Addition of Calcium and Phosphorus to Preterm Donor Human Milk and the Impact on Protein, Fat, and Calcium Digestibility In Vitro

Preterm delivery complications are the primary cause of death among children under the age of five. Preventive strategies include the use of pasteurized donor human milk (DHM), its fortification with human milk fortifiers (protein supplements), and supplementation with probiotics. Our aim was to examine the impact of DHM and fortified DHM (FDHM) on the mucus adhesion properties of two widely used probiotics. The study covered two forms of human milk fortifier, liquid and powdered, with or without probiotics and storage at 4 °C for 24 h. To test the adhesion properties of the probiotic strains, DHM+probiotics and FDHM+probiotics were prepared and added to immobilized mucus isolated from the stool of healthy Finnish infants. The probiotic adhesion was then measured by liquid scintillation. Our results suggest that addition of liquid or powdered human milk fortifier in donor human milk had no impact on probiotic adhesion. In addition, given the increased adhesion of probiotics suspended in buffer, other matrices should be further studied. These factors need to be considered when designing future intervention strategies using probiotics in preterm infants.

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Caries Protective Agents in Human Milk and Bovine Milk: An in vitro Study

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.35.4.r1668v3l38mh8404 ◽

2011 ◽

Vol 35 (4) ◽

pp. 389-392 ◽

Cited By ~ 7

Author(s):

Vabitha Shetty ◽

Amitha Hegde ◽

Nandan S ◽

Suchetha Shetty

Keyword(s):

Human Milk ◽

Whey Protein ◽

Milk Fat ◽

Bovine Milk ◽

Dental Enamel ◽

In Vitro Study ◽

Labor Ward ◽

Calcium And Phosphorus ◽

The Individual

Objectives: To estimate Calcium and Phosphorus withdrawal from hydroxyapatite in the presence of bovine milk and human milk from which the following protective fractions namely Casein, Whey protein, Lactose and Milk fat have been individually removed and to compare the above protective fractions in human and bovine milk. Method: Human milk obtained from lactating mothers in the labor ward of Kshema hospital was subjected to immediate analysis. Bovine milk was obtained from a local dairy. Equal quantities of human milk and bovine milk (1ml) were separately subjected to the systematic removal of the four milk fractions. As each fraction was removed, the remaining milk samples were subjected to testing. Powdered hydroxyapatite from human dental enamel was subjected to demineralization with the addition of the milk sample under test for 20 minutes. This mixture was then centrifuged. Aliquots of the supernatant were taken for calcium and Phosphorus analysis using photospectrometry. Ten demineralization tests were similarly carried out for every milk fraction for both human and bovine milk separately. Equal samples of whole bovine milk and whole human milk were also subjected to similar testing. Results: The calcium and phosphorus dissolution values were higher when the individual fractions were eliminated from both human milk/enamel samples and bovine milk/enamel samples as compared to the values obtained from whole human milk/whole bovine milk /enamel samples. Further, higher calcium and phosphorus dissolution values were observed when the fractions were individually and separately removed from the whole human milk/enamel samples as compared to the corresponding values obtained when these fractions were removed from bovine milk/enamel samples. Conclusion: The evaluated milk fraction in bovine milk namely casein,whey protein, lactose and milk fat were individually more caries protective when compared to the corresponding fractions in human milk.

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Inoculation of mother’s own milk could personalize pasteurized donor human milk used for feeding preterm infants

Journal of Translational Medicine ◽

10.1186/s12967-021-03096-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

D. Mallardi ◽

C. Tabasso ◽

P. Piemontese ◽

S. Morandi ◽

T. Silvetti ◽

...

