Immediate fortification of human milk with a bovine milk-derived human milk fortifier in very low birth weight infants: a randomized clinical trial.

OBJECTIVE: Double-blind randomized control trial of early addition of a bovine milk-derived human milk fortifier (HMF) in very low birth weight (VLBW) infants (NCT05228535). METHODS: VLBW infants were randomized to receive bovine milk-derived HMF with first feedings or delayed fortification at 80 ml/kg/day. Anthropometrics were assessed weekly through 36 weeks postmenstrual age (PMA). Unadjusted and adjusted (race, gender, gestational age, and birth weight) differences between study arms were examined using two-sample t-test and ANCOVA, respectively. RESULTS: Fifty-two VLBW infants (57% female, 60% Black) were enrolled. Baseline demographics did not differ between groups. Weight velocity at DOL 28 did not differ between study arms. Secondary outcomes including NPO occurrence, incidence of metabolic acidosis, NEC, retinopathy, or late-onset sepsis did not differ between groups. CONCLUSION: Immediate fortification of enteral feedings with a bovine milk-derived HMF appears safe and well-tolerated although no clear growth benefit could be established.

Osmolality of fortified donor human milk: An experimental study.

BACKGROUND: We quantify the osmolality of human milk fortified with human milk fortifiers (HMFs), powder infant formulas and protein additives. METHODS: Commercial liquid HMFs and powder infant formulas were added to pasteurized pooled donor human milk in triplicate and stirred. The osmolality of unfortified and fortified human milk at 22, 24, 26, 27, 28, and 30 kcal/oz (0.73, 0.8, 0.87, 0.9, 0.93, and 1 kcal/ml, respectively) was determined using freezing-point depression. RESULTS: The osmolality of fortified human milk associated with energy density in a linear relationship regardless of the fortification strategies. Multiple liquid HMFs and every powder infant formula exceeded the osmolality threshold of 450 mOsm/kg H2 O within the energy densities tested. CONCLUSION: The osmolality of fortified human milk is highly variable and should be considered when selecting a fortifying agent for human milk.

Nutrient Composition of Donor Human Milk and Comparisons to Preterm Human Milk.

BACKGROUND: Human milk is the preferred diet for very low birth weight (VLBW, <1500 g) infants. When mother's own milk is unable to meet the needs of VLBW infants, donor human milk (DHM) is the preferred alternative. Unfortunately, the composition of DHM remains elusive and no comparative studies between preterm human milk and DHM have been performed previously. OBJECTIVES: We aimed to analyze the nutrient content of commercial pooled DHM and compare nutrient content in DHM with that of early and mature preterm human milk. METHODS: We analyzed nutrient content in 15 DHM samples provided from 7 commercial milk banks including calories, carbohydrate, fat, protein, sodium, chloride, potassium, zinc, calcium, phosphorus, magnesium, and vitamin D and compared each nutrient to early (7 d of life) and mature (28 d of life) preterm human milk samples (n = 28-36 per nutrient, gestational age = 28 ± 3 wk). Protein-to-energy ratio and carbohydrate-to-nonprotein energy ratio were calculated for each sample and compared. RESULTS: Mean values for all macro- and micronutrients in DHM are reported. In comparison to early or mature preterm human milk, DHM had significantly lower protein, sodium, chloride, potassium, and zinc content. Calorie, carbohydrate, calcium, phosphorus, magnesium, and vitamin D content did not differ statistically between DHM and early or mature preterm human milk. Fat content was modestly lower in early but not mature human milk when compared with DHM. CONCLUSIONS: We provide mean values for several macro- and micronutrients for DHM and identify key differences between DHM and preterm human milk, which may be considered when designing human milk-based feeding plans. This study was registered at clinicaltrials.gov as NCT05742815.

Displacement of human milk during fortification: An experimental study.

