Alergia a las proteínas de la leche de vaca: proceso diagnóstico. Consenso interdisciplinario de expertos / Cow's milk allergy: diagnostic process. Expert consensus

Las proteínas de la leche de vaca pueden causar alergia alimentaria. Los distintos mecanismos de acción involucrados y la variabilidad clínica según la etapa de la vida pediátrica en la que se manifieste ocasionan dificultades en su abordaje, con riesgo de sub- o sobrediagnóstico. En este proceso, intervienen profesionales de diversas áreas y es recomendable su interacción. Es por ello que el objetivo de este consenso ha sido reflejar el conocimiento actualizado desde la interdisciplina, generando recomendaciones para su correcto diagnóstico. Hemos trabajado con el método de Delphi para sumarle a la evidencia científica, la experiencia proveniente de neonatólogos, pediatras, especialistas en alergia, nutrición y gastroenterología. Pensamos que este enfoque interdisciplinario de trabajo va a resultar de utilidad práctica y promoverá una atención más integral de estos pacientes.

Cow's milk protein can cause food allergy. The different mechanisms of action involved, the clinical variability depending on the stage of pediatric life in which it manifests, leads to difficulties in its approach, with the risk of under- or over-diagnosis. Professionals from various areas intervene in this process and their interaction is recommended. That is why the objective of this consensus has been to reflect the updated knowledge in an interdisciplinary mode, generating recommendations for its correct diagnosis. We have worked with the Delphi method to add to the scientific evidence, the experience from neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology. We think that this interdisciplinary approach will be of practical use and will promote more comprehensive care for these patients.

Breast feeding and infection control in premature newborns: an integrative review / Aleitamento materno e controle de infecções em recém-nascidos prematuros: revisão integrativa / Lactancia materna y control de infecciones en recién nacidos prematuros: revisión integrativa

Background and Objectives: investigating the relationship between breast milk use infection control in premature newborns may provide a basis for continuing exclusive breastfeeding, reducing the rates of early introduction of formula and strengthening their immune system. In view of this, the objective was to analyze the relationship between breastfeeding and infection control in premature newborns. Content: an integrative review, which included original articles, available electronically and with a temporal cut of the last five years. Searches were carried out in August 2022 in the Medical Literature Analysis and Retrieval System Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scopus, Web of Science and Science Direct databases, using the descriptors Breastfeeding, Milk Human, Infection Control, Infection Control and Premature Newborn, concatenated with the search operators "AND" and "OR". The Rayyan digital tool was used to organize the study selection stages. A total of 490 studies were identified in the search, of which seven were selected. All studies were published in English between 2018 and 2022. Regarding design, three were case-control studies, one was a cohort, one was cross-sectional, and two were clinical trials. Regarding the level of evidence, studies classified as level IV predominated. Conclusion: human breast milk has the power to reduce the incidence of necrotizing enterocolitis and cytomegalovirus, reduce the worsening of inflammatory states and late-onset sepsis, prevent diseases, encourage the physical and cognitive development of premature newborns.(AU)

Justificativa e Objetivos: a investigação da relação do uso de leite materno com o controle de infecções em recém-nascidos prematuros poderá fornecer embasamento para continuidade do aleitamento materno exclusivo, diminuindo os índices de introdução precoce de fórmula e propiciando o fortalecimento de seu sistema imunológico. Diante disso, objetivou-se analisar a relação do aleitamento materno com o controle de infecções em recém-nascidos prematuros. Conteúdo: revisão integrativa, que incluiu artigos originais, disponíveis eletronicamente e com recorte temporal dos últimos cinco anos (2018 a 2022). Foram realizadas buscas no mês de agosto de 2022 nas bases de dados Medical Literature Analysis and Retrieval System Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scopus, Web of Science e Science Direct, sendo utilizado os descritores Aleitamento Materno, Leite Humano, Controle de Infecções, Controle de Infecção e Recém-Nascido Prematuro, concatenados com os operadores de pesquisa "AND" e "OR". Foi utilizada a ferramenta digital Rayyan para a organização das etapas de seleção dos estudos. Foram identificados 490 estudos na busca, dos quais sete foram selecionados. Todos os estudos foram publicados em inglês entre 2018 e 2022. Quanto ao delineamento, três eram estudos de caso controle, um era coorte, um era transversal e dois eram ensaios clínicos. Em relação ao nível de evidência, predominaram os estudos classificados em nível IV. Conclusão: o leite humano materno tem o poder de diminuir a incidência de enterocolite necrosante e citomegalovírus, reduzir o agravamento de estados inflamatórios e de sepse tardia, prevenir doenças, estimular o desenvolvimento físico e cognitivo do recém-nascido prematuro.(AU)

Justificación y Objetivos: investigar la relación entre el uso de la leche materna y el control de infecciones en los recién nacidos prematuros puede brindar una base para continuar con la lactancia materna exclusiva, reducir las tasas de introducción temprana de fórmula y fortalecer su sistema inmunológico. Ante ello, el objetivo fue analizar la relación entre la lactancia materna y el control de infecciones en recién nacidos prematuros. Contenido: revisión integradora, que incluyó artículos originales, disponibles electrónicamente y con un corte temporal de los últimos cinco años. Las búsquedas se realizaron en agosto de 2022 en las bases de datos Medical Literature Analysis and Retrievel System Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web of Science y Science Direct, utilizando los descriptores Lactancia Materna, Leche Humana, Control de Infecciones, Control de Infecciones y Recién Nacido Prematuro, concatenado con los operadores de búsqueda "AND" y "OR". Se utilizó la herramienta digital Rayyan para organizar las etapas de selección de estudios. En la búsqueda se identificaron 490 estudios, de los cuales se seleccionaron siete. Todos los estudios fueron publicados en inglés entre 2018 y 2022. En cuanto al diseño, tres fueron estudios de casos y controles, uno fue de cohorte, uno fue transversal y dos fueron ensayos clínicos. En cuanto al nivel de evidencia predominaron los estudios clasificados como nivel IV. Conclusión: la leche materna humana tiene el poder de reducir la incidencia de enterocolitis necrotizante y citomegalovirus, reducir el agravamiento de estados inflamatorios y sepsis tardía, prevenir enfermedades, estimular el desarrollo físico y cognitivo de los recién nacidos prematuros.(AU)

