Evaluación del valor de acidez Dornic de la leche humana según el tiempo de conservación en freezer y el lugar de extracción / Assessment of Dornic acidity in breast milk based on storage time in the freezer and place of expression

Introducción. El grado de acidez Dornic (AD), medida indirecta del grado de contaminación de la leche humana cruda (LHC), proporciona información sobre la calidad de esta. Recién extraída, el valor oscila entre 1,0° y 4,0° (óptimo). Descalifica el consumo si es >8,0 °D. Se evaluó la correlación de la AD de la LHC de donantes internas (DI) y externas (DE) según el tiempo de conservación hasta la pasteurización, y se determinó la prevalencia de AD ≤4 ºD. Población y método. Estudio retrospectivo analítico. Resultados. Sobre 13 203 muestras, la AD a partir del día 14 de conservación fue menor en las donantes internas, de 2,92; (IC95% 2,69-3,15) versus 4,01 (IC95%: 3,94-4,08); p <0,001] con mayor proporción de AD ≤4 ºD (88 % en DI versus 76 % en DE); OR: 2,30 (IC95%: 1,25-4,24); p = 0,003. Coeficiente de correlación para las DI: R 2 :0; p = 1). Conclusión. La AD a partir del día 14 fue menor en DI, presentando mayor prevalencia de AD ≤ 4ºD. No existió correlación entre el tiempo de conservación y la AD en las DI.

Introduction. The degree of Dornic acidity (DA) is an indirect measure of milk contamination and quality. In freshly expressed milk, DA ranges between 1.0 and 4.0 (optimal). If DA is > 8.0 °D, it should be discarded. The correlation between DA in raw breast milk from internal donors (ID) and external donors (ED) based on storage time until pasteurization was assessed. Population and method. Retrospective, analytical study. Results. In 13 203 samples, DA was lower in IDs as of 14 days of storage: 2.92 (95% CI: 2.69­3.15) versus 4.01 (95% CI: 3.94­4.08), with a higher proportion of DA ≤ 4 °D (88% in IDs versus 76% in EDs); odds ratio: 2.30 (95% CI: 1.25­4.24). Conclusion. DA as of 14 days of storage was lower in IDs, with a higher prevalence of DA ≤ 4 °D. No correlation was observed between storage time and DA in ID samples.

Factors associated with early weaning in the human milk bank of a university hospital / Fatores associados ao desmame precoce em banco de leite humano de hospital universitário

Abstract Objectives: to identify the sociodemographic, obstetric, and breastfeeding factors associated with early weaning in a human milk bank. Methods: data from maternal and child evaluation forms of women assisted at the human milk bank of the Federal University of Maranhão university hospital in 2016, 2017 and 2018 were compiled. Results: of the 1,276 forms evaluated, 1,275 (99.9%) had information about early weaning (outcome variable), which was identified in 30.6% of assisted pairs. The frequency of early weaning was higher among mothers who had already breastfed (169-31%) [p=0.0235, OR=4.03; CI95%=1.21-13.46] and among mothers who had "household" occupation (204-36%) [p<0.0001, OR=1.58, CI95%=1.24-2.00]. The other independent variables evaluated did not show significant association (p>0.05). Conclusions: among the evaluated characteristics, only maternal occupation and previous breastfeeding experience were associated with early weaning.

Resumo Objetivos: avaliar a associação de variáveis sociodemográficas, obstétricas e de aleitamento materno com o desmame precoce em um banco de leite humano. Métodos: foram compilados dados das fichas de avaliação materno-infantil de mulheres atendidas no banco de leite humano do hospital universitário da Universidade Federal do Maranhão em 2016, 2017 e 2018. Resultados: das 1.276 fichas avaliadas, 1.275 (99,9%) tinham informações sobre desmame precoce (variável de desfecho), que foi identificado em 30,6% dos pares atendidos. A frequência de desmame precoce foi maior entre as mães que já amamentaram (169-31%) [p=0,0235, OR=4,03; IC95%=1,21-13,46] e entre aquelas que tinham ocupação "do lar" (204-36%) [p<0,0001, OR:1,58, IC95%=1,24-2,00]. As demais variáveis independentes avaliadas não apresentaram associação significativa (p>0,05). Conclusões: entre as características avaliadas, apenas a ocupação da mãe e a experiência previa de amamentação associaram-se ao desmame precoce.

Reflexão sobre a organização do trabalho de Enfermagem no banco de leite: cuidado compartilhado e multiprofissional / Reflexión sobre la organización del trabajo de Enfermería en el banco de leche: cuidado compartido y multiprofesional / Reflection on the organization of Nursing work in the milk bank: shared and multidisciplinary care

Resumo Objetivo refletir sobre a organização do trabalho de Enfermagem no Banco de Leite Humano a partir das ações de cuidado compartilhado com a equipe multiprofissional. Método trata-se de um estudo teórico-reflexivo com base nos conceitos de campo e habitus de Pierre Bourdieu de modo a compreender o modus operandi dos seus agentes no campo e no subcampo da saúde. Resultados evidenciou-se que o Processo de Enfermagem faz parte dos procedimentos de cuidado em saúde nos diferentes espaços de atuação, todavia, é importante pontuar que há uma interdependência dos serviços prestados. Percebem-se a integralidade da proposta e a organização do trabalho do BLH a partir de uma equipe multiprofissional. Para a Enfermagem, o habitus está posto desde a formação inicial dos seus profissionais, pois há o reconhecimento do saber próprio do campo e que as ações são pautadas em conhecimentos teórico-científicos. Conclusão e implicações para a prática o cuidado compartilhado é reconhecido como importante fator de equalização da assistência e demais serviços realizados no campo do BLH. Ao mobilizar os conceitos de Pierre Bourdieu, é possível inferir o habitus nos modos de cuidar, considerando-se, ainda, aquele específico construído ao longo da história da Enfermagem.

