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Concentrating human milk: an innovative point-of-care device designed to increase human milk feeding options for preterm infants

Journal of Perinatology volume 41, pages 582–589 (2021)Cite this article

Subjects

Abstract

Objective

The purpose of this study was to determine whether a point-of-care osmotic device concentrates important human milk (HM) nutrients to support feeding neonates requiring high-nutrient, low-volume feedings.

Study design

Raw and pasteurized HM samples were concentrated to determine the effects of time and temperature on concentration. Concentrated samples were compared with matched baseline samples to measure changes in selected nutrient concentrations. Furthermore, changes in concentration of certain bioactive components of raw milk samples were measured.

Result

The device significantly increased the concentrations of the majority of the measured nutrient and bioactive levels (p < 0.05). Increasing temperature of HM from 4 to 37 °C increased the concentration rate >30%. In all cases, the concentration rate of pasteurized HM was greater than that of raw HM.

Conclusions

The osmotic concentration of HM is a promising option for neonatal nutrition. Further studies are needed to establish an evidence base for the practical applications of this point-of-care device.

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Fig. 1: Representative graph of milk volume over time varying milk type and temperature.
Fig. 2: Representative graph of membrane weight (% increase) varying milk type and temperature.
Fig. 3: Boxplots of Percent (%) Change in Nutrient vs Milk Concentration.

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References

  1. Ballard O, Morrow AL. Human milk composition. Pediatr Clin North Am. 2013;60:49–74.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Meier PP, Patel AL, Esquerra-Zwiers A. Donor human milk update: evidence, mechanisms and priorities for research and practice. J Pediatrics. 2017;180:15–21.

    Article  Google Scholar 

  3. Bertino E, Giuliani F, Occhi L, Coscia A, Tonetto P, Marchino F, et al. Benefits of donor human milk for preterm infants: current evidence. Early Hum Dev. 2009;85:S9–10.

    Article  PubMed  Google Scholar 

  4. Moro GE, Arslanoglu S, Bertino E, Corvaglia L, Montirosso R, Picaud JC, et al. XII. Human milk in feeding premature infants: consensus statement. J Pediatr Gastroenterol Nutr. 2015;61:S16–9.

    Article  PubMed  Google Scholar 

  5. Bauer J, Gerss J. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants. Clin Nutr. 2011;30:215–20.

    Article  CAS  PubMed  Google Scholar 

  6. Hay WW, Thureen P. Protein for preterm infants: how much is needed? How much is enough? How much is too much? Pediatr Neonatol. 2010;51:198.

    Article  PubMed  Google Scholar 

  7. Schanler RJ, Lau C, Hurst NM, Smith EO. Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in feeding of extremely premature infants. Pediatrics. 2005;116:400–6.

    Article  PubMed  Google Scholar 

  8. García-Lara NR, Escuder-Vieco D, García-Algar O, De la Cruz J, Lora D, Pallás- Alonso C. Effect of freezing time on macronutrients and energy content of breastmilk. Breastfeed Med. 2012;7:295–301.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fusch G, Rochow N, Choi A, Fusch S, Poeschl S, Ubah AO, et al. Rapid measurement of macronutrients in breast milk: how reliable are infrared milk analyzers?. Clin Nutr. 2015;34:465–76.

    Article  CAS  PubMed  Google Scholar 

  10. Smilowitz JT, Gho DS, Mirmiran M, German JB, Underwood MA. Rapid measurement of human milk macronutrients in the neonatal intensive care unit: accuracy and precision of Fourier transform mid-infrared spectroscopy. J Hum Lactation. 2014;30:180–9.

    Article  Google Scholar 

  11. Herrmann K, Carroll K. An exclusively human milk diet reduces necrotizing enterocolitis. Breastfeed Med. 2014;9:184–90.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2018.

  13. Johnson TJ, Patel AL, Bigger HR, Engstrom JL, Meier PP. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology. 2015;107:271–6.

    Article  CAS  PubMed  Google Scholar 

  14. Pammi M, Cope J, Tarr PI, Warner BB, Morrow AL, Mai V, et al. Intestinal dysbiosis in preterm infants preceding necrotizing enterocolitis: a systematic review and meta- analysis. Microbiome. 2017;5:31.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sherman MP, Miller MM, Sherman J, Niklas V. Lactoferrin and necrotizing enterocolitis. Curr Opin Pediatr. 2014;26:146–50.