Comparison of the short-term outcomes in very/extremely low birth weight infants supplemented with fortified donor human milk or preterm formula / 中华围产医学杂志

Objective:To compare the short-term outcomes of very low birth weight (VLBW) and extremely low birth weight (ELBW) infants supplementarily fed with fortified donor human milk (DHM) or preterm formula (PF) when the mother's own milk (MOM) is insufficient.Methods:This retrospective cohort study included 91 VLBW or ELBW preterm infants with birth weight<1 500 g who were hospitalized in Peking Union Medical College Hospital from October 1, 2017, to September 30, 2020. Based on the supplemental feeding method when MOM was insufficient, these infants were divided into the DHM group ( n=51) and PF group ( n=40). Mann-Whitney U, t-test, Chi-square test, or Fisher's exact test were used to compare the short-term clinical outcomes during hospitalization between the two groups. Results:(1) There were no statistically significant differences between the 91 preterm infants in the DHM group and PF group in their gestational age, birth weight, sex ratio, birth mode, mothers' age at delivery, or the proportion of infants of small gestational age (all P>0.05). (2) The feeding volume in the DHM group was significantly greater than that in the PF group on the 14th day after birth [(108.2±53.1) vs. (81.0±47.8) ml/(kg·d), t=0.78, P=0.020]. Moreover, the time to achieve the feeding amounts up to 120 ml/(kg·d) and 150 ml/(kg·d) for infants in the DHM group were significantly shorter than those in the PF group [(17.5±10.2) vs. (30.0±12.0) d, t=4.38; (22.1±13.3) vs. (32.3±11.9) d, t=0.02; both P<0.05]; (3) Lower proportion of peripherally inserted central catheter (PICC) [58.8% (30/51) vs. 100% (40/40), χ 2=21.88, P<0.001] and shorter PICC duration were observed in the DHM group [10.0 (0.0-19.0) vs. 29.0 (17.0-40.5) d, Z=5.56, P<0.001] compared to the PF group. The times of red blood cell transfusions and the incidence of late sepsis in the DHM group were less than those in the PF group [0.0 (0.0-2.0) vs. 2.0 (1.0-3.0) times, Z=4.44, P<0.001; 23.5% (12/51) vs. 50.0% (20/40), χ 2=6.39, P=0.011]. There were no statistically significant differences observed in the incidence of bronchopulmonary dysplasia, neonatal necrotizing enterocolitis, retinopathy of prematurity, and the length of hospitalization (all P>0.05). Conclusion:When MOM is insufficient, supplementing VLBW and ELBW infants with fortified donor human milk can shorten the time to achieve enteral nutrition and reduce the use rate and time of PICC, the incidence of late-onset sepsis, and the times of red blood cell transfusion.

Polyphenol analysis in human milk by a rapid, cost-effective, and accurate micromethod: translational development / Análise de polifenóis no leite humano por meio de um micrométodo rápido, econômico e preciso: desenvolvimento translacional

ABSTRACT Objective: To develop a rapid method for analysing polyphenols, which are potentially active antioxidants against neonatal oxidative stress, from small human milk (HM) volumes. Methods: Acid and alkaline extractions were compared using two dyes: Folin-Ciocalteu and Fast Blue BB. Linearity, sensitivity, recovery percentage, polyphenol content, precision, and stability were assessed in 14 HM samples and compared using the Kruskal-Wallis H test (p<0.05). The best technique was applied to 284 HM samples to determine their polyphenolic content and its association with maternal diet by multifactorial linear regression. Results: Acidic extraction successfully recovered the gallic acid reference standard, whereas alkaline extraction overestimated it. Calibration curves for all methods were linear (R2>0.96) up to 500 mg/L. All bicarbonate-based Folin-Ciocalteu methods assayed were stable and repeatable, whereas Fast Blue BB-based variants were not. HM polyphenols (mean=94.68 mg/L) positively correlated to the dietary intake of hydroxycinnamic acids, the most consumed polyphenolic family in this population. Conclusions: A bicarbonate-based Folin-Ciocalteu micromethod allowed the accurate determination of polyphenols in HM, which might be useful for translational research settings and HM banks.

RESUMO Objetivo: Desenvolver um método rápido para analisar polifenóis, que são antioxidantes potencialmente ativos contra o estresse oxidativo neonatal, em pequenos volumes de leite humano (LH). Métodos: Foram comparadas extrações ácidas e alcalinas usando dois corantes: Folin-Ciocalteu e Fast Blue BB. Foram avaliadas variáveis como linearidade, sensibilidade, percentagem de recuperação, teor de polifenóis, precisão e estabilidade em 14 amostras de LH, comparadas usando o teste de Kruskal-Wallis H (p<0,05). A melhor técnica foi aplicada a 284 amostras de LH para determinar seu teor polifenólico e sua associação com a dieta materna por regressão linear multifatorial. Resultados: A extração ácida recuperou com sucesso o padrão de referência do ácido gálico, enquanto a extração alcalina o superestimou. As curvas de calibração para todos os métodos foram lineares (R2>0,96) até os 500 mg/L. Todos os métodos testados baseados em Folin-Ciocalteu com bicarbonato foram estáveis e repetíveis, enquanto as variantes baseadas em Fast Blue BB não. Os polifenóis do HM (média=94,68 mg/L) correlacionaram-se positivamente com a ingestão dietética de ácidos hidroxicinâmicos, a família de polifenóis mais consumida nesta população. Conclusões: Um micrométodo baseado em bicarbonato de Folin-Ciocalteu permitiu a determinação precisa de polifenóis no HM, o que pode ser útil para configurações de pesquisa translacional e bancos de HM.