Resumen Objetivo reflexionar sobre la organización del trabajo de Enfermería en el Banco de Leche Materna, a partir de acciones de cuidado compartido con el equipo multiprofesional. Método es un estudio teórico-reflexivo basado en los conceptos de campo y habitus de Pierre Bourdieu, con el fin de comprender el modus operandi de sus agentes en el campo y en el subcampo de la salud. Resultados mostraron que el Proceso de Enfermería es parte de los procedimientos de atención en salud en diferentes áreas de actuación, sin embargo, es importante señalar que existe una interdependencia de los servicios brindados. La integridad de la propuesta y la organización del trabajo del BLM se puede ver desde un equipo multiprofesional. Para la Enfermería, el habitus se establece a partir de la formación inicial de sus profesionales, pues se reconoce el conocimiento del campo y que las acciones se basan en conocimientos teórico-científicos. Conclusión e implicaciones para la práctica la atención compartida se reconoce como un factor importante en la igualación de la atención y otros servicios realizados en el campo del BLM. Mediante la movilización de los conceptos de Pierre Bourdieu, es posible inferir el habitus en los caminos de cuidado, teniendo en cuenta incluso el específico construido a lo largo de la historia de la Enfermería.

Abstract Objective reflect on the organization of nursing work in the Human Milk Bank based on shared care actions with the multi-professional team. Method this is a theoretical-reflexive study based on Pierre Bourdieu's concepts of field and habitus in order to understand the modus operandi of its agents in the field and subfield of health. Results it was evidenced that the Nursing Process is part of the health care procedures in the different performance spaces, however, it is important to point out that there is an interdependence of the services provided. The integrality of the proposal and the organization of the work of the HMB are perceived from a multi-professional team. For nursing, the habitus is set from the initial training of its professionals, since there is recognition of the knowledge of the field and that the actions are based on theoretical and scientific knowledge. Conclusion and implications for practice shared care is recognized as an important factor in equalizing care and other services performed in the field of HMB. By mobilizing the concepts of Pierre Bourdieu, it is possible to infer the habitus in the modes of care, considering also the specific habitus built throughout the history of Nursing.

Contaminación microbiológica y factores asociados en la leche materna del banco de leche humana de un Hospital en Perú / Microbiological contamination and associated factors in breast milk from the human milk bank of a Hospital in Peru

Objetivo: Estimar la contaminación microbiológica e identificar sus factores asociados en leche materna dentro del BLH de un Hospital en Perú. El estudio. Diseño transversal, donde se realizó evaluación física, química y microbiológica a muestras de leche materna. Hallazgos. Evaluamos 187 muestras de leche donadas por madres La acidez Dornic y crematocrito promedio fue de 5,2±1,6 y 2,7±0,9%, y la contaminación microbiológica representó el 3,7% del total de muestras evaluadas, aislándose Acynetobacter iwoffi, Moraxela lacunata, Pseudomona aeruginosa y Staphylococcus coagulasa negativa. Se evidenció que el pH de la leche fue la única variable asociada a contaminación microbiológica (OR: 3.7 IC95: 1.5-8.8). Conclusión. El incremento de pH es un factor asociado a contaminación microbiológica en muestras de leche donadas en el BLH de un Hospital en Perú, por lo que es recomendable reevaluar los criterios de aceptabilidad del rango de pH de la leche materna donada.

Objetive: Estimate microbiological contamination and identify its associated factors in breast milk within the BLH of a Hospital in Peru. The study. Cross-sectional design, where a physical, chemical and microbiological evaluation was carried out on samples of breast milk. Findings. We evaluated 187 milk samples donated by mothers. The average Dornic acidity and crematocrit were 5.2 ± 1.6 and 2.7 ± 0.9%, and the microbiological contamination represented 3.7% of the total samples evaluated, isolating Acynetobacter iwoffi, Moraxela lacunata, Pseudomona aeruginosa and Staphylococcus negative coagulase. It was evidenced that the pH of the milk was the only variable associated with microbiological contamination (OR: 3.7 IC95: 1.5-8.8). Conclusion. The increase in pH is a factor associated with microbiological contamination in donated milk samples at the BLH of a Hospital in Peru, so it is advisable to re-evaluate the acceptability criteria of the pH range of donated breast milk.

Significance and status of human milk bank development in mainland China / 中国实用护理杂志

This article aims to summarize the significance of the establishment of human milk banks, the status of human milk banks in mainland China, analyze the relevant factors that affect the development of human milk banks, and propose corresponding countermeasures to provide a reference for improving the status of human milk banks in mainland China and promoting sustainable development.

Características y motivaciones de las mujeres donantes del banco de leche en el Complejo Asistencial Dr. Sótero del Río / Characteristics and motivations of donors to the human milk ba nk in Dr. Sótero del Rio Hospital, Chile

El propósito de este trabajo fue describir las características, motivaciones, barreras y fuentes de información de las mujeres donantes del Banco de Leche en el Complejo Asistencial Dr. Sótero del Río (CASR). MÉTODO: El diseño utilizado en este estudio correspondió a uno de tipo transversal descriptivo. Se realizó una encuesta telefónica con 15 preguntas a 82 mujeres que fueron donantes en al menos una oportunidad en el banco de leche del CASR desde el año 2015 a septiembre de 2017. Se estimaron proporciones para las variables categóricas y medidas de tendencia central y de dispersión para la edad Se calcularon intervalos de confianza al 95%. RESULTADOS: La edad media de las donantes fue de 31,3 años con una desviación estándar de 4,6. El 92,7% se encontraba casada o en convivencia y un 58,5% (IC 95% 47,1 - 69,3) cursó educación profesional superior completa. La principal motivación para donar fue la empatia (41,5% [IC 95% 30,7 - 52,9]) y las principales fuentes de conocimiento fueron internet/redes sociales 43,9% (IC 95% 33,0 - 55,3) y personal de salud 32% (IC 95% 22,9 - 44,2). CONCLUSIONES: La mujer donante del banco de leche del CASR, se encuentra principalmente casada o en convivencia, posee un alto nivel educacional y trabaja fuera del hogar. Estos resultados podrían orientar estrategias al fortalecimiento del banco de leche.

