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Kashyap V, Choudhari SG. Unlocking the Potential: A Systematic Literature Review on the Impact of Donor Human Milk on Infant Health Outcomes. Cureus 2024; 16:e57440. [PMID: 38699095 PMCID: PMC11064102 DOI: 10.7759/cureus.57440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Human mother milk is considered the most healthy and best source of nutrition for both premature and full-term infants, as it possesses many health benefits and is associated with its consumption. Some of the mothers are not able to produce an adequate quantity of milk to meet the required needs of the infants, particularly in cases involving premature births or facing challenges in breastfeeding. Especially for the most vulnerable premature infants, donor human milk (DHM) provides a helpful bridge for effective breastfeeding. Even with the advancement in baby formulas, no other dietary source can match the bioactive matrix of benefits found in human breast milk. This literature review discusses the risks associated with prematurity and explores the use of DHM in the care of premature infants. It helps prevent substantial preterm complications, especially necrotizing enterocolitis, bronchopulmonary dysplasia, and late-onset sepsis, which are more commonly seen in infants who are given formulated milk made from cow's milk. It gives insights into the benefits of DHM, such as immunological and nutritional benefits, which is a basic infant's need. When medical distress prevents mothers from producing enough breast milk for their infants, pasteurized human donor breast milk should be made accessible as an alternative feeding option to ensure infants remain healthy and nourished. A systematic literature search was conducted using PubMed and Google Scholar databases and other sources. A total of 104 articles were searched, of which 35 were included after identification, filters were applied, eligibility was checked, and references out of scope were excluded. Human milk banking should be incorporated into programs encouraging breastfeeding, highlighting lactation in mothers and only using DHM when required.
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Affiliation(s)
- Vijiya Kashyap
- Department of Community Medicine, Jawaharlal Nehru Medical College, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sonali G Choudhari
- Department of Community Medicine, Jawaharlal Nehru Medical College, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Weaver G, Chatzixiros E, Biller-Andorno N, Grummer-Strawn L. International expert meeting on the donation and use of human milk: Brief report. Matern Child Nutr 2024:e13550. [PMID: 38318678 DOI: 10.1111/mcn.13550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 02/07/2024]
Abstract
Where a mother's own milk is not available or is insufficient, donor human milk (DHM) processed by a human milk bank (HMB) is the recommended next best alternative. HMBs exist in over 65 countries. However, most countries have yet to establish national policies or programmes that support the provision of DHM. In July 2019, a group of international experts in fields relevant to human milk banking gathered at a meeting organised by the Institute of Biomedical Ethics, University of Zurich, and co-sponsored by the World Health Organisation. Prompted by the growing interest globally in creating and sustaining HMBs and addressing current safety and ethical concerns and standards, the aims of the meeting were to define knowledge gaps, determine the need for and scope of global guidelines and provide recommendations on steps that need to be taken at the international level. Following wide-ranging discussions that included the integration of milk banks into health care systems, strategy and policy, quality and safety, the use of DHM and associated ethical considerations, the overall conclusion of the meeting was that in the absence of global recommendations on the implementation, operation and regulation of HMBs, evidence-based guidance is urgently needed.
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Affiliation(s)
| | - Efstratios Chatzixiros
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
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Israel-Ballard K, LaRose E, Mansen K. The global status of human milk banking. Matern Child Nutr 2024:e13592. [PMID: 38318679 DOI: 10.1111/mcn.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 02/07/2024]
Abstract
Human milk provides essential nutrition for infants and holds many health benefits for infants and mothers. When a mother's own milk is not available for her infant, the World Health Organization recommends feeding donor human milk (DHM) from a human milk banking facility. DHM is human milk produced, collected then donated to a human milk bank (HMB). HMBs serve many vital functions, including screening donor mothers, then collecting, processing, storing, and allocating DHM to recipients. The first HMB opened in 1909, and today there are more than 700 HMBs globally. Unfortunately, HMB facilities are not present in all locales, with notable gaps in South Asia and Africa. Additionally, there are no global standards to guide HMB operational procedures. Even though most HMBs attempt to employ quality control systems to provide safe DHM, differences in community needs, resource availability, and a range of methods and policies to execute processes result in significant variations in DHM quality and HMB operations. Robust and collaborative systems that ensure safe and equitable access to DHM are needed. In this paper, we present a global snapshot of current human milk banking practices; review an interdisciplinary framework to guide and support HMB activities as an integrated part of health and newborn care systems; discuss factors that contribute to HMB sustainability; outline barriers to scaling HMBs worldwide; and highlight knowledge, policy, and research gaps. Developing global HMB guidance and rigorous, adaptable standards would strengthen efforts to improve newborn health.
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Affiliation(s)
| | - Emily LaRose
- Harvard School of Public Health, Boston, Massachusetts, USA
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Tenenbaum Weiss Y, Ovnat Tamir S, Globus O, Marom T. Protective Characteristics of Human Breast Milk on Early Childhood Otitis Media: A Narrative Review. Breastfeed Med 2024; 19:73-80. [PMID: 38386988 DOI: 10.1089/bfm.2023.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Introduction: Human breast milk (HBM) contains a complex and dynamically changing variety of factors that contribute to the infant's developing immune system's ability to fight upper respiratory tract infections, including otitis media (OM). We sought to summarize the current evidence on the protective characteristics of HBM, through direct or donated feeding, toward early childhood OM. Methods: For this narrative review, we performed a literature search on OM in the context of HBM feeding in the PubMed, Embase, and Google Scholar databases, between January 1, 2008, and July 1, 2023. Results: Immunoglobulin A (IgA) provides a short-term immunity of 2-3 days against otopathogens causing OM. IgA-mediated immunity is effective against OM up to 7 months of age if breastfeeding continues. The role of transferred IgM and IgG in HBM is unclear. Although there is a potential protective value of microRNA, hormones, oligosaccharides, stem cells, and interleukins present in HBM, their role is unclear. Any duration of breastfeeding is superior to no breastfeeding in OM risk reduction, with a big variability among studies (odds ratio 0.23-0.81, depending on the duration). Duration of breastfeeding ≥6 months was found to be the most effective in OM risk reduction, but there was no evidence of continued benefits after 2 years of age. Expressed breastfeeding was not shown to be more beneficial. The protective values of donor HBM against OM are still undetermined. Conclusion: HBM has numerous components that contribute to protection against early childhood OM.
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Affiliation(s)
- Yarden Tenenbaum Weiss
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Omer Globus
- Neonatal Intensive Care Unit, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
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Taksande AA, Tote S, Taksande A, Javvaji CK. Knowledge, Attitudes, and Perceptions of Medical and Paramedical Students Toward Human Milk Banks and Breast Milk Donation. Cureus 2024; 16:e55145. [PMID: 38558671 PMCID: PMC10979709 DOI: 10.7759/cureus.55145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background and objectives Human milk benefits for both mothers and babies are widely acknowledged. Human milk banks (HMBs) are essential in providing newborns who would not otherwise have access to pasteurized and stored human milk. The objective of this research was to investigate the understanding, opinions, and outlooks of medical and paramedical students regarding breast milk donation and the concept of an HMB. Material and methods A total of 398 professional female students specializing in physiotherapy, nursing, and medicine were given an online self-administered questionnaire as part of a descriptive cross-sectional study. Data on the characteristics, HMB knowledge, awareness levels, and attitudes toward HMB and breast milk donation were to be gathered through the questionnaire. Every student's answer to the survey was kept private and confidential. Result According to the survey, 188 students (47.24%) belong to the medical college, 126 students (31.66%) belong to the physiotherapy college, and the remaining 84 students (21.11%) are from the nursing college. A total of 294 students (74.12%) had heard about human milk banking before and received information from health professionals (195 students, 48.99%), the news (67 students, 16.83%), and family and friends (61 students, 15.33%). However, only 224 students (56.28%) are willing to feed their babies with HMB milk in the future. On the other hand, 216 students (54.27%) are ready to donate breast milk to HMB. The majority of students have a favorable opinion of breast milk donation. A staggering 394 students (98.99%) think that donating human milk can save babies. Furthermore, 379 students (95.23%) think that all the nutrients needed for a baby's healthy development are found in human milk. Merely 350 students (87.93%) think that breastfeeding does not result in malnourishment for either the mother or the baby. When there is an excess of milk, the majority of students (378 or 94.97%) think that there is nothing wrong with donating it. Moreover, 312 (80.41%) students are happy to donate milk in the future. A total of 373 students (93.71%) are overjoyed that a sick baby will survive because of their donated milk. Only 100 students (25.12%) will give milk, though, and only to the infants of their friends and relatives, never to complete strangers. Conclusion A dearth of knowledge pertaining to human milk banking is rampant among medical and paramedical female students, yet the gravity of the circumstances remains concealed. Consequently, it is imperative to extensively educate all Indian communities about the concept of human milk banking to gain widespread acceptance. This research sheds light on the issue and promotes scientific knowledge of HMB, as many students are unaware of it.
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Affiliation(s)
- Anugya A Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Tote
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wilunda C, Israel‐Ballard K, Wanjohi M, Lang'at N, Mansen K, Waiyego M, Kibore M, Kamande E, Zerfu T, Kithua A, Muganda R, Muiruri J, Maina B, Njuguna E, Njeru F, Kiige LW, Codjia P, Samburu B, Mogusu E, Ngwiri T, Mirie W, Kimani‐Murage EW. Potential effectiveness of integrating human milk banking and lactation support on neonatal outcomes at Pumwani Maternity Hospital, Kenya. Matern Child Nutr 2024; 20:e13594. [PMID: 38051296 PMCID: PMC10750015 DOI: 10.1111/mcn.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre-post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score-matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting.
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Affiliation(s)
- Calistus Wilunda
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | | | - Milka Wanjohi
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Nelson Lang'at
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Kimberly Mansen
- Maternal, Newborn, Child Health and Nutrition ProgramPATHSeattleWashingtonUSA
| | | | | | - Eva Kamande
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Taddese Zerfu
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | | | | | | | | | | | | | - Laura W. Kiige
- Nutrition SectionUNICEF ‐ Kenya Country OfficeNairobiKenya
| | - Patrick Codjia
- Nutrition SectionUNICEF ‐ Kenya Country OfficeNairobiKenya
| | - Betty Samburu
- Nutrition and Dietetics UnitMinistry of HealthNairobiKenya
| | - Esther Mogusu
- Nutrition and Dietetics UnitMinistry of HealthNairobiKenya
| | - Thomas Ngwiri
- Clinical ServicesGertrude's Children's HospitalNairobiKenya
| | - Waithera Mirie
- School of Nursing SciencesUniversity of NairobiNairobiKenya
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Wang H, Hu XL, Li QF, Zhou J, Wu MY. Operation Status of the Mutual Aid Human Milk Bank for Preterm Infants and Data Analysis. J Multidiscip Healthc 2023; 16:3521-3530. [PMID: 38024124 PMCID: PMC10658946 DOI: 10.2147/jmdh.s440114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study aimed to investigate the matching degree between the donated supply and demand, clinical characteristics of both donors and recipients, along with the operation cost. Methods From January 1, 2018 to December 31, 2021, the data on human milk donation and usage, the clinical characteristics of donors and recipients, and the cost of each operating center were collected from the Manual Donation Registration Form and Information Management System of the selected human milk bank. Results During the four years that the human milk bank was in operation, the volume of donated milk was slightly greater than the volume of consumed milk. A total of 1364 donors donated 2434.63 liters of qualified human milk, for RMB 1,791,000 (USD 257, 202), ie, RMB 385.3 (USD 55.3)/L; 97.8% of the donors were preterm puerperae, and 59% of the donors donated between 1 week and 1 month after delivery. All recipients were preterm infants and received donated human milk for a duration of 9.4 days on average. During the four years of operation, the proportion of donors who had previously received donated milk among all donors showed an overall increasing trend, while the incidence of NEC in preterm infants gradually decreased. Conclusions The increasingly optimized structure of donors, the more economical operation, and the fact that the use of donated milk may not affect breastfeeding of the recipients have made it a human milk bank operation mode worthy of promotion.
