RESUMO

Introduction: The gastrointestinal and immune systems of premature infants are not fully developed, rendering them more vulnerable to severe complications like necrotizing enterocolitis. Human milk offers a rich array of bioactive factors that collectively contribute to reducing the incidence of gut infections and inflammatory conditions. When a mother's milk is unavailable, preterm infants are often provided with donor human milk processed in Human Milk Banks. However, it remains uncertain whether pasteurized milk confers the same level of risk reduction as unprocessed milk. This uncertainty may stem from the well-documented adverse effects of heat treatment on milk composition. Yet, our understanding of the comprehensive impact on protective mechanisms is limited. Methods: In this study, we conducted a comparative analysis of the effects of raw versus pasteurized milk and colostrum versus mature milk on cellular functions associated with the gut epithelial barrier and responses to inflammatory stimuli. We utilized THP-1 and HT-29 cell lines, representing monocyte/macrophages and gut epithelial cells, respectively. Results: Our observations revealed that all milk types stimulated epithelial cell proliferation. However, only raw colostrum increased cell migration and interfered with the interaction between E. coli and epithelial cells. Furthermore, the response of epithelial and macrophage cells to lipopolysaccharide (LPS) was enhanced solely by raw colostrum, with a milder effect observed with mature milk. In contrast, both raw and pasteurized milk diminished the LPS induced response in monocytes. Lastly, we examined how milk affected the differentiation of monocytes into macrophages, finding that milk reduced the subsequent inflammatory response of macrophages to LPS. Discussion: Our study sheds light on the impact of human milk on certain mechanisms that potentially account for its protective effects against necrotizing enterocolitis, highlighting the detrimental influence of pasteurization on some of these mechanisms. Our findings emphasize the urgency of developing alternative pasteurization methods to better preserve milk properties. Moreover, identifying the key components critically affected by these protective mechanisms could enable their inclusion in donor milk or formula, thereby enhancing immunological benefits for vulnerable newborns.

Assuntos

RESUMO

We assessed the effectiveness of lyophilised banked human milk (HM) as a fortifier to feed very-low-birth-weight infants (VLBWI). This study aimed to evaluate the safety and tolerability of HM with HM lyophilisate as an additive compared with the standard additive (cows' milk protein). In this phase I double-blind randomised controlled clinical trial, set in the intensive and intermediate care units of a tertiary hospital, forty VLBWI were enrolled and allocated into two groups: HM plus HM lyophilisate (LioNeo) or HM plus commercial additive (HMCA). The inclusion criteria were preterm infants, birth weight 750-1500 g, small or adequate for gestational age, exclusively receiving donor HM, volume ≥ 100 ml/kg per d and haemodynamically stable. Participants were followed up for 21 consecutive days. The primary outcome measures were necrotising enterocolitis (NEC), late-onset sepsis (LOS), death, gastrointestinal (GI) bleeding or perforation, diarrhoea, regurgitation, vomiting and abdominal distension. The LioNeo and HMCA groups had similar weights at baseline. The regression models showed no differences between the groups in terms of the primary outcomes. Diarrhoea, GI perforation, NEC and LOS were absent in the LioNeo group (one LOS and one NEC in the HMCA group). Multiple regression analysis with the total volume of milk as a covariate did not show significant differences. The lyophilisation of donor HM was considered safe and tolerable for use in stable haemodynamically VLBWI.

Assuntos

RESUMO

The retention of human milk (HM) fat in nasogastric probes of infusion pumps can be observed during the feed of infants unable to suck at the mother's breast. The lack of homogenisation of HM could contribute to the fat holding. Therefore, the present study evaluated (i) the influence of homogenisation on milk fat retaining in infant feeding probes and (ii) the in vivo effect of the homogenisation on lipid absorption by Wistar rats. The animals were fed with HM treated following two processing conditions, that is, pasteurised and homogenised-pasteurised. The animals were randomly subdivided into four experimental groups: water-fed (control), pasteurised milk, homogenised-pasteurised milk and pasteurised-skimmed milk. The results of food consumption, mass body gain, corporate metrics and plasma blood levels of total cholesterol did not show any difference (P < 0·05) among the three types of HM used in the experiments. The liver, intestine and intra-abdominal adipose tissue of the four groups of animals presented normal and healthy histology. The composition of fatty acids in the brain tissue of animals fed with homogenised HM increased when compared with the groups fed with non-homogenised HM. These values were 11·08 % higher for arachidonic acids, 6·59 % for DAH and 47·92 % for nervous acids. The ingestion of homogenised HM promoted higher absorption of milk nutrients. Therefore, the addition of the homogenisation stage in HM processing could be an alternative to reduce fat retention in probes and to improve the lipids' absorption in the body.