This study sought to describe characteristics, motivations, barriers, and sources of information of human milk donors to the milk bank at Dr. Sótero del Río Hospital, Chile. METHODS: A descriptive and cross - sectional study was carried out. We conducted a 15-question telephone survey in 82 women who were at least one-time milk donors between 2015 and 2017. Statistical analysis included frequencies and percentages for categorical variables and measures of central tendency and dispersion for quantitative variables. We calculated 95% confidence intervals (CI). RESULTS: The mean age of donors was 31.34,6 years; 92.7% were married or were living with their partner and 58.5% (95% CI of 47.1- 69.3) had completed higher education. The main motivation for donating was helping others (41.5% [95% CI of 30.7- 52.9]). The primary sources of knowledge on milk donations were the internet and social networks (43.9% [IC 95% 33.0- 55.3]), followed by health personnel 32% (95% CI of 22.9- 44.2). CONCLUSIONS: The donor profile in CASR's milk bank is a young woman, with a stable partner and high educational level. These results could provide useful information to improve strategies for human milk donation.

Development and present situation of breast milk bank / 国际儿科学杂志

Foreign Breast milk Banks have developed for more than 100 years in foreign countries.They have not only established the corresponding the Human Milk Banking Association of North America and the European Breast Milk banks Association accordingly,but also established a mature breast milk banks management guideline.However,the research on cognition and technology of breast milk bank in China is still in the stage of exploration and needs further development.The desire for breast milk donation and acceptance of d onor human milk in puerpera are limited.At present,as more and more attention were paid to breast milk feeding,the current situation cannot meet the needs of medical development.We need a formal management guideline to guide the development of breast milk bank.In this article,we introduce the concept and importance of breasffeeding,the necessity and feasibility of establishing breast milk banks,the development prospects of the breast milk bank,for reviewing a systematic thinking of the cognitive formation of breast milk bank,and other aspects to form a system review of the knowledge of breast milk bank.We aim to let puerpera have a better understanding of breast milk bank,eliminate the concerns about donating breast milk and increase the breast milk donation rate,thus the premature babies and newborns with diseases will benefit from the construction of the breast milk bank.

Banco de leite humano: mulheres com dificuldades na lactação / Banco de leche humana: mujeres con dificultades en la lactancia / Human milk bank: women with lactation difficulties

RESUMO Objetivo: conhecer as dificuldades das mulheres que procuram atendimento no Banco de Leite Humano. Método: trata-se de um estudo documental, retrospectivo, utilizando amostra de 292 formulários de puérperas que buscaram o serviço especializado do Banco de Leite Humano em Hospital Universitário no Nordeste do Brasil. Realizado de janeiro a agosto de 2017. Foram utilizados testes de Qui quadado e medidas de Odds Ratio. Resultados: amostra composta por mulheres com Ensino Superior Completo 118 (40,4%), 198 (67,81%) realizaram partos em serviço de saúde privado, por cirurgia cesariana 209 (71,58%) e 118 (40,41%) não recebeu informações sobre amamentação em nenhum momento. Dificuldades de amamentação: pega 167 (57,19%), fissura mamilar 96 (32,88%), confusão de bicos 69 (23,63%), insegurança materna 65 (22,26%) e ingurgitamento mamário 61 (20,89%). Conclusão: orientações realizadas pelos profissionais voltadas para a prática do aleitamento materno e acompanhamento adequado à mulher no período gravídico puerperal resultam no sucesso da amamentação.

RESUMEN: Objetivo: conocer las dificultades de las mujeres que procuran atención en el Banco de Leche Humana. Método: se trata de un estudio documental y retrospectivo con una muestra de 292 formularios de puérperas que se acercaron al servicio especializado del Banco de Leche Humana de un Hospital Universitario en el nordeste de Brasil. Se realizó en el período de enero a agosto de 2017. Se utilizaron pruebas de Chi-cuadrado y medidas de Odds Ratio. Resultados: la muestra estuvo compuesta por 118 (40,4%) mujeres con Enseñanza Superior Completa, 198 (67,81%) tuvieron sus partos en servicios privados de salud, 209 (71,58%) por cirugía cesárea, y 118 (40,41%) no recibieron información alguna sobre lactancia en ningún momento. Dificultades de lactancia: agarre 167 (57,19%), fisura mamilar 96 (32,88%), confusión de pezones 69 (23,63%), inseguridad materna 65 (22,26%), y congestión mamaria 61 (20,89%). Conclusión: las pautas orientadoras proporcionadas por los profesionales dirigidas a la práctica de la lactancia materna y al adecuado acompañamiento de la mujer en el período de embarazo puerperal derivan en una lactancia exitosa.

ABSTRACT Objective: To investigate the difficulties experienced by women who seek care at the Human Milk Bank. Method: This is a documentary, retrospective, and quantitative study with a sample of 292 forms from postpartum women who sought specialized care at the Human Milk Bank of a university hospital in Northeastern Brazil. The present study was conducted from January to August 2017. Chi-square tests and odds ratio values were used. Results: The study population consisted mainly of women with a complete higher education degree (118; 40.4%). Additionally, 198 (67.81%) of the childbirths took place in private health facilities, and 209 (71.58%) were by Cesarean section. Moreover, 118 (40.41%) mothers did not receive information on breastfeeding at any time. The most common breastfeeding difficulties were latch-on (167; 57.19%), nipple fissure (96; 32.88%), nipple confusion (69; 23.63%), maternal insecurity (65; 22.26%), and breast engorgement (61; 20.89%). Conclusion: Professional guidance on breastfeeding and proper maternal follow-up during pregnancy and postpartum result in successful breastfeeding.

Human milk bank operation and management mode / 国际儿科学杂志

Breasffeeding has reached a consensus on the beneficial effects of promoting the health of newborns,especially premature babies.There are still some newborns or premature babies who are unable to get their own mother's breast milk after birth due to the mother's health reasons.So the significance of establishing a human milk bank for collection,processing,screening,storage and distribution of donor milk is also obvious.The human milk bank has been developed for more than a century since its first establishment.The operation and management models of human milk banks in all countries in the world have formed a relatively stable management system.This review summarizes the operation and management mode and cost problems of the global human milk bank,which may provide references for management and guideline development of human milk bank in China.

