Tipos de leite consumidos durante o primeiro ano de vida e estado nutricional de lactentes do Sul do Brasil / Types of milk consumed during the first year of life and nutritional status of infants in Southern Brazil

Resumo Introdução A Organização Mundial da Saúde (OMS) recomenda o aleitamento materno exclusivo até o 6º mês de vida da criança e a sua manutenção com alimentação complementar até pelo menos os 2 anos de idade. Apesar da sua importância, a ingestão de substitutos do leite materno é altamente prevalente, sendo uma preocupação em saúde pública. Objetivo Avaliar a associação entre os tipos de leite ingeridos e o estado nutricional no primeiro ano de vida. Método Estudo longitudinal observacional com crianças brasileiras pertencentes a um estudo multicêntrico. Aos 3, 6, 9 e 12 meses de idade foram investigados os tipos de leite consumidos por meio de questionário de frequência alimentar (QFA) e foi realizada antropometria. As associações brutas e ajustadas foram avaliadas por intermédio de regressão linear. Resultados Das 2.965 duplas de mães-bebês rastreadas, 362 atenderam aos critérios e aceitaram participar do estudo (50% meninos). Aos 12 meses de idade, os maiores escores-z de peso para idade e de peso para comprimento foram observados nos meninos que consumiam apenas fórmula ou apenas leite de vaca. Os maiores escores-z de comprimento para idade foram encontrados entre as meninas que ingeriam apenas fórmula ou apenas leite de vaca aos 9 e 12 meses. Ambos foram comparados àqueles que ingeriam apenas leite materno nas mesmas idades. Conclusão Os tipos de leite consumidos associaram-se ao estado nutricional no primeiro ano de vida, sendo observadas diferenças entre os sexos. Os maiores índices antropométricos nas crianças que não recebiam leite materno chamam a atenção para a persistência futura desses desvios, em direção ao excesso de peso.

Abstract Introduction The World Health Organization (WHO) recommends exclusive breastfeeding up to the 6th month of life of the child and its maintenance with complementary feeding until at least 2 years of age. Despite its importance, the intake of breast milk substitutes is highly prevalent and a public health concern. Objective To evaluate the association between the types of milk ingested and nutritional status in the first year of life. Method Observational longitudinal study with Brazilian children from a multicentric study. At 3, 6, 9, and 12 months of age, the types of milk consumed were investigated using a food frequency questionnaire (FFQ), and anthropometric measurements were performed. Crude and adjusted associations were assessed by linear regression. Results Of the 2,965 pairs of mothers-babies screened, 362 met the criteria and accepted to participate in the study (50% of boys). At 12 months of age, higher weight-for-age and weight-for-length z-scores were observed in boys who consumed only formula or only cow's milk, compared to boys who consumed only breast milk. Higher length-for-age z-scores were found among girls who consumed only formula or only cow's milk at 9 and 12 months, compared to girls who consumed only breast milk at the same ages. Conclusion The types of milk consumed were associated with nutritional status during the first year of life, with differences between boys and girls. The higher anthropometric indexes in children who did not receive breastmilk call our attention to the persistence of such deviations toward excessive weight status in the future.

Effect of oral stimulation combined with maternal milk sucking on physiological stress response caused by PICC puncture in children with congenital digestive tract malformation / 中国实用护理杂志

