Raw Breast Milk Research Articles

A case of breast milk-acquired cytomegalovirus infection in an extremely low birth weight infant.

Although breast milk is considered the optimal nutrition for infants, it is also the primary cause of postnatal cytomegalovirus (CMV) infection. Preterm infants with postnatal CMV infections are susceptible to a variety of life-threatening conditions. Twin male infants were delivered via emergency caesarian section at 27 weeks' gestation secondary to maternal complete uterine rupture. The Apgar scores at 1 and 5 min were 1 and 1 for the older twin (Twin A) and 0 and 3 for the younger twin (Twin B). Their birth weights were 1203 g (+ 0.65SD) and 495 g (- 3.79SD) respectively. On day 41, laboratory blood test results for Twin B showed a moderate elevation in C-reactive protein (CRP), thrombocytopenia. CMV quantitative polymerase chain reaction (qPCR) tests in Twin B's urine and blood as well as in the mother's breast milk were positive, but stored, dried umbilical cord CMV qPCR tests were negative. Twin B was diagnosed with a postnatal CMV infection secondary to infected breast milk and ganciclovir was commenced on day 52. Treatment was switched to valganciclovir at 74 days of age, but a negative CMV-DNA level in the blood was not achieved. Postnatal CMV infection in this infant led to an exacerbation of pre-existing bronchopulmonary dysplasia (BPD) and he demised at 182 days of age. Postnatal cytomegalovirus infections may lead to exacerbations of BPD. Early use of raw breast milk in preterm infants should be done with careful consideration of this potential complication.

Assessment of Dornic acidity in breast milk based on storage time in the freezer and place of expression.

Introduction. The degree of Dornic acidity (DA) is an indirect measure of milk contamination and quality. In freshly expressed milk, DA ranges between 1.0 and 4.0 (optimal). If DA is > 8.0 °D, it should be discarded. The correlation between DA in raw breast milk from internal donors (ID) and external donors (ED) based on storage time until pasteurization was assessed. Population and method. Retrospective, analytical study. Results. In 13 203 samples, DA was lower in IDs as of 14 days of storage: 2.92 (95% CI: 2.69-3.15) versus 4.01 (95% CI: 3.94-4.08), with a higher proportion of DA ≤ 4 °D (88% in IDs versus 76% in EDs); odds ratio: 2.30 (95% CI: 1.25-4.24). Conclusion. DA as of 14 days of storage was lower in IDs, with a higher prevalence of DA ≤ 4 °D. No correlation was observed between storage time and DA in ID samples.

Examining Evidence of Benefits and Risks for Pasteurizing Donor Breastmilk

An evidence map is visualized as a starting point for deliberations by trans-disciplinary stakeholders, including microbiologists with interests in the evidence and its influence on health and safety. Available evidence for microbial benefits and risks of the breastmilk ecosystem was structured as an evidence map using established risk analysis methodology. The evidence map based on the published literature and reports included the evidence basis, pro- and contra-arguments with supporting and attenuating evidence, supplemental studies on mechanisms, overall conclusions, and remaining uncertainties. The evidence basis for raw breastmilk included one benefit–risk assessment, systematic review, and systematic review/meta-analysis, and two cohort studies. The evidence basis for benefits was clear, convincing, and conclusive, with supplemental studies on plausible mechanisms attributable to biologically active raw breastmilk. Limited evidence was available to assess microbial risks associated with raw breastmilk and pasteurized donor milk. The evidence map provides transparent communication of the ‘state-of-the-science’ and uncertainties for microbial benefits and risks associated with the breastmilk microbiota to assist in deeper deliberations of the evidence with decision makers and stakeholders. The long-term aims of the evidence map are to foster deliberation, motivate additional research and analysis, and inform future evidence-based policies about pasteurizing donor breastmilk.

Knowledge and Attitude of Lactating Mothers and Health Professionals Towards Pasteurized Donor Human Milk Banking: A Preliminary Study on the Feasibility of Establishing Donor Human Milk Banking in Neonatal Intensive Care Unit of Selected Hospitals in Addis Ababa