Perfil calórico e higienicossanitário do leite pasteurizado pelo banco de leite humano do estado do Acre / Caloric and hygienicosanitary profile of the milk pasteurized by the human milk bank of the state of Acre

Este estudo teve por objetivo analisar o perfil calórico e higienicossanitário do leite humano pasteurizado pelo Banco de Leite Humano da Maternidade Barbara Heliodora, localizado no município de Rio Branco-AC. Trata-se de uma pesquisa descritiva e transversal realizada a partir de dados secundários do registro dos exames de teor calórico avaliados pelo crematócrito, e titulação de acidez pelo método de Dornic do leite humano coletado e processado pelo banco de leite humano referente ao período de janeiro a dezembro de 2014. Foram analisadas 499 amostras de leite humano, totalizando 146,39 litros de leite coletados. Deste leite humano pasteurizado 15% foi classificado como hipocalórico, 52% normocalórico e 33% hipercalórico. De acordo com o estágio de lactação, o leite maduro foi o leite com maior quantidade de doações. Em relação à acidez Dornic, encontraram-se resultados dentro da média de titulação aceitável, sendo os maiores valores encontrados na faixa de 4,1 a 7,9% (n=252). As perdas de leite materno representaram 18,34 litros, sendo as principais causas o prazo de validade expirado, quantidade insuficiente para o processamento, sujidade, frasco quebrado e doadora sem cadastro. As doações de leite humano são essenciais para a garantia do leite destinado às crianças que dele necessitam. Assim, o presente estudo concluiu que o leite é normocalórico e está próprio para o consumo, com relação ao alto teor calórico e baixa titulação acidez. É importante o registro dessas informações para que se intensifiquem os estudos nessa área e medidas que busquem melhorar as boas práticas de manipulação.

This study aimed to analyze the caloric and hygienic conditions of the pasteurized breast milk in a Breast Milk Bank in the maternity hospital Barbara Heliodora, in Rio Branco, Ac. This is a descriptive cross-sectional analyzes of secondary data survey of calorie tests by crematocrit, and titratable acidity of the Dornic method of human milk collected and processed by the Breast Milk Bank from January to December 2014. It was analyzed 499 samples of pasteurized breast milk or 146,39 liters. Of those, 15% was hypocaloric, 52% normalcaloric and 33% hypercaloric. The mature milk was the type of milk in more quantity of donations. The Dornic acidity found was between 4,1 to 7,9% (n=252), considered acceptable. A total 18,34 liters of breast milk wasted. The breast milk donations are essential guaranty of milk, designated to the ones in need. Therefore, the present study conclude that the milk is normocaloric and is suitable for consumption. It's important to record those informations so that more studies are performed in this area, besides measures and proceedings of good manipulation practices.

A importância da cooperação sul-sul em saúde no processo de implantação da Rede Latino-americana de Banco de Leite Humano / The importance of health cooperation in the implementation process of the Latin American Human Milk Bank Network / La importancia de la cooperación en salud en el proceso de implantación de la RedLatinoamericana de Banco de Leche Humana

Objetivo: Este estudo tem como objetivo analisar a importância do modelo de cooperação sul-sul para a implantação da Rede Latino-americana de Banco de Leite Humano e as ações desempenhadas pelo Brasil neste processo de implantação. Metodologia: Tratou-se de uma pesquisa com a utilização da análise bibliográfica e documental, para a compreensão da cooperação estruturante. Sendo realizada a busca nas bases de dados do SciELO, e LILACS, e no site da Rede Global de Banco de Leite da Fundação Oswaldo Cruz. Foram selecionados 10 artigos e cinco documentos oficiais. Resultados: Percebe-se que a trajetória de cooperação entre os países teve sua construção marcada por eventos e acordos, que permitiram a estruturação da Rede Global de Leite Humano, maior articuladora para o sucesso da política pública em amamentação no Brasil, enfrentando da mortalidade infantil, e afirmando o protagonismo feminino que movimenta todas as ações que cooperam para a redução da mortalidade infantil. Conclusão: A estratégia mantém um perfil solidário entre os países pactuados, pois o objetivo de redução da mortalidade é enfrentado como experiência exitosa

Objective: This study aims to analyze the importance of the South-South cooperation model for the implementation of the Latin American Network of Human Milk Bank and the actions carried out by Brazil in this implementation process. Methodology: It is a research with the use of bibliographical and documentary analysis, for the understanding of structuring cooperation. The search was carried out in the databases of Scielo, and LILACS, and in the website of the Global Network of Milk Bank of the Oswaldo Cruz Foundation. We selected 10 articles and five official documents. Results: It is noticed that the cooperation path between the countries was built by events and agreements, which allowed the structuring of the Global Network of Human Milk, the main articulator for the success of the public policy on breastfeeding in Brazil, facing infant mortality, and affirming the female protagonism that moves all actions that cooperate to reduce infant mortality. Conclusion: The strategy maintains a solidarity profile between the agreedments countries, because the objective of mortality decrease is confronting as a successful experience

Objetivo: Este estudio tiene como objetivo analizar la importancia del modelo de cooperación sur-sur para la implantación de la Red Latinoamericana de Banco de Leche Humana y las acciones desempeñadas por Brasil en este proceso de implantación. Metodología: Se trata de una investigación con la utilización del análisis bibliográfico y documental, para la comprensión de la cooperación estructurante. Se realizó la búsqueda en las bases de datos de Scielo, y LILACS, y en el sitio de la Red Global de Banco de Leche de la Fundación Oswaldo Cruz. Se seleccionaron 10 artículos y cinco documentos oficiales. Resultados: Se percibe que la trayectoria de cooperación entre los países tuvo su construcción marcada por eventos y acuerdos, que permitieron la estructuración de la Red Global de Leche Humana, mayor articuladora para el éxito de la política pública en lactancia en Brasil, enfrentándose a la mortalidad infantil, y afirmando el protagonismo femenino que mueve todas las acciones que cooperan para la reducción de la mortalidad infantil. Conclusión: La estrategia mantiene un solidario perfil entre los países pactados, porque el objetivo de reducir la mortalidad se enfrentado como una experiencia exitosa.