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Affiliation(s)
- Hua Wang
- Department of NICU, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Xiao-Li Hu
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Qiu-Fang Li
- Department of Nursing, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Jie Zhou
- Department of NICU, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Ming-Yuan Wu
- Department of NICU, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
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Rodríguez-Camejo C, Puyol A, Arbildi P, Sóñora C, Fazio L, Siré G, Hernández A. Effects of human donor milk on gut barrier function and inflammation: in vitro study of the beneficial properties to the newborn. Front Immunol 2023; 14:1282144. [PMID: 38022652 PMCID: PMC10663376 DOI: 10.3389/fimmu.2023.1282144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The gastrointestinal and immune systems of premature infants are not fully developed, rendering them more vulnerable to severe complications like necrotizing enterocolitis. Human milk offers a rich array of bioactive factors that collectively contribute to reducing the incidence of gut infections and inflammatory conditions. When a mother's milk is unavailable, preterm infants are often provided with donor human milk processed in Human Milk Banks. However, it remains uncertain whether pasteurized milk confers the same level of risk reduction as unprocessed milk. This uncertainty may stem from the well-documented adverse effects of heat treatment on milk composition. Yet, our understanding of the comprehensive impact on protective mechanisms is limited. Methods In this study, we conducted a comparative analysis of the effects of raw versus pasteurized milk and colostrum versus mature milk on cellular functions associated with the gut epithelial barrier and responses to inflammatory stimuli. We utilized THP-1 and HT-29 cell lines, representing monocyte/macrophages and gut epithelial cells, respectively. Results Our observations revealed that all milk types stimulated epithelial cell proliferation. However, only raw colostrum increased cell migration and interfered with the interaction between E. coli and epithelial cells. Furthermore, the response of epithelial and macrophage cells to lipopolysaccharide (LPS) was enhanced solely by raw colostrum, with a milder effect observed with mature milk. In contrast, both raw and pasteurized milk diminished the LPS induced response in monocytes. Lastly, we examined how milk affected the differentiation of monocytes into macrophages, finding that milk reduced the subsequent inflammatory response of macrophages to LPS. Discussion Our study sheds light on the impact of human milk on certain mechanisms that potentially account for its protective effects against necrotizing enterocolitis, highlighting the detrimental influence of pasteurization on some of these mechanisms. Our findings emphasize the urgency of developing alternative pasteurization methods to better preserve milk properties. Moreover, identifying the key components critically affected by these protective mechanisms could enable their inclusion in donor milk or formula, thereby enhancing immunological benefits for vulnerable newborns.
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Affiliation(s)
- Claudio Rodríguez-Camejo
- Área Inmunología, Departamento de Biociencias (DEPBIO), Facultad de Química, Universidad de la República, Montevideo, Uruguay
- Unidad Asociada de Inmunología, Instituto de Química Biológica (IQB), Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
- Laboratorio de Inmunología, Instituto de Higiene “Prof. Arnoldo Berta”, Universidad de la República, Montevideo, Uruguay
| | - Arturo Puyol
- Banco de Leche “Ruben Panizza”, Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Paula Arbildi
- Área Inmunología, Departamento de Biociencias (DEPBIO), Facultad de Química, Universidad de la República, Montevideo, Uruguay
- Unidad Asociada de Inmunología, Instituto de Química Biológica (IQB), Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
- Laboratorio de Inmunología, Instituto de Higiene “Prof. Arnoldo Berta”, Universidad de la República, Montevideo, Uruguay
| | - Cecilia Sóñora
- Área Inmunología, Departamento de Biociencias (DEPBIO), Facultad de Química, Universidad de la República, Montevideo, Uruguay
- Unidad Asociada de Inmunología, Instituto de Química Biológica (IQB), Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
- Laboratorio de Inmunología, Instituto de Higiene “Prof. Arnoldo Berta”, Universidad de la República, Montevideo, Uruguay
- Escuela Universitaria de Tecnología Médica (EUTM), Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Laura Fazio
- Banco de Leche “Ruben Panizza”, Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Gabriela Siré
- Banco de Leche “Ruben Panizza”, Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Ana Hernández
- Área Inmunología, Departamento de Biociencias (DEPBIO), Facultad de Química, Universidad de la República, Montevideo, Uruguay
- Unidad Asociada de Inmunología, Instituto de Química Biológica (IQB), Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
- Laboratorio de Inmunología, Instituto de Higiene “Prof. Arnoldo Berta”, Universidad de la República, Montevideo, Uruguay
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Vaddi VK, Mascarenhas D, Kirthana SB, Mundhra N, Nanavati R. A Quality Improvement Initiative to Increase the Milk Donation to the Human Milk Bank Post-Coronavirus Disease-19 Pandemic. Breastfeed Med 2023; 18:864-869. [PMID: 37733277 DOI: 10.1089/bfm.2023.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Background and Objective: Donor human milk (DHM) from the human milk bank (HMB) is the next best alterative in circumstances when mother's own milk is not available. There was a steep decline in the volume of DHM collected during the coronavirus disease-19 (COVID-19) pandemic due to various factors, while DHM demand increased. Hence, a quality improvement (QI) study was conducted to increase the volume of milk donation to HMB from postpandemic baseline of 300-400 to 1,000 mL/day over 8 weeks. Materials and Methods: Fish bone analysis was used to identify the potential barriers, and four Plan-Do-Study-Act (PDSA) cycles were conducted from January 2021 to March 2021 to address the key barriers. In the first PDSA cycle, training of health care providers was done. Sessions for educating mothers in the second PDSA cycle and individualized one-to-one counseling of mothers by a mother support group were done in the third PDSA cycle. The availability of breast pump was increased in the fourth PDSA cycle. Sustainability of the interventions was studied for 6 months and data were analyzed. Results: The average DHM collected per day at the end of each PDSA cycle was 900, 1,500, 1,000, and 1,100 mL. Although the sustenance phase was affected by the second COVID-19 wave, prompt identification of the issues and timely interventions prevented the donated volume from dropping to preintervention levels. Conclusion: QI initiatives customized for local settings can result in significant improvement in voluntary milk donation in HMB, which can result in more availability of DHM to premature babies.
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Affiliation(s)
- Vamsi Krishna Vaddi
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Dwayne Mascarenhas
- Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
| | - S B Kirthana
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nitu Mundhra
- Department of Neonatology, Wockhardt Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Gutierrez Dos Santos B, Shenker N, Weaver G, Perrin MT. Comparison of Breastfeeding and Pumping Experiences of Milk Bank Donors in the United States and United Kingdom. Breastfeed Med 2023; 18:870-880. [PMID: 37889994 DOI: 10.1089/bfm.2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Background/Objective: As human milk banking services expand, information about lifestyle characteristics and infant feeding experiences of milk bank donors is relatively limited. Our goal was to describe and compare milk bank donors' demographic, clinical, and lifestyle characteristics, and breastfeeding experiences in a variety of geographic settings. Methods: A cross-sectional online survey was conducted from August 2022 to December 2022 with approved donors from three milk banks in the United States (n = 369), and one milk bank in United Kingdom (n = 187). Results: Donors in all settings were predominantly in their early 30s, White, married, educated, and identified as female. U.K. donors reported more frequently being on maternity leave (33% versus 5%, p < 0.001), predominantly feeding directly at the breast in the first 3 months postpartum (51% versus 28%, p < 0.001), and breastfeeding a single child longer (21.2 versus 13.3 months, p < 0.001) than U.S. donors. Significantly more U.S. donors reported pumping due to work (34% versus 11%, p < 0.001) and pumping multiple times per day (57% versus 36%, p < 0.001). Most donors reported receiving information about breastfeeding from a health care provider (94% United States and 88% United Kingdom, p = 0.022), while the internet was the most popular source of information about pumping (65% United States and 64% United Kingdom, p = 0.751). Conclusion: Factors not directly related to milk banking (e.g., maternity leave, sources of breastfeeding/pumping assistance) may have an impact on how donors feed their children and ultimately on their milk donation pattern. The impact of donor characteristics and feeding practices on donation patterns warrants further investigation.
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Affiliation(s)
| | - Natalie Shenker
- Human Milk Foundation, Rothamsted Institute, Harpenden, United Kingdom
- Department of Surgery and Cancer, Imperial College London, IRDB, London, United Kingdom
| | - Gillian Weaver
- Human Milk Foundation, Rothamsted Institute, Harpenden, United Kingdom
| | - Maryann T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
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Tran HT, Nguyen TT, Nguyen OTX, Barnett D, Weaver G, Mathisen R. Characteristics and factors influencing the volume of breastmilk donated by women to the first human milk bank in Vietnam. Front Glob Womens Health 2023; 4:1185097. [PMID: 37849562 PMCID: PMC10577291 DOI: 10.3389/fgwh.2023.1185097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background Donor human milk (DHM) is essential to the operation of human milk banks (HMB). This study examined characteristics and factors associated with higher volumes of DHM donation at the first HMB in Vietnam. Method Data from an online HMB monitoring system collected between February 2017 and July 2022 included demographic characteristics, child information, the timing of donation, and the volume of DHM. Higher volume is defined as equal to or greater than the median DHM volume per donor of 14.4 liters (L). Potential contributors to higher DHM volume were examined using the chi-square test in univariate and multivariable logistic regression analysis. Results During the 5.5-year operation, this HMB recruited 517 donors with an average age of 28.6 years. Approximately 60.9% of donors had a college or higher degree and 97.3% gave birth in Da Nang city. Of these donors, the prevalence of cesarean birth was 48.2%, preterm births was 40.2%, and 27.9% had babies with a birth weight of less than 1,500 g. There was a similar proportion of donors between the hospital (48.2%) and community (51.8%). On average, hospital donors started their donations 15 days after birth when their newborns were 33.9 weeks corrected age compared to 63 days and 47.7 weeks among community-based donors. The overall median volume of DHM per donor was 14.4 L over a period of 46 days. The amount and duration were higher in community-based donors (17.5 L in 72 days, 300 ml/day) than those in the hospital (8.4 L in 30 days, 258 ml/day). More than 37% of donors contacted the HMB themselves; the remainder were introduced by health professionals. Factors associated with higher volumes of DHM included higher education (OR: 1.77; 95% CI: 1.09, 2.87), having a full-term newborn (OR: 2.46; 95% CI: 1.46, 4.13), and community-based donors (OR: 2.15; 95% CI: 1.22, 3.78). Conclusions Mothers with higher education and from the community donate more breastmilk over a longer duration than those with lower education and from the hospital. Breastfeeding protection, promotion, and support should be offered to all mothers with specialized breastfeeding support for mothers of preterm and sick infants. This will ensure mothers have sufficient breastmilk for their newborns and potentially surplus breastmilk for donation.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Pediatrics, School of Medicine and Pharmacy, Da Nang University, Da Nang, Vietnam
| | | | - Oanh Thi Xuan Nguyen
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Debbie Barnett
- Milk Bank Scotland, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Ureta-Velasco N, Montealegre-Pomar A, Keller K, Escuder-Vieco D, Fontecha J, Calvo MV, Megino-Tello J, Serrano JCE, García-Lara NR, Pallás-Alonso CR. Associations of Dietary Intake and Nutrient Status with Micronutrient and Lipid Composition in Breast Milk of Donor Women. Nutrients 2023; 15:3486. [PMID: 37571421 PMCID: PMC10421487 DOI: 10.3390/nu15153486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
The influence of the diet and nutritional status of milk donors on the nutritional composition of donor human milk (DHM) is unknown. The present study aimed to determine the nutritional profile of DHM and the associations between donors' dietary intake and nutritional status and the micronutrient and lipid composition in DHM. For this purpose, 113 donors completed a food frequency questionnaire, provided a five-day weighed dietary record, and collected milk for five consecutive days. Nutrient determinations in donors' erythrocytes, plasma, urine, and milk were performed. Multiple linear regressions were conducted for the evaluation of the associations. We highlight the following results: DHM docosahexaenoic acid (DHA) was positively associated with donors' plasma DHA content and donors' DHA intake (R2 0.45, p < 0.001). For every 1 g/day DHA intake, an increase of 0.38% in DHA content and 0.78% in total omega-3 content was observed in DHM (R2 0.29, p < 0.001). DHM saturated fatty acids were positively associated with erythrocyte dimethyl acetals, plasma stearic acid, trans fatty acids intake, and breastfeeding duration and negatively associated with erythrocyte margaroleic acid (R2 0.34, p < 0.01). DHM cholecalciferol was associated with plasma cholecalciferol levels and dairy intake (R2 0.57, p < 0.01). Other weaker associations were found for free thiamin, free riboflavin, pyridoxal, dehydroascorbic acid, and the lipid profile in DHM. In conclusion, the diet and nutritional status of donors influence the fatty acid profile and micronutrient content of DHM.
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Affiliation(s)
- Noelia Ureta-Velasco
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (N.R.G.-L.); (C.R.P.-A.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Adriana Montealegre-Pomar
- Epidemiología Clínica, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá 110231, Colombia;
| | - Kristin Keller
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Diana Escuder-Vieco
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Javier Fontecha
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain; (J.F.); (M.V.C.); (J.M.-T.)
| | - María V. Calvo
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain; (J.F.); (M.V.C.); (J.M.-T.)
| | - Javier Megino-Tello
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain; (J.F.); (M.V.C.); (J.M.-T.)
| | - José C. E. Serrano
- Department of Experimental Medicine, Faculty of Medicine, University of Lleida, 25008 Lleida, Spain;
| | - Nadia Raquel García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (N.R.G.-L.); (C.R.P.-A.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen R. Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (N.R.G.-L.); (C.R.P.-A.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain; (K.K.); (D.E.-V.)
