1
|
Thayagabalu S, Cacho N, Sullivan S, Smulian J, Louis‐Jacques A, Bourgeois M, Chen H, Weerasuriya W, Lemas DJ. A systematic review of contaminants in donor human milk. MATERNAL & CHILD NUTRITION 2024; 20:e13627. [PMID: 38268226 PMCID: PMC10981490 DOI: 10.1111/mcn.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
Donor human milk (DHM) from a milk bank is the recommended feeding method for preterm infants when the mother's own milk (MOM) is not available. Despite this recommendation, information on the possible contamination of donor human milk and its impact on infant health outcomes is poorly characterised. The aim of this systematic review is to assess contaminants present in DHM samples that preterm and critically ill infants consume. The data sources used include PubMed, EMBASE, CINAHL and Web of Science. A search of the data sources targeting DHM and its potential contaminants yielded 426 publications. Two reviewers (S. T. and D. L.) conducted title/abstract screening through Covidence software, and predetermined inclusion/exclusion criteria yielded 26 manuscripts. Contaminant types (bacterial, chemical, fungal, viral) and study details (e.g., type of bacteria identified, study setting) were extracted from each included study during full-text review. Primary contaminants in donor human milk included bacterial species and environmental pollutants. We found that bacterial contaminants were identified in 100% of the papers in which bacterial contamination was sought (16 papers) and 61.5% of the full data set (26 papers), with the most frequently identified genera being Staphylococcus (e.g., Staphylococcus aureus and coagulase-negative Staphylococcus) and Bacillus (e.g., Bacillus cereus). Chemical pollutants were discovered in 100% of the papers in which chemical contamination was sought (eight papers) and 30.8% of the full data set (26 papers). The most frequently identified chemical pollutants included perfluoroalkyl substances (six papers), toxic metal (one paper) and caffeine (one paper). Viral and fungal contamination were identified in one paper each. Our results highlight the importance of establishing standardisation in assessing DHM contamination and future studies are needed to clarify the impact of DHM contaminants on health outcomes.
Collapse
Affiliation(s)
- Sionika Thayagabalu
- Department of Health Outcomes and Biomedical Informatics, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Nicole Cacho
- Department of Pediatrics, Division of NeonatologyUniversity of CaliforniaDavisCaliforniaUSA
| | - Sandra Sullivan
- Envision Healthcare, HCA Florida North Florida HospitalGainesvilleFloridaUSA
| | - John Smulian
- Department of Obstetrics and Gynecology, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
- Center for Perinatal Outcomes Research, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Adetola Louis‐Jacques
- Department of Obstetrics and Gynecology, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
- Center for Perinatal Outcomes Research, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Marie Bourgeois
- Department of Public HealthUniversity of South FloridaTampaFloridaUSA
| | - Henian Chen
- Department of Public HealthUniversity of South FloridaTampaFloridaUSA
| | | | - Dominick J. Lemas
- Department of Health Outcomes and Biomedical Informatics, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
- Department of Obstetrics and Gynecology, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
- Center for Perinatal Outcomes Research, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| |
Collapse
|
2
|
Jandová M, Fišerová M, Paterová P, Cacková L, Měřička P, Malý J, Kacerovský M, Kovaříková E, Strohalm J, Demnerová K, Kadavá J, Sýkorová H, Hyšpler R, Čížková D, Bezrouk A, Houška M. High-Pressure Inactivation of Bacillus cereus in Human Breast Milk. Foods 2023; 12:4245. [PMID: 38231674 DOI: 10.3390/foods12234245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024] Open
Abstract
Although Holder pasteurization is the recommended method for processing breast milk, it does affect some of its nutritional and biological properties and is ineffective at inactivating spores. The aim of this study was to find and validate an alternative methodology for processing breast milk to increase its availability for newborn babies and reduce the financial loss associated with discarding milk that has become microbiologically positive. We prepared two series of breast milk samples inoculated with the Bacillus cereus (B. cereus) strain to verify the effectiveness of two high-pressure treatments: (1) 350 MPa/5 min/38 °C in four cycles and (2) cumulative pressure of 350 MPa/20 min/38 °C. We found that the use of pressure in cycles was statistically more effective than cumulative pressure. It reduced the number of spores by three to four orders of magnitude. We verified that the method was reproducible. The routine use of this method could lead to an increased availability of milk for newborn babies, and at the same time, reduce the amount of wasted milk. In addition, high-pressure treatment preserves the nutritional quality of milk.