The influences of the establishment of breast milk bank to the premature infants in the hospital / 中国实用护理杂志

Objective To discuss the influences of the establishment of breast milk bank to the premature infants in the hospital. Methods The clinical datas of 239 premature infants admitted in NICU from Feb 2017 to Jan 2018 were retrospectively analyzed. Dividing them into two groups, one was control group that the premature infants born before the establishment of breast milk bank, the other was observation group that the premature infants born after that. Both groups were taken the same treatment;and fed the autogenous breast milk or donated breast milk or premature milk based on the intention of infant′s family. Results In observation group,the breastfeeding rate was 67.5％ (85/126),the average hospital-stay time was (24.5±4.4) days.But in control group, the breastfeeding rate was 34.5％(39/113),the average hospital-stay time was (36.3±8.3) days, there were significant differences between the two groups (χ2=4.217, t=2.941, P<0.05).The complications in observation group included necrotizing enterocolitis (5 cases),bronchopulmonary dysplasia(3 cases), retinopathy of prematurity (5 cases) and sepsis (6 cases), the incidence of which was lower than that in control group. But, there was statistical significance in the incidence of necrotizing enterocolitis and sepsis only (χ2=3.989,5.386,P<0.05). Conclusions The establishment of breast milk bank can help to improve the breastfeeding rate of premature infants,shorten the hospital-stay time,reduce the incidence of NEC and sepsis,make premature infants recover more quickly.

Fatores assistenciais e gestacionais associados à anemia em nutrizes atendidas em um banco de leite humano / Healthcare and gestational factors associated with anemia in nursing mothers attended in a human milk bank

Resumo A anemia é um problema de saúde pública que acomete cerca de 30% das gestantes brasileiras, podendo acarretar efeitos deletérios à saúde e qualidade de vida do binômio mãe-filho. O objetivo deste artigo é avaliar os fatores assistenciais e gestacionais associados à anemia entre nutrizes atendidas em um banco de leite humano (BLH) de referência. Estudo transversal com dados secundários referentes a informações sociodemográficas e gestacionais de 12283 nutrizes no período de 2009 a 2012. Aplicaram-se os testes Kolmogorov-Smirnov e Qui-quadrado ou exato de Fisher. Estimaram-se as Razões de Prevalência (RP) e respectivos Intervalos de Confiança-IC95%, por meio da Regressão de Poisson com variância robusta. Identificou-se a prevalência de anemia em 29,2% da amostra, sendo maior entre as mães que não realizaram o pré-natal (RP = 3,84; IC95% 3,26-4,54); as que realizaram até 3 consultas pré-natais (RP = 1,92; IC95% 1,21-3,06) e aquelas que tiveram gestação múltipla (RP = 2,29; IC95% 1,25-4,19). Os resultados apontaram maior prevalência de anemia entre as mulheres que não realizaram o pré-natal apropriado e as que tiveram gestações múltiplas, destacando-se a importância da assistência à saúde como fator de prevenção à anemia e demais intercorrências gestacionais.

Abstract Anemia is a public health problem that affects about 30% of Brazilian women, which may cause deleterious effects on the health and quality of life of mother and child. This article seeks to evaluate the healthcare and gestational factors associated with anemia among mothers receiving care at a human milk bank (HMB) of reference. It is a cross-sectional study with secondary data about sociodemographic and pregnancy information on 12283 nursing mothers from 2009 to 2012. The Kolmogorov-Smirnov and chi-square or Fisher's exact tests were applied. The prevalence ratios (PR) and their 95% confidence intervals were estimated by Poisson regression with robust variance. Anemia was identified in 29.2% of the sample and the prevalence was higher among mothers who did not have prenatal appointments (PR = 3.84; 95% CI 3.26 to 4.54); those who made 3 or less antenatal visits (PR = 1.92; 95% CI 1.21 to 3.06) and those who have had multiple pregnancies (OR = 2.29, 95% CI 1.25 to 4.19). The results showed a higher prevalence of anemia among women who did not have the appropriate prenatal care and who have had multiple pregnancies, highlighting the importance of healthcare as a factor in the prevention of anemia and other complications during pregnancy.

Saberes sobre processo de enfermagem no banco de leite humano / El saber sobre el processo de enfermería en el banco de leche humano / Knowledge regarding the nursing process in the human milk bank

RESUMO Objetivo: analisar os saberes dos enfermeiros sobre o processo de enfermagem como instrumento da Sistematização da Assistência de Enfermagem no Banco de Leite Humano. Método: estudo descritivo, exploratório, qualitativo, realizado no segundo trimestre de 2015 em sete Bancos de Leite Humano do Estado do Espírito Santo. Com essa perspectiva foram entrevistadas nove enfermeiras atuantes no serviço de saúde. Os dados foram submetidos à análise de conteúdo na modalidade temática. Resultados: O processo de enfermagem pode ser considerado um organizador dos trabalhos, no espaço do Banco de Leite Humano. Tais saberes no cotidiano e o conhecimento da aplicabilidade do processo de enfermagem necessitam ser um pressuposto para sustentar as ações dos enfermeiros nos Bancos de Leite Humano. Conclusão: as análises indicaram que o trabalho do enfermeiro deve estar embasado em uma metodologia científica, mas há uma fragmentação na efetivação das etapas do processo de enfermagem. Faz-se necessária a elaboração de um instrumento que possibilite a efetivação da Sistematização da Assistência de Enfermagem, mediante o instrumento processo de enfermagem.

