martes, 25 de noviembre de 2008

articulos Leche materna pasteurizadacientif 1

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

Franz R. NovakI; Dea M. B. CordeiroII
IDoutor. Instituto Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ IIMestre. Instituto Fernandes Figueira, Fiocruz, Rio de Janeiro, RJ

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 Pearson's coefficient, and the level of significance was set at p < 0.05.RESULTS: In the samples analyzed, Dornic acidity levels had a positive (R = 0.948) and statistically significant (p < 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. Keywords: Breastmilk, bacteria, acidity.

Journal of Human Lactation, Vol. 22, No. 3, 335-339 (2006)DOI: 10.1177/0890334406290099
Quality Control of Banked Milk in Brasília, Brazil Simone G. Almeida, MSc
Department of Nutrition at the University of Brasília
José G. Dórea, PhD
Department of Nutrition at the University of Brasília; Department of Nutrition
The authors studied quality control procedures at human milk banks and nutritional profiles of 909 milk samples (from 195 donors, aged 15 to 45 years) from banked human milk (BHM) in Brasília, Brazil. Number of donations per donor ranged from 1 to > 10 that consisted mostly of mature milk (90.9%) with a mean total energy of 529 ± 85 kcal/L and a mean total lipid of 22.7 g/L ± 13.2. Microbiological quality (titrable acidity—Dornic, °D) was suitable for infant feeding in 99.2% of samples (< href="">
05 OCT 07 Alimentación y desarrolloLa lactancia materna es beneficiosa incluso en prematuros
El alimento de la madre parece mejorar el desarrollo mental.Jano Online
Incluso los niños prematuros más pequeños deberían recibir leche materna mientras permanecen en la unidad de cuidados intensivos del hospital, dado que el alimento de la madre parece mejorar el desarrollo mental, según señala un estudio de la Brown Medical School (Estados Unidos). Una segunda investigación sobre la lactancia materna de la University of Rochester (Estados Unidos) reveló que no aumenta el riesgo de que los niños desarrollen caries dentales más adelante en sus vidas, algo que había sugerido un trabajo previo. Ambos informes han sido publicados en “Pediatrics”.
El estudio sobre niños prematuros incluyó a 773 pequeños nacidos con bajo muy peso (menos de 1 kilogramo), entre 1999 y el 2002.
La investigación indicó que los niños del grupo que recibió leche materna obtuvieron mejores calificaciones en una prueba que midió su inteligencia general a los 30 meses de edad. Las mayores calificaciones fueron las de los niños que más leche materna habían recibido durante su infancia temprana.
Los autores del trabajo sobre caries dijeron que los había impulsado la evidencia escasa y un estudio que indicaba que el amamantamiento, sobre todo prolongado, podía elevar el riesgo de problemas dentales en los niños pequeños.
Pero una revisión de datos del Gobierno sobre salud infantil, que incluían a más de 1.500 niños, no halló tal asociación.
No existe "evidencia para sugerir que el amamantamiento o su duración sean factores de riesgo independiente de la formación de caries en los niños", concluyó la investigación.
Pediatrics 2007;120:e944-e952,e953-e959
Articulo original en

Breastfeeding method and infant weight gain: look at the evidenceC A Walshaw, J Owens, M Walshaw
GP Bradford and Airedale Teaching Primary Care Trust, Oakworth Surgery, 3 Lidget Mill, Oakworth, Keighley, BD22 7HN, UK;
Accepted for publication 4 April 2008
We are delighted that our paper "Does breastfeeding method influence infant weight gain" has stimulated Woolridge and Ingram to look again at current breastfeeding practice,1 and we now take the opportunity to reply to their letter.2
They describe the "baby-led" breastfeeding method as "entrenched evidence-based practice": "entrenched" it may be, but we find the use of the term "evidence-based" surprising since this was not the conclusion reached in Enabling women to breastfeed co-authored by Woolridge himself.3 This was a structured literature review commissioned by the Department of Health to identify research studies that assessed interventions which enabled or interfered with the continuation of breastfeeding. It concluded that there wasn’t sufficient evidence on which to base breastfeeding advice. Indeed, we quote "the most striking finding is the paucity of good, well-designed research to inform an area of healthcare which has profound short- and long-term effects on such large numbers of . . . [Full text of this article]