Suficiência de leite humano para prematuros em Unidades de Terapia Intensiva / Suficiencia de leche humana para prematuros en Unidad de Cuidados Intensivos / Human milk sufficiency for premature babies in Intensive Care Units

Resumo Objetivo Analisar a suficiência de leite humano nas Unidades de Terapia Intensiva Neonatais da Região Metropolitana de São Paulo, segundo o quantitativo de prematuros, demanda estimada de leite humano e consumo efetivo. Métodos Estudo transversal em Postos de Coleta e Bancos de Leite Humano cadastrados na Rede Paulista de Bancos de Leite Humano em 2017. Utilizou-se dados de estatísticas vitais censitárias de 2017 para identificar a distribuição dos prematuros nas Redes Regionais de Atenção à Saúde. Resultados Participaram do estudo 100% dos Postos de Coleta e 84,6% dos Bancos de Leite Humano de São Paulo. Identificou-se uma insuficiência na distribuição do leite humano pasteurizado, entre a demanda estimada e o consumo efetivo dos prematuros. No período do estudo, apenas as regiões Centro e Sudeste atendiam 100% da cobertura de leite humano, seguidas da região do grande ABC com 44,62%. Conclusão A maioria dos Postos de coleta e Bancos de Leite humano da região metropolitana de São Paulo, não atendem todas as crianças prematuras. O gerenciamento destas unidades pode contribuir para estimular a captação de doadoras e a otimização do leite humano coletado.

Resumen Objetivo Analizar la suficiencia de leche humana en las Unidades de Cuidados Intensivos Neonatales de la Región Metropolitana de São Paulo, de acuerdo con la cantidad de prematuros, la demanda estimada de leche humana y el consumo efectivo. Métodos Estudio transversal en Puntos de Recolección y Bancos de Leche Humana registrados en la Red Paulista de Bancos de Leche Humana en 2017. Se utilizaron datos de estadísticas vitales censitarias de 2017 para identificar la distribución de los prematuros en las Redes Regionales de Atención en Salud. Resultados Participaron en el estudio el 100 % de los Puntos de Recolección y el 84,6 % de los Bancos de Leche Humana de São Paulo. Se identificó una insuficiencia en la distribución de leche humana pasteurizada entre la demanda estimada y el consumo efectivo de los prematuros. En el período del estudio, solo las regiones Centro y Sudeste atendían el 100 % de la cobertura de leche humana, seguidas por la región del Gran ABC con el 44,62 %. Conclusión La mayoría de los Puntos de Recolección y Bancos de Leche Humana de la región metropolitana de São Paulo no atiende a todos los bebés prematuros. La administración de estas unidades puede contribuir para estimular la captación de donantes y la optimización de la leche recolectada.

Abstract Objective To analyze human milk sufficiency in Neonatal Intensive Care Units in the Metropolitan Region of São Paulo according to the number of premature babies, estimated demand for human milk and actual consumption. Methods This is a cross-sectional study, carried out at Human Milk Collection Stations and Human Milk Banks registered with the São Paulo Network of Human Milk Banks in 2017. Data from 2017 census vital statistics were used to identify premature baby distribution in Regional Health Care Networks. Results 100% of Human Milk Collection Stations and 84.6% of Human Milk Banks in São Paulo participated in the study. Pasteurized human milk distribution insufficiency was identified between estimated demand and actual consumption by premature babies. During the study period, only the Center and Southeast regions met 100% of human milk coverage, followed by the Greater ABC region, with 44.62%. Conclusion Most Human Milk Collection Stations and Human Milk Banks in the metropolitan region of São Paulo do not assist all premature children. The management of these units can contribute to encouraging donor recruitment and collected human milk optimization.

Alimentación complementaria en lactantes y su relación con el estado nutricional / Complementary feeding of Mexican infants and its relation to the nutritional status

Background: Apropiate introduction to complementary feeding (CF) decreases the risk of nutritional diseases in infants; however there is a paucity of information about the characteristics of CF in mexican children. Objective: To characterize the complementary feeding of Mexican infants and its relation to the nutritional status. Methodology: Transversal, analytical and retrospective study in dyads that required medical care. We performed a nutritional evaluation of the infants and characterized the type of lactation, type and texture of initial solid foods and the subsequent feeding. Results: Final sample consisted of 141 children in which, 59.6% reported that feeding was provided exclusively with formula and only 40% received breast milk. 14.1% of the infants showed low weight-for-height, 17.7% low weight-for-age, and 24.1% low height-for-age. We observed that 55.3% of the infants did not receive complementary feeding with appropriate texture; 58.9% did not receive the appropriate amount; and 44.7, 62.4% and 11.3% received inappropriate amounts of carbohydrates, proteins and fats respectively. Conclusion: A high proportion of infants do not receive appropriate complementary feeding.

Introducción: La introducción apropiada a la alimentación complementaria (AC) disminuye las enfermedades nutricionales en los niños; sin embargo, actualmente, no contamos con una caracterización apropiada de la AC que reciben los lactantes mexicanos. Objetivo: Caracterizar la alimentación complementaria de los lactantes mexicanos y su relación con el estado nutricional. Métodos: Estudio transversal, analítico, retrospectivo en diadas (madre y lactantes de cinco a 12 meses de edad) que acudieron a la consulta externa en la IMF No 82 y la guardería infantil IMSS 001. Se realizó una valoración nutricional de los niños y se analizó la lactancia, el tipo y textura de los alimentos sólidos de inicio y subsecuentes. Resultados: la muestra consistió en 141 niños. Unicamente el 40% de los lactantes recibían leche materna. 14.1% de los lactantes presentaron bajo peso para la talla, 17.7% bajo peso para la edad y 24.1% baja talla para la edad. Observamos que 55.3% de los niños no recibían alimentación complementaria con textura apropiada; 58.9% no recibían cantidad apropiada; y 44.7%, 62.4% y 11.3% recibían cantidades inapropiadas de carbohidratos, proteínas y grasas respectivamente. Conclusión: nuestros datos indican que una alta proporción de los lactantes no reciben alimentación complementaria apropiada.