Assuntos

RESUMO

Resumo Objetivo refletir sobre a organização do trabalho de Enfermagem no Banco de Leite Humano a partir das ações de cuidado compartilhado com a equipe multiprofissional. Método trata-se de um estudo teórico-reflexivo com base nos conceitos de campo e habitus de Pierre Bourdieu de modo a compreender o modus operandi dos seus agentes no campo e no subcampo da saúde. Resultados evidenciou-se que o Processo de Enfermagem faz parte dos procedimentos de cuidado em saúde nos diferentes espaços de atuação, todavia, é importante pontuar que há uma interdependência dos serviços prestados. Percebem-se a integralidade da proposta e a organização do trabalho do BLH a partir de uma equipe multiprofissional. Para a Enfermagem, o habitus está posto desde a formação inicial dos seus profissionais, pois há o reconhecimento do saber próprio do campo e que as ações são pautadas em conhecimentos teórico-científicos. Conclusão e implicações para a prática o cuidado compartilhado é reconhecido como importante fator de equalização da assistência e demais serviços realizados no campo do BLH. Ao mobilizar os conceitos de Pierre Bourdieu, é possível inferir o habitus nos modos de cuidar, considerando-se, ainda, aquele específico construído ao longo da história da Enfermagem.

Resumen Objetivo reflexionar sobre la organización del trabajo de Enfermería en el Banco de Leche Materna, a partir de acciones de cuidado compartido con el equipo multiprofesional. Método es un estudio teórico-reflexivo basado en los conceptos de campo y habitus de Pierre Bourdieu, con el fin de comprender el modus operandi de sus agentes en el campo y en el subcampo de la salud. Resultados mostraron que el Proceso de Enfermería es parte de los procedimientos de atención en salud en diferentes áreas de actuación, sin embargo, es importante señalar que existe una interdependencia de los servicios brindados. La integridad de la propuesta y la organización del trabajo del BLM se puede ver desde un equipo multiprofesional. Para la Enfermería, el habitus se establece a partir de la formación inicial de sus profesionales, pues se reconoce el conocimiento del campo y que las acciones se basan en conocimientos teórico-científicos. Conclusión e implicaciones para la práctica la atención compartida se reconoce como un factor importante en la igualación de la atención y otros servicios realizados en el campo del BLM. Mediante la movilización de los conceptos de Pierre Bourdieu, es posible inferir el habitus en los caminos de cuidado, teniendo en cuenta incluso el específico construido a lo largo de la historia de la Enfermería.

Abstract Objective reflect on the organization of nursing work in the Human Milk Bank based on shared care actions with the multi-professional team. Method this is a theoretical-reflexive study based on Pierre Bourdieu's concepts of field and habitus in order to understand the modus operandi of its agents in the field and subfield of health. Results it was evidenced that the Nursing Process is part of the health care procedures in the different performance spaces, however, it is important to point out that there is an interdependence of the services provided. The integrality of the proposal and the organization of the work of the HMB are perceived from a multi-professional team. For nursing, the habitus is set from the initial training of its professionals, since there is recognition of the knowledge of the field and that the actions are based on theoretical and scientific knowledge. Conclusion and implications for practice shared care is recognized as an important factor in equalizing care and other services performed in the field of HMB. By mobilizing the concepts of Pierre Bourdieu, it is possible to infer the habitus in the modes of care, considering also the specific habitus built throughout the history of Nursing.

