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Unger SL, O'Connor DL. Review of current best practices for human milk banking. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 4:e13657. [PMID: 38752309 PMCID: PMC11184574 DOI: 10.1111/mcn.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 06/19/2024]
Abstract
Mother's/parent milk is the optimal way to feed infants and when unavailable, supplemental donor human milk is preferred. A safe supply of donor human milk should be available for all low birthweight infants for whom it has been shown to reduce morbidity. Human milk banking has been in existence for more than a century, although largely shut down during the 1980s, primarily due to fears of human immunodeficiency virus transmission. With renewed security in milk banking, has come an exponential growth in human donor milk use. Guidelines for milk banking have been published in many countries including Australia, France, India, Italy, Spain, Switzerland, the United Kingdom and the nonprofit organization PATH. The European Milk Bank Association and the Human Milk Banking Association of North America have also published recommendations for milk banks throughout Europe and North America, respectively. Although there is variability among these guidelines, there is general consensus on quality control measures required to provide a supply of safe donor milk. These measures include effective donor screening, safe collection, transport and storage of milk, standardized pasteurization and bacteriological testing. Operational considerations are also critical, such as appropriate training for staff, equipment maintenance and cleaning, protocol and record keeping and inspection and accreditation. Clearly delineating these key quality control measures provides an excellent foundation for establishing international guidelines. Acceptable modifications must be established for low- and middle-income countries that do not have sufficient resources; overly burdensome guidelines may make establishing a milk bank unnecessarily prohibitive. This review presents a summary of current best practices for human milk banking.
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Affiliation(s)
- Sharon L. Unger
- Department of PediatricsSinai HealthTorontoOntarioCanada
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Rogers Hixon Ontario Human Milk BankTorontoOntarioCanada
- Division of NeonatologyIWK HospitalHalifaxNova ScotiaCanada
| | - Deborah L. O'Connor
- Department of PediatricsSinai HealthTorontoOntarioCanada
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Rogers Hixon Ontario Human Milk BankTorontoOntarioCanada
- Translational MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
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Núñez-Delgado A, Mizrachi-Chávez VM, Welti-Chanes J, Macher-Quintana ST, Chuck-Hernández C. Breast milk preservation: thermal and non-thermal processes and their effect on microorganism inactivation and the content of bioactive and nutritional compounds. Front Nutr 2024; 10:1325863. [PMID: 38455872 PMCID: PMC10919153 DOI: 10.3389/fnut.2023.1325863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/26/2023] [Indexed: 03/09/2024] Open
Abstract
Human Breast Milk (HBM) is widely acknowledged as the best nutritional source for neonates. Data indicates that, in 2019, 83.2% of infants in the United States received breast milk at birth, slightly reducing to 78.6% at 1 month. Despite these encouraging early figures, exclusive breastfeeding rates sharply declined, dropping to 24.9% by 6 months. This decline is particularly pronounced when direct breastfeeding is challenging, such as in Neonatal Intensive Care Units (NICU) and for working mothers. Given this, it is vital to explore alternative breast milk preservation methods. Technologies like Holder Pasteurization (HoP), High-Temperature Short-Time Pasteurization (HTST), High-Pressure Processing (HPP), UV radiation (UV), and Electric Pulses (PEF) have been introduced to conserve HBM. This review aims to enhance the understanding of preservation techniques for HBM, supporting the practice of extended exclusive breastfeeding. It explicitly addresses microbial concerns, focusing on critical pathogens like Staphylococcus aureus, Enterococcus, Escherichia coli, Listeria monocytogenes, and Cytomegalovirus, and explores how various preservation methods can mitigate these risks. Additionally, the review highlights the importance of retaining the functional elements of HBM, particularly its immunological components such as antibodies and enzymes like lysozyme and Bile Salt Stimulated Lipase (BSSL). The goal is to provide a comprehensive overview of the current state of HBM treatment, critically assess existing practices, identify areas needing improvement, and advocate for extended exclusive breastfeeding due to its vital role in ensuring optimal nutrition and overall health in infants.
