Breast milk donation after neonatal death in Australia: a report

Lactation and breast milk can hold great value and meaning for grieving mothers who have experienced a recent death of an infant. Donation to a human milk bank (HMB) as an alternative to discarding breast milk is one means of respecting the value of breast milk. There is little research, national policy discussion, or organizational representation in Australia on the subject of breast milk donation after infant death. On 29 November 2013 the Mercy Hospital for Women in Melbourne, Australia hosted Australia’s first National Stakeholder Meeting (NSM) on the topic of milk donation after neonatal death. The NSM drew together representatives from Australian HMBs, neonatal intensive care units (NICUs) currently using donor human milk, and Australia’s chief NICU parent support organization. The NSM was video-recorded and transcribed, and analyzed thematically by researchers. This article reports the seven dominant themes discussed by stakeholders during the NSM: the spectrum of women’s lactation and donation experiences after infant death; the roles of the HMB and NICU in meeting the needs of the bereaved donor; how bereaved mothers’ lactation autonomy may interface with a HMB’s donation guidelines; how milk donation may be discussed with bereaved mothers; the variation between four categories of milk donation after neonatal death; the impact of limited resources and few HMBs on providing donation programs for bereaved mothers in Australia. This article provides evidence from researchers and practitioners that can assist HMB staff in refining their bank’s policy on milk donation after infant death, and provides national policy makers with key considerations to support lactation, human milk banking, and bereavement services nation-wide.     

Changes in element concentration and distribution in breast-milk fractions of a healthy lactating mother

Daily changes in components of breast milk with number of days of lactation after delivery were demonstrated by determining concentrations and distributions of several elements simultaneously. Concentrations of calcium, copper, magnesium, phosphorus, sulfur, and zinc were determined simultaneously by inductively coupled argon plasma-atomic-emission spectrometry (ICP) for whole milk and milk fractions (skimmed milk and whey) collected from 2 to 196 d postpartum from a healthy lactating mother. Calcium and phosphorus concentrations increased in transitional milk. With days postpartum, the other elements decreased from the highest concentrations in colostrum milk, the modes of decrease being characteristic for each element. Distributions of copper, iron, phosphorus, sulfur, and zinc in whey were determined on a gel-filtration column by HPLC with ICP detection (HPLC-ICP method). Distributions of the five elements and absorbance peaks at 254 and 280 nm changed dramatically day by day at the beginning (colostrum milk), resulting in constant distributions after 30 d (mature milk). These results suggest the important roles of daily changing constituents in breast milk, especially in colostrum milk, in the nutrition of the newborn. Several element peaks on a gelfiltration column were identified by comparison with standard samples.     

Secretion of Radioiodine in Milk Following a Single Oral Administration in the Cow

The secretion of radioiodine in the milk following the administration of a single oral dose was studied using I131. All of the values are corrected for the physical decay of the isotope. I131 began to appear in the milk 30 minutes after administration with a maximal concentration of, on the average, 1.7 per cent of the given dose per 1 of milk at about six hours following administration. The subsequent reduction in the concentration showed a two exponential course with biological half-lives of 0.6 days and 10 days, respectively. The total secretion in the milk was between 10 and 27 per cent of the given dose of I131 in six days. The total secretion of radioiodine in the milk was seen to be dependent upon the cow’s milk production.     

