Introdução: Recém-nascidos (RN) pré-termo tardios são submetidos repetidamente a lancetagem de calcâneo para controle glicêmico nas primeiras horas de vida. A lancetagem, embora dolorosa, raramente é acompanhada de medida analgésica. Objetivo: Comparar a eficácia do leite materno ordenhado com glicose 25% nos escores da dor em recém-nascidos pré-termo tardios, submetidos à lancetagem de calcâneo. Método: Ensaio clínico randomizado, de não inferioridade, conduzido no Berçário Anexo à Maternidade do Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo (BAM-ICrFMUSP) no período de agosto de 2009 a maio de 2010. A amostra foi de 113 RN, dos quais 56 randomizados no grupo experimental (GE) e 57, no grupo controle (GC). Dois minutos antes de serem submetidos à lancetagem de calcâneo, o GE recebeu 2mL de leite materno ordenhado (LMO) por via oral e os do GC, 2mL de glicose 25% por via oral. O desfecho primário foi o escore da dor obtido com a escala Premature Infant Pain Profile (PIPP) nos primeiros 180 segundos após a lancetagem (T30, T60, T90, T120, T150 e T180). Os desfechos secundários foram alterações relacionadas à mímica facial (sobrancelhas salientes, olhos espremidos, sulco nasolabial), frequência cardíaca (FC), saturação de oxigênio (SatO2), choro e eventos adversos. O projeto de pesquisa recebeu aprovação do comitê de ética da instituição, local do estudo, e foi registrado no Australian and New Zealand Clinical Trials Registry. Resultados: Pela ausência ou volume insuficiente de LMO, 25 neonatos não receberam a intervenção, mas foram incluídos na análise por intenção de tratar. Os grupos foram homogêneos em relação ao tipo de parto, Apgar no 5º minuto de vida, sexo, idade gestacional, idade em horas, intervalo entre a última mamada e a coleta de dados e glicemia capilar. Observou-se diferença estatística significante quanto ao peso do nascimento (p=0,013) e peso na data do procedimento (p=0,017). A análise de variância (ANOVA) indicou escores de dor inferiores no GC: houve diferença significativa entre os grupos de alocação, independente do tempo (p<0,001) e, ao longo do tempo, independente da intervenção (p<0,001). O GC apresentou maior freqüência de escores PIPP indicativos de dor mínima ou ausência de dor (p=0,002 e, na análise por intenção de tratar, p=0,003). A avaliação da mímica facial demonstrou menor porcentagem média de tempo de ocorrência de sobrancelhas salientes, olhos espremidos e sulco nasolabial para o GC em relação ao GE. Para sobrancelhas salientes, observou-se diferença estatisticamente significante entre os grupos (p<0,001) e ao longo do tempo (p<0,001). Com relação ao olhos espremidos, a ANOVA indicou interação (p=0,001). Para os neonatos que receberam leite materno, houve diferença significativa na ocorrência de olhos espremidos no T30 e nos demais intervalos, com redução da ocorrência da mímica ao longo do tempo (p_0,0014). No GC, foi observada redução significativa na ocorrência de olhos espremidos, em relação ao T30, no T90 (p=0,0155), no T150 (p=0,0261) e no T180 (p=0,0122). Quanto ao sulco nasolabial, observou-se interação (p<0,001). No GE, houve diferença estatisticamente significativa entre o T30 e todos os demais períodos de avaliação (p<0,001), exceto entre o T30 e T60. Para o GC, observou-se redução significativa só entre T30 e T90 (p=0,022) e entre T30 e T180 (p=0,0175). Houve interação entre as intervenções e ao longo do tempo na avaliação da FC (p=0,027). Não se observou diferença estatisticamente significante na FC ao longo do tempo para o GE (p=0,563) e para o GC (p=0,955). Para SatO2, observou-se diferença significativa entre os grupos (p=0,004) e ao longo do tempo (p=0,017). Foi observado choro pós-procedimento em 33 neonatos no GE e em 19 no GC (p=0,001 e na análise por intenção de tratar, p=0,001). A porcentagem média de tempo de choro foi maior no GE (p=0,014). Os eventos adversos foram benignos e autolimitados, sem diferença estatisticamente significante entre os grupos (p=0,736 e na análise por intenção de tratar, p=0,637). A margem de não inferioridade estabelecida foi de 2 pontos e, para o teste da hipótese, o intervalo de confiança de 95% foi de 1,507 a 4,483. Conclusão: O teste da hipótese de não inferioridade do efeito do LMO em relação ao efeito da solução de glicose 25% no escore da