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Jones KS, Meadows SR, Koulman A. Quantification and reporting of vitamin D concentrations measured in human milk by LC-MS/MS. Front Nutr 2023; 10:1229445. [PMID: 38035362 PMCID: PMC10687194 DOI: 10.3389/fnut.2023.1229445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Vitamin D is essential for optimal bone health, and vitamin D deficiency has been associated with an increased risk of adverse pregnancy, growth and developmental outcomes. In early life, and in the absence of endogenous vitamin D production from UVB light, infants are reliant on vitamin D stores established in utero and the vitamin D supply from human milk (HM). However, comprehensive data on vitamin D in HM is lacking. Thus, in this review we explore the application of liquid-chromatography tandem mass spectrometry (LC-MS/MS) to the assessment of vitamin D in HM. We discuss the challenges of extracting and measuring multiple vitamin D metabolites from HM including the frequent requirement for a large sample volume, and inappropriate poor sensitivity. Shortcomings in the reporting of experimental procedures and data analysis further hinder advances in the field. Data collated from all studies that have applied LC-MS/MS reveal that, in general, cholecalciferol concentration is greater and more variable than 25-hydroxyvitamin D concentration, and that the vitamin D content of HM is low and less than the currently recommended dietary requirement of infants, although maternal supplementation can increase the vitamin D content of HM. Improvements in analytical methods and their validation and larger, more representative studies are required to better characterize HM milk vitamin D metabolite concentrations and their relationship with maternal status. These data are essential to understand relationships with infant health and to inform public health policies around vitamin D fortification and supplementation.
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Affiliation(s)
- Kerry S. Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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2
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Growth after implementing a donor breast milk program in neonates <33 weeks gestational age or birthweight <1500 grams: Retrospective cohort study. J Perinatol 2023; 43:608-615. [PMID: 36737571 PMCID: PMC9897884 DOI: 10.1038/s41372-023-01627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Donor breast milk (DBM) feeding has been associated with less growth than formula in preterm infants. Zinc content in DBM is insufficient to support growth in preterm infants. OBJECTIVE To compare growth from birth to discharge, macro- and micronutrient intake and the frequency of poor growth before (Epoch-1) and after (Epoch-2) implementing a DBM program. METHODS Retrospective cohort study of 1069 infants born at < 33 weeks' gestational age or birthweight < 1500 g and fed using our adjustable feeding protocol with accurate serial length measurements. Growth was assessed by changes in Z-scores of weight, length and fronto-occipital circumference from birth to discharge. RESULTS Growth did not decrease significantly in Epoch-2. However, energy and protein intake increased by 5% and frequency of zinc and vitamin D supplementation increased by >30%. CONCLUSIONS DBM implementation did not significantly decrease growth from birth to discharge using our adjustable feeding protocol.
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How to Provide Breast Milk for the Preterm Infant and Avoid Symptomatic Cytomegalovirus Infection with Possible Long-Term Sequelae. Life (Basel) 2022; 12:life12040504. [PMID: 35454995 PMCID: PMC9031638 DOI: 10.3390/life12040504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 12/04/2022] Open
Abstract
Cytomegalovirus (CMV) is able to replicate in the breast milk of lactating mothers and thus the offspring might be affected by mild to severe symptoms of postnatal CMV disease in case of prematurity; not in term infants. Sepsis-like syndrome affects only very low birth infants; and few cases have been reported. The neurodevelopmental long-term outcome of those preterm infants revealed possible subtle deficiencies, but no major neurodevelopmental impairment. Neurodevelopmental sequelae are still in discussion and seem somewhat overestimated after careful evaluation of the published evidence. The main focus of postnatal CMV disease lies upon the extremely low birth weight of infants. Elimination of CMV is provided by short-term heating methods like the most widely used Holder pasteurization. Freezing and thawing methods leave a risk for CMV acquisition. The benefits of untreated breast milk have to be considered to outweigh the possible sequelae of postnatal CMV infection in the most vulnerable preterm infants.
