Concentrations and predictors of aluminum, antimony, and lithium in breast milk: A repeated-measures study of donors.

Aluminum (Al), antimony (Sb), and lithium (Li) are relatively common toxic metal(oid)s that can be transferred into breast milk and potentially to the nursing infant. This study assessed concentrations of Al, Sb, and Li in breast milk samples collected from donor mothers and explored the predictors of these concentrations. Two hundred forty-two pooled breast milk samples were collected at different times post-partum from 83 donors in Spain (2015-2018) and analyzed for Al, Sb, and Li concentrations. Mixed-effect linear regression was used to investigate the association of breast milk concentrations of these elements with the sociodemographic profile of the women, their dietary habits and utilization of personal care products (PCPs), the post-partum interval, and the nutritional characteristics of milk samples, among other factors. Al was detected in 94% of samples, with a median concentration of 57.63 µg/L. Sb and Li were detected in 72% and 79% of samples at median concentrations of 0.08 µg/L and 0.58 µg/L, respectively. Concentrations of Al, Sb, and Li were not associated with post-partum time. Al was positively associated with total lipid content of samples, weight change since before pregnancy, and coffee and butter intakes and inversely with meat intake. Li was positively associated with intake of chocolate and use of face cream and eyeliner and inversely with year of sample collection, egg, bread, and pasta intakes, and use of hand cream. Sb was positively associated with fatty fish, yoghurt, rice, and deep-fried food intakes and use of eyeliner and inversely with egg and cereal intakes and use of eyeshadow. This study shows that Al, Sb, and Li, especially Al, are widely present in donor breast milk samples. Their concentrations in the milk samples were most frequently associated with dietary habits but also with the lipid content of samples and the use of certain PCPs.

[Impact of the SARS-CoV-2 pandemic on a human milk bank]. / Impacto de la pandemia por SARS-CoV-2 en un banco de leche humana.

INTRODUCTION: Introduction: the pandemic caused by SARS-CoV-2 led to the declaration of the state of sanitary alarm between March and June 2020 in Spain. The activity of human milk banks was affected during that period, making it necessary to implement new measures in order to promote milk donation and diminish said impact. Method and objective: the aim of the study was to evaluate the impact of the state of alarm decreed from March 14 to June 22, 2020 on the breastmilk bank at Hospital Virgen de las Nieves, Granada, Spain, in comparison with the same period during the previous year. To that end, a retrospective descriptive study was undertaken in which the activity indicators of the breastmilk bank were collected and compared to data from the milk bank at Hospital Virgen de las Nieves and peripheral collaborating centers. Results: during the first state of alarm in 2020 a global reduction was seen in new donor registrations, number of donors who donated milk, donated mean volume per mother, and total volume of received and pasteurized milk. However, new registrations and number of donors who donated milk during this period increased in Granada's breastmilk bank. Discussion: the new measures adopted in the breastmilk bank in Granada, such as encouraging milk donation in mothers with admitted newborns in the Neonatal Unit, increasing information given to mothers, and home collection of donated milk, allowed to attenuate the impact of the pandemic while guaranteeing safety.

INTRODUCCIÓN: Introducción: la pandemia originada por el SARS-CoV-2 provocó la declaración del estado de alarma sanitaria entre marzo y junio de 2020 en España. Los bancos de leche materna han visto afectada su actividad durante este periodo, siendo necesario implementar nuevas medidas para promocionar la donación de leche y disminuir el impacto en la actividad. Método y objetivo: el objetivo del estudio es evaluar el impacto del estado de alarma decretado desde el 14 de marzo al 22 de junio de 2020 en el Banco de Leche del Hospital Virgen de las Nieves de Granada, en comparación con el mismo periodo del año previo. Para ello se ha realizado un estudio descriptivo retrospectivo en el que se han tenido en cuenta los indicadores de actividad del Banco de Leche de forma global y se han comparado los datos del Banco de Leche del Hospital Universitario Virgen de las Nieves, ubicado en Granada, con los datos de los centros periféricos que colaboran con el mismo. Resultados: durante el primer estado de alarma de 2020 hubo una disminución global de las inscripciones de nuevas donantes, del número de donantes que donaron leche, del volumen de donación media por madre y del volumen total de leche cruda recibida y pasteurizada. A pesar de ello, en el banco de leche de Granada aumentaron las nuevas inscripciones durante este periodo, así como el número de donantes que donaron leche. Discusión: las medidas adoptadas en el banco de leche ubicado en Granada, como incentivar la donación de leche entre las madres con niños ingresados en la Unidad Neonatal, aumentar la información a las madres y recoger la leche donada a domicilio, permitieron atenuar el impacto de la pandemia, garantizando la seguridad.