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
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13
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Tanaka M, Date M, Miura K, Ito M, Mizuno N, Mizuno K. Protein and Immune Component Content of Donor Human Milk in Japan: Variation with Gestational and Postpartum Age. Nutrients 2023; 15:nu15102278. [PMID: 37242161 DOI: 10.3390/nu15102278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Donor human milk (DHM) is the second-best nutrition for preterm infants when their own mother's milk is unavailable. The nutrient content of human milk is influenced by various factors, including gestational and postpartum age, but there are no data regarding DHM composition in Japan. The aim of this study was to determine the protein and immune component content of DHM in Japan and to elucidate the effects of gestational and postpartum age on nutrient composition. From September 2021 to May 2022, 134 DHM samples were collected from 92 mothers of preterm and term infants. Protein concentrations in preterm DHM (n = 41) and term DHM (n = 93) were analyzed using a Miris Human Milk Analyzer. The concentrations of secretory immunoglobulin A (sIgA) and lactoferrin, major immune components, were measured using enzyme-linked immunosorbent assays. Preterm DHM exhibited higher protein content than term DHM (1.2 g/dL and 1.0 g/dL, respectively, p < 0.001), whereas sIgA content was higher in term DHM than in preterm DHM (110 μg/mL and 68.4 μg/mL, respectively, p < 0.001). Gestational age was negatively correlated with protein levels and positively correlated with sIgA and lactoferrin levels. Furthermore, a negative correlation was found between postpartum week and protein, sIgA, and lactoferrin concentrations. Our data suggest that gestational and postpartum age affects protein, sIgA, and lactoferrin concentrations in DHM. These results indicate the importance of nutritional analysis for the appropriate use of DHM in preterm infants.
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Affiliation(s)
- Miori Tanaka
- The Nippon Foundation Human Milk Bank, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo 103-0016, Japan
| | - Midori Date
- The Nippon Foundation Human Milk Bank, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo 103-0016, Japan
| | - Kumiko Miura
- The Nippon Foundation Human Milk Bank, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo 103-0016, Japan
- Faculty of Medicine, Oita University, 1-1 Hasamamachiidaigaoka, Yufu-shi, Oita 879-5593, Japan
| | - Mizuho Ito
- The Nippon Foundation Human Milk Bank, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo 103-0016, Japan
- School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Noriko Mizuno
- Japan Human Milk Bank Association, 4-4 Nihonbashi-hisamatsucho, Chuo-ku, Tokyo 103-8480, Japan
| | - Katsumi Mizuno
- The Nippon Foundation Human Milk Bank, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo 103-0016, Japan
- Japan Human Milk Bank Association, 4-4 Nihonbashi-hisamatsucho, Chuo-ku, Tokyo 103-8480, Japan
- Department of Pediatrics, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
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Outurquin G, Obin O, Petit A, Weiss R, Léké A, Adjidé C, Mullié C. Bacillus cereus strains from donor human milk and hospital environment: uncovering a putative common origin using comparative analysis of toxin and infra-red spectroscopy profiles. AIMS Microbiol 2023; 9:419-430. [PMID: 37649803 PMCID: PMC10462457 DOI: 10.3934/microbiol.2023022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 09/01/2023] Open
Abstract
Bacillus cereus is reported as a common cause of toxin-induced food poisoning and of contamination in pasteurized human milk donations. As various toxins can be produced by B. cereus, the aim of this work was first to investigate the toxigenic potential and profiles of 63 B. cereus isolates from Amiens Picardie human milk bank. A comparison to the toxigenic profiles of 27 environmental B. cereus isolates harvested in the hospital in which this human milk bank is situated was performed. Toxin gene prevalences were the highest for nhe (ABC) and entFM followed by cytK and hbl(ACD). A 27% prevalence was found for ces human milk isolates, which is higher than previous works reporting on pasteurized milk and dairy products. No significant differences could be found between human milk and environmental isolates regarding toxin gene prevalences and/or toxin gene profiles. The second aim was to establish whether a B. cereus cross-contamination between human milk and the environment could occur. This was achieved with the help of Fourrier-transform infra-red spectroscopy which enabled the discrimination of 2 main clusters of 11 and 8 isolates, each containing human milk and Amiens Picardie human milk bank environmental isolates. For these two clusters, the time sequence showed that human milk isolates were the first to occur and might have contaminated the milk bank environment as well as other human milk donations. Routinely used on B. cereus isolates, Fourrier-transform infra-red spectroscopy could help in rapidly detecting such clusters and in limiting the spread of a B. cereus strain that might generate rejection of pasteurized donation by the human milk bank.
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Affiliation(s)
- Gaëtan Outurquin
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Odile Obin
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Anaïs Petit
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Roxane Weiss
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - André Léké
- Lactarium–Biberonnerie, Unité des soins intensifs de néonatologie et de médecine néonatale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Crespin Adjidé
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Catherine Mullié
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
- Laboratoire AGIR UR UPJV 4294, UFR de Pharmacie, Université de Picardie Jules Verne, Amiens, France
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15
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Ureta-Velasco N, Keller K, Escuder-Vieco D, Fontecha J, Calvo MV, Megino-Tello J, Serrano JCE, Romero Ferreiro C, García-Lara NR, Pallás-Alonso CR. Human Milk Composition and Nutritional Status of Omnivore Human Milk Donors Compared with Vegetarian/Vegan Lactating Mothers. Nutrients 2023; 15:nu15081855. [PMID: 37111074 PMCID: PMC10146700 DOI: 10.3390/nu15081855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Women of childbearing age in Western societies are increasingly adopting vegetarian diets. These women are sometimes rejected as milk donors, but little about the composition of their milk is known. The present study aimed to compare the intake, nutritional status, and nutritional composition of human milk from omnivore human milk donors (Donors) and vegetarian/vegan lactating mothers (Veg). Milk, blood, and urine samples from 92 Donors and 20 Veg were used to determine their fatty acid profiles, as well as vitamins and minerals. In a representative sample of both groups, we also determined the lipid class profile as a distribution of neutral and polar lipids, the molecular species of triacylglycerols, and the relative composition of phospholipids in their milk. A dietary assessment was conducted with a five-day dietary record (while considering the intake of supplements). We highlight the following results, expressed as the mean (SE), for the Veg vs. Donors: (1) Their docosahexaenoic acid (DHA) intake was 0.11 (0.03) vs. 0.38 (0.03) g/day; the plasma DHA was 0.37 (0.07) vs. 0.83 (0.06)%; and the milk DHA was 0.15 (0.04) vs. 0.33 (0.02)%. (2) Their milk B12 levels were 545.69 (20.49) vs. 482.89 (4.11) pM; 85% of the Veg reported taking B12 supplements (mean dose: 312.1 mcg/day); and the Veg group showed no differences with Donors in terms of total daily intake or plasma B12. (3) Their milk phosphatidylcholine levels were 26.88 (0.67) vs. 30.55 (1.10)%. (4) Their milk iodine levels were 126.42 (13.37) vs. 159.22 (5.13) mcg/L. In conclusion, the Vegs' milk was shown to be different from the Donors' milk, mainly due to its low DHA content, which is concerning. However, raising awareness and ensuring proper supplementation could bridge this gap, as has already been achieved for cobalamin.
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Affiliation(s)
- Noelia Ureta-Velasco
- Department of Neonatology, Research Institute i+12, 12 de Octubre University Hospital, Complutense University of Madrid, 28041 Madrid, Spain
| | - Kristin Keller
- "Aladina-MGU"-Regional Human Milk Bank, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Diana Escuder-Vieco
- "Aladina-MGU"-Regional Human Milk Bank, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Javier Fontecha
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain
| | - María V Calvo
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain
| | - Javier Megino-Tello
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL), CSIC-UAM, 28049 Madrid, Spain
| | - José C E Serrano
- Department of Experimental Medicine, Faculty of Medicine, University of Lleida, 25008 Lleida, Spain
| | - Carmen Romero Ferreiro
- Scientific Support Unit, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Nadia Raquel García-Lara
- Department of Neonatology, Research Institute i+12, 12 de Octubre University Hospital, Complutense University of Madrid, 28041 Madrid, Spain
- "Aladina-MGU"-Regional Human Milk Bank, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen R Pallás-Alonso
- Department of Neonatology, Research Institute i+12, 12 de Octubre University Hospital, Complutense University of Madrid, 28041 Madrid, Spain
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Wada YS, Tani Y, Shindo J, Miyata M, Sakurai M, Nishimaki S, Mizuno K. Survey of Enteral Feeding of Preterm Infants and the Human Milk Bank in Japan. Pediatr Int 2023:e15527. [PMID: 36932849 DOI: 10.1111/ped.15527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND In Japan, the first human milk bank (HMB) was established in 2017, which changed the practice of enteral feeding in neonatal care. This study investigated the practice of enteral feeding of preterm infants after the establishment of the HMB in Japan and examine future issues. METHODS A survey was conducted in 251 neonatal intensive care units (NICUs) from December 2020 to February 2021. RESULTS The response rate was 61%. Although approximately 59% and 62% NICUs responded for ELBWI and VLBWI, only 30% and 46% could achieve this, respectively. Artificial nutrition was used to initiate enteral feeding for ELBWI in 24% and VLBWI in 56% of NICUs. Of the NICUs, 92% considered HMBs necessary or rather necessary and 55% wanted to use the HMB but could not. The major reasons for the same were (1) paying the annual membership fee of the HMB is troublesome, (2) obtaining approval from the facility is difficult, and (3) using the HMB is complicated. The indication and discontinuation for using donor milk vary among NICUs. Only in 17%, milk expression started within 1h delivery. CONCLUSIONS Compared with before the establishment of the HMB, more NICUs are currently willing to start enteral feeding for preterm infants earlier. However, the implementation of enteral feeding appears to be challenging. Issues related to the HMB highlighted by the responses need to be addressed. Additionally, guidelines for using donor milk need to be established.
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Affiliation(s)
- Yuka Sano Wada
- Division of Neonatology, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yuki Tani
- Nara Medical University, Department of Pediatrics, Nara, Japan
| | - Jun Shindo
- Department of Neonatology, Tokyo, Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masashi Miyata
- Fujita Health University School of Medicine, Department of Pediatrics, Aichi, Japan
| | - Motoichirou Sakurai
- Kameda Medical Center, Department of Pediatrics and Neonatology, Chiba, Japan
| | | | - Kastumi Mizuno
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tran HT, Nguyen TT, Nguyen OTX, Huynh LT, Nguyen LT, Nguyen TT, Le HTT, Barnett D, Weaver G, Mathisen R. Differences in the Microbiological Profile of Raw and Pasteurized Breastmilk from Hospital and Community-Based Donors at the First Human Milk Bank in Vietnam. Nutrients 2023; 15. [PMID: 36678283 DOI: 10.3390/nu15020412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background: Microbiological quality is one of the key safety standards in human milk bank (HMB) operations. We describe the profiles of bacteria in donor human milk (DHM) before and after the pasteurization of samples collected from breastfeeding women in the hospital and from the community in the first HMB in Vietnam. Methods: Data were collected between February 2017 and January 2022 from an online HMB monitoring system. First, DHM samples were cultured, and the number of colony-forming units (CFU) were counted before (n = 708) and after pasteurization (n = 1146). The gram-staining method combined with the Vitek 2 Compact system were used to identify types of organisms at the Da Nang Hospital for Women and Children’s Laboratory. Passing criteria for DHM included pre-pasteurization samples had a total colony count <105 CFU/mL and post-pasteurization was <10 CFU/mL. Results: During five years of operation, Da Nang HMB had 491 donors (48.7% were hospital and the rest community donors) who donated an average amount of 14.2 L over 45 days. Of this DHM volume, 84.9% of donor samples passed the pre- and post-pasteurization microbiological tests. DHM from community donors had a higher pass rate (87.8%) compared to that from hospital donors (79.5%). Before pasteurization, 15.4% of DHM samples had a bacteria count <103 CFU/mL, 63.0% had 103-<105 CFU/mL, and 21.6% had ≥105 CFU/mL. Most of the unpasteurized DHM samples (93.0%) had microorganism growth: with one organism (16.4%), two (33.9%), three or more (43.6%). After pasteurization, 17.9% samples had a bacteria count of 1−9 CFU/mL and 7.2% had ≥10 CFU/mL. DHM samples from community donors had a lower bacterial count and number of organisms than those from hospital donors both before and after pasteurization. The highest microorganisms from unpasteurized DHM samples were Staphylococcus epidermidis (74.2%), Acinetobacter sp. (52.1%), gram-positive bacillus (51.7%), Staphylococcus coagulase-negative (15.8%), and Staphylococcus aureus (10.5%). Common microorganisms from pasteurized DHM were gram-positive bacillus (21.0%), Staphylococcus epidermidis (3.9%), and Acinetobacter sp. (0.9%). Samples from the hospital tended to have a higher contamination with those microorganisms than those from community donors. Conclusions: The majority of DHM samples in Da Nang passed microbiological testing criteria. DHM from community donors had higher pass rates than hospital donors. Corrective actions are needed to improve HMB operations and hospital microbiological quality standards, as well as general improvements in water and sanitation.