Objective:To investigate the application value of oral stimulation combined with maternal milk sucking in the pain caused by PICC in children with congenital digestive tract malformations.Methods:Using convenience sampling method, 80 children with congenital digestive tract malformations who were admitted to Hunan Children's Hospital from July 2018 to December 2019 were selected and divided into the experimental group and the control group of 40 cases in each group according to the random number table method. The control group was given routine nursing mode, while the experimental group was given oral stimulation combined with maternal milk sucking intervention on the basis of routine nursing. The intervention effects were evaluated by the Neonatal Infant Pain Scale (NIPS), the onset time of the first cry, the duration of crying, the onset time of the first painful face, the duration of the painful face, and indicators such as heart rate, respiratory rate and SpO 2. Results:The NIPS scores of children in the experimental group were (5.60 ± 1.24) and (4.10 ± 0.31) in the puncture period and the recovery period, which were significantly lower than those in the control group (6.10 ± 0.84), (4.93 ± 0.35), the differences were statistically significant (t = 2.12, 3.00, both P<0.05). The heart rate and respiratory rate of the children in the experimental group were (151.10 ± 12.37), (147.00 ± 12.16) times/min and (47.48 ± 7.59), (45.58 ± 6.51) times/min in the puncture period and the recovery period, which were significantly lower than those in the control group (159.75 ± 13.81), (156.05 ± 12.99) times/min and (52.38 ± 8.12), (49.75 ± 7.59) times/min, the differences were statistically significant (t values were 2.64-3.22, all P<0.05). The SpO 2 in the experimental group were 0.980 5 ± 0.009 0, 0.982 5 ± 0.010 8 in the puncture period and the recovery period, which were significantly higher than those in the control group 0.970 8 ± 0.014 2, 0.971 8 ± 0.018 1, the differences were statistically significant (t = 3.66, 3.23, both P<0.05). The onset time of the first cry, the duration of crying, the onset time of the first painful face, the duration of the painful face in the experimental group were (41.55 ± 6.38), (22.05 ± 4.47), (35.08 ± 5.94), (24.65 ± 5.46) s, significantly shorter than those in the control group (46.58 ± 5.26), (29.50 ± 6.48), (44.68 ± 13.31), (30.65 ± 9.42) s, the differences were statistically significant (t values were 2.63-5.98, all P<0.05). Conclusions:Oral stimulation combined with maternal milk sucking can effectively relieve the pain caused by PICC in children with congenital digestive tract malformation, and reduce the physiological stress response of children.

Amamentação, alimentação complementar e segurança alimentar e nutricional em uma região de fronteira / La lactancia materna, la alimentación complementaria y la seguridad alimentaria y nutricional en una región fronteriza / Breastfeeding, suplementary feeding and food and nutrition security in a border

RESUMO Objetivo: conhecer como a amamentação e alimentação complementar se relacionam à segurança alimentar e nutricional de crianças residentes em uma região de fronteira. Método: pesquisa qualitativa com 12 mães e 12 profissionais de saúde de Foz do Iguaçu, no contexto da Atenção Primária à Saúde. Os dados foram coletados entre abril e outubro de 2019, por meio de entrevista semiestruturada e submetidos à Análise Temática de Conteúdo. Resultados: foram identificadas três categorias: Aleitamento materno e alimentação complementar: direito da criança ao alimento seguro e adequado; Aleitamento materno e alimentação complementar: da orientação ao consumo; Amamentação, alimentação complementar e o contexto da Tríplice Fronteira. Conclusão: o leite materno e a alimentação complementar saudável contemplam a segurança alimentar e nutricional. Cultura, condição financeira, trabalho materno, somados à oferta de alimentos inadequados, comprometem esse processo. Acredita-se que esse estudo possa fomentar ações e políticas públicas voltadas ao direito à alimentação infantil na região.

RESUMEN Objetivo: conocer como la lactancia materna y alimentación complementaria se relacionan a seguridad alimentaria y nutricional de niños que residen en una región fronteriza. Método: investigación cualitativa con 12 madres y 12 profesionales de la salud de Foz do Iguaçu, en el contexto de la Atención Primaria de Salud. Los datos se recopilaron entre abril y octubre de 2019, mediante una entrevista semiestructurada y presentados para el Análisis Temática de Contenido. Resultados: se identificaron tres categorías: Lactancia materna y alimentación complementaria: el derecho del niño a una alimentación segura y apropiada; Lactancia materna y alimentación complementaria: de la orientación al consumo; Lactancia materna, alimentación complementaria y el contexto de la Triple Frontera. Consideraciones finales: la leche materna y la alimentación complementaria saludable abarcan la seguridad alimentaria y nutricional. La cultura, la condición financiera, el trabajo materno, sumados al suministro de alimentos inadecuados, comprometen este proceso. Se cree que este estudio pueda fomentar acciones y políticas públicas orientadas al derecho a la alimentación infantil en la región.

