Valerie writes:  What should be promoted to HIV positive mothers is
exclusive breastfeeding,
particularly in resource poor areas of the world.

I can't believe I wrote what I did Valerie, having exchanged many emails
with Pamela Morrison I firmly believe what you have written to be the
answer.  My only excuse is that I must have been too involved in thinking
NICU and medical and western at the time and had subconsciously tried to
work on an acceptable compromise for all :-)  You were also concerned about
the destruction of lactoferrin by pasteurisation.

The page I referred you to in my last email reports that lactoferrin isn't
completely destroyed by pasteurisation.  In fact 'flash pasteurisation'
(75C for 15 seconds) retains 100% and half an hour at 56C retains 75% of
lactoferrin activity.  The flash pasteurisation kills ALL CMV, while the
56C kills just about all CMV.  Freezing kills all CMV and retains 100%
lactoferrin activity.
I would hazard a guess that the single-bottle pasteuriser would still
retain a goodly amount of lactoferrin.  But I've gone off that now for the
treatment of the milk of mothers of VLBW infants who are shedding CMV.

http://www.latrobe.edu.au/microbiology/table7.html

For those working in NICUs which still "dump" the mother's milk if it is
shown to contain CMV, this excellent site also shows that in 25% of samples
ALL CMV was killed in the breastmilk after REFRIGERATION for 24 hours.  How
about pooling the milk expressed in one day from the mother shedding CMV,
refrigerate it and then send a sample to the lab after 24 hours.  I guess
the limiting factor is 'how long does it take to identify CMV in a
breastmilk sample?'  Can anyone enlighten me on that?
I'm sure a group of determined staff could work out a way, or combination
of ways (eg refrigeration, freezing or pasteurisation), that this mother
could continue to provide her VLBW infant with the best medicine it will
ever receive.

It appears to me that there are very simple and safe means to rid
breastmilk of CMV and that discarding breastmilk is uninformed arrogance.

Denise - quite overwhelmed with the superiority of breastmilk and
devastated that its value can be dismissed so easily, and for such an
inferior substitute.

*************************************************
Denise Fisher MMP, BN, IBCLC
BreastEd Online Lactation Studies
http://www.health-e-learning.com

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