Natural nutrition - present and future

Universitatea de Medicină şi Farmacie ”Gr. T. Popa” Iaşi, Departamentul Medicina Mamei şi Copilului, Secţia Neonatologie, Departamentul Ştiinţe Fundamentale şi Interdisciplinaritate, Spitalul Clinic de Obstetrică-Ginecologie ”Cuza Vodă” IaşiPromoting breastfeeding represents even nowadays an important matter either in maternities and later in early childhood. Variability in human milk composition is well studied and demonstrated by large several studies. Optimal content in principal macronutrients and energy content conferes to human milk vaşlues of inimitable nutrient. Aim: quantitative analyse of nutritive content and caloric value of term and preterm mothers milk, moment of initiating breastfeeding and it”s duration. Material and method: a study group of 222 cases were analised as main macronutrient composition in human milk (spectrophotometry with Miris Human Milk Analyzer) of different gestational age, postnatal age, type of delivery, maternal age and other significant parameters. The second study group of 1098 cases were questioned about timing and duration of breastfeeding, time of diversification and their impact on postnatal morbidity. Results: macronutrient content varied with moment of sampling, gestational age and postnatal age. Sampling methods influence probably this composition. 26,8% of newborns were breastfed in the delivery room. &1,2% were exclusively breastfed at discharge. Only 21,8% of C-sectioned mothers breastfeeded compared with 51,2% of vaginaly delivering mothers. Postnatal breastfeeding was maintained for an average of 48,1 weeks. Diversification was done at 21,8 weeks. Conclusion: macronutrient human milk analyse has to be done on large study groups, multicentric to distinguish eventual regional differences, milk has to be colected and sampled on 24 hour basis. The future of breastfeeding largely depends on enhancing efforts for promoting breastfeed in maternity and later at general practitioner level, because it represents the best and cheapest prophilaxis for neonatal and infant morbidity.Promovarea alimentaţiei naturale reprezintă şi astăzi o problemă de actualitate, atât în maternitate, cât şi ulterior în perioada de sugar. Variabilitatea compoziţiei laptelui matern, demonstrată de multiple studii, ca şi componenţa în principii nutritive de bază, optimă dezvoltării copilului, fac din acest lapte un aliment inimitabil. Obiectivele studiului: analiza cantitativă a principalelor principii nutritive şi valorii energetice în laptele mamelor care au născut la termen sau prematur, evaluarea momentului iniţierii alimentaţiei la sân, influenţa acesteia asupra duratei ulterioare a alimentaţiei naturale în perioada de sugar. Material şi metodă: s-au determinat principalii macronutrienţi din eşantioane de lapte proaspăt recoltat de la 222 cazuri, analizate prin metoda spectrometrica (Miris HMA), stabilindu-se corelaţii cu vârsta de gestaţie, momentul postnatal, felul naşterii, vârsta mamei şi alte variabile semnificative. Studiul a fost completat de analiza a 1098 pacienţi ale caror mame au fost interogate prin metoda chestionarului, vizând momentul iniţierii alimentaţiei naturale, durata postnatală a acesteia şi momentul diversificării, şi impactul acesteia asupra morbidităţii ulterioare. Rezultate: compoziţia în macronutrienţi a variat funcţie de momentul recoltării, vârsta de gestaţie şi tipul recoltării, având în vedere că recoltarea nu s-a făcut din laptele de pe 24 ore. Corelaţia semnificativă s-a constatat pentru vârsta de gestaţie şi vârsta postnatală. Iniţierea alimentaţiei la sân în sala de naştere a avut o incidenţă de 26,8%, explicat în parte de rata mare de cezariene (52%). La externare 71,2% erau alimentaţi exclusiv natural. Naşterea prin cezariană a limitat alimentaţia la sân la doar 21,8% faţă de 51,2% pentru mamele ce au născut natural. Durata alimentaţiei naturale a fost în medie de 48,1 săptămâni, iar diversificarea s-a făcut la 21,5 săptămâni. Concluzii: analiza laptelui de mamă este necesar a fi făcută pe loturi mari de mame şi prin recoltarea şi omogenizarea laptelui pe 24 ore, fiind oportune studii multicentrice, care să anlizeze compoziţia laptelui uman pentru diferite regiuni. Viitorul alimentaţiei naturale depinde de promovarea alăptării la nivelul maternităţilor şi la nivelul medicilor de familie, alimentaţia naturală reprezentând cea mai bună şi mai ieftină profilaxie a patologiei nou-născutului şi sugarului

Total antioxidant status in fresh and stored human milk from mothers of term and preterm neonates

Background: Antioxidant defense of the body is assured by both endogenous and exogenous factors comprising several enzymes, vitamins, protein components and derivates and oligoelements. Breast milk has been proven to have important and essential antioxidant composition to prevent and protect against diseases in infancy. The objective of this study was to determine the total antioxidant status (TAS) of human milk and to evaluate the differences between premature milk and term milk at different moments of lactation (colostrum, transitional milk and mature milk). A second objective was to evaluate how TAS varies whether the human milk is refrigerated or frozen. Methods: Pumped human milk samples of the third, seven and 30th day were collected from women who had term deliveries (30 cases) and preterm deliveries (60 cases). Samples were refrigerated (+4 °C) or frozen in domestic conditions (−20 °C) for various durations and TAS was determined using the ABTS® technique with Randox® reagents and compared for the two groups. Results: Higher values were found in term versus preterm fresh milk at 30 days of lactation. A slight reduction in TAS was found after 72 h of refrigeration, while 1 week freezing produced significant decrease of total antioxidants. Freezing for 12 weeks reduced more than 50% of TAS in fresh milk. Conclusion: Breastfeeding provides the optimal antioxidant for neonates, regardless of gestational age. Fresh milk has the higher antioxidant power. When it is not available, refrigerated milk for 24 h is better than for 72 h and preferable than frozen milk. Freezing human milk for 3 months in household conditions markedly diminishes TAS. Key Words: early lactation, human milk, preterm, term, total antioxidant statu

A Case of Inherited t(4;10)(q26;q26.2) Chromosomal Translocation Elucidated by Multiple Chromosomal and Molecular Analyses. Case Report and Review of the Literature

We present a complex chromosomal anomaly identified using cytogenetic and molecular methods. The child was diagnosed during the neonatal period with a multiple congenital anomalies syndrome characterized by: flattened occipital region; slight turricephaly; tall and broad forehead; hypertelorism; deep-set eyes; down slanting and short palpebral fissures; epicanthic folds; prominent nose with wide root and bulbous tip; microstomia; micro-retrognathia, large, short philtrum with prominent reliefs; low set, prominent ears; and congenital heart disease. The GTG banding karyotype showed a 46,XY,der(10)(10pter→10q26.2::4q26→4qter) chromosomal formula and his mother presented an apparently balanced reciprocal translocation: 46,XX,t(4;10)(q26;q26.2). The chromosomal anomalies of the child were confirmed by MLPA, and supplementary investigation discovered a quadruplication of the 4q35.2 region. The mother has a triplication of the same chromosomal fragment (4q35.2). Using array-CGH, we described the anomalies completely. Thus, the boy has a 71,057 kb triplication of the 4q26–q35.2 region, a 562 kb microdeletion in the 10q26.3 region, and a 795 kb quadruplication of the 4q35.2 region, while the mother presents a 795 kb triplication of the 4q35.2 region. Analyzing these data, we consider that the boy’s phenotype is influenced only by the 4q partial trisomy. We compare our case with similar cases, and we review the literature data