Background: Breast milk provides the optimal nutrition for growing infants. This is because it contains all the nutrients a baby needs in exactly the right proportions. It also contains biologically active live cells which promote health and helps to develop a passive acquired immunity by transferring antibodies developed by the mother. But, there are a large group of infants such as; pre-term, low birth weight and ill infants who are unable to breastfeed. On such condition, WHO recommends pasteurized donor human milk as the next best feeding option? However, its use is limited to industrialized countries and few developing countries. Thus, this study was designed to generate preliminary information on the knowledge and acceptability of pasteurized donor human milk banking. Methods: An institutional based descriptive cross sectional study was conducted to analyze the knowledge and attitude of mothers and health professional towards pasteurized donor human milk banking. In addition, the microbial safety of raw and pasteurized breast milk stored at -20 0C for 60 days was studied. Moreover, the flavor change of raw and pasteurized breast milk over 60 days of storage time was assessed. Result: Small number of mothers (5%) ever heard about donor human milk banking. About 53.7% of health professionals did not know donor human milk banking. All health professionals use infant formula as alternative to breast milk when mother unable to breastfeed. Only 20% of study mothers could accept feeding their baby donor human milk by physician prescription. Safety or fear of transfer of disease (85.1%) was the main factor for mothers not interested to feed their baby donor human milk. On the contrary, about two-third of study mothers were willing to donate their breast milk if human milk banking will be established. Three-fourth of health professionals believed that it is feasible to establish pasteurized donor human milk banking. Lack of knowledge about its safety by mothers and health professionals is the major challenge in establishing pasteurized donor human milk banking. In pasteurized breast milk sample stored at -20 0C (deep freezer) for 60 days no bacterial growth was detected. However, in raw breast milk samples a mean of 4.66 log10 CFU/ml of total aerobic plate count, 3.22 log10 CFU/ml of Enterobacteriaceae, 3.49 log10 CFU/ml of Staphylococcus aureus were detected. Within 60 days of storage time, pasteurized milk samples did not devolve off flavor. However raw breast milk samples developed off flavor. Conclusion: the present study showed that majority (95%) of mothers never heard about pasteurized donor human milk banking and substantial number (80%) of mothers did not went to feed their baby even after short description due to fear to transfer of disease. Additionally, more than half of health professionals never heard about pasteurized donor human milk banking. Similarly, fear of disease transfer and safety during processing of pasteurized donor human milk banking is the major concern mentioned by most health professionals on its acceptability. In our microbiological analysis Within 60 days of storage time pasteurized donor human milk was bacteriological safe and has acceptable sensory quality

Knowledge and Attitude of Lactating Mothers and Health Professionals Towards Pasteurized Donor Human Milk Banking: A Preliminary Study on the Feasibility of Establishing Donor Human Milk Banking in Neonatal Intensive Care Unit of Selected Hospitals in Addis Ababa

Background: Breast milk provides the optimal nutrition for growing infants. This is because it contains all the nutrients a baby needs in exactly the right proportions. It also contains biologically active live cells which promote health and helps to develop a passive acquired immunity by transferring antibodies developed by the mother. But, there are a large group of infants such as; pre-term, low birth weight and ill infants who are unable to breastfeed. On such condition, WHO recommends pasteurized donor human milk as the next best feeding option? However, its use is limited to industrialized countries and few developing countries. Thus, this study was designed to generate preliminary information on the knowledge and acceptability of pasteurized donor human milk banking. Methods: An institutional based descriptive cross sectional study was conducted to analyze the knowledge and attitude of mothers and health professional towards pasteurized donor human milk banking. In addition, the microbial safety of raw and pasteurized breast milk stored at -20 0C for 60 days was studied. Moreover, the flavor change of raw and pasteurized breast milk over 60 days of storage time was assessed. Result: Small number of mothers (5%) ever heard about donor human milk banking. About 53.7% of health professionals did not know donor human milk banking. All health professionals use infant formula as alternative to breast milk when mother unable to breastfeed. Only 20% of study mothers could accept feeding their baby donor human milk by physician prescription. Safety or fear of transfer of disease (85.1%) was the main factor for mothers not interested to feed their baby donor human milk. On the contrary, about two-third of study mothers were willing to donate their breast milk if human milk banking will be established. Three-fourth of health professionals believed that it is feasible to establish pasteurized donor human milk banking. Lack of knowledge about its safety by mothers and health professionals is the major challenge in establishing pasteurized donor human milk banking. In pasteurized breast milk sample stored at -20 0C (deep freezer) for 60 days no bacterial growth was detected. However, in raw breast milk samples a mean of 4.66 log10 CFU/ml of total aerobic plate count, 3.22 log10 CFU/ml of Enterobacteriaceae, 3.49 log10 CFU/ml of Staphylococcus aureus were detected. Within 60 days of storage time, pasteurized milk samples did not devolve off flavor. However raw breast milk samples developed off flavor. Conclusion: the present study showed that majority (95%) of mothers never heard about pasteurized donor human milk banking and substantial number (80%) of mothers did not went to feed their baby even after short description due to fear to transfer of disease. Additionally, more than half of health professionals never heard about pasteurized donor human milk banking. Similarly, fear of disease transfer and safety during processing of pasteurized donor human milk banking is the major concern mentioned by most health professionals on its acceptability. In our microbiological analysis Within 60 days of storage time pasteurized donor human milk was bacteriological safe and has acceptable sensory quality.

