Feeding premature infants banked human milk homogenized by ultrasonic treatment

doi:10.1016/S0022-3476(05)80399-3

The Journal of Pediatrics

Volume 123, Issue 6, December 1993, Pages 985-988

https://doi.org/10.1016/S0022-3476(05)80399-3 Get rights and content

Premature neonates fed ultrasonically homogenized human milk had better weight gain and triceps skin-fold thickness than did a control group given untreated human milk (p<0.01) and also had lower fat loss during tube feeding (p <0.01). Ultrasonic homogenization of human milk appears to minimize loss of fat and thus allows better growth of premature infants.

References (12)

GreerFR et al.
Changes in fat concentration of human milk during delivery by intermittent bolus and continuous mechanical pump infusion
J Pediatr
(1984)
MartinezFE et al.
Effects of ultrasonic homogenization of human milk on lipolysis, IgA, IgG, lactoferrin and bacterial content
Nutrition Research
(1992)
NakaiS et al.
Spectrophotometric determination of protein and fat in milk simultaneously
J Dairy Sci
(1970)
Van de KamerJH et al.
Rapid method for determination of fat in feces
J Biol Chem
(1949)
FomonSJ et al.
Excretion of fat by normal full-term infants fed various milks and formulas
Am J Clin Nutr
(1970)
BrookeOG et al.
Loss of energy during continuous infusion of breast milk
Arch Dis Child
(1978)

There are more references available in the full text version of this article.

Cited by (18)