Bioavailability of lead from various milk diets studied in a suckling rat model

The bioavailability of lead from various milk diets was studied in 14 day old suckling rats. Human milk, infant formula, cow's milk, rat milk and deionized water labeled with ²⁰³Pb were given to rat pups by gastric intubation. Animals were killed after 2 or 6 h and the radioactivity in the tissues was measured. At 2 h after administration the lead bioavailability, defined as lead uptake in the body, excluding the gastrointestinal tract, was 47% from water, 42% from human milk, 40% from infant formula, 31% from cow's milk and 11% from rat milk. After 6 h the bioavailability of lead was about 50% from water and human milk, 45% from infant formula and cow's milk, and 36% from rat milk. The blood lead levels in the pups reflected the total body uptake and were also correlated to the brain lead levels. Thus, rat pups given lead in human milk had approximately twice as high lead levels in blood and brain than pups given lead in rat milk. The intestinal absorption of lead was dependent on the milk diet given to the sucklings. In duodenum, the highest uptake of lead was found in rats given water or human milk, whereas in rats given rat or cow's milk the highest uptake of lead was found in ileum. The distribution of lead in cream, whey and casein fractions of the milk diets after in vitro labeling with ²⁰³Pb was also studied. The casein fraction in cow's and rat milk contained 90–96% of the total amount of lead in the diet. In infant formula and human milk, 77 and 56% lead was found in the casein fraction, respectively. The higher lead bioavailability observed in the suckling rat fed human milk than in those fed rat and cow's milk may partly be explained by a lower proportion of lead bound to casein in human milk.     

Hepatocyte growth factor in human breast milk acts as a trophic factor.

To evaluate the significance of hepatocyte growth factor (HGF) in milk in the perinatal period, we examined immunoreactive HGF levels and bioactivity in human milk. Human milk samples were obtained from women at various postpartum ages, and the levels of HGF were measured by ELISA. In the cross sectional study, the concentration of milk HGF from term deliveries showed a significant inverse correlation with progress of lactation, whereas in cases of preterm delivery concentrations, levels remained high after a long period of lactation. In the longitudinal analysis, the contents of HGF in colostrum, transitional, and mature milk from preterm deliveries were significantly be higher than those from term deliveries. Although mature milk from term and preterm deliveries contained significantly lower levels of HGF than colostrum, high levels of HGF persisted in mature milk from preterm deliveries. After partial purification, immunoblotting analysis showed the presence of both alpha- and beta-chains of HGF. HGF in milk stimulated proliferation of rat hepatocytes in primary culture, which was inhibited by supplementation with anti-HGF antibody. Thus, a high concentration of bioactive HGF is present in human milk in the postpartum period. Our results suggest that HGF in milk acts as a trophic factor for the gastrointestinal tract in neonates.     

Effects of amount of milk, milk flow and access to a rubber teat on cross-sucking and non-nutritive sucking in dairy calves

The aim of this study was to test the effects of different amounts of milk, flow rate of milk, and access to a teat after milk intake on non-nutritive sucking on an empty teat and on cross-sucking on other calves in Bos taurus dairy calves. An additional aim was to test if calves prefer to perform non-nutritive sucking on a teat with the taste of milk or on a clean teat. First experiment involved 11 groups of three calves during gradual decrease from 5 to 2.5 and 1 to 0l of whole milk per meal twice daily. Milk flow was either 0.5 or 1l/min, and the teat buckets were either left or removed after milk intake. When the calves were fed with 5l of milk, non-nutritive sucking and cross-sucking decreased (P<0.001), compared to 1 and 2.5l. Removing the empty teat after milk intake increased cross-sucking (P<0.001). Slow milk flow reduced non-nutritive sucking after milk intake (P<0.05), but did not influence cross-sucking. Duration of recorded milk intake was similar with fast flow and 5l of milk, compared to slow flow and 2.5l of milk. The latter combination increased non-nutritive sucking and cross-sucking, suggesting that amount of milk is more important than duration of milk intake.Second experiment was carried out on 12 individually kept calves. The calves received 2.5l of milk either in an open bucket, in a rubber teat bucket, or half/half in both buckets. When not used for feeding, the open bucket and the teat bucket were filled and emptied again to make them 'tasty' with some drops of milk. The tasty teat bucket was either removed or present after milk intake. The calves had always access to a second clean teat bucket. Source of milk had no influence on recorded behaviour after milk intake. The tasty teat was sucked for twice as long as the clean one when both teats were present (P<0.001). When the tasty teat was removed, the calves increased sucking on the clean teat (P<0.001), but decreased total time spent sucking (P<0.001). We conclude that a high amount of milk and the presence of the teat bucket after milk intake reduces cross-sucking, and that a clean teat is less effective in encouraging calves to suck than a teat with taste of milk.     