Aleitamento materno de prematuros internados em Unidade de Terapia Intensiva neonatal: coorte prospectiva / Breastfeeding of premature infants hospitalized in a neonatal Intensive Care Unit: a prospective cohort / Lactancia materna de bebés prematuros hospitalizados en la Unidad de Cuidados Intensivos neonatales: cohorte prospectiva

Identificar variáveis com potencial de intervenção que estejam associadas ao volume de leite esgotado das mães de recém-nascidos prematuros. Trata-se de um estudo de coorte, descritivo e exploratório. A coleta de dados ocorreu em um hospital materno-infantil do Sul do Brasil no período de julho de 2021 a janeiro de 2022, por meio de entrevistas a 20 mães de recém-nascidos prematuros. Verificou-se que, em relação ao número de vezes ao dia que foi realizado o esgotamento hospitalar e domiciliar, a mediana foi de 4 vezes. A maioria das mães utilizou dois métodos de esgotamento das mamas (manual e com bomba de sucção). O estudo identificou que o volume de leite esgotado foi abaixo do esperado pelo Ministério da Saúde. Destaca-se a falta de procura do banco de leite para o esgotamento, problemas relacionados à mama, como exemplo o método utilizado para esgotamento.

To identify variables with intervention potential that are associated with the volume of depleted milk from mothers of premature newborns. This is a cohort, descriptive, and exploratory study. Data collection occurred in a maternal-infant hospital in southern Brazil from July 2021 to January 2022, through interviews with 20 mothers of premature newborns. It was verified that, in relation to the number of times per day that hospital and home milk expression was performed, the median was 4 times. Most mothers used two methods of breast milk expression (manual and with suction pump). The study found that the volume of expressed milk was lower than expected by the Ministry of Health. We highlight the lack of demand of the milk bank for expression, problems related to the breast, as an example of the method used for expression.

Identificar variables con potencial de intervención que se asocian al volumen de leche agotada de madres de recién nacidos prematuros. Se trata de un estudio de cohortes, descriptivo y exploratorio. La recolección de datos ocurrió en un hospital materno-infantil en el sur de Brasil de julio de 2021 a enero de 2022, a través de entrevistas con 20 madres de recién nacidos prematuros. Se verificó que, en relación al número de veces por día que se realizaba el agotamiento hospitalario y domiciliario, la media fue de 4 veces. La mayoría de las madres utilizaron dos métodos de depleción mamaria (manual y con succión apretada). El estudio identificó que el volumen de leche empobrecida fue menor de que lo esperado por el Ministerio de Salud. Destacamos la falta de demanda del banco de leche por agotamiento, problemas relacionados con la mama, como ejemplo del método utilizado para el agotamiento.

Differential proteomic profiling of breast milk-derived extracellular vesicles from mothers of preterm and term infants / 中华围产医学杂志

Objective:To analyze the differential expression of breast milk-derived extracellular vesicles (BM-EV) from mothers of preterm and term infants .Methods:Breast milk samples were collected from preterm and term delivery (three cases in each) at the Women's Hospital of Nanjing Medical University in 2019. BM-EV was extracted using ultracentrifugation. After preliminary identification of the characteristics of BM-EV, liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used for protein quantification. Significantly up-regulated differential proteins (fold change≥1.5 and P<0.05) in the preterm group were screened. GO and KEGG were performed to predict the differentially expressed proteins' functional annotation and determine associated signaling pathways. Mann-Whitney U test and Fisher's exact test were used for intergroup comparisons. Pearson's correlation test describes the correlation of protein quantification values between samples. The differences in protein abundance were compared between the two groups using a t-test, followed by multiple corrections. Additionally, significantly enriched GO terms and KEGG pathways of the differentially expressed proteins were screened based on the hypergeometric distribution. Results:(1) There were three primiparae in the preterm group and one in the term group. Marker proteins CD9, CD81, and HSP70 were enriched in the BM-EV of both groups. (2) Six samples were comparable between groups and showed high reproducibility within groups. The correlation of protein quantification values between samples was up to 0.99. Furthermore, the coefficient of variation was 11.21% for preterm samples and 19.72% for term, and the data values in the preterm group were relative. (3) A total of 945 proteins were identified, and 156 were differentially expressed between preterm and term BM-EV, with 83 significantly up-regulated in preterm BM-EV. In the up-regulated proteins, the top three high-abundance proteins were complemented C4a, fatty acid synthase, and sclerostin domain-containing protein-1. (4) The biological processes or cellular components with the highest enrichment in GO functional prediction were mainly involved in hemoglobin and glycogen biosynthesis, immunological synapse formation, and phagocytosis mediated by the Fc γ receptor signaling pathway. The most relevant KEGG pathways were ribosome-related, complement and coagulation cascades, neutrophil extracellular trap formation, and Fc γ receptor-mediated phagocytosis.Conclusion:The significantly up-regulated differential proteins in BM-EV may play a protective role by regulating immunity, gastrointestinal function, and energy metabolism in preterm infants.

Progress in therapeutic potential of human breast milk-derived exosomes in neonate necrotizing enterocolitis / 中华围产医学杂志

Neonatal necrotizing enterocolitis (NEC) is one of the leading causes of neonatal death and no effective therapeutic drugs are currently available. Breastfeeding is a safe and effective preventive measure for NEC. Human breast milk-derived exosomes (HM-exos), which are membranous vesicles in breast milk, play an important role in maintaining the integrity of the intestinal barrier and promoting the repair of intestinal epithelial cells (IECs) damage through protecting IECs from oxidative stress, improving the proliferation and migration of IECs, maintaining the tight connection between IECs, inhibiting inflammatory response and regulating immune response.

Research progress in changes of Na + concentration and Na +/K + value in breast milk of lactating women at different conditions / 中华围产医学杂志

Breastfeeding is a key factor influencing infants' short- and long-term health, thus making it important to monitor breast function. This article reviews the changes in Na + concentration and Na +/K + value in breast milk during secretory activation and at physiological and pathological conditions, aiming to provide a reference for early clinical assessment and intervention of physiological or pathological changes in the breast during lactation and to improve the outcome of breastfeeding.

Breast-milk scientific research contributes to improvement of breast milk quality and development of human civilization / 中华围产医学杂志

Breast milk, the product of mammalian evolution, provides infants with not only vital nutrients, but also an array of nourishing contents, including bioactive substances, microorganisms, and cells. Being a crucial stage of reproductive health, breastfeeding serves as the primary means of nutrient absorption during early life. However, the scientific evaluation of its health effects remains inaccurate. The study of breast milk has emerged as a new interdisciplinary research hotspot, offering a new paradigm for explorations in life health, disease prevention, clinical treatment, social ethics, and economic advancement. This paper reviewed and discussed the research progress of breast milk science both domestically and internationally and the gap in between, and proposed a promising perspective for future research and development.

