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Núñez-Delgado A, Mizrachi-Chávez VM, Welti-Chanes J, Macher-Quintana ST, Chuck-Hernández C. Breast milk preservation: thermal and non-thermal processes and their effect on microorganism inactivation and the content of bioactive and nutritional compounds. Front Nutr 2024; 10:1325863. [PMID: 38455872 PMCID: PMC10919153 DOI: 10.3389/fnut.2023.1325863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/26/2023] [Indexed: 03/09/2024] Open
Abstract
Human Breast Milk (HBM) is widely acknowledged as the best nutritional source for neonates. Data indicates that, in 2019, 83.2% of infants in the United States received breast milk at birth, slightly reducing to 78.6% at 1 month. Despite these encouraging early figures, exclusive breastfeeding rates sharply declined, dropping to 24.9% by 6 months. This decline is particularly pronounced when direct breastfeeding is challenging, such as in Neonatal Intensive Care Units (NICU) and for working mothers. Given this, it is vital to explore alternative breast milk preservation methods. Technologies like Holder Pasteurization (HoP), High-Temperature Short-Time Pasteurization (HTST), High-Pressure Processing (HPP), UV radiation (UV), and Electric Pulses (PEF) have been introduced to conserve HBM. This review aims to enhance the understanding of preservation techniques for HBM, supporting the practice of extended exclusive breastfeeding. It explicitly addresses microbial concerns, focusing on critical pathogens like Staphylococcus aureus, Enterococcus, Escherichia coli, Listeria monocytogenes, and Cytomegalovirus, and explores how various preservation methods can mitigate these risks. Additionally, the review highlights the importance of retaining the functional elements of HBM, particularly its immunological components such as antibodies and enzymes like lysozyme and Bile Salt Stimulated Lipase (BSSL). The goal is to provide a comprehensive overview of the current state of HBM treatment, critically assess existing practices, identify areas needing improvement, and advocate for extended exclusive breastfeeding due to its vital role in ensuring optimal nutrition and overall health in infants.
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Affiliation(s)
- Alejandro Núñez-Delgado
- Tecnologico, de Monterrey, School of Engineering and Sciences, Monterrey, Mexico
- Tecnologico de Monterrey, Institute for Obesity Research, Monterrey, Mexico
| | | | - Jorge Welti-Chanes
- Tecnologico, de Monterrey, School of Engineering and Sciences, Monterrey, Mexico
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Wang K, Zhao Y, Song S, Lin Y, Luo Y, Zhang Y, Xue Y, Li W, Zhang Y, Lu Y, Quan H, Zhang H, Liu H, Gou Q, Luo Z, Guo H. Changes in properties of human milk under different conditions of frozen storage. Food Res Int 2024; 176:113768. [PMID: 38163699 DOI: 10.1016/j.foodres.2023.113768] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
Human milk is the best source of nutrition for infants. Lower freezing temperatures and faster freezing rates allow for better preservation of human milk. However, research on the freezing conditions of human milk is limited. This study investigated the effectiveness of quick freezing and suitable freezing conditions for home preservation. Human milk was stored under different freezing conditions (-18 °C, -18 °C quick freezing, -30 °C, -40 °C, -60 °C, and - 80 °C) for 30, 60, and 90 days and then evaluated for changes in the microbial counts, bioactive protein, and lipid. The results showed that the total aerobic bacterial and Bifidobacteria counts in human milk after storage at freezing temperatures of - 30 °C and lower were closer to those of fresh human milk compared to - 18 °C. Furthermore, the lysozyme loss, lipid hydrolysis degree, and volatile organic compound production were lower. However, -18 °C quick freezing storage was not markedly different from -18 °C in maintaining human milk quality. Based on the results, for household and environmental reasons, the recommended temperature for storing human milk is suggested as -30 °C.
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Affiliation(s)
- Kaibo Wang
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Yanfeng Zhao
- Qingdao Haier Refrigerator Co., Ltd, Qingdao 266100, China
| | - Sijia Song
- Food Laboratory of Zhongyuan, Luohe 462300, China
| | - Yingying Lin
- Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China
| | - Yujia Luo
- Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China
| | - Yafei Zhang
- Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China
| | - Yi Xue
- Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China
| | - Wusun Li
- Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China
| | - Yuning Zhang
- Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China
| | - Yao Lu
- Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China
| | - Heng Quan
- Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China
| | - Hao Zhang
- Qingdao Haier Refrigerator Co., Ltd, Qingdao 266100, China
| | - Huihui Liu
- Haier Smart Home Co., Ltd, Qingdao 266001, China
| | - Qian Gou
- Qingdao Haier Refrigerator Co., Ltd, Qingdao 266100, China
| | - Zisheng Luo
- College of Biosystem Engineering and Food Science, Zhejiang University, Hangzhou 310058, People's Republic of China.
| | - Huiyuan Guo
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; Key Laboratory of Functional Dairy, Department of Nutrition and Health, China Agricultural University, Beijing 100089, China.