BACKGROUND: This study quantified the displacement of human milk by commercial human milk fortifiers (HMFs) and infant formulas. METHODS: Commercial liquid HMFs and powder infant formulas were added to pasteurized pooled donor human milk in triplicate, stirred, and weighed. The difference in weight between unfortified and fortified human milk at 22, 24, 26, 27, 28, and 30 kcal/ounce was calculated. RESULTS: The displacement of human milk by liquid HMFs and powder infant formulas and powder HMF was highly associated with energy density. A human milk-derived HMF displaced significantly more human milk when compared with bovine milk-derived HMFs at equivalent energy densities. Similarly, powder infant formulas displaced less human milk when compared with a powder HMF, and the addition of hydrolyzed powder infant formulas resulted in less human milk displacement when compared with nonhydrolyzed powder infant formulas. CONCLUSIONS: The displacement of human milk by commercial liquid HMFs and infant formulas must be considered when selecting a fortifying strategy.

Acid/base balance in fortified donor human milk: An experimental study.

BACKGROUND: Our goal was to quantify the pH and total acidity of human milk fortified with human milk fortifiers (HMFs), powder infant formulas, and protein additives. METHODS: Commercial liquid HMFs and powder infant formulas were added to pasteurized pooled donor human milk in triplicate and stirred. The pH of unfortified and fortified human milk at 22, 24, 26, 27, 28, and 30 kcal/ounce (624, 680, 737, 765, 794, and 850 kcal/g, respectively) was determined using a pH meter. Phenolphthalein acidity at 24 and 30 kcal/ounce (680 and 850 kcal/g, respectively) was determined using diluted sodium hydroxide. RESULTS: The pH of unfortified human milk increased within the first hour (6.52 ± 0.06 vs 6.62 ± 0.05, P < 0.0001). Changes in pH largely correlated with caloric density; however, directional changes varied considerably between HMFs and powder infant formulas. Two liquid HMFs demonstrated modest reductions in pH with increasing caloric density whereas one liquid HMF alkalinized human milk with increasing caloric density (analysis of variance P < 0.0001). Phenolphthalein acidity was significantly higher for five HMFs and lower for one HMF at 30 kcal/ounce (850 kcal/g) but not 24 kcal/ounce (680 kcal/g). Powder infant formulas generally increased pH with increasing caloric density (analysis of variance P < 0.0001), but no differences in phenolphthalein acidity were noted. CONCLUSION: Changes in acid/base balancefor fortified human milk are variable and may be a consideration when selecting a fortifying agent for human milk.

Novel multinutrient human milk-based human milk fortifier promotes growth and tolerance in premature infants.

BACKGROUND: The objective of this study was to determine whether human milk supplemented with a novel human milk-based human milk fortifier (Novel HMF), compared with a bovine milk-based HMF (Bovine HMF), supports preterm infant growth through 36 weeks' postmenstrual age (PMA). METHODS: This single-center, prospective trial compared growth and nutrition outcomes of preterm infants provided a human milk-based diet (mother's own milk or donor milk) supplemented with a Novel HMF with historic controls provided Bovine HMF. Preterm infants with an estimated gestational age (EGA) between 23 and 33 weeks' PMA and birth weight between 750 and 1800 g were eligible for study inclusion. Weight, length, and head circumference (HC) were monitored weekly. The occurrence of late-onset sepsis, nil per os (NPO) days, necrotizing enterocolitis, metabolic acidosis, and serious adverse events were monitored. RESULTS: Birth weight, length, HC, and EGA were similar between the Novel HMF (n = 37) and Bovine HMF (n = 49) groups. The days to regain birth weight was shorter in the Novel HMF group (9.4 ± 4.0 vs 11.4 ± 4.8, P = .0343), with similar weight gain (g/day) from birth to 36 weeks' PMA. Adjusted weight growth velocity (g/kg/day) was significantly higher in the Novel HMF group at 14 and 21 days but similar at 36 weeks' PMA. The Novel HMF group experienced fewer NPO days with a similar total number of feeding days. CONCLUSIONS: A novel, multinutrient, human milk-based HMF is well tolerated and meets the nutrition needs of preterm infants.

Behavioural impacts of torpor expression: a transient effect in captive eastern chipmunks (Tamias striatus).