Manufacturing of fermented goat milk with a mixed starter culture of Bifidobacterium animalis and Lactobacillus acidophilus in a controlled bioreactor

AIMS: This work was undertaken to study the feasibility and the characteristics of a fermented product made of goat milk, using a mixed starter culture of Bifidobacterium animalis and Lactobacillus acidophilus under controlled conditions, and to determine their survival in the fermented milk during refrigerated storage. METHODS AND RESULTS: Goat milk was inoculated with Lact. acidophilus and Bif. animalis mixed starter, fermented in a glass bioreactor with controlled temperature (37 degrees C) and anaerobiosis, and monitored for growth and acidification. The fermented milk was then stored for 10 days under refrigeration, and monitored daily for starter microflora survival and pH changes. Lact. acidophilus viable counts reached a maximum of 7.1 x 10(8) colony-forming units (CFU) ml(-1), and Bif. animalis a maximum of 6.3 x 10(7) CFU ml(-1) by 20 h of fermentation. During refrigerated storage, both strains exhibited a good survival, with viable numbers remaining essentially constant throughout the experiment, whereas the pH of the fermented milk dropped slightly. CONCLUSIONS: Mixed cultures of Bif. animalis and Lact. acidophilus may be used to produce fermented goat milk with high counts of both probiotic strains. SIGNIFICANCE AND IMPACT OF THE STUDY: Goat milk fermented with Bif. animalis and Lact. acidophilus can be manufactured as an alternative probiotic dairy product.     

Detection in milk of a 60,000 Mr mouse and a 68,000 Mr human phosphorylated glycoprotein by histochemical analysis on polyacrylamide gels

Proteins in colostrum and skimmed milk from humans and mice were separated by electrophoresis on polyacrylamide gels and stained with Coomassie blue (CB), Ethyl-Stains-all (ESA), and periodic acid-Schiff (PAS) to investigate changes that may occur in milks throughout lactation. In mouse colostrum but not in mature mouse milk, a PAS-positive protein of apparent molecular weight of 60,000 stained prominently blue with ESA. A protein in human milk with a molecular weight of 68,000 stained similarly but was present throughout lactation. The intensity of blue staining of these minor proteins in milk approached that obtained with casein phosphoproteins. The metachromatic dye ESA stains phosphoproteins and sialic acid-rich glycoproteins blue to blue-green. Removal of phosphorus from the former and sialic acid from the latter results in those proteins staining red with ESA. The intensity of blue staining of the 60,000 and 68,000 Mr proteins was diminished but not lost following treatment with phosphatase. It was eliminated following neuraminidase digestion of the mouse protein and mild acid hydrolysis of the human protein. Coomassie blue staining of the proteins was not affected by these procedures. Following electrophoresis of milk and milk fractions in a non-sodium dodecyl sulfate-containing system, the proteins were identified by their characteristic staining properties with ESA and isolated.     

High pressure-induced changes in bovine milk proteins: a review

High pressure (HP)-induced changes in the proteins of bovine milk have become an area of considerable research interest in recent years; as a result, there is now a detailed understanding of the effects of HP on casein micelles and whey proteins. HP treatment at pressures >400 or >100 MPa denatures the two most abundant whey proteins, alpha-lactalbumin (alpha-la) and beta-lactoglobulin (beta-lg), respectively. The majority of denatured beta-lg in HP-treated milk associates with the casein micelles, although some denatured beta-lg remains in the serum phase or is attached to the milk fat globule membrane; HP-denatured alpha-la is also associated with the milk fat globules. Casein micelles are disrupted on treatment at pressures >200 MPa; the rate and extent of micellar disruption increases with pressure and is probably due to the increased solubility of calcium phosphate with increasing pressure. On prolonged treatment at 250-300 MPa, reassociation of micellar fragments occurs through hydrophobic bonding; this process does not occur at a pressure >300 MPa, leading to considerably smaller micelles in such milk. As a result of HP-induced changes, the size, number, hydration, composition and light-scattering properties of casein micelles in HP-treated milk differ considerably from those in untreated milk.     