Infect Dis Obstet Gynecol. 2006; 2006: 95938.
Published online 2006 January 25. doi: 10.1155/IDOG/2006/95938.
PMCID: PMC1581475
Copyright © 2006 Caroline J. Chantry et al.
Breast Milk Pasteurization: Appropriate Assays to Detect HIV Inactivation
Caroline J. Chantry,1 Barbara F. Abrams,2 Richard M. Donovan,3 Kiersten A. Israel-Ballard,2* and Haynes W. Sheppard3
1Department of Pediatrics, University of California, Davis Medical Center, 2516 Stockton Boulevard, Room 334, Sacramento, CA 95817, USA
2Division of Epidemiology, School of Public Health, University of California, 140 Earl Warren Hall #7360, Berkeley, CA 94720-7360, USA
3California Department of Health Services, Viral and Rickettsial Disease Laboratory, 850 Marina Bay Parkway, Richmond, CA 94804, USA
*Kiersten A. Israel-Ballard: Email:

Received January 11, 2006; Accepted January 12, 2006.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

We read the recent article “Breast milk pasteurization in developed countries to reduce HIV transmission. Do the benefits outweigh the risks?” in Infectious Diseases in Obstetrics and Gynecology with great concern. The authors tested two paired specimens of heated and unheated breast milk using HIV RNA quantification (NASBA and Roche ULTRA PCR). They found no decrease in HIV RNA levels between the heated and unheated samples and thus concluded there to be insufficient data to recommend heat treatment as a safe alternative in resource-rich countries. We are particularly concerned that they have misinterpreted their results and that this confusion may be perpetuated in discussions and policies around the globe, most importantly in resource-poor regions.
We strongly encourage the authors, editors, and readership of your journal to reinterpret the results presented since the HIV detection method used by Giles and Mijch does not differentiate between active (infectious) and inactive (noninfectious) HIV in breast milk. Our team has been investigating the safety of heat-treated breast milk as an infant feeding option for mothers in developing countries and have recently published the results of pilot safety data [2]. We have designed a simple “flash-heat” treatment method that a mother could use in her home or over a fire, similar to commercial high-temperature, short-time (HTST) pasteurization. Although the study published by Chantry et al [3] used a similar heating method and demonstrated destruction of HIV proviral DNA in HIV-infected breast milk cells [3], the method used in that report achieved higher milk temperatures due to smaller milk volumes and Pyrex glass. In designing a more gentle heating method, we also found, as reported by Giles and Mijch, no decrease in HIV RNA.
We ascertained, however, that assaying for presence of viral RNA, as performed by Giles in the above article, is not an adequate technique for detecting infectious virus in heated breast milk. Nucleic acid is very resistant to heating, up to the boiling point of water. It is to be expected that viral nucleic acid will remain postheating and will be detected by PCR-based assays even after the virus itself is rendered totally incapable of replication due to destruction of vital enzyme activities, structural proteins, and membrane structures due to the heat. We acknowledge that RNA detection is commonly used for quantification of HIV in both plasma and unheated breast milk. In order to determine the effect of heat on HIV in breast milk, however, the assay must effectively distinguish between live versus inactivated virus. We have demonstrated this in our recent pilot work comparing the flash-heat method with Pretoria pasteurization, another simple technique mentioned by Giles and Mijch [4, 5] . We found no decrease in cell-free HIV RNA as determined by TaqMan Real-time RNA PCR in breast milk (Log HIV RNA (SD) in unheated milk = 8.00(0.03) versus heated milk = 7.95(0.03)). We recognized the need for an alternative assay to accurately assess virus viability and, as traditional coculture methods are difficult with breast milk due to the innate antiviral properties of the milk, we chose quantitative measurement of reverse transcriptase (RT) as a marker for viable HIV (ExaVir Quantitative Reverse Transcriptase Load Kit, Cavidi, Uppsala Sweden). In contrast to our TaqMan PCR data from the same samples, we found inactivation of ≥ 3 logs of HIV-1 as detected by enzymatic activity of RT in postheated samples, with the flash-heat method more effectively eliminating RT than Pretoria pasteurization. We have subsequently confirmed these results by directly assaying for infectivity using transactivation of a green fluorescent protein (GFP) reporter group (data unpublished). Although we acknowledge that detection of HIV activity in breast milk can be challenging, we would encourage the authors to repeat their work using an appropriate assay.
We recognize the concerns mentioned by the authors regarding the impact of heat on vitamins, proteins, immunoglobulins, and the antimicrobial properties of breast milk. Low-temperature, long-time (LTLT) heat treatments, for example, Holder pasteurization, typically preserve nutrients less than HTST methods do. We reported pilot data suggesting limited impact on vitamins and proteins using flash-heat [2]. Our ongoing study is investigating the above concerns in-depth and we hope to have this data available in the near future.
We agree that it is not currently justifiable to recommend heat treatment of HIV-infected breast milk in resource-rich countries. However, we are concerned that the results, presented by Giles and Mijch of two heated breast milk samples demonstrating persistent HIV RNA being interpreted as “persistent HIV” without further exploration of viral infectivity, may have unwarranted repercussions. We strongly urge re-consideration of the results in light of our findings that HIV RNA is detectable after heating with no demonstrable activity of RT, which is necessary for virus to replicate. Heat treatment of breast milk is a recognized infant feeding option by the World Health Organization for HIV positive mothers who live in areas where no other alternatives are available. While we acknowledge that further research is needed, caution should be used when stating conclusions that may negatively impact policy makers' decisions regarding what may be appropriate in such communities.