The Impact of Homogenization on Donor Human Milk and Human Milk-Based Fortifiers and Implications for Preterm Infant Health
2022, Current Developments in Nutrition
An exclusive human milk diet (EHMD) has been shown to reduce health complications of prematurity in infants born weighing ≤1250 g compared with cow milk–based diets. Accordingly, the number of available human milk (HM)-based nutritional products continues to increase. Newly available products, and those reportedly soon to enter the market, include homogenized donor HM and homogenized HM–based fortifiers. Existing literature demonstrating the benefits of an EHMD, however, is limited to non-homogenized HM-based products. Herein, we summarize existing evidence on the impact of homogenization on HM, with a particular focus on changes to the macromolecular structure of the milk fat globule and the subsequent impact on digestion kinetics. We use these published data to create a conceptual framework for the potential implications of homogenized HM-based nutritional products on preterm infant health. Importantly, we underscore that the safety and efficacy of homogenized HM-based products warrant investigation.
Structural characteristics of triacylglycerols contribute to the distinct in vitro gastric digestibility of sheep and cow milk fat prior to and after homogenisation
2020, Food Research International
Citation Excerpt :
Zhao et al. (2019) reported recently that the amounts of FAs released increased considerably during in vitro gastric digestion after homogenisation, especially for the MCFAs. Other clinical studies by Rayol, Martinez, Jorge, Goncalves, and Desai (1993), Thomaz, Goncalves, and Martinez (1999), and de Oliveira et al. (2017) showed that homogenised human milk with smaller globule size increased the gastric digestibility of human milk fat by infants. Other studies have shown that particle size is not the only factor influencing fat digestion; the structural changes at the surface of milk fat globule (MFG) of the processed milk can also affect the fat digestion of milk (Gallier et al., 2013, 2017; Garcia et al., 2014).
The regiodistribution of fatty acids (FAs) in triacylglycerols (TAGs) is highly correlated to the digestion and absorption of dietary fats. During in vitro gastric digestion, medium-long-medium/short chain triacylglycerols (MLM) showed the fastest digestibility among 105 TAG molecular species, for both raw and homogenised milk, resulting from the higher activity of gastric lipase towards medium-chain fatty acids (MCFAs) than towards long-chain fatty acids (LCFAs). After 60 min of in vitro gastric digestion, the percentage of digestion of each MLM was 16.6–31.2% and 12.3–18.6% respectively in raw sheep and cow milk, and it reached 33.4–45.5% and 23.0–38.9% respectively, after homogenisation. Sheep milk TAGs were digested faster than cow milk TAGs in raw milk (16.1% and 12.4%, respectively) as well as after homogenisation (24.1% and 20.3%, respectively). This is due to the higher percentages of MCFAs esterified on the sn-1/3 positions of sheep milk TAGs (48.3–67.3% and 11.9–51.5% respectively for sheep and cow milk prior to and after homogenisation). Homogenisation favoured TAG lipolysis due to the increased fat globule surface area; however, it did not affect lipase regiospecificity towards TAG molecular species.
Impact of homogenization of pasteurized human milk on gastric digestion in the preterm infant: A randomized controlled trial
2017, Clinical Nutrition ESPEN
Citation Excerpt :
In this context, fortification of human milk is considered as a strategy to ensure adequate postnatal growth rate [7], although this practice remains a source of debate [14–17]. Some authors have suggested the homogenization of banked-PHM as a strategy for improving fat absorption [20] and weight gain [21] in preterm infants fed with PHM. Homogenization fragments the native milk fat globule (MFG, mean diameter of 4 μm) in smaller and uniformly distributed lipid droplets (from 0.1 to 1 μm), and leads to an increase in the surface available for digestive enzymes adsorption [22].
It has been suggested that homogenization of Holder-pasteurized human milk (PHM) could improve fat absorption and weight gain in preterm infants, but the impact on the PHM digestive kinetics has never been studied. Our objective was to determine the impact of PHM homogenization on gastric digestion in preterm infants.
In a randomized controlled trial, eight hospitalized tube-fed preterm infants were their own control to compare the gastric digestion of PHM and of homogenized PHM (PHHM). PHM was obtained from donors and, for half of it, was homogenized by ultrasonication. Over a six-day sequence, gastric aspirates were collected twice a day, before and 35, 60 or 90 min after the start of PHM or PHHM ingestion. The impact of homogenization on PHM digestive kinetics and disintegration was tested using a general linear mixed model. Results were expressed as means ± SD.
Homogenization leaded to a six-fold increase in the specific surface (P < 0.01) of lipid droplets. The types of aggregates formed during digestion were different between PHM and PHHM, but the lipid fraction kept its initial structure all over the gastric digestion (native globules in PHM vs. blend of droplets in PHHM). Homogenization increased the gastric lipolysis level (P < 0.01), particularly at 35 and 60 min (22 and 24% higher for PHHM, respectively). Homogenization enhanced the proteolysis of serum albumin (P < 0.05) and reduced the meal emptying rate (P < 0.001, half-time estimated at 30 min for PHM and 38 min for PHHM). The postprandial gastric pH was not affected (4.7 ± 0.9 at 90 min).
Homogenization of PHM increased the gastric lipolysis level. This could be a potential strategy to improve fat absorption, and thus growth and development in infants fed with PHM; however, its gastrointestinal tolerance needs to be investigated further.
