Franz Reis Novak

Adequacy of human milk viscosity to respond to infants with dysphagia: experimental study

Neonatal nutrition is an important subject in health in the short, medium and long term. In preterm newborns, nutrition assumes a predominant role for the childs overall development. Babies with uncoordinated swallowing or respiration may not have the necessary oral abilities to suck the mothers breast and will need to implement different feeding practices; one of them is changing the consistency of the milk offered. Objectives Determine viscosity variations of untreated human and pasteurized milk without and with thickening to adapt the diet to the needs of dysphagic infants hospitalized in the Neonatal Intensive Cara Unit (NICU). Material and Methods The authors altered the viscosity of natural infant powdered milk and, after thickening, determined and adopted a thickening standard for human milk. Untreated human and pasteurized milk was thickened in concentrations of 2%, 3%, 5% and 7% and the viscosity were determined every 20 minutes for a period of 60 minutes at a temperature of 37ºC. Results The infant lactose formula thickened at concentrations of 2% and 3% produced viscosities of 8.97cP and 27.73 cP, respectively. The increases were significantly different after 1 hour. Inversely, untreated human milk at 2%, 3%, 5% and 7% produced diminished viscosity over time; the changes were more accentuated in the first 20 minutes. In pasteurized human milk, the 2% concentration had no variation in viscosity, but with the 3%, 5% and 7% concentrations, there was a significant decrease in the first 20 minutes with stability observed in the subsequent times. Conclusion In powdered milk, the viscosity increases over time; the viscosity in human milk diminishes. The results point out the importance not only of considering the concentration of the thickener but also the time being administered after its addition to effectively treat dysphagic infants.

The correlation between aerobic mesophilic microorganism counts and Dornic acidity in expressed human breastmilk.

OBJECTIVE The study was designed to test for the existence of a correlation between the total population of aerobic mesophilic microorganisms in processed raw breastmilk from a human milk bank and the Dornic acidity of that milk. METHODS Two hundred consecutive samples of thawed expressed human breastmilk obtained from human milk bank, prior to pasteurization. Dornic acidity was titrated in triplicate for each sample. Aerobic mesophilic microorganisms were then plate counted. Data were analyzed to detect correlations between variables, using Pearsons coefficient, and the level of significance was set at p < or = 0.05. RESULTS In the samples analyzed, Dornic acidity levels had a positive (R = 0.948) and statistically significant (p < or = 0.001) correlation with the population of aerobic mesophilic microorganisms (CFU/mL). CONCLUSIONS The data obtained here support to the conclusion that Dornic titration is an effective method for the indirect evaluation of bacterial growth in expressed human milk.

Casca de banana: uma possível fonte de infecção no tratamento de fissuras mamilares

OBJECTIVE: the objective of the present investigation is 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.

Resistência antimicrobiana de coliformes isolados de leite humano ordenhado

The dispersion of potentially pathogenic, antibiotic-resistant microorganisms via expressed human milk can be considered a risk factor. The aim of this study was to contribute to a better understanding of coliform isolates from expressed human milk and their antimicrobial resistance profiles. The sampling scheme followed a totally randomized design, using 837 samples of expressed human milk. Of these, 71 (8.48%) were identified as contaminated with total coliforms, although in none of the samples did the population exceed 1.0x103 MPN/ml. Most of the microorganisms isolated (91.6%) belonged to only two species, Enterobacter cloacae and Klebsiella pneumoniae, which when subjected to antibiograms, revealed that several strains showed prior resistance to some of the antimicrobials tested. Coliforms may grow in expressed human milk if it is improperly stored, depleting protection factors and reducing the milks nutritional value.

Sensorial analysis of expressed human milk and its microbial load

Objective: To verify the existence of a relationship between presence of off-flavor and microorganism load in quality control rejected samples of expressed human milk from a donor milk bank. Methods: A total of 30 samples of expressed human milk with off-flavor were tested for the occurrence of the following microorganisms: aerobic mesophilic, psycrotrophic, proteolytic, psycrotrophic proteolytic, thermoduric, psycrotrophic thermoduric, lactate and lipolytic bacteria, molds and yeasts and Staphylococcus aureus, total coliforms and thermophilic coliforms, in accordance with official methods. Results: Percentage occurrence of microorganisms was as follows: aerobic mesophilic = 80%; psycrotrophic = 36.7%; proteolytic = 46.7%; psycrotrophic proteolytic = 16.7%; thermoduric = 6.7%; psycrotrophic thermoduric = 0%; lactate bacteria = 50%; lipolytic = 10%; molds and yeasts = 6.7%; S. aureus = 30%; total coliforms = 53.3%; and thermophilic coliforms = 16.7%.

Rede Nacional de Bancos de Leite Humano: gênese e evolução

OBJECTIVES: establishment and progress analysis of the Human Milk Banks National Network in Brazil. Determinant elements are highlighted for their acknowledged participation and influence on the state policy for the sector. METHODS: content analysis of primary documental sources generated by official organizations and institutions offering Human Milk Banks services were analyzed, as well as thesis, dissertations, books and scientific articles focusing on the subject. Social perceptions and concerns were assessed and the conclusion was that with time they suffered changes and depending on the historical moment considered, actors and social groups have conveyed different meanings to the service. RESULTS: knowledge appears to give conductivity to the network. That is, analysis performed of the Banks creation and progress, identified that in addition to the social actors involved, there are knowledge production dynamics that should be understood. CONCLUSIONS: its possible to identify a potential Network contribution to promote social change and to formulate public policies aiming at women and childrens health.

Bases conceituais para uma estratégia de gestão: o caso da Rede Nacional de Bancos de Leite Humano

The Brazilian National Network of Human Milk Banks (REDEBLH), with its headquarters in the Oswaldo Cruz Foundation in Rio de Janeiro, is experiencing rapid growth. The Networks activity has been acknowledged by the World Health Organization and received the Sasakawa Health Award in 2001 for best public health project. One of the main challenges is to ensure continuing development of competencies to respond to the needs arising from such growth. A new strategy is being pursued to deal with the Networks management issues. This article aims to develop a conceptual framework to contribute to the elaboration of a theoretical framework for new management strategies in the REDEBLH. Using such concepts, the aim is to draw on the typology of networks described in the specialized literature to identify the institutional profile of the REDEBLH. Based on the understanding that it is necessary to identify and understand the processes occurring within networks, and after which to consider management-related issues, the study used a proposal developed for the formation of innovation networks as its analytical tool.

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 103 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.

Sistema de gestão do conhecimento para Rede Nacional de Bancos de Leite Humano

This article has as objective to demarcate concepts that can contribute for enlargement of the theoretical chart for management of the knowledge in the REDEBLH. The structural bases for drawing the Knowledge Management System (KMS) are also presented. It adopts a theoretical approach to present the foundations that in the literature maintain reflections about KMS. Its included still a short analysis of the setting of the knowledge demarcated by the recent scientific output identified in the units from the net and in theirs headquarters. It expects that the questions discussed can make feasible the use of tools of share of the knowledge diminishing the deep social, economic, and cultural differences in the space of action from the REDEBLH.