ABSTRACT Objective: to know how breastfeeding and complementary feeding relate to the food and nutritional security of children living in a border region. Method: qualitative research with 12 mothers and 12 health professionals from Foz do Iguaçu, in the context of Primary Health Care. The data were collected between April and October 2019, through a semi-structured interview and submitted to Thematic Content Analysis. Results: Three categories were identified: Breastfeeding and complementary feeding: the child's right to safe and adequate food; Breastfeeding and complementary feeding: from orientation to consumption; Breastfeeding, complementary feeding and the Triple Border context. Conclusion: maternal milk and healthy complementary feeding contemplate food and nutritional security. Culture, financial condition, maternal work, added to the supply of inadequate food, compromise this process. It is believed that this study can foster actions and public policies aimed at the right to infant food in the region.

Factores que influyen en el abandono precoz de la lactancia materna / Factors that influence in the precocious abandonment of the maternal nursing

Introducción: la lactancia materna constituye el modo de alimentación que ha garantizado la supervivencia de la especie humana, y proporciona ventajas que son conocidas. Objetivo: identificar factores sociopsicológicos que influyen en el abandono de la lactancia materna exclusiva antes de los primeros seis meses de vida del niño. Métodos: investigación descriptiva, retrospectiva y de corte transversal a través de una encuesta aplicada a las madres de 64 lactantes de hasta seis meses de edad, pertenecientes al área de salud policlínico Dr. Tomás Romay, municipio Artemisa, provincia Artemisa, entre septiembre de 2011 y abril de 2012. Resultados: la mitad de las madres abandonó la lactancia materna exclusiva antes de los 6 meses, así como hubo una asociación entre su abandono y la aparición de enfermedades en los lactantes. Conclusiones: la única alimentación necesaria con múltiples ventajas para el niño antes de los 6 meses es la lactancia materna exclusiva(AU)

Introduction: the maternal nursing constitutes the feeding way that has guaranteed the survival of the human species and it provides advantages that are known. Objective: identifying factors social and psychological that influence in the abandonment of the nursing maternal sole right before the first six months of the boy's life. Methods: a descriptive, retrospective investigation, of traverse court in the period of September of 2011 to April of 2012 through a survey applied the mothers of 64 newborn of up to six months of age, belonging to the area of health policlínico Dr. Tomás Romay, municipality Artemisa, county Artemisa. The universe was conformed by 92 newborn of the advice popular New Allotment and Laundryman belonging to this area of health. The selection of the sample was carried out intentional in which 64 newborn was selected of up to six months of age. To carry out this investigation one kept in mind the basic principles of the ethics. The information was obtained through the history clinics and cards of the studied newborn as well as a survey that was carried out in an anonymous way. Results: half of the mothers he/she abandoned the nursing maternal sole right before the 6 months, as well as an association existed between its abandonment and the appearance of illnesses in the newborn, concluding that the only necessary feeding with multiple advantages for the boy before the 6 months is the nursing maternal sole right. Conclusions: the only necessary food with multiple benefits for the child before 6 months is exclusive breastfeeding(AU)

Milk and Protein Intake by Pregnant Women Affects Growth of Foetus.

The study assessed the effects of the daily intake of milk and protein by pregnant women on foetal growth and determined the growth pattern and velocity of growth. A total of 504 ultrasound observations from 156 respondents were collected following a cross-sectional design in the last trimester of pregnancy; majority of them were in the last month of pregnancy. De facto and purposive sampling was done, and direct interviews of affluent pregnant women were conducted. Kruskal-Wallis test shows that majority of the respondents had tendency to consume 155.65 to 465.17 mL of milk per day, resulting in better and higher foetal growth. Most respondents consumed about 50-70 g of protein per day, and the foetal growth measurements, such as abdomen-circumference, femur length, biparietal diameter, and head-circumference, on an average, were higher in the same group. Quadratic regression model exhibited that all the traits of growth pattern in Model 1 (low milk and protein intake) appeared to have more mode of decline, in contrast to Model 2 (more milk and protein intake), which shows better growth. In addition, velocity of growth pattern was obtained through the first derivative of quadratic regression of growth pattern. Moreover, 95% confidence interval calculated for regression line slope of Model 1 and Model 2 showed that the estimation point (2 B2) of Model 1 does not lay into 95% CI of Model 2; so, statistical significance assorted and also the same trend conversely hold for Model 2. The rate of growth was highly influenced by maternal milk and protein intake. These findings suggest that contribution of common nutrients or other nutritional factors present in milk and protein promote the growth of foetus.