The milk ejection of the rat,as a stimulus and a response to the litter

A finding that the milk ejection of the rat is stimulated effectively only if at least half the pups are suckled is confirmed. This relationship, however, is found if the mother is anaesthetized but not if the mother is conscious. If the mother is conscious, the milk obtained by individual hungry pups is unaffected by the number of other hungry pups suckled. This is true whether the other pups of the litter are removed, or whether they are present but satiated. After the milk ejection, pups tend to leave the mother's nipple. Milk yield decreases with each milk ejection of a series, but getting less milk does not make the pups more likely to leave the nipple in search of another.     

Transforming Milk in a Global Economy

Large-scale milk production and consumption historically have been localized to Europe and countries with large European-derived populations. However, global patterns have now shifted, with dramatic increases in milk consumption in Asian countries and flat or declining consumption in European and European-derived countries. Efforts to market it around the world emphasize milk's positive effects on child growth, and, by extension, the individual and national benefits that derive from that growth. At the same time, milk has newly emerged in milk promotions in the United States as food that facilitates weight loss. Milk has been able to achieve a global presence and continuing relevance in populations in which its consumption has been declining by continually transforming and repositioning itself as a "special" food with properties able to alleviate the health concerns seen as most salient at the time.     

Donor milk intake and infant growth in a South African neonatal unit: a cohort study

Background

Implications of donor milk feedings on infant growth in resource limited settings remain uncertain. This knowledge gap includes the impact of donor milk availability on infant intake of mother’s own milk. Therefore, this investigation aimed to measure intake and growth in infants receiving donor milk when born to women from resource limited backgrounds with high rates of human immunodeficiency virus (HIV).

Methods

A retrospective cohort study enrolled eligible infants admitted to a South African combined neonatal intensive and secondary high care unit, within a one year admission period during 2015, with signed consent for donor milk feedings. A certified milk bank provided donor milk. Daily nutritional intake during the first month was recorded. Details included proportional intake of donor milk, mother’s own milk and infant formula. The primary outcome of infant growth velocity from day back to birth weight to discharge was calculated when length of stay was ≥14 days. Analyses primarily used T-tests; mixed effects models compared weekly calorie intake.

Results

One hundred five infants with donor milk consent were born at 30.9?±?3.6 weeks of gestation, weighing 1389?±?708 g. Forty percent of mothers had HIV. Infant growth velocity did not differ based on percent of feedings as donor milk (≥ 50%: 11.8?±?4.9 g/kg/d; <?50%: 13.5?±?5.3 g/kg/d; p?=?0.3). Percent of feedings from donor milk was similar based on maternal HIV status (positive: 31?±?25%; negative: 36?±?29%; p?=?0.4), as was percent of feedings as mother’s milk (positive: 53?±?35%; negative: 58?±?30%; p?=?0.4). Calorie intake increased markedly during the first two weeks and then plateaued (p?<?0.0001).

Conclusions

Donor milk feedings in higher proportions did not further impair growth of infants managed in a South African combined neonatal intensive and secondary high care unit with growth rates already below reference ranges. The provision of donor milk contributed to feedings being composed of primarily human milk during the first month. Increasing early calorie intake may improve infant growth in this center.