Assuntos

RESUMO

Objetivo: Estimar la contaminación microbiológica e identificar sus factores asociados en leche materna dentro del BLH de un Hospital en Perú. El estudio. Diseño transversal, donde se realizó evaluación física, química y microbiológica a muestras de leche materna. Hallazgos. Evaluamos 187 muestras de leche donadas por madres La acidez Dornic y crematocrito promedio fue de 5,2±1,6 y 2,7±0,9%, y la contaminación microbiológica representó el 3,7% del total de muestras evaluadas, aislándose Acynetobacter iwoffi, Moraxela lacunata, Pseudomona aeruginosa y Staphylococcus coagulasa negativa. Se evidenció que el pH de la leche fue la única variable asociada a contaminación microbiológica (OR: 3.7 IC95: 1.5-8.8). Conclusión. El incremento de pH es un factor asociado a contaminación microbiológica en muestras de leche donadas en el BLH de un Hospital en Perú, por lo que es recomendable reevaluar los criterios de aceptabilidad del rango de pH de la leche materna donada.

Objetive: Estimate microbiological contamination and identify its associated factors in breast milk within the BLH of a Hospital in Peru. The study. Cross-sectional design, where a physical, chemical and microbiological evaluation was carried out on samples of breast milk. Findings. We evaluated 187 milk samples donated by mothers. The average Dornic acidity and crematocrit were 5.2 ± 1.6 and 2.7 ± 0.9%, and the microbiological contamination represented 3.7% of the total samples evaluated, isolating Acynetobacter iwoffi, Moraxela lacunata, Pseudomona aeruginosa and Staphylococcus negative coagulase. It was evidenced that the pH of the milk was the only variable associated with microbiological contamination (OR: 3.7 IC95: 1.5-8.8). Conclusion. The increase in pH is a factor associated with microbiological contamination in donated milk samples at the BLH of a Hospital in Peru, so it is advisable to re-evaluate the acceptability criteria of the pH range of donated breast milk.

RESUMO

El propósito de este trabajo fue describir las características, motivaciones, barreras y fuentes de información de las mujeres donantes del Banco de Leche en el Complejo Asistencial Dr. Sótero del Río (CASR). MÉTODO: El diseño utilizado en este estudio correspondió a uno de tipo transversal descriptivo. Se realizó una encuesta telefónica con 15 preguntas a 82 mujeres que fueron donantes en al menos una oportunidad en el banco de leche del CASR desde el año 2015 a septiembre de 2017. Se estimaron proporciones para las variables categóricas y medidas de tendencia central y de dispersión para la edad Se calcularon intervalos de confianza al 95%. RESULTADOS: La edad media de las donantes fue de 31,3 años con una desviación estándar de 4,6. El 92,7% se encontraba casada o en convivencia y un 58,5% (IC 95% 47,1 - 69,3) cursó educación profesional superior completa. La principal motivación para donar fue la empatia (41,5% [IC 95% 30,7 - 52,9]) y las principales fuentes de conocimiento fueron internet/redes sociales 43,9% (IC 95% 33,0 - 55,3) y personal de salud 32% (IC 95% 22,9 - 44,2). CONCLUSIONES: La mujer donante del banco de leche del CASR, se encuentra principalmente casada o en convivencia, posee un alto nivel educacional y trabaja fuera del hogar. Estos resultados podrían orientar estrategias al fortalecimiento del banco de leche.

This study sought to describe characteristics, motivations, barriers, and sources of information of human milk donors to the milk bank at Dr. Sótero del Río Hospital, Chile. METHODS: A descriptive and cross - sectional study was carried out. We conducted a 15-question telephone survey in 82 women who were at least one-time milk donors between 2015 and 2017. Statistical analysis included frequencies and percentages for categorical variables and measures of central tendency and dispersion for quantitative variables. We calculated 95% confidence intervals (CI). RESULTS: The mean age of donors was 31.34,6 years; 92.7% were married or were living with their partner and 58.5% (95% CI of 47.1- 69.3) had completed higher education. The main motivation for donating was helping others (41.5% [95% CI of 30.7- 52.9]). The primary sources of knowledge on milk donations were the internet and social networks (43.9% [IC 95% 33.0- 55.3]), followed by health personnel 32% (95% CI of 22.9- 44.2). CONCLUSIONS: The donor profile in CASR's milk bank is a young woman, with a stable partner and high educational level. These results could provide useful information to improve strategies for human milk donation.