Research progress of human milk exosomes and their effects on intestinal mucosal barrier in neonates / 中华围产医学杂志

Human breast milk-derived exosomes (HMDEs) are newly discovered active signaling vesicles in breast milk, which are rich in nucleic acids, proteins, and lipids. These exosomes play an essential role in the development and maturation of the intestinal mucosal barrier in newborns. In addition, HMDEs possess distinctive properties that allow for remodeling and modification, thereby are expected to provide more efficient prevention and treatment strategies for neonatal intestinal diseases. This article aims to provide a comprehensive review of the origin, isolation, identification, labeling, structural features, composition, and biological functions, and their unique impact on the intestinal mucosal barrier function in newborns.

Conteúdo energético do leite humano administrado em recém nascidos prematuros / Energy content of human milk administered to premature newborns / Contenido energético de la leche humana administrada a recién nacidos prematuros

Objetivo: avaliar e comparar o conteúdo energético do leite humano cru e do leite humano processado de recém-nascidos pré-termo. Método: foram coletadas 68 amostras de leite por meio de ordenha manual e o processamento foi realizado no Banco de Leite Humano. O valor energético foi obtido por meio de cálculos matemáticos específicos. Resultados: foram analisadas 32 amostras de leite humano cru e 28 de leite humano pasteurizado. O percentual médio de creme foi de 3,84±1,3% e mediana de 4,5 % no leite pasteurizado, e no cru de 8,9±4,6% e 8,53%. A média e mediana do conteúdo energético do leite cru foi de 78,91±15,46 kcal/100 ml e 81,07 kcal/100 ml e no leite pasteurizado 65,18±9,67 kcal/ 100 ml e 61,8 kcal/100 ml. Conclusão: o leite humano cru possui percentual de gordura e conteúdo energético maior do que o pasteurizado, mas este ainda é recomendado devido seus benefícios protetores.

Objective: to evaluate and compare the energy content of raw human milk and processed human milk from preterm newborns. Method: 68 milk samples were collected by hand milking and processing was carried out at the Human Milk Bank. The energy value was obtained through specific mathematical calculations. Results: 32 samples of raw human milk and 28 of pasteurized human milk were analyzed. The average percentage of cream was 3.84±1.3% and a median of 4.5% in pasteurized milk, and in raw milk, 8.9±4.6% and 8.53%. The mean and median energy content of raw milk was 78.91±15.46 kcal/100 ml and 81.07 kcal/100 ml and in pasteurized milk 65.18 ± 9.67 kcal/100 ml and 61.8 kcal/100 ml. Conclusion: raw human milk has a higher percentage of fat and energy content than pasteurized milk, but it is still recommended due to its protective benefits.

Objetivo: evaluar y comparar el contenido energético de la leche humana cruda y la leche humana procesada de recién nacidos prematuros. Método: Se recolectaron 68 muestras de leche por ordeño manual y el procesamiento se realizó en el Banco de Leche Humana. El valor energético se obtuvo mediante cálculos matemáticos específicos. Resultados: se analizaron 32 muestras de leche humana cruda y 28 de leche humana pasteurizada. El porcentaje medio de nata fue 3,84±1,3% y una mediana de 4,5% en leche pasteurizada, y en leche cruda 8,9±4,6% y 8,53%. El contenido energético medio y mediano de la leche cruda fue de 78,91±15,46 kcal/100 ml y 81,07 kcal/100 ml y de la leche pasteurizada de 65,18±9,67 kcal/100 ml y 61,8 kcal/100 ml. Conclusión: la leche humana cruda tiene un mayor porcentaje de contenido graso y energético que la leche pasteurizada, pero aun así es recomendada por sus beneficios protectores.

Banco de Leite Humano: possibilidades de atuação fonoaudiológica / Human Milk Bank: possibilities of speech therapy activities / Banco de leche humana: posibilidades de actuación fonoaudiológica

Introdução: os bancos de leite humano foram criados para apoiar e incentivar o aleitamento materno, atuando como estratégia de política pública na redução da mortalidade neonatal e proteção à saúde do binômio. Por se tratar de um espaço de atuação multidisciplinar, os bancos de leite tornam-se um ambiente ideal para a atuação do fonoaudiólogo, profissional que contribui no suporte às mães, especialmente durante o estabelecimento da amamentação exclusiva. Objetivo: relatar as possibilidades de atuação fonoaudiológica em um banco de leite humano. Descrição da experiência: estudo de abordagem qualitativa descritiva do tipo relato de experiência, realizado entre os meses de março e julho de 2020, em um Banco de Leite Humano de uma maternidade pública do Nordeste, credenciada na Iniciativa Hospital Amigo da Criança. A vivência compreendeu dois seguimentos: atuação técnica e atuação assistencial. As experiências foram apresentadas por meio da narração discursiva. O espaço de atuação da Fonoaudiologia em um banco de leite humano pode ser diversificado, pois abrange a atuação técnica e assistencial, desde o recebimento do leite humano doado à assistência a puérpera e ao recém-nascido. É necessário capacitação específica para que o profissional seja inserido dentro da equipe de um banco de leite humano. Considerações finais: Foi possível identificar, por meio da experiência, o papel do fonoaudiólogo no banco de leite humano, bem como compreender a necessidade da sua inserção na equipe deste setor no âmbito hospitalar.