Nutrition of Preterm Infants and Raw Breast Milk-Acquired Cytomegalovirus Infection: French National Audit of Clinical Practices and Diagnostic Approach.

Raw breast milk is the optimal nutrition for infants, but it is also the primary cause of acquired cytomegalovirus (CMV) infection. Thus, many countries have chosen to contraindicate to feed raw breast milk preterm infants from CMV-positive mothers before a corrected age of 32 weeks or under a weight of 1500 g. French national recommendations have not been updated since 2005. An audit of the French practices regarding the nutrition with raw breast milk in preterm infants was carried out using a questionnaire sent to all neonatal care units. Diagnosed postnatal milk-acquired CMV infections have been analysed using hospitalisation reports. Seventy-five percent of the neonatal units responded: 24% complied with the French recommendations, 20% contraindicated raw breast milk to all infants before 32 weeks regardless of the mothers’ CMV-status, whereas 25% fed all preterm infants unconditionally with raw breast milk. Thirty-five cases of infants with milk-acquired CMV infections have been reported. The diagnosis was undeniable for five patients. In France, a high heterogeneity marks medical practices concerning the use of raw breast milk and the diagnostic approach for breast milk-acquired CMV infection is often incomplete. In this context, updated national recommendations and monitored CMV infections are urgently needed.

A simple smart amplification assay for the rapid detection of human cytomegalovirus in the urine of neonates

Human cytomegalovirus (CMV) is the most common cause of infection-related congenital abnormalities in neonates and the leading cause of non-hereditary sensorineural hearing loss in childhood. In addition, the number of low-birth-weight infants has recently increased, especially in Japan, in association with an increasing frequency of postnatal CMV infections transferred through raw breast milk. The increase in the number of congenital CMV and postnatal CMV infections in low-birth-weight infants requires rapid detection at the bedside in order to ensure a correct diagnosis and provide early anti-viral therapy. In this report, a simplified smart amplification (SMAP) method was developed to detect CMV in the urine of neonates. This method does not require DNA extraction, and the DNA amplification procedure is performed under isothermal conditions. Therefore, it takes only 60min to detect CMV in a urine sample, and CMV DNA was rapidly detectable in symptomatic infants. In brief, this SMAP-based assay provides a simple, rapid and efficient method for detecting human CMV at the bedside.

Effects of Different CMV-Heat-Inactivation-Methods on Growth Factors in Human Breast Milk

Preterm infants can inoculate virulent cytomegalovirus (CMV) through their mothers' raw breast milk. Complete virus inactivation is achieved only by heat treatment, but the effect on growth factors has never been assessed systematically. Insulin-like-growth-factor-1-, IGF-2-, insulin-like-growth-factor-binding-protein-2-, and IGFBP-3-concentrations were measured, before and after heating, in 51 breast-milk-samples from 28 mothers, and epidermal-growth-factor-concentrations in a subgroup of 35 samples from 22 mothers. Two heating methods were applied: Short-term (5 s) pasteurisation at 62, 65, and 72 degrees C, and long-term Holder-Pasteurisation (30 min) at 63 degrees C. IGF-1, IGF-2, IGFBP-2, and IGFBP-3 were measured by RIA, and EGF by ELISA. Heating for 30 min decreased significantly IGF-1 by 39.4%, IGF-2 by 9.9%, IGFBP-2 by 19.1%, and IGFBP-3 by 7.0%. In contrast, IGF-1, IGF-2, IGFBP-2, and IGFBP-3 were not altered significantly when using a short heating duration of 5 s, irrespective of the level of temperature, except for IGF-2 at 62 degrees C for 5 s (p = 0.041) and IGFBP-2 at 72 degrees C for 5 s (p = 0.025). Neither long- nor short-time heating methods changed the concentration of EGF. Only short heating methods (5 s, 62-72 degrees C) can preserve, almost completely, the concentrations of IGFs in human milk, whereas Holder-Pasteurization does not.