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Ureta-Velasco N, Keller K, Escuder-Vieco D, Serrano JCE, García-Lara NR, Pallás-Alonso CR. Assessment of Iodine Concentration in Human Milk from Donors: Implications for Preterm Infants. Nutrients 2022; 14:nu14204304. [PMID: 36296988 PMCID: PMC9612023 DOI: 10.3390/nu14204304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Preterm infants are particularly vulnerable to developing iodine deficiency. Donor human milk (DHM) is the preferred feeding option if the mother’s own milk (MOM) is not available, but information on DHM iodine concentration (DHMIC) is lacking. Hence, we aimed to assess DHMIC to further evaluate the adequacy of iodine provision in preterm infants. Finally, associations that might influence DHMIC were studied. In 113 donors, we measured iodine intake by evaluating dietary records for five consecutive days with the DIAL® Software. From the second day of dietary record, donors provided human milk samples (at least one per day) for four consecutive days. Daily human milk samples were analyzed for DHMIC. A DHMIC ≥ 200 µg/L was considered an adequate iodine content for preterm infants. DHMIC and urine iodine concentration (UIC) were determined using ICP-MS. In our study, 83.2% of donors had a full-term infant. Breastfeeding time range was 1.5−49.4 months. During the dietary record, 55.8% took iodine-containing supplements, providing 40−200 µg/day of iodine. The medians (p25, p75) UIC and DHMIC were 112.4 (75.8, 160.1) and 148.5 (97.6, 206.1) µg/L, respectively. In this iodine-sufficient population, 70% had a DHMIC of <200 µg/L. Donors’ intake of iodine-containing supplements was associated with higher DHMIC.
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Affiliation(s)
- Noelia Ureta-Velasco
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
- Correspondence: ; Tel.: +34-913901929
| | - Kristin Keller
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - Diana Escuder-Vieco
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - José C. E. Serrano
- Department of Experimental Medicine, Medicine Faculty, Lleida University, 25008 Lleida, Spain
| | - Nadia Raquel García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - Carmen R. Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
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Wu T, Jiang PP, Luo P, Chen Y, Liu X, Jiang YN, Ma L, Zhou P. Availability of donor milk improves enteral feeding but has limited effect on body growth of infants with very-low birthweight: Data from a historic cohort study. Matern Child Nutr 2022; 18:e13319. [PMID: 35043572 PMCID: PMC8932717 DOI: 10.1111/mcn.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 01/01/2023]
Abstract
Compare with preterm formula, donor human milk (DM) is associated with a lower risk of mortality and morbidity in preterm infants. It is thus deemed superior to preterm formula as the sole diet or supplement to own mother's milk (OMM) for preterm infants, especially for those with very low birthweight (VLBW). This historic cohort study investigated the relationship between DM availability, and enteral feeding, body growth of VLBW infants by comparing two cohorts before and after the establishment of a human milk bank. A sub‐analysis was also conducted between small‐for‐gestational‐age (SGA) and non‐SGA infants in our cohorts. Our results showed that DM availability was associated with earlier initiation and faster advancement of enteral feeding, earlier attainment of full enteral feeding, and a higher proportion of OMM in enteral feeding. DM availability was also associated with earlier regain of birthweight, but not with better body growth. SGA and non‐SGA infants responded differently to DM availability with only the non‐SGA group showing improved enteral feeding associated with DM availability. The poor growth of VLBW infants with fortified DM warrants further investigations on better fortification strategies to further improve body growth. Studies are also needed on long‐term effects of DM feeding on the development of VLBW infants. Compared with the infants before the introduction of donor human milk (DM), very low birthweight infants after that had improved enteral feeding process, shown as earlier enteral feeding introduction, faster advancement, and earlier attainment of full enteral feeding. DM availability affects body growth to a limited extent, which calls for a better fortification strategy for DM‐fed infants. The setup of a human donor milk bank increased the use of own mother's milk for enteral feeding.
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Affiliation(s)
- Tong Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ping-Ping Jiang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Ping Luo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - You Chen
- Department of Neonatology, Baoan Women's and Children's Hospital, Shenzhen, China
| | - Xudong Liu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-Nan Jiang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Liya Ma
- Department of Child Health, Baoan Women's and Children's Hospital, Shenzhen, China
| | - Ping Zhou
- Department of Neonatology, Baoan Women's and Children's Hospital, Shenzhen, China
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21
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Chen CH, Chiu HY, Lee SC, Chang HY, Chang JH, Chen YJ, Kang L, Shen SP, Lin YC. Growth of Very Preterm Infants in a Low-Resourced Rural Setting after Affiliation with a Human Milk Bank. Children (Basel) 2022; 9:80. [PMID: 35053701 DOI: 10.3390/children9010080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.
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22
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Lakhkar B, Damke S, Meshram R. Human Milk Bank in a Rural Setup - A Success Story. Indian J Community Med 2022; 47:317-320. [PMID: 36438537 PMCID: PMC9693948 DOI: 10.4103/ijcm.ijcm_1158_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This article describes the experience of a rural human milk bank, with the problems faced in first 6 months including the coronavirus disease (COVID) crisis and interventions leading to success. METHODS The study included individual counselling by dedicated counsellors, focused counselling of primipara mothers seeking the help of obstetricians, counselling of pre-term mothers by neo-natal nurses, periodically delivered information in post-natal wards, and counselling of grandmothers and husbands. RESULTS The COVID crisis was dealt with donations from reverse transcriptase-polymerase chain reaction-negative mothers with social distancing and mask use. Younger, educated, working mothers with normal delivery and from middle-income families were easy to counsel. Periodic announcements in wards significantly increased awareness about milk banks and donation. Pre-term mothers could be motivated when their baby was nil by mouth or they saw other babies in need of milk. Lactation support to mothers with breast problems, especially in primipara, helps in getting more donors. Counselling of fathers was easier than that of grandmothers. CONCLUSIONS Structured awareness programs and counselling strategies along with education of grandmothers and husbands were very effective in increasing human milk donation.
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Affiliation(s)
- Bhavana Lakhkar
- Department of Neonatology, JNMC, Sawangi Meghe Wardha, DMIMS, Maharashtra, India
| | - Sachin Damke
- Department of Pediatrics, JNMC, Sawangi Meghe Wardha, DMIMS, Maharashtra, India,Address for correspondence: Dr. Sachin Damke, Department of Pediatrics, JNMC, Sawangi Meghe Wardha - 442 107, Maharashtra, India. E-mail:
| | - Revatdhamma Meshram
- Department of Pediatrics, JNMC, Sawangi Meghe Wardha, DMIMS, Maharashtra, India
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23
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Oda A, Mizuno K. Questionnaire survey on donor human milk programs targeting NICUs in Japan. Pediatr Int 2022; 64:e15344. [PMID: 36410722 DOI: 10.1111/ped.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/15/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since 2019, neonatal intensive care units (NICUs) with access to human milk banks (HMBs) have increased in Japan. In this study, using a questionnaire survey, we explored an understanding of the purpose, status, and problems of donor human milk (DHM) use and the status of enteral nutrition (EN) in very-low-birthweight infants (VLBWIs) in NICUs with access to HMBs. METHODS A questionnaire was sent to 47 NICUs that had access to HMBs. Participants were surveyed from the begining of January to the end of February 2022. RESULTS In total, 37 of 47 (78.9%) NICUs responded to the questionnaire. The most common indications for DHM were gestational age of less than 28 weeks (78.3%) and birthweight of less than 1500 g (100%). Informed consent was obtained from the physicians and most parents accepted DHM. All NICUs responded that EN for VLBWIs should start ideally within 24 h of birth, but in reality, nine NICUs (25%) and 18 NICUs (50%) began EN within 12 and 24 h of birth, respectively. Additionally, seven of the nine NICUs that started EN within 12 h after birth routinely used DHM for VLBWIs. For infants with birthweights of 1000-1499 g, it was not uncommon to start EN within 24 h of birth with formula milk. CONCLUSION All NICUs responded that the indication for DHM was very-low birthweight and that such infants would receive health benefits from DHM. In Japan, there is a trend of starting EN early in VLBWIs. Accessibility to HMB may be important for starting EN within 24 h of birth.
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Affiliation(s)
- Ayaka Oda
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Katsumi Mizuno
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
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24
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Billeaud C. 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; 10:1327. [PMID: 34207614 DOI: 10.3390/foods10061327] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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25
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Tran HT, Nguyen TT, Giang HTN, Huynh LT, Barnett D, Mathisen R, Murray JCS. Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam. Nutrients 2021; 13:nu13041151. [PMID: 33807207 PMCID: PMC8066195 DOI: 10.3390/nu13041151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Pasteurized donor milk (PDM) is typically prescribed to preterm or low birthweight newborns when their mother’s own milk is unavailable. In surplus, PDM is prescribed to meet the nutritional needs of healthy newborns in the first few days of life. However, its overuse can undermine efforts to promote and support breastfeeding, waste resources, and reduce the availability of PDM for at-risk newborns. We conducted this study to examine factors associated with the prescription and prolonged use (>48 h) of privately purchased PDM to healthy newborns. Methods: Prospective observational study of 2440 mothers of healthy, term, and normal birthweight newborns born at Da Nang Hospital for Women and Children between April and August 2019. In addition to the descriptive analysis, we performed multiple logistic regressions to examine factors associated with the prescription of PDM (n = 2440) and prolonged PDM use among those who used PDM (n = 566). Results: Twenty-three percent (566/2440) of healthy, term, and birthweight ≥2500 g newborns received PDM and were included in the study. The prevalence of PDM use was higher for cesarean births (OR: 2.05; 95% CI: 1.66, 2.55) and among male newborns (OR: 1.33; 95% CI: 1.09, 1.62), but lower for farmers or workers (vs. other jobs; OR: 0.71; 95% CI: 0.54, 0.93), family income <10 million VND (vs. ≥10 million VND; OR: 0.67; 95% CI: 0.55, 0.82), and duration of skin-to-skin ≥90 min (vs. <90 min; OR: 0.54; 95% CI: 0.39, 0.76). Prolonged PDM use (12.4% of 566 newborns who used PDM) was associated with the mother having a higher socioeconomic status job (professional, small trader or homemaker; OR: 4.00; 95% CI: 1.39, 12.5), being a first-time mother (OR: 3.39; 95% CI: 1.92, 6.01) or having a cesarean birth (OR: 2.09; 95% CI: 1.02, 4.28). Conclusions: The prescription and prolonged use of privately purchased PDM was associated with non-medical factors unrelated to the ability to breastfeed effectively. The findings suggest the need for improved breastfeeding communication, counseling and support skills for health staff, development, and application of strict criteria on PDM use for healthy newborns and better routine monitoring of PDM use over time.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam
- Correspondence: ; Tel.: +84-903-543-115
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (T.T.N.); (R.M.)
| | - Hoang Thi Nam Giang
- International Cooperation and Scientific Research Office, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam;
| | - Le Thi Huynh
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam
| | - Debbie Barnett
- Milk Bank Scotland, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK;
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (T.T.N.); (R.M.)