Recomendaciones de seguimiento del prematuro tardío / Follow-up recommendations for the late preterm infant

La población de prematuros tardíos (PT), aquellos nacidos entre las 340 y 366 semanas de gestación, representa el 70-74% de todos los prematuros, y no está incluida de forma específica en la mayoría de los protocolos de seguimiento para niños prematuros. Durante muchos años los PT han sido manejados como si de recién nacidos a término se tratasen, lo que ha llevado al desconocimiento de su evolución a medio y largo plazo. A la morbilidad neonatal se añade una mayor incidencia de afección posnatal, con una tasa de reingresos hospitalarios por malnutrición, hiperbilirrubinemia y problemas respiratorios superior a los nacidos a término. La inmadurez cerebral puede ser el principal responsable de los déficits observados en el neurodesarrollo a largo plazo en esta población y aumentar su vulnerabilidad. Se describen retrasos o discapacidades en la etapa preescolar, parálisis cerebral, retraso mental, discapacidad intelectual, esquizofrenia, trastornos del desarrollo psicológico, la conducta y la emoción. El grupo SEN34-36 de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, han desarrollado estas recomendaciones de seguimiento con el objetivo principal de disminuir el impacto de la prematuridad en el desarrollo de los PT. Los objetivos secundarios del documento son sensibilizar a neonatólogos y pediatras de los posibles riesgos de secuelas de los PT, determinar y unificar las evaluaciones y/o intervenciones que deberían realizarse, ofrecer herramientas de seguimiento clínico para detectar de manera precoz los déficits en el desarrollo y coordinar la atención de todos los profesionales implicados

The population of late preterm infants (PT), those born between 34 + 0 and 36 + 6 weeks of gestation, accounts for 70-74% of all premature infants, and is not specifically included in most of the follow-up protocols for preterm infants. For many years, PTs have been handled as if they were term newborns, which has led to a limited knowledge of their outcome in the medium and long term. Their neonatal morbidity is associated with a higher incidence of postnatal complications, with an increased rate of hospital re-admissions due to malnutrition, hyperbilirubinaemia, and respiratory problems, when compared to term infants. Cerebral immaturity may be the main cause of the deficits observed in the long-term neurodevelopment of this population, making them more vulnerable. Several issues have been described, such as delays or disabilities in the pre-school stage, cerebral palsy, mental retardation, intellectual disability, schizophrenia, and psychological development of behavioural and emotional disorders. The SEN34-36 Group of the Spanish Society of Neonatology, in collaboration with the Spanish Association of Primary Care Paediatrics, have developed these follow-up recommendations with the main objective of reducing the impact of prematurity on PT development. The secondary objectives of the document are to make neonatologists and paediatricians aware of the risks of sequelae of PTs, to determine and unify the evaluations and / or interventions that should be carried out, to offer clinical follow-up tools for the early detection of developmental delays, and to coordinate the care by all the professionals involved

[Follow-up recommendations for the late preterm infant]. / Recomendaciones de seguimiento del prematuro tardío.

The population of late preterm infants (PT), those born between 34+0 and 36+6 weeks of gestation, accounts for 70-74% of all premature infants, and is not specifically included in most of the follow-up protocols for preterm infants. For many years, PTs have been handled as if they were term newborns, which has led to a limited knowledge of their outcome in the medium and long term. Their neonatal morbidity is associated with a higher incidence of postnatal complications, with an increased rate of hospital re-admissions due to malnutrition, hyperbilirubinaemia, and respiratory problems, when compared to term infants. Cerebral immaturity may be the main cause of the deficits observed in the long-term neurodevelopment of this population, making them more vulnerable. Several issues have been described, such as delays or disabilities in the pre-school stage, cerebral palsy, mental retardation, intellectual disability, schizophrenia, and psychological development of behavioural and emotional disorders. The SEN34-36 Group of the Spanish Society of Neonatology, in collaboration with the Spanish Association of Primary Care Paediatrics, have developed these follow-up recommendations with the main objective of reducing the impact of prematurity on PT development. The secondary objectives of the document are to make neonatologists and paediatricians aware of the risks of sequelae of PTs, to determine and unify the evaluations and / or interventions that should be carried out, to offer clinical follow-up tools for the early detection of developmental delays, and to coordinate the care by all the professionals involved.

