Personalized Nutrition with Banked Human Milk for Early Gut Microbiota Development: In Pursuit of the Perfect Match.

The correct initial colonization and establishment of the gut microbiota during the early stages of life is a key step, with long-lasting consequences throughout the entire lifespan of the individual. This process is affected by several perinatal factors; among them, feeding mode is known to have a critical role. Breastfeeding is the optimal nutrition for neonates; however, it is not always possible, especially in cases of prematurity or early pathology. In such cases, most commonly babies are fed with infant formulas in spite of the official nutritional and health international organizations' recommendation on the use of donated human milk through milk banks for these cases. However, donated human milk still does not totally match maternal milk in terms of infant growth and gut microbiota development. The present review summarizes the practices of milk banks and hospitals regarding donated human milk, its safety and quality, and the health outcomes in infants fed with donated human milk. Additionally, we explore different alternatives to customize pasteurized donated human milk with the aim of finding the perfect match between each baby and banked milk for promoting the establishment of a beneficial gut microbiota from the early stages of life.

The acceptability of a donor human milk bank and donated human milk among mothers in Limpopo Province, South Africa.

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low-birth-weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in-depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping others and having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing culture and safety concerns at antenatal clinics.

Operation Status of the Mutual Aid Human Milk Bank for Preterm Infants and Data Analysis.

Objectives: This study aimed to investigate the matching degree between the donated supply and demand, clinical characteristics of both donors and recipients, along with the operation cost. Methods: From January 1, 2018 to December 31, 2021, the data on human milk donation and usage, the clinical characteristics of donors and recipients, and the cost of each operating center were collected from the Manual Donation Registration Form and Information Management System of the selected human milk bank. Results: During the four years that the human milk bank was in operation, the volume of donated milk was slightly greater than the volume of consumed milk. A total of 1364 donors donated 2434.63 liters of qualified human milk, for RMB 1,791,000 (USD 257, 202), ie, RMB 385.3 (USD 55.3)/L; 97.8% of the donors were preterm puerperae, and 59% of the donors donated between 1 week and 1 month after delivery. All recipients were preterm infants and received donated human milk for a duration of 9.4 days on average. During the four years of operation, the proportion of donors who had previously received donated milk among all donors showed an overall increasing trend, while the incidence of NEC in preterm infants gradually decreased. Conclusions: The increasingly optimized structure of donors, the more economical operation, and the fact that the use of donated milk may not affect breastfeeding of the recipients have made it a human milk bank operation mode worthy of promotion.

Donor Breast Milk Banking: Knowledge and Attitudes of Iranian Mothers.

INTRODUCTION: Milk donation is allowed in Islam and considered a virtue, though according to Islam Sharia, feeding donated milk of other mothers leads to kinship between infants, complicating milk donation programs in Islamic countries. This study aimed to determine the knowledge and attitude of Iranian Muslim mothers regarding milk donation and milk banks. METHODS: In this cross-sectional descriptive-analytic study, 634 mothers of infants below 1 year of age were recruited using cluster random sampling from health care centers in Tabriz, Iran. Data were collected by questionnaire. RESULTS: The findings revealed a low level of knowledge but relatively positive attitudes. Knowledge predictors were education level, income, type of birth, breastfeeding experience, encouragement to donate milk, and hearing about milk donation (p ≤ .02). Predictors of attitude were knowledge score and encouragement to donate milk (p ≤ .001). DISCUSSION: Comprehensive, culturally congruent education of mothers during pregnancy and post-pregnancy related to milk banks is recommended.

Breastfeeding and human milk bank in a neonatal intensive care unit: impact of the COVID-19 pandemic in an Italian cohort of very low birth weight infants.

BACKGROUND: Parental stress in neonatal intensive care units (NICU) is well known, as is the stress induced by the COVID-19 pandemic. This combination might increase stress to the extent of affecting the availability of maternal expressed milk and the success of establishing breastfeeding. This is particularly relevant in very preterm infants. METHODS: We conducted a single-centre retrospective analysis in two cohorts of very low birth weight infants born in a hospital in Italy. Babies born before the pandemic (September 2017 - December 2019) (n = 101) and during the pandemic (March 2020 - December 2021) (n = 67) were included in the analysis. We compared the rate of babies fed with maternal milk (both expressed and / or donated) at the achievement of full enteral feeding and the rate of those exclusively breastfed at discharge in the two groups. Then, we analysed the impact of donated human milk availability on infant formula use. We also compared mother's need for psychological support during NICU stay and the duration of psychological follow-up after discharge. RESULTS: In our NICU the availability of expressed maternal milk significantly decreased during the COVID-19 pandemic (86.1% before the pandemic vs 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement. Thanks to the availability of donated human milk, the rate of formula-fed babies remained almost unchanged (13.9% vs 14.9%). At discharge, the rate of breastfeeding was similar (73.3% vs 72.7%). The maternal need for psychological support was significantly higher during the pandemic (33% vs 64%, p < 0.001), as well as the duration of follow-up > 6 months (1% vs 15%, p < 0.001). No differences in the main clinical outcomes were found. CONCLUSION: Pandemic-induced stress had a significant impact on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted. Further research is desirable to optimise the use of donated human milk banks during emergency situations.