Species use torpor, an extreme form of heterothermy, to survive periods of limited resource supply. Studies of hibernating animals have shown that torpor causes major structural and physiological changes in the brain, many of which are reversed during periodic arousals. This suggests that behaviour may change during and following the hibernation period. Here we investigate individual performance in behavioural tests prior to and during hibernation by captive eastern chipmunks (Tamias striatus). Results indicate an association between deep torpor expression and atypical habituation patterns tested directly following torpor arousals. However, no association was found between torpor expression and spatial maze performance tested more than 24h post-arousal. Therefore, any behavioural impairment induced by torpor appears to be highly transient. The detected association between torpor and behaviour may be driven by previously confirmed effects of torpor on brain structure and function, though other potential covariates, such as the activation and deactivation of the stress axis, warrant consideration. Thus, our results are consistent with transient behavioural impairments following torpor arousals, but the causes and longer-term consequences of these transient impairments remain unclear.

A novel and inexpensive vaginal hysterectomy simulator.

INTRODUCTION: The number of vaginal hysterectomy procedures performed by resident physicians in the United States is highly variable, with half of residency graduates completing 18 procedures or fewer as primary surgeon. Complex anatomy and technical challenge contribute to a steep learning curve for novice surgeons. Surgical simulation may be a useful adjunct to this surgical training, but a vaginal hysterectomy simulator is not currently available. METHODS: We describe the construction of a vaginal hysterectomy simulator that prioritizes low cost, wide availability of materials, and ease of assembly. Initial construction and per-use simulation costs were calculated. Per-use preparation time was recorded. Surgical learners who used the simulator (n = 12) completed a survey to determine its contribution to their learning. RESULTS: Total cost per simulation was US $1.83 after an initial US $103.79 investment in a resin bony pelvis and stand. All relevant major anatomic landmarks (ureter, bladder, uterus, cervix, vesicouterine fold, vagina, and posterior cul-de-sac) were represented. Of the 12 surveyed surgical learners, 9 (75%) responded. On a 10-point scale (10 = highest), respondents noted that the simulator positively contributed to knowledge of procedure steps (8.3), anatomic relationships (7.7), preprocedure confidence with the first vaginal hysterectomy as primary surgeon (8), and overall learning on how to perform a vaginal hysterectomy (8.3). CONCLUSIONS: This technical report details the construction of a vaginal hysterectomy simulator, the individual parts, the cost of each part, and the results of a blinded survey of resident physicians who used the simulator during their vaginal hysterectomy instruction.

Actinobacillus equuli as a primary pathogen in breeding sows and piglets.

The death of over 300 sows in 2 months on a 3000 sow farrow-to-isowean operation in Manitoba was attributed to infection with Actinobacillus equuli. This pathogen commonly infects foals, and is rarely reported in swine. Our report is the second recently published case of this pathogen in North American swine.

Prevalence and distribution of Baylisascaris procyonis in urban raccoons (Procyon lotor) in Winnipeg, Manitoba.

The prevalence of Baylisascaris procyonis was estimated in the urban raccoon population of Winnipeg through the fecal flotation of raccoon feces collected at active latrines and through gross postmortem and fecal flotation of samples collected from nuisance raccoons. Fecal flotation of latrine-collected feces was positive in 33 of 89 samples and, of 52 latrines identified, 26 were positive on 1 or more occasions. Trapped individual raccoons subjected to postmortem examination were positive in 57 of 114 animals captured. Comparing a single fecal flotation to the gold standard of finding adult worms in the small intestine had a sensitivity of 78.9% and specificity of 92.9%. This study suggests that carriage of Baylisascaris procyonis is widespread in raccoons in the Winnipeg urban ecosystem. Raccoon latrines in Winnipeg should be treated as infectious sites and efforts should be made to limit access of pets and people at risk to those sites.

Baylisascaris procyonis encephalitis in Patagonian conures (Cyanoliseus patagonus), crested screamers (Chauna torquata), and a western Canadian porcupine (Erethizon dorsatum epixanthus) in a Manitoba zoo.

Neurological disease occurred in 4 Patagonian conures (Cyanoliseus patagonus), 2 crested screamer chicks (Chauna torquata), and 1 western Canadian porcupine (Erethizon dorsatum epixanthus) at a Manitoba zoo. Baylisascaris procyonis, the common raccoon roundworm, not previously identified in Manitoba, is considered the likely cause of neural larval migrans in these cases.