Masahiko Murase

Bedside analysis of human milk for adjustable nutrition strategy

Aim: Mothers milk is optimum for preterm infants, but human milk fortifier is required at times, because some nutrients are sometimes insufficient for infant growth. It is important to measure the nutrients in breast milk at bedside so that the amount of nutrients that need to be supplemented can be determined. A human milk analyser (HMA, Miris®) is currently available. We examined if the macronutrient values measured by human milk analyser are comparable with those measured by conventional methods. We also sought to discover whether we could dilute the milk sample used for the human milk analyser measurement if the amount of milk available for testing was insufficient.

Maturational changes in the feeding behaviour of infants - a comparison between breast-feeding and bottle-feeding.

Aim:  To obtain a better understanding of the changes in feeding behaviour from 1 to 6 months of age. By comparing breast‐ and bottle‐feeding, we intended to clarify the difference in longitudinal sucking performance.

Is increased fat content of hindmilk due to the size or the number of milk fat globules

BackgroundIt is known that the fat content of breast milk is higher in hindmilk than in foremilk. However, it has not been determined if this increased fat content results from an increase in the number of milk fat globules (MFGs), an increase in the size of MFGs, or both. This study aims to determine which factor plays the most important role.MethodsThirteen breastfeeding mothers were enrolled in the study and we obtained 52 samples from 26 breasts before (foremilk) and after (hindmilk) a breastfeeding session. The fat content was evaluated by creamatocrit (CrCt) values. MFG size was measured with the laser light scattering method. We compared CrCt values and MFG size between foremilk and hindmilk.ResultsAlthough the CrCt values were higher in the hindmilk (8.6 ± 3.6%) than in the foremilk (3.7 ± 1.7%), the MFG size did not change (4.2 ± 1.0 μm and 4.6 ± 2.1 μm, foremilk and hindmilk, respectively). There was no relationship between the changes in CrCt versus MFG size from foremilk to hindmilk.ConclusionThe results indicate that the increase in fat content results mainly from the increased number of MFGs, which may be released into the milk flow as the mammary lobe becomes progressively emptied.

Low HCMV DNA copies can establish infection and result in significant symptoms in extremely preterm infants: a prospective study.

Breast milk (BM) is the main source of human cytomegalovirus (HCMV) infection. We examined whether the number of HCMV DNA copies in BM is related to HCMV infection in very low birth weight (VLBW) infants. We identified 11 pairs of VLBW infants and mothers. BM samples were collected every week until 10 weeks postpartum. Urine samples were collected from the infants within 1 week, at 6 to 8 weeks, at discharge, and whenever HCMV infection was suspected. HCMV DNA in BM was positive in 7 of 11 mothers and reached a peak at 4 to 5 weeks postpartum. Of the 11, 5 infants were determined to be infected from positive HCMV DNA in the urine, despite the fact that BM was used after being frozen. Of the five, four infected infants exhibited symptoms between 35 and 60 days of age. Symptomatic infants had longer stays and slower weight gain. The HCMV infection rate is high in very preterm infants. A new strategy to prevent HCMV infection other than freezing should therefore be established.

The important role of deep attachment in the uniform drainage of breast milk from mammary lobe

Aim: To determine if the degree of attachment affects uniformity in the drainage of breast milk from mammary lobe during breastfeeding.

Comparison of creamatocrit and protein concentration in each mammary lobe of the same breast: does the milk composition of each mammary lobe differ in the same breast?

OBJECTIVE We sought to determine if different mammary lobes produce milk of varying composition. STUDY DESIGN Seventeen mothers were enrolled in this study. Foremilk was obtained from three nipple openings on each breast. After the breastfeeding session, hindmilk was sampled in the same manner. We measured creamatocrit (CrCt) and analyzed the protein concentration. Data were analyzed with the paired t test and Wilcoxon signed-rank sum test where appropriate. Coefficient of variance (COV) was calculated to identify the variation of protein content among different mammary lobes. RESULTS The fat and protein contents of the foremilk and hindmilk from each milk duct differed despite being expressed from the same breast. When we compared the CrCt values and protein content obtained from three ducts, a greater than 5% difference between the maximum and minimum value was observed in 64 out of 68 breasts (94%) for CrCt and in 61 out of 68 breasts (91%) for protein content. The mean COV of protein content in each breast was 13.2 +/- 8.0 (range, 1.2-45.3). CONCLUSIONS These study results demonstrate that milk synthesis differs in each mammary lobe, even in the same breast. The degree of fullness in each mammary lobe seems to play the most important role in the fat content. The protein content in the milk from each mammary lobe is determined by other factors, presumably by the feedback inhibitor of lactation, accumulated in the corresponding mammary lobe.

Is fat content of human milk decreased by infusion

Human milk (HM) is the optimum nutrition for preterm infants. Previous studies showed that tube infusion decreased the fat content in thawed HM. The aim of this study was to determine if freezing–thawing is the main reason for decrease of fat content. In neonatal intensive care units, thawed HM is used in general, therefore the aim of this study was to investigate fat loss during tube infusion with regard to changes in tube size, material, and infusion rate.

Development of fatty acid calcium stone ileus after initiation of human milk fortifier.

We report a case who was born with extremely low birth weight infant and had experienced abdominal operation for necrotizing enterocolitis, eventually developed ileus due to fatty acid calcium stones after giving human milk fortifier. He had developed necrotizing enterocolitis on day 30 of his age, such that we performed enterectomy and ileostomy. He could not tolerate enteral feeding fully, because intestinal fistula infection was repeated. Although we administered hindmilk, he grew up slowly and he suffered cholestasis as well. We performed end‐to‐end anastomosis to prevent fistula infections on day 87. After this operation, breast milk feeding volume was increased easily. However, we started to add HMF of half‐strength on day 124, because his body weight gain remained very poor. And we confirmed to intensify the ratio of HMF full‐strength on day 128. After that his abdomen had distended on day 131. As there is no effect of conservative therapy to occlusive ileus, we did emergency laparotomy on day 139. Intestinal calculi were impacted at anastomic portion. Although all stones were removed, he died on 144 days due to disseminated intravascular coagulation and renal failure. Calculi analysis revealed that all of them were fatty acid calcium stones. There is no report about like our case. We speculate that the construction of fatty acid calcium result from either high concentration of calcium/phosphorus or rapid increase in the fortification. We could have prevented this case happened by slower increment of fortification.

Body length and occipitofrontal circumference may be good indicators of neurodevelopment in very low birthweight infants - secondary publication

The aim of this study was to predict the neurological prognosis of very low birthweight (VLBW) infants. We examined the relationship between nutritional status, brain volume measured by magnetic resonance imaging (MRI) and anthropometric measurements of VLBW infants at term‐equivalent age (TEA).

Malnutrition caused by unexpectedly low protein concentration in breast milk

The energy and macronutrient content of breast milk in mothers of preterm infants can vary, and is subject to change over time, even in the same mother. We encountered the case of an extremely low-birthweight infant with subacute symptoms, induced by hypoproteinemia, associated with malnutrition, and caused by unexpectedly low protein levels in the breast milk despite full enteral feeding of fortified human milk.