Assuntos

RESUMO

RESUMO Objetivo: conhecer as dificuldades das mulheres que procuram atendimento no Banco de Leite Humano. Método: trata-se de um estudo documental, retrospectivo, utilizando amostra de 292 formulários de puérperas que buscaram o serviço especializado do Banco de Leite Humano em Hospital Universitário no Nordeste do Brasil. Realizado de janeiro a agosto de 2017. Foram utilizados testes de Qui quadado e medidas de Odds Ratio. Resultados: amostra composta por mulheres com Ensino Superior Completo 118 (40,4%), 198 (67,81%) realizaram partos em serviço de saúde privado, por cirurgia cesariana 209 (71,58%) e 118 (40,41%) não recebeu informações sobre amamentação em nenhum momento. Dificuldades de amamentação: pega 167 (57,19%), fissura mamilar 96 (32,88%), confusão de bicos 69 (23,63%), insegurança materna 65 (22,26%) e ingurgitamento mamário 61 (20,89%). Conclusão: orientações realizadas pelos profissionais voltadas para a prática do aleitamento materno e acompanhamento adequado à mulher no período gravídico puerperal resultam no sucesso da amamentação.

RESUMEN: Objetivo: conocer las dificultades de las mujeres que procuran atención en el Banco de Leche Humana. Método: se trata de un estudio documental y retrospectivo con una muestra de 292 formularios de puérperas que se acercaron al servicio especializado del Banco de Leche Humana de un Hospital Universitario en el nordeste de Brasil. Se realizó en el período de enero a agosto de 2017. Se utilizaron pruebas de Chi-cuadrado y medidas de Odds Ratio. Resultados: la muestra estuvo compuesta por 118 (40,4%) mujeres con Enseñanza Superior Completa, 198 (67,81%) tuvieron sus partos en servicios privados de salud, 209 (71,58%) por cirugía cesárea, y 118 (40,41%) no recibieron información alguna sobre lactancia en ningún momento. Dificultades de lactancia: agarre 167 (57,19%), fisura mamilar 96 (32,88%), confusión de pezones 69 (23,63%), inseguridad materna 65 (22,26%), y congestión mamaria 61 (20,89%). Conclusión: las pautas orientadoras proporcionadas por los profesionales dirigidas a la práctica de la lactancia materna y al adecuado acompañamiento de la mujer en el período de embarazo puerperal derivan en una lactancia exitosa.

ABSTRACT Objective: To investigate the difficulties experienced by women who seek care at the Human Milk Bank. Method: This is a documentary, retrospective, and quantitative study with a sample of 292 forms from postpartum women who sought specialized care at the Human Milk Bank of a university hospital in Northeastern Brazil. The present study was conducted from January to August 2017. Chi-square tests and odds ratio values were used. Results: The study population consisted mainly of women with a complete higher education degree (118; 40.4%). Additionally, 198 (67.81%) of the childbirths took place in private health facilities, and 209 (71.58%) were by Cesarean section. Moreover, 118 (40.41%) mothers did not receive information on breastfeeding at any time. The most common breastfeeding difficulties were latch-on (167; 57.19%), nipple fissure (96; 32.88%), nipple confusion (69; 23.63%), maternal insecurity (65; 22.26%), and breast engorgement (61; 20.89%). Conclusion: Professional guidance on breastfeeding and proper maternal follow-up during pregnancy and postpartum result in successful breastfeeding.