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Bello Durán LA, Vanegas Otalvaro D. [Variation in the level of the biocomponents immunoglobulin A and lactoferrin in human milk after Holder pasteurization]. NUTR HOSP 2023. [PMID: 36748426 DOI: 10.20960/nh.04218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND breast milk is the ideal food for newborns and infants, but there are factors that can prevent the practice of breastfeeding. Human milk banks (BLH) are a strategy to increase breastfeeding coverage; the donated milk is subjected to Holder pasteurization to guarantee its innocuousness, undergoing large changes in temperature and a decrease in the concentrations of biocomponents such as Immunoglobulin A (IgA) and lactoferrin (LF). This article describes the results of recent studies on the impact of Holder pasteurization on IgA and LF in human milk. MATERIAL AND METHODS a search for research articles related to the topic of interest was carried out in various databases and in accordance with inclusion criteria that considered the type of study, date of publication and quality of the journal. RESULTS the impact of Holder pasteurization on IgA and LF concentrations is not clear, given that the literature reports a variety of protocols and different results; however, the percentage reductions of both biocomponents are significant and consistent in the studies reviewed, suggesting the importance of establishing a standard protocol for their quantification. CONCLUSIONS Holder pasteurization guarantees the microbiological quality of the milk distributed in HMB, but affects the amount of beneficial biocomponents for the final recipient. Government entities that regulate HMBs should evaluate the possibility of using other techniques that reduce the impact on biocomponents while preserving the microbiological quality of the product.
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Kontopodi E, Hettinga K, Stahl B, van Goudoever JB, M van Elburg R. Testing the effects of processing on donor human Milk: Analytical methods. Food Chem 2022; 373:131413. [PMID: 34700038 DOI: 10.1016/j.foodchem.2021.131413] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 01/01/2023]
Abstract
Holder pasteurization is the current recommended method for donor human milk treatment. This method effectively eliminates most life-threatening contaminants in donor milk, but it also greatly reduces some of its biological properties. Consequently, there is a growing interest for developing novel processing methods that can ensure both microbial inactivation and a higher retention of the functional components of donor milk. Our aim was to offer a comprehensive overview of the analytical techniques available for the evaluation of such methods. To suggest an efficient workflow for the analysis of processed donor milk, a safety analytical panel as well as a nutritional value and functionality analytical panel are discussed, together with the principles, benefits, and drawbacks of the available techniques. Concluding on the suitability of a novel method requires a multifactorial approach which can be achieved by a combination of analytical targets and by using complementary assays to cross-validate the obtained results.
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Affiliation(s)
- Eva Kontopodi
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Human Milk Bank, Amsterdam, the Netherlands; Food Quality and Design Group, Wageningen University & Research, the Netherlands.
| | - Kasper Hettinga
- Food Quality and Design Group, Wageningen University & Research, the Netherlands
| | - Bernd Stahl
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Danone Nutricia Research, Utrecht, the Netherlands
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Human Milk Bank, Amsterdam, the Netherlands
| | - Ruurd M van Elburg
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Human Milk Bank, Amsterdam, the Netherlands
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García-González I, Corona-Cervantes K, Hernández-Quiroz F, Villalobos-Flores LE, Galván-Rodríguez F, Romano MC, Miranda-Brito C, Piña-Escobedo A, Borquez-Arreortúa FG, Rangel-Calvillo MN, García-Mena J. The Influence of Holder Pasteurization on the Diversity of the Human Milk Bacterial Microbiota Using High-Throughput DNA Sequencing. J Hum Lact 2022; 38:118-130. [PMID: 33906488 DOI: 10.1177/08903344211011946] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Human milk is the best food for infants; however, when breastfeeding is not possible, pasteurized milk from human milk banks is the best alternative. Little has been reported about variations in the bacterial microbiota composition of human milk after pasteurization. RESEARCH AIM To characterize and compare the bacterial microbiota composition and diversity within human milk among Mexican mothers before and after the Holder pasteurization process. METHODS A cross-sectional, observational, and comparative design was used. The effect of the pasteurization process on the bacterial composition and diversity of human milk samples of donors (N = 42) from a public milk bank was assessed before and after pasteurization by high throughput deoxyribonucleic acid sequencing of V3-16S rRNA gene libraries. Sequencing data were examined using the Quantitative Insights into Microbial Ecology software and Phyloseq in R environment. RESULTS A varied community of bacteria was found in both raw and pasteurized human milk. The bacterial diversity of the milk samples was increased by the pasteurization, where some thermoduric bacteria of the phyla Proteobacteria, Firmicutes, and Actinobacteria were more abundant. The source tracker analysis indicated that at most 1.0% of bacteria may have come from another source, showing the safety of the process used to treat milk samples. CONCLUSION The pasteurization process increased the bacterial diversity. We selected taxa capable of surviving the process, which could proliferate after the treatment without being a risk for infants.
