Banking for the future: investing in human milk

Effect of the PiAstra Benchtop Flash-Heating Pasteurizer on Immune Factors of Donor Human Milk

INTRODUCTION

PiAstra is a simulated flash-heat (FH) pasteurization temperature monitoring system designed using Raspberry Pi technology for the pasteurization of human milk. This study analyzed the effect of the PiAstra FH method on human milk immune components (immunoglobulin A [IgA] and lactoferrin activity).

METHODS

Donor milk samples (N = 45) were obtained from a human milk bank, and pasteurized. Concentrations of IgA and lactoferrin activity were compared to their unpasteurized controls using the Student's t test.

RESULTS

The PiAstra FH method retained 34.2% of IgA (p < 0.0001) and 40.4% of lactoferrin activity (p < 0.0001) when compared to unpasteurized controls. The retention of IgA by the PiAstra is similar to previous FH studies, while retention of lactoferrin activity was higher than previous FH studies.

DISCUSSION

The high-technology, low-cost PiAstra system, which is able to retain vital immune components of human milk, provides safe donor milk for low-resourced settings. This enables the use of pasteurized donor milk when human milk is not available, potentially saving vulnerable infant lives.

The effect of simulated flash heating pasteurisation and Holder pasteurisation on human milk oligosaccharides

BACKGROUND

Human milk oligosaccharides (HMOs) have important protective functions in human milk. A low-cost remote pasteurisation temperature-monitoring system has been designed using FoneAstra, a cell phone-based networked sensing system to monitor simulated flash heat pasteurisation.

AIM

To compare the pasteurisation effect on HMOs of the FoneAstra FH method with the current Sterifeed Holder method used by human milk banks.

METHODS

Donor human milk samples (n = 48) were obtained from a human milk bank and pasteurised using the two pasteurisation methods. HMOs were purified from samples and labelled before separation using high-performance liquid chromatography. Concentrations of total HMOs, sialylated and fucosylated HMOs and individual HMOs using the two pasteurisation methods were compared using repeated-measures ANOVA.

RESULTS

The study demonstrated no difference in total concentration of HMOs between the two pasteurisation methods and a small but significant increase in the total concentration of HMOs regardless of pasteurisation methods compared with controls (unpasteurised samples) (p<0.0001).

CONCLUSION

The FoneAstra FH pasteurisation system does not negatively affect oligosaccharides in human milk and therefore is a possible alternative for providing safely sterilised human milk for low- and middle-income countries.

Probiotics to prevent necrotising enterocolitis and nosocomial infection in very low birth weight preterm infants

The aim of the study was to determine whether routine probiotic supplementation (RPS) with Lactobacillus rhamnosus GG (LGG) or Lactobacillus acidophilus +Lactobacillus bifidum is associated with reduced risk of necrotising enterocolitis (NEC)≥Stage II in preterm neonates born at ≤32 weeks' gestation. We conducted a retrospective cohort study on the effect of probiotic supplementation in very low birth weight infants in our neonatal unit by comparing two periods: before and after supplementation. The incidence of NEC≥Stage II, late-onset sepsis and all-cause mortality was compared for an equal period 'before' (Period I) and 'after' (Period II) RPS with LGG or L. acidophillus+L. bifidum. Multivariate logistic regression analysis was conducted to adjust for relevant confounders. The study population was composed of 261 neonates (Period I v. II: 134 v. 127) with comparable gestation duration and birth weights. In <32 weeks, we observed a significant reduction in NEC≥Stage II (11·3 v. 4·8 %), late-onset sepsis (16 v. 10·5 %) and mortality (19·4 v. 2·3 %). The benefits in neonates aged ≤27 weeks did not reach statistical significance. RPS with LGG or L. acidophillus+L. bifidum is associated with a reduced risk of NEC≥Stage II, late-onset sepsis and mortality in preterm neonates born at ≤32 weeks' gestation.

The Effect of Simulated Flash-Heat Pasteurization on Immune Components of Human Milk

A pasteurization temperature monitoring system has been designed using FoneAstra, a cellphone-based networked sensing system, to monitor simulated flash-heat (FH) pasteurization. This study compared the effect of the FoneAstra FH (F-FH) method with the Sterifeed Holder method currently used by human milk banks on human milk immune components (immunoglobulin A (IgA), lactoferrin activity, lysozyme activity, interleukin (IL)-8 and IL-10). Donor milk samples (N = 50) were obtained from a human milk bank, and pasteurized. Concentrations of IgA, IL-8, IL-10, lysozyme activity and lactoferrin activity were compared to their controls using the Student's t-test. Both methods demonstrated no destruction of interleukins. While the Holder method retained all lysozyme activity, the F-FH method only retained 78.4% activity (p < 0.0001), and both methods showed a decrease in lactoferrin activity (71.1% Holder vs. 38.6% F-FH; p < 0.0001) and a decrease in the retention of total IgA (78.9% Holder vs. 25.2% F-FH; p < 0.0001). Despite increased destruction of immune components compared to Holder pasteurization, the benefits of F-FH in terms of its low cost, feasibility, safety and retention of immune components make it a valuable resource in low-income countries for pasteurizing human milk, potentially saving infants' lives.

Demonstrating the efficacy of the FoneAstra pasteurization monitor for human milk pasteurization in resource-limited settings

Human milk provides crucial nutrition and immunologic protection for infants. When a mother's own milk is unavailable, donated human milk, pasteurized to destroy bacteria and viruses, is a lifesaving replacement. Flash-heat pasteurization is a simple, low-cost, and commonly used method to make milk safe, but currently there is no system to monitor milk temperature, which challenges quality control. FoneAstra, a smartphone-based mobile pasteurization monitor, removes this barrier by guiding users through pasteurization and documenting consistent and safe practice. This study evaluated FoneAstra's efficacy as a quality control system, particularly in resource-limited settings, by comparing bacterial growth in donor milk flash-heated with and without the device at a neonatal intensive care unit in Durban, South Africa.

MATERIALS AND METHODS

For 100 samples of donor milk, one aliquot each of prepasteurized milk, milk flash-heated without FoneAstra, and milk pasteurized with FoneAstra was cultured on routine agar for bacterial growth. Isolated bacteria were identified and enumerated.

RESULTS

In total, 300 samples (three from each donor sample) were analyzed. Bacterial growth was found in 86 of the 100 samples before any pasteurization and one of the 100 postpasteurized samples without FoneAstra. None of the samples pasteurized using FoneAstra showed bacterial growth.

CONCLUSIONS

Both pasteurization methods were safe and effective. FoneAstra, however, provides the additional benefits of user-guided temperature monitoring and data tracking. By improving quality assurance and standardizing the pasteurization process, FoneAstra can support wide-scale implementation of human milk banks in resource-limited settings, increasing access and saving lives.

The relationship between feeding and necrotizing enterocolitis in very low birth weight infants

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the NICU, with often devastating consequences. The etiology of NEC is probably multifactorial, with preterm infants at the highest risk. The relationship between feeding and NEC was identified in the 1970s, leading to delayed feeding becoming standard treatment in NICUs. More recent research suggests that early feedings not only are safe, but reduce other morbidities associated with prematurity. Standardized feeding guidelines seem to confer some benefits in decreasing NEC, despite a wide variability in feeding practices within the published guidelines. A standardized approach to the management of feeding problems may be the key. This article briefly reviews the pathogenesis of NEC and examines studies of various feeding practices for their relationship to the development of NEC. It also highlights the potential benefits of breast milk in NEC prevention.