Effects of storage practices on long-chain polyunsaturated fatty acids and lipid peroxidation of preterm formula milk.

BACKGROUND: Preterm formula milk (FM) is often prepared in advance, potentially affecting nutritional quality. Long-chain polyunsaturated fatty acids (LCPUFAs), important for brain and immune system function, are prone to lipid peroxidation, which correlates with comorbidities of prematurity. The effects of clinical storage practices on LCPUFA content and lipid peroxidation of preterm FM were investigated. METHODS: UK liquid and powder preterm FM (2017) (from two manufacturers) were subjected to routine storage conditions (liquid: refrigeration ≤10 h; powder: weekly preparation in accordance with the manufacturer's instructions and refrigeration ≤24 h for 4 weeks). LCPUFA content, thiobarbituric acid reactive substances and 4-hydroxy-2-nonenal (HNE) content were analysed. RESULTS: Storage did not significantly decrease LCPUFA content. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition recommended LCPUFA intake, whereas in utero accretion rates could not be achieved with both FM brands (liquid and powder). Lipid peroxidation was evident on opening, with 6× higher levels in powder. No effect of ≤10-h refrigeration on peroxidation was seen in liquid FM. In powder FM, it increased over refrigeration (HNE opening: 6.5-9.7 µg mL-1 versus day 28, 24 h: 16.6-36.5 µg mL-1 ) with a significant interaction between storage time and refrigeration (P = 0.015), with higher HNE at 4 h on days 0, 7, 14 and 21 (all P < 0.05). CONCLUSIONS: The results suggest that preterm FM and storage conditions do not support in utero accretion rates for LCPUFAs. Although the results suggest different susceptibility of liquid and powder FM to peroxidation upon refrigeration, they are too preliminary to make specific recommendations. We suggest minimising storage time of fresh and prepared powder FM, wherever possible

Racial Disparities in Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is a serious disease of the intestinal tract affecting 5-10% of pre-term infants with up to 50% mortality in those that require surgery. There is wide variation in the rates and outcomes of NEC by race and ethnicity, and the reasons for this disparity are poorly understood. In this article, we review the epidemiology and discuss possible explanations for racial and ethnic differences in NEC. Most of the current evidence investigating the role of race in NEC comes from North America and suggests that Hispanic ethnicity and non-Hispanic Black race are associated with higher risk of NEC compared to non-Hispanic White populations. Differences in pre-term births, breastfeeding rates, and various sociodemographic factors does not fully account for the observed disparities in NEC incidence and outcomes. While genetic studies are beginning to identify candidate genes that may increase or decrease risk for NEC among racial populations, current data remain limited by small sample sizes and lack of validation. Complex interactions between social and biological determinants likely underly the differences in NEC outcomes among racial groups. Larger datasets with detailed social, phenotypic, and genotypic information, coupled with advanced bioinformatics techniques are needed to comprehensively understand racial disparities in NEC

A Proposed Machine Learning Based Collective Disease Model to Enable Predictive Diagnostics in Necrotising Enterocolitis

© 2018 IEEE. Despite 60 years of research into necrotising enterocolitis (NEC), our understanding of the disease has not improved enough to achieve better outcomes. Even though NEC has remained the leading cause of death and poor outcomes in preterm infants, there remain vital questions on how to define, differentiate and detect the condition. Numerous international groups have recently highlighted NEC as a research priority and called for broader engagement of the scientific community to move the field forward. The three foremost barriers at present are lack of suitable definition(s), lack of clean datasets and consequently a lack of scope to gain sufficient insights from data. This research paper proposes a new direction of travel to advance neonatal gastro-intestinal monitoring and strengthen our efforts to gain better insights from global databases. An integrated machine learning based model is recommended to produce a comprehensive disease model to manage the complexity of this multi-variate disease. This intelligent disease model would be used in the daily neonatal settings to help aggregate data to support clinical decision making, better capture the complexity of each patient to enrich global datasets to create bigger and better data. This paper reviews current machine learning and CAD technologies in neonatology and suggests an innovative approach for an NEC disease model

Experience of fathers with babies admitted to neonatal care units: A review of the literature

There is a growing understanding of the role and place of men in maternity care generally and for fathers of babies in neonatal care in particular. This review offers a systematic narrative review on issues affecting fathers, whose babies are admitted to neonatal units. Twenty-seven papers in the review highlighted four key themes: stress & anxiety; information; gender roles and emotions

Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis.