Formato de archivo: PDF/Adobe Acrobat - Versión en HTMLprocessamento (pasteurização) do leite humano cru para Bancos de Leite. .... 7.1 A pasteurização do leite humano deverá ser monitorizada a cada 5 minutos, - Páginas

Formato de archivo: PDF/Adobe Acrobat -
Versión en HTMLQualidade do Leite humano Coletado e Processado em. Bancos de Leite. ... 5.1.6 El transporte de la leche humana pasteurizada hasta la unidad receptora - Páginas

Qualidade microbiológica de leite humano obtido em banco de leite

Álvaro B Serafini; Maria Cláudia D P B André; Márcia A V Rodrigues; André Kipnis; Cynthia O Carvalho; Maria Raquel H Campos; Érica C Monteiro; Fábia Martins; Thiago F N Jubé
Departamento de Microbiologia, Imunologia, Parasitologia e Patologia do Instituto de Patologia Tropical e Saúde Pública da Universidade Federal de Goiás. Goiânia, GO, Brasil
Endereço para correspondência

OBJETIVO: Determinar a prevalência de microrganismos indicadores e potencialmente patogênicos que indicam as condições higiênico-sanitárias das amostras de leite humano ordenhado coletadas em banco de leite. MÉTODOS: Foram realizadas análises microbiológicas de 338 amostras de leite humano ordenhado, sendo 194 de leite cru e 144, pasteurizado, coletadas em banco de leite humano de um hospital materno infantil de Goiânia, GO. As análises microbiológicas foram realizadas com semeadura em ágar Mc Conkey, de acordo com o tipo de bactéria. RESULTADOS: No leite cru, verificou-se a presença de Staphylococcus spp. Streptococcus spp., bolores e leveduras e Enterobacteriaceae. Observou-se que Staphylococcus aureus esteve presente em 10 (5,2%) amostras, Staphylococcus epidermidis em 28 (14,4%), Streptococcus spp. em três (1,6%), bolores e leveduras em 43 (22,2%) e Enterobacteriaceae em 49 (25,3%). Das 144 amostras de leite humano ordenhado pasteurizado, detectaram-se Staphylococcus aureus em cinco (3,5%), Staphylococcus epidermidis em 15 (10,4%), Staphylococcus lugdenensis em duas (1,4%), Streptococcus spp. em quatro (2,8%), bolores e leveduras em 37 (25,7%) e Enterobacteriaceae em nove (6,3%). CONCLUSÕES: Os resultados mostraram um alto grau de contaminação no leite cru. No leite pasteurizado, apesar da eliminação da grande maioria de microrganismos potencialmente patogênicos, a percentagem de bolores e leveduras excedeu a de leite cru, mostrando a necessidade de obtenção de um leite com carga microbiana inicial mais baixa para que a pasteurização seja eficiente no controle microbiológico.
Descritores: Bancos de leite. Leite humano. Controle de qualidade.