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Artman A, Huang A, Bowker R, Cerwinske L, Cooper S, Johnson T, Patel AL. Evaluation of vitamin D protocol in the neonatal intensive care unit at Rush University Medical Center. JPEN J Parenter Enteral Nutr 2021; 46:618-625. [PMID: 34125972 DOI: 10.1002/jpen.2138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In 2017, the neonatal intensive care unit (NICU) at Rush University Medical Center (RUMC) implemented a protocol to provide individualized vitamin D supplementation dosing for very low-birth-weight (VLBW) and very preterm infants. This study evaluated the association of demographic and socioeconomic factors, vitamin D dose, and health indicators, including bone mineral status, measured by alkaline phosphatase and phosphorus levels; linear growth velocity; and occurrence of fractures. METHOD This retrospective cross-sectional study included 227 VLBW or very preterm infants (34 VLBW, 12 very preterm, and 181 VLBW and very preterm) born in and discharged from the RUMC NICU between February 1, 2017, and October 31, 2019. Vitamin D dose was classified as adjusted (supplemental dose of 800 IU/day, n = 169) or standard (recommended dose of 400 IU/day, n = 58), per the protocol. Binary logistic and linear regression models were constructed to test the associations between infant and maternal characteristics and vitamin D dose group and between vitamin D dose group and health indicators. RESULTS The analysis found a statistically significant association between maternal age, gestational age, infant birth weight, and race/ethnicity and receipt of an adjusted vitamin D dose. No significant associations were found between health indicators and vitamin D dose. CONCLUSION Sociodemographic factors may influence vitamin D deficiency in VLBW and very preterm infants in the NICU. At this time, there is insufficient evidence to support a tailored approach, but further research in this area is warranted.
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Affiliation(s)
- Alexis Artman
- Department of Health Systems Management, Rush University, Chicago, Illinois, USA.,Pediatric and Maternal & Fetal Service Line, Rush University Medical Center, Chicago, Illinois, USA.,Master of Science - Health Systems Management, Department of Health Systems Management, College of Health Sciences, Rush University, Chicago, Illinois, USA
| | - Annie Huang
- Department of Health Systems Management, Rush University, Chicago, Illinois, USA.,Pediatric and Maternal & Fetal Service Line, Rush University Medical Center, Chicago, Illinois, USA.,Master of Science - Health Systems Management, Department of Health Systems Management, College of Health Sciences, Rush University, Chicago, Illinois, USA
| | - Rakhee Bowker
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| | - Leah Cerwinske
- Department of Clinical Nutrition, Rush University, Chicago, Illinois, USA
| | - Shaun Cooper
- Department of Health Systems Management, Rush University, Chicago, Illinois, USA.,Pediatric and Maternal & Fetal Service Line, Rush University Medical Center, Chicago, Illinois, USA
| | - Tricia Johnson
- Department of Health Systems Management, Rush University, Chicago, Illinois, USA
| | - Aloka L Patel
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
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Escuder-Vieco D, Rodríguez JM, Espinosa-Martos I, Corzo N, Montilla A, García-Serrano A, Calvo MV, Fontecha J, Serrano J, Fernández L, Pallás-Alonso CR. High-Temperature Short-Time and Holder Pasteurization of Donor Milk: Impact on Milk Composition. Life (Basel) 2021; 11:life11020114. [PMID: 33546253 PMCID: PMC7913308 DOI: 10.3390/life11020114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 01/04/2023] Open
Abstract
Holder pasteurization (HoP; 62.5 °C, 30 min) is commonly used to ensure the microbiological safety of donor human milk (DHM) but diminishes its nutritional properties. A high-temperature short-time (HTST) system was designed as an alternative for human milk banks. The objective of this study was to evaluate the effect of this HTST system on different nutrients and the bile salt stimulated lipase (BSSL) activity of DHM. DHM was processed in the HTST system and by standard HoP. Macronutrients were measured with a mid-infrared analyzer. Lactose, glucose, myo-inositol, vitamins and lipids were assayed using chromatographic techniques. BSSL activity was determined using a kit. The duration of HTST treatment had a greater influence on the nutrient composition of DHM than did the tested temperature. The lactose concentration and the percentage of phospholipids and PUFAs were higher in HTST-treated than in raw DHM, while the fat concentration and the percentage of monoacylglycerides and SFAs were lower. Other nutrients did not change after HTST processing. The retained BSSL activity was higher after short HTST treatment than that following HoP. Overall, HTST treatment resulted in better preservation of the nutritional quality of DHM than HoP because relevant thermosensitive components (phospholipids, PUFAs, and BSSL) were less affected.