Benefícios do leite materno e impactos do leite de vaca / Benefits of maternal milk and impacts of cow milk

O trabalho destaca a supremacia da amamentação exclusiva ao seio materno para o desenvolvimento e crescimento do lactente, em relação à alimentação com fórmulas à base de leite de vaca, ressaltando as propriedades protetoras do AME contra as doenças infecciosas e outras prevalentes nos primeiros dois anos de vida...

El desarrollo de la microbiota intestinal humana, el concepto de probiótico y su relación con la salud humana / Development of the human intestinal microbiota, the concept probiotics and their relationships with human health

Probiotics are live microorganisms which, when ingested in adequate numbers, confer health benefits to the host. They originate mostly from the colonic and vaginal microbiota of humans although a number of strains originate from the environment. The human fetus is colonized after birth by bacteria of maternal fecal and vaginal origin and by microorganisms from the environment. Maternal milk contains a varied microbiota, mainly lactobacilli and bifidobacteria. After weaning the resident microbiota becomes more complex and by 2 years of age it is composed of some 1500 species with 1014 microorganisms. During the colonization of the digestive tract of premature infants low birth weight, immaturity of the defenses and artificial feeding may lead to necrotizing enterocolitis. This inflammatory condition involves mainly the terminal ileum and the colon and may result in necrosis and perforation of the wall with subsequent peritonitis. Anoxia and abnormal colonization are important associated factors. Probiotic administration is associated with a decreased risk of this condition and decreases of its morbidity, mortality and sequelae if the treatment is started early. The positive effects are associated with more than one species of probiotics. The risk of septicemia associated with probiotics has been widely discussed. Studies in Helsinki, Finland, demonstrated that the results of comparing the frequency and etiology of septicemia during the 10 years after the introduction of probiotics with the results in the 10 years previous to their introduction were not different. Septicemia due to probiotics is infrequent and most cases are associated with extreme prematurity, failure of the intestinal barrier function, heart valve disease, severe shock and congenital immune deficiencies; patients with these conditions should be closely watched if they consume probiotics. However, patients with HIV and AIDS benefit from the consumption of these microorganisms. It has nor been demonstrated that probiotics play a role in the genesis of obesity.

Los probióticos son microorganismos vivos que al ser ingeridos en cantidades adecuadas confieren beneficios para la salud del huésped. Provienen mayormente de la microbiota del colon de seres humanos aunque algunas cepas provienen del ambiente. El colon del recién nacido es colonizado durante el parto por bacterias provenientes de las microbiotas fecal y vaginal maternas, del ambiente y por lactobacilos y bifidobacterias de la leche materna. Con el destete esta microbiota se hace compleja y desde los 2 años de edad alberga unas 1500 especies y recuentos de 1014 bacterias. En la colonización del tubo digestivo de los prematuros el bajo peso de nacimiento, la inmadurez de las defensas y la alimentación artificial cuando la madre es incapaz de amamantar, llevan en una proporción de los casos a la enterocolitis necrosante, que puede afectar la pared ileal o colónica, con perforación y peritonitis en algunos prematuros. La colonización microbiológica anormal jugaría un papel importante. Los probióticos disminuyen el riesgo de este cuadro y su morbilidad y mortalidad en los casos iniciales y de intensidad media. Estos efectos positivos son causados por diferentes probióticos. El riesgo de septicemia asociado con los probióticos ha sido ampliamente discutido. Estudios en Finlandia no han demostrado que durante 10 años de su consumo masivo se produjeran aumentos de su incidencia ni cambios de su etiología en comparación con resultados previos a su introducción. Las septicemias han sido detectadas principalmente en individuos con graves alteraciones de su salud, pérdida de la función de barrera de su mucosa intestinal, trastornos congénitos graves de la inmunidad, lesiones valvulares cardíacas o en estado de shock. Los pacientes con VIH y/o SIDA se benefician con el consumo de estos agentes. No se ha demostrado que el consumo de probióticos esté asociado causalmente con la obesidad.