Cambios en la microbiota intestinal en neonatos pretérmino en un hospital de tercer nivel en Perú / Changes in the intestinal microbiota in preterm infants in a tertiary hospital in Peru

Introducción: La Microbiota Intestinal (MI) del recién nacido pretérmino (RNP) es modificada por factores como la hospitalización, los antibióticos, la nutrición post natal, entre otros. El estudio: Investigación observacional ­ longitudinal con objetivo de analizar los cambios en la MI promovidos por el tipo de lactancia recibida en neonatos <37 semanas de edad gestacional. Se analizaron muestras de 23 neonatos hospitalizados en las Unidades de Cuidados Intensivos (UCIN) y Neonatología. Hallazgos: No se encontró diferencia significativa en el desarrollo de la MI respecto al tipo de alimentación, sin embargo se observó una tendencia diferente entre los neonatos alimentados con Leche Humana (LH) que aumentaron la cantidad de Lactococcus y Clostridium mientras disminuyeron Lactobacillus, opuesto al grupo alimentado con Lactancia Mixta (LM) que aumentó la abundancia de Lactobacillus y disminuyó Lactococcus y Clostridium; Conclusión: Se concluye que los miembros específicos de la MI del RNP depende de la interacción dinámica entre el huésped y el tipo de selección dietética.

Background:The Intestinal Microbiota (IM) of the preterm newborn (RNP) is modified by factors such as hospitalization, antibiotics,postnatal nutrition,among others.The study:Observational-longitudinalresearchwiththeobjectiveof analyzing the changes in MI promoted by the type of breastfeeding received in neonates <37 weeks of gestational age. Samples of 23 neonates hospitalized in the Intensive Care Units (NICU) and Neonatology were analyzed. No significant difference Findings: was found in the development of IM with respect to the type of feeding, however a different trend was observed among the neonates fed with Human Milk (HL) that increased the amount of Lactococcusand Clostridiumwhile they decreased Lactobacillus, opposite to the group fed with Mixed Lactation (BF) that increased the abundance of Lactobacillus and decreased Lactococcusand Clostridium;Itisconcludedthatthespecific Conclusion:members of the MI of the RNPdepend on the dynamic interaction between the host and the type of dietary selection.

Donated Human Milk as a Determinant Factor for the Gut Bifidobacterial Ecology in Premature Babies.

Correct establishment of the gut microbiome is compromised in premature babies, with Bifidobacterium being one of the most affected genera. Prematurity often entails the inability to successfully breastfeed, therefore requiring the implementation of other feeding modes; breast milk expression from a donor mother is the recommended option when their own mother's milk is not available. Some studies showed different gut microbial profiles in premature infants fed with breast milk and donor human milk, however, it is not known how this affects the species composition of the genus Bifidobacterium. The objective of this study was to assess the effect of donated human milk on shaping the gut bifidobacterial populations of premature babies during the first three months of life. We analyzed the gut bifidobacterial communities of 42 premature babies fed with human donor milk or own-mother milk by the 16S rRNA-23S rRNA internal transcriber spaces (ITS) region sequencing and q-PCR. Moreover, metabolic activity was assessed by gas chromatography. We observed a specific bifidobacterial profile based on feeding type, with higher bifidobacterial diversity in the human donor milk group. Differences in specific Bifidobacterium species composition may contribute to the development of specific new strategies or treatments aimed at mimicking the impact of own-mother milk feeding in neonatal units.

Donated human milk use and subsequent feeding pattern in neonatal units.