dor PIPP em neonatos pré-termo tardios submetidos à punção capilar em calcâneo foi inconclusivo. / Background: Late preterm neonates undergo repeated heel lancing during their first hours of life due to capillary blood glucose monitoring. Heel lancing is a painful procedure however pain relief strategies are rarely implemented prior to the lances. Aim: To compare the efficacy of expressed breast milk and 25% glucose on pain scores of late preterm infants during heel lancing. Methods: This is a noninferiority randomized controlled trial, conducted at the Berçário Anexo à Maternidade do Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo (BAM-ICrFMUSP) between August 2009 and May 2010. A total of 113 newborns were randomized: 56 comprised the experimental group (EG) and 57, the control group (CG). Two minutes before heel lancing, EG received 2mL of expressed breast milk (EBM) orally and CG received 2mL of 25% glucose orally. The Premature Infant Pain Profile (PIPP) score was the primary outcome and it was assessed within 180 seconds after lancing (T30, T60, T90, T120, T150 and T180). Secondary outcomes were: grimacing (brow bulging, eye squeezing, nasolabial furrowing), changes in heart rate (HR), and oxygen saturation (SpO2), crying, and adverse events. The research project was approved by the local ethics committee and was registered at the Australian and New Zealand Clinical Trials Registry. Results: Due to absence or insufficient volume of EBM, 25 neonates did not receive the intervention, but were included in the intention to treat analysis. The groups were similar with respect to type of delivery, Apgar score at 5 minutes, sex, gestational age, postnatal age in hours, interval between last feeding and data collection, and capillary blood glucose. There were statistically significant differences amongst the groups regarding birth weight (p=0.013) and weight at the time of the procedure (p=0.017). The analysis of variance (ANOVA) indicated lower pain scores in the CG: there was a significant difference between the interventions, regardless time (p<0.001), and main effect of the time, independent of the intervention (p<0.001). The CG had a higher frequency of PIPP scores indicative of minimal pain or absence of pain (p= 0.002 and p=0.003 on intention to treat analysis). Lower mean percentage of time of brow bulging occurrence, eye squeezing and nasolabial furrowing was observed for CG in comparison to EG. There was a statistically significant difference on brow bulging occurrence amongst the groups (p<0.001) and over the time (p<0.001). ANOVA indicated interaction between interventions and time (p=0.001) for eye squeezing. Infants who received breast milk demonstrated significant reduction on eye squeezing occurrence when comparing T30 and the remaining intervals (p_0.0014). In the CG, a significant reduction on eye squeezing were observed when comparing T30 to T90 (p=0.0155), to T150 (p=0.0261) and to T180 (p=0.0122). As for nasolabial furrowing, there was interaction (p<0.001). Statistically significant differences between the T30 and all other periods (p<0.001) were observed for EG, except when comparing T30 and T60. For neonates who received glucose, there were significant reductions in nasolabial furrowing occurrence between T30 and T90 (p=0.022) and T30 and T180 (p=0.0175). There was interaction in the evaluation of HR (p=0.027). No statistically significant differences were observed in HR over time for EG (p=0.563) and CG (p=0.955). Regarding SpO2, there were significant differences between intervention groups (p=0.004) and over the time (p=0.017). Of the infants who received EBM, 33 cried after lancing; in the CG, 19 neonates cried (p=0.001 and p=0.001 on intention to treat analysis). Longer mean percentage of duration of crying was observed in EG (p=0.014). Adverse events were benign and self-limited and there was no statistically significant difference among the groups (p=0.736 and p=0.637 on intention to treat analysis). Noninferiority margin was established in 2 points and the hypothesis test indicated a 95% confidence interval 1.507 to 4.483. Conclusion: The hypothesis test of noninferiority of EBM as compared to 25% glucose solution on reducing PIPP score in late preterm neonates undergoing heel lancing in was inconclusive.