Breastfeeding and HCMV-Infection in the Preterm Infant

According to numerous national, international and WHO guidelines, breast milk feeding is recommended for all newborns, especially preterm infants irrespective of birthweight or gestational age. However, preterm and also term infants are at risk of acquiring Cytomegalovirus (CMV) infection in their first weeks of life through their mother's raw breast milk, because nearly all CMV-IgG-positive mothers (carriers) will reactivate the virus during lactation and excrete it into their breast milk [23] [24] [25] [26] [27] [40].

The correlation between aerobic mesophilic microorganism counts and Dornic acidity in expressed human breastmilk

The study was designed to test for the existence of a correlation between the total population of aerobic mesophilic microorganisms in processed raw breastmilk from a human milk bank and the Dornic acidity of that milk. Two hundred consecutive samples of thawed expressed human breastmilk obtained from human milk bank, prior to pasteurization. Dornic acidity was titrated in triplicate for each sample. Aerobic mesophilic microorganisms were then plate counted. Data were analyzed to detect correlations between variables, using Pearson's coefficient, and the level of significance was set at p < or = 0.05. In the samples analyzed, Dornic acidity levels had a positive (R = 0.948) and statistically significant (p < or = 0.001) correlation with the population of aerobic mesophilic microorganisms (CFU/mL). The data obtained here support to the conclusion that Dornic titration is an effective method for the indirect evaluation of bacterial growth in expressed human milk.

The childs name is Today

This article examines the chances of survival of children their way of life an their health in countries around the world. Statistics of the number of children show constant number in developed countries but an ever increasing rate in developing countries. Having children is the only way the poor can increase their capital. Large families mean a rapid population increase. Some countries have a population growth rate of over 3% some cities growing at a rate of 7% or more. This results in a dramatic effect on children. UNICEF has identified several priorities essential for child survival and development: oral rehydration immunization breast feeding and growth monitoring. Other important priorities are family planning through child spacing food supplements to priority groups and female literacy. Each of these is briefly discussed as well as improving health care. Oral rehydration is the main form of treatment for diarrhea and mothers should be taught how to prepare oral rehydration solution and how to administer it. Diptheria tetanus whooping cough tuberculosis polio and measles are responsible for 5 million deaths of children in the South which can be prevented by immunization. A study involving 200 babies in India clearly showed the advantages of raw breast milk in preventing infection. A major disadvantage of artifical or formula feeding is that women rapidly become pregnant again. Another pregnancy results in less contact with the 1st infant. Brain growth occurs mainly before birth and during the first 2 years of life and therefore should be a priority period in child care. Poor maternal health results in low birth weight infant. Physician training is important in influencing physicians to detect disease and also to provide preventive and promotive health care. Improving health care will not however drastically reduce mortality since income and income distribution are major contributing factors to the problem.

A simplified system of human milk banking

A simplified system of human milk banking, from milk supplied from home or hospital, has been evaluated for use in a neonatal intensive care unit. Twenty milk samples were obtained at a single expression using a standard hand pump and divided into three parts. Analyses were performed on the raw milk and on samples stored at −20°C for 1 week and 1 month. No pathogens were isolated from any samples and the counts of Staphylococcus albus in the raw milk remained unchanged after storage. 19% of the cells in the original milk survived freezing and remained viable. There was a loss of bacteriostatic activity after storage for one month but significantly less than that caused by pasteurization. No change in levels of IgA, IgM, IgF, lactoferrin, lysozyme, C3 and C4 was apparent and concentrations of amino acids and fatty acids also remained unchanged after storage. We conclude that milk can be safely and conveniently stored by this method without loss or damage to the components of raw breast milk important for preterm and sick infants.

Collecting and banking human milk: to heat or not to heat?

Data on human breast milk and its handling when fed to babies who cannot be breast-fed were reviewed to determine whether the method of processing and storage affected the properties of the milk. Breast milk is normally contaminated by potential pathogens, which seem to produce no ill effects, but it also contains antimicrobial properties which protect against infection. The evidence suggests that pasteurisation not only eliminates pathogenic bacteria but also damages bacteriostatic mechanisms, so making the milk more susceptible to later contamination. Pasteurisation also affects the nutritional properties of milk. Freezing has little effect on milk proteins, while a study on the effect of refrigeration showed that there was little bacterial growth at temperatures below 8 degrees C. Several years' experience of feeding donated raw milk to newborn infants has confirmed that it produces no ill effects. These findings suggest that pasteurisation of donated breastmilk is unnecessary, and it is not recommended, while the decision whether or not to freeze the milk may be made on practical grounds. Raw breast milk can be safely stored at 4-6 degrees C for 72 hours.