     

Characterization of oligosaccharides in milk of a mink, Mustela vison

Carbohydrates were extracted from a sample of milk from a mink, Mustela vison (Family Mustelidae). Free neutral and acidic oligosaccharides were isolated from the carbohydrate fraction and their chemical structures were compared with those of white-nosed coati (Nasua narica, Procyonidae) and harbour seal (Phoca vitulina, Phocidae) that we had studied previously. The ratio of free lactose to milk oligosaccharides was similar to that in milk of the white-nosed coati; in both species, this ratio was much lower than that in the milk of most eutherians. The neutral oligosaccharides of mink milk had alpha(1-3)-linked Gal or alpha(1-2)-linked Fuc residues at their non-reducing ends, as in the neutral oligosaccharides of white-nosed coati milk. Some of the neutral and acidic oligosaccharides, determined here, had been found also in harbour seal milk, but the harbour seal oligosaccharides did not contain alpha(1-3)-linked Gal residues.     

Jennet milk production during the lactation in a Sicilian farming system

In Italy, the interest for jennet milk production has recently developed. An 18-month-long experiment was carried out on a jennet farm near Milo (CT), where 24 jennets, which derived from the Ragusana breed, were tested for milk yield and composition over an entire lactation period. The jennets were fed with hay and concentrate in a large paddock. From the 28th post-foaling day to the end of the lactation, the jennets were machine-milked twice a day with an in-between milking interval of 5 h. The milk amount from each jennet was recorded every 3 weeks and individual samples were collected and analyzed for fat, protein, casein, non-proteic nitrogen, lactose and somatic cell count. This study showed that jennets at Sicilian latitudes are not seasonal polyestrous. The daily milk yield, the length of lactation and the milk characteristics varied depending on the foaling season. The total average milk production was 490 ± 36 kg in 295 ± 12 post-foaling days, considering two milking records per day. During the lactation, milk yield decreased constantly from 1.98 to 1.28 kg/jennet per day. When looking at the jennet milk quality during lactation, the percentage of fat and protein decreased, while the lactose percentage increased, according to a tendency apparently unique for equines when compared to the ruminants. When looking at the productive season, spring generally gave the best qualitative and quantitative results. Based on these results, jennet milk yield and quality could be improved; furthermore, jennet milk production may turn out to be a profitable business.     

Isolation of a low molecular weight zinc binding ligand from human milk

A low molecular weight zinc binding compound from human milk has been purified by ultrafiltration, gel filtration, and ion-exchange chromatography. Evidence is provided that this compound is citrate. A higher amount of citrate-bound zinc was found in human milk than in cow's milk. It is suggested that the therapeutic value of human milk for patients with the genetic disorder of zinc metabolism acrodermatitis enteropathica (AE) derives from a greater content of bioavailable zinc citrate in human than in cow's milk.     

Gastric negative feedback produced by volume and nutrient during a meal in rats

To investigate the gastric negative-feedback control of eating during a meal, we implanted male rats with pyloric cuffs and gastric catheters and gave them access to sweet milk for 30 min after overnight deprivation. Ingested milk and infused milk or saline were confined to the stomach because the pyloric cuffs were closed in all tests. Rats received five consecutive tests with no gastric infusion or with infusions of 3, 6, or 12 ml of milk or saline during the first 6 min of the test meal. Only 12-ml infusions decreased intake significantly compared with no infusion. Because 12 ml of saline inhibited intake as much as 12 ml of milk, the decreased intake was due to volume or rate of infusion, not nutrient. Although infusions of 3 and 6 ml of milk did not decrease intake, they decreased the number of licks after the infusions significantly more than equal volumes of saline. Thus a large volume or rapid rate of gastric infusion decreases intake, and some other aspect of small milk infusions decreases the rate of licking.     