    Article  CAS  PubMed  Google Scholar 

  16. Parra-Llorca A, Gormaz M, Alcantara C, Cernada M, Nunez-Ramiro A, Vento M, et al. Preterm Gut microbiome depending on feeding type: significance of donor human milk. Front Microbiol. 2018;9:1376.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gregory KE, Samuel BS, Houghteling P, Shan G, Ausubel FM, Sadreyev RI, et al. Influence of maternal breast milk ingestion on acquisition of the intestinal microbiome in preterm infants. Microbiome. 2016;4:68.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sherman MP, Zaghouani H, Niklas V. Gut microbiota, the immune system, and diet influence the neonatal gut-brain axis. Pediatr Res. 2015;77:127–35.

    Article  PubMed  Google Scholar 

  19. Collado MC, Cernada M, Neu J, Perez-Martinez G, Gormaz M, Vento M. Factors influencing gastrointestinal tract and microbiota immune interaction in preterm infants. Pediatr Res. 2015;77:726–31.

    Article  PubMed  Google Scholar 

  20. Lemas D, Young B, Baker P, Tomczik A, Soderborg TL, Hernandez T, et al. Alterations in human milk leptin and insulin are associated with early changes in the infant intestinal microbiome. Am J Clin Nutr. 2016;103:1291–300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, et al. Fortification of human milk for preterm infants: update and recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification. Front Pediatr. 2019;7:76.

  22. Peila C, Moro GE, Bertino E, Cavallarin L, Giribaldi M, Giuliani F, et al. The effect of holder pasteurization on nutrients and biologically active components in donor human milk: a review. Nutrients. 2016;8:477.

    Article  PubMed Central  Google Scholar 

  23. Marx C, Bridge R, Wolf AK, Rich W, Kim JH, Bode L. Human milk oligosaccharide composition differs between donor milk and mother’s own milk in the NICU. J Hum Lactation. 2014;30:54–61.

    Article  Google Scholar 

  24. Johnson TJ, Patel AL, Bigger HR, Engstrom JL, Meier P. Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants. Adv Nutr. 2014;5:207–12.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Young BE, Borman L, Heinrich R, Long J, Pinney S, Westcott J, 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 Pediatrics. 2019;214:54–5.

    Article  CAS  Google Scholar 

  26. John A, Sun R, Maillart L, Schaefer A, Hamilton Spence E, Perrin MT. Macronutrient variability in human milk from donors to a milk bank: implications for feeding preterm infants. PLoS ONE. 2019;14:e0210610.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Sauer CW, Boutin MA, Kim JH. Wide variability in caloric density of expressed human milk can lead to major underestimation or overestimation of nutrient content. J Hum Lactation. 2016;33:341–50.

    Article  Google Scholar 

  28. Cong X, Judge M, Xu W, Diallo A, Janton S, Brownell EA, et al. Influence of feeding type on gut microbiome development in hospitalized preterm infants. Nurs Res. 2017;66:123–33.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ganapathy V, Hay JW, Kim JH. Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants. Breastfeed Med. 2012;7:29–37.

    Article  PubMed  Google Scholar 

  30. Johnston M, Landers S, Noble L, Szucs K, Viehmann L. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41.

    Article  Google Scholar 

  31. Boquien CY. Human milk: an ideal food for nutrition of preterm newborn. Front Pediatrics. 2018;6:295.

    Article  Google Scholar 

  32. Gidrewwicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatrics. 2014;14:216.

    Article  Google Scholar 

  33. Chang JC, Chen CH, Fang LJ, Tsai CR, Chang YC, Wang TM. Influence of prolonged storage process, pasteurization, and heat treatment on biologically active human milk proteins. Pediatrics Neonatol. 2013;54:360–6.

    Article  Google Scholar 

  34. Triantis V, Bode L, Van, Neerven RJ. Immunological effects of human milk oligosaccharides. Front Pediatrics. 2018;6:190.

    Article  Google Scholar 

  35. Cong X, Xu W, Janton S, Henderson WA, Matson A, McGrath JM, et al. Gut microbiome developmental patterns in early life of preterm infants: impacts of feeding and gender. PLoS ONE. 2016;11:e0152751.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Briere CE, McGrath JM, Jensen T, Matson A, Finck C. Breast milk stem cells: current science and implications for preterm infants. Adv Neonatal Care 2016;16:410–9.