RESUMO

RESUMO Objetivo: analisar os saberes dos enfermeiros sobre o processo de enfermagem como instrumento da Sistematização da Assistência de Enfermagem no Banco de Leite Humano. Método: estudo descritivo, exploratório, qualitativo, realizado no segundo trimestre de 2015 em sete Bancos de Leite Humano do Estado do Espírito Santo. Com essa perspectiva foram entrevistadas nove enfermeiras atuantes no serviço de saúde. Os dados foram submetidos à análise de conteúdo na modalidade temática. Resultados: O processo de enfermagem pode ser considerado um organizador dos trabalhos, no espaço do Banco de Leite Humano. Tais saberes no cotidiano e o conhecimento da aplicabilidade do processo de enfermagem necessitam ser um pressuposto para sustentar as ações dos enfermeiros nos Bancos de Leite Humano. Conclusão: as análises indicaram que o trabalho do enfermeiro deve estar embasado em uma metodologia científica, mas há uma fragmentação na efetivação das etapas do processo de enfermagem. Faz-se necessária a elaboração de um instrumento que possibilite a efetivação da Sistematização da Assistência de Enfermagem, mediante o instrumento processo de enfermagem.

RESUMEN Objetivo: analizar el saber de los enfermeros sobre el proceso de enfermería como instrumento de la Sistematización de la Asistencia de la Enfermería en el Banco de Leche Humano. Método: estudio descriptivo, exploratorio y cualitativo realizado en el segundo trimestre del 2015 en siete Bancos de Leche Humano del Estado de Espírito Santo. Con esa perspectiva se entrevistaron nueve enfermeras actuantes en el servicio de salud. Los datos fueron sometidos al análisis del contenido en la modalidad temática. Resultados: el proceso de enfermería puede ser considerado como un organizador de los trabajos en el espacio del Banco de Leche Humano. Los conocimientos en lo cotidiano y en la aplicabilidad del proceso de enfermería necesitan ser un presupuesto para defender las acciones de los enfermeros en los Bancos de Leche Humano. Conclusión: los análisis mostraron que el trabajo del enfermero debe estar basado en una metodología científica, pero hay una fragmentación en la realización de las etapas del proceso de enfermería. Es necesaria la elaboración de un instrumento que posibilite la realización de la Sistematización de la Asistencia de Enfermería mediante el instrumento de proceso de la enfermería.

ABSTRACT Objective: to analyze nurses' knowledge regarding the nursing process as an instrument for Nursing Care Systematization in the Human Milk Bank. Method: descriptive, exploratory, qualitative study carried out in the second quarter of 2015 in seven Human Milk Banks in the State of Espírito Santo. With this perspective, nine nurses working in the health service were interviewed. The data were submitted to thematic content analysis. Results: the nursing process can be considered an organizer of work in the context of the Human Milk Bank. Such everyday knowledge and knowledge of the applicability of the nursing process needs to be an assumption in order to support the actions of nurses in the Human Milk Banks. Conclusion: the analyzes indicated that the nurses' work and activities must be based on a scientific methodology, however there is a fragmentation in the effectiveness in the steps of the nursing process. It is necessary to elaborate an instrument that enables the implementation of the Nursing Assistance Systematization, through the nursing process instrument.

Assuntos

RESUMO

BACKGROUND: Milk safety is an important concern in neonatal units and human milk banks. Therefore, evidence-based recommendations regarding raw milk handling and storage are needed to safely promote supplying hospitalized infants with their mother's own milk. OBJECTIVES: To evaluate raw human milk storage methods according to Brazilian milk management regulations by investigating the effects of refrigeration (5°C) for 12 hours and freezing (-20°C) for 15 days on the acidity and energy content in a large number of raw milk samples. METHODS: Expressed milk samples from 100 distinct donors were collected in glass bottles. Each sample was separated into 3 equal portions that were analyzed at room temperature and after either 12 hours of refrigeration or 15 days of freezing. Milk acidity and energy content were determined by Dornic titration and creamatocrit technique, respectively. RESULTS: All samples showed Dornic acidity values within the established acceptable limit (≤ 8°D), as required by Brazilian regulations. In addition, energy content did not significantly differ among fresh, refrigerated and frozen milk samples (median of ~50 kcal/100 mL for each). CONCLUSION: Most samples tested (> 80%) were considered top quality milk (< 4°D) based on acidity values, and milk energy content was preserved after storage. We conclude that the storage methods required by Brazilian regulations are suitable to ensure milk safety and energy content of stored milk when supplied to neonates.