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Bacterial Growth ◽

Microbiological Quality ◽

In Vitro Study ◽

Total Bacterial Count ◽

Milk Samples ◽

Donor Human Milk ◽

Mother’S Own Milk

Abstract Background Human milk is a vehicle for bioactive compounds and beneficial bacteria which promote the establishment of a healthy gut microbiome of newborns, especially of preterm infants. Pasteurized donor human milk (PDHM) is the second-best option when preterm mother’s own milk is unavailable. Since pasteurization affect the microbiological quality of donor milk, PDHM was inoculated with different preterm milk samples and then incubated, in order to evaluate the effect in terms of bacterial growth, human milk microbiome and proteolytic phenomena. Methods In an in-vitro study PDHM was inoculated at 10% v/v using ten preterm milk samples. Microbiological, metataxonomic and peptidomic analyses, on preterm milk samples at the baseline (T0), on PDHM and on inoculated milk (IM) samples at T0, after 2 h (T1) and 4 h (T2) of incubation at 37 °C, were conducted. Results IM samples at T2 showed a Total Bacterial Count not significantly different (p > 0.01) compared to preterm milk samples. At T2 lactic acid bacteria level was restored in all IM. After inoculation, metataxonomic analysis in IM samples showed that Proteobacteria remained the predominant phylum while Firmicutes moved from 3% at T1 to 9.4% at T2. Peptidomic profile of IM resembled that of PDHM, incubated for the same time, in terms of number and type of peptides. Conclusion The study demonstrated that inoculation of PDHM with mother’s own milk could restore bacterial growth and personalize human milk microbiome in PDHM. This effect could be beneficial because of the presence of maternal probiotic bacteria which make PDHM more similar to mother’s own milk.

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The Impact of Homogenization on Donor Human Milk and Human Milk-Based Fortifiers and Implications for Preterm Infant Health

Current Developments in Nutrition ◽

10.1093/cdn/nzab147 ◽

2021 ◽

Author(s):

Sarah M Reyes ◽

Biranchi Patra ◽

Melinda J Elliott

Keyword(s):

Human Milk ◽

Preterm Infant ◽

Milk Fat ◽

Infant Health ◽

Cow Milk ◽

Published Data ◽

Donor Human Milk ◽

Milk Fat Globule ◽

Health Complications ◽

The Impact

Abstract An exclusive human milk diet (EHMD) has been shown to reduce health complications of prematurity in infants born weighing ≤1250 grams compared to cow milk-based diets. Accordingly, the number of available human milk (HM)-based nutritional products continues to increase. Newly available products, and those reportedly soon to enter the market include homogenized donor human milk (DHM) and homogenized HM–based fortifiers. Existing literature demonstrating the benefits of an EHMD, however, is limited to non-homogenized HM-based products. Herein, we summarize existing evidence on the impact of homogenization on HM, with a particular focus on changes to the macromolecular structure of the milk fat globule and its subsequent impact on digestion kinetics. We use these published data to create a conceptual framework for the potential implications of homogenized HM-based nutritional products on preterm infant health. Importantly, we underscore that the safety and efficacy of homogenized HM-based products warrant investigation.

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Receiving Screened Donor Human Milk for Their Infant Supports Parental Wellbeing: a Mixed-methods Study

10.21203/rs.3.rs-1167440/v1 ◽

2021 ◽

Author(s):

Amy Brown ◽

Natalie Shenker

Keyword(s):

Mental Health ◽

Human Milk ◽

Infant Health ◽

Positive Impact ◽

Online Questionnaire ◽

Donor Human Milk ◽

Increased Risk ◽

Health And Development ◽

Almost All ◽

The Impact

Abstract Background: Donor human milk (DHM) protects the health and development of premature infants but there has been little examination of the broader impact of an infant receiving it upon parental mental health. Breastfeeding and mental health are closely tied with women who experience breastfeeding difficulties or are unable to meet their own breastfeeding goals often experiencing feelings of guilt, sadness and anger, alongside an increased risk of postnatal depression. The aim of the current study was to explore how experience of receiving DHM for their baby affected the wellbeing of parents.Methods: UK parents of infants aged 0 – 12 months who had received screened DHM from a milk bank (typically on the neonatal unit or in some cases in the community) completed an online questionnaire exploring their experiences. The questionnaire included Likert scale items examining perceived impact upon infant health, own wellbeing and family functioning alongside open-ended questions exploring perceptions of how receiving DHM affected wellbeing.Results: Almost all of the 107 participants (women=102) agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family’s wellbeing. Parents felt relieved that their infant was receiving DHM for health reasons but also due to the experience of being listened to, supported and having their infant feeding decisions facilitated. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby. Some parents did experience challenges, feeling guilty at receiving DHM, insecure that another woman was able to feed their baby when they could not, with some negative reactions from family. Although the impact of receiving DHM upon breastfeeding was not measured, some women who were working to build their own milk supply noted that it helped motivate them to continue.Conclusions: DHM may play an important role not only in protecting infant health and development but in supporting the mental health and wellbeing of mothers for whom their infant receiving human milk is important.