INTRODUÇÃO: A lactoferrina disponível no leite materno desempenha função imunológica e protege recém-nascidos de infecções por se ligar ao ferro e privá-lo de bactérias patogênicas, o que resulta em atividade bacteriostática contra organismos patogênicos ferro dependentes. A utilização de aditivo de leite materno suplementado com ferro poderia prejudicar os efeitos protetores da lactoferrina e aumentar os riscos de infecção em recém-nascidos. OBJETIVO: Comparar o crescimento bacteriano no colostro puro versus colostro com aditivo de leite materno suplementado com ferro. MÉTODO: O crescimento bacteriano de Escherichia coli, Staphylococcus aureus e Pseudomonas aeruginosa foi comparado em 78 amostras de colostro puro ou colostro com aditivo do leite humano suplementado com ferro. Para análise qualitativa, discos de papel filtro foram imergidos nas amostras de leite materno puro ou leite materno com aditivo suplementado de ferro e incubados por 48 horas em placas de Petri contendo 101 Unidades Formadoras de Colônia por ml (UFC/ml) de cada cepa de bactérias. Para a análise quantitativa, 1ml de cada cepa de bactérias contendo 107 UFC/ml foi homogeneizado com 1ml de colostro puro ou colostro com aditivo do leite humano suplementado com ferro e semeado em placa de Petri. O número de UFC/ml foi contado após 24 horas de incubação a 37oC. RESULTADOS: A análise qualitativa não mostrou diferença no crescimento bacteriano. Na avaliação quantitativa, o crescimento de Escherichia coli no colostro puro foi de 29.4 ± 9.7 x 106CFU/ml e no colostro com aditivo de leite materno suplementado de ferro foi de 31.2 ± 10.8x 106CFU/ml, com diferença na média de crescimento de 1.9 ± 4.9 x 106CFU/ml (p = 0,001). O crescimento bacteriano nas cepas de Staphylococcus aureus e Pseudomonas aeruginosa no colostro puro e no colostro com aditivo de leite materno não apresentou diferença estatística. CONCLUSÃO: O acréscimo de aditivo de leite materno suplementado com ferro nesta concentração reduziu a ação bacteriostática contra Escherichia coli / BACKGROUND: Lactoferrin in human breast milk has been shown to protect newborns from infection by binding to iron and depriving it from pathologic bacteria that need iron to proliferate. If iron-enriched fortifier is added to breast milk, it might impair the protective effect of lactoferrin and increase the risk of infection in newborns. OBJECTIVE: To compare bacterial growth in pure colostrum versus colostrum with human milk fortifier containing iron. METHODS: The growth of Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa in 78 samples of pure colostrum or of colostrum with added human milk fortifier containing iron was compared. For qualitative analysis, filter paper discs were immersed in samples from each group and incubated for 48 hours with 101Colony Forming Units/ml of each strain. For quantitative assessment, 1 ml of each strain containing 107Colony Forming Units/ml was homogenized with 1 ml of either colostrum or colostrum with human milk fortifier, seeded into a Petri dish, and incubated at 37oC. Twenty-four hours later the number of Colony Forming Units was counted. RESULTS: Qualitative analysis showed no difference in bacterial growth. In the quantitative evaluation, Escherichia coli growth in the pure colostrum group was 29.4 ± 9.7 x 106CFU/ml while in the human milk fortifier group it was 31.2 ± 10.8x 106CFU/ml; the difference between average growth was 1.9 ± 4.9 x 106CFU/ml (p = 0.001). There were no differences in Staphylococcus aureus and Pseudomonas aeruginosa growth. CONCLUSION: Addition of iron at this concentration reduced breast milk bacteriostatic action against Escherichia coli

Infectious diseases e.g. gastric ulcer, caries and perodontitis, are caused by bacteria in a biofilm. Adhesion of bacteria to host ligands e.g. proteins, polypeptides and glycoproteins, is a key event in biofilm formation and colonization of surfaces such as mucosa and tooth tissues. Thus, host ligands could contribute to the susceptibility to infectious diseases. The general aim of this doctoral thesis was to study the effect of phosphorylated polypeptides and gp-340 in saliva and milk on oral bacterial adhesion and aggregation. Statherin is a non-glycosylated, phosphorylated polypeptide in saliva. The polypeptide inhibits precipitation and crystal growth of calcium phosphate and mediates adhesion of microorganisms. By using a hybrid peptide construct, the domain for adhesion of Actinomyces isolated from human infections and from rodents was found to reside in the C-terminal end, and the adhesion was inhibitable. With alanine substitution the peptide