Assuntos

RESUMO

OBJECTIVE: To describe growth and clinical evolution of very low birth weight infants fed during hospital stay with milk from a human milk bank according to the caloric-protein value. METHOD: Forty very low birth weight infants were included: 10 were fed milk from their own mothers (GI), and 30 were fed human milk bank > 700 cal/L and 2 g/dL of protein. Growth curves were adjusted using nonlinear regression to the measured growth parameters. RESULTS: full enteral diet was reached in 6.3 days by GI and in 10.8 by GII; a weight of 2 kg was reached in 7.3 weeks for GI and in 7.8 for GII. In GI, 3/10 (33.3%) and in GII, 7/30 (23.3%) developed sepsis. Necrotizing enterocolitis did not occur in GI, but in 3/30 (10.0%) in GII. GI presented with urinary calcium > 4 mg/L in 1/10 (10.0%), urinary phosphorus (Pu) <1 mg/L in 10/10 (100%), and Ca/Cr >0.6 ratio in 1/10 (10.0%) of the cases; in GII, no children presented alterations of the urinary calcium or the Ca and Cr ratio, and Pu was <1 mg/L in 19/30 (63.3%). In terms of growth the 50th percentile for GI was a weight gain of 12.1 g/day (GI) vs. 15.8 g/day (GII), a length gain of 0.75 cm/week (GI) vs. 1.02 cm/week (GII), and a head circumference gain of 0.74 cm/week (GI) vs. 0.76 cm/week (GII). CONCLUSIONS: Human milk bank allowed a satisfactory growth and good clinical evolution for very low birth weight infants.

Assuntos

RESUMO

OBJECTIVE: To describe growth and clinical evolution of very low birth weight infants fed during hospital stay with milk from a human milk bank according to the caloric-protein value. METHOD: Forty very low birth weight infants were included: 10 were fed milk from their own mothers (GI), and 30 were fed human milk bank > 700 cal/L and 2 g/dL of protein. Growth curves were adjusted using nonlinear regression to the measured growth parameters. RESULTS: full enteral diet was reached in 6.3 days by GI and in 10.8 by GII; a weight of 2 kg was reached in 7.3 weeks for GI and in 7.8 for GII. In GI, 3/10 (33.3 percent) and in GII, 7/30 (23.3 percent) developed sepsis. Necrotizing enterocolitis did not occur in GI, but in 3/30 (10.0 percent) in GII. GI presented with urinary calcium > 4 mg/L in 1/10 (10.0 percent), urinary phosphorus (Pu) <1 mg/L in 10/10 (100 percent), and Ca/Cr >0.6 ratio in 1/10 (10.0 percent) of the cases; in GII, no children presented alterations of the urinary calcium or the Ca and Cr ratio, and Pu was <1 mg/L in 19/30 (63.3 percent). In terms of growth the 50th percentile for GI was a weight gain of 12.1 g/day (GI) vs. 15.8 g/day (GII), a length gain of 0.75 cm/week (GI) vs. 1.02 cm/week (GII), and a head circumference gain of 0.74 cm/week (GI) vs. 0.76 cm/week (GII). CONCLUSIONS: Human milk bank allowed a satisfactory growth and good clinical evolution for very low birth weight infants.

Assuntos

RESUMO

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.

Assuntos

RESUMO

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 -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.

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 -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 g/dL e 31,55 ± 8,29 g/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 g/dL.

RESUMO

Amamentação exclusiva até os seis meses de idade é fato importante para a saúde e para a relação mãe e filho. Quando essa amamentação é prejudicada, o desmame precoce pode ocorrer. O objetivo da pesquisa foi investigar o perfil das doadoras do Banco de Leite Humano do Hospital Universitário de Maringá, Estado do Paraná. Foram entrevistadas 48 nutrizes doadoras de leite humano durante os meses de outubro e novembro de 2004. O estudo foi observacional transversal e os dados foram coletados utilizando-se um questionário estruturado. Observou-se que 41,7% das nutrizes tinham entre 20 e 29 anos, 33,3% ensino médio completo e 66,6% receberam informações sobre amamentação. A falta de informação, contudo, sobre mama ingurgitada (20,8%), estimulação para produção de leite (29,1%) e outras funções do leite materno, além da alimentação (31,3%), foram relevantes. Apenas metade das nutrizes não tinha oferecido qualquer outro alimento para o bebê antes dos seis meses de vida. Dados apontam para importância de orientação das nutrizes de forma direcionada, ainda durante a gestação.

