The impact of milk banking processes on macronutrient variability in donor human milk (DHM) is largely unknown.
Objective:
To gain a better understanding of fat and protein composition in DHM and assess potential relationships with modifiable milk bank processes.
Methods:
Samples of raw, pooled DHM were collected from 20 milk banks (n = 300) along with the following processing attributes: if macronutrient analysis was used to select donors for pooling (target pooling; yes/no), number of donors per pool, pooling container material (glass/plastic/other), and method for mixing during bottling (manual/mechanical). Fat and protein were assessed. Homoscedasticity was assessed and magnitude of the spread was quantified.
Results
: Fat ranged from 1.9 to 6.1 g/dL (n = 298) and protein ranged from 0.7 to 1.4 g/dL (n = 300). Variability in fat was significantly lower in samples that had been target pooled (p = 0.04), contained more donors per pool (p < 0.001), and had been mixed mechanically (p < 0.001). Variability in protein was significantly lower in samples that contained more donors per pool (p = 0.001). In a stratified analysis, increasing the number of donors per pool only reduced nutrient variability in samples that were not target pooled.
Conclusion:
For milk banks that do not target pool, using a greater number of donors in a pool may reduce fat and protein variability.
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References
1.
KumarRK, SinghalA, VaidyaU, et al.Optimizing nutrition in preterm low birth weight infants—consensus summary. Front Nutr, 2017; 4:20.
2.
KoletzkoB, PoindexterB, UauyR, eds. Nutritional care of preterm infants: Scientific basis and practical guidelines. In: World Review of Nutrition and Dietetics. Vol 110. Basel, Switzerland: S. Karger AG, 2014.
3.
FernandesC, PammiM, KatakamL, eds. Guidelines for Acute Care of the Neonate. 27th ed. Houston, TX: Section of Neonatology, Department of Pediatrics, Baylor College of Medicine; 2019.
4.
PerrinM. Donor human milk and fortifier use in united states level 2, 3, and 4 neonatal care hospitals. J Pediatr Gastroenterol Nutr, 2018; 66:664–669.
5.
DonovanR, KellySG, PrazadP, et al.The effects of human milk fortification on nutrients and milk properties. J Perinatol, 2017; 37:42–48.
6.
PerrinMT, FoglemanAD, NewburgDS, et al.A longitudinal study of human milk composition in the second year postpartum: Implications for human milk banking: Human milk composition in second year postpartum. Matern Child Nutr, 2017; 13:e12239.
7.
Meredith-DennisL, XuG, GoonatillekeE, et al.Composition and variation of macronutrients, immune proteins, and human milk oligosaccharides in human milk from nonprofit and commercial milk banks. J Hum Lact, 2017; 34:120–129.
8.
FuTT, SchroderPE, PoindexterBB. Macronutrient analysis of target-pooled donor breast milk and corresponding growth in very low birth weight infants. Nutrients, 2019; 11:1884.
9.
YoungBE, BormanLL, HeinrichR, et al.Effect of pooling practices and time postpartum of milk donations on the energy, macronutrient, and zinc concentrations of resultant donor human milk pools. J Pediatr, 2019; 214:54–59.
10.
JohnA, SunR, MaillartL, et al.Macronutrient variability in human milk from donors to a milk bank: Implications for feeding preterm infants. PLoS One, 2019; 14:e0210610.
11.
PerrinM, BelfortM, HagadornJ, et al.The nutritional composition and energy content of donor human milk: A systematic review. Adv Nutr, 2020 [Epub ahead of print]; DOI:10.1093/advances/nmaa014.
12.
de HalleuxV, PieltainC, SenterreT, et al.Growth benefits of own mother's milk in preterm infants fed daily individualized fortified human milk. Nutrients, 2019; 11:772.
13.
RochowN, FuschG, ChoiA, et al.Target fortification of breast milk with fat, protein, and carbohydrates for preterm infants. J Pediatr, 2013; 163:1001–1007.
14.
McLeodG, SherriffJ, HartmannPE, et al.Comparing different methods of human breast milk fortification using measured. assumed macronutrient composition to target reference growth: A randomised controlled trial. Br J Nutr, 2016; 115:431–439.