recognition epitope in the C-terminal end was delineated to Q and TF, where QAATF was an optimal inhibitory peptide. In contrast, human commensal Actinomyces bound to the middle region in a non-inhibitable fashion. Gp-340 is another protein in saliva, and it is a large, multifunctional glycoprotein. Four novel size variants (I-IV) of salivary gp-340 were distinguished within individuals, and their glycoforms were characterized. All four size variants were identical in the N-terminal amino acid sequence and shared core carbohydrates. Low-glyco lung gp-340, high-glyco saliva gp-340, and size variants I-III aggregated bacteria differently. Human milk, which shares many traits with saliva, could inhibit adhesion of Streptococcus mutans to saliva-coated hydroxyapatite (s-HA), a model for teeth, in an individually varying fashion. Human milk caseins, lactoferrin, secretory IgA, and IgG inhibited the binding avidly. By using synthetic peptides the inhibitory epitope in b-casein was mapped to a C-terminal stretch of 30 amino acids. Inhibition by human milk, secretory IgA and the b-casein-derived inhibitory peptide was universal among a panel of mutans streptococci. The main conclusions are: (i) statherin mediates differential binding of commensal versus infectious Actinomyces strains with small conformation-dependent binding epitopes, (ii) salivary gp-340 has individual polymorphisms that at least affect binding of bacteria, (iii) human milk inhibits S. mutans adhesion to s-HA in an individually varying fashion, and the C-terminal end of human milk β-casein is one inhibitory component. Together these results suggest that the studied host ligands can influence the composition of the oral biofilm. Statherin may protect the host from colonization of bacteria associated with infections. Gp-340 size variants may affect functions related to host innate immune defences such as interactions with a wide array of bacteria, and human milk may have a protective effect in infants from colonization of mutans streptococci.

No description available.

Substantial evidence supports a role of diet in glucose metabolism, but only a few reports have investigated the impact of diet during pregnancy on risk of gestational diabetes (GDM). Although metabolic hormones have been detected in milk, no studies have investigated the impact of maternal metabolic status assessed during pregnancy on insulin and adiponectin concentrations in human milk. The purpose of this thesis was to investigate the association of maternal macronutrient intakes with metabolic status during pregnancy and its subsequent impact on human milk hormones. Participating women (n=216) underwent a 3-hour oral glucose tolerance test at 30 (95% confidence interval [CI] 25, 33) weeks gestation, recalled their second trimester dietary intake, and donated early (the first week) and mature (3 months postpartum) milk. Higher vegetable and fruit fiber intake was associated with reduced insulin resistance (beta±SE -0.100±0.029, p=0.0008) and increased insulin sensitivity (0.029±0.012, p=0.01) among those with a family history of type 2 diabetes. Lower % carbohydrate and higher % total fat were associated with increased GDM risk (odds ratio 0.60 [95% CI 0.40, 0.90] and 1.61 [1.06, 2.44], respectively). Prenatal metabolic abnormalities including higher pregravid body mass index (beta±SE 0.053±0.014, p=0.0003), in addition to gravid hyperglycemia (0.218±0.087, p=0.01), insulin resistance (0.255±0.047, p<0.0001), lower insulin sensitivity (-0.521±0.108, p<0.0001), and higher serum adiponectin (0.116±0.029, p<0.0001) were associated with higher insulin in mature milk. Obstetrical measures including nulliparity (0.171±0.058, p=0.004), longer duration of gestation (0.546±0.146, p=0.0002), and unscheduled caesarean section (0.387±0.162, p=0.02) were associated with higher adiponectin in early milk. Holder pasteurization, a process recommended by the Human Milk Bank Association of North America before distributing human donor milk, reduced milk adiponectin and insulin concentrations by 32.8% and 46.1%, respectively (both p<0.0001). In conclusion, the distribution of macronutrient intakes during pregnancy was associated with risk for abnormal glucose metabolism later in pregnancy. In addition, maternal prenatal metabolic abnormalities were associated with high insulin concentrations in mature milk, while only obstetrical parameters were associated adiponectin concentrations in early milk. Our findings support the need for continued work to determine optimal prenatal nutritional strategies to prevent GDM and subsequently to improve infant nutrition.