Intestinal malrotation with suspected cow's milk allergy: a case report

ABSTRACT: BACKGROUND: Intestinal malrotation is an incomplete rotation of the intestine. Failure to rotate leads to abnormalities in intestinal positioning and attachment that leave obstructing bands across the duodenum and a narrow pedicle for the midgut loop, thus making it susceptible to volvulus. One of the important differential diagnoses for malrotation is an allergy to cow's milk. Several studies have described infants with surgical gastrointestinal diseases and cow's milk allergy. However, to our knowledge, no study has reported infants with intestinal malrotation who have been symptomatic before surgery was performed and have been examined by allergen-specific lymphocyte stimulation test and food challenge tests with long-term follow-up. CASE PRESENTATION: The patient was a Japanese male born at 39 weeks of gestation. He was breast-fed and received commercial cow's milk supplementation starting the day of birth and was admitted to our hospital at 6 days of age due to bilious vomiting. Plain abdominal radiography showed a paucity of gas in the distal bowel. Because we demonstrated malpositioning of the intestine by barium enema, we repositioned the bowel in a normal position by laparotomy. The patient was re-started on only breast milk 2 days post surgery because we suspected the presence of a cow's milk allergy, and the results of an allergen-specific lymphocyte stimulation test showed a marked increase in lymphocyte response to kappa-casein. At 5 months of age, the patient was subjected to a cow's milk challenge test. After the patient began feeding on cow's milk, he had no symptoms and his laboratory investigations showed no abnormality. In addition, because the patient showed good weight gain and no symptoms with increased cow's milk intake after discharge, we concluded that the present case was not the result of a cow's milk allergy. At 1 year, the patient showed favorable growth and development, and serum allergy investigations revealed no reaction to cow's milk. CONCLUSION: When physicians encounter infants with surgical gastrointestinal disease, including intestinal malrotation, they should consider cow's milk allergy as a differential diagnosis or complication and should utilize food challenge tests for a definitive diagnosis.     

The composition of African lion (Panthera leo) milk collected a few days postpartum

There is very little information on the composition of lion milk. Milk was obtained from all four teats of two African lionesses (Panthera leo) while they were temporarily immobilized; the first lioness was 40 hours postpartum and the second lioness was 10 days postpartum. The lion's milk obtained from the two lionesses in this study contained less solids than reported in literature. The milk of the two females contained, respectively, 192.2 and 166.9 g dry matter/kg milk; 60.2 and 84.6 g protein/kg milk; 113.6 and 136.9 g fat/kg milk; and 68.6 and 77.9 g fat free dry matter/kg milk. Carbohydrate content, analysed only for the first lioness, was 26.5 g lactose/kg milk. These values are much lower than those cited in literature. Electrophoresis and identification of protein bands showed a similar pattern of proteins as seen in cow's milk, but with caseins of less negative charge and whey proteins of smaller molecular size. The milk fat content of the second lioness was higher and varied considerably more among teats. The lipid fraction of lion's milk is characterized by a high content of saturated (palmitic and stearic) and mono-unsaturated (palmitoleic and oleic) fatty acids. Regarding fatty acid composition, lion milk closely resembles human milk. Animal fat plays an important role in the nutrition of African lions. The high fat content of lion milk suggests that the dependency by large predators such as lions on dietary fat is present from birth.     

Characterisation of host defence proteins in milk using a proteomic approach

Besides providing nutrition to the newborn, milk also protects the neonate and the mammary gland against infection. As well as the six major proteins, bovine milk contains minor proteins, not all of which have been characterized. In this study, we have subjected bovine skim milk, whey, and milk fat globule membrane (MFGM) fractions to both direct liquid chromatography-tandem mass spectrometry (LC-MS/MS), and two-dimensional electrophoresis (2-DE) followed by matrix assisted laser desorption ionization-time-of-flight (MALDI-TOF) mass spectrometry (MS) of individual protein spots to better characterize the repertoire of minor milk proteins, particularly those involved with host defense. Milk from peak lactation as well as during the period of colostrum formation and during mastitis were analyzed to gain a more complete sampling of the milk proteome. In total, 2903 peptides were detected by LC-MS and 2770 protein spots by 2-DE. From these, 95 distinct gene products were identified, comprising 53 identified through direct LC-MS/MS and 57 through 2-DE-MS. The latter were derived from a total of 363 spots analyzed with 181 being successfully identified. At least 15 proteins were identified that are involved in host defense. These results demonstrate that the proteome of milk is more complex than has previously been reported and a significant fraction of minor milk proteins are involved in protection against infection.