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Affiliation(s)
- Igrid García-González
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | - Karina Corona-Cervantes
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | - Fernando Hernández-Quiroz
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | | | | | - Marta Catalina Romano
- Departamento de Fisiología, Biofísica y Neurociencias, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | - Carolina Miranda-Brito
- Departamento de Fisiología, Biofísica y Neurociencias, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | - Alberto Piña-Escobedo
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | | | | | - Jaime García-Mena
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
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Chrustek A, Sinkiewicz-darol E, Lampka M, Olszewska-słonina D, Sperkowska B, Linowiecka K. Effect of pasteurization on melatonin concentration in human breast milk. POSTEP HIG MED DOSW 2022; 76:220-227. [DOI: 10.2478/ahem-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Women who have problems with lactation can use human milk banks. Mainly this human milk is provided to premature babies and sick newborns. Human milk is the most suitable food for newborns and infants, recommended by WHO (World Health Organization). Human milk has anti-inflammatory, anti-infective, and anti-allergic properties, and also works for immunomodulation. Melatonin has a special, underestimated importance in the composition of breast milk. It is a hormone that has many body functions and, for several decades, its antioxidant potential has been increasingly talked about.
The aim of the study was to examine the effect of Holder pasteurization on melatonin concentration in human milk.
Materials and Methods
18 samples of human milk from donors from the human milk bank were used for the analysis. Melatonin concentration before and after pasteurization was determined by ELISA. In addition, the nutritional content composition of milk was analyzed using MIRIS Human Milk Analyzer and correlations examined.
Results
Melatonin concentration in human milk before pasteurization was 0.65–26.24 pg/mL (Me=9.58, IQR=12.72), while after pasteurization 0.80–29.58 pg/mL (Me=9.98, IQR=11.26). There was a positive correlation between melatonin concentration before and after pasteurization (r=0.797, p<0.001).
Conclusions
The Holder pasteurization process does not affect the concentration of melatonin in milk samples, which may be a recommendation for human milk banks.
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Manzardo OA, Toll LJ, Müller K, Nickel E, Jonas D, Baumgartner J, Wenzel F, Klotz D. A novel heat treatment protocol for human milk. Front Pediatr 2022; 10:990871. [PMID: 36330365 PMCID: PMC9623327 DOI: 10.3389/fped.2022.990871] [Citation(s) in RCA: 2] [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] [Received: 07/10/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Human milk (HM) is the recommended nutrition for premature infants, but it may require processing to ensure microbial safety. The current standard is Holder pasteurisation (HoP), i.e. heating milk at 62.5 ± 0.5°C for 30 min, which eliminates bacteria but destroys heat labile bioactive HM components. We aimed to test an alternative thermal method, high-temperature short-time (HTST) pasteurisation using a modified Holder pasteurisation platform as this method has shown to preserve proteins in experimental HM flow pasteurisers. We analysed the ability of this batch process to eliminate bacterial species and to retain alkaline phosphatase, secretory immunoglobulin A and lactoferrin in HM. HTST at 81°C/5 s was as effective as HoP in bacterial count reduction while the retention of bioactive components was only improved at 62°C/5 s as compared to 72°C/5 s and HoP. HTST is a promising alternative to HoP but an optimal temperature-time combination needs to be determined for each technical platform separately.