Substantial evidence supports a role of diet in glucose metabolism, but only a few reports have investigated the impact of diet during pregnancy on risk of gestational diabetes (GDM). Although metabolic hormones have been detected in milk, no studies have investigated the impact of maternal metabolic status assessed during pregnancy on insulin and adiponectin concentrations in human milk. The purpose of this thesis was to investigate the association of maternal macronutrient intakes with metabolic status during pregnancy and its subsequent impact on human milk hormones. Participating women (n=216) underwent a 3-hour oral glucose tolerance test at 30 (95% confidence interval [CI] 25, 33) weeks gestation, recalled their second trimester dietary intake, and donated early (the first week) and mature (3 months postpartum) milk. Higher vegetable and fruit fiber intake was associated with reduced insulin resistance (beta±SE -0.100±0.029, p=0.0008) and increased insulin sensitivity (0.029±0.012, p=0.01) among those with a family history of type 2 diabetes. Lower % carbohydrate and higher % total fat were associated with increased GDM risk (odds ratio 0.60 [95% CI 0.40, 0.90] and 1.61 [1.06, 2.44], respectively). Prenatal metabolic abnormalities including higher pregravid body mass index (beta±SE 0.053±0.014, p=0.0003), in addition to gravid hyperglycemia (0.218±0.087, p=0.01), insulin resistance (0.255±0.047, p<0.0001), lower insulin sensitivity (-0.521±0.108, p<0.0001), and higher serum adiponectin (0.116±0.029, p<0.0001) were associated with higher insulin in mature milk. Obstetrical measures including nulliparity (0.171±0.058, p=0.004), longer duration of gestation (0.546±0.146, p=0.0002), and unscheduled caesarean section (0.387±0.162, p=0.02) were associated with higher adiponectin in early milk. Holder pasteurization, a process recommended by the Human Milk Bank Association of North America before distributing human donor milk, reduced milk adiponectin and insulin concentrations by 32.8% and 46.1%, respectively (both p<0.0001). In conclusion, the distribution of macronutrient intakes during pregnancy was associated with risk for abnormal glucose metabolism later in pregnancy. In addition, maternal prenatal metabolic abnormalities were associated with high insulin concentrations in mature milk, while only obstetrical parameters were associated adiponectin concentrations in early milk. Our findings support the need for continued work to determine optimal prenatal nutritional strategies to prevent GDM and subsequently to improve infant nutrition.

