Abstract
Donor milk is the best alternative for the feeding of preterm newborns when mother's own milk is unavailable. For safety reasons, it is usually pasteurized by the Holder method (62.5°C for 30 min). Holder pasteurization results in a microbiological safe product but impairs the activity of many biologically active compounds such as immunoglobulins, enzymes, cytokines, growth factors, hormones or oxidative stress markers. High-temperature short-time (HTST) pasteurization has been proposed as an alternative for a better preservation of some of the biological components of human milk although, at present, there is no equipment available to perform this treatment under the current conditions of a human milk bank. In this work, the specific needs of a human milk bank setting were considered to design an HTST equipment for the continuous and adaptable (time-temperature combination) processing of donor milk. Microbiological quality, activity of indicator enzymes and indices for thermal damage of milk were evaluated before and after HTST treatment of 14 batches of donor milk using different temperature and time combinations and compared to the results obtained after Holder pasteurization. The HTST system has accurate and simple operation, allows the pasteurization of variable amounts of donor milk and reduces processing time and labor force. HTST processing at 72°C for, at least, 10 s efficiently destroyed all vegetative forms of microorganisms present initially in raw donor milk although sporulated Bacillus sp. survived this treatment. Alkaline phosphatase was completely destroyed after HTST processing at 72 and 75°C, but γ-glutamil transpeptidase showed higher thermoresistance. Furosine concentrations in HTST-treated donor milk were lower than after Holder pasteurization and lactulose content for HTST-treated donor milk was below the detection limit of analytical method (10 mg/L). In conclusion, processing of donor milk at 72°C for at least 10 s in this HTST system allows to achieve the microbiological safety objectives established in the milk bank while having a lower impact regarding the heat damage of the milk.
Highlights
Breast milk provides all the nutrients, vitamins, and minerals, required for infant growth
The High-temperature short-time (HTST) system consists of the following major units: holding tanks and pumps, heat exchange and holding sections, temperature and flow controllers, and a recording device (Figures 2A, B)
More are planned to open in a close future to foster the use of donor human milk (DHM) in preterm infants when mother’s own milk (MOM) is not available or enough to cope with the neonate requirements (Haiden and Ziegler, 2016), following the recommendations of organisms such as the World Health Organization2, the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN Committee on Nutrition et al, 2013), the Human Milk Banking Association of North America (Human Milk Banking Association of North America, 2015), and the American Academy of Pediatrics (Section on breastfeeding American Academy of Paediatrics, 2012)
Summary
Breast milk provides all the nutrients, vitamins, and minerals, required for infant growth. When MOM is unavailable or is in short supply to meet the nutritional requirements of the preterm infants, which is relatively frequent in Neonatal Intensive Care Units (NICUs), the best alternative is the use of donor human milk (DHM) (ESPGHAN Committee on Nutrition et al, 2013; DiLauro et al, 2016). The use of DHM is associated to a reduction in the incidence of necrotizing enterocolitis, protection against late-onset sepsis and improved feeding tolerance compared to formula milk in this high-risk group of infants (Quigley and McGuire, 2014; Sisk et al, 2017). In order to provide safe DHM, implementation of very stringent quality control and quality assurance systems are required in HMBs (DeMarchis et al, 2017)
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