Pasteurization Procedures for Donor Human Milk Affect Body Growth, Intestinal Structure, and Resistance against Bacterial Infections in Preterm Pigs.

Background: Holder pasteurization (HP) destroys multiple bioactive factors in donor human milk (DM), and UV-C irradiation (UVC) is potentially a gentler method for pasteurizing DM for preterm infants.Objective: We investigated whether UVC-treated DM improves gut maturation and resistance toward bacterial infections relative to HP-treated DM.Methods: Bacteria, selected bioactive components, and markers of antioxidant capacity were measured in unpasteurized donor milk (UP), HP-treated milk, and UVC-treated milk (all from the same DM pool). Fifty-seven cesarean-delivered preterm pigs (91% gestation; ratio of males to females, 30:27) received decreasing volumes of parental nutrition (average 69 mL · kg-1 · d-1) and increasing volumes of the 3 DM diets (n = 19 each, average 89 mL · kg-1 · d-1) for 8-9 d. Body growth, gut structure and function, and systemic bacterial infection were evaluated.Results: A high bacterial load in the UP (6×105 colony forming units/mL) was eliminated similarly by HP and UVC treatments. Relative to HP-treated milk, both UVC-treated milk and UP showed greater activities of lipase and alkaline phosphatase and concentrations of lactoferrin, secretory immunoglobulin A, xanthine dehydrogenase, and some antioxidant markers (all P < 0.05). The pigs fed UVC-treated milk and pigs fed UP showed higher relative weight gain than pigs fed HP-treated milk (5.4% and 3.5%), and fewer pigs fed UVC-treated milk had positive bacterial cultures in the bone marrow (28%) than pigs fed HP-treated milk (68%) (P < 0.05). Intestinal health was also improved in pigs fed UVC-treated milk compared with those fed HP-treated milk as indicated by a higher plasma citrulline concentration (36%) and villus height (38%) (P < 0.05) and a tendency for higher aminopeptidase N (48%) and claudin-4 (26%) concentrations in the distal intestine (P < 0.08). The gut microbiota composition was similar among groups except for greater proportions of Enterococcus in pigs fed UVC-treated milk than in pigs fed UP and those fed HP-treated milk in both cecum contents (20% and 10%) and distal intestinal mucosa (24% and 20%) (all P < 0.05).Conclusions: UVC is better than HP treatment in preserving bioactive factors in DM. UVC-treated milk may induce better weight gain, intestinal health, and resistance against bacterial infections as shown in preterm pigs as a model for DM-fed preterm infants.

Excretion of radionuclides in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption.

PURPOSE: To review early recommendations and propose guidelines for breastfeeding interruption after administration of radiopharmaceuticals, based on additional biokinetic and dosimetric data. METHODS: Activity concentrations in breast milk from 53 breastfeeding patients were determined. The milk was collected at various times after administration of 16 different radiopharmaceuticals. The fraction of the activity administered to the mother excreted in the breast milk, the absorbed doses to various organs and tissues and the effective dose to the infant were estimated. RESULTS: The fraction of the administered activity excreted per millilitre of milk varied widely from 10(-10) to 10(-3) MBq/MBq administered. For (99m)Tc-labelled radiopharmaceuticals, the total fraction of the administered activity excreted in the milk varied from 0.0057 % for (99m)Tc-labelled red blood cells (RBC) to 19 % for (99m)Tc-pertechnetate. The effective dose to an infant per unit activity administered to the mother ranged from 6.7 × 10(-6) mSv/MBq for (99m)Tc-labelled RBC to 3.6 × 10(-2) mSv/MBq for (99m)Tc-pertechnetate. For the other radiopharmaceuticals, the total fraction of administered activity excreted in the milk varied from 0.018 % ((51)Cr-EDTA) to 48 % ((131)I-NaI). The effective dose ranged from 5.6 × 10(-5) mSvinfant/MBqmother ((51)Cr-EDTA) to 106 mSvinfant/MBqmother ((131)I-NaI). CONCLUSIONS: Based on an effective dose limit of 1 mSv to the infant and a typical administered activity, we recommend cessation of breastfeeding for (131)I-NaI and interruption of feeding for 12 h for (125)I-iodohippurate, (131)I-iodohippurate, (99m)Tc-pertechnetate and (99m)Tc-MAA. During this 12-h period all breast milk should be expressed at least three times and discarded. For the other radiopharmaceuticals included in this study, no interruption of breastfeeding is necessary.