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Mildly Pasteurized Whey Protein Promotes Gut Tolerance in Immature Piglets Compared with Extensively Heated Whey Protein

Nutrients ◽

10.3390/nu12113391 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3391

Author(s):

Marit Navis ◽

Lauriane Schwebel ◽

Susanne Soendergaard Kappel ◽

Vanesa Muncan ◽

Per Torp Sangild ◽

...

Keyword(s):

Human Milk ◽

Whey Protein ◽

Transit Time ◽

Protein Composition ◽

In Vitro Digestion ◽

Whey Protein Concentrate ◽

Milk Formula ◽

The Impact ◽

Β Lactoglobulin

Human milk is the optimal diet for infant development, but infant milk formula (IMF) must be available as an alternative. To develop high-quality IMF, bovine milk processing is required to ensure microbial safety and to obtain a protein composition that mimics human milk. However, processing can impact the quality of milk proteins, which can influence gastro-intestinal (GI) tolerance by changing digestion, transit time and/or absorption. The aim of this study was to evaluate the impact of structural changes of proteins due to thermal processing on gastro-intestinal tolerance in the immature GI tract. Preterm and near-term piglets received enteral nutrition based on whey protein concentrate (WPC) either mildly pasteurized (MP-WPC) or extensively heated (EH-WPC). Clinical symptoms, transit time and gastric residuals were evaluated. In addition, protein coagulation and protein composition of coagulates formed during in vitro digestion were analyzed in more detail. Characterization of MP-WPC and EH-WPC revealed that mild pasteurization maintained protein nativity and reduced aggregation of β-lactoglobulin and α-lactalbumin, relative to EH-WPC. Mild pasteurization reduced the formation of coagulates during digestion, resulting in reduced gastric residual volume and increased intestinal tract content. In addition, preterm piglets receiving MP-WPC showed reduced mucosal bacterial adherence in the proximal small intestine. Finally, in vitro digestion studies revealed less protein coagulation and lower levels of β-lactoglobulin and α-lactalbumin in the coagulates of MP-WPC compared with EH-WPC. In conclusion, minimal heat treatment of WPC compared with extensive heating promoted GI tolerance in immature piglets, implying that minimal heated WPC could improve the GI tolerance of milk formulas in infants.

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Metabolomic Profile of Personalized Donor Human Milk

Molecules ◽

10.3390/molecules25245783 ◽

2020 ◽

Vol 25 (24) ◽

pp. 5783

Author(s):

Monica F. Torrez Lamberti ◽

Evon DeBose-Scarlett ◽

Timothy Garret ◽

Leslie Ann Parker ◽

Josef Neu ◽

...

Keyword(s):

Human Milk ◽

Complex Mixture ◽

Metabolomic Analysis ◽

Metabolomic Profile ◽

Beneficial Bacteria ◽

Donor Human Milk ◽

Metabolite Profiles ◽

Metabolite Concentrations ◽

Mother’S Own Milk ◽

The Impact

Human milk could be considered an active and complex mixture of beneficial bacteria and bioactive compounds. Since pasteurization drastically reduces the microbial content, we recently demonstrated that pasteurized donor human milk (DHM) could be inoculated with different percentages (10% and 30%) of mother’s own milk (MOM) to restore the unique live microbiota, resulting in personalized milk (RM10 and RM30, respectively). Pasteurization affects not only the survival of the microbiota but also the concentration of proteins and metabolites, in this study, we performed a comparative metabolomic analysis of the RM10, RM30, MOM and DHM samples to evaluate the impact of microbial restoration on metabolite profiles, where metabolite profiles clustered into four well-defined groups. Comparative analyses of DHM and MOM metabolomes determined that over one thousand features were significantly different. In addition, significant changes in the metabolite concentrations were observed in MOM and RM30 samples after four hours of incubation, while the concentration of metabolites in DHM remained constant, indicating that these changes are related to the microbial expansion. In summary, our analyses indicate that the metabolite profiles of DHM are significantly different from that of MOM, and the profile of MOM may be partially restored in DHM through microbial expansion.