[Truncated abstract] Mothers who deliver prematurely often have a delay in lactogenesis II and subsequent milk supply. Furthermore, due to the inability of their babies to breastfeed immediately after birth, these mothers are 'pump dependent' during both initiation and establishment of lactation. Apparently, there are no evidence based guidelines for the expression regime but some data suggesting that expression regimes for both breasts should be at least five times per day and at least 100 minutes expressing time per day. The project was set out to document the self selected current expression regimes of the preterm mothers from day 10 to 60 postpartum. It defined how various aspects of breast expression, such as frequency and interval, impact on the synthesis and production of milk. In addition, it determined the variations in the composition of preterm mother's milk. The collection of 24hr expression data and milk samples at each expression of each breast, each day, of 25 preterm mothers (<32 gestation age) from the neonatal intensive care unit in King Edward Memorial Hospital, Western Australia on day 10, 15-20, 30, 40, 50 and 60 postpartum showed that during the 'pump dependent' period (day 10 20), the frequency of expression for both breasts was 6, 6-7, 3-9 times per day (median, IQR, range) and total duration with the pump was 115, 80-160, 32-320 minute per day (median, IQR, range). Furthermore, during the 'transition from exclusively expressing to exclusively breastfeeding' period (day 30-60), frequency of expression/breastfeed and total duration of milk removal (both expressing and breastfeeding) for both breasts were 6, 5-7, 1-9 and 135, 75-170, 25-320, respectively (median, IQR, range). ... These nutrients make up the energy content of milk, thus the energy content of milk also varied greatly between mothers. Therefore, milk from individual preterm mothers varies greatly for individual values for fat, total protein, lactose and energy and this should be taken into account when calculating the level of fortification required for individual babies. The results suggest that when fortifying mother's milk, weekly measurement of fat and protein in milk would provide good estimates on which to base fortification requirements. The concentration of sIgA plus lactoferrin formed 32% of the total proteins in breastmilk. However there was large variations in the concentration of sIgA and lactoferrin (median, IQR, range: 0.82, 0.59-1.13, 0.05-2.93g/l and 2.41, 1.52-3.52, 0.04-8.82g/l, respectively) between mothers. Therefore the level of protection provided by these two proteins could differ greatly between babies. Further research on the relationship between the concentration of sIgA and lactoferrin in milk and the onset of infection would indicate the minimum amount of these proteins needed for the babies to benefit from the immune protection provided by their mother's milk. The hourly breast expression method and regression analysis of actual milk yield and interval since previous expression provides information that identifies the potential milk synthesis capacity of the breasts of the mothers and the impact of the interval between expressions on the milk production of the mothers. This information can be applied to individualize the interval between expression regimes to optimise milk production and minimize the demand on the mother. In addition, determining the changes in the milk composition of individual mothers would provide a more precise base to fortify their milk for their preterm babies.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.

Made available in DSpace on 2014-12-17T14:46:46Z (GMT). No. of bitstreams: 1 EdualeideJPBN_DISSERT.pdf: 536785 bytes, checksum: 958a6f06670a7767f5dc0cb70479ab35 (MD5) Previous issue date: 2011-03-28 / This is an exploratory and descriptive study that aimed to investigate the actions of professionals in the context of breastfeeding, on the assumption that the actions taken by employees working together to postpartum and newborn are not competing to effect the distribution of pasteurized human milk so that it meets the needs of infants who depend on it. Thus, the study aimed to analyze the actions of medical and nursing staff of the distribution of pasteurized human milk to the newly born. The investigation was developed by action research in a federal hospital, located in the capital the state of Rio Grande do Norte, Brazil, reference assistance to women during pregnancy, childbirth and postpartum high risk in 2010. Study participants were fifty-five professionals chosen from the following inclusion criteria: to act in the NICU or rooming, being a pediatrician and / or neonatologists, nurses and technical nursing. According to the methodology of action research a questionnaire was applied, techniques in focus groups and courses