Processing Human Milk to Increase Nutrient Density for Preterm Infants

Background: Human milk is the optimal food for newborns. Choices to feed preterm infants in neonatal intensive care units are mother’s milk, donor milk, or formula. Preterm infants have better tolerance for human milk, but the lower caloric density of donor milk might not meet preterm infant growth needs. Preterm infants have higher protein and energy requirements with a limited stomach capacity. Therefore, there is a need for human milk with increased nutrient density. Research Aim: To concentrate donor milk to have a higher caloric and protein density while avoiding side effects of high osmolality by precipitating lactose at low temperatures. Methods: We investigated the results of volume reduction and lactose removal processes on the lactose, protein, osmolality, and viscosity of human milk. Donor milk was obtained from WakeMed Mothers’ Milk Bank. Homogenization and evaporative condensation were applied to samples ( N = 36) before they were stored frozen overnight, followed by refrigerated centrifugation for lactose removal at 0 °C. Supernatants were separated and compared to the composition of controls. Results: A significant reduction of lactose ( SW = -262, p < .0001) and osmolality ( SW = -211.5 p < .01) was achieved in the concentrated milk without a significant protein loss from centrifugation ( SW = -44.5, p = .49). A 30%–40% volume reduction is within the American Academy of Pediatrics recommended osmolality for infant feeding. Conclusion: Concentrating human milk in a milk bank setting for feeding preterm infants might be a simple and low-cost process to achieve a product with higher nutrient density and no non-human components.

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Processing Human Milk to Increase Nutrient Density for Preterm Infants

The FASEB Journal ◽

10.1096/fasebj.31.1_supplement.316.7 ◽

2017 ◽

Vol 31 (S1) ◽

Author(s):

Hande Z. Ulus ◽

Ruth H. Watkins ◽

Jonathan C Allen

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Nutrient Density

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Availability of Donor Milk for Very Preterm Infants Decreased the Risk of Necrotizing Enterocolitis without Adversely Impacting Growth or Rates of Breastfeeding

Nutrients ◽

10.3390/nu11081895 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1895 ◽

Cited By ~ 8

Author(s):

Débora Cañizo Vázquez ◽

Sandra Salas García ◽

Montserrat Izquierdo Renau ◽

Isabel Iglesias-Platas

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Neonatal Intensive Care ◽

Late Onset ◽

Donor Milk ◽

Very Preterm Infants ◽

Very Preterm ◽

Breastfeeding Rates ◽

Group 2 ◽

Group 1

Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mother’s milk (OMM) is not enough. Our aim was to compare the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in very preterm infants (VPI) after the introduction of DM. Growth and breastfeeding rates were examined as secondary outcomes. Single center, observational and retrospective cohort study comparing 227 VPI admitted to our neonatal unit before (Group 1, n = 99) and after (Group 2, n = 128) DM introduction. Enteral nutrition was started earlier after DM availability (2.6 ± 1.1 vs. 2.1 ± 1 days, p = 0.001). Incidence of NEC decreased in group 2 (9.1% vs. 3.4%, p = 0.055), especially in those born between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044). Surgical NEC was also less frequent. Suffering NEC was 4 times more likely in group 1 (multivariate analysis). Availability of DM did not impact breastfeeding rates or preterm growth. Our findings support the protective role of DM against NEC, particularly in non-extreme VPI, a group less frequently included in clinical guidelines and research studies on the use of DM.

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Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification

Frontiers in Pediatrics ◽

10.3389/fped.2019.00076 ◽

2019 ◽

Vol 7 ◽

Cited By ~ 34

Author(s):

Sertac Arslanoglu ◽

Clair-Yves Boquien ◽

Caroline King ◽

Delphine Lamireau ◽

Paola Tonetto ◽

...

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Working Group ◽

Milk Bank

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Human Milk Feeding Status of Preterm Infants in Neonatal Intensive Care Units in China

Journal of Human Lactation ◽

10.1177/0890334419901265 ◽

2020 ◽

Vol 36 (2) ◽

pp. 283-290 ◽

Cited By ~ 1

Author(s):

Wenjing Peng ◽

Siyuan Jiang ◽

Shujuan Li ◽

Shiwen Xia ◽

Shushu Chen ◽

...

Keyword(s):

Intensive Care ◽

Human Milk ◽

Intensive Care Units ◽

Preterm Infants ◽

Significant Variation ◽

Neonatal Intensive Care ◽

Current Status ◽

Neonatal Intensive Care Units ◽

Feeding Rates ◽

Milk Feeding

Background Previous low human milk feeding rates in Chinese neonatal intensive care units of preterm infants were reported. There are no nationwide data on these. Research Aims To investigate the current status of human milk feeding for preterm infants in Chinese units and provide baseline data for future research. Methods A secondary data analysis was conducted from a previously established clinical database including 25 Chinese neonatal intensive care units. All infants born <34 weeks gestation and admitted to participating units from May 2015 to April 2018 were enrolled. Variables analyzed were infant data collected and the human milk feeding practices at participating units were surveyed. Results A total of 24,113 infants were included. The overall and exclusive human milk feeding rates were 58.2% and 18.8%, respectively, which increased significantly during study years. We found that rates of human milk feeding decreased with increase in gestational age and birth weight. There was significant variation in human milk feeding rates among units. Most participating Chinese neonatal intensive care units have taken measures to improve the rates of human milk feeding. Conclusions The human milk feeding rates in Chinese neonatal intensive care units have continued to increase in the past 3 years, but there was significant variation among them. More efforts are needed to further increase the human milk feeding rates in China. Trial registration This study was registered NCT02600195 with clinicaltrials.gov on November 9, 2015.

