Pamela D. Berens

Nitrate and Nitrite Content of Human, Formula, Bovine, and Soy Milks: Implications for Dietary Nitrite and Nitrate Recommendations

BACKGROUND Estimation of nitrate and nitrite concentrations of milk sources may provide insight into potential health risks and benefits of these food sources for infants, children, and adults. The World Health Organization and American Academy of Pediatrics recommends exclusive consumption of human milk for the first 6 months of life. Human milk is known to confer significant nutritional and immunological benefits for the infant. Consumption of formula, cows, and soy milk may be used as alternatives to human milk for infants. METHODS We sought to estimate potential exposure to nitrate and nitrite in human, formula, bovine, and soy milk to inform total dietary exposure estimates and recommendations. Using sensitive quantitative methodologies, nitrite and nitrate were analyzed in different samples of milk. RESULTS Human milk concentrations of colostrum (expressed days 1-3 postpartum; n=12), transition milk (expressed days 3-7 postpartum; n=17), and mature milk (expressed >7 days postpartum; n=50) were 0.08 mg/100 mL nitrite and 0.19 mg/100 mL nitrate, 0.001 mg/100 mL nitrite and 0.52 mg/100 mL nitrate, and 0.001 mg/100 mL nitrite and 0.3 mg/100 mL nitrate, respectively, revealing that the absolute amounts of these anions change as the composition of milk changes. When expressed as a percentage of the World Health Organizations Acceptable Daily Intake limits, Silk® Soy Vanilla (WhiteWave Foods, Broomfield, CO) intake could result in high nitrate intakes (104% of this standard), while intake of Bright Beginnings Soy Pediatric® formula (PBM Nutritionals, Georgia, VT) could result in the highest nitrite intakes (383% of this standard). CONCLUSIONS The temporal relationship between the provision of nitrite in human milk and the development of commensal microbiota capable of reducing dietary nitrate to nitrite supports a hypothesis that humans are adapted to provide nitrite to the gastrointestinal tract from birth. These data support the hypothesis that the high concentrations of breastmilk nitrite and nitrate are evidence for a physiologic requirement to support gastrointestinal and immune homeostasis in the neonate.

The Absence of Candida albicans in Milk Samples of Women with Clinical Symptoms of Ductal Candidiasis

OBJECTIVE The objective of this prospective study was to determine if Candida albicans is present in the milk of women suffering from symptoms of severe nipple and deep breast pain. STUDY DESIGN The symptomatic group included women who reported sore, inflamed, or traumatized nipples or intense stabbing or burning pain. The control group included breastfeeding women without symptoms. The skin of the nipple and areola were washed with detergent and thoroughly rinsed. Milk samples were analyzed for (1 --> 3)-beta-D-glucan and grown on Candida growth medium. RESULTS There was no significant difference in (1 --> 3)-beta-D-glucan levels between the control and symptomatic group. No Candida species were culturable either before or after the addition of iron to stimulate growth, with the exception of one patient. The addition of pure C. albicans to milk samples suggested that milk does not inhibit Candida growth. CONCLUSION These data suggest that C. albicans is not present in milk ducts and may not be associated with this syndrome.

Incidence of Methicillin-Resistant Staphylococcus aureus in Postpartum Breast Abscesses

OBJECTIVE The study objective is to determine the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in postpartum breast abscesses in two Houston, TX, area hospitals. STUDY DESIGN AND METHODS This is a retrospective chart review of women hospitalized for postpartum breast abscesses at Womans Hospital of Texas and Memorial Hermann Hospital between January 1, 2000 and December 31, 2006. Patients were identified by searching admission records for ICD-9 codes related to breast abscesses. Demographic characteristics, medical history, culture results, and pertinent procedures were recorded. Statistical analyses included the Fisher exact test for categorical data and Students test for continuous variables. RESULTS Thirty-three postpartum abscesses were identified: 19 from Memorial Hermann Hospital and 14 from Womans Hospital. MRSA and S. aureus were the only causative bacteria identified. Twelve of the 19 abscesses from Hermann Hospital were MRSA positive (63%), and nine of the 14 from Womans Hospital were MRSA positive (64%). There were no statistically significant differences among women with MRSA abscesses versus those with S. aureus abscesses in terms of ethnicity, age, time to presentation, parity, insurance, or mode of delivery. Susceptibility patterns were consistent with community-acquired MRSA. CONCLUSIONS MRSA is a significant pathogen in postpartum breast abscesses in our population, and a high level of suspicion is warranted. Local susceptibility patterns should guide treatment. Empirical treatment of breast abscesses without first obtaining cultures should be discouraged.

ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

PRENATAL, INTRAPARTUM, AND POSTPARTUM SUPPORT OF THE LACTATING MOTHER

Physicians must continue to improve their knowledge regarding lactation. Improved education will allow for alterations in standard practices that may deter breastfeeding. Presently known influences on successful breastfeeding should direct changes in clinic and hospital practices. Continued research into various aspects of care in and out of the hospital must be pursued to improve maternal-infant care and breastfeeding.

Premature termination of nursing secondary to Serratia marcescens breast pump contamination.

BACKGROUND: Serratia marcescens, a known pathogen associated with postpartum mastitis, may be identified by its characteristic pigmentation. CASE: A 36-year-old P0102 woman presented postpartum and said that her breast pump tubing had turned bright pink. S marcescens was isolated, indicating colonization. She was started on antibiotics. After viewing an Internet report in which a patient nearly died from a Serratia infection, she immediately stopped breastfeeding. CONCLUSION: Serratia colonization may be noted before the development of overt infection. Because this pathogen can be associated with mastitis, physicians should be ready to treat and should encourage patients to continue nursing after clearance of the organism. Exposure to sensational Internet reports may make treatment recommendations difficult.

Breast Pain: Engorgement, Nipple Pain, and Mastitis.

This review explores current concepts surrounding breastfeeding complications including nipple pain and trauma, breast engorgement, mastitis, and breast abscess. The review discusses possible etiologies, risk factors, incidence, differential diagnosis, and suggested treatment strategies. The evidence that supports these management options is discussed.

Evaluation of the maternal-fetal transfer of granisetron in an ex vivo placenta perfusion model.

The objective of this study was to estimate maternal-fetal transplacental passage of granisetron in an ex vivo placental perfusion model. Term human placentas (N=8) were collected immediately after delivery. A single cotyledon from each placenta was perfused granisetron concentration to mimic systemic maternal peak plasma concentrations following either IV (50ng/mL) or transdermal administration (5ng/mL). To assess drug transfer and accumulation, samples were collected from maternal and fetal compartments. In the 50ng/mL open model, the mean transport fraction was 0.21±0.08 with clearance index of 0.53±0.66. Fetal peak concentrations achieved was 5.6±6.6ng/mL with mean accumulation of 5.35±6.4ng/mL. No drug was detected in the fetal compartment with the 5ng/mL models. Transplacental passage of granisetron was inconsistent at the 50ng/mL concentration that achieved with IV dosing. However, there consistently was no detectable passage in all the placentas evaluated of the granisetron at 5ng/mL concentration that would be achieved after transdermal patch administration.

Evaluating the potential effect on fetal tissue after exposure to granisetron during pregnancy

The objective of this study was to elucidate the possible toxic effects on the fetal tissues after exposure to two clinically relevant concentrations of granisetron. Primary cells were isolated from human fetal organs of 16-19 weeks gestational age and treated with 3 ng/mL or 30 ng/mL of granisetron. Cell cycle progression was evaluated by flow cytometry. ELISA was used to detect alterations in major apoptotic proteins. Up to 10% apoptosis in cardiac tissue was observed following treatment with 30 ng/mL granisetron. Neither concentration of granisetron caused alteration in cell cycle progression or alterations in apoptotic proteins in any of the other tissues. At 30 ng/mL granisetron concentration had the potential to induce up to 10% apoptosis in cardiac tissue; clinical significance needs further evaluation. At granisetron 3 ng/mL there was no detectable toxicity or on any fetal tissue in this study. Further research is needed to confirm these preliminary findings and determine if clinically significant.

First‐trimester screening and its impact on uptake of diagnostic testing

To determine the influence of first‐trimester screening (FTS) on a patients decision regarding prenatal diagnostic testing (PDT) and if the uptake rate of PDT has changed among women with advanced maternal age (AMA) following the January 2007 American College of Obstetricians and Gynecologists statement regarding FTS.