    Article  PubMed  Google Scholar 

  37. Hård AL, Nilsson AK, Lund AM, Hansen-Pupp I, Smith L, Hellström A. Review shows that donor milk does not promote the growth and development of preterm infants as well as maternal milk. Acta Paediatrica. 2019;108:998–1007.

    Article  PubMed  Google Scholar 

  38. Bjelakovic L, Kocic G, Cvetkovic T, Stojanovic D, Najmen S, Jevtovic T. et al. Arginase activity in human milk during the first month of lactation. J Basic Clin Physiol Pharm. 2010;21:187–200.

    Article  CAS  Google Scholar 

  39. Baldeón ME, Mennella JA, Flores N, Fornasini M, San Gabriel A. Free amino acid content in breast milk of adolescent and adult mothers in Ecuador. SpringerPlus. 2014;3:104.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Zhang Z, Adelman AS, Rai D, Boettcher J, Lőnnerdal B. Amino acid profiles in term and preterm human milk through lactation: a systematic review. Nutrients. 2013;5:4800–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Zhu J, Dingess KA. The functional power of the human milk proteome. Nutrients. 2019;11:1834.

    Article  CAS  PubMed Central  Google Scholar 

  42. Briassouli E, Briassoulis G, Cuany D, Sanchez-Bridge B, Longet K, Bertschy E, et al. Glutamine randomized studies in early life: the unsolved riddle of experimental and clinical studies. Clin Dev Immunol. 2012:2012;749189.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Giuffrida F, Austin S, Cuany D, Sanchez-Bridge B, Longet K, Bertschy E, et al. Comparison of macronutrient content in human milk measured by mid-infrared human milk analyzer and reference methods. J Perinatol. 2019;39:497–503.

    Article  CAS  PubMed  Google Scholar 

  44. Ellis ZM, Tan HSG, Embleton ND, Sangild PT, van Elburg RM. Milk feed osmolality and adverse events in newborn infants and animals: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2019;104:F333–40.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Dr. Naomi Bar-Yam of Mothers’ Milk Bank Northeast, Laraine Lockhart Borman of Mother’s Milk Bank of Colorado, Maryanne Perrin, the Human Milk Bank Association of North America Research Committee and the generous mothers who donated their milk. Funding was provided by the Colorado Office of Economic Development and International Trade. This work was also supported by the National Institute of Health Grants R01HD079404 (LDB) and S10OD023553 (LDB). The Human Milk Concentration device is not commercially available at the time of submission; this medical device is pre-FDA release to market, currently available only for research.

Author information

Authors and Affiliations

  1. Mother’s Milk Is Best, Inc., Tyngsborough, MA, USA

    Elizabeth R. Schinkel & Elizabeth R. Nelson

  2. UCHealth, Fort Collins, CO, USA

    Elizabeth R. Schinkel

  3. Division of Pediatrics, Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Bridget E. Young

  4. Department of Anthropology and Institute of Behavioral Science, University of Colorado, Boulder, CO, USA

    Robin M. Bernstein

  5. Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA

    Sarah N. Taylor

  6. Perinatal Research Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Laura D. Brown

  7. University of Colorado (Retired), Denver, CO, USA

    William W. Hay Jr.

  8. Proteomics and Metabolomics Facility, Colorado State University, Fort Collins, CO, USA

    Kitty J. Brown & Jessica Prenni

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  1. Elizabeth R. Schinkel
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Corresponding author

Correspondence to Elizabeth R. Schinkel.

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Conflict of interest

Mother’s Milk Is Best (MMIB) Inc. is a neonatal medical device development company, that is pre-revenue and the HMC device process is pre-market and patent pending. MMIB Inc. was cofounded by ERS and ERN. MMIB Inc. has no corporate sponsors or partners. In 2019, MMIB Inc. received Phase I Small Business Innovation Research funding from the National Institute of Health for research in progress at the time of this submission. This research is independent of and does not reflect the views and beliefs of the UCHealth System, ERS’s NICU employer in Colorado. None of the university affiliated researchers who performed human milk nutrient analysis in this study have any equity or ownership of MMIB Inc. or other known conflicts of interest.

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Schinkel, E.R., Nelson, E.R., Young, B.E. et al. Concentrating human milk: an innovative point-of-care device designed to increase human milk feeding options for preterm infants. J Perinatol 41, 582–589 (2021). https://doi.org/10.1038/s41372-020-00820-x

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