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Tran HT, Nguyen TT, Barnett D, Weaver G, Nguyen OTX, Van Ngo Q, Le HTT, Huynh LT, Do CT, Mathisen R. Trends and Dynamics in the First Four Years of Operation of the First Human Milk Bank in Vietnam. Nutrients 2021; 13:1107. [PMID: 33800596 DOI: 10.3390/nu13041107] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Since 1979, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have recommended the use of pasteurized human milk from a human milk bank (HMB) to feed low birthweight (LBW) and preterm newborns as the ‘first alternative’ when mothers are unable to provide their own milk. However, they have not issued any guidelines for the safe establishment and operation of an HMB. This gap contributes to the demand for gathering experiences from HMB networks, especially those from lower-middle income countries. To fill this knowledge gap, this study examines the characteristics of donors, donation, pasteurization, and recipients during the first four years of operation in the first HMB in Vietnam. Methods: Data about the donors, donation, pasteurization, and recipients were extracted from the web-based electronic monitoring system of the HMB from 1 February 2017 to 31 January 2021. Results: In the first four years of operation there were 433 donors who donated 7642 L of milk (66% from the community) with an increased trend in the amount of donated milk, donation duration, and average amount of milk donated by a donor. Approximately 98% of the donated milk was pasteurized, and 82% passed both pre- and post-pasteurization tests. Although the pass rate tended to increase with time, a few dips occurred. Of 16,235 newborns who received pasteurized donor milk, two thirds were in the postnatal wards. The main reason for the prescription of pasteurized donor milk was insufficient mothers’ own milk in the first few days after birth. There was a decreased trend in the amount and duration of using pasteurized donor milk in both postnatal wards and the neonatal unit. Conclusions: The HMB has operated efficiently in the previous four years, even during the COVID-19 pandemic, to serve vulnerable newborns. Ongoing evidence-based adjustments helped to improve the operation to recruit suitable donors, to increase the access to and quality of raw donor milk, to improve the pasteurization process, and to meet the need of more newborns.
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27
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Hutchings C, Prokocimer Yair Z, Reifen R, Shemesh M. Antimicrobial Effect of Zn 2+ Ions Governs the Microbial Quality of Donor Human Milk. Foods 2021; 10:637. [PMID: 33802996 PMCID: PMC8002753 DOI: 10.3390/foods10030637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/21/2022] Open
Abstract
Donor human milk (HM) obtained at HM banks is exceptionally crucial for the feeding and treatment of preterm infants. Bacterial contaminations of HM in various stages of its handling are very common and can lead to disqualification of donations or severe infections in worse cases. Hence, HM donations are subject to strict bacteriological evaluations pre- and post-pasteurization. The main contaminating species vary between countries, banks and donors and even exhibit inter-individual variation. We initiated an assessment of the bacteriological composition of HM donated by women hospitalized in a neonatal intensive care unit in Israel. The most common bacterium identified was Staphylococcus epidermidis, found in all but one of the HM samples; the presence of several species of coagulase-negative Staphylococci was also noted. Next, we sought to develop a platform towards antibacterial treatment using Zn2+ ions that have recently been found to be potent against contaminants isolated from bovine milk. Zn2+ efficiently inhibited the growth of viable aerobic population and S. epidermidis in HM. Growth was also inhibited in other Gram-positive bacteria such as Bacillus cereus, a well-known food-borne pathogen. S. epidermidis and B. cereus cells grown in the presence of zinc were taken for microscopic evaluation, aiming to demonstrate zinc's antimicrobial mode of action morphologically. Images obtained using scanning electron microscopy indicated leakage of cellular content and cell lysis in S. epidermidis. Besides, B. cereus cells showed abnormalities in their cell surface and complete loss of flagella upon treatment with zinc. Along with the above findings, it should be noted that this was a pilot study that tested how high doses of Zn2+ affect breast milk as a product. Further research is likely needed on the safety of consumption of Zn2+-treated HM in infants and older children.
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Affiliation(s)
- Carmel Hutchings
- Department of Food Sciences, Institute for Postharvest Technology and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, Rishon LeZion 7528809, Israel;
- School of Nutrition Science, Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot 761001, Israel
| | - Zafnat Prokocimer Yair
- Schneider Children’s Medical Center Israel, Emergency Medicine Department, Petah-Tikva 49202, Israel;
| | - Ram Reifen
- School of Nutrition Science, Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot 761001, Israel
| | - Moshe Shemesh
- Department of Food Sciences, Institute for Postharvest Technology and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, Rishon LeZion 7528809, Israel;
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28
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Gayà A, Rittà M, Lembo D, Tonetto P, Cresi F, Sottemano S, Bertino E, Moro GE, Calvo J, Donalisio M. Analysis of Thermal Sensitivity of Human Cytomegalovirus Assayed in the Conventional Conditions of a Human Milk Bank. Front Pediatr 2021; 9:640638. [PMID: 34386465 PMCID: PMC8353116 DOI: 10.3389/fped.2021.640638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/01/2021] [Indexed: 01/18/2023] Open
Abstract
One of the main concerns in human milk banks (HMB) is the transmission of human cytomegalovirus (HCMV) that could be present in the milk of infected women. There are consistent data showing that this virus is destroyed by Holder pasteurization (62.5°C for 30 min), but there is a lack of information about the response of the virus to the treatment at lower temperatures in strict HMB conditions. In order to analyze the effectiveness of different temperatures of pasteurization to eliminate HCMV in human milk, a preliminary assay was performed incubating HCMV-spiked raw milk samples from donor mothers at tested temperatures in a PCR thermocycler and the viral infectivity was assayed on cell cultures. No signs of viral replication were observed after treatments at temperatures equal or >53°C for 30, 20, and 10 min, 58°C for 5 min, 59°C for 2 min, and 60°C for 1 min. These data were confirmed in a pasteurizer-like model introducing HCMV-spiked milk in disposable baby bottles. No viral infectivity was detected on cell cultures after heating treatment of milk for 30 min at temperatures from 56 to 60°C. Thus, our results show that by using conventional pasteurization conditions, temperatures in the range of 56-60°C are enough to inactivate HCMV. Consequently, we consider that, in order to provide a higher quality product, the current recommendation to pasteurize both mother's own milk and donated milk at 62.5°C must be re-evaluated.
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Affiliation(s)
- Antoni Gayà
- Banc de Teixits, Fundació Banc de Sang i Teixits de les Illes Balears (FBSTIB), Palma, Spain.,Cell Therapy and Tissue Engineering Group (TERCIT), Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Massimo Rittà
- Laboratory of Molecular Virology and Antiviral Research, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - David Lembo
- Laboratory of Molecular Virology and Antiviral Research, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Paola Tonetto
- Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
| | - Francesco Cresi
- Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
| | - Stefano Sottemano
- Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
| | - Enrico Bertino
- Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
| | - Guido E Moro
- Italian Association of Human Milk Banks, Milan, Italy
| | - Javier Calvo
- Banc de Teixits, Fundació Banc de Sang i Teixits de les Illes Balears (FBSTIB), Palma, Spain.,Cell Therapy and Tissue Engineering Group (TERCIT), Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Manuela Donalisio
- Laboratory of Molecular Virology and Antiviral Research, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Abstract
Background: The pasteurization is a mandatory step to inactivate pathogenic microorganisms of bank milk. For storage, freezing and thawing are necessary. The concentration of macronutrients and energy of bank milk could be influenced by these procedures which are routinely used in human milk bank. Research Aim: The aim of this study is to analyze the effect of bank milk processing (pasteurization and freezing/thawing) on the macronutrients (fat, protein, and carbohydrate) concentration and energy content. Materials and Methods: The samples of donor milk were collected and studied before/after pasteurization and after frozen for 3 months. Total 100 samples of bank milk were tested using an infrared analyzer. The measurements of fat, protein, carbohydrate, and energy were statistically analyzed by SPSS. Results: There was a prominent reduction of fat mean concentration following pasteurization and frozen (20.5% and 6.5%, respectively). The processing did not cause significant changes in protein content, but there were significant increase after pasteurization and decrease after frozen in carbohydrate (p < 0.05). Overall (postpasteurization and frozen storage), a 9.6% decrease was observed for energy content. Conclusion: This study revealed that the processing of bank milk (including Holder Pasteurization and frozen storage) decreased fat and energy content of human milk significantly, and this could not meet the specific needs of preterm infants.
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Affiliation(s)
- Fang-Yuan Chang
- Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
| | - Li-Jung Fang
- Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
| | - Chao-Sheng Chang
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Tsung-Zu Wu
- Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
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Irazusta A, Rodríguez-Camejo C, Jorcin S, Puyol A, Fazio L, Arias F, Castro M, Hernández A, López-Pedemonte T. High-pressure homogenization and high hydrostatic pressure processing of human milk: Preservation of immunological components for human milk banks. J Dairy Sci 2020; 103:5978-5991. [PMID: 32418693 DOI: 10.3168/jds.2019-17569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
Abstract
Human milk (HM) constitutes the first immunological barrier and the main source of nutrients and bioactive components for newborns. Immune factors comprise up to 10% of the protein content in HM, where antibodies are the major components (mainly IgA, IgG, and IgM). In addition, antibacterial enzymes such as lysozyme and immunoregulatory factors such as soluble cluster of differentiation 14 (sCD14) and transforming growth factor β2 (TGF-β2) are also present and play important roles in the protection of the infant's health. Donor milk processed in HM banks by Holder pasteurization (HoP; 62.5°C, 30 min) is a safe and valuable resource for preterm newborns that are hospitalized, but is reduced in major immunological components due to thermal inactivation. We hypothesized that high hydrostatic pressure (HHP) and high-pressure homogenization (HPH) are 2 processes that can be used on HM to reduce total bacteria counts while retaining immunological components. We studied the effects of HHP (400, 450, and 500 MPa for 5 min applied at 20°C) and HPH (200, 250, and 300 MPa, milk inlet temperature of 20°C) applied to mature HM, on microbiological and immunological markers (IgA, IgG, IgM, sCD14, and TGF-β2), and compared them with those of traditional HoP in HM samples from healthy donors. The HHP processing between 400 and 500 MPa at 20°C reduced counts of coliform and total aerobic bacteria to undetectable levels (<1.0 log cfu/mL) while achieving approximately 100% of immunological component retention. In particular, comparing median percentages of retention of immunological components for 450 MPa versus HoP, we found 101.5 versus 50.5% for IgA, 89.5 versus 26.0% for IgM, 104.5 versus 75.5% for IgG, 125.0 versus 72.5% for lysozyme, 50.6 versus 0.1% for sCD14, and 88.5 versus 61.1% for TGF-β2, respectively. Regarding HPH processing, at a pressure of 250 MPa and inlet temperature of 20°C, the process showed good potential to reduce coliforms to undetectable levels and total aerobic bacteria to levels slightly above those obtained by HoP. The median percentages of retention of immunological markers for HPH versus HoP were 71.5 versus 52.0%, 71.0 versus 27.0%, 104.0 versus 66.5%, and 30.9 versus 0.2%, for IgA, IgM, IgG, and sCD14, respectively; results did not significantly differ for lysozyme and TGF-β2. The HPH at 300 MPa produced higher inactivation of immunological components, similar to values achieved with HoP.
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Affiliation(s)
- A Irazusta
- Área de Tecnología de Alimentos, Departamento de Ciencia y Tecnología de Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay 11800
| | - C Rodríguez-Camejo
- Cátedra de Inmunología, Instituto de Química Biológica, Facultad de Ciencias-Área Inmunología, Departamento de Biociencias, Facultad de Química, Instituto de Higiene, Universidad de la República, Montevideo, Uruguay 11600
| | - S Jorcin
- Área de Tecnología de Alimentos, Departamento de Ciencia y Tecnología de Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay 11800
| | - A Puyol
- Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay 11600
| | - L Fazio
- Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay 11600
| | - F Arias
- Cátedra de Inmunología, Instituto de Química Biológica, Facultad de Ciencias-Área Inmunología, Departamento de Biociencias, Facultad de Química, Instituto de Higiene, Universidad de la República, Montevideo, Uruguay 11600
| | - M Castro
- Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay 11600
| | - A Hernández
- Cátedra de Inmunología, Instituto de Química Biológica, Facultad de Ciencias-Área Inmunología, Departamento de Biociencias, Facultad de Química, Instituto de Higiene, Universidad de la República, Montevideo, Uruguay 11600
| | - T López-Pedemonte
- Área de Tecnología de Alimentos, Departamento de Ciencia y Tecnología de Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay 11800.
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Lehman IM, Broers B, Czosnykowska-Łukacka M, Wesolowska W, Swiderska L, Krolak-Olejnik B. Donor human milk in Neonatal Intensive Care Unit - to whom, how much and how long? Ginekol Pol 2020; 90:534-538. [PMID: 31588551 DOI: 10.5603/gp.2019.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/27/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the study was to present the variability of patients who received donor human milk (DHM) duringNeonatal Intensive Care Unit (NICU) hospitalization, including time of its usage and volume of portions. MATERIAL AND METHODS A retrospective analysis of data was conducted for all infants admitted to the NICU at the UniversityHospital during the first year of the Human Milk Bank operation. One-way analysis of variance in the intergroup scheme,Kruskal-Wallis variance analysis with the Jonckheere-Tepstra test, correlation analysis using Pearson's r and Spearmann'srho, frequency analysis using the Fisher's exact test were used to conduct analyses. RESULTS 133 newborns received DHM. 3 groups of neonates were identified: < 32 0/7 weeks, 32 0/7-36 6/7 weeksand > 37 0/7 weeks of gestational age (GA). Time of DHM supplementation was similar in all groups and does not differdepending on the GA but preterm infants received the smallest total volume of DHM. However, infants > 37 weeks ofGA had almost a threefold greater chance of abandoning breastfeeding than the others (odds ratio (OR) = 2.89, 95% CI:0.69-12.20). There was a statistically significant, weak negative correlation between period of total parenteral nutrition andthe volume of milk from the bank: rho = -0.194; p = 0.026. CONCLUSIONS The DHM supply did not have a negative impact on lactation and breastfeeding. Stimulation of lactation wasnecessary for 5-7 days. The time of DHM supply was the same regardless of GA. The majority of infants were breastfed orreceived only MOM on the day of discharge from the hospital.