Exclusive maternal breast feeding until six months of age is an important practice for health and mother and son's relationship. However, when that exclusive maternal breast feeding is harmed, precocious weans may occur. This work aims at investigating the Human Milk Bank donors' profile at Hospital Universitário de Maringá, State of Paraná. Forty-eight nursing mothers were interviewed during two months: October and November, 2004. A transversal and observational study was carried out and the data were collected by means of individual interviews conducted by structured questionnaire. 41.7% of the women were aged between 20 and 29, 33.3% had concluded secondary school and 66.6% had received information on breast-feeding. The lack of information on engorged breast (20.8%), on stimulation for milk production (29.1%) and other maternal milk functions, besides feeding (31.3%), was also relevant. Only half of the breastfeeding women had not offered the baby any other food, except maternal milk. Data pointed out to the importance of these women?s direct orientation regarding breast feeding during gestation.

Assuntos

RESUMO

Banco de Leite Humano (BLH) é o serviço responsável pela promoção e incentivo ao aleitamento materno, que atende às necessidades nutricionais de recém-nascidos prematuros ou de baixo peso. Sua matéria prima é o leite materno, alimento único que possui componentes bioquímicos, celulares e nutricionais ideais para o desenvolvimento destes. Deve fornecer um produto perfeitamente processado e com qualidade garantida antes de sua distribuição. Para controlar o processamento do leite do BLH de Sorocaba, são realizados análises físico-químicas e microbiológicas no Instituto Adolfo Lutz - Laboratório Regional de Sorocaba. Durante o período pesquisado, a acidez foi determinada em 1.858 amostras de leite cru, o valor calórico calculado em 1.457 amostras e a presença de coliformes totais e termotolerantes pesquisada em 3.883 amostras de leite pasteurizado. O resultados obtidos mostraram que o índice de acidez acima de 8 graus Dornic foi responsável por 24,1 por cento das amostras de leite rejeitadas pelo BLH de Sorocaba, enquanto que apenas 2,6 por cento o foram por presença de contaminação bacteriana. A técnica do crematócrito permitiu classificar as amostras de leite em três faixas calóricas. A análise de rejeição das amostras de leite indicou a necessidade de reorientação das doadoras na etapa de coleta do leite humano ordenhado, visto que a alta incidência de amostras com acidez elevada pode ser devida às condições higiênico-sanitárias no momento da ordenha.(AU)

The Human Milk Bank ( HMB) is the service responsible for the promotion and incentive of breastfeeding since it meets nutritional need both for pronatis and low weight newborn babies. Its raw material is the maternal milk , a unique food that contains biochemical, cellular and nutritional components which are ideal for the babies's development. The HBM must provide an accurately processed product presenting assured quality prior to its distribution. To control the milk processing in the HBM in Sorocaba, microbiological and physicochemical analysis are carried out at Adolfo Lutz Institute -Regional Laboratory in Sorocaba. During the researched period, the acidity was determined in 1.858 samples of raw milk , the caloric value was calculated in 1.457 samples and the presence of total and thermotolerant colifonns was researched in 3.883 samples of pasteurized milk. The obtained results showed that acidity index over 8° Dornic was responsible for 24,1% of milk samples rejected by the HMB in Sorocaba whereas only 2,6% were rejected due to the presence of bacterial contamination. The Crematócrito technique permitted the milk samples classification into three caloric ranges. The rejection index analysis of milk samples indicated that it is necessary to re orient the donators in the moment of collecting the human milk since the great incidence of samples with high acidity may be due to unsatisfactory hygienic - sanitarium conditions in the moment of milking. (AU)