Introduction: human milk banks were created to support and encourage breastfeeding, acting as a public policy strategy to reduce neonatal mortality and protect the health of the binomial. Because it is a space for multidisciplinary activities, milk banks become an ideal environment for the performance of the speech therapist, a professional who contributes to support mothers, especially during the establishment of exclusive breastfeeding. Objective: to report the possibilities of speech therapy activities in a human milk bank. Description of the experience: a qualitative descriptive study of an experience report type, carried out between March and July 2020, at a Human Milk Bank of a public maternity hospital in the Brazilian Northeast, accredited by the Baby Friendly Hospital Initiative. The experience comprised two segments: technical performance and assistance performance. The experiences were presented through discursive narration. The area of performance of Speech Therapy in a human milk bank can be diversified, as it covers technical and assistance activities, from the receipt of donated human milk to assistance to the puerperal woman and the newborn. Specific training is necessary for the professional to be inserted into the team of a human milk bank. Final considerations: It was possible to identify, through experience, the role of the speech therapist in the human milk bank, as well as to understand the need for his insertion in the team of this sector in the hospital environment.

Introducción: los bancos de leche humana fueron creados para apoyar e incentivar en el amamantamiento materno, actuando como estrategia de política pública en la reducción de la mortalidad neonatal y la protección de la salud del binomio. Por tratarse de un espacio de actuación multidisciplinar, los bancos de leche se convirtieron en un ambiente ideal para la actuación del fonoaudiólogo, profesional que contribuye en apoyo a las madres, especialmente durante el establecimiento del amamantamiento exclusivo. Objetivo: relatar las posibilidades de actuación fonoaudiológica en un banco de leche humana. Descripción de la experiencia: estudio de abordaje cualitativo descriptivo de tipo relato de experiencia, realizado entre los meses de marzo a julio del 2020, en un Banco de leche humana de una maternidad pública del Noroeste, bajo la iniciativa del Hospital Amigo de los Niños. La vivencia comprendió dos seguimientos: actuación técnica y actuación asistencial. Las experiencias fueron presentadas por medio de la narración discursiva. El espacio de actuación de la fonoaudiología en un banco del hecho humana puede ser diversificado, pues comprende tanto la actuación técnica como la asistencial, desde el recibimiento de la leche materna donada a la asistencia, la matrona y al recién nacido. Es necesario capacitación específica para que el profesional sea inserto dentro del equipo de un Banco de leche humana. Consideraciones finales: fue posible identificar, por medio de la experiencia del papel del fonoaudiólogo en el banco de leche humana, así como comprender la necesidad de su inserción en el equipo de este sector en el ámbito hospitalario.

Problems and future development of human milk bank in China / 中华围产医学杂志

Human milk has its unique nutritional and immunological activities. Donor human milk, as the best alternative to breast milk, plays an important role in the rescue and treatment of premature and critically ill infants. This paper elaborates on the current situation, problems, and future development of human milk bank in China, and proposes to build a breast milk banking model based on local situation, establish evaluation standards, strengthen government supervision, set the charging standard based on the costs, and conduct research related to human milk bank, so as to improve the breastfeeding rate of critically ill and premature infants and reduce their mortality rate.

Influencing factors of milk volume in mothers of preterm infants in neonatal intensive care unit during maternal separation / 中华围产医学杂志

Objective:To analyze the factors influencing breast milk volume in mothers of preterm infants during the period of maternal separation.Methods:This study retrospectively analyzed the data from lactation diaries of mothers of preterm infants ( n=371) in neonatal intensive care unit from the first Affiliated Hospital of Zhengzhou University from January 2017 to August 2021. According to whether the milk production reached 800 ml/d or not within two weeks after delivery, these women were divided into the reached group ( n=289) or unreached group ( n=82). Two independent sample t-test and Chi-square test were used for univariate analysis, and logistic regression was used to analyze the influencing factors. Results:Mothers who achieved the target milk volume accounted for 77.9% (289/371). There were no statistically significant differences in the ratio of milk production ≥50 ml between breasts or between two adjacent breastfeeding sessions (both P>0.05), while there were statistically significant differences in the maternal education background[high school education or below:16.3% (47/289) vs 41.5% (34/82); junior college or above:83.7% (242/289) vs 58.5% (48/82); χ2=23.77], type of breast pump [diaphragm breast pump:34.9% (101/289) vs 51.2% (42/82); piston pump: 65.1% (188/289) vs 48.8% (40/82); χ2=7.14], pre-pregnancy body mass index [<18.5 kg/m 2: 3.5% (10/289) vs 4.9% (4/82);≥18.5～<24.0 kg/m 2: 90.7% (262/289) vs 61.0% (50/82); ≥24.0 kg/m 2: 5.9% (17/289) vs 34.1% (28/82); χ2=40.89], and the initiation of lactation instruction [within 7 d after delivery: 77.2% (223/289) vs 45.1% (37/82);at 7-14 d after delivery: 22.8%(66/289) vs 54.9%(45/82); χ2=31.28] between the reached and unreached group (all P<0.05). Logistic regression analysis showed that high school education or below ( OR=4.279, 95% CI: 2.253-8.126, P<0.001), diaphragm breast pump ( OR=2.352, 95% CI: 1.309-4.226, P=0.004), pre-pregnancy body mass index ≥24.0 kg/m 2 ( OR=9.352, 95% CI: 4.389-19.928, P<0.001), and seeking lactation consultation at 7-14 d after delivery ( OR=3.654, 95% CI: 2.043-6.535, P<0.001) were risk factors for not achieving the target milk volume. Conclusions:Instruction on breastfeeding for less-educated mothers of preterm infants should be strengthened. Using piston breast pump, maintaining pre-pregnancy body mass index within the normal range, and receiving lactation instruction as early as possible will contribute to achieving the target milk volume.

Conhecimento das mulheres que participam dos grupos virtuais hospedados no Facebook sobre o aleitamento materno / Knowledge about breastfeeding among women who participate in virtual groups hosted on Facebook / Conocimiento de las mujeres que participan en grupos virtuales alojados en Facebook sobre la lactancia materna

Objetivo: identificar o conhecimento das mulheres que participam de grupos virtuais hospedados no Facebook sobre o aleitamento materno. Método: pesquisa qualitativa de caráter exploratório e descritivo, realizada no período de setembro a novembro de 2020, com 15 mulheres que participam de grupos inscritos no Facebook que abordam a temática aleitamento materno. Os dados foram coletados por meio do Google Forms e, posteriormente, submetidos à análise de conteúdo. Resultados: as participantes demonstraram conhecimento sobre os benefícios do aleitamento materno, a pega e o posicionamento correto ao seio. Elas compreendem o conceito de aleitamento materno exclusivo e livre demanda. O discurso recorrente como motivador para participação dos grupos virtuais baseia-se na busca de conhecimento. Conclusão: a educação em saúde tem sua importância reafirmada pelas participantes ao apontarem que as informações sobre o aleitamento materno foram obtidas predominantemente por meio dos serviços de saúde e estratégias, como curso/grupo de gestantes.