Recomendaciones de seguimiento del prematuro tardío / Recommendations for the follow-up of the late preterm infant

La prematuridad continúa siendo la primera causa de morbimortalidad neonatal e infantil y constituye uno de los problemas de salud más importantes, sobre todo en la sociedad industrializada. La población de prematuros tardíos, que incluye a los niños nacidos entre las 340 y 366 semanas de edad gestacional, representa el 70-74% de todos los prematuros. Los prematuros tardíos presentan mayor incidencia de patología comparados con los recién nacidos a término y no solo en el periodo neonatal sino también durante la infancia, con unas mayores tasas de rehospitalización y consulta a los servicios de urgencias, un mayor riesgo de infecciones, de fallo de medro, de problemas respiratorios y de trastornos del neurodesarrollo. Nuestro objetivo debe ser poder realizar diagnósticos e intervenciones precoces, principalmente a nivel del neurodesarrollo, que multiplicarán la probabilidad de buena evolución. En esta línea, desde el grupo de trabajo SEN34-36 de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, se ha desarrollado este documento de Recomendaciones de seguimiento del prematuro tardío, con el objetivo de sensibilizar a pediatras y neonatólogos de las patologías en las que los prematuros tardíos presentan mayor riesgo y sobre las que debemos focalizar nuestra atención, facilitando una guía de trabajo a los profesionales implicados en el seguimiento de este grupo de prematuros

Prematurity continues to be the leading cause of neonatal and infant morbidity and mortality and stands as one of the most important health problems, especially in industrialized countries. Late preterm infants are those born between 34 and 36 weeks of gestational age and represent 70-74% of all premature births. Late preterm infants show a higher incidence of pathology compared to term infant and not only in the neonatal period but also during childhood, with higher rates of hospital readmissions and visits to emergency services, an increased risk of infections, of failure to thrive, respiratory problems and neurodevelopmental disorders. Our objective will be to anticipate diagnoses and apply early interventions, mainly at the level of neurodevelopment, which will increase the likelihood of better outcomes. In this line, from the working group SEN34-36 of the Spanish Society of Neonatology and in collaboration with the Spanish Association of Pediatrics of Primary Care, this document of Recommendations for the follow-up of the late preterm infant has been edited in order to raise awareness among pediatricians and neonatologists about the most common pathologies in these babies, and on which we must focus our attention, thereby providing a working guide to the professionals involved in the follow-up of this group of premature infants

Relationship between severe acidemia, verbal abilities, and behavior in a Spanish cohort of 5-year-old children born at term.

AIM: To determine whether a relationship exists between the markers of severe acidemia (SA) and the developmental, verbal, and behavioral characteristics of children with SA born at term 5 years previously, without apparent neurological impairment. METHODS: A cohort of 76 children-38 with SA (pH < 7, base deficit ≥12 mmol/L) and 38 non-SA (pH ≥ 7.20)-were evaluated using the Battelle Developmental Inventory, McCarthy's Verbal Scale, the Token Test for Children, and the Conners 3rd Edition-Parent. The relationships between markers of SA and verbal and behavioral scores were analyzed with parametric correlations. Multiple regression analysis was used to determine the possible effect of these markers on verbal abilities, verbal memory, and attention. RESULTS: Although none of the scores were in the "impaired" range, the SA group scored lower in verbal index (p = .000) and verbal memory (p = .004) on the McCarthy's Scales and in verbal comprehension (p = .001) on the Token Test for Children-2, and higher on the inattention (p = .003) and hyperactivity-impulsivity domains of the Conners Scales (p = .009) compared with the control group. There were no differences between the groups in the motor, personal-social, or cognitive domains on the Battelle Developmental Inventory. The SA markers were found to be predictors, accounting for 61.6% of verbal variability. CONCLUSIONS: SA markers reflect mild long-term consequences regarding verbal abilities and inattentiveness among children born at term without apparent neurological impairment on discharge but do not suggest severe impairment to the 5-year development of children. The authors recommend that these children should be monitored to determine whether they need or might benefit from an early intervention program.