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Wide Variability in Caloric Density of Expressed Human Milk Can Lead to Major Underestimation or Overestimation of Nutrient Content

Journal of Human Lactation ◽

10.1177/0890334416672200 ◽

2016 ◽

Vol 33 (2) ◽

pp. 341-350 ◽

Cited By ~ 13

Author(s):

Charles W. Sauer ◽

Mallory A. Boutin ◽

Jae H. Kim

Keyword(s):

Human Milk ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Nutrient Content ◽

Postnatal Growth ◽

Low Birth Weight Infants ◽

Caloric Density ◽

Wide Variability ◽

Fat Composition ◽

Nutrition Strategy

Background: Very-low-birth-weight infants continue to face significant difficulties with postnatal growth. Human milk is the optimal form of nutrition for infants but may exhibit variation in nutrient content. Objective: This study aimed to perform macronutrient analysis on expressed human milk from mothers whose babies are hospitalized in the neonatal intensive care unit. Methods: Up to five human milk samples per participant were analyzed for protein, carbohydrate, and fat content using reference chemical analyses (Kjeldahl for protein, high pressure liquid chromatography for carbohydrates, and Mojonnier for fat). Calorie content was calculated. Results: A total of 64 samples from 24 participants was analyzed. Wide variability was found in calorie, protein, carbohydrate, and fat composition. The authors found an average of 17.9 kcal/ounce, with only 34% of samples falling within 10% of the expected caloric density. Conclusion: The assumption that human milk contains 20 kcal/ounce is no longer supported based on this study. This supports promoting an individualized nutrition strategy as a crucial aspect to optimal nutrition.

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B. infantis EVC001 Is Well-Tolerated and Improves Human Milk Oligosaccharide Utilization in Preterm Infants in the Neonatal Intensive Care Unit

Frontiers in Pediatrics ◽

10.3389/fped.2021.795970 ◽

2022 ◽

Vol 9 ◽

Author(s):

Sarah Bajorek ◽

Rebbeca M. Duar ◽

Maxwell Corrigan ◽

Christa Matrone ◽

Kathryn A. Winn ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Human Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Fecal Microbiota ◽

Metagenomic Sequencing ◽

Human Milk Oligosaccharides ◽

Milk Oligosaccharides

Not all infants carry specialized gut microbes, meaning they cannot digest human milk oligosaccharides and therefore do not receive complete benefits from human milk. B. infantis EVC001 is equipped to convert the full array of complex oligosaccharides into compounds usable by the infant, making it an ideal candidate to stabilize gut function and improve nutrition in preterm infants. A prospective, open-label study design was used to evaluate the tolerability of B. infantis EVC001 and its effects on the fecal microbiota in preterm infants in a Neonatal Intensive Care Unit. Thirty preterm infants <1,500 g and/or <33 weeks gestation at birth were divided into two matched groups, and control infants were enrolled and discharged prior to enrolling EVC001 infants to prevent cross-colonization of B. infantis: (1) fifteen control infants received no EVC001, and (2) fifteen infants received once-daily feedings of B. infantis EVC001 (8.0 x 109 CFU) in MCT oil. Clinical information regarding medications, growth, nutrition, gastrointestinal events, diagnoses, and procedures was collected throughout admission. Infant stool samples were collected at baseline, Study Days 14 and 28, and 34-, 36-, and 38-weeks of gestation. Taxonomic composition of the fecal microbiota, functional microbiota analysis, B. infantis, and human milk oligosaccharides (HMOs) in the stool were determined or quantified using 16S rRNA gene sequencing, metagenomic sequencing, qPCR, and mass spectrometry, respectively. No adverse events or tolerability issues related to EVC001 were reported. Control infants had no detectable levels of B. infantis. EVC001 infants achieved high levels of B. infantis (mean = 9.7 Log10 CFU/μg fecal DNA) by Study Day 14, correlating with less fecal HMOs (ρ = −0.83, P < 0.0001), indicating better HMO utilization in the gut. In this study, B. infantis EVC001 was shown to be safe, well-tolerated, and efficient in colonizing the preterm infant gut and able to increase the abundance of bifidobacteria capable of metabolizing HMOs, resulting in significantly improved utilization of human milk.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03939546, identifier: NCT03939546.

