Storing human milk

It is also clear that children with ‘‘atypical’’ RTT (ie, preserved speech and delayed onset) also have a better outcome. Here, the issue may be that the availability of molecular testing may be identifying some children in whom the disorder might not have been established in an earlier period. The most powerful use of molecular testing is when it is combined with excellent clinical correlation. Large databases, such as that reported in this article, are the sine qua non for such work. Article Page 135 <

Storing human milk —Alan H. Jobe, MD, PhD

How much milk does the newborn get? —Alan H. Jobe, MD, PhD

Communityassociated MRSA finally gets to central New York —Sarah S. Long, MD

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he management of human milk is a major activity for many neonatal intensive care units (NICU). Storage is the critical step after collection for human milk to be used to feed preterm infants. One approach is to have the mother freeze the milk after storage and deliver frozen milk to the NICU. However, the cells in the milk will be destroyed, perhaps along with cytomegalovirus (CMV). Fresh milk is thought to be the preferred food for preterm infants. In this issue of The Journal, Slutzah et al reports that human milk can be refrigerated at 4  C for up to 96 hours without much change in composition or bacterial counts. The multiple immune functions of the 96 hour-old milk were not tested relative to fresh human milk. Another approach to feeding preterm infants human milk is to use heat-treated (pasteurized) and frozen milk from human milk banks. Some neonatal services use milk purchased from milk banks when the mother does not provide milk for her infant. Whether using fresh, refrigerated, frozen, or pasteurized frozen human milk, storage with careful labeling for each infant is now a time consuming activity in the NICU. Article Page 26 <

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urrent practices are to initiate breastfeeding as soon after birth as possible with the dual goals of stimulating milk production and providing early fluid and nutrition. The reality is that the second goal (fluid and nutrition) depends on the first goal (milk production) and successful breast-feeding. Although it is well-recognized that an infant’s initial feeding attempts will not provide much colostrum, Santoro, Jr et al have measured the mass of feeds taken by infants over the first 24 hours of life to be only 15  11 g. Perhaps, more surprisingly, volume per feeding did not increase during the first 24 hours. Because most infants get so little milk, it is less surprising that volume does not correlate with a number of obstetric or maternal variables. These results certainly strengthen the arguments against early discharge after birth and the use of selective feeding supplementation for some infants with perinatal problems, such as hypoglycemia. Article Page 29 <

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n this issue of The Journal, Suryadevara et al calculate the pediatric population-based incidence and hospitalization-based prevalence of invasive Staphylococcus aureus infection from 1996 through 2006 at the University Hospital in Syracuse, which serves 14 counties in central New York state. Their data are useful because such denominators are infrequently used in the plethora of case series describing the decade’s epidemic of community-associated methicillin-resistant S aureus (MRSA). The remarkable finding of this study and epidemiologic note is that MRSA has come late and seemingly less pervasively to New York state to date. Years after remarkable case loads mounted across the country – Los Angeles, Dallas, Houston, Corpus Christi, Chicago, Little Rock, Nashville, Baltimore, Philadelphia – in the latter 1990s, colleagues in New York City were unburdened by MRSA USA 300. The known risk factors early in the epidemic – crowding, lower socioeconomic status, underlying skin conditions, sports teams, jails – certainly were extant in New York. MRSA is catching up with New York. But curious geographic differences in MRSA prevalence, antibiotic Vol. 156, No. 1