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Affiliation(s)
- Alejandro Núñez-Delgado
- Tecnologico, de Monterrey, School of Engineering and Sciences, Monterrey, Mexico
- Tecnologico de Monterrey, Institute for Obesity Research, Monterrey, Mexico
| | | | - Jorge Welti-Chanes
- Tecnologico, de Monterrey, School of Engineering and Sciences, Monterrey, Mexico
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Arslanoglu S, Moro GE, Tonetto P, De Nisi G, Ambruzzi AM, Biasini A, Profeti C, Gagliardi L, Salvatori G, Bertino E. Recommendations for the establishment and operation of a donor human milk bank. Nutr Rev 2023; 81:1-28. [PMID: 36892193 PMCID: PMC9997086 DOI: 10.1093/nutrit/nuad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
In Europe, an increasing number of human milk banks (HMBs) collect donor human milk to feed preterm infants when their mother's milk is not available or not enough. Moreover, donor milk is a bridge to breastfeeding, with positive clinical and psychological advantages for both mother and infant. Italy, with 41 HMBs actively operating in 2022, has the highest number of HMBs in Europe. The process of human milk donation is complex, so activity of HMBs must be regulated according to well-established rules. The present recommendations have been prepared as a tool to standardize the organization, management, and procedures of HMBs operating in Italy and to determine the minimal essential requirements to establish new HMBs. This article covers all the aspects of human milk donation and human milk banking, including general recommendations, donor recruitment and screening, expression, handling and storage of donor human milk, milk screening, and milk treatment (pasteurization). A pragmatic approach was taken to drafting the recommendations. Items for which there was consensus or robust published evidence on which to base recommendations were included. When there were differences that could not be resolved by reference to published research, a statement of explanation based on the expert opinion of the authors (all members of the Italian Association of Human Milk Banks) was included. Implementation of these recommendations can contribute to promotion of breastfeeding.
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Affiliation(s)
- Sertac Arslanoglu
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,is with the Division of Neonatology, Department of Pediatrics, İstanbul Medeniyet University, School of Medicine, İstanbul, Turkey
| | - Guido E Moro
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Paola Tonetto
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,are with the Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
| | - Giuseppe De Nisi
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Amalia Maria Ambruzzi
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Augusto Biasini
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Claudio Profeti
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Luigi Gagliardi
- is with the Woman and Child Health Department, Azienda USL Toscana Nord-Ovest, Lucca, Italy
| | - Guglielmo Salvatori
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,is with the Donor Human Milk Bank, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Enrico Bertino
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,are with the Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
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[Variation in the level of the biocomponents immunoglobulin A and lactoferrin in human milk after Holder pasteurization]. NUTR HOSP 2023. [PMID: 36748426 DOI: 10.20960/nh.04218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND breast milk is the ideal food for newborns and infants, but there are factors that can prevent the practice of breastfeeding. Human milk banks (BLH) are a strategy to increase breastfeeding coverage; the donated milk is subjected to Holder pasteurization to guarantee its innocuousness, undergoing large changes in temperature and a decrease in the concentrations of biocomponents such as Immunoglobulin A (IgA) and lactoferrin (LF). This article describes the results of recent studies on the impact of Holder pasteurization on IgA and LF in human milk. MATERIAL AND METHODS a search for research articles related to the topic of interest was carried out in various databases and in accordance with inclusion criteria that considered the type of study, date of publication and quality of the journal. RESULTS the impact of Holder pasteurization on IgA and LF concentrations is not clear, given that the literature reports a variety of protocols and different results; however, the percentage reductions of both biocomponents are significant and consistent in the studies reviewed, suggesting the importance of establishing a standard protocol for their quantification. CONCLUSIONS Holder pasteurization guarantees the microbiological quality of the milk distributed in HMB, but affects the amount of beneficial biocomponents for the final recipient. Government entities that regulate HMBs should evaluate the possibility of using other techniques that reduce the impact on biocomponents while preserving the microbiological quality of the product.
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Picaud J. Review highlights the importance of donor human milk being available for very low birth weight infants. Acta Paediatr 2022; 111:1127-1133. [PMID: 35170785 PMCID: PMC9314126 DOI: 10.1111/apa.16296] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 12/14/2022]
Abstract
Aim The aim of this paper was to review the role that donor human milk plays in caring for very low birth weight (VLBW) infants. Methods This review focussed on academic papers and background information published in English and French up to 8 August 2021. Results Donor human milk provides a useful bridge to successful breastfeeding in hospitalised neonates and does not have a negative impact on the use of mother's own milk and breastfeeding rates at discharge. It helps to prevent key complications of prematurity, particularly necrotising enterocolitis up to 36 weeks of postmenstrual age, which is more common in infants fed formulas based on cows' milk. When it is carefully fortified, it supports the postnatal growth of the majority of very preterm infants. Well‐organised, accessible human milk banks are required to cover the needs of hospitalised infants, and donor human milk must be prioritised for patients who derive the greatest health benefit from it. These include very preterm infants and those born at term, or near term, with surgical digestive malformations or congenital heart disease. Conclusion Safe, high‐quality donor human milk, which is distributed by well‐organised human milk banks, is essential for the most vulnerable hospitalised neonates.
