Fresh human colostrum for the prevention of E. coli diarrhea--a clinical experience

Perinatal infections: prevention of long-term sequelae

All the congenital infections and most of the natal and postnatally acquired infections of man are associated with disease of the central nervous system and long-term sequelae in the survivors. The most important perinatal pathogens in this regard are group B streptococcus, Escherichia coli and other coliform bacteria, cytomegalovirus, Toxoplasma gondii and herpes simplex virus. All these agents are the subject of active and, in some instances, promising investigation. The strategies for prevention are discussed here. Recent clinical trails of two cytomegalovirus vaccines (Towne 125 and AD 169) are considered in detail.

Secretory immunoglobulin A obtained from pooled human colostrum and milk for oral passive immunization

Passive immunization is useful in cases of immunodeficiencies or infectious diseases, but usually seric gammaglobulin or hyperimmune sera are administered parenterally, providing good systemic immunization, though with low protection of the mucosal surfaces. The oral administration of secretory antibodies, especially surface immunoglobulin (SIg)A, which is perfectly adapted to the mucosal environment, would therefore, be preferable. The aim of the present study was to obtain a SIgA preparation from pooled human colostrum and milk, which should maintain the essential properties of the antibodies suitable for clinical oral administration. IgA preparations were obtained from colostrum and milk pools by salt precipitation. The final products were evaluated in terms of yield and purity, as well as antibody activity to bacterial antigens and toxins and inhibitory activity of bacterial adhesion to epithelial cells. The best yield and purity were achieved when the colostrum pool was used as a source of IgA; the final product showed very few bands of protein contamination. The IgA preparations preserved the antibody reactivity against various microbial antigens, well comparable with the reactivity exhibited by the original milk and colostrum pools. SIgA preparations were able to inhibit greatly the adhesion of enteropathogenic Escherichia coli to Hep-2 cells and the invasion of enteroinvasive E. coli. These promising results show the feasibility of obtaining SIgA suitable for oral use, which may in future be administered to immunodeficient patients with gastrointestinal manifestations, from human colostrum and milk.

Human milk for low birthweight infants: immunology, nutrition and newer practical technologies

Human milk has a number of unique properties which can be of benefit to high risk low birthweight and preterm infants. Immunological features are of particular importance. Growth is better with the use of the mother's own milk than with pooled bank milk. The quality of the latter can be improved by various measures noted in the text. Growth can be further improved by enriching the milk with human milk factors, powder formula or protein supplements. As breast-feeding is best for infants, the maternal milk supply should be maintained during the hospital stay of infants by frequent expression, galactogogues used where necessary under supervision, encouraging maternal contact with the infant, promotion of suckling initially on the "empty" breast after expression of milk, and subsequently institution of direct breast-feeding. With proper interventions and motivation of both staff and mothers, even very low birthweight infants below 1,500 gm can go on, in time, to exclusive breast-feeding.

Early initiation of weaning foods and proliferation of bacteria in Nigerian infants

Ninety-five children, age range from 1 to 18 months, were followed for the types of weaning foods. Forty-five of the 95 children were evaluated for intestinal bacteria colonization. The most frequently isolated pathogens were enteropathogenic Escherichia coli (EPEC) and Staphylococcus aureus. Children who were not subjected to early initiation of weaning and supplementary foods had lower bacteria counts than their counterparts.

A planned prospective evaluation of the anti-infective property of varying quantities of expressed human milk

This paper comprises 261 low birth weight infants who were divided into four groups with different feeding schedules. Group I--expressed human milk for all the feeds; Group II--human milk for half the feeds and the nursery formula for the rest; Group III--colostrum, 20 ml three times a day along with the nursery formula; and Group IV--control--only the nursery formula. The groups were matched by means of a randomized block design for identifiable factors which could predispose to the occurrence of infection. Infections were found to be significantly less in the groups which received human milk (p less than 0.001).

The effect of early initiation of colostrum feeding on proliferation of intestinal bacteria in neonates

One hundred eighty normal neonates with an average weight above 2.50 kg and having no feeding difficulties were divided into two groups and randomly assigned to either colostrum or to glucose water feeding regimens during the 3-day stay at the maternity ward. The effects of the feeding regimens on intestinal colonization were studied by examining the stools of the neonates. All bacteria recovered were identified quantitatively and biochemically. Of the 180 mothers, 105 complied with the instructions on feeding regimens. The majority of the neonates receiving colostrum had significantly lower bacterial counts than those on glucose water (p less than 0.001). The results of the preliminary study indicated that early initiation of colostrum feeding to neonates where potable water is not readily available will suppress the proliferation of bacteria in the neonates.

Effects of antibodies, trypsin, and trypsin inhibitors on susceptibility of neonates to rotavirus infection

Levels of antirotaviral secretory immunoglobulin A were measured by enzyme-linked immunosorbent assay in colostrum and milk samples collected daily for the first 5 days postpartum from 49 mothers breast-feeding their infants. The trypsin-inhibitory capacity of these lacteal secretion samples was assessed by their ability to inhibit the hydrolysis of alpha-N-benzoyl-DL-arginine-p-nitroanilide by trypsin. Stools passed by these breast-fed infants and by an additional 43 bottle-fed infants were pooled by individual and examined by electron microscopy for rotavirus. Stool trypsin levels were estimated with the gelatin hydrolysis test. Breast-fed infants were significantly less likely to become infected with rotavirus and showed significantly lower stool tryptic activity than did bottle-fed infants. Breast-fed infants who did not excrete rotavirus over the 5-day period received milk of significantly higher antirotaviral secretory immunoglobulin A or trypsin-inhibitory capacity or both than breast-fed infants who were infected with rotavirus. A case of probable maternal rotavirus infection during pregnancy, producing greatly elevated lacteal antirotaviral secretory immunoglobulin A levels lasting for 2 years, was detected. Results of this study suggest that both antibodies and trypsin inhibitors in human milk can be associated with the protection of neonates against rotavirus infection in the first 5 days of life.

Collecting and banking human milk: to heat or not to heat?

Data on human breast milk and its handling when fed to babies who cannot be breast-fed were reviewed to determine whether the method of processing and storage affected the properties of the milk. Breast milk is normally contaminated by potential pathogens, which seem to produce no ill effects, but it also contains antimicrobial properties which protect against infection. The evidence suggests that pasteurisation not only eliminates pathogenic bacteria but also damages bacteriostatic mechanisms, so making the milk more susceptible to later contamination. Pasteurisation also affects the nutritional properties of milk. Freezing has little effect on milk proteins, while a study on the effect of refrigeration showed that there was little bacterial growth at temperatures below 8 degrees C. Several years' experience of feeding donated raw milk to newborn infants has confirmed that it produces no ill effects. These findings suggest that pasteurisation of donated breastmilk is unnecessary, and it is not recommended, while the decision whether or not to freeze the milk may be made on practical grounds. Raw breast milk can be safely stored at 4-6 degrees C for 72 hours.