Milk supply related to childhood leukaemia treatment.

This literature review and case study answers the question: 'Do the late effects of childhood cranial radiation therapy include impacts on breastfeeding?' PubMed was searched for papers using the terms lactation and cranial radiotherapy or childhood cranial radiotherapy. The case study was written from one author's experience of helping a mother with a history of childhood cranial radiation therapy. The few available studies report a high rate of lactation failure in women who were treated with cranial radiation therapy for childhood cancer, but the exceptions indicate that lactation failure is not inevitable in this group of mothers. Breastfeeding may ameliorate some of the adverse effects of cranial radiation therapy. Health professionals caring for mothers with a history of cranial radiation therapy must balance encouraging women to breastfeed with preparing them for the possibility that they may be unable to do so.

Optimized Ultraviolet-C Processing Inactivates Pathogenic and Spoilage-Associated Bacteria while Preserving Bioactive Proteins, Vitamins, and Lipids in Human Milk.

Holder pasteurization (HoP) enhances donor human milk microbiological safety but damages many bioactive milk proteins. Though ultraviolet-C irradiation (UV-C) can enhance safety while better preserving some milk proteins, it has not been optimized for dose or effect on a larger array of bioactive proteins. We determined the minimal UV-C parameters that provide >5-log reductions of relevant bacteria in human milk and how these treatments affect an array of bioactive proteins, vitamin E, and lipid oxidation. Treatment at 6000 and 12 000 J/L of UV-C resulted in >5-log reductions of all vegetative bacteria and bacterial spores, respectively. Both dosages improved retention of immunoglobulin A (IgA), IgG, IgM, lactoferrin, cathepsin D, and elastase and activities of bile-salt-stimulated lipase and lysozyme compared with HoP. These UV-C doses caused minor reductions in α-tocopherol but not γ-tocopherol and no increases in lipid oxidation products. UV-C treatment is a promising approach for donor human milk processing.

Thermoultrasonication, ultraviolet-C irradiation, and high-pressure processing: Novel techniques to preserve insulin in donor human milk.

BACKGROUND & AIMS: Donor human milk (DHM) is recommended as the first alternative for preterm infants if their mother's own milk is not available or if the quantity is not sufficient. The most commonly used technique to eliminate microbial contaminants in DHM is holder pasteurization (HoP). However, the heating process during HoP partially destroys milk bioactive factors such as insulin. Therefore, innovative techniques have been developed as alternatives to HoP. The objective of this study was to determine the effect of HoP, high-temperature-short-time (HTST), thermoultrasonication (TUS), ultraviolet-C irradiation (UV-C), and high-pressure processing (HPP) on the insulin concentration in DHM. METHODS: Milk samples from 28 non-diabetic mothers were collected. The milk samples were aliquoted and either left untreated or treated with HoP (62.5 °C; 30 min), HTST (72 °C; 15 s), TUS (60 W; 6 min), UV-C (4863 J/L), or HPP (500 MPa; 5 min). RESULTS: The mean insulin concentration in untreated milk was 79 ± 41 pmol/L. The mean insulin retention rate was 67% for HoP, 78% for HTST, 97% for TUS, 94% for UV-C, and 106% for HPP. The mean insulin concentration in milk treated with HoP was significantly lower compared to untreated milk (p = 0.01). CONCLUSION: TUS, UV-C, and HPP preserve insulin in DHM. The insulin concentration in DHM is affected to a larger extent by HoP than by HTST. These results indicate that TUS, UV-C, and HPP may serve as alternatives to HoP.

The consequence of phototherapy exposure on oxidative stress status of expressed human milk.