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Affiliation(s)
- Jean‐Charles Picaud
- Department of Neonatology Hôpital de la Croix‐Rousse Hospices civils de Lyon Lyon France
- CarMen laboratory INSERM INRA Claude Bernard University Lyon1 Pierre‐Benite France
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Müller K, Toll LJ, Manzardo OA, Baumgartner J, Nickel E, Wenzel F, Klotz D. Holder Pasteurization: Comparison of Water-Bath and Dry-Tempering Devices. Front Pediatr 2022; 10:879853. [PMID: 35874591 PMCID: PMC9301034 DOI: 10.3389/fped.2022.879853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human milk (HM) for premature infants is frequently Holder pasteurized (heated at 62.5 ± 0.5°C for 30 min) despite its detrimental effects on heat-sensitive milk components. This tolerated compromise ensures HM's microbial safety while less detrimental methods like short-time HM treatments (HTST) are still being evaluated. Dry-tempering devices (DT-HoP) were recently introduced in clinical practice due to hygienic concerns about water-based Holder pasteurizers (WB-HoP). Evidence on the impact of such dry-tempering devices on HM quality is lacking. The aim of this study was to compare protein retention rates after DT-HoP, WB-HoP and HTST. METHODS We colorimetrically determined alkaline phosphatase activity (ALP), concentrations of secretory immunoglobulin A (sIgA), and lactoferrin (LF) before and after DT-HoP, WB-HoP and HTST. RESULTS ALP was below the detection limit after HoP, but retained 52.8 ± 13% activity after HTST (p < 0.01). Secretory IgA (WB-HoP = 73.2 ± 13.5% vs. DT-HoP = 57 ± 14%, p = 0.0018) and LF retention (WB-HoP=47 ± 40% vs. DT-HoP=25 ± 8%, p = 0.07) differed between the two HoP modes. Again, retention was better maintained after HTST compared to HoP (80.4 ± 23% sIgA and 70 ± 42% LF concentration, all p < 0.01). CONCLUSION Dry-tempering milk lowers even further the quality of HM when performing HoP compared to water-bath pasteurization, while HTST warrants continued evaluation for clinical application.
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Affiliation(s)
- Katharina Müller
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Luisa J Toll
- Faculty of Medical and Life Sciences Furtwangen University, Furtwangen, Germany
| | - Olimpia A Manzardo
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jana Baumgartner
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erika Nickel
- Faculty of Medical and Life Sciences Furtwangen University, Furtwangen, Germany
| | - Folker Wenzel
- Faculty of Medical and Life Sciences Furtwangen University, Furtwangen, Germany
| | - Daniel Klotz
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kontopodi E, Arslanoglu S, Bernatowicz-Lojko U, Bertino E, Bettinelli ME, Buffin R, Cassidy T, van Elburg RM, Gebauer C, Grovslien A, Hettinga K, Ioannou I, Klotz D, Mileusnić-Milenović R, Moro GE, Picaud JC, Stahl B, Weaver G, van Goudoever JB, Wesolowska A. "Donor milk banking: Improving the future". A survey on the operation of the European donor human milk banks. PLoS One 2021; 16:e0256435. [PMID: 34411191 PMCID: PMC8376009 DOI: 10.1371/journal.pone.0256435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Provision of donor human milk is handled by established human milk banks that implement all required measures to ensure its safety and quality. Detailed human milk banking guidelines on a European level are currently lacking, while the information available on the actual practices followed by the European human milk banks, remains limited. The aim of this study was to collect detailed data on the actual milk banking practices across Europe with particular emphasis on the practices affecting the safety and quality of donor human milk. MATERIALS AND METHODS A web-based questionnaire was developed by the European Milk Bank Association (EMBA) Survey Group, for distribution to the European human milk banks. The questionnaire included 35 questions covering every step from donor recruitment to provision of donor human milk to each recipient. To assess the variation in practices, all responses were then analyzed for each country individually and for all human milk banks together. RESULTS A total of 123 human milk banks completed the questionnaire, representing 85% of the European countries that have a milk bank. Both inter- and intra-country variation was documented for most milk banking practices. The highest variability was observed in pasteurization practices, storage and milk screening, both pre- and post-pasteurization. CONCLUSION We show that there is a wide variability in milk banking practices across Europe, including practices that could further improve the efficacy of donor human milk banking. The findings of this study could serve as a tool for a global discussion on the efficacy and development of additional evidence-based guidelines that could further improve those practices.