Objective: to identify the knowledge about breastfeeding of women who participate in virtual groups hosted on Facebook. Method: qualitative research, with an exploratory and descriptive nature, conducted from September to November 2020, with 15 women who participate in groups registered on Facebook that address the theme of breastfeeding. Data were collected using Google Forms and, subsequently, submitted to content analysis. Results: the participants demonstrated knowledge about the benefits of breastfeeding, latching and the correct positioning at the breast. They understand the concept of exclusive breastfeeding and free demand. The recurrent speech as a motivator for participating in the virtual groups is based on the search for knowledge. Conclusion: health education has its importance reaffirmed by the participants when they pointed out that the information on breastfeeding was predominantly obtained through health services and strategies, such as courses/pregnant women's groups.

Objetivo: identificar los conocimientos de las mujeres que participan en grupos virtuales alojados en Facebook sobre la lactancia materna. Método: investigación cualitativa de naturaleza exploratoria y descriptiva, realizada en el período de septiembre a noviembre de 2020, con 15 mujeres que participan en grupos inscritos en Facebook que abordan el tema de la lactancia materna. Los datos se recopilaron mediante Google Forms y, posteriormente, se sometieron a un análisis de contenido. Resultados: las participantes demostraron conocimiento sobre los beneficios de la lactancia materna, la captura y la posición correcta del pecho. Comprenden el concepto de lactancia materna exclusiva y la libre demanda. El discurso recurrente como motivador de la participación en los grupos virtuales se basa en la búsqueda del conocimiento. Conclusión: la educación en salud tiene su importancia reafirmada por las participantes cuando admiten que las informaciones sobre la lactancia materna fueron obtenidas predominantemente por medio de los servicios de salud y estrategias, como curso/grupo de embarazadas.

Qualidade microbiológica do leite humano pasteurizado de um Banco de Leite Paulista / Calidad microbiológica de la leche humana pasteurizada de un banco de leche paulista / Microbiological quality of pasteurized human milk from a Milk Bank of São Paulo

Resumo Objetivo Avaliar a qualidade microbiológica do leite humano pasteurizado proveniente de um Banco de Leite Humano do Estado de São Paulo. Métodos Estudo descritivo conduzido com 29 amostras de leite humano ordenhado pasteurizado (LHOP) obtidas entre julho de 2015 a março de 2016 por meio da avaliação dos registros da acidez titulável bem como da quantificação da microbiota heterotrófica (mesófilos, psicrófilos, termófilos), coliformes totais e termotolerantes, fungos filamentosos e leveduriformes e Staphylococcus spp. Realizou-se a avaliação dos parâmetros físico-químicos por meio do potencial hidrogeniônico-pH, teor energético-K e acidez Dornic-ºD. Análises estatísticas descritivas e bivariadas foram conduzidas. Resultados Evidenciou-se nas amostras a presença de psicrófilos (17,24%), termófilos (27,59%), mesófilos (55,17%), fungos filamentosos e leveduriformes (41,38%) e ausência de Staphylococcus spp. Detectou-se a presença de 82,76% de coliformes no teste presuntivo. Já no teste confirmativo VB constatou-se a presença de 54,16% de coliformes totais e no teste EC 33,33% de coliformes termotolerantes. Os valores de pH e de K não apresentaram oscilações, enquanto que, na expressão da acidez entre 3º a 15°D detectou-se crescimento microbiano. O microrganismo mesófilo, apresentou correlação positiva com variável da acidez Dornic (r=0.44;p=0.01). Conclusão A partir da avaliação da qualidade microbiológica das amostras de LHOP descartado e consideradas impróprias para consumo no referido BLH, especificamente com relação aos indicadores microbiológicos das condições de higiene, sugere que a inviabilidade das amostras possam estar associadas às boas práticas de manipulação do alimento.

Resumen Objetivo Evaluar la calidad microbiológica de la leche humana pasteurizada proveniente de un banco de leche humana del estado de São Paulo. Métodos Estudio descriptivo realizado con 29 muestras de leche humana ordeñada pasteurizada (LHOP) obtenidas entre julio de 2015 y marzo de 2016 por medio de la evaluación de los registros de acidez titulable, así como de la cuantificación de la microbiota heterótrofa (mesófilos, psicrófilos, termófilos), coliformes totales y termotolerantes, hongos filamentosos y levaduriformes y Staphylococcus spp. Se realizó la evaluación de los parámetros físico-químicos mediante el potencial de hidrógeno (pH), valor energético (K) y acidez Dornic-ºD. Se llevaron a cabo análisis descriptivos y bivariados. Resultados Se observó en las muestras la presencia de psicrófilos (17,24 %), termófilos (27,59 %), mesófilos (55,17 %), hongos filamentosos y levaduriformes (41,38 %) y ausencia de Staphylococcus spp. Se detectó la presencia del 82,76 % de coliformes en la prueba presuntiva. Por otro lado, en la prueba confirmativa VB se confirmó la presencia del 54,16 % de coliformes totales, y en la prueba EC se verificó el 33,33 % de coliformes termotolerantes. Los valores de pH y de K no presentaron oscilaciones, mientras que se detectó crecimiento microbiano en la expresión de la acidez entre 3 y 15°D. El microrganismo mesófilo presentó correlación positiva con variable de la acidez Dornic (r=0.44; p=0.01). Conclusión A partir de la evaluación de calidad microbiológica de las muestras de LHOP descartadas y consideradas inapropiadas para consumo en el BLH mencionado, especialmente respecto a los indicadores microbiológicos de las condiciones de higiene, se sugiere que la inviabilidad de las muestras pueda estar asociada con las buenas prácticas de manipulación del alimento.