RESUMEN Objetivo: analizar el saber de los enfermeros sobre el proceso de enfermería como instrumento de la Sistematización de la Asistencia de la Enfermería en el Banco de Leche Humano. Método: estudio descriptivo, exploratorio y cualitativo realizado en el segundo trimestre del 2015 en siete Bancos de Leche Humano del Estado de Espírito Santo. Con esa perspectiva se entrevistaron nueve enfermeras actuantes en el servicio de salud. Los datos fueron sometidos al análisis del contenido en la modalidad temática. Resultados: el proceso de enfermería puede ser considerado como un organizador de los trabajos en el espacio del Banco de Leche Humano. Los conocimientos en lo cotidiano y en la aplicabilidad del proceso de enfermería necesitan ser un presupuesto para defender las acciones de los enfermeros en los Bancos de Leche Humano. Conclusión: los análisis mostraron que el trabajo del enfermero debe estar basado en una metodología científica, pero hay una fragmentación en la realización de las etapas del proceso de enfermería. Es necesaria la elaboración de un instrumento que posibilite la realización de la Sistematización de la Asistencia de Enfermería mediante el instrumento de proceso de la enfermería.

ABSTRACT Objective: to analyze nurses' knowledge regarding the nursing process as an instrument for Nursing Care Systematization in the Human Milk Bank. Method: descriptive, exploratory, qualitative study carried out in the second quarter of 2015 in seven Human Milk Banks in the State of Espírito Santo. With this perspective, nine nurses working in the health service were interviewed. The data were submitted to thematic content analysis. Results: the nursing process can be considered an organizer of work in the context of the Human Milk Bank. Such everyday knowledge and knowledge of the applicability of the nursing process needs to be an assumption in order to support the actions of nurses in the Human Milk Banks. Conclusion: the analyzes indicated that the nurses' work and activities must be based on a scientific methodology, however there is a fragmentation in the effectiveness in the steps of the nursing process. It is necessary to elaborate an instrument that enables the implementation of the Nursing Assistance Systematization, through the nursing process instrument.

A representação social de mulheres doadoras de leite humano / Social representation of women who are human milk donors

O leite humano pasteurizado vem sendo apresentado como a alternativa mais eficaz para alimentar prematuros e também recém-nascidos cujas mães estejam com alguma dificuldade para amamentar. Para suprir essa demanda, aumentou significativamente a implantação de bancos de leite humano no Brasil e no mundo. O objetivo desta pesquisa foi conhecer as representações sociais sobre a doação de leite entre mulheres colaboradoras do banco de leite humano em um hospital universitário público. Os referenciais teórico e metodológico utilizados foram, respectivamente, a Teoria das Representações Sociais e a Análise de Conteúdo. Para os dados quantitativos, foi utilizada a análise estatística descritiva. Foram entrevistadas 30 mulheres cadastradas como doadoras no Banco de Leite Humano do Hospital Universitário de Londrina, no Paraná. A idade variou de 18 a 44 anos, a maioria teve seus filhos por cesariana, 96,7% estavam com o companheiro, 86,7% possuíam curso superior completo ou pós-graduação, 76,7% exerciam trabalho remunerado fora de casa, o maior volume de leite doado foi 88 litros, o tempo médio de doação foi 155 dias e o tempo médio de aleitamento materno foi de 371 dias. Das falas dessas mulheres emergiram quatro temas com suas respectivas categorias: A experiência de amamentar; O banco de leite humano: lugar de acolhimento e aprendizagem; A doação dá trabalho e exige compromisso e Ser doadora é compartilhar o que tem e ajudar a quem precisa. A gênese para uma mulher se tornar doadora é estar amamentando seu filho e esse processo, proveniente da sua vivência familiar, apresenta-se como tendo um lado bom e outro que exige desafios, mas ela percebe que seu leite é único, que sua produção é mais do que suficiente para seu filho, levando essa mulher a procurar o banco de leite para compartilhar esse alimento com outras crianças. O banco de leite se torna para ela um local de acolhimento, apoio e aprendizado e ela se torna divulgadora desse serviço. Também passa a conhecer as histórias de doação e constata que doar seu leite dá trabalho, mas o compromisso assumido supera tal dificuldade; o apoio da família é essencial e ela descobre a sua maneira de ordenhar esse leite. Expressa que sente muito orgulho por ser uma doadora e, ao se perceber nessa condição, as suas representações sociais vinculam-se à construção social da solidariedade e de um sentimento mais profundo do significado da maternidade, que lhes propicia o sentimento de ampliar, para além de seu filho, o sentir ser mãe de muitos, em que compartilhar o que tem e ajudar a quem precisa resulta na sensação de ver multiplicado o papel materno e conhecer que doar vale a pena. Os elementos aqui identificados oferecem subsídios importantes para a condução de campanhas e projetos de melhoria de adesão de doadoras nos trabalhos dos Bancos de Leite Humano.

Pasteurized human milk has presented itself as the most effective alternative to feed preterm babies as well as newborns whose mothers are having some difficulty to breastfeed. In order to supply this demand, the number of human milk banks has significantly increased worldwide and in Brazil as well. The aim of this study was to acknowledge the social representation of human milk donation among women who donated to a human milk bank from a public hospital. The Social Representation Theory and Content Analysis were used as theoretical and methodological approaches, respectively. Quantitative data was assessed using descriptive statistical analysis. Thirty women were interviewed, all were donors at the Human Milk Bank from Londrina´s University Hospital, in Paraná State. Their age ranged from 18 to 44 years old, most had caesarean-sections, 96.7% had a companion; 86.7% had higher education or were postgraduates; 76.7% had a paid job; the biggest amount of donated milk was 88 liters; average donation period was 155 days; and average breastfeeding period was 371 days. Four themes and categories emerged from the women´s speeches: The breastfeeding experience; The human milk bank: a welcoming and learning place; Donating is hard-working and demands commitment; and Being a donor is sharing what I have and helping with others need. What motivates a woman to become a human milk donor involves the experience of breastfeeding her baby, which presents itself as a positive attitude, however posing some challenges. She realizes that her milk is unique, that she produces more than her baby can take, so she goes to the milk bank to share this nourishment with other children. The human milk bank becomes a welcoming, supportive and learning place for her, who spreads the word about this service/facility. These women also become aware of donation stories and comprehends that donating their milk is hardworking, but the commitment overcomes the difficulties; family support is essential; and they find out their own way to express the milk. These donating women reveal that they are proud to be a donor, and by acknowledging themselves as such, their social representations link to the social construction of solidarity and a deeper feeling of what maternity means. This allows them to amplify the motherhood feeling, beyond their own child, as they feel they are the mother of many. Also, sharing what they have and helping those in need results in the visualization of the multiplication of the mother´s role and understanding that donating milk is worthwhile. The elements identified in this study offer important ground to implement campaigns and projects to improve compliance in Human Milk Bank donations.