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Affiliation(s)
| | - Barbara Broers
- Departament of Neonatology, Wroclaw Medical University, Poland
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Abstract
Background: Donor human milk plays a vital part in the care of sick neonates. There is paucity of literature on the profile of human milk donors of low- and middle-income countries (LMICs). Materials and Methods: This retrospective observational study evaluated the demographic profile of 1,553 donors of a human milk bank of a tertiary care center from a LMIC over a period of 21 months. Results: The mean age of the donors was 21.6 ± 2.7 years. Around 63% of the donors were from the postnatal care wards and 53.3% had given birth to a premature infant. The total volume of human milk donated was 413 L and the mean volume of milk per donor was 268 ± 386 mL. The mean amount of milk donated by the neonatal intensive care unit (NICU) mothers was significantly higher when compared to that donated by the postnatal care ward mothers (p = 0.0001). Two-thirds (65.5%) of the donated milk was from mothers who gave birth to a preterm infant and 20.8% was from mothers of preterm neonates of <32 weeks of gestation. There was no statistical difference between the mean amount of milk donated by a mother who had delivered extremely preterm neonates when compared to those who had delivered very preterm neonates (p = 0.18). Conclusions: The predominant donors of a human milk bank from a LMIC are of a younger age group, are more likely to have delivered a premature or a low birth weight baby, and are mostly the ones whose neonates require NICU admission or from postnatal care wards.
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Affiliation(s)
- Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | | | - Maheshwar Bhasin
- Vatsalya Maatri Amrit Kosh, Comprehensive Lactation Management Centre, Lady Hardinge Medical College, New Delhi, India
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Mizuno K, Shimizu T, Ida S, Ito S, Inokuchi M, Ohura T, Okumura A, Kawai M, Kikuchi T, Sakurai M, Sugihara S, Suzuki M, Takitani K, Tanaka D, Mushiake S, Yoshiike N, Kodama H, Okada K, Tsutsumi C, Hara M, Hanawa Y, Kawakami K, Inomata H, Oguni T, Bito Y, Uchida K, Sugiyama A. Policy statement of enteral nutrition for preterm and very low birthweight infants. Pediatr Int 2020; 62:124-127. [PMID: 32026585 PMCID: PMC7065204 DOI: 10.1111/ped.14067] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/03/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
Abstract
For preterm and very low birthweight infants, the mother's own milk is the best nutrition. Based on the latest information for mothers who give birth to preterm and very low birthweight infants, medical staff should encourage and assist mothers to pump or express and provide their own milk whenever possible. If the supply of maternal milk is insufficient even though they receive adequate support, or the mother's own milk cannot be given to her infant for any reason, donor human milk should be used. Donors who donate their breast milk need to meet the Guideline of the Japan Human Milk Bank Association. Donor human milk should be provided according to the medical needs of preterm and very low birthweight infants, regardless of their family's financial status. In the future, it will be necessary to create a system to supply an exclusive human milk-based diet (EHMD), consisting of human milk with the addition of a human milk-derived human milk fortifier, to preterm and very low birthweight infants.
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Affiliation(s)
- Katsumi Mizuno
- Director Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Toshiaki Shimizu
- Director Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Shinobu Ida
- Chair Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Setsuko Ito
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Mikako Inokuchi
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Toshihiro Ohura
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Akihisa Okumura
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Masanobu Kawai
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Toru Kikuchi
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Motoichiro Sakurai
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Shigetaka Sugihara
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Mitsuyoshi Suzuki
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Kimitaka Takitani
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Daisuke Tanaka
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Sotaro Mushiake
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Nobuo Yoshiike
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Hiroko Kodama
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Kazuo Okada
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Chiharu Tsutsumi
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Mitsuhiko Hara
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Yoshio Hanawa
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Kazue Kawakami
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Hiroaki Inomata
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Tatsuya Oguni
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Yuko Bito
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Keiichi Uchida
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
| | - Akihide Sugiyama
- Board Committee on Nutrition, The Child Health Consortium of Japan, Tokyo, Japan
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Cayer MP, Dussault N, de Grandmont MJ, Cloutier M, Lewin A, Brouard D. Evaluation of the Tempo® System: Improving the Microbiological Quality Monitoring of Human Milk. Front Pediatr 2020; 8:494. [PMID: 32984208 PMCID: PMC7492530 DOI: 10.3389/fped.2020.00494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Bacteriological testing of donor human milk is mostly done both before and after pasteurization to control contamination in the end-product and meet the microbiological standards. Although the plate count method represents a reliable and sensitive technique and is considered the gold standard for bacteriological testing, it is recognized for being time-consuming and requiring qualified personnel. Recently, faster testing technologies, mostly geared toward the food industry, have been developed. Among these, the bioMérieux TEMPO® system uses the most probable number method to assess microbiological content in a semi-automated fashion. Objective: The performances of the TEMPO® system in enumerating bacterial quality indicators in human milk were assessed and compared to the reference plate count method. Methods: Naturally and artificially contaminated human milk samples were used to compare the analytical performances of the TEMPO® system to the plate count technique. More specifically, bacteria belonging to the genera Bacillus, Enterobacteriaceae, Staphylococcus aureus, and total aerobic flora were screened using both methods. Bacteria isolated on agar plates containing selective media were identified by supplemental testing. Bacterial testing results and method parameters were compared using linear regression analyses and Bland-Altman approaches. Results: Naturally contaminated milk samples (n = 55) tested for total aerobic flora showed < 1 log (CFU/ml) discrepancy between the two methods in the output results for 98% of the samples. Comparative linear regression analyses demonstrate good correlations between the two methods (R 2 > 0.9). At lower levels of bacterial contamination, the TEMPO® method precision (C.V. < 8%) and accuracy (> 83%) were comparable to plate counts. Conclusions: The analytical performances of the TEMPO® system for human milk bacteriological testing are equivalent to the reference plate count method. Results from the TEMPO® system are available within a 24-h turnaround time from sample inoculation without the need for further supplemental testing, suggesting that this semi-automated method could be implemented within milk bank operations as an in-process monitoring technology to optimize end-product quality and safety.
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Affiliation(s)
| | | | | | - Marc Cloutier
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada.,Département de biochimie, Université Laval, Québec, QC, Canada
| | - Antoine Lewin
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada.,Département d'obstétrique et gynécologie, Université de Sherbrooke, Québec, QC, Canada
| | - Danny Brouard
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada.,Département de chimie, Université Laval, Québec, QC, Canada
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Sbrizzi S, Quitadamo PA, Ravidà D, Palumbo G, Cristalli PP, Pettoello-Mantovani M. Analytical Study of Donor's Milk Bank Macronutrients by Infrared Spectroscopy. Correlations With Clinic-Metabolic Profile of 100 Donors. Front Public Health 2019; 7:234. [PMID: 31572700 PMCID: PMC6752055 DOI: 10.3389/fpubh.2019.00234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
For its specific qualitative characteristics human donor milk (DM) is the main alternative to preterm infants nutrition and growing. How several studies suggest child's physical and mental development is influenced by breastfeeding that prevents the necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis common in preterm newborns. Our research was conducted in NICU's Human Milk Bank (HMB) "Allattiamolavita." Our study was based on macronutrients analysis (MA) of 100 DM samples taken until 10 days since childbirth and analyzed by spectroscopic infrared innovative method (MIRIS). This is a specific method to analyse fat (F), crude proteins (CP), true proteins (TP), carbohydrate (CHO), and total solids (TS). We also analyzed the 100 donors' clinic-metabolic profile by blood tests (PMT). Both data was collected between September 2015 and February 2018. The research was structured in two parts. In the first part we compared PMT with qualitative and quantitative characteristics of MA while in the second one we studied every DM macronutrient finding furthermore possible relations between them. Statistical Package for Social Sciences (SPSS-IBM 24) was used to compare data and reporting coefficient of determination using Spearman's Rho and Kendall's Tau. We also analyzed samples using Kolmogorov-Smirnov test, Student T-test, ANOVA, Whitney U-test, and chi-square test. Statistically significant correlations were noted between maternal serum proteins and CP-TP of DM. The research showed also significant correlations between azotaemia and TP and an inverse correlation between serum creatinine and CP. No statistically significant correlation was observed between donors' glycaemia and CHO. Mineral concentrations of DM emerged independent of blood minerals (P, Ca, Fe, Na). We also calculated a normal range for individual macronutrient of human transitional milk (TM) that was not established in literature yet. Our experience allowed us to underline that human milk is a privileged site compared to donors' clinical and metabolic disorders. Our analysis showed the major role of the HMB to provide DM to improve clinical status, growing, and neurocognitive short and long term outcome of preterm infants.
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Affiliation(s)
- Stefania Sbrizzi
- NICU, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
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Capriati T, Goffredo BM, Argentieri M, De Vivo L, Bernaschi P, Cairoli S, Laureti F, Reposi MP, Marino D, Benedetti S, Diamanti A. A Modified Holder Pasteurization Method for Donor Human Milk: Preliminary Data. Nutrients 2019; 11:nu11051139. [PMID: 31121859 PMCID: PMC6566761 DOI: 10.3390/nu11051139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Holder pasteurization (HoP) is the recommended method of pasteurization for donor human milk (DHM). The aim of the present study was to compare nutritional and microbiological impact on DHM of a new technique of pasteurization based on technical changes of HoP. Methods: We analyzed milk samples from 25 donors. Each sample, derived from one breast milk expression, was subdivided into three aliquots according to pasteurization: The first was not pasteurized, the second pasteurized by HoP, and the third was pasteurized by modified HoP (MHoP). Each aliquot was assessed as to its microbiological and nutritional profile. Nutritional profile included calcium and triglycerides concentrations detected by spectrophotometry and amino acid levels assessed by high-performance liquid chromatography (HPLC). Results: Triglycerides were significantly lower in pasteurized, by both methods, than in not pasteurized aliquots, while calcium and amino acids concentration were similar. Microbiological profile did not differ between HoP and MHoP aliquots. Conclusions: HoP and MHoP seem to have similar efficacy in preserving some nutritional characteristics of DHM and to confer similar microbiological safety. MHoP is time-saving and potentially costs-effective when compared to HoP, and it is; therefore, potentially of more interest from a practical point of view. Further studies are needed to confirm these findings.
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Affiliation(s)
- Teresa Capriati
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Bianca Maria Goffredo
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Marta Argentieri
- Unit of Microbiology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Liliana De Vivo
- Clinical Engineering Department, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Paola Bernaschi
- Unit of Microbiology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Sara Cairoli
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Francesca Laureti
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Maria Paola Reposi
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Daniela Marino
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Sabina Benedetti
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Antonella Diamanti
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Moro GE, Billeaud C, Rachel B, Calvo J, Cavallarin L, Christen L, Escuder-Vieco D, Gaya A, Lembo D, Wesolowska A, Arslanoglu S, Barnett D, Bertino E, Boquien CY, Gebauer C, Grovslien A, Weaver GA, Picaud JC. Processing of Donor Human Milk: Update and Recommendations From the European Milk Bank Association (EMBA). Front Pediatr 2019; 7:49. [PMID: 30873395 PMCID: PMC6403467 DOI: 10.3389/fped.2019.00049] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background: A mother's own milk (MOM) is the gold standard for the feeding and nutrition of preterm and full term infants. When MOM is not available or there is not enough, donor human milk (DHM) should be used. Milk delivered to Human Milk Banks (HMBs) should be pasteurized to inactivate viral and bacterial agents. Currently, a pasteurization process at 62.5°C for 30 min (Holder pasteurization, HoP) is recommended in all international HMBs guidelines. State of the art: It is known that HoP affects some of the nutritional and biological components of human milk. Studies have demonstrated that temperature cycle in HoP is not always controlled or calibrated. A better check of these parameters in the pasteurizers on the market today may contribute to an improvement of the quality of HM, still maintaining some of the negative effects of the heat treatment of human milk. So, food industry, and dairy industry in particular, are evaluating innovative methodologies alternative to HoP to better preserve the nutritional and biological properties of fresh human milk, while assuring at least the same microbiological safety of HoP. The most studied processing techniques include High-Temperature-Short-Time (HTST) pasteurization, High Pressure Processing (HPP), and Ultraviolet-C (UV-C) irradiation. HTST is a thermal process in which milk is forced between plates or pipes that are heated on the outside by hot water at a temperature of 72°C for 5-15 s. HPP is a non-thermal processing method that can be applied to solid and liquid foods. This technology inactivates pathogenic microorganisms by applying a high hydrostatic pressure (usually 300-800 MPa) during short-term treatments (<5-10 min). UV irradiation utilizes short-wavelength ultraviolet radiation in the UV-C region (200-280 nm), which is harmful to microorganisms. It is effective in destroying the nucleic acids in these organisms, so that their DNA is disrupted by UV radiation. Aim: The aim of this paper is to present the EMBA recommendations on processing of HM, based on the most recent results obtained with these new technologies. Conclusions: Although research on the most promising technologies that will represent an alternative to HoP (HTST, HPP, UV-C) in the future is progressing, it is now important to recognize that the consistency and quality assurance of the pasteurizers on the market today represent a fundamental component that was previously lacking in the Holder approach.