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.

The effects of expressed maternal milk and donor breast milk for feeding preterm infants / 国际儿科学杂志

When directly breast feeding for preterm infants is not available,a preferred alternative is expressed maternal milk or donor breast milk.The evidences to date indicated that feeding preterm infants with expressed maternal milk and donor breast milk was associated with a slower growth in the early postnatal period,the effects on long-term growth in preterm infants was still unclear.Feeding with expressed maternal milk and donor breast milk could deliver preterm infants a degree of specific components of human milk.The potential benefits of the specific components for preterm infants were associated with promoting neurodevelopment and decreasing the incidence of feeding complications.Before expressed maternal milk and donor breast milk are widely used in clinical practice,further studies are still needed to explore the long-term effects on growth and development in preterm infants.

Evaluación del conocimiento de las madres sobre lactancia materna: estudio multicéntrico en las áreas metropolitanas de Caracas y Maracaibo / Assessment of knowledge of mothers on breastfeeding: multicenter study in the metropolitan areas of Caracas and Maracaibo

Determinar los conocimientos básicos que poseen las madres sobre la práctica de la lactancia materna y relacionarlos con el inicio, la duración y forma de implementación del amamantamiento. Se realizó un estudio transversal y descriptivo, mediante la aplicación de una encuesta a 502 madres que acudieron a centros hospitalarios públicos y privados de Caracas y Maracaibo, entre julio y diciembre de 2007. El 90,64% (n: 455) de las madres amamantaron a sus hijos; la mayoría tenía un promedio de 2 ó menos hijos y provenía de áreas urbanas. El grupo etario que prevaleció fue de 26-35 años. El 55,12% (n: 113) de los niños recibió lactancia materna por un período de 6 meses o más. Sólo el 5,93% (n: 27) inició la lactancia materna antes de la primera hora post-parto. El 81,4% (n: 409) de las madres conocía las ventajas de la lactancia materna, sin embargo, la mayoría de ellas conocía sólo los beneficios para el niño. El 55,18% (n: 277) de las madres tenía información sobre alguna forma de conservación de la leche materna una vez extraída. El porcentaje de madres que practican la lactancia materna es alto, y esto se relaciona con la edad de las madres, procedencia y paridad. Sin embargo, la duración y la forma del amamantamiento no es la esperada, debido a la falta de información sobre aspectos fundamentales de la alimentación natural.

To determine the basic knowledge that mothers have about the practice of breast-feeding and to relate this knowledge to the beginning, the duration and forms of implementation of breast-feeding. A cross-sectional and descriptive study was made, by means of the application of a survey to 502 mothers who attended the outpatient clinic of public and private hospital centers of Caracas and Maracaibo during July to December 2007. 90.64% (n: 455) of the mothers nursed their children; most of these mothers had an average of 2 or less children and came from urban areas. The group of age that prevailed was the one between 26 and 35 years. 55.12% (n: 113) of the children received maternal milk by a period of 6 months or more. Only 5.93% (n: 27) initiated breast-feeding before the first hour post-childbirth. 81.4% (n: 409) of the mothers knew the advantages of breast-feeding, although, most of them only knew the benefits for the baby. Only 55.18% (n: 277) of the mothers had information about some conservation form of maternal milk once extracted. The percentage of mothers who practice breast-feeding is high, and this is related directly to the age of the mothers, origin and parity. Nevertheless, the duration of breast-feeding is not as expected, neither the way to practice it; this is explained by the lack of information of fundamental issues about natural feeding.