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Affiliation(s)
- Eva Kontopodi
- Amsterdam UMC, Emma Children’s Hospital, Human Milk Bank, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
- Food Quality and Design Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Sertac Arslanoglu
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Urszula Bernatowicz-Lojko
- Human Milk Bank Foundation, Warsaw, Poland
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Enrico Bertino
- City of Health and Science Hospital, Neonatal Care Unit of the University, Turin, Italy
| | | | - Rachel Buffin
- Neonatal Intensive Care Unit, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Tanya Cassidy
- School of Nursing, Psychotherapy, Community Health, Dublin City University, Dublin, Ireland
| | - Ruurd M. van Elburg
- Amsterdam UMC, Emma Children’s Hospital, Human Milk Bank, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Corina Gebauer
- Abteilung Neonatologie Klinik und Poliklinik für Kinder und Jugendliche, Leipzig, Germany
| | - Anne Grovslien
- Neonatal Unit, Milk Bank, Oslo University Hospital, Oslo, Norway
| | - Kasper Hettinga
- Food Quality and Design Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Ioanna Ioannou
- Human Milk Bank, Elena Venizelou Maternity Hospital, Athens, Greece
| | - Daniel Klotz
- Center for Pediatrics, Division of Neonatology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Guido E. Moro
- Italian Association of Human Milk Banks (AIBLUD), Milan, Italy
| | - Jean-Charles Picaud
- Neonatal Intensive Care Unit, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- CarMeN Unit, INSERM U1060, INRA U1397, Claude Bernard University Lyon 1, Pierre Bénite, France
| | - Bernd Stahl
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Gillian Weaver
- International Human Milk Banking Consultant, The Human Milk Foundation, Hertfordshire, United Kingdom
| | - Johannes B. van Goudoever
- Amsterdam UMC, Emma Children’s Hospital, Human Milk Bank, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Aleksandra Wesolowska
- Human Milk Bank Foundation, Warsaw, Poland
- Laboratory of Human Milk and Lactation Research, Regional Human Milk Bank of the Holy Family Hospital, Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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Caballero Martín S, Sánchez Gomez de Orgaz MC, Sánchez Luna M. [Quality study of Holder pasteurization of donor human milk in a neonatal personalized nutrition unit]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00180-6. [PMID: 34304984 DOI: 10.1016/j.anpedi.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/29/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Holder pasteurization is the technique used most frequently in milk banks to minimize the risk of transmission of infectious agents. Different pasteurization devices have been described that generally use hot water or air as heat sources. In our study, we analysed the quality of pasteurization achieved with a new automated water-free pasteurizer in a neonatal personalized nutrition unit in which donated milk from mothers of infants delivered at different gestational ages and of different postnatal ages is pasteurized. MATERIAL AND METHODS We analysed the temperatures of different phases of pasteurization with 8 external probes distributed evenly throughout the pasteurizer. We applied the optimal range criteria established by the European Milk Bank Association (EMBA) to assess the quality of pasteurization. We also analysed the macronutrient composition of 8 samples of donor human milk of different volumes before and after automated pasteurization. RESULTS We did not find no significant differences in the following parameters under study: time from 58°C to 62.5°C, duration of plateau, highest temperature during plateau and length of exposure to temperatures over 58°C. The macronutrient analysis showed significant changes in fat content but not in protein or lactose content. CONCLUSIONS Holder pasteurization of human milk with a water-free pasteurizer met the quality standards recommended by the European Milk Bank Association independently of the quantity of milk pasteurized in each bottle and with significant changes in the fat content but not in the protein or lactose content.
