Abstract
Concentrated human milk (HM-concentrate) can be obtained from the simple and inexpensive method of donated breast milk direct lyophilization. A previous study reported that HM-concentrate contains the adequate amount of main macro- and micronutrients for use as a nutritional resource for preterm infants with very low birth weight admitted to neonatal intensive care units. However, further details need to be elucidated about HM-concentrate composition, particularly its content of essential and potentially toxic trace elements. Therefore, this study aimed to determine the concentration of essential and toxic elements in human milk considered baseline (HM-baseline) and HM-concentrate, as well as to quantify changes in concentration of these elements after the HM concentration process. The concentration of Aluminum, Arsenic, Cadmium, Chromium, Iron, Mercury, Manganese, Nickel, Lead, Selenium, Tin, and Thallium was analyzed by inductively coupled plasma-mass spectrometry (ICP-MS). Moreover, Bayesian linear mixed effect models were applied to estimate the mean difference between HM-baseline and HM-concentrate samples. After comparison (HM-concentrate versus HM-baseline), a significant increase in concentration was observed only for Manganese (0.80 μg/L; 95% CrI [0.16; 1.43]) and Selenium (6.74 μg/L; 95% CrI [4.66; 8.86]), while Lead concentration (−6.13 μg/L; 95% CrI [-8.63; −3.61]) decreased. This study provides latest and reliable information about HM composition. After milk concentration by lyophilization, there was a significant increase only in the essential elements Manganese and Selenium. The essential micronutrient content in HM-concentrate was similar or higher than that in preterm mothers' milk, which suggests it is viable for nutritional support of preterm infants. In addition, the low concentrations of potentially toxic elements in HM-concentrate indicates that it is safe for consumption by premature newborns.
Highlights
Despite rising preterm survival rates, studies show that worldwide, an estimated 9–12% (12.65–16.73 million) of live births are premature (Chawanpaiboon et al, 2019)
The present study provides updated and reliable information about the composition of mature breast milk (HM-baseline) processed by the Brazilian Human Milk Bank (HMB) Network, which should be useful for HMB networks worldwide
We demonstrate that the human milk (HM) lyophilization and concentration processes are safe, since only low concentrations of the potentially toxic elements Al, As, Pb, Cd, and Hg were detected in HM-concentrate samples
Summary
Despite rising preterm survival rates, studies show that worldwide, an estimated 9–12% (12.65–16.73 million) of live births are premature (Chawanpaiboon et al, 2019). This significant figure suggests a need for improvement in neonatal nutritional support for preterm infants, especially in low and middle-income countries. Exclusive early enteral nutrition with human milk (HM) is an effective nutritional support strategy for feeding very low birth weight (VLBW) preterm infants Such practice is associated with lower incidence of necrotizing enterocolitis and neonatal mortality, with reduction in time and cost of hospitalization (Assad et al, 2016; Colaizy et al, 2016; Cortez et al, 2018). Current recommendations emphasize that preterm newborn infants should receive the mother's milk or HM donated to the Human Milk Bank (HMB), plus commercial fortifiers to improve the milk composition, since milk is the singular nutritional source for infants (Bertino et al, 2013; Colaizy et al, 2012; Dutta et al, 2015; Valentine et al, 2017)
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