Breastfeeding patterns in cohort infants at a high-risk fetal, neonatal and child referral center in Brazil: a correspondence analysis.

BACKGROUND: To investigate the prevalence and patterns of breastfeeding at discharge and in the first six months of life in a high-risk fetal, neonatal and child referral center. METHODS: Prospective, longitudinal study that included the following three steps: hospital admission, first visit after hospital discharge and monthly telephone interview until the sixth month of life. The total number of losses was 75 mothers (7.5%). Exposure variables were sorted into four groups: factors related to the newborn, the mother, the health service and breastfeeding. The dependent variable is breastfeeding as per categories established by the WHO. All 1200 children born or transferred to the high-risk fetal, neonatal and child referral center, within a seven-day postpartum period, from March 2017 to April 2018, were considered eligible for the study, and only 1003 were included. The follow-up period ended in October 2018. For this paper, we performed an exploratory analysis at hospital discharge in three stages, as follows: (i) frequencies of baseline characteristics, stratified by risk for newborn; (ii) a multiple correspondence analysis (MCA); and (iii) clusters for variables related to hospital practice and exclusive breastfeeding (EBF). RESULTS: The prevalence of EBF at hospital discharge was 65.2% (62.1-68.2) and 20.6% (16.5-25.0) in the six months of life. Out of all at-risk newborns, 45.7% were in EBF at discharge. The total inertia corresponding to the two dimensions in the MCA explained for 75.4% of the total data variability, with the identification of four groups, confirmed by the cluster analysis. DISCUSSION: Our results suggest that robust breastfeeding hospital policies and practices influence the establishment and maintenance of breastfeeding in both healthy and at-risk infants. It is advisable to plan and implement additional strategies to ensure that vulnerable and healthy newborns receive optimal feeding. It is necessary to devote extra effort particularly to at-risk infants who are more vulnerable to negative outcomes. CONCLUSION: At-risk newborns did not exclusively breastfeed to the same extent as healthy newborns at hospital discharge. A different approach is required for at-risk neonates, who are more physically challenged and more vulnerable to problems associated with initiation and maintenance of breastfeeding.

[Breastfeeding: a nature-culture hybrid]. / Amamentação: um híbrido natureza-cultura.

OBJECTIVE: To contribute to the creation of a new theoretical synthesis about the relationship between the biological and social dimensions of breastfeeding, categorizing it as a nature-nurture hybrid. SOURCES OF DATA: The methodological approach of the present article was based on the qualitative health research frame, and data were analyzed on the basis of dialectic-hermeneutic principles. Primary sources, comprising historical documents, books, scientific articles and medical theses written in the 19th and 20th centuries were analyzed. SUMMARY OF THE FINDINGS: Depending on the moment in history and on the expectations that surround the act of breastfeeding, the aspects related to nature and nurture, i.e., to biology and society, sometimes separate out and sometimes intermingle. A comprehensive approach to breastfeeding makes possible to see that it had to be considered instinctive, natural and biological in order to be assimilated as a cultural habit, and thus, it is not open to any kind of questioning. On other occasions, particularly in the course of the past decade, there has been a steady tendency to supplant traditional biological reductionism, which yielded cultural interpretations that do not reduce the human being to the status of a mammal like any other. Under this point of view, breastfeeding, in addition to being biologically determined, is socially conditioned, and thus constitutes an act embedded in ideologies and determinants resulting from the concrete conditions of life. In real life, however, a process apparently so natural, so loaded with affection and emotion is, in fact, affected by the most aggressive market interests, very often presented as scientific knowledge and decked out as health provisions. CONCLUSION: Breastfeeding focused as a nature-culture hybrid symbolizes the theoretical and methodological changes in the field, especially in the late 1990s. These changes reflect a renewed appreciation of biology and a more in-depth approach to interdisciplinary processes.

[Banana peel: a possible source of infection in the treatment of nipple fissures]. / Casca de banana: uma possível fonte de infecção no tratamento de fissuras mamilares.

OBJECTIVE: To study the microbiology of banana peel being sold in the city of Rio de Janeiro, in an attempt to determine the possibility that the peel may represent a source of infection for women who use it to treat nipple fissures. METHODS: The following microorganisms were studied in 20 banana peel samples: mesophiles, total coliforms, fecal coliforms, Pseudomonas aeruginosa, lipolytic and proteolytic microorganisms, molds and yeasts, lactic bacteria, and coagulase-positive staphylococcus. RESULTS: The microbiological analyses revealed the occurrence of several typical groups of microorganisms, with the following distribution of positive results being detected in banana peel samples: mesophiles, 100%; total coliforms, 20%; coagulase-positive staphylococcus, 25%; molds and yeasts, 30%; proteolytic microorganisms, 70%; lipolytic microorganisms, 30%, and lactic bacteria, 95%. Fecal coliforms and Pseudomonas aeruginosa were not isolated. CONCLUSION: The results show the presence of potentially pathogenic microorganisms in levels which could compromise the microbiological quality of the banana peel. Its use for the treatment of nipple fissures can initiate an infectious process.

[Alternative test for detection of coliforms bacteria in manually expressed human milk]. / Teste alternativo para detecção de coliformes em leite humano ordenhado.

OBJECTIVE: To compare an alternative method to the most probable number (MPN) test for the detection of total coliform present in manually expressed human milk. METHODS: 343 samples of manually expressed human milk from flasks donated to the Human Milk Bank of Instituto Fernandes Figueira--IFF were sent to the Laboratory of Food Control of IFF. The samples were used for comparing both methods, i.e., the most probable number (MPN) method, as described in the "Standard methods for the examination of dairy products", and the alternative method. RESULTS: Coliforms were detected in 31.2% of the samples analyzed, with populations ranging from 3.0 x 10(0) to 1.1 x 10(4) total coliform MPN/mL. The comparison between classical and alternative methods showed similar results regarding the presence of coliform microorganisms in expressed human milk samples. The alternative method detected the presence of total coliform in all contaminated and in four noncontaminated samples according to the MNP method. CONCLUSIONS: The alternative test allows the detection of the presence or absence of coliforms and it is useful for the quality control of pasteurized flasks containing manually expressed human milk manipulated at human milk banks. Therefore, we conclude that the alternative test can be used in the routine of human milk banks as a substitute for the MNP method, since its cost is equivalent to 1/7 of the cost of the traditional method.

[Contamination of expressed human milk by mycelial fungi]. / Contaminação do leite humano ordenhado por fungos miceliais.

OBJECTIVE: To characterize the genera of mycelial fungi detected in expressed human milk received at the human milk bank of Instituto Fernandes Figueira after home collection. METHODS: We studied 821 expressed human milk samples randomly obtained from flasks filled by the donors at home. The possible presence of molds, yeasts and mesophilic microorganisms was investigated. A total of 48 strains of mycelial fungi were isolated from the human milk bank samples and identified through standard laboratory techniques. RESULTS: Microbiological analysis revealed the occurrence of molds and yeasts in 43 samples (5.2%), with counts reaching 10(3) CFU/ml. The following microorganisms were identified: Aspergillus niger group (6.3%), Aspergillus sp. (4.2%), Paecilomyces sp. (12.6%), Penicillium sp. (60.4%), Rhizopus sp. (2.0%), and Syncephalastrum sp. (14.5%). Four samples showed the presence of more than one mycelial fungus type. CONCLUSIONS: The presence of molds and yeasts in human milk manually expressed at home suggests that the hygiene conditions of the collection site may contaminate milk. Thus, when hospitalized premature babies receive the raw product, it is very important to observe the collection, storage and transport conditions in order to avoid the presence and consequences of contaminants increase.