutrition, 2019Co-Authors: Luke Mills, Lynda Coulter, Emma Savage, Neena ModiAbstract:Better understanding of the variation in macronutrient content of human donor Milk (HDM) potentiates targeted nutrition for preterm babies. The present study describes the relationship of maternal age, parity, monthly lactation stage estimate (LSEm), daily volume of Milk expressed (Vd), sex, gestation and birth weight z scores with macronutrient content of HDM. Multilevel mother–infant pair ID random intercept models were performed using the predictor variables above on the outcome HDM macronutrient content determined using mid-IR spectroscopy. Mean macronutrient content was also compared by gestational age and small for gestational age (SGA) (z score < –1·28) or appropriate for gestational age (AGA) (z score ≥ –1·28) categories. A total of 2966 samples of donations from 1175 mother–infant pairs to the UK Northwest Human Milk Bank between 2011 and 2017 were analysed. Mean protein, fat, carbohydrate and calculated energy were 0·89 (SD 0·24) g/dl, 2·99 (SD 0·96) g/dl, 7·09 (SD 0·44) g/dl, and 60·37 (SD 8·41) kcal/dl (252·59 (SD 35·19) kJ/dl), respectively. Preterm SGA HDM was significantly higher in protein, fat and energy content than term AGA HDM and significantly lower in carbohydrate content than term AGA HDM after controlling for LSEm, Vd and between-subject effects. Degree of prematurity did not influence macronutrient content. Between-subject effects accounted for more of the variance in macronutrient content than the fixed effects in the model. Despite this, SGA status, as well as prematurity, may be an important determinant of macronutrient content in human Milk. As bioavailability of macronutrients from HDM is uncertain, studies evaluating growth and body composition in preterm and SGA babies fed HDM are warranted.
Steven J Gross - One of the best experts on this subject based on the ideXlab platform.
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low rate of necrotizing enterocolitis in extremely low birth weight infants using a hospital based preterm Milk Bank
Journal of Perinatology, 2019Co-Authors: Swati Murthy, Pamela R Parker, Steven J GrossAbstract:We examined the effect of two strategies to prevent necrotizing enterocolitis (NEC) in extremely low birth weight (ELBW) infants—adherence to a standardized feeding protocol and use of a hospital-based Milk Bank to provide exclusive preterm human Milk feedings. We conducted a single-center observational study from 2010 to 2015. Infants received preterm human Milk, initially trophic feeds from days 7 to 14 after birth, followed by advancement of 15 mL/kg/day to reach a goal of 180 mL/kg/day. Fortification was used selectively for weight gain < 15 g/kg/day. We determined the incidence of NEC, other morbidities, and growth. The cohort included 398 ELBW infants who survived to day 14 without congenital anomalies. Mean gestational age was 26.2 ± 1.9 weeks. Maternal Milk was used as the sole feeding in 62% of infants; preterm donor Milk was used solely or as supplement in 29%. Full feeds were reached at a median of 27 (IQR 23, 33) days. Four infants (1%) developed NEC. Use of standardized feedings with a hospital-based Milk Bank is associated with an incidence of NEC lower than previously reported.
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Low rate of necrotizing enterocolitis in extremely low birth weight infants using a hospital-based preterm Milk Bank.
Journal of perinatology : official journal of the California Perinatal Association, 2018Co-Authors: Swati Murthy, Pamela R Parker, Steven J GrossAbstract:We examined the effect of two strategies to prevent necrotizing enterocolitis (NEC) in extremely low birth weight (ELBW) infants—adherence to a standardized feeding protocol and use of a hospital-based Milk Bank to provide exclusive preterm human Milk feedings. We conducted a single-center observational study from 2010 to 2015. Infants received preterm human Milk, initially trophic feeds from days 7 to 14 after birth, followed by advancement of 15 mL/kg/day to reach a goal of 180 mL/kg/day. Fortification was used selectively for weight gain
Ja Hurtado Suazo - One of the best experts on this subject based on the ideXlab platform.
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PO-0607 Advising Milk Donation To A Hospital Milk Bank. Quality Analysis
Archives of Disease in Childhood, 2014Co-Authors: L Zamorano Bonilla, L Serrano López, M Peña Caballero, V Jiménez Cabanillas, E Martín Alvarez, Ja Hurtado SuazoAbstract:Introduction Increasing needs of human donor Milk in the Neonatal Units have arised the interest to develop attention points for donors in hospital where the Milk Bank is not present. Objectives To analyse the activity of the external points for donors attention of the Hospital " Virgen de las Nieves" Milk Bank. Assessment of quality of the process of theses points. Methods Staff members from theses centres were trained, visiting the Milk Bank and with written protocol. A transfer system was stablished with refrigerators and temperature records along the process. The hospital Milk Bank is responsable for ensuring the traceability of the process. Several variables were analysed and compared: acidity, microbiological culture and volume of pasteurised Milk rejected during 2013. Results Two points of attention for Milk donors have been operating regularly since 2012. Total number of donors was 43 and 158 litres of donor Milk were collected. Analysing the percentage of rejected Milk according to its origin:4% the volume received in the Bank was not processed, 12% point 2 and 8%point 1 were discarded. This difference lead us to the revision of the storage system, transportation and adequate information for hygiene during Milk collection. Results in Table 1 and 2. Comments Procedures for donors attention, registration, storage, transportation and Milk collection from attention points to the Milk Bank should preserve the security and quality. The comparison of average acidity according to the origin of Milk, coul be an adequate advisor in order to promote better strategies to minimise the percentage of rejected Milk.
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PO-0594 Who Is The Receptor Of Donor Milk From A Hospital Milk Bank?
Archives of Disease in Childhood, 2014Co-Authors: Mv Jimenez Cabanillas, L Zamorano Bonilla, L Serrano López, M Peña Caballero, E Martín Alvarez, Ja Hurtado SuazoAbstract:Objective To analyse if the recipients profile has changed since the implementation of a human Milk Bank (HMB) in the Neonatal Unit of a tertiary hospital, as well as the clinical indications of donor Milk (DM). Material and methods A descriptive research has been carried out by revising the HMB database from June 2010 to December 2013. The following variables were taken into account: gestational age (GA), birth weight (BW), time of DM reception and reasons for the DM administration. Results During the researched period, 255 newborn received DM in our centre: 29 (2010), 75 (2011), 84 (2012), 67 (2013). The average GA was 31. BW was 1575 g. Average duration ofintake was 17 days. Annual stratified analysis: In 2010, the average GA is 31 and the average BW is 1335 g. In 2011, 31 weeks and 1657 g. In 2012, 31 weeks and 1657 g. In 2013, 31 weeks and1688 g. Prematurity was the main indication for dispensing DM and enteral feeding intolerance is becoming an important indication for DM. In 15% of recipients in 2013, this was the reason for prescription. Conclusions According to the present information the main reasons for giving DM have been prematurity and low birth weight (63% of all recipients were premature babies born before 32 weeks). The number of children who take advantage of donor Milk has increased as the human Milk Bank has provided higher amounts of DM in our centre. The administering indications for DM have been also increased, outlining the enteral feeding difficulties.