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Affiliation(s)
- Guido E. Moro
- Associazione Italiana delle Banche del Latte Umano Donato, Milan, Italy
| | - Claude Billeaud
- Neonatology Nutrition, Lactarium Bordeaux-Marmande, CIC Pédiatrique 1401 Children's Hospital, Bordeaux, France
| | - Buffin Rachel
- Lactarium Auvergne Rhone Alpes, Hospices Civils de Lyon, Lyon, France
| | - Javier Calvo
- Fundació Banc Sang i Teixits de les Illes Balears, Palma de Mallorca, Spain
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Turin, Italy
| | | | - Diana Escuder-Vieco
- Banco Regional de Leche Materna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antoni Gaya
- Fundació Banc Sang i Teixits de les Illes Balears, Palma de Mallorca, Spain
| | - David Lembo
- Laboratory of Molecular Virology, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Aleksandra Wesolowska
- Department of Neonatology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Sertac Arslanoglu
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Debbie Barnett
- Greater Glasgow and Cycle Donor Milk Bank, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Enrico Bertino
- Neonatal Unit of Turin University, City of Health and Science, Turin, Italy
| | - Clair-Yves Boquien
- PhAN, Institut National de la Recherche Agronomique, Université de Nantes, CRNH-Ouest, Nantes, France
| | - Corinna Gebauer
- Abteilung Neonatologie Klinik und Poliklinik für Kinder und Jugendliche, Leipzig, Germany
| | - Anne Grovslien
- Breast Milk Bank, Oslo University Hospital, Oslo, Norway
| | - Gillian A. Weaver
- The Milk Bank, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jean-Charles Picaud
- Lactarium Auvergne Rhone Alpes, Hospices Civils de Lyon, Lyon, France
- CarMeN Unit, INSERM U1397, Claude Bernard University Lyon 1, Lyon, France
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38
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Fernández L, Ruiz L, Jara J, Orgaz B, Rodríguez JM. Strategies for the Preservation, Restoration and Modulation of the Human Milk Microbiota. Implications for Human Milk Banks and Neonatal Intensive Care Units. Front Microbiol 2018; 9:2676. [PMID: 30473683 PMCID: PMC6237971 DOI: 10.3389/fmicb.2018.02676] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Studies carried in the last years have revealed that human milk contains a site-specific microbiota and constitutes a source of potentially beneficial bacteria to the infant gut. Once in the infant gut, these bacteria contribute to the assembly of a physiological gut microbiota and may play several functions, contributing to infant metabolism, protection against infections, immunomodulation or neuromodulation. Many preterm neonates are fed with pasteurized donor’s human milk (DHM) or formula and, therefore, are devoid of contact with human milk microbes. As a consequence, new strategies are required to allow the exposition of a higher number of preterm infants to the human milk microbiota early in life. The first strategy would be to promote and to increase the use of own mother’s milk (OMM) in Neonatal Intensive Care Units (NICUs). Even small quantities of OMM can be very valuable since they would be added to DHM in order to microbiologically “customize” it. When OMM is not available, a better screening of donor women, including routine cytomegalovirus (CMV) screening of milk, may help to avoid the pasteurization of the milk provided by, at least, a relevant proportion of donors. Finally, when pasteurized DHM or formula are the only feeding option, their supplementation with probiotic bacteria isolated from human milk, such as lactic acid bacteria or bifidobacteria, may be an alternative to try to restore a human milk-like microbiota before feeding the babies. In the future, the design of human milk bacterial consortia (minimal human milk microbiotas), including well characterized strains representative of a healthy human milk microbiota, may be an attractive strategy to provide a complex mix of strains specifically tailored to this target population.
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Affiliation(s)
- Leónides Fernández
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Lorena Ruiz
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias - Consejo Superior de Investigaciones Científicas, Villaviciosa, Spain
| | - Josué Jara
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Belén Orgaz
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias - Consejo Superior de Investigaciones Científicas, Villaviciosa, Spain
| | - Juan M Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
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Demazeau G, Plumecocq A, Lehours P, Martin P, Couëdelo L, Billeaud C. A New High Hydrostatic Pressure Process to Assure the Microbial Safety of Human Milk While Preserving the Biological Activity of Its Main Components. Front Public Health 2018; 6:306. [PMID: 30460221 PMCID: PMC6232532 DOI: 10.3389/fpubh.2018.00306] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/05/2018] [Indexed: 11/22/2022] Open
Abstract
Background: The main process used to pasteurize human milk is the low-temperature, long-time Holder method. More recently, the high-temperature, short-time method has been investigated. Both processes lead to the appropriate inactivation of vegetative bacterial forms but are ineffective against bacterial spores. Research Aims/Questions: We aimed to accomplish two main objectives: inactivation of all pathogens, including spores; and preservation of the activity of milk components. Design/Methods: Recently, a novel high-hydrostatic pressure process has been developed by HPBioTECH. Using the same raw human milk samples, we compared the effects of this method with those of the Holder method on vegetative and spore forms of pathogens and on bioactive components (lipase activity, immunoproteins). Results: Two main microbial strains were selected: Staphylococcus aureus (as a reference for vegetative forms) and Bacillus cereus (as a reference for spores). Use of the high-hydrostatic pressure process led to microbial decontamination of 6 log for both S. aureus and B. cereus. Additionally, the bioactivity of the main components of human milk was preserved, with activities of lipase, α-lactalbumin, casein, lysozyme, lactoferrin, and sIgA of ~80, 96-99, 98-100, 95-100, 93-97, and 63-64%, respectively. Conclusions: Use of this novel high-hydrostatic pressure process to generate microbiologically safe human milk may provide important benefits for preterm infants, including improved assimilation of human milk (leading increased weight gain) and improved resistance to infections. Because 10% of all human milk collected is contaminated by B. cereus, use of this method will also prevent waste.
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Affiliation(s)
| | | | - Philippe Lehours
- Laboratoire de Bacteriologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Patrice Martin
- UMR1313 GABI, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France
| | - Leslie Couëdelo
- Department Nutrition-Health & Lipid biochemistry of ITERG, Bordeaux, France
| | - Claude Billeaud
- Neonatology Nutrition, Lactarium Bordeaux-Marmande, CIC Pédiatrique 1401 Children's Hospital, Bordeaux, France
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Abstract
Donor human milk (DHM) in human milk banks (HMB) is routinely subjected to heat treatment to ensure microbiological security, most guidelines recommending a temperature of 62. 5°C for 30 min. However, this procedure negatively impacts on milk quality, due to the destruction of biological components. Different studies have called for a more respectful treatment of DHM to preserve its properties, and have explored the use of alternative technologies. There is also clear evidence that bacterial and viral contamination in human milk can be effectively destroyed by temperatures lower than that currently recommended (62.5°C). Thus, a simple option would be to optimize the conventional pasteurization technique so the treated milk is free of infectious elements yet retains a maximum amount of biological components. An advantage of this approach is that it would be unnecessary to replace the pasteurization equipment currently available in most HMB. On the basis of a literature review, we here analyze and discuss evidence that pasteurization of human milk at a temperature below 62.5°C results in an improved preservation of its properties without compromising safety regarding the transmission of infectious agents.
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Affiliation(s)
- Antoni Gayà
- Banc de Llet Materna, Fundació Banc de Sang i Teixits de les Illes Balears, Palma de Mallorca, Spain
- Terapia Celular e Ingeniería Tisular, Institut d'Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | - Javier Calvo
- Banc de Llet Materna, Fundació Banc de Sang i Teixits de les Illes Balears, Palma de Mallorca, Spain
- Terapia Celular e Ingeniería Tisular, Institut d'Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
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Bertino E, Peila C, Cresi F, Maggiora E, Sottemano S, Gazzolo D, Arslanoglu S, Coscia A. Donor Human Milk: Effects of Storage and Heat Treatment on Oxidative Stress Markers. Front Pediatr 2018; 6:253. [PMID: 30345262 PMCID: PMC6182067 DOI: 10.3389/fped.2018.00253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/28/2018] [Indexed: 01/03/2023] Open
Abstract
Mother's own milk is the first choice for the feeding and nutrition of preterm and term newborns. When mother's own milk is unavailable or in short supply donor human milk (DM) could represent a solution. Heat treatment and cold storage are common practices in Human Milk Banks (HMBs). Currently, Holder pasteurization process is the recommended heat treatment in all international guidelines. This method is thought to lead to a good compromise between the microbiological safety and nutritional/biological quality of DM. Moreover, storage of refrigerated milk is a common practice in HMBs and in NICUs. Depending on the length and on the type of storage, human milk may lose some important nutritional and functional properties. The available data on oxidative stress markers confirm that pasteurization and refrigeration affected this important elements to variable degrees, even though it is rather difficult to quantify the level of deterioration. Nonetheless, clinical practice demonstrates that many beneficial properties of human milk are preserved, even after cold storage and heat treatment. Future studies should be focused on the evaluation of new pasteurization techniques, in order to achieve a better compromise between biological quality and safety of DM.
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Affiliation(s)
- Enrico Bertino
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| | - Chiara Peila
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
- Department of Maternal, Fetal and Neonatal Health, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesco Cresi
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| | - Elena Maggiora
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| | - Stefano Sottemano
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
| | - Sertac Arslanoglu
- Department of Pediatrics, Division of Neonatology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Alessandra Coscia
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
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Israel-Ballard K. Strengthening Systems to Ensure All Infants Receive Human Milk: Integrating Human Milk Banking into Newborn Care and Nutrition Programming. Breastfeed Med 2018; 13:524-526. [PMID: 30335484 DOI: 10.1089/bfm.2018.0133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kiersten Israel-Ballard
- 1 Department of Maternal, Newborn, Child Health and Nutrition , PATH, Seattle, Washington.,2 Department of Global Health, University of Washington, Seattle, Washington
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Adhisivam B, Kohat D, Tanigasalam V, Bhat V, Plakkal N, Palanivel C. Does fortification of pasteurized donor human milk increase the incidence of necrotizing enterocolitis among preterm neonates? A randomized controlled trial. J Matern Fetal Neonatal Med 2018; 32:3232-3237. [PMID: 29618272 DOI: 10.1080/14767058.2018.1461828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To compare the effect of fortified pasteurized donor human milk (PDHM) versus unfortified PDHM on the incidence of necrotizing enterocolitis (NEC) and immediate outcome among preterm neonates. Methods: This randomized controlled trial (RCT) conducted in a tertiary care teaching hospital, south India included 80 healthy preterm neonates randomized to two groups (Group A and B). Neonates in Group A and B were fed with fortified PDHM and unfortified PDHM, respectively. Neonates in both groups were managed uniformly as per standard NICU protocol. The primary outcome was the incidence of NEC and the secondary outcomes included severity of NEC, incidence of sepsis, mortality, duration of hospital stay, number of days to reach full enteral feeds and weight gain. Neonates were followed up for 28 days or discharge whichever was earlier. Results: The baseline maternal and neonatal characteristics in both groups were comparable. There was no increase in incidence of NEC in fortified PDHM group compared to unfortified PDHM group (2.5 versus 7.5%, p = .31). Severity of NEC, incidence of sepsis, mortality, duration of hospital stay, number of days to reach full enteral feeds and weight gain were also similar in both groups. Conclusions: Standard fortification of PDHM does not increase the incidence of NEC among preterm neonates.