were developed, and, finally, action evaluation. The project was submitted to the Ethics Committee at the Federal University of Rio Grande do Norte and approved with no protocol 448/2009. The problems identified in the responses issued by the social research were grouped into categories according to the similarity between them. The answer to the question of the survey - How is the need for pasteurized human milk for the newborns in neonatal intensive care unit and rooming identified? - Brought subsidies for action planning and implementation of strategies for change in the practice of professionals working in rooming and ICU. Thus, the study has relevance in social care and, when at the local level, will compete for the distribution pasteurized human milk to take effect as best as possible, as recommended by the Ministry of Health. It is also conceived that, in a macro view of society, it could contribute to minimizing the health problem that involves the child population / O leite humano atende ?s necessidades da crian?a com sua composi??o rica em nutrientes, como ?gua, prote?nas, lip?deos, carboidratos, minerais, vitaminas e ferro. Em fun??o disto, ? indicada a amamenta??o exclusiva para a crian?a at? os seis meses de vida. Entretanto, essa pr?tica, al?m de ser biologicamente determinada, ? socialmente condicionada e viabiliz?-la tem sido um grande desafio enfrentado por todos os profissionais que atuam junto ? mulher nessa realidade. O estudo teve o prop?sito de investigar as a??es de profissionais no contexto da amamenta??o, partindo do pressuposto de que as a??es desenvolvidas junto ? pu?rpera e ao rec?m-nascido pouco concorrem para se efetivar a distribui??o do leite humano pasteurizado, em conson?ncia com as necessidades de rec?m-nascidos que dele dependem. Assim, o estudo teve como objetivo geral analisar as a??es de profissionais m?dicos e equipe de enfermagem frente ? distribui??o do leite humano pasteurizado para o rec?m-nascido. Trata-se de um estudo explorat?rio e descritivo, com abordagem qualitativa, desenvolvido ? luz da pesquisaa??o em uma unidade hospitalar federal, situada na capital do estado do Rio Grande do Norte, Brasil, refer?ncia em atendimento ? mulher na gesta??o, no parto e no puerp?rio de alto risco. Participaram da investiga??o cinquenta e cinco profissionais escolhidos a partir dos seguintes crit?rios de inclus?o: atuar em UTI neonatal ou alojamento conjunto, ser m?dico pediatra e/ou neonatologista, enfermeiros e t?cnicos de enfermagem. De acordo com a metodologia da pesquisa-a??o, foi aplicado um question?rio, desenvolvidas t?cnicas de grupo focal, al?m da realiza??o de cursos. Por fim, procedeu-se ? avalia??o das a??es. O projeto foi submetido ao Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte e aprovado com Protocolo de n. 448/2009. Os problemas detectados nas respostas emitidas pelos atores sociais da pesquisa foram agrupados em categorias, de acordo com a similaridade existente entre si. A resposta ao questionamento da pesquisa - Como ? identificada a necessidade do leite humano pasteurizado para o rec?m-nascido em alojamento conjunto e UTI neonatal?- trouxe subs?dios para o planejamento de a??es e a implementa??o de estrat?gias de mudan?as na pr?tica dos profissionais atuantes no Alojamento Conjunto e na UTI Neonatal. Os participantes, embora tenham demonstrado conhecimento em rela??o ao funcionamento do BLH, evidenciaram desconhecer os problemas existentes no setor, no que diz respeito ? capta??o do leite humano. Tratando-se das a??es que os profissionais desenvolvem no processo da distribui??o, observou-se que estes revelaram conhecer, em sua maioria, as indica??es do RN em receber complemento em sua dieta, ressaltando-se que n?o foi poss?vel identificar no question?rio e nos grupos focais a preocupa??o em realizar o exame cl?nico na m?e antes da prescri??o. Considera-se que a equipe necessita apoiar efetivamente a pu?rpera na amamenta??o, com vistas a esclarecer d?vidas ou complica??es que possam surgir, prevenindo, inclusive, contra o desmame precoce. Assim sendo, o estudo apresenta relev?ncia no ?mbito assistencial e social e, em n?vel local, concorrer? para que a distribui??o do leite humano pasteurizado seja efetivada da melhor forma poss?vel, como preconizado pelo Minist?rio da Sa?de. Concebe-se, ainda, que, numa vis?o macro da sociedade, o referido estudo poder? contribuir para uma minimiza??o da problem?tica de sa?de que envolve a popula??o infantil