Background: Donated human milk (DHM) is a safe alternative in the absence of mother's own milk (MOM); however, specific clinical indications for DHM use and its impact on subsequent feeding practice remain unclear. We aimed to audit local DHM use and explore the impact of the introduction of DHM as the first enteral feed on subsequent MOM availability. Methods: We retrospectively audited DHM recipients nursed in Royal Hospital for Children, Glasgow from 2014 to 2016 against local guidelines. Data were collected from an operational electronic database. Descriptive data analysis was performed to describe DHM use. To explore the association between the first human milk feed with subsequent MOM availability Kruskal Wallis test was used. Adjustments for confounding variables were performed using analysis of variance (ANOVA). Results: A total of 165 recipients of DHM (5.3% of all admission to RHC) were identified. The majority of recipients (69%) were born < 32 weeks of gestation. The main indication for DHM was prematurity, other indications included congenital anomalies of bowel and heart. The local guideline was adhered to in 87% of cases. The median interquartile range (IQR) at DHM introduction was 6 days (3, 17) and the duration of use was 12 days (6, 22). In those born < 32 weeks of gestation the type of human milk (DHM and/ or MOM) used as first feed did not influence the subsequent median IQR days of feeding with any MOM [DHM 40 (9, 51); MOM 28 (17, 49), MOM & DHM 17 (10, 26) p value = 0.465] after adjusting for birthweight and length of hospital stay. Conclusions: In our unit, DHM is mainly used in preterm neonates in accordance with existing local guidance. Using DHM as first milk feed did not affect subsequent MOM availability.

Perceptions on donated human milk and human milk banking in Nairobi, Kenya.

Donor human milk (DHM) is recomended as the best alternative when use of mothers' own milk is not a feasible option. Kenya has not yet established human milk banks (HMBs) for provision of safe DHM, which is free from any physical, chemical, microbiological contaminants or pathogens. This study aimed to establish the perceptions on donating and using DHM, and establishing HMBs in Kenya. Qualitative data were collected through 17 focus group discussions, 29 key informant interviews, and 25 in-depth interviews, with women of childbearing age, community members, health workers, and policy makers. Quantitative interviews were conducted with 868 mothers of children younger than 3 years. Descriptive analysis of quantitative data was performed in STATA software, whereas qualitative interviews were coded using NVIVO and analysed thematically. Majority of them had a positive attitude towards donating breast milk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM for their own children (59%). The main concerns on donation and use of DHM were personal dislikes, fear of transmission of diseases including HIV, and hygiene concerns. Ensuring safety of DHM was considered important in enhancing acceptability of DHM and successful establishment of the HMBs. When establishing HMBs, Kenya must take into consideration communication strategies to address the main concerns raised regarding the quality and safety of the DHM. The findings will contribute to the development of HMB guidelines in Kenya and other African contexts.

Staphylococcus aureus Enterotoxin Production in Raw, Holder-Pasteurized, and Ultraviolet-C-Treated Donated Human Milk.

Background: Some strains of Staphylococcus aureus can produce heat-stable enterotoxins that have been associated with gastritis and potentially necrotizing enterocolitis in preterm infants. Objectives/Hypothesis: To assess the impact of different storage temperatures on S. aureus growth and enterotoxin production in raw, Holder-pasteurized (HP) and ultraviolet-C (UV-C)-treated donated human milk (DHM). Materials and Methods: The milk samples from individual donors were pooled and divided into four equal portions. One portion was HP, the second was UV-C treated, the third was not treated, and the fourth was UV-C treated after being spiked with S. aureus. All samples were incubated at 37°C (18 hours) and 4°C (14 days). Bacterial colony count, enterotoxin A and B, and immune proteins were quantified. Results: At 37°C, the colony count increased in HP DHM and decreased in raw and UV-C-treated DHM. At 4°C, colony counts in HP DHM reduced and were not detected in raw and UV-C-treated DHM from day 8 of incubation. No bacteria were detected in samples that were inoculated before UV-C treatment. Enterotoxin A was only detected in HP-DHM at 37°C from the 9th hour onward. Enterotoxin B was detected in one sample at the 15th hour. Immune protein concentrations were similar in raw and UV-C DHM, and were reduced in the HP DHM. Conclusion: UV-C-treated milk reduces S. aureus growth with similar kinetics to raw milk making it a promising emerging technique to eliminate bacteria while retaining essential immune proteins in DHM.

Improving Pasteurization to Preserve the Biological Components of Donated Human Milk.

Donor human milk (DHM) in human milk banks (HMB) is routinely subjected to heat treatment to ensure microbiological security, most guidelines recommending a temperature of 62. 5°C for 30 min. However, this procedure negatively impacts on milk quality, due to the destruction of biological components. Different studies have called for a more respectful treatment of DHM to preserve its properties, and have explored the use of alternative technologies. There is also clear evidence that bacterial and viral contamination in human milk can be effectively destroyed by temperatures lower than that currently recommended (62.5°C). Thus, a simple option would be to optimize the conventional pasteurization technique so the treated milk is free of infectious elements yet retains a maximum amount of biological components. An advantage of this approach is that it would be unnecessary to replace the pasteurization equipment currently available in most HMB. On the basis of a literature review, we here analyze and discuss evidence that pasteurization of human milk at a temperature below 62.5°C results in an improved preservation of its properties without compromising safety regarding the transmission of infectious agents.