OBJECTIVE: There exists evidence that phototherapy can disturb the oxidant/antioxidant balance in favor of oxidants. If phototherapy is continued during tube feeding in preterms, expressed human milk is subjected to phototherapy lights for about 20 min per feeding. We aimed to investigate the effects of phototherapy lights on oxidative/antioxidative status of expressed human milk. STUDY DESIGN: Milk samples of 50 healthy mothers were grouped as control and phototherapy and exposed to 20 min of day-light and phototherapy light, respectively. Total antioxidant capacity (mmol-Trolox equiv/L) and total oxidant status (mmol-H2O2/L) in expressed human milk samples were measured. RESULTS: Levels of antioxidant capacity of the expressed human milks in the phototherapy group were lower than those of the control group [mmol-Trolox equiv/L; median (interquartile-range): 1.30 (0.89-1.65) and 1.77 (1.51-2.06), p: < .001]. Levels of oxidant status were similar in both groups. CONCLUSION: We demonstrated that phototherapy decreased antioxidant capacity of expressed human milk without any alteration in oxidative status. We think that this observation is important for the care of very low birth weighted infants who have limited antioxidant capacity and are vulnerable to oxidative stress. It may be advisable either to turn off the phototherapy or cover the tube and syringe to preserve antioxidant capacity of human milk during simultaneous tube feeding and phototherapy treatment.

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.

Viability of infectious viral particles of HIV and BMCs in breast milk.

BACKGROUND: Infectious factors in breast milk such as viral particles and living infected cells are of prime importance in the transmission of HIV by breastfeeding. OBJECTIVES: To perform effective approaches for reducing HIV transmission via breastfeeding, we investigated the biological importance of infectious viral particles and infected BMCs in breast milk. STUDY DESIGN: Alteration of viral infectivity was monitored using a modified experimental infection assay that exploited the cytotoxicity of breast milk, and BMC viability was evaluated by flow-cytometric analysis. RESULTS: Infectious viral particles were found to decrease time-dependently after contact with breast milk, whereas BMCs showed prolonged survival in breast milk. CONCLUSIONS: The biological importance of infected BMCs in breast milk for the transmission of HIV via breastfeeding was considered.

The effect of simulated flash heating pasteurisation and Holder pasteurisation on human milk oligosaccharides.

BACKGROUND: Human milk oligosaccharides (HMOs) have important protective functions in human milk. A low-cost remote pasteurisation temperature-monitoring system has been designed using FoneAstra, a cell phone-based networked sensing system to monitor simulated flash heat pasteurisation. AIM: To compare the pasteurisation effect on HMOs of the FoneAstra FH method with the current Sterifeed Holder method used by human milk banks. METHODS: Donor human milk samples (n = 48) were obtained from a human milk bank and pasteurised using the two pasteurisation methods. HMOs were purified from samples and labelled before separation using high-performance liquid chromatography. Concentrations of total HMOs, sialylated and fucosylated HMOs and individual HMOs using the two pasteurisation methods were compared using repeated-measures ANOVA. RESULTS: The study demonstrated no difference in total concentration of HMOs between the two pasteurisation methods and a small but significant increase in the total concentration of HMOs regardless of pasteurisation methods compared with controls (unpasteurised samples) (p<0.0001). CONCLUSION: The FoneAstra FH pasteurisation system does not negatively affect oligosaccharides in human milk and therefore is a possible alternative for providing safely sterilised human milk for low- and middle-income countries.

68Ga-DOTATATE Breast Uptake and Expression in Breast Milk.

The excretion of Ga-DOTA-Octreotate (DOTATATE) and related somatostatin analogues in breast milk has not been demonstrated. We report a case of a 34-year-old woman, 7 months postpartum and breastfeeding, who was referred for DOTATATE imaging after the diagnosis of appendiceal carcinoid and subsequent appendectomy. Prominent breast uptake was noted. A breast milk sample from the patient at 90 minutes postinjection was assayed in a gamma counter and shown to have a concentration of 5.6 Bq/g per MBq administered. The excretion of DOTATATE in breast milk is important to consider when providing radiation safety advice to breastfeeding patients.

Inactivation of Cytomegalovirus in Breast Milk Using Ultraviolet-C Irradiation: Opportunities for a New Treatment Option in Breast Milk Banking.

Pasteurized donor human milk is provided by milk banks to very preterm babies where their maternal supply is insufficient or unavailable. Donor milk is currently processed by Holder pasteurization, producing a microbiologically safe product but significantly reducing immunoprotective components. Ultraviolet-C (UV-C) irradiation at 254 nm is being investigated as an alternative treatment method and has been shown to preserve components such as lactoferrin, lysozyme and secretory IgA considerably better than Holder pasteurization. We describe the inactivation of cytomegalovirus, a virus commonly excreted into breast milk, using UV-C irradiation. Full replication was ablated by various treatment doses. However, evidence of viral immediate early proteins within the cells was never completely eliminated indicating that some viral gene transcription was still occurring. In conclusion, UV-C may be a safe alternative to pasteurisation for the treatment of human donor milk that preserves the bioactivity. However, our data suggests that CMV inactivation will have to be carefully evaluated for each device designed to treat breast milk using UV-C irradiation.