Analysis of advertisements of infant food commercialized in the city of Natal, Rio Grande do Norte, Brazil / Análise das propagandas de alimentos infantis comercializados na cidade de Natal, Rio Grande do Norte, Brasil

The advertising about maternal milk substitutes has been pointed as one of the factors responsible for the breastfeeding low rates. In this way, legal support was created to assure that the use of such products would not interfere on the healthy breastfeeding habit of the population. This study, developed between June 2006 and May 2008 in the city of Natal, state of Rio Grande do Norte, analyzed the food advertisements divulged under the validity of Law # 11.265/2006, which controls in Brazil the food commercialization and the publicity addressed to parents or keepers of nursling and children in the first childhood. 220 advertisements, being 141 of technical-scientific nature, and 79 for strictly commercial promotion, were collected and evaluated according to legal requirements. The results from this analysis showed that 100 percent of the advertisements of technical-scientific nature overstepped the clause V; 18.4 percent the clause IV and 14.2 percent the clauses I, II and III of article 19th of Law # 11265/2006. In 42 percent of the advertisements strictly for commercial promotion, the mandatory information mentioned at clauses I and II of the article 5th were not shown. In 8.7 percent of the advertisements containing such information, it was placed in an area that embarrassed its identification and reading, due to used fonts size and/or color; similarly as occurred with the information required by article 19th, in the advertisements of technical-scientific nature.

A propaganda de substitutos do leite materno tem sido apontada como um dos fatores responsáveis pelos baixos índices da amamentação. Neste sentido, dispositivos legais foram criados para assegurar o uso desses produtos, sem que haja interferência no aleitamento materno. Este estudo objetivou analisar propagandas de alimentos abrangidos pela Lei nº 11.265/2006, que regulamenta a comercialização e publicidade de alimentos para lactentes e crianças de primeira infância no Brasil, no período de junho 2006 a maio de 2008, na cidade de Natal/RN. Foram coletadas 220 propagandas, sendo 141 de material técnico-científico e 79 de promoção comercial que foram avaliadas quanto às exigências legais. O resultado desta análise demonstrou que 100 por cento das propagandas veiculadas em material técnico-científico infringiram o inciso V; 18,4 por cento o inciso IV e 14,2 por cento os incisos I, II e III do artigo 19 da Lei nº 11.265/2006. Em 42 por cento das promoções comerciais não foram veiculadas as informações obrigatórias constantes dos incisos I e II do artigo 5º. Em 8,7 por cento das que continham essas informações, estas estavam postas em local que dificultava sua identificação e leitura devido ao tamanho e cor das letras, semelhantemente ao ocorrido com as informações exigidas pelo artigo 19 nas propagandas veiculadas em material técnico-científico.

Extracción manual de leche materna para el mantenimiento de la lactancia / Manual removal of breast milk for the maintenance of lactation

Objetivos. Determinar a través de extracción manual, el volumen de calostro, leche de transición y leche materna madura producidos por las madres de niños prematuros y medir el incremento de peso de estos niños alimentados exclusivamente con leche materna madura utilizando sonda orogástrica.Material y métodos. Estudio longitudinal, realizado en el Servicio de Neonatología del Hospital de la Mujer, ciudadde La Paz. Fueron incluidos doce madres y sus hijos prematuros y se aplicó una encuesta con variables sociodemográficas.Se registró la producción por extracción manual, de calostro, leche de transición y leche materna madura y la ganancia diaria de peso de los niños prematuros alimentados exclusivamente con leche materna madura utilizando sonda orogástrica. Resultados. Las madres producen mediante extracción manual, calostro en un promedio de 71 ml/día (+/- 41,6 DE)de 1 a 4 días, leche de transición 207 ml/día (+/- 81,9 DE) de 5 a 10 días y leche madura 333 ml/día (+/- 105,1 DE)de 11 a 17 días. Las madres de niños de Muy bajo peso al nacer (MBPN), producen un mayor volumen de calostro, leche de transición y madura. El volumen de leche madura producida es mayor en madres de niños Pequeños para la edad gestacional (PEG), en comparación con madres de niños Adecuados para la edad gestacional (AEG). Los niños estudiados fueron alimentados exclusivamente con leche materna, de los cuales 83,3...