This trial was registered at clinicaltrials.gov as NCT02112331.
The macronutrients in human milk change after storage in various containers
2012, Pediatrics and Neonatology
Citation Excerpt :
The adherence of fat to the tubing system and walls of a bag has been reported in several studies and appears to be unavoidable.9,12,19,20 Ultrasonic homogenization can reduce fat loss during tube feeding21 and increase fat absorption in very low birth weight infants22,23 by decreasing clumping and reducing the size of the fat globules. Therefore, we can reasonably expect that the loss of fat content may be greater during regular processing at home where homogenization is not performed.
The concentrations of macronutrients in human milk can be influenced by various processes, such as storage, freezing, and thawing, that are performed by lactating working mothers and breast milk banks. We evaluated the impact of various containers on the nutrient concentrations in human milk.
A total of 42 breast milk samples from 18 healthy lactating mothers were collected. A baseline macronutrient concentration was determined for each sample. Then, the breast milk samples were divided and stored in nine different commercial milk containers. After freezing at -20°C for 2 days, the milk samples were thawed and analyzed again. A midinfrared human milk analyzer (HMA) was used to measure the protein, fat, and carbohydrate contents.
There was a significant decrease in the fat content following the storage, freezing, and thawing processes, ranging from 0.27–0.30 g/dL (p = 0.02), but no significant decrease in energy content (p = 0.069) was noted in the nine different containers. There were statistically significant increases in protein and carbohydrate concentrations in all containers (p = 0.021 and 0.001, respectively), however there were no significant differences between the containers in terms of fat, protein, carbohydrate, or energy contents.
Human milk, when subjected to storage, freezing, and thawing processes, demonstrated a significant decrease in fat content (up to 9% reduction) in various containers. It is better for infants to receive milk directly from the mother via breastfeeding. More studies are warranted to evaluate the effects of milk storage on infant growth and development.
Effects of human milk homogenization on fat absorption in very low birth weight infants
1999, Nutrition Research
We tested the effects of ultrasonic homogenization of human milk on fat absorption in very low birth weight (VLBW) infants. The study was conducted on 18 VLBW infants divided into two groups: 8 infants whose mothers were able to produce a milk volume sufficient to satisfy their requirements received this milk without pasteurization, and the remaining 10 received their own mother's milk complemented with bank milk. Each group was submitted to two consecutive fat balances in which they received at random homogenized or non-homogenized milk. Gestational age, birth weight and amount of fat ingested did not differ between groups. Fecal fat excretion was significantly lower in the group fed homogenized and non-pasteurized own mother's milk. The groups fed non-pasteurized milk absorbed fat at percentages close to those of the group that received pasteurized and homogenized human milk. The group that received pasteurized and non-homogenized human milk presented the lowest fat absorption.
We conclude that the ultrasound homogenization process improved the absorption of human milk fat, suggesting that pasteurized human milk utilized as part of an infant feeding regime should be pre homogenized.
Growth and nitrogen balance in preterm infants fed formula with long chain polyunsaturated fatty acids
1999, Nutrition Research
A decrease in nitrogen retention and growth rate has been observed in some formulas supplemented with LCP. In the present study we report on the growth and nitrogen balance of preterm infants fed formula supplemented with or without a blend of LCP containing both ω-3 and ω-6 fatty acids. A prospective study was conducted on 58 VLBW-infants with a mean ± SEM weight of 1245±21g. The infants were divided into 3 groups. If the mother had milk, the infant received human milk fortified (18 infants). If the mother had no milk, the infant received one of two identical formulas except for the fat component in a double-blind manner (20 infants each group). Infants were followed up for 30 days on their diets. Initial and final anthropometric parameters, BUN, total protein, and albumin were normal and similar in the three groups. Both, protein intake and protein excretion through urine and feces, were similar for the three groups. Mean percent protein absorption was 71%. Plasma amino acid levels were similar at the beginning of the study and after 30 days were similar for the infants fed the two formulas. The infants that received fortified human milk presented significantly higher proline levels and significantly lower lysine, aspartic acid, threonine, glutamic acid, and methionine levels compared to the infants fed the two formulas. We conclude that the addition of LCP to preterm infant formula did not affect protein absorption or plasma amino acid profile. The formulas did not mimic fully the amino acid profile of preterm infants fed enriched human milk.

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⁺: Supported in part by the International Relations Program of the Natural Sciences and Engineering Research Council (NSERC) of Canada and by Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq) of Brazil.

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Clinical and laboratory observationFeeding premature infants banked human milk homogenized by ultrasonic treatment+

J Pediatr

Nutrition Research

J Dairy Sci

J Biol Chem

Am J Clin Nutr

Loss of energy during continuous infusion of breast milk

Arch Dis Child

Clinical and laboratory observation
Feeding premature infants banked human milk homogenized by ultrasonic treatment+