Effects of microwave radiation on anti-infective factors in human milk.

In intensive care nurseries it has become common practice to use microwave thawing of frozen human milk for more rapid accessibility. Twenty-two freshly frozen human milk samples were tested for lysozyme activity, total IgA, and specific secretory IgA to Escherichia coli serotypes 01, 04, and 06. The samples were heated by microwave for 30 seconds at a low- or high-power setting and then reanalyzed. One-mL aliquots of 10 additional human milk samples were microwaved at low (20 degrees C to 25 degrees C), medium (60 degrees C to 70 degrees C), and high (greater than or equal to 98 degrees C) setting before the addition to each of 1 mL of diluted E coli suspension. E coli growth was determined after 3 1/2 hours of incubation at 37 degrees C. Microwaving at high temperatures (72 degrees C to 98 degrees C) caused a marked decrease in activity of all the tested antiinfective factors. E coli growth at greater than or equal to 98 degrees C was 18 times that of control human milk. Microwaving at low temperatures (20 degrees C to 53 degrees C) had no significant effect on total IgA, specific IgA to E coli serotypes 01 and 04, but did significantly decrease lysozyme and specific IgA to E coli serotype 06. Even at 20 degrees C to 25 degrees C, E coli growth was five times that of control human milk. Microwaving appears to be contraindicated at high temperatures, and questions regarding its safety exist even at low temperatures.

Radiation dose from breastfeeding following administration of thallium-201.

UNLABELLED: Radiation exposure to a breast feeding infant was estimated when the mother underwent a nuclear medicine procedure using 201Tl. METHODS: A lactating mother was administered 111 MBq of 201Tl for a brain scan. Breast milk samples were collected over a period of three days, and the rate of 201Tl secretion was determined. The infant was not breast fed during that time. Based on our data, we determined the time-activity function for radioactivity in the breast milk. From these data, and assuming an intake of 1000 ml/day, we calculated the fraction of administered activity that might be taken in by the infant. We also calculated the intake assuming breastfeeding delays of 2, 24, 48, 72, 96 and 500 hr. RESULTS: We calculated the radiation dose to various organs and the effective dose to an infant and a 1-yr-old for breastfeeding delays of 2 to 500 hr. The effective dose to a 1-yr-old from an administration of 111 MBq of 201Tl to the mother ranged from 0.90 mSv to 0.00072 mSv, and the effective dose to a newborn ranged from 1.6 mSv to 0.0013 mSv depending on delay time. CONCLUSION: Our estimates of radiation exposure to an infant from breastfeeding indicate that in this case, a 1-yr-old would have received less than the NCRP's proposed limit on annual effective dose to members of the general public of 1 mSv with a 48-hr delay and no restrictions on holding the child. A newborn would have received less than the proposed infrequent exposure limit of 5 mSv without any delay or restrictions in breastfeeding.

Breast-milk radioactivity after a Tc-99m DTPA aerosol/Tc-99m MAA lung study.

Measurements were made of the concentration of Tc-99m activity in samples of breast milk following an administration of Tc-99m DTPA aerosol for a lung ventilation image and one of Tc-99m MAA for lung perfusion. The activity was 222 nCi/ml of milk (8.2 kBq/ml) at 2 hr after the MAA injection, and it was found to be excreted exponentially with an effective half-life of 4.6 hr. There was a small incorporation of Tc-99m into breast-milk protein. We conclude that the combined use of these two Tc-99m agents did not indicate the interruption of breast feeding beyond 24 hr after administration of the MAA, and that for an aerosol ventilation study alone, breast feeding need not be interrupted for more than 4 hr after the test.

Excretion of radionuclides in human breast milk after the administration of radiopharmaceuticals.