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Affiliation(s)
| | | | - Manuel Sánchez Luna
- Servicio de Neonatología, Hospital Universitario Gregorio Marañón, Madrid, España
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Caballero Martín S, Sánchez Gómez de Orgaz MDC, Sánchez Luna M. Quality study of Holder pasteurization of donor human milk in a neonatal personalized nutrition unit. An Pediatr (Barc) 2021; 96:294-299. [PMID: 34226171 DOI: 10.1016/j.anpede.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Holder pasteurization is the technique used most frequently in milk banks to minimize the risk of transmission of infectious agents. Different pasteurization devices have been described that generally use hot water or air as heat sources. In our study, we analysed the quality of pasteurization achieved with a new automated water-free pasteurizer in a neonatal personalized nutrition unit in which donated milk from mothers of infants delivered at different gestational ages and of different postnatal ages is pasteurized. MATERIAL AND METHODS We analysed the temperatures of different phases of pasteurization with 8 external probes distributed evenly throughout the pasteurizer. We applied the optimal range criteria established by the European Milk Bank Association (EMBA) to assess the quality of pasteurization. We also analysed the macronutrient composition of 8 samples of donor human milk of different volumes before and after automated pasteurization. RESULTS We did not find significant differences in the following parameters under study: time from 58 °C to 62.5 °C, duration of plateau, highest temperature during plateau and length of exposure to temperatures over 58 °C. The macronutrient analysis showed significant changes in fat content but not in protein or lactose content. CONCLUSIONS Holder pasteurization of human milk with a water-free pasteurizer met the quality standards recommended by the European Milk Bank Association independently of the quantity of milk pasteurized in each bottle and with significant changes in the fat content but not in the protein or lactose content.
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Affiliation(s)
| | | | - Manuel Sánchez Luna
- Servicio de Neonatología, Hospital Universitario Gregorio Marañón, Madrid, Spain
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10
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High Hydrostatic Pressure Treatment Ensures the Microbiological Safety of Human Milk Including Bacillus cereus and Preservation of Bioactive Proteins Including Lipase and Immuno-Proteins: A Narrative Review. Foods 2021; 10:foods10061327. [PMID: 34207614 PMCID: PMC8230168 DOI: 10.3390/foods10061327] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022] Open
Abstract
Breast milk is the nutritional reference for the child and especially for the preterm infant. Breast milk is better than donated breast milk (DHM), but if breast milk is not available, DHM is distributed by the Human Milk Bank (HMB). Raw Human Milk is better than HMB milk, but it may contain dangerous germs, so it is usually milk pasteurized by a Holder treatment (62.5 °C 30 min). However, Holder does not destroy all germs, and in particular, in 7% to 14%, the spores of Bacillus cereus are found, and it also destroys the microbiota, lipase BSSL and immune proteins. Another technique, High-Temperature Short Time (HTST 72 °C, 5–15 s), has been tried, which is imperfect, does not destroy Bacillus cereus, but degrades the lipase and partially the immune proteins. Therefore, techniques that do not treat by temperature have been proposed. For more than 25 years, high hydrostatic pressure has been tried with pressures from 100 to 800 MPa. Pressures above 400 MPa can alter the immune proteins without destroying the Bacillus cereus. We propose a High Hydrostatic Pressure (HHP) with four pressure cycles ranging from 50–150 MPa to promote Bacillus cereus germination and a 350 MPa Pressure that destroys 106 Bacillus cereus and retains 80–100% of lipase, lysozyme, lactoferrin and 64% of IgAs. Other HHP techniques are being tested. We propose a literature review of these techniques.
