Background Human milk consumption is a protective factor against infection. However, the high variability of human milk composition makes it difficult for clinicians and researchers to assess the adequacy of nutritional intake. Objective To identify the nutritional profiles and composition of premature human milk and dietary intake of breastfeeding mother. Methods Human milk specimens were collected from mothers who gave birth to very premature and/or very low birth weight infants. Infants had been admitted to the Neonatology Unit of Dr. Cipto Mangunkusumo Hospital, Jakarta. The milk specimens were analyzed with a mid-infrared milk analyzerTM (MIRIS) for four weeks, and  maternal dietary macronutrient intake was determined with food record questionnaires on food consumption frequency and food recall. Results Significant changes in nutritional composition of human milk were observed, with the fat concentration and calories increasing with time, and protein concentration decreasing with time. There were no significant differences observed in carbohydrate concentration of milk over the four weeks (P=0.447). Maternal intake of protein, carbohydrates, fat and calories was lower than the recommended values for breastfeeding women. Conclusion The macronutrient (protein and fat) and energy contents of human milk change weekly. Dietary intake of breastfeeding women are lower than recommended values.

BackgroundPostnatal growth failure (PGF) frequently occurred among preterm infants with malnutrition. The decline in a weight-for-age z-score of ≥1.2 has been proposed to define PGF. It was unknown whether this indicator would be useful among Indonesian preterm infants.MethodsInfants of <37 weeks of gestational age born between 2020 and 2021, both stable and unstable, were recruited for a prospective cohort study during hospitalization in the level III neonatal intensive care unit at the Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. The prevalence of PGF as defined by a weight-for-age z-score of <−1.28 (<10th percentile) at discharge, a weight-for-age z-score of <−1.5 (<7th percentile) at discharge, or a decline in a weight-for-age z-score of ≥1.2 from birth till discharge was compared. The association between those PGF indicators with the preterm subcategory and weight gain was assessed. The association between the decline in a weight-for-age z-score of ≥1.2 with the duration to achieve full oral feeding and the time spent for total parenteral nutrition was analyzed.ResultsData were collected from 650 preterm infants who survived and were discharged from the hospital. The weight-for-age z-score of <−1.28 or <−1.5 was found in 307 (47.2%) and 270 (41.5%) subjects with PGF, respectively. However, both indicators did not identify any issue of weight gain among subjects with PGF, questioning their reliability in identifying malnourished preterm infants. By contrast, the decline in a weight-for-age z-score of ≥1.2 was found in 51 (7.8%) subjects with PGF, in which this indicator revealed that subjects with PGF had an issue of weight gain. Next, a history of invasive ventilation was identified as a risk factor for preterm infants to contract PGF. Finally, the decline in a weight-for-age z-score of ≥1.2 confirmed that preterm infants with PGF took a longer time to be fully orally fed and a longer duration for total parenteral nutrition than the ones without PGF.ConclusionThe decline in a weight-for-age z-score of ≥1.2 was useful to identify preterm infants with PGF within our cohort. This could reassure pediatricians in Indonesia to use this new indicator.

Latar belakang. Anemia merupakan salah satu komplikasi yang sering dialami oleh bayi prematur. Batas kadar hemoglobin atau hematokrit untuk pemberian transfusi pada bayi prematur masih menjadi perdebatan. Transfusi sel darah merah bermanfaat, tetapi terdapat beberapa komplikasi. Saat ini, belum ada konsensus mengenai ambang batas kapan bayi prematur perlu mendapatkan transfusi sel darah merah.Tujuan. Mengetahui keamanan dan luaran klinis transfusi sel darah sel darah merah pada ambang batas hemoglobin liberal dan restriktif. Metode. Penulusuran pustaka database elektronik, yaitu Pubmed, Ebcohost, Embase, dan The Cochraine Library dengan kata kunci “preterm”, “AND” “transfusion”, “AND” “red blood cells”, “AND” “liberal”, “OR” “restrictive”Hasil. Penelusuran literatur diperoleh 2 artikel yang terpilih kemudian dilakukan telaah kritis. Studi oleh Fu dkk, transfusi liberal dapat mengurangi durasi suplementasi oksigen dan penggunaan ventilator dengan MD 3,56 (95% IK: 1,93-5,18, p<0,001) dan MD 3,31 (95% IK: 1,42-5,20, p=0,006), Untuk luaran keamanan kedua studi Fu dkk, dan Knee dkk, tidak didapatkan hasil yang bermakna pada kedua kelompok. Kesimpulan. Transfusi liberal tidak berbeda dalam keamanan dibandingkan dengan restriktif, tetapi dapat mengurangi durasi penggunaan ventilator dan durasi suplementasi oksigen.