Abstract
Background: Donor human milk (DHM) bank practices, such as pasteurization and pooling according to postpartum age of milk donations and number of donors included in a pool may impact the resulting concentration of bioactive components of DHM.Aims: We determined the impact of Holder pasteurization, postpartum milk age, and pool donor number (number of donors included in a pool) on resulting concentrations of total immunoglobulin A (IgA; which provides immune protection to the recipient infant) and insulin (an important hormone for gut maturation).We also documented inter-relationships between these bioactive components and macronutrients in DHM pools.Methods: Pre and post-pasteurization aliquots of 128 DHM samples were obtained from the Rocky Mountain Children's Foundation Mother's Milk Bank (a member of the Human Milk Banking Association of North America, HMBANA). Macronutrients were measured via mid-infrared spectroscopy. Total IgA was measured via customized immunoassay in skim milk and insulin was measured via chemiluminescent immunoassay.Results: Mean post-pasteurization total IgA concentration was 0.23 ± 0.10 (range: 0.04–0.65) mg/mL a 17.9% decrease due to pasteurization (n = 126). Mean post-pasteurization DHM insulin concentration was 7.0 ± 4.6 (range: 3–40) μU/mL, a decrease of 13.6% due to pasteurization (n = 128). The average DHM pool postpartum milk age was not associated with total IgA or insulin concentrations, but pool donor number was associated with bioactive components. Pools with only one donor had lower total IgA and lower insulin concentrations than pools with at least 2 donors (p < 0.05). Increasing the number of donors in a pool decreased the variability in total IgA and insulin concentrations (p < 0.04).Conclusion: Increasing the number of donors included in DHM pools may help optimize bioactive components in DHM received by premature infants. These results help inform milk banking practices to decrease compositional variability in produced DHM pools.
Highlights
The American Academy of Pediatrics recommends pasteurized donor human milk (DHM) as the best option to feed a premature infant when mother’s own milk is unavailable [1]
Two of the 128 post-pasteurization samples were inconclusive for total immunoglobulin A (IgA) analysis due to high %CV, giving a final sample size for post-pasteurization total IgA analysis of 126
Two of the term post-pasteurization samples were not included in the final data analysis in order to not bias results, as both were outliers over five standard deviations from the IgA mean (1.575 and 1.212 mg/mL)
Summary
The American Academy of Pediatrics recommends pasteurized donor human milk (DHM) as the best option to feed a premature infant when mother’s own milk is unavailable [1]. The Human Milk Banking Association of North America (HMBANA) supplies millions of ounces of pasteurized DHM annually to recipient infants [2]. The majority of this milk is provided to premature infants in the Neonatal Intensive Care Units (NICU), due to the protective effects of DHM against necrotizing enterocolitis [3, 4]. Human milk composition is dynamic, changing over the course of a feed, over the course of a day, and over the course of lactation For these reasons, DHM banks routinely pool milk donations from multiple donors in order to limit extreme variation. Donor human milk (DHM) bank practices, such as pasteurization and pooling according to postpartum age of milk donations and number of donors included in a pool may impact the resulting concentration of bioactive components of DHM
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