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The Nutritional Composition and Energy Content of Donor Human Milk: A Systematic Review

Advances in Nutrition ◽

10.1093/advances/nmaa014 ◽

2020 ◽

Vol 11 (4) ◽

pp. 960-970 ◽

Cited By ~ 1

Author(s):

Maryanne T Perrin ◽

Mandy B Belfort ◽

James I Hagadorn ◽

Jacqueline M McGrath ◽

Sarah N Taylor ◽

...

Keyword(s):

Systematic Review ◽

Human Milk ◽

Energy Content ◽

Feeding Strategy ◽

Nutritional Composition ◽

Conclusive Evidence ◽

Sources Of Information ◽

Donor Human Milk ◽

Information Bias ◽

The Impact

ABSTRACT The American Academy of Pediatrics recommends donor human milk (DHM) as the preferred feeding strategy for preterm infants when the milk of the mother is unavailable, based on conclusive evidence of lower rates of necrotizing enterocolitis with DHM feedings compared with preterm infant formula. The nutritional composition of DHM may differ from maternal milk for many reasons including differences in maternal characteristics, milk collection methods, and the impact of donor milk banking practices. The purpose of this systematic review is to examine the literature regarding research on the fat, protein, carbohydrate, vitamin, and mineral composition of DHM obtained through nonprofit milk banks or commercial entities. PubMed, CINAHL, and Scopus databases were searched for articles published between 1985 and 30 April, 2019. In total, 164 abstracts were screened independently by 2 investigators, and 14 studies met all inclusion criteria. Studies were predominantly small (<50 samples) and measured macronutrients. Few studies assessed vitamins and minerals. Information bias was prevalent due to the use of a variety of analytical methods which influence accuracy and cross-study comparisons. Other sources of information bias included missing information regarding methods for protein and calorie assessment. Despite these limitations, existing research suggests the potential for 2-fold and greater differences in the fat, protein, and energy composition of DHM, with mean values for energy and fat often below clinical reference values expected for human milk. Further research is warranted regarding the nutritional composition of DHM, with a prioritization on measuring macronutrients and micronutrients using established reference methods.

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What are Optimal Bacteriological Screening Test Cut-Offs for Pasteurized Donor Human Milk Intended for Feeding Preterm Infants?

Journal of Human Lactation ◽

10.1177/0890334420981013 ◽

2020 ◽

pp. 089033442098101

Author(s):

Vanessa Clifford ◽

Laura D. Klein ◽

Christine Sulfaro ◽

Tass Karalis ◽

Veronica Hoad ◽

...

Keyword(s):

Human Milk ◽

Clinical Excellence ◽

Screening Criteria ◽

Acceptance Criterion ◽

Donor Human Milk ◽

Safety Risks ◽

Food Standards ◽

Milk Bank ◽

Microbial Screening ◽

The Impact

Background Definitive criteria for microbial screening of pasteurized donor human milk are not well established and international recommendations vary. Aims (1) To review pasteurized donor human milk batch discard due to failed microbial screening criteria at our milk bank (following United Kingdom National Institute of Clinical Excellence guidelines), and (2) to compare our known milk discard proportion with estimated milk discard proportions that would be required by other international milk bank guidelines. Methods We reviewed our microbial screening results ( N = 783) over 18-months (July 2018-December 2019) and compared our known milk discard proportion with estimated milk discard proportions using other international milk bank guidelines. Results Of samples, n = 50 (6.4%) failed pre-pasteurization screening, most commonly due to the presence of >104 CFU/mL Enterobacterales in the pre-pasteurization sample ( n = 30; 3.8%). Two (0.3%) samples failed post-pasteurization screening, with Bacillus cereus identified in both cases, resulting in total discard proportion of 6.7% ( n = 52) of batches. Applying European Milk Bank Association recommended bacterial screening criteria, approximately 23.3% ( n = 183) of milk batches would have been discarded. Conclusions Further research is required to justify the stringent European Milk Bank Association recommendations for pre-pasteurization discard criteria, although we believe that a post-pasteurization acceptance criterion of <1 CFU/mL is appropriate and aligns with international guidance. Further work is needed to understand pasteurized donor human milk microbiological safety risks, to better integrate screening criteria within current food standards regulation, and to consider risk-based assessment including the impact on availability and affordability.

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