Objetivo: Verificar a associação entre os níveis de leptina do leite materno maduro e os escores de dobras cutâneas aos três e seis meses de vida de crianças expostas a diferentes ambientes intrauterinos. Metodologia: Trata-se de um estudo observacional longitudinal, para o qual foram recrutados pares de mães e crianças residentes em Porto Alegre. Foram excluídas puérperas com teste positivo para HIV, doenças hipertensivas específicas da gravidez, hipertensão arterial sistêmica crônica ou gestacional, crianças gemelares, prematuras, com doenças congênitas ou necessidade de internação hospitalar. Os pares foram divididos, conforme a exposição ao ambiente intrauterino, em grupo Diabetes Mellitus (DM), Tabaco, Pequeno para Idade Gestacional (PIG) e Controle. As entrevistas foram realizadas um, três e seis meses após o parto, e foram coletados dados antropométricos da mãe e da criança, além de informações sobre a alimentação desta. Na entrevista de um mês de vida, foi coletada amostra de leite materno, analisada para quantificação da leptina. Quanto aos procedimentos estatísticos, foi considerado o nível de significância de 5%. Para comparação entre variáveis categóricas e contínuas, quando paramétricas, foi utilizado o teste ANOVA com post hoc de Tukey, e para variáveis não paramétricas, foi utilizado o teste de Kruskal-Wallis com post hoc de Dunn. Na comparação entre variáveis categóricas, foi utilizado o teste de qui-quadrado de Pearson ou Exato de Fisher. Ao analisar variáveis contínuas, foi aplicada a correlação de Spearman. Resultados: Foram analisados os dados de 127 pares mãe-criança, sendo 18 no grupo DM, 34 no grupo Tabaco, 16 no grupo PIG e 59 no grupo Controle. A quantidade de leptina no leite materno não diferiu entre os grupos (p = 0,59). Houve correlação significativa positiva entre a quantidade de leptina do leite e o Índice de Massa Corporal (IMC) materno, a dobra cutânea tricipital (DCT) e a dobre cutânea subescapular (DCSE) maternas (p < 0,001). Sem considerar o tipo de alimentação, não houve correlação entre a leptina e as variáveis antropométricas da criança (p > 0,05). Dentre as crianças amamentadas exclusivamente aos três meses de vida, a leptina do leite materno correlacionou-se negativamente com o escore Z da DCT aos três meses (r = -0,447; p = 0,032) e seis meses (r = -0,499; p = 0,015), além do peso aos três (r = -0,408; p = 0,043) e seis meses de vida (r = -0,443; p= 0,034). Também houve correlação negativa com o ganho de peso do nascimento aos seis meses (r = -0,472; p = 0,023) e de um a três meses (r = -0,396; p = 0,050). Conclusão: A leptina, oferecida através do aleitamento materno exclusivo, atua na regulação do balanço energético corporal da criança, influenciando precocemente variáveis antropométricas. / Objective: Assess the association between mature breast milk leptin and skinfold thickness Z scores at 3 and 6 months of life of infant exposed to different intrauterine environments. Methods: This is a longitudinal study, for which mother and newborn pairs were recruited from 24-48 hours postpartum in three public hospitals in Porto Alegre city, Brazil. Exclusion criteria were mothers who test positive for HIV, with hypertensive disorders, newborn from twin gestation, preterm (gestational age <37 weeks), with malformations at birth, or requiring hospitalization. Pairs were divided as exposure to intrauterine environment in Diabetes Mellitus (DM), Tobacco, Small for Gestational Age (SGA) and Control group. Interviews occurred in postpartum, 1, 3 and 6 months of infant's life, where mother and infant anthropometric data were collected and information about infant’s complementary food was asked. The breast milk sample was collected in the 1 month interview. About statistical procedures, a significance level of 5% was considered. To compare categorical and continuous variables, was used the ANOVA test with Tukey post hoc, when parametric. For nonparametric variables, was used Kruskal -Wallis test with Dunn post hoc. When comparing categorical variables, was used the chi-square of Pearson or Fisher's exact test. To analyze continuous variables, the Spearman correlation was applied. Results: Data of 127 pairs were analyzed, 18 in DM group, 34 Tobacco, 16 SGA and 59 Control. Value of leptin in breast milk did not differ between groups (p = 0.59). There was a significant positive correlation between leptin milk and maternal anthropometric variables in the overall sample (p < 0.001) and between the groups (p< 0.05). Without considering infant's complementary feeding, there was no correlation between leptin and infant anthropometric variables (p > 0.05). However, among the infants exclusively breastfed at 3 months, leptin significantly negative correlated with Z score of triceps skinfold thickness at 3 (r = -0.447; p = 0.032) and 6 months (r = -0.499; p=0.015), infant weight at 3 (r = -0.408; p = 0.043) and 6 months (r = -0.443; p = 0.034), weight gain from birth to 6 months (r = -0.472; p = 0.023) and from 1 to 3 months (r = -0.396; p = 0.050) in the overall sample. Conclusion: Among the infants exclusively breastfed, leptin in mature milk acts in body energy balance and may impact early infant anthropometric variables.