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Affiliation(s)
- Bethou Adhisivam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Dilesh Kohat
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Vasanthan Tanigasalam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Vishnu Bhat
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Nishad Plakkal
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - C Palanivel
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
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Kanaprach P, Pongsakul N, Apiwattanakul N, Muanprasat C, Supapannachart S, Nuntnarumit P, Chutipongtanate S. Evaluation of Fetal Intestinal Cell Growth and Antimicrobial Biofunctionalities of Donor Human Milk After Preparative Processes. Breastfeed Med 2018; 13:215-220. [PMID: 29451823 DOI: 10.1089/bfm.2017.0208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Donor human milk is considered the next best nutrition following mother's own milk to prevent neonatal infection and necrotizing enterocolitis in preterm infants who are admitted at neonatal intensive care unit. However, donor milk biofunctionalities after preparative processes have rarely been documented. OBJECTIVE To evaluate biofunctionalities preserved in donor milk after preparative processes by cell-based assays. MATERIALS AND METHODS Ten pools of donor milk were produced from 40 independent specimens. After preparative processes, including bacterial elimination methods (holder pasteurization and cold-sterilization microfiltration) and storage conditions (-20°C freezing storage and lyophilization) with varied duration of storage (0, 3, and 6, months), donor milk biofunctionalities were examined by fetal intestinal cell growth and antimicrobial assays. RESULTS At baseline, raw donor milk exhibited 193.1% ± 12.3% of fetal intestinal cell growth and 42.4% ± 11.8% of antimicrobial activities against Escherichia coli. After bacteria eliminating processes, growth promoting activity was better preserved in pasteurized donor milk than microfiltrated donor milk (169.5% ± 14.3% versus 146.0% ± 11.8%, respectively; p < 0.005), whereas antimicrobial activity showed no difference between groups (38.3% ± 14.1% versus 53.7% ± 17.3%, respectively; p = 0.499). The pasteurized donor milk was further examined for the effects of storage conditions at 3 and 6 months. Freezing storage, but not lyophilization, could preserve higher growth-promoting activity during 6 months of storage (163.0% ± 9.4% versus 72.8% ± 6.2%, respectively; p < 0.005). Nonetheless, antimicrobial activity was lost at 6 months, regardless of the storage methods. CONCLUSIONS This study revealed that fetal intestinal cell growth and antimicrobial assays could be applied to measure donor milk biofunctionalities and support the utilization of donor milk within 3 months after preparative processes.
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Affiliation(s)
- Pasinee Kanaprach
- 1 Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Nutkridta Pongsakul
- 2 Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Nopporn Apiwattanakul
- 3 Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Chatchai Muanprasat
- 4 Department of Physiology, Faculty of Science, Mahidol University , Bangkok, Thailand
| | - Sarayut Supapannachart
- 5 Division of Neonatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Pracha Nuntnarumit
- 5 Division of Neonatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Somchai Chutipongtanate
- 2 Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
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45
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Adhisivam B, Vishnu Bhat B, Rao K, Kingsley SM, Plakkal N, Palanivel C. Effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. J Matern Fetal Neonatal Med 2018; 32:3016-3019. [PMID: 29587541 DOI: 10.1080/14767058.2018.1455089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: The objective of this study was to study the effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. Methods: This descriptive study was conducted in a Human Milk Bank of a tertiary care teaching institute in south India. Thirty random paired pooled donor human milk samples (before and after pasteurization) were analyzed for macronutrients (protein, fat, carbohydrates) using infrared spectroscopy. Similarly, immunoglobulin profile (IgA and IgG) before and after pasteurization was quantified using ELISA. Results: The mean values of protein, fat, and carbohydrates in pooled donor milk pre-pasteurization were 1.6, 3.6, and 6.1 g/dl compared with post-pasteurization values 1.4, 2.7, and 5.9 g/dl, respectively. Pasteurization reduced protein, fat, and energy content of pooled donor milk by 12.5%, 25%, and 16%, respectively. However, carbohydrates were not significantly reduced. Pasteurization decreased IgA by 30% and IgG by 60%. Conclusion: Holder pasteurization of pooled donor human milk decreases protein, fat, and energy content and also reduces the levels of IgA and IgG.
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Affiliation(s)
- B Adhisivam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - B Vishnu Bhat
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - Krishna Rao
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - S M Kingsley
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - Nishad Plakkal
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - C Palanivel
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
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Buffin R, Hays S, Drai J, Sarda MN, Picaud JC. Better Control of Holder Pasteurization Results in Higher Retention of Human Milk Lactoferrin, IgA, and Lysozyme. Front Pediatr 2018; 6:381. [PMID: 30560111 PMCID: PMC6287107 DOI: 10.3389/fped.2018.00381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Holder pasteurization is commonly used in milk banks. We previously reported that the pattern of temperature and time may be different according to the pasteurizer used. Aim: The aim of our study was to assess the variances in pasteurization using two different devices: a standard pasteurizer (Past STD) and an optimized pasteurizer (Past OPTI). Methods: Immunoglobulin A (IgA), lactoferrin (LF), and lysozyme (LZ) content were assessed before and after pasteurization of 24 donor human milk samples. The impact of the pasteurization device was evaluated by testing 50- to 200-mL samples. Results: Mean temperature and duration of the plateau were 1.5°C lower and 11 min shorter, respectively, with Past OPTI vs. Past STD. The loss of IgA, LF, and LZ was 17.6, 5.6, and 9.8% lower, respectively, with Past OPTI than with Past STD. Conclusions: Accurate control of temperature enabled better preservation of IgA, LF, and LZ in donor milk. Holder pasteurization should be optimized, and new techniques proposed to treat donor milk should be compared with Holder pasteurization performed with a well-controlled device under realistic conditions.
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Affiliation(s)
- Rachel Buffin
- Neonatology Department, Croix-Rousse Hospital, Lyon, France.,Régional Rhône Alpes Auvergne Human Milk Bank, Hôpital de la Croix-Rousse, Lyon, France
| | - Stéphane Hays
- Régional Rhône Alpes Auvergne Human Milk Bank, Hôpital de la Croix-Rousse, Lyon, France
| | - Jocelyne Drai
- Biochemistry Laboratory, Lyon-sud Hospital, Pierre-Bénite, France
| | | | - Jean-Charles Picaud
- Neonatology Department, Croix-Rousse Hospital, Lyon, France.,Régional Rhône Alpes Auvergne Human Milk Bank, Hôpital de la Croix-Rousse, Lyon, France.,CarMen Unit, INSERM U1060, INRA U197, Claude Bernard University, Pierre-Bénite, France
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Adhisivam B, Vishnu Bhat B, Banupriya N, Poorna R, Plakkal N, Palanivel C. Impact of human milk banking on neonatal mortality, necrotizing enterocolitis, and exclusive breastfeeding - experience from a tertiary care teaching hospital, south India. J Matern Fetal Neonatal Med 2017; 32:902-905. [PMID: 29046116 DOI: 10.1080/14767058.2017.1395012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study is to study the impact of a Human Milk Bank (HMB) on neonatal mortality, incidence of necrotizing enterocolitis (NEC) and rate of exclusive breastfeeding. METHODS This pre-post intervention study was conducted in a tertiary care teaching institute in south India. Data regarding neonatal mortality, incidence of NEC, and exclusive breastfeeding rates were collected for a period of 6 months before and after establishing a modern HMB and compared. RESULTS The number of deliveries, live births, and incidence of preterm and VLBW neonates during pre- and post-HMB periods were comparable. Neonatal mortality was 11.32/1000 live births pre-HMB compared with 10.77/1000 live births post HMB. The incidence of NEC was 1.26% of live births pre-HMB compared with 1.07% post-HMB. Exclusive breastfeeding rate pre-HMB was 34% compared with 74% post HMB (p < .001). CONCLUSION There is a decreasing trend in neonatal mortality and incidence of NEC after establishing a HMB. Human milk banking significantly improved exclusive breastfeeding rate in the population studied.
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Affiliation(s)
- B Adhisivam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Puducherry , India
| | - B Vishnu Bhat
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Puducherry , India
| | - N Banupriya
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Puducherry , India
| | - Rachel Poorna
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Puducherry , India
| | - Nishad Plakkal
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Puducherry , India
| | - C Palanivel
- b Department of Preventive & Social Medicine , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Puducherry , India
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Liu XH. [Research advances in breastfeeding]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18:921-925. [PMID: 27751204 PMCID: PMC7389531 DOI: 10.7499/j.issn.1008-8830.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 06/30/2016] [Indexed: 06/06/2023]
Abstract
Human breast milk is the most natural and ideal food for the baby. Breastfeeding provides benefits for maternal and child health, child immune function, growth and development, and society. The operation of human milk bank and the use of donor human milk undoubtedly provides a new way of nutrition support for the preterm infants without their own mother's milk and a new kind of treatment for other diseases. Present research on the composition of breast milk focuses on the variety and quantity of proteins, bioactive substances, probiotics and cell population.Future research may focus on the bioactive substances, the mechanism of regulation and effect of cell population, the application of probiotics and the clinical application of donor human milk.
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Affiliation(s)
- Xi-Hong Liu
- Department of Clinical Nutriology, Guangzhou Maternal and Child Medical Center, Guangzhou 510623, China.
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Grazziotin MCB, Grazziotin AL, Vidal NM, Freire MHDS, da Silva RPGVC. Analysis of the Storage Methods for Raw Human Milk from Mothers with Infants Admitted to a Neonatal Intensive Care Unit, According to Brazilian Regulations. J Hum Lact 2016; 32:446-54. [PMID: 27165765 DOI: 10.1177/0890334416647710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Milk safety is an important concern in neonatal units and human milk banks. Therefore, evidence-based recommendations regarding raw milk handling and storage are needed to safely promote supplying hospitalized infants with their mother's own milk. OBJECTIVES To evaluate raw human milk storage methods according to Brazilian milk management regulations by investigating the effects of refrigeration (5°C) for 12 hours and freezing (-20°C) for 15 days on the acidity and energy content in a large number of raw milk samples. METHODS Expressed milk samples from 100 distinct donors were collected in glass bottles. Each sample was separated into 3 equal portions that were analyzed at room temperature and after either 12 hours of refrigeration or 15 days of freezing. Milk acidity and energy content were determined by Dornic titration and creamatocrit technique, respectively. RESULTS All samples showed Dornic acidity values within the established acceptable limit (≤ 8°D), as required by Brazilian regulations. In addition, energy content did not significantly differ among fresh, refrigerated and frozen milk samples (median of ~50 kcal/100 mL for each). CONCLUSION Most samples tested (> 80%) were considered top quality milk (< 4°D) based on acidity values, and milk energy content was preserved after storage. We conclude that the storage methods required by Brazilian regulations are suitable to ensure milk safety and energy content of stored milk when supplied to neonates.
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Affiliation(s)
| | - Ana Laura Grazziotin
- Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Rio de Janeiro, Brasil
| | - Newton Medeiros Vidal
- National Center for Biotechnology Information, National Institutes of Health, Bethesda, MD, USA
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Mizuno K, Sakurai M, Itabashi K. Necessity of human milk banking in Japan: Questionnaire survey of neonatologists. Pediatr Int 2015; 57:639-44. [PMID: 25728542 DOI: 10.1111/ped.12606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/15/2015] [Accepted: 02/04/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND If their own mother's milk (OMM) is not available, another mother's milk may be used for extremely low-birthweight (ELBW) infants. Human milk is a bodily fluid, however, therefore we have assumed that other mother's milk is currently seldom given to infants despite its superiority to formula. Although the World Health Organization and the American Academy of Pediatrics have recommended using donor human milk (DHM) from a human milk bank (HMB) in the case that OMM is not available, there is no HMB in Japan. To assess whether other mother's milk is used for ELBW infants and whether an HMB is necessary in Japan, we surveyed neonatal intensive care units (NICU) via questionnaire. METHODS The questionnaire was sent by email to members of the Japanese Neonatologist Association who are responsible for NICU. RESULTS In total, 126 completed questionnaires (70.7%) were returned and analyzed. One-fourth of NICU give other mother's milk to ELBW infants. The first choice of nutrition is OMM, but other mother's milk or formula is given to infants at 19% of NICU if OMM is unavailable. Approximately three-fourths of NICU would like an HMB. CONCLUSION Although human milk contains contagious agents and authorities do not recommend giving other mother's milk as a substitute for OMM, other mother's milk is still a choice in NICU in Japan. Many neonatologists, however, would prefer a safer alternative, that is, DHM obtained from an accredited HMB. A well-regulated HMB should be established and safe DHM should be available for all preterm infants if necessary.
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Affiliation(s)
- Katsumi Mizuno
- Department of Pediatrics, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Motoichiro Sakurai
- Department of Pediatrics, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kazuo Itabashi
- Department of Pediatrics, Showa University of Medicine, Tokyo, Japan
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