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Affiliation(s)
- Olimpia A Manzardo
- Department of Neonatology, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Luisa J Toll
- Faculty of Medical and Life Sciences, Furtwangen University, Furtwangen, Germany
| | - Katharina Müller
- Department of Neonatology, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erika Nickel
- Faculty of Medical and Life Sciences, Furtwangen University, Furtwangen, Germany
| | - Daniel Jonas
- Institute for Infection Prevention and Hospital Epidemiology, University of Freiburg, Freiburg, Germany
| | - Jana Baumgartner
- Department of Neonatology, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Folker Wenzel
- Faculty of Medical and Life Sciences, Furtwangen University, Furtwangen, Germany
| | - Daniel Klotz
- Department of Neonatology, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Martysiak-Żurowska D, Malinowska-Pańczyk E, Orzołek M, Kiełbratowska B, Sinkiewicz-Darol E. Effect of convection and microwave heating on the retention of bioactive components in human milk. Food Chem 2021; 374:131772. [PMID: 34896952 DOI: 10.1016/j.foodchem.2021.131772] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 01/14/2023]
Abstract
Bioactive substances are very important components of human milk (HM), especially for premature newborns. The effects of convection (CH) and microwave heating (MWH) at 62.5 and 66 °C, on the level of selected bioactive components of HM: lysozyme (LZ), lactoferrin (LF), secretory immunoglobulin A (sIgA), basal lipase (BL), cytokine TGF-2, vitamin C and total antioxidant capacity (TAC) was compared. Regardless of the used heating methods the TAC of HM, determined by TEAC and ORAC-FL assay, proved to be insensitive to temperature pasteurization, in contrary to BL. MWH in the conditions of 62.5 for 5 min and 66 °C for 3 min are ensuring microbiological safety with a higher retention of most of the tested active HM proteins compared to CH. Only in the case of LZ the MWH had a more degradative effect on its concentration. Controlled conditions of MWH preserve the bioactive components of the HM better than CH.
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Affiliation(s)
- Dorota Martysiak-Żurowska
- Department of Chemistry, Technology and Biotechnology of Food, Chemical Faculty, Gdansk University of Technology, G. Narutowicza 11/12 Str., 80-233 Gdańsk, Poland.
| | - Edyta Malinowska-Pańczyk
- Department of Chemistry, Technology and Biotechnology of Food, Chemical Faculty, Gdansk University of Technology, G. Narutowicza 11/12 Str., 80-233 Gdańsk, Poland
| | - Małgorzata Orzołek
- Department of Chemistry, Technology and Biotechnology of Food, Chemical Faculty, Gdansk University of Technology, G. Narutowicza 11/12 Str., 80-233 Gdańsk, Poland
| | - Bogumiła Kiełbratowska
- Department of Obstetrics, Medical University of Gdańsk, Marii Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
| | - Elena Sinkiewicz-Darol
- Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Torun, 53-59 St. Jozef St., 87-100 Torun, Poland; Kazimierz Wielki University, Faculty of Natural Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064 Bydgoszcz, Poland
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Binte Abu Bakar SY, Salim M, Clulow AJ, Nicholas KR, Boyd BJ. Human milk composition and the effects of pasteurisation on the activity of its components. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.02.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yu X, Leconte N, Méjean S, Garric G, Even S, Henry G, Tessier FJ, Howsam M, Croguennec T, Gésan-Guiziou G, Dupont D, Jeantet R, Deglaire A. Semi-industrial production of a minimally processed infant formula powder using membrane filtration. J Dairy Sci 2021; 104:5265-5278. [PMID: 33685709 DOI: 10.3168/jds.2020-19529] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/08/2021] [Indexed: 01/07/2023]
Abstract
Infant formula (IF) is submitted to several heat treatments during production, which can lead to denaturation or aggregation of proteins and promote Maillard reaction. The objective of this study was to investigate innovative minimal processing routes for the production of first-age IF powder, thus ensuring microbial safety with minimal level of protein denaturation. Three nutritionally complete IF powders were produced at a semi-industrial scale based on ingredients obtained by fresh bovine milk microfiltration (0.8 and 0.1-µm pore size membranes). Low-temperature vacuum evaporation (50°C) and spray-drying (inlet and outlet temperatures of 160 and 70°C, respectively) were conducted to produce the T- formula with no additional heat treatment. The T+ formula was produced with a moderate heat treatment (75°C for 2 min) applied before spray-drying, whereas the T+++ formula received successive heat treatments (72°C for 30 s on the milk; 90°C for 2-3 s before evaporation; 85°C for 2 min before spray-drying), thus mimicking commercial powdered IF. Protein denaturation and Maillard reaction products were followed throughout the production steps and the physicochemical properties of the powders were characterized. The 3 IF powders presented satisfactory physical properties in terms of aw, free fat content, glass transition temperature, and solubility index, as well as satisfactory bacteriological quality with a total flora <103 cfu/g and an absence of pathogens when a high level of bacteriological quality of the ingredients was ensured. Protein denaturation occurred mostly during the heat treatments of T+ and T+++ and was limited during the spray-drying process. The IF powder produced without heat treatment (T-) presented a protein denaturation extent (6 ± 4%) significantly lower than that in T+++ (58 ± 0%), but not significantly different from that in T+ (10 ± 4%). Although T- tended to contain less Maillard reaction products than T+ and T+++, the Maillard reaction products did not significantly discriminate the infant formulas in the frame of this work. The present study demonstrated the feasibility of producing at a semi-industrial scale an infant formula being bacteriologically safe and containing a high content of native proteins. Application of a moderate heat treatment before spray-drying could further guarantee the microbiological quality of the IF powders while maintaining a low protein denaturation extent. This study opens up new avenues for the production of minimally processed IF powders.