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Kontopodi E, Boeren S, Stahl B, van Goudoever JB, van Elburg RM, Hettinga K. High-Temperature Short-Time Preserves Human Milk's Bioactive Proteins and Their Function Better Than Pasteurization Techniques With Long Processing Times. Front Pediatr 2021; 9:798609. [PMID: 35127595 PMCID: PMC8811466 DOI: 10.3389/fped.2021.798609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
Donor human milk is generally processed by holder pasteurization (HoP) at 62. 5°C for 30 min. This temperature-time combination is sufficient for eliminating pathogens in donor milk, but also negatively affects several bioactive milk components. Long heating up times may further affect the bioactive properties of pasteurized milk. High-Temperature-Short-Time (HTST), a treatment with shorter processing times (72°C for 15 sec), was investigated as a suitable alternative to HoP. In addition, pasteurization methods that follow the same temperature regime but with varying heating up times were compared. Human milk samples from four different donors were combined into one pool, which was then used to perform all analyses. The effects of these methods on the levels and functionality of immunoglobulin A, lactoferrin, lysozyme and bile salt-stimulated lipase, were evaluated with LC-MS/MS-based proteomics and activity assays, while the pasteurization efficacy was evaluated with an alkaline phosphatase test. HoP, a treatment with long processing times, times, caused the highest reduction in all proteins studied (reduced by 50-98%). Compounds such as lactoferrin and bile salt-stimulated lipase that are more sensitive to heat treatments were better retained with HTST, but their levels and functionality were still significantly lower than those of untreated donor milk (52 and 81% reduction of lactoferrin and bile salt-stimulated lipase activity, respectively). Our findings showed that a treatment with considerably shorter processing times, such as HTST, may reduce the thermal damage caused to the bioactive proteins compared to HoP, without affecting pasteurization efficacy. Since the vast majority of the donor human milk banks that are currently operating on a global level apply HoP to donor milk, our findings may provide relevant information for the optimization of donor milk processing.
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Affiliation(s)
- Eva Kontopodi
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands.,Food Quality and Design Group, Wageningen University and Research, Wageningen, Netherlands
| | - Sjef Boeren
- Laboratory of Biochemistry, Wageningen University, Wageningen, Netherlands
| | - Bernd Stahl
- Department of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.,Danone Nutricia Research, Utrecht, Netherlands
| | | | | | - Kasper Hettinga
- Food Quality and Design Group, Wageningen University and Research, Wageningen, Netherlands
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Sánchez Luna M, Caballero Martín S, Sánchez Gomez de Orgaz MDC, Rodriguez Corrales E, Jové Blanco A. Skimmed breast milk in newborns with chylothorax: Options with a personalised nutrition unit. An Pediatr (Barc) 2020. [DOI: 10.1016/j.anpede.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Leche materna descremada en recién nacidos con quilotórax: opciones con una unidad de nutrición personalizada. An Pediatr (Barc) 2020; 93:194-195. [DOI: 10.1016/j.anpedi.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 11/19/2022] Open
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Paulaviciene IJ, Liubsys A, Eidukaite A, Molyte A, Tamuliene L, Usonis V. The Effect of Prolonged Freezing and Holder Pasteurization on the Macronutrient and Bioactive Protein Compositions of Human Milk. Breastfeed Med 2020; 15:583-588. [PMID: 32856945 DOI: 10.1089/bfm.2020.0219] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Human donor milk is widely used to feed premature and sick newborns when the milk of their own mothers is insufficient. All treatment processes involving human milk affect its composition. The aim of this study was to assess changes in the macronutrients and bioactive protein (lactoferrin and lysozyme) content in human milk caused by freezing and Holder pasteurization. Materials and Methods: Milk samples were collected from 42 mothers 14-16 days after delivery. Each sample was divided into two parts and tested twice for macronutrient content, once upon being freshly collected and again after freezing at -40°C, thawing and Holder pasteurization. The lysozyme and lactoferrin concentrations were first determined in the unpasteurized thawed human milk after it was stored frozen at -80°C for up to 10 months and again after Holder pasteurization. The macronutrient concentrations were determined by midinfrared spectrophotometry, and enzyme-linked immunosorbent assay was used to measure the lysozyme and lactoferrin concentrations. Results: Freezing and Holder pasteurization had no significant effects on the macronutrient concentrations. The mean lactoferrin content before and after pasteurization was 2.5 ± 1.07 and 0.03 ± 0.03 mg/mL, respectively (p < 0.001), and the lysozyme content was 19.57 ± 20.11 and 12.62 ± 14.14 μg/mL, respectively (p = 0.007). Conclusions: Freezing and Holder pasteurization did not decrease the nutritional value of human milk but caused considerable loss of lactoferrin and lysozyme. New methods for treating human milk are needed that ensure the destruction of pathogenic microorganisms while retaining the biological and nutritional value of the milk. The Clinical Trial Registration number: NCT04382989.
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Affiliation(s)
- Ieva Jura Paulaviciene
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arunas Liubsys
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Audrone Eidukaite
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Department of Immunology, Center of Innovative Medicine, State Research Institute, Vilnius, Lithuania
| | - Alma Molyte
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Information Systems, Faculty of Fundamental Sciences, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Laima Tamuliene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vytautas Usonis
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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