Assuntos

RESUMO

Para normatizar o funcionamento dos Banco de Leite Humano (BLH) e promover a garantia da qualidade dos seus produtos, sob o aspecto de risco à saúde, buscou-se métodos para melhorar os processos de rotina, bem como a qualidade do produto final. O controle de qualidade tem como objetivo assegurar integridade de um produto de boa qualidade, desde a coleta até o consumo, a baixo custo e com o mínimo de risco para a saúde do consumidor. Porém, a atenção deve ser redobrada quando verificadas as atividades relacionadas com as doadoras (ordenha) e no controle do tratamento térmico (pasteurização), pois o grande desafio é certificar os processos e o produto com vistas às condições de higiene, pureza, uso de materiais e dispositivos que evitem o perigo de contaminação. Para monitorar todas as atividades executadas rotineiramente no BLH Conjunto Hospitalar de Sorocaba (CHS), foram elaborados os Procedimentos Operacionais Padrão (POPs), nos quais estão descritas a metodologia utilizada e fichas cadastrais de controle da manutenção dos equipamentos envolvidos no processo, prevenindo possíveis intercorrências.(AU)

In order to normalize the Human Milk Banks' functioning (HMB) and elevate the guarantee of quality of theirproducts, considering the aspect of risk of the health, methods that may improve the regular processes and the quality of the final product have been searched. The quality control has as an aim ensuring the integrity of a good quality product since its collection until its consumption, with a low cost and with the minimum risk of the consumer's health. However, we must pay much more attention when activities related with the donors (milking) and with the thermic treatment control (pasteurization) are verified; therefore the great challenge is certifying the processes and the product in consideration of hygiene conditions, pureness of its contamination, use of materials and devices that avoid the risk of contamination. In order to monitor all the activities that are regularly realized at HMB - Conjunto Hospitalar de Sorocaba(CHS) - the Sanittion Standard Operationing Procedures (SSOPs), which carry the used methodology, and the cadastral filling cards of the maintenance control of the equipments involved in the process were developed in order to prevent possible intercurrences. (AU)

Assuntos

RESUMO

A importância do aleitamento materno exclusivo até aos seis meses de vida é indiscutível e para garantir o acesso e a disponibilidade do leite humano aos neonatos foram implantados aos Bancos de Leite Humano (BLHs), que se constituem em centros especializados em aleitamento materno. O Brasil conta com uma rede de 163 BLHs, dos quais 11 se localizam no Distrito Federal; as normas de funcionamento destas unidades são estabelecidas pela Fundação Oswaldo Cruz (FIOCRUZ). O presente trabalho teve como objetivo avaliar as condições de funcionamento, a adequação às normas estabelecidas pela FIOCRUZ e a identificação de pontos críticos de controle em oito BLHs de hospitais da rede pública do Distrito Federal. De acordo com os dados obtidos, observou-se que os maiores problemas ocorrem no período de escassez de leite, pois a maioria dos BLHs não segue rigorosamente os critérios de qualidade físico-química (acidez) e microbiológica. Quanto à operacionalização, verificou-se que as diretrizes dos BLHs se fundamentam nas Boas Práticas de Fabricação (BRASIL, 1997) e não na Análise de Perigos e Pontos Críticos de Controle APPCC, evidenciados ao se constatar a inadequação da área física, o fluxo não unidirecional e a possibilidade de contaminação cruzada.(AU)

Undoubtedly, the use of exclusive breast feeding up to six month of age is extremely important for infants. To guarantee access and availability of human milk to the new born, the creation of specialized centers in human milk (Human Milk Banks - HMBs) was necessary. At present, Brazil has approximate 163 HMBs, of which 11 are in the Federal District. All the units adopt processing rules established by FIOCRUZ. In this study, 8 HMBs based in public hospitals in the Federal District were visited during the first semester of 2003. Factors evaluated included working conditions, obedience do FIOCRUZ guidelines and critical control points. All the HMBs follow the flow chart suggested by FIOCRUZ. Major problems were identified when the supply of milk decreases, because at this time most of the HMBs do not strictly adhere to acidity and microbiological criteria. HMB directives match Good Manipulation Practices, but not the Hazard Analysis and Critical Control Points (HACCP). This is seen by the lack of adequate physical structures and processing is not unidirectional. This increases the possibility of cross contamination. Processing should be altered to become unidirectional and HACCP guidelines should be implanted and strictly enforced. (AU)

Assuntos