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Macronutrient variability in human milk from donors to a milk bank: Implications for feeding preterm infants

PLoS ONE ◽

10.1371/journal.pone.0210610 ◽

2019 ◽

Vol 14 (1) ◽

pp. e0210610 ◽

Cited By ~ 18

Author(s):

Ashley John ◽

Ruichen Sun ◽

Lisa Maillart ◽

Andrew Schaefer ◽

Erin Hamilton Spence ◽

...

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Milk Bank

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Plasma amino acids in preterm infants fed different human milk diets from a human milk bank

e-SPEN the European e-Journal of Clinical Nutrition and Metabolism ◽

10.1016/j.eclnm.2007.03.002 ◽

2007 ◽

Vol 2 (2) ◽

pp. 51-56 ◽

Cited By ~ 3

Author(s):

Sandra Christo dos Santos ◽

Carmen Martimbianco de Figueiredo ◽

Sônia Maria Oliveira de Andrade ◽

Durval Batista Palhares

Keyword(s):

Amino Acids ◽

Human Milk ◽

Preterm Infants ◽

Plasma Amino Acids ◽

Milk Bank ◽

Human Milk Bank

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Turkish Women’s Beliefs Concerning Human Milk Banking

Journal of Human Lactation ◽

10.1177/08903344211037989 ◽

2021 ◽

pp. 089033442110379

Author(s):

Suzi Özdemir ◽

Sena Dilek Aksoy ◽

Gaye Soyaslan Akdağ

Keyword(s):

Social Media ◽

Human Milk ◽

Disease Transmission ◽

Online Survey ◽

Public Awareness ◽

Turkish Women ◽

Donor Milk ◽

Milk Bank ◽

Milk Banking ◽

Milk Banks

Background: A donor milk bank provides an alternative source of human milk for mothers who cannot breastfeed or provide their own milk. Although wet-nursing is a common practice, there is currently no donor milk bank in Turkey. Research Aims: The aims of our study were (1) to determine the knowledge and opinions of Turkish women in regard to donor milk banking; and (2) to raise awareness of donor milk banking. Methods: This was a prospective cross-sectional descriptive study, in which the data were collected with an online survey consisting of 22 questions. The link to the online survey was distributed through the social media accounts of the researchers, with a statement inviting women aged 18–64, who were literate and actively using social media, to participate in the survey. There were 648 female participants. Results: Of those who responded to the questionnaire, 54.1% had not previously given birth, and 54.2% had heard about donor milk banks before. The implementation of donor milk banks in Turkey was desired by 56.4% of the participants, and 50.8% of the participants considered donating their milk. It was determined that the reasons why the women did not want to benefit from donor milk banks were the risk of disease transmission to the baby and the possibility of their child marrying his or her milk sibling in the future. Conclusion: It appears that Turkish women lack information about donor milk banking. We recommend public awareness activities to be organized concerning donor milk banking.

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Trends and Dynamics in the First Four Years of Operation of the First Human Milk Bank in Vietnam

Nutrients ◽

10.3390/nu13041107 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1107

Author(s):

Hoang Thi Tran ◽

Tuan Thanh Nguyen ◽

Debbie Barnett ◽

Gillian Weaver ◽

Oanh Thi Xuan Nguyen ◽

...

Keyword(s):

Human Milk ◽

Low Birthweight ◽

Electronic Monitoring ◽

Pass Rate ◽

World Health ◽

Middle Income ◽

Donor Milk ◽

Milk Bank ◽

Human Milk Bank ◽

Health Organization

Background: Since 1979, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have recommended the use of pasteurized human milk from a human milk bank (HMB) to feed low birthweight (LBW) and preterm newborns as the ‘first alternative’ when mothers are unable to provide their own milk. However, they have not issued any guidelines for the safe establishment and operation of an HMB. This gap contributes to the demand for gathering experiences from HMB networks, especially those from lower-middle income countries. To fill this knowledge gap, this study examines the characteristics of donors, donation, pasteurization, and recipients during the first four years of operation in the first HMB in Vietnam. Methods: Data about the donors, donation, pasteurization, and recipients were extracted from the web-based electronic monitoring system of the HMB from 1 February 2017 to 31 January 2021. Results: In the first four years of operation there were 433 donors who donated 7642 L of milk (66% from the community) with an increased trend in the amount of donated milk, donation duration, and average amount of milk donated by a donor. Approximately 98% of the donated milk was pasteurized, and 82% passed both pre- and post-pasteurization tests. Although the pass rate tended to increase with time, a few dips occurred. Of 16,235 newborns who received pasteurized donor milk, two thirds were in the postnatal wards. The main reason for the prescription of pasteurized donor milk was insufficient mothers’ own milk in the first few days after birth. There was a decreased trend in the amount and duration of using pasteurized donor milk in both postnatal wards and the neonatal unit. Conclusions: The HMB has operated efficiently in the previous four years, even during the COVID-19 pandemic, to serve vulnerable newborns. Ongoing evidence-based adjustments helped to improve the operation to recruit suitable donors, to increase the access to and quality of raw donor milk, to improve the pasteurization process, and to meet the need of more newborns.

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