Annika

Dear Antoine, This is a very important topic, and I can say in advance that practices differ between countries. I will try to present the Estonian approach here, which applies in most centers dealing with high-risk newborns: We do not perform routine bacteriological analysis at any gestational age. We only analyze breast milk if the infant develops a clinical problem – such as signs of sepsis or feeding difficulties, etc. In Estonia, we try to follow Swedish donor milk bank guideline thresholds, which were originally and historically established for breast milk intended to be given raw. An important aspect here is that this approach is individualized and depends on gestational age. First, we assess the overall clinical picture. https://www.milknet.se/ We do not routinely check maternal seropositivity. We think that ~80% of them are seropositive. Holder pasteurization is performed only if there is a diagnosis of congenital or acquired infection. Our protocol is relatively liberal, and we believe that a mother’s own raw milk is the best for own child. One center freezes maternal breast milk for 72 hours to reduce CMV presence, but it is known that this method does not eliminate CMV. I hope it helped. Looking for other opinions! Best Annika (Tartu, Estonia)

Thank you for this excellent topic. I struggled with this a few days ago and came to the conclusion that we also need adequate resources within the perinatal center. At a moment we use synbase.ee and lactmed.com. OpenEvidence is very good source to find latest evidence. I’ll add a good article reference here that will help us look at the topic more broadly Best, Annika I MOBM.pdf

We have our "inside" agreemets regarding the observation of the newborn. When the pH is <7,0 - monitoring in skin-to-skin contact, neonatologist check-up and repeating the analysis after 2 hours if clinical pic is ok. When the pH is < than 7,1 - monitoring, repeating the analysis and neonatologist if needed. Some of my colleagues discuss about ICD code in those cases and document it as fetal distress. Im not sure its necessary...

I have a question regarding international codes. If a baby is born with low umbilical artery pH, but the Apgar score is normal, adapts well, pH/ BE/ lac normalizes, amniotic fluid is clear, and there is no multi-organ failure. Would you code it anyway P20.1 (fetal acidosis alone)