Comparação entre suplementos homólogos do leite humano e um suplemento comercial para recém-nascidos de muito baixo peso / Comparison between homologous human milk supplements and a commercial supplement for very low birth weight infants

OBJETIVOS: Descrever a metodologia de preparo de dois aditivos, líquido e em pó, derivados do leite humano e comparar a constituição com aditivo comercial FM85®. MÉTODOS: Foram utilizadas 40 amostras de leite humano para o preparo dos suplementos líquido e em pó. Ambos passaram por três fases de preparo: desnate, evaporação e retirada da lactose. Após essas fases, o suplemento líquido está pronto, e o em pó necessita da quarta fase - a liofilização. Em cada amostra dos suplementos líquido e em pó, foram adicionados, respectivamente, 80 mL (grupo I) e 100 mL (grupo II) de pool de leite humano de banco. Para comparação, 20 amostras de 100 mL do pool foram acrescidas de 5 g do suplemento FM85® (Nestlé) (grupo III). Realizaram-se análises de hidratos de carbono, proteína, lipídios, cálcio, fósforo, sódio, osmolalidade e conteúdo calórico, considerando diferença significativa p < 0,05. RESULTADOS: Os grupos I, II e III mostraram, respectivamente, os seguintes resultados: proteínas = 1,81, 2,38 e 1,96 g/dL (p < 0,001); hidratos de carbono = 6,70, 7,25 e 10,06 g/dL (p = 0,006); gordura = 3,75, 3,75 e 3,73 g/dL (p = 0,96); cálcio = 36,92, 44,75 e 79,37 mg/dL (p = 0,001); fósforo = 20,02, 23,28 e 56,30 mg/dL (p = 0,02); sódio = 14,32, 14,40 e 20,33 mEq/L (p = 0,143); osmolalidade = 391,45, 412,47 e 431, 00 mOsmol/kgH2O (p = 0,074); e conteúdo calórico = 67,78, 72,27 e 81,65 kcal (p = 0,001). CONCLUSÃO: Os aditivos estudados diferem significativamente do aditivo comercial FM85® em alguns de seus constituintes, e a sua constituição pode ou não atender às quantidades de nutrientes propostas pelas recomendações mais recentes.

OBJECTIVES: To describe the methodology for the preparation of two additives derived from human milk, liquid and powdered, and to compare this composition with the commercial additive FM85®. METHODS: For the preparation of the liquid and powdered supplements, 40 samples of human milk were used. Both supplements have been through three preparation phases: skimming, evaporation and lactose removal. After these phases, the liquid supplement is ready, and the powdered requires a fourth phase - lyophilization. To each sample of the liquid and powdered supplements were added, respectively, 80 mL (group I) and 100 mL (group II) of pooled banked human milk. For comparison, 20 samples of 100 mL of the pool were added to 5 g of the FM85® supplement (Nestlé) (group III). Analyses of carbohydrates, protein, lipids, calcium, phosphorus, sodium, osmolality and caloric content were performed, considering a significant difference p < 0.05. RESULTS: Groups I, II, and III showed, respectively, the following results: protein = 1.81, 2.38 and 1.96 g/dL (p < 0.001); carbohydrates = 6.70, 7.25 and 10.06 g/dL (p = 0.006); fat = 3.75, 3.75 and 3.73 g/dL (p = 0.96); calcium = 36.92, 44.75 and 79.37 mg/dL (p = 0.001); phosphorus = 20.02, 23.28 and 56.30 mg/dL (p = 0.02); sodium = 14.32, 14.40 and 20.33 mEq/L (p = 0.143); osmolality = 391.45, 412.47 and 431.00 mOsmol/kgH2O (p = 0.074); and caloric content = 67.78, 72.27 and 81.65 kcal (p = 0.001). CONCLUSION: The studied additives differ significantly from the commercial additive FM85® in some of its components, and its composition may or may not meet the quantity of nutrients suggested by the most recent recommendations.

The active components of milk in human milk bank / 国际儿科学杂志

Human milk is the optimal feeding choice for neonats, especialy for premature infants. Besides lactose, protein and fat, human milk also contains many kinds of active components, such as immunoglobins,lacferrins, lysozymes, vitamins and so on. Human milk bank has been well developed worldwide, but after cold storage and Pasteurization, many different microcomponents in milk have been affected. There is still controversy on how to preserve and sterilize human milk

Variaciones en la composición proteica de la leche materna madura durante el almacenamiento por congelación / Changes in protein composition of mature breast milk during storage by freezing

Introducción: La leche materna es el alimento ideal para niños desde el nacimiento hasta los seis meses de edad. Muchas madres interrumpen la lactancia materna por diversas causas, por lo que la administración de leche materna procedente de bancos de leche surge como alternativa a ser evaluada. Objetivo: Determinar las variaciones en la composición proteica de la leche materna durante el almacenamiento bajo congelación. Materiales y Métodos: Fueron colectadas 31 muestras de leche madura de mujeres entre 17 a 35 años. Las muestras se almacenaron en congelación (–20°C), durante períodos de 15, 30, 60, y 90 días. Una alícuota de cada muestra fue analizada como control basal. La concentración de proteínas totales (g/dl) fue determinada por el método de Lowry, se transformó en g/día y calculó las calorías proteicas, considerando el consumo de 850 ml de leche. Se caracterizaron las fracciones proteicas de la leche con la técnica de electroforesis en geles de poliacrilamida (SDS-PAGE). Resultados: Los resultados mostraron una concentración proteica de 1,58 g/dl al inicio y de 1,61 g/dl a los 90 días. No se encontraron variaciones significativas al comparar el contenido de proteínas, ni en el aporte proteico y calórico de la leche durante el almacenamiento bajo congelación (P>0,05). El perfil electroforético sólo demostró variaciones en fracciones proteicas de bajo peso molecular. Conclusiones: La estabilidad de los componentes proteicos ratifica como segura la forma de almacenamiento de la leche materna humana bajo congelación por un período de 3 meses en bancos de leche.