The fraction of injected activity that was excreted through the breast milk of nursing mothers at different times after the injection of various radiopharmaceuticals has been measured in 21 patients. For 99mTc-labeled radiopharmaceuticals the total excreted fraction was 10% for pertechnetate and 1.5-3% for MAA, plasmin, diethylenetriaminepentaacetic acid (DTPA), and methylene diphosphonate (MDP). For [125I]hippuran and [131I]hippuran the corresponding value was 3%. For the above mentioned radiopharmaceuticals the activity concentration in the milk decreased exponentially with an effective half-life of approximately 4 hr. For chromium-51 ethylenediaminetetraacetic acid ([51Cr]EDTA) and [99mTc]RBC, much smaller amounts were excreted in the breast milk. The absorbed dose to various organs of the baby has been calculated. We conclude that when [99mTc]pertechnetate, [99mTc]MAA, [99mTc]plasmin, [125I]hippuran, or [131I]hippuran are used the child should be fed just before the administration of the radionuclide to the mother and the next three milk fractions should not be used. For [99mTc]DTPA and [99mTc]MDP as well as [51Cr]EDTA, only the first fraction should not be used. According to our earlier investigations breast feeding has to be stopped for at least 3 wk after investigations with [125I]fibrinogen.

Effects of microwaving human milk: changes in IgA content and bacterial count.

On the basis of this study, IgA was best preserved in frozen human milk by thawing either overnight in the refrigerator or under warm running water. If either of those procedures are to be used, it is suggested that bacterial monitoring should be performed. Because current technology does not allow for accurate low internal temperature monitoring of liquids, it is concluded that use of the microwave oven for the treatment of human milk is inappropriate. However, because microwaving is as effective as holder pasteurization in killing bacteria, and because it would be less expensive and is faster, this process should be further investigated.

Breast milk radioactivity following injection of 99Tcm-pertechnetate and 99Tcm-glucoheptonate.

Measurements were made of the concentration of radioactivity in the breast milk of two patients: one following 100 MBq (2.7 mCi) 99Tcm-pertechnetate administration, and the other following administration of 550 MBq (15 mCi) 99Tcm-glucoheptonate. The fractional activity concentrations in the former case were about two orders of magnitude greater than in the latter and the effective half lives of secretion were 3 and 4 h, respectively. An infant breast fed without interruption would have ingested 5.2 and 0.055% of the 99Tcm administered with pertechnetate and with glucoheptonate, respectively. The former fractional ingestion was compatible with the larger value expected following pertechnetate injection without perchlorate pretreatment, and would have produced an effective dose equivalent to the infant of 1.5 mSV. An interruption to feeding of 12 h would reduce this dose to 0.2 mSV. It was concluded that breast feeding need not be interrupted after injection of 99Tcm-glucoheptonate other than for a short period of reassurance.

[Obstetric aspects of radiation exposure following the Chernobyl accident]. / Geburtshilfliche Aspekte zur Strahlenbelastung nach Tschernobyl.

Radioactivity was determined in the milk from 39 patients and in amniotic fluid, urine and placentas from 17 patients shortly after the Chernobyl disaster by means of a beta and gamma-scintillation counter. Elevated radioactivity (7.6 nCi/l beta activity and 7.4 nCi/l gamma activity) was found only in one sample of breast milk.

[One year after Chernobyl--radioactive cesium in breast milk]. / Ein Jahr nach Tschernobyl--radioaktives Cäsium in der Muttermilch.

Radioactivity in human breast milk was determined in 32 women in February and March 1987 by means of a Germanium detector. At this time radioactivity increased again by feeding the hay to the cattle harvested in the weeks following the disaster of Chernobyl. 8 (25%) of the values were above 0.3 nCi/l for babies milk recommended by the local authorities.

[10 years after Chernobyl--radioactivity of mother's milk-- measurements from Tirol, Tibet and Nepal]. / 10 Jahre nach Tschernobyl--Strahlenbelastung der Muttermilch--Messungen aus Tirol, Tibet und Nepal.

10 years after the Chernobyl disaster gamma radioactivity from Cs-137 was determined in 53 breast milk samples from Tyrol, as well as 9 samples from Tibet and 2 from Nepal by means of a gamma-spectrometer with a germanium detector. In contrast to the values obtained within a few days, and again 1 year after the nuclear plant catastrophe, all samples from Tyrol showed gamma radioactivity levels (median 0.07 nCi/l; range 0.02-0.20 nCi/l) which were now below the limit laid down for baby food in Austria (0.3 nCi/l-11.1 Bq). The samples from Tibet and Nepal registered a slightly higher level of gamma radioactivity (median 0.16 nCi/l; range 0.16-0.41 nCi/l).