As infecções exógenas oriundas do ambiente hospitalar são as que merecem maior atenção dos sanitaristas, pois são provocadas por agentes cuja fonte é o ser humano, como: funcionários, pacientes e visitantes, e também por equipamentos e instrumental.5 Como é muito difícil a implantação simultânea de medidas de controle de infecções hospitalares em todos os seus setores, os esforços devem ser concentrados nas áreas de risco, como berçários, serviço de nutrição e os centros cirúrgicos, de esterilização e de terapia intensiva. Desta forma, destaca-se entre esses setores o berçário, devido à contaminação cruzada ou pelo banco de leite, implicando que a veiculação de microrganismos patogênicos ou potencialmente patogênicos possa ser considerada fator de risco microbiológico em potencial. Sabe-se que para os bebês alimentados com leite materno, os primeiros seis meses podem ser a época mais sadia de vida. Este tipo de alimentação preenche perfeitamente suas demandas de nutrição e higiene.24 Porém, os recém-nascidos prematuros não dispõem de forças para sugar o leite materno e têm que ser alimentados por outros métodos. Há ainda o fato de que algumas mães, por algum problema fisiológico ou emocional, não conseguem produzir leite. Por outro lado, pode causar alergia aos recém-nascidos o leite oriundo de animais. Por estes e outros motivos, muitos lactentes são alimentados com leite obtido em bancos de leite humano (BLH), produto de doações voluntárias de mulheres que têm produção excedente.
A qualidade microbiológica do leite humano ordenhado (LHO) distribuído por esses bancos é um assunto de interesse para a saúde pública, pois as crianças que consumirão este produto têm baixa resistência a infecções neonatais.1,2,13,21 O problema mais importante dos BLHs é o controle bacteriológico do leite doado,11 sendo que o consumo de leite humano contaminado pode ser a causa de doenças neonatais.23
Torna-se importante a obtenção de mais dados epidemiológicos sobre a contaminação bacteriana de leite humano e o desenvolvimento de um trabalho educativo com as mães, enfermeiras, técnicos de enfermagem, nutricionistas, médicos pediatras e intensivistas, conscientizando-os sobre os riscos na preparação e consumo do leite humano.21 O presente trabalho tem por objetivo conhecer a prevalência de microrganismos existentes no leite oferecido por bancos de leite humano para subsidiar as autoridades competentes na melhor condução de programas de prevenção de infecções de recém- nascidos.

Foram coletadas 338 amostras de leite de um banco de leite humano de um hospital materno infantil de Goiânia, GO, sendo 194 amostras de leite humano cru e 144 pasteurizado. Essas amostras eram remetidas imediatamente acondicionadas, ao Laboratório de Microbiologia de Alimentos do Departamento de Microbiologia do Instituto de Patologia Tropical e Saúde Pública de Goiânia, onde se procederam as análises microbiológicas.
Por se tratar de secreção e da quantidade disponibilizada para a coleta, as análises microbiológicas foram realizadas segundo Koneman et al14 (1997) com semeadura inicial em ágar sangue e ágar Mc Conkey e, de acordo com o tipo de bactéria isolada, posterior identificação em meios apropriados. As bactérias pertencentes ao gênero Staphylococcus foram testadas para a capacidade de produção de coagulase, resistência à novobiocina. Para os Streptococcus, baseado na hemólise, foram realizadas provas de resistência à bacitracina, optoquina e outras provas bioquímicas. Na identificação de Gram-negativos, a triagem era realizada em TAF (tríplice açúcar ferro) e a identificação por provas bioquímicas. Para a análise de bolores e leveduras, utilizou-se a técnica de acordo com a American Public Health Association,25 com semeadura em ágar batata dextrose acidificado com ácido tartárico a 10% até pH 3,5, incubação a 25oC±1 por cinco a sete dias.
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