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Affiliation(s)
- Diana Escuder-Vieco
- Banco Regional de Leche Materna, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, 28041 Madrid, Spain
- Correspondence: (D.E.-V.); or (L.F.); Tel.: +34-913-908-811 (D.E.-V.); +34-913-943-745 (L.F.)
| | - Juan M. Rodríguez
- Sección Departamental de Nutrición y Ciencia de los Alimentos (Veterinaria), Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | | | - Nieves Corzo
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), 28049 Madrid, Spain; (N.C.); (A.M.); (A.G.-S.); (M.V.C.); (J.F.)
| | - Antonia Montilla
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), 28049 Madrid, Spain; (N.C.); (A.M.); (A.G.-S.); (M.V.C.); (J.F.)
| | - Alba García-Serrano
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), 28049 Madrid, Spain; (N.C.); (A.M.); (A.G.-S.); (M.V.C.); (J.F.)
| | - M. Visitación Calvo
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), 28049 Madrid, Spain; (N.C.); (A.M.); (A.G.-S.); (M.V.C.); (J.F.)
| | - Javier Fontecha
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), 28049 Madrid, Spain; (N.C.); (A.M.); (A.G.-S.); (M.V.C.); (J.F.)
| | - José Serrano
- Departament de Medicina Experimental, Facultad de Medicina, Universitat de Lleida, 25008 Lleida, Spain;
| | - Leónides Fernández
- Sección Departamental de Farmacia Galénica y Tecnología Alimentaria (Veterinaria), Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence: (D.E.-V.); or (L.F.); Tel.: +34-913-908-811 (D.E.-V.); +34-913-943-745 (L.F.)
| | - Carmen Rosa Pallás-Alonso
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Universidad Complutense de Madrid, 28041 Madrid, Spain;
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Poulimeneas D, Bathrellou E, Antonogeorgos G, Mamalaki E, Kouvari M, Kuligowski J, Gormaz M, Panagiotakos DB, Yannakoulia M. Feeding the preterm infant: an overview of the evidence. Int J Food Sci Nutr 2020; 72:4-13. [PMID: 32340495 DOI: 10.1080/09637486.2020.1754352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Feeding from own mother's milk is not always an option for preterm infants, and choosing between alternative means of feeding should be made in light of their effect on infants' health. In this work, we aimed to present evidence regarding feeding pre-term infants with human milk, either own mother's or donor milk (DM), and the potential effects on growth and other health related outcomes. Exclusive breastfeeding (BF) remains the optimal option, whereas feeding with DM as a sole diet or supplemental to maternal milk confers immunological advantages and fewer rates of necrotising enterocolitis against preterm formula feeding, yet the latter results in greater growth velocity. Literature gaps in the use of DM, practical suggestions for choosing suitable feeding means (i.e. continuous support of BF, adequate education regarding feeding preterm infants, including DM), and future perspectives on the potential effects of dietary manipulations of the maternal diet, are also discussed.