Collapse
Affiliation(s)
- Miroslava Jandová
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
- Department of Histology and Embryology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic
| | - Michaela Fišerová
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
| | - Pavla Paterová
- Department of Clinical Microbiology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic
| | - Lucie Cacková
- Department of Clinical Microbiology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic
| | - Pavel Měřička
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
| | - Jan Malý
- Department of Pediatrics, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
| | - Marian Kacerovský
- Biomedical Research Center, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
| | | | - Jan Strohalm
- Food Research Institute Prague, 102 00 Prague, Czech Republic
| | - Kateřina Demnerová
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, 166 28 Prague, Czech Republic
| | - Jana Kadavá
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, 166 28 Prague, Czech Republic
| | - Hana Sýkorová
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, 166 28 Prague, Czech Republic
| | - Radomír Hyšpler
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
| | - Dana Čížková
- Department of Histology and Embryology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic
| | - Aleš Bezrouk
- Department of Medical Biophysics, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic
| | - Milan Houška
- Food Research Institute Prague, 102 00 Prague, Czech Republic
| |
Collapse
|
3
|
Tabasso C, Piemontese P, Pesenti N, Perrone M, Menis C, Liotto N, Amato O, Orsi A, Mallardi D, Mosca F, Roggero P. Pooling Strategies to Modify Macronutrient Content of Pasteurized Donor Human Milk. Breastfeed Med 2023; 18:370-376. [PMID: 37098175 DOI: 10.1089/bfm.2023.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Background: Donor human milk (DHM) is the recommended feeding for preterm infants when mother's own milk is unavailable or insufficient. DHM macronutrient's variability may have significant implications on preterm growth. Different pooling strategies could be used to improve the macronutrient content, facilitating the achievement of nutritional requirements of preterm. Objective: The aim was to compare the impact of random pooling (RP) and target pooling (TP) strategies on the macronutrient content of DHM and to identify which RP practice allows the achievement of a macronutrient composition as similar as possible to that achievable with TP. Methods: The macronutrient content of 1,169 single-donor pools was analyzed, and a TP strategy combining 2,3,4, or 5 single-donor pools was adopted. On the bases of single-donor pools' analyses, a simulation of 10,000 randomly selected pools for each configuration of donor considered and for different milk volume proportions was performed. Results: Regardless of the type of strategy and milk volume, as the number of donor per pool increases, the percentage of pools with a macronutrient content equal or higher than the reference values for human milk increases. Conclusion: When a TP strategy is not feasible, a RP strategy combining at least five donors should be performed to obtain a better macronutrient content of DHM.
Collapse
Affiliation(s)
- Chiara Tabasso
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasqua Piemontese
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Pesenti
- Division of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Michela Perrone
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Menis
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nadia Liotto
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Orsola Amato
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Orsi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenica Mallardi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Roggero
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
4
|
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:nu15020412. [PMID: 36678283 PMCID: PMC9864883 DOI: 10.3390/nu15020412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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.
Collapse
|
5
|
Jandová M, Měřička P, Fišerová M, Landfeld A, Paterová P, Hobzová L, Jarkovská E, Kacerovský M, Houška M. Quantitative Risk Assessment of Bacillus cereus Growth during the Warming of Thawed Pasteurized Human Banked Milk Using a Predictive Mathematical Model. Foods 2022; 11:foods11071037. [PMID: 35407124 PMCID: PMC8997632 DOI: 10.3390/foods11071037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023] Open
Abstract
Bacillus cereus is relatively resistant to pasteurization. We assessed the risk of B. cereus growth during warming and subsequent storage of pasteurized banked milk (PBM) in the warmed state using a predictive mathematical model. Holder pasteurization followed by storage below −18 °C was used. Temperature maps, water activity values, and B. cereus growth in artificially inoculated PBM were obtained during a simulation of manipulation of PBM after its release from a Human Milk Bank. As a real risk level, we chose a B. cereus concentration of 100 CFU/mL; the risk was assessed for three cases: 1. For an immediate post-pasteurization B. cereus concentration below 1 CFU/mL (level of detection); 2. For a B. cereus concentration of 10 CFU/mL, which is allowed in some countries; 3. For a B. cereus concentration of 50 CFU/mL, which is approved for milk formulas. In the first and second cases, no risk was detected after 1 h of storage in the warmed state, while after 2 h of storage, B. cereus concentrations of 102 CFU/mL were occasionally encountered. In the third case, exceeding the B. cereus concentration of 102 CFU/mL could be regularly expected after 2 h of storage. Based on these results, we recommend that post-pasteurization bacteriological analysis be performed as recommended by the European Milk Bank Association (EMBA) and using warmed PBM within 1 h after warming (no exceptions).
Collapse
Affiliation(s)
- Miroslava Jandová
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
- Department of Histology and Embryology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic
- Correspondence: ; Tel.: +420-739-569-340
| | - Pavel Měřička
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
| | - Michaela Fišerová
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
| | - Aleš Landfeld
- Food Research Institute Prague, 102 00 Prague, Czech Republic; (A.L.); (M.H.)
| | - Pavla Paterová
- Department of Clinical Microbiology, University Hospital Hradec Králové, 500 05 and Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic;
| | - Lenka Hobzová
- Department of Hospital Hygiene, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Eva Jarkovská
- Department of Pediatrics, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Marian Kacerovský
- Department of Obstetrics and Gynecology, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Milan Houška
- Food Research Institute Prague, 102 00 Prague, Czech Republic; (A.L.); (M.H.)
| |
Collapse
|
6
|
Enteral Linezolid as an Effective Option to Treat an Extremely Preterm Infant with Bacillus cereus Sepsis. CHILDREN 2022; 9:children9030415. [PMID: 35327787 PMCID: PMC8947578 DOI: 10.3390/children9030415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Abstract
We report the safe and effective use of oral linezolid for treatment of Bacillus cereus sepsis in an extremely preterm neonate, previously fed with human donor milk, in which a Brevibacillus sp. was eventually found. Due to several predisposing factors, premature, very low birth weight newborns are extremely vulnerable to invasive infections by environmental pathogens. After vancomycin microbiologic treatment failure (despite adequate blood concentrations and clinical response), linezolid was chosen for its optimal enteral absorption and bioavailability, also after exhaustion of peripheral venous heritage. No adverse events were recorded, with clinical cure. We reviewed the literature on B. cereus infections in newborns, together with the available evidence on the use of linezolid in similar contexts.
Collapse
|