Necrotising enterocolitis (NEC) is a serious inflammatory bowel disease of prematurity with potentially devastating complications and remains a leading cause of morbidity and mortality among premature infants. In recent years, there has been accumulating data regarding benefits of using bowel ultrasound (BUS) in the diagnosis and management of NEC. Despite this, adoption of robust BUS programmes into clinical practice has been slow. As BUS is a relatively new technique, many barriers to implementation exist, namely lack of education and training for sonographers and radiologists, low case volume and unfamiliarity by clinicians regarding how to use the information provided. The aim of this manuscript is to provide a framework and a roadmap for units to implement BUS in day-to-day practice for NEC diagnosis and management

COVID-19 restrictions and psychological well-being of fathers with infants admitted to NICU—An exploratory cross-sectional study

Aim To describe the impact of the COVID-19 restrictions on the caregiving activities and psychological well-being of fathers with infants admitted to neonatal units. Methods Cross-sectional study using adapted COPE-IS and COPE-IU tools. Participants\u27 recruitment occurred online via social media and parents\u27 associations. Online survey in English, French and Italian were distributed and promoted via websites and social media platforms of parent\u27s associations. The study was undertaken across 12 countries in Asia, Australia, Africa and Europe. Results A total of 108 fathers of NICU infants completed the survey. COVID-19 related restrictions were categorised into 3 types: no restrictions, partial and severe restrictions. Fathers who experienced partial restrictions reported more involvement in caregiving activities but high levels of emotional difficulties and sleeping problems compared to those who experienced full or no restrictions. Conclusion Given the impact on the psychological well-being of fathers, restrictions should be avoided as much as possible in the neonatal unit and fathers given free access to their infants if they follow appropriate infection control precautions

COVID-19 restrictions and fathers of infants in neonatal care.

This is a letter without an abstract

Fathers in neonatal units: improving infant health by supporting the baby-father bond and mother-father co-parenting.

The Family Initiative’s International Neonatal Fathers Working Group, whose members are the authors of this paper, has reviewed the literature on engaging fathers in neonatal units, with the aim of making recommendations for improving experience of fathers as well as health outcomes in neonatal practice. We believe that supporting the fatherbaby bond and supporting co-parenting between the mother and the father benefits the health of the baby, for example, improved weight gain and oxygen saturation and enhanced rates of breastfeeding. We find, however, that despite much interest in engaging with parents as full partners in the care of their baby, engaging fathers remains suboptimal. Fathers typically describe the opportunity to bond with their babies, particularly skin-to-skin care, in glowing terms of gratitude, happiness and love. These sensations are underpinned by hormonal and neurobiological changes that take place in fathers when they care for their babies, as also happens with mothers. Fathers, however, are subject to different social expectations from mothers and this shapes how they respond to the situation and how neonatal staff treats them. Fathers are more likely to be considered responsible for earning, they are often considered to be less competent at caring than mothers and they are expected to be “the strong one”, providing support to mothers but not expecting it in return. Our review ends with 12 practical recommendations for neonatal teams to focus on: (1) assess the needs of mother and father individually, (2) consider individual needs and wants in family care plans, (3) ensure complete flexibility of access to the neonatal unit for fathers, (4) gear parenting education towards co-parenting, (5) actively promote father-baby bonding, (6) be attentive to fathers hiding their stress, (7) inform fathers directly not just via the mother, (8) facilitate peer-to-peer communication for fathers, (9) differentiate and analyse by gender in service evaluations, (10) train staff to work with fathers and to support co-parenting, (11) develop a father-friendly audit tool for neonatal units, and (12) organise an international consultation to update guidelines for neonatal care, including those of UNICEF

The effects of storage conditions on long-chain polyunsaturated fatty acids, lipid mediators, and antioxidants in donor human milk - A review.

Donor human milk (DHM) is the recommended alternative, if maternal milk is unavailable. However, current human milk banking practices may negatively affect the nutritional quality of DHM. This review summarises the effects of these practices on polyunsaturated fatty acids, lipid mediators and antioxidants of human milk. Overall, there is considerable variation in the reported effects, and further research is needed, particularly with lipid mediators and antioxidants. However, to preserve nutritional quality, DHM should be protected from light exposure and storage at 4 °C minimised, to prevent decreases in vitamin C and endocannabinoids and increases in free fatty acids and lipid peroxidation products. Storage at -20 °C prior to pasteurisation should also be minimised, to prevent free fatty increases and total fat and endocannabinoid decreases. Storage ≤-70 °C is preferable wherever possible, although post-pasteurisation storage at -20 °C for three months appears safe for free fatty acids, lipid peroxidation products, and total fat content