Objectives. To determine through the manual extraction, the volumes of colostrum, transition milk and mature maternal milk produced by premature children's mothers, and to measure the increase in these children's weight nourished exclusively with mature maternal milk using orogastric tube. Material and methods. A longitudinal study, carried out in the Service of Neonatology at the “Hospital de la Mujer”, in the city of La Paz. Twelve mothers and their premature sons were enrolled, and an inquiry with socio-demographic variables was applied. The maternal production of milk by manual extraction and a daily increase in the premature children’s weight nourished exclusively with mature maternal milk using orogastric tube was registered. Results. Mothers produce through manual extraction an average of 71 ml/day (+/- 41.6 SD) of colostrum between 1 to 4 days; transition milk of 207 ml/day (+/- 81.9 SD) between 5 to 10 days, and mature milk of 333 ml/day (+/- 105.1 SD) between 11 to 17 days.The mothers of children who are Very low birth weight (VLBW) produce a larger volume of colostrum, transition milk and mature milk. The volume of mature milk produced is larger in mothers of children who are Small for gestational age (SGA) in comparison to mothers of children who are Appropriate for gestational age (AGA).The children included in this study were nourished exclusively from maternal milk, from them 83.3% presented an adequate increase in weight. The average increase in weight from the tenth day to the seventeenth day oscillates between 18 and 40 grams per day.Conclusions.The manual extraction of mother’s milk allows for delayed suckle, giving volumes superior to the requirements of the lactant. These findings are important for nutritional education, and are a favorable alternative for mothers of premature children, or mothers who are studying, working or cannot suckle for any other reason.

Lactancia materna exclusiva y extracción manual de leche materna: a propósito de un caso exitoso / Exclusive breastfeeding and breastmilk manual removal: report of a successful case

La lactancia materna es una práctica naturalfundamental para el sano crecimiento y desarrollo delniño.La producción de leche materna (LM) se iniciadespués del parto y la cantidad producida, dependeráen primera instancia de la succión del niño y lafrecuencia en que es amamantado. La succiónestimula las terminaciones nerviosas del pezón quemandan un mensaje al cerebro para que la prolactinaproduzca leche y para que la oxitocina permita la salidade la leche. Los estímulos paratípicos que proporcionapara el crecimiento del sistema estomatognático con lasucción y la deglución ejercen un movimiento complejode la cara, los labios y la lengua, que constituyen lapreparación para el lenguaje, evitan la deformación dela dentadura y previenen la caries dental...

Calidad microbiológica de la leche humana procesada en el banco de leche materna: Hospital Ruiz y Páez: Ciudad Bolívar / Microbiological quality of human milk proccessed in the human milk bank: Hospital Ruiz y Paéz: City Bolívar

Los Bancos de Leche Humana son centros especializados que garantizan un producto bacteriológicamente seguro a los niños que la reciben. Evaluar la calidad microbiológica de la leche humana procesada en el Banco de Leche del Hospital "Ruiz y Páez", Ciudad Bolívar. Se recolectaron 30 muestras de leche obtenidas por extracción mecánica, durante el período agosto-noviembre del año 2004, se analizaron microbiológicamente antes y después de su pasteurización. Los parámetros investigados fueron recuento de Bacterias Aerobias Mesófilas, Coliformes Totales, Coliformes Fecales, Escherichia coli, y Estafilococos coagulasa positivos. La leche humana sin pasteurizar mostró una carga microbiana total con un máximo de 105 UFC/ml, representado por el recuento de aerobios mesófilos. En cuanto al recuento de estafilococos, en 76.7 por ciento (23 muestras) creció hasta 10 UFC/ml y Staphylococcus aureus, en 16.7 por ciento (5 muestras) se presentó en el orden de 10 UFC/ml. Con relación a los Coliformes Totales, sus recuentos fueron menor o igual 102 NMP/ml, Coliformes Fecales menor a 10NMP/ml, no se encontró Escherichia coli. Luego de efectuar el proceso de pasteurización, se determinó la ausencia de microorganismos en todas las muestras analizadas. La leche humana distribuida a los niños de este hospital se encuentra dentro de los estándares microbiológicos demostrando ser apropiadas las condiciones bajo las cuales se pasteuriza la leche humana en el Banco de leche del Hospital "Ruiz y Páez".