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Affiliation(s)
- X Yu
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | - N Leconte
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | - S Méjean
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | - G Garric
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | - S Even
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | - G Henry
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | - F J Tessier
- University of Lille, Inserm, CHU Lille, Pasteur Institute of Lille, U1167 - RID-AGE, F-59000 Lille, France
| | - M Howsam
- University of Lille, Inserm, CHU Lille, Pasteur Institute of Lille, U1167 - RID-AGE, F-59000 Lille, France
| | - T Croguennec
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | | | - D Dupont
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | - R Jeantet
- STLO, INRAE, Institut Agro, 35042, Rennes, France
| | - A Deglaire
- STLO, INRAE, Institut Agro, 35042, Rennes, France.
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11
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Mikawa T, Mizuno K, Tanaka K, Kohda C, Ishii Y, Yamamoto K, Kobayashi S. Microwave treatment of breast milk for prevention of cytomegalovirus infection. Pediatr Int 2019; 61:1227-1231. [PMID: 31282599 DOI: 10.1111/ped.13954] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/07/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast milk (BM) is the best nutrition for very preterm infants (VPI), except when provided by human cytomegalovirus (HCMV)-seropositive mothers. Given that VPI are at high risk of developing a sepsis-like syndrome or cholestasis, methods for prevention of HCMV infection via BM have been investigated. Although Holder pasteurization (HP) is the gold standard, HP needs special instruments. Microwave (MW) is available anywhere, therefore, we performed this study to determine whether MW can be used for HCMV prevention. METHODS Human cytomegalovirus Towne strain was added to formula, followed by heating procedure using HP or MW (at 500 W for 20, 30, 40, or 60 s). HFL-III cells were seeded in culture dishes. Aliquots of HCMV-milk samples after heating were inoculated onto susceptible cell monolayers. The number of plaques was counted to determine the viral titer. The determination of HCMV-DNA copies was also performed. RESULTS Addition of HCMV for a viral load of 5.0 × 103 plaque-forming units (p.f.u.)/mL achieved 772 p.f.u./mL at baseline, with a decrease to 257 p.f.u./mL after MW radiation for 20 s. No plaque was detected after HP or MW for 30, 40, and 60 s. The temperature of the breast milk reached 60°C after MW radiation for 40 s. The number of HCMV-DNA copies did not change with MW. CONCLUSIONS Microwave at 500 W for 40 s can be used as a prevention strategy for HCMV transmission. Further research including the loss of bioactive properties in BM is required prior to clinical application.
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Affiliation(s)
- Takeshi Mikawa
- Department of Pediatrics, Showa University Koto Toyosu Hospital, Koto, Tokyo, Japan
| | - Katsumi Mizuno
- Department of Pediatrics, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Kazuo Tanaka
- Department of Microbiology, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Chikara Kohda
- Department of Microbiology, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Youko Ishii
- Department of Pediatrics, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Kazuya Yamamoto
- Department of Pediatrics, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Shunjiro Kobayashi
- Bean Stalk Snow Co. Ltd, Research and Development Department, Tokyo, Japan
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12
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Gebauer C, Klotz D, Springer S. [The value of human milk for preterm infants-overview and practical aspects]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:952-9. [PMID: 29971449 DOI: 10.1007/s00103-018-2777-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Over the last decades the immense benefit of human milk on the nutrition of preterm infants has become increasingly evident. Research has confirmed that human milk has significant advantages for the preterm infant in terms of host defense, gastrointestinal development and maturation, neurological development, reduction of necrotizing enterocolitis, retinopathy of prematurity and chronic lung disease as well as mental and physical benefits for the mother. Computing these factors into a health-cost-benefit equation, positive economic consequences for a national public health system were demonstrated.Therefore, international feeding guidelines recommend human milk to be the first choice for preterm infants, the primary source being the infant's mother. The first alternative is milk from an established donor milk bank. To meet the unique nutritional demands of preterm infants and to avoid postnatal growth restriction, human milk must be fortified with additional micro- and macronutrients. Concerns about microbial colonization and contamination and hygienic aspects concerning milk handling need to be addressed when feeding human milk to preterm infants.Early initiation and maintenance of lactation is challenging for mothers of preterm infants and their caregivers. Providing lactation support from educated staff, optimal nursing environments, and the positive attitude of an experienced NICU (neonatal intensive care unit) team will contribute to successful lactation and breastfeeding even beyond discharge of the infant.