15.
MacedoI, Pereira da SilvaL, CardosoM. Associations of measured protein and energy intakes with growth and adiposity in human milk-fed preterm infants at term postmenstrual age: A cohort study. Am J Perinatol, 2018; 35:882–891.
16.
Stoltz SjostromE, OhlundI, AhlssonF, et al.Nutrient intakes independently affect growth in extremely preterm infants: Results from a population-based study. Acta Paediatr, 2013; 102:1067–1074.
17.
BoullataJI, CarreraAL, HarveyL, et al.ASPEN safe practices for enteral nutrition therapy. J Parenter Enter Nutr, 2017; 41:15–103.
18.
Human Milk Banking Association of North America. Guidelines for the Establishment and Operation of a Donor Human Milk Bank. Fort Worth, TX: HMBANA; 2018.
19.
ValentineC, MorrowG, ReisingerA, et al.Lactational stage of pasteurized human donor milk contributes to nutrient limitations for infants. Nutrients, 2017; 9:302.
20.
ChangY, ChenC, LinM. The macronutrients in human milk change after storage in various containers. Pediatr Neonatol, 2012; 53:205–209.
21.
GoldblumRM, GarzaC, JohnsonCA, et al.Human milk banking I. Effects of container upon immunologic factors in mature milk. Nutr Res, 1981; 1:449–459.
22.
LawrenceR. Storage of human milk and the influence of procedures on immunological components of human milk. Acta Paediatr, 1999; 88:14–18.
23.
WilliamsonMT, MurtiPK. Effects of storage, time, temperature, and composition of containers on biologic components of human milk. J Hum Lact, 1996; 12:31–35.
24.
GaoC, MillerJ, MiddletonPF, et al.Changes to breast milk fatty acid composition during storage, handling and processing: A systematic review. Prostaglandins Leukot Essent Fatty Acids, 2019; 146:1–10.
25.
WikingL.Milk Fat Globule Stability Lipolysis with Special Reference to Automatic Milking Systems. [dissertation]. Denmark, Sweden: Swedish University of Agricultural Sciences; 2005.
26.
GarwolinskaD, NamiesnikJ, Kot-WasikA, et al.Chemistry of human breast milk—A comprehensive review of the composition and role of milk metabolites in child development. J Agric Food Chem, 2018; 66:11881–11896.
27.
LucasA, GibbsJ, LysterR, et al.Creamatocrit: Simple clinical technique for estimating fat concentration and energy value of human milk. BMJ, 1978; 1:1018–1020.
28.
MillerEM, AielloMO, FujitaM, et al.Field and laboratory methods in human milk research. Am J Hum Biol, 2013; 25:1–11.
29.
WangCD, ChuPS, MellenBG, et al.Creamatocrit and the nutrient composition of human milk. J Perinatol, 1999; 19:343–346.
30.
MeierPP, EngstromJL, ZulegerJL, et al.Accuracy of a user-friendly centrifuge for measuring creamatocrits on mothers' milk in the clinical setting. Breastfeed Med, 2006; 1:79–87.
31.
KellerRP, NevilleC. Determination of total protein in human milk: Comparison of methods. Clin Chem, 1986; 32:120–123.
32.
PerrinMT, FestivalJ, StarksS, et al.Accuracy and reliability of infrared analyzers for measuring human milk macronutrients in a milk bank setting. Curr Dev Nutr, 2019; 3:nzz116.
de HalleuxV, RigoJ. Variability in human milk composition: Benefit of individualized fortification in very-low-birth-weight infants. Am J Clin Nutr, 2013; 98:529S–535S.
35.
Garcia-LaraNR, Escuder-ViecoD, Alonso DiazC, et al.Type of homogenization and fat loss during continuous infusion of human milk. J Hum Lact, 2014; 30:436–441.
36.
de OliveiraSC, BellangerA, MenardO, et al.Impact of human milk pasteurization on gastric digestion in preterm infants: A randomized controlled trial. Am J Clin Nutr, 2017; 105:379–390.