Abstract Objective To assess the microbiological quality of pasteurized human milk from a Human Milk Bank in the State of São Paulo. Methods This is a descriptive study conducted with 29 pasteurized expressed human milk (PEHM) samples obtained between July 2015 and March 2016 by assessing titratable acidity records as well as quantifying heterotrophic microbiota (mesophiles, psychrophiles, thermophiles), total and thermotolerant coliforms, filamentous and yeast-like fungi and Staphylococcus spp. The physical-chemical parameters were assessed via hydrogen-pH potential, K-energy content and Dornic-ºD acidity. Descriptive and bivariate statistical analyzes were conducted. Results The presence of psychrophiles (17.24%), thermophiles (27.59%), mesophiles (55.17%), filamentous and yeast-like fungi (41.38%) and absence of Staphylococcus spp were evidenced in the sample. The presence of 82.76% of coliforms was detected in the presumptive test. In the confirmatory VB test, the presence of 54.16% of total coliforms was found and, in the EC test, we verified 33.33% of thermotolerant coliforms. The pH and K values did not show oscillations, whereas, in the expression of acidity between 3º and 15°D, microbial growth was detected. The mesophilic microorganism showed a positive correlation with the Dornic acidity variable (r=0.44; p=0.01). Conclusion Based on the microbiological quality assessment of the HMB samples discarded and considered unfit for consumption in the HMB, specifically regarding the microbiological indicators of hygiene conditions, it suggests that the infeasibility of the samples may be associated with good food handling practices.

Covid-19: desafios para assistência maternoinfantil e amamentação exclusiva no período neonatal / COVID-19: Challenges for maternal child careand exclusive breastfeeding in the neonatal period / COVID-19: desafíos para la atención maternoinfantil y la lactancia materna exclusiva en el período neonatal

Introdução:O novo coronavírus, denominado SARS-CoV-2, multiplica-se ainda de forma acelerada em alguns países, causando impactos na qualidade de vida da população. A transmissibilidade vertical ou pelo leite materno ainda é uma questão controversa que, dada as incertezas, pode comprometer a interação equipe/família/mãe/recém-nascido e a oferta do aleitamento materno nas primeiras horas de vida, com sua permanência no período neonatal. Objetivo:Discutiros desafios da saúde maternoinfantil e do aleitamento materno no contexto da pandemia causada pela COVID-19. Metodologia:Estudo do tipo descritivo, no qual foram verificados boletins, portarias e manuscritos relacionados ao aleitamento materno e aos cuidados maternos e neonatais para prevenção e transmissão do SARS-CoV-2. Resultados:Osdesafios perpassam pelo pré-natal, parto e puerpério devido às dificuldades assistenciais, medidas de proteção para o binômio, vulnerabilidade social e não cumprimento das recomendações. Conclusões:As dificuldades encontradas na pandemia podem refletir na saúde materna, na promoção do aleitamento materno, e na qualidade da alimentação e nutrição do recém-nascido (AU).

Introduction:The new coronavirus, called SARS-CoV-2, is still multiplying at an accelerated rate in some countries, thereby causing impacts on the quality of life of the population. Vertical or breast milk transmissibility is still a controversial issue, which, given the uncertainties, can undermine the team/family/mother/ newborn interaction, and the provision of breastfeeding in the first hours of life and its continuity in the neonatal period.Objective:To discuss the challenges of maternal and child health and breastfeeding in the contextof the pandemic caused by COVID-19.Methodology:Descriptive study, in which newsletters, ordinances and manuscripts related to breastfeeding and maternal and neonatal care for the prevention and transmission of SARS-CoV-2 were checked.Results:The challenges run through prenatal care, childbirth and the puerperium due to assistance difficulties, protection measures for the binomial, social vulnerability and non-compliance with the recommendations.Conclusions:The difficulties found in the pandemic may reflect on maternal health, on the promotion of breastfeeding, and on the quality of food and nutrition of the newborn (AU).

Introducción: El nuevo coronavirus, llamado SARS-CoV-2, todavía se está multiplicando a un ritmo rápido en algunos países, provocando impactos en la calidad de vida de la población. La transmisibilidad vertical o de la leche materna sigue siendo un tema controvertido, que,dadas las incertidumbres, puede comprometer la interacción equipo/familia/madre/recién nacido, y la oferta de lactancia materna en las primeras horas de vida y su permanencia en el período neonatal. Objetivo: Discutir los desafíos de la salud maternoinfantil y la lactancia materna en el período neonatal en el contexto de la pandemia causada por COVID-19.Metodología: Estudio descriptivo, en el que se verificaron boletines, ordenanzas y manuscritos relacionados con la lactancia materna y la atención maternay neonatal para la prevención y transmisión del SARS-CoV-2. Resultados: Los desafíos pasan por la atención prenatal, el parto y el puerperio por dificultades asistenciales, medidas de protección al binomio, vulnerabilidad social e incumplimiento de las recomendaciones. Conclusiones: Las dificultades encontradas en la pandemia pueden reflejarse en la salud materna, en la promoción de la lactancia materna, en la calidad de la alimentación y nutrición del recién nacido (AU).

Breastfeeding during the COVID-19 pandemic: what do we know so far?

ABSTRACT Objective This study aimed to conduct a literature review on safety in breastfeeding in mothers with COVID-19. An integrative review of national and international literature was carried out. Methods The search took place in the SciELO, LILACS and MEDLINE® databases. Results A total of 25 scientific articles that specifically addressed the theme of breastfeeding and its risk and protective factors for infection by SARS-CoV-2 were selected. According to the studies analyzed, although the presence of viral RNA had already been detected by reverse transcriptase polymerase chain reaction in breast milk samples, there are still no proven cases of vertical transmission via human milk. Conclusion Breastfeeding appears to be safe if practiced according to precaution measures recommended by the World Health Organization. In addition, there is evidence of a potential for immunological protection by transfer of antibodies against SARS-CoV-2 in breast milk. Breastfeeding should continue to be promoted even in cases of mothers with clinical suspicion or confirmation of COVID-19, as well as the provision of expressed breast milk in cases where there is no possibility of direct breastfeeding.