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Wesolowska A, Sinkiewicz-Darol E, Barbarska O, Bernatowicz-Lojko U, Borszewska-Kornacka MK, van Goudoever JB. Innovative Techniques of Processing Human Milk to Preserve Key Components. Nutrients 2019; 11:E1169. [PMID: 31137691 PMCID: PMC6566440 DOI: 10.3390/nu11051169] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022] Open
Abstract
Human milk not only contains all nutritional elements that an infant requires, but is also the source of components whose regulatory role was confirmed by demonstrating health-related deficiencies in formula-fed children. A human milk diet is especially important for premature babies in the neonatal intensive care unit (NICU). In cases where breastfeeding is not possible and the mother's own milk is insufficient in volume, the most preferred food is pasteurized donor milk. The number of human milk banks has increased recently but their technical infrastructure is continuously developing. Heat treatment at a low temperature and long time, also known as holder pasteurization (62.5 °C, 30 min), is the most widespread method of human milk processing, whose effects on the quality of donor milk is well documented. Holder pasteurization destroys vegetative forms of bacteria and most viruses including human immunodeficiency virus (HIV) herpes and cytomegalovirus (CMV). The macronutrients remain relatively intact but various beneficial components are destroyed completely or compromised. Enzymes and immune cells are the most heat sensitive elements. The bactericidal capacity of heat-pasteurized milk is lower than that of untreated milk. The aim of the study was for a comprehensive comparison of currently tested methods of improving the preservation stage. Innovative techniques of milk processing should minimize the risk of milk-borne infections and preserve the bioactivity of this complex biological fluid better than the holder method. In the present paper, the most promising thermal pasteurization condition (72 °C-75 °C,) and a few non-thermal processes were discussed (high pressure processing, microwave irradiation). This narrative review presents an overview of methods of human milk preservation that have been explored to improve the safety and quality of donor milk.
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Affiliation(s)
- Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Hospital, Medical University of Warsaw, Department of Neonatology, 63A Zwirki i Wigury St., 02-091 Warsaw, Poland.
| | - Elena Sinkiewicz-Darol
- Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Torun, 53-59 St. Jozef St., 87-100 Torun, Poland.
| | - Olga Barbarska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Hospital, Medical University of Warsaw, Department of Neonatology, 63A Zwirki i Wigury St., 02-091 Warsaw, Poland.
| | - Urszula Bernatowicz-Lojko
- Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Torun, 53-59 St. Jozef St., 87-100 Torun, Poland.
| | | | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Malinowska-Pańczyk E, Królik K, Skorupska K, Puta M, Martysiak-Żurowska D, Kiełbratowska B. Microwave heat treatment application to pasteurization of human milk. INNOV FOOD SCI EMERG 2019. [DOI: 10.1016/j.ifset.2018.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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El-loly MM, Hassan LK, Farahat ES. Impact of heat treatments and some technological processing on immunoglobulins of Egyptian buffalo's milk. Int J Biol Macromol 2019; 123:939-44. [DOI: 10.1016/j.ijbiomac.2018.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/05/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022]
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Klotz D, Schreiner M, Falcone V, Jonas D, Kunze M, Weber A, Fuchs H, Hentschel R. High-Temperature Short-Time Treatment of Human Milk for Bacterial Count Reduction. Front Pediatr 2018; 6:359. [PMID: 30538974 PMCID: PMC6277678 DOI: 10.3389/fped.2018.00359] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/05/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Human milk (HM) for preterm infants will often be pasteurized for cytomegalovirus (CMV) inactivation and reduction of its bacterial count. High-temperature short-time (HTST) treatment compared to standard Holder pasteurization (HoP) reduces the impact of heat treatment on bioactive HM proteins while effectively inactivating CMV. No data are available for the efficacy of bacterial count reduction using HTST treatments that are available for clinical use. Objective: To test the antiviral and antibacterial efficacy of HTST treatment protocols in HM using a modified HTST treatment device compared to standard HoP. Methods: Holder pasteurized 95 mL HM samples were inoculated with Staphylococcus aureus (ATCC 6538), Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853), Serratia marcescens (Smarc 00697), two different strains of Klebsiella pneumoniae (ATCC 700603 and Kpn 01605) or spiked with 2 × 105 50% tissue culture infective dose of CMV (AD169) and subsequently subjected to HoP (62.5°C/30 min) or HTST treatment (62°C/5 s, 62°C/15 s, 72°C/5 s, 72°C/15 s, 87°C/2 s, and 87°C/5 s). Bacterial count was determined after treated HM was cultured for 24 h. CMV infectivity was determined by the number of specific CMV immediate early antigen stained nuclei after inoculating human fibroblasts with appropriately prepared HM samples. Results: Holder pasteurized samples revealed no growth after 24 h incubation. Viable bacterial cultures were retrieved from all tested strains after HTST treatment with the default HTST protocol (62°C/5 s) that is available for clinical use. Using other time-temperature combinations, growth rates of S. aureus, E. faecalis, P. aeruginosa, K. pneumoniae, K. pneumonia, and S. marcescens were depending on treatment time, treatment temperature, bacterial genera and strain. Only after treatment temperatures above 72°C no bacterial growth was observed. CMV was inactivated by any tested time-temperature combination. Conclusions: HTST treatment inactivates CMV in 95 mL HM samples but is less effective than HoP in bacterial count reduction at a time-temperature combination of 62°C/5 s. For a reliable bacterial count reduction HTST treatment at 87°C was required in this study.
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Affiliation(s)
- Daniel Klotz
- Center for Pediatrics, Department of Neonatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Marie Schreiner
- Center for Pediatrics, Department of Neonatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Valeria Falcone
- Institute of Virology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Daniel Jonas
- Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Andrea Weber
- Institute of Medical Microbiology and Hygiene, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Hans Fuchs
- Center for Pediatrics, Department of Neonatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Roland Hentschel
- Center for Pediatrics, Department of Neonatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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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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Goelz R, Hamprecht K. Verhinderung der postnatalen Zytomegalievirusinfektion bei Frühgeborenen. Monatsschr Kinderheilkd 2019; 167:11-7. [DOI: 10.1007/s00112-018-0594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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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Guerra AF, Mellinger-Silva C, Rosenthal A, Luchese RH. Hot topic: Holder pasteurization of human milk affects some bioactive proteins. J Dairy Sci 2018; 101:2814-2818. [PMID: 29397184 DOI: 10.3168/jds.2017-13789] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 09/05/2017] [Accepted: 01/03/2018] [Indexed: 12/16/2022]
Abstract
The aim of this research was to investigate the effect of Holder pasteurization (HoP; 62.5°C, 30 min) on the protein profile and activities of glutathione peroxidase (GPx) and lysozyme (LZ) in human milk. Over 6 mo of lactation, human milk samples were analyzed before (raw) and after HoP for GPx and LZ activity and electrophoresis protein profile. Holder pasteurization reduced human milk lactoferrin, immunoglobulin fractions, and GPx activity. In addition, GPx activity, which is high in colostrum and transitional milk, was naturally reduced over the 6-mo lactation period. In contrast, HoP did not affect human milk LZ activity. Besides its critical cellular antioxidant role in protecting the organism from oxidative damage, GPx decreases the redox potential of milk, stimulating the growth of anaerobic microorganisms, such as the probiotic Bifidobacterium. Considering the role of lactoferrin in infant health, we conclude that an important part of its function has been inactivated by pasteurization. These compounds should be replaced by human milk banks after the HoP step to recover lost functionality. Otherwise, an alternative technology to HoP that better retains human milk properties should be used by milk banks to eliminate the risk of transmission of infectious agents.