Introduction: Breast milk is the ideal food for children from birth to age six months. For various reasons many mothers stop breastfeeding early, for which reason supply of breast milk from milk banks is an alternative that should be evaluated. Objective: To determine variations in protein composition of breast milk during frozen storage. Materials and Methods: We collected 31 samples of mature milk of women between ages 17 and 35. Samples were stored frozen (-20° C) for periods of 15, 30, 60, and 90 days. An aliquot of each sample was analyzed for baseline control. Total protein concentration (g/dl) was determined by Lowry method and protein calories as g/day were calculated based on a consumption of 850 ml of milk. Protein fractions of milk were determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Results: Results showed a protein concentration of 1.58 g/dl at baseline and 1.61 g/dl at 90 days. Comparison found no significant differences in protein content or protein and calorie value of the milk during frozen storage (P>0.05). The electrophoretic profile showed changes only in low molecular weight protein fractions. Conclusions: The stability of the protein components demonstrates safe storage of frozen human milk in milk banks for a period of 3 months.

Growth of very low birth weight infants fed with milk from a human milk bank selected according to the caloric and protein value

OBJECTIVE: To describe growth and clinical evolution of very low birth weight infants fed during hospital stay with milk from a human milk bank according to the caloric-protein value. METHOD: Forty very low birth weight infants were included: 10 were fed milk from their own mothers (GI), and 30 were fed human milk bank > 700 cal/L and 2 g/dL of protein. Growth curves were adjusted using nonlinear regression to the measured growth parameters. RESULTS: full enteral diet was reached in 6.3 days by GI and in 10.8 by GII; a weight of 2 kg was reached in 7.3 weeks for GI and in 7.8 for GII. In GI, 3/10 (33.3 percent) and in GII, 7/30 (23.3 percent) developed sepsis. Necrotizing enterocolitis did not occur in GI, but in 3/30 (10.0 percent) in GII. GI presented with urinary calcium > 4 mg/L in 1/10 (10.0 percent), urinary phosphorus (Pu) <1 mg/L in 10/10 (100 percent), and Ca/Cr >0.6 ratio in 1/10 (10.0 percent) of the cases; in GII, no children presented alterations of the urinary calcium or the Ca and Cr ratio, and Pu was <1 mg/L in 19/30 (63.3 percent). In terms of growth the 50th percentile for GI was a weight gain of 12.1 g/day (GI) vs. 15.8 g/day (GII), a length gain of 0.75 cm/week (GI) vs. 1.02 cm/week (GII), and a head circumference gain of 0.74 cm/week (GI) vs. 0.76 cm/week (GII). CONCLUSIONS: Human milk bank allowed a satisfactory growth and good clinical evolution for very low birth weight infants.

Determinação de vitamina A no leite de mães doadoras do banco de leite humano (BLH) de Manaus/AM: efeito do processamento / Determination of vitamin A in the milk of donor mothers from the human milk bank (hmb) in Manaus/AM: Effect of processing

Esse estudo teve como objetivo determinar os teores de vitamina A no Leite Humano Materno (LHM), de 50 mães doadoras do Banco de Leite Humano (BLH), da Maternidade Ana Braga, em Manaus-AM. As amostras foram coletadas semanalmente e mantidas congeladas até a pasteurização. As análises de retinol e ß-caroteno no leite humano foram realizadas antes e após o tratamento (pasteurização), mediante o método cromatográfico. Foram retiradas alíquotas de 5 mL aproximadamente de leite de cada amostra. Os pesos dos bebês ao nascer das mães doadoras de leite incluídos no estudo foram > 2500g. A concentração de vitamina A no leite tanto antes quanto após o processamento, não foram suficientes para suprir o requerimento (46,75 ± 6,28 µg/dL e 31,55 ± 8,29 µg/dL, respectivamente), de crianças que se alimentam exclusivamente do leite do BLH, notadamente as pré-termo, cujos requerimentos de vitamina A são maiores e a capacidade de ingerir leite é menor do que os nascidos a termo. A perda de vitamina A pelo processamento, em nosso estudo foi de 32,51%. Para garantir a formação de reservas hepáticas e a proteção contra deficiência de vitamina A, seriam necessárias concentrações dessa vitamina no leite superiores a 80 µg/dL.

This study treats a transversal, descriptive, observational and analytical study with the objective of determining the Vitamin A chemical content in Human Maternal Milk (HMM) of 50 donor mothers from the Ana Braga Maternity Human Milk Bank (HMB), in Manaus, Amazonas. Samples were collected weekly and maintained frozen until pasteurization. Analyses of retinol and ß-carotene in human milk were undertaken before and after the treatment (pasteurization), chromatographic method. Aliquots of approximately 5 mL of milk were taken from each sample. The babies included in the study were weight > 2500g. The Vitamin A concentration in the milk, before and after the processing, was found to be insufficient for that required (46.57 ± 6.28 µg/dL and 31.55 ± 8.29 µg/dL respectively) for children who feed exclusively on HMB milk, notably premature babies, whose Vitamin A requirements are greater and whose capacity for ingesting milk is lower than that of fully born babies. The loss of Vitamin A through processing was, in this study, 32.51%. To guarantee hepatic reserves and protect against deficiencies, it would be necessary that the vitamin A concentration in the milk be higher than 80 µg/dL.