The Human Milk Banks are specialized centers that guarantee a bacteriologicaly safe product for those children who receive it. To evaluate the microbiological quality of processed human milk at the Milk Bank of the Hospital Ruiz y Páez, of Ciudad Bolivar. 30 milk samples were collected by mechanical extraction, during the period of August-November 2004. The samples were microbiologically analyzed before and after its pasteurization. The investigated parameters were counts of Aerobic Bacteria Mesophyla, Total Coliforms, Fecal Coliforms, Escherichia coli, and positive coagulase Staphylococci. Human milk prior pasteurization showed a total microbial load with a maximum of 10º UFC/ml, which was represented by the count of mesophile aerobes. The count of Staphylococci, reached 10 UFC/ml in 76,7 % (23 samples), Staphylococcus aureus was present up to10 UFC/ml in 16,7% (5 samples). In relation with the total Coliforms, their counts were under or equal to 10 NMP/ml and fecal Coliforms under 10 NMP/ml. Escherichia coli was not found. After pasteurization, all samples were free from any type of microorganism. The human milk distributed to children of this hospital, is within microbiological standards, indicating that the conditions under which human milk is pasteurized at the Milk Bank of the Hospital Ruiz and Páez are appropriate.

Determinación de los niveles de DDT, DDE y DDE-MESO2 en leche materna y sangre de poblaciones contaminadas por DDT en México / DDT, DDE and DDE-MeSO2 levels in maternal milk and blood serum from DDT exposed populations in Mexico

Se determinaron los niveles de DDE-MeSO2, DDT y DDE en 51 muestras de leche materna y en 40 muestras de sangre venosa de mujeres que viven en zonas donde el DDT se aplicó para el control de la malaria. Las concentraciones de los tres compuestos en leche materna en las diferentes comunidades fueron: El Ramonal 2.8 ng/glípido, 911 ng/glípido, 3100 ng/glípido; La Cigüeña 1.2 ng/glípido,134 ng/glípido, 764 ng/glípido; Tapachula 0.5 ng/glípido, 17 ng/glípido, 683 ng/glípido; la Huasteca 1.4 ng/glípido, 46 ng/glípido,490 ng/glípido; y Faja de Oro 0.4 ng/glípido, 18 ng/glípido, 268 ng/glípido. Las concentraciones encontradas de DDE-MeSO2 enEl Ramonal son siete veces mayores a las reportadas en Suecia en 1992 (0.4 ng/glípido). Los niveles de exposición a los 3 compuestos en sangre venosa fueron: Lacanjá 64 ng/glípido, 1323 ng/glípido, 3738 ng/glípido; El Ramonal 20 ng/glípido, 748 ng/glípido, 1271 ng/glípido; La Cigüeña 66 ng/glípido, 424 ng/glípido, 1059 ng/glípido; y Ventanilla 43 ng/glípido, 335 ng/glípido,1362 ng/glípido; de DDE-MeSO2, DDT y DDE respectivamente. Las comunidades de Lacanjá y La Cigüeña presentaron los mayores niveles de exposición al DDE-MeSO2, que comparados con los reportes de Eslovaquia son nueve veces mayor (7.3 ng/glípido).

The levels of the DDE-MeSO2, DDT andDDE were determined in 51 breast milk samples and in 40 blood samples from women living in endemic areas of malaria. The concentrations of the three compounds in maternal milk were: El Ramonal 2.8 ng/glipid, 911 ng/glipid, 3100 ng/glipid; La Cigueña 1.2 ng/glipid, 134 ng/glipid, 764 ng/glipid; Tapachula 0.5 ng/glipid, 17 ng/glipid, 683 ng/glipid; Huasteca 1.4 ng/glipid,46 ng/glipid, 490 ng/glipid; and Faja de Oro 0.4 ng/glipid, 18 ng/glipid, 268 ng/glipid. The concentrations of DDE-MeSO2 found in El Ramonal were seven times higher than those reported in Sweden in 1992 (0.4 ng/glipid). In blood the levels of the threecompounds were: Lacanjá 64 ng/glipid, 1323 ng/glipid, 3738 ng/glipid; El Ramonal 20 ng/glipid, 748 ng/glipid, 1271 ng/glipid; La Cigueña 66 ng/glipid, 424 ng/glipid, 1059 ng/glipid; and Ventanilla 43 ng/glipid, 335 ng/glipid, 1362 ng/glipid. The concentrations of DDE-MeSO2 in Lacanjá and La Cigueña were nine times than those reported in Slovakia (7.3 ng/glipid).