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Affiliation(s)
- Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - George Antonogeorgos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Eirini Mamalaki
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - María Gormaz
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Neonatal Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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Abstract
The aim of human milk banks is to deliver safe and high quality donor human milk. Treatment of human milk has to destroy most microorganisms while preserving immunological and nutrient components, which is obtained when using low time low temperature pasteurization. However it destroys bile-simulated lipase, reduces lactoferrin, lysozyme, immunoglobulins, and bactericidal capacity of human milk. New methods are under investigation such as high temperature short time pasteurization, high pressure processing, or ultraviolet irradiation. They have been tested in experimental conditions and there are promising results, but they have to be tested in real conditions in human milk bank.
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Affiliation(s)
- Jean-Charles Picaud
- Neonatal Unit, Hôpital de la Croix-Rousse, Lyon F-69004, France; Rhone-Alpes Auvergneregional Human Milk Bank, Hôpital de la Croix-Rousse, Lyon F-69004, France; Lyon Sud Charles Merieux School of Medicine, Université Claude Bernard Lyon 1, Pierre-Bénite F-69310, France; Rhone-Alpes Human Nutrition Research Center, Hôpital Lyon Sud, Pierre-Bénite F-69310, France; European Milk Bank Association (EMBA), Milano, Italy.
| | - Rachel Buffin
- Neonatal Unit, Hôpital de la Croix-Rousse, Lyon F-69004, France; Rhone-Alpes Auvergneregional Human Milk Bank, Hôpital de la Croix-Rousse, Lyon F-69004, France
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Hanson C, Lyden E, Furtado J, Van Ormer M, Anderson-Berry A. A Comparison of Nutritional Antioxidant Content in Breast Milk, Donor Milk, and Infant Formulas. Nutrients 2016; 8:nu8110681. [PMID: 27801820 PMCID: PMC5133069 DOI: 10.3390/nu8110681] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Human milk is the optimal food for human infants, including infants born prematurely. In the event that a mother of a hospitalized infant cannot provide breast milk, donor milk is considered an acceptable alternative. It is known that the macronutrient composition of donor milk is different than human milk, with variable fat content and protein content. However, much less is known about the micronutrient content of donor milk, including nutritional antioxidants. Samples of breast milk from 12 mothers of infants hospitalized in the Newborn Intensive Care Unit until were collected and analyzed for concentrations of nutritional antioxidants, including α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein + zeaxanthin, retinol, and α-tocopherol. Additionally, a homogenized sample of donor milk available from a commercial milk bank and samples of infant formulas were also analyzed. Concentrations of nutritional antioxidants were measured using high-performance liquid chromatography. Compared to breast milk collected from mothers of hospitalized infants, commercially available donor milk had 18%–53% of the nutritional antioxidant content of maternal breast milk. As donor milk is becoming a common nutritional intervention for the high risk preterm infant, the nutritional antioxidant status of donor milk–fed premature infants and outcomes related to oxidative stress may merit further investigation.
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Affiliation(s)
- Corrine Hanson
- College of Allied Health Professions, University of Nebraska Medical Center, Medical Nutrition Education, 984045 Nebraska Medical Center, Omaha, NE 68198-4045, USA.
| | - Elizabeth Lyden
- College of Public Health, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA.
| | - Jeremy Furtado
- Department of Nutrition, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02215, USA.
| | - Matthew Van Ormer
- Pediatrics, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA.
| | - Ann Anderson-Berry
- Pediatrics, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA.
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Ran LH, Bao L. [Research advances in breast milk-acquired cytomegalovirus infection in premature infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18. [PMID: 27751206 PMCID: PMC7389540 DOI: 10.7499/j.issn.1008-8830.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Breast milk is considered ideal food for premature infants, but it can also be the main source of cytomegalovirus (CMV) infection in premature infants. CMV infection may cause serious clinical symptoms, such as sepsis-like syndrome, thrombocytopenia, neutropenia, jaundice, hepatitis, and pneumonitis. This article reviews the research advances in symptoms, treatment strategies, prognosis and the prevention of breast milk-acquired CMV infection in premature infants.
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Affiliation(s)
- Li-Hong Ran
- Department of Neonatology, Children's Hospital of Chongqing Medical University, China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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