Professor, Neonatology, School of Pediatrics, University of Milan, Italy
President, Italian Association of Donated Human Milk Banks (AIBLUD)
Past President, European Milk Bank Association (EMBA)
Founder, Human Milk Bank of Milan
The American Academy of Pediatrics (1) and the ESPGHAN Committee on Nutrition (2) state that, because of the potential benefits, all preterm infants should receive human milk (HM). Own mother’s milk (OMM) should be the primary diet, and if OMM is not available or not in sufficient quantity, donor human milk (DHM) obtained from well recognized human milk banks (HMBs) should be used. OMM, when administered within 24 hours, does not require routine culturing or heat treatment (3). Instead, DHM needs to be checked microbiologically and should undergo heat treatment and storage procedures. For HMBs, pasteurization at 62.5°C for 30 minutes (Holder method) is recommended (4). Holder pasteurization allows a good compromise between microbiological safety and nutritional/biological quality of donor human milk, but it is also well known that this method affects some of the nutritional and biological properties of HM and decreases its nutritional value (5).
To overcome the limitations of Holder pasteurization, different methodologies of human milk treatment are under investigation. Rapid pasteurization at 72°C for 5-15 seconds (High- Temperature Short-Time = HTST) is a method that seems superior to Holder pasteurization. Although already established in food industry, the advantages of HTST technology in HM processing till now have been tested only at small laboratory scale. Recently we tested a new HTST device specifically designed to provide HMBs with the technology they need to ensure a safe and lower-impact pasteurization process. The device can pasteurize up to 10 L of milk per hour, with a minimum volume of 100 ml. The system is designed to be cleaned-in-place after each pasteurization run and sanitized immediately prior to the next use.
The efficacy of the new HTST device was assessed on inoculated Listeria monocytogenes, Staphylococcus aureus and Chronobacter sakazakii, as well as on raw human milk bacteria. The milk biochemical quality after HTST pasteurization was assessed in comparison to a standard Holder pasteurization by determining the secretory IgAs (sIgAs) content, the protein profile, lysozyme and the Bile Salt Stimulated Lipase (BSSL) activities. No pathogen or bacteria growth was detected after HTST pasteurization with the new instrument. The sIgAs content and BSSL activity were significantly higher in the milk pasteurized with the new device than in the milk treated with the standard Holder pasteurization.
In conclusion, the new HTST apparatus can: (1) pasteurize effectively human milk with a better retention of sIgAs content and BSSL activity; (2) comply with human milk banking safety requirement.
(1) American Academy of Pediatrics. Policy statement. Section on breastfeeding. Pediatrics 2005; 115:496-506
(2) Arslanoglu S., Corpeleijn W., Moro G.E., et al.: Donor human milk for preterm infants: current evidence and research directions. Journal Pediatr Gastroenterol Nutr 2013; 57(4):535-542
(3) American Academy of Pediatrics. Recommendations for care of children in special circumstances. In: Red Book 2009. Report of the Committee on Infectious Diseases, 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009: 108-124
(4) Arslanoglu S., Moro G.E.: Guidelines for the establishment and operation of a donor human milk bank. J Matern Fetal Neonatal Med 2010; 23 Suppl 2, pp 1-20
(5) Arslanoglu S., Moro G.E., Ziegler E.E.: Donor human milk in preterm infant feeding: evidence and recommendations. World Association of Perinatal Medicine (WAPM) Working Group on Neonatal Nutrition. J Perinat Med 2010; 38:347-351