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Affiliation(s)
- André F Guerra
- Department of Food Technology, Federal Rural University of Rio de Janeiro, 23.897-970 Seropédica, RJ, Brazil; Federal Center of Technological Education Celso Suckow da Fonseca, 27.600-000 Valença, RJ, Brazil.
| | | | - Amauri Rosenthal
- Embrapa Food Technology, Guaratiba 23.020-470, Rio de Janeiro, RJ, Brazil
| | - Rosa H Luchese
- Department of Food Technology, Federal Rural University of Rio de Janeiro, 23.897-970 Seropédica, RJ, Brazil
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Klotz D, Jansen S, Gebauer C, Fuchs H. Handling of Breast Milk by Neonatal Units: Large Differences in Current Practices and Beliefs. Front Pediatr 2018; 6:235. [PMID: 30234076 PMCID: PMC6131667 DOI: 10.3389/fped.2018.00235] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 04/19/2018] [Accepted: 08/02/2018] [Indexed: 01/25/2023] Open
Abstract
Background: Breast milk (BM) for premature infants is subjected to multiple steps of processing, storage and distribution. These steps may influence the quality and safety of BM. Guidelines concerning the use of mother's own milk are either not available or limited to specific aspects of BM handling and are based on evidence of variable strength. This may result in diverse BM handling routines by health care professionals. Objective: We surveyed neonatal units to increase the knowledge about the current practice of BM handling routines of mother's own milk and to identify controversial aspects that could give directions for future research. Methods: An online-based questionnaire was sent to 307 different neonatal departments providing level III to level I neonatal care within Germany, Austria and Switzerland. Practices concerning screening for cytomegalovirus and BM bacteria, pasteurization, fortification, storage, workforce and the incidence of BM administration errors were surveyed. Results: A total of 152 units, 56% of contacted level III units and 51% of level II units, participated in the survey (Germany 53%, Switzerland 71%, and Austria 56%). We found differences concerning indication and method of CMV inactivation (performed by 58%), bacterial count screening (48%) and bacterial count reduction (17%) within participating units. Thirty different thresholds for bacterial BM counts were reported by 65 units, resulting in pasteurization or discarding of BM. The use of nutrient analysis (12%) and fortification regimens in addition to standard multicomponent fortifiers (58%) using either individual (93%), targeted (3%), or adjusted (4%) fortification protocols varied profoundly. There is a high variability in staff and available facilities for BM handling. 73% of units report about BM administration errors. Conclusion: There is a wide variability in most aspects of BM handling in the participating units. Despite limited evidence labor and cost intensive procedures are applied which may have an impact on BM quality.
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Affiliation(s)
- Daniel Klotz
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefanie Jansen
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Corinna Gebauer
- Department of Neonatology, University Children's Hospital, Leipzig, Germany
| | - Hans Fuchs
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abstract
Background: Pasteurized donor human milk is an alternative feeding when mothers' own milk is not available for premature infants. The effects of pasteurization on the host defense properties of human milk are unclear. We investigated the effects of Holder pasteurization on concentrations of anti-inflammatory and pro-inflammatory cytokines in human milk. Objective: To compare concentrations of anti-inflammatory and pro-inflammatory cytokines before and after pasteurization of donor human milk. Study Design: A single milk sample was obtained from each of 24 mothers of premature infants in the neonatal intensive care unit by electric breast pump and was stored at -80°C. At the time of pasteurization, milk samples were thawed and divided into two aliquots. The first aliquot was re-stored at -80°C and the second aliquot was heat-treated at 62.5°C for 30 min and then re-stored at -80°C. At the time of batch cytokine analyses samples were thawed rapidly. Results: Most cytokine concentrations declined following pasteurization. The most prevalent cytokine, IL-8, was preserved (89%) following pasteurization. There were no relationships between gestational age, postnatal age of milk collection, duration of milk storage, and the concentrations cytokines. Conclusion: In contrast to most cytokines after pasteurization, IL-8 is preserved or liberated from another compartment. The maintenance of IL-8 in human milk after pasteurization and the loss of anti-inflammatory cytokines following pasteurization, suggests that the effects of inflammatory activity in pasteurized human milk should be evaluated. These data may account, in part, for the lesser protective effect on the host of pasteurized donor human milk compared with mother's own milk.
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Affiliation(s)
- Marilyn V Giorgi
- Lilling Family Neonatal Research Lab, Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra, Northwell, Feinstein Institute for Medical Research, New York, NY, United States
| | - Champa N Codipilly
- Lilling Family Neonatal Research Lab, Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra, Northwell, Feinstein Institute for Medical Research, New York, NY, United States
| | - Debra Potak
- Lilling Family Neonatal Research Lab, Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra, Northwell, Feinstein Institute for Medical Research, New York, NY, United States
| | - Howard S Heiman
- Lilling Family Neonatal Research Lab, Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra, Northwell, Feinstein Institute for Medical Research, New York, NY, United States
| | - Richard J Schanler
- Lilling Family Neonatal Research Lab, Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra, Northwell, Feinstein Institute for Medical Research, New York, NY, United States
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